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Objective: To compare survival and pathologic outcomes in patients with progressive muscle-invasive bladder cancer (pgMIBC) and de novo muscle-invasive bladder cancer (dnMIBC) after radical cystectomy (RC), with a focus on the role of neoadjuvant chemotherapy (NAC)., Methods: A comprehensive literature search was conducted on PubMed and EMBASE databases to identify studies comparing pgMIBC to dnMIBC. Survival outcomes, including cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS), and pathologic outcomes (rates of ≤pT1, pT0, pT3/T4, and pN+ disease) were compared between pgMIBC and dnMIBC., Results: The analysis included 19 cohorts from 16 studies, categorized into 3 groups based on NAC use: 1. patients who underwent RC and were all treated with NAC (RC + NAC only group); 2. patients who underwent RC, with or without NAC (RC +/- NAC group); 3. patients who only underwent RC without NAC (RC only group). Compared to dnMIBC, pgMIBC demonstrated worse outcomes for CSS, OS, and RFS. In the RC + NAC only group (3 cohorts), the hazard ratio (HR) for CSS was 1.52 (95% confidence interval [CI] = 1.05-2.2), while the HR for OS was 1.46 (95%CI = 1.05-2.02). Similarly, in the RC +/- NAC group (6 cohorts for CSS and 3 cohorts for OS), the HR for CSS was 1.27 (95%CI = 1.05-1.55), and the HR for OS was 1.27 (95%CI = 1.08-1.51). There were no significant differences observed in pathologic outcomes, including rates of ≤pT1, pT0, and pT3/T4 disease, across all subgroups. However, pgMIBC was associated with a higher risk of nodal metastatic (pN+) disease in the RC + NAC only group (4 cohorts, relative risk [RR] = 1.43, 95%CI = 1.12-1.84)., Conclusions: The findings highlight the potentially worse prognosis in patients with pgMIBC compared to dnMIBC, even with the modern use of NAC. The study emphasizes the importance of careful patient counseling, further classification of patients for treatment selection, and the consideration of additional or innovative systemic therapies for pgMIBC., Competing Interests: Declaration of competing interest The authors declare no commercial or financial conflicts of interest, or any funding sources related to this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Squamous cell carcinoma (SCC) and extramammary Paget's Disease (EMPD) of the scrotum are exceedingly rare. Given their propensity for local invasion and treatment with wide local excision, they can be highly morbid conditions. Outcomes of Mohs Micrographic Surgery (MMS) for scrotal cutaneous malignancy is not well described in current literature. We hypothesized that MMS for scrotal cutaneous malignancy would provide equivalent or improved oncologic outcomes while limiting the morbidity associated with wide excision., Materials/methods: This is a retrospective review and analysis of a prospectively maintained database spanning entries from 2005 to 2019. Collected data included general patient characteristics and surgical characteristics reported on a per lesion basis. MMS was performed by our institution's department of dermatology using their standard technique., Results: Overall, a total of 26 consecutive patients with 28 lesions (SCC or EMPD) were analyzed. Out of our cohort of 15 patients with 16 scrotal SCC lesions, 10 (66%) patients were current or former smokers, 4 (26%) were immunosuppressed, and 2 (13%) had HPV infections. The median preoperative and postoperative size of SCC lesions were 5.7cm [2] and 20.2cm [2] respectively. There was one (6%) oncologic recurrence of SCC of the scrotum and one (6%) local wound complication. Our cohort also included 11 patients with 12 scrotal EMPD lesions. One patient (9%) had an underlying associated malignancy (prostate cancer). The preoperative and postoperative area of lesions were 50.6cm [2] and 96.4cm [2] respectively. One (9%) EMPD lesion had a positive final margin at resection requiring reoperation. After achieving negative surgical margins, no patients in this cohort had an oncologic recurrence. 3 (26%) scrotal EMPD cases had local wound postoperative complications, only one required reoperation., Conclusion: To our knowledge, this is the first case series focused on MMS for both SCC and EMPD with scrotal involvement. Our data suggests that MMS for scrotal cutaneous malignancy may improve oncologic outcomes and may decreases local post-operative reconstructive issues when compared to reported outcomes of treatment with wide local excision. When able, scrotal cutaneous malignancy patients should be referred to urologists at centers with MMS capabilities as it likely will improve their outcomes. The urologist should maintain active involvement with these patients to coordinate this complex and advanced pattern of care., Competing Interests: Conflicts of Interest No relevant conflicts of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Previous studies showed suboptimal adherence to clinical practice guidelines for pelvic lymph node dissection (PLND) during radical prostatectomy (RP). Robot-assisted RP (RARP) has become the predominant surgical management for localized prostate cancer in the United States but contemporary national data on PLND adherence during RARP are still lacking., Methods: RARPs for clinically localized (cT1-2N0M0) intermediate-risk and high-risk prostate cancer diagnosed between 2010 and 2016 in National Cancer Database were identified. Outcome of interest was PLND and multivariable logistic regressions were used to identify whether patient demographics and facility characteristics were associated with the outcome., Results: We included 115,355 patients in the final cohort (intermediate-risk = 86,314, high-risk = 29,041). From 2010 to 2016, there was an increasing trend of PLND in the overall, intermediate-risk, and high-risk cohorts. In 2016, PLND was performed in 79.7% of the intermediate-risk and 93.5% of the high-risk patients. Multivariable logistic regressions showed Hispanic race/ethnicity (vs. white) (odds ratio [OR] = 0.90, P = .010), lowest socioeconomic status (vs. highest) (OR = 0.85, P < .001), rural area (vs. metro area) (OR=0.61, P < .001), and community facility (vs. academic) (OR = 0.56, P < .001) were some of the factors associated with lower PLND rate. Variations of PLND rate among reporting facility's locations were also identified., Conclusion: Contemporary national data showed significantly increased PLND rate in patients who underwent RARP for intermediate-risk and high-risk prostate cancer in recent years. However, there were still some variations in PLND rate among different patient populations and facilities. Continued efforts need to be made to further increase PLND rate and narrow or eliminate disparities we identified., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: National Comprehensive Cancer Network (NCCN) guidelines recommend confirmatory biopsy within 12 months of active surveillance (AS) enrollment. With <10 cores on initial biopsy, re-biopsy should occur within 6 months. Our objective was to determine if patients on AS within practices in the Pennsylvania Urologic Regional Collaborative (PURC) receive guideline concordant confirmatory biopsies., Materials and Methods: Within PURC, a prospective collaborative of diverse urology practices in Pennsylvania and New Jersey, we identified men enrolled in AS after first biopsy, analyzing time to re-biopsy and factors associated with various intervals of re-biopsy., Results: In total, 1,047 patients were enrolled in AS for a minimum of 12 months after initial biopsy. Four hundred seventy-seven (45%) underwent second biopsy at 1 of the 9 PURC practices. The number of patients undergoing re-biopsy within 6 months, 6 to 12 months, 12 to 18 months, and >18 months was 71 (14%), 218 (45.7%), 134 (28%), and 54 (11%), respectively. Sixty percent underwent confirmatory biopsy within 12 months. On multivariate analysis, re-biopsy interval was associated with number of positive cores, perineural invasion, and practice ID (all P < 0.05). Adjusted multivariable regression did not identify factors predictive of re-biopsy interval., Conclusion: Of patients who underwent confirmatory biopsy at PURC practices, 60.5% were within 12 months per NCCN guidelines. This suggests area for improvement in guideline adherence after enrollment in AS. All practices that offer AS should periodically perform similar analyses to monitor their performance. In an era of value-based care, adherence to guideline based active surveillance practices may eventually comprise national quality metrics affecting provider reimbursement., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Length of stay (LOS) is increasingly being viewed as a quality metric, and efforts to reduce LOS are present across most surgical subspecialties. However, data on whether reducing LOS is safe in patients who undergo radical nephrectomy (RN) are lacking. The purpose of this study was to assess whether early discharge after RN affects readmission rates and postdischarge complications using a national cohort of patients., Patients and Methods: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent RN from 2012 to 2015. Procedures were stratified as minimally invasive or open. Early discharge was defined as less than or equal to the procedure-specific 25th percentile for LOS. Multivariable analysis was used to identify factors associated with readmission and postdischarge complications. A sensitivity analysis excluded patients with a LOS >75th percentile., Results: A total of 11,429 patients were included. The 25th percentile for LOS was 2 days in the minimally invasive group and 3 days in the open group. In multivariable analysis, early discharge did not increase the risk of postdischarge complications (odds ratio, 0.88; 95% confidence interval, 0.71-1.08; P = .214) and decreased the risk of readmission (odds ratio, 0.72; 95% confidence interval, 0.59-0.87; P = .001)., Conclusion: Early discharge after RN does not increase the risk of postdischarge complications or readmission. With the appropriate patient selection, decreasing LOS might lead to decreased surgical costs and improved patient flow. This work provides a foundation for future research that might optimize perioperative care pathways to decrease LOS., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To investigate national utilization trends of minimally-invasive partial nephrectomy (PN) and minimally-invasive radical nephrectomy (RN), and to identify disparities in the usage of these techniques across different sociodemographic subgroups., Materials and Methods: A retrospective cohort study was conducted using the National Cancer Database to identify patients undergoing partial or RN for cT1N0M0 renal cancer diagnosed between 2010 and 2015. Main outcomes of interest were the utilizations of minimally-invasive (robotic and laparoscopic) PN and RN., Results: A total of 46,346 and 37,712 subjects who underwent PN and RN, respectively, were analyzed. During the study interval, increased utilization of robotic surgery paralleled the decreased utilization of open surgery. Robotic PN increased from 35.2% to 63.7% and robotic RN increased from 10.3% to 26.3%. The utilization of laparoscopic surgery was decreasing for PN but stable for RN through the study period. In the PN cohort, multivariable logistic regression showed non-Hispanic black (odds ratio [OR] = 0.90 [95% CI, 0.84-0.96]) and Hispanic (OR = 0.91 [0.84-0.99]) subjects were associated with less utilization of minimally invasive surgery (MIS) (vs. non-Hispanic white). Younger (18-64 years) Medicare (OR = 0.83 [0.77-0.90]), Medicaid (OR = 0.80 [0.74-0.87]), and uninsured (OR = 0.55 [0.49-0.62]) were also associated with less utilization of MIS (vs. private insurance). Compared with low socioeconomic status (SES), upper middle (OR = 1.14 [1.07-1.21]) and high (OR = 1.24 [1.16-1.33]) SES were associated with higher utilization of MIS. Similar demographic, insurance, and SES-related disparities were identified in the RN cohort., Conclusions: Utilization of MIS for localized renal cancer has increased significantly and was mainly attributed to increased usage of robotic surgery. Racial/ethnic, insurance, and SES related disparities in MIS utilization were identified. Our findings demonstrate a targetable subgroup of patients who do not have the same access to advances in surgical technology., (Copyright © 2018. Published by Elsevier Inc.)

Purpose: To determine a subset of women who could undergo ovary-sparing radical cystectomy (OSRC) for bladder cancer without compromising oncologic safety., Patients and Methods: A retrospective review was performed of 164 consecutive women who underwent cystectomy at a single tertiary-care center from 1997 to 2018. Clinicopathologic and preoperative radiographic data were reviewed. Univariable and multivariable logistic regression models adjusting for pathologic stage, lymphovascular invasion (LVI), and carcinomain-situ were performed to evaluate the risk of ovarian and reproductive organ (RO) involvement., Results: A total of 123 women with a median age of 71 years underwent radical cystectomy (RC) with removal of ROs for primary bladder cancer. Nineteen women (15%) had RO involvement by bladder cancer, and 5 of them (4%) were specifically found to have ovarian involvement. Patients with ovarian involvement of bladder cancer had more locally advanced disease (P = .01), LVI (P = .003) and positive margins (P = .003). On multivariable logistic regression, ≥ pT3 (odds ratio = 10.2; 95% confidence interval, 2.0-51.6; P = .005) and LVI (odds ratio = 3.9; 95% confidence interval, 1.1-14.2; P = .037) were associated with increased risk of RO involvement. Among 15 patients excluded for having a nonbladder primary malignancy, a third had RO involvement, and 2 (13%) had ovarian metastases. No women in our cohort had a primary ovarian malignancy detected at the time of RC., Conclusion: Women with ovarian involvement by malignancy at the time of RC either had locally advanced disease with LVI or a non-bladder primary malignancy. The risk of incompletely resecting the primary malignancy would be rare if OSRC was performed on women with organ-confined (≤T2) urothelial carcinoma., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Macroscopic complete resection can improve survival in a select group of patients with malignant pleural mesothelioma. During resection, differentiating residual tumor from inflammation or scar can be challenging. This trial evaluated near-infrared (NIR) intraoperative imaging using TumorGlow (a novel NIR imaging approach utilizing high-dose indocyanine green and delayed imaging) technology to improve detection of macroscopic residual disease., Methods: Twenty subjects were enrolled in an open-label clinical trial of NIR intraoperative imaging with TumorGlow (Indocyanine Green for Solid Tumors [NCT02280954]). Twenty-four hours before pleural biopsy or pleurectomy and decortication (P/D), patients received intravenous indocyanine green. All specimens identified during standard-of-care surgical resection and with NIR imaging underwent histopathologic profiling and correlative microscopic fluorescent tomographic evaluation. For subjects undergoing P/D (n = 13), the hemithorax was evaluated with NIR imaging during P/D to assess for residual disease. When possible, additional fluorescent lesions were resected., Results: Of 203 resected specimens submitted for evaluation, indocyanine green accumulated within 113 of 113 of resected mesothelioma specimens, with a mean signal-to-background fluorescence ratio of 3.1 (SD, 2.2 to 4.8). The mean signal-to-background fluorescence ratio of benign tissues was 2.2 (SD, 1.4 to 2.4), which was significantly lower than in malignant specimens (p = 0.001). NIR imaging identified occult macroscopic residual disease in 10 of 13 subjects. A median of 5.6 resectable residual deposits per patient (range, 0 to 11 deposits per patient), with a mean size of 0.3 cm (range, 0.1 to 1.5 cm), were identified., Conclusions: TumorGlow for malignant pleural mesothelioma is safe and feasible. Excellent sensitivity allows for to reliable detection of macroscopic residual disease during cytoreductive surgical procedures., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Intraoperative localization and resection of ill-defined pulmonary ground-glass opacities (GGOs) during minimally invasive pulmonary resection is technically challenging. Current preoperative techniques to facilitate localization of GGOs include microcoil and hook wire placement, both of which have logistic limitations, carry safety concerns, and do not help with margin assessment. In this clinical trial, we explored an alternative method involving near-infrared molecular imaging with a folate receptor-targeted agent, OTL38, to improve localization of GGOs and confirmation of resection margins., Methods: In a human trial, 20 subjects with pulmonary GGOs who were eligible for video-assisted thoracoscopic surgery (VATS) resection received 0.025 mg/kg of OTL38 before the resection. The primary objectives were to (1) determine whether use of OTL38 allows safe localization of GGOs and assessment of margins during VATS and (2) determine patient, radiographic, and histopathologic variables that predict the amount of fluorescence during near-infrared imaging., Results: We observed no toxicity. Of the 21 GGOs, 20 accumulated OTL38 and displayed fluorescence upon in situ or back table evaluation. Intraoperatively, near-infrared imaging localized 15 of 21 lesions whereas VATS alone localized 10 of 21 (p = 0.05). The addition of molecular imaging affected care of nine of 21 subjects by improving intraoperative localization (n = 6) and identifying close margins (n = 3). This approach was most effective for subpleural lesions measuring less than 2 cm. For lesions deeper than 1.5 cm from the pleural surface, intraoperative localization using fluorescent feedback was limited., Conclusions: This approach provides a safe alternative for intraoperative localization of small, peripherally located pulmonary lesions. In contrast to alternative localization techniques, use of OTL38 also allows confirmation of adequate margins. Future studies will compare this approach to alternative localization techniques in a clinical trial., (Copyright © 2018 International Association for the Study of Lung Cancer. All rights reserved.)

Background: Intraoperative identification of pulmonary nodules, particularly small lesions, can be challenging. We hypothesize that folate receptor-targeted intraoperative molecular imagining can be safe and improve localization of pulmonary nodules during resection., Methods: Twenty subjects with biopsy-proven pulmonary adenocarcinomas were enrolled in a phase I clinical trial to test the safety and feasibility of OTL38, a novel folate receptor-α (FRα) targeted optical contrast agent. During resection, tumors were imaged in situ and ex vivo and fluorescence was quantified. Resected specimens were analyzed to confirm diagnosis, and immunohistochemistry was utilized to quantify FRα expression. A multivariate analysis using clinical and tumor data was performed to determine variables impacting tumor fluorescence., Results: Of the 20 subjects, three grade I adverse events were observed: all transient nausea/abdominal pain. All symptoms resolved after completing the infusion. Sixteen of 20 subjects (80%) had tumors with in situ fluorescence with a mean tumor-to-background fluorescence level of 2.9 (interquartile range, 2.1 to 4.2). The remaining 4 subjects' tumors fluoresced ex vivo. In situ fluorescence was dependent on depth from the pleural surface. Four subcentimeter nodules not identified on preoperative imaging were detected with intraoperative imaging., Conclusions: This phase I trial provides preliminary evidence suggesting that folate receptor-targeted molecular imaging with OTL38 is safe, with tolerable grade I toxicity. These data also suggest that OTL38 accumulates in known lung cancers and may improve identification of synchronous malignancies. Our group is initiating a five-center, phase II study to better understand the clinical implications of intraoperative molecular imaging using OTL38., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the impact of surgical waiting time (SWT) on the survival outcome in patients with upper tract urothelial carcinoma (UTUC)., Materials and Methods: We identified patients with nonmetastatic UTUC who underwent radical nephroureterectomy (RNU) between 2004 and 2013 in the National Cancer Database. The association between SWT and overall survival (OS) was evaluated using Cox proportional hazards regression. SWT was categorized into 6 groups: SWT ≤ 7 days, SWT 8 to 30 days, SWT 31 to 60 days, SWT 61 to 90 days, SWT 91 to 120 days, and SWT 121 to 180 days. Multivariable analyses were adjusted for patient, tumor, and facility-related factors., Results: A total of 3,581 patients were included in the final overall cohort and 2,397 (66.9%) patients had the higher-risk disease (high-grade or ≥pT2). Multivariable Cox regressions showed that patients in the groups of SWT 31 to 60 days, SWT 61 to 90 days, and SWT 91 to 120 days had similar OS compared with patients who had SWT of 8 to 30 days in the overall cohort and higher-risk cohort. Patients with SWT 121 to 180 days had worse OS (HR = 1.61, 95% CI: 1.19-2.19, P = 0.002 in the overall cohort; HR = 1.56, 95% CI: 1.11-2.20, P = 0.010 in the higher-risk cohort)., Conclusions: Increased SWT from diagnosis to RNU appears to be not associated with worse OS within 120 days after the diagnosis of UTUC but SWT>120 days may be associated with worsened survival. These findings might have important implications for trial design in the evaluation of neoadjuvant chemotherapy for UTUC and future clinical practice., (Copyright © 2018. Published by Elsevier Inc.)

Introduction: The purpose of this study was to summarize the characteristics and identify associated factors of postoperative pulmonary complications (PPCs) in patients undergoing radical cystectomy (RC)., Materials and Methods: The National Surgical Quality Improvement Project (NSQIP) database (2005-2014) was used to identify patients who underwent RC for bladder cancer. PPCs were defined as pneumonia, unplanned reintubation, and ventilator support > 48 hours within 30 days of RC. Incidence, timing, and outcomes of PPCs were described and analyzed. Multivariable logistic regression was used to evaluate associated factors of PPCs., Results: Among 3790 patients included, 213 (5.6%) had at least 1 PPC. Patients with PPCs had a significantly higher 30-day mortality (17.4% vs. 0.7%; P < .001) and longer hospital stay (13 vs. 8 days; P < .001). Logistic regression showed that age ≥ 75 years (odds ratio [OR], 2.07; P = .001), body mass index < 18.5 kg/m 2 (OR, 2.48; P = .017), body mass index ≥ 30 kg/m 2 (OR, 1.71; P = .009), dependent functional status (OR, 2.77; P = .006), current smoker (OR, 1.57; P = .011), chronic obstructive pulmonary disease (OR, 1.70; P = .018), insulin-treated diabetes (OR, 1.70; P = .042), and albumin < 3.5 g/dL (OR, 1.72; P = .015) were associated with increased risk of overall PPCs., Conclusion: Approximately 5.6% of patients have at least one PPC within 30 days of RC. Several preoperative associated factors for PPCs were identified, which should be helpful for risk stratification, patient counseling, and perioperative care., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to determine the effect of preoperative anemia status and hemoglobin level on clinical outcomes in patients with bladder cancer undergoing radical cystectomy., Materials and Methods: A systematic review of literature with meta-analyses of predefined outcomes based on a search of PubMed and EMBASE was performed. Hazard ratios (HRs) measuring the association between preoperative anemia/hemoglobin and all-cause mortality, cancer-specific mortality, and disease recurrence were calculated with random effects model. Study heterogeneities were quantified by I 2 tests. Publication bias was assessed with funnel plots., Results: A total of 17 studies evaluating the impact of preoperative anemia status (categorical, 11 studies) and hemoglobin level (continuous, 7 studies) on clinical outcomes were included. The cutoff value of anemia varied among studies (10.5-13.5 g/dL for male, 10.5-13.4 g/dL for female). Meta-analyses showed that compared with non-anemia, anemia was associated with increased all-cause mortality (HR, 1.75; 95% confidence interval [CI], 1.48-2.05; P < .00001; I 2  = 30%), cancer-specific mortality (HR, 1.80; 95% CI, 1.45-2.25; P < .00001; I 2  = 26%), and disease recurrence (HR, 1.37; 95% CI, 1.16-1.62; P = .0002; I 2  = 9%). Meta-analyses showed that higher level of hemoglobin was associated with decreased all-cause mortality (HR, 0.90; 95% CI, 0.87-0.92; P < .00001; I 2  = 13%), cancer-specific mortality (HR, 0.90; 95% CI, 0.85-0.95; P = .0003; I 2  = 61%), and disease recurrence (HR, 0.95; 95% CI, 0.91-0.99; P = .01; I 2  = 53%). No obvious publication bias was observed., Conclusions: Preoperative anemia and low hemoglobin level are associated with earlier recurrence and shorter survival of patients with bladder cancer undergoing radical cystectomy. However, well-designed prospective studies with large sample size and limited confounding factors are needed to confirm and update our findings., (Copyright © 2016 Elsevier Inc. All rights reserved.)

How cells could proliferate quickly and maintain their biological activity by using appropriate scaffolds remains a big challenge for tissue engineering. By integrating icariin, a bioactive ingredient of traditional Chinese medicine (TCM) Epimedii herba, with PHBV scaffolds, novel icariin delivery porous PHBV scaffolds (IDPPSs) were fabricated with a combination of the solvent casting and salt leaching techniques. IDPPSs displayed a high porosity, 88.80%, and appropriate mechanical properties which were required for 3-D cell culture. IDPPSs significantly promoted the proliferation of human osteoblast-like MG-63 cells and the pre-osteoblast MC3T3-E1 cells, while IDPPSs containing 0.1% icariin (wt.%) showed the highest effect compared with other samples. Although IDPPSs continuously released icariin to the solution in 28 days, cells attached to IDPPSs received an enhanced growth stimulation compared with which were not physically in contact with IDPPSs. Up-regulated transcription of growth factor genes and extracellular matrix genes, including BMP2, BMP6, BMP7 and BGN, was observed in IDPPS-cultured MG-63 cells, illustrating that enhanced cellular proliferation results from alteration of gene transcription. These results implied the potential commercial use of IDPPSs in tissue engineering., (Copyright © 2013 Elsevier B.V. All rights reserved.)

A key challenge in tissue engineering is the construction of a scaffold with adequate properties which would mimic extracellular matrix (ECM) to induce the cells' efficient adhesion, proliferation and proper differentiation. Novel β-Ca2SiO4/PHBV composite scaffolds were fabricated by integrating β-Ca2SiO4 nanoparticles with PHBV backbone via a modified solvent casting-particulates leaching method, which generates interconnected porous structure and the high porosity, about 87%, of these scaffolds. Compared with PHBV scaffolds, β-Ca2SiO4/PHBV composite scaffolds facilitate the adhesion of human osteoblast-like MG-63 cells due to their increased hydrophilicity. The β-Ca2SiO4/PHBV composite scaffolds containing 2.5 or 5% β-Ca2SiO4 nanoparticles significantly enhance the proliferation of MG-63 cells by stimulating the transcription of the transforming growth factor-β1 (TGF-β1) and bone morphogenetic protein-7 (BMP-7) genes. These scaffolds also induce early differentiation via promoting the transcription of alkaline phosphatase (ALP). The results suggest the potential application of β-Ca2SiO4/PHBV composites in bone tissue engineering., (Copyright © 2013 Elsevier B.V. All rights reserved.)