Malignant Pleural Mesothelioma

Actos and Bladder Cancer : Bladder cancer treatment can include surgery, chemotherapy, radiation therapy, and immunotherapy. Although some of these treatments are used alone, often a combination of several treatments (i.e., both chemotherapy and surgery) is used for the most success. Selection of the most appropriate treatment is based on clinical staging, including pathological and ra­diographic information, and individual preference in close consultation with your physician. When choosing a blad­der cancer treatment, it is important that you consider not only the potential for cancer cure but also the side effects and quality of life impact of various treatments.

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SURGICAL TREATMENT

Surgery plays an important role in both the staging and subsequent treatment of bladder cancer. Transurethral resection of a bladder tumor (TURBT) is the initial treat­ment step in the vast majority of patients with bladder cancer. TURBT provides valuable staging information, and pathological results from these procedures are used to make further decisions regarding what, if any, addi­tional therapy is needed. The gold standard treatment for muscle-invasive bladder cancer is radical cystectomy (removal of the bladder). Advances in surgical technique and anesthesia have reduced the complications associated with this procedure in the last two decades. The develop­ment of continent urinary diversion, which allows one to empty the bladder through the urethra, is an option for certain patients. Minimally invasive procedures such as laparoscopic or robotic-assisted radical cystectomy may also be treatment options. In addition, bladder-sparing procedures (either with partial removal of the bladder or aggressive TURBT frequently in combination with che­motherapy and/or radiation therapy) have allowed some patients to treat their cancer while leaving their blad­ders intact. Advances in surgical techniques continue to this day with the development of minimally invasive approaches to cystectomy. Both robotic-assisted and lapa­roscopic radical cystectomy have been performed safely in highly specialized centers and have the potential for decreased morbidity and a shorter period of recovery, but longer term follow-up is needed to determine if these pro­cedures are equivalent to open surgical techniques.

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TURBT is often the first procedure you will have once diagnosed with a bladder tumor. This surgery is typically performed under general or spinal anesthesia as an out­patient procedure and without any incision, endoscopically through the urethra, which means a cystoscope is placed through the urethra and into the bladder. Through this scope your urologist can see the inside of your bladder and has the ability to resect, or remove, tumors in the bladder under direct vision using electrocautery. The electrocautery is also used to control bleeding after the resection is com­pleted. TURBT is extremely important for the staging of bladder tumors but can also be therapeutic for lower stage bladder cancers. Once the tumor has been removed, it can be analyzed under the microscope by a pathologist. The pathological findings dictate further treatment decisions. If the tumor is low grade and noninvasive, you will likely not need any further therapy at this point except for close follow-up.

Our use of the term or terms Actos and Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos and Bladder Cancer

Actos and Bladder Cancer : This is what is usually called a “false-positive” test result. The test was positive in a case where it seems that it should have been negative. Any medical test has a cer­tain false-positive rate (usually very low). The problem with a false-positive result with urine cytology is that there is no way to guarantee the absence of cancer. It is always possible that the cancer is there, but we have not been able to find it yet. Sometimes it can hide in places such as the ureters or kidney where we cannot see as well. Other times, especially with carcinoma in situ, the diseased areas look normal through the cysto- scope but actually harbor serious disease. Because of this, one should never ignore a positive cytology result. Close to 80% of patients with a positive cytology but a negative evaluation will eventually be found to have a urologic malignancy.

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The current recommendation for patients with a posi­tive urine cytology and a negative initial evaluation is to repeat the urine cytology 6 to 8 weeks later. Those patients with a negative cytology on the follow-up test do not need further evaluation. If the follow-up cytol­ogy is positive, however, careful evaluation should be undertaken, as most of these patients will eventually be found to have a malignancy. Your urologist may rec­ommend multiple small biopsies of the bladder to look for carcinoma in situ, a condition that is often associ­ated with positive cytology.

Although cytology has long been the gold standard for bladder cancer screening, including monitoring for recur­rences, it is far from perfect (see Question 33), and there is great interest in finding an even better test. Currently, at least four other markers are approved by the Food and Drug Administration (FDA), although none of them are clearly better than cytology. In addition to these four, many new tests are being developed. The four listed here are those that are currently available to patients. If you are considering a radical cystec­tomy, you want an individual who regularly performs that operation. A radical cystectomy is a complicated, time-consuming procedure that some urologists rarely or never perform. The old dictum “practice makes perfect” certainly applies here. Furthermore, if you are interested in the neobladder option for reconstruction of your urinary tract, you should make sure that the urologist is comfortable with that portion of the oper­ation. The neobladder adds complexity to the proce­dure for the surgeon, and not all urologists are well trained in this area. The urologist should know his or her own complication rate for the procedure and not just quote widely published rates for other surgeons. He or she should be comfortable and willing to discuss these rates with you.

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Cancer can be a frightening word and disease no matter how you look at it. You want a physician who understands your fears and concerns and who is willing to take the time to help you make your management decisions. There is no good measure for this, but trust your instincts at your first meeting with a new doctor. Sometimes you may feel that it is necessary to get a second opinion. You may have concerns about the treatment recommendations or may worry that there are other options that have not been presented. If you ever feel that you have not received enough informa­tion or that you are uncomfortable with the treatment recommendations from your urologist and/or oncolo­gist, then it is appropriate to seek a second opinion.

Our use of the term or terms Actos and Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos and Bladder Cancer

Actos and Bladder Cancer : Bladder cancer is a common cancer of the urinary tract. It is the fourth leading cause of cancer-related death among men and the seventh among women. Clinical management of bladder cancer is challenging because of the heterogeneity among bladder tumors with respect to invasion and metastasis and frequent occurrence of new tumors in the bladder among patients treated with bladder preservation treat­ments. Due to these factors it has been said that the cost per patient of bladder cancer from diagnosis to death is the highest of all cancers. In addition to it being a significant health problem, bladder cancer is an interesting cancer to study in many ways than one. For example, environmental factors such as cigarette smoking and other carcinogens play a major role in the development of transitional carci­noma of the bladder, whereas schistosomiasis, a protozoan infection, results in squamous cell carcinoma of the bladder. Different molecular pathways with distinct molecular signatures appear to be involved in the development of low-grade versus high-grade bladder tumors. Currently being monitored by an invasive endoscopic procedure, cystectomy, with urine cytology as an adjunct, bladder cancer is at the forefront of developing cancer biomarkers for noninvasive detection. Due to the differences in the invasive and metastatic potential of bladder tumors, treatment options differ depending upon the grade and stage of the tumor. New advances are being made in treatment options to improve the outcome and quality of life for patients with bladder cancer. Similarly, new molecular nomograms are being dis­covered to predict treatment outcome so that individualized treatment options can be offered to patients.

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This new text book on bladder cancer is organized to give both the clinicians and laboratory investigators state-of-the art information on basic science and clinical aspects of bladder cancer. Organizing this book that includes both the molecular basis as well as clinical practices in the management of bladder cancer would not have been possible without the invaluable contributions of the authors of each chap­ter. These authors who are experts in various aspects of bladder cancer were assembled from institutions in different parts of the world. All of these authors were generous with their time and commitment for bringing the readers up-to-date infor­mation on current advances in each area of bladder cancer. In addition, these experts have provided critical evaluation of the material presented in each chapter. Therefore, as editors of this book it has been our privilege to work with each contributor and we believe that this book will serve as a comprehensive reference on bladder cancer.

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Although, the readers are encouraged to read the entire book, we would like to present the highlight of each chapter in order to guide the readers to select the mate­rial of interest. Chapters 1-9 focus on molecular basis of bladder cancer, translational research into the areas of tumor markers, and standard mode of bladder diagnosis and detection. Chapters 10-22 focus on clinical aspects of bladder cancer.Smoking is well known; however, in Chap. 1 on epidemiology of bladder cancer, Dr. Ribal reminds us that other causes like occupational exposure, genetic predis­position, and infection are also linked to the development of bladder cancer. Bladder cancer is a carcinogenesis-driven cancer, with polycyclic aromatic hydro­carbons (PAH) and aromatic amines having causal links. Chapter 2 by Escudero, Shirodkar, and Lokeshwar focuses on xenobiotic metabolisms that convert PAH and aromatic amines into active carcinogens and on genetic polymorphisms that increase the risk for bladder cancer development. The chapter discusses theories of bladder cancer development (field cancerization versus clonal origin) and chromo­somal aberrations associated with bladder cancer.

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Actos and Bladder Cancer : In most populations the incidence of BC is three to four times higher in men than in women (Pelucchi et al. 2006). The excess of BC in men is not fully explained by differences in smoking habits and occupation.BC is a disease of the environment and age . Populations are increasing in number, but , they are growing older as well. Since more people are living longer, more are at potential risk. Furthermore, the changing environments in developed and devel­oping countries are causing more carcinogen concentration than can be associated to genesis of BC.

Several risk factors have been proposed for BC.

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Epidemiological evidence of the association between cigarette smoking and cancer began to be considered from the 1920s, and in 1950s, its relationship with lung cancer was perfectly established (Gandini et al. 2008). Tobacco smoking is cur­rently responsible for 30% of all cancer deaths in developed countries. If the current pattern of tobacco smoking continues, there will be more than one billion deaths attributable to tobacco in the twenty-first century compared with 100 million deaths in the twentieth century (Vineis et al. 2004). In the IARC Monographs of the Evaluation of Carcinogenic Risks to Humans, it is reported that there is sufficient evidence in humans that tobacco smoking causes cancer of lung, oral cavity, naso-, oro-, and hypopharynx, nasal cavity and paranasal sinuses, larynx, esophagus, stomach, pancreas, liver, kidney, ureter, urinary bladder, uterine cervix, and bone marrow (myeloid leukemia). (Sufficient evidence means that the Working group considers that a casual relationship has been established between exposure to the agent and cancer in studies in which chance, bias, and confounding could be ruled out with reasonable confidence) (International Agency for Research on Cancer 2002). Putative carcinogenic constituents of tobacco smoke include arylamines, in particular, the potent carcinogen 4-aminobiphenyl, polycyclic aromatic hydrocar­bons (PAHs), N-nitroso compounds, heterocyclic amines, and various epoxides.

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Tobacco smoking is the most well-established risk factor for BC, causing around 50%-65% of male cases and 20%-30% of female cases. The lower cases in women than in men is explained by the earlier stage of the tobacco-related epidemic among European women, and it is likely to increase in the future (Boffetta 2008). In addi­tion, it has been estimated that smoking is responsible for about 34% of deaths from BC in males worldwide and for 13% of BC deaths in females. Time trends in BC incidence and mortality are consistent with those of other tobacco-related cancers, with mortality rates being highest in birth cohorts with the maximum exposure to tobacco (Maxwell 2008).

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Actos and Bladder Cancer : Your physicians should be confident enough in their recommendations that they are neither intimidated nor angered by your desire to seek a second opinion. If you experience either of these reactions, then you can be confident in your decision to seek a second opinion. Generally, your physicians will hope that you return to them to discuss the second opinion afterward, espe­cially regarding anything that is divergent from their own recommendations. Most patients return to their original caregiver after getting a second opinion, although you are never obligated to do so.

Most patients will not need to stay in the hospital overnight after a TURBT. The final decision on stay­ing in the hospital or returning home is made based on the amount of resection necessary and the amount of blood in the urine after the procedure. These two fac­tors will also determine whether a catheter needs to be left in place after the procedure, usually for a few days. TURBT is generally regarded as a low-risk procedure. It is typically performed as a day surgery procedure, meaning that you will not need to stay in the hospital overnight. As with any surgery that requires anesthe­sia, a small risk is associated with the anesthesia. This risk is higher if you have other conditions such as asthma, chronic obstructive pulmonary disease, or car­diovascular disease, but is still generally very low risk.

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Perioperative chemotherapy refers to the practice of instilling one of the bladder chemotherapies immedi­ately after TURBT, usually while you are still in the operating room or the recovery room. Traditionally, these intravesical therapies have been given after the bladder has healed, 2 to 3 weeks after surgery. Several studies in the last 10 years have shown benefits to giv­ing a single dose of chemotherapy at the time of TURBT. The benefit presumably derives from killing any cancer cells that are still swirling around in the bladder after TURBT, thus preventing them from implanting in the bladder.

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PDT is a new treatment that is still evolving. It is cur­rently given only to patients with recurrent tumors who have failed BCG treatment. Newer sensitizing agents have improved its efficacy. In one study, 84% of patients with BCG-resistant papillary tumor had a complete response, and 75% of patients with carci­noma in situ had a complete response at the 3-month follow-up. At a median follow-up of 4 years, 31 of 34 patients who had responded were still tumor-free. PDT appears to be useful in patients with superficial bladder cancer but has not yet been widely adopted.

Superficial bladder cancer is a recurrent and potentially progressive disease. Most studies have shown that patients with a higher stage and/or grade (Questions 29 and 30) have recurrences more frequently than do patients with a lower stage or grade. Approximately half of the lowest stage and grade tumors (Ta, Grade I/II) will recur, most of them in the first 3 months after treat­ment. Carcinoma in situ recurs in up to 70% of patients.

The treatment of choice currently for carcinoma in situ is intravesical therapy with BCG (Question 35). Carci­noma in situ in most cases is not adequately treated by resection alone because it tends to be located diffusely throughout the bladder. Sixty to 70% of patients with carcinoma in situ will respond to a standard course of BCG. Although encouraging, this obviously means that 30% to 40% of patients will fail a standard course, and thus most experts advise further therapy. Some advocate two courses of BCG, whereas others prefer maintenance BCG for 3 years; urine is sent for cytology every 3 to 12 months. Also, periodic cystoscopy will need to be performed in the urologist’s office, and any suspicious lesions will need to be biopsied and exam­ined under the microscope by a pathologist.

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Actos and Bladder Cancer : Ureteral injury may occur when a tumor covers the ureter in the bladder. The ureter may be obscured by a bladder tumor, and the urologist may inadvertently resect it along with the tumor. In general, cutting current to remove a bladder tumor does not usually lead to long lasting problems as compared to cauterization, which is more likely to cause permanent blockage or obstruction of the ureter. If the urologist is working in the area of the ureter, he should avoid cauterization as much as possible. He may ask the anesthetist to inject an intravenous coloring agent which will turn the urine blue

and allow visualization of the ureter. If he knows a ureter may be in jeopardy, he may insert a stent (a small plastic tube that traverses the ureter) for several weeks to allow the ureter to heal in an open fashion.

Urethral injury is infrequent and is almost always in males. A stricture or narrowed area of the urethra may result from irritation or injury from the resectoscope pressing on the urethra. Individuals that develop strictures complain of difficulty urinating, experiencing a slow or split stream. Strictures are usually readily handled with a number of urologic procedures.

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Bladder tumor “seeding” may occur during the procedure. As the tumors are resected, cancer cells are released into the irrigant which fills the bladder. These cells may implant in other areas of the bladder traumatized during the procedure. It should be understood that the bladder is generally filled with urine, and tumor cells can naturally implant at other locations even without surgery. Implantation can be lessened during surgery by avoiding injury to other bladder areas and by the use of adjuvant intravesical chemotherapy. There have been numerous studies over the past decade showing a number of chemotherapy agents can be effective in decreasing initial tumor recurrence, possibly by preventing seeding. Reduction in recurrence may however be short lived. Previously, it was common practice to obtain multiple random bladder biopsies at the time of initial tumor resection. This was recommended to rule out the possibility of hidden CIS. Understanding these biopsy sites may increase the possibilities of tumor recurrence by tumor seeding, biopsies are now often limited to areas adjacent to the tumors removed and suspicious appearing areas only. CIS can be ruled out by using cytology, or by obtaining biopsies during future cystoscopy after the tumor has already been removed. When dealing with low grade tumors, random biopsies of the bladder will rarely show cancer.^[1]

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After your procedure, depending on the level of anesthesia and the extent of surgery, you will be brought either to the recovery room or back to the area where you were first prepared for your procedure. You will be released to home only when you have fully recovered from you anesthetic and are doing well.

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Actos and Bladder Cancer : The recurrence rate for superficial bladder cancer can be as high as 60-90%. Recurrences can cause bleeding and other difficulties and are best handled sooner rather than later. In addition, depending on the initial tumor grade and stage, progression to a more serious form of bladder cancer is an ongoing concern. Surveillance cystoscopy is therefore recommended.

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Cystoscopy is still the best means to check for recurrent disease. It is however, an invasive procedure and should be accomplished only as often as required. For solitary, low grade, non invasive disease, follow up cystoscopy can be accomplished with the flexible cystoscope if available. If negative at three months, further cystoscopic exams can be done yearly and eventually lengthened even further. For those with multiple tumors, large tumors, high grade tumors or those who also have CIS, frequent cystoscopies, initially every three months are called for. As long as there are no recurrences, the time between cystoscopies can be lengthened. Cytology can also be utilized to reduce the number of cystoscopies. If recurrence or progression does occur, heightened scrutiny is again called for.

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BESIDES A BLADDER TUMOR, MY CT SCAN INDICATED MY KIDNEY IS SWOLLEN BECAUSE OF A BLOCKAGE OF MY URETER. DID THE BLADDER TUMOR CAUSE THIS BLOCKAGE AND DOES IT MEAN MY PROGNOSIS IS WORSE?

There are many medical conditions that may result in hydroureteronephrosis (swelling of the kidney and ureter), having nothing to do with bladder cancer. It is also true large bladder tumors may grow into the wall of the bladder and cause ureteral obstruction at the level of the bladder. When this is found, the prognosis is usually poor, as the tumors involved are usually high grade and deeply invasive. On occasion, a superficial low grade tumor may grow directly into the ureteral opening. In this situation, prognosis is not generally any worse, as the blockage has not occurred from an invasive tumor.

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Actos and Bladder Cancer : The urinary system (Figure i-i) is very important and has a pretty tough job to do in everyone’s body. It filters your blood and produces waste products in the form of urine. More importantly, it allows you to store urine until it is convenient to urinate. Just think, if we couldn’t store urine, then we would constantly leak waste products. This would make life very difficult and get in the way of things we do during the course of a normal day. The human urinary system is made up of the kidneys, ureters, bladder, and urethra. Men have a prostate gland in addition to the previously mentioned components.

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Your kidneys are two bean-shaped organs that reside in the rear of your abdomen, just under the diaphragm on the left and below the liver on your right side. The kidneys filter blood and produce urine. They are extremely important to life and work extremely hard to filter waste from your bloodstream. Just imagine, the kidneys filter approximately 20 percent of your blood each minute. Although most people have two kidneys, some individuals have one and do just fine. The kidneys function independently, and when one is not working as well, the other compensates and filters more blood. In addition to filtering blood and producing urine, your kidneys help to regulate your blood pressure. They produce special hormones and control the salt and water balance in your body. Normally, the kidneys do not release blood cells into urine. This is why it’s important to be evaluated by a doctor if you have blood in your urine.

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URETERS

After urine is formed by the kidneys, special nerves and muscles in the renal pelvis propel urine downward into the ureters. The ureters are small tubes, very much like the renal pelvis, that allow passage of urine from die kidneys down to the bladder. They function as drainage pipes for the kidney. The ureters have nerves and layers of muscle that propel urine to the bladder. There is so much that your body does that you may not realize. Like the renal pelvis, the ureters are also lined with transitional cells serving as a continuation of die uxothelium.

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Actos and Bladder Cancer :

BLADDER

The ureters connect to the bladder, which is a muscular, balloon-lilce structure in the pelvis. The bladder functions as the storage unit of the urinary system. It can hold upward of 500-600 mL (2 cups) of urine. Hie bladder is very thick and elastic with multiple layers .

An inner layer made up of transitional cells forming the urothelium; under this lies a thin layer (the lamina propria), with blood vessels supplying the bladder; and finally a thick muscular layer that contracts to empty your bladder. There is a layer of fat surrounding the muscular layer.

The bladder expands in relation to the amount of fluid inside of it Bladder contraction is under complex control by your central nervous system. When your bladder contracts during urination, urine passes though the urethra before leaving your body. The inner cells, closest to the bladder, are transitional cells, whereas the cells closest to the outside of the body are squamous cells resembling skin. Although the urethra has different lengths in men and women, it functions the same. In men, the urethra passes through the prostate gland near the bladder.

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PROSTATE

The prostate, a walnut-sized organ that lies at the base of the bladder in men, plays a role in male fertility. Along with the seminal vesicles, the prostate gland produces fluid that helps sperm after ejaculation. Although the urethra passes through the prostate, the gland itself does not add much, if anything, to the volume of urine that reaches the bladder. As the urethra passes through the prostate, it is lined by transitional cells comprising the urothelium. Therefore, tilings that affect the urothelium can affect the prostate as well. This is very important when it comes to staging bladder cancer.

The urethra is a hollow tube lined with transitional cells at its beginning that connects the bladder to the outside world. The structure of the urethra is different in men and women. The urethra is short in women and is much longer in men due to the presence of the penis. The cells lining the

urethra change along its length. The inner cells, closest to the

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Actos Bladder Cancer 12/20/2011: During phase 1 of a cancer trial, the safety of the chemotherapy dose is being determined. During the early part of the trial, a lower dose may be used. The dose is gradually increased to determine the potential for side effects. Individuals entering the trial later may receive higher doses, more potentially serious side effects, and not necessarily more effective therapy. During phase 2, it is determined how often a particular cancer will respond to the chemotherapy at a fixed dose regimen. Lastly, during phase 3, the new drug which appears to be effective is compared to the current accepted chemotherapy for a particular cancer.

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Our use of the terms Actos and Bladder, Actos Side Effects is not intended to imply or insinuate that there is any relationship or connection between Best Legal Source and the maker of Actos. “Actos” is a trademark of its manufacturer, Takeda Pharmaceutical Company Limited. Best Legal Source is not the maker of Actos nor do we have any connection with Takeda Pharmaceutical Company Limited.

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