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Background: Papillary renal neoplasm with reverse polarity (PRNRP) is a novel entity with unique clinicopathological characteristics, and only a small number of patients with PRNRP have been described. Methods: We retrospectively analyzed the data for nine patients with PRNRP and evaluated differences in the clinical, histomorphological, immunohistochemical, and molecular features; prognosis; and differential diagnosis of PRNRP from other renal tumors with papillary structure. Results: There were six males and three females aged 36 to 74 years (mean: 62.33 years; median: 68 years). All the tumors were solitary and ranged from 1 to 3.7 cm (mean: 2.17 cm; median: 2 cm), with three and six tumors arose in the left and right renal tract, respectively. Pathologically, PRNRP is a small, well-circumscribed neoplasm with predominant papillary formations. The lining epithelium is composed of a monolayer of cuboidal to low-columnar cells with low-grade nuclei arranged against the apical pole of the tumor cells. Edema, mucinous degeneration, and hyaline degeneration are found in the fibrovascular cores. Foamy macrophages, psammoma bodies, hemosiderin deposition, and infiltrative tumor boundaries were present in some patients. Immunohistochemically, all tumors showed diffuse positive staining for GATA3. Sanger sequencing confirmed the presence of KRAS mutation in seven patients. All patients had a good prognosis after surgery and were relapse free. Positive staining for GATA3 and negative staining for vimentin were the most significant markers for differentiating PRNRP from other renal tumors with analogous structure. Conclusions: These findings suggested that PRNRP is a distinctive subtype of renal tumor with specific pathological features and indolent behaviors that should be distinguished from other renal tumors, especially papillary renal cell carcinoma. A monolayer of tumor cells with an inverted nuclear pattern, positive staining for GATA3, and KRAS mutation are essential for pathological diagnosis. Owing to its satisfactory prognosis, the surveillance and follow-up of patients with PRNRP should be additionally formulated.
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Objective: Bacillus Calmette-Guérin (BCG) instillation is the standard adjuvant treatment for intermediate- and high-risk non-muscle-invasive bladder cancer after transurethral resection. Nevertheless, its toxicity often causes bladder complications. On follow-up cystoscopy, post-BCG bladder lesions can be pathologically benign, urothelial carcinoma recurrence, or other types of bladder malignancy. Only a small number of case reports have been published on post-BCG bladder lesions. Their clinical features, natural course, and management remain unknown. Methods: We retrospectively studied cystoscopic videos and medical records of BCG-treated bladder cancer patients at our center. During a long-term follow-up, we took biopsies on tumor-like lesions and described their changes. In addition, we summarized previous studies on post-BCG bladder lesions by systematic literature searching and review. Results: We described a series of three cases with post-BCG bladder lesions mimicking tumor recurrence from a total of 38 cases with follow-up data for more than 5 years. Those lesions could last, grow, or disappear spontaneously, and remain pathological benign for years. In systematic review, we identified and analyzed a total of 15 cases with post-BCG bladder lesions with detailed clinical information. Eleven of the 15 were benign and have a good prognosis with nephrogenic adenoma being the most common pathological type. Conclusion: Based on previous studies and our experience, benign lesions after BCG instillation cannot distinguish with cancer recurrence by cystoscopy alone, even under narrow band imaging mode. Nonetheless, given most of them have a good prognosis, random biopsy or transurethral resection might be spared in the patients with long-term negative biopsy and urine cytology.
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Purpose: Photothermal therapy (PTT) is a promising anticancer treatment that involves inducing thermal ablation and enhancing antitumor immune responses. However, it is difficult to completely eradicate tumor foci through thermal ablation alone. Additionally, the PTT elicited antitumor immune responses are often insufficient to prevent tumor recurrence or metastasis, due to the presence of an immunosuppressive microenvironment. Therefore, combining photothermal and immunotherapy is believed to be a more effective treatment approach as it can modulate the immune microenvironment and amplify the post-ablation immune response. Methods: Herein, the indoleamine 2, 3-dioxygenase-1 inhibitors (1-MT) loaded copper (I) phosphide nanocomposites (Cu3P/1-MT NPs) are prepared for PTT and immunotherapy. The thermal variations of the Cu3P/1-MT NPs solution under different conditions were measured. The cellular cytotoxicity and immunogenic cell death (ICD) induction efficiency of Cu3P/1-MT NPs were analyzed by cell counting kit-8 assay and flow cytometry in 4T1 cells. And the immune response and antitumor therapeutic efficacy of Cu3P/1-MT NPs were evaluated in 4T1-tumor bearing mice. Results: Even at low energy of laser irradiation, Cu3P/1-MT NPs remarkably enhanced PTT efficacy and induced immunogenic tumor cell death. Particularly, the tumor-associated antigens (TAAs) could help promote the maturation of dendritic cells (DCs) and antigen presentation, which further activates infiltration of CD8+ T cells through synergistically inhibiting the indoleamine 2, 3-dioxygenase-1. Additionally, Cu3P/1-MT NPs decreased the suppressive immune cells such as regulatory T cells (Tregs) and M2 macrophages, indicating an immune suppression modulation effect. Conclusion: Cu3P/1-MT nanocomposites with excellent photothermal conversion efficiency and immunomodulatory properties were prepared. In addition to enhanced the PTT efficacy and induced immunogenic tumor cell death, it also modulated the immunosuppressive microenvironment. Thereby, this study is expected to offer a practical and convenient approach to amplify the antitumor therapeutic efficiency with photothermal-immunotherapy.
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Cobre , Dioxigenasas , Animales , Ratones , Cobre/farmacología , Linfocitos T CD8-positivos , Inmunoterapia , InmunomodulaciónRESUMEN
Synergistic photothermal immunotherapy has captured great attention owing to the mutually strengthening therapeutic outcomes towards both original tumors and abscopal tumors. Herein, a versatile theranostic agent displaying aggregation-induced emission, namely TPA-BT-DPTQ, was designed and prepared based on benzo[c]thiophene unit as a building block; it can be used for simultaneous fluorescence imaging (FLI) in the second near-infrared (NIR-II) window, photoacoustic imaging (PAI), photothermal imaging (PTI), and thermal eradication of tumors. Further experiments validate that photothermal therapy (PTT) mediated by TPA-BT-DPTQ nanoparticles not only destroys the primary tumor but also enhances immunogenicity for further suppressing the growth of tumors at distant sites. Furthermore, PTT combining a programmed death-ligand 1 (PD-L1) antibody prevents the metastasis and recurrence of cancer by potentiating the effect of immunotherapy.
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Nanopartículas , Neoplasias , Técnicas Fotoacústicas , Línea Celular Tumoral , Humanos , Inmunoterapia , Imagen Multimodal , Nanopartículas/uso terapéutico , Neoplasias/diagnóstico por imagen , Neoplasias/patología , Neoplasias/terapia , Técnicas Fotoacústicas/métodos , Fototerapia/métodos , Nanomedicina Teranóstica/métodosRESUMEN
PURPOSE: The citation count of a scientific article is considered as the recognition it received from this field. The purpose of this bibliometric analysis was to identify the top 100 most-cited scientific articles in penile surgical reconstruction. METHODS: The Web of Science database was used to extract the top 100 most-cited articles. Individual articles were reviewed to identify the authorship, published journal, journal impact factor (IF), primary disease, article type, institution and country of origin, and year of publication. RESULTS: The top 100 most-cited articles were published between 1947 and 2013. The number of citations ranged from 23 to 233. Journal of Urology contributed the most articles (n = 36). Articles with a high level of evidence like prospective analysis (n = 5), systematic review and meta-analysis (n = 2), and guideline (n = 1) were all published after 2000. The average citation per year of articles published in high-IF journals was significantly higher than that of other articles (p = 0.0129). There was a positive linear correlation between citation count per year and publication year (r2 = 0.26, p < 0.001). Among the top 100 articles, 74 articles were interlinked via citation of each other. The major topic of co-citation network was the application of flaps in penile reconstruction. CONCLUSIONS: The analysis of top 100 most-cited articles facilitates the comprehensive recognition of current focus in the field of penile surgical reconstruction, which is the exploration of flaps and development of new techniques in penile reconstruction. In the future, more attention should be paid to evidence-based medicine to provide high-level evidence for research. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Bibliometría , Medicina Basada en la Evidencia , Pene/cirugía , Humanos , Masculino , Procedimientos de Cirugía PlásticaRESUMEN
BACKGROUND: An efficient, fast and sensitive ultra high-performance liquid chromatography-mass spectrometry (UPLC-MS/MS) method for simultaneous determination of celecoxib (CEL), dezocine (DEZ) and dexmedetomidine (DEX) in beagle plasma were established. METHODS: The beagle dogs plasmawas precipitated by acetonitrile. The column was Acquity UPLC BEH C18 column and the mobile phase was acetonitrile-formic acid with gradient mode, and the flow rate was set at 0.4 mL/min. Under the positive ion mode, CEL, DEZ, DEX and Midazolam (internal standard, IS) were monitored by multiple reaction monitoring (MRM) as the following mass transition pairs: m/z 381.10â282.10 for CEL, m/z 246.20â147.00 for DEZ, m/z 201.10â94.90 for DEX, and m/z 326.10â291.10 for IS. RESULTS: This UPLC-MS/MS method had good linearity for CEL, DEZ and DEX. The RSDs of inter-day and intra-day precision were the values of 0.31-7.66% and 0.11-9.63%, respectively; the RE values were from -6.05% to 10.98%. The extraction recovery was more than 79%, and the matrix effect was around 100%. The RSDs of stability were less than 8.96%. All of them met the acceptance standard of biological analysis method recommended by FDA. CONCLUSION: This UPLC-MS/MS method is an effective tool for the simultaneous determination of CEL, DEX and DEX, and has been successfully applied to the study of pharmacokinetics in beagle dogs.
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Compuestos Bicíclicos Heterocíclicos con Puentes/farmacocinética , Celecoxib/farmacocinética , Cromatografía Líquida de Alta Presión/métodos , Dexmedetomidina/farmacocinética , Espectrometría de Masas en Tándem/métodos , Tetrahidronaftalenos/farmacocinética , Analgésicos/administración & dosificación , Analgésicos/farmacocinética , Animales , Compuestos Bicíclicos Heterocíclicos con Puentes/administración & dosificación , Celecoxib/administración & dosificación , Dexmedetomidina/administración & dosificación , Perros , Quimioterapia Combinada , Reproducibilidad de los Resultados , Tetrahidronaftalenos/administración & dosificaciónRESUMEN
Objective: To evaluate the learning curve in an untrained resident surgeon for the initial case series of tension-free vaginal tape-obturator (TVT-O) to treat stress urinary incontinence. Materials and Methods: A retrospective observational study was conducted in Changhai Hospital, Shanghai, China, between March 2014 and June 2018. All consecutive women included were treated by the TVT-O procedure performed by one surgeon working under the supervision of an expert surgeon. Clinical features, estimated blood loss, operative time, postoperative hospital stay, total hospital stay, adverse events, and subjective and objective cure rates were recorded. Learning curve patterns were estimated to determine the number of cases to reach a plateau using the moving average method. Results: In total, 188 patients were included for analysis. Patients ranged from 39 to 91 years, with the average age of 57.5 ± 9.7 years. The mean operative time was 32.0 minutes (range 20-60). Operative time and blood loss decreased with increase in the level of expertise, whereas postoperative hospital stay and total hospital stay were not influenced by the number of procedures performed. The number of cases required to reach a plateau was â¼30. Objective cure rate and subjective cure rate were achieved in 88.7% and 88.2% at 12 months, respectively. Groin pain was the most common postoperation complication, which continued to be present in 11.7% patients at 12 months after surgery. Conclusions: The TVT-O procedure showed encouraging objective and subjective outcomes and low complication rates, even at the initial stage of the learning curve. Thirty cases were required for a naïve resident surgeon to learn TVT-O procedures. However, long-term outcome and complications caused by the synthetic sling still need further follow-up.
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Curva de Aprendizaje , Cabestrillo Suburetral , Incontinencia Urinaria de Esfuerzo/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adulto , Anciano , Anciano de 80 o más Años , China , Femenino , Humanos , Tiempo de Internación , Persona de Mediana Edad , Tempo Operativo , Periodo Posoperatorio , Estudios Prospectivos , Estudios Retrospectivos , Cirujanos , Resultado del TratamientoRESUMEN
The prognosis of bladder urothelial carcinoma (BLCA) varies greatly even for patients with similar pathological characteristics. We conducted transcriptome sequencing on ten pairs of BLCA samples and adjacent normal tissues to identify differentially expressed genes. Anillin (ANLN) was identified as a transcript that was significantly up-regulated in BLCA samples compared with normal tissues. Prognostic power of candidate gene was studied using qRT-PCR and immunohistochemistry on 40 and 209 patients, respectively. Patients with elevated ANLN expression level was correlated with poorer cancer-specific (median, 22.4 vs. 37.3 months, p = 0.001), progression-free (median, 19.7 vs. 27.9 months, p = 0.001) and recurrence-free survival (median, 17.1 vs. 25.2 months, p = 0.011) compared with low ANLN expression. Public datasets TCGA and NCBI-GEO were analyzed for external validation. Knockdown of ANLN in J82 and 5637 cells using small interfering RNA significantly inhibited cell proliferation, migration, and invasion ability. Moreover, knockdown of ANLN resulted in G2/M phase arrest and decreased expression of cyclin B1 and D1. Microarray analysis suggested that ANLN played a major role in cell migration and was closely associated with several cancer-related signaling pathways. In conclusion, ANLN was identified as a promising prognostic biomarker which could be used to stratify different risks of BLCA.
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Biomarcadores de Tumor/genética , Carcinoma in Situ/diagnóstico , Regulación Neoplásica de la Expresión Génica , Proteínas de Microfilamentos/genética , Recurrencia Local de Neoplasia/diagnóstico , Transcriptoma , Neoplasias de la Vejiga Urinaria/diagnóstico , Animales , Biomarcadores de Tumor/metabolismo , Carcinoma in Situ/genética , Carcinoma in Situ/mortalidad , Carcinoma in Situ/patología , Línea Celular Tumoral , Movimiento Celular , Proliferación Celular , Ciclina B1/genética , Ciclina B1/metabolismo , Ciclina D1/genética , Ciclina D1/metabolismo , Conjuntos de Datos como Asunto , Puntos de Control de la Fase G2 del Ciclo Celular , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Ratones , Análisis por Micromatrices , Proteínas de Microfilamentos/antagonistas & inhibidores , Proteínas de Microfilamentos/metabolismo , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Pronóstico , ARN Interferente Pequeño/genética , ARN Interferente Pequeño/metabolismo , Transducción de Señal , Análisis de Supervivencia , Neoplasias de la Vejiga Urinaria/genética , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/patología , Ensayos Antitumor por Modelo de XenoinjertoRESUMEN
Bladder cancer (BC) is the second most prevalent malignancy in the urinary system and is associated with significant mortality; thus, there is an urgent need for novel noninvasive diagnostic biomarkers. A urinary pseudotargeted method based on gas chromatography-mass spectrometry was developed and validated for a BC metabolomics study. The method exhibited good repeatability, intraday and interday precision, linearity and metabolome coverage. A total of 76 differential metabolites were defined in the discovery sample set, 58 of which were verified using an independent validation urine set. The verified differential metabolites revealed that energy metabolism, anabolic metabolism and cell redox states were disordered in BC. Based on a binary logistic regression analysis, a four-biomarker panel was defined for the diagnosis of BC. The area under the receiving operator characteristic curve was 0.885 with 88.0% sensitivity and 85.7% specificity in the discovery set and 0.804 with 78.0% sensitivity and 70.3% specificity in the validation set. The combinatorial biomarker panel was also useful for the early diagnosis of BC. This approach can be used to discriminate non-muscle invasive and low-grade BCs from healthy controls with satisfactory sensitivity and specificity. The results show that the developed urinary metabolomics method can be employed to effectively screen noninvasive biomarkers.
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Biomarcadores de Tumor/orina , Carcinoma de Células Transicionales/diagnóstico , Metabolómica/métodos , Neoplasias de la Vejiga Urinaria/diagnóstico , Adulto , Anciano , Área Bajo la Curva , Carcinoma de Células Transicionales/orina , Femenino , Cromatografía de Gases y Espectrometría de Masas/métodos , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Neoplasias de la Vejiga Urinaria/orinaRESUMEN
Rs1495741 has been identified to infer N-acetyltransferase 2 (NAT2) acetylator phenotype, and to decrease the risk of bladder cancer. However, a number of studies conducted in various regions showed controversial results. To quantify the association between rs1495741 and the risk of bladder cancer and to estimate the interaction effect of this genetic variant with smoking, we performed a systematic literature review and meta-analysis involving 14,815 cases and 58,282 controls from 29 studies. Our results indicates rs1495741 significantly associated with bladder cancer risk (ORâ=â0.85, 95% CIâ=â0.82-0.89, test for heterogeneity Pâ=â0.36, Iâ=â7.0%). And we verified this association in populations from Europe, America, and Asia. Further, our stratified meta-analysis showed rs1495741's role is typically evident only in ever smokers, which suggests its interaction with smoking. This study may provide new insight into gene-environment study on bladder cancer.
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Arilamina N-Acetiltransferasa/genética , Predisposición Genética a la Enfermedad/epidemiología , Polimorfismo de Nucleótido Simple/genética , Fumar/epidemiología , Neoplasias de la Vejiga Urinaria/genética , Femenino , Genotipo , Humanos , Masculino , Fenotipo , Prevalencia , Pronóstico , Medición de Riesgo , Fumar/efectos adversos , Neoplasias de la Vejiga Urinaria/epidemiología , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
Bladder cancer (BC) is a fatal malignancy with considerable mortality. BC urinary metabolomics has been extensively investigated for biomarker discovery, but few BC blood metabolomic studies have been performed. Hence, a plasma pseudotargeted metabolomic method based on gas chromatography-mass spectrometry with selected ion monitoring (GC-MS-SIM) was developed to study metabolic alterations in BC. The analytical performance of the developed method was compared with that of a nontargeted method. The relative standard deviation (RSD) values of 89 and 70.7 % of the peaks obtained using the pseudotargeted and nontargeted methods, respectively, were less than 20 %. The Pearson correlations of 90.7 and 78.3 % of the peaks obtained using the pseudotargeted and nontargeted methods, respectively, exceeded 0.90 in the linearity evaluation. Compared with the nontargeted method, the signal-to-noise ratios (S/N) of 97.9 and 69.3 % of the peaks increased two- and fivefold, respectively. The developed method was fully validated, with good precision, recovery, and stability of the trimethylsilyl (TMS) derivatives. The method was applied to investigate BC. Significant increases in the contents of metabolites involved in, for example, the pentose phosphate pathway (PPP) and nucleotide and fatty acid synthesis were found in the high-grade (HG) BC group compared to the healthy control (HC) group. These differences imply that the activated PPP may regulate BC cell proliferation by promoting lipid and nucleotide biosynthesis and the detoxification of reactive oxygen species (ROS). These results illustrate that the plasma pseudotargeted method is a powerful tool for metabolic profiling. Graphical abstract The plasma pseudotargeted metabolic profiling suggested the metabolic alterations in bladder cancer (BC) and the significantly differential metabolites for BC discrimination.
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Cromatografía de Gases y Espectrometría de Masas/métodos , Metaboloma , Metabolómica/métodos , Neoplasias de la Vejiga Urinaria/sangre , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Neoplasias de la Vejiga Urinaria/metabolismoRESUMEN
As there are millions of cancer deaths every year, it is of great value to identify applicable prognostic biomarkers. As an important alarm, the prognostic role of high mobility group box 1 (HMGB1) in cancer remains controversial. We aim to assess the association of HMGB1 expression with prognosis in cancer patients. Systematic literature searches of PubMed, Embase and Web of Science databases were performed for eligible studies of HMGB1 as prognostic factor in cancer. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to evaluate the influence of HMGB1 expression on overall survival (OS) and progression-free survival (PFS) in cancer patients. 18 studies involving 11 different tumor types were included in meta-analysis. HMGB1 overexpression was significantly associated with poorer OS (HR: 1.99; 95% CI, 1.71-2.31) and PFS (HR: 2.26; 95% CI, 1.65-3.10) irrespective of cancer types including gastric cancer, colorectal cancer, hepatocellular carcinoma, pancreatic cancer, nasopharyngeal carcinoma, head and neck squamous-cell carcinoma, esophageal cancer, malignant pleural mesothelioma, bladder cancer, prostate cancer, and cervical carcinoma. Subgroup analyses indicated geographical area and size of studies did not affect the prognostic effects of HMGB1 for OS. Morever, HMGB1 overexpression had a consistent correlation with poorer OS when detected by immunohistochemistry in tissues and enzyme-linked immunosorbent assay in serum, whereas the correlation did not exist by quantitative real-time reverse-transcription polymerase chain reaction in tissues. HMGB1 overexpression is associated with poorer prognosis in patients with various types of cancer, suggesting that it is a prognostic factor and potential biomarker for survival in cancer.
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Regulación Neoplásica de la Expresión Génica , Proteína HMGB1/metabolismo , Neoplasias/metabolismo , Neoplasias/mortalidad , Biomarcadores de Tumor/metabolismo , Supervivencia sin Enfermedad , Geografía , Humanos , Pronóstico , Modelos de Riesgos Proporcionales , Resultado del TratamientoRESUMEN
Whether low-dose Bacillus Calmette-Guerin (BCG) treatment can reduce the side effects while maintaining efficacy for patients with nonmuscle invasive bladder cancer (NMIBC) is controversial.To investigate whether low-dose BCG treatment can reduce the side effects while maintaining efficacy for patients with NMIBC when compared with standard-dose BCG treatment.A comprehensive literature search of PubMed, EMBASE, CINAHL, LILACS, and CENTRAL databases was conducted to identify relevant randomized controlled trials (RCT) or quasi-randomized controlled trials (qRCT) that have assessed the efficacy of low- and standard-dose BCG therapy for patients with NMIBC. Systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis Criteria.Six RCTs and 2 qRCTs were eligible for meta-analysis. Low-dose BCG instillation was not inferior to reduce the risk of bladder tumor recurrence (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.00-1.31; Pâ=â0.05), meanwhile no difference was found regarding tumor progression (HRâ=â1.08; 95%CI, 0.83-1.42; Pâ=â0.57). However, low-dose BCG provided a significantly lower incidence of overall side effects (RRâ=â0.75; 95%CI, 0.60-0.94; Pâ=â0.01), systemic side effects (RRâ=â0.57; 95%CI, 0.34-0.97; Pâ=â0.04), severe side effects (RRâ=â0.52; 95%CI, 0.36-0.74; Pâ=â0.0003), and withdrawal due to BCG toxicity (RRâ=â0.49; 95%CI, 0.26-0.91; Pâ=â0.02). In contrast, local side effects were comparable between low- and standard-dose arms (RRâ=â0.89; 95%CI, 0.73-1.08; Pâ=â0.24).Low-dose BCG instillation significantly reduces the incidence of overall side effects, especially severe and systemic symptoms in patients with NMIBC, while the oncological control efficacy of low-dose BCG is not inferior to standard-dose BCG. Further studies with stratification using different risk factors at randomization are required to assess whether the efficacy of low-dose BCG is comparable to standard dose BCG for different risk of patients.PROSPERO registration No CRD42014014871 (http://www.crd.york.ac.uk/prospero/).
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Adyuvantes Inmunológicos/uso terapéutico , Vacuna BCG/uso terapéutico , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Adyuvantes Inmunológicos/administración & dosificación , Adyuvantes Inmunológicos/efectos adversos , Vacuna BCG/administración & dosificación , Vacuna BCG/efectos adversos , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Humanos , Recurrencia Local de Neoplasia , Modelos de Riesgos Proporcionales , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
INTRODUCTION: Transient elastography has good diagnostic accuracy for predicting fibrosis and cirrhosis related to hepatitis B virus. However, the enrolled subjects in some studies have also included chronic hepatitis B patients with chronic hepatitis C coinfection or other etiologies of liver diseases. This might under- or overestimate the role of transient elastography in chronic hepatitis B patients. METHODS: A systematic review was conducted on records in PubMed, EMBASE and the Cochrane Library electronic databases until 31 December 2013. We systematically assessed the effectiveness and accuracy of transient elastography for predicting the fibrosis and cirrhosis of the single hepatitis B virus. The questionnaire for quality assessment of diagnostic accuracy studies was used. RESULTS: In this meta-analysis, out of 257 articles evaluated for eligibility, 165 satisfied the predetermined inclusion criteria for meta-analysis. Eventually, our final data set for the meta-analysis contained 19 studies. The areas under the summary receiver-operating characteristic curve for transient elastography of significant fibrosis and cirrhosis were 0.8225 and 0.9108, respectively. The pooled diagnostic odds ratios for transient elastography of significant fibrosis and cirrhosis were 11.19 (95 % CI 6.63-18.89) and 26.87 (95 % CI 17.88-40.38), respectively. In Europe, the areas of significant fibrosis and cirrhosis were 0.803 and 0.905; those in Asia were 0.871 and 0.914, respectively. CONCLUSIONS: Based on this meta-analysis we claim that liver stiffness measurement using transient elastography has good diagnostic accuracy for predicting single hepatitis B virus-related significant fibrosis and cirrhosis, especially in Asian populations.
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Diagnóstico por Imagen de Elasticidad/métodos , Hepatitis B Crónica/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Hígado/diagnóstico por imagen , Humanos , Cirrosis Hepática/etiología , Curva ROC , Índice de Severidad de la EnfermedadRESUMEN
Most of recurrent bladder carcinoma after partial cystectomy did not cause diagnostic difficulties for urologists, because of the appearance of typical papillary in ultrasonography or cystoscopy, and could be easily confirmed by tumor biopsy. Three patients, ages from 35 to 62 years, had undergone bladder sparing treatment for muscle invasive bladder cancer, all of them had biopsy revealed benign bladder lesion at surveillance cystoscopy. However, transurethral resection of bladder tumor showed high-grade muscle invasive urothelial bladder carcinoma for these patients. Two patients were thus delayed for timely cystectomy and consequently resulted in local or distal metastasis.As a result, we recommended that timely pelvic enhanced computed tomography and transurethral resection of bladder tumor were necessary when bladder lesion occurred after partial cystectomy, avoiding the possibility of missing muscle invasive urothelial bladder carcinoma recurrence and delaying timely cystectomy.
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Carcinoma/patología , Carcinoma/cirugía , Cistectomía , Recurrencia Local de Neoplasia/cirugía , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugía , Adulto , Carcinoma/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Tratamientos Conservadores del Órgano , Neoplasias de la Vejiga Urinaria/mortalidad , UrotelioRESUMEN
BACKGROUND: To study whether extraperitoneal radical cystectomy (EORC) accelerates the postoperative recovery of bowel function compared with laparoscopic radical cystectomy (LRC). PATIENTS AND METHODS: All the patients with bladder cancer who underwent EORC or LRC with an ileal conduit by a single surgeon from January 2009 to June 2014 were investigated. The perioperative outcomes and follow-up data were analyzed, with a focus on postoperative ileus (POI). RESULTS: A total of 41 LRCs and 53 EORCs met the inclusion criteria. LRC was associated with a significant reduction in the estimated blood loss (278 vs. 356 mL, P = .017) and a shorter hospital stay (8.1 vs. 9.2 days, P = .003). However, LRC was also associated with longer operative times (349 vs. 316 minutes, P = .022). The incidence of paralytic POI was 7.3% (3 of 41) and 7.5% (4 of 53; P = .966) and the obstructive POI rate was 4.9% (2 of 41) and 3.8% (2 of 53; P = .792) for the LRC and EORC groups, respectively. No significant differences were noted in blood transfusion requirements, interval to flatus or liquid intake, or opioid dosage. No patient in either group had positive surgical margins, and no significant differences were observed in the lymph node count (P = .112). At a median follow-up period of 28.7 months (range, 3-62 months), no significant differences were seen between the LRC and EORC groups in the 3-year overall, cancer-specific, or cancer-free survival rates. CONCLUSION: EORC resulted in a POI rate similar to that of LRC, despite factors favoring LRC. Our results suggest that extraperitoneal LRC could improve the perioperative outcomes.
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Cistectomía/métodos , Ileus/clasificación , Ileus/epidemiología , Laparoscopía/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Cistectomía/efectos adversos , Femenino , Humanos , Ileus/etiología , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/fisiopatología , Derivación UrinariaRESUMEN
OBJECTIVE: The prognostic role of human epidermal growth factor receptor 2 (HER2) in bladder cancer (BCa) remains controversial. Thus, we conducted a meta-analysis to assess the prognostic significance of HER2 for patients with BCa. MATERIALS AND METHODS: Systematically computerised searching in PubMed, Scopus database, Embase and Cochrane Library Database was conducted. Published studies comparing the prognosis in patients with BCa stratified by HER2 status were included, and relationships between HER2 positivity and gender, stage, grade, lymph node metastasis and survival were analysed. RESULTS: Nine studies with 2,242 eligible patients were identified. HER2 expression was significantly correlated with poor disease-specific survival [pooled hazard ratio (HR) 2.00; 95% confidence interval (CI) 1.22-3.29; P=0.006] and disease-free survival (pooled HR 1.68; 95% CI 1.33-2.14; P<0.0001) of patients with BCa. The positive rates of HER2 ranged from 27.8 to 85.2% with a pooled positive rate of 41.2% (1,006/2,442). HER2 expression was significantly associated with tumour grade [high grade vs. low grade: odds ratio (OR) 4.08; 95% CI 1.29-12.93] and lymph node metastasis (positive vs. negative: OR 1.71; 95% CI 1.07-2.75). CONCLUSIONS: This meta-analysis indicated that HER2 expression is associated with poor prognosis. Thus, HER2 could serve as a useful biomarker for clinical prediction.
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Carcinoma/química , Carcinoma/patología , Receptor ErbB-2/análisis , Neoplasias de la Vejiga Urinaria/química , Neoplasias de la Vejiga Urinaria/patología , Carcinoma/secundario , Supervivencia sin Enfermedad , Humanos , Metástasis Linfática , Clasificación del Tumor , Tasa de SupervivenciaRESUMEN
BACKGROUND AND PURPOSE: The optimal treatment of patients with lower pole renal stones continues to be a dilemma for urologists. Retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and extracorporeal shockwave lithotripsy (SWL) all constitute viable therapeutic options in selected patients. The aim of this study was to assess the efficacy and safety of RIRS, PCNL, and SWL in management of lower pole renal stones. METHODS: A literature search was performed in July 2014 using PubMed, Embase, and Web of Science databases. Literature reviewed included meta-analysis and randomized and nonrandomized controlled studies to identify relevant studies for the meta-analysis. RESULTS: Six randomized and eight nonrandomized studies were identified for analysis. PCNL provided a significantly higher stone-free rate (SFR) compared with RIRS and SWL. Furthermore, no statistical significant difference was found when PCNL was compared with RIRS and SWL for complication rate. Compared with the other two treatments, RIRS had a longer operative time and PCNL had a longer hospital stay. SWL was associated with significantly higher re-treatment rate compared with RIRS and PCNL, whereas there were no significant differences in auxiliary procedure rates among the three treatment techniques. CONCLUSION: RIRS offers a relative higher SFR while it has a longer operative time. PCNL is associated with the highest SFR at the expense of the longest hospital stay. SWL is performed as an outpatient procedure with a relative shorter operative time; however, it has lower a SFR and higher re-treatment rate. The categories of complications vary while the overall complication rates are comparable among the three treatment techniques.
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Cálculos Renales/terapia , Litotricia/métodos , Nefrostomía Percutánea/métodos , Ensayos Clínicos como Asunto , Humanos , Tempo Operativo , Selección de Paciente , Retratamiento/estadística & datos numéricos , Seguridad , Resultado del TratamientoRESUMEN
INTRODUCTION: In order to anatomically reconstruct ureteral stenosis, we present a novel technique for laparoscopic ureteral reimplantation. PATIENTS AND METHODS: Three young females, who were diagnosed with hydroureteronephrosis caused by congenital vesicoureteral junction obstruction, were treated by laparoscopic ureteral reimplantation with a tunnel underneath the broad ligament. RESULTS: Surgery was performed successfully without conversion to open surgery. No major intra- or postoperative complications occurred. Postoperative follow-up was 38, 33 and 26 months, respectively. The operative time was between 220 and 260 min. The mean estimated blood loss was less than 20 ml. Subsequent imaging performed 3 months after surgery revealed relief of hydroureteronephrosis for all patients. The patients all gave birth to healthy neonates and showed normal urinary tract sonogram and urine analysis during the gestation period. CONCLUSION: Laparoscopic ureteral reimplantation with broad ligament tunnel is safe and effective, allowing for anatomical reconstruction of ureter defects. However, a larger clinical sample and longer follow-up period will be needed.
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Laparoscopía , Ligamentos/cirugía , Reimplantación , Uréter/cirugía , Obstrucción Ureteral/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adulto , Pérdida de Sangre Quirúrgica , Femenino , Humanos , Laparoscopía/efectos adversos , Nacimiento Vivo , Tempo Operativo , Embarazo , Reimplantación/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Uréter/anomalías , Obstrucción Ureteral/congénito , Obstrucción Ureteral/diagnóstico , Procedimientos Quirúrgicos Urológicos/efectos adversos , Adulto JovenRESUMEN
PURPOSE: To explore the morbidity, mortality and oncological results of laparoscopic radical cystectomy (LRC) in the elderly patients over 75-year-old in contrast with open radical cystectomy (ORC). MATERIALS AND METHODS: We analyzed 46 radical cystectomies from January 2009 to December 2013 in patients over 75-year-old in our institute, 21 patients in the LRC group and 25 in the ORC group. Demographic parameters, operative variables and perioperative outcome were retrospectively collected and analyzed between the two groups. Perioperative morbidity and mortality were categorized as early (within 90 days after surgery) or late (more than 90 days) according to the time of occurrence. RESULTS: Patients in both groups had comparable preoperative characteristics. A significant longer operative time (418 vs. 337 min, p = 0.018) and less estimated blood loss (400 vs. 500 ml p = 0.038) were observed in LRC group compared with ORC group. Infection and ileus were the most common early complications after surgery. Patients underwent ORC suffered from significantly more postoperative ileus (28.0% vs. 4.8%, P = 0.038) and infection (40% vs. 9.5%, P = 0.019) than LRC group within 90 days after surgery. The mortality rate was 4.7% (1/21) and 4% (1/25) for LRC group and ORC group respectively. At a median follow-up of 21 months (range 2-61 months), the Kaplan-Meier survival curves and log-rank analysis demonstrate that there were no significant differences between the LRC and ORC groups in the 3-year overall, cancer-specific, or recurrence-free survival rates. CONCLUSIONS: It is suggested that LRC should be recommended as the primary intervention to treat muscle invasive or high risk non-muscle invasive bladder cancer in elderly patients with a relative long life expectancy.