Percutaneous mechanical thrombectomy using the Rotarex®S device for the treatment of acute lower limb artery embolism: A retrospective single-center, single-arm study.

Objective: Acute limb embolism (ALE) is a challenging, highly morbid, and frequently fatal vascular emergency. Percutaneous mechanical thrombectomy (PMT) devices are an alternative treatment to restore perfusion by removing emboli in the limb arterial system. We evaluated the outcomes of treatment of ALE patients using PMT devices in our center. Methods: A retrospective review of ALE patients treated with Rotarex S (Straub Medical) at a single institution from 2018 to 2022 was performed. The primary outcome was technical success, defined as complete recanalization of the occluded segment with satisfactory outflow and good capillary filling of the distal parts of the foot without any major or obstructing residual emboli or thrombi either in the treated segment or in the outflow tract without the need for additional catheter-directed thrombolysis (CDT) or conversion to open surgery. Embolized segments treated, treatment outcomes, and perioperative complications were reviewed. Results: A total of 17 ALE patients (29% men, 71% women; mean age, 73 years) underwent PMT procedures. The femoral arteries and popliteal arteries are the most commonly treated vessels, with both present in 59% of the patients. The technical success rate was 100%, but the majority of cases (82%) had concurrent percutaneous transluminal angioplasty or stent grafting, and two patients were treated with urokinase during the operation. There was one thrombotic recurrence that required amputation. There were no 30-day deaths. Complications included extravasation after PMT (two), intraoperative embolization of the outflow tract (one), access site hematoma (one), target artery thrombosis (one), and acute kidney injury (one). There were no severe bleeding complications. Conclusions: The Rotarex S device has a satisfactory success rate, although complementary use of various adjunctive techniques is frequently required. It seems to be a moderately effective tool for treating ALE to avoid CDT or open surgery. The device appears safe, with low risks of amputation and mortality rates, but special attention should be given to the potential for extravasation and distal embolism.

Predictive value of gene methylation for second recurrence following surgical treatment of first bladder recurrence of a primary upper-tract urothelial carcinoma.

The clinical relevance of aberrant DNA promoter methylation is being increasingly recognized in urothelial carcinoma. The present study was conducted to explore the methylation status of patients with upper-tract urothelial carcinoma (UTUC) who experienced bladder recurrence, and to evaluate the predictive value of gene methylation for second bladder recurrence and tumor progression. A total of 85 patients with primary UTUC, who experienced bladder recurrence after radical nephroureterectomy, were enrolled between January 2001 and December 2013. Using methylation-sensitive polymerase chain reaction, the promoter methylation statuses of 10 genes were analyzed in the bladder tumor specimens. Among the patient group, 32 patients experienced second bladder recurrence, and bladder progression was detected in 16. With the exception of BRCA1, the methylation rate of the majority of genes tended to gradually increase to varying extents with the number of recurrences; a smaller proportion of primary tumors exhibited gene methylation when compared with the first recurrent tumors and second recurrent tumors. Univariate and multivariate Cox regression analyses revealed that unmethylated GDF15 [hazard ratio (HR)=0.36; 95% confidence interval (CI), 0.14-0.92] and methylated VIM (HR=2.91; 95% CI, 1.11-7.61) in the first recurrent bladder tumor, as well as male gender (HR=2.28; 95% CI, 1.06-4.87), first recurrence interval <8 months (HR=2.34; 95% CI, 1.15-4.78) and primary UTUC tumor size ≥5 cm (HR=3.48; 95% CI, 1.43-8.45) were independent risk factors for a second bladder recurrence after surgery for the first bladder recurrence; the Harrell's concordance index (c-index) for the related nomogram was 0.71 (95% CI: 0.61-0.81). Furthermore, methylated CDH1 (HR=2.91; 95% CI, 1.08-7.77) and VIM (HR=4.91; 95% CI, 1.11-21.7) in the first recurrent bladder tumor, male gender (HR=3.6; 95% CI, 1.1-11.73), and primary tumor stage T2-T4 (HR=4.57; 95% CI, 1.22-17.13), multifocality (HR=3.64; 95% CI, 1.19-11.16) and size ≥5 cm (HR=3.1; 95% CI, 1.91-10.54) for the primary UTUC were considered to be predictors of tumor progression; the c-index for the nomogram was 0.88 (95% CI, 0.69-0.92). The present findings demonstrated that promoter methylation of cancer-related genes was frequently observed in patients with urothelial carcinoma, and that the gene methylation rate of certain genes tended to gradually increase with the number of bladder recurrences. This may be used as a predictive factor for a second bladder recurrence and tumor progression after the surgical treatment of the first bladder recurrence.

Treatment strategies for upper tract urothelial carcinoma (UTUC) of a solitary kidney: a single-institutional analysis of 61 cases.

OBJECTIVE: To explore the treatment strategies for patients with upper tract urothelial carcinoma (UTUC) of a solitary kidney. METHODS: A retrospective analysis of 61 cases who underwent operation for UTUC of a solitary kidney from 2000 to 2012 was performed. Radical nephroureterectomy (RNU) or conservative management was performed. Patients were divided into three groups according to preoperative renal function: group A (eGFR ≥ 60 mL/min), group B (15 mL/min ≤ eGFR < 60 mL/min) and group C (eGFR < 15 mL/min). We analyzed treatment outcomes of patients with different renal function and surgical approaches. RESULTS: No significant complications were observed, and short-time recovery after operation was satisfactory in all patients. The 5-year cancer-specific survival (CSS) rates for the groups A, B and C were 92.9, 75.3 and 63.7 %, respectively (p = 0.683). The 5-year overall survival (OS) and recurrence-free survival rates were 92.9 and 53 % for group A, respectively, 75.3 and 64.8 % for group B, respectively, and 63.7 and 29.5 % for group C, respectively (all p > 0.1). The conservative management arm was associated with older age (p = 0.002), smaller tumor size (p = 0.013), lack of renal replacement history (p = 0.007) and better preoperative renal function (p = 0.002). There were no significant differences in 5-year CSS, OS or recurrence-free survival between the RNU and conservative management groups. Long-term hemodialysis was required in only three patients in the conservative management arm. CONCLUSION: Long-term oncological outcomes after conservative management are comparable to RNU in selected cases, and conservative management should be considered an alternative treatment measure. Preoperative renal function and clinicopathological characteristics are important in surgery selection for patients with UTUC of a solitary kidney.

Prognostic Value of Gene Methylation and Clinical Factors in Non-Muscle-Invasive Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy.

INTRODUCTION: To systematically analyze the outcomes and prognostic value of gene methylation and clinical parameters in non-muscle-invasive upper tract urothelial carcinoma (NMIUTUC) after radical nephroureterectomy (RNU). PATIENTS AND METHODS: The methylation status of 10 selected genes and clinical parameters of 192 NMIUTUC patients who received RNU and postoperative intravesical mitomycin were assessed. Univariate and multivariate Cox regression models were performed to evaluate the prognostic factors of cancer-specific mortality and intravesical recurrence. RESULTS: For 192 NMIUTUC patients, 1-, 3-, and 5-year cancer-specific survival (CSS)/bladder recurrence-free survival (BRFS) rates were 98.4%/86.4%, 90.6%/74.6%, and 86.9%/62.4%, respectively. After the multivariate analysis, the methylation of ABCC6 (hazard ratio [HR], 3.46, P = .005), GDF15 (HR, 2.03, P = .002), multiple tumors (HR, 2.11, P = .049), impaired renal function (HR, 3.09, P = .004), and open RNU (HR, 2.14, P = .047) were independently associated with cancer-specific mortality, whereas the methylation of GDF15 (HR, 0.55, P = .022), RASSF1A (HR, 0.31, P = .006), multiple tumors (HR, 2.11, P = .002), and concomitant ipsilateral hydronephrosis (HR, 1.87, P = .022) were independently associated with intravesical recurrence after RNU. The c index of the multivariate model to predict cancer-specific mortality and intravesical recurrence was 0.81 and 0.78, respectively. CONCLUSION: As an early stage disease, NMIUTUC has better postoperative survival and later intravesical recurrence than upper tract urothelial carcinoma; however, the intravesical recurrence rate is not decreased. The nomogram can be used to accurately predict the oncologic outcomes of NMIUTUC patients and can be used to guide clinical decision making.

KCNJ1 inhibits tumor proliferation and metastasis and is a prognostic factor in clear cell renal cell carcinoma.

Potassium inwardly rectifying channel, subfamily J, member 1 (KCNJ1), as an ATP-dependent potassium channel, plays an essential role in potassium balance. KCNJ1 variation is associated with multiple diseases, such as antenatal Bartter syndrome and diabetes. However, the role of KCNJ1 in clear cell renal cell carcinoma (ccRCC) is still unknown. Here, we studied the expression and function of KCNJ1 in ccRCC. The expression of KCNJ1 was evaluated in ccRCC tissues and cell lines by quantitative real-time PCR (qRT-PCR), Western blot, and immunohistochemistry analysis. The relationship between KCNJ1 expression and clinicopathological characteristics was analyzed. p3xFLAG-CMV-14 vector containing KCNJ1 was constructed and used for transfecting ccRCC cell lines 786-O and Caki-2. The effects of KCNJ1 on cell proliferation, invasion, and apoptosis were detected in ccRCC cell lines using cell proliferation assay, transwell assay, and flow cytometry, respectively. We found that KCNJ1 was low-expressed in ccRCC tissues samples and cell lines, and its expression level was significantly associated with tumor pathology grade (P = 0.002) and clinical stage (P = 0.023). Furthermore, the KCNJ1 expression was a prognostic factor of ccRCC patient's survival (P = 0.033). The re-expression of KCNJ1 in 786-O and Caki-2 significantly inhibited cancer cell growth and invasion and promoted cancer cell apoptosis. Moreover, knockdown of KCNJ1 in HK-2 cells promoted cell proliferation. Collectively, these data highlight that KCNJ1, low-expressed in ccRCC and associated with poor prognosis, plays an important role in ccRCC cell growth and metastasis.