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The 2 patients were both aged females with medical history of diabetes mellitus. The chief complaints were both hyperpyrexia. Laboratory tests presented markedly elevated white blood cells and C-reactive protein, indicating severe systemic infections. Urine culture confirmed the growth of Escherichia coli. CT scan revealed thickened bladder wall with intraluminal and interstitial collections of gas. After the diagnosis of emphysema cystitis was established, conservative treatments including bladder drainage, strict glycemic control and sensitive antibiotics were administered timely. Both of the 2 patients got fully recovery after standard treatment.
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Objective:To explore the application and preliminary evaluation of multidisciplinary rounds (MDRs) in the clinical teaching of urology.Methods:A total of 20 pediatrics medical students in the clinical medicine were selected as the control group, and the traditional single department teaching rounds were used. Another 20 clinical medical students in the same grade were taken as the experimental group, and MDRs were used. The teaching officer of urology served as the general ward round teacher, combined with nephrology physicians and imaging ultrasound physicians to conduct bedside teaching rounds, and the length of the rounds was about 60 to 90 minutes. Through the teaching evaluation form and the test scores, the effect of teaching ward rounds was evaluated. SPSS 21.0 was used for statistical evaluation data, and the unpaired t-test was performed to make comparison between groups. Results:In terms of theoretical test, the average score of students in the experimental group was (92.15±0.60), which was higher than that in the control group (90.05±0.71), and the difference was statistically significant ( P=0.030). In the experimental group, 95.0%(19/20) of the medical students affirmed the MDRs model, and 100% of them thought it was necessary to introduce this model in clinical teaching. Conclusion:MDRs are patient-centered, emphasize interdisciplinary cooperation, and are operable, which deepens the understanding of medical students on urological diseases, promotes the exchange of clinical teaching experience between urology and interdisciplinary research, and improves the quality of teaching.
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Objective To investigate the clinical characteristics and prognosis in upper urinary tract urothelial carcinoma concomitant with squamous or glandular differentiation.Methods The medical records of 176 patients treated with radical nephroureterectomy from January 2001 to December 2014 were retrospectively reviewed.This total cohort included 118 men and 58 women.The median age was 70 years (range 37 to 92).Ninety-eight cases had tumors in the left side and the remaining 78 cases in the right side.All eligible patients were divided into two groups according to the presence of squamous or glandular differentiation.One hundred and fifty-nine cases were in group A,including 107 men and 52 women.The median age of this group was 70 years (range 37 to 92).Ninety-one cases had tumors in left side and the remaining 68 cases in right side.Seventeen cases were in group B,including 11 men and 6 women.The median age of this group was 69 years (range 44 to 90).Seven cases had tumors in left side and the remaining 10 cases in right side.There was no significant difference in two groups about sex,age,tumor location,tumor side and existence of hydronephrosis (all P ＞ 0.05).Thirty-two cases(20.1％)and 7 cases (41.2％) in group A and B had previous or synchronous non-muscle-invasive bladder cancer (P =0.047).Kaplan-Meier and Cox proportional hazard regression analysis were used to evaluate predictors of oncologic outcomes.Results Of the 176 patients,10 (5.7％) had squamous differentiation and 7 (4.0％) had glandular differentiation.Comparing with pure urothelial carcinoma,concomitant squamous or glandular differentiation were more likely to have advanced tumor stage [≥ pT2 in group B vs.group A:17 cases (100.0％) vs.114 cases (71.7％)] and high grade [12 cases (70.6％) vs.57 cases(35.8％)] (all P ＜0.05).Overall survival (OS) rates at 3 years and 5 years in group B were significantly lower than those in group A (57.8％ vs.78.9％ and 30.8％ vs.62.8％,respectively;P =0.005).Likewise,cancerspecific survival (CSS) rates at 3 year and 5 years in group B were significantly lower than those in group A (63.5％ vs.80.4％ and 33.9％ vs.66.5％,respectively;P =0.02).Multivariable analysis revealed that squamous or glandular differentiation was a significant risk factor for OS and CSS (P =0.003,P =0.021).However,it was not significantly associated with bladder-recurrence-free survival(P =0.097).Conclusions Comparing with pure upper urinary tract urothelial carcinoma,concomitant squamous or glandular differentiation could increase the risk of advanced tumor stage,high grade and previous or synchronous nonmuscle-invasive bladder cancer.It was also a significant risk factor for postoperative survival and could be valuable for guiding risk stratification after surgery.
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Objective To investigate the correlation of positive margins after radical prostatectomy with Gleason score of biopsy specimens and percentage of positive biopsy cores in prostate cancer.Methods One hundred and thirty patients with localized prostate cancer were confirmed by biopsy underwent radical prostatectomy,the relationship between positive margins rate and Gleason scores,percentage of positive biopsy cores were analyzed.Results One hundred and thirty cases of biopsy specimens,Gleason score 6 group 50 cases,positive margins rate was 10.00％ (5/50),Gleason score 7 group 65 cases,positive margins rate was 21.54％(14/65),Gleason score 8 group 13 cases,positive margins rate was 0,Gleason score 9 group 2 cases,positive margins rate was 0,the positive margins rate among the different Gleason score group had no significant difference (x2 =5.917 5,P ＞ 0.05).All the statistics of percentage of positive biopsy cores were 89 cases,1％-25％ group 30 cases,positive margins rate was 3.33％ (1/30),26％-50％ group 27 cases,positive margins rate was 11.11％ (3/27),51％-75％ group 18 cases,positive margins rate was 6/18,76％-100％ group 14 cases,positive margins rate was 4/14,the positive margins rate among different percentage of positive biopsy cores group had significant difference (x2 =9.861 8,P ＜ 0.05).Conclusion There is no correlation between Gleason score and positive margins in prostate cancer,but there is correlation between percentage of positive biopsy cores and positive margins.