Integrating single-cell RNA sequencing with spatial transcriptomics reveals immune landscape for interstitial cystitis.

Interstitial cystitis (IC) is a severely debilitating and chronic disorder with unclear etiology and pathophysiology, which makes the diagnosis difficult and treatment challenging. To investigate the role of immunity in IC bladders, we sequenced 135,091 CD45+ immune cells from 15 female patients with IC and 9 controls with stress urinary incontinence using single-cell RNA sequencing (scRNA-seq). 22 immune subpopulations were identified in the constructed landscape. Among them, M2-like macrophages, inflammatory CD14+ macrophages, and conventional dendritic cells had the most communications with other immune cells. Then, a significant increase of central memory CD4+ T cells, regulatory T cells, GZMK+CD8+ T cells, activated B cells, un-switched memory B cells, and neutrophils, and a significant decrease of CD8+ effector T cells, Th17 cells, follicular helper T cells, switched memory B cells, transitional B cells, and macrophages were noted in IC bladders. The enrichment analysis identified a virus-related response during the dynamic change of cell proportion, furthermore, the human polyomavirus-2 was detected with a positive rate of 95% in urine of patients with IC. By integrating the results of scRNA-seq with spatial transcriptomics, we found nearly all immune subpopulations were enriched in the urothelial region or located close to fibroblasts in IC bladders, but they were discovered around urothelium and smooth muscle cells in control bladders. These findings depict the immune landscape for IC and might provide valuable insights into the pathophysiology of IC.

[Risk Factors for Wound Healing of Infective Surgical Incision after Radical Cystectomy in Patients of Muscle Invasive Bladder Cancer].

OBJECTIVE: To evaluate the risk factors for wound healing of infective surgical incision in patients of muscle invasive bladder cancer undergoing radical cystectomy. METHODS: This study retrospectively collected clinical data of the patients who received radical cystectomy and experienced incisional infection after operation between January 2009 and December 2016. The patients were divided into early healing group and delayed healing group (the healing time is less or more than 14 d after operation). The risk factors for wound healing and infection were analyzed by single factor and multivariate logistic regression. RESULTS: A total of 171 patients with wound infection after radical cystectomy were included in the study. The average time of wound healing time was (17.9±16.9) d. There were 118 and 53 patients in early healing group and delay healing group respectively. Age, body mass index (BMI), operative incision type, preoperative albumin level, diabetes mellitus, infection wound size, infection wound with sinus, postoperative intestinal fistula and urinary fistula were statistically significant differences between the two groups (P<0.05).Univariate logistic regression analysis indicated that male, older than 65 yr., T4 stage, Type-Ⅲ surgical incision (infective incision), low preoperative albumin level (<30 g/L), hemoglobin level (<90 g/L), diabetes, wound size (>30 mm), intestinal fistula, urinary fistula were risk factors for delayed wound-healing. Multivariate logistic regression analysis revealed that Type-Ⅲ surgical incision and wound size (>30 mm) were independent risk factors for delayed wound healing. CONCLUSION: Type-Ⅲ surgical incision and the size of wound (>30 mm) are independent risk factors for delayed wound healing after radical cystectomy in bladder cancer patients.

Is there a relationship between phosphodiesterase type 5 inhibitors and biochemical recurrence after radical prostatectomy: a systematic review and meta-analysis.

PURPOSE: Conduct a systematic review and meta-analysis of studies to evaluate the association between the use of PDE5I and biochemical recurrence (BCR) after radical prostatectomy (RP). METHODS: We searched Embase (from 1996 to Feb 2018), PubMed (from 1996 to Feb 2018), and Cochrane library (from 1999 to Feb 2018), then manually searched the reference lists of key retrieved articles. Original studies that reported the risk of postoperative BCR for PDE5I users, as compared with non-PDE5I users, were included. Data including the characteristic of participants, the risk of BCR after RP and key criteria of study quality were collected. The pooled relative risks (RRs) were calculated with random-effects model. RESULTS: A total of 5 cohort studies and 1 case-control study were conducted for data analysis (a total of 17752 participants). Only 1 cohort study reported adjusted RR greater than 1 (range for all derived RRs, 0.7-1.47). The meta-analysis revealed that the PDE5I users had no higher risk of BCR after RP (RR = 1.04, 95% confidence interval [CI], 0.79-1.36). Sensitivity analysis showed that the remaining pooled RR and 95% CI were not changed significantly by omitting each study. In addition, the 5-year BCR rate had no significant difference between PDE5I users and non-PDE5I users. CONCLUSIONS: Our meta-analysis indicated that PDE5I treatment in men following RP did not increase the risk of BCR. The results preliminarily suggested that the use of PDE5I for erectile dysfunction after RP was oncologically safe. Nevertheless, more large sample cohort studies are needed to validate this conclusion.

Paraneoplastic Cerebellar Degeneration Associated with Pelvic Liposarcoma: A Rare Case Report.

Paraneoplastic cerebellar degeneration (PCD) is one of the most common paraneoplastic neurological syndromes characterized by the rapid development of severe cerebellar ataxia. In this report, a 23-year-old female with noticeable dizziness and gait instability was described. The enhanced CT scanning suggested the presence of a pelvic tumor. Then, PCD was established. Postoperative pathological result defined it as a liposarcoma (LS) with dedifferentiation. Interestingly, clinical symptoms disappeared after the surgical removal of the pelvic tumor. To our knowledge, this was the first case report with PCD due to LS.

A network meta-analysis on the beneficial effect of medical expulsive therapy after extracorporeal shock wave lithotripsy.

We applied a newly introduced method, network meta-analysis, to re-evaluate the expulsion effect of drugs including tamsulosin, doxazosin, nifedipine, terazosin and rowatinex after extracorporeal shock wave lithotripsy (ESWL) as described in the literature. A systematic search was performed in Medline, Embase and Cochrane Library for articles published before March 2016. Twenty-six studies with 2775 patients were included. The primary outcome was the number of patients with successful stone expulsion. The data were subdivided into three groups according to duration of follow-up. A standard network model was established in each subgroup. In 15-day follow-up results, SUCRA outcome showed the ranking of effects was: doxazosin > tamsulosin > rowatinex > nifedipine > terazosin (88.6, 77.4, 58.6, 32.2 and 30.4, respectively). In 45-day follow-up results, SUCRA ranking was: tamsulosin > nifedipine > rowatinex (69.4, 67.2 and 62.6, respectively). In 90-day follow-up results, SUCRA ranking was: doxazosin > rowatinex > tamsulosin (84.1, 68.1 and 49.1, respectively). In conclusion, doxazosin and tamsulosin have potential to be the first choice for pharmacological therapy to promote the expulsion of urinary stone fragments after ESWL, with this doxazosin can improve the SFR in the long term, while tamsulosin may result more in accelerating the process of expulsion.

Different Tract Sizes of Miniaturized Percutaneous Nephrolithotomy Versus Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis.

PURPOSE: Miniaturized percutaneous nephrolithotomy (MPCNL), including minipercutaneous nephrolithotomy (PCNL), ultramini-PCNL, and micro-PCNL, have been developed recently. The aim of this meta-analysis was to compare the safety and efficacy of different tract sizes of MPCNL with retrograde intrarenal surgery (RIRS) in the management of kidney stones. MATERIALS AND METHODS: We searched PubMed, Embase, and Web of Science to identify case-control trials and randomized controlled trials, which evaluated MPCNL vs RIRS before February 2017. Two reviewers independently evaluated the methodologic quality of the included studies, and the disagreements were solved by discussion. Meta-analysis was performed with Review Manager version 5.3 software. RESULTS: Fourteen publications involving 1279 patients were included. Mini-PCNL provided a significantly higher stone-free rate (SFR; odds ratio [OR] OR 1.66; p = 0.005), especially for lower pole renal stones (OR 2.65; p = 0.003), but brought longer hospital stay (weighted mean difference [WMD] 1.23; p = 0.0001) and larger hemoglobin drop (WMD 0.77; p < 0.00001). There were no statistically significant differences between mini-PCNL and RIRS in the complications (OR 0.77; p = 0.23) and operative time (WMD: -6.52; p = 0.42). For ultramini-PCNL and micro-PCNL, the safety and efficacy were similar to RIRS. CONCLUSIONS: Mini-PCNL offers a significantly higher SFR than RIRS, for lower pole renal stones, the advantage of mini-PCNL is more obvious. However, RIRS is associated with shorter hospital stay and less hemoglobin drop. For ultramini-PCNL and micro-PCNL, tract size is smaller than mini-PCNL, and the SFR is similar to RIRS. In terms of the evidence at present, we recommend mini-PCNL for patients focusing more on the high SFR.

Efficacy and safety of barbed suture in minimally invasive radical prostatectomy: A systematic review and meta-analysis.

As one of the earliest surgeries applying knotless barbed suture, the minimally invasive radical prostatectomy (MIRP) was reported to have various effects on the patients and the surgeons. This study reviewed the available evidence about the efficacy and safety of barbed sutures in MIRP. We searched ClinicalTrials.gov, Cochrane Register of Clinical Studies, PubMed, and Embase to identify randomized controlled trials (RCTs) and cohort studies addressing the application of barbed sutures and conventional sutures in MIRP (until August 2016). Quality assessment was performed according to Cochrane recommendations. The data were analyzed using Review Manager (Version 5.3), and sensitivity analysis was performed by sequentially omitting each study. A total of 12 studies, including three RCTs (low to moderate risk of bias, 211 patients) and nine cohort studies (low to moderate risk of bias, 698 patients), fulfilled the study criteria. The pooling of trials did not show statistical difference. Pooling data of cohort studies showed that suture time [mean difference (MD) = -8.52, 95% confidence interval (CI) = -12.60 to -4.43, p < 0.0001] and length of hospital stay (MD = -0.96, 95% CI = -1.80 to -0.11, p = 0.03) were significantly shorter in the barbed group. Results of continence rate varied according to different studies. Subgroup analysis by type of MIRP suggested that patients who underwent barbed suture during robot-assisted surgeries had a shorter hospital stay (MD = -1.13, 95% CI = -1.82 to -0.45, p = 0.001). During the laparoscopic surgery, patients in the barbed suture group had fewer postoperative complications [odds ratio = 0.29, 95% CI = 0.08-0.98, p = 0.05). However, more evidence is needed to validate this state-of-the-art technology.

Factors Influencing Repair Outcomes of Vesicovaginal Fistula: A Retrospective Review of 139 Procedures.

INTRODUCTION: We aimed to report the outcomes of patients undergoing vesicovaginal fistula (VVF) repair to identify prognostic factors. MATERIALS AND METHODS: Patients who underwent VVF repair between January 2009 and October 2015 were reviewed. Primary outcome was fistula closure at 3 months. RESULTS: A total of 123 patients and 139 procedures of VVF repair were reviewed. The overall success rate was 85.6%. There were no significant differences in age (p = 0.476), etiology (p = 0.900), fistula duration (p = 0.491) and number of repairs (p = 0.509) between success and fail group. Moderate or severe perifistula fibrosis and multiple fistula were associated with failure in repair of fistula (70.8 vs. 93.4%, p < 0.001; 62.5 vs. 88.6%, p = 0.005). No difference was seen in success rate of vaginal and abdominal approaches (86.0 vs. 85.0%, p = 0.800). Logistic regression analysis identified fistula number (p = 0.003) and perifistula fibrosis (p = 0.002) as 2 independent prognostic factors. Medium/large fistulas were 3.2 times more likely to fail in repair than small fistulas (OR 3.2, 95% CI 0.95-10.6, p = 0.061). CONCLUSIONS: Fistula number and perifistula fibrosis were 2 independent prognostic factors for fistula repair. Unsuccessful closure was more likely in medium/large VVF.

[The Cross-sectional Study on the Influence Factors for Encrustation of Double J Stent in Patients with Urolithiasis].

OBJECTIVE: To study the influence factors for encrustation of double J stent in patients with urolithiasis. METHODS: In this study, there were 84 urolithiasis patients with double J stent included from February to July 2014 in our hospital. The encrustation on double J stent was evaluated by a PC stereo microscope. The nterrelated clinical data were obtained, then the factors which may affect the encrustation were studied by logistic regression analysis. RESULTS: The mean indwelling time was (17. 0±6. 0) d, and a thin encrustation formed on the stents for most cases [67/84(79. 8%)]. Compared with the cases who did not form a thin encrustation, those having a thin encrustation formation on the stent were younger [(44. 9±11. 5) vs. (54. 4±12. 6), P=0. 004]; The patients with proteinuria got a higher rate of encrustation [62/73(84. 9%) vs. 5/11 (45. 5%), P=0. 002]. The patients with urinary tract infection had a higher rate of encrustation [26/28(92. 9%) vs. 41/56(73. 2%), P 3. 035]. The patients with hematuriaalso got a higher rate of encrustation [67/80(83. 8%) vs. 0/4, P=0. 001]. Different sex, retention time,serum calcium,inorganic phosphorus, uric acid, urine pH,lithiasis component had no effects on encrustation (P>0. 05). Logistic regression analysis showed that age and proteinuria was retained as idependent correlated factors with encrustation (P<0. 05), while hematuria and urinary tract infections had a low ntensity correlation with encrustation (P>0. 05). CONCLUSION: For encrustation of double J stentin patients with urolithiasis, younger age, increased urinary protein, hematuria and infections are important risk-factors.

Prognostic role of microvessel density in patients with renal cell carcinoma: a meta-analysis.

Microvessel density (MVD), an indicator of angiogenesis, has been proposed to predict prognosis of patients with renal cell carcinoma (RCC), but its ability to predict survival of patients with RCC remains controversial. The present study sought to address this question rigorously by systematically reviewing the literature on MVD and RCC prognosis. We identified relevant studies in PubMed, EMBASE and the Cochrane Library, and two reviewers independently assessed study quality and extracted relevant data to compare survival based on MVD stratification in patients with RCC. We identified 15 studies that satisfied the inclusion criteria; eight studies assessed MVD in surgical samples by immunohistochemistry to label factor VIII; four studies, by immunohistochemistry to label CD34; two studies, CD31; and one study, CD105. Survival meta-analysis was performed using data pooled from 10 studies: five based on factor VIII, two based on CD34, two based on CD31 and one based on CD105. The overall survival hazard ratio describing the relationship between MVD and survival in all 10 pooled studies was 0.964 (95% CI: 0.873-1.065), while the individual hazard ratios for pooled studies based on factor VIII were 1.673 (95% CI: 0.860-3.252); CD34, 0.903 (95% CI: 0.853-0.956); and CD31, 0.926 (95% CI: 0.868-0.989). The corresponding result for the sole trial based on CD105 was 0.1759 (95% CI: 0.036-0.856). These findings suggest that MVD is not reliably associated with survival time of patients with RCC, which may reflect the need to take into account whether the microvasculature is differentiated or not. MVD as currently calculated may not be an ideal prognostic factor for patients with RCC.