Colorectal liver metastases: Correlations of contrast-enhanced ultrasound features with tumor clinicopathological factors and clinical outcomes following conversion therapy.

OBJECTIVE: To explore the prognostic impact of contrast-enhanced ultrasound (CEUS) features for initially unresectable colorectal liver metastases (CLMs) in a clinical setting of conversion therapy. METHODS: Between March 2015 and November 2020, consecutive patients with CLMs who received conversion treatment were prospectively enrolled. All participants underwent liver CEUS at baseline. The primary endpoint was conversion resection rate (R0 and overall resection). Secondary endpoints were objective response rate (ORR), overall survival (OS), and progression-free survival (PFS). RESULTS: 104 participants who completed conversion treatment were included. CEUS enhancement pattern was correlated with index lesion (size and echogenicity), primary (site, differentiation, perineural invasion, and RAS genotype) and serum (CA19-9 level) characteristics (P = <0.001-0.016). CEUS enhancement pattern was significantly associated with R0 resection rate, ORR, PFS, and OS (P = 0.001-0.049), whereas enhancement degree was associated with PFS and OS (P = 0.043 and 0.045). Multivariate analysis showed that heterogeneous enhancement independently predicted R0 and overall resection (P = 0.028 and 0.024) while rim-like enhancement independently predicted ORR and OS (P = 0.009 and 0.026). CONCLUSION: CEUS enhancement pattern was significantly associated with tumor characteristics and clinical outcomes following conversion therapy, and thus might be of prognosis impact for initially unresectable CLMs.

Identification of differentially expressed genes and biological pathways in bladder cancer.

The purpose of the present study was to identify key genes and investigate the related molecular mechanisms of bladder cancer (BC) progression. From the Gene Expression Omnibus database, the gene expression dataset GSE7476 was downloaded, which contained 43 BC samples and 12 normal bladder tissues. GSE7476 was analyzed to screen the differentially expressed genes (DEGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed for the DEGs using the DAVID database, and a protein­protein interaction (PPI) network was then constructed using Cytoscape software. The results of the GO analysis showed that the upregulated DEGs were significantly enriched in cell division, nucleoplasm and protein binding, while the downregulated DEGs were significantly enriched in 'extracellular matrix organization', 'proteinaceous extracellular matrix' and 'heparin binding'. The results of the KEGG pathway analysis showed that the upregulated DEGs were significantly enriched in the 'cell cycle', whereas the downregulated DEGs were significantly enriched in 'complement and coagulation cascades'. JUN, cyclin­dependent kinase 1, FOS, PCNA, TOP2A, CCND1 and CDH1 were found to be hub genes in the PPI network. Sub­networks revealed that these gene were enriched in significant pathways, including the 'cell cycle' signaling pathway and 'PI3K­Akt signaling pathway'. In summary, the present study identified DEGs and key target genes in the progression of BC, providing potential molecular targets and diagnostic biomarkers for the treatment of BC.

Experience of retaining encrusted ureteral stents: URL by 4.5/6.5F ureteroscope can reduce the possibility of PCNL.

The purpose of the study was to present our experience of retaining encrusted ureteral stents (EUS) and discuss the effectiveness of 4.5/6.5F ureteroscope (URS) in the procedure. The data of patients with EUS in our center from January 2012 to December 2016 were retrospectively analyzed. The inclusion criterion was ureteral stents that required intervention above the ureteral orifice to retain and was proved to be encrusted. Impacted stents would be removed by ureteroscope lithotripsy (URL) via 8/9.8F or 4.5/6.5F URS. Percutaneous nephrolithotomy (PCNL) then be the further step if URL failed. 46 cases of EUS were treated in 36 patients from January 2012 to December 2016 in our institution. All subjects consisted of 18 males and 18 females; the average age was 49.81 ± 16.40 years (range 5-86). The mean time from stent insertion to encrustation was 9.28 ± 17.15 months (range 1-120). URL was performed in 44 cases (95.7%), including 19 cases (41.3%) by 8/9.8F URS and 25 cases (54.4%) by 4.5/6.5F URS due to the conventional URS's failure to get into ureteral orifice or further part of ureter. Two patients (4.3%) underwent PCNL due to the inseparable circle developed by the intra-renal segment of encrusted stents. None of the patients underwent extracorporeal shock wave lithotripsy (ESWL) and open surgery. All stents were eventually removed without blood transfusion or ureteral injury, except three cases with post-operative fever. All procedures were performed under one-session anesthesia. URL by 4.5/6.5F ureteroscope might increase the success rate of retaining encrusted ureteral stents remarkably, and then reduce the possibility of PCNL effectively.