Current status of diagnosis and treatment of bladder cancer in China-Analyses of Chinese Bladder Cancer Consortium database

Objective:To investigate current status of diagnosis and treatment of bladder cancer in China.Methods:A database was generated by Chinese Bladder Cancer Consortium(CBCC).From January 2007 to December 2012,14,260 cases from 44 CBCC centers were included.Data of diagnosis,treatment and pathology were collected.Results:The average age was 63.5 year-old and most patients were male(84.3%).The most common histologic types were urothelial carcinoma(91.4%),adenocarcinoma(1.8%),and squamous carcinoma(1.9%).According to 1973 and 2004 WHO grading system,42.0%,41.0%,and 17.0% of patients were grade 1,2,and 3,and 16.0%,48.7%,and 35.3% of patients were papillary urothelial neoplasms of low malignant potential,low,and high grade,respectively.Non-muscle invasive bladder cancer(NMIBC)and muscle invasive bladder cancer(MIBC)were 25.2% and 74.1%,respectively(0.8% not clear).Carcinoma in situ was only 2.4%.Most patients were diagnosed by white-light cystoscopy with biopsy(74.3%).Fluorescence and narrow band imaging cystoscopy had additional detection rate of 1.0% and 4.0%,respectively.Diagnostic transurethral resection(TUR)provided detection rate of 16.9%.Most NMIBCs were treated with TUR(89.2%).After initial TUR,2.6%accepted second TUR,and 45.7%,69.9%,and 58.7% accepted immediate,induced,and maintenance chemotherapy instillation,respectively.Most MIBCs were treated with radical cystectomy(RC,59.7%).Laparoscopic RCs were 35.1%,while open RC 63.4%.Extended and standard pelvic lymph node dissection were 7% and 66%,respectively.Three most common urinary diversions were orthotopic neobladder(44%),ileal conduit(31%),and ureterocutaneostomy(23%).Only 2.3% of patients accepted neo-adjuvant chemotherapy and only 18%of T3 and T4 patients accepted adjuvant chemotherapy.Conclusion:Disease characteristics are similar to international reports,while differences of diagnosis and treatment exist.This study can provide evidences for revisions of the guideline on bladder cancer in China.

Survival after radical cystectomy for bladder cancer:Multicenter comparison between minimally invasive and open approaches

Objective:To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy(MIRC)or open radical cystectomy(ORC).Methods:We identified patients with bladder cancer who underwent radical cystectomy(RC)in 13 centers of the Chinese Bladder Cancer Consortium(CBCC).Perioperative outcomes were compared between MIRC and ORC.The influence of surgical approaches on overall survival(OS)and cancer-specific survival(CSS)in the entire study group and subgroups classified according to pathologic stage or lymph node(LN)status was assessed with the log-rank test.Multivariable Cox proportional hazard models were used to evaluate the association among OS,CSS and risk factors of interest.Results:Of 2098 patients who underwent RC,1243 patients underwent MIRC(1087 laparoscopic RC and 156 robotic-assisted RC,respectively),while 855 patients underwent ORC.No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate.MIRC was associated with less estimated blood loss,more LN yield,higher rate of neobladder diversion,longer operative time,and longer length of hospital stay.There was no significant difference in OS and CSS according to surgical approaches(pZ0.653,and 0.816,respectively).Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement.Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS.Conclusions:Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS.

Ectopic intrauterine device in the bladder causing cystolithiasis:A case report

BACKGROUND An intrauterine device(IUD)is a commonly used contraceptive among women in China.It is widely used because it is safe,effective,simple,economic,and reversible.Among the possible complications,an ectopic IUD in the bladder is rare.It occurs insidiously,has a long course,is associated with a high risk for injury,and is difficult to treat.CASE SUMMARY A 44-year-old woman was admitted for repeated episodes of urinary frequency,urgency,and dysuria over three months.Laboratory tests revealed significantly elevated urine leukocytes and bacteria.Urine culture suggested colonization with Enterococcus faecalis.Abdominal computed tomography images suggested an abnormally positioned IUD that was protruding into the bladder.Cystoscopy revealed a metallic foreign body with multiple stones on its surface in the left posterior bladder wall.The foreign body measured approximately 1 cm.Hysteroscopy revealed the arm of a V-type metal IUD embedded in the middle and upper sections of the anterior wall of the cervical canal.The majority of the IUD was located in the uterine cavity.Cystoscopy was performed,and a holmium laser was utilized to break the stones attached to the portion of the IUD in the bladder.The IUD was then removed through hysteroscopy.CONCLUSION Ectopic IUDs in the bladder can be diagnosed with thorough imaging and safely removed through cystoscopy or hysteroscopy.

Cystic nephroma: A bosniak Ⅲ benign tumor in the kidney

Dear editor,Cystic nephroma(CN)is a rare kind of tumor in the kidney,which has benign pathological features and biological behaviors but malignancy-like image manifestations.Pediatric CN is always associated with germline DICER1 mutation and belongs to DICER1 syndrome,while adult CN which is now considered a different entity apparently has nothing to do with DICER1 mutation[1].The accurate preoperative diagnosis is of great importance in choosing proper treatment.This paper provides a case of adult CN as below.

三磷酸腺苷结合盒转运体A1在肿瘤发生、发展及治疗中的研究进展

三磷酸腺苷结合盒转运体A1(ABCA1)是三磷酸结合盒转运体超家族的重要成员之一,促进细胞内游离胆固醇和磷脂的流出,在胆固醇逆转运(RCT)和高密度脂蛋白(HDL)生成的起始步骤中起重要作用。目前研究表明,脂质代谢在肿瘤生长中支持肿瘤细胞的特殊能量和结构需求,ABCA1介导胆固醇外流在抗肿瘤中起着一定的作用,ABCA1在肿瘤治疗方面有望成为新的方向。该文主要综述ABCA1在肿瘤发生发展及治疗中的研究进展。

Severe hematuria due to vesical varices in a patient with portal hypertension:A case report

BACKGROUND Hematuria is one of the most common clinical symptoms for urologists and is typically observed in urinary system tumors,prostate hyperplasia,and urinary stone disease.Hematuria due to vesical varices is very rare,and only a few cases have been reported since 1989.We report the first case of vesical varices due to portal hypertension with aberrant development and functioning of the genitourinary system along with the complete diagnosis and treatment process.CASE SUMMARY This patient was a 53-year-old man with a history of aberrant development of the genitourinary system and hepatitis B-associated cirrhosis.He was admitted to the emergency department with severe hematuria and bladder clot tamponade.Many abnormally dilated blood vessels were found surrounding the bladder in the pelvis by color Doppler ultrasound,contrast-enhanced computed tomography,and three-dimensional visualization technology.It was difficult to perform transurethral cystoscopy and hemostasis in this patient,so we performed open surgical bladder exploration for hemostasis and surgical devascularization around the bladder.CONCLUSION Urologists should improve the understanding of the pathophysiology,clinical manifestations,diagnosis,and treatment of vesical varices.This case may be presented as a reference for the diagnosis and management of severe hematuria due to vesical varices.

Improved deep residual shrinkage network for a multi-cylinder heavy-duty engine fault detection with single channel surface vibration

The health monitoring and fault diagnosis of heavy-duty engines are increasingly important for energy storage ecosystem. During operation, vibration characters corresponding to the specific fault need to be extracted from the overall system vibration. Faulty characteristics emanating from one single cylinder are also mixed with those from other cylinders. Besides, the change of working condition brings strong nonlinearities in surface vibration. To solve these problems, an improved deep residual shrinkage network (IDRSN) is developed for detecting diverse engine faults at various degrees using single channel surface vibration signal. Within IDRSN, a wide convolution kernel is utilized in first convolution layer to capture the long-term fault-related impacts and eliminate the short-time random impact. The residual network module is adopted to enhance the focus the relevant components of vibration signals. Mini-batch training strategy is used to improve the model stability. Meanwhile, Gradient-weighted class activation map is adopted to assess the consistency between the learned knowledge and the fault-related information. The IDRSN is implemented to diagnosing a diesel engine under various faults, faulty degrees and operating speeds. Comparisons with existing models are analyzed in terms of hyper-parameters, training samples, noise resistance, and visualization. Results demonstrate the proposed IDRSN's superior performance on fault diagnosis accuracy, stability, anti-noise performance, and anti-interference performance. An average accuracy rate of 98.38 % was achieved by the proposed IDRSN, in comparison to 96.64 % and 93.56 % achieved by the DRSN and the wide-kernel deep convolutional neural network respectively. These results highlight the proposed IDRSN's superiority in diagnosing multiple faults under various working conditions, offering a low-cost, highly effective, and applicable approach for complex fault diagnosis tasks.

Efficacy and safety of LY01005 versus goserelin implant in Chinese patients with prostate cancer: A multicenter, randomized, open-label, phase III, non-inferiority trial

Background:LY01005(Goserelin acetate sustained-release microsphere injection)is a modified gonadotropin-releasing hormone(GnRH)agonist injected monthly.This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer.Methods:We conducted a randomized controlled,open-label,non-inferiority trial across 49 sites in China.This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections.The primary efficacy endpoints were the percentage of patients with testosterone suppression≤50 ng/dL at day 29 and the cumulative probability of testosterone≤50 ng/dL from day 29 to 85.Non-inferiority was prespecified at a margin of-10%.Secondary endpoints included significant castration(≤20 ng/dL),testosterone surge within 72 h following repeated dosing,and changes in luteinizing hormone,follicle-stimulating hormone,and prostate specific antigen levels.Results:On day 29,in the LY01005 and goserelin implant groups,testosterone concentrations fell below medical-castration levels in 99.3%(142/143)and 100%(140/140)of patients,respectively,with a difference of-0.7%(95%confidence interval[CI],-3.9%to 2.0%)between the two groups.The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3%and 97.8%,respectively,with a between-group difference of 1.5%(95%CI,-1.3%to 4.4%).Both results met the criterion for non-inferiority.Secondary endpoints were similar between groups.Both treatments were well-tolerated.LY01005 was associated with fewer injection-site reactions than the goserelin implant(0%vs.1.4%[2/145]).Conclusion:LY01005 is as effective as goserelin implants in reducing testosterone to castration levels,with a similar safety profile.Trial registration:ClinicalTrials.gov,NCT04563936.

OsLTP47 may function in a lipid transfer relay essential for pollen wall development in rice

In plants,lipid transfer proteins(LTPs)transport pollen wall constituents from the tapetum to the exine,a process essential for pollen wall development.However,the functional cooperation of different LTPs in pollen wall development is not well understood.In this study,we have identified and characterized a grassspecific LTP gene,Os LTP47,an important regulator of pollen wall formation in rice(Oryza sativa).Os LTP47 encodes a membrane-localized LTP and in vitro lipid-binding assays confirms that Os LTP47 has lipidbinding activity.Dysfunction of Os LTP47 causes disordered lipid metabolism and defective pollen walls,leading to male sterility.Yeast two-hybrid and pull-down assays reveal that Os LTP47 physically interacts with another LTP,Os C6.These findings suggest that the plasma membrane-localized Os LTP47 may function as a mediator in a lipid transfer relay through association with cytosolic and/or locular Os C6 for pollen wall development and that various LTPs may function in a coordinated manner to transport lipid molecules during pollen wall development.