Intravesical explosion during transurethral resection of bladder tumor:A case report

BACKGROUND Intravesical explosion during transurethral resection of bladder tumor(TUR-BT)is a very rare complication,and it may result in rupture of the bladder,which usually requires surgical correction and causes a potential threat to the patient’s life.CASE SUMMARY This paper reports a case of intravesical explosion during TUR-BT.Combined with the literature review,the risk factors are analyzed and measures of prevention and treatment are discussed.CONCLUSION Although rare,intravesical explosions can cause serious consequences,and the loud explosion can also lead to a profound psychological shadow on the patient.Urologists must be aware of this potential complication.Careful operative techniques and special precautions can reduce the risk of this complication.

Validation of Vesical Imaging Reporting and Data System score for the diagnosis of muscle-invasive bladder cancer: A prospective cross-sectional study

Objective:Vesical Imaging Reporting and Data System(VIRADS)score was developed to standardize the reporting and staging of bladder tumors on pre-operative multiparametric magnetic resonance imaging.It helps in avoiding unnecessary repeat transurethral resection of bladder tumor in high-risk non-muscle-invasive bladder cancer patients.This study was done to determine the validity of VIRADS score prospectively for the diagnosis of muscleinvasive bladder cancer.Methods:This study was conducted from March 2019 to March 2020 at Sawai Man Singh Medical College and Hospital,Jaipur,Rajasthan,India.Patients admitted with the provisional diagnosis of bladder tumor were included as participants.All these patients underwent a 3 Tesla mpMRI to obtain a VIRADS score before they underwent transurethral resection of bladder tumor and these data were analyzed to evaluate the correlation of pre-operative VIRADS score with mus-cle invasiveness of the tumor in final biopsy report.Results:A cut-off of VIRADS≥4 for prediction of detrusor muscle invasion yielded a sensitivity of 79.4%,specificity of 94.2%,positive predictive value of 90.0%,negative predictive value of 87.5%,and diagnostic accuracy of 86.4%.A cut off of VIRADS≥3 for prediction of detrusor muscle invasion yielded a sensitivity of 91.2%,specificity of 78.8%,positive predictive value of 73.8%,negative predictive value of 93.2%,and accuracy of 83.7%.The receiver operating curve showed the area under the curve to be 0.922(95%confidence interval:0.862e0.983).Conclusion:VIRADS score appears to be an excellent and effective pre-operative radiological tool for the prediction of detrusor muscle invasion in bladder cancer.

Giant vesical diverticulum:A rare cause of defecation disturbance

Vesical diverticula frequently result from bladder outlet obstructions. However, giant vesical diverticula which cause acute abdomen or intestinal obstruction are very rare. Our review of the English medical literature found 3 cases of bladder diverticula which caused gastrointestinal symptoms. Here, we present a 57-yearold man with a giant diverticulum of the urinary bladder who complained of abdominal pain, nausea and vomiting, constipation, no passage of gas or feces, and abdominal distension for 3 d. A 20 cm x 15 cm diverticulum was observed upon laparotomy. The colonic obstruction was secondary to external compression of the rectum against the sacrum by a distended vesical diverticulum. We performed a diverticulectomy and primary closure. Twelve months postoperatively, the patient had no difficulty with voiding or defecation.

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.

Can magnetic resonance imaging differentiate muscle invasion(T2)and lamina propria invasion(T1)urothelial carcinoma of the bladder?A systematic review and meta-analysis of Vesical Imaging-Reporting and Data System accuracy

Background:Vesical Imaging-Reporting and Data System(Ⅵ-RADS)was developed as a structured reporting tool to anticipate the possibility of muscle invasion.This study is aimed to investigate the diagnostic accuracy ofⅥ-RADS for discriminating T2 from T1 bladder cancer.Materials and methods:Scopus,Web of Science,PubMed,and Embase were searched on October 4,2021,for studies with the following characteristics:(1)bladder cancer patient population,(2)Ⅵ-RADS as an index test,(3)retransurethral resection of bladder tumor/cystectomy as a reference,and(4)adequateⅥ-RADS score data for T1 and T2 lesions.The analyses were performed using the binary regression model of MIDAS in Stata.Results:Six studies with 624 magnetic resonance imaging reports were included.The receiver operating characteristics curve for differentiation of T2 from T1 bladder cancer showed an area under the curve of 0.93(95%confidence interval[CI],0.91-0.95)for aⅥ-RADS≥3 and 0.75(95%CI,0.71-0.79)for aⅥ-RADS≥4.AⅥ-RADS≥3 showed high sensitivity of 93%(95%CI,85%-97%),specificity of 61%(95%CI,30%-86%),positive likelihood ratio of 2.4(95%CI,1.1-5.3),and negative likelihood ratio of 0.11(95%CI,0.05-0.24).A total of 10.4%of T2 lesions were scored asⅥ-RADS 2,while 10%of T1 lesions were scored asⅥ-RADS 4 or 5.Conclusions:TheⅥ-RADS≥3 has high accuracy and sensitivity for detecting muscle invasion in borderline populations of T1 or T2 bladder cancer.Thus,theⅥ-RADS could be a good non-invasive screening test for the detection of T2 urothelial lesions.

Ample dietary fat reduced the risk of primary vesical calculi by inducing macrophages to engulf budding crystals in mice

Although primary vesical calculi is an ancient disease,the mechanism of calculi formation remains unclear.In this study,we established a novel primary vesical calculi model with D,L-choline tartrate in mice.Compared with commonly used melamine and ethylene glycol models,our model was the only approach that induced vesical calculi without causing kidney injury.Previous studies suggest that proteins in the daily diet are the main contributors to the prevention of vesical calculi,yet the effect of fat is overlooked.To assay the relationship of dietary fat with the formation of primary vesical calculi,D,L-choline tartrate-treated mice were fed a high-fat,low-fat,or normal-fat diet.Genetic changes in the mouse bladder were detected with transcriptome analysis.A high-fat diet remarkably reduced the morbidity of primary vesical calculi.Higher fatty acid levels in serum and urine were observed in the high-fat diet group,and more intact epithelia in bladder were observed in the same group compared with the normal-and low-fat diet groups,suggesting the protective effect of fatty acids on bladder epithelia to maintain its normal histological structure.Transcriptome analysis revealed that the macrophage differentiation-related gene C-X-C motif chemokine ligand 14(Cxcl14)was upregulated in the bladders of high-fat diet-fed mice compared with those of normal-or low-fat diet-fed mice,which was consistent with histological observations.The expression of CXCL14 significantly increased in the bladder in the high-fat diet group.CXCL14 enhanced the recruitment of macrophages to the crystal nucleus and induced the transformation of M2 macrophages,which led to phagocytosis of budding crystals and prevented accumulation of calculi.In human bladder epithelia(HCV-29)cells,high fatty acid supplementation significantly increased the expression of CXCL14.Dietary fat is essential for the maintenance of physiological functions of the bladder and for the prevention of primary vesical calculi,which provides new ideas for the reduction of morbidity of primary vesical calculi.

Depilatory double-disc mouse model for evaluation of vesicant dermal injury pharmacotherapy countermeasures

Background:Sulfur mustard(SM)is a chemical warfare vesicant that severely injures exposed eyes,lungs,and skin.Mechlorethamine hydrochloride(NM)is widely used as an SM surrogate.This study aimed to develop a depilatory double-disc(DDD)NM skin burn model for investigating vesicant pharmacotherapy countermeasures.Methods:Hair removal method(clipping only versus clipping followed by a depilatory),the effect of acetone in the vesicant administration vehicle,NM dose(0.5-20μmol),vehicle volume(5-20μl),and time course(0.5-21 days)were investigated using male and female CD-1 mice.Edema,an indicator of burn response,was assessed by biopsy skin weight.The ideal NM dose to induce partial-thickness burns was assessed by edema and histopathologic evaluation.The optimized DDD model was validated using an established reagent,NDH-4338,a cyclooxygenase,inducible nitric oxide synthase,and acetylcholinesterase inhibitor prodrug.Results:Clipping/depilatory resulted in a 5-fold higher skin edematous response and was highly reproducible(18-fold lower%CV)compared to clipping alone.Acetone did not affect edema formation.Peak edema occurred 24-48 h after NM administra-tion using optimized dosing methods and volume.Ideal partial-thickness burns were achieved with 5μmol of NM and responded to treatment with NDH-4338.No dif-ferences in burn edematous responses were observed between males and females.Conclusion:A highly reproducible and sensitive partial-thickness skin burn model was developed for assessing vesicant pharmacotherapy countermeasures.This model pro-vides clinically relevant wound severity and eliminates the need for organic solvents that induce changes to the skin barrier function.

Skin electrodes transduced signals to the bladder resulting in ameliorated hypomotility in a rabbit model of diabetes

Electric signals from a chest skin electrode can be conducted to the heart and activate contraction. In the present study, normal and diabetic rabbits were stimulated by skin electrode on the abnormal bladder projection area using three levels of exporting voltage （5.84 V, 8.00 V, and 11.00 V）. Results demonstrated significantly attenuated electric signals from both groups, in particular the diabetes group. The skin electrode signals were conducted to the bladders, and all vesical signals increased according to strength of stimulating signals from the skin electrode, However, vesical signals from diabetic rabbits were less than those from normal rabbits at the same stimulating strength of exporting voltage. Vesical pressures from the two groups increased along with increased vesical signals, but vesical pressure was less those from diabetic rabbits than in normal rabbits （basic status and different stimulating levels）. Linear correlation analysis showed a significantly positive correlation between vesical pressure and signal. These results demonstrated that electric signals from skin electrodes resulted in increased vesical pressure, and vesical pressure increased along with stimulation strength.

柔性承台下复合地基应力和沉降计算研究

柔性承台下复合地基的受力性状与刚性承台下复合地基有很大差别,常用的复合地基应力和沉降计算理论均基于刚性承台下复合地基,使计算值与实际值相差较大。利用Mindlin解与Boussinesq解联合求解柔性承台下复合地基的附加应力,可以得到与实际较符合的应力分布。利用Vesic小孔扩张理论计算桩体刺入柔性承台的量,并对分层总和法求得的沉降进行修正,可以得到与实测接近的沉降计算值。

基于圆孔扩张理论的桩基水平承载力计算方法

近年来,我国城市的基础设施建设规模不断扩大,桩基础是基础设施建设中常用的基础形式,其水平承载特性的分析计算是桩基设计中的重要问题。基于Vesic圆孔扩张理论,分析了水平荷载作用下桩侧土体的实际受力状态,推导了基于应力增量的桩侧土抗力的计算公式,进而提出了考虑摩擦效应的桩土相互作用的计算方法;并基于MATLAB编写了相应的分析程序,通过开展案例分析,验证了该计算方法的有效性;最后基于所建立的桩基水平承载力的力学模型,探讨了荷载、桩径等因素对水平受荷桩的承载特性的影响规律。

悬臂式管桩在基坑支护工程中的应用研究

基于土拱效应及土体M-C屈服准则,建立了桩间土拱计算模型,并得到了悬臂段桩身土反力计算公式;考虑桩身挤土效应及深度效应,利用Vesic圆孔扩张理论,推导出挤土管桩水平承载力与水平位移之间的关系式;在此基础上,利用力和弯矩平衡条件,建立了悬臂式管桩支护结构设计方法。为了验证理论公式的可行性,将计算结果、现场实测结果及朗肯土压力计算结果进行对比分析,结果表明本文计算结果与实测结果桩侧土反力相差较小,且变化趋势基本一致,并且其计算精度相对经典土压力理论得到较大的提高,验证了理论方法的可行性。

地埋梁与横观各向同性层状地基相互作用的广义Vesic解答

根据横观各向同性弹性理论和传递矩阵法,考虑梁底埋深、地基的横观各向同性及成层性,推导得到基床系数的广义Vesic解答。数值算例验证了基床系数取值方法的合理性和准确性,分析了各个参数变化对基床系数取值的影响。结果表明,基床系数k随梁底埋深h的增加而不断增大至最大值,约为地表时的2.05~2.25倍;k随着地基总厚H的增大而减小,而随横观各向同性参数r的增大而增大;当h为0或H超过100b或r为1时,本文解退化为Vesic解;土层加权平均弹性模量相同且首层土体越硬时,k值越大,且广义Vesic解用于有限长梁分析时的计算误差越小。

桩-网结构复合地基沉降计算研究

桩-网复合地基是一种有效的软土地基加固处理方法。目前对桩-网复合地基沉降尚未形成比较成熟的计算理论和方法。在简要分析桩-网复合地基沉降构成的基础上,利用Mindlin-Geddes方法联合推求加固区附加应力分布,再利用Boussinesq方法推求下卧层附加应力的分布,并结合小孔扩张理论求出桩体的刺入变形量,最终对联合求解得到的沉降值进行修正,得到了与实际情况比较吻合的解,可以为类似无砟轨道等对沉降要求严格的铁路工程复合地基沉降计算提供参考。

具有软弱下卧层的基坑隆起稳定计算

根据双层地基极限承载力Vesic公式及压力扩散角理论,研究了具有软弱下卧层的基坑隆起稳定问题,提出了稳定安全系数F_s以及不考虑下卧层影响的土层临界厚度H_(ct)的计算方法。

夯扩桩扩大头效应和竖向承载力的研究

夯扩桩在成桩过程中会产生挤土效应。本文介绍了Vesic球形孔理论在夯扩桩扩大头方面的应用,推导出夯扩桩形成扩大头时引起的挤土影响半径,并结合工程实例分析提出夯扩桩单桩承载力的计算公式,经实践证明用该方法求得夯扩桩单桩承载力可满足工程应用。

基于圆孔扩张理论散体材料-混凝土桩承载力计算

地基加固处理中应用广泛的碎石桩易于在桩顶发生鼓胀变形破坏,为解决此问题,提出一种新型优化复合地基形式,即散体材料-混凝土桩复合地基。采用圆孔扩张理论,基于Mohr-Coulomb屈服准则,用极坐标轴对称问题对散体材料-混凝土桩进行Vesic圆孔扩张压力求解,并由此推导出桩间土体内摩擦角φ=0和φ≠0时散体材料-混凝土桩的极限承载力计算公式。将计算方法应用于已有试验,并展开对比分析,结果表明该计算公式的计算结果与现场试验结果较为接近,验证了基于圆孔扩张理论对该新型桩进行极限承载力计算的准确性。

柔性基础复合地基沉降计算

柔性基础下复合地基的沉降计算一直较难确定。利用Mindlin解与Boussinesq解联合求解柔性基础下复合地基的附加应力,并利用Vesic小孔扩张理论计算桩体刺入柔性基础的量,后对分层总和法求得的沉降进行修正,可以得到与实测接近的沉降计算值。

Overview, prevention and management of chemotherapy extravasation

Chemotherapy extravasation remains an accidental complication of chemotherapy administration and may result in serious damage to patients. We review in this article the clinical aspects of chemotherapy extravasation and latest advances in definitions, classification, pre-vention, management and guidelines. We review the grading of extravasation and tissue damage according to various chemotherapeutic drugs and present an update on treatment and new antidotes including dexrazoxane for anthracyclines extravasation. We highlight the importance of education and training of the oncology team for prevention and prompt pharmacological and non-pharmacological management and stress the availability of new antidotes like dexrazoxane wherever anthracyclines are being infused.

A Rare Case of Severe Muscular Necrosis Due to Extravascular Leakage of Trabectedin—Severe Tissue Damage of Trabectedin Extravasation

Trabectedin is a synthetic antineoplastic drug, binding to the minor groove of DNA and affecting DNA repair pathways, resulting in G2-M cell cycle arrest and apoptosis. Trabectedin has demonstrated high efficacy against various soft tissue sarcomas. However, its extravasation causes serious complications, such as tissue necrosis and a delay in the treatment of underlying diseases. Methods: We experienced a rare case in which trabectedin extravasation caused severe pectoralis major muscle necrosis. A 45-year-old man with multiple lung metastases of follicular dendritic cell sarcoma received 2.15 mg of trabectedin totally through a central venous access device (CVAD) system in the right precordium. Computed tomography showed extensive turbidity of subcutaneous fatty tissue and swelling of the pectoralis major muscle to the upper margin of the liver, and the creatine kinase level was elevated to 759 U/L (reference value from 54 to 286). We performed surgical debridement twice, and the CVAD was concomitantly removed;thereafter, the skin defect was reconstructed with a split skin mesh graft. Results: Histopathology showed extreme degeneration of striated muscle and fatty tissue. Unfortunately, disability of the right arm abducens persisted after treatment because of debridement around the right humerus muscle. Discussion: Several reports have described cases of the extravasation of trabectedin. A few have mentioned severe muscular degeneration similar to that shown in the present case. Because trabectedin is a strong vesicant cytotoxic agent, it is principally administered through a CVAD rather than peripheral vessels and is continued during the nighttime;this can lead to a delay in patients or attending doctors noticing any extravasation. We need to spread appropriate knowledge of this drug and make an effort to prevent severe complications like in the present case.

基于Vesic圆孔扩张理论的桩周土抗力计算方法研究

随着目前城市建筑物容量的增大,对作为其主要承载构件的桩基础的承载性能提出了更高的要求。桩-土相互作用问题是桩基水平承载性能研究中必须考虑的重要内容,该问题的研究对于完善桩基础设计理论和指导工程实践具有重要意义。基于Vesic圆孔扩张理论,分析水平荷载作用下桩侧土体的实际受力状态,根据桩身产生水平位移后桩周土应力为近似椭圆形非均匀分布的特点,综合考虑纵向应力变化、桩基整体转动和桩-土摩擦效应对桩侧土抗力的影响,建立二维平面状态下的桩-土相互作用的力学模型,以此推导水平荷载作用下的桩侧土抗力计算公式,得到基于应力增量的p-y曲线计算方法,并通过实例计算验证该方法的适用性,最后针对桩-土参数进行影响因素分析。对比所提方法的计算结果与模型试验的结果可知:将该理论方法应用于水平荷载作用下桩侧土体力学效应的计算时,计算结果和现场实测数据较吻合,尤其在桩基受荷产生较大水平位移时,两者表现出了较好的一致性。通过对桩-土参数等影响因素的计算分析,讨论了桩径、土体内摩擦角和土体变形模量等桩-土参数对桩周土体应力结果的影响,得到了桩周不同位置处土体径向应力和切向应力的变化规律。