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 ...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.展开更多
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 avoidin...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.展开更多
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 ver...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.展开更多
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 w...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.展开更多
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...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.展开更多
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 projecti...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.展开更多
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 a...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.展开更多
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 again...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.展开更多
文摘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.
文摘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.
文摘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.
基金supported by grants from the National Natural Science Foundation of China(81974503 and 81871095)the National Key R&D Program of China(2018YFC2000304)+3 种基金the Key International S&T Cooperation Program of China(2016YFE0113700)the European Union’s Horizon 2020 Research and Innovation Program(633589)the Natural Science Foundation of Beijing,China(7202096)the Tsinghua University independent research program(7191007,China)。
文摘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.
基金Countermeasures Against Chemical Threats,NIH grant AR055073the Parke-Davis Endowed Chair in Pharmaceutics and Drug Delivery.
文摘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.
基金supported by a grant from the Science and Technology Bureau of Shenzhen (Shenzhen Pro-ject of Science and Technology in 2010), No. 201001003
文摘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.
文摘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.
文摘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.
