Kejia Zhu

Prognostic scores based on the preoperative plasma fibrinogen and serum albumin level as a prognostic factor in patients with upper urinary tract urothelial carcinoma

This study is to clarify the prognostic value of preoperative plasma fibrinogen and serum albumin level, as known as FA score, in a cohort of Chinese patients with upper urinary tract urothelial carcinoma (UTUC). We retrospectively evaluated clinicopathological data on 169 patients who underwent surgery between 2006 and 2013. The FA score was calculated based on cutoff values of 3.53g/L for fibrinogen and 43.56 g/L for albumin. Overall survival and cancer specific survival was assessed using the Kaplan-Meier method and the equivalences of the curves were tested by log-rank tests. The Cox proportional hazards regression model was applied in univariate and multivariate analyses. In univariate analysis, tumor size, tumor grade, pathological T stage and FA score were significantly associated with overall survival and cancer specific survival, and multivariate Cox proportional hazards regression analysis identified FA score (score 1: HR=3.486, 95%CI 1.358-8.948, p=0.009; HR=3.485, 95%CI 1.363-8.913, p=0.009, respectively; score 2: HR=5.509, 95%CI 2.144-14.158, p<0.001; HR=5.521, 95%CI 2.074-14.697, p=0.001, respectively) was an independent predictor for overall survival and cancer specific survival. The evaluation of preoperative FA score can be regarded as an independent prognostic factor for predicting overall survival and cancer specific survival in UTUC. The fibrinogen and albumin levels are low cost and easy accessibility in clinical practice.This study is to clarify the prognostic value of preoperative plasma fibrinogen and serum albumin level, as known as FA score, in a cohort of Chinese patients with upper urinary tract urothelial carcinoma (UTUC). We retrospectively evaluated clinicopathological data on 169 patients who underwent surgery between 2006 and 2013. The FA score was calculated based on cutoff values of 3.53g/L for fibrinogen and 43.56 g/L for albumin. Overall survival and cancer specific survival was assessed using the Kaplan-Meier method and the equivalences of the curves were tested by log-rank tests. The Cox proportional hazards regression model was applied in univariate and multivariate analyses. In univariate analysis, tumor size, tumor grade, pathological T stage and FA score were significantly associated with overall survival and cancer specific survival, and multivariate Cox proportional hazards regression analysis identified FA score (score 1: HR=3.486, 95%CI 1.358-8.948, p=0.009; HR=3.485, 95%CI 1.363-8.913, p=0.009, respectively; score 2: HR=5.509, 95%CI 2.144-14.158, p<0.001; HR=5.521, 95%CI 2.074-14.697, p=0.001, respectively) was an independent predictor for overall survival and cancer specific survival. The evaluation of preoperative FA score can be regarded as an independent prognostic factor for predicting overall survival and cancer specific survival in UTUC. The fibrinogen and albumin levels are low cost and easy accessibility in clinical practice.

Clinical characteristics and pathology of thyroid‑like follicular carcinoma of the kidney: Report of 3 cases and a literature review

Thyroid-like follicular carcinoma (TLFC) of the kidney is an extremely rare type of renal tumor, which has not been classified under a known subtype of renal cell carcinoma. It is histologically similar to the primary thyroid follicular carcinoma; however, the characteristics lack thyroid immunohistochemical markers. The aim of the present study was to illustrate the clinical characteristics of 3 new cases along with a review of the literature. The patients were compared with regards to gender, age, location and size of the tumor, imageology, morphology, immunohistochemistry and prognosis. According to the limited data, TLFC occurs mainly in young women and its clinical manifestations have no difference with other renal tumors. Its imageological features resemble a large spectrum of benign and malignant renal and extra-renal conditions, which should be eliminated in the diagnostic process. Confirmed diagnosis depends on the examination of pathology and immunohistochemistry. Surgical ablation is the preferred therapeutic method. Currently, TLFC has a relatively good prognosis; however, this conclusion requires further cases and long-term follow-ups. Improving the understanding of TLFC can help avoid misdiagnosis and prevent inappropriate treatment.

CCL17-CCR4 axis promotes metastasis via ERK/MMP13 pathway in bladder cancer: ZHAO et al.

As an important chemokine receptor, the role of CCR4 in the progression of bladder cancer (BC) remains unknown. In this study, we have shown that CCR4 expression was upregulated in bladder carcinoma tissues compared with adjacent nontumor tissues. Kaplan‐Meier survival analysis revealed that CCR4 expression was an independent prognostic risk factor in BC patients, and the addition of CCL17 induced CCR4 production and promoted migration and invasion of BC cells. In addition, CCR4 knockdown significantly attenuated the migratory and invasive capabilities of BC cells. Mechanistically, CCL17‐CCR4 axis is involved in ERK1/2 signaling and could mediate the migration and invasion of BC cells by regulating MMP13 activation. This study suggests that CCR4 might represent a promising prognostic biomarker and a potential therapeutic option for BC.

Endogenous H2S sensitizes the PAR4-induced bladder pain

Bladder pain is a prominent symptom of interstitial cystitis/painful bladder syndrome. Hydrogen sulfide (H2S) generated by cystathionine β-synthase (CBS) or cystathionine γ-lyase (CSE) facilitates bladder hypersensitivity. We assessed involvement of the H2S pathway in protease-activated receptor 4 (PAR4)-induced bladder pain. A bladder pain model was induced by intravesical instillation of PAR4-activating peptide in mice. The role of H2S in this model was evaluated by intraperitoneal preadministration of d,l-propargylglycine (PAG), aminooxyacetic acid (AOAA), or S-adenosylmethionine or the preintravesical administration of NaHS. SV-HUC-1 cells were treated in similar manners. Assessments of CBS, CSE, and macrophage migration inhibitory factor (MIF) expression, bladder voiding function, bladder inflammation, H2S production, and referred bladder pain were performed. The CSE and CBS pathways existed in both mouse bladders and SV-HUC-1 cells. H2S signaling was upregulated in PAR4-induced bladder pain models, and H2S-generating enzyme activity was upregulated in human bladders, mouse bladders, and SV-HUC-1 cells. Pretreatment with AOAA or NaHS inhibited or promoted PAR4-induced mechanical hyperalgesia, respectively; however, PAG only partially inhibited PAR4-induced bladder pain. Treatment with PAG or AOAA decreased H2S production in both mouse bladders and SV-HUC-1 cells. Pretreatment with AOAA increased MIF protein levels in bladder tissues and cells, whereas pretreatment with NaHS lowered MIF protein levels. Bladder pain triggered by the H2S pathway was not accompanied by inflammation or altered micturition behavior. Thus endogenous H2S generated by CBS or CSE caused referred hyperalgesia mediated through MIF in mice with PAR4-induced bladder pain, without causing bladder injury or altering micturition behavior.

AB048. Preoperative prognostic nutritional index and nomogram predicting recurrence-free survival in patients with primary non-muscle invasive bladder cancer without carcinoma in situ

Background To clarify the prognostic values of serum albumin and peripheral lymphocyte count in patients with non-muscle invasive bladder cancer (NMIBC) and establish a nomogram to predict recurrence-free survival (RFS). Methods The prognostic nutritional index (PNI) was calculated based on optimal cutoff values of 52.57. RFS was assessed using the Kaplan-Meier method and the equivalences of survival curves were tested. The Cox proportional hazards regression model was applied in univariate and multivariate analyses. Results In univariate analysis, age, tumor focality, tumor size, tumor grade, T stage and PNI were associated with RFS. And multivariate analysis identified PNI was an independent predictor for RFS in patients with NMIBC. And nomogram for the prediction of recurrence was developed. Conclusions The evaluation of PNI can be regarded as an independent prognostic factor for predicting RFS in patients with NMIBC. The nomogram could be useful for improving the personalized multidisciplinary therapy for patients with NMIBC.

AB149. Is two-layer suture necessary in laparoscopic partial nephrectomy?

Objective We intend to discuss the applications of various suture techniques and the necessity of two-layer suture in the wound suturing in the laparoscopic partial nephrectomy. Methods A literature search and review in the PubMed and Wanfang databases was conducted with the key words of ‘two-layer suture’ and ‘laparoscopic partial nephrectomy’. Results It is believed currently that there exist many different methods of sutures and compared to single-layer suture, two-layer suture is a relatively stable and safe kind of suture, which can shorten the warm ischemic time and reduce the incidence of complications. However, it also can increase the difficulty in operating for surgeons and impair the functional renal preservation. Conclusions So it is supposed to weigh the advantages and disadvantages of two-layer suture and single-layer suture flexibly and make the proper clinical choice.

AB194. A 12-year retrospective evaluation of TVT and TVT-O in the surgical management of SUI in females and the analysis of influence factors

Objective We evaluate the clinical effect of TVT and TVT-O slings in the surgical management of SUI in women at mostly 12-year follow-ups and the factors that influence it. Methods In this retrospective analysis, 94 women with stress incontinence treated by TVT (14 cases) or TVT-O (80 cases) were included. Subjective evaluation included ICIQ-SF, KHQ, PGI-I and patient satisfaction, and we recorded the objective data of the procedures. We analyzed whether the age, BMI, disease duration, surgery history, postoperative follow-up duration or other factors were related to the subjective cure rate. Results Eight cases of TVT and 59 cases of TVT-O completed the follow-up. Patients were followed up for 1.3–12 years in TVT and 0.2–9.2 years in TVT-O group. The rates of subjectively assessed success were 87.5% and 84.7%, respectively (P=1.00). The total KHQ were (21.93±30.42) and (16.89±25.85) (P=0.55). The operation duration were (59.29±21.02) in TVT group and (29.87±12.04) in TVT-O group (P=0.00). The postoperative days of indwelling catheter were (4.14±1.79) and (3.11±1.51) (P=0.02), and the post-operation hospitalization days were (5.64±2.06) and (5.01±1.77) (P=0.27). The factors above didn’t affect the subjective cure rate. Conclusions The patient reported long-term success rate were both high and had no significant differences between the groups. Operation duration and postoperative durations of indwelling catheter of TVT-O was shorter. The factors above didn’t affect the subjective cure rate.

AB151. Meta-analysis: comparison of partial nephrectomy and radiofrequency ablation in small renal tumors

Objective Comparison of partial nephrectomy and radiofrequency ablation in small renal tumors Methods We searched through the major medical databases such as PubMed, EMBASE, Medline, Science Citation Index, Web of Science and Chinese National Knowledge Infrastructure Database (CNKI) and Database of Chinese Ministry of Science & Technology (Wanfang) for all published studies without any limit on language until May 2015. The following search terms were used: partial nephrectomy, radiofrequency ablation, renal cell carcinoma, small renal tumor or mass. Furthermore, additional related studies were manually searched in the reference lists of all published reviews and retrieved articles. Results In this meta-analysis, there are not statistically differences between groups in 5y-DFS, recurrence rate and complications between RFA and PN. However, RFA has a lower rate of percentage change of decease rate in GFR than PN in terms of short-mediate follow-up time. Ultimately, the role of RFA and PN for small renal tumor remains to be defined and, ideally, this novel approach should be compared with PN in a well-designed, large, prospective, randomized and matched study before gaining wider acceptance. Conclusions In this meta-analysis, there are not statistically differences between groups in 5y-DFS, recurrence rate and complications between RFA and PN. However, RFA has a lower rate of percentage change of decease rate in GFR than PN in terms of short-mediate follow-up time. Ultimately, the role of RFA and PN for small renal tumor remains to be defined and, ideally, this novel approach should be compared with PN in a well-designed, large, prospective, randomized and matched study before gaining wider acceptance.

AB257. The study of the influence of the changes in alpha 1-adrenergic receptor and NGF on the diabetic urethral function

Background To study the influence of the changes in the α1-adrenergic receptor and NGF/ProNGF pathway on the diabetic urethral function. Methods A total of 20 female Wistar rats were divided into two groups equally at random. Urethral function was examined by recordings of bladder pressure and urethral perfusion pressure (UPP). The expression of α1-adrenergic receptor in the urethra was measured via RT-qPCR and ELISA method. The expression of nerve growth factor (NGF) in the urethra was measured via RT-qPCR and ELISA method. The expression of proNGF, P75NTR and sortilin in the urethra was measured by western blotting. Results The lowest urethral pressure (UPP nadir) during urethral relaxation was higher in diabetic rats. The UPP nadir and baseline UPP in diabetic rats was significantly decreased by intravenous administration of the α1-adrenoceptor antagonist (tamsulosin). The α1a and α1d adrenergic receptor in the urethra of the diabetic group was significantly increased via RT-qPCR and western blotting (P<0.05). The RT-qPCR and ELISA studies showed a significant decrease of NGF and the western blotting studies showed a significant increase of proNGF (P<0.05). There was a statistical decrease of the P75NTR in the urethras of diabetic rats (P<0.05) and no significant difference concerning sortilin between two groups (P>0.05). Conclusions The increase in the expression of α1-adrenoceptor and changes of the NGF/ProNGF pathway in the diabetic urethral was a possible mechanism of the diabetic urethral dysfunction.

AB258. Effect and mechanism of grape seed proanthocyanidin extract (GSPE) on diabetes-induced bladder dysfunction

Background To explore the effect and mechanism of grape seed proanthocyanidin extract (GSPE) on diabetes-induced bladder dysfunction. Methods Female Wistar rats was divided into 3 groups at random: Control group, STZ induced diabetes group and GSPE administrated diabetic group. Urodynamic method was used to examine the bladder pressure of the rats. The quantity of MDA and the activities of SOD and GSH-Px was examined by related assay. Results Compared with the control group, the bladder contraction pressure in diabetic group decreased and after GSPE administration, the bladder function of the diabetic rats was improved significantly (P<0.05). The bladder structure in diabetic group was damaged and some inflammatory cells infiltration and GSPE could improve it. Compared with the control group, the quantity of MDA was increased and the activities of SOD and GSH-Px were decreased in diabetic group (P<0.05) while GSPE could reverse the changes of MDA, SOD and GSH-Px. Conclusions GSPE could ameliorate diabetic bladder dysfunction which may be associated with its antioxidant activities.