ABSTRACT
Purpose@#Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. @*Materials and Methods@#Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. @*Results@#Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. @*Conclusion@#After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.
ABSTRACT
At present, the application of artificial intelligence in the diagnosis of renal cell carcinoma (RCC) is still at an early stage. There were more reports of imaging diagnosis than pathology. Studies of imaging diagnosis mainly focused on using artificial intelligence to identify benign and malignant renal tumors and predict pathological types of RCC by computed tomography. However, there were no reports of artificial intelligence in diagnosing RCC by magnetic resonance imaging. Studies of pathological diagnosis were mainly about the classification of the nucleus. In the future, artificial intelligence has great development potential in the diagnosis of RCC, and further research is needed.
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Objective To improve the accuracy of preoperative diagnosis of renal vein tumor thrombus in renal cell carcinoma (RCC),the clinical characteristics of RCC with misdiagnosis of renal vein tumor thrombus (RVTT) were analyzed.Methods Clinical data of 128 patients with RCC accompanied with RVTT from January 2000 to September 2015 were studied retrospectively.According to whether RVTT failed to be detected preoperatively,all patients were divided into 39 cases of misdiagnosis group and 89 cases of no misdiagnosis group.Forty cases of RCC with pathologically confirmed no RVTT were selected as no tumor thrombus group from January 2015 to June 2015.Misdiagnosis group included 29 males and 10 females,with age of (61.4 ± 11.1) years old,body mass index of (26.74 ±3.12) kg/m2,KPS ＜80 in 2 cases,paraneoplastic syndrome and Mayo grade 0 in 1 case.No misdiagnosis group consisted of 74 males and 15 females,with age of (60.2 ± 9.7) years old,body mass index of (25.12 ± 1.93) kg/m2,KPS ＜ 80 in 5 cases,paraneoplastic syndrome and Mayo grade 0 in 7 cases.No tumor thrombus group comprised of 31 males and 9 females,with age of (59.5 ± 10.7) years old,body mass index of (24.48 ± 2.56) kg/m2,KPS ＜ 80 in 3 cases,and paraneoplastic syndrome in 3 cases.There was no significant difference in general clinical data between misdiagnosis group and no misdiagnosis group,and misdiagnosis group and no tumor thrombus group (P ＞ 0.05).The tumor location,tumor diameter and imaging data were compared between misdiagnosis group and no misdiagnosis group,and misdiagnosis group and no tumor thrombus group.Results There was no significant difference in term of tumor locating in the middle pole [56.4％ (22/39) vs.38.2％ (34/89)],tumor with collateral vessels [33.3％ (13/39) vs.31.5％ (28/89)] and renal vein contrast agents filling defect [42.9％ (9/21) vs.61.8％ (21/34)] between misdiagnosis group and no misdiagnosis group (P ＞ 0.05).The proportion of renal tumor locating in the middle pole,tumor with collateral vessels and renal vein contrast agents filling defect in misdiagnosis group was significantly higher than that of no tumor thrombus group [30.0％ (12/40),P =0.018;10.0％ (4/40),P =0.012;16.7％ (4/24),P =0.002].Conclusions RVTT is vulnerable of misdianosis in RCC.It should be alert to the possibility of complicating tumor thrombus in the presence of renal tumor locating in the middle pole,renal tumor with collateral vessels and renal vein contrast agents filling defect.The clinical understanding of these features should be improved.
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Objective To investigate the protective effects of the ethanol extract of Zingiber officinale against focal hepatic ischemia-reperfusion injury in rats and itspossible mechanism.Methods The rats were randomly divided into six groups: sham operation group, model control group, ethanol extract of Zingiber officinale 100, 200, 400 and 600 mg/kg per-treated groups. The rats in the sham operation group and the model control group were given equal volume of saline by intragastric administration, once a day; two weeks later, the model were made. Except the sham operation group, the focal hepatic ischemia-reperfusion rats models were established in other groups. Two hours after ischemic-reperfusion, the activity of SOD/GSH-Px and the content of MDA in hepatic tissue were determined; the contents of ALT, AST and LDH in serum were determined; the histopathological changes and hepatocyte apoptosis were observed.Results Compared with the model control group, the activity of SOD in hepar tissue of Ethanol extract of Zingiber officinale 100, 200, 400 and 600 mg/kg per-treated groups (7.37 ± 1.89 U/mg, 10.18 ± 2.42 U/mg, 10.50 ± 2.31 U/mg, 11.17 ± 2.83 U/mgvs. 5.61 ± 1.72 U/mg) were significantly increased (P<0.05,P<0.01), the activity of GSH-Px (11.31 ± 2.64 U/mg, 13.07 ± 3.72 U/mg, 14.63 ± 3.40 U/mg, 15.14 ± 3.81 U/mgvs. 10.92 ± 2.25 U/mg) were significantly increased (P<0.05,P<0.01), and the content of MDA (8.53 ± 2.05 nmol/mg, 5.44 ± 1.37 nmol/mg, 5.20 ± 1.18 nmol/mg, 4.96 ± 1.42 nmol/mgvs. 10.26 ± 2.27 nmol/mg) were significantly decreased (P<0.05,P<0.01); the content of ALT in serum of the ethanol extract of Zingiber officinale 100, 200, 400 and 600 mg/kg per-treated groups (974.62±341.53 U/L, 621.83 ± 214.37 U/L, 553.75 ± 173.48 U/L, 517.92 ± 204.26 U/Lvs. 1 429.27 ± 618.33 U/L), AST (624.17 ± 148.62 U/L, 456.83 ± 127.35 U/L, 407.54 ± 141.49 U/L, 361.90 ± 104.73 U/Lvs. 957.61 ± 346.82 U/L), LDH (1 082.49 ± 312.35 U/L, 897.33 ± 242.76 U/L, 828.42 ± 265.84 U/L, 776.58 ± 182.47 U/Lvs. 1 385.61 ± 543.74 U/L) were all significantly decreased(P<0.05,P<0.01); and the histopathological changes and the hepatocyte apoptosis were significantly improved compared with the model control group.Conclusions The ethanol extract of Zingiber officinale could effectively reduce the damage of free radical, improve hepatic function, inhibit the histopathological changes and hepatocyte apoptosis, suggesting that the ethanol extract of Zingiber officinale had protective effects against focal hepatic ischemia-reperfusion injury in rats.