Ephrin-B1 Is a Novel Biomarker of Bladder Cancer Aggressiveness. Studies in Murine Models and in Human Samples.

Bladder cancer (BC) is the ninth most common cancer worldwide, but molecular changes are still under study. During tumor progression, Epithelial cadherin (E-cadherin) expression is altered and ß-catenin may be translocated to the nucleus, where it acts as co-transcription factor of tumor invasion associated genes. This investigation further characterizes E-cadherin and ß-catenin associated changes in BC, by combining bioinformatics, an experimental murine cell model (MB49/MB49-I) and human BC samples. In in silico studies, a DisGeNET (gene-disease associations database) analysis identified CDH1 (E-cadherin gene) as one with highest score among 130 BC related-genes. COSMIC mutation analysis revealed CDH1 low mutations rates. Compared to MB49 control BC cells, MB49-I invasive cells showed decreased E-cadherin expression, E- to P-cadherin switch, higher ß-catenin nuclear signal and lower cytoplasmic p-Ser33-ß-catenin signal, higher Ephrin-B1 ligand and EphB2 receptor expression, higher Phospho-Stat3 and Urokinase-type Plasminogen Activator (UPA), and UPA receptor expression. MB49-I cells transfected with Ephrin-B1 siRNA showed lower migratory and invasive capacity than control cells (scramble siRNA). By immunohistochemistry, orthotopic MB49-I tumors had lower E-cadherin, increased nuclear ß-catenin, lower pSer33-ß-catenin cytoplasmic signal, and higher Ephrin-B1 expression than MB49 tumors. Similar changes were found in human BC tumors, and 83% of infiltrating tumors depicted a high Ephrin-B1 stain. An association between higher Ephrin-B1 expression and higher stage and tumor grade was found. No association was found between abnormal E-cadherin signal, Ephrin-B1 expression or clinical-pathological parameter. This study thoroughly analyzed E-cadherin and associated changes in BC, and reports Ephrin-B1 as a new marker of tumor aggressiveness.

Functional and Objective Results of Urinary Undiversions in Oncologic Patients.

OBJECTIVE: To review surgical outcomes in urinary undiversions and describe short and long-term complications. METHODS: Retrospective review of patients who underwent urinary undiversion in our institution between May 2010 and May 2016. Complications were graded according to the Clavien classification. All patients completed the Patient Global Impression of Improvement questionnaire to indicate overall satisfaction with urinary undiversion. RESULTS: Median time from the cystectomy to undiversion was 29 months (range 11-53 months). Five patients (55%) reported significant distress related to the ileal conduit and were undiverted into an orthotopic neobladder. A female patient with an orthotopic neobladder and severe urinary incontinence received neobladder neck closure and catheterizable channel. Another female patient with an orthotopic neobladder was undiverted into an Indiana Pouch. Complications during the first 60 days were mostly minor, Clavien I (1 patient), 5 patients Clavien II, and a patient with Clavien IIIb. Patient Global Impression of Improvement questionnaire scores showed that 6 patients (67%) felt "Very much better" and 3 patients (33%) felt "Much better" after urinary undiversion 60%. CONCLUSION: After urinary undiversions, minor complication rate is high, and major complication rate is considerable. Urinary undiversions are a highly complex, yet feasible procedure, which requires experienced multidisciplinary teams and demands appropriate patient selection. Patients, after undiversions show a high degree of satisfaction with long-term satisfactory outcomes, which points out the need for consideration for these procedures once the oncologic disease is controlled.

A case of emphysematous cystitis caused by Klebsiella pneumoniae.

Emphysematous cystitis is a rare type of urinary tract infection that is characterized by air pockets within the bladder wall and lumen, which come from gas that is mainly produced by gram-negative bacteria, notably Escherichia coli. This infection is more common in older women with poorly controlled diabetes. An abdominal computerized tomography (CT) scan is the gold standard method to make the diagnosis. The infection can be life-threatening, so prompt treatment is essential. We present a case of a 39-year-old woman with poorly controlled type 2 diabetes who developed emphysematous cystitis after a bilateral adrenalectomy. The infection was diagnosed by a CT scan that revealed gas in the bladder wall. A urine culture revealed 106 colonies/mL of Klebsiella pneumoniae. After a month of treatment with intravenous antibiotics (vancomycin plus meropenem plus colistin), bladder drainage, and strict glycemic control, the patient had a good outcome.