Abstract Background The impact of lower urinary tract symptoms (LUTS) on the quality of life of patients with benign prostatic hyperplasia (BPH) has been rarely reported. Additionally, the challenges faced by these patients in seeking medical care have often been overlooked. In order to explore the personal struggles caused by LUTS and the difficulties or barriers experienced by Chinese patients with BPH when seeking help, we conducted a qualitative interview study. Methods Qualitative interviews were conducted among 46 patients with BPH who were hospitalized in three tertiary hospitals in China from July 2021 to November 2022. Grounded theory was adopted as the methodology for the qualitative study. After obtaining written informed consent from the study participants, semi-structured interviews were conducted according to the question guidelines. The interview process was audio-recorded; subsequently, the recordings were transcribed, coded, and thematically analyzed. Results The difficulties faced by Chinese patients with BPH were classified into seven main themes: (i) disturbed life, (ii) mental burden, (iii) disease cognition and communication, (iv) delayed treatment, (v) medication status, (vi) hospital visits barriers, and (vii) medical insurance issues. Further, each theme was subdivided into 2–5 sub-themes. Conclusions LUTS have a certain effect on the life and spirit of patients with BPH. These patients face different degrees of difficulties in treatment and hospital visits. Therefore, better healthcare systems and additional social support are crucial for improving the current plight of these patients.
BACKGROUND:This study investigated the correlation of programmed death 1 (PD-1) and T cell immunoglobulin and ITIM domain (TIGIT) with clinicopathological characteristics of renal cell carcinoma (RCC) and explored the biological roles of both proteins in the development, metastasis, and invasion of RCC. MATERIAL AND METHODS:The expressions of PD-1 and TIGIT were detected in the RCC and adjacent normal tissues, and their correlation with the clinicopathological characteristics of RCC, relationship between PD-1 and TIGIT in RCC, and the correlation of PD-1 and TIGIT expression with distance of adjacent normal tissues to RCC were further evaluated. RESULTS:TIGIT and PD-1 expression was detectable in the immune cells of peripheral blood mononuclear cells and lymphoid tumor infiltrating lymphocytes, and TIGIT expression was significantly higher than PD-1 expression in the same sample. Cells with transparent cytoplasm were diffuse, and several cells showed dark nuclear staining with mild atypia; the interstitium was rich in blood vessels and had mild fibrous hyperplasia, and immunofluorescence staining showed cells were positive for TIGIT. The expression of PD-1 and TIGIT was significantly different between RCC and adjacent normal tissues (P<0.05). Positive PD-1 expression was closely related to tumor size and Fuhrman grade (P<0.05). The expression of TIGIT and PD-1 was related to the distance of adjacent normal tissues to RCC (P<0.05).CONCLUSIONS:The activation of PD-1 and TIGIT may exert negative regulatory effects and inhibit the immune response to cancer cells, resulting in immune escape of cancer cells. Both PD-1 and TIGIT may serve as potential targets for the treatment of RCC.
The prognostic significance of E-cadherin expression in bladder cancer (BC) has been elevated for years, but published results remain controversial and inconsistent. We thus performed a systematic review and meta-analysis to determine the association between E-cadherin expression and BC prognosis. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases to identify eligible studies published until March 2017. On the basis of our inclusion and exclusion criteria, a total of 2,089 patients from 19 studies were eligible for final analysis. Our results showed that reduced E-cadherin expression in BC was associated with poor overall survival (hazard ratio [HR] = 2.73, 95% CI: 1.74-4.27, p < 0.001), poor progression-free survival (HR = 6.39, 95% CI: 3.48-11.73, p < 0.001), and poor recurrence-free survival (HR = 2.48, 95% CI: 1.68-3.64, p < 0.001). Moreover, reduced E-cadherin expression was significantly correlated with pathological T stage (T2-4 vs. Ta-1: risk ratio [RR] = 2.14, 95% CI: 1.70-2.71), metastasis (yes vs. no: RR = 1.68, 95% CI: 1.17-2.40), grade (3 vs. 1/2: RR = 1.58, 95% CI: 1.29-1.93), and carcinoma in situ (yes vs. no: RR = 1.68, 95% CI: 1.09-2.58). This meta-analysis suggested that reduced E-cadherin expression was associated with poor prognosis and advanced clinicopathological characteristics and can serve as a useful biomarker for the clinical management of BC.
Abstract Background Prostate biopsy is still unavoidable in patients with a rising prostate‐specific antigen even though multiparametric magnetic resonance imaging (MRI) is widely used. 18 F‐DCFPyL positron emission tomography (PET)/MRI was proved to be promising both in sensitivity and specificity. But its guiding fusion biopsy and the advantages in the diagnosis of prostate disease is seldom reported. This study aimed to verify the feasibility and advantage of 18 F‐DCFPyL PET/MRI‐guided fusion targeted biopsy (TB) over whole‐mount histopathology (WMH) for prostate cancer diagnosis. Methods A prospective study of 94 biopsy‐naïve patients were conducted using 18 F‐DCFPyL PET/MRI scans and scored on a scale of 1–4. Systematic biopsy was performed for all patients. Patients with suspicious lesions also underwent PET/MRI/transrectal ultrasound‐guided fusion biopsy. Patients with pathologically confirmed cancer underwent surgery and WMH sections. Systematic biopsy was compared with TB for the detection of index tumors (ITs). Significant cancer was defined as Grade group (GG) 2 or higher no matter the length of the cancer core. Results 18 F‐DCFPyL PET/MRI detected 30/94 (32%) patients with a score of 4, all of whom were verified to have prostate cancer. While it detected 10 patients with a score of 1 (10.6%), they were shown to have no cancer. The sensitivity and specificity of 18 F‐DCFPyL PET/MRI were 94.4% and 75%, respectively, if images with a score of 3 are defined as positive. Systematic biopsy detected 18% (203/1128) samples as prostate cancer; conversely, TB detected 113 samples out of 259 scores (43.6%). A statistically significant difference was seen between the PCa detection rates by TB and SB ( p < 0.001). All targeted lesions were pathologically proven to be the IT on WMH. Conclusions In biopsy‐naïve patients, the ultrasound fusion biopsy targeted by 18 F‐DCFPyL PET/MRI is an identical pathway for the detection of prostate cancer.
Cardiac resynchronization therapy (CRT) is an established treatment option for heart failure patients. However, the implementation of triple-chamber pacemakers can be cost-prohibitive. His-Purkinje system pacing (HPSP) can also enable cardiac resynchronization, and it can be achieved with relatively inexpensive conventional pacemakers.This article aims to comparatively evaluate the cost of implanting devices in different CRT strategies to provide meaningful guidance for clinical decision-making by electrophysiologists.Data was collected on the prices, designed life, and price/designed life of multiple mainstream models of CRT-P, CRT-D, dual-chamber pacemakers, and single-chamber pacemakers that were sold in the Chinese market in 2022. The prices, designed lives, and price/designed life of different pacemaker models were then compared.The costs of CRT-P and CRT-D (13008.44 ± 2752.30 USD and 22043.36 ± 3676.25 USD) were significantly higher than those of conventional pacemakers (dual-chamber: 11142.39 ± 4273.85 USD and single-chamber: 5634.28 ± 2032.80 USD) (p < .05). Additionally, the price/designed life of conventional pacemakers (dual-chamber: 839.63 ± 258.62 US dollar/year and single-chamber: 435.86 ± 125.44 US dollar/year) was significantly better than that of CRT-P and CRT-D (1386.91 ± 266.73 and 2585.53 ± 520.27 US dollar/year, respectively) (p < .05).Conduction system pacing (CSP)-based CRT is more cost-effective than BVP-based CRT. Furthermore, CSP-based CRT can achieve cardiac resynchronization with conventional pacemakers and may be a good option for HF patients who do not need defibrillation.
Abstract Extended pelvic lymph node dissection (PLND) is recommended in high risk prostate cancer (PCa). We aim to identify the prognostic significance of removed lymph node count (RLNC) for patients with D’Amico high risk PCa and different lymph node metastasis risk (LNMR). We identified surgically treated D’Amico high risk PCa patients with the Surveillance, Epidemiology, and End Result (SEER) Plus database (2004-2019). Multivariable logistic regression model was established to predict lymph node metastasis risk (LNMR) in patients with RLNC over 6. Multivariable Cox regression analysis were used to assess the impact of RLNC on cancer-specific survival (CSS) and overall survival (OS). A total of 96875 patients were identified. 5261 patients (5.43%) had LN metastasis. The median and 75th percentile RLNC was 6 and 11. LNMR was calculated for every patients and all the patients were divided into four subgroups: LNMR<0.1, 0.1≤LNMR<0.2, 0.2≤LNMR<0.3, LNMR≥0.3. Multivariable Cox regression analysis showed that more RLNC was associated with better CSS and OS in LNMR≥0.3 subgroup (CSS: HR 0.78 (0.63, 0.96) p=0.0213 for cutoff 11 RLNC; OS: HR 0.85 (0.72, 0.99) p=0.0407 for cutoff 11 RLNC, HR 0.9891 (0.9796, 0.9987) p=0.0256 for continuous RLNC). More RLNC is associated with better CSS and OS when the LNMR is over 30%.
Objective To present our initial experience with pure transvaginal natural orifice translumenal endoscopic surgery renal cyst decortication. Methods From D ecember 2010 to J uly 2011, five female patients with symptomatic renal cyst in the anterior portion and lower pole of the kidney were submitted to pure transvaginal natural orifice translumenal endoscopic surgery renal cyst decortication in our center. Under general anesthesia, the patients were placed in the lithotomy position with the affected side elevated by 60°. A 3‐cm incision was made at the posterior vaginal fornix and a modified three‐channel port was deployed across the vaginal incision. The cyst was dissected and the cyst fluid was aspirated using a suction device. The cyst wall was circumferentially excised. Results All five procedures were successfully carried out without additional transabdominal trocars. The median operative time was 80 min (range 60–90 min). The median estimated blood loss was 25 mL (range 25–50 mL). The median visual analog scale score was 1 on postoperative day 1. None of the patients required narcotic pain medications beyond postoperative day 2. Intestinal function recovered on postoperative day 1–3. There was no intraoperative or postoperative complication in any of the patients. During the follow‐up visits, all the patients were in good condition. All the patients reported unaltered sexual function after surgery by the F emale S exual F unction I ndex questionnaire. Conclusion Our initial experience suggests that pure transvaginal natural orifice translumenal endoscopic surgery renal cyst decortication is feasible and safe in selected patients.
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