低频电刺激结合康复训练对脊髓损伤神经源性膀胱患者排尿症状、膀胱功能及生活质量的影响

目的:探讨低频电刺激结合康复训练对脊髓损伤(SCI)诱发神经源性膀胱(NB)患者排尿症状、膀胱功能及生活质量的影响。方法:选取2017年3月～2019年12月期间我院收治的SCI诱发NB患者97例,根据随机数字表法分为对照组(n=48)和研究组(n=49),对照组患者予以康复训练,研究组在对照组基础上联合低频电刺激,比较两组患者排尿症状、膀胱功能、生活质量及并发症发生情况。结果:两组治疗2周后、治疗4周后日膀胱内压力、24 h单次排尿量、排尿次数、膀胱容量均较治疗前增加,且研究组高于对照组(P0.05);残余尿量均较治疗前下降,且研究组低于对照组(P0.05)。两组治疗2周后、治疗4周后膀胱功能积分均较治疗前下降,且研究组低于对照组(P0.05)。两组治疗4周后情感职能、躯体疼痛、精神健康、活力、生理职能、生理机能、健康状况、社会功能维度评分均升高,且研究组高于对照组(P0.05)。研究组并发症总发生率低于对照组(P0.05)。结论:低频电刺激结合康复训练治疗SCI诱发NB患者,可有效改善患者排尿症状,提高其膀胱功能及生活质量,同时还可减少并发症发生率,具有一定的临床应用价值。     

FAM83H-AS1 is associated with clinical progression and modulates cell proliferation,migration, and invasion in bladder cancer

FAM83H-AS1, also known as oncogenic long noncoding RNA (lncRNA)-3, is a novel lncRNA that has been suggested to be dysregulated in a variety of human cancers. However, the expression status and function of FAM83H-AS1 in bladder cancer are still unknown. The object of our study is to explore the clinical value of FAM83H-AS1 in patients with bladder cancer and the biological function of FAM83H-AS1 in bladder cancer cells. In our results, the expression of FAM83H-AS1 was obviously elevated in bladder cancer tissue samples and bladder cancer cell lines compared with adjacent normal tissue samples and normal bladder epithelial cell lines, respectively. In addition, high expression of FAM83H-AS1 was associated with advanced clinical stage and the presence of muscularis invasion and served as an independent poor prognostic factor for overall survival in patients with bladder cancer. The loss-of-function study showed that silencing FAM83H-AS1 expression suppressed cell proliferation, migration, and invasion and induced cycle arrest at G0/G1 phase. In conclusion, FAM83H-AS1 is involved in the progression of bladder cancer and serves as a prognostic biomarker and potential therapeutic target for patients with bladder cancer.     

Sacral anterior root stimulation for bladder control: clinical results

The Brindley bladder stimulator delivers intermittent stimulation to the anterior sacral roots. The stimulus parameters can be adjusted and set specifically for individuals. Its primary purpose is to improve bladder emptying, thereby to eliminate urinary infection and to preserve kidney function. It also assists in defecation and enables male patients to have a sustained full erection. In our unit so far 38 patients with a complete spinal cord lesion have received a Brindley bladder stimulator implant. One patient died 2 weeks after the surgery due to pulmonary embolism. Two other patients died due to unrelated causes during the follow up period. They used their implants for less than 1 year. Results relating to these 2 patients and the remaining 35 patients who regularly use their implant are presented. The follow-up period ranged from 3 months to 12 years. Residual urine volumes are substantially reduced in all patients; in 24 patients the residual urine volume is less than 30 ml. All patients have increased bladder capacity. Thirty-one patients are continent. Out of 33 males 29 can achieve a sustained full erection using the stimulator. Twenty-seven patients use the implant for bowel function. The following complications were encountered: (1.) Cerebro-spinal fluid collection occurred around the implant in 3 patients during the post-operative period; (2.) Receiver failure occurred in 3 patients. A successful replacement with a new receiver block was carried out in these cases. It is concluded that the use of a bladder stimulator in selected patients gives long term favourable results.     

三维适形放疗联合GT化疗方案对晚期膀胱癌患者免疫功能、生活质量及肿瘤标志物水平的影响

目的:探讨三维适形放疗联合吉西他滨及多西他赛(GT)化疗方案对晚期膀胱癌患者免疫功能、生活质量及肿瘤标志物水平的影响。方法:选取2015年3月~ 2018年8月期间我院收治的晚期膀胱癌患者98例,采用随机数字表法将患者分为两组,其中对照组49例患者,接受GT化疗,观察组49例患者,三维适形放疗联合GT化疗,均以4周为1个疗程,治疗4个疗程。观察两组治疗4个疗程后的疗效以及不良反应发生情况,对比两组治疗前、治疗4个疗程后的免疫功能、生活质量及肿瘤标志物水平,随访2年,观察两组患者生存率。结果:观察组的临床总有效率为53.06%(26/49),高于对照组的30.61%(15/49),差异有统计学意义(P<0.05)。两组不良反应发生率组间对比差异无统计学意义(P>0.05)。治疗4个疗程后,与对照组相比,观察组的CD8⁺更低,CD3⁺、CD4⁺、CD4⁺/CD8⁺更高(P<0.05)。治疗4个疗程后,与对照组相比,观察组的膀胱肿瘤抗原(BTA)、核基质蛋白22(NMP22)、尿膀胱癌抗原(UBC)更低,差异有统计学意义(P<0.05)。治疗4个疗程后,与对照组相比,观察组的物质功能、心理功能、社会功能、躯体功能各维度评分及总分更高(P<0.05)。观察组的生存率高于对照组(P<0.05)。结论:三维适形放疗联合GT化疗可有效阻止晚期膀胱癌患者疾病进展,减轻免疫抑制,同时治疗期间不会增加不良反应发生率,可促进患者生活质量改善,疗效可靠。     

腹腔镜根治性膀胱全切除联合回肠原位新膀胱术对膀胱癌患者免疫功能和生活质量的影响

目的:探讨腹腔镜根治性膀胱全切除联合回肠原位新膀胱术对膀胱癌患者免疫功能和生活质量的影响。方法:选取2016年7月到2017年8月在我院进行治疗的膀胱癌患者90例,患者均采用根治性膀胱全切除联合回肠原位新膀胱术治疗,其中50例行开放性根治性膀胱全切除联合回肠原位新膀胱术,作为对照组;40例行腹腔镜根治性膀胱全切除联合回肠原位新膀胱术,作为观察组。记录患者围手术期指标及并发症,比较两组患者的尿动力学指标和免疫功能变化情况以及SF-36量表评分。结果:观察组患者的手术时间长于对照组,术中出血量、住院时间、胃肠功能恢复时间均短于对照组(P<0.05)。两组患者的膀胱容量、最大尿流率、充盈期膀胱压力、排尿时最大膀胱压、最大尿道压、残留尿量和总并发症发生率比较无差异(P>0.05)。术后3 d,两组患者的CD3^+、CD4^+、CD4^+/CD8^+水平均有所下降,CD8^+水平有所上升(P<0.05),且观察组的CD3^+、CD4^+、CD4^+/CD8^+水平高于对照组,CD8^+水平低于对照组(P<0.05)。术后1个月两组患者的生理职能、生理机能、健康状况、躯体疼痛、社会功能、精力、情感职能以及精神健康评分均有增加(P<0.05),且观察组的生理职能、健康状况、精力、情感职能以及精神健康评分明显高于对照组(P<0.05)。结论:与开放手术相比,腹腔镜根治性膀胱全切除联合回肠原位新膀胱术手术时间更长,但术中出血量少,患者术后恢复快,且手术对患者的免疫功能影响较小,可显著提升患者的生活质量。     

Initiation of Bladder Voiding with Epidural Stimulation in Paralyzed,Step Trained Rats

The inability to control timely bladder emptying is one of the most serious challenges among the several functional deficits that occur after a complete spinal cord injury. Having demonstrated that electrodes placed epidurally on the dorsum of the spinal cord can be used in animals and humans to recover postural and locomotor function after complete paralysis, we hypothesized that a similar approach could be used to recover bladder function after paralysis. Also knowing that posture and locomotion can be initiated immediately with a specific frequency-dependent stimulation pattern and that with repeated stimulation-training sessions these functions can improve even further, we reasoned that the same two strategies could be used to regain bladder function. Recent evidence suggests that rats with severe paralysis can be rehabilitated with a multisystem neuroprosthetic training regime that counteracts the development of neurogenic bladder dysfunction. No data regarding the acute effects of locomotion on bladder function, however, were reported. In this study we show that enabling of locomotor-related spinal neuronal circuits by epidural stimulation also influences neural networks controlling bladder function and can play a vital role in recovering bladder function after complete paralysis. We have identified specific spinal cord stimulation parameters that initiate bladder emptying within seconds of the initiation of epidural stimulation. The clinical implications of these results are substantial in that this strategy could have a major impact in improving the quality of life and longevity of patients while simultaneously dramatically reducing ongoing health maintenance after a spinal cord injury.     

Lumbar spondylosis and neuropathic bladder: investigation of 73 patients with chronic urinary symptoms.

Seventy-three patients presented with either chronic urinary symptoms such as incontinence, retention, and recurrent urinary infection or chronic low back pain and neurogenic claudication. Lumbar spondylosis was considered to be the major cause of the urological and skeletal symptoms; the diagnosis of a neuropathic bladder depended as much on features in the history as on the results of urological and neurological investigations. The preoperative demonstration of significant lumbar spondylosis was often difficult, but decompressive laminectomy in 34 patients produced relief of urinary symptoms and improvement in bladder function in 75%.     

保留盆腔自主神经的宫颈癌根治术对Ib期宫颈癌患者性生活质量及膀胱直肠功能的影响

目的:探讨保留盆腔自主神经的宫颈癌根治术对Ib期宫颈癌患者性生活质量及膀胱直肠功能的影响。方法:选取我院于2010年1月~2017年1月期间收治的90例Ib期宫颈癌患者为研究对象,按乱数表法分为对照组和观察组,每组患者各45例。对照组患者采用传统的宫颈癌根治术治疗,观察组采用保留盆腔自主神经的宫颈癌根治术治疗。比较两组患者的手术情况、性生活质量以及膀胱直肠功能。结果:相比于对照组,观察组患者的手术时间较长,但住院时间较短(P0.05)。观察组术后残余尿量100 m L、50 m L的时间、肛门排气时间、排便时间与对照组比较均明显较短(P0.05)。术后观察组性生活质量各项评分低于对照组(P0.05)。观察组并发症发生率为6.67%,明显低于对照组的22.22%(P0.05)。结论:保留盆腔自主神经的宫颈癌根治术治疗Ib期宫颈癌患者临床疗效显著,有利于患者术后膀胱直肠功能的快速恢复,对患者的性生活质量影响较小,且术后并发症较少。     

lncRNA TUC338 is a potential diagnostic biomarker for bladder cancer

Although long noncoding RNA TUC338 has been characterized as an oncogene, its role in bladder cancer is unknown. The purpose of the present study is to investigate the function of TUC338 in bladder cancer. We found that TUC338 was upregulated in early-stage bladder cancer patients and showed early diagnostic values. After surgical resection, plasma levels of TUC338 were significantly downregulated. Moreover, microRNA 10b (miR-10b) was also upregulated in bladder cancer patients. TUC338 and miR-10b were positive and significantly correlated in bladder cancer patients, but not in healthy controls. Bladder cancer cells with TUC338 overexpression showed upregulated miR-10b, while miR-10b overexpression failed to significantly affect TUC338. TUC338 and miR-10b overexpression significantly promoted bladder cancer cell invasion and migration. Therefore, TUC338 may promote bladder cancer at least partially by upregulating miR-10b.     

Analysis of natural killer activity and natural killer cell subsets in patients with bladder cancer

Summary In order to analyze the state of the natural resistance system of bladder cancer patients in vivo, we measured natural killer (NK) activity and NK cell subsets of peripheral blood lymphocytes (PBL) from 46 patients with bladder cancer and 25 age- and sex-matched healthy volunteers. The mean NK activity in patients with lowstage bladder cancer was similar to that in the controls, while NK activity in patients with high-stage bladder cancer was significantly depressed. The mean proportions of Leu7⁺ cells in patients with both low-stage and highstage bladder cancer were significantly higher than that in the controls. The mean proportion of Leu11a⁺ cells in patients with low-stage bladder cancer was similar to that in the controls, while in patients with high-stage bladder cancer it was significantly higher. This study demonstrates the abnormal immunological state of bladder cancer patients; namely, abnormalities exist not only in NK activity but also in the proportions of circulating NK cell subsets.     

三种不同手术方式治疗中老年女性压力性尿失禁疗效及对患者膀胱功能和术后并发症的影响

摘要 目的：探讨耻骨后膀胱尿道悬吊术（Burch）、阴道无张力尿道悬吊术（TVT）及经闭孔经阴道尿道中段悬吊带术（TVT-O）三种不同手术方式治疗中老年女性压力性尿失禁（SUI）疗效及对患者膀胱功能和术后并发症的影响。方法：回顾性分析2019.1-2022.4收治的101例中老年女性SUI患者资料，按手术方式分为Burch组（n=30，Burch术治疗）、TVT组（n=31，TVT术治疗）和TVT-O组（n=40，TVT-O术治疗），观察三组患者临床疗效和手术情况[手术时间、出血量、住院时间、尿管留置时间]，并发症发生率，治疗前后膀胱功能[24h排尿次数、膀胱容量、每次排尿量、残余尿量]及尿道功能指标[尿道长度（FUL）、最大尿道闭合压（MUCP）、Valsalva漏尿点压（VLPP）]变化。结果：Burch组、TVT组、TVT-O组治愈及改善率分别为83.34%、87.10%、87.50%，13.33%、12.90%、12.50%，三组之间比较差异无统计学意义（P>0.05）；TVT组、TVT-O组患者手术时间、出血量、住院时间、尿管留置时间均显著短于Burch组（P<0.05），且TVT-O组患者手术时间显著短于TVT组（P<0.05）；治疗后，三组患者24 h排尿次数、残余尿量均显著降低（P<0.05），膀胱容量、每次排尿量、FUL、MUCP、VLPP水平均显著增加（P<0.05），但三组之间比较差异无统计学意义（P>0.05）；Burch组、TVT组、TVT-O组并发症总发生率分别为20.00%、12.91%、15.00%，三组之间比较差异无统计学意义（P>0.05）。结论：三种术式治疗中老年女性SUI疗效相当，均可有效改善膀胱功能及尿道指标，但TVT与TVT-O术患者康复快，TVT-O手术时间最短，TVT并发症低，可依据患者情况酌情选择。     

膀胱尿路上皮肿瘤合并2型糖尿病患者临床和病理特点的比较性研究

目的:对比分析膀胱尿路上皮肿瘤合并2型糖尿病患者的临床和病理特点,为临床诊疗工作提供一定的参考。方法:回顾性分析2015年1月至2019年2月于我院泌尿外科手术治疗且经病理确诊为原发性膀胱尿路上皮肿瘤的患者资料,合并2型糖尿病的膀胱肿瘤患者59例设为糖尿病组(T2DM组),根据性别和年龄按照1:2的比例匹配同时期未合并2型糖尿病的膀胱肿瘤118例患者为非糖尿病组(NT2DM组),比较两组患者的临床特征和病理特点。结果:T2DM组的高血压患者比例和血肌酐值高于NT2DM组(P<0.05),而在教育程度、吸烟、饮酒、BMI、前列腺增生、泌尿系感染、血常规、肝功、尿常规、肿瘤大小、数量方面无明显统计学差异(P>0.05)。T2DM组和NT2DM组在膀胱尿路上皮肿瘤良恶性分类、肿瘤数量、肿瘤大小的构成比上无明显统计学差异(P>0.05);然而,对膀胱恶性肿瘤患者进行亚组分析显示,T2DM亚组中肌层浸润性癌的比例和高级别癌的比例明显高于NT2DM亚组,差异有统计学意义(P<0.05)。结论:2型糖尿病可能使膀胱癌的病理分级和分期更高,导致患者预后更差,临床上应更加关注膀胱恶性肿瘤合并2型糖尿病患者的诊治。     

三维超声技术对于评估压力性尿失禁女性患者盆底肌肉收缩及膀胱颈活动度的价值研究

摘要 目的：探讨三维超声技术对于评估压力性尿失禁（SUI）女性患者盆底肌肉收缩及膀胱颈活动度的价值。方法：选取2020年1月至2021年8月本院的收治的因产后SUI的女性患者60例作为观察组,另选择同期产后正常的女性受试者60例作为对照组,所有受试者均行经会阴三维超声检查。比较两组之间盆底肌肉收缩及膀胱颈活动度等相关指标的差异。结果：在静息状态和最大Valsalva状态下,观察组中盆膈裂孔前后径、左右径、肛提肌裂孔面积以及膀胱颈后角均显著大于对照组（P<0.05）,观察组尿道长度显著低于对照组（P<0.05）;而仅在最大Valsalva状态下,观察组的膀胱颈位置显著低于对照组（P<0.05）;此外观察组膀胱漏斗化所占比例显著高于对照组（P<0.05）。结论：三维超声技术可以清晰直观地显示女性盆底组织结构和功能,对于评估SUI女性患者盆底肌肉收缩及膀胱颈活动度具有一定的诊断价值,并为临床提供真实客观的影像学证据。     

Urinary thrombomodulin is down regulated in schistosomiasis associated bladder cancer

BackgroundThrombomodulin (TM) is a surface glycoprotein and expressed in many cancers. The aim of the present study was to detect the expression levels of TM in plasma and urine of bladder cancer patients and to compare these levels to the clinicopathological data of the patients as well as the ploidy status of their exfoliated urinary cells. We studied the levels of TM in plasma and urine samples of 57 bladder cancer patients and 10 controls using the (ELISA) assay and compared the results to the ploidy status of the cells taken from the patents urine samples as well as their clinicopathological profile.ResultsUrinary TM was significantly down regulated while plasma TM was significantly up regulated in bladder cancer patients. Plasma TM was significantly higher in SCC than TCC patients. The sensitivity and specificity of urinary TM were 90% and 86%, respectively. While the sensitivity and specificity of plasma TM were 76% and 80%, respectively.ConclusionUrinary TM is significantly down regulated, while plasma TM is significantly up regulated in bladder cancer as compared to the control group. Urinary TM has superior sensitivity and specificity over plasma TM. Urinary TM could be used as a predictive marker in bladder cancer. Further studies are needed to detect the prognosis significance of thrombomodulin in schistosomiasis associated bladder cancer.     

帕金森病的尿动力学表现及临床意义

为了评估有持久膀胱排尿障碍的帕金森氏病患者的尿动力学表现及其临床意义,对25例帕金森氏病患者行尿动力检查,并要求记录并回收24小时排尿日记.结果显示,1)有18例患者出现膀胱过度活动,逼尿肌收缩力低下或无反射4例,膀胱出口梗阻6例,另3例检查结果正常,无一例出现逼尿肌-括约肌协同失调; 2)患者所返回的排尿日记显示帕金森氏病患者普遍出现日排尿次数增加及每次排尿量的减少.由此可以得出结论:逼尿肌反射亢进是帕金森氏病患者尿动力学检查的最常见类型;尿动力学检查对正确处理帕金森氏病患者的排尿障碍有指导意义.     

Tumor markers (CEA, TPA and CA 19-9) in urine of bladder cancer patients

This study was carried out to evaluate the usefulness of determining urinary levels of carcinoembryogenic antigen (CEA), tissue-polypeptide antigen (TPA), and gastro-intestinal cancer antigen (Ca19-9) in addition to the usual diagnostic procedures for bladder cancer. Sixty-seven patients with transitional bladder cancer, 40 healthy controls and 20 patients with inflammatory diseases of the urinary tract were considered. All urine samples were obtained from patients with intact renal function and no urinary tract infection. TPA and Ca19-9 urinary levels in patients with G3 bladder tumors were significantly higher than in those with lower graded neoplasms. The sensitivity, specificity, and predictive value of a positive (PV+) or negative (PV-) test and the diagnostic accuracy were also evaluated. Ca19-9 was the best urinary marker for bladder cancer (sensitivity 71.6%, specificity 91.6%, PV+ 90.5%, PV- 74.3%, diagnostic accuracy 81%).     

Multiplex PCR and Next Generation Sequencing for the Non-Invasive Detection of Bladder Cancer

Background

Highly sensitive and specific urine-based tests to detect either primary or recurrent bladder cancer have proved elusive to date. Our ever increasing knowledge of the genomic aberrations in bladder cancer should enable the development of such tests based on urinary DNA.

Methods

DNA was extracted from urine cell pellets and PCR used to amplify the regions of the TERT promoter and coding regions of FGFR3, PIK3CA, TP53, HRAS, KDM6A and RXRA which are frequently mutated in bladder cancer. The PCR products were barcoded, pooled and paired-end 2 x 250 bp sequencing performed on an Illumina MiSeq. Urinary DNA was analysed from 20 non-cancer controls, 120 primary bladder cancer patients (41 pTa, 40 pT1, 39 pT2+) and 91 bladder cancer patients post-TURBT (89 cancer-free).

Results

Despite the small quantities of DNA extracted from some urine cell pellets, 96% of the samples yielded mean read depths >500. Analysing only previously reported point mutations, TERT mutations were found in 55% of patients with bladder cancer (independent of stage), FGFR3 mutations in 30% of patients with bladder cancer, PIK3CA in 14% and TP53 mutations in 12% of patients with bladder cancer. Overall, these previously reported bladder cancer mutations were detected in 86 out of 122 bladder cancer patients (70% sensitivity) and in only 3 out of 109 patients with no detectable bladder cancer (97% specificity).

Conclusion

This simple, cost-effective approach could be used for the non-invasive surveillance of patients with non-muscle-invasive bladder cancers harbouring these mutations. The method has a low DNA input requirement and can detect low levels of mutant DNA in a large excess of normal DNA. These genes represent a minimal biomarker panel to which extra markers could be added to develop a highly sensitive diagnostic test for bladder cancer.