Explore the vast range of titles available.

Background Renal cell carcinoma (RCC), one of the most fatal urologic tumors, accounts for approximately 3% of all adult cancers and exhibits a high metastatic index at diagnosis and a high rate of relapse. Radical or partial nephrectomy is a curative option for nonmetastatic RCCs. Targeted therapy has been shown to improve the survival of patients with metastatic RCCs. However, the underlying cellular and molecular events associated with RCC pathogenesis are not well known. Methods To investigate the clinical role of the transcription factor activator protein (AP)-2α in RCC, methylated CpG island recovery assays and microarray analysis were employed. COBRA and RT‒qPCR assays were performed to assess AP-2α expression in RCC. Results A negative correlation was noted between AP-2α mRNA expression levels and methylation status. Multivariate analyses showed that AP-2α mRNA was a major risk factor not only for overall and disease-free survival in RCC but also for disease-free survival in clear cell RCC. Conclusions Our results indicated that AP-2α expression was deregulated in RCC and associated with overall patient survival and disease-free survival. Such findings suggest that AP-2α might play an important role in the pathogenesis of RCC.

BackgroundLymph node invasion is associated with poor outcome in patients with renal cell carcinoma (RCC). Patients and MethodsPatients with RCC within a single center from 2001 to 2018 were retrospectively obtained from the Chang Gung Research Database. Patient gender, physical status, Charlson Comorbidity Index, tumor side, histology, age at diagnosis, and body mass index (BMI) were compared. The overall survival (OS) and cancer-specific survival (CSS) of each group were estimated using the Kaplan–Meier method. Log-rank tests were used to compare between the subgroups. Results and ConclusionsA total of 335 patients were enrolled, of whom 76 had pT3N0M0, 29 had pT1–3N1M0, 104 had T1–4N0M1, and 126 had T1–4N1M1 disease. Significant OS difference was noted between pT3N0M0 and pT1–3N1M0 groups with 12.08 years [95% confidence interval (CI), 8.33–15.84] versus 2.58 years (95% CI, 1.32–3.85), respectively (P < 0.005). No significant difference was observed in OS between pT1–3N1M0 and T1–4N0M1 groups with 2.58 years (95% CI, 1.32–3.85) versus 2.50 years (95% CI, 1.85–3.15, P = 0.72). The OS of N1M1 group was worse than that of N0M1 group with 1.00 year (95% CI, 0.74–1.26) versus 2.50 years (95% CI, 1.85–3.15, P < 0.05). Similar results were also observed in CSS. In summary, we claim that RCC with lymph node (LN) invasion should be reclassified as stage IV disease in terms of survival outcome.

Purpose This study aimed to develop a novel model that combines both clinical and image-based parameters to predict early recovery of urinary incontinence after robotic-assisted radical prostatectomy (RARP) more easily and precisely. Materials and methods We retrospectively enrolled data from patients who underwent RARP performed by a single surgeon. Clinical parameters were collected through medical chart review. All patients received cystography one week after RARP to evaluate the anastomosis healing condition. All cystography images were analyzed by a single radiologist who was blinded to the clinical status of the patients. Multivariate analysis was performed to select significant predictors for early post-prostatectomy incontinence (PPI) recovery, defined as being pad-free within four weeks after surgery. Results A total of 293 patients were enrolled in this study. Among them, 26.7% experienced immediate dryness after surgery, while 47.6% achieved being pad-free within one month. The overall continence rate was over 90% six months after surgery. In univariate analysis, factors associated with early PPI recovery were BMI, T stage, NVB preservation, surgical margin status, downward bladder neck, and bladder neck angle on cystography. BMI, NVB preservation, and downward bladder neck remained significant in multivariate analysis (p-values = 0.041, 0.027, and 0.023, respectively). A nomogram model was established based on these three predictors. Conclusion This is the first model to combine preoperative clinical factors, peri-surgical factors, and postoperative image-based factors to predict PPI recovery after RARP. This model can assist clinicians in taking optimal actions for PPI and also reduce patient anxiety.

MRI-guided targeted biopsy (MRGB) was recommended as part of biopsy paradigm of prostate cancers by current guidelines. This study aimed to analyze the diagnostic efficacy of MRGB and systemic biopsy (SB), and to compare diagnostic capabilities within subgroups of MRGB: MRI-cognitive biopsy (MRCB) and MRI-fusion biopsy (MRFB). We retrospectively enrolled patients who underwent MRGB for suspicious malignant lesion(s) identified on MRI in a single tertiary center, sample size was 74 patients. An mpMRI was performed prior to biopsy and reviewed by an experienced radiologist specialized in prostate cancer. Per-person results of MRGB and each concomitant SB were analyzed as independent biopsies for its positive biopsy rate and positive core percentage. Per-lesion results of MRFB and MRCB were compared for the detection rate. Variables of interest were analyzed with t-test, chi-squared test, and logistic regression analysis. Statistical analyses were performed with IBM Statistical Product and Service Solutions (SPSS), Version 23 (IBM, Armonk, New York). Total of 74 patients fulfilled the inclusion criteria and were enrolled. MRFB had higher PCa detection rate comparing to both MRCB and SB (56.1%, 30.3%, and 33.9% respectively, p value = 0.036); clinically significant prostate cancer (csPCa) detection rate was also significantly higher in MRFB group (43.9%, 24.2%, and 16.9% in each group respectively, p value = 0.011). In per-lesion analysis, MRCB and MRFB had no significant difference in PCa and csPCa detection rate (41.0% vs. 26.2% and 29.5% vs. 16.7% respectively, p value = 0.090 and 0.103). In the lesion ≦ 1.3 cm group, MRFB could achieve higher PCa detection rate, comparing to MRCB (36.4% vs. 14.3%, p value = 0.047); there were also higher positive rates for PCa and csPCa per biopsied cores (22.1% vs. 6.8% and 15.6% vs. 2.7%, p value = 0.029 and 0.028, respectively). Further logistic regression of multi-variate analysis in subgroup of lesion ≦ 1.3 cm revealed that PIRADS score and biopsy method were significant predictors of positive biopsy result for PCa (p value = 0.045 and 0.026, respectively) and for csPCa (p value = 0.043 and 0.025, respectively). In patients receiving trans-perineal prostate biopsy, MRFB had higher cancer detection rate than MRCB and SB. In per lesion comparison, MRFB and MRCB had similar diagnostic accuracy. However, in lesions with diameter less than 1.3 cm, MRFB can provided better diagnose value for PCa and csPCa than MRCB.

Background This study employed a convolutional neural network (CNN) to analyze computed tomography (CT) scans with the aim of differentiating among renal tumors according to histologic sub-type. Methods Contrast-enhanced CT images were collected from patients with renal tumors. The patient cohort was randomly split to create a training dataset (90%) and a testing dataset (10%). Following image dataset augmentation, Inception V3 and Resnet50 models were used to differentiate between renal tumors subtypes, including angiomyolipoma (AML), oncocytoma, clear cell renal cell carcinoma (ccRCC), chromophobe renal cell carcinoma (chRCC), and papillary renal cell carcinoma (pRCC). 5-fold cross validation was then used to evaluate the models in terms of classification performance. Results The study cohort comprised 554 patients, including those with angiomyolipoma ( n  = 67), oncocytoma ( n  = 34), clear cell renal cell carcinoma ( n  = 246), chromophobe renal cell carcinoma ( n  = 124), and papillary renal cell carcinoma ( n  = 83). Dataset augmentation of the training dataset included this to 4238 CT images for analysis. The accuracy of the models was as follows: Inception V3 (0.830) and Resnet 50 (0.849). Conclusion This study demonstrated the efficacy of using deep learning models for the classification of renal tumor subtypes from contrast-enhanced CT images. While the models showed promising accuracy, further development is necessary to improve their clinical applicability.

Purpose Metastasis is the end stage of renal cell carcinoma (RCC), and clear cell renal cell carcinoma (ccRCC) is the most common malignant subtype. The hypoxic microenvironment is a common feature in ccRCC and plays an essential role in the regulation of epithelial–mesenchymal transition (EMT). Accumulating evidence manifests that long non‐coding RNAs (lncRNAs) participate in RCC tumorigenesis and regulate hypoxia‐induced EMT. Here, we identified a lncRNA RP11‐367G18.1 induced by hypoxia, that was overexpressed in ccRCC tissues. Methods A total of 216 specimens, including 149 ccRCC tumor samples and 67 related normal kidney parenchyma tissue samples, were collected. To investigate the biological fucntions of RP11.367G18.1 in ccRCC, migration, invasion, soft agar colony formation, xenograft tumorigenicity assays, and tail vein and orthotopic metastatic mouse models were performed. The relationship between RP11‐367G18.1 and downstream signaling was analyzed utilizing reporter assay, RNA pull‐down, chromatin immunopreciptation, and chromatin isolation by RNA purification assays. Results Hypoxic conditions and overexpression of HIF‐1α increased the level of RP11‐367G18.1. RP11‐367G18.1 induced EMT and enhanced cell migration and invasion through variant 2. Inhibition of RP11‐367G18.1 variant 2 reversed hypoxia‐induced EMT phenotypes. An in vivo study revealed that RP11‐367G18.1 variant 2 was required for hypoxia‐induced tumor growth and metastasis in ccRCC. Mechanistically, RP11‐367G18.1 variant 2 interacted with p300 histone acetyltransferase to regulate lysine 16 acetylation on histone 4 (H4K16Ac), thus contributing to hypoxia‐regulated gene expression. Clinically, RP11‐367G18.1 variant 2 was upregulated in ccRCC tissues, particularly metastatic ccRCC tissues, and it is linked to poor overall survival. Conclusion These findings demonstrate the prognostic value and EMT‐promoting role of RP11‐367G18.1 and indicate that this lncRNA may provide a therapeutic target for ccRCC. Hypoxia upregulated lncRNA RP11‐367G18.1 variant 2 which was associated with p300‐mediated chromatin modifying complex to activate H4K16Ac marks. RP11‐367G18.1 variant 2 increased the levels of H4K16Ac on the promoter of hypoxia‐regulated genes leading to EMT and tumor metastasis.

Purpose To determine retrospectively the prognostic factors for urinary incontinence following robot-assisted radical prostatectomy (RARP). Methods Altogether, 180 patients with localized prostate cancer underwent RARP (same surgeon). Preoperative physical status, disease characteristics, laboratory findings, and surgical technique were recorded and the patients checked 1, 6, 12, and 24 months after RARP regarding their contribution to predicting post-prostatectomy urinary incontinence (PPI). Results Overall, 114 (63.3%) patients had PPI 1 month after RARP and 19 patients (16.0%) at 24 months. Univariate analysis showed that age was a significant factor for predicting PPI at 1 month. PPI predictors at 24 months were age, body mass index, preoperative serum albumin level, previous transurethral resection of the prostate, total operative time, and bladder neck sparing. Multivariate analysis indicated that age and total operative time were significant predictors. Conclusion Older age and longer operative time were highly relevant to short- and long-term PPI occurrence after RARP.

To investigate the impact of body mass index (BMI) on preoperative characteristics, lower urinary tract symptoms (LUTS), intraoperative variables, surgical outcomes and postoperative complications. This is a retrospective observational study including 891 benign prostate hyperplasia (BPH) patients who underwent GreenLight Laser photoselective vaporization of the prostate (PVP) between 2014 and 2020. Clinical characteristics, uroflowmetry parameters, and surgery related parameters were extracted from electronic health records. Patients were categorized into different weight groups based on Taiwanese populations' BMI criteria. Statistical analyses, involving descriptive statistics, correlation analyses, and independent -tests, were employed to examine associations between BMI and relevant variables. Pearson's correlation analysis indicated a negative correlation between BMI (r = -0.172, p < 0.001) and age, and positive correlations with total prostate volume (TPV) (r = 0.123, p < 0.001) and transition zone volume (TZV) (r = 0.083, p = 0.017). Obese patients were found to be younger (p=0.007) and have larger TPVs (p=0.010) but showed no significant differences in International Prostate Symptom Scores (IPSS) scores when compared to non-obese patients. Notably, obese patients had lower preoperative and postoperative post-void residual (PVR), whereas non-obese patients exhibited a more significant PVR reduction post-surgery. BMI did not significantly affect surgical parameters or postoperative complications. In BPH patients treated with PVP, obese individuals were younger with larger prostates but had similar IPSS scores compared to non-obese patients. Obese patients had lower pre and post-surgery PVR, while non-obese patients saw greater PVR improvements. BMI plays a nuanced role BPH patients' characteristics.

Evaluating risk factors for bleeding events in robot-assisted partial nephrectomy (RAPN) for renal angiomyolipoma (RAML) is essential for improving surgical outcomes. We performed a retrospective analysis of patients who underwent RAPN for renal masses between May 2019 and June 2023 at a single medical center, categorizing them into AML and non-AML groups. We assessed demographic data, perioperative complications, and postoperative outcomes. Preoperative imaging was reviewed to calculate R.E.N.A.L and PADUA nephrometry scores. Receiver operating characteristic (ROC) curve analysis was used to evaluate the accuracy of risk factors related to estimated blood loss (EBL) and blood transfusion. Among 255 patients, 71 (27.8%) had AML, and 184 (72.2%) had non-AML. The average age was 54.5 years, with 80.2% of the AML group being female. The median tumor size was 50.2 mm. The AML group had larger tumor diameters (50.2 mm vs 34.9 mm) but shallower depths (16.1 mm vs 21.7 mm). Median R.E.N.A.L and PADUA scores were 6.5 and 8.2, respectively, with a median EBL of 128.2 mL. Blood transfusion was required in 15.5% of cases. Tumor diameter, depth, R.E.N.A.L score, and PADUA score significantly correlated with EBL, while BMI, tumor diameter, and R.E.N.A.L score correlated with blood transfusion. The AUCs for predicting EBL and blood transfusion were 0.778 and 0.771 for tumor diameter, and 0.661 and 0.711 for R.E.N.A.L score. RAPN might be a safe option for RAML, with tumor diameter being the most accurate predictor of EBL and blood transfusion. These findings can improve preoperative assessments and surgical planning.