bluuebunny/crossref_metadata_2025_split huggingface dataset:
Label-free Quantitative Phosphoproteomics Reveals the Role of Beta-Estradiol in Sunitinib-Resistant Renal Cell Carcinoma Growth Via Perturbing Transforming Growing Factor-Beta Pathway
Authors: Ku Wei-Chi , Chen Shao-Kuan , Lin Chih-Ming , Tang Chin , Wang Yen-Chieh 
Published: December 2021

Context:
Sunitinib is the first-line targeted therapy for metastatic renal cell carcinoma (RCC). However, resistance to sunitinib often occurred in patients receiving sunitinib treatment. On the other hand, 17-beta-estradiol (estrogen or E2) has been demonstrated to repress RCC growth in vitro, whether E2 can also affect the growth of sunitinib-resistant RCC remains unknown.

Aims:
In this study, the role of E2 in inhibiting sunitinib-resistant RCC growth and the underlining acting mechanisms was explored.

Settings and Design:
Sunitinib resistance was first induced in vitro in ACHN cells. The effect of E2 on cellular growth was then assayed. Label-free phosphoproteomics was also conducted.

Subjects and Methods:
ACHN cells were first challenged with 10-μM sunitinib up to 4 months to induce drug resistance. Then, E2 at different concentrations were tested in both parental and sunitinib-resistant ACHN cells. To conduct phosphoproteomics study, the total cell lysates from E2-treated ACHN cells were harvested, trypsin digested, and the phosphopeptides were enriched by Fe-IMAC.

Statistical Analysis Used:
For comparing the E2-induced cell growth inhibition, Student's t-test was used, and P < 0.05 was considered statistically significant. As for label-free phosphoproteomics, false discovery rate <0.01 and phosphosite possibility >0.75 were considered as positive identifications.

Results:
E2 at the physiological concentration, that is, 10 nM, can repress the cell growth in both parental and sunitinib-resistant ACHN cells. Further, label-free phosphoproteomics revealed that transforming growth factor beta (TGF-β) pathway, cell cycle, and cytoskeleton bindings were enhanced in sunitinib-resistant cells but can be reduced by E2 treatment. On the other hand, programmed cell death and apoptosis were repressed in sunitinib-resistant cells, and E2 at 10 nM did not reverse the effect. We further validated the expression of SMAD3, an important molecule in TGF-β pathway, and found that SMAD3 decreased in sunitinib-resistant cells but can be upregulated by E2 treatment.

Conclusions:
Our study demonstrated that E2 can inhibit the cell growth in sunitinib-resistant RCC cells at physiological concentration by upregulating SMAD3 in the TGF-β pathway, which may lead to growth inhibition in RCC.
A Lower Urine White Blood Cell Median Can be a Predictor of Undiscovered Urolithiasis in Patients with Acute Urinary Tract Symptoms
Authors: Chen Yuan , Liao Chun-Hou , Chiang Bing-Juin , Huang Hsu-Che , Chou Yu-Wei 
Published: December 2021

Purpose:
Acute urinary tract infection (UTI) causes symptoms including urgency, frequency, dysuria, and pain in the lower urinary tract. However, these symptoms are not unique to infection. Urolithiasis, injury, neurological disease, and malignancy present with the same symptoms. We aimed to find predictors in urinalysis to detect underlying causes in patients with acute UTI symptoms.

Materials and Methods:
We recruited 192 patients who presented with acute UTI symptoms from a single institute between September 2012 and September 2018. Each patient received urinalysis, kidney–ureter–bladder X-ray, and kidney plus transabdominal bladder sonography as primary surveys. Patients with flank pain and hydronephrosis but without definitive radiopaque lesion received computed tomography (CT) scan as an advanced intervention. Cystoscopy was ordered by the physician if the patient had gross hematuria and was suspected to have intravesical lesion. We correlated the urine nitrate, the median of red blood cells (RBCs) and white blood cells (WBCs), and the ratio of red and WBCs with the finding on image studies, which included sonography, X-ray, and CT by statistical models.

Results:
In patients with urolithiasis detected by either X-ray or CT, logistic regression showed that higher urine RBC and lower urine WBC medians were predictors of urolithiasis. In the ROC analysis, WBC median lower than 7.75 per high power field (HPF) was a significant predicting factor for the positive finding of urolithiasis on a CT scan.

Conclusion:
When presenting with acute UTI symptoms, patients with a lower urine WBC median are correlated with a higher probability to have urolithiasis. In addition, WBC median lower than 7.75 per HPF in urinalysis is a predictor for urolithiasis found on CT in patients with flank pain or hydronephrosis.
Factors Associated with the Success of Trial Without Catheter in Acute Urinary Retention Due to Benign Prostatic Hyperplasia
Authors: Phuong Hoai Dinh Thi , Thang Tai Luu Lam , Huu Loc Tran Thai , Fadlelmola Mohamed Muawia Yousif , Ahmed Ali Mahmoud , Huy Nguyen Tien , Khanh Le Dinh 
Published: December 2021

Purpose:
This study aims to evaluate the parameters that can predict the success or failure of trial without catheter (TWOC) for acute urinary retention (AUR) due to benign prostatic hyperplasia (BPH).

Materials and Methods:
A prospective cohort study was conducted to include 73 medically treated patients with AUR due to BPH. All patients underwent catheterization and were started on alfuzosin (10 mg/day), followed by TWOC. Age, international prostate symptom score (IPSS), quality of life, prostate volume, and urine volume after catheterization were analyzed.

Results:
Patients' mean age was 74.23 ± 9.63 years; the first successful and failed TWOC was reported in 47 (64.4%) and 26 patients (35.6%), respectively. On the one hand, 89.4% of the patients continued medical treatment with alfuzosin (10 mg/day) in the first successful TWOC group. On the other hand, 30.8% showed the second successful TWOC and continued medical treatment in the first TWOC failure group. The uni- and multivariable analyses in this study showed that severe lower urinary tract symptoms (IPSS ≥20 points), prostatic pain during digital rectal examination (DRE), high urine volume after catheterization (≥950 mL), and high blood urea (≥4.55 mmol/L) were the predictive factors of TWOC failure.

Conclusion:
Severe lower urinary tract symptoms, prostatic pain during DRE, large urine volume after catheterization, and high blood urea are the predictive factors for TWOC failure in AUR due to BPH.
Can Robot-assisted Radical Prostatectomy Improve Functional Outcomes Compared to Laparoscopic Radical Prostatectomy? Experience at a Laparoscopic Center
Authors: Lu Cheng-Hsin , Wu Chun-Hsien , Chen Yu-Chi , Chen Chung-Hsien , Wu Richard Chen-Yu , Lee Yeh-Hsi , Huang Ching-Yu , Yu Tsan-Jung , Lin Victor C. 
Published: December 2021

Purpose:
This study compared the perioperative parameters and early functional outcomes between robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) at a urological laparoscopic center.

Materials and Methods:
Between January 2006 and May 2017, 242 patients underwent endoscopic radical prostatectomy (LRP for 208 cases; RARP for 34 cases). Patients who were followed up > 12 months were included in the study. Propensity score-matched groups of patients who underwent LRP or RARP were created based on age, body mass index, history of diabetes mellitus, history of smoking, preoperative prostate-specific antigen level, clinical T status, risk group classification, American Society of Anesthesiologists score, and whether the nerve-sparing technique was performed.

Results:
There were no significant differences in the blood transfusion rate, surgical margin status, length of stay, catheterization time, or days to oral intake for both procedures. Although RARP is more time-consuming, it provided significant benefits regarding the yield of dissected lymph nodes (19 vs. 9; P < 0.001) and early urinary continence recovery (i.e., continence rates after 1 month [56.2% vs. 21.9%; P = 0.006] and after 3 months [84.4% vs. 53.1%; P = 0.001]). No difference was observed for early complications, although the RARP group had more late complications.

Conclusion:
Our experience indicated that RARP could provide less blood loss and faster recovery of urinary continence and yield more dissected lymph nodes compared to LRP. Further studies are needed to determine whether the long-term clinical, functional, and oncological outcomes are superior.
Effect of Hydroalcoholic Extract of Cyperus Rotundus L. Rhizome against Ethylene Glycol and Ammonium Chloride-Induced Urolithiasis in Male Sprague-Dawley Rats
Authors: Jahan Nasreen , Bano Humaira , Ahmed Makbul Shaikh Ajij , Kumar B. N. , Mushir Ansari 
Published: December 2021

Background:

Cyperus rotundus L. is used in various dosage forms by Unani physicians in the treatment of urolithiasis.

Aims and Objectives:
The present study aims to evaluate the effect of hydroalcoholic extract of Cyperus rotundus in nephrolithiatic male Sprague Dawley rats.

Materials and Methods:
The animals were divided into 6 groups of 6 each. Group I received regular rat food and drinking water ad libitum. Group II to VI were treated with Ethylene glycol (0.75%, V/V) and Ammonium chloride (1%, W/V) in drinking water for 7 days to induce urolithiasis. Group II was sacrificed after 7 days administration of lithogenic agents however, from 8th day, group IV was treated with Cystone (750 mg/kg) and group V and VI with hydroalcoholic extract of Cyperus rotundus (100 mg/kg and 170 mg/kg, respectively) for further 14 days. Group III left untreated after 7 days administration of lithogenic agent till 14 days and sacrificed on 22nd day. Urine, biochemical parameters, kidney homogenate analysis and histopathology were carried out. Crystalluria analysed by light microscopy.

Results:
The test drug at both the doses showed significant reduction (P < 0.001) in number of urinary crystals. Test groups showed significant reduction in urine sodium (P < 0.05) and calcium (P < 0.001) while increased in urine magnesium. Serum creatinine (P < 0.01) and urea (P < 0.05) level significantly reduced in test groups. Histopathology of kidney showed almost normal kidney architecture. Kidney homogenate analysis showed significant reduction (P < 0.05) of calcium in group VI.

Conclusion:
The results showed that test extract has significant antilithiatic effect in terms of solute balance, reduction in crystal numbers and improvement in renal cell derangement.
Presence of Residual Stones is Not a Contraindication for Tubeless Percutaneous Nephrolithotomy
Authors: Chang Shun-Kai , Lin Chang-Te , Kang Chun-Hsiung , Cheng Ming-Chin , Jou Yeong-Chin , Shen Cheng-Huang , Chen Pi-Che , Lai Wei-Hong 
Published: December 2021

Objective:
The objective of this study was to evaluate the safety of performing tubeless percutaneous nephrolithotomy (PCNL) for patients with residual stones.

Materials and Methods:
This study was conducted between 2007 and 2015, and a total of 815 patients were included in this study who underwent tubeless PCNL. Postoperatively, 591 patients were found to be stone free (Group 1), whereas residual stones were noted in 224 patients (Group 2). The hospital course and postoperative complications up to 3 months were analyzed by retrospective review. The complications were analyzed by Clavien–Dindo classification and grouped to severe/life-threatening complications (≥Grade 4) and none or nonsevere complications (≤3). All the demographic variables were scrutinized by regression analysis.

Results:
The mean days of hospital stay were 3.15 and 3.70 in Group 1 and Group 2, respectively (P < 0.001). Sixty-seven patients from Group 1 (11.3%) and 65 patients from Group 2 (29%) suffered postoperative complication (P < 0.001). A multivariate logistic regression model confirmed a higher risk of complications for the residual stone group versus the stone-free stone group (odds ratio [OR]: 2.37,P < 0.001). However, life-threatening complication rate reveals no difference between the two groups (1.4% vs. 3.1%,P = 0.093). Sixteen patients (2.7%) from Group 1 and 12 patients (5.4%) from Group 2 were rehospitalized in 3 months; however, the difference was not statistically significant (P = 0.064). The adjusted logistic regression model also established a nonelevated risk of rehospitalization (OR: 1.11, P = 0.823). Ninety-seven patients in the residual stone group received secondary stone managements in 3 months, but none of them underwent secondary PCNL.

Conclusion:
Patients from the residual stone group had remarkably longer hospital stay and higher postoperative complication rate because of more complicated stone nature. However, there was no significant difference in the incidence of severe complication and rehospitalization in both the groups. Tubeless PCNL is a relatively safe procedure and not contraindicated for patients with residual stones.
Sonography-Assisted Seldinger Wire Technique
Authors: Chen Chao-An , Chang Yu-Jun , Lio Man-Lok , Chiang Heng-Chieh , Wang Bai-Fu , Chen Pao-Hwa 
Published: December 2021

Context:
In Changhua Christian Hospital (CCH), the urology division is a branch of the surgical department. The urology residents in this division are, on average, off duty for 10 days/month; surgical residents from other divisions usually lack training to practice urology. Therefore, attending urology doctors or visiting urology staff members in CCH branches must be on call during off-duty periods in case a patient is indicated for suprapubic cystostomy.

Aims:
This study aims to promote a safe and efficient approach to train rotating residents to perform suprapubic catheterization.

Subjects and Methods:
On the basis of ultrasound-guided central venous catheter insertion, we designed training sessions for suprapubic cystostomy for rotating surgical residents during their urology course.

Participants and Methods:
From 2016 to 2018, senior residents or attending doctors of urology evaluated the clinical skills of rotating residents by using the direct observation of procedural skills tool before and after the training course.

Statistical Analysis Used:
Mann–Whitney U-test, Wilcoxon signed rank test, and multiple linear regression analysis.

Results:
The trainees were separated into different groups according to their sex, year of residency, and previous urology training in the postgraduate year (PGY). All groups had significant gain scores. Our multiple linear regression analysis revealed a relationship between previous urology training in the PGY and gain scores and between overall pretest score and gain scores.

Conclusions:
Real-time ultrasound-guided catheterization with a Seldinger wire is a safe and efficient approach to train rotating residents to perform suprapubic catheterization.
Comparative Assessment of Monopolar Versus Bipolar Transurethral Resection of Prostate for the Management of Benign Prostatic Enlargement
Authors: Raghuvanshi Kshitij , Raval Abid , Jain Devendra Kumar , Vartak Ketan P , Patil Sachin , Iqbal Shams , Dhake Rajesh , Deshmukh Hrishikesh 
Published: December 2021

Objectives:
The objective is to compare monopolar transurethral resection of the prostate (M-TURP) versus bipolar TURP (B-TURP).

Methods:
In this prospective comparative study, 102 patients scheduled to undergo transurethral resection of prostate were enrolled and table randomized to surgery by M-TURP or B-TURP. International Prostate Symptom Score (IPSS), uroflowmetry, ultrasonography (kidney-ureter-bladder), prevoid, postvoid and laboratory investigations (for preanesthetic fitness) were done preoperative and 3-month postsurgery.

Results:
Patients were divided into two groups namely M-TURP and B-TURP. The mean age of patients was comparable between both groups. There is a significantly lower mean resection time in M-TURP compared to B-TURP. IPSS, postvoid residual volume, and Qmaximproved in both groups, and it was statistically insignificant. Drop in hemoglobin levels (g/dl) in patients of M-TURP was higher compared than B-TURP.

Conclusions:
Both M-TURP and B-TURP are safe and effective modality. However, B-TURP will surely replace M-TURP as gold standard.
The Incremental Benefit of Upfront Surgery in Renal Cell Carcinoma with Venous Tumor Thrombus of the Inferior Venae Cavae
Authors: Huned Daanesh , Carsen John Allen , Huang Hong Hong , Lee Lui Shiong 
Published: December 2021

Background:
Surgical extirpation for renal cell carcinoma (RCC) with inferior venae cavae (IVC) thrombi is the standard of care. The incremental impact of upfront surgery has not been well described.

Objective:
We aim to quantify the overall survival (OS) benefit of upfront surgery in RCC with IVC thrombi when compared to a conservative approach and also analyze perioperative outcomes.

Materials and Methods:
Patients with RCC with IVC thrombus between January 1, 2001, and December 31, 2014, in a single institution were identified, and data reviewed for demographics, performance status, and tumor thrombus levels. Pathological and operative outcomes were analyzed in the surgical cohort (Sx). Survival outcomes were computed with Kaplan–Meier analysis. Prognostic factors were determined using univariate and multivariate analyses. Statistical significance was defined as P < 0.1.

Results:
There were 51 patients identified, comprising 31 and 20 in the Sx and nonsurgical (NSx) cohorts. For the Sx cohort, 5-year OS and recurrence-free survival were 48% and 45%, respectively, with a median OS of 51.7 months. Nodal involvement was an independent predictor for OS (P < 0.1) on multivariate analysis. In the NSx cohort, 75% (15/20) had distant metastasis at diagnosis, with a 5-year OS of 13.4 months. Patients with better baseline ECOG statuses had better survival outcomes (P < 0.1). The mean OS of patients (n = 5) with M0 disease was 18.8 months. The advantage conferred by surgery was a 38.2-month longer median OS (P < 0.0001). In the Sx cohort, 87% had no or minor perioperative complications.

Conclusion:
Nephrectomy and IVC thrombectomy have an OS survival advantage of 38.2 months with acceptable perioperative morbidity. Therefore, it is preferred over an initial nonsurgical approach where possible.
Evaluation of Modified STONE Score in Patients Presenting to the Emergency Department with Flank Pain
Authors: Uzun Ahmet , Korkut Mustafa , Kartal Mutlu , Bedel Cihan 
Published: December 2021

Purpose:
Renal colic due to urinary system stone disease is one of the main complaints in emergency department (ED) admissions. The STONE score is the most used model. The “race” item in the nomogram is not useful for communities where the Black race is not dominant. Therefore, we aimed at investigating the diagnostic value of a new modified scoring system, in which we replaced the “race” item in the original nomogram by “obstruction = pelvicalyceal dilation.”

Materials and Methods:
The study included patients who were admitted to a tertiary university ED with flank pain and underwent ultrasonography (US) from June 2017 to November 2017. Patients' demographic data such as US findings and the STONE score parameters were recorded. “Obstruction (pelvicalyceal dilation)” replaced the “race” item of the original STONE score. The diagnostic value of the modified system was investigated by categorizing the scores as low risk (0–5 points), moderate risk (6–9 points), and high risk (10–13).

Results:
The study included 305 patients who met the inclusion criteria. The mean age was 39.45 ± 13.83 years, and 170 patients (55.7%) were male. Pelvicalyceal dilation was detected on US at a statistically significantly higher percentage in patients with stones compared to stone-free patients (P < 0.001). The modified STONE score was statistically significantly higher in patients with stones compared to stone-free patients (P < 0.001).

Conclusion:
We suggest that the replacement of the race parameter of the original STONE score by the US finding of pelvicalyceal dilation will enhance the diagnostic value of scoring in societies mostly comprising a non-Black population.
Combination Alpha Blocker and Phosphodiesterase 5 Inhibitor Versus Alpha-Blocker Monotherapy for Lower Urinary Tract Symptoms Associated with Benign Prostate Hyperplasia
Authors: Chen Po-Cheng , Wang Chung-Cheng , Tu Yu-Kang 
Published: December 2021

Purpose:
The prevalence of erectile dysfunction (ED) is higher in patients with lower urinary tract symptoms (LUTS). Phosphodiesterase 5 inhibitors (PDE5is) can improve both ED and LUTS and therefore is useful for these patients. Our aim of this study is to evaluate whether combination therapy of alpha blockers and PDE5i is more effective than alpha-blockers monotherapy for the treatment of LUTS.

Materials and Methods:
A systematic review and meta-analysis were undertaken to assess the difference between the combination therapy and alpha-blockers monotherapy by searching published randomized controlled trials from electronic databases PubMed, Embase, and the Cochrane Library up to April 2018.

Results:
A total of 13 randomized controlled studies with 1173 patients were included in our meta-analysis. Compared with alpha-blocker monotherapy, the combination therapy obtained a significantly better improvement in International Prostate Symptom Score (IPSS) (1.73, 95% confidence interval [CI]: 1.1–2.35), voiding subscore (0.99, 95% CI: 0.54–1.44), storage subscore (0.57, 95% CI: 0.03–1.1), peak flow rate (0.69 cc/s, 95% CI: 0.27–1.1), and erectile function (EF) symptom score. Meta-regression showed that baseline IPSS, baseline peak flow rate, baseline prostate volume, age, baseline EF symptom score, and dosage of PDE5is were not associated with the difference in IPSS improvement.

Conclusion:
A combination of alpha blockers and PDE5is has better therapeutic effects than alpha-blocker monotherapy on LUTS related to benign prostate hyperplasia.