Objective The national lifetime prevalence of urolithiasis is estimated at 6.6%in Iran.However,reports on the composition of kidney stones have been based on imprecise methods like the chemical analysis.No prior large...Objective The national lifetime prevalence of urolithiasis is estimated at 6.6%in Iran.However,reports on the composition of kidney stones have been based on imprecise methods like the chemical analysis.No prior large-scale study has reported the composition of kidney stones based on the gold-standard methods(X-ray diffraction or infrared spectroscopy)in Iran.This study aimed to provide the composition of kidney stones based on Fourier transform infrared spectroscopy.Methods This is a cross-sectional study assessing urinary stone composition from various cities in Iran at a referral center using infrared spectroscopy from February 2019 to March 2023.Results This study determined the stone composition of 1092 patients from 10 cities in Iran.Overall,the majority of stones were composed of calcium oxalate(n=498;45.6%)and uric acid(UA,n=488;44.7%)followed by cystine(n=49;4.5%)and struvite(n=28;2.6%).Stone composition in Shiraz and Isfahan was roughly similar with a higher percentage of UA stones(53.4%and 53.6%,respectively)while the capital city of Iran(Tehran)had less frequent UA stones(39.9%)with a higher percentage of calcium oxalate stones.The percentage of UA stones increased with age as it was 11.1%in children,42.7%in adults,and 83.3%in geriatric patients(p<0.001).About 29.6%of cystine stones were observed in children.Conclusion The most frequent stone composition among kidney stones in Iran was calcium oxalate and UA stones.This relative frequency of UA stones is considerably higher than many international reports from neighboring as well as distant countries.More cystine stones were observed in children and women.Geriatric patients’stones were mostly composed of UA.展开更多
Background: Generically produced cyclosporine has long been approved in the treatment of organ transplant recipients and several publications have dealt with its use. For tacrolimus, however, very few data exist for s...Background: Generically produced cyclosporine has long been approved in the treatment of organ transplant recipients and several publications have dealt with its use. For tacrolimus, however, very few data exist for safety and efficacy after conversion to its generic in kidney transplant recipients. Methods: In this single-center observational study, 14 kidney transplant carriers were converted to generic tacrolimus as part of aftercare, and graft function, fasting tacrolimus levels and the daily tacrolimus dose was pursued for up to 95 weeks. Results: Average drug doses changed from 3.64 ± 1.88 mg/day with the original to 3.33 ± 1.72 mg/day after conversion to generic tacrolimus (p = 0.33). Tacrolimus fasting levels were 6.23 ± 1.68 ng/ml before and 5.89 ± 1.15 ng/ml after conversion (p = 0.66). Average serum creatinine values of 2.26 ± 1.08 mg/dl after conversion did not differ from previous values of 1.99 ± 0.74 mg/dl (p = 0.15). Conclusions: These data support the assumption, that it is safe to convert stable kidney transplant patients from the original galenic formulation under close scrutiny to the generically produced substance. Conversion is easy to be implemented in the routine follow-up and thus represents an option in the therapy with calcineurin inhibitors, which will contribute to cost reduction in the health system.展开更多
Objectives: The aim of this study is to review the diagnostic work-up, treatment methods and outcomes in patients treated for penile fractures. Methods: Thirty-one patients were treated for penile fracture during the ...Objectives: The aim of this study is to review the diagnostic work-up, treatment methods and outcomes in patients treated for penile fractures. Methods: Thirty-one patients were treated for penile fracture during the period 2006-2014. Data were retrieved from patients’ journals and analyzed retrospectively. Follow-up data were available for 23 patients. Results: Twenty-eight patients (90%) experienced immediate pain at incidence;29 (94%) experienced immediate swelling;23 (74%) heard a cracking sound;20 (65%) observed a blue discoloration immediately afterwards and 20 (65%) got immediate detumescence. Magnetic Resonance Imaging was used preoperatively in 10 patients and demonstrated the side and localization of the rupture in tunica albuginea in all cases. A longitudinal incision over the suspected site of the rupture was used in 20 patients and a sub-coronal de-gloving incision of the penile skin was used in 10 patients. The average operation time with longitudinal incision method and de-gloving was 43 minutes and 57 minutes, respectively. Short term complications were seen in four patients and long term complications were seen in 14 patients of which deviation of penis during erection was most common. Conclusions: Immediate pain, swelling and hearing a cracking sound are predominant features in the history of patients with penile fracture. Magnetic Resonance Imaging is recommended for localizing the rupture site. A longitudinal incision over the rupture site means significantly shorter operation time than de-gloving.展开更多
BACKGROUND Immune checkpoint inhibitors(ICIs)are a new class of antitumor agents.They enhance antitumor effects by blocking inhibitory receptors and related ligands expressed on T cells.ICIs also modulate regular immu...BACKGROUND Immune checkpoint inhibitors(ICIs)are a new class of antitumor agents.They enhance antitumor effects by blocking inhibitory receptors and related ligands expressed on T cells.ICIs also modulate regular immune cell activity,affecting the immune system and causing immune-related adverse events.The renal system is sometimes affected by these adverse events.Currently,the literature on ICIs-related glomerular injuries is scarce.CASE SUMMARY We present a patient who developed granulomatosis with polyangiitis(GPA)3 weeks after treatment with the anti-programmed cell death-1 inhibitor,tislel-izumab.The patient experienced proteinuria,hematuria,and acute kidney injury without pulmonary hemorrhage and tested positive for anti-neutrophil cyto-plasmic antibody(ANCA)-cytoplasmic type.Renal biopsy confirmed ANCA-associated vasculitis,and GPA was finally diagnosed.The patient received pulse treatment with glucocorticoids and cyclophosphamide,and renal function improved.After self-discontinuation of the drug,the disease recurred,and the original treatment regimen was continued.However,the patient’s renal function continued to deteriorate.CONCLUSION Glucocorticoids plus cyclophosphamide are effective for treating GPA induced by tislelizumab.However,follow-up and patient education are needed.展开更多
BACKGROUND Young-onset type 2 diabetes mellitus(T2DM)is associated with adverse health outcomes and increased mortality.Vitamin D(VitD)deficiency is likewise linked to various adverse health outcomes and is significan...BACKGROUND Young-onset type 2 diabetes mellitus(T2DM)is associated with adverse health outcomes and increased mortality.Vitamin D(VitD)deficiency is likewise linked to various adverse health outcomes and is significantly associated with lipid metabolism in patients with T2DM.However,little is known regarding the me-chanisms of interaction between VitD and apolipoprotein A1(apoA1)in young-onset T2DM.AIM To evaluate the relationship between VitD and apoA1 levels in patients with young-onset T2DM.METHODS This cross-sectional study was conducted at Zhejiang Provincial People’s Hospital between January 2019 and December 2023.A total of 642 patients with T2DM who aged 18-40 years were included and matched with 642 individuals without diabetes(controls)based on age and sex.No specific intervention was applied,and data were collected from medical records and laboratory tests.The re-lationship between VitD and apoA1 levels was examined using Spearman’s correlation and logistic regression models.RESULTS We found that VitD levels were significantly lower in patients with T2DM compared to controls(15.9 ng/mL vs 17.4 ng/mL,P<0.001),with a notable positive correlation between VitD deficiency and reduced apoA1 levels.Multifactor logistic regression analysis identified that severe VitD deficiency was an independent risk factor for apoA1 in young-onset T2DM patients(odds ratio=3.43,95%confidence interval:1.16-10.20,β=1.23,P=0.026).CONCLUSION Our findings reveal an association between VitD and apoA1 in young-onset T2DM,suggesting that VitD may play a crucial role in metabolic regulation and cardiovascular risk management.展开更多
Objective:The aim of this study was to find the optimal force that should be applied to control urine leakage using a non-hydraulic cuff design,and to investigate the relationship between the number of cuffs used in u...Objective:The aim of this study was to find the optimal force that should be applied to control urine leakage using a non-hydraulic cuff design,and to investigate the relationship between the number of cuffs used in urinary control and the change in demand force.Method:In this study,five sheep bladders were used to design and build a biomechanical evaluation system.The biomechanical system included the bladder,pressure gauge,pressure regulator system of the bladder,and force application system by the cuff.In this study,we increased the fluid pressure inside the bladder from 0 cmH_(2)O to 200 cmH_(2)O(1 cmH_(2)O=0.098 kPa),and at each point,the force applied by the cuff to prevent fluid leakage was measured and recorded.Results:The study revealed that a mean tensile force of 2.81(standard deviation 0.23)N for a single cuff and 1.63(standard deviation 0.16)N for double cuffs with symmetrical pressure effectively prevented bladder fluid leakage in the pressure range from 75 cmH_(2)O to 100 cmH_(2)O(p<0.001).However,there were no significant differences in results when comparing the applied tensile force required by double cuffs with asymmetric tensile force to that of the single cuff use.Furthermore,using three cuffs instead of two did not yield significantly different outcomes.Conclusion:Using double cuffs with symmetrical pressure had a greater effect compared with a single cuff with the same tensile force.Although multiple cuffs with varying tensile forces were not found to be useful in controlling urine leakage in this study,it is suggested that applying variable forces alternately and rotationally among several cuffs may reduce long-term risks such as atrophy and necrosis.Future in vivo studies are recommended to further evaluate efficiency.展开更多
The advent of targeted T-cell therapy,with chimeric antigen receptor(CAR)T-cell therapy as the most prominent example,has yielded significant clinical efficacy for both relapsed and refractory hematological malignanci...The advent of targeted T-cell therapy,with chimeric antigen receptor(CAR)T-cell therapy as the most prominent example,has yielded significant clinical efficacy for both relapsed and refractory hematological malignancies.However,this form of T-cell immunotherapy is often accompanied by severe systemic toxicities,suboptimal response rates,and host immune rejection in clinical sethings,which detracts from its therapeutic utility.展开更多
This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study...This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study.There is a need for a reliable,applicable,and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function.Seven adult male dogs were used for this study.The urethral sphincter was bypassed by inserting a catheter between the bladder neck and the distal sphincter.The animals'physical condition was closely monitored for 9 weeks,and standard urodynamic and radiologic studies were performed before and 1–2 months after surgery.The animals were killed at 9 weeks after surgery for pathological assessment.Catheter placement caused complete incontinence in the animal,with urodynamic assessments indicating that the animal was unable to control urination and radiological assessments indicating an empty bladder with a residual volume of 50±10 cc.Tissue analysis did not show significant histological damage and inflammation.The study shows that by bypassing the urethral sphincter,which is a reliable and reproducible method,an animal model of urinary incontinence can be developed,which can be used in various studies such as assessing the adequacy of artificial sphincter function.The animals under study did not have any permanent defect,so they were able to return to their normal life.展开更多
Venetoclax(Vene),a BCL-2 inhibitor,is widely used as a chemotherapeutic drug in acute myeloid leukemia(AML).However,its treatment specificity for leukemia cells is limited,often leading to side effects and treatment r...Venetoclax(Vene),a BCL-2 inhibitor,is widely used as a chemotherapeutic drug in acute myeloid leukemia(AML).However,its treatment specificity for leukemia cells is limited,often leading to side effects and treatment resistance.In this study,we utilized L-phenylalanine as an efficient nanocarrier to enhance the delivery of Vene,forming the complex Vene@8P6.This complex was then applied to AML mouse models and human AML cell lines.The in vitro analysis showed that THP-1 and HL60 cells rapidly absorbed the Vene@8P6 nanoparticles.This absorption resulted in severe DNA damage,increased reactive oxygen species(ROS)production,elevated apoptosis rates,and decreased cell proliferation compared to the administration of Vene alone.In vivo studies demonstrated that Vene@8P6 more efficiently targeted leukemia cells than normal hematopoietic cells within the bone marrow and other major organs in AML mice,as evidenced by bioluminescence imaging and flow cytometry analysis.Furthermore,Vene@8P6 treatment resulted in reduced drug side effects and improved therapeutic efficacy in AML mice.Overall,Vene@8P6 represents a novel and efficient therapeutic agent for AML,offering enhanced leukemia target specificity,reduced side effects,and improved treatment outcomes.展开更多
The onslaught of foreign antigens carried by spermatozoa into the epididymis, an organ that has not demonstrated immune privilege, a decade or more after the establishment of central immune tolerance presents a unique...The onslaught of foreign antigens carried by spermatozoa into the epididymis, an organ that has not demonstrated immune privilege, a decade or more after the establishment of central immune tolerance presents a unique biological challenge. Historically, the physical confinement of spermatozoa to the epididymal tubule enforced by a tightly interwoven wall of epithelial cells was considered sufficient enough to prevent cross talk between gametes and the immune system and, ultimately, autoimmune destruction. The discovery of an intricate arrangement of mononuclear phagocytes （MPs） comprising dendritic cells and macrophages in the murine epididymis suggests that we may have underestimated the existence of a sophisticated mucosal immune system in the posttesticular environment. This review consolidates our current knowledge of the physiology of MPs in the steady state epididymis and speculates on possible interactions between auto-antigenic spermatozoa, pathogens and the immune system by drawing on what is known about the immune system in the intestinal mucosa. Ultimately, further investigation will provide valuable information regarding the origins of pathologies arising as a result of autoimmune or inflammatory responses in the epididymis, including epididymitis and infertility.展开更多
Objective: To investigate the in vitro anticancer effect of Aloe vera(A. vera) and Calligonum comosum(C. comosum) extracts against hepatocellular carcinoma(HepG 2) cells. Methods: Hep G2 cells were tested against diff...Objective: To investigate the in vitro anticancer effect of Aloe vera(A. vera) and Calligonum comosum(C. comosum) extracts against hepatocellular carcinoma(HepG 2) cells. Methods: Hep G2 cells were tested against different doses of A. vera and C. comosum. Viability of the cells was assessed by MTT assay. Evaluation of apoptosis and DNA damage in HepG 2 cells were performed using annexin V apoptosis detection kit. The expression of p53 and anti-apoptotic(Bcl-2) were tested by real time-PCR and flow cytometer analyser. Hematoxylin and eosin stained sections from untreated and treated HepG 2 cells were observed using light microscopy.Results: The IC50 values of A. vera and C. comosum extracts were(10.45 ± 0.31) and(9.60 ± 0.01) μg/mL respectively. The extracts separately increased cytotoxicity against HepG 2 cells in a time and dose dependent manners. Also, it apparently induced apoptosis through increase P53 and decrease Bcl-2 genes expressions.Conclusions: The results indicated that the extracts could have anti-hepatocarcinogenic effect, at least in part, through modulation of apoptosis.展开更多
Oxidative stress processes play a major role in the development of the complications associated with diabetes and other diseases via non-enzymatic glycation,the hexosamine pathway,the polyol pathway and diacylglycerol...Oxidative stress processes play a major role in the development of the complications associated with diabetes and other diseases via non-enzymatic glycation,the hexosamine pathway,the polyol pathway and diacylglycerol-protein kinase C.Oxidative stress may lead to the production of hydroxyl free radicals,which can attack macromolecules,such as lipids,nucleic acids or amino acids.Phenylalanine(Phe) can be enzymatically converted to the physiological para-tyrosine(p-Tyr);however,a hydroxyl free radical attack on Phe may yield meta-and ortho-tyrosine(m-and o-Tyr,respectively) in addition to p-Tyr.Hence,m-and o-Tyr may be regarded as markers of hydroxyl free radical-induced damage.Their accumulation has been described;e.g.,this accumulation has been found in the urine of patients with diabetes mellitus(DM) and/or chronic kidney disease,in cataract lenses,in vessel walls,in irradiated food and in amniotic fluid,and it may serve as an indicator of oxidative stress.The use of resveratrol to treat patients with type 2 DM led to a decrease in the urinary excretion of o-Tyr and concomitantly led to an improvement in insulin signaling and insulin sensitivity.Literature data also suggest that m-and o-Tyr may interfere with intracellular signaling.Our group has shown that erythropoietin(EPO) has insulin-like metabolic effects on fat cells in addition to its ability to promote the proliferation of erythroid precursor cells.We have shown that the supplementation of cell culture medium with m-and o-Tyr inhibits erythroblast cell proliferation,which could be ameliorated by p-Tyr.Additionally,in vivo,the o-Tyr/p-Tyr ratio is higher in patients with renal replacement therapy and a greater need for EPO.However,the o-Tyr/p-Tyr ratio was an independent determinant of EPO-resistance indices in our human study.The o-Tyr content of blood vessel walls inversely correlates with insulin-and acetylcholineinduced vasodilation,which could be further impaired by artificial oxidative stress and improved by the use of antioxidants.In rats that receive o-Tyr supplements,decreased vasorelaxation is detected in response to insulin.Additionally,o-Tyr supplementation led to the incorporation of the unnatural amino acid into cellular proteins and caused a decrease in the insulin-induced phosphorylation of endothelial nitric oxide synthase.Our data suggest that m-and o-Tyr may not only be markers of oxidative stress;instead,they may also be incorporated into cellular proteins,leading to resistance to insulin,EPO and acetylcholine.展开更多
Diabetic kidney disease(DKD)is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease(ESKD).Wide glycemic var-iations,such as hypoglycemia and hyperglycemia,are broadly fou...Diabetic kidney disease(DKD)is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease(ESKD).Wide glycemic var-iations,such as hypoglycemia and hyperglycemia,are broadly found in diabetic patients with DKD and especially ESKD,as a result of impaired renal metabolism.It is essential to monitor glycemia for effective management of DKD.Hemoglobin A1c(HbA1c)has long been considered as the gold standard for monitoring glycemia for>3 months.However,assessment of HbA1c has some bias as it is susceptible to factors such as anemia and liver or kidney dysfunction.Continuous glucose monitoring(CGM)has provided new insights on glycemic assessment and management.CGM directly measures glucose level in interstitial fluid,reports real-time or retrospective glucose concentration,and provides multiple glycemic metrics.It avoids the pitfalls of HbA1c in some contexts,and may serve as a precise alternative to estimation of mean glucose and glycemic variability.Emerging studies have demonstrated the merits of CGM for precise monitoring,which allows fine-tuning of glycemic management in diabetic patients.Therefore,CGM technology has the potential for better glycemic monitoring in DKD patients.More research is needed to explore its application and management in different stages of DKD,including hemodialysis,peritoneal dialysis and kidney transplantation.展开更多
Men with chronic renal failure （CRF） on hemodialysis have been frequently associated with erectile dysfunc-tion （ED）, with an of between 20% to 87.7%. As a result of the multi-system disease processes present in m...Men with chronic renal failure （CRF） on hemodialysis have been frequently associated with erectile dysfunc-tion （ED）, with an of between 20% to 87.7%. As a result of the multi-system disease processes present in many uremic men, it is apparent that the pathogenesis of ED is most probably multifactorial. Factors to be con-sidered include peripheral vascular disease, neurogenic abnormalities, hormonal disturbances and medications used for treatment of conditions associated with CRF. These physiological abnormalities may be supplement-ed by signifcant psychological stresses and abnormali-ties resulting from chronic illness. Treatment must start with the determination and treatment of the underlying causes. In addition to psychological treatment, furtherlines of treatment of ED in CRF can be classifed as 1stline （medical treatment which includes oral phosphodi-esterase-5 inhibitors and hormone regulation）, 2nd line（intracavernosal injection, vacuum constriction devicesand alprostadil urethral suppositories） or 3rd line （sur-gical treatment）. Renal transplantation improves thequality of life for some patients with CRF and subse-quently it may improve erectile function in a signifcantnumber of them, however still there is high incidenceof ED after transplantation.展开更多
Hepatitis B represents a global health threat because its chronic course and sequelae contribute to a high morbidity and mortality.Hepatitis B virus(HBV)infection can be controlled by vaccines,antiviral treatment,and ...Hepatitis B represents a global health threat because its chronic course and sequelae contribute to a high morbidity and mortality.Hepatitis B virus(HBV)infection can be controlled by vaccines,antiviral treatment,and by interrupting transmission.Rare vaccine escape mutants are serious because they eliminate vaccine protection.Here,we present a 74-year-old vaccinated patient with HBV reactivation 11 years after kidney transplantation.The patient was HBV-positive but HBs Ag-negative prior to vaccination 6 years before transplantation.The reactivated virus was HBV genotype F3 with vaccine escape mutations G145 R,P120 Q,and Q129 P.The patient was successfully treated with entecavir.The epidemiological reasons for this subgenotype,which is extremely rare in Western Europe,were unclear.This case illustrates that second-generation vaccines are not always effective in a specific group of patients.展开更多
BACKGROUND Hypercalciuria is the most common metabolic risk factor for calcium urolithiasis and is associated with bone loss in adult patients.Reduced bone mineral density(BMD)was already described in idiopathic hyper...BACKGROUND Hypercalciuria is the most common metabolic risk factor for calcium urolithiasis and is associated with bone loss in adult patients.Reduced bone mineral density(BMD)was already described in idiopathic hypercalciuria(IH)children,but the precise mechanisms of bone loss or inadequate bone mass gain remain unknown.Life-long hypercalciuria might be considered a risk to change bone structure and determine low bone mass throughout life.The peak of bone mass should occur without interferences.A beneficial effect of citrate formulations and thiazides on bone mass in adult and pediatric patients with IH have been shown.AIM To evaluate whether pharmacological therapy has a beneficial effect on bone mass in children and adolescents with IH.METHODS This retrospective cohort study evaluated 40 hypercalciuric children nonresponsive to lifestyle and diet changes.After a 2-mo run-in period of citrate formulation(Kcitrate)usage,the first bone densitometry(DXA)was ordered.In patients with sustained hypercalciuria,a thiazide diuretic was prescribed.The second DXA was performed after 12 mo.Bone densitometry was performed by DXA at lumbar spine(L2-L4).A 24-h urine(calcium,citrate,creatinine)and blood samples(urea,creatinine,uric acid,calcium,phosphorus,magnesium,chloride,hemoglobin)were obtained.Clinical data included age,gender,weight,height and body mass index.RESULTS Forty IH children;median age 10.5 year and median time follow-up 6.0 year were evaluated.Nine patients were treated with Kcitrate(G1)and 31 with Kcitrate+thiazide(G2).There were no differences in age,gender,body mass index z-score and biochemical parameters between G1 and G2.There were no increases in total cholesterol,kalemia and magnesemia.Calciuria decreased in both groups after treatment.Lumbar spine BMD z-score increased after thiazide treatment in G2.There was no improvement in G1.CONCLUSION Results point to a beneficial effect of thiazide on lumbar spine BMD z-score in children with IH.Further studies are necessary to confirm the results of the present study.展开更多
We present a case of left ectopic ureter insertion into the left seminal vesicle which is a rare anomaly.The incidence of ectopic insertion of the ureter is more common in females and is usually associated with incont...We present a case of left ectopic ureter insertion into the left seminal vesicle which is a rare anomaly.The incidence of ectopic insertion of the ureter is more common in females and is usually associated with incontinence,leading to the diagnosis,while in males it is present with infection.Ectopic ureter is defined as abnormal insertion of the ureter,occurring in the posterior urethra in approximately 50%of cases in males.Other sites include the seminal vesicle(approximately one-third),vas deferens,bladder neck,prostate and epididymis,while the urethra and vagina are commonly affected in females.Management is usually addressed to the upper tract only;if there is incontinence it requires removal of the ureteric stump.Our case was initially diagnosed by magnetic resonance imaging and the diagnosis confirmed by computed tomography(CT)guided seminal vesiculography as transrectal guidance for seminal vesiculography was refused by the patient.CT guided seminal vesiculography is less painful and more tolerable than the transrectal route.展开更多
Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Method...Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.展开更多
文摘Objective The national lifetime prevalence of urolithiasis is estimated at 6.6%in Iran.However,reports on the composition of kidney stones have been based on imprecise methods like the chemical analysis.No prior large-scale study has reported the composition of kidney stones based on the gold-standard methods(X-ray diffraction or infrared spectroscopy)in Iran.This study aimed to provide the composition of kidney stones based on Fourier transform infrared spectroscopy.Methods This is a cross-sectional study assessing urinary stone composition from various cities in Iran at a referral center using infrared spectroscopy from February 2019 to March 2023.Results This study determined the stone composition of 1092 patients from 10 cities in Iran.Overall,the majority of stones were composed of calcium oxalate(n=498;45.6%)and uric acid(UA,n=488;44.7%)followed by cystine(n=49;4.5%)and struvite(n=28;2.6%).Stone composition in Shiraz and Isfahan was roughly similar with a higher percentage of UA stones(53.4%and 53.6%,respectively)while the capital city of Iran(Tehran)had less frequent UA stones(39.9%)with a higher percentage of calcium oxalate stones.The percentage of UA stones increased with age as it was 11.1%in children,42.7%in adults,and 83.3%in geriatric patients(p<0.001).About 29.6%of cystine stones were observed in children.Conclusion The most frequent stone composition among kidney stones in Iran was calcium oxalate and UA stones.This relative frequency of UA stones is considerably higher than many international reports from neighboring as well as distant countries.More cystine stones were observed in children and women.Geriatric patients’stones were mostly composed of UA.
文摘Background: Generically produced cyclosporine has long been approved in the treatment of organ transplant recipients and several publications have dealt with its use. For tacrolimus, however, very few data exist for safety and efficacy after conversion to its generic in kidney transplant recipients. Methods: In this single-center observational study, 14 kidney transplant carriers were converted to generic tacrolimus as part of aftercare, and graft function, fasting tacrolimus levels and the daily tacrolimus dose was pursued for up to 95 weeks. Results: Average drug doses changed from 3.64 ± 1.88 mg/day with the original to 3.33 ± 1.72 mg/day after conversion to generic tacrolimus (p = 0.33). Tacrolimus fasting levels were 6.23 ± 1.68 ng/ml before and 5.89 ± 1.15 ng/ml after conversion (p = 0.66). Average serum creatinine values of 2.26 ± 1.08 mg/dl after conversion did not differ from previous values of 1.99 ± 0.74 mg/dl (p = 0.15). Conclusions: These data support the assumption, that it is safe to convert stable kidney transplant patients from the original galenic formulation under close scrutiny to the generically produced substance. Conversion is easy to be implemented in the routine follow-up and thus represents an option in the therapy with calcineurin inhibitors, which will contribute to cost reduction in the health system.
文摘Objectives: The aim of this study is to review the diagnostic work-up, treatment methods and outcomes in patients treated for penile fractures. Methods: Thirty-one patients were treated for penile fracture during the period 2006-2014. Data were retrieved from patients’ journals and analyzed retrospectively. Follow-up data were available for 23 patients. Results: Twenty-eight patients (90%) experienced immediate pain at incidence;29 (94%) experienced immediate swelling;23 (74%) heard a cracking sound;20 (65%) observed a blue discoloration immediately afterwards and 20 (65%) got immediate detumescence. Magnetic Resonance Imaging was used preoperatively in 10 patients and demonstrated the side and localization of the rupture in tunica albuginea in all cases. A longitudinal incision over the suspected site of the rupture was used in 20 patients and a sub-coronal de-gloving incision of the penile skin was used in 10 patients. The average operation time with longitudinal incision method and de-gloving was 43 minutes and 57 minutes, respectively. Short term complications were seen in four patients and long term complications were seen in 14 patients of which deviation of penis during erection was most common. Conclusions: Immediate pain, swelling and hearing a cracking sound are predominant features in the history of patients with penile fracture. Magnetic Resonance Imaging is recommended for localizing the rupture site. A longitudinal incision over the rupture site means significantly shorter operation time than de-gloving.
文摘BACKGROUND Immune checkpoint inhibitors(ICIs)are a new class of antitumor agents.They enhance antitumor effects by blocking inhibitory receptors and related ligands expressed on T cells.ICIs also modulate regular immune cell activity,affecting the immune system and causing immune-related adverse events.The renal system is sometimes affected by these adverse events.Currently,the literature on ICIs-related glomerular injuries is scarce.CASE SUMMARY We present a patient who developed granulomatosis with polyangiitis(GPA)3 weeks after treatment with the anti-programmed cell death-1 inhibitor,tislel-izumab.The patient experienced proteinuria,hematuria,and acute kidney injury without pulmonary hemorrhage and tested positive for anti-neutrophil cyto-plasmic antibody(ANCA)-cytoplasmic type.Renal biopsy confirmed ANCA-associated vasculitis,and GPA was finally diagnosed.The patient received pulse treatment with glucocorticoids and cyclophosphamide,and renal function improved.After self-discontinuation of the drug,the disease recurred,and the original treatment regimen was continued.However,the patient’s renal function continued to deteriorate.CONCLUSION Glucocorticoids plus cyclophosphamide are effective for treating GPA induced by tislelizumab.However,follow-up and patient education are needed.
基金Supported by the Medical Science and Technology Project of Zhejiang Province,No.2022KY518General Scientific Research Project of Zhejiang Provincial Education Department,No.Y202352799Medical Science and Technology Project of Zhejiang Province,No.2024KY726.
文摘BACKGROUND Young-onset type 2 diabetes mellitus(T2DM)is associated with adverse health outcomes and increased mortality.Vitamin D(VitD)deficiency is likewise linked to various adverse health outcomes and is significantly associated with lipid metabolism in patients with T2DM.However,little is known regarding the me-chanisms of interaction between VitD and apolipoprotein A1(apoA1)in young-onset T2DM.AIM To evaluate the relationship between VitD and apoA1 levels in patients with young-onset T2DM.METHODS This cross-sectional study was conducted at Zhejiang Provincial People’s Hospital between January 2019 and December 2023.A total of 642 patients with T2DM who aged 18-40 years were included and matched with 642 individuals without diabetes(controls)based on age and sex.No specific intervention was applied,and data were collected from medical records and laboratory tests.The re-lationship between VitD and apoA1 levels was examined using Spearman’s correlation and logistic regression models.RESULTS We found that VitD levels were significantly lower in patients with T2DM compared to controls(15.9 ng/mL vs 17.4 ng/mL,P<0.001),with a notable positive correlation between VitD deficiency and reduced apoA1 levels.Multifactor logistic regression analysis identified that severe VitD deficiency was an independent risk factor for apoA1 in young-onset T2DM patients(odds ratio=3.43,95%confidence interval:1.16-10.20,β=1.23,P=0.026).CONCLUSION Our findings reveal an association between VitD and apoA1 in young-onset T2DM,suggesting that VitD may play a crucial role in metabolic regulation and cardiovascular risk management.
文摘Objective:The aim of this study was to find the optimal force that should be applied to control urine leakage using a non-hydraulic cuff design,and to investigate the relationship between the number of cuffs used in urinary control and the change in demand force.Method:In this study,five sheep bladders were used to design and build a biomechanical evaluation system.The biomechanical system included the bladder,pressure gauge,pressure regulator system of the bladder,and force application system by the cuff.In this study,we increased the fluid pressure inside the bladder from 0 cmH_(2)O to 200 cmH_(2)O(1 cmH_(2)O=0.098 kPa),and at each point,the force applied by the cuff to prevent fluid leakage was measured and recorded.Results:The study revealed that a mean tensile force of 2.81(standard deviation 0.23)N for a single cuff and 1.63(standard deviation 0.16)N for double cuffs with symmetrical pressure effectively prevented bladder fluid leakage in the pressure range from 75 cmH_(2)O to 100 cmH_(2)O(p<0.001).However,there were no significant differences in results when comparing the applied tensile force required by double cuffs with asymmetric tensile force to that of the single cuff use.Furthermore,using three cuffs instead of two did not yield significantly different outcomes.Conclusion:Using double cuffs with symmetrical pressure had a greater effect compared with a single cuff with the same tensile force.Although multiple cuffs with varying tensile forces were not found to be useful in controlling urine leakage in this study,it is suggested that applying variable forces alternately and rotationally among several cuffs may reduce long-term risks such as atrophy and necrosis.Future in vivo studies are recommended to further evaluate efficiency.
基金supported by the National Natural Science Foundation of China(52173150)the Guangzhou Science and Technology Program City-University Joint Funding Project(2023A03J0001)the Postdoctoral Fellowship Program of CPSF(GZC20233297)。
文摘The advent of targeted T-cell therapy,with chimeric antigen receptor(CAR)T-cell therapy as the most prominent example,has yielded significant clinical efficacy for both relapsed and refractory hematological malignancies.However,this form of T-cell immunotherapy is often accompanied by severe systemic toxicities,suboptimal response rates,and host immune rejection in clinical sethings,which detracts from its therapeutic utility.
文摘This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study.There is a need for a reliable,applicable,and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function.Seven adult male dogs were used for this study.The urethral sphincter was bypassed by inserting a catheter between the bladder neck and the distal sphincter.The animals'physical condition was closely monitored for 9 weeks,and standard urodynamic and radiologic studies were performed before and 1–2 months after surgery.The animals were killed at 9 weeks after surgery for pathological assessment.Catheter placement caused complete incontinence in the animal,with urodynamic assessments indicating that the animal was unable to control urination and radiological assessments indicating an empty bladder with a residual volume of 50±10 cc.Tissue analysis did not show significant histological damage and inflammation.The study shows that by bypassing the urethral sphincter,which is a reliable and reproducible method,an animal model of urinary incontinence can be developed,which can be used in various studies such as assessing the adequacy of artificial sphincter function.The animals under study did not have any permanent defect,so they were able to return to their normal life.
基金the National Natural Science Foundation of China(No.52173150 to J.Wu)the National Natural Science Foundation of China(No.82370164 to C.Chen)+5 种基金Guangzhou Science and Technology Program City-University Joint Funding Project(No.2023A03J0001 to J.Wu)the Affiliated Qingyuan Hospital of Guangzhou Medical University Open Project Fund(No.202301–211 to J.Wu)Sanming Project of Medicine in Shenzhen(No.SZSM201911004 to D.Lin and M.Zhao)National Natural Science Foundation of China(No.92268205 to D.Lin)Doctoral Scientific Research Foundation of Changzhi Medical College,China(to Z.Zhao)Post-doctoral Science Foundation(No.2022M723670 to L.Wang)。
文摘Venetoclax(Vene),a BCL-2 inhibitor,is widely used as a chemotherapeutic drug in acute myeloid leukemia(AML).However,its treatment specificity for leukemia cells is limited,often leading to side effects and treatment resistance.In this study,we utilized L-phenylalanine as an efficient nanocarrier to enhance the delivery of Vene,forming the complex Vene@8P6.This complex was then applied to AML mouse models and human AML cell lines.The in vitro analysis showed that THP-1 and HL60 cells rapidly absorbed the Vene@8P6 nanoparticles.This absorption resulted in severe DNA damage,increased reactive oxygen species(ROS)production,elevated apoptosis rates,and decreased cell proliferation compared to the administration of Vene alone.In vivo studies demonstrated that Vene@8P6 more efficiently targeted leukemia cells than normal hematopoietic cells within the bone marrow and other major organs in AML mice,as evidenced by bioluminescence imaging and flow cytometry analysis.Furthermore,Vene@8P6 treatment resulted in reduced drug side effects and improved therapeutic efficacy in AML mice.Overall,Vene@8P6 represents a novel and efficient therapeutic agent for AML,offering enhanced leukemia target specificity,reduced side effects,and improved treatment outcomes.
文摘The onslaught of foreign antigens carried by spermatozoa into the epididymis, an organ that has not demonstrated immune privilege, a decade or more after the establishment of central immune tolerance presents a unique biological challenge. Historically, the physical confinement of spermatozoa to the epididymal tubule enforced by a tightly interwoven wall of epithelial cells was considered sufficient enough to prevent cross talk between gametes and the immune system and, ultimately, autoimmune destruction. The discovery of an intricate arrangement of mononuclear phagocytes （MPs） comprising dendritic cells and macrophages in the murine epididymis suggests that we may have underestimated the existence of a sophisticated mucosal immune system in the posttesticular environment. This review consolidates our current knowledge of the physiology of MPs in the steady state epididymis and speculates on possible interactions between auto-antigenic spermatozoa, pathogens and the immune system by drawing on what is known about the immune system in the intestinal mucosa. Ultimately, further investigation will provide valuable information regarding the origins of pathologies arising as a result of autoimmune or inflammatory responses in the epididymis, including epididymitis and infertility.
文摘Objective: To investigate the in vitro anticancer effect of Aloe vera(A. vera) and Calligonum comosum(C. comosum) extracts against hepatocellular carcinoma(HepG 2) cells. Methods: Hep G2 cells were tested against different doses of A. vera and C. comosum. Viability of the cells was assessed by MTT assay. Evaluation of apoptosis and DNA damage in HepG 2 cells were performed using annexin V apoptosis detection kit. The expression of p53 and anti-apoptotic(Bcl-2) were tested by real time-PCR and flow cytometer analyser. Hematoxylin and eosin stained sections from untreated and treated HepG 2 cells were observed using light microscopy.Results: The IC50 values of A. vera and C. comosum extracts were(10.45 ± 0.31) and(9.60 ± 0.01) μg/mL respectively. The extracts separately increased cytotoxicity against HepG 2 cells in a time and dose dependent manners. Also, it apparently induced apoptosis through increase P53 and decrease Bcl-2 genes expressions.Conclusions: The results indicated that the extracts could have anti-hepatocarcinogenic effect, at least in part, through modulation of apoptosis.
基金Supported by The European Union and the State of Hungary and co-financed by the European Social Fund in the framework of TáMOP 4.2.4.A/2-11-1-2012-0001 National Excellence Program
文摘Oxidative stress processes play a major role in the development of the complications associated with diabetes and other diseases via non-enzymatic glycation,the hexosamine pathway,the polyol pathway and diacylglycerol-protein kinase C.Oxidative stress may lead to the production of hydroxyl free radicals,which can attack macromolecules,such as lipids,nucleic acids or amino acids.Phenylalanine(Phe) can be enzymatically converted to the physiological para-tyrosine(p-Tyr);however,a hydroxyl free radical attack on Phe may yield meta-and ortho-tyrosine(m-and o-Tyr,respectively) in addition to p-Tyr.Hence,m-and o-Tyr may be regarded as markers of hydroxyl free radical-induced damage.Their accumulation has been described;e.g.,this accumulation has been found in the urine of patients with diabetes mellitus(DM) and/or chronic kidney disease,in cataract lenses,in vessel walls,in irradiated food and in amniotic fluid,and it may serve as an indicator of oxidative stress.The use of resveratrol to treat patients with type 2 DM led to a decrease in the urinary excretion of o-Tyr and concomitantly led to an improvement in insulin signaling and insulin sensitivity.Literature data also suggest that m-and o-Tyr may interfere with intracellular signaling.Our group has shown that erythropoietin(EPO) has insulin-like metabolic effects on fat cells in addition to its ability to promote the proliferation of erythroid precursor cells.We have shown that the supplementation of cell culture medium with m-and o-Tyr inhibits erythroblast cell proliferation,which could be ameliorated by p-Tyr.Additionally,in vivo,the o-Tyr/p-Tyr ratio is higher in patients with renal replacement therapy and a greater need for EPO.However,the o-Tyr/p-Tyr ratio was an independent determinant of EPO-resistance indices in our human study.The o-Tyr content of blood vessel walls inversely correlates with insulin-and acetylcholineinduced vasodilation,which could be further impaired by artificial oxidative stress and improved by the use of antioxidants.In rats that receive o-Tyr supplements,decreased vasorelaxation is detected in response to insulin.Additionally,o-Tyr supplementation led to the incorporation of the unnatural amino acid into cellular proteins and caused a decrease in the insulin-induced phosphorylation of endothelial nitric oxide synthase.Our data suggest that m-and o-Tyr may not only be markers of oxidative stress;instead,they may also be incorporated into cellular proteins,leading to resistance to insulin,EPO and acetylcholine.
基金Supported by Natural Science Foundation of Zhejiang Province,No.LY23H050005and Zhejiang Medical Technology Project,No.2022RC009.
文摘Diabetic kidney disease(DKD)is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease(ESKD).Wide glycemic var-iations,such as hypoglycemia and hyperglycemia,are broadly found in diabetic patients with DKD and especially ESKD,as a result of impaired renal metabolism.It is essential to monitor glycemia for effective management of DKD.Hemoglobin A1c(HbA1c)has long been considered as the gold standard for monitoring glycemia for>3 months.However,assessment of HbA1c has some bias as it is susceptible to factors such as anemia and liver or kidney dysfunction.Continuous glucose monitoring(CGM)has provided new insights on glycemic assessment and management.CGM directly measures glucose level in interstitial fluid,reports real-time or retrospective glucose concentration,and provides multiple glycemic metrics.It avoids the pitfalls of HbA1c in some contexts,and may serve as a precise alternative to estimation of mean glucose and glycemic variability.Emerging studies have demonstrated the merits of CGM for precise monitoring,which allows fine-tuning of glycemic management in diabetic patients.Therefore,CGM technology has the potential for better glycemic monitoring in DKD patients.More research is needed to explore its application and management in different stages of DKD,including hemodialysis,peritoneal dialysis and kidney transplantation.
文摘Men with chronic renal failure （CRF） on hemodialysis have been frequently associated with erectile dysfunc-tion （ED）, with an of between 20% to 87.7%. As a result of the multi-system disease processes present in many uremic men, it is apparent that the pathogenesis of ED is most probably multifactorial. Factors to be con-sidered include peripheral vascular disease, neurogenic abnormalities, hormonal disturbances and medications used for treatment of conditions associated with CRF. These physiological abnormalities may be supplement-ed by signifcant psychological stresses and abnormali-ties resulting from chronic illness. Treatment must start with the determination and treatment of the underlying causes. In addition to psychological treatment, furtherlines of treatment of ED in CRF can be classifed as 1stline （medical treatment which includes oral phosphodi-esterase-5 inhibitors and hormone regulation）, 2nd line（intracavernosal injection, vacuum constriction devicesand alprostadil urethral suppositories） or 3rd line （sur-gical treatment）. Renal transplantation improves thequality of life for some patients with CRF and subse-quently it may improve erectile function in a signifcantnumber of them, however still there is high incidenceof ED after transplantation.
文摘Hepatitis B represents a global health threat because its chronic course and sequelae contribute to a high morbidity and mortality.Hepatitis B virus(HBV)infection can be controlled by vaccines,antiviral treatment,and by interrupting transmission.Rare vaccine escape mutants are serious because they eliminate vaccine protection.Here,we present a 74-year-old vaccinated patient with HBV reactivation 11 years after kidney transplantation.The patient was HBV-positive but HBs Ag-negative prior to vaccination 6 years before transplantation.The reactivated virus was HBV genotype F3 with vaccine escape mutations G145 R,P120 Q,and Q129 P.The patient was successfully treated with entecavir.The epidemiological reasons for this subgenotype,which is extremely rare in Western Europe,were unclear.This case illustrates that second-generation vaccines are not always effective in a specific group of patients.
文摘BACKGROUND Hypercalciuria is the most common metabolic risk factor for calcium urolithiasis and is associated with bone loss in adult patients.Reduced bone mineral density(BMD)was already described in idiopathic hypercalciuria(IH)children,but the precise mechanisms of bone loss or inadequate bone mass gain remain unknown.Life-long hypercalciuria might be considered a risk to change bone structure and determine low bone mass throughout life.The peak of bone mass should occur without interferences.A beneficial effect of citrate formulations and thiazides on bone mass in adult and pediatric patients with IH have been shown.AIM To evaluate whether pharmacological therapy has a beneficial effect on bone mass in children and adolescents with IH.METHODS This retrospective cohort study evaluated 40 hypercalciuric children nonresponsive to lifestyle and diet changes.After a 2-mo run-in period of citrate formulation(Kcitrate)usage,the first bone densitometry(DXA)was ordered.In patients with sustained hypercalciuria,a thiazide diuretic was prescribed.The second DXA was performed after 12 mo.Bone densitometry was performed by DXA at lumbar spine(L2-L4).A 24-h urine(calcium,citrate,creatinine)and blood samples(urea,creatinine,uric acid,calcium,phosphorus,magnesium,chloride,hemoglobin)were obtained.Clinical data included age,gender,weight,height and body mass index.RESULTS Forty IH children;median age 10.5 year and median time follow-up 6.0 year were evaluated.Nine patients were treated with Kcitrate(G1)and 31 with Kcitrate+thiazide(G2).There were no differences in age,gender,body mass index z-score and biochemical parameters between G1 and G2.There were no increases in total cholesterol,kalemia and magnesemia.Calciuria decreased in both groups after treatment.Lumbar spine BMD z-score increased after thiazide treatment in G2.There was no improvement in G1.CONCLUSION Results point to a beneficial effect of thiazide on lumbar spine BMD z-score in children with IH.Further studies are necessary to confirm the results of the present study.
文摘We present a case of left ectopic ureter insertion into the left seminal vesicle which is a rare anomaly.The incidence of ectopic insertion of the ureter is more common in females and is usually associated with incontinence,leading to the diagnosis,while in males it is present with infection.Ectopic ureter is defined as abnormal insertion of the ureter,occurring in the posterior urethra in approximately 50%of cases in males.Other sites include the seminal vesicle(approximately one-third),vas deferens,bladder neck,prostate and epididymis,while the urethra and vagina are commonly affected in females.Management is usually addressed to the upper tract only;if there is incontinence it requires removal of the ureteric stump.Our case was initially diagnosed by magnetic resonance imaging and the diagnosis confirmed by computed tomography(CT)guided seminal vesiculography as transrectal guidance for seminal vesiculography was refused by the patient.CT guided seminal vesiculography is less painful and more tolerable than the transrectal route.
文摘Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.
