A Comparison between Clinical and Pathologic Staging in Patients with Bladder Cancer

Purpose: To determine the accuracy of clinical staging methods of bladder cancer and TURBT results in estimating the pathologic stage of tumor.Materials and Methods: Thirty two patients who had undergone radical cystectomy were studied in this retrospective survey. The results of bimanual examination, cystoscopy, TURBT pathology report and the tumor contour in CT scan, (size, infiltrative deepness, pelvic lymph nodes involvement and hydronephrosis) were recorded. The type of surgery and pathologic report of cystectomy sample were analyzed as well. Then the results of bimanual examination, tumor size, hydronephrosis and CT scan findings including tumor infiltrative deepness, pelvic lymph adenopathy and TURBT findings were compared to pathologic results of cystectomy sample.Results: Seven patients were females and 25 were males. Their mean age was 62 (range 36 to 80) years. Gross hematuria and irritative urinary symptoms were the most common complaints. The duration between symptom manifestation and patient’s referral was 5 days to 72 months (mean 12 months). Bimanual examination in estimating the extravesical involvement of tumor had a specificity of 82%, sensitivity of 46%, positive predictive value of 70% and negative predictive value of 63%. The size of tumor in determining extravesical involvement had a specificity of 41%, sensitivity of 93%, and positive predictive value of 58% and negative predictive value of 87%. Hydronephrosis was present in 15 patients of whom, 14 (93%) had bladder muscle involvement. CT scan specificity was 70%, and sensitivity was 46% regarding pelvic lymph adenopathy and perivesical fat involvement. In TURBT report no muscle sample was observed in 11 cases, so that the interpretations of results were impossible. The reported grade of tumor was lower than pathologic sample of cystectomy in 4 patients.Conclusion: Clinical staging in invasive bladder cancers has not high accuracy regarding the involvement of bladder surrounding fats and pelvic adenopathies. A tumor sized more than 5 cm could be sensitive in estimating extravesical involvement. Positive predictive value of hydronephrosis is considerable regarding bladder muscle involvement. Tumor understaging by TURBT is happened in high percentage of patients with invasive bladder cancer.</p

Effect of PTEN Gene Mutations and Environmental Risk Factors on the Progression and Prognosis of Bladder Cancer.

Bladder cancer is the most frequent genitourinary malignancy in Iran. Environmental and genetic factors are the two factors linked with bladder cancer expansion. The aim of this study was to investigate the role of PTEN gene and environmental risk factors on the progression and prognosis of bladder cancer.We evaluated 55 tumor specimens and 66 bladder mucosa samples of non-cancerous patients between 2011 and 2013. All samples were analyzed for PTEN mutations using PCR and direct DNA sequencing methods. Demographic data collected, were analyzed using SPSS version 19.0 software and a P value of < 0.05 was considered statistically significant.Of the 55 patients examined, tumor stage was T1, T2 (T2a, T2b) in 34 (61.8%) and 21 (38.2%) and tumor grade was high, low in 34 (61.8%) and 21 (38.2%), respectively. No mutations in the PTEN gene were found in patients with bladder cancer and control. Among the risk factors studied, only the occupation and history of urinary tract stones, were significantly associated with bladder cancer (P valu

Microchimerism and Renal Transplantation: Doubt Still Persists

Objective: We sought to study microchimerism in a group of kidney transplant recipients. Materials and Methods: In this study, the peripheral blood microchimerism (PBM) after renal transplantation was retrospectively evaluated in 32 male-to-female recipients of living unrelated or cadaveric donor renal transplants. Using a nested polymerase chain reaction (PCR) amplification specific for SRY region of the Y chromosome, microchimerism was detected with a sensitivity of 1:1,000,000. Recipients were compared according to the presence of PBM, acute and chronic rejection episodes, type of allotransplant, recipient and donor age at transplantation, previous male labor or blood transfusion, allograft function (serum creatinine level), and body mass index. Results: Among 32 recipients, 7 (21.9) were positive for PBM upon multiple testing at various posttransplant times. All microchimeric recipients had received kidneys from living unrelated donors. No significant difference was observed with regard to other parameters. In addition the acute rejection rate in the microchimeric group was 3 (42) versus 4 (16) in the nonmicrochimeric recipients (not significant). Conclusion: Our results suggested better establishment of microchimerism after living donor kidney transplantation. However, doubt persists concerning the true effect of microchimerism after renal transplantation. It seems that microchimerism alone has no major protective role upon renal allograft survival. © 2007 Elsevier Inc. All rights reserved

The risk factors of prostate cancer: A multicentric case-control study in Iran

Prostate cancer (PC), in Iran, is the third most frequently diagnosed visceral cancer among men and the seventh most common underlying cause of cancer mortality. We evaluated the relation between speculated factors and PC risk using data from a multicentric case-control study conducted in Iran from 2005 to 2007 on 130 cases of incident, clinicopathologically confirmed PC, and 75 controls admitted to the same network of hospitals without any malignant disease. Odds ratios(OR) and corresponding 95 confidence intervals (CIs) were estimated using conditional logistic regression models. The risk of PC was increased with aging (OR: 5.35, 95 CI: 2.17-13.19; P<0.0001), and with the number of sexual intercourse �2 times/week (OR: 3.14, 95 CI: 1.2-8.2; P=0.02). One unit elevation in serum estradiol and testosterone concentration was related to increase (OR: 1.04, 95 CI: 1.01-1.06; P=0.006) and decrease (OR: 0.79; 95 CI: 0.64-0.96; P=0.02) of PC risk, respectively. Cases were less likely to have a history of diabetes (OR: 0.34, 95 CI: 0.12-0.98; P=0.04). Increasing in dietary consumption of lycopene and fat was associated with declined (OR: 0.45, 95 CI: 0.09-2.12) and increased (OR: 2.38, 95 CI: 0.29-19.4) PC development, respectively. Other factors including educational level, marriage status, dietary meat consumption, vasectomy and smoking have not been shown to affect PC risk in the Iranian population. Ourstudy adds further information on the potential risk factors of PC and is the first epidemiologic report from Iran. However, justification of these results requires more well-designed studies with a larger number of participants

Toward learning autonomous pallets by using fuzzy rules, applied in a Conwip system

Nowadays, material planning and control strategies are becoming continuously complex tasks spanning from individual plants to logistic networks. In fact, this is the consequence of increasing intricacy in product variants and their respective convolution in networks’ structures. Customers ask for specific products with individual characteristics that force companies for more clever performances by more flexibility. For doing so, the existing planning and control systems, which work based on central monitoring and controlling, show some limitations for organizing every operation on time or in the right time. Therefore, in the recent decade, a great attention is put on decentralized control and, to some extent, autonomy. This paper tries to investigate the possibility of combining this new research paradigm with existing strategies in production logistics, in order to improve material handling and control task according to material flow criteria. To show this, an exemplary plant after decoupling point out of a logistic network is considered for simulation and analysis. This combines Conwip system with learning autonomous pallets’ concept in a discrete event simulation model. Several decentralized control scenarios are experimented and compared together. Here, the learn methodology is brought to pallets based on fuzzy rules and advantage of closed loop systems

Application of learning pallets for real-time scheduling by use of artificial neural network

Generally, this paper deals with the problem of autonomy in logistics. Specifically here, a complex problem in inbound logistics is considered as real-time scheduling in a stochastic shop floor problem. Recently, in order to comply with real-time decisions, autonomous logistic objects have been suggested as an alternative. Since pallets are common used objects in carrying materials (finished or semi-finished), so they have the possibility to undertake the responsibility of real time dispatching jobs to machines in a shop-floor problem. By insisting on the role of pallets for this task, their sustainment's advantage in manufacturing systems motivated the idea of developing learning pallets. These pallets may deal with uncertainties and sudden changes in the assembly system. Here, among some intelligent techniques artificial neural network is selected to transmit the ability of decision making as well as learning to the pallets, as distributed objects. Besides, pallets make decisions based on their own experiences about the entire system and local situations. Consequently, the considered scheduling problem resembles an open shop problem with three alternative finished products. Finally, a discrete event simulation model is developed to solve this problem and defined the results of this transmission paradigm