How to Perform Intravesical Chemotherapy after Second TURBT for Non-Muscle-Invasive Bladder Cancer: A Single-Center Experience

Purpose: The objective of this study aimed to explore whether the original IVC regimen should be continued after the second TURBT or whether the IVC induction phase should be restarted from the beginning. Methods: A retrospective analysis was performed on 137 patients who underwent a second TURBT at the Affiliated Hospital of Xuzhou Medical University between April 2014 and June 2022. Based on the pathological findings, patients were divided into two groups: group A patients, who did not have a residual tumor on pathological examination after the second TURBT; and group B patients, who had residual tumor. Recurrence was determined using cystoscopy and imaging every three months. The endpoint was recurrence-free survival. Result: In the entire cohort, there was a statistically significant difference in the RFS between patients in the two IVC regimens (p = 0.029). The RFS of patients in group B1 was significantly lower than that of patients in group B2 (p = 0.009). There was no significant difference in RFS between the subgroups A1 and A2 (p = 0.560). Multivariate Cox regression analysis confirmed that the IVC regimen after a second TURBT (p = 0.012) and T stage after a second TURBT (p = 0.005) were both independent predictors for patient RFS. Conclusion: If the pathological findings of the second TURBT specimen is benign, patients can continue their previous treatment regimen without restarting an IVC induction phase. Unnecessary IVC can be avoided in these patients. In contrast, for patients with residual tumors in the second TURBT specimen, the need to restart the IVC induction phase should be emphasized to improve patient prognosis

The addition of tislelizumab to gemcitabine and cisplatin chemotherapy increases thrombocytopenia in patients with urothelial carcinoma: A single‐center study based on propensity score matching

Abstract Purpose Whether the addition of tislelizumab to gemcitabine and cisplatin (GC) chemotherapy increases the incidence of myelosuppression has not been well established. This study identified the risk factors for the development of myelosuppression in patients with urothelial carcinoma (UC) after receiving GC chemotherapy with or without tislelizumab. Materials and Methods We enrolled 192 UC patients who received GC with or without tislelizumab at the Affiliated Hospital of Xuzhou Medical University between July 2014 and November 2022. Patient baseline characteristics were included in the statistical analyses after adjusting for previously reported risk factors affecting survival using propensity score matching (1:1). Binary logistic regression analysis was used to identify the risk factors associated with posttreatment myelosuppression. Results A total of 192 patients were enrolled, of whom 96 were treated with tislelizumab plus gemcitabine and cisplatin (T + GC) and 96 with GC alone. The incidence of leukopenia, anemia, and thrombocytopenia of any grade was 50.0%, 70.8%, and 42.7%, respectively, in the T + GC group and 41.7%, 72.9%, and 20.8%, respectively, in the GC group. In multivariate analysis, patients aged over 70 years (OR = 2.486, 95% CI: 1.067–5.792, p = 0.035) and those who received T + GC (OR = 3.119, 95% CI: 1.576–6.173, p = 0.001) were more likely to develop thrombocytopenia. Patients aged over 70 years (OR = 3.213, 95% CI: 1.254–8.237, p = 0.015) were more likely to develop anemia, and patients with renal insufficiency (OR = 2.105, 95% CI: 1.035–4.280, p = 0.040) were more likely to develop leukopenia. Eventually, 99 (51.6%) patients with UC successfully completed all the treatment cycles. Conclusions This study demonstrates that the addition of tislelizumab to GC chemotherapy led to a considerable increase in the occurrence of thrombocytopenia, whereas no significant changes were observed regarding anemia or leukopenia. It is crucial to fully inform patients at increased risk for myelosuppression of potential risks and closely monitor changes in their blood routines

Microbiological quality of water in a city with persistent and recurrent waterborne diseases under tropical sub-rural conditions: The case of Kikwit City, Democratic Republic of the Congo

The availability of safe drinking water in sub-Saharan countries remains a major challenge because poor sanitation has been the cause of various outbreaks of waterborne disease due to the poor microbiological quality of water used for domestic purposes. The faecal indicator bacteria (FIB) used in the present study included Escherichia coli (E. coli) and Enterococcus (ENT). FIB and aerobic mesophilic bacteria (AMB) were quantified during July 2015 (dry season) and November 2015 (rainy season) in order to assess the quality of drinking water from wells (n = 3; P1, P2, and P3), and two rivers, the River Lukemi (RLK, n=3) and River Luini (RLN, n=2) in the city of Kikwit, which is located in the province of Kwilu in the Democratic Republic of the Congo. Kikwit is well known for its outbreaks of persistent and recurrent waterborne diseases including Entamoeba, Shigella, typhoid fever, cholera, and Ebola Viral Hemorrhagic Fever. Consequently, E. coli, ENT, and AMB were quantified in water samples according to the standard international methods for water quality determination using the membrane filtration method. The FIB characterization was performed for human-specific Bacteroides by PCR using specific primers. The results obtained revealed high FIB concentrations in river samples collected during both seasons. For example, E. coli respectively reached 4.3x104 and 9.2x104 CFU 100 mL-1 in the dry season and the wet season. ENT reached 5.3x103 CFU 100 mL-1 during the dry season and 9.8x103 CFU 100 mL-1 in the wet season. The pollution was significantly worse in the wet season compared to the dry season. Surprisingly, no faecal contamination was observed in well water samples collected in the dry season while E. coli and ENT were detected in all wells in the wet season with values of 6, 7, and 11 CFU mL-1for E. coli in wells P1, P2, P3, respectively and 3, 5, 9 CFU mL-1for ENT in the same wells. Interestingly, the PCR assays for human-specific Bacteroides HF183/HF134 indicated that 97-100 % captured in all analyses of isolated FIB were of human origin. The results indicate that contamination of E. coli, ENT, and AMB in the studied water resources increases during the wet season. This study improves understanding of the microbiological pollution of rivers and wells under tropical conditions and will guide future municipal/local government decisions on improving water quality in this region which is characterised by persistent and recurrent waterborne diseases. Although the epidemiology can be geographically localised, the effects of cross border transmission can be global. Therefore, the research results presented in this article form recommendations to municipalities/local authorities and the approach and procedures can be carried out in a similar environment

Seasonal variability of water quality by physicochemical indexes and traceable metals in suburban area in Kikwit, Democratic Republic of the Congo

Water resource contamination is still a major concern in several regions of developing countries especially in sub-Saharan countries in which polluted waters pose serious risks to human health and the environment. The seasonal variation of the physicochemical parameters including pH, electrical conductivity (EC), dissolved oxygen (O2), dissolved organic carbon (DOC), total organic carbon (TOC), and trace metals were assessed in water samples collected from wells (n=3) and two rivers which were the River Lukemi (RLK, n=3) and River Luini (RLN, n=2) located in the City of Kikwit (Province of Kwilu, Democratic Republic of the Congo). Samples were collected during the dry and wet seasons. The concentration of trace metals (Cr, Mn, Co, Ni, Cu, Zn, As, Mo, Ag, Cd, Sn, Sb, and Pb) in water was measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS), and soluble ions (Na+, K+, NH4+, SO42-, NO3-, and Cl-) analysis was performed using Ion Chromatography. The results indicate the seasonal difference in the physicochemical composition of water e.g., the pH was lower in the wet compared to the dry season. pH values during the wet season ranged from 4.12 to 5.60 in wells and from 5.55 to 6.31 in rivers while the dry season values ranged from 6.27 to 6.98 in wells and from 7.09 to 7.44 in rivers. The concentrations of soluble ions and other physicochemical parameters (O2, DOC, and TOC) also varied with the seasons, being higher in the wet and lower in the dry season. With the exception of Mn, the average concentrations of other trace metals measured in water samples from wells and rivers met the World Health Organization (WHO) guidelines for drinking/domestic water quality. Mn concentration in water samples analysed ranged between 634 and 812 and 1352 to 1741 µg L-1 during the dry and wet seasons, respectively. These results imply that the high concentration of Mn in the water samples may be explained by the geological origin and result of natural weathering processes. In general, according to the parameters analysed, the water samples taken from the sites studied in both seasons appear to meet drinking water standards according to the WHO guidelines but with the two exceptions of the pH and Mn. This study is important for the present situation and can be applied in similar environmental compartments in the future to assess the availability of safe drinking water in developing countries

Assessment of water quality and time accumulation of heavy metals in the sediments of tropical urban rivers: Case of Bumbu River and Kokolo Canal, Kinshasa City, Democratic Republic of the Congo

The aim of this study is to assess the status of tropical urban rivers contamination by heavy (toxic) metals and to evaluate the potential human and environmental risks. In this study, water and surface sediment samples from Bumbu River (BR) and Kokolo Canal (KC, named Jerusalem River) draining Kinshasa, the capital city of the Democratic Republic of the Congo were collected during the period of 2015-2017 from the same sites to assess the status of rivers contamination by heavy metals. Water samples were characterized for temperature (T), pH, electrical conductivity (EC) and dissolved oxygen (O2). The concentrations of heavy metals including Cu, Cr, Zn, Cd, and Pb in sediment samples were determined using Inductive Coupled Plasma-Mass Spectroscopy (ICP-MS). The Hg analysis was carried out using Advanced Mercury Analyzer (AMA). The evaluation of the pollution degree was based on Sediment Quality Guidelines (SQGs) as well as probable effect levels (PELs), Enrichment Factor (EF) and Geoaccumulation Index (Igeo). Spearman's Rank-order correlation and principal component analysis (PCA) were used in order to investigate the potential source of contaminants. The results show the high seasonal variability of the water physicochemical composition; for example, pH values varied significantly during the three years and ranged from 4.49-8.24 and 7.05-7.81 for BR and KC, respectively. The EC values ranged between 197-396 and 198-614 µS cm-1 for BR and KC respectively. The highest concentrations of heavy metals in sediments reached the values of (in mg.kg-1) 190.2 (Cu), 58.6 (Cr), 1117.9 (Zn), 1.2(Cd), 149.2 (Pb), and 11.8 (Hg). The results indicate high variability in metal concentrations in surface sediments according to sampling period and sites. In general, all metal concentrations showed a gradual increase with time, e.g. Cd and Pb consistently increased during the three sampling years. All analysed metals were above SQGs during the year 2017 and 2 to 4 times higher than PELs. EF and Igeo showed severe enrichment to extremely severe enrichment, and moderate to extremely polluted by Zn and Pb. Correlation analysis suggested that the metal contamination in the studied sites is caused by the anthropogenic activities as well as the influence of urban effluents discharge into the river receiving systems. The results of the present study will be helpful to assess and intervening effective management strategies at the local input source pollution level and similar environments