Background: The treatment of ketamine-induced bladder contractures remains poorly studied. We therefore evaluated the efficacy of cystectasia with a sodium hyaluronate balanced solution in this kind of bladder contracture.Methods: Eighteen patients presenting with ketamine-induced bladder contracture between July 2010 and February 2018 were selected and analysed. Ketamine was discontinued in all patients, who were then treated with weekly cystectasia (0.09% sodium hyaluronate balanced solution) 3 times. The volume of the first perfusion was twice the preoperatively measured bladder capacity, and the volume of the subsequent two perfusions was increased by 100 mL each time. The Pelvic Pain and Urgency/Frequency (PUF) symptom score, O'Leary-Sant Interstitial Cystitis (IC) Symptom Index (ICSI), IC Problem Index (ICPI), Quality of Life (QOL) score, and bladder capacity were recorded before surgery and 3 and 12 months after the 3 rd expansion.Results: No significant complications were observed during the 3 expansions. Fourteen patients completed the full follow-up schedule. Preoperatively and at the 3-and 12-month follow-up evaluations performed after the 3 rd expansion, the PUF symptom scores were 20.4±3.6, 11.5±3.1, and 13.2±3.3, respectively; the mean ICSI was 13.6±2.8, 7.7±2.3, and 8.2±2.5, respectively; the mean ICPI was 10.6±2.6, 7.3±2.1, and 7.7±2.5, respectively; and the mean QOL scores were 6.0±0, 2.1±0.5, and 2.7±0.8, respectively; and the mean bladder catheter volume was 83±27, 234±56, and 228±52 mL, respectively. There were significant differences between all preoperative and postoperative values.Conclusions: Cystectasia with a sodium hyaluronate balanced solution is an effective treatment modality for ketamine-induced bladder contracture.

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PurposeTo investigate the predictive performance of the combined model by integrating clinical variables and radiomic features for the accurate detection of prostate cancer (PCa) in patients with prostate-specific antigen (PSA) serum levels of 4-10 ng/mL.MethodsA retrospective study of 136 males (mean age, 67.3 ± 8.4 years) with Prostate Imaging-Reporting and Data System (PI-RADS) v2.1 category ≤3 lesions and PSA serum levels of 4-10 ng/mL were performed. All patients underwent multiparametric MRI at 3.0T and transrectal ultrasound-guided systematic prostate biopsy in their clinical workup. Radiomic features were extracted from axial T2-weighted images (T2WI) and apparent diffusion coefficient (ADC) maps of each patient using PyRadiomics. Pearson correlation coefficient (PCC) and recursive feature elimination (RFE) were implemented to identify the most significant radiomic features. Independent clinic-radiological factors were identified via univariate and multivariate regression analyses. Seven machine-learning algorithms were compared to construct a single-layered radiomic score (ie, radscore) and multivariate regression analysis was applied to construct the fusion radscore. Finally, the radiomic nomogram was further developed by integrating useful clinic-radiological factors and fusion radscore using multivariate regression analysis. The discriminative power of the nomogram was evaluated by area under the curve (AUC), DeLong test, calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC).ResultsThe transitional zone-specific antigen density was identified as the only independent clinic-radiological factor, which yielded an AUC of 0.592 (95% confidence interval [CI]: 0.527-0.657). The ADC radscore based on six features and Naive Bayes achieved an AUC of 0.779 (95%CI: 0.730-0.828); the T2WI radscore based on 13 features and Support Vector Machine yielded an AUC of 0.808 (95%CI: 0.761-0.855). The fusion radscore obtained an improved AUC of 0.844 (95%CI: 0.801-0.887), which was higher than the single-layered radscores (both P<0.05). The radiomic nomogram achieved the highest value among all models (all P<0.05), with an AUC of 0.872 (95%CI: 0.835-0.909). Calibration curve showed good agreement and DCA together with CIC confirmed the clinical benefits of the radiomic nomogram.ConclusionThe radiomic nomogram holds the potential for accurate and noninvasive identification of PCa in patients with PI-RADS ≤3 lesions and PSA of 4-10 ng/mL, which could reduce unnecessary biopsy.

ObjectivesThe association between platelet status and hepatocellular carcinoma (HCC) prognoses remains controversial. Herein, we aimed to clarify the prognostic value of multiple platelet‐related biomarkers, including platelet count, platelet/lymphocyte ratio (PLR), aspartate aminotransferase to platelet ratio index (APRI), and alkaline phosphatase‐to‐platelet count ratio index (APPRI) in HCC with microvascular invasion (MVI) after curative resection or liver transplantation.Materials and MethodsA retrospective review of 169 patients with solitary HCC and MVI who underwent resection or liver transplantation between January 2015 and December 2018 was conducted. Preoperative clinical, laboratory, pathologic, and imaging data were collected and analyzed. Overall survival (OS) and disease‐free survival (DFS) were defined as the clinical endpoints. Univariate and multivariate Cox proportional hazards regression analyses were conducted to investigate potential predictors of DFS and OS.ResultsMultivariate Cox regression analyses revealed that maximum tumor diameter, poor cell differentiation, and APPRI were independent predictors of DFS; while poor cell differentiation, APRI, APPRI, prothrombin time, and alpha‐fetoprotein were independent prognostic factors for OS. The 1‐, 3‐, and 5‐year DFS rates were 66.90%, 48.40%, and 37.40% for patients with APPRI ≤0.74 and 40.40%, 24.20%,and 24.20% for patients with APPRI>0.74. The corresponding rates of OS over 1, 3, and 5 years were 92.40%, 88.10% and 77.70%, and 72.30%, 38.20%, and 19.10%, respectively. The DFS and OS rates of patients whose APPRI was more than 0.74 were substantially lower than those of patients whose APPRI was less than or equal to 0.74 (p = 0.002 and p < 0.001, respectively).ConclusionElevated preoperative APPRI is a noninvasive, simple, and easily assessable parameter linked to poor prognosis in individuals with single HCC and MVI after resection or liver transplantation.