The incidence of bladder cancer is increasing annually, and the gold standard for its diagnosis relies on histopathological biopsy. Whole-slide digitization technology can produce thousands of high-resolution captured pathological images and has greatly promoted the development of digital pathology. Deep learning, as a new method of artificial intelligence, has achieved remarkable results in the analysis of pathological images for tumor diagnosis, molecular typing, and prediction of prognosis and recurrence of bladder cancer. Traditional pathology relies heavily on the professional level and experience of pathologists; as such, it is highly subjective and has poor reproducibility. Deep learning can automatically extract image features. It can also improve diagnostic efficiency and repeatability and reduce missed and misdiagnosed rates when used to assist pathologists in making decisions. This technology cannot only alleviate the pressure of the current shortage of skilled workforce and uneven medical resources but also promote the development of precision medicine. This article reviews the latest research progress and prospects of deep learning in pathological image analysis of bladder cancer.

Global Cancer Statistics for 2020 show that urinary system tumors account for approximately 13% of the total number of cancers. At present, the diagnostic methods of urinary system tumors are imaging, endoscopy, and pathological examination. As the gold standard of tumor diagnosis, pathological examination has problems such as lack of pathologists and long operation time. Artificial intelligence (AI), with a strong ability for pathology image recognition and feature analysis, can be used as an auxiliary diagnosis. It has realized automatic diagnosis, typing, staging, grading, and prognosis prediction in several urinary system tumors. However, AI still has many shortcomings, which limit its clinical application. This article will review the progress of AI and its application in the pathological study of urinary system tumors.

Objective:To summarize the institutional experiences of treating vascular complications caused by donor-derived infection(DDI)after kidney transplantation(KT).Methods:From January 1, 2015 to December 31, 2020, clinical data were retrospectively reviewed for 6 cases of vascular complications caused by DDI.Age, gender, surgical approaches, immunity induction therapy, immune suppression therapy, infection prevention, onset time of complication, type of complications, infection pathogens, therapeutic protocols and prognoses were summarized.Results:Six patients developed vascular complications caused by DDI in 997 KT recipients with an overall morbidity rate of 0.6%.In 3 cases, carbapenem resistant Klebsiella pneumoniae were positive in culture of secretion and blood samples.And Candida albicans was detected by blood cultures and pathological examinations.One case of antibiotic resistant Staphylococcus aureus was detected by blood culture.Among 3 cases of transplant kidney artery pseudoaneurysm on interventional therapy, there were curing(1 case)and immediate recurrent infection(2 cases). The latter two eventually died by cardiac complications.In 2 cases of arterial hemorrhage, graft nephrectomy was followed by hemodialysis.One case of transplanted renal artery stenosis was successfully cured by artery stenting and survived with normal graft function so far.Conclusions:Interventional endovascular therapy and open surgery are indicated for vascular complications caused by DDI post-KT.Interventional therapy may boost the odds of rescuing transplant kidney.However, clinicians should watch out for the risk of recurrent infection.Open surgery is an effective tool of eliminating infected focus.Preserving transplant kidney or nephrectomy may be adopted on the basis of specific conditions.

The clinical data of 1 patient with long-term survival metastatic prostate cancer were analyzed retrospectively, and the related literature was reviewed and discussed. The patient, male, 70 years old, was admitted to the hospital in 2009 due to dysuria with lower abdominal pain for one month.Blood PSA>1 000 ng/ml. The pathology of prostate biopsy was prostatic adenocarcinoma, Gleason score was 8 points (4+ 4), and was diagnosed as prostate cancer (T 4N 0M 1b) with bone metastasis. The patient underwent combined androgen-blocked treatment(castration and bicalutamide 50mg) for four years, then progressed to mCRPC. The initial treatment was continued in the fifth year due to the absence of novel therapeutic agents, and then symptoms progressed. The regimens were adjusted successively to increased anti-androgen (castration and bicalutamide 150 mg) from Jan 2015, then switch to another anti-androgen (Flutamide 250 mg) from Aug 2015, and then withdraw the anti-androgens from Feb 2016. All these treatments showed limited benefit for a relatively short time. The t-PSA increased steadily to over 1 000 ng/ml with persistent symptoms. In April 2017, he started the treatment with the original abiraterone acetate and underwent a PSA flare-up in the following month.tPSA decreased sharply since May 2017, less than 0.02ng/ml in Aug 2017. Meanwhile, the regimen relieved the ostealgia. He could take care of himself in daily life. raditional CAB therapy can maintain PSA-free progression and symptom-free progression for several years for some metastatic prostate cancer patients. After disease progression, the increased dosage of anti-androgens, the substitution of anti-androgen, and the withdrawal of anti-androgens showed limited benefit within a short time. However, the novel hormone therapy is still effective in relieving clinical symptoms and prolonging patients' survival time.

Coronary disease is one of the highest mortality diseases in the world,and interventional therapy has been the best treatment choice for its low risks,high efficiency,less wound and rapid recovery after the operation.Thrombus aspiration catheter is one of the most important equipment in the interventional therapy instrument of coronary disease.This paper is based on the demand of clinical and market,designed and manufactured aspirated catheter for the treatment of coronary thrombosis.Through the performance comparison of the material,confirmed the main material quality of thrombus aspiration catheter and its organization.We also made the appraisement for the function of the material and the main performance of the thrombus aspiration catheter.The experiment turned out that our catheter performance is stable and also with highly reliable,which is absolutely fit for the using requirements of the clinical.
Catheters ; Coronary Angiography ; Coronary Thrombosis ; therapy ; Humans ; Suction ; Thrombectomy ; instrumentation ; Treatment Outcome

Objective: To explore the clinicopathological features and the diagnostic value of the CT scan in multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and cystic nephroma (CN). Methods: The clinical data of 12 patients with CN and 20 patients with MCRNLMP, confirmed by pathology at the Renmin Hospital of Wuhan University and Jingzhou Central Hospital from Janu-ary 2000 to March 2019, were retrospectively analyzed. The receiver operating characteristic (ROC) curves were used to analyze the feature of contrast-enhanced CT images of the tumors, and the immunophenotypes of the tumors were observed by immunohisto-chemistry. Results: There were statistically significant differences between MCRNLMP and CN in terms of thickness of the cyst wall and partition, number of soft-tissue enhancing masses, peak intensity of enhancement, and the Bosniak classification (P<0.05). Based on ROC curve analyses, when the thickness of the capsule wall and partition was greater than 2.25mm, the number of enhanced high-density lesions was greater than 1, and the peaking intensity of fortification was above the moderate level in the diagnosis of CRNLMP. The areas under the curve of the three indexes were 0.879, 0.800 and 0.838, which can be used as the best diagnostic criterion for MCRNLMP. Immunophenotyping revealed that MCRNLMP characteristically expressed the renal cell carcinoma (RCC) marker, and CN characteristically expressed the estrogen receptor(ER) and progesterone receptor(PR). Conclusions: The cyst wall and septal thickness, number of soft-tissue enhancing masses, and peak intensity of enhancement show a higher diagnostic value in differentiating MCRN-LMP and CN. The precise diagnosis relies on the pathological and immunohistochemical examination.

Objective To investigate the effect of apigenin and the change of expression of Fas/FasL after renal ischemia/reperfusion injury in rats.Methods Establishing Renal ischemia/reperfusion injury rat model was established.Sixty rats were randomly divided into 5 Groups.Blood samples were collected for the detection of serum creatinine and urea nitrogen levels.The level of SOD,MDA and GSH-Px were detected.Histologic examinations were evaluated.The expression of Fas,FasL,Caspase-3 and Bcl-2 were performed by immunohistochemistry and Western blot.Results Compared with the sham group,the Cr and BUN levels in the I/R groups of were significantly increased,the level of SOD and GSH-Px reduced,the level of MDA improved.Histopathological damage of renal tubular aggravated.The immunohistochemical expression of FasL and Caspase-3 as shown in enhanced and Bcl-2 reduced.Western blot showed that Fas and FasL expression increased and Bcl-2 reduced significantly,and the difference was statistically significant (P ＜ 0.05).Compared with I/R group,apigenin significantly enhanced renal function,and alleviated renal tubular epithelial cell injury and decreased Fas,FasL and Caspase-3 expression,improved Bcl-2 expression,difference were statistically significant (P ＜ 0.05).Conclusion Apigenin can protect the rats subjected to ischemia/reperfusion injury.Its protective mechanism may be related to the inhibition in expression of Fas/FasL and the increase in expression of Bcl-2.

Objective To investigate the effects of metformin preconditioning on renal ischemia-reperfusion injury in rats and its possible mechanism.Methods A total of 30 rats which were healthy adult male SD rats weighing 220-250g were randomly divided into 3 groups randomly (n =10):sham operation group (Sham group),ischemia reperfusion group (I/R group) and metformin group (Metformin + I/R group).Group metformin + I/R was given intraperitoneal injection of metformin 0.125mg/(kg · d) before the establishment of I/R model,14days,while Sham group and I/R group were given equal amount of normal saline.After the end of administration,I/R group and metformin + I/R group used the mnethod of removing the right kidney,clamping the left renal artery and vein 45min after the recovery of perfusion to prepare the rat model of renal ischemia and reperfusion.In Sham group,resection of the right kidney was performod,without clamping the left renal artery and vein.Determination of serum creatinine in the blood from inferior vena cava at 24h after reperfusion (Cr) and urea nitrogen (BUN) concentration was performed.Then the rats were sacrificed.Renal tissue morphology,immunohistochemical expression of Bcl-2,Bax and caspase-3 were observed under light microscope.At the same time,Tunel staining were used to evaluate the degree of renal tubular epithelial cell apoptosis.Results Compared with sham group,BUN and Cr in the I/R group and metformin + I/R group were significantly higher than those in the sham group,while the BUN and Cr in the Metformin + I/R group were significantly lower than those in the I/R group,and the difference was statistically significant (P ＜ 0.05).Immunohistochemistry showed that,compared with Sham group,in I/R group and metformin + I/R group,the expression of Bcl-2,Bax and caspase-3 increased significantly.Compared with I/R group,in metformin + I/R group,caspase-3 and bax expression decreased significantly,while the expression of Bcl-2 was stronger than I/R group.Tunel results showed that compared with Sham group,I/R metformin + I/R group and the number of apoptosis of renal tubular epithelial cells was significantly increased in metformin + I/R group.At the same time,the apoptosis of renal tubular epithelial cells was significantly less than I/R group,and the difference was statistically significant.Conclusion Metformin pretreatment can improve renal damage in rats with renal ischemia-reperfusion injury,which may be related to the inhibition of renal tubular epithelial cell apoptosis.

Objective To investigate the effect and mechanism of pretreatment with allopurinol on renal ischemia-reperfusion injury (IRI)in rats.Methods Twenty four rats were randomly assigned into the sham operation (S), ischemia-reperfusion (IR)and allopurinol pretreatment (APC)groups (n =8 for each group).At preoperative 2 weeks, allopurinol at a dose of 50 mg/(kg·d)was administered via intraperitoneal injection in the APC group,and an equivalent quantity of physiological saline was given via intraperitoneal injection in the S and IR groups.After pretreatment,the right kidneys of rats in the S group were resected.In the IR and APC groups,the right kidneys were resected and the left kidneys were treated with 30 min ischemia-reperfusion.Blood sample was collected at 24 h after reperfusion and the kidney specimen was obtained at postoperative 2 weeks.The levels of blood urea nitrogen (BUN)and serum creatinine (Scr)were detected by automatic biochemistry analyzer.The activity of plasma malondialdehyde (MDA)and superoxide dismutase (SOD)was respectively assessed by detection kits.The expression levels of Bax,Bcl-2 and Caspase-3 of rat kidney were measured by western blot.Pathological changes in the rat kidney were observed under light microscope.Cell apoptosis of rat kidney was evaluated by TdT mediated-dUTP nick end labeling (TUNEL).Results Compared with the S group,the levels of BUN, Scr and plasma MDA in the IR and APC groups were significantly increased,whereas the activity of plasma SOD was significantly reduced (all in P <0.05).Compared with the IR group,the levels of BUN,Scr and plasma MDA in the APC group were significantly reduced,whereas the activity of plasma SOD was considerably elevated (all in P <0.05).Compared with the S group,the expression levels of Bax and Caspase-3 proteins were significantly up-regulated in the IR and APC groups,and the levels in the APC group were considerably lower than those in the IR group (all in P <0.05).Compared with the S group,the expression of Bcl-2 in rat kidney in the IR and APC groups was significantly down-regulated,and the value in the APC group was dramatically higher than that in the IR group (all in P <0.05).Under light microscope,the morphology of rat kidney was intact and normal in the S group.In the IR group,evident renal tubular ectasia,massive necrosis of renal tubular epithelial cells,evident stromal edema and a large quantity of lymph cellular infiltration were observed.In the APC group,mild renal tubular ectasia was observed,whereas no apparent kidney stromal edema was noted.A slight amount of lymph cellular infiltration was noted in the stroma.TUNEL staining revealed that the apoptosis rate of kidney cells in the S,IR and APC groups was (4.1 ±1 .7)%,(32.8 ±8.9)% and (1 2.6 ±3.4)% (all in P <0.05).Conclusions Allopurinol pretreatment could suppress cell apoptosis through anti-oxidation effect,thereby alleviating IRI of rat kidney and improving renal function.

Objective To summarize the experience in retroperitoneal living donor nephrectomy under 3D laparoscopy and to investigate its clinical effect and safety. Methods The clinical data of 19 cases who underwent retroperitoneal living donor nephrectomy under 3D laparoscopy were collected.Operation duration,intraoperative blood loss, renal warm ischemia time,length of renal artery,renal vein and ureter,incision size and operative complications were recorded.Postoperative renal function of donors and recipients was observed. Results Nineteen cases of living donor nephrectomy were successfully completed under the 3D laparoscopy,and there were no conversion into conventional laparoscopy and open surgery.The operation duration of living donor nephrectomy under 3D laparoscopy was 80.5﹣125.2 (with an average of 102.3)min;intraoperative blood loss was 40.6﹣90.4 (60.8)ml;renal warm ischemia time was 100﹣230 (161)s.Length of renal artery,renal vein and ureter was 2.6﹣3.2 (2.9)cm,2.2﹣3.0 (2.6)cm and 8﹣13 (10)cm, respectively.The incision size was about 5﹣6 cm,and the wound healed.Urine volume of the donors at 24 h after operation was 2 000﹣2 500 ml.Serum creatinine increased slightly in 1 case at 3 d after operation,and returned to normal through reexamination after 7 d and 1 month.The donors stayed in the hospital 5﹣7 (6)d after operation.All transplant operations were performed successfully,and delayed graft function did not occurred. Conclusions Accuracy of operation can be improved effectively by 3D laparoscopic surgery system.It is safe and feasible to perform retroperitoneal living donor nephrectomy under 3D laparoscopy.