Can We Predict the Grade of Clear Cell Renal Cell Carcinoma from Houns-Field Unit of Renal Lesion on Computerized Tomography Scan, a Retrospective Cross-Sectional Study

Mohammad Al-Zubi,1 Khayry Al-Shami,2 Leen Sawalha,3 Heyam Mahmoud Alguzo,2 Saddam Al Demour,4 Asma’a Mohammad Al-Mnayyis,2 Rami Alazab,5 Samer Fathi Al-Rawashdah,6 Lana Talal Alzoubi,7 Sawsan Radi Al-khawaldeh2 1Department of Surgery, Division of Urology, Yarmouk University MEdical SChool, Irbid, 21110, Jodan; 2Department of Clinical Medical Sciences, Yarmouk University Medical school, Irbid, Jordan; 3Department of Clinical Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Special Surgery, Division of Urology, the University of Jordan medical School, Amman, 11972, Jordan; 5Department of Surgery & Urology, Jordan University of Science & Technology, Irbid, 21110, Jordan; 6Department of Special Surgery, School of Medicine, Mutah University medical School, Karak, 61710, Jordan; 7Department of Dentistry, Private Sector, Amman, JordanCorrespondence: Mohammad Al-Zubi, Tel +962 789724264, Email [email protected]: Renal cell carcinoma (RCC) is a type of urological malignancy that affects approximately 2% of the global population. Imaging modalities, especially computed tomography (CT) scanning, play a critical role in diagnosing RCC. In this study, we investigated whether there is a relationship between tumour grade of clear cell RCC and HU values of renal lesions on CT scan performed before operation.Materials and Methods: We conducted a retrospective analysis of 123 patients who underwent radical or partial (open or laparoscopic) nephrectomy for clear cell RCC between January 2017 and January 2021. Post-operation histopathological grades were recorded according to World Health Organization (WHO)/International Society of Urological Pathology (ISUP) 2016 grading system and divided into low grade (includes grade 1 and 2) and high grade (grade 3 and 4), and their links to age, sex, smoking habits, tumour size, and HUs of renal lesions were evaluated.Results: The mean age of the patients studied was 63.02 years old. About 56.9% of the patients were low grade (grade 1 or grade 2), while 43.1% were high grade (grade 3 or 4). The mean tumour size was 6.31 cm. There were no significant differences in tumour grade according to age, sex, or smoking habits. We found a significant relation between tumour grade and HU in the pre-contrast and nephrogenic phases, with p values of 0.001 and 0.037, respectively. On the other hand, there was no significant relation linking the tumour grade to the difference in HU between these phases, where there was a p value of 0.641.Conclusion: HU in the pre-contrast and nephrogenic phases in addition to tumour size on CT scan have a significant relation to clear cell RCC grade.Keywords: renal cell carcinoma, grade, stage, Hounsfield unit, CT sca

Knowledge, awareness, and attitudes about research ethics committees and informed consent among resident doctors

Saddam Al Demour,1 Karem H Alzoubi,2 Anas Alabsi,1 Sadam Al Abdallat,1 Ashraf Alzayed11Department of Special Surgery, Division of Urology, The University of Jordan, School of Medicine, Amman, 11942, Jordan; 2Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, JordanBackground: Medical research involving humans is now common all over the world. Medical doctors and residents are increasingly involved in such research. As part of their training requirements, medical residents in many institutions have to be involved, to different degrees, in human research projects.Methods: In this study, knowledge, awareness, and attitudes of resident doctors toward research ethics committees (REC) and informed consent (IC) processes were evaluated. For that purpose, a sample of 209 medical residents of different years from a major teaching hospital was surveyed.Results: Results showed that resident doctors had minimal knowledge of major ethical guidelines such as the Declaration of Helsinki and Belmont Report. However, more than half of respondents in this study had general knowledge of REC. Additionally, the majority of participants believed that there is a need for REC in each research conducting institution, and that training is also needed for REC members. Moreover, 82.7% of participants thought that investigators should have some training in research ethics. Finally, the current study showed that 60.3%–88.7% of participants were aware of IC requirements in clinical research.Conclusion: Although many residents showed good knowledge and positive attitudes regarding certain aspects related to REC and IC, others need improvement.Keywords: knowledge, awareness, attitudes, research ethical committee, informed consent, resident doctors, Jorda

Use of conditioned media (CM) and xeno-free serum substitute on human adipose-derived stem cells (ADSCs) differentiation into urothelial-like cells

BackgroundCongenital abnormalities, cancers as well as injuries can cause irreversible damage to the urinary tract, which eventually requires tissue reconstruction. Smooth muscle cells, endothelial cells, and urothelial cells are the major cell types required for the reconstruction of lower urinary tract. Adult stem cells represent an accessible source of unlimited repertoire of untransformed cells.AimFetal bovine serum (FBS) is the most vital supplement in the culture media used for cellular proliferation and differentiation. However, due to the increasing interest in manufacturing xeno-free stem cell-based cellular products, optimizing the composition of the culture media and the serum-type used is of paramount importance. In this study, the effects of FBS and pooled human platelet (pHPL) lysate were assessed on the capacity of human adipose-derived stem cells (ADSCs) to differentiate into urothelial-like cells. Also, we aimed to compare the ability of both conditioned media (CM) and unconditioned urothelial cell media (UCM) to induce urothelial differentiation of ADCS in vitro.MethodsADSCs were isolated from human lipoaspirates and characterized by flow cytometry for their ability to express the most common mesenchymal stem cell (MSCs) markers. The differentiation potential was also assessed by differentiating them into osteogenic and adipogenic cell lineages. To evaluate the capacity of ADSCs to differentiate towards the urothelial-like lineage, cells were cultured with either CM or UCM, supplemented with either 5% pHPL, 2.5% pHPL or 10% FBS. After 14 days of induction, cells were utilized for gene expression and immunofluorescence analysis.ResultsADSCs cultured in CM and supplemented with FBS exhibited the highest upregulation levels of the urothelial cell markers; cytokeratin-18 (CK-18), cytokeratin-19 (CK-19), and Uroplakin-2 (UPK-2), with a 6.7, 4.2- and a 2-folds increase in gene expression, respectively. Meanwhile, the use of CM supplemented with either 5% pHPL or 2.5% pHPL, and UCM supplemented with either 5% pHPL or 2.5% pHPL showed low expression levels of CK-18 and CK-19 and no upregulation of UPK-2 level was observed. In contrast, the use of UCM with FBS has increased the levels of CK-18 and CK-19, however to a lesser extent compared to CM. At the cellular level, CK-18 and UPK-2 were only detected in CM/FBS supplemented group. Growth factor analysis revealed an increase in the expression levels of EGF, VEGF and PDGF in all of the differentiated groups.ConclusionEfficient ADSCs urothelial differentiation is dependent on the use of conditioned media. The presence of high concentrations of proliferation-inducing growth factors present in the pHPL reduces the efficiency of ADSCs differentiation towards the urothelial lineage. Additionally, the increase in EGF, VEGF and PDGF during the differentiation implicates them in the mechanism of urothelial cell differentiation.</jats:sec

Does post-void residual urine volume affect potential recurrence risk for non-muscle invasive bladder cancer?

Plain language summaryAim: Bladder cancer is the second most common urological malignancy after prostate cancer. Increase in the post-void residual (PVR) volume may result in an increase in the risk of cancer recurrence. Methods: Patient demographic data, tumor stage and grade, PVR volume and 2 years follow-up data for recurrence were obtained. Results: The increase of PVR volume was related to short recurrence-free survival (RFS) especially for patients with PVR volume of 60 ml or more. Conclusion: Low PVR volume in patients with non-muscle invasive bladder cancer may play a role in reducing cancer recurrence. However further research is needed in this field.Aim: Bladder cancer is the second most common urological malignancy after prostate cancer. Increase in the post-void residual (PVR) volume may result in an increase in the risk of cancer recurrence. Methods: Patient demographic data, tumor stage and grade, PVR volume and 2 years follow-up data for recurrence were obtained and evaluated. Results: One-hundred-and-nineteen patients were subdivided into three groups according to PVR urine volume. The increase of PVR volume was related to short recurrence-free survival (RFS) especially for patients with PVR volume of 60 ml or more. Conclusion: Low PVR volume in patients with non-muscle invasive bladder cancer may play a role in reducing cancer recurrence. However further research is needed in this field