The Vesical Imaging-Reporting and Data System (VI-RADS) scoring system effectively determines detrusor muscle invasion in patients with untreated bladder cancer undergoing multiparametric MRI before transurethral resection of bladder tumor and/or cystectomy. BackgroundThe Vesical Imaging-Reporting and Data System (VI-RADS) scoring system was created in 2018 to standardize imaging and reporting of bladder cancer staging with multiparametric MRI. The system provides a five-point VI-RADS score, which suggests the likelihood of detrusor muscle invasion. Muscle-invasive disease carries a worse prognosis and requires radical surgery.PurposeTo determine the performance of the VI-RADS score in detecting muscle-invasive bladder cancer in a cohort of patients undergoing multiparametric MRI before surgery.Materials and MethodsIn this retrospective study, a total of 340 patients with bladder cancer were identified from a database of consecutive patients undergoing multiparametric MRI from November 2011 to August 2018. The tumor with the largest burden was selected in those patients with multifocal tumors. Bladder tumors were retrospectively categorized according to the VI-RADS five-point scoring system by two readers, independently and in consensus, who were blinded to h...

Purpose: Bladder cancer treatment remains a major clinical challenge due to therapy resistance and a high recurrence rate. Profiling intratumor heterogeneity can reveal the molecular mechanism of bladder cancer recurrence. Experimental Design: Here, we performed single-cell RNA sequencing and Assay for Transposase-Accessible Chromatin using sequencing (ATAC-seq) on tumors from 13 patients with low recurrence risk, high recurrence risk, and recurrent bladder cancer. Results: Our study generated a comprehensive cancer-cell atlas consisting of 54,971 single cells and identified distinct cell subpopulations. We found that the cancer stem-cell subpopulation is enriched during bladder cancer recurrence with elevated expression of EZH2. We further defined a subpopulation-specific molecular mechanism whereby EZH2 maintains H3K27me3-mediated repression of the NCAM1 gene, thereby inactivating the cell invasive and stemness transcriptional program. Furthermore, taking advantage of this large single-cell dataset, we elucidated the spectrum of epithelial–mesenchymal transition (EMT) in clinical samples and revealed distinct EMT features associated with bladder cancer subtypes. We identified that TCF7 promotes EMT in corroboration with single-cell ATAC with high-throughput sequencing (scATAC-seq) analysis. Additionally, we constructed regulatory networks specific to recurrent bladder cancer. Conclusions: Our study and analytic approaches herein provide a rich resource for the further study of cancer stem cells and EMT in the bladder cancer research field.

Study Type – Therapy (RCT) Level of Evidence 1b What’s known on the subject? and What does the study add? α‐blocker tamsulosin in medical expusion therapy was determined to be safe and effective for distal ureteric stones with renal colic. This trial further demonstrates that the tamsulosin in MET is more efficative and more safer than nifedipine for distal ureteric stones with renal colic. OBJECTIVE: To determine the comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy (MET) for distal ureteric stones with renal colic. PATIENTS AND METHODS: We evaluated the comparative efficacy of tamsulosin and nifedipine in MET in a prospective randomized trial of 3189 outpatients from 10 centres in China. Eligible patients randomly received tamsulosin or nifedipine. Efficacies of the two agents in MET were compared at 4 weeks. The primary endpoint was overall stone‐expulsion rate. Secondary endpoints were stone‐expulsion time, rate of pain relief therapy, mean analgesic consumption for renal colic recurrence, and side‐effects incidence. RESULTS: Stone‐expulsion rates in the tamsulosin group (group 1) were greater than those in the nifedipine group (group 2; P < 0.01). There was a significant variation in stone‐expulsion rates and times between groups 1 and 2 ( P < 0.01); with improvements in stone‐expulsion rate and time significantly better in group 1 than in group 2. There was a significant variation in the rate of pain relief therapy for renal colic recurrence between groups 1 and 2 ( P < 0.01); patients in group 1 required significantly less analgesics than those in group 2 ( P < 0.01). There were no statistically significant differences in side‐effects incidence between the groups. CONCLUSIONS: Administration of tamsulosin and nifedipine in MET was determined to be safe and effective for distal ureteric stones with renal colic. Tamsulosin was significantly better than nifedipine in relieving renal colic and facilitating ureteric stone expulsion.