Purpose: We determined the incidence of urinary tract cancer in patients with hematuria, stratified risk by age, gender and hematuria degree, and examined current best policy recommendations.Materials and Methods: We performed a large, retrospective population based cohort study of patients who underwent microscopic urinalysis during 2004 and 2005 in a large managed care organization. Patients were followed for 3 years for urinary tract cancer.Results: We identified 772,002 patients who underwent urinalysis during the study period. After exclusions due to previous hematuria, age less than 18 years, pregnancy, urinary tract infection, inpatient status and prior urinary tract cancer 309,402 patients were available for analysis, of whom 156,691 had hematuria. The overall 3-year incidence of urinary tract cancer in those with hematuria was 0.68%. Older age (greater than 40 years OR 17.0, 95% CI 11.2-25.7), greater hematuria (greater than 25 red blood cells per high power field OR 4.0, 95% CI 3.5-4.5) and male gender (OR 4.8, 95% CI 4.2-5.6) were associated with a higher risk of cancer. The American Urological Association definition of microhematuria had 50% sensitivity, 84% specificity and 1.3% positive predictive value.Conclusions: The incidence of urinary tract cancer is low even in individuals with microhematuria. Thus, current best policy recommendations do not perform well. Since older age, male gender and greater hematuria are associated with a higher risk of cancer, future studies should evaluate strategies that target these populations.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2010348 ASSOCIATION OF HEMATURIA ON MICROSCOPIC URINALYSIS AND RISK OF URINARY TRACT CANCER DEVELOPMENT Howard Jung, Joseph Gleason, Jeff Slezak, Ronald Loo, Hetal Patel, Gary Chien, and Steven Jacobsen Howard JungHoward Jung More articles by this author , Joseph GleasonJoseph Gleason More articles by this author , Jeff SlezakJeff Slezak More articles by this author , Ronald LooRonald Loo More articles by this author , Hetal PatelHetal Patel More articles by this author , Gary ChienGary Chien More articles by this author , and Steven JacobsenSteven Jacobsen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.414AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detection of urinary tract cancer is of paramount importance during evaluation of hematuria. The American Urological Association (AUA) recommends evaluation of a patient with microscopic hematuria defined as 3 or more RBC/HPF from at least 2 urinalysis specimens. Meanwhile, the Canadian Urological Association (CUA) recommends evaluation within these parameters only if the patient is more than 40 years old. Currently, no large population study is available to validate either recommendation. The purpose of this study is to determine the incidence of urinary tract cancer in patients with hematuria, to stratify risk according to age, sex, and degree of hematuria, and to examine current best policy recommendations. METHODS This is a retrospective cohort study including all members in a large health maintenance organization with hematuria diagnosed by microscopic urinalysis from January 1, 2004 to December 31, 2005. Members with recent hospitalization, pregnancy, urinary tract infection, or prior cancer diagnosis were excluded. The primary outcome was the diagnosis of malignancy associated with the upper or lower urinary tracts by the end of 2008. Further analysis according to age, gender, and degree of hematuria was performed. Logistic regression was used to model the probability of cancer detection. RESULTS The cohort includes 309,402 members with at least one urinalysis in the defined time period. Of them, 156,691 demonstrated hematuria. There were 1,353 urinary tract cancers identified in the cohort at the end of 3 years. Of them, 1,071 demonstrated hematuria on at least one urinalysis. Urinary tract cancer rates were associated with older age (OR for >40 =17.0, 95% CI=11.2-25.7), degree of hematuria (OR for >25 RBC/HPF =4.0, CI=3.5-4.5), and male sex (OR =4.8 CI=4.2-5.6). Using the AUA recommendations, we calculated a sensitivity of 50.2%, specificity of 83.8%, and positive predictive value (PPV) of 1.3%. Using the CUA recommendations, we calculated a sensitivity of 49.2%, specificity of 88.4%, and PPV of 1.8%. Using an alternative cutoff of >25RBC/HPF in members >40, we calculated a sensitivity of 50.4%, specificity of 92.2%, and PPV of 2.8%. CONCLUSIONS Current recommendations for the evaluation of hematuria yield low rates of cancer detection. Meanwhile, certain populations, such as young age groups with low degrees of hematuria, may safely be spared full evaluation. These findings suggest the need for an alternative policy to improve identification of patients at risk of developing urinary tract cancer. Los Angeles, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e138 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Howard Jung More articles by this author Joseph Gleason More articles by this author Jeff Slezak More articles by this author Ronald Loo More articles by this author Hetal Patel More articles by this author Gary Chien More articles by this author Steven Jacobsen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The present study characterized a cell wall chitin from Saccharomyces cerevisiae and investigated the effect of a postharvest chitin treatment on disease resistance against Botrytis cinerea infection in tomato fruit and the possible mechanisms involved. The results indicated that treatment with chitin could effectively induce strong resistance against gray mold rot caused by B. cinerea in tomato fruit. Moreover, chitin treatment promoted the accumulation of ROS and callose deposition. The activities of six defense-related enzymes, including superoxide dismutase, catalase, peroxidase, phenylalanine ammonia-lyase, β-1,3-glucanase and chitinase, along with the expression of these corresponding genes, were markedly enhanced in the chitin-treated fruit. Meanwhile, the key enzyme genes of SA biosynthesis and signal transduction pathway were found up-regulated in the chitin treatment. Therefore, these results suggest that the increased disease resistance of tomato fruit after chitin treatment during storage might be attributed to an elicitation of defense response as mentioned above in fruit.

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 Nov 2003Benign Prostatic Stromal Hyperplasia With Bizarre Nuclei JOSEPH H. CHANG, APURBA S. PATHAK, ARMEN H. DIKRANIAN, TAREK DANIAL, HETAL S. PATEL, and JON A. KASWICK JOSEPH H. CHANGJOSEPH H. CHANG More articles by this author , APURBA S. PATHAKAPURBA S. PATHAK More articles by this author , ARMEN H. DIKRANIANARMEN H. DIKRANIAN More articles by this author , TAREK DANIALTAREK DANIAL More articles by this author , HETAL S. PATELHETAL S. PATEL More articles by this author , and JON A. KASWICKJON A. KASWICK More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000091658.48190.94AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Benign Prostatic Stromal Hyperplasia With Bizarre Nuclei." The Journal of Urology, 170(5), p. 1951 References 1 : Prostatic stromal hyperplasia with bizarre nuclei. Arch Pathol Lab Med1991; 115: 87. Google Scholar 2 : Prostatic stromal hyperplasia with atypia: a study of 10 cases. Mod Pathol1997; 10: 94A. Google Scholar 3 : Urological Pathology.. Philadelphia: W. B. Saunders Co.1989: 479. Google Scholar From the Departments of Urology and Pathology, Kaiser Permanente Medical Center, Los Angeles, California© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 170Issue 5November 2003Page: 1951 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordsprostateprostatic hyperplasiastromal cellscell nucleusMetricsAuthor Information JOSEPH H. CHANG More articles by this author APURBA S. PATHAK More articles by this author ARMEN H. DIKRANIAN More articles by this author TAREK DANIAL More articles by this author HETAL S. PATEL More articles by this author JON A. KASWICK More articles by this author Expand All Advertisement PDF downloadLoading ...