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Folci M, Ramponi G, Arcari I, Zumbo A, Brunetta E. Eosinophils as Major Player in Type 2 Inflammation: Autoimmunity and Beyond. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1347:197-219. [PMID: 34031864 DOI: 10.1007/5584_2021_640] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Eosinophils are a subset of differentiated granulocytes which circulate in peripheral blood and home in several body tissues. Along with their traditional relevance in helminth immunity and allergy, eosinophils have been progressively attributed important roles in a number of homeostatic and pathologic situations. This review aims at summarizing available evidence about eosinophils functions in homeostasis, infections, allergic and autoimmune disorders, and solid and hematological cancers.Their structural and biological features have been described, along with their physiological behavior. This includes their chemokines, cytokines, granular contents, and extracellular traps. Besides, pathogenic- and eosinophilic-mediated disorders have also been addressed, with the aim of highlighting their role in Th2-driven inflammation. In allergy, eosinophils are implicated in the pathogenesis of atopic dermatitis, allergic rhinitis, and asthma. They are also fundamentally involved in autoimmune disorders such as eosinophilic esophagitis, eosinophilic gastroenteritis, acute and chronic eosinophilic pneumonia, and eosinophilic granulomatosis with polyangiitis. In infections, eosinophils are involved in protection not only from parasites but also from fungi, viruses, and bacteria. In solid cancers, local eosinophilic infiltration is variably associated with an improved or worsened prognosis, depending on the histotype. In hematologic neoplasms, eosinophilia can be the consequence of a dysregulated cytokine production or the result of mutations affecting the myeloid lineage.Recent experimental evidence was thoroughly reviewed, with findings which elicit a complex role for eosinophils, in a tight balance between host defense and tissue damage. Eventually, emerging evidence about eosinophils in COVID-19 infection was also discussed.
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Affiliation(s)
- Marco Folci
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Giacomo Ramponi
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Ivan Arcari
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Aurora Zumbo
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Enrico Brunetta
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Mascitti M, Togni L, Rubini C, Troiano G, Lo Muzio L, Santarelli A. Tumour-associated tissue eosinophilia (TATE) in oral squamous cell carcinoma: a comprehensive review. Histol Histopathol 2020; 36:113-122. [PMID: 32985680 DOI: 10.14670/hh-18-250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Oral squamous cell carcinoma is the most common head and neck malignancy, characterised by high invasive capacity, lymph node metastasis, and high recurrence rate. Among the morphological features of oral cancer, the tumour-associated tissue eosinophilia has gained growing interest in the last years. Eosinophils are a minor subpopulation of leukocytes, representing 1-3% of all circulating white blood cells. The presence of high levels of eosinophils is associated with several diseases, but their role in cancer pathophysiology is controversial. In particular, an uncertain and contradictory relationship exists between the exact role of tumour-associated tissue eosinophilia and oral cancer development. Many studies have shown that tumour-associated tissue eosinophilia increases both in the progression of oral potentially malignant disorders as well as in the grade and stage progression of oral cancer. Despite this, both negative and positive prognostic outcomes have been associated with eosinophil infiltration. The heterogeneous results may be partially due both to several methodological inconsistencies and to an incorrect interpretation of the physiological role of eosinophils. Therefore, further studies to elucidate the contribution of eosinophil infiltration are needed, focusing on the existence of eosinophil subpopulations regulated by the cancer immune microenvironment. Furthermore, the correct reporting of prognostic marker research is encouraged, in order to ensure the reproducibility and the comparability of the results from different studies.
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Affiliation(s)
- Marco Mascitti
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona, Italy.
| | - Lucrezia Togni
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Corrado Rubini
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Santarelli
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona, Italy.,Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, Ancona, Italy
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Sethi A, Shetty DC, Rathore AS, Tandon A, Juneja S, Gulati N. Quantitative assessment of CD15 positive tissue eosinophils in Oral Squamous Cell Carcinoma: effects on mast cells and tumor angiogenesis. ACTA ACUST UNITED AC 2020; 69:133-140. [PMID: 32610722 DOI: 10.23736/s0026-4970.19.04285-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The present study determines to correlate eosinophil, mast cell and microvessel densities with the histopathological grades and clinical staging of Oral Squamous Cell Carcinoma (OSCC) cases, as the potential role of inflammatory mediators within tumor stroma remains debatable. METHODS The study sample comprised 60 cases consisting of 40 cases of Well to moderately differentiated OSCC (group 1) and 20 cases of poorly differentiated OSCC (group 2). Immunohistochemistry with anti-CD15 antibody and antifactor VIII antibody; and toluidine blue special stain were employed for the detection of eosinophils, microvessels, and mast cells, respectively. RESULTS The mean numbers of eosinophils, mast cells, and microvessels per high power field in group 1 and group 2 were 15.37±11.86 and 12.62±14.30, 6.00±4.84 and 4.51±4.51, 13.96±6.25 and 6.62±2.05, respectively. Eosinophil density had a positive correlation with both mast cell and microvessel density. Also, the correlation of primary tumor size (T status) with microvessel density was found to be statistically significant (P≤0.05). CONCLUSIONS The cohesive interpretation of the aforementioned mediators in OSCC suggested that while these variables correlate well with the differentiation of tumor, the quantification did not correlate with the clinical staging of the disease.
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Affiliation(s)
- Aashka Sethi
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, I.T.S Center for Dental Studies and Research, Muradnagar, India -
| | - Devi C Shetty
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, I.T.S Center for Dental Studies and Research, Muradnagar, India
| | - Ajit S Rathore
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, I.T.S Center for Dental Studies and Research, Muradnagar, India
| | - Ankita Tandon
- Department of Oral Pathology, Microbiology and Forensic Odontology, Dental Institute, RIMS, Ranchi, India
| | - Saurabh Juneja
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, I.T.S Center for Dental Studies and Research, Muradnagar, India
| | - Nikita Gulati
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, I.T.S Center for Dental Studies and Research, Muradnagar, India
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Siddiqui S, Jaiswal R, Hashmi GS. Quantitative analysis of tumor-associated tissue eosinophils and tumor-associated blood eosinophils in oral squamous cell carcinoma. J Oral Maxillofac Pathol 2020; 24:131-137. [PMID: 32508461 PMCID: PMC7269303 DOI: 10.4103/jomfp.jomfp_70_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 01/14/2020] [Accepted: 02/07/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Stromal response to cancer is usually characterized by intense lymphoplasmacytic infiltrate. However, recently, the attention has shifted to tumor-associated tissue eosinophils (TATE). Tumor-associated blood eosinophils (TABE) are rare in solid cancers; however, carcinoma of the head and neck shows its prevalence. Aim: The aim of the study was to investigate the prevalence and relationship of tissue and blood eosinophils in various grades of oral cancer. The purpose of the article is to emphasize the possible clinical and biological significance of eosinophils in patients of oral squamous cell carcinoma (OSCC) so that appropriate therapeutic strategies can be devised accordingly. Study Design: Thirty histologically confirmed cases of oral squamous cell carcinoma were divided into well, moderate and poorly differentiated carcinoma. Eosinophilic infiltration in the tissue was graded as low, moderate and massive TATE. The number of eosinophils per 100 WBCs was taken as the differential eosinophil count. Blood eosinophilia (BE) >6% was considered to be TABE. Materials and Methods: Hematoxylin and eosin-stained tissue sections at 5 μ were evaluated. Prolonged staining in dilute 0.05% aqueous eosin demonstrated eosinophils selectively. Blood smears were stained by Leishman stain. Statistical Analysis: Student's t-test, Chi-square test, ANOVA, Newman–Keuls Multiple Comparison Test and Karl Pearson correlation coefficient® method were used. Results: The mean TATE value was highest in poorly differentiated carcinoma. TABE was seen only in a few cases and was associated mostly with poorly differentiated OSCC. Conclusion: There was a statistically significant correlation between TATE and histological grades of OSCC. Eosinophilia of the peripheral blood is an adverse sign in patients with carcinoma.
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Affiliation(s)
- Safia Siddiqui
- Department of Oral Pathology and Microbiology, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rohit Jaiswal
- Department of Oral Pathology and Microbiology, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ghulam Sarwar Hashmi
- Department of Oral and Maxillofacial Surgery, ZA Dental College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Onyema OO, Guo Y, Hata A, Kreisel D, Gelman AE, Jacobsen EA, Krupnick AS. Deciphering the role of eosinophils in solid organ transplantation. Am J Transplant 2020; 20:924-930. [PMID: 31647606 PMCID: PMC7842192 DOI: 10.1111/ajt.15660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 01/25/2023]
Abstract
Eosinophils are rare granulocytes that belong to the innate arm of the immune system. This cell population is traditionally defined as a destructive and cytotoxic mediator in asthma and helminth infection. Limited data in transplantation have suggested that eosinophils play a similar role in potentiating deleterious organ inflammation and immunologic rejection. Contrary to this long-held notion, recent data have uncovered the possibility that eosinophils play an alternative role in immune homeostasis, defense against a wide range of pathogens, as well as downregulation of deleterious inflammation. Specifically, translational data from small animal models of lung transplantation have demonstrated a critical role for eosinophils in the downregulation of alloimmunity. These findings shed new light on the unique immunologic features of the lung allograft and demonstrate that environmental polarization may alter the phenotype and function of leukocyte populations previously thought to be static in nature. In this review, we provide an update on eosinophils in the homeostasis of the lung as well as other solid organs.
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Affiliation(s)
- Oscar Okwudiri Onyema
- Department of Surgery, Carter Center for Immunology, University of Virginia, Charlottesville, Virginia, USA
| | - Yizhan Guo
- Department of Surgery, Carter Center for Immunology, University of Virginia, Charlottesville, Virginia, USA
| | - Atsushi Hata
- Department of Surgery, Carter Center for Immunology, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel Kreisel
- Department of Surgery, Washington University in St Louis, Missouri, USA
| | - Andrew E. Gelman
- Department of Surgery, Washington University in St Louis, Missouri, USA
| | - Elizabeth A. Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Alexander Sasha Krupnick
- Department of Surgery, Carter Center for Immunology, University of Virginia, Charlottesville, Virginia, USA
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KUMAR M, VİNEETHA R, M PAİ K, T KAMATH A, CHANDRASHEKAR C. Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE)-A Precursor of Oral Squamous Cell Carcinoma? CUMHURIYET DENTAL JOURNAL 2020. [DOI: 10.7126/cumudj.648880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Yang F, Xiao W, Liu Y, Liu R, Kramer R, Li X, Ajena Y, Baehr CM, Rojalin T, Zhang H, Lam KS. One-bead one-compound combinatorial library derived targeting ligands for detection and treatment of oral squamous cancer. Oncotarget 2019; 10:5468-5479. [PMID: 31534631 PMCID: PMC6739215 DOI: 10.18632/oncotarget.27189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/12/2019] [Indexed: 12/12/2022] Open
Abstract
Oral squamous cancers (OSC) are hallmarked by poor prognosis, delayed clinical detection, and a lack of defined, characteristic biomarkers. By screening combinatorial one-bead one-compound (OBOC) peptide libraries against oral squamous cancer cell lines, two cyclic peptide ligands, LLY12 and LLY13 were previously identified. These ligands are capable of specific binding to the oral cancer cell lines (MOK-101, HSC-3, SCC-4 and SCC-10a) but not non-cancerous keratinocytes, leukocytes, fibroblast, and endothelial cells. These two peptides were synthesized and evaluated for their binding property, cytotoxicity and cell permeability. In vitro studies indicate that both LLY12 and LLY13 were able to bind to oral cancer cells with high specificity but did not show any cytotoxicity against human keratinocytes. Biotinylated LLY13, in complex with streptavidin-alexa488 was taken up by live oral cancer cells, thus rendering it as an excellent candidate vehicle for efficient delivery of drug loaded-nanoparticles. In vivo and ex vivo near infra-red fluorescence imaging studies confirmed the in vivo targeting efficiency and specificity of LLY13 in oral cancer orthotopic murine xenograft model. In vivo studies also showed that LLY13 was able to accumulate in the OSC tumors and demarcate the tumor margins in orthotopic xenograft model. Together, our data supports LLY13 as a promising theranostic agent against OSC.
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Affiliation(s)
- Fan Yang
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Wenwu Xiao
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
| | - Yanlei Liu
- Department of Pathology, University of California Davis Medical Center, Sacramento, CA, USA
| | - Ruiwu Liu
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
| | - Randall Kramer
- Department of Cell and Tissue Biology, University of California, San Francisco, CA, USA
| | - Xiaocen Li
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
| | - Yousif Ajena
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
| | - Christopher M Baehr
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
| | - Tatu Rojalin
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
| | - Hongyong Zhang
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
| | - Kit S Lam
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
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Kurose N, Mizuguchi S, Ohkanemasa Y, Yamashita M, Nakano M, Guo X, Aikawa A, Nakada S, Sasagawa T, Yamada S. Adenosquamous carcinoma of the uterine cervix displaying tumor-associated tissue eosinophilia. SAGE Open Med Case Rep 2019; 7:2050313X19828235. [PMID: 30800306 PMCID: PMC6378426 DOI: 10.1177/2050313x19828235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/10/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Tumor-associated tissue eosinophilia is defined as an inflammatory response with the marked infiltration of eosinophils within tumor tissues. Tumor-associated tissue eosinophilia has been reported in various organs; however, no studies have examined the detailed cytopathological findings of tumor-associated tissue eosinophilia. Case Presentation: A 49-year-old woman presented with lower abdominal and back pain that had started 1 month earlier. A cervical biopsy revealed a diagnosis of non-keratinizing squamous cell carcinoma. A mildly increased number of eosinophils was observed in both cervical cytology and a biopsy. On pelvic computed tomography, a tumor mass measuring up to 5.5 cm in the largest diameter was seen in the uterine cervix. After 1 month, endometrial cytology was performed, and non-keratinizing squamous cell carcinoma together with normal endometrial glands was obtained in a background of marked eosinophil numbers. Tumor cells in an irregular-shaped solid nest had variable-sized hyperchromatic nuclei and light-green-stained cytoplasm. The number of eosinophils was obviously increased. Considering the possibility of tumor-associated tissue eosinophilia, we evaluated a peripheral blood sample and confirmed an increased number of eosinophils. Radical hysterectomy was performed, and the final pathological diagnosis was adenosquamous carcinoma. Although the number of eosinophils decreased after surgery, it increased again at the time of recurrence 1 year later. Chemo-irradiation was performed, but the patient died 1 year and 8 months after the operation. Conclusion: Cytopathologists should consider the presence of tumor-associated tissue eosinophilia by focusing on not only tumor cells but also the markedly eosinophilic background. The eosinophil count might be a useful marker of the disease activity.
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Affiliation(s)
- Nozomu Kurose
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Seiya Mizuguchi
- Department of Pathology, Kanazawa Medical University, Uchinada, Japan
| | | | - Manabu Yamashita
- Department of Pathology, Kanazawa Medical University, Uchinada, Japan
| | - Mariko Nakano
- Department of Pathology, Kanazawa Medical University, Uchinada, Japan
| | - Xin Guo
- Department of Pathology, Kanazawa Medical University, Uchinada, Japan
| | - Akane Aikawa
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Satoko Nakada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Toshiyuki Sasagawa
- Department of Reproductive and Perinatal Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
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Deepthi G, Kulkarni PG, K Nandan SR. Eosinophils: An imperative histopathological prognostic indicator for oral squamous cell carcinoma. J Oral Maxillofac Pathol 2019; 23:307. [PMID: 31516251 PMCID: PMC6714271 DOI: 10.4103/jomfp.jomfp_111_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Inflammation in tumor microenvironment assists in both promotion and growth of tumor. Tumor-associated tissue eosinophilia (TATE) is the term used when eosinophils are observed in a tumor tissue with inflammatory infiltrate. Although carcinogenesis with inflammation is one of the important hallmarks, the exact role of eosinophils remains unclear. Various studies on oral squamous cell carcinoma (OSCC) that focused on eosinophils reported both favorable and unfavorable prognosis in cancer tissue, because of which the exact function of eosinophils still remains uncertain. Aims and Objectives The present study aims at identifying the role of TATE in OSCC and in malignant transformation of oral epithelial dysplasia (OED). Materials and Methods The study includes 70 samples that divided into two groups, of which 50 histopathologically proven cases of different grades of OSCC and 20 cases of OED (oral leukoplakia). Congo red stain was used to stain the tissue sections. Each slide was viewed under high power in 10 consecutive microscopic fields for counting of eosinophils. Results Statistical analysis of values obtained was done using ANOVA, unpaired t-test and Mann-Whitney test. The results were statistically significant (P < 0.05) with a mean total eosinophil count of 2.12 in OED and 4.31 in OSCC. Conclusion The present study showed higher eosinophil counts in OSCC when compared to dysplasia which should prompt for a thorough evaluation of tumor front for invasiveness. Therefore, tissue eosinophil count may be used as an adjunct to predict the malignant transformation of dysplastic lesions to OSCC.
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Affiliation(s)
- G Deepthi
- Department of Oral and Maxillofacial Pathology, Government Dental College and Hospital, Hyderabad, Telangana, India
| | - Pavan G Kulkarni
- Department of Oral and Maxillofacial Pathology, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Telangana, India
| | - S R K Nandan
- Department of Oral and Maxillofacial Pathology, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Telangana, India
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Yao X, Yuan Y, Fang J, Jiang H. Benefits of urethroplasty for managing urethral amyloidosis: A case report. Exp Ther Med 2017; 14:3519-3522. [PMID: 29042942 PMCID: PMC5639385 DOI: 10.3892/etm.2017.4983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/16/2017] [Indexed: 11/06/2022] Open
Abstract
Urethral amyloidosis is a rare condition in which eosinophilic amyloid proteins are deposited in the urethra. Only a small number of reports on urethral amyloidosis have been published. Increased interest has been associated with this disease due to its clinical similarities with urothelial carcinoma. A biopsy of the lesion and a histological examination are essential for the correct diagnosis. Conservative management has been suggested by various urologists as the optimal treatment approach for urethral amyloidosis; however, recurrence and urethral stricture are common, and typically further treatment is required. Urethroplasty has been used in a limited number of urethral amyloidosis cases, with beneficial short-term outcomes; however, long-term follow-up data are lacking. The present case report describes the cases of 2 patients with urethral amyloidosis who underwent urethroplasty without recurrence or progression for >2 years. These findings indicate that urethroplasty is beneficial for the long-term management of urethral amyloidosis.
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Affiliation(s)
- Xiaolin Yao
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Yufang Yuan
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jiajie Fang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Hai Jiang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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