A robot-assisted laparoscopic revision of an artificial urinary sphincter in a patient with spinal cord injury.

This step-by-step article demonstrates our approach to robot-assisted laparoscopic revision of a bladder neck sited artificial urinary sphincter (AUS) for a spinal cord injured patient. The bladder neck location of an AUS in the spinal cord injured demographic is ideal to minimise urethral complications and urinary tract infections, whilst the transabdominal approach reduces the risk of wound breakdown that can occur via the typical perineal incision for AUS insertion. The accompanying video will guide viewers as to our minimally invasive technique for cuff revision in the event of secondary surgery for recurrent urinary incontinence.

Evaluation of MV140 in preventing recurrent urinary tract infections: a multicentre double-blind randomized controlled trial protocol.

OBJECTIVES: To determine, firstly, whether MV140 reduces rates of recurrent urinary tract infections (rUTIs) in patients older than 65 years, measured as the number of urinary tract infections (UTIs) detected over 12 months following the completion of a 3-month treatment course and, additionally, to assess the number of re-admissions to the emergency department, the rate of antibiotic use for UTIs, the safety profile of MV140, and quality of life. MATERIALS AND METHODS: This is a multicentre, double-blind, randomized controlled trial with two arms. Patients will be randomized and allocated to receive either a 3-month course of MV140 or placebo (two sublingual sprays daily). Participants will have 3-monthly consultations with the investigator for 12 months to assess differences in rates of rUTIs between the two groups. Study candidates will be identified and recruited from inpatient and outpatient clinics across Sydney via referral to the investigation team. After obtaining consent, participants will undergo initial study consultations including urine microscopy and culture, uroflowmetry, and bladder scan to assess postvoid residual urine volume. Participants will be randomized and provided with a unique trial number. Electronic medical records will be reviewed to collect relevant information. Participants will be provided with a study diary to record relevant data. RESULTS: Follow-up consultations will be conducted every 3 months for a 12-month duration, during which the study diary will be reviewed. These follow-up consultations will primarily occur via telephone review, however, there will be flexibility for in-person reviews for participants who find telephone consultation prohibitively difficult. CONCLUSION: This is a multicentre, double-blinded, randomised control trial, the first in Australia to assess the safety and efficacy of MV140 Uromune vaccine in prevention of recurrent UTIs. Results have been promissing in the global literatures.

A narrative review: evaluation and surgical management of persistent and recurrent urinary incontinence after previous surgical treatment.

Background and Objective: Urinary incontinence after prostate treatment is associated with significant morbidity and impact on quality of life. Stress urinary incontinence can be treated by insertion of a urethral sling or artificial urinary sphincter. Persistent or recurrent urinary incontinence after such treatment can be frustrating and require specific evaluation and approach to management to optimize chance of successful outcomes and patient satisfaction whilst avoiding further patient morbidity. The aim of this review is to outline the evaluation and management of persistent and recurrent urinary incontinence in men after previous surgical treatment for stress urinary incontinence by way of narrative review. Methods: A literature review was performed using PubMed, MEDLINE, and Google Scholar between 2010 to 2023. The search strategy included the following MeSH terms: device, men, urinary incontinence, persistence, recurrence, and revision. A total of 140 English-language articles were identified and reviewed; 68 articles were considered relevant to the aims and the findings have been outlined in this narrative review. Key Content and Findings: There are many approaches currently practiced by surgeons in continence revision surgery. There is not clear consensus regarding optimum revision strategy for persistent and recurrent incontinence post urethral sling and artificial urinary sphincter insertion. Whilst small observational studies have reviewed different surgical approaches, there is a paucity of high volume comparative data from which to draw conclusions. However, there have been recent studies enabling a paradigm shift in the understanding of incontinence post artificial urinary sphincter insertion that may lead to improved revision strategies in future. Conclusions: There are various surgical modalities used to manage incontinence following urethral sling and artificial urinary sphincter insertion. There is currently no clear consensus on the optimal surgical technique for persistent or recurrent urinary incontinence after surgery. Further comparative studies would be beneficial to help guide surgeons as to which revision approaches would be suitable for select patients.

In vivo bone marrow microenvironment siRNA delivery using lipid-polymer nanoparticles for multiple myeloma therapy.

Multiple myeloma (MM), a hematologic malignancy that preferentially colonizes the bone marrow, remains incurable with a survival rate of 3 to 6 mo for those with advanced disease despite great efforts to develop effective therapies. Thus, there is an urgent clinical need for innovative and more effective MM therapeutics. Insights suggest that endothelial cells within the bone marrow microenvironment play a critical role. Specifically, cyclophilin A (CyPA), a homing factor secreted by bone marrow endothelial cells (BMECs), is critical to MM homing, progression, survival, and chemotherapeutic resistance. Thus, inhibition of CyPA provides a potential strategy to simultaneously inhibit MM progression and sensitize MM to chemotherapeutics, improving therapeutic response. However, inhibiting factors from the bone marrow endothelium remains challenging due to delivery barriers. Here, we utilize both RNA interference (RNAi) and lipid-polymer nanoparticles to engineer a potential MM therapy, which targets CyPA within blood vessels of the bone marrow. We used combinatorial chemistry and high-throughput in vivo screening methods to engineer a nanoparticle platform for small interfering RNA (siRNA) delivery to bone marrow endothelium. We demonstrate that our strategy inhibits CyPA in BMECs, preventing MM cell extravasation in vitro. Finally, we show that siRNA-based silencing of CyPA in a murine xenograft model of MM, either alone or in combination with the Food and Drug Administration (FDA)-approved MM therapeutic bortezomib, reduces tumor burden and extends survival. This nanoparticle platform may provide a broadly enabling technology to deliver nucleic acid therapeutics to other malignancies that home to bone marrow.

Reductive C-O Cleavage of Ethereal Solvents and 18-Crown-6 in Ln(NR2)3/KC8 Reactions (R = SiMe3).

The high reactivity accessible from the reduction of the tris(amide) complexes Ln(NR2)3 (R = SiMe3) with potassium graphite in the presence of a variety of ethers is demonstrated by crystal structures of six different types of products of C-O bond cleavage reactions with Ln = Y, Ho, Er, and Lu. Specifically, 1,2-dimethoxyethane (DME) can be cleaved in Ln(NR2)3/KC8 reactions as shown by three different types of crystals: [K (crypt)][(R2N)3Y(OCH2CH2OCH3)], 1-Y, [(R2N)2Y(µ-OCH2CH2OCH3-κO,κO')]2, 2-Y, and [K2(18-c-6)3]{[(R2N)3Lu]2[(µ-OCH2CH2O)]}, 3-Lu (18-c-6 = 18-crown-6; crypt = 2.2.2-cryptand). THF can be ring opened by the Y(NR2)3/KC8 reaction system, as shown by crystals of the butoxide, [K(crypt)][(R2N)3Y(OCH2CH2CH2CH3)], 4-Y. The cyclic ether, oxetane, OC3H6, ring opens in Ln(NR2)3/KC8 reactions to form crystals of the propoxide, [K(18-c-6)(OC3H6)][(R2N)3Ln(OCH2CH2CH3)], 5-Ln, for Ln = Ho and Er. In Et2O, the Y(NR2)3/KC8 reactions do not attack the solvent, but C-O cleavage of 18-c-6 is observed to form {[(R2N)2]Y[µ-η1:η1-O2(C10H20O4)K]}2, 6-Y. These Ln(NR2)3/KC8 C-O cleavage reactions are typically accompanied by C-H bond activation reactions, which form cyclometalates such as [K(crypt)]{(R2N)2Ln[N(SiMe3)(SiMe2CH2)-κC,κN]}, 7-Ln (Ln = Y, Ho, Er), and [K(18-c-6)]{(R2N)2Y[N(SiMe3)(SiMe2CH2)-κC,κN]}, 8-Y, which are common decomposition products of Ln(NR2)3 reactions. In addition, in this study, the hydride complex, [K(18-c-6)][(R2N)3YH], 9-Y, was isolated. NMR analysis indicates that the yttrium reactions form mixtures that consistently contain the yttrium cyclometalates 7-Y and 8-Y as major components. These results show the diversity of available reaction pathways for the Ln(NR2)3/KC8 system and highlight the inherent difficulties in isolating Ln(II) complexes containing the [Ln(NR2)3]1- anion.

Psychological Health of Surgeons in a Time of COVID-19: A Global Survey.

OBJECTIVE: To assess the degree of psychological impact among surgical providers during the COVID-19 pandemic. SUMMARY OF BACKGROUND DATA: The COVID-19 pandemic has extensively impacted global healthcare systems. We hypothesized that the degree of psychological impact would be higher for surgical providers deployed for COVID-19 work, certain surgical specialties, and for those who knew of someone diagnosed with, or who died, of COVID-19. METHODS: We conducted a global web-based survey to investigate the psychological impact of COVID-19. The primary outcomes were the depression anxiety stress scale-21 and Impact of Event Scale-Revised scores. RESULTS: A total of 4283 participants from 101 countries responded. 32.8%, 30.8%, 25.9%, and 24.0% screened positive for depression, anxiety, stress, and PTSD respectively. Respondents who knew someone who died of COVID-19 were more likely to screen positive for depression, anxiety, stress, and PTSD (OR 1.3, 1.6, 1.4, 1.7 respectively, all P < 0.05). Respondents who knew of someone diagnosed with COVID-19 were more likely to screen positive for depression, stress, and PTSD (OR 1.2, 1.2, and 1.3 respectively, all P < 0.05). Surgical specialties that operated in the head and neck region had higher psychological distress among its surgeons. Deployment for COVID- 19-related work was not associated with increased psychological distress. CONCLUSIONS: The COVID-19 pandemic may have a mental health legacy outlasting its course. The long-term impact of this ongoing traumatic event underscores the importance of longitudinal mental health care for healthcare personnel, with particular attention to those who know of someone diagnosed with, or who died of COVID-19.

Solid-State End-On to Side-On Isomerization of (N═N)2- in {[(R2N)3Nd]2N2}2- (R = SiMe3) Connects In Situ LnIII(NR2)3/K and Isolated [LnII(NR2)3]1- Dinitrogen Reduction.

Examination of the reduction chemistry of Nd(NR2)3 (R = SiMe3) under N2 has provided connections between the in situ Ln(III)-based LnIII(NR2)3/K reductions of N2 that form side-on bound neutral (N=N)2- complexes, [(R2N)2(THF)Ln]2[µ-η2:η2-N2], and the Ln(II)-based [LnII(NR2)3]1- reductions by Sc, Gd, and Tb that form end-on bound (N=N)2- complexes, {[(R2N)3Ln]2[µ-η1:η1-N2]}2-, which are dianions. The reduction of Nd(NR2)3 by KC8 under dinitrogen in Et2O in the presence of 18-crown-6 (18-c-6) forms dark yellow solutions of [K2(18-c-6)3]{[(R2N)3Nd]2N2} at low temperatures that become green as they warm up to -35 °C in a glovebox freezer. Green crystals obtained from the solution turn yellow-brown when cooled below -100 °C, and the yellow-brown compound has an end-on Nd2(µ-η1:η1-N2) structure. The yellow-brown crystals isomerize in the solid state on the diffractometer upon warming, and at -25 °C, the crystals are green and have a side-on Nd2(µ-η2:η2-N2) structure. Collection of X-ray diffraction data at 10 °C intervals from -50 to -90 °C revealed that the isomerization occurs at temperatures below -100 °C. In the presence of tetrahydrofuran (THF), the dianionic {[(R2N)3Nd]2N2}2- system can lose an amide ligand to provide the monoanionic [(R2N)3NdIII(µ-η2:η2-N2)NdIII(NR2)2(THF)]1-, characterized by X-ray crystallography. These data suggest a connection between the in situ Ln(III)/K reductions and Ln(II) reductions that depends on solvent, temperature, the presence of a chelate, and the specific rare-earth metal.

Strengthening Management, Community Engagement, and Sustainability of the Subnational Response to Accelerate Malaria Elimination in Namibia.

Leadership and management skills are critical for health programs to deliver high-quality interventions in complex systems. In malaria-eliminating countries, national and subnational health teams are reorienting strategies to address focal transmission while preventing new cases and adapting to decentralization and declines in external financing. A capacity-strengthening program in two regions in Namibia helped malaria program implementers identify and address key operational, political, and financial challenges. The program focused on developing skills and techniques in problem-solving and teamwork, engaging decision-makers, and using financial evidence to prioritize domestic resources for malaria through participatory approaches. Results of the program included an observed 40% increase in malaria case reporting, 32% increase in reporting and tracing of imported malaria cases, 10% increase in malaria case management, integration of malaria activities into local operational plans, and an increase in subnational resources for malaria teams. To promote program sustainability beyond the implementation period, key program aspects were institutionalized into existing health system structures, program staff were trained in change leadership, and participants integrated the skills and approaches into their professional roles. A capacity -strengthening program with joint focus on leadership, management, and advocacy has potential for application to other health issues and geographies.

Postcoital cyst rupture presenting as peritonitis and hemorrhagic shock: A case report.

INTRODUCTION: This report presents an unusual case of severe post-coital abdominal pain and signs of hemorrhagic shock requiring admission to a surgical intensive care unit (SICU) and emergent laparoscopy. This case was unique given the timing and progression of the patient's symptoms, as well as her age, surgical history, and symptomatic progression. Here we document the notable characteristics and treatment of this patient. CASE PRESENTATION: The patient presented to a local emergency department with signs progressive peritonitis and shock after an episode of non-traumatic intercourse. Her initial computed tomography (CT) scan showed signs of free fluid in the abdomen around the bladder and liver with no definitive source of bleed. She developed worsening shock with severe pain. She was then emergently transferred to a tertiary care center for evaluation by gynecology service and for general trauma surgery evaluation. She was further stabilized in the emergency department, and then admitted to the surgical critical care service. Following additional imaging, she received exploratory surgery with gynecology to control a hemorrhagic ruptured cyst. She remained stable and was discharged the next day. CONCLUSION: This case demonstrated a complication of an often-benign diagnosis, revealing the potential danger of underestimating this chief complaint, as well as the importance of understanding how minimal trauma can lead to cyst rupture.

Effective management of district-level malaria control and elimination: implementing quality and participative process improvements.

Although it is widely recognized that strong program management is essential to achieving better health outcomes, this priority is not recognized in malaria programmatic practices. Increased management precision offers the opportunity to improve the effectiveness of malaria interventions, overcoming operational barriers to intervention coverage and accelerating the path to elimination. Here we propose a combined approach involving quality improvement, quality management, and participative process improvement, which we refer to as Combined Quality and Process Improvement (CQPI), to improve upon malaria program management. We draw on evidence from other areas of public health, as well as pilot implementation studies in Eswatini, Namibia and Zimbabwe to support the proposal. Summaries of the methodological approaches employed in the pilot studies, overview of activities and an outline of lessons learned from the implementation of CQPI are provided. Our findings suggest that a malaria management strategy that prioritizes quality and participative process improvements at the district-level can strengthen teamwork and communication while enabling the empowerment of subnational staff to solve service delivery challenges. Despite the promise of CQPI, however, policy makers and donors are not aware of its potential. Investments are therefore needed to allow CQPI to come to fruition.

Repeated Administration of 2-Hydroxypropyl-ß-Cyclodextrin (HPßCD) Attenuates the Chronic Inflammatory Response to Experimental Stroke.

Globally, more than 67 million people are living with the effects of ischemic stroke. Importantly, many stroke survivors develop a chronic inflammatory response that may contribute to cognitive impairment, a common and debilitating sequela of stroke that is insufficiently studied and currently untreatable. 2-Hydroxypropyl-ß-cyclodextrin (HPßCD) is an FDA-approved cyclic oligosaccharide that can solubilize and entrap lipophilic substances. The goal of the present study was to determine whether the repeated administration of HPßCD curtails the chronic inflammatory response to stroke by reducing lipid accumulation within stroke infarcts in a distal middle cerebral artery occlusion mouse model of stroke. To achieve this goal, we subcutaneously injected young adult and aged male mice with vehicle or HPßCD 3 times per week, with treatment beginning 1 week after stroke. We evaluated mice at 7 weeks following stroke using immunostaining, RNA sequencing, lipidomic, and behavioral analyses. Chronic stroke infarct and peri-infarct regions of HPßCD-treated mice were characterized by an upregulation of genes involved in lipid metabolism and a downregulation of genes involved in innate and adaptive immunity, reactive astrogliosis, and chemotaxis. Correspondingly, HPßCD reduced the accumulation of lipid droplets, T lymphocytes, B lymphocytes, and plasma cells in stroke infarcts. Repeated administration of HPßCD also preserved NeuN immunoreactivity in the striatum and thalamus and c-Fos immunoreactivity in hippocampal regions. Additionally, HPßCD improved recovery through the protection of hippocampal-dependent spatial working memory and reduction of impulsivity. These results indicate that systemic HPßCD treatment following stroke attenuates chronic inflammation and secondary neurodegeneration and prevents poststroke cognitive decline.SIGNIFICANCE STATEMENT Dementia is a common and debilitating sequela of stroke. Currently, there are no available treatments for poststroke dementia. Our study shows that lipid metabolism is disrupted in chronic stroke infarcts, which causes an accumulation of uncleared lipid debris and correlates with a chronic inflammatory response. To our knowledge, these substantial changes in lipid homeostasis have not been previously recognized or investigated in the context of ischemic stroke. We also provide a proof of principle that solubilizing and entrapping lipophilic substances using HPßCD could be an effective strategy for treating chronic inflammation after stroke and other CNS injuries. We propose that using HPßCD for the prevention of poststroke dementia could improve recovery and increase long-term quality of life in stroke sufferers.

Reductive Reactivity of the 4f75d1 Gd(II) Ion in {GdII[N(SiMe3)2]3}-: Structural Characterization of Products of Coupling, Bond Cleavage, Insertion, and Radical Reactions.

The reductive reactivity of a Ln(II) ion with a nontraditional 4fn5d1 electron configuration has been investigated by studying reactions of the {GdII(N(SiMe3)2)3]}- anion with a variety of reagents that survey the many reaction pathways available to this ion. The chemistry of both [K(18-c-6)2]+ and [K(crypt)]+ salts (18-c-6 = 18-crown-6; crypt = 2.2.2-cryptand) was examined to study the effect of the countercation. CS2 reacts with the crown salt [K(18-c-6)2][Gd(NR2)3] (1) to generate the bimetallic (CS3)2- complex {[K(18-c-6)](µ3-CS3-κS,κ2S',S'')Gd(NR2)2]}2, which contains two trithiocarbonate dianions that bridge Gd(III) centers and a potassium ion coordinated by 18-c-6. In contrast, the only crystalline product isolated from the reaction of CS2 with the crypt salt [K(crypt)][Gd(NR2)3] (2) is [K(crypt)]{(R2N)2Gd[SCS(CH2)Si(Me2)N(SiMe3)-κN,κS]}, which has a CS2 unit inserted into a cyclometalated amide ligand. Complexes 1 and 2 reductively couple pyridine to form bridging dipyridyl moieties, (NC5H4-C5H4N)2-, that generate bimetallic complexes differing only in the countercation, {[K(18-c-6)(C5H5N)2]}2{[(R2N)3Gd]2[µ-(NC5H4-C5H4N)2]} and [K(crypt)]2{[(R2N)3Gd]2[µ-(NC5H4-C5H4N)2]}. Complexes 1 and 2 also show similar reactivity with (2,2,6,6-tetramethylpiperidin-1-yl)oxyl (TEMPO) to form the (TEMPO)- complexes [K(18-c-6)][(R2N)3Gd(η1-ONC5H6Me4)] and [K(crypt)][(R2N)3Gd(η1-ONC5H6Me4)], respectively. The first example of a bimetallic coordination complex containing a Bi-Gd bond, [K(crypt)][(R2N)3Gd(BiPh2)], was obtained by treating 2 with BiPh3.

Electrical neuromodulation in bladder dysfunction: Mapping the state-of-the-art with bibliometric analysis of field and top 100 cited articles.

AIMS: Electrical neuromodulation of bladder function has been extensively investigated in the literature. To date, there has been no characterization of the field, and there is a lack of bibliometric literature to guide future studies. We directed this scientometric analysis to characterize the distribution, characteristics and relationships of the field, with subanalysis of top 100 articles. METHODS: The Web of Science Core Collection of the Thompson Reuters Web of Science was searched and analyzed to determine distributions and characteristics of clinical research investigating electrical neuromodulation in bladder dysfunction. Field citation and coauthorship networks were mapped, and recent citation bursts of the past decade are described. The top 100 cited articles were categorized, with level of evidence rating system applied. RESULTS: A total of 872 articles published from 1949 until October 2020 were included in field analysis. Europe demonstrated the highest continental productivity within field (n = 539, 61.81%), and the United States the top nation (35.55% of field, 39.24% of top 100 articles). The Journal of Urology has historically published the most articles in the field (n = 150, 17.20%), and top 100 articles (n = 41, 40.20%). Top 100 articles reported studies of neuromodulation effects via sacral neuromodulation (n = 59); of non-neurological bladder dysfunction (n = 72); urinary incontinence (n = 92), frequency (n = 73) and urgency (n = 68) symptomology. CONCLUSIONS: Analysis of electrical neuromodulation of bladder dysfunction literature reveals historical development, core research clusters and relationships, and an increase in publication activity over past decades.

Genome-wide programmable transcriptional memory by CRISPR-based epigenome editing.

A general approach for heritably altering gene expression has the potential to enable many discovery and therapeutic efforts. Here, we present CRISPRoff-a programmable epigenetic memory writer consisting of a single dead Cas9 fusion protein that establishes DNA methylation and repressive histone modifications. Transient CRISPRoff expression initiates highly specific DNA methylation and gene repression that is maintained through cell division and differentiation of stem cells to neurons. Pairing CRISPRoff with genome-wide screens and analysis of chromatin marks establishes rules for heritable gene silencing. We identify single guide RNAs (sgRNAs) capable of silencing the large majority of genes including those lacking canonical CpG islands (CGIs) and reveal a wide targeting window extending beyond annotated CGIs. The broad ability of CRISPRoff to initiate heritable gene silencing even outside of CGIs expands the canonical model of methylation-based silencing and enables diverse applications including genome-wide screens, multiplexed cell engineering, enhancer silencing, and mechanistic exploration of epigenetic inheritance.

Global Survey of the Roles and Attitudes Toward Social Media Platforms Amongst Urology Trainees.

OBJECTIVES: To perform a global survey assessing the role of and the attitudes toward media platforms amongst training Urologists METHODS: We distributed a 21-item online survey on social medial (SoMe) and other media platforms to current Urology trainees by email via individual institutions and multiple Urological associations. The survey acquired data including baseline characteristics, the role of and attitudes toward SoMe and other media platforms in training and assessed the prevalence of Social Media Disorder (SMD) based on the validated 9-item SMD Scale. Stata IC was used for statistical analysis. RESULTS: Three hundred and seventy-two urology trainees in 6 continents participated in the survey. Overall, 99.4% used SoMe and 27.3% listened to healthcare-focused podcasts. Most trainees (85.5%) are using guideline apps for education purposes, with the top 3 most utilized apps being the EAU, AUA, and UpToDate applications. There was mixed sentiment regarding the impact of SoMe on the patient-physician relationship, wherein most felt it challenges the doctor's authority (56.7%) but also empowers the patient (62.7%) and encourages shared-care (57.3%). Unfortunately, 11.3% of urology trainees met criteria for SMD while 65.4% had not reviewed professional guidelines on appropriate SoMe use. CONCLUSION: Despite practically all urology trainees using SoMe and guideline applications, the majority of trainees have not reviewed or have been educated on professional guidelines for SoMe usage. There is a small but significant number of trainees who are at risk for SMD which may be contributing to higher rates of physician burnout amongst urologists.

Association between ureteric stent dwell time and urinary tract infection.

BACKGROUND: Ureteric stone obstruction commonly presents to the emergency department, with definitive management often involving ureteroscopy and laser lithotripsy. Insertion of a ureteric stent prior to staged lithotripsy is commonly performed in the public healthcare system. Foreign bodies in the urinary tract are also known to increase urinary tract infection (UTI) risk. This study aims to evaluate the association between stent dwell time and UTI prior to lithotripsy. METHODS: The medical records of all patients who were treated for ureteric stones with initial stent insertion and staged lithotripsy, from 1 January 2018 to 30 June 2019 at a single tertiary centre, by eight urologists were retrospectively reviewed. Demographic features, disease factors and urine culture data were collected and analysed. RESULTS: Of the 172 patients (median age 56.7 years) identified, one-third had a positive pre-stent urine culture. Twenty-three percent had a positive pre-lithotripsy urine culture with 38% of females compared with 15% of males having a positive culture (P = 0.001). Only 4.3% of patients had a pre-lithotripsy UTI when the stent dwell time was less than 1 month compared with 26.2% when ureteric stents were in situ for longer than 1 month (P = 0.021). The correlation between ureteric stent dwell time and pre-lithotripsy UTI was not linear. Patient comorbidities, stone size, burden and location were not statistically correlated to pre-lithotripsy UTI. CONCLUSION: In delayed two-staged surgical management of acute urolithiasis, optimal ureteric stent dwell time is less than 1 month to reduce pre-lithotripsy UTI. Female gender is an independent risk factor for pre-lithotripsy UTI.

Nanoparticle-encapsulated siRNAs for gene silencing in the haematopoietic stem-cell niche.

Bone-marrow endothelial cells in the haematopoietic stem-cell niche form a network of blood vessels that regulates blood-cell traffic as well as the maintenance and function of haematopoietic stem and progenitor cells. Here, we report the design and in vivo performance of systemically injected lipid-polymer nanoparticles encapsulating small interfering RNA (siRNA), for the silencing of genes in bone-marrow endothelial cells. In mice, nanoparticles encapsulating siRNA sequences targeting the proteins stromal-derived factor 1 (Sdf1) or monocyte chemotactic protein 1 (Mcp1) enhanced (when silencing Sdf1) or inhibited (when silencing Mcp1) the release of stem and progenitor cells and of leukocytes from the bone marrow. In a mouse model of myocardial infarction, nanoparticle-mediated inhibition of cell release from the haematopoietic niche via Mcp1 silencing reduced leukocytes in the diseased heart, improved healing after infarction and attenuated heart failure. Nanoparticle-mediated RNA interference in the haematopoietic niche could be used to investigate haematopoietic processes for therapeutic applications in cancer, infection and cardiovascular disease.