Single-port plus one in pediatric robotic-assisted Lich-Gregoir ureteral reimplantation for vesicoureteral reflux, a comparative analysis with short-term outcomes.

OBJECTIVE: To observe the safety and short-term outcomes of a new way of laparoscopic trocar placement in pediatric robotic-assisted Lich-Gregoir ureteral reimplantation for vesicoureteral reflux. METHODS: The retrospective study included 32 patients under 14 years diagnosed with primary vesicoureteral reflux (VUR). All these patients underwent robotic-assisted Lich-Gregoir ureteral reimplantation in our department from December 2020 to August 2022. These patients were divided into the following groups according to the different ways of trocar placement: 13 patients in group single-port plus one (SR) and 19 patients in group multiple-port (MR). Patients' characteristics as well as their perioperative and follow-up data were collected and evaluated. RESULTS: There was no significant difference in the data regarding patients' characteristics and preoperative data. These data included the grade of vesicoureteral reflux according to the voiding cystourethrogram (VCUG), and the differential degree of renal function (DRF) at the following time points: preoperative, postoperative, and comparison of preoperative and postoperative. There was no difference between the two groups. During surgery, the time of artificial pneumoperitoneum establishment, ureteral reimplantation time, and total operative time in the SR group were longer than those in the MR group. Yet only the time of artificial pneumoperitoneum establishment shows a statistical difference (P < 0.0001). Also, the peri-operative data, including the volume of blood loss, fasting time, hospitalization, and length of time that a ureteral catheter remained in place, and the number of postoperative complications demonstrate no difference. In addition, the SFU grade and VCUG grade at the following time point also show no difference between the two groups. CONCLUSION: The study demonstrates that SR in robotic-assisted Lich-Gregoir ureteral reimplantation has reached the same surgical effects as MR. In addition, the single-port plus one trocar placement receives a higher cosmetic satisfaction score from parents and did not increase the surgical time and complexity.

Comparison of robot-assisted single-port-plus-one pyeloplasty vs. laparoscopic single-port pyeloplasty in the treatment of ureteropelvic junction obstruction in children.

Objective: To compare the efficacy of robot-assisted single-port-plus-one pyeloplasty (RSPY) and laparoscopic single-port pyeloplasty (LSPY) in the treatment of children with ureteropelvic junction obstruction (UPJO). Methods: The clinical data of 47 children who underwent surgery for UPJO at the Department of the Pediatric Surgery of the Fujian Provincial Hospital from October 2020 to September 2022 were analyzed retrospectively. Of these 47 children, 27 received RSPY while 20 underwent LSPY. The baseline data, operation time, intraoperative anastomosis time, intraoperative blood loss, postoperative hospital stay, complications, total cost, preoperative and postoperative renal parenchymal thickness (PT), anteroposterior renal pelvis diameter (APD), and differential renal function (DRF) of the two groups were compared to evaluate the clinical efficacy of the two surgical methods. Results: The results showed that both surgical techniques were successful and no patient transitioned to open surgery. There was no significant difference between the two groups in baseline data, intraoperative blood loss, complications, APD, and PT 6 months after surgery. There was also no significant difference in APD, PT, and DRF 12 months after surgery (all P > 0.05). Compared with the LSPY group, the RSPY group had shorter operation time [(153.04 ± 14.44) vs. (189.90 ± 32.59) min, t = -5.24, P < 0.05], less intraoperative anastomosis time [(68.81 ± 16.80) vs. (97.45 ± 11.99) min, t = -6.49, P < 0.05], shorter postoperative hospital stay [(5.96 ± 1.34) vs. (9.00 ± 1.33) d, t = -7.68, P < 0.05], but higher total cost [(57,390 ± 7,664) vs. (30,183 ± 4,219) yuan, t = 14.32, P < 0.05]. Conclusion: Compared with LSPY, RSPY achieves equivalent efficacy in the treatment of UPJO in children and has certain advantages by shortening the operation time, intraoperative anastomosis time, and postoperative hospital stay. However, its cost burden is heavy, and appropriate cases need to be selected for popularization and application.

Single-port-plus-one robot-assisted laparoscopic modified Lich-Gregoir direct nipple ureteral extravesical reimplantation in children with a primary obstructive megaureter.

Purpose: To introduce a new technique of single-port-plus-one robotic laparoscopic-modified Lich-Gregoir direct nipple ureteral extravesical reimplantation and ascertain its validity in the treatment of pediatric primary obstructive megaureter. Methods: Between January 2021 and November 2021, we retrospectively analyzed the clinical data of 12 children with primary obstructive megaureter who were admitted to the Department of Pediatric Surgery of Fujian Provincial Hospital. All 12 children were treated with single-port-plus-one robotic laparoscopic Lich-Gregoir direct nipple ureteral extravesical reimplantation. Five of them were female and seven were male, including nine cases were simple obstructive type, while the remaining three cases were obstructive with reflux type. The mean age of the children was 17.33 ± 6.99 (10-36) months and the mean follow-up time was 14.16 ± 1.75 (12-17) months. Changes in preoperative and first-year postoperative parameters were compared. Results: The mean operative time for all 12 children was 123.58 ± 10.85 (110-145) min, with a mean internal operative time of 101.42 ± 0.85 (90-120) min, a mean operative bleeding time of 2.42 ± 0.67 (2-4) ml, and a mean hematuria duration of 16.08 ± 1.44 (14-19) h. The mean indwelling catheterization time was 2.25 ± 0.45 (2-3) days and the mean hospitalization time was 3.83 ± 0.39 (3-4) days. At the postoperative first year, the ureteral diameter, calyceal diameter, and anterior-posterior renal pelvic diameter were found to be significantly smaller than at the preoperative period (18.83 ± 3.21 mm vs. 6.83 ± 1.27 mm, 13.99 ± 3.58 mm vs. 3.5 ± 2.90 mm, and 34.92 ± 4.25 mm vs. 10.08 ± 1.88 mm, P < 0.001). There was a significant increase in renal cortical thickness and the percentage of differential renal function (3.63 ± 1.66 mm vs. 5.67 ± 1.88 mm, 33.75 ± 2.77 mm vs. 37.50 ± 1.31 mm, P < 0.001). The resolution rate of obstruction was 100% and no child developed DeNovo vesicoureteral reflux. Conclusion: The technique of modified Lich-Gregoir direct nipple ureteral extravesical reimplantation can help maintain the physiological direction of the ureter and at the same time enhance the effectiveness of antirefluxing in robotic surgery. The design of a single-port-plus-one wound can produce a cosmetic appearance by concentrating and hiding the wound around the umbilicus. This modified reimplantation procedure has the potential to become a promising technique in the robot-assisted treatment of primary obstructive megaureter.

Cuproptosis in ccRCC: key player in therapeutic and prognostic targets.

Background: Classical biomarkers have been used to classify clear cell renal cell carcinoma (ccRCC) patients in a variety of ways, and emerging evidences have indicated that cuproptosis is closely related to mitochondrial metabolism, thereby accelerating the development and progression of ccRCC. Nevertheless, the specific relationship between cuproptosis and the prognosis and treatment of ccRCC remains unclear. Methods: We comprehensively integrated several ccRCC patient datasets into a large cohort. Following that, we systematically analyzed multi-omics data to demonstrate the differences between two cuproptosis clusters. Results: We identified two cuproptosis clusters in ccRCC patients. Among the two clusters, cluster 1 patients showed favorable prognosis. We then confirmed the significant differences between the two clusters, including more typical cancer hallmarks were enriched in cluster 2 patients; cluster 2 patients were more susceptible to develop mutations and had a lower level of gistic score and mRNAsi. Importantly, both Tumor Immune Dysfunction and Exclusion analysis and subclass mapping algorithm showed that cuproptosis 1 patients were more susceptible to be responded to immunotherapy. In addition, a prognostic signature was successfully developed and also showed prominent predictive power in response to immunotherapy. Conclusion: As a result of our findings, we were able to classify ccRCC patients according to cuproptosis in a novel way. By constructing the cuproptosis clusters and developing the signature, patients with ccRCC could have a more accurate prognosis prediction and better immunotherapy options.

Study on Erosion Behavior of Laser Wire Feeding Cladding High-Manganese Steel Coatings.

High-manganese steel (HMnS) coating was prepared using laser wire feeding cladding technology. Erosion damage behavior and erosion rate of both the HMnS coating and the HMnS substrate were investigated at room temperature using an erosion testing machine. SEM/EDS, XRD, EPMA, and microhardness analyses were used to characterize the cross sections of the coating and matrix, as well as the morphology, phase composition, and microhardness of the eroded surface. The phase composition, orientation characteristics, and grain size of the eroded surfaces of both the coating and substrate were examined by using the EBSD technique. The erosion mechanism under different erosion angles was revealed. By analyzing the plastic deformation behavior of the subsurface of the HMnS coating, the impact hardening mechanism of the high-manganese steel coating during the erosion process was investigated. The results demonstrated that the HMnS coating, prepared through laser wire feeding cladding, exhibited excellent metallurgical bonding with the substrate, featuring a dense microstructure without any cracks. The erosion rate of the coatings was lower than that of the substrate at different erosion angles, with the maximum erosion rate occurring at 35° and 50°. The damage to the coating and substrate under low-angle erosion was primarily attributed to the micro-cutting of erosion particles and a minor amount of hammering. At the 90° angle, the dominant factor was hammering. After erosion, the microhardness of both the coating and substrate sublayer increased to 380HV0.3 and 359HV0.3, respectively. Dendrite segregation, refined grains, low-angle grain boundaries, and localized dislocations, generated by laser wire feeding cladding, contributed to the deformation process of HMnS. These factors collectively enhance the hardening behavior of HMnS coatings, thereby providing excellent erosion resistance.

Do you reap what you sow? Driving mechanism of supply chain transparency on consumers' indirect reciprocity.

Introduction: To maintain sustainable poverty alleviation in the post-pandemic world, China encourages firms to participate in the "Social Commerce Helping Farmers Project." This study aims to explore the phenomenon of indirect reciprocity between firms, consumers, and farmers in the supply chain. This study explores how supply chain transparency stimulates indirect reciprocity among consumers through competence trust, goodwill trust, and integrity trust. Furthermore, we explore the impact of compassion and the need for social status on the model. Methods: We fit a partial least square analysis structural equation modeling (PLS-SEM) using data from an online random vignette-based experiment questionnaire survey. Results: Supply chain transparency of social responsibility practices asymmetrically affects three dimensions of consumer trust by improving perceived information quality. And the three dimensions of trust asymmetrically contribute to indirect reciprocity. Furthermore, compassion has a positive moderating effect on the relationship between perceived information quality and trust. However, the moderating effect of the need for social status on the relationship between the three dimensions of trust and indirect reciprocity differed significantly. Discussion: Our findings indicate that supply chain transparency improves consumer trust, making consumers more responsive and rewarding companies that assist vulnerable groups in their supply chains. Faced with a trust crisis, companies can take different measures to achieve their goals based on each dimension of trust. At the same time, companies need to consider differences in the responses of consumers with different personality traits (e.g., compassion and the need for social status) when revealing their corporate social responsibility practices to consumers.

A potassium-chloride co-transporter promotes tumor progression and castration resistance of prostate cancer through m6A reader YTHDC1.

SLC12A5, a neuron-specific potassium-chloride co-transporter, has been reported to promote tumor progression, however, the underlying mechanism remains unclear. Here we report that SLC12A5 functions as an oncogene to promote tumor progression and castration resistance of prostate cancer through the N6-methyladenosine (m6A) reader YTHDC1 and the transcription factor HOXB13. We have shown that the level of SLC12A5 was increased in prostate cancer, in comparison to its normal counterparts, and further elevated in castration-resistant prostate cancer (CRPC). The enhanced expression of SLC12A5 mRNA was associated with neuroendocrine prostate cancer (NEPC) progression and poor survival in prostate cancer. Furthermore, we demonstrated that SLC12A5 promoted the castration resistance development of prostate cancer in addition to the cell proliferation and migration. Interestingly, SLC12A5 was detected in the cell nucleus and formed a complex with nuclear m6A reader YTHDC1, which in turn upregulated HOXB13 to promote the prostate cancer progression. Therefore, our findings reveal a mechanism that how the potassium-chloride cotransporter SLC12A5 promotes the tumor progression and provide a therapeutic opportunity for prostate cancer to apply the neurological disorder drug SLC12A5 inhibitors.

Prevention of breast cancer-related lymphoedema: Quality of clinical practice guidelines and variations in recommendations.

AIM: We aimed to evaluate the quality of clinical practice guidelines (CPGs) for breast cancer related lymphoedema (BCRL) and compare the similarities and differences in recommendations. BACKGROUND: Many CPGs of BCRL have been developed; however, their recommendations and quality are controversial. METHODS: Relevant papers were retrieved from electronic databases, professional associations and guideline development organizations, from 1 January 2015 to 30 September 2021. The Appraisal of Guidelines Research and Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was used to evaluate the overall consistency among evaluators. RESULTS: Eight CPGs were included. The ICC values evaluation for CPGs ranged from 0.76 to 0.95, with good consensus among evaluators. The highest median score was 68.75% (61.46, 72.22%) for clarity, and the lowest was 37.50% (25.78, 51.30%) for applicability. The NICE, ACS/ACSO and APTA CPGs were rated well in most areas. Professional health education, individualized exercise programme and regular surveillance are the main methods to prevent lymphoedema. CONCLUSION: In the past 6 years, the quality of BCRL guidelines has varied greatly, especially in the domains of rigour and applicability. Interrater agreement was excellent, but recommendation showed some inconsistencies in the details.

Robot-assisted pyeloplasty and laparoscopic pyeloplasty in children: A comparison of single-port-plus-one and multiport surgery.

Objective: This study aimed to compare the effects of various trocar placements in robot-assisted and laparoscopic pyeloplasty involving children diagnosed with obstruction of the ureteropelvic junction (OUPJ). Methods: We retrospectively collected the data on 74 patients under 14 years of age who had been diagnosed with OUPJ; these patients underwent either robot-assisted or laparoscopic pyeloplasty in our hospital between January 2015 and November 2021. There were four groups, as follows: •Laparoscopic multiport pyeloplasty (LMPY),•Laparoscopic single-port pyeloplasty (LSPY),•Robotic-assisted multiport pyeloplasty (RMPY),•Robotic-assisted single-port-plus-one pyeloplasty (RSPY).Patients' characteristics as well as their perioperative and follow-up data were collected and evaluated. Results: There was no significant difference in the data regarding patients' characteristics. These data included the grade of hydronephrosis according to the Society of Fetal Urology (SFU grade), anterior and posterior diameter of the renal pelvis and ureter (APDRPU), and the differential degree of renal function (DRF) at following time points: preoperative, postoperative, and comparison of preoperative and postoperative. There was no difference among these groups. During surgery, the time of trocar placement, urethroplasty time, and total operative time in the robotic groups (RMPY and RSPY) were longer than those in the laparoscopic groups (LMPY and LSPY). However, the ratio of the urethroplasty time and full operative time (UT/WT) in the robotic groups (RMPY and RSPY) was lower than that in the laparoscopic groups (LMPY and LSPY) (P = 0.0075). Also, the volume of blood loss was lower in the robotic groups (RMPY and RSPY) than that in the laparoscopic groups (LMPY and LSPY), although there was no statistical difference (P = 0.11). There were, however, significant differences in hospitalization days (P < 0.0001) and parents' cosmetic satisfaction scores (P < 0.001). There were no differences in fasting time, the length of time that a ureteral catheter remained in place, or the number of postoperative complications. Conclusion: Our study shows that both robotic multiple-port and single-port-plus-one approaches are comparable, with laparoscopic multiple-port and single-port approaches equally effective in resolving OUPJ in children. Robotic and single-port-plus-one approaches may be associated with some advantages in hospitalization time and cosmetic outcomes; therefore, these approaches may be useful in urologic surgery that requires precise suturing, especially in pediatric patients.

WDR4 gene polymorphisms increase hepatoblastoma susceptibility in girls.

Hepatoblastoma, originating from hepatoblasts, is the most common hepatic malignancy. WD repeat domain 4 (WDR4) is a subunit of RNA N(7)-methylguanine (m7G) methyltransferase complex. Recently, WDR4 has shown oncogenic potential in various adult cancers, but its roles in pediatric cancers have not been reported. We performed a case-control study (313 cases vs. 1446 controls) to investigate whether genetic variants in the WDR4 gene influence hepatoblastoma susceptibility in the Chinese Han nationality. We first determine the genotypes of five WDR4 gene polymorphisms (rs2156315 C>T, rs2156316 C>G, rs6586250 C>T, rs15736 G>A, rs2248490 C>G) in participants, using the Taqman assay. And then, an unconditional logistic regression analysis was performed to assess the association between WDR4 gene polymorphisms and hepatoblastoma risk. Overall, we did not find any polymorphism significantly associated with the risk of developing hepatoblastoma. Instead, the stratified analysis revealed that the co-existence of 2-5 risk genotypes increased hepatoblastoma risk by 2.23 folds in girls (adjusted odds ratio=2.23, 95% confidence interval=1.17-4.23, P=0.014). In conclusion, our results demonstrate that single selected polymorphisms were too weak to exert a significant effect on the whole study population. However, in combination, two or more WDR4 gene polymorphisms significantly conferred increased hepatoblastoma risk in girls. Our findings may encourage more genetic association studies to discover significant polymorphisms in the WDR4 gene for hepatoblastoma.

Investigation of Measurement Accuracy of Bridge Deformation Using UAV-Based Oblique Photography Technique.

This paper investigates the measurement accuracy of unmanned aerial vehicle-based oblique photography (UAVOP) in bridge deformation identifications. A simply supported concrete beam model was selected and measured using the UAVOP technique. The influences of several parameters, such as overall flight altitude (h), local shooting distance (d), partial image overlap (λ), and arrangement of control points, on the quality of the reconstructed three-dimensional (3D) beam model, were presented and discussed. Experimental results indicated that the quality of the reconstructed 3D model was significantly improved by the fusion overall-partial flight routes (FR), of which the reconstructed model quality was 46.7% higher than those with the single flight route (SR). Despite the minimal impact of overall flight altitude, the reconstructed model quality prominently varied with the local shooting distance, partial image overlap, and control points arrangement. As the d decreased from 12 m to 8 m, the model quality was improved by 48.2%, and an improvement of 42.5% was also achieved by increasing the λ from 70% to 80%. The reconstructed model quality of UAVOP with the global-plane control points was 78.4% and 38.4%, respectively, higher than those with the linear and regional control points. Furthermore, an optimized scheme of UAVOP with control points in global-plane arrangement and FR (h = 50 m, d = 8 m, and λ = 80%) was recommended. A comparison between the results measured by the UAVOP and the total station showed maximum identification errors of 1.3 mm. The study's outcomes are expected to serve as potential references for future applications of UAVOP in bridge measurements.

A nomogram to predict survival probability of gastric cancer patients undergoing radical surgery and adjuvant chemotherapy.

Gastric cancer (GC) is the third-leading cause of cancer mortality worldwide. The aim of this study was to develop a nomogram that estimates 1-year, 3-year, and 5-year survival probability of GC patients after D2 gastrectomy combined with adjuvant chemotherapy. The results showed that median age is 58 (range: 18-85) years in the training cohort and 59 (range: 32-85) years in the validation cohort. On multivariate analysis, four factors were found to be significantly associated with worse overall survival (OS): late TNM stage, positive resection margin, preoperative carcinoembryonic antigen (CEA) level, and single chemotherapy regimens compared with multiple chemotherapy regimens. All of these findings were validated in the validation cohort. Furthermore, the four factors were included in the final nomogram for the prediction of 1-year, 3-year, and 5-year survival probability, with accurate calibration and reasonable discrimination (C-index = 0.676 for training cohort, and C-index = 0.664 for validation cohort). The AUC values analyzed by the ROC analysis demonstrated a good predictive accuracy of the nomogram for OS (1-year, 3-year, and 5-year OS were 94.43%, 77.42%, and 73.03% in the training cohort, respectively; 96.95%, 81.54%, and 73.41% in the validation cohort, respectively). In conclusion, the proposed nomogram may be used to objectively and accurately predict survival probability of GC patients in a multi-institutional clinical setting.

Ureteral reimplantation for pediatric vesicoureteral reflux and primary obstructive megaureter: Transvesicoscopic cohen vs. Politano-Leadbetter approaches.

BACKGROUND: Transvesicoscopic approaches for ureteral reimplantation (UR) are effective surgical techniques with which to resolve vesicoureteral reflux (VUR) or primary obstructive megaureter (POM) in pediatric patients. However, the effectiveness of different UR surgical methods for these two diseases is still unclear. PURPOSE: To compare the effects of Cohen's cross-trigonal and Politano-Leadbetter techniques in children in need of UR. METHODS: A retrospective chart review was performed for consecutive patients who underwent UR at our institution between May 2018 and November 2019, including those treated for vesicoureteral reflux (VUR) or primary obstructive megaureter (POM). Patients who underwent Cohen's technique included in Group C, and those who underwent the Politano-Leadbetter technique were included in Group P. Patient characteristics, perioperative parameters, and short-term postoperative outcomes were compared. RESULTS: Forty-six patients who underwent unilateral UR were included in the analysis. At presentation, those in Group P (N = 22, 12 diagnosed with VUR and 10 with POM) did not differ from those in Group C (N = 24, 12 diagnosed with VUR and 12 with POM) with respect to age, sex, disease type or severity. For VUR patients, reflux was clinically resolved for all patients in both groups; however, only a 75% resolution rate was observed in Group C, with 3 patients experiencing persistent low-grade, clinically insignificant reflux, while a 100% resolution rate was found in Group P (P > 0.05). Among POM patients, the obstruction was resolved for all those in Group P and for 90% of those in Group C; this difference was also not statistically significant (P > 0.05). At the 1-year follow-up, the ureteral diameter (P < 0.05) and anterior-posterior renal pelvic diameter (APRPD) (P < 0.05) of Group P were significantly reduced, and differential renal function (DRF) (P < 0.05) was slightly improved compared with that in Group C in both VUR and POM patients. CONCLUSIONS: Politano-Leadbetter and Cohen are both reliable techniques for UR in children with VUR or POM, and the short-term outcomes of these methods in solving reflux and obstruction are comparable. Besides traditional Cohen's technique, Politano-Leadbetter's technique maybe a potential choice for ureteral reimplantation in children.

Microplastic pollution in urban green-belt soil in Shihezi City, China.

The problems are associated with microplastic (MP) pollution of global concern. However, little is known about the pollution characteristics and sources of MPs in urban green-belt soils. Therefore, this study investigated MP pollution in 11 sampling sites (22 green belts) in Shihezi City. The results showed that the abundance of MPs (0.02-5.00 mm) ranged from 287 ± 100 items/kg dw to 3227 ± 155 items/kg dw (mean + SD). Fibers (69.9%) accounted for the majority of MPs, and the MPs were mainly black (36.7%) and 0.02-0.5 mm (64.8%). The main types of MPs were polystyrene (PS) and polyethylene (PE). Compared with agricultural soil, the color and composition of green-belt soil MPs are diverse, which means that the source of green-belt soil MPs is more diverse. In different types of green-belt soil, MP pollution of industrial green land is more serious. Through cluster analysis and spatial distribution, fragments and fibers were found to have similar sources, mainly originating from food and textile industrial activities. This study provides important information for revealing MP pollutions in urban green-belt soils.

Evaluation of microplastic pollution in Shihezi city, China, using pine needles as a biological passive sampler.

Microplastic (MP) pollution has attracted much attention. To understand the characteristics of atmospheric MP pollution in Shihezi, Northwest China, this study used pine needles from trees in Shihezi City as passive samplers. MP contamination was found in all pine needle samples, with an average concentration of 16.52 ± 3.76 items/g. MPs were mainly in the shape of fragments (<0.05 mm). Differences in MP pollution were observed in different functional areas. The abundance of MPs in pine needles was the highest on the main traffic road (19.02 ± 2.52 items/g). Spectral analysis showed that the main polymer of MPs was polyethylene (17.2%), followed by polystyrene (15.5%) and polypropylene (13.8%). By analyzing the principal components and spatial distribution, fragments and pellets were found to have similar sources (mainly industrial activities), whereas films and fibers were influenced by traffic flow. The source of films was related to the packaging industry. The purpose of this study was to provide a reference for the future use of pine needles as atmospheric MP passive samplers, for the traceability and prevention of urban atmospheric MP pollution and for the formulation of national atmospheric MP environmental standards.

Global, regional, and national burden of kidney, bladder, and prostate cancers and their attributable risk factors, 1990-2019.

BACKGROUND: The burden of kidney, bladder, and prostate cancers has changed in recent decades. This study aims to investigate the global and regional burden of, and attributable risk factors for genitourinary cancers during the past 30 years. METHODS: We extracted data of kidney, bladder, and prostate cancers from the Global Burden of Disease 2019 database, including incidence, mortality, disability-adjusted life-years (DALYs), and attributable risk factors from 1990 to 2019. Estimated annual percentage changes (EAPC) were calculated to assess the changes in age-standardized incidence rate, age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR). The associations between cancers burden and socio-demographic index (SDI) were also analyzed. RESULTS: Compared with 1990, the global incident cases in 2019 were higher by 154.78%, 123.34%, and 169.11% for kidney, bladder, and prostate cancers, respectively. During the 30-year study period, there was a downward trend in ASMR and ASDR for bladder cancer (EAPC = - 0.68 and - 0.83, respectively) and prostate cancer (EAPC = - 0.75 and - 0.71, respectively), but an upward trend for kidney cancer (EAPC = 0.35 and 0.12, respectively). Regions and countries with higher SDI had higher incidence, mortality, and DALYs for all three types of cancers. The burden of bladder and prostate cancers was mainly distributed among older men, whereas the burden of kidney cancer increased among middle-aged men. Smoking related mortality and DALYs decreased, but high body mass index (BMI) and high fasting plasma glucose (FPG) related mortality and DALYs increased among kidney, bladder, and prostate cancers during the study period. CONCLUSIONS: Kidney, bladder, and prostate cancers remain major global public health challenges, but with distinct trend for different disease entity across different regions and socioeconomic status. More proactive intervention strategies, at both the administrative and academic levels, based on the dynamic changes, are needed.

Identification of key carcinogenic genes in Wilms' tumor.

This study aimed to probe carcinogenic genes and pathways associated with Wilms' tumor (WT) onset and malignancy progression. After screening, three datasets acquired from the Gene Expression Omnibus database were analyzed. Differentially expressed genes (DEGs) were identified and GO functional enrichment, KEGG pathway enrichment and protein-protein interaction (PPI) were analyzed. The DEGs with top fold change values or top protein interaction scores were used to analyze overall survival based on the TARGET WT dataset. Together, 866 up-regulated genes in GDS1791, 585 up-regulated genes in GDS2010, and 277 down-regulated genes in GDS4802 were found, from which 46 key DEGs were selected for further analysis. In the PPI network, hub positions included COL5A1, COL4A1, ARPP21, SPARCL1, CD86, LY96 and PPP1R12B. The top DEGs (ARPP21, SYNPO, PRRC2B, PPP1R12B, EFCAB2 and LY96) were selected for survival analysis, and they consistently showed a significantly positive correlation with poor survival. Together, five key carcinogenic genes (SYNPO, PRRC2B, PPP1R12B, EFCAB2 and LY96) were highly associated with WT onset and patient survival. These risk genes, interaction networks and enrichments should improve our understanding of the complex molecular mechanisms in WT development and help clinical applications.

Quality of and Recommendations for Relevant Clinical Practice Guidelines for COVID-19 Management: A Systematic Review and Critical Appraisal.

Background: The morbidity and mortality of coronavirus disease 2019 (COVID-19) are still increasing. This study aimed to assess the quality of relevant COVID-19 clinical practice guidelines (CPGs) and to compare the similarities and differences between recommendations. Methods: A comprehensive search was conducted using electronic databases (PubMed, Embase, and Web of Science) and representative guidelines repositories from December 1, 2019, to August 11, 2020 (updated to April 5, 2021), to obtain eligible CPGs. The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to evaluate the quality of CPGs. Four authors extracted relevant information and completed data extraction forms. All data were analyzed using R version 3.6.0 software. Results: In total, 39 CPGs were identified and the quality was not encouragingly high. The median score (interquartile range, IQR) of every domain from AGREE II for evidence-based CPGs (EB-CPGs) versus (vs.) consensus-based CPG (CB-CPGs) was 81.94% (75.00-84.72) vs. 58.33% (52.78-68.06) in scope and purpose, 59.72% (38.89-75.00) vs. 36.11% (33.33-36.11) in stakeholder involvement, 64.58% (32.29-71.88) vs. 22.92% (16.67-26.56) in rigor of development, 75.00% (52.78-86.81) vs. 52.78% (50.00-63.89) in clarity of presentation, 40.63% (22.40-62.50) vs. 20.83% (13.54-25.00) in applicability, and 58.33% (50.00-100.00) vs. 50.00% (50.00-77.08) in editorial independence, respectively. The methodological quality of EB-CPGs were significantly superior to the CB-CPGs in the majority of domains (P < 0.05). There was no agreement on diagnosis criteria of COVID-19. But a few guidelines show Remdesivir may be beneficial for the patients, hydroxychloroquine +/- azithromycin may not, and there were more consistent suggestions regarding discharge management. For instance, after discharge, isolation management and health status monitoring may be continued. Conclusions: In general, the methodological quality of EB-CPGs is greater than CB-CPGs. However, it is still required to be further improved. Besides, the consistency of COVID-19 recommendations on topics such as diagnosis criteria is different. Of them, hydroxychloroquine +/- azithromycin may be not beneficial to treat patients with COVID-19, but remdesivir may be a favorable risk-benefit in severe COVID-19 infection; isolation management and health status monitoring after discharge may be still necessary. Chemoprophylaxis, including SARS-CoV 2 vaccines and antiviral drugs of COVID-19, still require more trials to confirm this.

A mussel-inspired supramolecular hydrogel with robust tissue anchor for rapid hemostasis of arterial and visceral bleedings.

In recent years, the developed hemostatic technologies are still difficult to be applied to the hemostasis of massive arterial and visceral hemorrhage, owing to their weak hemostatic function, inferior wet tissue adhesion, and low mechanical properties. Herein, a mussel-inspired supramolecular interaction-cross-linked hydrogel with robust mechanical property (308.47 ± 29.20 kPa) and excellent hemostatic efficiency (96.5% ± 2.1%) was constructed as a hemostatic sealant. Typically, we combined chitosan (CS) with silk fibroin (SF) by cross-linking them through tannic acid (TA) to maintain the structural stability of the hydrogel, especially for wet tissue adhesion ability (shear adhesive strength = 29.66 ± 0.36 kPa). Compared with other materials reported previously, the obtained CS/TA/SF hydrogel yielded a lower amount of blood loss and shorter time to hemostasis in various arterial and visceral bleeding models, which could be ascribed to the synergistic effect of wound closure under wet state as well as intrinsic hemostatic activity of CS. As a superior hemostatic sealant, the unique hydrogel proposed in this work can be exploited to offer significant advantages in the acute wound and massive hemorrhage with the restrictive access of therapeutic moieties.

An investigation to identify tumor microenvironment-related genes of prognostic value in lung squamous cell carcinoma based on The Cancer Genome Atlas.

BACKGROUND: Lung squamous cell carcinoma (LUSC) is a prevalent and lethal malignancy with a poor clinical prognosis. Major constituents of the tumor microenvironment (TME) include infiltrating immune cells and stromal cells, which play a pivotal role in the progression and growth of the disease. To improve the understanding of the prognostic influence of immune and stromal cell-related genes for patients with the disease, we performed a comprehensive bioinformatics analysis to identify TME-relevant biomarkers, and investigated the potential role of these candidate signatures in LUSC. METHODS: Estimation of STromal and Immune cells in MAlignant Tumor tissues using Expression data (ESTIMATE) assessed the samples of LUSC obtained from The Cancer Genome Atlas (TCGA). The samples were grouped according to their immune/stromal scores (high or low). Multivariate cox regression and receiver operating characteristic curves (ROC) were implemented to construct the risk assessment model for prognosis prediction. The co-upregulated differentially expressed genes (DEGs) in the immune and stromal groups were used for further analyses. Overall survival (OS) curves were used to determine the prognostic value of the DEGs, and the TME-related DEGs were verified with Gene Expression Omnibus (GEO) datasets. The functional assessments were performed include Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and protein-protein interaction (PPI) analyses. RESULTS: The immune/stromal scores calculated by ESTIMATE showed significant associations with OS (log-rank P<0.05). In addition, the prognostic risk score model based on immune and stromal scores also showed significant correlations with OS. A total of 94 TME-related genes were obviously related to poor OS. Among them, BHMT2, FES, HSPB7, NOVA2, LPAP2, and SEMA3B (BFHNLS) were confirmed using GSE4573 and GSE17710 datasets. The functional assessments exhibited those TME-related genes mostly participate in immune response, cytokine-cytokine receptor interaction, and metabolic pathways, which elucidated the probable correlation of TME with tumorigenesis in LUSC. CONCLUSIONS: In this study, 6 potential biomarkers named BFHNLS were identified as TME-related genes with prognostic value based on immune and stromal scores of LUSC patients of TCGA, and were verified using GEO datasets, which might serve as therapeutic targets.