Flexible ureteroscopic treatment of kidney stones: How do the new laser systems change our concepts?

Objective: Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety. Methods: We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction. Results: We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency. Conclusion: While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.

Genetic susceptibility of urolithiasis: comprehensive results from genome-wide analysis.

BACKGROUND: The pathogenesis of urolithiasis is multi-factorial and genetic factors have been shown to play a significant role in the development of urolithiasis. We tried to apply genome-wide Mendelian randomization (MR) analysis and figure out reliable gene susceptibility of urolithiasis from the largest samples to date in two independent genome-wide association studies (GWAS) database of European ancestry. METHODS: We extracted summary statistics of expression quantitative trait locus (eQTL) from eQTLGen consortium. Urolithiasis phenotype information was obtained from both FinnGen Biobank and UK Biobank. Multiple two-sample MR analysis with a Bonferroni-corrected P threshold (P < 2.5e-06) was conducted. The primary endpoint was the causal effect calculated by random-effect inverse variance weighted (IVW) method. Sensitivity analysis, volcano plots, scatter plots, and regional plots were also performed and visualized. RESULTS: After multiple MR tests between 19942 eQTLs and urolithiasis phenotype from both cohorts, 30 common eQTLs with consistent effect size direction were found to be causally associated with urolithiasis risk. Finally only one gene (LMAN2) was simultaneously identified among all top significant eQTLs from both FinnGen Biobank (beta = 0.6758, se = 0.0327, P = 6.775e-95) and UK Biobank (beta = 0.0044, se = 0.0009, P = 2.417e-06). We also found that LMAN2 was with the largest beta effect size on urolithiasis phenotype from the two cohorts. CONCLUSION: We for the first time implemented genome-wide MR analysis to investigate the genetic susceptibility of urolithiasis in general population of European ancestry. Our results provided novel insights into common genetic variants of urinary stone disease, which was of great help to subsequent researches.

Is antibiotic prophylaxis generally safe and effective in surgical and nonsurgical scenarios? Evidence from an umbrella review of randomized controlled trials.

BACKGROUND: The authors aimed to comprehensively evaluate the efficacy and safety of antibiotic prophylaxis through surgical and nonsurgical scenarios and assess the strength of evidence. MATERIALS AND METHODS: The authors performed an umbrella review of meta-analyses of randomized controlled trials (RCTs). An evidence map was created to summarize the absolute benefits of antibiotic prophylaxis in each scenario and certainty of evidence. RESULTS: Seventy-five meta-analyses proved eligible with 725 RCTs and 78 clinical scenarios in surgical and medical prophylaxis. Of 119 health outcomes, 67 (56.3%) showed statistically significant benefits, 34 of which were supported by convincing or highly suggestive evidence from RCTs. For surgeries, antibiotic prophylaxis may minimize infection occurrences in most surgeries except Mohs surgery, simple hand surgery, herniorrhaphy surgery, hepatectomy, thyroid surgery, rhinoplasty, stented distal hypospadias repair, midurethral sling placement, endoscopic sinus surgery, and transurethral resection of bladder tumors with only low to very low certainty evidence. For nonsurgery invasive procedures, only low to very low certainty evidence showed benefits of antibiotic prophylaxis for cystoscopy, postoperative urinary catheterization, and urodynamic study. For medical prophylaxis, antibiotic prophylaxis showed greater benefits in nonemergency scenarios, in which patients were mainly with weakened immune systems, or at risk of recurrent chronic infections. Antibiotics prophylaxis may increase antibiotic resistance or other adverse events in most scenarios and reached significance in cystoscopy, afebrile neutropenia following chemotherapy and hematopoietic stem cell transplantation. CONCLUSIONS: Antibiotic prophylaxis in surgical and nonsurgical scenarios is generally effective and seems independent of surgical cleanliness and urgency of diseases. Its safety is not well determined due to lack of available data. Nevertheless, the low quality of current evidence limits the external validity of these findings, necessitating clinicians to judiciously assess indications, balancing low infection rates with antibiotic-related side effects.

Vitamin E and Multiple Health Outcomes: An Umbrella Review of Meta-Analyses.

The relationship between vitamin E intake or circulating α-tocopherol and various health outcomes is still debatable and uncertain. We conducted an umbrella review to identify the relationships between vitamin E intake or circulating tocopherol and health outcomes by merging and recalculating earlier meta-analyses. The connections that were found to be statistically significant were then classified into different evidence levels based on p values, between-study heterogeneity, prediction intervals, and small study effects. We finally included 32 eligible meta-analyses with four vitamin E sources and 64 unique health outcomes. Only the association between circulating α-tocopherol and wheeze or asthma in children was substantiated by consistent evidence. Suggestive evidence was suggested for seven results on endothelial function (supplemental vitamin E): serum C-reactive protein (CRP) concentrations (supplemental vitamin E), cervical cancer (dietary vitamin E), esophageal cancer (dietary vitamin E), cervical intraepithelial neoplasia (CIN, dietary vitamin E), pancreatic cancer (total vitamin E intake), and colorectal cancer (circulating α-tocopherol levels); all of these showed a protective effect consistent with the vitamin E source. In conclusion, our work has indicated that vitamin E is protective for several particular health outcomes. Further prospective studies are required when other factors that may contribute to bias are considered.

Association between antibiotic exposure and adverse outcomes of children and pregnant women: evidence from an umbrella review.

BACKGROUND: Antibiotics are widely prescribed among children and pregnant women, but their safety profile is controversial. This study aimed to summarize and appraise current evidence for the potential impact of antibiotic exposure on pregnancy outcomes and children's health. METHODS: PubMed, Embase, Web of Science and the Cochrane Database of Systematic Reviews were searched from inception to June 2022. Meta-analyses of any study design comparing the impact of antibiotic exposure with nonexposure among children, pregnant women and prepregnant women on adverse health outcomes of children and pregnancy were retrieved. The quality of evidence was assessed by a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Data were reanalyzed, and the credibility of the evidence was determined. RESULTS: Out of 2956 studies identified, 19 articles with 39 associations were included. Totally 19 of the associations (48.72%) were statistically significant with a P value ≤ 0.05, while only six were supported by highly suggestive evidence. Children with postnatal antibiotic exposure had a higher risk of developing asthma odds ratio (OR): 1.95, 95% confidence interval (CI): 1.76-2.17, wheezing (OR: 1.81, 95% CI 1.65-1.97) and allergic rhinoconjunctivitis (OR: 1.66, 95% CI 1.51-1.83), with prediction intervals excluding the nulls. Quality assessed by both AMSTAR2 and GRADE of included meta-analyses were very low in general. CONCLUSIONS: Antibiotic exposure in early life was associated with children's long-term health, especially in cases of allergic diseases. Prenatal exposure might also influence children's health in some aspects but requires more high-quality evidence. Potential adverse effects of antibiotics on pregnancy outcomes were not observed in our study. Studies with higher quality and better quantification of antibiotic exposure are needed in the future.

Antibiotic prophylaxis after extraction of urinary catheter prevents urinary tract infections: A systematic review and meta-analysis.

OBJECTIVE: To investigate the effect of antibiotic prophylaxis for consequent urinary tract infections (UTIs) after extraction of urinary catheter and further explore the association between the outcome and clinical characteristics of patients. METHODS: We systematically searched PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov databases through March 2020. Studies were included if they inquired into antibiotic prophylaxis for UTIs after extraction of a temporary (≤14 days) urinary catheter. We used fixed-effect models to obtain pooled risk ratio (RR) estimates. Heterogeneity was evaluated with I2 value. Sensitivity analysis and subgroup analysis were also conducted to assess heterogeneity. RESULTS: We finally included 8 randomized controlled trials in our study. Only 2 studies showed that antibiotic prophylaxis can reduce the consequent UTIs after extraction of urinary catheters while 6 did not. Overall, antibiotic prophylaxis was associated with reduced UTIs (RR, 0.47, 95% confidence interval [CI] 0.28-0.72, P< .01, I2 = 31%). Subgroup analysis indicated that patients who are older than 60 (RR = 0.50, 95% CI: 0.33-0.76, P< .05, I2 = 29%) or received Trimethoprim/sulfamethoxazole (TMP/SMX; RR = 0.21, 95% CI: 0.09-0.48, P< .01, I2 = 0%) or indwelling catheters for more than 5 days (RR = 0.34, 95% CI: 0.19-0.63, P< .01, I2 = 0%) could get more benefit from antibiotic prophylaxis after extraction of catheters. CONCLUSIONS: Patients with catheters removed might get benefit from antibiotic prophylaxis as a result of fewer consequent UTIs, and those who have advanced age (over 60 years old) or long-term catheterization (over 5 days) could get more benefit from prophylaxis. And TMP/SMX could be a good choice of prophylaxis for UTIs after extraction of urinary catheters. This approach should apply to high-risk patients (advanced age or long-term catheterization) due to the potential harm of widespread antibacterial agents such as side effects and bacterial resistance.

Comparison of spontaneous fetal loss rates between women with singleton and twin pregnancies after mid-trimester amniocentesis - A historical cohort study.

OBJECTIVE: To assess and compare fetal loss rates before 28 weeks of singleton and twin pregnancies after mid-trimester amniocentesis. METHOD: This historic cohort study included 13 773 women with singletons and 426 women with twins undergoing mid-trimester amniocentesis from 1/2015 to 3/2017. Pregnancies resulting in termination or selective reduction before 28 weeks were excluded, as well as twin gestations undergoing single-puncture amniocentesis. Fetal loss rates were compared between singleton and twins taking into account maternal characteristics, amniocentesis procedure, and fetal chromosomal abnormalities. RESULTS: The rates of fetal chromosomal abnormalities were similar in singleton and twin gestations (1.13% vs 0.70%, P = .253). No difference was found in maternal or fetal characteristics, or amniocentesis procedure between the two groups. The fetal loss rate was significantly higher in twin compared with singleton pregnancies (1.91% vs 0.24%, P < .001, RR = 8.25 [95% CI: 4.51 to 15.09]). The fetal loss rate between monochorionic twins and dichorionic twins was similar (1.80% vs 1.78%, P = 1.000). CONCLUSIONS: Twin pregnancies have higher risk of fetal loss after mid-trimester amniocentesis, which cannot be explained by differences in rates of fetal chromosomal abnormalities, maternal characteristic, or amniocentesis technique.

Multi-Scale Multi-View Deep Feature Aggregation for Food Recognition.

Recently, food recognition has received more and more attention in image processing and computer vision for its great potential applications in human health. Most of the existing methods directly extracted deep visual features via convolutional neural networks (CNNs) for food recognition. Such methods ignore the characteristics of food images and are, thus, hard to achieve optimal recognition performance. In contrast to general object recognition, food images typically do not exhibit distinctive spatial arrangement and common semantic patterns. In this paper, we propose a multi-scale multi-view feature aggregation (MSMVFA) scheme for food recognition. MSMVFA can aggregate high-level semantic features, mid-level attribute features, and deep visual features into a unified representation. These three types of features describe the food image from different granularity. Therefore, the aggregated features can capture the semantics of food images with the greatest probability. For that solution, we utilize additional ingredient knowledge to obtain mid-level attribute representation via ingredient-supervised CNNs. High-level semantic features and deep visual features are extracted from class-supervised CNNs. Considering food images do not exhibit distinctive spatial layout in many cases, MSMVFA fuses multi-scale CNN activations for each type of features to make aggregated features more discriminative and invariable to geometrical deformation. Finally, the aggregated features are more robust, comprehensive, and discriminative via two-level fusion, namely multi-scale fusion for each type of features and multi-view aggregation for different types of features. In addition, MSMVFA is general and different deep networks can be easily applied into this scheme. Extensive experiments and evaluations demonstrate that our method achieves state-of-the-art recognition performance on three popular large-scale food benchmark datasets in Top-1 recognition accuracy. Furthermore, we expect this paper will further the agenda of food recognition in the community of image processing and computer vision.

Multi-Task Deep Relative Attribute Learning for Visual Urban Perception.

Visual urban perception aims to quantify perceptual attributes (e.g., safe and depressing attributes) of physical urban environment from crowd-sourced street-view images and their pairwise comparisons. It has been receiving more and more attention in computer vision for various applications, such as perceptive attribute learning and urban scene understanding. Most existing methods adopt either (i) a regression model trained using image features and ranked scores converted from pairwise comparisons for perceptual attribute prediction or (ii) a pairwise ranking algorithm to independently learn each perceptual attribute. However, the former fails to directly exploit pairwise comparisons while the latter ignores the relationship among different attributes. To address them, we propose a Multi-Task Deep Relative Attribute Learning Network (MTDRALN) to learn all the relative attributes simultaneously via multi-task Siamese networks, where each Siamese network will predict one relative attribute. Combined with deep relative attribute learning, we utilize the structured sparsity to exploit the prior from natural attribute grouping, where all the attributes are divided into different groups based on semantic relatedness in advance. As a result, MTDRALN is capable of learning all the perceptual attributes simultaneously via multi-task learning. Besides the ranking sub-network, MTDRALN further introduces the classification sub-network, and these two types of losses from two sub-networks jointly constrain parameters of the deep network to make the network learn more discriminative visual features for relative attribute learning. In addition, our network can be trained in an end-to-end way to make deep feature learning and multi-task relative attribute learning reinforce each other. Extensive experiments on the large-scale Place Pulse 2.0 dataset validate the advantage of our proposed network. Our qualitative results along with visualization of saliency maps also show that the proposed network is able to learn effective features for perceptual attributes.