Is the Supine Position Suitable for Ultrasound-Guided Percutaneous Nephrolithotomy in Patients with Complex Renal Stones?

INTRODUCTION: The aim of the study was to assess the safety and efficacy of ultrasound (US)-guided percutaneous nephrolithotomy (PCNL) for complex renal stones when performed in a modified supine position. METHODS: We retrospectively reviewed the charts of patients who underwent PCNL for complex renal stones at our institution between August 2018 and December 2021. During this time, 188 consecutive patients underwent US-guided PCNL in the prone position (P group, n = 129) or in the flank-free modified supine position (S group, n = 59). Patient demographics and intraoperative and postoperative data were analyzed. RESULTS: Successful renal access was achieved in all patients. The baseline demographics were comparable between the two groups. The numbers of renal access were significantly higher (2.1 ± 0.4 vs. 1.2 ± 0.2, p = 0.002), and the operation time was comparable (79.1 ± 14.6 min vs. 96.2 ± 19.6 min, p = 0.06) between the two groups. The postoperative hospital stay was also shorter in the P group (6.2 ± 1.5 d vs. 10.2 ± 1.7 d, p = 0.008). The postoperative hemoglobin loss was similar between the P and S groups (1.7 ± 0.4 g/dL vs. 1.8 ± 0.3 g/dL, p = 0.12). The stone-free rate was significantly lower in the S group (57.5% vs. 82.7%, p < 0.001). There were no embolization or septic complications. Twelve patients (20.3%) in the S group underwent simultaneous or staged retrograde flexible ureteroscopy to remove residual stones. CONCLUSION: US-guided PCNL in the modified supine position was a safe treatment for complex renal stones. However, the single-session stone clearance rate was not ideal. The supine flank-free position may be unsuitable for US-guided PCNL in patients with complex renal stones according to our preliminary findings.

Practical quantum access network over a 10 Gbit/s Ethernet passive optical network.

Quantum key distribution (QKD) provides an information-theoretically secure method to share keys between legitimate users. To achieve large-scale deployment of QKD, it should be easily scalable and cost-effective. The infrastructure construction of quantum access network (QAN) expands network capacity and the integration between QKD and classical optical communications reduces the cost of channel. Here, we present a practical downstream QAN over a 10 Gbit/s Ethernet passive optical network (10G-EPON), which can support up to 64 users. In the full coexistence scheme using the single feeder fiber structure, the co-propagation of QAN and 10G-EPON signals with 9 dB attenuation is achieved over 21 km fiber, and the secure key rate for each of 16 users reaches 1.5 kbps. In the partial coexistence scheme using the dual feeder fiber structure, the combination of QAN and full-power 10G-EPON signals is achieved over 11 km with a network capacity of 64-user. The practical QAN over the 10G-EPON in our work implements an important step towards the achievement of large-scale QKD infrastructure.

Long-distance transmission of quantum key distribution coexisting with classical optical communication over a weakly-coupled few-mode fiber.

Quantum key distribution (QKD) is one of the most practical applications in quantum information processing, which can generate information-theoretical secure keys between remote parties. With the help of the wavelength-division multiplexing technique, QKD has been integrated with the classical optical communication networks. The wavelength-division multiplexing can be further improved by the mode-wavelength dual multiplexing technique with few-mode fiber (FMF), which has additional modal isolation and large effective core area of mode, and particularly is practical in fabrication and splicing technology compared with the multi-core fiber. Here, we present for the first time a QKD implementation coexisting with classical optical communication over weakly-coupled FMF using all-fiber mode-selective couplers. The co-propagation of QKD with one 100 Gbps classical data channel at -2.60 dBm launched power is achieved over 86 km FMF with 1.3 kbps real-time secure key generation. Compared with single-mode fiber using wavelength-division multiplexing, given the same fiber-input power, the Raman noise in FMF using the mode-wavelength dual multiplexing is reduced by 86% in average. Our work implements an important approach to the integration between QKD and classical optical communication and previews the compatibility of quantum communications with the next-generation mode division multiplexing networks.

Integrating quantum key distribution with classical communications in backbone fiber network.

Quantum key distribution (QKD) provides information-theoretic security based on the laws of quantum mechanics. The desire to reduce costs and increase robustness in real-world applications has motivated the study of coexistence between QKD and intense classical data traffic in a single fiber. Previous works on coexistence in metropolitan areas have used wavelength-division multiplexing, however, coexistence in backbone fiber networks remains a great experimental challenge, as Tbps data of up to 20 dBm optical power is transferred, and much more noise is generated for QKD. Here we present for the first time, to the best of our knowledge, the integration of QKD with a commercial backbone network of 3.6 Tbps classical data at 21 dBm launch power over 66 km fiber. With 20 GHz pass-band filtering and large effective core area fibers, real-time secure key rates can reach 4.5 kbps and 5.1 kbps for co-propagation and counter-propagation at the maximum launch power, respectively. This demonstrates feasibility and represents an important step towards building a quantum network that coexists with the current backbone fiber infrastructure of classical communications.

Designing 3D interconnected continuous nanoporous Co/CoO core-shell nanostructure electrodes for a high-performance pseudocapacitor.

A high-performance supercapacitor electrode is designed and fabricated with the 3D interconnected continuous nanoporous Co/CoO core-shell hybrid nanostructure grown on nickel foam. The Co/CoO core-shell hybrid nanostructures are obtained via a hydrothermal method, followed by high-temperature annealing in hydrogen atmosphere, and finally placed in air at 50 °C for 1 h. The Co/CoO core-shell nanostructure assembled by a conductive metal-core and a CoO shell, brings low resistance, high specific capacitance of 5.632 F cm-2 and good capability stability (81.5% capacitance retention after 6000 cycles). An asymmetric supercapacitor device built by the Co/CoO (positive electrode) and activated carbon (negative electrode) can deliver a working voltage of 1.7 V and display a high energy density of 0.002 67 Wh cm-2 at a power density of 0.001 62 W cm-2, which is far superior to that of a supercapacitor at a similar power density.

Percutaneous Nephrolithotomy Under X-Ray-Free Technique in Upper Urinary Stone Patients with Autosomal Dominant Polycystic Kidney Disease: Experience from a Large-Volume Stone Management Center.

Objectives: To present our large single-center experience in the management of autosomal dominant polycystic kidney disease (ADPKD) with total ultrasound (US)-guided percutaneous nephrolithotomy (PNL) and to evaluate the role of PNL under US in these patients. Patients and Methods: We retrospectively reviewed the charts of patients with ADPKD who underwent PNL from August 2011 to December 2019. A total of 56 patients were included in this study; all procedures were completed by the total US-guided technique. Demographic characteristics, operative parameters, and postoperative data were collected and analyzed. Results: Effective renal access was achieved in all patients. The mean stone size was 3.1 cm (range 1.7-6.5 cm). The initial stone-free rate was 70.6% (36/51); five patients underwent second-look PNL to remove residual stones. The other patients underwent oral medication therapy. No severe intraoperative complications occurred; one patient received selective embolization for bleeding on the contralateral side and one patient needed percutaneous drainage for perinephric abscess. Clavien I or II complications were seen in nine patients. Renal function was improved or stable in most patients; the condition of only one patient deteriorated after surgery. Conclusion: Total US-guided PNL is a safe and efficient treatment for kidney stones in patients with ADPKD; perioperative renal function was not adversely affected and complications were acceptable compared with patients in the general population.

Development of ipsilateral chest wall spindle cell carcinoma in a patient with invasive ductal breast carcinoma during postoperative adjuvant therapy: A case report.

RATIONALE: Metaplastic breast carcinoma (MBC) is rare subtype of breast carcinoma and is regarded as ductal carcinoma that undergoes metaplasia into a glandular growth pattern. Spindle cell carcinoma (SPC) is a subtype of MBC with a predominant spindle cell component. PATIENT CONCERNS: The patient was a 52-year-old female with invasive ductal breast carcinoma who underwent a modified radical mastectomy and an axillary node dissection. A new lump was observed underneath the surgical site between the pectoralis major and pectoralis minor muscles 45 days after the patient underwent sequential postoperative chemotherapy and radiotherapy. DIAGNOSES: It was speculated that the new lesion had developed during postoperative adjuvant therapy. And the new lesion was regarded as a recurrence. INTERVENTIONS: We performed a wide dissection of the tumor with negative margins. The pathology of the tumor indicated SPC. Then, the patient received chemotherapy and demonstrated a poor response. OUTCOMES: Local recurrence and pulmonary metastasis developed shortly afterwards, and the patient succumbed to the disease within 5 months. LESSONS: Local recurrence with metaplastic SPC transformed from invasive ductal breast carcinoma during postoperative chemotherapy and radiotherapy is rare. The failure of subsequent chemotherapy and the progression of disease indicate the aggressive nature of SPC and its decreased sensitivity to chemotherapy and radiotherapy. Further studies must be performed to improve the prognosis of these patients.

Upregulating MMP-1 in carcinoma-associated fibroblasts reduces the efficacy of Taxotere on breast cancer synergized by Collagen IV.

Chemotherapy is an important comprehensive treatment for breast cancer, which targets micro-environment of tumors as well as their characterisitcs. A previous microarray analysis revealed that matrix metalloproteinase (MMP)-1 was highly upregulated in carcinoma-associated fibroblasts (CAFs) prior to and following treatment with Taxotere under co-culture conditions. However, whether the chemotherapeutic effects of Taxotere were influenced by the changes in MMP-1 remained unclear. The purpose of the present study was to investigate the impact and mechanism of CAFs in regulating the efficacy of Taxotere on breast cancer cells. CAFs isolated from primary invasive ductal human breast tumors following surgical resection, were used in co-culture with MDA-MB-231 cells to simulate the tumor micro-environment. Following the addition of Taxotere, changes in MMP-1 gene and protein expression were assessed by reverse transcription-quantitative polymerase chain reaction and western blot analysis, respectively. Proliferation, invasion and apoptosis assays revealed that when MMP-1 was upregulated in CAFs, the therapeutic efficacy of Taxotere was reduced in breast cancer cells. Chemosensitivity was significantly increased when MMP-1 expression was inhibited by GM6001. In addition, Collagen IV was upregulated in CAFs following chemotherapy and protected breast cancer cells against chemotherapeutic side effects. Collagen IV expression significantly decreased, as well as MMP-1 expression when GM6001 was added. Proliferation and invasion assays demonstrated that the exogenous addition of Collagen IV weakend the chemotherapeutic effect of Taxotere on breast tumor cells. Overall, the results revealed that in CAFs, MMP-1 synergized with Collagen IV as a key gene in regulating the chemotherapeutic effect of Taxotere on breast tumor cells and served an important role in reducing the efficacy of Taxotere on breast cancer, potentially via the transforming growth factor-ß signaling pathway. These fidings provide a theoretical basis for the mechanism of CAFs in reducing the chemotherapeutic effect of Taxotere on breast cancer cells and a novel approach for enhancing the chemosensitivity of tumors.

Breast fibroblasts in both cancer and normal tissues induce phenotypic transformation of breast cancer stem cells: a preliminary study.

BACKGROUND: Breast cancer stem cells (BCSCs) are associated with the invasion of breast cancer. In recent years, studies have demonstrated different phenotypes among BCSCs. Furthermore, BCSCs of diverse phenotypes are present at different tumour sites and different histological stages. Fibroblasts are involved in the phenotypic transformation of BCSCs. Cancer-associated fibroblasts (CAFs) participate in the induction of epithelial-mesenchymal transition, thereby promoting the acquisition of stem cell characteristics, but little is known about the role of normal fibroblasts (NFs) in the phenotypic transformation of BCSCs or about the effect of CAFs and NFs on BCSC phenotypes. METHODS: A total of six pairs of primary CAFs and NFs were isolated from surgical samples of breast cancer patients and subjected to morphological, immunohistochemical, cell invasion and proteomics analyses. After establishing a cell culture system with conditioned medium from CAFs and NFs, we used the mammosphere formation assay to explore the effect of CAFs and NFs on the self-renewal ability of BCSCs. The effect of CAFs and NFs on the phenotypic differentiation of BCSCs was further analysed by flow cytometry and immunofluorescence. RESULTS: The isolated CAFs and NFs did not show significant differences in cell morphology or alpha-smooth muscle actin (α-SMA) expression, but cell invasion and proteomics analyses demonstrated heterogeneity among these fibroblasts. Both CAFs and NFs could promote the generation of BCSCs, but CAFs displayed a greater ability than NFs in promoting mammosphere formation. Conditioned medium from CAFs increased the proportion of aldehyde dehydrogenase-1 positive (ALDH1+) BCSCs, but conditioned medium from NFs was more likely to promote the generation of CD44+CD24- BCSCs from MCF-7 cells. DISCUSSION: This study validated the heterogeneity among CAFs and NFs and expanded on the conclusion that fibroblasts promote the generation of cancer stem cells. Our results particularly emphasized the effect of NFs on the phenotypic transformation of BCSCs. In addition, this study further highlighted the roles of CAFs and NFs in the induction of different phenotypes in BCSCs.

Asymmetric Supercapacitor Based on Porous N-doped Carbon Derived from Pomelo Peel and NiO Arrays.

A three dimensional (3D) porous framework-like N-doped carbon (PFNC) with a high specific surface area was successfully fabricated through ammonia doping and graphitization based on pomelo peel. The obtained PFNC exhibits an enhanced specific capacitance (260 F g(-1) at 1 A g(-1)) and superior cycling performance (capacitance retention of 84.2% after 10000 cycles at 10 A g(-1)) on account of numerous voids and pores which supply sufficient pathways for ion diffusion during cycling. Furthermore, a fabricated asymmetric PFNC//PFN device based on PFNC and porous flake-like NiO (PFN) arrays achieves a specific capacitance of 88.8 F g(-1) at 0.4 A g(-1) and an energy density of 27.75 Wh kg(-1) at a power density of 300 W kg(-1) and still retains 44 F g(-1) at 10 A g(-1) and 13.75 Wh kg(-1) at power density of 7500 W kg(-1). It is important that the device is able to supply two light-emitting diodes for 25 min, which demonstrates great application potential.

Novel topotactically transformed carbon-CoO-NiO-NiCo2O4 nanosheet hybrid hetero-structured arrays as ultrahigh performance supercapacitors.

A novel carbon-CoO-NiO-NiCo2O4 integrated electrode has been designed by reducing the hetero-structured NiCo2O4 nanosheet array with C2H2 on the nickel foam at a low temperature of 350 °C. The topotactical transformation from NiCo2O4 to the integrated electrode has been first conceived and investigated. Such unique nanoarchitectures exhibit excellent electrochemical performance with ultrahigh capacitance and desirable cycle life at high rates.