Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety.

BACKGROUND: Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion (iRARC) is increasingly being used in recent years. Whether iRARC offers advantages over open radical cystectomy (ORC) remains controversial. This study aimed to compare the difference of perioperative outcomes, oncological outcomes and complications between iRARC and ORC. METHODS: The PubMed, Embase, Cochrane Library, Web of Science and CNKI databases were searched in July 2023 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Studies were identified to be eligible if they compared perioperative outcomes, oncological outcomes and complications in patients who underwent iRARC with ORC. RESULTS: Twenty-two studies involving 7020 patients were included. Compared to ORC, iRARC was superior for estimated blood loss [estimated blood loss (EBL) weighted mean difference (WMD): -555.52; 95% CI, -681.64 to -429.39; P <0.001], blood transfusion rate [odds ratio (OR): 0.16; 95% CI, 0.09-0.28; P <0.001], length of hospital stay [length of hospital stay (LOS) WMD: -2.05; 95% CI, -2.93 to -1.17; P <0.001], Clavien-Dindo grades ≥III complication rate [30 days: OR: 0.57; 95% CI 0.44-0.75; P <0.001; 90 days: OR: 0.71; 95% CI 0.60-0.84; P <0.001], and positive surgical margin [positive surgical margin (PSM) OR: 0.65; 95% CI 0.49-0.85; P =0.002]. However, iRARC had a longer operative time [operative time (OT) WMD: 68.54; 95% CI 47.41-89.67; P <0.001] and a higher rate of ureteroenteric stricture [ureteroenteric stricture (UES) OR: 1.56; 95% CI 1.16-2.11; P =0.003]. Time to flatus, time to bowel, time to regular diet, readmission rate, Clavien-Dindo grades less than III complication rate for iRARC were similar to that for ORC. Interestingly, the results of subgroup analysis revealed no difference in EBL between iRARC and ORC when the diversion type was neobladder. When the ileal conduit was selected as the diversion type, the LOS was similar in both procedures. CONCLUSION: Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion appears to be superior to open radical cystectomy in terms of effectiveness and safety. However, attention should be paid to the occurrence of ureteroenteric stricture during follow-up.

Diagnostic and therapeutic effects of fluorescence cystoscopy and narrow-band imaging in bladder cancer: a systematic review and network meta-analysis.

BACKGROUND: This review aims to compare the efficacies of fluorescence cystoscopy, narrow-band imaging (NBI), and white light cystoscopy in the treatment and diagnosis of bladder cancer. METHODS: The authors searched PubMed, EMbase, Web of Science, and the Cochrane Library from January 1990 to April 2022. A total of 26 randomized controlled studies and 22 prospective single-arm studies were selected. Most patients had nonmuscle-invasive bladder cancer. The study protocol has been registered at PROSPERO. RESULTS: In the pairwise meta-analysis, 5-aminolevulinic acid (5-ALA) reduced the short-term and long-term recurrence rates of bladder cancer compared with white light cystoscopy (WLC); however, no statistical difference was observed in intermediate-term recurrence rates (RR=0.79, 95% CI: 0.57-1.09). Hexaminolevulinic acid and NBI reduced short-term, intermediate-term, and long-term recurrence rates. The sensitivity of 5-ALA, hexaminolevulinic acid, NBI, and WLC for bladder cancer were 0.89 (95% CI: 0.81-0.94), 0.96 (95% CI: 0.92-0.98), 0.96 (95% CI: 0.92-0.98), and 0.75 (95% CI: 0.70-0.79), respectively; however, only NBI had the same specificity as WLC (0.74 vs. 0.74). Compared with WLC, 5-ALA improved the detection rate of carcinoma in situ and Ta stage bladder cancer but had no advantage in T1 stage tumors (OR=2.39, 95% CI:0.79-7.19). Hexaminolevulinic acid and NBI improved the detection rates of all nonmuscular-invasive bladder cancers. In the network meta-analysis, there was no significant difference in either recurrence or detection rates between 5-ALA, hexaminolevulinic acid, and NBI. CONCLUSION: Fluorescence cystoscopy and NBI are advantageous for treating and diagnosing patients with nonmuscle-invasive bladder cancer.

Strongly fluorescent conjugated polymer nanoparticles in aqueous colloidal solution for universal, efficient and effective development of sebaceous and blood fingerprints.

Taking the same developing strategy for different types of latent fingerprints is helpful in improving the efficiency of criminal investigation. Here we advanced a new strategy based on amino-functionalized poly(p-phenylenevinylene) nanoparticles (PPV-brPEI NPs) in aqueous colloidal solution as the developing reagent. The desirable amino functionality and strong emission of NPs were simultaneously realized by adding branched polyethyleneimine (brPEI) during the process of thermal elimination of the PPV polymer precursor. The NPs were demonstrated to have negligible effects on the extraction of biological information from DNA. Using the PPV-brPEI NPs-soaked cotton pad, both latent sebaceous fingerprints (LSFPs) and latent blood fingerprints (LBFPs) can be effectively developed on different nonporous substrates. This strategy was highly sensitive and effective for aged, contaminated and moldy fingerprints. Additionally, the developed fingerprints could tolerate humidity environment and the alcohol atmosphere. The mechanism investigation suggests that interaction between PPV-brPEI NPs and sebum ingredients contributes to the development of LSFPs and interaction between PPV-brPEI NPs and proteins in blood contributes to the development of LBFPs, but the former is not as stable as the latter. This work provides a simple, environment/operator-friendly strategy for efficient fingerprint development, which is very promising for practical criminal investigations.

Prognostic nutritional index combined with NLR to construct a survival prediction model and decision analysis of patients with muscle-invasive bladder cancer after surgery.

OBJECTIVES: To build a nomogram prediction model, assess its predictive ability, and perform a survival decision analysis on patients with muscle-invasive bladder cancer (MIBC) to study risk factors affecting overall survival (OS). METHODS: A retrospective analysis was performed on the clinical information of 262 patients with MIBC who underwent radical cystectomy (RC) at the Urology Department of the Second Affiliated Hospital of Kunming Medical University between July 2015 and August 2021. The final model variables that were included were chosen using single-factor stepwise Cox regression, optimal subset regression, and LASSO regression + cross-validation with the minimum AIC value. The next step was to do a multivariate Cox regression analysis. The establishment of a nomogram model by fitting and the screening out of independent risk factors impacting the survival of patients with MIBC having radical resection. Receiver Activity Characteristic curves, C-index, and a calibration plot evaluated the prediction accuracy, validity, and clinical benefit of the model. The 1-, 3-, and 5-year survival rates were then computed for each risk factor using a Kaplan-Meier survival analysis. RESULTS: 262 eligible patients in total were enrolled. With a median follow-up of 32 months, the follow-up period ranged from 2 to 83 months. 171 cases (65.27%) survived while 91 cases (34.73%) perished. Age (HR = 1.06 [1.04; 1.08], p = 0.001), preoperative hydronephrosis (HR = 0.69 [0.46, 1.05], p = 0.087), T stage (HR = 2.06 [1.09, 3.93], p = 0.027), lymphovascular invasion (LVI, HR = 1.73 [1.12, 2.67], p = 0.013), prognostic nutritional index (PNI, HR = 1.70 [1.09, 2.63], p = 0.018), and neutrophil-to-lymphocyte ratio (NLR, HR = 0.52 [0.29, 0.93)], p = 0.026) were independent risk factor for the survival of bladder cancer patients. Create a nomogram based on the aforementioned findings, and then draw the 1-year, 3-year, and 5-year OS receiver operating characteristic curves by the nomogram. The AUC values were 0.811 (95% CI [0.752, 0.869]), 0.814 (95% CI [0.755, 0.873]), and 0.787 (95% CI [0.708, 0.865]), respectively, and the calibration plot matched the predicted value well. The 1-year, 3-year, and 5-year decision curve analyses were higher than the ALL line and None line at threshold values of >5%, 5%-70%, and 20%-70% indicating that the model has good clinical applicability. The calibration plot for the Bootstrap 1000-time resampled validation model was similar to the actual value. Patients with preoperative combination hydronephrosis, higher T-stage, combined LVI, low PNI, and high NLR had worse survival, according to Kaplan-Meier survival analysis for each variable. CONCLUSIONS: This study might conclude that PNI and NLR were separate risk factors that affect a patient's OS after RC for MIBC. The prognosis of bladder cancer may be predicted by PNI and NLR, but additional confirmation in randomized controlled trials is required.

Dynamic Fluorescent Anti-Counterfeiting Labels Based on Conjugated Polymers Confined in Submicron Fibrous Membranes.

Developing a new anti-counterfeiting strategy is of great significance to combating the global counterfeiting problem. Here we report the construction of a dynamic fluorescence response system for anti-counterfeiting by combining the photochromism induced by the ring-opening of spiropyran (SP) to merocyanine (MC) with the fluorescence resonance energy transfer (FRET) between the conjugated polymer and MC. After elucidating the design principle, a new conjugated polymer, PPETE-SP, consisting of a poly[p-(phenylene ethynylene)-alt-(thienylene-ethynylene)] (PPETE) backbone with pendant SP, was synthesized and characterized. With poly(methyl methacrylate) (PMMA) as the matrix, the PPETE-SP/PMMA fibrous membrane was prepared via electrospinning. Under the irradiation of UV light, the fluorescent color of the membrane dynamically changed from green to light green, then light pink, and finally pink, and this process was reversible under visible light. The fluorescence emission switch was examined for 10 cycles and proved to have good repeatability, indicating that the membrane can be directly used as an anti-counterfeiting label for multiple verifications. The FRET efficiency was found to be about 61% based on the FRET study with confocal laser scanning microscopy. The covalent bonding between PPETE backbone and SP, the confinement of PPETE-SP chains in the fibrous membrane, as well as employing PMMA as the matrix were demonstrated to be crucial in realizing the photochromism and the FRET. Different anti-counterfeiting modes were proposed, providing rich selections for operation of verification. Such facile-to-operate and hard-to-imitate dynamic fluorescent responsive materials are very promising for use in practical anti-counterfeiting applications.

Comparative Efficacy of Different Drugs for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia: A Bayesian Network Meta-Analysis.

Background: Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) are common in middle-aged and elderly men. The current drugs for treating this disease include α1-adrenoceptor antagonists (ABs), muscarinic receptor antagonists (MRAs), phosphodiesterase five inhibitors (PDE5-Is), and ß3-adrenoceptor agonists (B3As). However, direct comparative studies analyzing different therapies are limited; therefore, we conducted a network meta-analysis (NMA) to evaluate the efficacy of different drug regimens for treating BPH/LUTS. Methods: The PubMed, EMbase, Web of Science, and Cochrane Library databases were searched to collect randomized controlled trials (RCTs) of different drug treatments for BPH/LUTS from January 2000 to April 2021. The NMA was performed using R 4.1 software. Results: Fifty-five RCTs were included among a total of 1639 trials. ① ABs + PDE5-Is, ABs + B3As, ABs + MRAs, ABs, and PDE5-IS were superior to the placebo in improving the total International Prostate Symptom Score (IPSS), IPSS-Voiding, and IPSS-storage. ② For increasing the maximum flow rate (Qmax), ABs + PDE5-Is, ABs + MRAs, and ABs were more effective than the placebo. ③ Regarding reducing post-void residual urine (PVR), none of the six treatment plans had significant effects. Conclusion: Combination therapy showed greater efficacy than monotherapy, and ABs + PDE5-Is was the most successful treatment for improving the overall IPSS score. ABs are a primary therapeutic measure to increase Qmax, and ABs + PDE5-I may be a more suitable choice for enhancing Qmax. The combination of MRA and AB+ MRA may lead to an increase in PVR. Systematic Review Registration: [website], identifier [registration number].

Comparison of Radiofrequency Ablation Versus Cryoablation For T1 Renal Tumors: An Evidence-Based Analysis of Comparative Outcomes.

Objective: To discuss the differences in the effectiveness and security for T1 renal tumors by radiofrequency ablation (RFA) and cryoablation (CA). Methods: We systematically searched the Cochrane Library, PubMed, Embase, CNKI databases, and Science databases, and the date was from the above database establishment to August 2021. Controlled trials on RFA and CA for T1 renal tumors were included. The meta-analysis was conducted with the Review Manager 5.4 software. Results: A total of ten studies with 2,367 patients were included in the analysis. There were no significant differences in complications (odds ratio [OR], 1.23; 95% CI, 0.80 to 1.90; p=0.35), primary technique efficacy rate (OR, 1.01; 95% CI, 0.33 to 3.14; p=0.98), changes in serum creatinine (weighted mean difference [WMD], 0.53; 95% CI, -0.50 to 1.57; p=0.31), or 5-year survival rate (hazard ratio [HR], 1.11; 95% CI, 0.41 to 3.00; p=0.84) among patients undergoing RFA and CA. However, compared with patients who underwent RFA, patients who underwent CA had a lower Local recurrence (OR: 2.25; 95% CI: 1.38 to 3.67; p = 0.001). Conclusion: The analysis demonstrated that in the treatment of T1 renal tumors, CA may be associated with lower local recurrence rates. However, no differences were observed in terms of primary technique efficacy rate, 5-year survival rate, changes in serum creatinine, and complication rate between groups. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier PROSPERO (CRD42021295160).

Small-cell carcinoma of the prostate with negative CD56, NSE, Syn, and CgA indicators: A case report.

BACKGROUND: Small-cell carcinoma of the prostate (SCCP) is a clinically rare malignant tumor, accounting for < 1% of all prostate tumors. However, negativity for all SCCP neuroendocrine markers is rare. Herein, we report a case of SCCP with completely negative neuroendocrine markers and explore its clinicopathologic features, thus improving the understanding of its clinical diagnosis and management. CASE SUMMARY: We report the case of a 48-year-old patient with SCCP negative for common sensitive neuroendocrine-staining indicators. Dysuria was the first symptom, and rectal examination revealed a hard prostate, palpable nodules, diffuse prostate enlargement, no pressure pain, no blood staining in the finger sleeve, 1.33 ng/mL total prostate-specific antigen level, and a free-to-total prostate-specific antigen ratio of 0.21 ng/mL. Ultrasound suggested a prostate size of 5.3 cm × 5.8 cm × 5.6 cm, and magnetic resonance imaging suggested prostate cancer. The lower posterior bladder wall, rectal mesentery, and bilateral seminal vesicles were invaded, with multiple lymph node metastases in the pelvis. A whole-body bone scan suggested an abnormally active multiple bone metabolism and possible bone metastases. Head and lungs computed tomography revealed no significant nodal shadow. Following a pathological diagnosis of SCCP after a prostate puncture, with negative indicators of common sensitive neuroendocrine staining, chemotherapy was administered; the patient died 4-5 mo after SCCP diagnosis. CONCLUSION: SCCP is a rare disease characterized by atypical clinical symptoms, limited treatment options, a short survival period, and a poor prognosis.

Primary adrenal diffuse large B-cell lymphoma with normal adrenal cortex function: A case report.

BACKGROUND: Diffuse large B-cell lymphoma, which accounts for about approximately 30% to 40% of non-Hodgkin's lymphomas, is the most common type and is a class of aggressive B-cell lymphomas. However, diffuse large B-cell lymphomas primary to the adrenal gland are rare. CASE SUMMARY: A 73-year-old man was admitted with abdominal pain and fatigue. After admission, enhanced adrenal computed tomography indicated irregular masses on both adrenal glands, with the larger one on the left side, approximately 8.0 cm × 4.3 cm in size. The boundary was irregular, and surrounding tissues were compressed. No obvious enhancement was observed in the arterial phase. Resection of the left adrenal gland was performed. Pathological diagnosis revealed diffuse large B-cell lymphoma. After surgery, the patient received R-CHOP immunochemotherapy. During the fourth immunochemotherapy, patient condition deteriorated, and he eventually died of respiratory failure. CONCLUSION: R-CHOP is the conventional immunochemotherapy for primary adrenal diffuse large B-cell lymphoma. Surgery is mainly used to diagnose the disease. Hence, the ideal treatment plan remains to be confirmed.

Fluorescent Cationic Conjugated Polymer-Based Adaptive Developing Strategy for Both Sebaceous and Blood Fingerprints.

Both latent sebaceous and blood fingerprints may provide valuable information for forensic investigation. To detect both types of fingerprints with no need to predistinguish them, a new adaptive developing strategy was proposed. A cationic conjugated polymer with poly[p-(phenylene ethylene)-alt-(thienylene ethynylene)] backbone (PPETE-NMe3+) was synthesized, which was dissolved in N,N-dimethylformamide (DMF) to form the developing solution. Fingerprints were developed by a simple dropping and incubating process without any pre-/post-treatments. Fluorescent photographs of the developed fingerprints on various substrates demonstrated that this developing strategy was effective for both types of fingerprints on nonporous substrates. Gray value analysis further confirmed the enhancement of the legibility of the fingerprint images. The preliminary mechanism exploration suggested that certain weak interactions, such as hydrophobic interaction and electrostatic interaction, may synergistically contribute to the interaction between the polymer and fingerprint components. The molecular design of the polymer combined with an appropriate solvent endowed the developing system the adaptiveness toward different types of fingerprints. This adaptive developing strategy made the fingerprint-developing process more efficient and may be further extended to more practical application scenes.

Fluorescence development of fingerprints by combining conjugated polymer nanoparticles with cyanoacrylate fuming.

Selecting appropriate developing methods/reagents or their combination to enhance the effect for fingerprint development is of great significance for practical forensic investigation. Ethyl-2-cyanoacrylate ester (superglue) fuming is a popular method for "in-situ" developing fingerprints in forensic science, followed by fluorescence staining to enhance the contrast of the fingerprint image in some occasion. In this study, a series of fluorescent poly(p-phenylene vinylene) (PPV) nanoparticles (NPs) in colloidal solution were successfully prepared and the emission color was tuned via a simple way. The fuming process was carried out using a home-made device. The staining was accomplished by immersing a piece of absorbent cotton into the solution of NPs, and then gently applied on the fumed fingerprints for several times. The PPV NPs were found to have a better developing effect than Rhodamine 6G when excited by 365 nm UV lamp. Different emission colors of NPs are advantageous in developing fingerprints on various substrates. Mechanism study suggested that the NPs were embedded in the porous structure of the superglue resin. In all, the combination of fuming method with the staining by conjugated polymer NPs has been demonstrated to be successful for fluorescent fingerprint development and be promising for more practical forensic applications.