Efficacy and safety of low-intensity pulsed ultrasound (LIPUS) combined with tadalafil in the treatment of severe erectile dysfunction: a retrospective cohort study.

Background: Low-intensity pulsed ultrasound (LIPUS) is an effective and safe treatment for mild to moderate erectile dysfunction (ED). This study aimed to investigate the efficacy and safety of combining LIPUS with tadalafil in treating severe ED. Methods: The data from 27 patients treated with LIPUS alone (group A) and 21 patients treated with a combination of LIPUS and daily 10 mg tadalafil (group B) were retrospectively analyzed. The LIPUS regimen consisted of twice-weekly treatments for 4 consecutive weeks. The treatment was considered effective if the change in International Index of Erectile Function-Erectile Function Domain (IIEF-EF) score after treatment was greater than or equal to the minimal clinically important difference (MCID) (the MCID for severe ED is 7 points). The effectiveness, IIEF-EF score, erectile hardness score (EHS), peak systolic velocity (PSV), end diastolic velocity (EDV), and adverse events were evaluated before treatment, 4 weeks after treatment, and 12 weeks after treatment. Results: Compared to pre-treatment, both groups showed significant improvement in IIEF-EF score and EHS at 4 and 12 weeks after treatment (P<0.001), with no statistically significant difference between the two time points (P>0.05). The effective rate did not significantly differ between group A (9/27, 33.3%) and group B (10/21, 47.62%) at 4 weeks or between group A (9/27, 33.3%) and group B (12/21, 57.14%) at 12 weeks after treatment (P=0.32, P=0.10). However, in patients without comorbidities, the effective rate of group B (12/18, 66.67%) was higher than that of group A (9/25, 36.00%) at 12 weeks after treatment (P=0.047). After LIPUS treatment, the PSV level significantly increased and the EDV level significantly decreased compared with before treatment (P<0.05). No adverse events were reported. Conclusions: The study suggests that LIPUS has a therapeutic effect on severe ED patients, especially those without comorbidities. It may have a synergistic or overlapping effect with phosphodiesterase type 5 inhibitors (PDE5Is) on severe ED patients without comorbidities.

Association between adverse childhood experiences and obesity, and sex differences: A systematic review and meta-analysis.

BACKGROUND: Obesity is one of the most common health problems worldwide. Although studies have reported associations between adverse childhood experiences (ACEs) and obesity, specific subtype associations and sex differences are unclear. OBJECTIVE: To systematically evaluate the association between ACEs and adult obesity risk and sex differences. METHODS: Five databases, PubMed, Web of Science, Cochrane Library, Embase, and PsycINFO, were searched with a June 10, 2024 deadline. Included studies investigated the association between at least one ACE and obesity. Two researchers independently assessed the risk of bias using the Newcastle-Ottawa Scale (NOS) and its adaptations and extracted relevant characteristics and outcomes. Statistical analyses were performed using STATA 17.0, including random effects models, heterogeneity tests, sensitivity analyses, publication bias assessments, Meta-regression analyses, and subgroup analyses. Dose-response analyses revealed potential trends between different levels of abuse and risk of obesity. RESULTS: The meta-analysis included 46 studies and showed a notable increased risk of obesity in adults experiencing ACEs (OR: 1.48, 95% CI: 1.38-1.59). Subgroup analyses showed significantly increased risk in Europe and North America, with significant increases observed in both developed and developing countries. Prospective, retrospective, and cross-sectional studies showed strong associations. Different types of ACEs (physical, sexual, psychological, and non-physical, psychological, or sexual abuse) were linked to a higher obesity risk. Sex difference analyses showed that females faced a greater risk when experiencing physical (OR: 1.606), sexual (OR: 1.581), and non-physical, psychological, or sexual (OR: 1.319) abuse; males exhibited increased risk only with non-physical, psychological, or sexual abuse (OR: 1.240). Dose-response analyses indicated that a higher number of ACEs was associated with an increased risk of obesity in adults. CONCLUSIONS: ACEs significantly increase the risk of adult obesity, with consistent findings across geographic regions, levels of economic development, and types of study design. Sex difference analysis indicates that females are particularly affected. Future research should prioritize including studies from underrepresented geographic areas to enhance understanding of the global impact of ACEs on obesity risk. Additionally, strengthening child protection and intervention efforts is crucial to mitigate the adverse effects of ACEs on adult health.

The association between novel negative pressure ureteroscopic lithotripsy combined with flexible ureteroscopy versus percutaneous nephrolithotomy on stone-free rates: implications for clinical practice and policy.

The correlation between novel negative pressure ureteroscopic lithotripsy (NP-URL) combined with flexible ureteroscopy (FU) and percutaneous nephrolithotomy (PCNL) on stone-free rates (SFR) remains unclear. There is a lack of evidence from Chinese populations regarding the relationship between SFR and NP-URL combined with FU (NP-URL-FU) versus PCNL. We aimed to assess the association between NP-URL-FU and PCNL on SFR. We conducted a cohort study involving 166 participants with 2-4 cm kidney stones. Data on SFR (7 days and 2 months) were collected from all participants. Logistic regression analysis was used to substantiate the research objectives. NP-URL-FU versus PCNL showed an 86% decrease in the 7-day SFR (OR = 0.14, 95% CI 0.07-0.29). The results remained stable even after adjusting for potential confounders. However, no statistically significant association was found between the surgical method and the 2-month SFR. Further exploratory subgroup analyses showed no significant interactions, with all P values > 0.05. Among patients with 2-4 cm kidney stones, NP-URL-FU was associated with a lower risk of incident 7-day SFR than PCNL. However, no statistically significant difference was found in the long-term stone removal rate. Therefore, NP-URL-FU may be a viable alternative surgical option for patients seeking minimally invasive procedures.

Study on the expression and prognostic relationship of MYL6B in liver cancer based on bioinformatics.

BACKGROUND: Primary liver cancer is a prevalent and deadly cancer type. Despite treatment advances, prognosis remains poor, with high recurrence rates. Early detection is crucial but challenging due to the disease's insidious nature. Myosin proteins play significant roles in cancer development, influencing cell migration, invasion, and tumor suppression. MYL6B, a myosin light chain, is involved in various cellular processes and has been associated with poor prognosis in colorectal adenocarcinoma and potential as a biomarker in breast cancer. AIM: To investigate the expression of MYL6B in liver hepatocellular carcinoma (LIHC) and its impact on prognosis and potential mechanisms of action using bioinformatics methods. METHODS: The expression of MYL6B in pan-cancer and normal tissues was analyzed using the gene expression profiling interactive analysis 2 and tumor immune estimation resource databases. The expression level of MYL6B in LIHC tissues and its relationship with prognosis were analyzed, immunohistochemical analysis of MYL6B and its effect on immune cell infiltration, and the protein network were further studied. RESULTS: MYL6B was highly expressed in diffuse large b-cell lymphoma, LIHC, pancreatic adenocarcinoma, skin cutaneous melanoma, thymoma, uterine corpus endometrial carcinoma, uterine carcinosarcoma, and lowly expressed in kidney chromophobe, acute myeloid leukemia, testicular germ cell tumors. The expression level of MYL6B was significantly different between cancer and normal tissues. It had a significant impact on both overall survival and disease-free survival. MYL6B is highly expressed in hepatocellular carcinoma and its expression level increases with cancer progression. High MYL6B expression is associated with poor prognosis in terms of overall survival and recurrence-free survival. The immunohistochemical level of MYL6B is high in hepatocellular carcinoma tissues, and MYL6B has a high level of immune infiltration inflammation. In protein network analysis, MYL6B is correlated with MYL2, MYL6, MYL9, MYLK4, MYLK2, MYL12A, MYL12B, MYH11, MYH9 and MYH10. CONCLUSION: The expression level of MYL6B in LIHC was significantly higher than in normal liver tissues, and it was correlated with the degree of differentiation survival rate, and immune infiltration. MYL6B is a potential target for LIHC treatment.

A Mendelian randomization study of the association between serum uric acid and osteoporosis risk.

Background: The relationship between serum uric acid (SUA) and osteoporosis (OP) has yielded conflicting results in observational studies. This Mendelian randomization (MR) study aims to elucidate the causal association between SUA and OP. Methods: A two-sample MR analysis was conducted using summary-level data from genome-wide association studies (GWAS). Two sets of polygenic instruments strongly associated (p < 5 × 10-8) with SUA were extracted from the CKDGen consortium and UK biobank. Polygenic instruments associated with OP (p < 5 × 10-8) were derived from FinnGen biobank and UK biobank. Inverse variance weighting (IVW) was employed as the primary analysis method. Additionally, we utilized MR-Egger, weighted median, the simple mode method, and the weighted mode as complementary analyses. Cochran's Q statistics were used to assess heterogeneity, with MR-Egger intercept testing and MR pleiotropy residual sum and outlier (MR-PRESSO) to examine horizontal pleiotropy. Sensitivity analysis was performed using the leave-one-out method. Results: The IVW analysis conducted across four groups confirms no significant causal relationship between SUA concentration and OP: UKB-UKB (OR: 1.001, 95% CI: 0.999-1.003, p=0.464), CKD-UKB (OR: 1.001, 95% CI: 0.999-1.003, p=0.349), UKB-Fin (OR: 0.934, 95% CI: 0.747-1.168, p=0.549), CKD-Fin (OR: 1.041, 95%CI: 0.934-1.161, p=0.470). Furthermore, additional four MR analyses corroborated these findings. Upon excluding all outliers identified by the MR-PRESSO test, no significant directional pleiotropy was observed, except for some data heterogeneity noted in the UKB-UKB group (Q=50.65, P=0.002). Additionally, a leave-one-out analysis indicated that no single SNP exerted undue influence on the results. Conclusion: This MR analysis provides convincing genetic evidence that there is no causal association between SUA and OP, SUA is unlikely to increase or reduce the risk of OP.

The prevalence of alexithymia in schizophrenia: A systematic review and meta-analysis.

OBJECTIVES: This study aims to systematically evaluate the prevalence of alexithymia in patients with schizophrenia. METHODS: Computer searches were conducted in PubMed, PsycInfo, Web of Science, The Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, and China Biology Medicine (CBM) electronic databases to collect studies that utilized the TAS-20 scale as a measurement tool with clearly defined diagnostic criteria to determine the prevalence of alexithymia in patients with schizophrenia, from the inception of the databases to December 29, 2023. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies, followed by meta-analysis using Stata 16.0 software. RESULTS: A total of 17 studies with 5628 participants were included. The results of the meta-analysis showed that the prevalence of alexithymia in patients with schizophrenia was 35 % (95 % CI: 32-38 %). Subgroup analysis indicated that male gender, smoking, Asian ethnicity, case-control design and divorce were associated with higher rates of alexithymia (all P<0.05). CONCLUSION: The prevalence of alexithymia in patients with schizophrenia is relatively high (35 %). However, due to limitations in the quality and quantity of included studies, further high-quality literature is needed to confirm the above conclusion.

Viscoelastic modeling based force control framework for enhancing operation safety of soft tissue for orthopedic surgical robots.

In robot-assisted laminectomy, precise control of touch force on the spinal cord during the dissection of ossified ligaments is critical to prevent dura mater tearing and ensure surgical safety. However, the complex viscoelastic characteristics of tissue at the lesion site pose a significant challenge for accurately applying touch force. This paper proposes a safe touch force servo framework based on tissue model identification and preoperative optimization of the force controller. First, a soft tissue model is established using elastic and viscoelastic elements, and the transfer function from tissue deformation to touch force is derived. Subsequently, the path and parameters of a safe pre-touch are designed, and force information required for tissue model identification is obtained through the pre-touch experiment. The model order and specific parameter values are then identified using a differential evolution algorithm. Next, force control simulation is conducted based on the identified model, and a specifically designed loss function is introduced to achieve preoperative tuning of the force controller. Finally, step force control experiments on sheep spines validate the effectiveness of the proposed method. This paper provides a safe and available touch motion control framework that can be expandable to impose precise force on various vulnerable soft tissues, with the potential for widespread application.

Economic evaluations of robot-assisted radical prostatectomy and the factors affecting its cost-effectiveness: a systematic review.

This systematic review aims to summarize the progress made in the study of the cost-effectiveness of robot-assisted radical prostatectomy (RARP) worldwide and to analyze the economic factors influencing this, in an attempt to provide methodological guidance for conducting economic evaluation studies in a domestic context, and to put forward suggestions for improving the cost-effectiveness of RARP in emerging markets. We conducted a systematic literature review and analysis of studies published worldwide from January 2000 to July 2024 concerning the economic evaluation of RARP compared with laparoscopic radical prostatectomy (LRP) or open radical prostatectomy (ORP). A total of 16 papers were included. The literature was generally of good quality. Methodological approaches. varied among studies, leading to inconsistent economic findings. The choice of research settings, including the perspective of the study and time horizon, as well as differences in parameters such as surgical volumes and cost of equipment purchases, were the main factors that affected the cost-effectiveness of RARP. Based on the methodology used in the included studies, we suggest that short-term, localized economic evaluations should be carried out first, based on follow-up studies in emerging markets, whereas long-term economic evaluations can be performed when sufficient data are available. Referring to the analysis of the economic factors influencing cost-effectiveness in the included studies, we suggest that different research settings should be chosen according to the purpose for which policymakers allocate public funds, and that the cost-effectiveness of RARP can be enhanced through technical improvements and resource optimization.

N-type and P-type series integrated hydrogel thermoelectric cells for low-grade heat harvesting.

Low-grade heat is abundant and ubiquitous, but it is generally discarded due to the lack of cost-effective recovery technologies. Ion thermoelectric cells are an affordable and straightforward approach of converting low-grade heat into usable electricity for sustainable power. Despite their potential, ion thermoelectric cells face challenges such as limited Seebeck coefficient and required series integration. Here, we demonstrate that the N-type and P-type conversion of ion thermoelectric cells can be achieved through the phase transition of temperature-sensitive hydrogel containing the triiodide/iodide redox couple. Through the strong interaction between the hydrophobic region of the hydrogel and triiodide, the hydrophobic side selectively captures triiodide and the hydrophilic side repels triiodide, raising the concentration difference of triiodide and thereby increasing the Seebeck coefficient. Specifically, the Seebeck coefficient of the N-type ion thermoelectric cells is 7.7 mV K-1, and the Seebeck coefficient of P-type ion thermoelectric cells is -6.3 mV K-1 (ΔT = 15 K). By connecting 10 pairs of the N-type and P-type ion thermoelectric cells, we achieve a voltage of 1.8 V and an output power of 85 µW, surpassing the reported triiodide/iodide-based ion thermoelectric cells. Our work proposes a phase transition strategy for the N-P conversion of ion thermoelectric cells, and highlights the prospect of series integrated hydrogel ion thermoelectric cells for low-grade heat harvesting.

Preparation and Formation Mechanism of ß-SiC Coatings Using a SiCl4-CH4-H2-N2 System.

The mechanism of ß-SiC preparation via chemical vapor deposition (CVD) of the SiCl4-CH4-H2-N2 system remains unclear. Consequently, the change of molar Gibbs free energy of the CVD ß-SiC chemical reaction in the SiCl4-CH4-H2-N2 system has been studied by the Helsinki Software Corporation (HSC) Chemistry code for the first time. The role of nitrogen in the reaction was confirmed. Seven potential reaction pathways of CVD ß-SiC were presented, and the thermodynamic equilibrium components of each reaction were calculated systematically. The most viable reaction pathway and corresponding optimal temperature range for CVD ß-SiC were determined. In addition, a kinetic study of CVD ß-SiC was conducted. The microscopic morphology and crystal structure of ß-SiC coatings prepared on the graphite surface at different temperatures were charactered by scanning electron microscopy (SEM), X-ray diffraction (XRD), Raman, etc. Ultimately, through SEM, XRD, and Raman observation, uniform and dense ß-SiC coatings with fine grains and high crystallinity were successfully obtained. Furthermore, large ß-SiC-coated graphite trays with diameters of 230 and 465 mm were prepared by CVD using the SiCl4-CH4-H2-N2 system, and the average thickness of ß-SiC was about 100.6 µm. This study provides a theoretical basis and technical recommendations for the fabrication of SiC-coated graphite trays used in metal-organic chemical vapor deposition (MOCVD) equipment.

Human breast milk-derived phospholipid DOPE ameliorates intestinal injury associated with NEC by inhibiting ferroptosis.

Neonatal necrotizing enterocolitis (NEC) is a severe inflammatory bowel disease that commonly affects premature infants. Breastfeeding has been proven to be one of the most effective methods for preventing NEC. However, the specific role of lipids, the second major nutrient category in human breast milk (HBM), in intestinal development remains unclear. Our preliminary lipidomic analysis of the HBM lipidome revealed that dioleoyl phosphatidylethanolamine (DOPE) is not only abundant but also shows high solubility in lipids, endowing it with significant biological utility. Experimental results confirmed that DOPE significantly reduces the mortality of neonatal rats, ameliorates impairment of intestinal barrier function, and alleviates the expression of intestinal inflammatory factors IL-1ß and IL-6. Furthermore, DOPE promotes the migration and proliferation of intestinal epithelial cells, thereby enhancing the integrity of the intestinal barrier function in vitro. The progression of NEC is linked with the onset of ferroptosis. Our cellular-level analysis of lipid peroxide and iron ion concentrations revealed that DOPE significantly reduces the indicators of ferroptosis, while also modulating the expression of pivotal ferroptosis-associated factors, including SLC7A11, GPX4, and ACSL4. Hence, this research on DOPE is expected to provide novel insights into the bioactive lipids present in HBM.

Exploration of Nutraceutical Potentials of Isorhapontigenin, Oxyresveratrol and Pterostilbene: A Metabolomic Approach.

Resveratrol (trans-3,5,4'-trihydroxystilbene, RES) is one of the most well-known natural products with numerous health benefits. To explore the nutraceutical potentials of some dietary RES derivatives including isorhapontigenin (trans-3,5,4'-trihydroxy-3'-methoxystilbene, ISO), oxyresveratrol (trans-3,5,2',4'-tetrahydroxystilbene, OXY) and pterostilbene (trans-3,5-dimethoxy-4'-hydroxystilbene, PTS), their impacts on metabolism and health were assessed in Sprague Dawley rats after a two-week daily oral administration at the dose of 100 µmol/kg/day. Non-targeted metabolomic analyses were carried out with the liver, heart, brain and plasma samples using gas chromatography-tandem mass spectrometry (GC-MS/MS). Notable in vivo health benefits were observed, as the rats received ISO, PTS or RES showed less body weight gain; the rats received OXY or RES displayed healthier fasting blood glucose levels; while all of the tested stilbenes exhibited cholesterol-lowering effects. Additionally, many important metabolic pathways such as glycolysis, pentose phosphate pathway, tricarboxylic acid cycle and fatty acid oxidation were found to be modulated by the tested stilbenes. Besides the reaffirmation of the well-known beneficial effects of RES in diabetes, obesity, cardiovascular disease and Alzheimer's disease, the metabolomic analyses also suggest the anti-diabetic, cardio-, hepato- and neuro-protective activities of ISO; the anti-diabetic, cardio-, hepato- and neuro-protective effects of OXY; and the anti-aging, anti-inflammatory, cardio-, hepato- and neuro-protective potential of PTS. Interestingly, although these stilbenes share a similar structure, their biological activities appear to be distinct. In conclusion, similarly to RES, ISO, OXY and PTS have emerged as promising candidates for further nutraceutical development.

PSFHS challenge report: Pubic symphysis and fetal head segmentation from intrapartum ultrasound images.

Segmentation of the fetal and maternal structures, particularly intrapartum ultrasound imaging as advocated by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for monitoring labor progression, is a crucial first step for quantitative diagnosis and clinical decision-making. This requires specialized analysis by obstetrics professionals, in a task that i) is highly time- and cost-consuming and ii) often yields inconsistent results. The utility of automatic segmentation algorithms for biometry has been proven, though existing results remain suboptimal. To push forward advancements in this area, the Grand Challenge on Pubic Symphysis-Fetal Head Segmentation (PSFHS) was held alongside the 26th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2023). This challenge aimed to enhance the development of automatic segmentation algorithms at an international scale, providing the largest dataset to date with 5,101 intrapartum ultrasound images collected from two ultrasound machines across three hospitals from two institutions. The scientific community's enthusiastic participation led to the selection of the top 8 out of 179 entries from 193 registrants in the initial phase to proceed to the competition's second stage. These algorithms have elevated the state-of-the-art in automatic PSFHS from intrapartum ultrasound images. A thorough analysis of the results pinpointed ongoing challenges in the field and outlined recommendations for future work. The top solutions and the complete dataset remain publicly available, fostering further advancements in automatic segmentation and biometry for intrapartum ultrasound imaging.

Clinical efficacy and safety of high-intensity focused ultrasound combined with ultrasound-guided suction curettage at different time intervals for Cesarean scar pregnancy: a retrospective study.

OBJECTIVE: This study aims to assess the clinical efficacy and safety of combining high-intensity focused ultrasound (HIFU) with ultrasound-guided suction curettage for the treatment of cesarean scar pregnancy (CSP) at different time intervals. METHODS: A total of 115 CSP patients were enrolled and divided into two groups based on the time between HIFU ablation and suction curettage. Group A (n = 50) underwent suction curettage 24-48 h after HIFU ablation, while Group B (n = 65) had suction curettage within 6 h of HIFU ablation. The study compared and analyzed the clinical characteristics, treatment success rates, and intraoperative hemorrhage during ultrasound-guided suction curettage. RESULTS: The demographic characteristics of the two groups were similar, with no statistically significant differences observed in HIFU parameters, treatment success rates, blood loss, the use of Foley catheter balloons, or hospital expenses (p > 0.05). Importantly, suction curettage performed within 6 h after HIFU ablation resulted in shorter hospitalization times compared to suction curettage performed 24-48 h after the ablation (p < 0.05). CONCLUSIONS: Suction curettage within 6 h after HIFU ablation is an effective, safe, and cost-efficient treatment for patients diagnosed with CSP.

Synergistic Intramolecular Non-Covalent Interactions Enable Robust Pure-Blue TADF Emitters.

Stability-issues of organic light-emitting diodes (OLEDs) employing thermally activated delayed fluorescence (TADF) require further advancements, especially in pure-blue range of CIEy < 0.20, existing a dilemma between color purity and device lifetime. Though improving bond-dissociation-energy (BDE) can effectively improve material intrinsic stability, strategies to simultaneously improve BDE and photophysical performances are still lacking. Herein, it is disclosed that synergistic intramolecular non-covalent interactions (Intra-NI) can achieve not only the highest C─N BDE among blue TADF materials, but enhanced molecular-rigidity, near-unity photoluminescent quantum yields and short delayed lifetime. Pure-blue TADF-OLEDs based on proof-of-concept TADF material realize high external-quantum-efficiency and record-high LT80@500 cd m-2 of 109 h with CIEy = 0.16. Furthermore, deep-blue TADF-sensitized devices exhibit high LT80@500 cd m-2 of 81 h with CIEy = 0.10. The findings provide new insight into the critical role of Intra-NI in OLED materials and open the way to tackling vexing stability issues for developing robust pure-blue organic emitters and other functional materials.

Enhanced and robust nitrogen removal using an integrated zeolite and partial denitrification anammox process.

Anammox has received increased attention due to its enhanced and cost-efficient approach to nitrogen removal. However, its practical application is complicated by strict influent NO2--N to NH4+-N ratio demands and an 11% nitrate production from the anammox process. This study was the first known research to propose and verify a system of zeolite integrated with partial denitrification and anammox (Z-PDA) in an up-flow anaerobic sludge bed (UASB) reactor. The enhanced and robust nitrogen removal resulted in an ultra-high nitrogen removal efficiency (NRE, 93.0 ± 2.0%). Zeolite adsorption and biological desorption of ammonium contributed to robust nitrogen removal with fluctuating influent NO2--N to NH4+-N ratios. Applying 16S rRNA gene sequencing found that Candidatus Brocadia and Thauera were the key bacteria responsible for anammox and partial denitrification (PD), respectively. Zeolite also acted as a biological carrier. This significantly enriched anammox bacteria with a higher relative abundance of Candidatus Brocadia, reaching 49.2%. Metagenomic analysis demonstrated that the multiple functional genes related to nitrogen removal (nrfA/H, narG/H/I) and the metabolic pathways (Biosynthesis of cofactors, the Two-component system, the Biosynthesis of nucleotide sugars, and Purine metabolism) ensured the resilience of the Z-PDA system despite influent fluctuations. Overall, this study provided novel insights into the impacts of zeolite in the PDA system. It described the fundamental mechanism of zeolite based on adsorption and biological desorption, and demonstrated a meaningful application of the anammox process in sewage treatment.

"A diamond-shaped" penoplasty technique with or without concurrent suprapubic liposuction for adult-acquired buried penis: clinical outcomes and patient satisfaction rates.

Various techniques have been described for reconstructing the skin of the penile shaft; however, no universally accepted standard exists for correcting buried penis in adults. We aimed to describe a new technique for correcting an adult-acquired buried penis through a diamond-shaped incision at the penopubic junction. We retrospectively analyzed data from patients treated with our technique between March 2019 and June 2023 in the Department of Andrology, Nanjing Drum Tower Hospital (Nanjing, China). Forty-two adult males with buried penises, with a mean (±standard deviation [s.d.]) age of 26.6 (±6.6) years, underwent surgery. All patients were obese, with an average (±s.d.) body mass index of 35.56 (±3.23) kg m-2. In addition to phalloplasty, 32 patients concurrently underwent circumcision, and 28 underwent suprapubic liposuction. The mean (±s.d.) duration of the operation was 98.02 (±13.28) min. The mean (±s.d.) duration of follow-up was 6.71 (±3.43) months. The length in the flaccid unstretched state postoperatively was significantly greater than that preoperatively (mean ± s.d: 5.55±1.19 cm vs 1.94±0.59 cm, P < 0.01). Only minor complications, such as wound disruption (7.1%) and infection (4.8%), were observed. The mean (±s.d.) score of patient satisfaction was 4.02 (±0.84) on a scale of 5. This technique provides excellent cosmetic and functional outcomes with a minimal risk of complications. However, additional clinical studies are needed to evaluate the long-term effects of this procedure.

Evaluation of the therapeutic efficacy of high-intensity focused ultrasound ablation combined with different drugs in the treatment of adenomyosis.

OBJECTIVES: To observe the therapeutic efficacy of high-intensity focused ultrasound (HIFU) combined with different pharmacological treatments for adenomyosis. MATERIALS AND METHODS: A total of 126 patients with adenomyosis who underwent HIFU combined with pharmacological treatment were retrospectively reviewed. Patients were treated with either dienogest (DNG) (Group A, N = 38) or GnRH-a (Group B, N = 88) for three months after HIFU, and received levonorgestrel-releasing intrauterine systems (LNG-IUS) at the end of the third month. Visual Analog Scale (VAS) and Pictorial Blood Loss Assessment Chart (PBAC) scores were used for evaluating symptom improvement. RESULTS: After propensity score matching (1:2), 38 patients were included in Group A and 76 in Group B. All patients showed significant improvement in VAS and PBAC scores after HIFU, but the PBAC score of Group A was significantly higher than that of patients in Group B at 18 months [11.50 (1.00, 29.50) vs. 0.00 (0.00, 16.50), p < 0.01] and 24 months [4.00 (0.25, 27.75) vs. 0.00 (0.00, 12.75), p = 0.04] after HIFU. Furthermore, patients in Group B had a greater uterine volume reduction at 24 months after HIFU than that of patients in Group A [51.00 (27.00, 62.00) vs. 30.00 (17.00, 42.75, p = 0.02)]. However, the adverse effects in Group A were lower than those in Group B [7 (15.79) vs. 35 (46.05), p < 0.01]. No significant difference was observed in the recurrence rate between the two groups. CONCLUSIONS: HIFU combined with DNG and LNG-IUS is a safe and effective treatment for patients with adenomyosis.

Altered brain activity associated with premature ejaculation improved by electroacupuncture in rats.

Background: Premature ejaculation (PE) is linked with abnormal brain activity that is modifiable by electroacupuncture (EA). Aim: In this study we aimed to explore the central pathological mechanism underlying EA in treating PE. Methods: Six-week-old male Sprague-Dawley rats were divided into a PE group (n = 8) and a control group (n = 8) according to ejaculatory frequency during copulatory behavior. All rats underwent EA at the Zusanli acupoint (ST-36) for 4 weeks. Magnetic resonance imaging data were collected before and after EA. Outcomes: The behavioral parameters, plasma norepinephrine levels, fractional amplitude of low frequency fluctuation (fALFF), and regional homogeneity (ReHo) were evaluated. Results: The PE group ejaculated more times with shorter latency compared with controls. After EA, the ejaculation frequency of the PE group decreased, and the ejaculation latency period increased, with no changes observed in the control group. Norepinephrine levels were higher in the PE group than in the controls and were positively correlated with ejaculation frequency and negatively correlated with ejaculation latency. The PE group showed lower fALFF in the right striatum and higher ReHo in the brainstem compared with controls. After EA, controls showed decreased fALFF in the right striatum, left olfactory bulb, and dorsal fornix and increased ReHo in the right interpeduncular nucleus, as well as decreased ReHo in the left striatum, prelimbic system, right basal forebrain region, septal region, and olfactory bulb, while the model group exhibited increased fALFF in the right hypothalamic region, decreased fALFF in the left globus pallidum and right basal forebrain region and increased ReHo in the right interpeduncular nucleus, as well as decreased ReHo in the left striatum, olfactory bulb, basal forebrain region, dentate gyrus, right dysgranular insular cortex, and striatum. Compared with the controls after EA, the model group showed increased ReHo of the right hypothalamic region and decreased ReHo of the right dysgranular insular cortex. Clinical Implications: These findings might enhance the understanding of PE and contribute to new, targeted therapies for PE. Strengths and Limitations: The therapeutic effects might be achieved by EA inhibiting the activity in brain regions involved in ejaculatory behavior. However, the curative effect of acupuncture might be underestimated due to some curative effects of sham acupuncture used in the control group. Conclusion: In conclusion, the ejaculatory frequency of rats may be reduced and ejaculation latency could be extended by EA at ST-36, which might be achieved by the effects of this treatment on brain activity.

Taking measurement in every direction: Implicit scene representation for accurately estimating target dimensions under monocular endoscope.

BACKGROUND AND OBJECTIVES: In endoscopy, measurement of target size can assist medical diagnosis. However, limited operating space, low image quality, and irregular target shape pose great challenges to traditional vision-based measurement methods. METHODS: In this paper, we propose a novel approach to measure irregular target size under monocular endoscope using image rendering. Firstly synthesize virtual poses on the same main optical axis as known camera poses, and use implicit neural representation module that considers brightness and target boundaries to render images corresponding to virtual poses. Then, Swin-Unet and rotating calipers are utilized to obtain maximum pixel length of the target in image pairs with the same main optical axis. Finally, the similarity triangle relationship of the endoscopic imaging model is used to measure the size of the target. RESULTS: The evaluation is conducted using renal stone fragments of patients which are placed in the kidney model and the isolated porcine kidney. The mean error of measurement is 0.12 mm. CONCLUSIONS: The approached method can automatically measure object size within narrow body cavities in any visible direction. It improves the effectiveness and accuracy of measurement in limited endoscopic space.