Meta-analysis of prognostic factors related to early urinary incontinence following new transurethral procedures dominated by laser therapy for benign prostatic hyperplasia.

To investigate the predictors of early postoperative UI after new minimally transurethral procedures dominated by laser therapy for benign prostatic hyperplasia. A literature review of articles published before June 30, 2021 was conducted using the PubMed, Web of Sciences, Cochrane database, and Embase databases. All studies reporting odds ratio (OR) data of prognostic factors in univariable or multivariable analyses were included. The cutoff points of follow-up were within 1 month, at 3 months, and at 6 months. Fourteen studies were identified and assessed for the meta-analysis. The pooled analysis yielded that three prognostic factors related to postoperative urinary incontinence. The pooled OR for age as a continuous variable was 1.066 (95% CI 1.005-1.031) at 3 months, the pooled OR was 3.7 (95% CI 1.276-10.733) for age as a categorical variable within 1 month. The OR for prostate volume was 1.014 (95% CI 1.002-1.026) within 1 month. The pooled OR for prostate volume as a categorical variable was 2.199 (95% CI 1.038-4.659) at 3 months. The OR for resected prostate weight was 1.008 (95% CI 1.001-1.016) within 1 month and the pooled OR for resected prostate weight as a categorical variable was 3.481 (95% CI 1.674-7.239) at 3 months. For patients who have undergone transurethral surgery of prostate using new minimally invasive method, especially laser-based therapy, main factors influencing the development of postoperative UI within 1 month and at 3 months were age, prostate volume, and resected prostate weight.

Exploration of IMDC model in patients with metastatic renal cell carcinoma using targeted agents: a meta-analysis.

PURPOSE: To explore the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model application for predicting outcome of patients with metastatic renal cell carcinoma using targeted agents. MATERIALS AND METHODS: We performed a literature review of 989 articles. The selecting process used preferred reporting items for systematic reviews and meta-analyses (PRISMA). All included studies were assessed by Newcastle-Ottawa scale. Results of individual studies were pooled using Stata 14.0 software. RESULTS: A total of 17 articles were included. Most articles provided univariate and multivariate analysis of IMDC model prognosis. Combined HRs were 1.58 (95% CI 1.34-1.82) and 3.74 (95% CI 2.67-4.81) for univariate PFS of intermediate to favorable and poor to favorable respectively. In the category of multivariate PFS, combined HRs were 1.27 (95% CI 0.99-1.56) and 2.29 (95% CI 1.65-2.93) with intermediate to favorable and poor to favorable respectively. Regarding univariate OS, combined HRs were 1.93 (95% CI 1.62-2.24) and 6.25 (95% CI 4.18-8.31) with intermediate to favorable and poor to favorable respectively. With multivariate OS, combined HRs were 1.32 (95%CI 1.04-1.59) and 2.35 (95%CI 1.69-3.01) with intermediate to favorable and poor to favorable respectively. CONCLUSION: In summary, analysis of currently available clinical evidence indicated that IMDC model could be applied to classify patients with metastatic renal cell carcinoma using targeted agents. However, different types of targeted agents and various areas could affect the accuracy of the model. There was also a difference in predicting patients' PFS and OS.

DRD4 alleviates acute kidney injury by suppressing ISG15/NOX4 axis-associated oxidative stress.

Acute kidney injury (AKI) is a life-threatening health condition associated with increasing morbidity and mortality. Despite extensive research on the mechanisms underlying AKI, effective clinical tools for prediction and treatment remain scarce. Oxidative stress and mitochondrial damage play a critical role in AKI and dopamine D4 receptor (DRD4) has been confirmed to be associated with oxidative stress. In this study, we hypothesized that DRD4 could attenuate AKI through its antioxidative and antiapoptotic effects. In vivo, DRD4 was remarkably decreased in the kidneys of mice subjected to ischemia/reperfusion injury (IRI) or cisplatin treatment. Notably, DRD4 significantly attenuated nephrotoxicity by suppressing oxidative stress and enhancing mitochondrial bioenergetics through the downregulation of reactive oxygen species (ROS) generation and NADPH oxidase 4 (NOX4) expression. In vitro, DRD4 demonstrated the ability to ameliorate oxidative stress-induced apoptosis in HK-2 cells subjected to hypoxia/reoxygenation- or cisplatin treatment. Transcriptome sequencing revealed that, mechanistically, DRD4 reduced the expression of its downstream target, interferon-stimulated gene 15 (ISG15), suppressing NOX4 ISGylation, enhancing the ubiquitination of NOX4, leading to its degradation, and ultimately counteracting oxidative stress-induced AKI. Altogether, these findings underscore the significance of DRD4 in AKI and elucidate DRD4 as a potential protectant against IRI or cisplatin-induced nephrotoxicity.

Platelet-derived extracellular vesicles aggravate septic acute kidney injury via delivering ARF6.

Circulating plasma extracellular vesicles (EVs) mostly originate from platelets and may promote organ dysfunction in sepsis. However, the role of platelet-derived EVs in sepsis-induced acute kidney injury (AKI) remains poorly understood. The present study extracted EVs from the supernatant of human platelets treated with phosphate buffer saline (PBS) or lipopolysaccharide (LPS). Then, we subjected PBS-EVs or LPS-EVs to cecal ligation and puncture (CLP) mice in vivo or LPS-stimulated renal tubular epithelial cells (RTECs) in vitro. Our results indicated that LPS-EVs aggravate septic AKI via promoting apoptosis, inflammation and oxidative stress. Further, ADP-ribosylation factor 6 (ARF6) was identified as a differential protein between PBS-EVs and LPS-EVs by quantitative proteomics analysis. Mechanistically, ARF6 activated ERK/Smad3/p53 signaling to exacerbate sepsis-induced AKI. LPS upregulated ARF6 in RTECs was dependent on TLR4/MyD88 pathway. Both genetically and pharmacologically inhibition of ARF6 attenuated septic AKI. Moreover, platelets were activated by TLR4 and its downstream mediator IKK controlled platelet secretion during sepsis. Inhibition of platelet secretion alleviated septic AKI. Collectively, our study demonstrated that platelet-derived EVs may be a therapeutic target in septic AKI.

A systematic review and meta-analysis of neoadjuvant chemotherapy for bladder cancer between ddMVAC and GC regimen.

OBJECTIVE: The purpose of this systematic literature review and meta-analysis was to compare the pathological response rate and prognosis of the dose dense Methotrexate, vinblastine, doxorubicin and cisplatin (ddMVAC) regimen and gemcitabine and cisplatin (GC) regimen as neoadjuvant chemotherapy choices for bladder cancer. METHODS: A literature review of articles published before February 28, 2021, was conducted using the PubMed, Web of Sciences and Embase databases. Data for comparison included pathological response rate and overall survival. RESULTS: Five studies including 1,206 patients were identified and assessed for the meta-analysis. The pooled analysis yielded an odds ratio value of 1.29 (95% CI, 0.86-1.92) with a downstaging rate and an odds ratio value of 1.57 (95% CI, 1.10-2.25) with a complete response rate when comparing ddMVAC with the GC regimen. The pooled analysis yielded a hazard ratio of 0.47 (95% CI, 0.30-0.72) with regard to overall survival between the two regimens. CONCLUSION: Compared with the GC regimen, ddMVAC has a better pathological response rate, especially the complete response rate, and provides longer overall survival as a neoadjuvant chemotherapy regimen for bladder cancer.

Targeted and Systematic Prostate Biopsy in Biopsy-naive Men With Positive Multiparameter Magnetic Resonance Imaging Findings: A Meta-analysis.

We assessed the difference in the detection rate of prostate cancer, specifically clinically significant prostate cancer, using targeted biopsy (TB), systematic biopsy (SB), and the combination of these 2 (CB) in biopsy-naive men with positive multiparameter magnetic resonance imaging results. We performed a literature review in September 2018 using PubMed and the Web of Science. Relevant studies acquired from specific articles' references were also reviewed. Only those studies that had provided the detection rate of TB, SB, and CB in biopsy-naive men with positive multiparameter magnetic resonance imaging findings were included for a total of 11 studies with 2099 patients. The combined strategy was better than TB or SB alone, with an odds ratio (OR) of 1.47 (95% confidence interval [CI], 1.30-1.67; P < .001) and 1.45 (95% CI, 1.28-1.65; P < .001), respectively, in the overall detection rate. Also, TB was not better than SB, with an OR of 0.99 (95% CI, 0.87-1.12; P = .825). For the clinically significant prostate cancer detection rate, CB was still better than TB or SB alone, with an OR of 1.25 (95% CI, 1.11-1.42; P < .001) and an OR of 1.23 (95% CI, 1.08-1.40; P = .002), respectively. Again, TB was not better than SB, with an OR of 0.98 (95% CI, 0.86-1.12; P = .768). In conclusion, CB resulted in a better detection rate than TB or SB alone for both the overall prostate cancer detection rate and the clinically significant prostate cancer detection rate.

The Association of Shorter Interval of Biopsy-Radical Prostatectomy and Surgical Difficulty.

PURPOSE: We discuss the safety and perioperative outcomes of a 2-week interval between prostate biopsy and laparoscopic radical prostatectomy (LRP). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 182 patients with prostate cancer (PCa) who underwent transperitoneal LRP 2 weeks after prostate biopsy between 2012 and 2015. We evaluated the following perioperative outcomes: operative time, estimated blood loss (EBL), infection, conversion to open surgery, positive surgery margins (PSM), and complications. We also reviewed studies discussing a shorter interval between biopsy and LRP in peer-reviewed publications. RESULTS: The mean operative time and EBL were 100.2 min and 82.2 ml, respectively. There were no rectal injuries or conversions to open surgery, totally 19 (10.4%) patients experienced complications (Clavien-Dindo Grade I and II): fever occurred in six patients (3.3%), urinary leak in four (2.2%), incomplete paralytic ileus in four (2.2%), deep vein thrombosis in two (1.1%), and postoperative anemia in four. The average bedrest time after surgery was 2.5 days. PSM was detected in twenty-one patients (11.5%) . 167 patients (91.7%) recovered continence.Follow-up ranged from 13-37 months, the biochemical recurrence (BCR) rate was 10.4% (19/182).The seven peer-reviewed studies we reviewed that a shorter interval was safe and did not influence surgical outcomes. CONCLUSION: Our study shows that a 2-week interval between biopsy and LRP is safe and does not negatively affect surgical outcomes.

Exploration of IMDC model in patients with metastatic renal cell carcinoma using targeted agents: a meta-analysis

ABSTRACT Purpose: To explore the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model application for predicting outcome of patients with metastatic renal cell carcinoma using targeted agents. Materials and Methods: We performed a literature review of 989 articles. The selecting process used preferred reporting items for systematic reviews and meta-analyses (PRISMA). All included studies were assessed by Newcastle-Ottawa scale. Results of individual studies were pooled using Stata 14.0 software. Results: A total of 17 articles were included. Most articles provided univariate and multivariate analysis of IMDC model prognosis. Combined HRs were 1.58 (95% CI 1.34-1.82) and 3.74 (95% CI 2.67-4.81) for univariate PFS of intermediate to favorable and poor to favorable respectively. In the category of multivariate PFS, combined HRs were 1.27 (95% CI 0.99-1.56) and 2.29 (95% CI 1.65-2.93) with intermediate to favorable and poor to favorable respectively. Regarding univariate OS, combined HRs were 1.93 (95% CI 1.62-2.24) and 6.25 (95% CI 4.18-8.31) with intermediate to favorable and poor to favorable respectively. With multivariate OS, combined HRs were 1.32 (95%CI 1.04-1.59) and 2.35 (95%CI 1.69-3.01) with intermediate to favorable and poor to favorable respectively. Conclusion: In summary, analysis of currently available clinical evidence indicated that IMDC model could be applied to classify patients with metastatic renal cell carcinoma using targeted agents. However, different types of targeted agents and various areas could affect the accuracy of the model. There was also a difference in predicting patients' PFS and OS.