Carbide slag and sodium metasilicate synergistic activation of sludge ash-based alkali-activated materials: Towards a cleaner activation approach.

Traditional activators such as sodium hydroxide and sodium silicate are commonly used in the preparation of alkali-activated materials; however, their significant environmental impact, high cost, and operational risks limit their sustainable use in treating solid waste. This study explores the innovative use of carbide slag (CS) and sodium metasilicate (NS) as alternative activators in the production of sewage sludge ash-based alkali-activated materials (SSAM) with the aim of reducing the carbon footprint of the preparation process. The results demonstrate that CS effectively activates the sewage sludge ash, enhancing the compressive strength of the SSAM to 40 MPa after curing for 28 d. When used in conjunction with NS, it synergistically improves the mechanical properties. Furthermore, the microstructure and phase composition of the SSAM are characterized. Increasing the quantities of CS and NS accelerates the dissolution of the precursor materials, promoting the formation of a higher quantity of hydration products. This significantly reduces the number of voids and defects within the samples, further enhancing the densification of the microstructure. Environmental assessments reveal that CS and NS offer substantial sustainability benefits, confirming the feasibility of activating SSAM using these materials. This approach provides a less energy-intensive and more environmentally friendly alternative to conventional activation methods and presents an effective strategy for managing large volumes of sewage sludge ash and CS.

Profiling of carbonyl metabolic fingerprints in urine of Graves' disease patients based on atmospheric ionization mass spectrometry.

Graves' disease (GD) is considered among the organ autoimmune diseases and is somewhat linked to other autoimmune and secondary diseases. Commonly used detection methods rely on identifying characteristic clinical features and abnormal biochemical markers, but they have certain limitations and may be affected by patient medication. In this study, a desorption separation ionization (DSI) device coupled with a linear ion trap mass spectrometer is introduced for effective detection and screening of urine from GD patients. To enhance the sensitivity of MS analysis, derivatization reagent is utilized as a labeling method. The MS signal is used for metabolic profiling, through which differential metabolites and pathways are identified. Subsequently, processing the acquired spectra with a machine learning algorithm enables successful differentiation of GD patients and healthy individuals. This method is believed to provide versatile and powerful technical support for effective detection on the scene. Notably, this method offers the advantage of achieving early and rapid diagnosis of thyroid-related diseases.

Pocket-Size Wireless Nanoelectrospray Ionization Mass Spectrometry for Metabolic Analysis of Salty Biofluids and Single Cells.

Analysis of volume-limited biological samples such as single cells and biofluids not only benefits clinical purposes but also promotes fundamental research in life sciences. Detection of these samples, however, imposes strict requirements on measurement performance because of the minimal volume and concentrated salts of the samples. Herein, we developed a self-cleaning nanoelectrospray ionization device powered by a pocket-size "MasSpec Pointer" (MSP-nanoESI) for metabolic analysis of salty biological samples with limited volume. The self-cleaning effect induced by Maxwell-Wagner electric stress helps with keeping the borosilicate glass capillary tip free from clogging and thus increasing salt tolerance. This device possesses a high sample economy (about 0.1 µL per test) due to its pulsed high voltage supply, sampling method (dipping the nanoESI tip into analyte solution), and contact-free electrospray ionization (ESI) (the electrode does not touch the analyte solution during ESI). High repeatable results could be acquired by the device with a relative standard deviation (RSD) of 1.02% for voltage output and 12.94% for MS signals of caffeine standard. Single MCF-7 cells were metabolically analyzed directly from phosphate buffered saline, and two types of untreated cerebrospinal fluid from hydrocephalus patients were distinguished with 84% accuracy. MSP-nanoESI gets rid of the bulky apparatus and could be held in hand or put into one's pocket for transportation, and it could operate for more than 4 h without recharge. We believe this device will boost scientific research and clinical usage of volume-limited biological samples with high-concentration salts in a low-cost, convenient, and rapid manner.

Efficacy and Safety of Polycaprolactone in Treating Nasolabial Folds: A Prospective, Multicenter, and Randomized Controlled Trial.

Nasolabial folds (NLFs) are the most pronounced sign of facial aging. This study explored the efficacy and safety of polycaprolactone gel in treating Chinese patients with moderate-to-severe NLFs. Patients with moderate-to-severe NLF who wished to be treated by dermal fillers were recruited from three centers between July 2017 and September 2019. The randomizing ratio was 1:1 in the polycaprolactone group (polycaprolactone injection) or control group (sodium hyaluronate gel injection). The primary endpoint was the effectiveness rate of Wrinkle Severity Rating Score (WSRS) scores at 12 months after injection. The full-analysis set (FAS) and safety sets had 80 patients in the polycaprolactone group and control group, respectively. In the FAS, the effectiveness rate at 12 months in the polycaprolactone group was 88.8% compared with 23.8% in controls (P < 0.001). The improvement in WSRS sustained during 12 months in the polycaprolactone group, while gradually vanished in the control group since 3 months after surgery. The global aesthetic improvement scale (GAIS) by investigator assessments was improved, much improved, or very much improved in all patients during follow-up, while the proportion of patients with a "no change" assessment gradually increased during follow-up after 6 months in the control group. The rates of injection-related adverse event (AE) and serve injection-related AE were 8.8 versus 11.3% and 0 versus 1.3% in the polycaprolactone group and control groups, respectively. Polycaprolactone gel injection is effective and safe to treat moderate-to-severe NLFs in Chinese patients.

Direct observation of nodeless superconductivity and phonon modes in electron-doped copper oxide Sr1-xNdxCuO2.

The microscopic understanding of high-temperature superconductivity in cuprates has been hindered by the apparent complexity of crystal structures in these materials. We used scanning tunneling microscopy and spectroscopy to study the electron-doped copper oxide compound Sr1- x Nd x CuO2, which has only bare cations separating the CuO2 planes and thus the simplest infinite-layer structure of all cuprate superconductors. Tunneling conductance spectra of the major CuO2 planes in the superconducting state revealed direct evidence for a nodeless pairing gap, regardless of variation of its magnitude with the local doping of trivalent neodymium. Furthermore, three distinct bosonic modes are observed as multiple peak-dip-hump features outside the superconducting gaps and their respective energies depend little on the spatially varying gaps. As well as the bosonic modes, with energies identical to those of the external, bending and stretching phonons of copper oxides, our findings reveal the origin of the bosonic modes in lattice vibrations rather than spin excitations.

Fabrication of highly efficient phenylphosphorylated chitosan bio-based flame retardants for flammable PLA biomaterial.

Modified chitosan (CS)-based flame retardants exhibit promising prospects owing to their sustainability, biodegradability, and good charring properties. A series of novel modified-CS bio-based flame retardants (phenylphosphorylated CS (PhPCS) and phenylphosphoramidated CS (PhPNCS)) were prepared by the phosphorylation and phosphoramidation reactions of CS with phenylphosphoryl dichloride and tetraethylenepentamine, respectively. Bio-based PhPCS and PhPNCS exhibited excellent flame retardancy efficiency for poly(lactic acid) (PLA). The limited oxygen index (LOI) values of the PLA/3 wt% PhPCS and PLA/3 wt% PhPNCS biocomposites increased to 29% and 27%, respectively, and they both achieved a V-0 rating during the UL-94 vertical combustion test. However, the mechanical properties of the PLA/PhPCS biocomposites decreased with increasing PhPCS content. The mechanical strengths of the PLA/PhPNCS biocomposites were better than those of the PLA/PhPCS biocomposites owing to the reactive compatibilization of the interface between the amino and carboxyl end groups of the PhPNCS nanoparticles and PLA matrix, respectively.

Constrained two-stage Kalman filter for real-time state estimation of systems with time-varying measurement noise covariance.

Considering the statistical properties of the measurement noise are not deterministic, which is very common in engineering and may bring large errors to system state estimation, a novel constrained two-stage Kalman filter algorithm is proposed. Based on the prior estimate of system states, the covariance update model is established and the constraint algorithm is introduced to accurately estimate the measurement noise covariance. The results are subsequently substituted back into the main-filter to obtain the posterior estimate of system states. Finally, the proposed algorithm is validated by two simulation cases, and the performance is compared with that of Kalman filter and adaptive Kalman filter. The results show that the proposed method is more effective than conventional methods when facing the time-varying measurement noise covariance problem.

The accuracy of MRI in diagnosing and classifying acute traumatic multiple ligament knee injuries.

BACKGROUND: Magnetic resonance imaging (MRI) is widely used for the evaluation of knee injuries, however, the accuracy of MRI in classifying multiple ligament knee injuries (MLKIs) remains unknown. This study aimed to investigate the accuracy of MRI in diagnosing and classifying acute traumatic MLKIs, we hypothesize that MRI had high accuracy in detecting and classifying MLKIs. METHODS: The clinical data of 97 patients who were diagnosed with acute traumatic MLKIs and managed by multi-ligament reconstruction between 2012 and 2020 were retrospectively reviewed. The MR images were read by two experienced radiologists and results were compared with intraoperative findings, which were considered as the reference for the identification of injured structures. The value of MRI in detecting injuries of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and meniscus was evaluated by calculating the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and kappa coefficients analysis. The value of MRI in classifying MLKIs was evaluated by calculating the agreement between MRI and intraoperative findings. RESULTS: For detecting the specific injured structures in MLKIs, MRI had high sensitivity (90.7% for ACL, 90.4% for PCL, and moderate specificity (63.6% for ACL, 50% for PCL) in detecting cruciate ligament injuries, moderate sensitivity (79.1% for MCL, 55.6% for LCL) and specificity (46.7% for MCL, 68.4% for LCL) in detecting collateral ligament injuries, fair sensitivity (61.5%) and low specificity (39.4%) in the diagnosis of injuries to the meniscus. For classifying the MIKIs, MRI had a moderate agreement with intraoperative findings in classifying KD-V (kappa value = 0.57), poor agreement in the KD-I (kappa value = 0.39) and KD-IIIM (kappa value = 0.31), meaningless in the KD-II and KD-IIIL (kappa value < 0). The overall agreement between MRI and intraoperative findings in classifying MLKIs was poor (kappa value = 0.23). CONCLUSIONS: MRI is valuable in early detection and diagnosis of acute MLKIs, however, the accuracy of MRI in classifying MLKIs is limited. The management of MLKIs should be based on intraoperative findings, physical examinations, and comprehensive imaging results.

Exploring the Potential Mechanism of Guchang Zhixie Wan for Treating Ulcerative Colitis by Comprehensive Network Pharmacological Approaches and Molecular Docking Validation as Well as Cell Experiments.

Guchang Zhixie Wan (GZW) is a commonly used Chinese medicine for the treatment of ulcerative colitis (UC). This research explored the potential pharmacological mechanism of GZW in UC. The active ingredients, potential targets, and UC-related genes of GZW were retrieved from public databases. The pharmacological mechanisms including key components, potential targets and signal pathways were determined through bioinformatics analysis. The results of this study were verified through virtual molecular docking and cell experiments. Network analysis revealed that 26 active GZW compounds and 148 potential GZW target proteins were associated with UC. Quercetin, kaempferol and ß-sitosterol were identified as the core active ingredients of GZW. IFNG, IL-1A, IL-1B, JUN, RELA, and STAT1 were indicated as key targets of GZW. These key targets have a strong affinity for quercetin, kaempferol, and ß-sitosterol. GO and KEGG enrichment analysis showed that GZW target proteins are highly enriched in inflammatory, immune, and oxidative stress-related pathways. This study confirmed the therapeutic effect and revealed potential molecular mechanism of GZW on UC. And the protective effects of GZW on inflammatory bowel disease pathway were also revealed through STAT3/NF-κB/IL-6 pathway. The findings of this study enhanced our understanding of GZW in the treatment of UC and provided a feasible method for discovering potential drugs from traditional Chinese medicine formulations.

Co-Culture of Adipose-Derived Stem Cells and Chondrocytes With Transforming Growth Factor-Beta 3 Promotes Chondrogenic Differentiation.

Tissue engineering cartilage is a promising strategy to reconstruct the craniofacial cartilaginous defects. It demands plenty of chondrocytes to generate human-sized craniofacial frameworks. Partly replacement of chondrocytes by adipose-derived stem cells (ADSCs) can be an alternative strategy.The study aimed at evaluating the chondrogenic outcome of ADSCs and chondrocytes in direct co-culture with transforming growth factor-beta (TGF-ß3). Porcine ADSCs and chondrocytes were obtained from abdominal wall and external ears. Four groups: ADSCs or chondrocytes monocultured in medium added with TGF-ß3; ADSCs and ACs co-cultured with or without TGF-ß3. Cell growth rate was performed to evaluate the cell proliferation. Morphological, histologic and real-time polymerase chain reaction analysis were performed to characterize the chondrogenic outcome of pellets. ADSCs had favorable multi-lineage differentiation potential. Further, when ADSCs were co-cultured with chondrocytes in medium added with TGF-ß3, the cell proliferation was promoted and the chondrogenic differentiation of ADSCs was enhanced. We demonstrate that pellet co-culture of ADSCs and chondrocyte with TGF-ß3 could construct high quantity cartilages. It suggests that this strategy might be useful in future cartilage repair.

Gelation, flame retardancy, and physical properties of phosphorylated microcrystalline cellulose aerogels.

Flame-retardant bio-based cellulose aerogels, with abundant renewable sources, are considered as promising sustainable heat-insulation alternatives to conventional petroleum-based foams. An environmentally friendly method was employed to fabricate phosphorylated microcrystalline cellulose (PMCC) aerogel through the gelation of PMCC/H2O dispersion and freeze-drying of PMCC hydrogel. The dispersion stability of PMCC and its readiness to undergo gelation in the aqueous phase were enhanced by increasing the phosphorous content via phosphorylation, thereby effectively weakening the strong intra- and intermolecular hydrogen-bond interactions of the cellulose chains. The morphology of the PMCC aerogel changed from a short rod-shaped and sheet-like aggregation of a three-dimensional skeleton structure to a mostly sheet-like aggregation of a three-dimensional structure with increased phosphate esterification. Remarkably, PMCC aerogels exhibited improved flame retardancy and superior suppression of toxic gas, compared to MCC. This is attributable to the synergic effect of phosphate dehydration, catalytic carbonization, and protection of the aerogel network structure.

Rapid discrimination of Notopterygium incisum and Notopterygium franchetii based on characteristic compound profiles detected by UHPLC-QTOF-MS/MS coupled with multivariate analysis.

INTRODUCTION: The herbs Notopterygium incisum (NI) and N. franchetii (NF) are referred to as "Qianghuo" in the Chinese Pharmacopeia and are popular for treatment of certain conditions, including headaches, rheumatoid arthritis and the common cold. Recently, several adulterations of NI and NF have been found in the Chinese herbal market. OBJECTIVE: The aim of this study was to rapidly identify the unique characteristic compounds of NI and NF, to discriminate Qianghuo from its adulterations. METHODOLOGY: Twenty-four batches of NI and NF samples with different origins were collected and extracted with methanol. The extracts were analysed using ultrahigh-performance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry (UHPLC-QTOF-MS/MS). Principal component analysis (PCA) and orthogonal partial squared discriminant analysis (OPLS-DA) were then used to distinguish between NI and NF and to identify their potential characteristic markers. RESULTS: Fifty compounds were identified or tentatively characterised according to the retention time, m/z value and MS/MS fragment analysis. Six compounds were selected as potential markers of NI and NF by PCA and OPLS-DA. They were successfully applied to authenticate 17 kinds of Chinese patent medicines containing Qianghuo. The markers could not be detected in three of the Chinese patent medicines, indicating that they were counterfeit products. CONCLUSION: The UHPLC-QTOF-MS/MS coupled with the multivariate analysis method could discriminate NI and NF from their adulterations. Moreover, the data clearly demonstrated significant differences in the chemical compositions of NI and NF. Further research is needed to examine the relationship between therapeutic efficacy and the chemical constituents of NI and NF.

Collaborative implementation of stereotactic ablative body radiotherapy: A model for the safe implementation of complex radiotherapy techniques in Australia.

INTRODUCTION: Stereotactic ablative radiotherapy (SABR) for lung cancer is a modality of treatment that has improved outcomes for lung cancer patients. However, radiotherapy for lung cancer is underutilized and fewer than half of elderly patients with non-small cell lung cancer (NSCLC) receive active treatment. The purpose of this study is to report on a collaboration in implementing an NSCLC SABR (stereotactic ablative body radiation) program safely, efficiently, and uniformly across several centers, including regional sites. The first aim of this paper is to detail the collaboration and implementation that started in 2013 and is ongoing. The second aim of this paper is to document early toxicities and quality of life outcomes. METHOD: A tripartite approach was used to develop the protocol and networks required for the implementation of SABR across multiple sites in NSW. Departments starting the programmes were supported and physics credentialing with central site submission was required before commencing the treatment. Additional ongoing support was available via an email discussion group involving all members of the collaboration. RESULTS: Between July 22, 2013 and February 22, 2016, 41 patients were enrolled with 34 patients in active follow up. The toxicity profile so far is similar to those of published studies with no appreciable effect on quality of life outcomes. CONCLUSION: The collaboration formed an effective framework in facilitating the implementation of SABR across several sites in NSW and could be used as a model for the safe and uniform implementation of new technologies in Australia.

Flame Retardancy and Toughness of Poly(Lactic Acid)/GNR/SiAHP Composites.

A novel flame-retardant and toughened bio-based poly(lactic acid) (PLA)/glycidyl methacrylate-grafted natural rubber (GNR) composite was fabricated by sequentially dynamical vulcanizing and reactive melt-blending. The surface modification of aluminum hypophosphite (AHP) enhanced the interfacial compatibility between the modified aluminum hypophosphite by silane (SiAHP) and PLA/GNR matrix and the charring ability of the PLA/GNR/SiAHP composites to a certain extent, and the toughness and flame retardancy of the PLA/GNR/SiAHP composites were slightly higher than those of PLA/GNR/AHP composites, respectively. The notched impact strength and elongation of the PLA composite with 20 wt. %GNR and 18 wt.% SiAHP were 13.1 kJ/m2 and 72%, approximately 385% and 17 fold higher than those of PLA, respectively, and its limiting oxygen index increased to 26.5% and a UL-94 V-0 rating was achieved. Notedly, the very serious melt-dripping characteristics of PLA during combustion was completely suppressed. The peak heat release rate and total heat release values of the PLA/GNR/SiAHP composites dramatically reduced, and the char yield obviously increased with an increasing SiAHP content in the cone calorimeter test. The good flame retardancy of the PLA/GNR/SiAHP composites was suggested to be the result of a synergistic effect involving gaseous and condensed phase flame-retardant mechanisms. The high-performance flame-retardant PLA/GNR/SiAHP composites have great potential application as replacements for petroleum-based polymers in the automotive interior and building fields.

Study of target spacing of thermo-sensitive carrier on the activity recovery of immobilized penicillin G acylase.

The immobilized penicillin G acylase (PGA) is an important industrial catalyst, the activity recovery rate of it directly affects enterprise efficiency. How to improve the enzyme activity recovery rate has been a research focus in this field. Based on the above problems, this work further improved the activity recovery rate by adjusting the target spacing for the first time. Glycidyl methacrylate (GMA) was used as the immobilized target and methyl methacrylate (MMA) as the copolymer monomer. According to the copolymer composition equation of P(MMA-co-GMA), the thermo-sensitive copolymers, PDEA-b-PHEMA-b-P(MMA-co-GMA) with different target spacings, were synthesized rapidly and efficiently via reversible addition-fragmentation chain transfer (RAFT) polymerization method. The error range between the theoretical and actual values of MMA and GMA in the copolymers carrier was (0-4)%, which demonstrated that the reliability of using composition equation to accurately and quickly synthesize copolymers with specific spacing. Studies on the thermo-sensitive showed that the low critical solution temperature (LCST) of the copolymer carrier decreased with the increase of hydrophobic monomer. Most importantly, the activity recovery rate increased with the increase of target spacing, and when the molar ratio of MMA to GMA in the copolymer was 8.75:1, the recovery of activity of immobilized PGA could be up to 63.50%, which was 21.70% higher than that of pure GMA. This work provided an important idea for improving the activity of immobilized PGA.

[Factors affecting the safety and efficacy of peroral endoscopic myotomy for achalasia].

OBJECTIVE: To identify the factors that affect the safety and efficacy of peroral endoscopic myotomy (POEM) for treatment of achalasia. METHODS: Data of consecutive patients undergoing POEM for confirmed achalasia between December, 2010 and December, 2015 were collected, including the procedure time, approach of tunnel entry incision, approach of myotomy, complications and follow-up data. RESULTS: Among the total of 439 patients enrolled, the overall complication rate was 28.7% (126/439). Treatment success (Eckardt score≤3) was achieved in 94.5% of 364 patients followed up for a median of 6 months (1-48 months), and the mean score was reduced significantly from 6.7∓1.5 before treatment to 1.2∓1.1 after the treatment (P<0.05). Logistic regression revealed that the year when POEM was performed and the approach of entry incision were two significant factors contributing to complications: with the year 2015 as the reference, the odds ratio (OR) was 9.454 (95% CI: 2.499-35.76) for the years before 2011, 2.177 (95% CI: 0.794-5.974) for 2012, 3.975 (95% CI: 1.904-8.298) for 2013, and 1.079 (95% CI: 0.601-1.940) for 2014; with the longitudinal entry incision as the reference, the OR was 0.369 (95% CI: 0.165-0.824) for inverted T entry incision and 0.456 (95% CI: 0.242-0.859) for transverse entry incision. The approach of myotomy was the significantly associated with symptomatic relapse: with full-thickness myotomy combined with indwelling an anti-reflux belt as the reference, the OR was 0.363 (95% CI: 0.059-2.250) for gradual full-thickness myotomy, 2.137 (95% CI: 0.440-10.378) for circular muscle myotomy, and 4.385 (95% CI: 0.820-23.438) for circular muscle myotomy in combination with balloon shaping; the recurrence rate was 0 with a full-thickness myotomy. CONCLUSION: The complication rates of POEM appears to decrease over time, and an inverted T entry incision is the best choice for controlling the complications. Gradual full-thickness myotomy is an excellent approach for treatment of achalasia in terms of the relapse rate, procedure time and the incidence of reflux esophagitis.

[Preliminary Investigation of Medicinal Plant Resources in Kangle County, Gansu Province].

OBJECTIVE: To study the medicinal plant resources and their diversity in Kangle County, Gansu Province, and to provide scientific basis on utilization and protection of the medicinal plant resources of the county. METHODS: By field survey, sample collection, taxonomic identification and data verification methods. RESULTS: There were 258 species, 65 families in existing medicinal plants, of which 43 species, 39 genera and 24 families were national protection medicinal plants. Dominant families were mainly Asteraceae and Rosaceae. In this area,the plants used whole herbs and roots ( or rhizomes) as medicinal materials represented 40.31% and 25.19% respectively, and antipyretic and rheumatism medicine accounted for 28.68% and 12.79% respectively. 12 medicinal plants were cultivated and the cultivated area was 3,000 hectares. CONCLUSION: However, the reserves of most medicinal plants are less enough and the resources are diminishing increasingly in recent years. So we should accelerate the research progress as well as developing and utilizing rationally on the premise of protection.

Circumcision plus antibiotic, anti-inflammatory, and α-blocker therapy for the treatment for chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized, multicenter trial.

PURPOSE: The purpose of the study was to evaluate the efficacy of circumcision combined with antibiotic, anti-inflammatory, and α-blocker therapy for the treatment for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: Subjects assigned to the circumcision group were given antibiotic, anti-inflammatory, and α-blocker medications and scheduled for surgery the same period in each site by study clinicians. Subjects assigned to the control group were asked to only take the same medications and remain uncircumcised until the end of the 3-month study period. The primary outcome was a reduction of at least four points on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). RESULTS: A total of 774 eligible participants underwent randomization, and the ratio of men with a decrease of at least four points on the total NIH-CPSI score from baseline to 12 weeks was 84.6% in the circumcision group and 68.5% in the control group (P < 0.001). Of the 713 men who completed the trial, the median total NIH-CPSI score decreased significantly from 21.0 ± 7.0 to 12.0 ± 8.0 (P < 0.001) in the circumcision group, and in the control group, the change was from 21.0 ± 8.0 to 15.0 ± 7.0 (P < 0.001). Comparison of the changes in the total and three subdomain NIH-CPSI scores over time revealed significant differences between the circumcision and control groups (P < 0.001). CONCLUSIONS: Our findings show that circumcision plus antibiotic, anti-inflammatory, and α-blocker therapy for CP/CPPS patients resulted in improved NIH-CPSI scores compared with medication therapy only.