Minimally invasive versus open ileal ureter with ileocystoplasty: comparative outcomes and 5-year experience.

PURPOSE: To present the experience of ileal ureter with ileocystoplasty (IUC), and compare the outcomes of IUC in minimally invasive procedures to open procedures. PATIENTS AND METHODS: From December 2017 to April 2023, twenty patients underwent IUC in open or minimally invasive (including laparoscopic and robotic) procedures. The baseline characteristics, perioperative data and follow-up outcomes were collected. Success was defined as relief of clinical symptoms, stable postoperative serum creatine and absence of radiographic obstruction. The perioperative and follow-up outcomes of open procedures and minimally invasive procedures were compared. RESULTS: The etiology included pelvic irradiation (14/20), urinary tuberculosis (3/20) and surgical injury (3/20). Bilateral ureter strictures were repaired in 15 cases. The surgeries conducted consisted of open procedures in 9 patients and minimally invasive procedures in 11 patients. Compared to open procedures, minimally invasive surgeries had less median estimated blood loss (EBL) (100 ml vs. 300 min, p = 0.010) and shorter postoperative hospitalization (27 d vs. 13 d, p = 0.004). Two patients in the open group experienced grade 3 complications (sigmoid fistula and acute cholecystitis in one patient, and pulmonary embolism in another patient). Over a median follow-up period of 20.1 months, the median bladder functional capacity was 300 ml, with a 100% success rate of IUC. CONCLUSION: IUC is feasible in both open and minimally invasive procedures, with acceptable complications and a high success rate. Minimally invasive procedures can have less EBL and shorter postoperative hospitalization than open procedure. However, prospective studies with larger groups and longer follow-up are needed.

Ultrastretchable Electrically Self-Healing Conductors Based on Silver Nanowire/Liquid Metal Microcapsule Nanocomposites.

Stretchable conductive nanocomposites are essential for deformable electronic devices. These conductors currently face significant limitations, such as insufficient deformability, significant resistance changes upon stretching, and drifted properties during cyclic deformations. To tackle these challenges, we present an electrically self-healing and ultrastretchable conductor in the form of bilayer silver nanowire/liquid metal microcapsule nanocomposites. These nanocomposites utilize silver nanowires to establish their initial excellent conductivity. When the silver nanowire networks crack during stretching, the microcapsules are ruptured to release the encased liquid metal for recovering the electrical properties. This self-healing capability allows the nanocomposite to achieve ultrahigh stretchability for both uniaxial and biaxial strains, minor changes in resistance during stretching, and stable resistance after repetitive deformations. The conductors have been used to create skin-attachable electronic patches and stretchable light-emitting diode arrays with enhanced robustness. These developments provide a bioinspired strategy to enhance the performance and durability of conductive nanocomposites.

Robotic buccal mucosal graft ureteroplasty using combination of posterior-inlay and anterior-onlay technique.

Buccal mucosal graft (BMG) ureteroplasty, particularly with the anterior-onlay technique, shows promise for treating complex ureteral strictures. However, long and circumferential strictures remain challenging. This study aimed to present the surgical technique of the posterior-inlay and anterior-onlay technique in robotic ureteroplasty with a BMG (RU-BMG). A 37-year-old male patient with a medical background of failed laparoscopic ureteroplasty and multiple endourological interventions was admitted to our hospital. Preoperative anterograde and retrograde pyelography revealed a 5-cm ureteral stricture. During the surgical procedure, the ureteral posterior wall was insufficient to facilitate a complete posterior augmented anastomosis, resulting in a posterior defect subsequent to the partial posterior augmented anastomosis. Ultimately, a BMG was utilized to address the posterior defect initially, followed by anterior-onlay ureteroplasty with a BMG. The Foley catheter was removed 2 weeks after surgery, while the nephrostomy tube was clamped on postoperative day 14. The double-J stent was removed 3 months after surgery. The preoperative serum creatine was 102.9 µmol/L. The surgery was performed successfully within 240 min, with estimated blood loss of 100 mL. The postoperative hospitalization was 4 days. Throughout the 12-month follow-up period, no symptoms or complications were observed, with a serum creatine of 82.0 µmol/L. Computed tomography urography indicated relieved hydronephrosis. In conclusion, RU-BMG using a combination of posterior-inlay and anterior-onlay technique is safe and feasible in the management of ureteral stricture. More cases and longer follow-up for this procedure are needed for better perfection of this procedure.

Trends and disparities in sleep quality and duration in older adults in China from 2008 to 2018: A national observational study.

Background: Poor sleep status as a common concern is a risk factor for many health problems among older people. China with an aging society lacks relevant nationwide data on the sleep status among older people. Therefore, the purpose of this study was to investigate trends and disparities in sleep quality and duration among older adults, and exploring influencing factors of poor sleep in China between 2008 and 2018. Method: We used the four-waves data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Sleep quality and average sleep hours per day was investigated by using questionnaires in the CLHLS. We categorized sleep duration as three groups including ≤5 h (short duration), 5-9 h (normal duration), or ≥9 h (long duration) per day. Multivariate logistic regression models were used to examine trends and risk factors of poor sleep quality, short sleep duration, and long sleep duration. Results: The prevalence of poor sleep quality significantly increased from 34.87% in 2008 to 47.67% in 2018 (p < 0.05). Short sleep duration significantly increased from 5.29 to 8.37%, whereas long sleep duration decreased from 28.77 to 19.27%. Multivariate analysis showed that female sex, poor economic status, a greater number of chronic diseases, underweight, poor self-reported quality of life, and poor self-reported health were associated with poor sleep quality and short sleep duration (p < 0.05). Conclusion: Our findings revealed that older adults had increased prevalence of poor sleep quality and short sleep duration from 2008 to 2018. More attention should be paid to the increased sleep problems among older adults and early interventions should be made to improve sleep quality and guarantee enough sleep time.

A comparative study of attention mechanism based deep learning methods for bladder tumor segmentation.

BACKGROUND: Artificial intelligence aided tumor segmentation has been applied in various medical scenarios and showed effectiveness in helping physicians observe the potential malignant tissues. However, little research has been conducted for the cystoscopic image segmentation problem. METHODS: This paper provided a comprehensive comparison of various attention modules for improving the bladder tumor segmentation performance by utilizing the cystoscopic images from Peking University Third Hospital within 2017-2022. Furthermore, this paper presented an attention mechanism based cystoscopic images segmentation (ACS) model, which was featured by the following points: (1) A mixed attention module including both the channel and spatial attention modules was integrated in the encoder-decoder path, which helped to exploit the global information of the tumor area more effectively. (2) A guidance and fusion attention module was introduced in the skip connection part, facilitating the integration of the high-level semantic features with low-level fine-grained features and the discarding of irrelevant features. (3) An inception attention module was added to enhance the feature expression in the scale of pixel level, so as to better discriminate multi-scale targets. RESULTS: The proposed ACS model showed obviously better tumor segmentation performance than the compared models, with Dice of 82.7% and MIoU of 69% achieved. CONCLUSIONS: The proposed ACS model achieved significantly better diagnostic performance than the previous bladder tumor segmentation method based on U-Net. Our ACS model is expected to be a useful support tool to assist the tumor segmentation under cystoscopy.

Small Cell Carcinoma of the Ureter With Early Recurrence and Multiple Metastases Shown on 18 F-FDG PET/CT.

ABSTRACT: Primary small cell carcinoma of the ureter is an extremely rare malignancy with a poor prognosis. We present rare interesting 18 F-FDG PET/CT images of primary small cell carcinoma of the ureter in a 37-year-old man with early recurrence and multiple metastases 2 months after laparoscopic left nephroureterectomy and pelvic tumor resection. PET/CT showed high FDG-avid lesions in the pelvis, peritoneum, the left posterior wall of the bladder, and in the right lung, providing important value in the detection of recurrence and systemic metastases.

Nuclear medicine radiomics in digestive system tumors: Concept, applications, challenges, and future perspectives.

Radiomics aims to develop novel biomarkers and provide relevant deeper subvisual information about pathology, immunophenotype, and tumor microenvironment. It uses automated or semiautomated quantitative analysis of high-dimensional images to improve characterization, diagnosis, and prognosis. Recent years have seen a rapid increase in radiomics applications in nuclear medicine, leading to some promising research results in digestive system oncology, which have been driven by big data analysis and the development of artificial intelligence. Although radiomics advances one step further toward the non-invasive precision medical analysis, it is still a step away from clinical application and faces many challenges. This review article summarizes the available literature on digestive system tumors regarding radiomics in nuclear medicine. First, we describe the workflow and steps involved in radiomics analysis. Subsequently, we discuss the progress in clinical application regarding the utilization of radiomics for distinguishing between various diseases and evaluating their prognosis, and demonstrate how radiomics advances this field. Finally, we offer our viewpoint on how the field can progress by addressing the challenges facing clinical implementation.

A rectal gastrointestinal stromal tumor case accompanied by elevated CEA mimicking rectal carcinoma on 18F-FDG PET/CT.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm arising from gastrointestinal tract and can be benign or malignant. Rectal GISTs are rare and have poor prognosis. We here reported an older male who presented with features of distending discomfort in the rectum and pain in the anus due to a large rectal tumor. Physical examinations detected a mass in the rectum without blood staining on the gloved finger. Carcinoembryonic antigen (CEA) was found to be slightly elevated and the prostate-specific antigen level was normal. 18F-FDG PET/CT showed a soft tissue density mass at the bottom of the pelvic, with an unclear boundary to the surroundings with the significantly increased FDG uptake (SUVmax 17.5). Although a rectal carcinoma was suspected based on the finding of PET/CT and CEA, the histopathological examination confirmed the diagnosis of the malignant GIST of the rectum. The patient was then treated with imatinib and on follow-up regularly. In this case, 18F-FDG PET/CT shows the advantage of visualizing both primary and metastatic lesions and provides valuable information for the diagnosis, staging, evaluation, and prognosis of GIST.