A Nomogram Model Based on the Inflammation-Immunity-Nutrition Score (IINS) and Classic Clinical Indicators for Predicting Prognosis in Extranodal Natural Killer/T-Cell Lymphoma.

Background: Systemic inflammation, immunity, and nutritional status are closely related to patients' outcomes in several kinds of cancers. This study aimed to establish a new nomogram based on inflammation-immunity-nutrition score (IINS) to predict the prognosis of extranodal natural killer/T-cell lymphoma (ENKTL) patients. Methods: The clinical data of 435 patients with ENTKL were retrospectively reviewed and randomly assigned to training cohort (n=305) and validation cohort (n=131) at a ratio of 7:3. Cox regression analysis was employed to identify independent prognostic factors and develop a nomogram in the training cohort. Harrell's concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) curve were employed to assess the performance of the nomogram and compare it with traditional prognostic systems (PINK, IPI, KPI). Internal validation was performed using 1000 bootstrap resamples in the validation cohort. Kaplan-Meier survival analyses were conducted to compare the overall survival (OS) of patients in different risk groups. Results: In the training cohort, in addition to several classic parameters, IINS was identified as an independent prognostic factor significantly associated with the OS of patients. The nomogram established based on the independent prognostic indicators showed superior survival prediction efficacy, with C-index of 0.733 in the training cohort and 0.759 in the validation cohort compared to the PINK (0.636 and 0.737), IPI (0.81 and 0.707), and KPI (0.693 and 0.639) systems. Furthermore, compared with PINK, IPI, and IPI systems, the nomogram showed relatively superior calibration curves and more powerful prognostic discrimination ability in predicting the OS of patients. DCA curves revealed some advantages in terms of clinical applicability of the nomogram compared to the PINK, IPI, and IPI systems. Conclusion: Compared with traditional prognostic systems, the nomogram showed promising prospects for risk stratification in ENKTL patient prognosis, providing new insights into the personalized treatment.

A study of land use changes and its impacts on flood inundation in the Konkoure River Basin, Republic of Guinea.

Due to rising land development, mitigating the negative effects of land use change is becoming a problem. Understanding how land development affects flood inundation is critical for long-term water resource management. This study evaluates the land use change in the Konkoure River Basin and its impact on flood inundation. The land use changes were assessed using Landsat image (level 1) in August 2006 and August 2021. In addition, we used GIS and remote sensing applications to assess the degree of changes that took place in the Konkoure watershed. According to the findings, 32.16% of the total area became built-up areas, and 35.51% was converted to other land uses in Konkoure watershed. Konkoure's most significant change is that 29.50% of forest area transformed into built-up areas and other land uses. The rainfall-runoff-inundation model (RRI) based inundation of the Konkoure River Basin was compared to the MODIS extent between 31 August 2006 and 30 August 2021 flood events. Flood inundation variations in the Konkoure watershed were studied in terms of inundation area, peak inundation depth, runoff volume, and the infiltration rate. As a result, the flood inundation area increased from 139.98 to 198.72 km2 and the infiltration rate decrease from 7 to 5 mm/h. Moreover, we used flow duration curves (FDCs) to fully comprehend the streamflow processes. The result indicates that the Konkoure watershed has experienced flooding partly due to land use change.

Association between the Systemic Immune-Inflammation Index and Prostate Cancer.

The systemic immune-inflammation index (SII) is a novel and integrated marker that has not been studied with prostate cancer. We aimed to ascertain the association between SII levels and prostate cancer. We utilized data from the 1999-2010 cycles of the National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression analyses were conducted to evaluate the relationship between SII and prostate cancer. Additionally, subgroup analyses stratified by age, BMI, history of hypertension and diabetes were performed. A total of 8,020 participants were included in our analysis. After full adjustment, SII was associated with a 7% increased risk of prostate cancer (OR 1.07, 95% CI 0.99-1.15, p = 0.094). We further categorized SII values into three segments and found that individuals in the highest SII group had a 33% increased risk of prostate cancer than those in the tertile 1 group (OR 1.33; 95% CI 1.01-1.81; p = 0.044; P for trend = 0.046). In addition, a higher SII level was associated with a 137% increased risk of prostate cancer in the diabetes subgroup (OR 2.37; 95% CI 1.08-5.21; p = 0.031). The current study suggested that SII was positively associated with increased risks of prostate cancer. The SII might be an easily accessible indicator for identifying prostate cancer.

Network meta-analysis of the treatment safety and efficacy of different energy systems in prostate vaporization.

Many clinical trials and meta-analyses have examined vaporization with different energy instruments has been recognized by the American Urological Association (AUA) and the European Association of Urology (EAU) as a promising treatment for benign prostate hyperplasia. However, there is still a lack of evidence for a network comparison between different vaporization devices. The PubMed, Embase, Cochrane and Web of Science databases were searched to identify randomized controlled trials (RCTs) of different energy systems for prostate vaporization. Pairwise and network meta-analyses (NMA) were performed to analyze the outcome regarding surgery time, complications, short-term maximum urine flow rate (Qmax), and long-term Qmax. The Stata software was used for paired meta-analysis. A Bayesian NMA model with ADDIS software was applied to achieve the indirect comparison of different energy systems. Node-splitting analysis and inconsistency factors were used to test inconsistency for closed-loop indirect comparison. Fifteen studies were included in this study, involving three types of energy systems used in prostate vaporization: diode laser (wavelength: 980 nm, power: 200-300 W, mode: continuous), green-light laser (wavelength: 532 nm, power: 80-180 W, mode: continuous), and bipolar plasma vaporization (bipolar electrode, power: 270-280 W, mode: pulsed). In the conventional paired meta-analysis, significantly better short-term efficacy was found in green light laser vaporization, while no significant difference was detected in other parameters. According to the results of the NMA, a greenlight laser is recommended for prostate vaporization rather than the other two systems. When considering operation time, overall complications, short-term Qmax, and long-term Qmax, there were no significant differences among green-light laser vaporization, diode laser vaporization, and bipolar vaporization in BPH treatment. However, according to the probability ranking and benefit-risk analysis results, the green-light laser might be the best energy system for prostate vaporization in BPH treatment.

Smoking is an independent risk factor for stricture recurrence after the urethroplasty: a systematic review and meta-analysis

ABSTRACT Objective: To clarify the association between smoking and stricture recurrence after urethroplasty. Materials and Methods: Pubmed, Web of Science, Embase, and Cochrane databases were searched with keywords: "urethroplasty," "buccal mucosa graft urethroplasty," "oral mucosa graft urethroplasty," "excision and primary anastomosis urethroplasty," "urethral stricture recurrence" until July 1, 2022. Inclusion and exclusion criteria were based on PICOS principles. The quality of included studies was assessed by Newcastle-Ottawa Scale (N.O.S.) system. Hazard ratio (H.R.), odds ratio (OR), and relative risk (RR) with 95% confidence interval (CI) were extracted or re-calculated from included studies. Meta-analysis was performed with Stata 15.0 based on univariate and multivariate data separately. Sensitivity analysis was performed to test the stability of the meta-analysis. I2 was calculated to evaluate heterogeneity. Publication biases were assessed by Egger's and Begg's tests. Funnel plots of univariate analysis and multivariate analysis were also offered. Results: Twenty one studies with 6791 patients were involved in this meta-analysis. The analysis results of the two stages were consistent. In the univariate meta-analysis stage, 18 studies with 5811 patients were pooled, and the result indicated that smoking might promote stricture recurrence (RR=1.32, P=0.001). Based on the adjusted estimate, 11 studies with 3176 patients were pooled in the multivariate meta-analysis stage, and the result indicated that smoking might promote stricture recurrence (RR=1.35, P=0.049). There was no significant heterogeneity in both the univariate and multivariate stages. Conclusion: Our study demonstrates that smoking may prompt stricture recurrence after the urethroplasty. Quitting smoking may be a good option for patients undergoing urethroplasty surgery.

Smoking is an independent risk factor for stricture recurrence after the urethroplasty: a systematic review and meta-analysis.

OBJECTIVE: To clarify the association between smoking and stricture recurrence after urethroplasty. MATERIALS AND METHODS: Pubmed, Web of Science, Embase, and Cochrane databases were searched with keywords: "urethroplasty," "buccal mucosa graft urethroplasty," "oral mucosa graft urethroplasty," "excision and primary anastomosis urethroplasty," "urethral stricture recurrence" until July 1, 2022. Inclusion and exclusion criteria were based on PICOS principles. The quality of included studies was assessed by Newcastle-Ottawa Scale (N.O.S.) system. Hazard ratio (H.R.), odds ratio (OR), and relative risk (RR) with 95% confidence interval (CI) were extracted or re-calculated from included studies. Meta-analysis was performed with Stata 15.0 based on univariate and multivariate data separately. Sensitivity analysis was performed to test the stability of the meta-analysis. I2 was calculated to evaluate heterogeneity. Publication biases were assessed by Egger's and Begg's tests. Funnel plots of univariate analysis and multivariate analysis were also offered. RESULTS: Twenty one studies with 6791 patients were involved in this meta-analysis. The analysis results of the two stages were consistent. In the univariate meta-analysis stage, 18 studies with 5811 patients were pooled, and the result indicated that smoking might promote stricture recurrence (RR=1.32, P=0.001). Based on the adjusted estimate, 11 studies with 3176 patients were pooled in the multivariate meta-analysis stage, and the result indicated that smoking might promote stricture recurrence (RR=1.35, P=0.049). There was no significant heterogeneity in both the univariate and multivariate stages. CONCLUSION: Our study demonstrates that smoking may prompt stricture recurrence after the urethroplasty. Quitting smoking may be a good option for patients undergoing urethroplasty surgery.

Superior calyceal access vs. other calyceal access in percutaneous nephrolithotomy: A systematic review and meta-analysis.

Purpose: To evaluate the superior calyceal access's performance and safety in relation to other calyceal access during percutaneous nephrolithotomy (PCNL). Methods: The suggested reporting items for systematic reviews and meta-analysis were used to conduct this meta-analysis (PRISMA). To find pertinent studies for this meta-analysis, we searched PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI). Operation time and hospital stay are two secondary outcomes, whereas failed stone clearance and complication events are the two major outcomes. Utilizing Stata 15.0, RevMan 5.3, and R 4.0.2, relative data were extracted and evaluated. Results: This meta-analysis was based on 16 studies with 8,541 individuals. Pooled results suggested that superior calyceal access could offer fewer failed stone clearance [odds ratio (OR): 0.64, 95% confidence interval (CI), 0.47-0.88, P = 0.006] and lower additional puncture rate (OR: 0.35, 95% CI, 0.24-0.51, P < 0.001) than other calyceal access. No complication difference was found (OR: 1.10, 95% CI, 0.78-1.56, P = 0.57). Superior calyceal access could offer shorter operation time [standard mean difference (SMD): -0.57, 95% CI, -0.98 to -0.15, P = 0.007]. No hospital stay difference was found (SMD: 0.07, 95% CI, -0.09 to 0.22, P = 0.38). Large heterogeneity was detected in stone clearance comparison (I 2 = 71%, P < 0.001) and operation time (I 2 = 97%, P < 0.001). The stone clearance comparison also identified significant publication bias (P = 0.026). These defects weaken the credibility of the results. Conclusion: Superior calyceal access in PCNL may result in a higher stone clearance rate, a lower rate of subsequent punctures, and a faster operation duration with no increase in postoperative complications or hospital stay for kidney stone patients, despite the significant heterogeneity and publication bias. By conducting bigger randomized controlled studies, this discovery still has to be confirmed.

Network Meta-Analysis of the Treatment Safety and Efficacy of Different Lasers in Prostate Enucleation.

Purpose: This study aimed to compare different laser systems for the enucleation of benign prostate hyperplasia. Methods: Randomized controlled trials (RCTs) on different lasers for prostate enucleation were searched from PubMed, Embase, and CNKI databases. Pairwise and network meta-analyis (NMA) were performed to analyze the outcome regarding surgery time, complications, short-term postvoid residual (PVR), long-term PVR, and short-term international prostate symptom score (IPSS), long-term IPSS, short-term maximum urine flow rate (Qmax), and long-term Qmax. RevMan software was used for paired meta-analysis. Considering the variance uncertainty caused by the different source regions of RCTs and the different primary conditions of surgeons and patients, this study uses Bayesian NMA conducted with ADDIS software to compare different treatment methods indirectly. Node-splitting analysis was used to test inconsistency for closed-loop indirect comparison. Results: Nine studies were included in this study, involving four types of lasers: diode laser, holmium laser, thulium laser, and greenlight laser. In safety paired meta-analysis, holmium laser could bring more complication risk than thulium laser (odds ratio: 2.70, 95% confidential interval [CI]: 1.79-4.00, p < 0.001), and no other significant result was detected. In the efficacy comparisons, holmium laser could offer better postoperative long-term PVR (standardized mean difference [SMD]: -0.35, 95%CI: -0.62, -0.09, p = 0.011), better postoperative long-term IPSS (SMD: -0.30, 95%CI: -0.57, -0.04, p = 0.011), better postoperative short-term Qmax (SMD: 0.44, 95%CI: 0.17, 0.70, p = 0.001) compared with greenlight laser. According to the results of NMA, greenlight laser may bring more complication risks when applied to prostate enucleation than the other three lasers. Thulium laser may be the recommended laser system for prostate enucleation. Conclusion: Thulium laser may be the recommended laser system since it can bring less complication risk with comparable efficacy. More RCTs are still needed to validate this study.

Efficiency and Safety of Erector Spinae Plane Block in Percutaneous Nephrolithotomy: A Meta-Analysis Based on Randomized Controlled Trials.

OBJECTIVE: To pool the data of published studies using the meta-analysis method to provide high-level evidence for the use of ESPB in pain control after PCNL. METHODS: Two main stream databases, Pubmed and Embase, were used to identify potentially included studies. Primary outcomes included pain visual analogue scale (VAS) at different time points, intraoperative fentanyl use, time to first rescue analgesia and total tramadol or paracetamol consumption. Secondary outcome was defined as side effects of nausea and vomiting. RESULTS: Fourteen studies were identified after database searching and 6 studies were included in the quantitative analysis. Overall, ESPB could significantly reduce the postoperative short-time (1-2 hours) and long-time (24 hours) VAS values (MD: -1.35, 95%CI: -1.71, -1.00 for short-time and MD: -0.39, 95%CI: -0.61, -0.17 for long-time) without significant heterogeneity. When it came to other primary outcomes, ESPB still showed its advantages in less intraoperative fentanyl use and total tramadol/paracetamol consumption, and longer time to first rescue analgesia. Complications were similar between groups (OR:0.90, 95%CI:0.38-2.14). CONCLUSION: ESPB was an efficient and safe procedure for postoperative pain management in PCNL. More RCTs with larger sample size are still needed.

Comparison of Primary and Secondary Prophylaxis Using PEGylated Recombinant Human Granulocyte-Stimulating Factor as a Cost-Effective Measure in Malignant Neoplasms: A Multicenter Retrospective Study.

Purpose: The aim of the study was to evaluate the cost-effectiveness of PEGylated recombinant human granulocyte-stimulating factor (PEG-rhG-CSF) as a means of achieving primary and secondary prophylaxis against chemotherapy-induced neutropenia cancer cases. Methods: Individuals who underwent PEG-rhG-CSF therapeutics were monitored for 12 months, together with thorough examination of individual medical records for extracting medical care costs. Both prophylaxis-based therapeutic options (primary/secondary) were scrutinized for cost-effectiveness, using a decision-making analysis model which derived the perspective of Chinese payers. One-way and probabilistic sensitivity analyses were used to assess the robustness of the model. Results: In summary, 130 clinical cases treated using PEG-rhG-CSF prophylaxis were included in this study: 51 within the primary prophylaxis (PP) group and 79 within the secondary prophylaxis (SP) group. Compared with SP, PP-based PEG-rhG-CSF successfully contributed to a 14.3% reduction in febrile neutropenia. In general, PP was estimated to reduce costs by $4,701.81 in comparison to SP, with a gain of 0.02 quality-adjusted life years (QALYs). Equivalent results were found in differing febrile neutropenia (FN) risk subgroups. Sensitivity analyses found the model outputs to be most affected for the average time of hospitalization and for the cost of FN. Conclusion: From the perspective of Chinese payers, PP with PEG-rhG-CSF should be considered cost-effective compared to SP strategies in patients who received chemotherapy regimens with a middle- to high-risk of FN.

Oral Mucosa vs. Penile Skin Flap in Substitution Urethroplasty for Anterior Urethral Strictures: A Systematic Review and Meta-Analysis.

Background: The purpose of this study is to compare the effectiveness and safety of oral mucosa and penile skin flaps in the treatment of anterior urethral stricture. Methods: This meta-analysis was carried out according to the principle of preferred reporting items for systematic reviews and meta-analysis (PRISMA) and registered at PROSPERO (CRD42021277688). The Cochrane Library, PubMed, Embase, CKNI databases were searched and reviewed up to Sep 2021. Quality evaluation was performed with Newcastle-Ottawa Scale (NOS) system for non-randomized studies and Cochrane stools for randomized studies. Data synthesis was conducted with RevMan 5.4 software (Cochrane) and a Stata 15.0 environment (Stata Corpor, College Station, TX, USA). Results: After the research screening, eight studies (comprising 445 patients) were finally included in the quantitative analysis. In the success rate comparison, there was no significant difference between oral mucosa and penile skin flaps (oral mucosa vs. penile skin flap, Mantel-Haenszel statistic [M-H] fixed model, OR: 0.80, 95% CI: 0.47-1.34, P = 0.39). There was no significant difference in the post-operative complication comparison (oral mucosa vs. penile skin flap, Mantel-Haenszel statistic [M-H] fixed model, OR: 0.68, 95% CI: 0.40-1.16, P = 0.15). However, considering that the site of oral mucosa is far from the anterior urethra, it may have advantages in operation time through simultaneous operations (oral mucosa vs. penile skin flap, MD: -40.05, 95% CI: -79.42, -0.68, P = 0.046). Conclusion: When the oral mucosal graft was used in the anterior urethra urethroplasty, it had a similar success rate and post-operative complication rate, and oral mucosa substitution had a shorter operation time. This evidence-based medical research further supports the view that oral mucosa is the preferred substitution material for the anterior urethra urethroplasty.

ß-Adrenoceptors regulate matrix metalloproteinase expression in human urothelial cells under hydrostatic pressure.

The bladder wall is constantly subjected to intravesical pressure during the filling and voiding cycles. An imbalance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) under elevated intravesical pressure contributes to pathological changes in the bladder. To investigate the changes in human urothelial cells (HUCs) under elevated intravesical pressure, this study analyzed the effect of ß-adrenoceptor signaling on the expression of MMPs and TIMPs in HUCs exposed to pathological hydrostatic pressure (HP) (70 cm H2 O) for 6 hours. Quantitative polymerase chain reaction, Western blot analysis, and cell fluorescence staining were used to explore the effect of ß-adrenoceptor signaling on the expression of MMPs and TIMPs in HUCs after agonist and/or antagonist treatment. The expression levels of ß2 - and ß3 -adrenoceptor, MMP1, and MMP2 were greatly downregulated, while the expression of TIMP1 was greatly upregulated. Formoterol and BRL 37344, which are agonists of ß2 - and ß3 -adrenoceptor, respectively, significantly increased MMP1 and MMP2 expression under 70 cm H2 O. As a classic downstream pathway of ß2 - and ß3 -adrenoceptor, protein kinase A (PKA) signaling inhibited MMP1 and MMP2 expression by regulating cAMP response element binding protein (CREB) activity. MMP1 and MMP2 expression in HUCs under 70 cm H2 O was modified by ß2 - and ß3 -adrenoceptor via the PKA/CREB pathway. This outcome suggests that MMPs likely participate in the pathological effects of elevated intravesical pressure. The underlying mechanism of ß2 - and ß3 -adrenoceptor in elevated intravesical pressure was also revealed; this mechanism constitutes a new potential therapeutic target for partial bladder outlet obstruction.

Association between male pattern baldness and prostate disease: A meta-analysis.

BACKGROUND: Male pattern baldness (MPB) has been associated with an increased risk of prostate cancer (PC) as well as benign prostatic hyperplasia (BPH). We performed a meta-analysis to quantitatively determine the level of risk of PC and BPH in individuals with baldness. METHODS: A systematic literature search was conducted using several databases. We calculated pooled odds ratios (OR) and 95% CIs. RESULTS: In total, 17 studies comprising 68,448 participants were eligible for the meta-analysis and showed that MPB is associated with an increased risk of aggressive PC (OR = 1.59; 95% CI: 1.36-1.86; P<0.001) as well as BPH (OR = 1.26; 95% CI: 1.05-1.51; P = 0.01). There was statistically significant association between vertex baldness and PC (OR = 1.18; 95% CI: 1.05-1.32; P = 0.006). No statistically significant association between vertex, frontal plus vertex hair loss pattern, and BPH were identified. CONCLUSIONS: MPB is associated with an increased risk of PC and BPH. Despite our findings, further studies, preferably prospective cohort studies, are required to better elucidate these relationships and to advance knowledge in this field.