Management of Nontraumatic Spontaneous Renal Hemorrhage (Wünderlich Syndrome) through Robotic-Assisted Laparoscopic Nephrectomy: A Case Series.

BACKGROUND Wünderlich syndrome (WS) is a rare diagnosis of nontraumatic spontaneous renal hemorrhage into the subcapsular, perirenal, or pararenal spaces. Prompt and effective intervention is necessary for an accurate pathological diagnosis and preservation of life. In the current literature, open surgery is the primary option when conservative treatment fails, but there can be serious trauma and corresponding consequences. Herein, we present 3 cases of Wünderlich syndrome managed by robot-assisted laparoscopic nephrectomy via a retroperitoneal approach. CASE REPORT Patient 1 was a 44-year-old woman with right flank pain for 6 h. Patient 2 was a 53-year-old woman with a history of diabetes who had pain in her right flank pain and nausea for 1 day. Patient 3 was a 45-year-old man with left flank pain for 1 day. All cases of WS were confirmed by CT. All 3 patients were treated with retroperitoneal robot-assisted nephrectomy after conservative treatment failed. Pathological examination confirmed that patient 1 had angiomyolipoma, and patients 2 and 3 had renal clear cell carcinoma. At the 9-month follow-up, renal function was good and no evidence of recurrence or metastasis has been detected. CONCLUSIONS These cases have highlighted the importance of the clinical history and imaging findings in the diagnosis of Wünderlich syndrome, and show that rapid management can be achieved using robot-assisted laparoscopic nephrectomy. However, it is crucial to have a skilled surgical team and adequate preoperative preparation.

Modified hood technique for single-port robot-assisted radical prostatectomy contributes to early recovery of continence.

Background and purpose: Urinary incontinence is one of the common side effects of robot-assisted radical prostatectomy (RARP). Here, we described the modified Hood technique for single-port RARP (sp-RARP) and assessed the interest of this new technique for early continence recovery. Methods: We retrospectively reviewed 24 patients who underwent sp-RARP modified hood technique from June 2021 to December 2021. The pre-and intraoperative variables, postoperative functional and oncological outcomes of patients were collected and analyzed. The continence rates were estimated at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal. Continence was defined as wearing no pad over a 24 h period. Results: Mean time of operation and estimated blood loss were 183 min and 170 ml, respectively. The postoperative continence rates at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal were 41.7%, 54.2%, 75.0%, 91.7% and 95.8%, respectively. There were two patients who detected positive surgical margins and no patients observed complications requiring further treatment. Conclusion: The modified hood technique is a safe and feasible method that provides better outcomes in terms of early return of continence, without increasing estimated blood loss and compromising oncologic outcomes.

Stabilizing FASnI3-based perovskite light-emitting diodes with crystallization control.

The toxicity of lead presents a critical challenge for the application of perovskite optoelectronics. Lead-free perovskite solar cells were achieved with formamidinium tin iodide (FASnI3) perovskites, exhibiting decent power-conversion efficiencies (PCEs) of up to 14%, with >98% of the initial PCE retained after 3000 h of storage. However, when employed in light-emitting applications, FASnI3-based perovskite LEDs (PeLEDs) show limited stability, with T50 lifetimes of up to 0.25 h at 10 mA cm-2. Here, we improve the stability of FASnI3-based PeLEDs through the inclusion of a two-dimensional precursor phenethylamine iodide (PEAI), allowing controlled crystallization of the mixed-dimensional perovskite emitters. The density of defects is found to be reduced, accompanied by the suppression of oxidation from Sn2+ to Sn4+. Using an optimized perovskite composition, we achieve an EQE of 1.5% (a ∼10-fold improvement over the control devices), a maximum radiance of 145 W sr-1 m-2, and a record-long T50 lifetime of 10.3 h at 100 mA cm-2 for FASnI3-based PeLEDs. Our results illuminate an alternative path toward lead-free PeLED applications.

Effects of Compression and Porosity Gradients on Two-Phase Behavior in Gas Diffusion Layer of Proton Exchange Membrane Fuel Cells.

Water management within the gas diffusion layer (GDL) plays an important role in the performance of the proton exchange membrane fuel cell (PEMFC) and its reliability. The compression of the gas diffusion layer during fabrication and assembly has a significant impact on the mass transport, and the porosity gradient design of the gas diffusion layer is an essential way to improve water management. In this paper, the two-dimensional lattice Boltzmann method (LBM) is applied to investigate the two-phase behavior in gas diffusion layers with different porosity gradients under compression. Compression results in an increase in flow resistance below the ribs, prompting the appearance of the flow path of liquid water below the channel, and liquid water breaks through to the channel more quickly. GDLs with linear, multilayer, and inverted V-shaped porosity distributions with an overall porosity of 0.78 are generated to evaluate the effect of porosity gradients on the liquid water transport. The liquid water saturation values within the linear and multilayer GDLs are significantly reduced compared to that of the GDL with uniform porosity, but the liquid water within the inverted V-shaped GDL accumulates in the middle region and is more likely to cause flooding.

Construction and Validation of a Novel Cuproptosis-Related Seven-lncRNA Signature to Predict the Outcomes, Immunotherapeutic Responses, and Targeted Therapy in Patients with Clear Cell Renal Cell Carcinoma.

Background: Cuproptosis was recently recognized as a novel form of cell death, linked closely to the occurrence and progression of cancer. We aimed to identify prognostic cuproptosis-related long noncoding RNAs (lncRNAs) and build a risk signature to predict the prognosis and treatment responses of clear cell renal cell carcinoma (ccRCC) in this work. Methods: LASSO-Cox regression was conducted to construct the signature based on prognostic cuproptosis-related lncRNAs (CR-lncRNAs). The signature's reliability and sensitivity were assessed by the Kaplan-Meier survival analysis and receiver operating characteristic analysis. External validation was performed via data from the International Cancer Genome Consortium database. On the basis of CR-lncRNAs, an lncRNA-microRNA-mRNA regulatory network was created, and functional enrichment analysis was used to investigate the underlying biological roles of these genes. In addition, the relationship between the risk signature and immunotherapy and targeted therapy responses was examined. Finally, the expression levels of seven candidate lncRNAs between tumor and normal cells were compared in vitro using quantitative real-time PCR. Results: A seven-CR-lncRNA risk signature was constructed, which showed a stronger potential for survival prediction than standard clinicopathological features in patients with kidney cancer. Functional enrichment analysis showed that the CR-lncRNA risk signature was enriched in ion transport-related molecular functions as well as various immune-related biological processes. Furthermore, we discovered that individuals in the high-risk group were more likely than those in the low-risk group to respond to immunotherapy and targeted therapies with medications like sunitinib and pazopanib. Finally, quantitative real-time PCR revealed that the expression levels of seven candidate lncRNAs differed significantly between RCC and healthy kidney cells. Conclusion: In summary, we generated a CR-lncRNA risk signature that may be utilized to predict outcomes in patients with ccRCC and responsiveness to immunotherapy and targeted treatment, potentially serving as a reference for clinical personalized medicine.

How many cases are required to achieving early proficiency in purely off-clamp robot-assisted partial nephrectomy?

Background and purpose: Off-clamp robot-assisted partial nephrectomy (Offc-RAPN) is a technically challenging procedure that can effectively avoid renal ischemia owing to the absence of hilar vessel preparation and clamping. However, data on the learning curve (LC) for this technique are limited. The purpose of this study was to assess the LC of Offc-RAPN and compare the perioperative outcomes between different learning phases. Methods: This retrospective study included 50 consecutive patients who underwent purely Offc-RAPN between January 2022 and April 2023. Multidimensional cumulative sum (CUSUM) analysis method was used to assess LC. Spearman's correlation and LOWESS analysis were performed to analyze the continuous variables of perioperative outcomes. Baseline characteristics and perioperative outcomes were compared using χ2-test, t-test and U-test. Results: CUSUM analysis identified two LC phases: phase I (the first 24 cases) and phase II (the subsequent 26 cases). Phase II showed significant reductions in mean operative time (133.5 vs. 115.31 min; p = 0.04), mean console time (103.21 vs. 81.27 min; p = 0.01), and mean postoperative length of stay (5.33 vs. 4.30 days; p = 0.04) compared to phase I. However, no significant differences were observed in other perioperative outcomes or baseline characteristics between the two LC phases. Conclusions: Offc-RAPN performed by a surgeon with experience in laparoscopic and robotic surgeries achieved early proficiency in 24 cases. Moreover, Offc-RAPN alone is safe and feasible even in the initial phase of the LC for an experienced surgeon.

Tuning Precursor-Amine Interactions for Light-Emitting Lead Bromide Perovskites.

Organic additives with amino moieties are effective in improving the properties of archetypical formamidinium (FA)-based hybrid perovskites for photovoltaic and light-emitting applications. However, a detailed understanding of how amino additives affect the perovskite materials is lacking, impeding developments in this area. Here, by investigating the interactions of lead bromide perovskite precursors with phenethylamine (PEA) and its derivatives with small variations in chemical structure, we reveal that only the secondary amine (N-methyl-2-phenylethylamine (N-PEA)) results in strengthened hydrogen bonds with FABr in precursor solutions, allowing the formation of high-quality perovskite films. The photoluminescence quantum efficiencies (PLQEs) of the resultant perovskite samples on widely used charge-transport substrates are retained to 82% of their original values, indicating reduced sensitivity to interfacial nonradiative traps critical to device applications. Using a standard device structure, green perovskite light-emitting diodes with peak external quantum efficiencies of 12.7% at ∼500 cd m-2 and operational lifetimes (T50) exceeding 10 h (at 100 cd m-2) are obtained.

Case report and literature review: Robot-assisted laparoscopic left renal mucinous cystadenocarcinoma radical nephrectomy.

Background: Mucinous cystadenocarcinoma (MC) of the kidney is a rare renal epithelial tumor originating from the renal pelvic urothelium. There are only a few published reports on MC. Due to its rare and unknown tissue origin, its diagnosis is difficult which almost can be diagnosed through the pathological method. Case presentation: In this case report, we report a female patient whose chief complaint was low back pain lasting for one month. The three-dimensional computed tomography scan of the urinary system detected approximately 7 cm of a left renal cystic mass. The renal cystic mass was diagnosed as MC after robot-assisted laparoscopic radical nephrectomy. The MC originated from the kidney after completing colorectal adenocarcinoma and ovarian adenocarcinoma. Conclusions: We reported a case of MC of the kidney which was a rare renal tumor. We not only aimed to present an unusual case of MC and review the previous literature on its pathology and differential diagnosis, but also used new method to treat this type of tumor.

Effects of Hydration and Temperature on the Microstructure and Transport Properties of Nafion Polyelectrolyte Membrane: A Molecular Dynamics Simulation.

To investigate the effects of temperature and hydration on the microstructure of polymer electrolyte membrane and the transport of water molecules and hydronium ions, molecular dynamics simulations are performed on Nafion 117 for a series of water contents at different temperatures. The interactions among the sulfonate groups, hydronium ions, and water molecules are studied according to the analysis of radial distribution functions and coordination numbers. The sizes and connectivity of water clusters are also discussed, and it is found that the hydration level plays a key role in the phase separation of the membrane. However, the effect of the temperature is slight. When the water content increases from 3.5 to 16, the size of water clusters in the membrane increases, and the clusters connect to each other to form continuous channels for diffusion of water molecules and hydronium ions. The diffusion coefficients are estimated by studying the mean square displacements. The results show that the diffusion of water molecules and hydronium ions are both enhanced by the increase of the temperature and hydration level. Furthermore, the diffusion coefficient of water molecules is always much larger than that of hydronium ions. However, the ratio of the diffusion coefficient of water molecules to that of hydronium ions decreases with the increase of water content.

Germanium-lead perovskite light-emitting diodes.

Reducing environmental impact is a key challenge for perovskite optoelectronics, as most high-performance devices are based on potentially toxic lead-halide perovskites. For photovoltaic solar cells, tin-lead (Sn-Pb) perovskite materials provide a promising solution for reducing toxicity. However, Sn-Pb perovskites typically exhibit low luminescence efficiencies, and are not ideal for light-emitting applications. Here we demonstrate highly luminescent germanium-lead (Ge-Pb) perovskite films with photoluminescence quantum efficiencies (PLQEs) of up to ~71%, showing a considerable relative improvement of ~34% over similarly prepared Ge-free, Pb-based perovskite films. In our initial demonstration of Ge-Pb perovskite LEDs, we achieve external quantum efficiencies (EQEs) of up to ~13.1% at high brightness (~1900 cd m-2), a step forward for reduced-toxicity perovskite LEDs. Our findings offer a new solution for developing eco-friendly light-emitting technologies based on perovskite semiconductors.

Refractive index and pulse broadening characterization using oil immersion and its influence on three-photon microscopy excited at the 1700-nm window.

Three-photon microscopy excited at the 1700-nm window enables deep-tissue penetration. However, the refractive indices of commonly used immersion oils, and the resultant pulse broadening are not known, preventing imaging optimization. Here, we demonstrate detailed characterization of the refractive index, pulse broadening and distortion for excitation pulses at this window for commonly used immersion oils. On the physical side, we uncover that absorption, rather than material dispersion, is the main cause of pulse broadening and distortion. On the application side, comparative three-photon imaging results indicate that 1600-nm excitation yields 5 times higher three-photon signal than 1690-nm excitation.

The prevalence and risk factors of stroke in patients with chronic schizophrenia.

OBJECTIVE: To investigate the stroke risk and risk factors in patients with chronic schizophrenia. PATIENTS AND METHODS: This study was a large-sample, cross-sectional survey. A total of 363 patients with chronic schizophrenia were selected from the Changping Traditional Chinese Medicine Hospital, Beijing, in August 2014. The patients were divided into either stroke group or control group based on the presence of stroke. Clinical evaluation included positive and negative syndrome scale assessment and a detailed questionnaire to collect the general information and disease-related conditions. RESULTS: The prevalence of stroke was 16.5% (60 cases). Stroke and control groups showed a significant difference in age, sex, smoking, combined medication, doses, negative factor score in positive and negative syndrome scale, body mass index, waist circumference, and systolic blood pressure. Multivariate analysis showed that a number of factors are significantly related to stroke, including age, sex, smoking, combined medication, doses, body mass index, and systolic blood pressure. CONCLUSION: The prevalence of stroke is relatively higher in Chinese patients with chronic schizophrenia. Chronic schizophrenia patients are more likely to suffer from stroke; meanwhile, a number of risk factors were identified, including old age, female sex, smoking history, combined medication with a variety of drugs, high doses, obesity, and high blood pressure.

Factors associated with decreased bone mineral density in postmenopausal women with schizophrenia.

OBJECTIVE: This study examined the risk factors for decreased bone mineral density (BMD) in postmenopausal women with schizophrenia. METHODS: Cluster sampling method was adopted in this large-sample, cross-sectional study. A total of 219 postmenopausal female inpatients with schizophrenia were selected and interviewed in Beijing. The average age of the patients was 60.4±7.0 years. Clinical assessment instruments included the Positive and Negative Syndrome Scale (PANSS) and a questionnaire with detailed general information and disease-related investigations. Laboratory measurements included prolactin (PRL), estradiol, progesterone, thyroid stimulating hormone, FT3, and FT4. BMD testing was performed by dual-energy X-ray absorptiometry. RESULTS: The prevalence of osteoporosis or osteopenia was 66.2% (n=145). Decreased BMD was associated with age, illness duration, therapeutic dose (equivalent chlorpromazine dose), treatment duration, PANSS-negative scores, body mass index (BMI), daily exercises (min/d), drinking (unit/wk), PRL, and estradiol. Multiple logistic regression analysis revealed that age, treatment duration, PANSS-negative score, BMI, and PRL were significantly associated with decreased BMD. CONCLUSION: Prevalence of BMD loss was higher in Chinese postmenopausal women with schizophrenia compared to the normal BMD group. A combination of demographic and clinical factors play important roles in determining decreased BMD, including older age, longer treatment duration, more PANSS-negative scores, higher BMI, and higher PRL level.

[Study on distribution of phosphorus in surface sediments of the Yellow Sea and the East China Sea].

Different phosphorus compositions (TP, IP and OP) were determined in surface sediments of the Yellow Sea (YS) and the East China Sea (ECS),sampled from two cruises between March and June, 2011. The results showed that, contents of TP were from 10.50 micromol x g(-1) to 24.10 micromol x g(-1), IP ranged from 7.14 micromol x g(-1) to 17.10 micromol x g(-1) was the major phosphorus speciation accounting for more than 70% in TP. The percent of IP in TP at most stations was between 50% and 90% , only four stations which lied in the East China Sea with the percent was over 90%. The dominant factors affecting the phosphorus concentration and distribution in surface sediments were anthropogenic activities, sources of input materials, grain size, depositional environments and hydrological conditions. TP burial flux (TPBF) that appeared regional differences was affected by sedimentation rates, porosity and oxygen in bottom water, but TP content and sedimentation rates were crucial factors for TPBF.

[Distribution and air-sea fluxes of methane in the Yellow Sea and the East China Sea in the spring].

A survey was carried out in the Yellow Sea and the East China Sea from March 17 to April 06 of 2011. Dissolved CH4 in various depths were measured and sea-to-air fluxes were estimated. Methane concentrations in surface and bottom waters ranged between 2.39-29.67 nmol x L(-1) and 2.63-30.63 nmol x L(-1), respectively. Methane concentrations in bottom waters were slightly higher than those in surface waters, suggesting the existence of methane source in bottom waters or sediments. The horizontal distribution of dissolved CH4 showed a decrease from the river mouth to the open sea, and was influenced by the freshwater discharge and the Kuroshio intrusion. Surface methane saturations ranged from 93%-1 038%. Sea to air CH4 fluxes were (2.85 +/- 5.11) micromol x (m2 x d)(-1) (5.18 +/- 9.99) micromol x (m2 x d)(-1) respectively, calculated using the Liss and Merlivat (LM86), the Wanninkhof (W92) relationships and in situ wind speeds, and estimated emission rates of methane from the East China Sea and the Yellow Sea range from 7.05 x 10(-2) - 12.0 x 10(-2) Tg x a(-1) and 1.17 x 10(-2) - 2.20 x 10(-2) Tg x a(-1), respectively. The Yellow Sea and East China Sea are the net sources of atmospheric methane in the spring.

[Distributions and pollution status of heavy metals in the suspended particles of the estuaries and coastal area of eastern Hainan].

The distributions and pollution status of heavy metals in the suspended particles were investigated in the Wanquan and Wenchang/Wenjiao estuaries and the coastal area of eastern Hainan in July 2008. The concentrations of metal elements (Al, Fe, Mn, Cr, Cu, Ni, V, Zn) were determined by ICP-AES after microwave digestion. Multivariate statistical methods (e. g. correlation analysis and principal factor analysis) were used to discuss the major factors controlling the variability of heavy metal concentrations and the pollution status in those areas. There was an obvious variability in particulate metal concentrations from upstream to estuary of both rivers. The concentrations first increased with increasing salinity and then decreased with further increase of the salinity; the concentrations were slightly higher at the coastal area in the east. The variability of particulate metal concentrations reduced significantly after the normalization by Al, indicating the effects of grain size. Enrichment factor calculation results showed that there was heavy metal pollution (especially Cu, Ni) in the Wenchang/Wenjiao River and estuary, while the situation in Wanquan River remained at pristine level. Concentrations of particulate metals in the study area were mainly controlled by source geology and provenance, as well as contamination from the discharge of waste water and biological activity.

CD24, COX-2, and p53 in epithelial ovarian cancer and its clinical significance.

Epithelial ovarian cancer (EOC) prognosis is associated with International Federation of Gynecology and Obstetrics (FIGO) staging, cancer cell classification, patient age, and residual tumor size. However, the molecular markers for predicting EOC prognosis remain to be explored. In this study, we investigated the expression of CD24, COX-2, and p53 in EOC, and their relationships to clinical prognosis. We found that the expression of CD24 was detected in the cell membrane in 90.6 percent (58/64) of EOC cases and in the cytoplasm in 54.7 percent (35/64) of EOC cases; 78.6 percent (11/14) cases of borderline tumors had CD24-positive staining in the cell membrane. All 9 cases of benign tumors were negative for CD24 staining. Expression of CD24 correlated with the nuclear expression of p53, but not with the expression of COX-2. Overexpression of CD24 is an independent factor associated with tumor metastasis, a low survival rate, and a short survival time. Our results suggest that CD24 may be a valuable molecular marker for predicting prognoses of patients with EOC.

[Loss of heterozygosity at chromosome 3p14, 25 in serum DNA from ovarian cancer patients].

OBJECTIVE: Investigate the frequency of loss of heterozygosity (LOH) at chromosome arm the short arm chromosome 3p14, 25 in the serum DNA from ovarian cancer and its clinical application. METHODS: Thirty-eight ovarian cancer serum samples with 18 corresponding tumor tissues and 8 benign ovarian tumors were obtained, and DNA samples extracted from serum and tissue were examined for 3p14, 25 LOH by using of polymerase chain reaction with four polymorphic microsatellite markers (D3S1029, D3S1228, D3S1300, D3S1481). RESULTS: Matched serum and tissue DNAs from 18 ovarian cancer patients showed significant concordance of 3p14, 25 LOH (P < 0.05). 3p14, 25 LOH in at least one of four loci occurred in 29 out of 38 (76%) serum samples, while 17 serum samples (45%) exhibited LOH at more than one locus. According to International Federation of Gynecology and Obstetrics (FIGO) staging, there was a trend that the rate of LOH was higher in advanced stages, and the frequency of loss in stage II, III, IV was 2/4, 78%, 8/9 respectively. It was also found that the number of microsatellite markers with 3p14, 25 LOH was increased with tumor progressed. No significant association of pathological types with LOH in serum DNA could be demonstrated except at locus D3S1029. CONCLUSIONS: Since the strong correlation of 3p14, 25 LOH between serum DNA and tumor tissue DNA, as well as the frequency of 3p14, 25 LOH associated with malignancy of ovarian cancer, it is suggested that detection of serum DNA 3p14, 25 LOH may be used as a molecular marker for staging and monitoring human ovarian cancer.