Patterns of lymph node metastasis in level IIB and contralateral level VI for papillary thyroid carcinoma with pN1b and safety of low collar extended incision for neck dissection in level II.

OBJECTIVE: To explore relevant clinical factors of level IIB and contralateral level VI lymph node metastasis and evaluate the safety of low-collar extended incision (LCEI) for lymph node dissection in level II for papillary thyroid carcinoma (PTC) with pN1b. METHOD: A retrospective analysis was performed on 218 patients with PTC with pN1b who were treated surgically in the Head and Neck Surgery Center of Sichuan Cancer Hospital from September 2021 to May 2022. Data on age, sex, body mass index (BMI), tumor location, maximum tumor diameter, multifocality, Braf gene, T staging, surgical incision style, and lymph node metastasis in each cervical subregion were collected. The chi-square test was used for comparative analysis of relevant factors. All statistical analyses were completed by SPSS 24 software. RESULT: Each subgroup on sex, age, BMI, multifocality, tumor location, extrathyroidal extension, Braf gene, and lymphatic metastasis in level III, level IV, and level V had no significant difference in the positive rate of lymph node metastasis in level IIB (P > 0.05). In contrast, patients with bilateral lateral cervical lymphatic metastasis were more likely to have level IIB lymphatic metastasis than those with unilateral lateral cervical lymphatic metastasis, with a statistically significant difference (P = 0.000). In addition, lymph node metastasis in level IIA was significantly associated with lymph node metastasis in level IIB (P = 0.001). After multivariate analysis, lymph node metastasis in level IIA was independently associated with lymph node metastasis in level IIB (P = 0.010). The LCEI group had a similar lymphatic metastasis number and lymphatic metastasis rate in both level IIA and level IIB as the L-shaped incision group (P > 0.05). There were 86 patients with ipsilateral central lymphatic metastasis (78.2%). Patients with contralateral central lymphatic metastasis accounted for 56.4%. The contralateral central lymphatic metastasis rate was not correlated with age, BMI, multifocality, tumor invasion, or ipsilateral central lymphatic metastasis, and there was no significant difference (P > 0.05). The contralateral central lymphatic metastasis in males was slightly higher than that in females, and the difference was statistically significant (68.2% vs. 48.5%, P = 0.041). CONCLUSION: Lymphatic metastasis in level IIA was an independent predictor of lymphatic metastasis in level IIB. When bilateral lateral cervical lymphatic metastasis or lymph node metastasis of level IIA is found, lymph node dissection in level IIB is strongly recommended. When unilateral lateral cervical lymphatic metastasis and lymphatic metastasis in level IIA are negative, lymph node dissection in level IIB may be performed as appropriate on the premise of no damage to the accessory nerve. LCEI is safe and effective for lymph node dissection in level II. When the tumor is located in the unilateral lobe, attention should be given to contralateral central lymph node dissection because of the high lymphatic metastasis rate.

Survivin knockdown alleviates pathological hydrostatic pressure-induced bladder smooth muscle cell dysfunction and BOO-induced bladder remodeling via autophagy.

Aim: Bladder outlet obstruction (BOO) leads to bladder wall remodeling accompanying the progression from inflammation to fibrosis where pathological hydrostatic pressure (HP)-induced alteration of bladder smooth muscle cells (BSMCs) hypertrophic and excessive extracellular matrix (ECM) deposition play a pivotal role. Recently, we have predicted survivin (BIRC5) as a potential hub gene that might be critical during bladder fibrosis by bioinformatics analyses from rat BOO bladder, but its function during BOO progression remains unknown. Here, we investigated the role of survivin protein on bladder dysfunction of BOO both in vitro and in vivo. Methods: Sprague-Dawley female rats were divided into three groups: control group, BOO group, and BOO followed by the treatment with YM155 group. Bladder morphology and function were evaluated by Masson staining and urodynamic testing. To elucidate the underlying mechanism, hBSMCs were subjected to pathological HP of 200 cm H2O and co-cultured with the presence or absence of survivin siRNA and/or autophagy inhibitor 3-MA. Autophagy was evaluated by the detection of Beclin1 and LC3B-II expression, proliferation was conducted by the EdU analysis and PCNA expression, and fibrosis was assessed by the examination of Col 1 and Fn expression. Results: BOO led to a gradual alteration of hypertrophy and fibrosis of the bladder, and subsequently induced bladder dysfunction accompanied by increased survivin expression, while these histological and function changes were attenuated by the treatment with YM155. HP significantly increased survivin expression, upregulated Col1 and Fn expression, enhanced proliferation, and downregulated autophagy markers, but these changes were partially abolished by survivin siRNA treatment, which was consistent with the results of the BOO rat experiment. In addition, the anti-fibrotic and anti-proliferative effects of the survivin siRNA treatment on hBSMCs were diminished after the inhibition of autophagy by the treatment with 3-MA. Conclusion: In summary, the upregulation of survivin increased cell proliferation and fibrotic protein expression of hBSMC and drove the onset of bladder remodeling through autophagy during BOO. Targeting survivin in pathological hBSMCs could be a promising way to anti-fibrotic therapeutic approach in bladder remodeling secondary to BOO.

Application of 3D Bioprinting in Urology.

Tissue engineering is an emerging field to create functional tissue components and whole organs. The structural and functional defects caused by congenital malformation, trauma, inflammation or tumor are still the major clinical challenges facing modern urology, and the current treatment has not achieved the expected results. Recently, 3D bioprinting has gained attention for its ability to create highly specialized tissue models using biological materials, bridging the gap between artificially engineered and natural tissue structures. This paper reviews the research progress, application prospects and current challenges of 3D bioprinting in urology tissue engineering.

Does Listening to Music Improve Pain Perception and Anxiety in Patients Undergoing Cystoscopy: A Meta-Analysis.

Objective: To identify the effect of music on outpatient-based cystoscopy. Methods: We systematically reviewed the effect of music on all reported outpatient for cystoscopy and extracted data from randomized trials from inception to February 3, 2021, with no language restrictions. The analysis was completed via STATA version 14.2. Results: A total of 27 studies were initially identified, and 6 articles containing 639 patients were included in the final analysis. In terms of post-procedural pain perception, a pooled analysis of 6 articles containing 639 patients showed that music seems to improve discomfort in patients who undergo cystoscopy (WMD: -1.72; 95%CI: -2.37 to -1.07). This improvement remained consistent in patients undergoing flexible cystoscopy (FC) (WMD: -1.18; 95% CI: -1.39 to -0.98) and rigid cystoscopy (RC) (WMD: -2.56; 95% CI: -3.64 to -1.48). The music group also had less post-procedural anxiety than those in no music group during cystoscopy (WMD: -13.33; 95% CI: -21.61 to -5.06), which was in accordance with the result of FC (WMD: -4.82; 95% CI: -6.38 to -3.26) than RC (WMD: -26.05; 95% CI: -56.13 to 4.04). Besides, we detected a significantly lower post-procedural heart rate (HR) in the music group than no music group during cystoscopy (WMD: -4.04; 95% CI: -5.38 to -2.71), which is similar to the results of subgroup analysis for FC (WMD: -3.77; 95% CI: -5.84 to -1.70) and RC (WMD: -4.24; 95% CI: -5.98 to -2.50). A pooled analysis of three trials indicated that patients in the music group had significantly higher post-operative satisfaction visual analog scale (VAS) scores than those in the no-music group during RC. However, there was no significant difference between the music group and no music group regarding post-procedural systolic pressures (SPs) during cystoscopy (WMD: -3.08; 95% CI: -8.64 to 2.49). For male patients undergoing cystoscopy, the music seemed to exert a similar effect on decreasing anxiety and pain, and it might serve as a useful adjunct to increase procedural satisfaction. Conclusions: These findings indicate that listening to music contributes to the improvement of pain perception, HR, and anxiety feeling during cystoscopy, especially for male patients undergoing RC. Music might serve as a simple, inexpensive, and effective adjunct to sedation during cystoscopy.

Local climate change cultures: climate-relevant discursive practices in three emerging economies.

In recent decades, greater acknowledgement has been given to climate change as a cultural phenomenon. This paper takes a cultural lens to the topic of climate change, in which climate-relevant understandings are grounded in wider cultural, political and material contexts. We approach climate-relevant accounts at the level of the everyday, understood as a theoretically problematic and politically contested space This is in contrast to simply being the backdrop to mundane, repetitive actions contributing to environmental degradation and the site of mitigative actions. Taking discourse as a form of practice in which fragments of cultural knowledge are drawn on to construct our environmental problems, we investigate citizens' accounts of climate-relevant issues in three culturally diverse emerging economies: Brazil, South Africa and China. These settings are important because greenhouse gas (GHG) emissions are predicted to significantly increase in these countries in the future. We conducted semi-structured interviews with a range of citizens in each country using a narrative approach to contextualise climate-relevant issues as part of people's lifestyle narratives. Participants overwhelmingly framed their accounts in the context of locally-salient issues, and few accounts explicitly referred to the phenomenon of climate change. Instead, elements of climate changes were conflated with other environmental issues and related to a wide range of cultural assumptions that influenced understandings and implied particular ways of responding to environmental problems. We conclude that climate change scholars should address locally relevant understandings and develop dialogues that can wider meanings that construct climate-relevant issues in vernacular ways at the local level.

Reflecting on Behavioral Spillover in Context: How Do Behavioral Motivations and Awareness Catalyze Other Environmentally Responsible Actions in Brazil, China, and Denmark?

Responding to serious environmental problems, requires urgent and fundamental shifts in our day-to-day lifestyles. This paper employs a qualitative, cross-cultural approach to explore people's subjective self-reflections on their experiences of pro-environmental behavioral spillover in three countries; Brazil, China, and Denmark. Behavioral spillover is an appealing yet elusive phenomenon, but offers a potential way of encouraging wider, voluntary lifestyle shifts beyond the scope of single behavior change interventions. Behavioral spillover theory proposes that engaging in one pro-environmental action can catalyze the performance of others. To date, evidence for the phenomenon has been mixed, and the causal processes governing relationships between behaviors appear complex, inconsistent and only partly understood. This paper addresses a gap in the literature by investigating accounts of behavioral spillover in three diverse cultural settings using qualitative semi-structured interviews. The analysis shows that while around half of participants overall who were questioned recalled spillover effects, the other half had not consciously experienced spillover. There were few significant differences across cultures, though some forms of spillover effects were reported more in some cultures than others. More environmentally engaged participants across all three countries were significantly more likely to experience spillover than those who were less engaged. Accounts of within-domain spillovers were most commonly reported, mainly comprising waste, resource conservation and consumption-related actions. Accounts of between-domain spillover were very rare. Recollection of contextual and interpersonal spillover effects also emerged from the interviews. Our findings suggest that more conscious behavioral spillover pathways may be limited to those with pre-existing environmental values. Behavioral spillover may comprise multiple pathways incorporating conscious and unconscious processes. We conclude that targeting behavioral catalysts that generate more socially diffuse spillover effects could offer more potential than conventional spillover involving a single individual.