Endoscopic Combined Intrarenal Surgery Versus Percutaneous Nephrolithotomy for Complex Renal Stones: A Systematic Review and Meta-Analysis.

BACKGROUND: Endoscopic combined intrarenal surgery (ECIRS) adds ureteroscopic vision to percutaneous nephrolithotomy (PCNL), which can be helpful when dealing with complex renal stones. Yet, there is still no consensus on the superiority of ECIRS. We aimed to critically analyze the available evidence of studies comparing efficacy, safety, bleeding risk, and efficiency of ECIRS and PCNL. METHODS: We searched for studies comparing efficacy (initial and final stone-free rate), safety (postoperative fever, overall and severe complications), efficiency (operative time and hospital stay) and bleeding risk between ECIRS and PCNL. Meta-analysis was performed. RESULTS: Seven studies (919 patients) were identified. ECIRS provided a significantly higher initial stone-free rate, higher final stone-free rate, lower overall complications, lower severe complications, and lower rate of requiring blood transfusion. There was no difference between the two groups in terms of postoperative fever, hemoglobin drop, operative time, and hospital stay. In the subgroup analysis, both minimally invasive and conventional ECIRS were associated with a higher stone-free rate and lower complication outcomes. CONCLUSIONS: When treating complex renal stones, ECIRS has a better stone-free rate, fewer complications, and requires fewer blood transfusions compared with PCNL. Subgroups either with minimally invasive or conventional intervention showed a consistent trend.

A Rare Case Report of Metastatic Urothelial Carcinoma to Skull with Significant Reossification after Pembrolizumab.

Background: Urothelial carcinoma ranks as the fourth most common cancer in men in the U.S; upon diagnosis, 10-15% have metastasized, mostly to lymph nodes, liver, lung, bone, and adrenal glands. Very few cases of skull invasion have been reported, and there is no established definite treatment. Case presentation: A 64-year-old Taiwanese male presented with metastatic urothelial carcinoma (mUC) of bladder with skull invasion. A sunken forehead without painful sensation could be palpated. After failure of chemotherapy, the patient received immunotherapy pembrolizumab, and complete remission of distant metastasis with reossification of osteolytic skull were noted. Conclusion: Immunotherapy has been reported to show significant remission in mUC, but mostly in solid organs or bone. While skull metastasis usually suggests late progression of the disease, immunotherapy has fewer systemic adverse effects than chemotherapy, and should be taken into consideration as a first-line therapy.

Determination of Diphenylether Herbicides in Water Samples Using Dispersive Liquid-Liquid Microextraction Combined with High-Performance Liquid Chromatography.

Shaker-assisted dispersive liquid-liquid microextraction (SA-DLLME) and surfactant dispersive liquid-liquid microextraction (SDLLME) have been developed to determine five diphenylether herbicides in water samples using high-performance liquid chromatography with photodiode array detection (HPLC-PDA). For SA-DLLME, an up-and-down shaker-assisted emulsification was used. Extraction was complete in 3 min. Only 30 µL of decyl acetate was required, without a dispersive solvent. The linear range was from 2 to 1000 µg L-1, the coefficient of determination (r2) was better than 0.9992, and the limit of detection (LOD) was from 0.62 to 1.74 µg L-1. The relative recovery (RR) ranged from 90 to 102% for river water, 88 to 104% for lake water, and 93 to 102% for irrigating water. In SDLLME, a microsyringe was used to withdraw and discharge a mixture consisting of an extraction solvent and 1 mg L-1 Tween 60 as a surfactant four times within 10 s to form an emulsified solution. The linear range for the target compounds was from 2 to 1000 µg L-1. The LODs were between 0.72 and 1.38 µg L-1. The RR ranged from 95 to 108% for river water, 96 to 109% for lake water, and 86 to 114% for irrigating water.