Nanoporous Nickel Cathode with an Electrostatic Chlorine-Resistant Surface for Industrial Seawater Electrolysis Hydrogen Production.

Seawater electrolysis presents a promising avenue for green hydrogen production toward a carbon-free society. However, the electrode materials face significant challenges including severe chlorine-induced corrosion and high reaction overpotential, resulting in low energy conversion efficiency and low current density operation. Herein, we put forward a nanoporous nickel (npNi) cathode with high chlorine corrosion resistance for energy-efficient seawater electrolysis at industrial current densities (0.4-1 A cm-2). With the merits of an electrostatic chlorine-resistant surface, modulated Ni active sites, and a robust three-dimensional open structure, the npNi electrode showed a low hydrogen evolution reaction overpotential of 310 mV and a high electricity-hydrogen conversion efficiency of 59.7% at 400 mA cm-2 in real seawater and outperformed most Ni-based seawater electrolysis cathodes in recent publications and the commercial Ni foam electrode (459 mV, 46.4%) under the same test condition. In situ electrochemical impedance spectroscopy, high-frame-rate optical microscopy, and first-principles calculation revealed that the improved corrosion resistance, enhanced intrinsic activity, and mass transfer were responsible for the lowered electrocatalytic overpotential and enhanced energy efficiency.

The Impact of Hot Spring Hydrotherapy on Pain Perception and Dysfunction Severity in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis.

Background: Chronic Low Back Pain (CLBP) is a prevalent global health issue, leading to prolonged discomfort and functional limitations. Hot spring hydrotherapy, which utilizes mineral-rich, warm spring water, offers a unique physical therapy that holds promise in alleviating CLBP symptoms. Objective: This meta-analysis aims to assess the effectiveness of hot spring hydrotherapy in improving CLBP symptoms, encompassing pain intensity, functional disability, quality of life, and medication usage. Methods: A systematic review and meta-analysis were conducted by searching relevant literature in multiple databases. Included studies compared hot spring hydrotherapy with control interventions or other treatments. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated for pain intensity, functional disability, medication usage, and quality of life. Results: A total of 16 studies met the inclusion criteria, involving 1656 participants with chronic low back pain across various countries. The meta-analysis demonstrated that hot spring hydrotherapy was effective in reducing pain intensity (SMD = -0.901, 95% CI [-1.777, -0.025], P < 0.05) and improving functional disability (SMD = -3.236, 95% CI [-4.898, -1.575], P < 0.0001) in CLBP patients. Hot spring hydrotherapy also resulted in a significant reduction in medication usage (P < 0.05). Subgroup analysis showed that the effects of hot spring hydrotherapy were more pronounced in patients aged 60 and above, while no significant differences were observed in patients below 60 years of age, single hot Spring Hydrotherapy help improve patients' quality of life. Conclusion: Hot spring hydrotherapy is an effective intervention for improving CLBP symptoms, including pain intensity, functional disability, and medication usage. It is particularly beneficial for CLBP patients aged 60 and above. These findings support the integration of hot spring hydrotherapy into the treatment approach for CLBP, although further research is needed to determine its efficacy in younger patients and to explore the underlying mechanisms of its therapeutic effects. Prospero Id: CRD42023430860.

Microplastics affect soil bacterial community assembly more by their shapes rather than the concentrations.

Polyethylene film mulching is a key technology for soil water retention in dryland agriculture, but the aging of the films can generate a large number of microplastics with different shapes. There exists a widespread misunderstanding that the concentrations of microplastics might be the determinant affecting the diversity and assembly of soil bacterial communities, rather than their shapes. Here, we examined the variations of soil bacteria community composition and functioning under two-year field incubation by four shapes (ball, fiber, fragment and powder) of microplastics along the concentration gradients (0.01%, 0.1% and 1%). Data showed that specific surface area of microplastics was significantly positively correlated with the variations of bacterial community abundance and diversity (r=0.505, p<0.05). The fragment- and fiber-shape microplastics displayed more pronounced interfacial continuity with soil particles and induced greater soil bacterial α-diversity, relative to the powder- and ball-shape ones. Strikingly, microplastic concentrations were not significantly correlated with bacterial community indices (r=0.079, p>0.05). Based on the variations of the ßNTI, bacterial community assembly actually followed both stochastic and deterministic processes, and microplastic shapes significantly modified soil biogeochemical cycle and ecological functions. Therefore, the shapes of microplastics, rather than the concentration, significantly affected soil bacterial community assembly, in association with microplastic-soil-water interfaces.

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.

Which frequency is better for pediatric shock wave lithotripsy? Low intermediate or high: A systematic review and meta-analysis.

Background: To explore the optimal frequency for pediatric extracorporeal shock wave lithotripsy (ESWL) in the treatment of upper urinary stones. Methods: A systematic literature search was undertaken using PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases to identify eligible studies published before January 2023. Primary outcomes were perioperative efficacy parameters, including ESWL time, anesthesia time for ESWL sessions, success rates after each session, additional interventions needed, and treatment sessions per patient. Secondary outcomes were postoperative complications and efficiency quotient. Results: Four controlled studies involving 263 pediatric patients were enrolled in our meta-analysis. In the comparison between the low-frequency and intermediate-frequency groups, we observed no significant difference as regards anesthesia time for ESWL session (WMD = -4.98, 95% CI -21.55∼11.58, p = 0.56), success rates after ESWL sessions (first session: OR = 0.02 95%CI -0.12∼0.17, p = 0.74; second session: OR = 1.04 95%CI 0.56∼1.90, p = 0.91; third session: OR = 1.62 95%CI 0.73∼3.60, p = 0.24), treatment sessions needed (WMD = 0.08 95%CI -0.21∼0.36, p = 0.60), additional interventions after ESWL (OR=0.99 95%CI 0.40∼2.47, p = 0.99) and rates of Clavien grade 2 complications (OR = 0.92 95%CI 0.18∼4.69, p = 0.92). However, the intermediate-frequency group may exhibit potential benefits in Clavien grade 1 complications. In the comparison between intermediate-frequency and high-frequency, the eligible studies exhibited higher success rates in the intermediate-frequency group after the first session, the second session and the third session. More sessions may be required in the high-frequency group. With respect to other perioperative, postoperative parameters and major complications, the results were similar. Conclusions: Intermediate-frequency and low-frequency had similar success rates and seemed to be the optimal frequency for pediatric ESWL. Nevertheless, future large-volume, well-designed RCTs are awaited to confirm and update the findings of this analysis. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022333646.

[Visual analysis of research on traditional Chinese medicine treatment of Alzheimer's disease in recent ten years].

This study employed bibliometrics tools to review the studies of traditional Chinese medicine(TCM) treatment of Alzheimer's disease(AD) in recent ten years, aiming to explore the research status, hotspots, and future trends in this field at home and abroad. The relevant literature published from January 1, 2012 to August 15, 2022 was retrieved from Web of Science and CNKI. CiteSpace 6.1R2 and VOSviewer 1.6.15 were used for the visual analysis of authors, countries, institutions, keywords, journals, etc. A total of 2 254 Chinese articles and 545 English articles were included. The annual number of articles published showed a rising trend with fluctuations. The country with the largest number of relevant articles published and the largest centrality was China. SUN Guo-jie and WANG Qi were the authors publishing the most Chinese articles and English articles, respectively. Hubei University of Chinese Medicine and Beijing University of Chinese Medicine published the most articles in Chinese and English, respectively. Journal of Ethnopharmacology and Neuroscience Letters published the articles with the highest cited frequency and the highest centrality. According to the keywords, the research on TCM treatment of AD mainly focused on the mechanism of action and treatment methods. Metabolomics, intestinal flora, oxidative stress, tau hyperphosphorylation, ß-amyloid(Aß), inflammatory cytokines, and autophagy were the focuses of the research on mechanism of action. Acupuncture, clinical effect, kidney deficiency and phlegm stasis, and dredging governor vessel to revitalize mind were the hotspots of clinical research. This research field is still in the stage of exploration and development. Exchanges and cooperation among institutions should be encouraged to carry out more high-quality basic research on TCM treatment of AD, obtain high-level evidence, and clarify the pathogenesis and prescription mechanism.

EGFR inhibitor erlotinib plus monoclonal antibody versus erlotinib alone for first-line treatment of advanced non-small cell lung carcinoma: A systematic review and meta-analysis.

PURPOSE: Immuno-combination therapy is emerging as an effective treatment for advanced non-small cell lung carcinoma (NSCLC). However, compared to monotherapy, such as monoclonal antibodies or kinase inhibitors, whether combination therapy can enhance antitumor efficacy or alleviate side effects remains unclear. METHODS: A systematic literature search was undertaken using the PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases to identify eligible studies concentrating on treatment with erlotinib or erlotinib plus monoclonal antibodies in NSCLC patients published between January 2017 and June 2022. The primary outcomes included progression-free survival (PFS), overall survival (OS), response rate (RR) and treatment-related adverse events (AEs). RESULTS: Seven independent randomized, controlled clinical trials including 1513 patients were obtained for the final analysis. Erlotinib plus monoclonal antibodies was significantly associated with the improvement of PFS (hazards ratio [HR], 0.60; 95% CI 0.53-0.69; z = 7.59, P < 0.01) and with moderate performance regarding OS (HR, 0.81; 95% CI 0.58-1.13; z = 1.23, P = 0.22) and RR (odds ratio [OR], 1.25; 95% CI 0.98-1.59; z = 1.80, P = 0.07), irrespective of EGFR mutation status. In the safety evaluation, erlotinib plus monoclonal antibodies had a markedly higher occurrence of adverse events (AEs) of Clavien grade 3 or higher (OR, 3.32; 95% CI 2.66-4.15; z = 10.64, P < 0.01). CONCLUSION: Compared with erlotinib alone, combination therapy (erlotinib plus monoclonal antibodies) was associated with significantly improved PFS in NSCLC therapy, accompanied by increased treatment-related AEs. REGISTRATION: Our systematic review protocol was registered in the PROSPERO international register of systematic reviews (CRD42022347667).

Antifibrotic Effects of Tetrahedral Framework Nucleic Acids by Inhibiting Macrophage Polarization and Macrophage-Myofibroblast Transition in Bladder Remodeling.

Bladder outlet obstruction (BOO) is a prevalent condition arising from urethral stricture, posterior urethral valves, and benign prostatic hyperplasia. Long-term obstruction can lead to bladder remodeling, which is characterized by inflammatory cell infiltration, detrusor hypertrophy, and fibrosis. Until now, there are no efficacious therapeutic options for BOO-induced remodeling. Tetrahedral framework nucleic acids (tFNAs) are a type of novel 3D DNA nanomaterials that possess excellent antifibrotic effects. Here, to determine the treatment effects of tFNAs on BOO-induced remodeling is aimed. Four single-strand DNAs are self-assembled to form tetrahedral framework DNA nanostructures, and the antifibrotic effects of tFNAs are investigated in an in vivo BOO animal model and an in vitro transforming growth factor beta1 (TGF-ß1)-induced fibrosis model. The results demonstrated that tFNAs could ameliorate BOO-induced bladder fibrosis and dysfunction by inhibiting M2 macrophage polarization and the macrophage-myofibroblast transition (MMT) process. Furthermore, tFNAs regulate M2 polarization and the MMT process by deactivating the signal transducer and activator of transcription (Stat) and TGF-ß1/small mothers against decapentaplegic (Smad) pathways, respectively. This is the first study to reveal that tFNAs might be a promising nanomaterial for the treatment of BOO-induced remodeling.

The association between urinary organophosphate insecticide metabolites and erectile dysfunction in the United States.

Organophosphate (OP) insecticides are the main chemicals used in agriculture for pest elimination, and they have been linked with many diseases. However, there is no literature regarding the impacts of organophosphate insecticide metabolite exposure on erectile dysfunction (ED). We aimed to evaluate the correlation between 4 urinary organophosphate insecticide metabolites and the presence of ED in a representative sample of men aged 20 and older. The dataset including a total of 555 subjects was obtained from the National Health and Nutrition Examination Survey (NHANES) 2003-2004. ED was assessed by a question from a self-report questionnaire. Weighted proportions and multivariable logistic regression analysis were utilized to examine the relationship between organophosphate insecticide metabolite exposure and ED. In multivariable logistic regression analysis, diethylphosphate (DEP) was positively correlated with ED (OR 1.07; 95% CI 1.01-1.14; P = 0.033) after full adjustment. Men in DEP tertile 4 had a significant 33% higher risk of ED than those in tertile 1. Furthermore, in a subgroup analysis, our results showed that higher DEP levels were significantly associated with ED in the young age group (20 ≤ age ≤ 39). Our study revealed a significant association between organophosphate insecticide metabolite exposure and an increased risk of ED. Moreover, the correlations were more evident in the young age group. The evaluation of urinary organophosphate insecticide metabolite exposure should be included in the risk assessment of ED. Further study to investigate the underlying mechanism, such as how long the urinary metabolite is present, whether ED is reversible in this population by lowering DEP concentrations, and how exposure to this metabolite affects erectile tissue, is warranted.

YAP/Smad3 promotes pathological extracellular matrix microenviroment-induced bladder smooth muscle proliferation in bladder fibrosis progression.

Fibrosis is a chronic inflammation process with excess extracellular matrix (ECM) deposition that cannot be reversed. Patients suffer from bladder dysfunction caused by bladder fibrosis. Moreover, the interactive mechanisms between ECM and bladder fibrosis are still obscure. Hence, we assessed the pivotal effect of Yes-associated protein (YAP) on the proliferation of bladder smooth muscle in fibrosis process. We identified that stiff ECM increased the expression and translocation of YAP in the nucleus of human bladder smooth muscle cell (hBdSMC). Sequencings and proteomics revealed that YAP bound to Smad3 and promoted the proliferation of hBdSMC via MAPK/ERK signaling pathway in stiff ECM. Moreover, CUT and TAG sequencing and dual-luciferase assays demonstrated that Smad3 inhibited the transcription of JUN. The YAP inhibitor CA3 was used in a partial bladder outlet obstruction (pBOO) rat model. The results showed that CA3 attenuated bladder smooth muscle proliferation. Collectively, YAP binding with Smad3 in the nucleus inhibited the transcription of JUN, and promoted the proliferation of bladder smooth muscle through the MAPK/ERK signaling pathway. The current study identified a novel mechanism of mechanical force induced bladder fibrosis that provided insights in YAP-associated organ fibrosis.

Polarization improvement of perovskite nanowire composite films by mechanical stretching method.

Perovskite nanowires (NWs) have attracted considerable interest because of their excellent polarization properties. In this work, we first synthesized colloidal lead halide CsPbBr3NWs with suitable lengths and excellent polarization performance by the method of the thermal injection. By embedding the NWs in polyvinyl alcohol (PVA) to prepare practical a polymer composite and combining it with the mechanical stretching method, we achieved films with higher polarizing properties. The optimized stretched composite film achieved a polarization degree of 0.4992, which is superior to that of the unstretched one. The stretched PVA molecules are arranged in a straight line, which absorbs the polarized light parallel to the alignment direction, and only allows the polarized light in the vertical direction to pass through. Therefore, the arrangement of the spin-coated NWs combined with the arrangement direction of the PVA molecules led to an improvement in the polarization performance of the composite film. The NWs-PVA-stretched composite films will show important application value in the manufacture of next-generation polarization-sensitive optoelectronic devices and other fields.

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.

The preventive effects of colony-stimulating factor 1 receptor (CSF-1R) inhibition on bladder outlet obstruction induced remodeling.

INTRODUCTION: Bladder outlet obstruction (BOO) is a common problem that can affect bladder structure and function. Currently, there is no effective drugs available to prevent BOO-induced remodeling. Previous reports have demonstrated that the pathogenesis of BOO is associated with macrophage infiltration and polarization, which is physiologically dependent on colony-stimulating factor 1 receptor (CSF-1R) activation. Here we utilized a highly selective CSF-1R inhibitor, GW2580, to determine its preventive effects on BOO-induced remodeling. METHODS: A total of 24 Sprague-Dawley rats were randomly divided into sham, BOO + vehicle, and BOO + GW2580 group. GW2580 or vehicle control was administrated by oral gavage at daily doses of 40 mg/kg for 6 weeks. Bladder samples were collected for histopathology, immunohistochemistry, immunofluorescence, western blotting, and flow cytometry analysis. RESULTS: Our results demonstrated that bladder fibrosis was ameliorated by GW2580 compared with the vehicle group (22.01% ± 5.13% vs. 32.15% ± 7.24%, p < 0.01). Furthermore, treatment with GW2580 induced an inhibition of macrophage infiltration (4.41% ± 1.28% vs. 13.57% ± 3.42%, p < 0.001) and M2 macrophage polarization (10.67% ± 4.15% vs. 28.59% ± 6.38%, p < 0.001). There was also a decrease of profibrotic F4/80+  α-smooth muscle actin+ (α-SMA+ ) macrophage to myofibroblast transition (9.11% ± 2.58% vs. 17.33% ± 4.01%, p < 0.001) and CD163+ TGF-ß1+ cells (7.68% ± 2.10% vs. 14.17% ± 4.09%, p < 0.01) in the GW2580 group when compared with the vehicle group. CONCLUSIONS: In summary, our findings showed that GW2580 is a worthwhile candidate for a follow-up study to test in the treatment of BOO-induced remodeling.

Does combined lithotripter show superior stone-success rate than ultrasonic or pneumatic device alone during percutaneous nephrolithotrotomy? A meta-analysis.

OBJECTIVES: To compare the stone clearance rate and stone-success rate among lithotripter with ultrasonic lithotripter alone, pneumatic lithotripter alone and combined mechanisms. METHODS: Up till 2021 May, we conducted a literature search among several widely used database around the world, including Pubmed, Embase (Ovid Version), Medline (Ovid Version) and Cochrane Central Register of Controlled Trials. Only English literature was considered. Pediatric patients were excluded. Reviews and protocols without any published data were excluded. Conference abstracts and articles with unrelated contents were also excluded. RESULTS: Fifteen articles were included in our final meta-analysis, with 9 RCTs and 6 cohort studies. In Lithoclast combined with ultrasonic device vs pneumatic device subgroup, overall stone-success rate yielded insignificant difference. As for subgroup of Shock Pulse vs pneumatic device, pooled analysis yielded a higher 1-month stone-success rate for Shock Pulse (RR = 1.10, 95% CI: 1.01-1.19). In Lithoclast combined with ultrasonic device vs ultrasonic device subgroup and Cyberwand vs ultrasonic device subgroup, both overall stone-success rate did not differ from one another. We found Lithoclast with ultrasonic device was more efficient in stone clearance rate than pneumatic device (mean difference = 8.23, 95% CI: 4.99-11.47). The same situation was applied to the comparison between Lithoclast with ultrasonic device and ultrasonic device (mean difference = 13.02, 95% CI: 4.57-21.46). CONCLUSIONS: Combined lithotripter was more efficient in clearing stones than pneumatic or ultrasonic device alone. However, when it came to stone-success rate, no obvious superiority was seen in combined one.

Self-expanding metal ureteral stent for ureteral stricture: Experience of a large-scale prospective study from a high-volume center - Cross-sectional study.

BACKGROUND: The management of ureteral stricture is still a challenge for urologists. The aim of this prospective study was to assess the safety and effectiveness of self-expanding metal ureteral stents (URS) in ureteral strictures. METHODS: We performed URS placement procedures for ureteral stricture from Jan 2019 to July 2020, and prospectively collect various data before and after the operation. A paired T test was used to compare continuous variables before and after surgery, binary logistic regression analysis was used to identify the independent risk predictors of surgical failure. RESULTS: A total of 147 patients with 157 renal units received successful placement of URS. The mean operative time was 70.0 min. After a median follow-up time of 15 months, 73.2% (115/157) of stents were kept in situ. The most common complication was hematuria (13, 8.8%), followed by urinary tract infection (11, 7.5%) and pain (8, 5.4%). The volume of hydronephrosis (67.9 ± 34.9 VS 34.9 ± 51.1 cm3, P = 0.0001), serum creatinine level (103.0 ± 54.5 VS 93.8 ± 45.1 µmol/L, P = 0.034) and blood urea nitrogen level (6.6 ± 6.7 VS 5.4 ± 2.4 mmol/L, P = 0.032) decreased significantly at last follow up when compared with baseline. Stricture of the distal ureter was an independent risk factor for stent failure (HR 1.77, 95% CI 1.15, 2.73, P = 0.009). CONCLUSIONS: URS was found to be safe and effective for ureteral strictures with a limited complications and good long-term results. For those who are not suitable for surgical reconstruction, the URS is an alternative management.

Comparison of Micro-Percutaneous and Mini-Percutaneous Nephrolithotomy in the Treatment of Renal Stones: A Systematic Review and Meta-Analysis.

Background: To assess the efficacy and safety of micro-percutaneous nephrolithotomy (Microperc) and mini-percutaneous nephrolithotomy (Miniperc) in the treatment of moderately sized renal stones. Methods: Literature search of PubMed, Web of Science, and Embase was performed prior to January 2021. We used odds ratios (OR) and weighted mean difference (WMD) for dichotomous variables and continuous variables, respectively. Results were pooled using Review Manager version 5.3 software. Results: A total of six studies involving 291 Microperc and 328 Miniperc cases was included. The overall stone-free rate (SFR) of Microperc was 87.29% (254/291), while the SFR of Miniperc was 86.59% (284/328). Microperc was associated with lower hemoglobin drop (WMD: -0.98; P = 0.03) and higher renal colic requiring D-J stent insertion (OR: 3.49; P = 0.01). No significant differences existed between Microperc and Miniperc with respect to SFR (OR: 1.10; P = 0.69), urinary tract infection (OR: 0.38; P = 0.18), operative time (WMD: -5.76; P = 0.62), and hospital stay time (WMD: -1.04; P = 0.07). Conclusions: Our meta-analysis demonstrated that Microperc could produce an SFR that was comparable with that of Miniperc. Microperc was associated with lower hemoglobin drop, while Miniperc was associated with lower renal colic rates. In addition, the operation time and hospital stay time for both these procedures were similar.

Step-by-step technique for the endoscopic treatment of ureteric stricture.

OBJECTIVE: To outline our step-by-step technique for the endoscopic treatment of ureteric stricture. MATERIALS AND METHODS: Between January 2019 and June 2020, 25 patients with ureteric strictures underwent ureteric bypass and were included in this study. The ureteric bypass surgery included three key steps. First, holmium laser endoureterotomy was used to establish a small channel. Then, balloon dilatation was performed to create a large channel. Finally, an Allium stent was inserted. RESULTS: Over a median follow-up time of 12 months, the success rate of ureteric bypass surgery was 92.0% (23/25). The median operating time was 78 min. The incidence of pain was 16% (4/25), and the incidence of fever was 4.0% (1/25). The preoperative hydronephrosis volume and urea nitrogen levels decreased significantly after surgery. CONCLUSIONS: We performed ureteric bypass for patients with ureteric strictures. This technique was found to be safe and effective over a short follow-up time. For patients who are not suitable for surgical reconstruction, the ureteric bypass technique is a good choice.

The roles of MCP-1/CCR2 mediated macrophage recruitment and polarization in bladder outlet obstruction (BOO) induced bladder remodeling.

Bladder outlet obstruction (BOO) can lead to alternation of bladder structure and function, known as bladder remodeling. Macrophage is a heterogeneous cell type and implicated in immunity regulating and tissue repairment. The relationship between macrophage and BOO remains unclear. We determined the pivotal role of macrophage recruitment and polarization in bladder remodeling. Sprague-Dawley rats underwent surgical operation of a BOO for either 1, 3, 6 weeks and were compared with sham-operated rats. The BOO rats in the experimental group were orally administrated with 5 mg/kg RS-504393, a C-C chemokine receptor (CCR2) antagonist, for 6 weeks, and the rats in the control group were treated with vehicle. Bladder tissues were harvested for assays of flow cytometry, quantitative reverse transcription polymerase chain reaction, histological examinations, immunohistochemistry staining and immunofluorescence. After induction of BOO, M1 macrophages were predominantly observed at inflammatory stage while M2 macrophages were mainly found during fibrosis stage. Flow cytometry analysis revealed that the ratio of M1/M2 significantly increased at 3 weeks (P = 0.0013) when compared to the sham-operated group. Interestingly, our results showed that M2 macrophages promoted BOO-induced fibrosis through indirectly secreting TGF-ß and directly transforming to collagen-producing myofibroblast. Additionally, RS-504393 treatment significantly decreased the number of M1 and M2 macrophage infiltration in bladder tissue, and bladder fibrosis was attenuated by RS-504393 treatment compared with that in the vehicle-treated rats. In summary, macrophages play a pivotal role in bladder remodeling and targeting MCP-1/CCR2 signaling pathway might be a therapeutic strategy for human bladder fibrosis.

How can artificial intelligence models assist PD-L1 expression scoring in breast cancer: results of multi-institutional ring studies.

Programmed death ligand-1 (PD-L1) expression is a key biomarker to screen patients for PD-1/PD-L1-targeted immunotherapy. However, a subjective assessment guide on PD-L1 expression of tumor-infiltrating immune cells (IC) scoring is currently adopted in clinical practice with low concordance. Therefore, a repeatable and quantifiable PD-L1 IC scoring method of breast cancer is desirable. In this study, we propose a deep learning-based artificial intelligence-assisted (AI-assisted) model for PD-L1 IC scoring. Three rounds of ring studies (RSs) involving 31 pathologists from 10 hospitals were carried out, using the current guideline in the first two rounds (RS1, RS2) and our AI scoring model in the last round (RS3). A total of 109 PD-L1 (Ventana SP142) immunohistochemistry (IHC) stained images were assessed and the role of the AI-assisted model was evaluated. With the assistance of AI, the scoring concordance across pathologists was boosted to excellent in RS3 (0.950, 95% confidence interval (CI): 0.936-0.962) from moderate in RS1 (0.674, 95% CI: 0.614-0.735) and RS2 (0.736, 95% CI: 0.683-0.789). The 2- and 4-category scoring accuracy were improved by 4.2% (0.959, 95% CI: 0.953-0.964) and 13% (0.815, 95% CI: 0.803-0.827) (p < 0.001). The AI results were generally accepted by pathologists with 61% "fully accepted" and 91% "almost accepted". The proposed AI-assisted method can help pathologists at all levels to improve the PD-L1 assay (SP-142) IC assessment in breast cancer in terms of both accuracy and concordance. The AI tool provides a scheme to standardize the PD-L1 IC scoring in clinical practice.