Comparing Sonazoid contrast-enhanced ultrasound to contrast-enhanced CT and MRI for differentially diagnosing renal lesions: a prospective multicenter study.

PURPOSE: To evaluate the diagnostic performance of contrast-enhanced (CE) ultrasound using Sonazoid (SNZ-CEUS) by comparing with contrast-enhanced computed tomography (CE-CT) and contrast-enhanced magnetic resonance imaging (CE-MRI) for differentiating benign and malignant renal masses. MATERIALS AND METHODS: 306 consecutive patients (from 7 centers) with renal masses (40 benign tumors, 266 malignant tumors) diagnosed by both SNZ-CEUS, CE-CT or CE-MRI were enrolled between September 2020 and February 2021. The examinations were performed within 7 days, but the sequence was not fixed. Histologic results were available for 301 of 306 (98.37%) lesions and 5 lesions were considered benign after at least 2 year follow-up without change in size and image characteristics. The diagnostic performances were evaluated by sensitivity, specificity, positive predictive value, negative predictive value, and compared by McNemar's test. RESULTS: In the head-to-head comparison, SNZ-CEUS and CE-MRI had comparable sensitivity (95.60 vs. 94.51%, P = 0.997), specificity (65.22 vs. 73.91%, P = 0.752), positive predictive value (91.58 vs. 93.48%) and negative predictive value (78.95 vs. 77.27%); SNZ-CEUS and CE-CT showed similar sensitivity (97.31 vs. 96.24%, P = 0.724); however, SNZ-CEUS had relatively lower than specificity than CE-CT (59.09 vs. 68.18%, P = 0.683). For nodules > 4 cm, CE-MRI demonstrated higher specificity than SNZ-CEUS (90.91 vs. 72.73%, P = 0.617) without compromise the sensitivity. CONCLUSIONS: SNZ-CEUS, CE-CT, and CE-MRI demonstrate desirable and comparable sensitivity for the differentiation of renal mass. However, the specificity of all three imaging modalities is not satisfactory. SNZ-CEUS may be a suitable alternative modality for patients with renal dysfunction and those allergic to gadolinium or iodine-based agents.

Selective Recovery of Battery-Grade Li2CO3 from Spent NCM Cathode Materials Using a One-Step Method of CO2 Carbonation Recovery Without Acids or Bases.

The recovery of spent lithium-ion batteries by traditional acid leaching is limited by serious pollution, complicated technology, and the low purity of Li2CO3. To address the problems of the traditional acid leaching process and increasing demand for decarbonization, a technique for the selective carbonation leaching of Li and the recovery of battery-grade Li2CO3 by a simple concentration precipitation process without acids or bases was developed. The coupling of CO2 and reducing agents could effectively promote the precipitation of MCO3 (M=Ni/Co/Mn) and the selective leaching of Li by decreasing the reducing capability needed for transition metals and decreasing the pH of the solution. The optimal selective leaching process of Li was obtained under 1 MPa CO2 with 20 g/L Na2S2O3 at an L/S ratio of 30 mL/g for 1.5 h. FT-IR, XRD, ICP-MS and other methods were used to reveal the multiphase interfacial reaction mechanism of the carbonation reduction of layered cathode materials, which indicated that the reducing agent Na2S2O3 could promote lattice distortion of the cathode materials and effective separation of Li. In summary, a green and economical method for the selective recovery of battery-grade Li2CO3 using a one-step method of CO2 carbonation recovery in a near-neutral environment was proposed.

Transvaginal natural orifice specimen extraction surgery for 3D laparoscopic radical cystectomy: A cohort study.

Objective: Transvaginal natural orifice specimen extraction surgery (NOSES) has been widely used in laparoscopic surgery due to its benefits. However, laparoscopic radical cystectomy (LRC) with NOSES has rarely been reported. Materials and Methods: A retrospective analysis of 25 patients who underwent 3D LRC with NOSES from November 2014 to November 2019 was performed. The clinical and perioperative related data, peri and postoperative complications, and oncologic outcomes were recorded. Results: Surgery was successfully completed in 25 patients, and none were converted to open surgery. Mean total operative time was 294.1 ± 48.80 min. Mean NOSES time was12 ± 6.48 min. The median post-op hospital stay was 10.5 d (range 6-27 d). The median visual analog pain score on post-op day 1, 2, and 3 was 2, 2, and 1, respectively. Thirteen patients had 30-day complications (3 had Clavien grade I and 11 had Clavien grade II). Pelvic floor distress inventory-short form 20 (PFDI-20) was 9.8 ± 1.9 after three months (compared with pre-PFDI-20, P = 0.06) and 9.3 ± 1.2 after six months (compared with pre-PFDI-20, P = 0.15). At the mean follow-up of 24.7 ± 12.05 months (range 11-60 months), one patient (4%) had recurrence, two (8%) had metastasis, and one (4%) died. Conclusion: Transvaginal NOSES in 3D LRC is safe and feasible. Understanding the female vagina anatomy and comprehending the techniques is conducive to avoid incision-related complications. NOSES is minimally invasive with good cosmetic outcomes with few surgical complications or affecting pelvic floor function.

Co-pyrolysis of peanut shell with municipal sludge: reaction mechanism, product distribution, and synergy.

Biomass/sludge co-pyrolysis contributes to the high-efficiency resource utilization, harmless treatment, and reduction in volume of sludge. Due to the complexity of co-pyrolysis reaction, it is essential to evaluate the thermodynamic behavior, synergy, and reaction mechanism of this process to make it commercially viable. In this work, the pyrolysis properties, thermodynamic analysis and product distribution of municipal sludge (MS), peanut shell (PS), and their blends with various sludge mass ratios (SMRs) were investigated by a thermogravimetric analyzer and a fixed bed reactor. There was a considerable synergy existing in the process of PS/MS co-pyrolysis, and the synergy occurred mainly at the devolatilization phase, accelerating the mixture pyrolysis. When the conversion rate α was less than 0.7, the apparent activation energy decreased continuously with SMR at the same α; however, it increased dramatically with SMR when α was greater than 0.7. Reactants and reaction stages greatly affected the kinetic mechanism of fuel pyrolysis, and this finding was beneficial for the numerical simulation of mixture pyrolysis. Based on the conclusions and precision of this work, the mass ratio of PS to MS was recommended to be 6:4, which had the strongest synergy, with a gas yield of 26.69 wt.% at 600°C and a lower heating value (LHV) of pyrolysis gas of 14.89 MJ/Nm3.

Membrane dual-targeting probes: A promising strategy for fluorescence-guided prostate cancer surgery and lymph node metastases detection.

Fluorescence-guided surgery (FGS) with tumor-targeted imaging agents, particularly those using the near-infrared wavelength, has emerged as a real-time technique to highlight the tumor location and margins during a surgical procedure. For accurate visualization of prostate cancer (PCa) boundary and lymphatic metastasis, we developed a new approach involving an efficient self-quenched near-infrared fluorescence probe, Cy-KUE-OA, with dual PCa-membrane affinity. Cy-KUE-OA specifically targeted the prostate-specific membrane antigen (PSMA), anchored into the phospholipids of the cell membrane of PCa cells and consequently showed a strong Cy7-de-quenching effect. This dual-membrane-targeting probe allowed us to detect PSMA-expressing PCa cells both in vitro and in vivo and enabled clear visualization of the tumor boundary during fluorescence-guided laparoscopic surgery in PCa mouse models. Furthermore, the high PCa preference of Cy-KUE-OA was confirmed on surgically resected patient specimens of healthy tissues, PCa, and lymph node metastases. Taken together, our results serve as a bridge between preclinical and clinical research in FGS of PCa and lay a solid foundation for further clinical research.

Cuproptosis Induced by ROS Responsive Nanoparticles with Elesclomol and Copper Combined with αPD-L1 for Enhanced Cancer Immunotherapy.

Cuproptosis is a new cell death that depends on copper (Cu) ionophores to transport Cu into cancer cells, which induces cell death. However, existing Cu ionophores are small molecules with a short blood half-life making it hard to transport enough Cu into cancer cells. Herein, a reactive oxygen species (ROS)-sensitive polymer (PHPM) is designed, which is used to co-encapsulate elesclomol (ES) and Cu to form nanoparticles (NP@ESCu). After entering cancer cells, ES and Cu, triggered by excessive intracellular ROS, are readily released. ES and Cu work in a concerted way to not only kill cancer cells by cuproptosis, but also induce immune responses. In vitro, the ability of NP@ESCu to efficiently transport Cu and induce cuproptosis is investigated. In addition, the change in the transcriptomes of cancer cells treated with NP@ESCu is explored by RNA-Seq. In vivo, NP@ESCu is found to induce cuproptosis in the mice model with subcutaneous bladder cancer, reprograming the tumor microenvironment. Additionally, NP@ESCu is further combined with anti-programmed cell death protein ligand-1 antibody (αPD-L1). This study provides the first report of combining nanomedicine that can induce cuproptosis with αPD-L1 for enhanced cancer therapy, thereby providing a novel strategy for future cancer therapy.

Polyphotosensitizer-Based Nanoparticles with Michael Addition Acceptors Inhibiting GST Activity and Cisplatin Deactivation for Enhanced Chemotherapy and Photodynamic Immunotherapy.

Glutathione S-transferase (GST), which is a key enzyme in the conjugation reaction of glutathione (GSH), is overexpressed in cancer cells, leading to cisplatin deactivation and ultimately drug resistance. In addition, many tumors are immune "cold tumors," limiting the application of immune checkpoint inhibitors. Herein, a reactive oxygen species (ROS)-responsive polyphotosensitizer-based nanoparticle (NP2) with Michael addition acceptors inhibiting GST activity and cisplatin deactivation is designed. Under the 808 nm light irradiation, on the one hand, the Michael addition acceptor in NP2 can react with GST and inhibit its activity, thereby decreasing the GSH conjugation and reducing the GSH-mediated deactivation of cisplatin and improving its chemotherapeutic effect. On the other hand, NP2+L induces more ROS production in prostate tumor cells, which can further induce type II immunogenic cell death (ICD) and stimulate a stronger antitumor immune response. It is found that NP2 under the 808 nm light irradiation (NP2+L) can increase PD-L1 expression on the surface of prostate cancer cells. Subsequently, NP2+L combined with PD-L1 treatment is found to simultaneously enhance the efficacies of chemotherapy and photodynamic immunotherapy in prostate tumors, providing a new paradigm for the clinical multimodal treatment of tumors.

A Modified and Practical Surgical Technique for Pure Transperitoneal Laparoscopic Radical Nephroureterectomy in a Single Position and Research Outcomes.

Purpose: To explore the surgical techniques and clinical value of pure transperitoneal laparoscopic nephroureterectomy (LNU) plus bladder cuff excision (BCE) conducted without changing the patient's position in the treatment of upper tract urothelial carcinoma (UTUC). Methods: From August 2018 to July 2021, we retrospectively reviewed 66 patients who underwent LNU + BCE in a single position. Then, their demographic characteristics, perioperative and pathological outcomes, and postoperative follow-up data were evaluated. Results: All 66 operations in this group were successfully completed without conversion to open surgery. The mean operative time was 125 ± 47 minutes, whereas the estimated blood loss was 10 (10, 15) mL. The median postoperative drainage time was 4 (3.8, 6.0) days, the time to catheter extraction after the operation was 4.5 (3.0, 6.0) days, and the median postoperative hospital stay was 6 (5, 7) days. Pathological results showed urothelial carcinoma in 65 cases, including 56 high-grade and 9 low-grade cases. Lymph node metastasis was found in 8 cases of high-grade urothelial carcinoma. All the surgical margins were negative. The median follow-up was 16.5 (11.0-25.6) months, and there was neither tumor recurrence nor distant metastasis. Conclusions: Pure transperitoneal LNU + BCE in a single position is a safe and effective minimally invasive technique for UTUC and is worthy of clinical application and promotion. It takes advantage of a programmed procedure, short operation time, less blood loss, less trauma, and quick recovery after the operation. However, multicenter randomized controlled studies with large samples are needed to further confirm these findings. Trial Registration: The study was registered at Cancer Hospital, Chinese Academy of Medical Sciences (No. 22/054-3255) and the registration date is August 2018.

Application of Transvaginal Natural Orifice Specimen Extraction Surgery in Urological Surgery.

Background: To summarize and analyze the application of transvaginal natural orifice specimen extraction surgery (TV-NOSES) in the operation of renal carcinoma, upper tract urothelial carcinoma, and bladder cancer. Methods: Fifty-seven female patients who underwent 3D laparoscopic radical surgery for urinary tumors and TV-NOSES were analyzed retrospectively. The basic clinical data, perioperative-related data, postoperative complications, and related indexes of postoperative functional evaluation were analyzed and evaluated. Results: All 57 operations were successfully performed according to the original plan. One patient developed mild vaginal infection after operation, which was cured after symptomatic treatment. The visual analog scale scores at 24 and 48 hours after operation were 2.5 (1-4) and 1.1 (0-2), respectively. Patient scar assessment questionnaire scores at 3 months after operation were 37.1 (32-48). Pelvic floor distress inventory-short form 20 scores at preoperative and postoperative 3 months were 5.9 (3-9) and 6.3 (3-9), respectively, and the difference was not statistically significant (P = .48). There was no significant difference in female sexual function index scores between preoperative and postoperative 3 months (P = .82). Conclusions: TV-NOSES in urological surgery is feasible and practical. In addition, this technique further reduces wound pain and wound-related complications without affecting postoperative sexual function and pelvic floor function. The successful development of this technique has laid a solid foundation for further clinical application and promotion. Clinical Trial Registration number: 22/141-3342.

Color Design Decisions for Ceramic Products Based on Quantification of Perceptual Characteristics.

The appearance characteristics of ceramic color are an important factor in determining the user's aesthetic perception of the product. Given the problem that ceramic color varies and the user's visual sensory evaluation of color is highly subjective and uncertain, a method of quantifying ceramic color characteristics based on the Back Propagation (BP) neural network algorithm is proposed. The semantic difference method and statistical method were used to obtain quantified data from ceramic color perceptual semantic features and were combined with a neural network to study the association between ceramic color features and user perceptual-cognitive evaluation. A BP neural network was used to build a ceramic color perceptual semantic mapping model, using color semantic quantified values as the input layer, color L, A, and B component values as the output layer, and model training to predict the sample. The output color L, A, and B components are used as the input layer and the color scheme was designed. The above method can effectively solve the mapping problem between the appearance characteristics of ceramic color and perceptual semantics and provide a decision basis for ceramic product color design. The case application of color design of daily-use ceramic products was conducted to verify the effectiveness and feasibility of the quantitative research method of ceramic color imagery.

Research on Thermal Behaviors and NO x Release Properties during Combustion of Sewage Sludge, Sawdust, and Their Blends.

To investigate the thermal behaviors and NO x emission properties during combustion of sewage sludge (SS), sawdust (SD), and their blends (SS5SD5, SS3SD7, and SS1SD9 with SD proportions of 50, 70, and 90 wt %, respectively), tests were conducted using thermogravimetry-mass spectrometry (TG-MS), Fourier transform infrared spectroscopy (FTIR), and a tube furnace in this study. Results indicated that hydrogen in the fuel was mainly released during volatile combustion, and carbon conversion proceeded during the whole combustion process. With the SD proportion increasing, samples exhibited better combustion characteristics. Compared to SD, SS emitted more NO x due to its higher nitrogen content but showed lower conversion ratios from fuel nitrogen to NO x , and the NO x yields decreased significantly with the increase in SD proportion. NO x emissions of higher volatile samples were more sensitive to temperature, and NO x yields of SD and SS1SD9 continued to decrease from 800 to 1000 °C, whereas NO x yields of SS, SS5SD5, and SS3SD7 changed slightly from 800 to 900 °C and decreased significantly from 900 to 1000 °C. Synergistic effects of cocombustion on NO x emission varied with the blending ratio and temperature. SS5SD5 and SS3SD7 always presented a positive NO x reduction performance, and SS1SD9 exhibited opposite NO x reduction effects at different temperatures. Synthetically considering the SS disposal capacity, combustion characteristic, and NO x yield, an SS proportion of around 30% in blends is more recommended in practical applications.

The establishment of polypeptide PSMA-targeted chimeric antigen receptor-engineered natural killer cells for castration-resistant prostate cancer and the induction of ferroptosis-related cell death.

BACKGROUND: The mortality of castration-resistant prostate cancer (CRPC) is high due to lack of an effective treatment. Chimeric antigen receptor (CAR)-based therapy is a promising immunotherapeutic strategy. Here, we aimed to design a novel CAR-natural killer (NK) cells with a clinically significant tumoricidal effect on CRPC. METHODS: We constructed novel CAR-NK92MI cells with a CD244-based recombinant lentiviral vector. Different intracellular segments (CD244, NKG2D, or CD3ζ) were screened to identify the best candidate according to cell lysis assay and CD107a expression levels. To enhance the affinity of the CAR to the tumor antigen, we compared an antibody specific for prostate-specific membrane antigen (anti-PSMA) with PSMA-targeted polypeptide (p-PSMA), which was screened by phage display combinatorial library. Then, CAR-NK92MI cells with both a high affinity for PSMA and a strong tumoricidal capacity were generated. In addition, we verified their tumor-killing effect in vitro and in vivo. The release of cytokine by NK92MI cells was compared with that by CAR-NK92MI cells through flow cytometry and enzyme-linked immunosorbent assay. Moreover, ferroptosis-related cell death was explored as a possible underlying mechanism. RESULTS: Three different CAR intracellular regions CAR1 (CD244), CAR2 (CD244, NKG2D) and CAR3 (CD244, NKG2D, and CD3ζ) were constructed. CAR2 was chosen to confer a stronger tumoricidal ability on CAR-NK92MI cells. Compared with anti-PSMA, p-PSMA exhibited enhanced affinity for the tumor antigen. Thus, p-PSMA-CAR-NK92MI cells, which expressed CAR with a polypeptide-based antigen-binding region, an intracellular CD244 and a NKG2D costimulatory domain, were generated. They could selectively and successfully kill PSMA+ target cells and exhibited specific lysis rate of 73.19% for PSMA-positive C4-2 cells and 33.04% for PSMA-negative PC3 cells. Additionally, p-PSMA-CAR-NK92MI cells had significantly higher concentrations of IFN-γ, TNF-α and granzyme B than NK92MI cells. In a CRPC cancer xenograft model, p-PSMA-CAR-NK92MI cells significantly inhibited tumor growth and exerted a more consistent killing effect than NK92MI cells. Moreover, ferroptosis is a potential mechanism through which CAR-NK92MI cells attack cancer cells, and is triggered by IFN-γ. CONCLUSIONS: p-PSMA-CAR-NK92MI cells can effectively kill CRPCPSMA+ cells in vitro and in vivo. This strategy may provide additional treatment options for patients with CRPC.

Co-combustion of high alkali coal with municipal sludge: Thermal behaviour, kinetic analysis, and micro characteristic.

Blending sludge rich in protein and aliphatic hydrocarbons into the high alkali coal (HAC) has been demonstrated to reduce the ash melting temperature of the HAC/sludge mixture, thereby increasing the effectiveness and efficiency of liquid slagging. However, whether the incorporation of sludge can affect the combustion stability of the original coal-fired boiler is still debatable. As the combustion stability of the fuel can directly affect the operational safety of the boiler, it is of great practical value for exploring the effect of sludge incorporation on the combustion performance of HAC. In this work, the thermal behaviour and microscopic properties of individual HAC, municipal sludge (MS) and HAC/MS mixtures were tested using a Thermogravimetric analyser (TGA) and a Fourier transform infrared (FTIR) spectrometer, respectively. The exothermic, thermodynamic and functional group evolution patterns during the combustion of these samples were also evaluated. Ignition temperatures (Ti) of the HAC/MS mixtures were relatively lower than that of individual HAC, and decreased with the increase in sludge mass ratio (SMR). The synergistic effect of the co-combustion of HAC and MS resulted in a slightly higher total heat release during the combustion of MS10HAC90 (i.e., the mass percentage of MS and HAC is 1:9) than HAC alone, however, the total heat release of the blend decreased progressively with increasing SMR. The experimental values of the average Eα for all four mixtures were lower than the theoretical values, indicating that the addition of MS lowered the reaction energy barriers of the mixtures. Consumption rates of the principal groups in samples during the oxidation and combustion all tended to increase progressively with increasing SMR. There are three major synergistic effects existing during co-combustion of HAC and MS: (1) the reaction of free radicals with benzene molecules; (2) the interaction of free radicals; and (3) the catalytic effect of alkali and alkaline earth metals. These findings can provide theoretical guidance for the determination of key parameters (mixing ratio) for the blending of HAC and MS, and can fill the research gap in terms of microscopic reactivity and synergistic effects during the co-combustion of HAC and MS.

Research on Combustion Properties and Pollutant Emission Characteristics of Blends of Maltol Byproduct/Pine Sawdust.

In this paper, the combustion and pollutant emission characteristics of maltol byproduct, pine sawdust, and their blends were experimentally studied by thermogravimetry, tube furnace experiment, and scanning electron microscopy. The results show that the combustion process of maltol byproduct, pine sawdust, and their blends can be divided into three stages, in which the volatile release of the maltol byproduct includes two stages. The ignition temperature of the blended fuel is lower than that of sawdust. The NO x produced by combustion of the blended fuel is lower than that produced by sawdust combustion alone, and the SO2 emission is always at a low level. There is a certain synergy between maltol byproduct and pine sawdust mixed combustion. Comprehensively comparing the combustion characteristics and emission characteristics, the blended fuel made by adding less than 10% maltol byproduct into pine sawdust can improve the combustion characteristics and reduce emissions, and 10% is the best proportion of the blended fuel.

Comparative Analyses between Raw and Preoxidized Pulverized Coals: Combustion Behaviors and Thermokinetic and Microcharacteristics.

Investigating the difference in the combustion performance and microcharacteristics of oxidized and raw pulverized coal (PC) can contribute to effectively prevent and control the spontaneous combustion of deposited coal dust in high-temperature environment and further help guarantee the safe operation of coal-fired boiler. In this study, the combustion performance and thermokinetic and microcharacteristics of three raw coal samples and their preoxidized forms were explored by a thermogravimetric analyzer (TGA) and Fourier transform infrared spectroscopy (FTIR). According to the characteristic temperatures and variations of the mass loss rate during heating, the entire combustion process of PC was divided into four periods. For each type of coal, the preoxidized PC had relatively lower characteristic temperatures than the corresponding raw PC. The preoxidized samples had larger values of ignition index (C ig) and comprehensive combustibility index (S), but lower values of burnout index (C b) than raw samples. The values of apparent activation energy (E) for the preoxidized PC were below that of the corresponding raw PC at the same conversion rate (α), which suggested the preoxidized PC required relatively less energy to react and was more prone to spontaneous combustion. In addition, although parts of -OH, C=O, and aliphatic hydrocarbon groups were consumed after the preoxidation treatment, the increase in C-O and -COO- bonds compensated for the adverse effect of the reduction of the aforementioned groups on coal combustion.

[Lycopene combined with quercetin and curcumin for chronic prostatitis/chronic pelvic pain syndrome in rats: Effect and mechanism].

OBJECTIVE: To study the therapeutic effect of lycopene combined with quercetin and curcumin on chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) in rats and its underlying mechanism. METHODS: Thirty-three 6-week-old SD male rats were randomly divided into six groups: normal control (n = 3), CP/CPPS model control (n = 6), quercetin (n= 6), curcumin (n = 6), lycopene (n = 6) and combination therapy (n = 6). CP/CPPS was induced by injection of complete Freund's adjuvant into the ventral lobe of the prostate in the latter five groups of rats. After modeling, the rats in the normal and CP/CPPS model control groups were given corn oil by gavage, and those in the latter four groups treated intragastrically with quercetin at 50 mg/kg/d, curcumin at 50 mg/kg/d, lycopene at 10 mg/kg/d, and quercetin + curcumin + lycopene, respectively, once daily for a course of 4 weeks. Then, cardiac blood and prostate tissue samples were collected from the rats for measurement of related indexes. RESULTS: Histopathological changes in the model rats were basically consistent with the characteristics of CP/CPPS. The expressions of the inflammatory factors IL-1ß, IL-2, IL-6, TNFα, MCP1 and MIP-1α in the prostate tissue were all dramatically decreased in the quercetin, curcumin, lycopene and combination therapy groups compared with those in the normal controls (P < 0.01), even lower in the combination therapy group than in the quercetin, curcumin and lycopene groups (P < 0.05). The activities of the oxides CAT, GSH-PX and T-SOD were significantly increased and that of MDA decreased in the four treatment groups (P < 0.05), even more significantly in the combination therapy group than in the other three (P < 0.01). The phosphorylation of MAPKs was inhibited, the activation of NF-kB blocked and the transcriptional activity of Nrf2 enhanced in the four treatment groups (P < 0.05), even more significantly in the combination therapy group (P < 0.01). Conclusions: Lycopene combined with quercetin and curcumin is more effective than any of the three drugs used alone in the treatment of CP/CPPS, which may be associated with its alleviation of inflammatory response and oxidative stress by interaction between the NF-κB, MAPKs and Nrf2 signaling pathways.?

Transvaginal natural orifice specimen extraction surgery (NOSES) in 3D laparoscopic partial or radical nephrectomy: a preliminary study.

BACKGROUND: With the development of minimally invasive technology, more and more people pay attention to aesthetics of the wound after operation. This study is aim to introduce a new surgical technique of transvaginal natural orifice specimen extraction surgery (NOSES) in 3D laparoscopic partial or radical nephrectomy and evaluate the safety, feasibility and clinical effect. METHODS: Eleven patients who underwent 3D laparoscopic partial nephrectomy (n = 7) or radical nephrectomy (n = 4) and NOSES were included in this study. The surgical procedures and techniques, especially the NOSES operation, are reported in detail. In addition, the basic clinical data, perioperative related data, perioperative complications were analyzed. RESULTS: All 11 patients were performed successfully without conversion to open surgery. The mean total operative time was 133 (84, 150) min. NOSES time was 15 (13, 16) min, and the postoperative hospital stay was 5 (5, 5) d. The mean visual analogue score (VAS) was 3 (2, 4) point and 1 (0, 1) point at 24 h and 48 h after operation, respectively. No patient had recurrence, metastasis and death during the follow-up period of 3 to 17 months. The median Vancouver Scar Scale (VSS) was 1 (1, 1) point. The mean of Female Sexual Function Index (FSFI) was 21.60 (20.20, 21.60), 21.80 (19.80, 21.80) respectively between preoperative and postoperative 3 months, which has no statistical difference (P = 0.179). There was no statistical difference in the Pelvic Floor Distress Inventory-short form 20 (PFDI-20) score between preoperative and postoperative 3 months (P = 0.142). CONCLUSIONS: Transvaginal NOSES is safe and feasible in 3D laparoscopic partial or radical nephrectomy. Furthermore, it results in low incision-related pain without affecting the pelvic floor and sexual function.

Surgical techniques, oncologic and functional outcomes of two types of modified ileal orthotopic neobladders.

BACKGROUND: In recent years, the construction of orthotopic neobladder has become the focus of research. Our study is aim to illustrate and evaluate surgical techniques, oncologic and functional outcomes of two types of modified ileal orthotopic neobladders (IONB). METHODS: We retrospectively reviewed of 64 patients who underwent laparoscopic radical cystectomy (LRC) + Xing's neobladder (n=41), Institute of Urology Peking University neobladder (IUPUB) (n=23) at two tertiary referral centers. Then demographic characteristics, operation outcomes were analyzed. In addition, postoperative complication rates, oncologic outcomes, continence, and neobladders' function were further evaluated. RESULTS: All LRC + IONB were carried out in 64 patients successfully. Pathological results show that 63 were urothelial carcinoma and 1 was adenocarcinoma. Time to flatus was 3 [1-6] d in Xing's neobladder group while 3 [2-5] d in IUPUB group (P=0.049). In terms of overall survival (OS), cancer specific survival (CSS) and recurrence-free survival (RFS), there is no statistical difference between the two groups. Overall, grade 1-2 complications were 36%, grade 3-4 complications were 1.6% on the 30th day, and 15.6%, 1.6% respectively on the 90th day. On the whole, daytime and night continence were 96.4%, 83.6% respectively one year after operation. CONCLUSIONS: The two types of modified IONB are safe and feasible. The technical improvements significantly simplify the procedure and decrease the difficulty of the surgery, probably shorten the operative time and reduce blood loss. Furthermore, they take the advantage of less late complications and comparative good functional outcomes without affecting the prognosis of oncology. In addition, Xing's neobladder is more beneficial to the recovery of postoperative gastrointestinal function.

A new and practical surgical technique of transvaginal natural orifice specimen extraction surgery (NOSES) in laparoscopic nephroureterectomy-an initial clinical experience.

OBJECTIVE: To explore the safety, feasibility and clinical effect of transvaginal natural orifice specimen extraction surgery (NOSES) in 3D laparoscopic nephroureterectomy (LNU) for upper tract urothelial carcinoma (UTUC). METHODS: A retrospective analysis was made of 16 female patients who underwent 3D LNU and NOSES in the Department of Urology, Cancer Hospital, Chinese Academy of Medical Sciences from June 2019 to December 2020. The basic clinical data, perioperative related data, perioperative complications, visual analogue pain score (VAS), postoperative scar assessment questionnaire (PSAQ) at 3 months, female pelvic floor dysfunction questionnaire (PFDI-20) and female sexual function index questionnaire (FSFI) at preoperative and postoperative 3 months were analyzed and evaluated. RESULTS: The surgery was successfully completed in all 16 patients, and none of them was converted to open surgery. No postoperative complications, such as abdominal incision-related infection. No cases of local recurrence and distant metastasis were observed during follow-up of 3 to 21 months. The VAS scores at 24 h and 48 h after operation were 2.9 ± 0.7, 1.3 ± 0.6, respectively. PSAQ scores at 3 months after operation were 34.3 ± 3.3. PFDI-20 scores of women preoperative and postoperative 3 months were 6.25 ± 1.75, 6.3 ± 1.8, respectively, and the difference was not statistically significant (p = 0.924). There was no significant difference in FSFI scores between preoperative and postoperative 3 months (p = 0.892). CONCLUSION: Transvaginal NOSES in 3D LNU for UTUC is safe, feasible and practical. The successful development of this technique has laid a solid foundation for further clinical application and promotion.

"Sandwich" Technique of Total Urethral Reconstruction in the Laparoscopic Radical Prostatectomy: A Prospective Study.

BACKGROUND: Early incontinence that has great impact on the quality-of-life is one usual drawback after laparoscopic radical prostatectomy (LRP). This prospective study aims at further documenting the improved effect of the "Sandwich" urethra reconstruction technique on continence at the early stage after LRP. METHODS: During the period from October 2017 to December 2018, 130 patients undergoing LRP in our institution were recruited into this prospective study. Sixty-six patients in Group A received LRP with the "Sandwich" technique of urethra reconstruction, while the remaining 64 patients in Group B did not adopt this reconstruction technique. The basic clinical data, perioperative related data, urinary continence, and urodynamic tests were analyzed and evaluated. RESULTS: There is no statistical difference in patients' basic clinical data, perioperative related data except urethral reconstruction time, which was 23.49±4.72 minutes in Group A and 20.16±5.75 minutes in Group B (P<0.001). The continence rates in Group A at 2, 4, 8, and 12 weeks were 54.55%, 83.33%, 93.94%, and 96.97%, respectively. The continence rates in Group B were 10.94%, 14.06%, 37.50%, and 71.88%, respectively. The continence rate of Group A was significantly higher after surgery compared with Group B (P<0.001). Maximum flow rates before and after the "Sandwich" procedure for 12 months were 13.2±2.8 m/s and 15.4±3.6 m/s, respectively (P=0.034). In addition, residual volumes before and after the "Sandwich" procedure for 12 months were 15 (0-20) mL and 0 (0-12.5) mL, respectively (P=0.107). CONCLUSION: Our prospective study confirms that the "Sandwich" technique of the total urethral reconstruction is safe and feasible. It also very possibly takes the significant advantage in early recovery of urinary continence after LRP. However, multicenter, randomized controlled large sample randomized controlled trials are needed to further confirm this final conclusion.