Correction: Glucocorticoid-Induced Osteoporosis (GIOP).

[This corrects the article DOI: 10.1007/s43465-023-01037-8.].

Reproductive Risk Factors Associated with Female Infertility in Sonepat District of Haryana: A Community Based Cross-Sectional Study.

Background: Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Aims: The aim of this study was to estimate the prevalence of infertility and its association with reproductive risk factors amongst women of reproductive age group (18-49 years) in district Sonepat, Haryana. Settings and Design: This observational community-based cross-sectional study was conducted amongst 444 reproductive age group (18-49 years) women residing in district Sonepat, from August 2021 to May 2022. Materials and Methods: A simple random sampling technique was used to select the study subjects. After taking written informed consent, all the participants were interviewed using a pre-designed, pre-tested semi-structured questionnaire for desired information. Statistical Analysis Used: Mean and standard deviation (SD) were calculated for quantitative data. Percentages and proportions were calculated for qualitative data. Results: Out of 444 study population, majority of women were fertile (88.7%), while 6.3% of women were secondary infertile and 5% of women were primary infertile. Most women were aged between 30 and 39 years. The difference of occurrence of infertility in relation to genital discharge (P = 0.049), genital ulcer/sores (P ≤ 0.001), groin swelling (P ≤ 0.001), warts (P = 0.015), menstrual cycle duration (P ≤ 0.001) and menstrual flow amount (P = 0.048) was statistically significant. The mean age of menarche for the female with infertility was 14.34 years (standard deviation = 1.40). Conclusion: Almost all of the symptoms of sexually transmitted infection/reproductive tract infection were high amongst infertile females. Awareness generation about the preventable risk factors and provision of infertility care services at primary healthcare facilities will be of use in addressing infertility in Sonepat.

Glucocorticoid-Induced Osteoporosis (GIOP).

Use of glucocorticoid in various diseases including rheumatology and respiratory diseases is on the rise because of its prompt beneficial effects. This culminates in osteoporosis and fragility fractures. Judicious use of glucocorticoid hence calls for attention with regard to the dose schedule, route of administration and accompanying enhancing factors. Institution of proper therapeutic management as per WHO risk stratification with anabolic and/or resorptive drugs like bisphosphonates, teriparatide or denosumab is necessary to prevent the eventuality of fragility fractures. Even otherwise, knowledge of glucocorticoid, its metabolism, various dose schedules, adverse effects are areas worth discussing.

Osteoporosis in Asthma and COPD.

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are principally lifestyle related chronic inflammatory airway disease. They are globally associated with various systemic comorbidities and mortality. Osteoporosis is the common associated metabolic bone disease with respiratory disturbances, which affect the prognosis and increase mortality and morbidity in the patients. Apart from OSTEOPOROSIS, exhaustive attention has been paid towards other associated systemic comorbidities like cardiovascular diseases, cerebrovascular diseases, metabolic syndrome, malnutrition, skeletal muscle dysfunction (sarcopenia), anxiety, depression and so on (Iheanacho et al. in Int J Chronic Obstr Pulm Dis 15:439-460, 2020; Singh et al. in Eur Respir J 53:1900164, 2019). Osteoporosis is a significant extrapulmonary manifestation in asthma and COPD, which are grossly neglected and inadequately treated. The comorbidities have significant impact in terms of morbidity, mortality and economic burden in asthma and COPD patients, hence management of asthma and COPD should comprise thorough management, as this will also have an impact on the outcome of these patients. Various risk factors such as smoking, systemic inflammation, vitamin deficiency, and the use of oral or inhaled corticosteroid are responsible for osteoporosis in patients with asthma and COPD. The presence of osteoporosis in patients with asthma and COPD is invariably asymptomatic unless complicated by fragility fractures, therefore, it is necessary to explore the pathogenesis of osteoporosis in asthma and COPD and special attention is to be paid for early recognition of patients at high risk for osteoporosis in these patients. This chapter is focussed on osteoporosis as an extrapulmonary manifestation of asthma and COPD with an emphasis on the pathogenesis, risk factor, potential mechanism of osteoporosis, diagnosis, and prevention with passing reference to treatment as well in asthma and COPD patients.

Pain Management in Osteoporosis.

The most prevalent metabolic bone disease, osteoporosis, is characterized by a decrease in bone mineral density and alterations to the bone's microstructure, both of which can result in fragility fractures. It affects a significant section of the population. Acute or chronic pain from these fractures is typical in elderly adults with other coexisting conditions. Since the antiresorptive medication only partially reduces pain, other analgesics are required for effective pain management. NSAIDs or selective COX-2 inhibitors can reduce acute pain, but persistent neuropathic pain is difficult to manage with these drugs. Opioids have their adverse effects and safety concerns, although they can be used to address acute or chronic pain. Hence, a multifaceted approach is to be implemented, including pharmacological and nonpharmacological therapy and surgical treatment in a selected number of cases. This chapter briefly describes the etiology of pain, its mechanism, and pain management in osteoporotic patients.

Facile Hydrogenolysis of Sugars to 1,2-Glycols by Ru@PPh3/OPPh3 Confined Large-Pore Mesoporous Silica.

Tandem hydrogenation vis-à-vis hydrogenolysis of xylose to 1,2-glycols remains a major challenge. Although one-pot conversion of xylose to 1,2-glycols requires stringent conditions, a sustainable approach would be quite noteworthy. We have developed a microwave route for the one-pot conversion of pentose (C5) and hexose (C6) sugars into glycol and hexitol, without pressurized hydrogen reactors. A pronounced hydrogenolysis of sugars to glycols is observed by Ru single atom (SA) on triphenylphosphine/phosphine oxide-modified silica (Ru@SiP), in contrast to Ru SA on pristine (Ru@SiC) and 3-aminopropyl-modified silica (Ru@SiN). A promising "ligand effect" was observed through phosphine modification of silica that presents a 70% overall yield of all reduced sugars (xylitol + glycols) from a 99% conversion of xylose with Ru@SiP. A theoretical study by DFT depicts an electronic effect on Ru-SA by triphenylphosphine that promotes the catalytic hydrogenolysis of sugars under mild conditions. Hence, this research represents an important step for glycols from biomass-derived sources.

Association of Different Biochemical and Hemodynamic Characteristic with Type 2 Diabetes Mellitus and Hypertension in Nephrolithiasis Patients.

Background Although Nephrolithiasis is a common condition caused by a wide variety of metabolic or environmental disturbances, its being one of the major factor of morbidity. Incidence of kidney stone disease (KSD) is highly affected by metabolic disorders and change in blood pressure and glucose. Objective To find out association of different biochemical and hemodynamic parameters with various glycemic status and hypertension in kidney stone disease. Method A cross sectional study was conducted in patients diagnosed as nephrolithiasis by using re¬nal ultrasonography and underwent nephrectomy between January 2019 to January 2021 in Shahid Dharmabhakta National Transplant Centre (SDNTC). A total of 100 subjects with 60 male and 40 females were enrolled. Glycemic status was categorized based on criteria of American Diabetes Association (ADA) and hypertension was defined as BP ≥ 140/90 mm Hg in right arm supine position. All biochemical and hemodynamic profile was carried out following standard protocol. Result Out of 100 patients enrolled, pre-diabetes accounted for 31% followed by diabetes (4%). However, hypertension comprised of 66% in total subjects. Serum urea, cholesterol and triglyceride level were found to be increased by 84.6%, 67.7% and 64.7% respectively in diabetes followed by increase of 3.9%, 19.5% and 3.1% respectively in prediabetes when compared to normal glycemic condition in nephrolithiasis subjects. Serum fasting blood glucose, creatinine and uric acid level was observed significantly higher (p=0.003, p=0.004, p < 0.001 respectively) in hypertensive patients. Duration of hospital stay was also seen positively correlated with hypertension. Conclusion Not only diabetes, prediabetes also manifests the increased risk of kidney stone disease along with hypertension. There is significant impairment in renal function and lipid profile based on diabetes mellitus and hypertension. Early identifying these systemic diseases, different biochemical and hemodynamic parameters and proper treatment accordingly may minimize risk and prevent serious complication in these patients.

Understanding Organisms Using Ecological Observatory Networks.

Human activities are rapidly changing ecosystems around the world. These changes have widespread implications for the preservation of biodiversity, agricultural productivity, prevalence of zoonotic diseases, and sociopolitical conflict. To understand and improve the predictive capacity for these and other biological phenomena, some scientists are now relying on observatory networks, which are often composed of systems of sensors, teams of field researchers, and databases of abiotic and biotic measurements across multiple temporal and spatial scales. One well-known example is NEON, the US-based National Ecological Observatory Network. Although NEON and similar networks have informed studies of population, community, and ecosystem ecology for years, they have been minimally used by organismal biologists. NEON provides organismal biologists, in particular those interested in NEON's focal taxa, with an unprecedented opportunity to study phenomena such as range expansions, disease epidemics, invasive species colonization, macrophysiology, and other biological processes that fundamentally involve organismal variation. Here, we use NEON as an exemplar of the promise of observatory networks for understanding the causes and consequences of morphological, behavioral, molecular, and physiological variation among individual organisms.

Comprehensive study on the origin of orthorhombic phase stabilization in Gd-doped HfO2 and DFT calculations.

In recent times, ultra-thin films of hafnium oxide (HfO2) have shown ferroelectricity (FE) attributed to the orthorhombic (o) phase of HfO2 with space group Pca21. This polar o-phase could be stabilized in the doped thin film of the oxide. In the present work, both polar and non-polar o-phases of HfO2 could be stabilized in Gd-doped bulk polycrystalline HfO2. Rietveld analysis of XRD data shows that the relative population of o-phases in the presence of the monoclinic (m) phase of HfO2 increases with increasing Gd-content. The local environment around the host atom has been investigated by time differential perturbed angular correlation (TDPAC) spectroscopy, synchrotron based X-ray near edge structure (XANES) and extended X-ray absorption fine structure (EXAFS) measurements. Field emission scanning electron microscopy (FESEM) and transmission electron microscopy (TEM) measurements showed a reduction in grain size with increasing Gd-dopant indicating a solute drag effect. It could be established that the segregation of the Gd-dopant in the grain boundary is a thermodynamically favorable process and the solute drag effect plays an important role in nucleation of the o-phase in bulk HfO2. Stabilization of Gd in both Pbca and Pca21 phases of HfO2 was supported by defect formation energy calculations using density functional theory (DFT). The present study has important implications in future applications of HfO2 in ferroelectric devices and in understanding the role of dopants in stabilizing the o-phase of HfO2 in the bulk.

Energetic Electron Precipitation Driven by Electromagnetic Ion Cyclotron Waves from ELFIN's Low Altitude Perspective.

We review comprehensive observations of electromagnetic ion cyclotron (EMIC) wave-driven energetic electron precipitation using data collected by the energetic electron detector on the Electron Losses and Fields InvestigatioN (ELFIN) mission, two polar-orbiting low-altitude spinning CubeSats, measuring 50-5000 keV electrons with good pitch-angle and energy resolution. EMIC wave-driven precipitation exhibits a distinct signature in energy-spectrograms of the precipitating-to-trapped flux ratio: peaks at >0.5 MeV which are abrupt (bursty) (lasting ∼17 s, or ΔL∼0.56) with significant substructure (occasionally down to sub-second timescale). We attribute the bursty nature of the precipitation to the spatial extent and structuredness of the wave field at the equator. Multiple ELFIN passes over the same MLT sector allow us to study the spatial and temporal evolution of the EMIC wave - electron interaction region. Case studies employing conjugate ground-based or equatorial observations of the EMIC waves reveal that the energy of moderate and strong precipitation at ELFIN approximately agrees with theoretical expectations for cyclotron resonant interactions in a cold plasma. Using multiple years of ELFIN data uniformly distributed in local time, we assemble a statistical database of ∼50 events of strong EMIC wave-driven precipitation. Most reside at L∼5-7 at dusk, while a smaller subset exists at L∼8-12 at post-midnight. The energies of the peak-precipitation ratio and of the half-peak precipitation ratio (our proxy for the minimum resonance energy) exhibit an L-shell dependence in good agreement with theoretical estimates based on prior statistical observations of EMIC wave power spectra. The precipitation ratio's spectral shape for the most intense events has an exponential falloff away from the peak (i.e., on either side of ∼1.45 MeV). It too agrees well with quasi-linear diffusion theory based on prior statistics of wave spectra. It should be noted though that this diffusive treatment likely includes effects from nonlinear resonant interactions (especially at high energies) and nonresonant effects from sharp wave packet edges (at low energies). Sub-MeV electron precipitation observed concurrently with strong EMIC wave-driven >1 MeV precipitation has a spectral shape that is consistent with efficient pitch-angle scattering down to ∼ 200-300 keV by much less intense higher frequency EMIC waves at dusk (where such waves are most frequent). At ∼100 keV, whistler-mode chorus may be implicated in concurrent precipitation. These results confirm the critical role of EMIC waves in driving relativistic electron losses. Nonlinear effects may abound and require further investigation.

Single parent adoption in India: Mental health and legal perspectives and the way forward.

Single parent adoption (SPA) is a relatively new construct worldwide and in India. The Ministry of Women and Child Development, Government of India, has laid down criteria for adoption in general and SPA in particular, in conjunction with the Juvenile Justice Act (Care and Protection of Children), 2015. There is scant literature on this topic of SPA, more so in India, that looks into the various psychological nuances of SPA from a mental health professional's (MHP) perspective. This review paper aims to assess SPA from the perspective of a MHP that will focus on its various legal nuances as well as the psychological connotations attached to it. For this, a search strategy was employed that included a thorough literature search from two databases (PubMed and Google Scholar) with relevant keywords related to the topic. The various legal issues pertaining to SPA in the current scenario, the psychological issues and challenges faced by single parents, the behavioral outcomes of adoptees who are adopted by single parents, and ways to deal with the various obstacles of SPA are discussed.

Magneto-strain effects in 2D ferromagnetic van der Waal material CrGeTe[Formula: see text].

The idea of strain based manipulation of spins in magnetic two-dimensional (2D) van der Waal (vdW) materials leads to the development of new generation spintronic devices. Magneto-strain arises in these materials due to the thermal fluctuations and magnetic interactions which influences both the lattice dynamics and the electronic bands. Here, we report the mechanism of magneto-strain effects in a vdW material CrGeTe[Formula: see text] across the ferromagnetic (FM) transition. We find an isostructural transition in CrGeTe[Formula: see text] across the FM ordering with first order type lattice modulation. Larger in-plane lattice contraction than out-of-plane give rise to magnetocrystalline anisotropy. The signature of magneto-strain effects in the electronic structure are shift of the bands away from the Fermi level, band broadening and the twinned bands in the FM phase. We find that the in-plane lattice contraction increases the on-site Coulomb correlation ([Formula: see text]) between Cr atoms resulting in the band shift. Out-of-plane lattice contraction enhances the [Formula: see text] hybridization between Cr-Ge and Cr-Te atoms which lead to band broadening and strong spin-orbit coupling (SOC) in FM phase. The interplay between [Formula: see text] and SOC out-of-plane gives rise to the twinned bands associated with the interlayer interactions while the in-plane interactions gives rise to the 2D spin polarized states in the FM phase.

Generation of map on natural environmental background absorbed dose rate in India.

A systematic mapping of natural absorbed dose rate was carried out to assess the existing exposure situation in India. The mammoth nationwide survey covered the entire terrestrial region of the country comprising of 45127 sampling grids (grid size 36 km2) with more than 100,000 data points. The data was processed using Geographic Information System. This study is based on established national and international approaches to provide linkage with conventional geochemical mapping of soil. Majority (93%) of the absorbed dose rate data was collected using handheld radiation survey meters and remaining were measured using environmental Thermo Luminescent Dosimeters. The mean absorbed dose rate of the entire country including several mineralized regions, was found to be 96 ± 21 nGy/h. The median, Geometric Mean and Geometric Standard Deviation values of absorbed dose rate were 94, 94 and 1.2 nGy/h, respectively. Among the High Background Radiation Areas of the country, absorbed dose rate varied from 700 to 9562 nGy/h in Karunagappally area of Kollam district, Kerala. The absorbed dose rate in the present nationwide study is comparable with the global database.

Assessing the prospect of XAFS experiments of metalloproteins under in vivo conditions at Indus-2 synchrotron facility, India.

The feasibility of X-ray absorption fine-structure (XAFS) experiments of ultra-dilute metalloproteins under in vivo conditions (T = 300 K, pH = 7) at the BL-9 bending-magnet beamline (Indus-2) is reported, using as an example analogous synthetic Zn (0.1 mM) M1dr solution. The (Zn K-edge) XAFS of M1dr solution was measured with a four-element silicon drift detector. The first-shell fit was tested and found to be robust against statistical noise, generating reliable nearest-neighbor bond results. The results are found to be invariant between physiological and non-physiological conditions, which confirms the robust coordination chemistry of Zn with important biological implications. The scope of improving spectral quality for accommodation of higher-shell analysis is addressed.

Role of C and B4C barrier layers in controlling diffusion propagation across the interface of Cr/Sc multilayers.

The optical performance of low-bilayer-thickness metallic multilayers (ML) can be improved significantly by limiting the intermixing of consecutive layers at the interfaces. Barrier layers are supposed to exhibit a decisive role in controlling diffusion across the interfaces. The element-specific grazing incidence extended X-ray absorption fine structure technique using synchrotron radiation has been used in conjunction with grazing incidence X-ray reflectivity and diffuse X-ray scattering measurements to study the impact of the two most common barrier layers, viz., C and B4C, at the interfaces of Cr/Sc MLs. The diffusion propagation is reduced by both the barrier layers; however, it is found that the improvement is more significant with the B4C barrier layer. It is seen that C forms an intermixed layer with Sc and leads to carbide formation at the interface, which then acts as shielding and prevents further interdiffusion, while B4C hardly penetrates into Sc and stops the overlap between Sc and Cr directly by wetting the corresponding interface. Thus, the above measurements reveal crucial and precise information regarding the elemental diffusion kinetics at the interfaces of Cr/Sc MLs in a non-destructive way, which is very important for technological applications of these MLs as X-ray optical devices.

Transcriptomic response of bioengineered human cartilage to parabolic flight microgravity is sex-dependent.

Spaceflight and simulated spaceflight microgravity induced osteoarthritic-like alterations at the transcriptomic and proteomic levels in the articular and meniscal cartilages of rodents. But little is known about the effect of spaceflight or simulated spaceflight microgravity on the transcriptome of tissue-engineered cartilage developed from human cells. In this study, we investigate the effect of simulated spaceflight microgravity facilitated by parabolic flights on tissue-engineered cartilage developed from in vitro chondrogenesis of human bone marrow mesenchymal stem cells obtained from age-matched female and male donors. The successful induction of cartilage-like tissue was confirmed by the expression of well-demonstrated chondrogenic markers. Our bulk transcriptome data via RNA sequencing demonstrated that parabolic flight altered mostly fundamental biological processes, and the modulation of the transcriptome profile showed sex-dependent differences. The secretome profile analysis revealed that two genes (WNT7B and WNT9A) from the Wnt-signaling pathway, which is implicated in osteoarthritis development, were only up-regulated for female donors. The results of this study showed that the engineered cartilage tissues responded to microgravity in a sex-dependent manner, and the reported data offers a strong foundation to further explore the underlying mechanisms.

A first-in-human study of the anti-LAG-3 antibody favezelimab plus pembrolizumab in previously treated, advanced microsatellite stable colorectal cancer.

BACKGROUND: Treatment options are limited for participants with microsatellite stable (MSS) metastatic colorectal cancer (mCRC) that progressed after two or more prior therapies. Studies have shown that blockade of both lymphocyte-activation gene 3 (LAG-3) and programmed cell death protein 1 (PD-1) can improve antitumor activity. Here, we evaluate the antitumor activity of the LAG-3 antibody favezelimab alone or in combination with pembrolizumab in participants with MSS mCRC. PATIENTS AND METHODS: Eligible participants with MSS PD-1/programmed death-ligand 1 (PD-L1) treatment-naive mCRC that progressed on two or more prior therapies received 800 mg favezelimab, 800 mg favezelimab plus 200 mg pembrolizumab, or 800 mg favezelimab/200 mg pembrolizumab co-formulation, every 3 weeks. The primary endpoint was safety, the secondary endpoint was objective response rate (ORR), and exploratory endpoints included duration of response, progression-free survival (PFS), and overall survival (OS). RESULTS: At the data cut-off date of 23 October 2020, a total of 20 participants received favezelimab alone, 89 received favezelimab plus pembrolizumab (including as favezelimab/pembrolizumab co-formulation); 48 had PD-L1 combined positive score (CPS) ≥1 tumors. At this interim analysis median follow-up was 5.8 months with favezelimab and 6.2 with favezelimab plus pembrolizumab. Treatment-related adverse events (TRAEs) were 65% with favezelimab and 65.2% with favezelimab plus pembrolizumab. Grade ≥3 TRAEs were 15% with favezelimab and 20% with favezelimab plus pembrolizumab. No grade 5 TRAEs occurred. Common TRAEs (≥15%) included fatigue (20.0%), nausea (15.0%) with favezelimab, and fatigue (16.9%) with favezelimab plus pembrolizumab. Confirmed ORR was 6.3% with favezelimab plus pembrolizumab, with median duration of response of 10.6 months (range 5.6-12.7 months), median OS of 8.3 months (95% confidence interval 5.5-12.9 months), and median PFS of 2.1 months (1.9-2.2 months). In an exploratory analysis of PD-L1 CPS ≥1 tumors, the confirmed ORR was 11.1%, median OS was 12.7 months (4.5 to not reached), and median PFS was 2.2 months (1.8-4.2 months) with favezelimab plus pembrolizumab. CONCLUSIONS: Favezelimab with or without pembrolizumab had a manageable safety profile, with no treatment-related deaths. Promising antitumor activity was observed with combination therapy, particularly in participants with PD-L1 CPS ≥1 tumors.

Gamma radiation induced changes in expression of heat shock proteins (Hsc70 and Hsp83) in the dengue vector Aedes aegypti (L.).

We aimed to assess the effect of gamma radiation on the expression of heat shock proteins Hsc70 and Hsp83 in Aedes aegypti. Adult males were irradiated with 50Gy of gamma radiation, and changes in the expression of proteins in SDS-PAGE gel bands corresponding to molecular weights ~60-75kDa and ~80-95kDa were analyzed at two different time points 6 and 12-hour post-irradiation, using a temporal mass spectrometry based semi-quantitative analysis. A 2-3-fold increase was observed in both proteins Hsc70 and Hsp83, at both time points. In addition, the experiment also revealed the overexpression of several other molecules such as Arginine Kinase - known to be upregulated in certain insects during stress, Esterase B1- implicated in insecticide resistance, and also down-regulation of the 26S proteasome non-ATPase regulatory subunit 1 and ubiquitin-activating enzyme E1 - both known to be involved in ubiquitin-mediated protein degradation. The results taken together with existing data on Hsp83 and Hsc70, indicate that these proteins may enhance the survival of Ae. aegypti following gamma radiation and could serve as molecular markers for the detection of radiation-induced stress.

Hydrogeochemical characterization and evaluation of subsurface water quality in the Proterozoic Cuddapah Basin, Andhra Pradesh, India.

In the current survey, different hydrogeochemical processes governing the geochemistry of aquifers, the usefulness of groundwater for regular consumption, and agricultural purposes were evaluated around the Tummalapalle area. One hundred forty-four borehole locations were chosen to characterize the major physicochemical components of the aquifer water. The analysis results of pH inferred that the groundwater is nominally acidic to basic, and pH ranged from 6.6 to 8.4. The average concentrations of TDS, Ca2+, Mg2+, total hardness (TH), HCO3-, and total alkalinity (TA) are within the allowable limits of potable water quality as prescribed by the Bureau of Indian Standards (BIS) and WHO. However, the average concentrations of Na+, K+, Cl-, and SO42- were all below the permissible limit. All samples were analyzed with the help of Piper and Chadha charts to determine the dominant hydrogeochemical components of groundwater. The dominance of cations in groundwater in this region is in the sequence of Ca2+ > Na+ > Mg2+ > K+, followed by anions HCO3- > Cl- > SO42-. The Gibbs plot analysis suggested the predominance of rock aquifer interaction as the major hydrogeochemical process governing groundwater geochemistry in this region. The water quality index (WQI) of all groundwater samples in the Tummalapalle region was estimated, with 55% of the samples being potable grade. The different irrigation indices were analyzed for the groundwater samples to estimate their desirability for agriculture. The maximum number of water samples was found to be well-suited for cultivation.

Proper understanding of recurrent stress urinary incontinence treatment in women (PURSUIT): a randomised controlled trial of endoscopic and surgical treatment.

BACKGROUND: Women with stress urinary incontinence (SUI) experience urine leakage with physical activity. Currently, the interventional treatments for SUI are surgical, or endoscopic bulking injection(s). However, these procedures are not always successful, and symptoms can persist or come back after treatment, categorised as recurrent SUI. There are longstanding symptoms and distress associated with a failed primary treatment, and currently, there is no consensus on how best to treat women with recurrent, or persistent, SUI. METHODS: A two-arm trial, set in at least 20 National Health Service (NHS) urology and urogynaecology referral units in the UK, randomising 250 adult women with recurrent or persistent SUI 1:1 to receive either an endoscopic intervention (endoscopic bulking injections) or a standard NHS surgical intervention, currently colposuspension, autologous fascial sling or artificial urinary sphincter. The aim of the trial is to determine whether surgical treatment is superior to endoscopic bulking injections in terms of symptom severity at 1 year after randomisation. This primary outcome will be measured using the patient-reported International Consultation on Incontinence Questionnaire - Urinary Incontinence - Short Form (ICIQ-UI-SF). Secondary outcomes include assessment of longer-term clinical impact, improvement of symptoms, safety, operative assessments, sexual function, cost-effectiveness and an evaluation of patients' and clinicians' views and experiences of the interventions. DISCUSSION: There is a lack of high-quality, randomised, scientific evidence for which treatment is best for women presenting with recurrent SUI. The PURSUIT study will benefit healthcare professionals and patients and provide robust evidence to guide further treatment and improve symptoms and quality of life for women with this condition. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number (ISRCTN) registry ISRCTN12201059. Registered on 09 January 2020.