Anomaly based multi-stage attack detection method.

Multi-stage attacks are one of the most critical security threats in the current cyberspace. To accurately identify multi-stage attacks, this paper proposes an anomaly-based multi-stage attack detection method. It constructs a Multi-Stage Profile (MSP) by modeling the stable system's normal state to detect attack behaviors. Initially, the method employs Doc2Vec to vectorize alert messages generated by the intrusion detection systems (IDS), extracting profound inter-message correlations. Subsequently, Hidden Markov Models (HMM) are employed to model the normal system state, constructing an MSP, with relevant HMM parameters dynamically acquired via clustering algorithms. Finally, the detection of attacks is achieved by determining the anomaly threshold through the generation probability (GP). To evaluate the performance of the proposed method, experiments were conducted using three public datasets and compared with three advanced multi-stage attack detection methods. The experimental results demonstrate that our method achieves an accuracy of over 99% and precision of 100% in multi-stage attack detection. This confirms the effectiveness of our method in adapting to different attack scenarios and ultimately completing attack detection.

System-level biological effects of extremely low-frequency electromagnetic fields: an in vivo experimental review.

During the past decades, the potential effects of extremely low-frequency electromagnetic fields (ELF-EMFs) on human health have gained great interest all around the world. Though the International Commission on Non-Ionizing Radiation Protection recommended a 100 µT, and then a 200 µT magnetic field limit, the long-term effects of ELF-EMFs on organisms and systems need to be further investigated. It was reported that both electrotherapy and possible effects on human health could be induced under ELF-EM radiation with varied EM frequencies and fields. This present article intends to systematically review the in vivo experimental outcome and the corresponding mechanisms to shed some light on the safety considerations of ELF-EMFs. This will further advance the subsequent application of electrotherapy in human health.

Motivation to interaction media: The impact of automation trust and self-determination theory on intention to use the new interaction technology in autonomous vehicles.

Introduction: This research investigated the effects of three psychological needs (competence, autonomy, and relatedness) of self-determination theory (SDT) and automation trust on the intention of users to employ new interaction technology brought by autonomous vehicles (AVs), especially interaction mode and virtual image. Method: This study focuses on the discussion from the perspective of psychological motivation theory applied to AV interaction technology. With the use of a structured questionnaire, participants completed self-report measures related to these two interaction technologies; a total of 155 drivers' responses were analyzed. Result: The results indicated that users' intentions were directly predicted by their perceived competence, autonomy, and relatedness of SDT and automation trust, which jointly explained at least 66% of the variance in behavioral intention. In addition to these results, the contribution of predictive components to behavioral intention is influenced by the type of interaction technology. Relatedness and competence significantly impacted the behavioral intention to use the interaction mode but not the virtual image. Discussion: These findings are essential in that they support the necessity of distinguishing between types of AV interaction technology when predicting users' intentions to use.

[Tonglong Kaibi Prescription for the treatment of severe benign prostate hyperplasia: A clinical study].

OBJECTIVE: To evaluate the clinical effect of the traditional Chinese medicine (TCM) Tonglong Kaibi Prescription (TKP) in the treatment of severe BPH with kidney deficiency and blood stasis combined with damp heat syndrome. METHODS: We randomly divided 120 cases of severe BPH with kidney deficiency and blood stasis combined with damp heat syndrome into three groups of equal number, treated with TKP, doxazosin mesylate sustained-release tablets (the DM control), and TKP + DM, all for 8 weeks. We obtained the IPSS, TCM symptoms scores, quality of life (QOL) scores, maximum urinary flow rate (Qmax) and postvoid residual urine volume (PVR) from the patients before and after treatment and compared them among the three groups. RESULTS: After 8 weeks of treatment, the effectiveness rate was significantly higher in the TKP + DM than in the DM control group (P < 0.05). The IPSS, TCM symptoms scores, QOL scores and PVR decreased (P < 0.01), while the Qmax increased dramatically (P < 0.01) in all the three groups. Pairwise comparison showed that the IPSS and QOL scores were lower in the TKP + DM than in the TKP and DM control groups (P < 0.05 or 0.01), and so were the TCM syndrome scores in the TKP + DM and TKP groups than in the DM control (P < 0.01). There were no statistically significant differences in PVR and Qmax among the three groups after treatment (P> 0.05), and no serious adverse events during the treatment. CONCLUSION: TKP is safe and effective in the treatment of severe BPH, which can improve the TCM symptoms, reduce the IPSS, QOL scores and PVR and increase the Qmax of the patients. TKP is evidently superior to DM alone in improving TCM symptoms of BPH and combined medication of TKP and DM produces even better clinical efficacy.

[Magnetic resonance and magnetoelectric therapy combined with Danhong Tongjing Prescription for the treatment of CP/CPPS and its effects on secretory IgA, vascular cell adhesion molecule-1 and interleukin-8].

OBJECTIVE: To investigate the therapeutic effect of magnetic resonance and magnetoelectric therapy (MRMT) combined with oral Danhong Tongjing Prescription (DTP) on chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) and the changes in the levels of cytokine-secretory IgA (sIgA), vascular cell adhesion molecule-1 (VCAM-1) and interleukin-8 (IL-8) after treatment. METHODS: Totally 200 patients with CP/CPPS of the qi stagnation and blood stasis type were randomly divided into three groups to receive MRMT + DTP (n = 68), MRMT (n = 67) and DTP (n = 65), respectively, all for 12 weeks. After treatment, we compared the total effectiveness rate, patients' scores on NIH-CPSI and traditional Chinese medicine (TCM) syndrome, and the expressions of sIgA, VCAM-1 and IL-8 in the EPS among the three groups of the patients. RESULTS: After treatment, the patients in the MRMT + DTP group, compared with those in the MRMT and DTP groups, showed a significantly higher total effectiveness rate (86.76% vs 79.10% and 78.46%, P < 0.05 and P < 0.01) and lower scores on pain or discomfort (4.61 ± 2.37 vs 5.86 ± 3.26 and 6.94 ± 2.25 P < 0.01), abnormal urination symptoms (2.98 ± 1.75 vs 3.85 ± 2.01 and 3.94 ± 1.95) and quality of life (3.26 ± 1.87 vs 4.54 ± 2.13 and 4.69 ± 1.72). There were statistically significant differences in the total NIH-CPSI scores among the three groups (10.64 ± 5.91 vs 4.59 ± 6.87 vs 15.54 ± 5.76, P < 0.05). The MRMT + DTP group also exhibited a remarkably lower TCM syndrome score than the MRMT and DTP groups (5.56 ± 3.42 vs 7.37 ± 4.57 and 8.16 ± 3.65, P < 0.05). Compared with the baseline, the expressions sIgA, VCAM-1 and IL8 were all markedly decreased after treatment in the MRMT + DTP (Z = －7.170, Z = －7.182, Z = －7.18), MRMT (Z = －6.802, Z = －6.973, Z = －6.768) and DTP groups (Z = －5.963, Z = －6.990 Z = －5.618) (P < 0.05), even more significantly in the former than in the latter two groups (P < 0.05). CONCLUSION: Magnetic resonance and magnetoelectric therapy combined with Danhong Tongjing Prescription has a good therapeutic effect on CP/CPPS of the qi stagnation and blood stasis type, probably by regulating sIgA, VCAM-1, IL-8 and other cytokines, activating the function of the immune system, inhibiting inflammation, and promoting the absorption of local inflammatory substances.

[Pricking-reinforcing -reducing therapy improves semen quality and seminal plasma biochemical indexes in patients with varicocele infertility].

OBJECTIVE: To investigate the effect of pricking-reinforcing -reducing therapy (PRRT) on the semen quality and seminal plasma biochemical indexes of varicocele (VC) infertility patients. METHODS: We randomly and equally assigned 160 patients with VC infertility into a PRRT and a control group, the former treated by PRRT and the latter with oral ShengjingCapsules. Before and after treatment, we obtained the semen parameters, sperm morphology, sperm survival rate, sperm acrosin activity, seminal plasma neutral α glucosidase and seminal plasma zinc in the patients and compared them between the two groups. RESULTS: Before treatment, there were no statistically significant differences between the PRRT and control groups in sperm concentration (ï¼»16.81 ± 7.83ï¼½ vs ï¼»16.80 ± 7.54ï¼½ ×106 /ml, P > 0.05), total sperm count (ï¼»42.01 ± 19.57ï¼½ vs ï¼»41.99 ± 18.84ï¼½ ×106, P > 0.05), percentages of progressively motile sperm (PMS) (ï¼»15.37 ± 11.03ï¼½% vs ï¼»14.68 ± 10.27ï¼½%, P > 0.05) and morphologically normal sperm ( MNS) (1.62 ± 1.51ï¼½% vs ï¼»1.62 ± 1.13ï¼½%, P > 0.05), sperm survival rate (ï¼»28.11 ± 18.95ï¼½% vs ï¼»28.23±18.38ï¼½%, P > 0.05) and sperm acrosin activity (ï¼»28.11 ± 14.64ï¼½ vs ï¼»27.19 ± 14.07ï¼½ U/L, P > 0.05). After three months of treatment, all the patients showed evident increases in the above parameters (P < 0.05), even higher in the PRRT than in the control group, more significantly in sperm concentration (ï¼»38.88 ± 30.54ï¼½ vs ï¼»25.60 ± 14.71ï¼½ ×106 /ml, P < 0.05), PMS (ï¼»32.60 ± 12.46ï¼½% vs ï¼»27.67 ± 12.27ï¼½%, P < 0.05) and sperm acrosin activity (ï¼»65.74±31.81ï¼½ vs ï¼»67.94±17.95ï¼½ U/L, P < 0.05), though not significantly in total sperm count (97.20 ± 76.35ï¼½ vs ï¼»88.19 ± 39.56ï¼½ ×106, P > 0.05), MNS (ï¼»2.35 ± 1.83ï¼½% vs ï¼»1.87 ± 1.20ï¼½%, P > 0.05) and sperm survival rate (ï¼»61.44 ± 20.02ï¼½% vs ï¼»59.12 ± 22.48ï¼½%, P > 0.05). Compared with the baseline, after treatment, the patients in the PRRT group also exhibited elevated levels of neutral α-glucosidase (ï¼»14.42 ± 5.90ï¼½ vs ï¼»28.43 ± 19.76ï¼½ U/L, P < 0.05) and seminal plasma zinc (ï¼»2.11 ± 1.22ï¼½ vs ï¼»2.89 ± 1.23ï¼½ mmol/L, P < 0.05), and so did the controls (ï¼»14.44 ± 5.61ï¼½ vs ï¼»26.66 ± 17.69ï¼½ U/L , P < 0.05) and (ï¼»2.09 ± 1.10ï¼½ vs ï¼»2.82±1.08ï¼½ mmol/L, P < 0.05). No statistically significant difference, however, was observed between the two groups after treatment (P > 0.05). CONCLUSION: PRRT can significantly improve semen quality in patients with VC infertility, even more effective than ShengjingCapsules in improving sperm concentration, PMS, sperm survival rate, and sperm acrosin activity, which may be related to its effect of elevating the levels of seminal plasma neutral-α glucosidase and zinc providing sufficient energy for basic sperm metabolism, maturation, energy acquisition and motility.

[Danhong Tongjing Prescription versus microsurgery in the treatment of varicocele-induced infertility: A retrospective multivariate analysis of 218 cases].

OBJECTIVE: To compared the traditional Chinese medicine Danhong Tongjing Prescription (DTP) and microsurgery in the treatment of varicocele (VC)-induced infertility and investigate the factors influencing the recovery of semen parameters of the patients. METHODS: We retrospectively analyzed the clinical data on 218 cases of VC-induced infertility with qi-deficiency and blood-stasis treated with DTP (n = 86) or by microsurgery (n = 132) in our hospital from January 2017 to July 2019, and compared the semen parameters between the two groups of patients after treatment. With age, course of disease, degree of VC, change of the testis volume, estrogen/testosterone (E/T) ratio and levels of FSH and LH as independent variables, and increased semen parameters after treatment as dependent variables, we constructed a multivariate linear regression model and identified statistically significant independent variables. RESULTS: After treatment, sperm concentration and the percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS) were obviously improved in both the DTP and microsurgery groups, with statistically significant difference between the two groups in sperm concentration and MNS, but not in PMS. Linear regression analysis showed that the severity of VC was an influencing factor for the recovery of sperm concentration after treatment in the DTP group (r = －11.599, Ra2 = 0.044 9) and the course of VC infertility was a factor affecting the recovery of sperm count in the microsurgery group (r = －1.837, Ra2 = 0.035 7). CONCLUSION: DTP is comparable to microsurgery in improving sperm motility while microsurgery is more effective in increasing the percentage of MNS in the treatment of VC-induced infertility. Early surgery is recommended for the treatment of infertility induced by severe bilateral VC, and DTP can be selected for infertility caused by mild or moderate bilateral VC if the patient is unwilling to accept surgery or microsurgery is inaccessible in the hospital.

Prognostic and Clinicopathological Significance of the Systemic Immune-Inflammation Index in Patients With Renal Cell Carcinoma: A Meta-Analysis.

BACKGROUND: The systemic immune-inflammation index (SII) is a hematological parameter based on neutrophil, platelet, and lymphocyte counts. Studies that have investigated the prognostic value of SII in patients with renal cell carcinoma (RCC) have reported controversial results. In this study, we systematically investigated the prognostic value of SII in patients with RCC. METHODS: We systematically searched English articles in the PubMed, Embase, Web of Science, and Cochrane Library databases up to October 2021. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were used to obtain pooled results. RESULTS: The meta-analysis included 10 studies that enrolled 3,180 patients. A high SII was associated with poor overall survival (HR 1.75, 95% CI 1.33-2.30, p<0.001) in patients with RCC. However, a high SII was not shown to be a significant prognostic factor for progression-free survival/disease-free survival (HR 1.22, 95% CI 0.84-1.76, p=0.293) or poor cancer-specific survival (HR 1.46, 95% CI 0.68-3.12, p=0.332) in patients with RCC. A high SII was correlated with male sex (OR 1.51, 95% CI 1.11-2.04, p=0.008), Fuhrman grade G3-G4 (OR 1.80, 95% CI 1.08-3.00, p=0.024), and poor risk based on the International Metastatic Renal Cell Carcinoma Database Consortium criteria (OR 19.12, 95% CI 9.13-40.06, p<0.001). CONCLUSION: A high SII was independently associated with poor survival outcomes in patients with RCC. Additionally, an elevated SII indicated more aggressive disease. The SII may serve as a useful cost-effective prognostic indicator in patients with RCC.

Noni (Morinda citrifolia L.) Fruit Polysaccharides Regulated IBD Mice Via Targeting Gut Microbiota: Association of JNK/ERK/NF-κB Signaling Pathways.

Inflammatory bowel disease (IBD) is a disease characterized by intestinal inflammation with immune dysregulation and intestinal microecological imbalance. In a dextran sulfate sodium salt (DSS)-induced IBD mouse model, noni (Morinda citrifolia L.) fruit polysaccharides (NFP) with homogalacturonan and rhamnogalacturonan-I domain decreased the concentration of serum LPS, TNF-α, and IL-17 by 84, 42, and 65%, respectively. It was abolished when intestinal microbiota were depleted by antibiotics. Sequencing analysis of gut microbiota showed an attenuated disruption of the microbial composition in the DSS+NFP group. Targeted metabolomic analysis revealed that NFP upregulated the content of acetic acid, propionic acid, and butyric acid by onefold but reduced isobutyric acid and isovaleric acid contents. NFP also inhibited JNK, ERK, and NF-κB phosphorylation of IBD mice. Taken together, the mechanism of NFP alleviating IBD is related to the intestinal microecological balance to inhibit inflammatory signaling pathways. This study provides a basis for NFP as a cheap intervention for the prevention and treatment of IBD patients.

Association Between Prediabetes and Erectile Dysfunction: A Meta-Analysis.

Background: Diabetes has been associated with the increased risk of erectile dysfunction (ED). However, previous studies evaluating the association between prediabetes and ED showed inconsistent results. We performed a meta-analysis of observational studies to systematically evaluate the above association. Methods: Relevant observational studies were retrieved by search of PubMed, Embase, and Web of Science databases. A random-effect model which incorporated the potential intra-study heterogeneity was used for the meta-analysis. Subgroup analyses were performed to evaluate the influences of study characteristics on the outcome. Results: Nine studies (five matched case-control studies and four cross-sectional studies) were included. Age were adjusted or matched in all of the studies. Pooled results showed that compared to men with normoglycemia, men with prediabetes were associated with higher prevalence of ED (odds ratio = 1.62, 95% confidence interval: 1.28 to 2.07, P < 0.001; I2 = 78%). Subgroup analyses showed that the association was not significantly affected by definition of prediabetes, diagnostic tool for ED, or controlling of additional variables besides age (both P for subgroup difference > 0.05). However, the association between prediabetes and ED seemed to be stronger in case-control studies than that in cross-sectional studies, and in studies with younger men (mean age < 50 years) than in those with older men (mean age ≥ 50 years; both P for subgroup difference < 0.05). Conclusions: Prediabetes is associated with higher prevalence of ED, which may be independent of age of the males and may be stronger in young men.

Downregulated caveolin-1 expression serves a potential role in coronary artery spasm by inducing nitric oxide production in vitro.

The present study aimed to investigate the effects of downregulated caveolin-1 (Cav-1) expression on nitric oxide (NO) production in lipopolysaccharide (LPS)-damaged primary human umbilical vein endothelial cells (HUVECs) in a model of coronary artery spasm (CAS) microenvironment induced by acetylcholine (ACh) treatment. Small interfering RNA (siRNA)-mediated Cav-1 downregulation in HUVECs was confirmed by western blotting. The cell viability and superoxide dismutase (SOD) inhibition in HUVECs incubated with LPS (0, 10, 25, 50, 75 and 100 µg/ml) were measured by cell counting kit-8 assay and a SOD kit, respectively. Intracellular Ca2+ [(Ca2+)i] in Fluo4-acetoxymethyl ester-loaded cells was detected by fluorescence microscopy. NO levels in the cell culture supernatants were measured by the nitrate reductase method. The results indicated that transfection with Cav-1 siRNA, in particular siCav-1 (2), downregulated the Cav-1 protein expression. LPS at a dose of 75 µg/ml induced a significant decrease in HUVECs/si-NC and HUVECs/siCav-1 viability compared with the other concentrations of LPS. Compared with the effects of untreated cells, SOD inhibition in HUVECs/si-NC and HUVECs/siCav-1 was significantly decreased by LPS (75 µg/ml). In addition, ACh stimulation caused a greater increase in [Ca2+]i in HUVECs/si-NC as compared with LPS-treated HUVECs/si-NC. ACh stimulation also induced significantly higher NO levels in LPS-treated HUVECs/siCav-1 compared with LPS-treated HUVECs/si-NC cells (P<0.05). In conclusion, the downregulated Cav-1 expression served a key role in NO production in the in vitro model of CAS induced by ACh stimulation of LPS-damaged HUVECs.

Tenascin­C promotes the migration of bone marrow stem cells via toll­like receptor 4­mediated signaling pathways: MAPK, AKT and Wnt.

There are currently limitations in stem cell therapy due to the low rate of homing and proliferation of cells following transplantation. The present study was designed to investigate the effects of Tenascin­C (TN­C) on bone marrow mesenchymal stem cells (BMSCs) and its underlying mechanisms. BMSCs were obtained from C57BL/6 mice. The survival and proliferation of BMSCs was analyzed by Cell Counting Kit­8 assay, migration was evaluated using the Transwell method, and differentiation was assessed by immunocytochemistry and immunofluorescence. In addition, the levels of proteins were detected by western blotting. High concentrations of TN­C promoted the migration of BMSCs. H2O2 at concentrations of 60­90 µmol/ml induced cell death in BMSCs, and thus, it was used to simulate oxidative stress in the microenvironment of acute myocardial infarction (AMI). High concentrations of TN­C were able to protect BMSCs from cell death, and promoted the migration of BMSCs (P<0.05). However, TAK­242 [the inhibitor of Toll­like receptor 4, (TLR4)] reduced the promoting effect of TN­C (P<0.05). By contrast, TN­C had no effect on the proliferation and differentiation of BMSCs. TN­C reduced the phosphorylation levels of p38 mitogen­activated protein kinase (MAPK), and increased the phosphorylation levels of Ser473 protein kinase B (AKT) and ß­catenin, all of which were inhibited by TAK­242 (P<0.05). In the simulated AMI microenvironment, TN­C promoted the migration of BMSCs via TLR4­mediated signaling pathways, including MAPK, AKT and Wnt.

Subcutaneous injection of dendritic cells aggravates atherosclerosis in ApoE­knockout mice by activation of TLR4.

Dendritic cells (DCs) are specialized antigen­presenting cells which are important in immune diseases, in particular atherosclerosis, a chronic inflammatory disease, however their role in atherosclerosis­associated immunity is unclear. To evaluate the role of DCs in atherosclerosis, exogenous bone marrow­derived DCs were transferred into ApoE­/­ mice in the present study. The extent of disease was measured in the aorta and was compared with mice treated with phosphate­buffered saline (PBS) or left untreated and fed a western diet. Mice receiving exogenous DCs demonstrated significantly larger atherosclerotic lesions compared with the mice treated with PBS, with increasing numbers of mature DCs in circulation and enhanced DC infiltration into plaque lesions, in addition to activation of circulating inflammatory components and atherosclerotic lesions. Furthermore, it was demonstrated that exogenous DCs upregulated the expression of Toll­like receptor 4 (TLR4) on DCs, which may be an important mechanism to activate DCs and aggravate atherosclerosis. Therefore the present study concluded that exogenous DCs may induce maturation of endogenous DCs via upregulation of TLR4, further increasing the inflammatory response and accelerating atherosclerosis.

The impact of advanced proteomics in the search for markers and therapeutic targets of bladder cancer.

Bladder cancer is the most common cancer of the urinary tract and can be avoided through proper surveillance and monitoring. Several genetic factors are known to contribute to the progression of bladder cancer, many of which produce molecules that serve as cancer biomarkers. Blood, urine, and tissue are commonly analyzed for the presence of biomarkers, which can be derived from either the nucleus or the mitochondria. Recent advances in proteomics have facilitated the high-throughput profiling of data generated from bladder cancer-related proteins or peptides in parallel with high sensitivity and specificity, providing a wealth of information for biomarker discovery and validation. However, the transmission of screening results from one laboratory to another remains the main disadvantage of these methods, a fact that emphasizes the need for consistent and standardized procedures as suggested by the Human Proteome Organization. This review summarizes the latest discoveries and progress of biomarker identification for the early diagnosis, projected prognosis, and therapeutic response of bladder cancer, informs the readers of the current status of proteomic-based biomarker findings, and suggests avenues for future work.

Is Overexpression of Ki-67 a Prognostic Biomarker of Upper Tract Urinary Carcinoma? A Retrospective Cohort Study and Meta-Analysis.

BACKGROUND: Upper tract urinary carcinoma (UTUC) is a relatively uncommon but aggressive disease. The Ki-67 antigen is a classic marker of cellular proliferation, but there is still controversy regarding the significance and importance of Ki-67 in tumor progression. METHODS: In this study, we first detected Ki-67 expression in UTUC patients by immunohistochemistry (IHC). Subsequently, we quantitatively combined the results with those from the published literature in a meta-analysis after searching several databases. RESULTS: IHC results demonstrated that patients with muscle-invasive tumors (T2-T4) had higher Ki-67 expression than those with non-muscle-invasive tumors (Tis-T1), suggesting that high Ki-67 expression may be associated with the aggressive form of UTUC. Kaplan-Meier curves showed that patients with high Ki-67 expression had significantly poorer cancer-specific survival (CSS) and disease-free survival (DFS). Furthermore, multivariate analysis suggested that Ki-67 expression was an independent prognostic factor for CSS (hazard ratio, HR=3.196) and DFS (HR=3.517) in UTUC patients. Then, a meta-analysis of the published literature investigating Ki-67 expression and its effects on UTUC prognosis was conducted. After searching the PubMed, Medline, Embase, Cochrane Library and Scopus databases, 12 articles met the eligibility criteria for this analysis. The eligible studies included a total of 1740 patients with a mean number of 82 patients per study (range, 38-475). The combined results showed that increased Ki-67 levels were associated with poor survival and disease progression, with a pooled HR estimate of 2.081 and 2.791, respectively. In subgroup analysis, the pooled HR was statistically significant for cancer-specific survival (HR=2.276), metastasis-free survival (HR=3.008) and disease-free survival (HR=6.336). CONCLUSIONS: In conclusion, high Ki-67 expression was associated with poor survival in patients with UTUC, as well as a high risk of disease progression, although these findings need to be interpreted with caution. Large-scale, adequately designed, prospective trials are needed to further confirm the value of Ki-67 in prognosis of UTUC patients.