Perioperative and Oncological Outcomes of Partial Versus Radical Nephrectomy for Complex Renal Tumors (RENAL Score ≥ 7): Systematic Review and Meta-Analysis.

OBJECTIVE: Which is superior, partial nephrectomy (PN) or radical nephrectomy (RN), for the treatment of complex renal tumours (RENAL or score ≥ 7)? METHODS: This systematic review and meta-analysis was conducted in accordance with the PRISMA statement. A systematic search of the literature published before November 2023 was conducted using Pubmed, Embase, Cochran, and Web of Science libraries. We included studies comparing perioperative and oncologic outcomes of partial nephrectomy and radical nephrectomy for complex renal tumors. RESULTS: A total of 2602 patients from six studies meeting the criteria were included. The PN group had a longer operative time, increased estimated blood loss, and major complications but a smaller reduction in renal function. There were no significant differences in complications, length of hospital stay, and blood transfusion. In terms of oncological outcomes, the PN group had longer OS, CSS, and no significant difference in RFS. CONCLUSIONS: For complex renal tumours, PN requires more operative time and has a higher chance of complications in the short term. However, in long-term follow-up, PN has a small decrease in renal function with longer OS and CSS.

Exposure estimation and neurotoxicity inhibition of dioxins in sensitive populations near domestic waste incineration plant through adverse outcome pathway.

The neurotoxicity induced by dioxins has been recognized as a serious concern to sensitive population living near waste incineration plants. However, investigating the intracellular neurotoxicity of dioxin in humans and the corresponding mitigation strategies has been barely studied. Thus, a domestic waste incineration plant was selected in this study to characterize the neurotoxicity risks of sensitive populations by estimating the ratio of dioxin in human cells using membrane structure dynamics simulation; and constructing a complete dioxin neurotoxicity adverse outcome pathway considering the binding process of AhR/ARNT dimer protein and dioxin response element (DRE). Six dioxins with high neurotoxicity risk were identified. According to the composite neurotoxicity risk analysis, the highest composite neurotoxicity risk appeared when the six dioxins were jointly exposed. Dietary schemes were designed using 1/2 partial factor experimental design to mitigate the composite neurotoxicity risk of six dioxins and No. 16 was screened as the optimum combination which can effectively alleviate the composite neurotoxicity risk by 29.52%. Mechanism analysis shows that the interaction between AhR/ARNT dimer protein and DRE was inhibited under the optimal dietary scheme. This study provides theoretical feasibility and reference significance for assessing composite toxicity risks of pollutants and safety mitigation measures for toxic effects.

Spatiotemporal dynamics of dissolved organic matter and disinfection by-products formation potential of Shengzhong Lake in southwest China.

The quality and quantity of dissolved organic matter (DOM) in lakes as well as its environmental effects associated with the unintended disinfection by-products (DBPs) have received continuous attention. This work investigated the spatiotemporal dynamics of DOM in Shengzhong Lake in southwest China and the formed DBPs during the chlorine disinfection process. The results showed that lake water in summer had significantly higher dissolved oxygen and dissolved organic carbon than that in winter. In contrast, DOM in winter demonstrated an obviously higher aromaticity and molecular weight than that in summer. Four fluorescence components, i.e., terrestrial humic-like substances (C1), protein-like substances (C2), and microbial humic-like substances (C3 and C4), were identified, and their relative abundance followed in the order of C3 > C4 > C2 > C1 in winter and C4 > C3 > C1 > C2 in summer. The formation potential of trihalomethanes and haloacetic acids in winter was higher and lower than that in summer, which was mainly ascribed to the content of aromatic and hydrophobic substances. Compared to the significant seasonal dynamic, the spatial variation of DOM and the formed DBPs was not obvious. This work sheds light on the spatial-temporal distribution of DOM and the potentially formed DBPs in Shengzhong Lake, and will be helpful for understanding the biogeochemical cycle of carbon and assessing the drinking water safety.

Accumulation characteristics of liquid crystal monomers in plants: A multidimensional analysis.

Liquid crystal monomers (LCMs), identified as emerging contaminations, have been detected in soils and plants, but their accumulation characteristics in plants haven't been studied. Therefore, this study systematically investigated the accumulation characteristics of LCMs in plants from four dimensions (i.e., plant fruit species, soil types, plant growth stages, and LCMs categories) for the first time. The LCMs concentrations (9.96 × 10-4 to 114.608 ng/g) in 22 plant fruits were predicted by the partition-limited model. Grains with the highest lipid content showed the highest LCMs accumulation propensity. Plants grown in paddy soil showed a strong LCMs accumulation capacity. Results showed that the LCMs accumulation capacity in plants from soils decreased when the soil organic matter content increased. A preferential accumulation of LCMs in plant root systems during growth was found by the molecular dynamics simulations. Compared to polychlorinated biphenyls (as the reference contaminants of LCMs), LCMs exhibit higher accumulation in plant roots and lower translocation to shoots. For the fourth dimension, lipophilicity was found to be the main reason of LCMs accumulation by intergraded stepwise linear regression with sensitivity analysis. This is the inaugural research concentrating on LCMs accumulation in plants, providing insights and theoretical guidance for future LCMs management strategies multidimensionally.

Mayo Adhesion Probability Score Predicts Perioperative Outcome of Partial Nephrectomy: A Systematic Review and Meta-Analysis.

Objective: Assessing whether Mayo adhesive probability (MAP) levels affect perioperative outcomes after partial nephrectomy (PN). Methods: This systematic review and meta-analysis were conducted in accordance with the PRISMA statement. A systematic search of the literature published before February 1, 2023 was conducted using Pubmed, Embase, Cochran, and Web of Science libraries. We included all articles evaluating adherent perirenal fat by MAP during PN. Results: A total of 1807 patients from 7 studies meeting the criteria were included. In the high MAP group, the operation time was longer, and the estimated blood loss and postoperative complications were increased. There was no significant difference in positive surgical margin, warm ischemia time, and hospitalization time. Conclusions: As a simple and easy scoring method, MAP can predict the perioperative outcome of PN patients, especially when ≥3 is the boundary. However, more cohort studies are still needed to determine the optimal cutoff point of MAP.

Optimal peritoneal cancer index cutoff point for predicting surgical resectability of pseudomyxoma peritonei in treatment-naive patients.

BACKGROUND: The peritoneal cancer index (PCI) has been used to predict surgical outcomes for pseudomyxoma peritonei (PMP). The present study aimed to establish the optimal cutoff point for PCI to predict surgical resectability of PMP. METHODS: A total of 366 PMP patients were included. The patients were divided into low-grade and high-grade groups. Based on the completeness of the cytoreduction (CC) score, both low-grade and high-grade PMP patients were further divided into complete cytoreductive surgery (CRS) and maximal tumor debulking (MTD) subgroups. The ability to predict surgical resectability of total and selected PCI (regions 2 + 9 to 12) was analyzed through receiver operating characteristic (ROC) curves. RESULTS: Both total and selected PCI demonstrated excellent discriminative ability in predicting surgical resectability for low-grade PMP patients (n = 266), with the ROC-AUC of 0.940 (95% CI: 0.904-0.965) and 0.927 (95% CI: 0.889-0.955). The corresponding optimal cutoff point was 21 and 5, respectively. For high-grade PMP patients (n = 100), both total and selected PCI exhibited good performance in predicting surgical resectability, with the ROC-AUC of 0.894 (95% CI: 0.816-0.946) and 0.888 (95% CI: 0.810-0.943); correspondingly, the optimal cutoff point was 25 and 8, respectively. The discriminative ability between total and selected PCI in predicting surgical resectability did not show a statistical difference. CONCLUSIONS: Both total and selected PCI exhibited good performance and similarity in predicting complete surgical resection for both low-grade and high-grade PMP patients. However, the selected PCI was simpler and time-saving in clinical practice. In the future, new imaging techniques or predictive models may be developed to better predict PCI preoperatively, which might assist in confirming whether complete surgical resection can be achieved.

Triple-Phase Photocatalytic H2O2 Production on a Janus Fiber Membrane with Asymmetric Hydrophobicity.

Photocatalytic O2 reduction is an intriguing approach to producing H2O2, but its efficiency is often hindered by the limited solubility and mass transfer of O2 in the aqueous phase. Here, we design and fabricate a two-layered (2L) Janus fiber membrane photocatalyst with asymmetric hydrophobicity for efficient photocatalytic H2O2 production. The top layer of the membrane consists of superhydrophobic polytetrafluoroethylene (PTFE) fibers with a dispersed modified carbon nitride (mCN) photocatalyst. Amphiphilic Nafion (Naf) ionomer is sprayed onto this layer to modulate the microenvironment and achieve moderate hydrophobicity. In contrast, the bottom layer consists of bare PTFE fibers with high hydrophobicity. The elaborate structural configuration and asymmetric hydrophobicity feature of the optimized membrane photocatalyst (designated as 2L-mCN/F-Naf; F, PTFE) allow most mCN to be exposed with gas-liquid-solid triple-phase interfaces and enable rapid mass transfer of gaseous O2 within the hierarchical membrane, thus increasing the local O2 concentration near the mCN photocatalyst. As a result, the optimized 2L-mCN/F-Naf membrane photocatalyst shows remarkable photocatalytic H2O2 production activity, achieving a rate of 5.38 mmol g-1 h-1 under visible light irradiation.

Comparing the safety and efficacy of single-port versus multi-port robotic-assisted techniques in urological surgeries: a systematic review and meta-analysis.

OBJECTIVE: Comparing the safety and efficacy of single-port (SP) versus multi-port (MP) robotic-assisted techniques in urological surgeries. METHODS: A systematic review and cumulative meta-analysis was performed using PRISMA criteria for primary outcomes of interest, and quality assessment followed AMSTAR. Four databases were systematically searched: Embase, PubMed, The Cochrane Library, and Web of Science. The search time range is from database creation to December 2022. Stata16 was used for statistical analysis. RESULTS: There were 17 studies involving 5015 patients. In urological surgeries, single-port robotics had shorter length of stay (WMD = - 0.63, 95% Cl [- 1.06, - 0.21], P < 0.05), less estimated blood loss (WMD = - 19.56, 95% Cl [- 32.21, - 6.91], P < 0.05), less lymph node yields (WMD = - 3.35, 95% Cl [- 5.16, - 1.55], P < 0.05), less postoperative opioid use (WMD = - 5.86, 95% Cl [- 8.83, - 2.88], P < 0.05). There were no statistically significant differences in operative time, positive margins rate, overall complications rate, and major complications rate. CONCLUSION: Single-port robotics appears to have similar perioperative outcomes to multi-port robotics in urological surgery. In radical prostatectomy, single-port robotics has shown some advantages, but the specific suitability of single-port robots for urological surgical types needs to be further explored.

LViT: Language Meets Vision Transformer in Medical Image Segmentation.

Deep learning has been widely used in medical image segmentation and other aspects. However, the performance of existing medical image segmentation models has been limited by the challenge of obtaining sufficient high-quality labeled data due to the prohibitive data annotation cost. To alleviate this limitation, we propose a new text-augmented medical image segmentation model LViT (Language meets Vision Transformer). In our LViT model, medical text annotation is incorporated to compensate for the quality deficiency in image data. In addition, the text information can guide to generate pseudo labels of improved quality in the semi-supervised learning. We also propose an Exponential Pseudo label Iteration mechanism (EPI) to help the Pixel-Level Attention Module (PLAM) preserve local image features in semi-supervised LViT setting. In our model, LV (Language-Vision) loss is designed to supervise the training of unlabeled images using text information directly. For evaluation, we construct three multimodal medical segmentation datasets (image + text) containing X-rays and CT images. Experimental results show that our proposed LViT has superior segmentation performance in both fully-supervised and semi-supervised setting. The code and datasets are available at https://github.com/HUANGLIZI/LViT.

Zero-Shot Medical Image Translation via Frequency-Guided Diffusion Models.

Recently, the diffusion model has emerged as a superior generative model that can produce high quality and realistic images. However, for medical image translation, the existing diffusion models are deficient in accurately retaining structural information since the structure details of source domain images are lost during the forward diffusion process and cannot be fully recovered through learned reverse diffusion, while the integrity of anatomical structures is extremely important in medical images. For instance, errors in image translation may distort, shift, or even remove structures and tumors, leading to incorrect diagnosis and inadequate treatments. Training and conditioning diffusion models using paired source and target images with matching anatomy can help. However, such paired data are very difficult and costly to obtain, and may also reduce the robustness of the developed model to out-of-distribution testing data. We propose a frequency-guided diffusion model (FGDM) that employs frequency-domain filters to guide the diffusion model for structure-preserving image translation. Based on its design, FGDM allows zero-shot learning, as it can be trained solely on the data from the target domain, and used directly for source-to-target domain translation without any exposure to the source-domain data during training. We evaluated it on three cone-beam CT (CBCT)-to-CT translation tasks for different anatomical sites, and a cross-institutional MR imaging translation task. FGDM outperformed the state-of-the-art methods (GAN-based, VAE-based, and diffusion-based) in metrics of Fréchet Inception Distance (FID), Peak Signal-to-Noise Ratio (PSNR), and Structural Similarity Index Measure (SSIM), showing its significant advantages in zero-shot medical image translation.

Bilateral extended FDK: An improved weighting method for static CT imaging.

BACKGROUND: Improving imaging speed has always been the focus of research in CT technology, which is related to the radiation dose and imaging quality of moving organs, including heart and blood vessels. However, it is difficult to achieve further improvement by increasing the rotation speed of the gantry due to its structural strength limitation. Differing from the conventional CTs, the static CT employs dozens of ray sources to acquire projection data from different angular ranges, and each source only needs to be rotated in a small range to finish a full 360° scan, thus greatly increasing the scanning speed. PURPOSE: As sources of static CT need to be evenly distributed over 360°, the sources and detectors have to be arranged on two parallel rings independently. Such a geometry can be considered as a special case of CT systems with a significantly large cone angle, that is, a part of the detector is missing in the vicinity of the mid-plane. Due to restriction of upper and lower bounds of the cone angle of the static CT, there are uneven projection data varying in each portion of the reconstruction volume, the conventional analytical or iterative reconstruction methods may introduce artifacts in the reconstructed outcomes. METHODS: Following the weighting approach extended FDK (xFDK) by Grimmer et al., we propose an improved bilateral xFDK algorithm (bixFDK), which focuses on the reconstruction of the expanded volume. With the same philosophy as xFDK in terms of weighting function design, bixFDK takes the longitudinal offset of the detector with respect to the source into consideration, making our method applicable to a wide range of CT geometries, especially for the static CT. Based on the proposed bixFDK, a new iterative scheme bixFDK-IR is also constructed to extend the applications to a wide range of scan protocols such as sparse-view scan. RESULTS: The proposed method has been validated with the simulated phantom data and the actual clinical data of the static CT, and demonstrates that it can ensure good image quality and enlarge the reconstruction volume in z-direction of the static CT. CONCLUSIONS: The bixFDK algorithm is an ideal reconstruction approach for static CT geometry, and the iterative scheme of bixFDK-IR is applicable to a wide range of CT geometries and scan protocols, thus providing a wide range of application scenarios.

Single Zn Atoms with Acetate-Anion-Enabled Asymmetric Coordination for Efficient H2 O2 Photosynthesis.

Exploring unique single-atom sites capable of efficiently reducing O2 to H2 O2 while being inert to H2 O2 decomposition under light conditions is significant for H2 O2 photosynthesis, but it remains challenging. Herein, we report the facile design and fabrication of polymeric carbon nitride (CN) decorated with single-Zn sites that have tailorable local coordination environments, which is enabled by utilizing different Zn salt anions. Specifically, the O atom from acetate (OAc) anion participates in the coordination of single-Zn sites on CN, forming asymmetric Zn-N3 O moiety on CN (denoted as CN/Zn-OAc), in contrast to the obtained Zn-N4 sites when sulfate (SO4 ) is adopted (CN/Zn-SO4 ). Both experimental and theoretical investigations demonstrate that the Zn-N3 O moiety exhibits higher intrinsic activity for O2 reduction to H2 O2 than the Zn-N4 moiety. This is attributed to the asymmetric N/O coordination, which promotes the adsorption of O2 and the formation of the key intermediate *OOH on Zn sites due to their modulated electronic structure. Moreover, it is inactive for H2 O2 decomposition under both dark and light conditions. As a result, the optimized CN/Zn-OAc catalyst exhibits significantly improved photocatalytic H2 O2 production activity under visible light irradiation.

PLZF protein forms a complex with protein TET1 to target TCF7L2 in undifferentiated spermatogonia.

The transcription factor promyelocytic leukemia zinc finger (PLZF, also known as ZBTB16) is critical for the self-renewal of spermatogonial stem cells (SSCs). However, the function of PLZF in SSCs is not clear. Here, we found that PLZF acted as an epigenetic regulator of stem cell maintenance and self-renewal of germ cells. The PLZF protein interacts with the ten-eleven translocation 1 (TET1) protein and subsequently acts as a modulator to regulate the expression of self-renewal-related genes. Furthermore, Transcription Factor 7-like 2 (TCF7L2) is promoted by the coordination of PLZF and Tri-methylation of lysine 4 on histone H3 (H3K4me3). In addition, testicular single-cell sequencing indicated that TCF7L2 is commonly expressed in the PLZF cluster. We demonstrated that PLZF directly targets TCF7L2 and alters the landscape of histone methylation in the SSCs nucleus. Meanwhile, the RD domain and Zn finger domain of PLZF synergize with H3K4me3 and directly upregulate TCF7L2 expression at the transcriptional level. Additionally, we identified a new association between PLZF and the histone methyltransferase EZH2 at the genomic level. Our study identified a new association between PLZF and H3K4me3, established the novel PLZF&TET1-H3K4me3-TCF7L2 axis at the genomic level which regulates undifferentiated spermatogonia, and provided a platform for studying germ cell development in male domestic animals.

Real-time liver motion estimation via deep learning-based angle-agnostic X-ray imaging.

BACKGROUND: Real-time liver imaging is challenged by the short imaging time (within hundreds of milliseconds) to meet the temporal constraint posted by rapid patient breathing, resulting in extreme under-sampling for desired 3D imaging. Deep learning (DL)-based real-time imaging/motion estimation techniques are emerging as promising solutions, which can use a single X-ray projection to estimate 3D moving liver volumes by solved deformable motion. However, such techniques were mostly developed for a specific, fixed X-ray projection angle, thereby impractical to verify and guide arc-based radiotherapy with continuous gantry rotation. PURPOSE: To enable deformable motion estimation and 3D liver imaging from individual X-ray projections acquired at arbitrary X-ray scan angles, and to further improve the accuracy of single X-ray-driven motion estimation. METHODS: We developed a DL-based method, X360, to estimate the deformable motion of the liver boundary using an X-ray projection acquired at an arbitrary gantry angle (angle-agnostic). X360 incorporated patient-specific prior information from planning 4D-CTs to address the under-sampling issue, and adopted a deformation-driven approach to deform a prior liver surface mesh to new meshes that reflect real-time motion. The liver mesh motion is solved via motion-related image features encoded in the arbitrary-angle X-ray projection, and through a sequential combination of rigid and deformable registration modules. To achieve the angle agnosticism, a geometry-informed X-ray feature pooling layer was developed to allow X360 to extract angle-dependent image features for motion estimation. As a liver boundary motion solver, X360 was also combined with priorly-developed, DL-based optical surface imaging and biomechanical modeling techniques for intra-liver motion estimation and tumor localization. RESULTS: With geometry-aware feature pooling, X360 can solve the liver boundary motion from an arbitrary-angle X-ray projection. Evaluated on a set of 10 liver patient cases, the mean (± s.d.) 95-percentile Hausdorff distance between the solved liver boundary and the "ground-truth" decreased from 10.9 (±4.5) mm (before motion estimation) to 5.5 (±1.9) mm (X360). When X360 was further integrated with surface imaging and biomechanical modeling for liver tumor localization, the mean (± s.d.) center-of-mass localization error of the liver tumors decreased from 9.4 (± 5.1) mm to 2.2 (± 1.7) mm. CONCLUSION: X360 can achieve fast and robust liver boundary motion estimation from arbitrary-angle X-ray projections for real-time imaging guidance. Serving as a surface motion solver, X360 can be integrated into a combined framework to achieve accurate, real-time, and marker-less liver tumor localization.

UCHL1 maintains microenvironmental homeostasis in goat germline stem cells.

Spermatogonial stem cells (SSCs) play a crucial role in mammalian spermatogenesis and maintain the stable inheritance of the germline in livestock. However, stress and bacterial or viral infections can disrupt immune homeostasis of the testes, thereby leading to spermatogenesis destruction and infertility, which severely affects the health and productivity of mammals. This study aimed to explore the effect of ubiquitin C-terminal hydrolase L1 (UCHL1) knockdown (KD) in goat SSCs and mouse testes and investigate the potential anti-inflammatory function of UCHL1 in a poly(I:C)-induced inflammation model to maintain microenvironmental homeostasis. In vitro, the downregulation of UCHL1 (UCHL1 KD) in goat SSCs increased the expression levels of apoptosis and inflammatory factors and inhibited the self-renewal and proliferation of SSCs. In vivo, the structure of seminiferous tubules and spermatogenic cells was disrupted after UCHL1 KD, and the expression levels of apoptosis- and inflammation-related proteins were significantly upregulated. Furthermore, UCHL1 inhibited the TLR3/TBK1/IRF3 pathway to resist poly(I:C)-induced inflammation in SSCs by antagonizing HSPA8 and thus maintaining SSC autoimmune homeostasis. Most importantly, the results of this study showed that UCHL1 maintained immune homeostasis of SSCs and spermatogenesis. UCHL1 KD not only inhibited the self-renewal and proliferation of goat SSCs and spermatogenesis but was also involved in the inflammatory response of goat SSCs. Additionally, UCHL1 has an antiviral function in SSCs by antagonizing HSPA8, which provides an important basis for exploring the specific mechanisms of UCHL1 in goat spermatogenesis.

LncRNA TYMSOS is a novel prognostic biomarker associated with immune infiltration in prostate cancer.

The long noncoding RNA thymidylate synthetase opposite strand (lncRNA TYMSOS) plays an important role in cancers; however, its impact on prostate cancer (PCa) is still unclear. By analyzing the online data, we found that lncRNA TYMSOS was highly expressed in PCa and associated with T stage, Gleason score, age, and primary therapy outcome. The results of the ROC curve showed that lncRNA TYMSOS has a significant diagnostic ability. Furthermore, Kaplan-Meier analyses suggested that lncRNA TYMSOS plays an important role in progression-free survival (PFS). Increased lncRNA TYMSOS expression was an independent risk factor correlated with PFS in PCa patients. GSEA and GSVA indicated that the lncRNA TYMSOS was involved in the cell cycle, neurodegenerative diseases, oxidative phosphorylation, spliceosomes, and adaptive immune system pathways. Additionally, lncRNA TYMSOS expression was also associated with immune cell infiltrates and tumor mutational burden in PCa. Functional experiments were further conducted, and we verified that lncRNA TYMSOS played an oncogenic role in regulating PCa aggressiveness. Specifically, silencing of lncRNA TYMSOS suppressed cell proliferation, division and epithelial-mesenchymal transition (EMT) but promoted cell apoptosis in PCa cells, and conversely, lncRNA TYMSOS overexpression had the opposite effects. In summary, our study revealed that the lncRNA TYMSOS could be a biomarker and therapeutic target in PCa and participate in tumor-immune cell infiltration.

[Clinical and genetic analysis of a case of Gitelman syndrome with comorbid Graves disease and adrenocortical adenoma].

OBJECTIVE: To report the clinical and genetic characteristics of a rare case of Gitelman syndrome with comorbid Graves disease and ACTH-independent adrenocortical adenoma. METHODS: A patient who had presented at the Nanchong Central Hospital on December 21, 2020 was selected as the study subject. Clinical data of the patient was collected. Whole-exome sequencing was carried out on DNA extracted from peripheral venous blood samples from the patient and her family members. RESULTS: The patient, a 45-year-old woman, was found to have Graves disease, ACTH-independent Cushing syndrome, hypokalemia and hypomagnesemia following the discovery of an adrenal incidentaloma. MRI scan had revealed a 3.8 cm × 3.2 cm mass in the left adrenal gland. The mass was removed by surgery and confirmed as adrenocortical adenoma. DNA sequencing revealed that the patient and her sister have both harbored compound heterozygous variants of the SLC12A3 gene, namely c.1444-10(IVS11)G>A and c.179(exon1)C>T (p.T60M), which were respectively inherited from their father and mother. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the c.1444-10(IVS11)G>A and c.179(exon1)C>T (p.T60M) were respectively classified as a variant of uncertain significance (PM2_Supporting+PP3) and a likely pathogenic variant (PM3_Strong+PM1+PP3). CONCLUSION: The conjunction of Gitelman syndrome with Graves disease and adrenal cortex adenoma is rather rare. The newly discovered c.1444-10(IVS11)G>A variant of the SLC12A3 gene, together with the heterozygous variant of c.179(exon1)C>T (p.T60M), probably underlay the pathogenesis in this patient.

Single-Atom Zinc Sites with Synergetic Multiple Coordination Shells for Electrochemical H2 O2 Production.

Precise manipulation of the coordination environment of single-atom catalysts (SACs), particularly the simultaneous engineering of multiple coordination shells, is crucial to maximize their catalytic performance but remains challenging. Herein, we present a general two-step strategy to fabricate a series of hollow carbon-based SACs featuring asymmetric Zn-N2 O2 moieties simultaneously modulated with S atoms in higher coordination shells of Zn centers (n≥2; designated as Zn-N2 O2 -S). Systematic analyses demonstrate that the synergetic effects between the N2 O2 species in the first coordination shell and the S atoms in higher coordination shells lead to robust discrete Zn sites with the optimal electronic structure for selective O2 reduction to H2 O2 . Remarkably, the Zn-N2 O2 moiety with S atoms in the second coordination shell possesses a nearly ideal Gibbs free energy for the key OOH* intermediate, which favors the formation and desorption of OOH* on Zn sites for H2 O2 generation. Consequently, the Zn-N2 O2 -S SAC exhibits impressive electrochemical H2 O2 production performance with high selectivity of 96 %. Even at a high current density of 80 mA cm-2 in the flow cell, it shows a high H2 O2 production rate of 6.924 mol gcat -1 h-1 with an average Faradaic efficiency of 93.1 %, and excellent durability over 65 h.