Vacuum-Assisted vs Conventional Minimally Invasive Percutaneous Nephrolithotomy for the Treatment of Two-to-Four-Centimeter Stones: A Multicenter Prospective and Randomized Trial.

Introduction: Percutaneous nephrolithotomy (PCNL) is the recommended treatment for 2-4-cm renal stones. Minimally invasive PCNL (MPCNL) with ≤22F sheath was frequently used instead of standard PCNL. MPCNL uses pressurized irrigation to flush out stone fragments through a conventional nephrostomy sheath (cNS), which may result in higher intrarenal pressure (IRP) and longer operating time. The novel vacuum-assisted nephrostomy sheath (vaNS) was developed to mitigate higher IRP and to facilitate stone removal. It might improve the performance of MPCNL. This prospective and randomized trial compares these two sheaths. Materials and Methods: In total, 120 patients with 2-4-cm renal stones were accrued in six tertiary medical centers with equal numbers in 2021. In total, 120 patients underwent mPCNL, 60 using 18F cNS and 60 using 18F vaNS, in a prospective and randomized assignment. The primary outcome measurement is decrease in IRP. The secondary outcome is efficacy in stone retrieval. Results: The IRP was lower with vaNS than with cNS: mean IRP during lithotripsy was 12.0 ± 2.7 mm Hg with vaNS vs 20.4 ± 6.0 mm Hg with cNS, p = 0.000. IRP duration ≥30 mm Hg was shorter with vaNS than with cNS (6.7 ± 7.4 seconds vs 113.4 ± 222.7 seconds, p = 0.001). vaNS has shorter stone removal time (26.9 ± 14.3 minutes vs 35.7 ± 11.8 minutes, p = 0.000). Stone extraction rate was higher (166.4 ± 88.1 mm3/min vs 90.4 ± 31.7 mm3/min, p = 0.000). Stone grasper usage was less (1.4 ± 2.6 vs 11.9 ± 9.7, p = 0.000). vaNS maintained the safety profile. Blood loss, creatinine changes, perioperative complications, and hospital stays were the same in both groups, all p > 0.05. Conclusion: MPCNL for stones 2-4 cm using vaNS has shorter stone removal time, higher stone extraction rate, and less use of stone extractor. vaNS is superior to cNS at reducing IRP and is associated with improved stone free rates at 3 days but not at 30 days postoperatively. The trial was registered with Chinese Clinical Trial Registry (ClinicalTrials.gov, NCT ChiCTR2000039681).

Double-stranded RNA-specific adenosine deaminase-knockdown inhibits the proliferation and induces apoptosis of DU145 and PC3 cells by promoting the phosphorylation of H2A.X variant histone.

Double-stranded RNA-specific adenosine deaminase (ADAR1) is a member of the adenosine deaminases acting on RNA family that catalyze the adenosine-to-inosine editing of double-stranded RNA substrates. Several studies have reported that ADAR1 is closely associated with numerous malignancies. However, the functional roles of ADAR1 in prostate cancer (PCa) have not been fully elucidated. Thus, the present study aimed to investigate the effects of ADAR1 on PCa. The results demonstrated that ADAR1 was highly expressed in PCa tissues compared with normal tissues. Furthermore, the protein expression level of ADAR1 was significantly increased in castration-resistant PCa (CRPCa) tissues and CRPCa cell lines. Thus, these findings indicated that ADAR1 may act as a tumor promoter for PCa development. Next, the potential effects of ADAR1-knockdown on the proliferation of DU145 and PC3 cells were investigated. ADAR1 was knocked down via small interfering RNA transfection, which was found to exert antitumor effects on DU145 and PC3 cells at 24 and 48 h post transfection. Furthermore, a significant positive association was observed between ADAR1-knockdown and the apoptosis of DU145 and PC3 cells, which increased the phosphorylation of H2A.X variant histone. The results of the present study indicated a positive association between ADAR1 expression and PCa, which may promote the development of CRPCa. Moreover, ADAR1-knockdown may serve as a tumor suppressor and represent a potential target for the treatment of PCa.

Risk Scores Based on Six Survival-Related RNAs in a Competing Endogenous Network Composed of Differentially Expressed RNAs Between Clear Cell Renal Cell Carcinoma Patients Carrying Wild-Type or Mutant Von Hippel-Lindau Serve Well to Predict Malignancy and Prognosis.

Clear cell renal cell carcinoma (ccRCC) carrying wild-type Von Hippel-Lindau (VHL) tumor suppressor are more invasive and of high morbidity. Concurrently, competing endogenous RNA (ceRNA) network has been suggested to play an important role in ccRCC malignancy. In order to understand why the patients carrying wild-type VHL gene have high degrees of invasion and morbidity, we applied bioinformatics approaches to identify 861 differentially expressed RNAs (DE-RNAs) between patients carrying wild-type and patients carrying mutant VHL from The Cancer Genome Atlas (TCGA) database, established a ceRNA network including 122 RNAs, and elected six survival-related DE-RNAs including Linc00942, Linc00858, RP13_392I16.1, hsa-miR-182-5p, hsa-miR-183-5p, and PAX3. Examining clinical samples from our hospital revealed that patients carrying wild-type VHL had significantly higher levels of all six RNAs than those carrying mutant VHL. Patients carrying wild-type VHL had significantly higher risk scores, which were calculated based on expression levels of all six RNAs, than those carrying mutant VHL. Patients with higher risk scores had significantly shorter survival times than those with lower risk scores. Therefore, the risk scores serve well to predict malignancy and prognosis.

Travelling waves of a delayed SIR epidemic model with nonlinear incidence rate and spatial diffusion.

This paper is concerned with the existence of travelling waves to a SIR epidemic model with nonlinear incidence rate, spatial diffusion and time delay. By analyzing the corresponding characteristic equations, the local stability of a disease-free steady state and an endemic steady state to this system under homogeneous Neumann boundary conditions is discussed. By using the cross iteration method and the Schauder's fixed point theorem, we reduce the existence of travelling waves to the existence of a pair of upper-lower solutions. By constructing a pair of upper-lower solutions, we derive the existence of a travelling wave connecting the disease-free steady state and the endemic steady state. Numerical simulations are carried out to illustrate the main results.