CDK4/6 inhibitors dephosphorylate RNF26 to stabilize TSC1 and increase the sensitivity of ccRCC to mTOR inhibitors.

BACKGROUND: The combined use of CDK4/6 inhibitors and mTOR inhibitors has achieved some clinical success in ccRCC. Exploring the underlying mechanism of the CDK4/6 pathway in cancer cells and the drug interactions of CDK4/6 inhibitors in combination therapy could help identify new therapeutic strategies for ccRCC. Notably, CDK4/6 inhibitors inactivate the mTOR pathway by increasing the protein levels of TSC1, but the mechanism by which CDK4/6 inhibitors regulate TSC1 is still unclear. METHODS: Mass spectrometry analysis, coimmunoprecipitation analysis, GST pull-down assays, immunofluorescence assays, Western blot analysis and RT‒qPCR analysis were applied to explore the relationships among CDK4, RNF26 and TSC1. Transwell assays, tube formation assays, CCK-8 assays, colony formation assays and xenograft assays were performed to examine the biological role of RNF26 in renal cancer cells.TCGA-KIRC dataset analysis and RT‒qPCR analysis were used to examine the pathways affected by RNF26 silencing. RESULTS: CDK4/6 inhibitors stabilized TSC1 in cancer cells. We showed that CDK4 enhances the interaction between TSC1 and RNF26 and that RNF26 activates the mTOR signaling pathway in ccRCC, contributes to ccRCC progression and angiogenesis, and promotes tumorigenesis. We then found that RNF26 functions as an E3 ligase of TSC1 to regulate CDK4-induced TSC1. This finding suggested that RNF26 promotes ccRCC progression and angiogenesis to some extent by negatively regulating TSC1. CONCLUSION: Our results revealed a novel CDK4/RNF26/TSC1 axis that regulates the anticancer efficacy of CDK4/6 inhibitors and mTOR inhibitors in ccRCC.

Analysis of preoperative nutrition, immunity and inflammation correlation index on the prognosis of upper tract urothelial carcinoma surgical patients: a retrospective single center study.

BACKGROUND: SII, PNI, SIRI, AAPR, and LIPI are prognostic scores based on inflammation, nutrition, and immunity. The purpose of this study was to examine the prognostic value of the SII, PNI, SIRI, AAPR, and LIPI in patients with UTUC who underwent radical nephroureterectomy with bladder cuff excision. MATERIALS AND METHODS: Data of UTUC patients in Sichuan Provincial People's Hospital from January 2017 to December 2021 were collected. The optimal critical values of SII, PNI, SIRI, and AAPR were determined by ROC curve, and LIPI was stratified according to the dNLR and LDH. The Kaplan-Meier method was used to draw the survival curve, and Cox proportional hazard model was used to analyze the factors affecting the prognosis of UTUC patients. RESULTS: A total of 81 patients with UTUC were included in this study. The optimal truncation value of PNI, SII, SIRI and AAPR were determined to be 48.15, 596.4, 1.45 and 0.50, respectively. Univariate Cox proportional hazard regression showed that low PNI, high SII, high SIRI, low AAPR and poor LIPI group were effective predictors of postoperative prognosis of UTUC patients. Multivariate Cox proportional hazard regression showed that high SII was an independent risk factor for postoperative prognosis of UTUC patients. According to ROC curve, the prediction efficiency of fitting indexes of PNI, SII, SIRI, AAPR and LIPI is better than that of using them alone. CONCLUSIONS: The SII, PNI, SIRI, AAPR, and LIPI was a potential prognostic predictor in UTUC patients who underwent radical nephroureterectomy with bladder cuff excision.

Efficacy of high-fidelity simulation in advanced life support training: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Simulation is an increasingly used novel method for the education of medical professionals. This study aimed to systematically review the efficacy of high-fidelity (HF) simulation compared with low-fidelity (LF) simulation or no simulation in advanced life support (ALS) training. METHODS: A comprehensive search of the PubMed, Chinese Biomedicine Database, Embase, CENTRAL, ISI, and China Knowledge Resource Integrated Database was performed to identify randomized controlled trials (RCTs) that evaluated the use of HF simulation in ALS training. Quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions version 5.0.1. The primary outcome was the improvement of knowledge and skill performance. The secondary outcomes included the participants' confidence and satisfaction at the course conclusion, skill performance at one year, skill performance in actual resuscitation, and patient outcomes. Data were synthesized using the RevMan 5.4 software. RESULTS: Altogether, 25 RCTs with a total of 1,987 trainees were included in the meta-analysis. In the intervention group, 998 participants used HF manikins, whereas 989 participants received LF simulation-based or traditional training (classical training without simulation). Pooled data from the RCTs demonstrated a benefit in improvement of knowledge [standardized mean difference (SMD) = 0.38; 95% confidence interval (CI): 0.18-0.59, P = 0.0003, I2 = 70%] and skill performance (SMD = 0.63; 95% CI: 0.21-1.04, P = 0.003, I2 = 92%) for HF simulation when compared with LF simulation and traditional training. The subgroup analysis revealed a greater benefit in knowledge with HF simulation compared with traditional training at the course conclusion (SMD = 0.51; 95% CI: 0.20-0.83, P = 0.003, I2 = 61%). Studies measuring knowledge at three months, skill performance at one year, teamwork behaviors, participants' satisfaction and confidence demonstrated no significant benefit for HF simulation. CONCLUSIONS: Learners using HF simulation more significantly benefited from the ALS training in terms of knowledge and skill performance at the course conclusion. However, further research is necessary to enhance long-term retention of knowledge and skill in actual resuscitation and patient's outcomes.

Prognostic factors of non-muscle invasive bladder cancer: a study based on next-generation sequencing.

OBJECTIVE: To investigate the genetic prognostic factors for the recurrence of non-muscle invasive bladder cancer. MATERIALS AND METHODS: The patients underwent transurethral resection of bladder tumor and received bacillus Calmette-Guérin (BCG) or epirubicin. Next-generation sequencing was performed and alterations of genes, pathways, and tumor mutation burden were recorded. Associations between these clinicopathological and genetic variants were estimated, and prognostic factor identified. RESULTS: A total of 58 cases were included in our study, and 46 patients underwent treatment with BCG. FGFR3 was the most frequently altered gene (48%), and more commonly detected in intermediate-risk patients. Univariate Cox analysis demonstrated that 10 genes were significantly correlated with BCG failure, while NEB, FGFR1 and SDHC were independent recurrence predictors. Besides, epigenetic-related gene pathway mutations were negatively correlated with recurrence (hazard ratio: 0.198, P = 0.023). DNA damage response and repair gene alterations were positively correlated with tumor burden, while altered TP53 was most frequent among these genes and significant correlated with high tumor burden. CONCLUSION: BCG instillation significantly reduced the rate of recurrence compared with epirubicin in this population. Potential biomarkers and therapeutic targets were found with the help of next-generation sequencing; correlations between DDR genes alterations and high tumor mutation burden were also demonstrated.

Ureteral urothelial carcinoma with squamous cell carcinoma and sarcomatoid carcinoma differentiation: a case report.

BACKGROUND: Upper urinary tract urothelial carcinoma (UTUC) with multiple pathological types is extremely rare in the clinic, but the recurrence rate and mortality these patients are high. At present, there is no standard treatment for such cases. CASE PRESENTATION: We reported a case of ureteral urothelial carcinoma with squamous cell carcinoma and sarcomatoid carcinoma differentiation and rapid ileal metastasis and reviewed the literature related to different pathological types of upper urinary tract tumours to explore the diagnosis, treatment and prognosis characteristics of the disease, enhance our understanding of its clinical manifestations and history of evolution and provide guidance for avoiding missed diagnosis and misdiagnosis. CONCLUSION: There is no standard treatment for urinary malignant tumours with multiple pathological types; radical surgery is considered a suitable choice. Chemotherapy, targeted drug therapy and immunotherapy may be beneficial to the survival of patients. In short, these patients have a high risk of recurrence and metastasis and a poor prognosis.

[Extraperitoneal robot-assisted laparoscopic radical prostatectomy through single incision: Establishment and application of a modified channel].

Objective: To assess the feasibility and validity of the establishment of a modified channel for extraperitoneal robot-assisted laparoscopic radical prostatectomy (RARP) through single incision. METHODS: From November 2020 to January 2021, 35 cases of localized PCa were treated by extraperitoneal RARP through single incision in our center. All the operations were performed by the same surgeon, none via the multichannel port for the establishment of the channel. We recorded and analyzed the intra- and postoperative parameters, operation cost, complications, pathological findings and follow-up data. RESULTS: All the operations were successfully completed, without conversion to open surgery or additional channels, or serious postoperative complications, the time for establishing the extraperitoneal space averaging 25.4 (20.0－45.0) min, the operation time 67.3 (35.0－125.0) min, intraoperative blood loss 75.5 (60.0－150.0) ml, time to first postoperative anal exhaust 26 (8－48) h, and postoperative hospital stay 7.89 (7－10) d. Postoperative pathology showed adenocarcinoma in all the cases, with Gleason score (GS) 3+3 in 9 (25.7%), GS 3+4 in 9 (25.7%), GS 4+3 in 8 (22.9%), and GS ≥ 8 in 9 (25.7%) of the cases, 23 (65.7%) in the

DaVinci robotic-assisted laparoscopic resection of parapelvic cavernous hemangioma: a case report.

BACKGROUND: Cavernous hemangioma, as a rare tumor, is difficult to differentiate from retroperitoneal lymphoma and paraganglioma. They are more difficult to excise completely through open surgery and traditional laparoscopic surgery. The study aimed to evaluate the role of DaVinci surgical system in laparoscopic resection of parapelvic cavernous hemangioma. CASE PRESENTATION: A 46-year-old female, who diagnosed as parapelvic cavernous hemangioma accompanying with thrombosis and calcification, was performed laparoscopic resection using DaVinci surgical system under general anesthesia. The patient well recovered without recurrence or spread of the lesion after operation for 3 months as well as hydronephrosis was significantly relieved. CONCLUSION: Laparoscopic resection of parapelvic cavernous hemangioma under the help of DaVinci surgical system was feasible and safe.

Improved Performance of SRAM-Based True Random Number Generator by Leveraging Irradiation Exposure.

Encryption is an important step for secure data transmission, and a true random number generator (TRNG) is a key building block in many encryption algorithms. Static random-access memory (SRAM) chips can be easily available sources of true random numbers, benefiting from noisy SRAM cells whose start-up values flip between different power-on cycles. Embarking from this phenomenon, a novel performance (i.e., randomness and throughput) improvement method of SRAM-based TRNG is proposed, and its implementation can be divided into two phases: irradiation exposure and hardware postprocessing. As the randomness of original SRAM power-on values is fairly low, ionization irradiation is utilized to enhance its randomness, and the min-entropy can increase from about 0.03 to above 0.7 in the total ionizing irradiation (TID) experiments. Additionally, while the data remanence effect hampers obtaining random bitstreams with high speed, the ionization irradiation can also weaken this impact and improve the throughput of TRNG. In the hardware postprocessing stage, Secure Hash Algorithm 256 (SHA-256) is implemented on a Field Programmable Gate Array (FPGA) with clock frequency of 200 MHz. It can generate National Institute of Standards and Technology (NIST) SP 800-22 compatible true random bitstreams with throughput of 178 Mbps utilizing SRAM chip with 1 Mbit memory capacity. Furthermore, according to different application scenarios, the throughput can be widely scalable by adjusting clock frequency and SRAM memory capacity, which makes the novel TRNG design applicable for various Internet of Things (IOT) devices.

The SPO11-C631T gene polymorphism and male infertility risk: a meta-analysis.

To evaluate the association between the SPO11 gene C631T polymorphism and the risk of male infertility. We conducted a search on PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), China biology medical literature database (CBM), VIP, and Chinese literature database (Wan Fang) on 31 March 2016. Odds ratio (OR) and 95% confidence interval (95%CI) were used to assess the strength of associations. A total of five studies including 542 cases and 510 controls were involved in this meta-analysis. The pooled results indicated that the SPO11 gene C631T polymorphism was significantly associated with increased risk of male infertility (TT + CT vs. CC: OR = 4.14, 95%CI = 2.48-6.89; CT vs. CC: OR = 4.34, 95%CI = 2.56-7.34; T vs. C: OR = 4.35, 95%CI = 2.58-7.34). Subgroup analysis of different countries proved the relationship between SPO11 gene C631T polymorphism and male infertility risk in Chinese, but not in Iranian peoples. In conclusion, this study suggested that SPO11 gene C631T polymorphism may contribute as a genetic factor susceptible to cause male infertility. Furthermore, more large sample and representative population-based cases and well-matched controls are needed to validate our results.

[Immediate Inguinal Lymph Node Dissection Improves Survival in Patients of Penile Cancer].

OBJECTIVE: To investigate the clinical outcome of immediate inguinal lymph node dissection on the survival of the patients with penile carcinoma. METHODS: A total of 67 patients of penile carcinoma whose inguinal lymph nodes (ILN) were initial clinically impalpable, received inguinal lymph node dissection (ILND) from Dec 2008 to April 2014. Among them, 33 patients received immediate ILND within 1 month after the resection of penile cancer, while 34 patients underwent delayed ILND which was performed when ILN was found clinically apparent during follow-up. The Kaplan-Meier survival analysis was performed. The prognostic factors was evaluated by log-rank test, including age, morphology, location, T stage, grade of primary tumor, clinical status of ILN before ILND, lymphatic pathology, time to ILND. Cox proportional hazard model was used to find the independent risk factors on survival. RESULTS: The median age was 50 year-old (range 26 to 84 year-old). The median follow-up time was 23 months (range 3-76 months). The 3-year and 5-year overall survival were 70.1% and 65.4%, respectively, The 5-year survival rate in immediate ILND and delayed ILND group were 93.1%, and 33.7% respectively. Positive ILN metastasis was found in 7 patients from immediate ILND group but 26 patients from delayed ILND group that the prognostic factors included T stage, tumor grade, clinical status of inguinal lymph nodes before ILND, and lymphatic pathology. Cox model found the status of inguinal lymph nodes was independent prognostic factor for the survival. CONCLUSION: Inguinal lymph node metastasis is the important prognostic indicator of the survival of penile cancer. Immediate ILND could improve survival for the patients with clinically impalpable lymph nodes.

[Differentiation of human bone marrow mesenchymal stem cells into Leydig or steroidogenic cells in vivo].

OBJECTIVE: To study the differentiation of human bone marrow mesenchymal stem cells (BMSCs) into Leydig or steroidogenic cells in vivo and the immunoreaction related to transplantation into mouse testis. METHODS: After differentiation and cultivation, the 3rd-passage BMSCs were collected and labeled with Hoechest 33342, and joined the saline fluorouracil to form cell-suspending fluid. After injection of the etgane dimethane sulphonate (EDS), the mice received the transplanted cell-suspending fluid by testis net injection with a dose of each side testicular 0.05 mL. Since the first day prior to transplantation, mice were executed every 2 d (one mouse each time) and the testosterone concentrations were analyzed. The control group included 20 BALB/c mice without any treatment during the same period. The results were analyzed by microscopic observation, using 3beta-hydroxysteroid dehydrogenase (3beta-HSD) monoclonal antibody and mouse anti-human cell nucleus monoclonal antibody for immunofluorescence assay on the testis. For tracking the BMSCs, the cells which were positively stained with both 3beta-HSD and mouse anti-human cell nucleus monoclonal antibodies were retrieved. RESULTS: Certain killing effect of EDS to the mouse Leydig cells was observed. Transplantation of human BMSCs into the mouse testis by testis net injection was effective and feasible, no immunoreactions were detected. After transplantation, no positive cells of 3beta-HSD) and mouse anti-human cell nucleus monoclonal antibody were found. CONCLUSION: Transplantation of human BMSCs into the mouse testis by testis net injection was effective and feasible, no immunoreactions were detected. After transplantation, the human BMSCs failed to differentiate into Leydig cells or steroidogenic cells.

Early outcomes of single-site versus multi-port robotic-assisted radical prostatectomy: A systematic review and meta-analysis.

BACKGROUND: Single-site robotic-assisted radical prostatectomy (ssRARP) has been promoted in many institutions due to its minimally invasive approach. This review aimed to investigate early outcomes of ssRARP in comparison with multi-port robotic-assisted radical prostatectomy (mpRARP). METHODS: A systematic literature search was performed for articles related to ssRARP case series and studies that compared ssRARP with mpRARP. The primary outcomes were functional and oncological outcomes, incision length, length of hospital stay and cost. RESULTS: 24 ssRARP case series involving 1385 cases, and 11 comparative studies involving 573 ssRARP cases and 980 mpRARP cases were included. Rate of immediate, 3-month, 6-month and 12-month recovery of continence in the ssRARP case series were 41 % [95 % CI: 0.38-0.45], 70 % [95 % CI: 0.67-0.73], 90 % [95 % CI: 0.87-0.93] and 93 % [95 % CI: 0.90-0.96]. 3-month potency recovery and positive surgical margin rate were 53 % [95 % CI: 0.46-0.60] and 21 % [95 % CI: 0.19-0.24]. No significant differences were detected between ssRARP and mpRARP in terms of 3-month (OR: 1.12; 95 % CI: 0.80-1.57) or 6-month (OR: 0.72; 95 % CI: 0.36-1.46) continence recovery rate, 3-month potency recovery rate (OR: 0.92; 95 % CI: 0.50-1.70), positive surgical margin rate (OR: 0.83; 95 % CI: 0.62-1.11), biochemical recurrence rate or total cost. Furthermore, ssRARP was associated with a significantly shorter length of incision and hospital stay. CONCLUSION: ssRARP has significant advantages in cosmetic effect, length of incision and rapid recovery. Consequently, ssRARP is expected to become the preferred form although more evidence is needed to determine its long-term effect.

Adverse renal outcomes following targeted therapies in renal cell carcinoma: a systematic review and meta-analysis.

Introduction: To clarify the prevalence of adverse renal outcomes following targeted therapies in renal cell carcinoma (RCC). Methods: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Central Library. Studies that had reported adverse renal outcomes following targeted therapies in RCC were eligible. Outcomes included adverse renal outcomes defined as either renal dysfunction as evidenced by elevated serum creatinine levels or the diagnosis of acute kidney injury, or proteinuria as indicated by abnormal urine findings. The risk of bias was assessed according to Cochrane handbook guidelines. Publication bias was assessed using Funnel plot analysis and Egger Test. Results: The occurrences of the examined outcomes, along with their corresponding 95% confidence intervals (CIs), were combined using a random-effects model. In all, 23 studies including 10 RCTs and 13 observational cohort studies were included. The pooled incidence of renal dysfunction and proteinuria following targeted therapies in RCC were 17% (95% CI: 12%-22%; I2 = 88.5%, p < 0.01) and 29% (95% CI: 21%-38%; I2 = 93.2%, p < 0.01), respectively. The pooled incidence of both types of adverse events varied substantially across different regimens. Occurrence is more often in polytherapy compared to monotherapy. The majority of adverse events were rated as CTCAE grades 1 or 2 events. Four studies were assessed as having low risk of bias. Conclusion: Adverse renal outcomes reflected by renal dysfunction and proteinuria following targeted therapies in RCC are not uncommon and are more often observed in polytherapy compared to monotherapy. The majority of the adverse events were of mild severity. Systematic Review Registration: Identifier CRD42023441979.

Comparison of perioperative and functional outcomes of single-incision versus standard multi-incision robot-assisted laparoscopic radical prostatectomy: a prospective, controlled, nonrandomized trial.

To compare perioperative and functional outcomes between improved (port-free) single-site robot-assisted laparoscopic radical prostatectomy (pf-ssRARP) and standard multi-port robot-assisted radical prostatectomy (MPRARP). A total of 372 consecutive patients underwent RARAP using the da Vinci Si® robotic surgical system. Group I (n = 210) included patients undergoing pf-ssRARP and Group II (n = 162) included patients undergoing MPRARP. Demographics and perioperative data including postoperative recovery outcomes were recorded and compared between the two groups. Overall mean operative time was significantly shorter with the pf-ssRARP compared to the MPRARP (p < 0.05). The length of hospitalization after the pf-ssRARP was shorter (p < 0.05). In Group I, the positive surgical margin rate was 15.2%; while in Group II, the positive margin rate was 33.3% (p < 0.05). The rate of instant urinary continence was significantly higher in Group I than in Group II (p < 0.05). The percentage of urinary continence was higher in the pf-ssRARP than in the MPRARP, at 6 months post-surgery (p < 0.05) and 9 months post-surgery (p < 0.05). There was no significant difference in the proportion of erectile function in the pf-ssRARP and MPRARP groups at the time of reaching the endpoint of this study (p > 0.05). The two groups were comparable in terms of total hospitalization costs (p < 0.05). The improved (port-free) single-site robot-assisted laparoscopic radical prostatectomy is a practical and easy technique to implement in clinical practice. Extraperitoneal implementation of the modified technique requires only a small incision, no special PORT, no additional auxiliary foramen creation, increased postoperative aesthetics and reduced hospitalization costs, and a high percentage of early postoperative urinary control recovery.

Excessive SOX8 reprograms energy and iron metabolism to prime hepatocellular carcinoma for ferroptosis.

Lipid peroxidation and redox imbalance are hallmarks of ferroptosis, an iron-dependent form of cell death. Growing evidence suggests that dysregulation in glycolipid metabolism and iron homeostasis substantially contribute to the development of hepatocellular carcinoma (HCC). However, there is still a lack of comprehensive understanding regarding the specific transcription factors that are capable of coordinating glycolipid and redox homeostasis to initiate the onset of ferroptosis. We discovered that overexpression of SOX8 leads to impaired mitochondria integrate, increased oxidative stress, and enhanced lipid peroxidation. These effects can be attributed to the inhibitory impact of SOX8 on de novo lipogenesis, glycolysis, the tricarboxylic acid cycle (TCA), and the pentose phosphate pathway (PPP). Additionally, upregulation of SOX8 results in reduced synthesis of NADPH, disturbance of redox homeostasis, disruption of mitochondrial structure, and impairment of the electron transport chain. Furthermore, the overexpression of SOX8 enhances the process of ferroptosis by upregulating the expression of genes associated with ferroptosis and elevating intracellular levels of ferrous ion. Importantly, the overexpressing of SOX8 has been observed to inhibit the proliferation of HCC in immunodeficient animal models. In conclusion, the findings suggest that SOX8 has the ability to alter glycolipid and iron metabolism of HCC cells, hence triggering the process of ferroptosis. The results of our study present a novel strategy for targeting ferroptosis in the therapy of HCC.

Oral nutritional supplement helps to improve nutritional status of dialysis dependent patients: a systematic review and meta-analysis of randomized controlled trials.

Background: The prevention and treatment of malnutrition holds remarkable implications in the overall management of dialysis patients. However, there remains a dearth of comprehensive evaluations regarding the impact of oral nutrition supplement (ONS) on all pertinent dimensions of malnutrition in the dialysis population. Methods: A systematic search was conducted in MEDLINE, EMBASE, and Cochrane Central Library. RCTs that had assessed the effects of oral nutritional supplement in dialysis-dependent populations were considered eligible. Outcomes included laboratory indicators, anthropometric measures, nutritional indices, dialysis adequacy, body composition analysis measures, and systemic inflammation indicators. The risk of bias was assessed according to Cochrane guidelines. Weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results: In all, 22 RCTs with 1,281 patients were included. The pooled analyses revealed the serum ALB, BMI, nPCR, and MIS improved by 1.44 g/L (95% CI: 0.76, 2.57), 0.35 kg/m2 (95% CI: 0.17, 0.52), 0.07 g/(kg d) (95% CI, 0.05, 0.10), and -2.75 (95% CI, -3.95, -1.54), respectively following ONS treatments when compared to control treatments. However, no significant differences were observed in relation to the other outcomes examined. 15 studies were rated as having high risk of bias. Visual inspection of the funnel plot and Egger test argued against the presence of publication bias. Conclusion: ONS treatments helps to improve the nutritional status of dialysis dependent patients. More evidence is needed from future investigations with longer study duration and standardized procedures to support long-term use of ONS in this population. Systematic review registration: https://www.crd.york.ac.uk/prospero/, Identifier CRD 42023441987.

Validation and comparison of prognostic value of different preoperative systemic inflammation indices in non-metastatic renal cell carcinoma.

BACKGROUND: Several preoperative systemic inflammation indices have been proven to be correlated with the prognosis of patients diagnosed with non-metastatic renal cell carcinoma (RCC). However, these indices are currently not included in the main prognostic models, and few studies have compared the prognostic efficacy of different preoperative systemic inflammation indices. PATIENTS AND METHODS: This retrospective study reviewed patients diagnosed with non-metastatic RCC who underwent nephrectomy at West China Hospital of Sichuan University from 2011 to 2013. Different preoperative systemic inflammation indices (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], monocyte-to-lymphocyte ratio [MLR], systemic immune-inflammation index [SII], and systemic inflammation response index [SIRI]) were calculated. Logistic regression was used to explore the relationship between systemic inflammation indices and clinical characteristics, and Cox regression was used to identify independent prognostic factors of overall survival (OS). The concordance index (c-index) was also calculated. RESULTS: A total of 820 patients were included in the study, with a median follow-up of 78 months. Higher levels of NLR (> 3.04), PLR (> 147), MLR (> 0.32), SII (> 700), and SIRI (> 1.27) were found to be associated with more advanced tumor stage, higher Furman grade, and larger tumor size. In multivariate Cox regression, NLR, PLR, MLR, SII, and SIRI were identified as independent prognostic factors, and SII had the highest and most significant hazard ratio and the largest c-index. CONCLUSION: In conclusion, various systemic inflammation indices were found to be associated with poorer OS. Among them, SII exhibited the highest predictive efficacy, suggesting its potential inclusion as a component in future prognostic models.

Prognostic value of preoperative microscopic hematuria in patients with non-metastatic renal cell carcinoma who underwent nephrectomy.

BACKGROUND: Microscopic hematuria is associated with various urinary system diseases and is commonly used for the diagnosis of these conditions. Its prognostic role in non-metastatic renal cell carcinoma (RCC) patients who underwent nephrectomy remains unclear. PATIENTS AND METHODS: A retrospective analysis of non-metastatic RCC patients who underwent nephrectomy in West China Hospital of Sichuan University from 2011 to 2013 was performed. Significant microscopic hematuria (SMH), defined as a threshold with a significant impact on disease-free survival (DFS) and overall survival (OS), was determined by Kaplan-Meier curves and the Maximally Selected Log-Rank Statistic. Kaplan-Meier curves were then used to estimate patients' DFS and OS, and the log-rank test was used to examine statistical significance. Logistic regression was utilized to identify clinical-pathological factors associated with SMH, while Cox regression was employed to determine independent factors of survival. RESULTS: A total of 773 patients were included, and 20 red blood cells per high-power field was identified as the cutoff of SMH, of which 90 patients had preoperative SMH (11.6%) and 683 patients (88.4%) did not. Larger tumor size (OR = 1.10 [per cm], 95% CI 1.01-1.19, p = 0.036) and higher Fuhrman grade (grade 3 vs. grade 1-2, OR = 1.76, 95% CI 1.09-2.83, p = 0.02; grade 4 vs. grade 1-2, OR = 2.15, 95% CI 0.73-6.31, p = 0.164) were predictors of SMH. Compared to non-SMH patients, SMH patients had poorer DFS (HR = 3.16, 95% CI 2.07-4.83, p < 0.001) and OS (HR = 2.11, 95% CI 1.34-3.32, p = 0.001). CONCLUSION: In summary, preoperative SMH is associated with larger tumor size and higher Fuhrman grade, and it is also independently correlated with poorer DFS and OS in non-metastatic RCC patients who underwent nephrectomy.

Recent advances in single-site/incision robotic-assisted radical prostatectomy.

INTRODUCTION: Single-site robotic-assisted radical prostatectomy (ssRARP) has been successfully applied to treat prostate cancer. This review aims to describe the recent advances of surgical approaches, working accesses and novel robotic platforms in ssRARP. MATERIAL AND METHODS: A systematic literature search was performed by searching the PubMed, EMBASE, Web of Science and Scopus databases in December 2022 to identify all literature related to ssRARP. RESULTS: A total of 48 relevant studies were found worldwide from 2008 to 2023. Since the introduction of ssRARP, various modifications of this technique in surgical approaches, working accesses and novel robotic platforms have been developed. The application of ssRARP using the da Vinci SP platform has shown great superiority with encouraging clinical outcomes. DISCUSSION: There has been a potential shift toward ssRARP using the da Vinci SP platform due to its potential advantages in terms of lower blood loss, minimal postoperative pain, better cosmetic outcome and rapid recovery. More convincing evidence, further technical improvement and higher cost-effectiveness are needed for its widespread acceptance.

Prognostic value of a baseline prognostic nutritional index for patients with prostate cancer: a systematic review and meta-analysis.

BACKGROUND: The prognostic nutritional index (PNI) integrates both nutritional and immune indicators and provides promising prognostic value for various malignancies. However, there is still no specific consensus relating to the precise relationship between the pretreatment PNI and the survival outcome of patients with prostate cancer (PCa). Here, we performed a meta-analysis to determine the prognostic significance of PNI for patients with PCa. METHODS: We used the PubMed, EMBASE, Web of Science, Cochrane Library (CENTRAL), and CNKI databases to identify and retrieve eligible articles that were published in any language up to the 1st March 2023. Our analysis considered hazard ratios (HRs) and 95% confidence intervals (CIs) published in the included studies. Data synthesis and analysis were conducted using Stata 15.1 software. RESULTS: A total of ten studies featuring 1631 cases were included in our quantitative analysis. Analysis showed that a low PNI at baseline was significantly associated with poor overall survival (OS) (HR: 2.16; 95% CI: 1.40-3.34; p = 0.01), progression-free survival (PFS) (HR: 2.17; 95% CI 1.63-2.89; p < 0.001). Owing to high levels of heterogeneity, we performed subgroup analysis based on disease staging, sample size, and cutoff value; we found that disease staging may have been the source of the heterogeneity. A low pretreatment PNI was associated with poor survival outcomes for both metastatic castration-resistant prostate cancer (mCRPC) patients and nonmetastatic castration-resistant prostate cancer (nmCRPC) patients. CONCLUSIONS: A low pretreatment PNI was significantly correlated with a worse OS and PFS in patients with PCa. A low pretreatment PNI may act as a reliable and effective predictor for the prognosis of patients with PCa. Further well-designed studies should be performed to fully evaluate the prognostic performance of this novel indicator for PCa.