A controlled study of the hygienic technical evaluation of the transaxillary approach for inflation-free single-port lumpectomy versus conventional transcervical anterior open surgery in radical thyroid cancer resection.

OBJECTIVE: To evaluate sanitary techniques for radical thyroid cancer surgery via the transaxillary approach without inflation single-port endoscopic surgery (TAWISES) and the conventional open anterior cervical approach (COACAS) in a controlled manner. METHODS: This work was a retrospective analysis of the clinical data of 60 patients admitted to our hospital for unilateral radical thyroid cancer surgery between 01/2021 and 12/2022. The control group underwent COACAS (30 patients), and the experimental group underwent TAWISES (30 patients). The patients' operative time, intraoperative bleeding volume, 24-h postoperative pain index, drainage tube carrying time, hospitalization duration and complication rate were compared and analyzed. The patients were followed up for 3, 6 and 12 months postoperatively and evaluated based on numbness, muscular tightness, pain and other discomfort in the neck, as well as satisfaction with social adaptation and cosmetic incisions. The recurrence status was assessed for 1 year in both groups of patients. A questionnaire survey was conducted to assess patient acceptance of the two surgical approaches. The economic characteristics (cost-effectiveness and cost-utility) of the different approaches in our region were evaluated comprehensively. RESULTS: The length of the incision, drainage tube carrying time and hospitalization duration were greater in the experimental group than in the control group (P < 0.05). The differences in complication rate, intraoperative bleeding volume, 24-h postoperative pain index and recurrence rate were not statistically significant between the two groups (P > 0.05). Neck discomfort was greater in the control group, and the difference was statistically significant at the 3-month postoperative follow-up (P < 0.05). The differences at the 6- and 12-month postoperative follow-ups were not statistically significant (P > 0.05). However, mild discomfort was significantly more common in the experimental group (63.33% > 36.67%, 80% > 53.33%, P < 0.05). The experimental group had better social adaptability, greater total medical costs, and better overall patient medical satisfaction than did the control group (P < 0.05). The acceptance of TAWISL was greater than that of COACAS (P < 0.05). CONCLUSION: Compared with COACLAS, TAWISES is safe and effective and better meets the cosmetic, psychological and social adaptation needs of patients. TAWISES is also more cost effective and can be better utilized for the population in our region, filling the gap in surgical modalities for thyroid cancer in in our region.

Impact of atorvastatin on erectile dysfunction: A meta-analysis and systematic review.

Atorvastatin may be an effective treatment for erectile dysfunction (ED). The purpose of this meta-analysis was to determine whether atorvastatin therapy is effective in the treatment of ED. All published research on atorvastatin in the treatment of ED patients in EMBASE, PubMed, Web of Science and Cochrane were investigated till 30 October 2021. A meta-analysis of randomized controlled trials (RCTs) was done to investigate the efficacy of atorvastatin and placebo in the treatment of ED. Moreover, we also performed a meta-analysis based on single-arm trials (SATs) to explore the atorvastatin treatment on the efficacy of ED. In a meta-analysis based on RCTs, the weighted mean difference of the change of International Index for Erectile Function-5 (IIEF-5) score in the atorvastatin treatment group with or without treatment was 4.53 (95 per cent confidence interval [CI] of 3.28-5.79) higher than in the control group. In an SAT-based meta-analysis, the ES of the change in IIEF-5 score in the atorvastatin treatment group before and after treatment was 3.22 (95 per cent CI of 1.32-5.12). Atorvastatin is an effective therapeutic drug for patients with ED. However, we expect that more multicentre clinical trials will be conducted to support this assertion.

The underlying molecular mechanism and drugs for treatment in adrenal cortical carcinoma.

Purpose: The study aimed to predict and explore the possible clinical value and mechanism of genetic markers in adrenal cortical carcinoma using a bioinformatics analysis method. Methods: The RNA-seqs and miRNAs data were downloaded from TCGA database to identify the differentially expressed genes and differentially expressed miRNAs. The hub-genes were screened by building protein-protein interaction sub-networks with 12 topological analysis methods. We conducted the receiver operating characteristic curve to elevate the diagnostic value of hub-genes in distinguishing the death and alive groups. The survival analysis of hub-genes and key miRNAs were conducted using Kaplan-Meier curves. Furthermore, most significant small molecules were identified as therapeutic candidates for adrenal cortical carcinoma by the CMap analysis. Results: Compared to survival group, we found 475 up-regulated genes and 354 genes and the key pathways leading to the death of different ACC individual patients. Then we used 12 topological analysis methods to found the most possible 22 hub-genes. Among these hub-genes, nine hub-genes (C3, CXCL5, CX3CR1, GRM8, HCAR2, HTR1B, SUCNR1, PTGER3 and SSTR1) could be used to distinguish the death and survival groups for patients. We also revealed that mRNA expressions of 12 genes (C3, CXCL8, CX3CR1, GNAT3, GNGT1, GRM8, HCAR2, HTR1B, HTR1D, PTGER3, SSTR1 and SUCNR1) and four key miRNAs (hsa-mir-330, hsa-mir-489, hsa-mir-508 and hsa-mir-513b) were related to survival. Three most small molecules were identified (H-9, AZ-628 and phensuximide) as potential therapeutic drugs for adrenal cortical carcinoma. Conclusion: The hub-genes expression was significant useful in adrenal cortical carcinoma, provide new diagnostic, prognosis and therapeutic approaches for adrenal cortical carcinoma. Furthermore, we also explore the possible miRNAs involved in regulation of hub-genes.

Premature Ejaculation, True or False? Clinical evaluation of PE patients with multiple intercourse in one day.

Clinical characteristics of 216 adult males previously diagnosed with premature ejaculation (PE) were studied. Using a survey questionnaire, characteristics included intravaginal ejaculation latency time (IELT), penile hardness scores and the refractory period (RP). Ninety-four PE patients reported they had experienced vaginal intercourse more than once (2 to 4 times) in one day (~44%). IELT was significantly increased at the second and subsequent intercourses, and IIEF-15 (International Index of Erectile Function-15) and relevant subclass scores were markedly improved compared to their first intercourse and also compared to the single intercourse group in this cohort study. Overall sexual satisfaction was achieved in the PE patients with multiple intercourse experiences. The same trend was observed in both the patients diagnosed with lifelong and acquired PE. Based on the evidence, the argument is that the PE patients who were diagnosed using their performance at the first intercourse but who have the ability to participate in multiple vaginal intercourses in one day are unlikely to be true PE. The false PE may account for over 40% of PE patients diagnosed by current guidelines and definitions.

New insights into the potential mechanisms of spermatogenic failure in patients with idiopathic azoospermia.

Idiopathic azoospermia (IA) refers to azoospermia without a clear aetiology. Due to the unclear aetiology and pathological mechanism of IA, there is no effective treatment for IA. The development of assisted reproductive and microsperm extraction technologies has brought hope to patients with IA with fertility problems. However, there are still many patients with IA whose testes lack healthy sperm, causing infertility. Therefore, it is key to identify how testicular spermatogenic failure can be reversed to promote spermatogenesis in patients with IA to resolve fertility problems; these goals are a great challenge in reproductive medicine. The underlying genetic factors seem to be important pathological factors of IA. Understanding the role of genetic factors in the pathological mechanism of spermatogenic failure in patients with IA is of great value for future studies and treatments and is also an important reference for the reproductive health of males and their offspring. A method combining sequencing technology and bioinformatics analysis is an important means to understand the genetic pathological mechanisms. We used bioinformatics analysis to study the public human IA dataset. We found that the pathogenic mechanism of IA may be related to abnormal ciliary structure and function and disrupted RNA metabolism in spermatogenic cells. Disrupted m6A regulation of spermatogenesis may be an important pathological mechanism of IA and warrants attention. Finally, we screened for key genes and potential therapeutic drugs to determine future research directions.

[Advances in the studies of special biomarkers for the experimental diagnosis of CP/CPPS].

At present, there are no widely accepted specific biomarkers for the experimental diagnosis of chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). Recent studies show that many related biomarkers exist in expressed prostatic secretions (EPS) or semen, urine and blood or serum. The monocyte chemotactic protein-1 (MCP-1/CCL-2), macrophage-inflammatory-protein-1 alpha (MIP-1α/CCL-3), interleukin-6 (IL-6), interleukin-8 (IL-8), nerve growth factor (NGF) and B7-H3 in EPS, prostatic exosomal protein (PSEP) in the urine, and prostate-specific antigen (PSA), mean platelet volume (MPV) and macrophage migration inhibitory factor (MIF) in the serum are believed to be of significant clinical and research value, and expected to become important laboratory biomarkers for the diagnosis of CP/CPPS.

Clinicopathological and prognostic significance of survivin expression in renal cancer patients: a meta-analysis.

BACKGROUND: Survivin has been reported to play a role in the diagnosis and prognosis of renal cell carcinoma (RCC); however, published data on this subject are conflicting. AIM: To conduct a meta-analysis to evaluate the impact of survivin as a prognostic marker and its association with clinicopathological variables in patients with RCC. METHOD: Comprehensive searches of electronic databases (PubMed, ISI Web of Knowledge Embase, Google Scholar Web and the Cochrane Library) were updated to June 2016 to retrieve eligible studies. The association strength was measured with relative risks (RRs) and pooled HRs with 95% CIs, which were extracted and pooled to determine the association between survivin expression and patient survival and clinicopathological features. RESULTS: Ten studies with 1063 cases of RCC were included. Positive survivin expression in RCC was associated with the TNM stage (pooled RR 1.49; 95% CI 1.07 to 2.07) or Fuhrman grade (pooled RR 1.63; 95% CI 1.15 to 2.32) in patients. The correlation between survivin expression and gender was not significant (pooled RR 0.97; 95% CI 0.83 to 1.15). In addition, a considerable association was found between survivin expression and overall survival for patients with RCC (pooled HR 1.94; 95% CI 1.24 to 3.05 (multivariate model) and 5.41; 95% CI 4.08 to 7.17 (univariate model)). CONCLUSIONS: Our results indicate that survivin is of prognostic significance in patients with RCC.

Down-regulation of Sphk2 suppresses bladder cancer progression.

Bladder cancer is the second most common urological malignancy around the world and is by far the most frequent urological malignancy in China. The abnormal expression of sphingosine kinase 2 (SphK2) is associated with tumor progression and a poor patient survival rate, however, the effect of SphK2 on the bladder cancer cells remains unclear. The aim of the paper was to study the expression of SphK2 in bladder cancer and the role of SphK2 on the cell proliferation, metastasis, and apoptosis in bladder cancer in vitro. Our results showed that SphK2 is up-regulated in bladder cancer tissues compared with the corresponding adjacent non-neoplastic tissues, and the expression level of SphK2 was significantly higher in human bladder cancer cells in comparison with normal bladder epithelial cells. Silencing of SphK2 could inhibit the proliferation ability of T24 cells in vitro. In addition, SphK2 knockdown could induce a significant increase in the number of apoptotic cells. Furthermore, the transwell assay also showed significant cell migration inhibition in SphK2 siRNA transfectant compared with cell lines transfected with NC. Thus, this study suggested that SphK2 inhibition may provide a promising treatment for bladder cancer patients.

[Analysis of the diagnosis and treatment of desmoplastic small round cell tumor].

OBJECTIVE: To explore the clinical diagnostic features and treatment of desmoplastic small round cell tumor (DSRCT), and to improve the understanding and management of this tumor. METHODS: The clinicopathological data of nine patients treated in our hospital from October 2004 to June 2014 were retrospectively analyzed and a review of the literature was made. The clinical manifestations, pathological characteristics, diagnosis and differential diagnosis, treatment and prognosis of this tumor were summarized and analyzed. RESULTS: Nine patients with DSRCT, 5 males and 4 females, with an average age of 21 years (range 8-56 years) were included in this study. Ultrasound examination revealed irregular low-density mass shadow in the abdominal cavity. CT examination found that 6 cases had abdominal and retroperitoneal multiple solid tumor nodules, uneven density, and visible low density fluid area. Postoperative pathological examination revealed that the tumor cells were small, mostly elliptic, gathered to form clear structure of nests with clear irregular boundaries. The central portion of large tumor nests often showed necrosis. Scattered fibroblasts and large amount of hyalinization of collagen fibers were seen in the interstitial tissue around the nests. Six patients received laparotomy surgery, however, all failed to resect the tumor completely. Three patients received postoperative chemotherapy, i. e. two cases had carboplatin and paclitaxel chemotherapy, and one case of chemotherapy regimen not specified. Two patients had radiation and chemotherapy (no concrete plan was available). Another case was lost to follow-up. Two of the three patients without surgery received chemotherapy with CAP (cyclophosphamide+adriamycin+carboplatin) and total rectal lesions, pelvic and inguinal lymph nodes, ilium metastases radiation therapy. Another one patient received EP regimen (DDP+VP16) which was then changed into a TP chemotherapy alone. Eight of the nine cases died shortly after surgery, and only one patient treated with chemotherapy alone was still alive after 11 months of follow-up. CONCLUSIONS: Desmoplastic small round cell tumor is a very rare, special type of soft tissue tumor, with very poor prognosis. This tumor may be preliminarily diagnosed according to the imaging characteristics and detection of tumor markers, however, final diagnosis is made by pathology. Surgery is the priority of treatment, combined with complementary radiation and chemotherapy.

Diagnostic and Prognostic Value of Neutrophil-Lymphocyte Ratio in Adrenocortical Carcinoma.

BACKGROUND: The aim was to explore the value of neutrophil-lymphocyte ratio (NLR) as a biomarker for predicting the prognosis or diagnosis in adrenocortical carcinoma (ACC). METHODS: We identified 262 patients with adrenal gland disease who underwent operation at our institution between 2013 and 2018. According to postoperative pathology, patients were divided into 2 groups: ACC and non-ACC groups. The neutrophil and lymphocyte count of patients were recorded. Within the intergroup comparison, data obtained from ACC and non-ACC groups were evaluated using ANOVA test. The cut-off values of NLR for the prognosis in ACC were determined according to 3 methods. RESULTS: The NLR values of ACC and non-ACC groups were 5.36 ± 5.30 and (1.73 ± 0.26) ∼ (2.56 ± 1.35), respectively (P < .001). NLR carry a differential property was evaluated with ROC curve to distinguish the above 2 groups. The cut-off value of NLR was estimated as 2.65 according to the Youden index. With this value, sensitivity was found as 67.5%, specificity was 83.8% and AUC was 0.749 (P < .001, confidence interval = 0.638-0.860). In ACC, the higher NLR group was not shown significantly poorer overall survival than the lower NLR group (NLR ≥2.65 vs. NLR < 2.65, NLR ≥5 vs. NLR <5, NLR ≥5.36 vs. NLR <5.36) (P > .05). CONCLUSION: According to the data in this study, it can be said that adrenocortical tumors are likely to be malignant by 67.5% if the NLR value is greater than 2.65. When we use the NLR to predict the prognosis of ACC, there is not statistically significant.

Prognostic value of fibrinogen change value in adrenocortical carcinoma patients.

PURPOSE: The aim was to explore the preoperative and postoperative fibrinogen changes value (FCV) as a prognosis biomarker for in patients with adrenocortical carcinoma (ACC). METHODS: We identified 42 patients with ACC and 190 patients with adrenal adenoma (AA) who underwent surgery at our institution between 2015 and 2023. Preoperative fibrinogen, postoperative fibrinogen and follow-up information of the patients were recorded and analysed. The relationship between FCV and overall survival (OS)/ relapse-free survival (RFS) was evaluated. RESULTS: The mean level of preoperative and postoperative fibrinogen for ACC were 4.00 ± 1.64 g/L and 2.75 ± 0.59 g/L, respectively (p < 0.001). The mean level of preoperative and postoperative fibrinogen for AA were 2.79 ± 0.59 g/L and 2.71 ± 0.58 g/L, respectively (p = 0.144). In ACC, the lower FCV (≤ 1.25 g/L) showed a significantly poorer RFS than the higher (> 1.25 g/L) (p = 0.007); however, the lower FCV (≤ 1.25 g/L) showed no poorer OS than the higher (> 1.25 g/L) (p = 0.243). On multivariate survival analyses, FCV remained a predictor of RFS (HR 3.138). CONCLUSION: According to the data in this study, it can be said that FCV is correlated with prognosis of ACC. The FCV might be a new biomarker for predicting the RFS of ACC.

Primary glomus tumor of the thymus in a 66-year-old patient.

We report a unique case of a 66-year-old man who was incidentally identified to have a mass in the thymus region by computerized tomography scan. CT revealed a well-defined 1.6 × 1 × 0.9 cm thymus mass with moderate uniform enhancement. Thoracoscopic thymectomy was performed, and the pathological diagnosis was primary glomus tumor of the thymus. There were no atypia or malignant histological features, and no primary tumors in other sites. To our knowledge, this is the first case of primary thymic glomus tumor reported in the literature.

Erectile dysfunction in testicular cancer survivors: a meta-analysis of case-control studies.

Introduction: Testicular cancer (TC) is the most frequent cancer among men aged 14-44 years. The risk of erectile dysfunction (ED) in TC patients varied within a wide range across different studies. This study aims to estimate the risk of ED in TC patients by conducting a meta-analysis of case-control studies. Material and methods: Relevant studies were searched using PubMed, EMBASE, Scopus, and the Cochrane Library up to June 2019. Case-control studies that reported the incidence of ED in TC patients were included. Results: A total of 8 studies involving 2060 TC patients and 2651 healthy men were included. All the TC patients underwent unilateral orchiectomy; other treatment modalities were also conducted if necessary. ED occurred in 16.9% (348/2060) of TC patients and 9.4% (251/2651) of healthy men. Compared with healthy men, TC patients experienced a significantly increased risk of ED (OR = 2.39, 95% CI: 1.56-3.67). Substantial heterogeneity was observed. In addition, subgroup analysis revealed that the risk (OR = 3.76, 95% CI: 2.45-5.78) for ED in TC patients with follow-up < 5 years was significantly higher than that (OR = 1.61, 95% CI: 1.10-3.67) with follow-up ≥ 5 years. Heterogeneity was improved after subgroup analysis. Conclusions: TC patients experienced an increased risk for ED compared with healthy men. The long-term risk for ED in TC patients was lower than the short-term risk.

Can a nomogram predict apical prostate cancer pathology upgrade from fusion biopsy to final pathology? A multicenter study.

BACKGROUND: This study evaluates the efficacy of a nomogram for predicting the pathology upgrade of apical prostate cancer (PCa). METHODS: A total of 754 eligible patients were diagnosed with apical PCa through combined systematic and magnetic resonance imaging (MRI)-targeted prostate biopsy followed by radical prostatectomy (RP) were retrospectively identified from two hospitals (training: 754, internal validation: 182, internal-external validation: 148). A nomogram for the identification of apical tumors in high-risk pathology upgrades through comparing the results of biopsy and RP was established incorporating statistically significant risk factors based on univariable and multivariable logistic regression. The nomogram's performance was assessed via the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA). RESULTS: Univariable and multivariable analysis identified age, targeted biopsy, number of targeted cores, TNM stage, and the prostate imaging-reporting and data system score as significant predictors of apical tumor pathological progression. Our nomogram, based on these variables, demonstrated ROC curves for pathology upgrade with values of 0.883 (95% CI, 0.847-0.929), 0.865 (95% CI, 0.790-0.945), and 0.840 (95% CI, 0.742-0.904) for the training, internal validation and internal-external validation cohorts respectively. Calibration curves showed good consistency between the predicted and actual outcomes. The validation groups also showed great generalizability with the calibration curves. DCA results also demonstrated excellent performance for our nomogram with positive benefit across a threshold probability range of 0-0.9 for the training and internal validation group, and 0-0.6 for the internal-external validation group. CONCLUSION: The nomogram, integrating clinical, radiological, and pathological data, effectively predicts the risk of pathology upgrade in apical PCa tumors. It holds significant potential to guide clinicians in optimizing the surgical management of these patients.

Primary synovial sarcoma of the pleura in an 18­year­old male patient: A case report.

Primary synovial sarcoma of the pleura (PSSP) is a rare disease. The present study reported the case of a patient (male; age, 18 years) with two tumors (7.8×2.8 cm and 6.5×5.8 cm) treated with surgery and chemotherapy. To the best of our knowledge, this is the first reported case of two tumors diagnosed as PSSP, which was confirmed by immunohistochemical staining. After six months of follow-up, the symptoms of dry cough and wheezing disappeared and all of the laboratory results were within normal limits. PSSP requires clinical suspicion combined with strategic diagnostic evaluation to confirm the diagnosis and a comprehensive treatment program based on surgery and assisted by chemotherapy.

Changes of Colon in Rats with Different Ages in Response to Lipopolysaccharide.

BACKGROUND: Lipopolysaccharide (LPS) is an endotoxin that causes inflammation, and the content of LPS increases gradually during the process of aging. Whether the response of the colon to LPS stimulation will increase with age is yet unknown. OBJECTIVE: The study investigated the effects of LPS stimulation on the colon of adult and aging rats. METHOD: 43 healthy male SD rats were divided into 4 different groups: adult group and LPS-stimulated adult group at the age of 4 months, and aging group and LPS-stimulated aging group at the age of 22 months. Rats were stimulated by intraperitoneal injection of LPS (1mg/kg) for 24 h. The morphological changes of the colon were observed, and intestinal inflammatory response, tight junction proteins, apoptosis, and proliferation in intestinal epithelial cells were detected. RESULTS: A series of morphology changes occurred in the colon of adult rats after LPS stimulation, the higher inflammatory response (TLR4, NF-κB, and IL-1ß), changes in the protein levels of tight junctions (ZO-1, Claudin1, and Claudin2), and increased apoptosis (Bax, Bcl2) and proliferation (PCNA) of intestinal epithelial cells. The above changes were also found in aging rats. LPS stimulation further promotes the above changes to some extent in the colon of aging rats. CONCLUSION: A series of colon changes in rats was significantly damaged during LPS stimulation and aging, and these changes were further aggravated to some extent in LPS-stimulated aging rats.

Prevalence and Reasons for the Absence of Vaginal Intercourse in Chinese Middle-Aged and Elderly Men.

INTRODUCTION: As the global population ages, research on the health of middle-aged and elderly men has intensified. AIM: To report a paucity of data on the prevalence, etiology, and risk factors associated with lack of vaginal intercourse in middle-aged and elderly Chinese men. METHODS: Between January, 2018, and May, 2020, 6,096 men aged 40-90 years old who reside in mainland China were included in the community-based study. Validated scales related to erectile dysfunction (EHS and IIEF-5) and late-onset hypogonadism (ADAM and AMS), and in-person interview method were used to collect data. Multivariable analysis was performed to examine the risk factors associated with the absence of intercourse. OUTCOMES: Prevalence estimate of no current vaginal intercourse and its associations with basic factors and medical comorbidities. Reasons for no current vaginal intercourse. RESULTS: The prevalence of intercourse absence was 19.8% (95% CI; 18.8-20.8%) in middle-aged and elderly Chinese males, and this proportion was significantly higher in older age groups (8.6%, 11.5%, 24.1%, and 34.2% for men aged 40-49, 50-59, 60-69, and 70-90, respectively; P < .05). Among the men who attributed the lack of intercourse to themselves, 168 (21.4%, 95% CI; 18.7-24.4%) had erectile problems and were apprehensive about erectile failure during intercourse. Strained spousal relationships (35 men, 8.4%, 95% CI; 6.1-11.4%), marital issues (163 men, 39%, 95% CI; 34.4--43.8%), and poor health of the partner (179 men, 42.8%, 95% CI; 38.2-47.6%) were described as reasons for lack of intercourse with spouses. Same risk factors were also found in the multivariate analysis. CLINICAL IMPLICATIONS: Modifiable factors that are related to lack of intercourse may be beneficial to Chinese middle-aged and elderly men. STRENGTH & LIMITATIONS: The main strength of the study is that it involved real-world settings. The limitations are as follows. Firstly, psychological data, data on sexual frequency and data regarding types of sex other than vaginal intercourse were not recorded. Secondly, this is a cross-sectional study, from which definite or causative conclusions can't be drawn. Thirdly, the spouses of the participants were not included in the study, and hence the data represent the perceptions of males only. Finally, objective data are required. CONCLUSION: Modifiable factors related to both the patients and their partners were associated with an increased rate of no intercourse in Chinese middle-aged and elderly men. Guidance for sexual life may benefit men with an absence of intercourse. Future studies are warranted to reexamine our findings. Lu Y, Zhang J, Ma C, et al. Prevalence and Reasons for the Absence of Vaginal Intercourse in Chinese Middle-Aged and Elderly Men. Sex Med 2022;10:100511.

The Efficacy of Sexual Intercourse Or Masturbation For The Expulsion Of Distal Ureteral Stones In Men: A Systematic Review And Meta-analysis Of Randomized-controlled Trials.

PURPOSE: Several randomized-controlled trials (RCTs) were performed to compare the efficacy of sexual intercourse or masturbation and no sexual activity in treating distal ureteral stones, indicating conflicting results. The meta-analysis was conducted to assess the role of sexual intercourse or masturbation in the treatment of distal ureteral calculi. MATERIALS AND METHODS: PubMed, Cochrane Library, EMBASE, Scopus, Clinicaltrail.gov, and Web of Science were searched by October 2021. Men who were instructed of no sexual intercourse or masturbation, and only received standard symptomatic treatment are comparators. Relative risk (RR), weighted mean difference (WMD), and their 95% confidence intervals (CIs) were calculated using random or fixed effects models. RESULTS: Five RCTs including 500 subjects were analyzed in the study. Compared with controls, subjects in experimental group had significantly higher expulsion rate at 2nd and 4th week (95%CI: 1.334 to 2.638, RR: 1.876, I2 = 73.6%, P < .001; 95%CI: 1.148 to 1.752, RR: 1.418, I2 = 55.9%, P < .001), significantly decreased requirement for analgesic injections (95%CI: -1.071 to -.126, WMD: -.598, I2 = 90.3%, P = .013), and significantly shorter expulsion time (95%CI: -6.941 to -.436, WMD: -3.689, I2 = 83.7%, P = .026). CONCLUSION: Performing sexual intercourse or masturbation 3 or 4 times a week can be an alternative treatment option of distal ureteral calculi (0-10 mm in size). However, more clinical evidence with better designs solving raised concerns is warranted.

Competitive Risk Model for Specific Mortality Prediction in Patients with Bladder Cancer: A Population-Based Cohort Study with Machine Learning.

Background: Noncancer death accounts for a high proportion of all patients with bladder cancer, while these patients are often excluded from the survival analysis, which increases the selection bias of the study subjects in the prediction model. Methods: Clinicopathological information of bladder cancer patients was retrieved from the Surveillance, Epidemiology, and End Results (SEER) database, and the patients were categorized at random into the training and validation cohorts. The random forest method was used to calculate the importance of clinical variables in the training cohort. Multivariate and univariate analyses were undertaken to assess the risk indicators, and the prediction nomogram based on the competitive risk model was constructed. The model's performance was evaluated utilizing the calibration curve, consistency index (C index), and the area under the receiver operator characteristic curve (AUC). Results: In total, we enrolled 39285 bladder cancer patients in the study (27500 patients were allotted to the training cohort, whereas 11785 were allotted to the validation cohort). A competitive risk model was constructed to predict bladder cancer-specific mortality. The overall C index of patients in the training cohort was 0.876, and the AUC values were 0.891, 0.871, and 0.853, correspondingly, for 1-, 3-, and 5-year cancer-specific mortality. On the other hand, the overall C index of patients in the validation cohort was 0.877, and the AUC values were 0.894, 0.870, and 0.847 for 1-, 3-, and 5-year correspondingly, suggesting a remarkable predictive performance of the model. Conclusions: The competitive risk model proved to be of great accuracy and reliability and could help clinical decision-makers improve their management and approaches for managing bladder cancer patients.