Risk factors for extraurothelial recurrence in upper tract urothelial carcinoma after radical nephroureterectomy: a retrospective study based on a Chinese population

ObjectivesThe risk factors for extraurothelial recurrence (EUR) after radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UTUC) are currently inconsistent and unclear. In this study, we aimed to identify these risk factors and develop a grading system for EUR.MethodsWe retrospectively analyzed 220 patients who underwent RNU for UTUC in our center from January 2009 to December 2020. Overall survival (OS) and extraurothelial recurrence-free survival (EURFS) were compared using the Kaplan–Meier curve with a log-rank test. Univariate and multivariate Cox regression models were applied to identify the independent risk factors related to EUR.ResultsThe median follow-up period was 42 (range: 2–143) months. Of the 220 patients, 61 patients developed EUR in our cohort, which had worse survival outcome. Multivariate Cox regression analysis showed pathologic stage, lymph node (LN) status, lymphovascular invasion (LVI), Ki-67, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were independent risk factors for EUR. The Kaplan–Meier curves revealed a significant difference in EUR among the three risk groups.ConclusionOur study suggests that pathologic stage, LN status, LVI, Ki-67, NLR, and PLR are independent risk factors for EUR in UTUC patients after RNU. The development of a grading system for EUR risk stratification may assist urologists in making clinical decisions regarding the management of UTUC

Comparative analysis of the efficacies of probiotic supplementation and glucose-lowering drugs for the treatment of type 2 diabetes: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to evaluate the effects of probiotics and glucose-lowering drugs (thiazolidinedione [TZD], glucagon-like pep-tide-1 receptor agonists [GLP-1 RA], dipeptidyl peptidase IV inhibitors, and sodium glucose co-transporter 2 inhibitors [SGLT-2i]) in patients with type 2 diabetes from randomized con-trolled trials (RCTs). The PubMed, Web of science, Embase, and Cochrane Library databases were searched on the treatment effects of probiotics and glucose-lowering drugs on glycemia, lipids, and blood pressure metabolism published between Jan 2015 and April 2021. We performed meta-analyses using the random-effects model. We included 25 RCTs (2,843 participants). Overall, GLP-1RA, SGLT-2i, and TZD significantly reduce fasting blood sugar (FBS) and glycated hemoglobin (HbA1c), whereas GLP-1 RA increased the risk of hypoglycaemia. Multispecies probiotics decrease FBS, total cholesterol (TC), and systolic and diastolic blood pressure (SBP, DBP). Moreover, subgroup analyses indicated that participants aged >55 years, BMI ≥30 kg/m2, longer duration of intervention, and subjects from Eastern countries, showed significantly higher reduction in FBS and HbA1c, TC, TG and SBP. This meta-analysis revealed that including multiple probiotic rather than glucose-lowering drugs might be more beneficial regarding T2D prevention who suffering from simultaneously hyperglycemia, hypercholesterolemia, and hypertension

Mesoscale modeling and simulation of microstructure evolution during dynamic recrystallization of a Ni-based superalloy

Microstructural evolution and plastic flow characteristics of a Ni-based superalloy were investigated using a simulative model that couples the basic metallurgical principle of dynamic recrystallization (DRX) with the twodimensional (2D) cellular automaton (CA). Variation of dislocation density with local strain of deformation is considered for accurate determination of the microstructural evolution during DRX. The grain topography, the grain size and the recrystallized fraction can be well predicted by using the developed CA model, which enables to the establishment of the relationship between the flow stress, dislocation density, recrystallized fraction volume, recrystallized grain size and the thermomechanical parameters

2D PIV Measurement of Twin Buoyant Jets in Wavy Cross-Flow Environment

The multiport diffuser effluent discharge facilities constructed beneath the coastal waters were simplified in the laboratory as twin buoyant jets in a wavy cross-flow environment. The near-field flow structure of twin jets was studied by series of experiments conducted in a physical wave⁻current flume. The particle image velocimetry (PIV) system was used to measure the velocity field of the jets in various cross-flow-only and wavy cross-flow environments. By means of flow visualization, the distinctive “effluent cloud„ (EC) phenomenon was clearly observed and the jet penetration height was found to be notably increased compared with that of cross-flow-only environment at the downstream position. It was found that the wave-to-current velocity ratio Rwc is a very important parameter for effluent discharge. A new characteristic velocity uch and the corresponding characteristic length scale lmb for twin buoyant jets in the wavy cross-flow environment were defined. Using curve-fitting, a new equation to estimate the effects of the jet-to-current velocity ratio (Rjc), wave-to-current velocity ratio (Rwc) and Strouhal number (St) on the jet trajectory were derived to enhance understanding the physical processes underpinning the rise and the dilution of buoyant jets, which is critical to the design of discharge facilities

Spatiotemporal dynamics of human ecosystems in the context of protected areas as a policy tool: Insights from Sanjiangyuan National Park, China

As one of the most critical ecological functional areas in China and even the world, Sanjiangyuan National Park’s sustainable development has attracted attention. The integrated evaluation method, the coupling coordination model, and the grey correlation model were employed to uncover the coupling coordination relationship among sub-systems in the human ecosystem of Sangjiangyuan National Park. The results are as follows. First, the sustainable development capacity of the human ecosystem in Sanjiangyuan National Park fluctuated and declined during the study period, with insufficient momentum for sustainable development. Second, from 2005 to 2020, Sanjiangyuan National Park experienced a process of optimization and adjustment from moderately uncoordinated to nearly uncoordinated. At the county scale, the coupling coordination state of the sub-system was consistent with the overall national park. Third, among the four dimensions, the correlation degree of openness to the human ecosystem of Sanjiangyuan National Park was far ahead, followed by harmony, independence, and vulnerability. Our research can provide a reference for the coordinated development of the human ecosystem in other national parks with similar ecological functions around the world

Comparison between joint operation schemes for Lines AB/C of Central Asia‒China Gas Pipeline in Uzbekistan

In the actual construction of Central Asia-China Gas Pipeline, 8 cross-over lines were set up for Line C in Kazakhstan, achieving the interconnection between Lines AB and C. Meanwhile, 8 reserved points were provided along Line C in Uzbekistan. With the experience of the joint operation in Kazakhstan section, the comprehensive capacity of the whole system can be further improved if cross-over lines are added at appropriate positions in the Uzbekistan section. For this purpose, a simulation model was established for the joint operation of the Lines AB/C of Central Asia–China Gas Pipeline, the optimal distribution principle of Lines AB and C under different total throughput was determined, and the effect of operation with cross-over lines added at the 8 reserved points in Uzbekistan section was estimated respectively. Additionally, comparison was made for the throughput increasing schemes of the system with cross-over lines by assuming that the emergency shutdown occurred at the gas resources of Turkmenistan and Uzbekistan, and finally, it was determined to add cross-over lines at 4 reserved points in Uzbekistan. Hence, the research results could provide reference for the practical engineering reformation and the subsequent production

Single- versus Multiple-Tract Percutaneous Nephrolithotomy in the Surgical Management of Staghorn Stones or Complex Caliceal Calculi: A Systematic Review and Meta-analysis

Objective. To assess current evidence on the effectiveness and safety of single- versus multiple-tract percutaneous nephrolithotomy in the surgical management of complex caliceal calculi or staghorn stones through a comprehensive literature review. Methods. A comprehensive literature review of articles investigating the clinical efficacy and safety of single- versus multiple-tract percutaneous nephrolithotomy was performed. Relevant literature was obtained by systematically searching PubMed, EMBASE, and the Cochrane Library through May 2020. We followed the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary outcomes, including the stone-free rate (SFR), and secondary outcomes (peri- and postoperative complications and operative data) were evaluated using RevMan 5.3 statistical software. Results. Ten studies involving 1844 patients with complex caliceal calculi or staghorn stones met the inclusion criteria. Single-tract percutaneous nephrolithotomy (STPCNL) had noninferior clinical efficacy with respect to the immediate SFR (odds ratio OR=0.80, 95% confidence interval (CI) (0.46 to 1.38), p=0.42) and 3-month SFR (OR=1.22, 95% CI (0.38 to 3.92), p=0.74) compared with multiple-tract percutaneous nephrolithotomy (MTPCNL). In addition, pooled analyses showed that STPCNL resulted in significantly lower hemoglobin decreases (MD=−0.46, 95% CI (-0.68 to -0.25), p<0.0001), fewer blood transfusions (OR=0.48, 95% CI (0.34 to 0.67), p<0.0001), and fewer pulmonary complications (OR=0.28, 95% CI (0.09 to 0.83), p=0.02) than MTPCNL. However, the overall evidence was insufficient to suggest a statistically significant difference for other adverse events. Conclusion. This meta-analysis indicated that STPCNL is an effective method for treating complex caliceal calculi or staghorn stones. Compared with MTPCNL, STPCNL not only yields similarly high SFRs but also is associated with many advantages, less blood loss, fewer blood transfusions, and fewer pulmonary complications without an increase in other complications. However, the findings of this study should be further confirmed by well-designed prospective randomized controlled trials (RCTs) with a larger patient series

The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity

Bladder cancer is a common malignant tumor. FOXP1 has been found to be abnormally expressed in tumors such as renal cell carcinoma and endometrial cancer. Here, this investigated the biological roles of Foxp1 in the occurrence and development of bladder cancer. Patients with bladder cancer were obtained from China-Japan Friendship Hospital. Bladder cancer cell lines (5637, UMUC3, J82, and T24 cell) were used in this experiment. Foxp1 mRNA and protein expression levels in patients with bladder cancer were increased, compared with paracancerous tissue (normal). OS and DFS of Foxp1 low expression in patients with bladder cancer were higher than those of Foxp1 high expression. Foxp1 promoted bladder cancer cell growth in vitro model. Foxp1 increased the Warburg effect of bladder cancer. Foxp1 suppressed β-adrenoceptor (β-AR) expression in vitro model. ChIP-seq showed that Foxp1 binding site (E1, TTATTTAT) was detected at −2,251 bp upstream of the β-AR promoter. β-AR Reduced the effects of Foxp1 on cell growth in vitro model. β-AR reduced the effects of Foxp1 on the Warburg effect in vitro model by STAT3 activity. Taken together, our findings reveal that Foxp1 promoted the occurrence and development of bladder cancer through the Warburg effect by the activation of STAT3 activity and repressing β-AR transcription, and which might serve as an important clue for its targeting and treatment of bladder cancer

Data from: One-shot dilation versus serial dilation technique for access in percutaneous nephrolithotomy: a systematic review and meta-analysis

Objective: The purpose of this study was to systematically review the outcomes of the use of one-shot dilation (OSD) and serial tract dilation for percutaneous nephrolithotomy (PCNL). Methods: A systematic review and meta-analysis was conducted. The randomized controlled trials (RCTs) included in the study were identified from EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. The last search was performed on April 30, 2018. Summary effects were calculated as risk ratios (RRs) with 95% confidence intervals (CIs) or mean differences (MDs) with 95% CIs. The endpoints included access time, fluoroscopy time, successful dilation rate, stone-free rate, postoperative decrease in hemoglobin levels, transfusion rate, complication rate, and length of postoperative hospital stay. Results: A total of 7 RCTs were included in the study, with clinical data reported for 697 patients. The overall access time was approximately 110 seconds shorter in the OSD group than in the serial dilation group (MD, -110.14; 95% CI, -161.99 to -58.30; P<0.0001). The fluoroscopy time was shorter with OSD in all RCTs. In addition, the decrease in postoperative hemoglobin levels was approximately 0.23 g/dl less in patients in the OSD group than in those in the serial dilation group (MD, -0.23; 95% CI, -0.39 to -0.07; P=0.004). No relationship was found between the successful dilation rate, stone-free rate, transfusion rate, or complication rate and the method of tract dilation. Conclusion: OSD is a safe and efficacious tract dilation technique that can reduce the access time, fluoroscopy time, and postoperative decrease in hemoglobin level. No difference was found in the successful dilation rate, stone-free rate, transfusion rate, or rate of complications between the OSD and serial dilation groups. The difference in the length of postoperative hospital stay was uncertain. OSD may be a better method of tract creation for PCNL