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Purpose This study aimed to determine whether administering intravesical chemotherapy (IVC) during the Bacillus Calmette - Guérin (BCG) waiting period after the second TURBT improves the recurrence-free survival (RFS) of patients with non - muscle - invasive bladder cancer (NMIBC). Methods A retrospective analysis was performed on patients who had undergone a second TURBT and subsequent intravesical BCG immunotherapy (IBI) at the Affiliated Hospital of Xuzhou Medical University between January 2012 and December 2023. The patients were divided into two groups (A and B) based on whether they continued IVC during the BCG waiting period, and RFS was compared between the two groups. Results A total of 164 patients were included in this study. The log-rank test results indicated that IVC administered during the BCG waiting period was associated with a more favorable RFS for patients with NMIBC, particularly those at high risk. Multivariate analysis revealed that pathological T-stage (HR 2.084, 95% CI [1.132, 3.834], p  = 0.018) and IVC received during the BCG waiting period (HR 0.261, 95% CI [0.140, 0.488], p  < 0.001) were significantly correlated with patient RFS. Conclusions Administering IVC during the BCG waiting period is recommended to prolong the time to recurrence in patients with high-risk NMIBC. Conversely, this additional treatment is unnecessary for patients at intermediate risk.

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.

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.

BackgroundFor medical institutions without robotic equipment, it remains uncertain whether laparoscopic radical nephroureterectomy (LNU) can achieve results similar to those of robotic surgery for the treatment of upper tract urothelial carcinoma (UTUC). This meta-analysis aimed to compare the efficacy and safety of robot-assisted radical nephroureterectomy (RANU) with that of LNU using a large sample size of patients.MethodsA systematic meta-analysis was performed using data (available to May 2022) acquired from multiple scientific databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, according to the protocols registered with PROSPERO (CRD42021264046), were followed to perform this cumulative analysis.ResultsNine high-quality studies were included in this analysis, considering factors such as operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), positive surgical margins (PSM), and complications. Statistical indicators revealed no significant differences between the RANU and LNU groups in terms of OT (weighted mean difference [WMD] 29.41, 95% confidence interval [CI] −1.10 to 59.92; p = 0.22), EBL (WMD −55.30, 95% CI −171.14 to 60.54; p = 0.13), LOS (WMD −0.39, 95% CI −1.03 to 0.25; p = 0.12), PSM (odds ratio [OR] 1.22, 95% CI 0.44–3.36; p = 0.17], or complications (OR 0.91, 95% CI 0.49–1.69; p = 0.13).ConclusionThe meta-analysis showed that the perioperative and safety indicators of both RANU and LNU were similar and both showed favorable outcomes in UTUC treatment. However, some uncertainties remain in the implementation and selection of lymph nodes for dissection.

We performed a meta-analysis to compare the safety and effectiveness of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in treating nephrolithiasis ≥ 2 cm in patients with solitary kidneys. This systematic review was registered on PROSPERO (registration ID: CRD42021270519). The search time was set from the establishment of the databases until April 30, 2021. A systematic search was performed in the PubMed, MEDLINE, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Cochrane Library, and Embase databases. Stata 16 was used to perform the statistical analysis of the extracted data. After screening using strict inclusion and exclusion criteria, five studies with a total of 474 patients were included in the final meta-analysis. According to the literature quality assessment scale statistics, the five studies included were of high quality. The results of the meta-analysis showed that RIRS had lesser hemoglobin loss (HL), shorter length of hospital stay (LOS), lower initial (OR = 3.39, 95% CI [1.97, 5.83], P = 0.02) and final stone-free rates (OR = 2.24, 95% CI [1.24, 4.06], P = 0.03), but a higher incidence of grade III-IV complications (OR = 0.29, 95% CI [0.08, 0.97], P = 0.04) than PCNL. The difference between the two surgical methods was not statistically significant in terms of operation time (OT), grade I–II complication rate, and total complication rate. For nephrolithiasis ≥ 2 cm in patients with a solitary kidney, RIRS has the advantage of less HL and shorter LOS, while PCNL benefits from its higher SFR (both initial and final). Both RIRS and PCNL are effective treatments for nephrolithiasis in patients with a solitary kidney, and clinicians should choose the most appropriate option to achieve the best treatment outcome, taking into account the patient's underlying conditions and medical conditions.

Renal ischemia-reperfusion injury (IRI) triggers a sterile immune response, primarily mediated by the innate immune system. Interleukin-33 (IL-33) promotes neutrophil infiltration during inflammatory processes, and neutrophils play a critical role in renal IRI pathology. This study aims to elucidate the mechanisms of IL-33 in neutrophil extracellular trap (NET) formation during renal IRI. The association between IL-33 and NET formation was investigated using suppression of tumorigenicity 2 (ST2) knockout (KO) mice, RNA sequencing, and pharmacological interventions. Results revealed that compared with preoperative levels, postoperative serum IL-33 and NET formation were elevated and positively correlated in patients undergoing renal transplantation. Similarly, the mouse model of renal I/R exhibited increased IL-33 expression and NET formation, which were also highly correlated. Administration of recombinant IL-33 during renal I/R enhanced NET formation and worsened renal IRI. However, treatment with an anti-IL-33 monoclonal antibody decreased NET formation and mitigated renal IRI. ST2 KO mice exhibited reduced NET formation and increased protection against renal IRI compared to control mice after renal I/R. In vitro studies showed that IL-33 dose-dependently promoted NET formation in neutrophils. Mechanistically, IL-33-induced NET formation was markedly reduced in ST2 KO mouse-derived neutrophils. Furthermore, RNA sequencing results revealed that IL-33-induced NET formation was mediated via ST2/ PI3K/Akt and ST2/peptidylarginine deiminase 4 (PAD4) signaling pathways. Inhibition of these pathways significantly suppressed IL-33-induced NET formation. In summary, this study demonstrates that IL-33/ST2 signaling exacerbates renal IRI by amplifying NETs. Targeting the IL-33/ST2 axis and inhibiting NET formation offers promising therapeutic strategies for preventing and treating renal IRI.

To investigate the influence of circulation distribution on axial-flow pump performance, this study integrates numerical simulation and theoretical analysis methods, establishing a simulation framework based on MATLAB and CFX. By adjusting the circulation distribution function from the hub to the tip of the impeller, various design models were constructed. Three-dimensional parametric modeling of the blades was achieved through MATLAB programming, generating key parameters such as blade profile coordinates. Subsequently, the geometric data were imported into CFX to establish a full-flow passage numerical model. The simulation employed the RANS equations with the k-ε turbulence model to analyze flow field characteristics and hydraulic performance under different circulation schemes. Numerical results indicate that under identical circulation distributions, the head–flow curve exhibits a monotonically decreasing trend, while the efficiency curve demonstrates a distinct single-peak characteristic. Notably, under specific design conditions, variations in design parameters can shift the best efficiency point while simultaneously improving efficiency. Cavitation performance analysis reveals that as the hub-to-tip ratio increases, the velocity circulation initially rises rapidly before gradually stabilizing. This distribution pattern effectively optimizes the pressure gradient at the impeller outlet, thereby significantly enhancing cavitation resistance across a wide operational range. The proposed circulation control methodology provides critical theoretical support and engineering guidance for the hydrodynamic optimization of low-head axial flow pumps.