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ObjectiveTo evaluate the role of stone components in postoperative fever following RIRS, and to investigate the role of quick stone component analysis during RIRS procedure.Patients and methods1493 patients with RIRS were retrospectively reviewed. Propensity score matching (PSM) analysis was performed as infection stones (IS) vs. calcium-containing stones (CS) and IS vs. other compositions (OS). Independent risk factors of postoperative fever were identified by logistic analysis and nomogram was constructed.ResultsA total of 73 patients suffered postoperative fever (4.9%), 8 patients with sepsis (0.5%), 4 patients with septic shock (0.3%). In IS vs. CS, the incidence of positive urine test (28.4% vs. 14.7%, p = 0.001), residual stone (48.2% vs. 37.6%, p = 0.04), and postoperative fever (9.1% vs. 2.0%, p = 0.004) was significantly higher in IS. In IS vs. OS, IS had a higher incidence of positive urine test (30.9% vs. 9.3%, p < 0.001) and residual stone (47.4% vs. 18.6%, p < 0.001), while there was no significant difference in postoperative fever (10.3% vs. 4.1%, p = 0.17). Multivariate regression analysis revealed that gender (OR 1.82, CI 1.09–3.07, p < 0.001), stone components (OR 0.6, CI 0.37–0.97, p = 0.038), urine test (OR 3.72, CI 2.23–6.20, p < 0.001), and neutrophil ratio > 75% (OR 5.17, CI 3.03–9.16, p < 0.001) were independent risk factors for postoperative fever. A nomogram with moderate discriminative ability (c-index: 0.813) was constructed to predict postoperative fever.ConclusionInfection stones were closely associated with postoperative fever following RIRS, as well as female gender, preoperative positive urine test, and postoperative neutrophil ratio > 75%. A quick stone component analysis would help in prevention of infectious complications. Early and longer duration of antimicrobial therapy was recommended for patients with infection stones.

ObjectiveIn the present prospective randomized controlled trial (RCT), enhanced-SMP (eSMP) and conventional Chinese mini-PCNL (mPCNL) were compared to test the low renal pelvic pressure (RPP) and high stone removal efficiency in eSMP.Materials and methodsHundred patients with 2–5 cm renal calculus were enrolled. Renal pelvic pressure, operation time, lithotripsy time, removed stone volume, and complications were compared between eSMP and mPCNL statistically.ResultsThere was no significant difference in removed stone volume between mPCNL and eSMP (8.09 ± 3.36 vs. 7.88 ± 3.07 mm3, t = 0.320, p = 0.750), lithotripsy time in mPCNL was longer than eSMP (49.6 ± 19.5 vs. 34.9 ± 14.2 min, t = 4.152, p < 0.001), thus stone removal efficiency was higher in eSMP (13.71 ± 1.18 vs. 9.82 ± 1.24 mm3/h, t = 15.499, p < 0.001). Intra-operative RPP in mPCNL was higher than eSMP (17.72 ± 3.33 vs. 12.03 ± 2.37 mmHg, t = 9.524, p < 0.001); accumulated time of backflow status (RPP > 30 mmHg) in mPCNL was longer than eSMP (23.3 ± 16.9 vs. 3.7 ± 4.2 s, t = 7.710, p < 0.001). There was no significant difference in postoperative fever rate between mPCNL and eSMP (12.77% vs. 4.34%, χ2 = 2.095, p = 0.148), nor final stone-free rate (87.2% vs. 91.3%, χ2 = 0.401, p = 0.526). Hospital stay in eSMP was shorter than mPCNL (2.54 ± 0.72 vs. 3.00 ± 0.88, t = 2.724, p = 0.008).ConclusionEnhanced SMP (eSMP) was safe and effective in the management of 2–5 cm renal calculus. It can keep a lower renal pelvic pressure and a higher stone removal efficiency when compared to conventional Chinese mini-PCNL.Clinical trial registrationNC03206515.

Background Physical therapy, including percussion, inversion, vibration and combinations, was clinically performed to improve the stone free rate (SFR) following lithotripsy procedures. However, physical therapy is not widely accepted in clinical practice owing to lack of high level evidence support and a standard protocol. The present meta-analysis aimed to evaluate the efficacy and safety of physical therapy in improving SFR following extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). Methods Systematic review of literature from PubMed, Scopus, Cochrane library and Embase was performed in March 2019. The efficacy and safety of physical therapy after ESWL and RIRS were assessed by meta-analysis of SFR and complication rate. Results A total of 8 prospective studies with 1065 patients were enrolled. When compared to non-intervention, physical therapy provided a higher SFR (OR:3.38, 95% CI: 2.45–4.66, p  < 0.0001) at all time points (week 1, week 2 and month 1), while there was no significant difference in complications such as hematuria, lumbago, dizziness and urinary tract infection (OR: 0.84; 95%CI: 0.62–1.13; p  = 0.237). In subgroup analysis of different stone locations, lower calyx stone (OR: 3.51; 95%CI: 2.21–5.55; p  < 0.0001), upper ureter and renal pelvic stones (OR:2.79; 95%CI:1.62–4.81; p  = 0.0002) had a higher SFR after physical therapy, while there was no significant improvement in SFR in upper and middle calyx stones. In subgroup analysis of different techniques, EPVL (external physical vibration lithecbole, OR:3.47; 95%CI:2.24–5.37; p  < 0.0001) and PDI (percussion, diuresis and inversion, OR:3.24; 95%CI:2.01–5.21; p  < 0.0001) were both effective in improving SFR when compared to non-intervention. Conclusions Physical therapy is effective in improving the SFR after ESWL and RIRS, especially for lower calyx stones, upper ureter and renal pelvic stones, while without significant side effects. External physical vibration lithecbole (EPVL) might provide a relative uniformed and repeatable protocol for clinical practice of physical therapy. Trial registration PROSPERO 2019 CRD42019130228 .

Chronic joint pain in rheumatoid arthritis (RA) represents a persistent therapeutic challenge, and although luteolin (LUT) exhibits established anti-inflammatory properties, its precise mechanism for alleviating RA-associated chronic pain remains undefined. Through systematic investigation in collagen-induced arthritis (CIA) mice, we demonstrated that LUT administration effectively attenuated chronic pain by modulating spinal cluster of differentiation 4 positive T (CD4+ T) cell dynamics and suppressing microglial activation. Integrated multi-omics profiling (cleavage under targets and tagmentation (CUT&Tag), RNA sequencing (RNA-seq), and metabolomics) coupled with functional validation revealed nuclear factor of activated T cells 2 (NFATC2) as the central transcriptional regulator governing T helper 17 (Th17) cell differentiation and spinal infiltration through protein kinase C epsilon (PRKCE)-signal transducer and activator of transcription 3 (STAT3) signaling transduction. Significantly, our mechanistic studies uncovered a previously unrecognized epigenetic cascade: LUT-mediated suppression of lactate dehydrogenase A (LDHA) activity disrupts glycolysis-fueled histone H3 lysine 9 lactylation (H3K9la), thereby epigenetically silencing NFATC2 transcription. Translational studies using RA patient-derived CD4+ T cells confirmed LUT's capacity to normalize pathological hyperactivity of the LDHA/H3K9la/NFATC2 axis, concomitantly regulating CD4+ T dynamics. Biophysical validation through molecular docking, surface plasmon resonance (SPR), and molecular dynamics (MD) simulations established LUT's direct binding to LDHA with high affinity. Collectively, these findings delineate a novel therapeutic paradigm wherein LUT alleviates RA-associated chronic pain by orchestrating Th17 differentiation and migratory capacity through coordinated blockade of the LDHA-H3K9la-NFATC2 signaling network, highlighting its potential as a disease-modifying agent for chronic pain management in RA. [Display omitted] •Suppressing spinal infiltration of CD4+ T cells contributed to the pain-relief effects of LUT in RA.•LUT inhibits Th17 pathogenicity via targeting novel LDHA/H3K9la/NFATC2 regulatory axis.•RA patient CD4+ T cells show LUT-reversible LDHA/H3K9la/NFATC2 hyperactivity.•LUT disrupts metabolite-driven Th17 neuroinflammation in RA.

Background Maintenance hemodialysis (MHD) is a commonly used renal replacement therapy for end-stage renal disease patients. MHD patients have undergone multiple physiological stressors, which may cause physical problems and affect their mental health; however, few qualitative studies have been done on the mental health of MHD patients. Such qualitative research becomes the basis for further quantitative research and is critical to validating its results. Therefore, the current qualitative study used a semi-structured interview format, and aimed to explore the mental health and its influencing factors of MHD patients who are not receiving intervention treatment to determine how best to ameliorate their mental health. Methods Based on the application of Grounded Theory, semi-structured face-to-face interviews were conducted with 35 MHD patients, following consolidated criteria for reporting qualitative studies (COREQ) guidelines. Two indicators (emotional state and well-being) were used to assess MHD patients’ mental health. All interviews were recorded, after which two researchers independently performed data analyses using NVivo. Results Acceptance of disease, complications, stress and coping styles, and social support were found to be the influencing factors of MHD patients’ mental health. High acceptance of disease, healthy coping styles, and high social support were positively correlated with mental health. In contrast, low acceptance of disease, multiple complications, increased stress, and unhealthy coping styles were negatively correlated with mental health. Conclusion One’s acceptance of the disease played a more significant role than other factors in affecting MHD patients’ mental health.

Hepatocellular carcinoma (HCC) is the third-leading cause of cancer deaths globally. Although considerable progress has been made in the treatment, clinical outcomes of HCC patients are still poor. Therefore, it is necessary to find novel prognostic factors upon which prevention and treatment strategies can be formulated. Ficolin-3 (FCN3) protein is a member of the human ficolin family. It activates complement through pathways associated with mannose-binding lectin-associated serine proteases. Herein, we identified that FCN3 was downregulated in HCC tissues and decreased FCN3 expression was closely related to poor prognosis. Overexpression of FCN3 induced apoptosis and inhibited cell proliferation via the p53 signaling pathway. Mechanistically, FCN3 modulated the nuclear translocation of eukaryotic initiation factor 6 (EIF6) by binding ribosome maturation factor (SBDS), which induced ribosomal stress and activation of the p53 pathway. In addition, Y-Box Binding Protein 1 (YBX1) involved in the transcription and translation level regulation of FCN3 to SBDS. Besides, a negative feedback loop in the downstream of FCN3 involving p53, YBX1 and SBDS was identified.

PurposeTo evaluate the effect of bladder emptying status on the ureteral access sheath (UAS) insertion resistance and following ureteral injury.MethodsEighty patients were enrolled and randomly divided into bladder emptying group and control group before UAS placement. A digital force gauge (Imada Z2-50N) was used to measure the resistance during the UAS insertion. The ureteral injury was evaluated and graded with Post-Ureteroscopic Lesion Scale (PULS) system at the end of procedure. The mean resistance, maximum resistance in different ureteral segments, and ureteral injury were compared between the two groups.ResultsThe mean resistance (3.12 ± 0.49 vs. 4.28 ± 0.52 N, P < 0.001), maximum resistance in the whole procedure (5.17 ± 0.72 vs. 6.39 ± 0.96 N, P < 0.001) and distal ureter (3.07 ± 0.75 vs. 6.18 ± 1.17 N, P < 0.001) in the bladder emptying group were significantly lower when compared to the control group. In subgroup analysis, the similar result was also noted in patients with BMI ≥ 25 when compared to patients with BMI < 25, while there was no significant difference between men and women, age ≥ 50 years versus age < 50 years. The incidence of PULS 1–2 ureteral injury in the bladder emptying group was lower than the control group (35% vs. 55%, P = 0.045). The ureteral injury in distal ureteral was less frequently noted in bladder emptying group than the control group (22.5% vs. 55%, P = 0.006); however, there was no significant difference in middle and upper ureter (P > 0.05).ConclusionEmptying the bladder before UAS insertion can effectively reduce the UAS insertion resistance and the risk of distal ureteral injury in RIRS.

Objective: Physical therapy, including percussion, inversion, vibration and combinations, was clinically performed to improve the stone free rate (SFR) following lithotripsy procedures. However, physical therapy is not widely accepted in clinical practice owing to lack of high level evidence support and a standard protocol. The present meta-analysis aimed to evaluate the efficacy and safety of physical therapy in improving SFR following extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). Methods: Systematic review of literature from PubMed, Scopus, Cochrane library and Embase was performed in March 2019. The efficacy and safety of physical therapy after ESWL and RIRS were assessed by meta-analysis of SFR and complication rate. Results: A total of 8 prospective studies with 1065 patients were enrolled. When compared to non-intervention, physical therapy provided a higher SFR (OR:3.38, 95% CI: 2.45-4.66, p< 0.0001) at all time points (week 1, week 2 and month 1), while there was no significant difference in complications such as hematuria, lumbago, dizziness and urinary tract infection(OR: 0.84; 95%CI: 0.62-1.13; p=0.237). In subgroup analysis of different stone locations, lower calyx stone (OR: 3.51; 95%CI: 2.21-5.55; p<0.0001), upper ureter and renal pelvic stones (OR:2.79; 95%CI:1.62-4.81; p=0.0002) had a higher SFR after physical therapy, while there was no significant improvement in SFR in upper and middle calyx stones. In subgroup analysis of different techniques, EPVL (external physical vibration lithecbole, OR:3.47; 95%CI:2.24-5.37; p<0.0001) and PDI (percussion, diuresis and inversion, OR:3.24; 95%CI:2.01-5.21; p<0.0001) were both effective in improving SFR when compared to non-intervention. Conclusions: Physical therapy is effective in improving the SFR after ESWL and RIRS, especially for lower calyx stones, upper ureter and renal pelvic stones, while without significant side effects. External physical vibration lithecbole (EPVL) might provide a relative uniformed and repeatable protocol for clinical practice of physical therapy. Review Registration: PROSPERO 2019 CRD42019130228.

Background Humans are commonly exposed to various heavy metals, but their effects on human respiratory health, especially lung function and airway inflammation, remain poorly understood. Methods This study included data from the 2011–2012 National Health and Nutrition Examination Survey (NHANES) and utilized multivariable linear regression, subgroup analyses, interaction tests, Bayesian kernel machine regression (BKMR), and weighted quantile sum (WQS) regression to explore the relationship between heavy metals, airway inflammation, and lung function. Results This study included 3576 adult participants. In the fully adjusted model, a positive relationship was observed between serum mercury (Hg) and fractional exhaled nitric oxide (FeNO) [0.20 (0.02, 0.37). Serum cadmium (Cd) had a significant negative connection with FEV1 [-106.22 (-143.64, -68.80)], FVC [-74.94 (-119.22, -30.66)], and FEV1/FVC [-1.35 (-1.82, -0.88)], serum lead (Pb) also showed a significant negative association with FEV₁ [-17.85 (-27.48, -8.21)], FVC [-14.84 (-26.22, -3.45)], and FEV₁/FVC [-0.14 (-0.26, -0.02)], while serum manganese (Mn) exhibited a significant positive relationship with FEV1/FVC [0.09 (0.02, 0.15)]. Selenium (Se) exposure showed a positive association with FEV₁ and FEV₁/FVC in Model 2, although these associations were not significant in the fully adjusted model. Subgroup analyses revealed that Body Mass Index (BMI) influenced the relationship between serum Hg, Mn, Se, Pb, and FeNO. BKMR analysis suggested a negative one-way exposure-response association among Cd exposure and FeNO, FEV1, and FEV1/FVC. The overall effect of co-exposure to the five heavy metals on FeNO levels was inhibitory. WQS analysis identified Cd exposure as the most significant negative associated factor on FeNO, FEV1, and FEV1/FVC. In contrast, Hg exposure was the most significant positive factor associated with FeNO, Se contributed the strongest positive weight to FEV₁ and FEV₁/FVC. Conclusions We found inconsistent associations between heavy metals, lung function, and airway inflammation. Cd and Pb exposure was associated with reduced lung function, whereas Hg exposure was positively associated with airway inflammation. Se contributed the strongest positive weight to FEV₁ and FEV₁/FVC in the WQS analysis, although Se was not significantly associated with FEV₁ and FEV₁/FVC in the fully adjusted model. These findings underscore the imperative for strengthened environmental regulation of heavy metal exposure. Future studies should employ more prospective methodologies to clarify these relationships.

In the field of the muscle–computer interface, the most challenging task is extracting patterns from complex surface electromyography (sEMG) signals to improve the performance of myoelectric pattern recognition. To address this problem, a two-stage architecture, consisting of Gramian angular field (GAF)-based 2D representation and convolutional neural network (CNN)-based classification (GAF-CNN), is proposed. To explore discriminant channel features from sEMG signals, sEMG-GAF transformation is proposed for time sequence signal representation and feature modeling, in which the instantaneous values of multichannel sEMG signals are encoded in image form. A deep CNN model is introduced to extract high-level semantic features lying in image-form-based time sequence signals concerning instantaneous values for image classification. An insight analysis explains the rationale behind the advantages of the proposed method. Extensive experiments are conducted on benchmark publicly available sEMG datasets, i.e., NinaPro and CagpMyo, whose experimental results validate that the proposed GAF-CNN method is comparable to the state-of-the-art methods, as reported by previous work incorporating CNN models.