Infants born to HBsAg/HBeAg-positive mothers remain risk for hepatitis B virus vaccine breakthrough infection (VBI). In this multicenter prospective cohort study, we assessed whether increased neonatal vaccine dose (20 μg vs. 10 μg) or booster immunization could reduce VBI among these children. Infants were vaccinated after birth and followed up to age 5. The 20 μg non-booster group sustained higher anti-HBs levels and lower seronegative rates at all follow-ups compared to the 10 μg non-booster group. Booster immunization increased antibody levels in both dose groups. By age 5, VBI incidence was highest in the 10 μg non-booster group, whereas all overt/occult infections occurred among non-booster children. Multivariate analysis suggested that both higher neonatal dose and booster immunization were associated with a reduced VBI risk, with the lowest risk observed when both strategies were combined. These findings suggest that increased neonatal vaccine dose and booster immunization may help sustain anti-HBs and reduce VBI in high-risk population.

BACKGROUND:People without effective immunization are vulnerable to infection with hepatitis B virus (HBV). At present, there is no appropriate hepatitis B vaccination strategy for HBV-susceptible adults. We aim to assess the long-term effect of neonatal hepatitis B immunization and HBV markers among college students, so as to explore hepatitis B vaccination strategies suitable for high-risk group. METHODS:The enrolled freshmen from four universities were initially tested for hepatitis B screening using colloidal gold test strips. Subjects with positive hepatitis B surface antigen (HBsAg) or negative hepatitis B surface antibody (anti-HBs) were further confirmed using Abbott reagents. HBsAg and anti-HBs double negative individuals were administered hepatitis B vaccination. RESULTS:Using Abbott reagents, we confirmed that among 3242 enrolled freshmen, 1604 (49.5 %) were negative for both HBsAg and anti-HBs, and 27 (0.8 %) were HBsAg-positive. Among the double negative freshmen, 1263 received hepatitis B vaccination. After the first and second dose of hepatitis B vaccine, the protective anti-HBs seroconversion rates reached 91.4 % and 98.5 %, respectively. Only one (0.1 %) freshman was still negative for anti-HBs after the third dose of hepatitis B vaccine. In addition, 96.3 % (104/108) of the fresmen who failed to achieve protective anti-HBs seroconversion after the first dose of hepatitis B vaccine had a baseline anti-HBs level < 2 mIU/mL. CONCLUSION:The HBsAg prevalence among college students has been significantly reduced after the integration of hepatitis B vaccine into Expanded Program on Immunization, but the rate of seroprotective anti-HBs among these students remains low. Hepatitis B vaccination or booster dose is advised for a high-risk group who have negative anti-HBs, and two doses of hepatitis B vaccine are advised for those with anti-HBs < 2 mIU/mL.

The goal of this study is to explore the role of the LMNB1 gene in glioma. A cohort of 160 patients who underwent glioma surgery were randomly selected of this study. The LMNB1 expression was assessed employing immunohistochemical and real-time quantitative polymerase chain reaction methods. Initially, RNA interference technology was applied to suppress gene expression, followed by the evaluation of tumor cell proliferation, apoptosis, cell cycle dynamics, and migration. The underlying molecular mechanisms of LMNB1 function were examined by a human phospho-kinase array and immunoblotting. And we established the xenograft models to determine the effect of tumor growth as well as the degree of invasion in shLMNB1 mice. Elevated LMNB1 expression correlated with unfavorable overall survival and disease-free survival. A substantial inhibition in cell growth was observed subsequent to LMNB1 knockdown in SHG-44 and U251 glioma cells. SHG-44-shLMNB1 cells exhibited a reduction in the S phase population, along with an increase in cells in G1 and G2 phases. Similarly, shLMNB1 U251 cells showed fewer cells in the S phase and an elevation in cells in G1 phase. Notably, increased apoptosis was observed in U251-shLMNB1 cells and SHG-44-shLMNB1 cells. Wound healing and Transwell migration assays demonstrated a significant decrease in the migration rate of both SHG-44-shLMNB1 and U251-shLMNB1 cells. The phosphorylation levels of Akt1/2/3, as well as the expressions of PI3K, AKT, and p-AKT proteins, were reduced in the shLMNB1 group. Downregulation of LMNB1 repressed tumor progress in vivo. The silencing of LMNB1 was found to significantly reduce the proliferation of human glioma cells, induce apoptosis in tumor cells, impede the progression of the cell cycle, and inhibit the migration of tumor cells. Consequently, we hypothesize that LMNB1 promotes glioma cell proliferation through mechanisms involving the inhibition of tumor cell apoptosis, acceleration of the cell cycle, and enhancement of tumor cell migration. We found that LMNB1 exert critical roles in glioma progression may via regulation of PI3K/Akt signaling pathway. These observations suggest that LMNB1 holds clinical potential for diagnostic and prognostic applications in glioma, presenting novel targets for drug development.

Background: Mitochondrial dysfunction is implicated in the pathogenesis of erectile dysfunction (ED); establishing a causal relationship remains a challenge. This study employed a two‐sample Mendelian randomization (MR) approach to investigate the potential causal associations between mitochondria‐associated proteins and ED. Methods: Association data on mitochondria‐associated proteins from the IEU OpenGWAS database were used for exposure, whereas ED association data from the UK Biobank and FinnGen databases served as the outcome. MR analyses were conducted separately, primarily employing the inverse‐variance weighted (IVW) method and supplemented by the MR‐Egger, weighted median, simple mode, and weighted mode methods. Sensitivity analyses included Cochran’s Q test, MR‐Egger test, leave‐one‐out analysis, and MR‐PRESSO. A meta‐analysis of both databases was conducted to enhance the credibility of the results. Results: Meta‐analysis revealed a significant causal relationship between five mitochondria‐related proteins and ED: 39S ribosomal protein L33 (RPL33; p = 0.013; odds ratio [OR] = 0.94; 95% confidence interval [CI]: 0.90–0.99), mitochondrial ubiquitin ligase activator of NFKB‐1 (MULAN1; p = 0.039; OR = 1.08; 95% CI: 1.00–1.16), nucleoside diphosphate‐linked moiety X motif ‐8 (NUDT8; p = 0.035; OR = 0.92; 95% CI: 0.84–0.99), pyruvate dehydrogenase (acetyl‐transferring) kinase isozyme‐1 (PDK1; p = 0.047; OR = 1.07; 95% CI: 1.00–1.14), and serine‐tRNA ligase (SerRS; p = 0.005; OR = 1.18; 95% CI: 1.05–1.33). Sensitivity analyses revealed no abnormalities. Conclusion: RPL33 and NUDT8 exhibited potential protective effects against ED, whereas MULAN1, PDK1, and SerRS may increase the risk of developing ED. These findings offer new insights into the role of mitochondrial dysfunction in ED pathogenesis and may guide the development of future therapeutic strategies.

SRY-box transcription factor 6 (SOX6) is a member of the SOX gene family and inhibits the proliferation of cervical cancer cells by inducing cell cycle arrest. However, the final cell fate and significance of these cell-cycle-arrested cervical cancer cells induced by SOX6 remains unclear. Here, we report that SOX6 inhibits the proliferation of cervical cancer cells by inducing cellular senescence, which is mainly mediated by promoting transforming growth factor beta 2 (TGFB2) gene expression and subsequently activating the TGFβ2-Smad2/3-p53-p21WAF1/CIP1-Rb pathway. SOX6 promotes TGFB2 gene expression through the MAP4K4-MAPK (JNK/ERK/p38)-ATF2 and WT1-ATF2 pathways, which is dependent on its high-mobility group (HMG) domain. In addition, the SOX6-induced senescent cervical cancer cells are resistant to cisplatin treatment. ABT-263 (navitoclax) and ABT-199 (venetoclax), two classic senolytics, can specifically eliminate the SOX6-induced senescent cervical cancer cells, and thus significantly improve the chemosensitivity of cisplatin-resistant cervical cancer cells. This study uncovers that the MAP4K4/WT1-ATF2-TGFβ2 axis mediates SOX6-induced cellular senescence, which is a promising therapeutic target in improving the chemosensitivity of cervical cancer.

目的:总结采用国产康多内窥镜手术机器人系统行经腹膜外根治性前列腺切除及尿道周围全重建术的临床应用经验,初步评价其安全性和有效性.方法:前瞻性收集2021年5月20日-2021年6月20日于本中心接受康多内窥镜手术机器人经腹膜外根治性前列腺切除及尿道周围全重建术的患者的临床资料.描述手术过程,观察记录手术时间、出血量、住院天数、围术期并发症、术后病理、术后血清前列腺特异性抗原(PSA)及拔除尿管后控尿情况,将24 h使用尿垫≤1片或24 h漏尿量≤20 g定义为完全自主控尿.结果:本研究纳入6例患者,平均年龄为65(58～72)岁,平均体重指数为25.3(20.8～28.0)kg/m2,平均前列腺体积为47.3(27.0～86.0)mL.术前平均前列腺特异性抗原(PSA)为10.51(6.50～17.98)ng/mL.穿刺病理示:Gleason评分6分1例,7分5例.临床分期:T2b期2例,T2c期4例.既往有腹盆部手术史者2例(均为阑尾切除术).6例手术均由单一术者完成,术中无并发症或器械相关不良事件发生.平均手术时间138(120～154)min,平均机械臂对接时间5.7(2.5～9.8)min,平均机械臂腔内操作时间为96(82～116)min,平均膀胱颈与尿道吻合时间为15.9(12.2～25.7)min,平均术中出血量为85(10～200)mL.术后平均住院时间为6(4～10)d,所有患者均无Clavien-DindoⅡ～V级并发症出现.术后组织病理示:Gleason评分7分者5例,9分者1例,病理分期T2a、T2c和T3a期各2例,切缘阳性1例.术后1个月平均PSA为 0.014(0.007～0.033)ng/mL.所有患者尿管均留置2周,拔除尿管后48 h,3例患者完全自主控尿;拔管后1周,所有患者控尿能力较前增强,3例患者自主控尿;拔管后1个月,所有患者均完全自主控尿.结论:国产康多内窥镜手术机器人系统用于施行经腹膜外根治性前列腺切除及尿道周围全重建术具有良好的安全性和有效性,术后短期随访手术效果满意.

进展期肝纤维化和肝硬化严重影响人民健康.近年来,随着医疗诊断技术的发展,肝病领域已开发出多种检查方法用于主动筛查肝纤维化患者,尤其非侵入性肝纤维化测试(non-invasive fibrosis tests,NIT)序贯检测(序贯无创检测)可逐步将晚期肝纤维化患者从高危人群中筛选出来.NIT序贯检测在降低医疗成本的同时,可有效减少不必要的转诊,进而可提高肝纤维化的筛查和诊疗效率并实现对肝纤维化患者的精准管理.本文概述了肝纤维化的筛查和诊断方法、NIT序贯检测的策略及其临床意义,以及近年报道的新型肝纤维化生物标志物,旨在为优化肝纤维化序贯无创检测的策略提供新思路,从而提高肝纤维化的筛查效率.

Objective: To compare the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RARP) performed using the KangDuo surgical robot system to the da Vinci Si robotic system in clinically localized prostate cancer (KD-RARP vs DV-RARP). Methods: A total of 16 patients underwent extraperitoneal KD-RARP performed by a single experienced surgeon using the KangDuo surgical robot system between May 2021 and August 2021. The data were prospectively collected. The most recent 16 cases of extraperitoneal DV-RARP performed in 2021 by the same surgeon were selected from a prospectively maintained database for comparison to prevent operator variability. Preoperative, perioperative, and postoperative data were collected and compared between the two groups. Results: No significant difference was noted between the two groups in terms of basic clinical characteristics. All operations were performed successfully without open or traditional laparoscopic conversion. KD-RARP had a significantly longer operation time compared with DV-RARP (127 [107-159] vs 70.5 [54-90] minutes, p < 0.001). No significant differences between the two groups were observed in neurovascular bundle sparing, estimated blood loss, postoperative hospital stay duration, complications, positive surgical margins, biochemical recurrence, and continence recovery 3 months after catheter removal. Conclusions: RARP using the KangDuo surgical robot system achieved similar short-term oncological and functional outcomes with a disadvantage in operation time compared with the da Vinci Si robotic system. A multicenter randomized clinical trial with a larger sample size is needed for more experience.

Mother-to-child transmission (MTCT) is still the main route of hepatitis B virus (HBV) infection. However, the virological factors affecting HBV MTCT have not been fully elucidated. In this study, based on a prospective cohort of mother-infant pairs with positive maternal hepatitis B surface antigen (HBsAg), we found that the average nucleotide mutation rate of HBV preS1 promoter (SPI) region in the immunoprophylaxis success group was significantly higher than that in the immunoprophylaxis failure group. Among the nucleotide mutations of the HBV SPI region, the C2729T mutation had the highest frequency. Next, we found that the C2729T mutation promoted HBsAg release but reduced HBV production by suppressing the expression of large hepatitis B surface antigen (LHBs), and overexpressing LHBs could rescue this phenomenon. Based on the fact that the C2729T mutation could alter the binding site of hepatocyte nuclear factor 1 (HNF1) in the HBV SPI region, we uncovered that such an alteration could downregulate the transcriptional activity of SPI by attenuating the binding ability of HNF1 and HBV SPI region. This study suggests that HBV C2729T mutation may contribute to the immunoprophylaxis success of HBV MTCT by reducing HBV production, which supplements the virological factors affecting HBV MTCT.

Chronic hepatitis B virus (HBV) infection is a major global public health problem. Approximately 887,000 people die of HBV infection-related diseases annually, with cirrhosis and hepatocellular carcinoma (HCC) being the principal causes of mortality.[1] Timely antiviral therapy greatly reduces the risks of cirrhosis and HCC. However, unfortunately, of those patients who are eligible for antiviral treatment, only 25% of patients in clinic settings and 12% of those in community settings obtain timely antiviral therapy.[2] Therefore, reliable means of identifying patients with chronic HBV infection that require antiviral therapy are necessary, particularly for use in the community. Liver biopsy has long been considered the gold-standard method for evaluating liver inflammation and fibrosis, but its routine use for diagnosis and community surveillance is limited because of its invasiveness. Golgi protein 73 (GP73) is a type II transmembrane protein that is located in the Golgi membrane and is recognized and cleaved by proprotein convertases, releasing it into the circulation.[3] Previous clinical studies had shown that serum GP73 concentration is high in patients with obvious liver lesions, including inflammation, fibrosis, and cirrhosis, which suggests that serum GP73 may represent a useful biomarker for the assessment of liver injury.[4] However, it is unclear whether the measurement of serum GP73 concentration would be an effective means of identifying patients with chronic HBV infection in the community who require antiviral therapy. Therefore, in the present study, we aimed to evaluate the use of serum GP73 for the identification of chronic HBV infection requiring antiviral therapy in a community setting. We performed a cross-sectional study of serum Hepatitis B surface antigen (HBsAg) positive community-dwelling patients who had accepted the health examination from July 2017 to September 2019 in the Beijing Center for Disease Prevention and Control (Beijing, China). The inclusion criteria were as follows: (1) age ≥18 years; (2) HBsAg-positivity (HBsAg ≥0.05 IU/mL) for ≥6 months; (3) availability of blood samples. The exclusion criteria were as follows: (1) history of hepatitis virus infection other than HBV; (2) history of antiviral treatment during the preceding 6 months; (3) pregnancy or other non-viral liver diseases, such as alcohol-related, autoimmune, or drug-induced liver disease. The study was conducted in accordance with the Declaration of Helsinki and its amendments and was approved by the Biomedical Ethics Committee of Peking University (No. IRB00001052-19081). Written informed consent was obtained from all the participants. At present, the latest Chinese guidelines for the prevention and treatment of chronic hepatitis B (CHB) state that the decision to start antiviral therapy should depend on a comprehensive analysis of serum HBV deoxyribonucleic acid (DNA) levels, alanine aminotransferase (ALT) levels, the severity of liver disease, as well as their age, family history, and concomitant diseases.[5] Therefore, the indications for antiviral therapy in this study include the following: (1) serum HBV DNA is positive, ALT levels are persistently abnormal (>upper limit of normal [ULN]), and other causes have been excluded; (2) HBV-related compensated cirrhosis patients with positive serum HBV DNA and HBV-related decompensated cirrhosis patients with positive HBsAg; (3) noninvasive tests or liver biopsy revealing obvious liver inflammation or fibrosis in those with persistently normal ALT levels and age >30 years old.[5] Liver fibrosis and cirrhosis were evaluated by liver stiffness measurement (LSM) using transient elastography. And the participants were allocated to three groups according to the expert consensus[6]: no/mild fibrosis, significant/advanced fibrosis, and cirrhosis [Supplementary Figure 1, https://links.lww.com/CM9/A979]. A total of 1529 patients with a mean age of 48.1 ± 13.13 years were included in this study, of whom 782 (51.1%) were men. The fibrosis/cirrhosis status of each patient was evaluated following the recommended diagnosis work-flow,[6] which showed that 1246 patients had no/mild fibrosis, 205 patients had significant/advanced fibrosis, and 68 patients had cirrhosis. The remaining 10 individuals were not assessed for liver fibrosis due to ALT ≥200 U/L or total bilirubin (TBil) ≥51 μmol/L, but still required antiviral therapy. A total of 422 (27.6%) patients met the recommended criteria for antiviral therapy, with abnormal ALT (>ULN) and/or significant or severe fibrosis/cirrhosis. To determine whether serum GP73 could reflect the severity of liver fibrosis, the concentrations in patients at different stages of fibrosis were compared. This showed that the serum GP73 levels of the non/mild fibrosis group were significantly lower than those of the significant/advanced fibrosis and cirrhosis groups (54.57 ng/mL vs. 67.79 ng/mL vs. 67.70 ng/mL, respectively; P < 0.001), implying that the measurement of serum GP73 may represent a means of identifying patients with significant/advanced fibrosis or cirrhosis. The potential utility of serum GP73 for the identification of patients with significant/advanced liver fibrosis and cirrhosis was further evaluated using receiver operating characteristic (ROC) analysis. The area under the ROC curve of serum GP73 for the identification of significant/advanced liver fibrosis and cirrhosis was 0.605 (95% confidence interval: 0.58–0.64, P < 0.001), and the sensitivity and specificity were 62.6% and 56.6%, respectively. There were no significant differences in the screening efficiencies of serum GP73 vs. the aspartate aminotransferase-to-platelet ratio index and fibrosis-4 index, two established non-invasive diagnostic indices of liver fibrosis (P = 0.338 and 0.925, respectively). The findings of community screening were also consistent with serum GP73 concentration reflecting liver inflammation. The participants were allocated to three groups, using ALT levels of >40 U/L and >80 U/L as cutoff values, and the serum GP73 concentrations of each group were compared. The serum GP73 concentration increased significantly with increases in ALT levels (60.63 ng/mL vs. 78.46 ng/mL vs. 103.1 ng/mL, respectively; P < 0.001). Further correlation analysis also showed that serum GP73 positively correlated with ALT serum concentrations, albeit relatively weakly (r = 0.275, P < 0.001). Serum GP73 could not only be used as a serum marker of significant fibrosis and cirrhosis but also for the evaluation of the severity of liver inflammation in patients with CHB. In this community-based study, we also evaluated the utility of serum GP73 for the screening of a population to identify patients who require antiviral therapy. The results showed that patients that needed antiviral therapy had significantly higher serum GP73 concentrations than those who did not (68.99 ng/mL vs. 53.17 ng/mL; P < 0.001). In addition, the ROC curve yielded a cut-off value of serum GP73 for the screening of patients for a requirement for antiviral therapy was 59.08 ng/mL, with a true-positive rate (TPR) and false-negative rate (FNR) of 62.8% and 37.2%, respectively. When ALT >40 U/L alone was used to screen such patients, the TPR and FNR were only 50.2% and 49.8%, and the screening efficacy slightly lower than that of serum GP73 (62.8% vs. 50.2%). When serum GP73 was combined with ALT for the screening of the patients, the TPR increased to 78.9%, the FNR decreased to 21.1%, and the patient detection rate was further improved [Table 1]. Table 1 - Use of serum GP73 concentration, ALT activity, and a combination for the screening of patients with CHB for a requirement for antiviral therapy. Needing antiviral therapy, n (%) Indicators Yes No Serum GP73 alone (+) 265 (62.8) 452 (40.8) Serum GP73 alone (−) 157 (37.2) 655 (59.2) ALT alone (+) 212 (50.2) 10 (0.9) ALT alone (−) 210 (49.8) 1097 (99.1) GP73 (+) and/or ALT (+) 333 (78.9) 458 (41.4) GP73 (−) and ALT (−) 89 (21.1) 649 (58.6) Total 422 (100) 1107 (100) Serum GP73 (+): GP73 > 59.08 ng/mL; serum GP73 (−): GP73 ≤ 59.08 ng/mL; ALT (+): ALT > 40 U/L; ALT (−): ALT ≤ 40 U/L. ALT: Alanine aminotransferase; CHB: Chronic hepatitis B; GP73: Golgi protein 73. Timely detection and the administration of antivirals are important ways of delaying the development of end-stage liver disease in and improving the quality of life of patients with CHB. In 2015, the World Health Organization produced its first set of guidelines regarding the prevention, care, and management of chronic HBV infection, in which it advocated the use of simple, non-invasive diagnostic tests to assess the stage of liver disease and eligibility for treatment. The current mainstream guidelines for CHB state that HBV DNA and abnormal ALT levels should be used to evaluate liver injury and serve as the marker to start antiviral treatment. However, previous studies have shown that 13.8% to 47.5% of HBsAg-positive individuals have ongoing liver damage but normal ALT levels,[7] which implies that the conventional means of identifying patients that require antiviral therapy is inadequate. Thus, new non-invasive biomarkers of liver injury are still required to identify patients who need antiviral treatment. Serum GP73 is an emerging serological marker in recent years, but its biological significance and clinical application value remain to be further investigated. In this community screening study, although limited by the availability of trials using LSM and ALT as criteria to identify patients requiring antiviral therapy, the results confirm serum GP73 not only reflects the severity of liver injury but also identifies more patients in need of antiviral treatment than ALT. In particular, a combination of serum GP73 and ALT significantly improved the efficacy of screening, which should help clinicians identify more patients with CHB who require antiviral treatment, improve the antiviral treatment rate, and contribute to achieving the goal of eliminating HBV infection by 2030. Funding This work was supported by the National Natural Science Foundation of China (No. 81902115), the National Key Research and Development Program of China (No. SQ2020YFF0426358), and the National S and T Major Project for Infectious Diseases (No. 2017ZX10201201). Conflicts of interest None.

Purpose To evaluate health-related quality of life (HRQoL), anxiety and depression levels in patients with ureteral stricture (US) and to further investigate factors independently affecting this. Methods We prospectively recruited a cohort of 275 consecutive patients with US between June 2020 and April 2021. The participants were required to provide complete sociodemographic, clinical and pathologic information. All patients were administered questionnaires to evaluate HRQoL, anxiety and depression. Multivariate linear regression analyses were performed to assess the contribution of covariates on HRQoL, anxiety and depression. Results Patients with US, particularly iatrogenic US, scored significantly lower than the Chinese general population in all domains of the SF-36 (all p < 0.001), except SF. Increased age, female and high education attainment were independently associated with poor HRQoL. Interestingly, iatrogenic US, nephrostomy tube placement, urinary symptoms, high anxiety and depression level independently predicted poor HRQoL. Furthermore, the percentages of anxiety and depression cases in patients with US were 31.3% and 20.7%, respectively. Iatrogenic US and urinary symptoms, specifically waist discomfort, were the strongest predictors of increased levels of anxiety and depression. Conclusion Patients with US exhibited poor quality of life and emotional status. Various factors independently predicted worse HRQoL and emotion, which provide potential targets for medical, lifestyle-related, psychological interventions.

Objective: To share our experience in robot-assisted pyeloplasty (RAP) with the Kangduo (KD) surgical robot vs the da Vinci Si (DV) robotic system (KD-RAP vs DV-RAP, respectively). Methods: From August 2019 to February 2021, 16 patients with ureteropelvic junction obstruction (UPJO) underwent KD-RAP and other 16 patients with UPJO accepted DV-RAP. All procedures were performed by the same surgeon. The perioperative results and follow-up data were prospectively collected and compared. Results: There was no conversion to open or laparoscopic surgery. The mean operation time was significantly longer in the KD-RAP group than the DV-RAP group (141 ± 28 minutes vs 118 ± 31 minutes, respectively, p = 0.04). The time per stitch was significantly longer in the KD-RAP group than the DV-RAP group (1.7 ± 0.5 minutes vs 1.4 ± 0.3 minutes, respectively, p = 0.05). No significant difference was noted in the estimated blood loss and the postoperative length of hospitalization. At a median follow-up of 19 (range 17-21) and 19.5 (range 14-33) months for the KD-RAP and DV-RAP groups, respectively, no difference was noted in the success rates between the KD-RAP and DV-RAP groups (93.75% and 100%, respectively; p = 0.31). Complications were comparable between the two groups (p = 0.54). One (6.3%) patient developed urinary infection, which responded well to oral antibiotics in KD-RAP group and 2 (12.5%) patients suffered from irritation symptoms of bladder, which improved after removal of Double-J stent in the DV-RAP group. Conclusions: The RAP with the use of the KD system was feasible, safe, and effective. The DV-RAP group showed advantage in the operation time and the time per stitch.

Background: Robot-assisted autologous graft ureteroplasty provides another treatment option for complex ureteral strictures, circumventing ileal ureter or renal autotransplantation. Objective: To report the medium-term outcome of robotic ureteroplasty with a lingual mucosal graft (RU-LMG) for managing complex ureteral strictures. Design, setting, and participants: Between June 2019 and September 2020, 12 patients underwent RU-LMG. The perioperative variables were prospectively collected, and the outcomes were assessed. Surgical procedure: After ureteral stricture dissection, the narrow segment was cut longitudinally, and a lingual mucosal graft (LMG) of the required length was harvested, followed by double-J stent placement and LMG ventral onlay anastomosis. If the diseased ureter required transection, posteriorly augmented ureteral anastomosis could be performed before LMG harvest. Finally, the anastomotic area was wrapped by the omental flap. Measurements: A descriptive statistical analysis was performed. The criteria for complete success included the absence of both clinical symptoms and obstruction on radiography. Results and limitations: Seven patients (58%) had a history of failed ureteral reconstruction. The mean (range) stricture length was 4.7 (3-6.5) cm, LMG length was 4.4 (3-7) cm, LMG width was 1.5 (1-2) cm, operative duration was 197.1 (130-346) min, estimated blood loss was 49.2 (10-200) ml, and the duration of postoperative hospitalization was 6 (4-14) d. No open conversions and intraoperative complications occurred. The median follow-up time was 15 mo (range: 13-27 mo). The overall success rate was 92% (11/12). Conclusions: These medium-term follow-up results demonstrate that RU-LMG is a safe and feasible technique for repairing ureteral strictures. Patient summary: Our study proves that robotic ureteroplasty with a lingual mucosal graft is a safe and feasible technique for ureteral reconstruction that can serve as another choice for managing long, complex ureteral strictures. (C) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

BACKGROUND:The KangDuo surgical robot (KD-SR) was recently developed in China. OBJECTIVE:To compare the safety and efficacy of the KD-SR versus the da Vinci Si Surgical System (DV-SS-Si) for robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS:A double-center prospective randomized controlled noninferiority trial of patients aged 18-75 yr with a suspicion of T1a N0M0 renal cancer (RENAL nephrometry score ≤9) was conducted. INTERVENTION:RAPN with the KD-SR versus the DV-SS-Si. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary endpoint was the success rate of operation. The operation was successful if (1) there was no open or laparoscopic conversion, (2) the warm ischemia time was <30 min for RENAL nephrometry scores of 4-6 or 40 min for RENAL nephrometry scores of 7-9, and (3) the pathological margin was negative. The secondary endpoint was the estimated glomerular filtration rate (eGFR). A threshold of 10% was set to demonstrate noninferiority. RESULTS AND LIMITATIONS:From September 2020 to March 2021, 100 participants were enrolled, of whom 99 (49 in the KD-SR group and 50 in the DV-SS-Si group) were finally included in the full analysis set and 98 (49 in the KD-SR group and -49 in the DV-SS-Si group) in the per-protocol set. Baseline demographic and clinical characteristics were similar between the two groups. All surgeries were completed successfully. The eGFR at postoperative weeks 4-12 and adverse events were similar between the two groups. The docking time and suture time per stitch were longer in the KD-SR group. The main limitation was that a negative margin was considered as the primary outcome rather than survival. CONCLUSIONS:The KD-SR achieved noninferior outcomes as compared with the DV-SS-Si regarding safety and efficacy for T1a tumors. PATIENT SUMMARY:The first trial comparing the KangDuo surgical robot (KD-SR) versus the da Vinci Si Surgical System for robot-assisted partial nephrectomy showed that the KD-SR is a viable option for minimally invasive treatment of T1a renal tumors.

Background The long-term protective effect of hepatitis B vaccine (HepB), the incidence of hepatitis B virus (HBV) vaccine breakthrough infections (VBIs), and whether a booster HepB is necessary remain to be clarified in children born to mothers with chronic HBV infection. Methods Based on a long-term follow-up prospective cohort of 1177 hepatitis B surface antigen (HBsAg)-positive mothers and their paired infants which was established from 2009 to 2011, total 454 children with immunoprophylaxis success as determined by postvaccination serologic testing (PVST) at 7 months old were included in this study. Among the 454 children, 246 never had a booster HepB, and 208 children received a booster HepB from 1 to 5 years of age. Multivariate logistic regression analysis was used to analyse the risk factors for HBV VBIs. Results The hepatitis B surface antibody (anti-HBs) levels declined sharply from 7 months to 2 years old, and the anti-HBs seronegative rate in the children increased significantly from 2 years old. A total of 31 (6.83%) of the 454 children experienced VBIs, of which 7 had overt and 7 had occult HBV infections. Notably, 14 (45.16%) of the 31 children with VBIs were diagnosed at 2 years old, and all of them had anti-HBs positivity (> 10 mIU/mL) at 1 year old. Maternal hepatitis B e antigen (HBeAg) positivity, higher HBV DNA and HBsAg levels, lower initial infant anti-HBs levels and not receiving a booster HepB were independent risk factors for VBIs. The incidence of VBIs was significantly lower in children with a booster HepB than in nonboosted children (0.50 vs. 11.90%, P < 0.001), and none of the boosted children developed overt or occult HBV infection. The anti-HBs levels of 76.67% for the children with VBIs in the nonboosted group indicated positivity before VBIs was detected. Conclusions After the primary full immunization with HepB, children born to mothers with chronic HBV infection, especially the children with maternal HBeAg positivity, high HBV DNA levels, high HBsAg levels and/or low initial infant anti-HBs levels, were at a high risk of VBIs, and a booster HepB for these children before 2 years old, instead of when their anti-HBs level is < 10 mIU/mL, could reduce the incidence of VBIs.

Background: To describe our technical experience of robotic appendiceal onlay flap ureteroplasty (RAUP) for complex ureteral stricture disease and report the updated analysis of 18-month follow-up outcomes. Methods: Since May 2019, nine patients with right ureteral strictures have undergone RAUP in our medical centre. Patients' perioperative data and follow-up information were collected prospectively. Patients were excluded in present study if the postoperative follow-up time was less than 6 months. Results: Eight patients were recruited. Proximal ureteric strictures were present in 5 patients, and 3 patients had middle ureteric strictures. The mean stricture length was 4.3 cm (range, 3.0-6.0 cm). Nephrostomy was performed in 4 patients, and 4 patients had indwelling double-J ureteral stents before they were admitted to our hospital. All operations were implemented successfully without intraoperative complications. The mean operation time was 162 minutes (range, 135-211 minutes), and the mean estimated blood loss was 78 mL (range, 30-200 mL). The mean postoperative hospital stay was 8 days (range, 4-12 days). No patients had high-grade postoperative complications (Clavien-Dindo III and IV) 30 days after surgery. At a mean follow-up of 18 months (range, 6-28 months), all patients were not needed further surgical intervention and could be considered successful. But 2 cases still have stable mild hydronephrosis without symptoms such as flank pain or fever. Conclusions: RAUP is a workable option for managing long-segment (3-6 cm) proximal and middle ureteral strictures of the right side. The outcomes of 18-month follow-up are satisfactory.

Ureteroplasty with a lingual mucosa graft (LMG) for complex ureteral stricture was reported promising. We aimed to compare outcomes of robotic versus laparoscopic ureteroplasty using a LMG (RU-LMG vs. LU-LMG, respectively). From October 2018 to January 2021, 32 ureteroplasties using LMGs were performed by one experienced surgeon, including 16 robotic and laparoscopic procedures each. Patient demographics and peri-operative, post-operative, and follow-up data were prospectively collected and compared. The robotic group had a higher rate of previous reconstruction than the laparoscopic group (62.50% vs. 18.75%; p = 0.012). The stricture length was significantly longer in the robotic group (4.8 ± 1.2 cm) than the laparoscopic group (3.7 ± 1.2 cm; p = 0.013). All procedures were completed successfully without open conversion. The operative time was shorter in the robotic group (192 ± 54 min) than the laparoscopic group (254 ± 46 min; p = 0.001). The robotic group had a shorter length of post-operative stay (6.1 ± 2.4 d vs. 8.9 ± 4.3 d; p = 0.033) but a higher hospital cost (76,801 ± 17,974 vs. 42,214 ± 15,757 RMB; p < 0.001) than the laparoscopic group. The mean follow-up time was 21 ± 7 months for the robotic group and 29 ± 9 months for the laparoscopic group respectively (p = 0.014). No difference was detected in the success rate (93.75% and 100%, respectively; p = 0.309) and complication rate (18.75% and 31.25%, respectively; p = 0.414) between the robotic and laparoscopic groups. Both RU-LMG and LU-LMG are feasible, effective, and safe for repair of complex ureteral strictures. RU-LMG had a shorter operative time and a shorter length of post-operative stay but a higher hospital cost.

Abstract Introduction: To discuss the clinical feasibility and oncologic outcomes of pure transperitoneal laparoscopic radical nephroureterectomy (LSRNU) for upper urinary tract urothelial carcinoma (UTUC).Methods: Between July 2010 and December 2020, 115 patients were admitted to the hospital with a diagnosis of UTUC treated with pure LSRNU by one surgeon. A special laparoscopic bulldog clamp was placed at the bladder cuff before cutting and suturing. The clinical and follow-up data were preoperatively collected and analyzed. Overall survival (OS) and cancer-specific survival (CSS) were estimated by the Kaplan–Meier method.Results All surgeries were completed uneventfully. The mean operative time was 145.69 minutes. The mean estimated blood loss was 56.61 ml. The mean removal time of the drain was 3.46 days. The mean time to liquid diet was 1.32 days, and the ambulation time was 1.50 days. All surgeries were effectively completed, and no case required open conversion. According to the Clavien–Dindo classification system, postoperative complications occurred in two patients (II, III). The mean length of postoperative hospital stay was 5.78 days. The median follow-up duration was 54.50 months. Recurrence in the bladder was 16.0% (15/94), compared with 4.6% (4/87) in the contralateral upper tract. The 5-year OS and CSS rates were 78.9% and 81.4%, respectively.Conclusion Pure transperitoneal laparoscopic RNU is a safe and effective minimally invasive technology for the management of UTUC.

Serum hepatitis B virus (HBV) pregenomic RNA (pgRNA) is a surrogate marker for reflecting the transcriptional activity of covalently closed circular DNA. However, there is still no standardized assay for the quantitative detection of serum HBV RNA in chronic hepatitis B patients. In this study, quantitative polymerase chain reactions for detecting the preC/C-RNA (preC/C region HBV pgRNA), SF-RNA (splicing variants-free pgRNA) and XR-RNA (X region remained pgRNA) regions were set up. The dynamic changes of serum pgRNA splicing variants and 3' terminal truncations were analysed in three retrospective cohorts: 35 treatment-naive chronic HBV-infected patients (cohort A), 52 chronic hepatitis B (CHB) patients who received nucleos(t)ide analogs (NAs) therapy for 48 weeks (cohort B) and eight CHB patients who are under long-term NAs treatment (cohort C). The accuracy and sensitivity of HBV RNA detection were assessed by the National Standard of HBV RNA. We confirmed that high proportions of pgRNA splicing variants and 3' terminal truncations were present and significantly affect the quantitative detection of serum HBV RNA in both treatment-naive and NAs-treated CHB patients. To achieve the higher accuracy and sensitivity on the detection of HBV RNA level, the primers and probes should be designed at the 5' terminal region of HBV genome and outside the mainly spliced sequence of pgRNA, especially for CHB patients under long-term NAs treatment. This study would help to better understand the significance of the pgRNA splicing variants and 3' terminal truncations, and further guide the clinical detection of serum HBV RNA.