Objectives To develop a machine learning (ML)-based prognostic model for predicting the risk of lower extremity deep vein thrombosis (DVT) after acute stroke, with an emphasis on limb functional assessments. Methods We conducted a retrospective analysis of 225 acute stroke patients admitted within 15 days of onset between December 1, 2015, and April 30, 2025. Predictor variables were selected using collinearity diagnostics and Least Absolute Shrinkage and Selection Operator (LASSO) regression. Three machine learning survival models—Gradient Boosting Machine (GBM), Random Survival Forest (RSF), and Generalized Linear Model (GLM)—were employed to identify the most effective model. The performance of the optimal ML model was compared with that of the traditional Cox proportional hazards model using the concordance index (C-index), cumulative/dynamic area under the curve (C/D AUC), and integrated Brier score (IBS). The optimal model was further interpreted using SurvSHAP(t). Results Six variables were selected for the model: age, stroke type, gender, tension of the muscle, Brunnstrom stage (lower limb), and sitting balance. The RSF model, implemented using the Ranger algorithm, demonstrated superior performance, with an integrated Brier score (IBS) of 0.081 and a C-index of 0.841. Age and Brunnstrom stage (lower limb) were identified as the most influential predictors. Conclusion We developed an ML-based prognostic model for predicting the risk of lower limb DVT after acute stroke. Age and Brunnstrom stage (lower limb) were the most significant predictors. This model shows promise for risk stratification in clinical practice.

ABSTRACT Purpose The present work investigated the expression and function of Lgals3 in cerebral ischemia/reperfusion (cerebral IR) injury. Methods Differentially expressed genes in cerebral IR were analyzed by the Gene Expression Omnibus (GEO) microarray. A middle cerebral artery occlusion (MCAO) mouse model was constructed. Adeno‐associated virus serotype 9 vector carrying Lgals3 shRNA was administered to mice via tail vein injection. Four weeks after virus administration, mice were subjected to MCAO modeling. Neurological function was reflected by evaluating the neurological deficit score. To assess infarct size and neuronal apoptosis, triphenyl tetrazolium chloride (TTC) staining and TUNEL assay were performed. The concentrations of IL‐6, TNF‐α, IL‐4, and IL‐1β in brain tissues were measured using enzyme‐linked immunosorbent assay (ELISA). Co‐immunoprecipitation (Co‐IP) was performed to examine the interaction between Lgals3 and TLR4. In addition, real‐time quantitative reverse transcription‐polymerase chain reaction (qRT‐PCR) and Western blotting were employed to analyze gene and protein expression levels. Results GEO bioinformatics analysis revealed that Lgals3 expression was significantly upregulated in cerebral IR. MCAO mouse model was successfully established, and Lgals3 was markedly upregulated in brain tissues of MCAO mice. Lgals3 knockdown reduced infarct volume, improved neurological deficit scores, and inhibited neuronal apoptosis, accompanied by decreased levels of pro‐inflammatory cytokines (IL‐6, TNF‐α, and IL‐1β) and increased levels of anti‐inflammatory cytokine IL‐4 in brain tissues of MCAO mice. Lgals3 silencing inhibited the activation of the TLR4/MyD88/NF‐κB pathway, as evidenced by downregulated expression of TLR4, MyD88, p‐p65, and p65. Co‐IP experiment confirmed a direct interaction between Lgals3 and TLR4. Conclusion Lgals3 knockdown alleviates neuroinflammation and neuronal apoptosis in brain tissues of mice with cerebral IR injury. The present findings indicate that Lgals3 participates in the progression of cerebral IR injury, and may serve as a potential intervention target for ameliorating cerebral IR damage.

To determine whether omitting routine indwelling catheterization after ureteroscopic lithotripsy reduces postoperative lower urinary tract symptoms and enhances patient comfort, without compromising safety. In this prospective, multicenter, randomized controlled trial, 180 patients undergoing ureteroscopic lithotripsy from August 2024 to June 2025 at four centers were allocated to either the No-Catheter group (n = 91) or the Catheter group (n = 89). The primary outcome was the incidence of lower urinary tract symptoms (LUTS) evaluated by the Patient Perception of Intensity of Urgency Scale and the Visual Analog Scale for pain at 1 h, 4 h, 1 day postoperatively. Secondary outcomes included complications (fever and urinary retention) and distressing memories assessed at a 1-month follow-up using the Subjective Units of Distress Scale. The No-Catheter group had significantly lower LUTS incidence at day 1 (9.9

Studies have shown that lung function and chronic obstructive pulmonary disease (COPD) are associated with functional outcome for several diseases, as well as the onset of stroke. However, the causal relationship between lung function, COPD and the functional outcome of ischemic stroke (IS) is unclear. The aim of this study was to investigate the causal relationship between lung function, COPD and IS functional outcomes using Mendelian randomization (MR). Lung function data were derived from the Genome-wide Association Study (GWAS) summary database. Data of COPD were derived from the national genetic factors data repository of the FinnGen project in Finland. The outcome data of IS function were obtained from the Genetics of Ischemic Stroke Functional Outcome (GISCOME) Network. Univariate MR analysis mainly used the inverse variance weighting (IVW) method, MR-Egger, weighted median method and two-sample Maximum Likelihood to evaluate the causal effects of lung function and COPD on the prognosis of IS. Sensitivity analyses were conducted by evaluating heterogeneity and potential pleiotropy. Additionally, multivariable MR analyses were employed to ascertain whether these effects were independent. In univariate MR analyses, the estimates of IVW, MR-Egger, weighted median method and two-sample Maximum Likelihood analysis all showed that there was no genetic causal relationship between COPD, FVC, FEV1, FEV1/FVC, PEF and functional outcome after IS (P>0.05). Sensitivity analyses yielded no evidence of directional pleiotropy or substantial heterogeneity. Multivariable MR analyses demonstrated that, after adjustment for insomnia, smoking initiation, waist-to-hip ratio(WHR) or depression, both COPD and PEF exhibited a causal association with adverse functional outcome following IS. Our research indicated that at the level of genetic causality, no significant associations were observed between lung function indices (FEV1, FVC, FEV1/FVC, PEF) or COPD and functional outcome following IS. Our discovery may challenge the conventional notion that “improving lung function itself can efficiently promote the prognosis of IS function”. Future research needs to further explore other possible causal pathways and consider various factors comprehensively to develop more effective rehabilitation strategies after IS.

This study investigated the effects of Computerized Quadrato Motor Training (CQMT) on balance and executive function in both single- and dual-task conditions for stroke patients. Patients (n = 60) were randomized to three groups: conventional training (CT), exercise training (ET), and interactive motor-cognitive training (IT). All participants underwent CT. Besides, the ET group undertook step training, and the IT group underwent CQMT for four weeks. The assessments comprised balance function, executive function, lower limb strength, as well as self-efficacy of balance control. Balance function was assessed via the Pro-Kin system and standardized scales (Berg Balance Scale [BBS], Tinetti Assessment [POMA]). Executive function was assessed by the Trail Making Test (TMT-A / B) and Stroop test. Dual-task cost (DTC) derived from Timed Up-and-Go Test with/without cognitive loading (TUGT / TUGTcog). Balance self-efficacy was assessed by the Activities-specific Balance Confidence (ABC) Scale, with lower limb strength assessed by Five-Times Sit-to-Stand (FTSTS). After the intervention, the ET significantly showed improvement in the elliptical trajectory area, BBS, and gait performance compared to CT(P < 0.05). The IT group demonstrated significantly greater improvements in balance parameters (swing speed, elliptical trajectory area, trajectory lengths; P < 0.05) and functional outcomes (BBS, POMA, FTSTS, Dual-Task performance, TMT, Stroop, ABC; P < 0.01) compared to both CT and ET. The IT group showed significant positive correlations between TMT improvements and enhanced Dual-ask performance. Our findings demonstrate that CQMT, as an integrative motor-cognitive intervention, significantly improves balance and executive function in stroke patients, thereby filling a critical gap in the clinical application of QMT in stroke rehabilitation research. These findings validate the 'guided plasticity facilitation' theory, highlighting CQMT as a cost-effective and broadly applicable clinical training.Trial registration: The clinical trial was registered on 08/10/2023, with the registration number ChiCTR2300076424.

Background: A considerable proportion of hypertensive patients may experience lacunar infarction. Therefore, early identification of the risk for lacunar infarction in hypertensive patients is particularly important. This study aimed to develop and validate a concise nomogram for predicting lacunar infarction in hypertensive patients. Methods: Retrospectively analyzed the clinical data of 314 patients with accurate history of hypertension in the Second Affiliated Hospital of Wannan Medical College from January 2021 to December 2022. All the patients were randomly assigned to the training set (n=220) and the validation set (n=94) with 7:3. The diagnosis of lacunar infarction in patients was confirmed using cranial CT or MRI. The independent risk factors of lacunar infarction were determined by Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis. The nomogram was built based on the independent risk factors. The nomogram's discrimination, calibration, and clinical usefulness were evaluated by receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA) analysis, respectively. Results: The incidence of lacunar infarction was 34.50% and 33.00% in the training and validation sets, respectively. Five independent predictors were made up of the nomogram, including age (OR=1.142, 95% CI: 1.089-1.198, P<0.001), diabetes mellitus (OR=3.058, 95% CI: 1.396-6.697, P=0.005), atrial fibrillation (OR=3.103, 95% CI: 1.328-7.250, P=0.009), duration of hypertension (OR=1.130, 95% CI: 1.045-1.222, P=0.002), and low-density lipoprotein (OR=2.147, 95% CI: 1.250-3.688, P=0.006). The discrimination with area under the curve (AUC) was 0.847 (95% CI: 0.789-0.905) in the training set and was a slight increase to 0.907 (95% CI: 0.838-0.976) in the validation set. The calibration curve showed high coherence between the predicted and actual probability of lacunar infarction. Moreover, the DCA analysis indicated that the nomogram had a higher overall net benefit of the threshold probability range in both two sets. Conclusion: Age, diabetes mellitus, atrial fibrillation, duration of hypertension, and low-density lipoprotein were significant predictors of lacunar infarction in hypertensive patients. The nomogram based on the clinical data was constructed, which was a useful visualized tool for clinicians to assess the risk of the lacunar infarction in hypertensive patients.

目的:了解江苏省昆山市不同腹膜透析技术使用者的特征,为患者合理选择腹膜透析技术提供参考.方法:采用混合方法研究的探索性序列设计,查阅文献以及访谈,获得不同腹膜透析技术使用者的相关特征因子,并进行问卷设计;通过问卷调查获取样本地区所有腹膜透析技术使用者的特征,运用logistic回归分析不同腹膜透析技术使用者的主要特征.结果:年龄(β=1.002,OR=2.723,P<0.05)、工作状态(β=1.056,OR=2.874,P<0.05)和照护方式(β=2.466,OR=11.778,P<0.05)是不同腹膜透析技术使用者的特征因素.结论:技术使用者参与到腹膜透析技术的选择中有利于卫生健康体系的高质量发展.对于中青年、有工作需求、需要他人照护的患者而言,自动化腹膜透析技术是一项值得选择的腹膜透析技术.

Objectives: To develop a nomogram for predicting calf muscle veins thrombosis (CMVT) in stroke patients during rehabilitation. Methods: We enrolled 360 stroke patients from the Rehabilitation Medicine Center from December 2015 to February 2019. Of the participants, 123 were included in the CMVT group and 237 in the no CMVT group. The least absolute shrinkage and selection operator (LASSO) regression model was applied to optimize feature selection for the model. Multivariable logistic regression analysis was applied to construct a predictive model. Performance and clinical utility of the nomogram were generated using the Harrell's concordance index, calibration curve, and decision curve analysis (DCA). Results: Age, Brunnstrom stage (lower extremity), D-dimer, and antiplatelet therapy were associated with the occurrence of CMVT. The prediction nomogram showed satisfactory performance with a concordance index of 0.718 (95% CI: 0.663-0.773) in internal verification. The Hosmer-Lemeshow test, P = .217, suggested that the model was of goodness-of-fit. In addition, the DCA demonstrated that the CMVT nomogram had a good clinical net benefit. Conclusions: We developed a nomogram that could help clinicians identify high-risk groups of CMVT in stroke patients during rehabilitation for early intervention.

目的:分析上海市标准化残疾人辅助器具(以下简称"辅具")服务社建设现状及存在问题,为推进辅具服务社标准化建设提供参考建议.方法:根据服务社类型进行分层抽样,选取7家辅具服务社开展典型案例调查,并对35位关键知情人进行访谈,通过Nvivo法和鱼骨图法进行标准化建设现况分析.结果:截至2020年,上海市残疾人辅具服务社共计239家,服务社标准化综合评分最高为92分,最低为62分.Nvivo分析确定服务设施硬件、服务人员、满意度、标准规范及服务质量五个树状节点,服务设施硬件和服务人员参考点数分别为115及69.其中硬件不足主要与场地申请困难,辅具利用率不高、部分辅具价格较高有关.结论:辅具服务社标准化建设问题仍较突出,需进一步加强服务社硬件和服务水平标准化建设.

In some patients, the passage of semi-rigid ureteroscopes up the ureter is impossible due to narrow ureteral lumen. We established a neural network to predict the inability of the ureter to accommodate the semi-rigid ureteroscope and the need for active or passive dilatation using non-contrast computed tomography (CT) images. Data were collected retrospectively from two centers of 1989 eligible patients who underwent ureteroscopic lithotripsy with ureteral stones. Patients were categorized into two groups: control and narrow ureter. The network was designed and trained for predicting a narrow ureter during initial ureteroscopic lithotripsy, which integrated multi-scale features of the ureter. The predictive efficacy of neural networks DenseNet3D, ResNet3D, ResNet3D MC, and TimeSformer was compared. Furthermore, a previous ureteroscopy or a history of double-J stent placement, ureteral wall thickness and Hounsfield unit (HU) density of the ureter under the stone were compared. Model performance was assessed based on the accuracy, area under the receiver operating characteristic curve (AUC ROC), etc. The DenseNet3D-based network achieved an AUC ROC score of 0.884 and an accuracy of 85.29%, followed by the ResNet3D-based network, the ResNet3D MC-based network, and the TimeSformer-based network. The DenseNet3D-based network significantly outperformed other candidate predictors. Furthermore, the networks were validated in an external test set. Decision curve analysis showed the clinical utility of the neural network. The neural network provides an individualized preoperative prediction of narrow ureter based on non-contrast CT images, which could be employed as part of a surgical decision-making support system.

BACKGROUND Long-term care of patients with chronic illnesses is an important global public health issue, compromising the well-being of family members and the family functioning. Previous studies have examined the interactive experiences and processes of various systems in the families coping with long-term care stress; however, these studies have not been systematically reviewed and integrated. AIMS This review aimed to synthesise the existing qualitative evidence on the experiences and processes of family resilience operate in families providing long-term care for patients with chronic illnesses and to provide suggestions for the development of interventions in future studies. MATERIALS & METHODS We searched databases including PubMed, CINAHL, EMBASE, Web of Science, ProQuest and CNKI from their inception to March 2022. We used the JBI Critical Appraisal Tool for qualitative studies to evaluate the quality of the included studies was evaluated according to. We followed The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The results were integrated using the thematic and content analysis method. RESULTS Fourteen studies from eight countries covering 11 diseases reported on the experiences and coping processes of long-term care families. Based on McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation (FAAR), five analytical themes were synthesised: stressors (risk factors), family belief system, internal family coping strategies, external support and resilient adaptation indicators; the relationships between themes and subthemes were illustrated. DISCUSSION This review synthesized qualitative evidence on the experiences and processes of family resilience operate in families providing long-term care. The results of this study found that the cognition and belief of family members regarding dilemmas have a two-way effect and act on the adaptation process of family members. In family adaptation, spirituality, hope, internal and external support are extremely important. In 14 studies, caregivers were from different countries with intercultural differences, but due to less reports on this content, it is difficult to compare the differences or impact that culture or ethnicity may have. CONCLUSIONS Family resilience plays an important role in coping with stressors associated with the long-term care of a loved one through family belief systems, internal support systems and external support systems. The development of family resilience-based interventions for long-term care families should consider the family as a whole and further construct a multidisciplinary, multilevel and multi-type social support network to enhance family resilience.

目的:分析相关政策文件总结归纳出我国老年健康管理相关政策的变迁,为完善老年健康管理政策体系提供借鉴.方法:采用文本内容分析法,运用文本分析工具对国务院等机构官方网站搜集到的与老年健康管理相关的政策文件进行词频分析、社会网络分析及文本内容的解读.结果:共纳入86份政策文件,最终将我国老年健康管理相关政策的变迁分为3个阶段,发现政策文件数量呈不断上升趋势且趋于精细化,相关法律政策体系不断完善、机制空白不断被填补.结论:老年健康管理总体呈不断前进发展趋势,但各部分发展程度存在差异,如随着价值目标的不断发展却没有出台相应配套的法律法规予以支持,另外卫生事业、老龄事业发展规划等在指标体系构建方面也较薄弱.

Background The R.I.R.S. scoring system is defined as a novel and straightforward scoring system that uses the main parameters (kidney stone density, inferior pole stones, stone burden, and renal infundibular length) to identify most appropriate patients for retrograde intrarenal surgery (RIRS). We strived to evaluate the accuracy of the R.I.R.S. scoring system in predicting the stone-free rate (SFR) after RIRS. Methods In our medical center, we retrospectively analyzed charts of patients who had, between September 2018 and December 2019, been treated by RIRS for kidney stones. A total of 147 patients were enrolled in the study. Parameters were measured for each of the four specified variables. Results Stone-free status was achieved in 105 patients (71.43%), and 42 patients had one or more residual fragments (28.57%). Differences in stone characteristics, including renal infundibulopelvic angle, renal infundibular length, lower pole stone, kidney stone density, and stone burden were statistically significant in patients whether RIRS achieved stone-free status or not ( P < 0.001, P : 0.005, P < 0.001, P < 0.001, P : 0.003, respectively). R.I.R.S. scores were significantly lower in patients treated successfully with RIRS than patients in which RIRS failed ( P < 0.001). Binary logistic regression analyses revealed that R.I.R.S. scores were independent factors affecting RIRS success ( P = 0.033). The area under the curve of the R.I.R.S. scoring system was 0.737. Conclusions Our study retrospectively validates that the R.I.R.S. scoring system is associated with SFR after RIRS in the treatment of renal stones, and can predict accurately.

Objective: To find out a better criterion to identify septic shock patients after flexible ureteroscopic lithotripsy (FUL). Materials and Methods: In total, 2364 patients who underwent the FUL procedure were enrolled in the study. The demographics and preoperative results of laboratory tests of the patients were collected. The postoperative white blood cell (WBC), systemic inflammatory response syndrome (SIRS), and quick sequential (sepsis-related) organ failure assessment score (qSOFA) were assessed 2 hours after FUL. The predictive efficacy was measured by sensitivity, specificity, positive and negative predictive value, and area under the receiver's operating characteristic curve (AUROC). Results: A total of 15 (0.63%) patients developed septic shock. There were 86 (3.64%) patients who were SIRS positive and 69 (2.92%) patients who were qSOFA positive. The pre- and postoperative WBC ratios in septic shock patients and normal patients were 2.50 +/- 1.55 and 0.69 +/- 0.24, respectively (p < 0.001). For sensitivity and negative predictive value, all reached 100%. For specificity, qSOFA was 97.70%, SIRS was 96.98%, and SIRS combining pre- and postoperative WBC ratio (the new criterion) was 99.79%. The new criterion had statistically significant higher specificity than SIRS or qSOFA (p < 0.001 for both), but when comparing SIRS and qSOFA, it had statistically insignificant specificity (p = 0.142). For positive predictive value, qSOFA was 21.73%, SIRS was 17.44%, and the new criterion was 75%. qSOFA and SIRS had similar AUROC (0.989 for qSOFA and 0.985 for SIRS), both lower than the new criterion (AUROC: 0.999). Conclusions: SIRS combined with pre- and postoperative WBC ratio has a much better specificity and positive predictive value than SIRS or qSOFA alone. It has 99.79% specificity and 75% positive predictive value, and as high as 100% sensitivity and negative predictive value.

OBJECTIVE To find out a better criterion to identify septic shock patients after flexible ureteroscopic lithotripsy. MATERIALS AND METHODS 2364 patients who underwent the flexible ureteroscopic lithotripsy procedure were enrolled in the study. The demographics and preoperative results of lab tests of the patients were collected preoperatively. The postoperative WBC, SIRS and qSOFA were assessed 2 hours after flexible ureteroscopic lithotripsy. The predictive efficacy was measured by sensitivity, specificity, positive and negative predictive value and area under the receiver's operating characteristic (AUROC). RESULTS A total of 15 (0.63%) patients developed septic shock. There were 86 (3.64%) patients who were SIRS positive and 69 (2.92%) patients who were qSOFA positive. The pre- and postoperative WBC ratio in septic shock patients was 2.50±1.55 and 0.69±0.24 in normal patients (p<0.001). For sensitivity and negative predictive value, all reached 100%. For specificity, qSOFA was 97.70%, SIRS was 96.98% and SIRS combining pre- and postoperative WBC ratio (new criterion) was 99.79%. The new criterion had statistically significant higher specificity compared to SIRS or qSOFA (p<0.001 for both), but when comparing SIRS and qSOFA, it had statistically insignificant specificity (p=0.142). For positive predictive value, qSOFA was 21.73%, SIRS was 17.44% and new criterion was 75%. qSOFA and SIRS had similar AUROC (0.989 for qSOFA and 0.985 for SIRS), both lower than new criterion (AUROC: 0.999). CONCLUSIONS SIRS combined with pre- and postoperative WBC ratio has a much better specificity and positive prediction value than SIRS or qSOFA alone. It has 99.79% specificity and 75% positive prediction value, and as high as 100% sensitivity and negative prediction value.

Objective:To discover the efficacy of the combination of preoperative/2 hours postoperative blood WBC count ratio and qSOFA to predict the urosepsis after flexible ureteroscopic lithotripsy.Methods:Retrospectively analyze the patients’ information from September 2015 to July 2018. In total, 2 364 patients who underwent the flexible ureteroscopic lithotripsy procedure were enrolled in the study. Patients gender (male: 1463, female: 751), age (54.9±14.0)years, BMI (23.9±2.8)kg/m 2, stone size(10.8±6.2)mm, side (left: 1 305, right: 1 018, both sides: 41), preoperative body temperature(36.8±0.4)℃, blood glucose level(5.7±1.5)mmol/L, WBC(7.4±4.6)×10 9/L, neutrophil percentage 0.62±0.11, C reactive protein(20.1±59.3)mg/L, procalcitonin(1.6±11.8)μg/L, interleukin-6(11.3±32.9)pg/ml. Results:The operative time was (39.3±23.0) min. The 2 hours postoperative WBC count was (6.7±2.9) ×10 9/L, neutrophil percentage was 0.70±0.12. qSOFA was positive for 69 cases and negative for 2 295 cases. 15 (0.6%) patients developed urosepsis. qSOFA positive patients were 15 in urosepsis group and 54 in normal group. The preoperative/2 hours postoperative blood WBC count ratio was 2.5±1.6 for urosepsis group and 0.7±0.2 for normal group. Univariate analysis showed that female patients(χ 2=16.20, P<0.001), large size of stones( t=2.14, P=0.050), high preoperative blood WBC( t=2.51, P=0.025), neutrophil percentage( t=2.90, P=0.012), C reactive protein( t=2.58, P=0.028), procalcitonin( t=16.09, P<0.001)and interleukin-6( t=7.88, P=0.032), positive preoperative mid-stream sample of urine culture(χ 2=21.10, P<0.001), preoperative/2 hours postoperative blood WBC count ratio >1( t=4.51, P=0.001)and qSOFA positive(χ 2=502.10, P<0.001) were recognized as statistically significant. Patients whose qSOFA was positive as well as preoperative/2 hours postoperative blood WBC count ratio >1 were diagnosed high-risk urosepsis patients. The efficacy of the combining of qSOFA and preoperative/2 hours postoperative blood WBC ratio >1 were higher than using separately. When using qSOFA alone, the area under the receiver operating characteristic curve was 0.98 but the positive prediction value was 21.7%. When using preoperative/2 hours postoperative blood WBC ratio alone, AUROC was 0.98, specificity was 60.0% and positive prediction value is 38.5%. Both indicate that the false positive rates were high. And for combining model, the area under the receiver operating characteristic curve was 1.00, specificity was 98.3% and the positive prediction value was 93.8%. It had a much higher efficacy which was a 2-hour-quick, sufficient and reliable indicator for diagnosing urosepsis. Conclusions:The combination of qSOFA positive and preoperative/2 hours postoperative blood WBC count ratio>1 could quickly and accurately predict the urosepsis after flexible ureteroscopic lithotripsy.

Background: Prostate cancer is the second most frequently diagnosed cancer and the fifth leading cause of cancer death. It is estimated that the incidence of prostate cancer is on the rise worldwide. Epigenetic changes in tumors play an important role in the occurrence and development of prostate cancer. DNA methylation is one of the mechanisms of tumor epigenetics and may be a new biomarker, which has great potential in early tumor screening, guiding treatment and predicting prognosis. The purpose of this study was to explore a classification method from the perspective of DNA methylation.Methods: The Least Absolute Shrinkage and Selection Operator (LASSO) was used to analyze the DNA methylation and RNA-seq datasets of the Cancer Genome Atlas (TCGA). The methylation sites with small differences were eliminated, and the 21 methylation sites with the most significant differences were obtained. Using their corresponding gene expression levels, a recurrence prediction model for prostate cancer patients was constructed to distinguish high-risk, medium-risk, and low-risk Cases. Immune cell abundance analysis, gene enrichment analysis, Tumor burden mutation analysis, gene copy number variation analysis are then used to analyze the differences among this three subtypes and their underlying mechanisms.Results: We observed the difference in disease-free survival(DFS) of the three methylated subtypes in the test set, which was verified in the validation set. We found three subtypes have different proportions of immune cells, especially in B memory cells, M2 macrophages, Treg cells. GSVA and GSEA analysis reveal that the relevant metastasis gene sets of prostate cancer are enriched in cluster3 subtype. In addition, the mutation frequencies of TP53, TTN and KMT2D were the highest, and gradually increased in the three genotypes according to Tumor burden mutation (TMB) analysis. Gene copy number variation (CNV) showed that AR, LAPTM4B, and MTDH were significantly amplified, while ATP1B2 and FAM92B were significantly deleted. Finally, univariate and multivariate analysis showed that there were statistical differences among the three methylation subtypes, which can be used as an index to predict prostate cancer recurrence.Conclusions: Our study suggests that classification based on DNA methylation is an independent factor for predicting tumor recurrence in patients with prostate cancer.Funding Statement: Project was supported by the Shanghai Committee of Science and Technology (Grant No.19441909400).Declaration of Interests: The authors declare that they have no competing interests.Ethics Approval Statement: Not required.

BACKGROUND:High quality of evidence comparing mini percutaneous nephrolithotomy (mPNL) with standard percutaneous nephrolithotomy (sPNL) for the treatment of larger-sized renal stones is lacking. OBJECTIVE:To compare the efficacy and safety of mPNL and sPNL for the treatment of 20-40mm renal stones. DESIGN, SETTING, AND PARTICIPANTS:A parallel, open-label, and noninferior randomized controlled trial was performed at 20 Chinese centers (2016-2019). The inclusion criteria were patients 18-70 yr old, with normal renal function, and 20-40mm renal stones. INTERVENTION:Percutaneous nephrolithotomy PNL was performed using either 18 F or 24 F percutaneous nephrostomy tracts. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary outcome was the one-session stone-free rate (SFR). The secondary outcomes included operating time, visual analog pain scale (VAS) score, blood loss, complications as per the Clavien-Dindo grading system, and length of hospitalization. RESULTS AND LIMITATIONS:The 1980 intention-to-treat patients were randomized. The mPNL group achieved a noninferior one-session SFR to the sPNL group by the one-side noninferiority test (0.5% [difference], p <  0.001). The transfusion and embolization rates were comparable; however, the sPNL group had a higher hemoglobin drop (5.2 g/l, p <  0.001). The sPNL yielded shorter operating time (-2.2 min, p = 0.008) but a higher VAS score (0.8, p <  0.001). Patients in the sPNL group also had longer hospitalization (0.6 d, p <  0.001). There was no statistically significant difference in fever or urosepsis occurrences. The study's main limitation was that only 18F or 24F tract sizes were used. CONCLUSIONS:Mini mPNL achieves noninferior SFR outcomes to sPNL, but with reduced bleeding, less postoperative pain, and shorter hospitalization. PATIENT SUMMARY:We evaluated the surgical outcomes of percutaneous nephrolithotomy using two different sizes of nephrostomy tracts in a large population. We found that the smaller tract might be a sensible alternative for patients with 20-40mm renal stones.

To evaluate the role of preoperative procalcitonin (PCT) levels in predicting postoperative fever after mini-percutaneous nephrolithotomy (mini-PCNL) in patients with a negative baseline urine culture. Between January 2014 and October 2017, 329 patients with a negative baseline urine culture and who underwent mini-PCNL were enrolled in this study. Patients were stratified into the control or febrile group based on a body temperature either less than or greater than 38 °C, respectively. Demographic and perioperative data were compared between the groups, and variables found to be statistically significant were included in a binary logistic regression analysis. A total of 68 (20.6%) patients experienced postoperative fever. The univariate analysis revealed a statistically significant difference between groups in preoperative fever (p = 0.032), stone burden (p < 0.001), C-reactive protein (p = 0.011), PCT (p < 0.001) and interleukin-6 (p = 0.035) levels. Binary logistic regression analysis indicated that stone burden > 353 mm3 (p = 0.003) and PCT > 0.05 ng/mL (p < 0.001) are independent risk factors for postoperative fever in mini-PCNL-treated patients with a negative baseline urine culture. We concluded that patients with stone burden > 353 mm3 or PCT > 0.05 ng/mL were more likely to develop postoperative fever after mini-PCNL, though with a negative baseline urine culture.

泌尿系结石是泌尿外科常见病,在泌尿外科住院病种中居首位.据调查,中国泌尿系结石发病率为6.1％,男性为6.85％,女性为5.25％[1].目前,上尿路结石的治疗方法主要为软性输尿管镜碎石术(FUL)、经皮肾镜碎石取石术(PCNL)和体外冲击波碎石术(SWL).FUL因具有安全、高效和微创的优势,已越来越多地应用于肾结石和输尿管上段结石的治疗,软性输尿管镜结合钬激光碎石目前已被广泛用于处理直径＜2 cm的肾结石和输尿管上段结石.随着软性输尿管镜及其辅助器械的技术进步,以及钬激光碎石效率的提高,对于直径≥2 cm的肾结石甚至鹿角形结石,已有学者开展了一些临床探索工作.