Benign prostatic hyperplasia (BPH) is highly prevalent among older men, yet its population-level assessment often depends on physician diagnosis, which may vary by healthcare access and reporting behavior. In China, substantial urban-rural differences in healthcare utilization raise questions about whether reported differences in BPH reflect true variation or diagnostic patterns. This study therefore examined urban-rural differences in self-reported physician-diagnosed BPH and associated factors using nationally representative data. We conducted a cross-sectional analysis of 8455 men aged 45 years and older using data from Wave 4 (2018) of the China Health and Retirement Longitudinal Study (CHARLS). BPH status was defined based on self-reported physician diagnosis. Urban-rural differences in reported BPH were compared, and multivariable logistic regression models were used to examine factors associated with reported BPH diagnosis. Of 8455 participants, the overall proportion reported a physician diagnosis of BPH was 11.9%, with subgroup-specific proportions of 18.4% in urban men and 10.1% in rural men. After adjustment for sociodemographic, lifestyle, and health-related variables, rural residence was associated with lower odds of reporting BPH (aOR 0.61, 95% CI 0.51-0.72). Several associations differed by residence, including a positive association between moderate physical activity and reported BPH in urban men, and inverse associations for longer sleep duration and regular alcohol consumption in rural men (P < .05). Urban men were more likely than rural men to report a physician diagnosis of BPH. Multiple sociodemographic and lifestyle factors were statistically associated with reported BPH, with some variation by residence. Given the cross-sectional design and self-reported measures, these findings reflect patterns of reporting and diagnosis rather than confirmed differences in underlying disease prevalence. Longitudinal studies using validated clinical assessments are needed to further clarify these relationships.

Pharmacological innovation for benign prostatic hyperplasia (BPH) has stagnated. As disease burden rises, whether trial activity is addressing disease-modifying therapy remains unclear, while the published literature captures only reported successes. We reviewed BPH drug trial registrations in ClinicalTrials.gov and ChiCTR (2000-2025), standardized design, phase, status, mechanism, and result-reporting variables, and analyzed 224 eligible trials. Of these, 211 were non-ongoing, but only 55.0% had publicly available results. Among 43 studies targeting prostate volume reduction, 25 (58.1%) reported results and 12 (48.0%) showed efficacy; among 137 targeting volume-independent symptom improvement, 82 (59.9%) reported results and 63 (76.8%) showed efficacy. Classical mechanisms, including α1-adrenergic antagonists (24.6%) and 5α-reductase inhibitors (8.5%), dominated Phase III/IV trials (51.9% and 61.1%), whereas emerging mechanisms were concentrated in Phase I/II trials, accounting for 20.0-50.0% of early-phase research. Most trials evaluated single agents (78.6%), while combination and head-to-head studies were uncommon. Industry sponsorship predicted result disclosure (OR 6.67; P < 0.001); mechanism was associated with reporting overall (P = 0.02) and borderline in Phase III (P = 0.05); enrollment ratio was associated in Phase II (OR 13.97; P = 0.04). BPH drug development remains trapped in symptomatic relief, with limited disease modification and substantial hidden failure, requiring greater priority for disease-modifying mechanisms, transparency, and societal and industry investment.

China’s rapidly aging population is increasing the prevalence and economic burden of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS-BPH). However, limited national-scale evidence exists regarding incidence, regional variation, and risk factor patterns among Chinese men. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we followed 6,713 men aged ≥ 45 years who were free of LUTS-BPH at baseline (2011–2012). LUTS-BPH onset was identified through biennial surveys (2013–2018). Age- and region-specific incidence rates were calculated, and multivariable Cox proportional-hazards models were used to identify independent risk factors. During a median follow-up of seven years (38,949 person-years), 1,175 incident LUTS-BPH cases were observed, yielding an overall incidence of 30.2 per 1,000 person-years (95% CI: 28.5–31.9). Incidence increased steadily with age until 75 years and then declined slightly. Predicted cumulative risks among 45-year-old men without LUTS-BPH were 16.7%, 30.6%, and 42.2% over 10, 20, and 30 years, respectively. Significant geographical heterogeneity was observed, with higher rates in Central and southern humid regions. Independent predictors included age, body-mass index, waist circumference, education, perceived health status, smoking, napping time, and residence region.These risk factors varied across different age groups (≤ 60, 60–75, and ≥ 75). LUTS-BPH incidence in Chinese men rises with age and varies substantially by region and lifestyle. Modifiable factors such as central obesity and prolonged napping may guide early risk stratification, though causal relationships require validation in future interventional and mechanistic studies. These findings support targeted, region-specific screening strategies for China’s aging male population.

Abstract Purpose The increasing incidence of urologic malignancy after renal transplantation (RT) has become a leading cause of recipient mortality. However, no recent analyses have been performed to identify the risk factors for post-transplant urologic malignancy (PTUM) and to evaluate the effect of PTUM on RT outcomes. Materials and methods This retrospective, population-based cohort study was based on Organ Procurement and Transplantation Network data. Results A total of 268,606 recipients underwent RT from January 2000 to December 2019 and met the inclusion criteria. Of these, 2,079 (0.77%), 1,983 (1.20% of male recipients), and 846 (0.32%) patients were diagnosed with renal cancer (RCa), prostate cancer (PCa), and bladder cancer (BCa), respectively, after RT. Urologic malignancy was a major cause of patient death after RT (RCa: 41.5%, PCa: 23.5%, BCa: 50.4%). The 5-year survival rates of the four groups ranking from best to worst were as follows: [95% confidence interval, lower value–upper value], PCa, 93.3% [92.2%–94.4%]; cancer-free, 87.2% [87.0%–87.3%]; RCa, 87.2% [85.8%–88.7%]; BCa, 81.0% [78.4%–83.7%] ( P < 0.001 for all, except cancer-free vs. RCa, P = 1.00). Conclusions The effects of PTUM on RT outcomes differ depending on the type of malignancy. Thus, a personalized approach to screening may be an appropriate strategy to address the multitude of complex issues that RT recipients encounter.

Immunotherapy with immune checkpoint inhibitors has revolutionized cancer treatment, yet many tumors evade immune surveillance through multiple suppressive mechanisms. In particular, the adaptive immune checkpoint programmed death 1 (PD-1)/programmed death-ligand 1 (PD-L1) and the innate "don't eat me" signal CD47/signal-regulatory protein alpha (SIRPα) represent two distinct pathways that cancers exploit to avoid T-cell attack and macrophage phagocytosis, respectively. Herein, we present BITE (Biomimetic Immune Targeting and Editing), a genetically engineered biomimetic nanoplatform designed to concurrently blockade both pathways by combining PD-1-mediated tumor targeting with CRISPR/Cas9 gene editing of CD47. BITE nanovesicles display PD-1 on their surface, enabling selective binding to PD-L1-expressing tumor cells and local disruption of PD-1/PD-L1 signaling. Simultaneously, they deliver a CRISPR/Cas9 payload that knocks out the CD47 gene in tumor cells, abolishing the anti-phagocytic signal and thus activating innate immune clearance. We demonstrate that BITE efficiently homes to PD-L1-positive tumors in vitro and in vivo, achieves significant CD47 gene disruption in tumor cells, and triggers robust phagocytosis by macrophages. In a mouse tumor model, dual checkpoint blockade by BITE reshapes the tumor microenvironment, yielding increased infiltration of CD4+ T cells, CD8+ T cells, and M1 macrophages; treatment with BITE induces pronounced tumor regression and extended survival, outperforming single-target controls. Our results establish a proof-of-concept for this dual-function nanovesicle approach, highlighting its potential to engage both adaptive and innate immunity synergistically. The BITE platform offers a versatile and targeted strategy to overcome immune resistance in cancer, representing a promising therapeutic avenue in biomedical engineering and nanomedicine.

ABSTRACT:This study investigated the impact of metabolic syndrome (MetS) and its components on prostate volume (PV) in the general Chinese population. In total, 43 455 participants in The First Medical Center of the Chinese PLA General Hospital (Beijing, China) from January 1, 2012, to December 31, 2022, undergoing health examinations were included in the study. Participants were categorized into four groups according to PV quartiles: Q1 (PV ≤24.94 ml), Q2 (PV >24.94 ml and ≤28.78 ml), Q3 (PV >28.78 ml and ≤34.07 ml), and Q4 (PV >34.07 ml), with Q1 serving as the reference group. Logistic regression analyses were used to examine the association between MetS and PV, with subgroup analyses conducted by age. Among the participants, 18 787 (43.2%) were diagnosed with MetS. In the multivariate analysis model, a significant correlation between MetS and PV was observed, with odds ratios (ORs) increasing as PV increased (Q2, OR = 1.203, 95% confidence interval [CI]: 1.139-1.271; Q3, OR = 1.300, 95% CI: 1.230-1.373; and Q4, OR = 1.556, 95% CI: 1.469-1.648). Analysis of MetS components revealed that all components were positively associated with PV, with abdominal obesity showing the most significant effect. The number of MetS components was identified as a dose-dependent risk factor for elevated PV. The impact of MetS, its components, and component count on PV exhibited a decreasing trend with advancing age. Overall, the influence of MetS, its components, and component count on PV was predominantly observed in the age groups of 40-49 years and 50-59 years. Early intervention targeting MetS can significantly alleviate the increase in PV, particularly benefiting individuals aged 40-59 years who have abdominal obesity.

Sound pollution (noise) is an increasing environmental concern, particularly associated with neurological and neurobehavioral abnormalities. However, the molecular mechanisms underlying noise-induced neural damage remain unclear. In this study, we conducted transcriptional profiling of zebrafish to investigate the mechanisms underlying acoustic stimulation (1,000 Hz, 130 dB). RNA sequencing and subsequent experiments revealed that TRPV1 is an important mediator of noise-induced neural damage in HuC(elavl3)-GFP transgenic zebrafish. The results demonstrated that inhibiting TRPV1 significantly mitigated noise-induced neural damage in zebrafish with trpv1 gene RNAi and in mice with Trpv1 knockout (Trpv1-/-). Specifically, TRPV1 antagonism significantly reduced neural damage in zebrafish and mice under noise exposure. Furthermore, activated TRPV1 could induce endoplasmic reticulum stress, leading to apoptosis and resulting in neural damage in mice and HEK293T cells. The findings of this study not only enhance our understanding of the molecular mechanisms underlying sound-induced neural damage but also highlight a novel target for drug intervention.

Despite the promising potential of organic nanoscintillator-mediated radiodynamic therapy (RDT) in enhancing the effectiveness of immunotherapy, their cutaneous phototoxicity exacerbates the risk for immune-related adverse events (irAEs). Herein, we demonstrate that organic nanoscintillators, when combined with checkpoint blockade immunotherapy and exposed to X-ray-induced RDT, can trigger cutaneous irAEs. To address this challenge, we engineered diselenide-bridged silicon coatings on organic nanoscintillators, fine-tuning the steric hindrance of the protective layer by varying its thickness. This strategy enables radiation-triggered reactive oxygen species (ROS) generation while mitigating off-target phototoxicity through neutralizing ROS. By optimizing the steric hindrance to precisely control energy transfer between the organic nanoscintillators and surrounding oxygen molecules, we effectively reduce phototoxicity and mitigate off-tumor effects through engineered surface protection. Under X-ray irradiation exposure, the steric hindrance is rapidly deactivated through the dissociation of the silicon coating, activating RDT and inducing abundant ROS generation within tumor cells. In an orthotopic 4T1 breast cancer model, intravenous administration of these surface-engineered nanoscintillators, combined with anti-programmed death-1 (anti-PD-1) antibodies, results in robust anti-tumor immune responses, while minimizing cutaneous irAEs. This work offers valuable insights into how surface engineering can modulate the delicate balance between anti-tumor efficacy and off-tumor toxicity in nanoscintillator-mediated RDT. (c) 2025 Published by Elsevier B.V. on behalf of Chinese Chemical Society and Institute of Materia Medica, Chinese Academy of Medical Sciences.

AIM:To estimate the prevalence of nocturia in middle-aged and elderly men and evaluate its associated factors and changes over time. METHODS:Data of middle-aged and older men aged ≥40 years from the 2007-2008 and 2017-2020 cycles of the National Health and Nutrition Examination Survey were retrospectively analyzed. The prevalence of nocturia was estimated using participant questionnaires on nocturia, lifestyle-related factors, and health factors, and its decadal changes were examined using multivariate logistic regression analysis to determine related factors associated with the prevalence of nocturia. RESULTS:The prevalence of nocturia was 38.0% in 2007-2008 and 39.6% in 2017-2020, with no significant increase observed (P = 0.3989). Being a non-Hispanic black was positively correlated with nocturia (adjusted odds ratio [AOR] = 1.54, 1.22-1.93, P < 0.001), whereas the correlation with being a Mexican American disappeared (AOR = 1.25, 0.90-1.73, P = 0.187). Diabetes (AOR = 1.32, 1.07-1.64, P = 0.010) and sleep disorders (AOR = 1.31, 1.07-1.60, P = 0.008) showed a statistically significant positive correlation with nocturia, whereas a significant negative correlation was observed between employment (AOR = 0.66, 0.54-0.82, P < 0.001) and nocturia. Above-high-school education (AOR = 0.60, 0.47-0.76, P < 0.001) showed a constant trend toward a negative correlation with nocturia. The correlation between high school education or general educational development and nocturia disappeared (AOR = 0.81, 0.62-1.05, P = 0.112). CONCLUSION:Diabetes and sleep disorders contribute to the development of nocturia, while work and high educational attainment can actively combat nocturia. Geriatr Gerontol Int 2024; 24: 1308-1314.

Cadmium is a common environmental pollutant associated with various health risks. Its neurotoxic, muscle-damaging, and pro-inflammatory properties may be related to overactive bladder (OAB), though few studies have assessed its impact on urinary function. This study aimed to examine the potential link between cadmium exposure and OAB. Using data from the 2007-2020 National Health and Nutrition Examination Survey (NHANES), we analyzed adults aged 40 and older (n = 15,467) in a cross-sectional design. OAB was defined by the refined Overactive Bladder Symptom Score (OABSS). Weighted multivariate logistic regression examined the associations between blood cadmium levels and OAB and its components. Age and gender stratifications were performed, and restricted cubic splines (RCS) were used to explore non-linear associations between blood cadmium and OAB. Sensitivity analyses and co-exposure analyses with other pollutants were conducted to assess OAB definition stability, subgroup differences, and exposure collinearity. The prevalence of OAB was 26.2%. While blood cadmium showed a small, non-significant positive association with overall OAB, it was inversely associated with nocturia severity (OR = 0.85, 95% CI 0.74-0.98, p < 0.05). Blood cadmium was also linked to more severe urinary incontinence in the 50-59 age group and among non-Hispanic Black adults. A non-linear association between blood cadmium and OAB was observed (p for nonlinearity = 0.016, p < 0.05). In co-exposure analyses, cadmium remained a dominant and independent factor. These findings suggest that cadmium exposure may have a complex association with OAB and may relate differently to its various components. Further research is needed to explore these relationships.

BACKGROUND:The impact of lower urinary tract symptoms (LUTS) on the quality of life of patients with benign prostatic hyperplasia (BPH) has been rarely reported. Additionally, the challenges faced by these patients in seeking medical care have often been overlooked. In order to explore the personal struggles caused by LUTS and the difficulties or barriers experienced by Chinese patients with BPH when seeking help, we conducted a qualitative interview study. METHODS:Qualitative interviews were conducted among 46 patients with BPH who were hospitalized in three tertiary hospitals in China from July 2021 to November 2022. Grounded theory was adopted as the methodology for the qualitative study. After obtaining written informed consent from the study participants, semi-structured interviews were conducted according to the question guidelines. The interview process was audio-recorded; subsequently, the recordings were transcribed, coded, and thematically analyzed. RESULTS:The difficulties faced by Chinese patients with BPH were classified into seven main themes: (i) disturbed life, (ii) mental burden, (iii) disease cognition and communication, (iv) delayed treatment, (v) medication status, (vi) hospital visits barriers, and (vii) medical insurance issues. Further, each theme was subdivided into 2-5 sub-themes. CONCLUSIONS:LUTS have a certain effect on the life and spirit of patients with BPH. These patients face different degrees of difficulties in treatment and hospital visits. Therefore, better healthcare systems and additional social support are crucial for improving the current plight of these patients.

BACKGROUND:Previous observational studies have been controversial regarding the association of leukocyte telomere length (LTL) with prostate cancer (PCa) and benign prostatic hyperplasia (BPH). METHODS:First, we conducted an observational study utilizing UK Biobank data. The correlation between LTL and the risk of PCa and BPH was evaluated via multivariate-adjusted logistic regression. Then, we conducted a 2-sample Mendelian randomization to examine causal links between LTL (472 174 individuals) and PCa as well as BPH. To verify the reliability of the primary analysis, we conducted a second analysis and sensitivity analyses. RESULTS:In the UK Biobank study, individuals in the longer quartiles of LTL were observed to have a higher risk of PCa (1.155-fold to 1.349-fold, all p < .001) and BPH (1.119-fold to 1.212-fold, all p < .001) compared to those in the lowest quartile in multivariate-adjusted logistic regression. We observed that genetically predicted longer LTL resulted in a 1.427-fold risk of PCa (odds ratio [OR] = 1.427, 95% confidence interval [CI] = 1.197-1.702, p < .001) and 1.539-fold risk of BPH (OR = 1.539, 95% CI = 1.387-1.707, p < .001) in the primary analysis. In the second analysis, the results also indicated that longer LTL increased the genetic liability to both PCa (OR = 1.338, 95% CI = 1.189-1.507, p < .001) and BPH (OR = 1.006, 95% CI = 1.003-1.008, p < .001). Sensitivity analyses also supported the reliability of the results. CONCLUSIONS:Our study provides convincing evidence supporting that longer LTL increases the risk of PCa and BPH in European individuals. Large-scale studies are needed to elucidate the potential mechanisms of LTL in PCa and BPH occurrence.

Objective The global concern regarding the health implications of night shift work has escalated. Nevertheless, variations exist in the observed association between night shift work and prostate cancer (PCa). This study aims to systematically explore the association between night shift work and the risk of PCa.Design Cohort study and Mendelian randomisation (MR) study were used.Setting Cohort study data was from the UK Biobank (UKB). MR study using data was from the Finngen study and UKB through the Integrative Epidemiology Unit (IEU) Open Genome-Wide Association Study Project.Participants Participants without prior PCa in paid employment or self-employment were include in the current work schedule cohort, participants without PCa who provided employment history formed the lifetime night shift work cohort.Main outcome measures The outcome, incident PCa, was obtained from cancer register through linkage to national cancer databases. National cancer registries centralised information received from separate regional cancer centres around the UK.Results A total of 130 853 participants were included in the current work schedule cohort, while the lifetime night shift work cohort comprised 49 511 participants. Over a median follow-up duration of 13.9 years, the current work schedule cohort witnessed 4993 incident cases of PCa, while the lifetime night shift work cohort recorded 2022 PCa cases. In the analysis of the current work schedule, final model showed that no significant association was found between shift work and PCa risk, whether it involved shift but no night shifts (HR 0.96, 95% CI 0.85 to 1.08), some night shifts (HR 1.16, 95% CI 0.99 to 1.33) and usual night shifts (HR 1.01, 95% CI 0.85 to 1.19). In the analysis of the average frequency of night shift work, final model showed no significant impact of different night shift frequencies (<3/month: HR 0.97, 95% CI 0.73 to 1.29; 3–8/month: HR 0.99, 95% CI 0.83 to 1.19; >8/month: HR 0.89, 95% CI 0.73 to 1.07) on the risk of PCa. No significant association was found for either <10 years (HR 0.89, 95% CI 0.72 to 1.09) or ≥10 years (HR 1.00, 95% CI 0.86 to 1.16) of night shift work. Subsequent subgroup and sensitivity analyses demonstrated consistent results without significant alterations. Furthermore, in the two-sample MR analysis, no statistically significant causal relationship was identified between night shift work and the incidence of PCa.Conclusion In both the cohort studies and MR analysis, our investigation did not find any association between night shift work and PCa.

Immunotherapy through the activation of the stimulator of interferon genes (STING) signaling pathway is increasingly recognized for its robust anti-tumor efficacy. However, the effectiveness of STING activation is often compromised by inadequate anti-tumor immunity and a scarcity of primed immune cells in the tumor microenvironment. Herein, we design and fabricate a co-axial 3D-printed scaffold integrating a non-nucleotide STING agonist, SR-717, and an AKT inhibitor, MK-2206, in its respective shell and core layers, to synergistically enhance STING activation, thereby suppressing tumor recurrence and growth. SR-717 initiates the STING activation to enhance the phosphorylation of the factors along the STING pathway, while MK-2206 concurrently inhibits the AKT phosphorylation to facilitate the TBK1 phosphorylation of the STING pathway. The sequential and sustained release of SR-717 and MK-2206 from the scaffold results in a synergistic STING activation, demonstrating substantial anti-tumor efficacy across multiple tumor models. Furthermore, the scaffold promotes the recruitment and enrichment of activated dendritic cells and M1 macrophages, subsequently stimulating anti-tumor T cell activity, thereby amplifying the immunotherapeutic effect. This precise and synergistic activation of STING by the scaffold offers promising potential in tumor immunotherapy.

BackgroundRacial/ethnic disparity in waiting-list mortality among candidates listed for kidney transplantation (KT) in the United States remains unclear. We aimed to assess racial/ethnic disparity in waiting-list prognosis among patients listed for KT in the United States in the current era.MethodsWe compared waiting-list and early posttransplant in-hospital mortality or primary nonfunction (PNF) among adult (age ≥18 years) white, black, Hispanic, and Asian patients listed for only KT in the United States between July 1, 2004 and March 31, 2020.ResultsOf the 516,451 participants, 45.6%, 29.8%, 17.5%, and 7.1% were white, black, Hispanic, and Asian, respectively. Mortality on the 3-year waiting list (including patients who were removed for deterioration) was 23.2%, 16.6%, 16.2%, and 13.8% in white, black, Hispanic, and Asian patients, respectively. The cumulative incidence of posttransplant in-hospital death or PNF after KT was 3.3%, 2.5%, 2.4%, and 2.2% in black, white, Hispanic, and Asian patients,respectively. White candidates had the highest mortality risk on the waiting list or of becoming too sick for a transplant, while black (adjusted hazard ratio, [95% confidence interval, CI], 0.67 [0.66–0.68]), Hispanic (0.59 [0.58–0.60]), and Asian (0.54 [0.52–0.55]) candidates had a lower risk. Black KT recipients (odds ratio, [95% CI] 1.29 [1.21–1.38]) had a higher risk of PNF or death before discharge than white patients. After controlling confounders, black recipients (0.99 [0.92–1.07]) had a similar higher risk of posttransplant in-hospital mortality or PNF as white patients than Hispanic and Asian counterparts.ConclusionsDespite having a better socioeconomic status and being allocated better kidneys, white patients had the worst prognosis during the waiting periods. Black recipients and white recipients have higher posttransplant in-hospital mortality or PNF.

BackgroundRace is a prognostic indicator in kidney transplant (KT). However, the effect of donor-recipient race-matching on survival after KT remains unclear.MethodsUsing the United Network for Organ Sharing (UNOS) database, a retrospective study was conducted on 244,037 adults who received first-time, kidney-alone transplantation between 2000 and 2019. All patients were categorized into two groups according to donor-recipient race-matching, and the living and deceased donor KT (LDKT and DDKT) were analyzed in subgroups.ResultsOf the 244,037 patients, 149,600 (61%) were race-matched, including 107,351 (87%) Caucasian, 20,741 (31%) African Americans, 17,927 (47%) Hispanics, and 3,581 (25%) Asians. Compared with race-unmatching, race-matching showed a reduced risk of overall mortality and graft loss (unadjusted hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84–0.87; and unadjusted HR 0.79, 95% CI: 0.78–0.80, respectively). After propensity score-matching, donor-recipient race-matching was associated with a decreased risk of overall graft loss (P < 0.001) but not mortality. In subgroup analysis, race-matching was associated with higher crude mortality (HR 1.12, 95% CI: 1.06–1.20 in LDKT and HR 1.11, 95% CI: 1.09–1.14 in DDKT). However, race-matching was associated with a decreased risk of graft loss in DDKT (unadjusted HR 0.97, 95% CI: 0.96–0.99), but not in LDKT. After propensity score-matching, race-matching had better outcomes for LDKT (patient survival, P = 0.047; graft survival, P < 0.001; and death-censored graft survival, P < 0.001) and DDKT (death-censored graft survival, P = 0.018). Nonetheless, race-matching was associated with an increased adjusted mortality rate in the DDKT group (P < 0.001).ConclusionRace-matching provided modest survival advantages after KT but was not enough to influence organ offers. Cofounding factors at baseline led to a contorted crude conclusion in subgroups, which was reversed again to normal trends in the combined analysis due to Simpson's paradox caused by the LDKT/DDKT ratio.

Background: To better address the burden of benign prostatic hyperplasia (BPH) in the aging population in China, this study aimed to evaluate the incidence rate, geographical variation and risk factors of lower urinary tract symptoms suggestive of BPH (LUTS-BPH) in China.Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS) to estimate the risk factors and incidence of LUTS-BPH in the middle-aged and elderly male Chinese population. The respondents were enrolled between 2011 and 2012. LUTS-BPH occurrence was followed via a questionnaire survey every 2 years. The 2018 CHARLS data was utilized to calculate the cumulative incidence rate (CI) and CI-based age-specific risks through a proportional hazards model.Findings: The median follow-up duration was 7 years. This study included 6,713 participants, with 1,175 ultimately diagnosed with LUTS-BPH. The overall LUTS-BPH incidence was 30ꞏ2 per 1,000 man-years (uncertainty interval [UI]: 28ꞏ5–31ꞏ9). The incidence rate exhibited a linear increase between the ages of 45 and 75(r2=0.91), followed by a linear decrease between the ages of 75 and 90(r2=0.89). Age, body mass index, waist circumference, education level, self-perception of health status, nap time, smoking status, and geographic region were all found to be independently associated with the incidence risk of LUTS-BPH (P<0ꞏ05). The risk factors varied across age groups of ≤60, 60–75, and ≥75.Interpretation: LUTS-BPH incidence in Chinese citizens exhibits a linear increase with an age of 45–75 years and displays a geographic variation. These identified risk factors may be beneficial preventive guides for Chinese citizens.Funding: Grants 2021YFC2009304 (Mr. Song) and 2022YFC3602905 (Mr. Yuan) from the National Key Research and Development Program of China and grant 20220484230 (Mr. Yuan) from Beijing Nova Program.Declaration of Interest: The authors declare that they have no competing interests.Ethical Approval: Ethical approval for all the CHARLS waves was granted by the Institutional Review Board of Peking University. The IRB approval number for the main household survey, including anthropometrics, is IRB00001052-11015; the IRB approval number for biomarker collection is IRB00001052-11014.

BACKGROUND As Hepatitis C virus infection （HCV+） rates in kidney donors and transplant recipients rise,direct-acting antivirals （DAA） may affect outcomes.AIM To analyze the effects of HCV+in donors,recipients,or both,on deceased-donor（DD） kidney transplantation （KT） outcomes,and the impact of DAAs on those effects.METHODS The Organ Procurement and Transplantation Network data of adult first solitary DD-KT recipients 1994-2019 were allocated into four groups by donor and recipient HCV+status.We performed patient survival （PS） and death-censored graft survival （DCGS） pairwise comparisons after propensity score matching to assess the effects of HCV+in donors and/or recipients,stratifying our study by DAA era to evaluate potential effect modification.RESULTS Pre-DAA,for HCV+recipients,receiving an HCV+kidney was associated with 1.28-fold higher mortality (HR 1.15 1.28 1.42 ) and 1.22-fold higher death-censored graft failure (HR 1.08 1.22 1.39 ) compared to receiving an HCV-kidney and the absolute risk difference was 3.3%（95%CI:1.8%-4.7%） for PS and 3.1%（95%CI:1.2%-5%） for DCGS at 3 years.The HCV dual-infection （donor plus recipient）group had worse PS （0.56-fold） and DCGS （0.71-fold） than the dual-uninfected.Donor HCV+derived worse post-transplant outcomes than recipient HCV+（PS 0.36-fold,DCGS 0.34-fold）.In the DAA era,the risk associated with HCV+in donors and/or recipients was no longer statistically significant,except for impaired PS in the dual-infected vs dual-uninfected （0.43-fold）.CONCLUSION Prior to DAA introduction,donor HCV+negatively influenced kidney transplant outcomes in all recipients,while recipient infection only relatively impaired outcomes for uninfected donors.These adverse effects disappeared with the introduction of DAA.