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Objectives: This study aimed to describe a novel double-sheath vacuum suction minimally invasive percutaneous nephrolithotomy (mini-PCNL) to overcome the deficiencies of the conventional procedure. Patients and Methods: Between March 2019 and December 2019, 65 patients (37 males and 28 females) with a mean age of 41 years (range 23–69) underwent mini-PCNL with double-sheath vacuum suction. It consisted of an F20 Y-shaped sheath as an outer sheath and an F16 Y-shaped sheath as an inner sheath, in which the inner sheath was longer than the outer sheath. The oblique arm of the outer sheath and the inner sheath was connected to the perfusion inflow and the vacuum suction, respectively. A 550-μm holmium-YAG laser was introduced for stone fragmentation through the working channel of the mini-nephroscope, which was no longer connected to the perfusion fluid. Results: All procedures were successful. Mean operation time was 50.2 min (range 39–83). Mean hemoglobin decrease was 5.2 g/L (range 1.0–15.5), and no patient needed a blood transfusion. One patient (1.5%) with low fever (<38°C) at day 1 had returned to normal at day 2 without administration of antibiotics. There were no Clavien grade 2–4 complications. Mean postoperative hospital stay was 2.4 days (range 2–6). The initial stone-free rate of PCNL was 81.53% (53 of 65 patients). One month after surgery, the final stone-free rate increased to 90.77% (59/65 patients). Conclusions: The double-sheath vacuum suction mini-PCNL is a safe and effective modality for large renal stones, which might increase the efficiency of stone extraction with low intrapelvic pressure. [ABSTRACT FROM AUTHOR]

During the onset and malignant development of liver fibrosis, the pernicious interplay between damaged hepatocytes and activated hepatic stellate cells (HSCs) induce a self-perpetuating vicious cycle, deteriorating fibrosis progression and posing a grave threat to public health. The secretions released by damaged hepatocytes and activated HSCs interact through autocrine or paracrine mechanisms, involving multiple signaling pathways. This interaction creates a harsh microenvironment and weakens the therapeutic efficacy of single-cell-centric drugs. Herein, a malignant crosstalk-blocking strategy is prompted to remodel vicious cellular interplay and reverse pathological microenvironment to put an end to liver fibrosis. Collagenases modified, bardoxolone and siTGF-β co-delivered nanoparticles (C-NPs/BT) are designed to penetrate the deposited collagen barriers and further regulate the cellular interactions through upregulating anti-oxidative stress capacity and eliminating the pro-fibrogenic effects of TGF-β. The C-NPs/BT shows successful remodeling of vicious cellular crosstalk and significant disease regression in animal models. This study presents an innovative strategy to modulate cellular interactions for enhanced anti-fibrotic therapy and suggests a promising approach for treating other chronic liver diseases., (© 2024 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

Background: cfDNA fragmentomics-based liquid biopsy is a potential option for noninvasive bladder cancer (BLCA) detection that remains an unmet clinical need., Methods: We assessed the diagnostic performance of cfDNA hotspot-driven machine-learning models in a cohort of 55 BLCA patients, 51 subjects with benign conditions, and 11 healthy volunteers. We further performed functional bioinformatics analysis for biological understanding and interpretation of the tool's diagnostic capability., Results: Urinary cfDNA hotspots-based machine-learning model enabled effective BLCA detection, achieving high performance (area under curve 0.96) and an 87% sensitivity at 100% specificity. It outperformed models using other cfDNA-derived features. In stage-stratified analysis, the sensitivity at 100% specificity of the urine hotspots-based model was 71% and 92% for early (low-grade Ta and T1) and advanced (high-grade T1 and muscle-invasive) disease, respectively. Biologically, cfDNA hotspots effectively retrieved regulatory elements and were correlated with the cell of origin. Urine cfDNA hotspots specifically captured BLCA-related molecular features, including key functional pathways, chromosome loci associated with BLCA risk as identified in genome-wide association studies, or presenting frequent somatic alterations in BLCA tumors, and the transcription factor regulatory landscape., Conclusions: Our findings support the applicability of urine cfDNA fragmentation hotspots for noninvasive BLCA diagnosis, as well as for future translational study regarding its molecular pathology and heterogeneity., (© Association for Diagnostics & Laboratory Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: To evaluate the efficacy and safety of a novel zero-intrarenal pressure (IRP) percutaneous nephrolithotomy (PCNL) technique for one-stage treatment of non-acute infectious calculous pyonephrosis. Patients and Methods: This retrospective study analyzed 12 patients (4 males, 8 females; mean age 56.4 years) who underwent zero-IRP PCNL. The technique utilized a double-sheath vacuum suction system, with the outer sheath allowing for gravity irrigation and the inner sheath facilitating continuous suction. Keeping the height of gravity perfusion at the level of the kidney inherently prevented high IRP and achieved zero-IRP PCNL, even when stone fragments obstructed the suction channel. Results: The procedure demonstrated a high initial stone-free rate of 75%, improving to 91.7% after 1 month. The average operative time was 50.7 minutes. The mean hemoglobin drop was 6.1 g/L, managed without transfusions. Complications were minimal, with low-grade fever in two patients. No significant intraoperative or postoperative complications, such as sepsis, were noted. Conclusions: The zero-IRP PCNL technique, characterized by its double-sheath vacuum suction system and zero-pressure gravity perfusion, shows promise in safely and effectively managing non-acute infectious calculous pyonephrosis. Preliminary results are encouraging, but further research with larger sample sizes is essential for broader clinical validation.