Ultrasound-guided paravertebral nerve block anesthesia for percutaneous endoscopic laser unroofing treatment of symptomatic simple renal cysts—An innovative ambulatory surgery mode

Objective:This study was designed to evaluate the feasibility,efficacy,and safety of percutaneous ureteroscopy laser unroofing as an ambulatory surgery for symptomatic simple renal cysts under multilevel paravertebral nerve block anesthesia.Methods:From December 2015 to September 2017,33 simple renal cyst patients who had surgical indications were enrolled.Under ultrasound guidance,the T10/T11,T11/T12,and T12/L1 paravertebral spaces were identified,and 7-10 mL 0.5%ropivacaine was injected at each segment.Then a puncture needle was placed inside the cyst cavity under ultrasonic monitoring.A guidewire was introduced followed by sequential dilation up to 28/30 Fr.The extra parenchymal portion of the cyst wall was dissociated and incised using a thulium laser,and a pathological examination was performed.Results:Sensory loss to pinprick from T8 to L1 and sensory loss to ice from T6 to L2 were observed in all patients.None of the patients complained of pain during surgery.No serious complications occurred perioperatively.After the surgery,all patients recovered their lower limb muscle strength quickly,got out of bed,resumed oral feeding,and left the hospital within 24 h of admission.The pathologic diagnosis of all cyst walls was a simple renal cyst.The mean follow-up was 35.8 months.At the end of follow-up,the cyst units were reduced in size by more than 50%compared to the preoperative size,and no patient experienced a recurrence.Conclusion:Multi-level paravertebral nerve block for percutaneous ureteroscopy laser unroofing as an ambulatory surgery mode is feasible,safe,and effective for the treatment of simple renal cysts in selected patients.

Bioinspired fish-scale-like magnesium composites strengthened by contextures of continuous titanium fibers:Lessons from nature

Natural fish scales demonstrate outstanding mechanical efficiency owing to their elaborate architectures and thereby may serve as ideal prototypes for the architectural design of man-made materials.Here bioinspired magnesium composites with fish-scale-like orthogonal plywood and double-Bouligand architectures were developed by pressureless infiltration of a magnesium melt into the woven contextures of continuous titanium fibers.The composites exhibit enhanced strength and work-hardening ability compared to those estimated from a simple mixture of their constituents at ambient to elevated temperatures.In particular,the double-Bouligand architecture can effectively deflect cracking paths,alleviate strain localization,and adaptively reorient titanium fibers within the magnesium matrix during the deformation of the composite,representing a successful implementation of the property-optimizing mechanisms in fish scales.The strength of the composites,specifically the effect of their bioinspired architectures,was interpreted based on the adaptation of classical laminate theory.This study may offer a feasible approach for developing new bioinspired metal-matrix composites with improved performance and provide theoretical guidance for their architectural designs.

Real-world effectiveness and safety of goserelin 10.8-mg depot in Chinese patients with localized or locally advanced prostate cancer

Objective:Real-word data on long-acting luteinizing hormone-releasing hormone(LHRH)agonists in Chinese patients with prostate cancer are limited.This study aimed to determine the real-world effectiveness and safety of the LHRH agonist,goserelin,particularly the long-acting 10.8-mg depot formulation,and the follow-up patterns among Chinese prostate cancer patients.Methods:This was a multicenter,prospective,observational study in hormone treatment-na?ve patients with localized or locally advanced prostate cancer who were prescribed goserelin 10.8-mg depot every 12 weeks or 3.6-mg depot every 4 weeks with or without an anti-androgen.The patients had follow-up evaluations for 26 weeks.The primary outcome was the effectiveness of goserelin in reducing serum testosterone and prostate-specific antigen(PSA)levels.The secondary outcomes included testosterone and PSA levels,attainment of chemical castration(serum testosterone<50 ng/d L),and goserelin safety.The exploratory outcome was the monitoring pattern for serum testosterone and PSA.All analyses were descriptive.Results:Between September 2017 and December 2019,a total of 294 eligible patients received≥1 dose of goserelin;287 patients(97.6%)were treated with goserelin 10.8-mg depot.At week 24±2,the changes from baseline[standard deviation(95%confidence interval)]in serum testosterone(n=99)and PSA(n=131)were-401.0 ng/d L[308.4 ng/d L(-462.5,-339.5 ng/d L)]and-35.4 ng/m L[104.4 ng/m L(-53.5,-17.4 ng/m L)],respectively.Of 112 evaluable patients,100(90.2%)achieved a serum testosterone level<50 ng/d L.Treatment-emergent adverse events(TEAEs)and severe TEAEs occurred in 37.1%and 10.2%of patients,respectively.The mean testing frequency(standard deviation)was 1.6(1.5)for testosterone and 2.2(1.6)for PSA.Conclusions:Goserelin 10.8-mg depot effectively achieved and maintained castration and was well-tolerated in Chinese patients with localized and locally advanced prostate cancer.

Clinical assessment and genomic landscape of a consanguineous family with three Kallmann syndrome descendants

Although some genes that cause Kallmann syndrome （KS） have been identified by traditional linkage analysis and candidate gene techniques, the syndrome＇s molecular etiology in the majority of patients remains poorly understood. In this paper, we present the clinical assessments of a consanguineous Hart Chinese family with three KS descendants. To understand the molecular etiology of KS from a genome-wide perspective, we investigated the genome-wide profile of structural variation in this family using the Affymetrix Genome-Wide Human SNP Array 6.0 platform. The results revealed that the three affected individuals had common copy number variants （microdeletions） on chromosomes lp21.1, 2q32.2, 8q21.13, 14q21.2 and Xp22.31. Moreover, the copy number variants on Xp22.31 were located in the intron of KAL 1, which causes X-linked KS. Two PCR assays were performed on these regions to validate the results obtained using the chips. In addition, genomic microdeletions in this region were verified in one of 29 Han Chinese sporadic KS cases and one of four other family cases, but not in 26 Han Chinese sporadic normosmic idiopathic hypogonadotropic hypogonadism cases and 100 unrelated Han Chinese normal controls. Our results provide a novel insight into the relative contributions of certain copy number variants to KS＇s molecular etiology and generate a list of interesting candidate regions for further studies.

Efficient polysulfide blocker from conductive niobium nitride@graphene for Li-S batteries

Lithium sulfur batteries are one of the most promising alternative electrochemical systems,but their practical applications are largely hindered by the serious shuttling problems and sluggish redox kinetics.Here,the conductive and polar niobium nitride(NbN)is in-situ introduced onto graphene with ultrasmall size and high dispersion,and their composite is used to construct an efficient lithium polysulfide blocking layer.The graphene helps to construct highly conductive pathways,and niobium nitride serves as the sulfiphilic sites to chemically adsorb the migrating lithium polysulfides and catalyze their redox conversion.Hence,the cells with the Nb N/G interlayers exhibit a long cycle life with a lower capacity decay of 0.096%/cycle at 1 C for 300 cycles and high rate capability of 937 m Ah g^-1 at 2 C.Further coupling with a sulfur/carbon nanofiber electrode,the cell with an ultra-high sulfur loading of 10.8 mg cm^-2 delivers an areal capacity of 12.5 m Ah cm^-2 at 0.1 C.

Survival after radical cystectomy for bladder cancer:Multicenter comparison between minimally invasive and open approaches

Objective:To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy(MIRC)or open radical cystectomy(ORC).Methods:We identified patients with bladder cancer who underwent radical cystectomy(RC)in 13 centers of the Chinese Bladder Cancer Consortium(CBCC).Perioperative outcomes were compared between MIRC and ORC.The influence of surgical approaches on overall survival(OS)and cancer-specific survival(CSS)in the entire study group and subgroups classified according to pathologic stage or lymph node(LN)status was assessed with the log-rank test.Multivariable Cox proportional hazard models were used to evaluate the association among OS,CSS and risk factors of interest.Results:Of 2098 patients who underwent RC,1243 patients underwent MIRC(1087 laparoscopic RC and 156 robotic-assisted RC,respectively),while 855 patients underwent ORC.No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate.MIRC was associated with less estimated blood loss,more LN yield,higher rate of neobladder diversion,longer operative time,and longer length of hospital stay.There was no significant difference in OS and CSS according to surgical approaches(pZ0.653,and 0.816,respectively).Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement.Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS.Conclusions:Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS.

Is Retzius-sparing robot-assisted radical prostatectomy associated with better functional and oncological outcomes? Literature review and meta-analysis

Objective:To evaluate the efficiency,safety and clinical outcomes of Retziussparing robot-assisted radical prostatectomy(RS-RARP)in comparison with the standard RARP.Methods:A systematic search from Web of Science,PubMed,EMBase,Cochrane Library and Google Scholar was performed using the terms“Retzius-sparing”,“Bocciardi approach”and“robot-assisted radical prostatectomy”.Video articles and abstract papers for academic conferences were excluded.Meta-analysis of interested outcomes such as positive surgical margins(PSMs)and continence recovery was undertaken.A comprehensive literature review of all studies regarding Retzius-sparing(RS)approach was conducted and summarized.Results:From 2010 to 2017,11 original articles about RS-RARP approach were retrieved.Of that,only four studies comparing the RS-RARP approach to the conventional RARP were comparable for meta-analysis.Faster overall continence recovery within 1 month after the surgery was noted in the RS group(61%vs.43%;pZ0.004).PSMs of pT2 and pT3 stages were not significantly different between the groups(10.0%vs.7.4%;p Z 0.39 and 13.1%vs.9.5%,p Z 0.56,respectively).Of all the studies,only one reported sexual recovery outcomes after RS treatment in which 40%of the participants achieved sexual intercourse within the first month.Conclusion:Though more technically demanding than the conventional RARP,the RS technique is a safe and feasible approach.This meta-analysis and literature review indicates that RS technique,as opposed to the conventional approach,is associated with a faster continence recovery while PSMs were comparable between the two groups.The limitations of observational studies and the small data in our meta-analysis may prevent an ultimate conclusion.Future well-designed RCTs are needed to validate and confirm our findings.

Robot-assisted laparoscopic ureteroneocystostomy in adults: A single surgeon experience and literature review

Objective:To present our experience and technique with robot-assisted uretero-neocystos tomy(RAUN)procedure in adults.Methods:Between February 2015 and August 2018,a total of 30(34 ureters)patients who un-derwent RAUN surgery under a single surgeon were retrospectively reviewed.Perioperative data such as age,sex,body mass index(BMI),American society of anesthes iologists score,esti-mated blood loss,surgical technique,operative time,complications,length of hospital stay,and stent removal time were recorded.During the follow-up,patients underwent renal func-tion test,urinalysis,and renal ultrasound examination for evaluation.Success was defined as symptomatic and radiologic relieve.Lastly,a literature search was conducted to review all published articles regarding RAUN surgery in adults.Results:The patients'mean age,BMI,EBL,operative time,and follow-up period were 45.4 years,23.1 kg/m^2,65.6 mL,182.9 min,and 21.3 months,respectively.The two most common indications for the surgery were benign ureteral strictures and ureteric injuries secondaryto a previous radical hysterectomy.Of the 34 cases,26(76.5%)and 8(23.5%)patients received pri-mary RAUN and RAUN with psoas hitch technique,respectively.Refluxing RAUN method was performed in all cases.No intraoperative complications were found.Two patients had a radio-logic and symptomatic recurrence;one was managed with a repeat surgery while the other received ureteral dilatation treatment.Conclusion:Both our study and the published literature showed that RAUN is a safe,less inva-sive,and effective surgical technique that can easily replicate the open ureteroneocystostomy for managing lower ureteral diseases.

Wear-resistant Ag-MAX phase 3D interpenetrating-phase composites:Processing,structure,and properties

Electrical contact materials are generally Ag-or Cu-based composites and play a critical role in ensuring the reliability and efficiency of electrical equipments and electronic instruments.The MAX(M is an early transition metal,A is an element from III or IV main groups,and X is carbon or/and nitrogen)phase ceramics display a unique combination of properties and may serve as an ideal reinforcement phase for electrical contact materials.The biological materials evolved in nature generally exhibit three-dimensional(3D)interpenetrating-phase architectures,which may offer useful inspiration for the architectural design of electrical contact materials.Here,a series of bi-continuous Ag-Ti_(3)SiC_(2) MAX phase composites with high ceramic contents exceeding 50 vol.%and having micron-and ultrafine-scaled 3D interpenetrating-phase architectures,wherein both constituents were continuous and mutually interspersed,were exploited by pressureless infiltration of Ag melt into partially sintered Ti_(3)SiC_(2) scaffolds.The mechanical and electrical properties as well as the friction and wear performance of the composites were investigated and revealed to be closely dependent on the ceramic contents and characteristic structural dimensions.The composites exhibited a good combination of properties with high hardness over 2.3 GPa,high flexural strength exceeding 530 MPa,decent fracture toughness over 10 MPa·m^(1/2),and good wear resistance with low wear rate at an order of 10^(-5)mm^(3)/(N·m),which were much superior compared to the counterparts made by powder metallurgy methods.In particular,the hardness,electrical conductivity,strength,and fracture toughness of the composites demonstrated a simultaneous improvement as the structure was refined from micron-to ultrafine-scales at equivalent ceramic contents.The good combination of properties along with the facile processing route makes the Ag-Ti_(3)SiC_(2)3D interpenetrating-phase composites appealing for electrical contact applications.

Triplex-structure based DNA circuits with ultra-low leakage and high signal-to-noise ratio

DNA circuits are powerful tools in various applications such as logical computation,molecular diagnosis and synthetic biology.Leakage is a major problem in constructing complex DNA circuits.It directly affects the output signal and harms the circuit’s performance significantly.In the traditional DNA circuits,the gate complex is a duplex structure.There are insufficient energy barriers to prevent spontaneous detachment of strands,resulting in a leak prone.Herein,we have developed triplex-structure based DNA circuit with ultra-low leakage and high signal-to-noise ratio(SNR).The triplex structure improves the stability in the absence of input.At the same time,the driving force of the strand displacement cascades reduces the influence of the triplex structure on the desired reaction.The SNR of the DNA circuit was increased to 695,while the desired reaction rate remained 90%of the conventional translator circuit.The triplex-structure mediated leakage prevention strategy was further tested at different temperatures and in DNA translator and seesaw circuits.We also constructed modular basic logic gates with a high efficiency and low leakage.On this basis,we further constructed triplex-structure based tertiary DNA logic circuits,and the SNR reached 295,which,to the best of our knowledge,was among the highest of the field.We believe that our scheme provides a novel,valid,and general tool for reducing leakages,and we anticipate that it will be widely adopted in DNA nanotechnology.

Corrigendum to“Bi-continuous Mg-Ti interpenetrating-phase composite as a partially degradable and bioactive implant material”[Journal of Materials Science&Technology 146(2023)211-220]

The authors are very sorry for their carelessness that there are some problems with Fig.3 in the original manuscript.

Bi-continuous Mg-Ti interpenetrating-phase composite as a partially degradable and bioactive implant material

Mg(and Mg alloys)and Ti(and Ti alloys)are two important classes of metallic implant materials which are respectively completely degradable and non-degradable after implantation.Making composites composed of them offers the promise for combining their property advantages for bone repair.Here,we present a Mg-Ti composite fabricated by pressureless infiltration of pure Mg melt into 3D printed Ti scaffold,and demonstrate a potential of the composite for use as new partially degradable and bioactive implant materials.The composite has such architecture that the Mg and Ti phases are topologically bicontinuous and mutually interspersed in 3D space,and exhibits several advantages over its constituents,such as higher strengths than as-cast pure Mg and Ti scaffold along with lower Young’s modulus than dense Ti.Additionally,the degradation of Mg phase may induce the formation and ingrowth of new bone tissues into the Ti scaffold to form mechanical interlocking between them;in this process,the Ti scaffold provides constant support and Young’s modulus adaptively decreases toward that of bone.Despite the accelerated corrosion than pure Mg,the composite remains non-cytotoxic and does not cause obvious adverse reactions after implantation as revealed by in vitro and in vivo experiments.This study may offer a new possibility for combining mechanical durability and bioactivity in implant materials,and allow for customized and targeted design of the implant.

Effect of reaction routes on the porosity and permeability of porous high entropy(Y0.2Yb0.2Sm0.2Nd0.2Eu0.2)B6 for transpiration cooling

Transpiration cooling technique is a reusable and high-efficiency thermal protection system(TPS),which is potential to improve the reusability and security of re-entry space vehicle.Relatively low density,high permeability and high porosity are general requirements for porous media of transpiration cooling systems.In this work,a new porous high entropy metal hexaboride(Y0.2Yb0.2Sm0.2Nd0.2Eu0.2)B6 is designed and prepared by the in-situ reaction/partial sintering method.Two reaction routes are designed to synthesize(Y0.2Yb0.2Sm0.2Nd0.2Eu0.2)B6,including boron thermal reduction and borocarbon thermal reduction.The as-prepared porous HE(Y0.2Yb0.2Sm0.2Nd0.2Eu0.2)B6 ceramics possess homogeneous microstructure and exhibit low density,high porosity,high compressive strength and high permeability.The combination of these properties makes porous HE(Y0.2Yb0.2Sm0.2Nd0.2Eu0.2)B6 promising as a candidate porous media for various transpiration cooling applications.

Ice-templated porous tungsten and tungsten carbide inspired by natural wood

The structures of tungsten and tungsten carbide scaffolds play a key role in determining the properties of their infiltrated composites for multifunctional applications.However,it is challenging to construct and control the architectures by means of self-assembly in W/WC systems because of their large densities.Here we present the development of unidirectionally porous architectures,with high porosities exceeding 65 vol.%,for W and WC scaffolds which in many respects reproduce the design motif of natural wood using a direct ice-templating technique.This was achieved by adjusting the viscosities of suspensions to retard sedimentation during freezing.The processing,structural characteristics and mechanical properties of the resulting scaffolds were investigated with the correlations between them explored.Quantitative relationships were established to describe their strengths based on the mechanics of cellular solids by taking into account both inter-and intra-lamellar pores.The fracture mechanisms were also identified,especially in light of the porosity.This study extends the effectiveness of the ice-templating technique for systems with large densities or particle sizes.It further provides preforms for developing new natureinspired multifunctional materials,as represented by W/WC-Cu composites.

Effects of different aging treatments on microstructures and mechanical properties of Al-Cu-Li alloy joints welded by electron beam welding

Post-weld single aging treatment（solution treatment at 510 ℃ for 1 h, water quenching,and aging at 155 ℃ for 16 h） and post-weld double aging treatment（solution treatment at 510 ℃ for 1 h, water quenching, aging at 155 ℃ for 16 h, and aging at 130 ℃ for 12 h） are carried out on Al-Cu-Li alloy joints by electron beam welding（EBW） respectively. The effects of aging treatments on microstructures and mechanical properties of welded joints are investigated. Results show that the mechanical properties of welded joints are obviously improved after both aging treatments. The strength coefficient of joints is increased from 0.64 in an as-welded condition（AW） to 0.90 after post-weld double aging treatment. Microstructure analysis shows that the precipitates of the fusion zone within grains and grain boundaries are less in the AW condition. After post-weld heat treatment（PWHT）, a lot of fine needle-like phases T_1（Al_2 Cu Li） precipitate in grain boundaries of the fusion zone, and more horseshoe-shaped β＇ （Al_3 Zr） particles precipitate within grains. In addition,grains of the fusion zone are refined after post-weld double aging treatment, which leads to an effect of grain refinement strengthening. Consequently, the mechanical properties of welded joints are greatly improved.

Electron Beam Melted Beta-type Ti–24Nb–4Zr–8Sn Porous Structures With High Strength-to-Modulus Ratio

Electron beam melting （EBM） has been used to manufacture β-type Ti-24Nb-4Zr-8Sn porous compo- nents with 70% porosity, EBM-produced components have favorable structural features （i.e. smooth strut surfaces, fewer defects） and an （α ＋ β）-type microstructure, similar to that subjected to aging treat- ment. EBM-produced components exhibit more than twice the strength-to-modulus ratio of porous Ti- 6A1-4V components having the same porosity. The processing-microstructure-property relationship and deformation behavior of EBM-produced components are discussed in detail. Such porous titanium com- ponents composed of non-toxic elements and having high strength-to-modulus ratio are highly attractive for biomedical applications.

Evolution of micro-pores in a single crystal nickel-based superalloy during 980℃ creep

The evolution of micro-pores in a single crystal nickel-based superalloy during creep at 980 ℃/220 MPa was investigated by X-ray computed tomography. Time-dependent ex-situ 3D information including the number, volume fraction, distribution and morphology of micro-pores was analyzed. The results reveal that the signifi cant formation and growth of micro-pores occur at the end of secondary/beginning of tertiary creep stage. The irregular large pores as well as high density pores located at strain concentration region are the major detrimental factors facilitating the creep damage. Creep failure is resulted from the connection of surface cracks induced by oxidation, and the internal cracks generated from growth and merging of micro-pores.

Motion and removal behavior of inclusions in electrode tip during magnetically controlled electroslag remelting:X-ray microtomography characterization and modeling verification

Detailed three-dimensional(3 D)microtomography characterizations of inclusions in electrode matrix,mushy zone(MZ)and liquid melt film(LMF)were performed to elucidate the motion and removal behavior of inclusions in electrode tip during magnetically controlled electroslag remelting(MC-ESR)process.A transient 2 D numerical model was also built to verify the experimental results and proposed mechanisms.The number and size of inclusions exhibited an obvious increasing trend from edge to mid region in LMF,while remained almost the same in electrode matrix and MZ.The inclusions in LMF migrated from edge to mid region of LMF,accompanied with removal process.In addition,the kinetic conditions for inclusion migrating to LMF/slag interface(LSI)were enhanced during MC-ESR process,thereby improving the inclusion removal efficiency in LMF.This work highlights the 3 D characterization and motion/removal mechanisms of inclusions in electrode tip,as well as sheds new light on preparing high purity materials.

Natural Cornstalk Pith as an Effective Energy Absorbing Cellular Material

The replacement of synthetic foam materials using natural biological ones is of great significance for saving energy/resources and reducing environmental pollutions.Here we characterized the microstructure and mechanical properties of natural cornstalk pith,which has a large annual output yet lacks an effective exploitation,and evaluated its feasibility for applications as a substitute for synthetic foam materials.The cornstalk pith was revealed to be a cellular material composed of closed cells elongated along the growth direction of com plant and reinforced by well-aligned vascular bundles penetrating the foam matrix.The compressive behavior is featured by a stable stress plateau which is favorable for energy absorption with its mechanical properties largely dependent on the hydration state and loading configuration.In particular,the initial dimension and mechanical properties of cornstalk pith can be effectively recovered after deformation simply by hydration treatment owing to swelling effect caused by the turgor pressure from osmosis.The cornstalk pith demonstrates an outstanding combination of low density and high energy absorption efficiency among various foam materials,specifically with its plateau stress and energy absorption comparable or even superior to those of some typical synthetic foam materials.These along with the huge resources and good biodegradability make it a promising natural energy absorbing cellular material for replacing synthetic counterparts.

A giant Müllerian duct cyst in the perineum:a case report

The authors present a case report of a giant Müllerian duct cyst in the perineum.A 37-year-old man presented with a mass with the size of 50 cm×40 cm×30 cm in the perineum.Computed tomography(CT)scan and magnetic resonance imaging(MRI)of the pelvis and perineum found a huge multilocular cystic mass.X-ray film of the pelvis showed a giant soft-tissue shadow of high density in the perineum.Voiding cystourethrogram did not show any cyst interlinked to posterior urethra.After related examinations,the patient underwent open surgical resection of the cyst.Pathologic examination confirmed the presence of a Müllerian duct cyst.Huge Müllerian duct cyst is uncommon in clinic.Treatments of Müllerian duct cysts depend on their sizes and symptoms.