Management of staghorn stones in special situations

Staghorn stones have always been a challenge for urologists,especially in some special situations,such as horseshoe kidney,ectopic kidney,paediatric kidney,and solitary kidney.The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications.The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function.Treatment methods for staghorn stones have developed rapidly,such as extracorporeal shock wave lithotripsy,retrograde intrarenal surgery,percutaneous nephrolithotomy and laparoscopy and open surgery.Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon.The decision should be made individually according to the circumstances of the patient.In this review,we evaluates the previous studies and comments on the management of staghorn stones under special situations in the hope of guiding the optimal choice for urologists.

The older the better:The characteristic of localized prostate cancer in Chinese men

Objective:To assess the clinicopathological features and overall survival between two groups of Chinese patients older or younger than 70 years after retropubic radical prostatectomy.Methods:From January 2001 to February 2010,390 patients receive dretropubic radical prostatectomy.After excluding 89 patients with adjuvant or neoadjuvant hormonal therapy or radiotherapy,a total of 301 patients were included in this study.We arbitrarily divided these patients into younger age group(<70 years,140 cases,46.5%)and older age group(≥70 years,161 cases,53.5%).The differences in serum prostate specific antigen(PSA),Gleason score,clinical tumor stage,and biochemical-free survival were analyzed between the two groups.Results:There were not significant differences between the two groups in high Gleason score rate and clinical tumor stage.However,older patients had significantly lower biochemical recurrence rate than those of younger patients,and had significantly higher PSA levels.Multivariate analysis showed that older age,PSA level and clinical tumor stage were significantly associated with biochemical recurrence free survival.Conclusion:In Chinese men,older age(≥70 years)is associated with better outcome.If the physical condition permits,older age alone should not exclude patients from radical prostatectomy.

Novel Class of Additive Manufactured NiTi-Based Hierarchically Graded Chiral Structure with Low-force Compressive Actuation for Elastocaloric Heat Pumps

Elastocaloric refrigeration is the most promising green solid-state refrigeration technology to replace conventional vapor compression refrigeration.The development direction of the elastocaloric component that acts as a key part of the elastocaloric refrigeration system contains a large elastocaloric effect,low stress hysteresis,high heat exchange performance,and small driving loads.The first two indices can be realized by material modification;however,the last two are more dependent on a novel porous structure design.However,the conventional porous structure is confronted with some critical challenges,including inhomogeneous stress,a significant hysteresis area,and deformation instability under the alternating cyclic loading.In this study,a NiTi-based elastocaloric structure model with chirality feature and gradient design as innovative elements was presented,bio-inspired by the structure of the plant tendrils.A quantitative optimization for the NiTi-based elastocaloric structure was performed using the finite element analysis(FEA)method.Strain and martensite volume fraction(MVF)fields during the loading and unloading processes were predicted and evaluated.The simulated results indicated that increasing the thickness gradient g_(1) of the strip or decreasing the diameter gradient g_(2) of the structure was beneficial to achieving more homogeneous strain and martensite distribution,simultaneously with higher energy storage efficiency and specific surface area.In addition,these NiTi-based chiral structures with different structural parameters were fabricated by laser powder bed fusion(LPBF).At the optimized structure parameters of g_(1)=2 and g_(2)=1.11,the LPBF-fabricated NiTi-based chiral structure could achieve an adiabatic temperature change ΔT_(ad) of 2.3 K,driving force of as low as 149.11 N,and|ΔT_(ad)/F|of as high as 15.42 K/kN at a recoverable compressive strain of 10%.