Evaluation of Airway Obstruction at Soft Palate Level in Male Patients with Obstructive Sleep Apnea/Hypopnea Syndrome:Dynamic 3-Dimensional CT Imaging of Upper Airway

This study examined the dynamic characteristics of upper airway collapse at soft palate level in patients with obstructive sleep apnea/hypopnea syndrome（OSAHS） by using dynamic 3-Dimensional（3-D） CT imaging.A total of 41 male patients who presented with 2 of the following symptoms,i.e.,daytime sleepiness and fatigue,frequent snoring,and apnea with witness,were diagnosed as having OSAHS.They underwent full-night polysomnography and then dynamic 3-D CT imaging of the upper airway during quiet breathing and in Muller＇s maneuver.The soft palate length（SPL）,the minimal cross-sectional area of the retropalatal region（mXSA-RP）,and the vertical distance from the hard palate to the upper posterior part of the hyoid（hhL） were compared between the two breathing states.These parameters,together with hard palate length（HPL）,were also compared between mild/moderate and severe OSAHS groups.Association of these parameters with the severity of OSAHS [as reflected by apnea hypopnea index（AHI） and the lowest saturation of blood oxygen（LSaO2）] was examined.The results showed that 31 patients had severe OSAHS,and 10 mild/moderate OSAHS.All the patients had airway obstruction at soft palate level.mXSA-RP was significantly decreased and SPL remarkably increased during Muller＇s maneuver as compared with the quiet breathing state.There were no significant differences in these airway parameters（except the position of the hyoid bone） between severe and mild/moderate OSAHS groups.And no significant correlation between these airway parameters and the severity of OSAHS was found.The position of hyoid was lower in the severe OSAHS group than in the mild/moderate OSAHS group.The patients in group with body mass index（BMI）≥26 had higher collapse ratio of mXSA-RP,greater neck circumference and smaller mXSA-RP in the Muller＇s maneuver than those in group with BMI26（P0.05 for all）.It was concluded that dynamic 3-D CT imaging could dynamically show the upper airway changes at soft palate level in OSAHS patients.All the OSAHS patients had airway obstruction of various degrees at soft palate level.But no correlation was observed between the airway change at soft palate level and the severity of OSAHS.The patients in group with BMI≥26 were more likely to develop airway obstruction at soft palate level than those with BMI26.

Computational Fluid Dynamics Simulation of the Upper Airway of Obstructive Sleep Apnea Syndrome by Muller Maneuver

This study aimed to use computer simulation to describe the fluid dynamic characteristics in patients with obstructive sleep apnea syndrome（OSAS） and to evaluate the difference between during quiet respiration and the Muller maneuver（MM）. Seven patients with OSAS were involved to perform computed tomographic（CT） scanning during quiet respiration and the MM. CT data in DICOM format were transformed into an anatomically three-dimensional computational fluid dynamics（CFD） model of the upper airway. The velocity magnitude, relative pressure, and flow distribution were obtained. Numerical simulation of airflow was performed to discuss how the MM affected airflow in the upper airway. To measure the discrepancy, the SPSS19.0 software package was utilized for statistic analysis. The results showed that the shape of the upper airway became narrower, and the pressure decreased during the MM. The minimal cross-sectional area（MCSA） of velopharynx was significantly decreased（P〈0.05） and the airflow velocity in MCSAs of velopharynx and glossopharynx significantly accelerated（P〈0.05） during the MM. This study demonstrated the possibility of CFD model combined with the MM for understanding pharyngeal aerodynamics in the pathophysiology of OSAS.

Treatment of severe upper gastrointestinal bleeding caused by Mallory-Weiss syndrome after primary coronary intervention for acute inferior wall myocardial infarction: A case report

BACKGROUND Upper gastrointestinal bleeding(UGIB) after an acute myocardial infarction(AMI) is not an uncommon complication. Acute UGIB caused by Mallory-Weiss syndrome(MWS) is usually a dire situation with massive bleeding and hemodynamic instability. Acute UGIB caused by MWS after an AMI has not been previously reported.CASE SUMMARY A 57-year-old man with acute inferior wall ST elevation myocardial infarction underwent a primary coronary intervention of the acutely occluded right coronary artery. Six hours after the intervention, the patient had a severe UGIB,followed by vomiting. His hemoglobin level dropped from 15.3 g/d L to 9.7 g/d L. In addition to blood transfusion and a gastric acid inhibition treatment,early endoscopy was employed and MWS was diagnosed. Bleeding was stopped by endoscopic placement of titanium clips.CONCLUSION Bleeding complications after stent implantation can pose a dilemma. MWS is a rare but severe cause of acute UGIB after an AMI that requires an early endoscopic diagnosis and a hemoclip intervention to stop bleeding.

A Study of Mallory-Weiss Syndrome Secondary to Upper Gastrointestinal Bleeding

Background: In Mallory-Weiss Syndrome (MWS), vomiting causes the mucous membrane and submucosa near the esophagogastric mucosal junction to tear and bleed. Thus, MWS can arise after heavy drinking and as a complication of endoscopic upper gastrointestinal examinations or procedures. However, there has been no report of MWS secondary to upper gastrointestinal bleeding thus far. Case Subjects: Of 79 MWS cases over a 10-year period from 2002 to 2011, we identified and studied 6 cases, in which MWS was probably caused by another lesion causing upper gastrointestinal bleeding. Results: There were 2 cases, each of gastric ulcers, duodenal ulcers, and varicose veins. In 3 cases, MWS was discovered during treatment of the primary lesion and was simultaneously treated. In the other 3 cases, patients were treated for MWS according to endoscopic diagnosis, and the primary lesion was overlooked;in these cases, the primary lesion was identified and treated after the bleeding recurred. One patient with cirrhosis died of hepatic failure. Conclusion: Care should be taken when dealing with MWS because it can occur as a result of vomiting caused by hematemesis or as a complication of endoscopic examination and treatment. When assessing MWS, other hemorrhagic lesions may be overlooked.

Association between upper leg length and metabolic syndrome among US elderly participants-results from the NHANES （2009-2010）

Objective To examine the relationship between upper leg length （ULL） and metabolic syndrome （MetS） in older adults.Methods Data was collected from National Health and Nutritional Examination Survey （NHANES, 2009-2010）. 786 individuals （385 males and 401 females） who were 60 years of age or older were included in this analysis. MetS was defined as having at least three of following conditions, i.e., cen-tral obesity, dyslipidemia, insulin resistance, and hypertension based on National Cholesterol Education Program guidelines. ULL was grouped into gender-specific tertiles.Results328 （41.7%） of participants were categorized as having MetS （38.7% in men and 49.1% in women,P = 0.002）. Compared to individuals in the 1st tertile （T1） of ULL, those in the 3rd tertile （T3） had lower levels of triglycerides （120.8 vs. 153.1 mg/dL,P = 0.045）, waist circumference （100.7vs. 104.2 cm,P = 0.049）, and systolic blood pressure （126.7vs. 131.4 mmHg, P = 0.005）, but higher levels of high-density-lipoprotein cholesterol （58.1vs. 52.4 mg/dL,P = 0.024）. The odds ratios （95% CI） of MetS from multivariate logistic regression were 0.57 （0.32-1.03） for individuals in the T2 of ULL and 0.39 （0.24-0.64） for individuals in the T3 of ULL, respectively （P-value for the trend 0.022）.Conclusions ULL was negatively associated with MetS in older adults. Further research is needed to identify potential mechanisms.

Effect of gastrointestinal heat retention syndrome on gut microbiota in children with upper respiratory tract infection and lung-heat syndrome

Objective:Gastrointestinal heat retention syndrome(GHRS)is associated with lung-heat syndrome and is related to recurrent respiratory infection.Upper respiratory tract infection(URTI)lung heat syndrome is common in children.The study will explore the effect of GHRS on the structure and function of gut microbiota in children with URTI lung-heat syndrome.Methods:Participants were divided into both groups using the self-developed URTI scale and the“GHRS Diagnostic Scale$Pediatric Part”:GHRS-positive children(LS group)and GHRS-negative children(L group).General information,clinical symptoms,and stool were collected.We used 16S rRNA amplicon sequencing technology to determine the gene sequence of the V3eV4 region in feces and measure the gut microbiota of the both groups at the genus level.Results:A total of 23 children were included in the both groups.There were 12 cases in the LS group and 11 cases in the L group.There was no statistical difference between the both groups in age,gender,height,weight,and body mass index.The effective sequences shared by the both groups accounted for 85.66%of the total.In the gut microbiota,there was no difference in the a diversity and the b diversity between the both groups.Compared with the L group,the LS group had a significant increase in the relative abundance of the Ruminococcus gnavus group,Prevotella-9,Staphylococcus,and Actinomyces(P<.05).The functions of the both groups of microbiota primarily concentrate on metabolism,genetic information processing,and environmental information processing.The relative abundance of signaling molecules and interactions in the LS group were higher than that in the L group(P<.05).The redundancy analysis(RDA)showed that the URTI score had the greatest impact on the distribution of microbiota.Conclusion:GHRS may affect the development of URTI lung-heat syndrome by changing the relative abundances of gut microbiota.

Exploration on the Treatment of Upper Airway Cough Syndrome Based on the Pathogenesis of Hidden Pathogen(Evil)

Upper airway cough syndrome refers to a clinical syndrome with chronic cough as the main manifestation caused by the reverse flow of secretions from various upper airway diseases such as allergic rhinitis,rhino-sinusitis,adenoid hypertrophy and other parts of the nose and pharynx.Professor Yin Dan believes that the main disease of upper airway cough syndrome is due to cold fluid retained in lung,blood stasis endogenous,compound feeling of wind evil.The pathogenesis is external wind evil and the hidden pathogen together to cause the disease.In the treatment,the warm cold fluid retention is the core,accompanied by the activation of blood and wind,so that the wind evil can go away,the cold evil can be warmed,the phlegm can be removed,and the blood stasis can be dispersed,so as to achieve the purpose of treating the upper airway cough syndrome of the children’s cold fluid retention in lung.

低频脉冲电刺激结合上肢运动训练对脑卒中后肩手综合征患者上肢功能的影响

目的分析低频脉冲电刺激结合上肢运动训练对脑卒中后肩手综合征患者上肢功能的影响。方法选取2021-01—2023-01南通大学第六附属医院收治的100例脑卒中肩手综合征患者,按随机数字表分为观察组50例与对照组50例。对照组患者予以常规康复治疗,观察组患者在对照组基础上采取低频脉冲电刺激结合上肢运动训练,2组患者康复治疗均为8周,比较2组患者的临床疗效、上肢肌肉的表面肌电信号(s EMG)、肩手功能与关节活动度状况及并发症发生情况。结果观察组患者的总有效率94.00%,高于对照组患者的80.00%(P<0.05)。观察组患者治疗后肱二头肌、肱三头肌、腕伸肌、三角肌等上肢肌肉s EMG的RMS、MF水平均高于对照组(P<0.05),SHSS评分[(3.87±0.95)分]低于对照组[(5.32±1.04)分](P<0.05),肩、腕ROM评分[分别为(2.21±0.47)分、(2.26±0.49)分]均高于对照组[分别为(1.78±0.55)分、(1.82±0.50)分](P<0.05)。观察组患者并发症发生率8.00%,低于对照组患者的24.00%,差异有统计学意义(P<0.05)。结论低频脉冲电刺激结合上肢运动训练能够显著改善脑卒中肩手综合征患者的上肢功能和肩腕活动度,促进上肢肌肉sEMG指标恢复,临床疗效显著,并发症发生率低。

基于“主客交”理论分期论治上气道咳嗽综合征

基于“主客交”理论,上气道咳嗽综合征的病机为肺脾气虚,风邪客于肺脾,痰浊上扰,风痰搏结,合而为病,故治疗以宣肺化痰、培土生金为法则。急性期治客,客去交易解,风热者疏风清热解表,药用连翘、金银花、菊花、蒲公英等;风寒者散之宣之,药用防风、荆芥、苍耳子、白芷、紫苏叶、辛夷等;缓解期治交,交去主客分离,药选陈皮、半夏、竹茹、瓜蒌、干姜、细辛、贝母、知母等;恢复期治主,主安邪不易犯,治应培土生金、健脾化痰,药选茯苓、白术、苍术、山药等。

寒温并用法辨治小儿上气道咳嗽综合征的临证体会

诠释了寒温并用法的定义、理论内涵及核心思想。认为小儿上气道咳嗽综合征的病因为外感风寒,内伏湿热,湿热蕴伏于阳明经之里,风寒复感于手太阴之表,表之风寒郁闭里之湿热,内外合邪而成太阴阳明表里相兼、寒热错杂之证。治宜外散风寒、内清湿热,用药应寒温并用,即以辛温药疏散外邪,以寒凉药清解湿热,临证时根据风寒与湿热的偏重,灵活加减。常予麻杏苡甘汤合甘露消毒饮化裁,可明显缓解临床症状,缩短病程,减少并发症及后遗症。附案例1则,以资验证。

Nasogastric tube syndrome induced by an indwelling long intestinal tube

The nasogastric tube(NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome(NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.

Numerical simulation of soft palate movement and airflow in human upper airway by fluid-structure interaction method

In this paper, the authors present airflow field characteristics of human upper airway and soft palate movement attitude during breathing. On the basis of the data taken from the spiral computerized tomography images of a healthy person and a patient with Obstructive Sleep Apnea-Hypopnea Syndrome （OSAHS）, three-dimensional models of upper airway cavity and soft palate are reconstructed by the method of surface rendering. Numerical simulation is performed for airflow in the upper airway and displacement of soft palate by fluid-structure interaction analysis. The reconstructed threedimensional models precisely preserve the original configuration of upper airways and soft palate. The results of the pressure and velocity distributions in the airflow field are quantitatively determined, and the displacement of soft palate is presented. Pressure gradients of airway are lower for the healthy person and the airflow distribution is quite uniform in the case of free breathing. However, the OSAHS patient remarkably escalates both the pressure and velocity in the upper airway, and causes higher displacement of the soft palate. The present study is useful in revealing pathogenesis and quantitative mutual relationship between configuration and function of the upper airway as well as in diagnosingdiseases related to anatomical structure and function of the upper airway.

上焦宣痹汤加减辅助治疗儿童急性鼻-鼻窦炎所致上气道咳嗽综合征湿热证30例临床观察

目的观察上焦宣痹汤加减辅助治疗儿童急性鼻-鼻窦炎所致上气道咳嗽综合征湿热证的临床疗效。方法选取2019年1月至2023年1月江西中医药大学第二附属医院儿科住院部就诊的急性鼻-鼻窦炎所致上气道咳嗽综合征湿热证患儿60例,采用随机数字表法分为治疗组和对照组,各30例。对照组给予西医对症治疗,治疗组在对照组治疗方法的基础上给予上焦宣痹汤加减治疗。2组均治疗2周后统计临床疗效,比较治疗前后咳嗽主观症状评分、视觉模拟量表(VAS)评分以及不良反应发生情况,随访3个月统计复发率。结果治疗组总有效率为93.33%(28/30),显著高于对照组的73.33%(22/30),2组比较,差异有统计学意义(P<0.05)。治疗前,2组VAS、咳嗽症状评分比较,差异无统计学意义(P>0.05),具有可比性;治疗后,2组上述评分较治疗前均降低,与同组治疗前比较,差异有统计学意义(P<0.05),且治疗组下降更显著(P<0.05)。对照组复发率为31.82%(7/22),显著高于治疗组的7.14%(2/28),2组比较,差异有统计学意义(P<0.05)。对照组不良反应发生率为10.00%(3/30),治疗组为13.33%(4/30),2组比较,差异无统计学意义(P>0.05)。结论上焦宣痹汤加减辅助治疗儿童急性鼻-鼻窦炎所致上气道咳嗽综合征湿热证疗效满意,可显著降低患儿咳嗽症状、VAS积分和复发率,且无明显不良反应,值得临床推广应用。

Rare case of upper gastrointestinal bleeding in achalasia

Achalasia is a prototypic esophageal motility disorder with complications including aspiration-pneumonia, esophagitis, esophageal-tracheal fistula, spontaneous rupture of the esophagus, and squamous cell carcinoma. However, achalasia is rarely associated with esophageal stones and ulcer formation that lead to upper gastrointestinal bleeding. Here, we report the case of a 61-year-old woman who was admitted to our department aftervomiting blood for six hours. Physical examination revealed that the patient had severe anemia and mild palpitation in the upper abdomen. CT revealed lower esophageal dilatation and esophageal wall thickening, and an emergency upper endoscopy showed that the esophagus was substantially expanded by a dark round stone, with multiple ulcers on the esophageal wall and a slit in the cardiac mucosa with a large clot attached. The patient's history included ingestion of 1 kg hawthorn three days prior. The acute upper gastrointestinal bleeding was caused by Mallory-Weiss syndrome associated with achalasia and an esophageal stone. For patients with achalasia, preventing excessive ingestion of tannins is crucial to avoid complications such as bleeding and rupture.

Case of Fitz-Hugh-Curtis syndrome in male without presentation of sexually transmitted disease

Fitz-Hugh-Curtis syndrome is a type of perihepatitis that causes liver capsular infection without infecting the hepatic parenchyma or pelvis. Fitz-Hugh-Curtis syndrome is known to occur commonly in women of childbearing age who do not use oral contraceptives and have sexual partners older than 25 years of age. However, the syndrome has been reported to occur rarely in males. The clinical symptoms are right upper quadrant pain and tenderness, and pleuritic right sided chest pain. The clinical presentation is similar in male and female. We experienced a case of Fitz-HughCurtis syndrome in a 60-year-old man with the chief complaint of right upper quadrant abdominal pain. Despite a previous history of gonorrhea, we have also described our experiences of improved symptoms and recovery with allopathic medicines and have thereby reported the present case with a literature review.

Upper extremity deep vein thrombosis:An intensivist’s perspective

Upper extremity deep vein thrombosis(UEDVT)is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients.Increasing cancer incidence,prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT.It is also associated with high rates of complications like pulmonary embolism,post-thrombotic syndrome and recurrent thrombosis.Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT;hence,a high suspicion index is required for diagnosis.Doppler ultrasound is commonly employed for diagnosis,but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients.Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies.Anticoagulant therapy alone is sufficient in most patients,and thrombolysis and surgical decompression is seldom indicated.The outcome depends on the cause and underlying comorbidities.

Instrumented assisted soft tissue mobilization vs extracorporeal shock wave therapy in treatment of myofascial pain syndrome

BACKGROUND Active myofascial trigger points(TrPs)often occur in the upper region of the upper trapezius(UT)muscle.These TrPs can be a significant source of neck,shoulder,and upper back pain and headaches.These TrPs and their related pain and disability can adversely affect an individual’s everyday routine functioning,work-related productivity,and general quality of life.AIM To investigate the effects of instrument assisted soft tissue mobilization(IASTM)vs extracorporeal shock wave therapy(ESWT)on the TrPs of the UT muscle.METHODS A randomized,single-blind,comparative clinical study was conducted at the Medical Center of the Egyptian Railway Station in Cairo.Forty patients(28 females and 12 males),aged between 20-years-old and 40-years-old,with active myofascial TrPs in the UT muscle were randomly assigned to two equal groups(A and B).Group A received IASTM,while group B received ESWT.Each group was treated twice weekly for 2 weeks.Both groups received muscle energy technique for the UT muscle.Patients were evaluated twice(pre-and posttreatment)for pain intensity using the visual analogue scale and for pain pressure threshold(PPT)using a pressure algometer.RESULTS Comparing the pre-and post-treatment mean values for all variables for group A,there were significant differences in pain intensity for TrP1 and TrP2(P=0.0001)and PPT for TrP1(P=0.0002)and TrP2(P=0.0001).Also,for group B,there were significant differences between the pre-and post-treatment pain intensity for TrP1 and TrP2 and PPT for TrP1 and TrP2(P=0.0001).There were no significant differences between the two groups in the post-treatment mean values of pain intensity for TrP1(P=0.9)and TrP2(P=0.76)and PPT for TrP1(P=0.09)and for TrP2(P=0.91).CONCLUSION IASTM and ESWT are effective methods for improving pain and PPT in patients with UT muscle TrPs.There is no significant difference between either treatment method.

Analysis and Study on the Effect of PNF Stretching and Resistance Training on the Rehabilitation of Superior Chiasma Syndrome

In this paper,18 subjects with superior chiasma syndrome were analyzed and studied according to the inducement and correction method of superior chiasma syndrome by questionnaire survey,literature review and experimental research.To explore the effect of bad posture on the posture of patients,and to explore the effect of PNF stretching,anti-resistance training and manual loosening on the rehabilitation of patients with superior chiasma.Methods:the subjects were divided into three experimental groups,A,B and C,for 6 weeks,4 times a week for resistance training and PNF stretching training.It has been proved that the population with chest ambushes for a long time will cause the imbalance of muscle strength of shoulder,neck and chest,abnormal physiological curvature of cervical vertebrae and thoracic vertebrae,and induce chronic injury of shoulder and neck muscles and soft tissue,which will lead to symptoms of superior chiasma syndrome.According to the designed rehabilitation training experiment,PNF stretching training and anti-resistance training were carried out for the shoulder and neck muscles which caused superior chiasma syndrome,and the rehabilitation effect was very significant,which was obviously better than that of PNF stretching or resistance training alone.Therefore,PNF stretching and resistance training should be fully combined in rehabilitation training to improve the posture problem in order to achieve twice the result with half the effort.

Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome:Two case reports

BACKGROUND A swallowing disorder may occur following a brainstem stroke,especially one that occurs in the swallowing centers.Lateral medullary syndrome(referred to as LMS),a rare condition in which a vascular event occurs in the territory of the posterior inferior cerebellar artery or the vertebral artery,has been reported to lead to more severe and longer lasting dysphagia.CASE SUMMARY We report two patients with dysphagia due to LMS and propose a novel technique named hyoid-complex elevation and stimulation technique(known as HEST).The two patients had no other functional incapacity back into life,but nasogastric feeding was the only possible way for nutrition because of severe aspirations.Swallowing function was evaluated by functional oral intake scale,modified water swallow test,surface electromyographic signal associated with video fluorography swallowing study to assess the situation of aspiration,pharyngeal residue,pharyngeal peristalsis,upper esophageal opening and the ability of deglutition.Both patients were treated with the HEST method for dysphagia and recovered quickly.CONCLUSION HEST is effective for shortening the in-hospital time and improving the quality of life for patients with dysphagia who suffer from LMS and likely other strokes.

Genitourinary manifestations of Lynch syndrome in the urological practice

Objective:Lynch syndrome(LS)is an autosomal dominant hereditary disorder resulting from germline mutation in at least one of the four mismatch repair genes or in EPCAM gene.From a clinical perspective,LS patients exhibit an increased predisposition to multiple primary malignancies and early age of onset compared to general population.We aimed to provide a comprehensive overview of all the genitourinary manifestations of LS,focusing on incidence,diagnosis,clinical features,therapeutic strategies,and screening protocols.Methods:Previous literature was assessed through Medline,Scopus,and Google Scholar data-bases.A narrative review of the most relevant articles from January 1996 to June 2021 on urological manifestations of LS was provided.Results:In the LS tumor spectrum,upper tract urothelial carcinoma(UTUC)represents the third most frequent malignancy,and the first most common cancer in the urological field,with an approximately 14-fold increased risk of developing UTUC compared to general population.LS diagnosis among patients experiencing UTUC as first malignancy is a step-by-step process,including(i)clinical criteria,(ii)molecular testing,and(iii)genetic testing to confirm the hereditary disorder.The current European Association of Urology(EAU)guidelines recommend to perform molecular testing among UTUC patients under 65 years old,or UTUC patients with personal history of LS-related tumor,or UTUC patients with one first-degree relative under the age of 50 years with LS-related tumor,or UTUC patients with two first-degree relatives with LS-related tumor regardless of age of onset.Newly diagnosed LS patients should be referred to a multidisci-plinary management,including gastroenterologists and gynecologists.Finally,considering the increased risk of metachronous recurrence,treatments other than radical nephroureterectomy may be a valuable therapeutic alternative.Whether urological malignancies other than UTUC should be included in the LS tumor spectrum is still controversial.Conclusion:Considering the strict association between UTUC and LS,we believe that the urologist should recognize patients at increased risk for hereditary disease according to current EAU clinical criteria and address them to a comprehensive diagnostic algorithm,including molecular evaluationandgenetic testing.To date,literature lacks clear evidence regarding the role of LS in developing bladder cancer,prostate cancer,or renal cell carcinoma,and current data are still inconclusive,highlighting the urgent need for further studies.