Objective To compare the effectiveness and safety of pulsed field ablation(PFA)and cryoballoon ablation(CBA)in treating atrial fibrillation(AF).Methods A computerized retrieval of academic papers concerning the comparison of the effectiveness and safety between PFA and CBA in treating AF from the databases of PubMed,Web of Science,Cochrane and Embase was conducted.The retrieval time period was from the establishment of the database to May 31,2024.Stata 18.0 software was used to make meta-analysis.Results A total of 12 articles including 3 765 AF patients were included in this analysis.Of the 3 765 AF patients,1 430 received PFA and 2 335 received CBA.In the PFA group,the total operation time(MD=-0.85,95％CI=-1.43 to-0.28,P=0.004),the phrenic nerve injury(OR=0.09,95％CI=0.04-0.24,P＜0.001),and the esophageal injury(OR=0.20,95％CI=0.04-0.90,P=0.036)were statistically significant different from those in the CBA group;while the X-ray fluoroscopy time(MD=0.31,95％CI=-0.02 to 0.63,P=0.066),the recurrence rate of atrial arrhythmia(OR=0.73,95％CI=0.53-1.01,P=0.057),and the incidence of pericardial tamponade(OR=2.37,95％CI=0.97-5.81,P=0.058)were not significantly different from those in the CBA group.Age-subgroup analysis revealed that in patients ≤65 years of age PFA could more remarkably reduce the recurrence rate of atrial arrhythmia than CBA(OR=0.61,95％CI=0.42-0.89,P=0.01),while in patients＞65 years of age the difference in reducing the recurrence rate of atrial arrhythmia between PFA and CBA was not statistically significant(OR=1.04,95％CI=0.69-1.56,P=0.853).Conclusion In treating AF,PFA is superior to CBA in shortening the operation time as well as in reducing the injury of phrenic nerve and esophagus,and there is no significant difference between CBA and PFA in the X-ray fluoroscopy time,the recurrence rate of atrial arrhythmia,and the incidence of cardiac tamponade.

Purpose: To determine the non-contrast computer tomography imaging features of pyonephrosis and evaluate the predictive value of Hounsfield units (HUs) in different hydronephrotic region slices. Materials and Methods: We retrospectively reviewed data from patients with hydronephrosis who had renal-ureteral calculi. All patients were categorized into pyonephrosis and simple hydronephrosis groups. Baseline characteristics, the mean HU values in the maximal hydronephrotic region (uHU) slice, and the range of uHU in different slices (△uHU) were compared between the two groups. Univariate and multivariate analyses were performed to identify risk factors for pyonephrosis. Results: Among the 181 patients enrolled in the current study, 71 patients (39.2%) were diagnosed with pyonephrosis. The mean dilated pelvis surface areas were comparable between patients with pyonephrosis and simple hydronephrosis (822.61 ㎟ vs.877.23 ㎟ , p=0.722). Collecting system debris (p=0.022), a higher uHU (p=0.038), and a higher △uHU (p<0.001) were identified as independent risk factors for pyonephrosis based on multivariate analysis. The △uHU sensitivity and specificity were 88.7% and 86.4%, respectively, at a cutoff value of 6.56 (p<0.001), whereas the sensitivity and specificity for detecting pyonephrosis at a uHU cutoff value of 7.96 was 50.7% and 70.9%, respectively (p=0.003). Conclusions Non-contrast computer tomography was shown to accurately distinguish simple hydronephrosis from pyonephrosis in patients with obstructive uropathy. Evaluation of the △uHU in different slices may be more reliable than the uHU acquired from a single slice in predicting pyonephrosis.

Background::Heterogeneity of tumor cells and the tumor microenvironment (TME) is significantly associated with clinical outcomes and treatment responses in patients with urothelial carcinoma (UC). Comprehensive profiling of the cellular diversity and interactions between malignant cells and TME may clarify the mechanisms underlying UC progression and guide the development of novel therapies. This study aimed to extend our understanding of intra-tumoral heterogeneity and the immunosuppressive TME in UC and provide basic support for the development of novel UC therapies.Methods::Seven patients with UC were included who underwent curative surgery at our hospital between July 2020 and October 2020. We performed single-cell RNA sequencing (scRNA-seq) analysis in seven tumors with six matched adjacent normal tissues and integrated the results with two public scRNA-seq datasets. The functional properties and intercellular interactions between single cells were characterized, and the results were validated using multiplex immunofluorescence staining, flow cytometry, and bulk transcriptomic datasets. All statistical analyses were performed using the R package with two-sided tests. Wilcoxon-rank test, log-rank test, one-way analysis of variance test, and Pearson correlation analysis were used properly.Results::Unsupervised t-distributed stochastic neighbor embedding clustering analysis identified ten main cellular subclusters in urothelial tissues. Of them, seven urothelial subtypes were noted, and malignant urothelial cells were characterized with enhanced cellular proliferation and reduced immunogenicity. CD8 + T cell subclusters exhibited enhanced cellular cytotoxicity activities along with increased exhaustion signature in UC tissues, and the recruitment of CD4 + T regulatory cells was also increased in tumor tissues. Regarding myeloid cells, coordinated reprogramming of infiltrated neutrophils, M2-type polarized macrophages, and LAMP3 + dendritic cells contribute to immunosuppressive TME in UC tissues. Tumor tissues demonstrated enhanced angiogenesis mediated by KDR + endothelial cells and RGS5 +/ACTA2 + pericytes. Through deconvolution analysis, we identified multiple cellular subtypes may influence the programmed death-ligand 1 (PD-L1) immunotherapy response in patients with UC. Conclusion::Our scRNA-seq analysis clarified intra-tumoral heterogeneity and delineated the pro-tumoral and immunosuppressive microenvironment in UC tissues, which may provide novel therapeutic targets.