Objective:To explore the application and research progress of lasers in the treatment of kidney neoplasms through an integrated bibliometric and Meta-analysis study.Methods:On June 7th, 2024, an online search of the Web of Science Core Collection (WoSCC) and China National Knowledge Infrastructure (CNKI) databases for all relevant literature on lasers in kidney neoplasms was conducted. The retrieved results were subjected to a comprehensive bibliometric analysis. The high-quality studies were then screened to further describe the clinical characteristics of patients who underwent laser-assisted laparoscopic partial nephrectomy (LLPN). Subsequently, a Meta-analysis was performed using RevMan 5.4.1 software on further selected high-quality studies to compare the changes in renal function before and after LLPN treatment, and the differences in efficacy between LLPN and traditional laparoscopic partial nephrectomy (LPN).Results:Our study obtained a total of 549 publications on lasers in kidney neoplasms, including 513 in English and 36 in Chinese. Bibliometric analysis revealed an overall upward trend in the annual publications and citations in this field. China was found to be a leading contributor ranking second in total publications ( n=100, 18.2%). The primary application of laser treatment was in nephron-sparing surgery for kidney neoplasms, especially in LPN. We further screened 11 high-quality studies comprising 284 patients who underwent LLPN for kidney neoplasms. Comprehensive descriptive statistical analysis was performed on clinical characteristics of the 284 patients. All patients had T 1a stage tumors with a mean tumor length of 2.6 cm (range: 0.8-4.0 cm), all being local, solitary, and exophytic tumors. Further Meta-analysis indicated that there were no significant differences in renal function indicators including both serum creatinine levels ( MD=4.52, 95% CI-9.73-0.69, P = 0.09) and estimated glomerular filtration rate ( MD=3.05, 95% CI-1.03-7.13, P= 0.14) before and after LLPN. Additionally, compared to traditional LPN, LLPN showed significantly reduced operative time ( MD=-10.58, 95% CI= -13.11-8.06, P<0.001), but no significant differences in estimated blood loss ( MD= -27.09, 95% CI-67.38-13.21, P=0.19) and hospital stay ( MD=-1.59, 95% CI-3.42-0.25, P=0.09). Conclusions:The application of lasers in managing of kidney neoplasms is arousing increasing attention among urologists. LLPN offers several advantages, including precise cutting and effective hemostasis. This technique demonstrates considerable clinical value for patients with exophytic T 1a kidney neoplasms undergoing "zero-ischemia" nephron-sparing surgery.

Objective:To explore the clinical application value of frozen-thawed single blastocyst derived from nonpronuclear (0PN) zygotes, monopronuclear (1PN) zygotes and two-pronuclei (2PN) discarded embryos.Methods:A retrospective cohort analysis of the data of patients who underwent frozen-thawed single blastocyst transfer at the Reproduction Center of the Third Affiliated Hospital of Zhengzhou University from March 2014 to November 2020. According to the different sources of transplanted blastocysts, they were divided into 4 groups including group A derived from 2PN available embryos (2PN embryos with morphological rating Ⅰ-Ⅲ), group B derived from 0PN embryos, group C derived from 1PN embryos, group D derived from 2PN discarded embryos (2PN embryos with morphological rating Ⅳ). The basic data of the four groups were analyzed,and group A was used as the reference group to compare the clinical pregnancy outcomes of groups B, C and D, respectively. The neonatal situation was compared at the cycle of singleton live birth. Logistic regression was used to correct for confounding factors and calculate the adjusted odds ratio (a OR) and 95% confidence interval ( CI). Results:After correcting for confounding factors by logistic regression, the live birth rate in group B was significantly lower than that in group A (a OR=0.701, 95% CI: 0.534-0.920, P=0.011). The clinical pregnancy rate and the live birth rate in group D were significantly lower than those in group A (a OR=0.595, 95% CI: 0.456-0.777, P<0.001; a OR=0.600, 95% CI: 0.449-0.800, P=0.001). The differences in miscarriage rate, pregnancy complications and multiple pregnancy rate were not statistically significant compared with group A (all P>0.05). The differences in all the above indicators in group C were not statistically significant compared with group A ( P>0.05). The risk of occurrence of macrosomia (group B: a OR=2.367, 95% CI: 1.299-4.315, P=0.005; group D: a OR=2.711, 95% CI: 1.463-5.026, P=0.002), large for gestational age (group B: a OR=1.930, 95% CI: 1.158-3.217, P=0.012; group D: a OR=2.039, 95% CI: 1.174-3.543, P=0.011) were significantly higher in groups B and D than in group A. The differences in the risk of occurrence of low birth weight, small for gestational age and preterm birth were not statistically significant in groups B and D compared with group A ( P>0.05), and the difference in the risk of occurrence of the above indicators was not statistically significant in group C compared with group A ( P>0.05). Conclusion:When 2PN embryos are not available, abandoned 0PN, 1PN, and 2PN embryos can be transferred after blastocyst culture, but attention should be paid to the increased risk of macrosomia and large for gestational age in offspring.

Objective:To explore the clinical application value of frozen-thawed single blastocyst derived from nonpronuclear (0PN) zygotes, monopronuclear (1PN) zygotes and two-pronuclei (2PN) discarded embryos.Methods:A retrospective cohort analysis of the data of patients who underwent frozen-thawed single blastocyst transfer at the Reproduction Center of the Third Affiliated Hospital of Zhengzhou University from March 2014 to November 2020. According to the different sources of transplanted blastocysts, they were divided into 4 groups including group A derived from 2PN available embryos (2PN embryos with morphological rating Ⅰ-Ⅲ), group B derived from 0PN embryos, group C derived from 1PN embryos, group D derived from 2PN discarded embryos (2PN embryos with morphological rating Ⅳ). The basic data of the four groups were analyzed,and group A was used as the reference group to compare the clinical pregnancy outcomes of groups B, C and D, respectively. The neonatal situation was compared at the cycle of singleton live birth. Logistic regression was used to correct for confounding factors and calculate the adjusted odds ratio (a OR) and 95% confidence interval ( CI). Results:After correcting for confounding factors by logistic regression, the live birth rate in group B was significantly lower than that in group A (a OR=0.701, 95% CI: 0.534-0.920, P=0.011). The clinical pregnancy rate and the live birth rate in group D were significantly lower than those in group A (a OR=0.595, 95% CI: 0.456-0.777, P<0.001; a OR=0.600, 95% CI: 0.449-0.800, P=0.001). The differences in miscarriage rate, pregnancy complications and multiple pregnancy rate were not statistically significant compared with group A (all P>0.05). The differences in all the above indicators in group C were not statistically significant compared with group A ( P>0.05). The risk of occurrence of macrosomia (group B: a OR=2.367, 95% CI: 1.299-4.315, P=0.005; group D: a OR=2.711, 95% CI: 1.463-5.026, P=0.002), large for gestational age (group B: a OR=1.930, 95% CI: 1.158-3.217, P=0.012; group D: a OR=2.039, 95% CI: 1.174-3.543, P=0.011) were significantly higher in groups B and D than in group A. The differences in the risk of occurrence of low birth weight, small for gestational age and preterm birth were not statistically significant in groups B and D compared with group A ( P>0.05), and the difference in the risk of occurrence of the above indicators was not statistically significant in group C compared with group A ( P>0.05). Conclusion:When 2PN embryos are not available, abandoned 0PN, 1PN, and 2PN embryos can be transferred after blastocyst culture, but attention should be paid to the increased risk of macrosomia and large for gestational age in offspring.

Objective:To investigate the effects of different sperm retrieval methods on clinical pregnancy and perinatal outcomes in patients undergoing intracytoplasmic sperm injection (ICSI) for pregnancy.Methods:A retrospective cohort study was conducted to analyze the clinical data of patients who underwent ICSI for male factors in Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from October 2015 to October 2020. A total of 3096 cycles were included. Patients with oligozoospermia had sperm retrieval by ejaculation, which was recorded as ejaculation group ( n=2558); patients with azoospermia had sperm retrieval by surgical method (PESA/TESA/mirco-TESE), which was recorded as surgical sperm retrieval group ( n=538). The ovulation promotion and embryo culture of the two groups were compared and analyzed, and the clinical pregnancy outcome and perinatal outcome indexes of fresh embryo transfer patients in the two groups were observed. Results:Data from both groups were adjusted for confounding factors by linear/logistic regression, which revealed that the number of high-quality embryos [ MD(95% CI)=0.412(0.153-0.670), P=0.002] and blastocyst formation [ MD(95% CI)=0.265(0.035-0.494), P=0.024] were significantly higher in surgical sperm retrieval group relative to ejaculation group, and the number of two pronuclei (2PN) and the number of available embryos were not statistically different (all P>0.05). The embryo implantation rate [a OR(95% CI)=1.311(1.010-1.701), P=0.042] and the clinical pregnancy rate [a OR(95% CI)=1.307(1.007-1.697), P=0.044] were significantly higher in patients after fresh embryo transfer. The differences in live birth rate, multiple birth rate, miscarriage rate, singleton preterm birth rate, singleton full-term neonatal weight and sex ratio between the two groups were not statistically significant (all P>0.05). Conclusion:Patients with azoospermia can still obtain a live birth rate comparable to that of conventional ICSI through surgical sperm retrieval and do not increase the risk of miscarriage, fetal malformation, singleton preterm birth, or full-term low birth weight babies.

Objective:To investigate the effects of different sperm retrieval methods on clinical pregnancy and perinatal outcomes in patients undergoing intracytoplasmic sperm injection (ICSI) for pregnancy.Methods:A retrospective cohort study was conducted to analyze the clinical data of patients who underwent ICSI for male factors in Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from October 2015 to October 2020. A total of 3096 cycles were included. Patients with oligozoospermia had sperm retrieval by ejaculation, which was recorded as ejaculation group ( n=2558); patients with azoospermia had sperm retrieval by surgical method (PESA/TESA/mirco-TESE), which was recorded as surgical sperm retrieval group ( n=538). The ovulation promotion and embryo culture of the two groups were compared and analyzed, and the clinical pregnancy outcome and perinatal outcome indexes of fresh embryo transfer patients in the two groups were observed. Results:Data from both groups were adjusted for confounding factors by linear/logistic regression, which revealed that the number of high-quality embryos [ MD(95% CI)=0.412(0.153-0.670), P=0.002] and blastocyst formation [ MD(95% CI)=0.265(0.035-0.494), P=0.024] were significantly higher in surgical sperm retrieval group relative to ejaculation group, and the number of two pronuclei (2PN) and the number of available embryos were not statistically different (all P>0.05). The embryo implantation rate [a OR(95% CI)=1.311(1.010-1.701), P=0.042] and the clinical pregnancy rate [a OR(95% CI)=1.307(1.007-1.697), P=0.044] were significantly higher in patients after fresh embryo transfer. The differences in live birth rate, multiple birth rate, miscarriage rate, singleton preterm birth rate, singleton full-term neonatal weight and sex ratio between the two groups were not statistically significant (all P>0.05). Conclusion:Patients with azoospermia can still obtain a live birth rate comparable to that of conventional ICSI through surgical sperm retrieval and do not increase the risk of miscarriage, fetal malformation, singleton preterm birth, or full-term low birth weight babies.