Yueqiang Peng

Homeobox B4 (HOXB4) is a homeobox transcription factor implicated in development and oncogenesis; however, its role in bladder cancer (BCa) remains insufficiently defined. Bladder cancer is among the most common malignancies worldwide, and its high rates of recurrence and progression highlight the need to identify new molecular drivers and therapeutic targets. In this study, we show that HOXB4 is overexpressed in BCa and that elevated levels of HOXB4 are associated with unfavorable clinical outcomes. Functionally, HOXB4 knockdown markedly suppressed cellular proliferation, migration, invasion, and experimental lung colonization in vitro and in vivo. Furthermore, transcriptomic analyses and validation assays, including quantitative PCR, immunoblotting, RNA‐sequencing, luciferase reporter, and chromatin immunoprecipitation (ChIP) assays, demonstrated that perturbing HOXB4 modulates Hedgehog signaling. Mechanistically, HOXB4 bound to the Smoothened (SMO) promoter and transcriptionally activated SMO, thereby amplifying Hedgehog pathway activity and promoting malignant phenotypes in BCa cells. Collectively, these findings delineate a HOXB4‐SMO axis that drives BCa progression and suggest this pathway as a candidate target for patient stratification and therapeutic exploration. Future studies should validate these findings in larger multi‐center cohorts and assess the therapeutic potential of SMO inhibition in preclinical BCa models.

Background: Postoperative anxiety following voluntary medical male circumcision (VMMC) poses a significant health challenge, with limited telemedicine access and inadequate communication compromising recovery and adherence. Narrative-based interventions have shown promise in reducing psychological distress in other contexts, and large language models may enable automated follow-up, but their role in VMMC care remains underexplored. Objective: We evaluated the effect of a narrative-enhanced tool (NET) on anxiety, sleep quality, quality of life, and pain management and identified risk factors for postoperative anxiety. We also assessed the feasibility of an artificial intelligence–assisted consultation (AAC) system in improving follow-up efficiency. Methods: From October 1, 2023, to April 29, 2024, patients aged ≥15 years undergoing VMMC were recruited and randomized 1:1 to a standardized risk tool (SRT) or NET group. In addition to the routine postoperative communication, the NET group received a narrative video highlighting positive recovery experiences. Both groups accessed an AAC chatbot for automated follow-ups. Primary outcomes were anxiety levels measured by the 7-item Generalized Anxiety Disorder scale (GAD-7), sleep quality measured by Pittsburgh Sleep Quality Index, quality of life measured by 3-level EuroQoL 5D questionnaire, and pain levels measured by Numerical Rating Scale. Secondary outcomes included analgesic use, satisfaction, and health care worker efficiency. Repeated measures ANOVA assessed trends and regression identified risk factors for anxiety. Results: Between October 1, 2023, and April 29, 2024, 671 eligible participants were enrolled, with 388 completing the 30-day follow-up (SRT group: n=189, mean age 26.21, SD 3.69 years; NET group: n=199, mean age 26.41, SD 3.56 years; P =.60). Both groups exhibited increased anxiety levels, diminished quality of life, and poorer sleep quality during the 30-day postoperative period. However, compared to SRT, the NET group demonstrated lower GAD-7 scores (7.06, SD 2.73 vs. 9.95, SD 3.50; P <.001), improved sleep quality (12.29, SD 3.57 vs 13.20, SD 3.54; P =.01), higher quality of life scores (0.87, SD 0.07 vs 0.84, SD 0.09; P <.001), more regular analgesic use (154/173, 89.02% vs 100/169, 59.17%; P <.001), reduced opioid consumption (5/173, 2.89% vs 25/169, 14.79%; P <.001), and higher pain medication satisfaction (4.21, SD 0.69 vs 3.76, SD 0.97; P <.001). Multivariate analysis identified SRT assignment, inability to recall opioid risk levels, hematoma, swelling, and pain as independent risk factors for elevated GAD-7 scores. Implementation of the AAC substantially reduced health care worker follow-up time (2.34, SD 1.95 min vs 7.85, SD 2.65 min; P <.001). Conclusions: The study demonstrates that narrative is effective in reducing anxiety, improving quality of life, and improving pain management post-VMMC. The integration of artificial intelligence into clinical follow-up protocols has the potential to enhance health care worker efficiency without compromising patient satisfaction.

Flexible ureteroscopy (f-URS) is a minimally invasive surgical technique used for treating urinary tract stones. While general anesthesia (GA) is the standard method used, it comes with risks. Local anesthesia (LA) is a safer and more cost-effective alternative to GA, and its use in f-URS could potentially reduce patients' risks and increase accessibility to treatment. This study aims to investigate the feasibility, safety, and efficacy of using LA for f-URS in treating stones, as an initial experience in the diagnosis related group (DRG) era of China. Patients who met the inclusion and exclusion criteria and were continuously included in the study Between 2021 and 2023. We analyzed the stone free status, postoperative complication rate, hospitalization costs, and presented key points of the procedure performed under LA that we had summarized over the past two years. A study of 614 patients undergoing f-URS under LA for urinary stones in our hospital showed 83.4% stone-free rate with a mean operative time of 44.12 ± 16.63 minutes; 18 patients experienced fever postoperatively, and 12 had ureteral injuries. No severe complication was reported. The cost of LA was found to be only 1.7% of the DRG payment, which is around $40. The highest VAS scores were observed during the sheath insertion, with STAI scores decreasing during and after surgery. The study revealed that f-URS administered under LA was a well-tolerated, efficient, safe, and economical procedure. In the DRG era, this new anesthetic option for f-URS provides urologists with a more cost-effective alternative.