Abstract: Bladder cancer (BCa) is a major global urinary tract malignancy characterized by high incidence, frequent recurrence, and significant mortality. Early diagnosis is crucial for improving prognosis and minimizing invasive procedures; however, current standard techniques, cystoscopy and urine cytology, are limited by invasiveness, cost, low sensitivity, and subjectivity. This has spurred the development of non‑invasive diagnostic strategies based on urine analysis. This review highlights five emerging approaches: AI‑augmented urine cytology, genomic biomarker assays (e.g., PCR and NGS for mutations and copy‑number variations), DNA methylation profiling, RNA biomarkers (mRNA, miRNA, lncRNA), and protein/peptide/metabolite detection utilizing ELISA, SERS, nanozymes, and mass spectrometry. We assess the diagnostic accuracy, innovations, and clinical potential of each, while addressing persisting issues such as lack of standardization, high costs, and insufficient sensitivity for early‑stage lesions. Future directions include integrating multi‑omics data with AI, advancing point‑of‑care devices, and conducting large‑scale multicenter trials. Together, these developments promise to shift BCa management toward molecular‑based early detection, enabling more precise, non‑invasive, and personalized patient care.

Abstract: Background/Objectives Robot-assisted radical prostatectomy (RARP) is widely used in contemporary prostate cancer surgery, although surgeons enter robotic practice through heterogeneous training pathways. This study aimed to compare early oncological and functional outcomes after RARP between two experienced robotic surgeons with different surgical backgrounds once the learning curve had been surpassed. Methods: We conducted a retrospective, consecutive, single-center study including patients undergoing RARP after completion of the learning curve (>40 cases) by two experienced robotic surgeons with different surgical backgrounds. Baseline characteristics, perioperative variables, and early oncological and functional outcomes were compared between surgeons. Pentafecta achievement was assessed as an exploratory composite outcome. Appropriate non-parametric and categorical statistical tests were applied. Results: Ninety-three patients were included (55 operated on by surgeon A and 38 by surgeon B). Preoperative clinical and pathological characteristics were largely comparable between groups, except for prostate volume. Median operative time was significantly shorter for surgeon A (70 vs. 120 minutes, p < 0.001). Postoperative morbidity was low, with no major complications and no differences in length of hospital stay. At 6 months, urinary continence and erectile function recovery rates were high and comparable between surgeons. Oncological outcomes, including positive surgical margin rates and biochemical recurrence, did not differ significantly, although recurrence events were infrequent and follow-up was limited. Overall pentafecta achievement was modest and similar between groups (23.6% vs. 21.1%, p = 0.77), with positive surgical margins emerging as the main limiting factor. Conclusions: In this exploratory post–learning curve analysis, early oncological and functional outcomes after RARP were similar between surgeons with different surgical backgrounds. These findings should be interpreted cautiously and considered hypothesis-generating.

Abstract: Objective: Nocturia, defined as waking from sleep to void, is a frequent lower urinary tract symptom associated with impaired sleep quality and reduced quality of life. This study aimed to evaluate the prevalence of nocturia episodes and their impact on sleep disturbance and health-related quality of life. Methods: A questionnaire-based cross-sectional study was conducted at the Urology Outpatient Clinic of the General Hospital of Eastern Achaia between November 2023 and May 2024. Participants reporting nocturia were assessed using the Nocturia Quality of Life (N-QOL) questionnaire, the Athens Insomnia Scale (AIS), and the EQ-5D questionnaire. Demographic data and comorbid conditions were also collected. Univariate analyses and multiple linear regression were applied to identify factors associated with nocturia-related outcomes. Results: A total of 89 participants (78 men and 11 women; mean age 68.9 years) were included. Most participants reported 2–3 nocturnal voids per night. The N-QOL score was significantly associated with the frequency of nocturia episodes (r = −0.55, p < 0.0001), and regression analysis confirmed this relationship (coefficient: −6.7; 95% CI: −10.4 to −3.1). Individuals scoring ≥ 8 on the OAB-V8 scale demonstrated significantly lower N-QOL performance. Conclusions: Increasing nocturia frequency is associated with impaired sleep, reduced vitality, and diminished quality of life, particularly among older adults. Nocturia should be recognized as a clinically relevant symptom requiring targeted evaluation and personalized management strategies.

Abstract: Stereotactic body radiation therapy (SBRT) for localized prostate cancer delivers high doses per fraction, making dose constraints to the rectum and other organs at risk critical during treatment planning. This study evaluated the association between prostate-rectum separation achieved with a biodegradable balloon rectal spacer at different anatomical levels and corresponding organ-at-risk dose patterns. Thirty-three patients underwent transperineal balloon spacer implantation followed by SBRT to 36.25 Gy in five fractions. Prostate-rectum separation at the apex, midgland, and base was measured on CT and/or MRI and categorized as < 10 mm, 10-14 mm, or ≥14 mm. Rectal dose-volume parameters and mean doses to the rectum, bladder, and penile bulb were assessed using linear regression analyses and group comparisons at 14 mm separation. Mean prostate-rectum separation was 16.6 mm overall, with minimal high-dose rectal exposure observed. Increasing separation was associated with reduced rectal dose-volume parameters at the apex and midgland, while greater base separation corresponded primarily to lower bladder mean dose. Increased apical separation was also associated with reduced penile bulb mean dose. No acute gastrointestinal toxicity was observed, and genitourinary toxicity was limited to low-grade events. These findings indicate that prostate-rectum separation varies by anatomical level and is associated with distinct organ-at-risk dose relationships in prostate SBRT.

Abstract:

Almost 10% of the global population suffers from chronic kidney disease (CKD), a severe, progressive and irreversible condition that usually leads to the necessity of life-sustaining renal replacement therapy. The inexistence of a therapeutic intervention able to restore renal function loss motivates the scientific community to develop experimental and preclinical studies in search for new drugs and treatments. Most of these studies require animal models of CKD in order to resemble human nephropathy and human pathophysiological responses, and one of the main employed animals for this purpose is the rat (Rattus norvegicus). Among the variety of available rat CKD models described in the literature, the sub-total nephrectomy model, achieved through the 5/6 renal ablation, stands out, since it better mimics human CKD development and progression. However, there are still no consensus on the most appropriate rat strain for this purpose. The aim of this study was to compare the development and severity of the nephropathy associated to the 5/6 renal ablation model in Wistar, Lewis and Fischer rats. In summary, we observed that, even submitted to the very same surgical procedure of renal mass reduction, the 3 studies rat strains presented completely distinct patterns of CKD progression: Wistar rats exhibited faster, rapidly-progressive and sustained renal function loss, with exuberant hypertension, proteinuria and renal inflammation, and can be considered as excellent animal models to study rapidly progressive, severe human nephropathy and to develop quick tests on new therapies and drugs. Lewis animals, in turn, presented mild and low-progressive CKD, which make this rat strain especially useful to simulate intermediate degrees of human CKD and to develop long-term drug tests. Finally, Fischer rats submitted to the same 5/6 renal ablation model, not even developed hypertension nor proteinuria or structural glomerular damage. We also demonstrated that, compared to Wistar rats, both Lewis and, especially Fischer control rats have a relative higher basal number of nephrons, which may have consistently contributed to the observer renoprotection exhibited by this last rat strain.

Abstract:

Background/Objectives: IgA nephropathy (IgAN) is the most common primary glomerulopathy worldwide; it is characterized by a complex pathophysiology involving several inflammatory pathways. The Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway may be critical in this process. This study aimed to investigate the role of this pathway in IgAN and examine related tissue inflammatory markers. Methods: We analyzed 63 biopsy-confirmed patients with IgAN and performed immunohistochemical analysis on renal samples. A panel of antibodies targeting the JAK/STAT pathway, including JAK2, JAK3, p-STAT, STAT3, and MAPK/ERK, was used for this analysis. Six kidney tumor border samples were used as controls. Additionally, CD68 staining was used to evaluate tissue inflammation in the kidney biopsies. Results: Patients with IgAN showed a significantly higher cellular density of JAK3 staining at the glomerular level compared to controls, indicating JAK3 activation (p < 0.0002). Nevertheless, the correlation between JAK3 positivity in glomeruli and clinical parameters such as the initial and final estimated glomerular filtration rate (eGFR) and proteinuria was not statistically significant. Identical results were obtained with CD68+ macrophage counts in the glomerular compartment, which did not show any correlation with clinical parameters, while CD68+ tubulointerstitial staining demonstrated a significant correlation with both initial (p = 0.002) and final eGFRs (p = 0.0014), proteinuria (p = 0.010), and interstitial fibrosis (p < 0.001), as well as with renal disease progression (p = 0.005). Conclusions: Patients with IgAN exhibited activation of the JAK/STAT pathway, in contrast to controls. Macrophage CD68 staining in the tubulointerstitial area increased and was associated with clinical and laboratory parameters such as eGFR and proteinuria. Additionally, MEST-C histological parameters, such as segmental glomerulosclerosis (S0/S1), tubular atrophy/interstitial fibrosis (T0/T1/T2), and crescents (C0/C1/C2), were associated with a higher number of CD68+ cells.

Abstract: Background/Objectives: Wilms tumor is the most common pediatric renal malignancy, and delayed or inaccurate diagnosis can significantly affect clinical outcomes. This study aimed to evaluate whether integrating traditional machine-learning and deep-learning models with computed tomography (CT) imaging could improve the accuracy of Wilms tumor detection. Methods: A large CT image dataset consisting of 18,205 kidney scans, including both normal and Wilms tumor cases, collected from publicly available medical sources. Images were preprocessed and resized to standardized dimensions before model training. Four supervised learning approaches: ResNet50, VGG16, XGBoost, and Random Forest, were developed and evaluated. The dataset was split into training (14,055 images) and independent testing (4,150 images) subsets. Model performance was assessed using accuracy, precision, recall, F1-score, and confusion matrix analysis. Results: Among the evaluated models, VGG16 demonstrated superior performance, achieving an accuracy of 99.98%, precision of 99.92%, recall of 100%, and an F1-score of 99.96%, indicating excellent sensitivity and overall classification reliability. The remaining models also performed robustly, with accuracies exceeding 94% and recall values above 90%. Conclusions: These findings suggest that deep-learning-based image classification, particularly using VGG16, can substantially enhance non-invasive detection of Wilms tumor from CT scans. The proposed approach has the potential to support clinical decision-making, reduce diagnostic delays, and improve early detection in pediatric oncology settings.

Abstract: Objectives: Acute obstructive pyelonephritis (AOP) is a urological emergency that combines bacterial infection with upper urinary tract obstruction. This retrospective study focuses on the microbial etiology and causes of obstruction, clinical manifesta-tions, antibacterial therapy, drainage type, and outcomes in patients diagnosed with AOP at a tertiary urology center between 1 January 2020 and 30 December 2024. Methods: One hundred patients with a mean age of 61.30 years were included in this retrospective study, which examines demographic data, comorbidities, clinical fea-tures, pathogens involved, antimicrobial regimens, and hospital outcomes. Results: Urolithiasis was the most frequent cause of obstruction (62%), followed by ureteral stenosis (14%) and tumors (11%). AOPs were mainly produced by Escherichia coli (58%), followed by Klebsiella spp. (21%); 18% of all identified bacteria were ESBL-producing Gram-negative bacilli, and 29% were MDR bacteria. The most used IV antibiotics were fluoroquinolones (52%), followed by cephalosporins (19%) and carbapenems (18%). Carbapenems were administered to all patients with AOP caused by ESBL-producing pathogens and to 62% of those with MDR bacteria. The duration of antibiotic therapy was individualized based on clinical response. Switch to oral administration was made after 4.3 ± 1.5 days, and the antibiotic treatment lasted 10.8 ± 3.2 days. Conclusions: The present study results support the integration of evidence-based guidelines with regional patterns of bacterial susceptibility to optimize therapeutic approaches and reduce severe outcomes in patients with AOP, most of whom have multiple comorbidities.

Abstract:

Background: Post-streptococcal glomerulonephritis (PSGN) is a common cause of acute nephritic syndrome in children. Rarely, it may result in life-threatening complications, including acute pulmonary edema and critical hyperkalemia. Case Presentation: We report a 10-year-old Yemeni girl (25 kg) presenting with severe respiratory distress, irritability, and generalized pitting edema. Laboratory tests confirmed PSGN with markedly reduced complement C3 (42.2 mg/dL) and nephritic urine sediment containing numerous red blood cells and casts. The patient developed critical hyperkalemia (7.0 mmol/L) and acute pulmonary edema, requiring urgent intubation and mechanical ventilation using pressure-controlled mandatory ventilation (P-CMV). Management: Aggressive fluid mobilization and electrolyte stabilization were initiated. High-dose intravenous furosemide (4 mg/kg/day), renal-dose dopamine (5 μg/kg/min), and potassium-lowering interventions were applied. Morphine sedation (0.1 mg/kg/dose) was administered every 4 hours during the first 24 hours, then every 8 hours for 12 additional hours, followed by withdrawal prior to extubation. Morphine effectively controlled irritability and optimized patient–ventilator synchronization. The patient produced 1700 mL urine in 17 hours, demonstrating a strong diuretic response. Conclusion: Early recognition of severe extra-renal complications in PSGN is critical. Intensive supportive care—including mechanical ventilation, meticulous fluid and electrolyte management, and appropriate sedation—is essential for survival in cases of acute pulmonary edema and critical hyperkalemia.

Abstract: Background: Bladder cancer (BC) is the most common malignancy of the urinary tract. Approximately 75% of cases are non–muscle-invasive BC (NMIBC), while muscle-invasive BC (MIBC) and advanced tumors account for most cancer-specific mortality. Accurate assessment of tumor invasion is essential, as staging variability may lead to inappropriate treatments. Tumor invasion involves several mechanisms including extracellular matrix (ECM) remodeling mediated by metalloproteinases, angiogenesis, and cell adhesions. Masson’s trichrome staining (MTS) provides relevant information on ECM composition. This study evaluated the application of machine learning to MTS-stained bladder biopsies to predict muscle invasion. Methods: A retrospective analysis of bladder biopsies images obtained from transurethral resections and cystectomies (2022–2024). A total of 702 histological images were analyzed. A convolutional neural network (CNN) was trained to classify tumors as MIBC or NMIBC and model outputs were correlated with clinical variables. Results: The CNN achieved an accuracy of 95.2% in the training set and 90.1% in validation. Model-derived probabilities were significantly associated with tumor grade, lesion size, and muscle invasion. Logistic regression demonstrated a strong association with invasive disease (OR = 0.07, p = 0.017). Conclusion: CNN-based analysis of MTS-stained bladder biopsies images enables accurate prediction of muscle invasion, with potential to improve diagnostic precision.

Abstract: Background and hypothesis. Mortality in hemodialysis (HD) remains high and cannot be entirely clarified by tradi-tional risk factors. The interplay between arterial stiffness, cardiac remodeling, and biomarker activation, such as galectin-3 and NT-proBNP, may be a potential driver of adverse outcomes in this setting. Combining biomarker profiling with NT-proBNP and galectin-3 may improve risk stratification. Methods. This was an observational study of 173 stable, asymptomatic HD patients, followed for more than 10 years. Patients were classified into four groups based on baseline NT-proBNP and galectin-3 medians (4,234 pg/mL and 28.1 ng/mL, respectively). Pri-mary outcomes were all-cause mortality, major cardiovascular events (MACE), and an exploratory outcome: all-cause mortality stratified by pulse wave velocity (PWV). Results. The overall mortality rate was 76.9% in our cohort: 21.1% died from cardiovascular causes, 21.1% from sepsis, and 22.6% of patients died from other causes. 31.6% of pa-tients were coded as sudden death. High NT-proBNP (Groups 3–4) was associated with the poorest survival (adjusted HR 2.58 and 1.93 vs. Group 1, p< 0.05). Age and PVW were independently associated with higher mortality risk. Each one-year increase in age was associated with a 4% higher risk of death, and each 1m/s increase in PVW corresponded to a 6% increase in mortality risk. MACE occurred in 26.8% and did not differ among biomarker groups. Conclusion. In this long-term HD cohort, biomarker profiles that included high NT-proBNP, pre-dicted all-cause mortality. Raised PWV further augmented risk, underlying the inter-play between cardiac stretch and vascular stiffness.

Abstract: Chronic kidney disease (CKD) markedly increases the risk of cardiovascular events (CVE), yet conventional biomarkers often fail to capture this excess risk. We evaluated whether circulating levels and genetic variability within the FGF19/β-Klotho/FGFR axis contribute to CV risk stratification in CKD. In 579 CKD patients, plasma FGF19 and β-Klotho con-centrations were quantified, and 64 genetic variants across FGF19, KLB, FGFR1 and FGFR4 genes were analyzed. Cluster analysis identified three distinct biomarker profiles, with one cluster—characterized by low/intermediate FGF19 and markedly elevated β-Klotho—showing significantly reduced CV event-free survival. After adjustment for clinical covariates, this cluster was independently associated with higher CV risk [HR=2.97 (1.12–7.92), p=0.029]. Two genetic variants also showed independent associa-tions: FGFR1 rs2288696 (protective) [HR=0.51 (0.27–0.95), p=0.029] and KLB rs2687971 (risk-increasing) [HR=2.03 (0.97–4.27), p=0.046]. A combined CV risk model incorporating biomarker clusters, relevant SNPs and traditional risk factors achieved good discrimina-tive ability (C-index = 0.80), with the FGF19/β-Klotho cluster showing predictive im-portance comparable to diabetes and previous CV history. These findings suggest that in-tegrating FGF19-Klotho biomarkers with genetic information may enhance CV risk pre-diction in CKD.

Abstract: Bladder cancer (BC) represents a significant global health burden, ranking as the tenth most commonly diagnosed malignancy worldwide, with an incidence rate of 5.6 per 100,000 person-years annually. This comprehensive review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to search four databases from January 2018 to November 2025 summarizes evidence on specialized nursing-led interventions for bladder cancer management across the disease continuum. This concise but informative systematic review of 20 studies revealed substantial clinical and patient-reported benefits from specialized nursing interventions. Enhanced recovery after surgery (ERAS) protocols incorporating structured nursing care demonstrated a 35% reduction in postoperative complications. Integrated nursing interventions during post-operative intravesical therapy significantly improved patient satisfaction (P ˂ 0.001), treatment compliance (100 vs. 84%), and self-efficacy, while reducing anxiety and de-pression (P ˂ 0.001). Digital health platforms, including internet based and mobile ap-plications, proved effective in reducing caregiver burden, enhancing disease knowledge, and improving coping strategies. Preoperative stoma education and postoperative osto-my care management significantly improved self-efficacy, stoma care knowledge (Co-hen’s d=1.60; P ˂0.001), and overall health-related quality of life. Psychosocial interven-tions, including cognitive behavioral therapy and mindfulness-based approaches, demonstrated significant improvements in quality of life and reductions in fear of recur-rence, depression, and anxiety. However, a critical evidence gap exists regarding bladder cancer-specific mental health interventions. This review demonstrates that specialized nursing led care significantly improves clinical outcomes, patient satisfaction, symptom management, and quality of life across all phases of bladder cancer care, while reducing caregiver burden and enhancing psychological well-being.

Abstract:

Background/Objectives: Surgical refinements in robot-assisted partial nephrectomy (RAPN) aim to reduce morbidity and optimize renal function preservation, particularly in patients with high-complexity renal tumours. This study describes the no-touch adaptive technique for RAPN and compares its perioperative outcomes, postoperative complications, and early renal function with those of the conventional approach. Methods: A cohort of 72 consecutive patients with high-complexity renal tumours undergoing RAPN was evaluated. The study group included 38 patients treated with the no-touch adaptive technique, while 34 patients underwent the conventional approach. The no-touch adaptive technique consisted of sutureless, off-clamp simple tumour enucleation with incremental haemostasis and the option to shift to arterial clamping, tumour enucleoresection, or renorrhaphy as needed. The conventional technique involved on-clamp minimal enucleoresection with double-layer renorrhaphy. Outcomes assessed included completion of a fully no-touch procedure, perioperative metrics, 90-day postoperative complications, and 3-month renal function change from baseline. Results: Baseline characteristics were comparable between groups. A fully no-touch RAPN was achieved in 30/38 (79%) patients. Adaptation was required in eight cases: shift to main arterial clamping (n=2), renorrhaphy (n=5), or both (n=1), with one conversion to total nephrectomy due to intractable bleeding. Estimated blood loss was similar between groups (study: 150 ml [IQR 75–250] vs. control: 180 ml [IQR 100–400]). Length of stay was significantly shorter in the study group (3 days [IQR 3–4]) compared with controls (5 days [IQR 6–8]). Any-grade 90-day complications were significantly lower with the no-touch technique (21% vs. 56%, p<0.01). Clinically significant 3-month eGFR decline occurred in 14% of controls versus 0% of study patients (p = 0.02). Conclusions: The no-touch adaptive RAPN technique is feasible in high-complexity renal tumours and provides reduced morbidity and superior early renal function preservation compared with the conventional approach.

Abstract: In synthetic aperture radar (SAR), low-power radiofrequency measurements from different antennae are combined to emulate a larger aperture. In the near-field below 6 GHz, SAR exploits the dielectric contrast between urine and the surrounding pelvic tissues to estimate bladder volume (BV). Herein, we describe and technically ground a wearable belt-SAR for contactless monitoring in urology and robotic surgery. The flexible belt carries 12–16 radiofrequency modules with time-division multiple-input/multiple-output frequency-modulated continuous-wave acquisition. Per-channel range spectra are fused with near-field back-projection or time-reversal, followed by segmentation and ellipsoidal model-fitting to estimate BV. Motion and posture are handled with inertial-measurement-unit gating. Benchwork relies on layered pelvic dielectric phantoms referenced to standard tissue-property datasets; clinical evaluation is planned versus handheld three-dimensional ultrasound with predefined BV thresholds. Belt-SAR may yield feasible axial and lateral resolution for centimeter-depth targets and stable reconstructions under breath-gated acquisition. It is designed to meet a BV absolute-error target of ≤80 mL over 100–600 mL. Use-case analyses suggest applicability in urinary-retention pathways, prostate-radiotherapy setup, community/long-term care, and intraoperative monitoring during robot-assisted urologic procedures. Belt-SAR may complement ultrasound for BV assessment, offering benefits in workflow, infection-prevention strategies, and patient experience. Regulatory compliance and prospective clinical validation are the next milestones.

Abstract: Sarcopenia is characterized by the progressive loss of muscle mass and function, and it represents a significant and prevalent condition in patients undergoing peritoneal dialysis (PD). However, limited research has been conducted to document techniques for the early detection of sarcopenia in PD patients. This review addresses the pathophysiology, prognostic implications, and various assessment techniques for sarcopenia, including creatinine kinetics, anthropometry, imaging techniques (computer tomography, magnetic resonance imaging, and ultrasound sonography), bioimpedance spectrometry, and the modified creatinine index. Each of these techniques presents unique strengths and limitations, necessitating careful consideration of the most appropriate assessment method based on specific clinical conditions. By synthesizing current knowledge, this review aims to evaluate the strengths and limitations of available muscle-assessment techniques and assist in the development of improved diagnostic strategies for sarcopenic PD patients.

Abstract: Background: Assisted reproductive therapy (ART) has been utilized as an effective therapeutic strategy for addressing infertility worldwide, and one of the key determinants of ART success is the acquisition of high-quality embryos through in vitro fertilization (IVF). We investigated here which male factors were associated with embryo formation and quality in conventional IVF (cIVF). Methods: This study was an exploratory sub-analysis of a trial conducted to examine the associations of clinical and lifestyle factors with sperm abnormalities in 41 men of infertile couples without identifiable male factors. From the original cohort, 21 men whose partners underwent cIVF were included for blastocyte outcome assessment. Semen samples were evaluated for standard sperm parameters and DNA fragmentation index (DFI). Blood biochemical parameters and lifestyle habits were also evaluated. Blastocysts were assessed 5 days after cIVF, and implantation success was determined 10 days after embryo transfer. Results: All participants showed normozoospermia with mild sperm DFI in 76%. Blastocysts were formed in 32% of the oocytes following cIVF, with good blastocyst development and quality observed in 71% and 39%, respectively. The implantation success and live birth rates after embryo transfer was 53% and 43%, respectively. Regression analysis identified sperm DFI as the only variable inversely associated with all blastocyst outcomes. In contrast, no parameters were associated with implantation success or live birth rates. Conclusions: The present findings suggest the hypothesis that sperm DNA fragmentation may negatively affect high-quality embryo formation in cIVF, even among normozoospermic men with non-severe levels of sperm DFI.

Abstract: Chronic kidney disease (CKD) is a growing global health burden for which there are no curative treatments; therefore, it is essential to implement preventive and kidney-protective strategies. The renal kallikrein-kinin system (KKS) is a vasodilator, anti-inflammatory, and antifibrotic pathway located in the distal nephron, whose decline contributes to hypertension and CKD progression. A thorough evaluation of both experimental and clinical data was undertaken to ascertain the interactions between dietary potassium, renal KKS activity, and kidney protection. A particular focus was placed on animal models of proteinuria, tubulointerstitial damage, and salt-sensitive hypertension, in conjunction with human studies on potassium intake and renal outcomes. Experimental models show that potassium-rich diets stimulate renal kallikrein synthesis, increase urinary kallikrein activity, and up-regulate kinin B₂ receptor expression, leading to reduced blood pressure, oxidative stress, apoptosis, inflammation, and fibrosis. These effects are lost with B₂ receptor blockade. In humans, higher potassium intake enhances kallikrein excretion and lowers cardiovascular and renal risk, independently of aldosterone, and low potassium intake has the potential to exacerbate CKD progression. Notwithstanding the concerns that have been raised regarding the potential necessity of increasing potassium intake in cases of advanced CKD, extant evidence would appear to indicate that potassium excretion persists until late disease stages. Activation and preservation of the renal KKS through a potassium-rich diet represents a rational, low-cost renoprotective strategy. Combined with sodium reduction and nutritional education, this approach could mitigate CKD progression and improve cardiovascular health on a population scale.

Abstract: Background: Arteriovenous fistula (AVF) occlusion remains a major cause of vascular access failure in hemodialysis patients. Early identification of high-risk patients may help prevent complications and improve outcomes. Methods: This retrospective cohort study included 1,498 adult patients who underwent AVF creation between 2015 and 2025 at Daegu Catholic University Medical Center. Clinical, surgical, and laboratory variables were used to develop machine learning (ML) models for predicting AVF occlusion. Five algorithms—LightGBM, CatBoost, XGBoost, Random Forest, and Logistic Regression—were trained and evaluated using stratified 5-fold cross-validation. Model performance was assessed using area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, and calibration. SHAP (Shapley Additive Explanations) analysis was used to interpret variable importance. Results: Among the 1,498 patients, 381 (25.4%) experienced AVF occlusion. LightGBM achieved the best performance (AUC = 0.887, accuracy = 0.858, specificity = 0.950), followed by CatBoost (AUC = 0.882) and XGBoost (AUC = 0.879). Calibration analysis demonstrated strong agreement between predicted and observed outcomes. SHAP analysis identified ferritin, hemoglobin, neutrophil percentage, and C-reactive protein as the most influential predictors, highlighting the role of inflammation and hematologic status in AVF failure. Conclusions: Gradient boosting–based ML models, particularly LightGBM and CatBoost, accurately predict AVF occlusion using routine clinical data. Explainable AI methods enhance interpretability, enabling early identification of high-risk patients and supporting precision vascular access management in hemodialysis care.

Abstract: Background/Objectives: Prostate cancer is the most prevalent malignancy in men and remains a leading cause of cancer-related mortality worldwide. Conventional imaging modalities exhibit limited sensitivity, particularly in the context of disease recurrence and advanced disease. Methods: A narrative review was conducted of studies published between 2015 and 2025, identified through PubMed, Embase, and Cochrane. Eligible publications addressed advanced imaging techniques, PSMA-targeted diagnostics and therapies, radiogenomics, liquid biopsy approaches, and artificial intelligence applica-tions and personalized medicine. Preclinical studies, single case reports, and conference abstracts without full text were excluded. Results: PSMA PET/CT outperforms conven-tional imaging for detection, and restaging, influencing clinical management across disease stages. Lutetium-177–PSMA-617 has become the standard radioligand therapy for metastatic castration-resistant prostate cancer, whereas alpha-emitting agents remain under clinical investigation. Radiogenomics and liquid biopsy assays (ctDNA, CTCs, AR-V7) provide complementary molecular insights. Artificial intelligence enhances imaging interpretations, standardization, and reproducibility, while multimodal data integration supports individualized risk stratification. Integrative models combining imaging, genomic, and liquid biopsy data pave the way toward precision oncology and personalized therapeutic decision-making. Conclusions: Advances in imaging and theragnostics are reshaping prostate cancer management, bridging the gap between molecular biology and clinical practice to enable precision oncology.