Objectives To investigate the outcomes of internal ureteral stents in comparison with ureteroscopy (URS) for pregnant women with urolithiasis. Data sources Relevant studies published from January 1980 to June 2022 were identified through systematic literature searches of MEDLINE, EMBASE, Web of Science and the Cochrane Library. Methods of study selection A total of 499 studies were initially identified. We included pregnant women in any stages of gestation who underwent double-J (D-J) stent insertion only or ureteroscopy for the treatment of urolithiasis; for a study to be included, the number of participants needed to exceed 10. This systematic review was registered on the PROSPERO website (Reference: CRD42020195607). Results A total of 25 studies were identified with 131 cases undergoing serial stenting and 789 cases undergoing URS. The pooled operative success rate was 97% for D-J stent insertion and 99% for URS. Only a few patients passed stones spontaneously after serial D-J stenting. The pooled stone free rate (SFR) in URS operations was about 91%. For internal ureteral stent therapy, the rate of normal fertility outcomes was 99%, although the pooled incidence of complications was approximately 45%. For group receiving URS treatment, the rate of normal fertility outcome was 99% and the pooled incidence of complications was approximately 1%. However, the pooled rate of premature birth and abortion were the similar between the two groups (< 1%); the rate of serious complications was also similar between the two groups. Conclusions Although internal ureteral stents may cause more minor complications, both ureteroscopy and internal ureteral stents showed had low rates of adverse effects on fertility outcomes when used to treat pregnant women with symptomatic urolithiasis. Evidence suggests that URS may have a greater advantage for pregnant patients with urinary stones when conditions permit. Since, it has been proven to be safe and effective, internal ureteral stents could be considered in emergency or other special situations.

Liu Wei Di Huang Wan (LWDHW) is a well-known Chinese herbal compound, which has been prescribed for the treatment of gestational diabetes mellitus (GDM). We sought to clarify the potential therapeutic effects of LWDHW against GDM. Differentially expressed genes (DEGs) in GDM were firstly identified from the Gene Expression Omnibus (GEO) database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed to reveal the biological functions of the DEGs. Subsequently, the LWDHW-compound–target network was constructed based on public databases to identify the relationship between the active components in LWDHW and the corresponding targets. Furthermore, gene functional analysis and protein–protein interaction (PPI) network construction were applied to investigate the function of potential targets and to evaluate hub genes. Finally, molecular docking was used to verify the binding activities between active ingredients and hub targets. Thirteen active components and 39 corresponding therapeutic target genes were obtained via network pharmacology analysis. The enrichment analysis demonstrated that the anti-GDM effect of LWDHW included oxidoreductase activity, involvement in renal system process, and regulation of blood pressure, which may be achieved through regulation of serotonergic synapses, vascular smooth muscle contraction, and neuroactive ligand–receptor interaction pathways. Additionally, molecular docking revealed that the main active component, Mu Dan Pi, exhibited the best affinity for proteins encoded by hub genes. This study applied network pharmacology analysis and molecular docking to display the multicomponent and multitarget characteristics of LWDHW in the treatment of GDM. Our findings provide novel insights into the pathogenesis of GDM and the therapeutic mechanisms of LWDHW against GDM.

Rapid adaptive evolution and phenotypic plasticity are two mechanisms that are often thought to underlie invasiveness of alien plant species, but whether they can co‐occur within invasive plant populations under altered environmental conditions such as nitrogen (N) enrichment has seldom been explored. Latitudinal clines in plant trait responses to variation in environmental factors may provide evidence of local adaptation. Here, we inferred the relative contributions of phenotypic plasticity and local adaptation to the performance of the invasive plant Ambrosia artemisiifolia under different soil N levels, using a common garden approach. We grew A. artemisiifolia individuals raised from seeds that were sampled from six invasive populations along a wide latitudinal cline in China (23°42'N to 45°43'N) under three N (0 g N·m‐2, 5 g N·m‐2, and 10 g N·m‐2) levels in a common garden. Results show significant interpopulation genetic differentiation in plant height, number of branches, total biomass, and transpiration rate of the invader A. artemisiifolia across the N treatments. The populations also expressed genetic differentiation in basal diameter, growth rate, leaf area, seed width, root mass, above‐ground biomass, stomatal conductance, and intercellular CO2 concentration regardless of N treatments. Moreover, plants from different populations of the invader displayed plastic responses in time to flowering, hundred‐grain weight, net photosynthesis rate, and relative biomass allocation to roots and shoots and seed length under different N treatments. Additionally, individuals of A. artemisiifolia from higher latitudes grew shorter and allocated less biomass to the roots regardless of N treatment, while latitudinal cline (or lack thereof) in other traits depended on the level of N in which the plants were grown. Overall, these results suggest that rapid adaptive evolution and phenotypic plasticity in the various traits that we quantified may jointly contribute to invasiveness of A. artemisiifolia under different levels of N availability. More broadly, the results support the idea that phenotypic plasticity and rapid adaptive evolution can jointly enable invasive plants to colonize a wide range of environmental conditions.

Objectives To investigate the outcomes of internal ureteral stent versus ureteroscopy (URS) treatments for pregnant women with urolithiasis. Design This is a systematic review and meta-analysis of observational studies that investigated the outcomes of internal ureteral stent and ureteroscopy for pregnancy with urolithiasis. This systematic review have been registered on the PROSPERO website (www.york.ac.uk/inst/crd, registration number: CRD42020195607). Data Sources Relevant studies published from January 1980 to April 2020 were identified through a systematic literature search in MEDLINE, EMBASE, Web of Science and the Cochrane Library. Data extraction and synthesis All pregnant women in their all pregnancy stages who were underwent double-J (D-J) stent insertion only or URS operation for lithotripsy/stone extraction/exploration were considered. The number of related participants in study more than 10 were included. Fertility outcome and complications of intervention were extracted as main outcomes, while other data such as operation success rate, stone free rate (SFR), patient characteristics, anaesthetic method, ureteral stone characteristics, detail of interventions were obtained as well. Complications were stratified according to Clavien-Dindo criteria. Two authors independently extracted data and assessed the quality of included studies. Study-specific prevalence rates were pooled using a random-effects model. We applied the Newcastle-Ottawa Scale quality assessment to evaluate the quality of the selected studies. Results A total of 25 studies were identified with 131 cases undergoing serial stenting and 789 cases undergoing URS operation. The age range was from 16 to 41, and urolithiasis occurred in the second trimester most. Ultrasound was the most commonly used diagnostic method. The most common site of calculi was distal ureter. The average stone size was between 6-17mm. There were 6 studies investigating D-J stent insertion only, while 23 studies involving URS operation. The most commonly used anesthesia for internal ureteral stent therapy was local anesthesia, and for URS treatments, general anesthesia and spinal anesthesia were widely used. The pooled operation success rate was 97% for D-J stent insertion, and 99% for URS. Serial D-J stenting was an effective methods for treating ureter obstruction and only a few patients passed stone spontaneously. Different common lithotripters were used in URS operations and the pooled SFR was about 91%. For internal ureteral stent therapy; the rate of normal fertility outcome was 99%, but the pooled incidence of complications was about 45%. For the URS treatment group, the rate of normal fertility outcome was 99% as well, and the pooled incidence of complications was about 1%. However, the pooled premature and abortion incidence rate of two group were the same as less than 1%, and the same as this in serious complication incidence rate. Conclusions Both ureteroscopy operation and internal ureteral stent were usually used for handing pregnancy with urolithiasis. Two treatments had less side effective on fertility outcome, but internal ureteral stent may cause more complications. Evidence suggests that URS therapy may have a greater advantage for pregnancy with urolithiasis when the conditions permit. As it is proved safe and effective, internal ureteral stent could be considered at emergency condition or preoperative preparations was lack.