The renal functional advantages of selective artery clamping (SAC) compared with main artery clamping (MAC) remain inconsistent. This study aimed to assess the impact of SAC versus MAC on ipsilateral renal function after minimally invasive partial nephrectomy (MIS-PN) in patients with bilateral kidneys. This study included 692 patients with bilateral kidneys who underwent ipsilateral clamped MIS-PN using either SAC or MAC, with available imaging, serum creatinine, and split renal function measured at defined pre- and postoperative time points. Propensity score matching (PSM, 1:2) was performed to balance baseline characteristics. Spectrum score was used to assess the degree of acute ipsilateral renal dysfunction. Recovery from ischemia (Recischemia) was defined as ipsilateral glomerular filtration rate preserved% normalized by parenchymal volume preserved%. Multivariable linear regression analyses were conducted to identify factors associated with Recischemia and spectrum score. After PSM, 365 patients were analyzed (125 SAC/240 MAC). In the limited ischemia cohort (warm ischemia time [WIT] ≤ 30min) (94 SAC/177 MAC), no significant differences were observed between the SAC and MAC groups in the spectrum score (0.1 vs. 0.1, p = 0.66) or Recischemia (92.9% vs. 94.2%, p = 0.97). However, in the prolonged ischemia cohort (WIT >30 min) (31 SAC/63 MAC), the SAC group exhibited significantly better Recischemia (97.9% vs. 92.5%, p = 0.03) and a lower spectrum score (0.1 vs. 0.2, p = 0.02) than the MAC group. Multivariable analyses confirmed SAC as an independent predictor of improved Recischemia (p < 0.01) and alleviated acute ipsilateral renal dysfunction (p = 0.03) in the prolonged ischemia cohort. Compared with the MAC group, the SAC group had a longer operative time (169 vs. 128min, p < 0.01) and greater blood loss (100 vs. 50 mL, p < 0.01). Under prolonged WIT, SAC afforded superior ipsilateral renal function preservation compared with MAC in patients with bilateral kidneys, which guides experienced surgeons in optimizing MIS-PN strategies for patients with complex renal masses.

Renography: Methods and Pitfalls.

Ureteropelvic junction obstruction (UPJO) is a major cause of obstructive uropathy in pediatric patients. However, the optimal management remains controversial. We aimed to summarize the evidence comparing surgical versus conservative treatment. We searched MEDLINE/PubMed (2016 to 31 October 2024) and the Cochrane Central Register of Controlled Trials (CENTRAL) on 31 October 2024. The primary outcome was split renal function (SRF). Results were summarized in a structured table. Study quality was assessed using the ROBINS-I tool and the level of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. Our search resulted in 2.251 reports. We included two non-randomized interventional studies with 136 patients. One study reported no statistically significant difference in SRF between the study groups after 1 year of follow up, while the second study reported higher SRF in surgical group 6 months postoperatively. The studies were judged to have a serious risk of bias, and the quality of evidence was rated as very low. The paucity of eligible data precluded the performance of a meta-analysis. Our findings could not support clinical recommendations. This study highlights the lack of high-quality evidence that will come from large, prospective, well-designed trials comparing surgical intervention to updated conservative treatment options.

Wireless contactless human activity sensing is a new type of sensing method that uses the propagation characteristics of wireless signals to accurately perceive and understand human behavior. However, facing the huge amount of newly generated data and expanding action categories in the sensing process, the traditional model needs to be retrained frequently. This model not only brings significant computational power overhead, but also seriously affects the real-time response speed of the system. To address this problem, this paper proposes a model, WIS (Wireless Incremental Sense), which is composed of two parts. The first part is the basic sensing module NFFCN (Nearest Neighbor Feature Fusion Classification). NFFCN is a fusion classification method based on Nearest Class Mean (NCM) classifier and Random Forest (RF). By combining the local feature extraction ability of NCM and the integrated learning advantage of RF, this method can efficiently extract human behavior features from wireless signals and achieve high-precision classification. The second part is the incremental learning module NFFCN-RTST, which uses the retraining subtree (RTST) incremental strategy to optimize the model. Unlike update leaf statistics (ULS) and the Incrementally Grow Tree (IGT) incremental strategy, RTST not only updates the statistical data of leaf nodes but also dynamically adjusts the previously learned splitting function, so as to better adapt to new data and categories. In the experimental validation on the rRuler and Stan WiFi datasets, the average recognition accuracy of NFFCN reaches 87.1% and 98.4%, respectively. In the class-incremental experimental validation, the recognition accuracy of WIS reaches 87% and 95%, respectively.

A multidisciplinary panel of lung cancer experts with a special interest in functional evaluation of lung cancer patients, and lung cancer patient representatives, has been facilitated by the European Society of Thoracic Surgeons and the European Respiratory Society to provide healthcare professionals with practical and up-to-date recommendations for the assessment of patients' fitness for curative intent treatments for lung cancer. The panel formulated four PICO (population, intervention, comparison and outcomes) questions and seven complementary narrative questions. Both types of questions were assigned to groups of at least two experts. A medical librarian conducted the literature searches, and the authors selected relevant studies based on predefined inclusion criteria. Risk of bias was assessed using the QUIPS (Quality in Prognosis Studies) tool. Data were summarised and the certainty of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluations) and the Evidence to Decisions framework was used to formulate recommendations. A series of multidisciplinary recommendations was formulated about the utilisation of pulmonary function tests, split lung function values, exercise tests, cardiologic testing, and the role of prehabilitation, sublobar resections, risk scores and comorbidities in selecting patients for curative intent treatment.

Pelvi-Ureteric Junction Obstruction (PUJO) is one of the most frequent causes of hydronephrosis in both children and adults. It may present with flank pain, vomiting, or progressive renal dysfunction, and if left untreated, may cause irreversible renal damage. Although laparoscopic and robotic techniques are gaining popularity, open pyeloplasty continues to be the gold standard, particularly in anatomically complex cases. A series of three cases of adult PUJO presented here, which were managed with open surgical reconstruction, each with distinct intraoperative findings and outcomes. A 30-year-old male presented with right flank pain and vomiting for two months. Computed Tomography (CT) urography revealed moderate hydronephrosis with a grossly dilated inferomedial calyx, while Diethylenetriaminepenta Acetic Acid (DTPA) scan showed reduced right renal function {24.2%, Glomerular Filtration Rate (GFR) 21.7 mL/min}. Intraoperatively, the dilated lower calyx was compressing a high-insertion ureter. Reduction calycoplasty with infundibular dilatation and Double J (DJ) stenting was performed. Follow-up DTPA showed a 10% increase in split function and +8 mL/min GFR improvement. A 20-year-old female with dull aching left flank pain for one year had a CT urography suggestive of severe hydronephrosis with cortical thinning. DTPA scan showed left kidney function at 18.3% (GFR 16.1 mL/min). Retrograde pyelography confirmed a grossly dilated pelvis. Anderson-Hynes dismembered pyeloplasty was performed, preserving a crossing systemic vein. Follow-up DTPA demonstrated a 10% rise in split function and +10.3 mL/min GFR gain. A 55-year-old female with intermittent right flank pain and vomiting for one year had Intravenous Pyelography (IVP) and Right Retrograde Pyelogram (RGP) suggestive of PUJO due to Pelvi-Ureteric Junction (PUJ) kink with poor drainage. She underwent standard dismembered pyeloplasty. Postoperative recovery was uneventful, and she remains asymptomatic with preserved renal function. In this case series, all three cases were rare and unique presentations of PUJO.

A multidisciplinary panel of lung cancer experts with a special interest in functional evaluation of lung cancer patients, and lung cancer patient representatives, has been facilitated by the European Society of Thoracic Surgeons and the European Respiratory Society to provide healthcare professionals with practical and up-to-date recommendations for the assessment of patients' fitness for curative intent treatments for lung cancer. The panel formulated four PICO (population, intervention, comparison and outcomes) questions and seven complementary narrative questions. Both types of questions were assigned to groups of at least two experts. A medical librarian conducted the literature searches, and the authors selected relevant studies based on predefined inclusion criteria. Risk of bias was assessed using the QUIPS (Quality in Prognosis Studies) tool. Data were summarised and the certainty of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluations) and the Evidence to Decisions framework was used to formulate recommendations. A series of multidisciplinary recommendations was formulated about the utilisation of pulmonary function tests, split lung function values, exercise tests, cardiologic testing, and the role of prehabilitation, sublobar resections, risk scores and comorbidities in selecting patients for curative intent treatment.

The substructure of jets in quantum chromodynamics (QCD) has garnered significant attention with the advent of infrared- and collinear-safe clustering algorithms and observables. A key question emerging from these studies is how in-jet emissions at soft and hard energy scales, across collinear and wide angles relative to the emitter, differ with the mass of the emitting parton. The Lund jet plane (LJP) is a perturbatively well-defined substructure observable that maps the radiation pattern of jets onto a plane, visually distinguishing emissions with different kinematic properties. Comparing LJP for jets containing hadrons of low versus high mass enables the testing of QCD splitting functions from first-principles calculations across both soft and hard regimes and at different radiation angles. This article presents the first measurement of the LJP for light-quark-enriched and beauty-initiated jets at a center-of-mass energy of 13 TeV at LHCb. This marks the first direct observation of the dead-cone effect in beauty-quark jets, measured in the collinear region of the LJP.

To compare renal function outcomes between asymptomatic and symptomatic ureteral stones and to develop and validate a predictive nomogram for postoperative renal recovery after ureteroscopic lithotripsy (URSL). This two-center retrospective study included consecutive patients who underwent URSL between March 2018 and March 2023. Patients were categorized into asymptomatic and symptomatic groups. Renal function recovery was defined as a postoperative glomerular filtration rate (GFR) of the affected kidney exceeding 90% of the contralateral side at 1year. Predictors were identified by logistic regression and incorporated into a nomogram. Model performance was assessed by receiver operating characteristic (ROC)analysis, calibration, and decision curve analysis (DCA), with both internal (bootstrap resampling) and external validation. Among 635 patients who underwent URSL, 465 (73.2%) demonstrated recovery of renal function at 1year postoperatively. Asymptomatic stones (n = 38, 5.98%) were associated with larger size, upper ureteral location, severe hydronephrosis, and lower preoperative GFR compared with symptomatic stones. Multivariate logistic regression identified six independent predictors of renal function recovery: older age, diabetes mellitus, higher hydronephrosis grade, complete obstruction, lower preoperative split renal function, and symptomatic status (all p < 0.05). The nomogram incorporating these variables demonstrated good discrimination (AUC = 0.786) and calibration (MAE = 0.02), which was confirmed by external validation (AUC = 0.805; MAE = 0.03). Decision curve analysis (DCA) further indicated superior clinical net benefit across a wide range of threshold probabilities. Asymptomatic ureteral stones were associated with delayed diagnosis, advanced obstruction, and limited renal recovery. The proposed nomogram provides a validated, individualized tool to estimate recovery probability and may inform early surgical intervention strategies.

BackgroundThe intrarenal resistive index (RI) is a reliable and well-established indicator for predicting total renal function in patients with two kidneys. However, it is not yet known whether the ultrasound (US) parameters, including the intrarenal RI, can be used to predict split renal function in solitary kidneys. This study aimed to investigate the relationship between US parameters, such as the RI and split renal function, in patients with solitary kidneys.MethodsA retrospective cross-sectional study was conducted of patients suspected of having solitary kidneys. From January 2004 to December 2023, the data of 78 patients who underwent US examinations for this condition at our hospital were reviewed. Renal function was evaluated using the estimated glomerular filtration rate (eGFR), calculated with the Chronic Kidney Disease Epidemiology Collaboration equation. US parameters, including kidney length and renal RI, were recorded. The study cohort was divided into two groups based on the eGFR results: the renal dysfunction (RDF) group (eGFR <60 mL/min per 1.73 m2), and the non-RDF group (eGFR ≥60 mL/min per 1.73 m2). The clinical characteristics and US parameters between these groups were compared. A logistic regression analysis was conducted to examine the relationships between the US parameters, such as the intrarenal RI and split renal function.ResultsUltimately, 57 patients with solitary kidneys [average age: 60.05±14.21 years (range, 31–86 years); 36 men] were included in the study. The multivariate regression analysis indicated that the RI and kidney length were independent predictors of RDF (P=0.005 and P=0.029, respectively). The receiver operating characteristic (ROC) curve analysis revealed area under the receiver operating characteristic (AUROC) curve values of 0.815 for the RI, 0.776 for kidney length, and 0.782 for the RI and kidney length combined (all P<0.0001). An RI cutoff value of 0.63 had a sensitivity of 85.71% and a specificity of 72.22%, while a kidney length cutoff value of 10.6 cm had a sensitivity of 61.9% and a specificity of 88.89%. The combination of both had a sensitivity of 61.9% and a specificity of 94.44%, as well as the highest accuracy of 82.46%. However, no significant differences were found among the AUROC values (all P>0.05).ConclusionsAn intrarenal RI of 0.63 or higher and a kidney length of 10.6 cm or shorter predict split kidney dysfunction in patients with solitary kidneys.

Abstract Precise and compact polarization control is vital in fields ranging from classical optics to high‐dimensional physics. Fiber‐based polarization optics offer low‐loss and high flexibility but are limited in miniaturization and functional diversity, while planar integrated optics often suffer from polarization sensitivity and poor fiber compatibility. A 3D polarization optics platform is presented, based on laser‐written gradient‐index (GRIN) waveguides in bulk glass. This approach enables high‐fidelity polarization engineering with record‐low birefringence (2 × 10 −8 )—over an order of magnitude lower than standard fibers—and low coupling losses (as low as 0.02 dB per facet). Besides, this platform supports the high‐fidelity implementation of polarization‐encoded 3D photonic circuits, integrating essential polarization operations such as splitting, conversion, and arbitrary waveplate functions, by customizing polarization‐dependent GRIN waveguides with birefringence accuracy of 10 −8 and arbitrary rotation of the optical axis over a full 0‐π range. Leveraging these capabilities, controlled polarization retardance covering the entire fiber‐optic communication band (1030–1700 nm) is further demonstrated, and realize a unidirectional waveguide array via spatially engineered birefringence and coupling strength, achieving &gt;20 dB crosstalk suppression without external fields. This platform bridges the gap between fiber and chip‐scale photonics, offering a versatile route to broadband optical interconnects, polarization‐encoded quantum optics, and nonreciprocal topological photonics.

We propose and demonstrate a dual-channel symmetric optical 90-degree hybrid on a 220 nm silicon-on-insulator (SOI) platform. The device integrates both coherent hybrid and signal splitting functions in a compact footprint based on an 8 × 8 multimode interference (MMI) structure, which helps reduce insertion loss and layout complexity. Simulations predict low phase error and high common-mode rejection ratio (CMRR). Experimental characterization confirms the functionality of the fabricated device. The hybrid formed by Output 1-4 exhibits CMRRs of over 10.6 dB in the 1520-1580 nm range, with a phase error of less than 9.5° in the 1520-1564 nm range. The Output 5-8 hybrid achieves CMRRs exceeding 15 dB in the 1520-1580 nm range, with a phase error remaining below 8.7° in the 1520-1564 nm range. These results validate the design and indicate the potential for further optimization in future fabrication iterations, highlighting the multifunctional integration advantage of the proposed device over conventional designs.

ABSTRACTBackgroundLiving kidney donation is a crucial option for addressing the global organ shortage and providing kidney transplantation for patients suffering from end‐stage kidney disease. Ensuring donor safety necessitates a comprehensive preoperative assessment of kidney anatomy and function. This study evaluates the relationship between kidney volumes derived from deep learning‐based MRI volumetry, intraoperative kidney volume measurements, split renal function measured by renal scintigraphy, and post‐donation eGFR. Deep learning‐based MRI volumetry is hypothesized to be a reliable method with good correlation.MethodsThis retrospective study analyzed 178 living kidney donors. Deep learning MRI volumetry‐based kidney volumes were compared with intraoperative volumes of the explanted donor kidneys obtained using the water displacement method. Additionally, MRI‐based volume ratios were compared with scintigraphy‐based split renal function ratios to determine their ability to predict the kidney with poorer renal function and post‐donation eGFR.ResultsDeep learning‐based MRI volumetry strongly correlated with intraoperatively measured kidney volumes (Pearson's correlation; r = 0.7671; p < 0.0001), confirming its precision in volume estimation. Although MRI‐based kidney volume ratios demonstrated only a moderate correlation with scintigraphy‐based split renal function ratios (r = 0.4798), MRI volumetry correlated with 1‐year post‐donation eGFR. It tended to be better than renal scintigraphy (r = 0.6829 versus r = 0.6191).ConclusionDeep learning‐based MRI volumetry is a reliable, non‐invasive tool for estimating kidney volumes in living donors, offering a radiation‐free alternative for preoperative assessment. While it differs from renal scintigraphy in evaluating split renal function ratios, its correlation with post‐donation eGFR tends to be better, supporting its potential role in living kidney donor assessment.

Background Hydrocephalus is a severe complication of neonatal bacterial meningitis (NBM), threatening the health and quality of life of neonates, affecting the outcome of nervous system development, and leading to neurological sequelae, such as movement disorders, hearing impairment, mental retardation, and epilepsy. Improvement in prognosis is closely related to early identification and active treatment. Objective To find the independent risk factors of NBM complicated with hydrocephalus, to construct the related risk prediction model and validate it, in order to provide help for clinicians to identify the children with high risk of hydrocephalus at an early stage, to guide clinical decision-making and improve prognosis. Methods528 children with NBM hospitalized in Kunming Children’s Hospital from January 2019 to December 2022 were selected. After excluding 46 patients with incomplete medical records And 1 death case, 481 patients remained. They were randomly divided into a training set (n = 337) and a validation set (n = 144) (the division ratio was 7:3) by using the split function in R language. The basic information, cerebrospinal fluid routine biochemistry, blood routine, blood culture, imaging findings, and other indicators of the children were collected. Determination of whether hydrocephalus was complicated based on the child’s brain magnetic resonance imaging or CT. LASSO regression was used to screen independent risk factors for NBM complicated by hydrocephalus, And independent risk factors were Analyzed by using multivariate logistic regression. The risk prediction model for NBM complicated by hydrocephalus was constructed by using the analysis results, and a nomogram was created. The model was internally validated based on the cases in the training and internal validation sets. A total of 132 children with NBM who were hospitalized at Peking University First Hospital from January 2006 to December 2021 were included in the study. After excluding 2 cases with incomplete medical records, the remaining 130 cases were used as external validation cases to externally validate the model.ResultsTwenty predictive variables were screened out by LASSO regression analysis, including NBM type, BW, age of onset, pregnancy complications, gestational age, birth asphyxia, umbilical cord, amniotic fluid, maximum body temperature, vomiting, convulsions, anterior fontanel, blood culture, PLT, peak value of WBC, peak value of N, peak value of PLT, CSF multinucleated percentage peak, lowest value of CSF glucose, and intracranial hemorrhage. The results of multifactorial Logistic regression analysis after oversampling showed that the significant risk factors were intracranial hemorrhage (OR = 6.922, P < 0.001), anterior fontanel (OR = 8.002, P < 0.001), lowest value of CSF glucose (OR = 0.416, P < 0.001), gestational week (OR = 0.870, P = 0.0088), maternal pregnancy complications (OR = 0.284, P = 0.0118), convulsions (OR = 2.906, P = 0.0178), amniotic fluid (OR = 2.417, P = 0.0263), and CSF multinucleated percentage peak (OR = 1.011, P = 0.0350). There was no statistically significant difference between convulsions, maternal pregnancy complications and CSF multinucleated percentage peak in binary logistic regression. Therefore, a nomogram risk prediction model was created with the remaining five predictive variables. The area under the ROC curve (AUC) of the training set after weighting was 0.925 (95%CI = 0.899–0.951), the internal validation set was 0.894 (95%CI = 0.829–0.959), And the external validation set was 0.758 (95%CI = 0.677–0.839); the goodness-of-fit test showed that the training set P = 0.431, internal validation set P = 0.224, and external validation set P = 0.176. Decision curve analysis (DCA) showed that the net benefit of the model was higher than the net benefit at the extremes in a large range of thresholds in the training set, internal validation set, and external validation set.ConclusionThe Nomogram risk prediction model established in this study, which includes five indicators of the lowest CSF glucose level, combined intracranial hemorrhage, anterior fontanel, gestational week, and amniotic fluid, can early predict the risk of NBM complicating hydrocephalus.

Recent research suggests that functional recovery begins to decline after ≈30 min of warm-ischemia time (WIT) following clamped partial nephrectomy (PN). However, the extent of this decline and populations at risk remain unclear. Our objective was to identify factors associated with functional decline following prolonged WIT in Japanese and American patients. A multi-institutional retrospective review of PN patients managed with prolonged WIT (> 30 min) at Tokyo Women's and Cleveland Clinic (2010-2024). Inclusion required pre-and post-operative serum creatinine and cross-sectional imaging. Ipsilateral split renal function (SRF) was assessed using parenchymal volume analysis (PVA). Recovery from ischemia (RecIschemia) was defined as ipsilateral GFR preserved normalized by percent parenchymal volume preserved (PPVP). Multivariable analysis identified factors associated with RecIschemia, PPVP, and % global GFR preservation. 300 U.S./171 Japanese patients met inclusion criteria. U.S. patients had increased comorbidities, including obesity, hypertension, and cardiovascular disease. A significant and similar decline in global GFR for every additional 10 min of WIT was seen in both the Japanese and U.S. patients (3.1% vs. 4.0%, respectively, p = 0.41). Independent predictors of decline in global GFR were PPVP in both cohorts and longer WIT only for U.S. R.E.N.A.L. and tumor size were primary drivers of decline in PPVP, and WIT and HTN were drivers of decline in RecIschemia, but only in U.S. Japanese and U.S. patients undergoing PN with prolonged WIT experienced a similar decline in global GFR, albeit driven by different factors potentially reflecting differences in patient populations and/or surgical technique. Our data suggest that avoiding prolonged WIT may be important in patients with solitary kidneys and/or severe CKD, although further studies will be needed.

Background/Objectives: This prospective study aimed to assess residual cortical function at follow-up in patients with traumatic renal injuries using Tc-99m dimercaptosuccinic acid (DMSA) single-photon emission computed tomography (SPECT) and evaluate clinical factors associated with residual cortical function. Methods: A total of 59 patients with renal injury who were treated non-operatively and underwent Tc-99m DMSA SPECT at the follow-up (3 months ± 1 year) were enrolled. The correlation between residual cortical function and renal injury grades, alongside other clinical factors, was analysed. Results: The mean age of the patients was 49.10 ± 22.67 years, and 35 (59.3%) were male. In total, 28 patients (47.5%) had high-grade injuries, and 20 (33.9%) underwent a renal artery endovascular procedure (RAE). High-grade renal injury correlated with laboratory renal function and DMSA scintigraphic parameters, especially SPECT split renal function (SRF) (ρ = −0.565; p < 0.001); meanwhile, a significant decrease existed in DMSA scintigraphic parameters in patients with high-grade injuries. Furthermore, laboratory renal function and DMSA scintigraphic parameters were significantly decreased in patients who underwent RAE. The multivariable analysis highlighted that high grade renal injury (odds ratio [OR], 9.50; 95% confidence interval (CI), 1.78–50.61; p = 0.008) and RAE (OR, 5.15; 95% CI, 1.07–24.88; p = 0.041) were significant factors associated with decreased residual cortical function. Conclusions: Tc-99m DMSA SPECT provides accurate information on the residual cortical function at follow-up in patients with renal injuries. Additionally, high-grade renal injury and RAE were associated with decreased residual cortical function.

Abstract We present a method for obtaining an initial-state parton shower model where the (backward) evolution fully consistent with the (forward) evolution of the collinear parton density used. As a proof-of-concept we use parton densities obtained with the parton branching (PB) approach, and modify the default initial-state shower in Pythia8 with this method to be consistent with them. PB is ideally suited for checking the validity of our method since, in addition to producing collinear parton densities, it also produces the corresponding transverse-dependent (TMD) ones, and these can then be directly compared to the transverse momentum distribution obtained from the parton shower. We show that TMD distributions which we in this way obtain from our modified Pythia8 shower using leading order (LO) parton densities and splitting functions are fully consistent with the corresponding leading order TMD densities. At next-to-leading order (NLO) it is not possible to achieve the same consistency using the built-in LO splitting functions in the shower, but we show that by introducing NLO splitting functions using a reweighting procedure, we can achieve consistency also at NLO. The method presented here, which we have named Pdf2Isr, can be easily extended to any collinear parton densities, as long as the exact conditions for the evolution are known. With the Pdf2Isr method we obtain an initial-state parton shower which in principle has no free parameters, and is fully consistent with collinear parton densities at LO and NLO.

We have determined the fourth-order nf contributions to the two splitting functions governing the evolution of all flavor differences of quark distributions of hadrons in perturbative quantum chromodynamics with nf light flavors. The analytic forms of these functions are presented in both Mellin N space and momentum-fraction x space for a general gauge group. In the small-x limit double logarithms occur, but the small-x rise of both splitting functions is confined to extremely small-x values, x≲10−6. The large-x limit includes the nf-part of the four-loop quark virtual anomalous dimension. Using this result we obtain also the nf contributions to the corresponding gluonic quantity and the complete threshold-enhanced logarithms from soft-gluon emission for a large class of inclusive observables, including Higgs boson production in gluon-gluon fusion.

Parenchymal-volume-analysis (PVA) appears superior to nuclear-renal-scans (NRS) for assessing split-renal-function (SRF). Our objective was to evaluate how ischemia during PN impacts the accuracy of PVA for estimating functional outcomes. Partial nephrectomy (PN) patients (2010-2022) with pre/postoperative NRS and cross-sectional imaging were retrospectively analyzed. Differences between NRS and PVA-derived ipsilateral SRF estimates were evaluated in warm/cold ischemia subgroups. The relationship between ischemia time and PVA/NRS discordance was evaluated with linear and segmented-regression. Correction for PVA overestimation was applied to a previously published cohort of PN patients managed with prolonged-ischemia. Among 437 PN, 246(56%)/191(44%) were managed with warm/cold ischemia, with median ischemia times of 21/28 minutes, respectively. Preoperative PVA and NRS-based ipsilateral SRF estimates were nearly identical (r=0.94). Post-PN, median PVA-based estimates of ipsilateral SRF were significantly higher than NRS-derived estimates for patients managed with warm-ischemia (WI)(44% vs. 42%, P=0.001), which was not observed with hypothermia. Segmented-regression revealed increasing PVA/NRS discordance only after 24 minutes of WI (P=0.04). No relationship was observed between ischemia time and PVA/NRS discordance for hypothermia or limited WI. Correcting for PVA overestimation in an independent cohort demonstrated that functional decline associated with prolonged WI was 2-3 fold greater than estimated by PVA alone. PVA is highly accurate for predicting SRF in PN patients preoperatively and for assessing functional outcomes in patients managed with hypothermia or limited WI. However, with prolonged WI, there is discordance between parenchymal volume and function that progressively increases beyond 24 minutes. Avoidance of prolonged WI should be considered in patients with solitary kidneys and/or significant pre-existing chronic kidney disease.

Long-Term Outcomes of Robotic-Assisted Laparoscopic Pyeloplasty for Unilateral Ureteropelvic Junction Obstruction in Infants.