Ureteral stricture (US) is a common urological disease with complex etiologies, including benign and malignant lesions, iatrogenic injuries, and idiopathic factors. Without timely intervention, it can lead to upper urinary tract obstruction and progressive, irreversible renal impairment. Traditional re-constructive surgeries are often limited by high technical demands, significant surgical risks, and strict requirements for patient fitness. To address these challenges, segmental metallic ureteral stents (SMUSs) have gained prominence in recent years. Featuring a non-full-length design for targeted support, excellent radial strength, and a large caliber, SMUSs provide reliable drainage and allow for long-term retention. They effectively overcome the common drawbacks of traditional double-J stents, such as frequent encrustation, the need for regular replacement, and severe bladder irritation. Consequently, SMUSs have become a vital maintenance therapy for patients with malignant obstructions or those unsuitable for re-constructive surgery. Moreover, they have shown curative potential by providing long-term efficacy for certain benign strictures. However, due to the high heterogeneity of stricture etiologies, significant controversies and knowledge gaps remain in clinical practice. These mainly pertain to the precise selection of stent types for specific indications, the standardization of surgical implantation, optimal indwelling durations, and strategies for preventing and managing long-term complications. Drawing upon the latest global evidence-based medicine and large-sample follow-up data from our center, this article systematically reviews the clinical application and efficacy differences of SMUSs across malignant, benign, and radiotherapy-induced ureteral strictures. We provide an in-depth analysis of major ongoing clinical controversies and propose practical management strategies for complications leading to stent failure, including stent obstruction, migration, encrustation, recurrent infections, and high-risk ureteral fistulas.

Prostate cancer is the second most common malignant tumor among men worldwide. Its early diagnosis relies on screening. How to increase the detection rate of clinically significant prostate cancer, avoid overdiagnosis and over-treatment of low-risk tumors, while also considering economic benefits, has become a core issue in the field of screening. Currently, international prostate cancer screening strategies are moving from a single prostate-specific antigen (PSA) screening to individualized risk stratification, and exploring the roles of various stratification tools, such as magnetic resonance imaging (MRI), new biomarkers, and risk prediction models. However, there is no universally recognized unified approach. In recent years, although the incidence of prostate cancer in China has increased rapidly, the early diagnosis rate is still low. This is directly related to the insufficient prevalence of prostate cancer screening in China. Moreover, China also faces problems such as the lack of a reasonable screening model for elderly high-risk populations, insufficient public awareness, and the absence of a refined screening path. Future work involves building stratified screening strategies suitable for the Chinese population based on Chinese data, promoting the transition of screening from opportunistic to systematic, and is a task that needs to be carried out.

Objective: To characterize the clinicopathological features of long-term survivors among patients with clear cell renal cell carcinoma (ccRCC) and venous tumor thrombus (VTT) who underwent surgical treatment, and to explore potential prognostic factors beyond tumor-related variables, with particular emphasis on host-related inflammatory and nutritional indicators. Methods: The patients with ccRCC and VTT who underwent radical nephrectomy combined with tumor thrombectomy at Peking University Third Hospital between 2014 and 2019 were retrospectively analyzed. The patients were stratified into a long-term survival group (overall survival ≥60 months) and a non-long-term survival group (overall survival < 60 months). The following parameters were compared between the two groups: clinical characteristics (age, sex, body mass index, Mayo classification), pathological features (T stage, M stage, histological grade, sarcomatoid change, perirenal fat invasion), perioperative parameters (surgical approach, operative time, intraoperative blood loss, complications), and laboratory parameters (platelet count, albumin, neutrophil count, etc.). Optimal cutoff values for continuous variables, such as age, body mass index (BMI), platelet count and serum albumin level, were determined using X-tile software based on the minimum P-value principle. Subsequently, Kaplan-Meier survival analysis with Log-rank test was performed within the long-term survival cohort to evaluate the association of the above-mentioned factors with long-term survival. Results: Long-term survival was achieved in 13.9% of 397 patients with ccRCC and VTT. Significant differences were observed between the long-term survival group (n=55) and the non-long-term survival group (n=342) in baseline platelet count (P=0.040), pathological T stage (P=0.001), histological grade (P=0.006), surgical approach (P < 0.001), as well as receipt of systemic therapy (P=0.028), treatment timing (P=0.003), and treatment regimen (P < 0.001). Regarding T stage, the long-term survival group had a significantly higher proportion of pT3a tumors (63.6% vs. 42.4%) and a significantly lower proportion of pT4 tumors (10.9% vs. 33.0%) compared with the non-long-term survival group. The long-term survival group also had a higher proportion of low-grade tumors (G1/G2: 50.9% vs. 31.9%). Regarding surgical approach, laparoscopic surgery predominated in the long-term survival group (35/55, 63.6%), whereas the non-long-term survival group had a more balanced distribution, including open surgery (102/342, 29.8%), laparoscopic surgery (123/342, 36.0%), and robotic surgery (117/342, 34.2%). Regarding systemic therapy, in the long-term survival group, 26 patients (47.3%) received systemic therapy, all of whom (100.0%) received adjuvant therapy. In the non-long-term survival group, 215 patients (62.9%) received systemic therapy, of whom 160 (74.4%) received adjuvant therapy and 55 (25.6%) received neoadjuvant therapy. Regarding treatment regimen, the long-term survival group was predominantly treated with targeted monotherapy (25/26, 96.2%), whereas the non-long-term survival group had a higher proportion of targeted therapy plus immunotherapy combination (64/215, 29.8%). The median follow-up time for the long-term survival group was 81.7 months. Further subgroup analysis of this group showed that age < 70 years (P=0.038), BMI≥18.5 kg/m² (P=0.032), platelet count 159×10⁹/L-273×10⁹/L (P=0.003), and albumin level >41.4 g/L (P=0.028) were significantly associated with better long-term survival, whereas Mayo classification of tumor thrombus showed no significant association with long-term survival (P=0.250). Conclusion: A subset of patients with ccRCC and VTT can achieve long-term survival. Beyond pathological tumor stage and grade, patient-related inflammatory and nutritional status may be associated with long-term survival. Exploring prognostic factors related to long-term survival may help further optimize risk stratification and treatment strategies for high-risk patients.

Objective: To investigate the clinicopathological and genetic features of acquired cystic kidney disease (ACKD) and secondary renal cell carcinoma (RCC) in end-stage renal disease (ESRD) patients undergoing dialysis. Methods: The clinicopathological data of 9 patients with ACKD, of whom, 7 had concurrent RCC, of the Department of Pathology, Peking University Third Hospital from 2020 to 2025 were retrospectively analyzed. Immunohistochemistry (IHC) and next-generation sequencing (NGS) were used to detect RCC-related proteins and targeted-drug associated gene variations/microsatellite instability (MSI) status. Results: The 9 patients were all male, aged 29-64 years. Causes of ESRD included hypertension, IgA nephropathy, chronic glomerulonephritis, and diabetes. Dialysis duration ranged from 1 to 30 years (median 9.0 years), and 3 patients had kidney transplantation history. Imaging showed reduced kidney size and multiple cysts, including complex cysts. Solid lesions were found in the cyst wall of 5 patients with secondary RCC. The maximum diameter of tumors was 1.3-7.0 cm (median 3.0 cm). Histologically, except for typical morphological changes of ACKD and atypical renal cysts, some cases had papillary adenoma and hemorrhage. Six ACKD-associated RCC (ACKD-RCC) patients and 1 papillary RCC (pRCC) patient were diagnosed. Most ACKD-RCC tumor cells had eosinophilic cytoplasm; 5 patients predominantly showed papillary structure, and 1 patient mainly presented sieve-cystic with acinar/solid/micropapillary structures. Oxalate crystals were found in all ACKD-RCC cases, and most patients were accompanied by necrosis and calcification. P504S and CK7 were diffusely or focally positive in all the cases, while CAⅨ was negative. The World Health Organization/International Society of Urological Pathology (WHO/ISUP) nuclear grading of ACKD-RCC and pRCC were 2-3 and 3-4, respectively. Pathological staging of 5 RCC patients was pT1 and of the other 2 patients was pT3a. NGS results identified one PIK3CA point mutation and SETD2 deletion in one ACKD-RCC patient and the pRCC patient, which were accompanied by marked necrosis and pT3a staging. The RCC patients were regularly followed up for 1-32 months postoperatively without additional treatment, and no recurrence or metastasis was observed. Conclusion: ACKD is a common complication in ESRD patients undergoing dialysis. In our cohort, ACKD-RCC was predominantly characterized by papillary architecture histologically with oxalate crystals in all cases. Immunohistochemically, P504S and CK7 were positive. Regardless of secondary occurrent tumor, atypical renal cysts were present in all ACKD cases in this study. NGS detected PIK3CA and SETD2 (Tier Ⅱ) variants in 2 RCC patients, respectively, accompanied by coagulative necrosis and advanced pathological stage, which may indicate a poor prognosis. This study suggests that imaging screening for RCC should be strengthened in young and middle-aged male ESRD patients with long-term dialysis, and adequate sample examination should be performed to detect potentially precancerous lesions, such as atypical renal cysts. The prognosis of ACKD-RCC requires comprehensive analysis combining clinicopathological and molecular genetic features.

Objective: To identify the cytokine genes influencing the formation of tertiary lymphoid structures (TLS) through CRISPR-Cas9 library screening, and to discover potential key regulatory molecules, providing new targets for enhancing the efficacy of bladder cancer immunotherapy. Methods: Based on a mouse whole-genome library, 44 chemokine-related genes were identified, and an single-guide RNA (sgRNA) library targeting these genes was designed and constructed, with three sgRNAs assigned to each gene. Using a lentiviral packaging system, the library plasmids were used to transfect HEK293T cells to generate a lentiviral library, which was then used to infect the mouse bladder cancer cell line MB49. Purinomycin selection was performed to obtain the MB49-mCherry cell line stably over-expressing chemokines. The cells were inoculated into the peritoneal cavity of C57BL/6 mice to establish a bladder cancer xenograft model, and tumor growth was monitored. Three weeks later, tumor tissue was excised, genomic DNA was extracted for high-throughput sequencing, and sgRNA enrichment was analyzed to screen for differentially expressed cytokine genes. Concurrently, immunohistochemical staining was performed to detect TLS markers CD20 and CD3, and the number, distribution, and maturity of TLS were assessed. The selected candidate genes were validated individually in vivo to further confirm their impact on TLS formation. Results: We successfully constructed a cytokine gene library containing 132 sgRNAs, covering 44 chemokine genes. Following lentiviral infection, we obtained the MB49-mCherry cell line, which stably expressed the library, and isolated dead Cas9-positive monoclonal cell lines via flow cytometry to ensure the homogeneity and reproducibility of subsequent experiments. Intratumoral tumor experiments in mice revealed that the number of TLS cells in the experimental group was significantly higher than in the control group, primarily distributed at the tumor margins. High-throughput sequencing results showed that, compared with the control group, in the experimental group, Cxcl16 sgDNA was significantly enriched, while Ccl20 and Cx3lc1 sgDNA levels decreased compared with baseline (P < 0.05). Further validation of the individual roles of each factor via intraperitoneal injection revealed that the number of TLSs in tumors decreased in the group treated with the CX3CL1 chemokine, suggesting that CX3CL1 might negatively regulate TLS formation. Immunohistochemical results showed that in the CX3CL1-treated group, the aggregation of CD20-positive B cells and CD3-positive T cells in the tumor tissue was reduced, and the TLS structure was incomplete. Conclusion: Through CRISPR-Cas9 library screening combined with in vivo validation, this study successfully identified CX3CL1 as a potential negative regulator of TLS formation in bladder cancer. High CX3CL1 expression was associated with a reduction in TLS numbers, suggesting that it might exert an inhibitory role in the immune microenvironment of bladder cancer. This finding provides new clues and research directions for understanding the molecular mechanisms of TLS formation in bladder cancer. However, whether CX3CL1 can serve as an immunotherapeutic target remains to be further validated through clinical specimen analysis, multidimensional mechanistic investigation, and immunotherapy response correlation studies.

Objective: To preliminarily investigate the safety and feasibility of domestic Jingfeng MP1000 multi-port robotic surgical system-assisted laparoscopic radical nephrectomy with venous tumor thrombectomy. Methods: Clinical data of 15 patients with renal cell carcinoma (RCC) and venous tumor thrombus who underwent Jingfeng MP1000 robot-assisted laparoscopic radical nephrectomy with venous tumor thrombectomy at the Department of Urology, Peking University Third Hospital from June 2024 to January 2026 were retrospectively analyzed. The primary outcomes were the success rate of the robotic procedure, overall complication rate, and major complication rate (Clavien-Dindo ≥ grade Ⅲ). Secondary outcomes included operative time, estimated blood loss, and length of hospital stay. Baseline characteristics, perioperative outcomes, pathological results, and postoperative complications were collected and analyzed using descriptive statistical methods. Results: All the 15 procedures were successfully completed with robotic assistance, with no conversions to open surgery. The success rate of robotic-assisted surgery was 100%. The median patient age was 60 years, and the median body mass index was 25.6 kg/m². Ten patients had right-sided and 5 had left-sided tumors, with a median tumor diameter of 9.1 cm. According to the Mayo classification, there were 5 cases of grade 0, 4 of grade Ⅰ, 5 of grade Ⅱ, and 1 of grade Ⅲ thrombus. The median operative time was 233.0 min, the median estimated blood loss was 250.0 mL, and 5 patients (33.3%) received blood transfusions. The median postoperative hospital stay was 6 days. Only one patient (6.7%) experienced a Clavien-Dindo grade Ⅱ complication (lymphatic leakage), with no grade ≥Ⅲ severe complications or perioperative mortality. Postoperative pathology revealed clear cell renal cell carcinoma in 12 cases, and venous wall invasion was confirmed in 8 patients (53.3%). After a median follow-up of 4.4 months, one patient developed duodenal metastasis 10 months postoperatively. Conclusion: The domestic Jingfeng MP1000 multi-port robotic system-assisted laparoscopic radical nephrectomy with venous tumor thrombectomy is technically safe and feasible, with favorable perioperative outcomes and a low complication rate. Its long-term oncological efficacy requires further validation through large-scale, prospective studies.

Objective: To explore the risk factors for acute kidney injury (AKI) in patients with stage 3 chronic kidney disease (CKD) after partial nephrectomy. Methods: The clinical data of 126 stage 3 CKD patients who underwent partial nephrectomy at Peking University Third Hospital from January 2013 to December 2025 were retrospectively analyzed. Demographic characteristics, comorbidities, surgical-related indicators, and laboratory data of the patients were collected. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Univariate and multivariate regression analyses were used to identify the independent risk factors for postoperative AKI, and the predictive cutoff value of the receiver operating characteristic (ROC) curve was determined. Results: A total of 126 stage 3 CKD patients were included. The incidence of AKI after surgery was 31.0% (39/126). Univariate analysis showed that the proportion of robotic surgery was lower in the AKI group (12.8% vs. 33.3%, P=0.018), the duration of renal artery occlusion was longer (25 min vs. 18 min, P < 0.001), and the intraoperative blood loss was greater (20 mL vs. 50 mL, P=0.028). Multivariate Logistic regression analysis confirmed that the duration of renal artery occlusion (OR=1.105, 95%CI: 1.041-1.173, P=0.001) and intraoperative blood loss (OR=1.004, 95%CI: 1.000-1.007, P=0.046) were independent risk factors for postoperative AKI. ROC curve analysis showed that the area under the curve for predicting AKI by renal artery occlusion time was 0.737, and the optimal cutoff value was 18 min. The incidence of AKI was significantly higher in the patients with renal artery occlusion time ≥ 18 min than those with < 18 min (43.2% vs. 8.8%, P < 0.001). Conclusion: The incidence of AKI after partial nephrectomy in stage 3 CKD patients is relatively high. The duration of renal artery occlusion and intra-operative blood loss are independent risk factors for postoperative AKI. Controlling the renal artery occlusion time within 18 min and minimizing intraoperative blood loss can help reduce the risk of AKI in this high-risk population after surgery.

Objective: Anemia is a common complication following kidney transplantation in children, yet its epidemiological characteristics and associated factors are not fully understood. This study aimed to investigate the incidence and clinical features of anemia within six months after pediatric kidney transplantation and to identify its associated factors, thereby providing evidence for management. Methods: A single-center retrospective cohort study was conducted on pediatric patients who underwent kidney transplantation at Peking University People' s Hospital from January 2022 to August 2025. Demographic, perioperative, and serial laboratory data up to 6 months post-transplantation were collected. Anemia was diagnosed according to the World Health Organization (WHO) age-specific criteria. Univariate analysis, multivariate binary Logistic regression, and receiver operating characteristic (ROC) curve analysis were performed to identify associated factors and assess their diagnostic value. Results: The study included 46 pediatric recipients. The incidence of anemia within 6 months post-transplantation was 41.3% (19/46), with normocytic anemia being the most prevalent type (63.1%, 12/19). Multivariate binary Logistic regression analysis showed that age (OR=0.293, P=0.018), postoperative serum urea at 6 months (OR=3.281, P=0.006), and estimated glomerular filtration rate (eGFR) (OR=0.893, P=0.030) were independently associated with anemia. Exploratory stratified analysis suggested that age < 13 years, serum urea >7 mmol/L, and eGFR < 120 mL/(min·1.73 m²) might serve as reference thresholds for clinical screening. ROC curve analysis indicated that postoperative serum urea had the best diagnostic value for anemia (area under the curve=0.890, P < 0.001). Hemoglobin levels began to differ significantly between the anemic and non-anemic groups from the third month postoperative onward, with the gap widening over time. Conclusion: This study demonstrates a high incidence of early-onset anemia after pediatric kidney transplantation, primarily mild to moderate normocytic anemia. It is associated with younger age and suboptimal allograft function, with the divergence in hemoglobin levels becoming apparent from the third month postoperative. Close monitoring of high-risk children, particularly those aged < 13 years or with serum urea >7 mmol/L and eGFR < 120 mL/(min·1.73 m²), and early intervention may help reduce the occurrence or severity of post-transplant anemia.

Objective: To systematically compare the differences in urinary organic acid metabolic profiles between patients with urinary calculi and non-calculi individuals, to screen disease-specific characteristic metabolic biomarkers and key signaling pathways, and to elucidate the potential mechanism underlying the occurrence and progression of urinary calculi at the metabolic level, so as to provide a theoretical basis for basic research and screening of intervention targets for urinary calculi. Methods: A total of 99 patients with urinary calculi and 57 non-calculi subjects were enrolled. Twenty-four-hour urine samples were collected and subjected to untargeted urinary organic acid metabolomics detection by gas chromatography-mass spectrometry (GC-MS). Principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) were used to analyze the differences in metabolic profiles between the groups and the effects of clinical covariates. Volcano plot and variable importance in the projection (VIP) analysis were applied to screen differential organic acids. The Kyoto Encyclopedia of Genes and Genomes (KEGG) database were used for metabolic pathway enrichment analysis. Machine learning algorithms were adopted to screen the most representative core metabolite combinations and verify the discriminatory efficacy of organic acids for disease status. Results: The urinary organic acid metabolic profiles showed a significant separation trend between the calculi group and the non-calculi group (OPLS-DA: R2X =0.139, R2Y =0.48, Q2 =0.457). Gender was an important covariate affecting metabolic profiles, while diabetes, hypertension and stone recurrence status exerted no significant influence. A total of 44 differential organic acids were screened (P < 0.05), including 6 upregulated and 38 downregulated metabolites. Ten core differential metabolites were identified via VIP analysis (P < 0.001, all downregulated). Differential organic acids were mainly enriched in energy metabolism pathways such as glyoxylate and dicarboxylate metabolism, as well as amino acid metabolism pathways including tryptophan metabolism. Among machine learning models, Gradient Boosting Machine and Random Forest exhibited the optimal efficacy with an average area under the curve (AUC) of 0.996. Five core metabolites including propionylglycine, 5-hydroxyindole-3-acetic acid, kynurenic acid, orotic acid and fumaric acid were identified as the optimal combination. The nomogram model constructed based on this combination yielded an AUC of 0.997; after calibration bias correction, the calibration curve was highly consistent with the ideal curve, with a mean absolute error of 0.022, which could effectively distinguish calculi patients from non-calculi individuals. Conclusion: Patients with urinary calculi present obvious disorders in urinary organic acid metabolism, which are mainly involved in energy and amino acid metabolic pathways and closely associated with the pathogenesis of urinary calculi. The five core metabolites (propionylglycine, 5-hydroxyindole-3-acetic acid, kynurenic acid, orotic acid and fumaric acid) can effectively distinguish calculi from non-calculi populations, and can serve as representative metabolic biomarkers to provide novel targets for subsequent mechanism exploration and targeted intervention.

Objective: To compare intrarenal pelvic pressure profiles and clinical outcomes between the leg-split-free lateral decubitus position and the conventional lithotomy position during flexible ureteroscopy with a negative-pressure aspiration sheath. Methods: A prospective study was conducted at Peking University People' s Hospital among patients undergoing unilateral flexible ureteroscopy with a negative-pressure aspiration sheath from January 2024 to December 2025. Participants were allocated into two groups according to surgical positioning: Leg-split-free lateral decubitus group and conventional lithotomy group. An intelligent, pressure- and temperature-controlled flexible ureteroscopy system was employed to continuously monitor intrapelvic pressure and temperature throughout the procedure. The incidence, duration, and clinical implications of intrapelvic hypertension were compared between the two groups. Results: A total of 40 patients were enrolled, 20 in each group. No statistically significant differences were observed between the groups in baseline characteristics, including gender, age, stone diameter, stone number, stone location, or degree of hydronephrosis (all P>0.05). Intraoperative analysis revealed that the duration of intrapelvic hypertension was significantly shorter in the leg-split-free lateral decubitus group than in the lithotomy group [25.0 (0.0, 31.8) s vs. 115.0 (79.8, 176.0) s, P < 0.01]; similarly, the duration of elevated intrapelvic temperature was also significantly reduced [3.0 (2.0, 9.8) s vs. 18.5(16.0, 24.5) s, P < 0.01]. Postoperative follow-up showed no cases of fever in the leg-split-free lateral decubitus group, whereas two patients in the lithotomy group developed fever; however, this difference in febrile complication rate did not reach statistical significance (P=0.15). All the patients underwent computed tomography three months postoperatively to assess stone-free status. The results indicated that the stone-free rate in the leg-split-free lateral decubitus position group was significantly higher than that in the lithotomy position group (P=0.04). Conclusion: This prospective exploratory study suggests that compared with the lithotomy position, the leg-free lateral decubitus position may be more conducive to maintaining lower intrapelvic pressure and temperature during the operation and is associated with a higher stone clearance rate postoperatively. However, these findings still need to be verified by large-sample, multi-center, randomized controlled trials.

Objective: To investigate the endoscopic surgical management strategies for duplex kidney and ureteral duplication anomalies complicated by upper urinary tract calculi, to summarize individualized diagnostic and therapeutic experiences for different anomaly subtypes, and to provide a reference for standardized clinical management of this condition. Methods: The clinical data of patients with duplex kidney and ureteral duplication anomalies and upper urinary tract calculi who underwent endoscopic surgery at the Department of Urology, Peking University Third Hospital from November 2012 to December 2025 were retrospectively analyzed. Baseline characteristics, imaging findings, perioperative parameters, complications, and changes in renal function were collected. Endoscopic surgical techniques and key diagnostic and therapeutic points for different anomaly subtypes were summarized. Statistical analysis was performed using SPSS 22.0 and R 3.6.1 software. Results: A total of 38 patients were enrolled, including 16 males and 22 females, with a mean age of (49.92±14.27) years. The median follow-up duration was 17.80 months (1.60-41.90). The predominant clinical symptom was flank pain (32 cases, 84.21%). The most common anomaly subtype was unilateral incomplete duplex kidney and ureteral duplication (24 cases, 63.16%). Based on the anomaly subtype and stone characteristics, all the patients underwent precise preoperative assessment using CT urography and other imaging modalities, and indivi-dualized surgical approaches were selected: In the study, 15 patients underwent ureteroscopic lithotripsy (URL), 15 underwent flexible ureteroscopic lithotripsy (FURL), 7 underwent percutaneous nephrolithotomy (PCNL), and 1 patient received PCNL combined with FURL. The median operative time was 74.00 (64.75-92.50) min, the median intraoperative blood loss was 2.00 (1.00-4.25) mL, and the median postoperative hospital stay was 3.00 (2.00-5.75) d. The overall postoperative stone-free rate was 94.74%. No severe perioperative complications occurred. Postoperative fever occurred in 14 patients (36.84%), all of whom recovered after symptomatic treatment. Postoperative serum creatinine levels were significantly lower than preoperative levels (P < 0.05), indicating significant improvement in renal function. Conclusion: Endoscopic surgery is safe and effective for the treatment of duplex kidney and ureteral duplication anomalies complicated by upper urinary tract calculi, offering advantages of minimal trauma, rapid recovery, and a high stone-free rate. The strategy of "precise diagnosis-individualized surgical approach selection" allows the formulation of tailored treatment plans for different anomaly subtypes and is worthy of clinical promotion and application.

Objective: To compare the effects of thulium laser enucleation of the prostate (ThuLEP) and monopolar transurethral resection of the prostate (TURP) on sexual function in patients with benign prostatic hyperplasia (BPH). Methods: A retrospective cohort study was conducted involving patients who underwent ThuLEP or TURP at the Department of Urology, Peking University First Hospital, between January 2022 and December 2023. Participants were recruited via convenience sampling. Propensity score matching (PSM) was subsequently employed to balance preoperative baseline characteristics between the two cohorts.Following propensity score matching, we conducted a comparative analysis of sexual function and voiding improvement metrics between the two cohorts. Sexual function was assessed using the international index of erectile function-5 (IIEF-5) scores and the incidence of retrograde ejaculation. Voiding outcomes were evaluated based on the international prostate symptom score (IPSS), qua-lity of life (QOL) scores. Results: Following propensity score matching, the study included 98 patients in both the ThuLEP and the TURP groups. Preoperative comparisons between the two groups regarding age, prostate volume, IIEF-5 scores, incidence of retrograde ejaculation, IPSS, and QOL showed no statistically significant differences (P>0.05), indicating comparability between the groups. Regarding erectile function, postoperative IIEF-5 scores at 1 month and 12 months in both the ThuLEP and TURP groups did not differ significantly from preoperative scores (P>0.05). At 1 month postoperatively, there was no significant difference in IIEF-5 scores between the ThuLEP and TURP groups (P>0.05). At the 12-month postoperative follow-up, the incidence of severe erectile dysfunction was significantly lower in the ThuLEP group compared with the TURP group (Z=8.522, P=0.036). Regarding ejaculatory function, the incidence of retrograde ejaculation at 1 month and 12 months postoperatively in both the ThuLEP and TURP groups differed significantly from preoperative rates (P < 0.05). Moreover, the incidence of retrograde ejaculation increased with time after surgery. At 1 month postoperatively, 9.2% of the ThuLEP group and 14.3% of the TURP group experienced retrograde ejaculation, which was not statistically different (Z=1.231, P=0.267). At 12 months postoperatively, the incidence of retrograde ejaculation in the ThuLEP and TURP groups was 19.4% and 25.5%, respectively, also showing no significant difference (Z=1.055, P=0.304). In terms of surgical parameters, comparisons of operative time, intraoperative blood loss, decrease in hemoglobin levels, and weight of resected prostate tissue between the ThuLEP and TURP groups revealed no significant differences (P>0.05). However, compared with the TURP group, the ThuLEP group had a shorter hospital stay (4 d vs. 5 d, P < 0.001) and shorter duration of indwelling urinary catheterization (3.67 d vs. 4.26 d, P=0.012), although bladder irrigation time was longer (19.00 h vs. 16.68 h, P=0.001). At 1 month and 12 months postoperatively, there were no significant differences between the two groups in IPSS, QOL metrics (P>0.05); how- ever, all these parameters showed significant improvement compared with preoperative values. Conclusion: While both ThuLEP and TURP effectively alleviate lower urinary tract symptoms and improve voiding parameters, ThuLEP offers distinct advantages in safeguarding erectile potency and facilitating accelerated postoperative recovery.

Objective: To systematically evaluate the impact of androgen deprivation therapy (ADT) on the immune microenvironment of prostate cancer at the levels of systemic immunity, animal model transcriptomics, and single-cell omics, and to elucidate the characteristics of ADT-mediated tumor immune remodeling. Methods: Twelve prostate cancer patients who received ADT at Peking University People' s Hospital were enrolled. Dynamic monitoring of serum prostate specific antigen (PSA), testosterone levels, peripheral blood immune cell proportions, and cytokine expression changes was performed. Transcriptomic data from patient-derived tumor xenograft (PDX) models before and after castration (GSE41193, 5 cases in total) were downloaded from the gene expression omnibus (GEO) database for relevant bioinformatics analyses. Single-cell RNA sequencing (scRNA-seq) was performed on 4 prostate cancer tissue samples (2 received neoadjuvant ADT, 2 untreated) to analyze tumor microenvironment cell composition and T-cell functional states. Results: ADT significantly reduced serum PSA and testosterone levels in the patients, but had no significant effect on peripheral blood immune cell proportions or most cytokines. PDX model analysis showed that differentially expressed genes after castration were enriched in neural-related and immune regulation pathways, with trending changes observed in the infiltration characteristics of various immune cells. scRNA-seq results indicated a decreased proportion of intratumoral effector CD8⁺ T cells after ADT treatment, with downregulated expression of cytotoxicity-related genes, such as GZMA, GZMB, GNLY, and NKG7, while regulatory T cells (Tregs) were relatively enriched. Hallmark pathway analysis revealed suppression of interferon signaling pathways. Conclusion: The preliminary results of this study suggest that ADT can induce a trend of change in the tumor immune microenvironment of prostate cancer, characterized by weakened T-cell killing function and enrichment of immunosuppressive cells. This suggests that ADT may promote the formation of an immunosuppressive tumor immune microenvironment (TIME), providing a theoretical basis for ADT combined with immune-modulating therapeutic strategies.

Objective: To evaluate the feasibility and clinical value of a prostate cancer screening model incorporating total prostate-specific antigen (tPSA) and biparametric magnetic resonance imaging (bpMRI) in a Chinese population. Methods: Between May 2024 and May 2025, 2 251 men aged 50 years or older from three community health service centers in Beijing were enrolled, who were randomly assigned to the precise screening group and the standard screening group in a 2 ∶ 1 ratio in the community health service centers. In the precision screening group, participants with tPSA≥4 μg/L underwent bpMRI; those with a prostate imaging reporting and data system (PI-RADS) score≥3 were recommended to undergo systematic combined with targeted biopsy, while those with tPSA≥10 μg/L and PI-RADS < 3 were recommended to undergo systematic biopsy alone. In the standard screening group, participants with tPSA≥4 μg/L were recommended to undergo systematic biopsy. The number of participants who actually underwent biopsy, biopsy positivity rate, and Gleason score concordance rate was recorded. The primary outcome measure was the detection rate of clinically significant prostate cancer (csPCa), and the intergroup comparisons were performed using the Mann-Whitney U test. Results: A total of 2 251 men were included in the analysis, with a median age of 68 years (range: 57-90 years). In the precision screening group (n=985), 115 (11.7%) participants had tPSA≥4 μg/L, of whom 30 underwent bpMRI. The recommended biopsy rate was 2.9% (29/985), and 20 participants actually underwent prostate biopsy. A total of 15 prostate cancer cases were detected, including 14 csPCa and one clinically insignificant prostate cancer. In the standard screening group (n=1 266), 111 (8.8%) participants had tPSA ≥4 μg/L, with a recommended biopsy rate of 8.8% (111/1 266); 26 of them underwent systematic biopsy, and 14 prostate cancer cases were detected, including 7 csPCa and 7 clinically insignificant prostate cancer. The overall positive biopsy rate in the precision screening group was 75.0%, which was not statistically significant compared with that in the standard screening group (58.3%, P=0.141). However, the csPCa detection rate in the precision screening group reached 70.0%, which was significantly higher than that in the standard screening group (26.9%), and the difference was statistically significant (P=0.004). Among the 29 diagnosed prostate cancer patients, 17 (58.6%) had localized disease, 10 (34.5%) had locally advanced disease, and 2 (6.9%) had metastatic disease. Among the 21 patients who underwent radical surgery, the concordance rate between biopsy and post-operative pathological Gleason scores was 70.0% in the precision screening group, higher than that in the standard screening group (36.4%), although the difference was not statistically significant (P=0.198). Conclusion: The prostate cancer screening model based on serum tPSA combined with bpMRI demonstrates good feasibility, reduces unnecessary biopsies, optimizes the allocation of screening resources, and provides a basis for precision screening strategies.

Objective: To compare radical prostatectomy (RP) versus permanent prostate brachytherapy (PPB) as primary local treatment modalities in delaying disease progression to castration-resistant prostate cancer (CRPC) among patients with oligometastatic prostate cancer (omPCa) receiving standard androgen deprivation therapy (ADT), and to provide clinical evidence for individualized treatment strategies. Methods: We performed a retrospective cohort analysis of 88 patients diagnosed with omPCa (defined as ≤5 metastatic lesions) at a single tertiary center between April 2011 and August 2019. All the patients, after receiving either RP (n=62) or PPB (n=26), were placed on a regimen of continuous ADT. To address significant baseline disparities-notably in patient age, presenting prostate-specific antigen (PSA) levels, and nodal disease burden: A 1 ∶ 1 propensity score matching (PSM) protocol was implemented. Matching variables included age at diagnosis, baseline PSA, clinical T stage (≤T2c vs. ≥ T3), and nodal status (N0 vs. N1). The primary study endpoint was the time interval from ADT initiation to CRPC development, as defined by the prostate cancer working group 3 (PCWG3) criteria. Survival outcomes were compared using Kaplan-Meier curves and the Log-rank test. Independent risk factors for progression were identified through both univariate and multivariate Cox proportional hazards regression analyses. Results: Prior to PSM, the RP and PPB groups exhibited significant differences in key prognostic factors: the PPB group was older (mean 73.2 vs. 68.1 years, P=0.002), had a higher median PSA (31.2 vs. 9.8 μg/L, P=0.002), and had a greater incidence of lymph node involvement (42.3% vs. 12.9%, P=0.006). Following PSM, a balanced cohort of 36 patients (18 in each group) was achieved. Over a median follow-up of 30.5 months (range: 3.2 to 113.4 months), 15 patients (17.0%) developed CRPC, with 8 events occurring in the PPB group and 7 in the RP group. Survival analysis demonstrated a consistent, statistically significant advantage for RP. In the pre-matched cohort, the RP group showed a significantly delayed progression to CRPC (Log-rank P=0.033, HR=3.38, 95%CI: 1.10-10.40), with a median CRPC-free survival of 80.0 months for PPB and not reached for RP. In the matched cohort, the survival advantage of RP was more pronounced (Log-rank P=0.032, HR=4.60, 95%CI: 1.14-18.49), with a median CRPC-free survival of 80.0 months for PPB and not reached for RP. Multivariate Cox regression, adjusting for T and N stages, confirmed treatment modality as a powerful independent predictor. Patients treated with PPB faced an 8.56-fold higher risk of progression compared with those treated with RP (HR=8.56, 95%CI: 1.51-48.64, P=0.015). Advanced primary tumor stage (≥T3) was also identified as a significant independent risk factor (HR=10.29, 95%CI: 1.75-60.57, P=0.010). Conclusion: For patients with omPCa receiving ADT, the choice of local therapeutic intervention significantly impacts the time to CRPC. Radical prostatectomy is associated with a markedly longer delay in disease progression to the castration-resistant state compared with permanent prostate brachytherapy, with the treatment modality itself serving as a strong independent prognostic factor. These findings underscore the importance of considering the type of local therapy in the multimodal management of omPCa and provide a rationale for individualized treatment planning. Prospective, randomized trials are necessary to validate these observations and further define optimal therapeutic paradigms.

Objective: To develop a transcriptomic-based recurrence prediction model for non-muscle-invasive bladder cancer (NMIBC), to comprehensively validate its efficacy in an independent Chinese cohort, and to explore the underlying biological mechanisms driving tumor recurrence. Methods: Transcriptome profiling data from the multicenter European Urothelial Cancer Molecular Classification Consortium (UROMOL) cohort (n=535) were used as the training cohort. The least absolute shrinkage and selection operator (LASSO) Cox regression was employed to identify prognostic genes and construct a risk score model. Internal validation was strictly performed using Bootstrap resampling and 10-fold cross-validation. External validation was conducted in an independent Chinese cohort (n=85) from Peking University People ' s Hospital. Gene set enrichment analysis (GSEA) was applied to elucidate the distinct biological differences between high- and low-risk groups. Results: A 36-gene prognostic signature was identified from 12 170 genes to construct the risk score model. In the training cohort, the model achieved a concordance index (C-index) of 0.702 (95%CI: 0.664-0.740), with 1-, 3-, and 5-year areas under the receiver operating characteristic curve (AUC) of 0.782, 0.811, and 0.799, respectively. The 5-year recurrence-free survival (RFS) rates for the high- and low-risk groups were 35.2% and 72.8%, respectively (Log-rank P < 0.001). Internal validation via Bootstrap (C-index=0.702) and 10-fold cross-validation (C-index=0.708) demonstrated robust stability. In the independent Chinese validation cohort, the model maintained a favorable C-index of 0.685 (95%CI: 0.631-0.739), with 1-, 3-, and 5-year AUC of 0.705, 0.743, and 0.665, respectively. Its predictive performance was comparable to the traditional European Organization for Research and Treatment of Cancer (EORTC) risk score (C-index=0.652). GSEA revealed that the low-risk group was enriched in energy metabolism and protein homeostasis pathways, while the high-risk group was associated with extracellular matrix (ECM) remodeling and cell adhesion pathways. Conclusion: The 36-gene signature developed in this study demonstrates favorable predictive performance and stability across both the training and independent Chinese cohorts. While exhibiting comparable predictive efficacy to the traditional EORTC scoring system, the model serves as an independent prognostic factor that provides crucial supplementary molecular stratification. Furthermore, the model underscores the critical roles of energy metabolism and ECM remodeling in NMIBC recurrence, providing a valuable molecular basis for precise individualized management of NMIBC patients in China.

Objective: To evaluate the impact of coexisted low-grade components on the prognosis of patients with high-grade solitary primary non-muscle invasive bladder cancer (NMIBC). Methods: A retrospective analysis was conducted on patients diagnosed with primary, solitary, high-grade non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TURBT) at Peking University People' s Hospital between January 2015 and December 2019. All patients received single-dose intravesical chemotherapy within 24 hours after TURBT. Only patients accetpting adequate adjuvant intravesical chemotherapy were included for further analysis. Adequate intravesical chemotherapy was defined as weekly instillation for 8 weeks and monthly instillation for at least 6 months. All patients were strictly followed up according to the preestablished schedule with cystoscopic surveillance. The primary endpoint was recurrence free survival. Kaplan-Meier curve was used to compare the recurrence free survival of mHG group and pHG group. Univariable and multivariable Cox regression was conducted to evaluate the risk factors for tumor recurrence. Patients with variant histology, concurrent upper tract urothelial carcinoma, and incomplete resection which required re-TURBT were excluded. Patients without single instillation postoperative were also eliminated from the final cohort. Results: A total of 167 patients were enrolled in the final cohort, with 35 patients having mixed high-grade tumors (mHG) and 132 patients having pure high-grade tumors (pHG). The median follow-up time was 39.32 (26.82, 61.37) months. Baseline characteristics were well balanced between the two groups with regard to age, gender, pathological characteristics and instillation doses. Compared with the mHG group, the 5-year recurrence-free survival rate (RFS) of the pHG group was significantly lower (80.0% vs. 50.5%, P=0.01). Multivariate Cox regression analysis further confirmed that the presence of mixed low-grade components was an independent protective factor for recurrence free survival (HR=0.42, P=0.02), and other risk factors included T1 stage (HR=2.09, P=0.01). while tumor size was not associated with recurrence free survival. Conclusion: Coexistence of low-grade component in pathological specimen was associated with lower recurrence rate in patients with primary, solitary high-grade non-muscle invasive bladder cancer. Thus, it should be considered as a favorable pathological feature in bladder cancer patients.

Objective: To investigate the association between preoperative nutritional indicators and survival outcomes in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU), and to compare the predictive performance of different nutritional scoring systems. Methods: A retrospective analysis was conducted on UTUC patients who underwent RNU. Nutritional scores [geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), controlling nutritional status (CONUT), triglycerides-total cholesterol-body weight index (TCBI)] were calculated. Variables with P < 0.10 in univariable Cox regression were entered into multivariable analysis using backward stepwise selection based on the Akaike Information Criterion (AIC) to identify independent predictors and construct a nomogram. Kaplan-Meier curves with log-rank tests and time-dependent ROC curves were applied for survival analysis. A two-sided P < 0.05 was considered statistically significant. Results: A total of 481 UTUC patients were included. Multivariable analysis identified pathological T3/T4 stage, N1/N2 stage, high World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade, estimated glomerular filtration rate (eGFR), blood transfusion, ureteral management, GNRI, and PNI as independent predictors of overall survival (OS) (P < 0.05). Independent predictors of cancer-specific survival (CSS) included pathological T2-T4 stage, N1/N2 stage, laparoscopic surgical approach, blood transfusion, GNRI, and PNI (P < 0.05). The nomogram constructed based on these independent predictors demonstrated good calibration. Patients with GNRI < 98 or PNI < 52 had significantly shorter OS and CSS (Log-rank P < 0.05). At the end of 60 months, the area under the curve (AUC) values of GNRI and PNI for predicting OS were 0.623 and 0.632, respectively, and for predicting CSS were 0.632 and 0.645, respectively. Time-dependent ROC analysis showed that both indicators had stable predictive performance for CSS, while their predictive ability for OS showed a mild increasing trend over the follow-up time. Conclusion: Preoperative GNRI and PNI are independently associated with OS and CSS in patients with UTUC after RNU, demonstrating stable predictive performance across different follow-up periods.

Objective: To investigate the expression pattern of Erb-B2 receptor tyrosine kinase 2 (ERBB2) in bladder urothelial carcinoma (BLCA) and its clinical relevance, prognostic value, and potential molecular mechanisms, thereby providing evidence for biomarker identification and targeted therapy research in BLCA. Methods: RNA sequencing expression data and clinical information were obtained from The Cancer Genome Atlas bladder urothelial carcinoma cohort (TCGA-BLCA). Differences in ERBB2 expression between tumor and normal tissues were analyzed, and associations with American Joint Committee on Cancer (AJCC) pathological stage and tumor grade were evaluated. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of ERBB2. Patients were stratified into high- and low-expression groups based on both the median value and the optimal cutoff, followed by Kaplan-Meier survival analysis and Cox regression to evaluate prognostic significance. Differentially expressed genes associated with ERBB2 were identified, and Kyoto Encyclopedia of Genes and Genomes (KEGG), gene ontology (GO), and single-gene gene set enrichment analysis (GSEA) were conducted. Correlations between ERBB2 and immune checkpoint molecules were further analyzed. In addition, immunohistochemistry data from the Human Protein Atlas (HPA) database and reverse transcription quantitative PCR (RT-qPCR) experiments were used to validate ERBB2 expression. Results: HPA immunohistochemistry demonstrated stronger ERBB2 staining in BLCA neoplastic tissues, and RT-qPCR confirmed elevated ERBB2 mRNA expression in BLCA neoplastic tissues. TCGA analysis showed that ERBB2 expression was significantly higher in tumor tissues than in normal tissues (P=0.005), with overall differences observed across AJCC pathological stages (P=0.004), whereas no significant difference was found between tumor grades (P=0.238). Receiver operating characteristic curve analysis indicated a moderate discriminatory ability of ERBB2 [area under the curve (AUC) =0.689]. No significant difference in overall survival was observed between high- and low-expression groups based on either the median cutoff or the optimal cutoff (P=0.240 and P=0.148, respectively), and both univariate and multivariate Cox analyses suggested that ERBB2 was not an independent prognostic factor for OS. Functional enrichment analyses revealed that ERBB2-associated differentially expressed genes were mainly enriched in cytokine-cytokine receptor interaction, interleukin 17 (IL-17) signaling pathway, phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling pathway, Janus kinase/signal transducer and activator of transcription (JAK-STAT) signaling pathway, chemokine signaling pathway, inflammatory response, immune response, extracellular matrix organization, and leukocyte migration. GSEA further demonstrated positive enrichment in IL-17 signaling, PI3K/AKT signaling, and cytokine-cytokine receptor interaction pathways. Immune checkpoint analysis showed that CD274, PDCD1, CTLA4, LAG3, TIGIT, and HAVCR2 were significantly upregulated in the ERBB2 high-expression group, and ERBB2 expression was positively correlated with CD274 and CTLA4 (Spearman ρ=0.45 and 0.36, both P < 0.001). Conclusion: ERBB2 is upregulated in BLCA and is associated with AJCC pathological stage and immune checkpoint expression, showing moderate diagnostic value but limited prognostic significance. ERBB2 may contribute to BLCA progression through regulation of immune-inflammatory responses, cytokine signaling, PI3K/AKT pathway, and tumor immune microenvironment.

Objective: To evaluate the clinical efficacy and safety of thermo-expandable nickel-titanium alloy ureteral stents (Memokath-051) for maintenance therapy of ureteral strictures. Methods: A retrospective analysis was conducted on the clinical data of 16 patients with ureteral strictures admitted to Beijing Geriatric Hospital from January 2024 to April 2025. The cohort comprised 3 males and 13 females, with a mean age of (57.60±9.79) years. Etiologies included post-radiation stricture following abdominopelvic tumor radiotherapy in 13 patients, retroperitoneal fibrosis in 2, and ureteral granuloma in 1. All the 16 patients had experienced failure of previous indwelling double-J stent placement and subsequently underwent conversion to thermo-expandable nickel-titanium alloy ureteral stent insertion. Among the 16 patients, 7 had bilateral ureteral lesions, with a total of 23 ureteral units treated. Operative time, complications (graded according to the Clavien-Dindo classification), stent patency rate, and ureteral stent symptom questionnaire (USSQ) scores were recorded. Follow-up assessments of serum creatinine levels and hydronephrosis improvement were performed 3, 6, and 12 months postoperatively. Results: All 23 stents were successfully placed in the 16 patients (technical success rate, 100%), with a mean operative time of (51.52±9.55) min. The overall stent patency rate 12 months postoperatively was 82.61% (19/23). Early complications occurred in 7 patients. Long-term complications developed in 4 patients, including stent migration (n=1), tissue hyperplasia-induced obstruction (n=2), and stone-related obstruction (n=1); the remaining 5 patients had no complications. Three months postoperatively, serum creatinine decreased from the preoperative baseline of 186.80 (111.80, 244.93) μmol/L to 103.05 (96.20, 135.97) μmol/L (P < 0.01), and hydronephrosis width decreased from 3.20 (2.78, 3.40) cm to 2.05 (1.08, 2.20) cm (P < 0.01). Serum creatinine levels and hydronephrosis remained stable 6 and 12 months postoperatively. Compared with the previous indwelling period of double-J stents, USSQ scores showed significant improvements in urinary symptoms (34.75±2.34 vs. 23.75±3.26), bodily pain (6.50±2.26 vs. 3.00±1.22), general health status, and work performance (all P < 0.001). Conclusion: Placement of thermo-expandable nickel-titanium alloy ureteral stents (Memokath-051) as maintenance therapy for ureteral strictures is safe and effective. Compared with double-J stenting, it improves renal function and hydronephrosis, and enhances patient quality of life. This approach is particularly applicable to patients with long-segment ureteral strictures secondary to post-radiation etiologies.

Objective: To explore the evolutionary trends of the disease burden of gastritis and duodenitis (GD) in China from 1990 to 2023, to clarify the driving factors of changes in this burden, to predict the disease burden situation from 2024 to 2040, and to provide data support for formulating GD prevention and control strategies. Methods: Based on the Global Burden of Disease Study (GBD) 2023 data, the Joinpoint regression model was applied to analyze the annual average percentage change (AAPC) of age-standardized incidence rate, age-standardized prevalence rate, age-standardized mortality rate, and age-standardized disability-adjusted life years (DALY) rate of GD in China from 1990 to 2023. The age-period-cohort model was used to investigate the effects of age, period, and cohort on incidence, prevalence, and mortality risks. Three factors—population structure change, epidemiological change, and population growth—were identified to determine their driving effects on the disease burden. The auto-regressive integrated moving average (ARIMA) time series model was employed to forecast the future disease burden. Results: From 1990 to 2023, the number of GD incident cases in China increased from 6.158 8 million to 9.354 5 million, the number of prevalent cases rose from 8.770 6 million to 13.145 9 million, the number of deaths decreased from 19 800 to 17 200, and the number of DALY slightly declined from 902 400 person-years to 851 600 person-years. The AAPCs of age-standardized incidence rate, age-standardized prevalence rate, age-standardized mortality rate, and age-standardized DALY rate were -1.08%, -1.18%, -3.81%, and -2.89%, respectively (all P < 0.001). Joinpoint regression analysis showed that all age-standardized rates presented a phased downward trend. Age-period-cohort model analysis revealed that the incidence and prevalence risks peaked in the 55-59 years age group, while the mortality risk increased significantly with age. The period effect of incidence and prevalence risks first increased and then decreased, whereas the period effect of mortality risk showed a conti-nuous downward trend; the cohort risk exhibited a decreasing trend across all the groups. Decomposition analysis indicated that population growth and structural change promoted the increase in incident and prevalent cases (the overall contribution rates to the incident cases were 165.66% and 167.00%, respectively), while epidemiological change was the main factor driving their decrease (with an overall contribution rate of -232.66% to the incident cases). Additionally, epidemiological change was the core factor for the reduction in deaths (with an overall contribution rate of 490.07%). The ARIMA time series model predicted that by 2040, the number of incident cases would rise to 11.086 1 million, the number of prevalent cases to 15.279 6 million, the mortality rate to 0.48 per 100 000 population, and the DALY rate to 26.18 per 100 000 population. Conclusion: From 1990 to 2023, the age-standardized disease burden of GD in China was significantly alleviated, with population factors and epidemiological changes jointly driving the burden changes. Although the number of incident and prevalent cases will increase in the future, the mortality and disability burden will continue to decrease. It is necessary to formulate targeted prevention and control strategies based on age, cohort characteristics, and driving factors.

Objective: To evaluate the clinical outcomes of one-stage debridement, arthrodesis, and Ilizarov external fixation for the treatment of septic arthritis of the ankle and hindfoot. Methods: A retrospective analysis was conducted on 12 patients with septic arthritis of the ankle or hindfoot who underwent one-stage debridement, arthrodesis, and Ilizarov external fixation performed by the same surgeon between April 2015 and June 2023. The study included 8 males and 4 females, with a mean age of (53.6±16.2) years at surgery; all procedures were unilateral. General clinical characteristics, bacterial culture results, and the time to external fixator removal were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) for pain were recorded and compared between the preoperative period and the final follow-up. Patient satisfaction with the surgery and the occurrence of complications were also documented. Results: All patients were followed up for a mean of (51.3±34.0) months postoperatively. Positive bacterial cultures were found in 7 cases. Infection control was achieved in all patients, with a 100% bone fusion rate confirmed by radiographs or CT. The median time to external fixator removal was 16 (12, 24) weeks. Preoperatively, the median VAS score was 7 (5.3, 7.8) points, and the mean AOFAS ankle-hindfoot score was (42.8±10.4) points. At the final follow-up, the median VAS score was 1 (0, 2) point, and the mean AOFAS score was (77.6±10.2) points, both showing significant improvement compared with preoperative values (P < 0.01). Regarding complications, there was 1 case of pin tract infection, 3 cases of limb shortening, and 2 cases of skin numbness. Nine patients were very satisfied with the surgery, and 3 were satisfied. Conclusion: One-stage debridement, arthrodesis, and Ilizarov external fixation are a reliable method for treating septic arthritis of the ankle and hindfoot. It effectively controls infection, shortens treatment duration, and yields favorable functional and imaging outcomes, with high patient satisfaction and acceptable complication rates.

Objective: To understand the oral health literacy of children and adolescents in Nagqu City, and to evaluate the effect of a single online digital integrated media science popularization course on improving oral health literacy. Methods: A cluster sampling method was employed in which all students aged 9-15 years in the Seni District of Naqu City, Xizang Autonomous Region, 406 students were surveyed class-by-class using a paper questionnaire. After baseline data collection, the students received a single remote digital-multimedia oral-health education lesson; a follow-up questionnaire was administered one week later to evaluate whether the online course improved oral-health literacy. The instrument collected demographic information, basic oral-health knowledge, beliefs, self-care practices, and dental-service utilization. Data were analyzed with R 4.4.1 and SPSS 27.0. Results: The awareness rate of oral health knowledge among the children and adolescents in Xizang was less than 50%. More than half of the adolescents consumed high-sugar foods, such as desserts and sugary beverages daily. Only 15.98% of the adolescents brushed their teeth twice or more daily, 7.71% used dental floss daily before the course, and the usage rate of fluoride toothpaste was 45.45%. Oral health issues among the children and adolescents in Xizang severely impacted their daily lives, particularly in eating, pronunciation, and brushing. A single oral health education session showed no significant impact on the awareness rate or the conversion of knowledge into behavior. Conclusion: The awareness rate of oral health knowledge among the children and adolescents in Xizang is lower than the national average a decade ago, and a significant portion has yet to develop good personal oral hygiene habits. Targeted measures are needed to improve oral health awareness among the children and adolescents in Xizang. These may include utilizing interactive digital education tools and emphasizing oral disease prevention to enhance both the awareness rate of oral health knowledge and the conversion of knowledge into behavior.

Objective: To investigate the effect of modified hot-etching treatment on the flexural strength and surface crystalline phase proportions of zirconia and zirconia/resin bond strength. Methods: Zirconia specimens were divided into three groups according to different surface treatments, including blank group, sandblasting treatment group and modified hot-etching treatment group. A scanning electron microscope (SEM) was used to observe the surface morphology of the treated zirconia, an X-ray diffractometer (XRD) was employed to detect the surface crystalline phase proportions, and a universal mechanical testing machine was utilized to measure the three-point flexural strength of the zirconia specimens of different treatment groups. A bonding surface was prepared with bovine enamel, and the zirconia specimens were bonded using resin cement. Half of the bonded specimens underwent 5 000 cycles of thermal cycling fatigue test, and the immediate and fatigued shear bond strengths (SBS) were detected by using a universal mechanical testing machine. Results: SEM observations revealed that the surface of the control group was smooth, the surface of sandblasting treatment group exhibited irregular scratches, and the surface of modified hot-etching treatment group showed a honeycomb-like etched morphology. XRD results indicated that the monoclinic phase proportions were 8.18% for the control group, 28.34% for the sandblasting treatment group, and 9.69% for the modified hot-etching treatment group. The flexural strength of the sandblasting treatment group [(316.40±58.37) MPa] was significantly (P < 0.01) lower than that of the blank group [(415.30±47.64) MPa] and the modified hot-etching treatment group [(398.77±47.94) MPa]. The immediate SBS of the modified hot-etching treatment group [(53.77±8.36) MPa] was higher (P < 0.01) than that of blank group[(35.50±4.72) MPa] and sandblasting treatment group [(42.97±6.95) MPa]. After thermal cycling fatigue test, the fatigued SBS of the blank group [(21.65±4.01) MPa] was lower (P < 0.01) than that of the modified hot-etching treatment group [(30.69±7.36) MPa] and the sandblasting treatment group [(29.37±5.73) MPa]. Conclusion: The modified hot-etching treatment could enhance the immediate zirconia/resin SBS, exhibited similar resistance to thermal fatigue test with sandblasting treatment group, could not significantly reduce the flexural strength, and did not obviously alter the surface crystalline phase proportions.

Objective: Giant renal angiomyolipoma (RAML), typically defined as having a maximum diameter of ≥8 cm, presents formidable surgical challenges and heightened clinical risks. These challenges primarily stem from the tumor's extensive volume, highly enriched but fragile vascularization, and significant susceptibility to spontaneous rupture and life-threatening hemorrhage. This study aims to comprehensively evaluate the clinical effectiveness and safety of laparoscopic nephron-sparing surgery (NSS) for the management of these complex giant lesions. Methods: A retrospective analysis was performed on 45 patients with giant (≥8 cm) RAML who received NSS at Peking University Third Hospital between January 2012 and September 2025. The cohort comprised 11 males and 34 females with a mean age of (40.9±14.1) years and a mean body mass index (BMI) of (23.7±4.0) kg/m². Preoperatively, 5 patients had a history of spontaneous hemorrhage, and 2 were pregnant. The mean maximum tumor diameter was (10.3±2.2) cm, ranging from 8.0 to 15.4 cm. Surgical procedures included standard laparoscopy (39 cases) and Da Vinci robotic-assisted laparoscopy (6 cases), utilizing either a retro-peritoneal approach (32 cases, 71.1%) or a transperitoneal approach (13 cases, 28.9%). Pathological diagnosis and differentiation were conducted in strict accordance with the 2022 World Health Organization (WHO) classification of tumors. Key outcome measures included operative time, warm ischemia time, estimated blood loss, postoperative complications, and length of postoperative hospital stay. Results: All the 45 operations were successfully completed with complete tumor resection and nephron preservation, although 5 cases required conversion to open surgery due to severe adhesions or bleeding. The operative time was (180.6±55.7) min (range: 86-312 min), the warm ischemia time was (21.9±9.8) min (range: 6-40 min); 36 cases had a warm ischemia time ≤30 min, while a zero-ischemia technique was employed in 3 cases. The postoperative hospital stay was (6.2±2.6) days (range: 3-14 days), and the time to drainage tube removal was (5.1±2.2) days (range: 2-14 days). Postoperative patho-logy confirmed RAML in all cases, and all surgical margins were negative. Postoperative complications included one case of pulmonary infection and one case of renal insufficiency. During a follow-up of 3 to 43 months, no tumor recurrence or significant loss of renal function was documented. Conclusion: NSS for selected patients with giant RAML is effective in preserving renal function while ensuring complete tumor resection, negative margins, and avoiding short-term and long-term complications. Robotic-assisted systems, in particular, offer distinct advantages in complex wound reconstruction and the reduction of surgical complications.

Clear cell renal cell carcinoma (ccRCC) is the most common histological subtype of renal cell carcinoma. Patients classified as intermediate- or poor-risk according to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC), particularly those with multiple organ metastases, generally have an unfavorable prognosis. Here, we report a case of advanced ccRCC in an IMDC poor-risk patient who achieved an unexpectedly prolonged survival with combination therapy followed by maintenance immunotherapy. A 65-year-old male developed multiple metastases involving the lungs, liver, and bone shortly after undergoing radical nephrectomy for right-sided renal cancer. Laboratory findings revealed anemia, neutrophilia, and thrombocytosis, and the IMDC score was 5, indicating poor-risk disease. The patient received first-line treatment with the programmed death-ligand 1 (PD-L1) inhibitor benmelstobart in combination with the multi-target tyrosine kinase inhibitors (TKIs) anlotinib. After 6 weeks of therapy, radiological evaluation demonstrated a partial response (PR), with an overall tumor reduction of approximately 48%. Subsequent imaging assessments confirmed a durable PR, accompanied by significant improvement in clinical symptoms and performance status. During treatment, the patient developed progressive proteinuria, with a maximum 24-hour urinary protein level of 5.18 g. Despite stepwise dose reduction of anlotinib, proteinuria recurred, necessitating discontinuation of the TKIs. Following cessation of anlotinib, the patient continued benmelstobart monotherapy as maintenance therapy and maintained sustained deep remission. After approximately 3 years of treatment, serum creatinine levels gradually increased, reaching a peak of 228 μmol/L. Considering the possibility of treatment-related renal toxicity and the durable disease control achieved, immunotherapy was subsequently discontinued. No further antitumor treatment was administered. The patient eventually experienced disease progression and died in September 2024, with an overall survival of 44 months. This case suggests that the combination of benmelstobart and anlotinib can induce rapid and durable antitumor responses in patients with IMDC poor-risk advanced ccRCC. Notably, in patients who respond well to combination therapy, discontinuation of TKIs due to intolerable adverse events followed by maintenance immunotherapy may still provide long-term disease control. This sustained benefit may be associated with tumor microenvironment remodeling and the establishment of immunological memory induced by anti-angiogenic therapy. Furthermore, this case highlights the importance of vigilant monitoring of renal toxicity and individualized treatment adjustment during combined targeted therapy and immunotherapy.

Lymphangioma is a congenital vascular malformation arising from aberrant lymphatic deve-lopment, with a reported incidence of approximately 1 in 4 000. The condition predominates in the pedia-tric population, with the head and neck representing the most frequently affected anatomical regions. By contrast, scrotal lymphangioma in adults is exceedingly rare and remains highly susceptible to misdiagnosis or diagnostic omission in clinical settings. Here, we report a case of cystic lymphangioma of the penis in a 42-year-old male who presented with a mass at the penile root persisting for over 30 years, with marked enlargement over the preceding six months. Physical examination revealed a cystic mass measuring approximately 7 cm×4 cm×5 cm on the left aspect of the penile root, with a positive transillumination sign. Bilateral testes, epididymides, and spermatic cords were unremarkable. Ultrasonography demonstrated an irregular cystic anechoic lesion at the penoscrotal junction with well-defined margins. Magnetic resonance imaging (MRI) revealed a multilocular cystic lesion at the scrotal root measuring approximately 5.6 cm×3.8 cm×6.3 cm. Both imaging modalities were consistent with cystic lymphangioma. The patient underwent complete surgical resection under epidural anesthesia. Intraoperatively, the mass was confirmed to be multilocular and contained taupe-colored fluid. Histopathological analysis revealed endothelial cell lining of the cyst wall, and immunohistochemical staining was positive for CD31, establishing the definitive diagnosis of cystic lymphangioma. Genomic profiling identified a somatic heterozygous missense mutation in the PIK3CA gene at codon E545 (GAG>GCG), consistent with the established pathogenic mechanism underlying lymphangioma. Mechanistically, somatic PIK3CA mutations activate downstream signaling cascades, driving aberrant proliferation of lymphatic endothelial cells and culminating in cystic lesion formation. Clinically, lymphangioma typically manifests as a painless, slowly enlarging cystic mass. Definitive diagnosis relies on integrated imaging and histopathological evaluation, with differential diagnoses encompassing indirect inguinal hernia, hydrocele, and varicocele. Complete surgical resection remains the first-line therapeutic strategy and is associated with a substantially reduced recurrence rate. For patients deemed ineligible for surgery, sclerotherapy or molecularly targeted agents, including sirolimus and alpelisib, represent viable alternatives. The patient achieved an uneventful postoperative recovery with no evidence of recurrence at one-month follow-up. Although adult scrotal cystic lymphangioma is a rare clinical entity, it exhibits characteristic clinical, radiological, and pathological features that, in conjunction with molecular genetic analysis, enable accurate diagnosis. Early complete resection confers a favorable prognosis. Heightened clinical awareness and standardized management of lymphangioma at atypical anatomical sites are warranted.

We reported the clinical records of 2 patients each with a foreign body in the urinary bladder admitted to Qingdao Central Hospital, University of Health and Rehabilitation Sciences. The size and shape of each foreign body in the urinary bladder were different, thus we chose different surgical approaches to remove them. Case 1 was a 21-year-old male patient. He presented to the outpatient service with urodynia. The patient currently complained of urodynia, and narrated that a foreign body was self-inserted via the urethra 2 days before. Physical examination revealed suprapubic pain. Ultimately he was admitted to the Department of Urology with a diagnosis of "bladder foreign body". A computed tomography (CT) scan of the pelvis was performed and the results demonstrated a linear metallic structure, mea-suring 4.2 cm in length, within the urinary bladder. Under general anesthesia, the patient was placed in lithotomy position and a rigid cystoscope was inserted into the bladder via urethra. The foreign body was a metal tubular structure and was located within the urinary bladder. Removal by foreign body forceps was attempted and long axis of the foreign body should be parallel to cystoscope. Removal was carefully performed after several attempts due to the smooth surface of the metal foreign body. Case 2 was a 42-year-old male patient. He presented to the outpatient service with dysuria and urodynia and was admitted to the Department of Urology. The patient narrated that a foreign body was self-inserted via the urethra 1 day before, and currently complained of dysuria, urodynia, and slight hematuria. A CT scan of the urologic system was performed and the results demonstrated a metal tubular structure, measuring 21.5 cm in length. The length of the foreign body was long (from top of iliac crest to perineum) and both ends were sharp, thus bladder perforation could not be excluded. Besides, with smooth metal surface, it was difficult to remove via cystoscopy and the risk of iatrogenic bladder perforation would increase simultaneously. Therefore, laparoscopic surgery was chosen to detect whether there would be a bladder perforation and could remove the foreign body. Under general anesthesia, the patient was placed in supine position and supraumbilical incision of 1 cm was performed. Pneumoperitoneum needle was used to establish a pneumoperitoneum and insufflation CO₂ pressure was maintained at 12 mmHg. The peritoneum was accessed and a 10-mm trocar and laparoscopic camera were inserted. A 5-mm trocar was inserted at 2 cm below the umbilical level of lateral margin of left rectus abdominis muscle. While a 12-mm trocar was inserted at symmetrical site of his right rectus abdominis muscle. Under laparoscope, dome of the bladder was lifted into the abdominal cavity by the foreign body, then the bladder wall was incised to expose the foreign body. We pushed the bottom of the foreign body from the perineum extracorporally and removed the foreign body from the supraumbilicus trocar.

This report details the cytogenetic and familial investigation of a 31-year-old female presenting with primary infertility of eight years' duration. Previous extensive evaluations, including assessment of hormonal profiles, tubal patency, and partner semen analysis, yielded no explanatory findings, prompting a genetic etiology workup. High-resolution G-banding chromosome analysis was subsequently performed. The patient's karyotype was characterized by a complex, apparently balanced, three-way re-arrangement involving chromosomes 1, 6, and 14. The precise nomenclature was 46, XX, der(1)(pter→q12:: q32→qter), der(6)(6pter→6q13:: 14p13→14pter), der(14)(6qter→6q13:: 1q12→1q32:: 14p13→14qter), formally interpreted as 46, XX, t(1;6;14). This result indicated a reciprocal translocation in which segments of chromosomes 1, 6, and 14 were rearranged, resulting in three derivative chromosomes: der(1), der(6), and der(14). To establish the inheritance pattern and provide accurate familial risk assessment, karyotypic analysis was extended to the proband's parents and her younger sister. Her father (46, XY) and sister (46, XX) were both found to have normal chromosomal constitutions. Crucially, her phenotypically normal mother was identified to carry an identical chromosomal re-arrangement: 46, XX, t(1;6;14). This confirmed a maternal origin and classified the mother as a balanced translocation carrier. The patient, inheriting this derivative chromosome complement, was thus also a balanced carrier. Her primary infertility, in the absence of a history of recurrent miscarriage, was highly likely attributable to this cytogenetic anomaly. The proposed mechanism is a markedly increased risk of producing gametes with unbalanced chromosomal segregation during meiosis, leading to conceptions with lethal aneuploidy or subviable genomic imbalances that precluded successful implantation or result in very early, undetected pregnancy loss. This case highlights several critical principles in reproductive genetics. First, it reaffirms that conventional karyotype analysis remains a fundamental and indispensable diagnostic tool in the evaluation of idiopathic primary infertility, capable of revealing cryptic balanced structural rearrangements that are not detectable by molecular karyotyping (chromosomal microarray). Second, it underscores the absolute necessity of systematic familial cytogenetic studies following the identification of an index case. Such studies are vital for distinguishing de novo from inherited rearrangements, providing precise recurrence risk quantification, and enabling comprehensive genetic counseling for all at-risk family members. Finally, for identified carriers of such translocations seeking biological parenthood, preimplantation genetic testing (PGT) for structural rearrangements represents the cornerstone of modern reproductive management. PGT allows for the selective transfer of embryos with a balanced or normal chromosomal complement, thereby offering a direct pathway to a healthy live birth while effectively preventing the intergenerational transmission of the chromosomal anomaly. This case also suggests the need for further investigation into whether the specific breakpoints in such complex rearrangements may disrupt genes critical for fertility, potentially explaining the phenotypic presentation of infertility in the absence of spontaneous abortion.

Primary hyperparathyroidism (PHPT) is caused by excessive production of parathyroid hormone by the parathyroid gland. PHPT discovered for the first time during pregnancy is extremely rare and has serious adverse effects on both the mother and the fetus. This article reports a case of pregnancy complicated by PHPT, hypercalcemic crisis, and acute pancreatitis. The patient was a 30-year-old woman at 32 weeks of gestation who presented with a four-day history of progressive abdominal pain and vomiting. Laboratory evaluation on admission revealed a markedly elevated serum total calcium of 3.56 mmol/L and a parathyroid hormone (PTH) level of 388.6 ng/L, with the normal reference range being 15 to 65 ng/L. Imaging studies confirmed the presence of acute pancreatitis, left nephrolithiasis, right hydronephrosis, and a suspicious cystic-solid mass at the lower pole of the right thyroid lobe measuring 2.1 cm × 2.0 cm × 1.2 cm. Due to rapid clinical deterioration and the development of a hypercalcemic crisis, an emergency cesarean section was performed, resulting in the delivery of a live premature male infant with a birth weight of 2 400 g and a length of 45 cm. The neonate's initial serum calcium was 3.08 mmol/L, and several episodes of hypocalcemic seizures occurred shortly after birth, necessitating admission to the neonatal intensive care unit. Postpartum, the mother was managed with aggressive intravenous fluid resuscitation, subcutaneous calcitonin, and intravenous bisphosphonate therapy. Notably, her serum PTH level decreased substantially after delivery, ranging from 48.91 to 53.08 ng/L. This spontaneous decline was likely attributable to reduced effective circulating blood volume during the episode of acute pancreatitis and partial ischemic necrosis of the parathyroid adenoma. At 47 days postpartum, the patient underwent successful surgical resection of a right inferior parathyroid adenoma measuring approximately 3 cm in diameter. Pathological examination of the resected specimen confirmed the diagnosis and revealed focal vascular proliferation and congestion, interstitial fibrosis with hyaline degeneration, and hemosiderin deposition. Following parathyroidectomy, her serum calcium and PTH levels normalized rapidly and remained stable. At the 9-month follow-up visit, the mother was completely asymptomatic with normal biochemical parameters, and the infant demonstrated appropriate growth and development. Clinicians should be vigilant about the presence of PHPT during pregnancy, especially during preconception and early pregnancy, monitoring blood calcium levels and taking preventive measures early to avoid complications and adverse pregnancy outcomes.

Visceral leishmaniasis (VL) is a rare parasitic infection characterized by distinctive features, including the overproduction of various autoantibodies by B cells, which may mimic manifestations and antibody profiles associated with autoimmune diseases. In this report, we presented two patients diagnosed with visceral leishmaniasis who were initially suspected of having an autoimmune disease. We discussed the similarities and differences between visceral leishmaniasis and autoimmune diseases based on clinical presentation, physical examination findings, laboratory tests, diagnosis, and treatment. Case 1 involved a 69-year-old female patient who was admitted to the hospital due to irregular fever. Physical examination revealed splenomegaly. Laboratory investigations indicated pancytopenia along with an abnormal autoantibody profile. The initial bone marrow aspirate demonstrated: Proliferative changes in the bone marrow, and abnormal lymphocytes in peripheral blood accounting for approximately 6%. Auto-immune disease was initially considered, and hormone therapy did not respond well. Further screening for immunological disorders, infections, tumors, and other related conditions was conducted. A second bone marrow aspirate was performed actively which revealed Leishman-Donovan body. Subsequent nuc-leic acid detection of pathogenic microorganisms confirmed the presence of Leishmania through real-time fluorescence PCR analysis; thus, confirming a diagnosis of visceral leishmaniasis. Case 2 involved a 41-year-old male patient who presented with fever and abdominal distension. Similar to Case 1, physical examination also showed splenomegaly alongside an abnormal autoantibody profile. During treatment, he tested positive for Leishmania infection and was ultimately diagnosed with visceral leishmaniasis complicated by hemophagocytic syndrome. The symptoms observed in the two patients included recurrent fever, anorexia, and splenomegaly. To further investigate the cause of pancytopenia and to rule out factors such as surgery, infection, tumors, and other related conditions, an abnormal antinuclear antibody profile was assessed. The initial misdiagnosis pointed towards autoimmune diseases; however, during treatment, visceral leishmaniasis infection was identified, leading to a final diagnosis of visceral leishmaniasis. The gold standard for diagnosing visceral leishmaniasis involves detecting Leishmania bodies through aspiration of bone marrow, lymph nodes, or spleen. The positive rate for bone marrow puncture is approximately 80% to 90%. However, clinical practice may encounter missed detections due to limitations associated with the puncture site. This underscores the necessity for secondary punctures when warranted. Addi-tionally, patients presenting with splenomegaly accompanied by trilineage cytopenia often seek care from Department of Hematology or Department of Rheumatology and Immunology rather than Department of Infection. This tendency can contribute to both misdiagnosis and missed diagnoses. It is hoped that this case report will offer valuable insights for clinicians in enhancing their diagnostic capabilities and improving the clinical detection rates of visceral leishmaniasis.