Low-level laser therapy (LLLT), a noninvasive photobiomodulation technique, employs red or near-infrared (NIR) light (600-1 000 nm) with power outputs ranging from 5 to 500 mW. It exerts therapeutic effects through molecular mechanisms, specifically the activation of cytochrome C oxidase (CCO) and the modulation of intracellular signaling pathways. By enhancing mitochondrial adenosine triphosphate (ATP) synthesis, LLLT mitigates oxidative stress, regulates the reactive oxygen species (ROS)/glutathione peroxidase (GSH-Px)/superoxide dismutase (SOD) axis, and activates key pathways, including phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) and mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK). These mechanisms confer antioxidant, anti-inflammatory, and pro-regenerative properties to LLLT, making it a viable intervention for dermatological conditions, oncological therapies, and musculoskeletal disorders. Recent preclinical studies underscore LLLT' s potential in male reproductive health. Specifically, it ameliorates cavernosal fibrosis and endothelial dysfunction in erectile dysfunction (ED) models by upregulating the PI3K/Akt and MAPK/ERK pathways. In the context of sperm biology, LLLT enhances motility and acrosomal integrity in both fresh and cryopreserved spermatozoa. This is achieved through mitochondrial metabolic reprogramming, such as CCO-mediated electron transport chain activation, redox homeostasis restoration, and epigenetic modulation involving DNA methylation and histone acetylation. Additionally, LLLT alleviates scrotal heat-induced oligospermia by promoting seminiferous epithelial differentiation, elevating serum testosterone levels, and suppressing lipid peroxidation. These findings highlight the translational potential of LLLT in regenerative medicine, particularly for male sexual and reproductive disorders. Future research efforts should focus on interdisciplinary collaborations spanning life sciences, engineering, and physics. The goal is to optimize laser parameters, including wavelength, irradiance, and treatment duration, and establish standardized protocols. Rigorous preclinical and clinical investigations are paramount to validate the safety, efficacy, and long-term outcomes of LLLT, ultimately paving the way for its integration into precision medicine frameworks for urological and reproductive therapies.

Objective: To investigate the relationship between oxidative stress-related genes and prostate cancer (PCa) from a multi-omics perspective using summary-data-based Mendelian randomization (SMR), colocalization analysis, and cellular experiments. Methods: Summary-level data on DNA methylation, gene expression, and circulating proteins were obtained and filtered. The PRACTICAL consortium was used as the discovery cohort, with the deCODE database serving as the validation cohort. SMR analysis and heterogeneity in dependent instruments (HEIDI) tests were conducted to assess the association and heterogeneity between oxidative stress-related genes and PCa. Colocalization analysis was performed to determine whether oxidative stress-related genes and PCa shared common causal variants. Finally, CCK-8 assays, wound healing assays, and Transwell invasion assays and Western blotting, were conducted to examine the effects of oxidative stress-related genes on the biological behavior of the PCa cell line C4-2. Results: Multi-omics analysis identified SCP2 as significantly associated with increased PCa risk across gene methylation, gene expression, and circulating protein levels. GSTP1 showed significant associations at the methylation and protein levels, while LPO was associated at the protein level. At the methylation level, SCP2 sites cg00581603 (OR=1.11, 95%CI: 1.05-1.17) and cg13078931 (OR=1.12, 95%CI: 1.05-1.18) were identified as pathogenic. Among the four methylation sites in GSTP1, only cg05244766 (OR=0.89, 95%CI: 0.84-0.95) was considered protective. At the gene expression level, SCP2 (OR=1.05, 95%CI: 1.02-1.07) was also found to be a pathogenic factor. At the circulating protein level, SCP2 (OR=2.10, 95%CI: 1.34-3.29) showed a consistent pathogenic trend. In addition, GSTP1 (OR=1.16, 95%CI: 1.07-1.25) and LPO (OR=1.12, 95%CI: 1.05-1.19) were significantly associated with increased PCa risk. Further functional assays demonstrated that knockdown of SCP2 significantly reduced the oncogenic phenotype of prostate cancer cells. Conclusion: Through integrated multi-omics analysis and experimental validation, this study confirmed a significant association between SCP2 and increased PCa risk. These findings enhance our understanding of PCa pathogenesis and provide new potential targets and therapeutic directions for PCa treatment.

Objective: To compare the clinicopathological characteristics and prognostic outcomes between patients with clear cell renal cell carcinoma (ccRCC) and non-clear cell renal cell carcinoma (nccRCC) accompanied by venous tumor thrombus. Methods: A retrospective analysis was conducted on clinical and pathological data from patients with RCC and venous tumor thrombus treated in the Department of Urology at Peking University Third Hospital between January 2014 and February 2024. Patients were stratified into two groups based on pathological type: ccRCC and nccRCC. Comparisons of baseline characteristics, intraoperative situation, and prognosis between the two groups were performed using t-tests, Mann-Whitney U tests, chi-square tests, and Log-rank tests. Survival curves were generated using the Kaplan-Meier method. Results: A total of 437 patients were included, with a median age of 58 years, including 317 males and 120 females. The cohort comprised 366 cases of ccRCC and 71 cases of nccRCC. The non-clear cell group included 38 cases (53.5%) of papillary renal cell carcinoma, 2 cases (2.8%) of chromophobe renal cell carcinoma, 11 cases (15.5%) of unclassified renal cell carcinoma, 19 cases (26.8%) of molecularly defined renal cell carcinoma, and 1 case (1.4%) of collecting duct carcinoma. Compared with the clear cell renal carcinoma group, patients in the non-clear cell carcinoma group demonstrated a younger age at diagnosis (59 years vs. 55 years, P=0.010), larger tumor size (8.4 cm vs. 9.5 cm, P=0.025), higher rates of lymph node metastasis (56.8% vs. 70.6%, P=0.034), more advanced tumor thrombus (P < 0.001) and pathological grading (P=0.010), longer surgical duration (272 minutes vs. 289 minutes, P=0.023), and shorter overall survival (80 months vs. 35 months, P < 0.001). Multivariate Cox analysis indicated that histologic type, distant metastasis, tumor thrombus grading, and sarcomatoid/rhabdoid differentiation were prognostic factors in the renal cell carcinoma patients with venous tumor thrombus. No significant differences were observed between the two groups in terms of gender, body mass index, tumor laterality, distant metastasis, sarcomatoid or rhabdoid differentiation, American Society of Anesthesiologists (ASA) score, surgical approach, conversion to open surgery, blood loss, or transfusion of red blood cells and plasma. Conclusion: Compared with patients with clear cell renal carcinoma and venous tumor thrombus, those with non-clear cell carcinoma and venous tumor thrombus exhibit earlier onset, more aggressive disease progression, and poorer prognosis.

Objective: To review the clinicopathological features of TFE3-rearranged renal cell carcinoma (TFE3-RCC) with venous tumor thrombus (VT) (TFE3-VT), to explore treatment strategies and to prognostic characteristics, and to provide diagnostic and therapeutic references for TFE3-VT patients. Methods: Patients who underwent surgery at Department of Urology, Peking University Third Hospital from January 2013 to January 2024 were enrolled, including three cohorts: Pathologically confirmed TFE3-VT patients, TFE3-RCC patients without VT (TFE3-non-VT), and non-TFE3-rearranged renal cell carcinoma patients with VT (non-TFE3-VT). Clinical history, imaging data, pathological data, and follow-up records were collected. Primary and secondary endpoints were progression-free survival (PFS) and overall survival (OS), respectively. (1) Baseline characteristics were compared between the TFE3-VT and TFE3-non-VT patients. Normally distributed continuous variables were expressed as mean±SD and compared using Student's t-test; non-normally distributed variables were expressed as M (P₂₅, P₇₅) and analyzed with Mann-Whitney U test; categorical variables were described as frequency and percentage [n (%)] and compared by χ² test or Fisher's exact test. (2) Clinical history, radiological presentations, surgical data, and histopathological features of the TFE3-VT patients were comprehensively characterized. (3) Survival analysis was performed for the TFE3-VT patients. Follow-up data of the TFE3-VT patients were described in detail, and their survival outcomes were compared with the TFE3-non-VT and non-TFE3-VT patients. When compared with the TFE3-non-VT counterparts, Kaplan-Meier method was used to generate PFS and OS curves among: (1) the TFE3-RCC patients across clinical stages Ⅰ-Ⅳ; (2) TFE3-VT versus TFE3-non-VT cohorts; (3) stage Ⅲ subgroups of the TFE3-VT and TFE3-non-VT patients. Intergroup survival differences were statistically evaluated using Log-rank tests. For comparisons with the non-TFE3-VT patients, a 1 : 1 propensity score matching (PSM) was implemented to balance baseline characteristics between the two cohorts. Post-matching Kaplan-Meier curves were generated to compare PFS and OS between the matched groups, with Log-rank tests employed to determine statistical significance of survival disparities. All statistical analyses were conducted with R software (v 4.2.3), and two-tailed P < 0.05 was considered statistically significant. Results: The study included 45 TFE3-RCC patients: 13 TFE3-VT and 32 TFE3-non-VT cases. Additionally, 523 non-TFE3-VT patients were enrolled. Among the 13 TFE3-VT patients, 9 were female (69.2%) and 4 male (30.8%), with a mean age of (37.9±14.4) years, mean BMI of (22.2 ± 3.5) kg/m², median age-adjusted Charlson comorbidity index (aCCI) of 1.0 (0.0, 1.0), and preoperative creatinine level of (75.3±15.9) μmol/L; tumors were located in the left kidney in 7 patients (53.8%) and right kidney in 6 (46.2%); preoperative distant metastasis (M1 stage) was present in 6 patients (46.2%), while 7 (53.8%) showed no metastasis; VT distribution by Mayo level comprised 7 cases (53.8%) at level 0, 1 case each at levels Ⅰ and Ⅳ (7.7% respectively), and 2 cases each at levels Ⅱ and Ⅲ (15.4% respectively); surgical approaches comprised open surgery (n=2, 15.4%), laparoscopic surgery (n=6, 46.1%), and robot-assisted laparoscopic surgery (n=5, 38.5%); mean operative time was (273±79) min, and intraoperative blood loss was (722±570) mL; mean maximum tumor diameter was (10.8±2.4) cm. All the 13 patients underwent TFE3 protein immunohistochemistry (IHC) staining, with 7 confirmed by fluorescence in situ hybridization (FISH). Tumor recurrence or metastasis occurred in 11 patients (84.6%), and 9 (69.2%) patients died during follow-up. Median PFS was 4 months (1 year PFS rate: 31%), and median OS was 13 months (1 year OS rate: 54%). Survival analysis of 45 TFE3-RCC patients revealed statistically significant differences in PFS and OS across all the clinical stages (P < 0.001). The TFE3-VT patients exhibited significantly worse PFS and OS than the TFE3-non-VT patients (P < 0.001), with persistent significance in stage Ⅲ subgroup analysis (P < 0.05). After PSM, TFE3-VT patients showed significantly inferior PFS compared with non-TFE3-VT (P=0.01), though no significant difference was shown between the OS curves (P=0.11). Conclusion: TFE3-VT predominantly occurs in young females with frequent preoperative metastases. Strongly-positive staining of TFE3 protein in IHC staining and red-green split signals in FISH tests are reliable diagnostic markers. TFE3-VT patients exhibit inferior survival compared with TFE3-non-VT patients and earlier progression than non-TFE3-VT patients.

Objective: To investigate the safety and feasibility of the domestic single-port serpentine-arm robotic surgical system for pyeloplasty in children with congenital ureteropelvic junction obstruction (UPJO). Methods: Data of UPJO patients who underwent pyeloplasty using a domestic single-port serpentine-arm robotic surgical system (Beijing Surgerii Robotics Co., Ltd.) in Beijing Children's Hospital from November 2023 to February 2024 were retrospectively collected. The patients who were not receiving surgical treatment for the first time, had hydronephrosis caused by other reasons (such as ureterovesical junction obstruction, posterior urethral valve, urinary tract stones, vesicoureteral reflux, ureterocele, etc.), had other urinary tract malformations (such as duplicated kidneys, congenital renal dysplasia, etc.), had severe atrophy of the affected kidney, severe urinary tract infection or severe renal insufficiency were excluded. All the surgeries were performed through the umbilicus and abdominal cavity, and the operation time, number of intraoperative incisions, incision size, intraoperative blood loss, and peri-operative complications were recorded. Statistical analysis was performed to compare changes in the anteroposterior pelvic diameter (APD) and renal cortical thickness before surgery and 6 months postoperatively. Results: A total of 10 patients were included (8 males and 2 females), with an average age of (10.20±3.12) years. Nine patients were on the left side and one patient was on the right side. The average height was (142.0±17.8) cm and the average weight was (37.6±17.9) kg. All the patients underwent surgery using the domestic single-port robotic surgery system, and no patient was converted to open pyeloplasty. The total operation time was (237±96) min, and the operation time on the operating table was (162.0±69.3) min. The intraoperative blood loss was 5.00 (2.25, 5.00) mL. No complications, such as bleeding, urine extravasation, fever, and poor wound healing occurred during the perioperative period. Compared with the preoperative measurements, the APD was significantly shortened postoperatively (P=0.005), and the renal cortical thickness significantly increased (P=0.011). Conclusion: The domestic single-port serpentine arm robotic surgical system is safe and feasible for UPJO pyeloplasty in children, with good surgical results, and can be promoted and applied in most domestic medical centers.

Objective: To review and summarize the experience of robot-assisted laparoscopic transplant nephrectomy, share the surgical steps and technical key points, and provide a reference for clinical practice. Methods: A retrospective analysis was conducted on the perioperative data of 5 patients who underwent robot-assisted laparoscopic donor nephrectomy at Peking University Third Hospital from August 2023 to December 2024. The surgical steps and key points were summarized. The continuous variables were described by medians(ranges). Results: A total of 5 patients were included in the analysis, of whom 2 were male and 3 were female. The median age of the patients was 37 (31-68) years. The median time from kidney transplantation to donor nephrectomy was 10 (3-22) years. The indications for donor nephrectomy included recurrent hematuria, abdominal pain, malignant tumor of the transplanted kidney, and recurrent infection with hydronephrosis of the transplanted kidney. The excised transplanted kidneys from all the 5 patients had a single renal artery and a single renal vein. The median operation time was 212 (145-351) min, the median blood loss was 300 (20-500) mL, and the median post-operative hospital stay was 7 (4-25) days. Only 1 patient experienced intraoperative complications, who experienced an external iliac artery injury during the operation and underwent suture repair. No patient died during the perioperative period. Postoperative pathological results showed that 3 patients had end-stage non-functional kidneys, 1 patient had BK virus-associated urothelial carcinoma, and 1 patient had chronic pyelonephritis with renal parenchymal atrophy. Conclusion: Robot-assisted laparoscopic transplant nephrectomy as a new surgical approach is feasible and safe. Compared with traditional open transplant nephrectomy, its advantage lies in the ability to directly observe and prioritize the management of the renal pedicle of the transplanted kidney, while completely freeing and removing the transplanted kidney outside the renal capsule. With the continuous accumulation of experience, this surgical technique is expected to become a powerful alternative to traditional open transplant nephrectomy.

Objective: To summarize the surgical strategies and to evaluate the clinical outcomes of upper urinary tract reconstruction in patients with stone-related ureteral strictures. Methods: This retrospective study included 71 patients diagnosed with ureteral strictures secondary to urinary stones who underwent upper urinary tract reconstructive surgery at Peking University First Hospital between March 2014 and November 2023. Patient data were collected, including demographic characteristics, clinical presentation, laboratory results, imaging findings, surgical procedures, and follow-up outcomes. Ureteral strictures were classified according to anatomical location into upper, middle, lower, or multiple segments. Surgical procedures were carried out depending on the stricture characteristics. Surgical success was defined as resolution or improvement of clinical symptoms, radiographic improvement or stabilization of hydronephrosis, and maintenance of normal and stable renal function. Results: Among the 71 patients, 36 (50.7%) had strictures in the upper ureter, 9 (12.7%) in the middle ureter, 15 (21.1%) in the lower ureter, and 11 (15.5%) had multifocal ureteral strictures. The median stricture length was 5.0 cm (interquartile range: 3.0-15.0 cm). Surgical approach selection was individualized based on the location and extent of the stricture. For upper ureteral strictures, the most frequently employed techniques were oral mucosal graft ureteroplasty (13/36, 36.1%) and appendiceal flap ureteroplasty (8/36, 22.2%). Other options included ureteroureterostomy and ileal ureter replacement for longer or more complex strictures. In middle ureteral strictures, treatment was stratified by length: balloon dilation (1/9, 11.1%) and ureteroureterostomy (1/9, 11.1%) were applied in shorter strictures, while oral mucosal graft ureteroplasty (3/9, 33.3%) and ileal ureter replacement (4/9, 44.4%) were reserved for longer segments. For lower ureteral strictures, ureteral reimplantation into the bladder was the most common approach (10/15, 66.7%), often combined with a psoas hitch or Boari flap when necessary. All the patients with multiple segmental strictures underwent ileal ureter replacement due to the extensive nature of the disease. The median follow-up period was 14.2 months (range: 6.1-107.1 months). During follow-up, 69 of 71 patients (97.2%) achieved surgical success. Conclusion: Stone-related ureteral strictures present with considerable heterogeneity in terms of anatomical location, length, and complexity. Careful preoperative evaluation and individualized surgical planning are critical to successful reconstruction. With appropriate selection of surgical methods, favorable long-term clinical outcomes can be achieved in the majority of patients.

Objective: To investigate the efficacy of rigid ureteroscopic laser lithotripsy combined with N-trap (RULL + N-trap), which is scoop-shaped, in the treatment of ureteral stones with a maximum diameter ≥ 1.5 cm. Methods: This retrospective cohort study included patients diagnosed with ureteral calculi who underwent rigid ureteroscopic lithotripsy (RULL) combined with N-Trap stone entrapment system at the Department of Urology, Peking University Third Hospital, by the same surgical team between June 2021 and September 2024. A total of 364 patients were initially enrolled. After excluding 21 patients due to missing critical outcome variables, two distinct cohorts were established: 38 patients with ureteral stones measuring ≥1.5 cm in maximum diameter, and 305 patients with stones < 1.5 cm in maximum diameter. To minimize selection bias and control for confounding variables, propensity score matching (PSM) was employed. This resulted in two well-balanced groups: 31 patients with stones ≥1.5 cm in maximum diameter and 31 patients with stones < 1.5 cm in maximum diameter, matched on baseline demographic and clinical characteristics. The primary outcomes assessed between the two groups included stone clearance. Secondary outcomes included changes in renal function indicators, specifically serum creatinine (SCr) and estimated glomerular filtration rate (GFR), and other factors like postoperative hospital stay and operative time. Results: In the matched cohort, the patients with stones ≥1.5 cm in maximum diameter had significantly longer operative time compared with those with smaller stones: (85.8±28.8) min vs. (62.4±24.6) min (P < 0.05). Postoperative length of hospital stay showed no significant difference: (2.26±1.79) d vs. (2.03 ± 0.80) d (P>0.05). The stone clearance on postoperative day one was 90.3% in the study group vs. 100.0% in the control group (P>0.05). One month postoperatively, the stone clearance was 93.5% vs. 100.0%, respectively (P>0.05). Changes in SCr were (-6.58±16.10) μmol/L vs. (-13.70±12.50) μmol/L, and changes in GFR were (5.92±14.90) mL/(min·1.73 m²) vs. (7.47±11.20) mL/(min·1.73 m²), with no statistically significant differences observed between the two groups for either renal function marker (P > 0.05). Conclusion: Ureteroscopic lithotripsy combined with N-trap is an optional method for treating ureteral stones with a maximum diameter ≥1.5 cm. The overall therapeutic efficacy is comparable, with the added benefit of significantly reducing the economic burden on patients.

Objective: To analyze the clinical features associated with pelvic lymph node metastasis (PLNM) in prostate cancer and to construct a preoperative prediction model for PLNM, thereby reducing unnecessary extended pelvic lymph node dissection (ePLND). Methods: Based on predefined inclusion and exclusion criteria, 344 patients who underwent radical prostatectomy and ePLND at the First Affiliated Hospital of Zhengzhou University between 2014 and 2024 were retrospectively enrolled, among whom, 77 patients (22.4%) were pathologically confirmed to have lymph node-positive disease. The clinical characteristics, MRI reports, and pathological results were collected. The data were then randomly divi-ded into a training cohort (241 cases, 70%) and a validation cohort (103 cases, 30%). Univariate and multivariate Logistic regression analysis were employed to construct a preoperative prediction model for PLNM. Results: Univariate Logistic regression analysis revealed that total prostate specific antigen (tPSA) (P=0.021), free prostate specific antigen (fPSA) (P=0.002), fPSA to tPSA ratio (fPSA/tPSA) (P=0.011), percentage of positive biopsy cores (P < 0.001), prostate imaging reporting and data system (PI-RADS) score (P=0.004), biopsy Gleason score ≥8 (P=0.005), clinical T stage (P < 0.001), and MRI-indicated lymph node involvement (MRI-LNI) (P < 0.001) were significant predictors of PLNM. Multivariate Logistic regression analysis demonstrated that the percentage of positive biopsy cores (OR=91.24, 95%CI: 13.34-968.68), PI-RADS score (OR=7.64, 95%CI: 1.78-138.06), and MRI-LNI (OR=4.67, 95%CI: 1.74-13.24) were independent risk factors for PLNM. And a novel nomogram for predicting PLNM was developed by integrating all these three variables. Compared with the individual predictors: percentage of positive biopsy cores [area under curve (AUC)=0.806], PI-RADS score (AUC=0.679), and MRI-LNI (AUC=0.768), the multivariate model incorporating all three variables demonstrated significantly superior predictive performance (AUC=0.883). Consistently, calibration curves and decision curve analyses confirmed that the multivariable model had high predictive accuracy and provided significant net clinical benefit relative to single-variable models. And using a cutoff of 6%, the multiparameter model missed only approximately 5.2% of PLNM cases (4/77), while reducing approximately 53% of ePLND procedures (139/267), demonstrating favorable predictive efficacy. Conclusion: Percentage of positive biopsy cores, PI-RADS score and MRI-LNI are independent risk factors for PLNM. The constructed multivariate model significantly improves predictive efficacy, offering a valuable tool to guide clinical decisions on ePLND.

Objective: To analyze and compare the interfractional setup errors between two body positioning fixation methods (lithotomy position with carbon fiber full-body fixation frame vs. conventional carbon fiber body fixation frame combined with thermoplastic membrane) in radical radiotherapy for prostate cancer, and to calculate the clinical target volume (CTV) to planning target volume (PTV) margin (MPTV) for both methods to optimize immobilization techniques and radiotherapy workflows. Methods: A retrospective analysis was conducted on 37 consecutive patients who underwent radical prostate radiotherapy at Peking University First Hospital between August 2021 and March 2023. The patients were divided into two groups based on the immobilization method: Group A (18 patients, 450 CBCT image sets) used a carbon fiber whole-body fixator in the lithotomy position, while Group B (19 patients, 461 CBCT image sets) used a conventional carbon fiber fixator combined with a thermoplastic mask. All the patients underwent daily cone-beam computed tomography (CBCT) image guidance. Bone registration combined with manual registration was used to obtain the setup error data in the left-right (X), cranio-caudal (Y) and anterior-posterior (Z) directions. The positioning errors of the two groups were compared by using the independent sample t-test, the Mann-Whitney U test and the chi-square test. The average positioning error, systematic positioning error (Σ) and random positioning error (δ) were calculated, and the CTV-PTV extension distance was calculated by using the (MPTV=2.5Σ+0.7δ). Results: The analysis of the setup errors in the three-dimensional direction showed significant differences between the two groups (all P < 0.01). Specifically, the median (quartile) absolute values of the errors in the X, Y, and Z directions of group A were [0.40 (0.20, 0.70) cm, 0.50 (0.30, 0.80) cm, and 0.35 (0.20, 0.60) cm], respectively. In group B, the corresponding values were significantly reduced to [0.20 (0.10, 0.40) cm, 0.40 (0.20, 0.70) cm and 0.20 (0.10, 0.40) cm]. The results of Mann-Whitney U test showed that the differences in each direction were highly statistically significant (X: z=-6.86; Y: z=-2.76; Z: z=-5.71). The cumulative distribution ratio of the setup error displacement within 0.5 cm in the X, Y, and Z directions in group A and group B were 297 (66.0%) and 408 (88.5%) (P < 0.01), 250 (55.6%) and 285 (61.8%) (P=0.055), 308 (68.4%) and 391 (84.8%) (P < 0.01), respectively. The CTV-PTV margins in three directions were X 0.66 cm in group A and 0.35 cm in group B; Y 0.67 cm and 0.45 cm; Z 0.54 cm and 0.42 cm. Conclusion: Conventional carbon fiber human body fixator combined with thermoplastic film can significantly reduce the setup error. However, the carbon fiber whole-body fixator in the lithotomy position demonstrated larger setup errors in the X, Y, and Z directions compared with the conventional fixator combined with a thermoplastic mask, indicating the need for further workflow optimization. Given that the lithotomy position is essential for transperineal ultrasound-guided techniques, further research and improvements are required to achieve higher positioning accuracy.

Objective: To explore the risk factors of adverse events during the perioperative period of transurethral resection of bladder tumor (TURBT) in bladder cancer patients with coronary atherosclerotic heart disease (CAD). Methods: We retrospectively analyzed the clinical data of bladder cancer patients who underwent TURBT in Beijing Anzhen Hospital from June 2022 to September 2024. All patients with bladder cancer and CAD underwent coronary computed tomography angiography (CCTA) for diagnosis and assessment of CAD before surgery. Based on the CCTA results, the patients with bladder cancer and CAD were divided into two groups: those with mild to moderate coronary stenosis and those with severe coronary stenosis. The severe coronary stenosis group was further divided into two subgroups based on whether they received low-molecular-weight heparin (LMWH) bridging therapy or continued their antiplatelet treatment before surgery. Perioperative anticoagulation and antiplatelet strategies were adjusted according to the opinions of the specialists. The incidence of adverse events within 30 days postoperatively was followed up and analyzed. Results: A total of 80 bladder cancer patients with CAD who underwent TURBT were included in the study. Among the 80 patients with CAD, 55 (68.8%) had mild to moderate coronary stenosis, and 25 (31.2%) had severe coronary stenosis. Compared with those had mild to moderate coronary stenosis, the patients who had severe coronary stenosis had a higher incidence of postoperative bleeding and pulmonary embolism, although the differences were not statistically significant (P>0.05). However, the incidence of postoperative myocardial infarction was significantly higher in the patients who had severe coronary stenosis (P=0.034). Among the patients with severe coronary stenosis, 8 (32.0%) received LMWH bridging therapy before TURBT, and 17 (68.0%) continued their previous antiplatelet treatment. Compared with those who continued antiplatelet treatment, the patients who received LMWH bridging therapy had a higher incidence of postoperative bleeding and pulmonary embo-lism, although the differences were not statistically significant (P>0.05). However, the incidence of postoperative myocardial infarction was significantly higher in the LMWH bridging group (P=0.032). Conclusion: Patients with mild-to-moderate coronary stenosis demonstrate relatively low perioperative risk during TURBT procedures and may safely undergo TURBT following antiplatelet therapy discontinuation. Conversely, those with severe coronary stenosis exhibit significantly higher perioperative risk and require intensive monitoring. In bladder cancer patients with concomitant severe coronary stenosis, perioperative LMWH bridging therapy is associated with increased myocardial infarction risk, whereas continued antiplatelet therapy does not elevate postoperative bleeding risk. Current evidence therefore supports maintaining antiplatelet therapy in these patients, with appropriate bleeding risk assessment.

Objective: To evaluate the long-term oncological outcomes of partial nephrectomy (PN) in patients with renal cell carcinoma (RCC) who were clinically staged as clinical T1 (cT1) preoperatively but upstaged to pathological T3a (pT3a) after surgery. Methods: A total of 427 RCC patients postoperatively diagnosed as pT3aN0M0 at Peking University Third Hospital from February 2013 to December 2022 were retrospectively reviewed. Among them, 33 cT1 patients upstaged to pT3a RCC received PN (PN group), while 394 non-upstaged pT3a RCC patients underwent radical nephrectomy (RN, RN group). Propensity score matching was performed at a 1 ∶ 1 ratio based on baseline characteristics. The Kaplan-Meier method was used to assess overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS), with Log-rank tests and Cox regression models for multivariate analysis. Results: Before matching, the PN group (n = 33) had significantly higher rates of perirenal fat invasion (PFI, 45.5% vs. 15.2%) and segmental renal vein involvement (42.4% vs. 20.8%), but lower rates of renal sinus invasion (RSI, 21.2% vs. 73.6%) and renal vein tumor thrombus (0% vs. 15.2%) compared with the RN group (n = 394, all P < 0.05). After matching, baseline characteristics were comparable between the PN group (n = 33) and RN group (n = 33). No significant differences were observed in operative time, blood loss, mean hospital stay, complication rate, positive margin rate, or conversion to open surgery between the two groups (P > 0.05). However, the PN group showed significantly higher estimated glomerular filtration rate (eGFR) postoperatively [76.9 (55.4, 87.3) mL/(min·1.73 m²) vs. 61.7 (56.8, 73.5) mL/(min·1.73 m²), P < 0.05], indicating better renal function preservation. No significant differences were found in OS, CSS, or DFS between the groups (P > 0.05). Multivariate ana-lysis identified renal vein invasion (RVI), higher Fuhrman grades (Ⅲ-Ⅳ), and sarcomatoid differentiation as independent risk factors for DFS and CSS in the pT3a RCC patients (P < 0.05). Conclusion: For cT1 RCC patients upstaged to pT3a, PN preserves renal function more effectively while achieving com-parable oncological outcomes to RN. RVI, higher Fuhrmann grade, and sarcomatoid differentiation are independent risk factors for pT3N0M0 RCC patients.

Objective: To evaluate the effectiveness and safety of thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of oversized (>200 mL) prostate. Methods: Clinical data of 475 benign prostatic hyperplasia (BPH) patients operated by the same urologist at Peking University First Hospital from January 2022 to May 2024 were retrospectively analyzed, all of whom were treated with thulium fiber laser, and the patients were divided into three groups according to the total volume of the prostate (TPV): group A (TPV < 100 mL), group B (100 mL≤TPV < 200 mL), and group C (TPV≥200 mL). The age of the patients in the three groups [(69.38±7.79) years, (69.64±8.69) years, (70.32±7.44) years], International Prostate Symptom Score (IPSS) [(22.7±1.9), (22.8±2.7), (25.8±3.7)], and the maximum urinary flow rate (Qmax) [(7.9±2.7) mL/s, (9.3±4.3) mL/s, (9.9±3.3) mL/s] were not statistically significant (P>0.05). The prostate volume in the three groups [(103.49±46.19) mL, (75.73±30.69) mL, (273.49±49.19) mL] and prostate specific antigen (PSA) [3.52 (1.05, 8.76) μg/L, 6.78 (1.61, 7.45) μg/L, 8.52 (5.05, 12.76) μg/L] were statistically significant (P < 0.05). Results: All surgeries were successfully completed. The dif-ferences in enucleation time [30.0 (21.2, 44.5) min, 41.6 (31.2, 52.5) min, 45.1 (35.2, 50.0) min] and hospitalization time [(6.06±1.21) d, (6.15±1.50) d, (7.71±1.74) d] among the three groups were not statistically significant (P>0.05); and the differences in the postoperative indwelling catheter time [(4.0±1.4) d, (4.0±1.3) d, (6.6±1.1) d], operative time [61 (42, 89) min, 82 (62, 105) min, 115 (96, 142) min], enucleation efficiency [1.29 (0.71, 1.56) g/min, 1.67 (1.23, 2.15) g/min, 2.74 (2.20, 3.34) g/min], and hemoglobin drop values [12 (7, 19) g/L, 17 (11, 24) g/L, 27 (19, 35) g/L] were statistically different (P < 0.05). Linear regression ana-lysis was used to show a strong positive linear correlation between enucleation efficiency and enucleation weight (r=0.880, P < 0.001), and the enucleation efficiency increased with the increase of prostate volume. The differences in IPSS [(6.6±1.7), (6.2±1.4), (4.6±1.1)] and Qmax [(18.9±3.1) mL/s, (16.8±3.8) mL/s, (22.9±7.1) mL/s] were not statistically significant among the three groups (P>0.05), and the differences in IPSS and Qmax were statistically significant compared with those before surgery. The differences were statistically significant in preoperative comparisons, but the postoperative urinary flow rate of group C increased significantly more than the remaining two groups in terms of Qmax (P < 0.05). The patients in the three groups were followed up for 3 months, and post-operative complications were categorized into Clavien-Dindo Ⅰ (urinary retention, persistent hematu-ria), Clavien-Dindo Ⅱ (glandular remnants, urinary tract infection, blood transfusion) and Clavien-Dindo Ⅲ (urethral stenosis, contracture of the bladder neck, and reoperation for hemorrhage) based on the Clavien-Dindo Complications System score, the incidence of Clavien-Dindo in the three groups was 5.2% (13 cases), 6.7% (12 cases) and 12.1% (7 cases), respectively, with statistically significant differences (P < 0.05); among them, there were statistically significant differences in urinary infection, blood transfusion and bleeding reoperation (P < 0.05), and there was no statistically significant difference in the remaining complications (P>0.05). Conclusion: The risk of blood transfusion and re-hemostasis increases with larger prostate volume, the efficiency of enucleation increases with the increase of prostate vo-lume, and thulium fiber laser prostate enucleation is safe and effective in the treatment of large-volume BPH.

Objective: To compare the changes of maximun flow rate and residual urine volume after tension-free vaginal tape (TVT) and trans-obturator tape (TOT) in the treatment of stress urinary incontinence in women. Methods: The clinical data of female patients with stress urinary incontinence who underwent transvaginal midsection tension-free urethral suspension in Peking University People' s Hospital from January 2022 to January 2024 were retrospectively analyzed. All the patients were followed up 1 month, 6 months and 12 months after surgery. Urodynamics were performed to evaluate urethral sphincter function before surgery. At the same time, B-ultrasonography was improved to determine the residual urinary volume of the bladder, and urgent incontinence, detrusor weakness and bladder outlet obstruction were excluded, and the diagnosis was clearly stress incontinence. Maximum flow rate and residual urinary volume were measured during follow-up, and combined with the urinary incontinence questionnaire of the International Urinary Incontinence Advisory Committee, the surgical effect was judged to be cured, improved or ineffective according to the degree of improvement of urinary leakage symptoms after surgery. Results: A total of 150 female patients with stress urinary incontinence were included in the study, the average age of the patients was (55.12±10.23) years old, and the follow-up time was 12 months. All patients completed postoperative follow-up, of whom 60 underwent TVT and 90 underwent TOT. The overall effective rates (cure + improvement) 1, 6, and 12 months after surgery in the TVT group were 93.3% (56/60), 91.7% (55/60), and 91.7% (55/60), and those in the TOT group were 92.2% (83/90), 90.0% (81/90), 90.0% (81/90), respectively, and there was no statistical difference between the two groups. The average maximum urinary flow rates 1, 6, and 12 months after surgery in the TVT group were (17.21±4.22) mL/s, (18.05±5.33) mL/s, and (18.37±4.92) mL/s, and those in the TOT group were (18.21±5.32) mL/s, (19.05±4.33) mL/s, and (19.27±4.92) mL/s, respectively, and there was no statistical difference between the two groups. The mean residual urine volume 1, 6, and 12 months after surgery in the TVT group was (13.21±5.22) mL, (18.25±5.33) mL, and (16.37±7.92) mL, and those in the TOT group was (11.21±6.32) mL, (13.05±5.33) mL, and (11.27±5.92)mL, respectively, and there was no statistical difference between the two groups. Compared with preoperative levels, there were no significant differences in the average maximum flow rate and the residual urine volume in both group at 1, 6, and 12 months after surgery. Conclusion: Both TVT and TOT are effective in the treatment of stress incontinence, and have no effect on postoperative maximum flow rate and residual urine volume.

Objective: To analyze the proportion of nonobstructive azoospermia (NOA) patients opting for sperm bank donation under different sperm retrieval methods [percutaneous testicular sperm aspiration (TESA), microdissection testicular sperm extraction (mTESE)] and its influencing factors. Methods: Retrospective data from assisted reproductive technology (ART) cycles at the Center for Reproductive Medical, Peking University Third Hospital (from January 2019 to December 2023) were collected. Data-complete ART cycles involving NOA patients and their partners (using the last treatment cycle as the endpoint) were selected. Sperm donation utilization rates were compared across retrieval methods (fresh mTESE, fresh TESA, thawed mTESE, thawed TESA). Log-linear models were used to analyze the relationship between sperm retrieval method and sperm source. Results: Among the 1 730 couples, the overall sperm donation utilization rate was 12.66%. The highest rate occurred in the fresh mTESE group (23.42%), followed by the thawed mTESE group (5.87%). The rates for the fresh TESA and thawed TESA groups were 5.22% and 0%, respectively. Log-linear analysis demonstrated that sperm retrieval method was significantly associated with sperm source (mTESE: Estimate=4.499; TESA: Estimate=2.780; P < 0.001). Conclusion: The low overall sperm donation utilization rate in ART cycles may reflect the efficacy of synchronous sperm retrieval ART. The proportion of NOA patients opting for sperm donation was influenced by the retrieval method. Compared with patients undergoing TESA, those undergoing mTESE were more inclined to utilize donor sperm after retrieval failure.

Objective: To explore the protective effect of knock-down the expression of B lymphocyte induced maturation protein 1 (Blimp1) gene on early liver injury in carbon tetrachloride (CCl₄)-induced mouse model of liver fibrosis. Methods: C57BL/6 mice were intraderitoneal injected with 5% CCl₄ olive oil solution to create mouse model of hepatic fibrosis. The expression of Blimp1 gene in the mice was reduced by intraderitoneal injection of short hairpin RNA (shRNA) adeno-associated virus (AAV). The mice were randomly divided into 3 groups: blank test group (n=10), CCl₄+AAV-shRNA-NC group (n=10) and CCl₄+AAV-shRNA-Blimp1 group (n=10). After 27 days of preparation of the CCl₄ mouse model, animal materials were carried out. Western blot and real-time PCR were used to detect the levels of Blimp1, α-smooth muscle actin (α-SMA), collagen type Ⅰ alpha 1 (COL1A1), collagen type Ⅲ alpha 1 (COL3A1), and their mRNA expression levels of liver tissue in each group. The serum of each group was separated to measure aspartate transaminase (AST) and alanine transaminase (ALT) by automatic biochemical analyzer. The pathological changes of liver tissue and the degree of liver fibrosis in the mice were detected by pathological staining including hematoxylin-eosin staining, Masson, and Sirius red. Results: The expression levels of Blimp1 protein in the liver of CCl₄+AAV-shRNA-NC group (2.036±0.244, t=3.690, P=0.002) were significantly increased than that of the blank test group. In the CCl₄+AAV-shRNA-Blimp1 group, the expression of Blimp1 protein decreased to the basal level (0.783±0.249, t=6.223, P=0.003). Compared with the serum levels of ALT [(1 957.8±633.6) U/L] and AST [(1 808.8±260.1) U/L] in the CCl₄+AAV-shRNA-NC group, the serum levels of ALT [(894.0±360.1) U/L, t=3.998, P=0.003] and AST [(820.0±100.6) U/L, t=6.141, P=0.004] in the CCl₄+AAV-shRNA-Blimp1 group were significantly decreased. The pathological results of the CCl₄+AAV-shRNA-Blimp1 group showed that compared with the CCl₄+AAV-shRNA-NC group, the infiltration of inflammatory cells in the liver tissue was reduced and the degree of fibrosis was alleviated. The level of α-SMA (0.676±0.064, t=7.930, P=0.001), COL1A1 (1.426±0.143, t=6.364, P=0.003) and COL3A1 (1.124±0.198, t=3.440, P=0.026) of liver in the CCl₄+AAV-shRNA-Blimp1 group were significantly decreased than that of CCl₄+AAV-shRNA-NC group, and the mRNA expression levels were altered as well as their protein levels. Conclusion: Blimp1 plays an important role in CCl₄-induced liver fibrosis in mice, and knock-down the expression of Blimp1 gene is beneficial to protect early liver injury in mice.

Objective: To analyze the factors associated with non-radiographic bone erosion in gout patients, to improve the understanding of bone erosion in gout, and to promote the early detection of bone erosion. Methods: A retrospective analysis was conducted on the medical records of gout patients treated at Beijing Jishuitan Hospital from January 2018 to January 2022. Bone erosion was detectable by ultrasound but not detected by X-ray as non-radiographic bone erosion; no bone erosion was detected by both ultrasound and joint X-ray as undetected bone erosion. A case-control study was used, and the two groups were matched 1 ∶ 2 according to age and sex. The differences between the two groups were compared in terms of general information, joint involvement characteristics, laboratory indicators and complications. In the univariate analysis, P < 0.1 was included in the multivariate analysis, and the conditional Logistic regression was used for the multivariate analysis. P < 0.05 was considered to have statistically significant differences. Results: Among the 41 patients with non-radiographic bone erosion, the top three joints with bone erosion before its occurrence were metatarsophalangeal joint (12 cases), ankle (10 cases), and knee (7 cases). There were 82 patients undetected with bone erosion. There were no significant differences in general information between the two groups (P>0.05), including age, gender, body mass index, and alcohol consumption history. The characteristics of affected joints in the non-radio-graphic bone erosion group were compared with those in the no bone erosion detected, and the former had more affected joints (P=0.02), and a higher proportion of patients with at least 3 attacks of gout per year (P < 0.001). There were no significant differences in serum uric acid, fasting blood glucose, cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, creatinine, homocysteine, white blood cell count, and urine pH between the two groups (P>0.05). The results of multivariate analysis showed that at least 3 flares of gout per year was an independent risk factor for radiologically negative bone erosion in patients with gout, with an OR (95%CI) of 5.139 (1.529-17.271). Conclusion: At least 3 flares of gout per year predicts the occurrence of radiologically negative bone erosion, and these patients should be given more attention to achieving treatment targets.

Objective: The greater tuberosity angle (GTA) and critical shoulder angle (CSA) are commonly referred to as radiographic markers which were used to described morphology of the greater tuberosity and acromion respectively. At present, most international studies focus on the correlation between the above two parameters and rotator cuff tears (RCTs), and their diagnostic value and risk assessment. This study attempts to find out the trend of GTA and CSA changes and risk threshold of RCTs, as well as the protective factors and risk factors. Methods: In this study, 130 individuals from May 2019 to December 2020 were recruited. According to Southern California Orthopedic Institute (SCOI) classification, the individuals were divided into four groups retrospectively: Group A, negative control group; Group B, partial tears (articular side); Group C, partial tears (bursal side); Group D, full-thickness tears. GTA and CSA were measured respectively on true anteroposterior position X-ray of shoulder with arm in neutral rotation and performed by the same trained technician team in single-blind. The correlations between RCTs and relevant factors were analyzed. Results: According to the area under the receiver operating characteristic curve (AUC), GTA and CSA of RCTs (Groups B, C and D) were 0.736 and 0.673 with 95% confidence interval (CI), the cut-off value of GTA and CSA of RCTs were 70.5° and 39.5° respectively. Comparing with the control group, RCTs groups had significant statistical differences in age and body mass index (BMI) (P < 0.05), especially the full-thickness RCTs (Group D), which was older than Groups A, B and C (P < 0.05, cut-off value: 56.5 years old) and shorter than Groups A and B (P < 0.05, cut-off value: 1.58 m). Analyzed from scatter plot and regression analysis, there was no linear correlation between GTA and CSA. There were no significant differences in gender, dominant shoulders and smoking between the RCTs groups and the control group (P>0.05). Conclusion: Larger GTA (>70.5°) and CSA (>39.5°) would be highly predictive in diagnosing RCTs without linear correlation, and GTA has a higher diagnostic value in contrast. Subacromial impingement and shoulder degeneration occurred before RCTs. Patients with age >56.5 years and height < 1.58 m were more likely to develop disease of full-thickness RCTs and no statistic differences in weight and BMI. Gender, dominant shoulder and smoking were neither risk factors nor protective factors.

Objective: To explore the safety of laparoscopic modified transcystic biliary drainage (modified C-tube technique) in the treatment of biliary stones and application of diagnosing biliary disease. Methods: A retrospective analysis was conducted on the clinical data of 68 cases of biliary stones successfully treated with laparoscopic modified C-tube technique from August 2021 to December 2023. The safety, effectiveness, and area of applications were analyzed. The reliability of the principle of the modified fixation method was verified by using an ex vivo gallbladder. Results: Three cases of ex vivo gallbladder demonstrated that the strength of the modified fixation method was reliable, and the sinus tract formed by suture after immediate extraction of the C tube could be dislocated and closed, resisting the bile outflow caused by the weight of the gallbladder. Among the 68 patients, 42 were difficult biliary stones, 6 were suspected common bile duct stones, and 5 were extrahepatic bile duct stones combined with intrahepatic bile duct stones. Among them, 48 cases underwent choledochoscopy assisted trans-choledochal approach for stone removal, and 10 cases underwent transcystic approach stone removal, Six patients underwent simply basket exploration and removal of stones through the cystic duct (5 patients had no residual stones on postoperative C-tube angiography, 1 patient had suspected residual stones, and the patient refused further examination and treatment for no symptom), and 4 patients only underwent biliary drainage through the cystic duct; two patients with retained stone passed after the use of topical nitrate drip infusion via C-tube, seven cases underwent endoscopic retrograde cholangiopancreatography(ERCP), stone removal with the assistance of a C-tube after laparoscopic surgery, and the results were uneventful. The mean surgical time was (131±44) min (76-279 min), the maximum daily drainage volume of the C-tube was (401±235) mL/d (10-1 150 mL/d), the hospital stay was (8.6±3.6) d (2-19 d), and the mean time of C-tube removal was (11±6.9) d (5-46 d). There were 14 overall complications, including 2 residual stones, and 12 C-tube related complications, comprising of 1 grade Ⅲa, 2 grade Ⅱ, and 9 grade Ⅰ. There were 9 cases of C-tube related adverse events that did not cause complications, including 3 of early detachment, 2 of displacement, and 4 of deep insertion. The median follow-up time after surgery was 21 (2-30) months, and 5 patients had recurrent stones. Among them, 4 patients had slow contrast outflow during cholangiogram, and 1 patient had obvious pancreaticobiliary reflux. 55 patients underwent C-tube amylase measurement, and 9 cases showed a significant increase in bile amylase (349-44 936 U/L), suggesting the presence of pancreaticobiliary reflux. Conclusion: Laparoscopic modified C-tube technique can be effectively used in the treatment of biliary stones, which is relatively safe and can be attempted in the diagnosis of biliary diseases.

Objective: To examine the impact of outpatient service utilization on hospitalization rates in patients with heart failure, with a focus on identifying the threshold effect, and to provide evidence to support the design of outpatient medical insurance reimbursement policies for heart failure patients. Methods: Using a stratified random sampling method, individual reimbursement data of heart failure patients covered by Urban Employee Basic Medical Insurance in Zhejiang Province from year 2013 to 2017 were extracted. A panel fixed-effects logit regression model and a threshold effect model were applied to analyze the impact of annual outpatient service utilization in the previous year on the hospitalization rate in the current year and to identify the threshold effect. The annual outpatient service utilization indicators included the annual outpatient visits, annual outpatient expenses, annual outpatient drug expenses, and annual outpatient self-expenses within the policy. Hospitalization rate indicators comprised the annual hospitalization rate, rehospitalization rate within 30 days, and rehospitalization rate within 90 days. Results: (1) The study found that an increase in prior-year annual outpatient service utilization led to a decrease in the current-year annual hospitalization rate. However, the effects on the rehospitalization rate within 30 days and rehospitalization rate within 90 days were not statistically significant; (2) The thre-shold effect of prior-year annual outpatient service utilization on the current-year annual hospitalization rate was also identified. When the prior-year annual outpatient visits were less than or equal to the threshold (12 visits), the current-year annual hospitalization rate decreased as the prior-year annual outpatient visits increased and statistically significant, and the regression coefficient was not significant when the prior-year annual outpatient visits were higher than the threshold (12 visits). Correspondingly, the thresholds for annual outpatient expenses and annual outpatient self-expenses within policy in the previous year were 3 342.8 yuan and 736.9 yuan, respectively. Conclusion: There is a threshold effect of prior-year annual outpatient service utilization on the current year' s annual hospitalization rate in heart failure patients. These results have important implications for designing outpatient health insurance policies for heart failure patients to improve the patients' utilization of outpatient services and decrease the hospitalization rates. Specifically, policymakers should consider the identified thresholds when designing reimbursement policies for heart failure patients, which may help to optimize the use of medical resources and reduce the burden of medical expenses.

Objective: To compare the differences in breastfeeding rates and the incidence of clinical complications in very/extremely low birth weight infants with and without the use of donor milk banks. Methods: Before and after the establishment of the donor milk bank, a total of 279 very/extremely low birth weight infants who were hospitalized in neonatal intensive care unit in a tertiary hospital in Beijing were selected. In the study, 136 infants who did not receive donated breast-feeding were included in control group and 143 infants who received donated breast-feeding were included in observation group. The clinical data of mothers and their infants were collected. The mother' s information included gestational age, maternal comorbidities, and mode of delivery. Infant information includes gender, weight, gestational age, duration of breastfeeding, total enteral feeding time, hospitalization time and incidence of complications (feeding intolerance, necrotizing enterocolitis, retinopathy of prematurity). Results: The maternal ages were (33.5 ± 4.2) years in the observation group and (32.5 ± 3.9) years in the control group. Cesareans were performed in 95 cases (70.4%) and 81 cases (66.9%), respectively. The gestational ages of preterm infants were (29.2 ± 2.1) weeks and (29.1 ± 2.2) weeks, with birth weights of (1 140.5 ± 247.1) g and (1 169.4 ± 228.6) g, respectively. Newborn boys accounted for 72 cases (50.3%) in the observation group and 63 cases (46.3%) in the control group. No statistically significant differences were found in baseline characteristics between the two groups (all P > 0.05). After the use of donor milk banks, the rate of exclusive breastfeeding in very/low birth weight infants increased from 3.1% to 10.5% (χ²=5.778, P=0.016) during hospitalization, the time to full enteral feeding was shortened from 13 d to 10 d (Z=-4.567, P < 0.001), the first breastfeeding time was shortened from the third day of admission to the first day of admission (Z= -11.812, P < 0.001), the first breastfeeding of mother' s own milk was extended from the third day of admission to the fourth day of admission (Z=-4.652, P < 0.001), and the incidence of feeding intolerance during hospitalization was reduced from 34.0% to 10.0% (χ²=17.015, P < 0.001). There were no significant differences in the incidence of necrotizing enterocolitis, late-onset sepsis, retinopathy of prematurity and total length of hospital stay (P>0.05). Conclusion: The use of donor milk bank can improve the breastfeeding rate, shorten the time to first breastfeeding, and reduce the incidence of feeding intolerance in very/extremely low birth weight infants, which provides a reference for the clinical treatment of very/extremely low birth weight infants.

Objective: To investigate whether escin (ESC) and dextromethorphan (DEX) have the protective effects on the progression and symptoms of Alzheimer disease (AD). Methods: The AD model of Caenorhabditis elegans (C. elegans) was established by transgenic amyloid β-protein (Aβ protein). Different concentrations of ESC or DEX or 50 μmol/L memantine (MEM) were used to treat the AD model worms, and their lifespan was detected. The movement ability of AD model C. elegans was evaluated by body bending frequency and head swinging frequency. The changes in cognitive functions of AD model C. elegans before and after treatment were detected by chemotaxis experiments. The changes in Aβ protein and reactive oxygen species (ROS) content in C. elegans were detected. The changes in gene pathways related to oxidative stress were detected by Real-time quantitative polymerase chain reaction (RT-qPCR). Results: At high dose 1 000 μmol/L, ESC or DEX treatment showed no significant effects on the activity of C. elegans. Compared with untreated worms, the survival time of AD model C. elegans in the 20 μmol/L ESC and 60 μmol/L DEX intervention groups was significantly extended. In the middle stage of AD progression, the body bending frequency and head swinging frequency of AD model worms after ESC or DEX treatment was significantly increased compared with the untreated control group with DEX being more effective in the recovery of head swinging frequency. For the early cognitive function tests, the chemotaxis index of ESC or DEX treated worms was significantly higher than that of the untreated worms, which correlated with marked reductions in the Aβ protein levels. The reactive oxygen species content in the drug intervention group was also lower than that in the control group. RT-qPCR results showed that ESC could inhibit oxidative stress in the AD model C. elegans by a 2-fold upregulation of skn1 expression. Conclusion: ESC and DEX could improve the reductions of movement ability and cognitive function in the AD model worms and delay the aggravation of AD-related symptoms. ESC delays the progression of AD possibly by activating the SKN-1/Nrf2 pathway to protect against oxidative injury in the AD model.

Objective: To analyze the inflammatory indexes and cytokines levels in serum and saliva of patients with chronic periodontitis (CP), and to explore the value of single index or multiple indexes combined detection in the clinical diagnosis and treatment of CP. Methods: The serum and saliva specimens of 42 CP patients and 38 periodontal healthy people admitted to the Department of Periodontology in Peking University Hospital of Stomatology were detected by inflammatory indexes and cytokines. According to clinical periodontal parameters, CP patients were performed by clinical staging, and the correlation between inflammatory indexes and cytokines levels and the severity of CP was analyzed. To evaluate the levels of inflammatory indexes and cytokines in serum and saliva samples in the periodontal health group and CP group. Three inflammatory indexes were involved in this study: C-reactive protein (CRP), serum amyloid A (SAA), procalcitonin (PCT); and 12 cytokines: Interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12P70, IL-17, interferon (IFN)-α, IFN-γ, and tumor necrosis factor α (TNF-α). The Spearman correlation statistical method was used to analyze the correlation between the levels of inflammatory indexes and cytokines and the severity of chronic periodontitis. Mann-Whitney U test was used to identify the indicators with differences between the groups, the optimal indicators were identified through binary Logistic regression analysis with stepwise selection, and the area under the curve (AUC) of receiver operating characteristic (ROC) was used to evaluate the diagnostic efficiency. Results: By testing the levels of inflammatory markers and cytokines in patients with chronic periodontitis with dif-ferent clinical stages, it was found that CRP, SAA, IL-8 in serum and IL-1β, IL-6, IL-8, IL-12P70, IL-17, TNF-α in saliva were significantly positively correlated with the severity of chronic periodontitis. Compared with the periodontal healthy group, the serum levels of CRP, SAA, IL-2, IL-5, IL-8, IL-12P70, IL-17 and IFN-α in the CP group were significantly increased (All P < 0.05). The AUC of SAA, IL-2, IL-8, IL-12P70, IL-17, IFN-α, combination 1 (IL-2+IL-8) and combination 2 (CRP+SAA+IL-12P70) were >0.7, and the AUC of combination 2 (0.998) was the highest, with high sensitivity (97.6%) and specificity (97.4%). The levels of IL-1β, IL-6, IL-8 and IL-12P70 in the saliva of the CP group were significantly higher than those in the periodontal healthy group, while the levels of IL-4 in the saliva were significantly lower than those in the periodontal healthy group (All P < 0.05). The AUC of IL-6, IL-8 and combination 3 (IL-4+IL-6+IL-8) were >0.7, and the AUC of combination 3 (0.852) was the highest. In the comparative analysis of diagnostic efficacy between single index and multi-index combined, combination 2, combination 1, and serum IL-8 demonstrated the highest AUC values (ranked top 3), with multi-index combinations exhibiting superior discriminative power over single index. Conclusion: Serum levels of IL-8, CRP, SAA, and salivary levels of IL-1β, IL-6, IL-8, and other indicators may be helpful for the clinical diagnosis and treatment of CP. Serum IL-8 and multiple indicators may be used as an auxiliary diagnostic indice to identify CP.

Objective: To evaluate the technical feasibility and perioperative safety of pyeloplasty assisted by the Carina^TM modular laparoscopic surgical robotic system in patients with ureteropelvic junction obstruction (UPJO). Methods: From November to December 2024, five consecutive patients diagnosed with UPJO underwent robot-assisted pyeloplasty using the Carina^TM modular laparoscopic surgical system at Peking University First Hospital. Data on patient demographics, intraoperative parameters (including docking time, console time, and estimated blood loss), perioperative outcomes, follow-up results, and surgeons' subjective evaluations of system performance were prospectively collected. Descriptive statistics were used; continuous variables were presented as median (range), and categorical variables as frequency and percentage. Results: The cohort included four females and one male. All the patients successfully completed the robotic procedure without conversion to open or conventional laparoscopic surgery. The median age was 32 years (24-37 years), and the median body mass index was 21.6 kg/m² (15.8-27.3 kg/m²). The median docking time was 8 min (3-12 min), and the median console time was 91 min (71-125 min). Intraoperative blood loss was uniformly 20 mL. The median postoperative drainage duration was 3 d (0-4 d), and the median length of hospital stay was 4 d (4-9 d). No Clavien-Dindo grade Ⅲ or higher complications occurred. All the patients had their double-J stents removed at 2 months postoperatively, and pain in the ipsilateral flank, reported preoperatively by all the five patients, was alleviated. The subjective surgical success rate was 100%. Surgeons reported stable system performance throughout all the procedures, with no instances of mechanical arm interference or visual drift affecting surgical fluency. Conclusion: Preliminary findings indicate that pyeloplasty using the domestically deve-loped Carina^TM modular laparoscopic robotic system is technically feasible and perioperatively safe for the treatment of UPJO.

Objective: To evaluate the safety and efficacy of a dual-endoscopic technique combining laparoscopy/robot-assisted laparoscopy with disposable flexible ureteroscopy for intraoperative localization and reconstruction in complex ureteral strictures. Methods: A retrospective analysis was conducted on 21 patients with complex ureteral strictures (stenosis length ≥2 cm, multiple strictures, or iatrogenic strictures, or radiation-induced strictures) treated at Peking University People' s Hospital between January 2023 and November 2024. All the patients underwent dual-endoscopic procedures using laparoscopy (n=17) or da Vinci robotic-assisted laparoscopy (n=4) combined with disposable flexible ureteroscopy. Preoperative evaluation included contrast-enhanced CT urography and diuretic renography. Intra-operatively, stricture localization was achieved by synchronizing laparoscopic light sources with ureteroscopic visualization. Surgical positions were optimized: non-split-leg oblique supine position for mid-upper strictures and lithotomy position for mid-lower strictures. Reconstruction strategies (lingual mucosa graft, bladder flap augmentation, or primary anastomosis) were selected based on stricture length and tension. Postoperative outcomes were assessed via symptom resolution, hydronephrosis improvement (ultrasonographic renal pelvis diameter), and stent-free patency. Results: The cohort included 10 males and 11 females [mean age (44.1±13.3) years]. Etiologies included lithogenic strictures (71.4%, 15/21), post-gynecologic surgery injury (4.8%), radiation-induced fibrosis (4.8%), and congenital factors (19.0%). Intraoperative findings revealed discrepancies in stricture localization compared with pre-operative imaging in 52.4% (11/21) of cases, necessitating extended resection or modified reconstruction. Mean stricture length was (4.81±4.33) cm. Postoperative complications included transient urinary leakage (1 case) and secondary ureteral obstruction due to stone migration (1 case), both resolved without sequelae. At a mean follow-up of (10.76±6.81) months (range 2-21), hydronephrosis significantly improved in all the patients (100% efficacy), with no recurrence of strictures or symptom recurrence. Conclusion: The dual-endoscopic technique enhances intraoperative precision in complex ureteral stricture management by integrating real-time luminal visualization with extraluminal anatomical guidance. This approach minimizes excessive resection of healthy ureter, optimizes reconstruction strategies, and reduces postoperative recurrence. The modified positioning protocol further improves ergonomic efficiency, making it a reliable and adaptable option for challenging ureteral pathologies.

Objective: To retrospectively evaluate the clinical efficacy and safety of total 3D laparoscopic ileal ureters replacement for bilateral ureters combined with bladder augmentation in patients with post-radiotherapy long-segment bilateral ureteral strictures and contracted bladder. Methods: Clinical data of two patients (aged 72 and 54 years) with radiation-induced long-segment bilateral ureteral strictures and reduced bladder capacity, treated at the Sixth Affiliated Hospital of Jinan University from October 2023 to June 2024, were analyzed. Both presented with bilateral flank pain, recurrent chills/fever, urinary frequency, and urgency. Preoperative ureteral stricture lengths were measured as follows: left 10.4 cm and right 8.7 cm in the first case; left 10.6 cm and right 11.7 cm in the second case. Bladder capacity assessed by nephrostomy-assisted antegrade urography was 90 mL and 130 mL respectively. Both underwent single-position, one-stage totally 3D laparoscopic bilateral ileal ureteral replacement and bladder augmentation based on membrane anatomy principles, with regular postoperative follow-up. Results: Procedures were completed by the same experienced urologist. Operative times were 420 min and 355 min, with intraoperative blood loss of 50 mL (no transfusion required). Postoperative bowel function resumed at the end of 4.5 and 3 days. No major perioperative complications occurred. Ureteral stents were removed at 2 months postoperatively, with imaging showing improved hydronephrosis, unobstructed ureteral drainage, symmetrical bladder morphology, and smooth walls. Postoperative bladder capacities were 230 mL and 250 mL. Follow-up durations were 10 and 8 months. Both patients experienced significant relief of flank pain and lower urinary tract symptoms. No complications (enteric fistula, urinary fistula, or metabolic acidosis) were observed. At the final follow-up, one patient had mildly elevated serum creatinine, while the other showed reduced levels compared with preoperative values; both remained stable. Conclusion: Membrane anatomy-based dissection facilitates safe mobilization of fibrotic ureters with minimal bleeding and collateral damage. Total intracorporeal 3D laparoscopic ileal ureters replacement for bilateral ureters combined with bladder augmentation effectively addresses long-segment ureteral obstruction and improves bladder capacity. This approach is technically safe and feasible, though further validation with larger clinical cohorts is warranted.

Objective: To evaluate the safety and oncological outcomes of robot-assisted laparoscopic inferior vena cava (IVC) segmental resection in renal tumor with IVC tumor thrombus (IVCTT). Methods: Clinical data from renal tumor patients undergoing robot-assisted laparoscopic IVC segmental resection at Peking University Third Hospital from Jan. 2021 to Feb. 2025 were retrospectively analyzed. Data collection included baseline demographics, tumor characteristics, perioperative parameters, and follow-up outcomes. Surgical records and pathological reports were retrieved from the electronic medical record system. Continuous variables were presented as median (P₂₅, P₇₅), and categorical variables as frequency (percentage). Results: Forty-four patients were enrolled. The cohort comprised 31 males and 13 females, with a median age of 62 (55, 68) years. Right-sided tumors were observed in 39 cases and left-sided in 5 cases. Median tumor diameter was 8.1 (6.1, 10.1) cm. Mayo classifications included grade Ⅱ (n=37), Ⅲ (n=6), and Ⅳ (n=1). Neoadjuvant therapy was administered to 23 patients. Seventeen patients were complicated by IVC bland thrombus. Median operative time was 224.0 (167.3, 303.8) min, with intraoperative blood loss of 500.0 (300.0, 850.0) mL. Transfusion was administered to 19 patients, with a median blood transfusion of 800.0 (400.0, 1 200.0) mL. Postoperative complications occurred in 25 cases (56.8%), classified as Clavien-Dindo grade Ⅰ (n=8) and grade Ⅱ (n=17). Procedure-specific complications included deep vein thrombosis (n=6), transfusion-requiring anemia (n=5), lower extremity edema (n=2), and pulmonary embolism (n=2), with no procedure- related mortality. Median postoperative serum creatinine was 116.0 (86.5, 157.5) μmol/L. Pathological examination identified clear cell renal cell carcinoma as the predominant subtype, observed in 34 cases (77.3%). Pathological staging revealed T3b (n=12), T3c (n=29), and T4 (n=3) disease, with nodal involvement (N1) in 8 cases and distant metastasis (M1) in 17. At a median follow-up of 10 months (range: 1-49 months), cancer-specific mortality occurred in 3 patients, while 1 succumbed to other causes. Disease progression included pulmonary metastasis (n=5), hepatic metastasis (n=4), and local recurrence (n=4). Adjuvant therapy regimens comprised targeted-immunotherapy combinations (n=9) and targeted monotherapy (n=18). Conclusion: Robot-assisted laparoscopic IVC segmental resection achieves precise thrombus removal with confirmed short-term efficacy in renal tumor with IVCTT, though vigilance against vascular complications remains critical.

Kidney transplantation is widely recognized as the optimal treatment for children with end-stage renal disease (ESRD), offering significant improvements in growth, development, and long-term quality of life compared with prolonged dialysis. However, kidney transplantation in low-age (< 5 years old) and low-weight (< 15 kg) children presents significant clinical challenges due to their delicate vascular structures, limited surgical space, and complex perioperative management. This report presents two cases of kidney transplantation in low-age, low-weight children performed at Peking University People' s Hospital. Case 1: a 2-year-3-month-old boy (8.8 kg), presenting a preoperative serum creatinine of 248 μmol/L post-dialysis and the estimated glomerular filtration rates (eGFR) of 35.17 mL/(min·1.73 m²). Case 2: a 3-year-8-month-old girl (11.25 kg), presenting a preoperative creatinine of 281 μmol/L post-dialysis and the eGFR of 22.63 mL/(min·1.73 m²). Both recipients underwent transplantation via the extraperitoneal approach, with end-to-side anastomosis of the donor renal artery and vein to the recipient' s common iliac artery and vein, respectively. The ureters were anastomosed to the bladder using the tunnel technique, and double-J stents were placed intraoperatively. The surgeries were uneventful, and both patients exhibited rapid recovery of renal function. Postoperatively, serum creatinine levels decreased to 26 μmol/L (Case 1) and 39 μmol/L (Case 2) by the third day, with the eGFR reaching 245.23 mL/(min·1.73 m²) and 164.12 mL/(min·1.73 m²), respectively. No complications, such as vascular thrombosis, ureteral stenosis, or abdominal compartment syndrome were observed during follow-up. A comprehensive literature review was conducted to contextualize these cases within global advancements in pediatric renal transplantation. Current evidence highlights the growing adoption of kidney transplantation for low-age, low-weight children, though debates persist regarding optimal surgical strategies (specifically, the intraperitoneal versus extraperitoneal approaches). This case report underscores the feasibility of the extraperitoneal approach in overcoming anatomical limitations of low-weight pediatric recipients, with distinct advantages including reduced gastrointestinal complications and enhanced accessibility for post-operative ultrasound monitoring. Furthermore, mean arterial pressure (MAP) and central venous pressure (CVP) were systematically monitored intraoperatively to ensure optimal renal blood perfusion and graft viability. Our single-center experience provides valuable insights into surgical strategy selection and perioperative management for this high-risk population. Nevertheless, larger multicenter studies are warranted to validate long-term outcomes and refine standardized protocols.

This case report describes the diagnostic and therapeutic management of a 67-year-old female with a 40-year history of Sjögren disease (SjD) who was hospitalized for evaluation of recurrent fever lasting over one month. The patient' s initial diagnosis of SjD was established four decades earlier based on clinical manifestations, serological findings, and evidence of glandular damage. Her clinical presentation included recurrent parotid gland enlargement accompanied by sicca symptoms, notably persistent xerostomia and xerophthalmia, followed by progressive dental caries. Serological studies demonstrated positivity for antinuclear antibodies, anti-SSA/Ro, and anti-α-fodrin antibodies. Objective assessments confirmed significant ocular involvement (Schirmer' s test ≤5 mm/5 min) and pulmonary interstitial changes on chest CT, consistent with the 2016 American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) classification criteria for SjD. The patient' s condition remained stable under low-dose corticosteroids and disease-modifying anti-rheumatic drugs (DMARDs) until the recent onset of prolonged fever, necessitating evaluation for fever of unknown origin. Differential diagnoses considered disease flare, infection, and malignancy. The European Sjögren' s Syndrome Disease Activity Index (ESSDAI) score was 5 points, indicating moderate systemic disease activity. Initial laboratory investigations revealed no evidence of infection, and empirical anti-infective therapy proved ineffective. Notably, despite the absence of lymphadenopathy, laboratory findings including borderline positive IgM λ M-protein, elevated lactate dehydrogenase, hyperferritinemia, and increased β2-microglobulin levels raised suspicion for lymphoproliferative disorders, given the established association between SjD and lymphoma. Bone marrow aspiration showed no significant abnormalities, but PET/CT imaging detected hypermetabolic lesions in the left breast and right distal femur, suggesting potential malignancy. Subsequent histopathological examination of the breast lesion confirmed non-Hodgkin' s lymphoma (NHL), specifically diffuse large B-cell lymphoma (DLBCL) of the germinal center B-cell (GCB) subtype. Treatment with R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) induced complete metabolic remission after three cycles. However, she subsequently developed treatment-related complications, including myelosuppression and pulmonary infection. This case underscores the importance of maintaining a high index of suspicion for atypical site involvement in SjD patients, particularly when lymphoma risk factors are present. Comprehensive differential diagnosis should include lymphoma and other malignancies, and the diagnostic value of PET/CT and histopathological examination in disease evaluation is emphasized. SjD complicated by breast lymphoma is exceptionally rare, and its pathogenesis may involve lymphocytic infiltration, abnormal activation of lymphocytes, formation of ectopic germinal centers in the breast, and eventual malignant transformation. These mechanisms require further investigation through clinical and basic research studies.