Objective:To investigate the clinicopathological and genetic features of acquired cystic kid-ney disease(ACKD)and secondary renal cell carcinoma(RCC)in end-stage renal disease(ESRD)pa-tients 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/microsatel-lite 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 dura-tion 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 atypi-cal 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 presen-ted 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 dif-fusely or focally positive in all the cases,while CAⅨ was negative.The World Health Organization/In-ternational 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 pa-tient 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,accompa-nied 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 com-prehensive analysis combining clinicopathological and molecular genetic features.
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 col-lected and analyzed using descriptive statistical methods.Results:All the 15 procedures were successful-ly 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 hos-pital 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 metasta-sis 10 months postoperatively.Conclusion:The domestic Jingfeng MP1000 multi-port robotic system-assisted laparoscopic radical nephrectomy with venous tumor thrombectomy is technically safe and feasi-ble,with favorable perioperative outcomes and a low complication rate.Its long-term oncological efficacy requires further validation through large-scale,prospective studies.
Primary hyperparathyroidism(PHPT)is caused by excessive production of parathyroid hor-mone 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 com-plicated 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 hydronephro-sis,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 re-suscitation,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 pancreati-tis and partial ischemic necrosis of the parathyroid adenoma.At 47 days postpartum,the patient under-went 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 complica-tions and adverse pregnancy outcomes.
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 im-proving 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 sur-veyed 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 col-lected 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 sin-gle 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 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.
Visceral leishmaniasis(VL)is a rare parasitic infection characterized by distinctive fea-tures,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 diag-nosed with visceral leishmaniasis who were initially suspected of having an autoimmune disease.We dis-cussed 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 abnor-mal 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 compli-cated 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,vis-ceral 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 In-fection.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 impro-ving the clinical detection rates of visceral leishmaniasis.
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 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 im-mune 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 charac-teristics of various immune cells.scRNA-seq results indicated a decreased proportion of intratumoral ef-fector 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 pre-liminary results of this study suggest that ADT can induce a trend of change in the tumor immune micro-environment of prostate cancer,characterized by weakened T-cell killing function and enrichment of im-munosuppressive 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.
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.
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: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 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.
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 main-tenance 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 re-duction 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 step-wise 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 discon-tinued.No further antitumor treatment was administered.The patient eventually experienced disease pro-gression 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 microenviron-ment 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.
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.
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 biomar-kers,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.More-over,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:Giant renal angiomyolipoma(RAML),typically defined as having a maximum diameter of ≥8 cm,presents formidable surgical challenges and heightened clinical risks.These challen-ges 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 com-prehensively 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.
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 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.
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 encrus-tation,the need for regular replacement,and severe bladder irritation.Consequently,SMUSs have be-come a vital maintenance therapy for patients with malignant obstructions or those unsuitable for recon-structive 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 re-views 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 obstruc-tion,migration,encrustation,recurrent infections,and high-risk ureteral fistulas.
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.
