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.
