Upper tract urothelial carcinoma (UTUC) is a rare and aggressive malignancy, accounting for only 5-10% of all urothelial carcinomas (UCs). Lung, bone, liver, and distant lymph nodes are common sites of metastasis, while gastrointestinal metastasis is extremely rare. We present a case of a 63-year-old female who developed a descending colon lesion 19 months after left radical nephroureterectomy for high-grade ureteral UC. The diagnosis was established by computed tomography (CT), magnetic resonance imaging (MRI), colonoscopy, and biopsy, which excluded primary colorectal malignancy. First-line therapy consisted of six 21-day cycles of gemcitabine plus cisplatin, followed by two cycles of tislelizumab maintenance immunotherapy. Restaging with contrast-enhanced CT and positron emission tomography/computed tomography (PET/CT) demonstrated disease progression. Despite switching to second-line nab-paclitaxel, the patient rapidly deteriorated from tumor cachexia and ultimately succumbed to septic shock secondary to severe pulmonary infection. This represents the first reported case of descending colon metastasis from primary ureteral UC. It highlights the colon as a potential metastatic site where biopsy is essential for definitive diagnosis. Notably, although the patient initially responded to platinum-based therapy, the subsequent rapid progression underscores the need for vigilant monitoring and timely adjustment of therapeutic strategies in managing such high-risk presentations.

PurposeSmoking is a well-established risk factor for kidney cancer. Analyzing the latest global spatio-temporal trends in the kidney cancer burden attributable to smoking is critical for informing effective public health policies.MethodsUsing data from the 2021 GBD database, we examined deaths, disability-adjusted life years (DALYs), and age-standardized rate (ASR) of kidney cancer attributable to smoking across global, regional, and national levels. Trends in ASRs were assessed through estimated annual percentage change (EAPC). We conducted a cross-country analysis to evaluate disparities in the kidney cancer burden from 1990 to 2021, with absolute and relative inequalities measured by the slope index of inequality and concentration index, respectively. Correlation analysis was conducted by the Spearman rank order correlation method. Additionally, we projected age-standardized death and DALYs rates up to 2036 using Bayesian age-period-cohort (BAPC) models in R.ResultsGlobally, kidney cancer deaths attributable to smoking increased by 67.64%, from 9,673 in 1990 to 16,216 in 2021. Despite this increase, the age-standardized death rate (ASDR) dropped from 0.25 to 0.19 per 100,000 (EAPC: −0.93). Similarly, the age-standardized disability-adjusted life years rate (ASDALY) decreased from 6.17 to 4.37 per 100,000 (EAPC: −1.15). Geographically, areas with a higher Socio-demographic Index (SDI) were the most affected. The positive correlation between higher SDI and increased deaths highlights the role of economic and social factors in disease prevalence. Cross-country analysis shows that while relative inequalities between groups are improving, absolute differences in health burdens continue to grow. Furthermore, projections indicate a gradual decline in ASDR and ASDALY for both sexes from 2022 to 2036.ConclusionBetween 1990 and 2021, both the global ASDR and ASDALY attributable to smoking in kidney cancer, which are positively correlated with SDI, have declined. However, significant demographic and geographic disparities persist, with the disease burden remaining higher in older populations and regions with elevated SDI levels. Moreover, while the overall burden is projected to decline annually over the next 15 years, it is expected to remain significantly higher in men. These findings emphasize the need for region-specific health prevention strategies to reduce smoking-related kidney cancer.

Retroperitoneal infantile hemangioma (RIH), a type of primary retroperitoneal tumors, are exceptionally rare in clinical practice. Infantile hemangiomas typically manifest on the skin’s surface. RIHs are exceptionally rare and typically small. In adults, these tumors often manifest without specific clinical symptoms or detectable signs for a definitive diagnosis. This case report details a patient diagnosed with RIH. We recommend complete excision of the tumor after a comprehensive evaluation, followed by postoperative pathology, to achieve a conclusive diagnosis. We believe that managing critical retroperitoneal structures and vessels intraoperatively presents a significant challenge for all procedures involving primary retroperitoneal tumors. A 47-year-old male was diagnosed with gallstones and underwent surgery 3 months ago at other institution for unexplained nausea and vomiting. Follow-up imaging 2 months after surgery revealed a retroperitoneal mass below the left renal pole. Upon presentation to our hospital, the patient continued to experience intermittent nausea and vomiting, with no other significant symptoms or signs. Considering the patient’s 8-year history of hypertension, a paraganglioma was initially suspected. We performed the laparoscopic mass resection after a detailed assessment. However, postoperative pathology revealed it a capillary hemangioma (old term)/infantile hemangioma. RIHs are exceedingly rare benign tumor. The possibility of malignancy should be ruled out, and surgical resection is recommended following a thorough evaluation, with the diagnosis confirmed through pathological examination.

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BACKGROUND:Human papillomavirus (HPV) has been proposed as a potential pathogenetic organism involved in prostate cancer (PCa), but the association between HPV infection and relevant genomic changes in PCa is poorly understood. METHODS:To evaluate the relationship between HPV genotypes and genomic alterations in PCa, HPV capture sequencing of DNA isolated from 59 Han Chinese PCa patients was performed using an Illumina HiSeq2500. Additionally, whole-exome sequencing of DNA from these 59 PCa tissue samples and matched normal tissues was carried out using the BGI DNBSEQ platform. HPV infection status and genotyping were determined, and the genetic disparities between HPV-positive and HPV-negative PCa were evaluated. RESULTS:The presence of the high-risk HPV genome was identified in 16.9% of our cohort, and HPV16 was the most frequent genotype detected. The overall mutational burden in HPV-positive and HPV-negative PCa was similar, with an average of 2.68/Mb versus 2.58/Mb, respectively, in the targeted whole-exome region. HPV-negative tumors showed a mutational spectrum concordant with published PCa analyses with enrichment for mutations in SPOP, FOXA1, and MED12. HPV-positive tumors showed more mutations in KMT2C, KMT2D and ERCC2. Copy number alterations per sample were comparable between the two groups. However, the significantly amplified or deleted regions of the two groups only partially overlapped. We identified amplifications in oncogenes, including FCGR2B and CCND1, and deletions of tumor suppressors, such as CCNC and RB1, only in HPV-negative tumors. HPV-positive tumors showed unique deletions of tumor suppressors such as NTRK1 and JAK1. CONCLUSIONS:The genomic mutational landscape of PCa differs based on HPV infection status. This work adds evidence for the direct involvement of HPV in PCa etiology. Different genomic features render HPV-positive PCa a unique subpopulation that might benefit from virus-targeted therapy.

Elevated Gamma-glutamyl transferase (GGT) levels are often suggestive of cholelithiasis, and previous studies have indicated that GGT is highly expressed in the urinary system. Therefore, we hypothesized that there may be an association between GGT levels and calculus of kidney (CK) incidence. To investigate this potential causal relationship, we employed Mendelian randomization (MR) analysis. Additionally, we analyzed the levels of other liver enzymes, including alanine transaminase (ALT) and alkaline phosphatase (ALP). The relationship between GGT levels and CK incidence was analyzed using two-sample Mendelian randomization. Summary Genome-Wide Association Studies data were utilized for this analysis. 33 single nucleotide polymorphisms known to be associated with GGT levels were employed as instrumental variables. We employed several MR methods including IVW (inverse variance weighting), MR-Egger, weighted median, weighted mode, and MR-PRESSO (Mendelian Randomization Pleiotropy RESidual Sum and Outlier). Furthermore, we conducted tests for horizontal multivariate validity, heterogeneity, and performed leave-one-out analysis to ensure the stability of the results. Overall, several MR methods yielded statistically significant results with a p -value < 0.05. The results from the IVW analysis yielded an odds ratio (OR) of 1.0062 with a 95% confidence interval (CI) of 1.0016–1.0109 ( p = 0.0077). Additional MR methods provided supplementary results: MR-Egger (OR 1.0167, 95% CI 1.0070–1.0266, p = 0.0040); weighted median (OR 1.0058, 95% CI 1.0002–1.0115, p = 0.0423); and weighted mode (OR 1.0083, 95% CI 1.0020–1.0146, p - = 0.0188). Sensitivity analyses did not reveal heterogeneity or outliers. Although potential horizontal pleiotropy emerged, we speculate that this could be attributed to inadequate test efficacy. However, subsequent use of MR-PRESSO did not provide evidence of pleiotropy. Our analysis suggests a positive association between elevated GGT levels and CK incidence, indicating an increased risk of CK development. However, no causal relationship was observed between levels of ALP or ALT and CK incidence.

肝肾囊肿是临床常见的囊性疾病,CT、核磁、B超等影像学检查有利于明确其诊断及鉴别诊断.单纯性的肝囊肿是肝脏最常见的良性病变之一,病位主要在肝,与脾、肾有关.单纯性的肾囊肿为良性的上皮囊肿,病位主要在肾,与肝、脾有关.肝肾囊肿病性皆为本虚标实.一般来说,囊肿体积较小,无压迫症状及肝肾功能障碍,仅需随访观察即可.若囊肿较大或多发囊肿,或病理性质倾向于恶性,损伤肝肾功能,或出现压迫症状,甚至引起肝肾功能衰竭,则应积极干预.治疗此类疾病之前,首先要明确诊断,明确病变病因,注意将单纯性囊肿与肝肾脏其他肿块相鉴别.临床在分期辨证的同时,将辨病与辨症相结合,采用中西医结合疗法可确保疗效.具体治疗,可采用外科手术改善压迫症状.中医治疗则可在辨证论治基础上,选用中药或针灸治疗,补虚祛邪并重,以恢复脏腑功能,延缓肝肾功能衰竭进展.

Human papillomavirus (HPV) has been recognized as an important risk factor in penile cancer. This study aimed to investigate the HPV subtypes and integration status in Chinese patients. Samples were collected from 103 penile cancer patients aged 24-90 years between 2013 and 2019. We found that HPV infection rate was 72.8%, with 28.0% integration. The aging patients were more susceptible to HPV (p = 0.009). HPV16 was the most frequent subtype observed (52/75) and exhibited the highest frequency of integration events, with 11 out of 30 single infection cases showing integration positive. The HPV integrations sites in the viral genome were not randomly distributed, the breakpoints were enriched in the E1 gene (p = 0.006) but relatively scarce in L1, E6 and E7. Our research might provide some clues how HPV leads to the progression of penile cancer.

尿窍是人体排出尿液的重要器官,尿窍的生理功能与多个脏腑经络相关,尿窍疾病也受到多脏腑经络影响,主要与肾、膀胱有关,与肝、脾、肺、心等脏腑也有密切联系.临床治疗尿窍疾病,需要在辨病、辨证相结合的基础上,处理好整体与局部的关系,多脏同治,方能取效.除中药汤剂治疗外,还需灵活应用针灸等多种治疗手段,从而提高临床疗效.此外,各脏腑疾病均与水液代谢有关,通利小便是治疗多种疾病的重要手段,有益于多种疑难杂病的治疗.

目的:探讨腹腔镜手术治疗钬激光碎石术后中上段输尿管闭锁的方法和疗效.方法:回顾性分析2015年6月至2021年7月我院收治的输尿管镜钬激光碎石术后输尿管中上段闭锁患者16例,根据闭锁段位置、长度、体重指数等综合因素选择经后腹腔或经腹腔入路行腹腔镜输尿管闭锁段切除+输尿管端端吻合术.结果:本组16例均顺利完成手术,9例输尿管上段闭锁,7例中段闭锁;闭锁段长度0.5～4.2(1.8±0.8)cm.手术时间80～220(110±40.5)min;出血量50～220(70±50.5)ml;引流管留置时间7～10(8.0±0.8)d.随访7～48个月,所有患者肾积水均减轻.2例患者术后出现吻合口狭窄,行球囊扩张术后好转.结论:腹腔镜输尿管闭锁段切除+端端吻合术是治疗钬激光碎石术后输尿管中上段闭锁的有效方法.

目的:探讨穿刺活检单针阳性前列腺癌患者根治性前列腺切除术后病理升级的危险因素.方法:回顾性分析2017年1月至2020年1月中国人民解放军总医院第一医学中心和北京中医药大学东直门医院泌尿外科收治的前列腺穿刺活检单针阳性前列腺癌患者76例,根据术后病理是否升级分为病理升级组39例和病理未升级组37例.多因素Logistic回归分析术后病理升级的危险因素.结果:术前多参数磁共振PI-RADS评分2分者6例(7.9％),3分者22例(28.9％),4分者44例(57.9％),5分者4例(5.3％).两组患者PI-RADS评分和tPSA差异有统计学意义(P<0.05);年龄、前列腺体积、BMI、PSAD、穿刺方式和术前临床分期差异无统计学意义(P>0.05).多因素Logistic回归分析结果显示PI-RADS评分>3分为穿刺活检单针阳性前列腺癌术后病理升级的独立危险因素(OR=42.8,95％CI:6.6-278.2;P<0.01).结论:基于多参数MRI的PI-RADS评分是根治性前列腺切除术后Gleason评分升高的危险因素.

The aim of the current study was to investigate the effect of aldosterone on apoptosis in human aortic smooth muscle cells (HA-VSMC) and to determine the role of fibulin-5 in the aldosterone-induced apoptosis of HA-VSMC cells. Through the construction of a fibulin-5 eukaryotic overexpression vector and a short hairpin RNA interference plasmid, fibulin-5 was overexpressed and silenced, respectively. The role of fibulin-5 in the aldosterone-induced apoptosis of HA-VSMC was subsequently determined. The overexpression of fibulin-5 inhibited the apoptosis of cells, particularly at low concentrations of aldosterone; a smaller effect on apoptosis was induced by high concentrations of aldosterone. fibulin-5 knockdown promoted the apoptosis of cells induced by high concentrations of aldosterone but had a smaller effect on the apoptosis of cells induced by low concentrations of aldosterone. Therefore, the results of the current study indicate that fibulin-5 inhibits the aldosterone-induced apoptosis of HA-VSMC cells and that this effect may be altered by changing the aldosterone concentration.

目的:探讨基于多参数磁共振成像(mp-MRI)的前列腺影像报告和数据系统(PI-RADS)评分Version 2对前列腺穿刺活检病理Gleason评分为3+3=6分的前列腺癌患者在根治性前列腺切除术后病理评分升级的预测价值.方法:回顾性分析2017年1月-2020年1月收治的前列腺穿刺活检Gleason评分为3+3=6分的前列腺癌患者89例,收集患者的临床病理资料,包括患者年龄、BMI、前列腺特异性抗原(PSA)、PSA密度(PSAD)、前列腺PI-RADS评分V2、穿刺相关资料及术后Gleason评分等,采用Logistic单因素及多因素回归分析得出术后病理升级的危险因素.结果:根治术后大体病理Gleason评分为3+3分者46例(51.7％);43例(48.3％)患者术后Gleason评分≥7分,其中38例患者PI-RADS评分为4分或5分,占比88.4％;多因素Logistic回归分析,结果显示PI-RADS评分(>3分)(HR=32.6,95％CI=6.2～170.8,P<0.01)、PSAD(≥0.20)(HR=9.6,95％CI=1.3～69.7,P=0.025)为前列腺癌术后病理升级的预测因子.结论:对于术前穿刺结果Gleason评分为3+3分的前列腺癌患者,基于多参数MRI的PI-RADS评分V2及PSAD是影响根治性前列腺切除术后Gleason评分升级的独立预测因子.

BACKGROUND Human papillomavirus (HPV) infection is associated with multiple types of cancer, but the evidence has not yet been fully elucidated in bladder cancer. METHODS Frozen tissue samples collected from 146 patients aged 32 to 89 years-old with bladder cancer pathological diagnosis between 2015 and 2019 were analyzed. HPV genotyping and integration status determination were performed by capture-based next generation sequencing. Statistical analysis of HPV type distributions was performed according to stage, grade, gender and age group of patients. RESULTS Mean age of 146 patients was 66.64 ± 10.06 years and 83.56% were male. Overall HPV infection rate was 28.77% (37.5% in female and 27% in male), with 11.90% HPV integration events. Among them, 17.12% single and 11.65% co-infections were observed. HPV18 (24.66%) was the most prevalent genotype, followed by HPV33, 16, 39. All HPV were European lineage (A). HPV16 was more prevalent in female (p=0.04). CONCLUSION HPV infection may contribute a causative role both in men and women with bladder cancer. HPV18, followed by HPV 33, 16 and 39 genotypes potentially represent the predominant oncogenic risk types of bladder carcinogenesis.

目的:探讨前列腺癌放射性粒子植入术后膀胱癌患者接受腹腔镜根治性膀胱切除的可行性、安全性及临床疗效.方法:回顾性分析2015年6月就诊于北京中医药大学东直门医院1例前列腺癌放射性粒子植入术后发生肌层浸润性膀胱癌患者的临床资料.该患者接受腹腔镜根治性膀胱全切+回肠膀胱术.通过查阅相关文献,分析放射粒子植入对膀胱癌发生和演进、根治膀胱全切手术操作及尿流改道选择等影响.结果:术中发现前列腺与周围组织粘连严重,通过逆行与顺行相结合的方式进行根治性膀胱切除,并采取回肠输出道作为尿流改道方式,未出现直肠损伤、尿漏、肠梗阻等早期并发症.随访5年6个月,无肿瘤复发、无输尿管回肠吻合口狭窄等远期并发症.结论:腹腔镜根治性膀胱切除术+回肠输出道可以作为前列腺癌粒子植入术后肌层浸润性膀胱癌患者安全、有效的手术方式之一.

目的:探讨腹腔镜膀胱外黏膜下隧道法输尿管膀胱再植术联合腰大肌悬吊术治疗末段输尿管缺损的适应证、手术要点及术后疗效.方法:回顾性分析2012年1月－2019年3月行腹腔镜输尿管膀胱再植术联合腰大肌悬吊术的22例末段输尿管病变患者的临床资料,男10例,女12例,年龄21～55岁,平均(40.6±7.2)岁.其中内镜激光碎石术后狭窄7例;妇产科术后输尿管狭窄6例;输尿管子宫内膜异位症3例;原发性狭窄6例.术前影像学结果提示输尿管缺损长度4～8 cm,平均(5.0±1.6)cm;输尿管扩张直径0.7～2.5 cm,平均(1.3±0.7)cm;肾盂分离1.5～4.1 cm,平均(2.6±0.8)cm.术中均先充分游离末段病变输尿管及膀胱,离断输尿管后将膀胱悬吊于腰大肌或腰小肌肌腱;将病变段输尿管裁剪后,采用膀胱外黏膜下隧道法行输尿管膀胱的再植术.结果:22例手术均在腹腔镜下成功完成,手术时间130～230 min,平均(168±30.2)min;出血量15～120 mL,平均(60±30.2)mL;引流管留置时间4～8 d,平均(6±0.5)d;尿管留置时间7 d;术后住院8～11 d,平均(9±1.2)d;术中留置双J管均于术后2～3个月拔除.随访5～80个月,平均(48.4±25.3)个月,患者均无尿瘘、吻合口瘘及吻合口狭窄;行B超、静脉肾盂造影、膀胱造影检查提示肾积水均明显减轻或消失,其中轻度肾积水8例,无明显肾积水14例,轻度膀胱输尿管反流1例.结论:腹腔镜膀胱外黏膜下隧道法联合腰大肌悬吊输尿管膀胱再植术治疗中等长度的末段输尿管缺损安全有效,损伤小,术后恢复快.腰大肌悬吊术能有效解决输尿管缺损较长的问题,使输尿管膀胱达到无张力吻合,黏膜下隧道法抗反流成功率高,降低了术后患者尿液反流导致逆行感染及慢性肾功能损害的发生率.

尿失禁是一种比较常见的泌尿系统疾病,是由于膀胱括约肌损伤或神经功能障碍导致排尿自控能力下降或丧失,出现不自主地间歇排尿、排尿没有感觉、尿频、尿急等症状.尿失禁可发生于各年龄阶段,但以老年人更为常见,尤其是老年女性.

目的:探讨秦皮乙素对肾透明细胞癌增殖、周期和凋亡的作用.方法:选取肾透明细胞癌786-O和SN12-PM6细胞,分别给予秦皮乙素(0、12.5、25、50、100、200、400、800 μg/mL),培养24 h或48 h后,通过MTS和平板克隆形成实验检测秦皮乙素对786-O和SN12-PM6细胞增殖能力的影响,通过流式细胞技术检测秦皮乙素对786-O和SN12-PM6细胞周期、凋亡的影响,通过Western Blot检测周期、凋亡相关蛋白表达情况.结果:秦皮乙紊能够抑制肾透明细胞癌786-O和SN12-PM6细胞的增殖(P＜0.05),且呈浓度和时间依赖性,与空白组(0 μg/mL)相比,秦皮乙素处理组(100、200μg/mL)S期比例明显减少,G0/G1期和G2/M期比例明显增加,凋亡率也明显增加(P＜0.05,P＜0.01),与空白组(0μg/mL)相比,秦皮乙素处理组(100、200 μg/mL)Cyclin D1、CDK4、CDK6、c-Myc表达明显减少,Caspase 3表达无明显差异,Cleaved Caspase 3表达明显增多(P＜0.05,P＜0.01).结论:秦皮乙素可有效抑制肾透明细胞癌786-O和SN12-PM6细胞增殖,并抑制细胞周期及诱导凋亡.

Background: Esculetin, the main active ingredient in the Chinese herbal medicineCortex Fraxini, has been shown to possess antitumor activity. However, the effect of esculetin on clear cell renal cell carcinoma (ccRCC) has not been investigated. Methods: MTS assays and colony formation assays were used to study the cytotoxicity of esculetin. The effects of esculetin on cell cycle and apoptosis were analyzed by flow cytometry. Western blot was used to detect cell cycle-, apoptosis-, and EMT-related proteins. Wound-healing assays and transwell assays were performed to study the effect of esculetin on cell migration and invasion in the ccRCC cell lines 786-O and SN12-PM6. Results: Esculetin exerted cytotoxic activities in 786-O and SN12-PM6 cells in a dose- and time-dependent manner. The compound arrested the cell cycle in G0/G1 and G2/M phase with down-regulation of Cyclin D1, CDK4, CDK6, and c-Myc expression. Esculetin also induced apoptosis and the expression of cleaved caspase 3 increased. Additionally, esculetin significantly inhibited 786-O and SN12-PM6 cell migration and invasion, the expression of E-Cadherin increased, and the expression of N-cadherin and vimentin decreased. Conclusion: Taken together, these results suggest that esculetin inhibits proliferation, migration, and invasion of ccRCC and is a potential novel therapeutic agent for the treatment of ccRCC.