Segmentation of the pancreatic computed tomography (CT) image in the Internet of Medical Things (IoMT) environment faces dual challenges of feature robustness and accurate recognition of small organs. As a clinically critical but anatomically challenging organ, the pancreas exhibits small volume, high interpatient variability, and low contrast with surrounding tissues, making automatic pancreas segmentation a representative and difficult task in abdominal CT analysis. Existing automatic, machine-centric segmentation methods often perform unsatisfactorily across different medical institutions due to variations in imaging devices, changes in scanning protocols, as well as the irregular shape and blurred boundaries of the pancreas. To address this problem, this article proposes a SimCLR-based Contrastive Swin-UNet (ContSwinU) model, which integrates contrastive learning with the Swin Transformer architecture to achieve feature robustness learning and high-precision pancreas segmentation. Specifically, ContSwinU leverages SimCLR to learn robust feature representations, thereby enhancing the model's generalization capability across diverse scenarios. Additionally, by incorporating the hierarchical window attention mechanism of the Swin Transformer, the model effectively balances local texture and global structural information, improving segmentation accuracy for the pancreas as a small organ. Experimental results on a public pancreas CT dataset demonstrate that ContSwinU achieves an IoU of 0.8041, a Dice coefficient of 0.8872, and a recall of 0.9014, significantly outperforming mainstream baseline methods. These results indicate that the proposed framework is well suited for challenging small-organ segmentation tasks and has the potential to be extended to other organs and multicenter IoMT scenarios. This study provides an effective solution for pancreas segmentation in IoMT environments and has substantial clinical application value.

Pancreatic cancer is one of the most aggressive malignant solid tumors, and achieving early screening and diagnosis is the key to improving patient survival rates. Although deep learning has made significant progress in medical image analysis, the classification of pancreatic cancer computed tomography (CT) images remains highly challenging due to subtle interlesion differences and overlapping category distributions. Moreover, existing methods rely heavily on large amounts of high-quality annotations, which can lead to overfitting and hinder the effective exploitation of structural and semantic features within images. To address these challenges, we propose a contrastive Swin transformer with masked autoencoder (CSTMA) for pancreatic cancer CT image classification in the Internet of Medical Things (IoMT) environment. CSTMA leverages contrastive learning to enhance feature discriminability, while its multitask self-supervised architecture based on masked autoencoder (MAE) guides the model to learn both structural and semantic representations. We conduct comprehensive experiments on pancreatic cancer CT image classification tasks, and the results demonstrate that the proposed CSTMA model achieves superior performance across multiple evaluation metrics.

Kidney transplant recipients (KTRs) exhibit a higher incidence of neoplasms compared to the general population, primarily due to the prolonged administration of immunosuppressive agents and viral infections. In China, the primary type of tumor among KTRs is urothelial carcinoma (UC), which lacks specific clinical manifestations. Accurate diagnosis necessitates the integration of multiple diagnostic modalities, while therapeutic approaches must judiciously balance oncological control with the preservation of renal function, thereby presenting a considerable challenge to the health of KTRs. This article provides a comprehensive review of the epidemiological characteristics, risk factors, diagnostic methodologies, and therapeutic strategies associated with urothelial carcinoma post kidney transplantation (KT), aiming to enhance healthcare professionals’ understanding of this condition and improve patient management.

The key drivers of symptom severity in atrial fibrillation (AF) patients remain unclear. The study aimed to explore associations between anxious and depressive status and AF-related symptoms as expressed by the modified European Heart Rhythm Association (mEHRA) score. The study enrolled 182 AF patients admitted to the Cardiology Department of Peking University Third Hospital between February 2017 to January 2020. Anxious and depressive status were assessed by “Generalized Anxiety Disorder-7” and “Patient Health Questionnaire-9,” respectively. The severity of AF-related symptoms was scored by mEHRA and classified into 2 groups: low mEHRA group (mEHRA = 1 or 2a) and high mEHRA group (mEHRA ≥ 2b), according to whether they were troubled or affected by AF-related symptoms. In all 182 AF patients, 56.0% (n = 102) patients presented mEHRA ≥ 2b. The high mEHRA group had significantly higher Patient Health Questionnaire-9 score [4.0 (2.0–7.0) vs 2.5 (0–4.8), P < .001] and Generalized Anxiety Disorder-7 score [3 (0–5) vs 0 (0–3), P < .001]. After adjusted for other covariates, persistent AF (odds ratio, OR = 0.48, 95% confidence interval [CI]: 0.23, 0.99), heart failure (OR = 2.91, 95% CI: 1.08, 8.43), depressive status (OR = 2.15, 95% CI: 1.01, 4.65), and anxious status (OR = 2.83, 95% CI: 1.17, 7.38) were independently associated with high mEHRA score (≥2b). Increased anxiety and depression levels was associated with feeling troubled or limited by AF-related symptoms scored by mEHRA.

Background The clinicopathologic and prognostic significance of T-cell lymphoma invasion and metastasis 2 (TIAM2) in hepatocellular carcinoma (HCC) remains unclear.Methods TIAM2 expression was detected immunohistochemically in matched HCC and adjacent liver (AL) specimens from 168 patients with radical resection. The correlations between TIAM2 and clinicopathologic parameters, overall and disease-free survival were evaluated. The expression, prognostic value and genomic alterations of TIAM2 gene were explored in the online publicly available databases.Results TIAM2 was significantly overexpressed in HCC tissues, compared with AL tissues (P < 0.001). Its expression in multiple tumors was also statistically higher than that in solitary ones (P = 0.017). Moreover, TIAM2 overexpression was univariately associated with poor overall and disease-free survival (P = 0.0066 and 0.0060). In multivariate Cox regression analysis, TIAM2 overexpression was one of significant determinants of both overall and disease-free survival. In the Ualcan and Kaplan-Meier Plotter databases, overexpression and prognostic power of TIAM2 gene in HCC was confirmed, while its genetic alterations included mutation, amplification and deep deletion in the cBioPortal database. Some known tumor-related genes, such as FGD6, FGFR2 and FZD1, were strongly related to TIAM2 gene.Conclusions TIAM2 overexpression closely correlated with tumor multiplicity and poor prognosis in resected HCC, thus being a potential therapeutic target.

Pancreatic ductal adenocarcinoma (PDAC) includes local progression out of control and early systemic dissemination. Dysregulation of anoikis is closely related to PDAC metastasis, but its heterogeneity and different expression subtypes in the tumor microenvironment (TME) have not been fully clarified. Electrochemical sensors can achieve rapid and sensitive detection of biomolecules, especially in the detection of tumor markers, providing strong support for the early diagnosis and treatment monitoring of cancer. This study aims to analyze the expression heterogeneity of nest-lost apoptosis-related genes (ARGs) by integrating electrochemical sensor technology and single-cell transcriptome sequencing (scRNA-seq). Three RNA sequence datasets were obtained from databases such as The Cancer Genome Atlas (TCGA-PAAD) and the International Cancer Genome Consortium (ICGC-PAAD-CA & ICGC-PAAD-AU). And three other gene expression data were extracted from the Comprehensive Gene Expression Database (GEO), etc. for external validation. The single-cell transcriptome file has been downloaded. Through integrated analysis, genes related to nest-lost apoptosis (ARG) were identified, and a prognostic risk scoring model was constructed based on these genes. Combining the application advantages of electrochemical sensors in medical laboratory tests, this paper explores their potential application value in the diagnosis and treatment monitoring of PDAC. The study revealed three distinct subtypes of ARG, which exhibit significant differences in TME composition, metabolic reprogramming, immune landscape, and chemotherapy sensitivity. The prognostic risk scoring model constructed based on six core ARGs can effectively divide patients into high-risk and low-risk groups. There is a significant difference in overall survival rates between the two groups, and this scoring model has been consistently validated in independent internal and external cohorts. Research on the application of electrochemical sensors in medical testing shows that they have significant advantages in detection speed, sensitivity and portability, and can rapidly detect tumor markers in blood, providing a new technical means for the early diagnosis and treatment monitoring of PDAC.

Background:. Pancreatic neuroendocrine tumors (pNETs) with synchronous liver metastasis (NELM) are associated with poor prognosis. Radical surgery is the only curative treatment option for these patients. However, the prognostic indicators for NELM patients who underwent radical surgery remain unclear. This study aimed to evaluate the prognostic value of liver metastasis burden (LMB) and other general clinicopathological indicators in patients who underwent radical resection. Methods:. A retrospective analysis was conducted on a cohort of 36 patients who underwent surgery between January 2016 and December 2023. The LMB indicator was defined as the ratio of metastatic volume to liver volume (RML). The optimal cutoff value of RML was identified via X-tile software, dividing the population into high and low groups. Results:. Kaplan-Meier (KM) curves for progression-free survival (PFS) revealed a significant difference between high and low groups of RML (P = .004), but there were no statistical differences in overall survival (OS) between the 2 groups (P = .309). Cox regression univariable analysis indicated that only high RML was associated with poor PFS (hazard ratio = 4.42, 95% confidence interval = 1.48–13.22; P = .008). However, it was not significantly associated with OS (P = .331). High RML emerged as an independent risk factor for PFS in these patients (hazard ratio = 4.73, 95% confidence interval = 1.59–14.03; P = .005). In the high RML group, patients receiving preoperative chemotherapy or chemotherapy plus somatostatin analogs (SSA), had lower recurrence rates compared with those without chemotherapy or without chemotherapy plus SSA, respectively. No such benefit was observed in the low RML group. Conclusion:. RML may serve as an effective prognostic indicator of PFS for patients with NELM who undergo curative surgery. For these patients with high liver metastatic burden, preoperative treatment regimens containing chemotherapy should be recommended.

It has recently been shown that mut-L homolog 1 (MLH1), frequently lost in cancer initiation and progression, inhibited pancreatic cancer metastatic potential by downregulating G-protein coupled receptor C5C (GPRC5C). However, their expression and prognostic significance in hepatocellular carcinoma (HCC) has not been elucidated, especially for GPRC5C. We detected MLH1 and GPRC5C expression using the tissue microarray-based immunohistochemical staining in tumor and matched adjacent non-tumor liver (ANL) specimens from 230 patients who underwent radical resection for HCC. The correlations between staining H-scores and clinicopathologic parameters, overall and disease-free survival were then evaluated. Finally, the prognostic value of the genes was evaluated in the online publicly available Kaplan-Meier Plotter database. Firstly, MLH1 expression was much lower in HCC than in ANL tissues, while GPRC5C had the opposite change. Spearman’s correlation coefficient analysis showed that MLH1 and GPRC5C were of a strong negative correlation (P < 0.001). In addition, MLH1 was negatively related to AFP level, and GPRC5C was positively linked to tumor size and vascular invasion. Univariately, high MLH1 or GPRC5C expression was remarkably associated with better or poorer overall and disease-free survival, respectively. In multivariate analyses, GPRC5C remains to be a powerful determinant for both overall and disease-free survival, while MLH1 was significant only for overall survival. Lastly, MLH1 predicted recurrence-free and progression-free survival in the Kaplan-Meier Plotter, GPRC5C might have the adverse effect, although being not statistically significant. MLH1 and GPRC5C have divergent expressions with an inverse correlation and function as promising novel prognostic indicators in resectable HCC.

Deep learning(DL) models can improve significantly discrimination of lymph node metastasis(LNM) of pancreatic ductal adenocarcinoma(PDAC), but have not been systematically assessed. To develop and test a transformer model utilizing dual-energy computed tomography (DECT) for predicting LNM in patients with PDAC. This retrospective study examined patients who had undergone surgical resection and had pathologically confirmed PDAC, with DECT performed between August 2016 and October 2022. Six predictive models were constructed: a DECT report model, a clinical model, 100 keV DL model, 150 keV DL model, a combined 100 + 150 keV DL model, and a model that integrated clinical information with DL-derived signatures. Multivariable logistic regression analysis was employed to develop the integrated model. The efficacy of these models was assessed by comparing their areas under the receiver operating characteristic curve (AUC) using the Delong test. Survival analysis was conducted using Kaplan-Meier curves. In brief, 223 patients (mean age, 57 years ± 11 standard deviation; 93 men) were evaluated. All patients were divided into training (n = 160) and test (n = 63) sets. Patients with LNM accounted for 96 of the 223 patients (43

Background & Aims: There are notable gender disparities in the incidence and mortality rates of hepatocellular carcinoma (HCC). Women have comparatively lower incidence and mortality rates of HCC than men. Circular RNAs (circRNAs) have emerged as pivotal regulators in HCC biology, yet their functions in patients of different genders remain unexplored. In this investigation, we aimed to identify the significant circRNA between male and female patients, and to explore its functional implications and underlying molecular mechanisms in the progression of HCC. Methods: First, we used microarray and found circRNA transcripts that are differently expressed in men and women patients with HCC. Then, through bioinformatics analysis, we identified a significant circular RNA KIF18A, and validated its expression in cells. And we analyzed the differentially expressed transcriptome genes between HCC cells with circKIF18A knockout and normal cells. Using bioinformatics methods, we identified pathways and proteins that may be associated with circKIF18A regulation. Meanwhile, we performed cell behavioral experiments to demonstrate the knockdown of circRNAs’ implication on HCC. Results: A novel circRNA named circKIF18A was found upregulated in males with HCC compared with females, promoting cell proliferation and migration, while inhibiting apoptosis. We performed extensive bioinformatic analyses, we discovered that the estrogen receptor pathway might be involved in KIF18A regulation of hepatocellular carcinoma. Within this pathway, KPNA2 was identified as the most significantly differentially expressed protein, and it is associated with the prognosis of hepatocellular carcinoma. Conclusions: Our working hypothesis suggests that circKIF18A may orchestrate KPNA2 through the estrogen signaling pathway, demonstrating their combined significance as promoting roles in the initiation and progression of HCC. Meanwhile, this finding may provide potential evidence for the observed disparities in incidence and mortality rates of HCC between male and female patients; however, further experimental validation is required.

Background: Preoperative recognition of irreversible bowel necrosis is important, as it provides valuable guidance for surgical strategy selection but also may inform perioperative risk assessment and communication. Few studies have focused on the association between CT signs and bowel necrosis. Purpose: To assess the diagnostic accuracy of CT signs to predict bowel necrosis in patients with closed -loop small bowel obstruction (CL-SBO). Materials and Methods: This retrospective single -center study included patients who were surgically confirmed to have CL-SBO caused by adhesion or internal hernia between January 2016 and May 2022. Necrosis was determined based on surgical exploration and postoperative pathologic examination. Two radiologists independently reviewed CT signs by both subjective visual assessment and objective measurement. Disagreements were resolved in consensus with a third gastrointestinal radiologist. Univariable and multivariable analyses were used to assess the association between CT signs and bowel necrosis, and Cohen kappa was used to assess interobserver agreement. Sensitivity and specificity were calculated for each CT sign. Results: This study included 145 patients: 61 (42.1%) in the necrotic group (median age, 62 years [IQR, 51-71.5 years]; 37 [60.7%] women) and 84 (57.9%) in the nonnecrotic group (median age, 61.5 years [IQR, 51-68.8 years]; 51 [60.7%] women). Univariable analysis and multivariable analysis showed that increased attenuation of intestinal contents and increased attenuation of intestinal wall were independent predictors for bowel necrosis (odds ratio = 45.3 and 15.1; P = .001 and P < .001, respectively). Increased attenuation of intestinal contents and increased attenuation of intestinal wall had similar sensitivity (64% and 67%, respectively) and specificity (99% and 92%, respectively) for predicting bowel necrosis. However, interobserver agreement was better for assessing the contents than the wall (kappa = 0.84 and 0.59, respectively). Conclusion: Increased attenuation of intestinal contents was a highly specific CT sign with good reproducibility to predict bowel necrosis in CL-SBO. (c) RSNA, 2024

BACKGROUND:The management of advanced clear cell renal cell carcinoma (ccRCC) remains a major challenge in clinical practice, and the construction of more reliable prognostic prediction models and the further elucidation of key molecular mechanisms of tumor progression are topics in urgent need of in-depth investigation.METHODS:We used CIBERSORT to estimate the proportion of 22 tumor-infiltrating immune cell types in the TCGA-KIRC cohort. Weighted gene co-expression network analysis, least absolute shrinkage and selection operator regression analysis were used to build risk prediction models. Expression patterns and clinical significance of TRAF2 were determined through bioinformatics analysis, real-time qPCR, Western Blot, immunohistochemistry. GSEA analysis, transmission electron microscopy, 2D/3D colony formation assay, cell migration and invasion assay, and tube-formation assay were used to investigate the underlying function and mechanism of the TRAF2/M2 macrophage/autophagy axis.RESULTS:We constructed a novel prognostic prediction model based on M2 macrophage-related genes, which was identified as an accurate, independent and specific prognostic risk model for ccRCC patients. A reliable nomogram was constructed to predict 1-, 3-, and 5-year overall survival for patients with ccRCC. As one of the constituent genes of the risk model, TRAF2 was determined to be upregulated in ccRCC and associated with poor clinical prognosis. We found that TRAF2 promotes malignant progression of ccRCC by regulating macrophage polarization, migration and angiogenesis. Mechanistically, we found that TRAF2 promotes the polarization of M2 macrophages, and this chemotaxis is achieved in an autophagy-dependent pathway. Orthotopic tumor growth assay results revealed that TRAF2 plays a key role as a promotor of ccRCC growth and metastasis.CONCLUSIONS:In conclusion, this risk model is highly predictive of prognostic in ccRCC patients, which is expected to promote improved treatment evaluation and comprehensive management of ccRCC. Moreover, our findings reveal that the TRAF2/M2 macrophage/autophagy axis plays a key regulatory role in the malignant progression of ccRCC, and suggest that TRAF2 is a potential novel therapeutic target for advanced ccRCC.

Background:Renal cell carcinoma (RCC) is a common and aggressive tumor. A newly discovered form of programmed cell death, ferroptosis, plays an important role in tumor development and progression. However, a clear prognostic correlation between Ferroptosis-related genes (FRGs) and RCC has not yet been established. In this study, prognostic markers associated with FRGs were investigated to improve the therapeutic, diagnostic, and preventive strategies available to patients with renal cancer.Methods:The present study analyzed the predictive value of 23 FRGs in RCC through bioinformatics techniques, including Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) tools, Kaplan-Meier survival analysis, Cox regression modeling, tumor mutational burden (TMB), CIBERSORT, and half maximal inhibitory concentration (IC50) difference analysis.Results:We screened FRGs by differentially expressed genes (DEGs) and overall survival (OS). Four candidate genes were obtained by hybridization. Then, we constructed a two-gene prognostic signature (NCOA4 and CDKN1A) via univariate Cox regression and multivariate stepwise Cox regression, which classified RCC patients into high- and low-risk groups, and patients in the high-risk group were found to have worse OS and progression-free survival (PFS). We also found that patients with higher TNM stage, T stage, and M stage had higher risk scores than those with lower TNM stage, T stage, and M stage (P<0.05). Males had higher risk scores than females. This signature was identified as an independent prognostic indicator for RCC. These results were validated in both the test cohort and the entire cohort. In addition, we also constructed a nomogram that predicted the OS in RCC patients, the consistency index (C-index) of the nomogram was 0.731 [95% confidence interval (CI): 0.672-0.790], the areas under the receiver operating characteristic (ROC) curves (AUCs) were 0.728, 0.704, and 0.898 at 1-, 3-, and 5-year, respectively, which shows that nomogram has good prediction ability. and we also analyzed the immune status and drug sensitivity between the high- and low-risk groups.Conclusions:We constructed a prognostic model associated with ferroptosis, which may provide clinicians with a reliable predictive assessment tool and offer new perspectives for the future clinical management of RCC.

Background: A novel procedure called shark mouth pancreaticojejunostomy (SMP) was developed, for the reconstruction of the pancreatic stump which has a theoretical advantage for anastomosis healing and wide applicability. Methods: A comparative study of the patients who underwent SMP (SMP cohort) and those who underwent end-to-end dunking pancreaticojejunostomy (historic cohort) at Peking University Third Hospital was conducted. Each group was analyzed for the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) and morbidities. Results: The clinicopathological data of 151 patients from the SMP cohort and 82 patients from the historic cohort were analyzed. In the SMP group, the rate of CR-POPF was 7.3% (11/151), which was significantly lower than the rate of CR-POPF in the historic group as 19.5% (16/82) (P = 0.005). The primary results were unaffected by sensitivity analyses based on several risk factors for CR-POPF. The rates of morbidities besides CR-POPF were 15.9% (24/151) in the SMP group and 17.1% (14/82) in the historic cohort (P = 0.194). The principal results were not changed by the propensity score matched (PSM) analysis. Conclusion: SMP is a safe and simple surgical procedure for the reconstruction of the pancreatic stump compared with end-to-end dunking pancreticojejunostomy.

Objectives The aims of this review were to determine whether positive peritoneal lavage cytology (CY+) precludes radical resection in pancreatic cancer and to propose prospections for future studies. Methods MEDLINE, Embase, and Cochrane Central were searched for related articles. Dichotomous variables and survival outcomes were analyzed with the estimation of odds ratio and hazards ratio (HR), respectively. Results A total of 4905 patients were included, of which 7.8% were CY+. Positive peritoneal lavage cytology was correlated with poor overall survival (univariate survival analysis [HR, 2.35; P < 0.00001]; multivariate analysis [HR, 1.62; P < 0.00001]), poor recurrence-free survival (univariate survival analysis [HR, 2.50; P < 0.00001]; multivariate analysis [HR, 1.84; P < 0.00001]), and higher initial peritoneal recurrence rate (odds ratio, 5.49; P < 0.00001). Conclusions Although CY+ predicts poor prognosis and a higher risk of peritoneal metastasis after curative resection, it is not sufficient to preclude curative resection based on the current evidence, and high-quality trials should be conducted to assess the prognostic impact of operation among resectable CY+ patients. In addition, more sensitive and accurate methods to detect peritoneal exfoliated tumor cells and more effective comprehensive treatment for resectable CY+ pancreatic cancer patients are clearly warranted.

Introduction Macrophage phenotype switch plays a vital role in the progression of malignancies. We aimed to build a prognostic signature by exploring the expression pattern of macrophage phenotypic switch related genes (MRGs) in the Cancer Genome Atlas (TCGA)-pancreatic adenocarcinoma (PAAD), Genotype-Tissue Expression (GTEx)-Pancreas, and Gene Expression Omnibus (GEO) databases. Methods We identified the differentially expressed genes between the PAAD and normal tissues. We used single factor Cox proportional risk regression analysis, Least Absolute Shrinkage and Selection Operator (LASSO) analysis, and multivariate Cox proportional hazard regression analysis to establish the prognosis risk score by the MRGs. The relationships between the risk score and immune landscape, "key driver" mutations and clinicopathological factors were also analyzed. Gene-set enrichment analysis (GSEA) analysis was also performed. Results We detected 198 differentially expressed MRGs. The risk score was constructed based on 9 genes (KIF23, BIN1, LAPTM4A, ERAP2, ATP8B2, FAM118A, RGS16, ELMO1, RAPGEFL1). The median overall survival time of patients in the low-risk group was significantly longer than that of patients in the high-risk group (P < 0.001). The prognostic value of the risk score was validated in GSE62452 dataset. The prognostic performance of nomogram based on risk score was superior to that of TNM stage. And GSEA analysis also showed that the risk score was closely related with P53 signaling pathway, pancreatic cancer and T cell receptor signaling pathway. qRT-PCR assay showed that the expressions of the 9 MRGs in PDAC cell lines were higher than those in human pancreatic ductal epithelium cell line. Conclusions The nine gene risk score could be used as an independent prognostic index for PAAD patients. Further studies validating the prognostic value of the risk score are warranted.

Background The debate over the association between vasectomy and prostate cancer has been lasted about 40 years and there is no sign of stopping. In the present study, we aimed to evaluate whether vasectomy is associated with prostate cancer based on the most comprehensive and up-to-date evidence available. Methods The PubMed, Cochrane Library, and EMBASE databases were systematically searched inception to March 14, 2021 without year or language restriction. Multivariable adjusted risk ratios (RRs) were used to assess each endpoint. Risk of bias was assessed using the Newcastle-Ottawa scale. Results A total of 58 studies involving 16,989,237 participants fulfilled inclusion criteria. There was significant association of vasectomy with risk of any prostate cancer (risk ratio, 1.18, 95% CI, 1.07-1.31). Association between vasectomy and advanced prostate cancer (risk ratio, 1.06, 95% CI, 1.01-1.12), low-grade prostate cancer (risk ratio, 1.06, 95% CI, 1.02-1.10), and intermediate-grade prostate cancer (risk ratio, 1.12, 95% CI, 1.03-1.22) were significant. There was no significant association between vasectomy and prostate cancer-specific mortality (risk ratio, 1.01, 95% CI, 0.93-1.10). Conclusions This study found that vasectomy was associated with the risk of any prostate cancer and advanced prostate cancer. From the current evidence, patients should be fully informed of the risk of prostate cancer before vasectomy.

Objective:To disiuss the application of liver free technique in renal cell carcinoma patients with Mayo Ⅱ-Ⅳ tumor thrombus.Methods:The clinical data of renal cell carcinoma patients with MayoⅡ-Ⅳ IVC tumor thrombus in our hospital from January 2014 to December 2019 were retrospectively analyzed. 25 patients underwent right part of liver or hepatic portal part dissection via open abdominal approach. There were 20 males and 5 females, aged 45-74 years (mean 61±6 years). All patients underwent urinary tract CTU or MRU examination, vena cava enhanced magnetic resonance angiography.There were left 8 cases, right 17 cases; the median length of tumor was 7 cm (3.6-12.1 cm). There were 1 case of Mayo grade Ⅱ tumor thrombus, 7 cases of Mayo grade Ⅲ tumor thrombus, and 17 cases of Mayo grade Ⅳ tumor thrombus. There were 7 cases of distant metastasis, including 6 cases of lung metastasis and 1 case of bone metastasis. After multi-disciplinary consultation (MDT), 19 patients underwent radical nephrectomy and 6 patients underwent tumor reducing nephrectomy. During the operation, the ligaments around the liver were completely dissociated and the space between the liver and kidney was opened. The bare area of the liver was fully dissociated, to expose the inferior vena cava. For Mayo grade Ⅳ tumor thrombus, 11 cases were treated with free diaphragmatic thrombus removal without thoracotomy, and 6 cases were treated with open chest cardiopulmonary bypass.Results:The median operation time was 444(258-694)min, the median intraoperative blood loss was 2 000(250-10 000)ml, and the median value of suspended red blood cell transfusion was 1 300(400-10 400)ml. The median postoperative hospital stay was 10(4-25)days.15 patients (60%) had postoperative complications, including 8 cases of liver injury, 5 cases of respiratory complications, 4 cases of kidney injury, 3 cases of anemia, 3 cases of infection and 1 case of thrombosis. Three patients died during perioperative period.Conclusions:The application of total liver free technique might obtain good exposure of surgical field, effectively control the hemorrhage of inferior vena cava, which is helpful for safe resection of tumor.