To evaluate the feasibility and outcomes of membrane-guided total intracorporeal laparoscopic reconstruction for ureteral avulsion (UA) following ureteroscopic lithotripsy. From January 2021July 2025, eight patients with UA secondary to ureteroscopic lithotripsy underwent membrane-guided total intracorporeal laparoscopic reconstruction. Five patients were treated with the Boari flap technique (BFT), and three underwent ileal ureter replacement combined with Boari flap-psoas hitch (IURBFPH). Preoperative evaluations to assess the ureteral defects included anterograde urography and computed tomography urography (CTU). For all procedures, the membranes were considered during gastrointestinal mobilization and ureteral defect preparation. The postoperative follow-up examinations included urological ultrasound, CTU, and clinical symptom assessment. All eight reconstructions were successfully completed intracorporeally without conversion to open surgery. The median length of the UA was 6.50 cm (range: 3.00–18.00 cm). The mean operative time was 362.00 min (range: 240.00–515.00 min), with an estimated blood loss volume of 75.00 ml (range: 20.00–400.00 ml). The mean postoperative length of hospital stay was 12.88 days (range: 7.00–18.00 days). No serious complications or progressive hydronephrosis were observed during a mean follow-up of 9.39 months (range: 1.00–35.00 months), and the success rate was 100

ObjectiveTo investigate the feasibility and potential indications of laparoscopic ureteral anastomosis to a bladder diverticulum for the treatment of ureteral fistula in the setting of complex reoperative pelvic surgery.Case presentationA 75-year-old man with a 7-year history of progressive dysuria underwent transabdominal laparoscopic bladder diverticulectomy and cystolithotomy combined with transurethral holmium laser enucleation of the prostate for benign prostatic hyperplasia–related bladder outlet obstruction, bladder stones, and bladder diverticula. Twelve days after surgery, the patient developed increased pelvic drainage output. Elevated drainage-fluid creatinine levels and computed tomography urography showing contrast extravasation from the left ureter with hydronephrosis confirmed a left ureteral fistula. During reoperation, severe adhesions around the left ureter and bladder precluded conventional reconstruction. A bladder diverticulum adjacent to the distal ureter was therefore used as an alternative implantation site, and laparoscopic ureteral reimplantation into the diverticulum was performed. At 4 months of follow-up, no progression of hydronephrosis, recurrent urinary leakage, or urinary tract infection was observed.ConclusionIn selected patients with postoperative ureteral fistula, severe perivesical adhesions, and limited feasibility of conventional reconstruction during complex reoperative surgery, ureteral anastomosis to a bladder diverticulum may serve as an individualized salvage option for urinary tract reconstruction.

Background Patients with renal injury are at increased risk of exacerbating kidney damage from contrast-enhanced radiological examinations. Therefore, a noninvasive and sustainable method for assessing renal function without contrast agents is imperative. This study evaluates the effectiveness of intravoxel incoherent motion-derived parameters in assessing renal function, comparing them to findings from single-photon emission computed tomography in rat models. Materials and methods This study involved 2 groups of rats. The first group underwent scans and biopsies on days 0, 3, 7, 10, and 14 after obstruction, whereas the second group was subjected to unilateral ureteral obstruction on the same days. Rats in the second group were also scanned on days 7 and 14 after obstruction release, with histopathological analyses performed on day 14 after recanalization. Parameters measured included the apparent diffusion coefficient, pure molecular diffusion, pseudodiffusion, perfusion fraction, and glomerular filtration rate (GFR) using both intravoxel incoherent motion and single-photon emission computed tomography. Data from each time point were analyzed using 1-way analysis of variance for multiple groups, and Pearson correlation analysis was used to evaluate the relationships between these parameters and GFR. Results Glomerular filtration rate showed positive correlations with apparent diffusion coefficient and pure molecular diffusion ( p < 0.05). Additionally, cortical f demonstrated a significant positive correlation with GFR ( r = 0.841, p < 0.05). Conclusions Intravoxel incoherent motion effectively captures changes in GFR during renal obstruction and recanalization. Notably, cortical f proves to be a promising indicator for assessing GFR.

ObjectiveThis study aims to describe the preliminary single-center clinical experience with membrane anatomy-based 3D laparoscopic partial nephrectomy (LPN) performed in a single stage for selected patients with ruptured renal angiomyolipoma (RAML), and to assess its perioperative feasibility and short-term outcomes.MethodsA single-center retrospective descriptive design was employed to collect clinical data from 12 patients with ruptured renal angiomyolipoma who were treated between January 2020 and December 2025. All patients underwent 3D LPN via a transabdominal approach, with strict adherence to membrane anatomy principles during surgery.ResultsA total of 12 patients underwent 3D laparoscopic surgery for ruptured renal angiomyolipoma. All patients successfully completed the procedure without conversion to open surgery, and none required radical nephrectomy. The average surgical duration was 311.83 ± 85.46 minutes, with a mean warm ischemia time of 25.5 ± 11.02 minutes. Intraoperative blood loss averaged 327.00 ± 114.00 mL, and 83.33% of patients required intraoperative blood transfusions. Pain levels progressively decreased after surgery, with average VAS scores of 4.00 ± 1.00 at 24 hours and 3.20 ± 0.84 at 48 hours. Renal function markers showed transient fluctuations. The preoperative mean serum creatinine was 78.44 ± 23.97 μmol/L, which increased to 90.68 ± 28.07 μmol/L postoperatively, and then decreased to 85.55 ± 22.84 μmol/L at the 3-month follow-up. No tumor recurrence was observed during the postoperative follow-up period.ConclusionMembrane anatomy-based 3D LPN for selected ruptured RAML cases showed acceptable perioperative safety, renal function preservation, and postoperative recovery, but requires validation in larger prospective comparative studies.

Background Melanoma is an aggressive malignancy characterized by a highly immunosuppressive tumor microenvironment (TME), in which tumor-associated macrophages (TAMs) play a key role. Although oxymatrine (OMT) has been shown to exert anticancer effects, its mechanism of action in melanoma, particularly its interaction with Sorbin and SH3 Domain-Containing Protein 2 (SORBS2), remains poorly understood. Purpose To elucidate the molecular mechanisms by which oxymatrine inhibits melanoma growth and metastasis, suppresses M2-like macrophage polarization, and remodels the TME. Methods Cell viability, cell migration, and apoptosis assays were used to assess the effects of oxymatrine on melanoma cells. RNA sequencing (RNA-seq) was performed to identify oxymatrine’s potential target. The candidate target, SORBS2, was validated through molecular docking and surface plasmon resonance (SPR) to confirm its binding to oxymatrine. Western blotting and qRT-PCR were additionally used to measure SORBS2 expression for further validation. SORBS2-overexpressing or SORBS2-knockout cells and macrophage-melanoma co-culture systems were used to explore oxymatrine’s effects on M2-like TAM polarization. Results Oxymatrine inhibited melanoma proliferation and migration while inducing apoptosis. In vivo, oxymatrine suppressed tumor growth and metastasis. Mechanistically, oxymatrine upregulated SORBS2 expression, suppressed M2-like macrophage polarization, reduced the secretion of TGF-β and IL-10, and enhanced antitumor immunity. SORBS2 overexpression mimicked oxymatrine’s effects: it inhibited M2-like macrophage polarization and reduced TGF-β and IL-10 secretion, and thereby reshaped the immunosuppressive TME to enhance antitumor immunity. Conclusion These findings suggest that oxymatrine exerts anti-melanoma effects potentially by upregulating SORBS2, which in turn inhibits M2-like polarization and remodels the TME. This SORBS2-mediated mechanism provides a novel strategy for melanoma immunotherapy.

Background:Sepsis-associated acute kidney injury (S-AKI) is a frequent and severe complication of sepsis driven by systemic inflammation, oxidative stress, and vascular dysfunction, culminating in renal tubular injury and impaired excretory function. Ferroptosis, an iron-dependent form of regulated cell death characterized by lipid peroxidation and reactive oxygen species (ROS) accumulation, is increasingly recognized as a key mechanism in S-AKI. Protective factors such as glutathione peroxidase 4 (GPX4) and the cystine/glutamate antiporter (SLC7A11) suppress ferroptosis-mediated renal damage. This study aimed to evaluate whether coelenterazine (CTZ), a marine-derived antioxidant, inhibits ferroptosis to mitigate S-AKI and to elucidate its underlying molecular mechanism. Methods:We investigated the effects of CTZ on oxidative stress and ferroptosis in renal tubular epithelial cells and in the context of S-AKI by examining lipid peroxidation, intracellular glutathione (GSH) levels, and ROS accumulation. Mechanistic studies focused on the role of ubiquitin-specific protease 14 (USP14) and modulation of the nuclear receptor coactivator 4 (NCOA4) pathway, with attention to ferroptosis-related regulators including GPX4 and SLC7A11. Results:CTZ attenuated oxidative stress and inhibited ferroptosis in renal tubular epithelial cells by targeting USP14 and modulating the NCOA4 pathway. This intervention reduced lipid peroxidation, restored intracellular GSH levels, and decreased ROS accumulation. CTZ's ferroptosis-suppressive effects were associated with preservation of GPX4/SLC7A11-mediated antioxidant defenses, leading to amelioration of S-AKI progression. Conclusions:CTZ functions as a novel inhibitor of ferroptosis in S-AKI by targeting USP14 and regulating the NCOA4 pathway, thereby reducing lipid peroxidation, restoring GSH, and limiting ROS accumulation. These findings identify CTZ as a promising therapeutic candidate for S-AKI and underscore the broader potential of ferroptosis inhibition in sepsis-induced organ dysfunction.

The diagnostic rate of prostate cancer (PCa) remains suboptimal, particularly for patients whose serum prostate-specific antigen (PSA) concentration is less than 10 ng/mL. Single-cell sequencing, machine learning, and Mendelian randomization have emerged in recent years as excellent methods for identifying tumour markers. We identified 3 genes (RAB3B, SPON2, and SLC4A4) through single-cell sequencing and a machine learning screen. Among them, RAB3B (Ras-related protein, Rab-3B) had a higher area under the diagnostic curve for PSA < 10 ng/mL PCa (0.763) than the other two genes did. Mendelian randomization analysis revealed that the occurrence of PCa led to an increase in circulating levels of the RAB3B protein. Western blot and immunohistochemical analyses demonstrated that RAB3B was overexpressed in PCa tumour. Subsequently, elevated levels of RAB3B were detected in the culture medium of PCa cells. Furthermore, urinary RAB3B protein levels were significantly increased in PCa patients. For patients with PSA levels < 10 ng/mL, urinary RAB3B exhibited an area under the receiver operating characteristic curve (AUC) of 0.733 for PCa diagnosis, outperforming both PSA concentration (AUC = 0.682) and age (AUC = 0.651). Notably, the AUC of the multivariate model urine RAB3B + PSA + Age is 0.8. GSEA at al analysis and functional experiments, including gain-of-function and loss-of-function studies revealed that RAB3B promotes the proliferation and migration of PCa cells. In summary, urinary RAB3B, discovered through a multiomics approach, is a promising biomarker that is complementary to serum PSA, and together these factors can improve diagnostic decision-making in the PSA grey zone.

Objective: Bladder cancer (BCa) is considered as the most common malignancy in the urinary tract. However, effective clinical approach to BCa is still lack. There is an urgent to explore novel therapeutic targets and strategies for BCa. Here, collected human primary BCa samples and BCa cell lines were used to explore gene profiles. Methods: Ferroptosis of BCa cells was identified by determining lipid peroxides, iron ion concentration and malondialdehyde (MDA). RNA antisense purification (RAP) was utilized to demonstrate RNA-RNA interactions, while methylated RNA immunoprecipitation (MeRIP) was used to identify N-6-methyladenosine (m(6)A) modification. Results: Long non-coding RNA (lncRNA) solute carrier family 7 member 11 (SLC7A11) antisense RNA 1 (SLC7A11-AS1) is upregulated in BCa tissues (2.2 fold change, P < 0.01) and cell lines (1.5-4 fold change, P < 0.05). Additionally, SLC7A11-AS1 suppresses the ferroptosis of BCa cells both in vitro and in vivo as SLC7A11-AS1 silence significantly increases levels of ferroptosis markers (1.5-9 fold change, P < 0.05). Mechanistically, SLC7A11-AS1 increases SLC7A11 expression to hinder the ferroptosis. Besides, SLC7A11-AS1 associates with SLC7A11 mRNA to improve its stability. Moreover, IGF2BP1 mediates the interaction of SLC7A11-AS1 and SLC7A11 mRNA, while m(6)A modification promotes the interaction of SLC7A11-AS1 and IGF2BP1. Conclusion: lncRNA SLC7A11-AS1 suppresses the ferroptosis of bladder cancer cells through improving SLC7A11 mRNA stability by IGF2BP1 via m(6)A modification. These findings highlight the oncogenic role of SLC7A11-AS1 in BCa and identify potential targets for BCa treatment.

Treatment of advanced clear cell renal cell carcinoma (ccRCC) primarily involves targeted therapy and immunotherapy, however a number of patients develop treatment resistance. Identifying preferred biomarkers and immune-related therapeutic targets is clinically important for the effective treatment of metastatic ccRCC. Due to the unmet clinical need for novel therapeutic approaches, it is important to explore potential biomarkers and their roles in tumor progression. Although guanylate-binding protein 5 (GBP5) expression is notably upregulated in several cancers and promotes tumor progression, its role in ccRCC remains largely unknown. In the present study, GBP5 expression levels were compared between tumors and adjacent normal tissue using data from the Gene Expression Omnibus, Gene Expression Profiling Interactive Analysis 2 and Tumor Immune Estimation Resource (TIMER) databases. The relationship between GBP5 expression and clinicopathological features, along with its diagnostic and prognostic values, was evaluated using R software and the Kaplan-Meier plotter. Gene Ontology term analysis and gene set enrichment analysis were performed to explore the biological functions of GBP5. The GeneMANIA database was used to investigate the protein-protein interaction networks involving GBP5. The Tumor Immune Single-Cell Hub and TIMER databases were used to evaluate the immune infiltration landscape of ccRCC and the association between GBP5 and immune cell markers. In vitro, GBP5 levels were manipulated in renal cancer cells through silencing or overexpressing GBP5 using lentivirus transfection experiments. The migratory and invasive capabilities of the cells were evaluated using wound-healing and Transwell assays. The GBP5 levels in ccRCC tissues were found to be higher compared with those in adjacent tissues. GBP5 expression was associated with the tumor-lymph node-metastasis classification and pathological stage. Furthermore, elevated GBP5 level was associated with a poor prognosis and demonstrated promising diagnostic value. Bioinformatics analysis of GBP5 suggested its involvement in multiple biological processes and its notable association with tumor-infiltrating immune cells. Cellular experiments demonstrated that GBP5 regulates the migration and invasion of renal cancer cells. Overall, GBP5 shows potential as a prognostic indicator and a candidate target for immunotherapy in patients with ccRCC.

The discovery of diverse functions and mechanisms in cancer has underscored the significance of emerging non-coding RNAs (ncRNAs), such as PIWI-interacting RNAs (piRNAs) and circular RNAs (circRNAs), within the clinical context of cancer. Understanding their role in clear cell renal cell carcinoma (ccRCC) is imperative and necessitates comprehensive investigation. This study aims to further explore the diagnostic potential of piRNAs and circRNAs for ccRCC. The dysregulated piRNAs and circRNAs in ccRCC were identified using small RNA (sRNA) high-throughput sequencing technology, while their expression in clinical samples was assessed by RT-qPCR. A paired t-test was performed to compare the expression levels of piRNAs and circRNAs between ccRCC and adjacent tissues. Additionally, ROC curve analysis was conducted to evaluate the diagnostic specificity, sensitivity, and area under the curve (AUC) of piRNAs and circRNAs. High-throughput sequencing revealed a significant downregulation of 17 piRNAs and 694 circRNAs in ccRCC tissues, accompanied by a significant upregulation of 5 piRNAs and 490 circRNAs. RT-qPCR analysis demonstrated markedly lower expression levels of piR-has-150997, 133872, 132556, 154502, and uniq-84737 in the ccRCC group compared to the adjacent tissue group (p < 0.05). When considering the combined detection of piR-hsa-150997, piR-hsa-133872, piR-hsa-132556, piR-hsa-154502, uniq_84737, circABCC1, circNETO2_006, and circARID1B_037, the diagnostic AUC for ccRCC was found to be high at an approximate value of AUC = 0.878. The diagnostic performance of piR-has-150997, 133872, 132556, 154502, uniq-84737, circABCC1, circNETO2_006, and circARID1B_037 demonstrates promise for ccRCC. A model incorporating piR-hsa-150997, uniq_84737, circABCC1, circNETO2_006, and circARID1B_037 could serve as an ideal diagnostic marker system with significant clinical utility.

Acute renal artery embolism (ARAE) is a rare vascular event that precipitates renal infarction (RI) caused by abrupt disruption of renal artery blood flow. RI is frequently misdiagnosed or diagnosed late because of its rarity and frequently ambiguous clinical presentation, potentially leading to irreversible harm to the renal parenchyma or an increased risk of other embolic events affecting other organs. Risk factors for ARAEs include atrial fibrillation, valvular or ischemic heart disease, renal artery embolism/dissection, and coagulopathy, and complete unilateral renal artery embolism is rare. We present the case of one patient with unilateral ARAE caused by atrial fibrillation. We performed percutaneous endovascular therapy (PET) for the renal artery embolism, including catheter-directed thrombolysis (CDT) and aspiration thrombectomy with systemic anticoagulant therapy. At the one-year follow-up, severe atrophy of the affected kidney and compensatory enlargement of the contralateral kidney were observed. We found that procedurally successful revascularization does not necessarily translate to functional recovery of the renal parenchyma. To accurately assess long-term renal functional restoration, we propose incorporating post-thrombectomy anatomical evaluations (e.g., via renal artery angiography or CT angiography [CTA]) combined with functional renal scintigraphy into standardized clinical protocols. This multimodal approach would not only validate the angiographic outcomes but also provide critical insights into the viability of the parenchyma, thereby guiding the development of patient-specific therapeutic strategies. Recommendations for optimal treatment for renal artery embolism are needed. Therefore, we share this case with the aim of providing valuable information for the treatment of renal infarction.

Although cigarette smoke is a recognized risk factor for prostate cancer (PCa), the specific contribution of benzo[a]pyrene (BaP), one of its major carcinogenic constituents, remains poorly understood. To elucidate the pathogenic mechanisms of BaP in PCa, this study integrated diverse methodologies, including network toxicology, single-cell transcriptomics, differential gene expression analysis, molecular docking, Mendelian randomization (MR), and bibliometrics. Two hundred thirty-two overlapping genes were identified between BaP targets and PCa-related genes. Hub genes TP53, EGFR, SRC, HSP90AA1, and INS were enriched in MAPK and PI3K-Akt pathways. Molecular docking confirmed strong BaP binding to these proteins. Single-cell transcriptomics revealed cell-type–specific expression patterns, while ROC (TP53 AUC = 0.67) and MR analyses (TP53 p = 2.66 × 10⁻⁶) supported their diagnostic and causal relevance. TP53 showed notable expression variability linked to Gleason scores. Bibliometric analysis highlighted TP53’s evolving research significance in PCa, particularly in resistance and personalized therapy. BaP may drive PCa progression by disrupting oncogenic pathways via core targets, notably TP53, EGFR, and HSP90AA1. TP53 may act as a protective factor associated with tumor aggressiveness. These findings offer mechanistic insights into BaP-related PCa etiology and suggest potential biomarkers for diagnosis and therapy.

High-fructose and high-fat diet (HFHFD) has been associated with impaired spermatogenesis, leading to decreased sperm quality and increased male infertility, with similar effects observed in offspring. Cyanidin-3-O-glucoside (C3G), a recognized food antioxidant, has shown promise in protecting in male reproduction and modulating epigenetic modifications. However, its potential role in ameliorating intergenerational inheritance induced by HFHFD remains underexplored. In this study, we investigated the effects of paternal HFHFD on reproductive injury of offspring and the protective effect of C3G. Paternal mice were subjected to 12 weeks of HFHFD induction and C3G treatment was conducted for 8 weeks. Offspring obtained via in vitro fertilization were fed either a normal diet (ND) or high-fat diet (HFD). Our findings indicate that while the paternal HFHFD did not result in observable reproductive impairments in paternal mice, it did affect offspring testicular function through intergenerational inheritance, rendering them more susceptible to testicular damage and reduced sperm counts when exposed to an HFD. Notably, C3G intervention significantly mitigated these effects, suggesting its potential as a therapeutic compound for alleviating the impact of paternal intergenerational inheritance on male fertility resulting from HFHFD. These results underscore the importance of further exploring the mechanisms underlying intergenerational inheritance and the potential of interventions such as C3G in mitigating its effects, with implications for both basic research and clinical practice.

The reversible unilateral ureteral obstruction (RUUO) model is pivotal for studying obstructive nephropathy (ON) but has limitations, including procedure complexity and inconsistent recanalization success. We developed a simpler, reliable, and efficient RUUO model, and utilized advanced auxiliary examination methods to assess hydronephrosis and renal function changes, providing evidence for procedural success. Male Sprague–Dawley rats were divided into control and experimental groups. Baseline data on glomerular filtration rate (GFR) and magnetic resonance imaging (MRI) were obtained from the control group. The experimental group was subdivided based on obstruction durations of 3, 7, 10, and 14 days. Unilateral ureteral obstruction models were created followed by obstruction release to establish the RUUO models. Dynamic renal scintigraphy with single-photon emission computed tomography was used to measure left kidney GFR pre-recanalization and on day 7 and 14 post-recanalization. MRI was used to evaluate hydronephrosis resolution. Key surgical modifications included complete removal of ligated ureter segments and wider ureter–bladder anastomosis, improving consistency and 93.35% recanalization success rate. MRI and 99mTc-DTPA dynamic renal scintigraphy indicated varying degrees of renal functional recovery. The 3-day obstruction group showed near-complete restoration within 1 week of recanalization. Conversely, extended obstruction durations significantly impaired recovery. The 14-day group demonstrated marked functional decline due to progressive renal fibrosis observed at 2 weeks post-recanalization. The optimized model offers simplified surgical techniques, enhanced recanalization success, and high reproducibility. These findings highlight the importance of early recanalization in preserving renal function, and provide a robust framework for future research on ON, including therapeutic strategies.

Abstract Purpose The aim of this study was to present our initial experience and prove the feasibility of total intracorporeal laparoscopic ileal ureter replacement (TILIUR) in a single position for ureteral stricture based on membrane anatomy. Materials and methods Between January 2021 and April 2023, six patients underwent TILIUR in a single position for ureteral strictures based on membrane anatomy. All patients with a past medical history underwent radical hysterectomy with bilateral pelvic lymph node dissection as well as extensive ureteral stricture due to radiotherapy. The procedure is performed completely laparoscopically. Dissection of the digestive system as well as ureteral stricture or renal pelvis is based on membrane anatomy. The surgery is performed in a single position. Results TILIUR in a single position for ureteral stricture based on membrane anatomy was successfully performed without open conversion in all patients. Among the 6 patients, 3 patients underwent combined ileal ureter replacement (IUR) and abdominal wall ostomy, 2 underwent unilateral IUR, and 1 underwent bilateral IUR. The mean length of the ileal substitution was 22.83 cm (range: 15–28). The average operative time was 458 ± 72.77 min (range 385–575 min), and the average intraoperative blood loss was 158 mL (range 50–400 mL). The median postoperative hospital stay was 15.1 d (range: 8–32). The median duration of postoperative follow-up was 15 months (range: 3–29 months). The success rate was 100%. Conclusions TILIUR in a single position may be a promising option for ureteral stricture based on membrane anatomy in selected patients. Moreover, it has a positive effect on patients with renal insufficiency and urinary incontinence. Although IUR is difficult and risky, proficient surgeons can perform the procedure safely and effectively.

Hematopoietic stem and progenitor cells (HSPCs) could be differentiated into mature myeloid and lymphoid cells, maintaining the requirements of immune cells. Atherosclerosis and ulcerative colitis (UC) drive HSPC homeostasis destruction, which triggers expansive HSPC proliferation and Ly6Chi monocyte production, contributing to aggravated inflammation. Vitisin A belongs to the anthocyanin derivatives with excellent stability and bioactivity in vitro. However, there is no report about the anti-inflammation of Vitisin A via reprogramming HSPC differentiation toward monocytes. In this study, we found that Vitisin A presents anti-inflammatory ability during the development of atherosclerosis and UC by depressing Ly6Chi monocyte production from bone marrow. This performance depended on restricted HSPC differentiation, which suggested that Vitisin A participated in monocyte generation and carried out the immunomodulation. Together, Vitisin A ameliorates inflammation during atherosclerosis and UC via the suppressed differentiation of HSPCs toward monocytes, which could be considered an ideal functional component with immunomodulatory effects.

Objective:To investigate the strategy, technique and short-term efficacy of partial clamping of the suprahepatic inferior vena cava (IVC) and aspiration of thrombus without median sternotomy and cardiopulmonary bypass under total 3D laparoscopy, combination with left radical nephrectomy in the treatment of left renal cell carcinoma with level Ⅳ IVC thrombus.Methods:The data of 54-year-old male patient in the First Affiliated Hospital of Jinan University with left renal tumor and level Ⅳ IVC thrombus was collected, the upper border of the thrombus of the patient reaching to the entrance of the right atrium (Mayo Ⅳ). Left renal artery embolization was performed one day before operation. On the day of operation, after the preparation for cardiopulmonary bypass, the patient was placed in the 70° right lateral decubitus supine position, clamped the suprahepatic IVC partially and extracted the thrombus successfully under Storz 3D laparoscopy. The whole process of extracting thrombus was monitored by transesophageal ultrasound. Then the posture was changed to 70° left lateral decubitus supine position for radical left nephrectomy and left retroperitoneal lymphatic dissection.Results:The operation was completed successfully with an operative time of 530 min, the intraoperative blood loss was 450 ml.The patient recovered smoothly and was discharged one week later. In addition, the patients received anticoagulation for three months and adjuvant targeted therapy. Imaging examination showed that there was no tumor recurrence in the thirteen months follow-up.Conclusions:The method of complete laparoscopic partial blockade of the inferior hepatic vena cava and thrombus aspiration without extracorporeal circulation and open chest is minimally invasive and feasible for some of the level Ⅳ IVC thrombus which are small and free. It could reduce the possible complications caused by open chest and extracorporeal bypass and help patients recover quickly, but more cases and longer-term follow-up are needed to confirm its efficacy.

Testicular hyperthermia induced by unhealthy living habits and pathological or occupational factors can cause spermatogenic dysfunction with an outcome of sub-fertility or even infertility. Cyanidin-3-O-glucoside (C3G) is the most typical anthocyanin in foods that has been recognized as an antioxidant with promising protection for male reproduction. However, its specific effect against testicular hyperthermia and the mechanisms involving its primary gastrointestinal metabolite protocatechuic acid (PCA) are still unexplored. In the present study, testicular hyperthermia in mice was established by employing a single hot water bath at 43 °C for 30 min. C3G and PCA were intragastrically given to investigate their prevention ability against heat stress-induced testicular damage. It was found that C3G and PCA restored the external diameter and thickness, and alleviated atrophy and vacuolation of seminiferous tubules. Simultaneously, C3G and PCA enhanced testicular heat stress tolerance through reducing superfluous eIF2α phosphorylation and stress granule formation. C3G and PCA effectively improved the testicular antioxidant system and regulated the IRE1α-XBP1 pathway, contributing to mitigatory spermatogenesis dysfunction and testicular damage. This finding revealed that anthocyanins were the novel compounds for alleviating testicular damage, and provided a reliable theoretical basis for improving male fertility disturbed by heat stress.

Cadmium (Cd) exposure damages the reproductive system. Lipid droplets (LDs) play an important role in steroid-producing cells to provide raw material for steroid hormone. We have found that the LDs of Leydig cells exposed to Cd are bigger than those of normal cells, but the effects on steroidogenesis and its underlying mechanism remains unclear. Using Isobaric tag for relative and absolute quantitation (iTARQ) proteomics, phosphodiesterase beta-2 (PLCβ2) was identified as the most significantly up-regulated protein in immature Leydig cells (ILCs) and adult Leydig cells (ALCs) derived from male rats exposed to maternal Cd. Consistent with high expression of PLCβ2, the size of LDs was increased in Leydig cells exposed to Cd, accompanied by reduction in cholesterol and progesterone (P4) levels. However, the high PLCβ2 did not result in high diacylglycerol (DAG) level, because Cd exposure up-regulated diacylglycerol kinases ε (DGKε) to promote the conversion from DAG to phosphatidic acid (PA). Exogenous PA, which was consistent with the intracellular PA concentration induced by Cd, facilitated the formation of large LDs in R2C cells, followed by reduced P4 level in the culture medium. When PLCβ2 expression was knocked down, the increased DGKε caused by Cd was reversed, and then the PA level was decreased to normal. As results, large LDs returned to normal size, and the level of total cholesterol was improved to restore steroidogenesis. The accumulation of PA regulated by PLCβ2-DAG-DGKε signal pathway is responsible for the formation of large LDs and insufficient steroid hormone synthesis in Leydig cells exposed to Cd. These data highlight that LD is an important target organelle for Cd-induced steroid hormone deficiency in males.

A 47-year-old man presented to the emergency department with right abdominal pain and a new onset of painless haematuria two weeks earlier. Urine cytology test results suggested urothelial carcinoma. Computed tomography urography (CTU) showed a filling defect in the lower right ureter with right hydronephrosis. Lymphadenopathy and any signs of metastatic disease were absent on CTU. Cystoscopy appeared normal. Creatinine level was also normal before surgery. After the treatment options were discussed, the patient chose to undergo 3D total intracorporeal laparoscopic kidney autotransplantation, bladder cuff excision, and segmental resection of the proximal two-thirds of the ureter based on the membrane anatomy concept. After more than one year of follow-up, the patient was in good health and showed no signs of haematuria. Surveillance cystoscopy and CTU examination showed no evidence of disease recurrence. Therefore, it is reasonable to assume that kidney-sparing surgery may be considered for carefully selected patients with high-grade upper tract urothelial carcinoma.