Purpose: Retrospective studies have explored the association between computed tomography (CT)-derived secondary signs and renal pelvic urine density (RPUD) with postoperative infection after ureteroscopic lithotripsy (URSL). This study evaluated the prognostic value of these indicators in chronic kidney disease (CKD) patients. Material and methods: Clinical data of patients undergoing URSL for ureteral calculi at two tertiary hospitals from June 2015 to June 2025 were retrospectively collected. Patients were categorized into infection and non-infection groups. Baseline demographics, stone characteristics, RPUD, perinephric fat stranding (PFS), tissue rim sign (TRS), CKD history, and intraoperative variables were compared. Independent predictors were identified via multivariate logistic regression, and a nomogram was constructed. Results: Postoperative infection occurred in 102 patients (12.6%). The infection group had significantly higher rates of positive preoperative urine culture, diabetes, larger stone diameter, longer operation time, advanced CKD stage, elevated RPUD, and increased incidence of PFS and TRS (all p < 0.05). Multivariate analysis confirmed these variables as independent risk factors. The nomogram demonstrated strong discrimination (C-index = 0.932). Conclusions: Elevated RPUD combined with positive CT secondary signs (PFS and TRS) is significantly associated with postoperative infection risk in CKD patients undergoing URSL. These easily obtainable non-contrast computed tomography-derived markers offer a novel and practical approach for preoperative risk stratification, enabling individualized preventive strategies and surgical optimization in this high-risk population.

Therapy resistance in prostate cancer arises from coordinated remodeling of malignant and stromal compartments, yet the mechanisms orchestrating this ecosystem adaptation remain elusive. Here, single-cell RNA sequencing of longitudinal biopsies obtained before and after androgen-deprivation therapy (ADT) delineated a therapy-induced stromal lineage bifurcation toward APOD+ and DPT+ fibroblast states. DPT+ fibroblasts activated a C3-ITGAX/ITGB2 complement signaling axis targeting macrophages, coinciding with suppression of M1 inflammatory programs, amplification of immune-checkpoint signaling, and a shift of CD8+ T cells from cytotoxic to exhausted phenotypes. Concomitantly, we identified pre-existing malignant epithelial subpopulations characterized by reduced AR/KLK3 activity and heightened chromosomal instability that preferentially persisted following therapy. Integrative multi-omic analyses nominated TSPAN1 as a functional effector of castrate resistant prostate cancer (CRPC) and NRXN1 as a regulator of neuroendocrine plasticity through calcium-dependent signaling programs. Genetic silencing of either gene suppressed proliferation, clonogenicity, migration, and tumor growth, while attenuating neuroendocrine features in vitro and in vivo. Spatial mapping, functional perturbation, and stromal-epithelial co-culture experiments mechanistically established a therapy-induced DPT+ fibroblast-complement circuit that enforced immune evasion and channels epithelial trajectories toward CRPC or neuroendocrine prostate cancer. Collectively, these findings defined the DPT+-complement-macrophage axis as an actionable vulnerability and position TSPAN1 and NRXN1 as therapeutic entry points to disrupt ADT-driven tumor ecosystem remodeling in prostate cancer.

Double J (DJ) stent encrustation is a common postoperative complication that can lead to severe infection, obstruction, or stent retention. Existing predictive models primarily focus on indwelling time and urinary pH but have largely excluded patients with chronic kidney disease (CKD), limiting their applicability. This multicenter study aimed to develop and externally validate a nomogram for individualized prediction of DJ stent encrustation, incorporating renal function status for the first time. A total of 760 patients who underwent upper urinary tract stone surgery with postoperative DJ stent placement were retrospectively analyzed. Clinical, biochemical, and behavioral variables were evaluated. Multivariate logistic regression identified independent predictors, which were used to construct a predictive nomogram. External validation was performed using an independent cohort of 337 patients from another tertiary hospital. Model discrimination, calibration, and clinical benefit were assessed by receiver operating characteristic (ROC) curve analysis, bootstrap calibration, and decision curve analysis (DCA). Stent encrustation occurred in 121 patients (15.9

Percutaneous nephrolithotomy (PCNL) is the standard treatment for large or complex renal calculi; however, postoperative hemorrhage requiring selective renal arterial embolization (SRAE) remains a rare but serious complication. Chronic kidney disease (CKD) may further increase bleeding risk, but predictive models for SRAE in this population are lacking. To develop and validate a nomogram for predicting the need for SRAE in patients with CKD who experience hemorrhage after PCNL. This retrospective cohort study included 3153 patients who underwent PCNL in two tertiary hospitals between June 2010 and June 2025. Of these, 986 had CKD. A total of 331 patients with post-PCNL hemorrhage and CKD were analyzed, including 299 who received conservative management and 32 who underwent SRAE. Clinical variables were compared between groups, and independent risk factors were identified using multivariate logistic regression. A nomogram was developed from the significant predictors and validated using receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA). Among 331 patients with post-PCNL hemorrhage and CKD, 32 (9.7

To compare renal function outcomes between asymptomatic and symptomatic ureteral stones and to develop and validate a predictive nomogram for postoperative renal recovery after ureteroscopic lithotripsy (URSL). This two-center retrospective study included consecutive patients who underwent URSL between March 2018 and March 2023. Patients were categorized into asymptomatic and symptomatic groups. Renal function recovery was defined as a postoperative glomerular filtration rate (GFR) of the affected kidney exceeding 90

This study investigated the relationship between Life's Essential 8 (LE8), a recently updated measure of cardiovascular health, and the prevalence of gout among adults in the United States. This study analyzed National Health and Nutrition Examination Survey 2005 to 2018 data using logistic regression to examine the association between LE8 scores and gout risk. The models were adjusted for several factors. Sensitivity, quartile, and subgroup analyses were conducted using the R software. In the National Health and Nutrition Examination Survey 2005 to 2018 study (n = 14,813), 4.83% of patients with gout were older (62.67 vs 49.02 years), predominantly male (68.58% vs 46.72%), and had a higher prevalence among non-Hispanic Blacks (25.28%) and Whites (46.65%). They also had higher cardiovascular disease rates (32.40% vs 9.92%) and lower LE8 scores (58.28 vs 67.06) than those without. A significant inverse association was observed between LE8 scores and gout risk. In the fully-adjusted models, the medium (50-79) and high (80-100) LE8 score groups showed reduced gout risk (odds ratio [OR] = 0.61 and 0.42, respectively) compared to the low-score group (0-49). Each 10-point LE8 increase corresponded to a 21% reduction in gout risk. Subgroup analysis revealed that higher LE8 scores were associated with reduced gout risk in both sexes (women: OR = 0.75, men: OR = 0.80) and age groups 40 to 59 (OR = 0.85), and 60+ years (OR = 0.81). A dose-response relationship was observed, with the highest LE8 score quartile showing a 54% reduced risk of gout compared with the lowest quartile. A negative nonlinear association was observed between the LE8 scores and gout prevalence. Encouraging adherence to optimal cardiovascular health metrics may help reduce the burden of gout.

Objective This study aims to establish a CT-based clinical deep learning radiomics (CDLR) model for preoperative prediction of pyelocaliceal Upper Tract Urothelial Carcinoma (UTUC) and xanthogranulomatous pyelonephritis (XGP), providing scientific guidance for personalized treatment. Methods A retrospective analysis was conducted on 161 post-operative pathology-confirmed cases of pyelocaliceal UTUC and XGP patients, divided into training cohort (n = 112) and validation cohort (n = 49). Radiomics (Rad) and deep learning (LR) features were extracted from three-phase CT images, combined with clinical features, and after feature selection, a logistic regression (LR) classifier was used to construct clinical, radiomics (Rad), deep learning (LR), deep learning radiomics (DLR), and clinical deep learning radiomics (CDLR) models. The top-performing model was chosen utilizing receiver operating characteristic (ROC) curve analysis. Decision curve analysis (DCA) was used to evaluate the model's practicality. Results The evaluation of clinical, Rad, LR, DLR, and CDLR models revealed that the CDLR model exhibited superior diagnostic performance. The area under the receiver operating characteristic curve (AUC) of the CDLR model in the training and validation cohorts were 0.984 and 0.970, respectively, outperforming other models (clinical model, Rad model, DL model, DLR model). DCA results showed that the CDLR model provided a higher net benefit in preoperative prediction. Conclusion The CDLR model, combining clinical, Rad, and LR features, could serve as a non-invasive tool for differentiating pyelocaliceal UTUC and XGP, offering valuable guidance for clinical treatment.

We aimed to develop a comprehensive predictive model for spontaneous stone passage (SSP) by integrating parameters from urinary ultrasound, non-contrast computed tomography (NCCT), and clinical markers. This retrospective cohort study included 303 patients with unilateral solitary ureteral stones (≤10 mm) who underwent both ultrasound and NCCT before conservative management between July 2023 and July 2025. Demographic, clinical, ultrasound, and NCCT parameters were recorded. Patients were followed for one month to assess SSP (NCCT-confirmed expulsion) versus failure. Univariate and multivariable logistic regression analyses were performed, and model performance was evaluated using receiver operating characteristic (ROC) curves, calibration analysis, and decision curve analysis (DCA). Of the 303 patients, 191 achieved SSP and 112 failed. Independent predictors of SSP included stone location (middle/lower vs. upper ureter), smaller transverse stone diameter, thinner ureteral wall thickness (UWT), higher ureteral jet frequency (UJF), and greater stone-side ureteral jet velocity (all p < 0.05). The integrated model achieved an AUC of 0.829, outperforming NCCT (0.694) and ultrasound (0.774). Calibration and decision curve analyses (DCA) confirmed good agreement and clinical utility. Combining ultrasound and NCCT parameters significantly improved prediction of SSP compared with single-modality approaches. This model enables individualized risk stratification, supporting clinical decision-making to reduce unnecessary interventions and optimize outcomes.

Objective To develop an ultrasound-driven clinical deep learning radiomics (CDLR) model for stratifying the risk of testicular masses, aiming to guide individualized treatment and minimize unnecessary procedures. Methods We retrospectively analyzed 275 patients with confirmed testicular lesions (January 2018 to April 2023) from two hospitals, split into training (158 cases), validation (68 cases), and external test cohorts (49 cases). Radiomics and deep learning (DL) features were extracted from preoperative ultrasound images. Following feature selection, we utilized logistic regression (LR) to establish a deep learning radiomics (DLR) model and subsequently derived its signature. Clinical data underwent univariate and multivariate LR analyses, forming the "clinic signature." By integrating the DLR and clinic signatures using multivariable LR, we formulated the CDLR nomogram for testicular mass risk stratification. The model’s efficacy was gauged using the area under the receiver operating characteristic curve (AUC), while its clinical utility was appraised with decision curve analysis(DCA). Additionally, we compared these models with two radiologists' assessments (5–8 years of practice). Results The CDLR nomogram showcased exceptional precision in distinguishing testicular tumors from non-tumorous lesions, registering AUCs of 0.909 (internal validation) and 0.835 (external validation). It also excelled in discerning malignant from benign testicular masses, posting AUCs of 0.851 (internal validation) and 0.834 (external validation). Notably, CDLR surpassed the clinical model, standalone DLR, and the evaluations of the two radiologists. Conclusion The CDLR nomogram offers a reliable tool for differentiating risks associated with testicular masses. It augments radiological diagnoses, facilitates personalized treatment approaches, and curtails unwarranted medical procedures.

Background: Differentiating seminomas from nonseminomas is crucial for formulating optimal treatment strategies for testicular germ cell tumors (TGCTs). Therefore, our study aimed to develop and validate a clinicalradiomics model for this purpose. Methods: In this study, 221 patients with TGCTs confirmed by pathology from four hospitals were enrolled and classified into training (n = 126), internal validation (n = 55) and external test (n = 40) cohorts. Radiomics features were extracted from the CT images. After feature selection, we constructed a clinical model, radiomics models and clinical-radiomics model with different machine learning algorithms. The top-performing model was chosen utilizing receiver operating characteristic (ROC) curve analysis. Decision curve analysis (DCA) was also conducted to assess its practical utility. Results: Compared with those of the clinical and radiomics models, the clinical-radiomics model demonstrated the highest discriminatory ability, with AUCs of 0.918 (95 % CI: 0.870 - 0.966), 0.909 (95 % CI: 0.829 - 0.988) and 0.839 (95 % CI: 0.709 - 0.968) in the training, validation and test cohorts, respectively. Moreover, DCA confirmed that the combined model had a greater net benefit in predicting seminomas and nonseminomas. Conclusion: The clinical-radiomics model serves as a potential tool for noninvasive differentiation between testicular seminomas and nonseminomas, offering valuable guidance for clinical treatment.

The objective of this study was to explore the role of ferroptosis in the formation of calcium oxalate (CaOx) kidney stones and the regulatory mechanism of the ankyrin repeat domain 1 (ANKRD1) gene. The study found that the Nrf2/HO-1 and p53/SLC7A11 signaling pathways were activated in the kidney stone model group, and the expression of the ferroptosis marker proteins SLC7A11 and GPX4 was significantly reduced, while the expression of ACSL4 was significantly increased. The expression of the iron transport-related proteins CP and TF increased significantly, and Fe2+ accumulated in the cell. The expression of HMGB1 increased significantly. In addition, the level of intracellular oxidative stress was increased. The gene with the most significant difference caused by CaOx crystals in HK-2 cells was ANKRD1. Silencing or overexpression of ANKRD1 by lentiviral infection technology regulated the expression of the p53/SLC7A11 signaling pathway, which regulated the ferroptosis induced by CaOx crystals. In conclusion, CaOx crystals can mediate ferroptosis through the Nrf2/HO-1 and p53/SLC7A11 pathways, thereby weakening the resistance of HK-2 cells to oxidative stress and other unfavorable factors, enhancing cell damage, and increasing crystal adhesion and CaOx crystal deposition in the kidney. ANKRD1 participates in the formation and development of CaOx kidney stones by activating ferroptosis mediated by the p53/SLC7A11 pathway.

Objective:To investigate the effect of L-carnitine on calcium oxalate-induced ferroptosis in renal tubular epithelial cells (HK-2).Methods:The effects of calcium oxalate(0, 2, 4 and 8 mmol/L) on the expression of ferroptosis-related protein long chain fatty acyl-CoA synthetase 4 (ACSL4), cystine/glutamate transporter(XCT) and glutathione peroxidase 4 (GPX4) in HK-2 cells were detected by Western blotting. The experiment was then divided into four groups: ①control group, cells were cultured in normal medium for 12 hours, then continued to use normal medium; ②L-carnitine group, cells were pretreated with medium containing 5mmol/L L-carnitine for 12 hours, then changed to medium containing 5mmol/L L-carnitine; ③calcium oxalate group, cells were cultured in normal medium for 12 hours, and then replaced with medium containing 4 mmol/L calcium oxalate; ④calcium oxalate+ L-carnitine group, the cells were pretreated with medium containing 5mmol/L L-carnitine for 12 h, and then replaced with 5mmol/L L-carnitine and 4mmol/L calcium oxalate medium. After changing the culture medium for 24 hours, the cells or supernatants were collected, and the expression levels of ferroptosis-related protein quinone oxidoreductase (NQO1), ACSL4, XCT and GPX4 were detected by Western blotting. The levels of superoxide dismutase (SOD), glutathione (GSH) and malondialdehyde were detected by corresponding kit, and the level of reactive oxygen species in cells was detected by reactive oxygen species kit.Results:The results of Western blotting showed that the expression of ACSL4 protein in 0, 2, 4, 8 mmol/L calcium oxalate was 0.37±0.16, 0.68±0.16, 0.73±0.09, 0.89±0.03 respectively. The expression of XCT protein was 1.11±0.10, 0.91±0.14, 0.83±0.09, 0.80±0.07, respectively. The expression of GPX4 protein was 1.23±0.13, 0.99±0.17, 0.81±0.05, 0.72±0.06, respectively. Compared with 0mmol/L group, the expression of ACSL4 protein increased and the expression of XCT and GPX4 decreased in 2, 4 and 8 mmol/L groups, and the difference was more significant between 4 mmol/L group and 0 mmol/L group. So 4 mmol/L was taken as the optimal concentration for follow-up experiment. The levels of NQO1 in control group, L-carnitine group, calcium oxalate group and calcium oxalate+ L-carnitine group were (0.36±0.06, 0.54±0.05, 0.76±0.07, 0.90±0.03) respectively. There was significant difference between L-carnitine group and control group ( P<0.05). There was significant difference between calcium oxalate group and control group ( P<0.05). There was significant difference between calcium oxalate group and control group ( P<0.01). There was significant difference between calcium oxalate + L-carnitine group and calcium oxalate group ( P<0.05). The levels of ACSL4 in control group, L-carnitine group, calcium oxalate group and calcium oxalate + L-carnitine group were (0.66±0.10, 0.58±0.08, 0.99±0.03, 0.77±0.09) respectively. There was no significant difference between L-carnitine group and control group(P>0.05). There was significant difference between calcium oxalate group and control group ( P<0.01). There was significant difference between calcium oxalate + L-carnitine group and calcium oxalate group ( P<0.05). The levels of XCT in control group, L-carnitine group, calcium oxalate group and calcium oxalate + L-carnitine group were (0.93±0.08, 0.85±0.07, 0.76±0.06, 0.99±0.05). There was no significant difference between L-carnitine group and control group (P>0.05). There was significant difference between calcium oxalate group and control group ( P<0.01). There was significant difference between calcium oxalate + L-carnitine group and calcium oxalate group ( P<0.05). The levels of GPX4 in control group, L-carnitine group, calcium oxalate group and calcium oxalate + L-carnitine group were (1.10±0.09, 1.09±0.09, 0.85±0.03, 0.99±0.02) respectively. There was no significant difference between L-carnitine group and control group( P>0.05). There was significant difference between calcium oxalate group and control group ( P<0.01). There was significant difference between calcium oxalate + L-carnitine group and calcium oxalate group ( P<0.05). The levels of LDH in control group, L-carnitine group, calcium oxalate group and calcium oxalate + L-carnitine were (100.00±5.37)%, (99.50±6.38)%, (153.77±6.06)% and (132.50±5.58)%, respectively. There was no significant difference between L-carnitine group and control group( P>0.05). There was significant difference between calcium oxalate group and control group ( P<0.01). There was significant difference between calcium oxalate + L-carnitine group and calcium oxalate group ( P<0.05). The SOD levels in control group, L-carnitine group, calcium oxalate group and calcium oxalate + L-carnitine group were (100.00±5.79)%, (105.80±3.26)%, (44.74±7.60)% and (85.01±5.15)%, respectively. There was no significant difference between L-carnitine group and control group( P>0.05). There was significant difference between calcium oxalate group and control group ( P<0.01). There was significant difference between calcium oxalate + L-carnitine group and calcium oxalate group ( P<0.05). The levels of GSH in control group, L-carnitine group, calcium oxalate group and calcium oxalate + L-carnitine group were (100.00±4.73)%, (107.10±5.48)%, (53.49±3.98)% and (85.18±5.48)%, respectively. There was no significant difference between L-carnitine group and control group( P>0.01). There was significant difference between calcium oxalate group and control group ( P<0.01). There was significant difference between calcium oxalate + L-carnitine group and calcium oxalate group ( P<0.01). The levels of MDA in control group, L-carnitine group, calcium oxalate group and calcium oxalate + L-carnitine group were (100.00±2.36)%, (98.00±11.10)%, (129.11±2.59)% and (113.35±5.79)%, respectively. There was no significant difference between L-carnitine group and control group( P>0.05). There was significant difference between calcium oxalate group and control group ( P<0.01). There was significant difference between calcium oxalate + L-carnitine group and calcium oxalate group ( P<0.01). The fluorescence intensity of ferrous ion in control group, calcium oxalate group and calcium oxalate + L-carnitine group was (39.77±0.68) AU, (68.40±3.14) AU and (48.60±4.30) AU, respectively. There was significant difference between calcium oxalate group and control group ( P<0.01). There was significant difference between calcium oxalate + L-carnitine group and calcium oxalate group ( P<0.05). The fluorescence intensity of reactive oxygen species in control group, calcium oxalate group and calcium oxalate + L-carnitine group was (63.98±9.41) AU, (145.41±8.39) AU and (85.37±4.51) AU, respectively. There was significant difference between calcium oxalate group and control group ( P<0.01). There was significant difference between calcium oxalate + L-carnitine group and calcium oxalate group ( P<0.01). Transmission electron microscopy results showed that mitochondria were wrinkled, cristae were broken or disappeared in the calcium oxalate group compared to the control group, and a double-layer membrane structure was evident. DAPI staining showed that compared with the control group, some of the nuclei in the calcium oxalate group were significantly more damaged, while compared with the calcium oxalate group, the nuclei in the calcium oxalate + L-carnitine were significantly less damaged. The results of crystal adhesion test showed that compared with the control group, calcium oxalate crystals in the calcium oxalate group adhered to the cells in black-like particles and formed clusters. Compared with the calcium oxalate group, the calcium oxalate + L-carnitine showed less black particles adhering to the cells. Conclusions:L-carnitine may reduce the effects of oxidative stress and ferroptosis induced by calcium oxalate, thus reducing cell damage and crystal adhesion.

目的 探讨三维可视化技术对指导经皮肾镜碎石术(PCNL)的安全性及有效性.方法 前瞻性选取河池市人民医院及广西医科大学第一附属医院 2021 年 9 月～2022 年 9 月收治的肾结石患者 100 例,随机数表法分为三维可视化指导下PCNL组及超声引导下PCNL组,各 50 例.常规PCNL组术前完善B超、泌尿系平片及CT等相关检查.三维可视化指导下PCNL组在在常规检查基础上增加三维可视化重建.完善术前准备,评估患者是否有手术指征,无手术禁忌症.患者均采用手术治疗,术后均进行复查.结果 两组患者在术中使用体位、穿刺部位、平均穿刺深度、穿刺通道大小及留置通道数量方面比较差异无统计学意义(P＞0.05);在平均碎石时间、平均手术时间、术后平均血色素下降值、平均住院时间、术后平均住院时间比较,差异无统计学意义(P＞0.05).而在三维可视化指导下PCNL组的I期清石率较常规PCNL组显著提高,差异有统计学意义(P= 0.036).结论 三维可视化技术能够直观地显示肾脏解剖及结石的位置、形状以及与周围组织的关系,从而设计出最佳的穿刺通道并建立手术入路,并进行PCNL模拟手术,提高清石效率.

Objectives: To compare the dusting efficiency and safety with basketing for treating renal stones <= 2 cm during flexible ureteroscopy (fURS).Materials and methods: This study included 218 patients with renal stones <= 2 cm treated with fURS. Among them, 106 patients underwent dusting, and 112 patients underwent fragmentation with basket extraction. All patients were followed up for 3 months postoperatively. The operating time, lasing time, stone-free rate (SFR) and complication rate were compared.Results: The mean stone size in the dusting group was 1.3 cm, whereas 1.4 cm in the basketing group. The mean operative time was significantly lower in the dusting group than in the basketing group (43.1 +/- 11.7 minutes VS 60.5 +/- 13.4 minutes, P <0.05), but the lasing time was significantly longer for the dusting group than for the basketing group (17.7 +/- 3.9 minutes VS 14.1 +/- 3.6 minutes, P <0.05). SFR was significantly higher in the basketing group immediately after the operation and follow-up after 1 month (76.8% vs 55.7%, P= 0.001 and 88.4% vs 78.3%, P = 0.045). However, the SFR was similar for both groups (88.8% in the dusting group vs. 90.2% in the basketing group) after 3 months postoperatively. There was no statistical difference in the complication rates between the two groups.Conclusions: Dusting has advantages in shortening the operation time and reducing the operation cost, but the lasing time was longer compared with the basketing. Although there is no difference in long-term effect, basketing is superior to dusting in terms of short-term SFR. Moreover, dusting should be avoided in some special cases and basketing a better choice. Both techniques are effective for the treatment of renal stones <= 2 cm and choice depends on patient demographic and stone characteristics.

目的 探讨草酸钙(CaOx)晶体诱导人肾小管上皮细胞(HK-2细胞)发生铁死亡的机制.方法 2021年3-9月使用CaOx晶体悬浊液干预HK-2细胞,构建HK-2-CaOx反应模型.设置 CaOx 晶体浓度分别为 0、0.25、0.5、1.0、2.0、4.0、8.0 mmol/L,干预 HK-2 细胞 24 h,干预完成后提取HK-2细胞蛋白.采用最佳干预浓度的CaOx晶体干预HK-2细胞,分别于干预后0、3、6、9、12、24、48 h提取细胞蛋白.蛋白质印迹法检测细胞内铁死亡标志蛋白谷胱甘肽过氧化物酶4(GPX4)的表达情况.用铁死亡诱导剂爱拉斯汀(Erastin)和铁死亡抑制剂3-氨基-4-环己基氨基苯甲酸乙酯(Fer-1)干预HK-2细胞以调控细胞内铁死亡水平.将HK-2细胞分为4组:正常对照组(NC组),无干预处理,单纯使用完全培养基培养;CaOx晶体刺激组(CaOx组),使用含4.0 mmol/L CaOx晶体的完全培养基培养;CaOx晶体+Erastin处理组(CaOx+Erastin组),使用含10.0 μmol/L Erastin和4.0 mmol/L CaOx晶体的完全培养基培养;CaOx晶体+Fer-1处理组(CaOx+Fer-1组),使用含1.0μmol/LFer-1和4.0 mmol/L CaOx晶体的完全培养基培养.培养24 h后,采用蛋白质印迹法和免疫荧光技术检测GPX4、长链脂酰辅酶A合成酶4(ACSL4)和溶质载体家族7成员11(SLC7A11)在HK-2细胞内的表达情况;检测HK-2细胞内谷胱甘肽含量;采用DCFH-DA荧光染色法观察HK-2细胞活性氧(ROS)表达情况.通过光学显微镜观察各组HK-2细胞内CaOx黏附情况,DAPI染色检测HK-2细胞核损伤情况.结果 采用0、0.25、0.5、1.0、2.0、4.0、8.0 mmol/L浓度CaOx晶体干预24 h后,细胞中GPX4的表达量分别为 5.67±1.05、5.60±0.02、4.99±0.94、4.82±0.93、4.50±0.70、4.14±0.53、0.97± 0.53,4.0 mmol/L组与0 mmol/L组相比差异有统计学意义(P=0.026).选用4.0 mmol/L作为最佳浓度干预细胞,干预0、3、6、9、12、24、48 h后细胞中GPX4的表达量分别为11.73± 1.29、11.68±1.32、1 1.72±1.30、10.97±1.28、10.63±1.21、8.79±1.10、8.03±1.06,24 h组与0h组相比差异有统计学意义(P=0.090).CaOx+Erastin组与NC组相比,ACSL4表达量(9.71±0.68 与 3.96±0.17,P＜0.01)升高;SLC7 A11(5.76±1.31 与 9.18±1.54,P=0.001)和 GPX4(3.61±0.25 与 9.26±0.13,P＜0.01)表达量降低;CaOx+Fer-1 组与 CaOx 组相比,GPX4(7.52±0.23 与 3.61±0.25,P＜0.01)、SLC7A11(7.85±1.34 与 5.76±1.31,P=0.012)表达量升高,ACSL4(5.84±0.62 与 9.71±0.68,P=0.002)表达量显著降低.CaOx+Erastin 组与 CaOx 组相比,GPX4(2.71±0.18 与 3.61±0.25,P=0.001)、SLC7A11(3.82± 1.60 与 5.75±1.31,P=0.017)表达量显著降低,ACSL4(11.15±0.44 与 9.71±0.68,P＜0.01)表达量升高.NC组、CaOx组、CaOx+Fer-1组、CaOx+Erastin组的谷胱甘肽含量分别为(81.88±4.02)、(53.38±3.53)、(68.26±4.55)、(38.22±2.95)mmol/L;DCFH-DA 荧光染色强度分别为(22.72±3.73)、(63.36±5.17)、(82.38±6.25)、(45.32±4.33);免疫荧光强度分别为(50.36±4.23)、(31.63±2.86)、(23.36±3.74)、(39.89±3.35),CaOx 组与 NC组、CaOx+Fer-1组、CaOx+Erastin组相比差异均有统计意义(P＜0.05).DAPI染色计算NC组、CaOx组、CaOx+Fer-1组、CaOx+Erastin组细胞核损伤比例分别为2.85％、11.96％、8.76％、16.27％.结论 CaOx晶体可以通过增加HK-2细胞内氧化应激水平进而诱导HK-2细胞发生铁死亡.

Objective:To investigate the feasibility and safety of suprapubic bladder puncture and gland fixation in transurethral enucleation of the prostate.Methods:The clinical data of 15 patients with benign prostatic hyperplasia admitted to the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2020 were retrospectively analyzed. The age was (70.27±5.35) years old, preoperative serum prostate-specific antigen (PSA) level was (3.03±1.37) ng/ml, preoperative total prostate weight was 80.3(70.49, 96.78)g, preoperative postvoid residual urine volume(PVR)was 80 (55, 108)ml, and the maximum urine flow rate (Q max) was (6.13±2.25) ml/s. The international prostate symptom score(IPSS) was 25(22, 27), quality of life (QOL)score was 5(5, 6), international erectile function index-5 (IIEF-5) score was (15.38±5.10). All 15 patients underwent conventional transurethral plasma enucleation of prostate by using the three-lobe method, and the enucleated gland was pushed into the bladder completely. Then a laparoscopic pneumoperitoneum needle was used to perform suprappubic cystipuncture, and ureteral grasping forceps were inserted through the outer sheath. The forceps were used to fix the enencied gland. A rapid harvesting electric resection was performed in the broad space of the bladder, and the Ellick was rinsed to remove the tissue fragments. Surgical indicators and complications were recorded. The improvement of subjective score (IPSS, QOL, IIEF-5) and objective index (Q max, PVR) was compared between preoperative and postoperative. Results:All the 15 operations were completed successfully and there were no complications such as blood transfusion, capsule perforation, transurethral resection syndrome, bladder injury, bladder puncture site laceration and bleeding. The weight of resected prostate tissue was 44(40, 60)g, with blood loss (79.20±18.93)ml.The time of enucleation operation was (54.13±10.88)min, with harvest cutting time (14.67±2.50)min, evisceration efficiency (0.89±0.08)g/min, harvesting efficiency (3.26±0.36)g/min, bladder irrigation time (2.47±0.52) d. The time of indwelling catheter was (3.73±0.80)d.The postoperative hospital stay was (4.40±0.91) d. Temporary urinary incontinence occurred in 1 case after operation. All patients were followed up for 6 months after operation. The IPSS score was 3(2, 3), QOL score was 0(0, 1), IIEF-5 score was (20.12±2.30), Q maxwas (21.80±2.14) ml/s and PVR was 10(5, 15)ml, which were all significantly different compared with those before surgery ( P<0.05). The symptoms of the patients were significantly improved. Conclusions:Transurethral plasma enucleation of prostate combined with suprapubic bladder puncture and fixed gland is effective in the treatment of benign prostatic hyperplasia. The subjective symptoms and objective examination of patients have been significantly improved, and no adverse operation-related complications have occurred. It is a suitable method for enucleation of prostate in units which are not equipped with transurethral tissue planer.

达芬奇手术机器人因在腹膜后、耻骨后等狭窄区域的手术中具有更高的灵巧性,受到了泌尿外科医师的青睐.但由于手术机器人的价格昂贵和临床工作安排紧凑,对住培医师进行达芬奇手术机器人的操作培训难以实现.通过模拟医学的方法,让住培医师熟悉机器人的构造和操作流程,提高其手术技巧,是目前机器人手术操作培训最为可行的方法.

Objective:To explore the value of preoperative fibrinogen to prealbumin ratio (FPR) in the prognosis of patients with clear cell renal cell carcinoma (ccRCC), and compare its ability to predict prognosis with traditional inflammatory factors, and establish a new prognostic model.Methods:This study included 204 ccRCC patients who underwent radical nephrectomy or partial nephrectomy from May 2012 to December 2016. COX univariate and multivariate analyses were used to determine the independent factors affecting the survival and prognosis of ccRCC patients. A nomogram was constructed for independent factors, and the predictive performance of related factors and models was evaluated through the C index, calibration curve and the decision curve analysis (DCA).Results:FPR was closely related to age ( P<0.05), tumor size ( P<0.01), hemoglobin (HGB, P<0.01), endogenous creatinine clearance (Ccr, P<0.01), prealbumin ( P<0.01), symptom ( P<0.01), surgery ( P<0.01), tumor necrosis ( P<0.01), TNM stage ( P<0.01), etc. Cox multivariate regression analysis showed that the independent prognostic factors affecting the survival rate of ccRCC patients were FPR [hazard ratio ( HR)=2.583, 95% confidence interval ( CI)=1.082-6.164, P<0.05], platelet to lymphocyte ratio (PLR, HR=2.785, 95% CI=1.222-6.345, P<0.05) and TNM stage ( HR=4.044, 95% CI=1.813-9.021, P<0.01). The C index (0.72) and DCA of FPR were better than traditional inflammation biomarkers. The nomogram composed of multiple independent factors had better predictive ability for patients after ccRCC. Conclusion:High FPR in peripheral blood is an independent risk factor for poor prognosis of ccRCC patients. The nomogram constructed by FPR, PLR and TNM stage has a certain predictive value for the prognosis of ccRCC patients.

摘要：目的 利用草酸钙晶体（Calciumoxalate，CaOx）建立草酸钙结石体外细胞模型，加入HMGB1高效抑制剂甘草酸观察炎性蛋白HMGB1及核因子κB（NF-κB）的表达情况。利用HMGB1 RNA干扰慢病毒感染正常HK-2细胞敲低HMGB1的转录和表达，观察炎性蛋白HMGB1及NF-κB的表达情况。从而探究使用甘草酸及下调HMGB1表达对人肾小管上皮细胞发生炎性反应时的保护作用。方法 根据实验设计将HK-2细胞随机分为对照组(无其他干预，采用HK-2专用培养基培养)、草酸钙晶体干预组(含8mmoL/L草酸钙晶体悬浊液的HK-2专用培养基)、甘草酸干预组(甘草酸5mmoL/L预处理2h后，加入草酸钙晶体使HK-2专用培养基包含5mmoL/L甘草酸和8mmol/L草酸钙晶体悬浊液，培养24小时)和HMGB1敲低组（利用HMGB1 RNA干扰慢病毒与HK-2细胞共培养，感染效率80%以上后更换培养基为含8mmoL/L草酸钙晶体的HK-2专用培养基，培养24h）。在恒温培养箱中培养24h后收集细胞并提取各组蛋白，利用蛋白质印迹法Westernblot检测炎性高迁移率族蛋白B1（HMGB1）和核因子κB（NF-κB）的相对表达水平并对检测结果进行统计分析。结果 利用蛋白质印迹法Westernblot检测蛋白样品并对结果进行统计分析显示，草酸钙晶体干预组和对照组相比，HMGB1的相对表达量（1.660±0.056与1.126±0.095，P<0.05）和NF-κB的相对表达量（1.001±0.019与0.651±0.177，P<0.05）有显著增加。甘草酸干预组和草酸钙晶体干预组对比，HMGB1的相对表达量（1.040±0.051与1.685±0.101，P<0.05）和NF-κB的相对表达量（0.287±0.023与4.658±0.108，P<0.05）出现显著减少。HMGB1敲低组和草酸钙晶体干预组相比，HMGB1的相对表达量（0.709-0.012与0.988-0.011,P<0.05）和NF-κB的相对表达量（0.603-0.011与0.872-0.073，P<0.05）出现显著减少。结论 草酸钙晶体可以刺激人肾小管上皮细胞分泌炎性蛋白HMGB1和NF-κB，且通过抑制HMGB1的表达可以减少炎性信号通路蛋白NF-κB的表达，发挥抗炎作用。

目的 探讨基于游戏设计的参与式教学法在无菌术教学中的应用前景.方法 选取广西医科大学2017级106名临床医学专业学生作为研究对象,其中试验组53名,采用基于游戏设计的参与式教学方法,对照组53名采用传统教学方法.将两组学生的技能和理论考试成绩进行比较.采用问卷调查的方式对比两组学生对教学的满意度.结果 试验组学生的技能和理论考试成绩均优于对照组学生,差异均有统计学意义(P＜0.05).问卷调查结果显示在促进知识掌握和应用、激发学习积极性、增强无菌观念等方面,试验组教学方法评价满意度均优于对照组.结论 基于游戏设计的参与式教学法可以提高学生的无菌术理论知识和临床实践应用能力,有助于学生全程无菌意识的培养.学生对这一教学方法较为满意,推荐在无菌术教学工作中广泛应用.