ObjectivesNutcracker syndrome (NCS) is a vascular disorder characterized by compression of the left renal vein (LRV), frequently complicated by varicocele in male patients. The Valsalva maneuver is routinely used to provoke venous reflux during ultrasound diagnosis, yet the hemodynamic response of the gonadal vein throughout a complete Valsalva cycle remains poorly characterized. This study aims to quantitatively elucidate the hemodynamic mechanisms by which intra-abdominal pressure elevation—simulated via the Valsalva maneuver—exacerbates gonadal venous reflux in NCS-associated varicocele.MethodsFifty-seven patients with NCS and concomitant varicocele were consecutively enrolled. Doppler ultrasonography was performed to measure anatomical and hemodynamic parameters, including aortomesenteric angle, LRV diameter, stenotic diameter, peak velocities, and gonadal vein diameter under resting and Valsalva conditions. A representative three-dimensional computational fluid dynamics (CFD) model incorporating the inferior vena cava, LRV, and gonadal vein was reconstructed from contrast-enhanced CT data. A physiologically relevant time-varying pressure boundary condition was applied at the gonadal vein inlet to simulate a complete Valsalva cycle. Pressure, velocity, wall shear stress, and streamline distributions were systematically analyzed.ResultsClinical data revealed significant anatomical compression and hemodynamic abnormalities, with gonadal vein diameter increasing from 3.0 ± 0.94 mm at rest to 3.86 ± 1.07 mm during Valsalva. CFD simulations demonstrated that during the Valsalva plateau phase, pressure at the gonadal vein inlet reached 6,000 Pa, with a pressure gradient of approximately 7,600 Pa across the LRV stenosis. Peak WSS at the stenosis increased 12-fold, exhibiting marked spatial heterogeneity. Velocity at the stenosis reached 2.7 m/s, with pronounced flow separation and disturbed streamlines developing downstream, which reduced the effective flow volume by 50%–60%.ConclusionThe Valsalva maneuver induces a high-pressure-negative-pressure-recompression vicious cycle across the LRV stenosis, with elevated upstream pressure increasing venous congestion risk and downstream negative pressure exacerbating stenotic collapse. The 12-fold WSS elevation far exceeds physiological thresholds, potentially precipitating cumulative endothelial injury. Recirculation zone formation compromises venous return and promotes thrombogenesis. Crucially, these hemodynamic perturbations are not confined to diagnostic maneuvers but are likely mirrored during daily activities that elevate intra-abdominal pressure (e.g., running, jumping), explaining the progressive symptom worsening and activity-related discomfort in NCS patients. These findings provide a hemodynamic rationale for dynamic clinical assessment.

Homozygous familial hypercholesterolemia (HoFH) presents a persistent and difficult-to-treat condition. This recalcitrance stems largely from loss-of-function mutations within the low-density lipoprotein receptor (LDLR) gene, which severely undermine the efficacy of standard therapeutic regimens. Here, we report a bioinspired "targeting and blockade" strategy for the efficient delivery of functional Ldlr mRNA to hepatocytes. This approach is realized through a rationally designed platform, Szd + AP@ExoE-Ldlr, which integrates APOA1-functionalized exosomes for hepatocyte-targeted delivery with a preemptive macrophage blockade using the clinical ultrasound contrast agent Sonazoid (Szd). The APOA1 modification confers specific recognition by the scavenger receptor class B type 1 on hepatocytes, while the pre-saturation of Kupffer cells with Szd significantly mitigates nonspecific clearance by the mononuclear phagocyte system (MPS). In a HoFH murine model, this synergistic strategy markedly enhanced the accumulation of exosomes in hepatocytes and achieved robust restoration of hepatic LDLR expression. Consequently, it elicited a profound correction of the atherogenic lipid profile and substantially attenuated the progression of atherosclerosis. A comprehensive biosafety evaluation confirmed the excellent biocompatibility of this platform. Our work provides a promising and broadly applicable solution for the treatment of liver-related genetic disorders by simultaneously overcoming the critical barriers of targeted delivery and MPS evasion.

ObjectiveThis study aims to explore the clinical efficacy and safety of a urethroplasty technique for fossa navicularis (FN) strictures using a transurethral annular inlay oral mucosa graft.MethodsA retrospective analysis was conducted on clinical data from patients with urethral meatus and navicular fossa stricture who underwent transurethral reconstruction using annular inlay oral mucosa graft urethroplasty in Tangdu Hospital from July 2021 to October 2024. Operation success was defined as the ability to pass the F24 urethral probe, and the secondary outcome is the urinary flow rate and patient satisfaction at 1, 3, 6, and 12 months.ResultsAll 12 patients successfully completed the surgery. The average age was 56.8 ± 6.8 years, and the average length of urethral stricture was 1.6 ± 0.2 cm. Three patients had a history of transurethral endoscopic surgery, eight had penile lichen sclerosus (LS), and one had no obvious causes. Over a median follow-up of 19 months, the average maximum urinary flow rate was 21.2 ± 3.2 ml/s at 3 months, and the average maximum urinary flow rate was 19.5 ± 4.2 ml/s at 12 months. One patient experienced urine pain with a thin stream and spraying urination after 3 months. Physical examination of the urethral meatus opening scar was found, and the symptoms disappeared after urethral incision. The follow-up survey of sexual life after 1 year showed that seven patients (58.3%) had successful life within 1 year compared with two patients (16.7%) before surgery. There were no cases of erectile dysfunction and poor wound healing. The patients were either very satisfied (75%) or satisfied (25%) with the operation. All patients would recommend urethroplasty to others.ConclusionTransurethral annular inlay oral mucosa urethroplasty for urethral meatus and navicular fossa stricture reconstruction is a safe, feasible, and effective surgical method, cosmetic effect on the penile head. This technique has advantages in improving sexual function and better penile head cosmesis.

Adopting noninvasive techniques to provide more precise parameters related to the clinical diagnosis and treatment of nutcracker syndrome is currently the focus of research on nutcracker syndrome. However, due to individual differences in patients and limitations in monitoring techniques, there is an urgent need for a new method to obtain more accurate parameters. This work is based on imaging data from two patients with nutcracker syndrome and numerically simulates the blood flow process in the left renal vein, revealing different clinical symptoms caused by changes in flow velocity, pressure, and wall shear stress. Besides, this work also compares the dynamic changes of blood flow parameters under two different degrees of compression. The study indicates that an increase in pressure at the entrance of the left renal vein increases the risk of venous congestion. The flow separation reduces the blood flow rate by 50%-60%, causing a series of flow obstacles. The wall shear stress near the compressed area increased by 15-20 times, exacerbating the damage of blood flow to the left renal vein. The increase in the degree of compression exacerbates flow barriers and the impact of blood flow on the vascular wall. This study introduces a method of obtaining hemodynamic parameters through computational fluid dynamics and summarizes the clinical symptoms caused by abnormal changes in different blood flow parameters. This method provides a more reliable approach for the clinical diagnosis of nutcracker syndrome and the optimization design of extracorporeal stent structures since it is not limited by monitoring techniques.

Immunotherapy is widely applied for the treatment of breast cancer, but to which some patients respond poorly or develop resistance. Therefore, the mechanism needs to be further studied. Transcriptomic data of 31 breast cancer patients treated with anti-programmed death receptor 1 (PD-1) was downloaded from the VIB-KULeuven Center for Cancer Biology to analyze the changes in myeloid cells in tumor tissues before and after immunotherapy. And 24 cell populations that may be immune-related were further identified. Representative cell populations were also screened and validated through cellular and animal experiments to evaluate the relevant molecular expression and pathways of tumor-associated macrophages (TAMs) in the tumor microenvironment.The results demonstrated that MGP+ TAMs and IDO1+ TAMs influenced the efficacy of immunotherapy in breast cancer patients. After anti-PD-1 treatment, Increased numbers of MGP+ TAMs and IDO1+ TAMs in breast cancer patients upregulated pro-tumorigenic factors associated with resistance to immunosuppressive therapy. This study provides new biomarkers for immunotherapy to predict therapeutic responses and overcome potential resistance to immunotherapy. It is an important complement to the immunosuppression caused by TAMs after immunotherapy for breast cancer.

Background: Radiotherapy (RT) for breast cancer (BC) may raise the risk of second primary cancers (SPCs), a relationship inadequately studied. Methods: We analyzed 248268 female BC patients from 9 SEER registries, 1988-2018, identifying SPCs >5 years after initial treatment, comparing SPC risks between RT and non-RT cohorts using Fine-Gray and Poisson regressions. Results: Of all participants, 55.4 % received surgery and RT. The RT group had a higher SPC incidence, with excess incidence significantly dropped from 6.9 % in 1990 to 0.2 % in 2012. The 30-year SPC incidence was 24.69 % in the RT cohort and 18.11 % in the NRT cohort. RT increased the risk of SPCs(HR, 1.29 [95% CI,1.26-1.33]; P G 0.001), BC(HR, 1.58[1.52-1.64]; P G 0.001), cancer of respiratory system(HR, 1.21 [1.13-1.30]; P = 0.013), skin cancer(HR, 1.26[1.10-1.44]; P G 0.001), leukemia(HR, 1.30[1.11-1.54]; P = 0.001), soft tissue cancer(HR, 1.78[1.34-2.37]; P G 0.001), and eye & orbit cancer(HR, 2.21[1.02-4.80]; P = 0.044), except for reducing the risk of multiple myeloma (HR 0.76). Notably, RT-related risks(RR) for BC declined with increasing age and the year of BC diagnosed, increased with longer latency, but the dynamic RR for cancer of respiratory system presented the almost opposite trends. The RT cohort had higher standardized incidence ratios for SPCs compared to both the NRT cohort and the general population overall. Although 15-year overall survival for SPCs was similar between RT and NRT cohorts, SPC presence significantly lowered 30-year survival from 35.64 % to 23.90 %. Conclusions: RT might increase susceptibility to SPC in breast, respiratory system, skin, soft tissue, eye and orbit, and leukemia in BC survivors. Efforts should be made to timely diagnose SPCs based on their specific patterns to improve patient's quality of life.

e16107 Background: Targeted drugs, immune checkpoint inhibitors and TACE are important non-surgical approaches to treat HCC. A triple combination of the three is under investigation. This prospective study was conducted to assess the efficacy and safety of donafenib combined with anti-PD-1 antibody and TACE as first-line treatment for unresectable or advanced HCC. Methods: Patients (pts) who had histologically or clinically confirmed HCC and with no prior systemic therapy, at least one measurable lesion per mRECIST, Child-Pugh score ≤7, and ECOG PS score 0-1 were enrolled and received donafenib 100 mg twice daily, anti-PD-1 antibody Q3W and on-demand conventional TACE. CT/MRI scans were performed every six weeks. The primary endpoint was progression-free survival (PFS). Secondary endpoints were objective response rate (ORR), disease control rate (DCR), overall survival and safety. Results: A total of 30 pts were enrolled between Dec 2021 and Nov 2022. All pts had HBV-related HCC and baseline ECOG PS score of 0. Baseline characteristics are shown in the Table. As of 6 Feb 2023, eleven pts had discontinued the triple therapy. The median follow up time was 3.6 months (range, 1.8-13.4). The median number of on-study TACE sessions was 2 (range, 1-4). Among 29 efficacy evaluable pts, five pts had disease progression and no death occurred. The median PFS was not reached (95%CI, 2.4 months -NE). The 6-month PFS rate was 69.4% (95%CI, 34.5%-84.0%). Five pts had a complete response and 13 had a partial response (responders). ORR and DCR were 62.1% (95%CI, 42.3%-79.3%) and 86.2% (95%CI, 68.3%-96.1%) per mRECIST. The median time to response was 1.3 months (95%CI, 1.1-1.6). The median duration of response was not reached (95%CI, 3.4 weeks-NE). Four pts (1 with BCLC B, 3 with BCLC C) underwent successful surgical resection after a median treatment duration of 2.9 months (range, 1.8-3.3) and no recurrence was noted with a median of 5.9 months (range, 2.8-10.2) follow-up after hepatectomy. In the safety population (n = 30), any grade and grade 3 treatment-related adverse events (TRAEs) occurred in 15 (50.0%) and 7 (23.3%) pts with no grade 4 TRAEs or toxic death. Rash was the most common grade 3 TRAE (incidence: 13.3%) and led to treatment discontinuation in one pt. Conclusions: The triple combination of donafenib plus anti-PD-1 antibody and TACE showed promising efficacy and was well tolerated in pts with unresectable or advanced HCC. Clinical trial information: NCT05262959 . [Table: see text]

BackgroundThis study aims to describe a novel laparoscopic aspirator bracket (LAB) and its use in laparoscopic nephron-sparing surgery (NSS) by a simple enucleation (SE) technique.MethodsA total of 123 renal tumor cases who underwent laparoscopic NSS via LAB or laparoscopic aspirator between July 2017 and April 2021 were retrospectively analyzed. General characteristics, perioperative data and postoperative follow-up data of patients were compared.ResultsThe application of LAB in laparoscopic renal tumor SE surgery shortened the operation time (88.58 ± 38.25 vs. 102.25 ± 35.84 min, p < 0.05) and improved the zero ischemia rate (18.75% vs. 3.39%, p < 0.05), shortened warm ischemia time (16.17 ± 5.16 vs. 19.39 ± 5.62 min, p < 0.05) and decreased intraoperative blood loss (166.19 ± 111.60 vs. 209.15 ± 127.10 ml, p < 0.05). In addition, the serum creatinine and eGFR values in the LAB group also showed faster and better renal function recovery.ConclusionThe new LAB could aspirate and expose the operative field with a single instrument. In operations that need to expose and aspirate simultaneously, such as in renal tumor simple enucleation, it could shorten operation time, reduce intraoperative blood loss and improve the postoperative renal function recovery.

Abstract Background: LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer. Methods: We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels. Results: On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs. 1.4% [2/145]). Conclusion: LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile. Trial registration: ClinicalTrials.gov, NCT04563936.

Background and ObjectivesLaparoscopic single-incision triangulated umbilical surgery (SITUS), which enables the extraction of intraabdominal specimens through a single umbilical incision, has yet to be used to perform adrenalectomy. We have modified SITUS to enable extraction of large (>5 cm) adrenal masses with optimal cosmetic outcomes and investigated efficacy and safety. Methods. In this retrospective study, we analyzed data of 16 patients with adrenal tumors >5 cm who had undergone adrenalectomy by SITUS between October 2015 and April 2018. Two C-shaped incisions were made around the umbilicus and sutured centripetally. After extracting the specimen, we evaluated these patients’ operative/postoperative data. Results. SITUS was performed in all 16 patients without conversion to laparoscopic or open surgery. The mean operation time was 75.31 ± 21.54 min (intraperitoneal time 41.94 ± 17.57 min; incision suturing time 33.38 ± 6.34 min). The estimated median blood loss was 57.5 mL (range 30–610 mL). Drainage time and duration of hospital stay were 55.69 ± 12.92 h and 3.94 ± 0.90 d, respectively. After surgery, all incisions were hidden under the umbilicus. Three patients developed keloid diathesis, resulting in enlargement of their scars. Conclusions. SITUS is a safe and feasible procedure for removing large adrenal tumors. In addition to its cosmetic advantages, SITUS facilitates functional recovery, particularly in patients with large adrenal tumors.

Percutaneous transluminal angioplasty (PTRA) is a common treatment method for renal vascular disease (RVD). However, PTRA may not be effective in patients with abnormal vascular disease. Renal autotransplantation (RAT) has been used as an alternative therapy for these diseases. Restrictions due to intracorporeal kidney cold preservation and the renal function of intracorporeal RAT were not as well protected compared with open operation. We developed this technique of 3D-printed polylactide (PLA) cold jackets for laparoscopic complete intracorporeal RAT for the purpose of better protecting the renal function and determining the feasibility of this novel procedure. The procedure was successfully applied to a 51-year-old woman with bilateral renal artery stenosis. The operation time was 5 hours, and blood loss was 200 ml. The patient’s blood pressure remained constant throughout the operation, and the pressure was maintained at 120-140/70–90 mmHg without antihypertensive drugs 1 week after the operation. B-ultrasound showed that the blood flow signal of the transplanted kidney was normal and the boundary between the skin and medulla was clear. The patient was discharged 2 weeks after surgery. One year postoperatively, Doppler ultrasound of the autotransplant showed that the transplanted kidney was normal in size and shape. Radionuclide renal dynamic imaging revealed that the glomerular filtration rate (GFR) of the transplanted kidney was 36.9 ml/min. 3D-printed polylactide (PLA) cold jackets for laparoscopic complete intracorporeal RAT are a safe and effective method for the treatment of renal artery stenosis and represent a feasible method for preserving the renal function of severe renal artery stenosis patients; however, the technology is still at the exploratory stage and has room for further improvements.

Abstract Background Laparoscopic nephron-sparing surgery (NSS) is the standard of care for small renal masses whenever feasible. This study aims to describe a novel laparoscopic aspirator bracket (LAB) and its use in laparoscopic NSS by a simple enucleation technique. Methods Between July 2017 and July 2019, we performed 54 laparoscopic NSS due to renal tumour using an SE technique by either LAB (n = 26) or laparoscopic aspirator (LA, n = 28) in 3 independent medical centres by 6 experienced surgeons. The novel aspirator could aspirate liquid and expose the operative field simultaneously. The details of operative technique are provided in the accompanying video. General characteristics and perioperative data of all patients were collected and retrospectively. Patients were followed up for 12 months after laparoscopic renal tumor simple enucleation (SE) operation. Renal function outcomes and perioperative complications were assessed. Results All 54 patients were successfully operated without conversion to open surgery. The use of the LAB in laparoscopic renal tumor SE operation can shorten the warm ischemia time ([WIT], LAB 12.92 ± 8.38 min vs. LA 17.89 ± 6.73 min) and increase the zero ischemia (ZI) rate (LAB 23.08% vs. LA 3.57%). In the one-year follow-up, the LAB group showed quicker renal function recovery (ipsilateral renal function 3 months after the surgery, LAB 41.67 ± 10.11% vs. LA 36.75 ± 10.30%). The limitations of this study were limited number of patients and retrospective attribute. Conclusion The new LAB could aspirate and expose the operative field with a single instrument. In operations that need to expose and aspirate simultaneously, such as in renal tumor simple enucleation, it could shorten WIT and improve the postoperative renal function recovery.

良性前列腺增生是中老年男性的常见疾病,经尿道前列腺电切术(transurethral resection of the prostate,TURP)被认为是治疗前列腺增生的金标准[1],但可能造成电切综合征等并发症,甚至危及生命[2].经尿道前列腺激光剜除手术较传统电切术具有出血少、手术时间短等优势,越来越多被应用于临床.自SHUJI NAKAMURA等发明发光二极管后,蓝激光获得了更多关注[3].200 W蓝激光手术系统是我国最新原创的激光手术设备,2022年6月9日我院采用蓝激光进行经尿道前列腺剜除手术治疗良性前列腺增生1例,取得满意效果.经科技文献查新,系世界首例.

Background and objective: At present, there is a lack of efficient modeling methods for bionic artificial bone scaffolds, and the tissue fluid/nutrient mass transport characteristics of bone scaffolds has not been evaluated sufficiently. This study aims to explore an effective and efficient modeling method for biomimetic porous bone scaffolds for biological three-dimensional printing based on the imitation of the histomorphological characteristics of human vertebral cancellous bone. The fluid mass transport and mechanical characteristics of the porous scaffolds were evaluated and compared with those of a human cancellous bone,and the relationship between the geometric parameters (e.g., the size, number, shape of pores and porosity) and the performence of biomimetic porous bone scaffolds are revealed. Methods: The bionic modeling design method proposed in this study considers the biological characteristics of vertebral cancellous tissue and performs imitation and design of vertebrae-like twodimensional slices images.It then reconstructs the slices layer-by-layer to form porous scaffolds with a three-dimensional reconstruction method, similar to computed tomography image reconstruction. By controlling the design parameters, this method can easily realize the formation of plate-like (femoral cancellous bone-like) or rod-like (vertebral cancellous bone-like) porous scaffolds. The flow characterization of porous structures was performed using the computational fluid simulation method. Results: The flow characterization results showed that the permeability of the porous scaffolds and human bone was 10(-8)similar to 10(-9) m(2), and when the porosity of the porous scaffolds was higher than 70%, the permeability was higher than that of human vertebrae with a porosity of 82%. The maximum shear stress of the designed porous scaffolds and human vertebra were less than 0.8Mpa, which was conducive to cell adhesion, cell migration, and cell differentiation. The results of 3D printing and mechanical testing showed good printability and reflected the relationship between the mechanical properties and design parameters. Conclusions: The design method proposed in this study has many controllable parameters, which can be adjusted to generate diversified functional porous structures to meet specific needs, increase the potential of bone scaffold design, and leave room for meeting the new requirements for bone scaffold characteristics in the future. (C) 2022 Elsevier B.V. All rights reserved.

This study evaluated the efficacy and safety of 3D printing technology combined with percutaneous nephrolithotomy in the treatment of complex renal calculi. Ninety patients with complex renal calculi were randomly divided into a 3D printing group (45 patients) and a control group (45 patients). In the 3D printing group, a patient-specific 1:1 3D printing model was established based on the patient's thin-layer CT scanning data. A 3D printing model was used for preoperative communication between doctors and patients. Preoperative puncture training, channel design, residual stone prediction, and percutaneous nephrolithotomy were performed under the guidance of a 3D printing model and B-ultrasound. The control group was treated with the conventional B-ultrasound-guided puncture method. Results suggest that there was a statistically significant difference between the two groups (P < 0.05). The overall score of the doctor-patient communication objects in the 3D printing group was 19.32 ± 1.57 points, and in the control group, it was 14.51 ± 2.13 points. The operation time of the 3D printing group was 103.21 ± 13.49 min, and that of the control group was 126.12 ± 25.87 min. The calculi clearance rate of the 3D printing group was 96%, while that of the control group was 80%. The incidence of postoperative complications was 6.67% in the 3D printing group and 22.22% in the control group. Compared with traditional percutaneous nephrolithotomy, 3D printing technology combined with percutaneous nephrolithotomy can significantly enhance the effectiveness of doctor–patient communication, shorten operation time, reduce operation bleeding, improve the stone clearance rate, reduce the incidence of complications and shorten the length of hospital stay. The proposed method is thus a safe and effective method to treat complex renal calculi.

目的:探讨miR144-3p在膀胱癌组织及细胞中的表达及其对T24细胞增殖与侵袭的影响。方法:选用2018年2月至2018年12月空军军医大学唐都医院手术切除的36例膀胱癌组织及10例正常膀胱上皮组织标本,以及人膀胱癌细胞株T24和正常尿路上皮细胞株SV-HUC-1,用qPCR法检测膀胱癌组织和细胞中miR144-3p的表达水平。用脂质体转染技术分别将miR-144-3p mimics、miR-NC等转染进T24细胞,通过MTT法、流式细胞术和Transwell小室法分别检测T24细胞的增殖、细胞周期和侵袭能力。利用TargetScan软件预测miR-144-3p与E2F转录因子3（E2F transcription factor 3,E2F3）的结合位点,用双荧光素报告基因实验验证miR-144-3p与E2F3的靶向关系,WB实验检测细胞中miR-144-3p与E2F3的表达水平。结果:miR-144-3p在膀胱癌组织和细胞中低表达（均P＜0.01）,其中肌层浸润性膀胱癌组织中的表达水平低于非肌层浸润膀胱癌组织（P＜0.05）。双荧光素报告基因实验证实,miR-144-3p与E2F3表达存在靶向调节关系。miR-144-3p过表达可抑制T24细胞的增殖和侵袭能力（均P＜0.01）,同时下调E2F3的表达水平（P＜0.01）;当上调E2F3表达时,对细胞侵袭和增殖的抑制作用则被逆转。结论:miR-144-3p在膀胱癌组织中低表达,其通过靶向调控E2F3表达从而抑制膀胱癌细胞的增殖与侵袭。

目的:总结8例机器人辅助3D打印PEEK血管外支架植入术治疗胡桃夹综合征的手术配合经验.方法:回顾性分析8例机器人辅助3D打印PEEK血管外支架植入术的术前准备、术中配合及术后注意事项.结果:8例患者手术均顺利完成,手术时间为(90±10)min,手术出血量为(40±10)ml,术后未出现相关并发症,医护配合满意度、患者满意度良好.术后3个月随访CT示左肾静脉支架位置无移位,疾病相关症状恢复良好.?结论:新技术的开展促使了手术配合模式的转变,给护理团队的配合提出了更高的要求.充分的术前准备、专业培训的护理团队、熟练的技能配合,以及合理的空间、时间管理是手术安全、顺利、有效的重要环节.

A 14-year-old boy with constant and intense periumbilical pain for the past 24 months caused by nutcracker syndrome (NCS) (visual analog pain scale, 8-9) was treated with 3D printed PEEK extravascular stent. To our best knowledge this is the first European application in a child. 3D model reconstruction showed that the left renal vein (LRV) and the duodenum were contracted at almost the same level via aortomesenteric angle, resulting in LRV compression from the abnormal high-level duodenal compartment. Surgical procedure included a dissection of fibrous bundles which freed the duodenum. LRV was dissected out medially from the renal hilum to the vena cava inferior until it was completely mobilized. A complete resection off the narrow fibrous ring between abdominal aorta and superior mesenteric artery was necessary. 3D printed PEEK extravascular stent via camera port was placed and bound to the narrowed portion of LRV to prevent blood vessel compression. Such stent demonstrates significant advantages over open or other minimally invasive surgery such as endovascular stenting and artificial vessels procedures with expanded polytetrafluoroethylene. It has distinctive personalized design and good rigidity as well as durability which allow vascular growth, preventing stent migration and thrombosis as well. Therefore, it is suitable for both adult and pediatric patients.

Three-dimensional printed polyetheretherketone (PEEK) extravascular stent was applied to treat a 14-year-old boy with nutcracker syndrome. Digital subtraction angiography revealed a segment of the left renal vein (LRV) with reduced contrast filling immediately before its inflow into the inferior vena cava, and high-pressure gradient. The three-dimensional reconstruction model demonstrated that the LRV and the duodenum were contracted at the aortomesenteric angle, resulting in LRV compression from the abnormal high-level duodenal compartment. When duodenum courses between the abdominal aorta and superior mesenteric artery (duodenal interposition), the LRV entrapment occurs even at <90 aortomesenteric degrees. Three-dimensional printed PEEK extravascular stent was chosen to elevate the superior mesenteric artery and lower the duodenum position, thus relieving LRV compression. This extravascular application has significant advantages over open surgery, endovascular stenting and artificial vessel procedures with expanded polytetrafluoroethylene. It provides better cellular vitality by ensuring soft tissue proliferation. By reducing external acceleration and centrifugal force, a three-dimensional printed PEEK extravascular stent reduces adverse side effects. Such a stent has a distinctive personalized design, good stiffness, and durability that allows blood vessel growth, preventing stent migration and thrombosis. Therefore, it is suitable for both adult and pediatric patients. According to the abdominal ultrasound and multi-slice computed tomography scan, the postoperative follow-up results were satisfactory one year after surgery. The patient felt well, the blood flow in the LRV was not obstructed, and the blood flow velocity was average. The external stent was in place.

目的 探索热休克蛋白60(HSP60)蛋白表达变化影响膀胱癌细胞逃避自然杀伤(NK)细胞免疫监视的作用及机制.方法 免疫组织化学染色法检测HSP60在膀胱癌组织及癌旁组织中的表达,统计学分析HSP60在膀胱癌及癌旁组织的表达差异及HSP60表达水平与膀胱癌患者预后的相关性.利用腺病毒载体构建HSP60稳定干涉及过表达的膀胱癌细胞系并与NKL细胞共培养,ELISA及LDH释放实验检测NK细胞活化及杀伤能力的变化.Western blot法检测膀胱癌细胞乳酸脱氢酶A(LDHA)表达,试剂盒检测乳酸分泌.在HSP60稳定干涉及过表达的膀胱癌细胞系,利用小干涉RNA (siRNA)敲低或利用质粒过表达膀胱癌细胞中的LDHA,检测对NKL细胞杀伤能力的影响.利用线粒体活性氧探针MitoSOX检测线粒体活性氧(ROS)水平,Western blot法检测膀胱癌细胞缺氧诱导因子1α (HIF-1α)的蛋白表达,利用靶向线粒体抗氧化剂MitoEMPO及siRNA降低HSP60稳定干涉膀胱癌细胞中线粒体ROS及HIF-1α水平,探索HSP6O表达降低促进LDHA表达的具体机制.结果 膀胱癌组织HSP60蛋白的表达水平较癌旁组织显著降低,且HSP60表达越低的膀胱癌患者其预后越差;敲低HSP60蛋白表达可显著上调膀胱癌细胞LDHA的表达及乳酸的分泌,反之,过表达HSP60可显著抑制膀胱癌细胞LDHA的表达及乳酸的分泌;siRNA LDHA可显著增强HSP60敲低导致NKL细胞的杀伤抑制,同时过表达LDHA可显著抑制HSP60过表达导致NKL杀伤增强.此外,敲低膀胱癌细胞HSP60表达可通过激活ROS/HIF-1α通路促进LDHA的表达.结论 敲低膀胱癌细胞HSP60表达通过激活ROS/HIF-1α通路促进LDHA的表达,抑制NK细胞的杀伤作用.