Chromosomal instability (CIN), a hallmark of malignancy, remains poorly understood in clear cell renal cell carcinoma (ccRCC). Here, we identify spindle and kinetochore-associated protein 3 (SKA3) as a critical regulator of CIN in ccRCC. BAP1 loss-of-function mutations, prevalent in ccRCC, drive aberrant SKA3 overexpression. Mechanistically, BAP1 deubiquitinates nuclear receptor co-repressor 1 (NCOR1) to enhance its recruitment to the SKA3 promoter, thereby repressing SKA3 transcription. Additionally, BAP1-mediated histone H2AK119 deubiquitination at the TRIM25 promoter activates the expression of TRIM25, facilitating ubiquitin-proteasome-mediated degradation of SKA3. BAP1 deficiency disrupts both regulatory pathways, leading to aberrant accumulation of SKA3, which fuels CIN and correlates with metastasis progression and poor prognosis. In conclusion, our findings establish dysfunction of the BAP1-SKA3 axis as a molecular driver of CIN in ccRCC and suggest SKA3 as a potential therapeutic target for BAP1-mutant ccRCC.

BACKGROUND:The development of adrenocortical adenoma (ACA) affects the endocrine homeostasis of the patient and causes various pathophysiological abnormalities. At this stage, the diagnosis of the disease and the distinguishing of adenoma subtypes in patients with ACA remains an unresolved clinical issue. Our study aimed to identify biomarkers for adenoma subtypes and their altered metabolic profiles. We also explored the metabolic differences between non-functional adenomas (NFA) of different sizes. METHODS:In this study, we employed untargeted metabolomic analysis on a discovery set of 246 subjects and a validation set of 275 subjects. Following the construction of a biomarker diagnostic model, we proceeded to validate the model through targeted metabolomic analysis in an independent cohort of 631 participants. RESULTS:In adenoma subtypes, the disturbed pathways in aldosterone-producing adenoma (APA), cortisol-producing adenoma (Cushing's syndrome, CS) and NFA were all mainly focused on the tricarboxylic acid cycle, purine metabolism, and lipid metabolism pathways. In NFA of different sizes, the metabolic profiles did not change significantly as the tumor increased in size. Furthermore, we successfully identified uric acid, isocitric acid, and proline as diagnostic biomarkers for ACA, 4-hydroxyestrone as a reliable marker for NFA, and LysoPC(P-16:0/0:0) for distinguishing APA from CS. CONCLUSIONS:The plasma of patients with ACA shows significant metabolic alterations, with a similar pattern of metabolic disturbances between the different adenoma subtypes. In addition, uric acid, isocitric acid and proline combinations, 4-hydroxyestrone and LysoPC (P-16:0/0:0) could serve as potential biomarkers to complement and improve the diagnosis of ACA.

Clear cell renal cell carcinoma (ccRCC) is the predominant subtype of renal cancer and is highly malignant. Despite advances in diagnostics and treatment, the prognosis for ccRCC remains poor. The dual nature (promotion or inhibition) of S100A2 in different cancer types shows the complex involvement of its tumorigenesis, but its effect in ccRCC remains unclear. In this study, we first elucidate the tumor-promoting function of S100A2 in ccRCC by reprogramming glycolysis. Mechanistically, we demonstrate that S100A2 accelerates cancer progression through its interaction with the transcription factor HNF1A, leading to activating GLUT2 transcription. The upregulation of GLUT2 significantly enhances glucose uptake by cancer cells, thereby fueling augmented glucose metabolism and fostering the malignant progression of ccRCC. Collectively, our findings highlight the pivotal role of the S100A2-HNF1A-GLUT2 axis in promoting migration and invasion of ccRCC by amplifying glycolysis and suggest that targeting the S100A2-HNF1A-GLUT2 axis is clinically relevant for the treatment of metastatic ccRCC.

The optimal investment-consumption analysis under insurer default risk and inflation risk for retirees who receive defined benefit pension payments is conducted. To enhance applicability, the minimum welfare guarantee and bequest motives are considered. Using the dynamic programming principle, we obtain the implicit solution of optimal consumption and investment strategies for retirees with a standard constant relative risk aversion utility. Certain implications consistent with financial advice are obtained by numerical analysis. As pension default risk increases, the rich prefer inflation-indexed bonds for hedging motive and the poor invest more in stocks for compensation motive. Despite of the presence of default risk, negative inflation risk premium leads to short positions in inflation-indexed bonds. The life portfolios of the rich tend to be more stable than those of the poor.

Following the ideas of prospect theory, a class of growth functions is used to characterize deterministic variations of firm size, which portrays the asymmetric efforts of the firm to achieve the desired size. Considering the differences in the ability of different firm size to cope with uncertainties, the Boltzmann equation for the evolution of firm size is constructed. Utilizing a suitable scaling limit, the Fokker-Planck equation is acquired and its explicit steady-state solution is derived. Our results illustrate that different choices of parameters in the growth function lead to various statistical laws for firm size, such as the Amoroso distribution, the lognormal distribution and Zipf's law. Under certain conditions, inequality for the distribution of firm size decreases as firm size increases. The numerical analyses are presented to illustrate our results.

Background: Kidney renal clear cell carcinoma (KIRC) is the most prevalent subtype of malignant renal cell carcinoma and is well known as a common genitourinary cancer. Stratifying tumors based on heterogeneity is essential for better treatment options. Methods: In this study, consensus clusters were constructed based on gene expression, DNA methylation, and gene mutation data, which were combined with multiple clustering algorithms. After identifying two heterogeneous subtypes, we analyzed the molecular characteristics, immunotherapy response, and drug sensitivity differences of each subtype. And we further integrated bulk data and single-cell RNA sequencing (scRNA-Seq) data to infer the immune cell composition and malignant tumor cell proportion of subtype-related cell subpopulations. Results: Among the two identified consensus subtypes (CS1 and CS2), CS1 was enriched in more inflammation-related and oncogenic pathways than CS2. Simultaneously, CS1 showed a worse prognosis and we found more copy number variations and BAP1 mutations in CS1. Although CS1 had a high immune infiltration score, it exhibited high expression of suppressive immune features. Based on the prediction of immunotherapy and drug sensitivity, we inferred that CS1 may respond poorly to immunotherapy and be less sensitive to targeted drugs. The analysis of bulk data integrated with single-cell data further reflected the high expression of inhibitory immune features in CS1 and the high proportion of malignant tumor cells. And CS2 contained a large number of plasmacytoid B cells, presenting an activated immune microenvironment. Finally, the robustness of our subtypes was successfully validated in four external datasets. Conclusion: In summary, we conducted a comprehensive analysis of multi-omics data with 10 clustering algorithms to reveal the molecular characteristics of KIRC patients and validated the relevant conclusions by single-cell analysis and external data. Our findings discovered new KIRC subtypes and may further guide personalized and precision treatments.

Shape-memory materials hold great potential to impart medical devices with functionalities useful during implantation, locomotion, drug delivery, and removal. However, their clinical translation is limited by a lack of non-invasive and precise methods to trigger and control the shape recovery, especially for devices implanted in deep tissues. In this study, the application of image-guided high-intensity focused ultrasound (HIFU) heating is tested. Magnetic resonance-guided HIFU triggered shape-recovery of a device made of polyurethane urea while monitoring its temperature by magnetic resonance thermometry. Deformation of the polyurethane urea in a live canine bladder (5 cm deep) is achieved with 8 seconds of ultrasound-guided HIFU with millimeter resolution energy focus. Tissue sections show no hyperthermic tissue injury. A conceptual application in ureteral stent shape-recovery reduces removal resistance. In conclusion, image-guided HIFU demonstrates deep energy penetration, safety and speed.

Pheochromocytomas and paragangliomas (PPGLs) cause symptoms by altering the circulation levels of catecholamines and peptide hormones. Currently, the diagnosis of PPGLs relies on diagnostic imaging and the detection of catecholamines. In this study, we used ultra-performance liquid chromatography (UPLC)/quadrupole time-of-flight mass spectrometry (Q-TOF MS) analysis to identify and measure the perioperative differential metabolites in the plasma of adrenal pheochromocytoma patients. We identified differentially expressed genes by comparing the transcriptomic data of pheochromocytoma with the normal adrenal medulla. Through conducting two steps of metabolomics analysis, we identified 111 differential metabolites between the healthy group and the patient group, among which 53 metabolites were validated. By integrating the information of differential metabolites and differentially expressed genes, we inferred that the cysteine-methionine, pyrimidine, and tyrosine metabolism pathways were the three main metabolic pathways altered by the neoplasm. The analysis of transcription levels revealed that the tyrosine and cysteine-methionine metabolism pathways were downregulated in pheochromocytoma, whereas the pyrimidine pathway showed no significant difference. Finally, we developed an optimized diagnostic model of two metabolites, L-dihydroorotic acid and vanylglycol. Our results for these metabolites suggest that they may serve as potential clinical biomarkers and can be used to supplement and improve the diagnosis of pheochromocytoma.

The annotation of digital pathological slide data for renal cell carcinoma is of paramount importance for correct diagnosis of artificial intelligence models due to the heterogeneous nature of the tumor. This process not only facilitates a deeper understanding of renal cell cancer heterogeneity but also aims to minimize noise in the data for more accurate studies. To enhance the applicability of the data, two pathologists were enlisted to meticulously curate, screen, and label a kidney cancer pathology image dataset from The Cancer Genome Atlas Program (TCGA) database. Subsequently, a Resnet model was developed to validate the annotated dataset against an additional dataset from the First Affiliated Hospital of Zhejiang University. Based on these results, we have meticulously compiled the TCGA digital pathological dataset with independent labeling of tumor regions and adjacent areas (RCdpia), which includes 109 cases of kidney chromophobe cell carcinoma, 486 cases of kidney clear cell carcinoma, and 292 cases of kidney papillary cell carcinoma. This dataset is now publicly accessible at http://39.171.241.18:8888/RCdpia/. Furthermore, model analysis has revealed significant discrepancies in predictive outcomes when applying the same model to datasets from different centers. Leveraging the RCdpia, we can now develop more precise digital pathology artificial intelligence models for tasks such as normalization, classification, and segmentation. These advancements underscore the potential for more nuanced and accurate AI applications in the field of digital pathology.

We investigate the competition between banks according to an evolutionary model, in which the payoff gradient depends on a time-variant technological innovation factor. The explicit solutions of equilibrium strategies are derived via the method of characteristics. Advantageous technological innovation reduces costs and increases profits and credit supply. Better technology also induces the market's herding behavior. Under the Bertrand competition, besides technological innovation, we consider the product substitutability and obtain the equilibrium price, which depends on a substitution parameter and the marginal cost. If there is moderate product differentiation, banks will not always reduce interest rates to seize market share.

Large models have become mainstream, yet their applications in digital pathology still require exploration. Meanwhile renal pathology images play an important role in the diagnosis of renal diseases. We conducted image segmentation and paired corresponding text descriptions based on 60 books for renal pathology, clustering analysis for all image and text description features based on large models, ultimately building a retrieval system based on the semantic features of large models. Based above analysis, we established a knowledge base of 10,317 renal pathology images and paired corresponding text descriptions, and then we evaluated the semantic feature capabilities of 4 large models, including GPT2, gemma, LLma and Qwen, and the image-based feature capabilities of dinov2 large model. Furthermore, we built a semantic retrieval system to retrieve pathological images based on text descriptions, and named RppD (aidp.zjsru.edu.cn).

ObjectivesTo identify the influence of healthy lifestyles on the incidence of the first NCD (FNCD), multiple chronic conditions (MCCs), and the progression from FNCD to MCCs. Design: cohort study. Setting: Zhejiang, ChinaParticipants10566 subjects (55.5 ± 13.5 years, 43.1% male) free of NCDs at baseline from the Zhejiang Metabolic Syndrome prospective cohort.MeasurementsHealthy lifestyle score (HLS) was developed by 6 common healthy lifestyle factors as smoking, alcohol drinking, physical activity, body mass index (BMI) and waist-to-hip ratio (WHR). Healthy lifestyle data and metabolic biomarkers collected via a face-to-face questionnaire-based interview, clinical health examination and routine biochemical determination. Biochemical variables were determined using biochemical auto-analyzer. Participants were stratified into four group based on the levels of HLS as ≤2, 3, 4 and ≥5. Multiple Cox proportional hazards model was applied to examine the relationship between HLS and the risk of FNCD, MCCs and the progression from FNCD to MCCs. The population-attributable fractions (PAF) were used to assess the attributable role of HLS. Mediating effect was examined by mediation package in R.ResultsAfter a median of 9.92 years of follow-up, 1572 participants (14.9%) developed FNCD, and 149 (1.4%) developed MCCs. In the fully adjusted model, the higher HLS group (≥5) was associated with lower risk of FNCD (HR = 0.68 and 95% CI: 0.56−0.82), MCCs (HR = 0.31 and 95%CI: 0.14−0.69); and the progression from FNCD to MCCs (HR = 0.39 and 95%CI: 0.18−0.85). Metabolic components (TC, TG, HDL-C, LDC-C, FPG, and UA) played the mediating roles with the proportion ranging from 5.02% to 22.2% for FNCD and 5.94% to 20.1% for MCCs. PAFs (95%CI) for poor adherence to the overall healthy lifestyle (HLS ≤ 3) were 17.5% (11.2%, 23.7%) for FNCD, 42.9% (23.4%, 61.0%) for MCCs, and 37.0% (15.5%, 56.3%) for the progression from FNCD to MCCs.ConclusionsHigh HLS decreases the risk of FNCD, MCCs, and the progression from FNCD to MCCs. These effects are partially mediated by metabolic components. Maintaining healthy lifestyles might reduce the disease burden of common chronic diseases.

Abstract Purpose Kidney renal clear cell carcinoma (KIRC) is the most prevalent heterogeneous subtype of malignant renal cell carcinoma and is well known as a common genitourinary cancer. Stratifying tumors based on heterogeneity is essential for better treatment options. Methods In this study, consensus clusters were constructed based on gene expression, DNA methylation, and gene mutation data, which were combined with multiple clustering algorithms. We further analyzed the gene differences, pathway enrichment, prognosis, genetic alterations, immunotherapy response and drug sensitivity of each subtype. In addition, we also performed integrated analysis of bulk data and scRNA-Seq data. Results Among the two identified subtypes, CS1 (consensus subtype) was enriched in more inflammation-related and oncogenic pathways than CS2, showing a worse prognosis. We found more copy number variations and BAP1 mutations in CS1. Although CS1 had a high immune infiltration score, it exhibited high expression of suppressive immune features. Based on the prediction of immunotherapy and drug sensitivity, we inferred that CS1 may respond poorly to immunotherapy and be less sensitive to targeted drugs. The analysis of bulk data combined with single-cell data further verified that the suppressive immune features were highly expressed in CS1 and the JAK STAT signaling pathway was enriched in CS1. Finally, the robustness of the new subtyping was successfully validated in four external datasets. Conclusion In conclusion, we conducted a comprehensive analysis of multi-omics data with 10 clustering algorithms to reveal the molecular characteristics of KIRC patients and validated the relevant conclusions by single-cell analysis and external data. Our findings discovered new KIRC subtypes and may further guide personalized and precision treatments.

A kinetic model of binary interactions is developed to describe an exchange market consisting of two groups (A and B) of manufacturing enterprises and two types of production factors (capital and labor). The relationship between production factors and output satisfies the Cobb-Douglas production function. The objective of the manufacturing enterprise is to obtain maximum profits. In the multi-agent market, manufacturing enterprises exchange surplus production factors for insufficient production factors. We assume that manufacturing enterprises in group A put all of the production factors into the market, while the manufacturing enterprises in group B have the priority of selecting a suitable percentage of production factors for exchange. A system of linear kinetic equations is developed for two groups of manufacturing enterprises to characterize the evolution of the quantity of exchanged production factors. The effect of various strategies on the price of production factors and the profit of manufacturing enterprises is explored. The findings reveal that the trading strategy of group B significantly impacts the price of production factors and effectively improves the profit under certain conditions. Furthermore, a system of Boltzmann equations for the probability distribution of production factors is presented to describe the price issues. Simulation experiments illustrate how the trading strategy and the elasticity coefficient of output influence the final price of production factors.

Purpose: To explore the preliminary safety and efficacy of the Shurui single-port (SP) surgical robot in partial nephrectomy (PN).Methods: This study prospectively enrolled patients with T1a renal tumors who met the inclusion criteria from February to July 2022 in The First Affiliated Hospital School of Medicine Zhejiang University. The operative outcomes and perioperative data, including clinical and histological data, were prospectively collected and analyzed.Results: A total of 13 patients were included in this study, including 7 males and 6 females. The median age was 53 (33-74) years, and the average body mass index was 24.9 +/- 4.2 kg/m(2). There were 6 cases of left kidney tumors and 7 cases of right kidney tumors in the 13 patients. The average tumor diameter was 1.9 +/- 0.9 cm. In all operations, the diseased tissue was removed according to the established surgical plan. The average warm ischemia time was 26.2 +/- 9.7 minutes; the average device docking time was 3.6 +/- 1.8 minutes; and the average robotic arm operation time was 124.7 +/- 40.4 minutes. All operations were successfully completed; there was no conversion to open surgery during the operation; and no operation holes were added. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) score was 26.3 +/- 2.6 points, and no device-related adverse events occurred during the operation. The median time to discharge was 6 days (range, 4-11 days). Postoperative pathological examination showed that all tumor margins were negative. There were no Clavien grade >= 3 surgical complications in any of the patients during the perioperative period or at the 1-month postoperative follow-up.Conclusion: The new SP surgical robot system is safe, effective, flexible, and stable for application in PN.

Objective: To compare the perioperative outcomes of patients undergoing retroperitoneal laparoscopic partial nephrectomy(LPN) and retroperitoneal robot-assisted partial nephrectomy (RPN) by matched analysis using R.E.N.A.L. nephrometry scoring system. Methods: Relevant clinical data of 543 case of laparoscopic and robot-assisted partial nephrectomy performed by a single surgeon via the RP approach from January 2016 to March 2020 from our database were screened and analyzed. Two groups were matched 1:1 (112 matched pairs) by R.E.N.A.L. nephrometry score, gender, and age. Statistical analysis was done to compare perioperative outcomes. Results: There was no significant difference between the LPN group and RPN group in terms of age, gender, body mass index (BMI), tumor size, American Society of Anesthesiologists (ASA) score or preoperative estimated glomerular filtration rate (eGFR). Patients undergoing LPN had a slightly higher proportion of the left side tumor (51.7％ Vs 42.9％, P=0.032). No significant differences regarding to operative time, estimated blood loss, postoperative LOS, postoperative eGFR, transfusion or postoperative complications were found between the two groups. However, Warm ischemia times (WIT) in the RPN group were significantly shorter than that in the LPN group (18.9 min Vs 22.6 min, P=0.032). Subset analysis based on complexity indicated that WIT of complex tumors in the RPN group was significantly shorter than that in the LPN group (21.1 min Vs 26.3 min, P=0.012), but no difference of WIT was found on simple tumors between the RPN group and LPN group (16.4 min Vs 18.3 min, P=0.085). Conclusion: Retroperitoneal RPN showed shorter WIT and generally equivalent perioperative results to retroperitoneal LPN. Robotic surgery may have advantages over the traditional laparoscopic surgery on complex tumor excision and renorrhaphy in the limited retroperitoneal space.

Clear cell renal cell carcinoma (ccRCC) is highly heterogeneous and accounts for about 70% of RCC. Its prognosis is worse than that of most histological types of RCC. In order to find potential biomarkers that may influence the prognosis and survival in ccRCC patients, we explored the expressions of STAT3, PDL1 and SCGN (secretagogin) in ccRCC based on the data of TCGA (n = 529), EMATAB-1980 (n = 99) and our own cohort (n = 99). Our study demonstrated that ccRCC patients with low STAT3 expression and high SCGN expression might have a better prognosis. No significant difference in the positive rate of SCGN expression was found when comparing the primary lesion with the matched metastatic liver lesions. The percentage of high SCGN expression in the primary lesion of metastatic ccRCC patients was significantly lower than that of patients with only the renal lesion. In view of the conclusion that STAT3 high expression cases are resistant to sunitinib, STAT3 immunohistochemistry results are essential for designing non-operative treatments. SCGN has the potential to become an indicator for subtype classification of ccRCC.

Purpose: The aim of this study was to explore the safety and efficacy of radical prostatectomy with a novel Shurui single-port (SR-SP) robotic surgical system. Methods: A total of 11 patients with prostate cancer were enrolled in this study. Extraperitoneal radical prostatectomy was performed using the SR-SP robotic surgical system for all patients. Clinicopathologic data, perioperative data, and short-term surgical outcomes were prospectively collected and analyzed. Results: Of the 11 patients, the median age was 65 years (range 52-73), and the median body mass index was 22.6 kg/m(2) (range 20.2-26.7). The median operative time was 229 minutes (range 194-317), and the median console time was 167 minutes (range 141-265). The median blood loss was 40 mL (range 10-120), and none of the patients required intraoperative transfusion. There was no conversion to open surgery during the operation, and no assistant ports were added. The surgeons reported a good task load rating with a National Aeronautics and Space Administration Task Load Index (NASA-TLX) score of 25.1 +/- 3.3 points. The median postoperative hospital stay time was 7 days (range 4-15). There were no severe intraoperative or postoperative complications (Clavien grade >= 3). Postoperative positive surgical margin occurred in 4 (36.4%) patients. No biochemical recurrence occurred within 1 month of surgery. The continence rate was 72.7% (8/11) 1 month after surgery. Conclusions: The new SR-SP robotic surgical system is safe, effective, flexible, and stable for application in radical prostatectomy.

Objective:To investigate the safety and efficacy of the novel single-port surgical robotic surgical system in extraperitoneal urological surgery.Methods:From February to April 2022, patients was prospectively enrolled who required laparoscopic radical prostatectomy, partial nephrectomy and adrenal tumor resection in urology department. Inclusion criteria were: age ≥ 18 years old; BMI 18.5-30 kg/m 2; American Society of Anesthesiologists (ASA) physical status classification system grades 1 to 3; can cooperate with the completion of the visits and related examinations stipulated in the plan, and participate voluntarily clinical trials, and consent or the guardian agrees to sign the informed consent form; tumor indicators meet one of the following surgical treatment indications: kidney tumor T 1 stage, single, maximum tumor diameter ≤ 4 cm; prostate cancer, stage ≤ T 2b, preoperative PSA ≤ 20 ng /ml; Gleason score ≤ 7; adrenal tumor diameter ≤ 7 cm, for non-functioning adrenal adenoma, tumor diameter ≥ 3 cm. Exclusion criteria were: patients with other malignancies or a history of other malignancies and the investigators believe that they are not suitable for inclusion in this researcher; patients who have received the same type of urological surgery in the past and are not suitable for participating in this study as assessed by the investigators; included Those who have undergone other major surgery within the first 3 months and during the trial period, or who cannot recover from the side effects of any such surgery; syphilis, hepatitis B, HIV infection and carriers; long-term use of anticoagulants or blood system diseases; Unable to use effective contraception during the trial period and other conditions that the investigators deem inappropriate to participate in this trial. All operations were performed by a novel single-port robotic surgical operating system, and all surgical procedures were performed through an extraperitoneal approach. Surgical method: the surgical system is mainly composed of a remote console including a high-definition display, a surgical equipment trolley, a surgical execution system that accommodates a serpentine robotic arm, and a bendable serpentine robotic arm. In this study, the extraperitoneal approach was used. For radical prostatectomy, the patient was placed in a supine position, a longitudinal incision of about 3 cm was made below the umbilicus, the anterior rectus sheath was incised, the extraperitoneal space was separated, and an operating sheath was placed. A 12 mm trocar is placed between the right McBurney point and the umbilicus as an auxiliary hole. For partial nephrectomy and adrenal tumor resection, the patient is placed in the lateral position, and an 3cm incision is made 2 cm above the iliac crest on the midaxillary line as the main operating hole. The skin, subcutaneous tissue, and muscle were incised to the retroperitoneal cavity, and a 12mm trocar was placed at the level of the anterior superior iliac spine on the anterior axillary line as an auxiliary hole. The operation was performed after connecting each robotic arm. After the operation, the specimen was placed in the specimen bag, and a drainage tube is placed in the auxiliary hole, the specimen was taken out, and the incision was closed in turn. Preoperative basic information, operation time, blood loss, incision size, postoperative complications, preoperative and postoperative PSA score, eGFR index, postoperative pathological information and other perioperative information were collected. Results:A total of 17 patients were included in this study, including 6 with prostate cancer, 8 with renal tumor, and 3 with adrenal tumor. There were 9 males and 8 females, with an average age of (56.7±14.6) years and a BMI of (23.3±3.4) kg/m 2. The mean operation time of radical prostatectomy was (244.6±35.1) min, the mean operating time of the chief surgeon was (184.0±39.0) min, and the mean blood loss was (36.6±23.8) ml. Postoperative positive margin was found in 2 cases. The average operation time of partial nephrectomy was (189.6±49.4) minutes, the average operating time of the chief surgeon was (115±39.7) minutes, the average blood loss was (12.7±8.3) ml, and the average warm ischemia time was (23.1±10.8) minutes. There was no significant difference in the eGFR index before and after the operation ( P>0.05). The average operation time of adrenalectomy was (177.6±26.9) min, the average operating time of the chief surgeon was (99±20.4) min, and the average blood loss was (11.6±6.2) ml. The overall average operation time of the three surgical methods was (206.9±50.1) min, the overall average operating time of the chief surgeon was (136.5±51.1) min, the overall average blood loss was (21.0±9.2) ml, and the overall average incision size was (3.5±0.5) cm, all added a 12 mm auxiliary channel, and the overall average hospital stay was (8.1±2.7) days. All operations were successfully completed, and there was no conversion to open surgery during the operation, and no operation holes were added. There was no Clavien-Dindo≥grade 3 complication after operation. Conclusions:The novel single-port robot could safely and effectively perform radical prostatectomy, partial nephrectomy and adrenalectomy which are common in urology through extraperitoneal approach.

We investigate the investment behavior of fund managers in financial markets according to evolutionary dynamics. We consider both the absolute and relative portfolio returns in the payoff gradient, to which the fund managers respond, and find the equilibrium proportion of risky investment. Compared to the case where only relative performance affects the payoff gradient, we find that, as the absolute performance affects the managers' belief, the equilibrium of long and short positions increases. If short sales are not allowed, negative excess returns will force the managers to stay out of the market until the excess return becomes positive. Furthermore, we use a quadratic function to depict the relative performance. The quadratic setting captures the exaggerated sentiments of winners and losers arising from certain behavioral biases, and leads to a lower speed of convergence, which implies that herding decelerates and the managers are likely to adhere longer to their own strategies.