Aggressive fibromatosis is a rare and benign stromal tumor. Aggressive fibromatosis is characterized by mesenteric fibrous hyperplasia. Although aggressive fibromatosis occasionally invades intestine or adjacent tissues with invasive myofibroblast proliferation, it lacks the ability of malignant tumorigenesis and distant metastasis. Aggressive fibromatosis associated ureteral stricture is a rare urinary disease. This paper reported a case of aggressive fibromatosis of ureter admitted to The Fifth Affiliated Hospital of Guangzhou Medical University in May 2021.

OBJECTIVE:To identify the key genes associated with the pathogenesis of PCa using the bioinformatics approach for a deeper insight into the molecular mechanisms underlying the development and progression of PCa.METHODS:The microarray datasets GSE70770, GSE32571 and GSE46602 were downloaded from the Gene Expression Omnibus (GEO) database, and differentially expressed genes (DEG) in the normal prostate tissue and PCa were identified with the GEO2R tool, followed by functional enrichment analysis. A protein-protein interaction (PPI) network of DEGs was constructed by STRING and visualized with the Cytoscape software.RESULTS:A total of 235 DEGs were identified, including 61 up-regulated and 174 down-regulated genes, which were mainly enriched in focal adhesion kinase (FAK), ECM-receptor interaction, and other signaling pathways. From the PPI network were screened out 12 highly connected hub genes, including MYH11, TPM1, TPM2, SMTN, MYL9, VCL, ACTG1, CNN1, CALD1, ACTC1, MYLK and SORBS1, which were shown by hierarchical cluster analysis to be capable of distinguishing prostate cancer from non-cancer tissue.CONCLUSIONS:A total of 235 DEGs and 12 hub genes were identified in this study, which may contribute to a further understanding of the molecular mechanisms of the development and progression of PCa, and provide new candidate targets for the diagnosis and treatment of the malignancy.

输尿管阴道瘘是输尿管损伤后的一种严重并发症,大多数为妇产科手术造成[1,2] ,目前多采用输尿管镜植入双 J 管或开放手术修复输尿管阴道瘘治疗[3].留置双J 管瘘口自愈率低( 5％ ～15％) ,开放手术修复输尿管阴道瘘创伤大,患者难以接受[3].近年来,新型覆膜金属支架已应用在输尿管狭窄的治疗中,这类支架具有覆膜结构以及自膨胀金属局段支撑的特点[4～6].2018年11月～2019年6月我们对6例妇科手术致输尿管阴道瘘采用新型覆膜金属支架( Allium Medical)治疗,现报道如下.

Clear cell renal cell carcinoma (ccRCC) carrying wild-type Von Hippel–Lindau (VHL) tumor suppressor are more invasive and of high morbidity. Concurrently, competing endogenous RNA (ceRNA) network has been suggested to play an important role in ccRCC malignancy. In order to understand why the patients carrying wild-type VHL gene have high degrees of invasion and morbidity, we applied bioinformatics approaches to identify 861 differentially expressed RNAs (DE-RNAs) between patients carrying wild-type and patients carrying mutant VHL from The Cancer Genome Atlas (TCGA) database, established a ceRNA network including 122 RNAs, and elected six survival-related DE-RNAs including Linc00942, Linc00858, RP13_392I16.1, hsa-miR-182-5p, hsa-miR-183-5p, and PAX3. Examining clinical samples from our hospital revealed that patients carrying wild-type VHL had significantly higher levels of all six RNAs than those carrying mutant VHL. Patients carrying wild-type VHL had significantly higher risk scores, which were calculated based on expression levels of all six RNAs, than those carrying mutant VHL. Patients with higher risk scores had significantly shorter survival times than those with lower risk scores. Therefore, the risk scores serve well to predict malignancy and prognosis.

目的 探讨经皮肾穿刺顺行输尿管镜技术及经尿道逆行输尿管镜技术在腔内治疗移植肾输尿管狭窄中的安全性及有效性.方法 回顾性分析2007年5月-2017年12月于该院治疗的43例移植肾输尿管狭窄患者的临床资料.平均年龄35.7岁,输尿管膀胱吻合口狭窄平均长度0.75 cm,输尿管行程段狭窄平均长度0.70 cm.术中采用经皮肾穿刺顺行输尿管镜技术及经尿道逆行输尿管镜技术对移植肾输尿管狭窄或闭锁段行电刀内切开和球囊扩张术,术后留置输尿管内支架管或金属支架.结果 43例移植肾输尿管狭窄患者中,经尿道逆行输尿管镜治疗组20例,联合经皮肾穿刺顺行输尿管镜技术治疗23例,平均手术时间为(53.3±10.5)min,30例经腔内治疗痊愈,其中一期治疗成功13例,17例行2或3次腔内球囊扩张后治愈;13例反复狭窄复发予以留置镍钛形状记忆合金支架,其中5例留置新型金属覆膜支架,术后随访时间为3～36个月,实验室复查血清肌酐(Scr)(143.4±28.0)μmol/L.结论 采用经皮肾穿刺顺行输尿管镜技术及经尿道逆行输尿管镜技术等腔内治疗途径,处理移植肾输尿管狭窄是安全、有效及可靠的.

Objective To compare the safety and effectiveness of using a conventional nephrostomy sheath (NS) vs using a new NS with suction and evacuation functions in minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of staghorn stones. Patients and Methods A prospective and randomised study of 60 patients with staghorn stones randomly assigned into two groups of 30 patients. One group underwent MPCNL using conventional NS, whereas the other group underwent MPCNL with suction-evacuation NS (SENS). Patient demographics, stone characteristics, intraoperative data, perioperative data, and surgical results were collected and analysed. Results The patient demographics and stone characteristics were similar amongst the two groups. The SENS group had a significantly lower peak and a significantly lower average renal pelvic pressure (RPP) throughout the procedure. The SENS group was more efficient for stone removal and had a much shorter stone treatment time, a lesser use of the stone extractor, and ultimately a higher stone-free rate (SFR). The effects of a lower RPP and shorter stone treatment time translated into less severe postoperative complications as measured per modified Clavien grade. Conclusion Using SENS in MPCNL for the treatment of staghorn stones has the advantages of lower RPP, increased effectiveness in stone retrieval, decreased surgery related complications, and an improved SFR.

目的 探讨电子输尿管软镜联合U100Plus激光治疗上尿路2～3 cm结石的安全性及有效性.方法 回顾性分析广州中医药大学金沙洲医院及广州医科大学附属第五医院2018年2月至2018年6月应用电子输尿管软镜结合U100Plus腔内激光碎石系统治疗66例上尿路2～3 cm结石的临床资料,记录术后1个月结石清除率,观察手术效果及围手术期并发症(Clavin-Dindo分级)情况.结果 平均结石直径(2.3±0.3)cm,单次碎石成功率100％.平均碎石时间(56±24)min,平均术后住院时间(2.3±1.2)d.术后1个月结石清除率为87.9％.手术并发症发生率为9.09％(6例),其中Ⅰ级4例,3例术后体温>38.5℃,1例反复疼痛需镇痛;ⅢA级2例,术后1个月形成输尿管石街,再次手术清石.结论 电子输尿管软镜联合U100Plus激光治疗上尿路2～3 cm结石,碎石效率高,并发症少,结石清除率高.

目的 对应用输尿管软镜(RIRS)治疗上尿路结石的经验进行总结,以评价该技术的安全性及临床疗效.方法 选取2007年6月-2017年6月该院采用RIRS治疗的上尿路结石患者10413例.回顾性分析可拆卸输尿管软镜(n=774)、纤维输尿管软镜(n=2293)和电子输尿管软镜(n=7346)3种软镜治疗上尿路结石的成功率、结石清除率、手术时间、住院时间和手术并发症等差异.结果 可拆卸输尿管软镜、纤维输尿管软镜和电子输尿管软镜一期手术成功率分别为73.00％、82.99％和91.00％.二期手术(一期放置输尿管内支架管)分别为27.00％、17.01％和9.00％.结石清除率分别为87.00％、89.00％和93.00％.平均手术时间分别为(112.0±32.5)、(90.0±24.0)和(75.5±20.5)min.平均住院时间分别为(9.0±1.5)、(7.0±1.0)和(5.0±1.5)d.手术并发症发生率分别为3.62％、1.30％和0.99％.结论 采用RIRS技术治疗上尿路结石安全、有效.随着RIRS技术的不断提高,以及输尿管软镜相关设备的不断优化,提高了该项技术的手术成功率及结石清除率、降低了并发症发生率和缩短了住院天数,RIRS治疗的临床适应证将逐步扩大.

目的 探讨腔内诊治妊娠期肾积水合并顽固性肾绞痛的安全性和有效性.方法 回顾性分析2017年3月至2018年9月我院收治的78例妊娠期肾积水合并顽固性肾绞痛患者的病例资料.根据顽固性肾绞痛持续时间将患者分为A组(6 h以内16例),B组(6～12 h 53例)和C组(12 h以上9例).结果 58例术中发现输尿管结石,16例(27.6%)术前彩超未见输尿管结石,行输尿管镜碎石取石和留置输尿管双J管.输尿管结石清除率87.9%(51/58).20例未发现输尿管结石但合并肾盂结石患者,术中留置输尿管双J管.9例(11.5%)有先兆流产表现,其中A组1例(6.25%), B组4例(7.55%),C组4例(44.4%).C组先兆流产的发生率高于A和B组(P＜0.05).1例(6.25%)患者出现尿源性脓毒血症,抗感染等对症处理后痊愈.所有患者均成功通过围产期并生产健康婴儿.结论 对于妊娠期肾积水合并顽固性肾绞痛的患者,早期输尿管镜腔内处理是有效安全的诊断和治疗手段,可降低孕妇和胎儿的风险.

目的 评估新型覆膜金属支架用于移植肾输尿管狭窄的安全性和有效性.方法 回顾性分析2018年12月～2019年10月使用覆膜金属支架治疗的7例移植肾输尿管狭窄的临床资料.结果 7例输尿管狭窄均位于移植肾输尿管膀胱连接部,狭窄段长5～15 mm,平均10 mm,均成功植入覆膜金属支架.6例术前、术后肾功能均正常;1例术前血肌酐455μmol/L,术后3天降至178μmol/L.7例术后3个月复查利尿肾图及尿路造影,提示上尿路引流通畅.随访3～11(6.6±2.6)月.1例术后3个月输尿管狭窄消失,覆膜金属支架排至膀胱,使用输尿管镜经尿道取出.7例均未发生尿路感染、结石形成、下腹痛等.结论 覆膜金属支架治疗移植肾输尿管狭窄安全有效.

Clear cell renal cell carcinoma (ccRCC) is one of the most common malignant tumors in the urinary system. Surgical intervention is the preferred treatment for ccRCC, but targeted biological therapy is required for postoperative recurrent or metastatic ccRCC. Autophagy is an intracellular degradation system for misfolded/aggregated proteins and dysfunctional organelles. Defective autophagy is associated with many diseases. Mul1 is a mitochondrion-associated E3 ubiquitin ligase and involved in the regulation of divergent pathophysiological processes such as mitochondrial dynamics, and thus affects the development of various diseases including cancers. Whether Mul1 regulates ccRCC development and what is the mechanism remain unclear. Histochemical staining and immunoblotting were used to analyze the levels of Mul1 protein in human renal tissues. Statistical analysis of information associated with tissue microarray and The Cancer Genome Atlas (TCGA) database was conducted to show the relationship between Mul1 expression and clinical features and survival of ccRCC patients. Impact of Mul1 on rates of cell growth and migration and autophagy flux were tested in cultured cancer cells. Herein we show that Mul1 promoted autophagy flux to facilitate the degradation of P62-associated protein aggresomes and adipose differentiation-related protein (ADFP)-associated lipid droplets and suppressed the growth and migration of ccRCC cells. Levels of Mul1 protein and mRNA were significantly reduced so that autophagy flux was likely blocked in ccRCC tissues, which is potentially correlated with enhancement of malignancy of ccRCC and impairment of patient survival. Therefore, Mul1 may promote autophagy to suppress the development of ccRCC.

Objective To compare the efficacy and safety of preoperative reserved double J catheter and balloon dilatation in the application of retrograde intra-renal surgery (RIRS). Methods Clinical data of 125 patients undergoing RIRS for unilateral ureteral dilatation in our hospital from May 2016 to May 2018 were retrospectively analyzed. Among them, 57 patients received reserved double J catheter for passive ureteral dilatation and 68 cases underwent primary balloon for active ureteral dilatation. General data and postoperative data were statistically analyzed between two groups. Results No statistical difference was observed in gender, age, stone site, the maximum diameter of stones and the number of multiple stones between the two groups (allP>0.05). The proportion of retained 16 F ureteral access sheath (UAS) in the reserved double J catheter group was significantly higher than that in the balloon dilation group (70.2% vs 30.9%,P 0.05). Conclusion Reserved double J catheter and balloon dilatation are safe and effective in RIRS. The selection of ureteral dilatation approach depends on the physical conditions of patients, the expertise of physicians and hospital equipment,etc. Key words: Flexible ureteroscope; Stone; Double J catheter; Balloon dilation; Ureteral access sheath

BackgroundP62 (also named sequestosome‐1, SQSTM1) is involved in autophagy regulation through multiple pathways. It interacts with autophagosomes‐associated LC3‐II and ubiquitinated protein aggregates to engulf the aggregates in autophagosomes, interacts with HDAC6 to inhibit its deacetylase activity to maintain the levels of acetylated α‐tubulin and stabilities of microtubules to enhance autophagosome trafficking, and regulates autophagy initiation and cell survival. We performed immunohistochemistry staining of P62 in prostate tissues from prostate cancer patients and found that levels of P62 in patients with prostate adenocarcinomas (PCA) are significantly higher than those in patients with benign prostate hyperplasia (BPH). High levels of P62 predict high tumor grade and high intensity of metastasis.MethodsWe created prostate cancer cell lines stably overexpressing P62 and then suppress the expression of P62 in the cell line stably overexpressing P62 with CRISPR technology. Cell proliferation assay with crystal violet, cell migration assay, cell invasion assay, Western blot analysis, and confocal fluorescent microscopy were conducted to test the impact of altered levels of P62 on the growth, migration, invasion, epithelial‐to‐mesenchymal transition, autophagy flux, HDAC6 activity, and microtubular acetylation of cancer cells.ResultsP62 increased the levels of HDAC6 and reduced the acetylation of α‐tubulin and the stability of microtubules. Consequently, high levels of P62 caused a promotion of epithelial‐to‐mesenchymal transition in addition to an impairment of autophagy flux, and further led to an enhancement of proliferation, migration, and invasion of prostate cancer cells.ConclusionP62 promotes metastasis of PCA by sustaining the level of HDAC6 to inhibit autophagy and promote epithelial‐to‐mesenchymal transition.

Objective To systematically analyze the clinical efficacy and safety of micro-percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in the treatment of kidney stones that measure smaller than 3 cm. Methods Through searching PubMed, Cochrane library, Embase, CNKI, Wanfang database and SinoMed, clinical trials related to micro-PCNL and RIRS in treating small-and medium-size kidney stones in both Chinese and English from January 1, 2011 to March 1, 2017 were retrieved. According to the inclusion and exclusion criteria, relevant clinical trial data were extracted from the literatures and statistically analyzed by Revman 5.0 software to draw a conclusion. Results Four articles consisting of 328 patients were included in this meta-analysis, including two randomized controlled trials and two retrospective trials. No statistical significance was noted in terms of the length of hospital stay [(WMD=2.71, 95%CI (-3.78,9.20)], operation time (WMD=6.56, 95%CI (-22.94,36.05)] and postoperative complications [OR=0.99, 95%CI (0.51,1.95)] between RIRS and micro-PCNL, whereas the removal rate of kidney stones by micro-PCNL was significantly higher compared with that by RIRS (OR=2.30, 95%CI (1.24,4.26)]. Conclusion Both micro-PCNL and RIRS are efficacious and safe in the treatment of kidney stones, whereas the removal rate of micro-PCNL is considerably higher than that by RIRS. Key words: Micro, percutaneous nephrolithotomy; Flexible ureteroscope; Kidney stone; Meta-analysis

Objective To study of using E.coli Nissle1917 which can express FCoAT (EcN-Frc) as probiotic treatment to reduce urine oxalate in a rat model. Methods Thirty male SD rats were randomly divided into 6 groups (A to F). 1% oxalate was added to the diet for rats in group B, C, D, E, F; while rats in group A received regular diet. Furthermore, 30 minutes before each feeding, each rats in group B received 1 ml suspension, while those in group C, D, E, F was given 1 ml EcN-Frc suspension (103 viable bacteria). Rats in group C, D, E, F were feeding bacteria every day, once every three days, once a week, respectively. 24-hour urine specimens were obtained on days 0, 3, 6, 9, 14 by placing the rats in metabolic cages. Results Hyperoxaluria rats due to high dietary oxalate were treated by EcN-Frc. It can effectively reduce the high urinary oxalate level in rat model since day 3 after supplementation. The effect of the decrease proved directly proportional to the dose of EcN-Frc.But, one dose of EcN-Frc (103 viable bacteria) can still effectively reduce urinary oxalate in a 2 weeks period. It showed that EcN-Frc had the ability to stay stable in rat’s intestine and grew well. In addition, during 2 weeks period, all rats kept health with no signs of toxicity. Conclusions Probiotic administration of low dose EcN-Frc can effectively reduce the high urinary oxalate in hyperoxaluria rats. EcN-Frc can stay stable in rat’s intestine and play a role in degrading oxalate. This approach appears to be safe and good tolerance. Key words: FCoAT; E.coli; Oxalate; Treatment; Rat; Random

Objective To evaluate the clinical value of minimally endoscopic combined intrarenal surgery (MECIS) in the prone split-leg position in managing the staghorn calculi.Methods The clinical data of 30 patients (10 males and 20 females) with staghorn calculi who underwent MECIS in prone split-leg position during May and August 2016 were retrospectively analyzed.The patients' mean age was (42.4± 10.9) years,the body mass index (BMI) was 23.1～30.1 kg/m2,and the diameter of stones was 3.4～5.4 cm.Results All procedures were performed successfully with a F20 single tract.The mean operation time was (116 ± 9.83)min.The initial stone-free rate (SFR) was 83.3 ％,and the final SFR was 87 ％.Residual stones were observed in 5 patients,1 of whom received extracorporeal shock wave lithotripsy (ESWL),2 received minimally invasive percutaneous nephrolithotomy (mPCNL) and 2 were followed up.No complications such as intestinal injury or septic shock occurred during operation.One patient required blood transfusion,and 3 patients had postoperative fever.All recovered after conservative treatment.The SFR was 87％ 1 month after operation.Conclusions MECIS in the prone split-leg position is a viable approach for staghorn calculi,with high SRF and low complication rate.Doctors who perform mPCNL are familiar with this position.This position is the ideal position for MECIS.

OBJECTIVE To explore the effect of double-J stent indwelling time in treatment of ureteral calculi patients complicated with infection so as to provide guidance for clinical application.METHODS A total of 123 ureteral calculi patients complicated with infection who were treated in hospitals from Jan 2012 to Mar 2016 were recruited as the study objects,the patients firstly received the double-J stent indwelling via rigid ureteroscope after admission and then underwent the ureteroscopic holmium laser lithotripsy or percutaneous nephrolithotomy for removal of stones.The enrolled patients were divided into the 7-day group with 58 cases and the more than 7-day group with 65 cases according to the indwelling time of double-J stent.The baseline data and surgical data were compared between the two groups of patients.RESULTS Totally 33 strains of pathogens were isolated,of which 66.7％ were gram-negative bacteria.As compared with the baseline data,there was no significant difference in the gender,age,body mass index,disease course,body temperature,or blood,urine white blood cell (WBC) counts between the two groups of patients,which was comparable.There was no significant difference in the urine WBC counts on right day of double-J stent indwelling,blood,urine WBC counts on day 7 of indwelling,or fever between the two groups of patients.As compared with the surgical data,there was no significant difference in the operation duration,surgical approach,postoperative hospitalization duration,clearance rate of stones 30 days after the surgery,incidence of postoperative complications,or Clavien-Dindo grading between the two groups of patients.CONCLUSION The indwelling time of double-J stent does not have significant impact on therapeutic effect and safety of the ureteral calculi patients complicated with infection.It is suggested that the double-J stent should be removed after 7 days of indwelling and carry out the stone surgery as early as possible.

Objective To investigate the safety and feasibility of minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of elderly patients with kidney cast calculi.Methods Clinical data of 107 elderly patients with renal calculi (experimental group) and 107 patients with renal calculi less than 70 years (control group) were retrospectively analyzed.All patients were treated with MPCNL.Hospitalization time,complications and follow-up of the patients were observed.Results All operations of the experimental group were successful.There were no differences in the operation time,hospitalization time and complications between the 2 groups (P＞0.05).Both groups were followed up for 3-18 months,mean (10.1±1.2) months.Conclusions MPCNL is safe and feasible for elderly patients,and the therapeutic effect is the same as in younger patients.It can reflect the superiority of minimally invasive surgery.

Objective To investigate the incidence and prevention of postoperative complications of minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with solitary kidney calculi and chronic renal insufficiency.Methods The clinical data of 122 patients with solitary kidney calculi and chronic renal insufficiency undergoing MPCNL during May 2007 and June 2015 were retrospectively analyzed.The patients included 65 males and 57 females,aged 26-78 years,mean (42±3.5)years.The postoperative complications were summarized.Results Complications occurred in 24 cases.Of the 10 patients who needed hemodialysis before operation,5 did not need it after operation.Of the 6 patients who received selective renal artery embolization,3 needed long-term hemodialysis.There were significant differences between serum creatinine,β2-MG,and creatinine clearance rate before and after operation (all P＜0.05).Conclusions MPCNL can cause few complica tions in the treatment of solitary kidney calculi and chronic renal insufficiency.Preoperative preparation,effective anti-infection,and skilled lithotripsy techniques can reduce the incidence of complications.Special attention should be paid on the risk factors of complications in order to spread the application of MPCNL.

Objective To explore the risk factors ,prevention and treatment of the occurrence of perirenal hematoma after flexible lithotripsy. Methods We retrospectively analyzed the clinical data of 18 patients with symptomatic perirenal hematoma from 1259 who had undergone ureteral flexible lithotripsy in our hospital during the period of April 2007 to April 2016. Of the 18 patients,7 were complicated with diabetes mellitus,11 had urinary tract infection;15 were female,and 3 were male. Results Perirenal hematoma was confirmed by B ultrasound and CT,which situated on the Posterolateral side of the kidney in 8 patients,and on the lower pole and abdominal side in 10. Hematoma depth was 2.6-15.3 cm(average was 5.2 cm). The hematoma?related symptoms gradually disappeared in 11 patients 7 to 14 days after they received conservative treatment. 5 recovered gradually 15 days after undergoing hematoma puncture and drainage ,and 2 recovered 36 days after receiving open surgery for removal of hematoma. Conclusions Female,diabetes,urinary tract infection,bigger stone size,prolonged surgical duration,and infected stones were the risk factors for perinephric hematoma related to ureteroscopic lithotripsy. Full preoperative preparation ,effective anti?infection ,intraoperative improvement of calculus?breaking skills and use of large caliber semirigid through sheath,low pressure perfusion,shorter surgical duration,and staging surgery are effective ways to reduce the occurrence of perirenal hematoma.