Bricker operation was used to treat advanced paraplegia with severe upper uninary tract deterioration, bilateral ureterohydronephrosis, recurrence urinary tract infection, and chronic renal failure.Three cases have good results. The operation is an extensive and complex procedure,indication should be strict.

Objective:To investigate the effect of cholesterol-modified prognostic nutritional index (cPNI) on postoperative long-term prognosis of the borderline resectable pancreatic cancer (BRPC).Methods:Clinical data of 173 patients with BRPC admitted to the Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University from January 2011 to September 2023 were retrospectively analyzed, including 90 males and 83 females, aged (61.7±9.8) years. The receiver operating curve (ROC) of preoperative cPNI predicting 1-year postoperative survival was drawn and the optimal cut-off value in predicting 1-year survival was 77.36. Patients were divided into low cPNI ( n=83, cPNI≤77.36) and high cPNI group ( n=90, cPNI>77.36). Kaplan-Meier method was used for survival analysis, log-rank test was used for univariate analysis, and Cox proportion hazard model was used for multivariate analysis to reveal the effect of cPNI on postoperative long-term survival in patients with BRPC. Results:The cumulative survival rates at 1, 2 and 3 years after surgery in low cPNI group and high cPNI group were 70.6%, 40.3%, 21.8%, and 48.3%, 21.5%, 9.5%, respectively ( χ2=8.49, P=0.004). Univariate analysis showed that preoperative cPNI, length of portal vein invasion, tumor differentiation degree, tumor TNM stage, tumor diameter, lymph node metastasis, and postoperative chemotherapy were correlated with long-term survival of BRPC patients (all P<0.05). Multivariate analysis showed that BRPC patients with preoperative cPNI >77.36 ( HR=1.452, 95% CI: 1.026-2.053, P=0.035) had a increased risk of postoperative death, while patients with length of portal venous invasion >3.0 cm, poorer tumor differentiation, lymph node metastasis and no postoperative chemotherapy had an increased risk of postoperative death. Conclusion:Preoperative cPNI >77.36 is a risk factor for long-term survival in BRPC patients.

Uncovering the functionally essential variations related to tumorigenesis and tumor pro-gression from cancer genomics data is still challenging due to the genetic diversity among patients, and extensive inter-and intra-tumoral heterogeneity at different levels of gene expression regulation, including but not limited to the genomic, epigenomic, and transcriptional levels. To minimize the impact of germline genetic heterogeneities, in this study, we establish multiple primary cultures from the primary and recurrent tumors of a single patient with hepatocellular carcinoma (HCC). Multi-omics sequencing was performed for these cultures that encompass the diversity of tumor cells from the same patient. Variations in the genome sequence, epigenetic modification, and gene expression are used to infer the phylogenetic relationships of these cell cultures. We find the discrepancy among the relationships revealed by single nucleotide variations (SNVs) and transcriptional/epigenomic pro-files from the cell cultures. We fail to find overlap between sample-specific mutated genes and differ-entially expressed genes (DEGs), suggesting that most of the heterogeneous SNVs among tumor stages or lineages of the patient are functionally insignificant. Moreover, copy number alterations (CNAs) and DNA methylation variation within gene bodies, rather than promoters, are significantly correlated with gene expression variability among these cell cultures. Pathway analysis of CNA/DNA methylation-related genes indicates that a single cell clone from the recurrent tumor exhibits distinct cellular characteristics and tumorigenicity, and such an observation is further confirmed by cellular experiments both in vitro and in vivo. Our systematic analysis reveals that CNAs and epigenomic changes, rather than SNVs, are more likely to contribute to the phenotypic diversity among subpop-ulations in the tumor. These findings suggest that new therapeutic strategies targeting gene dosage and epigenetic modification should be considered in personalized cancer medicine. This culture model may be applied to the further identification of plausible determinants of cancer metastasis and relapse.