Objective: To investigate the efficacy and safety of intelligent temperature-pressure-controlled flexible ureteroscopy combined with negative-pressure suction sheath lithotripsy in the treatment of upper urinary tract stones ≤2.5 cm. Methods: The clinical data of 225 patients with ≤2.5 cm upper urinary tract stones treated with this surgical method in our department during Aug. 2023 and Jul. 2024 were retrospectively analyzed. The patients were divided into the dual-control group (n=36) and conventional group (n=189) according to whether or not the intelligent temperature and pressure control device was used during operation. In the dual-control group，the intraoperative temperature and pressure in the renal pelvis were monitored and controlled in real time by the temperature and pressure sensors distributed at the end of the ureteral soft lens. The perioperative parameters，stone-removal rate，complication rate and renal function were compared between the two groups. Results: All operations were successfully completed in both groups. The postoperative procalcitonin (PCT) level [(22.75±5.85) ng/L vs. (29.08±6.60) ng/L，P=0.001]，difference in the white blood cell (WBC) level [(0.24±2.12)×10 cells/L vs. (1.19±2.17)×10 cells/L，P=0.016]，incidence of fever (2.8% vs. 16.9%，P=0.028) and overall complication rate (5.6% vs. 19.6%，P=0.042) were significantly lower in the dual-control group than in the conventional group，while the stone-clearance rate was slightly higher (88.9% vs. 82.5%，P=0.346)，with no significant difference. Conclusion: For upper urinary tract stones ≤2.5 cm，intelligent temperature-pressure-controlled ureteroscopy combined with negative-pressure suction sheath lithotripsy has a satisfactory stone-removal rate and a low rate of complications，which is worthy of clinical promotion.

【Objective】 To establish a nomogram model for predicting the risk of positive prostate biopsy in MRI-negative patients, and to perform the internal validation. 【Methods】 We retrospectively analyzed the clinical data of 197 MRI-negative patients who underwent prostate biopsy at our hospital, analyzed the independent predictors of positive prostate biopsy with univariate and multivariate logistic regression analysis, constructed the nomogram model and conducted internal validation. 【Results】 Multivariate logistic regression analysis showed age (P=0.003), digital rectal examination (DRE)(P=0.005), total prostate-specific antigen (tPSA) (P=0.001) and prostate volume (PV)(P<0.001) were independent risk factors of MRI-negative but prostate biopsy-positive results. The nomogram model based on all variables was established. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.862, which was greater than that of tPSA (AUC=0.739), PV(AUC=0.711) and DRE(AUC=0.666) (all P<0.05). The average absolute error of the model was 1.1% after 500 internal resampling, indicating that the prediction of positive prostate biopsy was consistent with the actual situation. 【Conclusion】 The age, DRE, tPSA and PV were independent predictors of positive prostate biopsy in MRI-negative patients. The nomogram model has a good prediction performance.

Objective:To explore the independent influencing factors of Gleason group upgrading (GGU)after radical prostatectomy (RP) of localized prostate cancer based on 2014 International Society of Urologic Pathology (ISUP)grouping system, then establish an effective prediction model.Methods:The study included 48567 patients with localized prostate cancer who underwent radical prostatectomy from the surveillance, epidemiology and end results (SEER) database. The age was (61.1±7.0) years, including 39 014 cases (80.3%), 7 063 cases (14.5%), 2 331 cases (4.8%), and 159 cases (0.3%) of White, Black, Asian or Pacific Islander, American Indian/Alaska Native. PSA<4 ng/ml, 4-10 ng/ml, 11-19 ng/ml, ≥20 ng/ml were 6 545 cases (13.5%), 35 007 cases (72.1%), 5 578 cases (11.5%), 1 437 cases (3.0%) respectively. Percent positive cores (PPC)≥33% were 24 743 cases (50.9%). Gleason group of biopsy specimen: G1 18 971cases (39.1%), G2 18 446 cases (38.0%), G3 7 093 cases (14.6%), G4 4 057 cases (8.4%). Simple random sampling was assigned to the cases, divided them into training cohort and internal validation cohort according to the ratio of 7∶3. 67 patients with localized prostate cancer who treated in The Second Affiliated Hospital of Zhengzhou University during January 2017 to December 2021 were set as external validation cohort. All these cases were Asian with Chinese nationality, age(66.4±10.3) years. PSA<4 ng/ml, 4-10 ng/ml, 11-19 ng/ml, ≥20 ng/ml were 13 cases (19.4%), 32 cases (47.8%)16 cases (23.9%), 6 cases (9.0%) respectively. PPC≥33% were 38 cases (56.7%). Gleason group of biopsy specimen: G1 18 cases (26.9%), G2 23cases (34.3%), G3 12 cases (17.9%), G4 14 cases (20.9%). The independent predictors of GGU were analyzed by logistic regression analysis, and the nomogram for predicting GGU were established. Then, the performance of nomograms was internally and externally validated via area under curve (AUC) and the calibration curve.Results:There were 8 716 cases (25.6%), 3 677 cases (25.2%) and 24 cases (35.8%) with GGU in the training group, internal validation group and external validation group, respectively. Logistic regression showed Gleason group of biopsy specimen (G2: OR=0.164, P<0.01; G3: OR=0.073, P<0.01; G4: OR=0.087, P<0.01), PSA (4-10 ng/ml: OR=1.550, P<0.01; 11-19 ng/ml: OR=2.084, P<0.01; ≥20 ng/ml: OR=2.664, P<0.01), age (60-69 years: OR=1.292, P<0.01; ≥70 years: OR=1.550, P<0.01), PPC (≥33%: OR=1.334, P<0.01) and race (Asian or Pacific Islander: OR=1.266, P<0.01) were independent influencing factors for GGU. The predicting model, was established according to Gleason group of biopsy specimen, PSA, age and PPC. The AUC of the model in the training cohort, the internal validation cohort and the external validation cohort were 0.759, 0.757 and 0.747 respectively. The calibration curves of the three cohorts were close to the ideal line and showed good consistency. Conclusions:Gleason group of biopsy specimen, PSA, age, PPC and race are independent influencing factors for GGU after RP of localized prostate cancer. G. P.A.P. model can effectively predict the risk of GGU after RP of localized prostate cancer.

Humans ; Femoral Artery/surgery* ; Hip Dislocation, Congenital ; Hip Joint ; Treatment Outcome

Vagus nerve reflex is a rare complication of percutaneous renal decompression. It is often induced by excessively rapid decompression of severe hydronephrosis and traction of the main nerves innervating the kidney. The clinical manifestations are irritability, sweating, clammy skin, hiccups, slow heart rate. It is easy to misdiagnose. In this study, 4 patients with vagus nerve excitement after percutaneous renal decompression were treated. After monitoring the patient’s vital signs and giving treatment such as expanding blood volume and raising blood pressure, the symptoms gradually disappeared.

The metastasis of renal cell carcinoma to the ureter is a rare phenomenon, and synchronal detection of metastasis to the contralateral ureter is a rarer phenomenon. A 62-year-old male patient with painless hematuria was examined and detected a renal cell carcinoma on the right kidney and bleeding from the left ureter. Ureteroscopy revealed a tumor in the left upper ureter, and biopsy suggested clear cell carcinoma. Laparoscopic radical nephrectomy was performed to resect the right renal cell carcinoma, and the pathology revealed a clear cell carcinoma, with Fuhrman nuclear grade 2 class. The ureteral tumor was resected 3 months later and the pathology revealed renal clear cell carcinoma. Sunitinib was used for 37 months, and there was no tumor recurrence or metastasis so far.

Objective To explore the significance of comprehensive treatment including anticoagulation,inferior vena cava filter implantation,mechanical thrombectomy,iliac vein angioplasty and stent placement and catheter-directed thrombolysis (CDT) in the treatment of acute iliac femoral vein thrombosis on the basis of left iliac vein compression.Methods In this study 61 patients were enrolled at Beijing Luhe Hospital,Capital Medical University between Mar 2013 and Mar 2019 in anticoagulation combined with CDT group and comprehensive treatment group.Short-term venous recanalization rate scores and long-term proximal valvular function of left femoral vein were compared.The survival curve was drawn using kaplan-meier method,and incidence of PTS was compared with the Log rank test.Results The short-term venous recanalization rate scores of the patients in the comprehensive treatment group were higher than scores of the patients in the traditional treatment group(t =9.872,P ＜ 0.001).16 patients developed PTS.The incidence of PTS in the comprehensive treatment group was lower than that in the traditional treatment group(x2 =7.146,P =0.008).Patients in comprehensive treatment group kept a better function of the proximal valvular of left femoral vein than patients in the traditional treatment group (x2 =23.834,P ＜0.001).Conclusions The comprehensive treatment can effectively reduce the occurrence of long-term PTS in patients with acute iliac femoral vein thrombosis complicated with left iliac vein compression,and improves the quality of patients' life.

Objective To investigate the clinical value of limited debridement in treating diabetic foot osteomyelitis with incomplete foot gangrene.Methods Retrospective analysis of traditional surgery (complete removal of diseased bone and soft tissue) and limited debridement (limited removal of diseased bone and soft tissue) in patients with incomplete foot gangrenuria foot osteomyelitis from February 2015 to March 2017,There were 38 cases in the traditional operation group and 76 cases in the limited debridement group.Between the two groups,the sex ratio (20/18 vs 41/35),age (64.90±8.40 vs 68.1±8.10),Wagner 3/4 grading ratio (12/26 vs 26/50),the ratio of nerve ulcers/ischemic neurotic ulcers (13/25 vs 24/52),the ulceration ratio of forefoot/middle foot±hind foot (33/5 vs 68/8),arterial ABI (0.71±0.39 vs 0.67±0.33),and lower extremity arterioplasty ratio (52.63％ vs 59.21％),combined with hypertension (78.95％ vs 77.63％),coronary heart disease (71.05％ vs 69.74％),cardiac insufficiency (10.53％ vs 9.21％),renal failure rate (21.05％ vs 22.37％),incidence of hypoproteinemia (10.53％ vs 10.53％),anaemia (15.79％ vs 19.74％) and drug resistance of drug resistant bacteria (26.32 vs 23.68％) had no statistical difference.All the patients received antibiotic after surgery.The incidence of antibiotic related complications,the rate of amputation on the ankle,the average length of hospitalization,the average healing time of the ulcer/wound,the rate of readmission in one year,the rate of recurrent ulcer,the rate of new ulceration,the rate of ulceration and the death rate were collected to evaluate the clinical effects.Results The duration of antibiotic use in the traditional operation group (25.2±12.3 d) and the average hospitalization time (16.9±7.6 d).The average healing time of ulcer/wound (121.6 ±23.7 d) was shorter than that of limited debridement group (32.5± 16.8 d,24.7± 12.5 d,153.2±27.8 d).The amputation rate (1.32％),re-admission rate (1.32％),ulcer recurrence rate (2.63％) and ulcer recurrence rate (1.32％) in the limited debridement group were significantly lower than those in the traditional operation group (10.53％,31.58％,21.05％,28.95％).There was no significant difference in the incidence of antibiotic-related complications and all-cause mortality between the two groups.Conclusion Conservative surgery for diabetic foot osteomyelitis of incomplete foot gangrene is scientific and reasonable,and the quality of life of patients can be improved.The clinical benefit is obvious.It is worth of clinical promotion.

Objective: To explore the feasibility of the modified RUSS (Resorlu-Unsal Stone Score) renal stone scoring system in predicting the stone free rate after Flexible Ureteroscopic Lithotripsy(FURL). Methods: Retrospective analysis was performed on 104 cases of renal stones treated by FURL from March 2017 to January 2019 in the second affiliated hospital of zhengzhou university, including 75 males and 29 females. Age 20-75 (47.79±13.21) years. BMI 18.2-38.3 (24.4±3.7) kg/m²; Crushed stone site: left 56 cases, right 48 cases. There were 23 cases of renal inferior calyces calculi, 81 cases of non-inferior calyces calculi, and 19 cases of renal inferior calyces calculi with IPA<45°; American Society of Anesthesiology (ASA) scores: 65 cases of grade Ⅰ, 39 cases of grade Ⅱ; There were 71 patients with urinary tract infection before operation. There were 6 cases of renal puncture fistula before operation. Preoperative indwelling ureteral stent in 26 cases; There were 32 cases with history of extracorporeal shock wave lithotripsy. There were 27 patients with a history of urolithiasis therapy. The same physician used preoperative urinary CT+ 3D reconstruction imaging data to measure the factors influencing the postoperative stone free rate. RUSS renal stone scoring system was used to score the stones of patients before operation, and the relationship between the scores and the stones free rate was analyzed. The RUSS renal stone scoring system was supplemented and improved by including staghorn stone, duplicate renal, caliceal diverticulum, renal malrotation, stone area, and CT value related indexes. The modified RUSS renal stone scoring system was used to score the preoperative stone condition of patients, and the relationship between the score and the stone free rate was analyzed. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to compare the advantages and disadvantages of the modified RUSS, the characteristics of the stones, and RUSS system. Results: The stone free rate was 69.2% (72/104) 4 weeks after the operation, and there were no postoperative complications. Single-factor analysis showed that stone area, CT value, number of renal calyx involved by stone, multiple stones, IPA, stone size grading, renal anatomic structure abnormality, staghorn stone were all related risk factors affecting postoperative patients. Multi-factor analysis showed that stone area, number of renal calyces involved by stone, multiple stones, IPA and stone size were independent risk factors affecting the stone free rate after FURL. RUSS scores ranged from 0 to 3 points, corresponding to stone clearing rates of 86.8% (33/38), 67.7% (23/34), 58.3% (14/24) and 25.0% (2/8), respectively. Stone clearing rates were significantly correlated with stone grading (P<0.05). The total scores of stone free group and residual stone group were (0.87±0.96) points and (1.53±0.98) points, respectively, with significant differences between the groups (P<0.05). The range of modified RUSS score was 0-4 points, corresponding to the stone clearing rate of 100.0% (25/25), 92.3% (24/26), 54.2% (13/24), 47.4% (9/19), and 10.0% (1/10), respectively. Stone free rate was significantly correlated with stone grading (P<0.05). The total scores of stone free group and residual stone group were (1.15±1.13) points and (2.81±0.93) points, respectively, with significant differences between the groups (P<0.05). The AUC of stone features was smaller than that of the modified RUSS scoring system. The AUC of RUSS scoring system (0.707, 95%CI 0.598-0.815) was smaller than that of the modified RUSS scoring system (0.865, 95%CI 0.797-0.933). Conclusions Both the RUSS scoring system and the modified RUSS scoring system could accurately predict the postoperative stone free status of FURL, while the modified RUSS scoring was more accurate than the RUSS scoring.

By means of literature review, this paper summarized fire hazard features of hospital ward buildings. Case study plus overseas literature enabled the authors to come to recommendations based on personnel layout and evacuation speed in hospital ward buildings. Then Pathfinder was used to simulate personnel evacuation in a hospital ward building, and to calculate the safe evacuation time needed in such conditions as normal state, blocked or locked safe exits. These calculations help present suggestions on fire safety management.