Objective To assess the efficacy of urethroplasty by using the mucosa of diverticulum as the distal urethral for the recurrence of urethral stricture.Methods We reviewed our experience about 6 cases from Jan.2007 to Oct.2012,including 5 hypospadias and 1 epispadias.The mean age of the patients was 28 ± 16 (12-45)month,range 12 to 45 months.The patients presenting urethral diverticulum should last for 6 months after urethroplasty,which should last for 6 months.The preoperative mean urinary flow rate was 5.1 ± 1.4 (range 3.1 to 7.3) ml/s.All the patients took the retrograde urethrography and cystoscopy to confirm the position and length of urethrostenosis.The positions of urethrostenosis were at the penis coronary in 5 cases and glans penis in 1 case.The mean length of stricture was 13.3 ±4.2(range 8.8 to 20.5) mm.The mean length of diverticulum was 37.5 ± 15.3 (range 21.8 to 55.2) mm.All patients received the urethral reconstruction by using the pedicel diverticulum mucosa.After resecting the stenosis urethra and exposed the whole diverticulum,we opened the diverticulum laterally and halved it.One was used for tabularized urethroplasty in situ,the other was flipped to the distal urethral as pedicel flap to remedy the defect of the urethral.Results Totally 6 cases received the procedure.The mean operating time was 133 ± 48 (range 84 to 192) min.Postoperatively,urethral catheter was remained 2 weeks.All the patients can urinate smoothly after removing the catheter.The postoperative mean urinary flow rate was 10o 9 ± 3.3 (range 6.3 to 15.9) ml/s.The mean follow-up time was 2.2 yrs(range 1 to 4 years).At the end point of follow-up,all patients had not experienced a recurrent diverticulum or stricture at the anastomotic site.Urethrocutaneous fistula in the coronary glan was reported in 2 patients,which were finally cured after 2nd repair.No complication was found in other 4 patients.Conclusions Urethroplasty by flipping the mucosa of diverticulum takes full advantage of urinary mucosa that already existing,which can be very useful in those patients who are lack of foreskin.This approach can also reduce the patient's pain by completing the urethroplasty in situ and avoiding staging operation.But up till now,it can only be applied to the urethral diverticulum secondary to urethrostenosis.It also demands flip flap skilled.And the long-term effects and complications still remain to be seen.

ATP binding cassette transporter A3（ABCA3）is a critical protein involved in phospholipid metabolism in typeⅡ alveolar cells，participating in the synthesis of pulmonary surfactant.Early studies have found that mutations in ABCA3 gene can lead to childhood interstitial lung disease（chILD），but the underlying mechanisms remain unclear.Recent elucidation of the ABCA3 structure，coupled with functional inquiries into the protein，has engendered fresh insights into the intricate mechanisms governing phospholipid metabolism orchestrated by ABCA3，inspiring the development of small molecule drugs targeting ABCA3 gene mutations.This article provides a comprehensive review of the involvement of ABCA3 in phospholipid metabolism，the pathogenic mechanisms of related lung diseases，the genotype-phenotype correlations，and the forefront advances in treatment.Additionally，it underscores lingering unresolved queries，aiming to provide a platform for the future refinement of precision treatments for ABCA3 mutations.

Objective To evaluate the feasibility and outcomes of robotic-assisted laparoscopic pyeloplasty in children .Methods A retrospective study was performed in patients who underwent robotic-assisted laparoscopic pyeloplasty ( Anderson-Hynes ) at our institution between January 2014 to August 2014.Totally 6 boys were diagnosed as left ureteropelvic junction obstruction depending on the symptoms and radiographic studies .The mean age was 9 years ( range 4 -12 years ) .Results The procedure was performed successfully without conversion to open surgery in all of the cases .Mean operative time was 216 min (range 175-269 min), with a mean robotic anastomosis time of 45 min (range 30-60 min).Mean estimated blood loss was less than 15 ml.The mean hospitalization was 4.5 days.Mean follow-up period was 10 months ( range 7 -14 months ) .There were no perioperative complications , and recovery was uncomplicated (without recurrence, pyelonephritis, nephrarctia) in all of the patients.Conclusion Robotic-assisted laparoscopic pyeloplasty can be safely performed in children older than 4-year-old with ureteropelvic junction obstruction .

Objective:To explore the factors affecting the operative time and postoperative complications of retroperitoneal laparoscopic adrenalectomy, and to establish a predicting model.Methods:A total of 298 patients who underwent retroperitoneal laparoscopic adrenalectomy at Beijing Friendship Hospital, Capital Medical University from October 2017 to July 2022 were retrospectively analyzed.Observe and record the patient′s operative time, postoperative complications, and record the possible influencing factors, including gender, age, body mass index (BMI), tumor size, Mayo adhesive probability (MAP) score, and distance from the lower pole of the adrenal tumor to the upper pole of the kidney (DAK), distance from the lower pole of the adrenal tumor to the renal pedicle (DARP), distance between the skin and Gerota′s fascia (S-GF), perinephric fat distance (PNF), posterior adiposity index (PAI), thickness of waist fat, thickness of subcutaneous fat, etc. Univariate analysis was performed on the above influencing factors with the operative time as the dependent variable, and all variables with statistical significance were included in the linear regression analysis, and get the regression equation. Then take the occurrence of postoperative complications as the dependent variable, and the above-mentioned influencing factors as independent variables, and incorporate univariate and multivariate Logistic analysis to obtain the relevant influencing factors of postoperative complications, and use R software to establish a risk prediction nomogram model for postoperative complications.Results:Male patients ( P<0.001) with high BMI ( P=0.001), thick waist fat ( P=0.013), high MAP score ( P<0.001), and high PNF ( P<0.001) were expected to require longer operative time, and get the linear regression equation: operative time=75.892+ 4.672×MAP score+ 13.574 (if male)+ 0.023×BMI+ 0.792×PNF+ 1.968×thickness of waist fat ( P<0.001); according to multivariate Logistic regression, short DARP ( P=0.003), high PAI ( P=0.002), and long operative time ( P=0.023) increase the risk of postoperative complications, and get a risk prediction nomogram model for postoperative complications. At the same time, postoperative complications were more likely to occur when the expected operative time was longer than 77.5 minutes. Conclusions:The prediction models of operative time and postoperative complications of retroperitoneal laparoscopic adrenalectomy established in this study provide an objective and reliable assessment. When the estimated operative time is longer than 77.5 minutes, the operation is more difficult and postoperative complications risk is higher and should be performed by more experienced doctors.

Objective:To analyze the pathological findings of ultrasound-guided transplant kidney puncture after renal transplantation and the pathogenesis of different types of diseases.Methods:A retrospective study was conducted to select 257 patients who underwent ultrasound-guided transplant kidney puncture pathology biopsy due to abnormal tests or uncomfortable symptoms at Beijing Friendship Hospital, Capital Medical University from June 2020 to April 2022, and to analyze the pathological results of puncture and the pathogenesis of different types of diseases and puncture-related complications in the post-transplantation patients after transplant kidney puncture biopsy. Measurement data conforming to normal distribution were expressed as mean ± standard deviation ( ± s), and independent sample t-test was used to compare different types of diseases; measurement data did not conform to normal distribution were expressed as median (interquartile distance) [ M( Q1, Q3)], and the comparison between different types of diseases was conducted by non-parametric test. The count data were compared among different types of diseases using Chi-squre test. Results:Among the 257 patients who underwent transplant renal puncture, 93 cases (36.2%) suffered from antibody-mediated rejection (ABMR), 76 cases (29.6%) suffered from IgA nephropathy, 63 cases (24.5%) suffered from T cell-mediated rejection (TCMR), 21 cases (8.2%) suffered from polyomavirus-associated nephropathy (PVAN), and 4 cases (1.6%) suffered from thrombotic microangiopathy (TMA), 16 cases (6.2%) suffered from diabetic nephropathy, and 12 cases (4.7%) suffered from calcineurin inhibitor (CNI) nephropathy. TCMR, TMA and PVAN occurred significantly in the early post-transplantation period (within about 4 years) ( P<0.001), and ABMR occurred significantly in the late post-transplantation period (after about 8 years) ( P<0.001). In terms of time distribution, creatinine abnormality and proteinuria were the main reasons for puncture. Among those diagnosed with PVAN, the time to transplantation was significantly shorter in those who underwent puncture for creatinine abnormality than in those who underwent puncture for proteinuria ( P=0.011). In terms of puncture-related complications, a total of 8 cases were found to have arteriovenous fistulae at the time of review, 2 cases had perinephric hematomas, and 1 case had both of these two puncture-related complications. Conclusions:Transplant renal complications in renal transplant patients mainly include ABMR, IgA nephropathy, TCMR, PVAN, diabetic nephropathy, CNI nephropathy and TMA. In terms of the pathogenesis of different types of diseases after transplantation, post-transplantation PVAN, TMA, and TCMR mostly occur in the early post-transplantation period, while ABMR occurs at a later time. However, it is worth noting that the clinical symptoms of different types of transplantation kidney-related diseases are similar and not typical.

With the rapidly increase of HIV infections in the elderly in China, new challenges have emerged in HIV/AIDS prevention and control. Low awareness of HIV and common unprotected casual sex and commercial sex has made older people at higher risk for HIV infection. In addition, HIV-infected and higher risk elderly people have limited awareness of HIV-related knowledge and access to testing services due to low educational level and socioeconomic status. Furthermore, HIV-infected elderly people usually have elevated risk of death because of late detection and comorbidities of chronic diseases. More research should be made to further understand the behavioural characteristics and social, cultural and psychological determinants of the elderly, development and adoption of HIV prevention service strategy catering for the elderly's need, and strengthening whole-process comprehensive health management of elderly infected people.

Objective:To investigate the effect of visceral fat thickness before operation on the operative difficulty and postoperative complications in renal transplantation recipients.Methods:A total of 179 patients diagnosed with end-stage renal disease who underwent kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2020 to January 2022 were retrospectively included. According to the visceral fat thickness measured by CT before transplantation (distance from anterior wall of abdominal aorta to parietal peritoneum at 1 cm above umbilicus), patients were divided into two groups, with 103 patients in thin visceral fat group with visceral fat thickness ≤7.5 cm and 76 patients in thick visceral fat group with visceral fat thickness>7.5 cm. The epidemiological data before renal transplantation, operative time, intraoperative blood loss, postoperative complications, renal function after transplantation and patients′ recovery state were analyzed and compared between the two groups. Measurement data were expressed as mean±standard deviation ( ± s), and independent sample t-test was used for comparison between groups. The Chi-square test was used to compare the count data. Results:The mean age and body mass index of patients in thin visceral fat group [(38.70±11.50) years and (21.28±2.93) kg/m 2] were lower than those in thick visceral fat group [(43.14±11.42) years and (24.78±3.37) kg/m 2], and the differences were statistically significant ( P< 0.05). There was no significant difference in other preoperative epidemiological data between the two groups ( P>0.05). In terms of operation difficulty, the mean operation time of thin visceral fat group was (117.16±34.33) min, which was significantly shorter than that of thick visceral fat group (137.11±20.02) min. The mean intraoperative blood loss in the thin visceral fat group was (89.12±45.95) mL, which was lower than that in the thick visceral fat group (125.39±54.88) mL, the differences were statistically significant ( P<0.001). In terms of postoperative complications, 41 patients in the thin visceral fat group had postoperative infection, incision pain and intraoperative effusion, and the incidence was 39.8% (41/103), which was significantly lower than that in the thick visceral fat group (78.9%, 60/76), the difference was statistically significant ( P<0.001); However, there was no significant difference in the incidence of Clavien-Dindo grade 3 or higher complications between the two groups ( P> 0.05). There was no significant difference in serum creatinine levels at 3, 5, 7 days and 1, 2 months after surgery among patients with different visceral fat thickness ( P> 0.05). However, the mean serum creatinine level in the thin visceral fat group was (116.06±36.45) μmol/L, which was lower than that in the thick visceral fat group (133.35±72.26) μmol/L, and the difference was statistically significant ( P=0.038). There was no significant difference in the incidence of delayed renal function recovery between the two groups ( P> 0.05). At the same time, there was no significant difference in postoperative drainage tube indwelling time and hospital stay between the two groups ( P> 0.05). Conclusions:The thicker visceral fat in end-stage renal disease patients before transplantation, the higher the incidence of general postoperative complications, but the severity of complications, patients′ recovery after transplantation and the short-term function of the transplanted kidney are not significantly related to the thickness of visceral fat in the recipients. Meanwhile, although the visceral fat thickness of the recipients in this study was correlated with serum creatinine levels at 3 months after transplantation, its correlation with long-term graft renal function and graft survival time remains to be further studied.

Objective:To summarize the experience and skills of ex-vivo ureteroscopy that performed on deceased donor kidneys with gifted lithiasis on bench prior to transplantation.Methods:From January 2018 to December 2019, a total of 7 death donors in Capital Medical University Beijing Friendship Hospital were found to have donor gifted lithiasis during pre-donation evaluation, and all of them underwent ureteroscope laser lithotripsy on bench before transplantation. We retrospectively analysied the demographic information of donors, stone size, location, operative complications and stone clearance rate of the total 7 donor kidneys. The mean age of donors was (49.6±6.8) years. The 7 gifted lithiasis consisted of 6 cases of simple pyelolithiasis and 1 case of upper ureteral calculi.Results:The mean diameter of the stones was (1.2±0.5)cm (0.4~2.1 cm). The 5 cases of pyelolithiasis and 1 case of ureteral calculi were examined with semi-rigid ureteroscopy and then underwent holmium laser lithotripsy. The other 1 case had not found the stone during the bench operation. The mean lithotripsy time was (23.0±6.1)min, and all donor kidneys underwent hypothermic machine perfusion after lithotripsy. The initial resistance index (RI) of donor kidney with gifted lithiasis was higher than the other side of the same donor ( P<0.05), but there was no statistical difference in end-point RI between the both sides. None of the 7 recipients had severe hematuria after operation and their renal function recovered well. CT scan at 1 month after the operation showed the clearance of stone was satisfied in all 7 recipients. Conclusions:Bench surgery is a minimally invasive method for donor gifted lithiasis management, and it is relatively safe and effective. For most cases, the semi-rigid ureteroscopy can handle it well, but the long-term effect still needs to be further evaluated.

Objective:To evaluate the effect of intraoperative incision combined with local anesthesia in improving postoperative pain after retroperitoneal laparoscopic living donor nephrectomy.Methods:Using retrospective research methods, 28 donors who underwent hand-assisted retroperitoneal laparoscopic living donor nephrectomy at the Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2020 were selected as the research group. Before the wound was sutured during the operation use 0.2% ropivacaine 20 mL+ 5 mg dexamethasone to block the transverse abdominis fascia and subcutaneously for infiltration anesthesia. The other 1∶1 matched 28 donors who had the same operation method but used on-demand systemic opioid analgesia after the operation as the control group. The demographic indicators (age, gender, body mass index, length of donor kidney), intraoperative conditions (intraoperative blood loss, operation time, warm ischemia time), 2, 12, 24, and 48 hours pain visual analogue scales(VAS) after operation were compared between the two groups of patients, postoperative systemic opioid demand rate, postoperative exhaust time, time to return to the ground, complication rate (postoperative bleeding, lung infection, lymphatic fistula, wound infection, intestinal obstruction), postoperative length of hospitalization and other information. Measurement data were expressed as mean±standard deviation ( Mean± SD), and independent sample t-test was used for comparison between groups; Chi-square test or Fisher exact probability method was used for comparison of count data between groups. Results:The pain VAS of the donors in the research group were significantly lower than those in the control group at 2 h, 12 h, 24 h, and 48 h after surgery (2 h: 1.6±1.0 vs 3.9±1.1; 12 h: 1.9±0.7 vs 3.1±1.0; 24 h: 1.6±0.5 vs 2.9±0.8; 48 h: 1.2±0.5 vs 2.3±0.8; P<0.05). The donors in the research group postoperative morphine requirement rate was also significantly lower than that of the control group (0 vs 21.4%), and the postoperative recovery time was significantly earlier than that of the control group [(25.7±4.5) h vs (30.6±6.6) h], the difference was statistically significant ( P<0.05). Lymphatic fistula was the main postoperative complication. There was no statistically significant difference between the research group and the control group (14.3% vs 25.0%) ( P>0.05). Conclusion:Intraoperative incision transversus abdominis fascia and subcutaneous combined local block anesthesia can effectively reduce the pain after laparoscopic donor nephrectomy, reduce the use of opioids, promote early postoperative activities of the donor, and will not increase postoperative complications incidence rate.

Objective To investigate the association of concomitant BRAFV600E mutation with central lymph node metastases in papillary thyroid carcinoma ( PTC ) . Methods The clinicopathological data of 126 PTC patients who underwent surgical treatment within a period of 2 years were retrospectively analyzed. The BRAF V600E gene mutation was detected by quantitative fluorescence PCR. Results The BRAF mutation rate was 69. 0% (87/126). The univariate analysis showed that BRAF mutation status was significantly associated with central lymph node metastasis (P<0. 05), while the gender, multiple lesions, tumor size, extra?thyroidal invasion, Hashimoto′s thyroiditis and tumor stage were not significantly associated with the BRAF mutation (P>0. 05 for all). The multivariate analysis showed that only central lymph node metastasis was significantly correlated with BRAF mutation (P<0. 05). When the diameter of tumor was≤10 mm, BRAF mutation was statistically not significantly correlated to central lymph node metastasis ( P>0. 05). When the diameter of tumor was >10 mm, the central lymph node metastasis rate was significantly higher in patients with positive BRAF mutation than that in patients with a negative BRAF mutation ( P<0. 05). Conclusions The presence of BRAF mutation is an independent predictive factor for central lymph node metastasis. When PTC is with preoperative positive BRAF mutation, the cervical dissection should be routinely performed. The larger the tumor diameter is, the more important is the central lymph node dissection. There should be re?evaluated the necessity of preventative central lymph node dissection when the tumor diameter was ≤5 mm in patients with negative BRAF mutation.