Based on spleen deficiency-phlegm dampness as the core pathogenesis of obesity， and integrating recent advances in modern medicine regarding the key role of immune inflammation in obesity， this paper proposes a multidimensional pathogenic network of "obesity-spleen deficiency-phlegm dampness-immune imbalance". Various traditional Chinese medicine （TCM） herbs that strengthen the spleen， regulate qi， and resolve phlegm and dampness can treat obesity by improving spleen-stomach transport and transformation， promoting water-damp metabolism， and regulating immune homeostasis. This highlights immune inflammation as an important entry point to elucidate the TCM concepts of "spleen deficiency-phlegm dampness" and the therapeutic principle of "strengthening the spleen and eliminating dampness to treat obesity". By systematically analyzing the intrinsic connection between "spleen deficiency generating dampness， internal accumulation of phlegm dampness" and immune dysregulation in obesity， this paper aims to provide theoretical support for TCM treatment of obesity based on dampness.

OBJECTIVE: To investigate the safety and prognostic factors influencing the treatment of upper urinary tract urothelial carcinoma (UTUC) combined with bladder cancer (BCa) by laparoscopic simultaneous radical cystectomy and nephroureterectomy (RCNU). METHODS: The clinical data of patients admitted to Peking University Third Hospital for laparoscopic RCNU surgery from January 2009 to September 2023 were analyzed retrospectively. Based on the same gender, age (±5 years), history of uroepithelial tumors, underlying diseases, T-stage, N-stage, M-stage, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, and body mass index (BMI) (±5), 34 patients with RCNU were matched 1 ∶1 with patients with bladder cancer who underwent laparoscopic radical cystectomy (RC) alone. Kaplan-Meier survival analysis was used to calculate patient survival, and Cox proportional regression risk model was used to analyze clinical factors affecting prognosis. RESULTS: Of the 68 patients enrolled, the follow-up rate was 100% with a median follow-up time of 27.0 (11.7, 60.2) months. Comparison of intraoperative conditions (including operation time, estimated intraoperative bleeding, intra-operative blood transfusion, etc.) between the two groups of patients showed no significant difference (P>0.05). Comparison of preoperative creatinine and postoperative creatinine between the two groups of patients showed significant differences (P < 0.05). The perioperative Clavien grade Ⅲ-Ⅳ complication rates were 2.9% (1/34) in the RC group and 5.9% (2/34) in the RCNU group. There was no significant difference in terms of perioperative complications between the two groups. Overall survival was significantly lower in the patients receiving RCNU compared with the matched group receiving RC alone (P < 0.05). Cox regression analysis suggested that two factors, high N stage and high postoperative creatinine, were independent risk factors affecting the prognosis of patients in the 2 groups (P < 0.05). CONCLUSION The overall survival prognosis of patients undergoing RCNU surgery was worse compared with laparoscopic RC surgery alone during the same period. There was no clinically significant difference between the two groups in terms of operation time, intraoperative bleeding, and perioperative complications, and there were clinically significant differences in preoperative renal function and post-operative renal function.
Humans ; Laparoscopy/methods* ; Nephroureterectomy/methods* ; Cystectomy/methods* ; Prognosis ; Male ; Retrospective Studies ; Female ; Urinary Bladder Neoplasms/mortality* ; Middle Aged ; Aged

Objective:To evaluate surgical strategies and clinical outcomes in supra-labyrinthine cholesteatoma management, providing evidence-based guidance for therapeutic decision-making. Methods:Seven patients with supra-labyrinthine cholesteatoma in our hospital from 2021 to 2023 were enrolled in this study. The clinical manifestations, imaging findings, and surgical outcomes of patients were retrospectively analyzed. A systematic literature review focused on surgical anatomy correlations and imaging-based approach selection. Results:All seven cases of supra-labyrinthine cholesteatoma were unilateral. Preoperative otoendoscopy, CT, and intraoperative findings confirmed that they were classified as supral-abyrinthine cholesteatoma according to Sanna's classification. Two cases were operated entirely with otoendoscopy, three cases used a postauricular approach with microscopic assistance, and two cases involved a combined approach with endoscopy and microscopy. Hearing reconstruction with ossicular prosthesis was performed in five cases, while two cases did not undergo hearing reconstruction due to preoperative anacusis confirmed by both subjective and objective hearing tests. In all seven cases, various segments of the facial nerve were exposed during surgery, but postoperative facial nerve function remained intact, hearing was preserved, no cerebrospinal fluid leakage occurred, and no recurrences have been observed to date（as of June 2024）. Conclusion:With the advancement of imaging techniques and microsurgical technology, early diagnosis and surgical methods for supral-abyrinthine cholesteatoma have significantly improved. Compared to traditional approaches, the newer methods reduce unnecessary complications and offer advantages such as minimal surgical trauma, superior hearing preservation rates, and shorter recovery times with better postoperative neural function. This study reviews recent literature on petroclival cholesteatomas, combined with our own cases, to analyze the classification of supral-abyrinthine cholesteatoma and surgical approach selection. The findings aim to optimize treatment strategies and guide appropriate surgical methods, ultimately improving patient prognosis and quality of life.
Humans ; Cholesteatoma/surgery* ; Ear, Inner/surgery* ; Retrospective Studies ; Treatment Outcome

Objective To evaluate the clinical efficacy of a sphincter-preserving technique combining cutting seton and loose seton drainage for the treatment of ischiorectal abscess.Methods A prospective ran-domized controlled trial was conducted involving 184 patients with ischiorectal abscess,who were randomly di-vided into an experimental group(n=92)and a control group(n=92).The experimental group underwent sphincter-preserving surgery combining cutting seton and loose seton drainage,while the control group re-ceived single-stage incision and seton drainage.Clinical outcomes,anal function,operative time,postoperative pain intensity,wound healing time,and pruritus ani were compared between the two groups.Results The sur-gical time of the experimental group was longer than that of the control group[31.50(25.00,40.00)min vs.20.00(20.00,30.00)min],and the difference was statistically significant(P<0.05).On postoperative days 1,3,and 7,the NRS scores for pain were lower than those in the control group,and the wound healing time was shorter than that in the control group[24.00(20.00,25.75)days vs.29.00(26.00,32.00)days],with statistically significant differences(P<0.05).The recent cure rate of the experimental group was lower than that of the control group(88.04%vs.94.57%),and the difference was not statistically significant(P>0.05).After follow-up,the long-term cure rate of the experimental group was lower than that of the control group(84.78%vs.93.48%),and the Wexner score for anal incontinence was lower than that of the control group[1.00(0.00,1.00)vs.1.00(0.00,2.00)],with statistically significant differences(P<0.05).Conclu-sion The sphincter-preserving technique combining cutting seton and loose seton drainage for ischiorectal ab-scess reduces postoperative pain,shortens wound healing time,and effectively protects anal function with reli-able short-term efficacy.However,further improvements are needed to enhance long-term clinical outcomes.

Objective To investigate the clinical value of serum hsa_circRNA_0002980 and hsa_circRNA_104348 expression in the diagnosis and prognosis evaluation of liver cancer patients.Methods From April 2020 to April 2022,a total of 105 liver cancer patients and 105 liver cirrhosis patients admitted in the hospital were selected as the liver cancer group and cirrhosis group,and another 105 healthy volunteers who underwent physical examinations in the hospital were selected as the control group.Real-time fluorescence quantitative PCR(qPCR)was applied to detect the expression of serum hsa_circRNA_0002980 and hsa_circRNA_104348.Receiver operating characteristic(ROC)curve was applied to evaluate the diagnostic value and prognostic val-ue of serum hsa_circRNA_0002980 and hsa_circRNA_104348 expression in liver cancer.Multivariate COX re-gression was performed to analyze the influencing factors of prognosis in liver cancer.Results The expression levels of serum hsa_circRNA_0002980 in the liver cancer group,liver cirrhosis group,and control group in-creased sequentially(P＜0.05),while the expression levels of serum hsa_circRNA_104348 decreased sequen-tially(P＜0.05).The levels of alanine aminotransferase and aspartate aminotransferase in the liver cancer group and the liver cirrhosis group were higher than those in the control group(P＜0.05),and the level of al-bumin was lower than that in the control group(P＜0.05).The area under the curve(AUC)for the diagnosis of liver cancer by hsa_circRNA_0002980 combined with hsa_circRNA_104348 was 0.888(95％CI:0.838-0.928),which was obviously higher than those of hsa_circRNA_0002980(Z=3.526,P＜0.001)and hsa_cir-cRNA_104348 alone(Z=2.184,P=0.029).The expression level of serum hsa_circRNA_0002980 in the poor prognosis group was lower than that in the good prognosis group(P＜0.05),and the expression level of ser-um hsa_circRNA_104348 and the proportion of TNM stage Ⅲ+Ⅳ were higher than those in the good progno-sis group(P＜0.05).The AUC for predicting prognosis in liver cancer patients by the combination of hsa_cir-cRNA_0002980 and hsa_circRNA_104348 was 0.870(95％CI:0.790-0.928),and there was no statistically significant difference compared to the AUC predicted separately by hsa_circRNA_0002980 and hsa_circRNA_104348(P＞0.05).The expression of serum hsa_circRNA_0002980,hsa_circRNA_104348 and TNM stage were influencing factors for the prognosis of liver cancer patients(P＜0.05).Conclusion The expression lev-el of hsa_circRNA_0002980 in the serum of liver cancer patients is relatively low,while the expression level of hsa_circRNA_104348 is relatively high.Both have certain clinical significance in the diagnosis and prognosis e-valuation of liver cancer.

Objective:To compare the efficacy and clinical practicality of fluorescence in situ hybridization (FISH), thinprep cytology test (TCT), urine nuclear matrix protein 22 (NMP22) and urine cytology test in the diagnosis of upper tract urothelial carcinoma (UTUC). Methods:A retrospective analysis was conducted on the clinical data of 62 patients who underwent surgical treatment (biopsy or partial urothelial resection) for suspected UTUC in the Department of Urology, Peking University Third Hospital from January 2021 to December 2023, and received paraffin pathological diagnosis. Taking the pathological examination results as the diagnostic criteria, the sensitivity, specificity, Youden index, positive predictive value and negative predictive value of the four detection methods in the diagnosis of UTUC were calculated, and the cost-effectiveness analysis was performed. Combine the four detection methods in pairs, calculate the sensitivity, specificity and Youden index after the combination, and conduct a cost-effectiveness analysis. The comparison of sensitivity, specificity and Youden index of the four detection methods was conducted using Chi-test or Fisher exact probability method. The comparison between groups after pairwise combinations was also conducted using Chi-test or Fisher exact probability method. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated.Results:The sensitivity (81.1%, 77.4%) and Youden index (0.700, 0.774) of FISH group and TCT group were significantly higher than those of NMP22 group and urine cytology group (39.6%, 43.4%; 0.174, 0.434), and the differences were statistically significant ( P<0.008 3). There were no statistically significant in the specificity (88.9%, 100.0%, 77.8%, 100.0%), positive predictive value (97.7%, 100.0%, 91.3%, 100.0%) and negative predictive value (44.4%, 42.9%, 17.9%, 23.1%) of the four groups ( P>0.008 3). The cost-effectiveness of the FISH group (3 256.4) was significantly higher than that of the TCT group (409.4), the NMP22 group (398.2) and the urine cytology group (627.9). After being combined in pairs, the net sensitivity of NMP22+ urine cytology (45.3%) was significantly lower than that of FISH+ TCT(88.7%), TCT+ NMP22(81.1%), FISH+ NMP22(86.8%), FISH + urine cytology (84.9%), TCT+ urine cytology (86.8%), and the difference was statistically significant ( P<0.008 3). The net specificities of the above combinations were 77.8%, 88.9%, 77.8%, 88.9%, 100.0%, respectively, and the differences were not statistically significant ( P>0.008 3). The cost-effectiveness was 1 008.0, 3 393.5, 632.8, 3 345.0, 3 513.5, and 737.3, respectively. Conclusions:In the diagnosis of UTUC, TCT has the highest diagnostic efficacy and relatively low cost, and is recommended for widespread promotion and application in clinical practice. If the patients economic conditions permit, it is recommended to combine TCT with urine cytology.

【Objective】 To investigate the protective effects of aflexible sleeve penile protection device on reducing postoperative pain and wound edema in patients after circumcision. 【Methods】 A total of 54 patients who underwent circumcision at Yan’an Branch of Peking University Third Hospital during Feb.1 and May 31, 2023 were enrolled.The patients were randomly divided into the experimental group and control group, with 27 patients in either groups.Patients in the experimental group were treated with a flexible sleeve penis protection device after surgery, and patients in the control group were treated with traditional gauze bandage after surgery.Postoperative pain, wound edema and complications were compared between the two groups. 【Results】 In terms of pain, the visual analogue scale of the experimental group was significantly lower at 6 hours [(1.7±0.9) vs.(3.3±1.9), P<0.001] and 2 days [(2.0±1.3) vs.(3.3±1.3), P<0.001] after surgery than that of the control group, but there were no statistically significant differences between the two groups on the 4th and 7th postoperative days (P>0.05).In terms of edema, the edema score of the experimental group was significantly lower than that of the control group on the 2nd postoperative day [(2.0±1.0) vs.(4.0±0.8), P<0.001] , the 4th postoperative day [(1.5±1.2) vs.(2.6±0.9), P<0.001] , and the 7th postoperative day [(0.9±1.3) vs.(2.3±1.5), P<0.001] .There was no statistically significant difference in the incidence of complications between the two groups (P>0.05). 【Conclusion】 The flexible sleeve penile protection device has significant effects of reducing early postoperative pain and reducing edema in patients undergoing circumcision.

Objective:To investigate the prognostic factors for all-cause mortality in patients with muscle-invasive bladder cancer(MIBC)with intermediate-to-high-risk primary prostate cancer.Methods:From January 2012 to October 2023,the clinical data of the patients with MIBC with intermediate-to-high-risk primary prostate cancer in Peking University Third Hospital were retrospectively analyzed.All the patients were monitored and the occurrence of all-cause death was documented as the outcome event in the prognostic study.Univariate and multivariate Cox proportional risk regression analysis models were implemented to search for independent influences on the prognosis of patients.For significant influencing factors(pathological T stage,M stage and perineural invasion of bladder cancer),survival curves were plotted before and after multifactorial Cox regression adjusting for confounding factors.Results:A total of 32 patients were included in this study.The mean age was(72.5±6.6)years;the median preoperative total prostate specific antigen(tPSA)was 6.68(2.47,6.84)μg/L;the mean preoperative creatinine was(95±36)μmol/L,and the median survival time was 65 months.The majority of the patients(87.5％)had high-grade bladder cancer,53.1％had lymphatic invasion,and 31.3％had perineural invasion.Prostate involvement was observed in 25.0％of the cases,and the positive rate of soft-tissue surgical margin was 37.5％.Multivariate Cox analysis revealed that preoperative creatinine level(HR=1.02,95％CI:1.01-1.04),pathological stage of bladder cancer T3(HR=11.58,95％CI:1.38-97.36)and T4(HR=19.53,95％CI:4.26-89.52)metastasis of bladder cancer(HR=9.44,95％CI:1.26-70.49)and perineural invasion of bladder cancer(HR=6.26,95％CI:1.39-28.27)were independent prognostic factors(P＜0.05).Survival curves with Log-rank test after adjusting for confounding factors demonstrated that bladder cancer pathology T3,T4,M1,and perineural invasion were unfavorable factors affecting the patients'survival prognosis(P＜0.05).Conclusion:Patients with MIBC with intermediate-to-high risk primary prostate cancer generally portends a poor prognosis.High preoperative serum creatinine,T3 or T4 pathological stage of bladder cancer,metastasis of bladder cancer and bladder cancer perineural invasion are poor prognostic factors for patients with MIBC with intermediate-to-high risk primary prostate cancer.

Objective:To investigate the impact of age,various hormonal levels,and biochemical markers on penile cavernous body vascular function in patients with erectile dysfunction(ED).Me-thods:A retrospective analysis of clinical data from male patients with ED who underwent color duplex Doppler ultrasonography(CDDU)and intracavernosal injection test(ICI)at the Reproductive Medicine Center of Peking University Third Hospital from January 2020 to August 2023.Data were managed and processed using SPSS 29.0,and a multivariable Logistic regression analysis was conducted.Results:A total of 700 ED patients were included,with 380 showing negative ICI results and 320 positive.In the study,84 patients had a peak systolic velocity(PSV)＜25 cm/s,while 616 had PSV ≥ 25 cm/s;202 patients had end-diastolic velocity(EDV)＞5 cm/s,and 498 had EDV ≤5 cm/s.264 patients had ab-normal PSV and/or EDV results,and 436 had normal results for both.Patients with vascular ED had sig-nificantly lower estrogen levels(t=-3.546,P＜0.001),lower testosterone levels(t=-2.089,P=0.037),and a higher rate of hyperglycemia(x2=12.772,P=0.002)compared with those with non-vascular ED.The patients with arterial ED were older(t=3.953,P＜0.001),had a higher rate of hyperglycemia(x2=9.518,P=0.009),and a higher estrogen/testosterone ratio(t=2.330,P=0.020)compared with those with non-arterial ED.The patients with mixed arteriovenous ED had higher age(t=3.567,P＜0.001),lower testosterone levels(t=-2.288,P=0.022),a higher rate of hyperglycemia(x2=12.877,P=0.002),and a larger estrogen/testosterone ratio(t=2.096,P=0.037)compared with those with normal findings.Multifactorial Logistic regression analysis indicated that higher levels of estrogen were a protective factor for vascular ED(OR=1.009,95％CI:1.004-1.014),and glucose 7.0 mmol/L was a risk factor(OR=0.381,95％CI:0.219-0.661).Older age was a risk factor for arte-rial ED(OR=0.960,95％CI:0.938-0.982).Additionally,older age(OR=0.976,95％CI:0.958-0.993)and glucose levels of 5.6-6.9 mmol/L(OR=0.591,95％CI:0.399-0.876)were also risk fac-tors for mixed arterio-venous ED.Conclusion:Hyperglycemia and aging may impair penile cavernous body vascular function,while higher levels of estrogen may have a protective effect on it.

SUMMARY The mesothelium,which consists of a monolayer of mesothelial cells,extends over the sur-face of the serosal cavities(pleura,pericardium,peritoneum and tunica vaginalis).Mesothelial tumours of the tunica vaginalis is rare compared with those arise from pleura or peritoneum.According to World Health Organization 2022 Classification of Urinary and Male Genital Tumours(5th edition),mesothelial tumours of the tunica vaginalis were categorized into adenomatoid tumour,well-differentiated papillary mesothelial tumour(WDPMT)and mesothelioma.Since WDPMT of tunica vaginalis was rare,there was no consensus concerning the treatment of it.In this case report,a 29-year-old man who had endured intermittent right scrotal pain for 8 months,aggravating scrotal pain for 2 weeks was admitted.No symptoms,such as frequent,urgent,or painful urination were shown.Physical examination revealed the enlargement and tenderness of right scrotum,with no signs of lifting pain.The most recent scrotal ultrasonography be-fore surgery revealed right hydrocele with maximum depth of 4 centimeters and poor blood flow of right testis.Under the circumstance of patient's chronic history of testicular hydrocele,he underwent an emer-gency operation of right scrotal exploration and hydrocelectomy under epidural anesthesia.After opening the vagina tunic cavity,spot-like bleeding was observed on the right testicle,epididymis and vaginalis surface.The vaginalis was obviously thickened and the inner and outer walls were smooth.The post-operative histopathology revealed a grayish-brown tissue with a thickness of 0.3-0.5 cm,smooth inner and outer walls,and a suspected WDPMT with a diameter of 1.5 cm.Immunohistochemical staining showed positive for Calretinin,BAP1,WT-1,CK5/6,D2-40 and P16,which confirmed the diagnosis of WDPMT.To sum up,the purpose of this case report was to raise awareness of a rare disease WDPMT,which was usually asymptomatic and could be diagnosed by pathology and immunohistochemistry.The disease should be differentiated from testicular torsion,epididymitis,orchitis and oblique inguinal hernia in symptoms,and from malignant mesothelioma and adenomatoid tumour in pathology.Because of the rarity of the cases,there was no unified standard for the treatment of WDPMT at present.The common treatment methods reported in literature included orchidectomy and vaginectomy.Due to the lack of un-derstanding of this disease,postoperative follow-up was still recommended for at least 5 years.