OBJECTIVE To evaluate the efficacy and safety of cadonilimab plus chemotherapy in patients with advanced gastric adenocarcinoma or adenocarcinoma of gastroesophageal junction （AEG） with intermediate， low， or no human epidermal growth factor receptor 2 （HER2） expression. METHODS Patients with advanced gastric adenocarcinoma or AEG with intermediate， low， or no HER2 expression who were treated at Liaoning Cancer Hospital between October 1， 2024 and June 30， 2025 were retrospectively included. According to the treatment regimen received， the patients were divided into group A [cadonilimab plus oxaliplatin and capecitabine （XELOX）， n ＝54 ] ， group B （sintilimab plus XELOX， n ＝68）， and group C （tislelizumab plus XELOX， n ＝49）. Short-term efficacy after 4 cycles of treatment， survival outcomes， and adverse events were compared among the three groups. Cox regression and Logistic regression analyses were further performed to evaluate the effects of the treatment regimen and baseline data on survival outcomes and the risk of grade 3-4 treatment related adverse events （TRAEs）. RESULTS No statistically significant differences in objective response rate or disease control rate were observed among the three groups （ P ＞0.05）. The median progression-free survival was 7.56 （5.62， 8.11） months in group A， 7.23 （5.33， 8.23） months in group B， and 7.33 （5.42， 8.19） months in group C， with no statistically significant difference among the three groups （ P ＞0.05）. The median overall survival （mOS） was 11.67 （8.82， 13.88） months in group A， 9.78 （6.82， 12.73） months in group B， and 9.69 （6.78， 12.66） months in group C. The mOS was significantly longer in group A than in group B and group C （ P ＜0.05）， whereas no statistically significant difference was observed between group B and group C （ P ＞0.05）. The correlation analysis indicated that treatment regimen， Eastern Cooperative Oncology Group performance status （ECOG PS）， number of metastatic organs， and peritoneal metastasis may be associated with overall survival （OS）. No significant association was observed between treatment regimen and the risk of grade 3-4 TRAEs. The incidences of grade 1-2 or grade 3-4 TRAEs did not differ significantly among the three groups （ P ＞0.05）. CONCLUSIONS In patients with advanced gastric adenocarcinoma or AEG with intermediate， low， or no HER2 expression， cadonilimab plus XELOX may provide a more significant OS benefit with a safety profile comparable to that of sintilimab or tislelizumab plus XELOX. Further studies with larger sample sizes are required to validate these findings.

Objective To evaluate the therapeutic efficacy of a novel ureterorenoscope(Sotn ureterorenoscope)combined with flexible ureteroscope in the management of ureteral long-term incarcerated stones.Methods From June 2019 to January 2024,116 cases of ureteral incarcerated stones that had developed for over 1 year were treated in our department.Among them,45 cases were treated by using the Sotn ureterorenoscope combined with flexible ureteroscope(Sotn group),and 71 cases were given rigid ureteroscopy with flexible ureteroscopy(regular group).In the Sotn group,a standard endoscope and a rigid ureteral channel sheath were inserted under direct vision.With the sheath indwelled,a lithotripsy endoscope was replaced for stone fragmentation and removal.If the stone moved up,a flexible ureteroscope was inserted to explore the renal pelvis for lithotripsy.In the regular group,a rigid ureteroscope was used to explore the affected ureter for lithotripsy.If the stone moved up during the lithotripsy process,a sheath was inserted and the ureteroscope was replaced for lithotripsy.The operation time,surgical bleeding volume,incidence of postoperative complications,stone-free rate after operation,and postoperative hospital stay were compared between the two groups.Results There were no statistically significant differences in operation time,surgical bleeding volume,and postoperative hospital stay between the two groups(P＞0.05).The incidence of postoperative complications(back pain,fever,nausea and vomiting)in the Sotn group was lower than that in the regular group[15.6％(7/45)vs.33.8％(24/71),x2=4.683,P=0.030;6.7％(3/45)vs.26.8％(19/71),x2=7.236,P=0.007;4.4％(2/45)vs.23.9％(17/71),x2=7.646,P=0.006].The instant stone-free rate(at day 1 after operation)in the Sotn group was significantly higher than that in the regular group[51.1％(23/45)vs.16.9％(12/71),x2=15.299,P=0.000].Conclusion The Sotn ureterorenoscope has lower incidence of postoperative complications and higher instant stone-free rate in the treatment of long-term incarcerated ureteral stones,which is a safe and effective surgical technique.

The risk factors for thromboembolism caused by Mycoplasma pneumoniae infection include severe Mycoplasma pneumoniae pneumonia，elevated D-dimer levels，abnormal inflammatory markers，platelet abnormalities，lung consolidation，lung necrosis and pleural effusion，and so on.In terms of treatment，tetracycline and quinolone antibiotics have shown new advantages in addressing the recent prevalence of macrolide resistant mycoplasma.Regarding anticoagulant therapy，direct oral anticoagulants represented by rivaroxaban have significant advantages and are safe in children's medication.In addition，the application of traditional Chinese medicine for promoting blood circulation and removing blood stasis needs to be developed.The identification and intervention of risk factors related to coagulation disorders and thromboembolism caused by Mycoplasma pneumoniae infection can help improve treatment effectiveness.

Objective:To explore the clinical effect of precise intraepiphyseal wedge osteotomy for the treatment of congenital hypertrophic epiphysis of the distal phalanx of the thumbs in children.Methods:A retrospective analysis was conducted on the data of children with congenital hypertrophic epiphysis deformity of the distal phalanx of the thumb treated by precisely located intraepiphyseal wedge osteotomy in Dongguan Integrated Traditional Chinese and Western Medicine Hospital from January 2020 to January 2023. Preoperative X-ray films all showed asymmetric thickening of the secondary ossification centers, presenting as triangular, elliptical, unequal trapezoidal, and bipartite epiphyseal fusion shapes respectively. During the operation, precise localization was performed, and wedge osteotomy was conducted at 1.5 mm from the articular surface. The osteotomy angle and volume were adjusted according to the morphology of the hypertrophic epiphysis and the comprehensive condition of the distal and proximal phalanges, with axial over-correction of approximately 10° for fixation. Six months after surgery, the ulnar deviation angle of the distal phalanx with the interphalangeal joint of the thumb, the maximum passive flexion angle, and the thickness of the distal epiphyseal plate on X-ray were followed up. Statistical analysis was conducted using paired t-tests before and after surgery, and P<0.05 was considered statistically significant. Results:A total of 32 children with 34 thumbs were included, aged from 6 months to 8 years old, with an average age of 2.1 years old. There were 27 thumbs accompanied by radial polydactyly, the main and accessory thumbs were clear, and the epiphysis of the distal phalanx of the main thumb was thickened. The lateral deviation angle of the distal phalanx of the thumb before surgery was (35.6±13.2)° (15.0°-67.0°), the maximum passive flexion range was (62.8±7.7)° (38.0°-80.0°), and the maximum thickness of the distal phalanx epiphysis in the X-ray was (3.7±0.9) mm (2.3-5.9 mm). All surgeries of all children were successfully completed, the wounds healed well without redness, swelling or infection. Patients were discharged smoothly. The average follow-up time after surgery was 13 month (rang from 6-22 months), with an average deviation angle of (7.6±5.6)° (1.8°-13.4°) in the distal phalanx with the interphalangeal joint, compared with before surgery, the difference was statistically significant ( t=10.36, P=0.012). Five thumbs had residual ulnar deviation after surgery, with an average deviation of (16.6±2.3)° (12.0°-20.0°), two cases had corrected positive radial deviation (15°, 18°), while the other cases had no significant ulnar deviation in the distal phalanx of the thumb. The average maximum angle of passive flexion of the distal thumb after surgery was (62.9±7.5)° (35.0°-80.0°), compared with before surgery, the difference was not statistically significant ( t=0.16, P=0.359). The average maximum thickness of the distal epiphyses on postoperative X-rays was (1.9±0.5) mm (1.2-3.1 mm), compared with before surgery, the difference was statistically significant ( t=17.04, P=0.012). The epiphyses were flat and round, and the growth lines were normal. Conclusion:Using precise intraepiphyseal wedge osteotomy, combined with postoperative fixation with mild overcorrection for the treatment of congenital hypertrophic epiphysis at distal phalanx of the thumb in children, can achieve satisfactory correction of deviation, significantly shorten and improve the morphology of the epiphysis without affecting the growth plate, and cause minimal impact on joint flexion activity.

Syndactyly is a deformity that the soft tissues and (or) bones of two or more fingers are joined together. Based on the severity of interphalangeal skin-soft tissue juxtaposition, syndactyly is categorized as: incomplete syndactyly and complete syndactyly. Complete syndactyly correction includes interphalangeal separation, web-space reconstruction, coverage of skin defects on the body of the finger, and fingertip formation. The key step is the formation of the lateral nail fold after the separation of the syndactyly, and the shaping technique is closely related to the postoperative appearance of the fingertip. By reviewing the literatures, this article presents an overview of the relevant anatomy, nail juxtaposition typing, and the principles and applications of the complete juxtaposition nail lateral nail fold molding procedure.

Objective To evaluate the therapeutic efficacy of a novel ureterorenoscope(Sotn ureterorenoscope)combined with flexible ureteroscope in the management of ureteral long-term incarcerated stones.Methods From June 2019 to January 2024,116 cases of ureteral incarcerated stones that had developed for over 1 year were treated in our department.Among them,45 cases were treated by using the Sotn ureterorenoscope combined with flexible ureteroscope(Sotn group),and 71 cases were given rigid ureteroscopy with flexible ureteroscopy(regular group).In the Sotn group,a standard endoscope and a rigid ureteral channel sheath were inserted under direct vision.With the sheath indwelled,a lithotripsy endoscope was replaced for stone fragmentation and removal.If the stone moved up,a flexible ureteroscope was inserted to explore the renal pelvis for lithotripsy.In the regular group,a rigid ureteroscope was used to explore the affected ureter for lithotripsy.If the stone moved up during the lithotripsy process,a sheath was inserted and the ureteroscope was replaced for lithotripsy.The operation time,surgical bleeding volume,incidence of postoperative complications,stone-free rate after operation,and postoperative hospital stay were compared between the two groups.Results There were no statistically significant differences in operation time,surgical bleeding volume,and postoperative hospital stay between the two groups(P＞0.05).The incidence of postoperative complications(back pain,fever,nausea and vomiting)in the Sotn group was lower than that in the regular group[15.6％(7/45)vs.33.8％(24/71),x2=4.683,P=0.030;6.7％(3/45)vs.26.8％(19/71),x2=7.236,P=0.007;4.4％(2/45)vs.23.9％(17/71),x2=7.646,P=0.006].The instant stone-free rate(at day 1 after operation)in the Sotn group was significantly higher than that in the regular group[51.1％(23/45)vs.16.9％(12/71),x2=15.299,P=0.000].Conclusion The Sotn ureterorenoscope has lower incidence of postoperative complications and higher instant stone-free rate in the treatment of long-term incarcerated ureteral stones,which is a safe and effective surgical technique.

The risk factors for thromboembolism caused by Mycoplasma pneumoniae infection include severe Mycoplasma pneumoniae pneumonia，elevated D-dimer levels，abnormal inflammatory markers，platelet abnormalities，lung consolidation，lung necrosis and pleural effusion，and so on.In terms of treatment，tetracycline and quinolone antibiotics have shown new advantages in addressing the recent prevalence of macrolide resistant mycoplasma.Regarding anticoagulant therapy，direct oral anticoagulants represented by rivaroxaban have significant advantages and are safe in children's medication.In addition，the application of traditional Chinese medicine for promoting blood circulation and removing blood stasis needs to be developed.The identification and intervention of risk factors related to coagulation disorders and thromboembolism caused by Mycoplasma pneumoniae infection can help improve treatment effectiveness.

Objective:To compare the clinicopathological characteristics and prognostic outcomes between patients with clear cell renal cell carcinoma(ccRCC)and non-clear cell renal cell carcinoma(nccRCC)accompanied by venous tumor thrombus.Methods:A retrospective analysis was conducted on clinical and pathological data from patients with RCC and venous tumor thrombus treated in the Depart-ment of Urology at Peking University Third Hospital between January 2014 and February 2024.Patients were stratified into two groups based on pathological type:ccRCC and nccRCC.Comparisons of baseline characteristics,intraoperative situation,and prognosis between the two groups were performed using t-tests,Mann-Whitney U tests,chi-square tests,and Log-rank tests.Survival curves were generated using the Kaplan-Meier method.Results:A total of 437 patients were included,with a median age of 58 years,including 317 males and 120 females.The cohort comprised 366 cases of ccRCC and 71 cases of nccRCC.The non-clear cell group included 38 cases(53.5％)of papillary renal cell carcinoma,2 cases(2.8％)of chromophobe renal cell carcinoma,11 cases(15.5％)of unclassified renal cell carcinoma,19 cases(26.8％)of molecularly defined renal cell carcinoma,and 1 case(1.4％)of collecting duct carcinoma.Compared with the clear cell renal carcinoma group,patients in the non-clear cell carcinoma group demonstrated a younger age at diagnosis(59 years vs.55 years,P=0.010),larger tumor size(8.4 cm vs.9.5 cm,P=0.025),higher rates of lymph node metastasis(56.8％vs.70.6％,P=0.034),more advanced tumor thrombus(P＜0.001)and pathological grading(P=0.010),longer surgical duration(272 minutes vs.289 minutes,P=0.023),and shorter overall survival(80 months vs.35 months,P＜0.001).Multivariate Cox analysis indicated that histologic type,distant metastasis,tumor thrombus grading,and sarcomatoid/rhabdoid differentiation were prognostic factors in the renal cell carcinoma patients with venous tumor thrombus.No significant differences were observed between the two groups in terms of gender,body mass index,tumor laterality,distant metastasis,sarcomatoid or rhabdoid differentiation,American Society of Anesthesiologists(ASA)score,surgical approach,conversion to open surgery,blood loss,or transfusion of red blood cells and plasma.Conclusion:Compared with pa-tients with clear cell renal carcinoma and venous tumor thrombus,those with non-clear cell carcinoma and venous tumor thrombus exhibit earlier onset,more aggressive disease progression,and poorer prognosis.

Objective:To review the clinicopathological features of TFE3-rearranged renal cell carcino-ma(TFE3-RCC)with venous tumor thrombus(VT)(TFE3-VT),to explore treatment strategies and to prognostic characteristics,and to provide diagnostic and therapeutic references for TFE3-VT patients.Methods:Patients who underwent surgery at Department of Urology,Peking University Third Hospital from January 2013 to January 2024 were enrolled,including three cohorts:Pathologically confirmed TFE3-VT patients,TFE3-RCC patients without VT(TFE3-non-VT),and non-TFE3-rearranged renal cell carcinoma patients with VT(non-TFE3-VT).Clinical history,imaging data,pathological data,and follow-up records were collected.Primary and secondary endpoints were progression-free survival(PFS)and overall survival(OS),respectively.(1)Baseline characteristics were compared between the TFE3-VT and TFE3-non-VT patients.Normally distributed continuous variables were expressed as mean±SD and compared using Student's t-test;non-normally distributed variables were expressed as M(P25,P75)and analyzed with Mann-Whitney U test;categorical variables were described as frequency and percentage[n(％)]and compared by x2 test or Fisher's exact test.(2)Clinical history,radiological presenta-tions,surgical data,and histopathological features of the TFE3-VT patients were comprehensively charac-terized.(3)Survival analysis was performed for the TFE3-VT patients.Follow-up data of the TFE3-VT patients were described in detail,and their survival outcomes were compared with the TFE3-non-VT and non-TFE3-VT patients.When compared with the TFE3-non-VT counterparts,Kaplan-Meier method was used to generate PFS and OS curves among:(1)the TFE3-RCC patients across clinical stages Ⅰ-Ⅳ;(2)TFE3-VT versus TFE3-non-VT cohorts;(3)stage Ⅲ subgroups of the TFE3-VT and TFE3-non-VT patients.Intergroup survival differences were statistically evaluated using Log-rank tests.For comparisons with the non-TFE3-VT patients,a 1∶1 propensity score matching(PSM)was implemented to balance baseline characteristics between the two cohorts.Post-matching Kaplan-Meier curves were generated to compare PFS and OS between the matched groups,with Log-rank tests employed to determine statistical significance of survival disparities.All statistical analyses were conducted with R software(v 4.2.3),and two-tailed P＜0.05 was considered statistically significant.Results:The study included 45 TFE3-RCC patients:13 TFE3-VT and 32 TFE3-non-VT cases.Additionally,523 non-TFE3-VT patients were enrolled.Among the 13 TFE3-VT patients,9 were female(69.2％)and 4 male(30.8％),with a mean age of(37.9±14.4)years,mean BMI of(22.2±3.5)kg/m2,median age-adjusted Charlson comorbidity index(aCCI)of 1.0(0.0,1.0),and preoperative creatinine level of(75.3±15.9)μmol/L;tumors were located in the left kidney in 7 patients(53.8％)and right kidney in 6(46.2％);preoperative distant metastasis(M1 stage)was present in 6 patients(46.2％),while 7(53.8％)showed no metastasis;VT distribution by Mayo level comprised 7 cases(53.8％)at level 0,1 case each at levels Ⅰ and Ⅳ(7.7％respectively),and 2 cases each at levels Ⅱ and Ⅲ(15.4％respectively);surgical approaches comprised open surgery(n=2,15.4％),laparoscopic surgery(n=6,46.1％),and robot-assisted laparoscopic surgery(n=5,38.5％);mean operative time was(273±79)min,and intraoperative blood loss was(722±570)mL;mean maximum tumor diameter was(10.8±2.4)cm.All the 13 patients underwent TFE3 protein immunohistochemistry(IHC)staining,with 7 confirmed by fluorescence in situ hybridization(FISH).Tumor recurrence or metastasis occurred in 11 patients(84.6％),and 9(69.2％)patients died during follow-up.Median PFS was 4 months(1 year PFS rate:31％),and median OS was 13 months(1 year OS rate:54％).Survival analysis of 45 TFE3-RCC pa-tients revealed statistically significant differences in PFS and OS across all the clinical stages(P＜0.001).The TFE3-VT patients exhibited significantly worse PFS and OS than the TFE3-non-VT patients(P＜0.001),with persistent significance in stage Ⅲ subgroup analysis(P＜0.05).After PSM,TFE3-VT pa-tients showed significantly inferior PFS compared with non-TFE3-VT(P=0.01),though no significant difference was shown between the OS curves(P=0.11).Conclusion:TFE3-VT predominantly occurs in young females with frequent preoperative metastases.Strongly-positive staining of TFE3 protein in IHC stai-ning and red-green split signals in FISH tests are reliable diagnostic markers.TFE3-VT patients exhibit in-ferior survival compared with TFE3-non-VT patients and earlier progression than non-TFE3-VT patients.

Objective:To review and summarize the experience of robot-assisted laparoscopic trans-plant nephrectomy,share the surgical steps and technical key points,and provide a reference for clinical practice.Methods:A retrospective analysis was conducted on the perioperative data of 5 patients who underwent robot-assisted laparoscopic donor nephrectomy at Peking University Third Hospital from August 2023 to December 2024.The surgical steps and key points were summarized.The continuous variables were described by medians(ranges).Results:A total of 5 patients were included in the analysis,of whom 2 were male and 3 were female.The median age of the patients was 37(31-68)years.The me-dian time from kidney transplantation to donor nephrectomy was 10(3-22)years.The indications for donor nephrectomy included recurrent hematuria,abdominal pain,malignant tumor of the transplanted kidney,and recurrent infection with hydronephrosis of the transplanted kidney.The excised transplanted kidneys from all the 5 patients had a single renal artery and a single renal vein.The median operation time was 212(145-351)min,the median blood loss was 300(20-500)mL,and the median post-operative hospital stay was 7(4-25)days.Only 1 patient experienced intraoperative complications,who experienced an external iliac artery injury during the operation and underwent suture repair.No pa-tient died during the perioperative period.Postoperative pathological results showed that 3 patients had end-stage non-functional kidneys,1 patient had BK virus-associated urothelial carcinoma,and 1 patient had chronic pyelonephritis with renal parenchymal atrophy.Conclusion:Robot-assisted laparoscopic transplant nephrectomy as a new surgical approach is feasible and safe.Compared with traditional open transplant nephrectomy,its advantage lies in the ability to directly observe and prioritize the management of the renal pedicle of the transplanted kidney,while completely freeing and removing the transplanted kidney outside the renal capsule.With the continuous accumulation of experience,this surgical technique is expected to become a powerful alternative to traditional open transplant nephrectomy.