Objective:To explore the effect of identifying pelvic lymph nodes by different injection of indocyanine green (ICG) during fluorescent laparoscopic radical cystectomy.Methods:The data of 54 male bladder cancer patients admitted to the First Hospital of Shanxi Medical University from September 2021 to September 2022 were analyzed. Preoperative cystoscopic biopsy all revealed a pathological diagnosis of urothelial carcinoma. All patients underwent fluorescent laparoscopic radical cystectomy plus pelvic lymph node dissection.They were divided into 3 groups according to the annotated route: 6 in the medial malleolus injection group, 68(61, 73) years; 4 in the perineal injection group, 67(59, 74) years; 44 in the medial malleolus and perineum, 64(45, 78) in the combined injection group. Under general anesthesia, patients were placed in the supine position with 0.3 to 0.5 ml of subcutaneous ICG solution (2.5 mg/ml) injected from 1.0 to 1.5 h before surgery. In the medial malleolus injection group, 0.3 to 0.5 ml (0.75 mg/place) was injected at 2 cm above the medial malleolus and 0.3 to 0.5 ml (0.75 mg/place) at two symmetrical sites above the anus. Intraoperatively, 4K fluorescent laparoscopy was used to observe the color development of the injection site and lymphatic vessels in vitro, and then to observe the development of pelvic lymph nodes in vivo.Results:In 3 groups, inguinal lymph nodes were developed about 30 min after ICG injection, and 1 h later, the longest (4.5±0.3) h. The external iliac and common iliac lymph nodes, the obturatorius lymph nodes in the perineal injection group, and the inguinal, obturatorius, external iliac, internal, anterior sacral, and common iliac lymph nodes in the medial malleolar and perineal injection group. In this study, in 54 cases, the postoperative pathological examination confirmed that the removed fluorescently labeled tissue was lymph node tissue, and the lymph node detection rate was 100%. The postoperative stage was pT 2, 14, 32 pT 3 and 8 pT 4; 4 pNx, 44 pN 0, 5 pN 1and 1 pN 2. In the medial malleolar injection group, 2 patients staged pT 2, 3 stage pT 3, 1 stage pT 4; 1stage pNx stage, 4 stage pN 0 and 1 stage pN 1 stage. In the perineal injection group, 4 patients had postoperative pathological stage pT 3N 0; in the medial malleolar and perineal injection group, 12 pT 2, 25 and 7 pT 3; 3 pNx, 36 pN 0, 4 pN 1 and 1pN 2. Conclusions:ICG injection through the perineum and subcutaneous labeling of pelvic lymph nodes, and the simple malleolus or perineal injection can not completely develop the pelvic lymph nodes. The combined injection could fully develop the pelvic lymph nodes, which may accurately guide the operator to locate, identify and remove pelvic lymph nodes.

Objective To investigate the correlation of human epididymis protein 4(HE4)with proteinuria in patients with type 2 diabetes mellitus(T2DM).Methods A total of 147 T2DM patients from January 2020 to July 2023 in Jiujiang NO.l People's Hospital were enrolled in observation group.According to the severity of proteinuria,observation group was divided into three groups:Normal albuminuria group(101 cases),microalbuminuria group(25 cases),and massive albuminuria group(21 cases).50 healthy examinees with gender and age matching during the same period were selected as control group.HE4 levels and clinical indicators in each group were compared and analyzed.Correlation between HE4 and proteinuria was analyzed by using univariate and multivariate linear regression.Results The correlation network diagram reveals that HE4 functions was a pivotal node linking serum albumin,urinary microalbumin,urinary microalbumin-to-creatinine ratio(UACR),and renal function biomarkers.Compared to control group,HE4 levels significantly elevated in observation group(P＜0.01).Both univariate and multivariate linear regression analysis demonstrate a positive correlation between HE4 and UACR.Logistic regression analysis shew that after adjusting for confounding factors including age,gender,estimated glomerular filtration rate(eGFR),albumin(ALB),blood urea nitrogen(BUN),serum creatinine(SCr),uric acid(UA),lactate dehydrogenase(LDH)etc.elevated HE4 levels was a risk factor for proteinuria(OR=1.110,95％CI:1.005-1.226).Conclusion Elevated HE4 levels in patients with T2DM is positivly correlated with UACR.Increase its level increases the risk of proteinuria in T2DM patients.

Objective To evaluate the safety, effectiveness and feasibility of robotic-assisted kidney transplantation (RAKT). Methods Clinical data of 16 patients who underwent kidney transplantation were collected. Among them, 8 recipients received RAKT (RAKT group) and 8 cases underwent open kidney transplantation (OKT) with the contralateral kidney from the same donor (OKT group). Perioperative status and the recovery of renal allograft function were compared between two groups. Results All patients successfully completed the surgery. In the RAKT group, no patient was converted to open surgery. The operation time in the RAKT group was longer than that in the OKT group (P=0.015). No significant differences were observed in the serum creatinine levels before surgery and upon discharge between two groups (both P>0.05). In the OKT group, one recipient developed delayed graft function (DGF), and the remaining recipients did not experience perioperative complications. No significant difference was noted in the short-term recovery of renal allograft function between two groups (P>0.05). Conclusions Postoperative recovery of the recipients in the RAKT group is equivalent to that of their counterparts in the OKT group. RAKT is a safe and effective procedure for the team expertise in kidney transplantation.

Objective:To explore the application value of Oxford nanopore technologies (ONT) in the diagnosis and treatment of periprosthetic joint infection (PJI).Methods:A prospective analysis was conducted on 32 patients with PJI admitted to the joint department of Xi'an Honghui Hospital from October 2021 to March 2023, who met the 2018 PJI diagnostic criteria of the American Skeletal Infection Society (MSIS), including 15 males and 17 females with an average age of 63.93±8.93 years. 32 revision patients who did not meet the 2018 MSIS PJI criteria during the same period were collected as controls (non PJI group), including 13 males and 19 females with an average age of 65.53±8.54 years. All patients underwent joint fluid puncture before or during surgery, and the specimens were tested by ONT, metagenomic next generation sequencing (mNGS), and general microbial culture. The receiver operating characteristic (ROC) curves were drawn for both groups, and the sensitivity, specificity, positive predictive value, negative predictive value, and Youden index of the three detection techniques were calculated and compared to evaluate the detection efficiency of different detection methods in PJI.Results:Among the 32 patients with PJI, 30 were positive for ONT, with a total of 30 pathogenic bacteria detected, and the detection time was 22.37±8.36 h. 31 were positive for mNGS, with a total of 33 bacterial species detected, and the detection time was 46.25±9.36 h. 17 were positive for microbial culture, with a total of 8 bacterial species detected, and the detection time was 96.23±15.62 h. Among the 32 patients with non PJI group, 1 was positive for ONT and 5 were positive for mNGS, with a total of 1 and 3 bacterial species detected, respectively. The results of microbial culture were all negative. The detection time and area under the curve (AUC) of ONT and mNGS were 22.37±8.36 h and 0.953[95% CI (0.901, 1.006)], 46.25±9.36 h and 0.906[95% CI (0.835, 0.977)], respectively, which were better than those of microbial culture 96.23±15.62 h and 0.766[95% CI (0.678, 0.853)], and the difference was statistically significant ( P<0.05). The sensitivity of ONT, mNGS, and microbial culture were 0.938, 0.969, and 0.531, respectively, and the specificity was 0.969, 0.844, and 1.000, respectively. The Jordan index was 0.906, 0.813, and 0.531, respectively. Conclusion:ONT testing has higher diagnostic efficacy than mNGS and microbial culture in the diagnosis of PJI, and also has advantages in detection time. It also suggests that some PJI are not caused by a single microbial infection.

In the all-media era,online public opinion events are causing more and more trouble to the healthcare industry,and public hospitals in this situation are facing a severe test in terms of online public opinion management,which is generally problematic.It introduces the hospital network public opinion governance strategies and methods based on hazard vulnerability analysis of Peking University People's Hospital and explores a practical and feasible hos-pital online public opinion management model from the aspects of public opinion risk identification,public opinion management system construction,and improvement of departmental management level,to enhance the level of hospital public opinion governance,with a view to reducing and avoiding negative impacts on the hospital caused by online public opinion events,building a harmonious doctor-patient relationship,and improving the work of medical services.The aim is to reduce and avoid the negative impact of online public opinion events on the hospital,to build a harmonious doctor-patient relationship and improve medical services.

In the all-media era,online public opinion events are causing more and more trouble to the healthcare industry,and public hospitals in this situation are facing a severe test in terms of online public opinion management,which is generally problematic.It introduces the hospital network public opinion governance strategies and methods based on hazard vulnerability analysis of Peking University People's Hospital and explores a practical and feasible hos-pital online public opinion management model from the aspects of public opinion risk identification,public opinion management system construction,and improvement of departmental management level,to enhance the level of hospital public opinion governance,with a view to reducing and avoiding negative impacts on the hospital caused by online public opinion events,building a harmonious doctor-patient relationship,and improving the work of medical services.The aim is to reduce and avoid the negative impact of online public opinion events on the hospital,to build a harmonious doctor-patient relationship and improve medical services.

In the all-media era,online public opinion events are causing more and more trouble to the healthcare industry,and public hospitals in this situation are facing a severe test in terms of online public opinion management,which is generally problematic.It introduces the hospital network public opinion governance strategies and methods based on hazard vulnerability analysis of Peking University People's Hospital and explores a practical and feasible hos-pital online public opinion management model from the aspects of public opinion risk identification,public opinion management system construction,and improvement of departmental management level,to enhance the level of hospital public opinion governance,with a view to reducing and avoiding negative impacts on the hospital caused by online public opinion events,building a harmonious doctor-patient relationship,and improving the work of medical services.The aim is to reduce and avoid the negative impact of online public opinion events on the hospital,to build a harmonious doctor-patient relationship and improve medical services.

In the all-media era,online public opinion events are causing more and more trouble to the healthcare industry,and public hospitals in this situation are facing a severe test in terms of online public opinion management,which is generally problematic.It introduces the hospital network public opinion governance strategies and methods based on hazard vulnerability analysis of Peking University People's Hospital and explores a practical and feasible hos-pital online public opinion management model from the aspects of public opinion risk identification,public opinion management system construction,and improvement of departmental management level,to enhance the level of hospital public opinion governance,with a view to reducing and avoiding negative impacts on the hospital caused by online public opinion events,building a harmonious doctor-patient relationship,and improving the work of medical services.The aim is to reduce and avoid the negative impact of online public opinion events on the hospital,to build a harmonious doctor-patient relationship and improve medical services.

In the all-media era,online public opinion events are causing more and more trouble to the healthcare industry,and public hospitals in this situation are facing a severe test in terms of online public opinion management,which is generally problematic.It introduces the hospital network public opinion governance strategies and methods based on hazard vulnerability analysis of Peking University People's Hospital and explores a practical and feasible hos-pital online public opinion management model from the aspects of public opinion risk identification,public opinion management system construction,and improvement of departmental management level,to enhance the level of hospital public opinion governance,with a view to reducing and avoiding negative impacts on the hospital caused by online public opinion events,building a harmonious doctor-patient relationship,and improving the work of medical services.The aim is to reduce and avoid the negative impact of online public opinion events on the hospital,to build a harmonious doctor-patient relationship and improve medical services.

In the all-media era,online public opinion events are causing more and more trouble to the healthcare industry,and public hospitals in this situation are facing a severe test in terms of online public opinion management,which is generally problematic.It introduces the hospital network public opinion governance strategies and methods based on hazard vulnerability analysis of Peking University People's Hospital and explores a practical and feasible hos-pital online public opinion management model from the aspects of public opinion risk identification,public opinion management system construction,and improvement of departmental management level,to enhance the level of hospital public opinion governance,with a view to reducing and avoiding negative impacts on the hospital caused by online public opinion events,building a harmonious doctor-patient relationship,and improving the work of medical services.The aim is to reduce and avoid the negative impact of online public opinion events on the hospital,to build a harmonious doctor-patient relationship and improve medical services.