Objective To compare the effects of main artery clamping(MAC)and selective artery clamping(SAC)strategies on postoperative renal function in patients with chronic renal insufficiency undergoing robot-assisted partial nephrectomy.Methods A retrospective cohort study was conducted on 231 patients with preoperative chronic renal insufficiency[eGFR<90 mL/(min·1.73 m2)with renal injury markers or eGFR<60 mL/(min·1.73 m2)]who underwent robot-assisted partial nephrectomy in the Department of Urology of the First Affiliated Hospital of Army Medical University from February 2018 to February 2024.According to intraoperative renal artery clamping strategy,they were divided into a MAC group(n=129)and a SAC group(n=102).Preoperatively,individualized renal artery clamping strategies were developed using a machine learning-based multimodal holographic 3-D reconstruction technique.Serum creatinine(Scr)level was measured at 3 d and 3 months after surgery,and estimated glomerular filtration rate(eGFR)was calculated using the chronic kidney disease epidemiology collaboration equation(CKD-EPI)formula.Renal dynamic imaging with 99mTc-DTPA or 99mTc-MAG3 was used to assess the GFR of the affected kidney.Results At 3 d after surgery,the decrease in GFR of the affected kidney was significantly lower[(8.3±7.7)vs(16.0±10.2)mL/(min·1.73 m2),95%CI:-10.2～-5.2,P<0.001]in the SAC group than the MAC group.Scr increment analysis showed that the SAC group exhibited notably lower Scr increase[8.2(2.5,18.7)vs 15.5(5.8,28.3)μmol/L,95%CI:-12.3～-1.8,P=0.027],and milder eGFR decline[3.0(0.5,7.8)vs 7.5(2.0,14.3)mL/(min·1.73 m2),95%CI:-6.2～-0.8,P=0.015].And,in 3 months after surgery,the SAC group had lower Scr level[(89.2±23.1)vs(95.3±22.1)μmol/L,95%CI:-11.9～-0.3,P=0.042],and higher GFR of the affected kidney[(33.5±10.5)vs(26.1±10.9)mL/(min·1.73 m2),95%CI:4.6～10.2,P<0.001].Conclusion For patients with chronic renal insufficiency undergoing robot-assisted partial nephrectomy,SAC strategy is superior to MAC strategy in protecting postoperative renal function without increasing surgical risk.

Objective To prepare the biodegradable polylactic acid glycolic acid (PLGA) copolymer.encapsulated vascular endothelial growth factor(VEGF) loaded fluorescent controlled release sub-microspheres,to understand the efficiency of microspheres loading and releasing VEGF and to observe in vitro microspheres degradation.Methods VEGF-loading PLGA sub-microspheres were prepared by the two-phase solvent evaporation method,the in vitro degradation of fluorescent microspheres was observed by the laser confocal scanning electron microscopy.The drug loading efficiency and drug release curve were observed by ELISA.Results The VEGF loading PLGA fluorescent microspheres were successfully prepared by using the two-phase solvent evaporation method.The microspheres morphology was normal by using the scanning electron microscope and laser confocal microscope.The particle size was 0.5-1.0 μm with the laser particle size analyzer.The distribution was homogeneous.The VEGF loading rate and encapsulation rate detected by the quantitative ELISA were 3.91％ and 51.42 ％ respectively.The fluorescent microscope observed their slow degradation.The VEGF gentle release was detected by the quantitative ELISA,which showing linear zero order release trend.Conclusion The drug loading efficiency of VEGF-loading PLGA microspheres with 0.5-1.0 μm diameter is higher with linear zero order release,which can be directly observed by fluorescent light.

Objective To explore the auxiliary method of urethral reunion operation on bulbous urethral complete rupture by en-doscope .Methods 11 cases of bulbous urethral complete rupture were inserted urethral probe from suprapubic puncture cystosto-my ,when it was difficult to find near end of disrupt urethra only by endoscopic realignment .Results 9 cases were reconstructed in one-stage endoscopic urethral realignment with the aid of urethral probe from suprapubic puncture cystostomy .Conclusion Ure-thral probe from suprapubic puncture cystostomy will improve the success rate of one-stage endoscopic urethral realignment for the cases of bulbous urethral complete rupture .