Objective To evaluate the feasibility and technical advantages of modified laparoscopic ileal-neobladder fistula repair.Methods A retrospective analysis was conducted on the clinical data of 4 patients who underwent radical cystectomy+orthotopic neobladder surgery and subsequently developed ileal-neobladder fistula and received modified repair surgery in our hospital during Jan.2019 and Dec.2023.Under laparoscopy,the ileum at both ends of the fistula was transected,and an end-to-end ileal anastomosis bypass was established.Results All 4 patients successfully completed the operation.Their age was 66,50,76 and 59 years,respectively.Ileal-neoblbladder fistula occurred 4,1,2 and 16 months after radical resection.The operation time was 129,98,105 and 90 minutes.The intraoperative blood loss was 50,60,70 and 50 mL.The postoperative exhaust time was 3,4,3 and 5 days.The postoperative hospital stay was 8,7,7 and 9 days,and the postoperative drainage tube indwelling time was 5,4,5 and 7 days.No obvious complications occurred after operation.During follow-up of 1 to 6 years,none recurrence or long-term stenosis of the intestinal anastomosis occurred.The symptoms of urinary tract infection improved significantly,and the bladder function remained stable.Conclusion The modified laparoscopic repair of ileal-neobladder fistula achieves minimally invasive repair by avoiding extensive adhesion separation.It has the advantages of safe operation,rapid recovery,and few complications,and is a safe option for the treatment of ileal-neobladder fistula.

Objective To evaluate the feasibility and technical advantages of modified laparoscopic ileal-neobladder fistula repair.Methods A retrospective analysis was conducted on the clinical data of 4 patients who underwent radical cystectomy+orthotopic neobladder surgery and subsequently developed ileal-neobladder fistula and received modified repair surgery in our hospital during Jan.2019 and Dec.2023.Under laparoscopy,the ileum at both ends of the fistula was transected,and an end-to-end ileal anastomosis bypass was established.Results All 4 patients successfully completed the operation.Their age was 66,50,76 and 59 years,respectively.Ileal-neoblbladder fistula occurred 4,1,2 and 16 months after radical resection.The operation time was 129,98,105 and 90 minutes.The intraoperative blood loss was 50,60,70 and 50 mL.The postoperative exhaust time was 3,4,3 and 5 days.The postoperative hospital stay was 8,7,7 and 9 days,and the postoperative drainage tube indwelling time was 5,4,5 and 7 days.No obvious complications occurred after operation.During follow-up of 1 to 6 years,none recurrence or long-term stenosis of the intestinal anastomosis occurred.The symptoms of urinary tract infection improved significantly,and the bladder function remained stable.Conclusion The modified laparoscopic repair of ileal-neobladder fistula achieves minimally invasive repair by avoiding extensive adhesion separation.It has the advantages of safe operation,rapid recovery,and few complications,and is a safe option for the treatment of ileal-neobladder fistula.

To construct a recombinant fowl adenovirus 4(FAdV-4)expressing the Cap protein of goose astrovirus genotype 2(GoAstV-2),the expression cassette of Cap gene was inserted into the natural 1 966 bp deletion region of the FAdV-4 genome in the infectious clone p15A-cm-FAdV4-HNJZ.The resulted recombinant plasmid p15A-cm-FAdV4-HNJZ-Cap/GoAstV-2 was linearized with restriction enzyme and transfected into chicken hepatoma cell line(LMH)to rescue the recombinant FAdV-4 expressing the Cap protein of GoAstV-2,rF Ad V4-Cap/GoAstV-2.After 15 passages in LMH cells,the recombinant rFAdV4-Cap/GoAstV-2 was identified by PCR using primers flanking the insertion site of the Cap gene expression cassette and using viral genome DNA extracted from rFAdV4-Cap/GoAstV-2 infected LMH cells as template.LMH cells were in-fected with 15th passage rFAdV4-Cap/GoAstV-2 and indirect immunofluorescence was performed with a polyclonal antibody against Cap protein as the primary antibody.Western blot was carried out with lysates of rFAdV4-Cap/GoAstV-2 infected LMH cells.The in vitro replication dynamic of the 15th passage of the rFAdV4-Cap/GoAstV-2 was also investigated in LMH cells.The results demonstrated that the Cap gene of GoAstV-2 was presented in the genome of the recombinant vi-rus rF AdV4-Cap/Go Ast V-2,and could be expressed stably.The prepared recombinant virus in this study will lay a foundation for developing inactivated bivalent vaccine candidate against co-in-fection of FAdV-4 and GoAstV-2 in goose.

Objective To investigate the safety and validity of laparoscopic autologous lingual mucosal graft ureteroplasty for the treatment of complex ureteral stricture.Methods A total of 10 patients who underwent laparoscopic autologous lingual mucosal graft ureteroplasty in our hospital from May 2021 to October 2023 were retrospectively analyzed.During the operation,the narrow segment was longitudinally dissected,and according to the length of stricture,the lingual mucosal graft of 2.0-7.0 cm in length and 1.0-1.5 cm in width was harvested and precisely anastomosed with the stenosed ureter,followed by double J stent placement.Results All the operations were successfully completed with no conversion to open surgery or intraoperative complications.The operative duration was(237.0±67.1)min,the estimated blood loss was 25.0(20.0,30.0)ml,the duration of drainage tube indwelling was 4.0(4.0,4.8)d,the duration of urinary catheter indwelling was 6.5(6.0,9.5)d,and the duration of postoperative hospitalization was 6.0(6.0,6.8)d.All the patients'oral function recovered well within 1 week,and the double J stent was removed 1-2 months after the surgery.The mean follow-up time was(12.3±7.1)months.One case of aggravated hydronephrosis on the affected side underwent a second laparoscopic ureteral stricture resection and end-to-end anastomosis.The remaining 9 cases showed significant improvement in hydronephrosis on the affected side,with improved renal pelvis separation[(2.9±1.2)cm,t=8.022,P=0.000]and renal function compared to before surgery.Their blood creatinine was(74.3±25.5)μmol/L,with no significant difference compared to preoperation[(80.1±26.6)μmol/L,t=1.825,P=0.105].Conclusion Laparoscopic autologous lingual mucosal graft ureteroplasty for the treatment of complex ureteral stricture is a safe and feasible ureteral reconstruction technique with advantages of quick recovery and reliable outcomes.

To construct a recombinant fowl adenovirus 4(FAdV-4)expressing the Cap protein of goose astrovirus genotype 2(GoAstV-2),the expression cassette of Cap gene was inserted into the natural 1 966 bp deletion region of the FAdV-4 genome in the infectious clone p15A-cm-FAdV4-HNJZ.The resulted recombinant plasmid p15A-cm-FAdV4-HNJZ-Cap/GoAstV-2 was linearized with restriction enzyme and transfected into chicken hepatoma cell line(LMH)to rescue the recombinant FAdV-4 expressing the Cap protein of GoAstV-2,rF Ad V4-Cap/GoAstV-2.After 15 passages in LMH cells,the recombinant rFAdV4-Cap/GoAstV-2 was identified by PCR using primers flanking the insertion site of the Cap gene expression cassette and using viral genome DNA extracted from rFAdV4-Cap/GoAstV-2 infected LMH cells as template.LMH cells were in-fected with 15th passage rFAdV4-Cap/GoAstV-2 and indirect immunofluorescence was performed with a polyclonal antibody against Cap protein as the primary antibody.Western blot was carried out with lysates of rFAdV4-Cap/GoAstV-2 infected LMH cells.The in vitro replication dynamic of the 15th passage of the rFAdV4-Cap/GoAstV-2 was also investigated in LMH cells.The results demonstrated that the Cap gene of GoAstV-2 was presented in the genome of the recombinant vi-rus rF AdV4-Cap/Go Ast V-2,and could be expressed stably.The prepared recombinant virus in this study will lay a foundation for developing inactivated bivalent vaccine candidate against co-in-fection of FAdV-4 and GoAstV-2 in goose.

Objective To investigate the safety and validity of laparoscopic autologous lingual mucosal graft ureteroplasty for the treatment of complex ureteral stricture.Methods A total of 10 patients who underwent laparoscopic autologous lingual mucosal graft ureteroplasty in our hospital from May 2021 to October 2023 were retrospectively analyzed.During the operation,the narrow segment was longitudinally dissected,and according to the length of stricture,the lingual mucosal graft of 2.0-7.0 cm in length and 1.0-1.5 cm in width was harvested and precisely anastomosed with the stenosed ureter,followed by double J stent placement.Results All the operations were successfully completed with no conversion to open surgery or intraoperative complications.The operative duration was(237.0±67.1)min,the estimated blood loss was 25.0(20.0,30.0)ml,the duration of drainage tube indwelling was 4.0(4.0,4.8)d,the duration of urinary catheter indwelling was 6.5(6.0,9.5)d,and the duration of postoperative hospitalization was 6.0(6.0,6.8)d.All the patients'oral function recovered well within 1 week,and the double J stent was removed 1-2 months after the surgery.The mean follow-up time was(12.3±7.1)months.One case of aggravated hydronephrosis on the affected side underwent a second laparoscopic ureteral stricture resection and end-to-end anastomosis.The remaining 9 cases showed significant improvement in hydronephrosis on the affected side,with improved renal pelvis separation[(2.9±1.2)cm,t=8.022,P=0.000]and renal function compared to before surgery.Their blood creatinine was(74.3±25.5)μmol/L,with no significant difference compared to preoperation[(80.1±26.6)μmol/L,t=1.825,P=0.105].Conclusion Laparoscopic autologous lingual mucosal graft ureteroplasty for the treatment of complex ureteral stricture is a safe and feasible ureteral reconstruction technique with advantages of quick recovery and reliable outcomes.

Objective To evaluate the change of energy metabolism during cisplatin-induced acute kidney injury.Methods Adult CD-1 male mice were intraperitoneally injected with a single dose of cisplatin (20 mg/kg), and renal function and renal tissue pathology were tested;gene expression was analyzed and signaling pathways were en-riched in cisplatin-treated renal tubular epithelial cells using transcriptome; the contents of renal glycolysis and a-mino acid metabolites were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) .Re-sults Serum urea nitrogen and blood creatinine significantly increased in cisplatin-treated mice.Pathological his-tology observed swelling and shedding of renal tubular epithelial cells.Transcriptome analysis revealed that 2632 genes were upregulated and 2799 genes were downregulated in cisplatin-treated HK-2 cells.GO and KEGG analy-sis showed that differential genes were enriched in energy metabolism.The GSEA analysis results showed that cispl-atin caused an upregulation of the oxidative phosphorylation pathway and a downregulation of the glycolysis pathway in renal tubular epithelial cells, further KEGG analysis demonstrated that cisplatin caused changes in the expression of amino acid genes in renal cells.Metabolomics showed that the contents of glycolytic intermediates and several a-mino acids were altered in the kidney of cisplatin-treated mice.Conclusion Cisplatin-induced acute renal injury is accompanied by modification in renal tubular cell glycolysis and amino acid metabolism.

Objective To observe the value of CT radiomics for differentiating spinal bone islands(BI)and osteoblastic metastases(OBM).Methods Data of 109 BI lesions in 98 patients and 282 OBM lesions in 158 patients(including 103 OBM in 48 lung cancer cases,86 OBM in 52 breast cancer cases and 93 OBM in 58 prostate cancer cases)from 3 medical institutions were retrospectively analyzed.Data obtained from institution 1 were used as the internal dataset and divided into internal training set and internal validation set at a ratio of 7∶3,from institution 2 and 3 were used as external dataset.All datasets were divided into female data subset(including OBM of female lung cancer and breast cancer)and male data subset(including OBM of male lung cancer and prostate cancer).Radiomics features were extracted and screened to construct 3 different support vector machine(SVM)models,including model1 for distinguishing BI and OBM,model2 for differentiating OBM of female lung cancer and breast cancer,and model3 for differentiating OBM of male lung cancer and prostate cancer.Diagnostic efficacy of model1,CT value alone and 3 physicians(A,B,C)for distinguishing BI and OBM were assessed,as well as differentiating efficacy for different OBM of model2 and model3.Receiver operating characteristic(ROC)curves were drawn,and area under the curves(AUC)were calculated and compared.The differential diagnostic efficacy of model2 and model3 were also assessed with ROC analysis and AUC.Results AUC of model1 for distinguishing spinal OBM from BI in internal training set,internal validation set and external dataset was 0.99,0.98 and 0.86,respectively.In internal training set,model1 had higher AUC for distinguishing BI and OBM than that of physician A(AUC=0.78),B(AUC=0.87)and C(AUC=0.93)as well as that of mean CT value(AUC=0.78,all P＜0.05).AUC in internal training set,internal validation set and external dataset of model2 for identifying female lung cancer and breast cancer OBM was 0.79,0.75 and 0.73,respectively,of model3 for discriminating male lung cancer from prostate cancer OBM was 0.77,0.74 and 0.77,respectively.Conclusion CT radiomics SVM model might reliablely distinguish OBM and BI.

Objective:To evaluate the safety and validity of perioperative antimicrobial prophylaxis with different administration period in patients undergoing transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).Methods:This prospective randomized controlled clinical trial was conducted on patients who underwent TURP in the Second Affiliated Hospital of Anhui Medical University from July 2022 to December 2023. The patients were randomly assigned to the experimental group and the control group in a 1∶1 ratio using a randomized block design. Inclusion criteria: age 55-78 years old, the indication of benign prostatic hyperplasia surgery, preoperative urine routine examination showed no pyuria or bacteriuria, preoperative catheterization being not reserved, postoperative pathology confirmed BPH and informed consent obtained. Exclusion criteria: severe heart, lung, brain and other diseases which could not tolerate anesthesia and surgery, complicated with bladder stones or bladder tumors, diabetic patients with poor glycemic control, immunosuppressive agents being administered. Patients in the experimental group received a single dose of cephalosporins or fluoroquinolones 30 minutes or 2 hours before surgery, while patients in the control group received a second dose 12 hours or 24 hours after the first dose. The primary outcome was the incidence of urinary tract infectious presenting fever (body temperature ≥38.5℃) within 1 week after surgery, while the white blood cell count, C-reactive protein concentration, serum heparin-binding protein concentration, red and white blood cell count in urine, the incidence of bacteriuria, pulmonary infection, and postoperative hospital stay were defined as secondary outcomes. The safety index was the incidence of adverse reactions of antibiotics.Results:A total of 180 patients were enrolled in this study, including 90 cases in each experimental group or control group. Two groups of patients had no significant difference ( P>0.05) in age [(71.7±3.9) and (69.9±4.8) years], prostate volume [55.0 ml(39.5, 62.0) and 52.5(45.5, 68.5) ml], operation time [(58.8±17.0) min vs. (60.9±16.7) min], and postoperative indwelling catheter days [3.0(3, 4) d vs. 3.8(3, 4) d]. The incidence of fever within 1 week after surgery was 7.8%(7/90) in the experimental group and 5.6%(5/90) in the control group, respectively, and the difference was not statistically significant ( P=0.550). Our data demonstrated that the white blood cell count [(10.5±1.2)×10 9/L vs. (9.7±4.1)×10 9/L], C-reactive protein concentration [(43.0±27.9) mg/L vs. (53.1±29.9) mg/L] and heparin-binding protein concentration [(44.7±19.4) ng/ml vs. (37.8±23.5) ng/ml], urine red blood cell count [4 768.2(2 387.9, 10 496.5)/μl vs. 6 577.2(3 691.5, 7 636.8) /μl], urine white blood cell count [447.1(283.9, 637.0)/μl vs 242.8(109.7, 691.8)/μl] were mildly elevated in two groups without significant difference ( P>0.05). The incidence of postoperative pulmonary infection [3.3% (3/90)] vs. 2.2% (2/90)], bacteriuria [6.7% (6/90) vs. 8.9% (8/90)], postoperative hospital stay [4.5(4.0, 5.1) days vs. 4.5(4.0, 5.5) days] also showed no significant difference ( P>0.05). While the incidence of adverse reactions of antibiotics in the experimental group 3.3% (3/90) was significantly lower than that in the control group 11.1% (10/90) ( P=0.044). Conclusions:A single-dose antibiotic administration as a perioperative antimicrobial prophylaxis is safe and effective for patients undergoing TURP who do not have preoperative pyuria or indwelling catheter.

Objective:To evaluate the safety and validity of perioperative antimicrobial prophylaxis with different administration period in patients undergoing transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).Methods:This prospective randomized controlled clinical trial was conducted on patients who underwent TURP in the Second Affiliated Hospital of Anhui Medical University from July 2022 to December 2023. The patients were randomly assigned to the experimental group and the control group in a 1∶1 ratio using a randomized block design. Inclusion criteria: age 55-78 years old, the indication of benign prostatic hyperplasia surgery, preoperative urine routine examination showed no pyuria or bacteriuria, preoperative catheterization being not reserved, postoperative pathology confirmed BPH and informed consent obtained. Exclusion criteria: severe heart, lung, brain and other diseases which could not tolerate anesthesia and surgery, complicated with bladder stones or bladder tumors, diabetic patients with poor glycemic control, immunosuppressive agents being administered. Patients in the experimental group received a single dose of cephalosporins or fluoroquinolones 30 minutes or 2 hours before surgery, while patients in the control group received a second dose 12 hours or 24 hours after the first dose. The primary outcome was the incidence of urinary tract infectious presenting fever (body temperature ≥38.5℃) within 1 week after surgery, while the white blood cell count, C-reactive protein concentration, serum heparin-binding protein concentration, red and white blood cell count in urine, the incidence of bacteriuria, pulmonary infection, and postoperative hospital stay were defined as secondary outcomes. The safety index was the incidence of adverse reactions of antibiotics.Results:A total of 180 patients were enrolled in this study, including 90 cases in each experimental group or control group. Two groups of patients had no significant difference ( P>0.05) in age [(71.7±3.9) and (69.9±4.8) years], prostate volume [55.0 ml(39.5, 62.0) and 52.5(45.5, 68.5) ml], operation time [(58.8±17.0) min vs. (60.9±16.7) min], and postoperative indwelling catheter days [3.0(3, 4) d vs. 3.8(3, 4) d]. The incidence of fever within 1 week after surgery was 7.8%(7/90) in the experimental group and 5.6%(5/90) in the control group, respectively, and the difference was not statistically significant ( P=0.550). Our data demonstrated that the white blood cell count [(10.5±1.2)×10 9/L vs. (9.7±4.1)×10 9/L], C-reactive protein concentration [(43.0±27.9) mg/L vs. (53.1±29.9) mg/L] and heparin-binding protein concentration [(44.7±19.4) ng/ml vs. (37.8±23.5) ng/ml], urine red blood cell count [4 768.2(2 387.9, 10 496.5)/μl vs. 6 577.2(3 691.5, 7 636.8) /μl], urine white blood cell count [447.1(283.9, 637.0)/μl vs 242.8(109.7, 691.8)/μl] were mildly elevated in two groups without significant difference ( P>0.05). The incidence of postoperative pulmonary infection [3.3% (3/90)] vs. 2.2% (2/90)], bacteriuria [6.7% (6/90) vs. 8.9% (8/90)], postoperative hospital stay [4.5(4.0, 5.1) days vs. 4.5(4.0, 5.5) days] also showed no significant difference ( P>0.05). While the incidence of adverse reactions of antibiotics in the experimental group 3.3% (3/90) was significantly lower than that in the control group 11.1% (10/90) ( P=0.044). Conclusions:A single-dose antibiotic administration as a perioperative antimicrobial prophylaxis is safe and effective for patients undergoing TURP who do not have preoperative pyuria or indwelling catheter.