Objective:To explore the predictive value of the difference in average CT attenuation values between renal pelvis urine and bladder urine on the risk of pyonephrosis, and to establish a nomogram model in combination with other parameters and to verify its predictive ability.Methods:The clinical data of patients with obstructive hydronephrosis who came to our hospital for emergency percutaneous nephrostomy (PCN) between January 2020 and December 2022 were retrospectively analyzed. There were 16 men and 33 women, with the age of (57.59, 14.67) years. Body mass index was (23.34, 3.11) kg/m 2. Urine nitrite was positive in 14 cases. Urine culture was positive in 21 cases. In the routine blood test, the median white blood cell count was 10.96 (7.21, 15.15) ×10 9/L, haemoglobin (115.08, 22.71) g/L and platelets (263.00, 97.20)×10 9/L. The difference in average CT attenuation values between renal pelvis urine and bladder urine (mean CT value of pyelonephritis-mean CT value of cysturia) was -2.19 (-7.04, 4.05) HU. Patients were divided into pyonephrosis group and hydronephrosis group according to whether the drainage fluid after PCN was pus. Single-factor and multi-factor logistic regression models were used to analyze the independent predictors of pyonephrosis and to construct nomograms. The discrimination of the model was assessed by the area under the curve (AUC) of the receiver operating characteristics (ROC), the accuracy by the calibration curve and the clinical efficacy by the decision curve analysis (DCA). Results:There were 49 cases in this study, 31 cases in the hydronephrosis group and 18 cases in the pyonephrosis group. The average CT attenuation values of renal pelvis urine were 3.35(0.56, 8.96) HU and 7.78 (3.75, 18.38) HU, respectively, and the difference between the two groups was statistically significant ( P=0.023). The average CT attenuation values of bladder urine were (7.81±6.15)HU and (7.22±7.50)HU, respectively, and there was no significant difference between the two groups ( P=0.780). The difference in average CT attenuation values between renal pelvis urine and bladder urine were -3.98(-7.54, 0.60)HU and 2.13 (-5.15, 9.36)HU, respectively, and the difference between the two groups was not statistically significant ( P=0.059); the white blood cells were 9.82(7.04, 12.46) ×10 9/L and 13.99(9.75, 18.44) ×10 9/L, respectively, and the difference between the two groups was statistically significant ( P=0.048). Platelet counts were (248.06±87.87)×10 9/L and (288.72±109.29)×10 9/L, respectively, and there was no statistical difference between the two groups ( P=0.189). The proportion of urine protein positive was higher in the pyonephrosis group (17 vs. 20, P=0.048). Between the two groups, sex, age, body mass index, clinical symptoms (with or without low back pain), surgical history of upper urinary tract stones, underlying diseases (including hypertension, diabetes, coronary heart disease, etc.), location of hydronephrosis (left, right, and both sides), reasons of obstruction [upper urinary tract stones, other factors (such as tumor, ureteral stricture, etc.)], haemoglobin, were not statistical different. There were no significant difference in blood glucose, blood potassium, blood sodium, urine leukocytes, urine erythrocytes, urine nitrite and urine culture ( P>0.05). Multivariate logistic regression analysis showed that the difference in average CT attenuation values between renal pelvis urine and bladder urine ( OR=1.196, 95% CI 1.055-1.437, P=0.018), white blood cells ( OR=1.252, 95% CI 1.036-1.615, P=0.038), and platelets ( OR=1.014, 95% CI 1.003-1.030, P=0.025) were independent predictors of pyonephrosis. According to the above indicators, the nomogram model was established and the AUC value of the model was 0.767 (95% CI 0.616-0.918), the sensitivity was 0.611 and the specificity was 0.935. The calibration curve showed that there is a good fit between the observed value and the predicted value. The DCA analysis showed that the nomogram model has a net gain in a wide threshold range, demonstrating its predictive accuracy and clinical practicality in predicting the risk of pyonephrosis. When the cut-off value of the difference between the average CT values of pyelonephritis and cystourethrosis was 6.54 HU, the AUC value of the independent prediction of pyonephrosis was 0.690(95% CI 0.564-0.816), the sensitivity was 0.444 and the specificity was 0.935. Conclusions:The difference in average CT attenuation values between renal pelvis urine and bladder urine is an independent risk factor for predicting pyonephrosis, and the nomogram constructed by combining it with white blood cells and platelets has a good predictive effect for predicting the risk of pyonephrosis. If the difference in average CT attenuation values between renal pelvis urine and bladder urine is greater than 6.54HU, it should be alert to the occurrence of pyonephrosis.

Objective:To retrospectively evaluate the clinical efficacy and safety of total 3D laparo-scopic ileal ureters replacement for bilateral ureters combined with bladder augmentation in patients with post-radiotherapy long-segment bilateral ureteral strictures and contracted bladder.Methods:Clinical data of two patients(aged 72 and 54 years)with radiation-induced long-segment bilateral ureteral stric-tures and reduced bladder capacity,treated at the Sixth Affiliated Hospital of Jinan University from Octo-ber 2023 to June 2024,were analyzed.Both presented with bilateral flank pain,recurrent chills/fever,urinary frequency,and urgency.Preoperative ureteral stricture lengths were measured as follows:left 10.4 cm and right 8.7 cm in the first case;left 10.6 cm and right 11.7 cm in the second case.Bladder capacity assessed by nephrostomy-assisted antegrade urography was 90 mL and 130 mL respectively.Both underwent single-position,one-stage totally 3D laparoscopic bilateral ileal ureteral replacement and blad-der augmentation based on membrane anatomy principles,with regular postoperative follow-up.Results:Procedures were completed by the same experienced urologist.Operative times were 420 min and 355 min,with intraoperative blood loss of 50 mL(no transfusion required).Postoperative bowel function re-sumed at the end of 4.5 and 3 days.No major perioperative complications occurred.Ureteral stents were removed at 2 months postoperatively,with imaging showing improved hydronephrosis,unobstructed ure-teral drainage,symmetrical bladder morphology,and smooth walls.Postoperative bladder capacities were 230 mL and 250 mL.Follow-up durations were 10 and 8 months.Both patients experienced significant relief of flank pain and lower urinary tract symptoms.No complications(enteric fistula,urinary fistula,or metabolic acidosis)were observed.At the final follow-up,one patient had mildly elevated serum cre-atinine,while the other showed reduced levels compared with preoperative values;both remained stable.Conclusion:Membrane anatomy-based dissection facilitates safe mobilization of fibrotic ureters with mini-mal bleeding and collateral damage.Total intracorporeal 3D laparoscopic ileal ureters replacement for bi-lateral ureters combined with bladder augmentation effectively addresses long-segment ureteral obstruction and improves bladder capacity.This approach is technically safe and feasible,though further validation with larger clinical cohorts is warranted.

Objective:To retrospectively evaluate the clinical efficacy and safety of total 3D laparo-scopic ileal ureters replacement for bilateral ureters combined with bladder augmentation in patients with post-radiotherapy long-segment bilateral ureteral strictures and contracted bladder.Methods:Clinical data of two patients(aged 72 and 54 years)with radiation-induced long-segment bilateral ureteral stric-tures and reduced bladder capacity,treated at the Sixth Affiliated Hospital of Jinan University from Octo-ber 2023 to June 2024,were analyzed.Both presented with bilateral flank pain,recurrent chills/fever,urinary frequency,and urgency.Preoperative ureteral stricture lengths were measured as follows:left 10.4 cm and right 8.7 cm in the first case;left 10.6 cm and right 11.7 cm in the second case.Bladder capacity assessed by nephrostomy-assisted antegrade urography was 90 mL and 130 mL respectively.Both underwent single-position,one-stage totally 3D laparoscopic bilateral ileal ureteral replacement and blad-der augmentation based on membrane anatomy principles,with regular postoperative follow-up.Results:Procedures were completed by the same experienced urologist.Operative times were 420 min and 355 min,with intraoperative blood loss of 50 mL(no transfusion required).Postoperative bowel function re-sumed at the end of 4.5 and 3 days.No major perioperative complications occurred.Ureteral stents were removed at 2 months postoperatively,with imaging showing improved hydronephrosis,unobstructed ure-teral drainage,symmetrical bladder morphology,and smooth walls.Postoperative bladder capacities were 230 mL and 250 mL.Follow-up durations were 10 and 8 months.Both patients experienced significant relief of flank pain and lower urinary tract symptoms.No complications(enteric fistula,urinary fistula,or metabolic acidosis)were observed.At the final follow-up,one patient had mildly elevated serum cre-atinine,while the other showed reduced levels compared with preoperative values;both remained stable.Conclusion:Membrane anatomy-based dissection facilitates safe mobilization of fibrotic ureters with mini-mal bleeding and collateral damage.Total intracorporeal 3D laparoscopic ileal ureters replacement for bi-lateral ureters combined with bladder augmentation effectively addresses long-segment ureteral obstruction and improves bladder capacity.This approach is technically safe and feasible,though further validation with larger clinical cohorts is warranted.

Objective:To explore the predictive value of the difference in average CT attenuation values between renal pelvis urine and bladder urine on the risk of pyonephrosis, and to establish a nomogram model in combination with other parameters and to verify its predictive ability.Methods:The clinical data of patients with obstructive hydronephrosis who came to our hospital for emergency percutaneous nephrostomy (PCN) between January 2020 and December 2022 were retrospectively analyzed. There were 16 men and 33 women, with the age of (57.59, 14.67) years. Body mass index was (23.34, 3.11) kg/m 2. Urine nitrite was positive in 14 cases. Urine culture was positive in 21 cases. In the routine blood test, the median white blood cell count was 10.96 (7.21, 15.15) ×10 9/L, haemoglobin (115.08, 22.71) g/L and platelets (263.00, 97.20)×10 9/L. The difference in average CT attenuation values between renal pelvis urine and bladder urine (mean CT value of pyelonephritis-mean CT value of cysturia) was -2.19 (-7.04, 4.05) HU. Patients were divided into pyonephrosis group and hydronephrosis group according to whether the drainage fluid after PCN was pus. Single-factor and multi-factor logistic regression models were used to analyze the independent predictors of pyonephrosis and to construct nomograms. The discrimination of the model was assessed by the area under the curve (AUC) of the receiver operating characteristics (ROC), the accuracy by the calibration curve and the clinical efficacy by the decision curve analysis (DCA). Results:There were 49 cases in this study, 31 cases in the hydronephrosis group and 18 cases in the pyonephrosis group. The average CT attenuation values of renal pelvis urine were 3.35(0.56, 8.96) HU and 7.78 (3.75, 18.38) HU, respectively, and the difference between the two groups was statistically significant ( P=0.023). The average CT attenuation values of bladder urine were (7.81±6.15)HU and (7.22±7.50)HU, respectively, and there was no significant difference between the two groups ( P=0.780). The difference in average CT attenuation values between renal pelvis urine and bladder urine were -3.98(-7.54, 0.60)HU and 2.13 (-5.15, 9.36)HU, respectively, and the difference between the two groups was not statistically significant ( P=0.059); the white blood cells were 9.82(7.04, 12.46) ×10 9/L and 13.99(9.75, 18.44) ×10 9/L, respectively, and the difference between the two groups was statistically significant ( P=0.048). Platelet counts were (248.06±87.87)×10 9/L and (288.72±109.29)×10 9/L, respectively, and there was no statistical difference between the two groups ( P=0.189). The proportion of urine protein positive was higher in the pyonephrosis group (17 vs. 20, P=0.048). Between the two groups, sex, age, body mass index, clinical symptoms (with or without low back pain), surgical history of upper urinary tract stones, underlying diseases (including hypertension, diabetes, coronary heart disease, etc.), location of hydronephrosis (left, right, and both sides), reasons of obstruction [upper urinary tract stones, other factors (such as tumor, ureteral stricture, etc.)], haemoglobin, were not statistical different. There were no significant difference in blood glucose, blood potassium, blood sodium, urine leukocytes, urine erythrocytes, urine nitrite and urine culture ( P>0.05). Multivariate logistic regression analysis showed that the difference in average CT attenuation values between renal pelvis urine and bladder urine ( OR=1.196, 95% CI 1.055-1.437, P=0.018), white blood cells ( OR=1.252, 95% CI 1.036-1.615, P=0.038), and platelets ( OR=1.014, 95% CI 1.003-1.030, P=0.025) were independent predictors of pyonephrosis. According to the above indicators, the nomogram model was established and the AUC value of the model was 0.767 (95% CI 0.616-0.918), the sensitivity was 0.611 and the specificity was 0.935. The calibration curve showed that there is a good fit between the observed value and the predicted value. The DCA analysis showed that the nomogram model has a net gain in a wide threshold range, demonstrating its predictive accuracy and clinical practicality in predicting the risk of pyonephrosis. When the cut-off value of the difference between the average CT values of pyelonephritis and cystourethrosis was 6.54 HU, the AUC value of the independent prediction of pyonephrosis was 0.690(95% CI 0.564-0.816), the sensitivity was 0.444 and the specificity was 0.935. Conclusions:The difference in average CT attenuation values between renal pelvis urine and bladder urine is an independent risk factor for predicting pyonephrosis, and the nomogram constructed by combining it with white blood cells and platelets has a good predictive effect for predicting the risk of pyonephrosis. If the difference in average CT attenuation values between renal pelvis urine and bladder urine is greater than 6.54HU, it should be alert to the occurrence of pyonephrosis.

Objective To explore the clinical value of laparoscopic radical cystectomy based on fascia anatomy for bladder cancer treatment.Methods The clinical data of 51 patients with bladder cancer who underwent 3D laparoscopic radical cystectomy during Jan.2015 and Jun.2022 were retrospectively analyzed.The surgery was performed based on membrane anatomy technology along four longitudinal and two transverse planes to complete the radical cystectomy.The pelvic plexus was preserved for patients with normal preoperative sexual function.Results All surgeries were completed without conversion to open operation.The mean operation time was(502.52±108.99)min,mean intraoperative blood loss was(275.96±155.18)mL,mean postoperative drainage time was(4.14±2.41)d,and the mean postoperative hospital stay was(16.37±4.85)d.The mean number of lymph nodes removed was(17.98±11.48).The mean postoperative follow-up was(30.27±19.39)months.At the last follow-up,no Clavien ≥grade 3 complications were observed.The estimated overall survival(OS),tumor-specific survival(TSS),and recurrence-free survival(RFS)were 82.4％,92.2％,and 88.2％,respectively.The lymph node positive patients had shorter OS and RFS(60.0％,60.0％)than the lymph node negative patients(84.8％,91.3％).Among the 19 male patients who underwent radical cystectomy with pre-exposure and preservation of pelvic plexus,daytime and nocturnal continence rate were 83.3％and 72.2％,respectively,and 17 patients recovered potency within 6 months postoperatively.Conclusion Laparoscopic radical cystectomy based on fascia anatomy is safe and effective in laparoscopic radical cystectomy,with standardized surgical procedure,satisfactory oncological outcomes,little hemorrhage,few complications and fast recovery.

Objective:To assess the clinical effectiveness and safety of Omalizumab for treating pediatric allergic asthma in real world in China.Methods:The clinical data of children aged 6 to 11 years with allergic asthma who received Omalizumab treatment in 17 hospitals in China between July 6, 2018 and September 30, 2020 were retrospectively analyzed.Such information as the demographic characteristics, allergic history, family history, total immunoglobulin E (IgE) levels, specific IgE levels, skin prick test, exhaled nitric oxide (FeNO) levels, eosinophil (EOS) counts, and comorbidities at baseline were collected.Descriptive analysis of the Omalizumab treatment mode was made, and the difference in the first dose, injection frequency and course of treatment between the Omalizumab treatment mode and the mode recommended in the instruction was investigated.Global Evaluation of Treatment Effectiveness (GETE) analysis was made after Omalizumab treatment.The moderate-to-severe asthma exacerbation rate, inhaled corticosteroid (ICS) dose, lung functions were compared before and after Omalizumab treatment.Changes in the Childhood Asthma Control Test (C-ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) results from baseline to 4, 8, 12, 16, 24, and 52 weeks after Omalizumab treatment were studied.The commodity improvement was assessed.The adverse event (AE) and serious adverse event (SAE) were analyzed for the evaluation of Omalizumab treatment safety.The difference in the annual rate of moderate-to-severe asthma exacerbation and ICS reduction was investigated by using t test.The significance level was set to 0.05.Other parameters were all subject to descriptive analysis.A total of 200 allergic asthma patients were enrolled, including 75.5% ( n=151) males and 24.5% ( n=49) females.The patients aged (8.20±1.81) years. Results:The median total IgE level of the 200 patients was 513.5 (24.4-11 600.0) IU/mL.Their median treatment time with Omalizumab was 112 (1-666) days.Their first dose of Omalizumab was 300 (150-600) mg.Of the 200 cases, 114 cases (57.0%) followed the first Omalizumab dosage recommended in the instruction.After 4-6 months of Omalizumab treatment, 88.5% of the patients enrolled ( n=117) responded to Omalizumab.After 4 weeks of treatment with Omalizumab, asthma was well-controlled, with an increased C-ACT score [from (22.70±3.70) points to (18.90±3.74) points at baseline]. Four-six months after Omalizumab administration, the annual rate of moderate-to-severe asthma exacerbation had a reduction of (2.00±5.68) per patient year( t=4.702 5, P<0.001), the median ICS daily dose was lowered [0 (0-240) μg vs. 160 (50-4 000) μg at baseline] ( P<0.001), the PAQLQ score was improved [(154.90±8.57) points vs. (122.80±27.15) points at baseline], and the forced expiratory volume in one second % predicted (FEV 1%pred) was increased [(92.80±10.50)% vs. (89.70±18.17)% at baseline]. In patients with available evaluations for comorbidities, including allergic rhinitis, atopic dermatitis or eczema, urticaria, allergic conjunctivitis and sinusitis, 92.8%-100.0% showed improved symptoms.A total of 124 AE were reported in 58 (29.0%) of the 200 patients, and the annual incidence was 0(0-15.1) per patient year.In 53 patients who suffered AE, 44 patients (83.0%) and 9 patients (17.0%) reported mild and moderate AE, respectively.No severe AE were observed in patients.The annual incidence of SAE was 0(0-1.9) per patient year.Most common drug-related AE were abdominal pain (2 patients, 1.0%) and fever (2 patients, 1.0%). No patient withdrew Omalizumab due to AE. Conclusions:Omalizumab shows good effectiveness and safety for the treatment of asthma in children.It can reduce the moderate-to-severe asthma exacerbation rate, reduce the ICS dose, improve asthma control levels, and improve lung functions and quality of life of patients.

Objective:To provide scientific basis for prevention and control measures of island regions through analyzing the characteristics of malignant tumor incidence and mortality in eastern island areas of China and comparing the data with the national cancer mortality data in the same period. Methods:Using the incidence and mortality data of malignant tumor in Daishan county,Zhoushan collected by the Daishan Center for Disease Control and Prevention(CDC)from 2014 to 2019,which was stratified by gender,the crude incidence rates(CIR)and crude mortality rates(CMR)were calculated,and the top 10 malignant tumors with the highest incidence or mortality rates were then ranked.The Segi's world standard population was used to calculate the age-standardized incidence(ASIR)and age-standardized mortality rate(ASMR).The local data were compared with the national cancer mortality data from 2014 to 2019,and Chi-square test was used to analyze the differences between these two sets of data using the SPSS software.The difference was considered statistically significant when P<0.05. Results:There was a total of 7 305 incidence cases of malignant tumors in Daishan county,Zhoushan from 2014 to 2019.The CIR was 662.39/105 and the ASIR was 306.81/105.Notably,the CIR was the highest in the age group of 75-79 years old.The top 5 malignant tumors with the highest incidence rates were lung cancer(27.15％),gastric cancer(12.76％),liver cancer(10.95％),colorectal cancer(6.92％)and breast cancer(5.42％),whose ASIR were 75.09/105,32.06/105,31.01/105,17.81/105 and 18.36/105,respectively.There was a total of 3 412 mortality cases of malignant tumors in Daishan county,Zhoushan from 2014 to 2019.The CMR was 309.39/105 and the ASMR was 122.73/105.Notably,the CMR was the highest in the age group of 80-85 years old.The top 5 malignant tumors with the highest mortality rates were lung cancer(24.94％),liver cancer(18.64％),gastric cancer(17.00％),colorectal cancer(7.56％)and esophageal cancer(5.72％),whose ASMR were 29.65/105,24.97/105,19.01/105,8.75/105 and 6.60/105,respectively.The total ASMR of malignant tumors in Daishan county,Zhoushan was higher than national total ASMR from 2014 to 2019(100.34/105)(P<0.001).Specifically,the ASMR of gastric cancer,lung cancer and colorectal cancer in Daishan county were significantly higher than national levels(gastric cancer:12.46/105;liver cancer:16.45/105;colorectal cancer:6.63/105)(P<0.01),whereas no significant difference in the ASMR of lung cancer and esophageal cancer between Daishan county and the whole nation(lung cancer:28.06/105;esophageal cancer:7.61/105)was observed. Conclusion:Lung cancer,gastric cancer,liver cancer and colorectal cancer were malignant tumors with higher incidence and mortality rates in Daishan county,Zhoushan from 2014 to 2019.Particularly,the ASMR of gastric cancer,liver cancer and colorectal cancer were significantly higher than the national levels,and these malignant tumors should be considered as the major focus of cancer prevention and control.

Melorheostosis is a rare disorder of osteopathia. The clinical characteristics of melorheostosis in children is totally different from that in adults. The radiographic features of melorheostosis include the hyperostosis in endosteal on the one side of the cavum medullare and formed streakiness. The soft tissue contracture of the limb and joint deformities are the symptoms of melorheostosis. Here, the authors reported a melorheostosis case of 6 years old girl who suffered from severe valgus deformity of the right knee with permanent patellar dislocation. A surgical stabilization was applied with lateral soft tissue release, medial soft tissue stabilization and transferred the vastus medialis laterally (kinetic stability). After 19 years follow up postoperatively, the limb developed well in satisfied alignment with good function of knee joints, even participated in some sports activities. Other authors reported a similar case of melorheostosis with surgical treatment and achieved good outcomes in limb realignment and reduction. The further suggested that the surgical treatment should be produced before epiphyseal closure.

Renal subcapsular abscess(RSA) is a rare disease with unknown etiology and pathogenesis. CT is an important assistant examination for the diagnosis. In this study, we reported 2 cases of RSA. One case achieved good therapeutic effect by timely debridement and surgery drainage, and the other case refused to perform debridement and drainage, which lead to the death. This kind of disease develops quickly and progresses rapidly. The adequate debridement and surgery drainage are important in treating this disease.

Spontaneous renal artery dissection is a rare disease with unknown etiology, confounded clinical manifestations, and easy to be misdiagnosed as urinary tract infection. The diagnosis mainly depends on imaging examinations. Intravascular interventional therapy is a safe and effective treatment. This study reported a case of spontaneous renal artery dissection , which treated by intravascular interventional therapy of renal artery , and had achieved good therapeutic effect.