Objective: To explore the efficacy of focal radiofrequency ablation (RFA) in the treatment of low-to-intermediate risk localized prostate cancer and its impact on postoperative urinary control and sexual function recovery，in order to explore the feasibility of minimally invasive methods for the treatment of localized prostate cancer. Methods: Clinical data of 28 patients with low-to-intermediate risk localized prostate cancer who underwent RFA in Nanjing Drum Tower Hospital，Affiliated Hospital of Medical School during Jun.2017 and Feb.2021 were retrospectively analyzed.The 5-year failure-free survival (FFS) rate，surgery related complications，postoperative urinary control and sexual function were collected.The differences between the survival curves of patients in the low-risk and intermediate-risk subgroups were assessed with log-rank test and Breslow test. Results: All surgeries were successfully completed under local anesthesia.During the median follow-up of 43 (40-49) months，the 5-year FFS rate predicted by Kaplan-Meier method was 78.57%; 25 patients (89.29%) did not experience surgery-related complications; 27 patients (96.43%) were able to control urination; 1 patient developed new-onset sexual dysfunction.There was no significant difference in the survival curves between patients in the low-risk and intermediate-risk groups (P>0.05). Conclusion: RFA for patients with low-to-intermediate risk localized prostate cancer has good clinical efficacy，little impact on urinary control and sexual function recovery，and few postoperative complications，which can be used as one of the treatment options for these patients.

Objective: To explore the diagnosis, treatment and prognosis of primary prostatic signet ring cell carcinoma (SRCC), so as to provide reference for the clinical diagnosis and treatment. Methods: A retrospective analysis was conducted on the clinical data of 6 patients with primary prostatic SRCC treated in Nanjing Drum Tower Hospital during Nov.2020 and Sep.2024.The clinical manifestations, imaging features, treatment methods, histological characteristics and prognosis were summarized. Results: The average age of the patients was (72.00±4.28) years.Varying degrees of dysuria occurred in 4 patients. All patients underwent multi-parametric magnetic resonance imaging (mpMRI) examination before surgery, and the results indicated typical prostate cancer.Preoperative biopsies showed high-grade (Gleason 8-10) prostate acinar adenocarcinoma.Postoperative pathological diagnoses were mixed types of prostate acinar adenocarcinoma and SRCC, and no metastasis was found in the pelvic lymph nodes.All patients were followed up for 1 to 46 months after surgery and are currently alive.Robot-assisted laparoscopic radical prostatectomy only was performed in 3 cases; apalutamide and leuprolide/triptorelin was administered after surgery in 2 cases; bicalutamide + goserelin was administered after surgery in 1 case, who developed bladder metastasis of prostate cancer 24 months later, and the serum prostate-specific antigen (PSA) concentration decreased to a safe level (<0.2 ng/mL) after the use of darolutamide with radiotherapy.No recurrence or metastasis was found in the remaining patients. Conclusion: Primary prostatic SRCC is a rare and highly aggressive malignant tumor of the prostate.The diagnosis depends on pathological examinations due to lack of specific imaging features and clinical manifestations.The prognosis is poor, and there is currently no standardized treatment.The combined use of surgery, hormonotherapy and radiotherapy can help improve the survival rate of patients.

Objective: To investigate the clinical efficacy of en bloc resection of ureteral orifice in the treatment of tumors around ureteral orifice. Methods: Clinical data of 43 patients treated at our hospital during Jul.2018 and Jun.2023 were retrospectively analyzed，including 34 male and 9 female patients.Prior to surgical intervention，all patients were diagnosed with bladder masses via imaging or cystoscopy，and no concurrent upper urinary tract tumors were detected.The initial surgical procedure was transurethral resection of bladder tumor，which removed the tumors around ureteral orifice.Subsequently，electrocoagulation was employed for hemostasis，followed by the placement of a double-J tube into the affected ureter.Tumor recurrence and hydronephrosis were observed after operation. Results: All operations were successful without conversion to open surgery.The operation time was (61±25) min.The postoperative pathological results showed 28 cases of Ta stage tumors，14 cases of T1 stage tumors，and 1 case of T2 stage tumor.During the follow-up of (17±11) months，8 patients (19%) had tumor recurrence，among whom 4 (9%) had recurrent tumor involving the ureteral orifice，and 1 (2%) had transient hydronephrosis after removal of double-J tube. Conclusion: The en bloc resection of the ureteral orifice with placement of a double-J tube is safe and effective for the treatment of tumors around the ureteral orifice，with low recurrence rate.It is an optional procedure for early stage patients.

Objective To explore the effects of prucalopride(PRUC)on the intestinal function during the perioperative period of robot-assisted laparoscopic radical cystectomy(RARC)and urinary diversion.Methods A total of 75 patients undertaking RARC with urinary diversion(orthotopic neobladder or ileal bladder)in Nanjing Drum Hospital during Jan.and Dec.2021 were divided into PRUC group(n=28)and control group(n=47)according to whether they took PRUC or not.Postoperative intestinal ventilation time and defecation time,drainage tube retention time,tolerance time for first intake of semi-flow food,postoperative hospital stay,and incidence of complications were observed and recorded in the two groups.Postoperative C-reactive protein(CRP)and neutrophil/lymphocyte ratio(NLR)were compared.Results The PRUC group had shorter intestinal ventilation time and defecation time[(47.14±16.31)h vs.(74.04±35.33)h,P＜0.01;(86.14±30.47)h vs.(123.57±79.12)h,P=0.02],smaller change of ΔCRP and ΔNLR[(79.99±29.71)mg/L vs.(127.75±56.98)mg/L;(9.24±6.43)vs.(16.11±9.90),P＜0.01].All complications were minor,the incidence of intestinal obstruction in PRUC group tended to decrease within 90 days after operation(P=0.38),and there was no significant difference in other complications between the two groups(P＞0.05).Conclusion The perioperative use of PRUC in RARC with urinary diversion is safe and effective,which can promote the recovery of intestinal function after operation.

Objective To compare the survival outcomes of bladder cancer with non-pure urothelium(BCa with n-pU)and bladder cancer with pure urothelium(BCa with pU)treated with robot-assisted radical cystectomy(RARC).Methods Clinical data of BCa patients treated with RARC in Nanjing Drum Tower Hospital during Oct.2014 and Mar.2022 were retrospectively analyzed.The patients were divided into n-pU group and pU group.After the baseline differences between groups were balanced with propensity score matching(PSM),the overall survival(OS)and recurrence-free survival(RFS)curve were plotted using Kaplan-Meier method and compared using Log-rank test.Univariate and multivariate analysis were performed with Cox model to identify the influencing factors of prognosis.Based on the results,a secondary grouping was performed to compare the survival differences between subgroups and further investigate the prognostic factors.Results After PSM,there were 53 pairs of BCa patients.There were no significant differences in the baseline data between the pU and n-pU groups(P＜0.05).Regardless of T stage,there were no significant differences in OS and RFS between the two groups(P=0.217,P=0.109).Univariate Cox regression analysis showed that T stage(＞T2)was a significant risk factor of OS and RFS(P＜0.05).In the early pathological stage(≤T2),there were no significant differences in OS and RFS(P=0.565,P=0.344).In the advanced pathological stage(＞T2),the OS and RFS of n-pU were significantly worse than those of pU patients(P=0.025,P=0.034).Conclusion The prognosis of BCa patients with n-pU who received RARC is significantly correlated with pathological status.At＞T2 stage,n-pU patients have worse prognosis than pU patients in the same pathological status.

Objective To analyze the characteristics and malignancy of red-patch like lesion(RPL)during cystoscopy,and to explore the significance of RPL biopsy.Methods Clinical data of patients who had RPL detected in our hospital during Jan.2019 and Jun.2023 were retrospectively analyzed,including gender,age,cause of examination,presence of scars,complications and biopsy pathology.The patients were divided into the benign and malignant groups,and their clinical and RPL characteristics were analyzed.Results A total of 521 cases of RPL were enrolled including 416(79.8％)benign cases,and 105(20.2％)malignant cases.The averae age of the malignant group was higher than the benign group's[(66.8±12.2)years vs.(62.8±12.9)years,P=0.005].The malignant detection rate of RPL in postoperative follow-up patients,those with hematuria and those with lower urinary tract symptoms was 23.7％(92/389),19.6％(9/46),4.7％(4/86),respectively.According to direct observation and experience,the detection rate of pathological malignancy in the three groups of patients with high suspicion of RPL malignancy,mild suspicion of RPL malignancy and high probability of benign was 56.9％(37/65),37.0％(30/81)and 10.1％(38/375),respectively.Conclusion Once RPL is detected during cystoscopy,active biopsy should be performed.For elderly male patients undergoing postoperative follow-up,RPL biopsy is particularly important,especially when the lesion is located on or near the scar surface.

Objective To compare and analyze the efficacy and risks of percutaneous CT/ultrasound-guided bipolar radiofrequency ablation(RFA)under local anesthesia with robotic-assisted laparoscopic partial nephrectomy(RAPN)for the treatment of sporadic small renal mass.Methods A retrospective study was conducted on 93 consecutive patients with T1a stage small renal mass during Mar.2019 and Oct.2021.Among them,51 underwent RAPN,and 42 underwent RFA.General information,tumor characteristics,perioperative and follow-up data were collected and statistically analyzed.Results There were no significant differences in general information and tumor characteristics between the two groups(P＞0.05).The operation time[(96.0±20.0)min vs.(113.5±24.1)min,P＜0.001],hospital stay[(3.5±0.8)day vs.(6.9±1.8)day,P＜0.001],and hospital costs[(2.4±0.7)ten thousand yuan vs.(6.6±0.4)ten thousand yuan,P＜0.001]were significantly decreased in the RFA group than in the RAPN group.There were no significant differences in the incidence of perioperative complications and long-term disease-free survival rate between the two groups(P＞0.05).However,the difference between one-year postoperative estimated glomerular filtration rate(eGFR)and preoperative eGFR was significantly lower in the RFA group than in the RAPN group[-2.3(-4.7-1.3)mL/(min·1.73 m2)vs.-5.0(-9.1 2.8)mL/(min·1.73 m2),P=0.003],and the reduction of one-year postoperative creatinine and preoperative creatinine was slightly lower in the RFA group than in the RAPN group[4.0(-0.2-5.5)μmol/L vs.4.5(1.8-9.2)μmol/L,P=0.122].Conclusion RFA can achieve comparable disease-free survival rate as RAPN in the treatment of T1a renal tumor,and can effectively preserve renal function,reduce medical costs,save medical resources,and lower the incidence of perioperative complications.

[Objective] To investigate the pathological characteristics of false-positive lesions of prostate cancer on ⁶⁸Ga-PSMA-11 PET/CT based on the pathology of whole mount specimens, in order to more accurately assess the degree of malignancy within the prostate tissue and avoid overdiagnosis and unnecessary treatment. [Methods] A total of 77 patients who underwent ⁶⁸Ga-PSMA-11 PET/CT before radical prostatectomy in Nanjing Drum Tower Hospital during Jan.2018 and Dec.2022 were retrospectively analyzed.The pathology of whole mount specimens was detected.Two nuclear physicians examined all imaging plates without knowing the pathological results.Two pathological physicians completed all pathological diagnosis without knowing the imaging results.The pathological characteristics of false-positive lesions were determined by matching ⁶⁸Ga-PSMA-11 PET/CT and pathological specimens.To analyze the pathological features of false-positive lesions, true-negative lesions were randomly delineated and defined.The pathological features of false-positive and true-negative lesions were analyzed and compared using Fisher exact test. [Results] After the imaging and pathological sections were matched, 21(16.3%) false-positive lesions were identified.The pathological characteristics of the 21 false-positive lesions were as follows: 16 (76.2%) simple atrophy with cyst formation, 3(14.3%) prostatic nodular hyperplasia, and 2(9.5%) inflammation.The pathological characteristics of 21 true-negative lesions were: 13(61.9%) normal glands, 5(23.8%) prostatic nodular hyperplasia and 3(14.3%) simple atrophy with cyst formation.Fisher exact test showed that the proportion of simple atrophy with cyst formation in the pathological features of false-positive lesions and true-negative lesions was statistically significant (76.2% vs.14.3%, P<0.001). [Conclusion] Simple atrophy with cyst formation may be a characteristic pathological type of the false-positive lesions of prostate cancer on ⁶⁸Ga-PSMA-11 PET/CT.

[Objective] To investigate the clinical utility of ATP-binding cassette transporter family in immunotherapy for bladder cancer based on IMvigor210 and UNC-108 (GSE176307) datasets. [Methods] Gene expression data of 348 patients with bladder urothelial carcinoma were downloaded from the IMvigor210 database.Firstly, consensus clustering was performed to the gene expression levels of the ATP-binding cassette transporter family, resulting in two clusters: Cluster 1 and Cluster 2.Survival analysis was conducted between the two clusters.Next, univariate Cox regression was employed to identify ATP-binding cassette transporter family genes significantly affecting prognosis.A predictive model was constructed using the random survival forest algorithm to predict treatment response and survival outcomes in patients with bladder cancer receiving immunotherapy.The model's accuracy was validated with UNC-108 dataset.Then, ESTIMATE and ssGSEA were applied to analyze differences in the tumor microenvironment.Furthermore, oncoPredict algorithm was used to predict the sensitivity of patients to cisplatin. [Results] A total of 9 ATP-binding cassette transporter family genes were selected to construct the ABC score predictive model.In the IMvigor210 datasets, the Kaplan-Meier analysis revealed that patients with low ABC score had significantly longer overall survival compared to those with high ABC score (P<0.001). The ABC score model demonstrated good performance with area under the ROC curve (AUC) of 0.80, 0.87, and 0.88 for predicting 0.5-year, 1-year, and 1.5-year survival, respectively.The predictive ability of the ABC score for immunotherapy response, with an AUC of 0.78, outperformed that of TMB (AUC: 0.72) and PD-L1 (AUC: 0.58). The ABC score also exhibited favorable predictive performance in the UNC-108 validation cohort.ABC score was also significantly correlated with tumor microenvironment immune scores, various immune cells, and the expression of immune checkpoint genes. [Conclusion] ATP-binding cassette transporter family is closely associated with the tumor microenvironment and the efficacy of immunotherapy for bladder cancer, making it a potential novel biomarker for immunotherapy.

Objective To investigate the relationship between platelet/hemoglobin ratio(PHR)and the severity of diabetic foot ulcer(DFU)and its predictive value for DFU progression.Methods A retrospective study was performed in 345 DFU patients treated in Department of Endocrinology,the First Affiliated Hospital of Army Medical University from March 2018 to March 2023.Their general demographic information was obtained,and the results of laboratory tests,including hemoglobin Alc(HbA1c),fasting plasma glucose(FPG),biochemical and related blood routine indicators were collected.According to Wanger grading,the patients were assigned into mild(n=145)and severe ulcer groups(n=200).The demographic data and clinical parameters were compared between the 2 groups.Multivariate logistic regression model was applied to identify the independent predictors for severe ulcer in DFU,and receiver operating characteristic(ROC)curve was plotted to evaluate the predictive performance of PHR for DFU progression.Results The severe ulcer group presented remarkable increases in male proportion,HbA1c and FPG levels,platelet(PLT)count and PHR when compared with the mild ulcer group(P＜0.05).Multivariate logistic regression analysis revealed that PHR and male were independent risk factors,while,HDL-C was a protective factor for progression to severe ulcer in DFU patients(P＜0.05).ROC curve analysis showed that the area under the curve of PHR for predicting severe ulcer was 0.701(95％CI:0.646～0.756).Conclusion PHR is strongly associated with the severity of DFU,and shows certain predictive value for the progression to severe ulcer in DFU patients.