Urolithiasis represents a prevalent clinical challenge marked by high recurrence rates and morbidity，with existing preventive strategies struggling to effectively curb its epidemic trajectory，thereby posing a significant threat to public health. The etiology of this condition is intricate，involving a complex network of interactions spanning classical supersaturation-crystallization theory，Randall’s plaque theory，and multifactorial elements such as cellular injury，inflammatory responses，metabolic derangements，the gut-kidney axis，immune dysregulation，and genetic predisposition. However，the critical mechanisms initiating stone formation and the early pathophysiological processes remain incompletely elucidated，constituting the core impasse in current preventive strategies. This review systematically synthesizes classical theories and cutting-edge advancements in urolithiasis etiology research，emphasizing the urgent need to integrate emerging technologies，including high-dimensional omics，advanced imaging modalities，and artificial intelligence，to dissect pivotal pathological nodes in early stone formation. Such interdisciplinary efforts are essential to overcome cognitive bottlenecks and ultimately achieve personalized，precision-based prevention strategies.

Objective This study aimed to explore the ability of ultrasonographic radiomics in predicting the occurrence of in-stent restenosis(ISR)after carotid artery stenting(CAS)by analyzing the correlation between radiomic features of responsible plaques in carotid artery stenosis and the incidence of ISR.Methods A retrospective collection was conducted on 206 cases that underwent CAS treatment at our hospital.The enrolled patients were randomly split into a training set(144 cases)and a test set(62 cases)at a 7∶3 ratio.We utilized the Darwin Intelligent Research Platform to extract radiomic features from each region of interest,and then screened 1125 ultrasonographic radiomic features.Different machine learning algorithms were employed to construct diagnostic models,and the best-performing classifier was selected.Various prediction models were established,including a clinical-ultrasonographic feature model,a radiomic model,and a combined clinical-ultrasonographic-radiomic model.Results Multivariate logistic regression analysis in the training set revealed that hypertension,hyperuricemia,triglycerides,and plaque location were independent risk factors for ISR after CAS.For the clinical-ultrasonographic model,the area under the curve(AUC)values for the training and validation sets were 0.896 and 0.644,respectively.The corresponding AUC values for the radiomic model were 0.961 and 0.715,while those for the combined model were 0.947 and 0.727.Conclusion The radiomic model demonstrates superior performance in predicting ISR compared to the traditional clinical-ultrasonographic model.The combined model exhibited an enhanced ability to predict ISR occurrence,thereby improving the diagnostic performance of traditional assessments.

Objective This study aimed to explore the ability of ultrasonographic radiomics in predicting the occurrence of in-stent restenosis(ISR)after carotid artery stenting(CAS)by analyzing the correlation between radiomic features of responsible plaques in carotid artery stenosis and the incidence of ISR.Methods A retrospective collection was conducted on 206 cases that underwent CAS treatment at our hospital.The enrolled patients were randomly split into a training set(144 cases)and a test set(62 cases)at a 7∶3 ratio.We utilized the Darwin Intelligent Research Platform to extract radiomic features from each region of interest,and then screened 1125 ultrasonographic radiomic features.Different machine learning algorithms were employed to construct diagnostic models,and the best-performing classifier was selected.Various prediction models were established,including a clinical-ultrasonographic feature model,a radiomic model,and a combined clinical-ultrasonographic-radiomic model.Results Multivariate logistic regression analysis in the training set revealed that hypertension,hyperuricemia,triglycerides,and plaque location were independent risk factors for ISR after CAS.For the clinical-ultrasonographic model,the area under the curve(AUC)values for the training and validation sets were 0.896 and 0.644,respectively.The corresponding AUC values for the radiomic model were 0.961 and 0.715,while those for the combined model were 0.947 and 0.727.Conclusion The radiomic model demonstrates superior performance in predicting ISR compared to the traditional clinical-ultrasonographic model.The combined model exhibited an enhanced ability to predict ISR occurrence,thereby improving the diagnostic performance of traditional assessments.

Urolithiasis represents a prevalent clinical challenge marked by high recurrence rates and morbidity，with existing preventive strategies struggling to effectively curb its epidemic trajectory，thereby posing a significant threat to public health. The etiology of this condition is intricate，involving a complex network of interactions spanning classical supersaturation-crystallization theory，Randall’s plaque theory，and multifactorial elements such as cellular injury，inflammatory responses，metabolic derangements，the gut-kidney axis，immune dysregulation，and genetic predisposition. However，the critical mechanisms initiating stone formation and the early pathophysiological processes remain incompletely elucidated，constituting the core impasse in current preventive strategies. This review systematically synthesizes classical theories and cutting-edge advancements in urolithiasis etiology research，emphasizing the urgent need to integrate emerging technologies，including high-dimensional omics，advanced imaging modalities，and artificial intelligence，to dissect pivotal pathological nodes in early stone formation. Such interdisciplinary efforts are essential to overcome cognitive bottlenecks and ultimately achieve personalized，precision-based prevention strategies.

Objective:To understand the epidemiological characteristics of infectious diarrhea pathogens in Pudong New Areas of Shanghai from 2013 to 2017 to provide evidence for control and prevention of the disease.Methods:From Jan 2013 to Dec 2017, active surveillance program on diarrhea was conducted in 14 sentinel hospitals (three tertiary-level and nine secondary-level, and two primary-level hospitals) in Pudong New Areas of Shanghai, based on location, catchment areas and number of patients. All recruited outpatients were interviewed in hospitals, using a standard questionnaire. Stool specimens were collected and tested for five viral and eight bacterial pathogens.Results:A total of 9 301 cases with infectious diarrhea were included, and the overall positive rate was 55.7 % (5 179). Positive rates of single virus, single bacteria and mixed infections were 26.7 % (2 481), 17.0 % (1 579) and 12.0 % (1 119), respectively. For single infection, the most commonly detected viruses appeared as norovirus (15.4 %, 1 428/9 301) and rotavirus (7.2 %, 667/9 301). The most commonly detected bacteria were diarrheagenic Escherichia coli (6.7 %, 619/9 301) and non-typhoid Salmonella (3.3 %, 305/9 301). The most common mixed infections were caused by virus-bacteria (4.9 %, 459/9 301). Norovirus (17.0 %, 838/4 938) showed the highest positive rates, followed by Escherichia coli (7.2 %, 354/4 938), both seen in the age group of 20-59 years old group. Rotavirus (9.4 %, 178/1 896) and non-typhoid Salmonella (4.9 %, 93/1 896) were the most common pathogens found in the age group of 0-4 years old. The prevalence of norovirus peaked both in spring and autumn. The other peaks were seen as: Rotavirus in winter, diarrheagenic Escherichia coli in summer and non-typhoid Salmonella in summer. Conclusions:Our data showed that the positive rates of infectious diarrhea pathogens were high in Pudong New Areas of Shanghai from 2013 to 2017. The dominant pathogens would include norovirus, rotavirus and diarrheagenic Escherichia coli but with differenct distributions in age groups. Obvious seasonal patterns were also observed.

Objective To compare the parameters of bilateral tubal ligation by LESS and multi-incision laparoscopy and their prognosis of IVF-ET. Methods From Jun. 2016 to Dec. 2017,32 patients underwent LESS bilateral tubal ligation and 60 patients under-went multi-incision laparoscopic bilateral tubal ligation were enrolled. The demographic data ,operative parameters ,and postoperative prognosis of IVF- ET in the two groups were summarized and compared. Results The mean operating time in LESS group was prolonged and its operative hospital stay was significantly decreased compared to multi-incision laparoscopic group. No significant difference was observed in the intraoperative blood loss in two groups. Moreover,no significant differences were found in the AFC,AMH,Gn stimulation days,total Gn dosage,Ovum number,good quality embryo rate,embryo implantion rate,clinical pregnancy rate and early spontaneous abortion rate in two groups. Conclusions For experienced laparoscopic surgeons,LESS is a safe and feasible procedure with similar perioperative outcomes to multi-incision laparoscopic surgery.

Objective To explore the association of synovial fluid vasoactive intestinal peptide levels with cartilage damage,radiological changes and symptomatic severity in patients with ankle post-traumatic osteoarthritis. Methods 74 patients with ankle traumatic osteoarthritis undergoing ankle anthroscopic debridement or joint replacement and 69 healthy controls receiving body check were enrolled in the this study. Serum and synovial fluid VIP concentrations were measured by a special radioimmunoassay method. Cartilage degradation biomarker colla-gen type Ⅱ(CTX-II)and inflammatory marker interleukin-6 were determined by enzyme-linked immunosorbent assay (ELISA). The symptomatic and functional severity was evaluated using Teeny & Wiss and AOFAS ankle-hindfoot rating scale. The radiographic progression of PTAOA was identified according to the modified ankle osteoar-thritis Kellgren-Lawrence (K-L) grading system. The mankin score was used for assessing the histopathological severity for cartilage lesions. Receiver operating characteristic (ROC) curve was conducted and the area under curve(AUC)was used to evaluate the diagnostic value of VIP,IL-6 and CTX-II levels for the prediction of the modified K-L grading by comparing with other biomarkers. Results There were no significant differences in serum VIP levels between PTAOA patients and controls. VIP levels in synovial fluid showed a negative correlation with modified ankle K-L grading,Mankin scores,CTX-Ⅱand IL-6. In addition,VIP levels were also positively associated with Teeny&Wiss and AOFAS ankle-hindfoot scores. The AUC area of VIP was similar to CTX-Ⅱat early stage of the disease. Conclusions Synovial fluid VIP levels show an independent and negative correlation with disease severity in patients with PTAOA. Low level of VIP in SF can be used as a potential biomarker for reflecting disease progression.

Objective:To compare the efficacy and safety of tubeless percutaneous nephrolithotomy ( tubeless-PCNL) and ureteroscopic lithotripsy ( URL) in treatment of impacted upper-ureteral calculi ≥1.5 cm in size.Methods:Patients with ureteral stones sized ≥1.5 cm and lodged above the fourth lum-bar vertebra who were treated between September 2009 and July 2013 in Peking University People ’ s Hos-pital were retrospectively analyzed .In the study , 182 patients underwent tubeless-PCNL or URL treat-ment respectively , and the operation success rates were compared .The duration of operation , intraopera-tive blood loss ( average hemoglobin decrease ) , complications , mean hospital stay and residual stone rates were also compared.Results: Fifty-four patients underwent tubeless-PCNL treatment,the average stone size was (1.9 ±0.4) cm,nephrostomy tubes were placed in two patients ,and the operation success rate was 96.3%(52/54).In the rest of the 52 patients,and the mean operation time was (30.1 ±14.8) minutes with an average postoperative hemoglobin decrease of (10.2 ±6.1) g/L, and the mean hospital stay was (3.0 ±1.4) days.Only one of the patients had residual fragments (2%).The main complica-tions included minor perirenal hematoma in 1 patient, fever in 2 patients, elevated blood WBC in 11 patients,and analgesics requirement in 3 patients.In the study, 128 patients were treated with URL,the average stone size was (1.7 ±0.3) cm.19 procedures failed,and 10 patients were converted to PCNL, extracorporeal shock wave lithotripsy was executed subsequently after double -J stent placement in 5 patients,and migration of calculi or stone fragments happened in 4 patients.The mean operative time was (51.3 ±25.5) minutes for the remaining 109 patients with a hemoglobin reduction of (5.2 ±7.2) g/L. The mean hospital stay was (2.9 ±1.3) days, and residual stones were found in 13 of the 109 patients (11.9%).The main complications included fever in 3 patients, elevated blood WBC in 42 patients, an-algesics requirement in 13 patients because of pain in the urethra or flank .The size of the stones between the two group didn ’ t show significant difference ,but the success rate of the tubeless-PCNL procedure was significantly higher .Except that hemoglobin decrease was slightly higher in the tubeless-PCNL group ,the mean operative time , the rate of residual stones and rate of complications of the tubeless-PCNL group were lower significantly.Conclusion:Treating stones above 4th lumbar vertebra larger than 1.5 cm were challenging .It is difficult to treat these stones with URL because of a high probability to fail , but on the contrary, tubeless-PCNL was more likely to be performed successfully .For surgeons experienced with the PCNL technology, treating stones≥1.5 cm with tubeless-PCNL procedure may turn out to be more effi-cient and with a higher operation success rate , and the risk of complications was lower without lengthe-ning the postoperative hospital stay .

Objective To summary our experiences in percutaneous nephrolithotomy for treating the caliceal diverticular calculi and postoperative outcome with technical modification.Methods A retrospective review was performed on 34 patients with caliceal diverticular calculi who underwent percutaneous nephrolithotomy between January 2009 and June 2013.The patients were divided into 2 groups.In group A (1 1patients),stones were removed and diverticular neck was incised.In group B (23 patients),fulguration of diverticular wall was performed after the stone removal and diverticular neck incision.Group A had 11 cases including 4 male and 7 female with average age (36.7± 16.0) years.Mean size of stone was (1.8±0.4) cm.Mean maximum diameter of diverticulum was (2.3±0.5) cm.Group B had 23 cases including 10 male and 13 female with average age (40.1±12.0) years.Mean size of stone was (1.9±0.6) cm.Mean maximum diameter of diverticulum was (2.3±0.8) cm.There were no significant difference in stone size and maximum diameter of diverticulum within two groups (P＞0.05).The following parameters such as operative time,drop in hemoglobin,stone clearance,complication rate and ablation rate of diverticulum were compared between two groups.Results In group A,average operative time was (62.7±11.7) min.Mean hemoglobin dropping was (12.0t9.7) g/L.Stone clearance rate was 90.9％ (10/11) and overall complications rate was 18.2％ (2/11).The ablation rate of diverticulum was 63.6％ (7/11).In group B,average operative time was (76.3±21.6) min.Mean Hemoglobin reducing was (12.9±16.7) g/L.Stone clearance rate was 91.3％(21/23) and overall complication rate was 21.7％.The ablation rate of diverticulum was 91.3％ (21/23).There was no significant difference in stone clearance and complication rate between two groups.It seemed that the operativc timc in group B was longer than that in group A.However,no significant difference was found (P＞0.05).The ablation rate of diverticulum in group B was significantly higher than that in group A (P＜0.05).Conclusion In percutaneous nephrolithotomy treatment for caliceal diverticular calculi,fulguration to diverticular wall is an effective method to achieve diverticular obliteration and reduce possibility of stone recurrence.