Objective:To investigate the effect of using " Four-Quadrant Pre-Positioning Method" combined with synchronous CT imaging to assist color doppler ultrasound in establishing an ideal puncture access for percutaneous nephrolithotomy (PCNL).Methods:A retrospective analysis was conducted on 113 patients with renal stones treated at the First Affiliated Hospital of Zhengzhou University from May 2021 to July 2023. Patients were divided into two groups based on the surgical method: the study group and the control group. The study group consisted of 64 patients who, from June 2022 to July 2023, underwent PCNL with the assistance of the four-quadrant pre-positioning method and color doppler ultrasound for puncture point localization. The control group consisted of 49 patients who underwent PCNL from May 2021 to May 2022. Based on the distribution of stones, both groups were further divided into three subgroups: subgroup 1: single renal pelvis or single renal calyx stones (study group: 27 patients, control group: 20 patients). Stone length was (34.27±7.69) mm vs. (39.77±11.34) mm, respectively. Subgroup 2: renal pelvis combined with a single renal calyx stone, or multiple stones in more than two renal calyces (study group: 19 patients, control group: 15 patients). Stone length was (45.77±9.50) mm vs.(40.94±11.34) mm, respectively. Subgroup 3: staghorn or cast stones (study group: 20 patients, control group: 17 patients). Stone length was (60.03±11.59) mm vs. (58.41±15.01) mm, respectively. There were no significant differences in gender, age, height, weight, side of the stone, stone length, or stone CT values between the subgroups ( P>0.05).The use of four-quadrant pre-positioning method results from multi-slice spiral CT imaging and the patient's anatomical characteristics. The 12th rib apex is taken as the origin, and the body's transverse and longitudinal axes are defined as the X and Y axes, respectively, to create the " Four Quadrants." The ideal puncture point is located within these quadrants. During the procedure, based on surface markings of the 12th rib apex, the " Four Quadrants" and ideal puncture point are identified on the patient's body surface, assisting the color doppler ultrasound in guiding the establishment of the puncture access. The puncture access establishment time, puncture first calyx success rate (criteria: for single renal pelvis or calyx stones, the first puncture access should achieve a stone-free rate >90%; for multiple renal calyx stones or staghorn stones, the first puncture access should achieve a stone-free rate >50%), surgical time, intraoperative blood loss, stone-free rate, and postoperative complications were compared between the study and control groups in each subgroup. Results:In subgroup 1, the puncture access establishment time was (4.74±2.25) minutes in the study group vs. (7.00±3.13) minutes in the control group ( P=0.006). In subgroup 2, the puncture access establishment time was (6.94±2.12) minutes in the study group vs. (9.80±2.83) minutes in the control group ( P=0.002), with the first calyx success rate being 94.7% (18/19) in the study group vs. 60.0% (9/15) in the control group ( P=0.028). The surgical time was (97.68±26.22) minutes vs. (136.29±33.00) minutes ( P=0.001).In subgroup 3, the puncture access establishment time was (8.00±2.69) minutes in the study group vs. (12.59±3.54) minutes in the control group ( P=0.001), with the first calyx success rate being 100.0% (20/20) in the study group vs. 76.5% (13/17) in the control group ( P=0.036). Intraoperative blood loss was (238.00±176.74) ml vs. (388.57±219.89) ml ( P=0.043). No significant differences were found between the two groups in terms of immediate postoperative stone-free rate (subgroup 1: 92.6% (25/27) vs. 95.0% (19/20), P=0.739; subgroup 2: 78.9% (15/19) vs. 73.3% (11/15), P=1.000; subgroup 3: 75.0% (15/20) vs. 70.5% (12/17), P=0.703) or complication rates (subgroup 1: 25.9% (7/27) vs. 25.0% (5/20), P=0.943; subgroup 2: 26.3% (5/19) vs. 40.0% (6/15), P=0.475; subgroup 3: 40.0% (8/20) vs. 41.2% (7/17), P=1.000). Conclusions:The four-quadrant pre-positioning method effectively assists in the use of color doppler ultrasound to establish an ideal puncture access during PCNL, reducing puncture access establishment time and improving the rationality of the puncture path. It also significantly reduces intraoperative blood loss, particularly for complex renal stones such as those in multiple renal calyces or staghorn stones, thereby enhancing the safety of the procedure.

Objective:To investigate the effect of using " Four-Quadrant Pre-Positioning Method" combined with synchronous CT imaging to assist color doppler ultrasound in establishing an ideal puncture access for percutaneous nephrolithotomy (PCNL).Methods:A retrospective analysis was conducted on 113 patients with renal stones treated at the First Affiliated Hospital of Zhengzhou University from May 2021 to July 2023. Patients were divided into two groups based on the surgical method: the study group and the control group. The study group consisted of 64 patients who, from June 2022 to July 2023, underwent PCNL with the assistance of the four-quadrant pre-positioning method and color doppler ultrasound for puncture point localization. The control group consisted of 49 patients who underwent PCNL from May 2021 to May 2022. Based on the distribution of stones, both groups were further divided into three subgroups: subgroup 1: single renal pelvis or single renal calyx stones (study group: 27 patients, control group: 20 patients). Stone length was (34.27±7.69) mm vs. (39.77±11.34) mm, respectively. Subgroup 2: renal pelvis combined with a single renal calyx stone, or multiple stones in more than two renal calyces (study group: 19 patients, control group: 15 patients). Stone length was (45.77±9.50) mm vs.(40.94±11.34) mm, respectively. Subgroup 3: staghorn or cast stones (study group: 20 patients, control group: 17 patients). Stone length was (60.03±11.59) mm vs. (58.41±15.01) mm, respectively. There were no significant differences in gender, age, height, weight, side of the stone, stone length, or stone CT values between the subgroups ( P>0.05).The use of four-quadrant pre-positioning method results from multi-slice spiral CT imaging and the patient's anatomical characteristics. The 12th rib apex is taken as the origin, and the body's transverse and longitudinal axes are defined as the X and Y axes, respectively, to create the " Four Quadrants." The ideal puncture point is located within these quadrants. During the procedure, based on surface markings of the 12th rib apex, the " Four Quadrants" and ideal puncture point are identified on the patient's body surface, assisting the color doppler ultrasound in guiding the establishment of the puncture access. The puncture access establishment time, puncture first calyx success rate (criteria: for single renal pelvis or calyx stones, the first puncture access should achieve a stone-free rate >90%; for multiple renal calyx stones or staghorn stones, the first puncture access should achieve a stone-free rate >50%), surgical time, intraoperative blood loss, stone-free rate, and postoperative complications were compared between the study and control groups in each subgroup. Results:In subgroup 1, the puncture access establishment time was (4.74±2.25) minutes in the study group vs. (7.00±3.13) minutes in the control group ( P=0.006). In subgroup 2, the puncture access establishment time was (6.94±2.12) minutes in the study group vs. (9.80±2.83) minutes in the control group ( P=0.002), with the first calyx success rate being 94.7% (18/19) in the study group vs. 60.0% (9/15) in the control group ( P=0.028). The surgical time was (97.68±26.22) minutes vs. (136.29±33.00) minutes ( P=0.001).In subgroup 3, the puncture access establishment time was (8.00±2.69) minutes in the study group vs. (12.59±3.54) minutes in the control group ( P=0.001), with the first calyx success rate being 100.0% (20/20) in the study group vs. 76.5% (13/17) in the control group ( P=0.036). Intraoperative blood loss was (238.00±176.74) ml vs. (388.57±219.89) ml ( P=0.043). No significant differences were found between the two groups in terms of immediate postoperative stone-free rate (subgroup 1: 92.6% (25/27) vs. 95.0% (19/20), P=0.739; subgroup 2: 78.9% (15/19) vs. 73.3% (11/15), P=1.000; subgroup 3: 75.0% (15/20) vs. 70.5% (12/17), P=0.703) or complication rates (subgroup 1: 25.9% (7/27) vs. 25.0% (5/20), P=0.943; subgroup 2: 26.3% (5/19) vs. 40.0% (6/15), P=0.475; subgroup 3: 40.0% (8/20) vs. 41.2% (7/17), P=1.000). Conclusions:The four-quadrant pre-positioning method effectively assists in the use of color doppler ultrasound to establish an ideal puncture access during PCNL, reducing puncture access establishment time and improving the rationality of the puncture path. It also significantly reduces intraoperative blood loss, particularly for complex renal stones such as those in multiple renal calyces or staghorn stones, thereby enhancing the safety of the procedure.

Objective:To investigate the clinical characteristics and prognostic factors of primary urethral cancer.Methods:The clinical data of 35 patients with primary urethral cancer admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to April 2022 were retrospectively analyzed. There were 12 males (34.3%) and 23 females (65.7%). The average age was 61.1 ± 13.0 years old. The clinical symptoms included 13 cases of urethral obstruction (37.1%), 7 cases of hematuria (20.0%), 6 cases of urethral bleeding (17.1%), 5 cases of urinary tract irritation (14.3%), 1 case of Urinary incontinence (2.9%), 1 case of low back pain (2.9%), 1 case of scrotal ulcer (2.9%), and 1 case (2.9%) by self examination. All patients underwent cystourethroscopy and tissue biopsy. The biopsy pathology showed 16 cases of urothelial carcinoma, 7 cases of squamous carcinoma, 4 cases of adenocarcinoma, 3 cases of malignant melanoma, 1 case of urothelial carcinoma with squamous carcinoma, 1 case of Signet ring cell carcinoma, 1 case of sarcomatoid carcinoma, 1 case of embryonic Rhabdomyosarcoma, and 1 case of epithelioid angiosarcoma. The tumors were located in the proximal urethra in 13 cases (37.1%) and in the distal urethra in 22 cases (62.9%). There were 14 cases (40.0%) with a maximum diameter of less than 3 cm, 16 cases (45.7%) with a diameter of ≥ 3 cm, and 5 cases (14.3%) with mucosal abnormalities. There were 12 cases of T 1 stage, 9 cases of T 2 stage, 7 cases of T 3 stage, and 7 cases of T 4 stage in tumor staging. Imaging evaluation of lymph nodes showed 25 cases of N 0 stage, 2 cases of N 1 stage, and 8 cases of N 2 stage; A total of 11 cases of lymph node biopsy were performed (including 8 cases of intraoperative lymph node dissection and 3 cases of preoperative lymph node biopsy), of which 6 cases had lymph node metastasis, and 1 case was initially diagnosed with distant metastasis. Thirty-one cases underwent surgical treatment, of which 16 cases underwent radical urethrectomy, and 8 cases underwent intraoperative pelvic and bilateral inguinal lymph node dissection, 8 cases underwent resection of urethral tumors, and 7 cases underwent transurethral resection of tumors. Four cases did not undergo surgical treatment, while 1 case had epithelioid angiosarcoma and received radiotherapy combined with chemotherapy, 2 cases received chemotherapy with GC (Gemcitabine+ cisplatin) regimen, and 1 case received immunotherapy with immune checkpoint inhibitors. The risk factors that affected patient prognosis were analyzed. Results:All 35 cases in this group were followed up, with a median follow-up time of 22 (2, 122) months. Seventeen cases survived, 18 cases died, and the overall median survival duration was 23 (13 to not reached) months. The overall 5-year survival rate was 45%. The results of univariate analysis showed that clinical T-stage ( P=0.019), maximum tumor diameter ( P=0.016), and tumor location ( P=0.006) were independent risk factors affecting patient prognosis. Result of multivariate analysis showed that the maximum diameter of the tumor ≥ 3 cm ( HR=2.673, P=0.029) and the proximal location of the tumor ( HR=3.064, P=0.023) were independent risk factors affecting patient survival. Gender, age, treatment method, lymph node dissection, adjuvant radiotherapy, adjuvant chemotherapy, clinical manifestations, pathological type, clinical N staging, and pathological N staging had no significant impact on patient survival rate ( P>0.05). Single factor analysis was conducted on female patients separately, and only tumor location was found to be a prognostic factor ( χ2=17.246, P<0.01). Conclusions:Primary urethral cancer is a rare disease with various symptoms and poor prognosis. The maximum diameter of the tumor ≥3 cm and the tumor located at the proximal end of the urethra are clinical risk factors affecting the prognosis of patients with primary urethral cancer.

Objective:To investigate the factors related to recurrence and prognosis of retroperitoneal liposarcoma.Method:The clinical data of patients with primary retroperitoneal liposarcoma who underwent surgical treatment in the First Affiliated Hospital of Zhengzhou University from June 2011 to January 2020 were analyzed retrospectively. There were 42 males and 47 females and patients’median age was 53 (26-78). Sixty-five cases were treated by operation in our hospital, and 24 cases were primarily treated by the operation in another hospital. The clinical manifestations of the initial diagnosis included retroperitoneal mass in 41 cases, abdominal distension in 12 cases, abdominal pain in 10 cases, fever in 11 cases, nausea, vomiting and poor appetite in 8 cases, frequent urination and dysuria in 6 cases, and bilateral lower limb edema in 1 case. Preoperative CT imaging showed that the tumor body was located in the retroperitoneal kidney area in 58 cases, while in the retroperitoneal space or the pelvic extraperitoneal space in 31 cases. There were 55 single cases and 34 multiple cases. The median tumor length was 20(3-52) cm. Among the primarily treated 65 patients, 47(72.3%) were considered as primary retroperitoneal liposarcoma by preoperative imaging examination. Among the 89 patients treated by surgery, 78 underwent endoscopic surgery, among which 21 underwent laparoscopic surgery, 38 cases of retroperitoneal laparoscopic surgery, 19 cases of Da Vinci robot-assisted laparoscopic surgery. Open operation was performed in 11 cases. There were 87 patients undergoing radical resection and 2 patients undergoing palliative resection. Forty-two patients underwent intraoperative combined resection of the adjacent organs. The recurrence and survival status of patients were followed up.Results:All the 89 patients underwent the operation successfully, with the median operative blood loss of 200 (10-2000) ml. There were 23 cases being diagnosed of well differentiated liposarcoma, 40 cases of dedifferentiated, 20 cases of myxoid/round, 5 cases of myxoid liposarcoma, and 1 cases of mixed type. Pathologically, there 42 cases with low grade histology and 47 cases with high grade histology. In this study, 89 patients were followed up for 3 to 108 months, and the median follow-up time was 28 months. The 5-year recurrence free survival rate, disease-free survival rate and overall survival rate of the patients were 16.7%, 16.1% and 52.6%, respectively. There were 57 patients presenting local recurrence, 1 patient of lung metastasis, and 1 patient of liver metastasis, and the median disease-free survival time was 24 months. There were 42 patients died of the disease, with a median survival time of 64 months. Univariate analysis showed that intraoperative blood loss( P<0.01), whether multiple cases( P<0.01), pathologic types( P<0.01), and histological grades ( P<0.01) were related to disease-free survival.The intraoperative blood loss( P<0.01), multiple cases( P<0.05), pathologic types ( P<0.05), and recurrence ( P<0.01)were related with overall survival. Gender, age, tumor size, tumor location, whether primary surgery, radical resection or combined resection of adjacent organ had no effect on the prognosis of patients ( P>0.05). Cox regression model multivariate analysis revealed that surgical bleeding ( RR=2.360, 95% CI 1.313-4.241, P=0.004), multiple tumor ( RR=1.899, 95% CI 1.068-3.375, P=0.029), and pathological type ( RR=4.976, 95% CI 1.622-15.264, P=0.005) were independent factors affecting disease-free survival. The recurrence was an independent factor affecting the overall survival of patients ( RR=31.495, 95% CI 1.062-933.684, P=0.046). Conclusions:Retroperitoneal liposarcoma is a rare disease with high recurrence rate. The intraoperative blood loss, whether multiplicity and pathological type are independent factors affecting the disease-free survival, and recurrence is independent factors affecting the overall survival.

Objective:To investigate the efficacy and safety of transperitoneal robot-assisted nephroureterectomy (RANU) with a single body position and original ports for upper urinary tract urothelial carcinoma(UTUC).Methods:Clinical data of 21 patients from March 2018 to November 2019 in the First Affiliated Hospital of Zhengzhou University was retrospectively analyzed, including 14 males and 7 females. The age was (63.8±11.4) years and the BMI was (23.6±2.5) kg/m 2.Of the 21 localized UTUC patients, 8 pelvic tumors, 3 middle ureter tumors, 10 lower ureter tumors; 11 on the left, 10 on the right; 20 of 21 tumors (95.2%) were high risk. Surgery was done by the same urologist. Under general anesthesia, the patients were in 75 ° healthy side lying position and overall 15 ° head down and foot high position. Improved layout of ports: camera port C was located at two fingers lateral to the umbilicus, 2 cm below the umbilicus; robotic arm port 1 and 2 were respectively located at pararestus line, close to costal margin and 2 cm below the midpoint between C and the affected iliac crest. Assistant port 1 and 2 were respectively located at 2 cm above the umbilicus and 4 cm below the umbilicus. The right cases need an additional assistant port under the xiphoid to provoke the liver. Hem-o-lok cliped the ureter distal to the tumor and the affected kidney was radically removed. Under the principle of tumor free, the ureter and the surrounding bladder wall within 1 cm were excised and the bladder was sutured. Lymphadenectomy was performed when the kidney and ureter were dissociated. Results:All 21 procedures were successful without open surgery or position change and intraoperative complications. No patients required a blood transfusion. The operation time was (205.2±57.3) min. The median intraoperative blood loss was 50 ml (20-120 ml). The median drainage tube indwelling time was 4d(3-7 d) and the median urinary catheter indwelling time was 7 d(5-8 d), the median postoperative hospital stay was 7 d(6-12 d).7 cases(33.3%)of Clavien-Dindo grade Ⅰ complications after surgery and they all relieved after giving symptomatic treatment. All postoperative pathology showed UTUC and negative resection margins. The median follow-up time was 12 months (4-22 months), 1 patient died of an accident 7 months after surgery and 3 patients had recurrence at 6, 8, and 10 months after surgery, survival at the last follow-up after treatment.Conclusions:The transperitoneal RANU with a single body position and original ports is safe and effective. The operation time is saved, the incidence of intraoperative and postoperative complications is low, the postoperative patients recover quickly.Short-term follow-up results prompt low recurrence rate and good tumor control effect.

Objective To summary the pathological and clinical characteristics,treatments and prognosis of malignant renal perivascular epithelioid cell tumor (PEComa).Methods Between August 2013 and June 2017,8 cases of malignant renal PEComa were analysed respectively.Of all the patients,there were 4 males and 4 females,aged 27-65 years with the average of 46.3 years old.Three cases were detected in routine examination occasionally,three cases complained of intermittent back pain with fever,one presented with swollen and painful right hand and right foot,and one case presented with hematuria.CT or MRI examinations indicated the malignant lesions before the surgery.Clinical staging was performed with 2 cases of T1N0M0,1 case of T1 N0M1,2 cases of T2N0M0,1 case of T3M0M0,and 2 cases of T4N0M1.Three cases underwent radical nephrectomy,1 case underwent radical nephrectomy plus renal artery embolization,2 cases underwent partial nephrectomy,and 2 cases underwent nephrectomy plus inferior vena cava tumor thrombectomy.One case was treated with ifosfamide plus epirubicin after operation due to multiple distant metastases and 1 case was treated with oxaliplatin before the sugery because of excessive tumor diameter.None of the rest received any adjuvant therapy.Results Postoperative histopathological examination showed multiple nodules in reddish gray and yellow color,with soft texture and partial incomplete capsule.Microscopically,there were large atypical cell components,some of which were spindle shaped,with disordered cell arrangement,some of which were associated with a large amount of necrotic tissue,and abundant light eosinophil cytoplasm.Tissue components can be found thick-wall blood vessels,smooth muscle-like cells,and adipose tissue.Immunohistochemistry showed 4 cases were positive of HMB-45,4 of Melan-A,7 of SAM.Seven cases were negative of CK,6 of S-100 75％ (6/8) and Ki67 (10％-70％).Two cases died of multiple metastases (lung,bone,liver),1 case survived with tumor recurrence,with a follow-up from 14 to 60 months (mean 29 months).Conclusions Primary malignant renal PEComa is rare in practice with relative large diameter.The diagnosis depends on pathological findings,and radical nephrectomy is the first choice of treatment.It is easy to recur and metastasize after the operation.

Objective To discuss the pathological and clinical characteristics,treatments and prognosis of schwannoma of the kidney.Methods Two cases of schwannoma of the kidney in our hospital were reviewed with clinicopathological data and their follow-up.The related literatures were reviewed.The first case was a male patient,28 years old,complained about paroxysmal abdominal pain with nausea over 2 weeks.The physical exam found a 10 cm,qualitative hard,poor activity,tenderness mass in kidney region.MRI preoperative diagnosis was right renal cell carcinoma with renal vein and inferior vena cava tumor thrombus formation.The second patient,female,53 years old,the mass on upper right kidney was found occasionally.It was diagnosed as adrenal pheochromocytoma before operation,laparoscopic resection of right renal hilum mass and right partial adrenectomy plus right nephrectomy were performed.There was no tumor recurrence in the follow-up.Results The abdominal aortography and double renal arteriography were done and right renal artery embolization and inferior vena cava filter were allocated.Then right radical nephrectomy and inferior vena cava tumor thrombus removal were carried out on the first patient.The first malignant and the second benign renal schwannoma patient showed significant difference in pathological presentations.Their immunohistochemistry also showed great diversity.Malignant renal schwannoma was significantly stained by Ki-67 ＞ 40％,S-100 was negative.Ki-67 in benign neurilemmomas was about 2％,and S-100 in benign renal schwannoma was positive.Conclusions Schwannoma of the kidney is rare with a favorable prognosis.The golden standard of diagnosis is pathology.Surgical resection has become the first choice for treatment.Recurrence and malignant transformation would happen after the surgery so that all the patients should be followed up.

Objective To discuss the clinical diagnosis,treatment and prognosis of malignant melanoma of urinary system.Methods The clinical data of 5 patients with primary malignant melanoma of urinary system were retrospectively analyzed.There were 2 cases of primary melanona of the urethra,3 cases of primary malignant melanoma of the bladder.The diameter of the tumor ranged from 0.9 to 5.1 cm with an average of 3.1 cm.Results Two cases of urethral patients underwent radical resection of urethra.Among 3 cases of bladder,1 cases were in poor condition,and underwent laparoscopic partial cystectomy.In 1 young men,radical resection was refused and only transurethral resection of the bladder tumor was performed.Radical resection of bladder was done in 1 cases.Postoperative pathology showed that the tumor cells of 4 cases were fusiform under microscope,1 case was polygonal.5 cases showed melanin in the cytoplasm and diffuse proliferation of tumor cells,with obvious heterogeneity,cell proliferation index Ki-67 10％-30％.During the follow-up period of 7-30 months (median 19 months),3 patients died of metastasis.Conclusions Malignant melanona of urinary system is rare,with high malignancy and poor prognosis.Targeted therapy and immune therapy has become a new treatment option,which could improve the prognosis of patients.

Organophosphate flame retardants (OPFRs), which have both great properties of flame retardation and plasticization, are currently widely used as additive flame retardants. Due to the restriction and phase-out of brominated flame retardants (BFRs), the market demand for OPFRs as excellent alternatives of BFRs has been rapid increasing. OPFRs can be slowly released into the environment during production and application. Some OPFRs might be persistent in the environment. As a result, OPFRs have been detected in various matrices in the environment and are expected to accumulate in human body through various pathways. OPFRs may cause adverse effects to human health as some of them have been identified as neurotoxicants, reproductive toxicants and potential carcinogens. The article summarized the occurrence and patterns of OPFRs in various environmental matrices such as air, dust, water, food and so on, and in human specimens, estimates the exposure status through different pathways and body burdens of OPFRs. The expected hotspots of OPFRs were also discussed in the future.

Natural product is an important source of new drug research and development (R&D). Traditional Chinese medicine (TCM) innovation is the key step for its modernization and internationalization. However, due to the complexity of TCM, there are many difficulties and confusions in this process. Target-based drug discovery is the mainstream model and method of R&D. TTD, short for therapeutic target database, is developed by National University of Singapore. Besides a large amount of information on drug targets, the database also contains considerable information related to natural products. This paper briefly introduces the TTD, analyzes the natural products derived drugs/compounds recorded in TTD, which we think might provide some inspiration for the innovation of TCM.