Objective To analyze the postoperative complications and survival outcomes of elderly patients with renal cell carcinoma undergoing laparoscopic surgery, and to identify the influencing factors, so as to provide reference for improving the safety of laparoscopic surgery in such patients. Methods A retrospective analysis was conducted on the clinical, surgical, and pathological data of 153 patients aged ≥75 years who underwent laparoscopic nephrectomy for renal cell carcinoma at our hospital during 2012 and 2025.Logistic regression analyses were performed to identify factors influencing postoperative complications, and a nomogram was constructed and validated to predict the complications.Kaplan-Meier method was used to draw the survival curve, and the effects of different surgical approaches on the prognosis and the survival difference in the age subgroups (75-＜80 years, ≥80 years) were analyzed.Cox regression analyses were conducted to determine factors affecting survival outcomes. Results Among the 153 patients, 15 developed postoperative complications, including 5 severe cases. Multivariate logistic regression identified Charlson Comorbidity Index (CCI) ≥3 and prolonged operation time as independent risk factors for postoperative complications (P＜0.05).The C-index of the logistic regression model constructed based on these factors (age, CCI≥3 and operation time) was 0.77 (95%CI:0.64-0.90), with an average absolute error of 1.6%.Subgroup analysis revealed superior overall survival in patients aged 75-＜80 years undergoing partial nephrectomy compared to radical nephrectomy (P=0.005 6).No statistically significant difference in overall survival was observed among patients ≥80 years who received different surgical approaches (P=0.062).Multivariate Cox regression analysis identified preoperative low albumin levels, preoperative renal insufficiency, tumor diameter＞4 cm, and pathological stage as independent risk factors for overall survival (P＜0.05). Conclusion Laparoscopic surgery is safe and effective for elderly patients with renal cell carcinoma, with survival outcomes correlated to nutritional status, renal function, tumor size and pathological staging.Patients aged ≥80 years still derive surgical benefit, and no survival differences exist between different surgical approaches in this age group.

As the first defense of respiratory system,airway epi-thelial cells(AECs)play an important role in separating the re-spiratory internal and external environment.They are essential for the natural immune function.Small airway lesions are an im-portant early pathology of chronic obstructive pulmonary disease(COPD),when AECs are exposed to harmful particles or gases for a long time,the epithelial barrier is damaged,and the signa-ling pathways which involved in differentiation,repair,and in-flammatory are disordered,resulting in epithelial cell cycle stag-nation and accelerated aging.A number of studies have sugges-ted that AECs of COPD patients express high levels of aging markers,suggesting that senescence of AECs is closely related to COPD.This review discusses the potential mechanisms of AECs senescence in COPD,the impact of AECs senescence on the de-velopment and severity of the disease,and highlights potential targets for modulating cellular senescence in airway epithelium as a therapeutic approach in COPD.

Aim To observe the interventional effects of Polygala fallax Hemsl.(PFH)on diabetic kidney disease(DKD)rats and the regulatory mechanism of ferroptosis.Methods Thirty-six SD rats were ran-domly divided into the control group,DKD group,fer-rostatin-1(Fer-1)group,PFH-L group,PFH-M group,and PFH-H group,with six rats in each group.Model-ing was induced by a one-time intraperitoneal injection of 35 mg·kg-1 streptozocin(STZ)in combination with high-sugar and high-fat feed.Ferrostatin-1(25μmol·kg-1)was injected intraperitoneally in Fer-1 group.The PFH-L,PFH-M,and PFH-H groups were gavaged with 50,100 and 200 mg·kg-1 of alcoholic extracts of PFH respectively,and the control and DKD groups were gavaged with an equal volume of distilled water once a day for eight weeks.At the end of drug administration,blood glucose,24h-UP,BUN and Scr levels were measured in each group of rats.HE stai-ning and Masson staining were used to observe renal histopathological changes.ELISA was employed to de-termine the levels of total iron,MDA and GSH activity.IHC was used to observe the expression of Nrf2,SLC7A11,and GPX4 in renal tissues.Western blot was used to detect the protein expression of COL1A1,α-SMA,TGF-,FTH-1,TFR-1,Nrf2,SLC7A1 1,GPX4,in renal tissues.RT-qPCR was used to detect the ex-pression levels of Nrf2,SLC7A11,GPX4 mRNA in re-nal tissues.Results Compared with the control group,blood glucose,24h-UP,BUN,Scr increased(P＜0.05);glomerular volume increased,tubular dilata-tion and collagen fiber deposition were obvious;total i-ron,MDA content increased and GSH activity de-creased(P＜0.05);there was increased protein ex-pression of COL1A1,α-SMA,TGF-β,TFR-1 and de-creased protein expression of FTH-1(P＜0.01);there was decreased mRNA and protein expression of Nrf2,SLC7A11,GPX4 in DKD group rats(P＜0.01).Compared with the DKD group,blood glucose,24h-UP,BUN and Scr decreased(P＜0.05);renal tissue le-sions were significantly reduced;total iron and MDA content decreased,and GSH activity increased(P＜0.05);COL1A1,α-SMA,TGF-β,and TFR-1 protein expression decreased and FTH-1 protein expression in-creased(P＜0.05,P＜0.01);Nrf2,SLC7A11,GPX4 mRNA and protein expression increased in Fer-1 and PFH dose groups(P＜0.05,P＜0.01).Conclusions PFH attenuates renal histopathological injury in DKD rats,and the mechanism may be related to the regula-tion of the Nrf2/SLC7A11/GPX4 signaling pathway.

[Objective] To explore the diagnosis and treatment experience of tension hydrocele. [Methods] The clinical data of 2 patients with tension hydrocele treated in our hospital were retrospectively analyzed.Relevant literature was retrieved to analyze the clinical characteristics of this disease. [Results] Case 1 was diagnosed due to swelling and pain of the left scrotum after trauma for more than one month, which worsened for one day.Physical examination showed high tension in the left scrotum and positive light transmission test.Ultrasound examination revealed that the blood flow signal in the left testis disappeared.Emergency left scrotal exploration and hydrocelectomy were performed.There was no sign of testis torsion during the operation.Case 2 was diagnosed mainly due to hydrocele of the right testis for 1 year, which worsened for 1 week and complicated with testis distension and pain.Physical examination showed high tension in the right scrotum and positive light transmission test.Ultrasound examination revealed that the blood flow signal in the right testis decreased.After 40ml of fluid was extracted under ultrasound monitoring, the blood flow signal in the right testis recovered.Hydrocelectomy was performed the next day.During the follow-up of 8 months, there was no recurrence of hydrocele.A search of domestic and foreign literature showed that there were no reports in domestic literature, while a total of 11 cases were reported in foreign literature. [Conclusion] Tension hydrocele of the testis is a rare emergency of the scrotum.Surgery or decompression should be performed as soon as possible to restore testicular blood supply, and hydrocelectomy should be performed simultaneously or in stages to prevent recurrence.

OBJECTIVE: To evaluate the effects of Chinese patent medicine Huatuo Zaizao Pill (HTZZ) on neurological function and limb motor in ischemic stroke (IS) patients during convalescence. METHODS: This is a prospective, open-labelled, randomized controlled trial. Patients with IS were recruited from the Neurology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences from May 2021 to June 2023. Eligible participants were randomly assigned to the HTZZ (40 cases) or control group (40 cases) at a ratio of 1:1. The HTZZ group was treated with oral HTZZ (8 g, thrice daily) combined with conventional treatment, while the control group received only conventional treatment. The treatment duration was 12 weeks. The primary outcome was the change in Modified Ashworth Scale (MAS) score from baseline to week 6 and 12. Secondary outcomes included changes in scores of National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FM), and Barthel Index (BI) from baseline to week 6 and 12, as well as lipid indices after 12 weeks. All adverse events (AEs) were recorded and liver and kidney indices were evaluated. RESULTS: A total of 72 patients completed the study (38 in the HTZZ group and 34 in the control group). Compared with the control group, the HTZZ group demonstrated significant improvements in MAS, NIHSS, FM, and BI scores following 6 and 12 weeks of treatment in both intent-to-treat and per-protocol analyses (all P<0.05). No significant differences were noted between groups in lipid indices, AEs, and liver and kidney dysfunction after 12 weeks (P>0.05). CONCLUSIONS HTZZ alleviated spasticity and enhanced neurological function and prognosis of IS patients during convalescence. However, further evaluation of HTZZ's effect on IS outcomes is warranted in clinical trials with larger sample sizes and extended observation periods. (Trial registration No. NCT04910256).
Humans ; Drugs, Chinese Herbal/pharmacology* ; Male ; Female ; Ischemic Stroke/physiopathology* ; Middle Aged ; Aged ; Recovery of Function/drug effects* ; Convalescence ; Extremities/physiopathology* ; Treatment Outcome ; Prospective Studies

As the first defense of respiratory system,airway epi-thelial cells(AECs)play an important role in separating the re-spiratory internal and external environment.They are essential for the natural immune function.Small airway lesions are an im-portant early pathology of chronic obstructive pulmonary disease(COPD),when AECs are exposed to harmful particles or gases for a long time,the epithelial barrier is damaged,and the signa-ling pathways which involved in differentiation,repair,and in-flammatory are disordered,resulting in epithelial cell cycle stag-nation and accelerated aging.A number of studies have sugges-ted that AECs of COPD patients express high levels of aging markers,suggesting that senescence of AECs is closely related to COPD.This review discusses the potential mechanisms of AECs senescence in COPD,the impact of AECs senescence on the de-velopment and severity of the disease,and highlights potential targets for modulating cellular senescence in airway epithelium as a therapeutic approach in COPD.

Objective:To observe the effect of Guilu Taohong Formula on semen quality in varicocele(VC)models of rats,and to explore its possible mechanism.Methods:Forty-eight male SD rats were randomly divided into four groups(sham group,model group,Guilu Taohong Formula group and L-carnitine group).After the establishment of models,the rats were treated with intra-gastric administration for eight consecutive weeks.The general condition of the rats was observed.After the gavage,the testicular and epididymal indices were calculated.Semen quality was assessed using an automatic semen analyzer.Apoptosis of testicular cells was assessed by TUNEL staining.And the expression levels of B-cell lymphocytoma-2(Bcl-2),Bcl-2-associated X protein(Bax)and cys-teine aspartate protease-3(caspase-3)in testicular tissue were detected by Western blot.Results:Compared with the sham group,testicular index,epididymal index,sperm concentration,the percentage of progressive motility of sperm(PR％)and the expression level of Bcl-2 decreased in model group(P＜0.01).An increased apoptosis rate of spermatogenic cells and the expression levels of Bax and caspase-3 proteins were observed in model group as well(P＜0.01).Compared with the model group,the testicular index,epidid-ymal index,sperm concentration,PR％and the expression level of Bcl-2 in Guilu Taohong Formula group increased significantly(P＜0.05,P＜0.01).A decreased apoptosis rate of spermatogenic cells and the expression levels of Bax and caspase-3 proteins were de-tected in Guilu Taohong Formula group as well(P＜0.01).Similarly,the L-carnitine group showed increased testicular index,epidid-ymal index,sperm concentration,PR％and the expression level of Bcl-2 protein(P＜0.05,P＜0.01),where showed decreased ap-optosis rate of spermatogenic cells and the expression levels of Bax and caspase-3 proteins compared with model group(P＜0.01,P＜0.05).Conclusion:Guilu Taohong Formula improves semen quality in VC model rats and reduces the apoptosis rate of spermato-genic cells in testicular tissue,which may be related to the promotion of Bcl-2 protein expression and the inhibition of Bax and caspase-3 protein expression levels.

Aim To observe the interventional effects of Polygala fallax Hemsl.(PFH)on diabetic kidney disease(DKD)rats and the regulatory mechanism of ferroptosis.Methods Thirty-six SD rats were ran-domly divided into the control group,DKD group,fer-rostatin-1(Fer-1)group,PFH-L group,PFH-M group,and PFH-H group,with six rats in each group.Model-ing was induced by a one-time intraperitoneal injection of 35 mg·kg-1 streptozocin(STZ)in combination with high-sugar and high-fat feed.Ferrostatin-1(25μmol·kg-1)was injected intraperitoneally in Fer-1 group.The PFH-L,PFH-M,and PFH-H groups were gavaged with 50,100 and 200 mg·kg-1 of alcoholic extracts of PFH respectively,and the control and DKD groups were gavaged with an equal volume of distilled water once a day for eight weeks.At the end of drug administration,blood glucose,24h-UP,BUN and Scr levels were measured in each group of rats.HE stai-ning and Masson staining were used to observe renal histopathological changes.ELISA was employed to de-termine the levels of total iron,MDA and GSH activity.IHC was used to observe the expression of Nrf2,SLC7A11,and GPX4 in renal tissues.Western blot was used to detect the protein expression of COL1A1,α-SMA,TGF-,FTH-1,TFR-1,Nrf2,SLC7A1 1,GPX4,in renal tissues.RT-qPCR was used to detect the ex-pression levels of Nrf2,SLC7A11,GPX4 mRNA in re-nal tissues.Results Compared with the control group,blood glucose,24h-UP,BUN,Scr increased(P＜0.05);glomerular volume increased,tubular dilata-tion and collagen fiber deposition were obvious;total i-ron,MDA content increased and GSH activity de-creased(P＜0.05);there was increased protein ex-pression of COL1A1,α-SMA,TGF-β,TFR-1 and de-creased protein expression of FTH-1(P＜0.01);there was decreased mRNA and protein expression of Nrf2,SLC7A11,GPX4 in DKD group rats(P＜0.01).Compared with the DKD group,blood glucose,24h-UP,BUN and Scr decreased(P＜0.05);renal tissue le-sions were significantly reduced;total iron and MDA content decreased,and GSH activity increased(P＜0.05);COL1A1,α-SMA,TGF-β,and TFR-1 protein expression decreased and FTH-1 protein expression in-creased(P＜0.05,P＜0.01);Nrf2,SLC7A11,GPX4 mRNA and protein expression increased in Fer-1 and PFH dose groups(P＜0.05,P＜0.01).Conclusions PFH attenuates renal histopathological injury in DKD rats,and the mechanism may be related to the regula-tion of the Nrf2/SLC7A11/GPX4 signaling pathway.

Objective:To develop a robotic digestive endoscope system (RDES) and to evaluate its feasibility, safety and control performance by experiments.Methods:The RDES was designed based on the master-slave control system, which consisted of 3 parts: the integrated endoscope, including a knob and button robotic control system integrated with a gastroscope; the robotic mechanical arm system, including the base and arm, as well as the endoscopic advance-retreat control device (force-feedback function was designed) and the endoscopic axial rotation control device; the control console, including a master manipulator and an image monitor. The operator sit far away from the endoscope and controlled the master manipulator to bend the end of the endoscope and to control advance, retract and rotation of the endoscope. The air supply, water supply, suction, figure fixing and motion scaling switching was realized by pressing buttons on the master manipulator. In the endoscopy experiments performed on live pigs, 5 physicians each were in the beginner and advanced groups. Each operator operated RDES and traditional endoscope (2 weeks interval) to perform porcine gastroscopy 6 times, comparing the examination time. In the experiment of endoscopic circle drawing on the inner wall of the simulated stomach model, each operator in the two groups operated RDES 1∶1 motion scaling, 5∶1 motion scaling and ordinary endoscope to complete endoscopic circle drawing 6 times, comparing the completion time, accuracy (i.e. trajectory deviation) and workload.Results:RDES was operated normally with good force feedback function. All porcine in vivo gastroscopies were successful, without mucosal injury, bleeding or perforation. In beginner and advanced groups, the examination time of both RDES and ordinary endoscopy tended to decrease as the number of operations increased, but the decrease in time was greater for operating RDES than for operating ordinary endoscope (beginner group P=0.033; advanced group P=0.023). In the beginner group, the operators operating RDES with 1∶1 motion scaling or 5∶1 motion scaling to complete endoscopic circle drawing had shorter completion time [1.68 (1.40, 2.17) min, 1.73 (1.47, 2.37) min VS 4.13 (2.27, 5.16) min, H=32.506, P<0.001], better trajectory deviation (0.50±0.11 mm, 0.46±0.11 mm VS 0.82±0.26 mm, F=38.999, P<0.001], and less workload [42.00 (30.00, 50.33) points, 43.33 (35.33, 54.00) points VS 52.67 (48.67, 63.33) points, H=20.056, P<0.001] than operating ordinary endoscope. In the advanced group, the operators operating RDES with 1∶1 or 5∶1 motion scaling to complete endoscopic circle drawing had longer completion time than operating ordinary endoscope [1.72 (1.37, 2.53) min, 1.57 (1.25, 2.58) min VS 1.15 (0.86, 1.58) min, H=13.233, P=0.001], but trajectory deviation [0.47 (0.13, 0.57) mm, 0.44 (0.39, 0.58) mm VS 0.52 (0.42, 0.59) mm, H=3.202, P=0.202] and workload (44.62±21.77 points, 41.24±12.57 points VS 44.71±17.92 points, F=0.369, P=0.693) were not different from those of the ordinary endoscope. Conclusion:The RDES enables remote control, greatly reducing the endoscopists' workload. Additionally, it gives full play to the cooperative motion function of the large and small endoscopic knobs, making the control more flexible. Finally, it increases motion scaling switching function to make the control of endoscope more flexible and more accurate. It is also easy for beginners to learn and master, and can shorten the training period. So it can provide the possibility of remote endoscopic control and fully automated robotic endoscope.

Objective To investigate the clinicopathologic characteristics of clear cell papillary renal cell tumor and the medium to long-term effect of surgical treatment.Methods A total of 23 cases of clear cell papillary renal cell tumor treated in our department from October 2013 to January 2024 were retrospectively analyzed.For patients undergoing partial nephrectomy,the renal artery was dissociated and blocked through abdominal or retroperitoneal approach to remove the tumor,and then the wound was sutured.For patients undergoing radical nephrectomy,the renal artery,vein,and ureter were dissociated and clipped by Hem-o-lok for cutting off,and then the kidney was removed.Results The operations were accomplished in all the patients,including 18 laparoscopic operations and 5 robot-assisted laparoscopic operations.Among them,17 cases underwent partial nephrectomy,with an operating time of 73-229 min (median,149 min),blocking time of 9-35 min (median,21 min),blood loss of 10-100 ml ( median,20 ml),and postoperative hospitalization time of 3-28 d ( median,6 d).Six cases underwent radical nephrectomy,with an operating time of 110-232 min ( median,123 min),blood loss of 5-200 ml ( median,10 ml),and postoperative hospitalization time of 3-7 d ( median,4 d).Postoperative pathology showed clear cell papillary renal cell tumor with nuclear grade ( WHO/ISUP grade) of Ⅰ-Ⅱ.The 23 cases were followed up for 7-121 months (mean,53 months),of which 10 cases were followed up for more than 3 years and 9 cases for more than 5 years.One case was found to have contralateral renal lesions one year after operation and underwent laparoscopic partial nephrectomy,with a pathological result of clear cell papillary renal cell tumor.Subsequent re-examinations showed that there were cysts in both kidneys.At 7 years after the first operation,solid nodules in both kidneys were found,and a recurrence was considered.The patient was given active monitoring for 2 years ( CT re-examinations every 3-6 months) and was in stable condition.Another case was found gastric cardia tubular adenocarcinoma at 29 months after operation and was resected under gastroscopy.No recurrence was found during follow-ups for 121 months.The remaining 21 cases had no recurrence.Conclusions Preoperative diagnosis of clear cell papillary renal cell tumor is difficult,and surgery is an effective method for treating this disease.Medium to long-term follow-up shows a good prognosis,but there are still some cases of recurrence or combined with multiple primary cancer.Postoperative follow-ups should be noted.