Objective:To compare the therapeutic effects of partial nephrectomy (PN) and cryoablation (CA) in patients with stage cT 1N 0M 0 renal cell carcinoma (RCC). Methods:A retrospective analysis was conducted on clinical data of patients with stage cT 1N 0M 0 RCC who underwent CA and PN treatment at The First Affiliated Hospital of Naval Medical University and Shanghai Ninth People's Hospital between March 2011 and December 2019. There were 50 cases in the CA group (36 from The First Affiliated Hospital of Naval Medical University and 14 from the Shanghai Ninth People's Hospital), and 1 323 cases in the PN group (all from The First Affiliated Hospital of Naval Medical University). PN included open surgery, laparoscopic surgery, or robotic surgery performed under general anesthesia through the abdominal or retroperitoneal approach. CA included laparoscopic surgery under general anesthesia and percutaneous treatment guided by CT or ultrasound under local anesthesia. Propensity score matching was performed based on baseline data of the patients to obtain balanced samples between the two groups using a 1∶2 nearest-neighbor matching method. After matching, comparisons were made between the two groups in terms of perioperative conditions, overall survival (OS), and recurrence-free survival (RFS). Results:After PSM, patient distributions were closely balanced in baseline data such as gender (male/female: 28/19 cases in CA group and 58/36 cases in PN group), age [66.0(53.0, 75.0) years vs. 59.5(50.0, 69.3) years], body mass index[ (24.1 ± 6.4) kg/m 2 vs. (24.1 ± 3.1) kg/m 2], Charlson comorbidity index [1(0, 2) vs. 1(0, 2)], history of malignant tumors [19.1% (9/47) vs. 17.0% (16/94)], preoperative estimated glomerular filtration rate (eGFR) [85.2(65.5, 97.1) ml/(min·1.73m 2) vs. 87.0(73.4, 100.4) ml/(min·1.73m 2)], and R. E.N.A.L. score [6(5, 7) vs. 7(6, 8)] between CA(n=47) and PN(n=94) group. There were significant differences in operative time [97.5(81.2, 117.5) min vs. 145.0(110.2, 185.0) min, P<0.001], estimated blood loss [85.0(50.0, 100.0) ml vs. 100.0(75.0, 200.0)ml, P=0.021], length of hospital stay [3.0(2.0, 4.0) days vs. 7.6(5.0, 9.0) days, P<0.001] between the CA and the PN group. No significant differences were observed in the incidence of postoperative complications [4.3% (2/47) vs. 5.3% (5/94), P=0.784], the eGFR within one week after surgery [83.7(65.6, 106.6) ml/(min·1.73m 2) vs. 83.2(66.7, 97.7) ml/(min·1.73m 2), P=0.645], the median follow-up time [ 93 (67, 126) months vs. 85 (68, 139) months, P=0.955], the RFS rate[81.8% vs. 96.8%, P=0.074], or the OS rate [85.7% vs. 97.8%, P=0.190] between the CA and the PN group. Conclusions:For patients with cT 1N 0M 0 stage RCC, CA and PN demonstrate comparable oncologic treatment efficacy, while CA offering the advantages of shorter surgical time, shorter hospital stay, and less blood loss.

Objective:To investigate the hemodynamic changes of the main arteries and veins of the extremities and the heart in patients with hypertrophic scar secondary to extensive burns after pressure treatment, and to analyze the relevant mechanisms.Methods:A retrospective before-after self-control study was conducted. From January 2017 to February 2022, 37 patients with hypertrophic scar secondary to extensive burns who met the inclusion criteria were hospitalized in the Burn Rehabilitation Department of Guangdong Industrial Injury Rehabilitation Hospital, including 25 males and 12 females, aged 23-52 years. The patients were admitted to the hospital within 12 weeks after wound healing, and within one week after admission, rehabilitation therapists, occupational therapists, and tailors custom-made pressure products such as full-body pressure garment, pressure pants, vests, split finger gloves, split finger socks, hoods, and plastic collars, with the pressure at each part maintained at 2.67-4.00 kPa when wearing. Before the first treatment with pressure products (hereinafter referred to as before pressure treatment) and at 1 h of the first treatment with pressure products (hereinafter referred to as 1 h of pressure treatment), color Doppler ultrasonography was performed to check the pulse rate of the axillary artery, the lumen diameter, peak systolic velocity (PSV), and resistance index of the axillary artery and femoral artery on the left side, the lumen diameter, cross-sectional area, and average blood flow velocity of the axillary vein and femoral vein, and the mitral valve E peak, mitral valve A peak, tricuspid valve E peak, aortic valve PSV, and pulmonary valve PSV of the heart; an optical chromatographic skin detector was used to detect the red color, red pigment, and surface brightness of the scar on the back of the hand to reflect the filling and distribution of the scar microvessels. Data were statistically analyzed with paired sample t test. Results:Compared with those before pressure treatment, the PSV of the axillary artery of patients was significantly slowed down at 1 h of pressure treatment ( t=55.42, P<0.01); the average blood flow velocity of the axillary vein was significantly accelerated ( t=-60.50, P<0.01); the pulse rate, lumen diameter, and resistance index of the axillary artery, as well as the lumen diameter and cross-sectional area of the axillary vein did not change obviously ( P>0.05); the average blood flow velocity of the femoral vein was significantly accelerated ( t=-80.52, P<0.01); the lumen diameter, PSV, and resistance index of the femoral artery, as well as the lumen diameter and cross-sectional area of the femoral vein had no significant change ( P>0.05); the mitral valve E peak and mitral valve A peak of the heart decreased significantly (with t values of 10.71 and 21.96, respectively, P<0.01); the tricuspid valve E peak of the heart increased significantly ( t=7.57, P<0.01); the PSV of the aortic valve and pulmonary valve of the heart did not change obviously ( P>0.05). At 1 h of pressure treatment, the red color and red pigment values of the scar on the back of the hand of patients were 15.3±1.1 and 16.8±1.2, respectively, which were significantly lower than 24.5±1.3 and 23.8±1.2 before pressure treatment (with t values of 8.32 and 8.04, respectively, P<0.01). The brightness value of the scar surface on the back of the hand of patients at 1 h of pressure treatment was similar to that before pressure treatment ( P>0.05). Conclusions:After pressure treatment for the hypertrophic scar in patients secondary to extensive burn, the average blood flow velocity of the axillary vein and femoral vein in patients are obviously accelerated, the PSV of the axillary artery is significantly slowed down, the peak values of mitral valve E and mitral valve A of the heart are significantly decreased, and the tricuspid valve E peak is significantly increased. These hemodynamic changes may be related to the reduction of microvascular blood flow in the local area of scar after systemic pressure treatment.

Ureteral artery fistula (UAF) is a rare complication after long-term indwelling of ureteral stent. In this study, two cases were presented. Both of them underwent pelvic tumor surgery and radiotherapy, and had a history of cutaneous terminal ureterostomy and long-term indwelling of ureteral stents. The first case, a 52-year-old female, was admitted to hospital because of intermittent bleeding from ureteral dermostomy for 1 week on April 2, 2020. CT examination revealed hematocele in the left upper urinary tract, and left nephrectomy was performed.However, bleeding still presented and the distal ureteral resection was performed at the same time, and partial ureteral was ligated. Postoperative diagnostic was ureteral artery fistula. After 8 months of follow-up, no recurrent bleeding presented. Another case, a 82-year-old male, was admitted to hospital because of bleeding at the ureteral dermostomy for an hour on June 15, 2020. Contrast enhanced CT examination revealed intersecting of the left ureter and common iliac artery, and interventional surgery was performed, by which UAF was diagnosed. Embolization of left internal iliac artery and stent implantation of common iliac artery and external iliac artery were performed intraoperatively. The bleeding stopped immediately after the operation, and there was no further bleeding during follow-up of 6 months.

Objective:To study and compare the prognosis of different pathological subtypes of renal cell carcinoma (RCC).Methods:Clinicopathological and prognostic data of 1 346 cases of postoperative renal cell carcinoma during July 2002 to June 2014 in West China Hospital were collected retrospectively.There were 839 males and 507 females, aged (55.1±13.4)years, including 1 120 cases of clear cell RCC, 62 cases of papillary RCC, 79 cases of chromophobe RCC and 85 cases of the other pathological types respectively. ECOG 0 and ≥1 were 911 and 435 cases, with; T 1, T 2, T 3 and T 4 of 1 019, 177, 102 and 48 cases respectively; WHO nuclear grade for well, intermediate, poor differentiation and unknown were 587, 530, 85 and 144 cases separately.Tumor size <5cm, 5-10cm, ≥10cm and unknown were 685, 541, 104 and 16 cases.Combined with necrosis or sacromatoid differentiation were 200/1 146 and 27/1 319 cases separately. Meanwhile, data of 80 439 cases from Surveillance, Epidemiology, and End Results Program (SEER) were also collected.There were 51 371 males and 29 068 females, aged (60.9±12.4) years; , with 66 261, 8 680, 5 022 and 476 cases of White, Black, Asian, American native, or unknown race separately. There were 62 600 of clear cell RCC, 12 170 of papillary RCC, 4 354 of chromophobe RCC and 1 315 of other pathological types, with T 1, T 2, T 3 and T 4 of 55 332, 8 687, 15 516 and 904 cases respectively; WHO nuclear grade for well, intermediate and poor differentiation were 52 323, 22 700 and 5 416 cases separately.Tumor size <5cm, 5-10cm, ≥10cm were 46 741, 25 760 and 7 938 cases respectively. Kaplan-Meier survival analysis were performed on these two group of cases, with different factors between subgroups (gender, age, pathological types, tumor stage, size and nuclear grade) evaluated by log-rank test. To evaluate accuracy of outcome prediction models of SSIGN, Leibovich and UISS score, concordance index of these models were evaluated. Results:In 1 346 cases of our cohort, those with chromophobe RCC were well prognostic, survival were relatively better in clear cell RCC than that of papillary RCC, and worst prognosis were demonstrated in those with other types of RCC (5 year overall survival rate: 97.5%, 87.9%, 79.7% and 68.4% separately). Poor prognosis were seen in those older than 50 years, with poor T stage or nuclear grade, large tumor size and tumors with necrosis or sacromatoid differentiation ( P<0.05). In 80 439 seer cases, the best prognosis was also seen in chromophobe RCC and the worst in other type of RCC separately (5 year overall survival rate: 96.3% and 85.3%). In addition, longer survival was seen in papillary RCC than clear cell RCC (5 year overall survival rate: 92.5% and 88.9%). However, similar results with our cohort were seen in Asian and American native subgroup of SEER cases (95.1%, 88.6%, 86.7%, 80.2% for chromophobe, clear cell, papillary and other types of RCC respectively). Poor prognosis were seen in those older than 50 years, males, Asian/ American Indian, poor T stage or nuclear grade and large tumor size ( P<0.05). Concordance index for SSIGN, Leibovich and UISS models in our cohort were 0.763-0.781, 0.725-0.752 and 0.641-0.660, respectively. The chromophobe RCC subgroup was relative better based on predictive value of prognosis models(c-index of UISS of 0.670-0.781, SSIGN and Leibovich of 0.733-0.903). Conclusions:In Asian RCC population, prognosis of chromophobe RCC is best, clear cell RCC is slightly better than papillary RCC, and the prognosis of other types of RCC is the worst. Concordance index of SSIGN and Leibovich in our cohort were higher than that of UISS, and the use value for predictive model was better in the chromophobe RCC subgroup.

The degradation and remodelling of extracellular matrix are important pathophysiological phenomena during the progression of various chronic liver diseases. With the expanded research on matrix metalloproteinases (MMPs) in recent years, it has been found that MMPs can affect the degradation and remodelling of extracellular matrix, participate in the regulation of inflammation and immune responses through various mechanisms, and thus participate in the progression of liver diseases. This article reviews the basic characteristics of matrix metalloproteinase-2 and matrix metalloproteinase-9, their regulatory mechanisms, and their role in the development and progression of chronic liver diseases, so as to provide a basis for exploring new therapeutic strategies for chronic liver diseases.

With the increase of obesity and type 2 diabetes, gestational diabetes mellitus (GDM) is growing public health problem worldwide. GDM is one of the most ubiquitous diseases affecting pregnancy outcomes in perinatal women, which increases the incidence of adverse outcomes such as miscarriage, macrosomia, premature birth and stillbirth. Non-coding RNA (ncRNA) plays an important role in regulating the occurrence and development of GDM, and it is also related to the occurrence of complications of GDM. NcRNA is a type of RNA that don't encode proteins, including long non-coding RNA (LncRNA), microRNA (miRNA) and circular RNA (circRNA). More and more studies show ncRNA contains abundant information. This review discusses the relationship between three kinds of ncRNA and GDM, in aim to provide theoretical basis for further research on gestational diabetes.

With the increase of obesity and type 2 diabetes, gestational diabetes mellitus (GDM) is growing public health problem worldwide. GDM is one of the most ubiquitous diseases affecting pregnancy outcomes in perinatal women, which increases the incidence of adverse outcomes such as miscarriage, macrosomia, premature birth and stillbirth. Non-coding RNA (ncRNA) plays an important role in regulating the occurrence and development of GDM, and it is also related to the occurrence of complications of GDM. NcRNA is a type of RNA that don't encode proteins, including long non-coding RNA (LncRNA), microRNA (miRNA) and circular RNA (circRNA). More and more studies show ncRNA contains abundant information. This review discusses the relationship between three kinds of ncRNA and GDM, in aim to provide theoretical basis for further research on gestational diabetes.

Objective To summarize our clinical experience of cryoablation for renal cancer and to analyze the therapeutic indication,security,selection of cryoablation and outcomes.Methods Sixty-four patients suffered with T1a renal cell carcinoma were enrolled in this study from March 2012 to March 2018.Among them,5 cases were senile patients (≥ 80 years),5 cases complicated with other cancers,3 cases complicated with renal insufficiency,4 cases complicated with decompensated cirrhosis,3 cases with bilateral renal cancer,4 cases with solitary kidney cancer and 39 cases with some other complications.The preoperative serum creatinine level was(80.5 ± 38.2)μmol/L.The patients underwent laparoscopic singlesite (LESS) renal cryoablation,conventional laparoscopic renal cryoablation,or percutaneous image-guided cryoablation according to individual situation.Contrast-enhanced CT scan or MRI were used during the procedures and follow-up was performed.Results All operations were completed successfully and technical success was achieved as well in all cases.Blood transfusion was necessary for 2 cases because of hemorrhage.The mean diameter of the mass was (2.6 ± 0.90) cm,the median volume of blood loss was 50ml(10-110 ml),and the mean operation time was(96.0 ± 24.5) min.The median inpatient hospital stay was 3 d (1-6 d).In one case,digital subtraction angiography (DSA) embolization was performed due to hemorrhage after surgery.None of the other cases had intraoperative or postoperative complications.The serum creatinine level after surgery was not significantly decreased [postoperative (83.8 ±42.1) μmol/L,P =0.64].The contrast-enhanced CT or MRI of the kidneys one week postoperatively showed uniform low density in all lesion areas,which represented complete ablation and regression of the tumor.All cases were followed up regularly.One case showed relapse at the 6 th month follow-up and underwent cryoablation again.Another case,who was not regularly followed up,relapsed at 69th month after surgery.No relapse was observed in the other cases during the follow-up.Conclusions Renal cancer cryoablation is a safe,feasible and efficacious therapy for the patients who suffered from unresectable T1a renal cell carcinoma because of high surgical risk or multifocal lesions.

Objective　To report a 4-year cumulative series (209 cases) of laparoendoscopic singlesite surgery (LESS) in urology and assess its clinical utilization.　Methods　Consecutive LESS cases done between December 2008 and July 2012 at our institution were prospectively recorded and retrospective analyzed in this study.Demographic data,main perioperative outcomes,and information related to the surgical technique were collected and analyzed.There were 209 patients ( 121 males and 88 females) with a mean age of (52.8 ±14.5) years,a mean B MIof (23.5 ±3.12) kg/m2 and a mean ASA score of (2.0±0.3).20.1％ (42 cases) of patients had previous abdominal or pelvic surgeries.29.2％ (61 cases) and 12.9％(27 cases) of patients had diabetes mellitus and hypertension. Indications were renal tumors (70 cases,33.5％),adrenal tumors (42,20.1％),renal cyst (22 cases,10.5％),ureteral calculi (22 cases,10.5％),nonfunctional kidneys (19 cases,9.1％),BPH (10 cases,4.8％),and others (24 cases,11.5％ ).Surgical conversions were evaluated,as well as intraoperative and postoperative complications.Two periods were arbitrarily dcfined:the first was from December 2008 to Septcmber 2010 (22 mon) and the second.was from October 2010 to July 2012 (22 mon).A comparative analysis between these two periods was conducted.　Results　There were 209 LESS surgeries included in this study.Most common procedures ( 92.3％ ) were done on the upper urinary tract,with 55.5％ of the whole cohort being tumor-related indications and only 16.3％ being reconstructive procedures.The transperitoneal approaches were preferentially adopted in 80.9％　cases,and transvesical access in 5.3％ cases. The transumbilical access was used in 46.9％ of cases.The overall conversion rate was 8.1％,with 4.3％ of cases converted to reduced - port laparoscopy,1.9％ to conventional laparoscopy,and 1.9％ to open surgery.The intraoperative complication rate was 4.8％ ( 10/209 ) and postoperative complications,mostly low grade,were encountered in 11.5％(24/209) of cases.There was a significant increase in the number of LESS cases during the second study period; the rate of some procedures (ie,transumbilical LESS,renal cyst decortication and transvesical single-port enucleation of the prostate) was lower,whereas some other procedures were performed more frequently (ie,tumor-related LESS procedures,radical nephrectomy and adrenalectomy).　Conclusions　A broad range of urological procedures can be finished with LESS technique in the experienced hands of a laparoscopic surgeons.However,LESS is still in its infancy with a certain risk of surgical complication and conversion.Stringent patient selection criteria should be applied,especially during the learning curve.Complex reconstructive procedures or malignant tumor related indications are not appropriate as the start of this kind of procedure.We need always put patient's safety and treatment efficacy first.