Objective:To evaluate the safety and efficacy of a dual-endoscopic technique combining laparoscopy/robot-assisted laparoscopy with disposable flexible ureteroscopy for intraoperative localization and reconstruction in complex ureteral strictures.Methods:A retrospective analysis was conducted on 21 patients with complex ureteral strictures(stenosis length ≥2 cm,multiple strictures,or iatrogenic stric-tures,or radiation-induced strictures)treated at Peking University People's Hospital between January 2023 and November 2024.All the patients underwent dual-endoscopic procedures using laparoscopy(n=17)or da Vinci robotic-assisted laparoscopy(n=4)combined with disposable flexible ureterosco-py.Preoperative evaluation included contrast-enhanced CT urography and diuretic renography.Intra-operatively,stricture localization was achieved by synchronizing laparoscopic light sources with uretero-scopic visualization.Surgical positions were optimized:non-split-leg oblique supine position for mid-upper strictures and lithotomy position for mid-lower strictures.Reconstruction strategies(lingual mucosa graft,bladder flap augmentation,or primary anastomosis)were selected based on stricture length and tension.Postoperative outcomes were assessed via symptom resolution,hydronephrosis improvement(ultrasono-graphic renal pelvis diameter),and stent-free patency.Results:The cohort included 10 males and 11 females[mean age(44.1±13.3)years].Etiologies included lithogenic strictures(71.4％,15/21),post-gynecologic surgery injury(4.8％),radiation-induced fibrosis(4.8％),and congenital factors(19.0％).Intraoperative findings revealed discrepancies in stricture localization compared with pre-operative imaging in 52.4％(11/21)of cases,necessitating extended resection or modified reconstruc-tion.Mean stricture length was(4.81±4.33)cm.Postoperative complications included transient urina-ry leakage(1 case)and secondary ureteral obstruction due to stone migration(1 case),both resolved without sequelae.At a mean follow-up of(10.76±6.81)months(range 2-21),hydronephrosis sig-nificantly improved in all the patients(100％efficacy),with no recurrence of strictures or symptom re-currence.Conclusion:The dual-endoscopic technique enhances intraoperative precision in complex ure-teral stricture management by integrating real-time luminal visualization with extraluminal anatomical guidance.This approach minimizes excessive resection of healthy ureter,optimizes reconstruction strate-gies,and reduces postoperative recurrence.The modified positioning protocol further improves ergonomic efficiency,making it a reliable and adaptable option for challenging ureteral pathologies.

Objective:To evaluate the safety and efficacy of a dual-endoscopic technique combining laparoscopy/robot-assisted laparoscopy with disposable flexible ureteroscopy for intraoperative localization and reconstruction in complex ureteral strictures.Methods:A retrospective analysis was conducted on 21 patients with complex ureteral strictures(stenosis length ≥2 cm,multiple strictures,or iatrogenic stric-tures,or radiation-induced strictures)treated at Peking University People's Hospital between January 2023 and November 2024.All the patients underwent dual-endoscopic procedures using laparoscopy(n=17)or da Vinci robotic-assisted laparoscopy(n=4)combined with disposable flexible ureterosco-py.Preoperative evaluation included contrast-enhanced CT urography and diuretic renography.Intra-operatively,stricture localization was achieved by synchronizing laparoscopic light sources with uretero-scopic visualization.Surgical positions were optimized:non-split-leg oblique supine position for mid-upper strictures and lithotomy position for mid-lower strictures.Reconstruction strategies(lingual mucosa graft,bladder flap augmentation,or primary anastomosis)were selected based on stricture length and tension.Postoperative outcomes were assessed via symptom resolution,hydronephrosis improvement(ultrasono-graphic renal pelvis diameter),and stent-free patency.Results:The cohort included 10 males and 11 females[mean age(44.1±13.3)years].Etiologies included lithogenic strictures(71.4％,15/21),post-gynecologic surgery injury(4.8％),radiation-induced fibrosis(4.8％),and congenital factors(19.0％).Intraoperative findings revealed discrepancies in stricture localization compared with pre-operative imaging in 52.4％(11/21)of cases,necessitating extended resection or modified reconstruc-tion.Mean stricture length was(4.81±4.33)cm.Postoperative complications included transient urina-ry leakage(1 case)and secondary ureteral obstruction due to stone migration(1 case),both resolved without sequelae.At a mean follow-up of(10.76±6.81)months(range 2-21),hydronephrosis sig-nificantly improved in all the patients(100％efficacy),with no recurrence of strictures or symptom re-currence.Conclusion:The dual-endoscopic technique enhances intraoperative precision in complex ure-teral stricture management by integrating real-time luminal visualization with extraluminal anatomical guidance.This approach minimizes excessive resection of healthy ureter,optimizes reconstruction strate-gies,and reduces postoperative recurrence.The modified positioning protocol further improves ergonomic efficiency,making it a reliable and adaptable option for challenging ureteral pathologies.

Metastasis of renal cell carcinoma to the contralateral testis is a rare occurrence, and we reported a case. The patient had previously undergone radical left nephrectomy for clear cell carcinoma of the left kidney. Six years postoperatively, he presented with enlargement of the right testis and subsequently underwent radical orchiectomy. The postoperative pathological results confirmed the diagnosis of metastasis from the left renal cell carcinoma to the right testis. Three months post-surgery, the patient initiated treatment with a combination of axitinib and pembrolizumab. At the last follow-up, the patient had completed five cycles of targeted and immunotherapy, and there was no evidence of recurrence or metastasis.

Metastasis of renal cell carcinoma to the contralateral testis is a rare occurrence, and we reported a case. The patient had previously undergone radical left nephrectomy for clear cell carcinoma of the left kidney. Six years postoperatively, he presented with enlargement of the right testis and subsequently underwent radical orchiectomy. The postoperative pathological results confirmed the diagnosis of metastasis from the left renal cell carcinoma to the right testis. Three months post-surgery, the patient initiated treatment with a combination of axitinib and pembrolizumab. At the last follow-up, the patient had completed five cycles of targeted and immunotherapy, and there was no evidence of recurrence or metastasis.

Objective:To investigate the clinical and pathological characteristics and prognosis of upper tract urothelial carcinoma (UTUC) with concurrent other histological variants.Methods:The clinical data of 566 UTUC patients admitted to Peking University People's Hospital from January 2007 to April 2021 were retrospectively analyzed. Among them, 289 were males and 277 were females, with an average age of (67.3±10.0)years old. Among the patients, 97 had a history of smoking, 29 had undergone kidney transplantation, 120 had diabetes, 76 had coronary heart disease, 146 had hyperlipidemia, 271 had hypertension, and 50 had a history of chronic kidney disease. Among the UTUC cases, 366 had concurrent hydronephrosis, 55 had concurrent bladder cancer, and 43 had a history of previous bladder cancer. The distribution included 210 cases of renal pelvis carcinoma, 5 cases of carcinoma at the renal pelvis-ureter junction, 226 cases of ureteral carcinoma, and 125 cases of multifocal tumors. Patients were classified into the pure UTUC group and the UTUC with concurrent other histological variants group based on postoperative pathology, and their clinical and pathological features were compared. Logistic regression analysis was used to explore risk factors for the occurrence of histological variations in UTUC. The log-rank test was employed to compare the overall survival (OS) and cancer-specific survival (CSS) between the two groups, while Cox regression analysis was performed to investigate prognostic factors.Results:Among the 566 cases, 511 were pure UTUC and 55 were UTUC with concurrent other histological variants. Among the latter, 30 cases had squamous differentiation, 6 had glandular differentiation, 5 had mucinous differentiation, 5 had sarcomatoid carcinoma, 2 had micropapillary carcinoma, 2 had neuroendocrine carcinoma, 1 had giant cell carcinoma, and 4 had other mixed histological variations. The proportion of patients with a history of kidney transplantation was higher in the UTUC with concurrent histological variants group than that in the pure UTUC group [14.5% (8/55) vs. 4.1% (21/511)], with statistically significant difference ( P=0.003). In the UTUC with concurrent histological variants group, the proportion of postoperative high-grade tumors [98.2% (54/55) vs. 80.2% (410/511)], muscle-invasive tumors [89.1% (49/55) vs. 68.1% (348/511)], lymph node metastasis tumors [10.9% (6/55) vs. 2.3% (12/511)], and maximum tumor diameter [(3.60±2.64) cm vs. (2.96±1.98) cm] were higher than those in the pure UTUC group ( P<0.05). Multivariate logistic regression analysis showed that a history of kidney transplantation ( OR=4.991, 95% CI 1.749-13.615, P=0.002) was an independent predictive factor for the occurrence of histological variants. Follow-up was conducted for 1 to 174 months, with a median follow-up time of 32.8 months. UTUC with concurrent histological variants was significantly associated with worse OS and CSS ( P<0.05). Multivariate Cox regression analysis indicated that histological variants were an independent risk factor for OS ( HR=1.860, 95% CI 1.228-2.816, P=0.003) and CSS ( HR=2.146, 95% CI 1.349-3.412, P=0.001). Conclusions:UTUC with concurrent other histological variants exhibited higher postoperative tumor grade and stage compared to pure UTUC, and UTUC with concurrent other histological variants was an independent risk factor for worse prognosis.

Objective:To comprehensively describe the experience of economic toxicity in breast cancer patients by systematically integrating qualitative studies.Methods:Search the qualitative research literature on the economic toxicity experience of breast cancer patients from the PubMed, Web of Science, PsycINFQ, CINAHL, Embase, Cochrane Library, EBSCO, China National Knowledge Infratructure, Vip Network, Wanfang Patent Database and SinoMed from the warehouse until April 2023. Unified criteria were evaluated for the quality of the included literature, and the literature results were integrated by the pooled integration method.Results:A total of 11 articles were included, and 41 research results were summarized into 9 categories into 3 integrated results: the impact of economic toxicity on patients and families; adjust self-response to economic toxicity and achieve role growth; the needs and expectations for economic toxicity.Conclusions:Medical staff should pay attention to the economic burden and psychological pressure borne by breast cancer patients and their families during treatment, implement active psychological nursing intervention. Hospitals should build special social assistance channels, and social security departments should improve relevant medical insurance policies to reduce the economic toxicity of patients from multiple levels.

OBJECTIVE: To investigate the mechanisms for inhibitory effect of aldehyde dehydrogenase 2 (ALDH2) on doxorubicin (DOX)-induced cytotoxicity in C2C12 myogenic cell line.
 METHODS: Cell apoptosis was evaluated by flow cytometry and the activity of capase-3/7. The relative content of reactive oxygen species (ROS) and 4-hydroxynonenal (4-HNE) were detected by chemical fluorometric enzyme immunoassay. The protein and mRNA expression of ALDH2, Bcl-2, NADPH oxidase 2 (NOX2) and the cytoplasmic subunit p-p47PHOX were evaluated by Western blot and quantitative PCR, respectively. 
 RESULTS: Overexpression of ALDH2 attenuated DOX-induced cell toxicity (increase in apoptosis and inhibition of proliferation), which were reversed by downregulation of ALDH2. Overexpression of ALDH2 reduced p47PHOX phosphorylation levels, and suppressed activation of NOX2 and ROS production, which were reversed by downregulation of ALDH2. Moreover, apocynin, an inhibitor of NOX, reduced the cytotoxicity of DOX concomitantly with a decrease in phosphorylation of p47PHOX, ROS production and caspase-3/7 activity, and an increase in the activity and expression of ALDH2. 
 CONCLUSION DOX-induced cytotoxicity is related to increase of intracellular oxidative stress, which is involved in unregulation of NOX2 and downregulation of ALDH2. Activation of ALDH2 could exert cytoprotection via inhibiting NOX2-dependent ROS production.
Aldehyde Dehydrogenase, Mitochondrial ; Aldehydes ; Animals ; Apoptosis ; Caspase 3 ; Cell Line ; Cell Survival ; Down-Regulation ; Doxorubicin ; Mice ; Oxidative Stress ; Phosphorylation ; Reactive Oxygen Species