Objective: To explore the potential application of PAK4-PROTAC targeted degradation drug (PpD) in renal cancer immunotherapy. Methods: TIMER 2.0 and TISIDB databases were used to analyze the relationship among PAK4 expression, tumor purity and abundance of immune cell infiltration in renal tumor microenvironment (TEM).Renal cancer cell lines OS-RC-2, 786-O and ACHN were treated with 0, 125 and 250 nmol/L PpD, and the effects of Jurkat cell co-culture on the results were investigated.The cell apoptosis was detected with flow cytometry, and the expression of programmed cell death 1 ligand 1 (PD-L1) in renal cancer cells was detected with immunoblotting. Results: The high expression of PAK4 was positively related to immune purity, and inhibited the abundance of immune killer cells in TEM, such as CD8 T cells, CD4 T cells, natural killer cells and dendritic cells.With 250 nmol/L PpD treatment, there were 21.02% apoptotic cells in OS-RC-2, 29.67% apoptotic cells in 786-O, and 15.39% apoptotic cells in ACHN, respectively.However, with the same concentration of 250 nmol/L PpD treatment, cell apoptotic rate was sharply increased to 70.13% in OS-RC-2/Jurkat, 70.68% in 780-O/Jurkat, and 60.27% in ACHN/Jurkat co-culture models, respectively. Conclusion: PpD can promote apoptosis of renal cancer cells by reducing the expression of PAK4 protein, and enhance the killing effects of immune cells on tumor cells.

Objective:To investigate the clinical outcomes of scrotal local flap combined with thick split-thickness skin grafting in the treatment of penoscrotal Paget’s disease.Methods:The clinical data of patients with penoscrotal Paget’s disease admitted to the Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University, were retrospectively analyzed. For the defect wounds remaining after extended resection of penile and scrotal lesions, scrotal local flap combined with thick split-thickness skin grafting was used for repair. The central part of the scrotal local flap was fenestrated (for penile passage) to cover the wounds of the penile root and perineum, and thick split-thickness skin grafts harvested from the thigh were used to resurface penile defects. The thigh donor sites were managed with direct pressure dressing. Postoperatively, the flap vascularity, incision healing, and skin graft survival were observed. The appearance of the penis, scrotum, and perineum, as well as penile erectile function, were followed up, and patients’ satisfaction with the surgical results was investigated.Results:A total of 15 male patients, aged 55-81 years, were included. The clinical manifestations included erythema and papules on the local skin of the penis and scrotum, with partial ulceration or exudation and obvious pruritus. The lesions involved the lower segment of the penis and the upper skin of the scrotum. After extended resection of the lesions, the perineal defect area ranged from 6.0 cm×7.5 cm to 15.0 cm×10.0 cm, and the penile wound area ranged from 4.0 cm×7.0 cm to 9.0 cm×9.0 cm. The area of the scrotal skin flap was approximately 6.0 cm×7.5 cm to 12.0 cm×8.0 cm, and the area of the transplanted skin graft was about 5.0 cm×7.0 cm to 8.0 cm×9.0 cm. Postoperatively, all flaps demonstrated good perfusion, and all skin grafts survived. Primary healing occurred in 12 cases, while 3 cases had mild distal flap dehiscence due to early ambulation, which healed by secondary intention after dressing changes. The thigh donor sites healed primarily. During the 12-36 months follow-up, the perineal appearance was good, no obvious contracture was observed in the penile skin grafts, urination was normal, and penile erectile function was not affected. No recurrence of the lesions was found during the follow-up period. There was mild pigmentation or uneven texture in the thigh donor sites, and no obvious scar hyperplasia. All patients were satisfied with the surgical outcomes.Conclusion:Scrotal local flap combined with thick split-thickness skin grafting can effectively repair the composite defect wounds of the penis and scrotum after lesion resection in penoscrotal Paget’s disease. The postoperative scar at the incision is inconspicuous, with no obvious displacement of the penis and scrotum and no impact on penile erectile function, leading to high patient satisfaction.

Objective:To investigate the value of biparametric-MRI (bpMRI) based peritumoral radiomics for preoperative prediction of extraprostatic extension (EPE) in prostate cancer (PCa).Methods:In this cross-sectional study, consecutive bpMRI of patients undergoing prostatectomy for PCa were retrospectively collected from the First Medical Center (center 1) and the Third Medical Center (center 2) of Chinese PLA General Hospital. A total of 274 patients were finally enrolled. Patients at center 1 from January 2020 to December 2022 were randomly divided into a training set (149 cases) and an internal validation set (63 cases) by stratified random sampling. Patients at center 2 from January 2023 to March 2024 were assigned to the external test set (62 cases). Patients were categorized into EPE-positive group and EPE-negative group according to pathological assessment postoperatively. In the training set, there were 49 cases in EPE-positive group and 100 cases in EPE-negative group. In the internal validation set, there were 26 cases in EPE-positive group and 37 cases in EPE-negative group. In the external test set, there were 22 cases in EPE-positive group and 40 cases in EPE-negative group. Axial T 2WI and apparent diffusion coefficient (ADC) images were manually annotated to obtain index lesion regions of interest (ROIs), with the peritumoral ROIs subsequently delineated by semi-automatic segmentation technique. Radiomics features were extracted from intra-tumoral, peri-tumoral, and intra-tumoral plus peri-tumoral ROIs. The training set data was employed to select and optimize features to build the radiomics models. The logistic regression analysis was used to develop radiomics, clinical, and integrated models. The predictive performance was assessed by the area under the receiver operating characteristic curve (AUC) in the external test set, and compared by the DeLong test. The sensitivity and specificity were compared by the exact McNemar test. Results:In the external test set, the peri-tumoral radiomics model based on bpMRI showed the highest performance in evaluating EPE, with an AUC of 0.739 (95% CI 0.611-0.842), which was identified as the optimal radiomics model. EPE grade ( OR=6.151, 95% CI 3.371-11.226, P<0.001) was incorporated into the clinical model, with an AUC of 0.780 (95% CI 0.657-0.875) in the external test set. The integrated model had an AUC of 0.817 (95% CI 0.698-0.904) in the external test set. There was no statistically significant difference in comparisons of AUCs among the three models (all P>0.05). The sensitivity of the integrated model (68.2%) showed no significant difference from those of the clinical model and the optimal radiomics model (77.3% and 86.4%, respectively; P=0.500 and P=0.289). However, the specificity of the integrated model (85.0%) was significantly higher than those of the clinical model (67.5%, P=0.016) and the optimal radiomics model (50.0%, P<0.001). Conclusion:A bpMRI-based peritumoral radiomics integrating clinical model demonstrates high performance for preoperative prediction of EPE in PCa.

Objective:To construct an evaluation system for the operation quality of the equipment of the urological department based on the pressure-state-response(PSR)model,so as to explore it's application effect in the evaluation for the operation quality of the equipment of urological department.Methods:Based on the PSR model,the analytic hierarchy process was used to determine the weights of index,and the fuzzy evaluation method was adopted to evaluate the management efficiency for equipment.A total of 160 devices of clinical use in the Urological Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2022 to January 2024 were selected.According to different management modes,the random number table was adopted to equally distribute these devices into conventional management mode(80 devices)and management mode with evaluation system(model evaluation)for operation quality of the equipment of the urological department(80 devices).A self-made questionnaire was used to investigate the satisfaction of the usage managers in the urological department and operation room,department of medical equipment,and department of managing infection for the clinical services of the two kinds of management modes.The infection situations,management quality of equipment operation,and the score of operation quality in using equipment between two kinds of management modes were compared.Results:The average repair rate of equipment failure,risk rate of infection,inefficiency rate of cleaning,and problem rate of quality inspection in the management mode with model evaluation were respectively(1.58±0.69)%,(1.98±0.69)%,(1.10±0.78)%and(1.01±0.70)%,all of which were lower than those in the conventional management mode,and the differences of them were statistically significant(t=7.879,6.663,7.863,14.601,P<0.05).In the 120 patients who adopted the management mode with model evaluation,the infection rates of using equipment in laparoscopic minimally invasive surgery,endoscopic surgery for stone,resectoscopic surgery and flexible ureteroscope were respectively 2.50%,3.33%,4.17%and 3.33%,all of which were lower than those in the conventional management mode,and the differences between the two kinds of modes were statistically significant(x2=6.696,6.916,5.154,7.101,P<0.05).The scores of the standardization of using equipment,effectiveness of cleaning and disinfection,recognition of emergency management,and qualification of controlling infection in the management mode with model evaluation were significantly higher than those in the conventional management mode,and the differences were statistically significant(t=22.198,11.806,9.385,18.071,P<0.05).The satisfaction scores of the managers involved in using equipment in the operation room of urology,department of medical equipment and department of managing infection for the management mode with model evaluation were all higher than those of the conventional management mode,and the differences were statistically significant(t=14.426,14.916,14.707,P<0.05).Conclusion:The quality evaluation system of equipment operation of the urological department based on the PSR model can reduce the failure rate of equipment,and improve the usage efficiency of equipment,and ensure the medical safety of patients.

Objective:To investigate the clinical outcomes of scrotal local flap combined with thick split-thickness skin grafting in the treatment of penoscrotal Paget’s disease.Methods:The clinical data of patients with penoscrotal Paget’s disease admitted to the Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University, were retrospectively analyzed. For the defect wounds remaining after extended resection of penile and scrotal lesions, scrotal local flap combined with thick split-thickness skin grafting was used for repair. The central part of the scrotal local flap was fenestrated (for penile passage) to cover the wounds of the penile root and perineum, and thick split-thickness skin grafts harvested from the thigh were used to resurface penile defects. The thigh donor sites were managed with direct pressure dressing. Postoperatively, the flap vascularity, incision healing, and skin graft survival were observed. The appearance of the penis, scrotum, and perineum, as well as penile erectile function, were followed up, and patients’ satisfaction with the surgical results was investigated.Results:A total of 15 male patients, aged 55-81 years, were included. The clinical manifestations included erythema and papules on the local skin of the penis and scrotum, with partial ulceration or exudation and obvious pruritus. The lesions involved the lower segment of the penis and the upper skin of the scrotum. After extended resection of the lesions, the perineal defect area ranged from 6.0 cm×7.5 cm to 15.0 cm×10.0 cm, and the penile wound area ranged from 4.0 cm×7.0 cm to 9.0 cm×9.0 cm. The area of the scrotal skin flap was approximately 6.0 cm×7.5 cm to 12.0 cm×8.0 cm, and the area of the transplanted skin graft was about 5.0 cm×7.0 cm to 8.0 cm×9.0 cm. Postoperatively, all flaps demonstrated good perfusion, and all skin grafts survived. Primary healing occurred in 12 cases, while 3 cases had mild distal flap dehiscence due to early ambulation, which healed by secondary intention after dressing changes. The thigh donor sites healed primarily. During the 12-36 months follow-up, the perineal appearance was good, no obvious contracture was observed in the penile skin grafts, urination was normal, and penile erectile function was not affected. No recurrence of the lesions was found during the follow-up period. There was mild pigmentation or uneven texture in the thigh donor sites, and no obvious scar hyperplasia. All patients were satisfied with the surgical outcomes.Conclusion:Scrotal local flap combined with thick split-thickness skin grafting can effectively repair the composite defect wounds of the penis and scrotum after lesion resection in penoscrotal Paget’s disease. The postoperative scar at the incision is inconspicuous, with no obvious displacement of the penis and scrotum and no impact on penile erectile function, leading to high patient satisfaction.

Objective:To investigate the value of biparametric-MRI (bpMRI) based peritumoral radiomics for preoperative prediction of extraprostatic extension (EPE) in prostate cancer (PCa).Methods:In this cross-sectional study, consecutive bpMRI of patients undergoing prostatectomy for PCa were retrospectively collected from the First Medical Center (center 1) and the Third Medical Center (center 2) of Chinese PLA General Hospital. A total of 274 patients were finally enrolled. Patients at center 1 from January 2020 to December 2022 were randomly divided into a training set (149 cases) and an internal validation set (63 cases) by stratified random sampling. Patients at center 2 from January 2023 to March 2024 were assigned to the external test set (62 cases). Patients were categorized into EPE-positive group and EPE-negative group according to pathological assessment postoperatively. In the training set, there were 49 cases in EPE-positive group and 100 cases in EPE-negative group. In the internal validation set, there were 26 cases in EPE-positive group and 37 cases in EPE-negative group. In the external test set, there were 22 cases in EPE-positive group and 40 cases in EPE-negative group. Axial T 2WI and apparent diffusion coefficient (ADC) images were manually annotated to obtain index lesion regions of interest (ROIs), with the peritumoral ROIs subsequently delineated by semi-automatic segmentation technique. Radiomics features were extracted from intra-tumoral, peri-tumoral, and intra-tumoral plus peri-tumoral ROIs. The training set data was employed to select and optimize features to build the radiomics models. The logistic regression analysis was used to develop radiomics, clinical, and integrated models. The predictive performance was assessed by the area under the receiver operating characteristic curve (AUC) in the external test set, and compared by the DeLong test. The sensitivity and specificity were compared by the exact McNemar test. Results:In the external test set, the peri-tumoral radiomics model based on bpMRI showed the highest performance in evaluating EPE, with an AUC of 0.739 (95% CI 0.611-0.842), which was identified as the optimal radiomics model. EPE grade ( OR=6.151, 95% CI 3.371-11.226, P<0.001) was incorporated into the clinical model, with an AUC of 0.780 (95% CI 0.657-0.875) in the external test set. The integrated model had an AUC of 0.817 (95% CI 0.698-0.904) in the external test set. There was no statistically significant difference in comparisons of AUCs among the three models (all P>0.05). The sensitivity of the integrated model (68.2%) showed no significant difference from those of the clinical model and the optimal radiomics model (77.3% and 86.4%, respectively; P=0.500 and P=0.289). However, the specificity of the integrated model (85.0%) was significantly higher than those of the clinical model (67.5%, P=0.016) and the optimal radiomics model (50.0%, P<0.001). Conclusion:A bpMRI-based peritumoral radiomics integrating clinical model demonstrates high performance for preoperative prediction of EPE in PCa.

Objective:To construct an evaluation system for the operation quality of the equipment of the urological department based on the pressure-state-response(PSR)model,so as to explore it's application effect in the evaluation for the operation quality of the equipment of urological department.Methods:Based on the PSR model,the analytic hierarchy process was used to determine the weights of index,and the fuzzy evaluation method was adopted to evaluate the management efficiency for equipment.A total of 160 devices of clinical use in the Urological Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2022 to January 2024 were selected.According to different management modes,the random number table was adopted to equally distribute these devices into conventional management mode(80 devices)and management mode with evaluation system(model evaluation)for operation quality of the equipment of the urological department(80 devices).A self-made questionnaire was used to investigate the satisfaction of the usage managers in the urological department and operation room,department of medical equipment,and department of managing infection for the clinical services of the two kinds of management modes.The infection situations,management quality of equipment operation,and the score of operation quality in using equipment between two kinds of management modes were compared.Results:The average repair rate of equipment failure,risk rate of infection,inefficiency rate of cleaning,and problem rate of quality inspection in the management mode with model evaluation were respectively(1.58±0.69)%,(1.98±0.69)%,(1.10±0.78)%and(1.01±0.70)%,all of which were lower than those in the conventional management mode,and the differences of them were statistically significant(t=7.879,6.663,7.863,14.601,P<0.05).In the 120 patients who adopted the management mode with model evaluation,the infection rates of using equipment in laparoscopic minimally invasive surgery,endoscopic surgery for stone,resectoscopic surgery and flexible ureteroscope were respectively 2.50%,3.33%,4.17%and 3.33%,all of which were lower than those in the conventional management mode,and the differences between the two kinds of modes were statistically significant(x2=6.696,6.916,5.154,7.101,P<0.05).The scores of the standardization of using equipment,effectiveness of cleaning and disinfection,recognition of emergency management,and qualification of controlling infection in the management mode with model evaluation were significantly higher than those in the conventional management mode,and the differences were statistically significant(t=22.198,11.806,9.385,18.071,P<0.05).The satisfaction scores of the managers involved in using equipment in the operation room of urology,department of medical equipment and department of managing infection for the management mode with model evaluation were all higher than those of the conventional management mode,and the differences were statistically significant(t=14.426,14.916,14.707,P<0.05).Conclusion:The quality evaluation system of equipment operation of the urological department based on the PSR model can reduce the failure rate of equipment,and improve the usage efficiency of equipment,and ensure the medical safety of patients.

OBJECTIVE To explore the predictive factors of cefoperazone/sulbactam-induced thrombocytopenia in adult inpatients， and to establish and validate the nomogram prediction model. METHODS Data of adult inpatients treated with cefoperazone/sulbactam in Xi’an Central Hospital from Jun. 30th， 2021 to Jun. 30th， 2023 were retrospectively collected. The training set and internal validation set were randomly constructed in a 7∶3 ratio. Singler factor and multifactor Logistic regression analysis were used to screen the independent predictors of cefoperazone/sulbactam-induced thrombocytopenia. The nomogram was drawn by using “RMS” of R 4.0.3 software， and the predictive performance of the model was evaluated by the receiver operating characteristic curve and C-index curve. Hosmer-Lemeshow goodness-of-fit test was used to evaluate the calibration degree of the model. Using the same standard， the clinical data of hospitalized patients receiving cefoperazone/sulbactam in Xi’an First Hospital in the same period were collected for external validation of the nomogram prediction model. RESULTS A total of 1 045 patients in Xi’an Central Hospital were included in this study， among which 67 patients suffered from cefoperazone/sulbactam-induced thrombocytopenia， with an incidence of 6.41%. After the false positive patients were excluded， 473 patients were included finally， including 331 in the training set and 142 in theinternal validation set. Multifactor Logistic regression analysis showed that age [OR＝1.043， 95%CI （1.017， 1.070）]， estimated glomerular filtration rate （eGFR） [OR＝0.988，95%CI（0.977， 0.998）]， baseline platelet （PLT） [OR＝0.989， 95%CI（0.982， 0.996）]， nutritional risk [OR＝3.863， 95%CI（1.884， 7.921）] and cumulative defined daily doses （DDDs） [OR＝1.082， 95%CI（1.020， 1.147）] were independent predictors for cefoperazone/sulbactam-induced thrombocytopenia （P＜0.05）. The C-index values of the training set and the internal validation set were 0.824 [95%CI （0.759， 0.890）] and 0.828 [95%CI （0.749， 0.933）]， respectively. The results of the Hosmer-Lemeshow test showed that χ 2 values were 0.441 （P＝0.802） and 1.804 （P＝0.406）. In the external validation set， the C-index value was 0.808 [95%CI （0.672， 0.945）]， the χ 2 value of the Hosmer-Lemeshow test was 0.899 （P＝0.638）. CONCLUSIONS The independent predictors of cefoperazone/sulbactam-induced thrombocytopenia include age， baseline PLT， eGFR， nutritional risk and cumulative DDDs. The model has good predictive efficacy and extrapolation ability， which can help clinic identify the potential risk of cefoperazone/sulbactam-induced thrombocytopenia quickly and accurately.

Objective:To investigate the impact of the interval period between biopsy and MR examination on tumor detection and extraprostatic extension (EPE) assessment for prostate cancer (PCa) using multi-parametric MRI (mpMRI).Methods:The study was cross-sectional and retrospectively included 130 patients with PCa who underwent RP and preoperative systematic biopsies followed by mpMRI between January 2021 and December 2022 in the First Medical Center of Chinese PLA General Hospital. Patients were divided into 3 groups according to interval following biopsy (group A,<3 weeks, 31 cases; group B, 3-6 weeks, 67 cases; group C,>6 weeks, 32 cases). The percentages of hemorrhage volume in the total prostate were drawn on T 1WI and calculated. The junior, senior and expert radiologists independently localized the index lesions and calculated the accuracy for tumor detection, in addition to assessing the probabilities of EPE according to EPE grade. The correlation between the hemorrhage extent and interval was analyzed using the Spearman correlation coefficient. The accuracy for tumor detection was compared using χ2 test among groups. The diagnostic performance of the radiologists for EPE prediction was assessed using the receiver operating characteristic curve, and the differences between the corresponding area under the curve (AUC) were compared using the DeLong test. Results:The percentage of hemorrhage was correlated with the interval between biopsy and MR examination ( r=-0.325, P<0.001). The detection accuracy of junior radiologist was 83.9% (26/31), 76.1% (51/67), and 78.1% (25/32) in group A, B and C, respectively; no differences were observed in the detection accuracy among three groups ( χ2=0.76, P=0.685). The detection accuracy of senior radiologist was 83.9% (26/31), 80.6% (54/67), and 71.9% (23/32) in 3 groups with no differences ( χ2=1.53, P=0.464). The detection accuracy of expert radiologist was 80.6% (25/31), 77.6% (52/67), and 93.8% (30/32) with no differences ( χ2=3.95, P=0.139). The AUC (95% CI) for predicting EPE were 0.830 (0.652-0.940), 0.704 (0.580-0.809), 0.800 (0.621-0.920) in the group A, B and C for junior radiologist; 0.876 (0.708-0.966), 0.768 (0.659-0.863), 0.896 (0.736-0.975) for senior radiologist; and 0.866 (0.695-0.961), 0.813 (0.699-0.895), 0.852 (0.682-0.952) for expert radiologist, respectively. No differences were observed among the subgroups in each radiologist ( P>0.05). Conclusion:The interval period does not significantly affect the detection accuracy and EPE assessment of PCa using mpMRI. There is probably no necessity for prolonged intervals following systematic biopsy to preserve the clarity of MRI interpretation for PCa.

To investigate the value of self-developed air-free laparoscopic auxiliary instruments in the clinical application of thyroid diseases.The clinical data of 70 transaxillary and 45 transareolar air-free laparoscopic surgeries for thyroid cancer and 40 conventional open surgeries were retrospectively compared.The transaxillary and transareolar laparoscopic groups had significantly longer operative times than the open group,while the postoperative satisfaction was higher in the endoscopic group than in the open group.This set of instruments has advantage of novel design,scientific structure,safe application.It can be compatible with a variety of thyroid and breast air-free laparoscopic procedures,which can promote the development and popularization of laparoscopic technology.