Objective To develop and validate a nomogram prediction model for residual stone risk after flexible ureteroscopic lithotripsy(FURL)in patients with 2-3 cm renal calculi,so as to provide reference for treatment options.Methods Clinical data of 342 patients with renal calculi measuring 2-3 cm undergoing FURL in our hospital during Jun.2017 and Apr.2024 were retrospectively collected.At a 3∶1 randomization ratio,patients were allocated to the training cohort(n=257)and validation cohort(n=85).Patients in the training cohort were stratified into two subgroups based on postoperative stone-free status:residual stone group(n=63)and stone-free group(n=194).Logistic regression analysis was employed to identify factors influencing stone retention and construct the nomogram prediction model.Bootstrapped resampling was applied to validate the model internally,model performance was assessed with calibration curves,Hosmer-Lemeshow test was used to test the degree of fitting,receiver operating characteristic(ROC)curve was plotted to evaluate the predictive accuracy,and decision curve analysis was used to determine the clinical net benefit.The model's generalization capability was evaluated with 10-fold cross-validation of the training set.Results Multivariate logistic regression revealed that stone size,CT value,lower calyx stones,multiple stones,renal infundibulum length(RIL),and renal infundibulum width(RIW)were independent predictors of residual stones(P＜0.05).The nomogram based on the above mentioned parameters demonstrated excellent discrimination,with Bootstrap-validated concordance indices of 0.876(training cohort)and 0.948(validation cohort).Hosmer-Lemeshow tests showed good calibration in both cohorts(P＞0.05).ROC analysis yielded the area under the curve(AUC)of 0.876 and 0.948 for the training and validation cohorts,respectively.The optimal cutoff value was 0.253,with corresponding sensitivity of 84.13％,specificity of 78.35％,and total score of nomogram of 143.The decision curve analysis showed when the threshold probability of the training cohort and verification cohort was 0-0.81 and 0-0.97,respectively,the nomogram could obtain good clinical net benefit in predicting the risk of residual stones.The average accuracy of 10-fold cross-validation was 0.814,and the average AUC was 0.865.Conclusion The nomogram model effectively predicts residual stone risk following FURL for 2-3 cm renal calculi.It is suggested that patients with a total score of ≤143 may consider undergoing FURL.

Objective To develop and validate a nomogram prediction model for residual stone risk after flexible ureteroscopic lithotripsy(FURL)in patients with 2-3 cm renal calculi,so as to provide reference for treatment options.Methods Clinical data of 342 patients with renal calculi measuring 2-3 cm undergoing FURL in our hospital during Jun.2017 and Apr.2024 were retrospectively collected.At a 3∶1 randomization ratio,patients were allocated to the training cohort(n=257)and validation cohort(n=85).Patients in the training cohort were stratified into two subgroups based on postoperative stone-free status:residual stone group(n=63)and stone-free group(n=194).Logistic regression analysis was employed to identify factors influencing stone retention and construct the nomogram prediction model.Bootstrapped resampling was applied to validate the model internally,model performance was assessed with calibration curves,Hosmer-Lemeshow test was used to test the degree of fitting,receiver operating characteristic(ROC)curve was plotted to evaluate the predictive accuracy,and decision curve analysis was used to determine the clinical net benefit.The model's generalization capability was evaluated with 10-fold cross-validation of the training set.Results Multivariate logistic regression revealed that stone size,CT value,lower calyx stones,multiple stones,renal infundibulum length(RIL),and renal infundibulum width(RIW)were independent predictors of residual stones(P＜0.05).The nomogram based on the above mentioned parameters demonstrated excellent discrimination,with Bootstrap-validated concordance indices of 0.876(training cohort)and 0.948(validation cohort).Hosmer-Lemeshow tests showed good calibration in both cohorts(P＞0.05).ROC analysis yielded the area under the curve(AUC)of 0.876 and 0.948 for the training and validation cohorts,respectively.The optimal cutoff value was 0.253,with corresponding sensitivity of 84.13％,specificity of 78.35％,and total score of nomogram of 143.The decision curve analysis showed when the threshold probability of the training cohort and verification cohort was 0-0.81 and 0-0.97,respectively,the nomogram could obtain good clinical net benefit in predicting the risk of residual stones.The average accuracy of 10-fold cross-validation was 0.814,and the average AUC was 0.865.Conclusion The nomogram model effectively predicts residual stone risk following FURL for 2-3 cm renal calculi.It is suggested that patients with a total score of ≤143 may consider undergoing FURL.

【Objective】 To compare the clinical safety and effectiveness of super-mini-percutaneous nephroscope (SMP) combined with flexible ureteroscopic lithotripsy (FURL) in oblique supine lithotomy position and FURL alone in the treatment of 2.0-3.0 cm renal calculi. 【Methods】 Clinical data of 55 patients treated during Jan.2018 and May 2021 were retrospectively analyzed, including 47 cases complicated renal calculi, and 14 cases of lower calyceal calculi with infundibulopelvic angle ≤30°. SMP combined with FURL was performed in 23 cases (combined group), and FURL alone was performed in 32 cases (FURL group). The operation time, hemoglobin reduction, postoperative hospital stay, hospitalization expenses, stone-clearance rate and complications were compared. 【Results】 All operations were successful. Compared with the FRUL group, the combined group had significantly more hemoglobin reduction [(16.30±10.17) g/L vs. (6.94±6.61) g/L], longer postoperative hospital stay [(5.35±1.61) d vs. (3.19±1.26) d], and higher hospitalization expenses [(22 481±2 234) yuan vs. (18 209±2 584) yuan] (P<0.05). However, there was no significant difference in operation time [(79.57±8.52) min vs. (79.22±3.83 min),P>0.05]. One month after surgery, CT results showed that the combined group had higher stone-clearance rate (91.30% vs. 65.63%, P=0.027). There was no difference in the complication rate (21.74% vs. 21.88%, P>0.05). One case (4.35%) in the combined group and 5 cases (15.63%) in the FURL group received retreatment (P>0.05). 【Conclusion】 SMP combined with FURL in oblique supine lithotomy position is safe and effective in the treatment of 2.0-3.0 cm renal calculi, with high stone-clearance rate and low complication rate.

Objective To evaluate the effectiveness of a newly designed modular flexible ureteroscope with holmium laser lithotripsy for the treatment of renal calculi based. Methods 40 patients were treated with modular flexible ureteroscopic lithotripsy (German Polydiagnost) with holmium laser. 40 patients were treated by traditional flexible ureteroscopic lithotripsy. Their therapeutic effects were compared. Results For modular flexible ureteroscopic lithotripsy group, 37 patients underwent successful operation, with lithotripsy with operation time of (86.0 ± 34.4) min and postoperative hospital stay of (5.3 ± 1.6) days. No severe complication including ureteral perforation, high fever or severe bleeding occurred. One month after the operation, KUB and B-ultrasonography showed complete stone free in 35 patients. Residual calculi (0. 4 cm in diameter) in the calyces were found in 2 patients. Medication and postural drainage therapy were applied. Two weeks later , KUB and B-ultrasonography showed that the residual stones have been removed completely. There was no significant differences in stone size , operation time, rate of calculus clearance, the incidence of postoperative complications, operating time and duration of postoperative hospitalization between the traditional flexible ureteroscopic lithotripsy group and modular ureteroscopic lithotripsy group. Conclusions The modular flexible ureteroscope is effective and safe in treating reanl calculi. It has similar surgical efficacy as traditional flexible ureteroscope , but is more costly effective in terms of maintenance costs.

AIM: To explore the expressions and significance of angiopoietin-2 (Ang-2) and tyrosine kinase with immunoglobulin and epidermal growth factor homology domains-2 (Tie-2) receptors in a rat model of acute lung injury (ALI). METHODS: Wistar rats (n=42) were divided into control group (n=12) and cecal ligation and puncture (CLP) group (n=30). Control group underwent sham operation, and CLP group underwent cecal ligation and puncture to make the model of ALI. 12 h after sham operation or CLP, 6 rats in each group were killed, and arterial blood gas analysis and lung coefficient were tested. The expressions of Ang-2 and Tie-2 receptors in lung tissue were observed by immunohistochemical method. Blood samples of the rest rats were collected from vena caudalis, and Ang-2 levels were measured by enzyme linked immunosorbent assay (ELISA). The mortality rate in each group within 36 h was compared. The lung architecture was observed under microscope. RESULTS: The lung architecture in control group was clear and intact. Alveolar septum was thicker, blood capillary was congested, and neutrophils and macrophages were infiltrated in the lung tissue in CLP group. Tie-2 receptors were expressed in bronchial epithelial cells, smooth muscle cells and endothelial cells in control group. Besides the similar expression as control group, high expression of Tie-2 on neutrophils and macrophages in CLP group was observed. In the adhesion location of Tie-2 receptors positive inflammatory cells, there was stronger staining in endothelial cells. Ang-2 was expressed in smooth muscle cells, bronchial epithelial cells and endothelial cells in control group. The Ang-2 level in CLP group were higher than that in control group [(8.14±1.74) μg/L vs (4.63±0.49) μg/L, P<0.01], and the Ang-2 level of dead rats was higher than that of survival rats within 36 h in CLP group [(8.95±1.61)μg/L vs (6.80±0.96)μg/L, P<0.01]. Oxygen partial pressure in control group was lower (P<0.01) and lung coefficient was higher (P<0.01) than that in CLP group. CONCLUSION: Ang-2 and Tie-2 receptors may participate in the pathophysiology of ALI, and Ang-2 level is correlated with mortality.