【Objective】 To investigate the clinical features, treatment methods and prognosis of advanced renal cell carcinoma (RCC) patients in Xinjiang, especially the Han population. 【Methods】 Clinical data of 233 patients with advanced RCC treated in The First Affiliated Hospital and The Affiliated Cancer Hospital of Xinjiang Medical University were retrospectively analyzed, including 133 Han patients.The median age of patients was 52 years (range: 23 to 87), and the maximum tumor diameter was (7.73±4.04) cm.Survival curves were plotted using the Kaplan-Meier method.Multivariate and univariate Cox regression analysis were conducted for all patients, and further analysis was performed for the Han patients. 【Results】 Among the 233 patients, 131 died during the average follow-up of 27.6 months (range: 1 to 120), and the median survival time was 12 months.In this cohort, 110 patients had lymph node metastasis, and 200 had distant metastasis, among them, 21 (10.5%) patients had brain metastasis and 45 (22.5%) patients had adrenal metastasis.The 1-, 3-, and 5-year survival rate were 48.9%, 18.3% and 6.1%, respectively.Univariate analysis revealed that International mRCC Database Consortium (IMDC) score, pathological type, lymph node metastasis, distant metastasis, number of metastatic foci and treatment methods impacted the prognosis in Xinjian (P<0.05).Multivariate analysis indicated that IMDC score, pathological type and distant metastasis were significant factors influencing the prognosis, which were also the prognostic factors of the Han patients (P<0.05). 【Conclusion】 In Xinjiang, patients with advanced renal cell carcinoma have a 6.1% 5-year survival rate and a median survival time of 12 months.Brain and adrenal metastases are common.Prognostic factors include IMDC score, pathological type, and distant metastasis for all patients, including the Han patients.

Objective:To examine the location and the reparative impact of iatrogenic ureteral injury.Methods:Retrospectively analyzed the clinical data of 43 patients with iatrogenic ureteral injury admitted from May 2019 to May 2022. The median age of the patients was 39 years. The injuries were predominantly on the left side in 26 patients (60.5%), in addition, there were 16 patients (37.2%) on the right side, and 1 patient on(2.3%)bilateral sides. The types of injuries were upper ureteral (8 patients, 18.6%), middle ureteral (8 patients, 18.6%), and lower ureteral (27 patients, 62.8%). The average injury length was 5.9 cm with a standard deviation of 2.4.During intraoperative diagnosis, 7 cases were found to have damage, transection, or ligation of the ureteral luminal structure. Surgical areas displayed extensive exudation and the presence of adipose tissue was observed during ureteroscopy. There were 36 cases manifested symptoms such as lumbar and abdominal pain (13 cases), fever (12 cases), peritoneal irritation sign (9 cases), vaginal discharge (9 cases), or hematuria (5 cases). Among these cases, 10 showed contrast agent spillage on urinary enhanced CT or intravenous urography, while 27 exhibited hydronephrosis or ureteral dilatation. Additionally, one case presented a renal tumor on the affected side, and creatinine examination was performed on drainage fluid in 7 cases. Furthermore, a unilateral renal nonfunction was identified in 1 case through renal ECT examination.Results:Out of the 43 patients followed up for a median of 18 months (range 11-47), 41 patients had no urinary symptoms such as hematuria, urine extravasation, or hypochondriac pain. Their urine tests (routine, urea nitrogen, and serum creatinine) were normal. Thirteen patients showed mild hydronephrosis on urinary ultrasonography, which remained stable during the follow-up period. One patient experienced restenosis at the ureterovesical anastomosis after renal autograft transplantation, but symptoms improved after balloon dilatation. Another patient underwent nephrostomy puncture and was found to have a clamped left ureteral end and a fistula in the sigmoid colon. This patient successfully underwent bilateral ureteroneocystostomy with a bladder flap and had a positive postoperative outcome.Conclusions:Iatrogenic ureteral injuries occur at seven specific sites, with gynecological surgeries posing a higher risk of injury at the ureter and external iliac artery, pelvic infundibulum ligament, and uterine artery intersection or adjacent areas. Similarly, colorectal surgeries can result in injury at the parallel segment of the ureter and mesenteric vessels, colon adjacent region, and vas deferens intersection. Urological surgeries are more likely to cause injury at the intersection of the ureter and external iliac artery, as well as the ureteropelvic junction.When treating ureteral injuries, it is important to consider the cause, location, and length of the injury. For short and deep injuries, options such as ureteral anastomosis or ureterovesical anastomosis may be considered. In cases of longer injuries, alternatives like renal autograft transplantation, ureteral surgery involving other tissues, or techniques such as the Boari flap or buccal/oral mucosal transplantation can be explored. The primary focus during repair surgeries should be on achieving tension-free anastomosis while maintaining sufficient blood supply to the ureter and placing it in an area with better blood circulation.

T cell immunoglobulin and immune receptor tyrosine-based inhibitory motif domain (TIGIT) is a co-inhibitory receptor, which is highly expressed in a variety of malignant tumors.It can inhibit T cells and NK cells, and plays a key role in regulating immune response and tumor immune escape.TIGIT is closely related to the growth, metastasis and prognosis of urologic tumors, and its overexpression is associated with tumor progression and poor prognosis.Currently, TIGIT-based urologic tumors treatment strategies include monoclonal antibody therapy and combined immunotherapy, such as combination therapy with PD-1/PD-L1 and other drugs.Experimental and clinical studies on TIGIT are also being carried out and significant progress has been made.Therefore, TIGIT is expected to become a new target for immunotherapy and a biomarker for predicting the prognosis of patients with urologic tumors.This article reviews the research progress of TIGIT in urologic tumors.

Objective:To assess the evidence for relevant factors associated with mortality in COVID-19 kidney transplantation recipients(KTR) through Meta-analysis.Methods:A complete search of PubMed, Web of Science, Medline, Scopus, Cochrane Library, CNKI and Wanfang Database were performed to search for eligible studies on 18 August 2022.Results:twenty-nine studies involving 7 978 Cases were included in our Meta-analysis.Patients with mean age ≥60 years( OR=1.09, 95% CI: 1.06-1.13), Comorbidities including diabetes mellitus( OR=1.49, 95% CI: 1.26-1.76), cardiovascular disease( OR=1.88, 95% CI: 1.33-2.65), and acute kidney injury( OR=3.46, 95% CI: 1.35-8.89) significantly increased mortality risk.KTR with dyspnea ( OR=2.17, 95% CI: 1.38-3.42), higher Hemoglobin ( OR=1.09, 95% CI: 1.00-1.19), Use of mycophenolic ( OR=1.18, 95% CI: 1.02-1.37) and Antibiotics( OR=7.26, 95% CI: 2.11-25.07) at presentation were at higher mortality risk, while diarrhea( OR=0.57, 95% CI: 0.34-0.96) and higher eGFR( OR=0.95, 95% CI: 0.92-0.98) decreased the risk.Overall in-hospital mortality in COVID-19 KTR was 19%, 95% CI: 15%-23%. Conclusions:Our systematic review and -analysis results suggest that overall in-hospital mortality in COVID-19 KTR declined progressively over time.KTR with these risk factors should receive more intensive monitoring and early therapeutic interventions to optimize health outcomes.

【Objective】 To investigate the risk factors and clinical significance of incidental prostate cancer (IPCa) in patients undergoing radical cystoprostatectomy (PCR). 【Methods】 The clinicopathological data of 260 patients undergoing RCP in our hospital during Jan. 2010 and Jan. 2022 were retrospectively analyzed, including 39 cases of IPCa detected with postoperative pathology, and 221 non-IPCa cases. 【Results】 The detection rate of IPCa was 15%. Univariate logistic regression analysis showed age (P<0.001), smoking (P<0.05), T stage (P<0.05), number of tumors (P<0.05), involvement of trigone (P<0.05), prostate volume (P<0.05), and preoperative total prostate-specific antigen (tPSA) (P<0.05) were influencing factors of prostate cancer. Multivariate logistic regression analysis showed that age (OR=1.061, 95%CI: 1.021-1.107, P=0.004), smoking (OR=2.852, 95%CI: 1.296-6.677, P=0.012), involvement of trigone(OR=2.967, 95%CI: 2.365-3.657, P=0.019) and preoperative tPSA (OR=1.109, 95%CI: 1.011-1.223, P=0.030) were independent risk factors of IPCa. 【Conclusion】 Advanced age, smoking, bladder tumor in trigone and preoperative PSA abnormality are risk factors for incidental prostate cancer in bladder cancer patients.

Abstract: Objective　To prepare a microparticle delivery system that regulates the release rate of extracellular vesicles (EVs), and to exert long-term enhancement of liver cell proliferation after only one intervention. Methods EVs was extracted by differential centrifugation. The structure of the EVs was observed by transmission electron microscopy and the membrane marker protein of EVs was detected by Western blotting. EVs-PLA microspheres with "core-shell" structure were prepared by emulsion-solvent evaporation method. Scanning and transmission electron microscopy were used to detect the morphology of EVs-PLA microspheres and EVs. The release test detected the release behavior of EVs in EVs-PLA microspheres. Scanning electron microscopy was used to detect the morphological changes of EVs-PLA microspheres at 8 weeks of release. EVs-PLA microspheres were co-cultured with hepatocytes, and Phalloidin/DAPI staining was used to observe the cell morphology and evaluate the cytotoxicity of the microspheres. CCK8-test was used to evaluate the cell proliferation activity. Western blot analysis was used to detect extracellular vesicles membrane marker protein expression. Results Comparing the ability of hepatocyte proliferation in the group treated with EVs-PLA microspheres and the control group, it was found that EVs-PLA microspheres did not cause cell apoptosis and mutation in cell structure, had biocompatibility and no cytotoxicity. The EVs-PLA microspheres with "core-shell" structure regulated the release behavior of EVs, which can continuously release EVs, exerting a continuous biological role in promoting hepatocyte proliferation after a single intervention. Conclusions The EVs-PLA microspheres can control-release EVs and promote hepatocyte proliferation continuously after a single intervention, providing a reference for further exploration of EVs-loaded delivery systems in promoting liver regeneration.

In this study, a new ileal orthotopic bladder (Urumqi Bladder) modified by our center based on the ileal "W" type orthotopic bladder and Studer bladder was used on 8 patients with invasive bladder cancer. All of patients were male and aged between 54 and 66 years. The history of disease ranged from 1 month to 3 years, including 5 patients with initial onset, 3 patients with ≥2 TURBT history. 6 patients had multiple tumors, tumor size from 0.5 cm to 2.5cm. There were 2 patients with single tumor. Preoperative PET-CT examination showed no distant metastasis and pelvic lymph node enlargement, no urinary tract hydronephrosis, and cystoscopy showed no suspected tumor in the urethra. Preoperative pathological results: high-grade invasive urothelial carcinoma was found in 6 cases and muscular invasive urothelial carcinoma in 2 cases. In 8 patients, 50cm ileum was taken from 15cm away from ileocecum after radical cystectomy, which was crimped clockwise inward from the right end into a nearly circular shape, with 10cm left at the left end. The remaining 40cm ileum was formed into 3 sections of about 13cm each, which were decanted to form a storage capsule. The last 10cm intestinal tube was crossed from the front of sigmoid colon. The end of intestine was anastomosed with the left ureter. The right ureter was anastomosed with the top of the right intestine pouch, and the urethra was anastomosed with the pouch to complete the diversion of urine flow. During 3-12 months of postoperative follow-up, 4 patients had short-term mild urinary incontinence. All had complete urinary control at 12 months. 1 patient still had mild left ureter reflux 12 months after surgery, and the other 7 patients had no ureter reflux. In this group of 8 patients, postoperative excretory cystography showed satisfactory effect of bladder voiding, residual, and bladder capacity. Follow-up review of chest CT, urinary CT and abdominal ultrasound showed no hydronephrosis, and no tumor recurrence or distant metastasis.

Objective:To discuss the clinical features, treatment and prognosis of renal mesenchymal malignancy.Methods:Retrospective analysis was performed on the clinical data of 48 patients with renal mesenchymal malignancies admitted from January 2005 to June 2019.The patients' age ranged from 16-79 years, including 29 males and 19 females. There were 21 cases of Han nationality and 27 cases of ethnic minorities. The main complained of lumbago were 31 cases, bloating 8 cases, blood urine 2 cases, and 6 cases by physical examination. And one case was seen in orthopedics due to upper arm pain. The patient's completion of the examination indicated a tumor of kidney origin. CT examination mostly showed renal space-occupying lesions. After enhancement, the tumor was irregularly enhanced, with unclear edges, which was difficult to distinguish from renal carcinoma. The tumors were on the left in 30 cases and on the right in 18 cases. All patients perfected preoperative blood routine, biochemical, coagulation and other examinations. Prothrombin time was normal in 39 cases. Clinical staging was conducted according to the imaging results at the time of initial diagnosis. 7 were in clinical Stage T 1, 16 were in Stage T 2, 20 were in stage T 3, and 5 were in stage T 4.Distant metastases were found in 8 cases, including 4 lung metastases, 2 retroperitoneal metastases, and 2 bone metastases. 13 patients underwent needle biopsy to confirm the diagnosis. Among the 48 cases in this group, 29 cases were diagnosed as renal tumor, 12 cases were diagnosed as renal space occupying lesions, and 7 cases were diagnosed as retroperitoneal space occupying. 17 underwent radical nephrectomy, 22 underwent partial nephrectomy, and 9 did not receive surgical treatment after needle biopsy. Results:Among the 48 patients, Conventional pathology confirmed 17 cases as leiomyosarcoma, 17 cases as liposarcoma, and 14 cases as other types of mesenchymal malignancies. Follow-up ranged from 7 to 180 months, with an average follow-up of 38.8 months. Thirty patients died, and the average survival time was 39 months. The 5-year survival rates of leiomyosarcoma, liposarcoma and other types of tumors were 18.2%, 30.8% and 50.1%, and the difference was statistically significant ( P=0.047). The 5-year survival rates of patients with normal and abnormal prothrombin time were 36.8% and 11.0%, the difference was statistically significant ( P=0.018). The 5-year survival rates of radical surgery and partial nephrectomy were 44.6% and 29.8%, and the difference was statistically significant ( P<0.05). The 5-year survival rates of T 1, T 2, T 3 and T 4 patients were 40.0%, 31.6%, 35.4% and 0, and the differences were statistically significant ( P=0.020). Multivariate analysis showed that preoperative prothrombin time ( P=0.013), clinical T stage ( P=0.030) and surgical method ( P=0.006) were independent factors affecting the prognosis of patients with RMM. Conclusions:Renal mesenchymal malignant tumor is rare, and highly malignant. Preoperative needle biopsy did not affect the prognosis of RMM. Patients with normal prothrombin time, early clinical staging and radical surgery had better prognosis. Renal liposarcoma has a better prognosis than renal leiomyosarcoma.

Objective:to investigate the effect of maximum transurethral cystectomy ((TURBT)) before radical cystectomy on the prognosis of patients with multiple bladder tumors.Methods:the clinical data and follow-up records of 90 patients with multiple bladder tumors treated in our hospital from August 2010 to August 2018 were analyzed retrospectively. There were 72 males and 18 females. The age ranged from 20 to 84 years old, with an average of (64.6 ±11.7) years. There were 50 cases of age <60 years old and 40 cases of ≥60 years old. The median age of male was 68 years old and that of female was 69 years old. The diameter of Tumor was ≥3 cm in 52 cases and <3 cm in 38 cases. There were 53 cases with 2 lesions and 37 cases with more than 2 lesions. According to the extent of TURBT resection, 55 patients (61.1%) were divided into maximum TURBT group, 42 males and 13 females, with an average age of (56.2±12.0) years. Tumor diameter ≥3 cm(n=29) and <3 cm(n=26). There were 35 cases (38.9%) in the non-maximal TURBT group, including 30 males and 5 females, with an average age of (59.8±13.4) years. In the non-maximum TURBT group. The diameter of tumor was ≥3 cm in 23 cases and <3 cm in 12 cases. There was no significant difference in preoperative data between the two groups ( P > 0.05). In the maximum TURBT group, all the tumors visible to the naked eye were completely removed, and the tissues were taken from the base and surrounding mucosa for pathological examination. Diagnostic TURBT group: multiple tumors in the bladder were found during the operation, the surface was rough, and there were no ureteral orifices on both sides. Samples of ureteral orifice and surrounding mucosal tissues were taken for biopsy, and the bladder tumor was not completely removed. Radical cystectomy was performed in both groups. The relationship between two different surgical methods and clinicopathological factors was analyzed. After that, the recurrence-free survival time (RFS) and overall survival time (OS) of patients were analyzed by Kaplan-Meier method, and the statistical difference of survival curve was analyzed by Log-rank method. Univariate Log-rank and multivariate Cox regression analysis were used to analyze the influencing factors of RFS and OS. Results:In this study, 90 cases of radical cystectomy were completed successfully. The postoperative follow-up time was 7-60 months, 1 case lost follow-up, and the median follow-up time was 30 (15-46) months. There was no significant difference in all data between maximum TURBT group and diagostic TURBT group ( P>0.05). Urethral recurrence occurred in 6 (6.7%) cases and pelvic recurrence in 9 (10%) cases after RC. 15 (16.7%) cases died, of which 8 cases died of postoperative pelvic recurrence, 3 cases died of myocardial infarction, 2 cases died of bone metastasis and 2 cases died of pulmonary metastasis. The results of Kaplan-Meier method showed that the 1-, 3-and 5-year overall survival rates of patients with RC after maximum TURBT were 96.67%, 86.05% and 80.86%, respectively, and the 1-, 3-and 5-year relapse-free survival rates were 89.97%, 76.93% and 71.41%, respectively. Univariate Log-rank results showed that pathological stage ( P=0.018), urethral recurrence ( P<0.01), pelvic recurrence ( P<0.01) and maximum TURBT ( P<0.01) were the risk factors of OS and RFS. The risk of death in patients with pelvic recurrence was higher than that in patients without pelvic recurrence ( HR=41.850, 95% CI 12.597-139.036, P<0.01). The risk of death in patients with urethral recurrence was higher than that in patients without urethral recurrence ( HR=8.128, 95% CI 1.551-42.606, P<0.01). The risk of death in patients with RC after maximum TURBT was lower than that in patients with diagnostic TURBT ( HR=0.164, 95% CI 0.036-0.746, P<0.01). Among them, there were only 2(3.9%) pelvic recurrence in patients with maximum TURBT combined with RC, 7(6.1%) pelvic recurrence and 6(6.7%) urethral recurrence in patients without maximum TURBT combined with RC, and there was significant difference between patients without maximum TURBT and patients without maximum urethral recurrence. Multivariate Cox analysis showed that urethral recurrence ( HR=8.128, 95% CI 1.551-42.606, P=0.013, P<0.01) and pelvic recurrence ( HR=41.850, 95% CI: 12.597-139.036, P<0.01) were independent risk factors for OS, and urethral recurrence ( HR=18.637, 95% CI 5.443-63.817, P<0.01) and pelvic recurrence ( HR=22.94, 95% CI 8.635-60.973, P<0.01) were independent risk factors for RFS. The maximum TURBT was the independent protective factor of OS ( HR=0.164, 95% CI 0.036-0.746 P<0.01) and RFS ( HR=0.153, 95% CI 0.048-0.493, P<0.01). Conclusions:For patients with multiple bladder tumors, radical cystectomy with maximum TURBT before radical cystectomy might reduce urethral and pelvic recurrence after radical cystectomy, and might improve the prognosis of patients with multiple bladder cancer. Maximum TURBT is an independent protective factor for OS and RFS. Urethral recurrence and pelvic recurrence are independent risk factors for OS and RFS.

Objective:To evaluate the risk factors of clinical cure and biochemical recurrence (BCR) after radical prostatectomy (RP).Methods:The clinical data of 896 patients who underwent RP at Peking University First Hospital from April 2001 to December 2020 were retrospectively analyzed. Average age was (65.90±6.3) years, median preoperative prostate specific antigen (PSA) was 10.75 (0.36-264.20) ng/ml, median prostate volume was 40.0 (12.0-220.9) ml, median PSA density (PSAD) was 0.27 (0.02-3.42) ng/(ml·g). Clinical staging: 432 cases in T 1c stage, 333 cases in T 2a/bstage, 76 cases in T 2c stage, and 55 cases in ≥T 3 stage. Preoperative Gleason score of biopsy: 193 cases in 3+ 3, 315 cases in 3+ 4, 162 cases in 4+ 3, 226 cases in ≥8. The RP surgery was operated by open or laparoscopic or robot-assisted approach. Clinical cure and BCR were used as the end points for analysis. Clinical cure was defined as a decrease in serum PSA level below 0.03 ng/ml 6 weeks after surgery. BCR was defined as the 2 consecutive serum PSA >0.2ng/ml during the follow-up after RP. Multivariate logistic regression was used to analyze the independent risk factors of clinical cure. The Kaplan-Meier method was used to draw the biochemical recurrence-free survival curve, the log-rank method was used for univariate analysis of BCR, and the Cox regression analysis was used for multivariate analysis. Results:All 896 patients were followed-up for 58 (5-241) months, 678 cases (75.7%) achieved clinical cure. Based on univariate analysis and multivariate analysis, among the preoperative indicators, whether the proportion of positive biopsy needles ≥33% ( P=0.007) and preoperative Gleason score of biopsy ( P=0.041) were independent risk factors of clinical cure. A total of 890 cases were included in the analysis of risk factors of BCR, of whom 172 cases (19.3%) had BCR. The 1-, 5-, and 10-year biochemical recurrence-free survival(BFS)rates were 98.1%, 83.1% and 68.4% respectively. The median BFS has not been reached, and the average BFS was 181 months (95% CI 172-189). The results of univariate and multivariate analysis showed that whether achieved clinical cure ( P=0.001) and postoperative pathological staging ( P<0.001) were independent risk factors of BCR. Conclusions:Whether the proportion of positive biopsy needles≥33% and preoperative Gleason score of biopsy were independent risk factors of clinical cure. Postoperative pathological staging and whether achieved clinical cure may be independent risk factors of BCR.