Objective: To construct prediction models of female stress urinary incontinence (SUI), and evaluate the efficacy of each model, so as to provide reference for the early diagnosis of SUI. Methods: Female SUI patients treated in our hospital during Oct. 2019 and Oct. 2023 and healthy women undergoing physical examination during the same period were involved. Women 42 days after delivery were included in the postpartum group (n=611), and perimenopausal and postmenopausal women were included in the non-postpartum group (n=409). The number of random seeds was set and the participants were divided into the training and verification sets in a ratio of 7∶3. Relevant clinical data were collected, and meaningful variables were screened using single factor and Lasso regression, which were then incorporated into the K-nearest neighbor method (KNN), support vector machine (SVM)，decision tree (DT) and random forest (RF) algorithms. The sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (AUC) of the models were calculated to screen out the optimal model. Results: There were 352 SUI patients (57.6%) in the postpartum group. According to single factor and Lasso regression, significant variables included age, body mass index (BMI), maximum rapid muscle stage, parity, bladder neck mobility (BND), urethral rotation angle (URA), lateral perineal incision, past incontinence, and constipation. In the verification set, the AUC of KNN，SVM，DT and RF models were 0.881，0.878，0.750 and 0.905,respectively; the AUC, accuracy, F1 index and Kappa value of RF model were the largest. In the non-postpartum group, there were 260 SUI patients, accounting for 63.6%. The significant variables were age，BMI, maximum value and recovery time of fast muscle stage, mean value of slow muscle stage, post-resting stage variability, vaginal delivery, past incontinence, and constipation. In the verification set, the AUC of KNN,SVM，DT and RF models were 0.819,0.805，0.603 and 0.830, respectively; the AUC, accuracy, Kappa value of the RF model were the largest. Conclusion: This study successfully established 4 prediction models for the incidence of SUI in women at 42 days postpartum, perimenopausal and postmenopausal women based on machine learning. Among them, the model adopting the RF algorithm had the best prediction efficiency.

Objective To assess the risk factors for systemic inflammatory response syndrome(SIRS)induced by flexible ureteroscopic lithotripsy(FURL)and compare the diagnostic value of bacterial culture for stone,midstream urine culture and pelvic urine culture in predicting postoperative infection.Methods Patients who underwent FURL for upper urinary tract stones from November 2021 to May 2023 were retrospectively enrolled.The patients were divided into non-SIRS and SIRS groups.We collected midstream urine one day before surgery and stone and pelvic urine samples during surgery.Multivariate lo-gistic regression analysis was used to identify the risk factors for SIRS induced by FURL.Results Totally,326 patients,11.66％(38/326)developed SIRS,and 4.29％(14/326)had severe sepsis.The percentages of positive bacterial cultures for mid-stream urine,pelvic urine and stone cultures were 16.87％(55/326),10.43％(34/326)and 15.95％(52/326),respectively.In the multivariate logistic regression analysis,stone size(P=0.010),operation time(P=0.030),and stone culture(P＜0.01)were identified as independent risk factors for SIRS induced by FURL.Positive bacterial culture for stone was an independent risk factor for postoperative severe sepsis(P=0.047).E.coli was the most common pathogen cultured from the three sam-ples.Compared with midstream urine and pelvic urine,a greater proportion of E.coli in stone were resistant to aminoglycoside and β-lactamase antibiotics.Conclusion Positive bacterial culture for stone was associated with an increased incidence of post-operative SIRS.Bacterial culture for stone might have important clinical value in the treatment of postoperative infection in FURL patients.

【Objective】 To explore the safety and efficacy of flexible ureteroscope in the treatment of upper and middle ureteral calculi complicated with lower ureteral stricture after the failure of rigid ureteroscopy. 【Methods】 Clinical data of 36 patients with middle and upper ureteral calculi and lower ureteral stricture treated with rigid ureteroscopy but failed during Oct.2019 and Oct.2021 were retrospectively analyzed. The patients’ average age was (46.2±13.2) years, and the maximum diameter of calculi was (1.3±0.3) cm. The intraoperative, postoperative and follow-up data were recorded. 【Results】 All 36 patients successfully completed first-stage operation. Intraoperatively, the stenosis degree was F6-8 and could be dilated to F9-11. The mean length of stenosis was (1.1±0.34) cm. No serious postoperative complications such as infection or bleeding occurred. Two patients were lost and 34 patients were followed up. There was no obvious hydronephrosis on ultrasound examination. The stone removal rates were 76.5%, 88.2% and 97.1%, respectively, in months 1, 2 and 3 after operation. One patient with residual stones underwent secondary ureteroscopy in month 3 and large stones were removed with stone removal basket. 【Conclusion】 In patients with middle and upper ureteral calculi and lower ureteral stricture, after the failure of rigid ureteroscopy, flexible ureteroscope is safe and effective, and can significantly increase the success rate of first-stage surgery.

Objective : To the effects and potential mechanisms of ST3GAL5 on biological behaviors of Bladder Urothelial Carcinoma(BLCA) . Methods : Differentially expressed genes related to bladder cancer were identified using microarray analysis . Suitable bladder cancer cell lines were then screened . In vitro experimental measurements , including CCK8 , EdU , colony formation assays , transwell migration , flow cytometry apoptosis experiments , scratch assay , were used to evaluate the effects of ST3GAL5 on biological behaviors of BLCA . ST3GAL5 gene Kyoto Encyclopedia of Genes and Genomes ( KEGG) , gene set enrichment analysis ( GSEA) were analyzed using The Cancer Genome Atlas (TCGA) database . Finally , Western blot technology was used to verify the classical proliferation and metastasis related pathway factors . Results : The combination of bioinformatics analyses and experimental measurements demonstrate that ST3GAL5 expression is aberrantly down⁃regulated in human cell lines of BLCA . Through Cancer Cell Line Encyclopedia (CCLE) database , HT⁃1376 cell lines were successfully screened for vitro test . Upregulation of ST3GAL5 was found to suppress the malignant biological behaviour of bladder cancer. GSEA enrichment analyses exhibited that ST3GAL5 and its co⁃expressed genes inhibited cell proliferation , invasion and metastasis of bladder urothelial carcinoma by activation of the PPAR pathway and inhibition of the PI3K/AKT pathway . The results of Western blot experiments verified that the key proteins of the PPAR signaling pathway showed a significant increase and the key proteins of the PI3K/AKT signaling pathway showed a significant decrease ( P <0. 05) after ST3GAL5 overexpression in bladder cancer. Conclusion ST3GAL5 gene might act as an oncogenic suppressor gene in bladder cancer , possibly inhibit the proliferation , invasion and metastasis of bladder cancer cells by activating the PPAR signaling pathway and inhibiting related molecules in the PI3K/AKT signaling pathway .

Metabolism reprogramming plays an important role in the process of tumor occurrence and development, and provides the necessary material basis for tumor cells. It can change the metabolic patterns of amino acids, glucose and fatty acids in tumor cells, which is one of the hallmark features of tumors. At present, it is shown that most tumors tend to take advantage of glycolysis for energy resource. In contrast, studies have shown that prostate cancer cells dependent more on the fatty acid oxidation pathway for metabolic reprogramming to obtain energy substances. Therefore, it is of great significance to understand the relation between key enzymes of lipid metabolism and regulatory genes for early diagnosis, targeted treatment and better prognosis of prostate cancer.

Objective : To investigation of the interaction between interstitial cells of Cajal (ICCs) and connexin 43 ( Cx43) in bladder contraction and its significance． Methods : Eighty male guinea pigs were randomly divided into blank control group，Glivec group，Gap27 group and Glivec + Gap27 group．Four groups of guinea pigs were per- fused with saline，Glivec，Gap 27，and Glivec + Gap 27 every morning for 2 months．Success of urodynamic testing model after 2 months．Bladder tissue was collected for an in vitro muscle strip test to detect muscle contraction in each group．Correlation between c-Kit and Cx43 was detected by immunofluorescence．The interaction between c- Kit and Cx43 in the bladder was further validated by qRT-PCR and Western blot．Ultrastructural changes in the muscle layer of the bladder were observed by electron microscopy. Results : Urodynamics revealed increased blad- der compliance in the experimental group compared to the blank control group (P＜0. 05) ; bladder compliance increased in the Glivec + Gap27 group compared to the Glivec and Gap27 groups (P＜0. 01) ．In vitro muscle strip experiments revealed that the frequency and tone of bladder muscle strip contractions were lower in the experimental group compared to the blank control group (P＜0. 05) ，and that muscle strip contractions were weaker in the ex- perimental group after administration of acetylcholine (ACH) compared to the control group(P＜0. 05) ．Immuno- fluorescence showed that c-Kit was co-expressed with Cx43 on ICCs cells．qRT-PCR and Western blot suggested that the protein expression level and gene expression level of Cx43 in bladder tissues were lower after inhibition of c-Kit than in the blank control (P＜0. 05) ; after inhibition of Cx43，the protein expression level and gene expres- sion level of c-Kit in bladder tissues the levels of c-Kit protein expression and gene expression in bladder tissues were lower than those in the blank control group (P＜0. 05) ．Electron microscopy revealed that the mitochondrial structure of bladder smooth muscle was disrupted after simultaneous inhibition of c-Kit and Cx43． Conclusion Cx43 is expressed on bladder ICCs and the two may be jointly involved in regulating bladder contractile function ; the joint reduction of Cx43 and c-Kit may have disrupted the mitochondria of bladder smooth muscle，affecting its function and consequently bladder contractile function.

Objective : To investigate the effect of the combination of stem cell leukemia(SCL)recombinant lentivirus and connexin 43 ( Cx43 ) recombinant lentivirus on the function of diabetic cystipathy ( DCP) in guinea pigs. Methods : After 90 healthy guinea pigs were fed normally for 1 week, streptozotocin(STZ)was injected intraperito⁃ neally at 200 mg/kg in a single dose, and random blood glucose was monitored weekly. After 12 weeks of normal feeding, 40 guinea pigs meeting the criteria were screened by urodynamic examination and randomly divided into 4 groups: diabetic group, SCL group, Cx43 group, and SCL + Cx43 group. In the diabetic group, 0. 2 ml of empty lentivirus without gene was instilled into the bladder through the urethra, in the SCL and Cx43 groups, 0. 2 ml of SCL lentivirus and Cx43 lentivirus were instilled using the same method, in the SCL + Cx43 lentivirus group, 0. 2 ml of each SCL and Cx43 lentivirus was instilled through the urethra. After 14 days of transfection, urodynamic examination was performed, and then the guinea pigs were executed after the examination, and the bladders were quickly removed for frozen bladder sections and fluorescent double staining. Results : There were no differences in urodynamic examinations between the SCL and Cx43 groups compared to the diabetic group( P > 0. 05 ) . Urodynamic examination in the SCL + Cx43 group showed improvement in detrusor pressure, abdominal pressure and bladder pressure compared to the diabetic group(P < 0. 05) . In laser confocal experiments, the number of interstitial cells of Cajal (ICC) was reduced in the diabetic group, and the spindle structure and cell protrusions were obviously destroyed and appeared in a state of cell lysis. In the SCL and Cx43 groups, there was an improvement in the spindle structure and cell protrusion of ICC⁃like cells, and there was no significant change in the number of cells. In the SCL + Cx43 group, there was an increase in the number of ICC⁃like cells, a significant improvement in the spindle structure and cell protrusion, and the formation of ICC⁃dimers. Conclusion Transurethral co⁃infusion of SCL and Cx43 gene recombinant lentivirus can be successfully transfected in guinea pig DCP bladder, which can restore the number and structure of damaged ICC cells and form ICC dimer structure, improve the pressure of diabetic bladder forced urinary muscle, improve the weakness of urination, ventral pressure voiding and other characteristics. It provides a new direction for the treatment of DCP.

Disorders of sex development (DSD) are a group of rare complex clinical syndromes with multiple etiologies. Distinguishing the various causes of DSD is quite difficult in clinical practice, even for senior general physicians because of the similar and atypical clinical manifestations of these conditions. In addition, DSD are difficult to diagnose because most primary doctors receive insufficient training for DSD. Delayed diagnoses and misdiagnoses are common for patients with DSD and lead to poor treatment and prognoses. On the basis of the principles and algorithms of dynamic uncertain causality graph (DUCG), a diagnosis model for DSD was jointly constructed by experts on DSD and engineers of artificial intelligence. "Chaining" inference algorithm and weighted logic operation mechanism were applied to guarantee the accuracy and efficiency of diagnostic reasoning under incomplete situations and uncertain information. Verification was performed using 153 selected clinical cases involving nine common DSD-related diseases and three causes other than DSD as the differential diagnosis. The model had an accuracy of 94.1%, which was significantly higher than that of interns and third-year residents. In conclusion, the DUCG model has broad application prospects as a computer-aided diagnostic tool for DSD-related diseases.

To determine the effect of a recombinant lentivirus containing human stem cell leukemia (SCL) gene on the expression of c-kit protein in damaged interstitial cells of Cajal (ICC) under high glucose condition.
 Methods: After isolation of ICC, the cells were cultured for 24 hours until the cells were adherent. After identification by inverted microscope and immunofluorescence, ICC cells were divided into two groups: A control group and a high glucose group. The control group was added with a medium containing 5 mmol/L of glucose. The high glucose group was added with a medium containing 20 mmol/L of glucose. After 48 h of continuous cultivation, the high glucose group was divided into 3 subgroups: A blank group, an empty lentivirus group, and an experimental group. The blank group, the empty lentivirus group, and the experimental group were added a medium containing PBS solution, empty lentivirus, and a recombinant lentivirus containing the SCL gene with a glucose concentration of 5 mmol/L, respectively. The cultures were incubated for 24 and 48 h. The expression of c-kit protein in ICC in each group was detected by Western blot.
 Results: After 24 or 48 h, the expression of c-kit protein in ICC was significantly lower in the blank group and the lentivirus group than that in the control group, and the expression of c-kit protein in ICC was significantly higher in the experimental group than that in the blank group and the empty lentivirus group, but it was still lower than that in the control group (all P<0.05).
 Conclusion: The recombinant lentivirus of SCL gene can up-regulate the expression of c-kit protein in functionally impaired ICC under high glucose condition.
Glucose ; Humans ; Interstitial Cells of Cajal ; Lentivirus ; Leukemia, Myeloid, Acute ; Proto-Oncogene Proteins c-kit

Objective To observe the effects of green fluorescence protein mediated by lentivirus in bladder, and to de?termine the amount of virus obtained good transfection effects. Methods lentivirus carring GFP gene was perfused using transurethral approach into bladder of guinea pigs. Samples of bladder, liver, kidney and lungs were collected for frozen sec?tions after feeding seven days. The distribution of green fluorescence was observed using laser confocal microscopy. Re?sults The titer of lentivirus was 4 × 108. GFP was found under the mucosa when the amount of lentivirus transurethral was 30μL. GFP was distributed widely in muscle layer using 40μL lentivirus. GFP was detected even stronger in muscle layer when the amount was 50μL. GFP was found in muscle layer when 25μL lentivirus was injected intravenously. GFP was not found in other tissues than in bladder via transurethral perfusion. There was higher GFP in liver, lungs and other organs than in bladder via intravenous injection. Conclusion Lentivirus can mediate GFP transfecting bladder of guinea pig successful?ly and escape the distribution of GFP all over the body intravenously, which will bring new research direction and method for clinical treatment of diseases in bladder.