Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for the treatment of muscle invasive bladder cancer and complex non-muscle invasive bladder cancer.Our department has routinely carried out laparoscopic radical cystectomy(ELRC)through the extraperitoneal approach in 340 cases.This article summarizes the establishment of the peritoneal space,the expansion of the peritoneal space,the operation steps of bladder resection and lymph node dissection through the peritoneal channel,and how to shorten the operation time and reduce the difficulty of the operation.During the surgery,the bladder is removed periperitoneally without destroying the peritoneum to preserve the functions of peritoneum support,secretion,protection and lubrication,which has little impact on the abdominal organs,reduces the incidence of complications,and provides favorable conditions for subsequent treatment.

Objective:To summarize the best evidence of prevention strategies for non-ventilator associated hospital-acquired pneumonia (NV-HAP) .Methods:The literature on the prevention and control of NV-HAP was searched on UpToDate, BMJ Best Practice, Agency for Healthcare Research and Quality, Guidelines International Network, Medlive, PubMed, Web of Science, Cochrane Library, WanFang Data, China Biology Medicine disc, and other databases and websites. The search period was from November 1, 2013, to November 1, 2023. Two researchers conducted a literature quality evaluation and extracted evidence.Results:A total of ten articles were included, including six guidelines, two systematic reviews, and two randomized controlled trials. Twenty-six pieces of evidence were summarized from seven aspects of oral hygiene, prevention of aspiration, nutrition and activity, airway management, hand hygiene, cleaning, disinfection and isolation, and antibiotic management.Conclusions:The best evidence of NV-HAP prevention strategies summarized provides a reference for medical and nursing staff to prevent and control NV-HAP.

Objective:To investigate the related factors of pleasure loss in patients with human immunodefi-ciency virus(HIV)/acquired immune deficiency syndrome(AIDS).Methods:Totally 237 patients with HIV/AIDS from a certain infectious disease hospital were selected and surveyed with a self-designed general information ques-tionnaire,the Temporal Pleasure Experience Scale(TEPS),Self Acceptance Scale(SAQ),Discrimination Percep-tion Scale(SIS),and Perceived Social Support Scale(PSSS).Results:The patient's TEPS score was(73.4±16.1).Stepwise linear regression analysis showed that the PSSS total scores,education level,and personal monthly income were positively correlated with the TEPS total scores(β=0.41,5.17,4.63),and age was negatively corre-lated with the TEPS total scores(β=-0.30).Conclusion:It suggests that more attention should be paid to the lack of pleasure in patients with HIV/AIDS,and the lack of pleasure is related to personal monthly income,educa-tion level,age and perceived social support.

Objective:To study the early use of inhaled nitric oxide (iNO) as a rescue therapy in extremely premature infants (EPIs) with refractory hypoxic respiratory failure (HRF).Methods:Between January 2021 and December 2021, EPIs with refractory HRF receiving iNO within the first week of life in our NICU were enrolled. Their clinical characteristics and outcomes were retrospectively analyzed.Results:A total of 11 EPIs were included with 5 males and 6 females. The median gestational age (GA) was 24(22.6, 25.2) weeks. The median birth weight (BW) was 580(490, 770) g. The most common primary diagnoses were moderate/severe respiratory distress syndrome (RDS) (5/11) and early-onset sepsis (3/11). The median age starting iNO therapy was 6.5(4.5, 34.0)h and the median duration of iNO was 24(12, 36)h. The median iNO starting dose was 5(5, 8) ppm and the therapeutic range was 5-20 ppm. Therapeutic efficacy was defined as ≥30% FiO 2 reduction after 6 h of iNO treatment. The treatment was effective in 8 cases. The oxygenation index (OI) decreased more than 10% from baseline 1 h after initiation in 9 patients and in all 11 patients after 12 h of iNO. The reduction of OI was more prominent in EPIs with a higher OI at baseline. Of the 11 patients, 8 survived, 1 died and 2 abandoned further treatments. Conclusions:As an early rescue therapy for EPIs with refractory HRF, iNO can improve oxygenation without obvious short-term adverse effects.

【Objective】 To explore the safety and efficacy of a modified one-piece posterior laparoscopic total nephroureterectomy with cystic sleeve resection in the treatment of upper urinary tract uroepithelial carcinoma (UTUC). 【Methods】 A total of 24 patients treated during Jan. and Jun. 2022 were involved, including 16 males and 8 females, aged 62 to 90 (average 73) years. The UTUC was in the left side in 15 cases, and in the right side in 9 cases. There were 10 cases of renal pelvis tumor, 6 cases of upper ureteral tumor and 8 cases of lower ureteral tumor. 【Results】 All operations were successful without conversion to open surgery. The operation time ranged from 60 to 100 minutes, average (71.25±9.80) minutes. The intraoperative bleeding volume was 20 to 200 mL, average (30.03±8.13) mL. No significant intraoperative or postoperative complications occurred. The postoperative hospital stay was 4 to 7 days, average (5.83±1.44) days. Bladder perfusion chemotherapy was performed after surgery. 【Conclusion】 The modified one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection for UTUC is an effective and feasible procedure with satisfactory tumor control, which is worth further promotion in clinical practice.

【Objective】 To investigate the efficacy and safety of single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy in the treatment of upper tract urothelial carcinoma (UTUC). 【Methods】 Clinical data of 31 UTUC cases treated in our hospital during Nov.2018 and Jun.2022 were retrospectively analyzed, including 11 tumors in the right side, and 20 in left side. There were 14 cases of renal pelvic carcinoma, 16 cases of ureter carcinoma, and 1 case of renal pelvic carcinoma plus ureter carcinoma. 【Results】 All surgeries were successfully performed without conversion to open surgery. The mean operation time was (81.45±19.80) min, and the estimated blood loss was (69.03±24.13) mL. No serious perioperative complications were observed. The average postoperative hospital stay was (6.13±2.44) d, and the median follow-up was 28 (3.0-49.0) months. At the last follow-up, 2 patients died, 3 had recurrence, but no contralateral recurrence was observed. 【Conclusion】 Single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy is safe, effective and feasible in the treatment of UTUC. It is worth clinical popularization.

【Objective】 To explore the correlation between CSAG1 expression and the prognosis and tumor-infiltrating lymphocytes in renal clear cell carcinoma (RCCC), and to predict the survival and tumor progression. 【Methods】 The gene expression profiles and clinical information of CSAG1 were downloaded from the Cancer Genome Atlas (TCGA). Based on the differential mRNA expression, GO annotation and KEGG pathway analysis were performed. The relationship between CSAG1 and tumor immune infiltration was assessed with Tumor Immunoassay Resource (Timer 2.0) database. The mRNA expression of CSAG1 in human RCCC specimens was validated with qRT-PCR. 【Results】 CSAG1 expression was significantly higher in RCCC tissues than in normal tissues (P<0.05). The qRT-PCR results revealed that the mRNA level of CSAG1 was consistent with that predicted by bioinformatic analysis. The KEGG analysis and GO annotation indicated high GSAG1 expression in RCCC was related to transmembrane transport, tricarboxylic acid cycle and lysosome. CSAG1 expression was positively related to the infiltration of pDC, aDC, CD8⁺ T cells, cytotoxic cells, TFH, TH1 cells, Tem, NK CD56^dm cells, Treg and T cells, but negatively correlated with macrophage infiltration. 【Conclusion】 CSAG1 may be associated with poor prognosis of RCCC and become a potential immunotherapy target.

Objective    To study the feasibility and safety of CT-guided preoperative Hookwire localization of pulmonary nodules in clinical application. Methods    Clinical data of 102 patients who were scheduled to undergo surgical treatment for pulmonary nodules from June 2015 to April 2020 in the North Ward of Thoracic Surgery Department of Ruijin Hospital were retrospectively analyzed. There were 38 males and 64 females, aged 23-82 (53.2±12.8) years. Results    All 102 patients with pulmonary nodules underwent CT-guided preoperative Hookwire localization successfully, with a localization success rate of 100.0%. The localization time was 27.0 (11-67) min; the number of times to adjust the angle during the positioning process was 6.9 (3-14); the needle depth of the positioning needle was 41.5 (16.3-69.1) mm. A total of 48 (47.1%) patients had a small amount of bleeding in the lung tissue in the positioning area after positioning; 53 (51.9%) patients had a small amount of pneumothorax after positioning; 16 (15.7%) patients were found that the positioning needle completely shedded from the lung tissue in the subsequent surgery. One patient was transferred to open thoracotomy because of extensive dense adhesion in the thorax, and the remaining 101 patients were operated on under thoracoscopy. Postoperative pathology showed that 5 (4.9%) patients were adenocarcinoma in situ, 28 (27.5%) were microinvasive adenocarcinoma, 36 (35.3%) patients were invasive carcinoma and 32 (31.3%) patients were benign lesions. No patients had complications or adverse events related to preoperative positioning. Conclusion    Pre-operative CT-guided localization of Hookwire intrapulmonary nodules is safe and effective, and can meet the intraoperative localization needs of thoracic surgeons in most clinical situations, and is not inferior to other preoperative localization methods currently used in clinics.

Primary acinic cell carcinoma (ACC) of the lung is extremely rare. The World Health Organization tumor classification defines ACC as "a malignant epithelial neoplasm that demonstrates some cytological differentiation towards (serous) acinar cells". It is considered to be a low-grade malignant tumor. Since the first case described by Fechner in 1972, less than 30 cases have been reported in the literature. The rarity of this tumor may leads it to be confused with other primary lung tumors and incorrectly diagnosed. We reported a female patient with primary ACC of the lung with mediastinum deviation at age of 27 years received a right pneumonectomy. She was followed up for 12 months postoperatively and remains well.

Objective:To examine the characteristics and trends regarding the 30-day coronary heart disease (CHD) readmission rates in patients discharged for acute myocardial infarction (AMI) in Beijing, during 2007-2012.Methods:Patients hospitalized for AMI in Beijing from 1 January 2007 to 31 December 2012 were identified from "The Cardiovascular Disease Surveillance System in Beijing". In total, 64 355 patients aged 25 years and over with permanent Beijing residency survived and discharged for AMI in Beijing during the above-said six years. After excluding duplicate and validation for the completeness and accuracy of the records, clinical features and 30-day CHD readmission rates for those AMI discharged patients were analyzed. Trends regarding the 30-day CHD readmission rates in patients discharged for AMI were analyzed by Poisson regression models.Results:The overall age-standardized average 30-day CHD readmission rate for AMI discharged patients was 7.7 % in patients aged 25 years and over in Beijing. During the six years under study, an increasing trend was observed on the 30-day CHD readmission rates for AMI discharged patients after adjusting the age and gender ( P<0.001). The age-standardized 30-day CHD readmission rates for AMI discharged patients increased by 21.3 % in the past six years, from 7.0 % in 2007 to 8.5 % in 2012. The increase of 30-day CHD readmission rates was noted in both men and women during the six years, whereas it appeared higher in women (8.4 %) than in men (7.4 %), after adjusting for age. Among the AMI discharged patients, the 30-day CHD readmission rates were higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than those with ST-segment elevation myocardial infarction patients ( P<0.01), and higher in discharged patients with multiple comorbidities than those without multiple comorbidities ( P<0.01). Conclusions:An increasing trend in the 30-day CHD readmission rates for AMI discharged patients was observed during 2007-2012 among Beijing residents aged 25 years and over. It called for an urgent need in improving the secondary prevention of AMI discharged patients, particularly in women, with NSTEMI and those with multiple comorbidities. Findings from these unselected "real-world" data in Beijing may help to guide the management of AMI in the country as well as in other developing countries.