Objective To investigate the safety and efficacy of domestic Kangduo endoscopic robotic surgical system(SR1500)in laparoscopic partial nephrectomy via abdominal approach.Methods Perioperative data of 5 patients with renal tumors undergoing transabdominal partial nephrectomy with SR1500 at Miyun Hospital during Jul.and Aug.2023 were prospectively collected.The surgical procedure,operation time,pathological margins,intraoperative bleeding,hospital stay,and catheter removal time were recorded.Results The average tumor diameter was 1.92 cm,staged as T1a in TNM classification,with an average R.E.N.A.L score of 5.80.The mean docking time of equipment was 3.00 min,robotic arm operating time 97.20 min,and renal warm ischemia time 19.80 min.Postoperative pathology revealed negative surgical margins in all patients.No high-grade perioperative complications or device-related adverse events occurred.Conclusion Laparoscopic partial nephrectomy using the Kangduo endoscopic robotic surgical system(SR1500)via abdominal approach is safe and effective in the treatment of T1a renal tumors.

Nephroptosis,a rare condition in urology,often results from inadequate support of the kidney's perinephric fat structures,leading to excessive renal mobility.It typically occurs in lean,tall,young females.Some cases manifest with abdominal pain and renal dysfunction.Open nephropexy,laparoscopic nephropexy and percutaneous nephropexy are all effective methods in the treatment of nephroptosis,among which percutaneous nephropexy is associated with less trauma and lower costs.Modifications to percutaneous nephropexy by the authors'team are also introduced mentioned in this article.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective:To investigate the therapeutic effectiveness and safety of "U shape" en bloc Thulium fiber laser enucleation and resection of the prostate (ThuLERP) technique.Methods:The clinical data of 105 benign prostatic hyperplasia (BPH) patients treated by a single surgeon in Peking University First Hospital from January to October 2022 were retrospectively reviewed. Among them, 50 patients underwent "U-shaped" en bloc technique prostate enucleation (UEBT), and 55 patients underwent prostate lobe removal using the lobe technique (LT). There were no significant differences between UEBT and LT groups ( P>0.05) in term of the age[(69.1±6.9)years old vs.( 68.8±9.1)years old], international prostate symptom score(IPSS)[(22.7±1.9)vs.(22.8±2.7)] and maximum flow rate(Q max ) [(9.0±3.7)ml/s vs.(9.3±4.3)ml/s]. The prostate-specific antigen(PSA) of UEBT group was higher than that of LT group[7.52(3.05, 8.76)ng/ml vs.6.78(1.61, 7.45)ng/ml], and the prostate volume of the UEBT group was larger than that of LT group [(103.49±46.19)ml vs.(75.73±30.69) ml, all P<0.05]. In the UEBT group, the apical of prostate was bluntly enucleated with pre-transection urethral mucosa at the apex of prostate technique. Secondly, glands formed grooves at 12 o'clock after vaporization, which served as anatomical marker. At last, the whole lobe which was like "U shape" were resected using laser. In the LT group, glands was divided to three lobe, the middle, the left and the right lobe was bluntly enucleated respectively. Perioperative data, postoperative complications and clinical outcomes were compared between the two groups. Correlation between enucleation efficiency and enucleation weight was analysed using linear regression. Results:There were no significant differences between the UEBT and LT group ( P>0.05) in term of morcellation time[18(9, 34)min vs.16(8, 28)min], resection rate[(0.5±0.1)g/ml vs.(0.5±0.1)g/ml], catheter indwelling duration[(3.8±1.4)d vs.(3.6±1.1)d] and hospitalization stay[(4.1±0.3)d vs.(3.9±0.8)d].The difference between the UEBT group and LT group in operation time[54(42, 100)min vs.80(60, 150)min], enucleated time[37(26, 75)min vs.47(31, 69)min], hemostasis time[4(3, 6)min vs.9(7, 15)min], enucleation efficiency[(1.8±0.5)g/min vs.(1.1±0.4)g/min] and hemoglobin decline[13(9, 22)g/L vs.17(10, 22)g/L]were statistically significant ( P<0.05). In both groups, postoperative IPSS were (6.6±1.7) and (6.2±1.4) respectively, and Q max were(18.9±3.1)ml/s and (16.8±3.8)ml/s respectively, which were significantly different from that before the operation ( P<0.05). However, there was no significant difference between the two groups ( P>0.05). The enucleation efficiency increased with the increase of prostate volume( r=0.791, 0.880 respectively, P<0.05).After 2 weeks of follow up the postoperative immediate urinary continence rate of UEBT group and LT group were 10.0%(5/50)and 27.3%(15/55), respectively, and the two groups had statistical differences ( P<0.05). But after 3 months of follow up, there was no urinary continence in the two groups, and incidence of postoperative urethral stricture were 2.0%(1/50) and 5.5%(3/55) respectively in UEBT and LT group, whose difference was not significant( P>0.05). Conclusions:ThuLERP can relieve lower urinary tract symptoms in a comparable way with high efficacy and safety. ThuLERP with the "U-shaped" en bloc technique was statistically superior to the lobe technique in operation time, enucleation time, enucleation efficiency, hemoglobin decline and also avoided stress urinary incontinence at early stage after operation.

Objective:To explore the mediating effect of smoking, emotional control, and family relationship on the association between relational bullying victimization and perpetration.Method:A total of 11 462 participants were included in the study. Mediating effect model was used to analyze the mediating effect of smoking, emotional control, and family relationship between relational bullying victimization and perpetration.Results:Family relationship (mediation effect value: 0.119, 95% CI: 0.075-0.165, mediation ratio: 8.5%) and smoking (mediation effect value: 0.061, 95% CI: 0.031-0.105, mediation ratio: 4.4%) constitute a separate mediating effect. Family relationship, emotional control, and smoking constitute a chain mediation effect (mediation effect value: 0.007, 95% CI: 0.003-0.013, mediation ratio: 0.5%); family relationship and smoking constitute a chain mediation effect (mediation effect value: 0.036, 95% CI: 0.020-0.056, mediation ratio: 2.6%); emotional control and smoking constitute a chain mediating effect (mediation effect value: 0.007, 95% CI: 0.003-0.013, mediation ratio: 0.5%). Conclusion:Smoking, emotional control, and family relationship partially mediate relational bullying victimization and perpetration.

This study applied both qualitative and quantitative research methods to describe Norwegian health care reform, covering such performance indicators as key reform process, healthcare reform trends in number of beds per thousand, health care resource utilization, hospital management system, general practitioners, and public health management system. Moreover, the paper put forward suggestions for the reform in China, namely health governance mechanism, the transformation from scale expansion to quality and performance-based development, reforming family physician system.

Objective To investigate the related factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy in the treatment of upper urinary tract stones.Methods The clinical data of 101 patients after percutaneous nephrolithotomy from August 2016 to April 2018 in Miyun Teaching Hospital,Capital Medical University were retrospectively analysed.Screened the independent variable such as gender,with fever or not,with diabetes or not,with hydronephrosis or not,urine leucocyte count,volume of urinary calculi,CT attenuation value of urinary calculi and presence of intraoperative infection,and analyzed the relationship those with systemic inflammatory response syndrome after surgery.Univariate and multivariate logistic regression analysis the factors related to systemic inflammatory response in patients after surgery.Results Of the 101 patients,62 cases was male,and 39 cases was female,12 (11.9％) suffered postoperative systemic inflammatory response syndrome.Univariate regression analysis indicated that the risk factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy were gender,with diabetes or not,urine leucocyte count,volume of urinary calculi and presence of intraoperative infection.Furthermore,multivariate logistic regression analysis revealed that with diabetes,intraoperative infection,urine leucocyte count and volume of urinary calculi were the independent factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy.Conclusion Patients with diabetes,intraoperative infection,urine leucocyte count and volume of urinary calculi could be predicted as the independent factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy,but it has no relationship with gender,with a history of fever or not,with hydronephrosis or not,and CT attenuation value of urinary calculi.

Objective: To evaluate the clinical efficacy of percutaneous nephrolithotomy combined with flexible ureteroscopy and holmium laser lithotripsy in the treatment of complicated renal calculi. Methods: Clinical data of 139 patients with complicated renal calculi from March 2013 to March 2019 in Miyun Teaching Hospital, Capital Medical University were retrospectively analyzed. There were 76 males and 63 females, the average was (47.9±3.1) years, aged from 27 to 75 years. The total patients were divided into control group (n=69) and treatment group (n=70) according to different treatment method. The patients in the control group treated with percutaneous nephrolithotorny, the patients in the treatment group were treated with flexible ureteroscopy and holmium laser lithotripsy on the bassis of the control group. Compared the operation time, hospital stays, intraoperative blood loss, effective rate and complication incidence rate between two groups. Measurement data were expressed as mean± standard deviation (Mean±SD), and t-test was used for comparison between groups; count data was compared by Chi-square test. Results: In the control group, the operation time, length of hospital stay and intraoperative blood loss were (65.85±3.83) min and (8.83±4.00) d, (130.72±1.20) ml, respectively, the treatment group were (43.44±3.16) min, (5.72±1.07) d, (96.21±0.98) ml, respectively, the difference between group there was statistical significance (P<0.05); the total effective rate of the control group was 84.0% (58/69), which was significantly lower than that of the treatment group [95.7% (67/70)], and the difference between the groups was statistically significant (P<0.05). The incidence of postoperative complications of the treatment group[2.8% (2/70)] was significantly lower than the control group[14.5% (10/69)], and the difference between the two groups was statistically significant (P<0.05). Conclusion The complicated renal calculi by percutaneous nephrolithotomy combined with flexible ureteroscopy and holmium laser lithotripsy has the advantage of short operation time, less blood loss, faster recovery and low complication incidence rates, has clinical use and promotion value.

This paper summarized health care delivery system in remote areas of Japan including criteria for underserved areas, regular adjustment to the list, comprehensive national plans, integrated provision system, governmental responsibilities, establishment of Jichi Medical University, participation of social organizations.We raise such suggestions as leading role of the government, precision listing underserved areas,implementing special plan, financing and payment policy, human resources for health, and regional co-ordination of medical resource.

Based on an analysis of the compensation policy and its problems of the primary medical and health institutions, this paper put forward the corresponding reform framework in Zhejiang province. It proposed to change the compensation policy of " predefining revenue and expenditure, subsidizing its gap after performance appraisal" into " a mixed system of special subsidy and pay for performance". Related policies were also described including governmental functions, special subsidies for input-based payments, classified payments for output services, precautions against financial risks, etc. This paper also suggested that we focus on dealing with the six pairs of balance, such as that between subsidy for the supply and demand sides, and that between internal market and external market.