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Objective To evaluate the application effect of the three-dimensions(3D) technology in teaching laparoscopic surgical skills in urology. Methods Eighteen clinical interns who rotated in the urology department of Peking Union Medical College Hospital from July 2023 to March 2024 were randomly divided into a test group and a control group with 9 in each. The test group received laparoscopic operation skill training using 3D reconstruction and 3D printing technology, while the control group received laparoscopic operation skill training using conventional methods. After one month of rotating training, two groups of interns underwent laparoscopic operation skill assessment, and the training outcomes were evaluated using a survey questionnaire. Results The laparoscopic operation skill assessment scores of the test group and the control group were (94.33±2.12) and (88.11±2.39) points, respectively (P＜0.01). In terms of clinical skills, the test group showed a significant improvement in skill of clinical performance. According to the feedback from the survey questionnaire, the test group showed satisfaction from trainees and trainers as compared to the control group. Conclusions The 3D digital technology in laparoscopic operation skill training can significantly improve the outcomes of laparoscopic operation skill of interns. The satisfaction of the teaching mode is high among both trainers and trainees, so it is a potential and effective teaching method for the training of interns in department of urology.

Objective To assess the application effect of Peyton's four-step teaching method in clinical internship training of urology. Methods Ten clinical interns rotated in urology department of Peking Union Medical College Hospital from April 2023 to February 2024 were randomly divided into a study group and a control group with seven in each. The study group used Peyton′s four-step teaching method while the control group used classical method. After one month of rotating training, two groups of interns were evaluated by theoretical test and clinical skill assessments, and a survey by questionnaire was performed to evaluate the effectiveness of the training. Results The theoretical scores of the study group and the control group were 93.60±3.05 vs 91.80±2.39 and the clinical skills assessment scores were 92.00±1.87 vs 86.80±3.27,the difference was statistically significant (P＜0.05). In terms of clinical skills, there was a significant improvement in clinical performance. The results of questionnaire survey showed that the Peyton's teaching group is more comfortable by both trainees and trainers, as compared to that of control group. Conclusions The application of the Peyton's four-step teaching method significantly improves operational skills of the trainees. Both the faculty staff and students are satisfied with the Peyton′s four-step teaching method, which is suitable for clinical application in urology internship training.

Tuberous sclerosis complex(TSC) is a rare autosomal dominant genetic disorder caused by mutations in the TSC1 or TSC2 genes. The disease can cause multiple organ lesions. The most common renal lesions are renal angiomyolipoma(RAML). In recent years, China has made progresss in the understanding of TSC-RAML, so that the standardization of the diagnosis and management of TSC-RAML have improved. Efforts have been taken in the studies of the pathogenesis and treatment of TSC-RAML. This article reviews the diagnosis, therapy, and research development of TSC-RAML in China.

ObjectiveTuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disease involving multiple organ system. Renal angiomyolipoma (RAML) is a leading cause of death for adult TSC patients. Our study aims at investigating the clinical manifestations of TSC-RAML to enable clinicians to have a better understanding of the disease in Chinese patients.MethodsWe reviewed retrospectively the data collected from patients with TSC-RAML in Peking Union Medical College Hospital from January 2014 to January 2023. We also collected information about the age, gender, imageological examination, RAML stage, and comorbidities.ResultsA total of 186 TSC-RAML patients were registered, 65 of whom were males and 121 were females(male-to-female ratio 1∶1.86). The median age of all patients was 31 years old. Totally, 117 cases (62.9%)of RAML were rated stage 6. Twenty-two cases (11.8%) had a history of tumor rupture and bleeding. Research shows statistical differences between high and low grade on RAML rupture bleeding(P=0.0475). Angiofibromas/fibrous cephalic plaque (155/186, 83.3%), subependymal nodules(103/146, 70.5%), lymphangioleiomyomatosis (102/157, 65.0%), hypomelanotic macules (114/186, 61.3%), and shagreen patch (83/186, 44.6%)were the most common clinical manifestations. All patients with lymphangioleiomyomatosis(LAM) were female(P < 0.0001).ConclusionsFemale patients predominated TSC-RAML patients. Most RAML were in stage 6. About 11.8% cases had a history of tumor rupture and hemorrhage. The higher grade meant the higher proportion of tumor rupture and hemorrhage. Dermatological and nervous lesions were the most common comorbidities. All patients with LAM in this study were female.

Tuberous sclerosis complex (TSC) is an autosomal dominant hereditary disease that affects multiple organs and systems throughout the body. TSC-associated kidney disease is the leading cause of death in adult TSC patients. This article retrospectively analyzed the characteristics of one TSC-related renal giant angiomyolipoma(RAML)treated with surgery. The patient, 25 years old, was diagnosed with tuberous sclerosis complex in 2000 due to multiple maculopapular rashes on both cheeks. At a regular follow-up in July 2019, imaging examinations revealed a tumor in the left lower quadrant with a maximum cross-sectional area of 16 cm×7 cm. Genetic testing showed a loss of heterozygosity in the EX18_ 41 of TSC2. After the diagnosis was confirmed, open left partial nephrectomy was performed, during which multiple tumors were found on the kidney surface and the largest one was located on the ventral side with a diameter of approximately 20 cm. After the renal artery was occluded, kidney tumors were completely enucleate. Postoperative pathological confirmed the diagnosis of angiomyolipoma. This case provides a reference for the treatment of TSC-related renal giant hamartoma.

Objective To exploratively analyze the efficacy and safety of combined laparoscopy and cystoscopy in the treatment of bladder diverticula. Methods Clinical data of patients who received bladder diverticulectomy in Peking Union Medical College Hospital from March 2007 to September 2022 were retrospectively collected.The patients were divided into open/laparoscopy alone group and combined laparoscopy and cystoscopy group based on surgical approach.Surgery-related outcomes and complication rates were compared. Results A total of 11 patients with bladder diverticula who met the inclusion and exclusion criteria were enrolled in thestudy, including 6 patients in the open/laparoscopy alone group and 5 patients in the combined laparoscopy and cystoscopy group.The median maximum diameter of diverticula in the open/laparoscopy alone group and combined laparoscopy and cystoscopy group were 7.5(4.5, 11.5) cm and 5.2(5.0, 7.9) cm, respectively, and the median diameter of diverticula neck were 1.1(1.0, 1.6) cm and 1.5(1.1, 1.8) cm, respectively.Operations were successfully performed in both two groups and the patients had normal urination after drawing the catheter.No recurrence of bladder diverticulum at 6 to 60 months of follow-up.The median operative time[150.0(142.5, 180.0) min vs. 160.0(108.8, 300.0) min], blood loss[50.0(35.0, 50.0) mL vs. 50.0(45.0, 62.5) mL]and indwelling time of drainage tube[5.0(3.5, 5.5) d vs. 4.5(4.0, 6.8) d]were similar between the two group.Compared to the open/laparoscopy alone group, the combined laparoscopy and cystoscopy group had a shorter postoperative hospital stay[6.0(6.0, 8.5) d vs. 9.5(7.0, 16.0) d]and longer indwelling time of urinary catheter[14.0(10.5, 14.0) d vs. 11.5(6.5, 13.3) d].No complications occurred in the combined laparoscopy and cystoscopy group.In the open/laparoscopy alone group, 2 patients underwent postoperative complications, including 1 patient with deep vein thrombosis of the lower extremities and 1 patient with hyperpyrexia. Conclusion Preliminary results show that cystoscopy combined with laparoscopic resection for bladder diverticula can achieve similar outcomes as open surgery alone or laparoscopic surgery, and with greater safety and faster postoperative patient recovery.

AbstractSludge flocs encapsulate a significant amount of bound water, resulting in poor dewatering efficiency. To address this issue, the addition of alum (KAl(SO4)2·12H2O) has emerged as an effective strategy for enhancing sludge dewatering performance. This research specifically investigates the effects of various alum dosages on the dewatering characteristics of sludge. The introduction of alum alters internal temperature, pH levels, and intracellular osmotic pressure, which facilitates the release of trapped water within the flocs. Additionally, alum accelerates sludge sedimentation and promotes the agglomeration of smaller particles into larger ones, further improving dewatering efficiency. However, determining the optimal alum dosage for sludge conditioning is essential, as excessive amounts can lead to a decrease in dewatering performance. [ABSTRACT FROM AUTHOR]

Background: Everolimus is an effective treatment for renal angiomyolipoma associated with TSC (TSC-RAML). However, its impact on hematologic parameters in TSC-RAML patients remains unclear. Methods: Hematologic data were collected from TSC-RAML patients undergoing everolimus treatment in two registered clinical trials. Dynamic changes in hematologic parameters during treatment were analyzed. Additionally, we also explored variations in hematologic impact based on gender and age within the patient population. Result: A total of 55 patients from the two clinical trials are included in this analysis. Hemoglobin, white blood cells (WBC), lymphocytes, neutrophils, and platelet showed significant decreases during everolimus treatment (P < 0.05). However, the decline in hemoglobin, WBC, and neutrophils attenuated by the 12th month (P ≥ 0.05). Aspartate transaminase (AST), Alanine transferase (ALT), total cholesterol (TC), and triglyceride (TG) increased significantly during everolimus treatment (P < 0.05), and these increases persisted throughout the year-long treatment. Hemoglobin decreased significantly more in male patients (− 15 vs − 6, P = 0.010), and AST showed a more significant increase in males (7.0 vs 3.0, P = 0.041). Platelet counts decreased significantly more in younger patients (≤ 30 years old) compared to older patients (− 50 vs − 14, P = 0.020). Conclusion: Everolimus administration in TSC-RAML patients may increase hematologic risks, with male and younger patients potentially exhibiting greater susceptibility to these effects. [ABSTRACT FROM AUTHOR]

Enzymatic modification, compared with traditional starch (St) chemical modification methods, avoids using toxic solvents and toxic catalysts. The horseradish peroxidase (HRP), being the most commonly employed natural green initiator, has found extensive application in starch grafting modification as a substitute for chemical initiators. HRP‐catalyzed grafting of starch with vinyl zwitterionic monomers has not been reported. Here, modified starch (St‐PSBMA) is first synthesized by grafting zwitterionic sulfobetaine [2‐(Methacryloyloxy)ethyl]dimethyl‐(3‐sulfopropyl) (SBMA) onto starch by HRP/Acetylacetone(ACAC) binary initiation system catalyzed. The modified starch‐based hydrogel is then prepared by the repeated freeze‐thaw method. Compared with native starch‐based hydrogels, which bind water molecules only through hydrogen bonding, the ability of modified starch‐based hydrogels to bind water molecules is enhanced by ionic solvation. The modified starch hydrogels also have excellent antiprotein adsorption and antibacterial properties due to the presence of a strong hydration layer. The modified starch‐based hydrogel also has excellent sensitivity and stability when used as a sensor for detecting joint motion. The binary HRP initiating system, employed in this study instead of the traditional three‐component HRP initiating system, offers a novel and promising approach for grafting modification of starch without the need for strong oxidant hydrogen peroxide. [ABSTRACT FROM AUTHOR]