Genetic diversity of Ichthyophthirius multifiliis (Fouquet, 1876) infecting farmed rainbow trout (Oncorhynchus mykiss Walbaum, 1792) in Turkey.

We assessed genetic diversities among Ichthyophthirius multifiliis (Ich) field isolates collected from farmed rainbow trout (Oncorhynchus mykiss) in Turkey. The overall prevalence of Ich was 35.3% (634/1798). Five novel Ich genotypes (ImulTR1 and ImulTR3-ImulTR6) were described based on mitochondrial cox-1 and nad1_b genes. The remaining genotype ImulTR2 was identical to the previously reported NY3 (or Ark9 and TW7) genotype from the United States and South Asia. Phylogenetic analysis indicated Turkish Ich isolates separated genetically into at least four distinct groups. Our study presents the first data on the genotypes of Ich in Turkey. We also provide evidence for the wide distribution of the NY3 genotype (or Ark9 and TW7) from the United States and South Asia to Turkey. Genetic diversities within the mitochondrial genes provided adequate resolution for describing novel genotypes and identifying the known genotype within Turkish Ich isolates. Description of the Ich genotypes allows for tracking of pathogen genotypes worldwide. Thus, we can better understand the connections between Ich outbreaks in the fisheries aquaculture.

Comparison of trauma scores and total prehospital time in the prediction of clinical course in a plane crash: Does timing matter?

OBJECTIVE: To investigate how the total prehospital time (TPT), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), and Trauma Score-Injury Severity Score (TRISS) affect the outcome of plane crash victims from anatomical, physiological and psychological perspectives. The accuracy or strength of these scores and TPT in predicting hospitalization and surgery, sequelae development and psychiatric complications [permanent temporary disability (PoTDs)] and PTSD can allow medical professionals to direct and prioritize management efforts of the victims of mass casualties in general. METHODS: The study was designed as a single-center retrospective study. By examining the records of victims of a plane crash transferred to the ED, AIS, ISS, TRISS and TPT were calculated on admission. The clinical severity of the patients was determined by a joint decision of five clinicians. The performances of the trauma scores on hospitalization, surgery, PTSD and PoTDs were compared. The study data were analyzed via the Mann-Whitney U test and descriptive statistical methods. Pearson's chi-square test was used for the comparison of qualitative data, and ROC analyses were employed to determine cutoff levels. RESULTS: The AIS, ISS, and TRISS scores of the victims with an indication for hospitalization, calculated on admission to the ED, were significantly higher than those of the other victims (p = 0.001). In addition, TPT, AIS, ISS, and TRISS scores were significantly higher in hospitalized patients than in outpatients (p < 0.05). The cutoff levels for AIS and ISS were ≥ 1.50 and ≥ 4.50, respectively, while they were ≥ 123.5 min for TPT with regard to hospitalization decisions. The AIS, ISS, and TRISS scores calculated on admission for the patients who underwent surgery were significantly higher than those who did not (p = 0.001). Cutoff levels for AIS and ISS were ≥ 2.50 and ≥ 11.50, respectively, while they were ≥ 135.5 min for TPT with respect to the decision to operate on the victims. CONCLUSIONS: It is expected that everyone who practices medicine be equipped to handle multiple casualties. As the number of people involved in mass casualties increases, diagnostic tools, workups such as laboratory and radiological studies, and prognostic markers such as trauma scores should be simpler and more user-friendly.

Green synthesis of allicin based hybrid nanoflowers with evaluation of their catalytic and antimicrobial activities.

OBJECTIVE: Although organic-inorganic hybrid nanoflowers (hNFs) with much enhanced catalytic activity and stability were fabricated using proteins and enzymes, in this study, for the first time, we report synthesis of allicin and copper ion (Cu2+) coordinated NFs and investigate their peroxidase-like and antimicrobial activities. RESULTS: The allicin (active ingredient of Allium sativum) and Cu2+ was acted as an organic and inorganic part, respectively for synthesis of the Cu-hNFs. The hNFs were characterized by various techniques. Spherical, uniform, mono-dispersed and flower-like-shaped morphology of the hNFs (synthesized at pH 5) were imaged by scanning electron microscopy. The presence of Cu metal in the hNFs was detected by energy dispersive X-ray spectroscopy. Characteristic bonds stretching and bending for structural analysis of the hNFs were carried out by Fourier transform infrared spectrometry. In terms of applications, the hNFs showed quite effective peroxidase-like activity towards to guaiacol (used as a model substrate) in the presence of hydrogen peroxide (H2O2) through Fenton reaction. We demonstrated that the NFs exhibited ~ 200% and ~ 500% higher catalytic activities in 1 h (hr) and 3 h (hrs) than their initial catalytic activity measured in 5 minute (min). Additionally, effective antibacterial properties of the Cu-hNFs were observed against fish pathogen bacteria (Aeromonas hydrophila, Vibrio parahaemolyticus, and Lactococcus garvieae). CONCLUSIONS: We finally demonsrated that allicin based hybrid nanomaterial can be prepared by a relatively cheap, one step, easy and eco-friendly method. The allicin hNFs can be considered as novel Fenton agent for peroxidase like activity and bactericidal.

Occurrence and molecular characterization of Clinostomum complanatum (Trematoda: Clinostomidae) in freshwater fishes caught from Turkey.

The metacercariae of Clinostomum species which known as yellow grubs have zoonotic potential by infecting humans. In the present study, a total of 403 freshwater fish specimens belonging to different genera from Central Anatolia Region of Turkey were examined for yellow grub metacercariae infections. Only three specimens belonging to Squalius cephalus were found to be infected with metacercariae with a prevalence on this host species of 2.4% and an overall prevalence of 0.7%. All the metacercariae were morphologically identified as Clinostomum complanatum. Partial fragments of mitochondrial cytochrome oxidase I (mt-COI) gene and internal transcribed spacer 2 (ITS-2) were amplified for sequence and phylogenetic analyses. The sequence analyses of ITS-2 and mt-COI revealed three and nine polymorphic sites leading to detection of four and five haplotypes within the related gene regions, respectively. Moreover, the intraspecific genetic distances for C. complanatum isolates ranged from 0.0 to 0.7% for ITS-2 and 0.0 to 1.4% for mt-COI data sets. Consequently, the present study has provided first combined morphologic and molecular data on C. complanatum infecting Turkish freshwater fishes.

Potential neuroprotective effect of Anakinra in spinal cord injury in an in vivo experimental animal model.

OBJECTIVE: To evaluate the therapeutic effects of inhibiting interleukin-1 beta (IL-1 beta) in vivo using Anakinra in an experimental model of spinal cord injury (SCI). METHODS: All experimental procedures were performed in the animal laboratory of Ankara Education and Research Hospital, Ankara, Turkey between August 2012 and May 2014. The SCI was induced by applying vascular clips to the dura via a 4-level T5-T8 laminectomy. Fifty-four rats were randomized into the following groups: controls (n = 18), SCI + saline (n = 18), and SCI + Anakinra (n = 18). Spinal cord samples were obtained from animals in both SCI groups at one, 6, and 24 hours after surgery (n = 6 for each time point). Spinal cord tissue and serum were extracted, and the levels of IL-1 beta, malondialdehyde, glutathione peroxidase, superoxide dismutase, and catalase were analyzed. Furthermore, histopathological evaluation of the tissues was performed. RESULTS: The SCI in rats caused severe injury characterized by edema, neutrophil infiltration, and cytokine production followed by recruitment of other inflammatory cells, lipid peroxidation, and increased oxidative stress. After SCI, tissue and serum IL-1 beta levels were significantly increased, but were significantly decreased by Anakinra administration. Following trauma, glutathione peroxidase, superoxide dismutase, and catalase levels were decreased; however, Anakinra increased the activity of these antioxidant enzymes. Malondialdehyde levels were increased after trauma, but were unaffected by Anakinra. Histopathological analysis showed that Anakinra effectively protected the spinal cord tissue from injury. CONCLUSION: Treatment with Anakinra reduces inflammation and other tissue injury events associated with SCI.

The comparative effects of recombinant human erythropoietin and darbepoetin-alpha on cerebral vasospasm following experimental subarachnoid hemorrhage in the rabbit.

BACKGROUND: Darbepoetin alpha is a hypersialylated analogue of erythropoietin effective for activating erythropoietin-receptors. This study investigated the vasodilator and neuroprotective effects of darbepoetin alpha on an experimental subarachnoid hemorrhage model and compared it with erythropoietin. METHODS: Forty adult male New Zealand white rabbits were randomly divided into four groups of ten rabbits each: group 1 (control), group 2 (subarachnoid hemorrhage), group 3 (erythropoietin), and group 4 (darbepoetin alpha). Recombinant human erythropoietin was administered at a dose of 1,000 U/kg intraperitoneally after the induction of subarachnoid hemorrhage and continued every 8 h up to 72 h. Darbepoetin alpha was administered at a single intraperitoneal dose of 30 µg/kg. Animals were killed 72 h after subarachnoid hemorrhage. Basilar artery cross-sectional areas, arterial wall thicknesses, hippocampal degeneration scores and biochemical analyses were measured in all groups. RESULTS: Both erythropoietin and darbepoetin alpha treatments were found to attenuate cerebral vasospasm and provide neuroprotection after subarachnoid hemorrhage in rabbits. Darbepoetin alpha revealed better morphometric and histopathological results than erythropoietin among experimental subarachnoid hemorrhage-induced vasospasm. CONCLUSIONS: Our findings, for the first time, showed that darbepoetin alpha can prevent vasospasm and provides neuroprotection following experimental subarachnoid hemorrhage. Moreover, darbepoetin alpha showed better results when compared with erythropoietin.

Viburnum opulus: could it be a new alternative, such as lemon juice, to pharmacological therapy in hypocitraturic stone patients?

OBJECTIVE: Citrate, potassium, and calcium levels in Viburnum opulus (V. opulus) and lemon juice were compared to evaluate the usability of V. opulus in mild to moderate level hypocitraturic stone disease. MATERIALS AND METHODS: V. opulus and lemon fruits were squeezed in a blender and 10 samples of each of 100 ml were prepared. Citrate, calcium, sodium, potassium, magnesium, and pH levels in these samples were examined. RESULTS: Potassium was found to be statistically significantly higher in V. opulus than that in lemon juice (p = 0.006) whereas sodium (p = 0.004) and calcium (p = 0.008) were found to be lower. There was no difference between them in terms of the amount of magnesium and citrate. CONCUSIONS: Because V. opulus contains citrate as high as lemon juice does and it is a potassium-rich and calciumand sodium-poor fluid, it can be an alternative to pharmaceutical treatment in mild-to-moderate degree hypocitraturic stone patients. These findings should be supported with clinical studies.

Massive lower gastrointestinal bleeding from a jejunal Dieulafoy lesion.

Dieulafoy lesion should be considered in massive gastrointestinal bleeding that may be difficult to localize. If the endoscopic and angiographic approaches fail, surgery must be considered according to the patient's clinical condition within an appropriate time. Although mostly seen in the stomach of old male patients with co-morbidities, here we presented a Dieulafoy lesion in the jejunum of a 21-year-old female patient without any significant comorbidity. After endoscopic and angiographic attempts, surgical resection with the help of intraoperative endoscopy was performed. It was shown that perioperative endoscopy may reveal the localization of jejunal bleedings and may guide the definitive treatment.

Neuroprotective Effects of Coenzyme Q10 and Ozone Therapy on Experimental Traumatic Spinal Cord Injuries in Rats.

OBJECTIVE: This study investigates the neuroprotective effects and functional recovery potential of Coenzyme Q10 (CoQ10) and ozone therapy in spinal cord injury (SCI). MATERIAL AND METHODS: In this study, 40 female Sprague-Dawley rats were divided into 5 groups of 8. Surgical procedures induced spinal cord trauma in all groups, except the control group. The ozone group received 0.7 mg/kg rectal ozone daily for 7 days, starting 1 hour postspinal cord trauma. The CoQ10 group was administered 120 mg/kg CoQ10 orally once daily for 7 days, beginning 24 hours prior to trauma. The CoQ10 + ozone group received both treatments. Examinations included a modified Tarlov scale and inclined plane test on days 1, 3, 5, and 7. Malondialdehyde (MDA) analysis was conducted on serum samples, and assessments of caspase-3, Bcl-2, and Bax levels were performed on tissue samples. Additionally, a comprehensive examination analyzed histopathological and ultrastructural changes. RESULTS: After SCI, there was a statistically significant increase in serum MDA, tissue caspase-3, and Bax levels (MDA P < 0.001, caspase-3 P < 0.001, Bax P = 0.003). In the CoQ10 + ozone group, serum MDA (P = 0.002), tissue caspase-3 (P = 0.001), and Bax (P = 0.030) levels were significantly lower compared to the trauma group. Tissue Bcl-2 levels were also significantly higher (P = 0.019). The combined treatment group demonstrated improved histopathological, ultrastructural, and neurological outcomes. CONCLUSIONS: This study shows that CoQ10 + ozone therapy in traumatic SCI demonstrates neuroprotective effects via antioxidant and antiapoptotic mechanisms. The positive effects on functional recovery are supported by data from biochemical, histopathological, ultrastructural, and neurological examinations.

The Diagnostic Value of Soluble Triggering Receptor Expressed on Myeloid Cells for Patients with Acute Stone Pyelonephritis.

Soluble triggering receptor expressed on myeloid cells (sTREM-1) is a new biomarker that can be used for the diagnosis and monitoring of urinary system infections. This study aimed to evaluate the diagnostic performance of serum sTREM-1 in patients with a diagnosis of acute stone pyelonephritis (ASP). This prospective study included 46 patients with a diagnosis of ASP and a control group of 23 individuals without urinary system infection. Blood samples were taken from participants upon hospital admission, and basal serum sTREM-1 levels were analyzed using the ELISA method. Serum sTREM-1 concentrations were measured after treatment of ASP patients. Basal leukocyte counts, C-reactive protein (CRP) levels, procalcitonin (PCT), and sTREM-1 (98.6 vs. 68.4 pg/mL, p < 0.001) levels were higher in the ASP group compared to the control group. After treatment, the median leukocyte counts, PCT, and sTREM-1 levels decreased and were similar to those of the control group. The median CRP level also decreased after treatment, but it remained higher than that of the control group. In predicting patients with ASP, the baseline sTREM-1 exhibited a sensitivity of 74.6% and a specificity of 78.2%, while its diagnostic performance was lower than that of leukocyte counts, CRP, and PCT. Despite the findings that levels of sTREM-1 were higher upon hospital admission in patients with ASP and significantly decreased after treatment, the utility of sTREM-1 as a biomarker for predicting patients with ASP remains constrained when compared to established inflammatory markers.

The protective effect of 2-mercaptoethane sulfonate (MESNA) against traumatic brain injury in rats.

BACKGROUND: The agent, 2-mercaptoethane sulfonate (MESNA), is a synthetic small molecule, widely used as a systemic protective agent against chemotherapy toxicity, but is primarily used to reduce hemorrhagic cystitis induced by cyclophosphamide. Because MESNA has potential antioxidant and cytoprotective effects, so we hypothesized that MESNA may protect the brain against traumatic injury. METHOD: Thirty-two rats were randomized into four groups of eight animals each; Group 1 (sham), Group 2 (trauma), Group 3 (150 mg/kg MESNA), Group 4 (30 mg/kg methylprednisolone). Only skin incision was performed in the sham group. In all the other groups, the traumatic brain injury model was created by an object weighing 450 g falling freely from a height of 70 cm through a copper tube on to the metal disc over the skull. The drugs were administered immediately after the injury. The animals were killed 24 h later. Brain tissues were extracted for analysis, where levels of tissue malondialdehyde, caspase-3, glutathione peroxidase, superoxide dismutase, nitric oxide, nitric oxide synthetase and xanthine oxidase were analyzed. Also, histopathological evaluation of the tissues was performed. RESULTS: After head trauma, tissue malondialdehyde levels increased; these levels were significantly decreased by MESNA administration. Caspase-3 levels were increased after trauma, but no effect of MESNA was determined in caspase-3 activity. Following trauma, both glutathione peroxidase and superoxide dismutase levels were decreased; MESNA increased the activity of both these antioxidant enzymes. Also, after trauma, nitric oxide, nitric oxide synthetase and xanthine oxidase levels were increased; administration of MESNA significantly decreased the levels of nitric oxide, nitric oxide synthetase and xanthine oxidase, promising an antioxidant activity. Histopathological analysis showed that MESNA protected the brain tissues well from injury. CONCLUSIONS: Although further studies considering different dose regimens and time intervals are required, MESNA was shown to be at least as effective as methylprednisolone in the traumatic brain injury model.

The surgical outcome of traumatic extra-axial hematomas causing brain herniation in children.

AIM: The aim of this study was to assess the surgical outcome and prognostic importance of clinical and radiological data from children operated on under emergency conditions due to an extra-axial hematoma causing brain herniation. METHODS: This retrospective study included 25 children operated on due to herniated traumatic extra-axial hematomas from January 2000 to December 2010. RESULTS: Of those 25 children, 17 (68%) were diagnosed with subdural hematoma (SDH), 7 (28%) with epidural hematoma (EDH) and only 1 patient (4%) suffered from both SDH and EDH. Overall mortality from a herniated extra-axial hematoma was 44%. The mortality rate for herniated SDH patients was 52.9%, and only 1 patient died from a herniated EDH (14.2%). Low Glasgow coma scale scores at admission, high postoperative intracranial pressure (ICP) values, longer intervals from trauma to surgery, longer durations of brain herniation, the presence of intraoperative brain swelling, larger and thicker hematomas and more displacement of the midline structures and obliteration of the basal cisterns were all correlated with mortality and an unfavorable outcome. CONCLUSIONS: Brain herniation is a serious consequence of traumatic extra-axial hematomas in children, and approximately one third of these patients have the potential for a favorable outcome. We recommend postoperative ICP monitoring to predict outcome and early decompressive surgery when possible for promising results.

Solitary dural plasmacytoma mimicking meningioma and invading calvarium.

Solitary plasmacytoma comprises 2%-10% of all plasma cell diseases. Cranial localization of plasmacytoma is quite rare. They may emerge after years without systemic involvement and symptoms. They may be confused with other tumors as they are not remembered primarily in radiological diagnosis. The definite diagnosis is made upon histopathological examination. Surgical resection followed by radiotherapy is the first choice of therapy. Chemotherapy may be administered for secretory tumors. In this paper, we discussed a patient who underwent surgery with the prediagnosis of meningioma and histopathologically diagnosed with plasmacytoma.

Giant intradiploic epidermoid cyst presenting as solitary skull mass with intracranial extension.

Epidermoid cysts are rare benign tumors that constitute 0.3% to 1.8% of all intracranial tumors. They are inclusion tumors that include epidermoid elements and are most commonly located in the cerebellopontine angle cistern and the parasellar region, and their location in the diploic space is very rare. These lesions slowly grow and usually do not involve the intracranial compartment. In this article, a case of giant epidermoid cyst located in the left frontal intradiploic space is presented with clinical, radiologic features and surgical treatment.

Percutaneous nephrolithotomy in patients with incidental encountered purulent urine at initial puncture.

We are reporting the 39 patients' outcomes who underwent percutaneous nephrolithotomy and purulent urine encountered at the initial steps of surgery. Of 873 patients who underwent PCNL, 48 had purulent fluid during the initial puncture. After excluding those at risk for infection, we studied 39 patients' preoperative and postoperative variables-including postoperative day (POD) 1, 3, 5 fevers. In group 1, 21 patients had a nephrostomy tube placed, and PCNL was postponed. In group 2, 18 patients had successful stone removal in the first session. All surgeries were successful, with no septic events during follow-up. No significant differences in preoperative variables were found. 14% and 22% of patients in groups 1 and 2 had infected fluid (p = 0.470). Four patients in group 1 (19%) and seven patients in group 2 (38.9%) had a high fever (≥ 38 C) on POD1 (p = 0.171), and 1 (5%) in group 1 and 3 (17%) in group 2 had high fever on POD 3 (p = 0.22). No patients remained with high fever on POD5. Mild sepsis was diagnosed in 9.5% of group 1 and 16% of group 2 (p = 0.820), and hospitalization time differed significantly (p < 0.001). Stone size and operation time were correlated with postoperative fever, and prolonged hospital stays were associated with positive blood cultures and postponed procedures. PCNL with proper technique and antibiotics can lead to quicker recovery and reduced hospitalization time in selected patients with pus in their pelvicalyceal system.

The Effect of the ABCB1(MDR-1) C3435T Polymorphism in Turkish Patients with Aspirin Resistance in Acute Ischemic Stroke.

Recurrence of thrombotic events during aspirin therapy is known as aspirin resistance (AR). This study aimed to investigate the rate of AR, the factors influencing AR in patients with acute ischemic stroke under regular aspirin use, and the relationship between AR and ABCB1 (MDR-1) C3435T (rs1045642) polymorphism. Throughout this multicenter prospective study, 174 patients with acute ischemic stroke who had been prescribed aspirin for at least one month due to the risk of vascular disease, along with 106 healthy volunteers, were included as part of the study group. The results of our study indicate that AR was detected in 21.3% of the patient group. According to the results of an analysis of the polymorphism of the ABCB1 C3435T in patients with AR compared to those with aspirin sensitivity, patients with AR possessed more heterozygous (CT) and homozygous genotypes (TT) than those with aspirin sensitivity (p = 0.001). Based on multivariate logistic regression analysis of factors affecting AR in acute ischemic stroke patients, hypertension (OR: 5.679; 95% CI: 1.144-28.19; p = 0.034), heterozygous (CT) genotype (OR: 2.557; 95% CI: 1.126-5.807; p = 0.025), increased platelet values (OR: 1.005; 95% CI: 1.001-1.009; p = 0.029), and CRP/albumin values (OR: 1.547; 95% CI: 1.005-2.382; p = 0.047) were found to be associated with a greater risk of AR. The presence of heterozygous (CT) genotype in the ABCB1 C3435T gene region in the Turkish population is associated with an increased risk of AR. When planning aspirin therapy, it is crucial to consider the ABCB1 (MDR-1) C3435T polymorphism.

Effect of SWL on renal hemodynamics: could a change in renal artery contraction-relaxation responses be the cause?

The aim of this study was to reveal the effect of shock wave lithotripsy (SWL) on renal artery contraction-relaxation responses and the relation of this effect with renal hemodynamics. Twenty-four rabbits are divided into six different groups. The first two groups evaluated as the control groups. After isolating the kidneys, we applied phenylephrine (Ph) and acetylcholine (Ach) in the first group and sodium nitroprusside (SNP) and histamine (H) in the second group. In the third, fourth, fifth and sixth groups, 14.5 kV shock wave (SW) was focused on the left kidneys. We adjusted the number of shocks to a total of 500, 1,500, and 3,000 SW, in the third, fourth and fifth groups, respectively. After isolating the kidneys, Ph, Ach was given in groups 3, 4 and 5. In the sixth group, to get the SNP and the H responses, 3,000 shocks modality was utilized. Marked contractile responses were obtained by phenylephrine in the control group. In kidneys that were exposed to 500 shocks SWL procedures, a decrease in contractile responses and hence, in perfusion pressures in different concentrations of phenylephrine was noted. However, a notable change in relaxation responses occurred after 3,000-shock applications. No difference in relaxation responses to nitroprusside, a direct vasodilating agent, was observed in any group, compared to the control group. Another cause of deterioration of renal hemodynamics after SWL can be attributed to the reduction in renal artery contraction-relaxation responses that result in the vascular smooth muscle and endothelial damage.

Quantitative analysis of colonization with real-time PCR to identify the role of Oxalobacter formigenes in calcium oxalate urolithiasis.

The objective of the study was to quantitatively measure the number of Oxalobacter formigenes (O. formigenes) colonizations in the gastrointestinal tract in calcium oxalate-forming patients with real-time polymerase chain reaction (PCR). Calcium oxalate-forming patients (n: 27) were included in the study. Serum calcium, sodium, potassium, urea and creatinine levels, as well as 24 h urine levels of calcium and oxalate were measured. The numbers of O. formigenes colonies in stool samples were detected by real-time PCR. One or two metabolic abnormalities were detected in 15 of 27 patients. The O. formigenes levels in patients with metabolic disturbance were significantly decreased when compared to the patients with no metabolic abnormalities (p: 0.038). The undetectable levels of O. formigenes were encountered in one of five patients with hypercalciuria, in three of four patients with hyperoxaluria and in four of six patients with both hypercalciuria and hyperoxaluria. In nine patients with a history of stone recurrence, O. formigenes colonization was significantly lower than the patients with the first stone attack (p: 0.001). O. formigenes formation ceased or significantly diminished in patients with calcium oxalate stones with a coexistence of both hyperoxaluria and hypercalciuria. The measurement of O. formigenes colonies by real-time PCR seemed to be an inconvenient and expensive method. For this reason, the real-time PCR measurements can be spared for the patients with stone recurrences and with metabolic abnormalities like hypercalciuria and hyperoxaluria. The exact measurement of O. formigenes may also help more accurate programming of O. formigenes-based treatments.