Endoscopic combined intrarenal surgery composed of micro-perc and retrograde intrarenal surgery in the treatment of complex kidney stones in children.

OBJECTIVE: This research aims to explore the efficiency and safety of endoscopic combined intrarenal surgery (Micro-ECIRS) composed of micro-percutaneous nephrolithotomy (Micro-perc) and retrograde intrarenal surgery (RIRS) in the Galdakao-modified supine Valdivia (GMSV) position for a single session for the treatment of complex nephrolithiasis in children. MATERIALS AND METHODS: This study retrospectively reviewed patients aged < 18 years who underwent Micro-ECIRS in the GMSV position for renal stones larger than 2 cm under ultrasound guidance between August 2020 to May 2022 at our institution. RESULTS: A total of 13 patients (8 males and 5 females) received Micro-ECIRS for renal stones under ultrasound guidancewhile adopting the GMSV position. The average stone size was 2.7 cm (range: 2.1-3.7 cm). Among them, 6 patients had left kidney stones, 5 patients had right kidney stones, and 2 patients had bilateral kidney stones. The mean operative time was 70.5 min (range: 54-93 min). The mean hospital stay was 6.4 days (range: 4-9 days). The mean hemoglobin decrease was 8.2 g/L (range: 5.1-12.4 g/L). The total number of kidneys that had complete stone clearance was 8 kidneys at 48 h postoperatively, 11 kidneys at 2 weeks postoperatively, and 14 kidneys at 1 month postoperatively. CONCLUSION: Our results demonstrate that Micro-ECIRS while patients are in the GMSV position is a safe and effective method for the treatment of complex children nephrolithiasis. However, all children made three hospital visits and received anesthesia three times. Further research is needed to confirm these findings.

Clonorchis sinensis calcium-binding protein Cs16 causes acute hepatic injury possibly by reprogramming the metabolic pathway of bone marrow-derived monocytes.

Introduction: Clonorchis sinensis infection results in various complications in the liver and biliary systems and is a neglected tropical disease in Eastern Asia. In this study, we report that C. sinensis calcium-binding protein Cs16 activates host immune cells and induces immunopathology in liver. Methods: Immunohistochemistry was used to detect the localization of Cs16 in C. sinensis adult worms. ELISA was used to detect the serum levels of anti-Cs16 IgG antibody in infected humans and mice. Bile duct injection model was used to figure out the role of Cs16 in vivo. RT-qPCR and ELISA were used to detect the cytokine production from Cs16-treated BMMs in vitro. Seahorse assay was used to detect the metabolic pathway of Cs16-treated BMMs in vitro. Result: Cs16 localizes in the tegument and gut of C. sinensis. Humans and mice with C. sinensis infection exhibited increased levels of anti-Cs16-specific antibody. Using the bile duct injection technique, we found that Cs16 induced obvious inflammation and hepatic necrosis in vivo. Cs16 treatment caused the upregulation of inflammatory cytokines in innate immune cells. Moreover, Cs16-treated monocytes relied more on the glycolytic metabolic pathway. Discussion: Our findings suggest that Cs16 is a potential pathogenic factor derived from C. sinensis adult worm. By reprogramming the metabolic pathway of innate immune cells, Cs16 triggers pro-inflammatory responses in the liver, and therefore, Cs16 is a potential target for the prevention and treatment of clonorchiasis.

Surgical management and molecular diagnosis of persistent Müllerian duct syndrome in Chinese patients.

Persistent Müllerian duct syndrome (PMDS) is a rare clinically and genetically overlapping disorder caused by mutations in the anti-Müllerian hormone (AMH) gene or the anti-Müllerian hormone receptor type 2 (AMHR2) gene. Affected individuals present uterus and tubes in normally virilized males and are discovered unexpectedly during other surgeries. Since it is rare and complex, a definitive clinical diagnosis can be missed, and there are no guidelines regarding how to deal with the uterus. In the present study, exome sequencing and Sanger verification were performed for causal variants in 12 PMDS patients. Preoperative diagnoses were made by positive exome sequencing in 8 patients. Of them, 7 patients evoked on the basis of ultrasound indicating bilateral testes on the same side of the body. Twelve different AMH variants (2 frameshift/nonsense, 1 deletion, 8 missense, and 1 in-frame) in 9 patients and 6 different AMHR2 variants (5 missense and 1 splicing) in 3 patients were identified. Seven variants were classified as "pathogenic" or "likely pathogenic", and 4 of them were novel. All but two patients with AMH defects showed low serum AMH concentrations, but all patients with AMHR2 defects showed elevated AMH levels. During surgery, an abnormal vas deferens was observed in half of the patients. Eight patients underwent orchidopexy with uterine preservation. Of them, 2 patients presented complications including irreducible cryptorchidism, and 3 patients developed Müllerian remnant cysts. Three patients underwent subtotal hysterectomy. Of them, one patient had complication of injury to the vas deferens, and one had hemorrhage after operation. This is the first report of PMDS involving a large Chinese population. The present study not only expands the variation spectrum but also provides clinical experience about the management of the uterus.

Divergence in Eco-Physiological Responses to Drought Mirrors the Distinct Distribution of Chamerion angustifolium Cytotypes in the Himalaya-Hengduan Mountains Region.

Polyploid species generally occupy harsher habitats (characterized by cold, drought and/or high altitude) than diploids, but the converse was observed for Chamerion angustifolium, in which diploid plants generally inhabit higher altitudes than their polyploid derivatives. Plants at high altitudes may experience cold-induced water stress, and we therefore examined the physiological responses of diploid and hexaploid C. angustifolium to water stress to better understand the ecological differentiation of plants with different ploidy levels. We conducted a common garden experiment by subjecting seedlings of different ploidy levels to low, moderate, and severe water stress. Fourteen indicators of physiological fitness were measured, and the anatomical characteristics of the leaves of each cytotype were determined. Both cytotypes were influenced by drought, and diploids exhibited higher fitness in terms of constant root:shoot ratio (R:S ratio) and maximum quantum yield of PS II (Fv/Fm ), less reduced maximal photosynthetic rate (A max), transpiration rate (E), intercellular CO2 concentration (C i) and stomatal conductance (g s), and higher long-term water use efficiency (WUEL) under severe water stress than did hexaploids. Analysis of leaf anatomy revealed morphological adjustments for tolerating water deficiency in diploids, in the form of closely packed mesophyll cells and small conduits in the midvein. Our results indicate that diploid C. angustifolium is more tolerant of drought than hexaploid plants, ensuring the successful survival of the diploid at high altitudes. This eco-physiological divergence may facilitate the species with different cytotypes to colonize new and large geographic ranges with heterogeneous environmental conditions.

[Development of a water tank for X-ray dose measurement in stereotactic radiotherapy (X-knife)].

This paper presents a novel x-ray dose testing water tank used for the stereotactic radiation therapy system, including its constitution, structure and the method of using it. The water tank has a simple structure of inner and outer sleeves which are connected through a drowned pump and a water pipe in order to control the water level of the tank. The water tank featuring autoregulation and easy use is worthy of clinical application and popularization.

[Immunoregulation of vasoactive intestinal peptide on rat Leydig cells].

AIM: To study the regulation of immune function of rat Leydig cells by vasoactive intestinal peptide (VIP). METHODS: Rat Leydig cells were seperated and infected by UU, with or without the incubation with VIP. The expression of FasL on Leydig cells in different group was analysed by flow cytometry(FCM). The mRNA expression of IL-1, IL-6, TGF-beta and FasL of Leydig cells in different group was identified by RT-PCR. SD rats were infected by UU with or without the injection of VIP, and the testis tissnes of each group were har vested and observed under transmission electron microscope. RESULTS: When testis was infected by UU, VIP up-regulated the mRNA expression of IL-1, IL-6, and TGF-beta, and down-regulated the expression of FasL in vitro. In addition, there was significant difference in testis morphous of rats from different group. CONCLUSION: VIP could regulate the expression pattern of IL-1, IL-6, TGF-beta and FasL by Leydig cells, which may contribute to maintain immune privilege of the testis. VIP could regulate rat Leydig cell immune function.

[A preliminary study of beam weight optimization of intensity-modulated radiation therapy with genetic algorithm].

UNLABELLED: To study the method for dose calculation and beam weight optimization of intensity-modulated radiation therapy (IMRT). METHODS: The IMRT dose calculation model based on two-dimensional convolution was constructed, the program of dose calculation and beam weight optimization with genetic algorithm was written with Visual c#.Net, and the optimization results were analyzed. RESULTS: Genetic algorithm optimization of beam weights can produce highly conformal dose distributions within a clinically acceptable computation time. CONCLUSION: Genetic algorithm is valid and efficient in IMRT beam weight optimization, which may facilitate IMRT treatment planning.

[A new method for static intensity-modulated radiation therapy].

OBJECTIVE: To develop a new method for static intensity-modulated radiation therapy (IMRT) possible for implementation in smaller hospitals by incorporating accurate location equipments and treatment planning system in the available equipments for general radiotherapy. METHODS: Based on the techniques of conformal radiotherapy, a new split method for fabricating the three-dimensional physical compensator was developed to achieve IMRT. RESULTS: Experiment with the new method showed that the fabricated compensator could achieve good match between the high dosage shape in the target area and the dimensions of the tumor, and allowed adjustment of the dosage distribution according to the therapeutic requirement. CONCLUSION: This simple and feasible method allows cost-effect application of IMRT in smaller hospitals.

[Development of a new system for head and neck stereotactic conformal radiotherapy].

This paper introduces the constitution and fabrication of the new head and neck stereotactic conformal radiotherapy system. It remedies the shortages in the head and neck stereotactic conformal radiotherapy at present and it is deserved to be popularized in clinical applications.

[Immunological up-regulation of cyclophosphamide-treated mice by turtle blood extract].

AIM: To explore the effect of turtle blood extract on murine immune system. METHODS: We compared the ratio of CD4(+) helper T cells and CD8(+) T cells, NK cell activity, lymphocyte proliferation stimulated by mitogen and capability of cytokine secretion of cyclosphophamide-treated mice with or without treatment of turtle blood extract. RESULTS: Turtle blood extract-treated mice displayed increased CD4(+) helper T cell population, stronger cytotoxicity of NK cells and enhanced of ConA-induced lymphocyte proliferation. In addition, the capacity of IFN-gamma secretion was dramatically up-regulated in turtle blood extract-treated mice group. CONCLUSION: Turtle blood extract can upregulate the immune function of cyclosphophamide-treated mouse.

[Influence of FasL overexpression in transgenic mice on the immune regulative function of Sertoli cell].

AIM: To study the influence of FasL overexpression in transgenic mice on the Sertoli cell immune response to testicular infection. METHODS: Ureaplasma urealyticum (UU) was directly injected into bladders of FasL transgenic mice and wild-type mice respectively, to mimic an ascending infection pathway. At week 1, 2 and 3 after injection, respectively, the mice were put to death to observe the pathological alterations in testis section. And at the same time the differences of FasL, TGF-beta, IL-1alpha and IL-6 expressions on Sertoli cells were compared by immunohistochemical staining between wild mice and transgenic mice before and after infection, respectively. The high-purified Sertoli cells were isolated from the testis tissue of wild-type mice, comparing apoptotic capability of Fas(+) Jurkat cells mediated by FasL(+) Sertoli cells of wild control and wild UU-infected groups. RESULTS: The pathological changes of testis tissue from transgenic mice were more serious as compared with wild-type mice and the model of cytokines secreted by sertoli cells was distinctive between the two kinds of mice. The UU-infected Sertoli cells increased Fas(+) Jurkat cell apoptosis. CONCLUSION: FasL overexpression can influence the cytokine's secretion in the process of anti-infection immunity and further affects the immune balance of testis locality. Not all FasL over expression is benefit to body's anti-infection immune response.