Postoperative Renal Abscess Following Tip-Flexible Suctioning Ureteral Access Sheath and Digital Ureteroscopic Lithotripsy: A Case Report.

BACKGROUND The tip-flexible suctioning ureteral access sheath (TFS-UAS) can be bent under flexible ureteroscopes, which facilitates removal of renal stone segments by irrigation and suctioning effects. Small-scale comparative studies found it safer and more efficacious than traditional UAS. However, complications such as renal abscess were not documented after TFS-UAS combined with digital FURS. CASE REPORT A 57-year-old woman had right lumbar pain that persisted for 1 year. A plain computed tomography (CT) scan revealed multiple renal pelvicalyceal stones (maximum diameter 20×9 mm). She was admitted to undergo elective surgery with a TFS-UAS combined with digital flexible ureteroscopic lithotripsy. The operation was deemed successful and she was given postoperative antibiotics for 2 days before discharge. Eight postoperative days later, she was admitted to the emergency department due to high fever (39.6°C). Plain CT revealed intact double-J stents and no abnormalities. She was readmitted to the urological department to receive antibiotic therapy, which progressed to septic shock (blood pressure 80/50 mmHg) and required immediate transfer to the intensive care unit. Contrast-enhanced CT revealed a right renal abscess. She was promptly resuscitated and given stronger antibiotics. She recovered well and was discharged with 2-week oral levofloxacin treatment. Follow-up ultrasound found no renal abscess. CONCLUSIONS While TFS-UAS with digital FURs is an effective approach for multiple renal stones, there is a risk of postoperative renal abscess, possibly due to altered intrarenal pressure.

Left endoscopic combined intrarenal surgery with electrocoagulation hemostasis and right flexible ureteroscopic lithotripsy for bilateral upper urinary tract stones: a case report.

Background: Percutaneous nephrolithotomy (PCNL) is the first-line treatment for large renal stones. However, multi-tract or staged procedures may be necessitated in bilateral or anatomically-complex stones to achieve stone clearance. Endoscopic combined intrarenal surgery (ECIRS) integrates the advantages of PCNL and retrograde intrarenal surgery. In this article, we detail a hybrid surgical technique adopted for the management of complex simultaneous bilateral upper urinary tract stones. In addition, we discuss the advantages and disadvantages of combining a variety of new techniques that may improve post-operative outcomes and patient satisfaction. Case Description: We report the case of a 36-year-old male with a large left renal pelvis stone, right proximal ureteric stone, and bilateral renal stones. Biochemical results showed raised inflammatory markers but he denied pre-stenting and staged surgery. After receiving 3-day antibiotic prophylaxis, he underwent an elective hybrid procedure. Under split-leg prone position, we performed a hybrid procedure that included left ECIRS with tubeless single-tract mini PCNL and left flexible ureteroscopy, and right flexible ureteroscopic lithotripsy. Hemostasis was achieved by electrocauterization with a novel device. The patient made an uneventful recovery. Follow-up computed tomography (CT) at 1-month revealed complete stone clearance. Conclusions: Unilateral ECIRS with tubeless single-tract mini PCNL with electrocoagulation hemostasis and adjacent retrograde intrarenal surgery in split-leg prone position is a safe, feasible, and efficient technique to manage large renal stones.

Flexible ureterolithotripsy for the management of multiple gas-containing renal calculi: A case report and literature review.

Gas-containing renal stones (GCS) are rare urological entities. Current literature has suggested possible associations with premenopausal women, urinary tract infection, and metabolic diseases. We report the case of a 25-year-old young woman with no underlying co-morbidities who had multiple right GCS and suspected emphysematous pyelitis. Antibiotic therapy was initiated to control her urinary tract infection with E. coli. She then underwent elective right flexible ureteroscopy to relieve her ureteropelvic junction obstruction. Complete stone retrieval was achieved and she made an uneventful recovery with no stone recurrence during 1-year follow-up.

A Patient with Fragmentation of a Calcified Ureteric Stent Requiring Ureteroscopy and Laser Lithotripsy.

BACKGROUND Encrustation of the ureteral stent is a common complication that occurs after a prolonged indwelling duration. Other identified risk factors in the literature include urinary sepsis, chemotherapy, chronic renal failure, metabolic or congenital abnormalities, and nephrolithiasis. This report presents the case of a 39-year-old man with nephrolithiasis and fragmentation of a calcified right ureteric stent that required ureteroscopy and laser lithotripsy. CASE REPORT A 39-year-old man was initially admitted for ureteroscopy and laser lithotripsy after the diagnosis of bilateral urolithiasis. Ureteral stents were placed. One postoperative month later, the patient returned for follow-up and stent withdrawal. Follow-up computed tomography revealed a normal left kidney, intact bilateral ureteral stents, and residual right renal stones. However, an attempt to completely withdraw the stent failed and the patient had to undergo a secondary right ureteroscopy with laser lithotripsy. The fragmented proximal section of a calcified right ureteral stent with occluded lumen was found intraoperatively and sent for product analyses. After successful reintervention, the patient had a new right ureteral stent placed, which was successfully withdrawn during his next follow-up. CONCLUSIONS Ureteral stent encrustation may occur earlier than anticipated, possibly due to underlying patient risk factors. Complications, such as fragmentation of the ureteral stent, may occur during withdrawal. Physicians should be aware of any predictors for early ureteral stent encrustation to prevent unnecessary reintervention.

[Contribution of Emissions from the Iron and Steel Industry to Air Quality in China].

Based on the data from a continuous emission monitoring systems network in 2015, this study analyzed the compliance rates of exhaust gas in the processes of China's iron and steel industry, and established a high-resolution steel plant emission inventory for China (HSEC, 2015), based on the bottom-up method. The contribution of emissions from the iron and steel industry to regional air quality was quantitatively simulated using a CAMx model. The results showed that in 2015, the total emissions of SO2, NOx, PM10, PM2.5, PCDD/Fs, VOCs, CO, BC, OC, EC, and F were 374800 t, 720500 t, 334800 t, 150300 t, 1.91 kg, 842900 t, 34788500 t, 6400 t, 8300 t, 800 t, and 7700 t, respectively. From a regional perspective, the iron and steel industry in Shanghai and Tianjin has the highest emission intensity per unit area and contributes a high proportion to regional air pollution. From a process perspective, in 2015, the exhaust concentration of flue gas in the main process gradually decreased, with a high compliance rate, and the emission factor significantly decreased to lower than that in the existing research results. From a species perspective, in 2015, NOx emission from the steel industry contributed the most to regional air quality, and there is therefore a great emission reduction potential for NOx.

Evaluation of the therapeutic effects of lateral approach combined with anteromedial approach in the treatment of terrible triad of the elbow.

OBJECTIVE: This study aims to evaluate the therapeutic effects of the lateral approach combined with anteromedial approach in the treatment of terrible triad of the elbow. METHODS: Between June 2010 and January 2015, 334 patients suffering from terrible triad of the elbow, amongst whom 105 cases underwent lateral approaches combined with anteromedial approaches, 112 cases underwent lateral approaches, and 117 cases underwent anteromedial approaches were included in the study. The serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) were detected using enzyme-linked immunosorbent assay (ELISA) before operation and at 7 days and 3 months after operation. X-ray imaging was employed to examine the recovery condition of the elbow, and the joint motion and the forearm rotation of elbow were evaluated before and after the operation. RESULTS: Excellent rate was obtained in accordance with the Mayo Elbow Performance Score (MEPS). The serum levels of CRP, IL-6, IL-8 and TNF-α gradually decreased to normal levels after the operation, and recovery was faster in patients undergoing lateral approach combined with anteromedial approach in comparison to those undergoing lateral and anteromedial approaches. The X-ray images showed good recovery of elbows in all patients, but the range of joint motion, forearm rotation degree, and MEPS were higher in patients undergoing lateral approach combined with anteromedial approach compared to those undergoing lateral and anteromedial approaches independently. CONCLUSION: Taken together, these findings demonstrate lateral approach combined with anteromedial approach reveals better therapeutic effect than lateral approach and anteromedial approach in the treatment of terrible triad of the elbow.

[Effect of Tongxinluo on Apoptosis of Rat Cardiac Microvascular Endothelial Cells].

OBJECTIVE: To observe the protective effects of Tongxinluo (TXL) on apoptosis of rat cardiac microvascular endothelial cells (RCMECs) resulting from homocysteine (Hcy) induced endoplasmic reticulum stress (ERS), and to determine the signaling pathway behind its protection. METHODS: Primary cultured RCMECs were isolated from neonatal rats using tissue explant method. The morphology of RCMECs was observed using inverted microscope, identified and differentiated by CD31 immunofluorescence method. Selected were well growing 2nd-4th generations of RCMECs. The optimal action time was determined by detecting the expression of glucose regulated protein 78 (GRP78) using immunofluorescence method. In the next experiment RCMECs were divided into 5 groups, i.e., the blank control group, the Hcy induced group (Hcy 10 mmol/L, 10 h), the Hcy + TXL group (Hcy 10 mmol/L + TXL 400 µg/mL), the Hcy +LY294002 group (Hcy 10 mmol/L + LY294002 5 µmol/L, LY294002 as the inhibitor of PI3K), the Hcy + LY294002 + TXL group (Hcy 10 mmol/L + LY294002 5 µmol/L + TXL 400 µg/mL). The apoptosis rate of RCMECs was detected by flow cytometry. mRNA and protein expressions of GRP78, C/ EBP homologous protein (CHOP), and cysteinyl aspartate specific proteinase-12 (caspase12) were detected by real-time reverse transcription PCR (RT-PCR) and Western blot respectively. Expression levels of phosphorylation of phosphatidylinositol 3-kinase (P-PI3K), total phosphatidylinositol 3-kinase (T- P13K) , phosphorylation of kinase B (P-Akt) , and total kinase B (T-Akt) were detected by Western blot. RESULTS: Ten hours Hcy action time was determined. Compared with the blank control group, the apoptosis rate was increased (22.77%), mRNA and protein expressions of GRP78, CHOP, and Caspase-12 were increased, protein expressions of P-PI3K and P-Akt,ratios of P-PI3K/T-PI3K and P-Akt/T-Akt were decreased in the Hcy induced group (P < 0.05, P < 0.01). Compared with the Hcy induced group, the apoptosis rate was decreased (10.17%), mRNA and protein expressions of GRP78, CHOP, and Caspase-12 were decreased, and expression levels of P-PI3K, P-Akt, P-PI3K/T-PI3K, and P-Akt/T-Akt were increased in the Hcy + TXL group (P < 0.05, P < 0.01). Compared with the Hcy + TXL group, the apoptosis rate was increased (17.9%), mRNA and protein expressions of GRP78, CHOP, and Caspase-12 were increased, expression levels of P-PI3K and P-Akt, ratios of P-PI3K/T-PI3K and P-Akt/T-Akt were decreased in the Hcy + TXL + LY294002 group (P < 0.05, P < 0.01). CONCLUSION: TXL could inhibit the apoptosis of RCMECs resulting from Hcy-induced ERS and its mechanism might be associated with activating PI3K/Akt signaling pathway.

Effects of sleep deprivation on pain-related factors in the temporomandibular joint.

BACKGROUND: The objective of this study was to investigate the effects of experimental sleep deprivation (SD) on the temporomandibular joint (TMJ) in rats by examining pain-related factors and to determine the possible involvement of estrogen and NF (nuclear factor) κB signaling in the TMJ synovial membrane. METHODS: The influence of SD, conducted in rats using the modified multiple platform method, was estimated by observing behavioral manifestations and examining changes in serum hormone levels. The morphologic changes of synovial tissue were observed with light microscopy and the serum levels of estrogen were measured by radioimmunoassay. Activation of NF-κB in the synovial membrane was examined using an immunofluorescence technique, and the expression levels of interleukin (IL) 1ß, IL-6, tumor necrosis factor α, cyclooxygenase 2, and inducible nitric oxide synthase were measured with real-time polymerase chain reaction. RESULTS: The SD group showed evidence of elevated anxiety and stress, and increased plasma levels of estradiol compared with the control group. The activity of NF-κB was significantly enhanced and translocation of NF-κB p65 was evident in the synovial membrane after SD. The expression of pain-related factors IL-1ß, IL-6, cyclooxygenase-2, tumor necrosis factor α, and inducible nitric oxide synthase in the synovial membrane significantly increased after SD. CONCLUSIONS: These results indicate that SD increases serum levels of estrogen and induces alterations in pain-related factors in the TMJ. The NF-κB pathway has been associated with the regulation of these inflammatory cytokines and plays an important role in temporomandibular disorders.

Low extracellular K+ increases intracellular Ca2+ oscillation and injury by activating the reverse mode Na+-Ca2+ exchanger and inhibiting the Na+, K+ ATPase in rat cardiomyocytes.

BACKGROUND: The effects of low K(+) on post-ischemic reperfused heart cells are not clearly understood. Calcium overload is one of the major causes for myocardial reperfusion injury, the present study was to investigate the role of intracellular calcium oscillations in the effects of reperfusion with low K(+) on rat myocytes. METHODS: Ischemic myocytes were reperfused with Tyrode solution containing K(+) at 5.4 (control) or 3.0 mM (low K(+)) for 10 min. the changes of intracellular calcium was recorded by spectrofluorometry. The exclusion of trypan blue by myocytes served as indices of viability. Measurements of cell length, reverse-mode Na(+)-Ca(2+) exchanger (NCX) and Na(+), K(+) ATPase activity were performed. RESULTS: Compared to control, myocytes reperfused with low K(+) had greater number of calcium oscillations and reverse-mode NCX activity, which were accompanied with decreased cell length recovery and cell viability. Reperfusion with KB-R7943, an inhibitor of reverse-mode NCX, attenuated the effects of low K(+) on all the parameters. Inhibition of Na(+), K(+) ATPase with Ouabain increased the susceptibility to calcium oscillations in myocytes reperfused with low K(+), which was accompanied with cell length shortening and decreased cell viability. Reperfusion with K(+) at 9.0 mM, which activated Na(+), K(+) ATPase, attenuated calcium oscillations, protected cell length recovery, and increased cell viability. CONCLUSIONS: These results suggest that increased calcium oscillations mediate the exacerbating reperfusion injury with low K(+) on myocytes, and inhibition of Na(+), K(+) ATPase activity and increase of reverse-mode NCX activity contribute to these effects.

An epidemiological survey of alcohol use disorders in a Tibetan population.

We performed an epidemiological survey in order to detect the prevalence of alcohol use disorders in a sub-group of the population of Tibet. The Alcohol Use Disorders Identification Test (AUDIT) questionnaire, the Severity of Alcohol Dependence Questionnaire (SADQ), and a 12-item version of the General Health Questionnaire (GHQ12) were used to obtain epidemiological data on alcohol use disorders and to assess the severity of 'problem drinking' and general mental health status. The AUDIT is a reliable and valid screening tool for both alcohol abuse and dependence in the Tibetan population to identify individuals with alcohol use problems. The cut-off points were set to be 10 and 13 of the AUDIT scores as a diagnostic discriminator of alcohol abuse and alcohol dependence, respectively, with both sensitivity and specificity>0.84. The prevalence of alcohol abuse, was 2.7% (female: 2.0%; male: 6.2%), alcohol dependence 13.5% (female: 7.6%; male: 25.4%) and alcohol use disorders 16.2% (female: 9.6%; male: 31.6%). Age and sex were the main factors affecting an individual's alcohol use and general mental health status. The epidemiological data on alcohol use disorders documented in this project may be helpful in future work seeking more valid causal inferences or interpretations related to this prevalent health problem in Tibet.

Morphological observation of immunological alterations in the spleens from estrogen receptor deficient mice.

AIM: To evaluate some immunological parameters in the spleens from estrogen receptor(ER) deficient mice. METHODS: Immunohistochemistry and immunofluorescence analysis were used in the study. RESULTS: Multiple alterations were found in the spleens of ER deficient mice, especially in ERbeta deficient mice, such as increased expression of proinflammatory cytokines and inducible nitric oxide synthase, elevated number of proliferating splenocytes and increased IgM/IgG production. Moreover, The splenocytes lack of ERbeta were resistant towards estrogen's suppression on proliferation. The activation of nuclear factor (NF)-kappaB in ERbeta deficient spleens may account for the above hyperactivity. CONCLUSION: ER, especially ERbeta, plays a key role in mediating the modulation of immune response by estrogen. ERbeta disruption may increase the sensibility towards autoimmune diseases.

Estrogen affects the differentiation and function of splenic monocyte-derived dendritic cells from normal rats.

AIM: To explore the mechanism resulting in the preventive effect of estrogen on experimental autoimmune encephalomyelitis (EAE), which is an animal model for multiple sclerosis (MS), and examine if estrogen can affect the immune response in EAE at dendritic cell (DC) level. METHODS: Flow cytometry was used to reveal the surface marker expression. 3H-thymidine incorporation was applied to examine the cellular proliferation. Levels of anti-myelin basic protein (MBP)(68-86) antibody and cytokines were determined by enzyme-linked immunospot and ELISA, respectively. RESULTS: 17beta-estradiol (E2) could dose-dependently accelerate the differentiation process of DCs by up-regulating CD11c, B7-2 and CD40 expressions, but exert no effect on its antigen presentation ability. MBP-specific T cells cocultured with E2-treated DCs (E2-DC) produced more IL-10 and less IFN-gamma in the supernatant than those without E2 pretreatment (ctr-DC). In contrast to ctr-DC, E2-DC, if injected i.v. into EAE rats on day 5 post immunization, could initiate antigen nonspecific hyper-responsivity in T cells in terms of enhanced proliferation and cytokine secretion of mononuclear cells in LN, but suppressed antibody secretion from splenocytes. CONCLUSION: These results suggest that estrogen can affect the differentiation and function of DCs, which leads T cells switching to Th2 secretion. This may account partly for the protective effect of estrogen on EAE.

[Vasorelaxing effect of idoxifene on human internal mammary arteries].

The purpose of this study was to investigate the vasorelaxing effect and mechanism of idoxifene (a new estrogen receptor modulator) on human internal mammary artery (HIMA). HIMA segments were harvested from men during coronary artery bypass grafting surgery. Patients with diabetes mellitus, hypercholesterolemia, hypertension, or smoking habit were excluded. The vasorelaxing effect of idoxifene on artery rings from HIMA with and without endothelium was measured by means of perfusion in vitro. Cumulative dose-response to idoxifene in the range of 0.01-10 micromol/L was observed in the presence and absence of NO synthase inhibitor L-NAME. It was also studied whether the vasodilation effect of idoxifene on HIMA was blocked by methylene blue (MB), an inhibitor of guanylate cyclase (GC). The results obtained from idoxifene were compared with those from 17beta-estradiol (E(2)). It was found that idoxifene caused a concentration-dependent relaxation on HIMA. The dose range was from 0.03 micromol/L (minimal vasodilatory concentration) to 3 mmol/L (maximal vasodilatory concentration). It was also found that the vasorelaxation effect of idoxifene on HIMA was dependent on endothelium. E(2) (0.1-100 micromol/L) also resulted in an endothelium-dependent vasorelaxation, but the vessels were 15-fold less sensitive to E(2) than to idoxifene in their vasorelaxation responses. The EC(50) for E(2) was 4.65+/-0.34 micromol/L, compared with 0.32+/-0.02 micromol/L for idoxifene. The mean maximal vasodilatory value of E(2) was 88.3+/-5.7%, compared with 88.6+/-7.2% for idoxifene. Pretreatment with L-NAME (100micromol/L) abolished idoxifene-induced vasodilation virtually by blocking nitric oxide production. The vasorelaxing effect of idoxifene disappeared in the presence of MB (10 micromol/L). These findings demonstrate that idoxifene results in an endothelium-dependent vasorelaxation of HIMA, like estrogen. The effect of idoxifene is more potent than that of traditional estrogen, and is possibly mediated by NO-GC-cGMP pathway.