Influencing Factors of Massive Hemorrhage and High-Grade Renal Vascular Injury after PCNL: A Retrospective Comparative Study.

Purpose: Severe hemorrhage after percutaneous nephrolithotomy (PCNL) is a rare but alerting event. In this study, we report the factors affecting massive hemorrhage after PCNL, various levels of vascular damage during renal angiography, and the therapeutic effect of superselective renal artery embolization (SRAE). Patients and Methods. A retrospective analysis was performed on the data of 69 patients with postoperative PCNL hemorrhage who underwent SRAE from January 2010 to March 2021. Inclusion criteria for all cases were failure of conservative treatment for severe renal hemorrhage after surgery and then treatment with SRAE. In addition, 98 patients without significant hemorrhage after PCNL were randomly selected as the control group. All clinical data are confirmed by imaging and laboratory examinations. We performed univariate and multivariate analyses to find risk factors of massive hemorrhage and high-grade renal vascular injury after PCNL. Results: A total of 69 patients underwent angiography, 64 of which received SRAE due to positive hemorrhages detected by angiography. Urinary tract infection (OR (95% CI) = 11.214 (2.804∼44.842)), high blood pressure (OR (95% CI) = 5.686 (1.401∼23.083)), and no hydronephrosis (OR (95% CI) = 0.189 (0.049∼0.724)) are the most important factors leading to massive hemorrhage after PCNL. In patients who need SRAE after hemorrhage, high-grade vascular injury (grade III) is related to advanced age and decreased hemoglobin. Conclusion: During the perioperative period of PCNL, patients with a risk of hypertension, urinary tract infection, and no hydronephrosis should be strengthened to monitor their high risk of postoperative hemorrhage. For patients with postoperative hemorrhage, we can use the patient's age and decreased hemoglobin before and after operation for analysis. In this way, individualized assessment can greatly improve the efficiency of SRAE treatment.

Helical Luttinger Liquid on the Edge of a Two-Dimensional Topological Antiferromagnet.

A boundary helical Luttinger liquid (HLL) with broken bulk time-reversal symmetry belongs to a unique topological class that may occur in antiferromagnets (AFM). Here, we search for signatures of HLL on the edge of a recently discovered topological AFM, MnBi2Te4 even-layer. Using a scanning superconducting quantum interference device, we directly image helical edge current in the AFM ground state appearing at its charge neutral point. Such a helical edge state accompanies an insulating bulk which is topologically distinct from the ferromagnetic Chern insulator phase, as revealed in a magnetic field driven quantum phase transition. The edge conductance of the AFM order follows a power law as a function of temperature and source-drain bias which serves as strong evidence for HLL. Such HLL scaling is robust at finite fields below the quantum critical point. The observed HLL in a layered AFM semiconductor represents a highly tunable topological matter compatible with future spintronics and quantum computation.

Renal puncture access using a blunt needle: proposal of the blunt puncture concept.

PURPOSE: Severe haemorrhage in percutaneous nephrolithotomy (PCNL) is an alarming event, and preventing injury to renal major vessels is a challenge. We evaluated the efficiency of a blunt needle in renal puncture procedures. METHODS: We first retrospectively reviewed the embolization images of post-PCNL patients to analyse the types of arteries injured, which were considered target arteries. Then, either a blunt needle or a conventional needle was used to directly puncture target arteries in ex vivo porcine kidneys and to establish renal access ex vivo and in vivo. The primary outcome was the incidence of target artery injuries, which were observed by digital subtraction angiography, nephroscopy and 3-dimensional endocasts. The secondary outcome was the rate of excreted fluid per access. RESULTS: The segmental and interlobar arteries were the most common types of injured arteries that needed to be embolized after PCNL. When these arteries were punctured directly, blunt needles reduced injury (1/20 vs. 16/20; OR 4.750; 95% CI 1.966-11.478; P < .001) by 76% compared to injuries induced by conventional needles. Moreover, the blunt needle group also had a significantly lower incidence of these arteries' injuries ex vivo due to renal puncture and yielded a lower rate of excreted fluid in ex vivo and in vivo renal puncture procedures. CONCLUSION: A blunt needle for renal puncture can be effective in reducing injury to renal major arteries and the accompanying haemorrhage. We propose the concept of blunt puncture, which may be a promising method for achieving safe renal access in PCNL.

Floating Ag-NPs@Cu-NW bundles fabricated on copper mesh for highly sensitive SERS detection of uric acid in pretreatment-free urine.

The rapid and sensitive detection of ultra-trace marker molecules from biological samples is of great significance for the wide application of surface-enhanced Raman spectroscopy (SERS) methods in clinical diagnosis and disease monitoring. However, the cumbersome biological sample processing procedures and the poor enrichment of target analytes in hot spots hinder the practical applications of SERS methods. In this paper, we synthesized a novel floating SERS substrate by a simple one-step oxidation process, annealing and in situ chemical etching to form Ag-NPs@Cu-NW bundles on copper mesh (CM). In particular, under spontaneous bottom-up capillary action, the pressure difference at different nanogaps drives uric acid molecules to actively enter hot spots, so that the Ag-NPs@Cu-NW bundle nanostructure with the advantages of a light weight CM is capable of preventing the common coffee-ring effect and enhancing the spatial enrichment of analytes. Therefore, this SERS substrate realizes highly sensitive detection of uric acid at a level of 50 nM in pretreatment-free urine. Currently, this portable, flexible, simple, fast and cost-effective SERS substrate has great potential for early screening and clinical diagnosis of diseases in different biofluids.

Prediction of percutaneous nephrolithotomy outcomes and flexible ureteroscopy outcomes using nephrolithometry scoring systems.

BACKGROUND: Kidney stones account for a high proportion of urological emergencies. The main objective of this paper is to evaluate the predictive ability of five scoring systems for overall stone-free status and postoperative complications after percutaneous nephrolithotomy and retrograde ureteroscopy. MATERIALS AND METHODS: This study retrospectively analysed 312 cases of kidney stone patients between January 2021 and May 2022 at our centre. Multivariate logistic regression as well as ROC curves were applied to determine the ability to evaluate each scale to predict stone-free rates and postoperative complications. RESULTS: 179 patients have undergone PCNL. After multivariate logistic regression, the S.T.O.N.E score and history of ipsilateral renal surgery were predictive of stone-free status, and the predictive power of the S.T.O.N.E score was higher than that of history of ipsilateral renal surgery. Grade 1 complications were considered to be related to Guy's score and grade 2 complications were considered to be related to history of diabetes mellitus. 133 patients have undergone f-URS. After multivariate logistic regression analysis, the modified S-ReSC score, RUSS score, and R.I.R.S score were predictive of stone-free status, with the R.I.R.S score being the strongest predictor. Evidence of grade 2 complications was considered to be related to abnormal renal function. CONCLUSION: For PCNL, the S.T.O.N.E score had the best efficacy in predicting stone-free status, and the Guy's score had the best efficacy in predicting postoperative complications; for f-URS, the R.I.R.S score had the best efficacy in predicting stone-free status, and no scoring system predicted postoperative complications.

Renal puncture access via a nonpapillary track in percutaneous nephrolithotomy: an in vitro porcine kidney experience.

Recently, an increasing number of investigators have debated the wide rule of the puncture to renal papilla in PCNL. We evaluated the effect of renal papillary and nonpapillary puncture on bleeding in an in vitro porcine kidney experience, with the aim of determining the safe puncture sites of collecting system in PCNL. A total of 70 fresh porcine kidneys were selected and subjected to nephrostomy. We performed a puncture through a renal papilla, infundibulum, renal column, or minor calyceal neck (including the front, back, up, and down). The primary outcome was the amount of bleeding. The results showed that the papillary puncture group yielded minimal bleeding (1.59 ± 1.01 ml/min) compared with the infundibular puncture group (6.25 ± 4.46 ml/min, P < .001), renal column puncture group (4.24 ± 3.79 ml/min, P = 0.001), and minor calyceal neck puncture group (2.27 ± 1.35 ml/min, P = 0.011). However, after stratifying by orientation, the up (1.75 ± 0.80 ml/min, P = 0.501) or down (1.77 ± 0.72 ml/min, P = 0.437) minor calyceal neck puncture group and papillary puncture group yielded comparable bleeding. In summary, nonpapillary puncture must be carefully considered. Infundibular and renal column punctures were inferior to papillary puncture, and up or down minor calyceal neck puncture may be a prudent choice in specific situations.

Is the visceral adiposity index a potential indicator for the risk of kidney stones?

Objective: To determine whether the visceral adiposity index (VAI) was linked to the risk of kidney stones (KS) in the representative U.S. adults. Methods: We investigated 59842 participants who joined the 2007-2018 National Health and Nutrition Examination Survey. The association between the visceral adiposity index (VAI) and KS was identified by logistic regression analysis. Meanwhile, the subgroup analysis as well as the calculation of dose-response curves were also utilized to identify sensitive groups. Results: Data from 29384 participants were available, including 2781 self-reported ever experiencing KS diseases. Overall, the VAI was 0.74 (0.70, 0.78) in the KS group, while 0.55 (0.52, 0.57) in the control group. After adjusting for confounders, the prevalence of KS increased by 13% for each unit of VAI increment (OR = 1.13, 95% CI: 1.08, 1.19). Moreover, a linear relationship was found between the VAI and the prevalence of KS. By subgroup analysis, we found that a positive correlation between VAI and the risk of KS both in male (OR=1.14, 95%CI:1.07, 1.22) and female (OR=1.14, 95%CI:1.05, 1.24), White (OR=1.20, 95%CI:1.11, 1.28) and other race, all aged subgroups, nonhypertensive (OR=1.06, 95%CI:1.08, 1.25) and nondiabetic subgroups (OR=1.14, 95%CI:1.07, 1.21). Conclusions: Elevated VAI was strongly associated with KS in representative U.S. adults, which may be a promising indicator for the risk of kidney stones.

Cpd-42 protects against calcium oxalate nephrocalcinosis-induced renal injury and inflammation by targeting RIPK3-mediated necroptosis.

Calcium oxalate (CaOx) crystals, as the predominant component of human kidney stones, can trigger excessive cell death and inflammation of renal tubular epithelial cells, involved in the pathogenesis of nephrocalcinosis. Necroptosis mediated by receptor-interacting protein kinase 3 (RIPK3) serves a critical role in the cytotoxicity of CaOx crystals. Here, we assessed the therapeutic potential of a novel RIPK3 inhibitor, compound 42 (Cpd-42), for CaOx nephrocalcinosis by comparison with dabrafenib, a classic RIPK3 inhibitor. Our results demonstrated that Cpd-42 pretreatment attenuated CaOx crystals-induced renal tubular epithelial cell (TEC) injury by inhibiting necroptosis and inflammation in vitro and in vivo. Furthermore, in an established mouse model of CaOx nephrocalcinosis, Cpd-42 also reduced renal injury while improving the impaired kidney function and intrarenal crystal deposition. Consistent with this finding, Cpd-42 was confirmed to exhibit superior inhibition of necroptosis and protection against renal TEC injury compared to the classic RIPK3 inhibitor dabrafenib in vitro and in vivo. Mechanistically, RIPK3 knockout (KO) tubular epithelial cells pretreated with Cpd-42 did not show further enhancement of the protective effect on crystals-induced cell injury and inflammation. We confirmed that Cpd-42 exerted protective effects by specifically targeting and inhibiting RIPK3-mediated necroptosis to block the formation of the RIPK1-RIPK3 necrosome. Taken together, targeted inhibition of RIPK3-mediated necroptosis with Cpd-42 may provide a potential therapeutic approach for CaOx nephrocalcinosis.

Frustrated ferromagnetic transition in AB-stacked honeycomb bilayer.

In two-dimensional (2D) ferromagnets, anisotropy is essential for the magnetic ordering as dictated by the Mermin-Wagner theorem. But when competing anisotropies are present, the phase transition becomes nontrivial. Here, utilizing highly sensitive susceptometry of scanning superconducting quantum interference device microscopy, we probe the spin correlations of ABC-stacked CrBr3 under zero magnetic field. We identify a plateau feature in susceptibility above the critical temperature (TC) in thick samples. It signifies a crossover regime induced by the competition between easy-plane intralayer exchange anisotropy versus uniaxial interlayer anisotropy. The evolution of the critical behavior from the bulk to 2D shows that the competition between the anisotropies is magnified in the reduced dimension. It leads to a strongly frustrated ferromagnetic transition in the bilayer with fluctuation on the order of TC, which is distinct from both the monolayer and the bulk. Our observation demonstrates unconventional 2D critical behavior on a honeycomb lattice.