A Scoring System for Optimal Selection of Endoscopic Treatment for 1-2cm Lower Pole Renal Calculi.

PURPOSE: To explore the establishment of a scoring system that can provide a reference for clinical decision making regarding the endoscopic treatment of 1-2 cm lower pole stones (LPS). MATERIALS AND METHODS: The data of patients with renal calculi who were treated with percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) in three hospitals from January 2013 to December 2017 were analyzed retrospectively. Multivariable logistic analysis was performed to determine the statistically significant indicators and regression coefficients, which were used to construct the scoring system. The stone-free rate (SFR) and postoperative complication rates of PCNL and RIRS within the two fractional segments of the scoring system were compared to select the optimal procedures. RESULTS: A total of 137 patients in the PCNL group and 152 patients in the RIRS group were included in this study. Five factors were found to be most predictive of endoscopic treatment choice: stone number, stone diameter, infundibulopelvic angle (IPA), infundibular length (IL), and infundibular width (IW), yielding a total score ranging from 0-5. In the 0-2 segments, the RIRS group had better outcomes than the PCNL group in terms of the postoperative complication rates (6.8% versus 18.0%, P = .026). In segments 3-5, the SFR of the PCNL group was significantly higher than that of the RIRS group (88.5% versus 70.6%, P = .017). CONCLUSION: Our scoring system was based on the patient's preoperative imaging examination to measure the stone number, stone diameter, IPA, IL and IW. RIRS was recommended at 0-2 segments, and PCNL was recommended at 3-5 segments. This new scoring system is expected to provide guidance for urologists to make endoscopic treatment decisions for 1-2 cm LPS.

A new basal ichthyosauromorph from the Lower Triassic (Olenekian) of Zhebao, Guangxi Autonomous Region, South China.

Here we describe a newly discovered basal ichthyosauromorph from the Lower Triassic of South China, Baisesaurus robustus gen. et sp. nov. The only known specimen of this new species was collected from the Lower Triassic (Olenekian) Luolou Formation in the Zhebao region of Baise City, on the northwest margin of the Nanpanjiang Basin, and comprises a partial skeleton including the ribs, the gastralia, a limb element, 12 centra, and seven neural arches. Comparisons to a wide variety of Early Triassic marine reptiles show Baisesaurus robustus to be a basal ichthyosauromorph based on the following features: neural arches lack transverse processes; dorsal ribs are slender, and not pachyostotic even proximally; and median gastral elements have long, sharp anterior processes. The limb element is long and robust, and is most likely to be a radius. Baisesaurus robustus is large (estimated length more than 3 m) relative to early ichthyosauromorphs previously discovered in China, and shares noteworthy morphological similarities with Utatsusaurus hataii, particularly with regard to body size and the morphology of the probable radius. Baisesaurus robustus also represents the first record of an Early Triassic ichthyosauromorph from Guangxi Autonomous Region, extending the known geographic distribution of ichthyosauromorphs in South China.

[Toxic Effects of Long-term Exposure to PM2.5 and Protective Effects of Chitosan on Bone Marrow Hematopoietic Environment of the Mice].

OBJECTIVE: To investigate the toxic damage and possible mechanism of chronic exposure of ambient particulate matter (PM2.5) to the marrow micro-environment of the mice, and the protective effect of chitooligosaccharides. METHODS: Mice were treated with different doses (150, 300, 600 mg/kg) of chitosan after exposure to PM2.5, and then the mice were divided into: high dose group, medium dose group, low dose group according to the given dose, and the model group and the drug group were set as well. The productions of inflammatory cytokines IL-2, IL-8, TPO and VCAM-1 in marrow tissues were detected by ELISA, the expression of CXCL12 and CXCR4 protein in bone marrow tissues were measured by Western blot. RESULTS: Compared with the mice in control group, IL-2 secretion and CXCL12 expression were decreased in the bone marrow of PM2.5 infected mice, while the secretion of IL-8, TPO and VCAM-1 were significantly increased, and CXCR4 expression was significantly up-regulated (P<0.05). Compared with the mice in control group, drug group and other dose groups, IL-2 secretion in the bone marrow of the mice in high-dose group was significantly increased, and IL-8, TPO and VCAM-1 secretion were significantly decreased (P<0.05). CONCLUSION: Chronic exposure of PM2.5 shows some toxicity effect on marrow micro-environment. Chitosan oligosaccharide can reduce the pathologic damage of bone marrow and the toxicity to bone marrow microenvironment caused by PM2.5 at a certain extent.

The tuberous sclerosis complex-associated giant renal angiomyolipoma: A case report.

Renal angiomyolipoma (RAML), also referred to as renal hamartoma, is a rare benign tumor. There are two types of RAML, which include the tuberous sclerosis complex (TSC)-associated type and the sporadic type. TSC is an autosomal dominant genetic disease characterized by the growth of benign tumors in the skin, brain, kidneys, lung and heart. TSC leads to organ dysfunction, as the normal parenchyma is replaced by a variety of cell types. The current study presents a case of giant RAML in a 20-year-old female, who was hospitalized for epileptic seizures. Large abdominal lesions were detected during hospitalization. Subsequently, she underwent open mass resection and right kidney partial resection. Postoperative pathological examination confirmed that the mass was angiomyolipoma.

Flexible ureteroscopy lithotripsy combined with metallic ureteral stents for the treatment of patients with upper urinary tract calculi.

Flexible ureteroscopy lithotripsy (FURS) is the most common treatment for patients with upper urinary tract calculi (diameter, <2 cm). The purpose of this prospective study was to assess the efficacy of FURS combined with metallic ureteral stents (MUS) for the treatment of upper urinary tract calculi. A total of 38 patients with upper urinary tract calculi were recruited in the present study, to compare the efficacy between FURS and FURS combined with MUS (FURS-MUS). The results demonstrated that FURS-MUS shortened operative time compared with FURS (35.2±1.2 vs. 57.4±1.7 min, respectively; P<0.01). Data also indicated that the clearance rate in FURS-MUS and FURS was decreased from 94.5 and 87.8%, respectively (P<0.05). FURS-MUS treatment decreased the duration of postoperative hospital stay compared with FURS (4.5±0.5 vs. 7.5±1.5 days, respectively; P<0.05). These data demonstrated that FURS-MUS significantly increased postoperative inflammation score compared with FURS (6.2±0.8 vs. 4.2±1.0, respectively; P<0.05). The complication rate and blood loss exhibited no significant difference between FURS-MUS and FURS (complication rate, 6.5% vs. 5.9%, respectively; blood loss, 4.2% vs. 4.6%, respectively). FURS-MUS significantly decreased inflammatory cytokines and risk of sepsis, and improved readmission rate, stone recurrence and progression-free survival compared with patients treated with FURS. In conclusion, these data suggested that FURS-MUS may be an efficient, minimally invasive and reproducible operation for patients with upper urinary tract calculi.

Minimally Invasive Percutaneous Nephrolithotomy with a Novel Vacuum-assisted Access Sheath for obstructive calculous pyonephrosis ：A Randomized Study.

PURPOSE: To investigate the safety and efficacy of Minimally Invasive Percutaneous Nephrolithotomy (MPCNL) combined with Vacuum-assisted Access Sheath in the treatment of obstructive calculous pyonephrosis. MATERIALS AND METHODS: Seventy-six patients with obstructive calculous pyonephrosis, who were planned to receive MPCNL, were randomly divided into two groups. Group A was treated with Amplatz sheath combined with Cyberwand double probe ultrasound lithotripsy, and group B was treated with Vacuum-assisted Access Sheath (VAAS, ClearPetra, Well lead Medical) combined with holmium laser lithotripsy. The primary outcome was the operation successful rate. Other perioperative, and postoperative data such as operation time, stone free rate and complications were compared between groups. RESULTS: Single 20F access sheath was established in all cases. All patients underwent one-stage procedure. Compared with group A, group B had a higher initial stone-free rate (84.2% vs 63.1%, P= .037). The operation time of group B was 56.3 ± 19.83 min, significantly shorter than that of group A at 70.4 ± 14.83 min. The complication rate of B group was 15.8%, which was lower than that of group A (P= .035 ). Five patients (15.8 %) of group B had a postoperative fever (>38.5 ºC) (Clavien grade 2) that required additional antibiotics; whereas 8 patients (21.1 %) of group A (P= .361). There was no blood transfusion in group A, and one case in group B required transfusion. CONCLUSION: One-stage MPCNL combined with Vacuum-assisted Access Sheath and holmium laser lithotripsy is a simple, safe, effective, and ergonomically practical method for selected patients with obstructive calculous pyonephrosis.

RIRS with Vacuum-Assisted Ureteral Access Sheath versus MPCNL for the Treatment of 2-4 cm Renal Stone.

OBJECTIVE: Comparison of outcomes between RIRS with vacuum-assisted ureteral access sheath (V-UAS) and MPCNL in the treatment of renal stone. MATERIALS AND METHODS: 28 patients with 2-4 cm renal stone were treated using RIRS with 14/16 F V-UAS. The outcomes were compared to those who underwent MPCNL with 16 F Amplatz sheath using a matched-pair analysis in a 1 : 2 scenario. Matching criteria included stone size, location and laterality, gender, age, BMI, and degree of hydronephrosis. Patients' demographics, perioperative and postoperative characteristics, complications, stone-free rate (SFR), and auxiliary procedures were compared. RESULTS: Mean operative times for the RIRS and MPCNL groups were 72.4 ± 21.3 minutes and 67.4 ± 25 minutes (P = 0.042). Postoperative pain was significantly less in the RIRS group. The initial SFR was 50% for the RIRS group and 73.2% for the MPCNL group (P = 0.035). The final SFR at postoperative three months improved to 89.3% for the RIRS group and 92.9% for the MPCNL group (P = 0.681). The auxiliary procedure rates were higher in the RIRS group (42.9% vs. 25%, P = 0.095). The overall complication rate in the RIRS group was lower, but the significant difference was not found. CONCLUSION: In the treatment of 2-4 cm renal stone, using V-UAS in RIRS can improve surgical efficiency with lower postoperative early pain scores. Comparing with MPCNL, its initial SFR was more depressed, and there is still a trend towards requiring more auxiliary procedures to achieve comparable final SFR.

Erratum: MicroRNA-429 inhibits cancer cell proliferation and migration by targeting AKT1 in renal cell carcinoma.

[This corrects the article DOI: 10.3892/mco.2019.1940.].

Comparison of two different minimally invasive percutaneous nephrostomy sheaths for the treatment of staghorn stones.

OBJECTIVE: To compare the safety and effectiveness of using a conventional nephrostomy sheath (NS) vs using a new NS with suction and evacuation functions in minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of staghorn stones. PATIENTS AND METHODS: A prospective and randomised study of 60 patients with staghorn stones randomly assigned into two groups of 30 patients. One group underwent MPCNL using conventional NS, whereas the other group underwent MPCNL with suction-evacuation NS (SENS). Patient demographics, stone characteristics, intraoperative data, perioperative data, and surgical results were collected and analysed. RESULTS: The patient demographics and stone characteristics were similar amongst the two groups. The SENS group had a significantly lower peak and a significantly lower average renal pelvic pressure (RPP) throughout the procedure. The SENS group was more efficient for stone removal and had a much shorter stone treatment time, a lesser use of the stone extractor, and ultimately a higher stone-free rate (SFR). The effects of a lower RPP and shorter stone treatment time translated into less severe postoperative complications as measured per modified Clavien grade. CONCLUSION: Using SENS in MPCNL for the treatment of staghorn stones has the advantages of lower RPP, increased effectiveness in stone retrieval, decreased surgery related complications, and an improved SFR.

Use of a Novel Vacuum-Assisted Access Sheath in Minimally Invasive Percutaneous Nephrolithotomy: A Feasibility Study.

Objective: To assess the safety and efficacy of a novel vacuum-assisted access sheath (VAAS) in minimally invasive percutaneous nephrolithotomy (MPCNL). Materials and Methods: Seventy-five consecutive patients with single renal pelvic stone were treated with MPCNL combined with a novel VAAS. Patients' demographics and surgical outcomes, as well as perioperative and postoperative data, were recorded. Matched-pair analysis in a 1:1 scenario was done in patients who underwent MPCNL by peel-away access sheath (PAAS). All MPCNL was done with a rigid 12F mini-nephroscope and an 18F access sheath. MINDRAY-PM9000 monitor was used to record the renal pelvic pressure (RPP) data. Results: Patients' demographics, stone size, burden, and density (HU) were comparable between the two groups. Operative time was significantly shorter in the study group, at a mean of 32.4 ± 9.6 vs 46.2 ± 11.8 minutes (p < 0.001). The immediate stone-free rate was 89.3% for the VAAS group and 77.3% for the PAAS group (p = 0.049). Patients in the VAAS group had a lower visual analogue pain scale score at postoperative 6 and 24 hours. Mean perioperative RPP was lower in the VAAS group (10.3 ± 4.3 vs 17.8 ± 5.1 mmHg, p < 0.001). More than 50 seconds of accumulative time of high RPP (>30 mmHg) was shown in 13 patients of the VAAS group vs 30 of the PAAS group (p = 0.002). Conclusion: Combining VAAS with high-power holmium laser in MPCNL significantly improves the efficiency of stone retrieval with low RPP. This novel approach also reduces operative time, postoperative fever, and pain due to its simultaneous suction property.

MicroRNA-429 inhibits cancer cell proliferation and migration by targeting AKT1 in renal cell carcinoma.

MicroRNAs (miRNAs or miR) serve as oncogenes and tumor suppressors. In a previous study, it was revealed that has-miRNA-429 (miR-429) is a tumor suppressor in 786-O renal cell carcinoma (RCC) cells. However, its mechanism in RCC remains to be determined. The present study aimed to explain the functional role and mechanism of miR-429 in RCC pathogenesis. Luciferase reporter assays demonstrated that miR-429 overexpression reduced the transcriptional activity of AKT serine/threonine kinase 1 (AKT1). Reverse transcripton-quantitative (RT-q) PCR and western blot analysis indicated that the mRNA and protein expression of AKT1 was downregulated in 786-O RCC cell lines when miR-429 was overexpressed, indicating that miR-429 may directly target AKT1 in RCC. Therefore, miR-429 overexpression enhanced the inhibition of tumor size and weight in nude mice in vivo. The current study indicated that the novel miR-429-regulated pathway may provide insights into RCC oncogenesis and metastasis.

Mitochondrial E3 ubiquitin ligase 1 promotes autophagy flux to suppress the development of clear cell renal cell carcinomas.

Clear cell renal cell carcinoma (ccRCC) is one of the most common malignant tumors in the urinary system. Surgical intervention is the preferred treatment for ccRCC, but targeted biological therapy is required for postoperative recurrent or metastatic ccRCC. Autophagy is an intracellular degradation system for misfolded/aggregated proteins and dysfunctional organelles. Defective autophagy is associated with many diseases. Mul1 is a mitochondrion-associated E3 ubiquitin ligase and involved in the regulation of divergent pathophysiological processes such as mitochondrial dynamics, and thus affects the development of various diseases including cancers. Whether Mul1 regulates ccRCC development and what is the mechanism remain unclear. Histochemical staining and immunoblotting were used to analyze the levels of Mul1 protein in human renal tissues. Statistical analysis of information associated with tissue microarray and The Cancer Genome Atlas (TCGA) database was conducted to show the relationship between Mul1 expression and clinical features and survival of ccRCC patients. Impact of Mul1 on rates of cell growth and migration and autophagy flux were tested in cultured cancer cells. Herein we show that Mul1 promoted autophagy flux to facilitate the degradation of P62-associated protein aggresomes and adipose differentiation-related protein (ADFP)-associated lipid droplets and suppressed the growth and migration of ccRCC cells. Levels of Mul1 protein and mRNA were significantly reduced so that autophagy flux was likely blocked in ccRCC tissues, which is potentially correlated with enhancement of malignancy of ccRCC and impairment of patient survival. Therefore, Mul1 may promote autophagy to suppress the development of ccRCC.

Fever and systemic inflammatory response syndrome after retrograde intrarenal surgery: Risk factors and predictive model.

This paper investigates the characteristics of patients who underwent retrograde intrarenal surgery (RIRS) to determine the predictive factors for post-operative fever and systemic inflammatory response syndrome (SIRS) and to construct a predictive nomogram to help with risk-stratification. A retrospective study of 337 patients who underwent RIRS was performed. Fever and SIRS were defined according to a previous consensus. Multivariate logistic regression coefficients were used to generate nomograms. Post-operative fever was found in 59 patients (17.5%), and SIRS was found in 22 patients (6.5%). Septic shock developed in 2 patients (0.6%). Three patients (0.9%) suffered from obstructive hydronephrosis. By multivariate analysis, concomitant diabetes mellitus (p = 0.015), high pre-operative C-reactive protein (CRP) (p = 0.015), long surgical times (p = 0.007), high stone burden (p = 0.004) and positive stone culture (p = 0.003) were independent risk factors for fever. Only high pre-operative CRP (p = 0.001), long surgical times (p = 0.001) and high stone burden (p = 0.001) were found to significantly affect the occurrence of SIRS. Predictive nomograms were built for fever and SIRS and the c-statistics for the two predictive models were 0.766 and 0.887, respectively. All patients recovered well after proper treatment, which included antipyretics, antibiotics, and inotropic support and nephrostomy when needed. In conclusion, high stone burden, long surgical time, positive stone culture, high pre-operative CRP and the presence of diabetes mellitus was could increase the risk of fever or SIRS after RIRS for kidney stone. The constructed nomograms could help clinicians in evaluating the risk for post-operative infectious complications.

Safety and efficacy of retrograde intrarenal surgery for the treatment of renal stone in solitary kidney patients.

PURPOSE: We present our experience of retrograde intrarenal surgery (RIRS) for the treatment of renal stones in patients with solitary kidneys and evaluate the safety and efficacy of this treatment modality. MATERIALS AND METHODS: Between March 2011 and July 2015, the clinical records of 60 patients with renal stones in solitary kidneys who underwent RIRS were retrospectively reviewed. Demographic characteristics, preoperative urinary culture, blood biochemistry, stone location, and surface area were documented. The final stone-free rates (SFRs) were assessed one month after the last treatment session by computed tomography (CT). Preoperative, operative, and postoperative parameters were analyzed. Serum creatinine (Scr) and glomerular filtration rate (GFR) were measured preoperatively, one month postoperatively, and at each follow-up visit. RESULTS: The mean stone burden was 628 ± 27.2 mm2 (range 301-1199). The mean operative time was 84.4 ± 21.3 min (range 40-115). The mean drop in postoperative hemoglobin was 0.6 ± 0.21 g/dL (range 0.1-0.7). Twelve patients (20%) required second-stage RIRS for residual stones. The SFRs after the single and second procedures were 80% and 95%, respectively. The mean preoperative Scr level was 111.6 ± 45.59 µmol/L, and the mean postoperative Scr level was 96.7 ± 34.12 µmol/L. The change was statistically significant (p = .008). The same findings were observed for GFR. The mean preoperative GFR was 65.04 ± 25.37 ml/min, and the mean postoperative GFR was 76.89 ± 27.2 ml/min (p = .023). Minor complications occurred in nine patients (15%). One patient experienced septic shock and acute renal failure due to steinstrasse. This patient required hemodialysis and percutaneous nephrostomy drainage. One patient developed perirenal abscess and was treated with percutaneous drainage. CONCLUSION: RIRS is a safe and effective procedure for the treatment of renal stones in patients with solitary kidneys. RIRS did not adversely affect renal function at either the short-term or the long-term follow-up.

Metastatic prostate cancer-associated P62 inhibits autophagy flux and promotes epithelial to mesenchymal transition by sustaining the level of HDAC6.

BACKGROUND: P62 (also named sequestosome-1, SQSTM1) is involved in autophagy regulation through multiple pathways. It interacts with autophagosomes-associated LC3-II and ubiquitinated protein aggregates to engulf the aggregates in autophagosomes, interacts with HDAC6 to inhibit its deacetylase activity to maintain the levels of acetylated α-tubulin and stabilities of microtubules to enhance autophagosome trafficking, and regulates autophagy initiation and cell survival. We performed immunohistochemistry staining of P62 in prostate tissues from prostate cancer patients and found that levels of P62 in patients with prostate adenocarcinomas (PCA) are significantly higher than those in patients with benign prostate hyperplasia (BPH). High levels of P62 predict high tumor grade and high intensity of metastasis. METHODS: We created prostate cancer cell lines stably overexpressing P62 and then suppress the expression of P62 in the cell line stably overexpressing P62 with CRISPR technology. Cell proliferation assay with crystal violet, cell migration assay, cell invasion assay, Western blot analysis, and confocal fluorescent microscopy were conducted to test the impact of altered levels of P62 on the growth, migration, invasion, epithelial-to-mesenchymal transition, autophagy flux, HDAC6 activity, and microtubular acetylation of cancer cells. RESULTS: P62 increased the levels of HDAC6 and reduced the acetylation of α-tubulin and the stability of microtubules. Consequently, high levels of P62 caused a promotion of epithelial-to-mesenchymal transition in addition to an impairment of autophagy flux, and further led to an enhancement of proliferation, migration, and invasion of prostate cancer cells. CONCLUSION: P62 promotes metastasis of PCA by sustaining the level of HDAC6 to inhibit autophagy and promote epithelial-to-mesenchymal transition.

One-step dilation technique in minimally invasive percutaneous nephrolithotomy / 中国内镜杂志

Objective To evaluate the efficacy and safety of one-step dilation technique in minimally invasive percutaneous nephrolithotomy (MPCNL). Methods Clinical data of 2813 patients who underwent MPCNL by one-step dilation technique from February 2011 to March 2015 was retrospectively analyzed. Results 2813 patients were successfully underwent MPCNL by one-step dilation, including 2383 cases who were accessed by single tracts (84.71%) and 430 (15.29%) cases by multiple tracts. The mean operating time was (78.6 ± 41.1) min, the mean tract accessing time was (2.3 ± 0.8) min.The stone-free rate after one session operation was 78.59%. It improved to 91.50% one month after operation. During and after operation, 93 cases needed transfusion, 21 underwent selective renal artery embolization. Adjacent viscera damage: 9 cases with pleural lesions and 1 case with colon injury, 13 cases with urinary extravasation, perirenal hematoma in 15 cases, without liver and spleen injury. Septic shock in 2 cases, who was recovered after anti-infection treatment. Conclusion One-step dilation is safe and effective technique to establish tracts in MPCNL, which can reduce X-ray exposure and operation time, but does not increase the risk of bleeding.

One-step dilation technique in minimally invasive percutaneous nephrolithotomy / 中国内镜杂志

Objective To evaluate the efficacy and safety of one-step dilation technique in minimally invasive percutaneous nephrolithotomy (MPCNL). Methods Clinical data of 2813 patients who underwent MPCNL by one-step dilation technique from February 2011 to March 2015 was retrospectively analyzed. Results 2813 patients were successfully underwent MPCNL by one-step dilation, including 2383 cases who were accessed by single tracts (84.71%) and 430 (15.29%) cases by multiple tracts. The mean operating time was (78.6 ± 41.1) min, the mean tract accessing time was (2.3 ± 0.8) min.The stone-free rate after one session operation was 78.59%. It improved to 91.50% one month after operation. During and after operation, 93 cases needed transfusion, 21 underwent selective renal artery embolization. Adjacent viscera damage: 9 cases with pleural lesions and 1 case with colon injury, 13 cases with urinary extravasation, perirenal hematoma in 15 cases, without liver and spleen injury. Septic shock in 2 cases, who was recovered after anti-infection treatment. Conclusion One-step dilation is safe and effective technique to establish tracts in MPCNL, which can reduce X-ray exposure and operation time, but does not increase the risk of bleeding.

Defects in MAP1S-mediated autophagy turnover of fibronectin cause renal fibrosis.

Excessive deposition of extracellular matrix proteins in renal tissues causes renal fibrosis and renal function failure. Mammalian cells primarily use the autophagy-lysosome system to degrade misfolded/aggregated proteins and dysfunctional organelles. MAP1S is an autophagy activator and promotes the biogenesis and degradation of autophagosomes. Previously, we reported that MAP1S suppresses hepatocellular carcinogenesis in a mouse model and predicts a better prognosis in patients suffering from clear cell renal cell carcinomas. Furthermore, we have characterized that MAP1S enhances the turnover of fibronectin, and mice overexpressing LC3 but with MAP1S deleted accumulate fibronectin and develop liver fibrosis because of the synergistic impact of LC3-induced over-synthesis of fibronectin and MAP1S depletion-caused impairment of fibronectin degradation. Here we show that a suppression of MAP1S in renal cells caused an impairment of autophagy clearance of fibronectin and an activation of pyroptosis. Depletion of MAP1S in mice leads to an accumulation of fibrosis-related proteins and the development of renal fibrosis in aged mice. The levels of MAP1S were dramatically reduced and levels of fibronectin were greatly elevated in renal fibrotic tissues from patients diagnosed as renal atrophy and renal failure. Therefore, MAP1S deficiency may cause the accumulation of fibronectin and the development of renal fibrosis.

Mini-nephroscope combined with pressure suction: an effective tool in MPCNL for intrarenal stones in patients with urinary tract infections.

We report our experience with a mini-nephroscope connected to pressure suction as a modified minimally invasive percutaneous nephrolithotomy (MPCNL) technique to manage intrarenal stones in patients with a urinary tract infection (UTI). We used a mini-nephroscope connected to pressure suction to aspirate infected urine and reduce intrapelvic pressure. From January 2010 to June 2014, we treated 683 patients with intrarenal stones and UTI with this modified MPCNL technique in our department (Group A). Patients with an intrarenal stone and without UTI treated by this modified MPCNL (Group B, N = 422) and patients with an intrarenal stone and UTI but treated by traditional MCPNL without pressure suction (Group C, N = 95) were collected as control groups. In group A, 635 of the 683 patients (93 %) had a positive urine culture preoperatively and the other 48 patients (7 %) were diagnosed with pyonephrosis intraoperatively. The mean stone bulk was 843 ± 151.4 mm(2) and mean operative time was 71.0 ± 11.5 min. The mean stone bulk and operative time were similar to those of group B and group C. However, the rates of infectious complications for groups A (6.4 %) and B (4.9 %) were similar, but higher in group C (28.4 %). In group A, only 38 patients had fever and 6 patients developed sepsis. None of the patients showed progression to multiple organ dysfunction syndrome or died in all of patients. Our results demonstrated that this modified MPCNL technique is safe, feasible, and efficient for managing intrarenal calculi in patients with an UTI.

Fast clearance of lipid droplets through MAP1S-activated autophagy suppresses clear cell renal cell carcinomas and promotes patient survival.

Clear cell renal cell carcinoma (ccRCC) is composed of cells whose cytoplasm filled with lipid droplets, subcellular organelles coated with adipocyte differentiation-related protein (ADFP) for the storage of triacylglycerol converted from excess free fatty acids. Mammalian cells primarily use the autophagy-lysosome system to degrade misfolded/aggregated proteins and dysfunctional organelles such as lipid droplets. MAP1S (originally named C19ORF5) is an autophagy activator and promotes the biogenesis and degradation of autophagosomes. Previously, we reported that MAP1S suppresses hepatocellular carcinogenesis in a mouse model and promoted the survival of patients with prostate adenocarcinomas by increasing the degradation of aggregated proteins and dysfunctional mitochondria. Here we show that a suppression of MAP1S in renal cells causes an impairment of autophagic clearance of lipid droplets. In contrast, an overexpression of MAP1S causes an activation of autophagy flux and a reduction of lipid droplets so less DNA double strand breakage is induced. The levels of MAP1S in normal renal cells are dramatically higher than those in the ccRCC tissues and cell lines derived from renal cell carcinomas. High levels of MAP1S are associated with a reduced malignancy and metastasis of ccRCC and predict a better survival of ccRCC patients. Therefore, autophagy defects in the degradation of lipid droplets triggered by the MAP1S deficiency may enhance the initiation and development of ccRCC and reduce the survival of ccRCC patients.