Engineered microorganisms: A new direction in kidney stone prevention and treatment.

Numerous studies have shown that intestinal and urinary tract flora are closely related to the formation of kidney stones. The removal of probiotics represented by lactic acid bacteria and the colonization of pathogenic bacteria can directly or indirectly promote the occurrence of kidney stones. However, currently existing natural probiotics have limitations. Synthetic biology is an emerging discipline in which cells or living organisms are genetically designed and modified to have biological functions that meet human needs, or even create new biological systems, and has now become a research hotspot in various fields. Using synthetic biology approaches of microbial engineering and biological redesign to enable probiotic bacteria to acquire new phenotypes or heterologous protein expression capabilities is an important part of synthetic biology research. Synthetic biology modification of microorganisms in the gut and urinary tract can effectively inhibit the development of kidney stones by a range of means, including direct degradation of metabolites that promote stone production or indirect regulation of flora homeostasis. This article reviews the research status of engineered microorganisms in the prevention and treatment of kidney stones, to provide a new and effective idea for the prevention and treatment of kidney stones.

Ferroptosis and its emerging role in kidney stone formation.

Kidney stone is a common and highly recurrent disease in urology, and its pathogenesis is associated with various factors. However, its precise pathogenesis is still unknown. Ferroptosis describes a form of regulated cell death that is driven by unrestricted lipid peroxidation, which does not require the activation of caspase and can be suppressed by iron chelators, lipophilic antioxidants, inhibitors of lipid peroxidation, and depletion of polyunsaturated fatty acids. Recent studies have shown that ferroptosis plays a crucial role in kidney stone formation. An increasing number of studies have shown that calcium oxalate, urate, phosphate, and selenium deficiency induce ferroptosis and promote kidney stone formation through mechanisms such as oxidative stress, endoplasmic reticulum stress, and autophagy. We also offered a new direction for the downstream mechanism of ferroptosis in kidney stone formation based on the "death wave" phenomenon. We reviewed the emerging role of ferroptosis in kidney stone formation and provided new ideas for the future treatment and prevention of kidney stones.

A Novel Hydrodynamic Design Greatly Improves the Debris Clearance Rate of Flexible Ureteroscopy.

Objectives: To introduce a novel hydrodynamic design for a flexible ureteroscope that can increase stone debris clearance. Methods: Based on hydrodynamics, the new design allowed the ureteroscope to have six water jets. Fluid gushed from the six jets and would ultimately converge into an eddy. The safety and stone debris clearance efficiency were tested in a 3D-printed kidney model. Stone fragments between 0.5 and 1 mm were used to mimic the debris. A ureteroscope already approved for marketing was used as a control. Results: The new design did not change the local renal pressure and did not raise the whole renal pressure under irrigation at 80 or 100 mL/min but slightly raised it under irrigation at 120 mL/min. The pressures in the 2 g stone clearance procedures were 26.0, 33.1, and 37.5 cmH2O for the new design and 25.1, 30.2, and 39.3 cmH2O for the current design; in the 4 g stone clearance procedures, the pressures were 30.1, 37.2, and 40.0 cmH2O for the new design and 26.9, 30.8, and 39.8 cmH2O for the current design, all under conditions of 80, 100, and 120 mL/min irrigation, respectively. The new design significantly improved the stone clearance rate by ∼10-fold. It effectively cleared 2 and 4 g stones within 900 seconds under the three irrigation rates. In contrast, the current design cleared <10% of the stone debris in all tests. Conclusion: The new hydrodynamic design significantly improved the stone debris clearance rate without causing obviously increased renal pressure, and the improvement was maintained under different irrigation pressures and stone burdens.

Causal relationship of genetically predicted circulating micronutrients levels with the risk of kidney stone disease: a Mendelian randomization study.

Background: Current studies have reported conflicting associations between circulating micronutrient levels and kidney stone disease (KSD). We aimed to elucidate the causal relationship between circulating micronutrient levels and KSD by a two-sample Mendelian randomization (MR) analysis. Methods: Total of 36 single nucleotide polymorphisms (SNPs) from published genome-wide association studies (GWAS) significantly associated with eight micronutrients (vitamin B12, folic acid, magnesium, iron, phosphorus, copper, zinc, and selenium) were used as instrumental variables. The GWAS summary data associated with KSD (8,060 cases and 301,094 controls) were obtained from the FinnGen consortium. Inverse variance weighted was the main MR analysis method. MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO), weighted median and MR-Egger were used to assess pleiotropy and heterogeneity. Results: Genetically predicted circulating vitamin B12 and zinc levels were causally associated with the risk of KSD (vitamin B12: OR: 1.17, 95% CI: 1.04-1.32, p = 0.008; zinc: OR: 1.15, 95% CI: 1.03-1.28, p = 0.015). We found no evidence that other circulating micronutrients were associated with risk of KSD. p-value for Cochrane Q test, MR Egger intercept test, and MR-PRESSO were >0.05, indicating no significant heterogeneity or horizontal pleiotropy in this MR analysis. Conclusion: Increasing circulating zinc levels may increase the risk of KSD. More studies are needed to provide evidence on whether genetically predicted circulating vitamin B12 and zinc levels are a risk factor for KSD.

Efficacy and safety of Water Vapor Thermal Therapy in the treatment of benign prostate hyperplasia: a systematic review and single-arm Meta-analysis.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a common chronic condition among men aged 50 or older, causing voiding and obstructive lower urinary tract symptoms. Water vapor thermal therapy (WVTT) using the Rezum® system is a new minimally invasive surgical technique that is increasingly reported as a treatment for BPH. METHODS: The protocol was submitted to the PROSPERO registry. We searched PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov up to July 29, 2022. Quality assessment was carried out by a 20-item checklist form prepared by the Institute of Health Economics (IHE). Double arcsine transformation was performed to stabilize the variance of the original ratio. When I2 > 50%, the random effect model was used to calculate the pooled parameters. Otherwise, the fixed effect model was used. 95% confidence intervals (CIs) were calculated. A leave-one-out sensitivity analysis was performed to evaluate the impact of each study on the pooled outcomes, and finally, Egger's test was used to assess publication bias. RESULTS: A total of seven single-arm observational studies and one random controlled trial, including 1015 patients, were included. One year after WVTT, the International Prostate Symptom Score decreased by 11.37 (95% CI: -12.53, -10.21), the IPSS Quality of Life scale decreased by 2.59 (95% CI: -2.92, -2.26), the maximum urine flow rate increased by 5.26 ml/s (95% CI: 4.53, 5.99), and the postvoid residual decreased by 13.18 ml (95% CI: -24.32, -2.03). The most common complication was dysuria, with a pooled incidence of 21% (95% CI: 14%, 29%), and the second most common complication was hematuria, with a pooled incidence of 14% (95% CI: 10%, 18%). The pooled incidence of retreatment was 3% (95% CI: 2%, 5%). CONCLUSIONS: WVTT is an attractive alternative to medication or more invasive surgical procedures and can serve as first-line therapy for men with BPH.

Metabolic Profiling for the Discovery of Structurally Diverse Gibberellins and Their Precursors from the Endophytic Fungus Fusarium sp. NJ-F5.

Gibberellins (GAs) are well-known tetracyclic diterpenoid phytohormones since the 1950s. In this work, eight skeletally diverse GAs (1-8) including four new compounds (1-4), and three known ent-kaurene diterpenoids (9-11), were isolated from the endophytic fungus Fusarium sp. NJ-F5 by integrating mass spectrometry (MS)- and nuclear magnetic resonance (NMR)-based metabolic profiling. Their planar structures and stereochemistry were determined by extensive spectroscopic analyses including MS, NMR, as well as electronic circular dichroism and their calculations, together with single-crystal X-ray diffraction studies. As far as we know, this is a rare report of naturally occurring GAs and their detailed spectroscopic data including MS and NMR in recent decades. Compound 1, as a new member of GAs family, showed an obvious promoting effect on the seedling's growth ofArabidopsis thaliana.

A simple predictive model with internal validation for assessment of stone-left after ureteroscopic lithotripsy in upper ureteral stones.

Background: Stone free rate in upper ureteral stones is not as high. We sought to identify easily accessible risk factors attributing to stones left in the ureteroscopy in the treatment of upper ureteral calculi, and to build a simple and reliable predictive model. Methods: Patients treating only for upper ureteral stones in 2018 were retrospectively analyzed. Correlations between factors and the stone free rate were analyzed using bidirectional stepwise regression, curve fitting and binary logistic regression. Stone shape was judged by the gap between length and width in the two-dimensional section. A predictive nomogram model was built based on those selected variables (P<0.05). The area under the receiver operator characteristic curve (AUC) and calibration curve were used to access its discrimination and calibration. Decision curve analysis (DCA) was conducted to test the clinical usefulness. Results: Totally, 275 patients with 284 stones were enrolled in this research. Bidirectional stepwise regression showed that stone length had a significant effect on stone free, instead of width or burden. Stone shapes were also found playing a big role. Curve fitting showed that quasi-circular stones had a high risk of retropulsion, and eventually led to stone left. Finally, stone length, shape, modality, and the distance of stones to the ureteropelvic junction were enrolled in the model. Among them, the distance of the stone to the ureteropelvic junction showed a noticeable impact on stone left. AUC was 0.803 (95% CI: 0.730-0.876), and the calibration curve showed good calibration of the model (concordance index, 0.792). DCA indicated the model added net benefit to patients. Conclusions: The present predictive model based on those factors, stones length, shape, modality, and distance of the stone to the ureteropelvic junction was easy, reliable and useful.

Two new stenosis detection methods of coronary angiograms.

PURPOSE: Coronary angiography is the "gold standard" for diagnosing coronary artery disease. At present, the methods for detecting and evaluating coronary artery stenosis cannot satisfy the clinical needs, e.g., there is no prior study of detecting stenoses in prespecified vessel segments, which is necessary in clinical practice. METHODS: Two vascular stenosis detection methods are proposed to assist the diagnosis. The first one is an automatic method, which can automatically extract the entire coronary artery tree and mark all the possible stenoses. The second one is an interactive method. With this method, the user can choose any vessel segment to do further analysis of its stenoses. RESULTS: Experiments show that the proposed methods are robust for angiograms with various vessel structures. The precision, sensitivity, and [Formula: see text] score of the automatic stenosis detection method are 0.821, 0.757, and 0.788, respectively. Further investigation proves that the interactive method can provide a more precise outcome of stenosis detection, and our quantitative analysis is closer to reality. CONCLUSION: The proposed automatic method and interactive method are effective and can complement each other in clinical practice. The first method can be used for preliminary screening, and the second method can be used for further quantitative analysis. We believe the proposed solution is more suitable for the clinical diagnosis of CAD.

Dietary Niacin Requirement of Juvenile Chinese Mitten Crab, Eriocheir sinensis.

Effects of dietary niacin on the growth performance, intestinal histomorphology, body composition, and antioxidant capacity were investigated in the present study to determine the optimum requirement of niacin for juvenile Eriocheir sinensis. All 360 crabs (initial average weight 1.14 ± 0.04 g) were randomly divided into 6 groups with 3 replicates in each group and 20 crabs in each replicate. Crabs were fed with the control diet (0.89 mg/kg) or niacin-supplemented diets (170.54 mg/kg, 347.05 mg/kg, 587.59 mg/kg, 784.85 mg/kg, and 1248.86 mg/kg) for 12 weeks (named as G1, G2, G3, G4, G5, and G6, respectively). The results showed that appropriate dietary niacin (above 347.05 mg/kg) significantly increased the weight gain rate (WGR) and specific growth rate (SGR) (p < 0.05), but did not affect the survival rate (SR), feed conversion ratio (FCR), daily feeding rate (DFR), and molting frequency (MF) of crabs (p > 0.05). The niacin content in the hepatopancreas of crabs in G1 and G2 was significantly lower than that of the other four groups (p < 0.05). Moreover, dietary niacin significantly affected the intestinal histomorphology of crabs, including the number of folds (NF), height of folds (HF), height of microvillus (HMV), and thickness of muscularis (TM) (p < 0.05). Additionally, moderate dietary niacin levels significantly affected the nonspecific immune responses of crabs, by improving the activity of catalase (CAT), glutathione s-transferase (GST), glutathione peroxidase (GSH-Px), and total superoxide dismutase (T-SOD) (p < 0.05). Based on the broken-line model analysis of SGR against dietary niacin level, the dietary niacin requirement of juvenile crabs was suggested to be 419.4 mg/kg.

Segmentation and Automatic Identification of Vasculature in Coronary Angiograms.

Coronary angiography is the "gold standard" for the diagnosis of coronary heart disease, of which vessel segmentation and identification technologies are paid much attention to. However, because of the characteristics of coronary angiograms, such as the complex and variable morphology of coronary artery structure and the noise caused by various factors, there are many difficulties in these studies. To conquer these problems, we design a preprocessing scheme including block-matching and 3D filtering, unsharp masking, contrast-limited adaptive histogram equalization, and multiscale image enhancement to improve the quality of the image and enhance the vascular structure. To achieve vessel segmentation, we use the C-V model to extract the vascular contour. Finally, we propose an improved adaptive tracking algorithm to realize automatic identification of the vascular skeleton. According to our experiments, the vascular structures can be successfully highlighted and the background is restrained by the preprocessing scheme, the continuous contour of the vessel is extracted accurately by the C-V model, and it is verified that the proposed tracking method has higher accuracy and stronger robustness compared with the existing adaptive tracking method.

Effects of graded levels of starch on the non-specific immune responses, antioxidant capacities and intestinal health in Chinese mitten crab, Eriocheir inensis.

A 9-week feeding trial was conducted to investigate the effects of graded levels of dietary starch (12%, 17%, 22%, 27% and 32%) on growth, non-specific immune responses, antioxidant capacities, immunity genes expression levels and pathogen resistance in Chinese mitten crab, Eriocheir inensis (initial body weight: 10.5 ± 0.5 g). Results showed that the highest weight gain rate of crabs was obtained in group containing 22% dietary starch. The highest activity of acid phosphatase, phenoloxidase and lysozyme in blood was found in crabs fed with 22-27% dietary starch. Additionally, 17%-27% dietary starch significantly increased the activities of superoxide dismutase and glutathione peroxidase, reduced malondinaldehyde content and then increased the total antioxidant capacities in hepatopancreas of crabs. The highest activity of alanine aminotransferase and aspartate aminotransferase was found in crabs fed with 32% dietary starch, indicating that excess starch had a negative effect on the liver function of crabs. With the dietary starch level increased, the transcription factors gene expression of the pro-inflammatory factors were significantly up-regulated, and the highest ILF2, IL-16, Relish and ADAM10 was found in crabs fed with dietary 32% starch, which may potentially promote the inflammatory response in intestines. Moreover, with the dietary starch increased, the activity of phenoloxidase and lysozyme, as well as the gene expression of crustin, were all increased in crabs after challenge against Citrobacter freundii, which demonstrated that additional dietary starch could provide immune-protection and help crabs improve their resistance against pathogens. In conclusion, these results suggest that adequate dietary starch can increase growth, enhance innate immune responses and promote disease resistance, reduce oxidative stress and inflammatory response in E. inensis. Taken together, 22-27% dietary starch (25.9-30.8% dietary carbohydrate) was suggested as a digestible energy source in crabs feed.

Effects of husbandry systems and Chinese indigenous chicken strain on cecum microbial diversity.

OBJECTIVE: This study was to evaluate the effect of husbandry systems and strains on cecum microbial diversity of Jingyang chickens under the same dietary conditions. METHODS: A total of 320 laying hens (body weight, 1.70±0.15 kg; 47 weeks old) were randomly allocated to one of the four treatments: i) Silver-feathered hens in enrichment cages (SEC) with an individual cage (70×60×75 cm), ii) Silver-feathered hens in free range (SFR) with the stocking density of 1.5 chickens per ten square meters, iii) Gold-feathered hens in enrichment cages (GEC), iv) Gold-feathered hens in free range (GFR). The experiment lasted 8 weeks and the cecum fecal samples were collected for 16S rDNA high throughput sequencing at the end of experiment. RESULTS: i) The core microbiota was composed of Bacteroidetes (49% to 60%), Firmicutes (21% to 32%) and Proteobacteria (2% to 4%) at the phylum level. ii) The core bacteria were Bacteroides (26% to 31%), Rikenellaceae (9% to 16%), Parabacteroides (2% to 5%) and Lachnoclostridium (2% to 6%) at the genus level. iii) The indexes of operational taxonomic unit, Shannon, Simpson and observed species were all higher in SFR group than in SEC group while in GEC group than in GFR group, with SFR group showing the greatest diversity of cecum microorganisms among the four groups. iv) The clustering result was consistent with the strain classification, with a similar composition of cecum bacteria in the two strains of laying hens. CONCLUSION: The core microbiota were not altered by husbandry systems or strains. The free-range system increased the diversity of cecal microbes only for silver feathered hens. However, the cecum microbial composition was similar in two strain treatments under the same dietary conditions.