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2.
Cell Transplant ; 29: 963689720943576, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32731817

RESUMO

Although 90% of clinical islet transplantations are performed via the portal vein approach, it is still far from the ideal transplant site. Alternative islet transplant sites are promising to reduce the islet dose required to reverse hyperglycemia, thereby improving the efficiency of islet transplantation. The aim of this study was to compare the differences in survival and metabolic function of islet grafts transplanted into the hepatic sinus tract (HST) and the splenic parenchyma (SP). Approximately 300 syngeneic mouse islets were transplanted into the HST (n = 6) and the SP (n = 6) of recipient diabetic mice, respectively. After transplantation, the glycemic control, glucose tolerance, and morphology of islet grafts were evaluated and compared in each group. The nonfasting blood glucose of the two groups of mice receiving islet transplantation gradually decreased to the normal range and sustained for more than 100 d. There is no significant difference in the time required to restore normoglycemia (P > 0.05). The results of the glucose tolerance test showed that the SP group presented a smaller area under the curve than the HST group (P < 0.05). Histopathological results showed that islet grafts in the HST and the SP were characterized with normal islet morphology and robust insulin production. Compared with the HST, islet transplantation in the SP presents better blood glucose regulation, although there is no significant difference in the time required to restore normoglycemia.

3.
BMC Nephrol ; 21(1): 238, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32576135

RESUMO

BACKGROUND: Renal transplant lithiasis is a rather unusual disease, and the recurrence of lithiasis presents a challenging situation. METHODS: We retrospectively analyzed the medical history of one patient who suffered renal transplant lithiasis twice, reviewed the relevant literature, and summarized the characteristics of this disease. RESULTS: We retrieved 29 relevant studies with an incidence of 0.34 to 3.26% for renal transplant lithiasis. The summarized incidence was 0.52%, and the recurrence rate was 0.082%. The mean interval after transplantation was 33.43 ± 56.70 mo. Most of the patients (28.90%) were asymptomatic. The management included percutaneous nephrolithotripsy (PCNL, 22.10%), ureteroscope (URS, 22.65%), extracorporeal shockwave lithotripsy (ESWL, 18.60%) and conservative treatment (17.13%). In our case, the patient suffered from renal transplant lithiasis at 6 years posttransplantation, and the lithiasis recurred 16 months later. He presented oliguria, infection or acute renal failure (ARF) during the two attacks but without pain. PCNL along with URS and holmium laser lithotripsy were performed. The patient recovered well after surgery, except for a 3 mm residual stone in the calyx after the second surgery. He had normal renal function without any symptoms and was discharged with oral anticalculus drugs and strict follow-up at the clinic. Fortunately, the calculus passed spontaneously about 1 month later. CONCLUSIONS: Due to the lack of specific symptoms in the early stage, patients with renal transplant lithiasis may have delayed diagnosis and present ARF. Minimally invasive treatment is optimal, and the combined usage of two or more procedures is beneficial for patients. After surgery, taking anticalculus drugs, correcting metabolic disorders and avoiding UIT are key measures to prevent the recurrence of lithiasis.

4.
Sci Total Environ ; 727: 138676, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32498186

RESUMO

Aerosols are an important contributor to global atmospheric changes and have critical effects on the climate system. Regionally, aerosols in central Asia comprise a significant portion of global aerosols. Based on aerosol optical depth (AOD)Level 2 daily product data and land cover type product data, the long-term AOD characteristics of six major land use/cover types and their relationships with landscape metrics are discussed. Contribution analysis is applied to quantitatively estimate the effects of land use/cover on regional AOD over central Asia. The results show that series of daily AODs over six land uses/covers display remarkable annual cyclic variations and obvious seasonal changes. The annual average AODs for barren land and cropland are highest, followed by regional AODs. There are different frequencies and times of occurrence for high AOD values of various land types. Urban areas are one of the major contributors to the regional atmosphere in winter; grasslands have a great influence on regional AOD decreases. Barren land always has a high contribution to the regional AOD. The land use types affected by anthropogenic activities were smaller contributors to regional aerosols than barren lands affected by climate factors. This paper advances the understanding of relationship between aerosols and land use/cover and facilitates land use decision making.

7.
J Diabetes Res ; 2020: 5860417, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32309447

RESUMO

Background: There is no clear consensus on the effect of coculture of islets with mesenchymal stem cells (MSCs) on islet function and viability. Methods: We conducted a meta-analysis of relevant studies to evaluate the effect of coculture of islets with MSCs on the function and viability of islets, both in vitro and in vivo. We searched PubMed, Embase, and Web of Science databases for all relevant studies that compared the effect of coculture of islets with MSCs on the function and viability of islets (language of publication: English; reference period: January 2000-May 2019). Data pertaining to islet function and viability, concentrations of some cytokines, and in vivo experimental outcomes were extracted and compared. Results: Twenty-four articles were included in the meta-analysis. In comparison to islets cultured alone, coculture of islets with MSCs was associated with a significantly higher islet viability [weighted mean difference (WMD), -15.59; -22.34 to -8.83; P < 0.00001], insulin level (WMD, -5.74; -9.29 to -2.19; P = 0.002), insulin secretion index (WMD, -2.45; -3.70 to -1.21; P = 0.0001), and higher concentrations of interleukin-6 (WMD, -1225.66; -2044.47 to -406.86; P = 0.003) and vascular endothelial growth factor (WMD, -1.19; -2.25 to -0.14; P = 0.03). Direct coculture of islets and MSCs significantly increased islet viability (WMD, -19.82; -26.56 to -13.07; P < 0.00001). In the in vivo experiments, coculture of islets with MSCs induced lower fasting blood glucose level (on postoperative days 21 and 28, WMD, 102.60; 27.14 to 178.05; P = 0.008 and WMD, 121.19; 49.56 to 192.82; P = 0.0009) and better glucose tolerance (blood glucose at 30 minutes after intraperitoneal injection of glucose, WMD, 85.92; 5.33 to 166.51; P = 0.04). Conclusion: Coculture of islets with MSCs improves insulin secretory function of islets and enhances islet viability. Direct coculture of two cells significantly increased islet viability. MSC-based strategy may be beneficial for clinical islet transplantation for type 1 diabetes in the future.

8.
Accid Anal Prev ; 141: 105508, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32334153

RESUMO

Traffic congestion is more likely to lead to aggressive driving behavior that is associated with increased crash risks. Previous studies mainly focus on driving behavior during congestion when studying congestion effects. However, the negative effects of congestion on driving behavior may also affect drivers' post-congestion driving. To fill this research gap, this study examined the influence of traffic congestion on driver behavior on the post-congestion roads (i.e., the roads travelled right after congestion). Twenty-five subjects participated in a driving simulation study. They were asked to complete two trials corresponding to post-congestion and non-congestion conditions, respectively. Driver behavior quantified by driving performance measures, eye movement measures, and electroencephalogram (EEG) measures was compared between the two conditions. Ten features were selected from the measures with statistical significance. The selected features were integrated to characterize drivers' response patterns using a hierarchical clustering method. The results showed that driver behavior in post-congestion situations became more aggressive, more focused in the forward area but less focused in the dashboard area, and was associated with lower power of the ß-band in the temporal brain region. The clustering results showed more aggressive and lack-of-aware response patterns while driving in post-congestion situations. This study revealed that traffic congestion negatively affected driver behavior on the post-congestion roads. Practical implications for driving safety education was discussed based on the findings from the present study.

9.
Opt Lett ; 45(6): 1362-1365, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32163966

RESUMO

Artificial neural networks have shown effectiveness in the inverse design of nanophotonic structures; however, the numerical accuracy and algorithm efficiency are not analyzed adequately in previous reports. In this Letter, we demonstrate the convolutional neural network as an inverse design tool to achieve high numerical accuracy in plasmonic metasurfaces. A comparison of the convolutional neural networks and the fully connected neural networks show that convolutional neural networks have higher generalization capabilities. We share practical guidelines for optimizing the neural network and analyzed the hierarchy of accuracy in the multi-parameter inverse design of plasmonic metasurfaces. A high inverse design accuracy of $\pm 8\;{\rm nm}$±8nm for the critical geometrical parameters is demonstrated.

11.
Front Pharmacol ; 10: 896, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31447682

RESUMO

The human islet amyloid polypeptide (hIAPP), the major component of islet amyloid deposition, is one of the amyloidogenic peptides and has been associated with ß cell loss and dysfunction in type 2 diabetes (T2D). Autophagy plays a central role in the clearance of hIAPP aggregates, thereby diminishing the hIAPP-induced cytotoxicity. Conversely, hIAPP has been reported to have interfering effects on the autophagy. The pentapeptide FLPNF developed in our previous study has been shown to have effects on the level of the downstream proteins of mTOR and autophagy-lysosome pathway. In the present study, the peptide FLPNF-mediated increase in autophagy flux and its underlying mechanisms, as well as its protecting effect on INS-1 cells, were investigated. Autophagy flux in INS-1 cells overexpressing hIAPP (hIAPP-INS-1 cells) markedly increased after exposure to peptide FLPNF for 24 h and peaked at a concentration of 200 µM. Peptide FLPNF enhanced the autophagy by inhibiting the mTORC1 activity. Flow cytometry results showed the peptide FLPNF bind to mammalian target of rapamycin (mTOR), and further molecular docking analysis revealed a direct interaction between peptide FLPNF and the FRB domain of mTOR. Meanwhile, both peptide FLPNF and rapamycin significantly decreased the hIAPP-induced apoptosis, whereas 3-MA increased the apoptosis. Furthermore, peptide FLPNF reduced the hIAPP oligomer and improved the hIAPP-INS-1 cells insulin release function at high glucose concentration. Taken together, the peptide FLPNF decreased the hIAPP oligomer via upregulating autophagy by inhibiting mTORC1 activity, thus protecting the INS-1 cells from hIAPP-induced apoptosis and improving the insulin release function of INS-1 cells.

12.
Biomed Res Int ; 2019: 4572130, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467891

RESUMO

Purpose: Acute kidney injury (AKI) is a major and severe complication following donation-after-circulatory-death (DCD) liver transplantation (LT) and is associated with increased postoperative morbidity and mortality. However, the risk factors and the prognosis factors of AKI still need to be further explored, and the relativity of intraoperative hepatic blood inflow (HBI) and AKI following LT has not been discussed yet. The purpose of this study was to investigate the correlation between HBI and AKI and to construct a prediction model of early acute kidney injury (EAKI) following DCD LT with the combination of HBI and other clinical parameters. Methods: Clinical data of 132 patients who underwent DCD liver transplantation at the first hospital of China Medical University from April 2005 to March 2017 were analyzed. Data of 105 patients (the first ten years of patients) were used to develop the prediction model. Then we assessed the clinical usefulness of the prediction models in the validation cohort (27 patients). EAKI according to Kidney Disease Improving Global Outcomes (KDIGO) criteria based on serum creatinine increase during 7-day of postoperative follow-up. Results: After Least Absolute Shrinkage and Selection Operator (LASSO) regression and simplification, a simplified prediction model consisting of the Child-Turcotte-Pugh (CTP) score (p=0.033), anhepatic phase (p=0.014), packed red blood cell (pRBC) transfusion (p=0.027), and the HBI indexed by height (HBI/h) (p=0.002) was established. The C-indexes of the model in the development and validation cohort were 0.823 [95% CI, 0.738-0.908] and 0.921 [95% CI, 0.816-1.000], respectively. Conclusions: In this study, we demonstrated the utility of HBI/h as a predictor for EAKI following DCD LT, as well as the clinical usefulness of the prediction model through the combination of the CTP score, anhepatic phase, pRBC transfusion and HBI/h.


Assuntos
Lesão Renal Aguda/diagnóstico , Complicações Intraoperatórias/diagnóstico , Transplante de Fígado/efeitos adversos , Fígado/irrigação sanguínea , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Adulto , Creatinina/metabolismo , Feminino , Sobrevivência de Enxerto , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Obtenção de Tecidos e Órgãos
13.
Asian J Urol ; 6(3): 217-221, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297312

RESUMO

Objective: To examine differences in outcomes of semi-rigid ureteroscopy (URS) with or without a modified-ureteral-access-sheath (mUAS) to treat large upper ureteral stones. Methods: Patients with single, radio-opaque large upper ureteral stone (≥10 mm) treated using semi-rigid URS between August 2013 and October 2016 were retrospectively evaluated. The stone-free status was determined from Kidney-ureter-bladder (KUB) X-ray films taken on postoperative Day 1 and after 1 month. Results: Of 103 patients meeting inclusion criteria, 43 (41.75%) and 60 (58.25%) were treated with semi-rigid URS with and without mUAS, respectively. The immediate stone-free rate (SFR) for the mUAS group was significantly higher than the non-mUAS group (40 [93.0%] vs. 46 [76.7%]; p = 0.033). The SFR at 1 month was also high for patients treated using mUAS, but not statistically different from patients not treated with mUAS (41 [95.3%] mUAS vs. 51 [85.0%] non-mUAS; p = 0.115). Auxiliary procedure rates were significantly lower for mUAS patients compared to non-mUAS patients (2 [4.7%] vs. 14 [23.3%]; p = 0.01). There were no significant differences in surgical duration and hospital stays, and the overall complication rates were statistically similar for mUAS patients compared to non-mUAS patients (1 [2.3%] vs. 3 [5.0%]; p = 0.638). Conclusion: Application of mUAS to treat large upper ureteric stones was associated with higher immediate SFR and final SFR, and lower auxiliary procedure rates relative to patients treated without use of mUAS. Moreover, the use of mUAS did not lengthen operation duration or hospital stays.

14.
EBioMedicine ; 45: 231-250, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31202812

RESUMO

BACKGROUND: Epidemiological evidence of over 9000 people suggests that daily intake of vinegar whose principal bioactive component is acetic acid is associated with a reduced risk of nephrolithiasis. The underlying mechanism, however, remains largely unknown. METHODS: We examined the in vitro and in vivo anti-nephrolithiasis effects of vinegar and acetate. A randomized study was performed to confirm the effects of vinegar in humans. FINDINGS: We found individuals with daily consumption of vinegar compared to those without have a higher citrate and a lower calcium excretion in urine, two critical molecules for calcium oxalate (CaOx) kidney stone in humans. We observed that oral administration of vinegar or 5% acetate increased citrate and reduced calcium in urinary excretion, and finally suppressed renal CaOx crystal formation in a rat model. Mechanism dissection suggested that acetate enhanced acetylation of Histone H3 in renal tubular cells and promoted expression of microRNAs-130a-3p, -148b-3p and -374b-5p by increasing H3K9, H3K27 acetylation at their promoter regions. These miRNAs can suppress the expression of Nadc1 and Cldn14, thus enhancing urinary citrate excretion and reducing urinary calcium excretion. Significantly these mechanistic findings were confirmed in human kidney tissues, suggesting similar mechanistic relationships exist in humans. Results from a pilot clinical study indicated that daily intake of vinegar reduced stone recurrence, increased citrate and reduced calcium in urinary excretion in CaOx stone formers without adverse side effects. INTERPRETATION: Vinegar prevents renal CaOx crystal formation through influencing urinary citrate and calcium excretion via epigenetic regulations. Vinegar consumption is a promising strategy to prevent CaOx nephrolithiasis occurrence and recurrence. FUND: National Natural Science Foundations of China and National Natural Science Foundation of Guangdong Province.


Assuntos
Ácido Acético/administração & dosagem , Epigênese Genética/genética , Cálculos Renais/dietoterapia , Nefrolitíase/dietoterapia , Adulto , Animais , Cálcio/urina , Oxalato de Cálcio/urina , Claudinas/genética , Transportadores de Ácidos Dicarboxílicos/genética , Epigênese Genética/efeitos dos fármacos , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Histonas/genética , Humanos , Cálculos Renais/genética , Cálculos Renais/prevenção & controle , Cálculos Renais/urina , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Nefrolitíase/genética , Nefrolitíase/prevenção & controle , Nefrolitíase/urina , Transportadores de Ânions Orgânicos Dependentes de Sódio/genética , Ratos , Recidiva , Simportadores/genética
15.
Int. braz. j. urol ; 45(3): 617-620, May-June 2019.
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1012325

RESUMO

ABSTRACT Objective: Pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). However, the failure rate of pyeloplasty is as high as 10% and repeat pyeloplasty is more difficult. This study aimed to evaluate the efficacy of balloon dilatation for failed pyeloplasty in children. Materials and Methods: Between 2011 and 2017, 15 patients, aged 6 months to 14 years, were treated with balloon dilation for restenosis of UPJO after a failed pyeloplasty. Ultrasound and intravenous urography were used to evaluate the primary outcome. Success was defined as the relief of symptoms and improvement of hydronephrosis, which was identified by ultrasound at the last follow-up. Results: All patients successfully completed the operation, 13 patients by retrograde approach and 2 patients by antegrade approach. Thirteen patients were followed for a median of 15 (4 to 57) months and 2 patients were lost to follow-up. Resolution of the hydronephrosis was observed in 5 cases. The anteroposterior diameter (APD) of the pelvis decreased by an average of 12.4 ± 14.4mm. Eight patients needed another surgery. The average postoperative hospital stay was 1.78 ± 1.4 days. Two patients experienced fever after balloon dilation. No other complications were found. Conclusions: Balloon dilatation surgery is safe for children, but it is not recommended for failed pyeloplasty in that group of patients, owing to the low success rate.

16.
PeerJ ; 7: e6926, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31110930

RESUMO

Soil moisture content (SMC) is an important factor that affects agricultural development in arid regions. Compared with the space-borne remote sensing system, the unmanned aerial vehicle (UAV) has been widely used because of its stronger controllability and higher resolution. It also provides a more convenient method for monitoring SMC than normal measurement methods that includes field sampling and oven-drying techniques. However, research based on UAV hyperspectral data has not yet formed a standard procedure in arid regions. Therefore, a universal processing scheme is required. We hypothesized that combining pretreatments of UAV hyperspectral imagery under optimal indices and a set of field observations within a machine learning framework will yield a highly accurate estimate of SMC. Optimal 2D spectral indices act as indispensable variables and allow us to characterize a model's SMC performance and spatial distribution. For this purpose, we used hyperspectral imagery and a total of 70 topsoil samples (0-10 cm) from the farmland (2.5 × 104 m2) of Fukang City, Xinjiang Uygur AutonomousRegion, China. The random forest (RF) method and extreme learning machine (ELM) were used to estimate the SMC using six methods of pretreatments combined with four optimal spectral indices. The validation accuracy of the estimated method clearly increased compared with that of linear models. The combination of pretreatments and indices by our assessment effectively eliminated the interference and the noises. Comparing two machine learning algorithms showed that the RF models were superior to the ELM models, and the best model was PIR (R 2 val = 0.907, RMSEP = 1.477, and RPD = 3.396). The SMC map predicted via the best scheme was highly similar to the SMC map measured. We conclude that combining preprocessed spectral indices and machine learning algorithms allows estimation of SMC with high accuracy (R 2 val = 0.907) via UAV hyperspectral imagery on a regional scale. Ultimately, our program might improve management and conservation strategies for agroecosystem systems in arid regions.

17.
Opt Lett ; 44(8): 1944-1947, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30985781

RESUMO

We report on the demonstration of a 386 nm light emission and detection dual-functioning device based on nonpolar a-plane n-ZnO/i-ZnO/p-Al0.1Ga0.9N heterojunction under both forward and reverse bias. The electroluminescence intensity under reverse bias is significantly stronger than that under forward bias, facilitated by carrier tunneling when the valence band of p-AlGaN aligns with the conduction band of i-ZnO under reverse bias. Also amid reverse bias, the photodetection was observed and applied in a duplex optical communication device. Optical polarization of the light emission is studied for potential polarization-sensitive device applications. The proposed device provides an important pathway for the multifunctional devices operating in a UV spectrum.

18.
Endocr Res ; 44(3): 103-109, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30773948

RESUMO

Aims: To investigate the association between body mass index (BMI) and all-cause mortality in patients with type 2 diabetes mellitus (T2DM) and to determine any sex-specific differences in this association. Methods: We retrospectively enrolled patients with T2DM and investigated the annual death data for seven years starting from 2010. All-cause mortality was calculated using Life Tables analysis. Multivariate Cox proportional hazards analysis was performed to identify the association between BMI and mortality. Results: During a mean survey period of 7.33 ± 1.42 years (X± SD), 996 of the 17259 patients enrolled died, resulting in an all-cause mortality rate of 5.77%, with no significant difference between women and men (6.04% vs. 5.56%; x2 = 1.766, P = 0.184). The top three causes of death were ischemic heart disease, cerebrovascular disease, and chronic kidney failure. A total of 87, 266, 332, and 311 patients with a BMI of <18.5, 18.5-23.99, 24.0-27.99, and ≥28.0 kg/m2, respectively, died, with the corresponding mortality rate calculated at 15.45%, 3.30%, 5.80%, and 10.70%, respectively. The BMI value associated with the highest all-cause mortality was <18.5 kg/m2, but this association was only significant in women aged <50 years (HR: 3.12; 95% CI, 1.62-4.34; P < 0.001). Conclusions: In patients with T2DM, a low BMI in women aged <50 years predicted high all-cause mortality.


Assuntos
Índice de Massa Corporal , Diabetes Mellitus Tipo 2/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida
19.
Int Braz J Urol ; 45(3): 617-620, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30676306

RESUMO

OBJECTIVE: Pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). However, the failure rate of pyeloplasty is as high as 10% and repeat pyeloplasty is more difficult. This study aimed to evaluate the efficacy of balloon dilatation for failed pyeloplasty in children. MATERIALS AND METHODS: Between 2011 and 2017, 15 patients, aged 6 months to 14 years, were treated with balloon dilation for restenosis of UPJO after a failed pyeloplasty. Ultrasound and intravenous urography were used to evaluate the primary outcome. Success was defined as the relief of symptoms and improvement of hydronephrosis, which was identified by ultrasound at the last follow-up. RESULTS: All patients successfully completed the operation, 13 patients by retrograde approach and 2 patients by antegrade approach. Thirteen patients were followed for a median of 15 (4 to 57) months and 2 patients were lost to follow-up. Resolution of the hydronephrosis was observed in 5 cases. The anteroposterior diameter (APD) of the pelvis decreased by an average of 12.4 ± 14.4mm. Eight patients needed another surgery. The average postoperative hospital stay was 1.78 ± 1.4 days. Two patients experienced fever after balloon dilation. No other complications were found. CONCLUSIONS: Balloon dilatation surgery is safe for children, but it is not recommended for failed pyeloplasty in that group of patients, owing to the low success rate.


Assuntos
Pelve Renal/cirurgia , Obstrução Ureteral/cirurgia , Cateterismo Urinário/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hidronefrose/cirurgia , Lactente , Pelve Renal/diagnóstico por imagem , Masculino , Reprodutibilidade dos Testes , Resultado do Tratamento , Ultrassonografia/métodos , Obstrução Ureteral/diagnóstico por imagem , Cateterismo Urinário/instrumentação , Urografia/métodos , Procedimentos Cirúrgicos Urológicos/instrumentação
20.
BJU Int ; 123(3): 485-492, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30253029

RESUMO

OBJECTIVES: To evaluate the long-term outcomes of patients undergoing observation of asymptomatic renal calculi and identify factors associated with stone-related events. PATIENTS AND METHODS: Patients with asymptomatic renal calculi electing active surveillance of their stones were retrospectively reviewed. Patients underwent annual ultrasonography and clinical visits with standardised questions regarding the development of symptoms or complications from calculi. Spontaneous stone passage, stone growth, development of stone-related symptoms, and requirement for intervention during follow-up were deemed as stone-related events. RESULTS: Between 2007 and 2017, 293 patients were reviewed to evaluate the natural history of asymptomatic renal calculi. The mean follow-up was 4.2 years. Overall incidences of spontaneous passage, stone growth, development of stone-related symptoms, and requirement of intervention were 32.1%, 16.7%, 28.3% and 12.3%, respectively. Stones >5 mm and lower pole stones were significantly less likely to pass spontaneously. Patients with diabetes mellitus (DM), hyperuricaemia or non-lower calyceal stone were more likely to experience stone growth. Stones >5 mm or non-lower pole stones were more likely to become symptomatic. Significant predictors of surgical intervention were stone size (>5 mm) and patients' age (>60 years). Primary therapy was extracorporeal shockwave lithotripsy in 33 patients and flexible ureteroscopy in three. CONCLUSION: The natural history of asymptomatic renal stones rarely requires intervention, although they do have a slightly higher rate of symptomatic events and growth over the intermediate term. In particular, patients with stones >5 mm, DM, hyperuricaemia, or non-lower calyceal stones are at higher risk of developing stone-related events, and should therefore be recommended for regular follow-up.


Assuntos
Cálculos Renais/diagnóstico por imagem , Litotripsia/estatística & dados numéricos , Ultrassonografia , Conduta Expectante , Adulto , Doenças Assintomáticas , Feminino , Seguimentos , Humanos , Cálculos Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
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