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1.
Vascul Pharmacol ; : 106597, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31479752

RESUMO

SUMOylation of peroxisome proliferator-activated receptor gamma (PPAR γ) plays important regulatory role in its transcriptional activity. Our recent studies in vitro found that over-SUMOylation of PPARγ, like high glucose and high fat (HG/HF), induced endothelial insulin resistance (IR). However, whether such an event occurs in rats remains unclear. Therefore, our study aimed at investigating whether PPARγ over-SUMOylation could mimic high sucrose/fat diet (HFD) to induce endothelial IR and dysfunction and explored its underlying mechanisms. Normal chow-fed rats were intravenously infected with adenoviruses carrying the wild type cDNAs encoding PPARγ, SUMO1 and PIAS1 (protein inhibitor of activated STAT1). HFD-fed rats were regarded as a positive control. Body physical and biochemical parameters, glucose tolerance and vessel function were detected. The expression and SUMOylation levels of PPARγ were measured by western blotting and co-immunoprecipitation. Our results showed that like HFD, PPARγ over-SUMOylation induced endothelial IR and dysfunction via a negative regulation of eNOS-NO pathway. More importantly, we found that PPARγ over-SUMOylation induced endogenous SUMOylation cascade and exacerbated endothelial IR and dysfunction.The findings will deepen the understanding on PPARγ SUMOylation- regulating insulin signaling network and offer a potential target for prevention and cure of diabetic vascular complications.

3.
Clin Exp Med ; 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31407099

RESUMO

The prognostic value of programed death-ligand 1 (PD-L1) in urothelial carcinoma (UC) has been assessed in previous studies, while the results remain controversial and heterogeneous. Therefore, we performed this meta-analysis to explore the prognostic effect of PD-L1 in patients with UC. PubMed, Embase and Web of Science were searched to identify the studies. Hazard ratios (HR) with 95% confidence interval (95% CI) and clinicopathological factors were extracted from included studies. A total of 1819 patients with UC from 11 published studies were incorporated. The results of meta-analysis showed that positive PD-L1 expression was significantly associated with poorer overall survival (OS) (HR 1.59, 95% CI 1.05-2.40) and disease-free survival (DFS) (HR 1.83, 95% CI 1.03-3.25), but not recurrence-free survival. Moreover, in the subgroup analysis, significant associations between PD-L1 expression and OS or DFS were found in bladder UC, the cutoff value of positive expression of PD-L1 ≥ 5% and the expression of PD-L1 on the tumor cell membrane. Interestingly, positive PD-L1 expression was correlated with poorer pathological T stage (OR 2.03, 95% CI 1.46-2.82). Our meta-analysis implies that PD-L1 might be a valuable biomarker of poor prognosis for UC, especially bladder UC, although further large-scale and well-designed studies are warranted to verify the prognostic value of PD-L1 for UC.

4.
Horm Metab Res ; 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31295749

RESUMO

Osteopontin (OPN), a secreted glycoprotein, is involved in various pathophysiological processes including immune response, inflammation, tumor formation, and metabolism. OPN exists in 2 forms, secreted-OPN (sOPN) and intracellular-OPN (iOPN). While they might have different biological activities, it remains largely unknown whether sOPN and iOPN induce the differentiation of brown adipocytes. To test this possibility, 3T3-L1 cells were induced by DMI induction with or without recombinant human OPN (rhOPN, 10, 50, 100, 200 µM), respectively. Meanwhile, another batch of 3T3-L1 cells were infected with Ad-GFP-ap2-OPN and followed by DMI differentiation. Subsequently, the infected cells were treated with either anti-CD44 antibody or immunoglobulin G (Ig G). Accumulation of lipid droplets was visualized by Oil red O staining and protein levels were assayed by western blotting analysis. The results showed that sOPN and not rhOPN, notably increased the accumulation of lipid droplets and the expression of brown adipocyte-related genes. Moreover, neutralization of CD44 partially abrogated the effects induced by sOPN. These data demonstrate that sOPN and not rhOPN has the capacity to induce the differentiation of white preadipocytes into brown adipocytes through a CD44-dependent mechanism. The findings might provide a potential target for sOPN to combat obesity.

5.
Oxid Med Cell Longev ; 2019: 5305014, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31178964

RESUMO

Females develop kidney stones less frequently than males do. However, it is unclear if this gender difference is related to altered estrogen/estrogen receptor (ER) signaling. Here, we found that ER beta (ERß) signals could suppress hepatic oxalate biosynthesis via transcriptional upregulation of the glyoxylate aminotransferase (AGT1) expression. Results from multiple in vitro renal cell lines also found that ERß could function via suppressing the oxalate-induced injury through increasing the reactive oxygen species (ROS) production that led to a decrease of the renal calcium oxalate (CaOx) crystal deposition. Mechanism study results showed that ERß suppressed oxalate-induced oxidative stress via transcriptional suppression of the NADPH oxidase subunit 2 (NOX2) through direct binding to the estrogen response elements (EREs) on the NOX2 5' promoter. We further applied two in vivo mouse models with glyoxylate-induced renal CaOx crystal deposition and one rat model with 5% hydroxyl-L-proline-induced renal CaOx crystal deposition. Our data demonstrated that mice lacking ERß (ERßKO) as well as mice or rats treated with ERß antagonist PHTPP had increased renal CaOx crystal deposition with increased urinary oxalate excretion and renal ROS production. Importantly, targeting ERß-regulated NOX2 with the NADPH oxidase inhibitor, apocynin, can suppress the renal CaOx crystal deposition in the in vivo mouse model. Together, results from multiple in vitro cell lines and in vivo mouse/rat models all demonstrate that ERß may protect against renal CaOx crystal deposition via inhibiting the hepatic oxalate biosynthesis and oxidative stress-induced renal injury.

6.
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.

7.
Int. braz. j. urol ; 45(3): 617-620, May-June 2019.
Artigo em Inglês | LILACS-Express | 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.

8.
Urolithiasis ; 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101948

RESUMO

To create an easy risk stratification to recommend the optimal subset of patients with 2-3 cm kidney stones to receive retrograde intrarenal surgery (RIRS) or mini-percutaneous nephrolithotomy (MPCNL). A retrospective patient cohort was reviewed and compared (RIRS, n = 147 and MPCNL, n = 129). Overall, RIRS group obtained a lower SFR (66% vs. 93.3%, p < 0.001) compared to MPCNL group. The RIRS group had more overall complication (12.2% vs. 8.5%) and more urosepsis (2.7% vs. 1.6%) than the MPCNL group, although there was no statistical significance. However, two patients in MPCNL group underwent embolization to treat perioperative bleeding. On multivariate analysis for RIRS group, lower calyx involved [OR 2.67], multiple calyces [OR 4.49], severe hydronephrosis [OR 2.38] were three significant predictors of SFR, which decreased from 88.8%, 70.3%, 52.1% to 25% corresponding to patients with 0, 1, 2, 3 risk predictors, respectively (p = 0.008), with a good predictive accuracy (AUC = 0.657; p = 0.002). When patients with no risk factor and patients undergoing RIRS had a similar high SFR and no possibility of bleeding, compared to matched patients undergoing MPCNL. Although generally RIRS showed a lower SFR for 2-3 cm stones compared to MPCNL, our easy risk stratification can recommend the optimal subset of patients with 2-3 cm kidney stones to receive RIRS or MPCNL. When these patients with no above-mentioned risk factors, RIRS can be first considered as an alternative to PCNL because it might be potentially less invasive and achieve a similar very high stone-free rate.

9.
Urolithiasis ; 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31062070

RESUMO

The objective of this study is to explore the efficacy and safety of mechanical percussion combined with changed patient position (MPPP) on elimination of residual stones/fragments in the upper urinary tract. The study was a systematic review and meta-analysis. A systematic literature review using Pubmed, Embase, Medline, and Cochrane Library was conducted to obtain randomized-controlled trials (RCTs) evaluating the efficacy and safety of MPPP treatment of patients with residual stones/fragments in the upper urinary tract. The retrieval of data ended in October 2018. Statistical analysis was carried out using summarized unadjusted risk ratios (RRs) with 95% confidence intervals (CIs). Seven RCTs comprising 1132 patients were included. Compared with patients in the control group, patients treated with MPPP had higher stone-free rates (SFRs) with RR 1.55 (CI 1.11-2.18; p = 0.01) and lower complication rates with RR 0.48 (CI 0.25-0.94, p = 0.03). In subgroup analysis based on stone location, the SFR for the lower calyx was significantly higher in the intervention group than in the control group: RR 1.80 (CI 1.47-2.21, p < 0.00001). In subgroup analysis based on complication type, compared with the control patients, the intervention patients had lower hematuria rate with RR 0.46 (CI 0.28-0.74, p = 0.001) and lower leucocyturia rate with RR 0.33 (CI 0.12-0.89, p = 0.03). MPPP is a worthwhile non-invasive method for elimination of residual stones/fragments in the upper urinary tract. Furthermore, we recommend MPPP for patients with residual stones or fragments located in the lower calyces.

10.
BJU Int ; 124(3): 496-503, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31136070

RESUMO

OBJECTIVE: To study the incidence of postoperative systemic inflammatory response syndrome (SIRS) following different antibiotic prophylaxis (ABP) regimens in retrograde intrarenal surgery (RIRS). PATIENTS AND METHODS: Single-centre, randomised, controlled trial (August 2014-September 2017) including 426 patients with renal stones with preoperative sterile urine managed by RIRS (ClinicalTrials.gov NCT02304822). Different ciprofloxacin-based ABP regimens were used and included a zero dose, single dose (30 min before surgery) or two doses (first dose at 30 min before RIRS and additional dose within 6 h after RIRS). The incidence of SIRS was compared using intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS: Each group enrolled 142 patients. In the ITT analysis, a zero dose of ABP was statistically similar to the two ABP regimes for the incidence of SIRS (9.9% vs single dose 4.9%, P = 0.112; vs two doses 4.2%, P = 0.062). There were also no relevant differences across groups in the PP analysis; no urosepsis was recorded. In subgroup analysis with stratification by stone area, the three regimens all had a low and similar incidence of SIRS for stones of ≤200 mm2 in the ITT analysis with a sufficient power value (5.4% vs 6.2% vs 3.6%, P = 0.945 vs single dose and P = 0.553 vs two doses). However, there was a greater chance of SIRS in patients who received no ABP with stones of >200 mm2 (18% vs single dose 4.3%, P = 0.036; vs two doses 5.5%, P = 0.044). Similar trends were seen in the PP analysis. CONCLUSIONS: For patients with preoperative sterile urine, ABP is not strongly recommended in patients with stones of ≤200 mm2 , but for stones >200 mm2 single-dose ABP is still required.

11.
PLoS One ; 14(4): e0215861, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31013336

RESUMO

BACKGROUND: There has been significant uncertainty in the selection of candidates for cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (mRCC). This report investigates the influence of site-specific metastases (bone, brain, liver, and lung) on the survival benefit of CN. METHODS: Within the Surveillance, Epidemiology and End Results database (2010-2014), 1113 mRCC patients treated with CN (n = 618) or no surgery (NS, n = 495) met the selection criteria. 168 pairs of patients using propensity scores were matched to balance the selection bias of undergoing CN. Multivariable competing risks regression analysis was used to calculate cancer-specific mortality (CSM) and overall survival (OS). Cases were subdivided to investigate the advantages of each procedure. RESULTS: Before or after matching, CN led to better OS and lower CSM in Kaplan-Meier analysis. In matched cohort, decreased CSM after CN compared to without CN were consistently found in most subgroups stratified by age, T stage, and patients with ≤2 site-specific metastases. However, patients with ≥ 3 site-specific metastases, or patients with ≥cT3 stage combined with ≥ 2 site-specific metastases were not benefit from the cytoreductive nephrectomy. CONCLUSIONS: The potential benefit of CN disappeared in patients with ≥ 3 site-specific metastases, or patients with ≥cT3 combined with ≥ 2 site-specific metastases.

12.
World J Urol ; 2019 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-31030229

RESUMO

PURPOSE: To compare the clinical efficacy and safety between the FURL with 365 µm and 200 µm holmium laser for treating nephrolithiasis. MATERIALS AND METHODS: A prospective randomized controlled trial was performed including analysis of data from 200 patients with nephrolithiasis. A total of 180 patients were randomized into two groups according to 1:1 ratio. In the 365 µm holmium laser group, kidney stones were disintegrated into less than 2 mm fragments with a 365 µm holmium laser fiber with the settings of 30-45 W under direct visualization; in the control group, the conventional 200 µm holmium laser was used. Descriptive statistics and logistic regression analyses tested the association among operation time, stone-free rate (SFR) and incidence of complications. RESULTS: Operation time in the FURL with 365 µm laser was significantly shortened and no significance was observed in the complication rate. Stone size and location were identified as two major confounding factors for the operation time and SFR. Moreover, the FURL using 365 µm laser showed less operation time for renal stones with the diameter between 1 and 2 cm, stones located in lower calyx and multiple calculi; stones larger than 2 cm and/or located in lower pole inclined to present better SFR using the FURL with 365 µm laser. CONCLUSIONS: The FURL combined with 365 µm holmium laser is safer and highly efficacious for the management of nephrolithiasis when compared to conventional FURL procedures, especially for those located in lower pole and larger than 2 cm.

13.
BJU Int ; 124(3): 395-400, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30993821

RESUMO

OBJECTIVES: To investigate the prevalence and associated factors of urolithiasis amongst Uyghur children. SUBJECTS AND METHODS: A cross-sectional survey was conducted of Uyghur children (aged ≤14 years) in the Kashgar Region of China, from July to December 2016. Children were selected by a two-stage random clustered sampling method, evaluated by urinary tract ultrasonography, low-dose computed tomography (CT) examination, blood and urine analysis, and a questionnaire. The prevalence by CT, the prevalence by self-report in the questionnaires, and the lifetime prevalence were evaluated. Binary logistic regression was used to estimate the associated factors. RESULTS: A total of 5605 children were selected and invited to participate in the study. In all, 4813 Uyghur children (2471 boys and 2342 girls), with an mean (SD; range) age of 75.79 (43.81; 2-177) months, were included in the final analysis, with a response rate of 85.9%. The prevalence of paediatric urolithiasis was 1.8% (95% confidence interval [CI] 1.5-2.2) by CT, 2.3% (95% CI 1.9-2.7) by self-report, and 3.6% (95% CI 3.0-4.1) for the overall life-time. The age-sex adjusted prevalence was 2.0% (95% CI 1.6-2.4) by CT. Binary logistic regression analysis showed that body mass index, urinary tract infection, a family history of urolithiasis, and excessive sweating could increase the risk of stone formation, whilst breast feeding and drinking water at midnight could decrease the risk. CONCLUSIONS: Urolithiasis is a major public health problem amongst Uyghur children, and strategies aimed at the prevention of urolithiasis are needed.

14.
BJU Int ; 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30958622

RESUMO

OBJECTIVES: To explore characteristics of urinary stone composition in China, and determine the effects of gender, age, body mass index (BMI), stone location and geographic region on stone composition. SUBJECTS AND METHODS: We prospectively used Fourier transform infrared spectroscopy to analyse stones from consecutive patients presenting with new-onset urolithiasis at 46 hospitals in seven geographic areas of China between June 1, 2010 and May 31, 2015.Chi-squared tests and logistic regression analyses were performed to determine associations between stone composition and gender, age, BMI, stone location, and geographic region. RESULTS: The most common stone components were calcium oxalate (CaOx; 65.9%), carbapatite (15.6%), urate (12.4%), struvite (2.7%), brushite (1.7%). CaOx and urate stones occurred more frequently in males, whereas carbapatite and struvite were more common in females (p<0.01). CaOx and carbapatite were more common in those 30-50 and 20-40 years old respectively than in other groups. Brushite and struvite were most common among those younger than 20 and older than 70 years old. The detection rate of urate increased with age,however cystine decreased with age. Obese patients were more likely to have urate stones than carbapatite or brushite stones (p<0.01). CaOx, carbapatite, brushite, and cystine stones were more frequently observed in the kidney than other types, whereas urate and struvite were more frequent in the bladder (p<0.01). Stone composition varied by geographic region. CONCLUSIONS: The most common stone compositions were CaOx, carbapatite, urate, struvite, brushite in turn. Stone composition differed significantly in patients grouped by gender, age, BMI, stone location, and geographic region. This article is protected by copyright. All rights reserved.

15.
Urolithiasis ; 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30949730

RESUMO

Kidney stone is a chronic metabolic disease that caused by many factors, especially by the metabolic disturbances of urine compositions, but the metabolic profiling of the urine from kidney stone patients remains poorly explored. In the present study, 1H NMR spectroscopy and multivariate pattern recognition analytical techniques were combined to explore the metabolic profiling of the urine from kidney stone patients. A total of 216 urine samples obtained from kidney stone patients (n = 110) and healthy controls (n = 106) were investigated. The results indicated that principal component analysis (PCA) and partial least-squares discriminant analysis (PLS-DA) models were capable of distinguishing kidney stone patients from healthy controls. In addition, a total of 15 metabolites was obviously different in concentration between the two groups. Furthermore, four metabolic pathways, including glyoxylate and dicarboxylate metabolism, glycine, serine and threonine metabolism, phenylalanine metabolism and citrate cycle (TCA cycle), were closely associated with kidney stone. Together, our results established a preliminary metabolic profiling of the urine from kidney stone patients via using 1H NMR-based analytical techniques for the first time and provided a novel method for recognizing and observing the kidney stone disease.

16.
Urol J ; 16(2): 107-114, 2019 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-30882159

RESUMO

PURPOSE: In this meta-analysis, we aimed to compared efficacy and safety of supracostal and infracostal access for percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: We included eligible studies from PubMed, EMBASE, Cochrane Library, Web of Science and China National Knowledge Infrastructure. Literature searching, quality assessment and data extraction were performed by two independent reviewers. Data were analyzed by RevMan software. Binary and continuous variables were calculated as odds ratios (OR) and mean difference (MD). RESULTS: Two prospective comparative studies and seven retrospective observational studies were included in the meta-analysis, which contained 1,024 cases of supracostal access and 1,249 cases of infracostal access for PCNL. The supracostal access resulted in a significant reduced mean hemoglobin (95% CI: 0.26-3.46, MD = 1.86 g/L, P = .02) and a higher incidence of hydrothorax (95% CI: 4.77-22.95: OR = 10.47, P < .00001) compared to infracostal access. However, there no difference between supracostal and infracostal access regarding additional procedures (95% CI: 0.70-1.69, OR = 1.09, P = .71), stone-free rate (95% CI: 0.80-1.72, OR = 1.18, P = .41), length of hospital stay (95% CI: -0.03-0.37, MD = 0.17 day, P = .10), and occurrence of fever (95% CI: 0.95-2.03, OR = 1.39, P = .09) and blood transfusion (95% CI: 0.45-1.70, OR = 0.88, P = .70). No publication bias was identified in the study. CONCLUSION: Supracostal access was effective, but not as safe as infracostal access PCNL due to a higher risk of reduced hemoglobin and hydrothorax. Therefore, infracostal access should be the preferred safe and effective approach recommended for PCNL. When a supracostal puncture is performed, essential precautions to avoid hemoglobin loss and hydrothorax should be used.

17.
Cell Death Dis ; 10(4): 275, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894518

RESUMO

Crystals can trigger a wide range of kidney injuries that may link to the development of kidney stones. Infiltrating macrophages may influence hyperoxaluria-induced intrarenal calcium oxalate (CaOx) crystals deposition, yet their linkage to sex hormones remains unclear. Here we demonstrated that suppressing the androgen receptor (AR) expression in renal tubular epithelial cells increased the macrophage recruitment/M2 polarization that may result in enhancing the phagocytosis of intrarenal CaOx crystals. Mechanism dissection suggested that AR can suppress macrophage colony-stimulating factor 1 (CSF-1) expression via increasing miRNA-185-5p expression to suppress the M2 macrophage polarization-mediated intrarenal CaOx crystals phagocytosis. The preclinical study using glyoxylate-induced intrarenal CaOx crystals deposition mouse model revealed that renal tubule-specific AR knockout mice have less intrarenal CaOx crystals deposition with more recruited M2 macrophages in the kidney compared with the wild-type mice. Results from the in vivo rat model using hydroxy-L-proline-induced CaOx crystals deposition also demonstrated that targeting the AR with ASC-J9® suppressed the intrarenal CaOx crystals deposition via increasing the renal macrophage recruitment/M2 polarization. Together, results from multiple preclinical studies using multiple in vitro cell lines and in vivo mouse/rat models all demonstrated that targeting the AR with a small molecule ASC-J9® may function via altering macrophage recruitment/M2 polarization to decrease the intrarenal CaOx crystals deposition, a key phenotype seen in many kidney stone disease patients with hyperoxaluria.

18.
PLoS One ; 14(1): e0206810, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703102

RESUMO

OBJECTIVES: To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and open surgery (OS) for surgical treatment of patients with staghorn stones based on published literatures. MATERIALS AND METHODS: A comprehensive literature search of Pubmed, Embase, CNKI and Cochrane Library was conducted to identify studies comparing outcomes of PCNL and OS for treating patients with staghorn stones up to Jan 2018. RESULTS: There was no significant difference in final-SFR between PCNL and OS (odds ratio[OR]: 1.17; 95% confidence interval [CI]: 0.64, 2.15; p = 0.61), while PCNL provided a significantly lower immediate-SFR compared with OS (OR: 0.29; 95% CI: 0.16, 0.51; P < 0.0001). PCNL provided significantly lower overall complication rate, shorter operative times, hospitalization times, less blood loss and blood transfusion compared with OS (OR: 0.59; 95% CI: 0.41, 0.84; P = 0.004), (weighted mean difference [WMD]: -59.01mins; 95% CI: -81.09, -36.93; p < 0.00001), (WMD: -5.77days; 95% CI: -7.80, -3.74; p < 0.00001), (WMD: -138.29ml; 95% CI: -244.98, -31.6; p = 0.01) and (OR: 0.44; 95% CI: 0.29, 0.68; P = 0.00002), respectively. No significant differences were found in minor complications (Clavien I-II) (OR: 0.72; 95% CI: 0.47, 1.09; p = 0.12) and major complications (Clavien III-V) (OR: 0.5; 95% CI: 0.23, 1.08; P = 0.08). In subgroup analysis, there were no significant differences for overall complications and operative times between mini-PCNL and OS. In sensitivity analysis, there was no significant difference for overall complications between PCNL and OS. CONCLUSION: Our analysis suggested that standard PCNL turns out to be a safe and feasible alternative for patients with staghorn stones compared to OS or mini-PCNL. Because of the inherent limitations of the included studies, further large sample, prospective, multi-centric and randomized control trials should be undertaken to confirm our findings.

19.
J Endourol ; 33(8): 634-638, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30722694

RESUMO

Purpose: To evaluate the safety and efficacy of new generation super-mini percutaneous nephrolithotomy (New-SMP) in the treatment of ≥20 mm renal stones. Methods: We retrospectively analyzed the New-SMP procedures (14F) performed in the cases with ≥20 mm renal stones between April 1, 2016 and July 1, 2018. The cases with ipsilateral Double-J stent and/or nephrostomy tube preoperatively, ipsilateral ureteral stone, uncorrected coagulopathy, active urinary tract infection, congenital abnormalities, and urinary diversion were excluded. Results: Of totally 188 included cases, 8 (4.3%) were children (≤14 years) and 180 (95.7%) were adults. The cases had a mean age of 47.14 ± 15.13 years, a mean stone size of 31.57 ± 9.8 mm, and a mean S.T.O.N.E score of 7.02 ± 0.73. The New-SMP took a median operative time of 35 minutes (range 6-127). A total of 173 (92%) cases received single-access-tract procedure. The drop in hematocrit was 14.62 ± 8.36 g/L after the procedure. The serum white blood cells (WBCs) increased to 2.58 ± 2.89 × 109/L. The mean hospital stay was 2.4 ± 1.5 days. New-SMP had a stone-free rate of 84% within 48 hours and 91.5% at 3 months postoperatively. Five (2.7%) cases required auxiliary procedures. The tubeless rate was 87.2%, including 44.1% cases with total tubeless, 41.5% cases with Double-J stent, and 1.6% cases with ureteral catheter. Totally 9.6% cases got fever (>38°C), 1.0% cases had urosepsis, and no cases developed shock. In addition, no transfusion and arterial embolization were required. Conclusions: New-SMP could be a safe and efficacious approach for the management of ≥20 mm renal stones. The novel modified technique and system may extend the indication of SMP to large renal stones. Further clinical studies and direct comparisons between New-SMP and other available modalities of percutaneous nephrolithotomy are required.

20.
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
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