Effect of bladder emptying status on the ureteral access sheath insertion resistance and following ureteral injury in RIRS: a prospective randomized controlled trial in academic hospital.

PURPOSE: To evaluate the effect of bladder emptying status on the ureteral access sheath (UAS) insertion resistance and following ureteral injury. METHODS: Eighty patients were enrolled and randomly divided into bladder emptying group and control group before UAS placement. A digital force gauge (Imada Z2-50N) was used to measure the resistance during the UAS insertion. The ureteral injury was evaluated and graded with Post-Ureteroscopic Lesion Scale (PULS) system at the end of procedure. The mean resistance, maximum resistance in different ureteral segments, and ureteral injury were compared between the two groups. RESULTS: The mean resistance (3.12 ± 0.49 vs. 4.28 ± 0.52 N, P < 0.001), maximum resistance in the whole procedure (5.17 ± 0.72 vs. 6.39 ± 0.96 N, P < 0.001) and distal ureter (3.07 ± 0.75 vs. 6.18 ± 1.17 N, P < 0.001) in the bladder emptying group were significantly lower when compared to the control group. In subgroup analysis, the similar result was also noted in patients with BMI ≥ 25 when compared to patients with BMI < 25, while there was no significant difference between men and women, age ≥ 50 years versus age < 50 years. The incidence of PULS 1-2 ureteral injury in the bladder emptying group was lower than the control group (35% vs. 55%, P = 0.045). The ureteral injury in distal ureteral was less frequently noted in bladder emptying group than the control group (22.5% vs. 55%, P = 0.006); however, there was no significant difference in middle and upper ureter (P > 0.05). CONCLUSION: Emptying the bladder before UAS insertion can effectively reduce the UAS insertion resistance and the risk of distal ureteral injury in RIRS.

Development and internal validation of a prediction model to evaluate the risk of severe hemorrhage following mini-percutaneous nephrolithotomy.

PURPOSE: To develop a new prediction model for assessing the severe hemorrhage events in post mini-percutaneous nephrolithotomy (mini-PCNL) patients and internally validate it, thus to guide decision making in clinical practice. METHODS: The patients who underwent mini-PCNL were retrospectively reviewed. Potential risk factors were included as prediction variables for multivariate logistic regression analysis to identify independent risk factors, and prediction model was constructed. The predictive ability of the model was evaluated using the Concordance index (C-index) and Brier score. Bootstrapping resampling technique was used to perform internal validation. The related packages in R were used to generate the web application based on the prediction model. RESULTS: Multiple-tract was the strongest predictor of severe hemorrhage following mini-PCNL. Other risk factors were none or mild hydronephrosis, congenital anomalies of urinary system, urinary tract infection, operation time and stone peak Hounsfield unit. A prediction model was constructed to assess the probability of severe hemorrhage after mini-PCNL. The C-index and Brier score were 0.731 and 0.093, respectively after correcting for optimism, which signified the excellent discrimination and calibration. CONCLUSION: A new prediction model was developed to estimate risk of severe hemorrhage after mini-PCNL. It had been internally validated with good discrimination and calibration. The prediction model might be beneficial for endourologists in surgical decision-making and risk aversion.

A bibliometric analysis of bladder cancer and microRNA research: Trends and advances from 2008 to 2022.

Bladder cancer (BC) is a significant global health issue with high incidence and mortality rates. MicroRNAs (miRNAs) play a crucial role in regulating gene expression and have been found to be dysregulated in BC. Understanding the role of miRNAs in BC development could lead to targeted therapies and improved patient management. Our study presents a thorough examination of the correlation between BC and miRNA research from 2008 to 2022. With the help of 3 powerful methods, including VOSviewer, Biblioshiny, and CiteSpace software, we analyzed the retrieved documents from "Core Collection databases online" on the Web of Science. In total, 798 articles were extracted from the Web of Science, and the number of published papers showed an upward trend from 2008 to 2019. The total number of citations was 21,233, of which the highest paper was a review article written by Chan Jiajia et al in 2018 with 752 citations. Based on the result of the coauthor analysis, Seki Naohiko was the most productive writer and China had the highest volume of published articles. Co-citation analysis was used to reveal the knowledge structure of the research field. In addition to the keywords "Bladder cancer" and "miRNA," "Proliferation," "Biomarkers," and "Apoptosis" were the high-frequency used keywords. Recently, increasingly researchers have paid more attention to the field about BC and miRNA around the worldwide. Through in-depth communication and close collaboration, the veil of miRNA in BC has gradually been unveiled. Bibliometric analysis helps to identify hotspots in research and areas for future investigation.

Translation and validation of the Chinese version of Wisconsin Stone Quality of Life questionnaire in patients with kidney stones.

BACKGROUND: Wisconsin Stone Quality of Life (WISQOL) has been designed specifically for patients with kidney stones. The present study aimed to develop the Chinese version of WISQOL and reach its validation. METHODS: The WISQOL was translated into Chinese following a standard procedure. Kidney stone patients admitted for surgical treatment were enrolled and fulfilled both WISQOL and SF-36 on the admission day and at one month postoperatively. The internal consistency, inter-domain correlation and convergent validity were analyzed. RESULTS: One hundred twenty-four 124 males and 76 females were enrolled. The total WISQOL Score and SF-36 had significant correlation both preoperatively (r=0.772, P<0.01) and postoperatively (r=0.639, P<0.01). The internal consistency of the Chinese version WISQOL's different domains ranged from 0.766 to 0.959. The value of Spearman rank correlation to assess the convergent validity of different domains ranged from 0.444 to 0.687. The postoperative WISQOL raised about 20% showing a better quality of life. CONCLUSIONS: The Chinese version of WISQOL questionnaire was a reliable tool to evaluate the health quality of life in Chinese-speaker patients with kidney stones. To evaluate its test-retest reliability, reliability and validity in a longer term, further studies are required.

Retrograde intrarenal surgery in lateral position for lower pole stone: an initial experience from Single Academic Hospital.

Retrograde intrarenal surgery (RIRS) was generally challenging in management of lower pole stone (LPS) since the unfavorable anatomy. Theoretically, LPS was prone to fall out and down to renal pelvis when patients turned to lateral position, thus to facilitate lithotripsy. The aim of the present study was to report our initial experience of RIRS in lateral position for LPS. From January 2020 to February 2021, 21 patients with LPS received RIRS in lateral position. The intraoperative finding, operation time, complications and stone-free rate (SFR) were recorded and analyzed. The mean stone size was 16.7 ± 2.4 mm, multiple stones in lower pole were noted in 38.1% (8/21) cases. The mean infundibular-pelvic angle (IPA) was 35.2 ± 6.9°, IPA less than 30° was noted in six cases (28.6%, 6/21). Mean operation time was 43.5 ± 6.3 min. Obvious stone fragments dropping from the lower calyx to renal pelvis during the lithotripsy were noted in 17 cases (81.0%). Only one case (4.8%) suffered postoperative fever (Clavien I), no severe complication (> Clavien II) was noted. Hospital stay was 1.1 ± 0.3 days, the SFR in postoperative 1 month was 85.7%. LPS was prone to fall out and down to renal pelvis when patients in lateral position, thus to facilitate the lithotripsy. RIRS in lateral position was feasible for the management of LPS; however, RCT with large sample was required to certify our initial finding.

Keratinocytes induce local tolerance to skin graft by activating interleukin-10-secreting T cells in the context of costimulation molecule B7-H1.

BACKGROUND: Intermingled skin grafting using autologous skin islets inlaid in allogeneic skin sheets was found to delay graft rejection, contributing to a significant reduction in mortality for patients with severe burns. In this study we examine the down-regulatory mechanisms underlying the effect of the autologous skin islets. METHODS: Mixed culture of lymphocytes with epidermal cells of autologous and allogeneic origin were performed with a comparing of cell activity from cytokine-knockout mice. And the Th1/Th2-related cytokine profiles were examined. RESULTS: Autologous keratinocytes act as potent inducers of suppression in the mixed culture by making a shift of the cytokine profile from Th1 to Th2. The observed suppression is predominantly mediated by interleukin (IL)-10, because the effect could be reversed by application of a neutralizing antibody to IL-10. The results of reconstitution experiments in BALB/c mice, with or without IL-10 gene-knockout, are consistent with this finding. These demonstrated that T cells were main effective components for the IL-10-related suppression. Furthermore, a newly identified member of the human B7 family (B7-H1) is found to play an important role in activating human IL-10-secreting lymphocytes. When transfected with the CD80 gene, autologous keratinocytes lost the ability to down-regulate the mixed cell culture, which effect could be reversed by introduction of the anti-CD80 antibody. CONCLUSIONS: Our study provides new evidence that autologous keratinocytes present in intermingled skin grafts are inducers for local immune tolerance by expression of B1-H1 in their activation of the IL-10-secreting T cells.

[Experimental study on the role of cytokines and keratinocytes in the survival mechanism of auto and allogeneic mixed skin grafting].

OBJECTIVE: To explore the role of cytokines and keratinocytes in the survival mechanism of mixed auto and allogeneic skin grafting. METHODS: Thirty-six SD rats were employed in the study. The rat model with mixed auto and allogeneic skin grafting and mixed human epithelial and lymphocytic culture (MELC) model were established. The change of IL-10 in the serum and the supernatant of the cultured tissue sample from the local wound was observed after the mixed skin grafting in scalded rats. And the role of epithelium in the induction of immunosuppression in vitro was monitored. RESULTS: The serum IL-10 content in the rats with mixed skin grafting (25.89 +/- 2.82 ng/L) at 7 postoperative day (POD) was evidently higher than that in normal rats (14.20 +/- 2.43 ng/L) (P < 0.05). The IL-10 content in the culture supernatant of rat tissue samples exhibited evident different during 4-14 PODs (P < 0.05-0.01), while which was no difference to that in normal rat on 21st and 28th POD. The inhibiting effects of autologous epithelia and keratinocytes in MELC system were correlated with their dosage. After the adding of autologous keratinocytes to MELC system the cytokines secreted from Th1 could induce the secretion of cytokines from Th2 by IL-10 mediation. This effect could be corrected by the addition of monoclonal antibody of IL-10. CONCLUSION: The keratinocytes inlayed in the autoskin during mixed grafting could increase the local IL-10 level by activating Th2 cells, which might be one of the important reasons of the survival of mixed skin grafting.