Outcomes of long-term follow-up of asymptomatic renal stones and prediction of stone-related events.

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.

Unraveling the prognostic significance and molecular characteristics of tumor-infiltrating B lymphocytes in clear cell renal cell carcinoma through a comprehensive bioinformatics analysis.

Introduction: Clear cell renal cell carcinoma (ccRCC) is a prevalent subtype of kidney cancer that exhibits a complex tumor microenvironment, which significantly influences tumor progression and immunotherapy response. In recent years, emerging evidence has underscored the involvement of tumor-infiltrating B lymphocytes (TIL-Bs), a crucial component of adaptive immunity, and their roles in ccRCC as compared to other tumors. Therefore, the present study endeavors to systematically explore the prognostic and molecular features of TIL-Bs in ccRCC. Methods: Initially, xCell algorithm was used to predict TIL-Bs in TCGA-KIRC and other ccRCC transcriptomic datasets. The Log-Rank test and Cox regression were applied to explore the relationship of B-cells with ccRCC survival. Then, we used WGCNA method to identify important modules related to TIL-Bs combining Consensus subcluster and scRNA-seq data analysis. To narrow down the prospective biomarkers, a prognostic signature was proposed. Next, we explored the feature of the signature individual genes and the risk-score. Finally, the potential associations of signature with clinical phenotypes and drugs were investigated. Results: Preliminary, we found ccRCC survival was negatively associated with TIL-Bs, which was confirmed by other datasets. Afterwards, ten co-expression modules were identified and a distinct ccRCC cluster was subsequently detected. Moreover, we assessed the transcriptomic alteration of B-cell in ccRCC and a relevant B-cell subtype was also pinpointed. Based on two core modules (brown, red), a 10-gene signature (TNFSF13B, SHARPIN, B3GAT3, IL2RG, TBC1D10C, STAC3, MICB, LAG3, SMIM29, CTLA4) was developed in train set and validated in test sets. These biomarkers were further investigated with regards to their differential expression and correlation with immune characteristics, along with risk-score related mutations and pathways. Lastly, we established a nomogram combined tumor grade and discovered underlying drugs according to their sensitivity response. Discussion: In our research, we elucidated the remarkable association between ccRCC and B-cells. Then, we detected several key gene modules, together with close patient subcluster and B-cell subtype,which could be responsible for the TIL-Bs in ccRCC. Moreover, we proposed a 10-gene signature and investigated its molecular features from multiple perspectives. Overall, understanding the roles of TIL-Bs could aid in the immunotherapeutic approaches for ccRCC, which deserve further research to clarify the implications for patient prognosis and treatment.

Design and development of a new type of phimosis dilatation retractor for children.

BACKGROUND: Phimosis is one of the most common diseases in children. Early selection of appropriate treatment for phimosis in children is beneficial to the development of their reproductive organs and significantly improves the prognosis of phimosis in children. Although traditional circumcision is the most widely used, it has many disadvantages, including postoperative bleeding and incision infection, pain, obvious scars on the surgical incision, and unsatisfactory appearance. In addition, there is much controversy regarding treatment options and timing at home and abroad. Surgical procedures such as circumcision and cerclage for children with excessively long foreskin will greatly affect the normal life of children after the operation. Young children need general anesthesia, but this anesthesia carries a great risk. AIM: To design a new children phimosis dilatation retractor for children phimosis. METHODS: The children phimosis was dilated with an elastic dilation frame, in order to expand the foreskin mouth and expose the penis head, and after that, the phimosis was cured. RESULTS: A new type of phimosis dilatation retractor was designed, which can gently dilate the prepuce at multiple angles and in multiple directions at the same time. It has obtained the national patent for clinical application. CONCLUSION: The phimosis dilatation retractor based on the principle of elastically expanding the prepuce can achieve the purpose of expanding the phimosis. The clinical application shows that the effect of the children phimosis retractor is significant, which is worth promoting.

Percutaneous nephrolithotomy versus open surgery for surgical treatment of patients with staghorn stones: A systematic review and meta-analysis.

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.

Externalized Ureteral Catheter Versus Double-J Stent in Tubeless Percutaneous Nephrolithotomy for Upper Urinary Stones: A Systematic Review and Meta-Analysis.

OBJECTIVE: The objective of this meta-analysis was to compare the efficacy and safety of externalized ureteral catheter (EUC) and Double-J stent (DJS) in tubeless percutaneous nephrolithotomy (PCNL) for patients with upper urinary stones based on published literature. MATERIALS AND METHODS: A comprehensive literature search using Pubmed, Embase, and Cochrane Library was performed to find studies comparing outcomes of EUC and DJS for treating patients with upper urinary stones up to December 2017. Seven studies, which included 863 patients from 5 randomized controlled trials (RCTs) and 2 non-RCTs published between 2009 and 2017, met our inclusion criteria and were included in this systematic review and meta-analysis. Between-studies heterogeneity was assessed and sensitivity analysis was conducted based on RCTs. RESULTS: The stent-related symptoms were higher for DJS compared with EUC (odds ratio [OR]: 0.09; confidence interval [95% CI]: 0.01-0.61; p = 0.01). No significant differences were found in minor (Clavien I-II) complications (OR: 1.37; 95% CI: 0.93-2.01; p = 0.11), major (Clavien III-V) complications (OR: 1.38; 95% CI: 0.73-2.60; p = 0.32), hemoglobin drop (weighted mean difference [WMD]: -1.43 g/L; 95% CI: -3.65 to 0.78; p = 0.2), pain score (VAS) (WMD: 0.01; 95% CI: -0.28 to 0.29; p = 0.95), analgesic required (OR: 1.02; 95% CI: 0.77-1.34; p = 0.91), stone-free rate (risk ratio: 0.98; 95% CI: 0.9-1.07; p = 0.67), duration of hospitalization (WMD: -0.21 days; 95% CI: -0.86 to 0.44; p = 0.53), and operative times (WMD: -7.59 minutes; 95% CI: -18.81 to 3.64; p = 0.19). CONCLUSION: We concluded that compared with DJS, EUC is also an effective alternative for patients with upper urinary stones in tubeless PCNL and could help patients by reducing stent-related discomfort and avoiding cystoscopy for DJS removal. However, the inherent limitations of the included studies should be considered, and well-designed RCTs with further large sample size should be performed to validate our findings.

TET1-mediated different transcriptional regulation in prostate cancer.

The recent studies demonstrated that the global 5-hydroxymethylcytosine (5 hmC) level decreased in prostate cancer (PCa) involved the 5-methylcytosine (5 mC) hydroxymethylase, Ten-eleven translocation (TET)1 reduction. 5 hmC and TET1 were both revealed a dual function in bivalent domain associated with developmental regulators in embryonic stem cell model. However, the mechanism underlying the DNA methylation and hydroxymethylation change mediated by TET1 downregulation in PCa remains unclear. Herein, using BSP to assess the 5 mC level in promoters of ten specific marker gene in PCa, our results present that Cdh1, Gstp1, Pten, Apc, Runx3 and Mgmt are observed to be hypermethylated in promoters and lower expression while Cyr61, Sema3c and Ptgs2 are reversed patterns compared to the normal prostate tissues. Furthermore, using ChIP methods to investigate the H3K4me3 and H3K27me3 patterns in promoters, these four markers are all demonstrated to be associated with Polycomb-repressed characterization and upregulated in response to TET1/PRC2 reduction in PCa. Thus, our findings reveal a distinct activating and repressive function of TET1-mediated transcriptional regulation in prostate cancer.