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Objective:To compare the clinical efficacy and safety of Shuo Tong ureteroscopy(ST-URS) and flexible ureteroscope(FURS)combined with holmium laser lithotripsy in the treatment of upper ureteral calculi with CT numerical value ≥ 1000 HU.Methods:A retrospective analysis of the clinical data of patients of upper ureteral calculi with CT numberical value≥1000 HU in the First Affiliated Hospital of Xiamen University was made from January 2018 to November 2020.There were 61 cases treated with ShuoTong ureteroscopy holmium laser lithotripsy (ST-URS group), including 45 males and 16 females, with 40 on the left and 21 on the right, age of(48.3±12.7) years, body mass index of(24.7±2.7)kg/m 2, the diameter of stone of(1.50±0.45)cm, and the CT numberical value of(1 288.8±179.0)(1 017-1 738)HU. There were 87 cases were treated with flexible ureteroscopy holmium laser lithotripsy (FURS group), including 58 males and 29 females, with 56 on the left and 31 on the right, age of(48.5±13.0) years, body mass index of(24.1±3.8)kg/m 2, the stone diameter of(1.45±0.40)cm, and the CT numberical value of(1 311.3±188.9)(1 009-1 817)HU. There were no significant differences in gender, age, body mass index, the location of stone, the diameter of stone and the CT numberical value of stone( P>0.05)between the two groups. For ST-URS group, a rigid ureteral channel sheath and standard mirror(F7.5/11.5)were placed under direct vision, exiting the standard mirror, leaving the channel sheath, inserting a lithotripsy mirror(F4.5/6.5)and a holmium laser[Power: 8-30 W(0.4-1.0 J/20-30 Hz)], and withdrawing the stone fragments after crushing the stone by "nibbling method" . For FURS group, a hard ureteroscope(F8/9.8)was used to explore the lesion side of the ureter, inserting a guide wire and placing a soft ureteral sheath, then inserting a flexible ureteroscope(F8)for holmium laser lithotripsy, and useing a stone basket to remove larger stone fragments. Ureteral stent was routinely indwelled after the operation. On the day 1 and 1 month after the operation, imaging examinations were performed to evaluate the stone-free rate. No residual stones or the diameter of stone was ≤0.4 cm and no urinary tract infection or any symptoms were defined as stone free. The operation time, blood loss, success rate of stage Ⅰ ureteral access sheath placement, incidence of postoperative complications, stone-free rate(SFR) at 1 day after operation, SFR at 1 month after operation, postoperative hospital stay and hospitalization costs were compared between the two groups. According to the size of calculi, the 2 groups were divided into 2 subgroups(≥1.5 cm and <1.5 cm)in order to make further analysis. The operation time, stone-free rate(SFR) at day 1 after operation and SFR at 1 month after operation were compared between the two groups. Results:The operation time of the ST-URS group was shorter than the FURS group(40.10 min vs. 49.43 min, P=0.020), and the incidence of postoperative complications was lower than the FURS group[3.28%(2/61)vs. 13.79%(12/87), P=0.031]. The SFR at day 1 after operation was significantly higher than the FURS group[60.7%(37/61)vs. 25.3%(22/87), P<0.01], and the hospitalization cost was lower than that of the FURS group(27 686 yuan vs. 32 281 yuan, P<0.010). There were no significant differences in the blood loss[(4.92±9.51)ml vs.(3.95±6.04)ml, P=0.452], success rate of stageⅠureteral access sheath placement[ 96.7%(59/61)vs. 96.6%(84/87), P=1.000], SFR at 1 month after operation[81.97%(50/61) vs. 75.86%(66/87), P=0.375] and postoperative hospital stay[(2.5±1.4)d vs.(2.4±0.8)d, P=0.543] between the two groups. When the size of calculi was ≥1.5cm, the operation time of the ST-URS group was shorter than the FURS group (43.67 min vs 55.00 min), the SFR at 1 day after operation was higher than the FURS group[40.00%(12/30)vs. 9.38%(3/32)], and the above differences are all statistically significant ( P<0.05). Conclusions:Compared with the FURS, for the treatment of upper ureteral calculi with CT numerical value ≥1000 HU, the ST-URS has shorter in operative time, lower in hospitalization cost and incidence of postoperative complications and higher SFR at day 1 after operation. The ST-URS is a safe and effective surgical technique, which is superior in the treatment of larger(≥1.5 cm) stones.
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In recent years, the incidence of single-gene nephrolithiasis has been increasing year by year. With the application of whole-genome analysis and whole-exome sequencing technology, the etiology of single-gene mutations leading to the development of urinary calculi has been extensively verified. Therefore, this article reviews the research on urinary calculi-related genetic diseases at home and abroad, and introduces transport proteins and channels; ions, protons and amino acids. The role of urinary calculi in the majority of clinicians realizes the significance of genetic testing in such diseases, thereby increasing the understanding of genetically related urinary calculi and improving the level of clinical diagnosis and treatment.
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Objective:To explore the clinical application value of 3D printing technology in percutaneous nephrolithotomy(PCNL) to complex renal calculi.Methods:The clinical data of 41 patients with complex renal calculi from May 2018 to October 2019, in the First Affiliated Hospital of Xiamen University and Xiang'an District of the First Affiliated Hospital of Xiamen University were retrospectively analyzed. There were 19 cases underwent PCNL after 3D printing (3D printing group), and 22 cases during the same period did not undergo 3D printing before operation (control group). Before operation, the two groups underwent CT plain scan enhanced examination. In 3D printing group, 3D printing technology was used to obtain 3D renal models, then 3D renal models were used for preoperative design and simulation of surgical puncture and preoperative conversation.The control group only underwent PCNL after routine examination.The ages of the patients in 3D printing group and control group were (42.9±2.5) vs. (41.3±2.9) years old, male/female ratio 11/8 vs. 12/10, body mass index (22.4±1.1) vs. (23.2±1.4) kg/m 2, serum creatinine (42.9±2.5) vs. (78.2±4.5) μmol/L, stone size (5.0±1.2) vs. (5.2±1.3) cm, the CT values of the stones was (930±210) vs.(950±200) HU. The difference of above parameters was not statistically significant ( P>0.05). The following indexes were compared between the two groups: score of questionnaire on satisfaction of preoperative conversation, and datas about operation and postopetation. Results:All the operations were successfully completed. The time of locating the target calyces in 3D printing group and control group was (3.3±1.3) vs. (5.3±3.1) min, and the coincidence of puncture calices was 94.7% (18/19) vs. 54.5%(12/22), and the stone removal rate of the 3D printing group was 78.9% (17/19) vs. 36.4% (8/22), 3D printing group was better than the control group in these respects( P < 0.05). However, there were no significant differences in postoperative complications [21.0% (4/19) vs. 13.6% (3/22)], multi-channel[89.4% (17/19) vs. 86.4% (19/22)], operation time [(121.8±20.2) vs. (132.1±18.5) min], time of hospitalization [(7.6±1.3) vs. (8.0±1.8)d] and time of extubation for renal fistula [(3.8±1.7)vs. (4.5±2.0 )d] (all P > 0.05). During preoperative conversation between the 3D printing group and the control group , the time spent on signing the consent [(17.0±3.9) vs.(21.0±3.3) min], the degree of understanding of the stone condition [(2.5±0.6)vs.(2.0±1.2) points], the degree of understanding of the PCNL surgical process and complications [(2.6±0.6) vs.(1.8±1.3) points] and the degree of satisfaction with the doctor’s preoperative conversation effects [(2.4±0.9) vs.(1.7±1.6) points]were significantly different in comparisons ( P<0.05). Conclusions:3D printing technology can be used in PCNL to directly display the internal anatomical relationship of renal calculi, guide accurate preoperative designing, help improve the operation efficiency and stone clearance rate, and can also be used as a mold in preoperative conversation to improve communication efficiency.
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Objective Explore the function and regulatory mechanism of Annexin A1 (ANXA1) in bladder cancer cell proliferation,apoptosis and migration.Methods From February 2018 to June 2019,we use T24 cells as the model and divide it into over-expression control group (ctrl),ANXA1 over-expression group (ANXA1),knockdown control group (shctrl),ANXA1 knockdown group 1 (shANXA1-1),ANXA1 knockdown group 2 (shANXA1-2) and ANXA1 knockdown group 3 (shANXA1-3).24 hours after the culture,the cells were collected and the mRNA expression level of ANXA1 was detected by Real-Time quantitative PCR.The cell activity was detected by CCK-8;the cell apoptosis and cycle were detected by flow cytometry.The cell migration was detected by Transwell assay.Results The Real-Time quantitative PCR showed that the expression of ANXA1 in the over expression group was significantly higher than that in the over expression control group (15 369.00 ± 874.20 and 1.00 ± 0.07,P ＜ 0.001).The expression of ANXA1 in the knockdown group 2 and 3 were significantly lower than that in the knockdown control group (0.51 ± 0.04,0.51 ± 0.02 and 1.00 ± 0.04,P ＜ 0.001).Compared with the over expression control group (1.61 ± 0.01),the cell activity of the over expression group(2.04 ± 0.02) was significantly increased (P ＜ 0.001),while the activity of the knockdown group 2 and 3 (1.40 ± 0.002 and 1.31 ± 0.003) were significantly decreased than the knockdown ctrl group (1.73 ± 0.01) (P ＜ 0.001).The results of flow cytometry showed that the number of G0/G1 cells in the over-expression group was significantly lower than that in the over-expression control group (28.14 ± 0.33 and 46.19 ± 0.73,P ＜ 0.001),while that in the knockdown group 2 and 3 were significantly higher than that in the knockdown control group (58.670 ± 0.49,62.34 ± 4.01 and 45.59 ± 0.19,P ＜ 0.001 and P ＜ 0.05).There was no significant difference in the number of apoptosis between the over-expression group and the over-expression control group (P ＞ 0.05),while the number of apoptosis in the knockdown group 2 and 3 were significantly higher than that in the knockdown control group (13.04％,14.58％ and 7.76％,P ＜ 0.001).Cell function analysis showed that the number of cells passing through the membrane of the over expression group was significantly higher than that of the over expression group (525.00 ± 9.30 and 385.70 ± 13.40,P ＜ 0.01),while that of the knockdown group 2 and 3 were significantly lower than that of the knockdown control group (214.70 ± 6.40,226.00 ± 5.30 and 398.70 ± 10.00,P ＜ 0.001).Conclusions Over-expression of ANXA1 significantly promoted the proliferation,cycle and migration of T24 cells and inhibited apoptosis.On the contrary,ANXA1 knockdown inhibited the proliferation,cycle and migration of T24 cells and promoted apoptosis.
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Objective@#Explore the function and regulatory mechanism of Annexin A1 (ANXA1) in bladder cancer cell proliferation, apoptosis and migration.@*Methods@#From February 2018 to June 2019, we use T24 cells as the model and divide it into over-expression control group (ctrl), ANXA1 over-expression group (ANXA1), knockdown control group (shctrl), ANXA1 knockdown group 1 (shANXA1-1), ANXA1 knockdown group 2 (shANXA1-2) and ANXA1 knockdown group 3 (shANXA1-3). 24 hours after the culture, the cells were collected and the mRNA expression level of ANXA1 was detected by Real-Time quantitative PCR. The cell activity was detected by CCK-8; the cell apoptosis and cycle were detected by flow cytometry. The cell migration was detected by Transwell assay.@*Results@#The Real-Time quantitative PCR showed that the expression of ANXA1 in the over expression group was significantly higher than that in the over expression control group (15 369.00±874.20 and 1.00±0.07, P<0.001). The expression of ANXA1 in the knockdown group 2 and 3 were significantly lower than that in the knockdown control group (0.51±0.04, 0.51±0.02 and 1.00±0.04, P<0.001). Compared with the over expression control group(1.61±0.01), the cell activity of the over expression group(2.04±0.02)was significantly increased (P<0.001), while the activity of the knockdown group 2 and 3 (1.40±0.002 and 1.31±0.003)were significantly decreased than the knockdown ctrl group (1.73±0.01)(P<0.001). The results of flow cytometry showed that the number of G0/G1 cells in the over-expression group was significantly lower than that in the over-expression control group (28.14±0.33 and 46.19±0.73, P<0.001), while that in the knockdown group 2 and 3 were significantly higher than that in the knockdown control group (58.670±0.49, 62.34±4.01 and 45.59± 0.19, P<0.001 and P<0.05). There was no significant difference in the number of apoptosis between the over-expression group and the over-expression control group (P>0.05), while the number of apoptosis in the knockdown group 2 and 3 were significantly higher than that in the knockdown control group (13.04%, 14.58% and 7.76%, P<0.001). Cell function analysis showed that the number of cells passing through the membrane of the over expression group was significantly higher than that of the over expression group (525.00±9.30 and 385.70±13.40, P<0.01), while that of the knockdown group 2 and 3 were significantly lower than that of the knockdown control group (214.70±6.40, 226.00±5.30 and 398.70±10.00, P<0.001).@*Conclusions@#Over-expression of ANXA1 significantly promoted the proliferation, cycle and migration of T24 cells and inhibited apoptosis. On the contrary, ANXA1 knockdown inhibited the proliferation, cycle and migration of T24 cells and promoted apoptosis.
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Objective To analyze the infiltration of inflammatory cells under the mucosa of female cystitis glandularis and the different inflammatory infiltration in different clinical pathological types of cystitis glandularis.Methods Immunohistochemical method was used to detect the bladder mucosal tissue samples of 10 female patients confirmed cystitis glandularis admitted from June 2016 to October 2016.The results of immunohistochemical staining were collected and statistically analyzed by the automatic microscopy and image analysis system.In addition,the clinical data and tissue sample of 49 cases of cystitis glandularis treated from December 2006 to August 2017 were collected.Age of 49 patients was (34.4 ±7.5) years old and BMI was (21.9 ± 4.2) kg/m2.There were 19 cases of hypertension and 18 cases of diabetes.According to the cystoscopic manifestations,follicular edema type,papilloma type,and intestinal adenomatosis type were defined as high risk.Chronic inflammatory type and mucosa unchanged type were defined as low risk.Immunohistochemical staining was used to detect tissue samples,to compare the general data of different types of cystitis glandularis and the degree of infiltration of bladder mucosal inflammatory cells.Results T lymphocytes were highly expressed in 10 patients,and B lymphocytes and plasma cells were not expressed or extremely low (P ＜ 0.01).Of the 49 patients,29 were high risk type cystitis glandularis (follicular edema type,papilloma type,and intestinal adenomatosis type),and 21 were low risk type (chronic inflammatory type and mucosa unchanged type).The age of the high-risk group was (34.4 ± 7.5) years old with BMI of (21.9 ±4.2) kg/m2,8 cases of hypertension and 8 cases of diabetes.The age of the low-risk group was (38.2 ±8.5) years old with BMI of (20.8 ±4.0) kg/m2,11 cases of hypertension and 10 cases of diabetes.There was no statistically significant difference between two groups (P ＞ 0.05).The OABSS of high-risk group(10.4 ± 2.6) was significantly higher than that of low-risk group (7.1 ± 2.1,P ＜ 0.01).QOL of high-risk group (4.9 ± 0.9) was significantly higher than that of low-risk group (4.1 ± 0.8,P ＜ 0.01).Qmax of high-risk group was (11.4 ± 3.6) ml/s,significantly lower than that of low-risk group[(15.8 ±3.8) ml/s,P ＜0.01].The positive number of T lymphocytes of high-risk group was (173.5 ± 26.8),which was significantly higher than that of low-risk group(119.5 ± 21.2,P ＜ 0.01).Conclusions T lymphocytes infiltration is the major phenomenon in bladder submucosa of female patients with cystitis glandularis.The inflammatory infiltration by T lymphocytes could be associated with patient's symptom and bladder's pathological changes.
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Purpose To evaluated the effect of ureteral stent placement before flexible ureteroscopic lithotripsy(FURL).Methods A systematic search of PubMed,Cochrane Library,Embase,Scopus,VIP,CNKI,Wanfang database from databases establishment to February 2017 was performed to identify all clinical trials on the effect of ureteral stenting before flexible ureteroscopic lithotripsy.The outcomes included stone-free rate,mean operative time,success rate of ureteral access sheath placement and postoperative complications.RevMan 5.3 software was used to complete the Meta statistical analysis.Results Three randomized and four non-randomized studies were analyzed,which consisted of 1 176 patients including 788 cases in experimental group,388 cases in control group.Meta-analysis showed significant differences between experimental group and control group in stone-free rate (OR =1.88,95％ CI 1.30-2.71,P ＜ 0.001).There was no statistically significant difference in mean operative time between experimental group and control group (WMD =-0.99,95 ％ CI-10.63-8.65,P =0.84).The success rate of ureteral access sheath placement was significantly higher in experimental group than that in the control group (OR =8.24,95％ CI 3.17-21.45,P ＜ 0.001).In term of postoperative complications,two groups had significant differences (OR =0.57,95 ％ CI 0.33-0.99,P =0.04).Conclusions Preoperative ureteral stenting can increase the stone-free rate and the success rate of ureteral access sheath placement,and reduce complications of FURL.There is no statistically significant difference in mean operative time.