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1.
Urol Pract ; 11(4): 654-660, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38758183

ABSTRACT

INTRODUCTION: We sought to determine if work relative value unit differences exist between analogous, sex-specific procedures. METHODS: Representatives from the AUA and the American College of Obstetricians and Gynecologists independently reviewed the entire procedural code set and identified sex-specific procedures that had an analogous procedure in the opposite sex. These pairs were then evaluated and compared using current American Medical Association Relative Value Scale Update Committee methodology. Comparable code pair values were then examined to determine any systemic bias in the work relative value units assigned between the procedures. Mean differences and 95% confidence intervals were used to determine any differences in procedure or physician time values. The methodology used considered global period, intraservice time, total time, hospital days, postoperative office visits, and the date of the committee review. RESULTS: Of the 10 directly analogous code pairs reviewed, 7 of the female procedures had higher work relative value unit differences (range 0.29-6.47), and 3 of the male procedures had higher work relative value unit differences (range 1.23-2.34). There was no statistical difference between the code pair work relative value units. The work relative value unit per minute of intraservice time and total time were not statistically different. CONCLUSIONS: In this study, we compared operative procedures performed in women with clinically comparable operative procedures performed in men that had similar surgical approaches, global periods, and valuation methodologies. Overall, no statistical differences in work relative value units were demonstrated.


Subject(s)
Gynecologic Surgical Procedures , Relative Value Scales , Urologic Surgical Procedures , Humans , Female , Male , Urologic Surgical Procedures/statistics & numerical data , United States
2.
Asian J Urol ; 11(2): 316-323, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38680585

ABSTRACT

Objective: To identify possible stone-promoting microbes, we compared the profiles of microbes grown from stones of patients with and without metabolic syndrome (MetS). The association between MetS and urinary stone disease is well established, but the exact pathophysiologic relationship remains unknown. Recent evidence suggests urinary tract dysbiosis may lead to increased nephrolithiasis risk. Methods: At the time of percutaneous nephrolithotomy, bladder urine and stone fragments were collected from patients with and without MetS. Both sample types were subjected to expanded quantitative urine culture (EQUC) and 16 S ribosomal RNA gene sequencing. Results: Fifty-seven patients included 12 controls (21.1%) and 45 MetS patients (78.9%). Both cohorts were similar with respect to demographics and non-MetS comorbidities. No controls had uric acid stone composition. By EQUC, bacteria were detected more frequently in MetS stones (42.2%) compared to controls (8.3%) (p=0.041). Bacteria also were more abundant in stones of MetS patients compared to controls. To validate our EQUC results, we performed 16 S ribosomal RNA gene sequencing. In 12/16 (75.0%) sequence-positive stones, EQUC reliably isolated at least one species of the sequenced genera. Bacteria were detected in both "infectious" and "non-infectious" stone compositions. Conclusion: Bacteria are more common and more abundant in MetS stones than control stones. Our findings support a role for bacteria in urinary stone disease for patients with MetS regardless of stone composition.

3.
BJUI Compass ; 5(2): 304-312, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38371209

ABSTRACT

Objectives: The aim of this study is to evaluate the impact of radiologist and urologist variability on detection of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) with magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion prostate biopsies. Patients and methods: The Prospective Loyola University MRI (PLUM) Prostate Biopsy Cohort (January 2015 to December 2020) was used to identify men receiving their first MRI and MRI/TRUS fusion biopsy for suspected PCa. Clinical, MRI and biopsy data were stratified by radiologist and urologist to evaluate variation in Prostate Imaging-Reporting and Data System (PI-RADS) grading, lesion number and cancer detection. Multivariable logistic regression (MVR) models and area under the curve (AUC) comparisons assessed the relative impact of individual radiologists and urologists. Results: A total of 865 patients (469 biopsy-naïve) were included across 5 urologists and 10 radiologists. Radiologists varied with grading 15.4% to 44.8% of patients with MRI lesions as PI-RADS 3. PCa detection varied significantly by radiologist, from 34.5% to 66.7% (p = 0.003) for PCa and 17.2% to 50% (p = 0.001) for csPCa. Urologists' PCa diagnosis rates varied between 29.2% and 55.8% (p = 0.013) and between 24.6% and 39.8% (p = 0.36) for csPCa. After adjustment for case-mix on MVR, a fourfold to fivefold difference in PCa detection was observed between the highest-performing and lowest-performing radiologist (OR 0.22, 95%CI 0.10-0.47, p < 0.001). MVR demonstrated improved AUC for any PCa and csPCa detection when controlling for radiologist variation (p = 0.017 and p = 0.038), but controlling for urologist was not significant (p = 0.22 and p = 0.086). Any PCa detection (OR 1.64, 95%CI 1.06-2.55, p = 0.03) and csPCa detection (OR 1.57, 95%CI 1.00-2.48, p = 0.05) improved over time (2018-2020 vs. 2015-2017). Conclusions: Variability among radiologists in PI-RADS grading is a key area for quality improvement significantly impacting the detection of PCa and csPCa. Variability for performance of MRI-TRUS fusion prostate biopsies exists by urologist but with less impact on overall detection of csPCa.

4.
Wirel Pers Commun ; : 1-17, 2023 Apr 21.
Article in English | MEDLINE | ID: mdl-37360141

ABSTRACT

In the Covid-19 pandemic situation, the world is looking for immunity-boosting techniques for fighting against coronavirus. Every plant is medicine in one or another way, but Ayurveda explains the uses of plant-based medicines and immunity boosters for specific requirements of the human body. To help Ayurveda, botanists are trying to identify more species of medicinal immunity-boosting plants by evaluating the characteristics of the leaf. For a normal person, detecting immunity-boosting plants is a difficult task. Deep learning networks provide highly accurate results in image processing. In the medicinal plant analysis, many leaves are like each other. So, the direct analysis of leaf images using the deep learning network causes many issues for medicinal plant identification. Hence, keeping the requirement of a method at large to help all human beings, the proposed leaf shape descriptor with the deep learning-based mobile application is developed for the identification of immunity-boosting medicinal plants using a smartphone. SDAMPI algorithm explained numerical descriptor generation for closed shapes. This mobile application achieved 96%accuracy for the 64 × 64 sized images.

5.
J Endourol ; 36(10): 1382-1387, 2022 10.
Article in English | MEDLINE | ID: mdl-35620899

ABSTRACT

Background and Purpose: More than 40% of patients undergoing percutaneous nephrolithotomy (PCNL) are left with residual stone fragments and often require secondary procedures. Portable CT (PCT) technology allows surgeons to obtain intraoperative cross-sectional imaging, identify and extract residual stones immediately, and thereby reduce the need for subsequent procedures. This prospective trial evaluates how incorporation of PCT during PCNL affects perioperative outcomes. Patients and Methods: We prospectively enrolled eligible patients undergoing initial PCNL for this trial (n = 60), which entailed a single intraoperative CT abdomen and ipsilateral antegrade ureteroscopy when the surgeon felt stone treatment was visually complete. If residual fragments were identified, the surgeon continued nephroscopy to find and remove them; if not, the procedure was concluded. These patients were compared with a retrospective cohort (n = 174) who underwent initial PCNL with postoperative imaging performed the following day. Results: The two cohorts had similar demographic properties and stone characteristics, and location of percutaneous access. In the prospective arm, 50% of intraoperative PCT scans identified residual fragments, prompting continuation of surgery to remove them. This cohort had significantly higher stone-free rate (82% vs 36%, p < 0.01), lower rate of planned reintervention (7% vs 32%, p < 0.01), lower rate of urgent presentation with ureteral obstruction (0% vs 7%, p = 0.04), lower total CT-based effective radiation dose (8.4 mSv vs 14.6 mSv, p < 0.01), and shorter length of stay (2.3 days vs 3.5 days, p < 0.01) when compared with the retrospective cohort that did not use intraoperative PCT. Conclusions: Obtaining an intraoperative PCT scan during PCNL can substantially improve perioperative outcomes. Further evaluation of this modality through a randomized controlled trial is warranted. Clinical Trial Registration Number: NCT04556396.


Subject(s)
Kidney Calculi , Nephrolithotomy, Percutaneous , Nephrostomy, Percutaneous , Humans , Kidney Calculi/diagnostic imaging , Kidney Calculi/surgery , Nephrostomy, Percutaneous/methods , Prospective Studies , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome
6.
J Food Sci Technol ; 59(3): 1024-1029, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35185206

ABSTRACT

Yogurt is one of the popular dairy products produced by the bacterial fermentation of milk. Researches proved that fruit enriched Rice-based yogurt is good alternative for the traditional yogurt. Hence, four different combinations of rice-based yogurt were prepared by adding rice slurry. Rice-based yogurt containing 25% milk and 75% rice slurry scored best in microbial analysis. Count of both Streptococcus salivarius ssp. thermophilus and Lactobacillus delbrueckii ssp. bulgaricus were higher in this combination but organoleptic quality was poor. The one with 75% milk and 25% slurry scored best in organoleptic analysis as it scored high in all the characters under study. Hence the combination with 75% milk and 25% slurry was selected and was enriched with the fruit pulps of Annona, Papaya and Guava. The one with 20% Annona fruit pulp and one with 5% Papaya fruit pulp were selected as the best combinations as they got the highest overall acceptability score and the count of both the bacteria were higher in these combinations, proved that fruit enrichment doesn't affect bacteria in yogurt. Cost analysis proved that collection of fruits from wild will help to reduce the price of the yogurt. Thus, Rice-based Probiotic Yogurt with 75% milk and 25% rice slurry with 20% Annona fruit pulp and one with 5% Papaya fruit pulp were developed as best combinations and can replace normal yogurts currently available in the market with low cost.

7.
ACS Chem Biol ; 16(7): 1191-1200, 2021 07 16.
Article in English | MEDLINE | ID: mdl-34161732

ABSTRACT

Intrinsically disordered regions in proteins often function as binding motifs in protein-protein interactions. The mechanistic aspects and molecular details of such coupled binding and folding reactions, which involve formation of multiple noncovalent bonds, have been broadly studied theoretically, but experimental data are scarce. Here, using a combination of protein semisynthesis to incorporate phosphorylated amino acids, backbone amide-to-ester modifications, side chain substitutions, and binding kinetics, we examined the interaction between the intrinsically disordered motif of amyloid precursor protein (APP) and the phosphotyrosine binding (PTB) domain of Mint2. We show that the interaction is regulated by a self-inhibitory segment of the PTB domain previously termed ARM. The helical ARM linker decreases the association rate constant 30-fold through a fast pre-equilibrium between an open and a closed state. Extensive side chain substitutions combined with kinetic experiments demonstrate that the rate-limiting transition state for the binding reaction is governed by native and non-native hydrophobic interactions and hydrogen bonds. Hydrophobic interactions were found to be particularly important during crossing of the transition state barrier. Furthermore, linear free energy relationships show that the overall coupled binding and folding reaction involves cooperative formation of interactions with roughly 30% native contacts formed at the transition state. Our data support an emerging picture of coupled binding and folding reactions following overall chemical principles similar to those of folding of globular protein domains but with greater malleability of ground and transition states.


Subject(s)
Amyloid beta-Protein Precursor/metabolism , Cadherins/metabolism , Carrier Proteins/metabolism , Nerve Tissue Proteins/metabolism , Amyloid beta-Protein Precursor/chemical synthesis , Amyloid beta-Protein Precursor/genetics , Animals , Cadherins/chemical synthesis , Cadherins/genetics , Carrier Proteins/chemical synthesis , Carrier Proteins/genetics , Hydrogen Bonding , Hydrophobic and Hydrophilic Interactions , Intrinsically Disordered Proteins/chemical synthesis , Intrinsically Disordered Proteins/genetics , Intrinsically Disordered Proteins/metabolism , Kinetics , Mutation , Nerve Tissue Proteins/chemical synthesis , Nerve Tissue Proteins/genetics , Protein Binding , Protein Domains/genetics , Protein Engineering , Protein Folding , Rats , Thermodynamics
8.
J Am Chem Soc ; 143(2): 891-901, 2021 01 20.
Article in English | MEDLINE | ID: mdl-33398998

ABSTRACT

There is an urgent need for novel therapeutic approaches to treat Alzheimer's disease (AD) with the ability to both alleviate the clinical symptoms and halt the progression of the disease. AD is characterized by the accumulation of amyloid-ß (Aß) peptides which are generated through the sequential proteolytic cleavage of the amyloid precursor protein (APP). Previous studies reported that Mint2, a neuronal adaptor protein binding both APP and the γ-secretase complex, affects APP processing and formation of pathogenic Aß. However, there have been contradicting results concerning whether Mint2 has a facilitative or suppressive effect on Aß generation. Herein, we deciphered the APP-Mint2 protein-protein interaction (PPI) via extensive probing of both backbone H-bond and side-chain interactions. We also developed a proteolytically stable, high-affinity peptide targeting the APP-Mint2 interaction. We found that both an APP binding-deficient Mint2 variant and a cell-permeable PPI inhibitor significantly reduced Aß42 levels in a neuronal in vitro model of AD. Together, these findings demonstrate a facilitative role of Mint2 in Aß formation, and the combination of genetic and pharmacological approaches suggests that targeting Mint2 is a promising therapeutic strategy to reduce pathogenic Aß levels.


Subject(s)
Amyloid beta-Peptides/antagonists & inhibitors , Amyloid beta-Protein Precursor/antagonists & inhibitors , Cadherins/antagonists & inhibitors , Nerve Tissue Proteins/antagonists & inhibitors , Peptides/pharmacology , Amyloid beta-Peptides/metabolism , Amyloid beta-Protein Precursor/metabolism , Cadherins/metabolism , Humans , Nerve Tissue Proteins/metabolism , Peptides/chemical synthesis , Peptides/chemistry , Protein Binding/drug effects
9.
J Med Chem ; 64(3): 1423-1434, 2021 02 11.
Article in English | MEDLINE | ID: mdl-33502198

ABSTRACT

Despite the recent advances in cancer therapeutics, highly aggressive cancer forms, such as glioblastoma (GBM), still have very low survival rates. The intracellular scaffold protein syntenin, comprising two postsynaptic density protein-95/discs-large/zona occludens-1 (PDZ) domains, has emerged as a novel therapeutic target in highly malignant phenotypes including GBM. Here, we report the development of a novel, highly potent, and metabolically stable peptide inhibitor of syntenin, KSL-128114, which binds the PDZ1 domain of syntenin with nanomolar affinity. KSL-128114 is resistant toward degradation in human plasma and mouse hepatic microsomes and displays a global PDZ domain selectivity for syntenin. An X-ray crystal structure reveals that KSL-128114 interacts with syntenin PDZ1 in an extended noncanonical binding mode. Treatment with KSL-128114 shows an inhibitory effect on primary GBM cell viability and significantly extends survival time in a patient-derived xenograft mouse model. Thus, KSL-128114 is a novel promising candidate with therapeutic potential for highly aggressive tumors, such as GBM.


Subject(s)
Antineoplastic Agents/chemistry , Antineoplastic Agents/pharmacology , Brain Neoplasms/drug therapy , Glioblastoma/drug therapy , Peptides/chemistry , Peptides/pharmacology , Syntenins/drug effects , Animals , Cell Line, Tumor , Drug Delivery Systems , High-Throughput Screening Assays , Humans , Ligands , Mice , Microsomes/metabolism , Models, Molecular , Mutation , Protein Binding , X-Ray Diffraction , Xenograft Model Antitumor Assays
10.
Urol Pract ; 8(5): 571-575, 2021 Sep.
Article in English | MEDLINE | ID: mdl-37145393

ABSTRACT

INTRODUCTION: We sought to investigate the clinical utility of volumetric measurements in predicting passage of symptomatic ureteral calculi. METHODS: We performed a retrospective review of patients seen in the emergency department for computerized tomography-confirmed symptomatic ureteral calculi with a subsequent discharge for trial of passage. Patient demographics and results of the passage trial were recorded. Stone parameters including location, 2-dimensional linear measurements and 3-dimensional volume measurements were calculated. Univariate and multivariate analyses were performed to evaluate the association between the aforementioned stone parameters and stone passage. RESULTS: A total of 70 patients were analyzed, of whom 37 (53%) passed their stones. On univariate analysis, patients who passed their stones had shorter axial diameters (mean±SD 3.3±1.3 mm vs 5.1±1.7 mm, p <0.01) and smaller volumes (0.03±0.02 cm3 vs 0.10±0.08 cm3, p <0.01). Stones that passed had traversed 79% of the ureter on presentation, compared to 41% for the stones that did not pass (p <0.01). Multivariate analysis demonstrated that shorter axial diameter was independently associated with stone passage (OR 0.46 [CI 0.29-0.71], p <0.01). Inclusion of stone volume measurements into the logistic regression model, however, provided no additional benefit for predicting stone passage rates (p=0.28). CONCLUSIONS: Although a stone's volume is expectedly correlated with passage, it does not seem to provide additional benefit when the stone's axial diameter and location within the ureter are known. Based on our findings, additional investment of time and resources into 3-dimensional modalities may not be warranted in this setting.

11.
Int Urol Nephrol ; 53(4): 679-683, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33206338

ABSTRACT

INTRODUCTION: Proton-pump inhibitors (PPIs) may increase the risk of kidney stone formation, but the mechanism has not been elucidated. There is a paucity of literature evaluating the effects of PPIs on urinary metabolites and urine pH. METHODS: We performed a retrospective review of nephrolithiasis patients treated at our institution and compared patients who were taking PPIs to those who were not at the time of their 24-h urine collections. Hierarchical multivariate linear regression was used to evaluate the independent relationship between PPI use and urinary mineral composition. RESULTS: We identified 301 consecutive patients, 88 (29%) of whom were taking PPIs at the time of their 24-h urine collections. Patients taking PPIs were older and more likely to have medical comorbidities associated with metabolic syndrome such as hypertension, diabetes, and dyslipidemia (p < 0.01). Controlling for these factors, patients taking PPIs were found to have 12% lower 24-h urine citrate excretion (ß = - 0.12, ΔF = 4.24, p = 0.04). There were no other differences in urinary mineral composition between the groups. CONCLUSION: Our findings suggest that patients who take PPIs regularly may be at risk for decreased urinary citrate excretion. The consequent decrease in urinary citrate may become clinically significant for patients with other predisposing factors for hypocitraturia.


Subject(s)
Citric Acid/urine , Nephrolithiasis/urine , Proton Pump Inhibitors/pharmacology , Adult , Aged , Citric Acid/metabolism , Female , Humans , Male , Middle Aged , Nephrolithiasis/chemically induced , Proton Pump Inhibitors/adverse effects , Retrospective Studies
13.
Urology ; 141: 45-49, 2020 07.
Article in English | MEDLINE | ID: mdl-32294484

ABSTRACT

OBJECTIVE: To investigate the effect of kidney function on stone composition and urinary mineral excretion in patients undergoing surgical intervention for nephrolithiasis. METHODS: Using our institutional kidney stone database, we performed a retrospective review of stone patients who underwent surgical intervention between 2004 and 2015. Patients' demographic information, 24-hour urinary mineral excretion, and stone characteristics were reported. The patients' estimated glomerular filtration rates (eGFR) were compared with their stone compositions and 24-hour urine mineral excretions. RESULTS: A statistically significant difference was noted between the groups, with uric acid stones being associated with lower eGFR and calcium phosphate stones associated with higher eGFR. No relationship could be demonstrated between eGFR and calcium oxalate or struvite stones. Patients with lower eGFR also demonstrated a statistically significant association with lower urinary pH as well as lower urinary excretion of calcium and citrate. CONCLUSION: While various factors have been found to play significant roles in kidney stone formation and composition, our findings demonstrate a definite relationship between these and renal function. This paper highlights the fact that renal function evaluation should be considered an important component in the evaluation, counseling, and management of patients with nephrolithiasis.


Subject(s)
Calcium/urine , Citric Acid/urine , Glomerular Filtration Rate , Kidney Calculi/chemistry , Renal Insufficiency, Chronic/physiopathology , Adult , Calcium Oxalate/analysis , Calcium Phosphates/analysis , Creatinine/blood , Diabetes Mellitus/epidemiology , Disease Progression , Dyslipidemias/epidemiology , Female , Humans , Hypertension/epidemiology , Incidence , Kidney Calculi/surgery , Kidney Calculi/urine , Male , Middle Aged , Renal Insufficiency, Chronic/urine , Retrospective Studies , Struvite/analysis , Uric Acid/analysis
14.
World J Urol ; 38(11): 2963-2969, 2020 Nov.
Article in English | MEDLINE | ID: mdl-31982963

ABSTRACT

PURPOSE: Percutaneous nephrolithotomy (PCNL) is performed commonly in patients with large kidney stones, but the management of their postoperative pain presents a major challenge. While it is not routinely performed in PCNL patients, paravertebral block (PVB) has been described as an effective strategy for pain control after various non-urologic surgeries. This trial aims to assess the effect of paravertebral blockade on intraoperative and postoperative opioid use as well as postoperative pain control in patients undergoing PCNL. METHODS: This was a prospective, randomized, double-blind, placebo-controlled study. Patients who consented to participate were randomly assigned to undergo either PVB or a placebo intervention preoperatively. The patient, surgeon, and anesthesia team were all blinded to the randomization. The outcome parameters were intraoperative opioid requirement, postoperative visual analog scale (VAS) pain scores, postoperative opioid use, and postoperative antiemetic use. RESULTS: 23 patients were enrolled in each arm of the study, and the two groups had no significant differences in baseline demographic or clinical characteristics. Patients in the PVB group had significantly lower intraoperative opioid use, postoperative opioid use, frequency of opioid use, and antiemetic. Patients in the PVB group also had lower postoperative VAS pain scores. There were no patients who suffered from complications attributable to PVB. CONCLUSION: The results of this randomized, double-blind, placebo-controlled trial suggest that PVB should be considered an effective strategy to reduce opioid requirement and improve pain control for patients undergoing PCNL.


Subject(s)
Nephrolithotomy, Percutaneous , Nerve Block/methods , Pain, Postoperative/therapy , Adult , Aged , Double-Blind Method , Female , Humans , Male , Middle Aged , Prospective Studies , Spinal Nerves
16.
J Endourol ; 33(2): 167-172, 2019 02.
Article in English | MEDLINE | ID: mdl-30612434

ABSTRACT

INTRODUCTION: Patients admitted to the hospital with an acute, noninfected episode of urolithiasis are candidates for medical expulsive therapy, ureteral stent placement, or upfront ureteroscopy (URS). We sought to assess socioeconomic factors influencing treatment decisions in managing urolithiasis and to determine differences in outcomes based on treatment modality. MATERIALS AND METHODS: The Healthcare Cost and Utilization Project State Inpatient Database, State Ambulatory Surgery and Services Database, and State Emergency Department Database for California from 2007 to 2011 and for Florida from 2009 to 2014 were utilized. Patients who were admitted to the hospital with a primary diagnosis of kidney or ureteral stone were identified. The initial treatment modality utilized was assessed and factors that influenced that decision were analyzed. Multivariate logistic regression model was fit to determine factors independently associated with upfront URS. Lastly, outcomes of noninfected patients who underwent stent alone vs URS were compared. RESULTS: We identified 146,199 patients who had an inpatient admission with urolithiasis. Overall, 45% of patients had no intervention at the time of their evaluation. Of the 55% of patients who underwent surgical intervention, 42% underwent stent alone, 44% underwent upfront URS, 1% had a PCN tube placement, 8% underwent extracorporeal shockwave lithotripsy, while 5% underwent PCNL. On multivariate logistic regression model, minorities, younger patients, publicly uninsured patients, more comorbid patients, those admitted on the weekends, and those admitted to an academic institution had significantly lower odds of undergoing upfront URS. Secondary analysis demonstrated clinical and economic advantages of upfront URS vs stent alone in eligible patients. CONCLUSION: Upfront URS is an overlooked procedure that has clinical and cost-saving implications. Unfortunately, minorities, publicly insured patients, and those admitted on the weekend are less likely to undergo upfront URS, a disparity that should be addressed by urologist.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Healthcare Disparities , Kidney Calculi/economics , Kidney Calculi/epidemiology , Patient Admission , Adult , Databases, Factual , Female , Humans , Kidney Calculi/ethnology , Kidney Calculi/therapy , Lithotripsy, Laser/methods , Male , Middle Aged , Socioeconomic Factors , United States/epidemiology , Ureteroscopy/methods
17.
Urolithiasis ; 47(5): 441-448, 2019 Oct.
Article in English | MEDLINE | ID: mdl-30368572

ABSTRACT

Antepartum nephrolithiasis presents a complex clinical scenario which often requires an intervention such as ureteral stent or percutaneous nephrostomy tube (PCNT) placement, especially in the setting of urinary tract infection (UTI). We assess the risk of UTI and preterm labor in the setting of antepartum nephrolithiasis. A retrospective review of an administrative dataset for California and Florida was performed, which included pregnant women admitted for a delivery between 2008 and 2011. Antepartum nephrolithiasis admissions were identified, as were urological intervention (ureteral stent/ureteroscopy) or PCNT placement. Descriptive statistics were performed, as was multivariable logistic regression to identify predictors of UTI and preterm delivery. Of the 2,750,776 deliveries included in this dataset, 3904 (0.14%) were complicated by antepartum nephrolithiasis. 71.4% of these patients were managed conservatively, while 20.6% (n = 803) underwent urological intervention and 8.0% (n = 312) underwent PCNT placement. Preterm delivery rates increased from a baseline of 7.0% for patients without a stone to 9.1% for patients with stones managed conservatively, 11.2% for those undergoing a urologic intervention, and 19.6% for patients who had PCNT placement. On multivariable analysis, conservative management (adjusted odds ratio, aOR 1.3), urologic intervention (aOR 1.5), and PCNT (aOR 2.3) placement each independently increased the risk of preterm delivery (all p < 0.001). Antepartum nephrolithiasis is a condition that affects 1 in 714 women and has been correlated with increased risk of UTI and preterm labor. Intervention with ureteral stent or PCNT placement independently increase these risks, however, receipt of a nephrostomy tube confers the greatest risk of UTI and preterm delivery to the antepartum nephrolithiasis patient.


Subject(s)
Nephrolithiasis/complications , Pregnancy Complications , Premature Birth/etiology , Urinary Tract Infections/etiology , Adult , Female , Humans , Nephrolithiasis/surgery , Nephrostomy, Percutaneous , Pregnancy , Pregnancy Complications/surgery , Premature Birth/epidemiology , Retrospective Studies , Risk Assessment , Risk Factors , Stents , Ureteroscopy , Urinary Tract Infections/epidemiology , Young Adult
18.
Chembiochem ; 19(20): 2136-2145, 2018 10 18.
Article in English | MEDLINE | ID: mdl-30073762

ABSTRACT

All proteins contain characteristic backbones formed of consecutive amide bonds, which can engage in hydrogen bonds. However, the importance of these is not easily addressed by conventional technologies that only allow for side-chain substitutions. By contrast, technologies such as nonsense suppression mutagenesis and protein ligation allow for manipulation of the protein backbone. In particular, replacing the backbone amide groups with ester groups, that is, amide-to-ester mutations, is a powerful tool to examine backbone-mediated hydrogen bonds. In this minireview, we showcase examples of how amide-to-ester mutations can be used to uncover pivotal roles of backbone-mediated hydrogen bonds in protein recognition, folding, function, and structure.


Subject(s)
Amides/chemistry , Codon, Nonsense , Esters/chemistry , Proteins/chemistry , Proteins/genetics , Hydrogen Bonding , Mutagenesis , Protein Conformation , Protein Folding
19.
J Endourol ; 32(11): 1039-1043, 2018 11.
Article in English | MEDLINE | ID: mdl-30129773

ABSTRACT

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for upper tract stone burdens greater than 2 cm. Metabolic syndrome (MetS) is a constellation of conditions (diabetes mellitus, hypertension, dyslipidemia, and obesity) and is a risk factor for nephrolithiasis. Our objective was to investigate adverse cardiovascular outcomes of PCNL in patients with comorbid MetS diagnoses. MATERIALS AND METHODS: Data from the Healthcare Cost and Utilization Project State Inpatient Database for Florida and California were used to identify PCNL patients (ICD9: 55.03, 55.04) between 2007 and 2011. Patients were categorized having 0, 1-2, or 3-4 components of MetS. Postoperative myocardial infarction (MI) and inhospital mortality rate outcomes were identified. Multivariate logistic regression was used to control for patient characteristics (age, race, and primary insurance provider) and medical comorbidities. RESULTS: PCNL was performed on 39,868 patients, of whom 17,932 (45.0%) had no MetS conditions, 19,268 (48.3%) had 1-2 MetS conditions, and 2668 (6.7%) had 3-4 MetS conditions. With increasing MetS conditions, patients had increased incidence of postoperative MI (0: 0.6%; 1-2: 1.0%; 3-4: 1.8%, p < 0.001). On multivariate analysis, the presence of 3-4 MetS comorbidities increased the odds of a postoperative MI (1-2: odds ratio [OR] 1.2, 95% confidence interval [CI] 0.94-1.53, p = 0.147; 3-4: OR 2.2, 95% CI 1.54-3.15, p < 0.001). CONCLUSIONS: MetS patients have an increased risk of MI following PCNL given their pre-existing comorbidities. Routine preoperative cardiac testing may benefit this population before PCNL.


Subject(s)
Kidney Calculi/surgery , Metabolic Syndrome , Myocardial Infarction/epidemiology , Nephrolithotomy, Percutaneous/adverse effects , Aged , California/epidemiology , Comorbidity , Female , Florida/epidemiology , Hospital Mortality , Humans , Incidence , Logistic Models , Male , Middle Aged , Myocardial Infarction/etiology , Odds Ratio , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Risk Factors
20.
Chembiochem ; 2018 Mar 26.
Article in English | MEDLINE | ID: mdl-29578633

ABSTRACT

The intracellular adaptor protein Mint2 binds amyloid precursor protein (APP) and presenilin-1, which are both central constituents of the amyloidogenic pathway associated with Alzheimer's disease (AD). Additional interaction partners have also been suggested for Mint2; several of them are also pertinent to AD pathogenesis. However, no comparative mapping of the Mint2 protein-protein interaction network is available. Here we provide a systematic characterization of seven interaction partners and address their specificities towards the different binding domains of Mint2, which reveal domain-specific and -nonspecific interaction partners. Moreover, we show that the last two C-terminal amino acids of Mint2 are both important for the intramolecular interaction with the PDZ1 domain and for the stability of Mint2.

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