Emergency decompression for patients with ureteral stones and SIRS: a prospective randomized clinical study.

OBJECTIVE: Patients with ureteral calculi and systemic inflammatory response syndrome (SIRS) often require emergency drainage, and percutaneous nephrostomy (PCN) and retrograde ureteral stent insertion (RUSI) are the most commonly used methods. Our study aimed to identify the best choice (PCN or RUSI) for these patients and to examine the risk factors for progression to urosepsis after decompression. METHODS: A prospective, randomized clinical study was performed at our hospital from March 2017 to March 2022. Patients with ureteral stones and SIRS were enrolled and randomized to the PCN or RUSI group. Demographic information, clinical features and examination results were collected. RESULTS: Patients (n = 150) with ureteral stones and SIRS were enrolled into our study, with 78 (52%) patients in the PCN group and 72 (48%) patients in the RUSI group. Demographic information was not significantly different between the groups. The final treatment of calculi was significantly different between the two groups (p < .001). After emergency decompression, urosepsis developed in 28 patients. Patients with urosepsis had a higher procalcitonin (p = .012) and blood culture positivity rate (p < .001) and more pyogenic fluids during primary drainage (p < .001) than patients without urosepsis. CONCLUSION: PCN and RUSI were effective methods of emergency decompression in patients with ureteral stone and SIRS. Patients with pyonephrosis and a higher PCT should be carefully treated to prevent the progression to urosepsis after decompression.Key messageIn this study, we evaluate the best choice (PCN or RUSI) for patients who have ureteral stones and SIRS and to examine the risk factors for progression to urosepsis after decompression. This study found that PCN and RUSI were effective methods of emergency decompression. Pyonephrosis and higher PCT were risk factors for patients to develop to urosepsis after decompression.

Mini-PCNL with a vacuum-assisted access sheath for renal calculi with pyonephrosis in the second stage.

OBJECTIVE: To compare the safety and efficacy of mini-PCNL with vacuum-assisted access sheath in the second-stage treatment of renal calculi with obstructive pyonephrosis. MATERIAL AND METHODS: A prospective, randomized clinical study was performed at our hospital from May 2020 to May 2022. Patients with pyogenic drainage fluid who needed percutaneous nephrolithotomy were randomized to the peel-away assisted mini-PCNL group (group A) and the vacuum-assisted mini-PCNL group (group B). Demographic information, clinical features, and perioperative period data were collected. RESULTS: Fifty mini-PCNLs using a single 16 F access sheath were performed in all patients of our study. All patients underwent second-stage surgical treatment. Demographic information and clinical features were not significantly different between groups A and B. But compared with group A, patients in group B had a short operative time (60.60 ± 7.68 min vs. 82.20 ± 14 min p = 0.018), a lower post-operative fever rate (8% vs. 32% p = 0.034), and a higher stone-free rate 2 d after the operation (88% vs. 64% p = 0.047). There was no significant difference between the two groups in blood transfusion, HB deficit, PCT after the operation, total hospitalization costs, stone-free rate 30 d after the operation, and length of stay or stay post-operative. And no serious complications after the operation occurred in either group. CONCLUSIONS: Mini-PCNL with vacuum-assisted access sheath is a safe and efficient treatment for patients with calculi-related obstructive pyonephrosis in the second stage.

High attenuation value in non-contrast computer tomography can predict pyonephrosis in patients with upper urinary tract stones.

To evaluate whether the higher attenuation value [Hounsfield unit (HU)] in non-contrast CT can predict pyonephrosis in patients with upper urinary tract stones (UTS). Between October 2019 and October 2021, patients with hydronephrosis or pyonephrosis secondary to upper UTS were retrospectively searched in our study. All patients with UTS were treated with percutaneous nephrostomy, percutaneous nephrolithotomy, retrograde ureteral stent or transurethral ureteroscope lithotripsy. We excluded patients treated with extracorporeal shock-wave lithotripsy. Patients whose CT was not performed in our hospital or treated in another hospital were also excluded. Clinical data regarding basic information, clinical feature, Calculi-related indicators, HU values of the renal pelvis, the thick wall of the renal pelvis on CT were collected. Univariate and multivariate logistic analyses were performed. Receiver operative characteristic curves were drawn to predict pyonephrosis. A total of 240 patients with UTS were retrospected in this research, 191 patients had hydronephrosis (Group 1), and 49 patients had hydronephrosis with pyonephrosis (Group 2). The HU value of the renal collecting system in Group 2 (mean, 15.46; range, +1/+30) was significantly higher than that in Group 1 (mean, 5.5; 5 range -6/+24) (P = .02); the receiver operative characteristic curve analysis revealed that the best cut-off value of 9.5 could predict the presence of pyonephrosis, with 71.4% sensitivity and 70.2% specificity (area under the curve = 0.613; 95% CI: 0.514-0.713). In this study, we found the HU attenuation value of the renal collecting system can be used to distinguish pyonephrosis from hydronephrosis in patients with UTS.

Erratum: Origin of amplitude synchronization in coupled nonidentical oscillators [Phys. Rev. E 101, 022210 (2020)].

This corrects the article DOI: 10.1103/PhysRevE.101.022210.

Cross-talk and clinical value of m[superscript 6]A regulatory gene in bladder cancer.

BACKGROUND: RNA modification is a regulation at the post-transcriptional level. RNA methylation modification accounts for more than 60% of all RNA modifications, and m[superscript 6]A(6-methyladenine) is the most common type of RNA methylation modification on mRNA of higher organisms. The modification level of transcription m[superscript 6]A is dynamically regulated by methyltransferase (reader), binding protein (writer) and demethylase (eraser). Furthermore, m[superscript 6]A methylation has been found to have an impact on tumor initiation and progression through various mechanisms. METHODS: 13 genes related m[superscript 6]A from all the gene expressions in The Cancer Genome Atlas (TCGA) were screened. Gene Ontology (GO) and KEGG analysis were applied to explore the functions of genes identified in study. We clustered the related regulators of m[superscript 6]A into three subgroups with "ConsensusClusterPlus". 13 genes were used for univariate Cox analysis to find genes associated with prognosis, and the risk model was constructed based on lasso regression. According to the median risk score of each patient, the patients were divided into high and low risk groups for survival analysis. The ROC curve evaluates the model. Then the risk group and clinical characteristics were analyzed. RESULTS: The three subgroups had different clinical characteristics. Our tumor clusters were related to grade, survival status. Moreover, we observed a significantly longer overall survival (OS) in the cluster 1 than the cluster 2 and cluster 3. Three m[superscript 6]A-related genes related to prognosis were used to construct a prognostic risk model. We found age are independent prognostic marker. What's more, risk score can also be an independent prognostic factor. CONCLUSION: Revealing the regulation and functional mechanism of cross-talk among m[superscript 6]A writers, erasers, and readers, and determine its role in bladder cancer may help in developing novel and efficient strategies for the diagnosis, prognosis and treatment of bladder cancer.

Origin of amplitude synchronization in coupled nonidentical oscillators.

The origin of amplitude synchronization (AS), or amplitude envelope synchronization, as a peculiar form of strong correlation between amplitudes of oscillators is studied by using a model of coupled Landau-Stuart periodic oscillators. We find that the AS extensively occurs within the traditional phase drift region, and the amplitude correlation does not change with variation of the coupling strength but is dampened with increase of the frequency mismatch. The AS appears only at weak couplings and before the occurrence of phase synchronization (PS), and the oscillator amplitude is modulated by its phase. This study could build a solid foundation for AS, which has not drawn much attention in the nonlinear dynamics field before, providing a clear physical picture for synchronization including not only PS, but also AS, and arousing general interest in many interdisciplinary fields, such as neuronal systems, laser dynamics, nanomechanical resonators, and power systems, etc., where phase and amplitude are always mutually influenced and both are important.

Protective effect of cyclosporine A in the treatment of severe hydronephrosis in a rabbit renal pelvic perfusion model

Background/aim: Cyclosporine A (CsA), a traditional immunosuppressive compound, has been reported to specifically prevent isch-emia reperfusion tissue injury via apoptosis pathway. This study aimed to explore the renoprotective effects of CsA on the kidneys of rabbits undergoing renal pelvic perfusion. Materials and methods: A total of 30 rabbits were randomly assigned into a control group (n = 6) and an experimental group (n = 24). The experimental group underwent a surgical procedure that induced severe hydronephrosis and was then stochastically divided into 4 groups (S1, S1', S2, and S2'), consisting of 6 rabbits each. Groups S1 and S1' were perfused with 20 mmHg of fluid, while groups S2 and S2' were perfused with 60 mmHg of fluid. Administration to groups S1' and S2' was done intravenously, with CsA once a day for 1 week before perfusion. In the control group, after severe hydronephrosis was induced, a sham operation was performed in a second laparoto-my. Acute kidney damage was evaluated using hematoxylin and eosin staining, in addition to analyzing the mitochondrial ultrastructure and mitochondrial membrane potential (MMP). The cytochrome C (CytC) and neutrophil gelatinase-associated lipocalin (NGAL) expression were examined immunohistochemically using Western blotting and reverse transcription-polymerase chain reaction. Results: It was found that the renal histopathological damage was ameliorated, mitochondrial vacuolization was lower, MMP was high-er, and the CytC and NGAL contents were decreased after drug intervention (groups S1' and S2') when compared to the experimental groups (S1 and S2). Furthermore, there was no difference between drug intervention groups S1' and S2'. Conclusion: These results suggest that CsA can attenuate renal damage from severe hydronephrosis induced by renal pelvic perfusion in rabbits. It plays a protective role in the acute kidney injury process, possibly through increased MMP and mitochondrial changes.

[Experimental varicocele affects the ipsilateral testis in rats].

OBJECTIVE: To investigate the impact of experimental varicocele (EV) on the ipsilateral testis in rats. METHODS: EV was induced by partial ligation of the left renal vein in male SD rats, the control rats subjected to sham operation, and the testes of the EV models and controls were extirpated 6, 12, and 18 weeks later. Johnson's score, ultrastructure of seminiferous tubules, intratesticular testosterone concentration (ITC) and germ cell apoptotic index (AI) of each left testis were evaluated. RESULTS: Johnson's scores were (6.92 +/- 0.52), (4.83 +/- 0.41) and (2.95 +/- 0.26), ITCswere (6.32 +/- 0.85), (5.17 +/- 0.76) and (4.11 +/- 0.69) and AIs were (5.32 +/- 1.23), (15.21 +/- 0.97) and (21.13 +/- 1.12) respectively in the 6 w , 12 w and 18 w EV groups, significantly lower than in the corresponding control groups, (9.56 +/- 0.35, 9.63 +/- 0.31, 9.39 +/- 0.46), (9.64 +/- 1.23, 9.38 +/- 0.69, 9.73 +/- 0.49) and (3.21 +/- 1.15, 3.43 +/- 1.21, 3.61 +/- 1. 15) (P < 0.05), the former two showing a gradual decline while the latter a significant elevation with the increasing duration of varicocele. The damage to the ultrastructure of seminiferous tubules was aggravated with the prolonging of varicocele. CONCLUSION: EV can cause a progressive decline of ITC, dyszoospermia and increased AI of germ cells.

Effects on the ipsilateral testis during progression of experimental varicocele in rat.

BACKGROUND: We used an animal model of experimental varicocele to investigate the effects on the ipsilateral testis during the progression of experimental varicocele in rat. MATERIAL/METHODS: Experimental varicocele was induced by partial ligation of the left renal vein in rats. Rats in each control group were subjected to a sham operation. After different periods of varicocele creation (6, 12, and 18 weeks), each animal's left testis was extirpated, and Johnsen's score, ultrastructure of seminiferous tubules, intratesticular testosterone concentration, and the germ cell apoptotic index of each left testis were compared between the experimental and control groups. RESULTS: Johnsen's score and intratesticular testosterone concentrations in each experimental varicocele group were significantly lower than those in the corresponding control groups (P<0.05) and showed significant declines as the duration of varicocele gradually increased; the apoptotic index showed an opposite tendency. Ultrastructural injury of seminiferous tubules gradually became severe as the duration of varicocele gradually increased. CONCLUSIONS: Experimental varicocele caused progressive impairment of the ipsilateral testis; apoptosis mediated the pathophysiological processes of dyszoospermia.