Characteristics of Double-J Stent Encrustations and Factors Associated with their Development.

PURPOSE: To evaluate the chemical composition of double-J stent encrustation and to assess risk factors associated with their development. MATERIALS AND METHODS: Patients who had double-J stents removed between July 2016 and June 2017 were recruited for this study prospectively. The clinical features of the patients were recorded and the composition of encrustation material was analyzed by infrared spectroscopy. RESULTS: Encrustments from a total of 372 double-J stents were collected. The mean age of patients was 50.4±13.1 years and deposits possible to analyze were obtained from 228 males (61.3%) and 144 females (38.7%). Calcium oxalate monohydrate was the most common constituent of stone and encrustments. The encrustation rate of vesical coils was significantly higher than that of renal coils (P<0.001). There was no significant difference in chemical composition between stone and encrustation regarding renal (P=0.086) and vesical coils (P=0.072). The only predictive risk factor for the development of encrustation on double-J stents was indwelling time. This phenomenon was observed in both renal (P<0.001) and vesical coils (P=0.021). Interestingly, patient with chronic kidney disease (CKD) was associated with less risk of encrustation on both renal (P<0.001) and vesical coils (P=0.001). CONCLUSION: The chemical composition of double-J stent encrustation was the same as the urinary stone. The prevention strategy for stone composition is also suitable for the prevention of encrustation of double-J stent. The only predictive factor for double-J stent encrustation was the indwelling time. CKD patient was shown to be less at risk for the development of encrustation.

The characteristic and relationship of Escherichia coli isolated from urine and stones in patients with calcium oxalate stones.

Previous clinical studies have shown that Escherichia coli (E. coli) predominated in urine and stone culture from calcium oxalate (CaOx) stone disease. The characteristic and relationship between E. coli isolated from urine cultures (EUC) and stone cultures (ESC) are compared. 83 E. coli (33 EUC and 50 ESC, respectively) from 66 CaOx stone patients were recruited in the study. E. coli in urine and stones from those patients were assessed by antimicrobial susceptibility test, genotyping and phylogenetic grouping. Furthermore, whole genome sequencing and comparative genomic analysis in paired ESC and EUC isolated strains from eight patients were carried out. The E. coli strains from ESC and EUC were not only multidrug resistant (MDR), but also had the similar pattern of resistant genes. The dominant phylogenetic group was B2, which was found in 54.0% of the ESC samples and 69.7% of the EUC samples, respectively. The virulence genes of E. coli, which isolated from stones and urine in the same patients, were highly homologous and largely consistent. Meanwhile, these E. coli strains were located in the same clade originated from a common ancestor. ESC and EUC isolated from patients with CaOx stones had a high prevalence of phylogenetic groups B2. Bacterial strains isolated from urine and stones in the same patient had consistent antimicrobial susceptibility profiles, genotyping, phylogenetic groups, virulence and resistance genes, also with high sequence co-linearity and close relationships.

Difference in urinary stone composition between Uyghur and Han children with urolithiasis.

The Objective of this study is to analyze the difference in renal stone composition between Uyghur and Han children with urolithiasis in China and possible reasons. From May 2011 to September 2013, we analyzed the stone compositions of 274 Chinese children with urolithiasis, including 151 Uyghur children from Xinjiang Province and 123 Han children from Guangdong Province. All the stone components were determined by Infrared spectroscopy and the main components were recorded. We also evaluated the data, including age, gender and geographic region of the patients. The mean age of Uyghur children was less than Han children (5.3 ± 4.2 vs 8.6 ± 5.7 years, p < 0.001). Calcium oxalate (CaOx) was the main stone composition in both Uyghur (35.1 %) and Han (64.2 %) children, but was more common in Han children (p < 0.0001). Cystine stone was also more abundant in Han children (8.9 % vs 0.7 %, p = 0.001). While, both uric acid (20.5 % vs 3.3 %, p < 0.0001) and magnesium ammonium phosphate (16.6 % vs 2.5 %, p < 0.0001) stones were more common in Uyghur. Interestingly, the significant differences in stone composition between the two groups were only observed in males. When the pediatric patients were further divided into three age groups which were 0-5, 6-12 and >12, the prevalence of calcium oxalate stones increased with age in both groups and was higher in Han children at each age level. The compositions of urinary stones were significantly different between Uyghur and Han children with urolithiasis, factors such as diet habit, life style, genetic diversity, environmental and medical conditions may all contribute to the variances.

Safety and efficacy of minimally invasive percutaneous nephrolithotomy in treatment of calculi in horseshoe kidneys.

OBJECTIVE: To evaluate the safety and efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) in horseshoe kidneys (HKs) with calculi. MATERIALS AND METHODS: From 2006 to 2012, 35 renal units in 32 patients with calculi in HKs underwent MPCNL. Patients and stone characteristics, stone-free rates (SFR), and complications were evaluated. The composition of the stones obtained from operation was also analyzed by infrared spectroscopy. RESULTS: The average age of patients was 38.2±7.3 years (range 14-72). The mean stone burden was 657±510.9 mm(2) (range 134.7-2460.1). The mean operative time was 93.4±17.6 minutes (53-152). The most popular access site was upper pole access (35/42, 83.3%). The SFR after initial MPCNL was 82.9% (29/35 renal units). Second-stage MPCNL was performed in 5 renal units, with a 91.4% (32/35 renal units) final SFR. Minor complications (Clavien grades I and II) were seen in six patients, and urosepsis requiring intensive care unit management in one (Clavien grade IVa). All were treated successfully. CONCLUSION: MPCNL is a safe and effective treatment modality in HK stones with acceptable results, which was compatible to a normal anatomy kidney. However, further studies with a larger sample size are required.

Interconversion of stone composition profiles from two recurrent stone episodes in stone formers.

BACKGROUND: The aim of the study was to investigate the interconversion of the stone chemical composition of two recurrent stone episodes in stone formers. METHODS: The data of 1098 stones analyses from 549 patients with a history of two renal stone episodes were selected and reviewed. The stone composition between the two recurrent episodes of stones was compared. RESULTS: The percent occurrences of stones caused by infection, known as infection stones, in new episodes of stones significantly increased by 7% and uric acid stones increased by 3.8% while the calcium oxalate stones decreased by 13.1% (each p<0.05). The mean recurrent interval of new episodes of stones was 34.2 months. Infection stones had a significant shorter interval time compared to calcium oxalate stones (p<0.001). On a patient-by-patient investigation, 32.9% of patients underwent conversions of stone compositions, with 31.9% and 34.1% in men and female, respectively (p=0.590). The mutual conversion of infection stones to calcium oxalate stones was most common. The 61.1% of patients with uric acid recurrent stones were composed of calcium oxalate in the previous episode of stones, and 5% and 51.7% of patients with infection stones developed stones of uric acid or calcium oxalate in the new episode, respectively. CONCLUSIONS: Alterations of stone components during follow-up were found in as high as 32.9% of patients with no gender difference. The impetus of these shifts is not readily apparent. Accurate and repeated stone analyses throughout the course of recurrent stone disease are highly warranted, which may be useful to prevent recurrence of composition-specific stones.

The characteristics of the stone and urine composition in Chinese stone formers: primary report of a single-center results.

OBJECTIVE: To assess urine composition in Chinese patients with urolithiasis. METHODS: Five hundred seven Chinese patients with urolithiasis from our center in southern China were included in this study. Analysis of stone composition was performed using infrared spectrometry. From all patients, 24-hour urine samples were collected for analysis of urinary variables. Some ion activity product risk indices were also calculated. RESULTS: The major stone constituents in the 507 analyzed stones were as follows: calcium oxalate (78.3%), infection stone components (14.6%), uric acid (3.6%), and calcium phosphate (3.4%). Only 1 stone was composed of cystine (0.2%). Of all patients, 504 (99.4%) had 1 or several urinary metabolic abnormalities. Hypocitraturia was recorded in 93.9%, high sodium excretion in 58.6%, small urine volume in 45.6%, hyperoxaluria in 31.0%, hypercalciuria in 26.0%, hyperuricosuria in 19.3%, and hyperphosphaturia in 2.8%. Moreover, high sodium excretion was more frequent in men than women (59.2% vs 49.3%, P = .027), whereas hypercalciuria was more common in women (34.5% vs 20.4%, P <.001). High levels of urine sodium (187.7 ± 86.9 vs 179.8 ± 107.7 mmol/24h, P = .038) and phosphate (18.26 ± 8.36 vs 15.69 ± 11.14 mmol/24h, P <.001) were found in men than in women. Infection stones were significantly (P <.004) more common in women. Compared with noninfection stone formers, the occurrence of hypomagnesuria (P = .040) was more common in patients with infection stones. CONCLUSION: The results of urinary risk factors for stone formation in this study might serve as a basis for design of recurrence prevention. It is of interest to note that some of the demonstrated abnormalities differ from that in reports from other countries.

Expression of PARP-1 and its active polymer PAR in prostate cancer and benign prostatic hyperplasia in Chinese patients.

BACKGROUND AND AIMS: Aberrant expression of PARP-1 has been reported in various human malignancies and was involved in the progression and metastasis of cancers. However, little is known about PARP-1 expression in prostate cancer (PCa). This study aimed to investigate the expression of PARP-1 and its active polymer poly(ADP-ribose) (PAR) in PCa and benign prostatic hyperplasia (BPH) tissues from Chinese patients. METHODS: The expression of PARP-1 and PAR in PCa and benign prostate hyperplasia tissues was assessed by immunohistochemistry in 78 PCa patients and 49 BPH patients. The relationship between the expression of PARP-1 or PAR and clinicopathological parameters in PCa patients was also analyzed. RESULTS: Both the positive and strong positive expression rates of PARP-1 in PCa tissues were significantly higher than those in BPH tissues. Although spearman correlations analysis showed the over-expression of PARP-1 and PAR in PCa tissues was not correlated with age, serum PSA level and Gleason scores (GS), an increasing trend was observed between over-expression of PARP-1 or PAR and the PSA levels (TPSA >20 vs TPSA ≤20) or GS grade (GS ≥8 vs GS ≤6). CONCLUSION: PARP-1 and PAR expression is markedly elevated in PCa than that in BPH tissues, which may implicate that PARP-1 and PAR are involved in the development of PCa, and the possible expansion in the use of poly(ADP-ribose) polymerase inhibitors for targeting therapy of PCa in select patients alone or combined with chemotherapy or radiation.

Urinary stone analysis on 12,846 patients: a report from a single center in China.

We reported a retrospective review of the urinary stone compositions in 12,846 patients. Data on urinary stone compositions analyzed between January 2003 and December 2012 in our center were collected. Infrared spectroscopy was used for stone analysis. Predominant stone component was recorded. Patients were divided into four age groups: 0-18, 19-40, 41-60, and 61-92, and five categories by components. In order to determine the change of stone characteristics with respect to time, data were also divided into two periods, 2003-2007 and 2008-2012. A total of 12,846 stones were included in this study. The age of the patients ranged from 1 to 92 years with 7,736 males and 5,110 females. Stone made of single component was rare, 2.61%. Calcium oxalate stone was the most common component at 82.56%. Calcium oxalate and uric acid stones were more common in male than in female. The incidence of calcium phosphate stones and uric acid stones had increased during the past 5 years, while calcium oxalate stones decreased. We found the highest incidence of stone disease in the 41-60 years old group and the lowest in the 1-18 years old for both genders. Calcium oxalate was the dominant component in every group but was more prevalent in 19-40 years group. The percentage of magnesium ammonium phosphate stone and uric acid stone increased with age.

Inhibition of PARP1 by small interfering RNA enhances docetaxel activity against human prostate cancer PC3 cells.

Though poly(ADP-ribose) polymerase 1 (PARP1) inhibitors have benefits in combination with radiotherapy in prostate cancers, few is known about the exactly role and underlying mechanism of PARP1 in combination with chemotherapy agents. Here our data revealed that inhibition of PARP1 by small interfering RNA (siRNA) could enhance docetaxel's activity against PC3 cells, which is associated with an accelerate repression of EGF/Akt/FOXO1 signaling pathway. Our results provide a novel role of PARP1 in transcription regulation of EGFR/Akt/FOXO1 signaling pathway and indicate that PARP1 siRNA combined with docetaxel can be an innovative treatment strategy to potentially improve outcomes in CRPC patients.

Small interference RNA-mediated silencing of prostate stem cell antigen attenuates growth, reduces migration and invasion of human prostate cancer PC-3M cells.

OBJECTIVES: Prostate stem cell antigen (PSCA), a glycosylphosphatidylinositol (GPI)-anchored cell surface glycoprotein, is highly expressed in both local and metastatic prostate cancer (CaP). Elevated PSCA expression has been shown to correlate with malignant phenotype and clinical progression. The purpose of the current study is to investigate the therapeutic potential of small interference RNA (siRNA) targeting PSCA on human CaP cells. MATERIALS AND METHODS: A set of two siRNAs directed different regions of human PSCA (siRNA-PSCA) were designed and transfected into a human CaP PC-3M cell line. The silencing effect was screened by RT-PCR and Western blotting. The biological effects of siRNA-PSCA on PC-3M cells were investigated by examining the cell proliferation through 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, cell cycle distribution through flow cytometry, and migration and invasion potencies through transwell invasion assay upon the PSCA silencing. RESULTS: PC-3M cells had positive PSCA expression on immunocytochemical assay. PSCA expression was depleted at 48 hours after transfection with siRNA-PSCA. Silencing of PSCA significantly suppressed cell proliferation. Cell cycle assay showed that the anti-proliferation effect of siRNA-PSCA was mediated by arresting cells in the G0/G1 phase rather than apoptosis. Furthermore, PSCA knockdown resulted in a marked decrease of cell migration and invasion capabilities in PC-3M cells. CONCLUSIONS: The present study provides the first evidence that silencing PSCA using siRNA can inhibit the proliferation and invasiveness properties of human CaP cells, which may provide a promising therapeutic strategy for CaP and open a novel avenue toward the investigation of the role of PSCA overexpression in cancers.

[The effects of lentivirus-mediated RNA interference silencing HMGA2 on proliferation and expressions of cyclin B2 and cyclin A2 in HL-60 cells].

OBJECTIVE: To explore the effects of lentivirus-mediated RNA interference silencing HMGA2 on proliferation and expressions of cyclin B2 and cyclin A2 in HL-60 cell line. METHODS: The protein and mRNA expressions of HMGA2 in HL-60 cells transduced by recombinant lentivirus producing HMGA2 gene short hairpin (shRNA) were examined by Western-blot and reverse transcription-polymerase chain reaction (RT-PCR) analysis; The effects of the lentivirus on cell proliferation inhibiting rate, the ability of cell proliferation and cell cycle were analyzed by soft agar colony formation assay and FCM, respectively; The protein and mRNA expressions of cyclin B2 and cyclin A2 were also examined by Western-blot and RT-PCR. RESULTS: Recombinant lentivirus producing HMGA2 shRNA was successfully constructed, which was identified by PCR and sequencing; Stable HMGA2-deficient HL-60 cell line was established by puromycin, its mRNA and protein expression inhibition rates were (80.66 ± 7.98)% and (76.35 ± 12.72)%, respectively. Silencing of endogenous HMGA2 resulted in efficient inhibition of the cellular proliferative activity, low and flat of the cell growth curve and the lack of typical character of exponential growth. FCM revealed significant more cell cycle G(2)/M arrest \[(30.00 ± 5.78)%\] in HL-60 cell line transfected specific shRNA than control group \[(13.90 ± 4.07)%\] (P < 0.05). The cyclin B2 mRNA and protein expression inhibition rates in stable HMGA2-deficient HL-60 cell line were (67.55 ± 7.69)% and (51.77 ± 4.81)%, respectively, while the expression of cyclin A2 had no significant change compared with control group. CONCLUSION: RNAi silencing of HMGA2 down-regulated cyclinB2, significantly inhibited the proliferation of HL-60 cells and induced the accumulation of HL-60 cells in the G(2)/M phase. Thus, HMGA2 may be an important target for anti-leukemia therapy.

[Determination of melamine by high-performance liquid chromatography-mass spectrometry in urinary calculi].

OBJECTIVE: To establish a high-performance liquid chromatography-mass spectrometry (LC/MS)-based method for efficient determination of melamine in urinary calculi in children taking melamine-contaminated formula milk powder. METHODS: LC/MS was employed to determine the contents of melamine in urinary calculi surgically removed from 17 children with a history of taking melamine-contaminated milk powder and in 4 samples of uric acid stone from adults. The positive ionization mode of electro-spray ionization source was used, and the limit of melamine determination was 0.1 mg/kg. RESULTS: No melamine was detected in the 4 uric acid stone samples from adults. Melamine was detected in 4 samples of urinary calculi from the 17 children, with the concentration ranging from 0.8 to 64 mg/lkg. CONCLUSION: LC/MS is simple and effective for detecting melamine in urinary calculi, which is helpful to the treatment and follow-up.

Preoperative serum levels of early prostate cancer antigen (EPCA) predict prostate cancer progression in patients undergoing radical prostatectomy.

BACKGROUND: Early prostate cancer antigen (EPCA) has been shown a prostate cancer (PCa)-associated nuclear matrix protein, however, its serum status and prognostic power in patients with PCa are unknown. The goals of this study are to measure preoperative serum EPCA levels in a cohort of PCa patients who were treated with radical prostatectomy (RP), and to investigate whether serum EPCA levels would independently predict cancer prognosis after the surgery. METHODS: The study group consisted of 109 consecutive patients with clinically localized PCa who were candidates for RP. Serum EPCA levels were measured by ELISA prior to the surgery, and were correlated with pathologic parameters and clinical outcomes postoperatively. RESULTS: A total of 106 patients underwent RP. Preoperative mean serum EPCA level in RP patients (15.84 ± 3.63 ng/ml) was significantly higher than that in healthy subjects (4.62 ± 1.15 ng/ml) (P < 0.001), but serum EPCA levels in the both groups were statistically lower than the levels in patients with PCa metastatic to regional lymph nodes (27.83 ± 6.22 ng/ml) and metastatic to bone (28.50 ± 6.67 ng/ml) (all P's < 0.001). In patients who progressed during follow-up, preoperative serum mean EPCA levels were higher in those with aggressive disease progression (27.64 ± 5.48 ng/ml) compared with nonaggressive disease progression (18.15 ± 4.63 ng/ml; P < 0.001). In pre- and postoperative multivariate analyses, preoperative serum EPCA level was an independent predictor for disease progression (Hazards Ratio = 5.016, P < 0.001 and Hazards Ratio = 4.305, P < 0.001, respectively). CONCLUSIONS: Preoperative serum EPCA level is significantly elevated in localized PCa patients with metastatic disease and strongly predicts cancer progression postoperatively.

Impact of plasmakinetic enucleation of the prostate (PKEP) on sexual function: results of a prospective trial.

INTRODUCTION: Recent data have shown that plasmakinetic enucleation of the prostate (PKEP) is a novel and effective procedure for symptomatic benign prostatic hyperplasia (BPH); however, data on patient sexual function after PKEP remain scarce. AIMS: This study aims to evaluate the impact of PKEP on sexual function in men with lower urinary tract symptoms because of BPH. METHODS: One hundred eighty-six consecutive patients who underwent the PKEP procedure were prospectively enrolled in this study. The International Index of Erectile Function (IIEF-15) and the International Prostate Symptom Score with quality of life scores were completed and compared preoperatively and at 1, 3, 6, and 12 months postoperatively. At each follow-up visit, maximum urinary flow rates, transrectal ultrasound-assessed prostate volume, postvoid residual urine volume, and serum prostate-specific antigen level were also measured and compared with the baseline. MAIN OUTCOME MEASURES: The IIEF global score and its five domains scores were evaluated for each patient, and the Friedman test or chi-square test was used to identify changes from the baseline. RESULTS: There was a slight and nonsignificant increase in the IIEF global score and four of its five domains scores (i.e., erectile function, intercourse satisfaction, sexual desire, and overall satisfaction) at each postoperative assessment (P > 0.05 for all). However, a statistically significant reduction was observed in the orgasmic function domain score of IIEF at 3 months (P = 0.016), 6 months (P < 0.001), and 12 months (P < 0.001), respectively, along with the corresponding retrograde ejaculation rates of 48.7%, 49.4%, and 48.8%. CONCLUSIONS: PKEP has no negative influence on the quality of erections measured by the self-administered IIEF questionnaire, but it significantly lowers the orgasmic function domain score, reflecting probably postoperative retrograde ejaculation. These findings are important in preoperative counseling of the patients undergoing PKEP for symptomatic BPH.

Peripheral blood reverse transcription PCR assay for prostate stem cell antigen correlates with androgen-independent progression in advanced prostate cancer.

Recent studies show that prostate stem cell antigen (PSCA) mRNA positivity in peripheral blood correlates with disease progression in prostate cancer (PCa). Our study is to evaluate the association between peripheral blood PSCA status and androgen-independent progression (AIP) in a cohort of patients with advanced PCa under androgen deprivation therapy (ADT). PSCA mRNA was measured by reverse transcriptase polymerase chain reaction (RT-PCR) assay in peripheral blood samples from 116 patients with locally advanced or metastatic PCa who were treated with primary ADT and from 40 healthy controls. The Kaplan-Meier and the Cox proportional hazards methods were used to assess potential predictors of AIP. Pretreatment RT-PCR-PSCA was positive in 37 (31.9%) of 116 patients. All healthy volunteers were negative for PSCA mRNA. Although seven (14.9%) of 47 patients with Gleason score ≤7 were PSCA positive, 30 (43.5%) of 69 patients with Gleason score >7 were PSCA positive (p = 0.016). PSCA mRNA was detected in 28 (58.3%) of 48 patients with metastatic PCa, compared to nine (13.2%) of 68 patients with locally advanced disease (p = 0.012). AIP developed in 59 (50.9%) patients during a median follow-up period of 35.4 months (range: 4-78 months). Patients with PSCA negativity experienced significantly longer remissions compared to those with PSCA positivity (log-rank test: p < 0.001). Multivariate Cox regression analysis further demonstrated that PSCA positivity had a significantly increased risk of AIP (HR = 4.303, 95% CI: 3.761-7.482, p < 0.001). Pretreatment RT-PCR PSCA positivity in peripheral blood independently signals the presence of AIP in patients with advanced PCa treated with ADT.

Serum early prostate cancer antigen (EPCA) level and its association with disease progression in prostate cancer in a Chinese population.

BACKGROUND: Early prostate cancer antigen (EPCA) has been shown a prostate cancer (PCa)-associated nuclear matrix protein, however, its serum status and prognostic power in PCa are unknown. The goals of this study are to measure serum EPCA levels in a cohort of patients with PCa prior to the treatment, and to evaluate the clinical value of serum EPCA. METHODS: Pretreatment serum EPCA levels were determined with an ELISA in 77 patients with clinically localized PCa who underwent radical prostatectomy and 51 patients with locally advanced or metastatic disease who received primary androgen deprivation therapy, and were correlated with clinicopathological variables and disease progression. Serum EPCA levels were also examined in 40 healthy controls. RESULTS: Pretreatment mean serum EPCA levels were significantly higher in PCa patients than in controls (16.84 ± 7.60 ng/ml vs. 4.12 ± 2.05 ng/ml, P<0.001). Patients with locally advanced and metastatic PCa had significantly higher serum EPCA level than those with clinically localized PCa (22.93 ± 5.28 ng/ml and 29.41 ± 8.47 ng/ml vs. 15.17 ± 6.03 ng/ml, P = 0.014 and P<0.001, respectively). Significantly elevated EPCA level was also found in metastatic PCa compared with locally advanced disease (P < 0.001). Increased serum EPCA levels were significantly and positively correlated with Gleason score and clinical stage, but not with PSA levels and age. On multivariate analysis, pretreatment serum EPCA level held the most significantly predictive value for the biochemical recurrence and androgen-independent progression among pretreatment variables (HR = 4.860, P<0.001 and HR = 5.418, P<0.001, respectively). CONCLUSIONS: Serum EPCA level is markedly elevated in PCa. Pretreatment serum EPCA level correlates significantly with the poor prognosis, showing prediction potential for PCa progression.