Noncystoscopic Removal of Double-J Stent in Women: Feasibility and Safety.

OBJECTIVE: To evaluate the feasibility and safety of a simple noncystoscopic method previously applied in children for removing double-J stents applied in women by comparing the hospitalization time, operation time, costs, complications, and success rate. METHODS: One hundred eighty women who underwent either cystoscopic or noncystoscopic double-J stent removal in a randomized manner. They were randomly assigned 1:1 to groups of cystoscopic double-J stent removal (n = 90) or noncystoscopic double-J stent removal (n = 90). The age ranged from 19 to 72years. After the removal of the double-J stent, the operation time, costs, complications, and success rate were compared between the two groups. RESULTS: The operation time of the noncystoscopic group was lower than that of the cystoscopic group (6.0(5.0,7.0) minutes vs 2.0(2.0,3.0) minutes, P < .001). The hospitalization costs of the noncystoscopic group were significantly shorter than that of the cystoscopic group (1361.2(1331.4,1379.2) Yuan vs 873.9(868.5,896.1) Yuan, P < .001). There were no complications such as infection and massive bleeding in the two groups during and after the operation. Most noncystoscopic double-J stent removal can succeed in less than three attempts (88/90). All patients in the noncystoscopic group used this technique to remove the double-J stent. CONCLUSION: Noncystoscopic removal of double-J stent has the advantages of short operation time and low hospitalization costs. It is a safe and feasible minimally invasive method to replace cystoscopic removal of the double-J stent.

OSCA-finder: Redefining the assay of kidney disease diagnostic through metabolomics and deep learning.

Liquid chromatography-mass spectrometry (LC-MS) is a platform for urine and blood sample analysis. However, the high variability in the urine sample reduced the confidence of metabolite identification. Therefore, pre and post-calibration operations are inevitable to ensure an accurate urine biomarker analysis. In this study, the phenomenon of a higher creatinine concentration variable in ureteropelvic junction obstruction (UPJO) patient urine samples than in healthy people was revealed, indicating the urine biomarker discovery of UPJO patients is not adapted to the creatinine calibrate strategy. Therefore, we proposed a pipeline "OSCA-Finder" to reshape the urine biomarker analysis. First, to ensure a more stable peak shape and total ion chromatography, we applied the product of osmotic pressure and injection volume as a calibration principle and integrated it with an online mixer dilution. Therefore, we obtained the most peaks and identified more metabolites in a urine sample with peak area group CV<30%. A data-enhanced strategy was applied to reduce the overfit while training a neural network binary classifier with an accuracy of 99.9%. Finally, seven accurate urine biomarkers combined with a binary classifier were applied to distinguish UPJO patients from healthy people. The results show that the UPJO diagnostic strategy based on urine osmotic pressure calibration has more potential than ordinary strategies.

Cancer Stem Cells in Tumours of the Central Nervous System in Children: A Comprehensive Review.

Cancer stem cells (CSCs) are a subgroup of cells found in various kinds of tumours with stem cell characteristics, such as self-renewal, induced differentiation, and tumourigenicity. The existence of CSCs is regarded as a major source of tumour recurrence, metastasis, and resistance to conventional chemotherapy and radiation treatment. Tumours of the central nervous system (CNS) are the most common solid tumours in children, which have many different types including highly malignant embryonal tumours and midline gliomas, and low-grade gliomas with favourable prognoses. Stem cells from the CNS tumours have been largely found and reported by researchers in the last decade and their roles in tumour biology have been deeply studied. However, the cross-talk of CSCs among different CNS tumour types and their clinical impacts have been rarely discussed. This article comprehensively reviews the achievements in research on CSCs in paediatric CNS tumours. Biological functions, diagnostic values, and therapeutic perspectives are reviewed in detail. Further investigations into CSCs are warranted to improve the clinical practice in treating children with CNS tumours.

Assessment of cancer-related signaling pathways in responses to polystyrene nanoplastics via a kidney-testis microfluidic platform (KTP).

As a new type of environmental pollutants, micro/nano plastics (MPs/NPs) derived from plastic products are commonly contact in daily life and lead to some serious health issues. The toxicity effects of MPs/NPs on the human body have aroused wide concerns. Although MPs/NPs have been reported to be transmitted into the kidney and reproductive organs, the molecular mechanisms of MPs/NPs toxicity remain unclear due to the lack of a physiologically relevant organ-organ linking platform in vitro. Here, we present a kidney-testis microfluidic platform (KTP) with NPs exposure that enables the communication of kidney and testis chambers and reproduces endothelium-linked chambers to simulate the state in vivo. The function of KTP was assessed by cell counting kit (CCK-8), tight junction protein claudin-2 and glucose consumption. Results revealed that MPs/NPs entered the kidney and testis via endocytosis. Immunofluorescence and ELISA analysis were performed on KTP at 200 µg/mL PS-NP to identify the dysregulated proteins on cancer-related signaling pathways, including the MAPK signaling pathway (RTK, RAS, ERK, JNK, P38, NRF2, TNF-α, and TNF-α-R) and the PI3K-AKT signaling pathway (PI3K, AKT, MDM2, P53, and ΒΑD). This multi-organ platform (KTP) contributes to clarifying cancer pathways triggered by MPs/NPs exposure and provides a promising method for assessing diseases induced by environmental pollutants.

Single-port laparoscopy-assisted trans-scrotal hernia sac ligation for pediatric male inguinal hernia.

Objective: We report the introduction of a novel single-port laparoscopic-assisted trans-scrotal hernia sac ligation (LAT-HSL) technique for the treatment of inguinal hernias in pediatric males. In this article, we describe the LAT-HSL technique and the outcomes. Methods: Twenty-five male children with confirmed unilateral inguinal hernia who underwent surgical treatment from January 2020 to September 2021 were selected for this study. All children underwent surgical treatment with LAT-HSL, and the operative time, hospital stay, and postoperative results and complications were recorded. Results: All 25 cases underwent LAT-HSL with minimal perioperative complications, and all children were successfully discharged from the hospital postoperatively. At the postoperative follow-up, there was no retraction or atrophy of the testes, no incisional infection, no chronic pain, no urinary retention, and no recurrent hernias. Conclusion: Single-port LAT-HSL allows for rapid and accurate localization of the extra-abdominal hernia sac. The method is safe, easy to perform, and adaptable. Additionally, the scar is hidden, and the operation time is short.

Matrix-assisted laser desorption/ionization mass spectrometric imaging the spatial distribution of biodegradable vascular stents using a self-made semi-quantitative target plate.

In recent years, the development and optimization of biodegradable coronary stents have become the research focus of many medical device manufacturers and scientific research institutions since they can be completely degraded and absorbed, and they restore vascular function. However, there is a lack of in situ quantification of these stents spatially in tissue in vivo. In this study, matrix-assisted laser desorption/ionization (MALDI) Fourier transform ion cyclotron resonance (FT ICR) and time-of-flight (TOF) mass spectrometric imaging (MSI) were used to analyze the time-dependent distributions of a biodegradable vascular scaffold, which consisted of copolymers of lactic acid and glycolic acid (PLGA) and its degradation products in cross-sections and longitudinal sections of blood vessels. The MALDI-MSI methods for analyzing the distribution of PLGA and its derivatives in vivo were established by optimizing the conditions of sample pretreatment and mass spectrometry (MS). In order to semi-quantify the contents of PLGA degradation products in blood vessels, self-made stainless-steel and indium tin oxide (ITO) target plates were developed to compare and establish the standard curves for semi-quantitative analysis. The target plate can be placed on the target carrier of MS simultaneously with the conductive slide, which can simultaneously carry out vapor deposition or spray on the substrate, to ensure the parallelism of the pretreatment experiments between the standards and the actual vascular samples. The proposed method provided a powerful tool for evaluating the distributions and degradation process of biological stent materials in the coronary artery, as well as provided technical support for the research and development of degradable biological stents and product optimization.

Renal-on-Chip Microfluidic Platform with a Force-Sensitive Resistor (ROC-FS) for Molecular Pathogenesis Analysis of Hydronephrosis.

Hydronephrosis is one of the most common diseases in urology. However, due to the difficulties in clinical trials and the lack of reliable in vitro platforms, the surgical indicators are not clear. Herein, the renal-on-chip with a force-sensitive resistor microfluidic platform was established to simulate the state of hydronephrosis. Cell counting kit-8 (CCK-8) and tight junction protein claudin-2 were detected on a renal-on-chip microfluidic platform with a force-sensitive resistor (ROC-FS). The results indicated that the ROC-FS had normal physiological functions and the cell viability on ROC-FS declined to around 40% after 48 h of hydronephrosis-simulated treatment. In addition, proteomics analysis of 15 clinical ureteropelvic junction obstruction (UPJO) samples showed that compared with normal children, a total of 50 common proteins were differentially expressed in UPJO children (P < 0.05, |log2fold change| ≥ 1). Metabolomic analysis of 39 clinical UPJO samples showed that a total of 241 metabolisms were dysregulated. Subsequent immunofluorescence and enzyme-linked immunosorbent assay (ELISA) analysis using ROC-FS were performed to identify the clinical multi-omics results for screening. All results pointed out that the TGF-ß-related signaling pathways and arginine-related metabolism signaling pathways were dysregulated and α-SMA, AGT, and AGA might be the potential biomarkers of hydronephrosis. In addition, correlation analysis of AGT and KLK1 with differential renal function (DRF) from clinical samples indicated good correlation coefficients (R2 0.923, 0.8742, 0.6412, and 0.8347). This demonstrates the state of hydronephrosis could be significantly correlated with the biomarkers. These findings could provide a reliable reference for determining surgical biomarkers clinically, and ROC could be further used in the analysis of other kidney diseases.

[Urine metabolomics analysis based on ultra performance liquid chromatography-high resolution mass spectrometry combined with osmolality calibration sample concentration variability].

Urine is an important source of biomolecular information for metabolomic studies. However, the acquisition of high-quality metabolomic datasets or reliable biomarkers from urine is difficult owing to the large variations in the concentrations of endogenous metabolites in the biofluid, which are caused by diverse factors such as water consumption, drugs, and diseases. Thus, normalization or calibration is essential in urine metabolomics for eliminating such deviations. The urine osmolality (Π), which is a direct measure of the total urinary solute concentration and is not affected by circadian rhythms, diet, gender, and age, is often considered the gold standard for estimation of the urine concentration. In this study, a pre-data acquisition calibration strategy based on osmolality was investigated for its feasibility to overcome sample concentration variability. Before data acquisition, the product of the osmolality×injection volume of all samples was set to be equivalent through the uses of a customized injection volume or dilution. After ultra performance liquid chromatography-high resolution mass spectrometry (UPLC-HRMS) analysis of the sample, the raw dataset was normalized to the total ion abundance or total useful MS signals (MSTUS) to achieve further calibration. The osmolality of each urine sample was determined with a freezing-point depression osmometer. For the instrumental analysis, a Vanquish UPLC system coupled to a Q-Exactive Plus HRMS device was used for metabolite analysis and accurate mass measurement. Full-scan mass spectra were acquired in the range of m/z 60-900, and the MS/MS experiments were conducted in "Top5" data-dependent mode. A Waters UPLC column (100 mm×2.1 mm, 1.8 µm) was used for chromatography separation. The raw data were imported into Progenesis QI software for peak picking, alignment, deconvolution, and normalization. SIMCA-P software was used for the principal component analysis (PCA) and orthogonal partial least-squares discrimination analysis (OPLS-DA). This strategy was first applied to sequentially diluted urine samples, where three frequently used normalization methods were compared. In the identical injection volume experiment, the points were scattered and showed relevant distribution according to the dilution multiple in the plot of PCA scores. There was little improvement after normalization to either the total ion abundance or MSTUS. In the customized injection volume experiment, the urine samples derived from the same source showed ideal clustering. With total ion abundance and MSTUS normalization, the dataset was further improved in the PCA model fitting and prediction. As a result, there were more peaks with a peak area RSD of <30%, which indicated better parallelism. The diluted urine solutions had higher Spearman's coefficient values with their sample source than those without calibration, which suggested less intra-group differences. The strategy was further validated using data from a metabolomic study of children with congenital hydronephrosis and healthy controls. As a concentration estimator, osmolality showed better linear correlation with the mass signal and was less influenced by physiological or pathological factors, thus obtaining broader application and more accurate results than creatinine. The concentration variability was effectively eliminated after customized dilution calibration and showed a more obvious clustering effect in the PCA score plot. The OPLS-DA-based statistical model used to identify discriminate metabolites was improved, with less chance of overfitting. In conclusion, the calibration strategy based on osmolality combined with total ion abundance or MSTUS normalization significantly overcame the problem of urine concentration variability, eliminated intra-group differences, and possessed better parallelism, thus giving better clustering effects in PCA or OPLS-DA and higher reliability of the statistical model. The results of this study provide guidance and a reference for future metabolomic studies on urine.

Association of neural tube defects with congenital abnormalities of the urogenital system in a Chinese cohort.

BACKGROUND: This study aimed to retrospectively analyze the correlation between congenital abnormality of the urogenital system and various factors in children with neural tube defects (NTDs). METHODS: A total of 190 children with congenital NTDs, who were admitted to a hospital from May 2013 to May 2018, were included into the present study. All admitted children with congenital NTDs were carried out routine abdominal B-ultrasound examinations to determine the malformations of the abdominal organs, including the urinary system. Children with a B-ultrasound result of suspected and unsure malformation underwent intravenous pyelography (IVP) and voiding cysto-urethrography (VCU), and this was further confirmed by the CT results. RESULTS: The incidence of urogenital malformation was 12.1% (23/190) in children with congenital NTDs. For the 23 children with urogenital malformations, most of these children had no definite urinary system symptoms, while some of these children had multiple incidences of urinary system infections. CONCLUSIONS: Congenital NTDs are often combined with urogenital malformations, if not specifically searched these may be overlooked. The early detection of these malformations is beneficial to reduce the risk of operation and improve the prognosis.

Corrigendum: The Application of External Ureteral Catheters in Children With Acute Kidney Injury Caused by Ceftriaxone-Induced Urolithiasis.

[This corrects the article DOI: 10.3389/fped.2020.00200.].

Maternal exposure to environmental endocrine disruptors during pregnancy is associated with pediatric germ cell tumors.

Environmental endocrine disruptors (EEDs) are natural or synthetic chemical compounds that interfere with normal endocrine function in both wildlife and humans. Previous studies have indicated that EEDs may contribute to oncogenesis. This study explores the relationship between EEDs and pediatric germ cell tumors (GCTs). A case-control study was conducted in 84 pediatric patients from 2014 to 2017, including 42 subjects with immature teratoma, yolk sac tumor, or germinoma, and 42 controls who experienced pneumonia or trauma. Serum PFASs, including PFBS, PFHpA, PFHxS, PFOA, PFOS, PFNA, PFDA, PFUA, PFOSA, and PFDoA, were measured in each subject, and their history of possible EED exposure was reviewed. Six of the 10 measured PFASs were significantly increased in the GCT group relative to the control group. With respect to lifestyle history, only PFHxS levels were statistically significantly associated with GCTs as determined by logistic regression analysis. The odds ratio for a 1 ng/L increase in PFHxS was 19.47 (95% CI: 4.20-90.26). Furthermore, in the GCT and control groups, both parental consumption of barbecued foods and hair dye use among parents were significantly correlated with elevated serum PFHxS levels (ρ = 0.383, 0.325 in the patient group and ρ = 0.370, 0.339 in the control group; p < 0.05). Our study confirmed that children with GCTs from our institute had relatively high serum levels of PFASs relative to those of tumor-free pediatric patients. Serum PFHxS levels were independently associated with germ cell tumor occurrence.

The Application of External Ureteral Catheters in Children With Acute Kidney Injury Caused by Ceftriaxone-Induced Urolithiasis.

Objective: To evaluate our use of external ureteral catheters in children with acute kidney injury (AKI) resulting from ceftriaxone-induced urolithiasis. Methods: From July 2010 to June 2015, a series of 15 children, including 12 males and 3 females, were referred to our department. All of them were diagnosed of post-renal AKI and underwent emergent hospitalization. Evaluation of serum electrolytes, creatinine (Cr), blood urea nitrogen (BUN), complete blood count, and blood gas analysis were completed in each child both before they were admitted, and again after surgery. Bilateral externalized ureteral catheters were placed cystoscopically in each of these patients. The composition of collected calculi was analyzed by infrared spectrography. Results: Bilateral externalized ureteral catheters were placed successfully in all patients. There were no procedure-related complications. Two days after catheter placement, the levels of serum Cr and BUN had improved in all patients, and these levels were noted to be significantly lower than before catheterization (P < 0.001). Infrared spectrography demonstrated that the primary composition of all calculi collected was ceftriaxone. No recurrent AKI or renal deterioration was detected during the follow-up which ranged from 3 to 8 years. Conclusions: These results show that short-term external ureteral catheters can be effectively utilized in children with AKI caused by ceftriaxone-induced urolithiasis. We recommend this procedure as a viable replacement to indwelling stents in patients with bilateral ureteral stones.

The clinical manifestations of intermittent hydronephrosis and their relationship with renal function in pediatric patients.

BACKGROUND AND OBJECTIVE: Most patients with intermittent hydronephrosis have preserved differential renal function (DRF), while others already have impaired DRF at diagnosis. We summarized the clinical manifestations of intermittent hydronephrosis to elucidate what may be related to DRF loss. STUDY DESIGN: We retrospectively reviewed patients presenting to our department with unilateral Dietl's Crisis between January 2014 and December 2017. Clinical characteristics were collected, including age of first onset, time of onset, duration of the longest single episodes and whether the patient had prenatally detected hydronephrosis. Ultrasonographic (US) parameters included anteroposterior diameter (APD) during the symptomatic and asymptomatic period. Dynamic renograms (DR) were reviewed to obtain preoperative DRF. RESULTS: A total of 150 patients met the selective criteria. Of the 128 patients whose mother had regular obstetric ultrasounds during pregnancy, 50 (39.06%) had prenatally detected pelvic dilation. The mean age of the first attack was earlier in the prenatally detected hydronephrosis group than in the postnatally detected group (4.58 vs 5.87, p = 0.002). The mean preoperative DRF was 41.03% in all of the patients. The patients whose DRFs were below 40% had longer durations of single attacks than those over 40%. The former group also had larger APD during the symptomatic periods than the latter group. The risk of DRF < 40% was higher in the patients whose APD at attack was greater than 35 mm (OR=5.111, χ2=12.899, p < 0.001). The attack times, waiting time before the surgery and age of the first onset had no association with preoperative DRF. DISCUSSION: Our study first found that in patients with Dietl's Crisis, the APD during the symptomatic periods and the longest duration of the attack were associated with DRF loss. But the retrospective nature of our study limited us to understand the relationship between DRF and total duration of all attacks. CONCLUSION: This study revealed that children with prenatal hydronephrosis could develop Dietl's Crisis at early ages. A longer duration of attack and larger APD during the attack were associated with impaired DRF.

Correlation between spinal coronal balance and static baropodometry in children with adolescent idiopathic scoliosis.

BACKGROUND: Scoliosis is accepted as a 3-dimensional deformity involving axial, sagittal and frontal planes. RESEARCH QUESTION: To evaluate the correlation between baropodometric parameters and coronal balance status for idiopathic scoliosis. METHODS: 44 patients (7 males and 37 females) of Adolescent Idiopathic Scoliosis (AIS) were recruited. All participants should have scoliosis confirmed by a spine X-ray performed less than one month ahead of the baropodometric study. Radiographic studies including Cobb angle, offset between Central Sacral Vertical Line (CSVL) and C7 Vertebra Plumb Line (C7PL) (considered as global coronal balance, GCB), Apical Translation of the major curve (AT, considered as regional coronal balance) as well as Lateral Pelvic Tilt (LPT) were examined. A static baropodometry was performed for each patient. The contact surface and load ratio (to the entire load of both feet) were measured. RESULTS: On both sides, the surface of the forefoot was significantly larger than that of the rearfoot (P < 0.001) and the load ratio of the forefoot was significantly smaller than that of the rearfoot (P < 0.001). On the major curve side, GCB showed a positive correlation with the contact surface of the forefoot (r = 0.36, P = 0.019), as well as the load ratio (r = 0.40, P = 0.008). AT also showed a positive correlation with the load ratio of the forefoot (r = 0.331, P = 0.03) but no correlation with contact surface. SIGNIFICANCE: In scoliosis, coronal balance is correlated to plantar pressure distribution. Apical translation of the major curve and offset between CSVL and C7PL are the best describers of coronal balance.

Nine novel HOGA1 gene mutations identified in primary hyperoxaluria type 3 and distinct clinical and biochemical characteristics in Chinese children.

BACKGROUND: Primary hyperoxaluria type 3 (PH3) is characterized by mutations in the 4-hydroxy-2-oxoglutarate aldolase (HOGA1) gene. PH3 patients are thought to present with a less severe phenotype than PH1 and PH2 patients. However, the clinical characteristics of PH3 patients have yet to be defined in sufficient detail. The aims of this study were to report HOGA1 mutations of PH3 in Chinese children, and to analyze the genotype and clinical characteristics of these PH3 patients. METHODS: Genetic analysis (targeted gene panel-based and/or whole-exome sequencing) of HOGA1 was performed in 52 patients with a high suspicion of PH3, and DNA was obtained from the patient and both the parents. The clinical, biochemical, and genetic data of these 12 patients identified with HOGA1 mutations were subsequently retrospectively reviewed. RESULTS: These 12 patients were identified with HOGA1 mutation. The median onset of clinical symptoms was 18.25 (range 5-38) months. In total, 14 different mutations were identified including 9 novel mutations in these 12 patients with PH3. All of these 12 patients initially presented with urolithiasis, and 3 patients among them comorbid urinary tract infection (UTI) as another initial symptom. Ten patients experienced hyperoxaluria (average oxalate 0.77 mmol/1.73 m2/24h). In contrast, urine calcium excretion was normal in 8 patients and 2 patients with hypercalciuria (urine calcium > 4 mg/kg/24 h). At the time of diagnosis, estimated GFR was 155.6 ml/min per 1.73 m2, and at last follow-up time (17.3 months later from diagnosis on average), estimated GFR was 157.5 ml/min per 1.73 m2. To date, none of the patients has impaired renal function based on and progressed to ESRD. CONCLUSIONS: We found that PH3 was significantly diagnosed in our urolithiasis patients during childhood. Nine novel HOGA1 mutations were identified in association with PH3, which provide a first-line investigation in Chinese PH3 patients. The eGFR was normal in all children with PH3. This finding is in contrast to the early impairment of renal function in PH1 and PH2.

Identification of 8 novel gene variants in primary hyperoxaluria in 21 Chinese children with urinary stones.

PURPOSE: We analyzed primary hyperoxaluria (PH) genotype and phenotype in Chinese children. Vitamin B6 response in the patients with genetically confirmed PH1 was also studied. METHODS: We, respectively, analyzed 80 children with urinary stones. Sixty-four children were diagnosed with hyperoxaluria. Twenty-one children consented to genetic evaluation (targeted gene panel-based and whole-exome sequencing), and DNA was obtained from the children and both the parents. RESULTS: PH accounted for 57.1% (12/21) of hyperoxaluria cases. We reported 12 PH cases, including 5 PH1, 1 PH2, and 6 PH3 cases; 2 novel mutations in AGXT and GRHPR each and 4 HOGA1 mutations were identified. The mutations in AGXT and GRHPR were c0.1161C>A and c0.551C>A, and c0.370C>T and c0.864_865delTG, respectively. Four HOGA1 mutations, c0.290G>A, c0.110G>A, c0.554C>T and c0.834_834 + 1delinsTT, were not reported previously. The average urine Ox 24 level in the PH patients was 0.91 mmol/1.73 m2. Moreover, the average urine Ox 24 level in the PH1 patients (1.07 mmol/1.73 m2) was higher than that in the PH2 and PH3 patients (0.73 mmol/1.73 m2 and 0.71 mmol/1.73 m2, respectively). The eGFR of the PH1 patients (76.86 mL/min) was lower than that of the PH2 and PH3 patients (132 mL/min and 136 mL/min, respectively). CONCLUSIONS: PH incidence was higher than the reported PH incidence in children with urinary stones. Hence, we suggested that genetic examination was necessary for all the children with hyperoxaluria. These novel mutations broaden the range of known gene mutations in PH.

Quantitative Urinary Proteome Reveals Potential Biomarkers for Ureteropelvic Junction Obstruction.

PURPOSE: Ureteropelvic junction obstruction (UPJO) is a common obstructive disease. To investigate useful urinary biomarkers in UPJO children, the urinary proteome in UPJO infants is analyzed and it is compared with normal controls. EXPERIMENTAL DESIGN: A tandem mass tag (TMT)-based quantitative proteomics study is performed to analyze the proteome of bladder urine (BU) and pelvis urine (PU) from unilateral UPJO infants with differential renal function less than 40% and they are compared with normal control urine (CON). GO analysis is then utilized to analyze general characterization of the proteins. Proteomic results are verified by western blot. RESULTS: There are 81 and 186 proteins significantly changed in BU and PU groups, respectively, as compared to the CON group. Fifty proteins overlaps are found between these two sets of statistically significant differential proteins. These 50 common differential proteins are involved in multiple biological processes. The increased urinary abundance of Fetuin-A, AGP1, AGP2, Alpha-1-microglobulin/Bikunin Precursor (AMBP), and prostaglandin-H2D-isomerase (PGDS) are verified by western blot analysis. CONCLUSIONS AND CLINICAL RELEVANCE: This proteomic analysis indicates that urinary Fetuin-A, AGP1, AGP2, protein AMBP, and PGDS may serve as noninvasive potential biomarkers and these proteins can help to further yield pathological mechanisms involved in UPJO.

Predictive Factors of Contralateral Operation after Initial Pyeloplasty in Children with Antenatally Detected Bilateral Hydronephrosis Due to Ureteropelvic Junction Obstruction.

OBJECTIVES: This study was performed to analyze the predictive factors of a contralateral operation after initial pyeloplasty in patients with antenatally detected bilateral ureteropelvic junction obstruction. METHODS: Patients with prenatally diagnosed bilateral ureteropelvic junction obstruction who underwent initial pyeloplasty (aged <12 months at initial pyeloplasty) were offered to participate in the study. Patients were recruited from January 2012 to December 2015. The anteroposterior renal pelvic diameter, parenchymal thickness, and calyceal dilatation were evaluated. Predictive factors of contralateral pyeloplasty after initial unilateral pyeloplasty were also examined. RESULTS: In total, 82 patients were included in the study (mean age, 2.8 months). Among all patients who underwent initial pyeloplasty, additional contralateral pyeloplasty was required in 11 patients (13.4%). The outcome of contralateral hydronephrosis was assessed as resolution, persistence, or surgery. The median anteroposterior renal pelvic diameter and calyceal dilatation were significantly different among the groups (p < 0.001). Calyceal dilatation of ≥10 mm and a calyceal dilatation/parenchymal thickness ratio of ≥5 strongly suggested the likelihood of a contralateral operation. CONCLUSIONS: In most patients with bilateral ureteropelvic junction obstruction, improvement or resolution of contralateral hydronephrosis following initial unilateral pyeloplasty can be expected. Patients with contralateral calyceal dilatation >10 mm and the calyceal dilatation/parenchymal thickness ratio >5 are at higher risk of surgery.

An initial differential renal function between 35% and 40% has greater probability of leading to normal after pyeloplasty in patients with unilateral pelvic-ureteric junction obstruction.

PURPOSE: We compared the outcomes in patients who were <1 year old and had hydronephrosis with SFU grade 3-4 PUJ obstruction to observe the potential recovery of renal morphology and DRF after successful pyeloplasty. METHODS: All children younger than 1 year old with SFU grade 3-4 PUJ obstruction from January 2013 to June 2015 were retrospectively analyzed. A total of 92 children were grouped according to their DRF value at pyeloplasty as follows: DRF from 30 to ≤35% (group I) and DRF from 35 to ≤40% (group II). We evaluated changes in anteroposterior diameter and differential renal function using ultrasound and diuretic renography. Outcomes were compared using Student t test. RESULTS: Group I comprised 45 patients, and group II included 47 patients. No significant difference was observed in the initial APD, final APD and the improvement of APD after pyeloplasty between two groups. Significant differences were observed between the initial and final DRF values in both groups. The difference in DRF improvement after pyeloplasty between groups I and II was significant. The DRF improved to a normal stage significantly more frequently in group II (21/47; 44.7%) than in group I (13/45; 28.9%). CONCLUSION: The improvement in DRF after pyeloplasty was significant for patients with an initial DRF from 30 to ≤35%. However, patients with an initial DRF from 35 to ≤40% had a greater probability of achieving normal renal function. Patients with severely impaired initial renal function had a marginal probability of achieving a normal value.

Iatrogenic Fibroepithelial Polyps in Children With Hydronephrosis.

OBJECTIVE: To discover the possible factor of the iatrogenic fibroepithelial polyps (FEPs). MATERIALS AND METHODS: A retrospective chart review of 28 pediatric patients who have undergone pyeloplasties for ureteropelvic junction obstruction with pathologically proven FEPs was performed from January 2009 to June 2016 at our hospital. Among them, 6 patients without apparent FEPs at the time of the first pyeloplasty were found to have FEPs at the time of reoperation. The medical history and clinical, diagnostic, intraoperative, pathologic, and follow-up data of the 6 patients were reviewed. RESULTS: All iatrogenic FEPs were located proximal to the anastomotic stoma. On pathological examination, the size of the FEPs ranged from 1.5 to 3.5 cm. The FEPs were pink, grayish-white, or tan-gray in color and cauliflower-like in shape. Microscopically, they arose from the submucosa and consisted of a layer of normal transitional epithelium covering a fibrovascular stromal core showing sparse vascularity and prominent edema. The mean follow-up period was 47 months (range, 4-82 months). All patients' symptoms disappeared and the function of the affected kidney was preserved after the second pyeloplasty. No patients developed FEP recurrence. CONCLUSION: Nephrostomy may associate with iatrogenic FEPs in young children. Iatrogenic FEPs are a specific type of polyp that grows rapidly within a very short time. Pathologically, iatrogenic FEPs are the same as other types of FEPs.