[Mechanism of ultrafiltration extract of Angelicae Sinensis Radix and Hedysari Radix regulates HIF-1α signaling pathway mediated by renal hypoxia to ameliorate renal fibrosis in DKD rats].

This study explored the mechanism of the ultrafiltration extract of Angelicae Sinensis Radix and Hedysari Radix in ameliorating renal fibrosis in the rat model of diabetic kidney disease(DKD) based on the expression of hypoxia-inducible factor-1α(HIF-1α)/vascular endothelial growth factor(VEGF) and HIF-1α/platelet-derived growth factor(PDGF)/platelet-derived growth factor receptor(PDGFR) signaling pathways in the DKD rats. After 1 week of adaptive feeding, 50 male SPF-grade Wistar rats were randomized into a blank group(n=7) and a modeling group. After 24 h of fasting, the rats in the modeling group were subjected to intraperitoneal injection of streptozocin and fed with a high-sugar and high-fat diet to establish a DKD model. After modeling, the rats were randomly assigned into model(n=7), low-dose ultrafiltration extract(n=7), medium-dose ultrafiltration extract(n=7), irbesartan(n=8), and high-dose ultrafiltration extract(n=8) groups. After intervention by corresponding drugs for 12 weeks, the general conditions of the rats were observed. The body weights and blood glucose levels of the rats were measured weekly, and the 24 h urinary protein(24hUP) was measured at the 6th and 12th weeks of drug administration. After the last drug administration, the renal function indicators were determined. Masson staining was employed to observe the pathological changes of the renal tissue. The expression of prolyl hydroxylase domain 2(PHD2) and HIF-1α in the renal tissue was detected by immunohistochemistry(IHC). Real-time qPCR was employed to determine the mRNA levels of PHD2, VEGF, PDGF, and PDGFR in the renal tissue. Western blot was employed to determine the protein levels of HIF-1α, VEGF, PDGF, and PDGFR in the renal tissue. The results showed that compared with the model group, drug administration lowered the levels of glycosylated serum protein(GSP), aerum creatinine(Scr), and blood urea nitrogen(BUN) in a dose-dependent manner(P<0.05 or P<0.01) and mitigated the pathological changes in the renal tissue. Furthermore, drug administration up-regulated mRNA level of PHD2(P<0.05 or P<0.01), down-regulated the mRNA levels of VEGF, PDGF, and PDGFR(P<0.05 or P<0.01) and the protein levels of HIF-1α, VEGF, PDGF, and PDGFR(P<0.01) in the renal tissue, and increased the rate of PHD2-positive cells(P<0.01). In conclusion, the ultrafiltration extract of Angelicae Sinensis Radix and Hedysari Radix effectively alleviated the renal fibrosis in DKD rats by inhibiting the expression of key proteins in the HIF-1α signaling pathway mediated by renal hypoxia and reducing extracellular matrix(ECM) deposition.

Composition analysis of renal and ureteral calculi in a single center in northern China in the past decade.

The current report aimed to evaluate the characteristics of stone composition in 3637 renal and ureteral calculi patients in a single center while clarifying its relationship with sex, age, and time. Out of 3637 cases of upper urinary tract stones, stone specimens were analyzed retrospectively. There were 2373 male patients aged 6 months-87 years, with an average age of 44.73 ±â€…15.63 years, and 1264 female patients aged 4 months-87 years, with an average age of 46.84 ±â€…16.00 years. The male-female ratio was 1.88:1. Five hundred twelve patients had ureteral calculi, and 3125 had renal calculi. The SPSS software helped analyze the relationship between renal and ureteral calculi composition and sex, age, and time. Stone composition demonstrated 2205 cases of calcium oxalate stones (60.6%), 518 carbonate apatite (14.2%), 386 uric acids (10.6%), 232 magnesium ammonium phosphate (6.4%), 117 calcium phosphate (3.2%), 76 cystine (2.1%), 47 sodium urate (1.3%), 31 others (0.9%), and 25 ammonium urate (0.7%) cases. The overall male-to-female sex ratio was 1.88:1. Stones in the upper urinary tract were significantly more frequent in men than in women between the ages of 31 and 60. However, such stones were significantly more frequent in women than men over 80 (P < .05). Cystine, Sodium urate, Carbonated apatite, and uric acid indicated significant differences between different age categories (all P < .001). Stone composition analyses revealed that the frequency of calcium oxalate calculi has increased annually, while cystine and carbonated apatite incidences have dropped annually over the past decade. The components of renal and ureteral calculi vary significantly based on age and sex, with calcium oxalate calculi being more frequent in men while magnesium ammonium phosphate stones are more frequent in female patients. The age between 31 and 60 years is the most prevalent for renal and ureteral calculi in men and women.

Association between metabolically healthy obesity and kidney stones: results from the 2011-2018 National Health and Nutrition Examination Survey.

Introduction: The risk of kidney stones in metabolically healthy obesity (MHO) individuals is largely unexplored. This study using percent body fat (%BF) to categorize obesity, to investigate the association between MHO as well as other metabolic syndrome-obesity combined phenotypes and kidney stones in a national representative population. Materials and methods: This cross-sectional study included 4,287 participants in the National Health and Nutrition Examination Survey from 2011 to 2018. Metabolically healthy status was defined as not having any component of metabolic syndrome or insulin resistance. Obesity was identified by %BF, which was measured and assessed by dual-energy x-ray absorptiometry (DXA) scan. Participants were cross-classified by metabolic health and obesity status. The outcome was self-report kidney stones. Multivariable logistic regression model was used to examine the association between MHO and kidney stones. Results: A total of 358 participants had kidney stones [weighted prevalence (SE): 8.61% (0.56%)]. The weighted prevalence (SE) of kidney stones in MHN, MHOW, and MHO groups was 3.13% (1.10%), 4.97% (1.36%), and 8.55% (2.09%), respectively. After adjusting for age, sex, race and ethnicity, education level, smoking status, alcohol consumption, physical activity, daily water intake, CKD stage 3-5, and hyperuricemia, MHO individuals (OR: 2.90, 95% CI: 1.18, 7.0) had a significantly higher risk of kidney stones than those with metabolically healthy normal weight. In metabolically healthy participants, a 5% increment in %BF was associated with a significantly higher risk of kidney stones (OR: 1.60, 95% CI: 1.20, 2.14). Furthermore, a nonlinear dose-response relationship between %BF and the kidney stones was observed in metabolically healthy participants (P for non-linearity = 0.046). Conclusion: Using %BF to define obesity, MHO phenotype was significantly associated with higher risks of kidney stones, suggesting that obesity can independently contribute to kidney stones in the absence of metabolic abnormalities and insulin resistance. Regarding kidney stones prevention, MHO individuals might still benefit from lifestyle interventions aimed at healthy body composition maintenance.

Prognostic nomogram for overall survival in upper urinary tract urothelial carcinoma (UTUC) patients treated with chemotherapy: a SEER-based retrospective cohort study.

OBJECTIVE: To establish a prognostic nomogram among UTUC patients who received chemotherapy. METHODS: 1195 UTUC patients who received chemotherapy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for the period between 2004 and 2015. Patients were randomly divided into a training and a validation set. Nomogram was constructed to predict 1-, 3-, and 5-year overall survival (OS) in those patients. Receiver-operating characteristic curves (ROCs), calibration plots, and Decision curve analysis (DCA) were applied to assess and compare the discrimination, accuracy, and practicability of the nomogram with 8th American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system. RESULTS: Six clinical parameters were identified as independent prognostic factors for UTUC patients' OS, including age, marital status, TNM stage, and surgical methods of the primary site. The ROC curves showed a satisfactory discrimination capacity of the nomogram, with 1-, 3-, and 5-year area under curve (AUC) values of 0.789, 0.772, and 0.763 in the training set and 0.772, 0.822, and 0.814 in the validation set, respectively. Calibration curves indicated a good agreement between actual observation and nomogram prediction. ROC and DCA curves showed our nomograms exhibited larger benefits than the 8th AJCC-TNM staging system. CONCLUSIONS: A prognostic nomogram was established and validated to present individual predictions of OS among chemotherapeutic UTUC patients. This nomogram may assist clinicians in accurate survival prognostication, treatment decision-making, and design of future clinical trials.

Multi-objective prediction for denitration systems in cement: an approach combining process analysis and bi-directional long short-term memory network.

Selective Non-Catalytic Reduction (SNCR) can improve the denitration process and reduce NOx emissions by accurizing prediction of NOx concentration and ammonia escape. However, there are inevitable time delays and nonlinearity problems in the prediction of NOx emission. To reduce NOx concentration quickly in SNCR, excessive ammonia spraying often causes a large amount of ammonia to escape, resulting in secondary pollution. Therefore, it is particularly important to monitor ammonia escape. To solve the above problems, this paper proposes a framework by specifically analyzing the cement denitration process and combining a multi-objective time series bi-directional long short-term memory network (MT-BiLSTM). Among them, the model achieves multi-objective prediction of NOx emission concentration and ammonia escape simultaneously. In addition, time series containing delay information are introduced in the input layer to eliminate the influence of delay. Based on the bi-directional LSTM model, the dropout strategy is adopted to improve the generalization of the model and the Adam optimizer is applied to improve the network performance. Besides, through the multi-step prediction of NOx emission at 3 time points, the dynamic nature of the data is preserved, which provides dynamic information support for realizing the automation of denitration system. The prediction performance of the MT-BiLSTM model is experimentally validated, and the results demonstrate that it can reliably predict both NOx and ammonia escape. The model achieves more accurate and reliable results for the prediction of flue gas concentrations compared with other methods such as SVR, DTR and LSTM. Therefore, the MT-BiLSTM model provides a basis for achieving NOx emission reduction and accurate ammonia injection.

Incidental Diagnosis of Renal Pelvic Tumor in Patients Who Underwent Percutaneous Nephrolithotomy: A Report of 6 Cases and Review of the Literature.

OBJECTIVES: To report the clinical characteristics of patients who were incidentally diagnosed as renal pelvic tumor during or after percutaneous nephrolithotomy (PNL). METHODS: The profiles of about 8,000 patients who underwent PNL in our center from 2011 to 2021 were retrospectively reviewed, 6 patients were diagnosed with renal pelvic tumor during or after PNL. Clinical data of these six patients were collected and summarized. RESULTS: Four males and two females with the average age of 59 years were researched. Chief complaints included loin pain, gross hematuria, and wound infection after PNL. Two patients had a definite long history of stones. Urinary tract infection occurred in 5 patients and all six patients had gross hematuria or microscopic hematuria. CT images revealed severe hydronephrosis in 4 patients and moderate hydronephrosis in 2 patients. Both staghorn and multiple stones were separately seen in 3 patients. Five patients were diagnosed with renal pelvic urothelial carcinoma via biopsy during PNL. One patient was diagnosed as renal pelvic tumor with extensive invasion by postoperative CT scan and received palliative treatment. Of two patients underwent radical surgery, one patient obtained long survival, one patient received endoscopic tumor resection and also obtained long survival. Two patients underwent renal artery embolization, one patient was still alive after 22 months, the other patient showed tumor growth in 3 weeks. CONCLUSIONS: The possibility of renal pelvic tumor should be considered in stone patients with several risk factors including elder age, long history of stones, complicated stones, hydronephrosis especially pyonephrosis, obvious hematuria etc.

The Association between Aortic Calcification Index and Urinary Stones: A Cross-Sectional Study.

Background: It is believed that vascular calcification and urinary stones may possibly have a shared mechanism. However, the association between vascular calcification and urinary stones is largely unexplored. Using the aortic calcification index (ACI) as a clinical indicator of vascular calcification, the present study aimed to examine the association between the ACI and urinary stones. Methods: This cross-sectional study included 282 patients hospitalized for either urinary stones or other urological diseases from January 2020 to December 2021 at the Department of Urology and Lithotripsy in Peking University People's Hospital. Among them, 137 and 145 patients were divided into the stone group and the non-stone group. Multivariable logistic regression analysis was performed to examine the association between the ACI and urinary stones. The restricted cubic splines model was used to further explore the dose−response relationship between the ACI and urinary stones. Results: The median (Q1−Q3) age of the study population was 59.0 (47.0−67.0) years. After adjusting coronary heart disease, triglycerides, glucose, serum creatinine, uric acid, urea, calcium, and eGFR, the ACI was independently associated with urinary stones (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03−1.11) in a linear dose−response pattern (p for non-linearity =0.153). Age was found to interact with the effect of the ACI on urinary stones (p for interaction <0.001). Conclusions: This study found that the ACI was independently associated with urinary stones in a linear dose−response manner. Our results indicate that the ACI might be a helpful indicator for identifying populations at risk for urinary stones.

Mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy and its initial clinical application.

BACKGROUND: To assess the outcome of the mini-track, mini-nephroscopy, mini ultrasonic probe percutaneous nephrolithotomy for upper ureteral and kidney stones. METHODS: We collected data of 53 patients (55 kidney units) who underwent mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy between September 2020 and March 2021. The study included single and upper ureteral stones from 12 kidneys, multiple stones from 28 kidneys, and staghorn stones from 15 kidneys. RESULTS: The mean operative duration was 50.6 min, ranging from 15 to 200 min, whereas the mean lithotripsy and stone removal time was 17.2 min (3-45 min). Moreover, the mean postoperative length of stay was 4.0 days (1-7 days). Besides, the stone-free rate (SFR) of discharge was 89.1% (49/55). The mean hemoglobin drop was 15.3 mg/dL, ranging 1-32 mg/dL. Out of the total cases, only 4 of them displayed minor complications. The outcomes of < 40 mm versus ≥ 40 mm calculi were compared by performing subgroup analysis. The results demonstrated a longer operation duration (65.2 vs. 40.2 min), higher complication rate (13.0% vs. 3.3%), and lower SFR in the ≥ 40 mm calculi subgroup. CONCLUSIONS: In summary, mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy is an effective and safe method to treat patients with upper ureteral and kidney calculi. This is especially significant for the stone size of 20-40 mm, demonstrating excellent SFR and a lower complication rate.

Integrated metabolomics and transcriptomic analysis of the flavonoid regulatory networks in Sorghum bicolor seeds.

BACKGROUND: The objective of this study was to reveal the flavonoid biosynthesis pathway in white (Z6), red (Z27) and black (HC4) seeds of the sweet sorghum (Sorghum bicolor) using metabolomics and transcriptomics, to identify different flavonoid metabolites, and to analyze the differentially expressed genes involved in flavonoid biosynthesis. RESULTS: We analyzed the metabolomics and transcriptomics data of sweet sorghum seeds. Six hundred and fifty-one metabolites including 171 flavonoids were identified in three samples. Integrated analysis of transcriptomics and metabolomics showed that 8 chalcone synthase genes (gene19114, gene19115, gene19116, gene19117, gene19118, gene19120, gene19122 and gene19123) involved in flavonoid biosynthesis, were identified and play central role in change of color. Six flavanone including homoeriodictyol, naringin, prunin, naringenin, hesperetin and pinocembrin were main reason for the color difference. CONCLUSIONS: Our results provide valuable information on the flavonoid metabolites and the candidate genes involved in the flavonoid biosynthesis pathway in sweet sorghum seeds.

Efficacy and safety of ultrasound-guided percutaneous nephrolithotomy for kidney calculi patients with ankylosing spondylitis: a retrospective single center analysis.

BACKGROUND: To investigate the efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in kidney calculi patients with ankylosing spondylitis (AS). METHODS: The data of 22 renal stone patients (25 kidney units) with AS who underwent PCNL in our institute from January 2008 to December 2019 were analyzed retrospectively. General information of these patients, intraoperative and postoperative data were recorded. The primary parameter for efficacy was initial and final stone free rates (SFR) with X-ray kidney, ureter, and bladder (KUB) were performed 1st or 2nd day and 1 month after surgery. Preoperative and postoperative laboratory results, surgical procedures and the occurrence of postoperative complications were used to identify the safety PCNL intervention. RESULTS: Most PCNLs were performed with general anesthesia (76%) and prone position (64%). The initial SFR and final SFR were 80% (20 kidney units) and 88% (22 kidney units) respectively. Haemoglobin decreased after PCNL occurred in 22 patients (88.0%) and the mean postoperative hemoglobin drop was 1.32±0.76 g/L (range, 0.10-3.10 g/L), with one patient received blood transfusion. One patient developed postoperative fever (T >38.5 °C). No other complications such as colon injury, extravasation of urine, perinephric infection and urosepsis occurred. CONCLUSIONS: The result of ultrasound-guided PCNL for kidney stone patients with AS is satisfactory with high SFR and security. Operative position, anesthesia method and damage caused by drugs used in the treatment of AS should be considered to achieve better result.

Red blood cell distribution width may be a new factor that influence the selection of invasive treatment in patients with renal abscess.

BACKGROUND: Red blood cell distribution width (RDW) is associated with the severe morbidity and mortality of some Gram-negative associated chronic diseases. We designed this retrospective study to identify whether RDW can be used as a factor to provide reference for the treatment of renal abscess. METHODS: All patients with renal abscess in our institution between April 2016 and November 2019 were collected, and 38 cases with the characteristic of initially diagnosis and no prior treatment were enrolled. Conservative treatment group and surgical intervention group were set based on the treatment of patients. Univariate analysis and the regression analysis were adopted to identify the difference between these two groups. RESULTS: Significant differences were found in Diabetes mellitus, RDW and size of renal abscess in both univariate and multifactor analysis. The median value of RDW in all patients was 13.62%, with 13.15% in conservative treatment group and 14.20% receiving surgical intervention (OR: 9.48, 95% CI: 1.15-78.02). Diabetes was present in 42.11% of patients, with the ratio of 20.0% in conservative treatment group and 66.67% in surgical intervention group (OR: 35.22, 95% CI: 1.55-799.05). The cut-off of RDW and size of renal abscess were 14.07% and 3.9 cm respectively. CONCLUSIONS: RDW as an independent predictor of mortality in patients with Gram-negative bacteremia showed differences among patients with renal abscess who received different treatments. Since the relationship between RDW and Gram-negative bacteremia related to mortality, higher initial RDW value may represent a higher severity of renal abscess and a greater likelihood of the need of surgical intervention.

Effects of high-sodium diet on lithogenesis in a rat experimental model of calcium oxalate stones.

BACKGROUND: This study aimed to investigate the effects of a high- and low-sodium diets on lithogenesis in a rat experimental model of calcium oxalate stones. METHODS: Twenty male Wistar rats were randomly divided into four groups; group A: 4% NaCl+1% ethylene glycol (EG); group B: 8% NaCl+1% EG; group C: 8% NaCl+normal drinking-water; group D: 1% EG +normal diet. All rats were sacrificed 4 weeks later, and blood samples were collected from the heart. The kidneys were collected for Von Kossa staining to evaluate the formation of calcium-containing crystals. The last 24-h urine samples were also gathered for metabolic analysis. RESULTS: Von Kossa staining demonstrated that the rats in both group A and group B had significantly more renal calcium crystals than those in group D. However, 24-h urinary volume increased significantly (142.26±20.91 mL) in group B compared with group A (100.52±28.23 mL), group C (107.36±14.24 mL), group D (40.79±8.71 mL) (P=0.004, 0.012, and 0.000 respectively). Level of urine sodium (Na), potassium (K), chlorine (Cl), and calcium (Ca), urea nitrogen were significantly higher in group B compared with group D. The urine phosphorus, oxalate, and creatinine levels; urine specific gravity; and urine PH were similar between group B and group D. The level of serum sodium was higher in group B (151.26±4.06 mmol/L) compared with group D (145.56±1.12 mmol/L) (P=0.002). CONCLUSIONS: A high sodium intake might increase the risk of lithogenesis in susceptible individuals (given by EG) or in individuals with water restriction.

Prediction of nitrogen oxide emission concentration in cement production process: a method of deep belief network with clustering and time series.

The concentration of nitrogen oxide (NOx) emissions is an important environmental index in the cement production process. The purpose of predicting NOx emission concentration during cement production is to optimize the denitration process to reduce NOx emission. However, due to the problems of time delay, nonlinearity, uncertainty, and data continuity in the cement production process, it is difficult to establish an accurate NOx concentration prediction model. In order to solve the above problems, a NOx emission concentration prediction model using a deep belief network with clustering and time series features (CT-DBN) is proposed in this paper. Particularly, to improve data sparsity and enhance data characteristics, a clustering algorithm is introduced into the model to process the original data of each variable; the time series containing delay information are introduced into the input layer, which combines previous and current variable data into time series data to eliminate the influence of the time delay on the prediction of NOx emission concentration. In addition, restricted Boltzmann machine (RBM) is used to extract data features, and a gradient descent algorithm is used to reversely adjust network parameters to establish a deep belief network model (DBN). Experiments prove that the method in this paper has higher accuracy, stronger stability, and better generalization ability in predicting NOx emission concentration in cement production. The CT-DBN model realizes the accurate prediction of NOx emission concentration, provides guidance for denitration control, and reduces NOx emissions.

The impact of metabolic syndrome on the safety and efficacy of flexible ureterorenoscopy.

BACKGROUND: To analyze the impact of metabolic syndrome on the safety and efficacy of flexible ureterorenoscopy (fURS) in managing kidney calculi. METHODS: We retrospectively analyzed the records of 151 patients who received fURS for the renal stones in our center between January 2014 and December 2016. The patients were divided into two groups based on whether they were diagnosed with metabolic syndrome. Information related to the patients, stones and surgeries were analyzed, and the stone-free rates (SFRs) and complications after fURS were reviewed. RESULTS: Group 1 consisted of patients with metabolic syndrome, and group 2 contained patients without metabolic syndrome. The mean stone size was 71.9±58.3 mm2 in group 1 and 64.9±43.7 mm2 in group 2 (P=0.399). The mean hospitalization and surgical durations were similar between both groups (P>0.05). The overall complication rates were 8.3% vs. 12.1% (P=0.514). The SFR at 3 months postoperative in group 1 was significantly lower than that in group 2 (80% vs. 92.3%, P<0.05). CONCLUSIONS: Our study results revealed that patients with metabolic syndrome can be treated safely with fURS. however, metabolic syndrome has a negative impact on the efficacy of fURS in the treatment of patients with kidney stone.

Ultrasound-Guided Minimally Invasive Percutaneous Nephrolithotomy is Effective in the Management of Pediatric Upper Ureteral and Renal Stones.

AIM: To evaluate the outcome of ultrasound (US)-guided minimally invasive percutaneous nephrolithotomy (MPCNL) in the management of upper ureteral and renal stones in pediatric patients. METHODS: We collected data of 112 pediatric patients who were admitted to the xxxx between March 2006 and December 2016 and treated by US-guided MPCNL. Our cohort included upper ureter stones (n = 11), single kidney stones (n = 46), multiple kidney stones (n = 56), and staghorn kidney stones (n = 12). RESULTS: Patients were between 0.5 and 13 years old with stone sizes from 10 to 50 mm. Operation duration ranged from 15 to 195 minutes. On average, the nephrostomy tube could be removed after 3.9 days and patients were discharged after 6.5 days. We found that hemoglobin concentration decreased in 34 patients after surgery by 1 to 37.8 g/L. Using US-guided MPCNL, the initial stone-free rate (SFR) was 86.4% and resulted in a final SFR of 95.2%. However, postoperative complications occurred in 18 patients including > 38.5 °C fever in 17 cases and reactive pleural effusion in one case. Blood transfusion was not required in all cases and no sepsis, kidney loss, ureteral stricture, and adjacent organ injury were observed. Follow-up after an average of 8.5 months showed normal renal function without hydronephrosis. However, recurrence of stones > 4 mm was found in 11 patients. CONCLUSIONS: US-guided MPCNL showed an excellent SFR and low complication rate in the management of pediatric patients with upper ureteral and renal stones.

Challenges and management of laparoscopic treatment of pyonephrosis caused by calculi.

BACKGROUND: Calculous pyonephrosis is a disease characterized by infectious hydronephrosis associated with pyogenic destruction of the renal parenchyma, with complete or almost complete loss of renal function. METHODS: The clinical data of laparoscopic nephrolithotomy performed at Peking University People's Hospital from May 2017 to June 2020 were analyzed retrospectively. Eight patients (2 men; 6 women) aged 27 to 65 years (average age, 45.8 years) were included. Among them, 7 patients were treated with retroperitoneal approach and 1 patient by transperitoneal approach. All patients had received more than one endoscopic lithotripsy before nephrectomy. Renal dynamic imaging and computed tomography revealed the absence of function in pyonephrosis before nephrectomy. General clinical data and perioperative data were recorded. All nephrectomies were performed by the same physician. RESULTS: Laparoscopic surgery was successfully performed in 7 patients; however, 1 patient underwent open surgery because of bleeding. The operation time, average operation time, and blood loss were 1.5-4.5 h, 3.4 h, and 100-1000 ml (average, 300 ml), respectively. The postoperative pathology showed inflammatory renal disease in 6 patients, xanthogranulomatous pyelonephritis in 1 patient, and high-grade urothelial cancer in 1 patient. The average postoperative hospital stay was 5.3 days. One patient had a Clavien-Dindo Grade IIIb complication (severe hematuria), which required laparotomy, and was found that there was bleeding of ureteral stump. None of the patients experienced poor healing of endoscopic wounds. CONCLUSION: For patients with complicated calculous pyonephrosis, renal inflammation could not be effectively controlled, and renal function was seriously damaged. Thus, kidneys should be immediately resected. With laparoscopy, patients may recover quickly, but surgeons require enough experience when performing laparoscopy to achieve safety.

Involvement of CsERF2 in leaf variegation of Cymbidium sinense 'Dharma'.

MAIN CONCLUSION: CsERF2, an ethylene response factor, plays a role in leaf variegation. Leaf variegation is a main ornamental characteristic in Cymbidium sinense (C. sinense). However, the mechanisms of leaf color variegation remain largely unclear. In the present study, we analyzed the cytological and physiological features, as well as molecular analyses of leaves from wild-type (WT) and leaf variegation mutants of Cymbidium sinense 'Dharma'. Chloroplasts with typical and functional structures were discovered in WT and green sectors of the mutants leaves (MG), but not in yellow sectors of the mutant leaves (MY). The activities of key enzymes involved in chlorophyll (Chl) degradation and their substrate contents were significantly increased in MY. Genes related to Chl degradation also showed a significant up-regulation in MY. Transcriptomic analysis showed that the expression of all identified ethylene response factors (ERFs) was significantly up-regulated, and the 1-aminocyclopropane-1-carboxylic acid (ACC) content in MY was significantly higher compared with MG. QRT-PCR analysis validated that the expression levels of genes related to Chl degradation could be positively affected by ethylene (ETH) treatment. Stable overexpression of CsERF2 in Nicotiana tabacum (N. tabacum) led to a decrease in Chl content and abnormal chloroplast. Transcriptomic analysis and qRT-PCR results showed that the KEGG pathway related to chloroplast development and function showed significant change in transgenic N. tabacum. Therefore, the leaf color formation of C. sinense was greatly affected by chloroplast development and Chl metabolism. CsERF2 played an important role in leaf variegation of C. sinense.

Correction to: Androgen receptor regulates expression of skeletal muscle-specific proteins and muscle cell types.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Outcome of Selective Renal Artery Embolization in Managing Severe Bleeding after Percutaneous Nephrolithotomy.

OBJECTIVES: The aim of this study was to evaluate the characteristics of the renal arterial segment bleeding and assess the outcome of selective renal artery embolization (SRAE). METHODS: Data on 35 patients in whom SRAE was performed after percutaneous nephrolithotomy (PCNL) from January 2005 to December 2015 in our institute were retrospectively analyzed. All patients had severe bleeding but failed to respond to conservative therapy. RESULTS: Forty-four SRAEs were performed in 35 patients (36 kidney units) after PCNL. The findings of 44 renal arteriographies before embolization revealed bleeding in 44 renal artery branch segments. Upper artery segment bleeding in 0, upper and anterior segment bleeding in 3, lower and anterior artery segment bleeding in 6, lower artery segment bleeding in 9, posterior artery segment bleeding in 24, and negative finding in 2 patients. Renal arteriography revealed pseudoaneurysms in 20 (45.5%) patients, arteriovenous fistulas in 6 (13.6%) patients, renal artery branch laceration in 16 (36.4%) patients, and negative angiography finding in 2 (4.5%) patients. Acute bleeding in 7 patients (20.0%) and delayed bleeding in 28 patients (80.0%) were observed. The target vascular lesions were successfully treated by embolization in the first time in 28 cases. Six patients underwent 2 sessions and 1 had 3 sessions. New vascular lesions were the most common cause of failure of initial SEAE in our hospital. Abnormal renal function was observed in 5 patients, and they recovered to preoperative or normal level within 3 weeks. CONCLUSIONS: The posterior artery segment of the kidney is the most common bleeding site due to the choice of puncture site. Delayed bleeding (>24 h) was the most common type of bleeding. SRAE is an effective and safe method to treat the severe bleeding after PCNL.