BackgroundThe study aimed to describe the epidemiological trend of chronic kidney disease (CKD) due to hypertension among adolescents and young adults during 1990–2021 worldwide. Additionally, the study seeks to provide comprehensive estimate of the associated risk factors for mortality and to project the burden of disease over the next decade.MethodsWe utilized the Global Burden of Disease (GBD) to assess the changing trends of the standardized incidence rate (ASIR), death (ASDR), and disability-adjusted life years (DALYs) ASR by calculating the estimated average percentage change (EAPC). Meanwhile, to assesses proportional death of CKD due to hypertension attributable to associated risk factors. The Bayesian Age-Time-Quest Model (BAPC) to predict the ASIR, ASDR and DALY ASR for young people aged 15 to 39 by 2035.ResultsIn 2021, there were 36,754 incident cases of CKD due to hypertension among adolescents and young adults worldwide. The corresponding ASIR of CKD due to hypertension was 0.91 per 100,000 population (95% uncertainty interval [UI], 0.67–1.18), and the EAPC was 0.99(95% Confidence interval (CI), 0.95–1.03) from 1990 to 2021. The DALYs case of CKD due to hypertension increased from 825,628.28(95%UI, 646,823.70–1,054,246.62) to 1,180,452.47(95%UI, 889,946.51–1,523,802.55), and the corresponding ASR increased from 37.67 per 100,000 population (95%UI, 29.51–48.10) to 39.68 per 100,000 population (95%UI, 29.92–51.22), the EAPC was −0.01(95% CI, −0.10 to 0.08). Among the 5 SDI regions, the middle SDI region had the highest ASIR of CKD due to hypertension in 2021. Regionally, High-income North America had the largest increase in ASDR (EAPC, 3.92; 95% CI, 3.58 to 4.26). Among 204 countries, Nicaragua had the highest national ASIR of CKD due to hypertension in 2021 (4.47 per 100,000 population; 95% UI, 2.48–7.31), Finland had the lowest ASDR (0.00 per 100,000 population; 95% UI, 0.00–0.00). Globally, dietary risks kidney dysfunction, high systolic blood pressure, were key risk factors for CKD due to hypertension-associated mortality in 2021. By 2035 years, ASDR and DALYs related to CKD due to hypertension will decline worldwide, ASIR are projected to continue rising among adolescents and young adults.ConclusionCKD resulting from hypertension globally poses a significant challenge for healthcare systems. Therefore, a comprehensive understanding of the epidemiological characteristics of CKD associated with hypertension will be crucial for developing more effective prevention and control strategies.

Introduction: The rising prevalence of urolithiasis and metabolic dysfunction-associated fatty liver disease (MAFLD) has become a significant concern within urology and hepatology, respectively. Emerging studies reveal a compelling association between these conditions, yet the underlying relationship remains poorly understood. This study aims to investigate the connection between urolithiasis and MAFLD within the Chinese population and leverages Mendelian Randomization (MR) analysis to explore potential causal links between the two diseases, shedding light on new avenues for both prevention and treatment. Methods: This cross-sectional study included 98,232 Chinese participants and employed logistic regression models and subgroup analyses to assess the association between MAFLD and urolithiasis. For the MR analysis, genetic instruments from genome-wide association studies served as instrumental variables. Bidirectional MR was conducted to investigate the potential causal relationship between genetically predicted MAFLD and urolithiasis. Additionally, multivariable MR and mediation analysis were used to assess both the direct effect of MAFLD on urolithiasis and any mediating pathways involved. Results: In a cohort of 98,232 Chinese participants, 10.1% (9,928) had urolithiasis, and 26.7% (26,217) had MAFLD. MAFLD was positively associated with urolithiasis, with an unadjusted odds ratio (OR) of 1.563 (95% CI, 1.495-1.633), an adjusted OR in model 1 of 1.204 (95% CI, 1.146-1.265), and an adjusted OR in model 2 of 1.137 (95% CI, 1.079-1.199). Subgroup analysis showed consistent associations across most subgroups, except for a significant interaction between MAFLD and triglyceride (TG) levels (p for interaction < 0.05). Bidirectional MR analysis suggested that genetically predicted MAFLD increased the risk of urinary stone disease, while no significant causal effect was observed from urolithiasis to MAFLD. Furthermore, multivariable MR and mediation analyses highlighted MAFLD as a key mediator in kidney stone formation driven by obesity and type 2 diabetes. Conclusions: This study demonstrates a causal link between MAFLD and an increased risk of urolithiasis, supported by both epidemiological and genetic evidence. Furthermore, MAFLD serves as a significant mediator in the pathway from obesity and type 2 diabetes to urolithiasis development.

Objective: Ureteroscopic lithotripsy (URSL) is the main method for treating ureteral calculi. The scholars used ureteroscopes with dual channels and access sheath to reduce the local temperature and flushing fluid pressure. This study compares the efficacy and safety of ureteral catheter-assisted URSL (UCA-URSL) and traditional URSL in treating ureteral calculi. Patients and Methods: A cross-regional retrospective case-control study in China, including 217 intention-to-treat patients from the First Affiliated Hospital of Kunming Medical University and Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, from August 2023 to July 2024. The primary outcome was the temperature of the lithotripsy point. The secondary outcomes included stone-free rate (SFR), operation time, hospital stay, and postoperative complications. Results: Compared with the traditional URSL group, the catheter-assisted URSL group had a significantly lower lithotripsy point temperature (max, 37.9 ± 2.60°C vs 49.98 ± 5.04°C, p < 0.0001; mean, 32.3 ± 3.25°C vs 38.56 ± 2.70°C, p < 0.0001). In addition, the UCA-URSL group showed higher absolute SFR (immediately, 89.81% vs 53.21%, p < 0.0001; 3 months, 99.07% vs 72.48%, p < 0.0001), and reduced operation time (22.74 ± 7.08 minutes vs 26.40 ± 6.72 minutes, p = 0.0001), postoperative fever rate (1.85% vs 15.60%, p = 0.0003), and ureteral stricture rate (0% vs 3.67%, p = 0.04). Conclusions: In treating ureteral calculi, UCA lithotripsy shows better safety than traditional URSL. Catheter-assisted URSL can be used to improve traditional URSL.

This study aims to evaluate the feasibility, safety, and effectiveness of an optimized treatment approach for complex renal calculi, utilizing visual needle nephroscopy in conjunction with standard PCNL and holmium YAG laser. We collected data from 62 patients diagnosed with complex kidney stones who underwent this combined procedure using the visual needle nephroscope (Needle-perc®, Youcare Tech, Wuhan, China). The percutaneous nephroscopic working channel was established by visual needle nephroscope, and the primary channel was expanded to 20 F to treat most of the main body of the calculi with a 550 μm holmium laser fiber. Visual needle nephroscope was used to locate the renal calyx where the residual calculi were located for precise puncture as a secondary channel, and the residual stones were treated by a 200 μm holmium laser fiber. Clinical data were collected, and intraoperative variables, postoperative complications and outcomes were assessed. All 62 patients successfully completed the operation without severe complications. The S.T.O.N.E. score of 62 patients before operation was 10.5 ± 0.9 points and above, of which the N score was more than 2 points. The average operation time was (65.5 ± 12.7) minutes, and the average hospital stay was (7.3 ± 2.1) days. After operation, 2 patients developed a fever, which improved after symptomatic treatment by intravenous antibiotics. 4 patients had clinically significant residual fragments, and the stone-free rate of primary operation was 93.5

Abstract Purpose: To present the feasibility, safety and effectiveness of an optimized treatment of complex renal calculi based on visual needle nephroscopy. Methods: We collected data of 31 patients with complex kidney calculi, who underwent standard PCNL combined with visual needle nephroscope (“needle-perc”, Youcare@, Wuhan, China). The percutaneous nephroscopic working channel was established by visual needle nephroscope, and the primary channel was expanded to 20F to treat most of the main body of the calculi with a 550 μm holmium laser fiber. Visual needle nephroscope was used to locate the renal calyx where the residual calculi were located for precise puncture as a secondary channel, and the residual stones were treated by a 200 μm holmium laser fiber. Clinical data were collected, and intraoperative variables, postoperative complications and outcomes were assessed. Results: All 31 patients successfully completed the operation without severe complications. The S.T.O.N.E. score of 31 patients before operation was 10.5±0.9 points and above, of which the N score was more than 2 points. The average operation time was (65.5±12.7) minutes, and the average hospital stay was (7.3±2.1) days. After operation, 1 patient developed a fever, which improved after symptomatic treatment by intravenous antibiotics. 2 patients had clinically significant residual fragments, and the stone-free rate of primary operation was 93.5% (29/31). Conclusions: The optimized operation for the treatment of complex renal calculi based on standard PCNL combined with visual needle nephroscope has good feasibility, safety and effectiveness.

Pyroptosis is a type of programmed cell death and plays a dual role in distinct cancers. It is elusive to evaluate the activation level of pyroptosis and to appraise the involvement of pyroptosis in the occurrence and development of diverse tumors. Accordingly, we herein established an indicator to evaluate pyroptosis related gene transcription levels based on the expression level of genes involved in pyroptosis and tried to elaborated on the association between pyroptosis and tumors across diverse tumor types. We found that pyroptosis related gene transcription levels could predict the prognosis of patients, which could act as either a favorable or a dreadful factor in diverse cancers. According to signaling pathway analyses we observed that pyroptosis played a significant role in immune regulation and tumorigenesis and had strong links with other forms of cell death. We also performed analysis on the crosstalk between pyroptosis and immune status and further investigated the predictive potential of pyroptosis level for the efficacy of immunotherapy. Lastly, we manifested that pyroptosis status could serve as a biomarker to the efficacy of chemotherapy across various cancers. In summary, this study established a quantitative indicator to evaluate pyroptosis related gene transcription levels, systematically explored the role of pyroptosis in pan-cancer. These results could provide potential research directions targeting pyroptosis, and highlighted that pyroptosis may be used to develop a novel strategy for the treatment of cancer.

体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)是指通过影像学技术方法精准定位病人体内结石,将冲击波聚焦于结石后利用冲击波产生的物理效应破碎结石的临床技术[1].自1980年Christian等[2]首次将冲击波技术引入结石的临床治疗以来,ESWL一直是被各指南推荐的泌尿系结石的重要治疗方法之一.在过去的四十年中,ESWL技术在冲击波发生,碎石策略,成像技术及其他辅助技术方面等多方面有了进一步发展[3].本文就ESWL的历史和发展综述如下.

Background. To conduct a comprehensive bioinformatics analysis on the transcriptome signatures of Toll-like receptors (TLRs) in pan-cancer. Materials and methods. A total of 11,057 tissues consisting of 33 types of carcinoma in The Cancer Genome Atlas (TCGA) were retrieved, and then we further explored the correlation between TLRs' expression with tumorigenesis, immune infiltration, and drug sensitivity. We conducted a comprehensive bioinformatics analysis on TLR1 to 10 in pan-cancer, including differential expression analysis between normal and tumor tissues, differential immune subtype correlation, survival analysis, tumor immune infiltration estimating, stemness indices correlation, and drug responses correlation. Results. TLR2 was highly expressed in most types of tumors. TLR9 was hardly expressed compared to other TLR genes, which lead to TLR9 showing less correlation with both immune-estimate scores and stromal-estimate scores. All the TLRs were related with immune subtype of tumor samples that all of them were differentially expressed in differential immune subtype samples. The expression of TLRs was positively related with immune-estimate scores and stromal-estimate scores in almost all types of tumor. The expression of TLRs was negatively correlated with mRNA expression-based stemness scores (RNAss) in nearly almost type of tumors except kidney renal clear cell carcinoma (KIRC) and also negatively correlated with DNA methylationbased stemness scores (DNAss) in many types of tumors except adrenocortical carcinoma (ACC), cholangiocarcinoma (CHOL), KIRC, acute myeloid leukemia (LAML), low-grade glioma (LGG), testicular germ cell tumors (TGCT), thyroid carcinoma (THCA), thymoma (THYM), and uveal melanoma (UVM). The expression of TLR9 was significantly positively correlated with the drug sensitivity of fluphenazine, alectinib, carmustine, and 7-hydroxystaurosporine. TLR7 was significantly positively correlated with the drug sensitivity of alectinib. Conclusions. Our study reveals the significant role of TLRs family in pan-cancer and provides potential therapeutic strategies of cancer.

Kidney renal clear cell carcinoma (KIRC) is the predominant pathological subtype of kidney cancer and is categorized as immunotherapy responsive. Hence, immunotherapy has become a worthwhile therapy for KIRC. Furthermore, tumor mutation burden (TMB) has been regarded as the most prevalent biomarker to predict immunotherapy response. Accordingly, we spent the effort to characterize the status and the predictive potential for immunotherapy response of gene mutations in KIRC. In this study, we identified common somatic mutations in KIRC patients from The Cancer Genome Atlas (TCGA), International Cancer Genome Consortium (ICGC), and UTokyo cohorts in cBioportal database. BRCA1-related protein 1 (BAP1) was identified as the only common gene mutation related to TMB and overall survival. We finally explored whether mutation of BAP1 was related to immune response and immune infiltration. In brief, we identified and demonstrated that BAP1 mutations commonly occurred in KIRC patients, associated with lower TMB, and indicating a poorer prognosis. Furthermore, BAP1 mutation reversed its function as a tumor suppressor via influencing Mast cells' quantity. These findings cast light on the predictive value of BAP1 to evaluate immunotherapeutic sensitivity and presented a potential target for KIRC treatment.

Background The postoperative sepsis is a latent fatal complication for both flexible ureteroscopy (fURS) and percutaneous nephrolithotomy (PNL). An effective predictive model constructed by readily available clinical markers is urgently needed to reduce postoperative adverse events caused by infection. This study aims to determine the pre-operative predictors of sepsis in patients with unilateral, solitary, and proximal ureteral stones after fURS and PNL. Methods We retrospectively enrolled 910 patients with solitary proximal ureteral stone with stone size 10–20 mm who underwent fURS or PNL from Tongji Hospital's database, including 412 fURS cases and 498 PNL cases. We used the least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis to identify the risk factors for sepsis. Finally, a nomogram was assembled utilizing these risk factors. Results In this study, 49 patients (5.4%) developed sepsis after fURS or PNL surgery. Lasso regression showed postoperative sepsis was associated with gender (female), pre-operative fever, serum albumin (<35 g/L), positive urine culture, serum WBC (≥10,000 cells/ml), serum neutrophil, positive urine nitrite and operation type (fURS). The multivariate logistic analysis indicated that positive urine culture (odds ratio [OR] = 5.9092, 95% CI [2.6425–13.2140], p < 0.0001) and fURS (OR = 1.9348, 95% CI [1.0219–3.6631], p = 0.0427) were independent risk factors of sepsis and albumin ≥ 35g/L (OR = 0.4321, 95% CI [0.2054–0.9089], p = 0.0270) was independent protective factor of sepsis. A nomogram was constructed and exhibited favorable discrimination (area under receiver operating characteristic curve was 0.78), calibration [Hosmer–Lemeshow (HL) test p = 0.904], and net benefits displayed by decision curve analysis (DCA). Conclusions Patients who underwent fURS compared to PNL or have certain pre-operative characteristics, such as albumin <35 g/L and positive urine culture, are more likely to develop postoperative sepsis. Cautious preoperative evaluation and appropriate operation type are crucial to reducing serious infectious events after surgery, especially for patients with solitary, unilateral, and proximal ureteral stones sized 10–20 mm.

Background Urolithiasis is one of the most common diseases in urology, with a lifetime prevalence of 14% and is more prevalent in males compared to females. We designed to explore sex disparities in the Chinese population to provide evidence for prevention measures and mechanisms of stone formation. Materials and methods A total of 98232 Chinese individuals who had undergone a comprehensive examination in 2017 were included. Fully adjusted odds ratios for kidney stones were measured using restricted cubic splines. Multiple imputations was applied for missing values. Propensity score matching was utilised for sensitivity analysis. Results Among the 98232 included participants, 42762 participants (43.53%) were females and 55470 participants (56.47%) were males. Patients' factors might cast an influence on the development of kidney stone disease distinctly between the two genders. A risk factor for one gender might have no effect on the other gender. The risk for urolithiasis in females continuously rises as ageing, while for males the risk presents a trend to ascend until the age of around 53 and then descend. Conclusions Patients' factors might influence the development of kidney stones distinctly between the two genders. As age grew, the risk to develop kidney stones in females continuously ascended, while the risk in males presented a trend to ascend and then descend, which was presumably related to the weakening of the androgen signals. Key messages We found that patients' factors might cast an influence on the development of kidney stone disease distinctly between the two sexes. The association between age and urolithiasis presents distinct trends in the two sexes The results will provide evidence to explore the mechanisms underlying such differences can cast light on potential therapeutic targets and promote the development of tailored therapy strategies in prospect.

To explore the roles microbiome of urinary tract played in calcium oxalate stones (CaOx) formation, we collected two sides' pelvis urine of patients with unilateral CaOx stones to set self-control to diminish the influence of systemic factors. Patients with unilateral CaOx stones were recruited in our study according to strict criteria. 16S rRNA gene sequencing was applied to every pair of pelvis urine. Bacterial genome sequencing of Enterobacter cloacae was conducted and bioinformatic analysis was applied to explore the possible pathways of Enterobacter cloacae inducing CaOx stones formation. In vivo experiments were conducted to validate our claims. Von Kossa staining, TUNEL assay and Western Blot were applied to SD rats exploring the mechanism of stone formation. We found 26 significantly different bacteria between stone sides and non-stone sides' pelvis urine, among which Enterobacter cloacae ranked the most different. Bacterial genome sequencing of Enterobacter cloacae revealed that its virulence factors included Flagellin, LPS and Fimbrial. GO and KEGG analysis revealed it probably induced CaOx stone formation via ion binging and signaling transduction pathways. The results of animal experiments indicated that Glyoxylic Acid could promote apoptosis and crystal depositions of kidney comparing with control group while pre-injected with Enterobacter cloacae could apparently compound the effects. While Western Blot demonstrated that Glyoxylic Acid or Enterobacter cloacae could increase the expression of IL-6, Mcp-1, BMP2 and OPN in rats' kidney, Glyoxylic Acid and Enterobacter cloacae together could aggravate these increases. These findings indicated that Enterobacter cloacae might play important roles in CaOx stones formation. However, this study is just a preliminary exploration; further studies still need to be conducted.

Background and AimsUrolithiasis is characterized by high rates of prevalence and recurrence. Hyperuricemia is related to various diseases. We hope to determine the association between serum uric acid (UA) level and kidney stone (KS).MethodsIn this population-based cross-sectional study, a total of 82,017 Chinese individuals who underwent a comprehensive examination in 2017 were included. The KS was diagnosed based on ultrasonography examination outcomes. Fully adjusted odds ratio (OR) for KS, and mean difference between the two groups were applied to determine the association of UA level with KS.ResultsAmong the 82,017 participants included in this study (aged 18~99 years), 9,435 participants (11.5%) are diagnosed with KS. A proportion of 56.3% of individuals is male. The mean UA level of overall participants is 341.77 μmol/L. The participants with KS report higher UA level than the participants without KS [mean UA level 369.91 vs. 338.11 μmol/L; mean difference (MD), 31.96 (95% CI, 29.61~34.28) μmol/L]. In men, the OR for KS significantly increases from 330 μmol/L UA level. Every 50 μmol/L elevation of UA level increases the risk of KS formation by about 10.7% above the UA level of 330 μmol/L in men. The subgroup analysis for male is consistent with the overall result except for the participants presenting underweight [adjusted OR, 1.035 (0.875~1.217); MD, −5.57 (−16.45~11.37)], low cholesterol [adjusted OR, 1.088 (0.938~1.261); MD, 8.18 (−7.93~24.68)] or high estimated glomerular filtration rate (eGFR) [adjusted OR, 1.044 (0.983~1.108); MD, 5.61 (−1.84~13.36)]. However, no significant association is observed in women between UA and KS either in all female participants or in female subgroups.ConclusionAmong Chinese adults, UA level is associated with KS in a dose-response manner in men but not in women. However, the association becomes considerably weak in male participants with malnutrition status.

Aims: We aimed at exploring the role of nicotinamide adenine dinucleotide phosphate oxidase subunit 4 (Nox4) in the regulation of hypercalciuria-induced renal oxidative damage and crystal depositions.Results: High calcium activated Nox4 expression through protein kinase C (PKC). Downregulation of Nox4 expression attenuated hypercalciuria-induced osteoblast-associated protein expression, oxidative stress injury, and crystal deposition in rat kidneys of 1,25-dihydroxyvitamin D3 (VitD) urolithiasis model. Further, calcium-induced activation of mitogen-activated protein kinase (MAPK), overexpression of osteoblast-associated protein, oxidative stress injury, apoptosis, and calcium salt deposition in normal rat kidney epithelial-like (NRK-52E) cells were reversed by downregulating Nox4 expression but were enhanced by upregulating Nox4 expression in vitro. Moreover, calcium-induced increases of osteoblast-associated protein expression were attenuated by the c-Jun-N-terminal kinase (JNK) and extracellular signal-regulated kinase (ERK) inhibitors.Innovation: Our results demonstrated the effect of Nox4 in the pathological process of kidney stones in in vitro and in vivo studies for the first time. Calcium aggravates renal oxidative stress injury and crystal deposition by activating the Nox4-related reactive oxygen species (ROS)-ERK/JNK pathway in the rat kidney. This study is expected to provide a new theoretical basis for the prevention and treatment of kidney stones.Conclusion: Nox4-derived ROS induced by calcium through PKC caused oxidative stress damage and apoptosis in renal tubular epithelial cells; in addition, Nox4-derived ROS induced by calcium mediated abnormal activation of the bone morphogenetic protein 2 (BMP2) signaling pathway through the MAPK signaling pathway, which induced renal tubular epithelial cells to transdifferentiate into osteoblast-like cells, resulting in the formation of a kidney stone.

Background: To evaluate the safety, efficacy and cost of paravertebral block anesthesia for ureteral stones patients undergoing ureteroscopic lithotripsy. Methods: Four hundred and eighty-two patients who underwent ureteroscopy for unilateral ureteral stones were incorporated into our retrospective study. A propensity-matched comparison in patients with paravertebral nerve block anesthesia (PVB) group and general anesthesia (GA) group was performed. Intraoperative hemodynamic parameters, operative time, visual analog scale for pain, stone-free rate, anesthetic cost and postoperative hospital stay were compared between the two groups. Results: Sixty-one GA cases were propensity matched to 61 PVB cases. In the PVB group, all the procedures were completed successfully without anesthesia conversion. Significantly less intraoperative severe hypotensive (P = 0.002) and arrhythmia (P < 0.001) episodes in PVB group. There were no significant differences in operative time (p = 0.702), initial stone-free rate (p = 0.686), and total stone-free rate (p = 0.794) between the two groups. The PVB group had lower postoperative pain and prolonged analgesia (p = 0.007). The postoperative hospital stay in the PVB group was significantly shorter (3.20 +/- 0.73 vs 3.84 +/- 1.32 d, p = 0.001). And the cost of anesthesia was lower in the PVB group (195.47 +/- 13.01 vs 396.31 +/- 36.45 US dollars, p < 0.001). Conclusion: Under PVB anesthesia, URS can be successfully completed without anesthetic transformation, and its efficacy and safety have been demonstrated. When economic aspects are taken into consideration, PVB seems to be a more economical and effective anesthetic method of URS. (c) 2021 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Idiopathic hypercalciuria is an important risk factor for the formation of calcium-containing kidney stones. Matrix metalloproteinase-9 (MMP-9) is closely related to cell and tissue remodeling and is involved in ectopic tissue calcification. However, little is known about its role in kidney stone formation. In this study, we found that the expression of MMP-9 and that of osteoblastic-related proteins was increased in normal rat kidney epithelial-like (NRK-52E) cells following treatment with a high concentration of calcium, while the knockout or overexpression of MMP-9 could, respectively, significantly inhibit or upregulate the expression of osteoblastic-related proteins and calcium crystal deposition. In addition, apoptosis and calcium crystal deposition were significantly reduced in Sprague–Dawley rats with 1,25(OH)2D3-induced hypercalciuria following MMP-9 inhibitor I treatment. Furthermore, inhibiting reactive oxygen species (ROS) production or the nuclear factor kappa-light-chain-enhancer of activated B cell (NF-κB) pathway significantly reduced calcium-induced MMP-9 expression and calcium crystal deposition. In summary, our results suggested that a high calcium concentration promotes epithelial–osteoblastic transformation and calcium crystal deposition in renal tubule cells by regulating the ROS/NF-κB/MMP-9 axis and identified a novel role for MMP-9 in regulating calcium-induced calcium crystal deposition in renal tubules.

目的 探讨经皮肾通道顺行输尿管软镜技术处理回肠输出道术后输尿管回肠吻合处狭窄的有效性及安全性.方法 回顾性总结2017年1月至2019年12月,同济医院泌尿外科收治的16例膀胱根治性切除结合回肠输出道术后发生输尿管回肠吻合处狭窄梗阻的患者,采用经皮肾通道顺行输尿管软镜联合输尿管硬镜的术式行腔内手术治疗.术后3d复查腹部平片及泌尿系CT以检查输尿管支架管位置及肾积水情况,术后7 d复查血肌酐以检查肾功能恢复情况.术后2～3个月后经回肠输出道造口拔除输尿管支架管,每3个月复查1次,随访12个月.结果 共进行18侧手术,17侧顺利完成,1侧因输尿管迂曲角度过大而未能完成手术;所有手术患者未出现严重并发症,有3例出现发热,9例患者术后出现短暂持续性血尿;手术时间为35～130 min,平均(53.7±16.5)min.术后3 d复查腹部平片及泌尿系CT,患侧肾积水均有不同程度缓解.术后随访12个月,13侧在随访期内患侧肾积水无明显加重,肾功能持续稳定.术后随访中有4侧出现狭窄复发,复发时间在术后4～6个月.结论 经皮肾通道顺行输尿管软镜联合输尿管硬镜处理回肠输出道术后输尿管回肠吻合处狭窄具有较好的临床应用价值.

Objective:To summarize our preliminary experience of the individual transurethral en bloc resection of bladder tumor (ERBT) based on vesical imaging-reporting and data system (VI-RADS).Methods:The clinical data of 32 bladder cancer patients admitted from January 2019 to October 2019 were retrospectively analyzed, including 26 males and 6 females. Among them, there were 27, 5, 26 and 6 patients who had primary, recurrent, single or mutiple blader tumors, respectively. And the median number of bladder tumor was 1(1-3) and the mean diameter was 2(0.6-4.5)cm.The patients were aged 37 to 82 years, with a median age of 63 years. All patients underwent multi-parameter magnetic resonance imaging (mpMRI) before surgery and acquired a VI-RADS score. Among the 32 patients, there were 8, 17, 2, 5, and 0 patients in the VI-RADS score category 1, 2, 3, 4, and 5, respectively. Based on the VI-RADS score and tumor size, morphology and number provided by the mpMRI, the urologists classified the tumor types into type 1, 2a, 2b, 2c, 3a, 3b, 3c, 4a, 4b or 5, and designed the surgical protocol for each type including the resection plan, boundary and depth. There were 8, 6, 7, 4, 0, 1, 1, 3, 2 and 0 patients in each type, respectively. The tumor types were further confirmed during the operation, and the operation was completed according to the surgical plans for different tumor types.Patients received intravesical therapy of gemcitabine within 24 hours after surgery.Results:All operations were successfully completed and none was converted to the traditional transurethral resection of the bladder tumor. The operation time was 5 to 35 minutes with a median time of 15 minutes. Tumor specimens from all patients contained the muscularis propria. Among the patients with scores 1, 2, 3 and 4, there were 8, 16, 1 and 0 patients diagnosed with non-muscle invasive bladder cancer (NMIBC), respectively. All the patients with NMIBC had negative basal resection margins and 6 out 7 muscle invasive bladder cancer (MIBC) patients had negative resection margins. There were no intraoperative complications such as bladder perforation and obturator reflex. Four patients experienced obvious postoperative bladder irritation and relieved after symptomatic treatment or removing catheter. Twelve patients received second resections, including 10 NMIBC patients and 2 MIBC patients. No residual tumor was found in the re-resected specimens. There were 9 and 12 NMIBC patients received regular intravesical therapy of gemcitabine or BCG, respectively. Among the 7 MIBC patients, 5 received radical cystectomy and two received bladder-preserving treatment including second resection, adjuvant chemotherapy and radiotherapy. The follow-up period was 3-12 months, with a median of 6 months. One NMIBC patient relapsed at 9th months after surgery and underwent ERBT.Conclusions:The personalized ERBT based on VI-RADS is safe and feasible, and can achieve negative margins in all NMIBC and some MIBC without severe complications.

The oxidative injury of renal tubular epithelial cells caused by inflammation and oxidative stress induced by hyperoxaluria is an important factor in the kidney calcium oxalate (CaOx) stone formation. Resveratrol (RSV) has been reported to reduce oxidative injury to renal tubular epithelial cells, and autophagy is critical for the protective effect of resveratrol. However, the protective mechanism of RSV in oxalate-induced oxidative injury of renal tubular cells and the role of autophagy in this process are still unclear. In our study, glyoxylic acid monohydrate-induced rats were treated with or without resveratrol, and it was detected that the overexpression of oxidant species, CaOx crystal deposition, apoptosis level, inflammatory cytokines and osteoblastic-associated protein expression were reversed by resveratrol. Additionally, Resveratrol pretreatment significantly reversed oxalate -induced decline in cell viability, cell damage, oxidant species overexpression, and osteogenic transformation in normal rat kidney epithelial-like (NRK-52E) cells. Furthermore, we found that RSV pretreatment promoted intracellular LC3II upregulation, p62 downregulation, and autophagosome formation, whereas 3-methyladenine treatment reduced this effect. Moreover, RSV induced the expression of transcription factor EB (TFEB) in the nucleus of NRK-52E cells in a concentration-dependent manner. After transfection of NRK-52E cells with TFEB siRNA, we showed that the RSV-induced increase in TFEB expression and autophagosome formation were inhibited. Simultaneously, RSV-induced NRK-52E cells protection was partially reversed. These results suggested that RSV regulates oxalate-induced renal inflammation, oxidative injury, and CaOx crystal deposition in vitro and in vivo through the activation of a TFEB-induced autophagy.