Volume 101 ·  Issue 38 ·  2021

Monogenic nephrolithiasis is comparatively rare in clinical practice, but its yearly increasing incidence and impacts on physical and mental health are worth wide attention. At present, management of monogenic nephrolithiasis are still the medication and surgery. This article regards the research progress on primary hyperoxaluria as the breakthrough point to review the etiological therapy of monogenic nephrolithiasis. We aim to promote more studies on other monogenic nephrolithiasis, more methods and drugs for gene therapy, precise and individualized treatment of monogenic nephrolithiasis, and thus to promote the prevention and treatment of monogenic nephrolithiasis in China.

Although minimally invasive diagnosis and treatment technology for urinary stones has been widely developed, with continuous progress and cross integration of imaging, laser technology, endoscopic technology, and materials science, new diagnosis and treatment equipment emerge in endlessly, which promotes the continuous progress and innovation in diagnosis and treatment technology for urinary stones. By introducing the advances in imaging, lithotripsy tools, new endoscopes and ureteral stents, and analyzing their application prospects, it helps us understand the development trend of diagnosis and treatment of urinary stones in the future.

Congenital heart disease (CHD) is the first malformation of birth defects in China, and most common CHD can achieve good results through percutaneous interventional treatment. At present, evidence-based medical evidence for common CHD percutaneous intervention is constantly emerging, and China's original radiation-free percutaneous intervention technology has also become a development hotspot in recent years. However, China's treatment opinions in this field are still in the early stage of expert consensus. In view of this, this guideline, on the basis of fully drawing on the latest clinical research results in the world, referring to international guidelines and China's national conditions, standardizes the indications, operation points, complication prevention and treatment and postoperative follow-up of common percutaneous interventional therapy for CHD, so as to provide guidance for clinical practice.

Adult occult autoimmune diabetes (LADA) is a type of diabetes caused by slow autoimmune damage to islet beta cells. According to the etiological classification, LADA should belong to the autoimmune subtype of type 1 diabetes. LADA does not rely on insulin therapy in the early stage and is easily misdiagnosed as type 2 diabetes. The prevalence of LADA in China is at a high level in the world, and the number of patients ranks first in the world. Early diagnosis and timely and correct intervention are beneficial to delay the development of LADA. In order to standardize the comprehensive management of LADA, the Endocrinology and Metabolism Branch of Chinese Medical Doctors Association and the National Clinical Medical Research Center for Metabolic Diseases (Changsha) specially organized experts to revise the first edition of the consensus, forming the Chinese Expert Consensus on the Diagnosis and Treatment of Adult Occult Autoimmune Diabetes (2021 Edition), which covers the epidemiology, genetics, immunological characteristics, clinical manifestations, diagnosis and classification, treatment and management of LADA. This consensus will help to convey recent important clinical advances and guide clinical practice.

The level of nitric oxide (NO) in exhaled breath is closely related to airway inflammation and airway hyperresponsiveness. In recent years, the development of NO detection technology including upper and lower airways, large and small airways has provided an important reference for the diagnosis and treatment of bronchial asthma, chronic cough, upper airway diseases, chronic obstructive pulmonary disease and even rare airway diseases. On the basis of the "Chinese Expert Consensus on the Clinical Application of Noninvasive Airway Inflammation in Evaluating Asthma" published in 2015 by the Chronic Airway Diseases Professional Committee of China Medical Education Association and China Asthma Alliance, this consensus was written with reference to relevant international guidelines and important literatures, and guidance was given on the methodology, quality control, result interpretation and clinical application of airway NO detection, so as to help better apply this technology to guide clinical diagnosis and treatment.

To analyze the genotype characteristics of children with monogenic nephrolithiasis.

The clinical data and genetic test results of 56 children with monogenic nephrolithiasis diagnosed and treated in Beijing Friendship Hospital, Capital Medical University from January 2016 to December 2020 were analyzed retrospectively. All pediatric patients were diagnosed by whole exome sequencing, and the genotype characteristics of the children were analyzed.

Among 56 children with monogenic nephrolithiasis, there were 39 males and 17 females, with an average age of 4 years (range, 5 months to 14 years). A total of 11 genes were found to have mutations, including 7 autosomal recessive genes, 1 X-linked recessive gene, and 3 genes with both recessive and dominant, of which HOGA1 gene mutation was the most common (16 cases, 28.6%), followed by AGXT gene (15 cases, 26.8%), SLC3A1 gene (6 cases, 10.7%), SLC7A9 gene (5 cases, 8.9%) and GRHPR gene (5 cases, 8.9%). The mutation types included nonsense mutations, frameshift mutations and splicing mutations, with 14 novel mutations. Genes such as AGXT, GRHPR and HOGA1 have hotspot mutations or hotspot mutation regions, which are c. 815-816 insGA and c. 33dupC mutation, c.864-865delTG mutation and c. 834-834+1 mutation region; SLC3A1 and SLC7A9 genes had 9 novel mutations, but no hotspot mutation or hotspot regions were found.

Monogenic nephrolithiasis is rare and mostly autosomal recessive in Chinese children, with mutations in the causative genes HOGA1, AGXT, SLC3A1,SLC7A9 and GRHPR. AGXT, GRHPR and HOGA1 genes have hotspot mutations or hotspot mutation regions, and mutations may have ethnic differences.

To compare the outcomes of multi-tract percutaneous nephrolithotomy (PCNL) and simultaneous combined single-tract percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy (ECIRS) as treatment for staghorn stones.

The clinical data of patients with staghorn stones who were treated with multi-tract PCNL or single-tract ECIRS in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2015 to December 2019 were retrospectively analyzed. Two group of patients were placed in semisupine-lithotomy position (Galdakao-modified supine Valdivia position). We punctured into the renal calyces guided by ultrasonography. A F6 double J stent and a nephrostomy tube were routinely inserted in both groups. Kidney-ureter-bladder radiography (KUB) or computed tomography (CT) were done within 24 hours and 1 month after procedure to determine stone free rate (SFR). Stone free was defined as no residual stones or residual stones of <4 mm in diameter. The SFR, operating time, intraoperative and postoperative complications, and hospitalization time of the two groups were compared and analyzed.

A total of 135 patients were included in the study, 70 patients were female, 65 patients were male. The average age were 50.8 years. A total of 74 patients were managed by multi-tract PCNL, while 61 patients were treated by single-tract ECIRS. The mean stone diameter was (58.5±11.4) mm in the PCNL group and (57.7±11.6) mm in the ECIRS group (P=0.658). Neither the 24-hour SFR (81.1% vs 80.3%) nor one-month SFR (91.9% vs 90.2%) after procedure was significantly different between the groups (both P>0.05). The operating time was significantly longer in PCNL group compared with ECIRS group [130(100,171) vs 105(90,135) min,P=0.015]. The rate of Clavien-Dindo grade 2 or higher were significantly higher in the PCNL group than the ECIRS group (18.92% vs 1.64%, P<0.01). The PCNL group required longer hospitalization time than the ECIRS group [8 (7, 9) vs 6 (5, 8) d,P<0.01].

Both multi-tract PCNL and single-tract ECIRS treating staghorn stones in semisupine-lithotomy position are safe and effective. The two procedures have comparable SFR. However, the ECIRS group has lower rates of postoperative complications, shorter operating time and hospitalization time.

To evaluate the feasibility and safety of Sotn ureterorenoscope combined with flexible ureteroscope on managing complex renal stones.

Patients treated with the Sotn ureterorenoscope combined with flexible ureteroscope between January 2010 and December 2019 were employed from the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and Jiangmen Wuyi Traditional Chinese Medicine Hospital. The patients′ information of age, gender, comorbidities, stone characteristics (stone size, hounsfield units, stone composition, stone location, etc.), operative time and console time, stone-free rate (SFR), and perioperative complication rate were collected. The primary outcome was defined as primary SFR in 1 month of operation, and the secondary outcome was the perioperative complication rate. The differences in preoperative and postoperative data between patients with different kinds of stones were compared.

A total of 347 patients were included in the study, with 220 males and 127 females. The age [M(Q₁,Q₃)] was 51 (42, 58) years. There were 94 patients suffered from multiple renal stones and 253 patients with staghorn renal stones. The operative time and console time age [M(Q₁,Q₃)] for all patients were 87 (55, 115) min and 59 (27, 75) min, respectively. The primary SFR was 81.3% [83.8% for multiple renal stones and 74.5% for staghorn renal stones (P=0.048)]. Complications occurred in 80 patients (23.1%), of which 79 cases were classified as Clavien-Dindo grade 1-2, and 1 case (0.3%) was grade 3-4. For patients with multiple renal stone, compared with the residual stone group, the complete stone-free group had smaller stone size [15.5 (12.0, 21.0) vs 22.0 (17.5, 28.1) mm, P<0.001], and lower hounsfield units [920.0 (658.0, 1 172.5) vs 1 125.0 (944.9, 1 247.5),P=0.022]. Patients with complications had longer operative time than those without complications [60.0 (38.5, 90.0) vs 75.0 (51.3, 110.0) min, P=0.022]. The SFR was higher in patients with stones size ≤ 20 mm compared to those with stones size > 20 mm (91.8% vs 67.5%, P<0.001), while the difference in complication rate was not statistically significant (P>0.05). In the staghorn renal stones group, compared with the residual stone group, the complete stone-free group had smaller stone size [35.0 (25.8, 45.3) vs 53.5 (39.3, 67.5) mm,P<0.001]. Patients with complications had larger stone size than those without complications [43.5 (34.8, 56.5) vs 36.0 (27.0, 50.0) mm,P=0.007]. Patients with stone size ≤ 40 mm had higher SFR (87.5% vs 55.3%, P<0.001) and lower complication rate(10.7% vs 31.6%,P=0.012) compared to those with stone size >40 mm.

Sotn ureterorenoscope combined with flexible ureteroscope is an effective and safe choice for the treatment of complex renal calculi.

To explore the value of preoperative neutrophil-to-lymphocyte ratio (NLR) and γ-glutamyl transpeptidase-to-platelet ratio index (GPRI) for predicting the prognosis of patients with HBV-related intrahepatic cholangiocarcinoma (ICC) after radical resection.

The data of 79 patients who underwent radical resection for HBV-related ICC in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi′an Jiaotong University from January 2010 to December 2018 were retrospectively analyzed. Among them, 48(60.8%) patients were male and 31 (39.2%) patients were female, (56.9±11.2) years old. X-Tile statistical software was used to determine the best cut-off values of NLR and GPRI. The χ² test was conducted to analyze the relationship between preoperative NLR and GPRI and the clinicopathological characteristics, and the Cox proportional hazard regression model was conducted for multivariate analysis. A nomogram prognostic prediction model was established based on independent risk factors screened by Cox regression model.

The best cut-off values of NLR and GPRI were 3.13 and 1.31 determined by the X-Tile software, respectively. With the best cut-off value, 79 patients were divided into NLR≤3.13 group (45 cases) and NLR>3.13 group (34 cases). GPRI≤1.31 group (54 cases) and GPRI>1.31 group (25 cases). Compared with the preoperative NLR ≤3.13 group, the proportion of patients with liver cirrhosis and atrophy, poor pathological differentiation, tumor diameter>5 cm and late TNM stage was significantly increased in the NLR>3.13 group (allP<0.05); Compared with preoperative GPRI ≤1.31 group, the proportion of patients with liver cirrhosis and atrophy was significantly increased in the GPRI>1.31 group (P=0.025). The postoperative overall survival time of the included patients was 2 to 126 months, with the median survival time being 18 months, and the 1, 3-year overall survival rates were 63.3%, 32.8%, respectively. Multivariate analysis showed that NLR, GPRI, liver cirrhosis and atrophy, and lymphatic metastasis were independent risk factors affecting the overall survival of patients with HBV-related ICC after radical resection (P<0.05). A nomogram prediction model was established based on independent risk factors, with the C-index of 0.750, and the prediction effect was close to the actual survival outcome of the patients.

Preoperative peripheral blood NLR and GPRI can be used to predict the prognosis of patients with HBV-related ICC after radical resection.

To investigate the different tracer materials in identifying the axillary reverse mapping(ARM) lymph nodes.

A retrospective analysis of clinical and pathological data of 478 breast cancer female patients(mean age: 50.5±8.0) under axillary lymph node dissection(ALND) with ARM technique was conducted between March 2019 and November 2020 in Wuhan University Zhongnan Hospital. Of the 478 patients, methylene blue was applied in 147 patients, indocyanine green in 119, and indocyanine green plus methylene blue in 212 patients. Wilcoxon rank-sum test, Chi-squire test or Fisher test, and binary logistic regression were carried out to identify the factors associated with identifying ARM lymph nodes.

The recognition rates of ARM lymph nodes were 73.5%, 79.0%, and 83.0%(P=0.091), and the recognition rate of ARM lymphatic vessels was 62.6%, 92.4%, 89.6%(P<0.001), respectively. The coincidence rate of ARM lymph node and SLN was 8.1%(12/148), and the metastasis rate was 16.1%(61/378). Supplemental injection of 1 ml of methylene blue or indocyanine green can improve the identification of ARM lymph nodes. The larger BMI and the performance of neoadjuvant therapy were associated with the lower recognition rate of ARM lymph nodes. Neoadjuvant therapy was an independent factor for the identification rate of ARM lymph nodes.

Indocyanine green combined with methylene blue can improve the recognition rate of ARM lymph nodes. Obese patients have a lower recognition rate of ARM lymph nodes, and the supplemental injection tracer can be injected to improve the recognition rate. In breast cancer patients whose ARM lymph nodes are not successfully identified during operation, it may be that the ARM lymph nodes are not located in the axilla.

To evaluate the predictive value of neutrophil-lymphocyte ratio (NLR) on admission and before discharge for long-term all-cause death (ACD) in patients hospitalized with heart failure with reduced ejection fraction (HFrEF).

Patients hospitalized and discharged from hospital alive with the clinical diagnosis of HFrEF in cardiac care unit (CCU) of TEDA International Cardiovascular Hospital from January 2013 to December 2017 were consecutively enrolled. NLR, which was defined as neutrophil counts divided by lymphocyte counts, was measured 1 day within admission and 3 days before discharge to evaluate the prognostic value of admission NLR in combination with discharge NLR for the ACD after discharge by using of multivariate Cox regression analysis. Patients were followed-up until December 2020 or ACD.

A total of 368 patients hospitalized with HFrEF were enrolled with an age of (54±14) years, including 79 females (21.5%). During the median (inter-quartile range, IQR) duration of follow-up after discharge of 30 (10, 60) months, 95 patients died, thus, the rate of ACD was 25.8%. Multivariate Cox regression analysis showed that the NLR level before discharge was an independent predictor of ACD after discharge [hazard ratio (HR)=1.143, 95% confidence interval (CI) 1.048-1.248, P=0.003] after adjusting for other parameters such as systolic blood pressure on admission and at discharge, left ventricular end-diastolic diameter on admission, and usage of aldosterone receptor blockers at discharge. Moreover, compared to those with NLR level at admission ≤2.25 and ≤2.00 before discharge, the long-term risk of ACD after discharge was nearly doubled for patients with NLR level at admission>2.25 and>2.00 before discharge (adjustedHR=1.968, 95%CI 1.198-3.234, P=0.008).

The NLR level before discharge was an independent predictor of ACD after discharge for patients hospitalized with HFrEF. Combining NLR levels at admission and before discharge help to better predictive the risk of long-term ACD after discharge.

In order to discuss the necessity of repeated renal arteriography in the treatment of severe bleeding after percutaneous nephrolithotomy, this study retrospectively analyzed the clinical data of patients with severe bleeding after percutaneous nephrolithotomy in the Department of Urology Surgery of the First Hospital of China Medical University from August 2010 to July 2020, summarily analyzing treatments, outcomes and follow-up results of 27 patients who were treated by renal arteriography more than twice. Of these 27 patients who underwent repeated renal arteriography, 23 of them were treated by two times, 4 by three times, all of whom were diagnosed as renal vascular injury. And 15 of them were diagnosed as pseudoaneurysm, 4 of them renal arteriovenous fistula, and 8 of them pseudoaneurysm combined with renal arteriovenous fistula. After clear diagnosis, all these patients were performed with renal artery embolization, after which the symptoms of hematuria and lumbar discomfort were relieved or disappeared immediately. These patients were followed up from 6 months to 5 years, without corresponding symptoms recurring and with the renal function equivalent to that before embolization. The results showed that repeated renal arteriography was of great significance in the treatment of patients with severe bleeding after percutaneous nephrolithotomy, helping to clarify the cause of bleeding and giving appropriate and timely treatment.

To summarize the clinical characteristics and surgical treatment experience of pregnant women with acute Stanford type A aortic dissection.We collected the clinical data of 12 cases with acute aortic dissection during pregnancy and puerperal period from June 2010 to July 2020 in Beijing Anzhen Hospital and analyzed retrospectively, and summarize the clinical characteristics, treatment and outcomes for both mother and fetus. The age of these patients was(29±5)years old, and the onset time was from 16 weeks of gestation and 1 month after delivery. All the 12 patients underwent surgical treatment. The patients in the puerperium received aortic surgery after delivery. Four of them received the aortic surgery and continued pregnancy. Five of them underwent aortic repair and cesarean section simultaneously. Surgical treatment should be actively considered in pregnancy complicated with acute Stanford type A aortic dissection. Multi-disciplinary team cooperation can effectively improve the safety of the patients and fetus.

A total of 1 295 516 dried blood spots were collected from newborns in Hainan Province from 2007 to 2019 who participated in the screening of neonatal diseases, and 43 cases of hyperphenylalaninemia were diagnosed. Among the 43 cases, 8 cases were confirmed to have tetrahydrobiopterin deficiency (4 males and 4 females). The incidence of tetrahydrobiopterin deficiency among newborns in Hainan Province was 6.2/1 million. Six mutations in the PTS gene were detected among 7 cases; the mutations were as follows: c.317C>T, c.286G>A, c.259C>T, c.155A>G, c.84+291A>G and c.83+1777T>G. A homozygous mutation at c.41T>C site of QDPR gene was detected in one case. Overall, it′s found that the incidence of tetrahydrobiopterin deficiency in newborn populations in Hainan Province is low, and PTS gene mutations account for the largest proportion of cases of tetrahydrobiopterin deficiency within the study population.

To investigate whether the abundance or diversity of intestinal flora in breast cancer (BC) patients effects on the degree of tumor infiltration lymphocytes in breast cancer tissues.

Between March 2017 and October 2017, a total of 80 biopsy-confirmed female patients with BC were enrolled in the present study at the Breast Center of the Fourth Hospital of Hebei Medical University (Shijiazhuang, China), age distribution ranged from 37 to 74 years, which were divided into three groups based on the infiltration of tumor-infiltrating lymphocytes, as follows: high infiltration of TILs (TIL-H) 25 cases, medium infiltration of TILs (TIL-M) 34 cases and low infiltration of TILs (TIL-L) 21 cases. DNA of the intestinal flora was determined by Illumina sequencing and taxonomy of 16S ribosomal RNA genes. Compare the differences in the abundance or diversity of intestinal flora between these three groups. The relationship between tumor-infiltrating lymphocytes and clinical characteristics was analyzed by χ² tested, and the relationship with intestinal flora was analyzed by β diversity.

There were 3, 174, 2, 996, and 2, 877 different OUTs in the TIL-H, TIL-M, and TIL-L groups. The β-diversity distribution was statistically significant (weighted UniFrac, P<0.01; unweighted UniFrac,P<0.01) when comparing the three groups (TIL-H vs. TIL-M vs. TIL-L), the differences between TIL-L and TIL-H groups were greatest.

The infiltration level of tumor-infiltrating lymphocytes in breast cancer patients was closely related to the diversity of intestinal flora.

Functional intestinal obstruction is a complication with high incidence after ileostomy reduction, which is rarely reported in China. This article reports a patient with functional intestinal obstruction after reduction of ileostomy. The patient recovered after conservative treatment such as fasting, gastrointestinal decompression, and intravenous nutritional support. Correct identification of this type of intestinal obstruction helps to select the correct treatment plan in time and avoid the occurrence of adverse outcomes.

Calcium oxalate stones, as the most common type of urinary stones, have a high incidence and recurrence rate, which is a health problem of widespread concern in the world. Because of this, finding its cause has always been a difficult problem for doctors or scholars. Except for a few hereditary or secondary calcium oxalate stones, most calcium oxalate stones lack a clear etiology, which is often considered as a polygenic disease under the influence of environmental factors. Searching for its susceptibility genes is a hot research topic in recent years, which provides a new direction for screening, treatment and prevention of calcium oxalate stones. This article reviews the latest literature at home and abroad, and summarizes the gene loci related to the pathogenesis of calcium oxalate stones discovered in recent years.

The incidence and recurrence rate of kidney stones are high, and the harm is serious. Calcium oxalate stones are the main type of kidney stones, and the cause is not completely clear, so there is no good targeted prevention strategy at present. With the development of 16S rRNA, metagenic and metabolomics methods, the influence of intestinal flora and its metabolites on diseases has become a hot spot in many research fields. At present, more and more studies also indicate that intestinal flora and its metabolites short chain fatty acids may be closely related to the occurrence and development of kidney stones. On the one hand, the intestinal flora can affect the homeostasis of oxalic acid; On the other hand, short chain fatty acids can participate in a series of physiological and pathological processes after reaching the kidney through intestinal absorption and circulation, and regulate related immune and inflammatory responses. This paper will systematically expound the research progress of intestinal flora and its metabolite short chain fatty acids on the formation of kidney stones, and look forward to the future research direction.

Influenza is an important infectious disease that seriously endangers people's lives and health. Every year, the seasonal epidemic of influenza can lead to 3 million to 5 million severe cases and 290,000 to 650,000 deaths related to respiratory diseases worldwide. Vaccination is the most cost-effective means of preventing influenza. At present, the influenza vaccines on the market in China are all traditional chicken embryo influenza vaccines, and their effectiveness against special populations and specific virus strain needs to be improved. In recent years, some new influenza vaccines have been launched abroad one after another, and a number of clinical studies have confirmed that they can further improve the protective effect. This paper mainly discusses the shortcomings of existing influenza vaccines in prevention and control, the protective effects of common new influenza vaccines abroad, and the latest influenza vaccine technology in research and development, hoping to improve people's understanding of new influenza vaccines, encourage and promote the research and development and introduction of new influenza vaccines in China.

Primary hyperaldosteronism (PA) is considered a rare condition and is almost always associated with hypokalemia. Extensive screening of hypertensive patients has shown an increased prevalence of normokalemic hypertension. Many studies have reported the prevalence of hypokalemia in patients with PA; In contrast, the prevalence of PA in patients with hypokalemia remains unknown. The aim of this study was to investigate the prevalence of hypokalemia in patients in a tertiary hypertension medical center and to determine the prevalence of PA in patients with hypokalemia. At the same time, independently of the diagnosis of PA, the authors also considered the correlation between blood potassium imbalance and cardiovascular disease, and also evaluated the cardiovascular risk of patients with normopotassium and patients with hypokalemia. In this retrospective observational study, the authors defined the prevalence of hypokalemia in patients referred to a tertiary hypertension medical center and the prevalence of PA in patients with hypokalemia and hypertension in 5 100 hypertensive patients included in the study. The results showed that 15.8% of the 5 100 cases of hypertension were hypokalemia, 76.9% were normopotassium and 7.3% were hyperkalemia. The prevalence of PA was 28.1% in patients with hypokalemia, which increased with decreasing blood potassium concentrations, up to 88.5% in patients with spontaneous hypokalemia, with potassium concentrations of<2.5 mmol/L. Multivariate regression analysis showed that hypokalemia was associated with the occurrence of cardiovascular events and not with PA diagnosis. PA was associated with the occurrence of cardiovascular events and target organ damage, not with hypokalemia. The results of this study confirm that PA is a common cause of secondary hypertension in patients with hypokalemia, and the presence of hypertension and spontaneous hypokalemia is a strong indication for the diagnosis of PA. Clinicians and general practitioners should focus on the risk of hypokalemia in patients diagnosed with essential hypertension and PA. The reported prevalence of PA in patients with hypokalemia should also be confirmed in large prospective multicenter cohort studies. Future research by the team may further clarify the relationship between hypokalemia and PA and increased cardiovascular risk and target organ damage.

Advances in computer software and three-dimensional (3D) printing have reduced the complexity and cost of model manufacturing, and increased the accessibility of its application in the medical field. In the field of urology, 3D printing and modeling technology has now been commonly used in the improvement of surgical protocols, surgical operation training and the development of patient-specific rehearsal (PSR) for complex urological procedures. In order to evaluate the anatomical accuracy of 3D printing and modeling techniques, 10 cases of PSR hydrogel 3D printing models of robot-assisted partial nephrectomy (RAPN) and percutaneous nephrolithotomy (PCNL) were selected in this study. First, 20 cases of 3D printing models were reconstructed by computer-aided design (CAD), and then the above 20 newly acquired CAD models were compared with their corresponding original CAD models in geometric similarity, volumetric overlap and spatial alignment, and finally compared by means of mean. In the comparison of geometric similarity, all structures of the RAPN 3D printed model (including renal parenchyma, tumor, renal arteriovenous, and collective system) had more than 80% point deviation<3 mm, while the PCNL 3D-printed model of calculus and ensemble system bias<94% and 59% for 3 mm points, respectively; In the comparison of volume overlap degree, except for the poor anastomosis degree of arterial structure in RAPN 3D printed model, the rest of the structures are ideal, while the anastomosis degree of stone in PCNL 3D printed model is ideal; In the comparison of the degree of spatial alignment, the tumor structure of the RAPN 3D printed model was most ideal aligned with the renal parenchyma, with 75% point deviation<3 mm, while the most ideal alignment reference for the PCNL 3D printed model is the rib tip with a deviation of 0.1%.

The incidence of kidney stones is high, which is closely related to lifestyle. However, in addition to surgical intervention, the development of pharmacological treatment of kidney stones is slow. Studies have confirmed that inflammation and oxidative stress can increase the adhesion of calcium oxalate (CaOx) crystals to renal tubular cells (RTCs) and promote the formation of kidney stones. Therefore, alleviation of cellular damage and inflammatory response can be used as a strategy to inhibit kidney stone formation. Among the protective mechanisms against cell injury, autophagy and ubiquitin proteasome system are the main pathways of cell degradation. Autophagy is upregulated when cells are ready for structural remodeling. It can be seen that autophagy not only plays a major role in the supply of nutrients for cell survival, but also plays an important role in cellular homeostasis. First, this study detected significant downregulation of autophagy activity in RTCs exposed to calcium oxalate crystals monohydrate (COM), GFP-MAP1LC3B (microtubule-associated protein 1 light chain 3 β) transgenic mouse models of glyoxylic acid (GOX) -induced CaOx nephrocalcification, and in the mucosa to which crystal plaques attached in patients with CaOx kidney stones. Due to decreased autophagy, the damaged organelles were not completely removed, exacerbating the inflammatory response and oxidative stress. Moreover, damaged organelles that have not been cleared can form cellular vacuoles, which accumulate in the lumen and may become nuclei for crystal formation. This study further explored the relevant mechanism and found that the reduction of autophagy was mainly caused by the upregulation of the rapamycinase mechanism target (mTOR) signal and the inhibition of the upstream autophagy regulator TFEB (transcription factor EB). Based on the above results, in vitro and in vivo experiments of mTOR signaling inhibition were conducted in this study. In vitro experiments, treating cells with the mTOR inhibitor Torin1 could reverse the decrease in autophagy activity caused by COM exposure, alleviate mitochondrial damage, impaired lysosomal pH homeostasis, and accumulation of LGALS3, while alleviating the inflammatory response and crystal adhesion caused by COM exposure. In vivo experiments, the number of autophagy lysosomes in GOX mice injected with rapamycin (inhibiting mTOR) daily was stable after 1~2 d, which inhibited the rise of GOX-induced SQSTM1. However, the number of autophagic lysosomes decreased after 1~2 d in mice without rapamycin injection. These results suggest that rapamycin can antagonize the decrease of autophagic activity. In summary, the upregulation of mTOR signal caused by calcium oxalate stone stimulation will lead to the reduction of autophagy function, which in turn promotes stone formation. mTOR inhibitors may be a promising treatment for kidney stones.

Patients with primary aldosteronism (PA) account for 3% to 10% of all hypertensive patients, which exceeds previous general perception. Adrenal vein sampling (AVS) is the standard procedure for determining excessive lateralization of aldosterone. Based on studies showing that adrenalectomy (AdX) has potential advantages over mineralocorticoid receptor antagonist (MRAs) drug therapy, the current clinical treatment guidelines recommend adrenalectomy as a treatment for unilateral PA. However, the majority of PA cases are composed of PA with bilateral adrenal hyperplasia as the etiology, so the efficacy of AdX will vary with different subtypes of PA. The aim of the study was to compare the clinical (improved blood pressure) and biochemical outcomes (improved hypokalemia) of AdX and MRAs in patients with unilateral PA with confirmed AVS subtype. The study included 339 patients with unilateral PA in the Japanese PA study database, of which 276 patients (AdX group) and 63 patients (MRAs group) received unilateral AdX and MRAs treatment, respectively. Baseline clinical features before treatment suggest that potassium replacement, plasma aldosterone concentration, aldosterone-to-renin ratio, glomerular filtration rate, and imaging prevalence of adrenal masses were significantly higher in the AdX group than in the MRAs group. After 6 months of PA-specific therapy, patients with unilateral PA who underwent adrenalectomy and medical therapy showed improvement in blood pressure. The increase of serum potassium in AdX group was greater than that in MRAs group, and the difference of serum potassium normalization rate between the two groups was statistically significant. The clinical and biochemical outcomes in the AdX group were better than those in the MRAs group.