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Urolithiasis Oct 2022We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy... (Meta-Analysis)
Meta-Analysis Review
We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.
Topics: Humans; Kidney Calculi; Length of Stay; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Postoperative Complications; Randomized Controlled Trials as Topic; Treatment Outcome; Urinary Fistula
PubMed: 35674819
DOI: 10.1007/s00240-022-01337-y -
The British Journal of Radiology Feb 2020Evaluate the efficacy and safety of renal artery embolization (RAE) for iatrogenic renal vascular injuries (IRVI) management at Fondazione Policlinico Universitario "A....
OBJECTIVE
Evaluate the efficacy and safety of renal artery embolization (RAE) for iatrogenic renal vascular injuries (IRVI) management at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, in the last 5 years.
METHODS
Retrospective analysis of all RAE procedures performed from January 2013 to December 2017. Patients-related (age, sex, vascular variants, hemoglobin and serum creatinine), IRVI-related (type and vascular level of IRVI, presence and extension of hematoma), management-related (temporal interval between diagnostic imaging and RAE) and procedure-related (embolic materials, technical success, clinical success and complications) parameters were evaluated.
RESULTS
28 RAE procedures performed on 28 patients (21 males; 7 females) were included. 19/28 patients had pseudoaneurysm, 7/28 active bleeding and 1/28 arteriovenous fistula; 4/28 patients had a combination of 2 IRVI.The extent of perirenal hematoma showed correlation with the cause of IRVI ( = 0.028).Technical success was achieved in all patients whereas clinical success in 25/28 (89.3%), with 3 patients requiring re-treatment. Minor complications were observed during 2/28 (7.1%) endovascular procedures. No major complications occurred. A longer procedural time was observed in patients with lower pre-procedural levels of hemoglobin ( = 0.016).No differences were found in mean serum creatinine ( = 0.23) before and immediately after treatment, while values of creatinine at 1 week from the procedure were significantly lower ( = 0.04).
CONCLUSION
RAE is safe and effective for the management of iatrogenic IRVI showing high technical and clinical success rate and low complication rate.
ADVANCES IN KNOWLEDGE
Low pre-procedural hemoglobin levels increase procedural duration time. Glue alone or in combination with other materials is as safe as coils.
Topics: Adult; Aged; Aged, 80 and over; Aneurysm, False; Arteriovenous Fistula; Embolization, Therapeutic; Female; Hemorrhage; Humans; Intraoperative Complications; Male; Middle Aged; Renal Artery; Retrospective Studies; Treatment Outcome
PubMed: 31794248
DOI: 10.1259/bjr.20190256 -
Therapeutics and Clinical Risk... 2018To study an uncommon life-threatening disease, spontaneous retroperitoneal and perirenal hemorrhage.
OBJECTIVES
To study an uncommon life-threatening disease, spontaneous retroperitoneal and perirenal hemorrhage.
CASE DESCRIPTIONS
A 69-year-old male presented with pain in the left waist and back of 1 month duration. The renal abscess was suspected by magnetic resonance imaging before operation. The perirenal hematoma was cleaned by operation. In another case, the patient had a functional solitary left kidney compressed by a huge retroperitoneal mass and uropenia appeared.
RESULTS
The first patient died of adult respiratory distress syndrome after surgery. The second patient died of cardiac insufficiency and pulmonary embolism on the second day after evacuation of retroperitoneal hematoma.
CONCLUSION
Conservative surgery, such as selective arterial embolization, is a reasonable approach in patients with chronic spontaneous retroperitoneal and perirenal space hemorrhage and with poor general condition. We strongly recommend drainage or interventional therapy, but not a major surgery, in patients with poor condition.
PubMed: 29563802
DOI: 10.2147/TCRM.S152460 -
BMC Urology Oct 2020To evaluate the feasibility, safety, applied value and efficacy of enhanced recovery after surgery (ERAS) for PCNL for the treatment of renal calculi. Although the ERAS... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To evaluate the feasibility, safety, applied value and efficacy of enhanced recovery after surgery (ERAS) for PCNL for the treatment of renal calculi. Although the ERAS is applied for many urological diseases, its application in percutaneous nephrolithotripsy (PCNL) is still limited.
METHODS
This was a prospective study of patients admitted to hospital January and December 2018 and who were only diagnosed with renal calculi and excepted for serious or uncontrollable basic diseases and patients with multiple operation history and medication history. Patients were randomized 1:1 to the ERAS and traditional operation groups starting on the day before operation and end on the day of discharge. Each group was 118 cases. The stone clearance rate, visual analogue scale (VAS) pain score, the occurrence of perirenal hematoma and effusion, the incidence of extravasation of urine, the incidence of fever, bleeding and blood transfusion, and postoperative hospital stay were observed.
RESULTS
The stone clearance rates were similar between the two groups (ERAS: 93.2% (109/117) vs. traditional: 89.8% (106/118), P = 0.800). The operation time was similar in the two groups (ERAS: 54 ± 12 vs. traditional: 58 ± 11 min, P = 0.656). VAS pain score that was 0.79 ± 0.76 in the ERAS group at 4 h after surgery and was significantly lower than 2.79 ± 0.98 in the traditional group (P < 0.0001). The total complication rate was 15 cases in the ERAS group and 22 cases in the traditional group (P = 0.573). There were no difference in costs (21,348 ± 2404 vs. 21,597 ± 2293 RMB, P = 0.529).
CONCLUSIONS
ERAS perioperative management in PCNL was feasible, was without additional complications, and had well economic and social benefits. It is worth of clinical promotion and application.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Double-Blind Method; Enhanced Recovery After Surgery; Feasibility Studies; Female; Humans; Kidney Calculi; Lithotripsy; Male; Middle Aged; Prospective Studies; Treatment Outcome; Young Adult
PubMed: 33081762
DOI: 10.1186/s12894-020-00728-w -
Frontiers in Genetics 2022Recent studies highlighted the influence of epigenetic marks in the variability of many complex traits, both in plants and animals. These studied focused only on...
Recent studies highlighted the influence of epigenetic marks in the variability of many complex traits, both in plants and animals. These studied focused only on specific sites of the genome having differentially methylated profiles among individuals and/or tissues. In contrast, we recently used the methylation rate of the entire genome as a unique measure considered as a novel quantitative phenotype in sheep. This phenotype named global DNA methylation rate (GDMR), measured by luminometric assay, integrates the methylation level of each CpG dinucleotide within the 6 million of CCGG sites along the ovine genome. GDMR measured in blood previously showed moderate heritability of 0.20 and provided evidence for a genetic determinism. The main objective of the present study was to better characterize the GDMR phenotype in various tissues and investigate its variability in several breeds of sheep reared in the same environment. GDMR was measured on blood samples collected monthly from 59 growing male and female lambs (24 Romane, 23 Blackbelly and 12 Charollais), between birth and 4 months of age. Blood GDMR was on average around 80% and was influenced by the sampling date ( < 0.001), the breed ( = 0.002) and the sex ( = 0.002). In addition, GDMR was determined in 12 somatic (frontal lobe, pituitary gland, heart, lung, sub cutaneous and perirenal adipose tissue, skeletal muscle, liver, spleen, adrenal gland, medulla and cortical kidney) and 6 reproductive tissues (ovary, oviduct, uterus, testis, epididymis and seminal vesicle). GDMR was on average 70% in somatic tissues but marked variation was observed depending on the tissue. The GDMR measured in blood was higher than that measured in other somatic tissues, and is not a good proxy of less accessible tissues. Female reproductive tissues had a 10% higher GDMR than male reproductive tissues. We demonstrated a significant influence of the breed on blood GDMR, certainly reflecting the influence of different genetic backgrounds. The effect of the breed on GDMR may be related to their specific abilities to adapt to and live in different conditions.
PubMed: 35360841
DOI: 10.3389/fgene.2022.791283 -
World Journal of Clinical Cases May 2020A vascular tumor is a benign tumor with unique clinical and pathological features. Perirenal vascular tumor is extremely rare and has not yet been reported. Clinically,...
BACKGROUND
A vascular tumor is a benign tumor with unique clinical and pathological features. Perirenal vascular tumor is extremely rare and has not yet been reported. Clinically, it manifests as soreness and swelling. Color ultrasound and renal angiography illustrated the perirenal mass, which was closely connected with the kidney and the surrounding tissues and organs. Histology showed extensive embedded perirenal fat, and thin-walled vascular tissue displayed a pink stain due to red blood cells.
CASE SUMMARY
Herein, a case of robot-assisted retroperitoneal laparoscopic excision of a perirenal vascular tumor is reported. Analysis of the clinical, biological, and histological features of the perirenal vascular tumor can provide an in-depth understanding of the disease, which provides a theoretical and practical basis for better diagnosis and treatment.
CONCLUSION
This study contributes to a practical basis for the diagnosis and treatment of perirenal hemangiom.
PubMed: 32518800
DOI: 10.12998/wjcc.v8.i10.2050 -
Oncotarget Apr 2017Laparoscopic cryoablation (LCA) and percutaneous cryoablation(PCA) have been used on patients with small renal masses(SRMs) for many years. However, clinical studies... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Laparoscopic cryoablation (LCA) and percutaneous cryoablation(PCA) have been used on patients with small renal masses(SRMs) for many years. However, clinical studies assessing their feasibility and safety have reported contradictory outcomes. This systematic evaluation was performed to obtain comprehensive evidence with regard to the feasibility and safety of PCA compared with LCA.
METHODS
A systematic search of Embase, Pubmed, Medline, the Cochrane Library were performed to identify studies that compared LCA with PCA were published up to Mar 2016. Outcomes of interest included perioperative, pathologic variables, and complications.
RESULTS
Thirteen studies estimating LCA versus PCA were included for meta-analysis. Patients undergoing PCA were significantly older(WMD = -0.16 years; P = 0.01) and patients with posterior tumors were significantly prefer undergoing PCA than LCA(OR = 0.23; P = 0.0007), whereas patients with anterior tumors were significantly prefer undergoing LCA(OR = 3.82; P = 0.02). although PCA was associated with shorter hospital stay(WMD = 1.17 days; P < 0.0001) and higher incidence rate of perirenal hematoma(OR = 0.18; P < 0.0001). All the other analyzed parameters were similar, regardless of the surgical approach.
CONCLUSIONS
Patients undergoing PCA have shorter hospital stay and PCA was more frequently used in older patients and posterior tumors. Whereas LCA was associated with lower incidence rate of perirenal hematoma. Further multicenter, prospective and long-term follow-up RCTs are required to verify these findings.
Topics: Cryosurgery; Humans; Kidney Neoplasms; Laparoscopy; Odds Ratio; Postoperative Complications; Treatment Outcome; Tumor Burden
PubMed: 28199973
DOI: 10.18632/oncotarget.15273 -
Frontiers in Nutrition 2022Coix seed extract (CSE) and probiotics have been reported to regulate glycolipid metabolism different modes of action. We tested the effects of CSE, BPL1, and their...
Coix seed extract (CSE) and probiotics have been reported to regulate glycolipid metabolism different modes of action. We tested the effects of CSE, BPL1, and their combination to determine their effects on glycolipid metabolism in obese mice. Male C57BL/6J mice were fed a high-fat diet for 8 weeks to establish an obesity model. Obese mice were selected and divided into four groups: the model control group and three intervention groups. After 10 weeks of continuous gavage intervention, the mice in the intervention groups exhibited lower body weight (lower about 2.31 g, vs. HFD mice 42.23 g) and epididymal (lower about 0.37 g, vs. HFD mice 2.5 g) and perirenal fat content (lower about 0.47 g, vs. HFD mice 0.884 g); decreased fasting blood glucose, total cholesterol, triglycerides, and VLDL; and increased HLDL, respiratory exchange ratio, energy expenditure, and amount of exercise performed. CSE, BPL1 and their combination can effectively control the weight gain in obese mice, reduce fat content, and regulate blood lipids and abnormal blood sugar. These results may be related to reduce the chronic inflammatory states, improve energy metabolism, exercise, relieve insulin sensitivity, and reduce lipid synthesis the intervention of CSE, BPL1 and their combination. Compared with the single use of CSE alone, the combination of CSE + BPL1 can better exert the regulation function of intestinal flora, and change in the abundance of bacteria that could improve the level of inflammatory factors, such as increasing , reducing . Compared with the use of BPL1 alone, the combination of CSE and BPL1 can better regulate pancreatic islet and improve blood sugar. CSE may act directly on body tissues to exert anti-inflammatory effects. BPL1 and CSE + BPL1 may improve the structure and function of the intestinal flora, and reduce tissue inflammation.
PubMed: 35923203
DOI: 10.3389/fnut.2022.939423 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Aug 2017Lymphangioma is a rare, benign mesenchymal neoplasm, which is characterized by numerous intercommunicating cystic spaces containing lymphatic fluid. It is considered a... (Review)
Review
Lymphangioma is a rare, benign mesenchymal neoplasm, which is characterized by numerous intercommunicating cystic spaces containing lymphatic fluid. It is considered a congenital disease resulting from the obstruction of regional lymph drainage during the developmental period. Lymphangioma frequently occurs in the cervical neck and axilla, also in the retroperitoneum, mediastinum, mesentery, omentum, colon, and pelvis, rarely in the perirenal space. These tumors usually present in childhood, but infrequently, these also present in adults. Patients often complain of hematuria, flank pain, or abdominal pain. Complications of lymphangioma have been reported to include infection, ruputure, or hemorrhage. There are three types of lymphangioma commonly identified: capillary, cavernous, and cystic. Cystic type is the one commonly found intra-abdominally or retroperitoneally, and may be uniloculated or multiloculated. All these perirenal tumors have a very low incidence, make it difficult to diagnose. Differential diagnosis must be performed with the primary renal lymphoma, urinoma, polycystic kidney, teratoma, both benign and malignant tumors, etc. Endoscopic ultrasound guided fine needle aspiration is recommended in some literatures, which may help make diagnosis and further guide subsequent therapeutic strategy. Regarding treatment, surgical excision can be performed via either laparotomy or laparoscopy. And injection of sclerosants into lympahgioma has been described in the literature in nonsurgical candidates. The optimal definitive treatment is total surgical excision. Despite being rare, the tumor has an excellent prognosis. Here, we report a case of a 48-year-old woman with a left renal mass found in an abdominal ultrasonography during a health checkup. In the case presented, abdominal ultrasonography and magnetic resonance urography (MRU) revealed an approximately 11.3 cm×10.6 cm×12.8 cm multilocular cystic mass in the left perirenal space. There was no history of bowel or bladder complaint, either previous illness episodes. Full blood count and kidney function tests were within normal limits. Laparoscopic surgical removal of the cyst was accomplished without incident. A benign cystic perirenal lymphangioma was diagnosed on histology and confirmed with immunohistochemical stains. One month after the surgery the ureteral stent was removed. The patient was free of disease after a 3-month follow-up period. We report the case and discuss the management of perirenal lymphangiomatosis with a literature review.
Topics: Adult; Child; Female; Humans; Kidney Neoplasms; Lymphangioma, Cystic; Mesentery; Middle Aged; Omentum; Retroperitoneal Space
PubMed: 28816297
DOI: No ID Found -
Nutrients Nov 2020Nelumbinis Semen (NS, the seeds of ) extract is a traditional Korean medicine with anti-oxidant activity. The present study examined the anti-obesity and antidiabetic...
Nelumbinis Semen (NS, the seeds of ) extract is a traditional Korean medicine with anti-oxidant activity. The present study examined the anti-obesity and antidiabetic effects of NS powder in high-fat diet (HFD)-induced obese C57BL/6 mice. Mice ( = 8/group) were fed a normal diet (CON), HFD, HFD containing 5% NS powder (HFD-NS5%), or HFD containing 10% NS powder (HFD-NS10%) for 12 weeks. Food intake was relatively higher in groups HFD-NS5% and HFD-NS10%, while the food efficiency ratio was highest in group HFD ( < 0.05). HFD-NS5% reduced the body weight (-39.1%) and fat weight (-26.6%), including epididymal fat and perirenal fat, and lowered the serum triglyceride levels (-20.6%) compared with HFD. Groups HFD-NS5% and HFD-NS10% showed hepatoprotective properties, reducing the serum ALT levels ( < 0.05) and fat globules (size and number) in the liver compared with group HFD. HFD-NS5% and HFD-NS10% regulated the blood glucose, improved the glucose intolerance, and showed a 12.5% and 15.0% reduction in the area under the curve (AUC) of intraperitoneal glucose tolerance test (IPGTT), and a 26.8% and 47.3% improvement in homeostatic model assessment insulin resistance (HOMA-IR), respectively, compared with HFD ( < 0.05). Regarding the expressions of genes related to anti-obesity and antidiabetes, there was a 1.7- and 1.3-fold increase in PPAR-α protein expression, 1.4- and 1.6-fold increase in PPAR-γ protein expression, and 0.7- and 0.6-fold decrease in TNF-α protein expression, respectively, following HFD-NS5% and HFD-NS10% treatments, compared with HFD, and GLUT4 protein expression increased relative to CON ( < 0.05). These results comprehensively provide the fundamental data for NS powder's functional and health-promoting benefits associated with anti-obesity and antidiabetes.
Topics: Animals; Anti-Obesity Agents; Blood Glucose; Diet, High-Fat; Drugs, Chinese Herbal; Glucose Transporter Type 4; Hypoglycemic Agents; Insulin Resistance; Lipids; Liver; Male; Mice; Mice, Inbred C57BL; Obesity; PPAR alpha; PPAR gamma; Plant Extracts; Republic of Korea; Tumor Necrosis Factor-alpha; Weight Gain
PubMed: 33266423
DOI: 10.3390/nu12113576