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Kidney International Dec 2023The presence of glycolysis in kidney proximal tubule has been long debated. However, recent reports suggest that aberrant glycolysis is induced in pathologic conditions...
The presence of glycolysis in kidney proximal tubule has been long debated. However, recent reports suggest that aberrant glycolysis is induced in pathologic conditions and may play a critical role in kidney damage. Azushima et al. provided additional evidence that the accumulation of glycolysis-derived lactate could be the clue to understanding the pathogenesis of diabetic kidney disease.
Topics: Kidney Tubules; Kidney; Kidney Tubules, Proximal; Glycolysis; Lactic Acid
PubMed: 37981426
DOI: 10.1016/j.kint.2023.09.019 -
Urology Dec 2023To evaluate a population of children with non-refluxing primary megaureter (NRPM), we investigated spontaneous resolution of ureteral dilation and the pattern (proximal...
OBJECTIVES
To evaluate a population of children with non-refluxing primary megaureter (NRPM), we investigated spontaneous resolution of ureteral dilation and the pattern (proximal to distal or distal to proximal) in which it occurs.
METHODS
From our prospectively collected prenatal hydronephrosis (HN) database (0-24 months, 2008-2017), selecting those with NRPM (n = 92). We excluded patients who underwent surgery (n = 20), children with <6 months follow-up (n = 2) and without a voiding cystourethrogram (VCUG) (n = 4). Images were segregated into 198 ureteric segments (proximal/mid/distal). We defined resolution as Society for Fetal Urology (SFU) (0/1), anteroposterior diameter (APD) <10 mm, and ureteric dilatation <5 mm. Descriptive statistics and Kaplan-Meier curves were created for time-to-resolution analyses.
RESULTS
Of 66 patients and 198 ureteral segments, median age at presentation was 2 months (0-12), 83% were male (33% circumcised). Mean APD at baseline was 11 ± 4 mm, and 79% had (SFU 3/4) HN. Mean dilatation of ureteral segments (mm) at baseline was: 9 ± 2 proximal, 9 ± 2 mid, and 11 ± 3 distal. At a median follow-up time of 26 (7-83) months, dilation of 55 (83%) proximal, 48 (72%) mid, and 22 (33%) distal ureteric segments had resolved. Overall, HN resolution occurred in 76% of patients. Resolution rates were similar for proximal/mid-ureters (83% vs 72%; P = .20); however, they were significantly different from distal segments (83% proximal vs 33% distal; 72% mid vs 33% distal, P <.01).
CONCLUSION
Our data suggest that spontaneous resolution of NRPM follows a proximal to distal progression. Distal ureteric dilatation takes up to 10 months longer to resolve compared to that of proximal and mid-ureteric segments, as well as that of the renal pelvis.
Topics: Child; Pregnancy; Female; Humans; Male; Infant; Infant, Newborn; Kidney Pelvis; Hydronephrosis; Ureteral Obstruction; Ureter; Dilatation, Pathologic; Retrospective Studies
PubMed: 37776954
DOI: 10.1016/j.urology.2023.09.005 -
Disease-a-month : DM Nov 2023The prevalence and incidence of Ulcerative Colitis (UC), a recurrent and remitting inflammatory condition, are rising. Any part of the colon may be affected, beginning... (Review)
Review
The prevalence and incidence of Ulcerative Colitis (UC), a recurrent and remitting inflammatory condition, are rising. Any part of the colon may be affected, beginning with inflammation of the mucosa in the rectum and continuing proximally continuously. Bloody diarrhea, tenesmus, fecal urgency, and stomach pain are typical presenting symptoms. Many patients present with extraintestinal manifestations (EIMs) including musculoskeletal, ocular, renal, hepatobiliary, and dermatological presentation, among others. Most cases are treated with pharmacological therapy including mesalazine and glucocorticoids. Fecal microbiota transplantation (FMT) is a novel procedure that is increasingly being used to treat UC, however, its use yet remains controversial because of uncertain efficacy. FMT can lower gut permeability and consequently disease severity by boosting short-chain fatty acids production, helping in epithelial barrier integrity preservation. Upadacitinib (JAK Kinase inhibitor) is another newer treatment option, which is an FDA-approved drug that is being used to treat UC. This review article provides a comprehensive review of the EIMs of UC, the role of FMT along with various recent clinical trials pertaining to FMT as well as other diagnostic and therapeutic updates.
Topics: Humans; Colitis, Ulcerative; Fecal Microbiota Transplantation; Feces; Inflammation; Treatment Outcome
PubMed: 37357103
DOI: 10.1016/j.disamonth.2023.101606 -
Anticancer Research Aug 2023Laparoscopic distal gastrectomy for gastric cancer has become a common procedure in many institutions. As manual palpation is impossible, various methods have been...
BACKGROUND/AIM
Laparoscopic distal gastrectomy for gastric cancer has become a common procedure in many institutions. As manual palpation is impossible, various methods have been developed to identify the location of the tumor and determine the proximal resection line. Intraoperative endoscopy requires manpower and is time-consuming. The authors take an intraoperative X-ray. Here, we demonstrate our methods and outcomes.
PATIENTS AND METHODS
We preoperatively applied metal clips just proximal to the tumor through esophagogastroduodenoscopy. During surgery, we applied metal vessel clips to the greater and lesser curvatures of the planned resection line of the stomach and took an intraoperative X-ray to examine the distance between the planned resection line and the tumor. If the distance was appropriate, the stomach was resected on the planned line, and if the distance was judged to be insufficient, the stomach was resected on the more proximal line, as appropriate. An intraoperative frozen section of the proximal resection margin was examined, as appropriate.
RESULTS
We performed this method for 71 patients. Tumors were successfully resected together with preoperative endoscopic clips in all patients. In five patients, intraoperative frozen section of the proximal resection margins was positive; however, additional resection confirmed negative margins. One patient underwent total gastrectomy, and the remaining 70 patients underwent distal gastrectomy.
CONCLUSION
An intraoperative X-ray seems to be a simple and useful method for identifying the location of the tumor and determining the proximal resection line.
Topics: Humans; Stomach Neoplasms; Laparoscopy; Gastroenterostomy; Radiography; Gastrectomy; Retrospective Studies
PubMed: 37500127
DOI: 10.21873/anticanres.16551 -
European Urology Open Science Apr 2024The optimal treatment for complex urethral stricture (CUS) is yet to be determined. Comparisons of methods based on validated questionnaires or objective outcome...
BACKGROUND
The optimal treatment for complex urethral stricture (CUS) is yet to be determined. Comparisons of methods based on validated questionnaires or objective outcome measures are lacking.
OBJECTIVE
To compare proximal urethrostomy and urethroplasty for CUS using objective measures and validated questionnaires, and to evaluate trends in subgroups of patients who underwent proximal urethrostomy as the intended definitive treatment versus first-stage urethroplasty.
DESIGN SETTING AND PARTICIPANTS
We identified all patients who underwent proximal urethrostomy at our center from 2004 to 2021. The control group comprised patients who underwent urethroplasty for CUS (strictures >6 cm, recurrent posturethroplasty strictures, or CUS due to lichen sclerosus or past hypospadias surgery).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The primary outcome was a recurrent stricture at a minimal follow-up of 1 yr. The secondary outcomes included validated questionnaires, uroflowmetry, and residual urine volume. Survival was compared by a Kaplan-Meier analysis.
RESULTS AND LIMITATIONS
The study included 57 proximal urethrostomy and 75 urethroplasty patients. Results for these two groups were as follows: the cumulative incidence of stricture recurrence over a median follow-up of 46 mo was 22.6% for proximal urethrostomy versus 36.2% for urethroplasty ( = 0.106); no statistically significant differences were observed between groups in terms of postoperative quality of urination or life, satisfaction with outcome, and erectile function. Both groups had a significant improvement in urinary flow after surgery (19.65 vs 20.29 ml/s), with no difference between the groups ( = 0.796); the proximal urethrostomy group had a significant improvement in postvoid residual after surgery, but there was no difference between the groups in the last follow-up visit (79.16 vs 52.03 ml; = 0.245). A subgroup analysis of the proximal urethrostomy group showed no significant differences in cumulative primary or secondary outcomes. Limitations included the retrospective design and the relatively small study population.
CONCLUSIONS
Comparisons of the two groups revealed no significant differences in stricture recurrence, results of validated questionnaires, or objective measures of urination.
PATIENT SUMMARY
Proximal urethrostomy is equivalent to urethral reconstruction, and it should be offered as a viable solution for complex urethral stricture.
PubMed: 38486615
DOI: 10.1016/j.euros.2024.02.008 -
Orthopaedics & Traumatology, Surgery &... Oct 2023The various methods for the proximal fixation of magnetic growing rods in patients with early-onset scoliosis (EOS) are associated with high rates of mechanical... (Observational Study)
Observational Study
BACKGROUND
The various methods for the proximal fixation of magnetic growing rods in patients with early-onset scoliosis (EOS) are associated with high rates of mechanical complications related to material failure or proximal junctional kyphosis (PJK). The bivertebral autostable claw (BAC) has been proven reliable in adolescent idiopathic scoliosis but has not been assessed when used with magnetic growing rods. The objective of this study was to describe the operative technique and outcomes of BAC proximal fixation of magnetic growing rods in children with EOS.
HYPOTHESIS
The BAC provides stable and effective proximal fixation in children with early-onset scoliosis.
MATERIAL AND METHODS
This retrospective observational study included 24 patients who had surgery in 2015-2019 for early-onset scoliosis with magnetic growing rod implantation and BAC proximal fixation. Radiological variables were measured in the coronal and sagittal planes before surgery, during the early postoperative period (<3months) and at last follow-up (≥2years).
RESULTS
No neurological complications were recorded. At last follow-up, four patients had radiological PJK, including one patient with clinical PJK due to material failure.
DISCUSSION
BAC proximal fixation is both effective and sufficiently stable (4.2% pull-out) to withstand the forces applied during distraction sessions and daily activities in children with EOS. Moreover, the polyaxial connecting rods ensure better BAC adaptation to the local proximal kyphosis, which is often marked in this population.
CONCLUSION
The BAC is a reliable proximal fixation device that is well-suited to magnetic growing rod fixation in children with EOS.
LEVEL OF EVIDENCE
IV, retrospective observational cohort study.
Topics: Child; Adolescent; Humans; Scoliosis; Retrospective Studies; Kyphosis; Radiography; Spinal Fusion; Magnetic Phenomena; Postoperative Complications; Follow-Up Studies
PubMed: 37172643
DOI: 10.1016/j.otsr.2023.103634 -
Quantitative Imaging in Medicine and... Sep 2023The proximal humerus is a common site of osteoporotic fractures, and bone quality is a predictor of surgical reduction quality. Dual-energy computed tomography (DECT) is...
BACKGROUND
The proximal humerus is a common site of osteoporotic fractures, and bone quality is a predictor of surgical reduction quality. Dual-energy computed tomography (DECT) is assuming an increasingly important role in the quantification of bone mineral density (BMD) due it is ability to perform three-material decomposition. We aimed to analyze the bone quality and distribution of the proximal humerus with DECT quantitatively.
METHODS
Sixty-five consecutive patients (average age 49.5±15.2 years; male: female ratio 32:33) without proximal humerus fractures who had undergone DECT were retrospectively selected. The humeral head was divided into 4 regions on a cross section in the medial plane between the greater tuberosity and the surgical neck. The quantitative parameters, including virtual noncalcium (VNCa) value, computed tomography value of calcium (CaCT), computed tomography value of mixed-energy images (regular CT value) (rCT), and relative calcium density (rCaD), were measured. The correlations between the quantitative parameters and age and body mass index (BMI) were analyzed, and the correlations of age, sex, BMI, region of the humeral head, and VNCa value on CaCT were evaluated.
RESULTS
The differences in CaCT, rCT, and rCaD between the 4 regions of proximal humerus were statistically significant (P<0.001), while the difference in VNCa values was not (P=0.688). The calcium concentration (CaCT and rCaD) was the densest in the posteromedial zone. The differences of CaCT, rCT, and rCaD between males and females in the 4 regions of proximal humerus were statistically significant (P<0.05), while those of the posterolateral zone were not (rCT; P>0.05). The differences in VNCa values between males and females were also not significant (P>0.05). Multivariable linear regression analysis indicated that sex, age, BMI, regions, and VNCa were significant (P<0.05) predictors of the CaCT value.
CONCLUSIONS
The concentration of calcium was the densest in the posteromedial region of proximal humerus, and the VNCa value of DECT may be used for quantifying the BMD of the proximal humerus.
PubMed: 37711831
DOI: 10.21037/qims-22-927