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Minerva Urology and Nephrology Apr 2023The aim of this study was to describe a novel outer layer renorrhaphy strategy during robot-assisted partial nephrectomy.
BACKGROUND
The aim of this study was to describe a novel outer layer renorrhaphy strategy during robot-assisted partial nephrectomy.
METHODS
This technique is presented in key steps. Renorrhaphy is performed with a double layer technique. The novel strategy of outer layer renorrhaphy is to approach the parenchymal margins in a zigzag-shaped manner with a 2-0 Vicryl running suture. Each pass begins immediately adjacent to the exit site. The needle is passed through the defect and the exiting suture is secured with a Hem-o-lok clip. At each exit site, the suture is secured with a Hem-o-lok clip. A second Hem-o-lok clip is placed at the loose ends, to tighten the suture in the clip locking mechanism. Patients submitted to robot-assisted partial nephrectomy at a single institution between January 2017 and January 2022 were included in the analysis. Descriptive statistics of baseline characteristics and surgical, pathological, and oncological outcomes were analyzed.
RESULTS
One hundred fifty-nine consecutive patients were recorded; 103 (64.8%) of them presented with a cT1a renal mass. Median (interquartile range [IQR]) total operative time was 146 (120-182) minutes. There was no conversion to open surgery, while 5 (3.1%) patients were converted to radical nephrectomy. We reported an overall low rate of postoperative complications. There were 5 documented perirenal hematomas and 6 cases of urinary leakage (2 pT2a, 2 pT1b, 2 pT1a renal cell carcinoma).
CONCLUSIONS
Z-shaped technique is a feasible and safe alternative for renorrhaphy of the outer layer, in experienced hands. Future comparative studies are needed to confirm our results.
Topics: Humans; Kidney Neoplasms; Robotics; Suture Techniques; Nephrectomy; Sutures
PubMed: 36999838
DOI: 10.23736/S2724-6051.23.05137-6 -
Trials Mar 2023Perirenal fat plays a key role in sustaining pathological high blood pressure. We aim to investigate the efficacy of intervention for perirenal fat mediated by focused...
Effect of focused power ultrasound-mediated perirenal fat modification on primary hypertension: protocol of a multicenter, randomized, double-blinded, sham-controlled study.
BACKGROUND
Perirenal fat plays a key role in sustaining pathological high blood pressure. We aim to investigate the efficacy of intervention for perirenal fat mediated by focused power ultrasound (FPU) on primary hypertension.
METHODS
A multicenter, randomized, sham-controlled, double-blinded trial will be implemented in 200 participants with mild to moderate hypertension. All enrolled participants will be randomly allocated to perirenal fat modification (PFM) intervention using FPU or sham-procedure at a ratio of 1:1 and will be followed up at 24 h, 14 days, 30 days, and 90 days after the intervention. The primary endpoint is changes in office systolic blood pressure (SBP) at 30 days compared with baseline. The secondary endpoints include the changes in office SBP from baseline to 90 days, changes in 24-h mean SBP from baseline to 30 days and 90 days, and changes in heart rate from baseline to 30 days. Safety endpoint is defined as any severe adverse events related to the intervention.
DISCUSSION
The present study is the first to use noninvasive FPU to intervene in perirenal fat to achieve the goal of reducing blood pressure for patients with essential hypertension. Our study is expected to provide a new treatment strategy to control high blood pressure.
TRIAL REGISTRATION
ClinicalTrials.gov. NCT05049096. Registered on September 7, 2021.
PROTOCOL VERSION
Version 1.3.1, data 23 August 2021.
SPONSOR
Prof. Xiangqing Kong is the principal investigator of this trial.
Topics: Humans; COVID-19; SARS-CoV-2; Kidney; Hypertension; Essential Hypertension; Treatment Outcome; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 36959658
DOI: 10.1186/s13063-023-07249-5 -
CEN Case Reports Nov 2023A 48-year-old woman presented with hyperreninemic hypertension and renal dysfunction and was diagnosed with hydronephrosis-related Page kidney. The pathophysiology was...
A 48-year-old woman presented with hyperreninemic hypertension and renal dysfunction and was diagnosed with hydronephrosis-related Page kidney. The pathophysiology was "renal tamponade", in which the kidney was compressed by the renal pelvis and Gerota's fascia, resulting in intrarenal microvascular ischemia. Ureteral stent placement promptly improved the hyperreninemic hypertension and renal dysfunction, and additional perirenal fluid drainage gradually improved these conditions. These observations indicated the following three points. First, renal compression-induced renin-angiotensin-aldosterone system upregulation plays an important role in the pathogenesis of Page kidney. Second, physicians should consider perirenal fluid drainage as a therapeutic option in addition to ureteral stenting in patients with hydronephrosis-related Page kidney. Third, bilateral perirenal subcapsular hematomas in this case could be caused by hydronephrosis. Hydronephrosis-induced intrarenal pressure elevation possibly caused chronic perirenal subcapsular hemorrhage at the vulnerable sites of the renal cortex and peeling of the renal capsule from the cortex, resulting in the bilateral massive subcapsular hematomas and Page kidney.
Topics: Female; Humans; Middle Aged; Kidney; Hypertension, Renal; Hydronephrosis; Hypertension; Hematoma
PubMed: 36856751
DOI: 10.1007/s13730-023-00779-6 -
BMC Veterinary Research Jan 2023The study assessed the effect of smectites (bentonite and zeolite) used as natural sorbents in the diet of pigs on feed digestibility, health parameters, the severity of...
BACKGROUND
The study assessed the effect of smectites (bentonite and zeolite) used as natural sorbents in the diet of pigs on feed digestibility, health parameters, the severity of anatomo-histological changes in organs, and the accumulation of volatile pollutants in organs.
MATERIAL AND METHODS
The study was conducted using fattening pigs (crossbreds from multiple breeds) assigned to three groups - a control (C) and two experimental groups (A and B), with 240 pigs in each group (3 replicates × 80). The animals in group C received a standard complete diet, while groups A and B received diets with 1.5% composed smectite sorbents. The feed and faeces were analysed for content of dry matter, crude ash, crude protein, ether extract, and crude fibre. The content of P was determined using a Helios Alpha UV-VIS spectrophotometer. Whole blood was analysed for haematological parameters and serum for biochemical parameters. Tissue samples were collected for analysis of volatile substances and histological analysis. After slaughter, samples of the lungs, liver, kidneys and jejunum were collected for morphological evaluation, and samples of the perirenal fat, liver, kidneys, lungs and brain for headspace gas chromatography (GC) to determine the levels of volatile toxic substances.
RESULTS
A statistical increase in the digestibility of crude fibre and an increase in that of P were observed in both experimental groups (A and B) in comparison to the control. The whole blood and serum of the pigs from the control group had statistically significantly higher levels of creatinine, urea, and Mg and a higher WBC count compared to both experimental groups (A and B).
CONCLUSIONS
The feed additives were not shown to have a negative effect on the health parameters analysed or on accumulation of pollutants in selected tissues. No significant effect on the digestibility of most nutrients was observed; only an increase in the digestibility of crude fibre and a decrease in P digestibility were noted in the experimental groups.
Topics: Swine; Animals; Digestion; Diet; Nutrients; Feces; Jejunum; Animal Feed; Animal Nutritional Physiological Phenomena
PubMed: 36609375
DOI: 10.1186/s12917-022-03563-3 -
Heliyon Dec 2022We describe the case of a 67-year-old male with decompensated liver cirrhosis caused by hepatitis B virus and alcohol consumption who presented with diarrhea and fever....
We describe the case of a 67-year-old male with decompensated liver cirrhosis caused by hepatitis B virus and alcohol consumption who presented with diarrhea and fever. Contrast CT of the abdomen revealed giant perirenal abscess. was cultured from pus in perirenal abscess but not the blood. Haematogenous spread may have resulted in perirenal abscess in this case. The patient was successfully treated by percutaneous drainage, antimicrobial therapy and albumin infusion. With high mortality rates, early diagnosis and effectively treatment of perirenal abscess is required to improve the prognosis of patients.
PubMed: 36593858
DOI: 10.1016/j.heliyon.2022.e12073 -
PeerJ 2022Adipose tissue is an organ with metabolic, endocrine and immune functions. In this tissue, the expressions of genes associated with several metabolic pathways, including...
Adipose tissue is an organ with metabolic, endocrine and immune functions. In this tissue, the expressions of genes associated with several metabolic pathways, including lipid metabolism, have been shown to be affected by genetic selection for feed efficiency, an important trait to consider in livestock. We hypothesized that the stimulation of immune system caused by poor hygiene conditions of housing impacts the molecular and cellular features of adipose tissue and that the impact may differ between pigs that diverge in feed efficiency. At the age of 12 weeks, Large White pigs from two genetic lines divergent for residual feed intake (RFI) were housed in two contrasting hygiene conditions (good vs poor). After six weeks of exposure, pigs were slaughtered ( = 36). Samples of blood, subcutaneous (SCAT) and perirenal (PRAT) adipose tissues were collected for cell response and gene expression investigations. The decrease in the relative weight of PRAT was associated with a decline in mRNA levels of , , and ( < 0.05) in pigs housed in poor conditions compared with pigs housed in good conditions for both RFI lines. In SCAT, the expressions of only two key genes ( and ) were significantly affected by the hygiene of housing conditions. Besides, the mRNA levels of both and were influenced by the RFI line ( < 0.05). Because we suspected an effect of poor hygiene at the cellular levels, we investigated the differentiation of stromal vascular cells isolated from SCAT in the absence or presence of a pro-inflammatory cytokine, Tumor Necrosis Factor- (TNF-). The ability of these cells to differentiate in the absence or presence of TNF- did not differ among the four groups of animals ( > 0.05). We also investigated the expressions of genes involved in the immune response and lipid metabolism in whole blood cells cultured in the absence and presence of LPS. The hygiene conditions had no effect but, the relative expression of the gene was higher ( < 0.001) in high RFI than in low RFI pigs while the expressions of ( = 0.027), ( = 0.023) and ( = 0.05) genes were lower in high RFI than in low RFI pigs. Overall, the current study indicates that the hygiene of housing had similar effects on both RFI lines on the expression of genes in adipose tissues and on the features of SCAT adipose cells and whole blood cells in response to TNF- and LPS. It further demonstrates that the number of genes with expression impacted by housing conditions was higher in PRAT than in SCAT. It suggests a depot-specific response of adipose tissue to the current challenge.
Topics: Swine; Animals; Housing Quality; Tumor Necrosis Factor-alpha; Lipopolysaccharides; Toll-Like Receptor 4; Adipose Tissue; Blood Cells; Hygiene; RNA, Messenger; Gene Expression
PubMed: 36530394
DOI: 10.7717/peerj.14405 -
Biomedical and Environmental Sciences :... Nov 2022This study was designed to provide the evidences on the toxicokinetics of microplastics (MPs) and nanoplastics (NPs) in the bodies of mammals.
OBJECTIVE
This study was designed to provide the evidences on the toxicokinetics of microplastics (MPs) and nanoplastics (NPs) in the bodies of mammals.
METHODS
100 nm, 3 μm, and 10 μm fluorescent polystyrene (PS) beads were administered to mice once by gavage at a dose of 200 mg/kg body weight. The levels and change of fluorescence intensity in samples of blood, subcutaneous fat, perirenal fat, peritesticular fat, cerebrum, cerebellum, testis, and epididymis were measured at 0.5, 1, 2, and 4 h after administration using an IVIS Spectrum small-animal imaging system. Histological examination, confocal laser scanning, and transmission electron microscope were performed to corroborate the findings.
RESULTS
After confirming fluorescent dye leaching and impact of pH value, increased levels of fluorescence intensity in blood, all adipose tissues examined, cerebrum, cerebellum, and testis were measured in the 100 nm group, but not in the 3 and 10 μm groups except in the cerebellum and testis at 4 h for the 3 μm PS beads. The presence of PS beads was further corroborated.
CONCLUSION
After a single oral exposure, NPs are absorbed rapidly in the blood, accumulate in adipose tissues, and penetrate the blood-brain/testis barriers. As expected, the toxicokinetics of MPs is significantly size-dependent in mammals.
Topics: Male; Animals; Mice; Microplastics; Plastics; Genitalia; Adipose Tissue; Polystyrenes; Nerve Tissue; Mammals
PubMed: 36443255
DOI: 10.3967/bes2022.131 -
Cureus Oct 2022Wunderlich syndrome is an uncommon condition of spontaneous subcapsular and perirenal hemorrhage of atraumatic etiology in the kidney, with the potential to spread to...
Wunderlich syndrome is an uncommon condition of spontaneous subcapsular and perirenal hemorrhage of atraumatic etiology in the kidney, with the potential to spread to the retroperitoneal region beyond the perirenal fascias. Its clinical manifestations usually include Lenk's triad, namely, acute flank pain, flank mass, and hemodynamic instability, which vary depending on the causative underlying renal pathology. Tumor bleeding of benign and malignant renal neoplasms is the most common cause of this syndrome, followed by vascular disorders and renal cystic diseases. Here, we report the case of a unilateral subcapsular renal hematoma on account of a left atrophic kidney with parapelvic cystic formations and variant hypoplastic vasculature which was successfully managed via radical nephrectomy after initial conservative treatment. Spontaneous cystic rupture contributed to the emergence of the syndrome, and its mechanisms are being addressed.
PubMed: 36407245
DOI: 10.7759/cureus.30386 -
Frontiers in Medicine 2022The frequency of vasculitis may be increased in patients with Familial Mediterranean Fever (FMF), according to several studies. Our aim was to assess the characteristics...
OBJECTIVE
The frequency of vasculitis may be increased in patients with Familial Mediterranean Fever (FMF), according to several studies. Our aim was to assess the characteristics of French adult patients with both diseases.
METHODS
Patients with vasculitis were selected from patients followed for FMF in the French JIR-cohort.
RESULTS
Twenty-two patients were included [polyarteritis nodosa (PAN) = 10, IgA vasculitis = 8, unclassified vasculitis = 2, granulomatosis with polyangiitis = 1, and microscopic polyangiitis = 1]. Pathogenic mutations in exon 10 were found in all 21 patients (96%) for which testing results were available, and 18 (82%) had two pathogenic mutations. Histology showed vasculitis in 59% of patients. Most patients with FMF-associated PAN were HBV-negative and had an inactive FMF before PAN onset, and 40% had a peri-renal or central nervous system bleeding. Most patients with FMF-associated IgA vasculitis had an active FMF before vasculitis onset, and 25% had digestive bleeding. Both patients with unclassified vasculitis had ischemic and/or hemorrhagic complications.
CONCLUSION
This study confirms the predominance of PAN and IgA vasculitis in patients with FMF and the high frequency of bleeding in FMF-associated PAN. FMF should be considered in case of persistent symptoms and/or inflammatory syndrome despite vasculitis treatment in Mediterranean patients.
PubMed: 36388918
DOI: 10.3389/fmed.2022.1000167 -
Adipocyte Dec 2022Brown adipose tissue (BAT) generates heat through non-shivering thermogenesis, and increasing BAT amounts or activity could facilitate obesity treatment and provide...
Brown adipose tissue (BAT) generates heat through non-shivering thermogenesis, and increasing BAT amounts or activity could facilitate obesity treatment and provide metabolic benefits. In mice, BAT has been reported in perirenal, thoracic and cranial sites. Here, we describe new pelvic and lower abdominal BAT depots located around the urethra, internal reproductive and urinary tract organs and major lower pelvic blood vessels, as well as between adjacent muscles where the upper hind leg meets the abdominal cavity. Immunohistochemical, western blot and PCR analyses revealed that these tissues expressed BAT markers such as uncoupling protein 1 (UCP1) and CIDEA, but not white adipose markers, and β3-adrenergic stimulation increased UCP1 amounts, a classic characteristic of BAT tissue. The newly identified BAT stores contained extensive sympathetic innervation with high mitochondrial density and multilocular lipid droplets similar to interscapular BAT. BAT repositories were present and functional neonatally, and showed developmental changes between the neonatal and adult periods. In summary, several new depots showing classical BAT characteristics are reported and characterized in the lower abdominal/pelvic region of mice. These BAT stores are likely significant metabolic regulators in the mouse and some data suggests that similar BAT depots may also exist in humans.
Topics: Animals; Mice; Adipose Tissue, Brown; Adrenergic Agents; Pelvis; Thermogenesis; Uncoupling Protein 1
PubMed: 36260113
DOI: 10.1080/21623945.2022.2133415