BACKGROUND Urosepsis is a life-threatening condition frequently associated with renal and ureteral calculi(RUC)and diabetes mellitus(DM),a combination that exacerbates susceptibility to infection due to urinary obstru...BACKGROUND Urosepsis is a life-threatening condition frequently associated with renal and ureteral calculi(RUC)and diabetes mellitus(DM),a combination that exacerbates susceptibility to infection due to urinary obstruction and impaired immune response.AIM To identify the risk factors for urosepsis in patients with RUC complicated by DM to enhance early detection and intervention strategies.METHODS This retrospective observational study included 298 patients with RUC and DM admitted between January 2020 and June 2024.Patients were divided into an observation group(n=32)with urosepsis and a control group(n=266)without urosepsis.Comprehensive clinical,laboratory,and imaging data were collected and analyzed using univariate and multivariate logistic regression models to identify factors associated with urosepsis.The study adhered to the STROBE guidelines and received ethical approval.RESULTS Multivariate analysis identified several independent risk factors for urosepsis.Female sex(OR=2.237,95%CI:1.086-4.605,P=0.03),advanced age(OR=1.05,95%CI:1.018-1.084,P=0.002),and fever(OR=2.999,95%CI:1.283-7.015,P=0.015)significantly increased the risk.Laboratory findings such as elevated urine leukocyte(U-LEU)(+++,OR=66.0,95%CI:7.031–580.125,P<0.001)and glucose(U-GLU)(+++,OR=7.248,95%CI:1.862-28.211,P=0.005)levels were strongly associated with urosepsis.Severe hydronephrosis also emerged as a significant predictor(OR=6.129,95%CI:3.027-9.623,P=0.011).Other factors,such as gross hematuria,stone laterality,and mild to moderate hydronephrosis,were not significantly associated with urosepsis.CONCLUSION This study identifies key demographic,clinical,laboratory,and imaging factors associated with urosepsis risk in patients with RUC and DM.Early identification of female patients,elderly individuals,those presenting with fever,severe hydronephrosis,and elevated U-LEU and U-GLU levels may facilitate timely intervention.These findings highlight the importance of comprehensive assessment and targeted management in the care of high-risk patients.展开更多
Objective Endothelial dysfunction is one candidate for triggering neointima formation after arteriovenous grafts(AVGs),but the factors mediating this process are unclear.The purpose of this study was to investigate th...Objective Endothelial dysfunction is one candidate for triggering neointima formation after arteriovenous grafts(AVGs),but the factors mediating this process are unclear.The purpose of this study was to investigate the role of endoplasmic reticulum stress(ERS)-induced endothelial dysfunction in neointima formation following AVGs in high-fat diet(HFD)mice.Methods CCAAT-enhancer-binding protein-homologous protein(CHOP)knockout(KO)mice were created.Mice were fed with HFD to produce HFD model.AVGs model were applied in the groups of WT ND,WT HFD,and CHOP KO HFD.Human umbilical vein endothelial cells(HUVECs)were cultured with oxidized low density lipoprotein(ox-LDL)(40 mg/L)for the indicated time lengths(0,6,12,24 h).ERS inhibitor tauroursodeoxycholic acid(TUDCA)was used to block ERS.Immunohistochemical staining was used to observe the changes of ICAM1.Changes of ERS were detected by real-time RT-PCR.Protein expression levels and ERS activation were detected by Western blotting.Endothellial cell function was determined by endothelial permeability assay and transendothelial migration assay.Results HFD increased neointima formation in AVGs associated with endothelial dysfunction.At the same time,ERS was increased in endothelial cells(ECs)after AVGs in mice consuming the HFD.In vitro,ox-LDL was found to stimulate ERS,increase the permeability of the EC monolayer,and cause endothelial dysfunction.Blocking ERS with TUDCA or CHOP siRNA reversed the EC dysfunction caused by ox-LDL.In vivo,knockout of CHOP(CHOP KO)protected the function of ECs and decreased neointima formation after AVGs in HFD mice.Conclusion Inhibiting ERS in ECs could improve the function of AVGs.展开更多
文摘BACKGROUND Urosepsis is a life-threatening condition frequently associated with renal and ureteral calculi(RUC)and diabetes mellitus(DM),a combination that exacerbates susceptibility to infection due to urinary obstruction and impaired immune response.AIM To identify the risk factors for urosepsis in patients with RUC complicated by DM to enhance early detection and intervention strategies.METHODS This retrospective observational study included 298 patients with RUC and DM admitted between January 2020 and June 2024.Patients were divided into an observation group(n=32)with urosepsis and a control group(n=266)without urosepsis.Comprehensive clinical,laboratory,and imaging data were collected and analyzed using univariate and multivariate logistic regression models to identify factors associated with urosepsis.The study adhered to the STROBE guidelines and received ethical approval.RESULTS Multivariate analysis identified several independent risk factors for urosepsis.Female sex(OR=2.237,95%CI:1.086-4.605,P=0.03),advanced age(OR=1.05,95%CI:1.018-1.084,P=0.002),and fever(OR=2.999,95%CI:1.283-7.015,P=0.015)significantly increased the risk.Laboratory findings such as elevated urine leukocyte(U-LEU)(+++,OR=66.0,95%CI:7.031–580.125,P<0.001)and glucose(U-GLU)(+++,OR=7.248,95%CI:1.862-28.211,P=0.005)levels were strongly associated with urosepsis.Severe hydronephrosis also emerged as a significant predictor(OR=6.129,95%CI:3.027-9.623,P=0.011).Other factors,such as gross hematuria,stone laterality,and mild to moderate hydronephrosis,were not significantly associated with urosepsis.CONCLUSION This study identifies key demographic,clinical,laboratory,and imaging factors associated with urosepsis risk in patients with RUC and DM.Early identification of female patients,elderly individuals,those presenting with fever,severe hydronephrosis,and elevated U-LEU and U-GLU levels may facilitate timely intervention.These findings highlight the importance of comprehensive assessment and targeted management in the care of high-risk patients.
基金funded by the National Natural Science Foundation of China(No.81770413)Hubei Provincial Natural Science Foundation of China(No.2017CFB669).
文摘Objective Endothelial dysfunction is one candidate for triggering neointima formation after arteriovenous grafts(AVGs),but the factors mediating this process are unclear.The purpose of this study was to investigate the role of endoplasmic reticulum stress(ERS)-induced endothelial dysfunction in neointima formation following AVGs in high-fat diet(HFD)mice.Methods CCAAT-enhancer-binding protein-homologous protein(CHOP)knockout(KO)mice were created.Mice were fed with HFD to produce HFD model.AVGs model were applied in the groups of WT ND,WT HFD,and CHOP KO HFD.Human umbilical vein endothelial cells(HUVECs)were cultured with oxidized low density lipoprotein(ox-LDL)(40 mg/L)for the indicated time lengths(0,6,12,24 h).ERS inhibitor tauroursodeoxycholic acid(TUDCA)was used to block ERS.Immunohistochemical staining was used to observe the changes of ICAM1.Changes of ERS were detected by real-time RT-PCR.Protein expression levels and ERS activation were detected by Western blotting.Endothellial cell function was determined by endothelial permeability assay and transendothelial migration assay.Results HFD increased neointima formation in AVGs associated with endothelial dysfunction.At the same time,ERS was increased in endothelial cells(ECs)after AVGs in mice consuming the HFD.In vitro,ox-LDL was found to stimulate ERS,increase the permeability of the EC monolayer,and cause endothelial dysfunction.Blocking ERS with TUDCA or CHOP siRNA reversed the EC dysfunction caused by ox-LDL.In vivo,knockout of CHOP(CHOP KO)protected the function of ECs and decreased neointima formation after AVGs in HFD mice.Conclusion Inhibiting ERS in ECs could improve the function of AVGs.
