Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not ...Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone;2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.展开更多
BACKGROUND Various stone factors can affect the net results of shock wave lithotripsy(SWL).Recently a new factor called variation coefficient of stone density(VCSD)is being considered to have an impact on stone free r...BACKGROUND Various stone factors can affect the net results of shock wave lithotripsy(SWL).Recently a new factor called variation coefficient of stone density(VCSD)is being considered to have an impact on stone free rates.AIM To assess the role of VCSD in determining success of SWL in urinary calculi.METHODS Charts review was utilized for collection of data variables.The patients were subjected to SWL,using an electromagnetic lithotripter.Mean stone density(MSD),stone heterogeneity index(SHI),and VCSD were calculated by generating regions of interest on computed tomography(CT)images.Role of these factors were determined by applying the relevant statistical tests for continuous and categorical variables and a P value of<0.05 was gauged to be statistically significant.RESULTS There were a total of 407 patients included in the analysis.The mean age of the subjects in this study was 38.89±14.61 years.In total,165 out of the 407 patients could not achieve stone free status.The successful group had a significantly lower stone volume as compared to the unsuccessful group(P<0.0001).Skin to stone distance was not dissimilar among the two groups(P=0.47).MSD was significantly lower in the successful group(P<0.0001).SHI and VCSD were both significantly higher in the successful group(P<0.0001).CONCLUSION VCSD,a useful CT based parameter,can be utilized to gauge stone fragility and hence the prediction of SWL outcomes.展开更多
The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the risi...The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the rising global prevalence of these conditions,understanding their interconnections is essential.The study emphasizes the importance of shared risk factors,such as obesity,type 2 diabetes,dyslipidemia,and oxidative stress,and calls for multidisciplinary screening strategies.This approach would improve patient outcomes and reduce the socio-economic burden.While the study contributes valuable insights from a Chinese population,further research across diverse populations is necessary to validate and extend these findings globally.Ultimately,the research underscores the need for integrated prevention programs to better manage these interconnected diseases and improve health outcomes.展开更多
Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral...Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.展开更多
Pear(Pyrus bretschneideri)fruit stone cells are primarily composed of lignin and have strongly lignified cell walls.The presence of stone cells has a negative influence on fruit texture and taste,and thus the reductio...Pear(Pyrus bretschneideri)fruit stone cells are primarily composed of lignin and have strongly lignified cell walls.The presence of stone cells has a negative influence on fruit texture and taste,and thus the reduction of stone cell content in pear fruit is a key goal of breeding efforts.However,research into the key transcription factors and regulatory networks associated with pear fruit stone cell formation have been limited.We here used a combination of co-expression network and expression quantitative trait locus(eQTL)analyses in 206 pear cultivars with different stone cell contents to identify relevant genes;these analyses uncovered the gene PbrMYB4,a R2R3 MYB transcription factor gene.There was a strong positive correlation between relative PbrMYB4 expression levels in the fruit flesh and stone cell/lignin contents.Overexpression of PbrMYB4 significantly increased the lignin contents,whereas silencing of PbrMYB4 had the opposite effect,decreasing the contents of lignin.PbrMYB4 overexpression in pear calli significantly promoted lignin biosynthesis.In Arabidopsis thaliana,PbrMYB4 overexpression resulted in increasing lignin deposition,cell wall thickness of vessels and xylary fiber,and accelerating expression level of lignin biosynthetic genes.PbrMYB4 was found to activate 4-Coumarate:Coenzyme A Ligase(Pbr4CL1)by binding to AC-I elements in the promoter regions,as demonstrated with dual-luciferase reporter assays and a yeast one-hybrid assay.These results demonstrated that PbrMYB4 positively regulated lignin biosynthesis in pear fruit stone cells by activating lignin biosynthesis genes.This study improves our understanding of the gene regulatory networks associated with stone cell formation in pear fruit,providing guidance for molecular breeding of pear varieties with low stone cell content.展开更多
BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modifie...BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.展开更多
In order to achieve the large-scale application of manufactured sand in railway high-strength concrete structure,a series of high-strength manufactured sand concrete(HMC)are prepared by taking the manufactured sand li...In order to achieve the large-scale application of manufactured sand in railway high-strength concrete structure,a series of high-strength manufactured sand concrete(HMC)are prepared by taking the manufactured sand lithology(tuff,limestone,basalt,granite),stone powder content(0,5%,10%,15%)and concrete strength grade(C60,C80,C100)as variables.The evolution of mechanical properties of HMC and the correlation between cubic compressive strength and other mechanical properties are studied.Compared to river sand,manufactured sand enhances the cubic compressive strength,axial compressive strength and elastic modulus of concrete,while its potential microcracks weaken the flexural strength and splitting tensile strength of concrete.Stone powder content displays both positive and negative effects on mechanical properties of HMC,and the stone powder content is suggested to be less than 10%.The empirical formulas between cubic compressive strength and other mechanical properties are proposed.展开更多
Industrial waste management constitutes a major challenge for sustainable development. This study aims to transform hardened cement waste stored in cement warehouses and in real estate construction sites into paving s...Industrial waste management constitutes a major challenge for sustainable development. This study aims to transform hardened cement waste stored in cement warehouses and in real estate construction sites into paving stones. This innovative solution will contribute to the protection of the environment and the reduction of inert industrial waste. To do this, paving stones based on hardened cement have been developed and characterized. The raw materials were subjected to physical and mechanical characterization tests. The hardened cement aggregates previously crushed with the 5/15 granular class were used as substitutes to replace the natural 5/15 aggregates in the hardened paving stones at contents ranging from 0 to 100%. The mechanical characterization results on the raw material showed that the hardened cement aggregate is made from lightweight aggregates. On the prepared mortar, in the fresh state, the Abrams cone slump test showed an increase in the quantity of waste water with the increase in the content of hardened cement aggregate. In the hardened state, physical (porosity, absorption and dry density) and mechanical (compression, splitting traction, 3-point bending traction and wear) characterization tests were carried out at periods of 7, 14 and 28 days of maturation in water on the cobblestones. These results show that the substitution of natural aggregates by hardened cement aggregates in increasingly large proportions leads to an improvement in compressive, flexural, splitting and wear resistance. In addition, the incorporation of hardened cement aggregate considerably slows down the mechanical degradation of the paving stones. They can, therefore, be used in road and interior or exterior floor coverings.展开更多
Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controver...Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controversial.This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions.Methods:We compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions.We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital,Naval Medical University between February 2012 and December 2021.After propensity score matching(1:1),101 patients were included in each group.The primary outcome was the rate of pancreatic stone clearance.Secondary outcomes included the rate of adverse events during hospitalization,long-term pain relief,and quality of life after one year follow-up period.Results:The rate of complete clearance was comparable between the two groups(86.1%vs.84.2%,P=0.692).In patients with stones≥2 cm before extracorporeal shock wave lithotripsy(ESWL),the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group[100%(19/19)vs.70.0%(14/20),P=0.031].In the multivariate logistic analysis,ESWL prior to stone extraction was the only independent predictor of complete clearance[with ESWL 58.4%(264/452)vs.without ESWL 41.6%(188/452),odds ratio=2.3,95%confidence interval:1.2–4.3;P=0.013].No significant differences between groups were found regarding the rates of adverse events during hospitalization,quality of life,and pain relief after one year of follow-up.Conclusions:Basket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions.However,the balloon catheter was superior to the basket catheter if the pancreatic stone size was≥2 cm before ESWL.展开更多
Background:Previous studies have not clarified the treatment of large pancreatic radiolucent stones(≥5 mm).The primary objective of this study was to assess the clinical features and therapeutic efficacy in patients ...Background:Previous studies have not clarified the treatment of large pancreatic radiolucent stones(≥5 mm).The primary objective of this study was to assess the clinical features and therapeutic efficacy in patients with chronic pancreatitis who have large radiolucent stones,and to propose a treatment strategy.Methods:This analysis examined the data of patients with large pancreatic ductal stones(≥5 mm)from March 2011 to June 2018.Patients with radiolucent stones were classified as the radiolucent stones group,while those with pancreatic radiopaque stones presented at the same time were randomly selected as controls in a 1:2 ratio.Data on demographics,disease courses and treatment details were retrieved,and stone clearance and pain relief during the follow-up were compared between the two groups.Results:A total of 52 patients with large radiolucent stones and 104 patients with large radiopaque stones were included in the study.Pancreatic extracorporeal shock wave lithotripsy(ESWL)was the ini-tial treatment for large radiopaque stone.Endoscopic retrograde cholangiopancreatography(ERCP)was the first-step treatment for all patients in the radiolucent stones group,of which one patient received medication after failed ERCP cannulation,and four who failed stone extraction were treated with ESWL following the placement of a nasopancreatic catheter.There was no significant difference in the complete stone clearance rate(75.0%vs.78.8%;P=0.553)between the two groups.Among the 51 patients in the large radiolucent stones group who were followed up for 5.8 years(range 2.1-12.6),complete pain relief was achieved in 42 patients(82.4%),with no significant difference compared with the radiopaque group(82.4%vs.76.4%;P=0.409).Conclusions:ERCP is an effective endotherapy for large radiolucent stone and should be considered the first-step treatment.When stone extraction failed during ERCP,ESWL is recommended following the placement of a nasopancreatic catheter.展开更多
Extracorporeal shock wave lithotripsy(ESWL)is recognised as the ideal noninvasive procedure for urolithiasis.However,the suitability of ESWL varies depending on the composition of the stone.The chemical structure of t...Extracorporeal shock wave lithotripsy(ESWL)is recognised as the ideal noninvasive procedure for urolithiasis.However,the suitability of ESWL varies depending on the composition of the stone.The chemical structure of the stone may not be uniform throughout the stone and this heterogeneity provides the clue in the form of variation coefficient of stone density.To be aware of the success of the stone breakage by ESWL is an advantage upfront,so that it is possible to apply the technology to the most appropriate patient.This is an important aspect in the successful management of urolithiasis.展开更多
Objective The national lifetime prevalence of urolithiasis is estimated at 6.6%in Iran.However,reports on the composition of kidney stones have been based on imprecise methods like the chemical analysis.No prior large...Objective The national lifetime prevalence of urolithiasis is estimated at 6.6%in Iran.However,reports on the composition of kidney stones have been based on imprecise methods like the chemical analysis.No prior large-scale study has reported the composition of kidney stones based on the gold-standard methods(X-ray diffraction or infrared spectroscopy)in Iran.This study aimed to provide the composition of kidney stones based on Fourier transform infrared spectroscopy.Methods This is a cross-sectional study assessing urinary stone composition from various cities in Iran at a referral center using infrared spectroscopy from February 2019 to March 2023.Results This study determined the stone composition of 1092 patients from 10 cities in Iran.Overall,the majority of stones were composed of calcium oxalate(n=498;45.6%)and uric acid(UA,n=488;44.7%)followed by cystine(n=49;4.5%)and struvite(n=28;2.6%).Stone composition in Shiraz and Isfahan was roughly similar with a higher percentage of UA stones(53.4%and 53.6%,respectively)while the capital city of Iran(Tehran)had less frequent UA stones(39.9%)with a higher percentage of calcium oxalate stones.The percentage of UA stones increased with age as it was 11.1%in children,42.7%in adults,and 83.3%in geriatric patients(p<0.001).About 29.6%of cystine stones were observed in children.Conclusion The most frequent stone composition among kidney stones in Iran was calcium oxalate and UA stones.This relative frequency of UA stones is considerably higher than many international reports from neighboring as well as distant countries.More cystine stones were observed in children and women.Geriatric patients’stones were mostly composed of UA.展开更多
Pancreatic duct stones(PDS)pose substantial therapeutic challenges owing to their tendency to induce recurrent pain and discomfort via mechanical irritation and ductal obstruction,resulting in a marked decline in pati...Pancreatic duct stones(PDS)pose substantial therapeutic challenges owing to their tendency to induce recurrent pain and discomfort via mechanical irritation and ductal obstruction,resulting in a marked decline in patients’quality of life.The pathogenesis of pancreatic duct calculi remains incompletely understood due to its multifactorial and intricate nature.Advances in minimally invasive endoscopic interventions have broadened the available treatment modalities for PDS.This review summarizes current perspectives on the mechanisms driving stone formation alongside evolving therapeutic strategies.展开更多
Objective:To analyze the effect of Shiwei Powder combined with stone composition analysis on stone removal efficiency and complication rates after ureteroscopic holmium laser lithotripsy(FURL).Methods:Ninety six patie...Objective:To analyze the effect of Shiwei Powder combined with stone composition analysis on stone removal efficiency and complication rates after ureteroscopic holmium laser lithotripsy(FURL).Methods:Ninety six patients with FURL admitted to the hospital from March 2023 to March 2025 were selected and randomly divided into two groups.The observation group was treated with FURL combined with Shiwei Powder,while the control group was treated with FURL monotherapy.Based on the stone composition of the two groups,the stone removal efficiency,complication rates,recurrence rates,TCM syndrome scores,and inflammatory factor levels were compared.Results:The stone removal efficiency of the observation group was higher than that of the control group.The stone composition was mainly calcium oxalate monohydrate and composite stones containing calcium oxalate monohydrate.The incidence of postoperative complications was lower in the observation group than in the control group(P<0.05).After 3–6 months of follow-up,the recurrence rate in the observation group was lower than that in the control group(P<0.05).After treatment,the TCM syndrome scores and inflammatory factor levels in the observation group were lower than those in the control group(P<0.05).Conclusion:Based on the results of urinary stone composition analysis,patients treated with Shiwei Powder after FURL have higher stone removal efficiency.The most significant effect is observed in urinary stones composed of calcium oxalate monohydrate and composite stones containing calcium oxalate monohydrate.This treatment can improve stone removal,prevent complications,reduce recurrences,effectively improve disease symptoms,and reduce inflammation.展开更多
Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and ...Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin,silodosin,and tadalafil on stone expulsion rate(SER)and stone expulsion time(SET),as well as their comparative safety,numbers of colic pain episodes,and need for analgesics.Methods:Randomized controlled trials were retrieved by searching PubMed,Scopus,and Web of Science up to November 27,2023.Hand-searching was also conducted in Google Scholar to find additional records.Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones≤10 mm were included.Results:In total,27 studies were identified(six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar).More than half of them(n=15,56%)were conducted in India.The SER significantly improved with silodosin compared with tamsulosin(odds ratio[OR]2.24,p<0.001),whereas the difference in SET was non-significant.Tadalafil achieved a significantly higher SER compared with tamsulosin(OR 1.42,p=0.042)without any difference in SET.Subgroup analysis of 5-and 10-mg doses of tadalafil showed no significant difference in SER or SET.We found no significant difference in need for analgesics(mean difference(MD−53.73,p=0.2)or the mean number of colic episodes(MD−0.42,p=0.060)between tadalafil and tamsulosin.SER or SET was not significantly different between silodosin and tadalafil.Tadalafil plus tamsulosin led to a significantly higher SER(OR 1.87,p<0.001)and SET(MD−2.99,p=0.002)compared with tamsulosin,without any significant difference in adverse effects.Conclusion:Compared with tamsulosin,SER significantly improved with silodosin,tadalafil,and the combination of tadalafil plus tamsulosin.Meanwhile,the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin.It appears that tadalafil and silodosin have similar efficacy in SET and SER.All medical expulsive therapies had comparable safety.展开更多
Objective:Several therapeutic modalities for the prevention of calcium oxalate(CaOx)stones have been studied,but only a select few of these modalities have been incorporated into the American Urological Association gu...Objective:Several therapeutic modalities for the prevention of calcium oxalate(CaOx)stones have been studied,but only a select few of these modalities have been incorporated into the American Urological Association guidelines.Our study aimed to organize and interrogate existing research that may be promising for CaOx prevention.Methods:A literature search was conducted using MEDLINE and Embase from inception to November 16,2022.Our study population included adults with or without a history of CaOx kidney stones.Studies in which patients were treated with pharmacotherapies,herbal supplements,or uncategorized research chemicals that are not included in the current American Urological Association guidelines for preventing CaOx stones were included.Nonoriginal research was excluded.Results:Out of the 6155 identified articles,38 were included in the final analysis.The five distinct categories of interventions for stone prevention were“medications”,“herbal supplements”,“food and macronutrients”,“micronutrients”,and“enzymes and probiotics”.Modalities that were found to reduce known urinary risk factors were tolvaptan,cranberry juice,magnesium citrate,oxalate-degrading enzyme ALLN-177,and malic acid.Prophylaxis that reduced stone formation were sodium-glucose cotransporter-2 inhibitors,eicosapentaenoic acid,ethane-1-hydroxy-1,1-disphosphonate.Therapies that reduced urinary risk factors and stone formation were Phyllanthus niruri,rice bran,and magnesium hydroxide.Conclusion:Several of the identified therapies may provide prophylactic benefits for CaOx stone formation and may be useful for inclusion in guidelines for kidney stone prevention.展开更多
Gallstone disease(cholelithiasis)is a common gastrointestinal(GI)disorder characterized by the accumulation of hardened bile constituents,often leading to complications such as cholecystitis,cholangitis,and pancreatit...Gallstone disease(cholelithiasis)is a common gastrointestinal(GI)disorder characterized by the accumulation of hardened bile constituents,often leading to complications such as cholecystitis,cholangitis,and pancreatitis.Most gallstones are cholesterol-based and form due to bile supersaturation,gallbladder dysm-otility,and inflammation.Current treatment options–such as ursodeoxycholic acid,laparoscopic cholecystectomy,and dietary modifications–have limitations including invasiveness,prolonged duration,side effects,and recurrence risk.Melatonin,a hormone secreted by the pineal gland,has gained attention for its antioxidant and anti-inflammatory properties,as well as its regulatory effects on lipid metabolism and gallbladder motility.Experimental studies suggest that melatonin reduces biliary cholesterol,suppresses oxidative stress,and restores gallbladder muscle function,thereby preventing gallstone formation.It is also present in bile and shown to enhance cholesterol conversion into bile acids and inhibit intestinal cholesterol absorption.Beyond gallstone prevention,melatonin demonstrates protective effects against GI malignancies,including hepatocellular carcinoma and cholangiocarcinoma,by regulating mitochondrial function,inhibiting glycolysis,and modulating apoptosis.With a strong safety profile and minimal side effects,melatonin may serve as a promising adjunct or alternative for gallstone management,particularly in patients unfit for surgery.Further clin-ical research is warranted to validate its therapeutic role.展开更多
While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasibl...While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasible.Percutaneous cystolitholapaxy is a safe,effective,minimally invasive alternative for diverse indications,including patients with benign prostatic hyperplasia,urethral stricture disease,closed bladder neck,continent catheterized channel,or other urinary diversion.In this article,we review the indications for and advantages of percutaneous cystolitholapaxy and describe our step-by-step technique for this procedure,including representative imaging and favored equipment.We also discuss preoperative and postoperative considerations,management of potential complications,strategies to optimize clinical outcomes and patient safety,and comparisons with transurethral approaches.Finally,we report outcomes from our institutional series of percutaneous cystolitholapaxy cases to highlight the safety and efficacy of the procedure.展开更多
tone fruits, also known as drupes, have evolved an extremely hard wood-like shell called a stone to protect the seeds. Recently, the market value of stoneless cultivars has risen dramatically, which highlights the nee...tone fruits, also known as drupes, have evolved an extremely hard wood-like shell called a stone to protect the seeds. Recently, the market value of stoneless cultivars has risen dramatically, which highlights the needto cultivate stoneless fruit. Therefore, determining the underlying mechanism of fruit stone development isurgently needed. By employing the stone-containing jujube cultivar 'Youhe' and two stoneless Chinese jujube cultivars, 'Wuhefeng' and 'Daguowuhe', we comprehensively studied the mechanism of fruit stone development in jujube. Anatomical analysis and lignin staining revealed that the stone cultivar 'Youhe' jujube exhibited much greater lignin accumulation in the endocarp than the two stoneless cultivars. Lignin accumulation may be the key factor in fruit stone formation. By analyzing the transcriptome data and identifying differentially expressed genes(DEGs), 49 overlapping DEGs were identified in the comparisons of 'Youhe' jujube vs. 'Wuhefeng' jujube and 'Youhe' jujube vs. 'Daguowuhe' jujube. ZjF6H1-3 and ZjPOD, which are involved in lignin synthesis, were identified among these DEGs. The overexpression and silencing of ZjF6H1-3 and ZjPOD in wild jujube seedlings further confirmed their roles in lignin synthesis. In addition, two bHLH transcription factors were included in the 49 overlapping DEGs, and bHLH transcription factor binding motifs were found in the promoters of ZjF6H1-3 and ZjPOD, indicating that bHLH transcription factors are also involved in lignin synthesis and stone formation in Chinese jujube. This study provides new insights into the molecular networks underlying fruit stone formation and can serve as an important reference for the molecular design and breeding of stoneless fruit cultivars of jujube and fruit trees.展开更多
文摘Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone;2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.
文摘BACKGROUND Various stone factors can affect the net results of shock wave lithotripsy(SWL).Recently a new factor called variation coefficient of stone density(VCSD)is being considered to have an impact on stone free rates.AIM To assess the role of VCSD in determining success of SWL in urinary calculi.METHODS Charts review was utilized for collection of data variables.The patients were subjected to SWL,using an electromagnetic lithotripter.Mean stone density(MSD),stone heterogeneity index(SHI),and VCSD were calculated by generating regions of interest on computed tomography(CT)images.Role of these factors were determined by applying the relevant statistical tests for continuous and categorical variables and a P value of<0.05 was gauged to be statistically significant.RESULTS There were a total of 407 patients included in the analysis.The mean age of the subjects in this study was 38.89±14.61 years.In total,165 out of the 407 patients could not achieve stone free status.The successful group had a significantly lower stone volume as compared to the unsuccessful group(P<0.0001).Skin to stone distance was not dissimilar among the two groups(P=0.47).MSD was significantly lower in the successful group(P<0.0001).SHI and VCSD were both significantly higher in the successful group(P<0.0001).CONCLUSION VCSD,a useful CT based parameter,can be utilized to gauge stone fragility and hence the prediction of SWL outcomes.
文摘The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the rising global prevalence of these conditions,understanding their interconnections is essential.The study emphasizes the importance of shared risk factors,such as obesity,type 2 diabetes,dyslipidemia,and oxidative stress,and calls for multidisciplinary screening strategies.This approach would improve patient outcomes and reduce the socio-economic burden.While the study contributes valuable insights from a Chinese population,further research across diverse populations is necessary to validate and extend these findings globally.Ultimately,the research underscores the need for integrated prevention programs to better manage these interconnected diseases and improve health outcomes.
文摘Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.
基金funded by the Science Foundation of China(Grant No.32230097)Earmarked Fund for China Agriculture Research System(Grant No.CARS-28)+2 种基金the Earmarked Fund for Jiangsu Agricultural Industry Technology System(Grant No.JATS[2023]412)Natural Science Foundation of Jiangsu Province for Young Scholar(Grant No.BK20221010)supported by the high-performance computing platform of Bioinformatics Center,Nanjing Agricultural University。
文摘Pear(Pyrus bretschneideri)fruit stone cells are primarily composed of lignin and have strongly lignified cell walls.The presence of stone cells has a negative influence on fruit texture and taste,and thus the reduction of stone cell content in pear fruit is a key goal of breeding efforts.However,research into the key transcription factors and regulatory networks associated with pear fruit stone cell formation have been limited.We here used a combination of co-expression network and expression quantitative trait locus(eQTL)analyses in 206 pear cultivars with different stone cell contents to identify relevant genes;these analyses uncovered the gene PbrMYB4,a R2R3 MYB transcription factor gene.There was a strong positive correlation between relative PbrMYB4 expression levels in the fruit flesh and stone cell/lignin contents.Overexpression of PbrMYB4 significantly increased the lignin contents,whereas silencing of PbrMYB4 had the opposite effect,decreasing the contents of lignin.PbrMYB4 overexpression in pear calli significantly promoted lignin biosynthesis.In Arabidopsis thaliana,PbrMYB4 overexpression resulted in increasing lignin deposition,cell wall thickness of vessels and xylary fiber,and accelerating expression level of lignin biosynthetic genes.PbrMYB4 was found to activate 4-Coumarate:Coenzyme A Ligase(Pbr4CL1)by binding to AC-I elements in the promoter regions,as demonstrated with dual-luciferase reporter assays and a yeast one-hybrid assay.These results demonstrated that PbrMYB4 positively regulated lignin biosynthesis in pear fruit stone cells by activating lignin biosynthesis genes.This study improves our understanding of the gene regulatory networks associated with stone cell formation in pear fruit,providing guidance for molecular breeding of pear varieties with low stone cell content.
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
文摘BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.
基金Funded by the National Natural Science Foundation of China(Nos.U1934206,52108260)China Academy of Railway Sciences Fund(No.2021YJ078)+1 种基金Railway Engineering Construction Standard Project(No.2023-BZWW-006)New Cornerstone Science Foundation through the XPLORER PRIZE。
文摘In order to achieve the large-scale application of manufactured sand in railway high-strength concrete structure,a series of high-strength manufactured sand concrete(HMC)are prepared by taking the manufactured sand lithology(tuff,limestone,basalt,granite),stone powder content(0,5%,10%,15%)and concrete strength grade(C60,C80,C100)as variables.The evolution of mechanical properties of HMC and the correlation between cubic compressive strength and other mechanical properties are studied.Compared to river sand,manufactured sand enhances the cubic compressive strength,axial compressive strength and elastic modulus of concrete,while its potential microcracks weaken the flexural strength and splitting tensile strength of concrete.Stone powder content displays both positive and negative effects on mechanical properties of HMC,and the stone powder content is suggested to be less than 10%.The empirical formulas between cubic compressive strength and other mechanical properties are proposed.
文摘Industrial waste management constitutes a major challenge for sustainable development. This study aims to transform hardened cement waste stored in cement warehouses and in real estate construction sites into paving stones. This innovative solution will contribute to the protection of the environment and the reduction of inert industrial waste. To do this, paving stones based on hardened cement have been developed and characterized. The raw materials were subjected to physical and mechanical characterization tests. The hardened cement aggregates previously crushed with the 5/15 granular class were used as substitutes to replace the natural 5/15 aggregates in the hardened paving stones at contents ranging from 0 to 100%. The mechanical characterization results on the raw material showed that the hardened cement aggregate is made from lightweight aggregates. On the prepared mortar, in the fresh state, the Abrams cone slump test showed an increase in the quantity of waste water with the increase in the content of hardened cement aggregate. In the hardened state, physical (porosity, absorption and dry density) and mechanical (compression, splitting traction, 3-point bending traction and wear) characterization tests were carried out at periods of 7, 14 and 28 days of maturation in water on the cobblestones. These results show that the substitution of natural aggregates by hardened cement aggregates in increasingly large proportions leads to an improvement in compressive, flexural, splitting and wear resistance. In addition, the incorporation of hardened cement aggregate considerably slows down the mechanical degradation of the paving stones. They can, therefore, be used in road and interior or exterior floor coverings.
基金supported by grants from the National Nat-ural Science Foundation of China(82222012 and 82120108006)Scientific Innovation Program of Shanghai Municipal Education Committee(201901070007E00052)。
文摘Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controversial.This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions.Methods:We compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions.We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital,Naval Medical University between February 2012 and December 2021.After propensity score matching(1:1),101 patients were included in each group.The primary outcome was the rate of pancreatic stone clearance.Secondary outcomes included the rate of adverse events during hospitalization,long-term pain relief,and quality of life after one year follow-up period.Results:The rate of complete clearance was comparable between the two groups(86.1%vs.84.2%,P=0.692).In patients with stones≥2 cm before extracorporeal shock wave lithotripsy(ESWL),the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group[100%(19/19)vs.70.0%(14/20),P=0.031].In the multivariate logistic analysis,ESWL prior to stone extraction was the only independent predictor of complete clearance[with ESWL 58.4%(264/452)vs.without ESWL 41.6%(188/452),odds ratio=2.3,95%confidence interval:1.2–4.3;P=0.013].No significant differences between groups were found regarding the rates of adverse events during hospitalization,quality of life,and pain relief after one year of follow-up.Conclusions:Basket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions.However,the balloon catheter was superior to the basket catheter if the pancreatic stone size was≥2 cm before ESWL.
基金supported by grants from the National Nat-ural Science Foundation of China(82270679 and 82370657)Shanghai Municipal Hospital Emerging Frontier Technology Joint Project(SHDC12021107)+1 种基金Shanghai Chenguang Program(20CG42)Shanghai New-Star Youth Doctor Program(HWRS2020087).
文摘Background:Previous studies have not clarified the treatment of large pancreatic radiolucent stones(≥5 mm).The primary objective of this study was to assess the clinical features and therapeutic efficacy in patients with chronic pancreatitis who have large radiolucent stones,and to propose a treatment strategy.Methods:This analysis examined the data of patients with large pancreatic ductal stones(≥5 mm)from March 2011 to June 2018.Patients with radiolucent stones were classified as the radiolucent stones group,while those with pancreatic radiopaque stones presented at the same time were randomly selected as controls in a 1:2 ratio.Data on demographics,disease courses and treatment details were retrieved,and stone clearance and pain relief during the follow-up were compared between the two groups.Results:A total of 52 patients with large radiolucent stones and 104 patients with large radiopaque stones were included in the study.Pancreatic extracorporeal shock wave lithotripsy(ESWL)was the ini-tial treatment for large radiopaque stone.Endoscopic retrograde cholangiopancreatography(ERCP)was the first-step treatment for all patients in the radiolucent stones group,of which one patient received medication after failed ERCP cannulation,and four who failed stone extraction were treated with ESWL following the placement of a nasopancreatic catheter.There was no significant difference in the complete stone clearance rate(75.0%vs.78.8%;P=0.553)between the two groups.Among the 51 patients in the large radiolucent stones group who were followed up for 5.8 years(range 2.1-12.6),complete pain relief was achieved in 42 patients(82.4%),with no significant difference compared with the radiopaque group(82.4%vs.76.4%;P=0.409).Conclusions:ERCP is an effective endotherapy for large radiolucent stone and should be considered the first-step treatment.When stone extraction failed during ERCP,ESWL is recommended following the placement of a nasopancreatic catheter.
文摘Extracorporeal shock wave lithotripsy(ESWL)is recognised as the ideal noninvasive procedure for urolithiasis.However,the suitability of ESWL varies depending on the composition of the stone.The chemical structure of the stone may not be uniform throughout the stone and this heterogeneity provides the clue in the form of variation coefficient of stone density.To be aware of the success of the stone breakage by ESWL is an advantage upfront,so that it is possible to apply the technology to the most appropriate patient.This is an important aspect in the successful management of urolithiasis.
文摘Objective The national lifetime prevalence of urolithiasis is estimated at 6.6%in Iran.However,reports on the composition of kidney stones have been based on imprecise methods like the chemical analysis.No prior large-scale study has reported the composition of kidney stones based on the gold-standard methods(X-ray diffraction or infrared spectroscopy)in Iran.This study aimed to provide the composition of kidney stones based on Fourier transform infrared spectroscopy.Methods This is a cross-sectional study assessing urinary stone composition from various cities in Iran at a referral center using infrared spectroscopy from February 2019 to March 2023.Results This study determined the stone composition of 1092 patients from 10 cities in Iran.Overall,the majority of stones were composed of calcium oxalate(n=498;45.6%)and uric acid(UA,n=488;44.7%)followed by cystine(n=49;4.5%)and struvite(n=28;2.6%).Stone composition in Shiraz and Isfahan was roughly similar with a higher percentage of UA stones(53.4%and 53.6%,respectively)while the capital city of Iran(Tehran)had less frequent UA stones(39.9%)with a higher percentage of calcium oxalate stones.The percentage of UA stones increased with age as it was 11.1%in children,42.7%in adults,and 83.3%in geriatric patients(p<0.001).About 29.6%of cystine stones were observed in children.Conclusion The most frequent stone composition among kidney stones in Iran was calcium oxalate and UA stones.This relative frequency of UA stones is considerably higher than many international reports from neighboring as well as distant countries.More cystine stones were observed in children and women.Geriatric patients’stones were mostly composed of UA.
基金Supported by the National Natural Science Foundation of Gansu province,No.22JR11RA023。
文摘Pancreatic duct stones(PDS)pose substantial therapeutic challenges owing to their tendency to induce recurrent pain and discomfort via mechanical irritation and ductal obstruction,resulting in a marked decline in patients’quality of life.The pathogenesis of pancreatic duct calculi remains incompletely understood due to its multifactorial and intricate nature.Advances in minimally invasive endoscopic interventions have broadened the available treatment modalities for PDS.This review summarizes current perspectives on the mechanisms driving stone formation alongside evolving therapeutic strategies.
文摘Objective:To analyze the effect of Shiwei Powder combined with stone composition analysis on stone removal efficiency and complication rates after ureteroscopic holmium laser lithotripsy(FURL).Methods:Ninety six patients with FURL admitted to the hospital from March 2023 to March 2025 were selected and randomly divided into two groups.The observation group was treated with FURL combined with Shiwei Powder,while the control group was treated with FURL monotherapy.Based on the stone composition of the two groups,the stone removal efficiency,complication rates,recurrence rates,TCM syndrome scores,and inflammatory factor levels were compared.Results:The stone removal efficiency of the observation group was higher than that of the control group.The stone composition was mainly calcium oxalate monohydrate and composite stones containing calcium oxalate monohydrate.The incidence of postoperative complications was lower in the observation group than in the control group(P<0.05).After 3–6 months of follow-up,the recurrence rate in the observation group was lower than that in the control group(P<0.05).After treatment,the TCM syndrome scores and inflammatory factor levels in the observation group were lower than those in the control group(P<0.05).Conclusion:Based on the results of urinary stone composition analysis,patients treated with Shiwei Powder after FURL have higher stone removal efficiency.The most significant effect is observed in urinary stones composed of calcium oxalate monohydrate and composite stones containing calcium oxalate monohydrate.This treatment can improve stone removal,prevent complications,reduce recurrences,effectively improve disease symptoms,and reduce inflammation.
文摘Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin,silodosin,and tadalafil on stone expulsion rate(SER)and stone expulsion time(SET),as well as their comparative safety,numbers of colic pain episodes,and need for analgesics.Methods:Randomized controlled trials were retrieved by searching PubMed,Scopus,and Web of Science up to November 27,2023.Hand-searching was also conducted in Google Scholar to find additional records.Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones≤10 mm were included.Results:In total,27 studies were identified(six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar).More than half of them(n=15,56%)were conducted in India.The SER significantly improved with silodosin compared with tamsulosin(odds ratio[OR]2.24,p<0.001),whereas the difference in SET was non-significant.Tadalafil achieved a significantly higher SER compared with tamsulosin(OR 1.42,p=0.042)without any difference in SET.Subgroup analysis of 5-and 10-mg doses of tadalafil showed no significant difference in SER or SET.We found no significant difference in need for analgesics(mean difference(MD−53.73,p=0.2)or the mean number of colic episodes(MD−0.42,p=0.060)between tadalafil and tamsulosin.SER or SET was not significantly different between silodosin and tadalafil.Tadalafil plus tamsulosin led to a significantly higher SER(OR 1.87,p<0.001)and SET(MD−2.99,p=0.002)compared with tamsulosin,without any significant difference in adverse effects.Conclusion:Compared with tamsulosin,SER significantly improved with silodosin,tadalafil,and the combination of tadalafil plus tamsulosin.Meanwhile,the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin.It appears that tadalafil and silodosin have similar efficacy in SET and SER.All medical expulsive therapies had comparable safety.
文摘Objective:Several therapeutic modalities for the prevention of calcium oxalate(CaOx)stones have been studied,but only a select few of these modalities have been incorporated into the American Urological Association guidelines.Our study aimed to organize and interrogate existing research that may be promising for CaOx prevention.Methods:A literature search was conducted using MEDLINE and Embase from inception to November 16,2022.Our study population included adults with or without a history of CaOx kidney stones.Studies in which patients were treated with pharmacotherapies,herbal supplements,or uncategorized research chemicals that are not included in the current American Urological Association guidelines for preventing CaOx stones were included.Nonoriginal research was excluded.Results:Out of the 6155 identified articles,38 were included in the final analysis.The five distinct categories of interventions for stone prevention were“medications”,“herbal supplements”,“food and macronutrients”,“micronutrients”,and“enzymes and probiotics”.Modalities that were found to reduce known urinary risk factors were tolvaptan,cranberry juice,magnesium citrate,oxalate-degrading enzyme ALLN-177,and malic acid.Prophylaxis that reduced stone formation were sodium-glucose cotransporter-2 inhibitors,eicosapentaenoic acid,ethane-1-hydroxy-1,1-disphosphonate.Therapies that reduced urinary risk factors and stone formation were Phyllanthus niruri,rice bran,and magnesium hydroxide.Conclusion:Several of the identified therapies may provide prophylactic benefits for CaOx stone formation and may be useful for inclusion in guidelines for kidney stone prevention.
文摘Gallstone disease(cholelithiasis)is a common gastrointestinal(GI)disorder characterized by the accumulation of hardened bile constituents,often leading to complications such as cholecystitis,cholangitis,and pancreatitis.Most gallstones are cholesterol-based and form due to bile supersaturation,gallbladder dysm-otility,and inflammation.Current treatment options–such as ursodeoxycholic acid,laparoscopic cholecystectomy,and dietary modifications–have limitations including invasiveness,prolonged duration,side effects,and recurrence risk.Melatonin,a hormone secreted by the pineal gland,has gained attention for its antioxidant and anti-inflammatory properties,as well as its regulatory effects on lipid metabolism and gallbladder motility.Experimental studies suggest that melatonin reduces biliary cholesterol,suppresses oxidative stress,and restores gallbladder muscle function,thereby preventing gallstone formation.It is also present in bile and shown to enhance cholesterol conversion into bile acids and inhibit intestinal cholesterol absorption.Beyond gallstone prevention,melatonin demonstrates protective effects against GI malignancies,including hepatocellular carcinoma and cholangiocarcinoma,by regulating mitochondrial function,inhibiting glycolysis,and modulating apoptosis.With a strong safety profile and minimal side effects,melatonin may serve as a promising adjunct or alternative for gallstone management,particularly in patients unfit for surgery.Further clin-ical research is warranted to validate its therapeutic role.
文摘While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasible.Percutaneous cystolitholapaxy is a safe,effective,minimally invasive alternative for diverse indications,including patients with benign prostatic hyperplasia,urethral stricture disease,closed bladder neck,continent catheterized channel,or other urinary diversion.In this article,we review the indications for and advantages of percutaneous cystolitholapaxy and describe our step-by-step technique for this procedure,including representative imaging and favored equipment.We also discuss preoperative and postoperative considerations,management of potential complications,strategies to optimize clinical outcomes and patient safety,and comparisons with transurethral approaches.Finally,we report outcomes from our institutional series of percutaneous cystolitholapaxy cases to highlight the safety and efficacy of the procedure.
基金supported by the Central Fund for Promoting Innovative Technology Development, China (236Z6801G)the Hebei Provincial Modern Seed Industry Technology Innovation Team-Dried Fruits, China (21326304D)the Construction of Innovative Teams for the Modern Agricultural Industry System in Hebei Province, China (HBCT2023120210, HBCT2024190203)。
文摘tone fruits, also known as drupes, have evolved an extremely hard wood-like shell called a stone to protect the seeds. Recently, the market value of stoneless cultivars has risen dramatically, which highlights the needto cultivate stoneless fruit. Therefore, determining the underlying mechanism of fruit stone development isurgently needed. By employing the stone-containing jujube cultivar 'Youhe' and two stoneless Chinese jujube cultivars, 'Wuhefeng' and 'Daguowuhe', we comprehensively studied the mechanism of fruit stone development in jujube. Anatomical analysis and lignin staining revealed that the stone cultivar 'Youhe' jujube exhibited much greater lignin accumulation in the endocarp than the two stoneless cultivars. Lignin accumulation may be the key factor in fruit stone formation. By analyzing the transcriptome data and identifying differentially expressed genes(DEGs), 49 overlapping DEGs were identified in the comparisons of 'Youhe' jujube vs. 'Wuhefeng' jujube and 'Youhe' jujube vs. 'Daguowuhe' jujube. ZjF6H1-3 and ZjPOD, which are involved in lignin synthesis, were identified among these DEGs. The overexpression and silencing of ZjF6H1-3 and ZjPOD in wild jujube seedlings further confirmed their roles in lignin synthesis. In addition, two bHLH transcription factors were included in the 49 overlapping DEGs, and bHLH transcription factor binding motifs were found in the promoters of ZjF6H1-3 and ZjPOD, indicating that bHLH transcription factors are also involved in lignin synthesis and stone formation in Chinese jujube. This study provides new insights into the molecular networks underlying fruit stone formation and can serve as an important reference for the molecular design and breeding of stoneless fruit cultivars of jujube and fruit trees.
