Objective
To explore the relationship between dyslipidemia and urinary stone formation.
Methods
The clinical data of 427 patients diagnosed with urolithiasis in our hospital during January 2015 to May 2016 were collected. Among them, 272 men accounting for 63.7%, 155 women account for 36.3%. The average age were 53 (43-63). 218 cases were kidney stones, accounting for 35.6%; 158 cases were ureteral calculi, accounting for 25.8%; 23 cases were kidney stones with ureteral calculi, accounting for 3.8%; 28 cases were bladder calculi, accounting for 4.6%. At the same time, 950 age and gender matched healthy controls were collected. Among them, 570 men accounting for 60%, 380 women account for 40%. The average age were 53 (48-60). All of them had undergone renal ultrasound to excluded urolithiasis. The difference between lipid level and incidence of dyslipidemia in patients with urolithiasis were observed. The relationship between lipid level and serum UA, urine pH and stone composition was evaluated and analyzed with logistic regression.
Results
The average serum TC, TG, HDL-C levels of patients with urolithiasis were 4.34mmol/L, 1.38mmol/L, 1.25mmol/L, which levels were 4.32mmol/L, 1.09mmol/L, 1.40mmol/L in healthy controls. Significant difference were seen between the two groups (P<0.05). The average serum LDL-C was 2.63mmol/L in patients with urolithiasis and 2.65mmol/L in healthy controls. No difference were seen between the two groups (P=0.241). 31.6% of patients with urolithiasis had different degree of dyslipidemia. The average serum UA levels, urine pH value of patients with dyslipidemia were 392μmol/L and 5, which were 339μmol/L and 6 in patients with normal lipid level. Significant difference were seen between the two groups (P<0.05). Among 193 patients who had stone composition analysis, 130 cases had normal lipid level, accounting for 67.4%; 63 cases had dyslipidemia, accounting for 32.6%. In 63 patients with calculi who had dyslipidemia, 31 cases had uric acid calculi, accounting for 49.2%. In 130 patients with calculi who had normal lipid level, 40 cases had uric acid calculi, accounting for 30.8%. Significant difference were seen between the two groups (P=0.013). Multivariate logistic regression showed TG was the independent risk factor of urinary stone formation (P=0.001).
Conclusion
Dyslipidemia is closely related to urinary stone formation, especially concerning the for hypertriglyceridemia.
Key words:
Dyslipidemia; Urolithiasis; Correlation
Motivation: Early and sensitive detection of graft renal dysfunction can help timely diagnosis of the disease and improve prognosis. Goal(s): We aimed to investigate the value of ASL and T1 mapping for assessing renal function in patients with long-term renal transplant survival. Approach: 63 patients were included, and all patients underwent MRI examination. MRI parameters were calculated and analyzed. Results: This study revealed that the combined application of ASL and T1 mapping can accurately assess the degree of renal impairment, and significant correlations were found between MRI parameters and several important Banff pathological scores which determined the diagnosis of renal allograft rejection and chronicity. Impact: The significant correlations between MRI parameters and pathological changes involving allograft rejection and chronicity highlight the clinical value of multiparametric MRI as a noninvasive and comprehensive modality for early diagnosis and longitudinal monitoring of renal allograft injury.
We evaluated the prognosis of the new grade groups and American Joint Committee on Cancer (AJCC) stage groups in men with prostate cancer (PCa) who were treated conservatively. A total of 13 798 eligible men were chosen from the Surveillance Epidemiology and End Results database. The new grade and AJCC stage groups were investigated on prostate biopsy specimens. Kaplan–Meier survival analysis and multivariable hazards models were applied to estimate the association of new grade and stage groups with overall survival (OS) and PCa-specific survival (CSS). Mean follow-up was 42.65 months (95% confidence interval: 42.47–42.84) in the entire cohort. The 3-year OS and CSS rates stepped down for grade groups 1–5 and AJCC stage groups I–IVB, respectively. After adjusting for clinical and pathological characteristics, all grade groups and AJCC stage groups were associated with higher all-cause and PCa-specific mortality compared to the reference group (all P ≤ 0.003). In conclusion, we evaluated the oncological outcome of the new grade and AJCC stage groups on biopsy specimens of conservatively treated PCa. These two novel clinically relevant classifications can assist physicians to determine different therapeutic strategies for PCa patients.
Acute rejection (AR) hinders renal allograft survival. Tubular epithelial cell (TEC) apoptosis contributes to premature graft loss in AR, while the mechanism remains unclear. Soluble fibrinogen-like protein 2 (sFGL2), a novel effector of regulatory T cells (Treg), induces apoptosis to mediate tissue injury. We previously found that serum sFGL2 significantly increased in renal allograft rejection patients. In this study, the role of sFGL2 in AR was further investigated both in vivo and in vitro. The serum level of sFGL2 and the percentage of CD4 + CD25 + Foxp3 + Treg in the peripheral blood were measured in renal allograft recipients with AR or stable renal function ( n = 30 per group). The human TEC was stimulated with sFGL2, tumor necrosis factor (TNF)-α, or phosphate buffered saline and investigated for apoptosis in vitro. Apoptosis-associated genes expression in TEC was further assessed. Approval for this study was obtained from the Ethics Committee of Fudan University. Our results showed that the serum level of sFGL2, correlated with Treg in the peripheral blood, was significantly increased in the AR patients. In vitro, sFGL2 remarkably induced TEC apoptosis, with a significant up-regulation of proapoptotic genes, including CASP-3, CASP-8, CASP-9, CASP-10, TRADD, TNFSF10, FADD, FAS, FASLG, BAK1, BAD, BAX, and NF-KB1. However, no significant changes were observed in the expression of antiapoptotic genes, including CARD-18, NAIP, BCL2, IKBKB, and TBK1. Therefore, sFGL2, an effector of Treg, induces TEC apoptosis. Our study suggests that sFGL2 is a potential mediator in the pathogenesis of allograft rejection and provides novel insights into the role of Treg in AR.
A 56-year-old female patient received triple-drug immunosuppressive therapy after allogenic renal transplantation, including tacrolimus 3 mg twice daily, mycophenolate mofetil 500 mg twice daily, and prednisone 20 mg once daily. The patient received compound sulfamethoxazole 0.48 g once daily for prevention of infection a month after operation. The laboratory tests showed that the levels of tacrolimus blood concentration (CTac), serum creatinine (Scr), and blood potassium were 6.56 μg/L, 142 μmol/L, and 4.3 mmol/L, respectively before medication, 12.13 μg/L, 147 μmol/L, and 7.1 mmol/L after 1 week of compound sulfamethoxazole treatment, and 16.72 μg/L, 176 μmol/L, and 8.3 mmol/L after 2 weeks, accompanied by lassitude and weakness of the feet. Compound sulfamethoxazole was stopped, potassium-lowering therapy was given, the dose of tacrolimus was reduced to 2 mg twice daily, and mycophenolate mofetil and prednisone were given at the same doses as before. Laboratory tests showed Scr 175 μmol/L and blood potassium 4.7 mmol/L on day 3 of compound sulfamethoxazole withdrawal and CTac 7.13 μg/L, Scr 150 μmol/L, and blood potassium 4.8 mmol/L on day 8. The patient took compound sulfamethoxazole 0.48 g twice daily again according to the doctor′s advice, and 2 weeks later, her blood potassium increased to 6.2 mmol/L. The dose of compound sulfamethoxazole was gradually reduced firstly to 0.48 g once daily, then to 0.48 g every other day, and was completely stopped 8 weeks later. Two weeks after drug withdrawal, her blood potassium decreased to 4.6 mmol/L. Hyperkalemia did not recur.
Key words:
Kidney transplantation; Sulfonamides; Hyperkalemia
Motivation: Renal interstitial fibrosis, a prevalent, irreversible, progressive chronic kidney injury, emerges as a crucial prognostic determinant for kidney transplantation. Goal(s): To explore the feasibility and performance of arterial spin labeling (ASL) in evaluating the degree of renal fibrosis after renal transplantation. Approach: ASL was performed on 64 renal transplantation recipients. ASL parameters were obtained and analyzed. Results: The study revealed a noteworthy negative correlation between the measured renal blood flow values, obtained through ASL, and the degree of interstitial fibrosis in transplanted kidneys. ASL can effectively differentiate various degrees of fibrosis in transplanted kidneys. Impact: Using ASL technology, it is possible to non-invasively assess the degree of fibrotic changes in transplanted kidneys and the progression of kidney function, thereby achieving early detection, diagnosis, and treatment.
We aim to evaluate the prognostic effect of the histological sub-type in patients with metastatic bladder cancer based on the Surveillance Epidemiology and End Results database. A total of 2634 eligible patients were included. The histological subtypes were: transitional cell carcinoma (TCC; 75.2%); adenocarcinoma (3.3%); squamous cell carcinoma (SQCC; 4.1%); and small cell carcinoma (4.3%). A significant association of adenocarcinoma with better survival outcomes (P < 0.015), and that of SQCC with worse outcomes (P < 0.001) was observed. On multivariate analysis, adenocarcinoma was significantly associated with longer and SQCC with shorter survival time as compared to TCC. Overall, 1331 (50.5%) patients had a single metastatic site and 523 (19.9%) had multiple sites involved. Single-site metastasis had a better survival outcome than multiple metastases (P < 0.001). Histological sub-type and presence of multiple metastatic sites are independent predictors of survival time. Prospective, in-depth research is needed to determine optimal therapeutic strategies for different histological subtypes of bladder cancer with different metastatic patterns.
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