Jackstone in the renal calyx:A rare case report

BACKGROUND Jackstone is a rare entity of calculi in urinary tracts and has the characteristic appearance resembling toy jacks.They are nearly always reported to occur in the urinary bladder,we first report a rare case of jackstone located in the obstructed renal calyx.CASE SUMMARY We report a 46-year-old man presenting with intermittent,painless gross hematuria and left flank pain.Urinary computed tomography revealed staghorn stones and secondary hydronephrosis.A jackstone with radiating branches was found in one of the dilated renal calyx.Percutaneous nephrolithotomy was performed and endoscopic images were recorded during the operation.Postoperative stone composition analysis revealed it as calcium oxalate monohydrate stones.CONCLUSION Jackstones can occur in the renal collecting system besides the bladder.The unique appearance and imaging manifestations are the most important factors in the diagnosis of jackstones,and further exploration of the formation mechanism is required.

Higher CO_2-insufflation pressure inhibits the expression of adhesion molecules and the invasion potential of colon cancer cells

AIM： To investigate the influence of CO2-insufflation pressure on adhesion, invasion and metastatic potential of colon cancer cells based on adhesion molecules expression. METHODS： With an/n vitro artificial pneumoperitoneum model, SW1116 human colon carcinoma cells were exposed to CO2-insufflation in 5 different pressure groups： 6 mmHg, 9 mmHg, 12 mmHg, 15 mmHg and control group, respectively for 1 h. Expression of E-cadherin, ICAM-I, CD44 and E-selectin was meas- ured at 0, 12, 24, 48 and 72 h after CO2-insufflation using flow cytometry. The adhesion and invasion capacity of SW1116 cells before and after exposure to CO2-insufflation was detected by cell adhesion/invasion assay in vitro. Each group of cells was injected intraperitoneally into 16 BALB/C mice. The number of visible abdominal cavity tumor nodules, visceral metas-tases and survival of the mice were recorded in each group. RESULTS： The expression of E-cadherin, ICAM-1, CD44 and E-selectin in SWl116 cells were changed significantly following exposure to CO2 insufflation at different pressures （P 〈 0.05）. The expression of E-cadherin, CD44 and ICAM-1 decreased with increasing CO2-insufflation pressure. The adhesive/ invasive cells also decreased gradually with increasing pressure as determined by the adhesion/invasion assay. In animal experiments, the number of abdominal cavity tumor nodules in the 15 mmHg group was also significantly lower than that in the 6 mmHg group （29.7± 9.91 vs 41.7±14.90, P = 0.046）. However, the survival in each group was not statistically different. CONCLUSION： CO2-insufflation induced a temporary change in the adhesion and invasion capacity of cancer cells in vitro. Higher CO2-insufflation pressure inhibited adhesion, invasion and metastatic potential in vitro and in vivo, which was associated with reduced expression of adhesion molecules.

TT genotype of GNAS1 T393C polymorphism predicts better outcome of advanced non-small cell lung cancer patients

AIM: To evaluate the potential prognostic value of GNAS1 T393 C polymorphism in advanced non-small cell lung cancer.METHODS: We extracted genomic DNA from the peripheral blood leucocytes of 94 patients with advanced non-small cell lung cancer. Quantitative real-time polymerase chain reaction was used to determine the allelic discrimination. The correlation between genotype and overall survival was evaluated using the multivariate analysis and Kaplan-Meier approach.RESULTS: Thirty-eight out of 94(40%) patients displayed a TT genotype, 29 out of 94(31%) a CT genotype and 27 out of 94(29%) a CC genotype. The median survival of TT(25 mo) genotype carriers was longer than CT(12 mo) or CC(8 mo) genotype carriers. The favorable TT genotype predicted better overall survival(OS)(2-year OS: 48%; P =0.01) compared with CT(2-year OS: 18%) or CC(2-year OS: 15%) genotype. However, dichotomization between C-genotypes(CC + CT) and T-genotypes(TT) revealed significantly lower survival rates(2-year OS: 16%; P = 0.01) for C allele carriers.CONCLUSION: Our data provided strong evidence that the GNAS1 T393 C genetic polymorphism influenced the prognosis in advanced non-small lung cancer with a worse outcome for C allele carriers.

Anti-epidermal growth factor receptor monoclonal antibodies in metastatic colorectal cancer: A meta-analysis

AIM: To investigate the correlation between Kirsten rat sarcoma viral oncogene homolog(KRAS) status and the therapeutic effects of anti-epidermal growth factor receptor(EGFR) monoclonal antibodies(Mo Abs) in metastatic colorectal cancer(m CRC).METHODS: Randomized controlled trials(RCTs) were identified and the association between KRAS mutation and clinical outcome in m CRC patients treated with anti-EGFR Mo Abs was investigated.Ten RCTs wereincluded in this meta-analysis.Progression-free survival and overall survival were used to assess the strength of the relationship between KRAS mutation and clinical outcome.RESULTS: In first-line treatment, survival benefit was confined to patients with wild-type KRAS.Chemotherapy regimens and angiogenesis inhibitor treatment influenced the results of the analysis.Wildtype KRAS m CRC patients did not seem to benefit from oxaliplatin-based chemotherapy(PFS: HR = 0.88, 95%CI: 0.70-1.10; OS: HR = 0.93, 95%CI: 0.82-1.04).Clinical benefit in m CRC patients was limited to therapeutic regimens which included anti-EGFR Mo Abs and fluorouracil-based therapy(PFS: HR = 0.77, 95%CI: 0.69-0.86; OS: HR = 0.85, 95%CI: 0.75-0.95).When anti-EGFR Mo Abs were used as second- or further-line treatment, clinical benefit was still confined to patients with wild-type KRAS.CONCLUSION: KRAS status is a potential predictive marker of clinical benefit due to anti-EGFR Mo Ab therapy in m CRC patients.

BRAF V600E Mutation as a Predictive Factor of Anti-EGFR Monoclonal Antibodies Therapeutic Effects in Metastatic Colorectal Cancer: a Meta-analysis

Objective To investigate the correlation between BRAF V600 E mutation and anti-epidermal growth factor receptor(EGFR) monoclonal antibodies(Mo Abs) therapeutic effects in metastatic colorectal cancer. Methods Studies were included into meta-analysis to investigate the association between BRAF V600 E mutation and clinical outcome in metastatic colorectal cancer patients treated with anti-EGFR Mo Abs. Results A total of 7 studies were included in this meta-analysis. The 7 studies included 1352 patients in total, sample sizes ranged from 67 to 493. Objective response rate(ORR), progression-free survival(PFS) and overall survival(OS) were collected from included studies and were used to assess the strength of the relation. In patients with wild-type KRAS, the pooled odds ratio for ORR of mutant BRAF over wild-type BRAF was 0.27(95% CI=0.10-0.70). BRAF mutation predicted a deterioration in PFS and OS in wild-type KRAS patients treated with anti-EGFR Mo Abs(hazard ratio=2.78, 95% CI=1.62-4.76; hazard ratio=2.54, 95% CI=1.93-3.32). Conclusion BRAF V600 E mutation is related to lack of response and worse survival in wild-type KRAS metastatic colorectal cancer patients treated with anti-EGFR Mo Abs.

A systemic review of glutathione S-transferase P1 Ile105Val polymorphism and colorectal cancer risk

Objectives： To investigate the correlation between glutathione S-transferase P1 （GSTP1） Ilel05Val polymorphism and colorectal cancer （CRC） risk. Methods： Studies were identified to investigate the association between GSTP1 Ilel05Val polymorphism and CRC risk. Systematic computerized searches of the PubMed, Chinese National Knowledge Infrastructure, WANFANG and SinoMed were performed. Summary odds ratios （OR） and 95% confidence intervals （95 % CI） were used to measure GSTP 1 Ile 105Val polymorphisms and CRC risk. Results： A total of 23 retrospective studies were included in the meta-analysis. During all studies including 6,981 cases and 8,977 controls, sample sizes ranged from 146 to 2,144. Overall, the pooled results revealed that lie 105Val polymorphism was not associated with CRC risk and confused results were found in subgroup analyses. Further meta-analyses were conducted after excluding low-quality studies. GSTP1 Ilel05Val is associated with increased risk of CRC limited in studies with matched control. There was no significant heterogeneity in all genetic comparisons, but heterogeneity existed in subgroup analyses of heterozygous and dominant comparisons. The meta-regression analyses indicated that matched controls were the significant factor influencing between-study heterogeneity in all possible influential factors including published year, ethnicity, source of control, sample size, Hardy-Weinberg equilibrium （HWE） in control and matched controls. Sensitivity analysis revealed the pooled ORs were not changed before and after removal of each single study in all genetic comparisons, indicating the robustness of the results. Conclusions： GSTP1 Ilel05Val might be associated with increased risk of CRC. However, more high- quality case-control studies should be performed to confirm the authenticity of our conclusion.

Endoscopic treatment of urothelial encrusted pyelo-ureteritis disease:A case series

BACKGROUND Urothelial encrusted pyelo-ureteritis disease is an infrequent condition and there is no unified surgical treatment and reference standard to consult.We have used a minimally invasive endoscopic method to treat three such cases,which yielded excellent results.CASE SUMMARY The first case was a 45-year-old man who had unilateral ureteropelvic junction(UPJ)atresia and contralateral stenosis and was treated by double endoscopic surgery using an anterograde percutaneous nephroscope coupled with a rigid retrograde ureteroscope.The second case was a 12-year-old boy who received a percutaneous nephroscopy on one side and a percutaneous nephroscopy with a rigid ureteroscope on the other side due to the presence of bilateral UPJ stenosis.The third case was a 32-year-old woman with bilateral lower ureteral stricture treated using a rigid retrograde ureteroscope.Endoscopic surgeries were successfully performed on all the three patients.Varying degrees of encrustation and erosion of the urothelium were observed during the operation.The calcified layer composition analysis showed magnesium ammonium phosphate or carbonate apatite.Two patients achieved a good prognosis.CONCLUSION Minimally invasive endoscopic treatment for urothelial encrusted pyelo-ureteritis disease can yield better results.

Mini-percutaneous Nephrolithotomy Under Total Ultrasonography in Patients Aged Less Than 3 Years： A Single-center Initial Experience from China

Background：Urolithiasis in pediatric population is a serious problem with the incidence increased these years.In the management of larger stones （diameters 〉2 cm）,percutaneous nephrolithotomy （PCNL） is considered to be the gold standard.This study aimed to investigate the efficacy and safety of mini-PCNL under total ultrasonography in patients aged 〈3 years.Methods：We reviewed 68 patients （80 renal units） aged 〈3 years between August 2006 and December 2014 in Peking University People＆#39;s Hospital and Beijing Tsinghua Changung Hospital,including 36 renal units with a single stone,6 with staghom stones,14 with upper ureteral stones,and 24 with multiple stones.The mean age of the patients was 24.2 months （range 6-36 months）,and the mean maximum stone diameter was 19.2 mm （range 10-35 mm）.The puncture site selection and tract dilation were guided by Doppler ultrasonography solely.All procedures were performed using 12-16 Fr tracts.Stones were fragrnented using pneumatic lithotripsy and a holmium laser with an 8/9.8 Fr rigid ureteroscope.Results：Fifty-six patients with unilateral stones underwent a single session procedure,and 12 patients with bilateral stones underwent two procedures.The mean time to establish access was 2.8 min （range 1.8-5.0 min）,the mean operative time was 36.5 min （range 20-88 min）,the mean decrease in hemoglobin concentration was 8.9 g/L （2-15 g/L）,and the stone-free rate （SFR） at hospital discharge was 94.0%.The mean postoperative hospital stay was 7.1 days （range 3-13 days）.Postprocedure complications included fever （〉38.5℃） in five patients and reactive pleural effusion in one patient.Blood loss requiring transfusion,sepsis,adjacent organ injury,and kidney loss were not observed.Conclusions：This study indicated that ultrasound-guided mini-PCNL is feasible and safe in patients aged 〈3 years,without major complications or radiation exposure.

Needle-perc: a new instrument and its initial clinical application

Percutaneous nephrolithotomy(PCNL)has achieved remarkable acceptance during the past decade.The minimization of the instruments used and flexible scope improvements helped lead to its popularity.A previous literature proved that the tract size was positively correlated with the rate of bleeding and renal injuries.11 On the basis of this conception,we devised a new PCNL technique,called"needle-perc"as the needle was even thinner than the micro-perc technique.In this study,we present our initial experience of using the needle-perc method to deal with small renal stones and to assess its feasibility and safety as new instrumentation in the field of minimally invasive endourology.

Influence of the Anatomy of the Collecting System Upon Percutaneous Nephrolithotomy for Removal of Renal Staghorn Stones

To the Editor： Percutaneous nephrolithotomy （PCNL） is first-line therapy for ＂staghorn＂ stones. A multi-access approach is the mainstay of treatment in many cases because the stone burden is high. Finding feasible parameters to predict the outcome of treatment for staghorn stones is important. The factors that can affect PCNL are controversial. Several parameters, such as the infundibular-pelvic angle （IPA）, upper-lower calyx angle （ULCA）, infundibular length （IL）, and infundibular width （IW） were important to affect the result of the operation. Whether the objective parameters in computed tomography （CT） can predict success through a particular approach has not been evaluated. This study investigated if the anatomy of the collecting system could improve the outcome in selected patients according to pretreatment images.

Percutaneous nephrolithotomy with X-ray free technique in morbidly obese patients

To the Editor:Percutaneous nephrolithotomy(PNL)constitutes the first-line of treatment for complex and staghorn stones.Performing PNL in morbidly obese patients is challenging because of potential risks and higher morbidity rates.[1]Previous literature has confirmed the safety and feasibility of the surgery under fluoroscopy.However,the efficiency of total ultrasound(US)-guided access established procedures in morbidly obese patients has not been proved before,with the traditional view holding that obesity is a risk factor that increases the difficulty of accessing the renal collecting system under US.US is sometimes used to reduce radiation exposure in some Western countries,whereas the spread of X-ray-free technique for PNL in China has been lasting for>10 years.This study aims to investigate the feasibility and safety of total US-guided PNL in morbidly obese patients and to highlight the difficulties and problems,which can be encountered and effectively resolved.