Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma: A single-center retrospective study in South Korea

BACKGROUND Intrahepatic duct(IHD)stones are among the most important risk factors for cholangiocarcinoma(CCC).Approximately 10%of patients with IHD stones develop CCC;however,there are limited studies regarding the effect of IHD stone removal on CCC development.AIM To investigate the association between IHD stone removal and CCC development.METHODS We retrospectively analyzed 397 patients with IHD stones at a tertiary referral center between January 2011 and December 2020.RESULTS CCC occurred in 36 of the 397 enrolled patients.In univariate analysis,chronic hepatitis B infection(11.1%vs 3.0%,P=0.03),carbohydrate antigen 19-9(CA19-9,176.00 vs 11.96 II/mL,P=0.010),stone located in left or both lobes(86.1%vs 70.1%,P=0.042),focal atrophy(52.8%vs 26.9%,P=0.001),duct stricture(47.2%vs 24.9%,P=0.004),and removal status of IHD stone(33.3%vs 63.2%,P<0.001)were significantly different between IHD stone patients with and without CCC.In the multivariate analysis,CA19-9>upper normal limit,carcinoembryonic antigen>upper normal limit,stones located in the left or both lobes,focal atrophy,and complete removal of IHD stones without recurrence were independent factors influencing CCC development.However,the type of removal method was not associated with CCC risk.CONCLUSION Complete removal of IHD stones without recurrence could reduce CCC risk.

Extracorporeal shockwave lithotripsy in the management of urinary stones: New concepts and techniques to improve outcomes

Objective: Extracorporeal shockwave lithotripsy (SWL) currently plays an important role in the treatment of urinary tract lithiasis. The purpose of this article was to describe new concepts and procedural strategies that would improve results using SWL as a treatment for urolithiasis, thereby achieving better clinical practice.Methods: A systematic review process was carried in PubMed/PMC from January 2003 to March 2023. A narrative synthesis of the most important aspects has been made.Results: The important recommendations for the adequate selection of the candidate patient for treatment with SWL are summarized, as well as the new strategies for a better application of the technique. Aspects about intraoperative position, stone localization and monitoring, analgesic control, machine and energy settings, and measures aiming at reduced risk of complications are described.Conclusion: To achieve the therapeutic goal of efficient stone disintegration without increasing the risk of complications, it is necessary to make an adequate selection of patients and to pay special attention to several important factors in the application of treatment. Technological development in later generation devices will help to improve current SWL results.

Percutaneous antegrade management of large proximal ureteral stones using non-papillary puncture

Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.

Natural history of asymptomatic gallbladder stones in clinic without beds:A long-term prognosis over 10 years

BACKGROUND Several studies have explored the long-term prognosis of patients with asymp-tomatic gallbladder stones.These reports were primarily conducted in facilities equipped with beds for addressing symptomatic cases.AIM To report the long-term prognosis of patients with asymptomatic gallbladder stones in clinics without bed facilities.METHODS We investigated the prognoses of 237 patients diagnosed with asymptomatic gallbladder stones in clinics without beds between March 2010 and October 2022.When symptoms developed,patients were transferred to hospitals where appropriate treatment was possible.We investigated the asymptomatic and survival periods during the follow-up.RESULTS Among the 237 patients,214(90.3%)remained asymptomatic,with a mean asymptomatic period of 3898.9279±46.871 d(50-4111 d,10.7 years on average).Biliary complications developed in 23 patients(9.7%),with a mean survival period of 4010.0285±31.2788 d(53-4112 d,10.9 years on average).No patient died of biliary complications.CONCLUSION The long-term prognosis of asymptomatic gallbladder stones in clinics without beds was favorable.When the condition became symptomatic,the patients were transferred to hospitals with beds that could address it;thus,no deaths related to biliary complications were reported.This finding suggests that follow-up care in clinics without beds is possible.

Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma

Hepatolithiasis(HL)poses a significant risk for cholangiocarcinoma(CCA)development,with reported incidences ranging from 5%-13%.Risk factors include older age,smoking,hepatitis B infection,and prolonged HL duration.Chronic inflammation and mechanical stress on the biliary epithelium contribute to CCA pathogenesis.Hepatectomy reduces CCA risk by removing stones and atrophic liver segments.However,residual stones and incomplete removal increase CCA risk.Kim et al identified carbohydrate antigen 19-9,carcinoembryonic antigen,and stone laterality as CCA risk factors,reaffirming the importance of complete stone removal.Nonetheless,challenges remain in preventing CCA recurrence post-surgery.Longer-term studies are needed to elucidate CCA risk factors further.

Enhanced properties of stone coal-based composite phase change materials for thermal energy storage

Phase change materials (PCMs) can be incorporated with low-cost minerals to synthesize composites for thermal energy storage in building applications.Stone coal (SC) after vanadium extraction treatment shows potential for secondary utilization in composite preparation.We prepared SC-based composite PCMs with SC as a matrix,stearic acid (SA) as a PCM,and expanded graphite (EG) as an additive.The combined roasting and acid leaching treatment of raw SC was conducted to understand the effect of vanadium extraction on promoting loading capacity.Results showed that the combined treatment of roasting at 900℃ and leaching increased the SC loading of the composite by 6.2%by improving the specific surface area.The loading capacity and thermal conductivity of the composite obviously increased by 127%and 48.19%,respectively,due to the contribution of 3wt% EG.These data were supported by the high load of 66.69%and thermal conductivity of 0.59 W·m^(-1)·K-1of the designed composite.The obtained composite exhibited a phase change temperature of 52.17℃,melting latent heat of 121.5 J·g^(-1),and good chemical compatibility.The SC-based composite has prospects in building applications exploiting the secondary utilization of minerals.

Risk factors for recurrence of common bile duct stones after surgical treatment and effect of ursodeoxycholic acid intervention

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an accurate diagnostic method for choledocholithiasis and treatment option for stone removal.Additionally,ursodeoxycholic acid(UDCA)can dissolve cholesterol stones and prevent their development and reappearance by lowering the cholesterol concen-tration in bile.Despite these treatment options,there are still patients who experience stone recurrence.The clinical data of 100 patients with choledochal stones who were hospitalized at the Yixing People’s Hospital and underwent ERCP for successful stone extraction between June 2020 and December 2022 were retrospectively collected.According to the post-ERCP treatment plan,100 patients were classified into UDCA(n=47)and control(n=53)groups.We aimed to assess the clinical efficacy and rate of relapse in the two patient populations.We then collected information(basic demographic data,clinical characteristics,and serum biochemical indicators)and determined the factors contributing to relapse using logistic regression analysis.Our secondary goal was to determine the effects of UDCA on liver function after ERCP.Compared to the control group,the UDCA group demonstrated a higher clinical effectiveness rate of 92.45%vs 78.72%(P<0.05).No significant differences were observed in liver function indices,including total bilirubin,direct bilirubin,gamma-glutamyl transpeptidase,alanine aminotransferase,alkaline phosphatase,and aspartate aminotransferase,between the two groups before treatment.After treatment,all liver function indices were significantly reduced.Comparing the control vs UDCA groups,the UDCA group exhibited significantly lower levels of all indices(55.39±6.53 vs 77.31±8.52,32.10±4.62 vs 45.39±5.69,142.32±14.21 vs 189.63±16.87,112.52±14.25 vs 149.36±15.36,122.61±16.00 vs 171.33±22.09,96.98±10.44 vs 121.35±11.57,respectively,all P<0.05).The stone recurrence rate was lower in the UDCA group(13.21%)in contrast with the control group(44.68%).Periampullary diverticula(OR:6.00,95%CI:1.69-21.30),maximum stone diameter(OR:1.69,95%CI:1.01-2.85),stone quantity>3(OR:4.23,95%CI:1.17-15.26),and positive bile culture(OR:7.61,95%CI:2.07-27.91)were independent factors that influenced the relapse of common bile duct stones after ERCP(P<0.05).Furthermore,postoperative UDCA was identified as a preventive factor(OR:0.07;95%CI:0.08-0.09).CONCLUSION The intervention effect of UDCA after ERCP for common bile duct stones is adequate,providing new research directions and references for the prevention and treatment of stone recurrence.

Comparison of the clinical effects of dual-modality endoscopy and traditional laparotomy for the treatment of intra-and extrahepatic bile duct stones

BACKGROUND Bile duct stones(BDSs)may cause patients to develop liver cirrhosis or even liver cancer.Currently,the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory,and there is a risk of postoperative complic-ations.AIM To compare the clinical effects of dual-modality endoscopy(duodenoscopy and laparoscopy)with those of traditional laparotomy in the treatment of intra-and extrahepatic BDSs.METHODS Ninety-five patients with intra-and extrahepatic BDSs who sought medical services at Wuhan No.1 Hospital between August 2019 and May 2023 were selected;45 patients in the control group were treated by traditional laparotomy,and 50 patients in the research group were treated by dual-modality endoscopy.The following factors were collected for analysis:curative effects,safety(incision infection,biliary fistula,lung infection,hemobilia),surgical factors[surgery time,intraoperative blood loss(IBL)volume,gastrointestinal function recovery time,and length of hospital stay],serum inflammatory markers[tumor necrosis factor(TNF)-α,interleukin(IL)-6,and IL-8],and oxidative stress[glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),malondialdehyde(MDA),and advanced protein oxidation products(AOPPs)].RESULTS The analysis revealed markedly better efficacy(an obviously higher total effective rate)in the research group than in the control group.In addition,an evidently lower postoperative complication rate,shorter surgical duration,gastrointestinal function recovery time and hospital stay,and lower IBL volume were observed in the research group.Furthermore,the posttreatment serum inflammatory marker(TNF-α,IL-6,and IL-8)levels were significantly lower in the research group than in the control group.Compared with those in the control group,the posttreatment GSH-Px,SOD,MDA and AOPPs in the research group were equivalent to the pretreatment levels;for example,the GSH-Px and SOD levels were significantly higher,while the MDA and AOPP levels were lower.CONCLUSION Dual-modality endoscopy therapy(duodenoscopy and laparoscopy)is more effective than traditional laparotomy in the treatment of intra-and extrahepatic BDSs and has a lower risk of postoperative complications;significantly shortened surgical time;shorter gastrointestinal function recovery time;shorter hospital stay;and lower intraop-erative bleeding volume,while having a significant inhibitory effect on excessive serum inflammation and causing little postoperative oxidative stress.

Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence

While endoscopic retrograde cholangiopancreatography(ERCP)remains the primary treatment modality for common bile duct stones(CBDS)or choledocho-lithiasis due to advancements in instruments,surgical intervention,known as common bile duct exploration(CBDE),is still necessary in cases of difficult CBDS,failed endoscopic treatment,or altered anatomy.Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes.This review elucidates relevant clinical anatomy,selection indications,and outcomes to enhance surgical understanding.The selection between trans-cystic(TC)vs trans-choledochal(TD)approaches is described,along with stone removal techniques and ductal closure.Detailed surgical techniques and strategies for both the TC and TD approaches,including instrument selection,is also provided.Additionally,this review comprehensively addresses operation-specific complications such as bile leakage,stricture,and entrapment,and focuses on preventive measures and treatment strategies.This review aims to optimize the management of CBDS through laparoscopic CBDE,with the goal of improving patient outcomes and minimizing risks.

Asymptomatic bile duct stones:The devil is in the details

Common bile duct(CBD)stones are a common biliary tract disease.For asymp-tomatic CBD stones,stone removal by endoscopic retrograde cholangiopancreato-graphy(ERCP)is recommended in available guidelines.Because asymptomatic CBD stones is a benign disease with no noticeable symptoms,the risk vs benefit strategy should be thoroughly considered before performing ERCP in these patients.Clinical care review,technical aspects of the procedure,and patient preferences should also be considered.

Evaluation of Textured Concrete as an Alternative for Stone as a Cladding Material

Along with the increasing demand on exterior wall cladding as a protective cover for the interior elements and an indicator for modernity and architectural innovation,comes the need to develop new cladding materials that can replace the old ones and overcome their setbacks.This paper discusses the possibility of replacing stone by textured concrete as a cladding material in order to overcome the main challenges faced stone cladding by comparing them together.The comparison was made based on the main requirements of the cladding materials namely:economic,environmental,social,functional and structural aspects.

Nursing Effect of Rapid Rehabilitation Surgery Concept in Laparoscopic Surgery for Extrahepatic Bile Duct Stones

Objective: To explore the application value of rapid rehabilitation concept in patients with extrahepatic bile duct stones under laparoscopy during perioperative period. Methods: 90 patients with extrahepatic bile duct stones treated in our hospital from January 2022 to February 2023 were selected as the research object and randomly divided into the study group and the control group. The control group was given routine care, and the observation group was given rapid surgical rehabilitation care. The postoperative anal exhaust time, first meal time, early activity time, pain time, abdominal drainage tube removal time, hospitalization time and complication rate were compared between the two groups. The independent sample T test was used for the measurement data, and the x2 test was used for the counting data, and the difference was statistically significant (P Results: The postoperative anal exhaust time, first meal time, early activity time, pain time, abdominal drainage tube removal time and hospitalization time in the study group were shorter than those in the control group (all P Conclusion: The concept of rapid rehabilitation can significantly improve the perioperative nursing effect of patients with extrahepatic bile duct stones and accelerate their rehabilitation, which is worth improving and popularizing.

Treatment of Kidney Stones by Percutaneous Nephrolithotomy: Evaluation of the Results of the First Series of Our Experience in the Urology Department of the Idrissa Pouye General Hospital in Dakar

The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study the epidemiological, clinical and paraclinical aspects of patients with renal lithiasis treated by PCNL and on the other hand the different technical aspects of PCNL. Materials and Methods: This was a retrospective descriptive study, conducted in the urology department of HOGIP, covering the period from January 2015 to January 2019. We studied the demographic and clinical aspects of patients presenting renal lithiasis;we also studied the technical aspects and treatment outcomes. Statistical significance was set for α = 0.05. Results: Our series covered 82 PCNLs performed during the study period. The average age was 45.95 years, the age group [40 - 49 years] was more affected. Our study involved 44 men and 38 women, a sex ratio of 1.15. At the clinic, atypical lumbar pain was more frequent in 45.83% of cases. On URO-CT, the calculations were located more at the pyelic level (31.2%) and lower caliceal (27.2%). The size of stones measured between 15 and 20 mm in 30.52%. The stone density was between 500 and 1000 HU in 47.54% of cases. Intraoperatively, the patients were placed in lateral decubitus in 41.46% of cases. Only one access to the kidney was necessary in 87.8% of cases. The lithoclast was used in 65.85% of cases. The overall success rate (stone free) in our series was 96%. The majority of cases, 41.44%, drainage were done by natural means (totally tubeless). The average duration was 92 minutes. The complications encountered in our experience concerned 10 cases, a rate of 12.19%. Conclusion: Urinary lithiasis is more and more frequent in our regions. The development of Endo-urology offers several therapeutic options. Thus, PCNL occupies an important place in the management of kidney stones.

Epidemiologic, Diagnostic, and Therapeutic Features of Urinary Stone Disease in Northern Benin from 2018 to 2023

Objective: To determine the epidemiologic, diagnostic, and therapeutic features of urinary in northern Benin from 2018 to 2023. Patients and Method: The study was an observational and descriptive one. We exhaustively and retrospectively collected data from the medical records of the patients that were managed from February 1, 2018 to February 1, 2023 at the Department of Surgery of “Centre Hospitalier Universitaire Départmental Borgou-Alibori or CHUD-BA”. Results: Among the 4522 patients managed, 75% or 1.7% had urinary stone disease. Their mean age was 41 years. The sex ratio was 2.75, the males being predominantly affected. Of the 75 cases of urinary stone disease, 30.7% (n = 23) were renal, 46.7% (n = 35) were ureteral, and 22.7% (n = 17) were vesical. The patients came from variable geographical areas, ethnic groups, and professional sectors. Their main complaints were pain (57.3%), hematuria (14.7%), dysuria (12%), and fever (5.3%). 15 (20%) patients, i.e., 7 renal stone and 8 ureteral stone patients, had an obstructive renal failure. The imaging tools available were ultrasonography, tomography and computed tomographic scan. 11 of the bladder stone cases (64.7%) were associated with a bladder outlet obstruction. Overall, 38.7% of the patients had either diabetes mellitus (6.7%), hypertension or high blood pressure (6.7%), benign prostate hyperplasia (8%), urinary schistosomiasis (6.7%), ureteral pelvic junction obstruction (2.7%), and prostate cancer (1.3%). Of the 19 patients whose dietary behavior was investigated 15 (79%), 11 (57.9%) et 11 (57.9%) demonstrated a diet which was respectively rich in milk, fromage and meat. 100% of bladder stones were removed through cystolithotomy. Renal stones were removed by pyelolithtomy (52.2%) and nephrolithotomy (21.7%). Ureteral stones were removed through ureterolithotomy (40%), expelled by means of alpha-blockers (40%) or managed with ureteral pigtail stent (20%). Conclusion: The hospital prevalence of urinary stone disease was 1.7%. The mean age in urinary stone-affected patients was 41 years. The urinary stone predominantly affected male patients: the sex ratio was 2.75. The stones were mainly removed through open surgery.

基于动态StoNED方法的工业企业创新资源配置效率研究

基于2011~2020年中国30个省市自治区规模以上工业企业面板数据,从投入产出角度,依据创新价值链理论,将企业技术创新活动分为技术成果研发和技术成果转化两阶段。构建两阶段StoNED模型对创新资源配置效率进行测算和研究,并利用Tobit模型分别对两阶段效率值的影响因素进行回归分析。结果表明:中国规模以上工业企业两阶段的创新资源配置效率皆呈现“倒U型”态势;区域间效率差异明显,呈“东-中-西”由高到低排列;地区经济发展水平和科研实力正向影响技术成果研发阶段效率,企业资产规模和企业重视程度正向影响技术成果转化阶段效率,政府支持力度对两阶段效率皆无明显作用。研究结论为创新驱动发展战略等政策制定和实施提供了来自区域规模以上工业企业的新证据。

从功能对等理论看Harry Potter and the Philosopher’s Stone中译本的专有名词之比较

谈到现代西方魔幻文学,我们马上就想到一位英国作家——乔安妮·凯瑟琳·罗琳,以及她的代表作品《哈利·波特》。这个作品为七部曲,主要介绍了主人公哈利·波特在经过魔法世界中的种种磨练,最终打败黑暗势力,成长为一位年轻优秀的魔法师的传奇故事。它是一部魔幻儿童文学作品,深受各个年龄阶层人们的喜爱,风靡全球。从《哈利·波特》引发的热潮开始,各种争议也此起彼伏,有关这个作品的学术研究也一直不断。文章以《哈利·波特与魔法石》的苏农译本和彭倩文译本为研究比较对象,利用尤金·奈达的功能对等理论,从各个角度对原著中的重要专有名词展开系统分类,以及深入分析专有名词的各种翻译途径,如何最贴切地翻译文学作品中的专有名称,来帮助中国读者更好地理解作者罗琳所创造的世界。

Cholangioscopy-assisted extraction through novel papillary support for small-calibre and sediment-like common bile duct stones

BACKGROUND To date,endoscopic retrograde cholangiopancreatography has become a wellestablished treatment for common bile duct(CBD)stones.However,it is not suitable for some special patients,such as pregnant women,children or those who cannot stop taking anti-coagulation/anti-platelet agents because of radiation injury and the risk of postoperative bleeding resulting from endoscopic sphincterotomy.To overcome these two problems,this study introduced cholangioscopy-assisted extraction through a novel papillary support for small-calibre and sediment-like CBD stones.AIM To assess the feasibility and safety of cholangioscopy-assisted extraction through a novel papillary support(CEPTS)for small-calibre and sediment-like common bile duct(CBD)stones.METHODS This Retrospective study was approved by the Ethics Committee of the Chinese PLA General Hospital.We designed a covered single dumbbell-style papillary support between 2021 and 2022.Between July 2022 and September 2022,7 consecutive patients with small-calibre(cross diameter≤1.0 cm)or sediment-like CBD stones underwent CETPS procedures in our center.The clinical characteristics and treatment outcomes of these 7 patients were extracted from a prospectively collected database.And the related data were analyzed.Informed consent was obtained from all participating patients.RESULTS A total of 2 patients had yellow sediment-like CBD stones,and aspiration extraction was performed after the insertion of papillary support.Of the 5 patients with clumpy CBD stones(0.4-1.0 cm),2 underwent basket extraction under direct vision for a single stone(0.5-1.0 cm,black and black grey),1 underwent balloon plus aspiration extraction under direct vision for 5 stones(0.4-0.6 cm,brown),and 2 underwent aspiration extraction only for a single stone(0.5-0.6 cm,yellow,none).Technical success,namely,no residual stones in the CBD or left and right hepatic ducts,was achieved in all 7 cases(100%).The median operating time was 45.0 minutes(range 13.0–87.0 minutes).Postoperative pancreatitis(PEP)occurred in one case(14.3%).Hyperamylasaemia without abdominal pain was noted in 2 of 7 patients.No residual stones or cholangitis were found during the follow-up.CONCLUSION CETPS appeared to be feasible to treat patients with small-calibre or sediment-like CBD stones.Patients,especially pregnant women and those who cannot stop anticoagulation/anti-platelet agents,could benefit from this technique.

Theoretical Calculation of ITZ Volume Fraction and Morphological Characterization of Crushed Stone in Concrete

According to the morphological characteristics of crushed stone,the sphericity was introduced to establish the theoretical calculation model of volume fraction of interfacial transition zone(ITZ)around crushed stone.The sphericity of crushed stone was obtained by image processing technology and numerical statistics.The experimental results show that when the maximum particle size of coarse aggregate is less than 31.5 mm,the practical sphericity is generally around 0.75,while the sphericity of sand is generally above 0.85.And the closer to 1 the practical sphericity is,the smaller the ITZ volume fraction(V_(ITZ))is,that is,the closer to spherical shape the aggregate is,the lower the ITZ content in concrete is.The V_(ITZ) and ITZ thickness in concrete and mortar have a linear relationship,and the ITZ content in concrete is lower than that in mortar at the same aggregate volume fraction.

Sheathless and fluoroscopy-free retrograde intrarenal surgery:An attractive way of renal stone management in high-volume stone centers

Objective:To evaluate the efficacy and safety of sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy(FURSL)for treating renal stones.Methods:Between May 2015 and May 2017,135 patients with renal stones treated with sheathless and fluoroscopy-free FURSL were prospectively evaluated.Our technique involved a semirigid ureteroscopic assessment of the ureter,and the guidewire was left in situ to railroad the flexible ureteroscope.A holmium laser was used to fragment and dust the stones;fragments were neither grasped nor collected.Results:The study population consisted of 135 patients including 85 males(62.96%)and 50 females(37.04%)with a mean age of 40.65 years(range:3-70 years)were evaluated.The mean stone size was 17.23 mm(range:8-41 mm).Complete stone-free status was achieved in 122(90.37%)patients and clinically insignificant residual fragments(CIRF)in two(1.48%),while residual stones were still present in 11(8.15%)patients.Postoperative complications occurred in 23(17.4%)cases and were mostly minor,including fever in 17(12.6%),pyelonephritis in four(3.0%),subcapsular hematoma in one(0.7%)and steinstrasse in one(0.7%).These complications were Clavien Ⅰ-Ⅱ,GⅠ in 17(12.6%)patients,GⅡ in five(3.7%),and Clavien Ⅲb in one(0.7%).No major complications were observed.Stone size2 cm,operative time ≥30 min,and lasing time ≥20 min were significantly associated with a higher rate of complications and lower stone-free rates upon univariate analysis(p<0.05).Conclusion:Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management,especially for stones under 2 cm in diameter.This process is a feasible option for avoiding sheath complications,which can protect surgeons from the negative effects of radiation.

Kidney stone matrix proteins:Role in stone formation

Stone formation is induced by an increased level of urine crystallization promoters and reduced levels of its inhibitors.Crystallization inhibitors include citrate,magnesium,zinc,and organic compounds such as glycosaminoglycans.In the urine,there are various proteins,such as uromodulin(Tamm-Horsfall protein),calgranulin,osteopontin,bikunin,and nephrocalcin,that are present in the stone matrix.The presence of several carboxyl groups in these macromolecules reduces calcium oxalate monohydrate crystal adhesion to the urinary epithelium and could potentially protect against lithiasis.Proteins are the most abundant component of kidney stone matrix,and their presence may reflect the process of stone formation.Many recent studies have explored the proteomics of urinary stones.Among the stone matrix proteins,the most frequently identified were uromodulin,S100 proteins(calgranulins A and B),osteopontin,and several other proteins typically engaged in inflammation and immune response.The normal level and structure of these macromolecules may constitute protection against calcium salt formation.Paradoxically,most of them may act as both promoters and inhibitors depending on circumstances.Many of these proteins have other functions in modulating oxidative stress,immune function,and inflammation that could also influence stone formation.Yet,the role of these kidney stone matrix proteins needs to be established through more studies comparing urinary stone proteomics between stone formers and non-stone formers.