Stone Analysis Research Articles

Assessment of Vitamin D Level in Patients with Recurrent Renal Calcium Stones

Background: a higher concentration of the active vitamin D metabolite colic calciferol 1,25-dihydroxyvitamin D3 is associated with increased urinary calcium excretion, which could lead to increase the risk of stone formation. Objectives: To assess vitamin D level in patients with recurrent renal calcium (Ca) stones. Patients and methods: This study was conducted in Urology Department at Menoufia University Hospital during the period from March 2018 to December 2019. 96 patients were included in this study divided into two groups. The first group (group 1) consisted of 76 patients with renal Ca stone and the second group (group 2) consisted of 20 cases without renal stone. Patients who were included in this study seeking for treatment of recurrent renal stone that proved to be Ca stone by CT KUB or stone analysis. Results: there was no statistically significant difference between the two groups regarding vitamin D level, there was no statistically significant difference between different types of calcium stone in relation to vitamin D levels (P= 0.981). There was no statistically significant correlation between vitamin D levels with age (P=0.300), Hounsfield unites of stone (P=0.650) or serum creatinine (P=0.690). Conclusion: There was no statistically significant difference between studied groups regarding vitamin D level. Further studies are needed to determine whether there is any untoward consequence of a concomitant rise in intestinal absorption and urinary excretion of calcium associated with vit D supplementation in idiopathic stone formers.

Automatic Segmentation and Analysis of Renal Calculi in Medical Ultrasound Images

Ultrasonography images have a high impact in the medical field for faster and accurate diagnosis of the diseases. The analysis and processing of ultrasound images is a tedious task. The proposed work focuses on automatic segmentation and analysis of renal calculi in digital ultrasound kidney images. The developed methodology includes steps such as preprocessing, segmentation and analysis. Preprocessing includes despeckling of input ultrasound images and is performed by using contourlet transform. Preprocessed images undergo automatic segmentation using the level set method. Analysis of the segmented stones is also carried out to obtain metrics such as the number of stones and their sizes. These metrics are essential to decide about the further plan of treatment by urologists and nephrologists. Performance of the developed algorithm is evaluated by the medical experts and also by using the various parameters such as dice similarity coefficient, Jaccard index, specificity, sensitivity, and accuracy.

Functional analysis of sandstone ground stone\xa0tools: arguments for a qualitative and quantitative synergetic approach

In the last few years, the application of quantitative methods in the field of use wear analysis has grown considerably, involving the use of different techniques. A development in surface measurements approaches has become necessary as standard assessments based upon qualitative functional analysis are often affected by a degree of subjectivity and a limited reproducibility. To advance the current methodological debate on functional analysis of ground stone technology, we present a combined methodological approach, including qualitative and quantitative analyses, applied to the study of experimental sandstone ground stone tools. We test surface quantification at a macro and micro-scale, paired with the observation and description of residue and use wear connected to the processing of plant, animal and mineral matters. Our results provide an exhaustive quantitative dataset concerning surface modifications associated with different uses and suggest an analytical workflow for the functional analysis of both experimental and archaeological ground stone assemblages. We also highlight the limitation and pitfalls of an exclusive adoption of quantitative methods in the study of ancient tool use demonstrating how a synergetic approach can enhance the quality, reproducibility and comparability of functional data.

Chemical Composition of Urinary Tract Stones: Experience in a Medical College Hospital, in Dhaka

Objective: To find out the chemical composition of urinary tract stones in patients attending our hospital. Methods: A cross sectional hospital based study was conducted among 140 patients from October 2011 to September 2014 in SSMC & MH. The study included all patients of either gender and all ages who were diagnosed to have urinary tract stones and were managed in our hospital. Chemical analysis of stones were performed on stones, fragments, gravel’s passed spontaneously, or retrieved from endourological intervention or after ESWL or open surgery. Results were reviewed and analyzed with the help of SPSS17. Result: Out of 140 patients about one third (31.4%) were female and two thirds were (68.6%) male. Most of the patients belong to age group 40-50 years. Mean age of the patients was 43.74 years with standard deviation of 10.28 years. 20% of the patients have recurrent stones. By the type of symptoms all of the patients had loin or back pain. One third of the patients had (36.7%) calcium oxalet stones, more than one fourth of respondents (27.1%) had mixed stones and 12.9% had magnesium, ammonium phosphate stones. Calcium containing stones were the most(60%). Conclusion: Calcium containing stones constitute the most common variety of urinary tract calculi in our local population. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.8-11

The utility of automated volume analysis of renal stones before and after shockwave lithotripsy treatment

This study aimed to evaluate the additional utility of an automated method of estimating volume for stones being treated with shockwave lithotripsy (SWL) using computed tomography (CT) images compared to manual measurement. Utility was assessed as the ability to accurately measure stone burden before and after SWL treatment, and whether stone volume is a better predictor of SWL outcome than stone diameter. 72 patients treated with SWL for a renal stone with available CT scans before and after treatment were included. Stone axes measurement and volume estimation using ellipsoid equations were compared to volume estimation using software using CT textural analysis (CTTA) of stone images. There was strong correlation (r > 0.8) between manual and CTTA estimated stone volume. CTTA measured stone volume showed the highest predictive value (r2 = 0.217) for successful SWL outcome on binary logistic regression analysis. Three cases that were originally classified as ‘stone-free with clinically insignificant residual fragments’ based on manual axis measurements actually had a larger stone volume based on CTTA estimation than the smallest fragments remaining for cases with an outcome of ‘not stone-free’. This study suggests objective measurement of total stone volume could improve estimation of stone burden before and after treatment. Current definitions of stone-free status based on manual measurements of residual fragment sizes are not accurate and may underestimate remaining stone burden after treatment. Future studies reporting on the efficacy of different stone treatments should consider using objective stone volume measurements based on CT image analysis as an outcome measure of stone-free state.

Urinary Calculi: A Microbiological and Biochemical Analysis at a Tertiary Care Hospital in Eastern Nepal.

Background The occurrence of urinary tract infection in presence of urolithiasis is frequently noted; however, microbial agents of urolithiasis and their antimicrobial susceptibility patterns remain underinvestigated. This study aimed to identify the microorganisms isolated from urine and stone matrices to determine their antimicrobial susceptibility, to find the association between the pathogens of urine and stone matrices, and to perform the biochemical analysis of stones. Methods A total of 88 cases of urolithiasis admitted for elective stone removal at Department of surgery, B.P. Koirala Institute of Health Sciences (BPKIHS), were enrolled. Preoperative urine culture and postoperative stone culture were performed. Isolation, identification, and AST were done by the standard microbiological technique. Further qualitative biochemical analysis of stones was also attempted. Result Among 88 stone formers recruited, culture of urine, whole stone, and nidus yielded the growth of bacteria 44, 32, and 30, respectively. Bacteria isolated from urine culture correlated with those from stone matrices with a sensitivity of 90%, specificity of 79.69%, PPV of 63.64%, and NPV of 95.45%. Escherichia coli (46.7%) was the most common bacteria followed by Klebsiella pneumoniae (16.7%) and Proteus mirabilis (13.3%) from urine and stone cultures. Almost all the uropathogens isolated were susceptible to commonly used antibiotics. Calcium oxalate (84.1%) was common biochemical constituent found in stone formers followed by calcium oxalate + phosphate (8%). Conclusions The association of microorganism isolated from urine and nidus culture was significant that can predict the source of infective stone; however, in some cases, microorganisms and the antimicrobial susceptibility pattern from urine and nidus were different. This study emphasizes the use of appropriate antimicrobial agents to prevent the regrowth of residual stones and minimize the risk of infectious complications after surgical removal of stones.

The use of Cornus sanguinea L. (dogwood) fruits in the Late Neolithic

Numerous fragments of Cornus sanguinea (dogwood) fruit stones were found in the cultural layer of the Late Neolithic pile dwelling site Strojanova voda at Ljubljansko barje, Slovenia, which indicate the Late Neolithic use of dogwood fruits. While these fruits are considered to be inedible, the research question about their use arose. Ethnobotanical and archaeobotanical sources were examined and experimental work on processing and using fresh C. sanguinea fruits was done, followed by chemical analyses of modern fruits (endocarps, mesocarps and exocarps) and archaeological fruit stones from the site. All these various approaches together suggest some possible uses. Fresh dogwood fruits can be crushed to give a soapy, creamy and oily emulsion with an exfoliant effect on the skin, which proved to be applicable, besides for oil, for cleaning and washing bodies, clothes and/or dishes. It can be concluded that Late Neolithic pile dwellers had a great knowledge of wild plants and their properties, and not only for food, and that the use of C. sanguinea fruits, at least south of the Alps, has been undervalued until now.

Identificación endoscópica de la composición de los cálculos urinarios: un estudio del Southeastern Group for Lithiasis Research (SEGUR 2)

Introduction and objectivesTo assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. Materials and methodsA series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. ResultsA total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1-12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. ConclusionsObservation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones.

Nephrolithiasis: Approach to Diagnosis and Management

Although kidney stones are less common in children than in adults, incidence in children is rising. Kidney stones may lead to significant morbidity in addition to escalating medical costs. Clinical presentation is variable. Bilateral kidney stones in a younger child should prompt work-up for primary hyperoxaluria. Metabolic abnormalities are more frequent in children and can result in frequent stone recurrence. Whole exome sequencing data shows genetic defects in about 30% of stone formers. 24h urine collection should be conducted when patient receives his usual diet and fluid intake with normal activity. Infrared spectroscopy and X-ray diffraction are used for stone analysis. Urine studies should be delayed by 4-6 wk after stone fragmentation or treatment of any stone related complications. The goal of evaluation is to identify modifiable risk factors for which targeted therapy may be instituted. Primary indications for surgical intervention include pain, infection and obstruction. Extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL) are most commonly used, and selection is based on stone size, anatomy, composition and anatomy. Advances in technology have allowed a shift to minimally invasive surgeries. Comprehensive management requires multidisciplinary team. Children with kidney stones require long term follow-up with periodic assessment of stone forming activity and ascertaining stone burden. High index of suspicion should be there to diagnose diseases like primary hyperoxaluria, Dent's disease, renal tubular acidosis (RTA) etc. as these diseases have ramifications on kidney function and growth.

Prevention of stone retropulsion during ureteroscopy: Limitations in resources invites revival of old techniques

ABSTRACT Objective To compare a modified technique using the Dormia basket vs Stone Cone for stone entrapment to avoid proximal stone migration during ureteroscopic pneumatic lithotripsy of ureteric stones. Patients and methods Our study included all patients with ureteric stones of <15 mm who underwent ureteroscopic pneumatic lithotripsy from January 2015 to September 2018. The study had two arms that were conducted over two consecutive periods; the first included 72 patients in whom we used the Stone Cone (Group 1) and the second included 86 patients in whom we started to use a Dormia basket with a modification (Group 2) to guard against proximal stone migration. Results Both groups were comparable for gender, age, and stone characteristics. Lower ureteric stones were the most prevalent as they represented 62.5% and 60.5% in groups 1 and 2, respectively; while upper ureteric stones were respectively found in 16.7% and 17.4%. Chemical stone analysis revealed that calcium oxalate stones were most predominant accounting for 51.3% and 51.1% in groups 1 and 2, respectively. Most of the stones were radio-opaque stones representing 57% and 58.1% in groups 1 and 2, respectively. There was a significant difference in operative time, with a mean (SD) operative time was 50.9 (11.2) in Group 1 vs 58.3 (12.4) min in Group 2 (P < 0.001). The success rate, defined as no retropulsion of stone fragments, was 97.7% in Group 2 vs 91.7% in Group 1 (P < 0.01). Complications were minor and comparable between the groups. There was no difference in hospital stay between the groups, but the cost assessment favoured Group 2. Conclusion We found that our modified-basket stone entrapment technique compared favourably with the Stone Cone to guard against stone retropulsion during ureteroscopic pneumatic lithotripsy. Our modification to the basket was found to be feasible, efficient, safe, reproducible and cost-effective in preventing proximal stone migration. This procedure is particularly suitable in cost-limited environments.

Metabolic and Clinical Characteristics of Children with Urolithiasis from Southern India.

To study the etiological profile and patterns of clinical presentations of urolithiasis (UL) in children. This observational study included patients <18 y with UL, who were referred to the pediatric nephrology clinic. Clinical features, family history, consanguinity and estimated glomerular filtration rate (eGFR) at presentation and follow-up were recorded. The children were evaluated using relevant blood and urine investigations. A total of 72 children with UL were evaluated for the study. The etiology of UL (n = 72) included hyperoxaluria (n = 25; 34.7%), idiopathic hypercalciuria (n = 21; 29.2%), idiopathic hyperuricosuria (n = 3; 4.2%), cystinuria (n = 3; 4.2%), urate transporter defect (n = 2; 2.8%) and mixed stones (predominant component calcium oxalate) (n = 9; 12.5%). No etiology was detected in 4 cases (5.5%). Common presenting complaints included flank pain (n = 41; 56.7%), hematuria (n = 29; 40.3%), urinary tract infection (UTI) (n = 29; 40.3%) and vomiting (n = 11; 15.3%). The median age of presentation was 60 (36, 96) mo. Family history and consanguinity were present in 30 cases (41.7%) and 28 cases (38.9%) respectively. Stone analysis was done in 20 cases, of which 9 cases were mixed stones (predominant calcium oxalate) and 6 were calcium oxalate stones. Among children with urolithiasis, hyperoxaluria, idiopathic hypercalciuria, idiopathic hyperuricosuria, and cystinuria were the predominant identifiable entities, together accounting for 72% of cases; and renal colic, hematuria and UTI were the commonest clinical complaints.

Kidney stones analysis by ICP-OES

The elemental composition of 100 oxalate type (only whewellite, weddellite and their mixture) urinary stones was determined by ICP OES. The calcium content varies from 130 to 320 g/kg; phosphorus – from 1.6 to 28 g/kg; sodium – from 0.54 to 8.7 g/kg; Ba, Fe, K, Li, Mg, Sr and Zn – from 0.0002 to 2.0 g/kg. The correlation analysis (Spearman rank correlation) showed a very weak tightness of the relationship between the elements of Ca/Li; a weak bond tightness for the pairs of elements Ba/Ca, Ba/Mg, Ba/Sr; Ca/Fe, Ca/Na, Ca/Sr; Fe/Mg, Fe/P, Fe/Sr, Fe/Zn; Li/Mg; Mg/Sr, Mg/Zn; P/Zn; average bond tightness for pairs of elements Ca/Mg, K/Na, Mg/P. All these correlations are positive.

Heavy Encrustation and Stone Formation on Forgotten Double “J” Ureteral Stent: A Case Repot

Background: Placement of double “J” ureteral stent for various indications is common in urological surgery. The encrustation and stone formation on forgotten DJ stents can result in significant morbidity and its management remains a challenging task. Case Presentation: A 51 years male presented with history of right flank pain of over 6 months duration. He had undergone right pyelolithotomy for right renal stones 4 years ago at some other hospital. There was no medical record available and the patient did not present himself to the surgeon for follow-up. Clinical examination was unremarkable. His complete blood counts, random blood sugar, renal function tests were normal. Urinalysis revealed many pus cells/hpf. At ultrasonography, there were two renal stone with moderate hydronephrosis and a 2 cm vesical stone. An x-ray KUB, revealed a forgotten ureteric stent with stones at its both ends. The patient underwent cystoscopy and a large stone on ureteric stent was dealt with by litholapaxy. The stone on the proximal end of was managed by percutaneous lithotripsy and stent was removed. The postoperative recovery was uneventful. On stone analysis, it was made of calcium oxalate 30% and ammonium urate 70%. Conclusion: The management of encrusted stents is challenging, and each case has to be dealt with individually depending on stone site and burden, and patient related factors. Endourological management is the preferred option. Adequate patient counseling and proper stent documentation (stent placement, proposed duration and removal of stent) is necessary to minimize stent related complications.

Urine stones of different chemical composition occurrence depending on the level of uricuria

Introduction. According to modern concepts one of the key links in the pathogenesis of urolithiasis is metabolic lithogenic disturbances. The study of the complex effect of many factors on the metabolism of urolithiasis patient is the basis of modern scientific research. We studied the frequency of various chemical urinary stones occurrence depending on various levels of uricuria.&#x0D; Materials and methods. Data from of 708 urolithiasis patients (303 men and 405 women) were analized. The results of blood and urine biochemical analysis and chemical composition of urinary stone were studied. The degree of uricuria was ranked by 10 intervals: from 0.4 to 14.8 mmol/day to assess the occurrence of different stones at various levels of uricuria.&#x0D; Results. The incidence of calculi consisting of uric acid also increases with increasing levels of uric acid in the urine. An increase in the level of uricuria above 3.11 mmol/day is observed to increase calcium-oxalate stones occurrence. Decrease in the prevalence of carbonatapatite and struvite stones observed at an increase of urine uric acid excretion. At high levels of uric acid excretion, we found uric acid and calcium oxalate stones most often.&#x0D; Conclusion. Control over the level of urinary acid excretion in urine is important in case of calcium-oxalate and uric acid urolithiasis.

The deterioration process of limestone in the Anahita Temple of Kangavar (West Iran)

The well-known archaeological site of Anahita Temple at Kangavar is one of the most important Iranian stone monuments. It has been dated by various authors in an interval extended from Achaemenid to Sasanian Persian Empires (sixth century BCE to seventh century AD). Significant weathering has been occurred in various stone blocks used in the construction of this monument. The aim of this research is to study the deterioration process of the stone blocks used in the Temple. It includes chemical and mineralogical analysis of stones, characterization of deterioration patterns and processes, and identification of factors influenced the process. Results have been obtained by on-site and laboratory studies, including optical microscopy, petrography, X-ray fluorescence, X-ray diffraction and scanning electron microscopy coupled with energy dispersive X-ray spectroscopy methods. They showed that low-porosity limestone and dolomitic limestone have been used in the construction of the Temple, which have a compact micritic structure with variable size calcite veins (sparite) and clay veins. According to the on-site and laboratory studies, the deterioration patterns are partially similar in majority of the stone blocks and include different types of detachments as well as biological colonisations. The multianalytical results proved that the deterioration process is mainly of physical weathering type, due to structural and chemical characteristics of the limestone as well as climate factors, temperature fluctuations in particular. It turned out that limestone characteristics (including presence of clay veins as well as heterogeneity of calcitic matrix (micrite and sparite)) can affect the behaviour of stone blocks against climate factors; helping us to find reasons behind physical weathering of limestone in the cultural/historical sites and monuments.

PT105 - Classification of the renal papillary abnormalities by flexible ureteroscopy: Evaluation of the 2016 version and update

To assess the use of the 2016 proposed classification of the renal papillary abnormalities during flexible ureteroscopy that aims to standardize their description. We performed a prospective monocentric single operator collection of the data using this classification during 88 consecutive flexible ureteroscopies required for renal stones treatment. Outcome measurements and statistical analysis: data of stones analysis (microscopy and infrared spectrophotometry) and of serum and urines biochemical samples have been compared with the results of the classified endoscopic descriptions. Mean duration of description was 81.4 s. We reported that 83% of the patients had Randall plaques (RP), as only 4.5% of the patients had no abnormality. Concerning the papillary stones and anchored stones were observed in 30.7% and aspect of intraductal crystallization (Sc) in 15.9%. Erosions were present in 55.7% and extrophic papillae in 8%. Sa1 and Pa2 were significantly correlated to RP, anchored stones (Sa) to papillary erosions and calcium phosphate stones to intraductal crystallization. Hypercalciuria was significantly higher in Sa2 than Sa1 stones. The different descriptions in the 2016 classification were confirmed by the results of this study. Papillary abnormalities are consequences of stones development. Their descriptions could also improve the follow-up and the diagnosis of a metabolic lithogenesis. We recommend their systematic description during ureteroscopy. Some improvements are proposed to update this classification.

Performance analysis and reuse of construction and demolition waste stone using fractal and gradation theory

This study aims to control the processing technology of granite aggregate through fractal theory, and to optimize the gradation of concrete to solve the reuse of waste stone derived from the construction and demolition wastes in China. This study applies the waste stone from construction and demolition wastes in concrete and provide a case example for the construction industry to implement the recycle, reuse and reduce principle to affect the management policy of waste stone. The demand for concrete is surging with the continuous expansion of global infrastructure construction. This study presents the process the waste stone produced by excavation along the line to concrete aggregate is a serious problem to be solved. The fractal and gradation theory are employed to investigate the effects of aggregate shape and gradation distribution on the concrete performances, including compressive strength, frost resistance and chloride ion permeability. The larger the fractal dimension of aggregate was, the worse the performance of concrete was. There was always an optimal gradation to optimize the performance of concrete. The 28-day compressive strength of C1 aggregate concrete with larger fractal dimension was 2–3 MPa lower than that of C2 and C3 aggregate concrete. In the freeze-thaw cycle test, the loss of C1 aggregate was 1% more than that of the other two aggregate. 100 times, 200 times and 300 times, the loss of C1 aggregate was reduced by 3–4%, 7–13% and 20% in average. In terms of chloride ion permeability, the impact to chloride ion permeability of graded concrete was greater than that of fractal dimension, and the RCM value of two concrete with worse gradation was about twice as much as that of better gradation concrete. This study conducts the performance analysis and optimize the overall calculation for mix design. The result indicated that larger fractal dimension of aggregate would lead to the worse appeal performance of concrete. When the ratio of 5 mm–10mm aggregate to 10 mm–20mm aggregate is close to 30:70 and the performance is the best. The C50HPC overall calculation method for mix design has achieved better results in engineering practice.

THE MINERAL COMPOSITION OF URINARY TRACT STONES IN KHOST, AFGHANISTAN

Background: The urinary tract stones include renal (nephrolithiasis), ureter (ureterolithiasis), and urinary bladder stones (cystolithiasis). The knowledge of the mineral composition of the urinary tract stone is important for the treatment, patient education, and to develop preventative strategies. Aim: This study aims to characterize the proportion of different types of urinary tract stones and their chemical composition in Khost province. Material and Methods: A retrospective, the hospital-based study design was used. The stones were analyzed using simple qualitative biochemical tests. A total of 63 patients were included in this study from Sept 2016 to Aug 2019. The stones were checked for the presence of calcium, magnesium, ammonium, oxalate, phosphate, uric acid, and cystine. Results: The results obtained showed the incidence of the kidney (48 stones), ureteric (4 stones), urinary bladder (11 stones) at the age group of 18-75 years (mean 56.2). The incidence in men was higher than women, male to female ratio being 3:1. The chemical analysis of overall stones has shown that 88.21% had mixed compositions, and 11.79% presented a unique composition. The majority of stones obtained from women was cystine (70%) and oxalate (72%) stones, whereas the majority of stones in men were that of calcium oxalate (76%) and uric acid (74%) stones. Eight of the stones were pure of calcium oxalate, five were pure uric acid, 7 were pure cystine, and 43 were mixed stones. Among the mixed stones, oxalate was present in 32 samples (43 of total), calcium was present in 36 samples, uric acid was seen in 17, phosphate was present in 23, and cysteine was present in 14 stones. Conclusion: This study showed that the most common type of mineral composition found in different urinary stones is calcium oxalate (81%), followed by cystine and uric acid. Further broader and large scale studies are required to assess the mineral base of the urinary tract stones in Afghanistan to develop preventive strategies and promote public awareness about dietary recommendations.

Tracing Palaeolithic human routes through the geochemical characterisation of chert tools from Caune de Belvis (Aude, France)

Caune de Belvis (Aude, France) is located in the northern slopes of the eastern Pyrenees, in south-east France. Excavations at the site during the final decades of the past century identified several human occupations from the Late Mousterian (Maroto et al. 2003) and the Magdalenian periods (Sacchi 1993). The archaeological remains are mostly composed of faunal bones and a rich bone and stone industry. In this paper, we focused on the analysis of stone remains recovered in the Magdalenian levels. The goals of this study are to determine the territorial behaviour of Magdalenian groups settled at Caune de Belvis and to identify their lithic procurement strategies. To do so, we applied a range of techniques for analysing stone remains from the Magdalenian levels and geological samples from the geological formations that may have been used. First, macroscopic studies were carried out to determine the textural and micropalaeontological content; then, geochemical analyses were conducted to quantify the elemental chemical composition. Energy-dispersive X-ray fluorescence (ED-XRF) was used to quantify major and minor elements and laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) was then used to quantify trace elements. The results show that the Magdalenian groups from Caune de Belvis exploited a range of geological formations in the northern and southern Pyrenees. They also highlight the relationship existing between the two sides of the Pyrenees during the Upper Palaeolithic and bear witness to the inhabitants’ thorough knowledge of the Pyrenean area.

Update on cystine stones: current and future concepts in treatment.

Cystine stones are relatively uncommon compared with other stone compositions, constituting just 1% to 2% of adult urinary tract stone diseases, and accounting for up to 10% of pediatric stone diseases. Two responsible genes of cystinuria have been identified, the SLC3A1 and the SLC7A9. Cystinuria is diagnosed by family history, stone analysis, or by measurement of urine cystine excretion. Current treatments for cystinuria include increased fluid intake to increase cystine solubility by maintaining daily urine volume of greater than 3 Liter (L). Limiting sodium and protein intake can decrease cystine excretion. When conservative therapy fails, then pharmacologic therapy may be effective. Alkaline urine pH in the 7.0-7.5 range will reduce cystine solubility and can be achieved by the addition of alkali therapy. If these measures fail, cystine-binding thiol drugs such as tiopronin and D-penicillamine are considered. These compounds bind cysteine and prevent the formation of less soluble cystine. These drugs, however, have poor patient compliance due to adverse effects. Captopril can be useful in the treatment of cystine stones but the drug has not been tested in rigorous clinical trials. Novel potential therapies such as alpha-lipoic acid and crystal growth inhibitors (L-cystine dimethyl ester (L-CDME) and L-cystine methyl ester (L-CME)) were developed and tested in animals. Those therapies showed promising results. Compliance with treatment was associated with a lower rate of cystine stone formation.