Stone Analysis Research Articles

V03-11 NOVEL USE OF THULIUM LASER FOR THE MANAGEMENT OF BILIARY CALCULI

You have accessJournal of UrologyCME1 May 2022V03-11 NOVEL USE OF THULIUM LASER FOR THE MANAGEMENT OF BILIARY CALCULI Akshay Reddy, Nicholas Freidberg, and Patrick Mufarrij Akshay ReddyAkshay Reddy More articles by this author , Nicholas FreidbergNicholas Freidberg More articles by this author , and Patrick MufarrijPatrick Mufarrij More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002539.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present the case of a 60-year-old female who underwent percutaneous endoscopic laser lithotripsy using thulium laser technology for removal of multiple complex biliary stones. Initial symptoms began six months prior, warranting workup for choledocholithiasis and pancreatitis. Multiple ERCP and ERCP/percutaneous rendezvous procedures were attempted, but unsuccessful due to massive stone size and burden. The patient was left with an IR-placed 20-French Bentec tube serving as a biliary drain. The next month, she presented to our institution for return of abdominal symptoms and rapidly developed septic shock. Following recovery, the patient underwent laparoscopic converted to open pancreatic debridement and cholecystectomy with removal of large common bile duct calculi. She subsequently developed failure to thrive and poor nutritional status requiring TPN feeding post-operatively. The accompanying video case report aims to describe the definitive management of complicated biliary stones with the use of the thulium laser. METHODS: Percutaneous access to the biliary tree was co-managed by interventional radiology and re-dilated prior to endoscopy with an Amplatz dilating sheath to 24-French. Upon placement of a flexible cystoscope into the biliary tract, several stones were identified. The 200- and 365-micron Soltive Thulium laser fibers were utilized at a frequency of 50Hz with a pulse energy of either 0.2 or 0.4J (power 10W and 20W, respectively) to fragment stones. Extraction of fragments through the transhepatic sheath was facilitated with the use a 1.7-French 8mm N-gage Cook Nitonol basket or pushed forward through the ampulla with the endoscope and gentle sterile saline irrigant. Exit endoscopy was performed without presence of any residual calculi. RESULTS: Two-week follow-up cholangiogram demonstrated moderate common bile duct narrowing with rapid flow of contrast into the duodenum and without the previous obstruction. The percutaneous drain was then removed. Compositional stone analysis was significant for cholesterol (90%) and calcium bilirubinate (10%). Microbiology demonstrated growth of Seratia marcescens with fluoroquinolone, ceftriaxone and penicillin-class resistance and Enterococcus sensitive to vancomycin and ampicillin. CONCLUSIONS: As described in our case and video, the use of thulium laser fiber was effective and safe in the removal of complex biliary stones refractory to alternative management options. This outcome is consistent with technical benefits seen in the setting of nephrolithiasis. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e204 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akshay Reddy More articles by this author Nicholas Freidberg More articles by this author Patrick Mufarrij More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD32-10 KIDNEY STONE ENDOTOXIN CONCENTRATION CORRELATES WITH POST-OPERATIVE SEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY

You have accessJournal of UrologyCME1 May 2022PD32-10 KIDNEY STONE ENDOTOXIN CONCENTRATION CORRELATES WITH POST-OPERATIVE SEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY David T. Tzou, Farhan Anwar, Ava C. Wong, David T. Harris, Thomas Chi, and Gayatri Vedantam David T. TzouDavid T. Tzou More articles by this author , Farhan AnwarFarhan Anwar More articles by this author , Ava C. WongAva C. Wong More articles by this author , David T. HarrisDavid T. Harris More articles by this author , Thomas ChiThomas Chi More articles by this author , and Gayatri VedantamGayatri Vedantam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002583.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with infected kidney stones are at risk for post-operative sepsis following surgical removal of their calculi. Of all the surgical approaches, percutaneous nephrolithotomy (PCNL) remains associated with the highest risk for experiencing post-operative SIRS (severe inflammatory response syndrome). Accurate prediction of patients at risk for SIRS after surgery would be of clinical value. While previous studies have demonstrated infected kidney stones contain variable levels of endotoxin concentrations, these were limited in their rigor and ability to correlate stone immunobiology with important clinical outcomes. The aim of this study was to quantitate endotoxin levels amongst PCNL patients who experienced and did not experience SIRS. METHODS: Between October 2020 and June 2021, urine & stone specimens from consecutive stone patients were prospectively collected as part of the Registry for Stones of the Kidneys and Ureter (ReSKU) at the University of Arizona. Clinical data including stone analyses and post-operative outcomes have been tracked. Equal weights of stones were uniformly broken using an easy-to-replicate ‘beat-beating’ homogenization approach, allowing for consistent measurement of stone endotoxin using a Pierce™ LAL Chromogenic Endotoxin Quantification Kit (ThermoFisher, Waltham, MA). Endotoxin levels from stones removed during PCNL were compared between patients who experienced and did not experience SIRS. Independent T-test was used to determine statistical significance. RESULTS: Endotoxin levels amongst 4 patients with infection calculi who experienced SIRS were compared to 16 patients who did not experience SIRS – 8 of which had infection calculi and 8 had non-infection calculi (Figure 1). In the SIRS group, the mean Endotoxin concentration was 1.084 endotoxin units (EU)/ml compared to 0.476 EU/ml in the non-SIRS group (p<0.01). CONCLUSIONS: Higher kidney stone bacterial endotoxin concentrations are present in patients who experienced SIRS after percutaneous stone removal compared to those who did not. Whether exceeding a threshold endotoxin level corresponds to patients experiencing SIRS warrants future study. Source of Funding: P30DK081943 – SUBK00015084 - NIH/NIDDK; University of Arizona Health Sciences Career Development Award © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e550 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David T. Tzou More articles by this author Farhan Anwar More articles by this author Ava C. Wong More articles by this author David T. Harris More articles by this author Thomas Chi More articles by this author Gayatri Vedantam More articles by this author Expand All Advertisement PDF DownloadLoading ...

Guideline Adherence of Paediatric Urolithiasis: An EAU Members' Survey and Expert Panel Roundtable Discussion.

Background: Paediatric nephrolithiasis has increased globally, requiring standardized recommendations. This study aims to assess the paediatric urolithiasis care between EAU members along with the statements of three experts in this field. Methods: The results of an electronic survey among EAU members comparing the guideline recommendations to their current practice managing paediatric nephrolithiasis in 74 centres are contrasted with insights from an expert-panel. The survey consisted of 20 questions in four main sections: demographics, instrument availability, surgical preferences and follow-up preferences. Experts were asked to give insights on the same topics. Results: A total of 74 responses were received. Computerised Tomography was predominantly used as the main imaging modality over ultrasound. Lack of gonadal protection during operations was identified as an issue. Adult instruments were used frequently instead of paediatric instruments. Stone and metabolic analysis were performed by 83% and 63% of the respondents respectively. Conclusions: Percutaneous Nephrolithotomy is the recommended standard treatment for stones > 20 mm, 12% of respondents were still performing shockwave lithotripsy despite PNL, mini and micro-PNL being available. Children have a high risk for recurrence yet stone and metabolic analysis was not performed in all patients. Expert recommendations may guide clinicians towards best practice.

Effects of Chemical Composition of Cholesterol and Pigment Stones on the Gallbladder Mucosa

Objective: To compare the effect of chemical composition of cholesterol and pigment stones on gallbladder mucosa. Study design &amp; setting: This comparative cross-sectional study was conducted in the Department of Anatomy, BMSI, JPMC, Karachi, Pakistan, from April to September 2021. Methodology: Total n= 120 gallbladder specimens were collected after cholecystectomies in 10% formalin. Gross morphological features of gallbladder and stones were observed. Specimens were processed and 5µm sections from fundus, body &amp; neck of gallbladder were stained and examined for microscopic changes. Chemical analysis of stones was carried out to differentiate between cholesterol &amp; pigment stones. Results: We evaluated different histomorphological alterations in gallbladder with reference to both type of gallstones. Muscular wall thickness in pigment stone group was noted to be (143.89±78.66) and in cholesterol group (158.37±83.95). Both pigment and cholesterol stone showed increased tendency of muscular hypertrophy. Mucosal ulceration, chronic inflammatory cell infiltration, capillary congestion and hyperplasia (p-value: 0.04) were observed in both type of stones. Statistical analysis showed that large cholesterol stones produce significant histopathological changes (p-value: 0.004); greater the size of stone, more profound was the mucosal hyperplasia. Rokitansky-Ashcoff sinuses were predominant in gallbladders with cholesterol stone. Conclusion: Gallstones cause series of histopathological changes ranging from chronic cholecystitis to pre-malignant and malignant changes. Hyperplasia was observed to be more frequent with long standing, large cholesterol stones

Medical Management of Kidney Stones: a review

The incidence of kidney stone disease has been rising in past decades. The prevalence has doubled in both genders, andthe prevalence ratio is shrinking from 3.4 to 1.3 between males and females. This condition greatly impacts individuals, thehealth care system, and socioeconomic levels. Kidney stone diseases are related to various risk factors and medical conditions.A detailed diagnosis through history taking, urinalysis, metabolic evaluation, and stone analysis is important to direct thetherapy approach. The therapy in managing kidney stone diseases comprises dietary and pharmacological treatment. Inaddition to general advice on sufficient fluid intake, citrate intake, maintaining ideal body weight, and restricting sodium andanimal protein, the therapy should be adjusted based on the specific type of stones.

Kidney stone formation in a novel murine model of polycystic kidney disease.

Individuals with autosomal dominant polycystic kidney disease have a higher incidence of stone formation than the general population. However, there are no cystic animal models known to develop stones. Cystic mice compound heterozygous for hypomorphic Pkd1V and Pkd1RC alleles develop cystic kidneys within a few weeks of birth but live beyond 20 wk of age, allowing for the study of cystic comorbidities including stone formation. Cystic Pkd1V/RC mice were euthanized at 3, 13, or 26 wk of age, and their kidneys were analyzed by microcomputed tomography (µCT) for stone formation. Mice had occasional mineral aggregates that could be detected by µCT analysis at 3 wk of age. At 13 or 26 wk of age, numerous white masses were visible beneath the kidney surface. µCT analysis confirmed the masses to be large mineral stone deposits throughout the renal cortex, with mineral content increasing with age. Staining of histological sections with alizarin red and von Kossa suggested that the stone deposits were composed primarily of calcium and phosphate. Microdissection confirmed stones localized within cyst lumens. Analysis of individual stones by µCT and infrared spectroscopy confirmed apatite mineral composition. Urinalysis revealed elevated levels of phosphate and citrate at 3 wk of age and lower pH and elevated levels of calcium and citrate at 13 wk of age, suggesting altered phosphate and calcium homeostasis as a potential cause of mineralization and renal stone formation. This is the first animal model exhibiting overt kidney stone formation in the context of cystic kidney disease.NEW & NOTEWORTHY Compound heterozygous Pkd1V/RC mice were found to form calcium phosphate-containing stones within cysts of the renal cortex by 13 wk of age. This is the first polycystic kidney disease animal model exhibiting spontaneous stone formation. A growing body of evidence suggests a link between renal stone formation and cystic kidney disease. This mouse model may be useful for studying the interplay between stone and cyst formation and the functional role of polycystins in mineral homeostasis.

Linking derived debitage to the Stonehenge Altar Stone using portable X-ray fluorescence analysis

AbstractThe Altar Stone at Stonehenge in Wiltshire, UK, is enigmatic in that it differs markedly from the other bluestones. It is a grey–green, micaceous sandstone and has been considered to be derived from the Old Red Sandstone sequences of South Wales. Previous studies, however, have been based on presumed derived fragments (debitage) that have been identified visually as coming from the Altar Stone. Portable X-ray fluorescence (pXRF) analyses were conducted on these fragments (ex situ) as well as on the Altar Stone (in situ). Light elements (Z&lt;37) in the Altar Stone analyses, performed after a night of heavy rain, were affected by surface and pore water that attenuate low energy X-rays, however the dry analyses of debitage fragments produced data for a full suite of elements. High Z elements, including Zr, Nb, Sr, Pb, Th and U, all occupy the same compositional space in the Altar Stone and debitage fragments, and are statistically indistinguishable, indicating the fragments are derived from the Altar Stone. Barium compares very closely between the debitage and Altar Stone, with differences being related to variable baryte distribution in the Altar Stone, limited accessibility of its surface for analysis, and probably to surface weathering.A notable feature of the Altar Stone sandstone is the presence of baryte (up to 0.8 modal%), manifest as relatively high Ba in both the debitage and the Altar Stone. These high Ba contents are in marked contrast with those in a small set of Old Red Sandstone field samples, analysed alongside the Altar Stone and debitage fragments, raising the possibility that the Altar Stone may not have been sourced from the Old Red Sandstone sequences of Wales. This high Ba ‘fingerprint’, related to the presence of baryte, may provide a rapid test using pXRF in the search for the source of the Stonehenge Altar Stone.

N-butyl-2-cyanoacrylate renal stone, a rare complication after embolization of urinary fistula: A case report

Embolization with N-butyl-2-cyanoacrylate (NBCA) is an effective and safe procedure recently used for closure of upper tract urinary fistula. However, NBCA constitutes a foreign body for human organs, so it can cause complications. In our case a 56-year-old man underwent an endoscopic embolization of urinary fistula with NBCA. Six years later an UroCT scan revealed a large lithiasis of the left kidney, treated with endoscopic and percutaneous surgery. Stone analysis revealed a composition of crystals mixed with cyanoacrylate. In our opinion this example of complication after NBCA use for endoscopic procedures, rarely reported in literature, can be an useful advisement to reconsider the use of this glue. Keywords: N-butyl-2-cyanoacrylate; gluestone; percutaneous; endoscopic; fistula

Development of a Nomogram Predicting the Infection Stones in Kidney for Better Clinical Management: A Retrospective Study.

Purpose: To establish the first comprehensive nomogram for prediction of infection stones before treatment for better perioperative treatment and postoperative prevention of infection stones. Methods: A total number of 461 patients with kidney stones who underwent mini-percutaneous nephrolithotomy and flexible ureteroscopy between January 2019 and March 2021 were retrospectively analyzed. Univariable analysis and multivariable logistic regression analysis were conducted to identify the predictors for infection stones. Furthermore, the nomogram was established as a predicted model for infection stones. Results: Among 461 patients with infrared spectroscopy stone analysis, 100 (21.70%) had infection stones and 361 (78.31%) had noninfection stones. Multivariate logistic regression analysis indicated that female (odds ratio [OR] 2.816, 95% confidence interval [CI] 1.148-6.909, p = 0.024), recurrent kidney stones (OR 8.263, 95% CI 2.295-29.745, p = 0.001), stone burden (OR 6.872, 95% CI 2.973-15.885, p < 0.001), HU (OR 15.208, 95% CI 6.635-34.860, p < 0.001), positive preoperative bladder urine culture (PBUC; OR 4.899, 95% CI 1.911-12.560, p = 0.001), positive urine leukocyte esterase (ULE; OR 3.144, 95% CI 1.114-8.870, p = 0.030), urine pH (OR 2.692, 95% CI 1.573-4.608, p < 0.001), and positive urine turbidity (OR 3.295, 95% CI 1.207-8.998, p = 0.020) were predictors for infection stone. Conclusions: For patients with kidney stones, female, recurrent kidney stones, stone burden (>601 mm2), HU (750-1000), positive PBUC, positive ULE, urine pH, and positive urine turbidity were predictors for infection stone. We established the first comprehensive model for identifying infection stones in vivo, which is extremely useful for the management of infection stones.

Quantitative phase analysis and microstructural characterization of urinary tract calculi with X-ray diffraction Rietveld analysis on a Caribbean island

In the twin-island state of Trinidad and Tobago, urinary stone analysis is not routinely performed. This study investigates, via powder X-ray diffraction, 52 urinary tract calculi collected from hospitals in Trinidad. Of these, 46 stones were analysed with Rietveld refinement for quantitative analysis and materials characterization. Refined unit-cell, microstructural and weight fraction parameters were obtained, with the last being used for stone classification. The results revealed seven distinct mineralogical phases of varying frequency: calcium oxalate monohydrate (COM, 58%), calcium oxalate dihydrate (COD, 23%), carbonated apatite (APA, 48%), brushite (BRU, 6%), struvite (STR, 42%), uric acid (UA, 23%) and ammonium acid urate (AAU, 19%). The average refined crystallite sizes were 1352 ± 90 Å (COM), 1921 ± 285 Å (COD), 83 ± 5 Å (APA), 1172 ± 9 Å (BRU), 1843 ± 138 Å (STR), 981 ± 87 Å (UA) and 292 ± 83 Å (AAU). Subsequently, 36.5% of stones were categorized as phosphates, 34.6% as oxalates, 13.5% as uric acid/urates and 15.4% as mixed compositions. The study findings highlight the importance of stone analysis as a necessary step towards disease management of local patients, and endorse the application of Rietveld refinement as a natural extension to diffraction-based kidney stone investigations.

POS-432 PRIMARY HYPEROXALURIA, A TOO OFTEN MISSED DIAGNOSIS AND CAUSE OF END STAGE KIDNEY DISEASE IN ADULTS : A MONOCENTRIC TUNISIAN STUDY

Primary hyperoxaluria (PH) is a rare hereditary metabolic disorder of oxalate overproduction. Persistently high plasma oxalate concentrations lead to potential life-threatening complications. The major objective of this study is to investigate this condition which is frequent in our country but under diagnosed. In a retrospective descriptive study, we reviewed the record of 9 patients who were diagnosed with primary hyperoxaluria hospitalized at a nephrology department during the period 2001-2020. Their demographics, clinical and investigations parameters were documented. Nine patients were enrolled and followed up. Mean age of patients was 21, 2 ± 12, 3 years with predominance of male (88, 8%). Consanguinity was noted in 28, 5%. All our patients were from Tunisian center (55, 5% were from Gafsa). Renal colic and urolithiasis were the most common symptoms in our study (100%). Ultrasonography and CT scans showed nephrocalcinosis in 5 cases (55, 55%). Urinary tract infections were observed in 2 cases (22, 2%). Renal failure was noted in almost all cases; serum creatinine level ranged from 144 to 986 µmol/L. Seven patients reached end-stage renal disease and were treated with hemodialysis at a median age of 23 years. The extra renal manifestations were bone impairment (4 cases), bone marrow fibrosis (2 cases), cardiac dysfunction (1case), digestive wall calcifications (1 case) and adrenal insufficiency (1 case). The diagnosis was based on Hyperoxaluria (1 case), positive crystalluria (1 case), kidney stone analysis (2 cases) and oxalate crystal deposition identified in both renal and bone marrow biopsy respectively in one and four cases. Mutational analysis of AGXT gene was carried out in five out of nine patients. We identified a novel frameshift mutation in the AGXT gene, the c.406_410dupACTGC resulting in a truncated protein (p.Gln137Hisfs*19). It was found in homozygous state in two related patients from the Tunisian center. Primary hyperoxaluria is not rare in the Tunisian population. In our study it was lately diagnosed in most cases. Awareness campaign to change attitude of family members to screening should be conducted.

Urinary Metabolic Disturbances During Topiramate Use and their Reversibility Following Drug Cessation

ObjectiveTo understand the metabolic disturbances of stone formers currently taking topiramate and to examine the reversibility of these disturbances with cessation of the medication. Materials and MethodsAll progress notes written by 5 endourologists from a single academic center were retrospectively reviewed from January 2010 to July 2020 containing the words “topiramate” or “topamax.” Inclusion criteria were age >18 and presence of either a 24-hour urine sample or stone analysis while on topiramate. In addition, a subgroup of 18 patients with 24-hour urine samples before and after stopping topiramate were identified. ResultsA total of 93 patients were identified and included for final analysis. Twenty-four hour urine samples were available in 67 patients and showed mean citrate excretion of 331 ± 322 mg/d, mean pH of 6.6 ± 0.5, and mean calcium phosphate supersaturation of 1.9 ± 1.1. In the subgroup analysis urinary citrate excretion increased from 225 mg/d to 614 mg/d (P <.01) and pH decreased from 6.59 ± 0.54 to 6.33 ± 0.47 (P = .06) after stopping topiramate. In addition, 114 stone events occurred in 73 distinct patients, with 50% of stones either pure or majority (≥50%) calcium phosphate by composition. ConclusionHypocitraturia and elevated pH is seen during topiramate use with resultant higher rate of calcium phosphate stone formation compared to the general population. Stopping topiramate leads to significant increase in citrate excretion and normalization of pH. These metabolic disturbances appear to be reversible with medication cessation.

Perception and attitude of medical and paramedical students of Umm Al-Qura University regarding urolithiasis: a crosssectional study

Background: Urolithiasis encompasses a common emergent problem that needs medical and surgical intervention. Therefore, our study focuses on determining the level of attitude concerning urolithiasis among medical and paramedics students at Umm Al-Qura University. Methods: An electronic survey was distributed among participants online in June 2022. We utilized convenient sampling methods to stratify students according to their college. After data collection, appropriate statistical analysis was performed using Statistical Package for Social Studies. Results: This study enrolled a total of 360 students from the department of medicine and paramedics at Umm Al-Qura University. The mean age was 22.2 (SD, 1.66). Most kidney stones generally show excellent and positive attitudes among students except for the incurability of kidney stones, which demonstrated a negative attitude. Furthermore, a significant association was found between the importance of calcium intake and stones analysis in preventing kidney stones and students&amp;apos; departments (p-value, 0.007 and 0.003, respectively). Conclusion: Detecting kidney stones is vitally crucial in minimizing their recurrence risk. Our finding indicates a negative attitude toward the curability of kidney stones. Thus, education and awareness programs should be employed in health-related departments to maximize the benefit.

MITRAIZAM NA PROSTORU JUŽNE SRBIJE – ISTORIJSKE OKOLNOSTI

The cult of Persian god Mithra, the Invincible Sun god, was the most significant and present cult in the Roman Empire. Epigraph and archeological evidence of worship of Mithra was recorded in all provinces of this huge Empire on three continents. Cult monuments were discovered in that way even on the territory of modern south Serbia, i.e. parts of the Roman provinces Upper Moesia and Thrace. This paper describes six such monuments: two votive altars with inscriptions from Osmakovo near Pirot and Ravna and four relief icons capturing tauroctonia from Ragodeš and Rasnica near Pirot, Ražanj near Aleksinac and Mramor near Niš. The aim of the paper is to emphasise certain historical circumstances of the growth of Mithraism in south Serbia taking the analyses of these monumetns into consideration. This region is seen as favorable for the spread of this eastern religion for numerous reasons. It is a rich mine region, the intersection of many imporant Roman roads on the Balkans and the main camp of some military units. All these circumstances resulted in the significant presence of the cult of Mithra. The period of the growth of Mithraism stretches from the middle of the 2nd century to the middle of the 3rd century, which is clearly confirmed by epighraph vows. The iconographic analysis of relief stones reveals that they belong to the Danube type and that Mithraism reaches south Serbia from lower Podunavlje through the Roman limes on the river. The lower frieze with side scenes from the Mithra cult legend points to the religious centres in Dacia as models in making the icons.

Suitability of Suluu-Terek Basalt Deposits for Stone Casting

This article is presenting history of stone casting and analysis of basalt raw materials assessment from other countries for stone casting technology and various basalts compositions were considered. Analytical methods for calculating composition of charge require a long calculation time and plotting diagrams, each method has its own advantages and disadvantages. As a research significance, we have proposed an experimental calculation method for calculating raw materials after charging. Analysis of the composition, structure of basalts and charging materials were used in the stone casting technology. According to the comparison method, the required amount of charging materials was calculated for the Suluu-Terek 1, Suluu-Terek 2 and Berestovetsk deposits. The calculated data was confirmed by experimental melts in the process of stone casting.

Metabolomic changes in cats with renal disease and calcium oxalate uroliths

IntroductionThere is a significant incidence of cats with renal disease (RD) and calcium oxalate (CaOx) kidney uroliths in domesticated cats. Foods which aid in the management of these diseases may be enhanced through understanding the underlying metabolomic changes.ObjectiveAssess the metabolomic profile with a view to identifying metabolomic targets which could aid in the management of renal disease and CaOx uroliths.MethodThis is a retrospective investigation of 42 cats: 19 healthy kidney controls, 11 with RD, and 12 that formed CaOx nephroliths. Cats were evaluated as adults (2 through 7 years) and at the end of life for plasma metabolomics, body composition, and markers of renal dysfunction. Kidney sections were assessed by Pizzolato stain at the end of life for detection of CaOx crystals. CaOx stone presence was also assessed by analysis of stones removed from the kidney at the end of life.ResultsThere were 791 metabolites identified with 91 having significant (p < 0.05, q < 0.1) changes between groups. Many changes in metabolite concentrations could be explained by the loss of renal function being most acute in the cats with RD while the cats with CaOx stones were intermediate between control and RD (e.g., urea, creatinine, pseudouridine, dimethylarginines). However, the concentrations of some metabolites differentiated RD from CaOx stone forming cats. These were either increased in the RD cats (e.g., cystathionine, dodecanedioate, 3-(3-amino-3-carboxypropyl) uridine, 5-methyl-2′-deoxycytidine) or comparatively increased in the CaOx stone forming cats (phenylpyruvate, 4-hydroxyphenylpyruvate, alpha-ketobutyrate, retinal).ConclusionsThe metabolomic changes show specific metabolites which respond generally to both renal diseases while the metabolomic profile still differentiates cats with RD and cats with CaOx uroliths.

Prediction of the composition of urinary stones using deep learning.

PurposeThis study aimed to predict the composition of urolithiasis using deep learning from urinary stone images.Materials and MethodsWe classified 1,332 stones into 31 classes according to the stone composition. The top 4 classes with a frequency of 110 or more (class 1: calcium oxalate monohydrate [COM] 100%, class 2: COM 80%+struvite 20%, class 3: COM 60%+calcium oxalate dihydrate [COD] 40%, class 4: uric acid 100%) were selected. With the 965 stone images of the top 4 classes, we used the seven convolutional neural networks (CNN) to classify urinary stones and compared their classification performances.ResultsAmong the seven models, Xception_Ir0.001 showed the highest accuracy, precision, and recall and was selected as the CNN model to predict the stone composition. The sensitivity and specificity for the 4 classes by Xception_Ir0.001 were as follows: class 1 (94.24%, 91.73%), class 2 (85.42%, 96.14%), class 3 (86.86%, 99.59%), and class 4 (94.96%, 98.82%). The sensitivity and specificity of the individual components of the stones were as follows. COM (98.82%, 94.96%), COD (86.86%, 99.64%), struvite (85.42%, 95.59%), and uric acid (94.96%, 98.82%). The area under the curves for class 1, 2, 3, and 4 were 0.98, 0.97, 1.00, and 1.00, respectively.ConclusionsThis study showed the feasibility of deep learning for the diagnostic ability to assess urinary stone composition from images. It can be an alternative tool for conventional stone analysis and provide decision support to urologists, improving the effectiveness of diagnosis and treatment.

Comparative evaluation of decalcifying agents for dissolution of pulp stones: An in vitro study.

Background:Despite constant advances in science, obscurity remains in the efficient removal of pulp stones to aid in successful root canal treatment. In this context, chemical means of dissolving pulp stones were explored.Aim:The aim of this study is to evaluate and to compare the efficacy of decalcifying agents on the dissolution of pulp stones.Materials and Methods:The study was divided into two groups for pulp stone analysis (21 samples) and dentin analysis (54 samples). Twenty-one pulp stones from patients aged 18–70 who underwent root canal treatment were collected and divided into three subgroups (n = 7) randomly. They were subjected to chemical treatment in a labeled glass container with 5 ml of the respective chemical agents, such as 17% ethylenediaminetetraacetic acid solution (positive control), no treatment (negative control), and newly developed Physiological Simulated Decalcifying Agent (PSDA). At the end of the study period (24 h), the samples were removed, rinsed with deionized water, and subjected to physical analysis, scanning electron microscopy (SEM), and Energy –dispersive X-ray spectroscopy (EDS) analysis. Under dentin analysis, 54 maxillary premolars scheduled for orthodontic extraction without caries or extensive restorations were selected, following which 2-mm thick transverse dentinal sections at the cementoenamel junction level were obtained and randomly divided into two groups for SEM (n = 21) and microhardness analysis (n = 33). The samples were subjected to respective chemical treatment groups similar to pulp stones for 24 h and analyzed using SEM, EDS, and microhardness analysis.Results:Postchemical treatment with the newly developed decalcifying solution, the pulp stones showed the absence of nodular crystallites and surface softening under SEM and a decrease in the calcium level under EDS analysis. Concerning the microhardness of dentin, no significant changes could be observed.Conclusion:The newly explored PSDA was found to be efficacious in the decalcification of pulp stones at a clinically relevant time of 24 h, without significantly affecting the structural integrity and the hardness values of dentin.

Epidemiology and composition of nephrolithiasis in a Lebanese tertiary care center: A descriptive study.

Introduction:Nephrolithiasis is a common affliction with a prevalence of 12% in men and 7% in women. The incidence rate diverges with geographic location. Arab countries report high nephrolithiasis prevalence rates, with Saudi Arabia being the highest (20.1%). To date, there is little knowledge about the demographics and composition of stones in Lebanon.Methods:A retrospective chart review was performed on stone composition at the American University of Beirut Medical Center, between 2005 and 2018. Patients’ demographics and stone characteristics were obtained from electronic medical records. Analysis of frequencies and Chi-square test were adopted for potential risk factor correlations by the Statistical Package for the Social Sciences (SPSS).Results:A total of 626 stone analyses were performed. Male patients predominated (69%). The mean age was 46.58 ± 16.5 years, and mean body mass index was 28.63 ± 5.6, for both sexes. Calcium oxalate was the most predominant stone in both sexes (70%). Uric acid stones followed (~16%), and calcium oxalate phosphate stones were the third most common (5%). Incidence of kidney stones peaks in the summer, with 11.86% presenting in July. Around 60% presented with flank pain to the Emergency Department, and 32% ended up with spontaneous passage of stones by medical expulsive therapies alone, with no further surgical intervention. Diabetes and hypertension were significantly correlated with stone recurrence in our cohort.Conclusion:There is a significant gender disparity in stone prevalence in Lebanon. Calcium oxalate is the most common type in both sexes. Future investigations of dietary and environmental factors are recommended from our region.

Диагностические возможности качественного экспресс-анализа минералогической структуры уролитов

the aim of the determination of the diagnostic information content of the qualitative analysis method - urinary calculus for use in medical practice in the study of the chemical structure of urolite. Materials, methods: Determination of the chemical composition of uroliths in the collection of urinary stones (n=2960), presented in "a Database of patients with urolithiasis who live in the territory of the Republic of Belarus" (2006-2019), made the developed method of qualitative analysisbased on the combined conduct of optical macroscopy of the sample, qualitative chemical reactions and chemical reactions of reprecipitation with subsequent microscopy of the crystals formed.The developed method allowed identifying the following clinically most significant mineral components of urinary stones: vevellite (42.4%), weddellite (28.1%), Apatite (19.6%), carbonate Apatite (5.1%), struvite (13.2%), uric acid (17.6%), ammonium urate (0.4%), cystine (0.7%). The obtained data were consistent with the results of studying the elemental composition of urinary stones (n=24) by atomic emission spectrometry with inductively coupled plasma. The calcium level was highest in calcium stones (25.56% C oxalate and 19.73% C phosphate) with a minimum content (0.012%) in urate stones. The amount of magnesium prevailed in the group with magnesium-ammonium-phosphate stones (2.51%) at extremely low concentrations in urate samples (7.810-4%). The percentage of phosphorus was maximum (13.47%) in the group of uroliths, represented by phosphate salts of calcium and magnesium (with values of 0.67% - calcium oxalate and 0.013% urate). Identification of trace elements Al, Ba, Cu, Fe, Zn, Sr revealed a fluctuation in their content in the range from 0.037 to 546.3 ppm.Considering the practical availability of implementation, low financial costs and sufficient information, the method of qualitative rapid analysis of urinary stone, based on a combined optical macroscopy of the sample, qualitative chemical reactions and chemical reactions of reindeposition with subsequent microscopy of the formed crystals, can be recommended for wide use in medical institutions of any regional level in the diagnosis of chemical types of uroliths in patients with ICD.