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BackgroundArsenic, cobalt, barium, and other individual metal exposure have been confirmed to be associated with the incidence of kidney stones. However, there are few studies on the association between mixed metal exposure and kidney stones, especially in occupational groups. ObjectiveTo investigate the association between mixed metal exposure and kidney stones in an occupational population from a metal smelting plant. MethodsA questionnaire survey was conducted to collect sociodemographic characteristics, medical history, and lifestyle information of 1158 mixed metal-exposed workers in a metal smelting plant in Guangdong Province from July 2021 to January 2022. Midstream morning urine samples were collected from the workers, the concentrations of 18 metals including lithium, vanadium, chromium, manganese, cobalt, nickel, copper, zinc, arsenic, selenium, strontium, molybdenum, cadmium, cesium, barium, tungsten, titanium, and lead were measured by inductively coupled plasma mass spectrometry, and the urinary mercury levels were measured by cold atomic absorption spectroscopy. Based on predetermined inclusion criteria, a total of 919 mixed metal-exposed workers were included in the study, including 117 workers in the kidney stone group and 802 workers in the non-kidney stone group. With a detection rate of urinary metals greater than 80% as entry criterion, 16 eligible metals were finally included for further analysis. Parametric or non-parametric methods were used to compare the differences between continuous or categorical variables of the non-kidney stone group and the kidney stone group. Logistic regression models were constructed to explore the association between individual metal exposures and kidney stones. Weighted quantile sum (WQS) regression models were used to evaluate the association between mixed metal exposure and kidney stones, as well as the weights of each metal on kidney stones. Then Bayesian kernel machine regression (BKMR) models were used to explore the overall effect of mixed metal exposure on renal calculi and the potential interactions between metals. ResultsWe found that there were significant differences in sex, age, length of service, and body mass Index (BMI) between the non-kidney stone group and the kidney stone group (P

Objective To investigate the impact of kidney stone physical characteristics obtained through CT three-dimensional reconstruction on the efficiency of flexible ureteroscopic lithotripsy (FURL). Methods A total of 86 patients with kidney stones who met the inclusion criteria were selected from West China Airport Hospital of Sichuan University between July 2021 and December 2022. The physical characteristics of the kidney stones, including number (units), length (mm), density (Hu), volume (cm³), and mass (Hu*cm³), were measured using CT three-dimensional reconstruction technology before surgery. All patients underwent FURL. Post-FURL, the patients were divided into a stone clearance group and a stone residual group based on the stone clearance status. Multifactorial binary logistic regression analysis was used to identify the influencing factors of the stone clearance rate after FURL. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of each stone characteristic for stone clearance after FURL. The correlation between each stone characteristic and operation time was analyzed using the Spearman correlation coefficient. Results There were 67 cases in the stone clearance group and 19 cases in the stone residual group, with a stone clearance rate of 77.9%. Multivariate analysis showed that stone length, density, volume, and mass were independent risk factors affecting the stone clearance rate after FURL (P＜0.05). ROC curves showed that the area under the curve (AUC) for stone length, density, volume, and mass were 0.891, 0.674, 0.919, and 0.957, respectively, with stone mass having a significantly higher predictive efficiency for stone clearance than the other characteristics. The Spearman correlation coefficient indicated that stone length, density, volume, and mass were positively correlated with operation time (r=0.521, 0.226, 0.573, 0.611, P＜0.05), with stone mass showing the highest correlation with operation time. Conclusion Stone length, density, volume, and mass obtained through CT three-dimensional reconstruction are all risk factors affecting the treatment of kidney stones by FURL. Among these, stone mass, as an indicator of stone burden, can better predict the lithotripsy efficiency of FURL in treating kidney stones. [ABSTRACT FROM AUTHOR]

Objective To discuss the correlation between urinary metal elements and kidney stones in Miao population in Guizhou Province since there are few studies on the association between urine metal concentration and the risk of kidney stones in ethnic minorities. Methods In this study, 3 933 Miao people were sampled from the cohort database of natural populations living in ethnic minority areas in southwest China, and the concentrations of urine metals (arsenic, cadmium, cobalt, chromium, copper, iron, mercury, lithium, manganese, molybdenum, nickel, lead, strontium, vanadium and zinc) were detected by inductively coupled plasma mass spectrometry. The urinary metal concentration was divided into four groups: QI, Q2, Q3 and Q4, and the relationship between the exposure of a single metal to the risk of kidney stones was analyzed by binary logistic regression model, and the dose 一 response relationship between the concentration of monometals and the risk of kidney stones was explored by restriction cubic spline. Results The detection rate of kidney stones of Miao ethnic group in Guizhou Province was 20. 59%, the detection rate of male was 18. 27%, and the detection rate of female was 22. 02%. The results of the binary logistic regression model showed that when the covariate was not adjusted. In Miao women, after adjusting the covariate, the QI exposure group was used as the reference, and the chromium Q4 group (OR = 0. 534, 95% CI: 0.337 - 0. 846) was used. Lead Q3 group(OR = 0. 546, 95% CI: 0.400 - 0.745); Lead Q4 group(07, = 0. 657, 95% CI: 0.482 - 0.895) was negatively correlated with the risk of kidney stones. In Miao men, after adjusting for covariates, manganese Q4 group(OR 二 1. 911, 95% CI: 1. 274 -2. 867) was positively correlated with the risk of kidney stones. Further restriction cubic spline analysis showed that there was a dose - response relationship between urine chromium and the risk of kidney stones in Miao women(P < 0. 05). There was no dose - response relationship between urine lead and the risk of kidney stones (P > 0. 05), and in Miao men, there was a dose 一 response relationship between urinary manganese and the risk of kidney stones(P < 0. 05), Conclusion Heavy metals in urine affect kidney stones which supports the view that metal exposure plays a role in the development of kidney stones. [ABSTRACT FROM AUTHOR]

Objective To understand the current status of discharge readiness and its influencing factors in patients undergoing local anesthesia percutaneous nephrolithotomy (PCNL) . Methods A survey was conducted on patients undergoing PCNL in urology department using a General Information Questionnaire, Readiness for Hospital Discharge, Quality of Discharge Teaching Scale, Hospital Anxiety and Depression Scale, and Social Support Scale. Results The mean score for discharge readiness in patients undergoing PCNL was 98.43±16.21, with item scores averaging 8.20±1.35. The scores for each dimension were as follows: personal status (7.64±1.9), adaptability (8.35±1.39), and expected support (8.44±1.32) . The quality of discharge guidance, anxiety, depression, and social support were identified as the main factors influencing patients′ self-perceived level of discharge readiness (R~2=0.611, adjusted R~2=0.604, F=80.168, P＜0.001) . Conclusion Patients undergoing local anesthesia percutaneous nephrolithotomy demonstrated a relatively high level of discharge readiness. However, the personal status dimension score was relatively low, indicating a need to enhance perioperative psychological care and discharge guidance to boost patients′ confidence in self-management during the transition period. [ABSTRACT FROM AUTHOR]

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Primary hyperoxaluria type Ⅱ (PH2) is an inherited disorder of the glyoxylate metabolism caused by the gene mutation of glyoxylate reductase/hydroxypyruvate reductase (GRHPR). PH2 is characterized by recurrent nephrolithiasis and nephrocalcinosis, which may even progress into end-stage renal disease. Currently, organ transplantation is the only treatment option for PH2, which mainly includes two strategies: kidney transplantation and combined liver and kidney transplantation. Kidney transplantation yields a high risk of recurrence of oxalate nephropathy, which may cause early graft dysfunction. Combined liver and kidney transplantation could mitigate the deficiency of oxalate metabolism, whereas it yields a high risk of graft complications. PH2 is an extremely rare disorder. No consensus has been reached on the indications, surgical selection and perioperative management of organ transplantation for PH2 patients. In this article, the pathogenesis, diagnosis, monitoring and organ transplantation experience of PH2 were reviewed, aiming to divert clinicians' attention to PH2 and provide reference for determining diagnosis and treatment regimens, especially transplantation strategy for PH2 patients. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical characteristics of patients with kidney stones after ureteroscopy and the influencing factors of stone residue. Methods: 200 patients with kidney stones admitted to our hospital from January 2019 to January 2022 were selected. All patients were treated with ureteroscopy. One week after surgery, urinary CT and ureterographic reexamination were carried out. According to the residual postoperative stones, they were divided into no stone group(n=155) and residual stone group(n=45). According to the two groups, they were divided into complications(n=41) and no complications(n=159). Baseline data, postoperative stone residue rate, single factors affecting postoperative stone residue in patients with kidney stones and Logistic regression analysis of postoperative stone residue in patients with kidney stones were compared between the postoperative complication group and the non-complication group. Results: Baseline data analysis results of postoperative complication group and non-complication group showed that previous history of ureteral disease, antler calculus, operation time and hospital stay all increased the risk of postoperative complications to varying degrees(P＜0.05). Age, preoperative chronic disease, gender, body mass index and stone location did not significantly increase the risk of postoperative complications(P＞0.05); In 200 patients with kidney stones after ureteroscopy, the stone residual rate was 22.50%(45/200)and stone clearance rate was 77.50%(155/200). There were no significant differences in gender, age and average course of disease between the residual stone group and the non-residual stone group(P＞0.05); Renal insufficiency, stone diameter, stone number, stone pus coating, renal lamp, stone composition, operation time, intraoperative bleeding is the postoperative stone residue(P＜0.05), diabetes, hypertension, hydronephrosis, stone location did not have a significant impact on postoperative stone residue(P＞0.05). Logistic Regression analysis suggested that renal insufficiency, stone diameter of 2cm, stone pus coating, renal calycapus Angle ＜30 and stone composition were independent risk factors for postoperative stone remains in patients with kidney stones(P＜0.05). Conclusion: After ureteroscopy, adverse risk events in patients with renal calculi can be warned according to clinical characteristics affecting postoperative complications. In addition, the study results suggest that renal insufficiency, stone diameter ≥2 cm, stone abscess coating, Angle between pelvis and renal calyx ＜ 30° and stone composition are independent risk factors affecting stone residue, and preoperative prevention can be carried out based on risk factors. To improve the stone clearance rate. [ABSTRACT FROM AUTHOR]

Objective To retrospectively analyze metabolism associated risk factors of hypocitrateuria in kidney stone patients. Methods Totally 92 kidney stone patients with qualified data from metabolic evaluation database of Peking Union Medical College Hospital from May 2020 to January 2021 were included in this retrospective analysis . With hypocitrateuria as dependent variable, and gender, age and metabolic factors, including body mass index, hypertension, diabetes mellitus, hyperlipidemia and hyperuricemia, as independent variables,binary Logistic regression was used to analyze metabolism associated risk factors of hypocitraturia. Results In kidney stone patients, hypertension was risk factors of hypocitrateuria (OR=4.48,95% CI:1.58～12.70,P＜0.05), and other factors were not found to be associated with hypocitrateuria. Conclusions In kidney stone patients, hypertension is a risk factor of hypocitrateuria.

Objective: To compare the clinical effect of microchannel percutaneous nephrolithotomy(MPCNL)with standard tract percutaneous nephrolithotomy(SPCNL). Methods: A total of 118 patients with kidney stone, who were treated in Caofeidian District Hospital from January 2010 to May 2014, were divided into MPCNL group(Group M, n=62) and SPCNL group(Group S, n=56) according to the treatment plan. The intraoperative and postoperative related indexes and complications were compared between the two groups. Results: Compared with Group S, operation time of Group M was longer, flushing water was more, but amount of bleeding during operation was less,with statistical significance(P<0.05); The postoperative Scr, hospitalization time, bed time, postoperative costs of Group M were less or shorter than these of Group S, with statistical significance(P<0.05); There was no significant difference in the stone clearance rate between the two groups(P>0.05); There was no significant difference in complications of two groups such as fever, bleeding, interventional embolization, combined with perforation, sepsis between the two groups(P>0.05). Conclusion: For kidney stone patients,MPCNL is superior to SPCN. So best operation types can be chosen according to the sizes of the stones. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between 24 h urinary ion content and kidney stones, and to explore the diagnostic values of kidney stone in primary gout patients., Methods: Patients diagnosed with primary gout had ultrasound scanning of both feet and kidneys in Peking University First Hospital from Jan. 2020 to May 2021. Their clinical characteristics were compared between the positive and negative kidney stone groups, and the relationship between kidney stone and urinary ion composition were analyzed. Risk factors of kidney stone were analyzed. The explored diagnostic values were evaluated for urinary oxalate and citrate according with uric acid kidney stones by dual-energy computed tomography (DECT)., Results: Among the 100 gouty patients, 80 patients had uric acid crystal deposition in lower joints of extremity by ultrasonography, 61 patients had kidney stone, and 34 had kidney uric acid stones by DECT. All the multiple kidney stones were proved as uric acid kidney stones by DECT. Compared with patients without kidney stone group proved by ultrasonography, patients with kidney stone had longer gouty duration [(48.7±26.6) months vs . (84.0±30.6) months, P =0.01], higher 24 h urinary oxalate [(20.1±9.6) mg vs . (28.6±20.7) mg, P =0.001] and lower 24 h urinary citrate [(506.3±315.4) mg vs . (355.7±219.6) mg, P =0.001]. Compared with the patients without kidney stone by DECT, the patients with uric acid kidney stone also had longer disease duration [(49.1±28.4) months vs . (108.3±72.2) months, P =0.001], higher 24 h urinary oxalate [(23.6±16.9) mg vs . (28.5±18.8) mg, P < 0.05], lower 24 h urinary citrate [(556.0±316.3) mg vs . (391.7±261.2) mg, P < 0.05], higher serum uric acid [(466.2±134.5) μmol/L vs . (517.2±18.1) μmol/L, P < 0.05] and higher 24 h urinary uric acid [(1 518.1±893.4) mg vs . (1 684.2±812.1) mg, P < 0.05]. Logistic regression analysis showed long gout disease duration ( OR =1.229, 95% CI : 1.062-1.522, P < 0.05), high serum uric acid level ( OR =1.137, 95% CI : 1.001-1.213, P =0.01), low 24 h urinary citrate ( OR =0.821, 95% CI : 0.659-0.952, P =0.01) were all risk factors of kidney stones by ultrasonography. Also, long gout disease duration ( OR =1.201, 95% CI : 1.101-1.437, P =0.005), high serum creatine uric level ( OR =1.145, 95% CI : 1.001-1.182, P =0.04), low 24 h urinary citrate ( OR =0.837, 95% CI : 0.739-0.931, P =0.02) were all risk factors of kidney uric acid stones by DECT., Conclusion: Long disease duration and low 24 h urinary citrate were risk factors for kidney stones.