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Purpose: To establish a male Wistar rat model of nanobacteria (NB)-induced kidney stones. Methods: Sixty male Wistar rats were randomly divided into control group (NC group) given caudal vein injection of saline + saline gavage, and NB-induced stone group (NBS group) given caudal vein injection of NB + saline gavage. Results: Compared with NC, serum creatinine, blood uric acid, urea nitrogen and urinary calcium levels in NBS group increased between weeks 3 and 8 (p < 0.05). Kidney index (kidney weight/body weight ratio) in the NBS group was higher than that in NC group from weeks 8-10. At week 8, urine pH and serum phosphorus in NBS group were higher than those in NC group (p < 0.05). Between weeks 6 and 7, serum calcium in NBS group was higher than that in NC group (p < 0.05). Calcium crystals in NBS rats were distributed mostly in the distal and proximal convoluted tubules. However, no such crystals were observed in NC rats. Similarly, no such pathological changes were seen in the renal tissue of NC group. Calculus analysis showed that stone formation was higher in NBS group than in NC group (p < 0.05). There was no significant difference in micro-CT between the two groups (p ˃ 0.05). Conclusion: The successful establishment of the Wistar rat kidney stone model using NB cultured from urine of upper urinary tract stone patient is potentially useful for further etiological studies on kidney stone formation.

Purpose: To evaluates the efficacy of four-quadrant method in CT and MRI for diagnosis and differential diagnoses of the orbital tumor. The location of the orbital tumor was assigned to: superolateral, superomedial, inferolateral, inferomedial, and optic never were considered as the center point. Methods: From Sep-2008 to April-2016 a total of 87 cases of orbital tumor were included in study. All included orbital tumors were verified radiologically and histopathologically. Forty nine patients underwent CT scanning and 38 patients underwent MR Imaging. We classified the orbital region according to four-quadrant location method and eight spaces. The frequency distribution of individual CT and MR imaging features in the benign tumor was compared with malignant tumor by using Chi-square tests. Results: Among the 87 cases of the orbital tumor, 70 cases (80.45%) were benign tumor and 17 cases (19.54%) were malignant tumor. Regarding the four-quadrant location of the orbit, 41 lesions (47.12 %) were in superolateral, 18 lesions (20.68%) in inferolateral, 16 lesions (18.39%) in inferomedial, 8 lesions (9.19%) in superomedial, 3 lesions (3.44%) in globe, 1 lesion (1.14%) was in optic nerve. There was significant difference in four quadrant location by comparing benign with malignant tumor (P=0.023). Hemangiomas were the predominant benign lesion and lymphoma was major type of malignancy. Conclusion: The four-quadrant and eight-space (FQES) division of the orbit may play an important role in determining the anatomical location, origin and nature of orbital tumor, and aid in diagnosis and treatment.

Summary: Objective: To report our experience in treating endophytic renal tumor by robot-assisted partial nephrectomy (RPN) with a standard laparoscopic ultrasound probe and our original approach for separating renal mass. Methods: All patients with endophytic renal tumor who underwent RPN in our department from January 2015 to December 2017 were retrospectively analyzed. All surgeries were performed by transperitoneally by a single, experienced surgeon. Baseline characteristics, tumor characteristics, operative profile and follow-up data were collected. Results: Among these 29 patients, 23 patients were male. The mean age of patients was 47.42 years old. 69% (20/29) tumors were completely endophytic tumors. The average tumor size was 3.1 cm. The average R.E.N.A.L. score was 9.0. Tumors from 3 patients were pathologically confirmed to be renal angiomyolipomas. And the rest were malignant including 23 clear cell renal cell carcinoma and 3 chromophobe renal cell carcinoma. The mean operative time was 3.0 h. The mean warm ischemia time was 22.3 min. All tumor margins were pathologically confirmed negative. No patient needed blood transfusion. Two patients presented had Grade II complication. Both of them had a fever after surgery with body temperature over 38 °C, leading to a prolonged postoperative hospitalization time. The mean postoperative hospitalization time was 6.8 days. During mean 21.3-month follow-up, no patient was confirmed to relapse by CT scan. Conclusion: RPN with a standard laparoscopic ultrasound probe is safe, effective and feasible in treating endophytic renal tumor. Our original approach for separating renal mass can avoid some problems caused by the standard laparoscopic ultrasound probe. Keywords: Robot-assisted partial nephrectomy, Standard laparoscopic ultrasound probe, Retrospective study

Budd-Chiari syndrome is a complex clinical disorder of hepatic venous outflow obstruction, originating from the accessory hepatic vein (HV), large HV, and suprahepatic inferior vena cava (IVC). This disorder includes both HV and IVC obstructions and hepatopathy. This study aimed to conduct a systematic review of the survival rate and clinical success of different types of endovascular treatments for Budd-Chiari syndrome (BCS). All participant studies were retrieved from four databases and selected according to the eligibility criteria for systematic review of patients with BCS. The survival rate, clinical success of endovascular treatments in BCS, and survival rates at 1 and 5 years of publication year were calculated accordingly. A total of 3398 patients underwent an endovascular operation; among them, 93.6% showed clinical improvement after initial endovascular treatment. The median clinical success rates for recanalization, transjugular intrahepatic portosystemic shunt (TIPS), and combined procedures were 51%, 17.50%, and 52.50%, respectively. The median survival rates at 1 and 5 years were 51% and 51% for recanalization, 17.50% and 16% for TIPS, and 52.50% and 49.50% for combined treatment, respectively. Based on the year of publication, the median survival rates at 1 and 5 years were 23.50% and 22.50% before 2000, 41% and 41% in 2000‒2005, 35% and 35% in 2006‒2010, 51% and 48.50% in 2010‒2015, and 56% and 55.50% after 2015, respectively. Our findings indicate that the median survival rate at 1 and 5 years of recanalization treatment is higher than that of TIPS treatment, and recanalization provides better clinical improvement. The publication year findings strongly suggest progressive improvements in interventional endovascular therapy for BCS. Thus, interventional therapy restoring the physiologic hepatic venous outflow of the liver can be considered as the treatment of choice for patients with BCS which is a physiological modification procedure.

Traumatic penis amputation is a urological emergency. Although repair techniques have been well described in literature, failure of replantation and its causes are poorly understood and reported. The aim of this study is to evaluate the treatment and prognosis of microsurgical replantation of penile amputation with a relative long-term ischemia, and review related literatures to summarize relevant clinical experiences. We report two cases of penile amputation and microsurgical replantation performed in our hospital in August 2016. In the first case, the patient was injured by sharp scissors due to family conflict, while in the second case, it was a mechanical injury. For both cases, microsurgical approaches were adopted. After the microsurgical replantation, both the patients recovered well and showed normal urination, erectile function, return of sensations and satisfactory cosmetic appearance. With the development of microsurgical techniques, the successful re-anastomosis of blood vessel and nerve can increase the survival and functional recovery of the penis even in cases exceeding 10 hours of ischemia. This provides greater possibility of graft survival with minimum complication.

Objective. We aimed to examine the performance of the distress thermometer (DT) and identify the prevalence and risk factors associated with psychological distress (PD) in heterogeneous cancer patients. Methods. This cross-sectional study enrolled 1496 heterogeneous cancer patients from the inpatient and outpatient departments. Receiver operating characteristic analysis (ROC) of DT was evaluated against the Hospital Anxiety and Depression Scale-Total (HADS-T ≥15). An area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and clinical utility index were calculated. Multiple binary logistic regression was used to identify the factors associated with PD. Results. Referring to ROC analysis, DT showed good discriminating accuracy (AUC = 0.88). A cutoff score of 4 was established, and it yielded sensitivity (0.81), specificity (0.88), PPV (0.87), NPV (0.82), and clinical utility indexes (screening utility = 0.71 and case-finding utility = 0.73). 46.5% of our participants was distressed. Lower education levels (odd ratio (OR) = 1.39), advanced stage (OR = 1.85), active disease status (OR = 1.82), lack of exercise (OR = 3.03), diagnosis known (OR = 0.64), emotional problems (OR = 3.54), and physical problems (OR = 8.62) were the predictive factors for PD. Conclusion. DT with a cutoff score (≥4) is a comprehensive, appropriate, and practical initial screener for PD in cancer patients. Predicting factors should be considered together for effective management of PD in such population.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global spread of coronavirus disease (COVID-19). Our understanding of the impact this virus has on the nervous system is limited. Our review aims to inform and improve decision-making among the physicians treating COVID-19 by presenting a systematic analysis of the neurological manifestations experienced within these patients. Methods Any study, released prior to May 20, 2020, that reported neurological manifestations in patients infected by SARS-CoV-2 was systematically reviewed using the PRISMA (Preferred Reporting Items for Systemic review and Meta-Analysis) statement. Results Our systematic review included data from 37 articles: twelve retrospective studies, two prospective studies, and the rest case reports/series. The most commonly reported neurological manifestations of COVID-19 were myalgia, headache, altered sensorium, hyposmia, and hypogeusia. Uncommonly, COVID-19 can also present with central nervous system manifestations such as ischemic stroke, intracerebral hemorrhage, encephalo-myelitis, and acute myelitis, peripheral nervous manifestations such as Guillain-Barré syndrome and Bell’s palsy, and skeletal muscle manifestations such as rhabdomyolysis. Conclusion While COVID-19 typically presents as a self-limiting respiratory disease, it has been reported in up to 20% of patients to progress to severe illness with multi-organ involvement. The neurological manifestations of COVID-19 are not uncommon, but our study found most resolve with treatment of the underlying infection. Although the timeliness of this review engages current challenges posed by the COVID-19 pandemic, readers must not ignore the limitations and biases intrinsic to an early investigation.

Gonadotropin therapy is commonly used to induce virilization and spermatogenesis in male isolated hypogonadotropic hypogonadism (IHH) patients. In clinical practice, 5.6%-15.0% of male IHH patients show poor responses to gonadotropin treatment; therefore, testosterone (T) supplementation can serve as an alternative therapy to normalize serum T levels and promote virilization. However, treatment with exogenous T impairs spermatogenesis and suppresses intratesticular T levels. This retrospective study aimed to determine whether oral testosterone undecanoate (TU) supplementation together with human chorionic gonadotropin (hCG) would negatively affect spermatogenesis in IHH patients compared with hCG alone. One hundred and seven IHH patients were included in our study. Fifty-four patients received intramuscular hCG and oral TU, and 53 patients received intramuscular hCG alone. The median follow-up time was 29 (range: 12-72) months in both groups. Compared with the hCG group, the hCG/TU group required a shorter median time to normalize serum T levels (P < 0.001) and achieve Tanner stage (III and V) of pubic hair and genital development (P < 0.05). However, there were no significant differences in the rate of seminal spermatozoa appearance, sperm concentration, or median time to achieve different sperm concentration thresholds between the groups. In addition, there were no significant differences in side effects, such as acne and gynecomastia, observed in both groups. This study indicates that oral TU supplementation together with hCG does not impair spermatogenesis in treated IHH patients compared with hCG alone, and it shortens the time to normalize serum T levels and promote virilization.

Objective: To compare outcomes and postoperative quality of life (QoL) among patients with kidney stone who received mini-percutaneous nephrolithotomy (mPCNL), partial tubeless mPCNL or mPCNL with ureter catheter in a prospective randomized clinical trial. Methods: From May 2017 to December 2017, 60 patients with kidney stone who underwent mPCNL were randomized into 3 groups: Group I (mPCNL), Group II (partial tubeless mPCNL), Group III (mPCNL with ureter catheter). We evaluated perioperative characteristics, stone clearance, analgesic requirements and QoL by using the Wisconsin Stone QOL questionnaire. Results: The age, gender, stone diameter, body mass index, length of operation, drop in hemoglobin and stone-free rates for the 3 groups were similar among these groups. However, the postoperative visual analog scale and the analgesic requirement in Group II were significantly the lowest (p < 0.05). According to Wisconsin Stone QOL questionnaire, compared to Group I, statistical significant difference in the QoL was seen in Group II and III, indicating a meaningful and immediate improvement in the postoperative QoL following mPCNL. Conclusion: Compared with standard and partial tubeless mPCNL, mPCNL with ureter catheter is a safe and useful form of mPCNL, which can offer better QoL and is more cost effective.

Chromium is an essential element that is required for the normal physiology but can be toxic to humans above a certain level. In spite of growing interest in research on chromium exposure to human health consensus about its effect on human, semen quality has not been achieved. The aim of the present study is to evaluate the impact of chromium exposure on semen parameters. A total of 760 males attending andrology laboratory of Tongji Hospital, Wuhan, for routine semen analysis were enrolled and requested to provide semen and urine samples. The urine level of chromium was evaluated using inductively coupled plasma mass spectrometry (ICP-MS), and computer-assisted semen analysis (CASA) was applied to examine semen parameters. Associations between semen parameters and urinary chromium were analyzed by means of multivariate linear regression analysis. Multivariate analysis showed a negative association between the urinary concentrations of chromium and progressive motility (β = − 0.014, p = 0.040) and total motility (β = − 1.077, p = 0.048), while other semen parameters did not show any statistically significant changes. Urinary chromium could influence semen quality parameters and impair male fecundity.

There is an ongoing debate on the declining semen quality, and unfortunately, existing evidence is inconclusive and inconsistence. We evaluated the impact of sociodemographic characteristics, lifestyle, medical history and work exposure on semen quality. Univariate and multivariate analysis was used to investigate the association between different risk factors and semen quality parameters. Total sperm count (p = 0.041), sperm concentration (p = 0.007), normal morphology (p = 0.002), total motility (p = 0.004) and progressive motility (p = 0.009) decreased in men with varicocele. Sperm concentration increased in tea (p = 0.044); progressive and total motility increased in cola (p = 0.018, p = 0.012) consumers. Progressive and total motility decreased in urogenital surgery (p = 0.016, p = 0.014) and infection (p = 0.037, p = 0.022). However, age, coffee and alcohol drinking, physical activities, sleep duration and cell phone use were unrelated to any of semen parameters. Interestingly, semen volume (p 0.0001), total sperm count (p 0.0001) and concentration (p 0.033) increased with longer abstinence period (5 days); normal morphology (p = 0.013) improved in men with higher body mass index (BMI 24), curvilinear velocity (p = 0.042) increased with smoking; semen volume (p = 0.050) increased in manual labourers. This study highlights the importance of sociodemographic characteristics, lifestyle, occupational exposure and medical history and provides time trends in semen quality, its clinical importance and direction for further research.

BACKGROUND Hydroxycitric acid is a potential lithontriptic agent for calcium oxalate (CaOx) stones in the kidneys. This study aimed to evaluate the safety and efficiency of hydroxycitric acid tripotassium (K-HCA) against CaOx crystal formation using Drosophila melanogaster hyperoxaluria models. MATERIAL AND METHODS Wild-type D. melanogaster were fed standard medium with ethylene glycol or sodium oxalate added to induce hyperoxaluria. Their Malpighian tubules were dissected and observed under a microscope every 3 days. Crystal deposit score of each Malpighian tubule were evaluated under a magnification of ×200. Using hyperoxaluria Drosophila models, we investigated the inhibitory efficiency of hydroxycitrate acid tripotassium and citric acid tripotassium (K-CA) against CaOx crystal formation. The survival rate of each group was also assessed. RESULTS When fed with 0.05% NaOx, the CaOx formation in Malpighian tubules increased significantly, without reduction of life span. Therefore, we selected 0.05% NaOx-induced hyperoxaluria models for the further investigations. After treatment, the stone scores showed that K-CA and K-HCA both significantly inhibit the formation of CaOx crystals in a dose-dependent manner, and with smaller dosage (0.01%), K-HCA was more efficient than K-CA. Moreover, after treatment of K-CA or K-HCA, the life span in different groups did not change, reflecting the safety to life. CONCLUSIONS The hyperoxaluria Drosophila models fed on 0.05% NaOx diet might be a useful tool to screen novel agents for the management of CaOx stones. K-HCA may be a promising agent for the prevention CaOx stones, with satisfying efficiency and acceptable safety.

Background Solute-linked carrier 26 gene family 6 (SLC26A6), which is mainly expressed in intestines and kidneys, is a multifunctional anion transporter crucial in the transport of oxalate anions. This study aimed to investigate the role of kidney SLC26A6 in urolithiasis. Methods Patients were divided into two groups: stone formers and nonstone formers. Samples were collected from patients following nephrectomy. Lentivirus with Slc26a6 (lentivirus-Slc26a6) sequence and lentivirus with siRNA-Slc26a6 (lentivirus-siRNA-Slc26a6) sequence were transfected into rats’ kidneys respectively and Slc26a6 expression was detected using Western blot and immunohistochemical analyses. After administering ethylene glycol, oxalate concentration and prevalence of stone formation between the transgenic and control groups were measured using 24-h urine analysis and Von Kossa staining, respectively. Results Immunohistochemical and Western blot analyses indicated that stone formers had a significantly higher level of expression of SLC26A6 in the kidney compared with the control group. After lentivirus infection, the urinary oxalate concentration and rate of stone formation in lentivirus-Slc26a6-tranfected rats increased remarkably, while lentivirus-siRNA-Slc26a6-transfected rats showed few crystals. Conclusion The results showed that high expression levels of renal SLC26A6 may account for kidney stone formation. Downregulating the expression of SLC26A6 in the kidney may be a potential therapeutic target to prevent or treat urolithiasis.

Percutaneous nephrolithotomy (PCNL) is generally accepted as the gold standard treatment for the treatment of large kidney stones (> 2 cm). For nearly 40 years, with the continuous progress of technology and the constant updating of ideas, PCNL has made great progress. In this review, we discuss the current research progress, recent advancement and hot spot of the whole process of PCNL including anesthesia, position, puncture, dilation, lithotripsy approaches, perfusate, tube placement, hospitalization time, drug, treatment of residual stones, prognosis judgment and operation evaluation by summarizing the related research in this article.

Varicocele is the most common cause of male infertility. Varicoceles are classified into two types: clinical and subclinical varicoceles. Some researchers reported right subclinical varicoceles are often accompanied with left clinical varicoceles. However, the treatment is controversial. Our aim was to compare the clinical outcome of unilateral varicocelectomy (UV) and bilateral varicocelectomy (BV) in infertile males with left clinical and right subclinical varicocele. A total of four randomised controlled trials (RCT) were enrolled in this study, including 637 cases with left clinical and right subclinical varicocele (318 cases in the BV group and 319 cases in the UV group). The fixed effects model combined difference in progressive sperm motility between the two groups was 6.42% (95% CI: 5.09, 7.75). The random effects model combined difference in normal sperm morphology between the two groups was 2.04% (95% CI: 0.60, 3.48). The odds ratio shown by the fixed effects model in spontaneous pregnancy rate was 1.73 (95% CI: 1.24, 2.43). No statistically significant difference between the two groups was found in sperm concentration and sperm motility. Thus, BV may be superior to UV for infertile male patients with left clinical and right subclinical varicocele. However, more properly conducted RCTs are still needed.

Varicocele is one of the common correctable causes of male infertility. Recent studies have demonstrated varicocelectomy in males with abnormal semen parameters was associated with better fertility outcome, but the effect of adjuvant drug therapy after varicocelectomy on fertility outcome in patients with varicocele-associated infertility remains undefined. Hence, the present meta-analysis was performed to assess the efficacy of adjuvant drug therapy after varicocelectomy. The protocol was registered with PROSPERO (No. CRD42018093749). Ten randomised controlled trails containing 533 patients with adjuvant drug therapy after varicocelectomy and 368 patients with no medical treatment after varicocelectomy were included. Our analysis revealed that the improvement in pregnancy rate after adjuvant drug therapy was insignificant. (OR = 1.70, 95%CI = 0.99-2.91), but resulted in significant improvements in sperm concentration (MD = 13.71, 95%CI = 5.80-21.63) and motility (MD = 4.77, 95%CI = 3.98-5.56) at 3 months, sperm DNA integrity (SMD = 3.13, 95%CI = 1.50-4.75) and serum FSH level (MD = -1.02, 95%CI = -1.79 to -0.24). Therefore, compared to no medical treatment, the adjuvant drug therapy, especially the use of antioxidants seems to be associated with better fertility outcome. However, more evidences with high-quality studies are necessary to conform its benefits.

Kallmann syndrome (KS) is a clinically and genetically heterogeneous condition characterised by hypogonadotropic hypogonadism with anosmia or hyposmia. More than nineteen genes causing KS have been reported to date. KAL1, first identified to causing the X-linked form of KS, accounts for 10%-20% of KS patients. In this study, we designed a panel including 17 known genes causing KS for genetic diagnosis and research and report a typical and rare family of which three generations had been affected by KS. A novel CNV in Xp22.3 was identified through targeted next-sequencing technology and high-resolution microarray. The breakpoint (chrX:8536480 and chrX:8730416) was defined, and the size of deletion is about 0.24 Mb. The CNV including KAL1 and FAM9A had a negative effect on the expression of KAL1, resulting in decreased level of KAL1 mRNA in whole blood. In addition, the proband had significant improvement in testicular volumes and secondary sex characters except spermatogenesis after regular treatment, which indicates the CNV may have a negative effect on spermatogenesis. Our study expands the genotypic spectrum of KAL1 mutations associated with KS and provides a practical pipeline for genetic diagnosis or research.