Comparison of Conventional Percutaneous Nephrolithotomy and Endoscopic Combined Intrarenal Surgery with Respect to Efficacy and Safety in Complex Renal Stone

When PCNL and RIRS alone are unable to completely clear complex renal calculi, a combination of the two modalities was tested. Endoscopically Combined Intra Renal Surgery (ECIRS) is name given to this procedure afterwards. It excludes the drawbacks of multi-puncture PCNL and simultaneously provides much higher stone free rates. ECIRS is a relatively new tool in the arsenal of urologists, and as of right now, there isn't much information available in developing nations. Methods: A Comparative Observational study where 40 patients were split into two groups of 20, one for ECIRS and the other for prone PCNL. Both groups' surgical times, stone removal rates, potential complications, and other post-operative results were compared. Results: The majority of the patients (26) were men between the ages of 36 and 45, and both the group's age and gender were similar. The average calculus size was 2.43 cm for the ECIRS group and 2.60 cm for the prone PCNL group. Mean duration of the surgery was 85.24 & 88.12 min in ECIRS and prone PCNL group respectively. In the ECIRS group, the stone-free rate was considerably greater with lesser requirement of additional punctures and blood transfusions. More ancillary procedures prone PCNL patients' hospital stays were observed, as well. Post-operative S. urea and S. creatinine, fever, pain, post-operative complications were comparable. Conclusion: In view of the findings of the study, ECIRS seems to be a better option in comparison to prone PCNL in terms of effectiveness and safety. &nbsp

Compare Outcomes Of Single Stage Vs Two Stage Urethroplasty For Panurethral Strictures Including Pre-Operative And Post-Operative Course

Aim: The aim of the present study was to compare outcomes of single stage vs two stage urethroplasty for panurethral strictures including pre-operative and post-operative course. Methods: The Observational study was conducted at Dr. D.Y. Patil Medical College and Research Centre, Pimpri for the period of 2 years. The study was conducted in 40 patients randomly dividing into two groups, 20 patients underwent single stage urethroplasty and 20 underwent two staged urethroplasty with or without buccal mucosal graft urethroplasty based on size of urethral plate. Results: In the present study, majority of the patients belonged to 41-50 years age group followed by 31-40 years age group and it was found that age groups were not statistically significant. Majority of the patients had Balanitis xerotica obliterans (LS) etiology followed by Post instrumentation/catheter and the results were not statistically significant. Majority of the patients had 13-15 cms length of stricture. In the present study, 12 and 16 were narrow external uretheral meatus in single and two stage respectively. In the two stage, Johanson’s urethroplasty procedure was done and in single stage, Kulkarni’s full length dorsal onlay BMG urethroplasty procedure was done. In single and two stage, Urethrocutaneous Fistula and Epididymo-orchitis complications were noted. In single stage, success was noted in 16 patients and in two stage, success was noted in 17 patients. Conclusion: The single stage repair in patients with LS had good results with less re-stricture rates. The use of BMG as a substitution in single stage repair had re-stricture rates compared to flaps substitution. The two-stage repair should be limited to complex urethral strictures, failed urethroplasty and obliterated urethral stricture urethral caliber is less than 6F

Synchronized renal tubular cell death involves ferroptosis

Receptor-interacting protein kinase 3 (RIPK3)-mediated necroptosis is thought to be the pathophysiologically predominant pathway that leads to regulated necrosis of parenchymal cells in ischemia-reperfusion injury (IRI), and loss of either Fas-associated protein with death domain (FADD) or caspase-8 is known to sensitize tissues to undergo spontaneous necroptosis. Here, we demonstrate that renal tubules do not undergo sensitization to necroptosis upon genetic ablation of either FADD or caspase-8 and that the RIPK1 inhibitor necrostatin-1 (Nec-1) does not protect freshly isolated tubules from hypoxic injury. In contrast, irondependent ferroptosis directly causes synchronized necrosis of renal tubules, as demonstrated by intravital microscopy in models of IRI and oxalate crystal-induced acute kidney injury. To suppress ferroptosis in vivo, we generated a novel third-generation ferrostatin (termed 16-86), which we demonstrate to be more stable, to metabolism and plasma, and more potent, compared with the firstin- class compound ferrostatin-1 (Fer-1). Even in conditions with extraordinarily severe IRI, 16-86 exerts strong protection to an extent which has not previously allowed survival in any murine setting. In addition, 16-86 further potentiates the strong protective effect on IRI mediated by combination therapy with necrostatins and compounds that inhibit mitochondrial permeability transition. Renal tubules thus represent a tissue that is not sensitized to necroptosis by loss of FADD or caspase-8. Finally, ferroptosis mediates postischemic and toxic renal necrosis, which may be therapeutically targeted by ferrostatins and by combination therapy

DipA, a Pore-Forming Protein in the Outer Membrane of Lyme Disease Spirochetes Exhibits Specificity for the Permeation of Dicarboxylates

Lyme disease Borreliae are highly dependent on the uptake of nutrients provided by their hosts. Our study describes the identification of a 36 kDa protein that functions as putative dicarboxylate-specific porin in the outer membrane of Lyme disease Borrelia. The protein was purified by hydroxyapatite chromatography from Borrelia burgdorferi B31 and designated as DipA, for dicarboxylate-specific porin A. DipA was partially sequenced, and corresponding genes were identified in the genomes of B. burgdorferi B31, Borrelia garinii PBi and Borrelia afzelii PKo. DipA exhibits high homology to the Oms38 porins of relapsing fever Borreliae. B. burgdorferi DipA was characterized using the black lipid bilayer assay. The protein has a single-channel conductance of 50 pS in 1 M KCl, is slightly selective for anions with a permeability ratio for cations over anions of 0.57 in KCl and is not voltage-dependent. The channel could be partly blocked by different di- and tricarboxylic anions. Particular high stability constants up to about 28,000 l/mol (in 0.1 M KCl) were obtained among the 11 tested anions for oxaloacetate, 2-oxoglutarate and citrate. The results imply that DipA forms a porin specific for dicarboxylates which may play an important role for the uptake of specific nutrients in different Borrelia species