Purpose
We evaluated if, during lithotripsy, bacteria may be detected in the irrigation fluid of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). The concordance between ...urine culture from stone fragmentation (SFUC), bladder (BUC), renal pelvic (RPUC) and stone (SC) was analyzed. We also assessed the correlation between variables and cultures and their association with systemic inflammatory response syndrome (SIRS) and of a positive SC.
Methods
We included 107 patients who underwent PCNL (
n
= 53) and RIRS (
n
= 54) from January 2017 to May 2018. Samples for RPUC were obtained by renal catheterization. Stone fragments and irrigation fluid sample were sent for culture.
Results
SFUC was positive in 17 (15.9%), BUC in 22 (20.6%), RPUC in 26 (24.3%) and SC in 30 patients (28%). The concordance between SFUC and SC was the highest among all cultures: 94.1%. SFUC and SC grew identical microorganisms in 15/17 (88.2%) patients. Out of 17 (15.9%) patients with SIRS, 8 (7.5%) had sepsis. SFUC had the highest PPV and specificity to detect positive SC and SIRS. Previous urinary tract infection, a preoperative nephrostomy, stone diameter and composition, staghorn calculi, PCNL, positive BUC, RPUC and SFUC were predictors of infected stone. Variables that indicate complex stones, complex PCNL and an infection of the upper tract were associated with SIRS.
Conclusion
SFUC is technically feasible, easy to retrieve and to analyze. The spectrum of SFUC potential application in clinical practice is when is not possible to perform a SC, e.g. complete dusting or during micro-PCNL.
Purpose
We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews.
Methods
Two semi-structured online focus ...group meetings were conducted to discuss the study’s need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews.
Results
Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11–15 years, and 4 with 6–10 years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement).
Conclusion
The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols.
BackgroundGastrointestinal involvement is recognized as a major cause of morbidity and mortality in Systemic Sclerosis (SSc) and its pathophysiology is still unclear. Few data on composition and ...function of gut microenvironment in SSc are reported in the literature but there is a growing body of evidences supporting the hypothesis of a relation between gut microbiota and the host immune system.ObjectivesThe goal of this study was to characterize fecal microbiota in SSc patients compared to healthy subjects to investigate whether specific microbial species may be responsible of dysbiosis in SSc. Furthermore, we investigated the composition of microbiota in the different clinical subsets of SSc.MethodsFaecal samples were obtained from 17 healthy controls and 39 SSc patients including subjects with different skin involvement (Diffuse and Limited) and disease duration. The BMI was normal and the mean age was similar both in SSc and controls groups. The composition of microbiota was determined through 16S rRNA pyrosequencing performed using the GS Titanium technology. Rarefaction was used to uniform abudance data. α-diversity was defined by the main indexes while β-diversity was determined according to Bray-Curtis and UniFrac, represented trough Principal Coordinate Analysis (PCoA) and compared using PERMANOVA test on distance matrices. Linear Discriminant Analysis Effect Size was used to identify taxa that showed differential expression between the groups.ResultsAt genus level SSc patients showed a differential expression in 12 taxa compared to controls with higher levels of Ruminococcus, Streptococcus, Lactobacillus, Blautia, Coprococcus and Phascolarctobacterium and a depletion of Bacteroides, Butyciromonas, Odoribacter, Succinivibrio, Sutterella and Prevotella. The differences in microbiota composition between SSc patients and controls were supported also by PCoA of the values representing phylogenetic distance of microbial communities between specimens (p<0.001) (see figure). Among scleroderma patients, those with diffuse skin involvement showed a greater abundance of bacteria of Bacteroidetes phylum with significantly lower values of alpha diversity by Chao1 and species richness (p=0.01). Differences were confirmed by PERMANOVA on Bray-Curtis distance matrix (p=0.016).PERMANOVA analysis of distance matrices (p-values adjusted according to FDR)Weighted UniFracBray-Curtis Control vs SSc<0.001*<0.001*Control vs Diffuse0,012*0,0015*Control vs Limited0,003*0,0015*Control vs Early0,003*0,0015*Control vs Long0,017*0,0015*Diffuse vs Limited0,2590,016*Early vs Long0,490,156ConclusionsOur analysis demonstrated an altered and distinct composition of gut microbiota in SSc patients compared to healthy controls. Furthermore, scleroderma patients show some differences in microbiota characteristics according to the extent of skin involvement, suggesting that microbiota may influence the severity of the disease. If validated and related to GI symptomathology and nutritional status our findings open up the opportunity of a rational intervention on microbiota to restore the gut equilibrium in SSc patients.Disclosure of InterestNone declared
Purpose
Live surgery (LS) is considered a useful teaching opportunity. The benefits must be balanced with patient safety concerns. To evaluate the rate of complications of a series of urologic LS ...performed by experts during the Congress Challenge in Laparoscopy and Robotics (CILR).
Methods
We present a large, multi-institution, multi-surgeon database that derives from 12 CILR events, from 2004 to 2015 with a total of 224 cases. Radical prostatectomy (RP) was the most common procedure and a selection of complex cases was noted. The primary measure was postoperative complications and use of a Postoperative Morbidity Index (PMI) to allow quantitative weighing of postoperative complications.
Results
From 12 events, the number of cases increased from 11 in 2004 to 27 in 2015 and a total of 27 surgeons. Of 224 cases (164 laparoscopic and 60 robotic), there were 26 (11.6%) complications: 5 grade I, 5 grade II, 3 grade IIIa, 12 grade IIIb and 1 grade V, the latter from laparoscopic cystectomy. Analysis of PMI was 23 times higher from cystectomy compared to RP.
Conclusions
In the setting of live surgery, the overall rate of complications is low considering the complexity of surgeries. The PMI is not higher in more complex procedures, whereas RP seems very safe.
BackgroundInterstitial lung disease (ILD) is the leading cause of death in systemic sclerosis (SSc) but its pathogenesis and the risk factors of pulmonary function deterioration are not fully ...understood. Esophageal disease is high frequent in SSc and motor activity abnormalities with occult micro-aspiration of both acid and non-acid gastro oesophageal reflux has been implicated in the pathogenesis of ILD. DLCO reduction is considered the earliest sign of microaspiration-induced lung damage1. Cross-sectional studies have demonstrated an association of SSc-ILD and esophageal abnormalities on 24 hours intraesophageal pH-monitoring and esophageal manometry but prospective evaluation of lung deterioration is lacking2,3. Esophagogram was proposed as a useful tool to evaluate disease severity of upper gastrointestinal tract involvement in SSc4.ObjectivesTo assess the role of esophagogram in predicting pulmonary function test deterioration in SSc-patients.MethodsWe retrospectively evaluated 160 consecutive SSc patients who underwent esophagogram because of suspected upper gastro-intestinal involvement. All patients underwent baseline pulmonary function tests and global clinical evaluation. Eighty-five patients underwent a High Resolution CT within 3 months from esophagogram because of suspected lung involvement. One hundred twenty three patients underwent pulmonary function test every 6 months up to 24 months.ResultsSeventy five patients (46.9%) presented abnormalities of peristaltic waves, 50 patients (31.2%) showed structural changes (hypotonic oesophagus or dilatation) while indirect signs of cardial incontinence (patent cardia or gastro-esophageal reflux) were present in 36 patients (22.5%). A reduced peristaltic activity with a prolongation of transit time was associated to reduced DLCO (50.16%±19.80% vs 60.36±22.69%, p=0.002) and TLC (87.05%±20.43% vs 95.09±20.59%, p=0.017). An hypotonic oesophagus was reported in 25.2% of patients and it was associated to ILD on CT (72.0% vs 28.0%, p=0.033). Patients with hypotonic oesophagus presented a reduced FVC (84.63%±22.86% vs 102.93±21.40%, p<0.0001), TLC (79.85%±19.62% vs 95.29±19.80, p<0.0001) and DLCO (42.88%±20.00% vs 59.89±20.78%, p<0.0001) at baseline and to a faster deterioration of DLCO median values (5.10%±20.61% vs −4.77±14.23%,p=0.012) at follow-up. Patients with hypotonic oesophagus have an higher prevalence of diffuse skin disease and ongoing immunosuppressive treatment, but were comparable in term of age, sex, BMI, smoking habits, disease duration and prevalence of autoantibodies to the patients without this alteration.ConclusionsThe esophagogram is wide available, well tolerated and inexpensive tool to assess upper gastro-intestinal tract involvement and its abnormalities are associated to SSc-ILD severity. Because of a faster deterioration of lung function is associated to esophagogram abnormalities, a complete gastro-intestinal evaluation in ILD-SSc patients is mandatory.References1 Schachter LM, et al. Chest2003.2 Christmann RB, et al. Semin Arthritis Rheum2010.3 Marie I, et al. Arthritis Care Res2001.4 Medsger TA, et al. Clin Exp Rheumatol2003.Disclosure of InterestNone declared
BackgroundAdipocytokines are implicated in the development of fibrosis, vasculopathy and immune abnormalities through a variety of biological effects, but their role in systemic sclerosis (SSc) is ...not fully investigated. Chemerin is implicated in chemotaxis of immune cells, in promoting angiogenesis and it is involved in inflammation. Adiponectin (APN) has metabolic actions and anti-inflammatory properties, while Leptin (LEP) mediates actions in endothelial cells, such as angiogenesis, vasodilation, NO production and upregulates various mediators of vascular inflammation.ObjectivesIn this study we investigated Chemerin, LEP and APN levels in SSc patients according to disease subtypes and clinical characteristics.MethodsChemerin, LEP and APN levels were evaluated in 100 SSc patients and in sex, age and BMI matched healthy controls. Clinical and demographical characteristics were available for all patients.ResultsChemerin, APN and LEP levels were lower in SSc patients compared to healthy controls (Chemerin: 58.7±27.6 ng/ml vs 74.0±29.0 ng/ml, p=0.004; LEP:19.6±18.3 ng/ml vs 28.5±23.8 ng/ml, p=0.03, APN: 6.5±3.9 µg/ml vs 12.8±6.0 µg/ml, p<0.001)Chemerin levels were lower in patients with anti-topoisomerase antibodies (50.2±22.7 ng/ml) respect to patients with other autoantibodies (64.6±29.7 ng/ml), p=0.018.Regarding capillaroscopic damage, Chemerin levels were lower in patients with late pattern (44.8±18.9 ng/ml) compared to patients with early (64.3±28.5 ng/ml) and active pattern (71.7±29.9 ng/ml), p<0.001. APN levels inversely correlate with IL-6 levels (R=-0.4, p<0.001), while directly correlate with capillary density (R=0.3,p=0.03). Patients with avascular areas presented lower levels of APN (5.3±3.9 µg/ml) compared to patients without avascular areas (7.3±3.4 µg/ml),p=0.005. LEP levels directly correlate with vascular density on nailfold capillaroscopy (R=0.3, p=0.02), confirming the role of LEP in endothelial homeostasis. Furthermore, patients with avascular areas presented lower LEP levels (15.5±13.0 ng/ml) compared to patients without avascular areas (31.1±28.4 ng/ml), p=0.003. LEP levels were lower in patients with active digital ulcers (9.3±6.6 ng/ml), compared to patients without ulcers (9.3±6.6 ng/ml), p=0.01. The anti-inflammatory and endothelium protective role of APN emerged also when we considered the lung involvement: in fact patients with DLCO >50% presented higher levels of APN (7.0±3.9 µg/ml) compared to patients with DLCO <50% (5.8±3.8 µg/ml), p=0.05.Considering the cardiopulmonary involvement, LEP levels inversely correlate with PAPs on echocardiography (R=-0.24, p=0.02). Finally LEP levels inversely correlate with skin score (R=-0.3, p=0.009) and patients with early disease presented lower LEP levels (15.1±13.2 ng/ml) compared to patients with long lasting disease (29.9±28.7 ng/ml), p=0.006.ConclusionsOur data suggest an imbalance of the levels of adipocytokines in SSc, their down-regulation in patients with a more aggressive pattern on nailfold videocapillaroscopy and organ damage, suggesting a possible role of Chemerin, LEP and APN in the impaired angiogenesis and in the development of vasculopathy of SSc patients.Disclosure of InterestNone declared
BackgroundPsoriatic arthritis(PsA)is characterised by several comorbidities;among these obesity and overweight have a major impact on patients’ quality of life and on disease treatment. Obesity ...increases the risk of developing psoriatic arthritis in the general population compared to normal-weight subjects. Obesity increases the risk of developing arthritis in patients with psoriasis, especially for HLA B27 negative and late onset forms.ObjectivesAim of the study was to evaluate the incidence of overweight and obesity in a cohort of PsA patients, the differences between disease phenotypes and therapeutic response between patients with normal weight and overweight/obesity.MethodsIn this retrospective observational study 332 PsA patients, afferent to our unit between 2010 and 2017, were assessed. At each visit data on disease characteristics, BMI, ongoing treatment, joint count and clinimetric indexes were collected.The baseline was defined as the onset of the disease in bio-naive patients or the start of the last bDMARD therapy for patients previously treated with cs or bDMARDS, while the last follow-up is considered the last visit at our unitResultsThe 332 patients had a mean age of 52.5±7.3 years;35% of the patients were normal weight, 39.5% were overweight and 25.5% obese. No differences were observed in terms of disease characteristics according to BMI cathegory at baseline and during follow-up, with comparable percentages of peripheral arthritis, enthesitis, dactylitis, axial arthritis or uveitis, as well as cutaneous psoriasis among the groups.At baseline, obese patients had more tender(4.4±5.2 vs 2.3±3.6 p=0.003)and swollen joints(mean value 2.3 vs 1 p=0.03)and higher activity indexes, as for DAS28(3.3±1.2 vs 2.7±1.2 p=0.002)and DAPSA(15.6±9.9 vs 11.5±9 p=0.004)compared to normal weight patients. The same difference was observed between normal-weight and overweight patients, with higher values of DAS28(3.04±1,4 vs 2,7±1.2,p=0.17)and DAPSA(13.6±11 vs 11.5±9, p=0.025)in overweight patients.No significant difference was observed in patients treated with NSAIDs, csDMARDs or bDMARDs according to BMI cathegory.In 190 patients followed according to the tight control strategy, with evaluations every 3 months, the disease activity indexes after two years of follow-up became similar in obese patients compared to normal weight patients.Among the normal-weight patients, 69.4% took csDMARDs,48.7% were treated with bDMARDs. 74.7% of obese patients took csDMARDs, while 36.1% took bDMARDs, with no statistically significant differences between the two groups(p=ns).In particular low-disease activity according to DAPSA was achieved in 76% of normal weight patients, compared with 68.9% of obese patients (p=ns), and also the percentage of patients reaching Minimal Disease Activity in the two groups was comparable (28.4% vs 22.7%, p=ns).ConclusionsClinical manifestations of psoriatic disease do not seem to differ according to BMI cathegory:however, at the first evaluation, obese patients appear to have more disease activity than non-obese patients.At the same treatment intensity, obese patients seem to achieve a percentage of remission comparable to normal weight patients, suggesting that the an intensive treatment strategy allows to obtain optimal results also in a more challenging group of patients.Disclosure of InterestNone declared
BackgroundGastrointestinal (GI) symptoms are seen in majority of patients with Systemic Sclerosis (SSc) and are a common presenting feature of disease. Severe GI involvement may lead to malabsorption ...which represents a poor prognostic factor. Accordingly, a regular monitoring of gastrointestinal tract involvement and nutritional status appears crucial in SSc patients. Previous studies reported low values of bone mass density (BMD) in SSc patients1. While no specific relationship has emerged between the two conditions, it’s likely that disease related GI involvement may contribute to the alterations in BMD.ObjectivesTo determine if GI-related clinical status was associated to low bone density in our cohort of SSc patients.MethodsTwo-hundred-ten unselected SSc patients have been enrolled. The 7-items UCLA SCTC GIT 2.0 questionnaire and Malnutrition Universal Screening Tool (MUST) were administered to each patient. A comprehensive medical history was collected. A blood panel for nutritional status was also performed. T-scores and Z-scores at lumbar spine, femoral neck, Ward’s and total hip measured by dual-energy X-ray absorptiometry (GE Lunar Prodigy) were measured.ResultsIn our cohort, 86.7% of patients reported some GI symptoms. The mean UCLA GIT total score was 0.345±0.34 and 51 patients (24.3%) were at risk of malnutrition according to MUST (score ≥1). 53.7% patients had BMD values<1, and 12.5% had BMD values≤−2.5 at any of the considered sections. Patients with reduced BMD (<-1) showed similar levels of selected nutritional blood markers compared to subjects with normal BMD, including vitamin D and albumin.Patients with spine T-score <-1 had lower BMI (23.2±3.9 vs 25.2±4.8; p=0.011) and reported higher UCLA GIT reflux (0.66±0.63 vs 0.42±0.48; p=0.016), distention (0.80±0.72 vs 0.53±0.56; p=0.15) and total score (0.42+0.37 vs 0.27±0.30; p=0.006) compared to patients with normal BMD. Similar significant differences were observed in the same domains for patients with total hip T-score values <-1.Femoral neck T-score <−2.5 was associated with higher UCLA GIT reflux (0.88±0.78 vs 0.48±0.50; p=0.022), soilage (0.50±0.78 vs 0.14±0.52; p=0.041) and total score (0.50±0.37 vs 0.31±0.33; p=0.012).On the other hand, the comparison of patients with severe, moderate and mild symptoms according to UCLA GIT total score2 showed an association between progressively lower values of spine and total hip T-score and increasing severity of GI symptoms (ANOVA for spine T-score: p=0.015; for total hip T-score: p=0.048).Patients at risk of malnutrition (MUST score ≥1) presented significant lower T-score for all the considered sections (spine and hip) and significant lower total hip Z-score.ConclusionsIn our SSc cohort gastrointestinal symptoms were frequent and were associated with low BMD. Considering the heterogeneity of GI involvement, UCLA SCTC GIT 2.0 emerged as a useful and feasible tool to assess GI involvement and other associated comorbidities. In particular, SSc patients who report remarkable GI symptoms and are at risk of malnutrition according to MUST may benefit from a stricter control of BMD to promptly detect osteopenia and osteoporosis.References1 Omair MA, et al. J Rheumatol. 20132 Khanna D, et al. Curr Opin Rheumatol. 2013Disclosure of InterestNone declared
Earthworms are useful bioindicator organisms for soil biomonitoring. Recently the use of pollution biomarkers in earthworms has been increasingly investigated for soil monitoring and assessment. ...Earthworm coelomic fluid is particularly interesting from a toxicological perspective, because it is responsible for pollutant disposition and tissue distribution to the whole organism. The aim of the present work was to study the effect of heavy metal exposure on metallothionein (Mt) induction in the coelomic fluid of Lumbricus terrestris in view of future use as sensitive biomarker suitable for application to metal polluted soil monitoring and assessment. L. terrestris coelomic fluid showed a detectable Mt concentration of about 4.0 ± 0.6 μg/mL (mean ± SEM, n = 10 ) in basal physiological condition. When the animals were exposed to CuSO4 or CdCl2 or to a mixture of the two metals in OECD soils for 72 h, the Mt specific concentration significantly ( P < 0.001 ) increased. The Mt response in the coelomic fluid perfectly reflected the commonly used Mt response in the whole organism when the two responses were compared on the same specimens. These findings indicate the suitability of Mt determination in L. terrestris coelomic fluid as a sensitive biomarker for application to metal polluted soil monitoring and assessment.
BackgroundHumoral immunity and B cells are thought to play an important role in the pathophysiology of the systemic sclerosis (SSc). The production of free light chains (FLC) of immunoglobulins is ...abnormally high in different pathological autoimmune conditions and reflects B cell activation. Furthermore FLCs demonstrated different biological activities including their capability to modulate the immune system, proteolytic activity, complement cascade activation, as well as FLC binding to antigens and chemotactic factors.ObjectivesTo determine the FLC levels in patients with SSc and in healthy controls and to study their possible association with organ involvement and disease characteristics.MethodsSixty-five SSc patients (90.0% females; mean age 50.8±17.0 years; 27 (41.5%) with diffuse skin involvement-dcSSc) and 20 age and sex matched healthy controls (HC) were studied. Clinical and immunological inflammatory characteristics were assessed for all the SSc patients. FLC levels were quantified by nephelometry (Freelite TM Human Kappa and Lambda Free Kits, The Binding Site, UK). IL6 and BAFF levels were measured in SSc patients by ELISA.ResultsThe mean serum FLC-κ level (SSc: 20.4±7.5 ng/ml vs HC 9.4±4.3 ng/ml, p<0.001) and FLC ratio (SSc: 1.6±0.6 vs HC 0.8±0.2, p<0.001) were significantly higher in patients with SSc compared to healthy controls, while the serum FLC-λ levels were comparable (SSc: 13.6±4.8 ng/ml vs HC 11.9±6.2 ng/ml, p=ns).The levels of FLC were comparable in patients with diffuse skin disease and limited skin involvement, while FLC-κ levels were increased in patients with restrctive lung (FVC<79%) disease (SSc: 26.4±7.4 ng/ml) when compared to patients with FVC>79% (HC 19.6±7.3 ng/ml, p=0.009).In SSc patients the levels of serum FLC-κ level directly correlate with the IL-6 levels (R=0.6, p<0.001), while no correlation was found with skin involvement and autoantibodies distribution.ConclusionsFree light chains of immunoglobulins (sFLC) levels are elevated in systemic sclerosis. High levels of sFLC are associated with the fibrotic lung involvement and with an higher degree of inflammation, supporting the role of B cell activation in the pathophysiology of SSc.Disclosure of InterestNone declared
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