A novel approach for removing an intra-renal migrated Memokath™ stent

INTRODUCTION

The use of metallic stents in managing benign and malignant ureteric strictures is gaining increasing popularity in urology and has been shown to be a safe and effective alternative to the commonly used double J stents.

PRESENTATION OF CASE

We present here the case of a 54 year old female with a symptomatic benign ureteric narrowing at the pelvi-ureteric junction of her left kidney who was successfully managed with a metallic Memokath™ stent inserted at the site of the stricture. She went on to develop a rare complication of proximal migration of the stent into the kidney necessitating removal.

DISCUSSION

Our study systematically reviews the published evidence for the clinical effectiveness of metallic ureteric stents in stricture management and details a novel and safe approach that was successfully used to remove the intra-renal migrated stent in an antegrade percutaneous fashion.

CONCLUSION

Our report highlights a rare complication of metallic ureteric stents and a novel approach to their removal. This has significant importance for the urologist managing an awkwardly positioned stent lying within the kidney and hence difficult to manipulate via the previously published retrograde approaches.Key words: Ureter, Stent, Migration, Intra-renal, Memokath™     

Reducing seed migration to near zero with stranded-seed implants: Comparison of seed migration rates to the chest in 1000 permanent prostate brachytherapy patients undergoing implants with loose or stranded seeds

PurposePulmonary seed emboli to the chest may occur after permanent prostate brachytherapy (PPB). The purpose of this study is to analyze factors associated with seed migration to the chest in a large series of PPB patients from a single institution undergoing implant with either loose seeds (LS), mixed loose and stranded seeds (MS), or exclusively stranded seeds in an absorbable vicryl suture (VS).Methods and MaterialsBetween May 1998 and July 2015, a total of 1000 consecutive PPB patients with postoperative diagnostic chest x-rays at 4 months after implant were analyzed for seed migration. Patients were grouped based on seed implant technique: LS = 391 (39.1%), MS = 43 (4.3%), or VS = 566 (56.6%). Univariate and multivariate analysis were performed using Cox proportional hazards regression models to determine predictors of seed migration.ResultsOverall, 18.8% of patients experienced seed migration to the chest. The incidence of seed migration per patient was 45.5%, 11.6%, and 0.9% (p < 0.0001), for patients receiving LS, MS, or VS PPB, respectively. The right and left lower lobes were the most frequent sites of pulmonary seed migration. On multivariable analysis, planimetry volume (p = 0.0002; HR = 0.7 per 10 cc [0.6–0.8]), number of seeds implanted (p < 0.0001, HR = 2.4 per 25 seeds [1.7–3.4]), LS implant (p < 0.0001, HR = 15.9 [5.9–42.1]), and MS implant (p = 0.001, HR = 7.9 [2.3–28.1]) were associated with seed migration to the chest.ConclusionsIn this large series, significantly higher rates of seed migration to the chest are observed in implants using any LS with observed hazard ratios of 15.9 and 7.9 for LS and MS respectively, as compared with implants using solely stranded seeds.     

GC法测定一次性肠外营养输液袋中乙酸乙烯酯迁移量

目的:建立GC法测定一次性肠外营养输液袋中乙酸乙烯酯的迁移量.方法:以DB-624毛细管色谱柱为固定液;程序升温:起始温度90℃,维持5 min,以每分钟50℃的速率升温至250℃,维持5 min;进样口温度为220℃;检测器温度为250℃;流速为1.0 mL·min-1;分流比为10:1.结果:本法可将溶剂、空白溶液与乙酸乙烯酯单体较好分离,乙酸乙烯酯在4.47~10.44μg·mL-1(r=0.9993)浓度范围内线性关系良好,回收率为100.4%,RSD为1.25%.结论:本法灵敏度高,操作简单、快速、准确,适合输液袋中乙酸乙烯酯单体迁移量的监测.     

ERCC 1在前列腺癌PC-3细胞和组织样本中的表达及其临床意义

目的探讨切除修复交叉互补基因1(ERCC 1)在前列腺癌（PCa）PC-3细胞和前列腺样本中的表达情况及与预后的关系。 方法Western blot检测小干扰核糖核酸（siRNA）ERCC 1在转染PC-3细胞后ERCC 1蛋白的表达水平,MTT法检测细胞增殖活力,Transwell试验检测细胞迁移和侵袭能力。免疫组化（IHC）检测80例PCa组织及30例前列腺增生（BPH）组织中ERCC 1蛋白的表达水平,分析ERCC 1与PCa临床病理特征及其预后关系。 结果siRNA ERCC 1质粒转染PC-3细胞后Western blot检测证实ERCC 1表达水平明显减低。Transwell试验结果显示siRNA干扰表达ERCC 1后PC-3细胞迁移和侵袭能力下降,差异有统计学意义（P<0.05）。IHC结果提示ERCC 1在PCa样本中阳性表达率为71.3%（57/80）,高表达率为23.8%（19/80,IRS≥6）;在BPH样本中阳性表达率为10%（3/30）,均为低表达（IRS<6）。ERCC 1表达与PCa患者术前PSA值,Gleason评分,病理分期（pT）,淋巴结转移和切缘阳性存在显著相关性（P<0.05）,与年龄无显著相关性（P>0.05）。在PCa患者中ERCC 1低表达的无生化复发生存期（BRFS）显著长于ERCC 1高表达患者的BRFS（P<0.05）。单因素和多因素COX回归分析显示ERCC l高表达和病理分期（pT）均是PCa患者术后BRFS的独立危险因素。 结论siRNA ERCC l抑制了PCa PC-3细胞的增殖生长、迁移和侵袭能力,ERCC 1在PCa样本中阳性表达率较高,并与低分化、高侵袭性特征的PCa相关。ERCC 1高表达可能是PCa患者预后独立危险因素之一。     

The effect of low-intensity pulsed ultrasound on repair of epithelial cell monolayers in vitro

Low intensity pulsed ultrasound (LIPUS) is widely used to accelerate tissue regeneration following injury, but the biological mechanisms of this effect are poorly understood. An in vitro model of epithelial wound healing was used to investigate the effect of LIPUS on the reepithelialization of scrape wounds in normal human urothelial (NHU) cell monolayers. The effects of clinical doses of ultrasound treatment on NHU cell growth and migration were investigated in cells grown under optimal conditions, without growth supplements and in media containing low vs. physiological calcium concentrations. No differences in cell growth or migration were observed. We conclude that there is no direct effect upon uro-epithelial regeneration by therapeutic ultrasound in vitro and suggest that any stimulation of epithelial wound repair in vivo may occur indirectly, for example by modulating the extracellular matrix composition and/or production of paracrine factors by the stroma.     

补阳还五汤含药血清对人脑微血管内皮细胞增殖和迁移的影响

目的观察不同浓度补阳还五汤(BYHWD)含药血清对人脑微血管内皮细胞(HBMECs)增殖和迁移影响。方法补阳还五汤灌胃SD大鼠后腹主动脉取血,制备含药血清;体外培养人脑微血管内皮细胞(HBMECs),随机分为空白组(正常大鼠血清)及补阳还五汤含药血清组,血清浓度分为5%、10%和20%3个浓度,共6组;四甲基偶氮唑蓝(MTT)法检测HBMECs增殖;细胞划痕法检测HBMECs迁移的相对距离。结果与空白组比较,5%、10%和20%含药血清均显著促进HBMECs增殖,差异有统计学意义(0.71±0.03比0.65±0.03、0.84±0.05比0.75±0.03、0.71±0.05比0.67±0.05,P0.05);与10%含药血清组比较,5%含药血清组和20%含药血清组细胞增殖显著减少,差异有统计学意义(0.71±0.03、0.71±0.05比0.84±0.05,P0.05)。与空白组比较,各含药血清组细胞迁移的相对距离均显著增加,差异有统计学意义(0.58±0.03比0.50±0.01、0.63±0.03比0.45±0.05、0.53±0.05比0.45±0.04,P0.05);与10%含药血清组比较,5%含药血清组和20%含药血清组细胞迁移的相对距离显著减小,差异有统计学意义(0.58±0.03、0.53±0.05比0.63±0.03,P0.05)。结论补阳还五汤含药血清可促进HBMECs增殖和迁移,10%含药血清作用最佳。     

水杨酸抑制胃癌细胞体外增殖及侵袭转移能力研究

目的探讨水杨酸抑制人胃癌细胞侵袭转移的分子机制。方法不同浓度水杨酸体外处理胃癌细胞株MGC-803后,采用基质胶黏附试验、迁移试验和Transwell侵袭试验检测胃癌细胞黏附、迁移和侵袭能力的变化;采用荧光定量PCR、Westernblot检测细胞黏附相关分子核纤层蛋白（Lamin）、核纤层蛋白C1（LaminC1）、核纤层蛋白B1（LaminB1）、纤连蛋白（FN1）、CD44、整合素A9（ITGA9）、连环蛋白A1（CTNNA1）和E钙粘素（CDH1）表达水平的变化。结果与空白对照比较,0.5mmol/L和1mmol/L水杨酸体外处理胃癌细胞24h后,胃癌细胞的增殖、黏附、迁移和侵袭能力均受抑制（均P＜0.05）;Lamin、LaminC1、LaminB1、FN1、CD44、ITGA9和CTNNA1mRNA表达水平均下降（均P＜0.05）,CDH1mRNA表达水平均升高（均P＜0.05）;LaminB1、FN1、CD44和CTNNA1蛋白表达水平均升高（均P＜0.05）。结论一定浓度的水杨酸可体外抑制胃癌细胞增殖、黏附、侵袭能力,从而抑制胃癌转移,其作用机制可能与调节细胞黏附相关分子的表达水平和抑制胃癌细胞上皮间质转化有关。     

Autocrine motility-stimulatory pathways of oral premalignant lesion cells

Patients with premalignant oral lesions have varying levels of risk of developing oral squamous cell carcinoma (OSCC), whose aggressiveness requires increased motility. Not known is if and how premalignant oral lesion cells acquire the increased motility characteristic of OSCC. This was addressed by immunohistochemical analysis of banked premalignant lesion tissues and by functional analyses using cultures established from premalignant oral lesions and OSCC. These studies showed premalignant oral lesion cells and OSCC to be more motile than normal keratinocytes. Concomitantly, levels of ceramide were reduced. The activity of the protein phosphatase PP-2A, which restricts motility and which can be activated by ceramide, was also diminished. This was due to IL-10 released from premalignant lesion cells. Treatment with a membrane-permeable ceramide restored PP-2A activity and blocked migration. These studies show an autocrine motility-stimulatory pathway that is mediated in premalignant lesion cells by IL-10 through its reduction of ceramide levels and inhibition of PP-2A activity.     

Calcitonin receptor-stimulated migration of prostate cancer cells is mediated by urokinase receptor-integrin signaling

Abundance of calcitonin (CT) and calcitonin receptor (CTR) mRNA in primary prostate tumors positively correlates with tumor grade, and exogenously added CT increases the invasion of prostate cancer cell lines. We examined acute and chronic actions of CT on migration of highly metastatic PC-3M cells and poorly invasive LNCaP cells on several extracellular matrices in a spheroid disaggregation/migration assay. While PC-3M spheroids displayed maximum disaggregation/migration on vitronectin (VN), LNCaP spheroids preferred collagen but also migrated significantly on VN. Up-regulation of CT significantly enhanced disaggregation/migration of PC-3M spheroids on VN, but not on fibronectin. In contrast, down-regulation of CT, CTR, protein kinase A or urokinase-type plasminogen activator receptor (uPAR) led to amelioration of PC-3M spheroid disaggregation/migration. CT selectively increased surface activity of αvβ3 or α6β5 integrins in PC-3M and LNCaP cell lines, respectively, and uPAR-integrin association. Finally, either CT or urokinase could completely restore migration of CT-knock-down PC-3M spheroids. But, only forced expression of urokinase receptor coupled with exogenous addition of urokinase restored migration of CTR-knock-down spheroids. These results support our hypothesis that up-regulation of CT biosynthesis and activation of CT–CTR axis in primary prostate tumors may have direct relevance in their progression to the metastatic phenotype.     

Blood polymorphonuclear leukocyte migration as a predictive marker for infections in severe trauma: comparison with various inflammation parameters

Objective To assess in patients with multiple trauma the relevance of the following as predictive markers for infections: the inflammation parameters white blood count, body temperature, blood polymorphonuclear leukocyte (PMN) migration; blood levels of C-reactive protein, PMN elastase, procalcitonin, neopterin, interleukin 6, interleukin 8, malondialdehyde, total antioxidative status; the stress parameters cortisol and lactate.Design Prospective observational cohort study.Setting Intensive Care Unit of a university surgical department.Patients Twenty-six patients with multiple trauma of differing severity.Measurements and results Trauma severity was estimated by the ISS. PMN migration upon F-Met-Leu-Phe stimulation was determined in fresh whole blood in a ready-for-use, one-way membrane filter assay and evaluated by automated image analysis. The other parameters were measured with commercially available tests. During hospitalization, nine patients developed infections, and 17 patients were free of infection. PMN migration below a critical minimum preceded infections in eight of the infected, but occurred in only three of the non-infected patients (positive/negative predictive values 0.72/0.93; sensitivity/specificity 0.88/0.82; likelihood ratio 5.0). Fever (38.0 °C) had predictive values of 0.83/0.80 and a high likelihood ratio of 9.4, but a low sensitivity/specificity of 0.55/0.94. The other parameters were without significance. Procalcitonin, elastase, C-reactive protein, neopterin and lactate correlated positively with the injury severity score.Conclusion PMN migration proved to be a highly sensitive predictive marker for infections. The whole-blood PMN migration test may facilitate early aggressive antimicrobial therapy.Coauthors are listed in alphabetical order