Remote lithotripsy with the URAT-P apparatus in treating urolithiasis in children

The Soviet-made device "URAT-P" for remote lithotripsy was used for the treatment of urolithiasis in children aged from 22 months to 14 years who suffered from various clinical patterns of urolithiasis with solitary or dendritic calculi. Out of 64 treated persons, 21 children had undergone 1-2 surgeries for the disease. The majority of them had pains and frequent aggravations of pyelonephritis. Excretory urography revealed the signs of hydronephrosis and hydrocalycosis. There was no need for additional adjustments to perform the procedure in patients with a height of under 75 cm. The authors employed erosive operating conditions of a shock-wave generator for lithotripsy in case of large or dendritic calculi and to avoid preliminary renal drainage. One treatment session was a success in 43 patients, 2 sessions were needed for 15, 3 for 4 and 4 for 2 patients. A beneficial effect (total disintegration and fragmental discharge) was reached in 64 (98.4%) of the patients. Partial disintegration was recorded only in 1 patient who was exposed to 2 sessions. Radioisotope, immunological, ultrasonic, and biochemical investigations failed to reveal inhibition of the renal functional parameters after remote lithotripsy. No renal injuries associated with hematogenesis were revealed in the parents. The signs of hematuria were observed in the first portion of the postoperative urine only. The only serious complication calling for close attention is acute pyelonephritis observed in 6 patients, one case requiring a surgical application of nephrostoma.     

Telelithotripsy in the treatment of staghorn nephrolithiasis in children using the URAT-P lithotriptor]

The paper presents the results of telelithotripsy monotherapy for 34 staghorn stones in 32 nephrolithiasis children carried out at the RSFSR Research Institute of Urology, Moscow. Commonest manifestations of the disease were leukocyturia (87.5% of cases) and Proteus bacteriuria (31.8% of cases). Basing on roentgenological findings, the stones were classified into 3 groups: initial (K1), incomplete (K2) and complete (K3). All the children underwent treatment on Soviet lithotriptor "URAT-P" under a delicate regime using different techniques of disintegration which started from the periphery and advanced to the pelvic part of the calculus. No pretreatment drainage of the pelvicaliceal system was performed. The intended staged disintegration of the stones was achieved in 94.2% of cases at 2.4 sessions, on the average, and overall number of impulses 1973.1 per each stone. At discharge 76.4% of the children were free of the main mass of the stone dust. Acute pyelonephritis which appeared the most frequent postoperative complication developed in 7.8% of the patients one of which required open nephrostomy and one percutaneous puncture nephrostomy. Other cases were treated by specific antimicrobial therapy. Complete series of investigations in the postoperative period did not reveal any intra- or pararenal hematomas. Radioisotopic renography revealed improvement in renal function in 62% of cases in early postoperative follow-up. Thus, 93.8% of children with stag-horn stones were spared of traumatic operative intervention or invasive manipulations. This makes the method of telelithotripsy a valuable therapeutic tool in childhood staghorn nephrolithiasis.     

Single-dose vaccine against tick-borne encephalitis

Tick-borne encephalitis (TBE) virus is the most important human pathogen transmitted by ticks in Eurasia. Inactivated vaccines are available but require multiple doses and frequent boosters to induce and maintain immunity. Thus far, the goal of developing a safe, live attenuated vaccine effective after a single dose has remained elusive. Here we used a replication-defective (single-cycle) flavivirus platform, RepliVax, to generate a safe, single-dose TBE vaccine. Several RepliVax-TBE candidates attenuated by a deletion in the capsid gene were constructed using different flavivirus backbones containing the envelope genes of TBE virus. RepliVax-TBE based on a West Nile virus backbone (RV-WN/TBE) grew more efficiently in helper cells than candidates based on Langat E5, TBE, and yellow fever 17D backbones, and was found to be highly immunogenic and efficacious in mice. Live chimeric yellow fever 17D/TBE, Dengue 2/TBE, and Langat E5/TBE candidates were also constructed but were found to be underattenuated. RV-WN/TBE was demonstrated to be highly immunogenic in Rhesus macaques after a single dose, inducing a significantly more durable humoral immune response compared with three doses of a licensed, adjuvanted human inactivated vaccine. Its immunogenicity was not significantly affected by preexisting immunity against WN. Immunized monkeys were protected from a stringent surrogate challenge. These results support the identification of a single-cycle TBE vaccine with a superior product profile to existing inactivated vaccines, which could lead to improved vaccine coverage and control of the disease.