Background Current surgical practice for nephron sparing surgery allows at least 1 cm margin of normal tissue around the tumour. However, recent studies show that the width of the margin is not important, even simple ...Background Current surgical practice for nephron sparing surgery allows at least 1 cm margin of normal tissue around the tumour. However, recent studies show that the width of the margin is not important, even simple enucleation is as effective as partial nephrectomy. We explored whether margin size has significant impacts on clinical outcomes in nephron sparing surgery for renal cell carcinoma of 4 cm or less. Methods Between 1998 and 2006, 115 patients with sporadic, pathologically confirmed, renal cell carcinoma 4 cm or less （Tla） and normal contralateral kidney were treated by nephron sparing surgery using a margin less than 5 mm. The surgical margin status was evaluated from frozen and permanent paraffin sections. Results Mean and median tumour diameter were 3.3 cm and 3.5 cm （range 1.0-4.0）. The mean margin width was 2.2 mm （median 2.0, range 0-6）. In addition, 114 cases had margins 5 mm or less （99.1%）, 97 cases （84.3%） had margin 3 mm or less, and 26 cases had margin zero （22.6%）. None of the patients had positive surgical margins. No patients died during follow-up （mean 65 months）. There were no any major surgical complications and no distant metastasis was detected. Local recurrence was detected in one case （0.9%） at a different site of the kidney. Conclusions For early localized renal cell carcinoma of 4 cm or less, as long as tumour is completely excised, the size of margin in nephron sparing surgery is not important. Nephron sparing surgery with 5 mm margin is enough for tumour control. It provides excellent renal function preservation, favourable long term progression free survival and is not associated with an increased risk of local recurrence.展开更多
The gene encoding bone morphogenetic protein-7(BMP7) is expressed in the developing kidney in embryos and also in the mature organ in adults. During kidney development, expression of BMP7 is essential to determine the...The gene encoding bone morphogenetic protein-7(BMP7) is expressed in the developing kidney in embryos and also in the mature organ in adults. During kidney development, expression of BMP7 is essential to determine the final number of nephrons in and proper size of the organ. The secreted BMP7 acts on the nephron progenitor cells to exert its dual functions: To maintain and expand the progenitor population and to provide them with competence to respond to differentiation cues, each relying on distinct signaling pathways. Intriguingly, in the adult organ, BMP7 has been implicated in protection against and regeneration from injury. Exogenous administration of recombinant BMP7 to animal models of kidney diseases has shown promising effects in counteracting inflammation, apoptosis and fibrosis evoked upon injury. Although the expression pattern of BMP7 has been well described, the mechanisms by which it is regulated have remained elusive and the processes by which the secretion sites of BMP7 impinge upon its functions in kidney development and diseases have not yet been assessed. Understanding the regulatory mechanisms will pave the way towards gaining better insight into the roles of BMP7, and to achieving desired control of the gene expression as a therapeutic strategy for kidney diseases.展开更多
From January 2008 to January 2013, 11 patients with central renal tumors underwent ultrasound-guided open nephron sparing surgery（ONSS） without renal artery occlusion. We removed the lesions, and the cut edges of th...From January 2008 to January 2013, 11 patients with central renal tumors underwent ultrasound-guided open nephron sparing surgery（ONSS） without renal artery occlusion. We removed the lesions, and the cut edges of the tumors were negative. Thus, we deduced that ultrasound-guided ONSS is suitable for the cases with obscure tumor boundary or multiple lesions. It could achieve the purpose of thoroughly removing lesions, as well as to expand the application range of nephron sparing surgery.展开更多
Von Hippel-Lindau （VHL） disease is a rare autosomal dominant disorder caused by germ line mutations of the VHL tumour suppressor gene. it predisposes affected individuals to develop a variety of neoplasms, including...Von Hippel-Lindau （VHL） disease is a rare autosomal dominant disorder caused by germ line mutations of the VHL tumour suppressor gene. it predisposes affected individuals to develop a variety of neoplasms, including haemangioblastomas of the central nervous system, retinal angiomas, renal cell carcinomas （RCCs）, pheochromocytomas and cysts of the kidneys and epididymis. Germ line VHL mutations have been found in all VHL disease families. RCC occurs in 25% to 45% of patients with VHL disease and is one of the leading causes of death.展开更多
Background：Cyclosporine A （CsA） is a commonly used clinical immunosuppressant.However,CsA exposure in rabbits during the gestation period was shown to cause a postnatal decrease in the number of nephrons,with the e...Background：Cyclosporine A （CsA） is a commonly used clinical immunosuppressant.However,CsA exposure in rabbits during the gestation period was shown to cause a postnatal decrease in the number of nephrons,with the effects remaining unknown.In this study,we aimed to explore the effects of CsA on metanephros development in the pregnant BALB/c mice.Methods：Pregnant mice were randomly divided into two groups,and CsA （10 mg·kg^-1·d^-1） was subcutaneously injected from gestation day 10.5 to day 16.5 in the CsA group,whereas a comparable volume of normal saline was given to the control group.All of the mice were sacrificed on gestation day 17.5 and serum CsA concentration was measured.The fetuses were removed and weighed,and their kidneys were prepared for histological assessment and polymerase chain reaction assay.In an in vitro experiment,embryo kidneys of fetal mice on gestation day 12.5 were used,and CsA （10 tmol/L） was added in the culture of the CsA group.The growth pattern of the ureteric bud and nephrons was assessed by lectin staining.Results：No significant differences in the weight of embryo （4.54 ± 1.22 vs.3.26 ± 1.09 mg） were observed between the CsA and control groups,the thickness of the cortical （510.0 ± 30.3 vs.350.0 ± 29.7 μm,P 〈 0.05） and nephrogenic zone （272.5 ± 17.2 vs.173.3 ± 24.0 μm,P 〈 0.05）,and the number of glomeruli （36.5 ± 0.7 vs.27.5 ± 2.1,P 〈 0.05） were reduced in the CsA group when compared to the control group.The cell proliferation of Ki-67 positive index between control and CsA group （307.0 ± 20.0 vs.219.0 ± 25.0,P 〈 0.05） in the nephrogenic zone was decreased with the increase of apoptotic cells （1 7.0 ± 2.0 vs.159.0 ± 33.0,P 〈 0.05）.The mRNA expression of WT-1,Pax2,and Pax8 was downregulated by CsA treatment.As for the in vitro CsA group,the branch number of the ureteric bud was decreased in the CsA-treated group with the nephrons missing in contrast to control after the incubation for 24 h and 72 h （all P〈 0.0001�展开更多
Background:In the last decade,a varied prevalence of lifestyle-mediated health ailments ranging from infectious disorders to non-curable diseases has been observed.Globally the stone formation(lithiasis)in human kidne...Background:In the last decade,a varied prevalence of lifestyle-mediated health ailments ranging from infectious disorders to non-curable diseases has been observed.Globally the stone formation(lithiasis)in human kidneys has increased the trauma and economic burden.Furthermore,affordable rapid diagnosis,clinical trials,and therapeutics have to be addressed with newer holistic approaches.Objective:The current comprehensive review attempts to study kidney stones using emerging translational,con-ventional,and non-conventional research models,which include prokaryotic and eukaryotic systems(in vitro,semi-in vivo,and in vivo).Methods:The study eligibility criteria included systematic reviews and meta-analyses to explore various lithiatic models.Further,PubMed,PubMed Central,CINAHL Plus,Scopus,Web of Science,and EMBASE were used as data sources for the current study.A Measurement Tool to Assess Systematic Reviews(AMSTAR)was used.Results:All curated literature from past 55 years(1967-2022)were considered for this review with keywords as"Experimental models for human kidney stones"AND"Nephrolithasis"AND"Urolithasis".A total of 765 abstracts were reviewed for inclusion with 414 selected for full-text review.A total of 47 studies were analyzed.Mean AMSTAR score of 6.96/11(±1.84)suggests moderate quality of the systematic reviews.Conclusion:This review will empower clinicians,veterinarians,and researchers for a better understanding of the pathogenesis,causative factors,and prevalence of nephrolithiasis and urolithiasis and their associated mech-anisms with rapid,reliable,and reproducible models.The findings of the study will aid in designing global healthcare policy and regional insurance for lithiatic disorders with effective therapeutics which will result in an increased quality of life,leading to better health and hygiene.展开更多
应用组织学、组织化学技术对南方鲇(Silurus meridionalis Chen)肾的发生及肾单位的发育进行了详细研究。结果表明:中肾的发生始于出膜后24h,其发生、发育过程可分为间充质细胞聚集、中肾小泡出现、肾小管芽形成、肾小体发生、初级肾单...应用组织学、组织化学技术对南方鲇(Silurus meridionalis Chen)肾的发生及肾单位的发育进行了详细研究。结果表明:中肾的发生始于出膜后24h,其发生、发育过程可分为间充质细胞聚集、中肾小泡出现、肾小管芽形成、肾小体发生、初级肾单位形成、初级肾单位成熟及第二、三级肾单位发生等时期。出膜后19d,前肾解体时,第一代中肾单位才开始行使功能。19d至3月龄幼鱼中肾有大量间充质细胞。中肾肾单位的发育包括分化前期、分化期、发育期、成熟期4个时期。幼鱼PI上皮细胞具有大型PAS阳性颗粒是由于肾单位发育不完善,血管球有较大的通透性所致,也是区别于成鱼肾单位的明显特点。3月龄至2龄个体肾中仍有大量发育中的肾单位。展开更多
Kidney disease is an escalating global health problem,for which the formulation of therapeutic approaches using stem cells has received increasing research attention.The complexity of kidney anatomy and function,which...Kidney disease is an escalating global health problem,for which the formulation of therapeutic approaches using stem cells has received increasing research attention.The complexity of kidney anatomy and function,which includes the diversity of renal cell types,poses formidable challenges in the identification of methods to generate replacement structures.Recent work using the zebrafish has revealed their high capacity to regenerate the integral working units of the kidney,known as nephrons,following acute injury.Here,we discuss these findings and explore the ways that zebrafish can be further utilized to gain a deeper molecular appreciation of renal stem cell biology,which may uncover important clues for regenerative medicine.展开更多
AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed datab...AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.展开更多
文摘Background Current surgical practice for nephron sparing surgery allows at least 1 cm margin of normal tissue around the tumour. However, recent studies show that the width of the margin is not important, even simple enucleation is as effective as partial nephrectomy. We explored whether margin size has significant impacts on clinical outcomes in nephron sparing surgery for renal cell carcinoma of 4 cm or less. Methods Between 1998 and 2006, 115 patients with sporadic, pathologically confirmed, renal cell carcinoma 4 cm or less （Tla） and normal contralateral kidney were treated by nephron sparing surgery using a margin less than 5 mm. The surgical margin status was evaluated from frozen and permanent paraffin sections. Results Mean and median tumour diameter were 3.3 cm and 3.5 cm （range 1.0-4.0）. The mean margin width was 2.2 mm （median 2.0, range 0-6）. In addition, 114 cases had margins 5 mm or less （99.1%）, 97 cases （84.3%） had margin 3 mm or less, and 26 cases had margin zero （22.6%）. None of the patients had positive surgical margins. No patients died during follow-up （mean 65 months）. There were no any major surgical complications and no distant metastasis was detected. Local recurrence was detected in one case （0.9%） at a different site of the kidney. Conclusions For early localized renal cell carcinoma of 4 cm or less, as long as tumour is completely excised, the size of margin in nephron sparing surgery is not important. Nephron sparing surgery with 5 mm margin is enough for tumour control. It provides excellent renal function preservation, favourable long term progression free survival and is not associated with an increased risk of local recurrence.
基金Supported by Grants-in-Aid for Young Scientists(B)(No.15K18454 to Tsujimura T)Scientific Research(B)(No.15H03001 to Hishikawa K)Scientific Research(C)(Nos.25461208 to Takase O,15K09244 to Yoshikawa M and 26462400 to Idei M)from the Japan Society for the Promotion of Science
文摘The gene encoding bone morphogenetic protein-7(BMP7) is expressed in the developing kidney in embryos and also in the mature organ in adults. During kidney development, expression of BMP7 is essential to determine the final number of nephrons in and proper size of the organ. The secreted BMP7 acts on the nephron progenitor cells to exert its dual functions: To maintain and expand the progenitor population and to provide them with competence to respond to differentiation cues, each relying on distinct signaling pathways. Intriguingly, in the adult organ, BMP7 has been implicated in protection against and regeneration from injury. Exogenous administration of recombinant BMP7 to animal models of kidney diseases has shown promising effects in counteracting inflammation, apoptosis and fibrosis evoked upon injury. Although the expression pattern of BMP7 has been well described, the mechanisms by which it is regulated have remained elusive and the processes by which the secretion sites of BMP7 impinge upon its functions in kidney development and diseases have not yet been assessed. Understanding the regulatory mechanisms will pave the way towards gaining better insight into the roles of BMP7, and to achieving desired control of the gene expression as a therapeutic strategy for kidney diseases.
文摘From January 2008 to January 2013, 11 patients with central renal tumors underwent ultrasound-guided open nephron sparing surgery（ONSS） without renal artery occlusion. We removed the lesions, and the cut edges of the tumors were negative. Thus, we deduced that ultrasound-guided ONSS is suitable for the cases with obscure tumor boundary or multiple lesions. It could achieve the purpose of thoroughly removing lesions, as well as to expand the application range of nephron sparing surgery.
基金This study was supported by a grant from the Doctoral Foundation of Shanghai Jiaotong University Medical School(No.BXJ0615)
文摘Von Hippel-Lindau （VHL） disease is a rare autosomal dominant disorder caused by germ line mutations of the VHL tumour suppressor gene. it predisposes affected individuals to develop a variety of neoplasms, including haemangioblastomas of the central nervous system, retinal angiomas, renal cell carcinomas （RCCs）, pheochromocytomas and cysts of the kidneys and epididymis. Germ line VHL mutations have been found in all VHL disease families. RCC occurs in 25% to 45% of patients with VHL disease and is one of the leading causes of death.
文摘Background：Cyclosporine A （CsA） is a commonly used clinical immunosuppressant.However,CsA exposure in rabbits during the gestation period was shown to cause a postnatal decrease in the number of nephrons,with the effects remaining unknown.In this study,we aimed to explore the effects of CsA on metanephros development in the pregnant BALB/c mice.Methods：Pregnant mice were randomly divided into two groups,and CsA （10 mg·kg^-1·d^-1） was subcutaneously injected from gestation day 10.5 to day 16.5 in the CsA group,whereas a comparable volume of normal saline was given to the control group.All of the mice were sacrificed on gestation day 17.5 and serum CsA concentration was measured.The fetuses were removed and weighed,and their kidneys were prepared for histological assessment and polymerase chain reaction assay.In an in vitro experiment,embryo kidneys of fetal mice on gestation day 12.5 were used,and CsA （10 tmol/L） was added in the culture of the CsA group.The growth pattern of the ureteric bud and nephrons was assessed by lectin staining.Results：No significant differences in the weight of embryo （4.54 ± 1.22 vs.3.26 ± 1.09 mg） were observed between the CsA and control groups,the thickness of the cortical （510.0 ± 30.3 vs.350.0 ± 29.7 μm,P 〈 0.05） and nephrogenic zone （272.5 ± 17.2 vs.173.3 ± 24.0 μm,P 〈 0.05）,and the number of glomeruli （36.5 ± 0.7 vs.27.5 ± 2.1,P 〈 0.05） were reduced in the CsA group when compared to the control group.The cell proliferation of Ki-67 positive index between control and CsA group （307.0 ± 20.0 vs.219.0 ± 25.0,P 〈 0.05） in the nephrogenic zone was decreased with the increase of apoptotic cells （1 7.0 ± 2.0 vs.159.0 ± 33.0,P 〈 0.05）.The mRNA expression of WT-1,Pax2,and Pax8 was downregulated by CsA treatment.As for the in vitro CsA group,the branch number of the ureteric bud was decreased in the CsA-treated group with the nephrons missing in contrast to control after the incubation for 24 h and 72 h （all P〈 0.0001�
文摘Background:In the last decade,a varied prevalence of lifestyle-mediated health ailments ranging from infectious disorders to non-curable diseases has been observed.Globally the stone formation(lithiasis)in human kidneys has increased the trauma and economic burden.Furthermore,affordable rapid diagnosis,clinical trials,and therapeutics have to be addressed with newer holistic approaches.Objective:The current comprehensive review attempts to study kidney stones using emerging translational,con-ventional,and non-conventional research models,which include prokaryotic and eukaryotic systems(in vitro,semi-in vivo,and in vivo).Methods:The study eligibility criteria included systematic reviews and meta-analyses to explore various lithiatic models.Further,PubMed,PubMed Central,CINAHL Plus,Scopus,Web of Science,and EMBASE were used as data sources for the current study.A Measurement Tool to Assess Systematic Reviews(AMSTAR)was used.Results:All curated literature from past 55 years(1967-2022)were considered for this review with keywords as"Experimental models for human kidney stones"AND"Nephrolithasis"AND"Urolithasis".A total of 765 abstracts were reviewed for inclusion with 414 selected for full-text review.A total of 47 studies were analyzed.Mean AMSTAR score of 6.96/11(±1.84)suggests moderate quality of the systematic reviews.Conclusion:This review will empower clinicians,veterinarians,and researchers for a better understanding of the pathogenesis,causative factors,and prevalence of nephrolithiasis and urolithiasis and their associated mech-anisms with rapid,reliable,and reproducible models.The findings of the study will aid in designing global healthcare policy and regional insurance for lithiatic disorders with effective therapeutics which will result in an increased quality of life,leading to better health and hygiene.
文摘应用组织学、组织化学技术对南方鲇(Silurus meridionalis Chen)肾的发生及肾单位的发育进行了详细研究。结果表明:中肾的发生始于出膜后24h,其发生、发育过程可分为间充质细胞聚集、中肾小泡出现、肾小管芽形成、肾小体发生、初级肾单位形成、初级肾单位成熟及第二、三级肾单位发生等时期。出膜后19d,前肾解体时,第一代中肾单位才开始行使功能。19d至3月龄幼鱼中肾有大量间充质细胞。中肾肾单位的发育包括分化前期、分化期、发育期、成熟期4个时期。幼鱼PI上皮细胞具有大型PAS阳性颗粒是由于肾单位发育不完善,血管球有较大的通透性所致,也是区别于成鱼肾单位的明显特点。3月龄至2龄个体肾中仍有大量发育中的肾单位。
基金Supported by National Institutes of Health,No.DP2 OD008470Private funding was provided from the University of Notre Dame College of Science and Graduate Schoola generous donation to support stem cell research provided by the Gallagher Family
文摘Kidney disease is an escalating global health problem,for which the formulation of therapeutic approaches using stem cells has received increasing research attention.The complexity of kidney anatomy and function,which includes the diversity of renal cell types,poses formidable challenges in the identification of methods to generate replacement structures.Recent work using the zebrafish has revealed their high capacity to regenerate the integral working units of the kidney,known as nephrons,following acute injury.Here,we discuss these findings and explore the ways that zebrafish can be further utilized to gain a deeper molecular appreciation of renal stem cell biology,which may uncover important clues for regenerative medicine.
文摘AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.
