Landscape of microenvironment in Randall's plaque by single-cell sequencing

Randall's plaque is significantly associated with the occurrence of nephrolithiasis. However, the microenvironment of Randall's plaque is poorly characterized. To investigate the microenvironment of Randall's plaque, we analyzed single-cell RNA data of 3 Randall's plaque and 3 normal renal papillae tissue and identified 11 different cell types. We screened differentially expressed genes among all cell types between Randall's plaque and normal renal papillae. The microenvironment showed two cell types with multiple stone formation-associated transcriptomic programs. Contrary to previous studies, we did not observe macrophage M1/M2 imbalance. Notably, we detected ossification-associated macrophage is enriched in Randall's plaque and validated GPNMB and ACP5 were potential biomarkers on the ossification-associated macrophage. We also identified an endothelial subset harboring active communication (COL15A1+ PCDH17+ endothelial, DPECs) with other cells. Together with Immunofluorescence, we validated ossification-associated macrophage and DPECs are enriched in Randall's plaque tissue. Finally, cell-to-cell communication revealed that Loop of Henle, DPECs, and osteoblasts-associated macrophages was the main source of SPP1 signaling. Our work will further the understanding of the microenvironment among Randall's plaque tissues and provide deep insight into immune modulation.

A study of reduced port laparoscopic cholecystectomy

Background: The objective was to study various technical feasibility and safety, benefit of three port cholecystectomy over four port cholecystectomy.Methods: Total 25 patients have taken part in study with valid consent, in B.J. Medical College, Ahmedabad. All patient study regarding operative time, conversion rate, inta-operative complication, immediate postoperative complication, postoperative pain, requirement of postoperative analgesic, hospital stay, feasibility and safety.Results: Out of 25 patient mean ages 39.5 ranging from 25 to 60. Female 88%, male 12% are in this study. 72% patient have multiple stone, 28% have single stone. 96% and 4% patient has distended and contracted GB respectively. 92% patient have normal GB wall and 8% have thickened GB wall. 8%, 68% and 20% patient were discharge on 3rd, 2nd and 1st postoperative day respectively. Mean postoperative day was 4 ranging from 1 to 10. Conversion rate to open procedure is 12% in this study.Conclusions: Three port cholecystectomy is safe procedure in expert hand. It has less requirement of analgesic with less hospital stay with good cosmetic result.

Prevalence of subclinical hypothyroidism in cases of cholelithiasis

Background: This prospective study was carried out to analyse the prevalence of subclinical hypothyroidism in patients of gall stones.Methods: A prospective study was carried out in the Gandhi Medical College and associated Hamidia Hospital Bhopal from 2015 to 2016. Data was collected from patients who were admitted in surgical wards, with a provisional diagnosis of cholelithiasis. Patient was diagnosed cholelithiasis on abdominal ultrasonography and was tested for having subclinical hypothyroidism by testing fasting blood samples for serum TSH.Results: A total of 50 patients of cholelithiasis were included in present study. Females were 42 out of 50 (84%) and males were 8 out of 50 (16%). Most common age group was 41-50 (36%) correct (insignificant at p<0.05). 12 (24%) out 50 patients were hypothyroid. Out of total 42 females 11(26.19 %) were hypothyroid (insignificant at p<0.05). All stones in hypothyroidism patients were >1cm and overall 58% stones were >1cm (statically significant P<0.05). 03 out of 12 hypothyroidisms (25%) patient had single stones while 9 (75%) patient have multiple stone (statically significant P value <0.05). In hypothyroid cases most stones were of cholesterol type (58%) (Statically significant at P value≤0.05).Conclusions: Early diagnosis of hypothyroid state at subclinical level by monitoring TSH level so that they can be treated at early stages and burden of Cholelithiasis thus can be prevented.

Are stone analysis results different with repeated sampling?

Introduction: We assessed differences in results of stone analyses on subsequent sampling.Methods: A retrospective review of patients with stone analyses at a tertiary stone centre between March 2006 and July 2012 was performed. All stones were analyzed at a centralized laboratory using infrared spectroscopy. Patients were grouped according to the first predominant stone type on record, as defined by the predominant stone component of at least 60%. Stone groups included calcium oxalate (CaOx), calcium phosphate (CaP), uric acid (UA), cystine, struvite, mixed CaOx-CaP and mixed CaOx-UA. All patients had a full metabolic stone workup.Results: Of the 303 patients with stone analyses, 118 (38.9%) patients had multiple stone analyses. The mean age was 53.4 ±15.1 years, and 87 (73.7%) were males. Of the 118, the initial stone analysis showed 43 CaOx, 38 CaP, 21 UA, 4 CaOx-CaP, 2 CaOx-UA, 6 cystine, and 4 struvite. There was a different stone composition in 25 (21.2%) patients with a median time delay of 64.5 days. Different compositions were found in 7 CaOx (to 3 CaP, 2 CaOx-CaP, and 2 UA), 5 CaP (to 3 CaOx and 2 CaOx-CaP), 3 UA (to 3 CaOx), 4 CaOx-CaP (to 2 CaOx, 1 UA and 1 CaP), 2 CaOx-UA (to 2 CaOx) and 4 struvite (to 3 CaP and 1 UA).Conclusions: Stone composition was different in 21.2% of patients on subsequent analyses.

Effects of Wavenumber and Chirality on the Axial Compressive Behavior of Wavy Carbon Nanotubes: A Molecular Mechanics Study

The effects of wavenumber and chirality on the axial compressive behavior and properties of wavy carbon nanotubes (CNTs) with multiple Stone-Wales defects are investigated using molecular mechanics simulations with the adaptive intermolecular reactive empirical bond-order potential. The wavy CNTs are assumed to be point-symmetric with respect to their axial centers. It is found that the wavy CNT models, respectively, exhibit a buckling point and long wavelength buckling mode regardless of the wavenumbers and chiralities examined. It is also found that the wavy CNTs have nearly the same buckling stresses as their pristine straight counterparts.