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Whiles BB, Bird VG, Canales BK, DiBianco JM, Terry RS. Caution! AI Bot Has Entered the Patient Chat: ChatGPT Has Limitations in Providing Accurate Urologic Healthcare Advice. Urology 2023; 180:278-284. [PMID: 37467806 DOI: 10.1016/j.urology.2023.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/20/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To conduct the first study examining the accuracy of ChatGPT, an artificial intelligence (AI) chatbot, derived patient counseling responses based on clinical care guidelines in urology using a validated questionnaire. METHODS We asked ChatGPT a set of 13 urological guideline-based questions three times. Answers were evaluated for appropriateness and using Brief DISCERN (BD), a validated healthcare information assessment questionnaire. Data analysis included descriptive statistics and Student's t test (SAS Studio). RESULTS 60% (115/195) of ChatGPT responses were deemed appropriate. Variability existed between responses to the same prompt, with 25% of the 13 question sets having discordant appropriateness designations. The average BD score was 16.8 ± 3.59. Only 7 (54%) of 13 topics and 21 (54%) of 39 responses met the BD cut-off score of ≥16 to denote good-quality content. Appropriateness was associated with higher overall and Relevance domain scores (both P < .01). The lowest BD domain scores were for Source categories, since ChatGPT does not provide references by default. With prompting, 92.3% had ≥1 incorrect, misinterpreted, or nonfunctional citations. CONCLUSION While ChatGPT provides appropriate responses to urological questions more than half of the time, it misinterprets clinical care guidelines, dismisses important contextual information, conceals its sources, and provides inappropriate references. Chatbot models hold great promise, but users should be cautious when interpreting healthcare-related advice from existing AI models. Additional training and modifications are needed before these AI models will be ready for reliable use by patients and providers.
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Affiliation(s)
| | - Vincent G Bird
- Department of Urology, University of Florida, Gainesville, FL
| | | | - John M DiBianco
- Department of Urology, University of Florida, Gainesville, FL
| | - Russell S Terry
- Department of Urology, University of Florida, Gainesville, FL
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2
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Khan SR, Canales BK. Proposal for pathogenesis-based treatment options to reduce calcium oxalate stone recurrence. Asian J Urol 2023; 10:246-257. [PMID: 37538166 PMCID: PMC10394280 DOI: 10.1016/j.ajur.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/02/2022] [Accepted: 01/18/2023] [Indexed: 08/05/2023] Open
Abstract
Objective Prevalence of kidney stone disease continues to increase globally with recurrence rates between 30% and 50% despite technological and scientific advances. Reduction in recurrence would improve patient outcomes and reduce cost and stone morbidities. Our objective was to review results of experimental studies performed to determine the efficacy of readily available compounds that can be used to prevent recurrence. Methods All relevant literature up to October 2020, listed in PubMed is reviewed. Results Clinical guidelines endorse the use of evidence-based medications, such as alkaline agents and thiazides, to reduce urinary mineral supersaturation and recurrence. However, there may be additional steps during stone pathogenesis where medications could moderate stone risk. Idiopathic calcium oxalate stones grow attached to Randall's plaques or plugs. Results of clinical and experimental studies suggest involvement of reactive oxygen species and oxidative stress in the formation of both the plaques and plugs. The renin-angiotensin-aldosterone system (RAAS), nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, mitochondria, and NOD-like receptor pyrin domain containing-3 (NLRP3) inflammasome have all been implicated at specific steps during stone pathogenesis in animal models. Conclusion In addition to supersaturation-reducing therapies, the use of anti-oxidants, free radical scavengers, and inhibitors of NADPH oxidase, NLRP3 inflammasome, and RAAS may prove beneficial for stone prevention. Compounds such as statins and angiotensin converting enzyme inhibitors are already in use as therapeutics for hypertension and cardio-vascular disease and have previously shown to reduce calcium oxalate nephrolithiasis in rats. Although clinical evidence for their use in stone prevention in humans is limited, experimental data support they be considered along with standard evidence-based medications and clinical expertise when patients are being counselled for stone prevention.
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Affiliation(s)
- Saeed R. Khan
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
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Donelan W, Li S, Dominguez-Gutierrez PR, Anderson Iv A, Yang LJ, Nguyen C, Canales BK. Expression and secretion of glycosylated barley oxalate oxidase in Pichia pastoris. PLoS One 2023; 18:e0285556. [PMID: 37167324 PMCID: PMC10174515 DOI: 10.1371/journal.pone.0285556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
Oxalate oxidase is an enzyme that degrades oxalate and is used in commercial urinary assays to measure oxalate levels. The objective of this study was to establish an enhanced expression system for secretion and purification of oxalate oxidase using Pichia pastoris. A codon optimized synthetic oxalate oxidase gene derived from Hordeum vulgare (barley) was generated and cloned into the pPICZα expression vector downstream of the N-terminal alpha factor secretion signal peptide sequence and used for expression in P. pastoris X-33 strain. A novel chimeric signal peptide consisting of the pre-OST1 sequence fused to pro-αpp8 containing several amino acid substitutions was also generated to enhance secretion. Active enzyme was purified to greater than 90% purity using Q-Sepharose anion exchange chromatography. The purified oxalate oxidase enzyme had an estimated Km value of 256μM, and activity was determined to be 10U/mg. We have developed an enhanced oxalate oxidase expression system and method for purification.
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Affiliation(s)
- William Donelan
- Department of Urology, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - ShiWu Li
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Paul R Dominguez-Gutierrez
- Department of Urology, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Augustus Anderson Iv
- Department of Urology, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Li-Jun Yang
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Cuong Nguyen
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Benjamin K Canales
- Department of Urology, College of Medicine, University of Florida, Gainesville, Florida, United States of America
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Pavlinec JG, Martin M, Donelan W, Kwenda E, Dominguez-Gutierrez P, Bird VG, Canales BK. Initial experience: ex-vivo perfused pig kidney to study urinary oxalate excretion. Urolithiasis 2022; 50:239-247. [PMID: 35294609 DOI: 10.1007/s00240-022-01322-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
Existing animal models of renal oxalate excretion utilize either gut or peritoneal cavity for oxalate absorption. Ex vivo renal perfusion is an established tool for graft preservation. We sought to repurpose this concept to study the early pathogenesis of urinary lithiasis. Juvenile female Yorkshire porcine kidneys were removed laparoscopically and placed on an ex vivo cardiopulmonary bypass circuit utilizing whole-blood based perfusate. Pre-defined goals were identified for each attempt (n = 5) with plans to increase physiologic model complexity. Tissue perfusion and oxygenation were monitored by serial perfusate iSTAT testing. Once steady urine production was achieved, aqueous oxalate was injected into the perfusate. Renal outcomes were assessed by histology and blood/urinary assays. After demonstrating proof-of-concept in early trials, normothermic (37 °C) ex vivo whole-blood perfusion with Steen Solution™ was performed exceeding three hours at physiologic mean arterial pressures. Circuit parameters remained in the physiologic range for electrolytes, temperature, mean arterial pressure, lactate, and pH. Urine was produced in three experiments. Urinary filtrate demonstrated consistently higher urine creatinine compared to perfusate, and arterial perfusate oxalate boluses lead to urinary oxalate spikes followed by continuous oxalate clearance. Histopathologic analysis with H&E and Pizzolato's method staining demonstrated formation of calcium oxalate crystals. In light of these promising metabolite clearances, ex vivo porcine renal perfusion appears to be a feasible alternative to study oxalate excretion. Longer validation studies are necessary to establish this technique as a model for kidney stone pathogenesis.
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Affiliation(s)
- Jonathan G Pavlinec
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA.,Division of Urology, Department of Surgery, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA
| | - Mark Martin
- Redline Perfusion & Consulting, LLC, Gainesville, FL, USA
| | - William Donelan
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA
| | - Elizabeth Kwenda
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA
| | - Paul Dominguez-Gutierrez
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA
| | - Vincent G Bird
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA.,Division of Urology, Department of Surgery, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA
| | - Benjamin K Canales
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA. .,Division of Urology, Department of Surgery, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA.
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Soberón JR, Awoniyi CA, Perez MA, Vasilopoulos T, Canales BK. Obturator Nerve Blockade vs. Neuromuscular Blockade for the Prevention of Adductor Spasm in Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized Controlled Trial. Pain Med 2021; 22:1253-1260. [PMID: 33537703 DOI: 10.1093/pm/pnaa448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The obturator nerve runs along the posterolateral walls of the bladder and electrosurgical stimulation in this region can result in adductor spasm which can occur suddenly and unexpectedly with potentially catastrophic results. METHODS Sixty patients were prospectively randomized to receive either a single-injection ultrasound-guided obturator nerve block (ONB) or intravenous rocuronium after induction of general anesthesia (i.e., neuromuscular block [NMB]). The primary objective was to compare the incidence of adductor spasm during posterolateral bladder tumor resection when ONB or NMB was used. Secondary objectives included assessment of fall risk and incidence of adverse events. RESULTS Five patients in the ONB group and six in the NMB group had nonlateral wall lesions. One patient in the ONB group suffered a cardiac arrest after induction of general anesthesia. Of the remaining 48 patients, six (10.2%) experienced adductor spasm. Most of these patients were in the NMB group (5/24, 20.8%), with only one patient (1/24, 4.2%) experiencing obturator reflex in the ONB group; this difference was not statistically significant (P=0.19). Patients in the ONB group had a greater decrease in mean hip adductor strength. Our study population was found to be at high risk of falls before surgery. There were no statistically significant group differences in the Timed Up and Go test, with time to perform the test increasing in both groups. CONCLUSIONS Both techniques are safe and efficacious for preventing adductor spasm. Our data and experience suggest that the ONB is relatively easy to perform and should be considered in patients with posterolateral bladder tumors.
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Affiliation(s)
- José R Soberón
- Department of Anesthesiology, North Florida/Southern Georgia Veterans Health System and the University of Florida, Gainesville, Florida, USA
| | - Caleb A Awoniyi
- Department of Anesthesiology, North Florida/Southern Georgia Veterans Health System and the University of Florida, Gainesville, Florida, USA
| | - Melissa Alvarez Perez
- Central Florida Pain Management (Physical Medicine and Rehabilitation), Ocala, Florida, USA
| | - Terrie Vasilopoulos
- Departments of Anesthesiology and Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Benjamin K Canales
- Department of Urology, University of Florida, Gainesville, Florida, USA.,Department of Surgery, North Florida/Southern Georgia Veterans Health System, Gainesville, Florida, USA
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Steadman SD, Canales BK. Gross Hematuria Eight Years Following Nephrectomy for Renal Cell Cancer. Urology 2020; 143:1-4. [PMID: 32505621 DOI: 10.1016/j.urology.2020.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022]
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Canales BK. Editorial Comment on: “Alkalinizing Agents: A Review of Prescription, Over-the-Counter, and Medical Food Supplements” by Stern et al. (J Endourol 2020;34(1):1–6; DOI: 10.1089/end.2019.0292). J Endourol 2020; 34:639. [DOI: 10.1089/end.2019.0666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Niu A, Carpenter TO, Grams JM, Bozorgmehri S, Tommasini SM, Schafer AL, Canales BK. High dose vitamin D supplementation does not rescue bone loss following Roux-en-Y gastric bypass in female rats. Bone 2019; 127:172-180. [PMID: 31226531 PMCID: PMC6708762 DOI: 10.1016/j.bone.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/26/2019] [Accepted: 06/17/2019] [Indexed: 01/30/2023]
Abstract
Postoperative bone loss and increased fracture risk associated with Roux-en-Y gastric bypass (RYGB) have been attributed to vitamin D/calcium malabsorption and resultant secondary hyperparathyroidism (HPT). Adequate vitamin D supplementation (VDS), particularly in an older female population, reduces incidence of secondary HPT but the effect on bone loss and fracture risk remains unclear. To investigate whether VDS corrects the RYGB bone phenotype, 41 obese adult female rats were randomized to RYGB with 1000 IU (R1000) or 5000 IU (R5000) vitamin D/kg food or a sham surgical procedure with either paired (PF) or ad libitum (AL) feeding. Bone turnover markers, urinary calcium/creatinine ratio (CCR), and serum calciotropic and gut hormones were assessed throughout a 14-week postoperative period. Femurs were analyzed by micro-computed tomography (μCT), three-point bending test, and histomorphometry. 1000 IU animals had low 25‑hydroxyvitamin D (25(OH)D), high serum parathyroid hormone (PTH), and very low urine CCR levels. 5000 IU corrected the 25(OH)D and secondary HPT but did not increase urine CCR or serum levels of 1,25‑dihydroxyvitamin D (1,25(OH)D) significantly between RYGB groups. Compared to sham animals at 14 weeks, RYGB animals had significantly higher serum osteocalcin (OCN) and C-terminal telopeptide (CTX) levels. The gut hormone peptide tyrosine tyrosine hormone (PYY) was higher in the RYGB groups, and leptin was lower. μCT and biomechanical testing revealed RYGB females had decreased cortical and trabecular bone volume and weaker, stiffer bone than controls. Histomorphometry showed decreased bone volume and increased osteoid volume with increased mineral apposition rate in RYGB compared to controls. No differences in bone phenotype were identified between 1000 IU and 5000 IU groups, and osteoclast numbers were comparable across all four groups. Thus, in our model, 5000 IU VDS corrected vitamin D deficiency and secondary HPT but did not rescue RYGB mineralization rate nor the osteomalacia phenotype. Longer studies in this model are required to evaluate durability of these detrimental effects. Our findings not only underscore the importance of lifelong repletion of both calcium and vitamin D but also suggest that additional factors affect skeletal health in this population.
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Affiliation(s)
- Aidi Niu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Thomas O Carpenter
- Department of Pediatrics, Endocrine Section, Yale University School of Medicine, New Haven, CT, United States of America
| | - Jayleen M Grams
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America; Department of Surgery, Birmingham VA Medical Center, Birmingham, AL, United States of America
| | - Shahab Bozorgmehri
- Department of Urology, North Florida/South Georgia Veterans Affairs Medical Center and University of Florida, Gainesville, FL, United States of America
| | - Steven M Tommasini
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT 06520, United States of America
| | - Anne L Schafer
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, United States of America
| | - Benjamin K Canales
- Department of Urology, North Florida/South Georgia Veterans Affairs Medical Center and University of Florida, Gainesville, FL, United States of America.
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Canales BK, Sharma N, Yuzhakov SV, Bozorgmehri S, Otto BJ, Bird VG. Long-term Recurrence Rates in Uric Acid Stone Formers With or Without Medical Management. Urology 2019; 131:46-52. [PMID: 31158354 DOI: 10.1016/j.urology.2019.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if medical therapy affects long-term clinical outcomes in uric acid stone formers (UASF). METHODS We identified 53 UASF who had complete stone clearance following stone procedure by computed tomography (CT) and had ≥1 postoperative 24-hour urine collection and a clinical follow-up ≥6 months with a surveillance CT scan. Patients were divided into "adherent to medical therapy" (compliance with potassium citrate ± allopurinol verified by computerized pharmacy data) or nonadherent groups. Primary outcomes were CT stone recurrence rate and need for surgical stone intervention. RESULTS We found 28 of 53 (53%) adherent and 25 of 53 (47%) nonadherent individuals (14 declined medication, 11 intolerant). With median follow-up of 24 months, no significant differences were noted between groups in regards to stone recurrence (32%; P = .99) or in 24-hour urine pH compared to baseline or follow-up (range 5.46-5.62; P = 0.06). Adherent patients, however, had smaller CT stone recurrence sizes (6.3 ± 3.8 vs 11.8 ± 6.2 mm, P = .02), were 28% less likely to require stone surgery compared to those without therapy (P <.01), and trended toward longer time intervals without recurrence (23.1 ± 18.8 vs 10.5 ± 7.5 months, P = .10) compared to nonadherents. Study confounders included a variety of medication dosages and adherences, limited nonadherent follow-up, and small study number. CONCLUSION UASF adherent to medical therapy had smaller recurrence sizes and fewer surgical interventions vs nonadherent, highlighting the protective role of potassium citrate in UA stone disease. The comparable urine pH and stone recurrence rates between groups, however, underscore areas for improvement in future UA stone prevention strategies.
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Affiliation(s)
| | - Nitin Sharma
- Department of Urology, University of Florida, Gainesville, FL
| | | | | | - Brandon J Otto
- Department of Urology, University of Florida, Gainesville, FL
| | - Vincent G Bird
- Department of Urology, University of Florida, Gainesville, FL
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Espino-Grosso P, Monsour C, Canales BK. The Effect of Calcium and Vitamin B6 Supplementation on Oxalate Excretion in a Rodent Gastric Bypass Model of Enteric Hyperoxaluria. Urology 2018; 124:310.e9-310.e14. [PMID: 30412704 DOI: 10.1016/j.urology.2018.06.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/21/2018] [Accepted: 06/11/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To test the effect of calcium and vitamin B6 therapies on urinary oxalate excretion in a rodent model of enteric hyperoxaluria after Roux-en Y gastric bypass (RYGB) surgery. METHODS Obese male Sprague-Dawley rats underwent sham (n = 7) or RYGB (n = 10). Animals were maintained on low oxalate (1.5%) and fat (10%; LOF), normal calcium (0.6 %) diet for 8 weeks and then completed a 2-phase crossover metabolic study. In the first 2-week phase, animals were fed a Low oxalate and fat (LOF), high calcium (2.4%; HC) diet. After a 2-week washout, rats were fed a LOF/normal calcium diet highly enriched with vitamin B6. Urine was collected before and after each intervention. Plasma pyridoxal 5'-phosphate (PLP) and metabolites were measured baseline and 11 weeks after sham or RYGB. RESULTS Compared to baseline, sham animals on LOF/HC diet doubled their urinary calcium excretion but not oxalate. RYGB animals on LOF/HC diet decreased urinary oxalate excretion 28% (P = .001) without a significant rise in urinary calcium. Vitamin B6 supplementation decreased RYGB urinary oxalate by approximately 15% (P = .06), and serum PLP explained 63% of urinary oxalate variability. CONCLUSION Based on the findings in this model, calcium supplementation appears to be a reasonable therapy to decrease urinary oxalate in RYGB patients who maintain a low fat and oxalate diet. Serum PLP had a fair correlation to urinary oxalate excretion and may be a useful screening tool in hyperoxaluric RYGB patients. Further experimental human studies after RYGB are necessary to determine whether these commonly employed supplements truly provide a benefit in enteric hyperoxaluria.
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O'Kell AL, Lovett AC, Canales BK, Gower LB, Khan SR. Development of a two-stage model system to investigate the mineralization mechanisms involved in idiopathic stone formation: stage 2 in vivo studies of stone growth on biomimetic Randall's plaque. Urolithiasis 2018; 47:335-346. [PMID: 30218116 DOI: 10.1007/s00240-018-1079-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/06/2018] [Indexed: 11/25/2022]
Abstract
Idiopathic stone formers often form calcium oxalate (CaOx) stones that are attached to calcium phosphate (CaP) deposits in the renal tissue, known as Randall's plaques (RP). Plaques are suggested to originate in the renal tubular basement membrane and spread into the interstitial regions where collagen fibrils and vesicles become mineralized; if the epithelium is breached, the RP becomes overgrown with CaOx upon exposure to urine. We have developed a two-stage model system of CaP-CaOx composite stones, consisting of Stage (1) CaP mineralized plaque, followed by Stage (2) CaOx overgrowth into a stone. In our first paper in this series (Stage 1), osteopontin (and polyaspartate) were found to induce a non-classical mineralization of porcine kidney tissues, producing features that resemble RP. For the Stage 2 studies presented here, biomimetic RPs from Stage 1 were implanted into the bladders of rats. Hyperoxaluria was induced with ethylene glycol for comparison to controls (water). After 4 weeks, rats were sacrificed and the implants were analyzed using electron microscopy and X-ray microanalyses. Differences in crystal phase and morphologies based upon the macromolecules present in the biomimetic plaques suggest that the plaques have the capacity to modulate the crystallization reactions. As expected, mineral overgrowths on the implants switched from CaP (water) to CaOx (hyperoxaluric). The CaOx crystals were aggregated and mixed with organic material from the biomimetic RP, along with some amorphous and spherulitic CaOx near the "stone" surfaces, which seemed to have become compact and organized towards the periphery. This system was successful at inducing "stones" more similar to human idiopathic kidney stones than other published models.
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Affiliation(s)
- Allison L O'Kell
- Department of Urology, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32610-0247, USA.,Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, Gainesville, FL, 32610-0126, USA
| | - Archana C Lovett
- Department of Materials Science and Engineering, University of Florida, 210A Rhines Hall, P.O. Box 116400, Gainesville, FL, 32611‑6400, USA
| | - Benjamin K Canales
- Department of Urology, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32610-0247, USA
| | - Laurie B Gower
- Department of Materials Science and Engineering, University of Florida, 210A Rhines Hall, P.O. Box 116400, Gainesville, FL, 32611‑6400, USA.
| | - Saeed R Khan
- Department of Urology, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32610-0247, USA. .,Department of Pathology, College of Medicine, University of Florida, JHMHSC D6‑33C 1600 SW Archer Road, Gainesville, FL, 32610, USA.
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Dominguez-Gutierrez PR, Kusmartsev S, Canales BK, Khan SR. Calcium Oxalate Differentiates Human Monocytes Into Inflammatory M1 Macrophages. Front Immunol 2018; 9:1863. [PMID: 30186283 PMCID: PMC6113402 DOI: 10.3389/fimmu.2018.01863] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/27/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose A number of hyperoxaluric states have been associated with calcium oxalate (CaOx) deposits in the kidneys. In animal models of stone disease, these crystals interact with circulating monocytes that have migrated into the kidney as part of innate immunity. Similarly, macrophages surround CaOx crystals in kidneys of patients excreting high levels of oxalate. We investigate the effect of this exposure and subsequent human immunological response in vitro. Materials and methods Primary human monocytes were collected from healthy donors and exposed to CaOx, potassium oxalate, and zinc oxalate (ZnOx). Cytokine production was measured with a multiplex ELISA. Quantitative reverse transcription-polymerase chain reaction was done to validate the mRNA profile expression. M1 macrophage phenotype was confirmed with immunofluorescence microscopy. Results Both primary monocytes and THP-1 cells, a human monocytic cell line, respond strongly to CaOx crystals in a dose-dependent manner producing TNF-α, IL-1β, IL-8, and IL-10 transcripts. Exposure to CaOx followed by 1 h with LPS had an additive effect for cytokine production compared to LPS alone, however, LPS followed by CaOx led to significant decrease in cytokine production. Supernatants taken from monocytes were previously exposed to CaOx crystals enhance M2 macrophage crystal phagocytosis. CaOx, but not potassium or ZnOx, promotes monocyte differentiation into inflammatory M1-like macrophages. Conclusion In our in vitro experiment, human monocytes were activated by CaOx and produced inflammatory cytokines. Monocytes recognized CaOx crystals through a specific mechanism that can enhance or decrease the innate immune response to LPS. CaOx promoted M1 macrophage development. These results suggest that monocytes have an important role promoting CaOx-induced inflammation.
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Affiliation(s)
| | - Sergei Kusmartsev
- Department of Urology, University of Florida, Gainesville, FL, United States
| | - Benjamin K Canales
- Department of Urology, University of Florida, Gainesville, FL, United States
| | - Saeed R Khan
- Department of Urology, University of Florida, Gainesville, FL, United States.,Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
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Canales BK, Hatch M. Oxalobacter formigenes colonization normalizes oxalate excretion in a gastric bypass model of hyperoxaluria. Surg Obes Relat Dis 2017; 13:1152-1157. [PMID: 28552742 DOI: 10.1016/j.soard.2017.03.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hyperoxaluria and oxalate kidney stones frequently develop after Roux-en-Y gastric bypass (RYGB). Oxalobacter formigenes can degrade ingested oxalate. OBJECTIVES Examine the effect of O. formigenes wild rat strain (OXWR) colonization on urinary oxalate excretion and intestinal oxalate transport in a hyperoxaluric RYGB model. SETTING Basic Science Laboratory, United States. METHODS At 21 weeks of age, 28 obese male Sprague-Dawley rats survived Sham (n = 10) or RYGB (n = 18) surgery and were maintained on a 1.5% potassium oxalate, 40% fat diet. At 12 weeks postoperatively, half the animals in each group were gavaged with OXWR. At 16 weeks, percent dietary fat content was lowered to 10%. Urine and stool were collected weekly to determine oxalate and colonization status, respectively. At week 20, [14 C]-oxalate fluxes and electrical parameters were measured in vitro across isolated distal colon and jejunal (Roux limb) tissue mounted in Ussing Chambers. RESULTS RYGB animals lost 22% total weight while Shams gained 5%. On a moderate oxalate diet, urinary oxalate excretion was 4-fold higher in RYGB than Sham controls. OXWR colonization, obtained in all gavaged animals, reduced urinary oxalate excretion 74% in RYGB and 39% in Sham and was further augmented by lowering the percentage of dietary fat. Finally, OXWR colonization significantly enhanced basal net colonic oxalate secretion in both groups. CONCLUSIONS In our model, OXWR lowered urinary oxalate by luminal oxalate degradation in concert with promotion of enteric oxalate elimination. Trials of O. formigenes colonization and low-fat diet are warranted in calcium oxalate stone formers with gastric bypass and resistant hyperoxaluria.
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Affiliation(s)
- Benjamin K Canales
- Department of Urology, North Florida/South Georgia Veterans Affairs Medical Center and University of Florida, Gainesville, Florida.
| | - Marguerite Hatch
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
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Abstract
OBJECTIVE To investigate the efficacy and safety of alpha blockers in the treatment of patients with ureteric stones. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane Central Register of Controlled Trials, Web of Science, Embase, LILACS, and Medline databases and scientific meeting abstracts to July 2016. REVIEW METHODS Randomized controlled trials of alpha blockers compared with placebo or control for treatment of ureteric stones were eligible. : Two team members independently extracted data from each included study. The primary outcome was the proportion of patients who passed their stone. Secondary outcomes were the time to passage; the number of pain episodes; and the proportions of patients who underwent surgery, required admission to hospital, and experienced an adverse event. Pooled risk ratios and 95% confidence intervals were calculated for the primary outcome with profile likelihood random effects models. Cochrane Collaboration's tool for assessing risk of bias and the GRADE approach were used to evaluate the quality of evidence and summarize conclusions. RESULTS 55 randomized controlled trials were included. There was moderate quality evidence that alpha blockers facilitate passage of ureteric stones (risk ratio 1.49, 95% confidence interval 1.39 to 1.61). Based on a priori subgroup analysis, there seemed to be no benefit to treatment with alpha blocker among patients with smaller ureteric stones (1.19, 1.00 to 1.48). Patients with larger stones treated with an alpha blocker, however, had a 57% higher risk of stone passage compared with controls (1.57, 1.17 to 2.27). The effect of alpha blockers was independent of stone location (1.48 (1.05 to 2.10) for upper or middle stones; 1.49 (1.38 to 1.63) for lower stones). Compared with controls, patients who received alpha blockers had significantly shorter times to stone passage (mean difference -3.79 days, -4.45 to -3.14; moderate quality evidence), fewer episodes of pain (-0.74 episodes, -1.28 to -0.21; low quality evidence), lower risks of surgical intervention (risk ratio 0.44, 0.37 to 0.52; moderate quality evidence), and lower risks of admission to hospital (0.37, 0.22 to 0.64; moderate quality evidence). The risk of a serious adverse event was similar between treatment and control groups (1.49, 0.24 to 9.35; low quality evidence). CONCLUSIONS Alpha blockers seem efficacious in the treatment of patients with ureteric stones who are amenable to conservative management. The greatest benefit might be among those with larger stones. These results support current guideline recommendations advocating a role for alpha blockers in patients with ureteric stones. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration No CRD42015024169.
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Affiliation(s)
- John M Hollingsworth
- Department of Urology, University of Michigan, 2800 Plymouth Rd, Building 16, 1st Floor, Ann Arbor, MI 48109, USA
| | - Benjamin K Canales
- Department of Urology, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Mary A M Rogers
- Department of Internal Medicine, Division of General Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, 4th Floor, Ann Arbor, MI 48109, USA
| | - Shyam Sukumar
- Minneapolis Veterans Administration Health Care System and Department of Urology, University of Minnesota, Mayo Memorial Building, 420 Delaware St SE, MMC 394, Minneapolis, MN 55455, USA
| | - Phyllis Yan
- Department of Urology, University of Michigan, 2800 Plymouth Rd, Building 16, 1st Floor, Ann Arbor, MI 48109, USA
| | - Gretchen M Kuntz
- Borland Library, University of Florida, 653-1 W 8th St, Jacksonville, FL 32209, USA
| | - Philipp Dahm
- Minneapolis Veterans Administration Health Care System and Department of Urology, University of Minnesota, Mayo Memorial Building, 420 Delaware St SE, MMC 394, Minneapolis, MN 55455, USA
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Canales BK, Sinclair L, Kang D, Mench AM, Arreola M, Bird VG. Changing Default Fluoroscopy Equipment Settings Decreases Entrance Skin Dose in Patients. J Urol 2016; 195:992-7. [DOI: 10.1016/j.juro.2015.10.088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - Lindsay Sinclair
- Department of Radiology, Oregon Health and Science University, Salem, Oregon
| | - Diana Kang
- Department of Urology, University of Florida, Gainesville, Florida
- Department of Urology, Scripps Green Hospital, La Jolla, California
| | - Anna M. Mench
- Department of Imaging, Salem Hospital, Salem, Oregon
| | - Manuel Arreola
- Department of Radiology, Clinical Radiological Physics, University of Florida, Gainesville, Florida
| | - Vincent G. Bird
- Department of Urology, University of Florida, Gainesville, Florida
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Canales BK, Hatch M. MP67-13 HIGH DIETARY FAT PROMOTES OXALATE TRANSPORT IN THE RAT COLON INDEPENDENT OF GASTRIC BYPASS SURGERY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Peck AB, Canales BK, Nguyen CQ. Oxalate-degrading microorganisms or oxalate-degrading enzymes: which is the future therapy for enzymatic dissolution of calcium-oxalate uroliths in recurrent stone disease? Urolithiasis 2015; 44:45-50. [PMID: 26645869 DOI: 10.1007/s00240-015-0845-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/05/2015] [Indexed: 12/25/2022]
Abstract
Renal urolithiasis is a pathological condition common to a multitude of genetic, physiological and nutritional disorders, ranging from general hyperoxaluria to obesity. The concept of quickly dissolving renal uroliths via chemolysis, especially calcium-oxalate kidney stones, has long been a clinical goal, but yet to be achieved. Over the past 25 years, there has been a serious effort to examine the prospects of using plant and microbial oxalate-degrading enzymes known to catabolize oxalic acid and oxalate salts. While evidence is emerging that bacterial probiotics can reduce recurrent calcium-oxalate kidney stone disease by lowering systemic hyperoxaluria, the possible use of free oxalate-degrading enzyme therapy remains a challenge with several hurdles to overcome before reaching clinical practice.
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Affiliation(s)
- Ammon B Peck
- Department of Infectious Diseases and Pathology, University of Florida College of Veterinary Medicine, P.O Box 100125, VAB, Bldg 1017, Gainesville, FL, 32610, USA.
| | - Benjamin K Canales
- Department of Urology, University of Florida College of Medicine, P.O. Box 100247, 1600 SW Archer Rd, Gainesville, FL, 32610, USA
| | - Cuong Q Nguyen
- Department of Infectious Diseases and Pathology, University of Florida College of Veterinary Medicine, P.O Box 100125, VAB, Bldg 1017, Gainesville, FL, 32610, USA
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Kusmartsev S, Dominguez-Gutierrez PR, Canales BK, Bird VG, Vieweg J, Khan SR. Calcium Oxalate Stone Fragment and Crystal Phagocytosis by Human Macrophages. J Urol 2015; 195:1143-51. [PMID: 26626217 DOI: 10.1016/j.juro.2015.11.048] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 01/28/2023]
Abstract
PURPOSE In murine and human hyperoxaluric conditions macrophages can be seen surrounding renal calcium oxalate crystal deposits. We hypothesized that macrophages have a role in degrading and destroying these deposits. We investigated the inflammatory response and phagocytic mechanisms when macrophages were exposed to human kidney stones and inorganic crystals. MATERIALS AND METHODS Human monocytes were differentiated into resting, fully differentiated macrophages by treatment with recombinant human macrophage colony-stimulating factor (M-CSF) or GM-CSF (granulocyte M-CSF) for 6 days. After confirming phenotype by flow cytometry the macrophages were exposed for 20 hours to fragments of sterile human calcium oxalate stones or calcium oxalate crystals. Crystal uptake was determined, and supernatant cytokine and chemokine profiles were analyzed using antibody arrays. Quantitative reverse transcriptase-polymerase chain reaction was done to validate mRNA profile expression. RESULTS Under direct vision fluorescence microscopy activated human macrophages were noted to surround stone fragments and synthesized crystals, and destroy them in a step-by-step process that involved clathrin mediated endocytosis and phagocytosis. An inflammatory cascade was released by macrophages, including the chemokines chemokine ligand (CCL)2, CCL3, interleukin (IL)-1 receptor antagonist (IL-1ra), complement component C5/C5a and IL-8. Response patterns to stone and crystal material depended on macrophage phenotype and activation status. CONCLUSIONS In our in vitro study macrophages differentiated with M-CSF showed greater ability to phagocytize crystal deposits than those treated with GM-CSF. Following clathrin mediated endocytosis macrophages released a number of cytokines that are crucial for the inflammatory immune response. This suggests that tissue macrophages have an important role in preventing kidney stone disease by removing and digesting interstitial renal crystal deposits.
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Affiliation(s)
- Sergei Kusmartsev
- Department of Urology, College of Medicine, University of Florida, Gainesville, Florida
| | | | - Benjamin K Canales
- Department of Urology, College of Medicine, University of Florida, Gainesville, Florida
| | - Vincent G Bird
- Department of Urology, College of Medicine, University of Florida, Gainesville, Florida
| | - Johannes Vieweg
- Department of Urology, College of Medicine, University of Florida, Gainesville, Florida
| | - Saeed R Khan
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida.
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20
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Canales BK. Comment On: Prospective evaluation of urinary metabolic indices in severely obese adolescents after weight loss surgery. Surg Obes Relat Dis 2015; 12:367-8. [PMID: 26077698 DOI: 10.1016/j.soard.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Benjamin K Canales
- Department of Urology, University of Florida, Gainesville, Florida; North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, Florida
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22
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Abstract
Over the past 10 years, a variety of reports have linked bariatric surgery to metabolic changes that alter kidney stone risk. Most of these studies were retrospective, lacked appropriate controls, or involved bariatric patients with a variety of inclusion criteria. Despite these limitations, recent clinical and experimental research has contributed to our understanding of the pathophysiology of stone disease in this high-risk population. This review summarizes the urinary chemistry profiles that may be responsible for the increased kidney stone incidence seen in contemporary epidemiological bariatric studies, outlines the mechanisms of hyperoxaluria and potential therapies through a newly described experimental bariatric animal model, and provides a focused appraisal of recommendations for reducing stone risk in bariatric stone formers.
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Khan SR, Canales BK. Unified theory on the pathogenesis of Randall's plaques and plugs. Urolithiasis 2014; 43 Suppl 1:109-23. [PMID: 25119506 DOI: 10.1007/s00240-014-0705-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/23/2014] [Indexed: 01/19/2023]
Abstract
Kidney stones develop attached to sub-epithelial plaques of calcium phosphate (CaP) crystals (termed Randall's plaque) and/or form as a result of occlusion of the openings of the Ducts of Bellini by stone-forming crystals (Randall's plugs). These plaques and plugs eventually extrude into the urinary space, acting as a nidus for crystal overgrowth and stone formation. To better understand these regulatory mechanisms and the pathophysiology of idiopathic calcium stone disease, this review provides in-depth descriptions of the morphology and potential origins of these plaques and plugs, summarizes existing animal models of renal papillary interstitial deposits, and describes factors that are believed to regulate plaque formation and calcium overgrowth. Based on evidence provided within this review and from the vascular calcification literature, we propose a "unified" theory of plaque formation-one similar to pathological biomineralization observed elsewhere in the body. Abnormal urinary conditions (hypercalciuria, hyperoxaluria, and hypocitraturia), renal stress or trauma, and perhaps even the normal aging process lead to transformation of renal epithelial cells into an osteoblastic phenotype. With this de-differentiation comes an increased production of bone-specific proteins (i.e., osteopontin), a reduction in crystallization inhibitors (such as fetuin and matrix Gla protein), and creation of matrix vesicles, which support nucleation of CaP crystals. These small deposits promote aggregation and calcification of surrounding collagen. Mineralization continues by calcification of membranous cellular degradation products and other fibers until the plaque reaches the papillary epithelium. Through the activity of matrix metalloproteinases or perhaps by brute physical force produced by the large sub-epithelial crystalline mass, the surface is breached and further stone growth occurs by organic matrix-associated nucleation of CaOx or by the transformation of the outer layer of CaP crystals into CaOx crystals. Should this theory hold true, developing an understanding of the cellular mechanisms involved in progression of a small, basic interstitial plaque to that of an expanding, penetrating plaque could assist in the development of new therapies for stone prevention.
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Affiliation(s)
- Saeed R Khan
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, 32610, USA,
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24
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Hegland DL, Canales BK, Katz RI. Quadriparesis from air emboli during percutaneous nephrolithotomy. J Clin Anesth 2014; 26:318-20. [PMID: 24867800 DOI: 10.1016/j.jclinane.2014.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/31/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
Quadriparesis is a potentially catastrophic complication during operative procedures. It may result from a number of different types of central nervous system insults. A case of quadriparesis following an otherwise unremarkable percutaneous nephrolithotomy surgery is reported. The quadriparesis resulted from multiple air micro emboli.
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Affiliation(s)
- Dustin L Hegland
- Anesthesiology Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA; Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA.
| | - Benjamin K Canales
- Department of Urology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Robert I Katz
- Anesthesiology Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA; Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA
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Canales BK, Schafer AL, Shoback DM, Carpenter TO. Gastric bypass in obese rats causes bone loss, vitamin D deficiency, metabolic acidosis, and elevated peptide YY. Surg Obes Relat Dis 2014; 10:878-84. [PMID: 24969093 DOI: 10.1016/j.soard.2014.01.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/12/2013] [Accepted: 01/18/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Metabolic bone disease and bariatric surgery have long been interconnected. The objective of this study is to better understand the mechanisms of bone mass loss after Roux-en-Y gastric bypass (RYGB) surgery. We evaluated mineral homeostasis and bone mass in diet-induced obese (DIO) rats after RYGB or sham surgery. METHODS Twelve DIO male Sprague Dawley rats underwent RYGB (n = 8) or sham (n = 4) surgery at 21 weeks of age. Postoperatively, animals ate an ad libitum 40% fat, normal calcium diet and were euthanized 22 weeks later. Serum and urine chemistries, insulin, leptin, bone turnover markers (BTM), and calciotropic and gut hormones were measured before and 22 weeks after surgery. Femurs were analyzed using microcomputed tomography (µCT). RESULTS Compared to sham, RYGB animals had lower serum bicarbonate, calcium, 25-hydroxyvitamin D, insulin, and leptin levels with higher serum parathyroid hormone, peptide YY, and urinary calcium at 43 weeks of age. Sham control rats gained weight and had coupled decreases in formation (P1NP and OC) and unchanged resorption (CTX) BTMs. Comparatively, RYGB animals had higher serum CTX and OC but even lower P1NP levels than controls. µCT revealed lower trabecular bone volume, number, and thickness and lower cortical bone volume, thickness, and moment of inertia relative to controls. CONCLUSION In rats with DIO, long-term RYGB-associated bone resorption appears to be driven in part by vitamin D malabsorption and secondary hyperparathyroidism. Other mechanisms, such as chronic acidosis, changes in fat-secreted hormones, and persistently elevated gut-derived hormone peptide YY, may also contribute to observed bone mass differences. Further investigation of these potential contributors to bone loss may lead to new targets for skeletal maintenance after RYGB.
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Affiliation(s)
- Benjamin K Canales
- Department of Urology, North Florida/South Georgia Veterans Affairs Medical Center and University of Florida, Gainesville, Florida.
| | - Anne L Schafer
- Endocrine Research Unit, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California
| | - Dolores M Shoback
- Endocrine Research Unit, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California
| | - Thomas O Carpenter
- Department of Pediatrics (Endocrinology), Yale University School of Medicine, New Haven, Connecticut
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Stone WZ, Wymer DC, Canales BK. Fluorodeoxyglucose-positron-emission tomography/computed tomography imaging for adrenal masses in patients with lung cancer: review and diagnostic algorithm. J Endourol 2014; 28:104-11. [PMID: 23927734 PMCID: PMC3880901 DOI: 10.1089/end.2013.0380] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Positron-emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) is used as first-line staging for patients with newly diagnosed non-small cell lung cancer (NSCLC). Our purpose was to review the accuracy of FDG-PET/CT to predict adrenal gland metastasis, explain the causes for false-positive PET, and provide a diagnostic algorithm. PATIENTS AND METHODS Two patients with incidentally discovered lung masses were found to have hypermetabolic adrenal activity by FDG-PET/CT with maximal standard uptake value (SUV) of 4.5 and 6.5. A MEDLINE search was performed on the topic of FDG-PET/CT, adrenal gland metastasis, and NSCLC. Literature was reviewed with regard to diagnosis, accuracy, outcomes, and alternative imaging or diagnostic strategies. RESULTS Both patients underwent transabdominal laparoscopic adrenalectomy and were found to have nodular hyperplasia without evidence of adrenal tumor. A total of seven articles containing 343 patients were identified as having pertinent oncologic information for NSCLC patients with adrenal lesions. Sensitivity and specificity of PET/CT for distant metastasis was 94% and 85%, respectively, but only 13% (44/343) of these patients had histologically confirmed adrenal diagnoses. Based on this, a diagnostic algorithm was created to aid in decision making. CONCLUSIONS Although PET/CT has high sensitivity and specificity for adrenal metastasis in the setting of NSCLC, adrenal biopsy or other secondary imaging should be considered to confirm the finding. Adrenalectomy in lieu of biopsy may have both diagnostic and therapeutic benefit in cases where the adrenal mass is ≥10 mm with high PET maximum SUV (≥3.1) and SUV ratios (>2.5), where washout CT or chemical shift MRI is positive, or where percutaneous biopsy is deemed too difficult or unsafe.
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Affiliation(s)
- W. Zachary Stone
- Department of Urology, University of Florida, Gainesville, Florida
| | - David C. Wymer
- Department of Radiology, University of Florida, Gainesville, Florida
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Canales BK, Ellen J, Khan SR, Hatch M. Steatorrhea and hyperoxaluria occur after gastric bypass surgery in obese rats regardless of dietary fat or oxalate. J Urol 2013; 190:1102-9. [PMID: 23499748 DOI: 10.1016/j.juro.2013.02.3229] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 02/20/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE We determined the effect of dietary fat and oxalate on fecal fat excretion and urine parameters in a rat model of Roux-en-Y gastric bypass surgery. MATERIALS AND METHODS Diet induced obese Sprague-Dawley® rats underwent sham surgery as controls (16), or Roux-en-Y gastric bypass surgery (19). After recovery, rats had free access to a normal calcium, high fat (40%) diet with or without 1.5% potassium oxalate for 5 weeks and then a normal (10%) fat diet for 2 weeks. Stool and urine were collected after each period. Fecal fat was determined by gas chromatography and urine metabolites were evaluated by assay spectrophotometry. RESULTS Daily fecal fat excretion remained low in controls on either diet. However, Roux-en-Y gastric bypass rats ingested a food quantity similar to that of controls but had eightfold higher fecal fat excretion (p <0.001) and heavier stools (p = 0.02). Compared to controls, gastric bypass rats on the high fat diet with potassium oxalate had a fivefold increase in urine oxalate excretion (p <0.001), while gastric bypass rats without potassium oxalate had a twofold increase in urine calcium (p <0.01). Lowering dietary fat in gastric bypass rats with potassium oxalate led to a 50% decrease in oxalate excretion (p <0.01), a 30% decrease in urine calcium and a 0.3 U increase in urine pH (p <0.001). CONCLUSIONS In this Roux-en-Y gastric bypass model high fat feeding resulted in steatorrhea, hyperoxaluria and low urine pH, which were partially reversible by lowering the dietary fat and oxalate content. Roux-en-Y gastric bypass rats on normal fat and no oxalate diets excreted twice as much oxalate as age matched, sham operated controls. Although Roux-en-Y gastric bypass hyperoxaluria appears primarily mediated by gut and diet, secondary causes of oxalogenesis from liver or other mechanisms deserve further exploration.
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Affiliation(s)
- Benjamin K Canales
- Department of Urology, University of Florida, Gainesville, Florida 32610, USA.
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Vincent CR, Thomas TL, Reyes L, White CL, Canales BK, Brown MB. Symptoms and Risk Factors Associated with First Urinary Tract Infection in College Age Women: A Prospective Cohort Study. J Urol 2013; 189:904-10. [DOI: 10.1016/j.juro.2012.09.087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Charles R. Vincent
- Departments of Urology and Infectious Disease and Pathology (TLT, LR, CLW, MBB), University of Florida, Gainesville, Florida
| | - Tami L. Thomas
- Departments of Urology and Infectious Disease and Pathology (TLT, LR, CLW, MBB), University of Florida, Gainesville, Florida
| | - Leticia Reyes
- Departments of Urology and Infectious Disease and Pathology (TLT, LR, CLW, MBB), University of Florida, Gainesville, Florida
| | - C. LeAnn White
- Departments of Urology and Infectious Disease and Pathology (TLT, LR, CLW, MBB), University of Florida, Gainesville, Florida
| | - Benjamin K. Canales
- Departments of Urology and Infectious Disease and Pathology (TLT, LR, CLW, MBB), University of Florida, Gainesville, Florida
| | - Mary B. Brown
- Departments of Urology and Infectious Disease and Pathology (TLT, LR, CLW, MBB), University of Florida, Gainesville, Florida
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Abstract
Blood and urine oxalate determinations have been limited to the laboratory setting because of complex sample storage and processing methods as well as the need for color spectrophotometry and ion chromatography. We hypothesized that glucometer test strips, impregnated with glucose oxidase and dyes that measure secondary hydrogen peroxide production, could be infused with oxalate oxidase and produce enhanced color changes in the presence of oxalate. By increasing the amount of sodium oxalate in fresh blood, we found that glucometer-measured oxalate increased on a linear scale. In addition, oxalate levels in synthetic urine could be measured using a visual scale, suggesting that strip dwell time or oxalate/oxalate oxidase concentrations could be manipulated to enhance optimal sensitivity. Although further testing is necessary, this simple, first-generation oxometer may eventually allow point of care testing in the home or office, empowering patients with oxalate-based medical conditions and giving healthcare providers real-time oxalate feedback.
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Affiliation(s)
- Benjamin K Canales
- Department of Urology, University of Florida, Gainesville, Florida 32610, USA.
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Canales BK. Editorial comment. Urology 2011; 78:1021-2; author reply 1022. [PMID: 22054367 DOI: 10.1016/j.urology.2011.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 05/25/2011] [Accepted: 05/26/2011] [Indexed: 11/29/2022]
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Gonzalez RD, Whiting BM, Canales BK. The history of kidney stone dissolution therapy: 50 years of optimism and frustration with renacidin. J Endourol 2011; 26:110-8. [PMID: 21999455 DOI: 10.1089/end.2011.0380] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Over the last 50 years, chemolysis as a primary or adjuvant treatment for urinary stones has fallen in and out of favor. We review the literature for a historical perspective on the origins and chronology of Renacidin therapy, focusing on landmark studies and impracticalities that have seemingly condemned it to history. MATERIALS AND METHODS A MEDLINE search was performed on the topic of chemolysis of urinary calculi. Historical literature was reviewed with regard to stone composition, treatment modalities, outcomes, and complications. RESULTS A total of 61 articles were reviewed, 40 of which were case series, representing a total of 817 patients studied. Mulvaney first introduced Renacidin in 1959 as a modification of Suby and Albright's 1943 solution. Because of an overabundance of nonstandardized irrigation protocols, six deaths were reported in the early 1960s resulting in a Food and Drug Administration ban on the practice of upper urinary tract stone dissolution. Over time, Renacidin returned to the urologist's arsenal, appearing first as an adjunct to dissolve catheter and bladder calculi and later (1990) as an approved agent for renal pelvis and ureter use. This feat was almost single-handedly the result of a successful hemiacidrin case series published in 1971 by Nemoy and Stamey. By using daily urine cultures, prophylactic antibiotics, and meticulous intrarenal pressure monitoring, Nemoy and Stamey virtually eliminated all major irrigation complications, paving the way for a flurry of studies. More importantly, they established the link between residual struvite stones, persistent infection, and recurrent staghorn stone formation. CONCLUSIONS Dissolution of urinary calculi by chemolysis has been shown to be safe and effective if performed with sterile urine cultures, prophylactic antibiotics, and low intrapelvic pressures. The pioneers of this therapy are remembered for their attempts to develop an alternative to open surgery, and, in the process, solidified the "stone-free" concept for infection-based stones.
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Affiliation(s)
- Ricardo D Gonzalez
- Department of Urology, University of Florida, Gainesville, FL 32610, USA
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Abstract
Calyceal diverticula are cystic dilations within renal parenchyma prone to urinary stasis, stone formation, and recurrent infection. Using ICD-9 code 55.39 and CPT code 50549, we identified five women and two men (mean age 42 years) who underwent laparoscopic calyceal diverticulectomy at our center from August 2007 to July 2010. Patient videos that highlight basic and advanced laparoscopic techniques (retroperitoneal approach and partial nephrectomy) were selected from an Institutional Review Board-approved video library. Because few published case series exist in the literature, we include equipment used and outcomes for all patients. Posterior diverticula (4/7) were ablated by balloon-assisted retroperitoneal approach. One patient required concomitant partial nephrectomy for a solid renal mass, and laparoscopic ultrasound probe was required for diverticular identification in two patients. No complications were noted with reasonable mean blood loss (40 mL), operating times (160 minutes), and hospital stay (2 days). All diverticula were resolved at 3-month follow-up computed tomography imaging.
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Affiliation(s)
- Ricardo Dario Gonzalez
- Department of Urology, Center for the Study of Lithiasis and Pathological Calcification, University of Florida, Gainesville, FL 32610, USA
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Abstract
Percutaneous nephrolithotomy (PCNL) is the procedure of choice for removing large, complex, and/or multiple renal calculi. Since its first description in 1976, PCNL techniques and equipment have evolved to maximize procedural efficacy, safety, and reproducibility. We reviewed current literature from January 2004 to November 2009 using Medline search regarding PCNL instrumentation and technology. Additional equipment discovered during the review process without published Medline evidence was summarized from manufacturer brochures and data. Included in this review are summaries of intracorporeal lithotriptors and accessory equipment, stone manipulation devices, PCNL tract sealants, and a digital rigid nephroscope. The evolution of these devices from their predecessors has increased the instrumentation options for the treating urologist and may represent more effective technology for the percutaneous treatment of large renal stones.
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Affiliation(s)
- Joseph W Pugh
- Department of Urology, University of Florida, Gainesville, FL, USA
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Thalji NK, Richards NG, Peck AB, Canales BK. Enzymatic dissolution of calcium and struvite crystals: in vitro evaluation of biochemical requirements. Urology 2011; 78:721.e13-721.e17. [PMID: 21741690 DOI: 10.1016/j.urology.2011.04.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 03/26/2011] [Accepted: 04/25/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the factors that affect the enzymatic dissolution rate of calcium oxalate monohydrate (COM), calcium phosphate (brushite), and magnesium ammonium phosphate (struvite) crystals as enzymatic digestion of kidney stones could enhance lithotripsy or provide alternatives to surgical removal. METHODS At pH 4.2, pelleted COM crystals were combined with oxalate decarboxylase (ODC from Bacillus subtilis), oxalate oxidase (from Hordeum vulgare), or control. Crystal dissolution was followed by measuring increases in solution calcium ion concentration. For phosphate-based crystals, the rates of phosphorolysis by the enzyme purine nucleoside phosphorylase (PNP, assay form) were compared to the control solution using spectrophotometry. RESULTS The addition of ODC to COM crystals resulted in production of highly soluble calcium formate and a 15-fold increase in COM solubility. By adding a formate-catabolizing enzyme (formate dehydrogenase), dissolution increased 47-fold compared with controls with nearly one half of the mineral dissolved. Oxalate oxidase showed much lower activity than ODC in COM dissolution. Using inorganic phosphate as a substrate, PNP was able to dissolve both brushite and struvite minerals in water at concentrations near saturation. Measuring dissolution by adding more PNP was not possible because of equilibrium and assay detection restraints. CONCLUSION Stone dissolution using enzymes appears to be viable, particularly for oxalate-based minerals. In a closed system, product inhibition by calcium formate appeared to limit the extent of COM crystal dissolution using ODC. Although phosphate-containing minerals appear to be suitable phosphate sources for PNP, the reversibility of the reaction limits the use of this enzyme.
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Affiliation(s)
- Nabil K Thalji
- Department of Urology, Center for the Study of Lithiasis and Pathological Calcification, University of Florida, Gainesville, Florida, USA
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Canales BK, Reyes L, Reinhard MK, Khan SR, Goncalves CG, Meguid MM. Renal glomerular and tubular injury after gastric bypass in obese rats. Nutrition 2011; 28:76-80. [PMID: 21723091 DOI: 10.1016/j.nut.2011.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 02/21/2011] [Accepted: 03/14/2011] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Roux-en-Y gastric bypass (RYGB) surgery is the most common surgical intervention for long-term weight loss in morbidly obese patients. By decreasing obesity-associated hyperfiltration, diabetes, and hypertension, RYGB is touted to stabilize, if not prevent, progression of chronic renal disease. To test this, the renal histology of diet-induced obese rats that underwent RYGB surgery was compared with that of pair-fed and sham obese controls. METHODS Sprague-Dawley rats, fed a high-fat, low-oxalate diet to induce gross obesity, were randomized to RYGB (n = 6), gastrointestinal-intact sham-operated obese controls (sham, n = 4), or gastrointestinal-intact sham-operated obese pair-fed controls (fed, n = 8). Daily body weight and food intake were recorded. On postoperative day 42, renal histology and immunohistochemistry were examined. Renal pathology was assessed by a categorical glomerular lesion score and a quantitative glomerular/tubular scoring system by experienced veterinary pathologists. Osteopontin and ED-1 (monocyte/macrophage cell) stainings were estimated by the percentage of stained area and the number of counted cells/high-power field, respectively. RESULTS Compared with sham and fed controls, RYGB rats had significant decreases in body weight (P < 0.001), more glomerular lesions (P = 0.02), and received higher glomerular and tubular lesion scores (P < 0.01). RYGB rodents had significantly stronger staining for osteopontin within the inner medullary region (P < 0.005) and ED-1 within the outer medullary region (P < 0.02) compared with sham and fed controls. CONCLUSION In this diet-induced obese rat model, RYGB is associated with chronic glomerulosclerosis and tubulointerstitial nephritis, confirmed by histology and immunohistochemistry. Prospective studies to better define the injurious mechanisms in this model are underway.
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Affiliation(s)
- Benjamin K Canales
- Department of Urology, Center for the Study of Lithiasis and Pathological Calcification, University of Florida, Gainesville, Florida, USA.
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Willis D, Canales BK, Cheng L, MacLennan GT. Neural neoplasms of the bladder. J Urol 2010; 184:1492-3. [PMID: 20727550 DOI: 10.1016/j.juro.2010.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Daniel Willis
- Department of Urology, University of Florida, Gainesville, Florida, USA
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Canales BK, Arreola M. Fluoroscopic organ and tissue-specific radiation exposure by sex and body mass index during ureteroscopy: editorial comment. J Endourol 2010; 24:1072-1073. [PMID: 20641171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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Affiliation(s)
- Adnan Javed
- Department of Urology, University of Florida, Gainesville, Florida
| | | | - Gregory T. MacLennan
- Institute of Pathology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
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Canales BK, Higgins L, Markowski T, Anderson L, Li QA, Monga M. Presence of five conditioning film proteins are highly associated with early stent encrustation. J Endourol 2009; 23:1437-42. [PMID: 19698053 DOI: 10.1089/end.2009.0389] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Ureteral stents are susceptible to biofilm formation and crystal deposition, especially in stone formers. To identify proteins responsible for this accumulation, we compared conditioning film proteomes obtained from human ureteral stents with and without encrustation. MATERIALS AND METHODS Twenty-seven Bard Inlay hydrophilic ureteral stents were removed after ureteroscopy. Stent encrustation was quantified by visual analog score 0 (none) to 4 (heavy) and further categorized as nonencrusted (scores 0 and 1; n = 22) or encrusted (scores 2, 3, and 4; n = 5). Stent conditioning film was sampled and digested with trypsin, and peptide tandem mass spectrometry data were acquired using liquid chromatography. After protein identification, unconditional exact tests were used to compare categorical variables versus encrustation outcome. Stone analysis and follow-up metabolic urine profiles were examined to identify additional risk factors for stent encrustation. RESULTS More than 300 unique proteins with >95% confidence were identified. Proteins alpha-1 anti-trypsin, Ig kappa, IgH G1, and histone H2b and H3a were found to be highly associated with stent encrustation (p < 0.05), while Tamm-Horsfall protein and histone H2a were found to have a marginal association (p < 0.1). Patients with early stent encrustation were more likely to have mixed stone analysis (p = 0.03) and low urinary volumes (p < 0.01). CONCLUSION Immunoglobulins and Tamm-Horsfall protein are common urinary proteins that appear to nonselectively bind early onto ureteral stent surfaces. Histones, nuclear DNA-condensing proteins, likely contribute to stent encrustation because of their unique net positive charge and may represent a potential clinical target for encrustation prevention.
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Affiliation(s)
- Benjamin K Canales
- Department of Urology, University of Florida, Gainesville, Florida, USA.
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Vincent CR, Brown M, Reyes L, Canales BK, Muller K, Vincent V, Li Q, Thomas T. SYMPTOMS AND RISK FACTORS ASSOCIATED WITH FIRST UTI IN COLLEGE-AGED WOMEN: A PROSPECTIVE COHORT STUDY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Canales BK, Khan SR, Glenton PA, Reyes L, Reinhard MK, Goncalves CG, Meguid MM. RENAL HISTOLOGICAL CHANGES AFTER RYGB IN A DIET INDUCED OBESE RAT MODEL. J Urol 2009. [DOI: 10.1016/s0022-5347(09)62013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Canales BK, Weiland D, Reardon S, Monga M. Urethral catheter insertion forces: a comparison of experience and training. Int Braz J Urol 2009; 35:84-9; discussion 89. [DOI: 10.1590/s1677-55382009000100013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2008] [Indexed: 11/21/2022] Open
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Canales BK, Anderson L, Higgins L, Slaton J, Roberts KP, Liu N, Monga M. Second prize: Comprehensive proteomic analysis of human calcium oxalate monohydrate kidney stone matrix. J Endourol 2008; 22:1161-7. [PMID: 18484873 DOI: 10.1089/end.2007.0440] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous efforts to identify the protein content of stone matrix have been limited by the lack of technology necessary to analyze the highly insoluble protein-crystalline complex. Our study objective is to characterize the matrix of calcium oxalate monohydrate (COM) stones using a comprehensive proteomics approach. MATERIALS AND METHODS Seven pure COM stones were powdered, and proteins were extracted using four different buffer solutions. Detergent cleanup spin columns or concentrators were used to remove detergent and to exchange buffers before trypsin digestion. Tryptic peptides were analyzed with reversed-phase, high-performance liquid chromatography (RP-HPLC) and tandem mass spectrometry (MS/MS) using a QSTAR Pulsar i quadrapole time of flight mass spectrometer. Tandem mass spectra were searched against National Center for Biotechnology Information human nonredundant database using ProteinPilot 1.0 software (Applied Biosystems, Inc.) for protein hits; peptide MS/MS spectra were manually inspected. RESULTS Of the four buffers, only 2% sodium dodecyl sulfate (SDS) samples had normal HPLC and MS/MS elution patterns. We identified 68 distinct proteins with 95% confidence. More than 50 of the proteins have not been previously identified in stone matrix. Of particular note, a significant number of inflammatory proteins were identified, including immunoglobulins, defensin -3, clusterin, complement C3a, kininogen, and fibrinogen. CONCLUSIONS SDS reducing buffer was efficient at solubilizing proteins from stone matrix for further MS-based proteomic analysis. A variety of cellular, structural, and plasma proteins comprise COM stone matrix. Several of the stone proteins are involved in cell injury pathways, which suggests that inflammation plays a role in human COM stone formation.
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Affiliation(s)
- Benjamin K Canales
- Department of Urologic Surgery, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, Minnesota, USA.
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Wignall GR, Canales BK, Denstedt JD, Monga M. Minimally Invasive Approaches to Upper Urinary Tract Urolithiasis. Urol Clin North Am 2008; 35:441-54, viii. [DOI: 10.1016/j.ucl.2008.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Pedro RN, Hinck B, Hendlin K, Feia K, Canales BK, Monga M. Alfuzosin Stone Expulsion Therapy for Distal Ureteral Calculi: A Double-Blind, Placebo Controlled Study. J Urol 2008; 179:2244-7; discussion 2247. [DOI: 10.1016/j.juro.2008.01.141] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Indexed: 11/16/2022]
Affiliation(s)
| | - Bryan Hinck
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Kari Hendlin
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Kendall Feia
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | | | - Manoj Monga
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
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Canales BK, Anderson L, Higgins L, Monga M. IS BIOFILM AND MATRIX RELATED? COMPREHENSIVE PROTEOMIC PROFILE OF EARLY URETERAL STENT BIOFILM. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61663-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Canales BK, Anderson L, Higgins L, Slaton JW, Ensrud-Bowlin K, Roberts KP, Wu B, Monga M. WHAT IS THE MATRIX? THE PROTEOME OF CALCIUM KIDNEY STONES. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61658-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Villicana P, Bischoff C, Cohen MS, Canales BK, Vieweg J, Dahm P, Parekattil SJ. VIDEO DEMONSTRATION OF LAPAROSCOPIC DOPPLER IDENTIFICATION OF CROSSING VESSEL DURING ROBOTIC OR LAPAROSCOPIC DISMEMBERED PYELOPLASTY – A POSSIBLE TOOL TO DECREASE OPERATIVE TIME? J Urol 2008. [DOI: 10.1016/s0022-5347(08)61074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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