ABSTRACT Purpose: To investigate the risk factors associated with adverse outcomes in patients with residual stones after percutaneous nephrolithotomy (PCNL) and to establish a nomogram to predict the probability of adverse outcomes based on these risk factors. Methods: We conducted a retrospective review of 233 patients who underwent PCNL for upper urinary tract calculi and had postoperative residual stones. The patients were divided into two groups according to whether adverse outcomes occurred, and the risk factors for adverse outcomes were explored by univariate and multivariate analyses. Finally, we created a nomogram for predicting the risk of adverse outcomes in patients with residual stones after PCNL. Results: In this study, adverse outcomes occurred in 125 (53.6%) patients. Multivariate logistic regression analysis indicated that the independent risk factors for adverse outcomes were the diameter of the postoperative residual stones (P < 0.001), a positive urine culture (P = 0.022), and previous stone surgery (P = 0.004). The above independent risk factors were used as variables to construct the nomogram. The nomogram model was internally validated. The calculated concordance index was 0.772. The Hosmer– Lemeshow goodness-of-fit test was performed (P > 0.05). The area under the ROC curve of this model was 0.772. Conclusions: Larger diameter of residual stones, positive urine culture, and previous stone surgery were significant predictors associated with adverse outcomes in patients with residual stones after PCNL. Our nomogram could help to assess the risk of adverse outcomes quickly and effectively in patients with residual stones after PCNL

SUMMARY: The cutaneous wounds of trunk and tail healing scar-free or with scar were different in lizard species. Full- thickness cutaneous injuries of tail and body of Scincella tsinlingensis were examined by histomorphological and immunohistochemistrical methods. The results showed that all injuries healed without scarring. The process of the wound healing of S. tsinlingensis involved hemostasis, re-epithelialization, proliferation and remodelling, which also could be further subdivided into six stages. Stage I, 0-2 day post wound (dpw), the blood oozed gradually, no obvious wound contraction, minimal blood loss. Stage II, 2-10 dpw, the wound bed covered by the fibrin clot of blood, tissue fluid and tissue debris. Stage III, 7d-15 dpw, the wrinkled wound epitheliums was gradually stratified, and its surface was keratinized and exfoliated. Stage IV, 10-28 dpw, pigment cells were distributed at the boundary between epidermis and dermis, with few blood vessels and no granulation tissue formation. Stage V, 20-70 dpw, opaque scales covered the wound epithelium with randomly scattered melanophores in the base of the epidermis. Stage VI, 45-135 dpw, the epidermis and dermis restored to the thickness of the original skin. Regenerated scales were similar to scales of the uninjured dermis. The positive immunostaining of matrix metalloproteinases-9, cytokeratin 6, alpha smooth muscle actin, caspase 3 and transforming growth factor-β3 showed the specificity of healing period and different stages, which participated in skin wounds healing of S. tsinlingensis.

RESUMEN: En las diferentes especies de lagartos las heridas cutáneas del tronco y la cola sin cicatrices, o con algún tipo de cicatriz son diversas. En este estudio se examinaron las heridas cutáneas de espesor total de la cola y el cuerpo de Scincella tsinlingensis mediante métodos histomorfológicos e inmunohistoquímicos. Los resultados indicaron que todas las lesiones sanaron sin cicatrices visibles. El proceso de cicatrización de heridas de S. tsinlingensis implicó hemostasia, reepitelización, proliferación y remodelación, que también podrían subdividirse en seis etapas. Etapa I, 0-2 días después de la herida (dph), la sangre filtraba gradualmente, sin contracción evidente de la herida, con pérdida mínima de sangre. Etapa II, 2-10 dph, el lecho de la herida estaba cubierto por el coágulo de sangre, líquido tisular y restos tisulares de fibrina. Etapa III, 7-15 dph, los epitelios de la herida se estratificaron gradualmente y su superficie se queratiniza y exfolia. Etapa IV, 10-28 dph, las células pigmentarias se distribuyeron en el límite entre la epidermis y la dermis, con pocos vasos sanguíneos y sin formación de tejido de granulación. Etapa V, 20-70 dph, escamas opacas cubrieron el epitelio de la herida con melanóforos dispersos al azar en la base de la epidermis. Etapa VI, 45-135 dph, la epidermis y la dermis restauradas al grosor de la piel original. Las escamas regeneradas eran similares a las escamas de la dermis sin herida. La inmunotinción positiva de metaloproteinasas- 9 de matriz, citoqueratina 6, actina de músculo liso alfa, caspasa 3 y factor de crecimiento transformante-β3 mostró la especificidad del período de curación y las diferentes etapas, que participaron en la curación de heridas cutáneas de S. tsinlingensis.

SUMMARY: The microstructure of inner ear in Scincella tsinlingensis was observed by light microscopy and the expression of glial fibrillary acidic protein (GFAP) in membranous labyrinth among the juvenile age group, subadult age group and adult age group were also detected by methods of immunohistochemistry. The inner ear in S. tsinlingensis resembled those in other Scincid lizards in their anatomy and histology. Large and elongate cochlear duct was slightly bowed or arched laterally. There was no hint of limbic modifications and the limbic lip was absent in cochlear recess. The basilar papilla elongated anteroventrally possessed specialized tectorial sallets. GFAP staining was significantly distributed in supporting cells of the sensory epithelia of cochlear duct, while the utricular macula and canal ampullae showed immunopositive for the GFAP antibody, with weaker staining in the saccular macula. The membranous inner ear of three different age groups revealed the similar pattern of GFAP expression, which suggested that the distribution of supporting cells were independent of age in S. tsinlingensis.

RESUMEN: La microestructura del oído interno en Scincella tsinlingensis fue analizada mediante microscopía óptica y por otra parte, fue cuantificada la expresión de la proteína ácida fibrilar glial (GFAP) en el laberinto membranoso, entre los grupos de edad juvenil, subadulto y adulto, utilizándose métodos inmunohistoquímicos. El oído interno de S. tsinlingensis se asemejaba al de otros lagartos Scincid tanto en su anatomía como en su histología. El conducto coclear mayor estaba ligeramente arqueado o arqueado lateralmente. No había indicios de modificaciones límbicas y no se evidenció el labio en el receso coclear. La papila basilar alargada anteroventralmente poseía sallets tectoriales especializados. La tinción de GFAP se distribuyó significativamente en las células del epitelio sensorial del conducto coclear, mientras que la mácula utricular y la ampolla del canal mostraron inmunopositividad para el anticuerpo GFAP, con una tinción más débil en la mácula sacular. El oído interno membranoso de los tres grupos de edad diferentes reveló un patrón similar de expresión de GFAP, lo que sugiere que la distribución de las células de soporte son independiente de la edad en S. tsinlingensis.