This study aimed to compare changes in enamel morphology, mineral composition, crystal structure, and mechanical properties under naturally formed dental plaque at different maturation stages versus dental calculus, using an intraoral in situ device and multimodal characterization. Six groups were analyzed (n = 5/group): a blank control group (fully bone-impacted mandibular third molars), a calculus group (extracted molars with naturally adherent dental calculus), and plaque groups formed in vivo for 1, 7, 14, and 28 days using an intraoral in situ device. Mirror-polished longitudinal sections were examined by EDS, Raman spectroscopy, and nanoindentation, followed by SEM for morphology. With increasing plaque coverage time, enamel prisms became progressively disrupted, with widened interprismatic spaces and more microcracks. Mean Ca/P across 5-100 μm decreased from 2.09 ± 0.08 (blank control) to 1.73 ± 0.09 (28-day plaque; P < 0.05). The ν₁(PO₄³⁻) band downshifted and broadened (960.85 ± 0.42-957.19 ± 0.56 cm-1; FWHM 16.03 ± 1.01-26.35 ± 1.06 cm-1; P < 0.05) with increased I(1070)/I(960) and I(1450)/I(960). Hardness and elastic modulus declined from 4.44 ± 0.72 and 88.67 ± 12.94 GPa to 3.45 ± 0.55 and 71.77 ± 14.34 GPa in the 28-day plaque group (P < 0.05). The calculus group showed changes in the same direction, but with a smaller magnitude within the measured indicators and depth range. Natural plaque and calculus coverage promoted dissolution of the enamel inorganic phase, increased lattice disorder, and deterioration of mechanical performance; however, mature plaque (e.g., the 28-day group) caused substantially greater damage than dental calculus. Early inhibition of plaque maturation may be more important for maintaining enamel structural stability than removal of dental calculus.
[This retracts the article DOI: 10.1007/s00500-022-06996-y.].
The rapid advancement of quantum-inspired classical algorithms, particularly Quantics Tensor Trains (QTT), has demonstrated that exponentially large vectors can be manipulated efficiently via Matrix Product States (MPS). Conventionally, the compression of these tensor networks relies exclusively on Singular Value Decomposition (SVD)-based truncation. While SVD is optimal for minimizing the Frobenius norm error, it remains structurally blind to exact algebraic correlations, such as reversible logic gates or Clifford symmetries, that do not require numerical approximation to factor out. In this work, we propose a hybrid compression protocol that integrates the topological rigor of ZX-Calculus with the numerical power of SVD. We construct an explicit isomorphism between Rank-3 MPS tensors and ZX-diagrams, allowing us to subject QTT representations to formal diagrammatic rewriting rules prior to numerical truncation. We establish that this Topological Preconditioning can algebraically collapse the effective bond dimension (χ) and T-count of the underlying tensor network without information loss. By benchmarking the algorithmic implementation against hardware-accelerated SVD on discretized functions and stabilizer states, we demonstrate that ZX-driven algebraic erasure fundamentally bypasses standard [Formula: see text] bottlenecks, yielding up to a computational speedup. Finally, we formalize this advantage by defining the structural complexity class [Formula: see text], proving that for systems characterized by algebraic symmetry, this work reflects our ongoing effort to deepen understanding of Categorical Quantum Mechanics, aiming to contribute to the optimization of high-dimensional linear algebra.
Mirizzi Syndrome (MS) is a rare cause of biliary obstruction. While laparoscopic cholecystectomy is the standard treatment, severe inflammation often necessitates subtotal cholecystectomy to prevent bile duct injury (BDI). However, retained stones in the gallbladder remnant or cystic duct can cause recurrent obstruction, termed post-cholecystectomy Mirizzi Syndrome (PCMS). A 34-year-old female presented with PCMS 6 years after undergoing a subtotal cholecystectomy for MS. Despite initial conservative management, definitive resolution required secondary surgical intervention. As subtotal cholecystectomy becomes more frequent to avoid BDI, the incidence of PCMS is expected to rise. Clinicians must maintain a high index of suspicion. Management should be multidisciplinary; however, surgery remains the definitive treatment when conservative approaches fail.
Oral health findings in pediatric chronic kidney disease (CKD) are heterogeneous, and CKD-related metabolic alterations may contribute to plaque mineralization and oral hygiene outcomes. Yet, the relationship between routinely measured serum biochemical parameters and standardized caries/oral hygiene indices in children with CKD is not well defined. This study aimed to evaluate the associations between serum biochemical parameters and oral health indices in pediatric CKD. This cross-sectional study included 34 children aged 6-14 years with diagnosed CKD. Demographic and available clinical data were recorded, and routinely measured serum biochemical parameters reflecting renal function, mineral metabolism, acid-base status, hematologic status, and nutritional/metabolic profile were obtained from routine laboratory records. Oral examination included caries assessment using Decayed, Missing, and Filled Teeth (dmft/DMFT) index for primary/permanent dentition and International Caries Detection and Assessment System (ICDAS) II indices, as well as oral hygiene evaluation using the Simplified Oral Hygiene Index (OHI-S), Debris Index (DI), and Calculus Index (CI). Developmental enamel defects were evaluated, and soft tissue lesions were examined. Pearson correlation analysis and Mann-Whitney U tests were performed. Statistical significance was set at p < 0.05. Most serum biochemical parameters were not significantly associated with caries experience or oral hygiene indices (p > 0.05). Serum magnesium showed weak-to-moderate negative correlations with CI (r = - 0.383, p = 0.026) and OHI-S (r = - 0.362, p = 0.035), indicating lower calculus accumulation and lower OHI-S scores with higher magnesium levels. In contrast, ALP demonstrated a weak-to-moderate positive correlation with CI (r = 0.386, p = 0.024). In this pediatric CKD cohort, routine serum biochemical parameters showed limited cross-sectional associations with caries experience and oral hygiene indices. However, the observed associations of serum magnesium and alkaline phosphatase with calculus accumulation suggest that mineral metabolism-related markers may be linked to plaque mineralization. These findings should be interpreted cautiously in view of the cross-sectional design, small sample size, and clinical heterogeneity of the study group.
This study aims to investigate the effects of abrasive flow finishing (AFF) on the surface quality, frictional resistance, and biological performance of orthodontic brackets. Stainless-steel brackets were randomly allocated into blank, control, and AFF groups. The blank group was left untreated. The control group underwent conventional magnetic polishing, while the AFF group was treated with AFF. Surface morphology was observed using scanning electron microscopy. Surface roughness at the micro- and nanoscale was investigated via 3D optical profilometry and atomic force microscopy, respectively. The arithmetic average roughness (Ra) and root mean square roughness (Rq) were analysed. The changes in slot dimensions were evaluated. Frictional resistance was determined using a universal testing machine. Biological performance was evaluated via bacterial adhesion and in vitro calculus formation assays. The AFF group presented a mirror-like finish. Scanning electron microscopy micrographs exhibited the smooth and uniform surface in outer and slot areas in the AFF group, while the control group showed obvious defects and pits within slots. 3D optical profilometry and atomic force microscopy demonstrated the smooth and regular surface topography in the AFF group. Quantitative analysis showed that Ra and Rq values of the slot area in the AFF group were significantly lower than those of blank and control groups. There were no significant changes in slot dimensions following AFF treatment. The kinetic friction force was significantly reduced in the AFF group. Furthermore, AFF treatment inhibited bacterial adhesion and calculus-like mineral deposition on brackets. AFF treatment effectively reduced the surface roughness of orthodontic brackets, especially within slot area, outperforming conventional magnetic polishing. This improvement further minimized frictional resistance and inhibited bacterial adhesion and calculus-like mineral deposition. This study demonstrates that AFF is a superior post-processing technique for orthodontic brackets.
Despite rapid growth in oral microbiome research, it remains unclear how well publicly available data reflect the diversity of the global human population. This study systematically evaluated the geographic and sampling-type representativeness of publicly available human oral microbiome data. A global meta-research analysis of publicly available human oral microbiome records in the NCBI BioSample database released up to December 31, 2025, was conducted. Records were retrieved, harmonized, and analyzed across 4 dimensions: geographic origin, oral sampling type, temporal trends, and population-adjusted representation using a derived representation index (RI). A total of 222,454 BioSamples from 1,600 studies were identified, spanning 92 countries and 4 major oral sampling-type groups: oral fluids, oral mucosa and surfaces, dental plaque and calculus, and special or lesion-associated sites. Geographic distribution was highly concentrated; nearly half of all geographically annotated samples originated from the United States and China, while 61% of countries worldwide contributed no samples. Low- and middle-income regions, including Central and Southern Asia (RI = -12.76) and Sub-Saharan Africa (RI = -11.21), were underrepresented relative to their population sizes. Sampling-type distribution was similarly uneven, with saliva samples comprising more than half of all samples. In contrast, disease-relevant sites, including carious lesions, periapical lesions, and the dental pulp, each represented less than 0.2% of the dataset. Together, these findings underscore that publicly available human oral microbiome data remain unevenly distributed across geographic origin and sampling types, reflecting structural and practical factors that have persisted over time. Deliberate efforts to improve global representation, sampling diversity, and metadata standardization are needed to build a more scientifically robust oral microbiome evidence base.
This in-vitro study compared cemental and periodontal ligament changes in fluorosed and non-fluorosed teeth using Scanning Electron Microscopy. Sixty premolar teeth (30 fluorosed and 30 non-fluorosed) extracted for orthodontic indications were retrieved from the Department of Oral and Maxillofacial Surgery, Mamata Dental College, Khammam, Telangana. Teeth were sectioned transverse to the cemento-enamel junction to separate crown and root portions. scanning electron microscopy photomicrographs of root specimens were analyzed for hypermineralized surfaces, mineralized debris, resorption bays/cavitation, calculus-related debris, fiber insertion areas, and mineralization of connective tissue fibers. Results revealed a higher percentage of resorption bays, calculus and calculus-related debris, and globular mineralized debris in fluorosed teeth compared to non-fluorosed counterparts. Additionally, partial and initial mineralization of connective tissue fibers was more prevalent in fluorosed teeth. These findings suggest that dental fluorosis induces distinct structural alterations at the cemental and periodontal ligament level, even in periodontally healthy teeth. This study concludes that fluorosis causes definite cemental and periodontal ligament changes on the root surface, which may have implications for periodontal health and clinical management of fluorosed dentition.
Electric toothbrushes are known to outperform manual devices in plaque removal, yet most comparative trials rely on conventional examiner-based indices and none have evaluated efficacy across smoking profiles using objective fluorescence-based measurement. This 24-week, 2-arm, parallel-group randomized controlled trial compared an oscillating-rotating electric toothbrush (Oral-B iO 6) with a manual toothbrush in 126 adults aged 18 to 50 years attending a dental clinic for routine scaling and polishing. Current smokers and never-smokers were enrolled to allow prespecified subgroup analysis by smoking status. Dental plaque accumulation was quantified using quantitative light-induced fluorescence (QLF) technology. The primary endpoint was ΔR30 (percentage of tooth surface with fluorescence increase ≥30%, reflecting total mature plaque); ΔR120 (fluorescence increase ≥120%, reflecting thick plaque and calculus-like deposits) was the secondary endpoint. The primary analysis used analysis of covariance adjusting for baseline plaque levels, treatment arm, smoking status, and their interaction. Use of the electric toothbrush was associated with significantly lower ΔR30 at 24 weeks compared with manual brushing (β = -1.84, 95% CI [-3.27, -0.41], p = .012), an effect that remained robust after adjustment for age, sex, and habitual oral hygiene behaviours. Baseline plaque level was the strongest predictor of follow-up values in both outcome models. No significant treatment effect was observed for ΔR120 (β = -0.77, 95% CI [-1.71, 0.18], p = .112). Subgroup analyses showed significant between-arm differences on both outcomes among never-smokers; among smokers, differences were directionally consistent but did not reach statistical significance, and the treatment-by-smoking interaction was not statistically significant. Oscillating-rotating electric toothbrushing produced significantly lower plaque accumulation than manual brushing over 24 weeks, as indexed by QLF-derived ΔR30. These findings support the potential advantage of oscillating-rotating powered toothbrushes for reducing plaque accumulation in adult patients and further support the utility of QLF as a precise and reproducible outcome measure for toothbrush efficacy trials. ClinicalTrials.gov, NCT06358482.
Generative AI adoption is often framed primarily as a question of learning technical skills. It is thought that if users learn better prompting and evaluation practices, useful outputs will follow, leading to greater reliance on the technology. This perspective overlooks a defining feature of large language models (LLMs): their output quality depends heavily on how users engage with them. Because LLM performance varies substantially with depth of disclosure, contextual richness, and iterative refinement, user interaction strategies directly shape perceived usefulness and observed performance. This paper develops a conceptual framework that proposes how risk salience may shape these interaction dynamics. Drawing on research in trust in automation, privacy calculus, algorithm aversion, and the social amplification of risk, we propose the guarded engagement loop, a multilevel feedback mechanism in which risk perceptions may shape interaction strategies that influence observed performance and, in turn, recalibrate trust in generative AI systems. At the micro level, elevated risk salience related to privacy, safety, or ethical concerns may lead users to adopt guarded interaction strategies characterized by reduced contextual disclosure and limited iteration. These constrained interactions can lower output quality and increase the likelihood of visible errors, which may further erode trust and reinforce cautious engagement. At the macro level, values-driven withdrawal from AI use has the potential to narrow the diversity of visible applications, amplifying risk-focused narratives, reinforcing perceptions of harm in public discourse. The guarded engagement loop framework conceptualizes generative AI adoption as a feedback process in which risk perceptions may shape interaction conditions that, in turn, can influence observed performance and subsequent trust calibration. We articulate testable propositions and discuss implications for organizational governance, AI system design, and institutional conditions that enable bounded openness and calibrated reliance.
Urolithiasis prevention depends on sustained fluid intake, timely urination, and appropriate dietary and lifestyle practices. However, occupational routines may make these behaviors difficult to maintain. This study explored participants' perceptions of how occupational routines relate to stone-preventive self-care among individuals with CT-confirmed urolithiasis. An observational qualitative exploratory study was conducted at a tertiary care teaching hospital in South India. Adults with CT-confirmed urolithiasis and at least one calculus measuring 3 mm or more were recruited using maximum-variation purposive sampling across physically demanding or heat-exposed, sedentary or professional, travel-based or mobile, and shift-based or irregular work contexts. Face-to-face semi-structured interviews were conducted in Tamil between February and July 2025. Contemporaneous interview notes were expanded after each interview, translated into English, and analysed using thematic analysis. Clinical and CT-related variables were summarized descriptively to characterize the sample. Twenty-four of 32 approached participants were included. The median maximum stone diameter was 7 mm (interquartile range, 5-10 mm), 15 participants had hydronephrosis and/or obstructive features, and 9 had recurrent stone disease. Six themes were identified: occupationally shaped inadequate hydration; restricted or delayed urination in relation to work setting; disruption of meal timing and food quality; occupational absorption and neglect of self-care; schedule instability, travel, and disruption of daily routines; and stone disease understood as multifactorial, with occupation interacting with other perceived contributors. Across themes, participants described three interconnected pathways through which work routines could make preventive self-care difficult to sustain: infrastructural and access constraints, schedule instability and routine disruption, and cognitive-attentional absorption. Family history, dietary and lifestyle practices, supplements, smoking, alcohol use, and comorbidities were also described as contextual contributors. Occupational routines may influence the feasibility of maintaining stone-preventive self-care among individuals with urolithiasis. The findings support occupation-sensitive counselling and practical workplace strategies that consider water and toilet access, break opportunities, travel demands, shift work, and workload. Longitudinal and implementation studies should assess whether such approaches improve preventive behaviours and stone-related outcomes.
The more advanced the symbolic mathematics, the more impenetrable the meaning. This is particularly evident in quantum theory, where symbolic formalisms foreground states and objects. An alternative diagrammatic approach, Quantum Picturalism (QPic), privileges structure, relation, and transformation. As a category theoretic formalism, it supports reasoning through the composition of visually represented quantum processes, a distinction that not only concerns representation but also shapes how quantum phenomena are conceptualized, opening new educational possibilities and ways of knowing. The choice of formalism-algebraic or diagrammatic-is not neutral, but embodies underlying ontological commitments that shape which structural features of quantum phenomena-such as states vs. relations; objects vs. transformations-are made accessible. This paper examines the epistemological, cognitive, and educational significance of non-symbolic thought in mathematics, and in quantum mechanics in particular, using QPic as a guiding example. We raise a central question: can quantum processes be represented in ways that align more naturally with human cognition? What is new here is showing how the epistemological and cognitive aspects of non-symbolic formalism are brought into pedagogical practice. Such paradigm largely benefits from the language of thought hypothesis alongside theories of embodied cognition, dual coding, and conceptual metaphor theory to articulate a holistic framework in which multiple, interacting conceptual systems underpin understanding. Drawing on historical precedents-from Euclidean geometry to Leibniz's universal calculus of thought-we contend that human intuition works more naturally within relational and visual frameworks, particularly those that help complex ideas to be seen and manipulated as structured wholes. The broader impact of this paradigm lies in democratizing access to quantum innovation and rethinking what it means to understand the quantum world, offering an inclusive entry point into it.
An 86-year-old man presented with epigastric pain. He had previously undergone distal gastrectomy with Roux-en-Y reconstruction. Computed tomography (CT) revealed a 32×17 mm common bile duct (CBD) stone with an internal 20 mm linear hyperdense component. Endoscopic removal was unsuccessful due to the size and impaction of the stone. Open choledochotomy retrieved multiple stones and a calcified fish bone, which was confirmed by infrared spectroscopy using the potassium bromide (KBr) wafer method. Although fish bone ingestion is relatively common, this case highlights that such foreign bodies can occasionally serve as a nidus for CBD stone formation, leading to unexpected and clinically significant pathologies. When CT demonstrates a linear high-attenuation intraductal structure, clinicians should suspect a bone fragment and follow a stepwise approach, considering early surgical intervention when endoscopic extraction is unsuccessful or likely to be challenging.
We present the case of a 64-year-old Caucasian man with severe abdominal pain and vomiting preceded by recurrent epigastric pain, nausea, polyuria, polydipsia, constipation, and weight loss. The patient had significantly elevated calcium 3.84 mmol/L (2.20-2.60), advanced renal impairment with serum creatinine 253 μmol/L (59-104), serum urea 11.2 mmol/L(2.5-7.8), elevated serum lipase 1599 U/L (13-60). Hematological studies revealed normocytic normochromic anemia, Hb 96 g/L(130-170), adequately suppressed parathyroid hormone 1.3 pmol/L (1.8-7.9), indicating parathyroid independent hypercalcemia. Abdominal computed tomography (CT) imaging showed features of acute pancreatitis and several non-obstructing left renal calculi. The patient was treated in hospital with intravenous fluid therapy, intravenous PPI therapy, and analgesics. Vitamin D supplements were discontinued. He also received intravenous pamidronate infusion during his hospital stay. The patient required another hospitalization three months after discharge for intravenous fluid therapy due to worsening hypercalcemia and required a second dose of intravenous pamidronate therapy. Seven months after the initial presentation, the patient's serum calcium levels remained within normal limits without the need for medical treatment. His 25-hydroxyvitamin D level became detectable and reached 285 nmol/L after 16 months. His renal function also improved significantly: the estimated glomerular filtration rate (eGFR) was 51 mL/min after 16 months, compared with 21 mL/min at the initial presentation. The patient was discharged and returned to the care of his primary care physician.
Currently, the main surgical approach for urinary stone removal is minimally invasive endoscopic procedures. Various laser systems compatible with most modern instruments are used for stone disintegration. Due to high efficacy and minimal fragment retropulsion during fragmentation, the domestic thulium fiber laser has become a serious alternative to the conventional holmium laser. At the same time, the safety profile of thulium fiber lithotripsy remains debatable because of the potential risk of irrigation fluid heating and damage to surrounding tissues during fragmentation. Implementation of a "Tissue Sensor" (TS) capable of differentiating stone from mucosa during lithotripsy allows automatic cessation of laser emission to prevent injury to the organ wall. To assess efficiency and improve the safety of lithotripsy using a new-generation thulium fiber laser with the tissue sensor function activated. The study included 70 patients from three medical centers aged 25 to 73 years with 101 ureteral and renal stones. Ureteroscopy with laser lithotripsy was performed in 23 patients, retrograde intrarenal surgery in 30, and percutaneous nephrolithotomy in 17. Mean stone volume was 0,7+/-0,4 cm3; stone density was 1080+/-370 HU. Various thulium fiber laser (TFL) settings were used for stone disintegration (dusting, fragmentation, popcorning). In addition to the standard rectangular pulse (Standard), different types of pulse modulation were used: minimal retropulsion modes (MRP); fine dusting (FinePulse); and fragmentation as a "packet" of pulses (UltraPulse). Energy and frequency ranges were 0,2-1,5 J and 5-40 Hz, respectively, for Standard, MRP, and FinePulse. For UltraPulse energies of 3-30 J and frequencies of 1-4 Hz were used. In all patients, laser lithotripsy was performed with the "Tissue Sensor" function enabled. Safety, based on the nature of mucosal impact in the organ where fragmentation was performed, was assessed using the Traxer-Sierra scale from 0 to 5. Early postoperative complications were recorded and graded using the modified Clavien-Dindo classification. The mean operative time was 48+/-28 minutes; laser time 16+/-13 minutes; pedal time 7 +/- 6 minutes; laser emission time 5+/-4 minutes. The TS efficiency coefficient, defined as the ratio of emission time to pedal time, was 65%, reflecting frequent sensor activation to prevent injury to surrounding tissues. The complete stone clearance rate was 98%. In the vast majority of cases (96%), no complications were observed. According to questionnaires, operating urologists reported that TS function did not affect procedure duration while helping avoid soft-tissue injury in most cases. No severe thermal injuries on the Traxer-Sierra scale were recorded (no injury in 46% of cases; grade I injury in 47%). A tissue type recognition system (Tissue Sensor) improves the safety of lithotripsy by reducing unintended mucosal injury and preventing an increase in irrigation fluid temperature while maintaining high stone disintegration efficacy.
Xanthinuria is a rare inherited metabolic disorder caused by xanthine dehydrogenase (XDH) deficiency, leading to excessive urinary xanthine excretion. It is associated with kidney stones and, in exceptional cases, renal failure. To date, no kidney biopsy findings have been reported in cases of xanthinuria. We present the first documented biopsy from such a patient, revealing a reduction in cyclooxygenase-2 (COX2) expression. A 38-year-old man of Afghan origin presented with flank pain and a staghorn calculus in the right kidney. Laboratory tests revealed impaired renal function with serum creatinine at 192 µmol/L. Percutaneous nephrolithotomy was performed to remove the stone, and infrared analysis confirmed its 100% xanthine composition. Genetic sequencing identified two pathogenic variants in the XDH gene, confirming type I xanthinuria. Despite stone removal, renal function progressively declined during the following months, with serum creatinine reaching 238 µmol/L and significant albuminuria. Imaging revealed no residual stones or atrophy of the right kidney, while the left kidney remained free of lithiasis. A biopsy of the left kidney demonstrated advanced chronic kidney disease with fibrosis, without crystal deposits or stones. As the etiology of nephropathy remained unclear, we assessed COX2 expression, an enzyme involved in prostaglandin synthesis, in the left kidney tissue. Compared with healthy controls and biopsies from other advanced chronic kidney disease cases, the xanthinuria biopsy showed considerably reduced tubular COX2 expression. The patient ultimately developed end-stage renal failure at age 41 and underwent successful kidney transplantation, achieving excellent graft function 32 months post-transplant. This case provides the first histopathological evidence of chronic kidney disease in xanthinuria without crystal deposition and identifies reduced tubular COX2 expression as a potential pathogenic mechanism. These findings support hypotheses from animal models suggesting that xanthine dehydrogenase deficiency may impair prostaglandin synthesis, contributing to kidney fibrosis and possibly abnormal nephrogenesis. Further investigation of similar cases could improve our understanding of rare metabolic disorders and inform strategies to preserve kidney function.
Streptococcus equi subspecies equi (SEE) causes a highly contagious disease colloquially known as "strangles" in equids. This disease is typically characterized by pyrexia, mucopurulent nasal discharge, and abscessation of the submandibular and retropharyngeal lymph nodes. Although typically localized to the upper respiratory tract, the infection can disseminate via lymphatic or hematogenous routes, leading to disseminated strangles involving peripheral lymph nodes and thoracic and abdominal organs. A 21-year-old Welsh Pony cross gelding presented for urine dribbling and presumptive cystolithiasis due to urine retention and bladder distention. Urinary catheterization and urethrocystoscopy revealed a large volume of hematuria, no urinary calculi, and an abnormal ureteral opening. Imaging revealed nonspecific renal abnormalities consistent with chronic kidney disease, with secondary acute kidney injury, and a mass near the aortic bifurcation. Aerobic urine culture yielded SEE identified via matrix-assisted laser desorption/ionization time-of-flight mass spectrometry with a score >2.0 and confirmed by PCR. The pony was euthanized due to poor prognosis, and autopsy results revealed pituitary pars intermedia hyperplasia and microadenoma and neutrophilic, hemorrhagic, and necrotizing pyelonephritis. The pyelonephritis is likely due to hematogenous or lymphatic dissemination of the organism to the kidney. We speculate that immunosuppression related to pars pituitary intermedia dysfunction may have predisposed this animal to this atypical manifestation. There are limited reports of metastatic strangles presenting as pyelonephritis in equids. This case highlights the potential for a common equine pathogen to manifest as an unexpected presentation and underscores the need to consider strangles in the differential diagnosis of equine renal disease.
Nephrolithiasis is a prevalent and recurrent condition affecting approximately 10-11% of the population. Percutaneous nephrolithotomy (PCNL) and mini-PCNL are established treatments for large renal stones. Outcomes are influenced by the choice of lithotripsy energy source. Available technologies include pneumatic, ultrasonic, Holmium:YAG (Ho:YAG), and thulium fiber laser (TFL), each with specific advantages and limitations. This review summarizes current evidence on these energy sources in PCNL and mini-PCNL. A narrative review was performed using PubMed and Cochrane Library, including studies published between 2014 and 2024. The search included terms related to PCNL and lithotripsy energy sources. Studies involving pediatric populations, anomalous kidneys, or non-standard energy sources were excluded. After screening 95 articles, 32 studies were included, of which 13 provided comparative data on different energy sources and were analyzed. Differences were observed in operative time, stone-free rates (SFR), bleeding, transfusion rates, complications, and hospital stay. In PCNL, ultrasonic and Ho:YAG lithotripsy showed comparable outcomes, while pneumatic demonstrated slightly lower SFR. In mini-PCNL, ultrasonic and laser technologies yielded similar efficacy. TFL displayed shorter operative time and reduced bleeding and transfusion rates compared to Ho:YAG, although many differences did not reach statistical significance. Ultrasonic and Holmium:YAG lithotripsy provide comparable outcomes in PCNL, while pneumatic devices may correlate with slightly lower stone-free rates. In mini-PCNL, ultrasonic and laser modalities show similar outcomes. TFL demonstrates potential advantages in operative time and bleeding, however, evidence remains heterogeneous, and further high-quality studies are needed.
Urolithiasis in donor kidneys presents a relative contraindication for transplantation due to the potential risk of obstruction and impaired graft function. Although less common in renal transplant recipients, obstructive urolithiasis remains a significant concern. Ex vivo stone removal during bench surgery has been explored as a safe and effective method to mitigate this risk. To present a case series demonstrating the feasibility and outcomes of ex vivo stone clearance using a rigid ultra-mini percutaneous nephrolithotomy (PCNL) set with a 7-Fr nephroscope via a retrograde approach (ureteral access) prior to renal transplantation. Three donor-recipient pairs underwent laparoscopic living donor nephrectomy via the retroperitoneal approach. The donor kidneys were preserved in ice slush, followed by ex vivo stone fragmentation using a holmium laser via a rigid ultra-mini PCNL set. The procedure was performed through the ureter, eliminating the need for flexible ureteroscopy (FURS). Surgical and postoperative outcomes recorded included cold ischemia time (CIT), serum creatinine levels, urine output, and graft perfusion assessed by Doppler ultrasound. This case series has been reported in line with the PROCESS Guideline. These three cases achieved complete stone removal with no intraoperative complications. The CITs were 54, 45, and 51 min, respectively. All grafts demonstrated immediate function postoperatively, evidenced by a marked decline in serum creatinine within 3 days. Imaging studies confirmed robust perfusion, and there were no signs of ureteral injury, obstruction, or residual stones. At 1-year follow-up, none of the recipients experienced recurrence of nephrolithiasis. Ex vivo retrograde lithotripsy using a rigid ultra-mini nephroscope via a ureteral approach is a safe, effective, and minimally invasive technique for managing renal calculi in donor kidneys before transplantation. Its shorter scope length enhances maneuverability and calyceal access while reducing trauma to the ureter, offering a promising alternative to FURS and pyelotomy in selected cases. The challenge remains to avoid prolonging CIT, which is critical for preserving graft function.
To compare the intraoperative outcomes of 2 indocyanine green (ICG) fluorescence imaging strategies (low-dose 0.25 mg vs conventional-dose 2.50 mg) with conventional white-light (WL) imaging during laparoscopic cholecystectomy for cystic duct (CD) stones and to determine whether a reduced ICG dose improves duct-to-liver contrast in the setting of biliary inflammation. This retrospective study included 138 patients with CD stones undergoing laparoscopic cholecystectomy between January 2024 and February 2026, allocated to 3 groups: low-dose ICG (0.25 mg), conventional-dose ICG (2.50 mg), or WL imaging. Propensity score matching (1:1 nearest-neighbor, caliper 0.2 standard deviation) was performed to balance baseline covariates. Primary outcomes were operative time, bile duct identification time, and the fluorescence intensity comparison value (FICV). Secondary outcomes included postoperative recovery parameters. After matching, 110 patients were included in the final analysis, and baseline characteristics were well balanced (all P > .05). Both ICG groups had significantly shorter operative time and bile duct identification time than the control group (both P < .001). Post hoc comparison between the 2 ICG protocols showed no significant difference for operative or bile duct identification time. The 0.25 mg group achieved a higher fluorescence success rate (78.6% vs 51.9%, P = .037) and a positive FICV, whereas the 2.50 mg group frequently showed a negative FICV (P < .001), indicating hepatic oversaturation. No significant differences were observed among the groups in postoperative recovery parameters (all P > .05). Fluorescence-guided surgery improves intraoperative efficiency and bile duct visualization in patients with CD stones compared with conventional WL imaging. Low-dose ICG (0.25 mg) provides enhanced duct-to-liver contrast versus 2.50 mg, highlighting the potential of pathology-specific dosing to improve surgical precision in inflammatory biliary conditions.