Cell Structure 3. Membrane Structure 4. Membrane Transport 5. Origin of Cells 6. Cell Division 2: Molecular Biology 1. Metabolic Molecules 2. Water 3. Protein 5. Enzymes 6. Cell Respiration 9. Photosynthesis 3: Genetics 1. Genes 2. Chromosomes 3. Meiosis 4. Inheritance 5. Genetic Modification 4: Ecology 1. Energy Flow 3. The number of patients undergoing flexible ureterenoscopy FURS for the treatment of kidney stones is increasing annually. Following FURS, there is a risk of developing post-operative complications such as infection, bleeding, renal injury, sepsis and pain [ 9 ].
With an annual increase in the number of patients undergoing FURS surgery, it is expected that the instances of such complications will also increase, and if left untreated, these complications may be fatal [ 10 ]. Although it recognised that FURS is a generally successful, minimally invasive means of removing stones, the primary consideration in managing stones must be diverted from analysing stone free rates: to instead focus on the process of removing stones with minimal complications, to reduce the incidences of associated morbidities.
It is, therefore, imperative that healthcare providers have a means to confidently predict those patients who undergo surgery, who are likely to develop post-operative complications such as obstructed kidneys, infection or subsequent urosepsis. Conventionally in the UK, patients undergoing urological surgery have been post-operatively monitored using C reactive protein CRP and erythrocyte sedimentation rate ESR , which are established markers of inflammation [ 11 ].
However, the disadvantage to measuring these markers is their non-specific nature [ 12 ], resulting in an inability to differentiate between inflammations due to inter-current or pre-existing disease processes, to those arising as a direct complication of treatment or surgery.
Phagocytic leukocytes are components of the non-specific immune system. Monocytes and neutrophils are examples of phagocytic leukocytes and it can be appreciated that they play a key role during inflammation due to their adhesion, trans-endothelial migration and subsequent activation into the surrounding tissues [ 13 , 14 ]. They are important cells that are able to mediate tissue damage with vital involvement in modulation of host defence via the innate immune response, they can internalise and destroy potentially harmful pathogens and infectious agents via phagocytosis [ 14 ].
Leukocytes are intrinsically involved with the vascular endothelium, and express specific adhesion molecules e. During cellular activation, leukocytes produce and release potent proteolytic enzymes and reactive oxygen intermediates [ 13 , 14 , 15 ], which may contribute toward some of the post-operative complications that can develop following FURS. Both neutrophils and monocytes have been implicated to play a key role during the inflammatory response post-surgery and thus deserve research attention [ 16 , 17 , 18 ].
CD62L L-selectin is an adhesion molecule that is part of the selectin family. It is a cell surface glycoprotein that is expressed on the cell surface of most leukocytes.
CD62L has a vital role in leukocyte migration. CD62L has a shedding mechanism, in an attempt to regulate the rate at which leukocyte extravasation occurs in inflamed tissues [ 19 ]. CD11b Mac-1 is a member of the integrin family and is expressed on the cell surface of the majority of leukocytes, including macrophages, monocytes and neutrophils as well as natural killer cells [ 20 ].
CD99 is a glycoprotein that is expressed on most leukocyte cells. CD99 has a unique role and is involved in the homophylic interactions during trans-endothelial migration. Raised levels of neutrophil CD99 levels were recently reported in a cohort of patients with inflammatory bowel disease, thus indicating that CD99 is directly involved to inflammatory responses [ 23 ].
Hydrogen peroxide is a strong oxidising agent and is produced by phagocytic cells such as monocytes and neutrophils. Increased intracellular production of H 2 O 2 levels has been reported following various orthopaedic surgical interventions, but as yet have not been reported following FURS [ 16 , 17 ].
The present study was designed to ascertain whether FURS for the treatment of kidney stones results in changes to neutrophils and monocytes cell surface expression of the CD62L, CD11b and CD99 adhesion molecules, and to assess the intracellular production of H 2 O 2. Whilst we, and others, have previously reported post-operative changes in routine blood tests haematological and biochemical following various urological surgical procedures [ 24 , 25 , 26 ], crucially, there is very little evidence investigating the direct effect of FURS on leukocyte function.
An important aspect of this clinical pilot-study was to provide a better understanding of the role of phagocytic leukocytes following FURS. Specifically, we aimed to evaluate changes in leukocyte function to provide a better understanding of their post-operative course following elective FURS, for the treatment kidney stones. Specifically, seven males and seven females aged between 27 and 70 years median An Olympus P5 Flexible Ureterorenoscopy was used during the surgery, while patients were under general anaesthesia using Propofol.
The mean FURS procedure time was 58 min 22— min. Complete stone clearance was achieved in all patients, with no complications reported post-treatment.
Prior to FURS, a venous blood sample was collected pre-operatively from the arm via the antecubital fossa Blood samples were collected into di-potassium ethylene diamine tetra-acetic acid EDTA , which stood as a baseline control measurement. The baseline pre-operative samples served as the control measures during this study, with the main aim being to compare the effects of FURS on the leukocyte parameters measured within each subject pre and post-operatively.
Following FURS, further blood samples were taken at 30, and min post-operatively. With regards to the choice of anticoagulant used during blood collection procedures in the present study, previous studies have reported that blood collected in heparin lead to cellular activation and increased expression of CD11b in comparison to cells in blood drawn into EDTA [ 27 ]. Interestingly, Patil et al. With regard to the present study, all blood samples were collected into EDTA vacutainers to avoid any unnecessary leukocyte activation.
Phagocytic leukocytes were isolated from whole blood samples. The isolated cells were analysed within 4 h to ensure live cell viability. Efficiency of leukocyte isolation methods. Example gating of leukocyte subpopulations during flow cytometric analysis, employing the BD Accuri C6 flow cytometer.
Cells were isolated and intracellular H 2 O 2 production was assessed by adaptation of a technique originally described by Bass et al. H 2 O 2 production was assessed in cells using a fixed volume of 0. Statistical analysis for this clinical pilot-study was carried out using SPSS for Windows, version Post hoc testing was conducted using the Bonferroni test for pairwise comparisons between means.
Data that did not comply with normality were analysed using the Friedman test. Where the Friedman test resulted in statistical significance, subsequent tests were performed using the Wilcoxon test.
The efficiency of the leukocyte isolation method is illustrated in Fig. The percentage isolation yield of the mononuclear monocyte and lymphocyte cells The low erythrocyte presence in the isolated cells 0. The results are expressed as Mean Fluorescent Intensity MFI and represent changes to the CD62L cellular surface expression in both neutrophils and monocytes, both pre-operatively baseline and after FURS 30, and min post-operatively , for the treatment of kidney stones.
Effect of flexible ureterenoscopy on CD62L cell surface expression of neutrophils and monocytes. The results are expressed as Mean Fluorescent Intensity MFI and represent changes to the CD11b cellular surface expression in both monocytes and neutrophils, both pre-operatively baseline and after FURS 30, and min post-operatively , for the treatment of kidney stones.
Effect of flexible ureterenoscopy on CD11b cell surface expression of neutrophils and monocytes. The results are expressed as Mean Fluorescent Intensity MFI and represent changes to the CD99 cellular surface expression in both monocytes and neutrophils, both pre-operatively baseline and after FURS 30, and min post-operatively , for the treatment of kidney stones. Effect of flexible ureterenoscopy on CD99 cell surface expression of neutrophils and monocytes.
The results are expressed as Mean Fluorescent Intensity MFI and represent changes seen in levels of intracellular H 2 0 2 production in both monocytes and neutrophils, both pre-operatively baseline and after FURS 30, and min post-op , for the treatment of kidney stones. Effect of flexible ureterenoscopy on H 2 0 2 on cell surface expression of neutrophils and monocytes.
The main aim of this study was to evaluate the role of phagocytic leukocytes neutrophils and monocytes in patients undergoing FURS for the treatment of kidney stones. It can generally be appreciated that damage occurs to the vascular endothelium following FURS, due to the passage, and consequential stone removal with a flexible ureterenoscope.
Consequently, it is speculated that leukocyte margination will occur at sites of trauma, subsequently leading to leukocyte activation. This was further supported by the increase in intracellular H 2 O 2 production of neutrophils and monocytes. It can also be appreciated that during leukocyte activation further bioactive material, such as other reactive oxygen intermediates e. Collectively, the actions of these degradative substances may potentially cause considerable damage to host tissue, prolong the inflammatory response following FURS and may play an integral role in the development of post-operative complications.
Search for:. White Blood Cells. Types of WBCs The different types of white blood cells leukocytes include neutrophils, basophils, eosinophils, lymphocytes, monocytes, and macrophages.
Learning Objectives Distinguish between the two major types of leukocytes white blood cells : granulocytes and agranulocytes. Key Takeaways Key Points The two main types of leukocytes are granulocytes and mononuclear leukocytes agranulocytes. Leukocytes arise from hemopoietic stem cells in the bone marrow.
Leukocytes are involved in pathogen recognition, phagocytosis ingestion of particles , pathogen destruction, inflammation mediation, and antigen presentation. Granulocytes include neutrophils, basophils, eosinophils, and mast cells. Their granules contain enzymes that damage or digest pathogens and release inflammatory mediators into the bloodstream. Mononuclear leukocytes include lymphocytes, monocytes, macrophages, and dendritic cells.
This group is involved in both innate and adaptive immune system function. Key Terms endocytosed : Engulfed during the process by which the plasma membrane of a cell folds inwards to ingest material. Examples include bacteria, viruses, protozoa, or fungi.
Microorganisms are not considered pathogenic until the population has grown large enough to cause disease. Learning Objectives Describe the functions of leukocytes white blood cells. Key Takeaways Key Points Leukocyte functions often occur in the bloodstream and may represent either the innate or adaptive immune systems. Innate immune system functions are non-specific and include phagocytosis, inflammation, and degranulation. Adaptive immune system functions are antigen -specific and involve antigen presentation as well as cell -mediated and humoral -mediated activities.
Compared to innate immune system functions, adaptive immune system functions take more time to initiate, but work much faster. They have a memory component to prevent reinfection by the same pathogen. Key Terms macrophage : A white blood cell that phagocytizes necrotic cell debris and foreign material, including viruses, bacteria, and tattoo ink. Part of the innate immune system.
Inflammation : An innate immune system function in response to a pathogen or injury. Chemical mediators cause the blood vessels to dilate and become more permeable, which draws neutrophils to the area. WBC Formation Haematopoiesis refers to the formation of blood cells components.
Key Takeaways Key Points Haematopoietic stem cells are self-renewing and reside in the medulla of the bone bone marrow. All blood cells are divided into two main lineages, produced through lymphoid progenitor cells or myeloid progenitor cells depending on lineage type.
Lymphoid progenitor cells differentiate into B and T cells and NK cells. Myeloid progenitor cells differentiate into myelocytes granulocytes and monocytes or non-leukocytes such as erythorocytes and megakaryocytes which produce platelets. Before birth, most blood cell formation occurs in the liver or spleen, which tend to enlarge when used for hematopoiesis. In adults, most blood production occurs in the bone marrow.
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