Minimally invasive options are safe and reliable alternatives for the treatment of nutcracker syndrome (NCS). After continued efforts, our team successfully devised a new and effective therapeutic method: 3D-printed extravascular stenting of the left renal vein. From December 2017 to May 2019, 28 patients (25 men and 3 women) from different parts of China between 18 and 37 years old (mean, 23.6 years) diagnosed with NCS were admitted for laparoscopic 3D-printed extravascular stenting treatment. The post-operative follow-up duration was 6-24 months (median, 16.3 months). Technical success of the operation was achieved in all patients. After treatment, the NCS symptoms all patients resolved or improved during the follow-up period, without relapse. Most symptoms, including macro-/microhematuria, proteinuria, and flank/abdominal pain, tended to resolve within 3-6 months after the surgery; other symptoms, such as left-sided varicocele, also showed varying degrees of improvement at different times post-operatively. Perioperative complications were noted in two patients, including transient and mild lymphatic leakage, without any adverse effects. All extravascular stents were visualized on computed tomography and Doppler ultrasound scans, and no migration or any side effects occurred during the entire follow-up period. Compared to endovascular stenting or polytetrafluoroethylene artificial vessel procedures, 3Dprinted polyetheretherketone extravascular stenting has more advantages in terms of stent design and rigidity and approach rationality while successfully preventing stent migration and thrombosis. Therefore, this method may serve as an accurate and effective treatment for NCS patients.

Introduction. Nephrotic syndrome (NS) is a kidney disease characterized by albuminuria, hyperlipidemia, edema, and hypoalbuminemia. Recent data shown that more than 80% of children with nephrotic syndrome respond to steroid treatment, remain steroid-sensitive during subsequent relapses, and consequently have a favorable long-term prognosis. Steroid resistance is believed to be associated with a high risk of developing chronic renal failure. Recent reports suggest different clinical, genetic and molecular markers to be accompanied with phenomenon of steroid resistance. However, molecular markers controlling apoptosis have not been studied as a predictors of steroid resistant NS (SRNS) and steroid sensitive NS (SSNS).Aim of the study. To identify clinical and molecular markers of the steroid-resistance phenomenon in children with NS. Methods We analyzed 56 clinical cases of children hospitalized in Pediatric Hospital №7 (Kyiv, Ukraine) with NS (26 SSNS and 30 SRNS). Clinical data (age, gender, disease duration, blood pressure), conventional laboratory markers (serum creatinine, serum urea, GFR, blood WBC, PLT), markers of apoptosis (BcL-xL, caspase-3, caspase-8, NF-kappa B) analyzed.Stepwise logistic regression models use to identify candidates with the potential to be related to have influence of steroid resistance in children with NS. Data processed using GraphPad Prism 9.0 Software for Windows (USA, San Diego, CA). ResultsStepwise logistic regression models identified arterial hypertension as a candidate among clinical characteristics (b: -0,3057; SE: 0,1487; 95% confidence interval [CI]: -0,6042 to -0,007281, p<0,05) as a candidate predictive of SRNS.

ultrasound scan, uroflow, urinalysis and culture, urine Ca/creatinine, and first-morning urine osmolality. Patients <5 years of age, with secondary enuresis, and those who did not show at the follow-up visit were excluded.Oral desmopressin lyophilisate was recommended to all patients with PMNE and normal bladder capacity. After one month of therapy, initial success was assessed according to ICCS. Correlation coefficients were used to identify variables that were significantly correlated to complete response. ROC analysis was used to determine the urine osmolality cut-off value. Odds ratio and correlation coefficients in favor of complete initial success were analyzed with binary logistic regression.There were 48 patients with PMNE who received desmopressin and were followed for treatment success. Of tested variables, only lower urine osmolality was found to be significantly in favor of complete response to desmopressin therapy. ROC analysis determined the value of £814 mOsm/L as a cut-off value for complete success (sensitivity 65% and specificity 75%). The odds ratio for complete success with desmopressin therapy in PMNE patients with first-morning urine osmolality £814 mOsm/L was 9.086 (95% CI 1.893 -43.618, P = 0.006).For PMNE patients with high pretreatment morning urine osmolality, an alternative treatment to desmopressin should be considered because of the significantly higher risk of treatment failure.