Preliminary clinical application of a double-tube flexible ureteral access sheath / 中华泌尿外科杂志

The placement of the flexible ureteroscopic sheath during lithotripsy may injure the ureter. We have developed a double-tube flexible ureteral access sheath. Thirteen patients with renal calculi were treated with double-tube and flexible sheath in one stage. CT examination of 13 cases showed that the ureter was normal. The double-tube flexible ureteral access sheath makes the operation of sheathing easy, safe and effective.

Recommedations for the diagnosis and treatment of anaphylaxis in Chinese children / 中华实用儿科临床杂志

Anaphylaxis is increasingly in children, which is currently undernotified, underdiagnosed, and undertreated in China.In order to further improved the understanding and management of anaphylaxis, this issue reviews the pathogenesis, triggers and risk factors, clinical diagnosis and management of anaphylaxis, thus offers the recommedations of anaphylaxis in Chinese children based on previous published evidence-based guidelines and practice parameters.Recommendation aims to develop guiding principles for the diagnosis and management of anaphylaxis in children, and provide a framework for the development of new guidelines.

Study on the correlation between serum lipid level and anti-Müllerian hormone with embryo quality in vitro fertilization cycle / 国际检验医学杂志

Objective To study the relationship between serum lipid level with embryo quality in vitro fertilization cycle.Methods A total of 603 pairs of infertile couples who were treated with in vitro fertilization and embryo transfer technique (IVF-ET) in our hospital from October 2015 to June 2016 were collected.All subjects underwent long-term ovarian hyperstimulation,blood lipid and the embryo quality were measured and evaluated.Results Triglyceride (TG),total cholesterol (TC) and body mass index(BMI) were significantly negatively correlated with fertilization rate,2PN fertilization rate,cleavage rate and embryo rate (P0.05).Conclusion There is a linear correlation between blood lipid level and AMI and embryo quality.Serum lipids and AMI can be used to evaluate the quality of embryo and provide suggestion for the quality control of IVF-ET.

Characteristics of Anaphylaxis in 907 Chinese Patients Referred to a Tertiary Allergy Center: A Retrospective Study of 1,952 Episodes

PURPOSE: Comprehensive evaluation of anaphylaxis in China is currently lacking. In this study, we characterized the clinical profiles, anaphylactic triggers, and emergency treatment in pediatric and adult patients. METHODS: Outpatients diagnosed with "anaphylaxis" or "severe allergic reactions" in the Department of Allergy, Peking Union Medical College Hospital from January 1, 2000 to June 30, 2014 were analyzed retrospectively. RESULTS: A total of 1,952 episodes of anaphylaxis in 907 patients were analyzed (78% were adults and 22% were children). Foods are the most common cause (77%), followed by idiopathic etiologies (15%), medications (7%) and insects (0.6%). In food-induced anaphylaxis, 62% (13/21) of anaphylaxis in infants and young children (0-3 years of age) were triggered by milk, 59% (36/61) of anaphylaxis in children (4-9 years of age) were triggered by fruits/vegetables, while wheat was the cause of anaphylaxis in 20% (56/282) of teenagers (10-17 years of age) and 42% (429/1,016) in adults (18-50 years of age). Mugwort pollen sensitization was common in patients with anaphylaxis induced by spices, fruits/vegetables, legume/peanuts, and tree nuts/seeds, with the prevalence rates of 75%, 67%, 61%, and 51%, respectively. Thirty-six percent of drug-induced anaphylaxis was attributed to traditional Chinese Medicine. For patients receiving emergency care, only 25% of patients received epinephrine. CONCLUSIONS: The present study showed that anaphylaxis appeared to occur more often in adults than in infants and children, which were in contrast to those found in other countries. In particular, wheat allergens played a prominent role in triggering food-induced anaphylaxis, followed by fruits/vegetables. Traditional Chinese medicine was a cause of drug-induced anaphylaxis. Furthermore, exercise was the most common factor aggravating anaphylaxis. Education regarding the more aggressive use of epinephrine in the emergency setting is clearly needed.

The clinical efficacy of inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope / 中华泌尿外科杂志

Objective To investigate the clinical efficacy of inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope.Methods From March 2013 to July 2015,there were 68 patients accepted a ureteral access sheath in flexible ureteroscopy with the help of rigid ureteroscope for the treatment of kidney stones.There were 46 cases male,22 cases female,aged from 22 to 76 years old,average 43.9 years.There were 68 cases with backaches or hematuria.There were 48 cases with single stone,20 patients with multiple stones.There were 5 cases with stones on both sides.The stone diameter were from 1.2 to 2.5 cm,the average (1.83 ± 0.16) cm.There was no hydronephrosis in 18 cases,mild hydronephrosis 42 cases.The operations were carry out under general anesthesia.By using rigid ureteroscope placed zebra guidewire,then intercept F8 single lumen tip to 1.0 cm section on rigid ureteroscope,was placed into a modified 42 cm ureteral access sheath.Then the modified 42 cm ureteral access sheath was inserted under direct view with the help of rigid ureteroscope.Preoperative patient characteristics,radiographic stone size,operation time,success rate of lithotripsy,serious complications especially ureteral injury was recorded.4 weeks and 12 weeks after operation,ultrasound and/or CT were reexamined to assess the success rate of lithotripsy and the incidence ureteral stricture.Results All the procedures were successful.The operation time was (62.2 ± 6.5)min,the hospital stay was (3.1 ± 0.2) d.The success rate of ureteral access sheath completely placement was 97.1％,partially placement was 2.9％.Postoperative complications included Clavien classification grade Ⅰ 6 cases and grade II 2 cases.The postoperative follow-up averaged (12 ± 1.2) months for all case.The success rate of lithotripsy was 76.5％ in 4 weeks postoperative,and it was 95.6％ in 12 weeks.During the follow-up,compared with the preoperative cases,62 cases were not found to increase the degree of hydronephrosis.There were 58 cases (58/62) without hydronephrosis.4 cases were mild hydronephrosis (4/62).CT showed normal ureter 52 cases (52/52).Conclusions It was safe and reliable procedure with good results.It would be a safe procedure to inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope.

Plasmakinetic enucleation and resection of the prostate by divided into three parts and blocking blood flow in advance / 中国内镜杂志

Objective To investigate the efficacy and safety of plasmakinetic enucleation and resection of the prostate by divided into three parts and blocking blood flow in advance (PKERPDPB). Methods 158 patients with BPH were randomly divided two groups: 81 patients treated by plasmakinetic enucleation and resection of the prostate by divided into three parts and blocking blood flow in advance (PKERPDPB), 77 patients treated by plasmakinetic resection of the prostate (PKRP). All patients were evaluated preoperatively and at 1, 6, 12 months after surgery by IPSS, QOL, Qmax and PVR. Operation time, resected adenoma weight, catheterization time, hospital stay and complications were documented. Results There were no significant differences in preoperative parameters. The resected adenoma weight in the PKERPADPB group was heavier than that in the PKRP group, the difference was significant. Compared with PKRP, PKERPDPB required a longer operation time, but resulted in less hemoglobin decrease, less catheterization time and hospital time. During the 1, 6, 12 months of follow-up, there was no significant difference in Qmax, IPSS, PVR and QOL between the groups. Conclusion PKERPDPB was statistically superior to PKRP in blood loss, catheterization time, hospital stay but inferior in operation time. It was a safe and effective treatment for BPH.

Papain Induced Occupational Asthma with Kiwi and Fig Allergy

Papain is a proteolytic enzyme which is widely used in food industry, pharmaceuticals, and cosmetics. Occupational and non-occupational papain allergies have previously been documented; however, there are limited publications about papain allergy with its relative fruit allergy. Here, we present a case of occupational, IgE-mediated papain allergy with kiwi fruit and fig fruit allergy. A 53-year-old man suffered from rhinitis for several years, with the onset of his symptoms coinciding with the time he started to work at a sausage processing plant where papain is often used as a meat tenderizer. He began to experience symptoms of chest tightness, shortness of breath and wheezing shortly after starting work 5 years ago. Furthermore, he experienced several episodes of oral itching, and tongue and oropharyngeal angioedema after injestion of kiwi fruit and fig fruit. The patient had a lifelong history of allergic conjunctivitis, allergic rhinitis, and childhood asthma. Specific IgE was positive to kiwi fruit, papain and chymopapain (2.95 kUA/L, >100 kUA/L, and 95.0 kUA/L, respectively). Similar bands at 10-15 kDa in blotting with papain and kiwi fruit extracts were found. This patient showed a potential association between papain allergy and sensitization to kiwi fruit. We also reviewed 13 patients with papain allergy published in the literature, with 85% (11/13) of the patients sensitized through the respiratory tract, and 40% (4/11) having atopy. Further studies should focus on the determination of cross-reactive allergens between papain and its fruit relatives, and the prevalence of food allergy in patients with papain allergy should be investigated in a relatively large cohort.

Delayed Anaphylaxis to Red Meat Associated With Specific IgE Antibodies to Galactose

A novel delayed anaphylactic reaction to red meat, associated with tick bites and IgE antibodies against galactose-alpha-1, 3-galactose (alpha-gal), was reported in 2009 in the US, Australia and Europe. In this case, serum specific IgE to galactose-alpha-1, 3-galactose (>100 kU/L) and IgE to multiple non-primate mammalian proteins were positive. However, the pathogenesis of this disease remains unclear. We report the first case in Asia of delayed anaphylactic reaction to red meat, which was induced by bites from the hard tick, Hematophagous ixodidae. We confirmed the increased concentration of IgE reactive epitopes in non-primate mammalian organs, which may be rich in alpha-gal proteins in lymphatic and endothelial tissues. All confirmed ticks associated with this disorder in the literature and in our case belonged to the hard tick family. We hypothesize that hard tick saliva is enriched with blood-type substances, such as oligosaccharides, from the non-primate mammal victim's blood after days to weeks of blood sucking, which sensitizes humans through the injection route while blood sucking.