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Objective:To summarize the preliminary clinical experience of utilizing ureteral balloon dilation catheter in the treatment of "difficult ureter" during ureteroscopic lithotripsy, and to discuss the efficacy and safety of the technique.Methods:Clinical data of 28 patients (30 sides) with upper urinary tract calculi admitted to Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University from April 2021 to July 2022 were retrospectively analyzed. There were 23 males (82.1%) and 5 females (17.9%), with age of (51.5±13.6) years. Among the 30 sides, 20 (66.7%) on the left and 10(33.3%) were on the right. Calculi were either located in the renal pelvis or calyxes in 7 sides (23.3%), upper ureter in 17 sides (56.7%), and lower ureter in 6 sides (20.0%). The maximum diameter of the stones was (9.4±4.2)mm, and 23 sides (76.7%) were combined with hydronephrosis before surgery. When "difficult ureter" was encountered during the procedure, that is, it was difficult to insert ureteroscope or ureteral access sheath (UAS) due to small ureteral lumen, balloon catheter was used for dilation in the first stage, in which the balloon diameter was 4 mm on 22 sides and 5mm on 8 sides. The instrument was retrogradely inserted through the working channel of F8 semi-rigid ureteroscope, and the small site of the ureteral lumen was dilated under direct endoscopic view. After a single dilation, the balloon catheter was withdrawn, and the effect of dilation was evaluated by semi-rigid ureteroscopy to determine whether to proceed with the following procedures. The intraoperative data were recorded, including surgical method, stage of "difficult ureter" occurred, site of the small part of the ureter, related data of utilizing ureteral dilatation balloon catheter, grade of ureteral injury after dilatation (according to the 0-4 grading classification of endoscopic ureteral injuries), total operation time, balloon catheter-related adverse events, stone-free rate, and time of removing ureteral stents.Results:Among the 30 sides, 29 (96.7%) had difficulty in the stage of ureteroscope insertion, and 1(3.3%) had difficulty in the stage of UAS insertion. A total of 37 small sites of ureter were involved, including 18 in the intramural segment, 10 in the lower part, 2 in the middle part, and 7 in the upper part. Each site was dilated once with a median time of 3 (0.5, 5.0) minutes and a median maximum balloon pressure of 1 215.9(1 215.9, 1 443.9)kPa[12.0(12.0, 14.3)atm]. There were 28 sites of grade Ⅰ injury, 8 sites of grade Ⅱinjury, and 1 site of grade Ⅲinjury. The total duration of unilateral procedure was (73.4±30.3) min. Ureteroscope or UAS insertion was successful in 28 sides(93.3%) after balloon dilation, and failed in 2 sides(6.7%), both of which were in the stage of inserting ureteroscope and ureteral stent was indwelled for the second-stage procedures. On the first day after surgery, the hemoglobin level was (134.1±12.9)g/L, which was significantly different from the preoperative parameters ( P<0.01), and serum creatinine level was (86.7±23.2)μmol/L, which showed no significant difference from the preoperative one ( P=0.263). The primary stone-free rate was 92.9% (26/28), and the total postoperative complication rate was 13.3% (4/30), including 3 of grade Ⅰ (lateral lower abdominal pain requiring additional analgesic drugs) and 1 of grade Ⅱ (postoperative hematuria requiring intravenous hemostatic drugs). Follow-up was conducted for 3 months. All of the 28 successful sides had their ureteral stents removed before the last follow-up, and the time of removal was (36.9±11.5) days. No hydronephrosis was found in the ipsilateral kidney by ultrasound 3 months after operation. Conclusions:Balloon dilation technique showed good efficacy and safety in the treatment of "difficult ureter" during ureteroscopic lithotripsy.
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Objective:To study the relationship of pathogenic bacteria in midstream urine culture and stone composition of patients characteristics with infection stones.Methods:Between January 2016 and December 2020, 989 patients with infectious stones who attended Tsinghua Chang Gung Hospital, affiliated with Tsinghua University, for surgical treatment were enrolled in the study. There were 545 male and 444 female patients, with the mean age (48±14) years. The left and right side stones were 396 and 333, respectively. There were 260 bilateral stones, 264 single stones, 334 multiple stones, and 391 deer-stalker-shaped stones. The maximum diameter of stones was (33.4±26.5)mm, combined with diabetes in 109 cases and hypertension in 235 cases. Clean middle-urine was collected for bacterial culture, and intraoperative stone specimens were collected by percutaneous nephrolithotomy (PCNL). Personal characteristics of the patient such as gender, age, body mass index, clinical information such as stone size, location, comorbidities, results of urine culture and stone composition were recorded. The differences of infectious stone composition was analyzed between urease-producing, non-urease-producing bacteria.Results:Among the 989 patients with infectious stones, 259 were pure infectious stones, 131 were mixed infectious stones, and 599 were combined with infectious stone components. Urine cultures were positive in 627(63.4%) patients with infectious stones. The predominant urease-producing bacteria included Ureaplasma urealyticum(94 case), Proteus mirabilis(58 case), and Staphylococcus spp.(36 case). Pure infectious stones were common in Proteus mirabilis, while combined with infectious stone components were common in Ureaplasma urealyticum and Staphylococcus spp. The predominant non-urease-producing bacteria included Escherichia coli(175 case), Enterococcus spp.(76 case) and Streptococcus spp.(35 case). Escherichia coli commonly contained in infectious stone components and pure infectious stones, whereas Enterococcus spp. and Streptococcus spp. commonly contained in infectious stone components. Escherichia coli (61 case), Proteus mirabilis (44 case) and Enterococcus spp.(20 case) were the most common bacteria in 259 cases of pure infectious stones. Escherichia coli (36 case), Enterococcus spp. (14 case) and Ureaplasma urealyticum (10 case) were the most common bacteria in 131 cases of mixed infectious stones. The most common bacteria in 599 cases of combined infectious stones were Escherichia coli (78 case), Ureaplasma urealyticum (68 case) and Enterococcus spp. (42 case).Conclusions:Urease producing bacteria were not common in infectious stones. It was common for the Ureaplasma urealyticum in combined infectious stone components, while Escherichia coli was common in pure and combined infectious stone components.
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Objective@#To investigate knowledge and behaviors towards infectious diseases and factors associated with school absence for health reasons among primary and middle school students across 10 provinces in China, and to provide a reference for conducting a targeted health education of infectious disease and improving the controling and preventing levels of infectious disease in schools.@*Methods@#Stratified multistage sampling was used in this self-administered, anonymous questionnaire survey was conducted among 17 042 primary and middle school students across 10 provinces during Mar. to Dec. 2013. Multivariate Logistic regression models were performed to identify factors associated with school absence for health reasons.@*Results@#About 57.1% of all the participants reported infectious disease-related symptoms including fever, cough, headache, abdominal pain, diarrhea, as well as rash during the past two weeks; 42.4% reported absence from school for health reasons during the past year. The awareness rate of infectious diseases was between 42.5%-87.8%, and reported rates of behaviors towards infectious disease prevention were between 28.8%-97.7%. Living with parents(OR=0.91, 95%CI=0.84-0.99), higher father’s education level(OR=0.88, 95%CI=0.81-0.95), higher mother’s education level(OR=0.85, 95%CI=0.79-0.92), adequate knowledge and behavior towards infectious disease prevention (OR=0.97, 95%CI=0.96-0.98) and living in eastern areas (OR=0.90, 95%CI=0.83-0.98) were significantly associated with school absence for health reasons during the past year.@*Conclusion@#Knowledge and behaviors towards infectious diseases among primary and secondary school remains to be improved. Education on infectious disease prevention should be strengthened in schools to prevent the transmission and prevalence of infectious diseases.
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Objective@#To understand the prevalence of infectious diseases in schools in Beijing in 2010-2017 academic years, and to provide the reference for the prevention and control of infectious diseases in schools.@*Methods@#Based in Disease Surveillance Information System, students aged 6-22 years were selected in 2010-2017 academic year into this descriptive analysis, and the legal infectious diseases and the intensively monitored diseases of surveillance system in Beijing were included.@*Results@#From 2010 to 2017 academic years, the incidence rate of notifiable and certain monitored infectious diseases declined from 1 213.48/100 000 to 749.30/100 000, the incidence rate of notifiable infectious diseases declined from 718.19/100 000 to 523.50/100 000. There was no report of category A. The top 4 infectious diseases of category B were scarlet fever(80.13/100 000), bacillary dysentery(74.42/100 000), tuberculosis(22.70/100 000) and acquired immunodeficiency syndrome (AIDS)(4.03/100 000). The top 4 diseases of category C were other infectious diarrhea(157.62/100 000), hand foot and mouth disease(100.55/100 000), influenza(51.39/100 000)and mumps(49.47/100 000). The other particular monitored infectious disease was mainly chicken pox(296.04/100 000). The prevalence of AIDS and influenza increased significantly in recent years. The main infectious diseases in primary and junior school students were scarlet fever, hand foot and mouth disease, influenza, and in high school and college students were AID, tuberculosis and viral hepatitis.@*Conclusion@#In the 2010-2017 academic year , the number and incidence of notifiable infectious diseases and particular monitored infectious diseases among students in Beijing showed an overall downward trend. The main diseases among students in Beijing are scarlet fever, bacillary dysentery, infectious diarrhea and chicken pox. Prevention and control of AIDS, tuberculosis and viral hepatitis in high school and college students should be paid special attention.