Clinical diagnosis and treatment of severe hydronephrosis induced vagus reflex by percutaneous renal puncture decompression / 中华泌尿外科杂志

Vagus nerve reflex is a rare complication of percutaneous renal decompression. It is often induced by excessively rapid decompression of severe hydronephrosis and traction of the main nerves innervating the kidney. The clinical manifestations are irritability, sweating, clammy skin, hiccups, slow heart rate. It is easy to misdiagnose. In this study, 4 patients with vagus nerve excitement after percutaneous renal decompression were treated. After monitoring the patient’s vital signs and giving treatment such as expanding blood volume and raising blood pressure, the symptoms gradually disappeared.

Feasibility study of modified RUSS to predict the stone free rate after flexible ureteroscopic lithotripsy / 中华泌尿外科杂志

Objective To explore the feasibility of the modified RUSS (Resorlu-Unsal Stone Score)renal stone scoring system in predicting the stone free rate after Flexible Ureteroscopic Lithotripsy(FURL).Methods Retrospective analysis was performed on 104 cases of renal stones treated by FURL from March 2017 to January 2019 in the second affiliated hospital of zhengzhou university,including 75 males and 29 females.Age 20-75 (47.79 ± 13.21) years.BMI 18.2-38.3 (24.4 ± 3.7) kg/m2;Crushed stone site:left 56 cases,right 48 cases.There were 23 cases of renal inferior calyces calculi,81 cases of non-inferior calyces calculi,and 19 cases of renal inferior calyces calculi with IPA ＜ 45°;American Society of Anesthesiology (ASA) scores:65 cases of grade Ⅰ,39 cases of grade Ⅱ;There were 71 patients with urinary tract infection before operation.There were 6 cases of renal puncture fistula before operation.Preoperative indwelling ureteral stent in 26 cases;There were 32 cases with history of extracorporeal shock wave lithotripsy.There were 27 patients with a history of urolithiasis therapy.The same physician used preoperative urinary CT + 3D reconstruction imaging data to measure the factors influencing the postoperative stone free rate.RUSS renal stone scoring system was used to score the stones of patients before operation,and the relationship between the scores and the stones free rate was analyzed.The RUSS renal stone scoring system was supplemented and improved by including staghorn stone,duplicate renal,caliceal diverticulum,renal malrotation,stone area,and CT value related indexes.The modified RUSS renal stone scoring system was used to score the preoperative stone condition of patients,and the relationship between the score and the stone free rate was analyzed.The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to compare the advantages and disadvantages of the modified RUSS,the characteristics of the stones,and RUSS system.Results The stone free rate was 69.2％ (72/104) 4 weeks after the operation,and there were no postoperative complications.Single-factor analysis showed that stone area,CT value,number of renal calyx involved by stone,multiple stones,IPA,stone size grading,renal anatomic structure abnormality,staghorn stone were all related risk factors affecting postoperative patients.Multi-factor analysis showed that stone area,number of renal calyces involved by stone,multiple stones,IPA and stone size were independent risk factors affecting the stone free rate after FURL.RUSS scores ranged from 0 to 3 points,corresponding to stone clearing rates of 86.8％ (33/38),67.7％ (23/34),58.3％ (14/24) and 25.0％ (2/8),respectively.Stone clearing rates were significantly correlated with stone grading (P ＜ 0.05).The total scores of stone free group and residual stone group were (0.87 ± 0.96) points and (1.53 ± 0.98) points,respectively,with significant differences between the groups (P ＜ 0.05).The range of modified RUSS score was 0-4 points,corresponding to the stone clearing rate of 100.0％ (25/25),92.3％ (24/26),54.2％ (13/24),47.4％ (9/19),and 10.0％ (1/10),respectively.Stone free rate was significantly correlated with stone grading (P ＜ 0.05).The total scores of stone free group and residual stone group were (1.15 ± 1.13) points and (2.81 ± 0.93) points,respectively,with significant differences between the groups (P ＜ 0.05).The AUC of stone features was smaller than that of the modified RUSS scoring system.The AUC of RUSS scoring system (0.707,95 ％ CI 0.598-0.815) was smaller than that of the modified RUSS scoring system (0.865,95％ CI 0.797-0.933).Conclusions Both the RUSS scoring system and the modified RUSS scoring system could accurately predict the postoperative stone free status of FURL,while the modified RUSS scoring was more accurate than the RUSS scoring.

Feasibility study of modified RUSS to predict the stone free rate after flexible ureteroscopic lithotripsy / 中华泌尿外科杂志

Objective@#To explore the feasibility of the modified RUSS (Resorlu-Unsal Stone Score) renal stone scoring system in predicting the stone free rate after Flexible Ureteroscopic Lithotripsy(FURL).@*Methods@#Retrospective analysis was performed on 104 cases of renal stones treated by FURL from March 2017 to January 2019 in the second affiliated hospital of zhengzhou university, including 75 males and 29 females. Age 20-75 (47.79±13.21) years. BMI 18.2-38.3 (24.4±3.7) kg/m2; Crushed stone site: left 56 cases, right 48 cases. There were 23 cases of renal inferior calyces calculi, 81 cases of non-inferior calyces calculi, and 19 cases of renal inferior calyces calculi with IPA<45°; American Society of Anesthesiology (ASA) scores: 65 cases of grade Ⅰ, 39 cases of grade Ⅱ; There were 71 patients with urinary tract infection before operation. There were 6 cases of renal puncture fistula before operation. Preoperative indwelling ureteral stent in 26 cases; There were 32 cases with history of extracorporeal shock wave lithotripsy. There were 27 patients with a history of urolithiasis therapy. The same physician used preoperative urinary CT+ 3D reconstruction imaging data to measure the factors influencing the postoperative stone free rate. RUSS renal stone scoring system was used to score the stones of patients before operation, and the relationship between the scores and the stones free rate was analyzed. The RUSS renal stone scoring system was supplemented and improved by including staghorn stone, duplicate renal, caliceal diverticulum, renal malrotation, stone area, and CT value related indexes. The modified RUSS renal stone scoring system was used to score the preoperative stone condition of patients, and the relationship between the score and the stone free rate was analyzed. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to compare the advantages and disadvantages of the modified RUSS, the characteristics of the stones, and RUSS system.@*Results@#The stone free rate was 69.2% (72/104) 4 weeks after the operation, and there were no postoperative complications. Single-factor analysis showed that stone area, CT value, number of renal calyx involved by stone, multiple stones, IPA, stone size grading, renal anatomic structure abnormality, staghorn stone were all related risk factors affecting postoperative patients. Multi-factor analysis showed that stone area, number of renal calyces involved by stone, multiple stones, IPA and stone size were independent risk factors affecting the stone free rate after FURL. RUSS scores ranged from 0 to 3 points, corresponding to stone clearing rates of 86.8% (33/38), 67.7% (23/34), 58.3% (14/24) and 25.0% (2/8), respectively. Stone clearing rates were significantly correlated with stone grading (P<0.05). The total scores of stone free group and residual stone group were (0.87±0.96) points and (1.53±0.98) points, respectively, with significant differences between the groups (P<0.05). The range of modified RUSS score was 0-4 points, corresponding to the stone clearing rate of 100.0% (25/25), 92.3% (24/26), 54.2% (13/24), 47.4% (9/19), and 10.0% (1/10), respectively. Stone free rate was significantly correlated with stone grading (P<0.05). The total scores of stone free group and residual stone group were (1.15±1.13) points and (2.81±0.93) points, respectively, with significant differences between the groups (P<0.05). The AUC of stone features was smaller than that of the modified RUSS scoring system. The AUC of RUSS scoring system (0.707, 95%CI 0.598-0.815) was smaller than that of the modified RUSS scoring system (0.865, 95%CI 0.797-0.933).@*Conclusions@#Both the RUSS scoring system and the modified RUSS scoring system could accurately predict the postoperative stone free status of FURL, while the modified RUSS scoring was more accurate than the RUSS scoring.

Clinical efficacy of improved TIPS therapy in portal hypertension with acute upper gastrointestinal bleeding / 实用放射学杂志

Objective To discuss the clinical efficacy of improved TIPS of percutaneous portal vein puncture in treatment of acute upper gastrointestinal bleeding induced by portal hypertension.Methods 28 patients with acute upper gastrointestinal bleeding underwent improved TIPS therapy in our hospital were enrolled.The clinical data,laboratory parameters and hemodynamic changes were collected and analyzed before and after operation.Results The success rate for the first time and hemostatic rate of postoperative 24 hours in all patients was 100%.2(7.14%)patients underwent mild hepatic encephalopathy.After TIPS operation,the concentration of serum albumin increased,whereas,concentration of total bilirubin and alanine aminotransferase decreased(P<0.01).Portal vein pressure (PVP)of pre-and post-operation was(41.48 ± 3.72)mmHg and(28.91 ± 2.59)mmHg,and the hepatic venous pressure gradient (HVPG)was(20.30 ± 2.76)mmHg and(8.81 ± 2.04)mmHg.PVP and HVPG were both decreased significantly after operation(P<0.01).Conclusion Improved TIPS therapy can obtain good clinical efficacy and safety for esophageal and gastric varicose bleeding in acute cirrhosis.

Clinical observation of the double-J stent indwelling time in the treatment of ureteral complicated calculi post-ureteroscope / 实用医学杂志

Objective To systematically evaluate the optimal indwelling time of double?J stent in the treatment of ureteral complicated calculi post?ureteroscopy. Methods A total of 161 patients with complicated ureteral calculi were enrolled in this study from August 2012 to August 2015. All patients received the treatment of ureteroscopic holmium YAG Laser lithotripsy and were randomly divided into 3 groups according to varied double?J stent indwelling time: group A 6 weeks (n = 51). Complications of three groups were compared and the hydronephrosis after removing double?J stent was recorded. Results The rate of complications of group C was significantly higher than that in group A and group B (P<0.017). However,group A(10/43)has a higher rate of ureterostenosis after removing double?J stent compared with group B(4/67)and group C(3/51),while no statistical significance was observed between group B and group C. Conclusion The incidence of complications after lithotripsy increased with the indwelling time of double?J stent,but the short indwelling time would led to ureterostenosis. Therefore,the optimal indwelling time of double?J stent after flexible ureteroscopy was 2 to 6 weeks,and the indwelling time for patients with injury ureteral mucosa could be appropriately prolonged.

A study on the adverse effects of extracorporeal shockwave lithotripsy (ESWL) for renal stones / 中华泌尿外科杂志

Objective To study the reason and the preventive measures that adverse effects of extracorporeal shockwave lithotripsy (ESWL) for renal stones during treatment.Methods From April 2015 to January 2016,165 patients who underwent ESWL treatment for renal stones were enrolled this retrospective study.All patients were in supine position.Direction of shockwave was by the path of preabdomen.The adverse effects during treatment were observed.The related factors were analyzed by Logistic regression analysis.Results There were 70 cases(42.4％) with pain,10 cases(6.1％) with cold sweat,8 cases (4.8％) with accelerated heart rate,5 cases (3.0％)with descent of heart rate,2 cases (1.2％) with nausea and vomiting.In the univariate Logistic regression analysis,four variables (BMI,history of ESWL treatment,stone location and energy) were found showing statistical significance.Multivariate Logistic regression analysis showed that the final significant related factors were BMI ＜ 24.0 kg/m2 (OR =4.155,CI 1.373-12.571),history of ESWL treatment (OR =0.163,CI 0.058-0.454),stone in pelvis(OR =123.051,CI 17.638-858.439),stone in middle calyceal (OR =169.171,CI 29.677-964.343),energy 86.3-94.7J (OR =0.094,CI 0.025-0.362).Conclusions Pain was the most common adverse effect during the treatment of ESWL.Stone location (pelvis and middle calyceal) was an independent risk factor,BMI ＜ 24.0 kg/m2 was one of the related risk factors.Both energy 86.3-94.7J and history of ESWL treatment were preventive factors.

Super-selective embolization of renal artery for severe hemorrhage after minimally invasive percutaneous nephrolithotomy / 中国医师进修杂志

Objective To evaluate the outcome of super-selective embolization of renal artery for severe hemorrhage after minimally invasive percutaneous nephrohthotomy (MPCNL) and its effect on renal function.Methods Super-selective embolization of renal artery were performed in 9 patients with kidney hemorrhage followed by MPCNL.Results Seven patients were cured after the first time of embolization and 2 patients were treated successful after the second time.The main renal function was reserved.There was no serious complication after intervention.Condusiom Super-selective embolization of renal artery is reliable and effective in the diagnosis and treatment of kidney hemorrhage followed by MPCNL and in keeping main function of the kidney.It' s a safe and effective method in the treatment of severe hemorrhage after MPCNL.

Observation of the clinical effects of ornithine aspartate and lactulose on the prevention and treatment of hepatic encephalopathy after modified transjugular intrahepatic portosystemic shunt treatment / 中国医师进修杂志

Objective To observe the clinical effects of ornithine aspartate (OA) and lactulose on the prevention and treatment of hepatic encephalopathy for patients with portal hypertension after modified transjugular intrahepatic portosystemic shunt (TIPS).Methods Fifty-six patients with portal hypertension were treated by modified TIPS,OA and lactulose after the operation were given,the incidence of postoperative hepatic encephalopathy and the changes of blood ammonia were observed.Patients with hepatic encephalopathy after modified TIPS accepted therapeutic dosage of OA and lactulose,and the clinical effects of combined OA and lactulose on treatment of the hepatic encephalopathy after modified TIPS and changs of blood ammonia were evaluated as well.Results Prophylactic use of combined OA and lactulose after modified TIPS,there was no hepatic encephalopathy happened in 56 patients.Hepatic encephalopathy was seen in 5 patients after discontinuation of combined OA and lactulose,the incidence rate of hepatic encephalopathy was 8.93％ (5/56).The level of blood ammonia in patients after modified TIPS was significanby higher than that before treatment [(88.2 ± 23.0) μ mol/L vs.(43.1 ± 19.2) μ mol/L,P ＜ 0.05].Five patients with hepatic encephalopathy was improved quickly after given therapeutic dosage of OA and lactulose (the average treatment time was 7 d),and the level of blood ammonia was significantly lower than before treatment [(69.1 ± 14.1) p mol/L vs.(139.2 ± 15.8) μ mol/L,P＜ 0.05].Conclusion Combined OA and lactulose can effectively prevent and treat the hepatic encephalopathy after modified TIPS,its mechanism may be associated with reduction of blood ammonia level.

Clinical application of physical vibration lithecbole in upper urinary calculi after extracorporeal shock-wave lithotripsy / 中华泌尿外科杂志

Objective To observe the curative effect of external physical vibration lithecbole (EPVL) therapy after extracorporeal shock-wave lithotripsy (ESWL) in upper urinary calculi.Methods A total of 133 patients of upper urinary calculi with randomly divided into 2 groups after ESWL therapy during the period of 2012 October to 2013 February.The EPVL group (66 cases) used the physical vibration lithecbole treatment,and the natural lithecbole group (67 cases) used the method by drinking water,adding exercise and other natural lithecbole method.Of the EPVL group,6 of the stones were located in the upper or middle calyx,13 in renal pelvis,16 in lower renal calyx and 31 in ureter,the stone diameter was 10-15 mm.Of the natural lithecbole group,8 of the stones were located in the upper or middle calyx,17 in renal pelvis,15 in lower renal calyx and 27 in ureter,the stone diameter was 10-15 mm.The clinical data of the curative effect,side-effect,and complications were collected and analyzed systematically.Results In the EPVL group,the average times of lithagogue treatment was 2.6 times,51 patients (77％) expelled stones on the day of lithecbole,and the stone free rate in a week was 79％ (52/66).Especially,81％ (13/16) of the lower renal calyx expelled stones on the day of lithecbole,and the stone free rate in a week was 88％ (14/16).Whereas,30 patients (45％) in the natural lithecbole group expelled stones on the day of ESWL,and the stone free rate in a week was 49％ (33/67) ; the lower renal calyx stone expulsion rate on the day of ESWL was 33％ (5/15),and the stone free rate in a week was 40％ (6/15).The curative effects were significantly different between the 2 groups (P＜ 0.05).There were no serious complications in both groups.Conclusions EPVL machine can significantly promote the stone expulsion after ESWL.Compared with traditional methods,EPVL therapy has a better curative effect,especially on lower renal calyx stones.EPVL is a safe and noninvasive treatment.

Determination of the composition of kidney stones and prediction of the efficacy of extracorporeal shock-wave lithotripsy by X-rays / 中华泌尿外科杂志

Objective To evaluate the clinical value of determination of composition of kidney stones by shap and density and of prediction of the efficacy of extracorporeal shock-wave lithotripsy (ESWL) by X-rays. Methods The data of 358 patients were analyzed,with 204 male and 154 female and with 276 cases of solitary stones and 82 cases of multiple stones.Determine the composition of kidney stones by shap and density,predict the efficacy of ESWL by X-rays,and choose the appropriate method of treatment.Analyze stone chemical property by Infrared stone composition automatic analyzer to checkout the prediction results before surgeries. Results 339 cases were successful to remove stones after treatment.The prediction results of 308 cases (86.0％) were consistent in stone chemical property,and the preperative prediction results of 339 cases (94.7％) were consistent in ESWL efficacy. Conclusions Determination of composition of kidney stones and prediction of the efficacy of ESWL by X-rays were feasible.

Effects of class career psychological guidance on career planning abilities of college students / 中国心理卫生杂志

Objective:To explore the effects of class career psychological guidance(CCPG)on the career planning abilities of college students.Methods:By random sampling and control study methods,one class of college students were regarded as the experimental class of subjects,the other class was regarded as the control.The experimental class received 3 months of group training of CCPG,while the control class did not.They were assessed with the effect assessment scale of CCPG and the experimental class was retested 3.5 months later.Results:The overall level of career planning abilities had been improved in the experimental class after 3 months of CCPG,such as in the career planning confidence and the ability to solve problems relating to career,not in the control class. Most of the improved factors in the experimental class were still good after 3.5 months.Conclusion:The class career psychological guidance has a positive role in promoting the career planning abilities of college students.

Research progress on immunosuppressive activity of monomers extracted from Chinese medicine / 中国中药杂志

The clinical or experimental study proves that Chinese medicine such as Tripteryglum wilfordii, Lignum Sappan, Caulis Sinomenii, Radix Trichosanthis and Herba Artemisiae Annuae have good immunosuppressive activity. Further researches on the immunosuppressive active components from Chinese medicine have been the main direction in recent years. The recent researches on immunosuppressive effect and possible mechanisms for the monomers such as triperine, triptolide, bazilein, potosappanin A, sinomenine, trichosanthin and artemisinin extracted from those Chinese medicine are introduced in this review.

Treatment of ureteral stones by pneumatic lithotripsy combined with ESWL / 中国微创外科杂志

Objective To explore the therapeutic efficacy of pneumatic lithotripsy combined with extracorporeal shock wave lithotripsy (ESWL) in patients with ureteral stones. Methods Pneumatic lithotripsy combined with ESWL was employed in the treatment of 365 cases of ureteral stones. Results Of the 365 cases,the operation succeeded in 360 cases and failed in 2 cases,and ureteral perforation occurred in 3 cases.ESWL was required in 80 cases after pneumatic lithotripsy. Conclusions Pneumatic lithotripsy combined with ESWL offers advantages of high efficacy,minimal invasion and broad indications.

Treatment of ureteral stones with pneumatic lithotripter under ureterscopy (A report of 43 cases) / 中国微创外科杂志

Objective To evaluate the treatment of ureteral stones with pneumatic lithotripter under ureterscopy and the prevention of complications. Methords 43 cases of ureteral stones that had been treated with pneumatic lithotripter under ureteroscopy was reviewed. Results 93.0%(40/43)of the stones were fragmented on one session,93.0%(40/43)of the stones were expelled within 7 days afer the procedure.No complications occurred. Conclusions Treatment of ureteral stones with pneumatic lithotripter under ureterscopy is safe and effecive.