Objective To evaluate the effect of one step flexible ureteroscopic lithotripsy for incarcerated upper ureteral calculi.Methods The clinical data of 80 cases of incarcerated upper ureteral calculi were retrospectively analyzed between August 2015 and September 2016.Theone step flexible ureteroscopic lithotripsy was used in 40 cases (one step group),including 22 male cases and 18 female cases.The average age was (40.0 ± 9.5) years.The maximal stone diameter was (i.8 ± 0.5) cm.The widest width of the ureter above the stone was (2.5 ± 1.1) cm.The CT value of stone was (1 089.0 ± 111.3) HU.Two step method was used in 40 cases (two step group),including 21 male cases and 19 female cases.The average age was (41.0 ± 10.7).The maximal stone diameter was (1.7 ± 0.6)cm.The widest width of the ureter above the stone was (2.3 ± 0.9) cm.The CT value of stone was (1 002.0 ± 97.2) HU.During the one step flexible ureteroscopic lithotripsy,only flexible ureteroscope was used to crush the stone,no matter whether the stone located in the ureter or return to the renal pelvis.During two stepmethod,the rigid ureteroscopy was firstly used for crushing the stone in the ureter.When the stone return to the renal pelvis,the rigid ureteroscopy was change into flexible ureteroscope for continuous crushing the stone.Compared two groups' operating time,2 weeks stone clearance rate and the cases of fever after operation.Results The mean operative time in the one step group was (37.45 ± 11.34) min.The mean operative time in the two step group was (55.07 ± 13.57) min.The difference was statistically significant (P ＜ 0.05).The number of infection 2 cases in one step group and 9 cases in two step group.The difference was statistically significant (P ＜ 0.05).2 weeks stone clearance rate was 87.5％ (35/40) in one step group and 82.5％ (33/40)in two step group.There was no significant difference between two groups.Conclusions Flexible ureteroscope one step method is a safe and effective alternation for incarcerated upper ureteral calculi.

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 < 2 weeks (n = 43),group B from 2 ~ 6 weeks(n = 67),and group C>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.

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.

OBJECTIVE: To retrieve the evidence for threshold setting of multi-parameter electrocardiograph (ECG) monitors in intensive care unit (ICU), and summarize the best evidence. METHODS: After literature retrieval, clinical guidelines, expert consensus, evidence summary and systematic review that met the requirements were screened. Guidelines were evaluated by the appraisal of guidelines for research and evaluation II (AGREE II), expert consensus and systematic review were evaluated by the Australian JBI evidence-based health care center authenticity evaluation tool, and evidence summary was evaluated by the CASE checklist. High-quality literature was selected to extract evidence related to the use and setup of multi-parameter ECG monitors in the ICU. RESULTS: A total of 19 literatures were included, including 7 guidelines, 2 expert consensus, 8 systematic reviews, 1 evidence summary, and 1 national industry standard. After evidence extraction, translation, proofreading and summary, a total of 32 pieces of evidence were integrated. The included evidence involved the environmental preparation for the application of the ECG monitor, the electrical requirements of the ECG monitor, ECG monitor use process, ECG monitor alarm setting principles, ECG monitor alarm heart rate or heart rhythm monitoring setting, ECG monitor alarm blood pressure monitoring setting, ECG monitor alarm respiratory and blood oxygen saturation threshold setting, alarm delay warning time setting, adjusting alarm setting method, evaluating alarm setting time, improving the comfort of monitoring patients, reducing nuisance alarm report the occurrence, alarm priority processing, alarm intelligent processing and so on. CONCLUSIONS This summary of evidence involves many aspects of the setting and application of ECG monitor. According to the latest guidelines and expert consensus, it is updated and revised to guide healthcare workers to monitor patients more scientifically and safely, and aims to ensure patient safety.
Humans ; Clinical Alarms ; Australia ; Intensive Care Units ; Arrhythmias, Cardiac ; Electrocardiography ; Monitoring, Physiologic

Objective:To explore the independent influencing factors of Gleason group upgrading (GGU)after radical prostatectomy (RP) of localized prostate cancer based on 2014 International Society of Urologic Pathology (ISUP)grouping system, then establish an effective prediction model.Methods:The study included 48567 patients with localized prostate cancer who underwent radical prostatectomy from the surveillance, epidemiology and end results (SEER) database. The age was (61.1±7.0) years, including 39 014 cases (80.3%), 7 063 cases (14.5%), 2 331 cases (4.8%), and 159 cases (0.3%) of White, Black, Asian or Pacific Islander, American Indian/Alaska Native. PSA<4 ng/ml, 4-10 ng/ml, 11-19 ng/ml, ≥20 ng/ml were 6 545 cases (13.5%), 35 007 cases (72.1%), 5 578 cases (11.5%), 1 437 cases (3.0%) respectively. Percent positive cores (PPC)≥33% were 24 743 cases (50.9%). Gleason group of biopsy specimen: G1 18 971cases (39.1%), G2 18 446 cases (38.0%), G3 7 093 cases (14.6%), G4 4 057 cases (8.4%). Simple random sampling was assigned to the cases, divided them into training cohort and internal validation cohort according to the ratio of 7∶3. 67 patients with localized prostate cancer who treated in The Second Affiliated Hospital of Zhengzhou University during January 2017 to December 2021 were set as external validation cohort. All these cases were Asian with Chinese nationality, age(66.4±10.3) years. PSA<4 ng/ml, 4-10 ng/ml, 11-19 ng/ml, ≥20 ng/ml were 13 cases (19.4%), 32 cases (47.8%)16 cases (23.9%), 6 cases (9.0%) respectively. PPC≥33% were 38 cases (56.7%). Gleason group of biopsy specimen: G1 18 cases (26.9%), G2 23cases (34.3%), G3 12 cases (17.9%), G4 14 cases (20.9%). The independent predictors of GGU were analyzed by logistic regression analysis, and the nomogram for predicting GGU were established. Then, the performance of nomograms was internally and externally validated via area under curve (AUC) and the calibration curve.Results:There were 8 716 cases (25.6%), 3 677 cases (25.2%) and 24 cases (35.8%) with GGU in the training group, internal validation group and external validation group, respectively. Logistic regression showed Gleason group of biopsy specimen (G2: OR=0.164, P<0.01; G3: OR=0.073, P<0.01; G4: OR=0.087, P<0.01), PSA (4-10 ng/ml: OR=1.550, P<0.01; 11-19 ng/ml: OR=2.084, P<0.01; ≥20 ng/ml: OR=2.664, P<0.01), age (60-69 years: OR=1.292, P<0.01; ≥70 years: OR=1.550, P<0.01), PPC (≥33%: OR=1.334, P<0.01) and race (Asian or Pacific Islander: OR=1.266, P<0.01) were independent influencing factors for GGU. The predicting model, was established according to Gleason group of biopsy specimen, PSA, age and PPC. The AUC of the model in the training cohort, the internal validation cohort and the external validation cohort were 0.759, 0.757 and 0.747 respectively. The calibration curves of the three cohorts were close to the ideal line and showed good consistency. Conclusions:Gleason group of biopsy specimen, PSA, age, PPC and race are independent influencing factors for GGU after RP of localized prostate cancer. G. P.A.P. model can effectively predict the risk of GGU after RP of localized prostate cancer.

Objective:To investigate the pathogenic bacteria profiles in preoperative urine bacterial cultures of patients with infected kidney stones and use antibacterial drugs to prevent recurrence.Methods:The data of 79 cases with infected kidney stones admitted to the Second Affiliated Hospital of Zhengzhou University from January 2017 to July 2021 were retrospectively analyzed, among whom 29 (36.7%) were male and 50 (63.3%) were female. The age ranged from 17-75 years, with a median age of 49.0 (40, 55) years. Fifteen cases (19.0%) combined hypertension, 13 cases (16.5%) combined diabetes mellitus, and 3 cases (3.8%) combined with cardiovascular disease. Fifty-one cases (64.6%) were diagnosed with cast infectious stones. All patients underwent surgical lithotripsy, and postoperative review of the urological computerized tomography (CT) revealed no residual stones defined as complete lithotripsy, and postoperative oral medication was continued to control infection and prevent stone recurrence. According to post-hospitalization compliance, patients were divided into high and low compliance groups. The high compliance group consisted of patients who returned to the hospital regularly for routine urinalysis and urine bacterial culture after discharge, followed the doctor's prescription for standardized antibacterial drug therapy, and complied with urease inhibitor therapy for ≥6 months. The low compliance group included patients who did not take sensitive antimicrobial drugs regularly and/or were unable to adhere to the medication even after the reduction of vinblastine due to adverse events such as tremor, palpitations, headache, anemia, or gastrointestinal discomfort. The recurrence of stones at 3, 6 and 12 months of follow-up was compared between the two groups.Results:Of the 79 cases in this group, 56(70.9%) were completely clear of stone after surgery. Thirty-three cases (41.8%) presented positive in preoperative urine bacterial culture, and the most common causative organism was Aspergillus oddus in 17 cases (21.5%), followed by Escherichia coli in 8 cases (10.1%) and Klebsiella pneumoniae in 3 cases (3.8%). Among the 17 positive cases of A. oddis, six were positive for ultra broad spectrum β-lactamases (ESBLs), 6/6 were resistant to ampicillin, cefazolin, and cotrimoxazole, 1/6 were resistant to amikacin, cefoxitin, and ticarcillin/stick acid, and none were resistant to imipenem, polymyxin, or aminotrans (0/6 cases). Of the cases, 11 were negative for ESBLs. Ten out of eleven cases were resistant to ampicillin. Furthermore, 8/11 cases were resistant to cefazolin, levofloxacin, ciprofloxacin, and cotrimoxazole and 1/11 were resistant to cefoxitin, cefaclor, furantoin, amikacin, and minocycline, and 0/11 were resistant to imipenem, ticarcillin/stick acid, aminotrans. ESBLs positive strains were resistant to 78.6% of the tested drugs (cefaclor, cefazolin, ceftazidime, furantoin, norfloxacin, levofloxacin, ciprofloxacin, cefoxitin, amoxicillin/rod acid, ticarcillin/rod acid, ampicillin, ceftriaxone, cefotaxime, cefuroxime, cefepime, gentamicin, cotrimoxazole, tobramycin, amikacin, tetracycline, chloramphenicol, and minocycline) at a lower rate of resistance than ESBLs positive strains. Of the eight positive cases of E. coli, seven were ESBLs positive, 7/7 were resistant to ampicillin, cefazolin, cefotaxime, cefuroxime, and cefepime, 1/7 were resistant to cefoxitin and minocycline, and 0/7 were resistant to imipenem, furantoin, or amikacin. One case was ESBLs negative and was resistant to all antimicrobial drugs except for ampicillin. Stone recurrence rates at 3, 6, and 12 months after discharge were 9.1%(4/44) and 31.4%(11/35), 13.6%(6/44), respectively, in the high compliance group, and 60.0%(21/35), 36.4%(16/44), and 71.4% (25/35), respectively, in the low compliance group. All differences were statistically significant.Conclusion:The most common pathogenic bacteria isolated from urine bacterial cultures of patients with infectious stones were A. chimaera, E. coli, and K. pneumoniae. The resistance rate of ESBLs-positive strains to antimicrobial drugs was significantly higher than that of ESBL-negative strains, and the resistance rate of antimicrobial drugs such as β-lactamase inhibitors, cefoxitin, amikacin, and imipenem was low. Combination therapy with standardized sensitive antimicrobial drugs and urease inhibitors significantly reduced the recurrence rate of stones among patients.

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.