Objective: To explore the efficacy and surgical techniques of ultrasound-assisted transurethral flexible ureteroscopic holmium laser incision and internal drainage in the treatment of special renal cystic diseases，so as to provide reference for the diagnosis and treatment of such diseases. Methods: The clinical data of 48 patients with special renal cystic diseases treated during Jan.2019 and May 2023 were retrospectively analyzed.The diagnosis was made by computed tomography urography (CTU) and three dimensional urinary tract reconstruction before operation.All patients received the abovementioned surgery in semisupine lithotomy position.The general information，clinical data，and incidence of complications were analyzed. Results: There were 27 males and 21 females，with an average age of (48.0±7.5) years，including 22 cases of parapelvic cysts，6 cases of endogenic simple renal cysts with an average diameter of (5.0±1.0) cm，and 20 cases of renal calyceal diverticulum with stones，with an average diameter of (2.5±1.3) cm for the diverticulum and an average diameter of (1.5±1.0) cm for the stones，which were located in the upper or middle calyces.In 7 cases，ureteroscopic localization was difficult，and the surgery was completed with percutaneous renal puncture needle assisted localization.Ureteral stenosis was detected in 2 cases during surgery，and surgery was performed 4 weeks after double J tubes were placed.The remaining operations were successfully completed.The average operation time was (42.0±14.5) minutes，and average hospital stay was (2.0±0.5) days.During the follow-up of (12.0±8.5) months，lumbar pain improved in 27 cases (100%)，renal cysts disappeared in 23 cases (82.1%,23/28)，cysts significantly reduced by ≥50% in 4 cases (14.3%,4/28)，slightly reduced by <50% in 1 case (3.6%,1/28)，and the renal calyx diverticulum disappeared in 20 cases (100%).Gross hematuria and lower back pain occurred in 2 cases，and no other complications developed. Conclusion: Ultrasound-guided transurethral flexible ureteroscopic holmium laser incision and internal drainage is a safe and effective treatment for special benign renal cystic diseases.When ultrasound-guided flexible ureteroscope localization is difficult to perform，percutaneous renal puncture needle may be applied.

Japanese encephalitis is an acute central nervous system infectious disease caused by Japanese encephalitis virus (JEV) with brain parenchyma inflammation, characterized by high fever, headache, positive meningeal irritation, impaired consciousness, convulsion, and respiratory failure, with mortality rate as high as 20%-30%, and with neurological sequelae in 30%-50% of survivors. The mechanism of brain damage caused by JEV infection is still unclear, and some studies imply its close relation with immune-inflammatory response. This article reviews the research progress on immune-inflammatory response mechanism of Japanese encephalitis to help to understand its pathogenesis.

Objective To analyze the causes and manifestations of non-pulmonary embolism induced perfusion defects (PDs) on dual-energy perfusion imaging (DEPI) using dual source CT.Methods Consecutive 208 patients without pulmonary embolism who underwent DEPI were reviewed retrospectively.The causes of PDs were analyzed by two radiologists, the pulmonary segment numbers, the proportion and the perfusion patterns of each case were recorded and analyzed respectively.Results 1 118 of 3 716 pulmonary segments showed the PDs.Among them, 752(67.26%), 36(3.22%), 308(27.55%) and 22(1.97%) pulmonary segments had PDs due to intra-pulmonary lesions, vascular diseases, artifacts and unidentifiable causes, respectively.In PDs resulted from intra-pulmonary lesions, vascular diseases and unidentifiable causes, three patterns (wedge-shaped, heterogeneous and regionally homogeneous) were identified,and most of those PDs were heterogeneous and regionally homogeneous, which were largely in accordance with the lesions showed on non-contrast enhanced scans.Artifacts included the beam hardening artifacts and artifacts caused by heart beat or diaphragmatic movement.The PDs caused by artifacts usually had particular locations and shapes.Conclusion Understanding of the manifestations and causes of PDs in patients without pulmonary embolism can improve the diagnosis accuracy of pulmonary embolism on DEPI.

Objective: To compare the outcome of radiofrequency catheter ablation under local anesthesia/sedation (S) or general anesthesia(GA) in atrial fibrillation patients. Methods: Data of 498 patients with atrial fibrillation undergoing radiofrequency catheter ablation in our departmentfrom January 2014 to December 2015 were retrospectively analyzed. Two hundred and twenty patients assigned to the GA group, the other 278 patients to the S group. Patients were followed clinically every 3 months within one year after procedure. Immediate electrocardiogram was performed in patients with palpitation or choking sensation in chest. The end point of the study was recurrence of any atrial tachyarrhythmia lasting >30 seconds in device interrogation, 24-hour Holter monitoring or 12-lead electrocardiogram after a single procedure. After the ablation procedure, a blanking period of 3 months was allowed according to the guidelines. Procedure time, radiofrequency time, fluoroscopy time, the detection of paroxysmal supraventricular tachycardia, the success rate and the complications were compared between the two groups. Results: There was no difference in the baseline characteristics between the two groups, such as age, gender, BMI, complications, LVEF, LAD (all P>0.05). The duration of procedure ((117.8±51.7)minutes vs.(115.4±36.9)minutes, P=0.79), duration of fluoroscopy((12.5±11.2)minutes vs. (10.4±10.2)minutes, P=0.35), duration of radiofrequency((40.1±12.9)minutes vs. (48.6±44.3)minutes, P=0.48) were similar between the two groups (P>0.05). Compared with S group, discovery of the frequency of atrioventricular node reentrant tachycardia (AVNRT) was significantly lower in GA group (0 vs. 3.6%(10/278), P<0.01), but the difference disappeared with repeat electrophysiological examination when patients become conscious from GA(3.2%(7/220) vs. 3.6%(10/278), P=0.311). The difference of atrioventricular reentrant tachycardia (AVRT) was similar between the two groups(0.9%(2/220) vs. 0.7%(2/278), P=0.841). Compared with S group, reflection of vagus nerve was less in GA group (1.4%(3/220) vs. 8.6%(24/278), P=0.026). After following up of (356±92) days, freedom from atrial fibrillation/atrial flutter/atrial tachyarrhythmia was similar between the two groups(77.9%(162/208) vs. 79.9%(215/269), P=0.818). Conclusion General anesthesia is a promising method to atrial fibrillation ablation, in view of stable patient status and safety for the procedure. There is no difference in complications, recurrence of arrhythmia between the two groups, but detection rate of AVNRT is lower in GA group.

Objective To investigate the application of semi-quantitative analysis of dual energy lung perfusion imaging(DEPI)in patients with acute pulmonary embolism(PE)before and after treatment.Methods 25 patients with acute PE diagnosed by dual source CT were recruited consecutively.All of them underwent CT pulmonary angiography(CTPA)and DEPI before and after treatment. Radiologists visually evaluated the PE numbers,its distribution(central or peripheral)and its nature(occlusive or non-occlusive)on CTPA.DEPI visual analysis and semi-quantitative analysis before and after treatment in different types of PE evaluated by CTPA were analyzed statistically.Results Four types of PE(central occlusive PE,central non-occlusive PE,peripheral occlusive PE and peripheral non-occlusive PE)were classified according to embolic sites and the extent of embolization.Comparing to CTPA as a standard reference,the positive rates of DEPI visual analysis were 100.00%,70.54%,87.23%,76.19% before treatment,100.00%, 76.67%,86.67%,77.78% after treatment,respectively.Significant differences were found in central occlusive PE,central non-occlusive PE and peripheral occlusive PE with mean difference of CT values before and after treatment[(70.7 ± 10.1)HU vs(29.8 ± 6.0)HU,P<0.01;(50.1 ± 9.6)HU vs(29.3 ± 7.8)HU,P< 0.01;(53.4 ± 11.4)HU vs(27.4 ± 8.9)HU,P<0.01,respectively].Although(24.5 ± 8.2)HU (after treatment)were lower than(28.5 ± 9.0)HU(before treatment),no significant difference was found in the type of peripheral non-occlusive PE(P> 0.05).Conclusion The combination of CTPA and DEPI can offer more comprehensive information of the acute PE therapeutic evaluation before and after treatment.

Cardiovascular Diseases ; Humans ; Natriuretic Peptides

OBJECTIVETo explore the clinical characteristics and risk factors of peripheral arterial thromboembolism (PAT) in patients with non valvular atrial fibrillation (NVAF).

METHODSA total of 18 456 patients admitted in our hospital and diagnosed with NVAF were included in this study. The study population was divided into three groups [PAT group, cerebral thromboembolism (CT) group and no thromboembolism group]. Risk factors of PAT were assessed by multivariate logistic regression.

RESULTSThe incidence of PAT and CT was 1.1% (204 cases) and 27.8% (5 132 cases), respectively. The in-hospital mortality of PAT group was 11.8% (24/204), in which the in-hospital mortality due to mesenteric arterial thromboembolism (37.5%, 6/16) was the highest. Multivariate logistic regression indicated that vascular disease (OR = 3.9, 95% CI 2.13-7.08, P < 0.01), age ≥ 65 years (OR = 2.7, 95% CI 1.66-4.27, P < 0.01), hypertension (OR = 2.1, 95% CI 1.36-3.34, P < 0.01), history of stroke/TIA/arterial thromboembolism (OR = 2.0, 95% CI 1.26-3.17, P < 0.01) and congestive heart failure (OR = 1.9, 95% CI 1.22-2.86, P < 0.01) were independent risk factors of PAT. Prevalence of vascular disease and histories of PAT was higher in PAT group than in CT group (P < 0.01), while CHADS2 and CHA2DS2VASc scores were similar between the PAT and CT groups.

CONCLUSIONPAT is not uncommon in NVAF patients, risk factors for PAT in NVAF patients are vascular disease, advanced age, hypertension, history of stroke/TIA/arterial thromboembolism and congestive heart failure.

Atrial Fibrillation ; complications ; Case-Control Studies ; Heart Failure ; Hospital Mortality ; Hospitalization ; Humans ; Hypertension ; Incidence ; Risk Factors ; Stroke ; Thromboembolism ; epidemiology ; etiology ; Vascular Diseases

The Long-term Thromboembolic Event Analysis in Atrial Fibrillation Patients With Radiofrequency Catheter Ablation
Objective: To observe the thromboembolic event in atrial fibrillation (AF) patients with long-term successful radiofrequency catheter ablation (RFCA), and to study the relationship between thromboembolic event and CHA2DS2-VASC score in order to guide the anticoagulation strategy for AF patients.
Methods: A total of 321 AF patients who received RFCA in our hospital from 2000-01 to 2009-05 were studied. There were 261 patients with paroxysmal AF and 60 with persistent AF, they were followed-up for (66.7±26.9) months. The patients were divided into 2 groups according to AF recurrence condition as Non-recurrence group, n=204 and Recurrence group, n=117. The relationship between thromboembolic event and CHA2DS2-VASC score was studied.
Results: The Non-recurrence group had significantly lower rate of thromboembolism than that in Recurrence group (1.96% vs 7.69%), P=0.017. In both groups, the patients with CHA2DS2-VASC score < 2 had much lower rate of thromboembolism than those with CHA2DS2-VASC score ≥ 2, (0% vs 5%), P=0.023 and (4.45% vs 17.24%), P=0.041. The patients with CHA2DS2-VASC score<2 in Non-recurrence group had lower rate of thromboembolism than those in Recurrence group (0%vs 4.45%), P=0.029. The rate of thromboembolism had no statistic meaning between 2 groups in patients with CHA2DS2-VASC score≥2 (5%vs 17.24%), P=0.054.
Conclusion: The AF patients who received RFCA without AF recurrence in long-term follow-up had the lower rate of thromboembolic event, CHA2DS2-VASC score was important for evaluating such event. The patients with CHA2DS2-VASC score < 2 could consider stopping warfarin anticoagulation, while the patients with CHA2DS2-VASC score ≥ 2 might be beneifted for warfarin anticoagulation.

Objective To explore the clinical characteristics and risk factors of peripheral arterial thromboembolism (PAT) in patients with non valvular atrial fibrillation (NVAF).Methods A total of 18 456 patients admitted in our hospital and diagnosed with NVAF were included in this study.The study population was divided into three groups [ PAT group, cerebral thromboembolism ( CT ) group and no thromboembolism group ].Risk factors of PAT were assessed by multivariate logistic regression.Results The incidence of PAT and CT was 1.1%( 204 cases ) and 27.8%( 5 132 cases ) , respectively.The in-hospital mortality of PAT group was 11.8%(24/204), in which the in-hospital mortality due to mesenteric arterial thromboembolism ( 37.5%, 6/16 ) was the highest.Multivariate logistic regression indicated that vascular disease(OR=3.9,95%CI 2.13-7.08, P<0.01), age≥65 years(OR=2.7, 95%CI 1.66-4.27,P<0.01), hypertension(OR=2.1, 95%CI 1.36-3.34,P<0.01), history of stroke/TIA/arterial thromboembolism(OR=2.0,95%CI 1.26-3.17,P<0.01) and congestive heart failure(OR=1.9,95%CI 1.22-2.86,P<0.01) were independent risk factors of PAT.Prevalence of vascular disease and histories of PAT was higher in PAT group than in CT group (P<0.01), while CHADS2 and CHA2DS2VASc scores were similar between the PAT and CT groups.Conclusion PAT is not uncommon in NVAF patients , risk factors for PAT in NVAF patients are vascular disease , advanced age , hypertension , history of stroke/TIA/arterial thromboembolism and congestive heart failure .

OBJECTIVETo investigate the efficacy and safety of intravenous ibutilide for conversion of atrial fibrillation (AF) and flutter (AFL) to sinus rhythm.

METHODSNinety-nine consecutive patients aged 18-75 y with AF/AFL were included. The duration of arrhythmia was <90 d (1 h-90 d) and ventricular rate was >60 beats/min. Patients were assigned randomly into two groups: 49 patients in ibutilide group received ibutilide 1 mg, then repeated if AF/AFL was not converted after 10 min; 50 patients in propafenone group received propafenone 70 mg, then repeated if AF/AFL persisted after 10 min. Two drugs were diluted by 50 ml of 5% glucose and injected intravenously within 10 min.

RESULTSVentricular rates were decreased in both groups. AF/AFL were converted in 34 of 49 patients (69.4 % ) in ibutilide group and in 22 of 50 patients (44.0 %) in propafenone group (P <0.05). The converting time of ibutilide was significantly shorter than that of propafenone [(16.79 ± 12.31) min compared with (36.92 ± 11.38)min, P <0.01]. The most serious adverse effect of ibutilide was non-sustained monomorphic ventricular tachycardia (3/49,6.12 %). Transient hypotension and heart pause were the main adverse events in patients who received propafenone, acute left heart failure occurred in one patient of propafenone group.

CONCLUSIONIntravenous ibutilide is a safe and effective agent for cardioversion of recent-onset AF/AFL. Furthermore,strict processing under electrocardio-monitoring is important.

Adolescent ; Adult ; Aged ; Atrial Fibrillation ; drug therapy ; Atrial Flutter ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Propafenone ; therapeutic use ; Sulfonamides ; therapeutic use ; Treatment Outcome ; Young Adult