Rigid ureteroscopic lithotripsy with a pressure-controlling ureteral access sheath for complex steinstrasse.

OBJECTIVE: To evaluate the safety and efficacy of rigid ureteroscopic lithotripsy with a pressure-controlling ureteral access sheath (PC-UAS) for complex steinstrasse. METHODS: Thirty-one consecutive patients (male: 18; female: 13) with steinstrasse were enrolled, six of whom had concurrent kidney stones. The mean cumulative stone size was 2.7 ± 1.3 cm. The patients were treated with rigid ureteroscopic lithotripsy using a PC-UAS. The cavity pressure parameters were set as follows: control value at -15 mmHg to -2 mmHg, warning value at 20 mmHg, and limit value at 30 mmHg. The infusion flow rate was set at 150-200 ml/min. A holmium laser (550 µm) was used to powderize the stone at 2.0-2.5 J/pulse with a frequency of 20-30 pulses/s. Analyses included cavity pressure, operative time, stone-free rates, and complications. RESULTS: Among the 31 patients, 29 were successfully treated with PC-UAS, with nine requiring adjunctive flexible ureteroscopy for stone migration to the kidney. Two procedures were converted to percutaneous nephrolithotomies due to failure of sheath placement. The cavity pressure of all 29 patients was well-maintained below 20 mmHg, with clear vision. The mean operative time was 48.2 ± 17.7 min. No complications, such as ureteral perforation, mucosal avulsion, or hemorrhage, occurred. Two cases of Clavien-Dindo grade I complications occurred. No major complications (Clavien-Dindo grade II-V) occurred. The mean postoperative hospitalization time was 1.7 days. The stone-free rates 1 day and 1 month after surgery were 93.1% and 96.6%, respectively. One patient with residual stones underwent extracorporeal shockwaves. CONCLUSIONS: Rigid ureteroscopic lithotripsy with PC-UAS can effectively control the cavity pressure, shorten the operation time, and improve the efficiency of broken stones, thus reducing the complication rate.

Mortality and Related Risk Factors of Fragile Hip Fracture.

OBJECTIVE: To explore the mortality of patients with fragile hip fractures and assess the death-associated risk factors. METHODS: A total of 690 patients with osteoporotic hip fractures (age, 50-103 years) that were treated from January 2010 to December 2015 were enrolled and followed-up in this study and the clinical data were retrospectively collected. Three months, 1 year, and the total mortality were measured. Mortality-related risk factors were assessed including age, gender, surgery, the duration from injury to operation, pulmonary infection, and the number and type of complications. The mortality of each group was compared by chi-square test or corrected chi-square test for univariate analysis, and the factors with statistically significant mortality difference confirmed by univariate analysis were analyzed by binary logistic multivariate analysis. RESULTS: The 3-month mortality was 7.69%, the 1-year mortality was 15.60%, and the total mortality of the follow-up time was 24.06%. The 1-year and total mortality during the follow-up of the patients were higher in the >75-year-old group than those in the ≤75-year-old group (p = 0.000, respectively); were higher in the male patients than that in the female patients (p = 0.042; p = 0.017, respectively); were significantly lower in the operation group than that in the non-operation group (p = 0.000, respectively); were significantly lower in the patients that underwent the operation in ≤5 days than the patients that underwent the operation within >5 days (p = 0.008; p = 0.000, respectively); were significantly lower in patients with >2 kinds of combined medical diseases than those with ≥2 kinds of chronic diseases (p = 0.000, respectively); were significantly lower in patients receiving anti-osteoporosis treatment than in patients not receiving anti-osteoporosis treatment (p = 0.000, p = 0.002, respectively). Binary logistic regression analysis showed that the independent risk factors affecting mortality included advanced age >75-years-old (OR = 5.653, p = 0.000), male (OR = 1.998, p = 0.001), non-surgical treatment (OR = 9.909, p = 0.000), the number of combined medical diseases ≥2 (OR = 1.522, p = 0.042), and non-anti-osteoporosis treatment (OR = 1.796, p = 0.002). CONCLUSION: Age, whether or not surgical treatment was performed, the number of medical diseases, and whether or not anti-osteoporosis treatment was performed were independent risk factors for 3-month and 1-year mortality in patients with fragile hip fractures.

Prediction of Re-positivity for Coronavirus Nucleic Acid Among COVID-19 Patients in the Recovery Phase.

Background and Objectives: Although the pathogenesis and treatment of coronavirus disease 2019 (COVID-19) have been gradually revealed, the risk for re-emergence of coronavirus nucleic acids in recovered patients remains poorly understood. Hence, this study evaluated the risk predictors associated with re-positivity for virus nucleic acid. Methods: Between February 1 and March 20, 2020, we retrospectively reviewed the clinical epidemiological data of 129 COVID-19 patients who were treated at Zhongxiang People's Hospital of Hubei Province in China. Subsequently, a risk prediction model for the re-positivity of virus nucleic acid was developed, and a receiver operating characteristic (ROC) curve was drawn for further validation. Results: In this study, the rate of re-positivity for virus nucleic acid was 17.8% (23/129) where all re-positivity cases were asymptomatic. The median time interval from discharge to nucleic acid re-positivity to discharge after being cured again was 11.5 days (range: 7-23 days). Multivariate logistic regression analysis showed that leukocytopenia [odds ratio (OR) 7.316, 95% confidence interval (CI) 2.319-23.080, p = 0.001], prealbumin < 150 mg/L (OR 4.199, 95% CI 1.461-12.071, p = 0.008), and hyperpyrexia (body temperature >39°C, OR 4.643, 95% CI 1.426-15.117, p = 0.011) were independent risk factors associated with re-positivity. The area under the ROC curve was 0.815 (95% CI, 0.729-0.902). Conclusion: COVID-19 patients with leukocytopenia, low prealbumin level, and hyperpyrexia are more likely to test positive for virus nucleic acid after discharge. Timely and effective treatment and appropriate extension of hospital stays and quarantine periods may be feasible strategies for managing such patients.

Analysis of Related Factors of Brittle Hip Fracture in Postmenopausal Women with Osteoporosis.

OBJECTIVE: To investigate the effects of age, body mass index (BMI), bone mineral density (BMD), and levels of serum 25-hydroxyvitamin D (25OHD) on hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. METHODS: A total of 252 postmenopausal women patients, whose bone density had reached the threshold of osteoporosis and age ≥50 years (50-98 years), collected from the Second Affiliated Hospital of Fujian Medical University from January 2015 to December 2018, were performed by retrospective analysis. According to whether or not they had a hip fracture, including femoral neck fracture or intertrochanteric fracture, the patients were divided into two groups, including 117 cases (50-84 years old) in the non-hip fracture group and 135 cases (57-98 years old) in the hip fracture group. BMD was measured by Hologic Discovery A DXA bone mineral densitometer. Levels of serum 25OHD were detected by ROCHE detection instrument. Comparisons of age, BMI, bone density of femoral neck, and levels of serum 25OHD between the two groups were performed by using the Student's t-test. Furthermore, the statistically significant factors were analyzed by multiple regression analysis to investigate the independent risk factors of hip fracture. RESULTS: The group without hip fracture: 117 cases; average age: 67.4 ± 8.5 years; BMI: 22.3 ± 3.2 kg/m2 ; bone density of femoral neck: (0.504 ± 0.067) g/cm2 ; T-value of femoral neck: -3.1 ± 0.6; levels of serum 25OHD: (24.9 ± 8.5) ng/mL. The group with brittle hip fracture: 135 cases; average age: 80.7 ± 7.6 years; BMI: 20.3 ± 3.5 kg/m2 ; bone density of femoral neck: (0.426 ± 0.077) g/cm2 ; T-value of femoral neck: -3.8 ± 0.7; levels of serum 25OHD: (15.9 ± 8.9) ng/mL. Age, BMI, bone density of femoral neck, and 25OHD level of the group without hip fracture were markedly lower than hip fracture group (P < 0.05). The results of logistic regression analysis suggested that age, bone density of femoral neck, and levels of serum 25OHD were independent risk factors for fragile hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. CONCLUSION: Higher age, lower levels of bone density and 25OHD are the main risk factors of hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis.

Anti-Osteoporosis Medications Associated with Decreased Mortality after Hip Fracture.

OBJECTIVE: To study the effect of anti-osteoporosis therapies on mortality after hip fracture. METHODS: This retrospective study was carried out in the Second Affiliated Hospital of Fujian Medical University and enrolled 690 patients 50 years of age and older who were admitted with hip fractures between 2010 and 2015. The patients were followed in 2017: 690 patients aged was from 50 to 103 years. There were 456 women and 234 men. There were 335 patients with fractures of the femoral neck and 355 patients with intertrochanteric fractures of the femur. There were 444 (64.35%) patients who also had internal diseases. The Charlson comorbidity index was 0-6. The anti-osteoporosis medications were classified into no anti-osteoporosis medication, calcium + vitamin D supplementations, non-bisphosphonate medication, and bisphosphonate medication. The physicians followed the patients or family members by personal visit and telephone. Multivariable Cox regression analyses were done with known risk factors for mortality of hip fracture, such as gender, age, number of combined internal diseases, fracture type, place of residence, and Charlson comorbidity index, to show which anti-osteoporosis medications had significant effects on mortality after adjustment for these variables. RESULTS: Out of 690 patients with hip fractures, 149 patients received no anti-osteoporosis medication, 63 patients received calcium +vitamin D supplementations, 398 patients received non-bisphosphonate medication, and 80 patients received bisphosphonate medication. The patients were followed between 7 months and 52 months, with the average of 28.53 ± 9.75 months. A total of 166 patients died during the follow-up period. Of 166 deaths, 43 occurred within 3 months, 65 within 6 months, and 99 within 1 year after the hip fracture. In this study, fracture type, place of residence, and Charlson comorbidity index were not associated with the mortality, and the male gender, age > 75 years, and ≥ 2 combined internal diseases were the independent factors for deaths post-hip fracture. The cumulative mortality was 36.24% in the patients receiving no anti-osteoporosis medication. The hazard ratio for mortality after hip fracture with bisphosphonate medication, non-bisphosphonate medication, and calcium/vitamin D supplementation was 0.355 (95% CI, 0.194-0.648), 0.492 (95% CI, 0.347-0.699) and 0.616 (95% CI, 0.341-1.114), respectively, as compared with no anti-osteoporosis group. Bisphosphonate and non-bisphosphonate medications for osteoporosis were significantly associated with the reduction of cumulative mortality post-hip fracture (P < 0.01). CONCLUSIONS: Bisphosphonate and non-bisphosphonate medications for osteoporosis were significantly associated with decreased mortality after fragility hip fracture.

Low Grip Strength is a Strong Risk Factor of Osteoporosis in Postmenopausal Women.

OBJECTIVE: To investigate the effect of grip strength on bone mineral density (BMD) in postmenopausal women. Low BMD is related to risk of fracture and falling is the strongest factor for fragility fractures. Handgrip strength is a reliable indicator of muscle strength and muscle strength is associated with falling. METHODS: For the present study 120 women were divided into two groups: those ≤65 years and those >65 years. Serum 25 hydroxyvitamin D (25OHD), BMD, and handgrip strength were measured to observe the effect of age on 25OHD, grip strength, and BMD, as well as the effect of 25OHD on grip strength and BMD. The correlation between grip strength and BMD was investigated. RESULTS: In the 120 patients, 25OHD was 24.31 ± 8.29 ng/mL. There were 37 cases with 25OHD <20 ng/mL and 83 cases with 25 OHD ≥20 ng/mL. The patients with 25OHD <20 ng/mL had significantly lower femoral neck BMD, most of them with a T score ≤-2.5 (P < 0.05). BMD measurement showed 66 patients with femoral neck T ≤-2.5, 30 cases with total hip T ≤-2.5 and 90 cases with lumbar BMD T ≤-2.5. The maximum grip strength in the group is 22.28 ± 6.17 kg. There were 38 cases with the maximum grip strength <20 kg and 82 cases with the maximum grip strength ≥20 kg. Patients >65 years had lower 25OHD, lower maximum grip strength, and lower BMD. The osteoporosis risk in postmenopausal women with a maximum grip strength <20 kg and who were >65 years was significantly elevated. CONCLUSION: Handgrip strength and 25OHD decrease with aging in postmenopausal women. The patients with lower 25OHD level had significantly lower BMD of femoral neck. The patients with lower handgrip strength had significantly lower BMD of lumbar spine, femoral neck, and total hip. Grip strength measurement is the simplest muscle strength measurement method. Our study confirmed that low grip strength was correlated with low BMD and was a strong risk factor for osteoporosis in postmenopausal women.

[Surgical options for delayed osteoporotic vertebral collapse].

OBJECTIVE: To investigate the surgical options and clinical effects of delayed osteoporotic vertebral collapse. METHODS: From May 2010 to October 2014, 19 patients (20 vertebrae) with delayed osteoporotic vertebral collapse(Kümmell's disease) were enrolled in this study. There were 7 males and 12 females, aged from 65 to 87 years old with a mean of (73.5±5.62) years. According to Li staging system of Kümmell's disease, 3 cases were stage II, 13 cases (14 vertebrae) were stage III without spinal cord injury, 3 cases were stage III with spinal cord injury. Patients were respectively treated with percutaneous vertebroplasty(PVP) or percutaneous kyphoplasty(PKP) on the basis of the degree of postural reduction during operation. Injected cement volume, cement leakage, vertebral height restoration and local kyphotic reduction were observed. Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were respectively used to assess the pain and function before and after operation. Frankel grade were used to evaluate neurological status. RESULTS: Seven vertebrae with satisfactory postural reduction were treated with PVP, 13 vertebrae with unsatisfactory postural reduction were treated with PKP, 3 patients with spinal cord injury were treated with decompression and posterior short segment fixation at the same time. All patients were followed up from 10 to 48 months with an average of 21.2 months. Cement leakage occurred in 4 cases with no symptom, 1 cases in PVP group and 3 cases in PKP group, there was no significant difference between two groups(P=0.561). The priming volume of cement was (6.40±0.94) ml in PVP group and (5.46±1.09) ml in PKP group (P>0.05). Three days after operation vs preoperation, the vertebral height restoration and kyphotic improvement was(31.71±11.35)%, (9.79±4.64)° in PVP group and (24.77±8.51)%, (8.15±2.97)° in PKP. There was no significant difference between two groups(P>0.05). Three days after operation, VAS of low back pain and ODI in all patients were improved than preoperative data(P<0.05), but there was no significant difference between two groups or between postoperative at 3 d and final follow up(P>0.05). Nerve function of 3 patients underwent decompression and fixation from Frankel D to E. CONCLUSIONS: According to Li staging system and the degree of introperative postural reduction, individualized surgical treatment for Kümmell's disease can obtain good clinical results. Bad postural reduction during operation maybe a risk factor of cement leakage.