Chinese mini percutaneous nephrolithotomy for upper urinary calculi under local infiltration anesthesia.

Percutaneous nephrolithotomy is generally performed under general or regional anesthesia; however, it is rarely performed under local infiltration anesthesia (LIA). This study aimed to assess the safety and effectiveness of Chinese mini percutaneous nephrolithotomy (MPCNL) for upper urinary calculi under LIA. A retrospective analysis of 52 patients with upper urinary stones who underwent MPCNL under LIA from April 2019 to May 2022 was performed. Pethidine and Phenergan were intramuscularly injected 30 minutes preoperatively. Oxybuprocaine hydrochloride gel was applied to the urethra for lubricating and mucosal anesthesia. Ropivacaine hydrochloride and lidocaine were injected into the whole percutaneous channel for local anesthesia. An 8/9.8F ureteroscope and an 18F vacuum-assisted access sheath were applied in MPCNL. All 52 patients tolerated procedures and underwent operations successfully; none of them converted the anesthesia method or required additional analgesia. The mean visual analogue scale scores intraoperatively and at 6 hours, 24 hours, and 48 hours after surgery were 3.25 ± 0.52, 3.13 ± 0.69, 2.25 ± 0.56, and 1.58 ± 0.50, respectively. The stone free rate was 84.6%. Complications were seen in 6 (11.5%) patients, including fever in 2 patients (Clavien I), renal colic in 1 patient (Clavien I), clinically insignificant bleeding in 2 patients (Clavien I), and urinary tract infection in 1 patient (Clavien II). No severe complications were observed in any patients. Chinese MPCNL under LIA was a feasible option and achieved good outcomes in appropriately selected patients, and it may become the routine procedure for general patients.

[A retrospective study of one case of X-linked agammaglobulinemia].

OBJECTIVE: To investigate the clinical manifestations, diagnostic methods and treatment of X-linked agammaglobulinemia (XLA). METHODS: Flow cytometric analysis of the peripheral monocytes using the anti-BTK antibody was used to characterize the expression of BTK in a 21 year old male patient and his mother. The patient suffered from frequent pneumonia, and was found to be complicated with lymphocytopenia in the B cell populations, hypogammaglobulinemia (IgG 1.38 g/L, IgA 0.25 g/L, IgM 0.17 g/L) and angiotelectasis (which had not been reported in XLA patients). Sequencing of the BTK cDNA obtained from the peripheral monocytes of the patient and his mother was performed to confirm the genetic defect. RESULTS: The BTK expressions in peripheral monocytes of the patient and his mother were 96.9% and 97.8% respectively. Sequencing of the BTK gene revealed a missense mutation of R525Q in exon 16, and his mother was confirmed to be an XLA carrier. The patient was treated with immunoglobulin replacement therapy (2 g/kg). One month later, the serum IgG level of the patient was elevated to 5.79 g/L, and the clinical symptoms (included angiotelectasis), lung function and the CT scan results significantly improved. CONCLUSION: Genetic diagnosis was made for one Chinese XLA adult patient complicated with angiotelectasis. This case suggests that some XLA cases may present angiotelectasis. High dose intravenous immunoglobulin given at 2 g/kg may be of efficacy in severe XLA cases. More attention should be paid to the disease in China.

Risk factors of community-associated infections in Chinese patients with diabetes: A meta-analysis.

OBJECTIVE: To identify the common sites and risk factors of community-associated infections in Chinese patients with diabetes. MATERIALS AND METHODS: The Wanfang, CNKI, PUBMED and VIP databases restricting to Chinese patients with diabetes were queried without restriction to time period. Randomized controlled trials (RCTs) on the risk factors of community-associated infections in Chinese patients with diabetes were considered. Polled odd ratios (OR) and 95% confidence intervals (95% CI) were used for each factor in fixed or random-effect meta-analyses. RESULTS: Twelve studies were identified that investigated seven risk factors of community-associated infections in Chinese patients with diabetes. The average infection incidence was 39.55%. The respiratory tract and urology tract were the predilection sites. Meta-analysis results are as follows: Diabetic patients with chronic complications (OR: 1.63; 95% CI 1.45-1.82), advanced age (OR: 1.30; 95% CI 1.19-1.42), longer duration (OR: 1.47; 95% CI 1.35-1.61) or ketoacidosis (OR: 1.37; 95% CI 1.13-1.66) were more prone to suffer from infections. Those with better glycemic control (OR: 0.68; 95% CI 0.61-0.76) or males (OR: 0.69; 95% CI 0.64-0.75) were less prone to suffer from infections. CONCLUSION: Chinese patients with diabetes had a high incidence of community-associated infections. We should highlight the risk factors that might provide a reference for the same.