Association between heat and upper urinary tract stones morbidity and medical costs: A study in the subtropical humid climate zone

Urolithiasis is a heat-specific disease.Exploring heat-related urolithiasis susceptibility subtypes,economic burden,and modifying factors could assist governments in targeting interventions to reduce the heat-related health risks of urolithiasis morbidity.We collected data on 23,492 patients with upper urinary tract stones(main subtypes of urolithiasis)from 2013 to 2017 in Nanjing,China.We adopted generalized additive quasi-Poisson models to examine the associations between daily mean temperatures and morbidity of upper urinary tract stones,while generalized additive Gaussian models were used to explore the relationships between temperatures and log-transformed medical costs.We examined the modification effects of disease subtypes(kidney and ureteral calculus),sex,and age through stratified analyses and the modif-cation effects of other meteorological factors by introducing interaction terms in the models.We found that short-term summer heat exposure has a statistically significant effect on ureteral calculus morbidity but not on kidney calculus morbidity.For ureter calculus,a 1℃ temperature increase was associated with a 4.36%(95%confidence interval[CI]:1.94%,6.83%)increase in daily hospitalization and a 5.44%(95%CI:2.71%,8.25%)increase in daily medical costs.The attributable fraction associated with heat(greater than the median value of daily mean temperature,26.8℃)was 7.85%(95%empirical confidence interval[eCI]:3.64%,11.44%)for hospitalization and 9.36%(95%eCI:4.91%,13.14%)for medical costs.The effects of heat on ureter calculus morbidity were significantly higher among the males and those with high sunshine duration than females and those with low sunshine duration.Short-term summer heat exposure was associated with increased morbidity and medical costs of ureteral calculus.Relevant government organizations should take effective intervention measures,including community health education,to reduce the health hazards and economic losses caused by heat.

Reply to： Correspondence Regarding the Study by Chen-Lu Yang et al. Published in the Chinese Medical Journal, 129（18）：2258-9

We are pleased to receive the letter from the reader about our article Herein, we are willing to respond to some of their comments. In our case, we reported a senile Chinese man with a 2-month history of fever accompanied by hearing loss, myalgia, elevated serum globulin, and erythrocyte sedimentation rate.

Monoclonal B-cell Lymphocytosis in a Patient with Wegener Granulomatosis： A Case Report and Update on 2016 World Health Organization Classification

The association between autoimmune disease and risk of monoclonal malignancy is well studied. Howeven monoclonal B-cell lymphocytosis （MBL） in patients with autoimmune diseases has rarely been reported. The newly published 2016 revision of the World Health Organization （WHO） classification of lymphoid neoplasms has officially accepted MBL as an independent disease entity Herein, we present a case of Wegener granulomatosis （WG） with MBL.

Diffuse Pulmonary Alveolar Hemorrhage Secondary to AII-Trans-Retinoic Acid in Acute Promyelocytic Leukemia

To the Editor：A 29-year-old Chinese woman was admitted for newly diagnosed acute promyelocytic leukemia （APL）.Initial laboratory tests were as follows：white blood cell （WBC） count 1.68× 109/L,hemoglobin 47 g/L,platelet count 35x 109/L,and fibrinogen 0.81 g/L.There was no sign of pulmonary infection or serum biochemistry abnormality on admission.She was treated with all-transretinoic acid （ATRA） and arsenic trioxide （ATO） immediately.

Silver recovery as Ag^0 nanoparticles from ion-exchange regenerant solution using electrolysis

Many silver(Ag)containing consumer-products(e.g.textiles)release Ag into the environment,posing ecotoxicological risks.Ag recovery mitigates environmental hazards,recycles Ag,and leads to sustainability.In the present work,Ag has been recovered as Ag^0nanoparticles from the spent solution(thiourea(TU)～0.5 mol/L pH～1.1–1.2,and Ag～550 mg/L)obtained from the regeneration of an Ag-loaded resin using a simple undivided electrolytic cell.The reclaimed regenerant solution has been recycled and reused in a closed-loop scheme over multiple cycles.The process parameters,i.e.,current(0.05 A)and stirring speed(600 r/min),have been optimized for Ag recovery of～94%and TU loss of～2%.The reclaimed regenerant solution has been shown to regenerate Ag-loaded resin samples with>90%regeneration efficiency over 4 cycles of consecutive extraction and regeneration.The recovered Ag^0nanoparticles are monodisperse,consistently spherical in shape,and have a mean diameter of～6 nm with standard deviation of the Gaussian fit as～2.66 nm.

Long-time remission of epstein-barr virus associated hemophagocytic lymphohistiocytosis by interferon-α treatment

To the Editor:A 59-year-old Chinese woman was admitted for fatigue and fever for 1 month.She was diagnosed with chronic active Epstein-Barr virus(CAEBV)infection 3 years ago due to intermittent fever and documented Epstein-Barr virus positive serology.On physical examination,her spleen,liver,and superficial lymph nodes were not palpable.There was no sign of pulmonary infection.Initial laboratory tests were as follows:white blood cell count 0.92×10^9/L,hemoglobin 66 g/L,platelet count 15×10^9/L.Serum biochemistry:alanine aminotransferase 44 U/L,aspartate transaminoferase 142 U/L,albumin 26.7 g/L,triglyceride 3.02 mmol/L,and lactate dehydrogenase 1166 U/L.Coagulation indexes were as follows:prothrombin time 14.3 s,activated prothromboplastin time 65.9 s,thrombin time 32.2 s,D-dimer 18.35 mg/L,and fibrinogen 0.81 g/L.Serum ferritin level was significantly elevated to as high as 8500 ng/mL and serum soluble interleukin-2 receptor(sIL-2R)was 13,200 U/mL.On admission,her serum EBV-DNA load was 1.99×10^3 copies/mL.Computed tomography did not find any enlarged lymph nodes and the spleen and liver had a normal size.The bone marrow morphology and pathology revealed no sign of lymphoma but slight hemophagocytosis.

Acute Myeloid Leukemia Masquerading as Acute Appendicitis

To the Editor： Extra medullary infiltration is often seen in acute myeloid leukemia （AML）. Many take the form of tumor masses as myeloid sarcoma. However, leukemic cell infiltration of the appendix is rare. Herein, we report a case of AML initially presented as acute nonsuppurative appendicitis due to leukemic cell infiltration which is a rarer manifestation of de novo AML.