目的 总结应用输尿管镜治疗结石梗阻性肾积脓手术配合的经验。 方法 对2003年4月-2007年12月因输尿管结石引起梗阻性肾积脓的27例患者行输尿管镜检查、气压弹道碎石、取石及留置双J管治疗的临床资料及手术配合进行回顾性分析。 结果 27例患者中，1次取净结石24例；术后2周经体外震波碎石治愈2例；改行开放手术1例，术中无明显并发症。 结论 手术护士应熟悉操作步骤，密切配合医生手术。应用输尿管镜治疗结石梗阻性肾积脓具有疗效好、创伤小、安全可靠等优点。
Objective To analyze the clinical presentations and radiological characteristics of acute exacerbation of idiopathic pulmonary fibrosis ( IPF) . Methods Clinical and radiological data of 2 patients with acute exacerbation of IPF from April 2006 to July 2008 were retrospectively analyzed and literatures were reviewed. Results Both patients were senior male patients over 60 years old. Dyspnea, cough and inspiratory crackles were the major symptoms and signs. Two patients were experiencing an exacerbation of dyspnea for one week and half of month, respectively. PaO2 /FiO2 of both patients was less than225 mm Hg. In both patients, high-resolution computed tomography ( HRCT) scans at the exacerbation showed typical signs of IPF including peripheral predominant, basal predominant reticular abnormality, with honeycombing and traction bronchiectasis and bronchiolectasis, and newly developing alveolar opacity. HRCT scan showed peripheral area of ground-glass attenuation adjacent to subpleural honeycombing in one patient, and diffusely distributed ground-glass opacity in another patient. Two patients had received corticosteroid treatment. For one patient, the symptoms improved, and ground-glass attenuation adjacent to subpleural honeycombing had almostly resolved. The other patient died of respiratory failure. Conclusions Some acute exacerbation in idiopatic pulmonary fibrosis can be idiopathic. The clinical presentations mainly include the worsening of dyspnea within short time. HRCT generally demonstrates new bilateral ground-glass abnormality with or without areas of consolidation, superimposed on typical changes of IPF.
Objective To evaluate the clinical significance of operative indication in patients with lung cancer accompanied by lung dysfunction using cardiopulmonary exercise test (CPET). Methods Before operation, using CPET with step program, work rate(W%), maximal oxygen uptake(VO2%P), maximal oxygen uptake per kilogram(VO2/kg) and other indexes were tested in the end of load exercise in 195 patients with lung cancer accompanied by lung dysfunction. Chi-square test and logistic regression analysis were performed for the abnormal rate of indexes mentioned above in patients with or without postoperative respiratory failure. Results After pneumonectomy, W%,VO2%P, VO2/kg, metabolic equivalent (MET), minute ventilation(VE) and respiratory frequency(BF) in patients with postoperative respiratory failure were lower than those in patients with non-postoperative respiratory failure (Plt;0.05 or 0.01). Logistic regression analysis showed that VElt;30 L/min and (BFlt;30) times/min were more related to the morbidity of postoperative respiratory failure than other indexes. As for the patients with lung dysfunction treated by lobectomy, this indexes didn’t show any significant difference between patients with or without postoperative respiratory failure. However, this indexes decreased in patients with postoperative respiratory failure whose ratio of forced expiratory volume in one second to forced vital capacity (FEV1%) were lower than 60%(Plt;0.05 or 0.01). Logistic regression analysis showed that VO2%Plt;60% related to the morbidity of postoperative respiratory failure. Conclusion CPET is useful to evaluate the operative indication in patients with lung cancer accompanied by lung dysfunction. VO2%Plt;60% should be selected as a evaluating index.
Objective To explore the key contents of nosocomial infection prevention and control training for medical staff in secondary and above hospitals, so as to provide scientific basis for training in the future. Methods The medical workers who participated in the training of nosocomial infection prevention and control in secondary and above hospitals of 6 prefecture-level cities in Jiangxi province in December 2020 were selected. The same questionnaire was used to test the participants before and after training, and the changes of scores before and after training were compared. Results A total of 73 medical workers were included. After training, the total scores of the questionnaire (14.13±1.95 vs. 11.27±2.76; t=11.053, P<0.001), scores of manual hygiene specifications knowledge unit (4.63±0.65 vs. 4.02±1.37; t=4.215, P<0.001), scores of hospital isolation technical specifications knowledge unit (4.28±1.05 vs. 3.47±1.29; t=4.895, P<0.001), scores of airborne disease hospital infection prevention and control norms knowledge unit (5.21±0.96 vs. 3.76±1.04; t=10.419, P<0.001) and the overall accuracy of the questionnaire (83.00% vs. 66.32%) were higher than those before training. Conclusions After the training, the accuracies of different topics are improved, but there is still room for improvement in each knowledge unit. More effective training strategies should be considered.
Objective To investigate the clinical characteristics of interstitial pneumonia patients with positive anti-signal recognition particle antibody (SRP-IP), and compare those with interstitial pneumonia patients with positive anti-Jo-1 antibody (Jo1-IP). Methods Clinical data of SRP-IP patients admitted to Department of Respiratory and Critical Care Medicine of Drum Tower Hospital affiliated to Nanjing University Medical School from May 2017 to May 2021, including clinical manifestations, laboratory examinations, pulmonary function tests and radiographic types, were retrospectively analyzed. The results were compared with those of Jo1-IP patients admitted during the same period. Results The SRP-IP patients were older than Jo1-IP patients (P=0.044). There were no significant differences in clinical manifestations or pulmonary function tests results between the two groups. The proportion of SRP-IP patients combined with positive anti-EJ antibody (P<0.001) or perinuclear anti-neutrophil cytoplasmic antibody (P=0.028) was significantly higher than that of Jo1-IP patients, while the proportion of SRP-IP patients combined positive anti-Ro-52 antibody was significantly lower than that of Jo1-IP patients (P=0.009). The erythrocyte sedimentation rate (ESR) of SRP-IP patients was faster than that of Jo1-IP patients (P=0.026). The serum IgM level (P=0.039) and peripheral NK cell counts (P=0.013) of SRP-IP patients were significantly lower than those of Jo1-IP patients. The most common chest CT findings in SRP-IP patients were organizing pneumonia and the proportion of usual interstitial pneumonia in SRP-IP patients was higher than that of Jo1-IP patients (P=0.032). The levels of creatine kinase (P=0.010), creatine kinase myocardial brand (P=0.025) and alanine aminotransferase (P=0.045) in interstitial pneumonia patients with high titer (++~+++) SRP antibody were higher than those in interstitial pneumonia patients with low titer (+) SRP antibody. SRP-IP and Jo1-IP patients were mainly treated with glucocorticoids combined with or without immunosuppressants, and there was no significant difference in the choice of treatment between the two groups. The proportion of patients with Jo1-IP evaluated as improved was significantly higher than that of patients with SRP-IP (p=0.005), while the proportion of patients with SRP-IP evaluated as stable was significantly higher than that of patients with Jo1-IP (P=0.035). The mortality of SRP-IP patients within 3 months was significantly higher than that of Jo1-IP patients (P=0.028). Conclusion Compared with Jo1-IP patients, SRP-IP patients are older, have faster ESR, are more likely to be combined with other autoantibodies, have lower serum IgM level and peripheral blood NK cell count, have more UIP imaging manifestations, and have a worse short-term prognosis.
Objective To evaluate the efficacy and safety of glucocorticoids (GC) monotherapy and GC combined with tacrolimus (TAC) therapy in patients with anti-synthetase syndrome-associated interstitial lung disease (ASS-ILD). Methods Through retrospective analysis and propensity score matching (PSM) analysis, the 2-year progression-free survival (PFS) and related side effects of ASS-ILD patients in TAC+GC group and GC monotherapy group were compared. Predictors associated with PFS were analyzed with COX. Results The 2-year PFS rate of TAC+GC group was better than that of GC group [P=0.0163; hazard ratio (HR) 0.347]; Univariate and multivariate analysis of the COX regression model for 2-year PFS in the two groups suggested that creatine kinase level (P=0.0019, HR 1.002) and initial treatment selection [(TAC+GC) vs. GC, P=0.0197, HR 0.207] were independent predictors of PFS; PSM analysis showed that the 2-year PFS rate of TAC+GC group (54.5%) was higher than that of GC group (18.2%) (P=0.0157, HR 0.275). In terms of adverse effect, there was no significant increase in GC+TAC group compared with GC group. Conclusion Compared with GC monotherapy, initial TAC+GC treatment significantly prolonged PFS in ASS-ILD patients and did not increase the incidence of drug-related complications.
Objective To evaluate the clinical applicability of clinical practice guidelines in China in the past 5 years, and to provide suggestions for better development and implementation of guidelines. Methods A cross-sectional study was conducted. A total of 61 guidelines issued by the Chinese Medical Association and the Chinese Medical Doctor Association from 2015 to 2020 were selected randomly based on CNKI database. Each guideline was evaluated by medical staff from three regions using the instrument for evaluating clinical applicability of guidelines (version 2.0). Quantitative data were described by mean, standard deviation, median and interquartile range, while qualitative data were described by frequency and composition ratio. Results A total of 6 904 valid questionnaires were collected from 119 medical institutions in 26 provinces of China. The results showed that the standardized scores ranged from 54.4% to 72.7% (median 64.3%) for accessibility, from 66.1% to 83.3% (median 74.9%) for readability, from 53.7% to 94.7% (median 86.0%) for acceptability, and ranged from 61.4% to 81.0% (median 72.5%) for feasibility. Approximately 4.3% of the medical staff considered that there were obstacles to implement the guidelines, including environmental factors (32.1%), medical staff factors (26.5%), guidelines factors (22.5%), and patients or family factors (18.9%). Conclusion The overall clinical applicability of the guidelines selected in this study is satisfactory. However, it is necessary to improve the accessibility of clinical guidelines. In addition, to improve the clinical applicability, it is suggested that medical staff should be trained and provided with supporting resources.