目的 總結應用輸尿管鏡治療結石梗阻性腎積膿手術配合的經驗。 方法 對2003年4月-2007年12月因輸尿管結石引起梗阻性腎積膿的27例患者行輸尿管鏡檢查、氣壓彈道碎石、取石及留置雙J管治療的臨床資料及手術配合進行回顧性分析。 結果 27例患者中，1次取凈結石24例；術后2周經體外震波碎石治愈2例；改行開放手術1例，術中無明顯并發癥。 結論 手術護士應熟悉操作步驟，密切配合醫生手術。應用輸尿管鏡治療結石梗阻性腎積膿具有療效好、創傷小、安全可靠等優點。
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 investigate the effects of caveolin-1 scaffolding domain peptide ( CSD-p)on expressions of extracellular matrix and Smads in human fetal lung fibroblasts. Methods Human fetal lung fibroblasts were cultured in vitro and divided into four groups. A control group: the cells were cultured in DMEMwithout TGF-β1 or CSD-p. A CSD-p treatment group: the cells were cultured in DMEMcontaining 5 μmol /L CSD-p. A TGF-β1 treatment group: the cells were cultured in DMEMcontaining 5 μg/L TGF-β1 .A TGF-β1 + CSD-p treatment group: the cells were cultured in DMEM containing 5 μg/L TGF-β1 and 5 μmol /L CSD-p. Caveolin -1 mRNA was detected by RT-PCR. Caveolin-1, collagen-Ⅰ, α-SMA, p-Smad2,p-Smad3 and Smad7 proteins were measured by Western blot. Results Compared with the control group,the Caveolin -1 mRNA and protein expressions in the cells of TGF-β1 group significantly reduced ( mRNA:0. 404 ±0. 027 vs. 1. 540 ±0. 262; protein: 0. 278 ±0. 054 vs. 1. 279 ±0. 085; P lt; 0. 01) , and the expression levels of collagen-Ⅰ and α-SMA proteins significantly increased ( collagen-Ⅰ: 1. 127 ±0. 078 vs.0. 234 ±0. 048; α-SMA: 1. 028 ±0. 058 vs. 0. 295 ±0. 024) . Meanwhile, the expression levels of p-Smad2 ( 1. 162 ±0. 049 vs. 0. 277 ±0. 014) and p-Smad3 proteins ( 1. 135 ±0. 057 vs. 0. 261 ±0. 046) increased with statistical significance ( P lt; 0. 01) , but the expression level of Smad7 protein significantly reduced( 0. 379 ±0. 004 vs. 1. 249 ±0. 046, P lt;0. 001) . In the CSD-p group, CSD-p had no significant effects on the expressions of above proteins compared with the control group. But in the TGF-β1 +CSD-p group, the overexpressions of collagen-Ⅰ, α-SMA, p-Smad2 and p-Smad3 induced by TGF-β1 were obviously inhibited by CSD-p ( collagen-Ⅰ: 0. 384 ±0. 040 vs. 1. 127 ±0. 078; α-SMA: 0. 471 ±0. 071 vs. 1. 127 ±0. 078;p-Smad2: 0. 618 ±0. 096 vs. 1. 162 ±0. 049; p-Smad3: 0. 461 ±0. 057 vs. 1. 135 ±0. 057; P lt; 0. 01) .Otherwise, the up-regulation of Smad7 ( 0.924 ±0. 065 vs. 0.379 ±0. 004) was found. Conclusions CSD-p can reduce fibroblast collagen-I and α-SMA protein expressions stimulated by TGF-β1 , possibly through regulation of TGF-β1 /Smads signaling pathway. It is suggested that an increase in caveolin -1 function through the use of CSD-p may be an intervention role in pulmonary fibrosis.
Objective To analyze the clinical presentations and radiological characteristics of pathologically proved cases of cryptogenic organizing pneumonia(COP).Methods The clinical and radiological features of 8 patients with COP confirmed by open lung biopsy were analyzed.Treatment and follow-up data were also recorded.Results There were 5 male an 3 female patients aged 37 to 68 years.Dyspnea，cough and inspiratory crackles were the most common symptoms and signs.Various computed tomography findings including ground glass opacities,pathy consolidation with air bronchograms，nodules and reticulation were simultaneously observed in the same patient.The diagnostic imaging features of COP were patchy or lobar consolidation，often by a predominantly subpleural distribution，and irregular band-like opacities distributed along the bronchovascular bundle or located in the subpleural area.All patients were treated with corticosteroids and yielded significant improvement in seven cases.Conclusions COP could be diagnosed by clinical and radiological findings and histopathological examination was needed for confirmed diagnosis.In general，COP responds well to glucocorticoid therapy and has a benign prognosis.
ObjectiveTo explore the predictive value of microRNA-215 (miR-215) and microRNA-7-5p (miR-7-5p) expression levels in gastric cancer tissues for recurrence after endoscopic submucosal dissection (ESD) based on restricted cubic spline (RCS). MethodsA total of 200 patients with early gastric cancer who underwent ESD in Yibin Second People’s Hospital from August 2020 to August 2022 were prospectively selected. The patients were followed up for 2 years, and the postoperative recurrence was counted. RCS was used to analyze the predictive value of miR-215 and miR-7-5p expression levels in gastric cancer tissues for recurrence after ESD and the dose-response relationship with recurrence after ESD. Helicobacter pylori (HP) infection, tumor maximum diameter, depth of invasion, carbohydrate antigen 724 (CA724) level, and neutrophils to lymphocytes ratio (NLR) were included to construct a basic nomogram prediction model, expression levels of miR-215 and miR-7-5p, HP infection, tumor maximum diameter, depth of invasion, CA724 level, and NLR were included to construct a new nomogram prediction model. The value of the two models in predicting recurrence after ESD was compared. The clinical data of 84 patients with early gastric cancer who underwent ESD in Deyang People’s Hospital from September 2022 to September 2023 were retrospectively collected for external validation. ResultsDuring the follow-up period, 5 of 200 patients with early gastric cancer were lost to follow-up, and 195 patients were included and analyzed. The recurrence rate after ESD was 11.28% (22/195). The expression level of miR-215 in gastric cancer tissues of recurrence group and non-recurrence group [recurrence group: (0.67±0.15) vs. (0.97±0.24); non-recurrence group: (0.84±0.19) vs. (0.98±0.26)], miR-7-5p [recurrence group: (0.45±0.12) vs. (1.59±0.36); non-recurrence group:(0.68±0.20) vs. (1.61±0.37)] were lower than those in adjacent tissues (P<0.05). The expression levels of miR-215 (OR=0.850, P=0.008) and miR-7-5p (OR=0.798, P=0.005) in gastric cancer tissues were the influencing factors of recurrence after ESD. There was a linear dose-response relationship between the expression levels of miR-215 and miR-7-5p in gastric cancer tissues and the recurrence after ESD (Poverall=0.009, Poverall<0.001; Pnonlinear=0.923, Pnonlinear=0.786). The area under curve (AUC) of the new nomogram prediction model including expression levels of miR-215 and miR-7-5p, HP infection, tumor maximum diameter, depth of invasion, CA724 level, and NLR for predicting recurrence after ESD was 0.964 [95%CI (0.900, 0.981)], which was greater than 0.857 [95%CI (0.796, 0.892)] of the basic nomogram prediction model, Z=2.158, P=0.032. The new nomogram prediction model has a high degree of calibration in predicting recurrence after ESD, and the clinical effect was good. External validation showed that the AUC of the new nomogram prediction model for predicting recurrence after ESD was 0.945 [95%CI (0.886, 0.978)], and the calibration degree for predicting recurrence after ESD was high and the clinical utility was good. ConclusionsThe expression levels of miR-215 and miR-7-5p in gastric cancer tissues of patients with early gastric cancer are lower than those in adjacent tissues, and there is a linear dose-response relationship with recurrence after ESD. The nomogram prediction model based on the expression levels of miR-215 and miR-7-5p in gastric cancer tissues can provide a reliable clinical basis for clinical prediction of postoperative recurrence.
ObjectiveTo highlight the characteristics of pulmonary MALT lymphoma with diffuse lung disease. MethodsThe clinical,radiological and pathological data of two patients with pulmonary MALT lymphoma were analyzed,and relevant literature was reviewed. ResultsOne patient was a 59-year-old male with cough for five years while antibiotic treatment was ineffective. The chest CT scan demonstrated diffuse lung disease,bilateral multiple consolidation and ground-glass opacities,small nodules and bronchiectasis. Thoracoscopy biopsy was performed and the pathology study confirmed the diagnosis of MALT lymphoma. Another case was a 50-year-old female,who suffered from fever,cough and dyspnea. The chest CT scan revealed bilateral multiple patchy consolidation,with air bronchogram. The eosinophils count in blood was high. Diagnosed initially as eosinophilic pneumonia,she was treated with corticosteroids. The clinical symptoms were improved,but the CT scan revealed no change. After the computed tomography guided percutaneous lung biopsy,pathological examination confirmed the diagnosis of MALT lymphoma. ConclusionMALT lymphoma with diffuse lung disease is rare and easy to be misdiagnosed. The positive rate of bronchoscopy is low and percutaneous lung biopsy or thoracoscopy biopsy is more useful for diagnosis.
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.