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 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.
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.
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 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.