BACKGROUND There are factors that significantly increase the risk of postoperative pulmonary infections in patients with primary hepatic carcinoma(PHC).Previous reports have shown that over 10%of patients with PHC exp...BACKGROUND There are factors that significantly increase the risk of postoperative pulmonary infections in patients with primary hepatic carcinoma(PHC).Previous reports have shown that over 10%of patients with PHC experience postoperative pulmonary infections.Thus,it is crucial to prioritize the prevention and treatment of postoperative pulmonary infections in patients with PHC.AIM To identify the risk factors for postoperative pulmonary infection in patients with PHC and develop a prediction model to aid in postoperative management.METHODS We retrospectively collected data from 505 patients who underwent hepatobiliary surgery between January 2015 and February 2023 in the Department of Hepatobiliary and Pancreaticospleen Surgery.Radiomics data were selected for statistical analysis,and clinical pathological parameters and imaging data were included in the screening database as candidate predictive variables.We then developed a pulmonary infection prediction model using three different models:An artificial neural network model;a random forest model;and a generalized linear regression model.Finally,we evaluated the accuracy and robustness of the prediction model using the receiver operating characteristic curve and decision curve analyses.RESULTS Among the 505 patients,86 developed a postoperative pulmonary infection,resulting in an incidence rate of 17.03%.Based on the gray-level co-occurrence matrix,we identified 14 categories of radiomic data for variable screening of pulmonary infection prediction models.Among these,energy,contrast,the sum of squares(SOS),the inverse difference(IND),mean sum(MES),sum variance(SUV),sum entropy(SUE),and entropy were independent risk factors for pulmonary infection after hepatectomy and were listed as candidate variables of machine learning prediction models.The random forest model algorithm,in combination with IND,SOS,MES,SUE,SUV,and entropy,demonstrated the highest prediction efficiency in both the training and internal verification sets,with areas under the curve of 0.823 and 0.801 and a 95%confidence interval of 0.766-0.880 and 0.744-0.858,respectively.The other two types of prediction models had prediction efficiencies between areas under the curve of 0.734 and 0.815 and 95%confidence intervals of 0.677-0.791 and 0.766-0.864,respectively.CONCLUSION Postoperative pulmonary infection in patients undergoing hepatectomy may be related to risk factors such as IND,SOS,MES,SUE,SUV,energy,and entropy.The prediction model in this study based on diffusion-weighted images,especially the random forest model algorithm,can better predict and estimate the risk of pulmonary infection in patients undergoing hepatectomy,providing valuable guidance for postoperative management.展开更多
Objective:To explore factors related to postoperative pulmonary infection in lung cancer patients after recovery from COVID-19 and to provide methods for preventing and reducing the incidence of postoperative lung inf...Objective:To explore factors related to postoperative pulmonary infection in lung cancer patients after recovery from COVID-19 and to provide methods for preventing and reducing the incidence of postoperative lung infection in patients with lung cancer.Methods:A total of 92 patients who underwent lung cancer surgery in the Department of Thoracic and Cardiac Surgery of Yichang Central People’s Hospital from January 28,2023,to March 3,2023,were selected.They were divided into a pulmonary infection group(47 cases)and a nonpulmonary infection group(45 cases)according to whether pulmonary infection occurred.General clinical data of patients were collected and collated to analyse the related influencing factors of pulmonary infection in lung cancer patients after recovery from COVID-19.Results:Univariate analysis showed that patient age(≥60 years),fever after COVID-19 infection,oral and laryngeal symptoms,digestive tract symptoms,neurological symptoms,long-term smoking history,hypertension history,and operation time(≥3 h)were correlated with pulmonary infection(all P<0.05).There was no significant correlation between postoperative pulmonary infection and sex,ocular,nasal and tongue symptoms,systemic symptoms,duration of COVID-19,COPD,lobectomy site,incision pain,mechanical ventilation time(≥6 h),drainage tube retention time(3 d),surgical method(P>0.05).Logistic multivariate analysis showed that age(≥60 years old),long operation time(≥3 h)and long-term smoking history were independent influencing factors for postoperative pulmonary infection in patients with radical resection of lung cancer(P>0.05).Conclusion:In this study,older age(≥60 years old),long-term smoking history,and long operation time(≥3 h)were risk factors for pulmonary infection after lung cancer surgery.In the future,active treatment measures can be taken to address these risk factors during the perioperative period to reduce the incidence of postoperative pulmonary infection.展开更多
Objective:To study the improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection....Objective:To study the improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection.Methods:A total of 78 patients with lung cancer who received surgical treatment in our hospital between August 2013 and January 2015 and were with postoperative infection were selected as the research subjects and randomly divided into two groups, control group received mechanical ventilation therapy, observation group received bronchoalveolar lavage by bronchoscope combined with mechanical ventilation, and the inflammatory factor levels, RAAS system activity and respiratory mechanics indexes of two groups were determined after treatment.Results:3 d after treatment, serum hs-CRP, TNF-α, IL-8, PCT, renin, angiotensin II and aldosterone levels of observation group were lower than those of control group, and PIP, Raw and WOB values were lower than those of control group while Cdyn value was higher than that of control group.Conclusion:For lung cancer patients with postoperative pulmonary infection, bronchoalveolar lavage by bronchoscope combined with mechanical ventilation can optimize patients' condition, relieve systemic inflammatory response and improve respiratory function, and it has positive clinical significance.展开更多
BACKGROUND Purpureocillium lilacinum(P.lilacinum)is a saprophytic fungus widespread in soil and vegetation.As a causative agent,it is very rarely detected in humans,most commonly in the skin.CASE SUMMARY In this artic...BACKGROUND Purpureocillium lilacinum(P.lilacinum)is a saprophytic fungus widespread in soil and vegetation.As a causative agent,it is very rarely detected in humans,most commonly in the skin.CASE SUMMARY In this article,we reported the case of a 72-year-old patient with chronic lymphocytic leukemia who was admitted with cough and fever.Computed tomography revealed an infection in the right lower lobe.Bronchoalveolar lavage fluid culture and metagenomic next-generation sequencing were ultimately confirmed to have a pulmonary infection with P.lilacinum.She was eventually discharged with good outcomes after treatment with isavuconazole.CONCLUSION Pulmonary infection with P.lilacinum was exceedingly rare.While currently there are no definitive therapeutic agents,there are reports of high resistance to amphotericin B and fluconazole and good sensitivity to second-generation triazoles.The present report is the first known use of isavuconazole for pulmonary P.lilacinum infection.It provides new evidence for the characterization and treatment of clinical P.lilacinum lung infections.展开更多
BACKGROUND Lung cancer is a malignant tumor with high morbidity and mortality among cancers.Surgery is currently one of the primary methods of treating lung cancer.Although it can slow down the progression of the dise...BACKGROUND Lung cancer is a malignant tumor with high morbidity and mortality among cancers.Surgery is currently one of the primary methods of treating lung cancer.Although it can slow down the progression of the disease by removing the lesion,this invasive surgery inevitably damages the integrity of the patient’s chest.Moreover,the patient’s pulmonary function may have a low compensatory capacity after surgery,causing various respiratory diseases such as atelectasis,respiratory function decline,and even serious cardiovascular disease.All of these have great negative impacts on the surgical effect and the prognosis of patients.With the continuous exploration and development of nursing,continuous nursing and respiratory exercise nursing have been gradually applied in the nursing of patients after lung cancer surgery,and have achieved good nursing results.AIM To investigate the effect of continuous nursing combined with respiratory exercise nursing on the pulmonary function of postoperative patients with lung cancer.METHODS A total of 80 patients with lung cancer who underwent surgery in our hospital from January 2021 to December 2021 were selected as the study subjects.All subjects were randomly divided into the control group(n=40 cases)and the experimental group(n=40 cases).Patients with lung cancer in the control group were given conventional nursing after surgery,while the experimental group was given continuous nursing combined with respiratory exercise nursing based on conventional nursing.The recovery of pulmonary function and respiratory symptoms was observed before and after 3 mo of intervention in both groups.The pulmonary function parameters,blood gas analysis,MD Anderson Symptom Inventory-lung cancer module(MDASI-LC)scores,incidence of pulmonary complications,and Morisky compliance scores were compared between the two groups before and after 3 mo of intervention.RESULTS There was no significant difference in pulmonary function and blood gas analysis between the two groups before intervention(P>0.05).3 mo after the intervention,the pulmonary function parameters in the experimental group(SpO2,VC,MVV,FEV1,FEV1%pred,and FEV1/FVC)were higher than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in blood gas analysis between the two groups before intervention(P>0.05).PaO2 in the experimental group was significantly higher than that in the control group,and PaCO_(2) was significantly lower than that in the control group 3 mo after the intervention.The difference had statistical significance(P<0.05).3 mo after the intervention,the MDASI score of respiratory symptoms in the experimental group was significantly lower than that in the control group(P<0.05),and the incidence of pulmonary complications was lower than that in the control group(P<0.05).In addition,the treatment compliance and nursing satisfaction of patients in the experimental group were higher than those in the control group,and the differences were statistically significant(P<0.05).CONCLUSION Continuous nursing combined with respiratory exercise nursing can significantly accelerate the recovery of respiratory function in postoperative lung cancer patients,reduce the incidence of postoperative complications of lung cancer as well as improve the treatment compliance of patients.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection is a global problem,causing significant morbidity and mortality.Furazolidone is recommended to eradicate H.pylori infections in China owing to the highly associated an...BACKGROUND Helicobacter pylori(H.pylori)infection is a global problem,causing significant morbidity and mortality.Furazolidone is recommended to eradicate H.pylori infections in China owing to the highly associated antibiotic resistance.CASE SUMMARY This article presents two cases of lung injury caused by furazolidone treatment of H.pylori infection and the relevant literature review.Two patients developed symptoms,including fever,cough,and fatigue after receiving a course of furazolidone for H.pylori infection.Chest computed tomography showed bilateral interstitial infiltrates.Laboratory studies revealed elevated blood eosinophil count.After discontinuing furazolidone with or without the use of corticosteroids,the symptoms improved rapidly.A PubMed database literature search revealed three reported cases of lung injury suggestive of furazolidone-induced pulmonary toxicity.CONCLUSION Clinicians should be aware of the side effects associated with the administration of furazolidone to eradicate H.pylori infection.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)-associated invasive pulmonary aspergillosis presents a diagnostic challenge due to its non-specific clinical/imaging features,as well as the fact that the proposed clinica...BACKGROUND Coronavirus disease 2019(COVID-19)-associated invasive pulmonary aspergillosis presents a diagnostic challenge due to its non-specific clinical/imaging features,as well as the fact that the proposed clinically diagnostic algorithms do not necessarily apply to COVID-19 patients.In addition,Fusarium spp.is a rare cause of opportunistic life-threatening fungal infections.Disseminated Fusarium infection in an immunocompromised host is intractable,with a high likelihood of resulting mortality.To our knowledge,this is the first case of secondary pulmonary infection by Fusarium solani(F.solani)and Aspergillus niger(A.niger)during systemic steroid treatment for COVID-19.CASE SUMMARY A 62-year-old male was transported to our hospital by ambulance with a complaint of fever and dyspnea.We established a diagnosis of pneumococcal pneumonia,complicated with COVID-19 and septic shock,together with acute renal failure.He was admitted to the intensive care unit,to be treated with piperacillin/tazobactam,vancomycin,and 6.6 mg per day of dexamethasone sodium phosphate,along with noradrenaline as a vasopressor,ventilator management,and continuous hemodiafiltration.His condition improved,and we finished the vasopressor on the fifth hospital day.We administered dexamethasone for ten days,and finished the course of treatment.On the eleventh day,patient respiratory deterioration was observed,and a computed tomography scan showed an exacerbation of bilateral ground-glass-opacity-like consolidation,together with newly appeared cavitary lesions in the lung.we changed antibiotics to meropenem plus vancomycin.In addition,a fungal infection was considered as a possibility based on microscopic findings of sputum,and we began coadministration of voriconazole.However,the pneumonia worsened,and the patient died on the seventeenth day of illness.Later,F.solani and A.niger were identified from sputum collected on the twelfth day.It was believed that he developed a cell-mediated immune deficiency during COVID-19 treatment,which led to the complication of pneumonia caused by the above-mentioned fungi,contributing to his death.CONCLUSION Because early initiation of intense antifungal therapy offers the best chance for survival in pulmonary fusariosis,computed tomography scans and appropriate microbiologic investigations should be obtained for severely immunocompromised patients.展开更多
Objective:To investigate the efficacy of montelukast sodium in the treatment of lung cancer patients with pulmonary infections.Methods:A total of 330 patients diagnosed with lung cancer and pulmonary infection,who wer...Objective:To investigate the efficacy of montelukast sodium in the treatment of lung cancer patients with pulmonary infections.Methods:A total of 330 patients diagnosed with lung cancer and pulmonary infection,who were admitted to the First Affiliated Hospital of Xi’an Medical University from 2020 to 2022,were selected as research subjects.They were randomly divided into two groups:a control group receiving conventional treatment and an observation group receiving conventional treatment combined with montelukast sodium.Each group consisted of 165 cases.The time required for clinical symptom improvement,the resolution of lung infection signs,and the levels of serum inflammatory factors before and after treatment were compared between the two groups.Results:The observation group exhibited significantly faster improvement in clinical symptoms compared to the control group(P<0.001).ELISA assays were conducted to detect the expression levels of IL-1β,IL-6,IL-8,and TNF-αin the serum of both groups at 1 week and 2 weeks into the treatment.The results indicated that,as the treatment progressed,the observation group displayed significantly lower levels of the four serum inflammatory factors compared to the control group(P<0.001).Conclusion:Montelukast sodium demonstrates efficacy in the treatment of patients with lung cancer complicated by pulmonary infections.These findings suggest its potential for further verification and clinical application.展开更多
BACKGROUND Both pulmonary rehabilitation training and psychological care have been shown to have a positive effect on the postoperative recovery of patients with lung cancer.However,few studies have combined the two t...BACKGROUND Both pulmonary rehabilitation training and psychological care have been shown to have a positive effect on the postoperative recovery of patients with lung cancer.However,few studies have combined the two to explore their combined effect.Therefore,this study aimed to investigate the effects of pulmonary rehabil-itation training combined with psychological care on postoperative respiratory function and mental health in lung cancer patients.AIM To investigate effect of nursing on postoperative respiratory function and mental health of lung cancer patients.METHODS 122 cases of lung cancer patients who underwent surgical treatment in our hospital and were treated in our department from January 2022 to April 2023 were selected and randomly divided into the control group and observation group.The control group performed the routine care intervention.The obser-vation group was given pulmonary rehabilitation training and psychological care based on conventional nursing interventions.Forced expiratory volume,forced vital capacity.Maximum ventilatory volume(MVV)in one second was measured,and the patient's 6-min walking distance and dyspnoea index scale were used to assess the patient's respiratory condition.The Connor-Davidson resilience scale(CD-RISC),self-rating anxiety scale(SAS),and self-rating depression scale(SDS)were used to evaluate the mental health of the patients.RESULTS There was no difference between the two groups regarding age,gender,education level,surgical procedure,type of pathology,and treatment(P>0.05).After treatment,MVV,6-min walking distance,toughness,strength,optimism,and total CD-RISC scores were significantly higher in the observation group(P<0.05),dyspnoea scores,SAS,and SDS scores were substantially lower in the control group compared to the observation group(P<0.05).CONCLUSION Pulmonary rehabilitation training combined with psychological care for patients after lung cancer resection could improve lung function,enhance daily activities,effectively relieve negative emotions such as anxiety and depression,and reduce complications.展开更多
BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cas...BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cases,with approximately 4.5 million individuals affected by active tuberculosis.Notably,T2DM poses a significant risk factor for the development of tuberculosis,as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis(T2DMPTB),which has risen from 19.3%to 24.1%.It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature.AIM To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis(T2DM-PTB),as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM.METHODS T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group,Simple DM patients presenting to our hospital in the same period were the control group,Controls and case groups were matched 1:2 according to the principle of the same sex,age difference(±3)years and disease duration difference(±5)years,patients were investigated for general demographic characteristics,diabetes-related characteristics,body immune status,lifestyle and behavioral habits,univariate and multivariate analysis of the data using conditional logistic regression,calculate the odds ratio(OR)values and 95%CI of OR values.RESULTS A total of 315 study subjects were included in this study,including 105 subjects in the observation group and 210 subjects in the control group.Comparison of the results of both anthropometric and biochemical measures showed that the constitution index,systolic blood pressure,diastolic blood pressure and lymphocyte count were significantly lower in the case group,while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group.The results of univariate analysis showed that poor glucose control,hypoproteinemia,lymphopenia,TB contact history,high infection,smoking and alcohol consumption were positively associated with PTB in T2DM patients;married,history of hypertension,treatment of oral hypoglycemic drugs plus insulin,overweight,obesity and regular exercise were negatively associated with PTB in T2DM patients.Results of multivariate stepwise regression analysis found lymphopenia(OR=17.75,95%CI:3.40-92.74),smoking(OR=12.25,95%CI:2.53-59.37),history of TB contact(OR=6.56,95%CI:1.23-35.03)and poor glycemic control(OR=3.37,95%CI:1.11-10.25)was associated with an increased risk of developing PTB in patients with T2DM,While being overweight(OR=0.23,95%CI:0.08-0.72)and obesity(OR=0.11,95%CI:0.02-0.72)was associated with a reduced risk of developing PTB in patients with T2DM.CONCLUSION T2DM-PTB patients are prone to worse glycemic control,higher infection frequency,and a higher proportion of people smoking,drinking alcohol,and lack of exercise.Lymphopenia,smoking,history of TB exposure,poor glycemic control were independent risk factors for T2DM-PTB,and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.展开更多
BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complic...BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.展开更多
BACKGROUND Gastric stromal tumors,originating from mesenchymal tissues,are one of the most common tumors of the digestive tract.For stromal tumors originating from the muscularis propria,compared with conventional end...BACKGROUND Gastric stromal tumors,originating from mesenchymal tissues,are one of the most common tumors of the digestive tract.For stromal tumors originating from the muscularis propria,compared with conventional endoscopic submucosal dissection(ESD),endoscopic full-thickness resection(EFTR)can remove deep lesions and digestive tract wall tumors completely.However,this technique has major limitations such as perforation,postoperative bleeding,and post-polypectomy syndrome.Herein,we report a case of postoperative serous surface bleeding which formed an encapsulated hemoperitoneum in a patient with gastric stromal tumor that was treated with exposed EFTR.Feasible treatment options to address this complication are described.CASE SUMMARY A 47-year-old male patient had a hemispherical protrusion found during gastric endoscopic ultrasonography,located at the upper gastric curvature adjacent to the stomach fundus,with a smooth surface mucosa and poor mobility.The lesion was 19.3 mm×16.1 mm in size and originated from the fourth ultrasound layer.Computed tomography(CT)revealed no significant evidence of lymph node enlargement or distant metastasis.Using conventional ESD technology for mucosal pre-resection,exposed EFTR was performed to resect the intact tumor in order to achieve a definitive histopathological diagnosis.Based on its morphology and immunohistochemical expression of CD117 and DOG-1,the lesion was proven to be consistent with a gastric stromal tumor.Six days after exposed EFTR,CT showed a large amount of encapsulated fluid and gas accumulation around the stomach.In addition,gastroscopy suggested intracavitary bleeding and abdominal puncture drainage indicated serosal bleeding.Based on these findings,the patient was diagnosed with serosal bleeding resulting in encapsulated abdominal hemorrhage after exposed EFTR for a gastric stromal tumor.The patient received combined treatments,such as hemostasis under gastroscopy,gastrointestinal decompression,and abdominal drainage.All examinations were normal within six months of follow-up.CONCLUSION This patient developed serous surface bleeding in the gastric cavity following exposed EFTR.Serosal bleeding resulting in an encapsulated hemoperitoneum is rare in clinical practice.The combined treatment may replace certain surgical techniques.展开更多
Postoperative surgical site infection(SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention,diagnosis and treatment of SSIs. Factors contributing to the ...Postoperative surgical site infection(SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention,diagnosis and treatment of SSIs. Factors contributing to the development of a SSI can be split into three categories:(1) microbiological factors;(2) factors related to the patient and their spinal pathology; and(3) factors relating to the surgical procedure. SSI is most commonly caused by Staphylococcus aureus. The virulence of the organism causing the SSI can affect its presentation. SSI can be prevented by careful adherence to aseptic technique,prophylactic antibiotics,avoiding myonecrosis by frequently releasing retractors and preoperatively optimizing modifiable patient factors. Increasing pain is commonly the only symptom of a SSI and can lead to a delay in diagnosis. C-reactive protein and magnetic resonance imaging can help establish the diagnosis. Treatment requires acquiring intra-operative cultures to guide future antibiotic therapy and surgical debridement of all necrotic tissue. A SSI can usually be adequately treated without removing spinalinstrumentation. A multidisciplinary approach to SSIs is important. It is useful to involve an infectious disease specialist and use minimum serial bactericidal titers to enhance the effectiveness of antibiotic therapy. A plastic surgeon should also be involved in those cases of severe infection that require repeat debridement and delayed closure.展开更多
Rotator cuff repair(RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder in...Rotator cuff repair(RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most commonly isolated pathogens are Propionibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus. Management of a deep soft-tissue infection of the shoulder after RCR involves surgical debridement with lavage and long-term intravenous antibiotic treatment based on the pathogen identified. Although deep shoulder infection after RCR is usually successfully treated, complications of this condition can be devastating. Prolonged course of intravenous antibiotic treatment, extensive soft-tissue destruction and adhesions may result in substantially diminished functional outcomes.展开更多
BACKGROUND Hypertensive cerebral hemorrhage(HICH)is a common clinical cerebrovascular disease and one of the most serious complications of hypertension.Early warning of the occurrence of infection during treatment and...BACKGROUND Hypertensive cerebral hemorrhage(HICH)is a common clinical cerebrovascular disease and one of the most serious complications of hypertension.Early warning of the occurrence of infection during treatment and timely anti-infective treatment are of great significance for the early prevention and treatment of postoperative infection in patients with HICH.Changes in the levels of inflammatory mediators,which are closely related to the occurrence and development of postoperative infection,and procalcitonin(PCT),which is a sensitive indicator for diagnosing bacterial infections,are widely used in clinical practice.AIM To explore the application value of inflammatory mediator profiles and PCT in predicting postoperative infection in patients with HICH.METHODS A total of 271 patients who underwent HICH surgery at our hospital between March 2019 and March 2021 were selected and divided into the infection(n=80)and non-infection(n=191)groups according to whether postoperative infection occurred.The postoperative infection status and etiological characteristics of the infective pathogens in the infection group were analyzed.Changes in inflammatory mediator profile indices and PCT levels were compared between the two groups,pre-and postoperatively.RESULTS A total of 109 strains of pathogenic bacteria were detected in the infection group,including 67 strains(61.47%)of gram-negative bacteria,32 strains(29.36%)of gram-positive bacteria,and 10 strains(9.17%)of fungi.The main infection site of the patients in the infection group was the respiratory system(63.75%).Preoperative interleukin(IL)-4,IL-6,IL-10,tumor necrosis factor-α,interferon-γ,and PCT levels were higher in the infection group than in the non-infection group(P<0.05),and there were no significant differences in the IL-2 Levels between the two groups(P>0.05).The inflammatory mediator profile indices and PCT levels were higher in the two groups of patients on the first postoperative day than preoperatively(P<0.05),and were higher than those in the non-infection group(P<0.05).Logistic regression analysis showed that preoperative IL-6 and PCT levels correlated with postoperative infection(P<0.05).Operating characteristic curve analysis results showed that the area under the curve(AUC)values of preoperative IL-6 and PCT levels in predicting postoperative infection in patients with HICH were 0.755 and 0.824,respectively.The AUC value of joint detection was 0.866,which was significantly higher than that of the single index(P<0.05).CONCLUSION Preoperative IL-6 and PCT levels are correlated with postoperative infection in patients with HICH.Their detection is clinically significant for early identification of patients at high risk for postoperative infection.展开更多
BACKGROUND Pulmonary infections often lead to poor prognoses in patients with chronic obstructive pulmonary disease(COPD).Activin A and CD64 play crucial pathological roles in the development of COPD.AIM To explore th...BACKGROUND Pulmonary infections often lead to poor prognoses in patients with chronic obstructive pulmonary disease(COPD).Activin A and CD64 play crucial pathological roles in the development of COPD.AIM To explore the bacterial spectrum via analysis of activing A levels,CD64 index,and related mechanisms in COPD patients complicated with pulmonary infection.METHODS Between March 2015 and January 2018,a total of 85 patients with COPD,who also suffered from pulmonary infections,were enrolled in this study as the pulmonary infection group.In addition,a total of 96 COPD patients,without pulmonary infection,were selected as the control group.Sputum samples of patients in the pulmonary infection group were cultivated for bacterial identification prior to administration of antibiotics.The neutrophil CD64 index was measured using flow cytometry,serum activin A levels were detected via an enzyme-linked immunosorbent assay,and activin A,Smad3,TLR4,My D88,and NFκB protein expression was analyzed by Western blotting.RESULTS Gram-negative bacteria were identified in 57.65%of the sputum samples in the pulmonary infection group.The most prevalent Gram-negative species were Pseudomonas aeruginosa and Klebsiella pneumoniae.Conversely,Gram-positive bacteria were identified in 41.18%of the sputum samples in the pulmonary infection group.The most common Gram-positive species was Streptococcus pneumoniae.Fungi were identified in 1.17%of the sputum samples in the pulmonary infection group.The CD64 index was significantly higher in the pulmonary infection group(0.91±0.38)than in the control group(0.23±0.14,P<0.001).The serum activin A levels were significantly higher in the pulmonary infection group(43.50±5.22 ng/m L),compared to the control group(34.82±4.16 ng/m L,P<0.001).The relative expression levels of activin A,Smad3,TLR4,My D88,and NFκB were all significantly higher in the pulmonary infection group,compared to the control group(all P<0.001).CONCLUSION Pulmonary infections in COPD patients are mainly caused by Streptococcus pneumoniae,Pseudomonas aeruginosa,and Klebsiella pneumoniae.Pulmonary infections can significantly increase neutrophil CD64 index and serum levels of activin A,thereby activating the activin A/Smad3 signaling pathway,which may positively regulate the TLR4/My D88/NFκB signaling pathway.展开更多
BACKGROUND Gastrointestinal tumors have a high incidence rate.The application value of the cooperative nursing care system of medical care has received widespread attention in recent years.However,there are few studie...BACKGROUND Gastrointestinal tumors have a high incidence rate.The application value of the cooperative nursing care system of medical care has received widespread attention in recent years.However,there are few studies on the value of the joint application of collaborative nursing care and self-efficacy education.AIM To explore the effect of cooperative nursing care management/self-efficacy education on postoperative infection and self-efficacy in gastrointestinal tumor surgery patients.METHODS A total of 102 patients with gastrointestinal tumors treated in our hospital from October 2018 to February 2020 were selected and divided into a conventional group(n=51)and a combined group(n=51)according to the nursing plan.The routine group adopted routine nursing,and the joint group adopted the medical care cooperative responsibility system nursing management combined with selfefficacy education.The self-efficacy scores,coping style scores,self-experience burden scores,and postoperative complication rates of the two groups before and after intervention were counted.RESULTS After intervention,the daily life behavior management,cognitive symptom management,and disease management scores of the two groups were higher than those before the intervention,and those of the combined group were higher than those of the conventional group(all P=0.000).After the intervention,the positive response scores of the two groups were higher than those before the intervention,the negative response scores were lower than those before the intervention,and the combined group was better than the conventional group(all P=0.000).After the intervention,the two groups’emotional,economic,and physical factor scores were lower than those before the intervention,and the combined group was lower than the conventional group(all P=0.000).The incidence of infection in the combined group(1.96%)was lower than that in the conventional group(15.69%)(P=0.036).CONCLUSION Cooperative nursing care management and self-efficacy education improved the physical and mental states of gastrointestinal cancer surgery patients,change the response to disease,and reduce the risk of postoperative infection.展开更多
In order to investigate the role of the MexA-MexB-OprM efflux pump system in the pathogenesis of Pseudomonas aeruginosa(PA)-induced pulmonary infection,pulmonary infection models were established by intratracheal inje...In order to investigate the role of the MexA-MexB-OprM efflux pump system in the pathogenesis of Pseudomonas aeruginosa(PA)-induced pulmonary infection,pulmonary infection models were established by intratracheal injection of K767(wild type),nalB(MexA-MexB-OprM up-regulated mutant),and △m exB(knockout) strains,separately.All mice were treated with Meropenem(intraperitoneal injection,100 mg/kg body weight,twice every day),and strain-related pathology,bacteria count,cytokine level,myeloperoxidase(MPO,indicator of neutrophil recruitment) activity,and macrophage inflammatory protein-2(MIP-2) expression were evaluated at early(3rd day post-infection) and late(7th and 14th day post-infection) stages of infection.E-test showed that △mexB was more significantly sensitive to panipenan(ETP),meropenem(MP) and imipenem(IP) than K767 and nalB strains.There was no significant difference in sensitivity to cefepime(TM) among the three stains.In contrast to the K767 and nalB groups,the △ mexB group showed decreased bacteria burden over time and less extensive pathological change.Additionally,MPO activity and levels of inflammatory cytokines(IL-1b,IL-12,and TNF-α) were increased at the early stage(day 3) and decreased at the later stage(day 14).Serum MIP-2 expression level was steadily increased in all three groups from early to late stages,but significantly higher in △m exB group than in K767 and nalB groups(P<0.05).In conclusion,the MexA-MexB-OprM efflux pump system might play an important role in PA-induced chronic pulmonary infection.High expression of the MexA-MexB-OprM efflux pump could increase antibacterial resistance and promote infection.展开更多
Objectives: We analyzed the clinical characteristics of patients with pulmonary mycobacterial disease diagnosed as coincidental pulmonary infection due to Mycobacterium species. Materials and Methods: One hundred sixt...Objectives: We analyzed the clinical characteristics of patients with pulmonary mycobacterial disease diagnosed as coincidental pulmonary infection due to Mycobacterium species. Materials and Methods: One hundred sixty patients satisfied the diagnostic criteria of nontuberculous mycobacterial disease proposed by American Thoracic Society during the last seven years. Six patients (3.8%) were coincidental pulmonary infection due to two Mycobacterium species. We investigated the background, laboratory findings, microbiological findings, radiological findings, treatment and prognosis. Results: There were six patients, 3 males and 3 females, with a mean age of 71.7 years. The causative microorganisms of coincidental pulmonary infection consisted of Mycobacterium avium + Mycobacterium intracellulare in two patients, Mycobacterium avium + Mycobacterium kansasii in one, Mycobacterium intracellulare + Mycobacterium chelonae in one, Mycobacterium intracellulare + Mycobacterium abscessus in one, and Mycobacterium intracellulare + Mycobacterium tuberculosis in one. Regarding the radiological findings, the distribution of the lesion was frequently shown in both the right middle and left lingula lobes, but the extent of the lesion was limited within the unilateral lung field. Centrilobular small nodules with bronchiectasis were recognized in all patients and cavities or infiltration shadows were recognized in half of them on chest computed tomography. A definite diagnosis was obtained by bronchoalveolar lavage fluid in four patients and expectorated sputum in two. Combined chemotherapy was performed for two patients and that for pulmonary tuberculosis in one. Conclusions: Coincidental pulmonary infection due to Mycobactterium species occurred at a low percentage. Although most patients were elderly with underlying disease and clinical features were compatible with pulmonary Mycobacterium avium complex disease, the prognosis was comparatively good with and without treatment.展开更多
The neutrophil-to-lymphocyte ratio(NLR)and the platelet-to-lymphocyte ratio(PLR)are found to increase in patients who develop postoperative complications(PCs).The aim of the present study was to explore the associatio...The neutrophil-to-lymphocyte ratio(NLR)and the platelet-to-lymphocyte ratio(PLR)are found to increase in patients who develop postoperative complications(PCs).The aim of the present study was to explore the association of the perioperative changes of NLR(ANLR)and PLR(OPLR)with PCs in non-small cell lung cancer(NSCLC).Clinical data of 509 patients,who were diagnosed with NSCLC and underwent thoracoscopic radical resection between January 1,2014 and July 31,2016 at the Department of Thoracic Surgery,West China Hospital,were reviewed.Patients were divided into PC and non-PC groups,and clinical characteristics including ANLR and APLR were compared between them.The optimal cut-off values of ONLR and APLR were determined by receiver operating characteristics(ROC)curves and patients were assigned to high ANLR/APLR and low ONLR/OPLR groups in terms of the cut-off values.Clinicopathologic characteristics and the incidence of different PCs were compared between the dichotomized groups.Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for PCs.The results showed that the ANLR and APLR in the PC group were significantly higher than those in the non-PC group(P<0.001 for both).The optimal cutoff values of ANLR and APLR were 6.6 and 49,respectively.Patients with ANLR>6.6 or 0PLR>49 were more likely to experience postoperative pulmonary complications(PPCs)(P<0.001 for both).Multivariate logistic regression analysis demonstrated that smoking[odds ratio(OR):2.450,95%confidence interval(95%CI):1.084--5.535,P=0.031)],tumor size(OR:1.225,95%CI:1.047-1.433,P=0.011),ANLR>6.6(OR:2.453,95%CI:1.2244.914,P-0.011)and APLR>49(OR:2.231,95%CI:1.182-4.212,P-0.013)were predictive of PPCs.In conclusion,the ONLR and APLR may act as novel predictors for PPCs in NSCLC patients undergoing thoracoscopic radical lung resection,and patients with ONLR>6.6 or APLR>49 should be treated more actively to prevent or reduce PPCs.展开更多
文摘BACKGROUND There are factors that significantly increase the risk of postoperative pulmonary infections in patients with primary hepatic carcinoma(PHC).Previous reports have shown that over 10%of patients with PHC experience postoperative pulmonary infections.Thus,it is crucial to prioritize the prevention and treatment of postoperative pulmonary infections in patients with PHC.AIM To identify the risk factors for postoperative pulmonary infection in patients with PHC and develop a prediction model to aid in postoperative management.METHODS We retrospectively collected data from 505 patients who underwent hepatobiliary surgery between January 2015 and February 2023 in the Department of Hepatobiliary and Pancreaticospleen Surgery.Radiomics data were selected for statistical analysis,and clinical pathological parameters and imaging data were included in the screening database as candidate predictive variables.We then developed a pulmonary infection prediction model using three different models:An artificial neural network model;a random forest model;and a generalized linear regression model.Finally,we evaluated the accuracy and robustness of the prediction model using the receiver operating characteristic curve and decision curve analyses.RESULTS Among the 505 patients,86 developed a postoperative pulmonary infection,resulting in an incidence rate of 17.03%.Based on the gray-level co-occurrence matrix,we identified 14 categories of radiomic data for variable screening of pulmonary infection prediction models.Among these,energy,contrast,the sum of squares(SOS),the inverse difference(IND),mean sum(MES),sum variance(SUV),sum entropy(SUE),and entropy were independent risk factors for pulmonary infection after hepatectomy and were listed as candidate variables of machine learning prediction models.The random forest model algorithm,in combination with IND,SOS,MES,SUE,SUV,and entropy,demonstrated the highest prediction efficiency in both the training and internal verification sets,with areas under the curve of 0.823 and 0.801 and a 95%confidence interval of 0.766-0.880 and 0.744-0.858,respectively.The other two types of prediction models had prediction efficiencies between areas under the curve of 0.734 and 0.815 and 95%confidence intervals of 0.677-0.791 and 0.766-0.864,respectively.CONCLUSION Postoperative pulmonary infection in patients undergoing hepatectomy may be related to risk factors such as IND,SOS,MES,SUE,SUV,energy,and entropy.The prediction model in this study based on diffusion-weighted images,especially the random forest model algorithm,can better predict and estimate the risk of pulmonary infection in patients undergoing hepatectomy,providing valuable guidance for postoperative management.
基金supported by the Open Foundation of Hubei Key Laboratory(China Three Gorges University)of Tumor Microenvironment and Immunotherapy(No.2022KZL1-08).
文摘Objective:To explore factors related to postoperative pulmonary infection in lung cancer patients after recovery from COVID-19 and to provide methods for preventing and reducing the incidence of postoperative lung infection in patients with lung cancer.Methods:A total of 92 patients who underwent lung cancer surgery in the Department of Thoracic and Cardiac Surgery of Yichang Central People’s Hospital from January 28,2023,to March 3,2023,were selected.They were divided into a pulmonary infection group(47 cases)and a nonpulmonary infection group(45 cases)according to whether pulmonary infection occurred.General clinical data of patients were collected and collated to analyse the related influencing factors of pulmonary infection in lung cancer patients after recovery from COVID-19.Results:Univariate analysis showed that patient age(≥60 years),fever after COVID-19 infection,oral and laryngeal symptoms,digestive tract symptoms,neurological symptoms,long-term smoking history,hypertension history,and operation time(≥3 h)were correlated with pulmonary infection(all P<0.05).There was no significant correlation between postoperative pulmonary infection and sex,ocular,nasal and tongue symptoms,systemic symptoms,duration of COVID-19,COPD,lobectomy site,incision pain,mechanical ventilation time(≥6 h),drainage tube retention time(3 d),surgical method(P>0.05).Logistic multivariate analysis showed that age(≥60 years old),long operation time(≥3 h)and long-term smoking history were independent influencing factors for postoperative pulmonary infection in patients with radical resection of lung cancer(P>0.05).Conclusion:In this study,older age(≥60 years old),long-term smoking history,and long operation time(≥3 h)were risk factors for pulmonary infection after lung cancer surgery.In the future,active treatment measures can be taken to address these risk factors during the perioperative period to reduce the incidence of postoperative pulmonary infection.
文摘Objective:To study the improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection.Methods:A total of 78 patients with lung cancer who received surgical treatment in our hospital between August 2013 and January 2015 and were with postoperative infection were selected as the research subjects and randomly divided into two groups, control group received mechanical ventilation therapy, observation group received bronchoalveolar lavage by bronchoscope combined with mechanical ventilation, and the inflammatory factor levels, RAAS system activity and respiratory mechanics indexes of two groups were determined after treatment.Results:3 d after treatment, serum hs-CRP, TNF-α, IL-8, PCT, renin, angiotensin II and aldosterone levels of observation group were lower than those of control group, and PIP, Raw and WOB values were lower than those of control group while Cdyn value was higher than that of control group.Conclusion:For lung cancer patients with postoperative pulmonary infection, bronchoalveolar lavage by bronchoscope combined with mechanical ventilation can optimize patients' condition, relieve systemic inflammatory response and improve respiratory function, and it has positive clinical significance.
文摘BACKGROUND Purpureocillium lilacinum(P.lilacinum)is a saprophytic fungus widespread in soil and vegetation.As a causative agent,it is very rarely detected in humans,most commonly in the skin.CASE SUMMARY In this article,we reported the case of a 72-year-old patient with chronic lymphocytic leukemia who was admitted with cough and fever.Computed tomography revealed an infection in the right lower lobe.Bronchoalveolar lavage fluid culture and metagenomic next-generation sequencing were ultimately confirmed to have a pulmonary infection with P.lilacinum.She was eventually discharged with good outcomes after treatment with isavuconazole.CONCLUSION Pulmonary infection with P.lilacinum was exceedingly rare.While currently there are no definitive therapeutic agents,there are reports of high resistance to amphotericin B and fluconazole and good sensitivity to second-generation triazoles.The present report is the first known use of isavuconazole for pulmonary P.lilacinum infection.It provides new evidence for the characterization and treatment of clinical P.lilacinum lung infections.
文摘BACKGROUND Lung cancer is a malignant tumor with high morbidity and mortality among cancers.Surgery is currently one of the primary methods of treating lung cancer.Although it can slow down the progression of the disease by removing the lesion,this invasive surgery inevitably damages the integrity of the patient’s chest.Moreover,the patient’s pulmonary function may have a low compensatory capacity after surgery,causing various respiratory diseases such as atelectasis,respiratory function decline,and even serious cardiovascular disease.All of these have great negative impacts on the surgical effect and the prognosis of patients.With the continuous exploration and development of nursing,continuous nursing and respiratory exercise nursing have been gradually applied in the nursing of patients after lung cancer surgery,and have achieved good nursing results.AIM To investigate the effect of continuous nursing combined with respiratory exercise nursing on the pulmonary function of postoperative patients with lung cancer.METHODS A total of 80 patients with lung cancer who underwent surgery in our hospital from January 2021 to December 2021 were selected as the study subjects.All subjects were randomly divided into the control group(n=40 cases)and the experimental group(n=40 cases).Patients with lung cancer in the control group were given conventional nursing after surgery,while the experimental group was given continuous nursing combined with respiratory exercise nursing based on conventional nursing.The recovery of pulmonary function and respiratory symptoms was observed before and after 3 mo of intervention in both groups.The pulmonary function parameters,blood gas analysis,MD Anderson Symptom Inventory-lung cancer module(MDASI-LC)scores,incidence of pulmonary complications,and Morisky compliance scores were compared between the two groups before and after 3 mo of intervention.RESULTS There was no significant difference in pulmonary function and blood gas analysis between the two groups before intervention(P>0.05).3 mo after the intervention,the pulmonary function parameters in the experimental group(SpO2,VC,MVV,FEV1,FEV1%pred,and FEV1/FVC)were higher than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in blood gas analysis between the two groups before intervention(P>0.05).PaO2 in the experimental group was significantly higher than that in the control group,and PaCO_(2) was significantly lower than that in the control group 3 mo after the intervention.The difference had statistical significance(P<0.05).3 mo after the intervention,the MDASI score of respiratory symptoms in the experimental group was significantly lower than that in the control group(P<0.05),and the incidence of pulmonary complications was lower than that in the control group(P<0.05).In addition,the treatment compliance and nursing satisfaction of patients in the experimental group were higher than those in the control group,and the differences were statistically significant(P<0.05).CONCLUSION Continuous nursing combined with respiratory exercise nursing can significantly accelerate the recovery of respiratory function in postoperative lung cancer patients,reduce the incidence of postoperative complications of lung cancer as well as improve the treatment compliance of patients.
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a global problem,causing significant morbidity and mortality.Furazolidone is recommended to eradicate H.pylori infections in China owing to the highly associated antibiotic resistance.CASE SUMMARY This article presents two cases of lung injury caused by furazolidone treatment of H.pylori infection and the relevant literature review.Two patients developed symptoms,including fever,cough,and fatigue after receiving a course of furazolidone for H.pylori infection.Chest computed tomography showed bilateral interstitial infiltrates.Laboratory studies revealed elevated blood eosinophil count.After discontinuing furazolidone with or without the use of corticosteroids,the symptoms improved rapidly.A PubMed database literature search revealed three reported cases of lung injury suggestive of furazolidone-induced pulmonary toxicity.CONCLUSION Clinicians should be aware of the side effects associated with the administration of furazolidone to eradicate H.pylori infection.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)-associated invasive pulmonary aspergillosis presents a diagnostic challenge due to its non-specific clinical/imaging features,as well as the fact that the proposed clinically diagnostic algorithms do not necessarily apply to COVID-19 patients.In addition,Fusarium spp.is a rare cause of opportunistic life-threatening fungal infections.Disseminated Fusarium infection in an immunocompromised host is intractable,with a high likelihood of resulting mortality.To our knowledge,this is the first case of secondary pulmonary infection by Fusarium solani(F.solani)and Aspergillus niger(A.niger)during systemic steroid treatment for COVID-19.CASE SUMMARY A 62-year-old male was transported to our hospital by ambulance with a complaint of fever and dyspnea.We established a diagnosis of pneumococcal pneumonia,complicated with COVID-19 and septic shock,together with acute renal failure.He was admitted to the intensive care unit,to be treated with piperacillin/tazobactam,vancomycin,and 6.6 mg per day of dexamethasone sodium phosphate,along with noradrenaline as a vasopressor,ventilator management,and continuous hemodiafiltration.His condition improved,and we finished the vasopressor on the fifth hospital day.We administered dexamethasone for ten days,and finished the course of treatment.On the eleventh day,patient respiratory deterioration was observed,and a computed tomography scan showed an exacerbation of bilateral ground-glass-opacity-like consolidation,together with newly appeared cavitary lesions in the lung.we changed antibiotics to meropenem plus vancomycin.In addition,a fungal infection was considered as a possibility based on microscopic findings of sputum,and we began coadministration of voriconazole.However,the pneumonia worsened,and the patient died on the seventeenth day of illness.Later,F.solani and A.niger were identified from sputum collected on the twelfth day.It was believed that he developed a cell-mediated immune deficiency during COVID-19 treatment,which led to the complication of pneumonia caused by the above-mentioned fungi,contributing to his death.CONCLUSION Because early initiation of intense antifungal therapy offers the best chance for survival in pulmonary fusariosis,computed tomography scans and appropriate microbiologic investigations should be obtained for severely immunocompromised patients.
文摘Objective:To investigate the efficacy of montelukast sodium in the treatment of lung cancer patients with pulmonary infections.Methods:A total of 330 patients diagnosed with lung cancer and pulmonary infection,who were admitted to the First Affiliated Hospital of Xi’an Medical University from 2020 to 2022,were selected as research subjects.They were randomly divided into two groups:a control group receiving conventional treatment and an observation group receiving conventional treatment combined with montelukast sodium.Each group consisted of 165 cases.The time required for clinical symptom improvement,the resolution of lung infection signs,and the levels of serum inflammatory factors before and after treatment were compared between the two groups.Results:The observation group exhibited significantly faster improvement in clinical symptoms compared to the control group(P<0.001).ELISA assays were conducted to detect the expression levels of IL-1β,IL-6,IL-8,and TNF-αin the serum of both groups at 1 week and 2 weeks into the treatment.The results indicated that,as the treatment progressed,the observation group displayed significantly lower levels of the four serum inflammatory factors compared to the control group(P<0.001).Conclusion:Montelukast sodium demonstrates efficacy in the treatment of patients with lung cancer complicated by pulmonary infections.These findings suggest its potential for further verification and clinical application.
文摘BACKGROUND Both pulmonary rehabilitation training and psychological care have been shown to have a positive effect on the postoperative recovery of patients with lung cancer.However,few studies have combined the two to explore their combined effect.Therefore,this study aimed to investigate the effects of pulmonary rehabil-itation training combined with psychological care on postoperative respiratory function and mental health in lung cancer patients.AIM To investigate effect of nursing on postoperative respiratory function and mental health of lung cancer patients.METHODS 122 cases of lung cancer patients who underwent surgical treatment in our hospital and were treated in our department from January 2022 to April 2023 were selected and randomly divided into the control group and observation group.The control group performed the routine care intervention.The obser-vation group was given pulmonary rehabilitation training and psychological care based on conventional nursing interventions.Forced expiratory volume,forced vital capacity.Maximum ventilatory volume(MVV)in one second was measured,and the patient's 6-min walking distance and dyspnoea index scale were used to assess the patient's respiratory condition.The Connor-Davidson resilience scale(CD-RISC),self-rating anxiety scale(SAS),and self-rating depression scale(SDS)were used to evaluate the mental health of the patients.RESULTS There was no difference between the two groups regarding age,gender,education level,surgical procedure,type of pathology,and treatment(P>0.05).After treatment,MVV,6-min walking distance,toughness,strength,optimism,and total CD-RISC scores were significantly higher in the observation group(P<0.05),dyspnoea scores,SAS,and SDS scores were substantially lower in the control group compared to the observation group(P<0.05).CONCLUSION Pulmonary rehabilitation training combined with psychological care for patients after lung cancer resection could improve lung function,enhance daily activities,effectively relieve negative emotions such as anxiety and depression,and reduce complications.
文摘BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cases,with approximately 4.5 million individuals affected by active tuberculosis.Notably,T2DM poses a significant risk factor for the development of tuberculosis,as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis(T2DMPTB),which has risen from 19.3%to 24.1%.It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature.AIM To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis(T2DM-PTB),as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM.METHODS T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group,Simple DM patients presenting to our hospital in the same period were the control group,Controls and case groups were matched 1:2 according to the principle of the same sex,age difference(±3)years and disease duration difference(±5)years,patients were investigated for general demographic characteristics,diabetes-related characteristics,body immune status,lifestyle and behavioral habits,univariate and multivariate analysis of the data using conditional logistic regression,calculate the odds ratio(OR)values and 95%CI of OR values.RESULTS A total of 315 study subjects were included in this study,including 105 subjects in the observation group and 210 subjects in the control group.Comparison of the results of both anthropometric and biochemical measures showed that the constitution index,systolic blood pressure,diastolic blood pressure and lymphocyte count were significantly lower in the case group,while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group.The results of univariate analysis showed that poor glucose control,hypoproteinemia,lymphopenia,TB contact history,high infection,smoking and alcohol consumption were positively associated with PTB in T2DM patients;married,history of hypertension,treatment of oral hypoglycemic drugs plus insulin,overweight,obesity and regular exercise were negatively associated with PTB in T2DM patients.Results of multivariate stepwise regression analysis found lymphopenia(OR=17.75,95%CI:3.40-92.74),smoking(OR=12.25,95%CI:2.53-59.37),history of TB contact(OR=6.56,95%CI:1.23-35.03)and poor glycemic control(OR=3.37,95%CI:1.11-10.25)was associated with an increased risk of developing PTB in patients with T2DM,While being overweight(OR=0.23,95%CI:0.08-0.72)and obesity(OR=0.11,95%CI:0.02-0.72)was associated with a reduced risk of developing PTB in patients with T2DM.CONCLUSION T2DM-PTB patients are prone to worse glycemic control,higher infection frequency,and a higher proportion of people smoking,drinking alcohol,and lack of exercise.Lymphopenia,smoking,history of TB exposure,poor glycemic control were independent risk factors for T2DM-PTB,and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.
基金Supported by the Zhejiang Provincial Natural Science Foundation of China,No.LQ20H260002.
文摘BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.
文摘BACKGROUND Gastric stromal tumors,originating from mesenchymal tissues,are one of the most common tumors of the digestive tract.For stromal tumors originating from the muscularis propria,compared with conventional endoscopic submucosal dissection(ESD),endoscopic full-thickness resection(EFTR)can remove deep lesions and digestive tract wall tumors completely.However,this technique has major limitations such as perforation,postoperative bleeding,and post-polypectomy syndrome.Herein,we report a case of postoperative serous surface bleeding which formed an encapsulated hemoperitoneum in a patient with gastric stromal tumor that was treated with exposed EFTR.Feasible treatment options to address this complication are described.CASE SUMMARY A 47-year-old male patient had a hemispherical protrusion found during gastric endoscopic ultrasonography,located at the upper gastric curvature adjacent to the stomach fundus,with a smooth surface mucosa and poor mobility.The lesion was 19.3 mm×16.1 mm in size and originated from the fourth ultrasound layer.Computed tomography(CT)revealed no significant evidence of lymph node enlargement or distant metastasis.Using conventional ESD technology for mucosal pre-resection,exposed EFTR was performed to resect the intact tumor in order to achieve a definitive histopathological diagnosis.Based on its morphology and immunohistochemical expression of CD117 and DOG-1,the lesion was proven to be consistent with a gastric stromal tumor.Six days after exposed EFTR,CT showed a large amount of encapsulated fluid and gas accumulation around the stomach.In addition,gastroscopy suggested intracavitary bleeding and abdominal puncture drainage indicated serosal bleeding.Based on these findings,the patient was diagnosed with serosal bleeding resulting in encapsulated abdominal hemorrhage after exposed EFTR for a gastric stromal tumor.The patient received combined treatments,such as hemostasis under gastroscopy,gastrointestinal decompression,and abdominal drainage.All examinations were normal within six months of follow-up.CONCLUSION This patient developed serous surface bleeding in the gastric cavity following exposed EFTR.Serosal bleeding resulting in an encapsulated hemoperitoneum is rare in clinical practice.The combined treatment may replace certain surgical techniques.
文摘Postoperative surgical site infection(SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention,diagnosis and treatment of SSIs. Factors contributing to the development of a SSI can be split into three categories:(1) microbiological factors;(2) factors related to the patient and their spinal pathology; and(3) factors relating to the surgical procedure. SSI is most commonly caused by Staphylococcus aureus. The virulence of the organism causing the SSI can affect its presentation. SSI can be prevented by careful adherence to aseptic technique,prophylactic antibiotics,avoiding myonecrosis by frequently releasing retractors and preoperatively optimizing modifiable patient factors. Increasing pain is commonly the only symptom of a SSI and can lead to a delay in diagnosis. C-reactive protein and magnetic resonance imaging can help establish the diagnosis. Treatment requires acquiring intra-operative cultures to guide future antibiotic therapy and surgical debridement of all necrotic tissue. A SSI can usually be adequately treated without removing spinalinstrumentation. A multidisciplinary approach to SSIs is important. It is useful to involve an infectious disease specialist and use minimum serial bactericidal titers to enhance the effectiveness of antibiotic therapy. A plastic surgeon should also be involved in those cases of severe infection that require repeat debridement and delayed closure.
文摘Rotator cuff repair(RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most commonly isolated pathogens are Propionibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus. Management of a deep soft-tissue infection of the shoulder after RCR involves surgical debridement with lavage and long-term intravenous antibiotic treatment based on the pathogen identified. Although deep shoulder infection after RCR is usually successfully treated, complications of this condition can be devastating. Prolonged course of intravenous antibiotic treatment, extensive soft-tissue destruction and adhesions may result in substantially diminished functional outcomes.
文摘BACKGROUND Hypertensive cerebral hemorrhage(HICH)is a common clinical cerebrovascular disease and one of the most serious complications of hypertension.Early warning of the occurrence of infection during treatment and timely anti-infective treatment are of great significance for the early prevention and treatment of postoperative infection in patients with HICH.Changes in the levels of inflammatory mediators,which are closely related to the occurrence and development of postoperative infection,and procalcitonin(PCT),which is a sensitive indicator for diagnosing bacterial infections,are widely used in clinical practice.AIM To explore the application value of inflammatory mediator profiles and PCT in predicting postoperative infection in patients with HICH.METHODS A total of 271 patients who underwent HICH surgery at our hospital between March 2019 and March 2021 were selected and divided into the infection(n=80)and non-infection(n=191)groups according to whether postoperative infection occurred.The postoperative infection status and etiological characteristics of the infective pathogens in the infection group were analyzed.Changes in inflammatory mediator profile indices and PCT levels were compared between the two groups,pre-and postoperatively.RESULTS A total of 109 strains of pathogenic bacteria were detected in the infection group,including 67 strains(61.47%)of gram-negative bacteria,32 strains(29.36%)of gram-positive bacteria,and 10 strains(9.17%)of fungi.The main infection site of the patients in the infection group was the respiratory system(63.75%).Preoperative interleukin(IL)-4,IL-6,IL-10,tumor necrosis factor-α,interferon-γ,and PCT levels were higher in the infection group than in the non-infection group(P<0.05),and there were no significant differences in the IL-2 Levels between the two groups(P>0.05).The inflammatory mediator profile indices and PCT levels were higher in the two groups of patients on the first postoperative day than preoperatively(P<0.05),and were higher than those in the non-infection group(P<0.05).Logistic regression analysis showed that preoperative IL-6 and PCT levels correlated with postoperative infection(P<0.05).Operating characteristic curve analysis results showed that the area under the curve(AUC)values of preoperative IL-6 and PCT levels in predicting postoperative infection in patients with HICH were 0.755 and 0.824,respectively.The AUC value of joint detection was 0.866,which was significantly higher than that of the single index(P<0.05).CONCLUSION Preoperative IL-6 and PCT levels are correlated with postoperative infection in patients with HICH.Their detection is clinically significant for early identification of patients at high risk for postoperative infection.
文摘BACKGROUND Pulmonary infections often lead to poor prognoses in patients with chronic obstructive pulmonary disease(COPD).Activin A and CD64 play crucial pathological roles in the development of COPD.AIM To explore the bacterial spectrum via analysis of activing A levels,CD64 index,and related mechanisms in COPD patients complicated with pulmonary infection.METHODS Between March 2015 and January 2018,a total of 85 patients with COPD,who also suffered from pulmonary infections,were enrolled in this study as the pulmonary infection group.In addition,a total of 96 COPD patients,without pulmonary infection,were selected as the control group.Sputum samples of patients in the pulmonary infection group were cultivated for bacterial identification prior to administration of antibiotics.The neutrophil CD64 index was measured using flow cytometry,serum activin A levels were detected via an enzyme-linked immunosorbent assay,and activin A,Smad3,TLR4,My D88,and NFκB protein expression was analyzed by Western blotting.RESULTS Gram-negative bacteria were identified in 57.65%of the sputum samples in the pulmonary infection group.The most prevalent Gram-negative species were Pseudomonas aeruginosa and Klebsiella pneumoniae.Conversely,Gram-positive bacteria were identified in 41.18%of the sputum samples in the pulmonary infection group.The most common Gram-positive species was Streptococcus pneumoniae.Fungi were identified in 1.17%of the sputum samples in the pulmonary infection group.The CD64 index was significantly higher in the pulmonary infection group(0.91±0.38)than in the control group(0.23±0.14,P<0.001).The serum activin A levels were significantly higher in the pulmonary infection group(43.50±5.22 ng/m L),compared to the control group(34.82±4.16 ng/m L,P<0.001).The relative expression levels of activin A,Smad3,TLR4,My D88,and NFκB were all significantly higher in the pulmonary infection group,compared to the control group(all P<0.001).CONCLUSION Pulmonary infections in COPD patients are mainly caused by Streptococcus pneumoniae,Pseudomonas aeruginosa,and Klebsiella pneumoniae.Pulmonary infections can significantly increase neutrophil CD64 index and serum levels of activin A,thereby activating the activin A/Smad3 signaling pathway,which may positively regulate the TLR4/My D88/NFκB signaling pathway.
文摘BACKGROUND Gastrointestinal tumors have a high incidence rate.The application value of the cooperative nursing care system of medical care has received widespread attention in recent years.However,there are few studies on the value of the joint application of collaborative nursing care and self-efficacy education.AIM To explore the effect of cooperative nursing care management/self-efficacy education on postoperative infection and self-efficacy in gastrointestinal tumor surgery patients.METHODS A total of 102 patients with gastrointestinal tumors treated in our hospital from October 2018 to February 2020 were selected and divided into a conventional group(n=51)and a combined group(n=51)according to the nursing plan.The routine group adopted routine nursing,and the joint group adopted the medical care cooperative responsibility system nursing management combined with selfefficacy education.The self-efficacy scores,coping style scores,self-experience burden scores,and postoperative complication rates of the two groups before and after intervention were counted.RESULTS After intervention,the daily life behavior management,cognitive symptom management,and disease management scores of the two groups were higher than those before the intervention,and those of the combined group were higher than those of the conventional group(all P=0.000).After the intervention,the positive response scores of the two groups were higher than those before the intervention,the negative response scores were lower than those before the intervention,and the combined group was better than the conventional group(all P=0.000).After the intervention,the two groups’emotional,economic,and physical factor scores were lower than those before the intervention,and the combined group was lower than the conventional group(all P=0.000).The incidence of infection in the combined group(1.96%)was lower than that in the conventional group(15.69%)(P=0.036).CONCLUSION Cooperative nursing care management and self-efficacy education improved the physical and mental states of gastrointestinal cancer surgery patients,change the response to disease,and reduce the risk of postoperative infection.
基金supported by grants from the National Natural Science Foundation of China (No. 30873189)the Natural Science Foundation of Hubei Province,China (No.2008CDB165)
文摘In order to investigate the role of the MexA-MexB-OprM efflux pump system in the pathogenesis of Pseudomonas aeruginosa(PA)-induced pulmonary infection,pulmonary infection models were established by intratracheal injection of K767(wild type),nalB(MexA-MexB-OprM up-regulated mutant),and △m exB(knockout) strains,separately.All mice were treated with Meropenem(intraperitoneal injection,100 mg/kg body weight,twice every day),and strain-related pathology,bacteria count,cytokine level,myeloperoxidase(MPO,indicator of neutrophil recruitment) activity,and macrophage inflammatory protein-2(MIP-2) expression were evaluated at early(3rd day post-infection) and late(7th and 14th day post-infection) stages of infection.E-test showed that △mexB was more significantly sensitive to panipenan(ETP),meropenem(MP) and imipenem(IP) than K767 and nalB strains.There was no significant difference in sensitivity to cefepime(TM) among the three stains.In contrast to the K767 and nalB groups,the △ mexB group showed decreased bacteria burden over time and less extensive pathological change.Additionally,MPO activity and levels of inflammatory cytokines(IL-1b,IL-12,and TNF-α) were increased at the early stage(day 3) and decreased at the later stage(day 14).Serum MIP-2 expression level was steadily increased in all three groups from early to late stages,but significantly higher in △m exB group than in K767 and nalB groups(P<0.05).In conclusion,the MexA-MexB-OprM efflux pump system might play an important role in PA-induced chronic pulmonary infection.High expression of the MexA-MexB-OprM efflux pump could increase antibacterial resistance and promote infection.
文摘Objectives: We analyzed the clinical characteristics of patients with pulmonary mycobacterial disease diagnosed as coincidental pulmonary infection due to Mycobacterium species. Materials and Methods: One hundred sixty patients satisfied the diagnostic criteria of nontuberculous mycobacterial disease proposed by American Thoracic Society during the last seven years. Six patients (3.8%) were coincidental pulmonary infection due to two Mycobacterium species. We investigated the background, laboratory findings, microbiological findings, radiological findings, treatment and prognosis. Results: There were six patients, 3 males and 3 females, with a mean age of 71.7 years. The causative microorganisms of coincidental pulmonary infection consisted of Mycobacterium avium + Mycobacterium intracellulare in two patients, Mycobacterium avium + Mycobacterium kansasii in one, Mycobacterium intracellulare + Mycobacterium chelonae in one, Mycobacterium intracellulare + Mycobacterium abscessus in one, and Mycobacterium intracellulare + Mycobacterium tuberculosis in one. Regarding the radiological findings, the distribution of the lesion was frequently shown in both the right middle and left lingula lobes, but the extent of the lesion was limited within the unilateral lung field. Centrilobular small nodules with bronchiectasis were recognized in all patients and cavities or infiltration shadows were recognized in half of them on chest computed tomography. A definite diagnosis was obtained by bronchoalveolar lavage fluid in four patients and expectorated sputum in two. Combined chemotherapy was performed for two patients and that for pulmonary tuberculosis in one. Conclusions: Coincidental pulmonary infection due to Mycobactterium species occurred at a low percentage. Although most patients were elderly with underlying disease and clinical features were compatible with pulmonary Mycobacterium avium complex disease, the prognosis was comparatively good with and without treatment.
文摘The neutrophil-to-lymphocyte ratio(NLR)and the platelet-to-lymphocyte ratio(PLR)are found to increase in patients who develop postoperative complications(PCs).The aim of the present study was to explore the association of the perioperative changes of NLR(ANLR)and PLR(OPLR)with PCs in non-small cell lung cancer(NSCLC).Clinical data of 509 patients,who were diagnosed with NSCLC and underwent thoracoscopic radical resection between January 1,2014 and July 31,2016 at the Department of Thoracic Surgery,West China Hospital,were reviewed.Patients were divided into PC and non-PC groups,and clinical characteristics including ANLR and APLR were compared between them.The optimal cut-off values of ONLR and APLR were determined by receiver operating characteristics(ROC)curves and patients were assigned to high ANLR/APLR and low ONLR/OPLR groups in terms of the cut-off values.Clinicopathologic characteristics and the incidence of different PCs were compared between the dichotomized groups.Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for PCs.The results showed that the ANLR and APLR in the PC group were significantly higher than those in the non-PC group(P<0.001 for both).The optimal cutoff values of ANLR and APLR were 6.6 and 49,respectively.Patients with ANLR>6.6 or 0PLR>49 were more likely to experience postoperative pulmonary complications(PPCs)(P<0.001 for both).Multivariate logistic regression analysis demonstrated that smoking[odds ratio(OR):2.450,95%confidence interval(95%CI):1.084--5.535,P=0.031)],tumor size(OR:1.225,95%CI:1.047-1.433,P=0.011),ANLR>6.6(OR:2.453,95%CI:1.2244.914,P-0.011)and APLR>49(OR:2.231,95%CI:1.182-4.212,P-0.013)were predictive of PPCs.In conclusion,the ONLR and APLR may act as novel predictors for PPCs in NSCLC patients undergoing thoracoscopic radical lung resection,and patients with ONLR>6.6 or APLR>49 should be treated more actively to prevent or reduce PPCs.
