Background:Community-acquired pneumonia (CAP) is associated with marked immune dysregulation, but the peripheral T-cell transcriptional alterations linked to CAP remain incompletely defined. We aimed to characterize CAP-associated T-cell heterogeneity and identify candidate blood biomarkers by integrating single-cell and bulk transcriptomic data. Methods:GEO-processed whole-blood microarray expression data from 108 patients with CAP and 42 healthy controls (GSE65682), together with processed PBMC scRNA-seq data from five non-influenza CAP donors and four control donors (GSE164948), were analysed. Cell annotation, differential expression, disease contribution scoring, LASSO regression, and support vector machine-recursive feature elimination were used to identify candidate genes. Immune infiltration, enrichment, and pseudotime analyses were performed. Key findings were evaluated by qRT-PCR in PBMCs from an independent cohort of 36 CAP patients and 18 healthy controls. Results:T cells showed the highest disease contribution score and were enriched for pathways related to antigen processing, phosphorylation, and immune regulation. Four candidate biomarkers, CD8B, GZMM, MYL12B, and TUBA1A, showed differential expression between CAP and controls. CIBERSORT suggested increased eosinophils and monocytes and reduced resting CD4+ memory T cells in CAP. Pseudotime analysis indicated that CAP-associated T cells accumulated at higher inferred pseudotime values. qRT-PCR confirmed significant upregulation of these four candidate biomarkers in CAP PBMCs; FCGR2A also showed CAP-associated expression changes. Conclusions:Integrative transcriptomic profiling identified peripheral T-cell dysregulation in CAP and highlighted CD8B, GZMM, MYL12B, and TUBA1A as candidate blood biomarkers. These findings provide a basis for further multicenter validation and mechanistic studies.

AIM:The purpose of this study was to explore and describe lung transplantation recipients' expectations and dilemmatic experiences of continuity of care. METHODS:A phenomenological research method was used to conduct face-to-face semi-structured interviews with 22 lung transplant recipients who visited the lung transplant centre of a hospital in Eastern China for follow-up visits, and NVivo 14 software was used to analyse the interview data and refine the themes. RESULTS:Four themes were identified in this study, including information support, maintaining collaborative relationships, standardised management, and facing multiple challenges. CONCLUSION:Accurately assessing patients' needs and experiences, developing and implementing effective continuity of care strategies, providing timely support and professional guidance, and maintaining a close working relationship with patients are effective means of ensuring the quality of information and continuity of relationships. At the same time, attention to assessing the quality and competence of condition management in different healthcare organisations, as well as assessing the effectiveness of telemedicine platform management, is also necessary to improve the quality of continuity of care.

OBJECTIVE:Currently, there is a lack of information on the clinical pharmacokinetics (PK), effectiveness, and safety of colistin sulphate (CS) in lung transplant recipients. This study aims to improve CS dosing regimens and evaluate its population PK in lung transplant recipients. METHODS:This study evaluated the clinical efficacy, microbiological efficacy, and adverse events of CS in lung transplant recipients. The NONMEM program was employed to construct the population PK model, and Monte Carlo simulations were executed to establish dosing regimens according to the probability of target attainment (PTA). RESULTS:The study included 146 CS concentrations, spanning from 0.05 to 4.18 mg/L from 39 lung transplant recipients with multidrug-resistant Gram-negative bacteria. 26 (66.67%) patients successfully eradicated bacteria, and 30 (76.92%) patients had clinical cure or improvement. Additionally, only 2 (5.13%) patients developed CS-related nephrotoxicity. The PK profile was effectively represented by a one-compartmental model with linear elimination. Creatinine clearance and concomitant furosemide use were recognized as covariates influencing the clearance of CS. Based on the PTA results, a daily dosage of 1.5 million IU, divided into 2-3 administrations, could attain a PTA exceeding 90% for MIC ≤ 1 µg/mL at creatinine clearance of about 110 mL/min. However, this regimen would lead to insufficient exposure for MIC ≥ 2 µg/mL. CONCLUSIONS:The clearance of CS is significantly influenced by concomitant furosemide use and renal function. The currently recommended dosing regimens by label sheet may result in subtherapeutic exposure for MIC exceeding 1 mg/L in lung transplant recipients.

目的:探讨活动性疼痛管理模式在肺移植病人围术期疼痛控制中的应用效果.方法:选取2020年10月—2021年12月在无锡市某三级甲等医院行肺移植手术的病人96例,其中2020年10月—2021年5月收治的48例病人为对照组,予以常规的疼痛管理;2021年6月—12月收治的48例病人为观察组,在常规疼痛管理的基础上实施围术期活动性疼痛管理模式.比较两组病人术后镇痛效果.结果:观察组病人术后功能活动评分(Functional Activity Score,FAS)、疼痛管理质量、疼痛控制满意度、生命体征、夜晚睡眠时间及首次下床时间均优于对照组(P＜0.05).结论:围术期活动性疼痛管理模式能够有效控制肺移植病人术后的活动性疼痛,促进其早期康复锻炼,提高睡眠质量,促进快速康复.

Background:Lung cancer is the leading cause of morbidity and mortality among all cancer types, with lung adenocarcinoma (LUAD) being the most prevalent subtype. DNA damage repair (DDR)-related genes are closely associated with cancer progression and treatment, with emerging evidence highlighting their correlation with tumor development. However, the relationship between LUAD prognosis and DDR-related genes remains unclear.Methods:RNA sequencing (RNA-seq) data and clinical information were obtained from The Cancer Genome Atlas (TCGA) database. The GSE31210 dataset, utilized for external validation, was retrieved from the Gene Expression Omnibus (GEO) database. Differentially expressed DDR genes were identified, and a DDR-related prognostic model was established and validated using Kaplan-Meier (KM) survival analysis, time-dependent receiver operating characteristic (ROC) curves, gene set enrichment analysis (GSEA), tumor mutational burden (TMB) analysis, and immune cell infiltration. A P value of less than 0.05 was considered statistically significant.Results:A total of 514 patients with LUAD from TCGA database were divided into distinct subtypes to characterize the diversity within the DDR pathway. DDR-activated and DDR-suppressed subgroups showed distinct clinical characteristics, molecular characteristics, and immune profiles. Nine genes were identified as hub DDR-related genes, including CASP14, DKK1, ECT2, FLNC, HMMR, IGFBP1, KRT6A, TYMS, and FCER2. By using the expression levels of these selected genes, the corresponding risk scores for each sample was predicted. In the training group, KM survival analysis revealed that the high-risk group exhibited significantly diminished overall survival (OS) [hazard ratio (HR) =3.341, P=1.38e-08]. The corresponding area under the curve (AUC) values for the 1-year follow-up periods was 0.767, respectively. Upon validation in the external cohort, patients with higher risk scores manifested significantly reduced OS (HR =2.372, P=1.87e-03). The AUC values of the ROC curves for the 1-year OS in the validation cohort was 0.87, respectively. Moreover, advanced DDR risk score was correlated with increased TMB scores, a heightened frequency of TP53 mutations, an increased abundance of cancer-testicular antigens (CTAs), and a lower tumor immune dysfunction and exclusion (TIDE) score in patients with LUAD (P<0.05).Conclusions:A nine-gene risk signature associated with DDR in LUAD was effectively developed, demonstrating its potential as a robust and reliable classification tool for clinical practice. This model exhibited the capability to accurately predict the prognosis and survival outcomes of LUAD patients.

总结 1 例肺移植等待期病人清醒状态下行体外膜肺氧合(ECMO)桥接治疗的管理经验.管理重点包括团队的配合、感染的预防、人文心理护理以及术后护理管理.病人最终安全转入重症监护病房,顺利完成肺移植手术.

Background:This study aimed to explore the effect of early extubation combined with physical training on pulmonary rehabilitation of patients after lung transplantation. Methods:This is an open parallel randomized controlled trial. A total of 96 lung transplant patients admitted to Wuxi People's Hospital (July 2018 to June 2019) were included. Inclusion criteria: (I) aged 18-75; (II) lung transplantation; (III) communicate normally; (IV) voluntary participation. According to the random number method, they were divided into the control group (routine nursing intervention) and the observation group (early extubation combined with a physical training program). The indwelling tracheal intubation time, discharge time, intensive care unit (ICU) stay time, lung function, 6 Minutes Walk Distance (6MWD), Modified Barthel Index (MBI) and satisfaction rate were recorded and analyzed. Results:The observation group's first-time postoperative ambulation (t=2.10, P=0.039), indwelling tracheal intubation time (Z=2.864, P=0.004), and discharge time (t=3.111, P<0.001) were shorter than the control group, while the difference of ICU stay time was not statistically significant (Z=-1.658, P=0.097). Before treatment, there was no significant difference in the lung function, 6MWD, and MBI of the two groups (P>0.05). After treatment, the Forced Expiratory Volume In 1 s (FEV1)% (t=-2.707, P<0.001), forced vital capacity (FVC)% (t=-3.716, P<0.001), FEV1/FVC (t=-3.539, P<0.001), 6MWD (t=-5.567, P<0.001), and MBI indexes (t=-4.073, P<0.001) were better than in observation group. The satisfaction rate of the observation group was better than the control group (P<0.05). Conclusions:For lung transplant recipients, early extubation combined with a physical training program is scientific, safe, and feasible. This approach is helpful to promote the postoperative recovery of lung transplant patients, reduce the length of hospitalization, help patients improve their lung function and ability to engage in activities of daily living, and increase the satisfaction rate of postoperative recovery. Results show that the combination of early extubation and a physical training program is worthy of clinical promotion for lung transplant recipients. Trial Registration:Chinese Clinical Trial Registry ChiCTR2100051954.

总结1例儿童中毒性表皮坏死松懈症后闭塞性细支气管炎行双肺移植术后的护理,主要包括预防感染、机械吸痰、纤维支气管镜的配合、俯卧式机械通气的监测、拔除套管、免疫抑制监测、镇静镇痛、运动训练、早期营养支持和心理护理,经过96 d的多学科团队合作,患儿病情稳定出院.

肺移植术后患者会出现不同程度的最大运动能力和骨骼肌功能受损,常影响患者的临床结局.抗阻力运动是肺康复的重要组成部分.本文综述了抗阻力运动在肺移植术后患者中的应用,包括抗阻力运动概述、肺移植术后运动受限的主要因素、训练方案及实施效果,以期为促进抗阻力运动在肺移植术后患者中的应用,减少肺移植术后不良结局的发生提供依据.

目的 探讨终末期肺病患儿行双肺移植术的术中临床护理经验.方法 回顾总结6例儿童肺移植术的术前准备、供肺获取术配合、病肺切除配合和供肺植入术配合等方面进行临床护理.结果 6例患儿均手术成功,平均住院时间为(85.2±98.9)d,术后均康复出院.结论 对终末期肺病患儿实施术中规范化流程不仅是手术成功的保证,同时还可缩短手术时间.

总结9例肺移植围手术期患者Passy-Muir呼吸活瓣(说话瓣膜)的应用与护理经验.使用前排除禁忌证,充分评估与气道管理,做好宣教工作,使用中注意密切监护,动态观察患者生命体征与呼吸困难情况,遇到紧急情况及时处理.9例患者在恢复一定的认知、吞咽、运动功能后,应用Passy-Muir呼吸活瓣,其间能自主交流,语音清晰,配合良好,吞咽功能得到一定程度的恢复,未发生误吸、窒息、呼吸困难等不良反应,康复效果较好.

从衰弱概念的来源、肺移植受者衰弱的病理生理学、影响因素、评价工具、干预措施方面综述肺移植受者衰弱的研究进展,以期为早期临床鉴别和干预提供依据.

目的 观察肺移植候选患者等待期团队管理下干预模式对术后营养状态和并发症的干预效果.方法 选取2018年1月—2019年12月收治80例拟行肺移植等待期患者资料,采用电脑数字随机分组法将其分为研究组和对照组,各40例,对照组给予常规护理,研究实施团队管理干预模式,对比两组患者营养状态和并发症控制效果.结果 与对照组相比,研究组患者营养状态中血清白蛋白、前白蛋白、血红蛋白指标分别为98.83±10.76 g/L、284.19±9.49 mg/L、31.67±8.57 g/L,显著高于对照组,差异有统计学意义(P<0.05);与对照组相比,研究组患者肺部感染、急性肺水肿、病死率并发症总发生率为5.0％,诸多并发症总发生率显著低于对照组,差异有统计学意义(P<0.05).结论 肺移植患者等待期实施团队管理干预模式,可有限改善营养状态,预防由于免疫系统低下所致并发症发生,促进病情快去快速康复.

目的 观察肺移植围手术期综合物理干预对患者动脉血气指标及并发症的影响.方法 选取2018年7月-2019年4月于南京医科大学附属无锡人民医院就诊接受肺移植治疗的78例肺移植患者为研究对象,依据不同干预方案将其分为研究组(39例)与对照组(39例),对照组对患者实施常规干预方案,研究组在此基础上对患者实施肺部综合物理干预方案,观察2组患者的动脉血气变化,比较2组患者术后有创呼吸机支持时间、无创呼吸机支持时间、住院时间、术后并发症情况、日常生活能力以及生活质量水平.结果 术后研究组患者的血氧分压显著高于对照组(P＜0.05),血二氧化碳分压显著低于对照组(P＜0.05);研究组患者的有创呼吸机支持时间、无创呼吸机支持时间及住院时间均明显短于对照组(P均＜0.05);研究组患者术后并发症总发生率低于对照组(P＜0.05);研究组患者的日常生活能力ADL评分与生活质量SF-36评分均高于干预前及对照组(P均＜0.05).结论 在肺移植患者围手术期实施肺部综合物理干预能够明显改善患者的呼吸功能,缩短住院时间以及应用呼吸机时间,降低并发症发生率,应用价值较高.

Delirium is a common complication during perioperative period of lung transplantation, which affects postoperative recovery and survival. This article reviews the general situation of delirium during perioperative period of lung transplantation and the risk factors of perioperative delirium associated with lung transplantation, and proposes comprehensive nursing intervention measures to prevent delirium, in order to provide a reference for the nursing of perioperative delirium in lung transplantation patients.

目的:探讨支持性心理护理对肺移植患者心理弹性、应对方式的影响.方法:选择2018年7月-2019年1月于笔者所在医院肺移植中心择期行肺移植手术的患者60例,采用随机数字表法将患者分为A组(n=30)与B组(n=30),A组患者予以常规护理模式干预,B组患者在此基础上接受支持性心理护理干预,比较两组干预效果.结果:B组干预后心理弹性优于A组,差异有统计学意义(P<0.05).B组干预后应对方式优于A组,差异有统计学意义(P<0.05).B组干预后疾病不确定感低于A组,家庭关怀度、社会功能优于A组,差异有统计学意义(P<0.05).B组干预后生活质量优于A组,差异有统计学意义(P<0.05).结论:支持性心理护理干预可有效提高肺移植患者的心理弹性,促进患者积极应对疾病,提高患者的家庭关怀度,降低患者的疾病不确定感,改善患者的社会功能及生活质量,干预效果满意,值得推荐.

总结1例妊娠合并肺动脉高压患者行剖宫取胎术、双肺移植及房缺修补术的护理经验.针对患者的护理问题做好产后肝素钠的合理使用及出血的观察、术后感染的预防控制及护理,配合医生做好药物的效果监测及护理,以及血栓后循序渐进的肺康复护理和气道狭窄护理.患者剖宫产后11 d行双肺移植及房间隔缺损修补术,术后成功撤去体外膜肺氧合和呼吸机,转普通病房继续康复治疗后顺利出院.

目的 分析针对性护理对肺纤维化患者身心健康的影响.方法 选择医院收治的肺纤维化患者64例,采用随机数字表法分为观察组和对照组,每组32例.观察组采取针对性护理模式干预,对照组采取基础护理模式干预,比较2组干预前后希望水平评分、肺功能指标、生活质量SGRQ问卷评分、幸福感量表评分.结果 干预后,2组积极态度、积极行动、与他人保持亲密关系评分较干预前均升高,且观察组升高幅度大于对照组(P<0.05);2组各项肺功能指标[最大呼气中段量(MMF)、肺活量(VC)、肺总量(TLC)、第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、一氧化碳弥散量(DLco)]较干预前均改善,且观察组改善情况优于对照组(P<0.05);2组呼吸症状、活状况力、疾病影响评分较干预前均下降,且观察组下降幅度大于对照组(P<0.05);观察组正性体验、正性情感评分较干预前均升高,负性体验、负性情感评分较干预前均降低,且观察组升高或降低幅度大于对照组(P<0.05).结论 针对性护理模式干预可有效提高肺纤维化患者的希望水平,促进肺功能好转,改善生活质量,提高患者的幸福感,干预效果良好,值得推荐.

目的 探讨不同术式治疗先天性单纯阴茎下弯的临床效果.方法 选择2009年1月至2017年9月江西省人民医院及芦溪县人民医院收治的先天性单纯阴茎下弯患者45例,分别采用不同术式治疗.观察不同的术式治疗效果.结果 45例患者中,行单纯阴茎伸直术8例,术后患者阴茎下弯矫正满意,无阴茎下弯复发.行横裁包皮带蒂岛状皮瓣尿道成形术26例,其中25例治愈;1例复发,经Ⅱ期修复后治愈.行尿道板纵切卷管尿道成形术11例,其中1例复发,1例发生尿道狭窄,1例发生阴茎皮肤愈合延迟,8例治愈.所有患者阴茎外观满意,阴茎完全伸直,且无明显的阴茎下弯,尿道外口呈裂隙状位于阴茎龟头正位.结论 不同术式治疗先天性单纯阴茎下弯均可获得良好的效果,但先天性单纯阴茎下弯的手术治疗应结合患者的年龄、阴茎下弯的程度、包皮材料充裕情况选择个体化手术治疗方式.