Objective:To analyze the application of bronchoscopy combined with rapid on-site cytologic evaluation(C-ROSE).Methods:Retrospective study of 240 cases who were performed with bronchoscopy at the Second Affiliated Hospital of Nanjing Medical University in 2020. There were 79 cases in C-Rose group and 161 cases in non-C-Rose group. The diagnostic yield and the secondary examination rates between C-ROSE group and non C-ROSE group were also compared.Results:Compared with the gold standard, the pulmonologist′s interpretation of sample adequacy, identification of benign and malignant lesions, and diagnosis of lung cancer were all highly consistent, the Kappa value were 0.904, 0.970, 0.794 respectively. When C-ROSE was applied to bronchoscopy, the diagnostic efficacy was pretty good, the sensitivity was 100%, the specificity was 97.83%, the diagnostic accuracy was 98.61%, the positive predictive value was 96.30% and the negative predictive value was 100%. The diagnostic yield of malignant disease was statistically higher in C-ROSE group than that in non C-ROSE group(92.86% vs. 73.21%, P<0.05). There was no statistical difference between the two groups in the total diagnostic yield and the benign disease diagnostic yield. The secondary examination rate of malignant disease was statistically lower than that in non C-ROSE group(7.14% vs. 26.79%, P<0.05).Conclusion:Pulmonologists can master C-ROSE technique after short time of systematic training. A trained pulmonologist can reliably carry out C-ROSE to interpret sample adequacy, distinguish between benign and malignant lesions, help improve the diagnostic yield and reduce the secondary examination rate. C-ROSE technique is effective-cost, it worthy of wide use in most hospitals.

胆管支气管瘘是临床少见病,现回顾2018年3月南京医科大学第二附属医院收治的1例胆管支气管瘘患者的临床资料并复习相关文献,结果发现肝动脉介入栓塞及射频消融术后是肝癌患者合并胆管气管瘘的主要危险因素,其主要临床表现包括大量黄绿色痰液、不易控制的肺部感染,可伴发热、胸痛等.当肝癌患者经肝动脉介入栓塞或射频消融术后,出现咳大量黄绿色胆汁样痰,特别是咳痰量超过100 ml/d、抗感染效果不佳及无法以感染解释的大量黄绿色痰液,应考虑到胆管支气管瘘的可能;痰液或支气管镜下肺泡灌洗液、胸腔引流液胆红素测定阳性有助于该病的诊断,内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)是确诊该病的重要手段,经皮经肝胆道引流术(percutaneous transhepatic cholangial drainage,PTCD)及膈肌修补术是该病的重要治疗方法,而胆道支架置入或单纯胸腔闭式引流亦可作为一般状况欠佳患者的治疗选择.

Objective To compare the clinical efficacy of conservative treatment and bronchial arterial embolization for massive hemoptysis in lung cancer .Methods A retrospective analysis of clinical data of 70 cases of lung cancer with massive he-moptysis was conducted .25 patients received conservative treatment ,45 cases was given bronchial arterial embolization with poly-vinyl alcohol particles ,gelatin sponge particles or in combination with steel coils .All patients were followed up for 2~12 months, the curative effects and the recurrence rates of the 2 groups were evaluated .Results Among 45 patients with massive hemoptysis in lung cancer,left bronchial artery embolization was 15 cases,right bronchial artery embolization was 17 cases,left and right bronchial artery embolization was 13 cases.Cure rate of conservative treatment was 32.0%,18 cases had recurrence ,the recur-rence rate was 72.0%;cure rate of bronchial arterial embolization was 82.2%,5 cases had recurrence,the recurrence rate was 11.1%;gelfoam particles embolization ,polyvinyl alcohol particles and gelfoam particles combined spring steel double emboliza-tion,double embolization combined spring steel double embolization had no serious adverse reactions .Conclusion Clinical effect of bronchial artery embolization in the treatment of lung cancer with massive hemoptysis is effective ,it can reduce mortality and complications ,and it is worthy of popularization and application in clinic .

目的 评估南京某三甲医院社区获得性肺炎(CAP)住院患者抗菌药物应用的合理性.方法 抽取该院呼吸内科2013年1月-2015年3月CAP患者住院病例116份,对其抗菌药物应用情况进行统计分析,以药物利用指数(DUI)作为分析判断指标.结果 DUI为0.9-1.1品种有6种,DUI小于0.9的品种有2种,DUI大于1.1的品种有2种;平均每人使用2.94种抗菌药物,每日抗菌药物费用为384.43元.结论 该院CAP患者抗菌药物应用基本合理、有效.

OBJECTIVE To investigate the distribution and drug resistance of pathogenic bacteria causing lower respiratory tract infections in intensive care unit(ICU),and provide evidence for the control of lower respiratory tract infections in the clinical departments,especially the ICU.METHODS The results of the bacterial culture of sputum specimens and the drug susceptibility testing were analyzed retrospectively VTTEK-2 Compacl automatic bacteria analyzer was employed to identify the bacteria isolated from the qualified sputum specimens,and the dray susceptibility tesing was performed by K-B methoclg,the result was judged accorcling to CLSI 2010.RESULTS A total of 555 strains of pathogenic bacteria were isolated,including the gram-negative bacteria(67.6%),gram-positive bacteria(18.7%),and fungi(13.7%).Among the gram-negative bacteria,Pseudomonas aeruginosa,Acinetobacter baumanii,Klebsiella pneumonia,and Serratia marcescens were the most common,accounting for 17.3%,11.9%,10.3%,and 6.1% respectively.Staphylococcus aureus was dominant in the gram-positive bacteria,accounting for 8.6%.Candida albicans was the main species of fungi,accounting for 10.5%.The majority of the gram-negative bacteria were multi-drug resistant or pandrug-resistant,and MRNCSA and MRSA were the common species of the gram-positive bacteria.The drug resistance rates of the gram-positive cocci to vancomycin,teicoplanin,quinupristin-dalfopristin,and fusidic acid were relatively low.CONCLUSION The non-fermenting bacteria,Enterobacteriaceae,MRNCSA,and MRSA are the most common species of pathogens causing lower respiratory tract infections in the hospitalized patient in ICU and are highly drug resistant.It is necessary to intensify the monitoring of the distribution and drug resistance of the pathogens causing lower respiratory tract infections in ICU patients.

Purose The study was designed to describe a modified technique,cobmined with mitomycin C(MMC) straight scleral tunnel incision-trabeculectomy with releasable suture and evaluate its efficacy and complications in the patients with primary angle-closure glaucoma(PACG).Methods Group A 128 eyes of 98 consecutive patients underwent straight scleral tunnel insicion-trabeculectomy with one releasable suture supplemented with MMC,Group B 95 eyes of 71 consecutive patients underwent releasable suture trabeculectomy with MMC,Group C 60 eyes of 48 consecutive patients underwent trabeculectomy with MMC,IOP,complications and surgically induced astigmatism(SIA)were evaluated preoperatively and up to 12 months postoperatively.Results The differences of complete success rate between the three groups were not significant after 12 months postoperatively.The incidence of shallow anterior chamber and hypotony were not significantly different between Group A and B.But beth were lower than that in Group C respectively.The incidence of hypertony and choroidal detachmdent were not significantly different between the three groups.The increase of mean astigmatism was not significant after 2 weeks in Group A(P=0.187,P0.05).After 12 monthes the astigmatism almost returned to preoperative levels. The increases of mean astigmatism were significant after 2 weeks in Group B and C.After 12 months the mean astigmatism in Group B and C were still more than before operation(P=0.001,P0.01).The increases of mean astigmatic polar values in three Groups were significant during early postoperative period.Then they decreased gradually.Conclusion Straight scleral tunnel insicion-trabeculectomy with one releasable suture supplemented with MMC appears to be equivalent to releasable suture trabeculcctomy with MMC and trabeculectomy with MMC in lowering the IOP of patients with PACG.But its SIA was lowerest in the three groups.SIA in the three groups showed with-the-rule change and followed against-the-rule astigmatic shift up to 12 months postoperatively.Using releasable suture technique can reduce the incidence of complications during the early postoperative period.

目的:探讨带窗自体巩膜包裹HA植入术后的临床效果.方法:对12例眼球摘除术患者Ⅰ期植入带窗自体巩膜包裹HA,术后随访3～6个月.结果:12例患者无一例眼台暴露,安装义眼后,外观效果好.结论:用带窗自体巩膜包裹HA植入术后效果好,并发症少.