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.
随着我国社会老龄化及医药卫生体制改革的不断深入,药学工作人员致力于提供以患者为中心、高效科学的药学服务,连续性药学服务成为药学领域学者研究的焦点.本文采用文献研究法,对连续性药学服务的概念、重要性、维度和评价指标、国内外发展现状等进行综述,并提出发展建议.连续性药学服务在一些发达国家已发展成熟,在我国起步较晚,急需探索与开发适合于我国医疗卫生服务体系的评价指标.我国连续性药学服务主要是以医联体内综合医疗机构与基层医疗机构间协调合作为基础,根据患者个体情况,实现医疗机构间有序双向转诊,为患者在疾病预防、治疗期间及治疗后提供个体化药物治疗管理.建议同质化不同层级医疗机构的药学服务水平,推进政府、医保、上级医疗机构等多方合作,以提升基层医疗机构的药学服务水平,加快连续性药学服务体系的建设.
T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT), an emerging immune checkpoint, plays an immunosuppression role in multiple steps of cancer immune cycle mainly by feat of immune regulation on T cells and natural killer cells.TIGIT is highly expressed in lung cancer, and it is normally associated with poor prognosis.Accordingly, targeting TIGIT immunotherapy may have great clinical significance, and the up-to-date research progress of TIGIT in lung cancer is reviewed in the paper.
