Objective To investigate the reasons of tracheobronchial tuberculosis misdiagnosis and its clinical charac?teristics as well as the diagnostic value of bronchoscope. Methods Clinical data of 92 cases of misdiagnosis of tracheobron?chial tuberculosis by electronic bronchoscopy in our department from January 2006 to January 2012 were analyzed retrospec?tively. Bronchoscopy, endoscopic biopsy, brushing, lavage and radiological images were all compared. Results Clinical symptoms and laboratory tests showed no specificity in diagnostic value;Chest X-ray was not typical. Bronchial stenosis was seen in 45 cases(48.9%)and bronchial obstruction was seen in 6 cases(6.5%)as shown in chest CT while no abnormality in the bronchus was seen in 41 cases(44.6%). Bronchoscopy revealed 28 cases (30.4%) of inflammatory infiltration, 14 cas?es (15.2%) of necrotizing ulceration, 35 cases (38.0%) of granulation hyperplasia and 15 cases (16.3%) of Scar stricture. En?doscopic biopsy confirmed 56 cases (60.9%), while bronchoscopic brushing and examination of acid-fast bacillus approved 32 cases (34.8%). Then, bronchoscopic lavage of acid-fast bacillus verified 39 cases (42.4%). Lastly, tuberculosis bacterium culture ascertained 75 cases (81.5%). Conclusion Bronchoscopy of local lesion with brush, lavage and biopsy is the most sensitive and specific diagnostic method to diagnose tracheobronchial tuberculosis. It has great clinical value in preventing tracheobronchial tuberculosis misdiagnosis.

Objective To explore the features of ambulatory blood pressure in patients with primary glomerular disease and their correlation with target organ damage (TOD).Methods Patients with primary glomerular disease admitted to the Nephrology Department,the Third Affiliated Hospital of Sun Yat-sen University from May 2010 to May 2015 were enrolled.Ambulatory blood pressure monitoring (ABPM),clinical BP,ultrasonographic assessment and other clinical data were collected.Univariate and multivariate analyses were used to ascertain the relationship between ABPM results and clinical parameters.Results 808 patients were enrolled.Patients turned out to have a higher level of 24-hour systolic blood pressure (SBP),day-time SBP,and night-time SBP as their kidney function declined (r,=0.547,0.538,0.546,P ＜ 0.01).Compared with that in CKD 1-3,The percentage of dipper blood pressure pattern decreased and that of reversed dipper blood pressure pattern increased in CKD stage 4-5 (P ＜ 0.05).A higher level of 24 h SBP was independently associated with kidney function damage (OR=1.069,P ＜ 0.01),and a higher level of night-time SBP was an independent factor affecting left ventricular hypertrophy (OR=1.033,P ＜ 0.01) and reduction of diastolic function of left ventricle (OR=1.019,P ＜ 0.01) after multivariate logistic regression analyses.Conclusion With advancing CKD stage,the level of 24 h SBP,day-time SBP,and night-time SBP was higher and the percentage of reversed dipper blood pressure pattern was higher.The parameters of ABPM were closely related to renal damage and cardiovascular injuries.

Objective To explore the teaching effects of Lecture Based Learning (LBL) incorporated with Case Based Learning (CBL) and Problem Based Learning (PBL) methods in the teach-ing of anatomy.Methods 740 students of Grades 2012 and 2013 from clinical medical major were chosen as the subjects,randomly divided into experimental and control groups.LBL was conducted in the control group of 644 students,while LBL+PBL+CBL method was applied in the experimental group of 96 students.After completion of the course,all students were surveyed with the questionnaire and tested with specimen and theoretical examinations.The data was collected and analyzed with SPSS 17.0 and two sample U tests.Results The students' time of learning anatomy in the control group outside classroom teaching was (105 ± 25) minutes per week,while the students' time of learning anatomy in the experimental group was (190 ± 25) minutes per week.The difference was statistically significant (t=31.08,P=0.000).The difference of after-class total learn-ing time was also statistically significant between two groups(t=27.42,P=0.000).Percentages of satisfaction with teaching methods for control group were 87.5％ and 87％,while for the experimental group 98％ and 100％.Kruskal-Wallis test showed there were significant differences in experimental groups of grades 2012(x2=31.19,P=0.000) and 2013 (x2=40.35,P=0.000) compared with control group.Comparison of both groups' results of the examinations was statistically significant concerning multiple choices,essays and case analysis questions (P＜0.05).Conclusion Teaching method of LBL incorporated with PBL and CBL was significantly effective than that of the sole traditional LBL method,which indicated its practice value.

Objective To evaluate the control status and knowledge level about disease in asthmatic patients in region level cities of Shaanxi province for effect appraisal of patient education.Methods Eight hospitals were selected from six region level cities, where questionnaire survey was completed in out-patients with asthma (≥ 14 years old).Results A total of 523 patients completed the questionnaire with a ratio of male to female of 1: 1.14,and an average age of (44.3±15.5) years old.The percentage of controlled, partly controlled and uncontrolled by self-evaluation was respectively 26.4%, 52.4% and 11.1%.48% insisted on using inhaled corticosteroids (ICS).The average score was 17.88±4.43 by asthma control test (ACT).The first three medicines used daily were ICS (26.6%), sustained-release theophyline (25.2%) and combination ICS/long-acting β2-agonists (21.8%).12.6% had no medicine and 5.2% used non-orthodox medicines.68.6% patients had omen before exacerbation, and those were sneezing, chest distress and cough.73.6% knew asthma is a disease of airway inilammatian,and 33.3% selected ICS as the leader medicine.Only 32.1% attended the lecture about asthma in hospitals and 85.0% longed for such education.Conclusions The control status and knowledge level about disease in asthmatic patients in cities still need to be improved in Shaanxi province, and too much work need to be done in order to realize the total control in all patients.

Objective:To search, evaluate and summarize the best research evidence of perioperative intestinal management in patients with cervical spinal cord injury, so as to provide evidence-based basis for clinical nursing practice.Methods:Literature on perioperative intestinal management of cervical spinal cord injury were systematically searched in databases, domestic and foreign relevant guidlines network and professional associations, such as UpToDate, Cochrane Library, PubMed, China National Knowledge Infrastructure, Wanfang Database, etc. The search period was from the establishment of the databases to October 1, 2023. The quality of the included literature was evaluated and the evidence was extracted and summarized.Results:Finally, 9 articles were included, including 2 guidelines, 2 expert consensuses, 1 randomized controlled trials, and 4 observational studies. Twenty-five pieces of evidence were summarized across six aspects: assessment, diet management, physical activity, physical therapy, drug therapy, prevention and management of intestinal complications.Conclusions:The best evidence of perioperative intestinal management in patients with cervical spinal cord injury summarized in this study can provide reference for clinical nursing practice.

Objective:To evaluate the clinical efficacy and safety of using the F4.8 Visual Puncture Micro-percutaneous nephrolithotomy to treat the female distal calculi associated with stricture.Methods:From June 2017 to December 2019, 32 female patients with distal ureteric calculi associated with stricture, aged(35.0±10.3) years ( range from 16 to 75 years)old, were enrolled into this retrospective study. They were diagnosed by colour doppler ultrasound, IVU(intravenous Urography), or CT, et al. The average stone size was (13.0±3.6)mm in diameter(range from 3 to 20 mm), and the stone obstruction duration was from 2 to 35 days, with average of(5±17) days. Twenty-seven cases were on the unilateral ureter and 5 cases were on the bilateral ureters. There were 17 cases undergoing ESWL 2 weeks before. Six cases of stone diameter less than 6 mm were administered medical therapy for more than 7 days. All the 32 case underwent ureteroscopic lithotripsy but failed because of the ureter stricture. They all suffered from hydronephrosis, with the diameter of renal collecting system from 15 to 45 mm, with(23±15)mm on average. The lithotomy position was taken, and the F4.8 Visual Micro-percutaneous nephrolithotomy using 0.9% Sodium chloride was applied to enter into ureter through urethra. There were 21 cases of ureter orifice stricture, including 8 cases associated with avulsion or perforation, 9 cases associated with intramural ureter abnormality and stricture, the zebra guidewire being failed to enter. The F4.8 Visual Micro-percutaneous nephrolithotomy cooperated with water pressure modulation was used to flush and open the ureter orifice and intramural ureter for entering. Holmium lase was used for lithotripsy. Two cases stone were infective and obstructed seriously. F4.8 Visual Micro-percutaneous nephrolithotriptor entered the ureter and destroyed the stones, and the stone fragments were discharged. Stone migrated upward and escaped occurred in 1 case, then the zebra guidewire was indwelled and ureteroscope was used for lithotripsy successfully. All cases were indewelled F4.7 doubld-J tube and urethral catheter after operation.Result:All the 32 patients underwent lithotripsy successful by one-stage. The operation time was 15-43 min [averaged (35.0±8.7)min]. All patients were recovered and discharged 4-7(averaged 5.3) days after operation. Three patients occured fever, T>38.5℃, and they recovered by using sensitive antibiotics according to the blood and urine culture. No severe complications occurred, such as ureteral perforation or extravasation. All patients were reviewed by ultrasound and KUB 3 days after operation, finding 24 cases with stone free, and 8 cases of a little residual stone, with the stone free rate of 75%. One month later, ultrasound and IVU was performed, and no residual stone was detected, with the stone free rate of 100%. The hydronephrosis alleviated by varying degrees. The diameter of the renal collecting system was from 0 to 35 mm, with(12±9)mm on average. The IVU showed the ureter was unobstructed. Conclusions:The F4.8 Visual Micro-percutaneous nephrolithotomy is safe and effective for the female distal calculi associated with stricture, when routine ureteroscopic lithotripsy failed.

Objective:To evaluate the potential differential diagnostic value of QuantiFERON-TB Gold Plus(QFT-Plus) in patients with active tuberculosis (ATB) and latent tuberculosis infection (LTBI) people.Methods:Case-control study. A total of 108 healthcare workers and 30 ATB patients in Xi′an Chest Hospital were tested by QFT-Plus from April to November 2019, and the demographic characteristics were analyzed.Then, flow cytometry was used to analyze the relations between the QFT-Plus TB2-TB1 and the distribution of peripheral blood T lymphocyte subsets in ATB patients with positive culture results.Finally, with 34 QFT-Plus positive volunteers as LTBI group and 30 bacteriologically confirmed ATB patients as ATB group, the QFT-Plus new lyadded antigen and its potential differential diagnostic value between LTBI and ATB groups was evaluated by using the receiver operating curve (ROC).Results:In patients with ATB,QFT-plus TB2-TB1 was positively correlated with the proportion of CD8+T cells in peripheral blood T lymphocytes( r=0.586, P=0.004), negatively correlated with the proportion of CD4+ T cells( r=-0.511, P=0.015) and the ratio of CD4/CD8 ( r=-0.520, P=0.013).The peripheral blood TB2-TB1 in the ATB patients was significantly higher than that in the LTBI group[0.47(0.12,1.17) IU/ml versus 0.01(-0.08,0.22) IU/ml, U=233.5, P<0.001]. QFT-Plus TB2-TB1 can effectively distinguish ATB from LTBI, with an area under the ROC curve of 0.771 (95 %CI=0.653-0.889, P<0.001). Conclusion:QFT-Plus specific CD8 response (TB2-TB1) has the potential value to identify ATB from LTBI people.

This study aims to evaluate the accuracy of portable hemoglobinometer (Hemocue Hb 201+ hemoglobin analyzer) in patients with maintenance hemodialysis (MHD) and its diagnostic value for anemia. The data of venous hemoglobulin (Hb) and fingertip capillary hemoglobulin (DHb) in MHD patients from Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed, and the correlation and difference between DHb and Hb and the accuracy of DHb in the diagnosis of anemia were evaluated. A total of 105 patients were included in the study. There was no significant difference between the paired DHb and Hb [(109±21) g/L vs. (108±20) g/L, t=-1.284, P=0.202]. Pearson correlation analysis showed that DHb was positively correlated with Hb ( r=0.929, P<0.001). Linear regression analysis showed that DHb and Hb met the regression equation Hb=0.88×DHb+12.23, and P<0.001. Bland-Altman analysis showed that the differences between the paired DHb and Hb was (1.0±7.8) g/L with the limit of agreement as (-14.2, 16.2) g/L. The mean percentage of the differences in Hb was 1% with limit of agreement as (-13.7%, 15.7%). A DHb of >110 g/L was 0.90 sensitive and 0.83 specific to identify patients with an Hb >110 g/L and its positive and negative predictive values were 0.84 and 0.90, respectively. It suggests that, in MHD patients, Hemocue Hb 201+ analyzer shows good accuracy, and can be used to monitor the Hb trend and serve as a screen method for those reaching target Hb.

Clopidogrel was believed to be superior to aspirin by the well-known CAPRIE trial. However, no other large clinical trials demonstrated the same results, but all focused on the combina-tion use of clopidogrel with aspirin, and combination therapy in CREDO was called the "Emperor's New Clothes". However, no one overturned the results of these clinical trials by quantitatively ana-lyzing them. We reviewed ten large-scale clinical trials about clopidogrel. On the basis of results of CAPRIE, CREDO and CHARISMA trials, we re-estimated their minimal sample sizes and their powers by three well-established statistical methodologies. From the results of CAPRIE, we inferred that the minimal sample size should be 85 086 or 84 968 but its power was only 30.70%. A huge gap existed. The same was also true of CREDO and CHARISMA trials. Moreover, in CAPRIE trial, 0 was included in the 95% confidence interval and 1 was included in the 95% confidence interval for the relative risk. There were some paradoxical data in CAPRIE trial. We are led to conclude that the results in CAPRIE, CREDO, and from the subgroup analysis in CHARISMA trials were questionable. These results failed to demonstrate that clopidogrel was superior to aspirin or that clopidogrel used in combination with aspirin was better than aspirin alone. The cost-effectiveness analyses by some pre-vious studies were not reliable.

Objective: To analyze application fields of 5G communication technology in Corona Virus Disease 2019 (COVID-19) epidemic prevention and control, and build a 5G intelligent medical service system for COVID-19 epidemic prevention and control in China. Methods: We collected and analyzed 5G technology application cases used in the fight against COVID-19 from December 2019 to February 2020: 5G + telemedicine application cases, 5G + negative pressure ambulance cases, 5G + remote monitoring cases, 5G + artificial intelligence cases, 5G + infrared thermography temperature detection cases, 5G + big data analysis cases for epidemic prevention and control. Results: Through the analysis of 5G application cases in COVID-19 epidemic prevention and control, we found out the key elements of 5G intelligent medical service system in COVID-19 epidemic prevention and control. By optimizing and upgrading the internal service mode of the hospital, breaking the internal and external barriers, integrating internal and external resources, and strengthening 5G intelligent medical security, we can form a 5G intelligent medical service system for COVID-19 epidemic prevention and control, including application layer, technical service layer, network support layer and security system layer. Conclusion 5G communication technology has the characteristics of faster speed, shorter time delay and denser capacity. In COVID-19 epidemic prevention and control work, it can further improve the efficiency of doctors' diagnosis, improve patients' medical experience, realize the remote sharing of high-quality medical resources and real-time information exchange, effectively block the spread of epidemic, alleviate the shortage of medical resources and medical staff, and make the epidemic prevention and control more efficient.