Objective:To explore the diagnosis and treatment strategy of emphysematous pyelonephritis (EPN).Methods:The clinical data of 11 cases patients with EPN admitted to 3 hospitals from March 2016 to June 2022 were retrospectively analyzed, among them, 4 cases from Qianhai Shekou Free Trade Zone Hospital, 5 cases from the Second Hospital Affiliated to Kunming Medical University, 2 cases from the Second Affiliated Hospital of Hubei University of Scinece and Technology. Among the 11 patients, 2 were males and 9 were females, aged 50-82 years; the lesions were located on the left side in 6 cases, right side in 4 cases and bilateral in 1 case; all patients had type 2 diabetes and poor glycemic control. The clinical manifestations at admission including back pain in 8 cases, fever in 11 cases, nausea and vomiting in 5 cases, disturbance of consciousness in 3 cases, septic shock in 3 cases, accompanied with ureteral or kidney stones in 5 cases. The pathogenic bacteria were Escherichia coli in 8 cases, Klebsiella pneumoniae in 2 cases and Proteus mirabilis in 1 case. All patients received minimally invasive surgery, anti-infection, subcutaneous injection of insulin, fluid rehydration and nutritional support after admission. 2 cases had a combination of an initial ureteral stenting and second stage percutaneous drainage, 3 patients underwent ureteral stent implantation, 6 patients underwent percutaneous drainage. According to the CT classification of EPN, there were 1 case of type Ⅰ, 3 cases of type Ⅱ, 2 cases of type ⅢA, 4 cases of type ⅢB, and 1 case of type Ⅳ. Results:All 11 cases were cured, 4 cases were admitted to intensive care unit for 2-7 days, 1 case underwent nephrectomy during hospitalization, and 1 case underwent nephrectomy due to renal atrophy during follow-up. After 12 to 18 months of follow-up with urinary CT or B-ultrasound, there were no recurrence cases.Conclusions:EPN is a rare and serious renal parenchymal necrotic infection. Early urinary CT examination is necessary for the diagnosis, and positive minimally invasive surgery combined with comprehensive medical treatment is the preferred treatment strategy. If those above treatment does not work, nephrectomy should be performed.

Objective To explore the relationship between cognitive function and sleep disturb-ance,depression and anxiety. Methods Totally 333 medical staff were investigated using the repetitive neu-ropsychological status questionnaire (RBANS),the Pittsburgh sleep quality index ( PSQI),the depression self-rating scale (SDS) and the anxiety self-rating scale ( SAS). Results ①The difference of visual span in gender(male:(81. 87±13. 48) vs female:(77. 12± 13. 09)) was statistically significant ( t=2. 928,P<0. 05).②Differences in immediate memory,language function,attention function and total score of RBANS among patients of different ages were statistically significant ( F=9. 654,8. 370,11. 465,11. 112, all P<0. 01).③There were significant differences in the RBANS,immediate memory,visual span,attention function and delayed memory between doctor and nurse(t=5. 374,4. 730,3. 389,4. 359,5. 675,all P<0. 01).④There were significant differences in the RBANS,immediate memory,and delayed memory between different PSQI levels ( F=3. 475,4. 892,4. 087, all P<0. 05). ⑤There were significant differences in RBANS ((88. 87±12. 47) vs (83. 69±13. 03)),immediate memory ((86. 18±16. 09) vs (80. 56±15. 38)),visual span ((79. 39±13. 32) vs (73. 47±12. 46)),and delayed memory ((89. 03±10. 26) vs (85. 49±11. 41)) between the depressive symptoms and not depressive symptoms groups( t=2. 794,2. 380,3. 042,2. 295,all P<0. 05) .⑥The total score of medical staff's RBANS was significantly negatively correlated with their PSQI,SDS and SAS scores (r=-0. 158,-0. 233,-0. 117,all P<0. 05).⑦SDS,age,occupation,education, time of sleep and PSQI entered multiple stepwise regression equations,which explain 39. 9% variation in cog-nitive function of medical staff. Conclusion The cognitive function of medical staff is affected by gender, age,occupation,education,depression,and sleep disturbance. The worse the sleep quality,the higher the de-gree of depression and anxiety,and the poorer the cognitive function.