Objective:To summarize the clinical characteristics and management experience of complications in patients with cervical necrotizing fasciitis （CNF） with or without descending necrotizing mediastinitis （DNM）, in order to provide a basis for optimizing diagnosis and treatment strategies. Methods:A retrospective analysis was conducted on the clinical data of 31 patients diagnosed with CNF and DNM at Shandong Provincial Hospital Affiliated to Shandong First Medical University between October 2019 and March 2024. A comprehensive evaluation was performed based on the patients' clinical characteristics, metagenomic next-generation sequencing （mNGS） pathogen detection results, imaging assessments, surgical interventions, management approaches for specific complications, and prognostic outcomes. Results:Among the 31 patients, 10 had severe diabetes mellitus. Etiological analysis was summarized as follows: 5 cases were odontogenic, 3 were of tonsillar origin, 3 were due to endogenous esophageal injury, 2 were due to exogenous cervical trauma, 2 originated from a congenital branchial cleft fistula, and 16 cases had an unknown etiology. Among them, 29 patients underwent surgery via an external cervical approach, 1 patient underwent surgery via an intraoral approach, and 1 patient received ultrasound-guided puncture and drainage therapy. Ultimately, 29 patients were cured and discharged （including 1 patient who experienced two instances of major neck vessel rupture and successfully underwent two interventional embolization procedures for hemostasis）; 2 patients died after failed rescue efforts due to concurrent sepsis and multiple organ dysfunction. The treatment success rate was 93%, and the mortality rate was 7%. In this cohort of CNF and DNM cases, only a minority had a clearly identified odontogenic cause; although the etiology was unknown in most cases, imaging consistently showed oropharyngeal lymph node necrosis, suggesting a possible pharyngeal origin of infection in adults. The mNGS pathogen profile was predominantly Gram-positive bacteria, accompanied by anaerobic bacilli and fungi. Conclusion:CNF and DNM are severe and rapidly progressive conditions that can lead to life-threatening complications within hours. Timely recognition can reduce unnecessary examinations and expedite treatment.
Humans ; Retrospective Studies ; Fasciitis, Necrotizing/therapy* ; Mediastinitis/complications* ; Neck/pathology* ; Male ; Female ; Middle Aged ; Adult ; Aged ; Prognosis

Objective:To explore the clinical features and prognostic factors of lymphoma-associated hemophagocytic lymphohistiocytosis (LAHS).Methods:A retrospective cohort study was conducted. The clinical data of 44 LAHS patients who diagnosed at the Second Hospital of Shanxi Medical University from September 2016 to September 2022 were retrospectively analyzed. All patients were divided into B cell LAHS (B-LAHS) group (19 cases) and NK/T cell LAHS (NK/T-LAHS) group (19 cases) according to the lymphoma types, except for 4 cases of classic Hodgkin lymphomas and 2 cases of splenic lymphoma lymphomas. The clinical features and the factors influencing the prognosis of both groups were compared. According to whether lymphoma treatment were included in the initial treatment regimen, the patients were divided into the group with lymphoma treatment and the group without lymphoma treatment, and the objective response rate (ORR) of both groups was compared. Kaplan-Meier method was used to analyze the overall survival (OS), the log-rank method was used for univariate analysis, and the Cox proportional hazards model was used for multivariate analysis.Results:Among 44 LAHS patients, 26 cases were male and 18 cases were female, with the age of (69±7) years. Most of them were secondary to diffuse large B-cell lymphoma (DLBCL), and 17 out of 44 patients were secondary to DLBCL. All patients had fever, lymphadenopathy, and ferritinemia. The differences in red blood cells (RBC), hemoglobin (Hb), activated partial thromboplastin time (APTT), peripheral blood Epstein-Barr virus DNA (EBV DNA) load, positive rate of Epstein-Barr virus-encoded small RNA (EBER) in tissues, triglycerides (TG), aspartate aminotransferase (AST) and fibrinogen between NK/T-LAHS patients and B-LAHS patients were statistically significant (all P<0.05). The ORR of 44 patients with LAHS was 52.3% (23/44); the median OS time of LAHS patients was 157 d, and that of NK/T-LAHS patients was 110 d; the median OS time of B-LAHS was 135 d; and the difference was statistically significant ( χ2 = 7.47, P = 0.024). The median OS was not reached in patients receiving initial treatment regimen containing lymphoma, while the median OS time was 65 d in patients receiving treatment without containing lymphoma, and the difference was statistically significant ( χ2 = 3.97, P = 0.046). The results of multivariate Cox proportional hazards model showed that age ≥ 70 years ( HR = 2.502, 95% CI: 1.047-5.978, P = 0.039), serum ferritin (SF) ≥ 1 500 μg/L( HR=0.521,95% CI:0.282~0.960, P=0.037), soluble CD25 ≥ 7 800 U/ml ( HR = 0.536, 95% CI: 0.348-0.828, P = 0.005), interleukin (IL)-10≥100 ng/L ( HR = 0.532, 95% CI: 0.33-0.85, P = 0.009), interferon (IFN)-γ≥5.0 ng/ L ( HR = 0.554, 95% CI: 0.32-0.95, P = 0.033), Th (CD3 + CD4 + T cells)/ Ts (CD3 + CD8 + T cells) < 2 ( HR = 1.731, 95% CI: 1.005-2.982, P = 0.048), and hepatomegaly ( HR = 2.581, 95% CI: 1.059-6.289, P = 0.037) were independent factors influencing the poor outcome of LAHS patients. Conclusions:LAHS is mostly secondary to DLBCL. The early clinical manifestations lack specificity and the prognosis is generally poor, and the worst prognosis occurs in patient with NK/T-LAHS. The initial treatment with lymphoma can prolong OS time in patients with LAHS.

Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.

Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.

Objective:To explore the clinical features and prognostic factors of lymphoma-associated hemophagocytic lymphohistiocytosis (LAHS).Methods:A retrospective cohort study was conducted. The clinical data of 44 LAHS patients who diagnosed at the Second Hospital of Shanxi Medical University from September 2016 to September 2022 were retrospectively analyzed. All patients were divided into B cell LAHS (B-LAHS) group (19 cases) and NK/T cell LAHS (NK/T-LAHS) group (19 cases) according to the lymphoma types, except for 4 cases of classic Hodgkin lymphomas and 2 cases of splenic lymphoma lymphomas. The clinical features and the factors influencing the prognosis of both groups were compared. According to whether lymphoma treatment were included in the initial treatment regimen, the patients were divided into the group with lymphoma treatment and the group without lymphoma treatment, and the objective response rate (ORR) of both groups was compared. Kaplan-Meier method was used to analyze the overall survival (OS), the log-rank method was used for univariate analysis, and the Cox proportional hazards model was used for multivariate analysis.Results:Among 44 LAHS patients, 26 cases were male and 18 cases were female, with the age of (69±7) years. Most of them were secondary to diffuse large B-cell lymphoma (DLBCL), and 17 out of 44 patients were secondary to DLBCL. All patients had fever, lymphadenopathy, and ferritinemia. The differences in red blood cells (RBC), hemoglobin (Hb), activated partial thromboplastin time (APTT), peripheral blood Epstein-Barr virus DNA (EBV DNA) load, positive rate of Epstein-Barr virus-encoded small RNA (EBER) in tissues, triglycerides (TG), aspartate aminotransferase (AST) and fibrinogen between NK/T-LAHS patients and B-LAHS patients were statistically significant (all P<0.05). The ORR of 44 patients with LAHS was 52.3% (23/44); the median OS time of LAHS patients was 157 d, and that of NK/T-LAHS patients was 110 d; the median OS time of B-LAHS was 135 d; and the difference was statistically significant ( χ2 = 7.47, P = 0.024). The median OS was not reached in patients receiving initial treatment regimen containing lymphoma, while the median OS time was 65 d in patients receiving treatment without containing lymphoma, and the difference was statistically significant ( χ2 = 3.97, P = 0.046). The results of multivariate Cox proportional hazards model showed that age ≥ 70 years ( HR = 2.502, 95% CI: 1.047-5.978, P = 0.039), serum ferritin (SF) ≥ 1 500 μg/L( HR=0.521,95% CI:0.282~0.960, P=0.037), soluble CD25 ≥ 7 800 U/ml ( HR = 0.536, 95% CI: 0.348-0.828, P = 0.005), interleukin (IL)-10≥100 ng/L ( HR = 0.532, 95% CI: 0.33-0.85, P = 0.009), interferon (IFN)-γ≥5.0 ng/ L ( HR = 0.554, 95% CI: 0.32-0.95, P = 0.033), Th (CD3 + CD4 + T cells)/ Ts (CD3 + CD8 + T cells) < 2 ( HR = 1.731, 95% CI: 1.005-2.982, P = 0.048), and hepatomegaly ( HR = 2.581, 95% CI: 1.059-6.289, P = 0.037) were independent factors influencing the poor outcome of LAHS patients. Conclusions:LAHS is mostly secondary to DLBCL. The early clinical manifestations lack specificity and the prognosis is generally poor, and the worst prognosis occurs in patient with NK/T-LAHS. The initial treatment with lymphoma can prolong OS time in patients with LAHS.

Objective:To investigate the value of 18F-FDG PET/CT imaging signs and metabolic parameters in predicting tumor spread through air spaces (STAS) of stage Ⅰ lung adenocarcinoma. Methods:From January 2019 to December 2021, clinical, imaging and metabolic parameters of 381 patients (126 males, 255 females, age (61.2±9.2) years) with stage Ⅰ lung adenocarcinoma were retrospectively analyzed in the Affiliated Hospital of Qingdao University. According to the postoperative pathological results, patients were divided into STAS positive group and STAS negative group. According to the operation time, patients were divided into training set ( n=254) and verification set ( n=127). χ2 test or Mann-Whitney U test was used to compare the differences of different parameters between patients with STAS positive and negative, and binary logistic regression analysis was used to select the predictors of STAS status. The prediction model was established, and ROC curve was used to evaluate the predictive efficacy. Results:There were 49(19.3%, 49/254) patients with STAS positive and 205(80.7%, 205/254) patients with STAS negative in the training set, while those were 35(27.6%, 35/127) and 92(72.4%, 92/127) in the verification set. In the training set, the differences of age ( z=-2.30, P=0.021), type of lesions ( χ2=6.81, P=0.009), spiculation ( χ2=12.64, P<0.001), bronchus truncation ( χ2=6.98, P=0.008), ground glass ribbon sign ( χ2=26.93, P<0.001) and SUV max ( z=-4.62, P<0.001) between the two groups were statistically significant. Multivariate logistic regression analysis showed that age (odds ratio ( OR)=1.048, 95% CI: 1.004-1.094, P=0.032), ground glass ribbon sign ( OR=3.857, 95% CI: 1.693-8.788, P=0.001) and SUV max ( OR=1.133, 95% CI: 1.001-1.282, P=0.049) were independent predictors of STAS status in stage Ⅰ lung adenocarcinoma patients. The logistic regression model was P=1/(1+ e - x), x=-5.292+ 0.480×age (year)+ 1.493×ground glass ribbon sign+ 0.170×SUV max. The AUCs of the model in the training set and verification set were 0.770 and 0.801, with the sensitivity of 81.6%(40/49) and 82.9%(29/35), and the specificity of 69.8%(143/205) and 65.2%(60/92), respectively. Conclusion:Age, ground glass ribbon sign and SUV max have good predictive effects on the occurrence of STAS in stage Ⅰ lung adenocarcinoma.

Objective:To explore the effect of mindfulness therapy on self burden, hope and sleep of middle-aged bladder cancer patients undergoing bladder sparing chemotherapy.Methods:Sixty patients with bladder cancer treated by intravesical instillation chemotherapy with bladder preservation from January 2018 to December 2019 were selected as the study subjects. They were divided into control group and intervention group according to the sequence of chemotherapy time, with 30 cases in each group. Both groups received routine nursing and rehabilitation training in urology, and mindfulness therapy was added to the intervention group for 6 weeks. Before and 6 weeks after the intervention, the sleeping and mental status of the two groups were compared by the Self-Burden Feeling Scale (SPBS), Herth Hope Scale (HHI) and Insomnia Severity Index Scale (lSI).Results:There was no significant difference in SPBS, HHI and ISI scores between the two groups before intervention ( P > 0.05). After 6 weeks of intervention, SPBS score of patients in the intervention group was 47.00±1.41, and that of the control group was 49.50±0.62.After 6 weeks of intervention, the total score of HHI was 32.61±1.94 in the intervention group and 27.22±2.67 in the control group.After 6 weeks of intervention, ISI score of patients in the intervention group was 19.17± 1.72, and that of the control group was 20.67±2.24. The difference between the two groups was statistically significant ( t values were 6.454, -7.042, 2.097, P < 0.01 or 0.05). Conclusions:Mindfulness therapy can effectively improve insomnia and cancer emotional problems in patients with bladder cancer who underwent bladder preservation and perfusion.

Objective To evaluate the efficacy of automated medication management system in increasing clinical anesthesia management specification.Methods Sixty registered anesthesiologists of both sexes in our hospital,residents or attending physicians,with 1-10 yr of work experience,were divided into 2 groups (n =30 each) using a random number table:traditional medication management mode group (group T) and automated medication management system group (group A).In the clinical anesthesia work,traditional artificial management mode was used in group T,the mode of automated medication management system was used in group A,and 2 licensed pharmacists worked in the center pharmacy of our hospital were introduced for each group.Time of taking medicine was recorded by licensed pharmacists,and the error rates of taking medicine and recording were determined by licensed pharmacists.Results Compared with group T,the error rates of taking medicine and recording were significantly decreased (P＜0.01),and no significant change was found in the time of taking medicine in group A (P＞0.05).Medication errors including taking wrong anesthesia drug,wrong prescription recording,wrong names of the common drugs and drug omission were not detected in group A.Conclusion Application of automated medication management system can reduce the occurrence of errors made in taking medicine and recording,specify medication management and increase the quality of clinical anesthesia management.