Objective To summarize the successful experience of extracorporeal membrane oxygenation (ECMO) combined with inhaled nitric oxide (iNO) in the treatment of severe acute respiratory distress syndrome (ARDS) after empyema surgery in a morbid obesity patient,and to explore the nursing points. Methods On July 3,2023,a patient was admitted to the department of intensive care unit (ICU) of Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences),Southern Medical University following the failure of closed thoracic drainage and catheterization at another hospital. Using the rapid integration of the WeChat group,a multidisciplinary team (MDT) model was built. This approach enabled the professional and standardized integration of clinical data and the implementation of targeted treatments,significantly reducing response times and optimizing the overall nursing process. Results A 27-year-old male patient with morbid obesity was admitted to the hospital due to dyspnea and chest pain for more than 7 days. ① Treatment process:on July 4,the patient underwent video-assisted thoracic surgery (VATS),including right chest exploration,pleural adhesion release,and empyema,performed under general anesthesia. Two thoracic drainage tubes were retained and water-sealed bottles were connected. The drainage fluid was purulent. After the operation,the patient was short of breath and the condition was aggravated and transferred to ICU. On admission,the patient's bedside chest X-ray showed that more moist rales were heard in both lungs,especially on the right side. At 18:30 on July 10,the pluse oxygen saturation (SpO2) was 0.75-0.80,and fiberoptic bronchoscopy was performed immediately. The ventilator parameters were up-regulated,the position was changed,and 20 mg of furosemide injection was injected intravenously,the effect was not good. Attempted to perform prone position ventilation,SpO2 did not improve. At 21:30,the SpO2 gradually decreased to 0.60,and the extracorporeal circulation was immediately decided. After veno-venous ECMO (VV-ECMO) at 2:30 on July 11,the SpO2 was 0.90,and the blood gas was stable after multiple reexaminations. During July 12,there was still shortness of breath and poor oxygenation index. According to the MDT consultation opinion,during the emergency treatment combined with iNO treatment,oxygenation improved rapidly to 172 mmHg (1 mmHg≈0.133 kPa) and 190 mmHg after 1 hour and 2 hours,respectively. After 6 days,the oxygenation index stabilized between 222-285 mmHg. On July 17,the iNO support was gradually reduced and successfully removed. On July 21,a chest X-ray showed that the patient's lung lesions were significantly improved,and ECMO support parameters were gradually reduced until ECMO treatment was successfully discontinued. On August 3,the patient's consciousness returned to normal,and the indicators returned to normal. The ventilator-assisted breathing was stopped,and the high-flow oxygen therapy was observed after extubation. He was transferred from the ICU on August 8 and was discharged on August 15. ② Nursing points:we focus on personalized analgesia and sedation,and adjust the types and doses of sedative drugs in stages to reduce oxygen consumption and reduce complications. For the treatment of ARDS with ECMO combined with iNO to improve oxygenation,close monitoring and supportive care were carried out. Special attention was paid to the fixation of ECMO pipeline and tracheal intubation in patients with morbid obesity and individualized fine skin care was implemented. Actively prevent the potential complications of ICU acquired myasthenia,and carry out phased psychological nursing to establish rehabilitation confidence. Conclusion ECMO combined with iNO treatment requires professional teamwork,close observation,effective nursing and perfect monitoring technology to ensure the safety of patients with severe ARDS morbid obesity,reduce complications and improve prognosis,which has important reference significance for relevant medical practice.

Objective To summarize the successful experience of extracorporeal membrane oxygenation (ECMO) combined with inhaled nitric oxide (iNO) in the treatment of severe acute respiratory distress syndrome (ARDS) after empyema surgery in a morbid obesity patient,and to explore the nursing points. Methods On July 3,2023,a patient was admitted to the department of intensive care unit (ICU) of Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences),Southern Medical University following the failure of closed thoracic drainage and catheterization at another hospital. Using the rapid integration of the WeChat group,a multidisciplinary team (MDT) model was built. This approach enabled the professional and standardized integration of clinical data and the implementation of targeted treatments,significantly reducing response times and optimizing the overall nursing process. Results A 27-year-old male patient with morbid obesity was admitted to the hospital due to dyspnea and chest pain for more than 7 days. ① Treatment process:on July 4,the patient underwent video-assisted thoracic surgery (VATS),including right chest exploration,pleural adhesion release,and empyema,performed under general anesthesia. Two thoracic drainage tubes were retained and water-sealed bottles were connected. The drainage fluid was purulent. After the operation,the patient was short of breath and the condition was aggravated and transferred to ICU. On admission,the patient's bedside chest X-ray showed that more moist rales were heard in both lungs,especially on the right side. At 18:30 on July 10,the pluse oxygen saturation (SpO2) was 0.75-0.80,and fiberoptic bronchoscopy was performed immediately. The ventilator parameters were up-regulated,the position was changed,and 20 mg of furosemide injection was injected intravenously,the effect was not good. Attempted to perform prone position ventilation,SpO2 did not improve. At 21:30,the SpO2 gradually decreased to 0.60,and the extracorporeal circulation was immediately decided. After veno-venous ECMO (VV-ECMO) at 2:30 on July 11,the SpO2 was 0.90,and the blood gas was stable after multiple reexaminations. During July 12,there was still shortness of breath and poor oxygenation index. According to the MDT consultation opinion,during the emergency treatment combined with iNO treatment,oxygenation improved rapidly to 172 mmHg (1 mmHg≈0.133 kPa) and 190 mmHg after 1 hour and 2 hours,respectively. After 6 days,the oxygenation index stabilized between 222-285 mmHg. On July 17,the iNO support was gradually reduced and successfully removed. On July 21,a chest X-ray showed that the patient's lung lesions were significantly improved,and ECMO support parameters were gradually reduced until ECMO treatment was successfully discontinued. On August 3,the patient's consciousness returned to normal,and the indicators returned to normal. The ventilator-assisted breathing was stopped,and the high-flow oxygen therapy was observed after extubation. He was transferred from the ICU on August 8 and was discharged on August 15. ② Nursing points:we focus on personalized analgesia and sedation,and adjust the types and doses of sedative drugs in stages to reduce oxygen consumption and reduce complications. For the treatment of ARDS with ECMO combined with iNO to improve oxygenation,close monitoring and supportive care were carried out. Special attention was paid to the fixation of ECMO pipeline and tracheal intubation in patients with morbid obesity and individualized fine skin care was implemented. Actively prevent the potential complications of ICU acquired myasthenia,and carry out phased psychological nursing to establish rehabilitation confidence. Conclusion ECMO combined with iNO treatment requires professional teamwork,close observation,effective nursing and perfect monitoring technology to ensure the safety of patients with severe ARDS morbid obesity,reduce complications and improve prognosis,which has important reference significance for relevant medical practice.

Objective:To evaluate the risk factors of clinical cure and biochemical recurrence (BCR) after radical prostatectomy (RP).Methods:The clinical data of 896 patients who underwent RP at Peking University First Hospital from April 2001 to December 2020 were retrospectively analyzed. Average age was (65.90±6.3) years, median preoperative prostate specific antigen (PSA) was 10.75 (0.36-264.20) ng/ml, median prostate volume was 40.0 (12.0-220.9) ml, median PSA density (PSAD) was 0.27 (0.02-3.42) ng/(ml·g). Clinical staging: 432 cases in T 1c stage, 333 cases in T 2a/bstage, 76 cases in T 2c stage, and 55 cases in ≥T 3 stage. Preoperative Gleason score of biopsy: 193 cases in 3+ 3, 315 cases in 3+ 4, 162 cases in 4+ 3, 226 cases in ≥8. The RP surgery was operated by open or laparoscopic or robot-assisted approach. Clinical cure and BCR were used as the end points for analysis. Clinical cure was defined as a decrease in serum PSA level below 0.03 ng/ml 6 weeks after surgery. BCR was defined as the 2 consecutive serum PSA >0.2ng/ml during the follow-up after RP. Multivariate logistic regression was used to analyze the independent risk factors of clinical cure. The Kaplan-Meier method was used to draw the biochemical recurrence-free survival curve, the log-rank method was used for univariate analysis of BCR, and the Cox regression analysis was used for multivariate analysis. Results:All 896 patients were followed-up for 58 (5-241) months, 678 cases (75.7%) achieved clinical cure. Based on univariate analysis and multivariate analysis, among the preoperative indicators, whether the proportion of positive biopsy needles ≥33% ( P=0.007) and preoperative Gleason score of biopsy ( P=0.041) were independent risk factors of clinical cure. A total of 890 cases were included in the analysis of risk factors of BCR, of whom 172 cases (19.3%) had BCR. The 1-, 5-, and 10-year biochemical recurrence-free survival(BFS)rates were 98.1%, 83.1% and 68.4% respectively. The median BFS has not been reached, and the average BFS was 181 months (95% CI 172-189). The results of univariate and multivariate analysis showed that whether achieved clinical cure ( P=0.001) and postoperative pathological staging ( P<0.001) were independent risk factors of BCR. Conclusions:Whether the proportion of positive biopsy needles≥33% and preoperative Gleason score of biopsy were independent risk factors of clinical cure. Postoperative pathological staging and whether achieved clinical cure may be independent risk factors of BCR.