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@#Objective To analyze the effect of type 2 diabetes (T2DM) on the short-term prognosis of patients with non-small cell lung cancer (NSCLC) after resection surgery. Methods Clinical data of 207 NSCLC patients who underwent resection surgery in our hospital from January 2016 to January 2019 were retrospectively analyzed. The 100 NSCLC patients with T2DM were allocated to a T2DM group (58 males and 42 females, with an average age of 65.26±7.26 years), and 107 patients without T2DM were allocated to a non-T2DM group (66 males and 41 females, with an average age of 64.21±7.51 years). The short-term prognosis of the patients was compared between the two groups. Results Compared with the non-T2DM group, the postoperative atelectasis (P=0.012) and pulmonary infection (P=0.040) were statistically different in the T2DM group. The postoperative complication rate in the T2DM group was significantly higher than that in the non-T2DM group (66.0% vs. 33.6%, P<0.001). The postoperative hospitalization time in the T2DM group was longer than that in the non-T2DM group (9.83±6.35 d vs. 8.09±4.40 d, P=0.007). Conclusion T2DM will increase the incidence of postoperative complications, prolong the length of hospital stay and increase the economic burden of the NSCLC patients, which is not conducive to the postoperative prognosis of patients.
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Objective To investigate the existence of pulmonary vascular remodeling after left pneumonectomy in rats and the role of hypoxia inducible factor-lα( HIF-1α) and vascular endothelial growth factor ( VEGF) in pulmonary vascular remodeling.Methods Twenty-four healthy male Sprague-Dawley rats were randomly divided into experimental and control groups, 12 in each group.The rat models of pulmonary vascular remodeling were created by open-chest left pneumonectomy.After 12 weeks of feeding, the mean pulmonary artery pressure ( mPAP) and partial pressure of arterial oxygen ( PaO2 ) of each rat were measured.The ultrastructure of small arteries in the lung specimens were examined by e-lectron microscopy.Muscularized degree of three kinds of small pulmonary vessels ( muscularized artery MA, partially mus-cularized artery PMA, and non-muscularized artery NMA) were observed by light microscopy, and the percentage of each kind of pulmonary arteries ( MA%, PMA%, NMA%) were calculated.Arterial external diameter, media thickness of ves-sel ( MTV) , total vascular area, media area of vessel ( MAV) , MTV%and MAV%were calculated as indicators of pul-monary vascular remodeling.The expressions of HIF-1αand VEGF in artery were detected by immunohistochemistry.Re-sults The values of mPAP, MA%, PMA%, MTV, MAV, MTV% and MAV% in the experimental group were signifi-cantly higher than those in the control group (P<0.01), but the value of PaO2 and NMA%were significantly lower than those in the control group (P<0.01).The IOD value of HIF-1αand VEGF expressed in the pulmonary arterial wall of the experimental group were 26.47 ±4.16 and 42.04 ±3.79, respectively, significantly higher than those in the control group (6.12 ±2.14 and 11.53 ±2.29, P<0.01).Linear correlation analysis showed that the expression of HIF-1αand VEGF was positively correlated with MTV% and MAV%, negatively correlated with PaO2 , and the HIF-1αexpression was posi-tively correlated with VEGF expression.Conclusions A rat model of pulmonary vascular remodeling can be successfully established by left pneumonectomy.Hypoxia is a key factor in the development of pulmonary vascular remodeling, HIF-1αand VEGF may play an important role in its pathogenesis.
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Objective To assay the early quality of life and posttraumatic stress disorder (PTSD) and relating influential factors in patients with severe blunt chest trauma (sBCT).Methods Demographic and clinical data of sBCT patients treated between January 2011 and December 2011 were collected.Early quality of life and PTSD symptom level at posttraumatic months 1,3,and 6 were analyzed by using short form 36 health survey (SF-36) and impact of event scale-revised (IES-R) respectively.Furthermore,logistic regression analysis was performed to identify the risk factors associated with quality of life of the patients.Results A total of 107 patients were included in the study.Ultimately,83 patients were available to the 6-month follow-up.A low score for SF-36 remained at posttraumatic 6 months and one-third of the 83 patients sustained mild or severe PTSD symptoms.Major influential factors to posttraumatic quality of life included age,ISS ≥ 20,combined craniocerebral injury,combined spinal and pelvic injuries,posttraumatic complications,and PTSD.Conclusions Early quality of life in sBCT patients is poor.Therefore,the early intervention with identification of specific risk factors is contributive to better quality of life.
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Objective Arrhythmias are one of the main causes of postoperative morbidity after thoracic surgery.The aim of this study was to evaluate whether video-assisted thoracoscopic surgery decreases the risk of postoperative arrhythmias compared with traditional open lung lobectomy.Methods 138 consecutive patients were enrolled from January 2011 to February 2012,after five age and risk factors matched,68 patients undergoing video-assisted thoracic surgery and 70 patients undergoing traditional open lung lobectomy were eligible for analysis.The rhythm was documented preoperatively and postoperatively with standard electrocardiogram (ECG) recording and ECG monitoring.All patients followed 3 months after hospital admission.Results There was a 17.6％ incidence (12/68) of postoperative new-onset arrhythmias undergoing video-assisted thoracic surgery and 18.6％ of patients (13/70) undergoing thoracotomy,but the difference was not statistically significant.In both groups,atrial fibrillation was the most common arrhythmia (60％).There was no significant difference in the other morbidity (P ＞0.05) and mortality rate(P =0.57,1.5％ vs 2.9％) between the two groups.Conclusion New-onset arrhythmias,most frequently atrial fibrillation,are common after lung lobectomy.Regardless of surgical approach,postoperative arrhythmias after lobectomy occurred with equal frequency.New insights in the pathophysiology of postoperative thoracic arrhythmias and advances in prevention and therapy are need future study.
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Objective To investigate the risk factors affecting the mortality in patients with severe chest trauma (SCT).Methods A total of 777 patients with SCT (AIS≥ 3) treated at Chongqing Emergency Medical Center from January 2006 to April 2009 were involved for retrospective study.Multivariate stepwise logistic regression analysis was used to analyze 15 possible risk factors affecting their mortality.Results The factors affecting mortality in patients with SCT included hemorrhagic shock (X6,B =1.710,OR =1.291,P＜0.01),multiple organ dysfunction syndrome (MODS) (X7,B=3.453,OR =1.028,P＜0.01 ),pulmonary infection ( X9,B =2.396,OR=10.941,P ＜ 0.01 ),abdominal organ injury (X11,B=1.542,OR=1.210,P＜0.01) and thoracic AIS ≥3 (X14,B =0.487,OR =1.622,P＜0.01 ).While the protective factors affecting mortality in patients with SCT contained age ≤60 years old (X1,B =-0.035,OR =0.962,P＜0.05) and GCS≥12 (X13,B=- 0.635,OR=0.530,P＜0.05).Conclusions The age,posttraumatic complications (hemorrhagic shock,MODS,pulmonary infection)and accurate diagnosis and evaluation of trauma severity are the related factors to predict the prognosis.Development of effective treatment measures based on these risk factors plays a key role in the survival rate of patients with SCT.
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Bilingual education is an imporant teaching reform in universities. In recent years, cardiothoracic department has enacted the practice and exploration for bilingual teaching of cardiothoracic surgery. By creating high-quality teaching team, improving teaching methods and quality, creating bilingual learning environment, we have achieved satisfactory teaching effect.
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Combined with the features of clinical practice teaching of cardiothoracic surgery ,we discuss how to improve the quality of clinical practice teaching of cardiothoracic surgery and strengthen the cultivation of medicos'capability and diathesis,thus correctly guiding medicos to finish their interim study commendably and change their roles from students to doctors.
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Objective:To study the protective effects of autogenous oxygenator cardiopulmonary bypass(CPB) for ischemia-reperfusion injury of the lung.Methods:16 adult mongrels(15?1Kg)were randomly divided into tow groups: 8 for experimental group in which the dog's own lung was used as oxygenator;8 for control group in which the bubly oxygenator was used.The tectniques of myocardium protection and cardiac arrest were the same in both groups(cold crystalline cardioplegia).The CPB was controlled running for 1 hour in both groups.The amount of leukocytes(samples of right atrium and left atrium),the pulmonary artery pressure,the oxygen pressure were measured at the time point of before CPB at and the 5th,30~(th),60~(th) and 90~(th) minute after CPB in both groups.And the ratio of leukocyte was calculated.Lung biopsies were obtained before and after CPB in both groups for microscope pathological examination.Results:Autogenous oxygenator CPB technique can provide satisfactory oxygenation during CPB.The ratio of leukocyte after CPB was significantly lower in the experimental group than that in the control group at different time points(P
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Objective:To establish an experimental autogenous oxygenator cardiopulmonary bypass in dogs.Methods:Sixteen mongrel dogs were used.Under intravenous anesthesia and artificial respiration,thoracotomy and cardiac cannulations were performed:right atrium cannulation and pulmonary artery cannulation,connecting to reservoir and pump,the right heart bypass system was established;left atrium and ascending aotra cannulation,connecting to reservoir,heat exchanger and pump,the left heart bypass was established.Results:The experimental model was established successfully in fifteen dogs and one failed.Conclusion:The susscessful establishment of this experimental model depends on skillful cannulation,balance of left and right circulation,appropriate body temperature.
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OBJECTIVE: To compare the effects of de-addiction with the therapy of acupuncture, acupuncture plus opium, opium plus buprenorphine and opium plus Han's instrument for de-addiction and to study the effects of the four therapeutic methods on the protracted withdrawal syndrome and craving. METHODS: The effects of de-addiction were assessed with the opiate withdrawal scale and the craving degree with visual analogue scale (VAS). RESULTS: The dominance of acupuncture treatment for withdrawal syndrome appeared to be after the 6th day, and the dominance for controlling craving showed after the 8th day, moreover, there were little side effects. CONCLUSION: Acupuncture treatment had the potentiality of preventing relapse and could be used for treating the protracted withdrawal syndrome and psychic dependence during the period between the stages of abstinence and rehabilitation.
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OBJECTIVE:To evaluate the analgesic efficacy and safety of tramadol im.on pain after thoracic surgery.MET_ HODS:34cases after thoracic surgery were given tramadol im.in a dose of1.5mg/kg.The analgesic effect and adverse effect were observed.RESULTS:The significant effective rate of pain relief was41.2%and effective rate was38.2%with a total effective rate of79.4%.Some adverse effects including temporary nausea,vomiting,perspiration,dysuria were observed in a part of the patients.No respiratory inhibition was found.CONCLUSION:Tramadol(1.5mg/kg)im.is safe and effective in treatment of the pain after thoracic surgery.
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OBJECTIVE:To investigate the effects of urapidil on the hemodynamics of the right heart in patients with rheumatic heart disease and secondary pulmonary hypertension METHODS:34 patients with rheumatic heart disease and varying degrees of secondary pulmonary hypertension were included in the study In all patients,the hemodynamic parameters and pressure of systemic circulation were determined before and 20,40,60 min after urapidil intraverous injection in a dose of 0 4mg/kg RESULTS:Pulmonary artery pressure,pulmonary vascular resistance,pulmonary capillary wedge pressure and systemic artery pressure were decreased after urapidil injection The reduction of resistance in the pulmonary vascular bed was greater than that in the systemic circulation There were no significant alterations in heart rate and cardic output No serious side-effects were observed in the study CONCLUSION:Urapidil may be a promising drug in the treatment of patients with pulmonary hypertension due to rheumatic heart disease
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Objective:To introduce the clinical experiences of repairing ventricular septal defect through right subaxillary minithoracotomy and to evaluate it's clinical effect.Methods:46 cases of VSD were repaired through right subaxillary minithoracotomy.The sizes of the defects varied from 0.4～0.8cm in diameter and all of them were membranous or conventricular defects.The average age was 7.1 ys.Results:There was no operative death or complication.The lenth of incision varied from 5～10cm.Cardiopulmonary bypass time were 21～42 minutes.Postoperative hospitalized time were 6 to 10 days.Conclusion:Repairing of ventricular septal defect through subaxillary minithoracotomy have the advantages of minimal trauma,hidden incision and quicker recovery.
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Objective:To investigate lung injury and protective effect of autogenous oxygenator cardiopulmonary bypass(CPB) on lung after CPB.Methods:24 adult mongrels (weight 15?1kg) were randomly divided into two groups,12 for experimental group,in which the dog's own lung was used as oxygenator;12 for control group,in which the artificial lung (bubble oxygenator) was used as oxygenator.Leukocyte count of right atrium and left atrium,difference of transpulmonary leukocyte,the pulmonary artery pressure,and the oxygen pressure of artery were measured during the perioperative period.And lung biopsies were obtained before and after CPB in both groups for microscope pathological examination.Results:Autogenous oxygenator CPB technique could provide satisfactory oxygenation during CPB.The oxygen pressure after CPB was significantly higher in the experimental group than that in the control group at different time points( P