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Objective:To explore the effect of acute kidney injury(AKI)on near-term survival after lung transplantation(LT)in patients with idiopathic pulmonary fibrosis(IPF).Methods:Through consulting electronic medical records, anesthetic modes and Chinese Lung Transplant Registration System, clinical data are retrospectively reviewed for 275 IPF patients undergoing LT at Affiliated Wuxi People's Hospital of Nanjing Medical University from January 2017 to April 2021.According to the diagnostic criteria of Kidney Disease: Improving Global Outcomes(KDIGO), they are divided into two groups of AKI(169 cases)and non-AKI(106 cases).Perioperative findings of two groups are recorded.Then univariate and multivariate Cox regression models are employed for determining whether or not inter-group differences existed in survival rates post-LT.Also AKI is staged according to the KDIGO.And the effect of stage 1/2/3 AKI on near-term postoperative prognosis is examined.Results:The differences are significantly different in recipient gender, creatinine, 6-minute walking test, forced vital capacity(FVC), lung allocation score, oxygenation index, N-terminal pro-brain natriuretic peptide(NT-Pro BNP), preoperative hormone use and volume of crystal infusion( P<0.05).After multivariate Cox regression correcting for covariates, no statistical significance exists in effect of AKI stage 1 on near-term postoperative survival rate( P<0.05).AKI stage 2/3 still has statistical significance in risk of mortality at Day 30/90/180/365 post-operation( P>0.05). Conclusions:As a common complication post-LT, AKI significantly affects near-term postoperative prognosis of transplant IPF patients.Stage 2/3 AKI impacts near-term postoperative survival while stage 1 AKI is not associated with higher mortality.
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Objective:To investigate the risk factors of early death after lung transplantation in patients with idiopathic pulmonary fibrosis (IPF) complicated with pulmonary arterial hypertension (PAH).Methods:A retrospective cohort study was conducted. The clinical data of 134 patients with IPF and PAH who underwent lung transplantation at Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 to December 2020 were collected. The donor's gender, age, duration of mechanical ventilation, and cold ischemia time, the recipient's gender, age, body mass index (BMI), smoking, history of hypertension and diabetes, preoperative usage of hormones, mean pulmonary arterial pressure (mPAP), cardiac echocardiography and cardiac function, serum creatinine (SCr), N-terminal pro-brain natriuretic peptide (NT-proBNP) as well as surgical type, extracorporeal membrane oxygenation (ECMO) treatment, duration of operation, and plasma and red blood cell infusion ratio were collected. The cumulative survival rates of patients at 30, 60, and 180 days after lung transplantation were calculated by Kaplan-Meier method. The univariate and multivariate Cox proportional hazards regression models were used to analyze the effects of donor, recipient, and surgical factors on early survival in donors after lung transplantation.Results:The majority of donors were male (80.6%). There was 63.4% of the donors older than 35 years old, 80.6% of the donors had mechanical ventilation duration less than 10 days, and the median cold ischemia time was 465.00 (369.25, 556.25) minutes. The recipients were mainly males (83.6%). Most of the patients were younger than 65 years old (70.9%). Most of them had no hypertension (75.4%) or diabetes (67.9%). The median mPAP of recipients was 36 (30, 43) mmHg (1 mmHg≈0.133 kPa). There were 73 patients with single lung transplantation (54.5%), and 61 with double lung transplantation (45.5%). The survival rates of 134 IPF patients with PAH at 30, 60, 180 days after lung transplantation were 81.3%, 76.9%, and 67.4%, respectively. Univariate Cox proportional risk regression analysis showed that recipient preoperative use of hormone [hazard ratio ( HR) = 2.079, 95% confidence interval (95% CI) was 1.048-4.128], mPAP ≥ 35 mmHg ( HR = 2.136, 95% CI was 1.129-4.044), NT-proBNP ≥ 300 ng/L ( HR = 2.411, 95% CI was 1.323-4.392), New York Heart Association (NYHA) cardiac function classification Ⅲ-Ⅳ ( HR = 3.021, 95% CI was 1.652-5.523) were the risk factors of early postoperative death in patients with IPF complicated with PAH (all P < 0.05). In the multivariable Cox proportional risk regression analysis, recipient preoperative hormone usage (model 1: HR = 2.072, 95% CI was 1.044-4.114, P = 0.037; model 2: HR = 2.098, 95% CI was 1.057-4.165, P = 0.034), NT-proBNP ≥ 300 ng/L ( HR = 2.246, 95% CI was 1.225-4.116, P = 0.009) and NYHA cardiac function classification Ⅲ-Ⅳ ( HR = 2.771, 95% CI was 1.495-5.134, P = 0.001) were independent risk factors of early postoperative death in patients with IPF. Conclusions:Preoperative hormone usage, NT-proBNP ≥ 300 ng/L, NYHA cardiac function classification Ⅲ-Ⅳ are independent risk factors for early death in patients with IPF and PAH after lung transplantation. For these patients, attention should be paid to optimize their functional status before operation. Preoperative reduction of receptor hormone usage and improvement of cardiac function can improve the early survival rate of such patients after lung transplantation.
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Objective To evaluate the effect of donor age on short-term survival of patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 235 IPF donors and recipients of lung transplantation were retrospectively analyzed. Univariate and multivariate Cox proportional hazard regression models were employed to analyze the correlation between donor age and short-term mortality rate of IPF patients after lung transplantation. Kaplan-Meier was used to draw the survival curve. Results Univariate Cox regression analysis showed that donor age was correlated with the 1-year fatality of IPF patients after lung transplantation. The 1-year fatality of recipients after lung transplantation was increased by 0.020 times if donor age was increased by 1 year (P=0.009). Oxygenation index of the donors, preoperative oxygenation index, preoperative lung allocation score, preoperative N-terminal pro brain natriuretic peptide, pattern of transplantation, pattern of intraoperative extracorporeal membrane oxygenation and intraoperative blood transfusion volume of the recipients were correlated with 1-year fatality after lung transplantation (all P < 0.1). Multivariate Cox regression analysis demonstrated that there was no correlation between donor age and 30-, 90-, 180-d and 1-year fatality of IPF patients after lung transplantation (all P > 0.05). Sensitivity analysis showed that there was no significant difference in 30-, 90-, 180-d and 1-year fatality after lung transplantation among donors aged < 18, 18-33, 34-49 and ≥50 years (all P > 0.05). Conclusions Donor age exerts no effect upon short-term survival of IPF patients after lung transplantation. Considering the mechanical ventilation time, oxygenation index, infection and other factors of donors, the age range of lung transplant donors may be expanded.
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Objective:To explore the early prognosis on patient of idiopathic pulmonary fibrosis (IPF) combined with different degrees of pulmonary arterial hypertension (PAH) undertake lung transplantation (LTx).Methods:From January 2017 to December 2020, the clinical data of 134 patients with IPF who underwent LTx in Wuxi People's Hospital were analyzed retrospectively. According to the average pulmonary artery pressure detected by right cardiac catheter before operation, the patients were divided into mild PAH group (63 cases), moderate PAH group (47 cases) and severe PAH group (24 cases). The donor data and the recipient's preoperative, intraoperative and postoperative data were collected; the postoperative survival curve to analyze early survival among the three patient groups.Results:With the increase of pulmonary artery pressure, the rate of abnormal right ventricular function increased, the end diastolic diameter of left ventricle decreased before operation, and the rate of using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) increased during the surgery ( P<0.05). Multivariate analysis found that combined severe PAH had significant effects on primary graft dysfunction (Primary graft dysfunction, PGD), retracheal intubation or tracheotomy, hypovolemic shock within 72 h, and 6-month survival after LTx. The survival surve showed that 30-day survival rates of patients with IPF complicated with mild, moderate and severe PAH were 85.7%, 80.8% and 66.7% respectively, and the 6-month survival rates were 80.9%, 74.0% and 62.2%, respectively. Conclusion:Patient of IPF combined with different degrees of PAH had a significant impact on cardiac function and intraoperative ECMO selection of LTx, and severe PAH could significantly reduce the early survival rate after LTx.
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Objective:To analyze the clinical characteristics of hospitalized patients with distal deep venous thrombosis (DDVT).Methods:Medical records of patients without DDVT at admission and discharged from January 1,2021 to June 30,2021, were retrospectively reviewed. During the pre-hospitalization and hospitalization period the ultrasonography was performed for detection of DDVT. The venous thromboembolism (VTE) risk scores were evaluated with Caprini scale for surgical patients, and evaluated with Padua scalefor nonsurgical patients.Results:A total of 16 400 patients, 8 827 males and 7 573 females with a mean age of (63.8±14.2) years (14 to 101 years) were enrolled, among whom DDVT occurred in 1 193 patients (DDVT group), including 73 cases developed during pre-hospitalization; meanwhile 124 patients were diagnosed as deep vein thrombosis(DVT), and 15 083 patients without DVT served as non-DDVT group. The detection rate of DDVT in patients with medium/high VTE risk scorewas significantly higher than thatin low-risk patients [12.8% (982/7 644) vs. 2.4% (211/8 756), χ2=659.10, P<0.001]. The detection rate of DDVT for medium/high VTE risk score group was the highest in emergency intensive care unite and intensive care unite(ICU; 34.3%, 68/198), followed by that in departments of rehabilitation (25.7%, 45/175), neurology (19.9%,37/186), neurosurgery(19.4%,83/428), respiratory medicine(19.0%,56/295) and orthopedics (15.4%, 378/2 451).The detection rate of DDVT increased with age.The lowest detection rate was found in the age group 14 to 40 years, for low VTE risk score group it was 0.5%(4/770), for the medium/high VTE risk score group it was 3.0%(11/362, χ2=10.10, P<0.001).In patients over 75 years of age, the detection rate of DDVT was 5.2%(85/1 624) in low VTE risk score group, and 18.0%(389/2 158) in medium/high VTE risk score(χ2=138.82, P<0.001).The mean age of the DDVT group was older than that of non-DDVT group [(71.0±12.1) vs. (63.2±14.2) years, t=21.14, P<0.001]. The abnormality rate of D-dimer level in DDVT patients was significantly higher than that in non-DDVT patients [71.4%(813/1 138) vs. 25.4%(3 492/13 770), χ2=1 086.80, P<0.001]. The median length of hospital stay was significantly longer than that of the non-DDVT group [11.0 (8.0, 19.0) vs. 6.0 (4.0, 10.0)d, Z=-26.67, P<0.001].The risk factors for non-surgical DDVT patients were age, bed rest for ≥3 d, and acute infection; while the risk factors for surgical DDVT patients were age, fracture in hip, pelvis or lower limb, bedridden for ≥3 d and body mass index (BMI)>25 (kg/m 2). Conclusion:The detection rate of DDVT is higher in hospitalized patients, especially for those in ICU and rehabilitation department, and those over 75 years old with high VTE score. Advanced age, fracture or immobilization, and long-term bed rest are the main risk factors for DDVT.
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Objective:To compare the effect of extracorporeal membrane oxygenation(ECMO)on pulmonary transplantation(LTx)in patients with idiopathic pulmonary fibrosis(IPF)complicated with pulmonary hypertension(PH).Methods:From January 2017 to December 2020, clinical data were retrospectively reviewed for 112 IPF patients complicated with PH undergoing LTx assisted by venous ECMO(VV-ECMO group, n=68)or venous arterial ECMO(VA-ECMO group, n=44). Gender, age, mechanical ventilation time, oxygenation index, cold ischemic time, preoperative gender, age, smoking history, PO 2, PCO 2, PH degree, NYHA cardiac function grade, right cardiac function, ejection fraction(EF)and complications(hypertension & diabetes)of two groups were compared. Intraoperative approach, operative duration, ECMO transfer time, blood loss, blood transfusion, urine volume, postoperative blood transfusion, mechanical ventilation time, ICU stay time, re-thoracotomy, pulmonary infection, primary graft dysfunction(PGD)and renal insufficiency were recorded. And the effects of two different diversion modes on early postoperative complications and short-term outcomes of LTx were further analyzed by multiple factors. Cox proportional risk model was employed for comparing VV-ECMO and VA-ECMO flow patterns with factors related to recipient survival after transplantation. Results:The preoperative PO 2 of 58.3(51.3, 72.0)mmHg was significantly lower in VV-ECMO bypass group than that of 73.2(63.3, 96.8)mmHg in VA-ECMO group and the difference was statistically significant( P<0.006). Compared with VV-ECMO group, 24(54.5%), 15(34.1%)and 22(50.0%)had NYHA class Ⅲ, severe PH and preoperative right heart enlargement in VA-ECMO group respectively and the differences were statistically significant compared with 17(25.0%), 6(8.8%)and 16(23.5%)in VV-ECMO group( P<0.05 for all). No significant inter-group differences existed in postoperative PGD, postoperative mechanical ventilation time(≥3 d), pulmonary infection, postoperative thoracotomy ratio, postoperative renal insufficiency, ICU stay, hospital stay and other aspects( P>0.05). And 6-month postoperative survival rates of VV-ECMO and VA-ECMO groups were 80.9% and 61.4%, respectively and no significant inter-group difference existed in short-term survival rate(6 months)after adjustment by multivariate Cox regression model( P>0.05). Multivariate statistics indicated that the risk of delayed postoperative withdrawal was 14.452-fold higher in VV-ECMO group than in VA-ECMO group and the inter-group difference was statistically significant(95% CI: 2.448-85.323, P=0.03). Conclusions:No differences exist in postoperative complications or short-term survival rate between IPF recipients with mild PH on VV-ECMO mode and IPF recipients with severe PH on VA-ECMO mode. VV-ECMO flow reversal can delay the transplant back-off time.
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Lung transplantation is the only effective approach to treat end-stage lung diseases. Nevertheless, early prognosis of lung transplant recipients is significantly worse than that of other solid organ transplant recipients. Primary graft dysfunction (PGD) is one of the main causes affecting clinical prognosis of the recipients. PGD is an early acute lung injury after lung transplantation, which is the main cause of early death of lung transplant recipients. Risk factors of PGD after lung transplantation consist of donor, recipient and operation, etc. In this article, the risk factors of PGD after lung transplantation were reviewed, aiming to provide reference for clinical practice.
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Objective To investigate the design,incisional method and clinical experiences of using the mi cro-dissected polyfoliate anterolateral thigh perforator flap to repair of complex soft tissue defect in extremities.Methods From June,2017 to September,2018,12 cases of different kinds of complex soft tissue defect in extremities were repaired by micro-dissected free polyfoliate anterolateral thigh perforator flap.Each flap was divided into two cutaneous perforators to give two separate flap with a common vascular supply.The flaps were cut from the superficial layer of the deep cervical fesciae and without fascia lata.The donor sites were treated by subcutaneous cosmetic suture.Patients were followed-up by outpatient service,telephone and WeChat video to observe and record the flap's appearance,sensory recovery,extremities function and the scars of the donor site to evaluate its clinical efficacy.Results All flaps survived without vascular crisis happened except one-leaf necrosis occurred,which healed with local flap transferring.The donor sites remained linear scars.The mean flap thickness of this group after micro-dissection was (4.5±0.5) mm.All the patients were followed-up for 5-15 months.The 2 point discrimination ranged between 0.5-2.0 cm.Sensory restoration ranking was S3-S3+.The range of montion of wrist joint was 65°-90°,and that of ankle joint was 40°-60°.Conclusion The micro-dissected polyfoliate anterolateral thigh perforator flap is an ideal method for complex and irregular multiple sites soft tissue defect in extremities as it can keep good economic benefit and minimal damage to the donor site.
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Objective To investigate the clinical value of long chain non-coding RNA ( lncRNA) combined with pepsinogen in the detection of gastric cancer. Methods Totally eighty-six gastric cancer patients hospitalized in Chongqing Three Gorges Central Hospital from June 2014 to June 2017 were selected as the gastric cancer group. Another 86 patients who had no obvious abnormalities in the stomach during the same period were selected as the control group. Univariate analysis was used to compare the differences in baseline data and Carcinoembryonic antigen (CEA),carcinoembryonic antigen 19-9 (CA19-9),pepsinogen I (PGⅠ), pepsinogen II (PGⅡ) and lncRNA BC200 between the two groups. Univariate analysis was applied to analyze the differences of the baseline date between the two groups and to select the statistically significant factors which are further detected by multivariate logistic regression analysis. Meanwhile,the correlation analysis was used to analyze the relationship between the above-mentioned factors and traditional variables. Furthermore, the sensitivity and specificity of these factors in the value of diagnosing gastric cancer was calculated by ROC curve. Results The level of CEA (2. 84(1. 63- 8. 45) μg/ L),CA19-9(9. 05(5. 89- 29. 47) U/ ml) and lncRNA BC200(1. 872(1. 125-2. 611) in the gastric cancer group were significantly higher than those in the control group (CEA (1. 26(0. 87-2. 66) μg/ L,CA19-9(6. 42(4. 32-9. 86) U/ ml,lncRNA BC200( 1. 006 (0. 594-1. 282))(U= 3684,4782,2764;P<0. 001,P<0. 001,P = 0. 007); while the levels of PGⅠ(68. 3 (51. 2-89. 4) μg/ L ) and PGⅡ(18. 85(10. 06-29. 37) μg/ L) in the gastric cancer group were lower than those in the control group ( PGⅠ(115. 1(81. 7 - 166. 0) μg/ L,PGⅡ(23. 38(13. 72 - 34. 09) μg/ L) ( P<0. 001). Multivariate logistic analysis showed that CA19-9 (OR = 1. 206,95%CI 1. 302-1. 375,P = 0. 039), PGⅠ (OR= 1. 300,95%CI 1. 224-1. 623,P= 0. 023),PGⅡ (OR = 1. 208,95%CI 1. 002-1. 501,P = 0. 044) and lncRNA BC200 (OR = 1. 276,95%CI 1. 008 ~ 1. 107,P = 0. 020) had significant effects on gastric cancer and PGⅠ had the highest degree of influence. Spearman rank correlation showed that there was a positive correlation between lncRNA BC200 and CA19-9,and the difference was statistically significant (rs = 0. 891,P<0. 05); while PGⅠ (rs= -0. 482,P = 0. 026) and PGⅡ (rs = -0. 531,P = 0. 014) were negative correlated with CA19-9. The ROC curve indicated that the area under the ROC curve of lncRNA BC200 combined with PGⅠ,lncRNA BC200 combined with PGⅡ and CA19-9 in the detection of gastric cancer were 0. 844,0. 783 and 0. 721 respectively. The AUC (Area Under Curve) of lncRNA BC200 combined with PGⅠ was the highest,with a sensitivity of 53. 5% and a specificity of 100% . Conclusion LncRNA BC200 combined with PGⅠ can detect the existence of gastric cancer to a certain extent, and has a certain clinical diagnostic value, thus providing a theoretical basis for further diagnosis of early gastric cancer.
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Objective To study the relationship of apoptosis-related gene Survivin with Bcl-2,Bax protein in adenomyosis.Methods The expressions of Survivin,Bcl-2 and Bax protein were deteeted by immunohistochemical method(SP)in ectopic and eutopic endometrium of adenomyosis from 46 cases,and compared with that in eutopic endometrium from endometrium 30 cases without adenomyosis.Results The expression rate of Survivin protein in ectopic endometrium of adenomyosis was much higher than that in normal endometrial cells.The Survivin was positively corelated to Bcl-2,negatively to Bax.Conclusion Survivin may play an important role in pathogenesis of adenomyosis.With Survivin gene,apoptosis-related gene Bcl-2 may have a synergic role and Bax have an antagonistic role in the formation and progression of adenomyosis.