Objective
To assess the effects of physiotherapy on pulmonary function in COPD patients with lung cancer after lobectomy or pneumonectomy.
Methods
Fifty-five COPD patients with lung cancer undergoing lobectomy or pneumonectomy from January 2005 to May 2014 were recruited in the study. They were divided into group A received comprehensive physiotherapy before surgery and group B without comprehensive physiotherapy before surgery. The changes of lung function and tolerance were compared before physiotherapy (T1 time point) and after physiotherapy (T2 time point) in the group A, and between two groups before lung resection (T2 time point) and after lung resection (T3 time point).
Results
In group A, the forced expiratory volume in one second (FEV1), vital capacity (VC), peak expiratory flow at 50% of vital capacity (FEF50) and FEF25 increased significantly respectively by 16.96%, 14.75%, 20.69% and 13.79% compared with those before physiotherapy. Meanwhile, six-minutes walking distance (6MWD) achieved a significant improvement. After resection of lung, FEV1 and VC appeared to reduce, and pulmonary small airway function, tolerance, and clinical features deteriorated significantly. The differences between T2 and T1 in FEV1, FEF50 and FEF25 in the patients with FEV1%pred ≥80% and 50%-80% were similar with those in the patients with FEV1%pred<50%. The differences between T2 and T3 in FEF50 and FEF25 in the patients with FEV1%pred≥80% and 50%-80% were higher than those with FEV1%pred<50%. For the patients with lobectomy, FEV1 and VC in the group B were lower than those in the group A (FEV1: 10.24% vs. 22.44%; VC: 10.13% vs. 20.87%). For the patients with pulmonary resection, FEV1 and VC had little differences (FEV1: 36.33% vs. 36.78%; VC: 37.23% vs. 38.98%).
Conclusion
Physiotherapy is very important for the preoperative treatment and postoperative nursing of COPD patients with primary lung cancer.
Objective To investigate the comprehensive interventions of hypertension in urban community, and to provide evidence for the hypertension intervention of urban community. Methods A stratified random sampling method was used to enroll 136 patients with essential hypertension in Shuangnan community of Chengdu city, including 77 males and 59 females. Their average age was 59±3.9. The indexes of compliance index (CI) and control rates for blood pressure by using different kinds of antihypertensive drugs were observed after 3 months. With the same medications, the level and control rates for blood pressure were evaluated at baseline and after 3 months of participation in the program of therapeutic lifestyle changes (TLC). Results The group of combination of antihypertensive drugs (n=12) had the highest control rate (83.3%). The group of long-acting calcium antagonist (n=31) had high index of control rate (54.8%) and CI (91.4%). The group of short-acting agents (n=25) had the lowest index of control rate (8.0%) and CI (41.2%). The patients had greater reduction in the level for blood pressure after TLC with significant difference (Plt;0.05). Conclusion It is necessary to strengthen and standardize the measures of comprehensive interventions on community treatment of hypertension. The program of reasonable antihypertensive drugs based on TLC should be developed positively.
Objective To investigate the current status of health promoting lifestyle in maintenance hemodialysis (MHD) patients and to explore its correlation with chronic illness resource utilization. Methods Patients who underwent outpatient MHD in the Hemodialysis Room of the Department of Nephrology, West China Hospital, Sichuan University between January and March 2023 were selected. Patients were surveyed using the General Information Questionnaire, Chronic Illness Resource Survey, and Health Promoting Lifestyle Profile-Ⅱ Revise. Results A total of 158 patients were surveyed. MHD patients scored 103.37±18.52 on health promoting lifestyle, and 68.95±14.14 on chronic illness resource utilization. The Pearson correlation analysis results showed that there was a positive correlation between the chronic illness resource utilization and the total score of health promoting lifestyle in MHD patients (r=0.765, P<0.001), as well as scores in all dimensions (P<0.05). The results of multiple linear regression analysis showed that the main caregivers being parents [non-standardized partial regression coefficient (b)=8.150, 95% confidence interval (CI) (0.804, 15.497), P=0.030], weekly dialysis times [b=10.701, 95%CI (2.787, 18.615), P=0.008], and chronic illness resource utilization [b=0.936, 95%CI (0.800, 1.072), P<0.001] were influencing factors for health promoting lifestyle. Conclusions MHD patients have an average health promoting lifestyle, and ideal chronic illness resource utilization. Hemodialysis nurses can take targeted measures to enhance chronic illness resource utilization and health promoting lifestyle in MHD patients, which can further improve the quality of life of MHD patients.
Objective To investigate the mediating effect of phase angle between muscle strength and muscle function in maintenance hemodialysis (MHD) patients, aiming to provide a reference basis for clinical improvement of muscle strength and muscle function in MHD patients. Methods Random sampling was used to collect patients undergoing outpatient MHD in the Wenjiang Hemodialysis Room of the Department of Nephrology, West China Hospital, Sichuan University between September and December 2023 as the subjects of this study. Muscle strength was assessed by handgrip strength, muscle function was assessed by Short Physical Performance Battery (SPPB), and phase angle was measured by bioelectrical impedance analysis. The mediating effect of phase angle between muscle strength and muscle function was analyzed. Results A total of 239 MHD patients were included, including 125 males (52.3%) and 114 females (47.7%). The mean phase angle of MHD patients was (5.77±1.17)°, 89 patients (37.2%) showed decreased muscle strength, and 109 patients (45.6%) showed muscle hypoplasia. Spearman’s correlation analyses showed that phase angle was significantly and positively correlated with both handgrip strength and SPPB in MHD patients (P<0.001). The results of mediation effect analysis showed that handgrip strength was able to positively predict phase angle (β=0.535, P<0.001); handgrip strength was able to positively predict SPPB (β=0.481, P<0.001); phase angle was able to positively predict SPPB (β=0.296, P<0.001); and when both handgrip strength and phase angle entered in the regression equation, both handgrip strength (β=0.392, P<0.001) and phase angle (β=0.165, P<0.05) could positively predict SPPB. Phase angle in MHD patients partially mediated the association between muscle strength and muscle function, with the mediating effect accounting for 32.5% of the total effect. Conclusions There is a close relationship between phase angle, muscle strength and muscle function in MHD patients, and muscle strength can affect muscle function directly or indirectly through phase angle. Medical professionals should pay attention to the muscle function of MHD patients and further improve their muscle function by improving their phase angle and muscle strength.
ObjectiveTo estimate the prognosis of duodenum-preserving resection of pancreatic head (DPRPH) in the treatment of space occupying with extensive calcification of pancreatic head, and to summarize the key points of surgery.MethodsThe clinical data of a middle-aged woman with rare space occupying with extensive calcification of pancreatic head who underwent surgery in Department of Pancreatic Surgery of West China Hospital in May. 2016 was collected and analyzed.ResultsThe DPRPH operation was successfully completed, with the operative time was 207 min, the intraoperative blood loss was 130 mL, and the hospital stay was 12 d. Removing time of the gastric tube and off-bed activity were on the 3rd day after operation, and the volume of peritoneal drainage per day was decreasing from 30 mL to 10 mL until 7th day after operation. We made examination of serum amylase and fluid amylase for the patient every 2 days, and the examination indexes were within normal level. After removing the peritoneal drainage tube, the pain was obviously relieved on the 12th day after operation, then the patient made hospital discharge. There was no observable pancreatic fistula, duodenal fistula, biliary fistula, delay gastric emptying, peritoneal effusion, pleural effusion, abdominal infection, and abdominal bleeding, neither nor any special discomfort. During the follow-up period of 18 months, we got a good prognosis without any symptom of relapse or discomfort according to the result of CT scans and other examinations.ConclusionDPRPH can make a satisfied prognosis in the treatment of rare space occupying with extensive calcification of pancreatic head.
【Abstract】 Objective To investigate the cl inical effect of transplanting by auto-fat granule injection for mastatrophy post suckl ing. Methods From March 2000 to June 2006, 73 patients(146 breasts ) with mastatrophy post suckl ing were treated by transplanting auto-fat granule. The mastatrophy occurred between ages 28 and 52 years with a median of 37 years post suckl ing. The breasts shrank and their elasticity decreased gradually within 2-10 years post suckl ing. The autofat granule was obtained by l iposuction with syringe from patient’s abdomen, waist, buttocks and thighs, etc. After repeated wash and purification, the auto-fat granule was transplanted into the interspace behind the breast by injection. The quantity of auto-fat granule was 50-100 mL in each side of breast per transplantation at 3-6 months intervals, and the whole course of treatment needed 2-6 transplantations. Results The incisions in all cases healed primarily postoperatively. In 73 cases, 65 were followed up from 6 months to 3 years post operation. All patients had a significant improvement in their breast size and shape postoperatively and their breasts were soft and natural in appearance and feel. All of them had more perfect arcuation ofphysique and body with strengthened self-confidence, rel ieved mood and improved qual ity of l ife. However, small indurations were found sporadically in 7 cases (10 breasts) within 2-7 months, and calcifications in 5 cases (8 breasts) within 9-14 months post the first operation. Conclusion The transplantation by auto-fat granule injection for mastatrophy post suckl ing is an effective and practical method. The surgical technique is well worth performing in cl inical practice.
Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods A computerized search was conducted in CNKI, Wanfang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase, and Web of Science databases from inception to June 2023 for cohort studies on the prognostic impact of PH in severe AS patients undergoing TAVR. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Stata 17.0 software was used for meta-analysis. Results A total of 16 cohort studies were included, all with Newcastle-Ottawa Scale scores≥7. Meta-analysis results showed that, compared with AS patients without PH, those with PH had significantly higher 1-year all-cause mortality after TAVR [OR=2.10, 95%CI (1.60, 2.75), P<0.01], 30-day all-cause mortality [OR=2.09, 95%CI (1.54, 2.83), P<0.01], and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P<0.01]. The differences between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation, and postoperative renal failure were not statistically significant. For outcome indicators with significant heterogeneity, subgroup analyses were performed based on PH measurement methods, diagnostic criteria, and different types of PH. The results showed that most subgroup combined results were consistent with the overall findings and that heterogeneity was significantly reduced. Conclusion PH significantly increases the 30-day all-cause mortality, 1-year all-cause mortality, and cardiovascular mortality in patients with severe AS undergoing TAVR.
【摘要】 目的 評價彩色多普勒超聲對腎動脈狹窄（ARAS）的診斷指標及準確性。 方法 1999年10月-2008年12月對患有高血壓病的58例共113根腎動脈進行彩色多普勒超聲檢查。每例患者均測量腎動脈峰值流速（PSV）與腎內段動脈的阻力指數及腎臟長軸。在雙盲條件下，以患者腎動脈造影、MRI血管造影及CT血管造影為標準，評價彩色多普勒超聲診斷ARAS的診斷指標及準確性。 結果 彩色多普勒超聲診斷腎動脈狹窄的敏感性為60%，特異性為83%，陽性預測值為83%，陰性預測值為61%。患側腎長軸小于健側腎長軸，患側腎峰值流速高于健側腎峰值流速，患側腎阻力指數低于健側腎阻力指數。 結論 腎動脈彩色多普勒超聲對于腎動脈狹窄初篩診斷以及評價腎動脈狹窄介入治療后的近、遠期療效，是一種簡便可靠的無創檢查手段。【Abstract】 Objective To evaluate the accuracy and index of color Doppler ultrasonography (CDU) diagnosing renal artery stenosis (RAS).〖WTHZ〗Methods〖WTBZ〗A total of 113 renal arteries of 58 patients with hypertension from October 1999 to December 2008 were examined by CDU. The peak systolic velocity (PSV) of the renal artery, resistant index of interior artery of kidney,and long axis of kidney of each patient were obtained. Under the double-blind condition, accuracy and diagnostic index of CDU for diagnosing RAS were evaluated according to the standard of renal arteriography, magnetic resonance angiography or computerized tomography angiography. Results The sensitivity of CDU for diagnosing RAS was 60%, specificity was 83%, positive predictive value was 83%, and negative predictive value was 61%. Long axis of kidney in patients with RAS was shorter than that in the healthy ones. The PSV in patients with RAS was higher than that in the healthy ones, and the resistant index of section artery of kidney in patients with RAS was lower than that in the healthy ones. Conclusion CDU is an easy and reliable non-invasive examination for early diagnosis and screening of RAS and for evaluating a short-or long-term therapeutic effect.
【摘要】 目的 探討外周血管動靜脈瘺的超聲特征及其鑒別診斷。 方法 回顧性分析2003年1月-2010年3月間收治的36例先天性及后天性動靜脈瘺患者的臨床資料，使用彩色超聲診斷儀觀察受累血管的內徑、血管壁的連續性，根據血流動力學變化尋找瘺口；對受累血管血流頻譜進行分析，并與健側對照。 結果 18例先天性動靜脈瘺查見紆曲擴張的血管網，無法辨認瘺口；18例后天性動靜脈瘺全部可顯示瘺口，2例合并靜脈破裂的為囊瘤型，其余后天性動靜脈瘺均為洞口型。受累動脈近心端血流為高速低阻型，全部患者受累靜脈出現動脈樣血流，近心端靜脈呈高速低阻型頻譜；10例患者遠心端靜脈內出現逆向離心血流。 結論 引流靜脈出現高速、動脈樣血流頻譜是動靜脈瘺的特征性表現；先天性動靜脈瘺可見異常血管網，不能辨認瘺口；后天性動靜脈瘺均可顯示瘺口。彩色超聲多普勒檢查對動靜脈瘺能夠正確診斷及鑒別診斷。【Abstract】 Objective To observe characteristic imaging of arteriovenous fistulas (AVF) of periphery vessel, and to evaluate the differential diagnosis of AVF by ultrasonography. Methods Thirty-six patients suffering from congenital and acquired AVF in this hospital from January 2003 to March 2010 were selected to undergo Doppler ultrasonography. The blood flow of arteriovenous fistulas, diameter, morphology and blood flow characters of affected vessels were observed. Spectral of fistula and affected vessels were analyzed and compared with the healthy side. Results Deformed vascular net was observed, and the localization of arteriovenous fistulas was not observed directly in 18 congenital AVF patients.Inversely the localization of arteriovenous fistulas was observed directly in 18 acquired AVF patients.Two acquired AVF patients with venous rupture belonged to kystoma form, and others acquired AVF patients belonged to orifice form.Spectral analysis of proximal arteries of the fistula revealed high velocity and low resistance.Arterialized flow pattern was observed in affected veins.Proximal veins of the fistula revealed arterialized spectral with high velocity and low resistance.Reversed blood flow was observed in the distal veins of the fistulas in 10 patients. Conclusion Arterialized flow with high velocity in veins are characteristic signs of AVF.Deformed vascular net is observed, and the localization of arteriovenous fistulas in not observed directly in congenital AVF patients, but the localization of arteriovenous fistulas is observed directly in acquired AVF patients.Color Doppler ultrasonography has great value in confirming diagnosis and differential diagnosis of AVF.
