ObjectiveTo investigate the safety, feasibility and advantages of subxiphoid uni-portal thoracoscopic thymectomy.MethodsClinical data of 65 patients undergoing subxiphoid uni-portal thoracoscopic thymectomy in our hospital from September 2018 to March 2019 were retrospectively analyzed. They were treated as a subxiphoid surgery group, including 36 males and 29 females, aged 49.5 (29-71) years. The incision with the length of about 3 cm was located approximately 1 cm under the xiphoid process. From January 2016 to December 2017, 65 patients received intercostal uni-portal thoracoscopic thymectomy, who were treated as a control group, including 38 males and 27 females, aged 48.9 (33-67) years. All patients who were clinically diagnosed with thymic tumor before surgery were treated with total thymectomy. After surgery, expectoration and analgesia were used.ResultsThere was no statistically significant difference in general clinical data, lesion size, intraoperative blood loss, postoperative catheterization time, postoperative hospital stay and postoperative pathology between the two groups. All operations were successfully completed, and the patients in both groups recovered uneventfully after surgery. Visual analogue scale scores on the 1st, 3rd, 7th and 30th day after surgery in the subxiphoid surgery group were lower than those in the control group.ConclusionThe subxiphoid uni-portal thoracoscopic approach can achieve total thymectomy with less trauma and faster postoperative recovery.
ObjectiveTo compare the efficacy of varicose great saphenous vein (GSV) treatment alone versus combined treatment with iliac vein compression (IVC) intervention in improving lower extremity symptoms and prognosis among the patients with varicose GSV complicated by IVC. MethodsBased on inclusion and exclusion criteria, the patients with varicose GSV complicated by IVC treated at the Day Service Center of the First Affiliated Hospital of Chongqing Medical University from May 2022 to January 2025 were retrospectively enrolled. The patients were assigned into two groups according to the treatment strategies: the varicose GSV treatment alone group (control group) and the combined treatment group for varicose GSV and IVC (observation group). The primary endpoints included the closure rate of the GSV trunk, venous clinical severity score (VCSS), and venous insufficiency epidemiological and economic study quality of life/symptom (VEINES-QOL/Sym) questionnaire score at 6 and 12 months postoperatively. The significance level was set at α=0.05. ResultsA total of 264 patients with left lower extremity varicose GSV complicated by IVC were included. The observation group comprised 32 patients, while the remaining 232 patients underwent 1∶3 propensity score-matching, resulting in 96 matched patients in the control group. The baseline characteristics, including gender, age, and comorbidities, showed no statistically significant differences between the two groups (P>0.05). At 12 months postoperatively, the GSV trunk closure rate was 100% in both groups. Within-group comparisons revealed significant improvements in the VCSS and VEINES-QOL/Sym points at 6 and 12 months as compared with preoperative (on admission) values (P<0.05). Between-group comparisons showed that the observation group had greater improvement in the VEINES-QOL/Sym score at 6 months (P=0.028), but no significant difference in the VCSS (P=0.775); At 12 months, the observation group demonstrated significantly better the VCSS (P<0.001) and VEINES-QOL/Sym points (P<0.001) as compared with the control group. ConclusionsFor patients with left lower extremity GSV varicosities complicated by IVC, both treatment strategies significantly improve symptoms. Results of short-term follow-up (6 months) demonstrate early advantages in quality of life improvement with concurrent IVC intervention, while results of 12-month follow-up indicate superior efficacy in both symptom relief and quality of life enhancement. Therefore, concurrent IVC intervention may provide greater clinical benefits for mid- to long-term prognosis for patients with left lower extremity GSV varicosities complicated by IVC.
Objective
To investigate the correlation between plasma aminoterminal pro-B-type natriuretic peptide (NT-proBNP) level and severity of coronary artery lesions in patients with non-ST segment elevation myocardial infarction (NSTEMI).
Methods
NSTEMI patients presenting to the Emergency Department and Department of Cardiology from January 2013 to March 2017 were divided into four groups: thrombosis without stenosis, single vessel disease, double vessel diseases, and three vessel diseases. The general situation of the patients, the plasma NT-proBNP, troponin T, echocardiogram and coronary angiography results were analyzed.
Results
A total of 88 patients were included including 6 in thrombosis without stenosis group, 20 in single vessel disease group, 31 in double vessel diseases group, and 31 in three vessel diseases group. The NT-proBNP level, left ventricular ejection fraction, left ventricular end diastolic diameter, and coronary Gensini score in three vessel diseases group differed much from those in the other groups (P<0.05). The correlation of NT-proBNP with coronary Gensini score in all the patients was positve (t=0.663, P<0.05).
Conclusion
The level of plasma NT-proBNP in patients with NSTEMI is related to the severity of coronary artery disease.
Objective To evaluate the diagnostic yield and safety of two biopsy methods, electromagnetic navigational bronchoscopy (ENB) and transthoracic needle biopsy (TTNB), in peripheral pulmonary lesions. To select a low-risk and high-benefit biopsy method based on the clinical characteristics of the lesions and patients. Methods A retrospective analysis was conducted on inpatients who underwent ENB and/or TTNB for peripheral pulmonary lesions in Huadong Hospital Affiliated to Fudan University. Propensity score matching was used to compare the diagnostic yield and safety of the two biopsy methods. Results A total of 126 patients were included in the ENB group, and 104 patients in the TTNB group. After propensity score matching, 83 matched pairs were obtained. The TTNB group exhibited a significantly higher diagnostic yield compared with the ENB group (90.4% vs. 48.2%, P<0.001), but it was also associated with a higher incidence of pneumothorax (1.2% vs. 21.7%, P<0.001). In the ENB group, the diagnostic efficacy was correlated with lesion diameter (P<0.001, OR=0.183, 95%CI 0.071 - 0.470), but there was no statistically significant difference in the diagnostic yield among different lung segments (P>0.05). In the TTNB group, lesion characteristics did not significantly affect the diagnostic yield, but a lesion diameter ≤30 mm (P=0.019, OR=5.359, 95%CI 1.320 - 21.753) and a distance from the pleura ≥20mm (P=0.030, OR=6.399, 95%CI 1.192 - 34.360) increased the risk of pneumothorax. When stratified based on lesion and patient blood characteristics, no significant difference was found in the diagnostic yield between the two groups for characteristics such as left upper lobe (P=0.195), right middle lobe (P=0.333), solid with cavity (P=0.567), or abnormal serum white blood cell count (P=0.077). However, the incidence of pneumothorax in the TTNB group was higher than that in the ENB group. Conclusions The diagnostic yield of ENB is affected by the size of the lesion, while the incidence of pneumothorax in TTNB is influenced by both lesion size and distance from the pleura. In cases with lesions located in the left upper lobe, right middle lobe, solid with cavity, or with abnormal serum white blood cell count, selecting ENB for biopsy is considered preferable to TTNB.
Objective To investigate the relationship between preoperative mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients. Methods From 2018 to 2021, the elderly patients with pulmonary complications after thoracoscopic lobectomy were included. A 1∶1 propensity score matching was performed with patients without pulmonary complications. The clinical data were compared between the two groups. ResultsTotally, 100 elderly patients with pulmonary complications were enrolled, including 78 males and 22 females, aged 66.4±4.5 years. And 100 patients without pulmonary complications were matched, including 71 males and 29 females aged 66.2±5.0 years. There was no significant difference in the preoperative data between the two groups (P>0.05). Compared to the patients with pulmonary complications, the ICU stay was shorter (8.1±4.4 h vs. 12.9±7.5 h, P＜0.001), the first out-of-bed activity time was earlier (8.8±4.5 h vs. 11.2±6.1 h, P=0.002), and the tube incubation time was shorter (19.3±9.2 h vs. 22.5±9.4 h, P=0.015) in the patients wihout pulmonary complications. There was no statistical difference in other perioperative data between the two groups (P>0.05). The mean daily step counts in the pulmonary complications group were significantly less than that in the non-pulmonary complications group (4 745.5±2 190.9 steps vs. 6 821.1±2 542.0 steps, P＜0.001). The daily step counts showed an upward trend for three consecutive days in the two groups, but the difference was not significant. Conclusion The decline of preoperative mean daily step counts is related to pulmonary complications after thoracoscopic lobectomy in elderly patients. Recording daily step counts can promote preoperative active exercise training for hospitalized patients.
ObjectiveTo analyze the effect of different drainage modes on the postoperative thoracic drainage after video-assisted thoracoscopic surgery for radical resection of lower lung carcinoma.MethodsA total of 183 patients with non-small cell lung cancer who received biportal thoracoscopic anatomical lower lobectomy combined with mediastinal lymph node dissection in the First Affiliated Hospital of Xi'an Jiaotong University from August 2017 to August 2019 were enrolled, including 113 males and 70 females, aged 31-77 (56.5±6.4) years. The patients were randomly divided into three groups, including an anterior axillary line group, a mid-axillary line group and a modified anterior axillary line group. Clinical efficacy of the three groups was compared.ResultsNo significant difference among these three groups in terms of gender, age, surgical site, pathological type, pathological staging, postoperative chest wall subcutaneous emphysema, postoperative pain score, and postoperative hospital stay was found (P>0.05). There were significant differences among the patients in terms of postoperative pleural effusion, re-insertion of chest tube or aspiration, total liquid quantity of thoracic drainage, drainage time and chest wall incision stitches time (P<0.05). The anterior axillary line group had higher risk of postoperative pleural effusion than the other groups (P<0.05). The occurrence of postoperative pleural effusion and rate of reposition of chest tube or aspiration were significantly reduced in the modified anterior axillary line group (P<0.05).ConclusionChest drainage tube with large diameter (24F) in the 5th intercostal space of the anterior axillary line combined with another micro-tube (8.5F) in the 7th or 8th intercostal space of the inferior scapular angle line can shorten drainage time to reduce postoperative pain, reduce the occurrence of postoperative pleural effusion, and shorten the time of surgical incision stitches.
ObjectiveTo develop a score system to predict the probability of failure of monotherapy in epilepsy patients with initial treatment, and then provide pillars for early use of polytherapy.MethodsThis is a retrospective analysis of the clinical data of 189 patients with epilepsy treated in Department of Neurology, the Third Xiangya Hospital of Central South University from January 2019 to July 2020. Patients were divided into monotherapy acceptable group and monotherapy poor effect group according to their drug treatment plan and drug efficacy. The influencing factors were screened out by single factor analysis and binary logistic regression analysis. And on the basis of this β value, a quantitative scoring table for predicting the unsatisfying treatment effect of monotherapy is developed. And the receiver operating curve (ROC curve) was used to evaluate the effectiveness of the scale.ResultsBased on a standard of 75% reduction in seizures during the observation period, 138 cases (73%) were effective with monotherapy plan, while 51 cases (23%) were unsatisfactory. Regression analysis showed that multiple forms of seizures, status epilepticus (t2), brain damage, and the number of seizures ≥ 7 times before treatment are independent risk factors for poor outcome of monotherapy. The resulting score sheet has a total score of 12 points; the area under the ROC curve is 0.779, and the critical score is 6 points (sensitivity: 0.314; specificity: 0.957). Patients with more than this score have a strong probability of poor response in monotherapy.ConclusionThis prediction model can effectively assess the risk of unsatisfactory therapeutic effect of monotherapy in epilepsy patients who are initially treated, and thus has reference function for the early selection of polytherapy.
Objective To investigate the changes of microRNA-150 ( miR-150) in peripheral blood leukocytes in sepsis patients, and their relationship with expression of immune cytokines and sepsis severity. Methods The level of mature miR-150 was quantified by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and normalized to that of control miRNA, U6, in peripheral blood leukocytes of 40 patients with sepsis, 20 patients with systemic inflammatory response syndrome ( SIRS) , and 20 normal individuals. Serum concentrations of tumor necrosis factor alpha (TNF-α) and interleukin-10 (IL-10) were measured by enzyme-linked immunoabsorbent assay in all subjects. The sequential organ failure assessment ( SOFA) score systemwas used to evaluate the severity of sepsis. The relationships between miR-150 and the white blood cell count ( WBC) , TNF-α, IL-10 and SOFA score of the sepsis patients were analyzed. Results MiR-150 was stable for at least 5 days when specimen stored at 4 ℃ and the determination of miR-150 had a broad linear detecting range ( 6. 97-6. 97 ×104 pg/ μL RNA, the lowest detecting limit: 6. 97 pg/μL RNA,r=0.999) .MiR-150 expression in the peripheral blood leukocytes in the sepsis group was significantly lower than that in the healthy control group ( Plt;0.01) , while WBC, IL-10 and IL-10/TNF-α ratio were significantly higher ( Plt;0.05) . There was no significant difference in levels of miR-150, IL-10, IL-10/TNF-α ratio, and WBC between the sepsis group and the SIRS group (Pgt;0.05) . There was no significant difference in serum concentrations of TNF-α among three groups ( Pgt;0.05) . MiR-150 expression in non-survivor sepsis patients was significantly lower than that in survivor sepsis patients (Plt;0.05) , while serum IL-10 and IL-10/TNF-αratio were significantly higher (Plt;0.01) , but there was no significant difference in serum TNF-α between the non-survivor group and the survivor group ( Pgt;0.05) . There was significantly negative correlation between miR-150 and SOFA score, TNF-α and IL-10( r=-0. 619, - 0.457, -0. 431, Plt;0.05, respectively) , but no correlation between miR-150 and WBC ( r =-0. 184, Pgt;0.05) . There was no relationship between serum TNF-α, IL-10, IL-10 /TNF-α ratio or SOFA score ( Pgt;0.05) . Conclusions MiR-150 expression in the peripheral blood specimens is significantly decreased in sepsis patients. The expression level of miR-150 not only reflect the situation of inflammatory response, but also may be used as a prognostic marker in sepsis, as it can reflect the severity of sepsis in certain degree.
Objective
To investigate the correlation between the initial arterial blood lactic acid and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score in trauma patients and its value in prognosis.
Methods
From August 1st 2015 to July 31st 2016, the clinical data of trauma patients treated in Department of Emergency were analyzed retrospectively. All patients were divided into survival group and death group by observing 28-day prognosis. We compared the relationship between the initial blood lactate level and APACHEⅡ score, and analyzed the relationship between the above indexes and the prognosis of the patients.
Results
A total of 743 patients were enrolled, with692 in survival group and 51 in death group.The APACHEⅡ score and initial blood lactate level in the survival group [(9.93±4.62) points, (2.02±1.44) mmol/L] were significantly lower than those in the death group [(22.84±7.26) points, (4.60±3.69) mmol/L] with significant differences (t=18.20, 9.77; P<0.01). The APACHEⅡ score and the mortality rate of patients with lactic acid level >4 mmol/L were significantly higher than those of patients with lactic acid of 2-4 mmol/L and <2 mmol/L; the differences were significant (P<0.05). The blood lactate and mortality in patients with APACHEⅡ score >20 were significantly higher than those in the patients with ≤10 and 11-20; the differences were significant (P<0.05). There was a significant positive correlation between initial blood lactate level and APACHEⅡ score (r=0.426, P<0.01).
Conclusions
The initial blood lactate level and APACHEⅡ score of trauma patients are correlated with the severity of injury and mortality. Both of the increase of initial blood lactic acid level and APACHEⅡ score suggest the risk of death in trauma patients.
ObjectiveTo systematically review the implant survival and postoperative aesthetics of immediate versus delayed implant treatment in the anterior maxilla regions.MethodsWe searched databases including PubMed, The Cochrane Library, EMbase, CBM, CNKI and WanFang Data from inception to April 2017, to collect randomized controlled trials (RCTs) and cohort studies on immediate implant and delayed implant in the anterior teeth areas. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used to perform meta-analysis.ResultsA total of 4 RCTs and 12 retrospective cohort studies involving 1 316 implants were finally included. The results of meta-analysis showed that: there was no significant difference between two groups in retention rate (RCT: RR=0.99, 95%CI 0.97 to 1.02, P=0.70; retrospective cohort study: RR=0.99, 95%CI 0.96 to 1.02, P=0.54), the implant stability of permanent restoration for 4 months (MD=0.82, 95%CI –0.11 to 1.76, P=0.08), alveolar bone resorption of long-term permanent crown restoration (12 months: RCT: MD=0.06, 95%CI –0.35 to 0.47, P=0.79; retrospective cohort study: MD=–0.27, 95%CI –0.57 to 0.03, P=0.07; 24 months: retrospective cohort study MD=–0.09, 95%CI –0.18 to 0.00, P=0.05), respectively. The immediate implant group was superior to the control group in alveolar bone resorption of short-term permanent crown restoration (3 months: MD=–0.08, 95%CI –0.13 to –0.04, P=0.000 1; 6 months: MD=–0.23, 95%CI –0.38 to –0.07, P=0.004). The PES score in the immediate implant group was higher than that in the delayed implant group(MD=1.12, 95%CI 0.11 to 2.13, P=0.03).ConclusionsCurrent evidence shows that both immediate and delayed implant procedures have similar outcomes in terms of implant retention, long-term stability and long-term alveolar bone resorption of the implants in the anterior maxilla regions, but the former procedure possesses better short-term reduction of alveolar bone absorption and postoperative gingival aesthetics. Furthermore, due to the limited quality and quantity of the included studies, more large-scale and high-quality studies are needed to verify the above conclusions.
