Objective To summarize the clinical manifestations, diagnosis and treatment of severe primary graft dysfunction ( PGD grade 3 ) in early stage after lung transplantation. Methods From September 2002 to December 2010, there were 10 patients with severe PGD ( grade 3) in early stage after lung transplantation ( LTx) in 100 patients with end-stage lung disease underwent LTx in Wuxi People’s Hospital. In which there were 2 cases with chronic obstructive pulmonary disease, 4 with idiopathic pulmonary fibrosis,1 case with lung tuberculosis, 1 case with silicosis, 2 cases with bronchiectasis. There were 7 patients with single LTx [ 3 cases with extracorporeal membrane oxygenation ( ECMO) support] and 3 patients with bilateral LTx ( 1 case with ECMO support) . Results The surgical procedures of these 10 patients were successful, however severe PGD occurred on 1-5 days after operation. 4 cases died of respiratory failure with negative fluid balance and mechanical ventilation support, and 2 cases recovered. 4 cases underwent ECMO support, in which 2 cases successfully weaned from ECMO and discharged from hospital, others died of multiple organ failure.Conclusions Severe PGD is one of the fatal early complication after lung transplantation. Early diagnosis and treatment are very important to improve the perioperative mortality rate.
Abstract: Objective To evaluate the clinical effects and health economics of lung volume reduction surgery（LVRS）, single lung transplantation（SLTx） and bilateral lung transplantation（BLTx） for patients with end-stage emphysema. Methods A total of 61 patients with end-stage emphysema, including 39 patients who underwent LVRS（LVRS group）, 14 patients who underwent SLTx（SLTx group）, and 8 patients who underwent BLTx（BLTx group） from September 2002 to August 2008 in Wuxi People’s Hospital, were analyzed retrospectively. Lung function, arterial blood gas analysis and 6-minute walk distance（6-MWD）were assessed before their surgery and 6 months, 1-year and 3-year after their surgery respectively. Their 1-year and 3-year survival rates were observed. Cost-effectiveness analyses were made from a health economics perspective. Results Compared with their preoperative results, their mean forced expiratory volume in 1 second（FEV1.0）in LVRS group increased by 75%, 83% and 49% at 6 months, 1-year and 3-year postoperatively, by 176%, 162% and 100% in SLTx group, and by 260%, 280% and 198% in BLTx group respectively. Their mean forced vital capacity（FVC）in LVRS group increased by 21%, 41% and 40% at 6 months, 1-year and 3-year postoperatively, by 68% , 73% and 55% in SLTx group, and by 82%, 79% and 89% in BLTx group respectively. Their exercise endurance as measured by 6-MWD increased by 75%, 136% and 111% in LVRS group at 6 months, 1-year and 3-year postoperatively, by 513%, 677% and 608% in SLTx group, and by 762%, 880% and 741% in BLTx group respectively. The 1-year and 3-year survival rates after operation were 74.40% and 58.90% in LVRS group, 85.80% and 64.30% in SLTxgroup, and 62.50% and 50.00% in BLTx group respectively. The three years’ cost utility of SLTx group was significantly higher than that of BLTx group（1 668.00 vs.1 168.55, P＜ 0.05）and LVRS group （1 668.00 vs. 549.46, P＜ 0.05）. Conclusion SLTx and BLTx are better than LVRS in improving patients’ lung function and exercise endurance for end-stage emphysema patients. LVRS is more cost-effective than SLTx and BLTx in the early postoperative period. With the development of medical technology and decreased expenses of lung transplantation and immunosuppressive agents, lung transplantation will become the first surgical choice for end-stage emphysema patients.
Abstract: Objective To compare the multiple organ dysfunction score (MODS), the sequential organ failure assessment (SOFA), the acute physiology, age, and chronic health evaluation system Ⅱ(APACHE Ⅱ), the acute physiology, age, and chronic health evaluation system Ⅲ(APACHE Ⅲ) in evaluating risks for patients after cardiac surgery, in order to provide better treatment and prediction of prognosis after cardiac operation. Methods A prospective study was carried out on 1 935 cardiac postoperative patients, including 1 050 males and 885 females, enrolled in cardiac postoperative intensive care unitof Anzhen hospital between October 2007 and April 2008. The age of the patients ranged from 18 to 86 years with the mean age of 53.96 years. The patients underwent the surgery because of various cardiac diseases including coronary heart disease, valve disease, congenital heart disease, aortic aneurysm, pericardial disease, atrial fibrillation, and pulmonary embolism. We used MODS, SOFA, APACHE Ⅱ, and APACHE Ⅲ respectively to calculate the value of the first day after operation, the maximum value during the first three days, the maximum value, and the change of the value between the third day and the first day for every patient, and then we compared the calibration and discrimination of these different systems using HosmerLemeshow goodnessoffit analysis and Receiver Operating Characteristic (ROC) curve. Results There were 47 perioperative deaths because of circulating system failure, respiration failure, kidney failure, liver failure or nervous system diseases. The death rate was 2.43%. In discrimination analysis, the area under the curve (AUC) in ROC of the first day value after operation, the maximum value, the maximum value during the first three days, and the change of value between the third day and the first day for MODS were respectively 0.747, 0.901, 0.892, and 0.786; for SOFA were respectively 0.736, 0.891, 0.880, and 0.798; for APACHE Ⅱ were respectively 0.699, 0.848, 0,827, and 0.562; for APACHE Ⅲ were respectively 0.721, 0.872, 0.869, and 0.587. In calibration analysis, we compared the χ2 value of the first day value, the maximum value, the maximum value during the first 3 days, and the change of value between the third day and the first day of these systems. χ2 value of MODS was 4.712, 5.905, 5.384, and 13.215; χ2 value of SOFA was 8.673, 3.189, 3.111, and 14.225; χ2 value of APACHE Ⅱ was 15.688, 10.132, 8.061, and 42.253; χ2 value of APACHE Ⅲ was 13.608, 11.196, 19.310, and 47.576. AUC value of MODS and SOFA were all larger than those of APACHE Ⅱ and APACHE Ⅲ (Plt;0.05); AUC value of APACHE Ⅱ was smaller than that of APACHE Ⅲ (Plt;0.05). Conclusion MODS, SOFA, APACHE Ⅱ and APACHE Ⅲ are all applicable in evaluating risks for patients after cardiac surgery. However, MODS and SOFA are better than APACHE Ⅱ、APACHE Ⅲ in predicting mortality after cardiac surgery. In cardiac surgery, the complicated APACHE Ⅱ and APACHE Ⅲ systems can be replaced by MODS and SOFA systems which are simpler for use.
Objective To evaluate the primary cl inical effect of proximal femoral nail anti-rotation (PFNAR) in treating femoral intertrochanteric fractures, to summarize operation skills and to analyze correlated curative effective influentialfactors. Methods From July 2006 to May 2007, 19 cases of intertrochanteric fractures (including 8 males, 11 females, aged45-87 years old) were treated with closed reduction and PFNAR fixation. Fractures were caused by fall ing. The locations were left sides in 10 cases and right sides in 9 cases. According to AO classification, there were 14 cases of type A2 and 5 cases of type A3. Operative time, volume of blood loss and weight bear time were analyzed, the condition of fracture union was observed and the hip function was evaluated using Harris criterion after 9 months of follow-up. Results Operative time ranged 23-78 minutes with an average time of 47 minutes, the volume of blood loss ranged 50-120 mL with an average volume of 85 mL, getting-outof- bed time ranged 2-14 days with an average time of 7.4 days; the weight bearing time ranged 10-14 weeks with an average time of 12.4 weeks. No intra-operative femoral fractures and no regional or deep infection occurred during hospital ization period. Seventeen cases were followed up from 3 months to 12 months with an average time of 9.4 months, and achieved bone heal ing within 15-18 weeks with an average time of 16.5 weeks. No compl ications such as delay heal ing, coxa vara or coxa valga, cut-out and screw extraction occurred. Fifteen cases were followed up over 9 months; according to the Harris criterion for evaluation, the results were excellent in 13 cases, good in 1 case and fair in 1 case, the excellent and good rate was 93.3%. Conclusion PFNAR has the advantages of micro invasion, easy-to-perform, less blood loss, less bone loss and stable fixation in treatment of unstable comminuted intertrochanteric fracture, especially in old patients with osteoporosis.
Objective To summarize the effect of self-setting CPC on the repair of bone defect after tumor resection in children. Methods From December 1998 to December 2006, 32 patients with benign bone tumor were treated, and the bonedefect was repaired by CPC. Among them, there were 21 males and 11 females, aged 4-14 years old (9.8 on average). The course of disease was 3-18 months. There were 12 cases of non-ossifying fibroma, 8 of bone cyst, 7 of osteoid osteoma and 5 of fibrous dysplasia. The bone defect was located in femur in 15 cases, in tibia in 8 cases, in humerus in 6 cases and in other positions in 3 cases. The range of bone defect was 2.0 cm × 1.5 cm × 1.0 cm - 10.0 cm × 5.0 cm × 4.0 cm. CPC spongiosa granules of 3-23 g were filled in 26 cases, including 3 children with pathologic fracture and internal fixation with plate, and injectable CPC of 5-20 mL was filled in 6 bone cyst cases. Results Thirty-two patients obtained heal ing by first intertion. All the patients were followed up for 12-48 months (23.5 months on average). No allergic reaction, toxicity, rash or high fever was found after operation. There was no pain or pruritus at the incisions. The X-ray films showed that the implanted CPC began to fuse with the host bone 4-9 months (7 month on average) after operation. The internal fixation was removed within 6-12 months of operation. And CPC spongiosa granules were absolutely absorbed within 8-36 months of operation. However, injectable CPC could be found 4 years after operation. The children’s l imbs could do normal exercises. Finally, bone matrix grew well and no recurrence was found. Conclusion CPC in repairing bone defect after benign bone tumor in children is a safe, economical, convenient and non-toxic method.
Objective To investigate the applied significance of adjustable low-concentration of mixed oxygenand nitrous oxide inhalation sedation combined with lidocaine local anesthesia in anorectal surgery. Methods Three hundreds patients underwent anorectal surgery in our hospital were divided into control group （n=154） and observation group （n=146）. Patients of control group underwent pure lidocaine local anesthesia， and patients of observation group underwent mixed oxygen and nitrous oxide sedation analgesia combined with lidocaine local anesthesia. Vital signs before and after operation as well as results of sedation and analgesia were compared between the 2 groups. Results Anorectal surgeries of all patients were performed successfully. There were no significant differences on change of heart rate， blood pressure， and oxygen saturation between the 2 groups before and after operation （P＞0.05）. The operation time between the control group 〔（36.3±6.8） min〕 and observation group 〔（35.4±6.5） min〕 had no statistically significant difference（t=-0.607， P=0.544）. The analgesic effects （Z=-6.859， P=0.000） and sedative effects （Z=-5.275， P=0.000） of obser-vation group were both better than those of control group. Conclusions Low-concentration of mixed oxygen and nitrous oxide inhalation sedation combined with lidocaine local anesthesia can relieve the discomfort of fear and pain， no side-impacts on vital sign before and after operation were observed，and it has better effects of sedation and analgesia， therefore it can be recommended to clinical application.
Objective To investigate the ability of gene-loaded lipopolysaccharide-amine nanopolymersomes (LNPs) in inducing osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) by in vitro gene transfection, where LNPs were used as a non-viral cationic carrier, and their properties were optimized during synthesis. Methods LNPs were synthesized by a graft-copolymerization method, and the effects of different pH environments during synthesis on physicochemical properties of LNPs and LNPs/plasmid of bone morphogenetic protein 2-green fluorescent protein (pBMP-2-GFP) complexes were explored. Then, optimized LNPs with maximum transfection efficiency and safe cytotoxicity in rat BMSCs were identified by cytotoxicity and transfection experiments in vitro. Thereafter, the optimized LNPs were used to mediate pBMP-2-GFP to transfect rat BMSCs, and the influences of LNPs/pBMP-2-GFP on osteogenic differentiation of BMSCs were evaluated by monitoring the cell morphology, concentration of BMP-2 protein, activity of alkaline phosphatase (ALP), and the formation of calcium nodules. Results The nitrogen content, particle size, and zeta potential of LNPs synthesized at pH 8.5 were lower than those of the other pH groups, with the lowest cytotoxicity (96.5%±1.4%) and the highest transfection efficiency (98.8%±0.1%). After transfection treatment, within the first 4 days, BMSCs treated by LNPs/pBMP-2-GFP expressed BMP-2 protein significantly higher than that treated by Lipofectamine2000 (Lipo)/pBMP-2-GFP, polyethylenimine 25K/pBMP-2-GFP, and the blank (non-treated). At 14 days after transfection, ALP activity in BMSCs treated by LNPs/pBMP-2-GFP was higher than that treated by Lipo/pBMP-2-GFP and the blank, comparable to that induced by osteogenic medium; with alizarin red staining, visible calcium nodules were found in BMSCs treated by LNPs/pBMP-2-GFP or osteogenic medium, but absent in BMSCs treated by Lipo/pBMP-2-GFP or the blank with apoptosis. At 21 days after transfection, transparent massive nodules were discovered in BMSCs treated by LNPs/pBMP-2-GFP, and BMSCs exhibited the morphologic features of osteoblasts. Conclusion LNPs synthesized at pH 8.5 has optimal transfection efficiency and cytotoxicity, they can efficiently mediate pBMP-2-GFP to transfect BMSCs, and successfully induce their directional osteogenic differentiation, whose inducing effect is comparable to the osteogenic medium. The results suggest that gene transfection mediated by LNPs may be a convenient and effective strategy in inducing directional differentiation of stem cells.
As an important means of treating heart failure (HF), cardiac assist device has been widely used in clinic. This paper reviews the application status, existing problems and future development trend of cardiac assist devices, including the classification of cardiac assist devices, representative research achievements and indications of the assist devices. It also summarizes the biomechanical indexes of the heart and the new approaches and methods for treating heart failure, as well as the hemodynamic studies of cardiac assist devices in recent years. The research findings provide references for further optimization of cardiac assist device structure and clinical application of the device.
China is facing the peak of an ageing population, and there is an increase in demand for intelligent healthcare services for the elderly. The metaverse, as a new internet social communication space, has shown infinite potential for application. This paper focuses on the application of the metaverse in medicine in the intervention of cognitive decline in the elderly population. The problems in assessment and intervention of cognitive decline in the elderly group were analyzed. The basic data required to construct the metaverse in medicine was introduced. Moreover, it is demonstrated that the elderly users can conduct self-monitoring, experience immersive self-healing and health-care through the metaverse in medicine technology. Furthermore, we proposed that it is feasible that the metaverse in medicine has obvious advantages in prediction and diagnosis, prevention and rehabilitation, as well as assisting patients with cognitive decline. Risks for its application were pointed out as well. The metaverse in medicine technology solves the problem of non-face-to-face social communication for elderly users, which may help to reconstruct the social medical system and service mode for the elderly population.
Objective To evaluate the effect of day surgery with diagnosis-related groups (DRG) evaluation indicators. Methods The inpatients undergoing surgery in Beijing Tongren Hospital of Capital Medical University between March and September 2022 were enrolled in this study. The medical quality, medical efficiency, hospitalization cost, DRG insurance payment and other DRD-related indicators were retrospectively collected and compared between day surgery patients and non-day surgery patients, and the average length of hospital stay and hospitalization costs were compared between the two surgery modes within DRGs. Chi-square test was used for enumeration data, and t-test and Mann-Whitney U test were used for measurement data. Results A total of 29339 day surgery patients and 19019 non-day surgery patients were enrolled. In the day surgery group, the proportions of local patients (71.71% vs. 68.62%), routine discharge (99.93% vs. 99.78%), and class A incisions (99.92% vs. 99.55%) were better than those in the non-day surgery group (P<0.05), and the average length of hospital stay [(1.00±0.00) vs. (6.98±5.00) d] and the average hospitalization costs [(7306.62±4605.73) vs. (24913.97±24623.54) yuan] were lower than those in the non-day surgery group (P<0.05). The top 2 reduction of average length of hospital stay were in the CB49 group and CB39 group, decreasing by 87.45% and 86.24%, respectively. The top 2 reduction of hospitalization costs were in the DC19 group and CC15 group, decreasing by 84.15% and 73.61%, respectively. DRG payment balance of medical insurance in the day surgery group was higher than that in the non-day surgery group (22.95% vs. 5.98%). Conclusions Day surgery not only ensure the medical quality, but also shorten the length of hospital stay and reduce the burden of medical expenses. Day surgery can effectively improve the utilization efficiency of hospital bed resources, it is an effective measure to promote the high quality development of hospital and comply with DRG payment reform.