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.
Mass point-spring model is one of the commonly used models in virtual surgery. However, its model parameters have no clear physical meaning, and it is hard to set the parameter conveniently. We, therefore, proposed a method based on genetic algorithm to determine the mass-spring model parameters. Computer-aided tomography (CAT) data were used to determine the mass value of the particle, and stiffness and damping coefficient were obtained by genetic algorithm. We used the difference between the reference deformation and virtual deformation as the fitness function to get the approximate optimal solution of the model parameters. Experimental results showed that this method could obtain an approximate optimal solution of spring parameters with lower cost, and could accurately reproduce the effect of the actual deformation model as well.
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.
ObjectiveTo discuss the feasibility and security of breast conserving surgery (BCS) in patients with multifocal/multicentric breast cancer (MMBC).MethodThe clinical trials about BCS in patients with MMBC at home and abroad in recent years were searched and reviewed.ResultsThe results of most retrospective clinical trials showed that BCS in patients with MMBC could achieve similar or at least as good results as mastectomy. However, for there were some inevitable bias in retrospective studies, the conclusion should be analyzed modestly. Two prospective multicenter randomized controlled trials, the MIAMI UK trial and the ACOSOG Z11102 trial, were still ongoing, of which results were expected to confirm these conclusions further. ConclusionsUnder the premise of mastering the indications, BCS would be a reasonable option for MMBC when incisal margin is negative and cosmetic result is satisfactory. In addition, the lack of standard classification and definition for multifocality and multicentricity increases the difficulty of the research, and the distance of the cancer foci and the ratio of tumor to breast volume in patients with MMBC might be the key factors affecting the efficacy of BCS. Therefore, more rational-designed prospective studies and accurate subgroup analysis are expected to provide impelling evidence for application of BCS in patients with MMBC.
Objective To evaluate the association between anesthesia regimen (volatile or intravenous anesthetics) and postoperative infection in adult cardiac patients undergoing cardiac surgery. MethodsThe clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed, including 251 females and 245 males with an average age of 54.1±11.4 years. American Society of Anesthesiologists grade was Ⅰ-Ⅲ. There were 243 patients in a volatile group with sevoflurane or desflurane, and 253 patients in an intravenous anesthesia group with propofol. The primary outcome was the incidence of infection within 30 days after cardiac surgery, including pulmonary infection, surgical site infection, sepsis, and urinary tract infection. The secondary outcomes were duration of mechanical ventilation, incidence of reintubation, ICU stay, postoperative length of hospital stay and total hospitalization cost. Results A total of 155 (31.3%) patients developed postoperative infection within 30 days, with an incidence of 32.9% in the volatile group and 29.6% in the intravenous anesthesia group. There was no statistical difference in the incidence of infection (RR=1.111, 95%CI 0.855 to 1.442, P=0.431) or the secondary outcomes (P>0.05) between the two groups. Conclusion The anesthesia regimen (volatile or intravenous anesthetics) has no association with the risk of occurrence of postoperative infection in adult patients undergoing elective cardiac surgery with cardiopulmonary bypass.
Objective To evaluate the effect of intraoperative fluid infusion volume on postoperative pulmonary complications (PPCs) in patients after minimally invasive endoscopic esophageal carcinoma resection. Methods From June 2019 to August 2021, 486 patients undergoing elective minimally invasive endoscopic esophagectomy for esophageal cancer were retrospectively screened from the electronic medical record information management system and anesthesia surgery clinical information system of West China Hospital of Sichuan University. There were 381 males and 105 females, with a median age of 64.0 years. Taking the incidence of pulmonary complications within 7 days after operation as the primary outcome, the correlation between intraoperative fluid infusion volume and the occurrence of PPCs within 7 days was clearly analyzed by regression analysis. ResultsThe incidence of pulmonary complications within 7 days after surgery was 33.5% (163/486). Regression analysis showed that intraoperative fluid infusion volume was correlated with the occurrence of PPCs [adjusted OR=1.089, 95%CI (1.012, 1.172), P=0.023], especially pulmonary infection [adjusted OR=1.093, 95%CI (1.014, 1.178), P=0.020], and pleural effusion [adjusted OR=1.147, 95%CI (1.007, 1.306), P=0.039]. Pulmonary infection was significantly less in the low intraoperative fluid infusion group [<6.49 mL/(kg·h), n=115] compared with the high intraoperative fluid infusion group [≥6.49 mL/(kg·h), n=371] (18.3% vs. 34.5%, P=0.023). Intraoperative fluid infusion volume was positively associated with death within 30 days after surgery [adjusted OR=1.442, 95%CI (1.056, 1.968), P=0.021]. Conclusion Among patients undergoing elective minimally invasive endoscopic esophageal cancer resection, intraoperative fluid infusion volume is related with the occurrence of PPCs within 7 days after the surgery, especially pulmonary infection and pleural effusion, and may affect death within 30 days after the surgery.