Objective To study the relationship between the changes of short-term health-related life quality and the improvement/deterioration of forced expiratory volume in one second (FEV1) in patients with chronic obstructive pulmonary disease (COPD), and explore the feasibility of planning the frequency of pulmonary function test by evaluating the changes of life quality of COPD patients. Methods Based on the change of FEV1 (△FEV1), COPD patients from the standardized COPD and asthma management project database and its extended database of the center for chronic airway disease management, from 2020 to now, who completed pulmonary function tests and St. George's Respiratory Questionnaire (SGRQ) twice with an interval of 28 days, were divided into △FEV1 improvement group, △FEV1 deterioration group and △FEV1 maintenance group. The differences of SGRQ scores in different △FEV1 groups were analyzed, and the high-risk factors of △FEV1 deterioration group and the importance of influencing factors of △FEV1 deterioration were analyzed by neural network. Results A total of 1233 patients were included in the analysis. There were significant differences in △SGRQ total score, △SGRQ symptom, △SGRQ activity and △SGRQ impacts among △FEV1 groups (P<0.05). Compared with the △FEV1 maintenance group, the △FEV1 improvement group showed clinically significant improvement in both the total SGRQ score and each sub score, and the improvement value was more than 4 points. While the △FEV1 deterioration group showed statistically significant difference in the total SGRQ score and each sub score, but only showed clinically significant deterioration in the SGRQ symptom sub evaluation. Logistic regression model showed that the risk factors of △FEV1 deterioration included female (OR=2.11, 95%CI 1.23 - 3.59, P=0.006), baseline FEV1 (OR=2.63, 95%CI 1.92 - 3.60, P<0.001), △SGRQ (OR=1.02, 95%CI 1.01 - 1.03, P<0.001), baseline SGRQ symptom (OR=1.02, 95%CI 1.01 - 1.02, P<0.001) and △SGRQ symptom (OR=1.02, 95%CI 1.01 - 1.03, P<0.001), further neural network analysis showed that the importance orders of the five variables were △SGRQ total score (100.0%), △SGRQ symptom (86.9%), baseline FEV1 (71.4%), baseline SGRQ symptom (56.6%) and gender (29.6%). Conclusions The variables of short-term health-related life quality assessment of COPD patients are helpful to predict the changes of pulmonary function improvement, but the ability to predict the changes of pulmonary function deterioration is limited. For patients with no changes or improvement in short-term health-related life quality assessment, it is still recommended to increase the frequency of pulmonary function test in order to detect the deterioration of pulmonary function early.
Objective To investigate the clinical characteristics of upper airway cough syndrome ( UACS) and the relationship of UACS with upper airway diseases, cough variant asthma ( CVA) , and gastroesophageal reflux disease ( GERD) . Methods 92 subjects with chronic cough and throat symptoms and signs were included in the study. The medical records were collected fromall subjects, and 49 subjects suspected for CVA undertook bronchial provocation test. Then the efficacy was evaluated and etiology were analyzed based on the efficacy of targeted treatment. Results Bronchial provocation test yielded positive results in 14 subjects suspected of CVA, accounting for 15. 2% of all cases ( 14/92) . 18. 5% ( 17 /92) of patients had a history of chronic gastritis or combined symptoms of GERD, of whom anti-gastroesophagealreflux treatment was effective. The patients with rhinitis, sinusitis history and/ or symptoms accounted for 33. 7% of cases ( 31 cases) . 51. 1% ( 47/92) of patients had only signs and symptoms of chronic pharyngitis. Conclusions UACS is not only due to the rhinitis and/ or sinusitis but also chronic pharyngitis. Chronic pharyngitis may be secondary to chronic rhinitis/ sinusitis with post nasal drip and gastroesophageal reflux, also may be an independent cause of chronic cough.
Objective To investigate the different clinical features of chronic cough induced by rhinitis /sinusitis or gastro-esophageal reflux, and its significance for etiological diagnosis of chronic cough.Methods Chronic cough patients were recruited from respiratory medicine clinic in Chongqing Xinqiao Hospital from December 2009 to December 2010. Medical history, symptoms and signs were recorded from all selected patients. The patients with chronic rhinitis / sinusitis, but without gastro-esophageal reflux symptoms were suspected upper airway cough syndrome ( UACS) , and given chlorpheniramine, nasal decongestant, and corticosteroid treatment for 1 week. The patients with clinical symptoms associated with gastroesophageal reflux or with history of gastric diseases were suspected gastroesophaged reflux-related cough ( GERC) , were given esomeprazole ( 40 mg, bid) , combined prokinetic agent for 2 weeks. The patients were confirmed the diagnosis of UACS or GERC when their cough was relieved after the above targeted treatment.Results 114 patients were enrolled in this study. 47 patients were suspected GERC, of which 32 were confirmed, and 67 patients were suspected UACS, of which 43 were confirmed. There was no significant difference in age, duration of disease, severity of cough, proportion of night cough, proportion of clear throat symptom, or proportion of cobblestone sign between the UACS patients and the GERC patients ( P gt;0. 05) .There were more females in the GERC patients and more males in the UACS patients ( P lt; 0. 05) . Cough with sputum, throat symptoms and signs were more common in the UACS patients ( P lt;0. 05) . The hoarseness and sore throat symptoms were found only in the GERC patients, but postnasal drip symptoms were found only in the UACS patients. Conclusions Throat signs and symptoms are not completely similiar in the GERC and the UACS patients. Comprehensive judgments combining with patient history,characteristics of concurrent cough, throat symptoms, and signs can provide important references for the clinical diagnosis of chronic cough caused by rhinitis/ sinusitis or gastro-esophageal reflux.
ObjectiveTo compare the effectiveness and safety of preoperative lung localization by microcoil and anchor with scaled suture.MethodsA total of 286 patients underwent CT-guided puncture localization consecutively between October 2019 and December 2020 in our hospital. According to the different methods of localization, they were divided into a microcoil group (n=139, including 49 males and 90 females, aged 57.92±10.51 years) and an anchor group (n=147, including 53 males and 94 females, aged 56.68±11.31 years). The clinical data of the patients were compared.ResultsA total of 173 nodules were localized in the microcoil group, and 169 nodules in the anchor group. The localization success rate was similar in the two groups. However, the anchor group was significantly better than the microcoil group in the localization time (8.15±2.55 min vs. 9.53±3.08 min, P=0.001), the pathological receiving time (30.46±14.41 min vs. 34.96±19.75 min, P=0.029), and the hemoptysis rate (10.7% vs. 30.1%, P=0.001), but the pneumothorax rate was higher in the anchor group (21.3% vs. 11.0%, P=0.006).ConclusionPreoperative localization of small pulmonary nodules using anchor with suture is practical and safe. Due to its simplicity and convenience, it is worth of promotion in the clinic.
ObjectiveTo analyze the recent clinical results of emergency conversion of transcatheter aortic valve replacement (TAVR) to surgery, and summarize the clinical experience. Methods The clinical data of patients who underwent TAVR emergency conversion surgery in the Department of Cardiovascular Surgery of the Second Hospital of Hebei Medical University from 2018 to 2023 were collected, and the results of 1-month follow-up after surgery were recorded. Results Totally 253 patients underwent TAVR, and 11 patients underwent emergency conversion to surgery, with an emergency conversion rate of 4.3%. Among the 11 patients, 7 were males and 4 were females, with an average age of 69.55±5.01 years. The causes of urgent conversion to surgery in TAVR were valve stent displacement (63.6%), left ventricular perforation and rupture (18.2%), and a large amount of perivalvular reflux (18.2%) after the insertion of the second valve. One patient died intraoperative, with a perioperative mortality rate of 9.1%. Among the 10 surviving patients, 8 had pulmonary infection, 7 severe pneumonia, 3 pleural effusion, 8 liver function injury, 3 renal function injury, 5 upper gastrointestinal bleeding, 1 cerebrovascular complications, 1 atrial fibrillation, 1 ventricular premature contraction, 1 atrioventricular block, and 3 complete left bundle branch block. After one month of postoperative follow-up, one patient died. The 30-day mortality rate after TAVR emergency conversion surgery was 18.2%, and the quality of life of 9 patients (81.8%) improved significantly compared to before surgery. There were no readmission patients with cardiovascular system diseases. Conclusion The incidence of emergency conversion to surgery in TAVR is low, but the incidence of surgical complications is high, and the 30-day postoperative mortality rate is also high. When severe complications occur during TAVR surgery, emergency conversion to surgical surgery can still bring good early clinical results for most patients.
ObjectiveTo investigate the new-onset conduction block after transcatheter aortic valve replacement (TAVR) and summarize the relevant experience. Methods The perioperative data of TAVR patients in the Second Hospital of Hebei Medical University from 2016 to 2023 were collected, and the new-onset incidence of conduction block after TAVR was analyzed retrospectively. ResultsThere were 352 patients of TAVR operation (256 patients of Venus-A, 69 patients of Vita-Flow, 27 patients of J-Valve), among whom 38 (10.8%) patients of new-onset postoperative block. There were 6 (1.7%) patients of new-onset postoperative grade Ⅲ atrioventricular block, including 5 (2%) patients of Venus A and 1 (1.4%) patient of Vita-Flow. Conduction function was restored in 2 patients within 14 days after surgery, and failed to be restored in 4 patients, who then received permanent pacemaker implantation in the department of cardiology. There were 27 (7.7%) patients of new left bundle branch block after surgery, including 22 (8.6%) patients of Venus-A , 4 (5.8%) patients of Vita-Flow and 1 (3.7%) patient of J-Valve; and conduction function was restored within 7 days after surgery in 23 patients, and 5 (1.4%) patients developed new right bundle branch blocks after surgery including 4 (1.5%) patients of Venus-A and 1 (1.4%) patient of Vita-Flow. Conclusion New-onset block is a common complication after TAVR, the new-onset rate of left bundle branch block is the highest, followed by the grade Ⅲ atrioventricular block. Mastering reasonable methods and applying appropriate strategies can also effectively reduce the new rate of postoperative conduction block and improve the overall success rate of TAVR surgery.
Objective To evaluate the short-term efficacy of transcatheter aortic valve replacement (TAVR) using Venus A-Plus valve delivery system in patients with severe aortic stenosis. Methods The clinical data of patients undergoing TAVR in our hospital from August 2018 to March 2022 were collected and divided into a Venus A-PLUS and a Venus A group according to the type of valve delivery system used. The perioperative data of the two groups were compared. ResultsA total of 121 patients were included, including 70 patients in the Venus A-Plus group (45 males and 25 females with a mean age of 67.81±6.62 years), and 51 patients in the Venus A group (33 males and 18 females with a mean age of 68.25±7.01 years). All patients underwent TAVR, and the postoperative hemodynamic features (left ventricular ejection fraction, mean cross-valve pressure difference, peak flow rate) were significantly improved (P<0.05). There was no statistical difference in surgical success rate, all-cause mortality, conversion to thorax opening, midvalve placement, moderate or above perivalvular regurgitation, new left bundle branch block or new right bundle branch block between the two groups (P>0.05). Conclusion TAVR with Venus A-Plus valve delivery system in patients with severe aortic stenosis is satisfactory, safe and reliable.
Objective To investigate the clinical characteristics of neutrophilic asthma ( NA) .Methods NA patients were collected from the out-patient and in-patient departments of Respiratory Diseases of Xinqiao Hospital between January 2010 and December 2010. The results of the medical records,pulmonary function tests, and induced sputum cytology were analyzed retrospectively. Results The NA patients with neutrophil percent ≥ 61% accounted for 33. 1% ( 51 /154 ) of all the asthmatics patients detected by induced sputumin the same period, and 45 cases with complete records were included. Of the 45 cases recruited, 20 cases ( 44. 4% ) were in-patients,2 cases ( 4. 4% ) were with controlled asthma, 3 cases ( 6. 7% ) were with cough variant asthma, 30 cases ( 66. 7% ) were female, 12 cases ( 26. 7% ) were atopic patients, and 27 cases ( 60% ) had acute exacerbation. The age of onset of 35 patients ( 77. 8% ) were after 12 years. FEV1% pred lt; 60% and gt; 80% was obtained in 55. 9% ( 19/34) and 14. 7% ( 5 /34) of patients respectively. The result of bronchodilator test was positive in 64% ( 16/25) of patients, and mean increase in FEV1 was 11. 7% . The percentage of neutrophil and eosinophil was ( 74. 5 ±9. 1) % and ( 2. 4 ±2. 5) % respectively in induced sputum, and 35. 6% ( 16/45) of the patients had increased eosinophil percentage ( gt;3% ) . Conclusions In our study, most of NA is severe and acute exacerbation asthma, and its clinical features are various. The mechanismand clinical significance of increased neutrophils in asthmatic patients are unclear and more studies are needed.