Six-minute walk test (6MWT) is one of the cardiopulmonary exercise testing (CPET). It is not only used to assess the cardiac and pulmonary function of patients with chronic obstructive pulmonary disease (COPD), but also used to assess COPD patients’ health-related quality of life (HRQoL) or self-management in daily life. With the concept of enhanced recovery after surgery (ERAS) put forward, assessing patients’ preoperative cardiac and pulmonary function, establishing preoperative and early postoperative exercises standards, as well as assessing cardiac and pulmonary rehabilitation after surgery become much more important. CPET gets more attention from clinical surgeons. This study focuses on the clinical value and status of 6MWT in thoracic surgery.
ObjectiveTo explore the role of preoperative evaluation indicators for decision-making on treatment modalities in papillary thyroid microcarcinoma (PTMC) with intermediate- and high-risk. MethodThe recent pertinent literatures on studies of risk factors influencing PTMC were collected and reviewed. ResultsThe surgical treatment was advocated for the PTMC with intermediate- and high-risk. However, the intraoperative surgical resection range and the postoperative prognosis of patients were debated. The malignancy of cell puncture pathology was a key factor in determining the surgical protocol. The patients with less than 45 years old at surgery, male, higher body mass index, higher serum thyrotropin level, and multifocal and isthmic tumors, and nodule internal hypoecho, calcification, unclear boundary, and irregular morphology by ultrasound, as well as mutations in BRAFV600E and telomerase reverse transcriptase gene were the risk factors for preoperative evaluation of PTMC with intermediate- and high-risk. ConclusionsAccording to a comprehensive understanding of preoperative risk factors for PTMC with intermediate- and high-risk, it is convenient to conduct an accurate preoperative evaluation and fully grasp the patients’ conditions. Clinicians should formulate individualized surgical treatment plans for patients based on preoperative assessment and their own clinical experiences.
ObjectiveTo observe the effect of comorbidity for patients with non-small cell lung cancer (NSCLC) on exercise tolerance and cardiopulmonary function. MethodsNSCLC patients who underwent cardiopulmonary exercise testing (CPET) before surgery were retrospectively included. According to the Charlson comorbidity index (CCI) score, patients were divided into two groups: a CCI≥3 group and a CCI＜3 group. The patients were matched with a ratio of 1 : 1 by propensity score matching according to the age, body mass index, sex, smoking histology, exercise habits, pathological stage and type of surgery. After matching, CPET indexes were compared between the two groups to explore the differences in exercise tolerance and cardiopulmonary function. ResultsA total of 276 patients were included before matching. After matching, 56 patients were enrolled with 28 patients in each group, including 38 (67.9%) males and 18 (32.1%) females with an average age of 70.7±6.8 years. Compared with the CCI＜3 group, work rate at peak (WR peak), WR peak/predicted (WR peak%), kilogram oxygen uptake at anaerobic threshold (VO2/kg AT), VO2/kg peak, VO2/kg peak%, peak carbon dioxide output (VCO2 peak), the minute ventilation to carbon dioxide production slope (VE/VCO2 slope), O2 pulse peak and O2 pulse peak% of CCI≥3 group were statistically different (P＜0.05). Among them, the rate of postoperative pulmonary complication in the CCI≥3 group was higher than that in the CCI＜3 group (60.7% vs. 32.1%, P=0.032). ConclusionIn the NSCLC patients, exercise tolerance and cardiopulmonary function decreased in patients with CCI≥3 compared with those with CCI<3. CPET can provide an objective basis for risk assessment in patients with comorbidity scored by CCI for pulmonary resection.
A 55-year-old male patient was admitted to the hospital due to "recurrent chest pain for 8 months, with worsening symptoms for 2 weeks". After admission, comprehensive relevant examinations led to the consideration of a giant chronic left ventricular pseudoaneurysm caused by myocardial infarction with non-obstructive coronary arteries. Surgical treatment was performed at our hospital. We discuss the diagnosis and treatment of this patient.