The neutrophil-to-lymphocyte ratio(NLR)and the platelet-to-lymphocyte ratio(PLR)are found to increase in patients who develop postoperative complications(PCs).The aim of the present study was to explore the associatio...The neutrophil-to-lymphocyte ratio(NLR)and the platelet-to-lymphocyte ratio(PLR)are found to increase in patients who develop postoperative complications(PCs).The aim of the present study was to explore the association of the perioperative changes of NLR(ANLR)and PLR(OPLR)with PCs in non-small cell lung cancer(NSCLC).Clinical data of 509 patients,who were diagnosed with NSCLC and underwent thoracoscopic radical resection between January 1,2014 and July 31,2016 at the Department of Thoracic Surgery,West China Hospital,were reviewed.Patients were divided into PC and non-PC groups,and clinical characteristics including ANLR and APLR were compared between them.The optimal cut-off values of ONLR and APLR were determined by receiver operating characteristics(ROC)curves and patients were assigned to high ANLR/APLR and low ONLR/OPLR groups in terms of the cut-off values.Clinicopathologic characteristics and the incidence of different PCs were compared between the dichotomized groups.Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for PCs.The results showed that the ANLR and APLR in the PC group were significantly higher than those in the non-PC group(P<0.001 for both).The optimal cutoff values of ANLR and APLR were 6.6 and 49,respectively.Patients with ANLR>6.6 or 0PLR>49 were more likely to experience postoperative pulmonary complications(PPCs)(P<0.001 for both).Multivariate logistic regression analysis demonstrated that smoking[odds ratio(OR):2.450,95%confidence interval(95%CI):1.084--5.535,P=0.031)],tumor size(OR:1.225,95%CI:1.047-1.433,P=0.011),ANLR>6.6(OR:2.453,95%CI:1.2244.914,P-0.011)and APLR>49(OR:2.231,95%CI:1.182-4.212,P-0.013)were predictive of PPCs.In conclusion,the ONLR and APLR may act as novel predictors for PPCs in NSCLC patients undergoing thoracoscopic radical lung resection,and patients with ONLR>6.6 or APLR>49 should be treated more actively to prevent or reduce PPCs.展开更多
BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because ...BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms.No studies on FES with pulmonary embolism(PE)and tympanic membrane perforation have been reported to date.Here,we report a rare case of concomitant FES,PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.CASE SUMMARY A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road.X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification.A successful minimally invasive operation was performed 3 d after the injury.Postoperatively,the patient developed sudden symptoms of respiratory distress and hearing loss.Early diagnosis was made,and supportive treatments were used at the early stage of FES.Seven days after surgery,he presented a clear recovery from respiratory symptoms.The outcome of fracture healing was excellent,and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.CONCLUSION Concomitant FES,PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms.Early diagnosis and treatment can reduce the mortality of FES,and prevention is better than a cure.展开更多
Objective: The aim of this preliminary study was to evaluate the feasibility of exercise testing (ET) for predicting postoperative complications in patients with impaired pulmonary function. Methods: Thirteen patients...Objective: The aim of this preliminary study was to evaluate the feasibility of exercise testing (ET) for predicting postoperative complications in patients with impaired pulmonary function. Methods: Thirteen patients were prospectively enrolled. The enrollment criteria were FEV1.0% 8 by the Goddard classification or interstitial pneumonia on chest computed tomography. Patients underwent testing for pulmonary function, six-minute walking test (6MWT), and stair-climbing test (SCT). Postoperative cardiopulmonary complications (PCPCs) were recorded. Results: Four patients developed PCPCs. There were no significant differences between the patients with PCPCs (n = 4) and those without PCPCs (n = 9) for background data and PFT. The distances achieved in the 6MWT were 503 ± 72.7 m for patients without PCPCs and 369 ± 50.7 m for patients with PCPCs (p = 0.011). The SCT climbing heights were 20.4 ± 5.3 m for patients without PCPCs and 14.9 ± 4.0 m for patients with PCPCs (P = 0.187). Cut-off points, including a 6MFT distance of less than 400 m, SCT height lower than 15 m, and SCT climbing speed less than 8.5 m/min, were predictive of CPCP. Conclusions: Exercise testing is more feasible for predicting postoperative cardiopulmonary complications than stationary pulmonary function testing.展开更多
Objective： To evaluate the effects of preoperative inspiratory muscle training （IMT） on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective total hi...Objective： To evaluate the effects of preoperative inspiratory muscle training （IMT） on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective total hip replacement surgery under general anesthesia. Methods： Thirty two high-risk patients undergoing elective total hip replacement surgery under general anesthesia were chosen from Nanjing Medical University, Affiliated Nanjing First Hospital. In this single-blind randomized controlled clinical triM, patients were randomly assigned to receive preoperative inspiratory muscle training or conventional treatment （CT）. The major effectiveness outcome variables were atelectasis and duration of postoperative hospitalization. Results： Both groups were comparable prior to surgery. Seven patients in the CT group and 3 in the IMT group developed atelectasis （P = 0.25）. Median duration of postoperative hospitalization was 13 days （range, 10～17 days） in the IMT group versus 16 days （range, 11～23 days） in the CT group （Mann- Whitney U statistics, Z = -2.22, P = 0.03）. Mean postoperative inspiratory pressure was 5% higher in the IMT group. Conclusion： Preoperative intensive inspiratory muscle training appears to reduce the incidence of atelectasis and duration of postoperative hospitalization in patients at high risk of developing postoperative pulmonary complications who were scheduled for elective total hip replacement surgery under general anesthesia.展开更多
Objective： To analyze the tolerance of lung cancer patients with moderate pulmonary hypofunction to open-chest operation. Methods： The postoperative complications of 31 patients with moderate pulmonary hypofunction ...Objective： To analyze the tolerance of lung cancer patients with moderate pulmonary hypofunction to open-chest operation. Methods： The postoperative complications of 31 patients with moderate pulmonary hypofunction （study group） and 62 patients with normal pulmonary function （control group） were reviewed. Statistical t test and χ^2 test were set to examine the data, and logistic regression was performed to find the associated factors. Results： In patients with moderate pulmonary hypofunction, hypoxemia （41.9%）, arrhythmia and cardiac dysfunction （25.8%）, and pulmonary inflammation （25.8%） were common postoperative complications, and respiratory failure and cardiac failure （9.2%） severe complications. In-hospital mortality rate was 3.2%. In the control group, the incidence of the above 4 postoperative complications was 16.1%, 8.1%, 9.6% and 3.2% accordingly, and no case died in hospital. Regression analysis showed that age and resection range were associated with the occurrence of the complications. Conclusion： Common postoperative complications （hypoxemia） in patients with moderate pulmonary hypofunction are remarkably higher than those in control group, but severe complications and in-hospital mortality rate are not significantly high. Patients with older age and larger resection range undergo higher complication rate.展开更多
文摘The neutrophil-to-lymphocyte ratio(NLR)and the platelet-to-lymphocyte ratio(PLR)are found to increase in patients who develop postoperative complications(PCs).The aim of the present study was to explore the association of the perioperative changes of NLR(ANLR)and PLR(OPLR)with PCs in non-small cell lung cancer(NSCLC).Clinical data of 509 patients,who were diagnosed with NSCLC and underwent thoracoscopic radical resection between January 1,2014 and July 31,2016 at the Department of Thoracic Surgery,West China Hospital,were reviewed.Patients were divided into PC and non-PC groups,and clinical characteristics including ANLR and APLR were compared between them.The optimal cut-off values of ONLR and APLR were determined by receiver operating characteristics(ROC)curves and patients were assigned to high ANLR/APLR and low ONLR/OPLR groups in terms of the cut-off values.Clinicopathologic characteristics and the incidence of different PCs were compared between the dichotomized groups.Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for PCs.The results showed that the ANLR and APLR in the PC group were significantly higher than those in the non-PC group(P<0.001 for both).The optimal cutoff values of ANLR and APLR were 6.6 and 49,respectively.Patients with ANLR>6.6 or 0PLR>49 were more likely to experience postoperative pulmonary complications(PPCs)(P<0.001 for both).Multivariate logistic regression analysis demonstrated that smoking[odds ratio(OR):2.450,95%confidence interval(95%CI):1.084--5.535,P=0.031)],tumor size(OR:1.225,95%CI:1.047-1.433,P=0.011),ANLR>6.6(OR:2.453,95%CI:1.2244.914,P-0.011)and APLR>49(OR:2.231,95%CI:1.182-4.212,P-0.013)were predictive of PPCs.In conclusion,the ONLR and APLR may act as novel predictors for PPCs in NSCLC patients undergoing thoracoscopic radical lung resection,and patients with ONLR>6.6 or APLR>49 should be treated more actively to prevent or reduce PPCs.
基金The Subject Leadership Project of Shanghai Pudong New Area,No.PWRd2016-06the Featured Clinical Discipline Project of Shanghai Pudong,No.PWYts2018-03.
文摘BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms.No studies on FES with pulmonary embolism(PE)and tympanic membrane perforation have been reported to date.Here,we report a rare case of concomitant FES,PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.CASE SUMMARY A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road.X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification.A successful minimally invasive operation was performed 3 d after the injury.Postoperatively,the patient developed sudden symptoms of respiratory distress and hearing loss.Early diagnosis was made,and supportive treatments were used at the early stage of FES.Seven days after surgery,he presented a clear recovery from respiratory symptoms.The outcome of fracture healing was excellent,and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.CONCLUSION Concomitant FES,PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms.Early diagnosis and treatment can reduce the mortality of FES,and prevention is better than a cure.
文摘Objective: The aim of this preliminary study was to evaluate the feasibility of exercise testing (ET) for predicting postoperative complications in patients with impaired pulmonary function. Methods: Thirteen patients were prospectively enrolled. The enrollment criteria were FEV1.0% 8 by the Goddard classification or interstitial pneumonia on chest computed tomography. Patients underwent testing for pulmonary function, six-minute walking test (6MWT), and stair-climbing test (SCT). Postoperative cardiopulmonary complications (PCPCs) were recorded. Results: Four patients developed PCPCs. There were no significant differences between the patients with PCPCs (n = 4) and those without PCPCs (n = 9) for background data and PFT. The distances achieved in the 6MWT were 503 ± 72.7 m for patients without PCPCs and 369 ± 50.7 m for patients with PCPCs (p = 0.011). The SCT climbing heights were 20.4 ± 5.3 m for patients without PCPCs and 14.9 ± 4.0 m for patients with PCPCs (P = 0.187). Cut-off points, including a 6MFT distance of less than 400 m, SCT height lower than 15 m, and SCT climbing speed less than 8.5 m/min, were predictive of CPCP. Conclusions: Exercise testing is more feasible for predicting postoperative cardiopulmonary complications than stationary pulmonary function testing.
文摘Objective： To evaluate the effects of preoperative inspiratory muscle training （IMT） on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective total hip replacement surgery under general anesthesia. Methods： Thirty two high-risk patients undergoing elective total hip replacement surgery under general anesthesia were chosen from Nanjing Medical University, Affiliated Nanjing First Hospital. In this single-blind randomized controlled clinical triM, patients were randomly assigned to receive preoperative inspiratory muscle training or conventional treatment （CT）. The major effectiveness outcome variables were atelectasis and duration of postoperative hospitalization. Results： Both groups were comparable prior to surgery. Seven patients in the CT group and 3 in the IMT group developed atelectasis （P = 0.25）. Median duration of postoperative hospitalization was 13 days （range, 10～17 days） in the IMT group versus 16 days （range, 11～23 days） in the CT group （Mann- Whitney U statistics, Z = -2.22, P = 0.03）. Mean postoperative inspiratory pressure was 5% higher in the IMT group. Conclusion： Preoperative intensive inspiratory muscle training appears to reduce the incidence of atelectasis and duration of postoperative hospitalization in patients at high risk of developing postoperative pulmonary complications who were scheduled for elective total hip replacement surgery under general anesthesia.
文摘Objective： To analyze the tolerance of lung cancer patients with moderate pulmonary hypofunction to open-chest operation. Methods： The postoperative complications of 31 patients with moderate pulmonary hypofunction （study group） and 62 patients with normal pulmonary function （control group） were reviewed. Statistical t test and χ^2 test were set to examine the data, and logistic regression was performed to find the associated factors. Results： In patients with moderate pulmonary hypofunction, hypoxemia （41.9%）, arrhythmia and cardiac dysfunction （25.8%）, and pulmonary inflammation （25.8%） were common postoperative complications, and respiratory failure and cardiac failure （9.2%） severe complications. In-hospital mortality rate was 3.2%. In the control group, the incidence of the above 4 postoperative complications was 16.1%, 8.1%, 9.6% and 3.2% accordingly, and no case died in hospital. Regression analysis showed that age and resection range were associated with the occurrence of the complications. Conclusion： Common postoperative complications （hypoxemia） in patients with moderate pulmonary hypofunction are remarkably higher than those in control group, but severe complications and in-hospital mortality rate are not significantly high. Patients with older age and larger resection range undergo higher complication rate.
