Objective To investigate the protective effects of antitumor necrosis factor-α antibody （TNF-αAb） on lung injury after cardiopulmonary bypass （CPB） and their mechanisms. Methods Forty healthy New Zealand white rabbits，weighting 2.0-2.5 kg，male or female，were randomly divided into 4 groups with 10 rabbits in each group. In groupⅠ，the rabbits received CPB and pulmonary arterial perfusion. In group Ⅱ，the rabbits received CPB and pulmonary arterial perfusion with TNF-αAb. In group Ⅲ，the rabbits received CPB only. In group Ⅳ，the rabbits only received sham surgery. Neutrophils count，TNF-α and malondialdehyde （MDA） concentrations of the blood samples from the left and right atrium as well as oxygenation index were examined before and after CPB in the 4 groups. Pathological and ultrastructural changes of the lung tissues were observed under light and electron microscopes. Lung water content，TNF-α mRNA and apoptoticindex of the lung tissues were measured at different time points. Results Compared with group Ⅳ，after CPB，the rabbitsin group Ⅰ to group Ⅲ showed significantly higher blood levels of neutrophils count，TNF-α and MDA（P＜0.05），higherTNF-α mRNA expression，apoptosis index and water content of the lung tissues （P＜0.05），and significantly lower oxyg-enation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with group Ⅱ，after CPB，the rabbits in groups Ⅰ and Ⅲ had significantly higher blood concentrations of TNF-α （5 minutes after aortic declamping，220.43±16.44 pg/ml vs.185.27±11.78 pg/ml，P＜0.05；249.99±14.09 pg/ml vs.185.27±11.78 pg/ml，P＜0.05），significantly higher apoptosis index （at the time of CPB termination，60.7‰±13.09‰ vs. 37.9‰±7.78‰，P＜0.05；59.6‰±7.74‰ vs. 37.9‰±7.78‰，P＜0.05），significantly higher blood levels of neutrophils count and MDA （P＜0.05），significantly higher TNF-α mRNA expression and water content of the lung tissues （P＜0.05），and significantly loweroxygenation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with groupⅠ，rabbits in group Ⅲ had significantly higher above parameters （P＜0.05） but lower oxygenation index （P＜0.05） only at 30 minutes after the start of CPB. Conclusion Pulmonary artery perfusion with TNF-αAb can significantly attenuate inflammatory lung injury and apoptosis of the lung tissues during CPB.
ObjectiveTo explore the effect of continuous nursing on lung transplant patients at home based on humanistic care. MethodsAccording to hospitalization order, patients who received lung transplantation in our hospital from January 2016 to October 2020 were divided into a control group and a nursing group. The control group was treated with routine lung transplantation education and regular follow-up after discharge, and the nursing group received humanistic care during follow-up, health education at discharge, cultural exchange activities, and home care plans. After discharge, the self-management ability at home, medication adherence and satisfaction of home care between the two groups were campared. ResultsA total of 60 patients were included in the study. There were 23 patients in the control group, including 16 males and 7 females, with an average age of 58.70±11.00 years. There were 37 pateints in the nursing group, including 25 males and 12 females, with an average age of 57.90±13.20 years. The scores of self-management ability at home of the nursing group (self-concept 27.41±2.37 points vs. 21.78±3.54 points; self-care responsibility 20.73±1.63 points vs. 16.83±2.79 points; self-care skills 41.46±3.77 points vs. 28.26±4.11 points; health knowledge level 57.95±4.10 points vs. 44.87±5.79 points) were higher than those in the control group (all P＜0.05). The medication adherence (7.47±0.46 points vs. 6.87±0.28 points) and satisfaction of home care (23.80±1.20 points vs. 20.50±1.90 points) in the nursing group were higher than those in the control group (both P<0.05). ConclusionContinuous nursing based on humanistic care for lung transplant patients can effectively improve the self-management ability, medication adherence and nursing satisfaction of patients after discharge.
Objective To investigate whether long term bronchodilator tiotropium has an acute bronchodilator effect on COPD patients. Methods 46 patients with stable COPD were enrolled in the study.Lung function test was performed before and at 10 min, 20 min, 1 h after inhaling tiotropium. FEV1 , FVC,FEV1/FVC, PEF25% -75% were measured by ambulatory spirometer. The patients were followed up after 1 month.Results The mean FEV1 was ( 1. 110 ±0. 34) L before inhaling tiotropiumand ( 1. 172 ±0. 359) L, ( 1. 221 ±0. 391) L, ( 1. 225 ±0. 392) L at 10 min,20 min, 1 h after inhaling tiotropium, respectively. FEV1 at 1 h after inhaling tiotropiumsignificantly increased compared with that before inhaling tiotropium. FVC also increased and reached highest at 1 h after inhaling tiotropium. PEF25%-75% at 1 h after inhaling tiotropium increased, but there was no significance difference compared with that before inhaling tiotropium. Mean FEV1 was 1. 287 Lafter 1 month, with significant difference compared with baseline. Conclusion Tiotropium can release the symptoms and improve compliance of COPD patients for its acute bronchodilator effect on COPD patients.
Objective To compare the short-term efficacy and long-term survival of patients with non-small cell lung cancer (NSCLC) treated by uniportal or three portal thoracoscopic radical resection. Methods A total of 388 patients who underwent uniportal or three portal thoracoscopic radical resection of lung cancer in the Department of Thoracic Surgery of Anhui Chest Hospital from 2015 to 2016 were analyzed retrospectively. The patients were divided into two groups including an uniportal group and a three portal group according to the procedure. The clinicopathological features, perioperative data and long-term survival of the two groups were compared. Results Finally, we included 205 patients with 105 males and 100 females at an average age of 58.73±10.93 years. There were 102 patients in the uniportal group and 103 patients in the three portal group. There was no statistical difference in clinicopathological features between the two groups (P>0.05). But compared with the three portal group, the uniportal group had less postoperative drainage, shorter postoperative catheterization time and postoperative hospital stay (P<0.05). There was no statistical difference in the number of lymph node dissection stations between the two groups (P=0.058). The pain score at 24 hours after operation in the uniportal group was significantly lower than that in the three portal group (P<0.001). There was no statistical difference in the total incidence of complications and the incidence of pulmonary complications between the two groups (P=0.161 and P=0.275). The median survival period and the 1st, 3rd, and 5th year survival rate in the uniportal group was 63.0 months and 95.0%, 75.2%, 51.5%, respectively. The median survival period and the 1st, 3rd, and 5th year survival rate in the three portal group was 61.0 months and 89.3%, 70.9%, 50.5%, respectively. There was no satistical difference in the survival results between the two groups (P=0.440). Conclusion Uniportal thoracoscopic radical resection of lung cancer is more minimally invasive and safe and effective in the treatment of NSCLC. It can make patients recover faster after operation.
Objective To systematically evaluate the efficacy and safety of single and bilateral lung transplantation in the treatment of end-stage chronic obstructive pulmonary disease (COPD). Methods Chinese and English databases were searched by computer, including PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, Wanfang database, VIP database and CBM. Case-control studies on single lung transplantation or bilateral lung transplantation for COPD were collected from the inception to July 31, 2022. We evaluated the quality of the literature via Newcastle-Ottawa Scale (NOS). All results were analyzed using Review Manager V5.3 and STATA 17.0. Results A total of 8 studies were included covering 14076 patients, including 8326 patients in the single lung transplantation group and 5750 patients in the bilateral lung transplantation group. NOS scores were≥6 points. The results of meta-analysis showed that there was no statistical difference in the postoperative 1-year survival between the two groups (P=0.070). The 2-year survival rate (P=0.002), 3-year survival rate (P<0.001), 5-year survival rate (P<0.001), overall survival rate (P＜0.001), postoperative forced expiratory volume in one second/predicted value (P<0.001), postoperative forced vital capacity (P<0.001), and postoperative 6-minute walking distance (P=0.002) were lower or shorter than those in the bilateral lung transplantation group, the postoperative intubation time (P=0.030) was longer than that in the bilateral lung transplantation group. Bilateral lung transplantation group showed better surgical results. There was no statistical difference in the mortality, obliterative bronchiolitis, length of hospitalization, primary graft dysfunction, or postoperative adverse events (P>0.05). Conclusion Bilateral lung transplantation is associated with better long-term survival and postoperative lung function compared with single lung transplantation. In-hospital mortality and postoperative complications are similar between them.