ObjectiveTo evaluate clinical outcomes of diaphragm plication for the treatment of diaphragmatic paralysis (DP) in infants after surgical correction for congenital heart diseases. MethodsClinical data of 13 infants who had DP after surgical correction for congenital heart diseases from December 2009 to December 2012 were retrospectively analyzed. There were 5 male and 8 female patients with their age of 35 days-11 months (6.6±3.2 months) and body weight of 3.5-9.6 (6.2±1.8) kg. Diaphragm plication was performed 19.08±4.29 days after open heart surgery. All the patients were not able to wean from mechanical ventilation,or were repeatedly reintubated because of severe respiratory failure after extubation. All the 13 patients received diaphragm plication for singleor double-sided DP. ResultsTwo patients had ventilator associated pneumonia (15.4%) including 1 patient with positive sputum cultures for Acinetobacter baumannii but negative blood culture. Another patient who had double-sided DP after surgical correction for tetralogy of Fallot with pulmonary atresia underwent double-sided diaphragm plication and later died of multiple organ dysfunction syndrome,whose sputum and blood cultures were both positive for Pseudomonas aeruginosa on the 11th day after double-sided diaphragm plication. Chest X-ray of all the patients showed plicated diaphragm in normal position after diaphragm plication. The average time from diaphragm plication to extubation was 5.38±3.09 days. After diaphragm plication,arterial partial pressures of oxygen (PaO2) significantly increased (90.22±8.47 mm Hg vs. 80.69±6.72 mm Hg,P<0.05) and arterial partial pressures of carbon dioxide (PaCO2) significantly decreased (39.87±6.31 mm Hg vs. 56.38±7.19 mm Hg,P<0.05). Twelve patients were followed up for 24 months after discharge. During follow-up,1 patient who received double-sided diaphragm plication had 2 episodes of pneumonia within 6 months after discharge. Respiratory function of all the other patients was normal. All the patients were in NYHA class Ⅰ-Ⅱ. ConclusionDiaphragm plication is a safe,easy and effective treatment to increase survival rate and decrease the incidence of hospital-acquired infection for infants who have DP and are unable to wean from mechanical ventilation after surgical correction for congenital heart diseases.
ObjectiveTo investigate the relationship of diaphragmatic mobility (ΔM) evaluated by ultrasonography with quality of life and athletic ability in patients with chronic obstructive pulmonary disease (COPD) , and analyze the factors those affect the diaphragmatic mobility.MethodsA total of 48 male patients with stable COPD were recruited in the study. The body height, body weight, diaphragmatic mobility, airflow obstruction (FEV1%pred), and exercise capacity (6MWD) were measured. The quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ).ResultsThe minimum value of ΔM was 1.89 cm and the maximal value was 8.11 cm in the COPD patients. There were significant correlationship between ΔM and the SGRQ score of the total score, symptom score, impact points, activity points and 6MWD, with correlation coefficients of –0.474, –0.416, –0.432, –0.502 and 0.536, respectively. Multivariate stepwise regression analysis showed that the factors influencing ΔM were height (β=0.407, P=0.021) and FEV1%pred (β=–0.391, P=0.035).ConclusionsDiaphragmatic mobility and quality of life are closely related in COPD patients. The height and FEV1%pred have the greatest effect on diaphragmatic activity. The smaller diaphragm mobility is relevant to the worse quality of life and the smaller activity capacity.
ObjectiveTo evaluate the predictive value of diaphragmatic rapid shallow breathing index (D-RSBI) for weaning outcome prediction.MethodsThis was a prospective observation study. Respiratory rate (RR) and tidal volume (Vt) were recorded at the end of spontaneous breathing trial, and both M-Mode and B-Mode ultrasonography were used to assess the right diaphragmatic displacement (DD). In parallel, outcome of the weaning attempt, length of mechanical ventilation, length of stay in intensive care unit (ICU) and mortality of ICU were recorded. According to the weaning outcome, the patients were grouped into the successful group and the failed group. The receiver operator characteristic (ROC) curve was used to assess the value of rapid shallow breathing index (RSBI, RR/Vt) and D-RSBI (RR/DD) in predicting weaning failure for ICU patients with mechanical ventilation.ResultsA total of 110 patients recruited in this study. Of them, 73 (66.4%) patients were successfully liberated from mechanical ventilation, and 37 patients failed (33.6%) weaning procedure. The RSBI and D-RSBI of the patients in the failed group were higher than those in the success weaning group (P<0.01). The area under the ROC curves of RSBI and D-RSBI for predicting weaning failure was 0.78 (95% confidence interval 0.69 - 0.87), 0.91 (95% confidence interval 0.85 - 0.97), respectively, a cutoff of RSBI>69 breaths/(L·min) yielded sensitivity of 55% and specificity of 89%, and a cutoff of D-RSBI>1.5 breaths/(min·mm) yielded sensitivity of 87% and specificity of 80%.ConclusionD-RSBI is more accurate than traditional RSBI in predicting the weaning outcome.
ObjectiveTo investigate the clinical manifestations, diagnosis and treatment of diaphrammatic paralysis (DP) in infants with congenital heart disease (CHD) after cardiac surgery. MethodsBetween October 2008 and June 2014, among 2 962 infant patients ( < 1 year) underwent cardiac surgery for congenital heart disease, postoperative DP was diagnosed in 31 patients. The paralysed hemidiaphragm was left side in 10 patients, right side in 15 patients, and bilateral in 6 patients. There were 22 males and 9 females. The age at operation was 1-12 (4.5±4.2) months on the average. The body weight at operation was 2.9 to 8.5 (5.6±2.2) kg on the average.All children received mechanical ventilation. ResultsNo patient died in this study.There was a statistical difference between preoperative and postoperative mechanical ventilation time at 123-832 (420±223) hours versus 15-212 (75±58) hours (P < 0.05). ConclusionsDP caused by phrenic nerve injury during surgical intervention for congenital heart disease is an important risk factor in terms of morbidity during the postoperative period. Diaphragmatic plication appears a good option, especially in infant children, to wean patients from mechanical ventilation and to prevent long-term side effects of mechanical ventilation.
ObjectiveTwitch transdiaphragmatic pressure is used to evaluate the diaphragm function of mechanical ventilated chronic obstructive pulmonary disease patients before weaning in the intensive care unit, and compared with healthy normal values.MethodsPatients were recruited if they were with acute exacerbation of chronic obstructive pulmonary disease, admitted between May to November in 2013 and December 2014 to February 2016 to the intensive care unit in the First Affiliated Hospital of Guangzhou Medical University, intubated and mechanical ventilated more than 72 hours, and recovered to the clinical stability states after passing the readiness to wean, getting ready for spontaneous breathing test. The newly designed esophageal electrode catheter and bilateral anterolateral magnetic phrenic nerves stimulation were utilized to detect the twitch transdiaphragmatic pressure. At the same time, the function of diaphragm was detected in 10 healthy adults for comparison.ResultsTwenty-two patients were recruited in this study. Two cases had no twitch signals. In the rest 20 cases, the twitch transdiaphragmatic pressure was (7.6±2.5) cm H2O. In 10 healthy adults, twitch transdiaphragmatic pressure was (26.7±4.9) cm H2O. There was significant difference between the patients and the health control subjects (P<0.05).ConclusionTwitch transdiaphragmatic pressure is significantly decreased in weaning chronic obstructive pulmonary disease patients compared with healthy adults.
ObjectiveTo explore the effect of early graded respiratory severe rehabilitation training for patients with mechanical ventilation under a multidisciplinary model.MethodsTwo hundred and thirty-six patients were surveyed, who were hospitalized in the intensive care unit of the First Affiliated Hospital of Anhui Medical University from June 3, 2019 to March 31, 2020. They were randomly divided into an observation group and a control group, with 118 patients in each group. The observation group received rehabilitation training using early graded rehabilitation training under the mode of multidisciplinary cooperation, while the control group received routine respiratory rehabilitation training. Diaphragmatic excursion (DE) and diaphragmatic thickening fraction (DTF) of the patients before ventilator weaning were measured by ultrasound. The differences of DE, DTF, peak expiratory flow (PEF), maximal inspiratory pressure (MIP), success rate of withdrawal, duration of mechanical ventilation and intensive care unit (ICU) stay between the two groups were recorded and compared.ResultsAll evaluation indexes were statistically significant between the observation group and the control group (all P<0.05). There were interaction between oxygenation index, PEF, MIP, Acute Physiology and Chronic Health Score, Clinical Pulmonary Infection Score and recovery time.ConclusionRehabilitation training on early graded severe respiratory diseases under a multidisciplinary model can improve the respiratory function of patients on mechanical ventilation and shorten the duration of mechanical ventilation and ICU stay.
ObjectiveTo explore the technical feasibility, safety, and short- and long-term efficacy of totally portal minimally invasive thoracoscopic diaphragmatic folding assisted by a stapler for the treatment of symptomatic diaphragmatic eventration in adults. MethodsAretrospective study was conducted on patients with symptomatic diaphragmatic eventration who underwent totally portal minimally invasive thoracoscopic stapler-assisted diaphragmatic folding from August 2021 to February 2025. Surgical time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and complications were recorded. One month postoperatively, diaphragmatic position, lung function [forced expiratory volume in one second (FEV1), forced vital capacity (FVC) ], and symptom relief were assessed, with extended follow-up to 36 months to monitor long-term efficacy. ResultsA total of 7 patients were included, comprising 3 (42.9%) males and 4 (57.1%) females, with an age range of 34 to 66 years and a mean age of (56.4±12.5) years. All surgeries were successfully completed without conversion to open thoracotomy or intraoperative complications. The average surgical time was (44.29±11.47) minutes, intraoperative blood loss was (25.71±33.09) mL, and the postoperative length of stay was (2.00±0.58) days. One-month follow-up showed that the diaphragmatic position returned to normal anatomical levels, FEV1 improved from preoperative (1.93±0.33) L to (2.36±0.47) L, and the effective rate of clinical symptom relief reached 100.0%. Long-term follow-up (36 months) showed: (1) Pain scores decreased from (1.14±0.38) points at one month postoperatively to (0.14±0.38) points at three months postoperatively, remaining at 0 points at six months and thereafter; (2) All patients had stable diaphragmatic positions with no recurrence; (3) FEV1/FVC was ≥80% at three months postoperatively, with three assessable patients at six months maintaining ≥80%; (4) SpO2 remained ≥95% throughout, with no hypoxic events. ConclusionTotally portal minimally invasive thoracoscopic stapler-assisted diaphragmatic folding is a minimally invasive procedure with rapid recovery, significantly improving lung function and stabilizing diaphragmatic anatomical position. Follow-up at 36 months showed complete pain relief, no recurrence, and long-term stability of lung function, making it a safe and effective surgical option for treating symptomatic diaphragmatic eventration in adults. Long-term efficacy still requires validation with a larger sample size.
ObjectiveTo observe the curative effect of pulmonary rehabilitation in patients with stable moderate to severe chronic obstructive pulmonary disease (COPD).MethodsSixty-four patients with stable moderate to severe COPD who visited during January 2016 and December 2017 were recruited in the study. They were randomly divided into an observation group and a control group, with 32 cases in each group. The spirometry was conducted in all patients. The right deep inspiratory end diaphragm thickness and the quiet end expiratory diaphragm thickness were measured by ultrasound, and the diaphragm thickness fraction (DTF) was calculated. The routine drug treatment was given in both groups. The comprehensive pulmonary rehabilitation treatment was given in the observation group (include breath training, exercise training, health education and nutrition guide). The pulmonary function, diaphragm function, severity and quality of life were evaluated before and 6 months later after the treatment.ResultsIn the observation group, the predicted value of forced expiratory volume in one second (FEV1%pred), FEV1/FVC ratio and DTF were all significantly improved compare with before treatment and the control group (all P<0.05). While the BODE index was significantly declined compare with before treatment and the control group (all P<0.05).ConclusionPulmonary rehabilitation treatment can help improve pulmonary function, diaphragm function, condition of the disease and quality of life.
Objective To study the role of ubiquitin-proteasome pathway in diaphragm of COPD rats. Mathods Thirty rats were divided into a normal control group and a COPD group. COPD model was established by exposure to cigarette smoke for three months. The protein levels of E2-14k and proteasome subunit C8 in diaphragms were measured by Western blot. The mRNA levels of ubiquitin and proteasome subunit C2 in diaphragms were measured bymeans of realtime polymerase chain reaction( RT-PCR) . Results Compared with the control group, the protein expression of E2-14k increased significantly in the COPD group ( 0. 81 ±0. 28 vs 0. 50 ±0. 25, P lt;0. 05) , but C8 protein level was not significantly different between the two groups( P gt;0. 05) . The mRNA expression of ubiquitin increased significantly in the COPD group( 0. 89 ±0. 20 vs 0. 50 ±0. 15, P lt;0. 05) , but C2 mRNA level was not significantly different between the two groups ( P gt; 0. 05 ) . Conclusions The mRNA and protein expressions of ubiquitin-proteasome pathway in diaphragmincreased significantly in COPD rats, suggesting that the activity of ubiquitin-proteasome pathwayincreased, which lead to an increase of protein degradation.
Objective To investigate the expressions of ubiquitin-proteasome markers，including E2-14K，MAFbx，MuRF-1，and nuclear factor-κB（NF- κB） p50，in diaphragm of COPD rats，and their relationship with IL-17 level in diaphragm and serum in order to elucidate the potential mechanism of diaphragm atrophy. Methods Thirty healthy adult male SD rats were randomly divided into a model group （n=18） and a normal control group （n=12）. The COPD rat model was established by instillation of lipopolysaccharide （LPS） and exposure to cigarette smoke for 28 days. The protein levels of E2-14K，MAFbx，MuRF-1，and NF-κB p50 in diaphragm were measured by Western blot. The concentration of IL-17 in serum and diaphragm was measured by ELISA. Results Western blot showed that the protein expressions of E2-14K，MAFbx，MuRF-1，and NF-κB p50 in diaphragm increased significantly in the COPD model group compared with the normal control group （0.96±0.12 vs. 0.53±0.09，0.99±0.10 vs. 0.53±0.08，0.95±0.08 vs. 0.51±0.16，1.11±0.10 vs. 0.64±0.50，respectively，Plt;0.01）. The IL-17 level in serum and diaphragm was significantly higher in the COPD group than the control group. The expression of NF-κB p50 was positively correlated with E2-14K，MAFbx，and MuRF-1 expressions （r=0.82，0.92，0.86，respectively，Plt;0.01）. Both in serum and diaphragm，IL-17 level was positively correlated with the percentage of neutrophils，levels of NF-κB p50，E2-14K，MAFbx，and MuRF-1 expressions（all Plt;0.01）. The IL-17 levels in serum and diaphragm were also positively correlated each other （r=0.84，Plt;0.01）. Conclusions The results show that the ubiquitin-proteasom pathway，the NF-κB pathway and IL-17 are up-regulated in diaphragm of COPD rats .These alterations may contribute to diaphragm atrophy in COPD.