Objective To explore the association of mean platelet volume and neutrophil to lymphocyte ratio with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in elderly patients and its clinical value for the short-term prognosis. Methods A total of 52 patients with AECOPD who had been hospitalized during the period of April 2014 to April 2015 were enrolled in this prospective observational study. Levels of mean platelet volume (MVP),C-reactive protein,complete blood count,D-dimer,fibrinogen,percent-of-predicted FEV1 and percent-of-predicted FEV1/FVC were measured at admission(acute exacerbation)and after 3 months(stable period). Fifty-two age-and sex-matched healthy individuals constituted the control group. Pearson′s correlation was used to analyze the association of MPV with WBC,NLR,CRP,DD,FIB,FEV1%,and FEV1/FVC%. Results In AECOPD,as compared with stable COPD and the control group,levels of WBC,NLR,D-dimer,fibrinogen and CRP elevated;FEV1,FVC,percent-of-predicted FEV1 and percent-of-predicted FEV1/FVC declined;and MPV level decreased obviously. As a cut-off point of MVP level of<8.35fl for predicting AECOPD,it showed a sensitivity of 84.6%and a specificity of 86.5%. A decreased MVP level was significantly correlated with an increased in white blood cell count, neutrophil to lymphocyte ratio,D-dimer,fibrinogen and C-reactive protein level(P=0.01,0.02,0.01,0.02,and 0.01 respectively). Conclusions Mean platelet volume and neutrophil to lymphocyte ratio may be inflammatory markers inAE COPD,and measurement of mean platelet volume level may be useful for identifying elderly patients at increased risks for acute exacerbation.

Objective To explore the differences and infection factors of adherence of pulmonary rehabilitation (PR) in patients with different periods of chronic obstructive pulmonary disease (COPD). Methods The 304 patients were randomly distributed into two groups, stable COPD with PR group (n=178) and acute exacerbation COPD (AECOPD) with PR group (n=126). The course of PR was 12 weeks. According to the adherence definition (practical time of accompolish PR programm>70%of that planned time), patients were divided into good adherence group (n=115) and bad adherence group (n=189). The practical-perform time of PR, proportion of good adherence and PR quitting were compared between two groups. Basic data were collected and analyzed in two groups of patients. After the pulmonary rehabilitation, binary Logistic regression was used to analyse the compliance of pulmonary rehabilitation. Results The practical-perform time of PR and the proportion of good adherence were significantly higher in stable COPD with PR group than those of AECOPD with PR group (5 641.5±1 080.1 min vs. 4 426.5± 1 046.8 min,46.7%vs. 25.4%). The PR quitting proportion (10.6%, 21/199) was significantly lower in stable COPD with PR group than that of AECOPD with PR group (26.7%, 46/172). Compared with AECOPD PR group, the income level and 6 minutes walking distance (MWD) were significantly higher in stable COPD PR group, and the everage age, proportion of tabacco-exposed, MRC score and CAT score were significantly lower in stable COPD group (P<0.05). Logistic regression analysis showed that older-age, tabacco-exposed, higher MRC score and CAT score were risk factors for PR adherence, while the higher income level (≥3 000 yuan) and longer 6MWD were protective factors for PR time-adherence in patients with COPD (P<0.05). Conclusion The time adherence of COPD patients, who undergo pulmonary rehabilitation, is disappointing, especially post-exacerbation. Good adherence would be expected in younger age, non tabacco-exposed, higher income level and better health-related quality of life.

Objective To observe the effects of pulmonary rehabilitation (PR) on depression and anxiety at different stages of chronic obstructive pulmonary disease (COPD) patients. Methods Ninety-seven COPD patients hospitalized in Department of Respiratory Intensive Care Unit, Tianjin Chest Hospital, were randomly divided into two groups:control group (n=39) and acute exacerbation COPD (AECOPD) group (n=58). Patients in both groups were assessed for baseline date when symptoms were improved from acute phase (T1). Then patients in control group were received pharmaco-therapy and rehabilitation publicity without PR. When symptoms was relieved and stable (T2), patients were given 12-week PR (T3). The Beck depression inventory (BDI) scores and State-Trait Anxiety Inventory (STAI) scores were observed in both groups respectively. Results There were no statistics differences in baseline data in both groups (P>0.05). In control group, the BDI score was significantly lower at T3 than that of T1 and T2 (F=5.309, P<0.05). But there was no significant difference in BDI between T1 and T2 (P>0.05). Similarly in AECOPD group, the BDI score was significantly lower at T2 than that of T1 (t=3.612, P<0.05). At T1, there was no significant difference in BDI score between both groups (P>0.05). At T2 the BDI score was significantly lower in AECOPD group than that of control group, and also which was lower than that of T 3 of control group (P<0.05). In control group, the STAI score was significantly lower at T3 than that of T1 and T2 (F=9.852, P<0.05), but there was no significant difference in STAI between T1 and T2 (P>0.05). The STAI score was significantly lower in T2 than that of T1 in AECOPD group (t=5.091, P<0.05). There was no significant difference in STAI score at T1 between two groups (P>0.05). There was significantly lower STAI score at T2 in AECOPD group than that of control group (P<0.05),while there was no significant difference in STAI score at T3 between two groups (P>0.05). Conclusion Pulmonary rehabilitation at early stage may reduce the degree of depression and anxiety in AECOPD patients.

Objective To explore the relationship between visceral pleura closure of primary spontaneous pneumotho?rax (PSP) using different diameters of drainage tube and the time of implementing closed chest-drain. Methods According to the diameters of tubes for chest drain they used, 214 patients with PSP were divided into standard tube group (136 cases) and fine catheter group (78 cases). Patients in standard tube group who were inserted chest drain for≤1 d,≤3 d,≤6 d,>6 d included 48, 43, 29 and 16 cases respectively while their counterpart in fine catheter group include 24, 23, 17, 14 cases re?spectively. Closed time of crevasse were noted and incidence of preoperative closed pneumothorax converting into open pneu?mothorax, subcutaneous emphysema and prolonged pain after operation were all recorded. Results There is no statistical difference in closing time of crevasse nor in the distribution of various drainage times (proportions of≤6 d and>6 d are low?er than proportions of≤1 d and≤3 d) between standard tube group [(4.76 ±1.65) d] and fine catheter group [(4.54±1.67) d] (t=0.963). However, in both standard tube group and fine catheter group, closing time of crevasse is shorter if drainage time≤6 d or>6 d than if it≤1 d and≤3 d. Closing time of crevasse show negative correlation with period of chest drain in?sertion in both standard tube group and fine catheter group (P<0.05). The rate of converting from close pneumothorax into open pneumothorax were 51.96%(53/102) and 36.21%(21/58) respectively in standard pipe group and fine catheter group. Furthermore, the incidence of subcutaneous emphysema and prolonged pain were all higher than those in standard tube group than those in the fine catheter group (P<0.05). Conclusion Using closed chest drain to treat patients with PSP, di?ameter of the drain tube did not affect closing time of crevasse. But longer insertion period of chest drain can reduce closing time of crevasse.

Objective To investigate the reliability of CT-guided percutaneous lung biopsy pathological results in diag?nosing Non-small cell lung cancer (NSCLC). Methods Patients (n=91) were selected whose radiology examination re?vealed pulmonary masses but were failed to be confirmed with pulmonary lesion through sputum or bronchoscopy. Then, they were diagnosed as non-small cell lung cancer by CT-guided percutaneous lung biopsy. After that, they received surgical op?eration and biopsies were taken during operations for pathological analysis. Pathological results between from percutaneous lung biopsy (pathological types and using different analysis tools) and from surgical operation were compared. Results The coincidence rate of pathological type is 86.81%(79/91) using pathological results through percutaneous lung biopsy or oper?ation. Compared with the pathological results of operation, the coincidence rate of pathological type using percutaneous lung biopsy show no statistical significance [Squamous cell carcinoma 88.57%(31/35) vs Grandular cell carcinoma 86.27%(44/51) vs adeno-squamous carcinoma 80.00%(4/5),χ2=0.310,P>0.05];the coincidence rate of percutaneous lung biopsy pathologi?cal results using different approaches demonstrate statistical significance compared with surgical biopsy pathological results (χ2=9.698, P<0.05). The coincidence rate of pathological results obtained by Smear and biopsy [94.4%(51/54)] is higher than that of surgical biopsy pathological results using smear alone [60.0%(6/10)] and by biopsy alone [81.4%(22/27)]. Con?clusion Using CT-guided percutaneous lung biopsy, it can produce reliable results on pathological type of non-small cell lung cancer. But the reliability can be affected by different analysis approaches that were hired to exam samples from CT-guided percutaneous lung biopsy.

Objective To investigate the risk factors,clinic charactertics and survival prognosis of pulmonary embolism (PE) in patients with lung cancer.Methods The clinic data of 28 lung cancer patients with PE,hospitalized in department of respiratory and critical care medicine of Tianjin Chest Hospital between June 2012 to June 2015,were retrospectively reviewed.Eleven of them were diagnosed with primary lung cancer and PE (symptomatic group),and 17 lung cancer patients were found PE accidentally (asymptomatic group).A total of 56 lung cancer patients without PE were used as control subjects (no PE group).Data of pathological types,clinical staging of lung cancer,systemic chemotherapy,white blood cell (WBC),hemoglobin (Hb),platelet (PLT),D-dimer (DD),albumin (ALB) and C-reactive protein (CRP) were analyzed by univariate analysis in the symptomatic group and asymptomatic group.Logistic regression analysis was carried out on the statistically significant indexes to observe the influencing factors.The morphology and location of the remobilization images were analyzed in lung cancer patients with PE.The median time to embolism and survival of PE patients were compared between symptomatic group and asymptomatic group.Results The proportion of adenocarcinoma,systemic chemotherapy and stage Ⅲ + Ⅳ were significantly higher in PE group than those in no PE group (P ＜ 0.01).The ratio of white blood cells (WBC)＞ 11× 109/L (hyperleukocytosis) and albumin (ALB) ＜30 g/L and D-dimer (DD)＞ 0.5 mg/L were significantly higher in PE group than those of no PE group (P ＜ 0.05).There were no statistical differences in other indicators including clinical symptoms between the two groups (P ＞ 0.05).The logistic regression analysis showed that adenocarcinoma,chemotherapy,WBC＞ 11× 109/L and DD＞0.5 mg/L were the risk factors of lung cancer with PE (P ＜ 0.05).There was higher ratio of asymptomatic PE in lung cancer patients with PE.There were no significant differences in morphology and location of the remobilization images in symptomatic group.The median time of embolization was 3.6 months (95％ CI:3.2-4.0) in the asymptomatic group,which was significantly earlier than that in the symptomatic group (10.5 months,95％ CI:8.88-12.12,P ＜ 0.01).The median survival time was 7.2 months (95％ CI:5.86-8.56) in the asymptomatic group,which was significantly longer than that of symptomatic group (2.8 months,95％ CI:2.48-3.12,P ＜ 0.05).Conclusion Lung adenocarcinom,systemic chemotherapy,hypoproteinemia and increased D-dimer are the independent risk factors in lung cancer patients with PE.PE in lung cancer is frequently asymptomatic in the early stage.Compared to symptomatic patients,asymptomatic cases have better prognosis.

Objective To investigate the clinic value of enhanced CT-guided percutaneously transthoracic lung biopsy. Methods A total of 423 patients who underwent CT-guided percutaneously transthoracic lung biopsy were retrospectively analyzed. The percentage of specimen are satisfactory,the rate of sample with pathological findings,the number of cases with complications,the average goes of unsuccessful biopsy and the times of changing puncture point were compared between the enhanced CT group and the plain CT group. Results Compare parameters in patients whose procedure were guided with the enhanced CT group and with plain CT group, the average goes of unsuccessful biopsy, the times of changing puncture point in patients, the percentage of specimen that were satisfactory, the rate of sample with positive pathological findings and the rate that complicated with pneumothorax or hemorrhage show statistical significance.(3.08±1.05 vs 3.75±1.34, 8.52%vs 18.54%,90.13%vs 73.60%, 76.62%vs 63.36%, 15.51%vs 27.53%, 7.76%vs 14.04%, P<0.05). Conclusion In patient whose biopsys were guided by enhanced CT, the percentage of samples that are satisfactory is higher, the incidence of complication is fewer and the sample with pathological finding is higher compared to those in patients whose biopsys were guided by plain CT. Therefore, enhanced CT-guided percutaneous transthoracic biopsy is more valuable than plane CT.

Objective To analyze rick factors for postoperative recurrence of spontaneous pneumothorax surgery. Methods The clinic characteristics of 1128 patients who received spontaneous pneumothorax surgery in Tianjin Chest Hospital were collected from January 2009 to March 2015. The relationship between clinic characteristics and the pulmonary bullae was analyzed. Logistic regression analysis was used to assess factors affecting the postoperative relapse of spontaneous pneumothorax. Results The pulmonary bullae were found in 877 patients of 1128 during the operation. The incidence of pulmonary bullae was significantly high in patients with age below 25 years compared with patients over 25 years (P<0.05). The duration of surgery was significantly longer in patients with pulmonary bullae compared with that of patients without pulmonary bullae (P<0.05). Postoperative recurrence occurred in 21 cases, with a recurrence rate of 1.86%. Logistic regression analysis showed that pulmonary bullae, pleurodesis without pleura friction, delayed drainage duration (> 3 d) were independent risk factors of postoperative recurrence for spontaneous pneumothorax (P<0.05). Conclusion Pulmonary bullae, pleurodesis without pleura friction and delayed drainage duration are risk factors of postoperative recurrence for spontaneous pneumothorax, which should be paid more attention in clinic.

Objective To research the impact of various PEEP parameters of mechanical ventilation on liver mor-phology and function and on hemodynamics. Methods Fifty patients of respiratory failure due to COPD using mechanical ventilation was observed by prospective, exoterical and self-control methods after their condition were stabilized. The varia-tion of abdominal pressure was measured with different PEEP of 0 cmH2O, 5 cmH2O and 10 cmH2O with mechanical ventila-tion, and measured when patients breathe autonomously with tracheostomy tube. The changes of liver morphology, hepatic por-tal vein diameter, hemodynamics and liver function were also measured on above circumstances. Results With PEEP value increases:the abdominal pressure (IAP) rise (P＜0.01) while liver morphology, function and hepatic portal did not change markedly evidently (P>0.05). By contrast, blood flow of hepatic portal vein reduced with PEEP increase (P＜0.05). Conclu-sion Higher PEEP values on mechanical ventilation will causes abdominal pressure increases and low blood flow of hepatic portal , but not obvious impact on portal vein diameter and liver function.

Objective To discuss the effect of different mechanical ventilation parameters on intra-abdominal pres-sure. Methods A total of 42 cases with mechanical ventilation suffering from chronic obstructive pulmonary diseases (COPD) and respiratory failure were selected for observing the effects of inspiratory platform time (Tplat), inspiratory time (Ti) and end-expiratory pressure (PEEP) on intra-abdominal pressure. Results In SIMV+PSV ventilation mode, changes of Tplat and Ti had no significant effects on intra-abdominal pressure (P>0.05). There were no significant differences be-tween SIMV+PEEP0 and base line values (P>0.05). Conclusion The alteration of peep has a great influence in intra-ab-dominal pressure, which suggests the importance of selecting proper mechanical ventilation parameters.