With the diversification in surgical population and the progress of surgical techniques, the current clinical application of pre-operative pulmonary function assessment methods can hardly be qualified for accurately assessing whether lung cancer patients can tolerate surgical treatment and surgery-related risk. This paper focuses on the advantages and weaknesses of the commonly-used pul-monary function assessment methods, with the literature review of the clinical application status and progress of pulmonary function currently. We aim to achieve a reasonable evaluation of preoperative cardio-pulmonary function assessment, and sequentially reduce the risk and occurrence of surgical-related complications.

Objective To explore the effect of folic acid on neural stem cells(NSCs) proliferation from fetal rats in vitro.Method NSCs were isolated and cultured by microdissection,mechanical blowing and serum-free suspension culture,and identified by immunofluorescent staining using antibody against nestin.BrdU(5’bromo-2’deoxyuridine) was used to mark dividing neural stem cells.Cultured NSCs were divided into four groups:control group,low,high dose group(liquid media with added 4,40 mg/L folic acid),and deficiency group(liquid media with added 0.4 mg/L methotrexate,MTX).Monotetrazolium(MTT) and double-label immunofluorescence technique detected NSCs proliferation under the condition of folic acid.Results In the serum-free suspension medium,neurospheres that consisted of a great number of nestin-positive cells could be obtained.The proliferative ability of NSCs were observed by BrdU labeling methods.MTT assay and double-label immunofluorescence for nestin+BrdU showed that the growth tendency was increased with folate concentration in the medium.Compared with control group,NSCs growth rate of folate group was significantly increased in vitro.Conclusion The culture of NSCs isolated from fetal rats possesses the abilities of proliferation and self-regeneration.Folic acid may stimulate proliferation of NSCs efficiently.

Objective:To investigate the therapeutic range of tacrolimus and effects of tacrolimus on liver and re- nal functions and blood routine in renal transplant recipients.Method:The whole blood tacrolimus concentration was meas- ured by micro-particle enzyme immunoassay(MEIA).Blood tacrolimus concentrations in 390 cases of renal transplant re- cipients were analyzed.The effects of tacrolimus on liver and renal function and blood routine were also studied.Result: The blood tacrolimus concentrations in 377 of 390 cases were within the range from 3 to 15?g?L~(-1).Their blood tacrolimus concentration differed greatly in renal transplant recipients within 6 months after transplantation.Their blood tacrolimus concentration was gradually decreased as time went on.Tacrolimus with therapeutic dosage had no effects on liver and renal function and blood routine.Conclusion:The therapeutic ranges of tacrolimus with MEIA were as follows:5 to 15?g?L~(-1) within 3 months after transplantation,5 to 10?g?L~(-1)between 4 to 6 months after transplantation,3 to 10?g?L~(-1)6 months after transplantation.The administration of tacrolimus had no effects on the liver and renal function and blood routine in re- nal transplant recipients.

Objective To investigate the clinical treatment and outcomes of severe community-acquired pneumonia (CAP) complicated with mediastinal emphysema after renal transplantation. Methods Clinical data of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation were retrospectively analyzed. The acute physiology and chronic health evaluationⅡ(APACHEⅡ) and oxygenation index were recorded when the patients were admitted to the intensive care unit (ICU). The complications of mediastinal emphysema and corresponding treatment were observed. The treatment course during the ICU, mortality rate in ICU, ICU stay time and hospital stay time were recorded. All patients underwent pathogenic examinations. Results The APACHEⅡ score of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation was 14 (8-21) scores and the oxygenation index was 150 (133-189) mmHg. Among 9 patients, 3 cases were infected by bacteria alone, 3 cases were infected by bacterial infection combined with viral infection, 1 case was infected by mycobacterium tuberculosis complicated with other bacterial infection and 1 case was viral infection. No pathogenic evidence was detected in the remaining 1 patient. Mediastinal emphysema complicated with subcutaneous emphysema occurred in 7 cases and pneumothorax occurred in 6 cases. Treatment methods included anti-infection, modified immunosuppressive program, mediastinal drainage, thoracic closed drainage, subcutaneous incision and extracorporeal membrane oxygenation (ECMO) treatment. Six patients received invasive mechanical ventilation (IMV), 2 received non-invasive positive pressure ventilation (NIV) and 1 received high-flow nasal oxygen cannula (HFNC). Among 9 patients, the mortality rate in ICU was 6/9, the remaining 3 patients were recovered and discharged, the ICU stay time was 26 (17-40) d, and the total hospital stay time was 27-61 d. Conclusions Mediastinal emphysema is a serious complication of patients presenting with severe CAP after renal transplantation with a high mortality rate. For these patients, imaging evaluation, timely drainage and full sedation should be strengthened, and ECMO treatment should be delivered when necessary.

Background and objective hTere are incresing lung cancer patients detected and diagnosed at the in-termediate stage when the pre-malignant or early lesions are amenable to resection and cure, owing to the progress of medical technology, the renewal of detection methods, the popularity of medical screening and the improvement of social health con-sciousness. hTe aim of this study is to investigate the risk factors of the occurrence of postoperative cardio-pulmonary compli-cations in stage I non-small cell lung cancer (NSCLC) patients, based on routine laboratory tests, basic characteristics, and in-traoperative variables in hospital.Methods hTe 421 patients atfer lobectomy in patients with stage I NSCLC at the West China Hospital of Sichuan University from January 2012 to December 2013 were included into the study and stratiifed into complica-tion group and non-complication group, according to whether to occur postoperative cardio-pulmonary complications atfer lobectomy in 30 days.Results Of them, 64 (15.2%) patients were ifnally identiifed and selected into the complication group, compared with 357 (84.8%) in non-complication group: pneumonia (8.8%, 37/421) was the primary complication, and other main complications included atelectasis (5.9%, 25/421), pleural effusion (≥middle) (5.0%, 21/421), persistent air leak (3.6%, 15/421); hTe operation time (P=0.007), amount of blood loss (P=0.034), preoperative chronic obstructive pulmonary disease (COPD) (P=0.027), white blood cell (WBC) count (P<0.001), neutrophil-lymphocyte ratio (NLR) (P<0.001) were signiif-cantly different between the two groups. According to the binary logistics regression analysis, preoperative COPD (OR=0.031, 95%CI: 0.012-0.078,P<0.001) and WBC count (OR=1.451, 95%CI: 1.212-1.736,P<0.001) were independent risk factors for postoperative cardio-pulmonary complications.Conclusion Among an array of clinical variables in hospital, operation time, preoperative white blood cell count, preoperative COPD, may be the independent risk factors of the occurrence of postopera-tive cardio-pulmonary complications.

Background and objective It is unknown that the postoperation fast-track recovery and in hospital cost of the lobectomy in lung cancer, we explored the inlfuencing factor of postoperative fast-track recovery and in hospital cost atfer undergoing lobectomy for lung cancer. Methods We retrospectively reviewed the medical records of all patients (n=176) who underwent lobectomy for lung cancer between January 2010 and November 2011 by a thoracic surgeon. Results hTe hospital costs of video-assisted thoracic surgery (VATS) lobectomy (47,308.21 ￥) is signiifcantly higher than open lobectomy (45,664.31 ￥)(P=0.007). hTe hospital costs of body mass index (BMI)≥24 kg/m2 (51,186.99 ￥) is signiifcantly higher than BMI<24 kg/m2 (41,701.64 ￥)(P=0.032). hTe hospital stay of VATS lobectomy (5.70 d) is signiifcantly less than open lobectomy (7.10 d)(P<0.001). Conclusion hTese ifndings indicate that preoperative pulmonary rehabilitation and VATS lobectomy is contrib-uted to fast-track recovery for patients who undergo lobectomy, but increase the hospital costs.

Background and objective Postoperative pulmonary complications (PPCs),especially postoperative pneumonia (POP),directly affect the rapid recovery of lung cancer patients after surgery.Peak expiratory flow (PEF) can reflect airway patency and cough efficiency.Moreover,cough impairment may lead to accumulation of pulmonary secretions which can increase the risk of PPCs.The aim of this study is to investigate the effect of preoperative PEF on PPCs in patients with lung cancer.Methods Retrospective research was conducted on 433 lung cancer patients who underwent lobectomy at the West China Hospital of Sichuan University from January 2014 to December 2015.The associations between preoperative PEF and PPCs were analyzed based on patients' basic characteristics and clinical data in hospital.Results Preoperative PEF value in PPCs group (280.93±88.99) L/min was significantly lower than that in non-PPCs group (358.38±93.69) L/min (P＜0.001).According to the binary logistics regression analysis,PEF and operative time were independent risk factors for PPCs.Further,ROC curve showed that PEF=320 L/min was the cut-off value for predicting the occurrence of PPCs (AUC=0.706,95％CI:0.661-0.749).The incidence of PPCs in PEF≤320 L/min group (26.6％) was significantly higher than that in PEF＞320 L/min group (9.4％)(P＜0.001).Conclusion Preoperative PEF and PPCs are correlated,and PEF maybe used as a predictor of PPCs.

Objective To compare the effect of nutritional support with and without tube feeding on the incidence of adverse reactions in radiotherapy for esophageal cancer.Methods A total of 120 esophageal cancer patients with high-risk factors receiving radiotherapy were selected and randomly assigned into the tube feeding (TF,n=60) and non-tube feeding groups (NTF,n=60) according to the random number method.Nutritional interventions were performed during radiotherapy in both groups.The incidence of esophagitis and myelosuppressioa,aulmonary infectioa,autritional status and the completion of radiotherapy were observed and statistically compared between TF and NTF groups.Results In the TF groua,ahe incidence of ≥ grade 2 esophagitis was lower than that in the NTF group.The incidence of grade 3 esophagitis significantly differed between two groups (P＜ 0.05).The incidence of grade 1-2 myelosuppression did not differ between two groupa,ahereas the incidence of grade 3 myelosuppression in the TF group was significantly lower than that in the NTF group (P＜0.05).In the TF groua,ahe incidence of pulmonary infection was remarkably lower than that in the NTF group (P＜0.05).The changes of BMI and prealbumin in the TF group were better than those in the NTF group (both P＜0.05).One patient in the NTF group failed to complete the radiotherapy due to grade Ⅳ esophagitia,and 5 cases in the NTF group (P＜ 0.05).In the TF groua,ahe length of hospital stay was significantly shortened by 6.2 d on average (P＜ 0.05).Conclusions During radiotherapy for esophageal cancer patients with high-risk factora,autritional support with tube feeding can effectively reduce the incidence of adverse reactiona,amprove the completion rate of treatmena,and shorten the average length of hospital stay.

Objective To investigate the application value of ultrasound-guided fine-needle aspiration cytology of lymph nodes in the pre-radiotherapy evaluation of superficial lymph nodes metastases in patients with lung cancer and esophageal cancer. Methods A total of 115 patients with lung cancer and esophageal cancer prepared for thoracic radiotherapy from February 2017 to September 2018 in Cancer Hospital of Huanxing Chaoyang District Beijing were retrospectively analyzed. Ultrasound-guided fine-needle aspiration cytology examination was performed in 166 lymph nodes. Puncture tissues were prepared for cytology production. Then cytological specialist read the film to evaluate if the cancer cells metastasis were present after conventional papanicolaou staining. The effects of short diameter of lymph nodes, blood flow signal and tumor characteristics of patients on the results of cytological examination were analyzed. Results The ultrasound results showed the median short diameter of lymph nodes was 0.6 cm (0.2-3.5 cm), and 25 (15.1％) lymph nodes had blood flow signals, 50 (30.1％) lymph nodes had positive results of puncture tissues cytology. The positive rate of puncture tissues cytology was 10.0％(4/40), 21.6％(21/97) and 86.2％(25/29) in the shortdiameter of lymph nodes <0.5 cm group, ≥0.5 cm and <1 cm group, and ≥1 cm group, respectively (P<0.01). Cytology positive rate of lymph nodes with or without blood flow signal detected by ultrasound was 48.0％ (12/25) and 27.0％ (38/141), and there was a statistical difference (P = 0.034). Location of primary tumor, T stage and chemotherapy history had no significant influence on the cytological results in patients with lung cancer (all P> 0.05). Pathological types had a significant influence on cytological results (χ2= 8.050, P= 0.045). Lymph node metastasis of the upper mediastinum was a risk factor for lymph node metastasis in lower neck and supraclavicular region (χ2= 9.699, P= 0.002). Location of primary tumor, T stage and chemotherapy history had no significant influence on cytological results in patients with esophageal cancer (all P> 0.05). Conclusions Ultrasound-guided fine-needle aspiration cytology is safe and efficient. It can be used to evaluate the metastasis status of superficial lymph nodes in pre-radiotherapy patients with lung cancer and esophageal cancer.