The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation (LT) waiting list. A steady increase in the threshold at which age is taken into consideration for LT has been observed. This retrospective cohort study recruited 166 lung transplant recipients aged ≽ 65 years between January 2016 and October 2020 in the largest LT center in China. In the cohort, subgroups of patients aged 65-70 years (111 recipients, group 65-70) and ≽ 70 years (55 recipients, group ≽ 70) were included. Group D restrictive lung disease was the main indication of a lung transplant in recipients over 65 years. A significantly higher percentage of coronary artery stenosis was observed in the group ≽ 70 (30.9% vs. 14.4% in group 65-70, P = 0.014). ECMO bridging to LT was performed in 5.4% (group 65-70) and 7.3% (group ≽ 70) of patients. Kaplan-Meier estimates showed that recipients with cardiac abnormalities had a significantly increased risk of mortality. After adjusting for potential confounders, cardiac abnormality was shown to be independently associated with the increased risk of post-LT mortality (HR 6.37, P = 0.0060). Our result showed that LT can be performed in candidates with an advanced age and can provide life-extending benefits.
Aged ; Humans ; East Asian People ; Heart Diseases/etiology* ; Lung Transplantation/adverse effects* ; Retrospective Studies

OBJECTIVETo study the weak loop in the treatment of children with out-of-hospital cardiac arrest (OHCA) and the treatment strategy for improvement.

METHODData of a total of 133 patients with OHCA who were rescued by Wuxi pre-hospital care center during the 2005 - 2011 were analyzed.

RESULTThe main causes of pediatric OHCA were drowning (52/133) and accidental injury disease (30/133). The cases of OHCA were mainly located in public places (60/133) and the majority occurred in winter and summer. The emergency rescue response time was (13.21 ± 8.09) min, the rate of first witness treatment was 3.91%, intubations was performed in 11.11%, opening of vein access was 23.15% and one case got restoration of spontaneous circulation (ROSC).

CONCLUSIONThe rate of ROSC of pre-hospital cardiac arrest in children was significantly lower than that of hospital cardiac arrest. Preventive interventions on children's accidents and the skills of pre-hospital staff on pediatric advanced life support (PALS) need to be urgently improved.

Advanced Cardiac Life Support ; education ; Cardiopulmonary Resuscitation ; methods ; Chi-Square Distribution ; Child ; Child, Preschool ; China ; epidemiology ; Emergency Medical Services ; methods ; organization & administration ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Out-of-Hospital Cardiac Arrest ; epidemiology ; etiology ; therapy ; Pediatrics ; education ; Retrospective Studies ; Risk Factors ; Survival Rate ; Time Factors ; Treatment Outcome

Objective　To study the effects of repeated high-frequency cranial magnetic resonance on the fine motor function and cognitive function of upper limbs in patients with traumatic cerebral hemorrhage.Methods　Ninety-four patients with traumatic cerebral hemorrhage who were treated in our department of neurosurgery from September 2015 to June 2019 were enrolled as subjects.According to the random number method,44 patients with low-frequency cranial magnetic stimulation in the affected side were used as the control group,and 50 patients with high-frequency cranial magnetic stimulation in the affected side were used as the observation group.The Fugl-Meyer Assessment score (FMA),the modified Barthel index (MBI),the motor assessment scale (MAS),and the NIH Stroke Scale (NIHSS) were used to measure the daily life ability,fine motor function,and cognitive function in patients,the clinical treatment effects were compared between groups.Results　The clinical efficacy of traumatic cerebral hemorrhage in the observation group was significantly higher than that in the control group (P<0.05).FMA scores in the observation group were significantly higher than those in the control group both 2 weeks and 4 weeks after treatment (P<0.05).The MBI scores of the observation group were significantly higher than those of the control group 2 weeks and 4 weeks after treatment (P<0.05).The MAS scores in the observation group were significantly higher than those in the control group 2 weeks and 4 weeks after treatment (P<0.05).The NIHSS scores of the observation group were significantly lower than those of the control group (P<0.05).Conclusion　Repeated high-frequency magnetic stimulation can effectively improve the upper limb motor function,daily living ability and fine motor ability in patients with traumatic cerebral hemorrhage,and can effectively improve their cognitive function.

Surgical technique of lung transplantation exerts significant impact on clinical prognosis of the recipients. Choosing an appropriate surgical incision determines the exposure of intraoperative visual field, which is the first step of surgical success and directly affects subsequent surgical procedures. Lung transplantation incision is usually considered as primary closure. Nevertheless, for patients with high-risk factors such as oversized lung allografts and primary graft failure after lung transplantation, primary closure cannot be achieved. Hence, delayed chest closure is an effective strategy. The selection of incisions and the adoption of delayed chest closure of lung transplantation exert profound impact upon perioperative prognosis, long-term quality of life and surgical complications of the recipients. Therefore, the development and research status of Clamshell incision, anterolateral incision, posterolateral incision and median sternal incision in lung transplantation were reviewed, highlighting the effect of incision patterns on clinical prognosis of lung transplantation and providing reference for the selection of incisions in clinical lung transplantation.

Objective To analyze the influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation. Methods Clinical data of 66 patients with airway stenosis requiring clinical interventions after lung transplantation were retrospectively analyzed. Univariate and multivariate Cox’s regression models were adopted to analyze the influencing factors of survival of all patients with airway stenosis and those with early airway stenosis. Kaplan-Meier method was used to calculate the overall survival and delineate the survival curve. Results For 66 patients with airway stenosis, the median airway stenosis-free time was 72 (52,102) d, 27% (18/66) for central airway stenosis and 73% (48/66) for distal airway stenosis. Postoperative mechanical ventilation time [hazard ratio (HR) 1.037, 95% confidence interval (CI) 1.005-1.070, P=0.024] and type of surgery (HR 0.400, 95%CI 0.177-0.903, P=0.027) were correlated with the survival of patients with airway stenosis after lung transplantation. The longer the postoperative mechanical ventilation time, the higher the risk of mortality of the recipients. The overall survival of airway stenosis recipients undergoing bilateral lung transplantation was better than that of their counterparts after single lung transplantation. Subgroup analysis showed that grade 3 primary graft dysfunction (PGD) (HR 4.577, 95%CI 1.439-14.555, P=0.010) and immunosuppressive drugs (HR 0.079, 95%CI 0.022-0.287, P<0.001) were associated with the survival of patients with early airway stenosis after lung transplantation. The overall survival of patients with early airway stenosis after lung transplantation without grade 3 PGD was better compared with that of those with grade 3 PGD. The overall survival of patients with early airway stenosis after lung transplantation treated with tacrolimus was superior to that of their counterparts treated with cyclosporine. Conclusions Long postoperative mechanical ventilation time, single lung transplantation, grade 3 PGD and use of cyclosporine may affect the survival of patients with airway stenosis after lung transplantation.

Objective To explore the establishment of a prognostic model based on machine learning algorithm to predict primary graft dysfunction (PGD) in patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 226 IPF patients who underwent lung transplantation were retrospectively analyzed. All patients were randomly divided into the training and test sets at a ratio of 7:3. Using regularized logistic regression, random forest, support vector machine and artificial neural network, the prognostic model was established through variable screening, model establishment and model optimization. The performance of this prognostic model was assessed by the area under the receiver operating characteristic curve (AUC), positive predictive value, negative predictive value and accuracy. Results Sixteen key features were selected for model establishment. The AUC of the four prognostic models all exceeded 0.7. DeLong and McNemar tests found no significant difference in the performance among different models (both P>0.05). Conclusions Based on four machine learning algorithms, the prognostic model for grade 3 PGD after lung transplantation is preliminarily established. The overall prediction performance of each model is similar, which may predict the risk of grade 3 PGD in IPF patients after lung transplantation.

Objective:To explore the suggestion and key points of implementing community rehabilitation centered on peer education for patients with chronic obstructive pulmonary disease (COPD). Methods:From June, 2016 to June, 2017, 19 doctors, 15 nurses and 27 patients with COPD were selected for semi-structured interviews with the phenomenological research method, and the data were analyzed using the 7-step analysis method of Colaizzi. Results:The points were as follows: establishment and orientation of group leader education, hospital-community-family interaction mode, collective and individual intervention mode and effect and interaction monitoring. Conclusion:There is still lack of unified standards and teaching materials for the application of peer education in the rehabilitation of COPD patients. COPD community rehabilitation implementation strategies with peer education as the core are formulated to provide further reference for the rehabilitation of COPD patients.

OBJECTIVESTo understand the hepatic pathology, hepatitis B reactivation rates and serological changes in chronic HBV carriers.

METHODSA 5 year dynamic observation and survey of 220 chronic HBV carriers in Wuxi district was taken, analyzing their clinical symptoms, liver histopathology, virology and HBV immunological markers.

RESULTSThirty-five of the 220 (15.9%) patients, showed hepatitis B reactivation. The hepatitis B reactivation rate of patients with obvious hepatic tissue inflammation (> or = G2) was 27.0% (33/122) and the rate of the patients with mild hepatic tissue inflammation (G0-G1) was 2.0% (2/98), showing significant differences (x2=25.41, P less than 0.01). The reactivation rate of patients with high inflammation was clearly higher than those with mild inflammation. Twenty-seven of the 35 hepatitis B reactivation cases were older than 40 years, showing a significant association between the ages of the patients and hepatitis B reactivation rates (x2=6.72, P less than 0.01), moreover there was no relationship between sex and the hepatitis B reactivation rate. There were differences in the inflammation grades and fibrosis stages between HBeAg positive and anti-HBe positive group cases (Kruskal-Wallis Test, x2=8.68, P less than 0.01, x2=6.84, P less than 0.01), showing inflammation grades and fibrosis stages of the anti-HBe positive group were higher than those of the HBeAg positive group. There were no obvious differences about the inflammation grade between age less than 40 years old and > or = 40 years old group cases (x2=0.62, P more than 0.05), but there were significant statistical differences about the fibrosis stage (x2=7.37, P less than 0.01), showing fibrosis stage of more than 40 years old group cases was clearly higher than the less than 40 years old group cases. Fifty-six cases received a liver biopsy for a second time and 23 for a third time. We found those whose hepatic tissues were normal in their first liver biopsies, then their liver histology continued remaining stable for several years while those with abnormal ones hardly or only recovered slightly. The rate of HBsAg turning to negativity per year was 1.55% and for HBeAg was 5.4%.

CONCLUSIONThe hepatic tissue pathology for most chronic HBV carriers (55%) had significant abnormalities (inflammation grade > or = G2), and the rates of hepatitis B reactivation were highly relevant to the liver inflammation grades and the ages of the patients.

Adolescent ; Adult ; Carrier State ; virology ; Child ; Female ; Follow-Up Studies ; Hepatitis B virus ; physiology ; Hepatitis B, Chronic ; pathology ; virology ; Humans ; Inflammation ; Liver ; pathology ; virology ; Male ; Middle Aged ; Virus Activation ; Virus Replication ; Young Adult

AIM: To study and analyze the clinical effect of phacoemulsification and intraocular lens(IOL)implantation combined with goniosychialysis in treatment of acute angle-closure glaucoma with cataract.

METHODS: From June 2010 to October 2018, 40 patients(40 eyes)with acute angle-closure glaucoma and cataract which anterior chamber angle adhesion is less than 180°admitted to our hospital were enrolled in this study. They were divided into observation group and control group according to different surgical methods. The patients in the control group were treated by phacoemulsification and IOL implantation. The observation group was treated with phacoemulsification and IOL implantation combined with goniosychialysis. The difference between the two groups was compared.

RESULTS: At 3mo, 6mo after operation, the visual acuity, intraocular pressure, anterior chamber depth, anterior chamber angle grading of the observation group were better than those of the control group(P<0.05).

CONCLUSION: Regarding the treatment of acute angle closure glaucoma, who has cataract and less than 180° peripheral anterior synechia, phacoemulsification and IOL implantation combined with goniosychialysis showed significant clinical effect.

Adhesins, Escherichia coli ; genetics ; Bacterial Typing Techniques ; Escherichia coli Proteins ; genetics ; Fimbriae Proteins ; genetics ; Genes, Bacterial ; Genotype ; Uropathogenic Escherichia coli ; classification ; genetics