Objective    To explore the treatment strategies for patients with fever and pulmonary complications after thoracic surgery during COVID-19 epidemic. Methods    The clinical data of 537 patients who ungerwent selective surgery at the Department of Thoracic Surgery, Shangjin Branch of West China Hospital between February and December 2020 were retrospectively analyzed, including 242 (45.1%) males and 295 (54.9%) females aged 53.3±13.4 years. We have established a procedure for the patients with fever and pulmonary complications after thoracic surgery to investigate the cause of the disease and track risk factors. Results    The overall postoperative complication rate was 16.4% (88/537), and 1 (0.2%) patient died. Of 537 patients, 179 (33.3%) patients were enrolled in our model according to the inclusion criteria: ratio of males [112 (62.6%) vs. 130 (36.3%), P<0.010], patients with a history of smoking [74 (41.3%) vs. 87 (24.3%), P<0.010], or with esophageal cancer surgery [36 (20.1%) vs. 15 (4.2%)], or with traditional thoracotomy [14 (7.8%)  vs. 4 (1.1%)] was higher than that of the other patients. Patients in our process due to fever or pulmonary complications had longer ICU stay and postoperative hospital stay (P=0.010). Logistic regression multivariate analysis showed that gender was an independent risk factor for postoperative fever or pulmonary complications. Conclusion    In low-risk areas of the epidemic, the treatment process is simple and feasible, and the cause traceability and corresponding treatment can basically be completed within 24 hours. At the same time, the treatment process has been running stably for a long time.

Objective    To analyze the results and diagnostic value of postoperative chylous test of pleural effusion and to verify the clinicopathological factors affecting the results of chylous test. Methods    The clinical data of 265 consecutive patients undergoing selective surgery at the Department of Thoracic Surgery, Shangjin Nanfu Hospital between May and August 2020 were retrospectively analyzed, including 106 males and 159 females with an average age of 53.0±12.2 years. According to the results of the chylous test on the operation day and postoperative first and second days, the patients were divided into two subgroups, including a positive group and a negative group, and the clinical data of the two groups were compared. Sensitivity and specificity of the chylous test were calculated. The influencing factors for chylous test were analyzed by multiple logistic regression analysis. Results    The positive rate of chylous test was 91.7%, 95.8% and 87.9% on the operation day and postoperative first and second days, respectively. There was no statistical difference in age, sex, surgical type, surgical approach, surgical site, surgical time, degree of lymph node dissection, treatment of thoracic duct, 24 hours pleural fluid drainage or 24 hours protein and fat food intake between the positive group and the negative group (P>0.05). The diagnostic sensitivity and specificity of the chylous experiment were 100.0%and 4.0%, respectively. Multiple logistic regression analysis showed that the surgical site (left/right chest) might be an influencing factor for the results of the chylous test (P=0.043, OR=0.458, 95%CI 0.216-0.974). Conclusion    The positive rate of chylous test of pleural effusion after thoracic surgery is very high. The chylous test produces a high misdiagnosis rate of chylothorax. The surgical site (left/right chest) may be an influencing factor for chylous test. The positive result of chylous test is not recommended as the direct diagnostic basis for postoperative chylothorax and guidance of the subsequent treatment.

Objective To study the correlation between homocysteine (Hcy) level and arteriosclerosis in hypertension pa-tients.Methods Four hundred and twenty hypertension patients (assigned as the experimental group) and 192 healthy examinees (as-signed as the control group) were recruited for the study, and the hypertension patients were further subdivided into the normal Hcy group, the slightly higher Hcy group and the obviously high Hcy group, in accordance with the plasma levels of Hcy.Carotid-femoral pulse wave velocity ( CFPwV) was measured by automatic pulse wave velocity detector and was used as an arteriosclerosis indicator. Blood pressure parameters, Hcy levels, CFPwV levels were compared between the 4 groups and the incidence of atherosclerosis for each group were calculated accordingly.Then, Pearson correlation analysis and multiple regression analysis were performed in all the associ-ated factors of hypertension with CFPwV.Results (1) As compared with those of the control group, the levels of systolic blood pres-sure ( SBP) , diastolic blood pressure ( DBP) , mean arterial blood pressure ( MAP) , pulse pressure ( PP) , Hcy and CFPwV increased in all the experimental groups (P<0.05).As compared with those of the Hcy normal group, the levels of SBP, DBP, MAP, PP, Hcy and CFPwV increased in the slightly higher Hcy group and the obviously high Hcy group (P<0.05).And as compared with those of the slightly higher Hcy group, the levels of SBP, Hcy and CFPwV in the obviously high Hcy group all elevated significantly ( P<0.05).(2) The incidence of atherosclerosis in the slightly higher Hcy group and the obviously high Hcy group was higher than those of the normal Hcy group (P<0.05).(3) Pearson correlation analysis revealed that CFPwV was positively correlated with age, SBP, DBP, PP, MAP and Hcy.Results of multiple linear regression analysis indicated that Hcy, SBP and PP were independent influential factors of CFPwV.Conclusion Hcy, SBP and PP were independent influential factors of CFPwV.High Hcy level and hypertension were synergistic, and high Hcy could increase the risk of atherosclerosis due to hypertension, indicating that hypertension and high Hcy level were all involved in the occurrence and development of atherosclerosis.