This paper aims to focus on and implement strategies for preventing and resolving medical complaints and dis-putes at their emergence.The hospital promptly compiled a summary of the main problems and concerns reported from patients o-ver the past few years.It combined medical practices with the characteristics of admitted patients with severe diseases,complex treatment plans,and high risks.Since 2020,this hospital has been actively engaging with intractable high-risk patients and de-veloped a scheme that engaging clinical departments,medical management,and dispute management departments together to con-duct preoperative/pre-treatment communication.With a focus on patient management,this hospital upholds the concept of the pa-tient-centered humanistic philosophy in the process of doctor-patient communication to enhance the quality of communication.Consequently,the hospital has benefited from the communication scheme,achieving satisfactory effect in ensuring a solid medical safety and reducing the incidence of medical disputes.

BACKGROUND: Chronic obstructive pulmonary diseases (COPD) affects 45%-63% of lung cancer patients worldwide. Lung cancer patients complicated with COPD have decreased cardiopulmonary function and increased perioperative risk, and their postoperative exercise endurance and lung function are significantly lower than those with conventional lung cancer. Previous studies have shown that postoperative exercise training can improve the exercise endurance of unselected lung cancer patients, but it is unclear whether lung cancer patients with COPD can also benefit from postoperative exercise training. This study intends to explore the effects of postoperative exercise training on exercise endurance, daily activity and lung function of lung cancer patients with COPD. METHODS: Seventy-four patients with non-small cell lung cancer (NSCLC) complicated with COPD who underwent pneumonectomy in the lung cancer center of West China Hospital of Sichuan University from August 5, 2020 to August 25, 2021 were prospectively analyzed. They were randomly divided into exercise group and control group; The patients in the two groups received routine postoperative rehabilitation in the first week after operation, and the control group was given routine nursing from the second week. On this basis, the exercise group received postoperative exercise rehabilitation training for two weeks. Baseline evaluation was performed 3 days before operation and endpoint evaluation was performed 3 weeks after operation. RESULTS: The exercise endurance, daily activity and pulmonary function test results of the two groups decreased from baseline to the end point. However, after the operation and intervention program, the maximum oxygen consumption of Cardiopulmonary Exercise Test and the walking distance of 6-Minute Walking Test in the exercise group were significantly better than those in the control group [(13.09±1.46) mL/kg/min vs (11.89±1.38) mL/kg/min, P=0.033; (297±46) m vs (243±43) m, P=0.041]. The average number of we-chat steps in the exercise group was also significantly better than that in the control group (4,381±397 vs 3,478±342, P=0.035). Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in the exercise group were better than those in the control group, but the difference did not reach a statistically significant level [(1.76±0.19) L vs (1.60±0.28) L, P=0.084; (1.01±0.17) L vs (0.96±0.21) L, P=0.467]. CONCLUSIONS Postoperative exercise rehabilitation training can improve exercise endurance and daily activity ability of patients with lung cancer complicated with COPD and promote postoperative rehabilitation.
Carcinoma, Non-Small-Cell Lung/surgery* ; Exercise ; Forced Expiratory Volume ; Humans ; Lung Neoplasms/surgery* ; Pulmonary Disease, Chronic Obstructive/complications*

Objective:To evaluate the safety of naborphine hydrochloride combined with propofol in painless colonoscopy diagnosis and treatment of hypertensive patients.Methods:From October 2018 to September 2020, 900 patients with ASA grade Ⅰ to Ⅲ, aged 18 to 65, who underwent colonoscopy in Zhuhai Hospital Affiliated to Jinan University and Shanghai East Hospital Affiliated to Tongji University were prospectively selected. According to the random number table method, the patients were divided into 3 groups ( n=300): naborphine hydrochloride group 1 (N1 group, intravenous injection of 0.05 mg/kg naborphine hydrochloride); naborphine hydrochloride group 2 (N2 group, intravenous injection of 0.1 mg/kg naborphine hydrochloride); sufentanil group (SF group, intravenous injection of 0.1 μg/kg sufentanil). During anesthesia induction, propofol was combined with sedation, and the dose of propofol was 1.5 mg/kg. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO 2), respiratory rate (RR), and mean arterial pressure (MAP) of the three groups were compared before anesthesia (T 0), during induction (T 1), 1 min after induction (T 2), 2 min after induction (T 3), 3 min after induction (T 4) and 4 min after induction (T 5), and the bispectral index (BIS) were monitored. At the same time, the examination time, total dosage of propofol, recovery time, postoperative Visual Analogue Scale (VAS) score and perioperative anesthesia related adverse reactions of the three groups were compared. Results:There was no significant difference among the three groups in examination time, total dosage of propofol, recovery time, postoperative VAS score and adverse anesthetic reactions (all P>0.05). There was no significant difference in HR, SpO 2 and RR among the three groups at different time points (all P>0.05). The SBP, DBP and MAP in N1 group at T 1, T 3, T 4 and T 5 were lower than those in SF group (all P<0.05); The SBP, DBP and MAP in N2 group at T 1, T 3 and T 4 were higher than those in N1 group (all P<0.05). The BIS in T 3 and T 4 of N2 group was higher than that of N1 group (all P<0.05). Conclusions:0.1 mg/kg naborphine hydrochloride combined with propofol for painless enteroscopy in patients with hypertension has fine anesthetic effect and safety.

Objective:To investigate the related factors affecting intraoperative blood loss in patients with spinal tumors undergoing preoperative selective arterial embolization.Methods:The clinical data of 90 patients with spinal tumors who underwent preoperative selective arterial embolization in the Affiliated Hospital of Jining Medical College and the Second Affiliated Hospital of Shanxi Medical University from January 2017 to December 2020 were retrospectively analyzed. The influencing factors of intraoperative bleeding were analyzed by using multiple linear regression.Results:There were statistically significant differences in intraoperative blood loss of spinal tumor patients undergoing preoperative selective arterial embolization with different blood supply abundance and the number of tumors involving vertebral body (all P < 0.05). There were no significant differences in age, gender, body mass index, interval after embolization, operation time, pathological type, tumor site, embolization degree, the number of embolized vessels, preoperative Frankel grade among different groups (all P > 0.05). Multiple linear regression analysis showed that the number of tumors involving vertebral body and tumor blood supply abundance were factors affecting intraoperative blood loss, and vertebra number and tumor blood supply were positively correlated with intraoperative blood loss (all P < 0.05). Conclusion:For patients with spinal tumors undergoing preoperative selective arterial embolization, the number of tumors involving vertebral body and the abundance of the tumor blood supply are factors affecting the amount of intraoperative bleeding.

Objective To retrospectively study the incidence and risk factors of thyroid disease induced by peginterferon plus ribavirin (Peg IFN/RBV) antiviral treatment in patients with chronic hepatitis C (CHC).Methods From January 2012 to December 2014,a total of 362 CHC patients were treated with Peg IFN/RBV antiviral therapy at Wuxi Fifth People's Hospital,among whom 315 patients were included in this study.Thyroid function,autoantibodies and thyroid ultrasound were measured at baseline,weeks 12,24 and 48.Comparisons between groups were performed using chi-square test for qualitative data and the unpaired t test for continuous variables.Results After treatment,thyroid dysfunction developed in 12.1％ of patients.Positive anti-thyroid peroxidase and anti-thyrobolulin antibodies were detected in 21％ of patients.The thyroid ultrasound changes developed in 14.9％ of the patients,among whom normal thyroid function and thyroid autoantibodies negative were detected in 8.7 ％ of patients.The titer of thyroid autoantibodies increased steadily from baseline to the end of treatment.Logistic regression analysis showed that positive thyroid autoantibody (OR =5.423,95％ CI:3.441 8.716),sustained virological response (OR=7.201,95％CI:6.231-10.206),female(OR=1.22,95％ CI:0.951-2.212) were the risk factors of thyroid dysfunction.Conclusions Peg IFN/RBV antiviral treatment increases the incidence of thyroid disease in CHC patients.Positive thyroid autoantibody,sustained virological response and the female gender are the risk factors of thyroid dysfunction.

Anthrax is a highly lethal infectious disease caused by the spore-forming bacterium Bacillus anthracis. The major virulence factor of B. anthracis consists of protective antigen (PA), lethal factor (LF) and edema factor (EF). PA binds with LF to form lethal toxin (LT), and PA binds with EF to form edema toxin (ET). Antibiotics is hard to work in advanced anthrax infections, because injuries and deaths of the infected are mainly caused by lethal toxin (LT). Thus, the therapeutic neutralizing antibody is the most effective treatment of anthrax. Currently most of the anthrax toxin antibodies are monoclonal antibodies (MAbs) for PA and US FDA has approved ABTHRAX humanized PA monoclonal antibody for the treatment of inhalational anthrax. Once B. anthracis was artificially reconstructed or PA had mutations within recognized neutralization epitopes, anti-PA MAbs would no longer be effective. Therefore, anti-LF MAbs is an important supplement for anthrax treatment. Most of the anti-LF antibodies are murine or chimeric antibodies. By contrast, fully human MAbs can avoid the high immunogenicity of murine antibodies. First, we used LF to immunize the transgenic mice and used fluorescent cell sorting to get antigen-specific memory B cells from transgenic mice spleen lymphocytes. By single cell PCR method, we quickly found two strains of anti-LF MAbs with binding activity, 1D7 and 2B9. Transiently transfected Expi 293F cells to obtain MAbs protein after purification. Both 1D7 and 2B9 efficiently neutralized LT in vitro, and had good synergistic effect when mixed with anti-PA MAbs. In summary, combining the advantages of transgenic mice, fluorescent cell sorting and single-cell PCR methods, this study shows new ideas and methods for the rapid screening of fully human monoclonal antibodies.

Objective To investigate the risk factors for neurological complications after deep hypothermic ciculatory arrest (DHCA) operation.Methods From January 2009 to October 2013, 70 patients who were diagnosed as aortic dissection or aortic an-eurysm underwent aortic operations under DHCA .According to the occurrence of neurological complications after surgery , patients were divided into neurological complication group (26 patients) and normal group (44 patients).Risk factors of neurological complications after surgery were evaluated by univariate analysis and multivariate logistic regression analysis .Results Central neurological compli-cations occurred in 26 patients (37.14%) , including 18 patients with temporary neurological dysfunction and 7 patients with perma-nent neurological dysfunction , 1 patient with paraplegia , 1 patient died of cerebral infarction .Univariate analysis showed that hyperten-sion disease( P =0.001), emergency surgery within 72 hours( P =0.009),cardiopulmonary bypass time ( P =0.015),antegrade se-lective cerebral perfusion ( ASCP) ( P =0.005 ) , hemodilution degree ( P =0.001 ) , erythrocyte ( P =0.033 ) and plasma ( P =0.034 ) transfusion volume in the perioperative period , oxygen index <200 mmHg in 4 hours postoperatively ( P =0.043 ) , arterial blood pressure instability ( P =0.037 ) and hypernatremia in 24 hours postoperatively ( P =0.001 ) , and the Acute Physiology And Chronic Health Evaluation II (APACHE II) score are the risk factors for central neurological complication .Hypertension disease( P =0.017 ) , emergency surgery within 72 hours ( P =0.048 ) , ASCP ( P =0.015 ) , hypernatremia in 24 hours postoperatively ( P =0.008 ) were independent determinats for central neurological complication .Conclusions A series of procedure including evaluating patients condition correctly before operation , controlling hypertension effectively in the perioperative period , applying the ASCP and the suitable hemodilution degree in operation , maintaining electrolyte balance , and correcting hypernatremia timely in the postoperative pe-riod maybe reduce the incidence of neurological complications after DHCA operation .

Objective To explore the therapeutic effect influencing factors of intra-aortic balloon pump(IABP) support during cardiac surgery perioperative period and countermeasures.Methods Clinical data of 42 patients using IABP in the cardiac surgery was analyzed retrospectively.The patients were classified into 2 groups:living group (32 patients) and died group (10 patients).The time of IABP implantation,preoperative cardiac function,the duration of cardiopulmonary bypass(CPB) and aorta block,mean arterial pressure (MAP) and inotropic score (IS) before using IABP and postoperative complications were recorded and compared.Results In died group,2 patients were used IABP preoperatively,1 patient was used intraoperatively,7 patients were used postoperatively,8 patients were in NYHA cardiac function class Ⅲ or Ⅳ preoperative,the duration of CPB and aorta block were (144.43 ± 49.03),(97.29 ± 39.99)min respectively,MAP and IS before using IABP were (57.34 ±7.25) mm Hg (1 mm Hg =0.133 kPa) and (28.22 ±17.72) scores,IABP time was (86.00 ±52.31) min.Compared with living group,all above comparisons showed significant difference [(100.43 ± 35.03) min,(60.45 ± 20.55) min,(69.34 ± 8.05)mm Hg,(10.82 ± 15.75) scores,(49.00 ± 25.23) min] (P ＜ 0.05).Postoperative complications in died group included 7 patients of ventilator dependency,6 patients of acute renal failure,5 patients of refractory metabolic acidosis,2 patients of malignant arrhythmia,1 patient of acute myocardial infarction,significantly higher than those in living group (0,4,2,0,0) (P ＜ 0.05).Conclusions Erroneously choose the timing of using IABP,poor preoperative cardiac function,prolonging CPB and aorta block time,MAP less than 60 mm Hg and high dose positive inotropic agent before using IABP,and postoperative complications are main influencing factors for clinical outcomes of IABP in cardiac surgery.Reasonably choosing adaptive indication and timing of IABP,preventing and treating postoperative complications effectively can improve effects of IABP in cardiac surgery.

Objective To study the mechanism of pulmonary injury and protective effect of modified ultrafiltration on lung function in infant open heart surgery.Methods According to the wishes of parents,40 cases of congenital heart disease were divided into without modified ultrafiltration control group (C) and modified ultrafiltration group (M),and parents signed informed consent.The cardiopulmonary bypass (CPB) was used without ultrafiltration in Group C,while with modified ultrafiltration in group M.The pneumodynamic parameters and C3a,C5a,TXA2,LT were measured at specific time points.Results The static pulmonary compliance (Cstat) and oxygen index (OI) were lower,and alveolar-arteria oxygen difference (AaDO2) was higher after CPB in the two groups(P ＜ 0.05).At T3,T4 and T5 time points,the Cstat and OI in Group M was higher than that in Group C; AaDO2 in Group M was lower than that in Group C (P ＜0.05).The levels of C3a and C5a were lower after CPB in the two groups; levels of TXA2,LT were higher after CPB in the C groups.At T2,T3,T4 and T5 time points,the TXA2 and LT in Group M were lower than that in Group C(P ＜0.05).Conclusions The pulmonary injury in pediatric open heart surgery may be concerned with the the alexin(C3a,C5a) activation and I/R.The level of C3a and C5a was considered earlier index of inflammatory reaction and pulmonary injury.Modified ultrafiltration improves pulmonary function due to elevating coloid osmotic pressure and degrading the plasma level of TXA2,LT.

AIM: To investigate the effect of Chinese herbs, Ganxianfang(GXF), on rat hepatic stellate cells (HSC) proliferation and collagen synthesis. METHODS: Two types of herb serum, portal venous serum and circumferential venous serum, were prepared from rats infused intragastrically with 16,8,4 times adult dose of GXF decoction. HSC isolated from rat liver were processed with the above sera in vitro . Then we mensurated the radioactivity of HSC admixed with [ 3H]proline and [ 3H]thymine to judge the effect on proliferation and collagen synthesis of HSC. RESULTS: Both two types of serum collected 0 5, 1, 2 h after intragastrical infusion inhibited HSC proliferation ( P 0 05). CONCLUSION: Inhibition of HSC proliferation and decrease of collagen synthesis may contribute to the GXF antifibrotic action.