In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.
Humans ; Lung ; Walking/physiology* ; Walk Test ; Heart Valves/surgery* ; Postoperative Period ; Postoperative Complications/etiology*

Objective    To investigate the safety and feasibility of early mobilization in critically ill patients with femoral catheters, and to provide reference for guiding clinical rehabilitation training. Methods    The literature on the safety and feasibility of early mobilization in critically ill patients with femoral catheters included in PubMed, EMbase, OVID, Springer-link, Wiley Online Library, and Web of Science up to June 2021 was searched, and relevant data were extracted for analysis. Results    Seventy-two papers were initially screened, and 12 papers that met the criteria were finally included, covering 1 056 patients, and 489 patients had femoral catheters. Patients underwent 6 495 sessions of physical therapy, and a total of 62 patients had adverse events, including 14 (2.86%, 14/489) patients with catheter-related adverse events. Conclusion    Although early mobilization in critically ill patients with femoral catheters may lead to adverse catheter-related events, the incidence is low. Therefore, the associated risks and benefits should be weighed in clinical practice, and femoral catheter is not recommended as a contraindication for early mobilization in critically ill patients.

In the past two decades, adult cardiac surgery has developed by leaps and bounds in both anesthetic techniques and surgical methods, whereas the incidence of postoperative pulmonary complications (PPCs) has not changed. Until now PPCs are still the most common complications after cardiac surgery, resulting in poor prognosis, significantly prolonged hospital stays and increased medical costs. With the promotion of the concept of enhanced recovery after surgery (ERAS), pre-rehabilitation has been becoming a basic therapy to prevent postoperative complications. Among them, preoperative inspiratory muscle training as a very potential intervention method has been widely and deeply studied. However, there is still no consensus about the definition and diagnostic criteria of PPCs around the world; and there is significant heterogeneity in preoperative inspiratory muscle training in the prevention of pulmonary complications after cardiac surgery in adults, which impedes its clinical application. This paper reviewed the definition, mechanism, and evaluation tools of PPCs, as well as the role, implementation plan and challenges of preoperative inspiratory muscle training in the prevention of PPCs in patients undergoing cardiac surgery, to provide reference for clinical application.

Objective    To investigate the morbidity of postoperative pulmonary complications (PPCs) in patients after transcatheter tricuspid valve replacement (TTVR). Methods    A prospective cohort study enrolled 19 patients who were diagnosed with severe or greater tricuspid regurgitation in West China Hospital from October 11, 2020 to March 1, 2021, and would receive TTVR using LuX-valve for valve replacement. The patients were divided into a PPCs group and a non-PPCs group according to the presence of PPCs. The incidence of PPCs after tricuspid valve intervention between the two groups was compared. Results    Of 19 patients diagnosed with severe or greater tricuspid regurgitation registered in the database, 17 met the inclusion criteria, including 15 females and 2 males, with a mean age of 68.4±8.0 years. PPCs occurred in 9 of 17 (52.9%) patients. At discharge, compared with the non-PPCs group, the PPCs group had a longer postoperative hospital stay [11.0 (10.0, 17.0) d vs. 7.5 (7.0, 8.0) d, P=0.01], longer ICU stay [72.0 (45.5, 95.0) h vs. 20.5 (16.0, 22.8) h, P<0.01], and more hospital cost [74.3 (65.9, 98.3) thousand yuan vs. 52.6 (44.2, 57.4) thousand yuan, P<0.01]. At 30 days of follow-up, the PPCs group was found that the rate of New York Heart Association cardiac function≥class Ⅲ (66.7% vs. 12.5%, P<0.01) was higher, the six-minute walk distance (170.2±169.3 m vs. 377.9±80.5 m, P<0.01) was shorter and Kansas City Cardiomyopathy Questionnaire heart failure score (40.9±31.2 vs. 80.4±5.8, P<0.01) was less than those of the non-PPCs group. Conclusion    PPCs are common in the patients undergoing TTVR and severely affect patients' cardiac function, exercise function and quality-of-life recovery. Proactive preoperative intervention as well as early postoperative rehabilitation management should be provided to those at high risk of PPCs.

Tricuspid valve, also known as "forgotten valve" because of the high natural and surgical mortality. Transcatheter tricuspid valve replacement is an innovative surgical method to treat tricuspid regurgitation, which improves the prognosis of patients and is gradually being popularized in clinics. However, postoperative pulmonary complications are still the main causes affecting the rapid recovery and death. More and more medical experts begin to use preoperative inspiratory muscle training to reduce postoperative pulmonary complications and improve the quality of life of patients after cardiac surgery. However, there was no report on the effect of preoperative inspiratory muscle training on pulmonary complications after transcatheter tricuspid valve replacement. Therefore, for the first time, we boldly speculate that inspiratory muscle training can reduce pulmonary complications after transcatheter tricuspid valve replacement, and put forward suggestions for its treatment mechanism and strategy. But this rehabilitation intervention lacks practical clinical research. Unknown challenges may also be encountered, which may be a new research direction.

Objective:To investigate the effect of neoadjuvant chemotherapy on locally advanced rectal cancer.Methods:After collecting the clinical data of 180 rectal cancer patients diagnosed initially as cT3-4N0-2M0 stage, patients were divided into neoadjuvant chemotherapy group, neoadjuvant chemoradiotherapy group and control group. First-line chemotherapy regimen CAPEOX was used as neoadjuvant therapy. Second-line chemotherapy regimen FOLFIRI was used for the patients not sensitive to CAPEOX . Long-term radiotherapy (total dosage: 45-50 Gy)was used in the neoadjuvant chemoradiotherapy group. The compliance, anastomotic fistula , infection and incidence of anal dysfunction, effective rate of neoadjuvant therapy and tumor reduction rate were observed.Results:The compliance of neoadjuvant treatment was higher than that of the control group(90% vs.85% vs.73%, χ 2=6.16, P<0.05); The rate of adverse reaction in neoadjuvant chemoradiotherapy group was higher than that in the neoadjuvant chemotherapy group and control group(28% vs.6% vs.12%, χ 2=10.57, P<0.05); The anastomotic fistula(17% vs. 6% vs. 5%, χ 2=6.95, P<0.05), infection rate(16% vs. 5% vs. 3%, χ 2=6.89, P<0.05)and incidence of anal dysfunction(21% vs. 9% vs.7%, χ 2=6.42, P<0.05) in neoadjuvant chemoradiotherapy group were higher than that in the neoadjuvant chemotherapy group and control group. There was no significant difference between the neoadjuvant chemotherapy group and the control group( P>0.05) .Overall effective rate in neoadjuvant chemotherapy group and neoadjuvant chemoradiotherapy group was 40 % and 66%, respectively. Conclusions:Patients with locally advanced rectal cancer have better compliance with neoadjuvant chemotherapy and lower toxic side effects compared to neoadjuvant chemoradiotherapy. Neoadjuvant chemotherapy can be safely and effectively used in locally advanced rectal cancer.

Objective To evaluate the clinical effect of warm acupuncture,manipulation combined with western medicine in the treatment of primary frozen shoulder. Methods A total of 90 patients with primary frozen shoulder, from October 2015 to February 2017, were randomly divided into three groups (n=30):the western medicine group, the traditional Chinese medicine(TCM) group and the integrated TCM and western medicine group. The western medicine group was treated with local block and intra-articular injection. The TCM group was treated with acupuncture combined with manipulation. The integrated TCM and western medicine group were treated with western medicine and TCM. The three groups were treated for four weeks. The shoulder function (Constant-Murley shoulder scores) and shoulder pain (VAS scores) were evaluated in the three groups after treatment. Results The effective rate in TCM and western medicine group was 100％ versus TCM group 83.3％,and Western medicine group 76.7％, which showed significantly higher differnce among three groups (P<0.05). The Constant-Murley shoulder scores in TCM and western medicine group were (72.4 ± 3.8 vs. 67.5 ± 4.5, 58.9 ± 5.4), which were significantly higher than those in TCM group and western medicine group (P<0.05). The VAS scores in TCM and western medicine group were (1.6 ± 0.7 vs. 2.5 ± 0.8, 2.7 ± 0.7) which were lower than those in TCM group and western medicine group (P<0.05). Conclusions The combination of warm acupuncture, manipulation and western medicine could improve shoulder function and reduce shoulder pain in patients with primary frozen shoulder..

Objective To evaluate the effect on threshold of triggered angiographic acquisition by different iodine flow rate on renal artery CTA using Smart Prep tracking technique.Methods A total of 420 patients were randomly divided into A-D group with iodine flow rate of 0.90 gI/s,1.11 gI/s,1.20 gI/s,1.48 gI/s on average respectively.And each group were divided 7 subgroups with threshold 140-＜150 HU,150-＜ 160 HU,160-＜ 170 HU,170 ＜180 HU,180 ＜190 HU,190-＜200 HU,200-210 HU respectively.The quality of the images were graded from 1 5 by 2 radiologists.The best image quality subgroups were achieved,and the scores were compared among the best image quality subgroups.Results Image quality of renal CTA in each group were best performed with a threshold of 170-＜ 190 HU,160-＜ 190 HU,170-＜ 180 HU,160-＜ 180 HU respectively.When the threshold were 170-＜180 HU,image quality were good with all iodine flow rate groups.There was no significant difference among the scores of the best image quality subgroups (all P＞0.05).Conclusion Different iodine flow rate with appropriate threshold can acquire better image quality of renal CTA.

Objective To investigate the relationship between carotid artery intima-media thickness and renal function in patients with diabetes mellitus.Methods 424 patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study.According to their artery intima-media thickness (IMT),the patients were divided into normal group and higher IMT group.All patients according to UAER or 24h urinary protein were divided into normal proteinuria group,micro-proteinuria group and clinical proteinuria group.The biochemical examination,eGFR,and atherosclerotic plaque of different groups were compared.Pearson or spearman correlation was used to analyze the relationship between eGFR,IMT and other parameters.Risk factors for eGFR decline were analyzed by binary logistic regression.Results Compared with normal group,patients in the higher IMT group were older [(63.3±10.2) year vs (52.5 ± 10.6) year,P ＜ 0.05],and underwent longer duration of diabetes [(8.9±6.7) year vs (6.2±5.7) year,P ＜ 0.05].Their level of eGFR was decreased [(75.92±28.00) ml/min vs (91.64±24.05) ml/ min,P ＜ 0.05],while plaque incidence (71.3％ vs 18.3％,x2=112.42,P ＜ 0.01) and prevalence of hypertension (56.4％ vs 29.6％,x2=27.22,P ＜ 0.01) increased.Correlation analysis showed that IMT was positively correlated with age (r=0.503,P ＜ 0.01),duration of diabetes (r=0.204,P ＜ 0.01),24 h urine protein (rs=0.175,P ＜ 0.05),plaque (rs=0.562,P ＜ 0.01),and hypertension (rs=0.193,P ＜ 0.01),but negatively correlated with eGFR (r=-0.307,P ＜ 0.01).Logistic regression analysis showed that age,serum uric acid,24 h urine protein and carotid artery intima-media thickness were independent risk factors for eGFR decline [OR=1.115,95％CI(1.053,1.165),P ＜ 0.001;OR=1.008,95％CI (1.002,1.014),P=0.006;OR=1.492,95％ CI(1.170,1.903),P=0.001;OR=1.619,95％ CI(1.121,2.339),P=0.010].Conclusion Carotid artery intima-media thickness is an independent risk factor for kidney function decline in patients of diabetes.

Objective To investigate the expression and clinical significance of serum microRNA (miRNA) expression profiling in the occurrence and progression of diabetic nephropathy.Methods The miRNA expression profiling was detected by miRNA TaqMan Low Density Array chip from 10 patient with diabetic nephropathy,10 diabetes patients with normoalbuminuria and 10 health control.Real-time quantitative PCR was applied to verify the result of miRNA array in serum samples of 66 patients with diabetic nephropathy (36 patients with microalbuminuria,30 patients with macroalbuminuria),40 diabetes patients with normoalbuminuria and 40 health control.And the relationship of differetial expression with clinical features was analyzed.Results miR-150-5p,miR-155-5p,miR-30e-5p and miR-3196 being validated by real-time quantitative PCR differentially expressed in 3 groups of serum samples from the diabetes patients with microalbuminuria (n=36),with normoalbuminuria (n=40) and health control (n=40) (P ＜ 0.05).Serum miR-150-5p (P=0.005) and miR-155-5p (P=0.006) changed significantly between diabetes patients with microalbuminuria (n=36) and with macroalbuminuria (n=30).Compared with the diabetes patients with microalbuminuria,serum miR-150-5p and miR-155-5p increased by 2.3 and 1.5 times in macroalbuminuria group,respectively.Estimated glomerular filtration rate and urinary albumin excretion rate significantly correlated with serum miR-150-5p and miR-155-5p level.Conclusions miR-150-5p and miR-155-5p may be involved in the process of pathological mechanisms of diabetic nephropathy.Serum miR-150-5p and miR-155-5p may be regarded as potential biomarkers to diagnosis the occurrence and development of diabetic nephropathy.