Search

Objective To analyze the influencing factors of pulmonary infection in patients with primary liver cancer (PHC) before intervention, and establish a nomogram risk prediction model to verify it. Methods A total of 1 635 patients with PHC diagnosed and hospitalized for the first time were selected and divided into the infected group (197 cases) and the non-infected group (1 438 cases) according to whether they had pulmonary infection. General data such as body mass index (BMI), chronic hepatitis B (CHB), chronic hepatitis C (CHC), Barcelona stage (BCLC), white blood cells (WBC), neutrophils (NEU), hemoglobin (Hb) and other blood routine indicators were collected. Total protein (TP), prealbumin (PA), aspartate aminotransferase (AST), gamma glutamylaminotransferase (GGT), alkaline phospholipase (ALP), abnormal prothrombin (PIVKA- Ⅱ), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP), cholinesterase (ChE), total cholesterol (TC) and other blood biochemical indicators, CD3 cell count (CD3+ ), CD4 cell count (CD4+ ), CD4/CD8 ratio (CD4+ /CD8+ ), CD19 cell count (CD19+ ), interleukin (IL)-2, interferon (IFN)-α, tumor necrosis factor (TNF) - α and other cytokines were also collected. Univariate analysis and Lasso regression were used to screen variables, and binary Logistic regression analysis was used to determine risk factors for pulmonary infection in PHC patients before intervention. The risk prediction model was established and evaluated. Results Compared with the noninfected group, age, smoking rate, CHC, pleural effusion, gastrointestinal hemorrhage, Child-Pugh grade C, BCLC Phase A /C /D ratio, WBC, NEU, AST, GGT, ALP, PIVKA-Ⅱ, AFP, CEA, PCT, hs-CRP, IL-2, IL-5, IL-6, IL-8, IL-10, IL-12, IFN-γ and TNF-α levels were higher in the infected group, and levels of BMI, CHB ratio, Hb, TP, PA, ChE, TC, CD3+, CD4+, CD4+ /CD8+, CD19+ and IFN-α were lower (P < 0.05). Lasso regression and binary Logistic regression analysis showed that pleural effusion, gastrointestinal hemorrhage, higher level of age, WBC, Hb and lower level of TP were independent risk factors for pulmonary infection in patients with PHC before intervention. The area under receiver operating curve (ROC) of the established nomogram model was 0.700（95%CI: 0.659-0.740), and Hosmer-Lemeshow test results showed good goodness-fit of the model. Self-sampling was repeated 1 000 times for internal verification. The consistency of the model was good. Conclusion Pleural effusion, gastrointestinal hemorrhage, higher level of age, WBC, Hb and lower level of TP are independent risk factors for pulmonary infection in PHC patients before intervention. The established nomogram prediction model can effectively evaluate the risk of pulmonary infection in PHC patients before intervention. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of general anesthesia (GA) combined with thoracic paravertebral nerve block (TPVB) on postoperative analgesia and pulmonary infection in patients undergoing lung cancer surgery. Methods A total of 170 lung cancer patients who underwent thoracoscopic lung lobectomy were divided into the GA group (80 cases) and the GA combined with TPVB group (90 cases) according to the anesthetic regimen. Intraoperative dosage of anesthetics, postoperative pressing times of analgesic pump, diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR) before anesthesia induction, after anesthesia induction and after operation, and pain (VAS) score within 48 h after operation were compared between the two groups. The levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) were measured by enzyme-related immunosorbent assay before and after surgery in the two groups. The postoperative recovery time and the incidence rates of pulmonary infection and adverse anesthesia reactions were compared between the groups. Results The dosages of remifentanil, propofol and the total pressing times were lower in the GA combined with TPVB group than those in the GA group (P＜0.05). DBP, SBP and HR after anesthesia induction and after operation were higher in the GA combined with TPVB group than those of the GA group (P＜0.05). The VAS scores at 4, 8, 12, 24 and 48 h after operation were lower in the GA combined with TPVB group than those of the GA group (P＜0.05). After operation, levels of IL-6, TNF-α and IL-8 were lower in the GA combined with TPVB group than those in the GA group (P＜0.05). The recovery time of spontaneous breathing, extubation time, length of stay in recovery room, postoperative first ambulation time and hospital stay were shorter in the GA combined with TPVB group than those of the GA group (P＜0.05). The incidence rates of postoperative pulmonary infection and adverse anesthesia reactions were lower in the GA combined with TPVB group than those in the GA group (P＜0.05). Conclusion GA combined with TPVB can achieve good analgesic effect on patients undergoing lung cancer surgery and reduce the incidence of postoperative pulmonary infection. [ABSTRACT FROM AUTHOR]

Objective To analyze the risk factors of multiple drug resistant bacterial infections in patients with chronic obstructive pulmonary disease (COPD), and provide guidance for disease control and prevention. Methods Clinical data of 814 COPD patients were retrospectively analyzed from June 2011 to May 2015, including patient's age, gender, smoking history, age of onset, severity, aggravated frequency, duration of exacerbations, diabetes mellitus, complications, use frequency and use duration of glucocorticoid, use frequency of antimicrobial agents and use duration of each time, types of antimicrobial drugs used, combined with antibacterial drugs, plasma albumin concentration, blood glucose, bacteria culture detection of multi drug resistant bacteria infection. The risk factors of multi drug resistant bacteria infection were analyzed. Results A total of 857 pathogenic bacteria were isolated from 814 COPD patients with pulmonary infection. Multiple drug resistant bacteria infection were detected in 170 cases, and 175 strains (20.42%) were detected. The detection rate of multi drug resistant/PAN resistant pseudomonas aeruginosa (MDR/PDR- PA) was 55.38% (36/65). There were significant differences in patients with multi drug resistant bacteria infection between different clinical pathological characteristics. Logistic regression analysis showed that the acute exacerbation duration (days), long time use of antimicrobial drugs, and high frequency of corticosteroids and antibiotics use were independent risk factor of multi drug resistant bacteria infection in COPD patients. Conclusion Prevention and treatment of multiple drug resistant bacteria infection in COPD patients should pay attention to the combination of community and hospital, and take effective measures to prevent and control the risk factors. [ABSTRACT FROM AUTHOR]

Objective To evaluate the diagnostic yield and safety of transbronchial lung biopsy (TBLB) under virtual bronchoscopic navigation (Direct Path), endobronchial ultrasonography with a guide sheath (GS) and rapid on-site evaluation using an ultrathin bronchoscopy (UNRE) for bacterial infection located in the peripheral third of the lung field. Methods Ninety-seven patients with bacterial infection, which located in the peripheral third of the lung field on CT images, were randomly assigned to UNRE (n=49) or non-UNRE (NUNRE, n=48) groups, who were treated in General Hospital of Tianjin Medical University between April 1, 2014 and March 31, 2015. The TBLB guided by UNRE was performed in two groups. The diagnostic yield, safety and complication rate were compared between two groups. Moreover, the differences of autofluorescence intensity of alveolar macrophage in alveolar lavage fluid were compared between two groups of patients. Results The diagnostic yield was significantly higher in UNRE group than that of NUNRE group (81.6% vs 56.2%, χ2 =7.313, P < 0.01). The diagnostic yield was higher in UNRE group with bronchus sign compared to that of NUNRE. All patients had a mild bleeding at the time of biopsy. There were no hemoptysis, pneumothorax or other serious complications. The autofluorescence intensity of alveolar macrophage was different in different levels of infection in patients. Conclusion The procedure of UNRE has higher diagnostic rate and fewer complications. The careful selection of suitable cases can further improve the diagnostic accuracy. The autofluorescence intensity of alveolar macrophage in alveolar lavage fluid indicates the severity of infection in patients. [ABSTRACT FROM AUTHOR]