Heparin-free veno-arterial extracorporeal membrane oxygenation in lung transplantation: a retrospective cohort study.

BACKGROUND: In lung transplantation (LTx) surgery, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide mechanical circulatory support to patients with cardiopulmonary failure. However, the use of heparin in the administration of ECMO can increase blood loss during LTx. This study aimed to evaluate the safety of heparin-free V-A ECMO strategies. METHODS: From September 2019 to April 2022, patients who underwent lung transplantation at the First Affiliated Hospital of Guangzhou Medical University were retrospectively reviewed. A total of 229 patients were included, including 117 patients in the ECMO group and 112 in the non-ECMO group. RESULT: There was no significant difference in the incidence of thrombus events and bleeding requiring reoperation between the two groups. The in-hospital survival rate after single lung transplantation (SLTx) was 81.08%in the ECMO group and 85.14% in the Non-ECMO group, (P = 0.585). The in-hospital survival rate after double lung transplantation (DLTx) was 80.00% in the ECMO group and 92.11% in the Non-ECMO groups (P = 0.095). CONCLUSIONS: In conclusion, the findings of this study suggest that the heparin-free V-A ECMO strategy in lung transplantation is a safe approach that does not increase the incidence of perioperative thrombotic events or bleeding requiring reoperation.

Spontaneous ventilation anaesthesia: total intravenous anaesthesia with local anaesthesia or thoracic epidural anaesthesia for thoracoscopic bullectomy.

OBJECTIVES: At present, few data exist regarding the comparisons of perioperative outcomes and recurrence of spontaneous ventilation (SV) video-assisted thoracic surgery (VATS) bullectomy using total intravenous anaesthesia (TIVA) with local anaesthesia (LA) or thoracic epidural anaesthesia (TEA). We evaluated the feasibility and safety of TIVA with LA in the management of primary spontaneous pneumothorax (PSP). METHODS: We conducted a single-institution retrospective analysis of patients undergoing VATS bullectomy between July 2011 and May 2015; 240 patients were included for analysis. Preoperative, intraoperative and postoperative variables of patients undergoing VATS bullectomy using TIVA-TEA (n = 140) were compared with those using TIVA-LA (n = 100). RESULTS: Baseline demographics were similar between groups. No patients in either group required conversion to thoracotomy. Three patients (TIVA-TEA: 2; TIVA-LA: 1) required conversion to intubated general anaesthesia. Both groups had comparable surgical duration, estimated blood loss, peak EtCO2 and lowest intraoperative SpO2 level. Postoperatively, thoracic drainage volume, duration of chest tube drainage and hospitalization cost did not differ between groups. The incidence of postoperative complications between groups was not significant (2% for TIVA-TEA vs 2% for TIVA-LA, P = 1.00). Pneumothorax recurrence rate was 3% in TIVA-TEA cases (n = 4) and 2% in TIVA-LA cases (n = 2). CONCLUSIONS: SV-VATS bullectomy using TIVA with LA or TEA is technically feasible and safe. Both groups have comparable short-term outcomes and recurrence rates; TIVA-LA seems a valid alternative to TIVA-TEA for the surgical management of PSP under SV.

[Effects of small needle-knife comprehensive therapy on pain and lumbar flexion range in the chronic nonspecific low back pain patient].

OBJECTIVE: To observe therapeutic effect of small needle-knife comprehensive therapy on pain and lumbar flexion range in the chronic nonspecific low back pain patient. METHODS: Three hundred and five cases were randomly divided into a needle-knife group of 153 cases and a physiotherapy group of 152 cases. The needle-knife group were treated with small needle-knife releasing therapy, blocking and functional training. The physiotherapy group were treated with ultra-short wave, modulated medium frequency current, massage and functional training. Pain was assessed by visual analogue scale (VAS) and the lumbar flexion range was determined before and after treatment. RESULTS: After treatment, the pain and the lumbar flexion range were significantly improved in the two groups; and after treatment, the VAS score and the lumbar flexion range were (1.60 +/- 0.38) points and (65.76 +/- 15.11) cm in the needle-knife group and (4.59 +/- 1.09) points and (53.74 +/- 15.13) cm in the physiotherapy group, respectively, the needle-knife group being significantly better than the physiotherapy group (P < 0.01). Follow-up survey of 6-36 months showed that the VAS score and the lumbar flexion range in the needle-knife group were superior to those in the physiotherapy group. CONCLUSION: Small needle-knife comprehensive therapy can significantly improve pain and lumbar flexion range in the chronic nonspecific low back pain patient, with a stable long-term therapeutic effect.

[The effect of smoke and alcohol abuse to voice].

OBJECTIVE: To explore parameters which can discriminate the voice of smoke and alcohol abuse and healthy voice by contrasting the voice parameters of two groups, and to study the pathogenic mechanism of the adverse effect of smoke and alcohol abuse to voice by the change of parameters. METHOD: Selecting 33 male subjects with smoke and alcohol abuse, and selecting other 33 healthy male subjects with no smoking and alcohol abuse and no ENT disease as control, randomly. Assessed by "vocal assessment", each subject was required to phonate /ae/ for 3 s, voice parameters including F0, Jitter, NNE and CQ were collected for multivariate analysis. RESULT: There were significant difference between smoke and alcohol abuse group and controlled group on the voice parameters (P < 0.01). F0 of the former is significantly lower than that of the latter (P < 0.01). Jitter of the former is significantly larger than that of the latter (P < 0.01). NNE of the former is significantly larger than that of the latter. CQ of the former is significantly smaller than that of the latter (P < 0.01). CONCLUSION: Smoke and alcohol abuse had the adverse effect on the human voice. Both theory and experiment analysis were useful methods of selecting sensitive parameters. F0, Jitter, NNE and CQ were effect parameters which can reflect the voice characteristic of smoke and alcohol abuse, and can be used to monitor the effect of therapy for this kind of pathological voice.

[Relationship between voice acoustic parameters and vocal quality].

OBJECTIVE: This research is aimed at looking for the effect acoustic parameters of voice quality through the Spearman correlation analysis between auditory-perceptual judgment of voice quality and synthesized acoustic parameters. METHOD: Thirty-six vowel samples of /ae/ synthesized with six acoustic parameters (F0, Jitter, Shimmer, NNE, Spectral tilt, Formant Flutter), each parameter dimension included 25% coped ones, altogether 45 samples. Then give the serial number to each sample after their order is randomized. The sound samples were given by computer, intensity was fixed at 70dB. Eight famous ENT doctors participated in the task of auditory-perceptual judgment. Give the grades to G, R, B, resulting that there are high inherent consistency (P<0.01). Then do the Spearman correlation analysis with each acoustic parameter respectively. RESULT: There are significant correlation between the auditory-perception (G, R, B) and Jitter, Shimmer and NNE (P<0.01). CONCLUSION: Jitter, Shimmer and NNE are effect acoustic parameters reflecting the voice quality. Human voice is multidimensional. The combination the auditory-perceptual (G, R, B) judgment with acoustic analysis is the best method of assessing the voice quality.

Clinicopathologic features and results of transcatheter arterial chemoembolization for osteosarcoma.

PURPOSE: To evaluate the effect of transcatheter arterial chemoembolization (TACE) for osteosarcoma and to describe the clinicopathologic features produced by TACE as well as the effect of different embolic materials. METHODS: From January 1998 to December 2003, preoperative TACE was carried out in 32 patients. The preoperative and postoperative clinical response, levels of alkaline phosphatase (AKP), leukocyte count, and clinicopathologic features were recorded. We also compared the effect of different embolic materials: adriblastine gelatin microspheres, anhydrous alcohol, common bletilla tuber, and gelatin sponge particles. RESULTS: The levels of AKP were significantly decreased after treatment (p < 0.05), but there was no significant difference in the leukocyte count. Large areas of necrosis were found histologically within 85.5% tumors after TACE. Embolic agents such as adriblastine microspheres, anhydrous alcohol, and common bletilla tuber have better clinical effects than gelatin sponge particles, but there was no significant difference among the first three embolic materials. After treatment, no serious complications were noted. During successful follow-up for 86 months, the survival rate after TACE at 1, 2, and 5 years was 95.5%, 72%, and 42% respectively. CONCLUSION: TACE accelerated tumor necrosis and shrank the tumor volume, thus making adequate tumor resection possible. The optimal time to operate is 10-14 days after TACE. TACE in combination with limb salvage surgery and postoperative periodical chemotherapy may be beneficial for increasing local control rates.