Unified performance analysis of interference-limited and interference-free dual-hop mixed RF/FSO systems with partial relay selection under pointing errors.

This paper investigates the performance of interference-limited and interference-free dual-hop mixed radio frequency (RF)/free space optical (FSO) systems with partial relay selection (PRS) for the variable-gain (VG) amplify-and-forward (AF) relaying scenario. We concentrate on the generalized channel model that not only describes different application scenarios but also allows a more accurate description of the channel characteristics. Specifically, the PRS-aided RF link is modeled by the κ-µ shadowed distribution, and the FSO link is expressed in terms of Fox's H-function, which unifies Fisher-Snedecor F, Gamma-Gamma (GG), and Malága (M) distributions for atmospheric turbulence along with pointing errors and detection modes. The interference signals at the selected relay are modeled by independent identically κ-µ shadowed distributions. Using our analytical framework, new unified closed-form expressions for the cumulative distribution function (CDF), the average bit error rate (BER), and the ergodic capacity are derived. Additionally, we provide asymptotic expressions of the average BER at high SNR. The analysis quantifies the impact of co-channel interference, pointing errors, number of relays, and rank of the selected relay on the considered system's performance. Finally, numerical results and Monte Carlo (MC) simulations are presented to confirm the effectiveness of the derived expressions. Note that our results provide a generalized framework for comprehensive studies of this kind of systems.

Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study.

BACKGROUND: Prolonged mechanical ventilation (PMV), mostly defined as mechanical ventilation > 72 h after lung transplantation with or without tracheostomy, is associated with increased mortality. Nevertheless, the predictive factors of PMV after lung transplant remain unclear. The present study aimed to develop a novel scoring system to identify PMV after lung transplantation. METHODS: A total of 141 patients who underwent lung transplantation were investigated in this study. The patients were divided into PMV and non-prolonged ventilation (NPMV) groups. Univariate and multivariate logistic regression analyses were performed to assess factors associated with PMV. A risk nomogram was then established based on the multivariate analysis, and model performance was further examined regarding its calibration, discrimination, and clinical usefulness. RESULTS: Eight factors were finally identified to be significantly associated with PMV by the multivariate analysis and therefore were included as risk factors in the nomogram as follows: the body mass index (BMI, P = 0.036); primary diagnosis as idiopathic pulmonary fibrosis (IPF, P = 0.038); pulmonary hypertension (PAH, P = 0.034); primary graft dysfunction grading (PGD, P = 0.011) at T0; cold ischemia time (CIT P = 0.012); and three ventilation parameters (peak inspiratory pressure [PIP, P < 0.001], dynamic compliance [Cdyn, P = 0.001], and P/F ratio [P = 0.015]) at T0. The nomogram exhibited superior discrimination ability with an area under the curve of 0.895. Furthermore, both calibration curve and decision-curve analysis indicated satisfactory performance. CONCLUSION: A novel nomogram to predict individual risk of receiving PMV for patients after lung transplantation was established, which may guide preventative measures for tackling this adverse event.

Image Encryption Using Quantum 3D Mobius Scrambling and 3D Hyper-Chaotic Henon Map.

In encryption technology, image scrambling is a common processing operation. This paper proposes a quantum version of the 3D Mobius scrambling transform based on the QRCI model, which changes not only the position of pixels but also the gray values. The corresponding quantum circuits are devised. Furthermore, an encryption scheme combining the quantum 3D Mobius transform with the 3D hyper-chaotic Henon map is suggested to protect the security of image information. To facilitate subsequent processing, the RGB color image is first represented with QRCI. Then, to achieve the pixel-level permutation effect, the quantum 3D Mobius transform is applied to scramble bit-planes and pixel positions. Ultimately, to increase the diffusion effect, the scrambled image is XORed with a key image created by the 3D hyper-chaotic Henon map to produce the encrypted image. Numerical simulations and result analyses indicate that our designed encryption scheme is secure and reliable. It offers better performance in the aspect of key space, histogram variance, and correlation coefficient than some of the latest algorithms.

Secrecy performance analysis in the FSO communication system considering different eavesdropping scenarios.

In this paper, we numerically study the secrecy performance of the free-space optical (FSO) system by considering different eavesdropping scenarios. More precisely, we considered three possible eavesdropping scenarios for Eve: 1) Eve is between Alice and Bob; 2) Eve and Bob are in the same receiving plane; 3) Eve is behind Bob. We adopt the Málaga (M)-distribution channel to model atmospheric turbulence due to the presence of link blockage while considering the non-zero boresight pointing error and path loss. To do so, we obtain a novel probability density function (PDF) and cumulative distribution function (CDF) under different eavesdropping scenarios, based on which we derived the secrecy outage probability (SOP) analytical expressions as well as their asymptotic expressions at a high SNR regime. We verified the results using Monte Carlo simulations, which showed that the parameters related to atmospheric turbulence and pointing errors, as well as the location of the eavesdropper, have different effects on different eavesdropping scenarios.

Performance of dual-hop FSO/RF systems with fixed-gain relaying over Fisher-Snedecor F and κ-µ shadowed fading channels.

We investigate the performance of a dual-hop mixed free space optical (FSO) /radio frequency (RF) system with fixed-gain relaying under direct detection and heterodyne detection techniques. The FSO link is modeled by the Fisher-Snedecor F distribution, which matches well with the experimental data under weak-to-strong turbulence regimes. The RF link experiences κ-µ shadowed fading, which unifies popular RF fading models. The κ-µ shadowed distribution is approximated by an α-µ distribution. Capitalizing on this approximation, closed-form approximate expressions for the cumulative distribution function, the average bit error rate of different modulation schemes, and the ergodic capacity are derived in terms of the bivariate Fox's H function. Moreover, asymptotic analysis is carried out at a high signal-to-noise ratio to further illustrate the obtained diversity order and the influence of system and channel parameters. Numerical results and Monte Carlo simulations are presented to validate the derived approximate expressions.

Circ_GRN Promotes the Proliferation, Migration, and Inflammation of Vascular Smooth Muscle Cells in Atherosclerosis Through miR-214-3p/FOXO1 Axis.

ABSTRACT: Dysfunction of vascular smooth muscle cells (VSMCs) assumes a fundamental part in the pathogenesis of atherosclerosis (AS). Circular RNA granulin precursor (circ_GRN) was identified to promote the proliferation and invasion of human VSMCs (HVSMCs) in an in vitro AS model. However, the underlying mechanisms remain unclear. Levels of circ_GRN, microRNA (miR)-214-3p, and forkhead box protein O1 (FOXO1) were detected using quantitative real-time polymerase chain reaction and Western blot assays. The proliferation, migration, and inflammatory response of HVSMCs were evaluated by using flow cytometry, colony formation, Cell Counting Kit-8, Western blot, transwell assays, and enzyme-linked immunosorbent assay, respectively. The binding interaction between miR-214-3p and circ_GRN or FOXO1 was detected by dual-luciferase reporter assay. In this study, we found that circ_GRN was elevated in the serum of AS and oxidized low-density lipoprotein (ox-LDL)-induced HVSMCs. The in vitro AS model was established by exposing HVSMCs to ox-LDL, and we found circ_GRN knockdown reversed ox-LDL-evoked cell proliferation, migration, and inflammation. In a mechanical study, miR-214-3p directly bound to circ_GRN or FOXO1, and circ_GRN could regulate FOXO1 expression by competitively binding to miR-214-3p. Importantly, we demonstrated that miR-214-3p inhibition attenuated the protective effects of circ_GRN knockdown on ox-LDL-induced HVSMCs; besides that, miR-214-3p overexpression abolished ox-LDL-triggered HVSMC proliferation, migration, and inflammation, which were counteracted by FOXO1 upregulation. In conclusion, circ_GRN promoted the proliferation, migration, and inflammation of HVSMCs through miR-214-3p/FOXO1 axis in ox-LDL-induced AS model in vitro, suggesting the potential involvement in an AS process, which provided a potential candidate for future clinic intervention in AS.

Mucosal delivery of allergen peptides expressed by Lactococcus lactis inhibit allergic responses in a BALB/c mouse model.

Allergen-specific immunotherapy (SIT) is considered to be the only curative treatment of allergy, but its safety is always affected by immunologic properties and quality of allergen. Recombinant allergen derivative could be a potential therapeutic strategy, but clinical studies showed that macromolecular derivatives could not avoid T cell-mediated side effects. In this study, five Der p2-derived peptides (DPs) containing major T cell epitopes of Der p2 were first artificially synthesized. Compared with Der p2 macromolecular derivative DM, these DPs not only fully eliminated IgE-binding capacity but also reduced T cells reactivity, suggesting these DPs could be better therapeutic molecules. For their application in vivo, Lactococcus lactis was engineered to express these DPs, and their protective effects were evaluated in BALB/c mice models. Western blot showed that all DPs could be produced in the recombinant strains. Mucosal delivery of these strains could inhibit Der p2-induced allergic responses in Der p2-sensitized mice, characterized by a reduction in specific IgE antibody and lung inflammatory responses. These protective effects were associated with an increase of specific IgG2a in serum and regulatory T cells in the mesenteric lymph nodes. On the whole, the suppressive effect induced by the DP mixture could be better than single DP, but a bit weaker than DM. These DPs could be promising candidate molecules for active vaccination and induction of tolerance, and thus promote the development of non-allergenic peptide in the treatment and prevention of allergy.

Suppression of dust mite allergy by mucosal delivery of a hypoallergenic derivative in a mouse model.

Allergic asthma caused by house dust mite (HDM) is becoming a public health problem. Specific immunotherapy is considered to be the only curative treatment, but it is always associated with IgE-mediated side effects in the therapy process. A few studies showed that the disruption of allergen IgE epitopes could reduce IgE reactivity and thus reduce allergenic activity. In this study, a hypoallergenic derivative of the major HDM allergen Der p2 was constructed by genetic engineering. This derivative was confirmed to have a considerably reduced IgE reactivity compared with Der p2. For its application in vivo, recombinant Lactococcus lactis (LL-DM) was engineered to deliver the Der p2 derivative to the intestinal mucosal surface. Oral administration of LL-DM significantly alleviated Der p2-induced airway inflammation, as shown by reduced inflammatory infiltration and a reduction in Th2 cytokines in bronchoalveolar lavage. This protective effect was associated with an up-regulation of specific IgG2a and a decrease in IL-4 level in the spleen which may affect specific IgE response. Moreover, the levels of regulatory T cells in the mesenteric lymph nodes and spleen were markedly increased in mice fed with LL-DM, suggesting that LL-DM can inhibit allergic responses via the induction of regulatory T cell. Our results indicate that the Der p2 derivative is a promising therapeutic molecule for specific immunotherapy and recombinant lactic acid bacteria could be developed as a promising treatment or prevention strategy for allergic diseases.

Chest tube-free video-assisted thoracoscopic surgery secured by quantitative air leak monitoring: a case series.

Background: Although chest tube-omitted video-assisted thoracoscopic surgery (VATS) has been proven to be safe and efficacious, its universal application is precluded by a varying morbidity rate due to a lack of standardization. Since digital chest drainage has already shown improved accuracy and consistency in the management of postoperative air leak, we incorporated it in the strategy of intraoperative chest tube withdrawal, aiming to achieve better results. Methods: We collected the clinical data of 114 consecutive patients who underwent elective uniportal VATS pulmonary wedge resection at the Shanghai Pulmonary Hospital from May 2021 to February 2022. Their chest tubes were withdrawn intraoperatively after an air-tightness test facilitated by digital drainage: the end flow rate had to be kept ≤30 mL/min for >15 s at the setting of -8 cmH2O suctioning. The recordings and patterns of the air suctioning process were documented and analyzed as potential standards of chest tube withdrawal. Results: The mean age of the patients was 49.7±11.7 years. The mean size of the nodules was 1.0±0.2 cm. The location of the nodules encompassed all lobes, and 90 (78.9%) patients received preoperative localization. The postoperative morbidity and mortality rates were 7.0% and 0%, respectively. Six patients had clinically overt pneumothorax and two patients had postoperative bleeding that required intervention. All of the patients recovered on conservative treatment except for one case of pneumothorax that required additional tube thoracostomy. The median length of postoperative stay was 2 days; and the median time of suctioning, peak flow rate, and end flow rate were 126 s, 210 mL/min, and 0 mL/min, respectively. The median numeric rating scale for pain was 1 on postoperative day (POD) 1 and 0 on the day of discharge. Conclusions: Chest tube-free VATS assisted by digital drainage is feasible with minimal morbidity. Its strength of quantitative air leak monitoring produces important measurements for the prediction of postoperative pneumothorax and future standardization of the procedure.

The clinical-histologic and prognostic characteristics in patients with a second primary non-small-cell lung cancer after a lobectomy.

OBJECTIVES: The goal of this study was to investigate whether an operation can offer survival benefits for patients with a second primary non-small-cell lung cancer (NSCLC) after a lobectomy for a first primary NSCLC and to analyse the characteristics affecting the survival of those patients. METHODS: We performed survival analyses of patients with a second primary NSCLC based on the Surveillance, Epidemiology and End Results program and used propensity score matching to reduce the potential bias and analyse the data. In addition, the primary observational end point was overall survival (OS), and the secondary observational end point was histologic migration. RESULTS: The data from 944 patients were used to perform the main analysis. A total of 36.2% of patients experienced a shift in tumour histologic type between 2 diagnoses of primary NSCLC, and this shift significantly affected OS (P = 0.0065). The median survival time in patients with surgical resection and those without an operation was 52.0 months versus 33.0 months, respectively. Patients with surgical resection at the secondary diagnosis had better survival than those without surgery (5-year OS rate: 48.0% vs 34.0%, P < 0.001). In addition, compared with a pneumonectomy and a sublobar resection, a lobectomy was the optimal surgical procedure for patients diagnosed with a second primary NSCLC after adjusting for other confounders (adjusted hazard ratio: 0.68, P < 0.01). However, in the subgroup analysis, lobar and sublobar resections could provide similar survival benefits for patients with tumour size ≤20 mm (P = 0.5). CONCLUSIONS: The operation, especially a lobectomy, can prolong OS in patients with a second primary NSCLC. Besides, sublobar resection can be performed in selected patients with tumour size ≤20 mm. Moreover, histologic migration may impact the survival of those patients with a secondary primary NSCLC.

[Quantity of Desulfovibrios and analysis of intestinal microbiota diversity in health and intestinal disease people in Wuxi, Jiangsu province].

OBJECTIVE: This paper provides an overview of Desulfovibrio (DSV) incidence and its effect on bacterial diversity in human gastrointestinal tract of four groups: ulcerative colitis (UC), colorectal cancer (CRC), polypus (PP) and the healthy control (H). METHODS: Real time fluorescence quantitative PCR (RT-PCR) assays were used to enumerate DSV in gastrointestinal tract of 58 subjects. Diversity of gut microbiota was analyzed by PCR-Denaturing Gradient Gel Electrophoresis (PCR-DGGE) and 16S rRNA V3 sequencing. RESULTS: RT-PCR detected DSV in all samples. Significantly increased numbers of DSV were observed for UC and PP groups compared with CRC and H groups. No significant difference was observed for CRC and H groups with gene copy numbers of DSV. Alterations of DSV and gut microbiota were observed in disease groups. CONCLUSION: We found that quantity and diversity of DSV are significantly increased in UC and PP compared to controls. The increased numbers of DSV in disease groups suggests a possible harmful role.

Evaluation of nutritional status in lung transplant recipients and its correlation with post-transplant short-term prognosis: a retrospective study.

Background: Lung transplantation is an effective treatment for saving the lives of patients with end-stage lung disease (ESLD). Lung transplant-related morbidity and mortality has significantly higher than other solid organ transplants. Among the pre-transplant variables that affect the survival rate after transplantation, nutritional status are associated with poor survival rate. In order to provide basis for formulating nutritional evaluations for lung transplant recipients in the future, we retrospectively analyzed the nutritional status of lung transplantation recipients and explore its correlation with the short-term prognosis. Methods: This retrospective cohort study included patients who were hospitalized in 2020 and underwent lung transplant surgery at Shanghai Pulmonary Hospital. Inclusion criteria: (I) aged ≥18 years; (II) have been diagnosed with ESLD; (III) have received no other effective treatments; (IV) have undergone a transplantation at Shanghai Pulmonary Hospital. We summarized the patients' general information, including their sex, age, major lung disease etc. And we also collected nutritional status, such as Nutritional Risk Screening 2002 (NRS 2002), subjective global assessment (SGA) and nutritional-related indicators, including albumin, prealbumin, retinol-binding protein etc. before surgery and 1 month after surgery. In addition, we collected postoperative drainage volume, length of stay in intensive care unit (ICU), total hospital days, and hospitalization costs to evaluate the short-term prognosis. Results: A total of 33 lung transplant recipients were included and successfully underwent surgery. Of the patients, 16 had preoperative NRS 2002 scores ≥3 points, of whom 7 were assessed by the SGA as having mild-moderate malnutrition and 9 as having severe malnutrition. The albumin indexes of these 16 patients, including their prealbumin, and calcium contents, were significantly lower than those of patients with NRS scores <3. Patients with preoperative NRS scores ≥3 had higher drainage volumes, longer hospitalization times, and higher total hospitalization costs than those with NRS scores <3. Conclusions: Lung transplant recipients have a higher incidence of nutritional risk and malnutrition, which seriously affects their short-term prognosis. Thus, in clinical practice, lung transplant recipients should be screened for nutritional risk and provided preoperative nutritional support to maintain a good preoperative status to improve their prognosis.

Extracorporeal membrane oxygenation support for lung transplantation: Initial experience in a single center in China and a literature review.

Background: Extracorporeal membrane oxygenation (ECMO) is a versatile tool associated with favorable outcomes in the field of lung transplantation (LTx). Here, the clinical outcomes and complications of patients who underwent LTx with ECMO support, mainly prophylactically both intraoperatively and post-operatively, in a single center in China are reviewed. Methods: The study cohort included all consecutive patients who underwent LTx between January 2020 and January 2022. Demographics and LTx data were retrospectively reviewed. Perioperative results, including complications and survival outcomes, were assessed. Results: Of 86 patients included in the study, 32 received ECMO support, including 21 who received prophylactic intraoperative use of ECMO with or without prolonged post-operative use (pro-ECMO group), while the remaining 54 (62.8%) received no external support (non-ECMO group). There were no significant differences in the incidence of grade 3 primary graft dysfunction (PGD), short-term survival, or perioperative outcomes and complications between the non-ECMO and pro-ECMO groups. However, the estimated 1- and 2-year survival were superior in the pro-ECMO group, although this difference was not statistically significant (64.1% vs. 82.4%, log-rank P = 0.152; 46.5% vs. 72.1%, log-rank P = 0.182, respectively). After regrouping based on the reason for ECMO support, 30-day survival was satisfactory, while 90-day survival was poor in patients who received ECMO as a bridge to transplantation. However, prophylactic intraoperative use of ECMO and post-operative ECMO prolongation demonstrated promising survival and acceptable complication rates. In particular, patients who initially received venovenous (VV) ECMO intraoperatively with the same configuration post-operatively achieved excellent outcomes. The use of ECMO to salvage a graft affected by severe PGD also achieved acceptable survival in the rescue group. Conclusions: Prophylactic intraoperative ECMO support and post-operative ECMO prolongation demonstrated promising survival outcomes and acceptable complications in LTx patients. Particularly, VV ECMO provided safe and effective support intraoperatively and prophylactic prolongation reduced the incidence of PGD in selected patients. However, since this study was conducted in a relatively low-volume transplant center, further studies are needed to validate the results.

Perioperative risk factors for atrial fibrillation (AF) in patients underwent uniportal video-assisted thoracoscopic (VATS) pneumonectomy versus open thoracotomy: single center experience.

OBJECTIVES: To evaluate perioperative risk factors for AF in patients undergoing uniportal VATS pneumonectomy versus open thoracotomy, and to investigate mediastinal lymph nodes dissection (MLND) on the occurrence of AF. METHODS: Patients were divided into 2 groups based on the surgical approach: uniportal VATS and open pneumonectomy. Analysis was done using chi-square test. Multiple variables were tested using univariate analysis. A p value ≤ 0.05 was considered statistically significant. RESULTS: Three-hundred and forty-one patients underwent pneumonectomy between 2014 and 2018 in Shanghai Pulmonary Hospital. Fifty-eight patients underwent uniportal VATS, and 283 underwent thoracotomies. AF was the most common event observed. The overall occurrence of peri-operative AF was 33/341 (9.67%). In the uniportal, converted, and open group the incidence of AF was: 3/52 (5.76%), 1/6 (16.6%), and 29/283 (10.42%), respectively. Overall, there was no specific surgical technique correlated with increased incidence of AF (p = 0.432). By univariate analysis; large tumor size > 4.5 cm (p < 0.010), operative time (OT) > 125 min (p < 0.002), and greater volume of blood loss (p < 0.001) increased the risk of AF. Additionally, patients who experienced higher post-operative pain (p < 0.002) were more vulnerable to developing AF. Mortality occurred in one AF patient (1/33, 3%). Number of lymph nodes harvested was not related to AF incidence (p = 0.520). CONCLUSIONS: Although AF incidence was lower in uniportal group, it was not statistically significant. Large tumor size, long operative time, and increased blood loss were associated with increased risk of perioperative AF. These results need to be confirmed by larger studies.

Risk Factors and Anticoagulation Therapy in Patients With Isolated Distal Deep Vein Thrombosis in the Early Post-operative Period After Thoracic Surgery.

Background: Isolated distal deep vein thrombosis (IDDVT) accounts for ~50% of all patients diagnosed with deep venous thrombosis (DVT), but the diagnosis and optimal management of IDDVT remains unclear and controversial. The aim of this study was to explore potential risk factors and predictors of IDDVT, and to evaluate different strategies of anticoagulation therapy. Methods: A total of 310 consecutive patients after thoracic surgery, who underwent whole-leg ultrasonography as well as routine measurements of D-dimer levels before and after surgery were evaluated. The general clinical data, anticoagulant therapy, pre- and postoperative D-dimer levels were collected. Differences between IDDVT, DVT and non-DVT groups were calculated. Logistic regression analysis was used to analyze risk factors of postoperative IDDVT. Results: Age and postoperative D-dimer levels were significantly higher in IDDVT group than in non DVT group (p = 0.0053 and p < 0.001, respectively). Logistic regression analysis showed that postoperative D-dimer level was a significant independent predictor of IDDVT even when adjusted for age and operation method (p = 0.0003). There were no significant side effects associated with both full-dose and half-dose anticoagulation regimens. Half-dose therapy was associated with a significant decrease in the requirement for anticoagulation medications after discharge (p = 0.0002). Conclusion: Age and D-dimer levels after surgery are strong predictors of IDDVT following thoracic surgery. Half-dose therapeutic anticoagulation has the same efficiency in preventing IDDVT progression, is not associated with any additional risks of adverse effects compared to a full-dose regimen, and may be adopted for treating IDDVT patients after thoracic surgery.

Derivation and validation of a nomogram model for pulmonary thromboembolism in patients undergoing lung cancer surgery.

BACKGROUND: A specific risk-stratification tool is needed to facilitate safe and cost-effective approaches to the prophylaxis of acute pulmonary thromboembolism (PTE) in lung cancer surgery patients. This study aimed to develop and validate a simple nomogram model for the prediction of PTE after lung cancer surgery using readily obtainable clinical characteristics. METHODS: A total of 14,427 consecutive adult patients who underwent lung cancer surgery between January 2015 and July 2018 in our institution were retrospectively reviewed. Included in the cohort were 136 patients who developed PTE and 544 non-PTE patients. The patients were randomly divided into the derivation group (70%, 95 PTE patients and 380 non-PTE patients) and the validation group (30%, 41 PTE patients and 164 non-PTE patients). A nomogram model was developed based on the results of multivariate logistic analysis in the derivation group. The cut-off values were defined using Youden's index. The prognostic accuracy was measured by area under the curve (AUC) values. RESULTS: In the derivation group, multivariate logistic analysis was carried out to evaluate the risk score. The risk assessment model contained five variables: age [95% confidence interval (CI): 1.008-1.083, P=0.016], body mass index (95% CI: 1.077-1.319, P=0.001), operation time (95% CI: 1.002-1.014, P=0.008), the serum level of cancer antigen 15-3 (CA15-3) before surgery (95% CI: 1.019-1.111, P=0.005), and the abnormal results of compression venous ultrasonography before surgery (95% CI: 2.819-18.838, P<0.001). All of them were independent risk factors of PTE. To simplify the risk assessment model, a nomogram model was established, which showed a good predictive performance in the derivation group (AUC 0.792, 95% CI: 0.734-0.853) and in the validation group (AUC 0.813, 95% CI: 0.737-0.890). CONCLUSIONS: A high-performance nomogram was established on the risk factors for PTE in patients undergoing lung cancer surgery. The nomogram could be used to provide an individual risk assessment and guide prophylaxis decisions for patients. Further external validation of the model is needed in lung cancer surgery patients in other clinical centers.

Implementation of a pulmonary thromboembolism prophylaxis program in Chinese lung surgery patients: compliance and effectiveness.

BACKGROUND: Most studies on prophylaxis against pulmonary embolism (PE) after lung surgery have come from the West. Whether such prophylactic programs can be successfully developed in China has not been fully studied. METHODS: A prospective observational trial included 581 Chinese patients receiving lung resection surgery between August 8 and September 12 of 2017. The Caprini score was assessed on the first postoperative day (POD1). For PE prophylaxis, patients with a low score (0-4, n=55) received early ambulation, and those with a high score (≥5, n=526) received early ambulation combined with low-molecular weight heparin (LMWH) injection. PE incidence and the compliance with this protocol was recorded. RESULTS: Three patients (0.52%) developed PE and all 3 were in the high-risk group, but LMWH was not given (non-compliance). Within the non-compliance patients (n=275), the incidence of PE was 1.09%, higher than that in the compliance patients (0%). The rate of non-compliance with the program was 47.3% (275/581) in the entire cohort. The factors associated with non-compliance were: extended lobectomy performed (9.2% vs. 1.0%, P<0.001); higher volume of postoperative chest drainages (278 vs. 239 mL, P=0.028). The non-compliance group had longer duration of ICU stay (mean of 1.3 vs. 1.1 days, P<0.001); and longer overall hospital stay (mean of 9.7 vs. 8.5 days, P<0.001). CONCLUSIONS: Developing a PE prophylaxis program for patients receiving lung surgery in China contributed to lowering the risk of PE. Failure of compliance in patients with high risk for PE after lung surgery may be linked to worse outcomes.

Clinical comparison of two thoracic drainage methods after thoracoscopic pneumonectomy / 中国胸心血管外科临床杂志

@#Objective    To explore an effective and safe drainage method, by comparing open thoracic drainage and conventional thoracic drainage for lung cancer patients after thoracoscopic pneumonectomy. Methods    The clinical data of 147 patients who underwent thoracoscopic pneumonectomy from January 2015 to March 2018 in our hospital were retrospectively analyzed, including 128 males and 19 females. Based on drainage methods, they were divided into an open drainage group (open group) and a conventional drainage group (regular group). The incidence of postoperative complications, chest tube duration, drainage volume at postoperative 3 days, postoperative hospital stay, hospitalization cost and quality of life were compared between the two groups. Results    Postoperative complication rate was lower in the open group than that in the regular group (10.20% vs. 23.47%, P=0.04). The chest tube duration of the open group was longer compared with the regular group (5.57±2.36 d vs. 3.22±1.23 d, P<0.001). The drainage volume at postoperative 3 days was less in the regular group. In the open group, ambulation was earlier, thoracocentesis was less and re-intubation rate was lower (all P<0.001). The postoperative hospital stay in the regular group was significantly longer than that in the open group (8.37±2.56 d vs. 6.35±1.87 d, P<0.001) and hospitalization cost was significantly higher (66.2±5.4 thousand yuan vs. 59.6±7.3 thousand yuan, P<0.001). Besides, quality of life in 1 and 3 months after operation was significantly better than that in the open group (P<0.001). Conclusion    Compared with the regular chest drainage, the effect of open thoracic drainage is better, which can help reduce postoperative complications, shorten the length of hospital stay, reduce the hospitalization cost and improve the quality of postoperative life. It is worthy of clinical promotion.