Objective To investigate the clinical significance of changes in cardiopulmonary function, degree of hypoxia and inflammatory factors in obstructive sleep apnea hypopnea syndrome (OSAHS) patients combined chronic obstructive pulmonary disease (COPD). Methods A retrospective case-control study was conducted on 209 patients with OSAHS admitted from October 2015 to April 2022. The OSAHS patients were divided into an OSAHS-only group, an OSAHS combined with mild COPD group, an OSAHS combined with moderate COPD group, and an OSAHS combined with severe and very severe COPD group based on pulmonary function test. The characteristics of cardiopulmonary function [(pulmonary artery pressure, N terminal pro B type natriuretic peptide (NT-proBNP), forced expiratory volume in the first second to forced vital capacity (FEV1/FVC), percent predicted value of FEV1 (FEV1%pred)], hypoxia indexes [night lowest saturation of pulse oxygen (NL-SpO2), night medial saturation of pulse oxygen (NM-SpO2), saturation of pulse oxygen less than 85% of the time (TS85), diurnal lowest saturation of pulse oxygen (DL-SpO2)], inflammatory factor indicators [procalcitonin (PCT), interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP), neutrophil to lymphocyte ratio (NLR)], and other characteristics were compared separately. The partial correlation analysis and logistic regression were used to analyze the influencing factors of OSAHS with COPD. Results There were statistically significant differences in age, days of hospitalization, cardiopulmonary function indexes, hypoxia indexes and inflammatory factor indexes between the OSAHS combined with COPD group and the OSAHS-only group (all P<0.05). And pulmonary artery pressure, NT-proBNP, TS85, IL-6, and NLR were higher and DL-SpO2, NL-SpO2, and NM-SpO2 were lower in the OSAHS combined with severe and very severe COPD group compared with the OSAHS combined with mild COPD group (all P<0.05). In the partial correlation analysis, FEV1%pred was negatively correlated with pulmonary artery pressure, NT-proBNP, TS85, IL-6, hs-CRP and NLR, and positively correlated with DL-SpO2, NL-SpO2 and NM-SpO2 (all P<0.05). In regression analysis, NLR and TS85 were the main risk factors for OSAHS combined with COPD (all P<0.05). Conclusions OSAHS patients combined with COPD have longer hospital days, greater burden of hypoxia, cardiopulmonary function and inflammation compared with patients with OSAHS alone, especially more significant in patients with poorer pulmonary function, and higher incidence of pulmonary heart disease, atrial fibrillation, and lower limb edema. NLR and TS85 are the main risk factors in patients with OSAHS combined with severe and very severe COPD.
[Abstract]Pectus excavatum (PE) is a common congenital chest malformation in children, manifested by inward depression of the anteriorthorax wall, which can compress the normal tissues and organs in the chest and cause adverse effects on the physiology and psychology of patients. Surgery is the most important means of treating PE, and with the invention of Nuss surgery, the surgical treatment of PE has entered the minimally invasive era. At present, there are many indexes to evaluate the severity of thoracic malformations in PE patients, and selecting appropriate evaluation indexes is of great significance for the formulation of surgical protocols. As a physical and mental disease, PE's deformed thoracic appearance will not only affect the function of thoracic organs, but also affect the psychological state of patients. Therefore, there is still controversy over whether the role of orthopedic surgery is to improve function or cosmetic plastic surgery. At the same time, the orthopedic efficacy and postoperative complications of the existing modified and novel surgical methods need to be further observed and evaluated. In addition, the design of surgical plan and the selection of surgical timing for PE combined with other diseases are also critical and controversial issues in clinical practice. Therefore, this article explores and reviews the controversial points in the current surgical treatment of PE.
Objective To observe the clinical characteristics of asthma patients with chronic duration stage combined with small airway dysfunction (SAD), and analyze the influencing factors of SAD and the cardiopulmonary function of such patients under exercise. Methods The patients with chronic duration of asthma admitted to Nanjing Affiliated Hospital of Traditional Chinese Medicine from July 2022 to April 2024 were divided into a SAD group and a non-SAD group according to the lung function results. Clinical data and relevant data of cardiopulmonary exercise test (CPET) were collected, the clinical data and cardiopulmonary function between the two groups were compared. The influencing factors of SAD were explored by multivariate logistic regression analysis. Results A total of 102 patients with chronic asthma duration, 59 (57.8%) in the SAD group and 43 (42.2%) in the non-SAD group were included. In the SAD group, age, body masss index, asthma duration were greater than those in the non-SAD group, and SAD score was lower than that in the non-SAD group; the proportion of patients with acute onset of asthma, history of smoking, allergic rhinitis, and asthma control test score were higher than those in the non-SAD group, the exhaled nitric oxide level of SAD group was higher than that in the non-SAD group, and the conventional lung function level was lower than that in the non-SAD group (P<0.05). CPET showed that the VE/VCO2 slope and CO2 equivalent in the SAD group were higher than those in the non-SAD group, and the peak kg oxygen uptake, peak heart rate, and respiratory reserve were lower than those in the non-SAD group, showing a statistically significant difference (P<0.05). Multivariate logistic analysis showed that age, increase of carbon dioxide equivalent at peak exercise, acute onset of asthma and allergic rhinitis were independent risk factors for SAD, and the increase of peak expiratory flow rate was the protective factor (P<0.05). Conclusions SAD in chronic persistent asthma is affected by various factors such as age, acute asthma attacks and history of allergic rhinitis. CPET indicates that patients with asthma who also have SAD have their cardiopulmonary function and aerobic capacity impaired to some extent.