ObjectiveTo analyze perioperative prognostic factors of pediatric patients undergoing surgical correction of ventricular septal defect (VSD)and severe pulmonary arterial hypertension (PAH).
MethodsForty pediatric patients with VSD and severe PAH (mean pulmonary artery pressure (PAPm) < 50 mm Hg)who underwent surgical repair in Beijing Anzhen Hospital from 2004 to 2012 were included in the study. There were 21 male and 19 female patients with their age of 7.2±3.3 years and body weight of 19.6±7.1 kg. All the patients were randomly divided into 2 groups:Group Ⅰ (Group=0, n=20, M/F:12/8, continuous nitroglycerin administration via central venous catheter (CVC)and GroupⅡ (Group=1, n=20, M/F:9/11, continuous prostaglandin E1 (PGE1)administration via CVC). The duration of intubation (Tintubation)was used as the dependent variable (Y). Patient age, cardiopulmonary bypass time (TCPB), postoperative PAPm, pulmonary vascular resistance index (PVRI), systemic to pulmonary pressure ratio (Ps/p), Group, left ventricular stroke work index (LVSWI)and right ventricular stroke work index (RVSWI)were used as independent variables (X). Multivariate liner regression analysis model was used to evaluate the influence of X on Y.
ResultsThere was no perioperative death or severe complication in this group. Perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH included group[x1, P=0.004, 95% CI (-71, -16)], TCPB[x2, P=0.011, 95% CI (0.9, 5.8)], posto-perative PAPm (x3, P=0.004 with 95% CI 3.2 to 13.3), RVSWI (x4, P=0.003 with 95% CI-16.9 to-4.3)and PVRI (x5, P=0.03 with 95% CI-0.29 to-0.02). The standardized regression equation was:Y=-0.60x1+0.54x2+2.22x3-1.70x4-0.15x5.
ConclusionPGE1 administration, TCPB, postoperative PAPm, RVSWI and PVRI are predominant perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH.
Objective To develop and validate a nomogram prediction model of early knee function improvement after total knee arthroplasty (TKA). Methods One hundred and sixty-eight patients who underwent TKA at Sichuan Province Orthopedic Hospital between January 2018 and February 2021 were prospectively selected to collect factors that might influence the improvement of knee function in the early postoperative period after TKA, and the improvement of knee function was assessed using the Knee Score Scale of the Hospital for Special Surgery (HSS) at 6 months postoperatively. The patients were divided into two groups according to the postoperative knee function improvement. The preoperative, intraoperative and postoperative factors were compared between the two groups; multiple logistic regression was performed after the potential factors screened by LASSO regression; then, a nomogram predictive model was established by R 4.1.3 language and was validated internally. Results All patients were followed up at 6 months postoperatively, and the mean HSS score of the patients increased from 55.19±8.92 preoperatively to 89.27±6.18 at 6 months postoperatively (t=?40.706, P<0.001). LASSO regression screened eight influencing factors as potential factors, with which the results of multiple logistic regression analysis showed that preoperative body mass index, etiology, preoperative joint mobility, preoperative HSS scores, postoperative lower limb force line, and postoperative analgesia were independent influencing factors for the improvement of knee function in the early postoperative period after TKA (P<0.05). A nomogram model was established based on the multiple logistic regression results, and the calibration curve showed that the prediction curve basically fitted the standard curve; the receiver operating characteristic curve showed that the area under the curve of the nomogram model for the prediction of suboptimal knee function in the early postoperative period after TKA was 0.894 [95% confidence interval (0.825, 0.963)]. Conclusions There is a significant improvement in knee function in patients after TKA, and the improvement of knee function in the early postoperative period after TKA is influenced by preoperative body mass index, etiology, and preoperative joint mobility, etc. The nomogram model established accordingly can be used to predict the improvement of knee function in the early postoperative period after TKA with a high degree of differentiation and accuracy.
Objective To analyze the risk factors for delirium of the Stanford A aortic dissection patients after surgery.
Method We retrospectively analyzed the clinical data of 335 patients with type A aortic dissection in Guangdong Cardiac Institution from January 2012 through December 2014. There were 280 males and 55 females. The average of age was 48.5±10.3 years. Delirium status of the patients were evaluated based on confusion assessment method for intensive care unit (CAM-ICU). The patients were divided into two groups including a delirium group and a control group. We tried to find the risk factors for postoperative delirium.
Results There were 169 patients of delirium with a incident rate of 50.4%. One-way analysis of variance and multivariate analysis indicated that pre-operative D-dimer level (OR=2.480, 95% CI 1.347-4.564, P<0.01), the minimum mean arterial pressure during operation (OR=0.667, 95% CI 0.612-0.727, P<0.01), the postoperative ventilation time (OR=2.771, 95% CI 1.506-5.101, P<0.01) and the postoperative acute kidney failure (OR=1.911, 95% CI 1.065-3.430, P<0.05) were the independent risk factors for delirium of the Stanford A aortic dissection patient after surgery.
Conclusion The incident rate of postoperative delirium of the Standford A aortic dissection patient is relatively high. Patients in this study with elevated pre-operative D-dimer level, lower intraoperative mean arterial pressure, longer postoperative ventilation and combination of acute kidney failure have a higher rate of postoperative delirium. Better understanding and intervention of these factors are meaningful to reduce the occurrence of postoperative delirium.
Objectives
To observe the distribution of enlarged perivascular spaces (EPVSs) in acute ischemic stroke, and determine the factors that influence basal ganglia and centrum semiovale EPVSs.
Methods
We prospectively registered consecutive patients with acute ischemic stroke at the neurological wards of Jianyang Municipal People’s Hospital and West China Hospital of Sichuan University from February 1st to November 1st, 2014. Patients with ischemic stroke within 14 days of symptom onset, having magnetic resonance image (MRI) scan were included. Basal ganglia and centrum semiovale EPVSs, white matter hyperintensity, cerebral atrophy and lacunar infraction were rated using validated scales by reading MRI. Clinical information was obtained using standardized forms. The distribution of EPVSs was observed and analyzed. The evalution of EPVSs was analyzed in relation to age, vascular risk factor, cerebral atrophy, white matter hyperintensity, lacunar infraction, etc, by using univariate and multivariate logistical regression to evaluate the influencing factors for basal ganglia and centrum semiovale EPVSs.
Results
A total of 170 patients with acute ischemic stroke within 14 days from onset were included; in whom, 97.6% had EPVSs in basal ganglia and all had EPVSs in centrum semiovale. The most common scores of basal ganglia EPVSs were 1 point and 2 points. The most common scores of centrum semiovale EPVSs were 2 and 3 points. In logistic regression, age [odds ratio (OR)=1.043, 95% confidence interval (CI) (1.015, 1.071), P=0.002], periventricular white matter hyperintensity [OR=4.203, 95%CI (1.525, 11.583), P=0.006] and hypertension [OR=3.965, 95%CI (1.927, 8.157), P<0.001] were independently associated with increased severity of basal ganglia EPVSs. Only periventricular white matter hyperintensity [OR=2.248, 95%CI (1.054, 4.795), P=0.036] was independently associated with increased severity of centrum semiovale EPVSs in logistic regression.
Conclusions
EPVSs are common in ischemic stroke. There is a lower prevalence of EPVS in the basal ganglia compared with the centrum semiovale. Compared with centrum semiovale EPVSs, basal ganglia EPVSs are more associated with hypertensive cerebral small vessel disease, which may be a marker for hypertensive cerebral small vessel disease.
Objective To investigate and analyze the employment status and related influencing factors of maintenance hemodialysis (MHD) patients. Methods MHD patients from four hemodialysis centers in Beijing between January 2020 and January 2021 were selected. The baseline data and clinical data of patients with long dialysis interval were collected. An anxiety and depression survey was conducted on the patient. Results A total of 108 MHD patients were included. Among them, 41 patients were working and 67 patients were not working. Among the 41 patients at work, there were 3 workers, 1 farmer, 14 company employees, 6 public institution employees, 11 self-employed, 5 freelancer and 1 other. Among the 67 patients who did not work, 8 patients had the ability to work but did not work. Body mass index was an independent influencing factor for employment in MHD patients [odds ratio=1.135, 95% confidence interval (1.017, 1.266), P=0.024]. Conclusion The nutritional status of MHD patients should be taken seriously to improve their employment rate.
ObjectiveTo investigate the long-term efficacy and the influencing factors of thymectomy for thymoma patients associated with myasthenia gravis.
MethodsWe retrospectively analyzed the clinical and follow-up data of 126 thymoma patients associated with myasthenia gravis underwent extended thymectomy from June 2002 to December 2015 in our hospital. There were 26 males and 37 females at the mean age of 54.51±12.62 years. We built up survival analysis model to analyze the effect of those following factors on postoperative result:sex, the age when operated, the preoperative course of disease, the condition of associating with other diseases, history of critical illness, steroid administration time before operation, Osserman classification, Masaoka staging, WHO pathological type, surgical approach, tumor size and so on. Result The average follow-up time was 35(5-96) months. During follow-up period, 12 patients (19%) achieved complete remission, 39 patients (62%) achieved partial remission, 7 patients (11%) kept stable, 5 patients (8%) deteriorated and the total effective rate was 81%. The result of log-rank analysis showed that the preoperative course of disease (P=0.027), history of critical illness on myasthenia gravis (P=0.035) and Osserman classification (P=0.018) were related to incomplete remission, whlie the result of Cox regression analysis showed that the preoperative course of disease (P=0.001) and Osserman classification (P=0.012) were the independent risk factors for incomplete remission.
ConclusionExtended thymectomy is an effective treatment for thymoma patients associated with myasthenia gravis, but the symptom of those patients whose preoperative course of disease are more than 12 months or Osserman classification is at ⅡB, Ⅲ and Ⅳ type of Osserman classification have poor effect after operation.
【摘要】 目的 探討IgA腎病腎血管病變的危險因素。 方法 回顧性分析2000年1月－2009年6月間經腎活檢確診的175例IgA腎病患者資料，其中有腎血管病變者93例，無腎血管病變者82例，進行對照研究。采用多因素非條件logistic回歸模型分析影響IgA腎病腎血管病變的危險因素。 結果 高血壓[OR=11.593，P=0.001，95%CI（2.800，47.991）]、24 h尿蛋白定量[OR=1.754，P=0.001，95%CI（1.270，2.424）]、血肌酐[OR=1.005，P=0.001，95%CI（1.002，1.008）]、腎小球硬化[OR=8.341，P=0.000，95%CI（2.716，25.610）]、腎間質纖維化[OR=4.880，P=0.014，95%CI（1.385，17.199）]對IgA腎病腎血管病變的影響有統計學意義。 結論 高血壓、24 h尿蛋白定量、血肌酐、腎小球硬化和腎間質纖維化可能是影響IgA腎病腎血管病變的獨立危險因素。積極控制以上危險因素對延緩IgA腎病病變的進展具有重要意義。【Abstract】 Objective To explore the risk factors for renal vascular lesions in patients with immunoglobulin A (IgA) nephropathy. Methods We retrospectively analyzed the clinical data of 175 IgA nephropathy patients diagnosed through renal biopsy from January 2000 to June 2009. Among them, there were 98 cases of renal vascular lesions and 82 cases without renal vascular lesion. Controlled study between the two groups of patients were carried out. A multivariate unconditional logistic regression model was employed to analyze the risk factors for renal vascular lesions in IgA nephropathy patients. Results The following factors had significant correlations with renal vascular lesions in IgA nephropathy patients: hypertension [OR=11.593,P=0.001,95%CI (2.800, 47.991)], 24-hour urine protein level [OR=1.754,P=0.001, 95%CI (1.270, 2.424)], serum creatinine [OR=1.005,P=0.001, 95%CI (1.002, 1.008)], glomerulosclerosis [OR=8.341,P=0.000,95%CI (2.716, 25.610)], and renal interstitial fibrosis [OR=4.880,P=0.014, 95%CI(1.385,17.199)]. Conclusion Hypertension, 24-hour urine protein, serum creatinine, glomerulosclerosis and renal interstitial fibrosis were risk factors for renal vascular lesions in IgA nephropathy patients. It will be very significant to actively control all the above risk factors to prevent occurrence of renal vascular lesions.
Objective To explore the risk factors of invasive fungal infection ( IFI) in respiratory ward. Methods A multi-center, retrospective, case-control study was carried out. Patients from five general hospitals in Chongqing city, diagnosed as fungal infection, or whose respiratory specimens were fungal positive, were retrospectively screened for IFI. Patients with respiratory infection and colonization of nonfungal cases in the same period of hospitalization were enrolled as control. Results Thirty-four patients diagnosed with IFI and 50 patients diagnosed with bacterial infection were analyzed for the risk factors of IFI. The demographic characteristics of patients including age and gender were not different( P gt; 0. 05) , but hospitalization days, carbapenem antibiotic use, chemotherapy, deep venous catheterization, total parenteralnutrition( TPN) , neutropenia, and renal disfunction were different significantly between the IFI group and the control group. Multiple logistic regression analysis showed that carbapenem antibiotic use ( OR = 6. 753) ,central venous catheterization ( OR = 5. 021) and TPN ( OR = 3. 199) were main risk factors of invasive fungal infection. Conclusion The carbapenem antibiotic use, central venous catheterization and TPN are risk factors for IFI in respiratory ward.
