Objective
To explore the influencing factors of palliation efficacy in malignant obstructive jaundice.
Methods
Clinical data of 107 patients with malignant obstructive jaundice who treated in Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, from March 2014 to December 2017, were retrospectively collected to analyze the influencing factors of palliation efficacy in 1 week and1 month after operation.
Results
Multivariate analysis results showed that, hilar obstruction and preoperative albumin level were influencing factors of palliation efficacy in 1 week after operation (P<0.05), patients with hepatic portal obstruction, and low preoperative albumin level had poor effect; hilar obstruction, preoperative albumin and total bilirubin level were influencing factors of palliation efficacy in 1 month after operation (P<0.05), patients with hepatic portal obstruction, low preoperative albumin level, and high total bilirubin level had poor effect.
Conclusions
The obstruction location, preoperative albumin level, and total bilirubin level are the independent influencing factors of palliation efficacy which played an important role in prognostic assessment.
ObjectiveTo investigate the mid-to-long term quality of life (QOL) and influencing factors in the patients after heart valve replacement.MethodsConvenient sampling method was used to recruit 224 patients who had heart valve replacement surgery in our hospital from June 2008 to June 2017. There were 63 males and 161 females, aged 18-83 (51.49±10.60) years. General information questionnaire and MOS SF-36 scale were used to collect data. Univariate analysis and multiple linear regression analysis were used to analyze and determine the influencing factors for the QOL.ResultsThe total score of QOL of 224 patients was 71.78±17.60 points. All these scores of the patients were significantly lower than those of the general population of Chengdu (P<0.05) except the dimension of vitality. The QOL scores differences between sex, marital status, family income, working condition, the occurrence of anticoagulant complications and other complications were significant (P<0.05). Multivariate analysis showed that family income, working condition, the occurrence of anticoagulant complications and other complications could be included in the regression model, explaining 26.8% of total variance. ConclusionThe mid-to-long term QOL is lower in the patients after heart valve replacement. Family income, working condition, anticoagulant complications and other complications are the main influencing factors for mid-to-long term QOL for patients after heart valve replacement.
Objective To explore the potential categories and influencing factors of chronic comorbidity treatment burden in maintenance hemodialysis (MHD) patients. Methods Convenience sampling method was used to select MHD patients between April and May 2023 at Northern Jiangsu People’s Hospital and Jiangdu People’s Hospital as the research subjects. The general information questionnaire, Chronic Disease Comorbidity Treatment Burden Scale, and Health Literacy Scale for Chronic Disease Patients were used for the questionnaire survey. The latent class analysis was used to explore the classification of chronic comorbidity treatment burden in MHD patients, and the multi-class logistic regression analysis was used to explore the influencing factors of comorbidity treatment burden. Results A total of 450 survey questionnaires were distributed, and 406 valid questionnaires were collected, with an effective response rate of 90.22%. According to the latent class analysis results, the comorbidity treatment burden of MHD patients was divided into three potential categories. Among them, there were 26 cases in the low-burden group, 194 cases in the medium-burden group, and 186 cases in the high-burden group. The results of the ordered multi-class logistic regression analysis showed that patient age, educational level, dialysis age, number of comorbidities, and level of economic support were potential factors affecting the comorbidity treatment burden in MHD patients (P<0.05). Conclusions The comorbidity treatment burden of MHD patients can be divided into three potential categories. The age, educational level, dialysis age, number of comorbidities, and level of economic support of patients are potential factors affecting the comorbidity treatment burden in MHD patients.
ObjectiveTo analyze the influencing factors of fear of cancer recurrence (FCR) and its correlation with social support and quality of life in patients with differentiated thyroid cancer (DTC) at 5 years after surgery. MethodsA total of 116 patients with DTC from West China Hospital, Sichuan University at 5 years after surgery were selected as the research objects. The patients were investigated using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Social Support Rating Scale (SSRS) and the European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30 (EORTC QLQ-C30, hereinafter referred to as QLQ-C30). The χ2 test or Fisher exact probability method were used for univariate analysis, and multivariate logistic regression analysis was used for influencing factor analysis. The diagnostic value of variables with significant influence on FCR in multivariate logistic regression was further studied by receiver operating characteristic (ROC) curve, and Pearson correlation analysis was finally adopted to analyze the relationship between FCR and social support and quality of life in patients with DTC at 5 years after operation. ResultsThe questionnaire survey showed that the FoP-Q-SF score of 116 patients with DTC at 5 years after surgery was (35.92±2.52) scores, of which 75 patients had FoP-Q-SF score ≥34 scores, 41 patients had FoP-Q-SF score <34 scores, and the FCR rate was 64.66% (75/116). Multivariate logistic regression showed that gender, family annual income, SSRS score and total QLQ-C30 score were the main factors of FCR in patients with DTC at 5 years after surgery (P<0.05). Further ROC curve diagnosis showed that the accuracy rate of diagnosis of FCR with SSRS score ≤47.5 scores was 70.70%, the total score of QLQ-C30 ≤617.225 scores was 69.02%. The accuracy rate of diagnosis of FCR was 66.03% when the annual income of family was less than 150 000 yuan. The accuracy of women’s diagnosis of FCR was 62.28%. Pearson correlation analysis showed that FoP-Q-SF score was negatively correlated with SSRS score and total score of QLQ-C30 in DTC patients at 5 years after operation (r=–0.629 6, P=0.000 1; r=–0.568 5, P=0.000 1). ConclusionsThe proportion of patients who have FCR at 5 years after DTC operation is high, and gender, family annual income, SSRS score and total score of QLQ-C30 are the influencing factors. Therefore, we can develop targeted management strategies to reduce patients’ FCR and improve their quality of life.
Objective
To investigate the influencing factors for restenosis after femoral endarterectomy in treatment of arteriosclerosis obliterans at femoral artery .
Methods
A total of 103 patients with arteriosclerosis obliterans at femoral artery who underwent femoral endarterectomy from Jan. 2012 to Jan. 2017 in our hospital were retrospectively selected as subjects of this study, to compare the clinical feathers between restenosis group and patent group, and then exploring the influencing factors for restenosis after femoral endarterectomy.
Results
Thirty-six patients (35.0%) suffered from restenosis after femoral endarterectomy. Patients in the restenosis group had a high proportion of high smoking and diabetes mellitus, and high level of low density lipoprotein than those corresponding indexes of the patent group (P<0.05). Results of Cox proportional hazard model showed that, diabetes mellitus 〔RR=3.338, 95% CI was (1.003, 11.113), P=0.049〕 and high level of low density lipoprotein 〔RR=3.311, 95% CI was (1.166, 9.397), P=0.024〕 were independent risk factors for restenosis after femoral endarterectomy.
Conclusions
Monitoring of high-risk factors like controlling blood glucose strictly and strengthening statin treatment should be done to reduce the risk of restenosis after femoral endarterectomy for patients with arteriosclerosis obliterans at femoral artery.
Objective To systematically review the willingness to use pre-exposure prophylaxis (PrEP) and its influencing factors among men who have sex with men (MSM) in China. Methods We conducted a comprehensive search on various databases, including China National Knowledge Infrastructure, VIP database, Wanfang data, China Biomedical Literature Service System, PubMed, Web of Science, Cochrane Library, and Embase, covering the period from database inception to September 6th, 2023. We focused on studies that publicly reported data on the willingness to use PrEP and its influencing factors among MSM in China. The quality of included studies was assessed using the quality evaluation criteria recommended by the Agency for Healthcare Research and Quality. RevMan 5.3 software and Stata 13.1 software were used to perform meta-analysis for the willingness to use PrEP and its influencing factors among MSM in China. Results A total of 24 cross-sectional studies with 19 influencing factors and a sample size of 16499 participants were included in the review. The results revealed a PrEP usage intention rate of 60.4% [95% confidence interval (CI) (51.8%, 68.9%)] among the MSM population in China. Factors such as awareness of PrEP [odds ratio (OR)=5.26, 95%CI (1.33, 20.82)], having heard of PrEP [OR=1.84, 95%CI (1.28, 2.64)], age<25 years [OR=1.92, 95%CI (1.34, 2.77)], being a student [OR=1.92, 95%CI (1.17, 3.16)], monthly income of 1000-3000 yuan [OR=1.36, 95%CI (1.12, 1.65)], history of human immunodeficiency virus (HIV) testing [OR=2.05, 95%CI (1.53, 2.74)], history of sexually transmitted infections [OR=1.75, 95%CI (1.27, 2.40)], seeking sexual partners online [OR=1.38, 95%CI (1.19, 1.59)], openness about sexual orientation [OR=1.90, 95%CI (1.27, 2.84)], having a non-local household registration [OR=1.66, 95%CI (1.37, 2.02)], and recommending PrEP to friends [OR=20.14, 95%CI (2.59, 156.91)] were identified as promoting factors for the willingness to use PrEP. Conversely, a homosexual orientation [OR=0.67, 95%CI (0.52, 0.85)] was identified as a barrier to the willingness to use PrEP. Conclusions Chinese MSM have a low intention to use PrEP, and there are many factors affecting the intention to use PrEP in MSM. In the future HIV prevention and control work, measures such as strengthening education and publicity of PrEP, providing a certain degree of support for PrEP costs, strengthening health education on campus, strengthening community organizations and support networks should be taken to promote the willingness of MSM to use PrEP.
Objective To analyze the influencing factors of single-center day surgery patients who are discharged from the hospital on the same-day, in order to provide reference and basis for the clinical practice of follow-up day surgery. Methods The electronic medical records of patients who underwent day surgery in the Day Surgery Center of the First Affiliated Hospital of the Air Force Military Medical University between February and October 2021 were analyzed retrospectively. The patients were divided into the same-day discharge group and non-same-day discharge group. The baseline data and perioperative indicators of the patients were analyzed. Results A total of 857 patients were included, including 264 patients (30.81%) in the same-day discharge group and 593 patients (69.19%) in the non-same-day discharge group. Univariate analysis showed that there were significant differences between the two groups in gender, age, body mass index, whether the first one, disease classification, anesthesia method, and intraoperative blood loss (P<0.05). Logistic regression analysis showed that gender, whether the first one, disease classification, surgical grade, anesthesia method, and intraoperative blood loss were independent factors affecting the delayed discharge of patients undergoing daytime surgery (P<0.05). Conclusions There are many factors that affect day surgery patients’ discharge. It is suggested that more rigorously screen patients for day surgery, improve medical technology, strengthen out-of-hospital continued care, and optimize management procedures, so as to shorten the time of patients in hospital and provide more information for patients, and provide more efficient and convenient medical services for patients.
Objective To explore the current situation and influencing factors of self-regulatory fatigue in maintenance hemodialysis (MHD) patients, so as to provide good dialysis treatment for MHD patients, reduce their level of self-regulated fatigue and improve their quality of life. Methods The convenient sampling method was used to select the MHD patients in the Wenjiang Hemodialysis Center of West China Hospital of Sichuan University between April 12 and April 30, 2022. The patients were investigated by self-made basic information scale and self-regulatory fatigue scale. Results A total of 131 patients were included. The average score of self-regulatory fatigue was 53.47±6.45, cognitive dimension was 20.21±2.39, emotional dimension was 20.85±2.85, behavioral dimension was 12.40±3.63. The results of multiple linear stepwise regression analysis showed that age, duration of dialysis and educational background could inversely predict the score of self-regulatory fatigue (P<0.05). Conclusions MHD patients have a high level of self-regulatory fatigue. Clinical nurses can make individual dialysis programs according to the actual situation of MHD patients, improve their self-regulated level and physical and mental health, and improve the quality of life of MHD patients.
Objective To document the effect of surgical steps, including penile degloving, plate transection, dorsal plication, and fasciocutaneous coverage, in primary hypospadias repair on penile length. Methods A consecutive series of 209 prepubertal boys with primary hypospadias repair was included with the age ranged from 10 to 97 months (mean, 31.7 months). Intraoperative stretched penile length (SPL) was measured before operation (n=209), and after each step, namely penile degloving (n=152), plate transection (n=139), dorsal plication (n=170), and fasciocutaneous coverage (n=209). SPLs before and after each steps or the entire operation were analyzed. The SPL was compared between plate transection group and plate preservation group, dorsal plication group and non-plication group, and plate preservation with plication group and plate preservation without plication group, respectively. Differences of SPL between before and after each steps were analyzed with factors including neourethra length, rest dorsal penile length, rest ventral penile length, preoperative SPL, and the degree of penile curvature after penile degloving, with multivariate linear regression analysis. ResultsAll the four steps resulted in SPL difference. The SPL increased after penile degloving and plate transection (P<0.05), and decreased after dorsal plication and fasciocutaneous coverage (P<0.05). The SPL increased after all steps were completed (P<0.05). In patients with plate transection, postoperative SPL increased when compared with that before operation (P<0.05). No significant difference was noted in patients without plate transection (P>0.05). And there was significant difference in the increased length of SPL between patients with and without plate transection (P<0.05). In patients with dorsal plication, a significant increase of postoperative SPL (P<0.05) was noted. No significant difference was noted in patients without dorsal plication (P>0.05). And there was no significant difference in increased length between patients with and without dorsal plication (P>0.05). When patients with plate transection were excluded, dorsal plication resulted in no significant difference on postoperative SPL (P>0.05). The increased length of SPL after penile degloving, dorsal plication, or cutanofascial coverage was not related to the neourethra length, the rest dorsal penile length, the rest ventral penile length, the preoperative SPL, and the degree of penile curvature (P>0.05). However, the neourethra length and preoperative SPL were the influencing factors for the increased length of SPL after plate transection (P<0.05). ConclusionThe main steps in primary hypospadias repair can change SPL. The lengthening effect of plate transection would not be counteracted by dorsal plication. Dorsal plication makes no significant difference on postoperative SPL.
ObjectiveTo explore value of ultrasound real-time elastography (RTE) technology for identification of benign and malignant solid thyroid nodules.MethodsA retrospective analysis was performed on 125 patients with thyroid nodules who underwent ultrasound RTE in this hospital from February 2018 to August 2019. All patients underwent RTE on the basis of conventional ultrasound. The ultrasound elasticity contrast index (ECI) was used as the evaluation index and the pathological examination result was used as the gold standard. The receiver operating characteristic (ROC) curve analysis was used to evaluate the value of ECI in the identification of benign and malignant solid thyroid nodules. Logistic regression analysis was used to analyze the influencing factors of ECI.ResultsAmong the 125 patients with solid thyroid nodules, 51 were malignant nodules, 74 were benign nodules. The ECI value of patients with benign thyroid nodules was lower than that of patients with malignant nodules (2.71±0.83 versus 3.42±1.14, t=–4.030, P<0.001). The result of ROC analysis showed that the cutoff value of ECI to distinguish benign and malignant solid thyroid nodules was 3.07, area under curve of ROC was 0.806 [95%CI (0.717, 0.894), P<0.001], sensitivity was 80.3%, specificity was 70.4%. The multivariate logistic regression analysis showed that the thyroid nodules with diffuse lesions, calcification, and maximum nodule diameter ≥1 cm were the risk factors for elevated ECI values (P<0.05). For the solid thyroid nodules without diffuse lesions, without calcification, and maximum nodule diameter <1 cm, ECI had the higher sensitivity, specificity, accuracy, and positive predictive value for the differential diagnosis of benign and malignant thyroid nodules (all exceed 80%), but these indexes were lower (under 60%) for the differential diagnosis of solid thyroid nodules with diffuse diseases, with calcification, and maximum nodule diameter ≥1 cm.ConclusionsECI obtained by ultrasound RTE can be used to differentiate solid thyroid nodules from benign ones. The presence or absence of diffuse lesions, calcification, and maximum nodule diameter are the influencing factors for ECI to differentiate solid thyroid nodules. In clinical diagnosis, it should be paid attention to the comprehensive analysis of the above factors.
