Objective To identify the risk factors for postoperative recurrence of peripheral solid small-nodule lung cancer (PSSNLC) (T≤2 cm), and to explore the effects of surgery types on prognosis. Methods We extracted data from Western China Lung Cancer Database (WCLCD), a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University, and Surveillance, Epidemiology, and End Results (SEER) database for peripheral solid small-nodule lung cancer patients (T≤2 cm N0M0, stageⅠ) who underwent surgerybetween 2005 and 2016. We used univariable and multivariable logistic regression to analyze risk factors for recurrence of PSSNLC. We applied propensity-score matching to compare the long-term results of segmentectomy and lobectomy, as well as the survival of patients from WCLCD and SEER. We finally included 4 800 patients with PSSNLC (T≤2 cm N0M0) (WCLCD∶SEER=354∶4 446). We matched 103 segmentectomies and 350 lobectomies in T≤1 cm, and 280 segmentectomies and1 067 lobectomies in 1 cm<T≤2 cm at a ratio of 1∶4 according to the propensity scores. Results The results of multivariable logistic regression showed that older age (HR=1.04, 95%CI 1.03-1.05, P<0.001), male (HR=1.60, 95%CI 1.37-1.88, P<0.001), squamous carcinoma (HR=1.65, 95%CI 1.40-1.95, P<0.001), lymph node removed (HR=0.97, 95%CI 0.96-0.99, P<0.001) were risk factors for recurrence after surgery. We found that segmentectomy and lobectomy could reach similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm. Analyses of 1 441 patients with PSSNLC after matching (WCLCD∶SEER=325∶1 116) indicated that the 5-year overall survival rate of the patients in WCLCD was better than that in SEER database ( 89.8% vs. 77.1%, P<0.001). Conclusion Older age, male, squamous carcinoma, and lymph node removed are the risk factors for recurrence of PSSNLC. Segmentectomy shows similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm N0M0. The patients in the WCLCD shows better survival compared with of the patients in the SEER database.
Objective To investigate the clinical characteristics, risk factors and perioperative outcome of prolonged mechanical ventilation (PMV) in elderly patients undergoing coronary artery bypass grafting (CABG). Methods The data of elderly patients receiving CABG in the Nanjing First Hospital from January 2013 to June 2019 were collected. All patients were divided into a control group and a PMV group according to whether ventilation time≥24 h.The clinical characteristics and risk factors of PMV were compared between the two groups. Variables were 1∶1 balanced through propensity score matching (PSM) and perioperative outcomes of two groups was analyzed. Results Finally 956 patients were collected, including 187 in the PMV group and 769 in the control group. There were 586 males and 370 females aged 70-94 (74.3±3.5) years. Compared with the control group, the PMV group had higher rates of smoking, preoperative renal impairment, intraoperative blood transfusion and intra-aortic balloon pump (IABP) implantation, worse cardiac function, lower glomerular filtration rate and ejection fraction, larger left atrial diameter, longer cardiopulmonary bypass time and aortic cross-clamping time (P<0.05). There was no statistical difference in other clinical data between the two groups (P>0.05). Binary multivariate logistic regression analysis showed that females, smoking, chronic obstructive pulmonary disease, left ventricular ejection fraction≤56.0%, cardiopulmonary bypass time>106.0 min, IABP implantation and intraoperative blood transfusion were independent risk factors for PMV in elderly patients. After PSM, there were 146 patients in the control group and the PMV group, respectively. The PMV group had longer ICU stay and length of hospital stay and more drainage volume compared with the control group (all P<0.05). There was no statistical difference in perioperative mortality or other complications between the two groups (all P>0.05). ConclusionThere are a lot of factors associated with PMV of the elderly patients undergoing on-pump CABG. In order to establish a complete and formal PMV prediction model, clinicians can make a further step of assessment according to perioperative elements, and improve the prognosis of such patients.
Objective To study the risk factors of developing progressive pulmonary fibrosis (PPF) within one year in patients diagnosed with rheumatoid arthritis-associated interstitial lung disease (RA-ILD), and develop a nomogram. Methods A retrospective study was conducted in 145 cases of RA-ILD patients diagnosed and followed up in the Affiliated Hospital of Qingdao University from January 2010 to October 2022. Among them, 106 patients and 39 patients were randomly assigned to a training group and a verification group. The independent predictors of PPF in patients with RA-ILD within one year were determined by univariate and multivariate logistic regression analysis. Then a nomogram is established through these independent predictive variables. Calibration curve, Hosmer-Lemeshow test, receiver operating characteristic (ROC) curve and area under ROC curve (AUC) and clinical decision curve were used to evaluate the predictive efficiency of the nomogram model for PPF in RA-ILD patients within one year. Finally, internal validation was used to test the stability of the model. Results Of the 145 patients with RA-ILD, 62 (42.76%) developed PPF within one year, including 40 (37.7%) in the training group and 22 (56.41%) in the verification group. The PPF patients had higher proportion of subpleural abnormalities, higher visual score of fibrosis and shorter duration of RA. Logistic regression analysis showed that the duration of rheumatoid arthritis (RA), visual score of fibrosis and subpleural abnormality were independent risk factors for the occurrence of PPF within one year after diagnosis of RA-ILD. A nomogram was constructed based on these independent risk factors. The AUC values of the training group and the verification group were 0.798 (95%CI 0.713 - 0.882) and 0.822 (95%CI 0.678 - 0.967) respectively, indicating that the model had a good ability to distinguish. The clinical decision curve showed that the clinical benefit of PPF risk prediction model was greater when the risk threshold was between 0.06 and 0.71. Conclusion According to the duration of RA, the visual score of fibrosis and the presence of subpleural abnormalities, the predictive model of PPF was drawn to provide reference for the clinical prediction of PPF in patients with RA-ILD within one year after diagnosis.
ObjectiveTo analyze the prevalence and risk factors of metabolic syndrome (MS) after adult liver transplantation (LT) recipients. MethodsThe clinicopathologic data of patients with survival time ≥1 year underwent LT in the People’s Hospital of Zhongshan City from January 1, 2015 to August 31, 2020 were analyzed retrospectively. The logistic regression model was used to analyze the risk factors affecting MS occurrence after LT, and the receiver operating characteristic (ROC) curve was used to evaluate the optimal cutoff value of the index of predicting MS occurrence and its corresponding evaluation effect. ResultsA total of 107 patients who met the inclusion criteria were collected in this study. Based on the diagnostic criteria of MS of Chinese Medical Association Diabetes Association, the occurrence rate of MS after LT was 32.7% (35/107). Multivariate logistic regression analysis showed that the increased age of the recipient [OR (95%CI)=1.106 (1.020, 1.199), P=0.014], preoperative increased body mass index [OR (95%CI)=1.439 (1.106, 1.872), P=0.007] and blood glucose level [OR (95%CI)=1.708 (1.317, 2.213), P<0.001], and with preoperative smoking history [OR (95%CI)=5.814 (1.640, 20.610), P=0.006] and drinking history [OR (95%CI)=5.390 (1.454, 19.984), P=0.012] increased the probability of MS after LT. The areas under the ROC curve (AUC) corresponding to these five indexes were 0.666, 0.669, 0.769, 0.682, and 0.612, respectively. The corresponding optimal cutoff values of three continuous variables (recipient’s age, preoperative body mass index, and blood glucose level) were 53 years old, 23.1 kg/m2, and 6.8 mmol/L, respectively. The AUC of combination of the above five indexes in predicting occurrence of MS was 0.903 [95%CI (0.831, 0.952)], and the sensitivity and specificity were 80.0% and 90.3%, respectively. ConclusionsIncidence of MS after adult LT recipient is not low. For recipients with preoperative hyperglycemia, obese, elderly, histories of drinking and smoking before LT need to pay attention to the early detection and early intervention of MS.
ObjectiveTo explore the risk factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC), and try to establish a risk prediction model for LNM of EGC.MethodsThe clinicopathologic data of EGC patients who underwent radical gastrectomy and lymph node dissection from January 1, 2015 to December 31, 2019 in this hospital were retrospectively analyzed. Univariate analysis and logistic regression analysis were used to determine the risk factors for LNM of EGC, and the risk prediction model for LNM of EGC was established based on the multivariate results.ResultsA total of 311 cases of EGC were included in this study, and 60 (19.3%) cases had LNM. Univariate and multivariate analysis showed that age (younger), depth of tumor invasion (submucosa), vascular invasion, and undifferentiated carcinoma were the risk factors for LNM of EGC (P<0.05). The optimal threshold for predicting LNM of EGC was 0.158 (area under the receiver operating characteristic curve was 0.864), the sensitivity was 80.0%, and the specificity was 79.3%.ConclusionsFrom results of this study, risk factors for LNM of EGC have age, depth of invasion, vascular invasion, and differentiation degree. Risk prediction model for LNM of EGC established on this results has high sensitivity and specificity, which could provide some references for treatment strategy of EGC.
ObjectiveTo systematically summarize the research progress in risk prediction models for postoperative anastomotic leakage in gastric cancer, and to explore the advantages and limitations of models constructed using traditional statistical methods and machine learning, thereby providing a theoretical basis for clinical precision prediction and early intervention. MethodBy analyzing domestic and international literature, the construction strategies of logistic regression, least absolute shrinkage and selection operator (LASSO) regression, and machine learning models (support vector machine, random forest, deep learning) were systematically reviewed, and their predictive performance and clinical applicability were compared. ResultsThe traditional logistic regression and LASSO regression models performed excellently in terms of interpretability and in small-sample scenarios but were limited by linear assumptions. The machine learning models significantly enhanced predictive capabilities for complex data through non-linear modeling and automatic feature extraction, but required larger data scales and had higher demands for interpretability. ConclusionsDifferent prediction models have their own advantages and limitations; in practical clinical applications, they should be flexibly selected or complementarily applied based on specific scenarios. Current anastomotic leakage prediction models are evolving from single factor analysis to multi-modal dynamic integration. Future efforts should combine artificial intelligence and multi-center prospective clinical studies to validate, so advancing the development of precise and individualized anastomotic leakage predictive tools for patients after gastric cancer resection.
ObjectiveTo investigate the risk factors of cervical lymph node metastasis of papillary thyroid microcarcinoma (PTMC) with clinical lymph node metastasis negative (cN0).MethodThe clinicopathologic data of patients with cN0 PTMC who underwent at least one lobectomy plus central lymph node dissection in this hospital from January 2013 to December 2018 were retrospectively collected and the risk factors of lymph node metastasis were analyzed.ResultsA total of 1 821 patients with cN0 PTMC were enrolled in this study. The results of postoperative pathology showed there were 837 (46.0%) cases with lymph node metastasis, in which of 805 (44.2%) cases with central lymph node metastasis; 252 (33.1%) had lateral lymph node metastasis among 761 patients underwent lateral lymph node dissection. The results of univariate analysis showed that male, age <55 years old, tumor diameter ≥5 mm, bilateral cancer, capsule invasion, and multiple foci were associated with lymph node metastasis of cN0 PTMC (P<0.05). Further binary logistic regression multivariate analysis results showed that these factors (except multiple foci) were the independent risk factors of lymph node metastasis of cN0 PTMC (P<0.05). While the results found that the risk of lateral lymph node metastasis was increased with the increasing of the number of central lymph node metastasis in patients with cN0 PTMC (P<0.05).ConclusionsCervical lymph node metastasis of cN0 PTMC is related to many factors, and central lymph node metastasis indicates a higher risk of lateral lymph node metastasis. For patients with risk factors, preventive central lymph node dissection should be given at the first surgery and decided whether to perform lateral lymph node dissection according to the intraoperative situation.
ObjectiveTo analyze the causes and potential risk factors of re-catheterization after failure of no urinary catheter in patients undergoing lung cancer surgery.MethodsThe clinical data of 1 618 patients without urinary catheter indwelling during the perioperative period of thoracic surgery in our hospital from 2013 to 2019 were retrospectively analyzed, including 791 males and 827 females, with a median age of 58 years, ranging from 27 to 85 years. And the risk factors for re-insertion after failure of urinary catheter were investgated.ResultsThe rate of catheter re-insertion was 1.5% (24/1 618). Compared with patients without re-insertion, patients with re-insertion had longer operation time [120.0 (95.0, 130.0) min vs. 120.0 (115.0, 180.0) min, P=0.015] and more intraoperative fluid infusion [800.0 (600.0, 1 100.0) mL vs. 1 150.0 (725.0, 1 350.0) mL, P=0.008]. Further multivariate analysis found that the operation time (OR=1.014, P=0.004, 95%CI 1.005-1.024) and intraoperative fluid infusion (OR=1.001, P=0.022, 95%CI 1.001–1.002) were independent risk factors for re-insertion.ConclusionThe rate of catheter re-insertion in lung cancer patients is relatively low, and conventional no placement of catheter is safe and feasible after lung cancer surgery. Increasing operation time or intraoperative infusion volume may increase the risk of catheter re-insertion after lung cancer surgery.
Objective To investigate the early warning value of urinary selenium binding protein 1 (SBP1) in acute kidney injury (AKI) and its risk factor exposure, and compare it with urinary neutrophil gelatinase-associated lipocalin (NGAL). Methods Adult AKI inpatients and medical workers from the Department of Nephrology of the Second Affiliated Hospital of Xi’an Jiaotong University between April 2023 and April 2024 were selected. Patients who underwent percutaneous coronary intervention (PCI) in the Department of Cardiology of the Second Affiliated Hospital of Xi’an Jiaotong University were selected in June 2023. Patients who received cisplatin treatment in the Respiratory Department of the Second Affiliated Hospital of Xi’an Jiaotong University were selected in June 2023. Urinary SBP1 and NGAL levels of patients and medical workers were detected by enzyme-linked immunosorbent assay. Results A total of 14 medical workers and 36 AKI patients were included. Except for gender, alanine aminotransferase, aspartate aminotransferase, total cholesterol (P>0.05), there were statistically significant differences in other indicators between the medical workers and the AKI patients (P<0.05). The urine SBP1 [100.30 (71.50, 138.75) vs.75.60 (65.90, 80.08) pg/mL; U=2.918, P=0.004] and NGAL [423.70 (73.93, 839.80) vs. 14.80 (5.83, 29.98) ng/mL; U=4.668, P<0.001] levels in the AKI group were higher than those in the control group. But the area under the curve of receiver operative characteristic curve of urine SBP1 was smaller than that of urine NGAL (0.768 vs. 0.929). The urine SBP1 level in AKI patients was positively correlated with alanine aminotransferase, aspartate aminotransferase, serum creatinine, and serum glucose (P＜0.05), but negatively correlated with estimated glomerular filtration rate and total cholesterol (P＜0.05). A total of 14 patients who underwent PCI were included. The urinary SBP1/creatinine levels of PCI patients increased 6 hours after surgery compared to preoperative levels [(39.54 ± 8.00) vs. (19.34±2.90) pg/μmol; F=8.862, P=0.011]. The urea nitrogen level decreased 72 hours after surgery compared to preoperative levels (P=0.036), while there were no statistically significant differences in other indicators at other time points (P>0.05). There was no significant change in urinary NGAL levels before and after PCI treatment in patients. A total of 19 patients received cisplatin treatment were included. After cisplatin treatment, the level of urinary SBP1 increased compared to before treatment (P=0.024), while there was no significant change in the level of urinary NGAL after treatment compared to before treatment (P=0.350). After treatment, the levels of urea nitrogen (P=0.041) and cystatin C (P=0.002) increased compared to before surgery, while there was no statistically significant difference in blood creatinine and estimated glomerular filtration rate compared to before treatment (P>0.05). Conclusions Urinary SBP1 levels have certain diagnostic value for AKI, but the diagnostic efficacy is not as good as urinary NGAL. Urinary SBP1 is more sensitive to renal tubular injury caused by nephrotoxic drugs than urinary NGAL.
Objective To explore the risk factors, clinical characteristics and pathogenic bacteria of late-onset septicemia (LOS) in neonates, so as to guide clinical diagnosis and treatment. Methods Collect LOS in neonates admitted to the Department of Pediatrics, Chaohu Hospital of Anhui Medical University between January 2015 and February 2020, and set them as the observation group. The neonates born at the same time and hospitalized without septicemia were selected as the control group. The general situation and risk factors of the two groups of neonates were analyzed, and the clinical manifestations, complications and pathogenic bacteria of LOS in neonates were analyzed. Results 182 neonates were enrolled, 91 in each group. There were significant differences between the two groups in mechanical ventilation, indwelling peripherally inserted central catheter, parenteral nutrition, tracheal intubation, neonatal asphyxia, gestational age<37 weeks, birth weight<2.0 kg (P<0.05). Logistic regression analysis showed that gestational age<37 weeks [odds ratio (OR)=3.010, 95% confidence interval (CI) (1.489, 6.085), P=0.002], parenteral nutrition [OR=3.506, 95%CI (1.681, 7.312), P=0.001] were independent risk factors for LOS. The main clinical manifestations of LOS were abnormal temperature, feeding difficulties, jaundice, apnea, hypersensitive C-reactive protein and procalcitonin increase. The neonates with LOS were prone to necrotizing enterocolitis and purulent meningitis. A total of 74 pathogenic bacteria were cultured from neonates with LOS, including 49 Gram-positive bacterium, 21 Gram-negative bacteria and 4 fungi. The critical and death cases were mainly infected by Gram-negative bacteria. Conclusions A number of factors are related to LOS. Gestational age<37 weeks and parenteral nutrition are independent risk factors for LOS. In order to avoid LOS, attention should be paid to prevention, aseptic concept should be strengthened, and drugs should be used reasonably.
