急性会厌炎不良预后的危险因素分析

目的：对比不同预后急性会厌炎患者的特异性症状及检查结果,以确定可能影响其预后的危险因素。方法回顾性分析本院门急诊系统中1995年至2014年的698例经间接喉镜或纤维喉镜确诊的急性会厌炎患者,将患者按预后分为两组：最终进行急诊气道干预者为重症组（n ＝115）,未进行气道干预为轻症组（n ＝583）。采用χ2检验及成组 t 检验对比两组患者既往史、一般情况、实验室检查结果;运用 Spearman 相关系数分析呼吸困难分级与会厌水肿程度的关系;并用 Logistic 回归确定可能影响预后的危险因素。结果男女比例为1.366∶1,重症患者易发生于冬春季节及夜间。重症组中有吸烟史者较轻症组多（χ2＝41.957,P ＜0.01）。患者呼吸困难严重程度与不良预后呈正相关（r ＝0.573,P ＜0.01）,但入院时会厌水肿程度分级与不良预后无关（r ＝－0.024,P ＝0.525）。Logistic 回归分析发现男性（OR ＝1.84,95％CI：1.41～3.22,P ＝0.001）、夜间发病（OR ＝2.61,95％CI：1.98～3.16,P ＝0.07）、有吸烟史（OR ＝1.63,95％CI：1.05～3.39,P ＝0.04）及 PaO2降低（OR ＝2.97,95％CI：1.58～4.49,P ＝0.02）为急性会厌炎不良预后的危险因素。结论男性、夜间发病、吸烟史及 PaO2降低是急性会厌炎预后不良的独立危险因素。对于入院时会厌水肿不重,而有以上危险因素的患者,亦应密切监测病情变化。     

急性颈内或大脑中动脉闭塞患者临床预后分析

目的探讨急性颈内或大脑中动脉闭塞的缺血性卒中患者的临床预后及预测结局的因素。方法选择发病6h内磁共振血管造影检查示颈内或大脑中动脉闭塞的患者48例，收集临床及影像学数据，在90d后评定患者的改良Ranking量表（mRS）评分，Logistic回归分析临床结局相关因素。结果48例患者临床结局好者（mRS 0～2分）17例（35．4％），临床结局不良者（mRS 3～6分）31例（64．6％），其中7例（14．6％）死亡。Logistic回归分析仅大面积梗死（OR=21．1，95％CI1．4～314．2，P=0．027）及高血糖（OR=5．1，95％CI1．3～19．8，P=0．019）同临床结局不良相关。结论急性颈内或大脑中动脉闭塞患者大部分临床预后较差，大面积梗死及高血糖是预测临床结局的独立因素。     

急性心肌梗死患者发生无复流现象的危险评分

目的：建立一种预测急性心肌梗死（AMI）患者经皮冠脉介入诊疗（PCI）术中发生无复流风险的评分方法。方法收集接受介入治疗的 AMI 患者的无复流相关因素的临床资料,分为评分模型组和验证组,采用二项多变量 Logistic 回归研究的方法,筛选独立危险因素,建立无复流风险评分系统,对发生风险进行分层,并对评分系统真实性及可靠性进行评价。结果模型组多变量 Logistic 回归分析显示女性（OR ＝0.587,P ＝0.019）、心功能 Killip 分级≥2级（OR ＝3.656, P ＜0.01）、TIMI 血流分级≤2（OR ＝0.774,P ＝0.013）、PCI 术前血栓负荷＞4分（OR ＝2.629,P＜0.01）、发病至球囊扩张病变时间＞6 h （OR ＝1.485,P ＝0.083）为 AMI 患者 PCI 中发生无复流的独立危险因素。危险分层：评分＜2分为低危,2～5分为中危,＞5分为高危。模型组受试者工作曲线下面积（AUC）为0.716（95％CI：0.671～0.761）。采用 Hosmer-Lemeshow 拟合优度检验评价得出：χ2＝1.027,P ＝0.994,提示预测值与实际值差异无统计学意义。验证组二项 Logistic 回归分析的 AUC ＝0.891（95％CI：0.822～0.959）。分别比较验证组 killip 分级、血栓负荷、评分、危险分层的受试者工作曲线,显示无复流评分的 AUC 最大（AUC ＝0.851,95％ CI：0.776～0.927）。结论根据基于 AMI 患者临床和造影特征建立的简单无复流风险评分系统,可用于对 PCI中无复流发生风险进行分层,为临床提供了一个方便快捷预测无复流发生的工具。     

川崎病患儿并发冠状动脉损伤的危险因素及风险预测指标的评价与构建

【摘要】目的 分析川崎病（KD）患儿并发冠状动脉损伤（CALs）的危险因素,并评价风险预测指标构建的模型价值。方法 选取2019年1月～2022年5月某院收治的100例KD患儿,根据是否合并CALs分为CALs组33例和无CALs组67例。收集KD患儿临床资料和生化指标,采用单因素和多因素Logistic回归分析KD患儿并发CALs的影响因素,H-L检验预测模型拟合度。采用受试者工作特征（ROC）曲线分析构建的预测模型对KD患儿并发CALs的预测价值。结果 CALs组发热持续时间≥10d、丙种球蛋白（IVIG）治疗延迟、IVIG无反应比例和血小板计数、中性粒细胞计数、红细胞沉降率（ESR）、C反应蛋白（CRP）、降钙素原（PCT）、N端脑利钠肽前体（NT-proBNP）、肌酸激酶MB（CK-MB）水平高于无CALs组（均P＜0.05）。多因素Logistic回归分析分析显示,发热持续时间≥10d（OR＝2.196,95％CI：1.085～4.445）、IVIG治疗延迟（OR＝1.030,95％CI：1.012～1.048）、IVIG无反应（OR＝1.379,95％CI：1.115～1.705）、ESR（OR＝1.306,95％CI：1.105～1.544）、CRP（OR＝1.029,95％CI：1.009～1.050）、PCT（OR＝1.454,95％CI：1.140～1.854）、NT-proBNP（OR＝1.278,95％CI：1.131～1.444）、CK-MB（OR＝1.272,95％CI：1.066～1.516）为KD患儿并发CALs的危险因素（均P＜0.05）。以多因素Logistic回归所保留的变量构建KD患儿并发CALs的预测模型,H-L拟合优度检验P＞0.05。ROC曲线分析显示,该模型预测KD患儿并发CALs的曲线下面积为0.938,Youden指数为0.745,灵敏度为87.88％、特异度为86.57％。结论 发热持续时间、IVIG治疗延迟、IVIG无反应和ESR、CRP、PCT、NT-proBNP、CK-MB升高是KD患儿并发CALs的危险因素,根据风险预测指标构建的预测模型对KD患儿并发CALs的预测能效较好。     

列线图预测模型评估急性缺血性脑卒中患者 1年预后不良的风险

目的：探讨急性缺血性脑卒中（AIS）患者1年发生预后不良的危险因素，并建立其列线图风险预测模型。方法：通过西安脑卒中数据库平台，连续收集本市4所三级甲等医院2015年1～12月入院的AIS患者，并在入院确诊后随访1年。采用单因素和多因素Logistic回归分析，探讨AIS患者1年预后不良的相关危险因素，采用R软件及rms程序包构建AIS患者1年预后不良的列线图预测模型。结果：多因素Logistic回归分析显示，年龄（OR=1.069,95%CI 1.052～1.087,P=0.000）、合并肺炎（OR=3.121,95%CI 1.595～6.107,P=0.001）、白细胞计数（OR=1.137,95%CI 1.062～1.217,P=0.000）、心房颤动（OR=1.816,95%CI1.059～3.115,P=0.030）、入院NIHSS评分（OR=1.196,95%CI 1.153～1.241,P=0.000）是西安地区AIS患者随访1年发生预后不良的独立危险因素。根据上述危险因素，成功建立预测AIS患者1年发生预后不良的列线图预测模型。该模型ROC曲线下面积（AUC）为0.84...     

构建急性脑卒中机械取栓治疗后预后预测模型的研究

目的通过构建基于临床因素、影像因素、临床联合影像因素的预后预测模型,以期寻找卒中患者机械取栓治疗后最优的预后预测模型.材料与方法回顾性分析在南京市第一医院接受机械取栓治疗的急性脑卒中患者71例.所有患者均为发病24 h内并于治疗前接受MRI检查.收集所有患者的MRI资料及一般临床资料.患者预后采用3个月改良Rankin量表(modified Rankin Scale,mRS)评分评估.应用多元逻辑回归分析方法分别筛选卒中患者预后的独立预测因子并构建临床预测模型、影像预测模型及临床联合影像预测模型,并采用ROC曲线分析模型对卒中预后的预测效能.结果71例患者中预后良好者为35例,预后不良者为36例.多元逻辑回归临床因素结果显示年龄(OR=1.071;95％CI:1.010～1.135;P=0.022)、入院NIHSS评分(OR=1.225;95％CI:1.099～1.366;P<0.001)为预测卒中预后的独立预测因子,该模型预测卒中预后的AUC为0.810(95％CI:0.709～0.911),敏感度和特异度分别为80.6％、71.4％.回归影像因素结果显示低灌注强度比值(hypoperfusion intensity ratio,HIR)(OR=4.037;95％CI:1.241～13.136;P=0.005)为预测卒中预后的独立预测因子,该模型预测卒中预后的AUC为0.862(95％CI:0.772～0.952),敏感度和特异度分别为72.2％、94.3％.回归临床联合影像因素显示入院NIHSS评分(OR=1.157;95％CI:0.998～1.341;P=0.043)、HIR(OR=6.669;95％CI:4.817～15.051;P=0.009)为预测卒中预后的独立预测因子,该模型预测卒中预后的AUC最高,达0.905(95％CI:0.830～0.979),其敏感度为94.4％、特异度为82.9％.结论临床联合影像的预测模型优于临床模型、影像模型,可有效提高急性脑卒中机械取栓治疗后预后的预测效能.     

脑小血管病负荷预测轻型急性脑梗死静脉溶栓后不良预后

  目的   探讨脑小血管病（CSVD）负荷与轻型急性脑梗死（ACI）静脉溶栓后3月不良预后的关系。  方法  回顾性分析2016~2019年在东莞市人民医院神经内科接受重组组织纤溶酶原激活剂静脉溶栓的161例轻型ACI患者的资料。研究的临床变量包括年龄、性别、血管危险因素、美国国立卫生研究院卒中评分（NIHSS）及血液学和MR参数。轻型ACI定义为基线NIHSS≤7分，3月不良预后定义为改良Rankin评分≥3分。CSVD负荷包括脑白质高信号（WMHs）、腔隙性脑梗死、脑微出血（CMBs）和扩大的周围血管间隙。根据头颅MR影像评价CSVD总体负荷，根据Fazekas分级量表评估WMHs严重程度。  结果  161例患者中男性117例（72.7%），3月不良预后患者为29例（18.0%）。单因素分析显示，基线NIHSS、房颤、症状性颅内动脉狭窄、WMHs和CMBs与急性轻型ACI静脉溶栓后3月不良预后有关（P < 0.05）。分别将WMHs及CMBs进入两个Logistic回归方程模型。模型1中，基线NIHSS（OR=1.601, 95% CI: 1.203~2.130, P=0.001）、症状性颅内动脉狭窄（OR=2.658, 95% CI: 1.013~6.978, P=0.047）和WMHs（OR=1.449, 95% CI: 1.033~2.031, P=0.032）与轻型ACI静脉溶栓后3月不良预后显著相关；模型2中，基线NIHSS（OR=1.650, 95% CI: 1.232~2.210, P=0.001），症状性颅内动脉狭窄（OR=3.732, 95% CI=1.435~9.702, P=0.007）和CMBs（OR=1.242, 95% CI: 1.062~1.452, P=0.007）与轻型ACI静脉溶栓后3月不良预后显著相关。  结论  WMHs和CMBs是轻型ACI静脉溶栓后3月不良预后的预测因子。      

首发缺血性卒中患者短期预后不良的危险因素分析

目的探讨首发缺血性卒中患者短期预后不良的危险因素。方法采用一般资料调查表和简化改良的Rankin问卷对142例首发缺血性卒中患者进行调查,并采用Logistic回归分析进行预后不良危险因素分析。结果 82例患者3个月后预后不良;Logistic回归分析结果显示:年龄≥60岁、合并高血压、合并糖尿病和入院时NIHSS评分增高与首发缺血性卒中患者出院3个月预后不良有关。结论大多数首发缺血性卒中患者短期预后不良,年龄增加、合并高血压、合并糖尿病以及入院时NIHSS评分增高是短期预后不良的危险因素。     

脑白质病变对急性脑梗死rt-PA静脉溶栓患者 临床预后及出血转化的影响

目的:观察脑白质病变(WML)对急性脑梗死rt-PA静脉溶栓患者的临床预后及出血转化的影响。方法:收集进行rt-PA静脉溶栓治疗的急性缺血性卒中合并WML患者326例,收集临床资料,分析WML对急性缺血性卒中rt-PA静脉溶栓治疗的预后和出血转化的影响。结果:预后不良组的高龄、冠心病、合并中重度WML、溶栓前NHISS评分、合并房颤患者比例较预后良好组升高(P0.05),多因素Logistic回归分析显示中重度WML(OR 2.040,P=0.024)、溶栓前NIHSS评分(OR 1.128,P0.01)是急性脑梗死rt-PA溶栓患者预后不良的影响因素。出血转化组的合并高血压、冠心病、中重度WML、溶栓前NHISS评分的患者较未出血组升高(均P0.05),多因素Logistic回归分析显示中重度WML(OR 4.059,P=0.012)是急性脑梗死rt-PA溶栓患者出血转化的影响因素。结论:中重度WML是急性缺血性卒中rt-PA静脉溶栓临床预后不良的独立危险因素,也是出血转化独立危险因素。     

乙肝肝硬化并发原发性肝癌危险因素的logistic回归分析

【目的】探讨乙肝肝硬化（hepatitic cirrhosis ,HC）并发原发性肝细胞癌（Hepatocellular carcinoma ,HCC）的危险因素。【方法】选取2011年5月至2016年5月本院收治的133例 HC 并发 HCC 患者作为观察组,选取同期本院收治的 HC 未并发 HCC 患者133例作为对照组（HC 病程≥10年）。收集整理两组患者的临床资料,采用多因素 Logistic 回归分析筛选 HC并发 HCC 的危险因素。【结果】单因素分析结果显示：观察组患者在肝癌家族史（一级亲属）、饮酒史、吸烟史、酒精性脂肪肝、非酒精性脂肪肝、糖尿病史、HBeAg 阳性、HBVDNA ＞104 copies／mL 及未抗病毒治疗等方面的构成比明显高于对照组,差异具有统计学意义（ P ＜0．05）。多因素 Logistic 回归分析结果显示,HC 并发 HCC 的独立危险因素有：肝癌家族史（一级亲属）（OR ＝4．173,95％ CI 1．673～9．602,P ＝0．000）;饮酒指数3～7（OR ＝3．282,95％ CI 1．265～5．273,P ＝0．001）;饮酒指数8～16（OR ＝4．732,95％ CI 1．644～8．574,P ＝0．000）;吸烟指数8～16（OR ＝4．121,95％ CI 1．543～5．288,P ＝0．000）;酒精性脂肪肝（OR ＝4．763,95％ CI 1．442～7．219,P ＝0．000）;糖尿病史（OR ＝3．982,95％ CI 1．743～6．182,P ＝0．000）;HBeAg 阳性（OR ＝3．172,95％ CI 1．543～5．182,P ＝0．001）;HBVDNA （104～105 copies／mL ）（OR ＝5．874,95％ CI 2．382～9．104,P ＝0．000）;HBVDNA（105～106 copies／mL）（OR ＝7．473,95％ CI 2．874～12．129,P ＝0．000）;HBVDNA （106～107 copies／mL ）（OR ＝10．393,95％ CI 6．182～34．645,P ＝0．000）;HBVDNA （≥107 copies／mL）（OR ＝12．475,95％ CI 6．987～39．543,P ＝0．000）;未抗病毒治疗（OR ＝6．122,95％ CI 2．884～8．138,P ＝0．000）。【结论】HBeAg 阳性、HBVDNA ＞104 copies／mL 、未抗病毒治疗、有长期吸烟饮酒史、糖尿病史、肝癌家族史（一级亲属）的 HC 患者发生 HCC 的危险性较高。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."