腹膜透析患者退出及死亡原因分析

目的探讨腹膜透析患者退出原因及死亡原因并分析对策。方法回顾性分析邯郸市中心医院腹膜透析中心2007年1月至2011年12月的腹膜透析患者资料,统计例数,分析退出原因及死亡原因。结果共有109例患者退出腹膜透析,退出的主要原因是死亡63例（占57．8％）,其次为。肾移植5例（占4．6％）、转血液透析9例（占8．3％）、其他32例（占29．4％,因经济原因放弃、转院及失访）。原发病为糖尿病患者的病死率为74．3％（26／35）,高血压患者为70．0％（21／30）,均显著高于慢性肾炎患者的32．4％（12／37）（P均〈O．05）,前两者间的差异无统计学意义（P〉0．05）。死亡的首位原因是心血管事件23例（占36．5％）,其余依次是脑血管事件13例（占20．6％）、感染11例（肺部感染和腹腔感染,占17．5％）、营养不良11例（占17．5％）、呼吸系统疾病3例（占4．8％）、肿瘤2例（占3．2％）。其中透析开始前合并心功能不全的病死率高,存在残余。肾功能的透析患者病死率低,两者与肾移植组比较,差异有统计学意义（P均do．05）。研究期间腹膜透析患者共发生腹膜炎75例,操作不当38例（占50．7％）,腹泻25例（占33．3％）,重复用帽7例（占9．3％）,隧道炎2例（占2．7％）,便秘1例（占1．3％）,尿路感染1例（占1．3％）,使用国产腹膜透析液1例（占1．3％）。结论死亡是持续性不卧床腹膜透析（continuousambulatoryperitonealdialysis,CAPD）患者退出腹膜透析的主要原因,患者死亡的主要原因为心脑血管病和感染。高龄、糖尿病、残余肾功能差、血压、营养不良、感染和透析前心功能状况是影响患者生存的危险因素。     

Psychopathology influences treatment retention among drug-dependent women

Three subgroups of drug dependent women (N = 78) were identified through cluster analysis on MCMI-II scores. Group 1 (26%) presented a relatively benign clinical picture. In contrast, Group 2 (37%) evidenced severe addiction, psychiatric (Axis I), and personality (Axis II) problems. Group 3 (37%) was characterized by fewer Axis I problems, prominent addiction and externalizing (Cluster B) personality deficits. Group membership was significantly associated with retention in a gender-specific day treatment program. Group 2 experienced rapid attrition, with only 36% completing treatment, compared to 57% for Group 1 and 76% for Group 3. Results indicate that drug-dependent women with externalizing psychopathology can be retained in treatment when environmental barriers are removed and an adequate “holding environment” is maintained. However, women with severe psychiatric problems, unstable mood, and interpersonal deficits are less likely to complete treatment. Early identification of women at risk for drop-out affords an opportunity to intervene to prevent its occurrence.     

广西壮族自治区2008－2015年艾滋病病毒感染者基线CD4+T淋巴细胞计数水平对抗病毒治疗脱失的影响

目的 探讨HIV感染者开始抗病毒治疗（ART）时基线CD₄⁺T淋巴细胞计数（CD₄）不同水平对治疗脱失的影响。方法 采用回顾性队列研究方法,从艾滋病防治基本信息系统ART库选取2008－2015年广西壮族自治区（广西）首次开始ART、年龄≥18岁的HIV感染者,分析其ART脱失情况,随访时间截至2016年5月30日。采用Cox比例风险模型分析ART时基线CD₄不同水平对ART脱失的影响。结果 共计58 502例HIV感染者进入队列,平均脱失比例为4.8/100人年。在控制了年龄、性别、婚姻状况、感染途径、ART前WHO临床分期、初始治疗方案、目前治疗方案、治疗方案改变、ART开始年份等因素后,基线CD₄为200～、351～、≥500个/μl组HIV感染者的脱失风险分别是<200个/μl组的1.110（95% CI：1.053～1.171,P<0.001）、1.391（95% CI：1.278～1.514,P<0.001）、1.695（95% CI：1.497～1.918,P<0.001）倍。HIV感染者因为依从性差而停药的比例为56.0%（1 601/2 861）。结论 随着HIV感染者接受ART时CD₄水平提高,ART脱失风险明显增加。为减少ART脱失,应充分考虑开始ART时CD₄水平,加强依从性宣传教育和治疗机构人员培训。     

某校医学生休退学情况分析

对某校2006年～ 2011年休退学的医学生情况进行分析,为教学及管理提供参考.2006年～2011年某校累积休退学253名医学生,各年度医学生休退学率在1.0％上下浮动,基本稳定,是各专业的一种正常淘汰机制.休退学的医学生中,从性别上看,男生偏多;从学生来源上看,中国港澳台和外国留学生占大部分;从专业上看,生物医学英语专业休退学率最高.休学的主要原因是疾病,以精神疾病为主,学校应当加强医学生的健康教育和心理卫生咨询.退学以主动退学为主,中国港澳台和外国留学生占大部分,多是非疾病原因,需要学校适时调整管理办法和培养方案.     

Euroforgen-NoE collaborative exercise on LRmix to demonstrate standardization of the interpretation of complex DNA profiles

There has been very little work published on the variation of reporting practices of mixtures between laboratories, but it has been previously demonstrated that there is little consistency. This is because there is no current uniformity of practice, so different laboratories will operate using different rules. The interpretation of mixtures is not solely a matter of using some software to provide ‘an answer’. An assessment of a case will usually begin with a consideration of the circumstances of a crime. Assumptions made about the numbers of contributors follow from an examination of the electropherogram(s) – and these may differ between the prosecution and the defence hypotheses. There may be a necessity to evaluate several sets of hypotheses for any given case if the circumstances are uncertain. Once the hypotheses are formulated, the mathematical analysis is complex and can only be accomplished by the use of specialist software. In order to obtain meaningful results, it is essential that scientists are trained, not only in the use of the software, but also in the methodology to understand the likelihood ratio concept that is used. The Euroforgen-NoE initiative has developed a training course that utilizes the LRmix program to carry out the calculations. This software encompasses the recommendations of the ISFG DNA commissions on mixture interpretation and is able to interpret samples that may come from two or more contributors and may also be partial profiles. Recently, eighteen different laboratories were trained in the methodology. Afterwards they were asked to independently analyze two different cases with partial mixture DNA evidence and to write a statement court-report. We show that by introducing a structured training programme, it is possible to demonstrate, for the first time, that a high degree of standardization, leading to uniformity of results can be achieved by participating laboratories.     

Reasons and predictors of discontinuation of running after a running program for novice runners

Objectives

To determine the proportion of participants of a running program for novice runners that discontinued running and investigate the main reasons to discontinue and characteristics associated with discontinuation.

PGT for aneuploidy does not affect three-cycle cumulative IVF discontinuation rate in women of advanced maternal age

Research questionDoes preimplantation genetic testing for aneuploidy (PGT-A) influence the discontinuation rate in women with advanced maternal age (AMA) undergoing IVF?DesignRetrospective longitudinal cohort study carried out at a single IVF clinic in Turkey. In total, 401 consecutive AMA cases were included. Discontinuation rates of pre-intervention (conventional IVF; June 2013 to October 2014; 203 couples; 270 cycles) and post-intervention (PGT-A; April 2015 to June 2016; 198 couples; 285 cycles) periods were compared. To delineate the reason for discontinuation, a telephone survey was conducted. Primary outcome measure was cumulative discontinuation rate before completing three cycles of IVF treatment without achieving an ongoing pregnancy.ResultsThe discontinuation rates after the first and second failed cycles were comparable between the two arms as were the cumulative discontinuation rates before completing three cycles. The cumulative ongoing pregnancy rate per embryo transfer was significantly higher in the PGT-A arm (43.2% versus 16.8%; P < 0.001). The cumulative ongoing pregnancy rate per patient was comparable between the two arms (20.7% versus 16.3%, respectively). Female age was the only significant contributor to treatment discontinuation (hazard ratio [HR] 1.07; 95% CI 1.09 to 1.13). Of the 296 couples discontinuing treatment in both arms, 179 (179/296 [60.5%]) participated in the survey; overall, psychological burden was the main reason for treatment discontinuation (37/179 [20.7%]).ConclusionsAbout 90% of AMA cases not achieving an ongoing pregnancy discontinue IVF treatment before completing three cycles. Discontinuation rate is not reduced by carrying out PGT-A. Female ageing is the only significant contributor, with a hazard of discontinuing further IVF treatment of 7% with female ageing of 1-year.     

血液透析患者退出及住院原因分析

目的调查分析血液透析患者退出及住院的原因。方法对159例长期维持性血液透析患者进行追踪,调查分析其退出及住院的时间和原因。结果159例患者中有38例退出,退出的主要原因分别是心脑血管系统疾病和感染性疾病。159例患者的年住院次数为（0．93±1．02）次,住院率为9．6天／年。住院的主要原因分别是感染性疾病和心脑血管系统疾病。结论心脑血管系统疾病和感染性疾病是导致血液透析患者退出及住院的重要因素。