Incidence,risk factors and clinical implications of postoperative urinary tract infection in geriatric hip fractures

IntroductionPostoperative urinary tract infection (UTI) is common in geriatric patients; however, little is known about the impact of UTI in orthopedic trauma. The present study was designed to determine the risk factors and clinical impact of postoperative urinary tract infection (UTI) in acute geriatric hip fractures.Patients and methodsGeriatric patients (≥65 years of age) undergoing hip fracture surgery were identified within the American College of Surgeons National Surgical Quality Improvement Program between 2016 and 2019. Patients presenting with UTI at the time of surgery were excluded. Baseline characteristics and outcomes were compared between patients with and without postoperative UTI. Multivariate logistic regression was performed, controlling for potential confounders.ResultsA total of 46,263 patients included in the study. Overall, 1,397 (3.02%) patients had postoperative UTI. Patients who developed postoperative UTI had higher rates of pneumonia (6.44% vs. 3.76%, p < 0.001), DVT (2.22% vs. 1.04%, p < 0.001), sepsis (7.73% vs. 0.62%, p < 0.001), and more frequently experienced postoperative hospital lengths of stay exceeding 6 days (37.94% vs. 20.33%, p < 0.001). Hospital readmission occurred more frequently in patients with postoperative UTI (24.55% vs. 7.85%, p < 0.001), but surprisingly, these patients had a lower mortality rate (1.36% vs. 2.2%, p < 0.001). Adjusted analysis demonstrated the following variables associated with postoperative UTI: age ≥ 85 (OR = 1.37, 95%CI = 1.08 - 1.73), ASA class ≥ 3 (OR = 1.59, 95%CI = 1.21 – 2.08,), chronic steroid use (OR = 1.451, 95%CI = 1.05 - 1.89), blood transfusion (OR = 1.24, 95%CI = 1.05 - 1.48), and >2 days delay from admission to operation (OR = 1.37, 95%CI = 1.05 - 1.79). Postoperative UTI was significantly associated with sepsis (OR = 7.65, 95%CI = 5.72 – 10.21), postoperative length of stay >2 days (OR = 1.83, 95%CI = 1.07 – 3.13), and readmission (OR = 3, 95%CI = 2.54 – 3.55).ConclusionsIn our study, postoperative UTI was found in 3% of geriatric hip fracture patients. Predictors of postoperative UTI were age ≥ 85, ASA class ≥ 3, chronic steroid use, blood transfusion, and time to operation > 2 days from admission. Results showed that postoperative UTI is independently associated with sepsis, postoperative length of stay beyond 2 days, and hospital readmission. To diminish the risk of UTI and its consequences, we recommend operating geriatric hip fractures in 24–48 hours after admission.     

物联网技术及其在医疗系统中的应用

介绍了物联网的发展,指出了物联网的特征、关键技术与数据特点,研究了物联网技术在医疗系统数据查询和复杂事件处理上的应用,物联网技术对医疗信息化水平的提升将起到积极有效的推动作用。     

经皮椎体后凸成形后再发骨折相关因素的Meta分析

文题释义： 经皮椎体后凸成形：通过可膨胀性气囊抵达病变椎体,膨胀后可更好的恢复椎体高度,然后植入骨水泥稳定脊柱,能减少骨水泥渗漏,缓解骨质疏松性椎体压缩骨折患者的腰背疼痛。但近年来临床实践中发现术后新发骨折时有发生,对于哪些因素影响术后骨折再发仍然没有统一的结论。 再发骨折：可发生在椎体后凸成形术后原发强化椎体、邻近节段椎体或跳跃节段椎体,往往在患者随访复查中发现,可出现持续的腰背部慢性疼痛不缓解,发生原因并没有明确结论,有学者研究认为与患者骨质疏松程度、骨水泥渗漏等因素有关,也有学者认为骨水泥渗漏并不会造成术后椎体的再发骨折。 背景：经皮椎体后凸成形术是在椎体成形术基础上改良而来,能更好的恢复压缩椎体高度,减少骨水泥渗漏,近年来普遍应用于临床上骨质疏松性椎体压缩性骨折的治疗,但时常有报道术后发生强化椎体及邻近节段椎体的再发骨折,对于影响再发骨折的相关因素仍存在争议。 目的：通过Meta分析探讨老年骨质疏松性椎体压缩骨折患者经皮椎体后凸成形后再发骨折的相关因素。 方法：计算机搜索The Cochrane Library、PubMed、中国生物文献数据库、CNKI、万方数据库,并手工辅助检索主要的中英文骨科杂志,并追查纳入文献的参考文献,收集2009年1月至2019年4月有关老年骨质疏松性椎体压缩骨折患者经皮椎体后凸成形后再发骨折因素分析的文献,提取相关数据后用RevMan 5.3软件进行统计分析。 结果与结论：①年龄[WMD=1.87,95%CI(0.79,2.95),P < 0.05]、骨密度[WMD=-0.46,95%CI(-0.61,-0.31),P < 0.05]、骨水泥渗漏[OR=2.68,95%CI(2.11,3.39),P < 0.000 01]、 初次术后后凸角矫正量[WMD=2,95%CI(0.34,3.66),P=0.02]、初次术后椎体高度恢复率[WMD=5.25,95%CI(2.16,8.34),P=0.000 9]等因素与经皮椎体后凸成形后再发骨折相关;②而经皮椎体后凸成形后再发骨折与性别[OR=0.83,95%CI(0.67,1.02),P > 0.05]、体质量指数[WMD=-0.27,95%CI(-1.06,0.51),P=0.49]、骨水泥注入量[WMD=0.06,95%CI(-0.21,0.32),P=0.68]、手术入路方式[OR=0.87,95%CI(0.61,1.25),P=0.46]、原发骨折为胸腰段(T₁₁-L₂)[OR=1.48,95%CI(0.93,2.38),P=0.1]无关;③结果表明,年龄、骨密度、骨水泥渗漏、初次术后后凸角矫正及初次术后椎体高度恢复率均与椎体后凸成形后再发骨折相关,而性别、体质量指数、骨水泥注入量、原发骨折为胸腰段、手术入路方式与椎体后凸成形后再发骨折无明显相关性,以上结论还需以后纳入更多的高质量文献加以研究验证。 ORCID: 0000-0002-0018-5231(刘群) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

军队地震医学救援应急卫勤统计平台研究与设计

目的：为提高地震医学救援应急卫勤统计效率,设计一套基于军事综合信息网和远程医学卫星网的应急卫勤统计平台。方法：根据四川芦山4·207．0级强烈地震军队医学救援应急卫勤统计特点,对应急统计平台进行需求分析,从平台框架结构、工作流程及各功能模块等方面进行设计。结果：该平台可实现卫勤信息远程上报、快速传输、海量存储、分级汇总、科学分析、全面共享等功能。结论：该平台为统计人员提供了方便快捷的上报及统计途径,为决策人员提供了及时准确的统计信息,具有良好的推广应用前景。     

基于调幅-调频与熵图多模态医学图像的配准

背景：基于传统互信息量的多模态医学图像配准方法配准时需要利用二维直方图或者Parzen窗函数的方法估计概率密度分布,进而计算互信息量,这种方式计算速度慢,而且只考虑了图像的灰度信息,容易出现误配。 目的：针对目前主流的配准方法鲁棒性差、耗时的缺点,提出了一种新的基于调幅-调频(AM-FM)特征互信息量的快速配准方法。 方法：该方法考虑了图像的空间和结构信息;首先通过AM-FM模型对图像进行分解,得到图像的AM-FM特征,与图像的灰度特征一起组成高维特征;然后利用熵图和最小生成树加快AM-FM特征互信息量的计算,从而实现了医学图像的快速配准。 结果与结论：对20组磁共振T1-T2加权图像、CT/正电子发射计算机断层成像图像进行了实验,结果表明该方法在图像空间分辨率较低,有噪声影响等情况下均可以达到较好的结果,且配准精度优于国际上的主流方法,具有计算速度快,精度高,鲁棒性强的特点,适于临床应用。     

A new method without reference channels used for ventricular fibrillation detection during cardiopulmonary resuscitation

Ventricular fibrillation (VF) is observed as the initial rhythm in the majority of patients suffering from sudden cardiac arrest. It is vitally important to accurately recognize the initial VF rhythm and then implement electrical defibrillation. However, artifacts produced by chest compression during cardiopulmonary resuscitation (CPR) make the VF detection algorithms utilized by current automated external defibrillators (AEDs) unreliable. CPR must be traditionally interrupted for a reliable diagnosis. However, interruptions in chest compression have a deleterious effect on the success of defibrillation. The elimination of the CPR artifacts would enable compressions to continue during AED VF detection and thereby increase the likelihood of resuscitation success. We have estimated a model of this artifact by adaptively incorporating noise-assisted multivariate empirical mode decomposition (NA-MEMD) and least mean squares (LMS) and then removing the artifact from the corrupted ECGs. The simulation experiment indicated that the CPR artifact could be accurately modeled without any reference channels. We constructed a BP neural network to evaluate the results. A total of 372 VF and 645 normal sinus rhythm (SR) ECG samples were included in the analysis, and 24 CPR artifact signals were used to construct corrupted ECGs. The results indicated that at different SNR levels ranging from 0 to ?12 dB, the sensitivity and specificity were always above 95 and 80 %, respectively.     

基于调幅-调频与熵图多模态医学图像的配准

背景：基于传统互信息量的多模态医学图像配准方法配准时需要利用二维直方图或者Parzen窗函数的方法估计概率密度分布,进而计算互信息量,这种方式计算速度慢,而且只考虑了图像的灰度信息,容易出现误配。 目的：针对目前主流的配准方法鲁棒性差、耗时的缺点,提出了一种新的基于调幅-调频(AM-FM)特征互信息量的快速配准方法。 方法：该方法考虑了图像的空间和结构信息;首先通过AM-FM模型对图像进行分解,得到图像的AM-FM特征,与图像的灰度特征一起组成高维特征;然后利用熵图和最小生成树加快AM-FM特征互信息量的计算,从而实现了医学图像的快速配准。 结果与结论：对20组磁共振T1-T2加权图像、CT/正电子发射计算机断层成像图像进行了实验,结果表明该方法在图像空间分辨率较低,有噪声影响等情况下均可以达到较好的结果,且配准精度优于国际上的主流方法,具有计算速度快,精度高,鲁棒性强的特点,适于临床应用。     

营区军训和野外长途行军对军校新生心理健康的影响

目的：探讨野外长途行军综合训练对军校新生心理素质和心理健康的影响。方法：采用军人心理素质问卷(Mental Quality Questionnaire for Army Men,MQQA)、症状自评量表(symptom checklist 90, SCL-90)、焦虑自评量表(Self-Rating Anxiety Scale, SAS)、抑郁自评量表(Self-Rating Depression Scale, SDS)和特质焦虑量表(Trait anxiety Inventory,TAI)于不同军训阶段对某军校330名新生进行心理测评。采用配对样本t检验对训练效果进行评价。结果：(1)营区军训后,除抑郁因子外,新生SCL-90各因子得分和总均分显著下降(P<0.05, 0.01)；与军训前相比,野外长途行军后军校新生SCL-90各因子得分和总均分显著下降(P<0.05, 0.01)；与营区军训后相比,野外长途行军后军校新生SCL-90各因子得分,除恐怖、偏执、精神病性外,其余因子得分和总均分显著下降(P<0.05, 0.01)。(2)SDS、SAS得分随军训的进行呈现先升后降的倒“V”型变化趋势。营区军训后,SAS、SDS得分显著升高(P<0.01)；与军训前相比,野外长途行军后军校新生TAI得分显著下降(P<0.01)；与营区军训后相比,野外长途行军综合训练后军校新生SAS、SDS和TAI得分显著下降(P<0.05, 0.01)。(3)营区军训和野外长途行军综合训练后,新生心理素质各因子得分未发现显著差异(P>0.05)。结论：野外长途行军能有效提高军校新生心理健康水平,缓解其焦虑和抑郁情绪。