湖南省 15 岁及以上患者门诊和住院满意度分析

目的：评价2013年湖南省两周内门诊患者和近1年内住院患者的满意度及影响因素。方法：利用2013 年湖南省第1次卫生服务调查数据,采用国家第5次卫生服务调查方案中门诊(住院)患者的满意度指标评估患者满 意度,采用加权logistic回归分析门诊和住院患者医疗服务总体满意度的影响因素,运用SAS9.2的SURVEYFREQ和 SURVEYLOGISTIC过程实现数据分析。结果：门诊患者总体满意度为73.85% (95% CI：68.67%~79.03%),住院患者总体 满意度为66.31% (95% CI：61.28%~71.34%)。调整地区、性别、年龄和家庭人均年收入等因素后,门诊患者满意度与 医护人员认真倾听病情、患者信任医护人员和患者自评医疗花费不贵呈正相关,对应的调整优势比分别为3.64,5.38 和3.34;住院患者满意度与医护人员较好的解释问题态度、患者信任医护人员和患者自评医疗花费不贵呈正相关,对 应的调整优势比分别为2.56,4.69和4.35。结论：2013年大多数湖南省门诊和住院患者对医疗服务表示满意。医护人 员解释问题态度好、认真倾听病情、患者自评医疗花费不贵以及患者信任医护人员与患者高满意度相关。     

Effects of cooking oil fume derived fine particulate matter on blood vessel formation through the VEGF/VEGFR2/MEK1/2/ERK1/2/mTOR pathway in human umbilical vein endothelial cells

In China, cooking oil fume derived fine particulate matter (COF-derived PM_2.5) is a principal source of indoor air pollution. Here, we investigated cytotoxicity of COF-derived PM_2.5, as well as the roles of VEGF, VEGFR2, MEK1/2, ERK1/2, and mTOR cascade in the inhibitory effects of COF-derived PM_2.5, on angiogenesis in human umbilical vein endothelial cells (HUVECs). After exposure to COF-derived PM_2.5, cell viability and tube formation, as well as protein and mRNA levels of VEGF, VEGFR2, MEK1/2, ERK1/2, and mTOR in HUVECs were measured. Cell viability and number of tubes reduced dose-dependently after COF-derived PM2.5 and SU5416 treatment. In addition, SU5416 and VEGF significantly affected tube formation. The protein and mRNA levels of VEGF, VEGFR2, MEK1/2, ERK1/2, and mTOR all tended to reduce with the increase of COF-derived PM2.5 concentrations. These findings demonstrate that VEGF, VEGFR2, MEK1/2, ERK1/2, and mTOR play key roles in COF-derived PM_2.5 induced inhibition of angiogenesis in HUVECs.     

Improving Surgical Start Times by Improving Wayfinding

PurposeThis performance improvement project was undertaken to reduce costly delays in first-case, operating room (OR) start times.DesignTwo Plan, Do, Study, Act (PDSA) cycles.MethodsIn PDSA 1, student nurses observed 30 patients' paths of travel from hospital entrance to OR and documented time spent at key stopping points. Directional signs were placed after PDSA 1. PDSA 2 consisted of an electronic medical record (EMR) review of pre- and postsignage cases (n = 492 and n = 538 respectively).FindingsIn the initial PDSA cycle (n = 30), one reason for delay was the time patients spent finding the preoperative area (POA). Signage was placed at strategic points noted to confuse patients. PDSA cycle 2 found median presignage POA arrival times (34 minutes) were significantly higher than postsignage POA arrival times (20 minutes) (U = 51,618.0, z = −16.934, P < .001).ConclusionsDelayed wayfinding contributed to delayed OR starts but improved with appropriate signage.     

Prevalence and factors associated with left ventricular remodeling in renal artery stenosis

The objective of this study is to evaluate the prevalence, geometric patterns, and factors associated with left ventricular remodeling in patients with renal artery stenosis (RAS). Demographic, clinical, and echocardiographic data were assessed in 77 patients with RAS prior to endovascular stenting. The left ventricular mass index (LVMI) and relative wall thickness were calculated using American Society of Echocardiography (ASE) recommendations. Patients were classified based on LVMI and relative wall thickness into four ventricular remodeling patterns: normal geometry, concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Logistic regression was done to investigate the determinants of the different ventricular remodeling patterns. Mean LVMI and relative wall thickness were 118 ± 40 g/m² and 0.45 ± 0.1. Left ventricular hypertrophy was observed in 65%. CH was the most prevalent geometric pattern of remodeling (normal, 16.9%; CR, 18.2%; CH, 40%; EH, 24.6%). Thirty (39%) patients had an abnormal LV systolic function (ejection fraction <55%), with 14 (46%) of them having eccentric hypertrophy. Independent predictor of EH was glomerular filtration rate (odds ratio [OR], 0.943; confidence interval [CI], 0.899–0.989; P = .01). Systolic elevation of blood pressure (OR, 1.030; CI, 1.003–1.058; P = .03) was associated with CH, and elevated diastolic blood pressure was associated with CR (OR, 0.927; CI, 0.867–0.992; P = .02). Patients with RAS have a high prevalence of left ventricular remodeling and LVH. Even though CH was the most prevalent pattern of left ventricular remodeling, EH was commonplace and was associated with renal dysfunction and heart failure.     

孕妇血红蛋白浓度与早产关联强度剂量反应关系

目的 探讨孕妇血红蛋白浓度与早产关联强度的剂量反应关系。方法 选取广西壮族自治区武鸣、平果、靖西、德保、隆安、田东等县级医院2015年1月至2017年12月入院的12 780例壮族孕妇及其分娩的新生儿作为研究对象，回顾性地收集研究对象的一般人口学资料、孕期产检资料以及出生结局资料。采用非条件logistic回归方法初步分析孕期贫血对早产的影响，采用限制性立方样条模型分析孕期血红蛋白浓度与早产关联强度剂量反应关系。结果 排除2 053例高血压或年龄≥ 35岁的孕妇，非条件logistic回归分析显示，孕早期贫血组发生早产的风险是非贫血组的1.29倍（OR=1.29，95% CI：1.04~1.59，P=0.019）；限制性立方样条模型显示，孕早期血红蛋白浓度与早产的关联呈非线性"L"形剂量反应关系（非线性检验：P<0.001），孕晚期血红蛋白浓度与早产的关联呈非线性"U"形剂量反应关系（非线性检验：P<0.001）。结论 孕妇孕早期和孕晚期血红蛋白浓度与早产的关联呈非线性剂量反应关系。     

Radical cystectomy under continuous antiplatelet therapy with acetylsalicylic acid

IntroductionAim of this study was to analyse the perioperative outcome of patients undergoing radical cystectomy under continuous antiplatelet therapy with acetylsalicylic acid.Materials and methodsUsing prospectively maintained databases of two departments of urology, we identified 461 consecutive patients who underwent radical cystectomy for bladder cancer (2011–2017). Patients were divided into three groups: 1) on-going antiplatelet therapy with acetylsalicylic acid (n = 50), 2) discontinuing antiplatelet therapy (n = 65) and 3) no antiplatelet therapy (n = 346). Perioperative outcome was compared between the three groups using ANOVA, likelihood ratio or Kruskal Wallis test with post-hoc testing. Uni- and multivariate analyses were performed to identify predictor for perioperative complications and transfusion.ResultsGroup 1 showed an average estimated blood loss of 732 ± 424, group 2 752 ± 488 and group 3 810 ± 544 ml (p = 0.51). There was no significant difference in transfusion rate (44% in group 1, 45% and 39% in groups 2 and 3, p = 0.63). Severe complications occurred in 26%, 15% and 15% in groups 1–3 (p = 0.19). Ischemic complications were more often observed in group 1 (n = 4, 8%) and 2 (n = 5, 8%) than group 3 (n = 7, 2%), p = 0.02. 90-day readmission (n = 99, 22%) and mortality rate (n = 10, 2.2%) were low and did not show any significant differences between the groups. In uni- and multivariate analysis ongoing therapy with acetylsalicylic acid was no independent risk factor for transfusion or severe complications.ConclusionPerioperative continuation of therapy with acetylsalicylic acid in radical cystectomy is safe with no difference in intraoperative blood loss, transfusion rate, complications or mortality.     

Incidence of lymph node metastasis at each station in Siewert types Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction: A systematic review and meta-analysis

The optimal extent of lymphadenectomy for adenocarcinoma of the esophagogastric junction (AEG) has been continuously debatable. The study aimed to determine the incidence of lymph node metastasis at each station in Siewert types Ⅱ/Ⅲ AEG. PubMed was searched and publications reporting metastasis at each nodal station were eligible. Meta-analysis was performed using RevMan 5.3. Twenty-one studies involving 4662 patients were included. The incidence of lymph node metastasis was high (≥20%) in stations No. 3, 1, 2 and 7 in decreasing order, and moderate (10–20%) in stations No. 9, 19 and 110. The incidence did not exceed 10% in stations No. 10, 11p, 20, 8a, 4sa, 4 s b and 4d, was less than 5% in stations No. 5, 6, 11d, 12a, and even close to 0 in stations No. 107, 111 and 112. Compared with type Ⅲ tumors, type Ⅱ tumors had significantly lower incidence in some abdominal stations including No. 3, 4sa, 4 s b, 6, 8a and 10, while significantly higher in the lower mediastinal stations. The present analysis established a map of lymph node metastasis in Siewert types Ⅱ/Ⅲ AEG, which may serve as a valuable reference for the extent of lymphadenectomy.     

Limbs and trunk soft tissue sarcoma systematic local and remote monitoring by MRI and thoraco-abdomino-pelvic scanner: A single-centre retrospective study

IntroductionSoft tissue sarcomas (STS) are rare malignant tumors that require management by an expert center. Monitoring modalities are not consensual. The objective of our study is to report systematic radiological monitoring data obtained by local MRI and by thoracic-abdominal-pelvic computed tomography (TAP CT).Material and methods113 consecutive patients managed at “Centre Georges François Leclerc, Dijon”, between 2008 and 2016, for an initially localized STS were included. Patient follow-up consisted of a local MRI and a TAP CT. Follow-up exams schedule was initially every 4 months during 2 years, followed by every 6 months during 3 years and finally every year during 5 years.ResultsMedian follow-up time was 37.2 months [min = 2.4 – max = 111.6]. After 5 years of surveillance, local recurrence (LR) rate was 8.8% and diagnosed by imaging in 60% of cases. No deep LR was clinically found. Median LR diagnosis time was 23.9 months [min = 2.0 – max = 52.4]. 50% of patients locally treated for their LR were alive without recurrence. Metastatic recurrence (MR) rate was 31%. 42.8% had extra-pulmonary involvement and 17.1% had exclusive extrathoracic metastases. The median time to diagnosis of MR was 17.4 months [min = 2.7- max = 77.2]. High-grade tumors relapsed more (20.4%) and earlier (all before the 5th year) than low grade.ConclusionLocal MRI seems particularly suitable for monitoring deep tumors. In addition, the systematic monitoring by TAP CT highlighted a limited number of cases of exclusive extrathoracic metastases. The schedule of local and remote monitoring should primarily be adjusted to tumor grade.     

2012年湖北省肿瘤登记地区恶性肿瘤发病与死亡情况分析

目的 分析湖北省肿瘤登记地区2012年恶性肿瘤的发病与死亡流行特征。方法 收集整理2012年湖北省肿瘤登记地区上报的恶性肿瘤发病与死亡数据,计算发病/死亡粗率、年龄别发病（死亡）率,0~74累积率等指标。结果 2012年湖北省肿瘤登记地区覆盖人口数为8 221 036人（其中男性4 183 884人,女性4 037 152人）。新发病例数24 182例,发病粗率为294.15/10万（男性319.92/10万,女性267.44/10万）,中国人口标化率（用2000年中国人口）为194.33/10万,世界人口标化率为210.93/10万。恶性肿瘤死亡病例14 459例,死亡粗率为175.88/10万 ,中标率是111.20/10万,世标率125.76/10万。湖北省肿瘤登记地区的恶性肿瘤发病首位为肺癌,其次为乳腺癌、肝癌、结直肠癌、胃癌、子宫颈癌、食管癌、甲状腺癌、前列腺癌和卵巢癌。占全部恶性肿瘤发病的74.35%。恶性肿瘤死亡前十位分别为肺癌、肝癌、胃癌、结直肠癌、乳腺癌、食管癌、胰腺癌、淋巴瘤、子宫颈癌及前列腺癌。占全部恶性肿瘤死亡的81.05%。结论 湖北省肿瘤登记地区发病主要癌种为肺癌、乳腺癌、消化系统肿瘤。湖北肿瘤登记城市地区甲状腺癌发病率较高需引起重视。     

武汉市初一年级学生网络成瘾现状及其影响因素研究

目的 了解武汉市初一年级学生网络成瘾的流行情况及其影响因素.方法 采用分层整群抽样方法 ,从武汉市区抽取4所中学的初一年级学生共1219名,进行问卷调查.结果武汉市初一年级学生总上网率为96.43%,初次上网平均年龄(8.93±1.95)岁,网络成瘾倾向(IAT)和网络成瘾(1AD)报告率分别为10.87%和7.7l%,男生IAT和IAD检出率均高于女生.经有序logistic回归分析,IAT及IAD的影响因素主要是性别、功课差、上网次数、上网时间、上网地点及上网费用6个方面.结论 武汉市初一年级学生IAT和IAD的现状不容乐观,需要学校、老师和家长三方共同努力,引导学生正确使用网络,并及时对有IAI的学生进行有效干预,减少IAD的发生.