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.     

基于美军二战海战减员数据的校正

目的：通过对二战减员数据的校正，为下一步建立海战减员预计模型提供数据支持．方法：选取美军在二战太平洋海战中的减员数据作为研究的基本资料，通过专家咨询法(Delph method)对其进行校正，所有结果都对其进行了t检验．结果：水面舰艇遭受炸弹、舰炮及航空火炮、短程导弹、鱼雷和水雷的攻击时减员将减少，遭受中程导弹攻击时减员将会增加．结论：该校正结果可作为研究未来海战卫生减员预计的基本依据之一．     

经剑突下孔直接取石法在腹腔镜胆总管切开取石术中的应用

目的 探讨经剑突下孔直接取石法在腹腔镜胆总管切开取石术中的应用效果,并总结手术经验。方法 回顾性分析蚌埠市第一人民医院2014年11月-2018年4月86例胆总管结石患者的临床资料,其中男28例、女58例,年龄25~78(50.8±10.5)岁,均观察行腹腔镜手术,术中于胆总管切开后经剑突下孔直接取石。记录成功实施腹腔镜手术患者的手术时间、术中出血量、术后下床时间、术后排气时间、引流管拔除时间、术后住院时间、手术成功率及随访并发症,并总结技术经验。结果 成功完成腹腔镜下手术81例,成功率94.2%(81/86),其中1例因末端结石嵌顿难以取出,后经胆道镜下碎石取出。其余5例中,1例因胆囊十二指肠漏中转开放手术,4例因胆囊炎急性发作后三角区纤维化难以分离而中转开腹。81例成功手术者:手术时间为(80.2±18.6)min,术中出血量为 (20.0±3.0) mL,术后下床时间为(15.5±5.7)h,术后排气时间为(30.2±10.2)h,引流管拔除时间为术后(2.4±0.4)d,术后住院时间 (10.4±2.6) d。术后4~6周拔除T管;随访6~12个月,平均8.5个月,无术后胆漏、胆道狭窄、再发胆管结石等并发症。结论 经剑突下孔直接取石法使腹腔镜下胆总管切开取石术变得简单易行且安全,通过选择合适的患者,调整剑突下孔的位置、注意手术细节,改进手术流程,可减少了手术时间、创伤,并能取尽结石,获得满意的疗效。     

玻璃化解冻和慢速解冻在程序化冷冻胚胎解冻移植中的比较研究

目的探讨玻璃化解冻(vitrificative thawing,VT)和慢速解冻(slow thawing,ST)对程序化冷冻胚胎解冻移植的影响,优化程序化冷冻胚胎的解冻方案,从而提高不孕不育临床治疗效果。方法选取2016年1月至2018年12月解放军第九六〇医院生殖医学中心行解冻胚胎移植的400例患者,使用随机数分配的方式(Excel数据随机分组),分为VT组(200例)和ST组(200例),比较两组患者最初施行体外受精-胚胎移植(invitro fertilization-embryo transfer,IVF-ET)时的基本情况、胚胎发育情况及本次移植胚胎复苏情况、移植情况和临床妊娠结局。结果两组患者年龄、不孕年限、获卵数、促性腺激素(gonadotropins,Gn)用量和基础促卵泡成熟激素(follicle stimulating hormone,FSH)值等基本情况比较,差异无统计学意义(P>0.05),两组MⅡ卵率(metaphase II egg rate)、受精率、卵裂率、优质胚胎率、可用胚胎率和冷冻胚胎率比较,差异无统计学意义(P>0.05)。但VT组的胚胎复苏完整率和复苏可用率(88.34%、97.51%)明显高于ST组(72.47%、82.23%),差异有统计学意义(P<0.001);两组患者胚胎移植日移植次数、移植胚胎数和内膜厚度比较,差异无统计学意义(P>0.05);两组临床妊娠结局比较,差异无统计学意义(P>0.05)。结论VT可以显著提高程序化冷冻胚胎的复苏效果,提高程序化冷冻胚胎患者的胚胎利用率,可以考虑成为ST的较好替代方案。     

医院信息采集质量监控方案的设计

就医院信息系统运行过程中出现的数据质量缺陷问题，提出了实时数据质量监控和终末数据质量监控方案。该方案实施的是以标准库为基础的服务器端数据质量监控模式，该模式的优点是尽可能快地发现可疑数据，发出预警提示，反馈给有关用户，且不影响客户端数据录入程序的使用。     

利比里亚埃博拉防控指挥协调体系特点分析

利比里亚在防控埃博拉病毒病(Ebola virus disease,EVD)疫情中,逐步构建形成一套相应的指挥协调体系。中国人民解放军首批援利医疗队赴利执行埃博拉病毒病患者诊疗任务以来,积极参与并融入利比里亚埃博拉防控指挥协调体系。作者作为我军首位援利埃博拉诊疗中心医院院长,亲自参与了利比里亚埃博拉防控指挥协调体系相关工作。本文分析总结认为该体系具有应急组建、结构开放、实体运作、交互作用、利方主导等特点,在埃博拉疫情防控中发挥了重要作用。针对我国未来疫情防控需求,有针对性地提出了强化联防联控机制、改进援外实施策略、提高疫情防控能力、深化军队走出战略等建议。     

Bilirubin and its changes were negatively associated with diabetic kidney disease incidence and progression: A five-year's cohort study based on 5323 Chinese male diabetic patients

Aims

This study aimed to evaluate the association between baseline bilirubin (TBiL) and follow-up TBiL changes for diabetic kidney disease (DKD) incidence and progression based on a 5?years' cohort study.

内镜下射频消融术治疗胃低级别上皮内瘤变的临床研究

目的通过临床大样本研究,进一步明确内镜下射频消融术(RFA)治疗胃低级别上皮内瘤变(LGIN)的有效性及安全性。 方法回顾性选择2014年10月至2019年12月经解放军总医院消化内镜中心术前筛查的175例患者证实为胃LGIN的255例病变纳入研究,并进行内镜下RFA,关注其围手术期并发症发生情况,术后采用Wong-Baker面部表情量表进行疼痛评分,并追踪其复查随访结果。 结果255例病变均成功完成内镜下RFA,术中无明显并发症发生;术后3个月、6个月、1年、2年、3年的治愈率分别为91.3%、90.8%、89.4%、88.2%、86.5%,术后腹痛为主要并发症。 结论内镜下RFA是治疗胃LGIN的一种安全有效、操作简便、可门诊治疗的新方法,具有良好的临床应用前景。