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1.
目的探讨脂蛋白a[Lp(a)]联合单核细胞/高密度脂蛋白胆固醇(HDL-C)比值(MHR)在非ST段抬高型急性冠脉综合征(NSTE-ACS)患者冠状动脉(冠脉)病变严重程度及预后中的评估及其价值。方法选择2020年3月至2021年3月安徽医科大学第一附属医院符合纳入标准的NSTE-ACS患者(n=310),依据冠脉造影结果进行Gensini评分,以Gensini积分的第3四分位数(QU=38)为切点,分为高危组(QU≥38,n=74)和非高危组(QU<38,n=236),比较其一般资料,并使用Logistic回归分析Lp(a)、MHR与冠脉病变严重程度的相关性;使用ROC曲线评估Lp(a)联合MHR评估冠脉病变严重程度及预后的价值。结果高危组和非高危组患者性别、吸烟史、高血压病、糖尿病、高胆固醇血症、肾功能不全等病史、他汀药物应用发生率差异无统计学意义(P>0.05),但高危组患者年龄、血Lp(a)水平和MHR均显著高于非高危组(P<0.01)。Spearman相关分析发现,Lp(a)和MHR分别与Gensini评分呈正相关(r=0.316,P<0.05;r=0.715,P<0.05)。Logistic多因素二元回归分析示,Lp(a)、年龄和MHR是冠脉高危病变的独立危险因素(P<0.01,P<0.05)。ROC曲线分析示,Lp(a)和MHR联合检测对冠脉高危病变评估的AUC(0.854),分别大于Lp(a)和MHR单独检测的AUC(0.852、0.754);联合评估的敏感度73.0%,高于单独检测Lp(a)的55.6%,但低于MHR的82.4%;联合评估的特异度85.6%,高于Lp(a)及MHR单独检测(84.1%、61.9%)。ROC曲线分析示,Lp(a)和MHR联合对NSTE-ACS患者不良预后评估的AUC(0.800),分别大于Lp(a)和MHR单独检测的AUC(0.781、0.739);联合评估患者预后的敏感度为72.2%,高于Lp(a)及MHR单独检测(66.7%、66.7%);联合评估的特异度为81.9%,高于MHR单独检测的80.9%,但低于Lp(a)单独检测的84.8%。结论异常升高的血Lp(a)水平联合MHR对NSTE-ACS患者冠脉病变的严重程度和不良预后具有较高的判断价值。  相似文献   
2.
ObjectiveThe current study has been conducted to identify the risk factors associated with blood transfusion in women undergoing cesarean section (C-section). A detailed account of the risk factors associated withblood transfusion will ultimately prevent unnecessary crossmatching in hospitals , leading to the conservation of declining blood supplies and resources without subjugating the quality of care.Material and methodsWe performed a rigorous literature search using electronic databases, including PubMed, Cochrane CENTRAL, and Embase, for studies evaluating the risk factors for blood transfusion in C-section published until March 31, 2021. The Newcastle-Ottawa Quality Assessment Scale was deployed to assess the methodologic quality of the included studies. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals were calculated using Review Manager version 5.3.ResultsThe search yielded 1563 records, 22 of which were eligible for inclusion, representing 426,094 women (10,959 in the transfused group and 415,135 in the non-transfused group). Participants in the transfused group had lower mean preoperative hematocrit (MD = ?3.71 [?4.46, ?2.96]; p < 0.00001; I2 = 88%). Placenta previa (OR = 9.54 [7.23, 12.59]; p < 0.00001; I2 = 88%), placental abruption (OR = 6.77 [5.25, 8.73]; p < 0.00001; I2 = 72%), emergency C-section (OR = 1.92 [1.42, 2.60]; p < 0.0001; I2 = 75%), general anesthesia (OR = 8.43 [7.90, 9.00]; p < 0.00001; I2 = 72%), multiple gestations (OR = 1.60 [1.24, 2.06]; p = 0.0003; I2 = 85%), preterm labor (OR = 3.34 [2.75, 4.06]; p < 0.00001; I2 = 85%), prolonged labor (OR = 1.68 [1.44, 1.96]; p < 0.00001; I2 = 78%), unbooked cases (OR = 2.42 [1.22, 4.80]; p = 0.01; I2 = 80%), hypertensive disorders of pregnancy (OR = 1.81 [1.72, 1.90]; p < 0.00001; I2 = 71%), and fibroids (OR = 2.32 [1.55, 3.47]; p < 0.0001; I2 = 72%) were significantly higher in the transfused group compared to the non-transfused group. Chronic hypertension (OR = 0.67 [0.29, 1.55]; p = 0.36; I2 = 90%), maternal age (MD = 0.09 [?0.27, 0.45]; p = 0.62; I2 = 50%), maternal body mass index (MD = ?0.14 [?0.81, 0.53]; p = 0.67, I2 = 86%), diabetes (OR = 0.93 [0.75, 1.15]; p = 0.51; I2 = 52%), and malpresentation (OR = 0.65 [0.38, 1.11]; p = 0.13; I2 = 64%) were not significantly associated with an increased risk of blood transfusion in C-section in the two groups.ConclusionPlacenta previa, placental abruption, emergency C-section, booking status, multiple gestations, and preoperative hematocrit were the risk factors most significantly associated with blood transfusion, while a prior C-section did not increase the risk of transfusion.  相似文献   
3.
目的探究术前血小板淋巴细胞比值(PLR)、中性粒细胞淋巴细胞比值(NLR)及白蛋白球蛋白比值(AGR)在评估乳腺癌患者预后中的价值。 方法选取2013年1月至2017年12月收治的1184例浸润性乳腺癌女性患者为浸润性乳腺癌组,随机选取仅患乳腺纤维腺瘤的患者279例为乳腺纤维腺瘤组。收集患者一般资料、术后病理资料、血型、术前外周血血小板、中性粒细胞、淋巴细胞数量以及血清白蛋白和球蛋白水平,并计算得出PLR、NLR及AGR。应用受试者功能特征曲线下面积来评估三者预测乳腺癌患者预后的能力。本研究使用SPSS 20.0及MedCalc软件进行统计学分析和绘图,P<0.05代表差异具有统计学意义。 结果浸润性乳腺癌患者的术前PLR及NLR均值显著高于乳腺纤维腺瘤患者(P<0.05),而AGR低于乳腺纤维腺瘤患者(P<0.05)。Cox比例回归风险分析显示,患者的诊断年龄、PLR、NLR、AGR、肿瘤直径、组织学分级、阳性淋巴结个数和分子分型均为乳腺癌的预后危险因素(P<0.05)。ROC曲线分析结果得出,PLR、NLR及AGR的最佳诊断临界值分别为147.4、2.9及1.7。应用术前PLR(AUC=0.796,P<0.001)、NLR(AUC=0.716,P<0.001)及AGR(AUC=0.748,P<0.001)预测乳腺癌患者预后均有价值,且PLR价值更高。 结论术前PLR、NLR及AGR对乳腺癌患者预后的判断均具价值,三者相比,PLR价值更高,有望成为判断乳腺癌患者预后的补充指标。  相似文献   
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IntroductionAs the American’s Federal Health Insurance Portability and Accountability Act (HIPAA) stated that patients should be allowed to review their medical records, and as information technology is ever more widely used by healthcare professionals and patients, providing patients with online access to their own medical records through a patient portal is becoming increasingly popular. Previous research has been done regarding the impact on the quality and safety of patients’ care, rather than explicitly on medication safety, when providing those patients with access to their electronic health records (EHRs).AimThis narrative review aims to summarise the results from previous studies on the impact on medication management safety concepts of adult patients accessing information contained in their own EHRs.ResultA total of 24 studies were included in this review. The most two commonly studied measures of safety in medication management were: (a) medication adherence and (b) patient-reported experience. Other measures, such as: discrepancies, medication errors, appropriateness and Adverse Drug Events (ADEs) were the least studied.ConclusionThe results suggest that providing patients with access to their EHRs can improve medication management safety. Patients pointed out improvements to the safety of their medications and perceived stronger medication control. The data from these studies lay the foundation for future research.  相似文献   
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IntroductionLung cancer is the leading cause of cancer-death worldwide. The U.S. Preventative Services Task Force (USPTSF) approved screening for current or former smokers aged 55–80 based on the results of the National Lung Screening trial (NLST). Following the NLST, new evidence has emerged from clinical trials and updates to previous trials prior to the anticipated update to the USPSTF guideline. We review the new evidence on lung cancer screening with low dose computed tomography (LDCT) and the surgical implications.MethodsA review of new literature was performed pertaining to lung cancer screening since implementation of UPSTF guidelines. Articles for inclusion were identified by both authors’, then search of the Pubmed and Cochrane database was performed from January 1st, 2013 through February 4th, 2020 using the MeSH search terms: “lung cancer”; “screening”; “low dose CT”. The results of these studies are summarized.ResultsWe identified multiple prospective randomized control trials and meta-analysis since the NLST supporting lung cancer-specific mortality with screening. We identified new nodule classification systems and the development of risk-models which may reduce false positive rates and identify high risk patients not currently eligible for screening. Finally, we discussed the surgical implications of screening.ConclusionNew data supports NLST findings and show ongoing benefit to LDCT for lung cancer screening. Standardized LDCT screening classification has been shown to reduce harm and lower false positive rates. Further study is needed regarding use of risk-modeling. Screening will require an increase in the thoracic workforce to accommodate the amount of surgically operable cancers.  相似文献   
8.
This study estimated the associations between neighbourhood characteristics and self-reported body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) risk categories among Canadian men and women. Using data from the Alberta's Tomorrow Project (n = 14,550), we estimated 3- and 4-way intersections, business destinations, population count, and normalized difference vegetation index (NDVI) within a 400 m radius of participant's home. Intersections, business destinations, and population count (z-scores) were summed to create a walkability score. Four-way intersections and walkability were negatively associated with overweight and obesity. Walkability was negatively associated with obesity. NDVI was negatively associated with high-risk WHR and population count and walkability positively associated with high-risk WHR. Among men, population count and walkability were negatively associated with obesity, and business destinations and walkability were negatively associated with overweight and obesity. Among women, NDVI was negatively associated with overweight (including obesity), obesity, and high-risk WC. Interventions promoting healthy weight could incorporate strategies that take into consideration local built environment characteristics.  相似文献   
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Background & aimsTo date, the literature examining the effects of whole-egg consumption on health outcomes focuses primarily on cardiovascular health markers; however, a significant gap exists in the literature about how egg consumption may influence body composition indicators. The aim of this study was to estimate the association between egg consumption and body composition indicators and to examine whether this relationship is mediated by protein intake in young adults.MethodsA cross-sectional study was conducted involving 355 first-year university students (aged 18–30 years) from a Spanish public university. Body composition was measured using bioimpedance and dual-energy X-ray absorptiometry (DXA) and fitness components were determined using the course-navette test. Egg consumption and protein intake (both in g/day/kg of body weight) were determined using a 137-item Food-Frequency Questionnaire. ANCOVA models were used to test the mean differences in body composition indicators (body mass index [BMI], ratio waist circumference/height [WC/height], body fat mass percentage, and body lean mass percentage) by egg consumption categories (<1 egg/week, 1–4 eggs/week, ≥5 eggs/week). Hayes's PROCESS macro was used for mediation analyses.ResultsParticipants reporting high egg consumption (≥5 eggs/week) showed significantly lower BMI, WC/height and body fat mass percentage values and higher body lean mass percentage values than those reporting low egg consumption (<1 egg/week) (p < 0.05). However, these relationships were not maintained after adjusting for protein intake. Protein intake acted as a full mediator of the relationships of egg consumption with BMI (indirect effect [IE] = ?1.19; 95% CI [?3.33; ?0.36]), WC/height (IE = ?0.01; 95% CI [?0.04; ?0.01]) and body lean mass percentage (IE = 2.99; 95% CI [1.26; 5.73]) as a partial mediator of the relationship be-tween egg consumption and body fat mass percentage (IE = ?2.19; 95% CI [?4.92; ?0.46]).ConclusionsThe association between egg consumption and body composition is mediated by protein intake. This finding is important from a public health perspective, suggesting that higher egg consumption (≥5 eggs/week) may lead to a healthier body composition, especially due to higher protein intake.  相似文献   
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