Postoperative complications and mortality in older patients having non-cardiac surgery at three Melbourne teaching hospitals

OBJECTIVE: To determine the incidence of postoperative complications, including 30-day mortality rate, and need for intensive care unit (ICU) admission in older patients after non-cardiac surgery. DESIGN AND SETTING: Prospective observational study of all patients aged 70 years or older having elective and non-elective, non-cardiac surgery, and staying at least 1 night after surgery in one of three Melbourne teaching hospitals, June to September 2004. MAIN OUTCOME MEASURES: Postoperative complications and 30-day mortality rate. RESULTS: 1102 consecutive patients were audited in mid 2004; 70% had pre-existing comorbidities. The 30-day mortality rate was 6%; 19% had postoperative complications; and 20% of patients spent at least 1 night in ICU. On multivariate analysis, preoperative factors associated with 30-day mortality included age (odds ratio [OR], 1.09 per year over 70 years; 95% CI, 1.04-1.13; P < 0.001); increasing severity of systemic disease (American Society of Anesthesiologists physical status classification) (OR, 2.53; 95% CI, 1.65-3.86; P < 0.001); and albumin level < 30 g/L (OR, 2.23; 95% CI, 1.09-4.57; P = 0.03). Postoperative factors associated with 30-day mortality were unplanned ICU admission (OR, 3.95; 95% CI, 1.63-9.55; P = 0.003); sepsis (OR, 2.75; 95% CI, 1.17-6.47; P = 0.02); and acute renal impairment (OR, 2.40; 95% CI, 1.06-5.41; P = 0.04). Thoracic surgery was the only surgical specialty significantly associated with mortality (OR, 3.96; 95% CI, 1.44-9.10; P = 0.008) in the multivariate analysis. CONCLUSION: Older patients having surgery had high rates of comorbidities and postoperative complications, placing considerable demands on critical care services. Patient factors were often stronger predictors of mortality than the type of surgery.     

Association between nonalcoholic fatty liver disease and Helicobacter pylori infection in Dali City,China

Objectives:To investigate whether gastric Helicobacter pylori (H. pylori) infection is associated with the progress of nonalcoholic fatty liver disease (NAFLD) in Dali city, China.Methods:One thousand and one hundred eighty-five adults who had visited a health examination center were enrolled. Nonalcoholic fatty liver disease and H. pylori infection were assessed by abdominal color ultrasound and ¹³C-urea breath test, respectively. Serum lipid metabolic indices were compared between NAFLD subjects without and with H. pylori infection.Results:The prevalence rate of NAFLD for the entire study population (n=1185) was 44.6% (n=529), including 167 women and 362 men. Among 529 NAFLD subjects, H. pylori was confirmed as a significant and independent risk factor for NAFLD (95% CI 1.02-1.79, p=0.036, OR =1.35). Compared with H. pylori non-infected individuals (n=721), higher contents of LDL-C (p=0.012) along with TC (p=0.014) were also observed in H. pylori-infected individuals (n=464).Conclusion:A positive correlation is identified between H. pylori infection and NAFLD.     

胰十二指肠切除术后胰胃吻合与胰空肠吻合前瞻性对照试验的Meta分析

目的 比较胰十二指肠切除术后胰胃吻合与胰空肠吻合的安全性。方法 检索2010 年12月以前EMBASE 、MEDLINE、Cochrane Library、Cochrane 协作网随机对照试验注册数据库、中国期刊全文数据库（CNKI）、中国生物文献数据库（CBM）等数据库,纳入前瞻性对照试验进行系统评价和Meta 分析。结果 纳入6个篇前瞻性对照试验,其中4篇RCT,2篇非随机的前瞻性对照试验,共867例PD病例,行PG手术病人440例,PJ手术病人426例。采用前瞻性研究（包括RCT）和单纯RCT分组进行Meta分析：前瞻性对照试验组（包括RCT）Meta分析中胰胃吻合在术后并发症[OR 为0.53,95%CI（0.30,0.95）,P=0.03],、胰瘘[OR 为0.47,95%CI（0.22,0.97）,P=0.04]、腹腔积液[OR 为0.42,95%CI（0.25,0.72）,P=0.001],这三项指标中明显优于胰空肠吻合,在胆瘘、腹腔内并发症、病死率这三个指标上两种吻合方式未见明显差异;RCT研究组Meta分析中胰胃吻合在术后腹腔积液[OR 为0.46,95%CI（0.26,0.79）,P=0.005]这项指标中明显优于胰空肠吻合,在术后并发症、胰瘘、胆瘘、腹腔内并发症、病死率、胃排空延迟这些指标上两种吻合方式未见明显差异。结论 目前绝大部分回顾性分析支持胰胃吻合优于胰空肠吻合,而大部分RCT研究并没有发现PG优于PJ;对前瞻性对照试验进行Meta分析后可以发现胰胃吻合在术后并发症、胰瘘、腹腔积液方面优于胰空肠吻合。单纯对RCT进行Meta 分析后发现胰胃吻合仅在术后腹腔积液方面优于胰空肠吻合。表明胰胃吻合在安全性上并不低于胰空肠吻合。     

Relationship of Inflammation and Endothelial Dysfunction with Risks to Cardiovascular Disease among People in Inner Mongolia of China

Objective To explore the relationship of inflammation and endothelial dysfunction with risks to cardiovascular disease （CVD）. Methods Blood pressure, body weight, body height, waist circumference and lifestyle risk factors were measured and studied among 2589 participants in Inner Mongolia of China, and biomarkers of inflammation and endothelial dysfunction including high-sensitivity C-reactive protein （hsCRP）, soluble inter-cellular adhesion molecule-1 （slCAM-1）, soluble E-selectin （sE-selectin）, and angiotensin II were investigated. Results Subjects with metabolic risk factors for CVD had higher levels of hsCRP, sE-selectin and slCAM-1 than those without such risk factors （all P〈O.05）. Levels of all biomarkers positively and significantly increased with aggregation of the metabolic risk factors among the subjects （all P for trend 〈0.001）. Data from the multivariate analysis showed that participants with high levels of hsCRP [odds ratio （OR}： 1.96, 95% confidence interval （CI）： 1.52-2.53], sE-selectin （OR： 1.35, 95% Cl： 1.05-1.72）, and angiotensin II （OR： 1.81, 95% CI＂ 1.40-2.33） were more likely to develop hypertension; participants with high levels of hsCRP （OR： 2.33, 95% CI： 1.85-2.94）, sE-selectin （OR： 1.24, 95% CI： 1.00-1.54）, and slCAM-1 （OR： 1.70, 95% CI： 1.30-2.22） were more likely to develop dyslipidemia, and those with high levels of hsCRP （OR： 2.95, 95% CI： 2.27-3.83） and slCAM-I（OR： 2.80, 95% CI： 2.06-3.80） were more likely to develop hyperglycemia. Conclusion Biomarkers of inflammation and endothelial dysfunction were separately associated with relevant metabolic risk factors for CVD. And appropriate measures should be taken to control inflammation and improve endothelial function among individuals with different metabolic risk factors for CVD.     

重症急性胰腺炎合并腹腔感染患者血清Ghrelin、AMS、hs-CRP的表达水平及预后价值分析

目的 探讨重症急性胰腺炎（SAP）合并腹腔感染患者血清生长激素释放肽（Ghrelin）、淀粉酶（AMS）、高敏感C反应蛋白（hs-CRP）表达意义及预后价值。方法 选取2016年5月—2019年5月攀枝花市中西医结合医院收治的SAP合并腹腔感染患者58例作为观察组。选取同期该院收治的SAP未合并腹腔感染患者116例作为对照组。比较两组血清Ghrelin、AMS、hs-CRP水平。根据28 d预后情况将观察组分为生存组（40例）、死亡组（18例）,比较两组血清Ghrelin、AMS、hs-CRP水平及Ranson、多器官功能障碍综合征（MODS）评分。Pearson法分析各血清指标与Ranson、MODS评分的相关性,Logistic回归分析SAP合并腹腔感染预后的影响因素,受试者工作特征（ROC）曲线分析血清Ghrelin、AMS、hs-CRP对预后的预测价值,并采用Kaplan-Meier曲线进行生存分析。结果 观察组血清Ghrelin、AMS、hs-CRP水平高于对照组（P <0.05）。生存组与死亡组患者不同病因、不同病原菌、是否合并基础疾病比较,差异无统计学意义（P >0.05）。生存组与死亡组患者不同年龄、是否并发多器官功能障碍、是否合并低氧血症比较,差异有统计学意义（P <0.05）。生存组治疗前后血清Ghrelin、AMS、hs-CRP及Ranson、MODS评分的差值高于死亡组。确诊感染5 d后血清Ghrelin、AMS、hs-CRP与Ranson评分呈正相关（r =0.570、0.515和0.650,均P <0.05）,与MODS评分亦呈正相关（r =0.657、0.745、0.527,P <0.05）。Logistic回归分析显示,年龄> 50岁［O^R=1.937（95% CI：1.215,3.087）］、并发多器官功能障碍［O^R=3.384（95% CI：2.332,4.911）］、合并低氧血症［O^R=2.021（95% CI：1.308,3.124）］、Ghrelin［O^R=2.994（95% CI：1.706,5.253）］、AMS［O^R=3.109（95% CI：2.041,4.736）］、hs-CRP［O^R=3.863（95% CI：2.455,6.079）］、Ranson评分［O^R=3.544（95% CI：2.118,5.931）］、MODS评分［O^R=4.297（95% CI：2.704,6.829）］是SAP合并腹腔感染的影响因素（P <0.05）。ROC曲线分析显示,确诊感染5 d后血清hs-CRP预测预后AUC为0.819（95% CI：0.535,0.789）,当截断值>334.71 ng/L时,敏感性为61.11%（95% CI：36.14%,81.74%）,特异性为70.00%（95% CI：53.29%,82.91%）。AMS AUC为0.775（95% CI：0.646,0.874）,当截断值> 330.56 u/L时,敏感性为88.89%（95% CI：63.93%,98.05%）,特异性为62.50%（95% CI：45.81%,76.83%）。Ghrelin AUC为0.671（95% CI：0.646,0.874）,当截断值> 32.22 mg/L时,敏感性为72.22%（95% CI：46.41%,89.29%）,特异性为87.50%（95% CI：72.40%,95.31%）。Kaplan-Meier曲线分析显示,Ghrelin、AMS、hs-CRP高低危患者生存率比较,差异有统计学意义（P <0.05）。结论 血清Ghrelin、AMS、hs-CRP在SAP合并腹腔感染中呈异常高表达状态,与病情程度密切相关,可作为预后的重要因子,为临床提供参考依据。     

Prevalence and determinants of distress among oncology patients at a tertiary care medical city in Riyadh,Saudi Arabia

Objectives:To estimate the prevalence of distress in patients with cancer in Saudi Arabia and to identify common psychosocial stressors in these patients. We also looked for associations between distress and psychological, sociodemographic, and medical factors.Methods:This cross-sectional study was performed in the oncology outpatient clinic at King Saud University Medical City, Riyadh, Saudi Arabia, from January 2018 to December 2019. It included 280 patients with breast cancer, colorectal cancer, or lymphoma. Sociodemographic information was collected using questionnaire, along with information on medical history and any psychiatric history. Distress was assessed using the Distress Thermometer and Problem List. Satisfaction with social support was rated using the visual analog scale. All patients were screened for depression using the Patient Health Questionnaire 9-item depression scale and anxiety using the Generalized Anxiety Disorder 7-item scale.Results:The prevalence of distress in our study population was found to be 46%. Distress was associated with several practical, family, emotional, and physical stressors in the problem list. Logistic regression identified predictors of distress to be anxiety (odds ratio [OR] 8.7, confidence interval [CI] 1.98-38.24, p=0.002) and receiving radiotherapy (OR 3.6, CI 1.33-9.99, p=0.009), while Saudi nationality (OR 0.22, CI 0.05-0.95, p=0.037) and stage I cancer (OR 0.18, CI 0.05-1.40, p=0.002) were associated with low distress.Conclusion:Approximately half of cancer patients were found to have distress. Anxiety, advanced cancer stage, and radiotherapy were independently associated with distress.     

脑室出血术后并发颅内感染相关危险因素研究

目的 探讨脑室出血术后并发颅内感染(VAI)的危险因素,为其预防提供参考。 方法 回顾性分析2013年8月-2016年8月在金华市中心医院神经外科收治的脑室出血术后患者的资料,通过临床表现和实验室检查诊断颅内感染。采用Logistic回归分析脑室出血术后并发颅内感染的危险因素。 结果 共纳入符合标准的脑室出血术后患者276例,其中男性184例(66.7%),女性92例(33.3%);年龄32~79岁,平均(65.9±8.1)岁。根据术后是否发生颅内感染,将患者分为VAI组和非VAI组,其中VAI组31例(11.2%),非VAI组245例(88.8%)。Logistic多因素回归分析显示,双侧脑室引流(OR=1.213,95% CI:1.003~1.632,P=0.023)、皮下隧道<5 cm(OR=1.821,95% CI:1.554~2.232,P<0.001)和引流管留置>7 d(OR=2.658,95% CI:1.813~3.223,P<0.001)是VAI的独立危险因素。 结论 脑室出血术后并发颅内感染是脑室出血术后常见的并发症,双侧脑室引流、皮下隧道<5 cm和引流管留置>7 d是脑室出血术后并发颅内感染的独立危险因素,对此类患者应重点监护。      

中国人群脑卒中并发尿路感染相关危险因素的Meta分析

目的:荟萃分析脑卒中患者并发尿路感染相关危险因素,为防治脑卒中患者并发尿路感染提供科学依据。方法:按统一检索策略检索文献数据库,获取截至2017年1月国内外关于中国人群脑卒中患者并发尿路感染相关危险因素的研究文献。按纳入标准纳入合格文献,提取数据并进行Meta分析。结果:共纳入11篇,收集病例组6 748例和对照组5 702例。Meta分析结果显示性别和年龄与脑卒中并发尿路感染有显著统计学差异(性别:OR=0.37,95%CI:0.28~0.49,P<0.001;年龄:OR=0.33,95%CI:0.24~0.45,P<0.001);留置导尿管和患糖尿病是脑卒中患者并发尿路感染的重要危险因素(留置导尿管:OR=10.85,95%CI:5.35~22.02,P<0.001;患糖尿病:OR=8.63,95%CI:5.03~14.81,P<0.001);Brunnstrom运动功能分期与脑卒中患者并发尿路感染有显著统计学意义(OR=0.14,95%CI:0.09~0.21,P<0.001)。然而,脑卒中类型、全身抗生素使用情况、住院时间及伴发尿路结石与脑卒中患者并发尿路感染均无显著统计学意义(P>0.05)。结论:性别、年龄、留置导尿管、糖尿病和Brunnstrom运动功能分期是中国人群脑卒中并发尿路感染的重要危险因素,未来需扩大样本量和人群结构进一步进行多中心、随机研究予以验证。     

Predictors of liver failure in primary biliary cirrhosis

Background The disease progression of patients with primary biliary cirrhosis (PBC) varies significantly, and the prognostic markers that identify those patients who will develop liver failure have been scarcely studied from a Chinese cohort.Aims We aimed to determine the predictive factors of liver failure in patients with PBC.Methods Patients who were first diagnosed as PBC with hepatic compensation between January 2007 and December 2009 were enrolled in this cohort study.Results Altogether 398 patients were finally included. Of these patients, 80% were women, 98% had positive antimitochondrial antibodies, and 45% had positive antinuclear antibodies (ANA). To December 2012, a total of 38 patients developed liver failure. According to the outcome, patients who developed liver failure had had higher serum concentration of baseline total bilirubin (TBil) (p = 0.013) and total bile acid (TBA) (p < 0.001), and lower concentrations of baseline total cholesterol (Tch) (p = 0.008), than patients who did not develop liver failure. Additionally, the proportion of ANA positivity was statistically different between the two groups (p = 0.009). In the established model for predicting liver failure in PBC, three variables were finally selected out, including Tch (odds ratio (OR) 0.552, 95% confidence interval (CI) 0.394–0.774, p < 0.001), TBA (OR 1.006, 95% CI 1.002–1.010, p = 0.002), and ANA (+ versus –, OR 5.518, 95% CI 1.155–26.376, p = 0.032).Conclusions ANA, Tch, and TBA are predictors of liver failure in PBC.     

急性脑出血患者院内感染相关因素分析

目的:探讨急性脑出血患者院内感染的发生率及导致急性脑出血患者发生院内感染的相关因素,为防治急性脑出血患者院内感染提供理论依据。方法:对我院神经内科自2011年1～12月收治的246例急性脑出血患者进行回顾性分析,调查急性脑出血患者院内感染的发生率及导致其发生院内感染的相关因素,进一步分析院内感染与急性脑出血患者预后的关系。结果:246例急性脑出血发生院内感染57例,发生率为23.2%。单因素分析发现,患者的年龄、GCS评分、吸烟史、糖尿病史、慢性支气管炎、低蛋白血症、院内侵袭性操作及呼吸机使用是脑出血患者院内感染发生的危险因素,差异有统计学意义。多因素分析发现,吸烟史、糖尿病史、慢性支气管炎、低蛋白血症及入院时GCS评分是影响脑出血患者发生院内感染的独立危险因素;院内感染和GCS评分是影响脑出血患者预后的独立危险因素。结论:脑出血患者院内感染发生率高,且是影响脑出血患者预后的独立危险因素。     

Methicillin-resistant Staphylococcus aureus development in intensive care patients: A case-control study

Objectives:To determine the factors associated with the development of methicillin-resistant Staphylococcus aureus (MRSA), hospital stay and mortality, and early versus late MRSA infection.Methods:Cases (n=44) were intensive care unit (ICU) patients admitted to King Fahd Specialist Hospital, Al-Qassim, Saudi Arabia between 2015 and 2019 who developed MRSA during their hospital stay. Controls (n=48) were patients from the same place and period who did not develop MRSA. Data were abstracted from hospital records.Results:Admission with sepsis (case: 46% vs. control: 2%, p<0.001) and having at least one comorbid condition (case: 95% vs. control: 46%, p<0.001) were significantly associated with the development of MRSA. Age (mean ± SD: case: 65±18, control: 64±18, p=0.7) and gender (% male, case: 52%, control: 56%, p=0.70) were not associated with the development of MRSA. Approximately 73% of all MRSA cases developed within the first 2 weeks of admission. Among the early cases, 44% died during their ICU stay; the corresponding percentage among the late cases was 42% (p=0.69). There was no difference between early and late MRSA cases in terms of non-sepsis admissions (50% vs. 67%, p=0.32) or comorbid status (at least one: 97% vs. 92%, p=0.17).Conclusion:Sepsis and comorbid conditions were significant risk factors for MRSA development among hospital patients.     

Impact of empirical oseltamivir discontinuation in hospitalized patients with community-acquired pneumonia after confirmed negative for influenza

Objectives:To study the effect of appropriate oseltamivir discontinuation in patients hospitalized with pneumonia, after they tested negative for influenza.Methods:A retrospective study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients admitted with a diagnosis of community-acquired pneumonia and started on empirical oseltamivir were included. The duration of stay at the hospital and readmission rates were identified. Additionally, we studied factors that led healthcare providers to continue patients on oseltamivir therapy despite testing negative for influenza.Results:A total of 210 patients were studied. The rate of empirical oseltamivir appropriate discontinuation was 31% (66 patients). No significant difference was noted between the 2 groups in the length of hospital stay (p=0.46). There was no significant difference in terms of 30-day (OR=0.67, 95% CI [0.28-1.59]), 60-day (OR=1.14, 95% CI [0.47, 2.78]), and 90-day readmission rates (OR=1.35, 95% CI [0.35-5.27]). After adjusting for other variables, admission to the intensive care unit was independently associated with appropriate discontinuation compared with patients admitted to general wards.Conclusions:This study showed that appropriate discontinuation of empirical antiviral therapy is safe, effective, and has no impact on the length of stay and readmission rates.     

胰十二指肠切除术后胰胃吻合术与胰空肠吻合术前瞻性对照试验的荟萃分析

目的 比较胰十二指肠切除术(PD)后胰胃吻合术(PG)与胰空肠吻合术(PJ)的安全性.方法 检索2010年12月以前EMBASE、MEDLINE、Cochrane Library、Cochrane协作网随机对照试验注册数据库、中国期刊全文数据库(CNKI)、中国生物文献数据库(CBM)等数据库,纳入前瞻性对照试验,评估文献质量并提取数据资料,应用RevMan5.0对其进行荟萃分析.结果 纳入6个前瞻性对照试验,其中4个随机对照试验(RCT),2个非随机的前瞻性对照试验,共867例PD病例,行PG手术患者440例,PJ手术患者426例.采用前瞻性研究(包括RCT)和单纯RCT分组进行荟萃分析:前瞻性对照试验组(包括RCT)荟萃分析中PG在术后并发症[OR0.53,95％ CI(0.30,0.95),P=0.03]、胰瘘[OR 0.47,95％ CI(0.22,0.97),P=0.04]、腹腔积液[OR 0.42,95％CI(0.25,0.72),P=0.001],这3项指标中明显优于PJ,腹腔内并发症、病死率等指标上两种吻合方式差异未见统计学意义;RCT研究组荟萃分析中PG在术后腹腔积液[OR 0.46,95％ CI(0.26,0.79),P=0.005]这项指标中明显优于PJ,在术后并发症、胰瘘、腹腔内并发症、病死率、胃排空延迟这些指标上两种吻合方式差异未见统计学意义.结论 前瞻性对照试验进行荟萃分析后可以发现PG在术后并发症、胰瘘、腹腔积液方面优于PJ.单纯对RCT进行荟萃分析后发现PG仅在术后腹腔积液方面优于PJ.表明PG在安全性上并不低于PJ.     

产妇医院感染的危险因素调查分析

目的 探讨产妇发生医院感染的情况与相关因素,为医院感染的预防提供理论依据.方法 对我院2263例产妇的病历资料进行回顾性调查研究,并对其中发生医院感染的产妇资料与未发生医院感染的产妇资料进行对比分析.单因素分析采用x2检验,多因素采用非条件Logistic回归分析.结果 在2 263例产妇中,医院感染发生率为3.66％（83/2263）,呼吸道、泌尿道、手术切口是发生感染的常见部位.多因素非条件Logistic回归分析显示：妊娠并发症（OR=18.323;95％ CI：0.853 ～4.643）;住院时间＞7d （OR =5.463;95％ CI：0.271～2.652）;侵袭性操作（OR=6.421;95％CI：0.368～3.140）;平均每天探视人员≥10人（OR=3.853;95％CI：0.941～1.342）,是产科发生医院感染的危险因素.结论 产科发生医院感染的情况并不少见,应当加强对产科发生医院感染的危险因素进行干预,方可降低产科医院感染的发生率.     

老年急腹症术后肺部感染观察及相关危险因素分析

目的】观察老年急腹症患者术后肺部感染的发生情况,并分析其相关危险因素,以期有效降低老年急腹症患者术后肺部感染的发生率。【方法】回顾性分析114例经手术治疗的老年急腹症患者,统计术后肺部感染的发生率,相关因素分析采用单因素χ2检验和多因素Logistic回归分析。【结果】114例患者中共发生肺部感染30例,发生率为26．32％（30/114）。多因素Logistic检验显示肺部感染危险因素有年龄（OR＝2．356,95％CI1．845～3．009）、合并肺部疾病（OR＝3．526,95％CI2．346～5．300）、全身麻醉（OR＝3．410,95％CI2．469～4．710）、自主排痰（OR＝0．472,95％CI0．335～0．665）、人工排痰（OR＝0．503,95％CI0．394～0．642）、口腔清理（OR＝0．481,95％CI0．369～0．627）、贫血（OR＝1．821,95％CI1．632～2．032）、免疫功能差（OR＝2．526,95％CI1．887～3．381）和住院时间（OR＝1．793,95％CI1．421～2．262）。【结论】老年急腹症患者术后肺部感染的发生率很高,并且与多种因素有关,应根据相关危险因素加强围手术期的预防、治疗和护理工作。     

桡骨远端骨折掌侧锁定接骨板固定术后并发症的相关因素分析

目的探讨桡骨远端骨折掌侧锁定接骨板术后并发症的相关危险因素。方法收集2013年1月-2017年12月邢台矿业集团总医院创伤骨科收治的桡骨远端骨折患者796例,均行掌侧锁定接骨板治疗,回顾性分析并发症情况(软组织、肌腱、骨愈合、切口等相关并发症),并根据有无并发症将其分为2组。其中有并发症组102例,无并发症组694例,采用单因素分析及多因素Logistic回归分析探讨影响桡骨远端骨折术后发生并发症的相关危险因素。结果 796例桡骨远端骨折患者术后发生并发症102例,总体并发症发生率为12.8%。其中腕管综合征发生率最高为23例,发生率2.9%;其次为切口感染14例(1.8%),复位不良或复位丢失13例(1.6%)。单因素分析结果显示,并发症组与无并发症组患者在年龄、BMI、骨折AO分型、骨折类型、伴有月骨凹明显塌陷、手术时间和术者年资等差异具有统计学意义(P <0.05)。多因素Logistic回归分析显示,桡骨远端骨折术后并发症的独立危险因素为C型骨折(OR=2.14,95%CI1.28~3.08,P=0.004)、开放骨折(OR=3.44,95%CI 1.84~4.77,P<0.001)、伴有明显月骨凹塌陷(OR=3.79,95%CI2.11~4.98,P <0.001)以及术者年资较低(<5年)(OR=1.96,95%CI1.14~2.82,P=0.037)。结论开放骨折、伴有明显月骨凹塌陷、C型骨折以及术者年资较低是桡骨远端骨折术后并发症的危险因素,对于伴多个危险因素的,应采取更优化的方案以预防并发症的发生。     

Detection of Human Bocavirus in Children with Acute Respiratory Tract Infections in Lanzhou and Nanjing,China

Objective The aim of this study was to explore the prevalent characteristics of HBoV1 and its co-infection.Methods PCR was used to detect HBoV1-DNA（HBoV1） and other viruses.A multivariate logistic regression model was used to explore possibility of co-detected for related viruses.Results The positivity rates in Nanjing and Lanzhou were 9.38%（74/789） and 11.62%（161/1386）,respectively（P〉0.05）.The HBoV1 positive group was younger than negative group（P〈0.05）.Seasonal differences were noted,with a higher frequency of infection in December and July.HBoV1-positive children [72.34%（169/235）] were co-infected with other respiratory viruses.Multifactorial analysis showed no correlations between HBoV1 and the clinical classification,region,gender,age,or treatment as an outpatient or in a hospital.Correlations were identified between HBoV1 infections with ADV（OR=1.53,95% CI 1.03-2.28）,RSV（OR=0.71,95% CI 0.52-0.98）,and IFVA（OR=1.77,95% CI 1.00-3.13）.Conclusions Presence of HBoV1 in nasopharyngeal aspirates did not correlate with region or gender,although the prevalence of HBoV1 was higher in younger children.There were no correlations between HBoV1 and other variables,except for the season and ADV,RSV,or IFVA infections.     

泌尿系结石日间手术患者延迟出院的危险因素分析

  目的  探讨泌尿系结石日间手术患者延迟出院的危险因素。  方法  回顾性分析广州医科大学附属第一医院泌尿外科2019年1—12月泌尿系结石日间手术的749名患者的电子病历资料,根据患者出院时间将其分为延迟出院组(71例)和正常出院组(678例),对2组患者的一般资料、术后1 h生命体征和常见血液学指标等进行比较,用logistic回归分析研究患者术后延迟出院的危险因素。  结果  泌尿系结石日间手术患者延迟出院的发生率为9.5%。Logistic回归分析显示年龄(OR=3.209,95% CI:1.621~6.352,P=0.001)、PCNL治疗(OR=2.212,95% CI:1.290~3.793,P=0.004)、体温(OR=4.363,95% CI:1.967~9.682,P < 0.001)、中性粒细胞比率(neutrophil ratio,NEUT;OR=1.973,95% CI:1.156~3.370,P=0.013)、血红蛋白(hemoglobin,Hb;OR=2.776,95% CI:1.170~6.582,P=0.020)和血清钾(serum potassium,K+;OR=2.680,95% CI:1.162~6.177,P=0.021)是患者延迟出院的独立危险因素。  结论  高龄、行PCNL、术后1 h体温＞38 ℃、NEUT＞70%、Hb＜90 g/L和低血钾的日间手术患者延迟出院风险增加,医护人员应重点关注并及时应对,以减少日间手术风险,提高其质量和安全性。      

Characteristics and treatment outcomes of patients with multi-drug resistant tuberculosis at a tertiary care hospital in Peshawar,Pakistan

Objectives:

To determine characteristics and treatment outcomes of multidrugs resistant tuberculosis (MDR-TB) patients and risk factors for poor outcomes in MDR-TB patients in a tertiary care hospital in Peshawar, Pakistan.

Methods:

This retrospective study was conducted at the Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital Peshawar, Pakistan and included all MDR-TB patients registered between January 2012 and December 2012. A special proforma was used for data collection. Analysis was performed using SPSS version 16, after exporting data from the proforma. Differences in proportions were assessed using Pearson’s Chi square test whereas for predictors of poor outcomes, multivariate logistic regression analysis with Wald Statistical criteria using backward elimination method was performed.

Results:

The treatment success rate was 74.3%. In univariate analysis, poor outcomes were associated in patients with age ≥44 years (odds ratio [OR]=0.250; 95% confidence interval [CI]: 0.114-0.519, p=0.001), rural residence (OR=0.417; 95% CI: 0.18-0.937, p=0.03), lung cavitation (OR=0.22; 95% CI, 0.007-0.067, p=0.001), resistance to second line drugs (SLD) (OR=3.441; 95% CI: 1.579-7.497, p=0.001), and resistance to ofloxacin (OR=2.944; 95% CI: 1.361-6.365, p=0.005); whereas multivariate logistic regression analysis, poor outcomes were associated in patients with age ≥44 years (OR=0.249, 95% CI: 0.075-0.828, p=0.023), rural residence (OR=0.143, 95% CI: 0.052-0.774, p=0.032), and cavitatory lungs (OR=0.022, 95% CI: 0.007-0.072, p=0.000).

Conclusion:

The MDR-TB patient needs special attention for better treatment outcomes. The presence of older age, rural area residence, resistance to ofloxacin, SLD resistance, and cavitary disease are independent prognostic factors for poor outcome in patients with MDR-TB.Tuberculosis (TB) is a communicable, chronic granulomarous disease that ranks second as the leading cause of death from a single infectious agent after the human immunodeficiency virus (HIV). Due to world-wide efforts its control, the mortality rate of TB has decreased by 45% since 1990. However, despite all the possible measures to fight against TB, its global burden remains the same. According to the World Health Organization (WHO) report in 20131 TB infected 9 million people with 1.5 million deaths. Though the disease has been controlled by programmatic directly observed treatment short courses (DOTS) strategies, still its resurgence in the form of drug-resistant TB (DR-TB) is alarming. Among various resistance patterns, multi drug-resistant TB (MDR-TB) and extensive DR-TB (XDR-TB) demands more attention of health professionals. Multi drug-resistant TB is a purely man-made problem, which originates from wrong diagnosis, improper treatment, and non-compliance; thus, demanding more profound efforts. On average, 9% of estimated MDR-TB patients fail to achieve the desired therapeutic outcome and become extensive by DR. Globally in 2013,1 an estimated 480,000 people were infected by MDR-TB with estimated deaths of 210,000. The WHO data reveals that 3.7% of new cases, and 20% of previously treated cases are estimated to have MDR-TB.1 Multi drug-resistant TB offers a great challenge to TB control programs, and is significantly more difficult to treat than drug-susceptible TB. It requires the use of less effective second line drugs associated with more intolerable adverse effects compared with drug susceptible TB. It has a prolonged treatment of a minimum of 24 months with a low treatment success rate.2 Hence, it is very important to find out and efficiently treat an MDR-TB patient. Inadequate treatment of MDR-TB may worsen patients’ outcome, consequently increasing the risk of extensive drug resistance.3 Without proper treatment, multidrug resistant strains can spread rapidly within vulnerable populations.4 Because standard short-course chemotherapy for MDR-TB have been associated with unacceptably high rates of failure and relapse, and new approaches to treatment in poor countries are needed.5 Due to a rapid increase in the incidence of MDR-TB, it is very important to identify the predictors for unsuccessful treatment outcomes. Once the predictors are identified, they may be elaborated expeditiously for more effective control of DR-TB. Pakistan is one of the top listed countries ranking fourth among the top 22 MDR-TB countries. Based on 4.2% primary resistance and 19% resistance in re-treatment cases, the WHO has an estimated annual incidence of approximately 15000 MDR-TB cases in Pakistan.6 The increasing rate of MDR and XDR-TB in Pakistan underscores the importance of effective treatment programs of DR-TB. There is an urgent need for extensive research to elaborate efficient diagnosis, treatment, and control of MDR-TB as poor implementation of treatment protocols leads to further resistance, which emerge in the form of XDR-TB. Understanding the risk factors responsible for poor treatment outcomes among MDR-TB, patients is necessary to improve the treatment outcomes.7 This study was conducted to determine the overall treatment outcome and predictors attributing towards poor treatment outcome.     

胰十二指肠切除术后早期液体平衡与胰瘘相关

目的 评价胰十二指肠切除术（pancreaticoduodenectomy,PD）后48 h累积液体平衡量（cumulative fluid balance postoperative 48h,FB 48 h）与术后胰瘘（postoperative pancreatic fistula,POPF）发生率的关系。方法 回顾性分析首都医科大学附属北京朝阳医院外科重症加强治疗病房（surgical intensive care unit,SICU）连续收治的237例PD术后患者,收集并整理其术前、术中和术后临床资料。按照是否发生POPF将患者分为胰瘘组（POPF）和非胰瘘组（Non-POPF）,采用单自变量Logistic回归模型筛选POPF的危险因素,采用多自变量Logistic回归模型去除混杂因素,最终确定POPF的危险因素。进一步根据FB 48 h将患者分为液体负平衡组（FB 48 h ≤ 0 mL·kg^-1·h^-1）、少量液体正平衡组（0 mL·kg^-1·h^-1 < FB 48 h ≤ 0.5 mL·kg^-1·h^-1）、中等量液体正平衡组（0.5 mL·kg^-1·h^-1 < FB 48 h ≤ 1 mL·kg^-1·h^-1）和大量液体正平衡组（FB 48 h>1 mL·kg^-1·h^-1）等4个亚组,分析FB 48 h与POPF之间的关系。结果 30例（12.7%）患者发生了POPF,其中B级POPF 24例（10.1%）,C级POPF 6例（2.5%）。多自变量Logistic回归分析显示,性别（男性）（OR=23.917,95% CI：3.775~151.526,P=0.001）、高体质量指数（body mass index,BMI）（OR=1.313,95% CI：1.059~1.628,P=0.013）、罹患糖尿病（OR=9.120,95% CI：2.262~36.771,P=0.002）、入院时低白蛋白浓度（OR=0.876,95% CI：0.783~0.981,P=0.022）、术前高胆红素浓度（OR=1.008,95% CI：1.002~1.013,P=0.005）和FB 48 h（OR=4.870,95% CI：1.906~12.443,P=0.001）为POPF的独立危险因素。大量液体正平衡组患者C级POPF发生率显著高于少量液体正平衡组（P=0.002）和中等量液体正平衡组（P=0.002）。结论 PD术后FB 48 h是POPF的独立危险因素,FB 48 h>1 mL·kg^-1·h^-1时,C级POPF发生率显著增高。