Risk factors for ventilator dependency following coronary artery bypass grafting

Background: Ventilator dependency following coronary artery bypass grafting (CABG) is often associated with significant morbidity and mortality. However, few reports have focused on the independent risk factors for ventilator dependency following CABG. This study aimed to evaluate the independent risk factors for ventilator dependency following coronary artery bypass grafting (CABG). Methods: The relevant pre-, intra- and post-operative data of patients without a history of chronic obstructive pulmonary disease undergoing isolated CABG from January 2003 to December 2008 in our center were retrospectively analyzed. Elapsed time between CABG and extubation of more than 48 hours was defined as postoperative ventilator dependency (PVD). Results: The incidence of PVD was 13.8% (81/588). The in-hospital mortality in the PVD group was significantly higher than that in the non-PVD group (8.6% versus 2.4%, p=0.0092). Besides the length of ICU and hospital stay, PVD correlated with negative respiratory outcomes. The independent risk factors for PVD were preoperative congestive heart failure (OR=2.456, 95%CI 1.426-6.879), preoperative hypoalbuminemia (OR=1.353, 95%CI 1.125-3.232), preoperative arterial oxygen partial pressure (PO₂) (OR=0.462, 95%CI 0.235-0.783) and postoperative anaemia (OR=1.541, 95%CI 1.231-3.783). Conclusions: Preoperative congestive heart failure, preoperative hypoalbuminemia, low preoperative PO₂ and postoperative anaemia were identified as four independent risk factors for ventilator dependency following CABG.     

脊柱术后发生手术部位感染独立危险因素的Meta分析

文题释义：手术部位感染：术后30 d内(或者置入内固定装置1年内)发生的浅表、深部或者器官的感染。浅部感染指术后30 d内发生感染，感染只涉及切口皮肤或皮下组织。深部感染指若无植入物留在原位，感染发生在术后30 d内；若植入物在原位，感染发生在1年内，并且感染可能与手术有关，深部感染涉及深部软组织。当感染涉及解剖的任何部分(如器官或空间)而非手术操作的切口感染即为器官感染。 背景：脊柱术后手术部位感染的危险因素多样且复杂，目前国内外对于脊柱术后手术部位感染相关危险因素的研究仍然存在较大的争议。 目的：系统评价脊柱术后手术部位感染的独立危险因素，为手术部位感染的防治提供理论依据。 方法：检索2004年1月至2019年6月中外数据库，按照拟定的文献纳入与排除标准获得有关脊柱术后手术部位感染独立危险因素的病例-对照研究和队列研究，提取有效数据，分别采用固定效应模型和随机效应模型计算各独立危险因素(高血压、糖尿病、肥胖、吸烟、手术史)的合并OR值和95%CI进行Meta分析，比较其结果的一致性，分析合并结果的可靠性。 结果与结论：①共纳入19篇文献，共包括脊柱术后发生手术部位感染的病例1 008例，对照组7 527例；②各独立危险因素合并OR值(95%CI)由高到低依次为：糖尿病(OR=3.24，95%CI：2.09-5.02)、肥胖(OR=2.99，95%CI：1.77-5.05)、手术史(OR=2.12，95%CI：1.79-2.50)、高血压(OR=1.90，95%CI：1.34-2.69)、吸烟(OR=1.85，95%CI：1.39-2.48)；③提示糖尿病、高血压、肥胖、吸烟、手术史均为脊柱术后发生手术部位感染的独立危险因素，各独立危险因素与脊柱术后发生手术部位感染的概率均呈正相关。 ORCID: 0000-0002-4963-6988(覃作恒) 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     

代谢综合征患者脊柱融合术后的并发症：系统回顾和Meta分析

目的：代谢综合征对一系列外科手术患者的术后结果有负面影响,然而,目前尚不清楚代谢综合征是否与脊柱融合术后的并发症有关。通过系统回顾和Meta分析评估代谢综合征患者脊柱融合术后并发症的相关风险。方法：综合检索知网、万方、维普、PubMed、OVID和Web of Science数据库,选取有关代谢综合征患者脊柱融合术后并发症的相关研究,相关结果指标包括全因并发症、心血管并发症、肺并发症、手术部位感染、败血症、静脉血栓栓塞事件（包括深静脉血栓和肺栓塞）、尿路感染、术后30 d再入院率、术后30 d再手术率、术后30 d死亡率和住院费用。对11种结果进行数据提取、Meta分析或定性研究系统综述。结果：（1）共纳入8项研究,包括1项前瞻性队列研究和7项回顾性队列研究,涉及283 593例患者,纳入的研究文献总体质量较好;（2）Meta分析结果显示,与非代谢综合征组相比,代谢综合征组全因并发症[RR=1.53,95%CI（1.22,1.93）,P=0.000 3]、肺部并发症[RR=1.68,95%CI（1.29,2.17）,P <0.000 1]、心血管并发症[RR=2.05,95%CI...     

普外科术后继发脑梗死的多因素Logistic回归分析

目的 探讨普外科术后并发脑梗死的高危因素,为早期识别及干预提供依据。方法 收集2013年1月~2017年12月我院普外科术后发生脑梗死患者及同期其它手术患者共2835例的临床资料,通过多因素Logistic回归分析确定普外科术后并发脑梗死的独立危险因素。结果 多因素回归分析显示,年龄（OR=2.001,95%CI:1.117~3.472）、手术类型（OR=2.199,95%CI:1.203~4.425）及术中低灌注（OR=2.421,95%CI:1.387~4.974）是普外科术后继发脑梗死的独立因素（P＜0.05）。结论 年龄≥65岁、恶性肿瘤手术及术中低灌注是普外科术后脑梗死形成的可能原因,早期识别高危患者及对相关高危因素进行干预,对预防普外科围手术期脑梗死的发生意义重大。     

全膝关节置换治疗类风湿性膝关节炎的早期急性并发症

文题释义：全膝关节置换：是通过手术将人工关节假体置入患者膝关节部位,以替代原有的病损关节,达到缓解疼痛、恢复下肢力线及改善患者生活质量的目的,对治疗类风湿性膝关节炎、膝关节退行性病变等膝关节疾病具有显著疗效。 类风湿性关节炎：是一种病因未明的慢性、以炎性滑膜炎为主的系统性疾病。其特征是手、足小关节的多关节、对称性、侵袭性关节炎症,经常伴有关节外器官受累及血清类风湿因子阳性,可以导致关节畸形及功能丧失。晚期累及膝关节的类风湿性关节炎可行全膝关节置换术可显著改善患者生活质量。 背景：类风湿性关节炎患者行全膝关节置换的数量不断增加,但是目前尚无研究报道类风湿性关节炎患者行全膝关节置换后早期并发症的发生情况及相关危险因素。 目的：探讨类风湿性关节炎患者行初次全膝关节置换后早期急性并发症的发生情况及危险因素。 方法：回顾性分析2013年9月至2019年5月于青岛大学附属医院因类风湿性关节炎行初次全膝关节置换的300例患者(337膝)的资料,其中男62例,女238例,平均(65.61±8.40)岁。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。收集并记录患者基本信息、并存疾病、术前检查、手术信息、住院其他信息及随访资料,分析患者并发症发生的相关危险因素,并利用受试者工作特征曲线计算相关资料对类风湿性关节炎患者术后30 d内并发症的预测价值。 结果与结论：①共9例患者在术后30 d内出现急性并发症,发生率为3.33%;②多因素Logistic回归分析结果显示,并发症组患者手术时间、年龄、病程和术前合并脑血管疾病是类风湿性关节炎患者全膝关节置换后30 d内并发症发生的独立危险因素;③并发症组患者手术时间大于无并发症组(OR=1.023,95%CI：1.001-1.045,P=0.037),年龄大于无并发症组(OR=1.163,95%CI：1.025-1.319,P=0.019),病程大于无并发症组(OR=1.110,95%CI：1.031-1.195,P=0.006),术前合并脑血管疾病比例大于无并发症组(OR=31.736,95%CI：4.053-248.517,P=0.001);④受试者工作特征曲线表明,年龄、病程及手术时间预测类风湿性关节炎患者全膝关节置换后30 d内并发症的曲线下面积分别为0.693,0.865,0.685。 ORCID: 0000-0003-2279-2742(沈瑞) 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     

老年髋部骨折围术期肺部感染危险因素分析

背景：目前对于老年骨折治疗后肺部感染的研究少有报道,对于老年特殊部位,如髋部骨折后围术期肺部感染的并发症也无少见相关报道。 目的：探讨老年髋部患者骨折患者围术期合并肺部感染的危险因素。 方法：回顾性分析46例老年髋部骨折围术期合并肺部感染的病例资料,并随机选择同时期同一区域住院的未合并肺部感染的老年髋部骨折患者46例作为对照,比较两组患者围术期各临床指标的差异性,合并肺部感染的危险因素行Logistic回归多因素分析。 结果与结论：单因素相关分析筛选出14个可能的围术期合并肺部感染相关因素,包括：慢性阻塞性肺病、吸烟、糖尿病、心脏疾病、机械通气、术中出血量、输注红细胞、手术时间、术前低体质量指数(体质量指数< 18.5 kg/m²)、血清白蛋白< 35 g/L、电解质紊乱、入住ICU及住院时间;Logistic多因素回归分析显示：慢性阻塞性肺病(OR=23.317;95%CI：2.702-60.312;P=0.000)、入住ICU(OR= 7.890;95%CI：2.624-76.012;P=0.008)、机械通气 (OR=35.210;95%CI：8.464-131.203;P=0.017)、手术时间(OR=12.122;95%CI：5.154-99.098;P=0.012)为老年髋部骨折患者围术期肺部感染的独立危险因素。说明老年髋部骨折患者存在慢性阻塞性肺病、入住ICU及机械通气等因素时应警惕发生肺部感染的可能。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;组织工程全文链接：     

血嗜酸性粒细胞计数与冠状动脉旁路移植手术后肺炎风险（英文）

目的:研究血嗜酸性粒细胞计数与冠状动脉旁路移植手术患者术后肺炎风险的关系。方法:收集2008年~2017年在我院进行冠状动脉旁路移植手术的613例患者资料进行分析,比较不同血嗜酸性粒细胞计数患者术后肺炎发生率及住院死亡率,采用多因素回归分析明确患者术后肺炎的危险因素。结果:研究共纳入582例患者,其中220例患者血嗜酸性粒细胞比例2%(低血嗜酸性粒细胞组),362例患者血嗜酸性粒细胞比例≥2%(高血嗜酸性粒细胞组)。低血嗜酸性粒细胞组术后肺炎发生率(14.1%,31/220)明显高于高血嗜酸性粒细胞组(6.4%,23/362,P=0.002),而2组患者住院死亡率无明显差异。多因素回归分析结果显示低血嗜酸性粒细胞计数(OR=3.521,95%CI:1.213~10.223,P=0.021)、鼻胃管(OR=6.490,95%CI:2.757~15.280,P0.001)和机械通气时间≥24 h(OR=3.496,95%CI:1.156~10.178,P=0.035)为术后发生肺炎的独立危险因素。结论:低血嗜酸性粒细胞计数患者冠状动脉旁路移植手术后发生肺炎的风险升高。     

Mediastinitis due to Gram-negative bacteria is associated with increased mortality

The aim of this study was to describe the features of a large cohort of patients with postoperative mediastinitis, with particular regard to Gram-negative bacteria (GNB), and assess their outcome. This bicentric retrospective cohort included all patients who were hospitalized in the Intensive Care Unit with mediastinitis after cardiac surgery during a 9-year period. Three hundred and nine patients developed a mediastinitis with a mean age of 65 years and a mean standard Euroscore of six points. Ninety-one patients (29.4%) developed a GNB mediastinitis (GNBm). Of the 364 pathogens involved, 103 GNB were identified. GNBm were more frequently polymicrobial (44% versus 3.2%; p <0.001). Being female was the sole independent risk factor of GNBm in multivariate analysis. Initial antimicrobial therapy was significantly more frequently inappropriate with GNBm compared with other microorganisms (24.6% versus 1.9%; p <0.001). Independent risk factors for inappropriateness of initial antimicrobial treatment were GNBm (OR = 8.58, 95%CI 2.53–29.02, p 0.0006), and polymicrobial mediastinitis (OR = 4.52, 95%CI 1.68–12.12, p 0.0028). GNBm were associated with more drainage failure, secondary infection, need for prolonged mechanical ventilation and/or use of vasopressors. Thirty-day hospital mortality was significantly higher with GNBm (31.9 % versus 17.0%; p 0.004). GNBm was identified as an independent risk factor of hospital mortality (OR = 2.31, 95%CI 1.16–4.61, p 0.0179).     

Incidence of postoperative hypothermia and its risk factors in adults undergoing orthopedic surgery under brachial plexus block: A retrospective cohort study

Postoperative hypothermia increases patient mortality and morbidity. However, the incidence of, and risk factors for, postoperative hypothermia in patients undergoing surgery under brachial plexus block (BPB) as the primary method of anesthesia remain unclear. This study aimed to determine the incidence of, and risk factors for, postoperative hypothermia in patients undergoing surgery under BPB. We retrospectively analyzed 660 patients aged ≥ 19 years who underwent orthopedic surgery under BPB in our hospital between October 2014 and October 2019. Postoperative hypothermia was defined as a tympanic membrane temperature < 36 °C when the patient arrived in the post-anesthesia care unit. Multivariate logistic regression analysis was performed to identify the independent risk factors for postoperative hypothermia. Postoperative hypothermia was observed in 40.6% (268/660) of patients. Independent risk factors for postoperative hypothermia were lower baseline core temperature before anesthesia (odds ratio [OR] 0.355; 95% confidence interval [CI] 0.185-0.682), alcohol abuse (OR 2.658; 95% CI 1.105-6.398), arthroscopic shoulder surgery (OR 2.007; 95% CI 1.428-2.820), use of fentanyl (OR 1.486; 95% CI 1.059-2.087), combined use of midazolam and dexmedetomidine (OR 1.816; 95% CI 1.268-2.599), a larger volume of intravenous fluid (OR 1.001; 95% CI 1.000-1.002), and longer duration of surgery (OR 1.010; 95% CI 1.004-1.017). Postoperative hypothermia is common in adult patients undergoing orthopedic surgery under BPB. The risk factors identified in this study should be considered to avoid postoperative hypothermia in these patients.     

A novel risk score to predict diagnosis with coronavirus disease 2019 (COVID-19) in suspected patients: A retrospective,multicenter, and observational study

The aim of the study was to explore a novel risk score to predict diagnosis with COVID-19 among all suspected patients at admission. This was a retrospective, multicenter, and observational study. The clinical data of all suspected patients were analyzed. Independent risk factors were identified via multivariate logistic regression analysis. Finally, 336 confirmed COVID-19 patients and 139 control patients were included. We found nine independent risk factors for diagnosis with COVID-19 at admission to hospital: epidemiological exposure histories (OR:13.32; 95%CI, 6.39-27.75), weakness/fatigue (OR:4.51, 95%CI, 1.70-11.96), heart rate less than 100 beat/minutes (OR:3.80, 95%CI, 2.00-7.22), bilateral pneumonia (OR:3.60, 95%CI, 1.83-7.10), neutrophil count less than equal to 6.3 × 10⁹/L (OR: 6.77, 95%CI, 2.52-18.19), eosinophil count less than equal to 0.02 × 10⁹/L (OR:3.14, 95%CI, 1.58-6.22), glucose more than equal to 6 mmol/L (OR:2.43, 95%CI, 1.04-5.66), D-dimer ≥ 0.5 mg/L (OR:3.49, 95%CI, 1.22-9.96), and C-reactive protein less than 5 mg/L (OR:3.83, 95%CI, 1.86-7.92). As for the performance of this risk score, a cut-off value of 20 (specificity: 0.866; sensitivity: 0.813) was identified to predict COVID-19 according to reciever operator characteristic curve and the area under the curve was 0.921 (95%CI: 0.896-0.945; P < .01). We designed a novel risk score which might have a promising predictive capacity for diagnosis with COVID-19 among suspected patients.     

农村自杀者心理解剖条件Logistic回归分析

目的：应用心理解剖的方法探讨农村自杀的危险因素。方法：选择2000年～2001年辽宁省大连金州和庄河地区自杀死亡者66例，并按1：1选取对照组进行问卷调查。结果：本次研究的结果有3个因素作为自杀的重要危险因素保留在最后的方程中，分别为社会支持总分(OR=0．66，95％CI=0．48～0．91)、汉密顿抑郁总分(OR=1．18，95％CI=1．03～1．35)、神经症(OR=2594．59，95％CI=6．29～1069550)。结论：自杀并不是单一因素作用的结果，预防自杀要对多个因素共同干预。     

Risk Factors for the Development of Extended-Spectrum Beta-Lactamase-Producing Bacteria in Nonhospitalized Patients

Although the risk factors for acquiring infection by extended-spectrum beta-lactamase (ESBL)-producing bacteria have been investigated in hospitalized patients, such risk factors have not been defined in the community setting. In this study, clinical data from a total of 311 nonhospitalized patients with community-acquired urinary tract infection (128 with ESBL-positive strains and 183 with ESBL-negative strains) were obtained. According to a multivariate analysis, the following were identified as independent risk factors: previous hospitalization in the past 3 months (OR=8.95, 95%CI, 3.77–21.25), antibiotic treatment in the past 3 months (OR=3.23, 95%CI, 1.76–5.91), age over 60 years (OR=2.65, 95%CI, 1.45–4.83), diabetes (OR=2.57, 95%CI, 1.20–5.51), male gender (OR=2.47, 95%CI, 1.22–5.01), Klebsiella pneumoniae infection (OR=2.31, 95%CI, 1.17–4.54), previous use of third-generation cephalosporins (P=0.014, OR=15.8, 95%CI, 1.7–143), previous use of second-generation cephalosporins (P<0.0001, OR=10.1, 95%CI, 4.2–24), previous use of quinolones (P=0.001, OR=4.1, 95%CI, 1.8–9.0), and previous use of penicillin (P=0.003, OR=4.0, 95%CI, 1.6–9.0).     

Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

Background: Liver transplantation (LT) is associated with a significant risk of intraoperative hemorrhage and massive blood transfusion. However, there are few relevant reports addressing the long-term impacts of massive transfusion (MT) on liver transplantation recipients.Aim: To assess the effects of MT on the short and long-term outcomes of adult liver transplantation recipients.Methods: We included adult patients who underwent liver transplantation at West China Hospital from January 2011 to February 2015. MT was defined as red blood cell (RBC) transfusion of ≥10 units within 48 hours since the application of LT. Preoperative, intraoperative and postoperative information were collected for data analyzing. We used one-to-one propensity-matching to create pairs. Kaplan-Meier survival analysis was used to compare long-term outcomes of LT recipients between the MT and non-MT groups. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors associated with MT in LT.Results: Finally, a total of 227 patients were included in our study. After propensity score matching, 59 patients were categorized into the MT and 59 patients in non-MT groups. Compared with the non-MT group, the MT group had a higher 30-day mortality (15.3% vs 0, p=0.006), and a higher incidence of postoperative complications, including postoperative pulmonary infection, abdominal hemorrhage, pleural effusion and severe acute kidney injury. Furthermore, MT group had prolonged postoperative ventilation support (42 vs 25 h, p=0.007) and prolonged durations of ICU (12.9 vs 9.5 d, p<0.001) stay. Multivariate COX regression indicated that massive transfusion (OR: 2.393, 95% CI: 1.164-4.923, p=0.018) and acute rejection (OR: 7.295, 95% CI: 2.108-25.246, p=0.02) were significant risk factors affecting long-term survivals of LT patients. The 1-year and 3-year survival rates patients in MT group were 82.5% and 67.3%, respectively, while those of non-MT group were 93.9% and 90.5%, respectively. The MT group exhibited a lower long-term survival rate than the non-MT group (HR: 2.393, 95% CI: 1.164-4.923, p<0.001). Finally, the multivariate logistic regression revealed that preoperative hemoglobin <118 g/L (OR: 5.062, 95% CI: 2.292-11.181, p<0.001) and intraoperative blood loss ≥1100 ml (OR: 3.212, 95% CI: 1.586-6.506, p = 0.001) were the independent risk factor of MT in patients undergoing LT.Conclusion: Patients receiving MT in perioperative periods of LT had worse short-term and long-term outcomes than the non-MT patients. Massive transfusion and acute rejection were significant risk factors affecting long-term survivals of LT patients, and intraoperative blood loss of over 1100 ml was the independent risk factor of MT in patients undergoing LT. The results may offer valuable information on perioperative management in LT recipients who experience high risk of MT.     

股骨近端锁定钢板与动力髋螺钉修复股骨转子间骨折的系统评价

背景：股骨近端锁定加压钢板与动力髋螺钉作为临床修复股骨转子间骨折两种主要的髓外固定方法,其疗效孰优孰劣,目前仍有争议。 目的：系统评价解剖型锁定加压钢板与动力髋螺钉治疗股骨转子间骨折的临床疗效,为临床应用提供理论依据。 方法：运用计算机检索1999年1月至2014年4月的PubMed、Embase、Cochrane图书馆、中国知网、维普期刊数据库、万方资源数据库、中国生物医学文献服务系统,搜集解剖型锁定加压钢板与动力髋螺钉修复股骨转子间骨折临床疗效比较的对照研究。制定入选和剔除标准,筛选出符合纳入标准的文献,评价纳入研究的方法学质量。利用 RevMan5.2进行Meta分析。 结果与结论：最终有8篇研究符合纳入标准,共682例患者,其中锁定加压钢板组336例,动力髋螺钉组346例。Meta分析结果显示：锁定加压钢板组的手术时间[MD=-12.07,95%CI(-29.85,5.71),P=0.18]、术中出血量[MD=-15.01,95%CI(-87.85, 57.83),P=0.69]、术后引流量[MD=-13.62,95%CI(-28.49,1.26),P=0.07]、下地活动时间[MD=-0.14,95%CI(-0.68,0.41),P=0.63]、住院时间[MD=-0.74,95%CI(–2.29,0.82),P=0.35]、骨折愈合时间[MD=-1.18,95%CI(-2.78,0.42),P=0.15]均与动力髋螺钉组无明显差别。而对于术后髋关节功能恢复的优良率[OR=2.03,95%CI(1.23,3.36),P=0.006],锁定加压钢板组则明显高于动力髋螺钉组。并发症方面,锁定加压钢板组的髋内翻发生率[OR=0.34,95%CI(0.12,0.96),P=0.04]低于动力髋螺钉组,但对于内固定松动、断裂、退出[OR=1.20,95%CI(0.59,2.45),P=0.61]和总的并发症发生率[OR=0.55,95%CI(0.24,1.28),P=0.16],两者则无明显差别。鉴于纳入研究存在选择性偏倚和测量性偏倚的高度可能性,势必影响结果的论证强度,因此尚需更多设计严谨的临床随机对照研究加以证实。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;组织工程全文链接：     

β1肾上腺素能受体基因389A/G多态性与急性心肌梗死的关系

目的探讨βl肾上腺素能受体基因389A／G多态性与急性心肌梗死（acute myocardial infarcfion，AMI）的关系。方法应用聚合酶链反应-限制性片段长度多态性分析技术检测150例急性心肌梗死患者和150例性别和年龄匹配的对照者的基因型，同时采集相关的临床资料，进行病例．对照统计学分析和多因素参与的回归分析。结果AMI组和对照组在基因型和等位基因频率分布上的差异均有统计学意义（P均〈0．01），A等位基因在AMI组明显高于对照组。在多因素参与的回归分析中，389A／G多态性（OR：2．88，95％CI：1．70—4．88，P〈0．01）、吸烟（OR：2．72，95％CI：1．52—4．88，P〈0．01）、高脂血症（OR：2．85，95％CI：1．68—4．86，P〈0．01）、糖尿病（OR：2．38，95％CI：1．27—4．47，P〈0．01）和高血压（OR：2．00，95％CI：1．62—3．45，P〈0．05）均为AMI的独立危险因素。结论β1肾上腺素能受体基因389A／G多态性与AMI明显相关，为AMI的独立危险因素。     

不同亚型急性脑梗死出血转化的发生及相关危险因素分析

目的　研究不同亚型急性脑梗死出血转化的发生率及相关危险因素。 方法　选择南方医科大学南方医院及中山市人民医院神经内科自2008年1月至2011年12月收治的连续入院的急性脑梗死患者977例,按是否发生出血转化分为出血转化组（HT）142例及非出血转化组（NHT）835例,登记所有患者的基线资料并统计各病例的TOAST分型,分析不同亚型的急性脑梗死患者出血转化的发生率,采用Logistic回归分析脑出血转化的危险因素。 结果　大动脉粥样硬化性、心源性脑梗死、小动脉闭塞型脑梗死出血转化的发生率分别为12.8%、31.1%、6.6%;多因素Logistic回归分析显示出血转化的主要危险因素分别为大面积脑梗死（OR=10.498,95% CI6.520～17.131,P=0.000）、心房纤颤（OR=1.718,95% CI 　1.217～2.941,P=0.005）、糖尿病（OR=1.817,95%CI 1.135～2.903,P=0.012）及抗凝（OR=7.748,95% CI 　2.416～25.847,P=0.000）治疗。高血压、高低密度脂蛋白胆固醇以及抗血小板聚集治疗不是HT的独立危险因素。 结论　不同亚型脑梗死HT发生率不同,心源性脑梗死是脑出血转化的主要原因,大面积脑梗死、心房纤颤、糖尿病及抗凝治疗是HT的独立危险因素。     

Hemofiltration during cardiopulmonary bypass for high risk adult cardiac surgery

AIMS: The role of hemofiltration (HF) during cardiopulmonary bypass (CPB) in adult cardiac surgery is controversial. It may be beneficial during prolonged CPB in high-risk surgery. Accordingly, we sought to compare two groups of patients undergoing high-risk cardiac surgery with or without HF. METHODS: One hundred and eighteen patients who underwent complex cardiac surgical procedures during a 12-month period were divided into two groups. Group I (n=61) comprised patients who were treated with hemofiltration during CPB. Group II (n=57) were not filtered. Estimated risk of death, standard demographic, clinical and surgical features were obtained and predetermined outcomes were studied. Statistical comparisons were made. RESULTS: Age, procedure times and mortality rates were similar in both groups. The mean volume of fluid removed in group I was 3.4 L. The preoperative mean Parsonnet score was 24.8 in group I and 22.5 in group II (ns). Postoperative serum hemoglobin, hematocrit, platelet, and albumin levels were all significantly higher in group I patients (p=0.0015) indicating hemoconcentration. Post-operative chest drainage showed a trend toward decreased post-operative bleeding in group I (p=0.065). Postoperative pleural effusions requiring chest tube drainage were significantly less in group I (9.8% vs. 29.8% 6; p = 0.0062). The incidence of lung infection was also decreased from 26.3% to 13.1% (p=0.05). Operative mortality was similar in both groups (11.4% in group 1, 10.5% in group II, ns). CONCLUSION: Hemofiltration during CPB attenuates postoperative anemia, thrombocytopenia and hypoalbuminemia, may reduce post-operative bleeding and appears to decrease post-operative pulmonary complications.     

髋膝关节置换应用临床路径与传统方法比较的Meta分析

文题释义： 临床路径：患者住院后治疗计划,详细地列举了实现最佳效率所需的一系列措施,临床路径采用多种格式,作为具有文档空间的多页表单或作为日常项目清单的单个页面合并到每日医院进度记录中。 背景：髋膝关节置换已在各级医院普遍开展且手术量逐年增加,手术方法及技巧已发展至瓶颈,所以推广临床路径是目前提升髋膝关节置换临床疗效简单且行之有效的方法。 目的：系统评价髋膝关节置换应用临床路径与传统方法效果的差异。 方法：计算机检索MEDLINE、Cochrane、Embase、CNKI 数字图书馆等数据库,并手工检索查找有关比较进入临床路径与接受传统医疗护理方法髋膝关节置换患者的临床试验研究。由2名评价员独立筛查试验、提取资料和评估方法学质量,采用Cochhrane 协作网提供的RevMan 5.0软件进行Meta分析。 结果与结论：①共纳入符合研究设计标准的临床试验17篇,其中13 篇半随机对照试验,4 篇随机对照试验;②传统方法组的并发症发生率高于临床路径组[OR=0.63,95%CI(0.53,0.74),P < 0.000 01];③目测类比疼痛评分[MD=1.49,95%CI(0.69,2.85),P=0.001]、术后Harris 髋关节评分[MD=19.31,95%CI(-13.98,-4.92),P < 0.000 1]、5年假体生存率[OR=0.59,95%CI(0.36,0.98),P=0.04]临床路径组优于传统方法组,差异有显著性意义;④2组全膝关节置换后下肢机械轴线平均偏差值比较差异无显著性意义[MD=0.00,95%CI(-0.14,0.14),P=0.99];⑤结果表明,与传统技术相比,进入临床路径的髋膝关节置换患者能得到更好的临床疗效,并发症更少,术后关节功能更佳。 ORCID: 0000-0002-4655-6659(董锐) 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     

Polymorphisms of TNF microsatellite marker a and HLA-DR-DQ in diabetes mellitus-a study in 609 Swedish subjects

We explored the importance of the genetic markers microsatellite TNFa, HLA-DR3-DQ2, and DR4-DQ8 in diabetes mellitus. The studied groups comprised autoimmune type 1 (n = 63), nonautoimmune type 1 (n = 35), latent autoimmune diabetes in adults (LADA; n = 54), and nonautoimmune type 2 (n = 340) and these patients were compared to 117 healthy controls. HLA genotyping was done with polymerase chain reaction and sequence-specific oligonucleotides. TNFa microsatellites were determined with polymerase chain reaction and fragment size determination. Univariate analysis of these genetic risk factors demonstrated that homozygosity for TNFa2/2 was a significant risk factor for autoimmune type 1 diabetes (odds ratio (OR) = 5.82; 95% confidence interval (95%CI) 1.97-17.2), for autoimmune negative type 1 diabetes (OR = 4.63; 95%CI 1.32-16.2), and for LADA (OR = 3.90; 95%CI 1.21-12.5). Moreover, heterozygosity for HLA-DR3-DQ2/DR4-DQ8 was an important risk factor for autoimmune type 1 diabetes (OR = 16.4; 95%CI 3.60-75) as was DR4-DQ8/x (OR = 2.52; 95%CI 1.27-4.98). Heterozygosity for HLA-DR3-DQ2/DR4-DQ8 was a risk factor also for LADA (OR = 10.0; 95%CI 2.05-48.9). Neither HLA-DR3-DQ2 nor DR4-DQ8 were risk factors for nonautoimmune type 1 or type 2 diabetes. We concluded that heterozygosity for DR3-DQ2/DR4-DQ8 and to some extent homozygosity for TNFa2/2 were risk factors for autoimmune diabetes irrespective of the clinical classification.     

HSP90B1基因多态性与系统性红斑狼疮易感性的关联研究

目的：探讨HSP90B1基因多态性与中国汉族人群系统性红斑狼疮(SLE)易感性的关系。方法：从医院收集360例对照和360例SLE患者,按照年龄和性别进行匹配。利用Multiplex SNaPshot分型技术对SNP位点分型。采用基于错误发现率 (FDR) 标准的本杰明-汉伯格 (BH) 法进行多重检验校正。结果：显性模型分析发现rs1165681的基因型频率分布在对照组和SLE组之间存在统计学差异(Crude OR = 0.621, 95%CI = 0.450-0.856, P=0.004; Adjusted OR = 0.619, 95%CI = 0.449-0.855, P=0.004);隐性模型分析发现rs10778306 (Crude OR = 0.568, 95%CI = 0.328-0.984,P = 0.044; Adjusted OR = 0.570, 95%CI = 0.329-0.988, P = 0.045)、rs2722188(Crude OR = 0.227, 95%CI = 0.076-0.681, P = 0.008; Adjusted OR = 0.227, 95%CI=0.076-0.682, P=0.008) 的基因型分布在两组之间存在统计学差异。BH法校正后,rs1165681基因型分布在两组之间有统计学差异 (P_BH = 0.044)。单倍型分析后CCATTAGGCAT(OR=0.323, 95%CI=0.154-0.680, P = 0.002)、CCCTTAGGCAC (OR = 1.324, 95%CI = 1.014-1.729, P =0.039)、TCCCTAGTCGC(OR = 0.465, 95%CI = 0.221-0.979, P = 0.039)和TTCTCGGGCAT(OR=0.443, 95%CI = 0.224-0.875, P = 0.016) 与SLE的发病风险有关;BH法校正后,CCATTAGGCAT在两组之间的分布有统计学差异(P_BH = 0.028),其他单倍型均无统计学差异 (P>0.05)。结论：HP90B1基因多态性可能与中国汉族人群的SLE发病有关。