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1.
目的通过分析老年病人髋关节置换术后静脉血栓栓塞症(VTE)发生的危险因素,建立列线图评价模型,并评价模型预测术后VTE的准确性。方法选择2017年1月至2019年1月期间,四川省骨科医院收治的老年髋关节置换术病人144例为研究对象,其中发生术后VTE的病人24例作为VTE组,另外120例无VTE的病人为对照组。采用单因素、多因素Logistic回归模型,分析老年病人髋关节置换术后VTE的危险因素。根据回归分析结果,建立列线图评价模型。利用ROC曲线及Hosmer-Lemeshow检验评价模型的预测效能。结果多因素分析显示,年龄、血糖、应用骨水泥是发生术后VTE的危险因素,应用预防血栓药物、按计划进行主被动训练是发生术后VTE的保护因素(P<0.05)。根据多因素分析结果,成功建立列线图预测模型。Hosmer-Lemeshow检验结果显示,模型的预测效能为95.83%,模型拟合良好。ROC曲线显示,列线图模型预测老年病人髋关节置换术后VTE的AUC为0.988,特异性为96.77%,敏感性为99.82%。结论基于年龄、血糖、是否应用骨水泥、术后是否应用预防血栓药物治疗、术后是否按计... 相似文献
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目的 分析探讨老年髋关节置换术病人围手术期内并发心力衰竭(心衰)的风险因素,建立列线图预测模型。方法 选取联勤保障部队第940医院198例行髋关节置换术的老年病人,根据围手术期是否并发心衰分为心衰组56例和非心衰组142例。收集所有病人的临床相关资料并进行比较分析,采用Logistic回归分析老年髋关节置换术病人围手术期内并发心衰的影响因素,采用R语言软件包构建列线图预测模型并采用Bootstrap法进行验证。结果 心衰组年龄≥70岁、有高血压史、术前美国麻醉医师协会(ASA)分级Ⅲ~Ⅳ级、术中输血量≥400 mL、术后卧床时间≥4 d比例显著高于非心衰组(P<0.05)。多因素Logistic回归结果显示,年龄、高血压史、术前ASA分级、术中输血量、术后卧床时间均是影响老年髋关节置换术病人围手术期内并发心衰的独立危险因素(P<0.05)。列线图模型预测老年髋关节置换术病人围手术期内并发心衰的预测值与实测值基本一致。ROC曲线验证列线图模型的AUC为0.901,预测效能较高。结论 依据老年髋关节置换术病人围手术期内并发心衰的危险因素构建的列线图模型有较高的预测效能。 相似文献
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目的?构建预测慢性乙型肝炎(chronic hepatitis B, CHB)患者停用核苷(酸)类药物(nucleoside and nucleotide analogs, NAs)后并发慢加急性肝衰竭(acute-on-chronic liver failure, ACLF)风险的列线图模型,并验证模型的预测能力。方法?选取2018年3月—2022年10月我院收治的停用NAs后复发的CHB住院患者作为研究对象,收集患者临床资料,采用单因素和多因素Logistic回归分析其发生ACLF的危险因素,并建立列线图模型。结果?停药持续时间长、HBeAg阳性、总胆红素≥85.5 μmol/L、凝血酶原活动度<50%、血小板计数<100×109/L和白蛋白<35 g/L是CHB患者停用NAs后并发ACLF的独立危险因素(P均<0.05)。模型验证结果显示,一致性指数为0.851(95% CI:0.819~0.883),校准曲线趋近于理想曲线,ROC曲线的AUC为0.847(95% CI:0.759~0.842),在2%~79%预测范围内,模型净获益。结论?CHB患者停用NAs后并发ACLF的危险因素较多,基于危险因素建立的列线图模型对CHB患者停用NAs后并发ACLF风险具有良好的预测效能。 相似文献
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目的 总结超重/肥胖型多囊卵巢综合征(PCOS)患者体外受精/卵胞质内单精子注射—胚胎移植(IVF/ICSI-ET)妊娠失败的危险因素,基于危险因素构建预测超重/肥胖型PCOS患者IVF/ICSI-ET妊娠失败风险列线图(列线图模型)。方法 131例拟行IVF/ICSI-ET的超重/肥胖型PCOS患者,均完成胚胎移植周期,收集其体成分特征变量、实验室检查特征变量及临床病例资料变量等。将131例患者分为训练集91例和验证集40例,采用LASSO回归分析法分析超重/肥胖型PCOS患者IVF/ICSI-ET妊娠失败的独立危险因素。基于独立危险因素,构建列线图模型,分别采用受试者工作特征曲线(ROC)、校准曲线、Hosmer-Lemeshow拟合优度检验评价列线图模型的预测能力、校准度、拟合度,采用临床决策曲线评价列线图模型的临床应用价值。结果 超重/肥胖型PCOS患者IVF/ICSIET妊娠失败的独立危险因素有年龄、身体质量指数、水合率和胰岛素抵抗(λ分别为-0.186、-0.947、-0.064、-0.290)。列线图模型的曲线下面积为0.934,校准曲线及拟合曲线预测列线图模型的校准度、... 相似文献
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目的]分析老年急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后不良心血管事件影响因素,并建立列线图预测模型。 [方法]选取2021年2月—2023年1月在辽宁省金秋医院接受PCI术的老年急性STEMI患者216例,依照术后院内不良心血管事件发生情况划分为发生组(n=33)和未发生组(n=183)。收集所有患者一般资料、实验室指标、影像学检查资料、术后用药资料,采用单因素与多因素Logistic回归分析探究不良心血管事件独立危险因素,根据独立危险因素中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、C反应蛋白/白蛋白比值(CAR)、C反应蛋白与高密度脂蛋白胆固醇比值(CHR)构建列线图预测模型,绘制校准曲线对列线图模型进行验证,并绘制受试者工作特征(ROC)曲线,分析列线图模型的预测效能。 [结果]发生组NLR、PLR、CAR、CHR水平及Gensini评分、血小板聚集率(PAR)明显较未发生组高,左心室射血分数(LVEF)明显较未发生组低(P<0.05);Logistic回归分析结果显示,Gensini评分、LVEF、PAR、NLR、PLR、CAR、CHR是老年急性STEMI患者PCI术后发生不良心血管事件的独立危险因素(P<0.05);根据独立危险因素构建预测老年急性STEMI患者PCI术后发生不良心血管事件风险的列线图模型,模型校准曲线与理想模型较为接近,ROC曲线显示,列线图预测不良心血管事件发生风险的ROC曲线下面积为0.914。 [结论]NLR、PLR、CAR、CHR是影响老年急性STEMI患者PCI术后发生不良心血管事件的独立危险因素,基于以上因素构建的列线图模型能有效预测老年急性STEMI患者PCI术后发生不良心血管事件的风险。 相似文献
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目的:探讨冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后应用主动脉内球囊反搏(intra-aortic balloon pump,IABP)的危险因素,构建预测CABG术后应用IABP风险的列线图模型。方法:回顾性收集2020年3月至2022年9月,在河南省人民医院心脏中心行CABG手术的161例冠心病患者的临床资料,根据CABG术后是否应用IABP将患者分为IABP组(58例)和非IABP组(103例)。通过单因素及多因素Logistic回归分析筛选影响CABG术后应用IABP的危险因素,应用R软件建立预测IABP应用风险的列线图模型,利用ROC曲线下面积(AUC)、校准曲线和Hosmer-Lemeshow拟合优度检验评估列线图预测模型。结果:多因素Logistic回归分析显示:术前NT-proBNP(OR=1.288,95%CI:1.063~1.560,P=0.010)升高、术前肌钙蛋白T(TnT)(OR=2.460,95%CI:1.079~5.383,P=0.032)升高、术前LVEF(OR=0.873,95%CI:0.830~0... 相似文献
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[摘要]?目的?探究住院患者发生耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae, CRKP)血流感染的危险因素,并构建列线图模型。方法?选取2016年1月1日—2021年12月31日我院药学部收治的190例肺炎克雷伯菌(Klebsiella pneumonia, KP)所致血流感染患者作为研究对象,并根据是否耐碳青霉烯类抗菌药物,分为CRKP组(n=40)和碳青霉烯类敏感肺炎克雷伯菌(carbapenem-sensitive Klebsiella pneumonia, CSKP)组(n=150)。Logistic回归模型分析住院患者发生CRKP血流感染的危险因素,并绘制预测CRKP血流感染的列线图模型。使用ROC曲线、校准曲线及Hosmer-Lemeshow(H-L)检验对列线图模型进行验证。结果?感染前1个月内留置导尿管、留置中心静脉导管、使用免疫抑制剂、使用碳青霉烯类抗菌药物以及年龄≥65岁是影响住院患者发生CRKP血流感染的危险因素(P均<0.05)。对列线图进行验证,校准曲线拟合良好,H-L检验χ2 =7.630,P=0.366,AUC为0.817(95% CI:0.739~0.895)。结论?感染前1个月内留置导尿管、留置中心静脉导管、使用免疫抑制剂、使用碳青霉烯类抗菌药物以及年龄≥65岁是住院患者发生CRKP血流感染的危险因素,据此构建的列线图模型对住院患者发生CRKP所致血流感染有较好预测价值,可为临床医护人员制定个体化防治策略提供参考。 相似文献
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目的 探讨肺癌患者术后未快速康复的影响因素,并构建其风险预测列线图模型。方法 选取2020年5月—2023年5月在淮安市第二人民医院接受手术治疗的183例肺癌患者为研究对象,根据患者术后住院时间将其分为未快速康复组(术后住院时间>7 d,n=68)和快速康复组(术后住院时间≤7 d,n=115)。比较两组一般资料、术前实验室检查指标、诊疗情况。肺癌患者术后未快速康复的影响因素分析采用多因素Logistic回归分析;采用R软件构建肺癌患者术后未快速康复的风险预测列线图模型,采用ROC曲线分析列线图模型预测肺癌患者术后未快速康复的区分度,采用H-L拟合优度检验评估列线图模型的拟合情况,采用校准曲线分析列线图模型预测肺癌患者术后未快速康复的校准度。结果 未快速康复组与快速康复组年龄、合并慢性呼吸系统疾病者占比、术前开展肺功能训练者占比、手术方式、手术时间、术中失血量比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、合并慢性呼吸系统疾病、术前开展肺功能训练、手术方式、手术时间是肺癌患者术后未快速康复的独立影响因素(P<0.05)。基于多因素... 相似文献
9.
目的探讨影响老年直肠黏液腺癌(RMAC)患者预后的独立危险因素,并构建可以预测总生存(OS)和肿瘤特异性生存(CSS)的列线图。
方法从美国国家癌症研究所的监测、流行病学和结果数据库(SEER)中收集2010~2016年确诊并登记的、年龄在60岁及以上的RMAC患者共1 657例的临床病理资料,应用R软件按照7:3随机分为训练队列和验证队列。应用单因素及多因素COX回归模型分析影响预后的独立危险因素,并以此构建预测3年和5年总生存以及肿瘤特异性生存的列线图。用C指数评价列线图的预测效能。应用校正曲线在训练队列和验证队列中检查其预测精准度。
结果性别、年龄、婚姻状态、肿瘤组织学分级、TNM分期、放疗、辅助化疗、阳性淋巴结数量和肿瘤大小是影响老年RMAC患者OS的独立预后因素;而婚姻状态、种族、肿瘤组织学分级、TNM分期、辅助化疗、阳性淋巴结和肿瘤大小是影响老年RMAC患者CSS的独立预后因素。所构建的列线图模型,对OS和CSS预测的精准度分别为0.735和0.780。新辅助放疗联合辅助化疗可以提高患者的OS(χ2=7.682,P=0.006)和CSS(χ2=6.476,P=0.011)。
结论本研究发现了影响老年RMAC患者预后的独立危险因素,构建了评价预后的列线图模型。并发现新辅助放疗联合术后辅助化疗可能会改善这部分患者的预后。 相似文献
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目的 通过分析对比剂急性肾损伤(CI-AKI)的发生危险因素,建立预测CI-AKI发生风险的列线图模型并评价其效能。方法 回顾性分析1214例于徐州医科大学附属医院接受PCI的非ST段抬高型急性冠脉综合征(NSTE-ACS)患者,随机分配(2:1比例)至训练集(n=809)和验证集(n=405)。通过LASSO回归及多因素Logistic分析确定CI-AKI的独立危险因素,采用R软件建立发生CI-AKI风险的列线图预测模型,并对该模型进行内部和外部验证,采用C-指数、Calibration校正曲线评价列线图的预测性能。结果 年龄>75岁、左室射血分数(LVEF)、糖尿病、纤维蛋白原与白蛋白比值(FAR)、超敏C反应蛋白(hs-CRP)和淋巴细胞计数为发生CI-AKI的独立危险因素;列线图的C指数在训练集和验证集分别为0.835(95%CI:0.800~0.871)、0.767(95%CI:0.711~0.824),Calibration校正曲线拟合度良好。结论 该列线图模型具有良好的区分度和准确度,可较直观、个体化地识别术前高危患者,对NSTE-ACS患者PCI术后CI-AKI的... 相似文献
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The immunoneuroendocrine role of melatonin 总被引:19,自引:0,他引:19
Georges J. M. Maestroni 《Journal of pineal research》1993,14(1):1-10
Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ. 相似文献
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Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland 总被引:2,自引:0,他引:2
Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland. 相似文献
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Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage. 相似文献
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Martinez-Cecilia D Arjona-Sanchez A Gomez-Alvarez M Torres-Tordera E Luque-Molina A Valenti-Azcarate V Briceno-Delgado J Padillo FJ Lopez-Cillero P Rufian-Pena S 《World journal of gastroenterology : WJG》2008,14(12):1949-1951
Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs. 相似文献
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H.P.J.M. Noteborn P.P. van Balen A.A. van der Gugten I.C. Hart I. Ebels C.A. Salemink 《Journal of pineal research》1993,14(1):11-22
Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the Mr range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [125I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (Ka of 4.7 ± 0.2 × 109 M-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of Mr 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL. 相似文献
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Gary S. Goldberg B.A. Bruce A. Orkin M.D. Lee E. Smith M.D. 《Diseases of the colon and rectum》1994,37(5):439-443
PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae
(16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum
was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy. 相似文献