Risk factors for 90-day all-cause mortality in post-operative central nervous system infections (PCNSIs): A retrospective study of 99 patients in China

Post-operative central nervous system infections (PCNSIs) are serious complications of craniotomy. Many factors, including patient-related, surgical, and postoperative factors, affect the survival of patients with PCNSIs. Timely and effective implementation of antibiotics targeting pathogenic bacteria is crucial to reduce mortality. Metagenomic next-generation sequencing (mNGS) has been used successfully to detect pathogens associated with infectious diseases. This study was designed to evaluate the factors influencing mortality and to explore the application value of mNGS in patients with PCNSIs. We conducted a retrospective study of patients with PCNSIs in our unit from 1/12/2019 to 28/2/2021. Clinical data, cerebrospinal fluid (CSF) parameters, surgical information, and mNGS results were collected. Follow-up telephone calls were made in June 2021 for 90 days survival after discharge. 99 patients were enrolled, and the overall mortality rate was 36.4% (36/99). Kaplan–Meier survival analysis suggested that the risk factors for poor prognosis included age ≥ 53 years, Glasgow Coma scale (GCS) score ≤ 8, CSF/blood glucose ratio (C/B-Glu) ≤ 0.23, 2 or more operations, mechanical ventilation (MV), and non-mNGS test. MV and poor wound healing were independent risk factors for 90 day mortality according to the multivariate Cox proportional hazards model (OR = 6.136, P = .017, OR = 2.260, P = .035, respectively). Among the enrolled patients, causative pathogens were identified in 37. Gram-negative pathogens were found in 22 (59.5%) patients, and the remaining 15 (40.5%) were Gram-positive pathogens. Univariate analysis showed that white cell count and protein and lactate levels in the CSF of the Gram-negative group were higher than those of the Gram-positive group (P < .05). mNGS and conventional microbiological culture were tested in 34 patients, and the positive detection rate of mNGS was 52.9%, which was significantly higher than that of microbiological culture (52.9% vs 26.5%, χ² = 4.54, P = .033). The mortality rate of PCNSIs is high, and patients with MV and poor wound healing have a higher mortality risk. Gram-negative pathogens were the predominant pathogens in the patients with PCNSIs. mNGS testing has higher sensitivity and has the potential to reduce the risk of mortality in patients with PCNSIs.     

Avaliação do Impacto da Implantação de um Sistema de Ambulância Pré-Hospitalar sobre Mortalidade por Infarto Agudo do Miocárdio em um País em Desenvolvimento

BackgroundThe effective management of patients with acute myocardial infarction (AMI) is time-dependent.ObjectivesTo assess the impacts of the implementation of prehospital care on admission rates and mortality associated with AMI.MethodsRetrospective, ecological study, which assessed data from the Brazilian Universal Health System, from all 853 municipalities of Minas Gerais, from 2008 to 2016. Excessive skewness of general and in-hospital mortality rates was smoothed using the empirical Bayes method. This study assessed the relationship between Mobile Emergency Care Service (SAMU) in each municipality and the following 3 outcomes: mortality rate due to AMI, AMI in-hospital mortality, and AMI hospitalization rate, using the Poisson hierarchical model. Rates were corrected by age structure and detrended by seasonality and temporal influences. A confidence interval of 95% was adopted.ResultsAMI mortality rates decreased throughout the study, on average 2% per year, with seasonal variation. AMI in-hospital mortality also showed a decreasing trend, from 13.81% in 2008 to 11.43% in 2016. SAMU implementation was associated with decreased AMI mortality (odds ratio [OR] = 0.967, 95% confidence interval [CI] 0.936 to 0.998) and AMI in-hospital mortality (OR = 0.914, 95% CI 0.845 to 0.986), with no relation with hospitalizations (OR = 1.003, 95% CI 0.927 to 1.083).ConclusionSAMU implementation was associated with a modest but significant decrease in AMI in-hospital mortality. This finding reinforces the key role of prehospital care in AMI care and the need for investments on this service to improve clinical outcomes in low- and middle-income countries.     

国家谈判药品门诊医保待遇现状、问题及完善措施

2017-2019年国家医保目录准入谈判有效缓解了高值创新药品的"看病贵"难题。但"重住院、轻门诊"医保现状使得谈判药品门诊实际报销水平较低,进而影响患者的健康福利。本文以97个谈判药品、337个统筹市为统计样本,实证分析门诊用药的医保报销情况,结果显示有40个品种在大部分统筹市(统筹市占比超过70%)的实际报销水平低于50%。进一步探究门诊待遇低的原因发现未纳入门诊特殊政策、或门诊特殊政策不完善是其主要原因。最后,本文基于国内各统筹市门诊补偿政策经验提出提高门诊保障待遇的建议与方案,认为各统筹市可通过实现门诊统筹、完善门诊特殊政策、探索创新支付等手段提高谈判药品门诊保障待遇,确保医保目录准入谈判结果落地工作的顺利实施。     

移动医疗干预在HIV相关人群中应用研究进展

近年来,移动医疗（mhealth）因移动通信技术的快速迅猛发展而成为公共卫生领域的研究热点。作为一种新兴干预手段,mhealth在加强艾滋病预防、治疗、护理和支持方面表现出巨大的发展潜力。尤其在全球卫生资源分布不均衡,仅靠传统医疗手段进行人类免疫缺陷病毒（HIV）防控难以满足各个国家需求的背景下,利用mhealth干预加强HIV防控,是全球尤其是HIV高发的中低收入国家和偏远地区的有利选择。为此,本文通过文献综述,分析国内外mhealth干预在HIV相关人群中的应用研究及效果,为未来中国HIV相关人群的mhealth应用研究提供参考。     

医学评估对孤独症谱系障碍儿童训练效果影响的研究

目的 探索医学评估对孤独症谱系障碍(ASD)儿童康复训练的影响。方法 采用Gesell发育量表、社会生活能力量表(SM)、社会沟通能力问卷(SCQ)分别对特教学校67名ASD儿童的发育水平、社会生活能力,社会交流能力进行评估。然后对其中48名干预组儿童,根据其发育年龄、实际生活能力制定干预目标,由特教老师根据目标,制定符合其发育水平的个体化训练方案实施训练。对19名对照组儿童按特教学校原有日常康复训练课程进行训练。训练1年后,采用同样方法再次进行评估。结果 干预组儿童训练后,在适应性、语言、沟通能力方面的进步情况好于对照组,差异有统计学意义。结论 在医学评估的基础上对ASD儿童制定康复训练方案,有利于促进ASD儿童发育水平、社会生活能力,沟通能力的提高。     

Comparative Prospective and Longitudinal Analysis on the Platelet-to-Lymphocyte,Neutrophil-to-Lymphocyte,and Albumin-to-Globulin Ratio in Patients with Non-Metastatic and Metastatic Prostate Cancer

Purpose: To prospectively evaluate the albumin/globulin ratio (AGR), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) diagnostic and prognostic predictive value in a stratified population of prostate cancer (PC) cases. Methods: Population was divided based on the clinical and histologic diagnosis in: Group A: benign prostatic hyperplasia (BPH) cases (494 cases); Group B: all PC cases (525 cases); Group B1: clinically significant PC (426 cases); Group B2: non-metastatic PC (416 cases); Group B3: metastatic PC (109 cases). NLR, PLR, and AGR were obtained at the time of the diagnosis, and only in cases with PC considered for radical prostatectomy, determinations were also repeated 90 days after surgery. For each ratio, cut-off values were determined by receiver operating characteristics curve (ROC) analysis and fixed at 2.5, 120.0, and 1.4, respectively, for NLR, PLR, and AGR. Results: Accuracy in predictive value for an initial diagnosis of clinically significant PC (csPC) was higher using PLR (0.718) when compared to NLR (0.220) and AGR (0.247), but, despite high sensitivity (0.849), very low specificity (0.256) was present. The risk of csPC significantly increased only according to PLR with an OR = 1.646. The percentage of cases with metastatic PC significantly increased according to high NLR and high PLR. Accuracy was 0.916 and 0.813, respectively, for NLR and PLR cut-off, with higher specificity than sensitivity. The risk of a metastatic disease increased 3.2 times for an NLR > 2.5 and 5.2 times for a PLR > 120 and at the multivariate analysis. Conclusion: PLR and NLR have a significant predictive value towards the development of metastatic disease but not in relation to variations in aggressiveness or T staging inside the non-metastatic PC. Our results suggest an unlikely introduction of these analyses into clinical practice in support of validated PC risk predictors.     

武汉市居民社区卫生服务需求调查

目的 了解湖北省武汉市社区居民卫生服务需求,为促进社区卫生服务工作提供科学依据。方法 采取现况调查方法,对武汉市10个社区2 026名居民进行社区卫生服务需求调查。结果 38.4%的社区居民将慢性病防治放在第1位,其次为健康体检与健康管理（19.0%）、健康教育（17.0%）;社区居民需求的健康保健信息依次为预防疾病知识（44.9%）、健康生活知识（16.6%）和健康饮食知识（12.7%）;喜欢的健康教育方式依次为专家授课（32.5%）、面对面咨询（30.5%）、阅读健康教育资料（18.2%）;愿意接受的家庭健康服务依次为居家疾病护理（37.0%）、预防保健（22.3%）和饮食营养（21.1%）。结论 武汉市居民社区卫生服务需求较为广泛,应重点加强社区卫生服务项目、健康保健信息、健教方式、家庭健康服务等建设。