Low body mass index can be predictive of bracing failure in patients with adolescent idiopathic scoliosis: a retrospective study

Purposes

To determine the relationship between low body mass index (BMI) and the outcome of brace treatment in patients with adolescent idiopathic scoliosis (AIS).

Methods

350 braced female AIS patients were included in this study. The baseline characteristics of the patient were recorded at their first visit, including age, Risser sign, digital skeletal age, BMI, curve pattern, and curve magnitude. Underweight was defined as lower than the 5th percentile of the sex- and age-specific BMI. The treatment was considered as a failure if the curve progressed more than 5°, or if patients underwent surgery. According to the final outcome of brace treatment, the cohort was divided into the success group and the failure group. A logistic regression model was created to determine the independent predictors of the bracing outcome.

Results

24.5% (86/350) of the patients were identified as underweight at their initial visit, which was significantly higher than the rate of 13.1% (46/350) at the final follow-up (p < 0.001). At the initial visit of the patients, the rate of underweight was 17.6% (45/255) in the success group, which was significantly lower than the rate of 43.1% (41/95) in the failure group (p < 0.001). Logistic regression analysis showed that low BMI was significantly associated with bracing failure (p < 0.001).

Conclusion

The low BMI could be predictive of bracing failure in AIS patients, which should be taken into account when surgeons prescribe brace treatment to such patients.

     

Relationship between intermedin and renal interstitial capillary loss in IgA nephropathy patients

Objective To explore the relationship between intermedin (IMD) and renal interstitial capillary loss in IgA nephropathy (IgAN) patients. Methods Renal biopsy specimens collected from primary IgAN patients in our hospital (n=80) were compared with normal renal tissues. Expressions of IMD, CD31 and VE-cadherin were examined by immunohistochemical method, and plasma concentrations of IMD and TGF-β1 in 37 cases from the 80 cases were compared. The relationship between IMD and renal interstitial capillary loss in IgAN patients was analyzed. Results IMD and VE-cadherin in renal tubule interstitium expressions increased compared to the control group at the early stage of IgAN (P＜0.05). CD31 expression remained unchanged at the early stage of pathological lesions of IgAN (P＞0.05), but decreased at the early stage of clinical stage of IgAN compared to the control (P＜0.05). Expressions of IMD, CD31 and VE-cadherin were reducing as the disease progressed, and the correlations of CD31 and VE-cadherin (r=0.517, P＜0.01), IMD and CD31 (r=0.655, P＜0.01) or IMD and VE-cadherin (r=0.576, P＜0.01) were positive. Plasma concentrations of IMD and TGF-β1 were higher than those of the control group at the early stage of IgAN (P＜0.05), and the changes of IMD and TGF-β1were correlated positively (r=0.582, P＜0.01). Conclusion Compared with the control group, expression of IMD in kidney tubules increases at the early stage of IgAN, and change of IMD correlates closely with the renal interstitial capillary loss. Plasma concentrations of IMD and TGF-β1 increase compared with the control group at the early stage of IgAN, and the changes of IMD and TGF-β1 are related closely.     

Association between obesity and absolute renal risk factors in patients with IgA nephropathy

Objective To investigate the influence of obesity on renal lesion in IgA nephropathy (IgAN) patients by analyzing the association between obesity and absolute renal risk factors (ARR). Method Clinical-pathological data of IgAN patients diagnosed by renal biopsy in General Hospital of Ningxia Medical University were collected retrospectively. According to the body mass index (BMI), patients were divided into non-obese group (BMI＜28, N-OB group) and obese group (BMI≥28, OB group). Their clinical characteristics, pathological index and ARR scores were compared. The relationship of BMI and ARR was analyzed by ordinal logistic regression models. Results (1) A total of 674 IgAN patients with mean age of 35.5±11.3 years were enrolled, including 94 in OB group and 580 in N-OB group respectively. Compared with those in the N-OB group, the proportion of male, age, mean arterial pressure, blood uric acid, blood triglyceride, diabetes mellitus and hypertension increased in OB group (all P＜0.01). Patients in OB group had lower estimated glomerular filtration rate (eGFR) and higher ARR score than those in N-OB group (all P＜0.05). (2) More severe thickening renal small artery wall and hyaline degeneration were observed in the OB group than in the N-OB group (all P＜0.01). There was no statistical difference between the two groups in Lee classification, Oxford classification, mesangial cell proliferation, glomerular sclerosis, crescent formation, renal tubular atrophy, interstitial inflammatory cell in filtration and endothelial cell proliferation. (3) After adjusting for age, sex, blood uric acid, serum albumin, eGFR, low density lipoprotein, glomerular sclerosis, interstitial inflammatory cell infiltration, renal tubular atrophy and vascular wall thickening, BMI was still an independent risk factors for ARR in IgAN patients (OR=1.09, 95%CI 1.03-1.14). Conclusions BMI is an independent risk factors for ARR in IgAN patients. Early prevention and control of obesity and its associated risk factors may improve outcomes of IgAN patients.     

腹腔镜与开腹手术在老年结直肠癌患者中的应用分析

目的 比较腹腔镜与开腹手术对70岁以上老年结直肠癌患者的近期疗效,并评价腹腔镜手术的安全性和可行性.方法 回顾分析2009年1月-2015年12月仪征市人民医院普外科收治的91例行腹腔镜与开腹手术的70岁以上老年结直肠癌患者的临床资料,其中腹腔镜组38例,开腹组53例.比较两组的手术学指标、术后恢复及并发症发生情况等.数据比较采用t检验、Mann-WhitneyU检验、Pearson x2检验或Fisher确切概率检验.结果 两组患者的年龄、性别、ASA评分、既往腹部手术史、病理分期及慢性合并症构成差异无统计学意义.两组均无死亡病例.腹腔镜组38例,1例(2.1％)因右侧输尿管损伤中转开腹行输尿管修补吻合+双“J”管置入术,传统开腹组53例.腹腔镜组和开腹组手术时间(238 ±71.3) minvs(175±60.8) min、术中出血量(145 ±58) ml vs (186 ±45) ml比较,差异均具有统计学意义(P＜0.05).淋巴结清扫数目(11.6±2.8)枚vs(13.1±3.0)枚,P=0.513,差异无统计学意义,所有标本切缘病理检查均为阴性.腹腔镜组术后首次下床活动时间(2.1±1.7)dvs(2.9±0.8)d、肠功能恢复时间(3.6±0.5)dvs(4.1±0.6)d、进食流质时间(3.3±0.3)dvs(3.9±0.6)d、术后住院时间(11.9±3.9) dvs (14.5±3.7)d,均显著低于开腹组(P＜0.05).术后总并发症23.7％,显著低于开腹组45.3％ (P =0.035);切口感染也显著降低(P=0.017).术中并发症以及术后吻合口瘘、吻合口出血、尿路感染、肺部感染、腹腔感染、肠梗阻、淋巴漏、心律失常、谵妄发病率两组差异均无统计学意义(P＞0.05).结论 老年结直肠癌患者实施腹腔镜手术是安全可行的,近期疗效优于开腹手术.     

早期功能锻炼路径在肝切除患者术后加速康复中的应用

目的 探讨早期功能锻炼路径在肝切除患者术后加速康复应用中的安全性和有效性.方法 选取安徽省立医院肝脏外科2014年12月-2015年8月原发性肝癌行肝切除治疗的患者共50例,根据数字表法随机分为2组,实验组(早期功能锻炼组)和对照组(传统早期活动组),每组均25例,比较两组患者术后住院时间、住院费用、并发症发病率、术后疼痛评分、术后下床活动时间和肠道通气时间.符合正态分析的计量资料以(x±s)表示,组间比较采用f检验,计数资料比较采用x2检验.结果 实验组术后住院时间(7.00±2.27)d,少于对照组(9.36±4.58) d(t =3.090,P=0.003);住院费用实验组(28 184.57±8 675.65)元,低于对照组(32 867.26±10 694.11)元(t=2.281,P=0.025);与对照组比较,实验组患者一般并发症发病率低和总体并发症发病率更低;肠道恢复时间实验组(36.56 h)早于对照组(45.24 h)(均P＜0.05).结论 早期功能锻炼路径在肝切除患者术后加速康复锻炼应用中安全、有效,可以减少患者术后住院时间与住院费用,降低一般并发症发病率,加快肠道功能恢复.     

大庆市社区脑卒中患者残疾状况及影响因素分析

目的了解大庆市社区脑卒中患者残疾率,并探究相关影响因素,以期为此类患者开展社区护理提供参考。方法随机整群抽取大庆市5个社区的311例脑卒中患者,采用一般资料调查表和改良Barthel指数量表(MBI)进行问卷调查。结果社区脑卒中患者总残疾率为38.59%,轻、中、重度残疾率分别为12.86%、7.07%和18.65%。年龄、脑卒中类型、发作次数、高血压为影响社区脑卒中患者残疾的独立危险因素(P0.05,P0.01)。结论大庆市社区脑卒中患者残疾率较高,多种因素影响患者残疾。建议制定社区脑卒中患者康复治疗方案及健康管理体系,改善脑卒中患者的预后,提高其生活质量。     

脑卒中偏瘫患者照顾者睡眠质量、照顾负担与心理弹性的关系

目的评估脑卒中偏瘫患者照顾者睡眠质量、照顾负担与心理弹性状况,探索脑卒中偏瘫患者照顾者心理弹性在照顾负担和睡眠质量间的中介和调节作用。方法采用匹兹堡睡眠质量指数、照顾负担量表、Connor-Davidson心理弹性量表对306名脑卒中偏瘫患者照顾者进行测评。结果照顾者睡眠质量总分为9.3±3.7,睡眠障碍检出率为57.8%;照顾负担总分为35.9±11.2,心理弹性总分为55.0±16.1。照顾负担得分与心理弹性得分呈负相关,与睡眠质量得分呈正相关;心理弹性得分与睡眠质量得分呈负相关(均P0.01)。心理弹性在照顾负担和睡眠质量间起到部分中介和调节作用。结论增强脑卒中偏瘫患者主要照顾者的心理弹性水平,有利于减轻其照顾负担,改善其睡眠质量。     

社区护士对老年居民跌倒预防认知的调查

目的了解社区护士对老年人跌倒预防的认知情况,为制定社区老年人跌倒预防工作方案提供参考。方法采用自行设计的问卷,对宁波市20所社区卫生服务中心的220名护士进行老年人跌倒预防认知情况调查。结果 93.64%社区护士愿意参加老年人跌倒预防知识技能培训,84.54%愿意参与社区老年人跌倒预防管理。社区护士对老年人跌倒预防认知总分(75.54±12.27)分,其中跌倒知识(54.07±10.24)分,知识条目均分为3.40~3.77分,处于中等水平;跌倒态度(21.47±3.60)分,各条目均分为4.20~4.40分,态度总体良好。有无接受过跌倒预防相关知识培训,既往有无对老年人进行跌倒风险评估、有无对老年人进行跌倒预防教育的社区护士在跌倒预防知识得分及总体得分方面存在差异(均P0.01)。结论社区护士对老年人跌倒预防态度较好,但需采取多种形式对社区护士进行跌倒预防相关知识培训,使社区护士更好地掌握老年居民跌倒预防知识和技能。建议开展和推进社区老年人跌倒预防工作。