婴幼儿室间隔缺损合并重度肺动脉高压围手术期预后影响因素分析

目的探讨婴幼儿室间隔缺损合并重度肺动脉高压患者围手术期预后的影响因素,为此类患者的预后判断提供参考。方法选取2004～2012年北京安贞医院40例室间隔缺损合并重度肺动脉高压（PAPm〉50mmHg）的手术治疗患儿,男21例、女19例,年龄（7．2±3.3）岁,体重（19．6±7．1）kg。入选患儿随机分成两组：组Ⅰ（Group=0,n=20,男／女：12／8）经中心静脉持续泵入硝酸甘油;组Ⅱ（Group=1,n=20,男／女：9／11）,经中心静脉持续泵人前列腺素E1（PGE1）脂质微球。以气管内插管时间（Tintubation）为因变量（Y）,以患者年龄（Age）、体外循环时间（TCPB）、术后平均肺动脉压（PAPm）、术后肺血管阻力指数（PVRI）、术后体循环压力／肺循环压力（Ps/p）、用药分组（Group）、术后左心室每搏功指数（LVSWI）和术后右心室每搏功指数（RVSWI）为自变量（X）,采用多因素线性回归分析模型评价各影响因素的作用。结果40例患儿围手术期无死亡,无严重并发症发生。婴幼儿室间隔缺损合并重度肺动脉高压患者围手术期预后影响因素包括药物分组[Group,x1,P=0．004,95％CI（-71,-16）]、TCPB[x2,P=0．011,95％CI（0．9,5．8）]、术后PAPm[x3,P=0．004,95％CI（3．2,13．3）]、术后RVSWI[x4,P=0．003,95％CI（-16．9,-4．3）]和术后PVRI[x5,P=0．03,95％CI（-0．29,-0．02）]。标准化回归系数的回归方程为：Y=-0．60x1＋0．54x2＋2．22x3-1．70x4-0．15x5。结论在婴幼儿室间隔缺损合并重度肺动脉高压围手术期临床监测指标中,是否应用PGE1脂质微球、TCPB、术后PAPm、术后RVSWI和术后PVRI与患儿的预后转归密切相关。     

胸外科手术患者PACU滞留时间延长的多因素分析

目的分析胸外科手术后患者麻醉后监护室(PACU)滞留时间延长(120min)的影响因素。方法回顾性分析495例胸外科手术患者的麻醉复苏记录单,按Logistic回归分析的要求进行量化或赋值,先行单因素回归,筛选有显著差异的各个因素再做多因素非条件回归分析。结果单因素回归分析:年龄60岁(OR=2.411,95%CI 1.592~3.742),ASA分级每增加1级(OR=1.833,95%CI 1.209~2.780),尿量20ml/h(OR=0.173,95%CI 0.065~0.458),术中心血管活性药物使用(OR=1.613,95%CI 1.198~2.173)对患者PACU滞留时间有明显影响。多因素回归分析:年龄60岁(OR=2.322,95%CI 1.448~3.722),术中心血管活性药物使用(OR=1.441,95%CI 1.050~1.976),尿量≤20ml/h(OR=0.139,95%CI 0.049~0.396)为PACU滞留时间延长的独立危险因素。结论胸外科手术患者PACU滞留时间延长的相关因素有年龄60岁、尿量≤20ml/h、术中使用血管活性药物、ASA分级增加。     

Results of a comparative study analyzing octogenarians with renal cell carcinoma in a competing risk analysis with patients in the seventh decade of life

ObjectivesTo analyze clinicopathological features and survival of surgically treated patients with renal cell carcinoma (RCC)≥80 years of age in comparison with patients between the ages of 60 and 70 years.Materials and methodsThe data for 2,516 patients with a median follow-up of 57 months were retrieved from a multinational database (Collaborative Research on Renal Neoplasms Association [CORONA]), including data for 6,234 consecutive patients with RCC after radical or partial nephrectomy. Comparative analysis of clinicopathological features of 241 octogenarians (3.9% of the database) and 2,275 reference patients between the ages of 60 and 70 years (36.5%) was performed. Multivariable regression analysis adjusted for competing risks was applied to identify the effect of advanced age on cancer-specific mortality (CSM) and other-cause mortality (OCM). Furthermore, instrumental variable analysis was employed to reduce residual confounding by unmeasured parameters.ResultsSignificantly more women were present (50% vs. 40%, P = 0.004), and significantly less often nephron-sparing surgery was performed in octogenarians compared with the reference group (11% vs. 20%, P<0.001). Although median tumor size and stages did not significantly defer, older patients less often had advanced or metastatic disease (N+/M1) (4.6% vs. 9.6%, P = 0.009). On multivariable analysis, higher CSM (hazard ratio = 1.48, P = 0.042) and OCM rates (hazard ratio = 4.32, P<0.001) were detectable in octogenarians (c-indices = 0.85 and 0.72, respectively). Integration of the variable age group in multivariable models significantly increased the predictive accuracy regarding OCM (6%, P<0.001), but not for CSM. Limitations are based on the retrospective study design.ConclusionsOctogenarian patients with RCC significantly differ in clinical features and display significantly higher CSM and OCM rates in comparison with their younger counterparts.     

Risk Factors for Highly Pathogenic Avian Influenza in Commercial Layer Chicken Farms in Bangladesh During 2011

A case–control study conducted during 2011 involved 90 randomly selected commercial layer farms infected with highly pathogenic avian influenza type A subtype H5N1 (HPAI) and 175 control farms randomly selected from within 5 km of infected farms. A questionnaire was designed to obtain information about potential risk factors for contracting HPAI and was administered to farm owners or managers. Logistic regression analyses were conducted to identify significant risk factors. A total of 20 of 43 risk factors for contracting HPAI were identified after univariable logistic regression analysis. A multivariable logistic regression model was derived by forward stepwise selection. Both unmatched and matched analyses were performed. The key risk factors identified were numbers of staff, frequency of veterinary visits, presence of village chickens roaming on the farm and staff trading birds. Aggregating these findings with those from other studies resulted in a list of 16 key risk factors identified in Bangladesh. Most of these related to biosecurity. It is considered feasible for Bangladesh to achieve a very low incidence of HPAI. Using the cumulative list of risk factors to enhance biosecurity pertaining to commercial farms would facilitate this objective.     

肝门部胆管癌的外科治疗及预后影响因素分析

目的总结肝门部胆管癌的治疗并探讨其预后的影响因素。方法回顾性分析2000年1月至2010年12月期间笔者所在医院收治的189例肝门部胆管癌患者的临床资料,采用Cox比例风险模型进行预后影响因素的多因素分析。结果189例肝门部胆管癌患者中,行根治性手术切除62例,行姑息性手术切除54例,行非切除I生手术73例。多因素分析结果显示,手术方式（RR=0．165）、分化程度（RR=2．692）、淋巴结转移（RR=3．014）、神经浸润（RR=2．857）和血管浸润（RR=2．365）均是预后的独立影响因素（P〈0.05）。结论根治性切除术是治疗肝门部胆管癌的最佳手术方法,有效的肝十二指肠韧带“骨骼化”、受侵神经和血管的彻底切除是改善患者预后的重要因素。     

Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging

Background

The purpose of this analysis is to describe the differences in cardiac magnetic resonance characteristics between benign and malignant tumors, which would be helpful for surgical planning.

急性重度颈脊髓损伤患者临床特征分析及远期死亡危险因素初探

目的:总结重度创伤性颈脊髓损伤患者临床特征,分析影响其远期死亡的相关因素。方法:回顾性分析我院2010年1月1日～2018年5月31日收治的207例重度颈脊髓损伤患者临床特点,统计其人口学特征(性别、年龄等)、致伤因素、损伤特点(责任节段、AISA分级、合并伤等)、住院治疗情况(是否手术、手术方式、手术时机等)和并发症以及远期死亡情况,建立二元Logistic回归模型分析远期死亡的危险因素。结果:男性183例,女性24例,男女比例为7.63∶1,年龄15～74岁,平均44.7±13.7岁,以高能量损伤(包括高处坠落、车祸、重物砸伤以及其他复合伤)多见(159例,76.8%),50岁以下患者134例(64.73%),损伤节段C1～C2(3例,1.4%)、C3(28例,13.5%)、C4～C5(124例,58%)、C6(25例,12.1%)、C7(26例,12.6%)、C8(5例,2.4%),所有患者治疗受伤至住院时间3.6±3.5d,住院时间为16.2±16.9d;住院期间以呼吸系统(63例,30.4%)和水电解质紊乱(25例,12.1%)为主要并发症。8年间总死亡率为30.91%(64例),多元Logistic回归分析显示,年龄≥50岁、C1-C4损伤、保守治疗、需要呼吸机辅助呼吸是远期死亡的危险因素(P0.05)。结论:重度创伤性颈脊髓损伤常见于中青年男性患者,损伤部位好发于C4、C5节段,以高能量暴力创伤为主;高龄、上颈椎损伤、未行手术减压及合并呼吸功能障碍易导致患者远期死亡。     

骨创伤患者并发静脉血栓栓塞症的影响因素分析

目的探讨烟威地区骨创伤患者并发静脉血栓栓塞症的影响因素。方法取山东省文登整骨医院2012年1月至2016年12月骨科收治的31 652例骨创伤住院患者作为研究对象(烟威地区),采用彩色多普勒超声或静脉造影进行检查,最终确诊1 424例并发静脉血栓栓塞症患者。回顾性分析入组患者基本资料,包括性别、年龄、既往病史、吸烟史、骨创伤部位、深静脉血栓(deep venous thrombosis,DVT)好发部位、伴随疾病等进行单因素和多因素Logistic回归分析,分析骨创伤患者并发静脉血栓栓塞症的影响因素。结果 31 652例骨创伤住院患者中,1 424例确诊为并发静脉血栓栓塞症,发生率为4.50%。其中,DVT 1 304例,发生率为4.12%,肺栓塞(pulmonary embolism,PE)237例,发生率为0.74%。单因素及多因素Logistic分析结果显示:骨创伤患者并发静脉血栓栓塞症发生率与年龄、是否需要长期制动、骨创伤部位、糖尿病、D-二聚体水平、简明损伤分级(abbreviated injury scale,AIS)及创伤严重程度评分(injury severity scale,ISS)具有统计学意义(P<0.05)。结论骨创伤患者并发静脉血栓栓塞症发生率与年龄、是否需要长期制动、骨创伤部位、糖尿病及D-二聚体水平、AIS分级及ISS评分关系密切。     

基于贝叶斯网络不确定性推理的肺癌风险预测模型

目的 将贝叶斯网络与Cox模型相结合,预测包含缺失协变量的个体的肺癌发病风险。方法 研究使用的数据来自于英国生物样本库,采用单因素Cox回归分析筛选与肺癌发病相关的预测因素;基于识别出的肺癌潜在预测因素,应用上述联合模型建立个体化肺癌风险预测模型;从鉴别和校准两方面评价模型的预测性能。结果 建立的预测模型具有较好的鉴别和校准能力,训练和验证队列的AUC分别为0.854(95%CI:0.836～0.870)和0.885(95%CI:0.871～0.897)。结论 本研究构建了基于贝叶斯网络和Cox模型的肺癌风险预测模型;该模型具有良好的鉴别和校准能力,能有效预测肺癌发病高危人群;联合模型在存在缺失预测因子的情况下提供了一种有效的风险预测方法,可为肺癌预防控制提供理论支撑。