基于术前系统免疫炎症指数及控制营养状况评分对胰腺癌根治术后列线图预后预测模型的构建及评价

目的基于术前系统免疫炎症指数(SII)及控制营养状况(CONUT)评分探讨影响胰腺导管腺癌(PDAC)根治术后预后的危险因素并建立预后预测模型。方法回顾性收集兰州大学第二医院2014年1月至2019年12月期间确诊为PDAC患者的临床病理资料。采用X-tile软件确定SII最佳截断值,使用Kaplan-Meier法进行生存分析,采用Cox比例风险回归模型对PDAC根治术后预后影响因素进行多因素分析,使用R4.0.5软件绘制1、2、3年生存率的列线图预测模型,然后评价该预测模型的效能并建立网页计算器。结果共131例患者纳入本研究,中位生存时间18.6个月,术后1、2、3年累积总生存率分别为73.86%、36.44%、11.95%。术前SII最佳截断值为313.1,Kaplan-Meier生存曲线分析显示SII>313.1者较SII≤313.1者的预后更差(χ2=8.917,P=0.003)。Cox比例风险回归模型多因素分析结果显示,年龄>65岁、临床分期晚(Ⅲ、Ⅳ期)、术前SII>313.1、CONUT评分>4分是PDAC根治术后影响预后(总生存时间)的独立危险因素(P<0.05)。包括年龄、临床分期、术前SII、CONUT评分及术后化疗构建的列线图预测模型内部验证一致性指数(C指数)为0.669,绘制的列线图校正曲线预测的生存情况与实际观察到的生存情况拟合良好,决策曲线分析显示列线图具有更广的临床净获益(阈值概率为0.05~0.95),网页计算器运行良好。结论年龄、临床分期、术前SII、CONUT评分是PDAC根治术后预后的独立影响因素。通过将年龄、临床分期、术前SII、CONUT评分及术后化疗纳入构建的列线图对PDAC根治术后预后预测更精确,建立的网页计算器更方便医生和患者使用。     

Nutritional outcomes in patients undergoing transoral robotic surgery for head and neck cancers compared to conventional open surgery. Systematic review

This systematic review examined nutritional outcomes in patients undergoing transoral robotic surgery (TORS), compared to open surgery (OS) for head and neck cancer. PUBMED, CINAHL, and Web of Science were systematically reviewed. Target nutritional outcomes included: weight, nutritional status, use of enteral feeding, swallowing function/ability, and time to oral diet. Risk of bias was assessed using the risk of bias in non-randomized studies tool, and certainty of evidence was assessed using grading of recommendations, assessment, development, and evaluation (GRADE). Eight studies were included (total n = 608). Compared to OS, TORS probably reduces short- and long-term enteral feeding use or duration (GRADE “moderate” certainty), may reduce time to full swallow ability (GRADE “low” certainty), but it remains uncertain whether TORS reduces long-term patient reported swallowing function or time to oral feeding (GRADE “very-low” certainty). No studies examined nutritional status or weight. There is limited body of evidence examining nutrition outcomes following TORS. Further studies are warranted, which may improve the certainty of evidence and assist in determining the optimal nutrition care for these patients.     

Socioeconomic dissociations in the neural and cognitive bases of reading disorders

Childhood socioeconomic status (SES) strongly predicts disparities in reading development, yet it is unknown whether early environments also moderate the cognitive and neurobiological bases of reading disorders (RD) such as dyslexia, the most prevalent learning disability. SES-diverse 6–9-year-old children (n = 155, half with RD) completed behavioral and functional magnetic resonance imaging (fMRI) tasks engaging phonological and orthographic processing, which revealed corresponding double-dissociations in neurocognitive deficits. At the higher end of the SES spectrum, RD was most strongly explained by differences in phonological skill and corresponding activation in left inferior frontal and temporoparietal regions during phonological processing—widely considered the “core deficit” of RD. However, at the lower end of the SES spectrum, RD was most strongly explained by differences in rapid naming skills and corresponding activation in left temporoparietal and fusiform regions during orthographic processing. Findings indicate that children’s early environments systematically moderate the neurocognitive systems underlying RD, which has implications for assessment and treatment approaches to reduce SES disparities in RD outcomes. Further, results suggest that reliance on high-SES convenience samples may mask critical heterogeneity in the foundations of both typical and disordered reading development.     

Neighborhood Socioeconomic Disadvantage Associated With Increased Healthcare Utilization After Total Hip Arthroplasty

BackgroundThe multifaceted effects of socioeconomic status on healthcare outcomes can be difficult to quantify. The Area Deprivation Index (ADI) quantifies a socioeconomic disadvantage with higher scores indicating more disadvantaged groups. The present study aimed to describe the ADI distribution for primary total hip arthroplasty (THA) patients stratified by patient demographics and to characterize the association of ADI with healthcare utilization (discharge disposition and length of stay [LOS]), 90-day emergency department (ED) visits, and 90-day all cause readmissions.MethodsTwo thousand three hundred and ninety one patients who underwent primary elective THA over a 13-month period were included. A multivariable binary logistic regression analysis with outcomes of nonhome discharge, prolonged LOS (>3 days), 90-day ED visits, and 90-day readmission were performed using predictors of ADI, gender, race, smoking status, body mass index, insurance status, and Charlson comorbidity index. Plots of restricted cubic splines were used to graph associations between ADI as a continuous variable and the outcomes of interest using odds ratios.ResultsIn the multivariable regression model, there were statistically significant higher odds of nonhome discharge (OR, 1.82; 95% CI, 1.19-2.77, P = .005) for individuals in the 61-80 ADI quintile as compared to the reference group of 21-40. Individuals in the highest ADI quintile, 81-100, had the greatest odds of nonhome discharge (OR, 2.20; 95% CI, 1.39-3.49, P < .001) and prolonged LOS (OR, 1.91, 95% CI, 1.28-2.84, P = .001).ConclusionsHigher ADI is associated with an increased healthcare utilization within 90 days of THA.     

康复计划对腹膜透析病人社会回归的影响

目的:通过对腹膜透析患者实施以五“E”为中心的康复计划,提高其生活质量,最终达到社会回归。方法:对腹膜透析患者进行包括体液控制、饮食指导、运动康复、心理辅导4个方面的康复治疗,观察治疗12周前后患者的生活状态变化,将患者分为3级。结果:实施康复治疗前后患者生活状态等级构成比分别为:治疗前1级:50%,2级:40.6%,3级:9.4%;治疗后1级:14.1%,2级:28.1%,3级:57.8%,经检验差异有显著性意义(P<0.001)。治疗后有37例患者达到3级,其中6例重新参加工作,2例从事志愿者活动,其余患者能象同年龄的正常人一样生活。结论:以五“E”为中心的康复计划可提高腹膜透析患者的生活质量,促进社会回归。     

临床护士的心理状况分析

目的了解综合医院护士心理健康水平状况，探索改进方法。方法对551名护士采用症状自评量表(SCL—90)进行问卷测试，使用SPSS1O．0软件统计分析。结果被测总体心理健康状况尚好，被测群体的依从性较强；工作6-10年的护士身心健康状况明显差于5年以下工龄的护士。结论提示管理者注意管理方法，关心10年内工龄的护士，提高其心理适应能力，调动10年以上工龄护士的工作积极性，增强群体活力。     

企业员工心肺复苏知识的认知现状及技能培训的探讨

目的了解企业员工对心肺复苏（cardiopulmonary resuscitation，CPR）知识的认知及需求状况，探讨对企业员工进行CPR知识与技能培训的方法和意义。方法通过整群抽样的方法，对111名参加CPR培训的企业员工进行问卷调查，了解企业员工对CPR知识的认知现状及需求情况，并比较不同年龄及学历层次者和受过专门CPR培训员工的CPR知识得分情况。结果企业员工心肺复苏知识缺乏，平均得分为（3．36±1．82）分；不同年龄及学历层次的企业员工对CPR知识的掌握情况，无统计学差异；曾接受过培训的企业员工CPR知识测评得分较高（P〈0．01）；企业员工有强烈的学习需求，99．09％的员工认为有必要举办相关培训班。结论企业员工需要通过专门的CPR培训以提高CPR知识和技能，培训形式应多样化，且有必要进行定期的重复培训；企业员工参加CPR培训是普及CPR知识与技能、提高我国现场急救水平、降低院前病死率的一条有效途径。     

Determinants of post-intensive care mortality in high-level treated critically ill patients

Objective To assess the predictive ability of preillness and illness variables, impact of care, and discharge variables on the post-intensive care mortality.Setting and patients 5,805 patients treated with high intensity of care in 89 ICUs in 12 European countries (EURICUS-I study) surviving ICU stay.Methods Case-mix was split in training sample (logistic regression model for post-ICU mortality: discrimination assessed by area under ROC curve) and in testing sample. Time to death was studied by Cox regression model validated with bootstrap sampling on the unsplit case-mix.Results There were 5,805 high-intensity patients discharged to ward and 423 who died in hospital. Significant odds ratios were observed for source of admission, medical/surgical unscheduled admission, each year age, each SAPSII point, each consecutive day in high-intensity treatment, and each NEMS point on the last ICU day. Time to death in ward was significantly shortened by different source of admission; age over 78 years, medical/unscheduled surgical admission; SAPSII score without age, comorbidity and type of admission over 16 points; more than 2 days in high-intensity treatment; all days spent in high treatment; respiratory, cardiovascular, and renal support at discharge; and last ICU day NEMS higher than 27 pointsConclusions Worse outcome is associated with the physiological reserve before admission in the ICU, type of illness, intensity of care required, and the clinical stability and/or the grade of nursing dependence at discharge.This study was supported in part, by the Foundation for Research on Intensive Care in Europe (FRICE) and by a grant from the Commission of the European communities (BMH1-CT93-1340)     

机械通气患者的脱机（附85例分析）

分析了８５例机械通气患者恢复时的脱机过程。列举２例脱机困难者的处理。讨论了脱机患者的病理生理改变，脱机标准的掌握和营养支持与脱机的关系。认为脱机时机的掌握，脱机过程的调节，以及必要的营养支持有益于顺利脱机。