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41.
把腹部局部解剖学与临床知识相结合,特别是与急腹症和腹部外科手术相结合,可以提高学生的学习兴趣和热情,提高教学质量;也可以为学生下一步学习临床学科及将来的临床工作奠定坚实的基础,架起方便的桥梁. 相似文献
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Wisit Kaewput Charat Thongprayoon Tananchai Petnak Api Chewcharat Boonphiphop Boonpheng Tarun Bathini Saraschandra Vallabhajosyula Wisit Cheungpasitporn 《The American journal of the medical sciences》2021,361(1):69-74
BackgroundThis study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilization of hospitalization for methanol intoxication in the United States.Materials and MethodsA total of 603 hospitalized patients with a primary diagnosis of methanol intoxication from 2003 to 2014 were identified in the National Inpatient Sample database. The inpatient prevalence, clinical characteristics, treatments, outcomes, resource utilization, were investigated. Multivariable logistic regression was performed to identify factors independently associated with in-hospital mortality.ResultsThe overall inpatient prevalence of methanol intoxication among hospitalized patients was 6.4 cases per 1,000,000 admissions in the United States. The mean age was 38±18 (range 0–86) years. 44% used methanol for suicidal attempts. 20% of admissions required mechanical ventilation, and 40% required renal replacement therapy. The three most common complications were metabolic acidosis (44%), hypokalemia (18%), and visual impairment or optic neuritis (8%). The three most common end-organ failures were renal failure (22%), respiratory failure (21%), and neurological failure (17%). 6.5% died in the hospital. Factors associated with increased in-hospital mortality included alcohol drinking, hypernatremia, renal failure, respiratory failure, circulatory failure, and neurological failure. The mean length of hospital stay was 4.0 days. The mean hospitalization cost per patient was $43,222ConclusionThe inpatient prevalence of methanol intoxication in the United States was 6.4 cases per 1,000,000 admissions. The risk of in-hospital mortality mainly depended on the number of end-organ failures. 相似文献
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Diana L. Vork Terry D. Schneekloth Adam C. Bartley Lisa E. Vaughan Maria I. Lapid Sheila G. Jowsey-Gregoire Ziad M. El-Zoghby Sandra M. Herrmann Cheryl L. Tran Robert C. Albright LaTonya J. Hickson 《Mayo Clinic proceedings. Mayo Clinic》2018,93(3):321-332
Objective
To examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy.Patients and Methods
Antidepressant use, hospitalizations, and emergency department (ED) visits were examined in young adults (N=130; age, 18-44 years) initiating HD (from January 1, 2001, through December 31, 2013) at a midwestern US institution. Primary outcomes included hospitalizations and ED visits during the first year.Results
Depression diagnosis was common (47; 36.2%) at HD initiation, yet only 28 patients (21.5%) in the cohort were receiving antidepressant therapy. The antidepressant use group was more likely to have diabetes mellitus (18 [64.3%] vs 33 [32.4%]), coronary artery disease (8 [28.6%] vs 12 [11.8%]), and heart failure (9 [32.1%] vs 15 [14.7%]) (P<.05 for all) than the untreated group. Overall, 68 (52.3%) had 1 or more hospitalizations and 33 (25.4%) had 1 or more ED visits in the first year. The risk of hospitalization during the first year was higher in the antidepressant use group (hazard ratio, 2.35; 95% CI, 1.39-3.96; P=.001), which persisted after adjustment for diabetes, coronary artery disease, and heart failure (hazard ratio, 1.94; 95% CI, 1.22-3.10; P=.006). Emergency department visit rates were similar between the groups.Conclusion
Depression and antidepressant use for mood indication are common in young adult incident patients initiating HD and and are associated with higher hospitalization rates during the first year. Further research should determine whether antidepressants are a marker for other comorbidities or whether treated depression affects the increased health care use in these individuals. 相似文献49.
《Nutrition, metabolism, and cardiovascular diseases : NMCD》2022,32(3):577-585
Background and aimsFamilial hypercholesterolemia (FH) is a common inherited disorder of low-density lipoprotein (LDL) catabolism that causes elevated LDL-cholesterol (LDL-C) and premature atherosclerotic cardiovascular disease (ASCVD). Despite the availability of effective treatments, FH remains underdiagnosed and undertreated. The aims of the study were to identify putative FH subjects using data from laboratory and cardiology databases, genetically characterize suspected FH patients referred to the Lipid Clinic and monitor attainment of treatment goals in identified patients.Methods and resultsWe retrieved the electronic health records of 221,644 individuals referred to laboratory for routine assessment and of 583 ASCVD patients (age ≤65) who underwent percutaneous transluminal coronary angioplasty (PTCA). We monitored the lipid profiles of subjects with LDL-C ≥ 250 mg/dl identified by laboratory survey (LS-P), PTCA patients and patients from the Lipid Clinic (LC-P). The laboratory survey identified 1.46% of subjects with LDL-C ≥ 190 mg/dl and 0.08% with LDL-C ≥ 250 mg/dl. Probable/definite FH was suspected in 3% of PTCA patients. Molecularly-confirmed FH was found in 44% of LC-P subjects. Five new LDLR mutations were identified. The 50% LDL-C reduction target was achieved by 70.6% of LC-P patients. Only 18.5% of PTCA patients reached the LDL-C < 55 mg/dl target.ConclusionBy using a combined approach based on laboratory lipid profiles, documented ASCVD and Lipid Clinic data, we were able to identify subjects with a high probability of being FH. Attainment of LDL-C goals was largely suboptimal. Efforts are needed to improve FH detection and achievement of lipid targets. 相似文献
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目的探寻冠状动脉慢血流现象(CSFP)的临床危险因素,了解冠状动脉形态对心肌梗死溶栓治疗试验(TIMI)血流的影响,推测CSFP的发病机制。方法回顾性收集2017年1月至2019年7月于兰州大学第一医院心脏中心行冠状动脉造影无狭窄病变的患者256例,根据TIMI血流帧数将其中血流减慢的患者设为CSFP组(100例),将血流正常患者设为对照组(156例),按年龄和性别匹配。收集患者临床数据和冠状动脉造影数据,采用二元logistic回归模型分析CSFP的危险因素,并采用Pearson相关分析检验冠状动脉形态学参数与平均校正的TIMI帧数(cTFC)的相关性。结果CSFP组同型半胱氨酸[(22.07±7.27)mmol/L比(18.16±6.63)mmol/L]、中性粒细胞百分比[(44.40±15.60)%比(35.43±12.49)%]、淋巴细胞百分比[3.65%(1.32%,24.65%)比1.80%(1.02%,6.22%)]、平均血小板体积(MPV)[(13.17±1.82)fl比(12.20±1.57)fl]、血小板分布宽度(PDW)[(14.17±2.17)f l比(13.21±2.42)f l]与对照组相比更高,三酰甘油[(3.05±1.37)mmol/L比(3.44±1.36)mmol/L]、纤维蛋白原[(2.65±0.68)g/L比(2.86±0.66)g/L]与对照组相比更低,术中血压更低,冠状动脉平均直径更大,平均远端分支数更少,差异均有统计学意义(均P<0.05)。二元logistic回归模型拟合显示:同型半胱氨酸(OR 1.077,95%CI 1.034~1.123,P<0.001)、中性粒细胞百分比(OR 1.064,95%CI 1.032~1.097,P<0.001)、PDW(OR 1.194,95%CI 1.051~1.356,P=0.006)、MPV(OR 1.338,95%CI 1.127~1.588,P=0.001)是预测CSFP的独立危险因素。相关性分析显示,冠状动脉平均直径与平均cTFC呈显著正相关(r=0.583,P<0.05);冠状动脉平均远端分支数与平均cTFC呈显著负相关(r=-0.508,P<0.05)。结论同型半胱氨酸、中性粒细胞百分比、PDW和MPV是预测CSPF的独立危险因素。冠状动脉平均直径和远端分支数均与冠状动脉平均cTFC密切相关。炎症可能是CSFP发生的关键机制。 相似文献