ObjectiveTo analyze retrospectively the risk factors of nonarteritic anterior ischemic optic neuropathy (NAION). MethodsThe complete clinical data of 116 patients (134 eyes) were collected. All patients were asked in detail about the disease history and symptoms and were examined for the visual acuity, intraocular pressure, fundus, visual field and fundus fluorescein angiography (FFA), blood pressure, blood glucose, blood fat and head MRI or CT. Suspicious cases and patients with incomplete clinical data were excluded. The relationship between NAION and age, visual field, FFA, systemic and ocular factors, onset seasons were retrospectively analyzed. Results80 patients (68.97%) were 55 to 70 years old. 97 patients (83.7%) had systemic diseases, including 38 patients (39.2) with diabetes mellitus, 32 patients (32.9%) with hypertension (8 patients had low blood pressure at night), 28 patients (28.9%) with hyperlipidemia, 16 patients (16.5%) with cerebrovascular diseases (mainly lacunar cerebral infarction), 6 patients (6.2%) with coronary heart disease. There were 8 patients with ocular factors, including 3 patients (2.6%) with cataract surgery history, 5 patients (4.2%) with small optic discs. The difference of percentage of with or without diabetes mellitus and hypertension was significant (χ2=362, 259; P < 0.05). There were 27.6% patients with disease onset at March to April, 24.1% patients with disease onset at September to October, much higher than other months (χ2=580, P < 0.05). Visual field test results showed that 49 eyes (36.5%) had inferior visual field defect, 12 eyes (9.0%) had superior visual field defect. FFA showed that in the early stage 103 eyes (76.9%) had optic weak fluorescence, 13 eyes (9.7%) had strong fluorescence; in the late stage, 110 eyes (82.1%) had strong fluorescence, 8 eyes (6.0%) had weak fluorescence. ConclusionsDiabetes mellitus, hypertension may be the system risk factors of NAION. The seasonal variation from spring to summer and from autumn to winter may also be another risk factor for the onset of NAION.
ObjectiveTo evaluate the methodological quality of cross-sectional surveys about Chinese medicine syndrome in a population at potential risk of cerebrovascular diseases. Methods The CNKI, WanFang Data, CBM and PubMed databases were electronically searched to collect cross-sectional surveys about Chinese medicine syndromes in a population at potential risk of cerebrovascular diseases from inception to December, 2022. The methodological quality was assessed using the JBI scale. Results A total of 105 studies were included. The average reporting rate of JBI was 52.06%, and the items with the highest scores included "sufficient coverage of the identified sample in data analysis" (100%), "description of study subjects and setting" (92.38%), and "using valid methods for the identification of the condition" (86.67%). Items with the lowest scores included "adequate sample size" (13.33%), "adequate response rate or low response rate managed appropriately" (14.29%), and "study participants recruited in an appropriate way" (20.95%). Subgroup analysis suggested that type of publication and number of implementation centers were potential factors influencing methodology quality (P<0.05). Conclusion The methods essential to a cross-sectional survey such as sampling, sample size calculation and handling with the response rate, and the syndrome diagnosis scales specific to Chinese medicine require further improvement.
Objective To analysis the risk factors for lower airway bacteria colonization and ventilator-associated pneumonia ( VAP) in mechanically ventilated patients. Methods A prospective observational cohort study was conducted in intensive care unit. 78 adult inpatients who underwent mechanical ventilation( MV) through oral endotracheal intubation between June 2007 and May 2010 were recruited. Samples were obtained from tracheobronchial tree immediately after admission to ICU and endotracheal intubation( ETI) , and afterward twice weekly. The patients were divided naturally into three groups according to airway bacterial colonization. Their baseline characteristics, APACHEⅡ score, intubation status and therapeutic interventions, etc. were recorded and analyzed. Results In the total 78 ventilated patients, the incidence of lower airway colonization and VAP was 83. 3% and 23. 1% , respectively. The plasma albumin( ALB) ≤29. 6 g/L( P lt; 0. 05) , intubation attempts gt; 1( P lt; 0. 01) were risk factors for lower airway colonization. In the patients with lower airway colonization, preventive antibiotic treatment, applying glucocorticoid and prealbumin( PA) ≤ 69. 7 mg/L were risk factors for VAP ( P lt; 0. 05) . Conclusions The risk factors for lower airway colonization in ventilated patients were ALB≤29. 6 g/L and intubation attempts gt; 1. And for lower airway colonized patients, PA ≤ 69. 7 mg/L, preventive antibiotic treatment and applying glucocorticoid were risk factors for VAP.
ObjectiveTo observe and analyze the risk factors and optical coherence tomography (OCT) characteristics of exudative retinal detachment in patients with HELLP syndrome. MethodsA retrospective clinical study. From January 2015 to March 2021, 168 eyes of 84 patients with HELLP syndrome who were hospitalized in The Third Central Hospital of Tianjin were included in the study. The average age of the patients was 30.96±4.09 years old. The patient’s general clinical data which included age, gestational week of delivery, type of HELLP syndrome, onset time of HELLP syndrome, parity, number of pregnancy, systolic and diastolic blood pressure, total amount and duration of glucocorticoid, whether been admitted to intensive care unit; laboratory indicators, which included platelet count,serum albumin, serum uric acid, 24-hour urine protein quantification,aspartate aminotransferase, lactate dehydrogenase, total bilirubin (TBIL) were collected. Whose the general condition was not allowed, however patients had a complaint of vision loss or suspected retinal detachment under direct ophthalmoscope examination, B-mode ultrasound was used to assist in the diagnosis. According to the presence or absence of exudative retinal detachment, patients were divided into retinal detachment group (net detachment group) and non-retinal detachment group (non-retinal detachment group), respectively 31 (36.90%, 31/84), 53 (63.10%, 53/84) cases. Among the 31 cases in the network disconnection group, 34 eyes in 17 cases underwent OCT. Two independent sample t tests were used to compare the measurement data of normal distribution between groups, Wilcoxon rank sum test was used to compare skewed distributions; the χ2 test was used to compare count data. The variables with statistical differences in univariate analysis were selected as independent variables, and binary logistic regression analysis was performed. ResultsAmong 84 patients, HELLP syndrome was classified into partial type and complete type, 41 (48.81%, 41/84) and 43 (51.19%, 43/84) cases, respectively. Compared with the non-net-off group, the patients in the off-line group had shorter gestational weeks (t=2.51), higher diastolic blood pressure (t=?2.61), greater total glucocorticoid use (Z=?2.14), and longer use time of glucocorticoid (Z=?2.75), the difference were statistically significant (P＜0.05); TBIL (Z=?2.49), serum albumin (t=2.06) levels decreased, and 24-hour urine protein quantitative (Z=?4.35) levels increased, the difference were statistically significant (P＜0.05). Logistic regression analysis showed that the increase of 24-hour urine protein level increased the risk of exudative retinal detachment (P＜0.05) (odds ratio=1.20, 95% confidence interval 1.06-1.37). Among the 34 eyes that underwent OCT examination, 18 eyes showed that the retinal pigment epithelium (RPE) layer was not smooth, thickened, and seemed to have adhesion to the detached retina. After the reattachment of retinal detachment, the above-mentioned changes of RPE still existed, but reduced; the ellipsoid zone still has discontinuity, partial rupture, and even extensive loss in 16 eyes. ConclusionThe quantitative increase of 24-hour urine protein is a risk factor for the occurrence of exudative retinal detachment in HELLP syndrome; some patients with exudative retinal detachment are still missing the ellipsoid zone after reattachment.
ObjectiveTo retrospectively evaluate the risk factors of mortality in postoperative acute kidney injury (AKI) patients undergoing continuous renal replacement therapy (CRRT) after cardiopulmonary bypass (CPB). MethodsWe retrospectively analyzed the clinical data of 66 patients (38 males and 28 females with mean age of 59.11±12.62 years) underwent CRRT after cardiovascular surgery in our hospital between May 2009 and June 2014. The patients were divided into a survival group (18 patients) and a death group (48 patients) according to treatment outcome at discharge. Univariate analysis for risk factors of death was carried out for preoperative characteristics and lab results among study population. Significant univariate factors were then further analyzed by multivariable logistic regression models. ResultsSignificant predictors of death included blood transfusion volume during operation, peak level of blood sugar and lactate during operation, the total bilirubin level and platelet count on the first day after operation, hypotension on the first day after operation, pulmonary infection, multiple organ dysfunction syndrome (MODS) and the interval time of oliguria and CRRT (P<0.05). Logistic regression showed that there were statistical differencs in hypotension on the first day after operation, postoperative platelet count, and interval time of oliguria and CRRT respectively (P<0.05). ConclusionImproving intraoperative management, reducing bleeding and blood transfusion, controlling blood sugar level, dealing with complications such as hypotension, pulmonary infection and MODS more aggressively, starting CRRT when needed may be helpful to reduce mortality. Monitoring of the blood pressure and platelet count on the first day after operation is useful for prognosis estimation.
ObjectiveTo systematically review the association between -765 G > C (rs20417) polymorphism of cyclooxygenase-2 (COX-2) gene and the risk of gastric cancer (GC). MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 10, 2015), CBM, CNKI, VIP and WanFang Data were searched from inception to October 2015 to collect case-control studies about the correlation between -765 G > C (rs20417) polymorphism of COX-2 gene and GC. Two reviewers independently screened literature, extracted data and evaluated the quality of included studies. Meta-analysis was performed using Stata 12.0 software. ResultsA total of 15 case-control studies were included in this meta-analysis, including 2 891 cases and 4 967 controls. Meta-analysis showed that the -765 G > C (rs20417) polymorphism was significantly associated with the risk of GC (OR=1.70, 95%CI 1.21 to 2.38, P=0.002). Subgroup analysis showed there was a significant association between the -765 G > C (rs20417) polymorphism and GC in Asians (OR=2.24, 95%CI 1.70 to 2.96, P=0.000); However, no association was found in the Caucasians and Americans. In the subgroup analysis by Helicobacter pylori (H. pylori) status, there were statistical significances between helicobacter pylori (+) and helicobacter pylori (-) with the risk of GC in COX-2 polymorphism of CC/CG vs. GG (OR=2.11, 95%CI 1.41 to 3.14, P < 0.001). ConclusionThe COX-2-765 G > C (rs20417) polymorphism may be significantly associated with an increased risk of GC, especially among Asians.
Retinopathy of prematurity (ROP) is a serious ophthalmic disease threatening the vision of premature infants, characterized by abnormal retinal vascular development and pathological neovascularization. Its pathogenesis follows a two-stage model of “early hyperoxia inhibiting angiogenesis - late hypoxia promoting neovascularization,” in which oxidative stress damage, inflammatory immune activation, and abnormal expression of growth factors such as vascular endothelial growth factor and insulin-like growth factor-1 play key roles. Current studies indicate that the occurrence of ROP is closely associated with maternal factors (such as gestational hypertension, diabetes, smoking during pregnancy) and fetal factors (including low birth weight, low gestational age, inappropriate oxygen therapy, anemia, blood transfusion, multiple pregnancies, nutritional imbalances, infections, and genetic susceptibility), among which low birth weight and low gestational age are independent risk factors, while the clinical management of oxygen therapy parameters (duration, concentration, and fluctuations) is particularly important. Given the rapid progression, high blindness rate, and poor prognosis of ROP, there is an urgent need to achieve early precise identification and intervention through multifactorial integration models. Future research should further explore the interaction mechanisms of risk factors and develop individualized prevention and treatment strategies to improve the long-term quality of life for affected children.
ObjectiveTo analyze the related factors of cognitive impairment in patients with post-traumatic epilepsy. MethodsFrom January 2016 to January 2019, 45 patients with post-traumatic epilepsy (epilepsy group) and 48 patients with physical examination (control group) at the Department of Neurosurgery, the 904th Hospital of PLA were analyzed retrospectively. Cognitive assessment were evaluated by the following scales: Montreal cognitive assessment (MoCA), Mini-mental state examination (MMSE), Audio verbal memory test (AVMT), Rey-osterrieth complex figure test (CFT) and Trail making test (TMT). Then we analyzed the influences of gender, age, course of disease, cause, type, degree and location of injury, seizure frequency and Anti-seizure medications (ASMs) on cognitive impairment. ResultsThe results showed that there were significant differences between the epilepsy group and the control group in all scales (P<0.01). Analysis of influencing factors in epilepsy group showed: MoCA and MMSE scores: there were statistical significance in the comparison of seizure frequency and injury degree (P<0.05); AVMT, CFT and TMT scores: there were statistical significance in the comparison of seizure frequency, injury degree and location, ASMs within the group (P<0.05). ConclusionPost-traumatic epilepsy can cause cognitive impairment. The more frequent epileptic seizures and the more severe the degree of trauma, the more serious the cognitive impairment. Different injury sites affect the scope of cognitive impairment, temporal lobe injury is easy to cause memory function decline, frontal lobe injury is easy to cause spatial structure and executive ability decline, at the same time, the combined use of ASMs has an impact on cognitive function.
Objective By comparing the clinical characteristics, etiological characteristics, laboratory examination and prognosis of community acquired pneumonia (CAP) patients with and without pleural effusion (PE), the risk factors affecting the 30-day mortality of CAP patients with PE were analyzed. Methods The clinical data of inpatients with CAP in 13 hospitals in different regions of China from January 1, 2014 to December 31, 2014 were analyzed retrospectively. According to the imaging examination, the patients were divided into two groups: PE group (with pleural effusion) and non-PE group (without pleural effusion). The clinical data, treatment, prognosis and outcome of the two groups were compared. Finally, multivariate analysis was used to analyze the risk factors of 30-day mortality in patients with PE. Results Of the 4781 patients with CAP, 1169 (24.5%) were PE patients, with a median age of 70 years, and more males than females, having smoking, alcoholism, inhalation factors, long-term bed rest, complicated with underlying diseases and complications, such as respiratory failure, acute respiratory distress syndrome (ARDS), cardiac insufficiency, septic shock, acute renal failure and so on. The hospitalization time was prolonged; the intensive care unit (ICU) occupancy rate, mechanical ventilation rate, mortality within 14 days and mortality within 30 days in the PE group were higher than those in the non-PE group. Multivariate analysis showed that the risk factors affecting 30-day mortality in the patients with PE were urea nitrogen >7 mmol/L (OR=2.908, 95%CI 1.095 - 7.724), long-term bed rest (OR=4.308, 95%CI 1.128 - 16.460), hematocrit <30% (OR=4.704, 95%CI 1.372 - 16.135), acute renal failure (OR=5.043, 95%CI 1.167 - 21.787) and respiratory failure (OR=6.575, 95%CI 2.632 - 16.427), ARDS (OR=8.003, 95%CI 1.852 - 34.580). ConclusionsThe hospitalization time and ICU stay of PE patients are prolonged, the risk of complications increases, and the hospital mortality increases significantly with the increase of age, complication and disease severity. The independent risk factors affecting 30-day mortality in PE patients are urea nitrogen >7 mmol/L, long-term bed rest, hematocrit <30%, acute renal failure, respiratory failure, and ARDS.
ObjectiveTo investigate the epidemiology of tuberculosis in Mianyang city, and investigate its risk factors to provide scientific evidence for tuberculosis prevention and management. MethodsA stratified cluster random sampling method was applied and 184094 residents were recruited in the study. The prevalence of tuberculosis was analyzed by questionnaires, physical examinations, X-ray, and laboratory tests. The risk factors of tuberculosis were analyzed by binary logistic regression method. ResultsOne hundred and seventy-five subjects were diagnosed with active tuberculosis, and the incidence of tuberculosis was 95.06 per thousand. There were 32 smear-positive pulmonary tuberculosis patients, and the incidence was 17.38/100 per thousand. Males, farmers and workers, diabetes, family history of tuberculosis, smoking, drinking were risk factors for tuberculosis. ConclusionsThe prevalence of tuberculosis in Mianyang city is similar with the whole country. Male, farmers and workers, diabetes, family history of tuberculosis, smoking, and drinking maybe the risk factors of tuberculosis.