ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.
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.
Abstract： Objective To analyze possible associated risk factors of postoperative pulmonary complications (PPC) after lung resection in order to decrease the incidence and mortality of PPC. Methods We reviewed the data of 302 patients including 228 males and 74 females undergoing lung resection from January 2007 to December 2009 in our department. The age of the patients ranged from 23 to 91 years old with an average age of 63.38 years. Based on the present definition of PPC, we recorded the related information and data before, during and after the operation, and observed the rate of PPC. The independent risk factors of PPC were evaluated by multiple logistic regression analysis. Results A total of 22 patients (7.28%) died during the operation and 75 patients (24.83%) experienced 110 times of PPC, the majority of which were prolonged air leak/bronchopleural fistula (8.94%, 27/302), nosocomial pneumonia (6.95%, 21/302) and acute respiratory failure (6.29%, 19/302). The results of logistic regression analysis showed that an American Society of Anesthesiology (ASA) score ≥3 (OR=2.400，P=0.020) and prolonged duration of immediate postoperative mechanical ventilation (OR=1.620，P=0.030) were independent factors associated with the development of PPC.Conclusions The ASA score based on the patients’ general condition and the function status of the main organs, and the prolonged duration of immediate postoperative mechanical ventilation are independent risk factors of PPC. In order to decrease the PPC rate, more attention should be paid to perfecting preoperative preparation, improving the function and condition of the organs, preserving pulmonary function and decreasing the duration of immediate postoperative mechanical ventilation for patients with high risk factors.
Objective To analyze the preoperative risk factors of atrial fibrillation (AF) in patients with coronary artery disease after coronary artery bypass grafting (CABG). Methods From September 2007 to April 2008, the clinical information of 226 patients who underwent onpump coronary artery bypass grafting(CABG)or offpump coronary artery bypass grafting(OPCAB) was collected. The patients were divided into nonAF group and AF group according to whether AF lasted more than 5 mins in 3 days after operation. Ultrasonic cardiography (UCG) and clinical information of preoperation in two groups were analyzed. Results Twentyfour（10.6%） patients had AF after operation. There were more patients whose left atrial diameter gt;35 mm in AF group than that in nonAF group ［41.7%（10）vs. 22.3% (45),χ2=4.380, P=0.036）］, more patients had mitral regurgitation in AF group than that in nonAF group ［37.5%（9） vs. 17.3% (35),χ2=5.568, P=0.018）］, more patients had left main coronary artery involvement in AF group than that in nonAF group ［33.3% (8) vs.12.4% (25),χ2=7.560,P=0.006］, and patients in AF group were older than those in nonAF group ［65.7±9.5 years vs. 60.1±10.1 years,t=-2.724,P=0.010］. In univariate analysis, in terms of preoperative clinical indexs such as the aged, mitral regurgitation, left atrial diameter, left mainm coronary artery involvement, and postoperative clinical indexs such as ventilatory time （χ2=4.190，P=0.040）, electrocardiogram (ECG) monitoring time（χ2=5.948，P=0.015）, hospitalization expense（χ2=4.110，P=0.043）, there were significant differences between 2 groups. Conclusion Risk factors such as the aged, mitral regurgitation, left atrial diameter and left main coronary artery involvement are related to AF after CABG. Clinical index, ECG and echocardiography are helpful to predict AF, and can provide better prevention and treatment, and reduce the rate of AF.
ObjectiveTo explore the clinical application value of antithrombin Ⅲ (ATⅢ) in pulmonary thromboembolism (PTE).MethodsA retrospective study included 204 patients with confirmed PTE who were admitted to Fujian Provincial Hospital from May 2012 to June 2019. The clinical data of the study included basic conditions, morbilities, laboratory examinations and scoring system within 24 hours after admission. The relationship between ATⅢ and PTE in-hospital death was analyzed, and the value of ATⅢ to optimize risk stratification was explored.ResultsFor ATⅢ, the area under receiver operating characteristic curve (AUC) of predicting in-hospital mortality was 0.719, with a cut-off value of 77.7% (sensitivity 64.71%, specificity 80.21%). The patients were divided into ATⅢ≤77.7% group (n=48) and ATⅢ>77.7% group (n=156) according to the cut-off value, and significant statistically differences were found in chronic heart failure, white blood cells count, platelets count, alanine aminotransferase (ALT), albumin and troponin I (P<0.05). According to the in-hospital mortality, patients were divided into a death group (n=17) and a survival group (n=187), and the differences in count of white blood cells, ATⅢ, D-dimer, ALT, albumin, estimated glomerular filtration rate and APACHEⅡ were statistically significant. Logistic regression analysis revealed that ATⅢ≤77.7% and white blood cells count were independent risk factors for in-hospital death. The risk stratification and the risk stratification combined ATⅢ to predict in-hospital death were evaluated by receiver operating characteristic curve, and the AUC was 0.705 and 0.813, respectively (P<0.05). A new scoring model of risk stratification combined with ATⅢ was showed by nomogram.ConclusionsATⅢ≤77.7% is an independent risk factor for in-hospital death, and is beneficial to optimize risk stratification. The mechanism may be related to thrombosis, right ventricular dysfunction and inflammatory response.
Objective To systematically evaluate the risk factors and population attributable risk of children leukemia in China, so as to provide references for policy-making. Methods The case-control studies about risk factors of children leukemia in China were searched in PubMed, CNKI, CBM, VIP and WanFang Data from inception to December 2011. According to the inclusion and exclusion criteria, two reviewers independently screened articles, extracted data, and evaluated the quality of the included studies. Then Meta-analysis was performed using STATA 11 and Excel 2003. The pooled odds ratio (OR) and 95% confidence interval (95%CI) of each risk factor were calculated, and the population attributable risk percent (PARP) based on the exposure rate of the risk factors was computed, and published bias was estimated according to the fail-safe number. Results A total of 15 case-control studies were included. The first 5 risk factors related to children leukemia were: dwelling environmental pollution (OR=2.782, 95%CI 2.268 to 3.413), house decoration (OR=2.525, 95%CI 1.736 to 3.673), maternal exposure to chemical hazards (OR=2.428, 95%CI 1.976 to 2.985), family history of tumor (OR=2.212, 95%CI 1.677 to 2.919), and child exposure to electromagnetic field around dwelling (OR=2.144, 95%CI 1.761 to 2.610). Factors with higher PARP were influenza history (37.56%), house decoration history (32.95%), X-ray exposure history (20.47%), and chemical hazards exposure history (17.37%). The fail-safe number showed the results were generally reliable. Conclusion In order to prevent and control children leukemia, positive and effective measures should be taken in the following aspects: strengthening child care, avoiding unnecessary X-ray exposure, and providing good living environment.
Abstract： Objective?To analyze the risk factors for early shunt dysfunction after systemic-pulmonary shunt in order to improve early postoperative outcomes. Methods We retrospectively analyzed the clinical records of 189 patients who underwent systemic-pulmonary shunt in General Hospital of Shenyang Military District between February 2002 and December 2010. There were 87 males and 102 females with their age ranging from 3 months to 50（5.3±6.2）years，and body weight ranging from 3 to 56（17.7±11.0）kg. There were 94 patients with tetralogy of Fallot （TOF） and pulmonary artery stenosis，51 patients with pulmonary atresia （PA） and ventricular septal defect，4 patients with PA and intact ventricular septum，10 patients with functional single ventricle （SV） and pulmonary stenosis（PS），6 patients with SV and PA，6 patients with double outlet right ventricle and PS，8 patients with transposition of the great arteries（TGA） and PS，and 10 patients with TGA and PA. The surgical procedures included central aorto-pulmonary shunt （Waterston） in 105 patients, modified Blalock-Taussig shunt in 61 patients and Melbourne shunt in 23 patients. Results Early postoperative death occurred in 13 patients （6.9%）. There were 12 patients （6.3%） with intra-operative severe hypotension or arrhythmia, 10 patients （5.3%） with postoperative severe low cardiac output, and 10 patients （5.3%） with early shunt dysfunction within the first 24 h postoperatively. Univariate analysis identified low body weight （P=0.027）, shunt size with diameter＜4 mm （P=0.025） and severe intra-operative adverse event （hypotension or arrhythmia with P=0.002） were risk factors for early shunt dysfunction. In multivariate analysis, intra-operative adverse event was an independent risk factor for early shunt dysfunction（P=0.017）. Conclusion Early outcomes after systemic-pulmonary shunt can be significantly improved by preventing intra-operative severe hypotension or arrhythmia and choosing shunt size larger than 4 mm，especially for patients with young age, low body weight, and poorly-developed pulmonary artery.
ObjectiveTo explore the risk factors of nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy.MethodsThe children with acute lymphoblastic leukemia who were admitted to the Department of Pediatrics, Huai’an First Hospital Affiliated to Nanjing Medical University between December 2012 and December 2018 were divided into the infection group (including the severe infection subgroup and the non-severe infection subgroup) and the non-infection group according to whether nosocomial infection occurred during induction and remission chemotherapy. The clinical data of patients were collected. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia.ResultsA total of 96 patients were included. There were 67 cases in the infection group (26 in the severe infection subgroup and 41 in the non-severe infection subgroup) and 29 cases in the non-infection group. Univariate analysis showed that the granulocyte deficiency time and the prevalence of skin and mucosal damage in the infection group were significantly higher than those in the non-infection group, and the infection group had significantly lower laminar bed use and serum albumin level than the non-infection group did (P< 0.05). Multivariate logistic regression analysis showed that prolonged agranulocytosis [odds ratio (OR)=23.075, 95% confidence interval (CI) (3.682, 144.617), P=0.001], skin and mucosal lesions [OR=12.376, 95%CI (1.211, 126.507), P=0.034], hypoalbuminemia [OR=5.249, 95%CI (1.246, 22.113), P=0.024] were independent risk factors for nosocomial infection during induction and remission of childhood acute lymphoblastic leukemia, while laminar bed [OR=0.268, 95%CI (0.084, 0.854), P=0.026] was the protective factor.ConclusionsLong-term agranulocytosis, skin and mucosal lesions, and hypoalbuminemia are independent risk factors for nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy. Laminar flow bed is its protective factor.
The current issue of air pollution has pushed the development of the corresponding observational air pollution studies. The World Health Organization has developed a new risk of bias (RoB) assessment instrument and a related guideline for assessing the risk of potential bias in observational air pollution studies. This study introduced the background, methods, uses, advantages and disadvantages, precautions, and usage scenarios of the RoB instrument. It is expected to provide researchers with corresponding quality evaluation tools when writing related systematic review and meta-analysis, which will also help provide reporting standards for observational air pollution studies, thereby improving the quality of studies.
ObjectiveThis study aims to compare different references for the fetal risk of drugs used in pregnancy to provide evidence for the safety of drug use in pregnancy.MethodsFour drug databases, including Lexicomp, Micromedex, TERIS, and Reprotox, as well as two books of drugs in pregnancy edited by Briggs and Schaefer, were searched. Descriptive analysis was performed regarding the definition of pregnancy recommendations and the specific content of medication.ResultsThe six references employed slightly different approaches to drugs in pregnancy, however, all of them included summaries of the risk in pregnancy, data of crossing the placenta, and human and animal data. The databases of Micromedex, TERIS, and a book edited by Briggs had their risk classification systems for drug use during pregnancy. For specific drugs, the summary of different information in pregnancy was different, the amount and content of listed evidence varied, and there was no evaluation of the quality and relevance of evidence among the references.ConclusionsThere is no consensus on the risk assessment of drugs in pregnancy. Risk classification systems for drugs in pregnancy are still an important method for determining the fetal risk of drugs. The existing references merely list studies of drugs in pregnancy, without comprehensive quality assessment. A methodological study of assessment of the risk of drugs in pregnancy is required.