ObjectiveTo observe multimodal imaging characteristics in eyes with focal choroidal excavation (FCE) and preliminarily analyze the risk factors in FCE with complications correlated with RPE.MethodsA retrospective case series. Thirty-one patients (31 eyes) with monocular FCE, first identified by spectral-domain (SD)-OCT in the Eye Center of The Second People’s Hospital of Foshan from December 2014 to December 2018, were involved in this study. There were 14 males and 17 females, with the mean age of 45.84±13.57 years. All patients underwent BCVA, optometry, and SD-OCT examinations. FFA and ICGA were simultaneously performed in 3 FCE patients with RPE complications. The subfoveal choroidal thickness (SFCT) and excavation width were measured with enhanced depth imaging OCT (EDI-OCT). The eyes with FCE were divided into two groups (FCE alone group 17 eyes vs. FCE complication group 14 eyes), based on whether complicated by RPE dysfunction. Among 14 eyes of FCE complication group, 7 (22.6%) with choroidal neovascularization, 4 (12.9%) with central serous chorioretinopathy, 1 (3.2%) with polypoidal choroidal vasculopathy, and 2 (6.5%) with RPE detachment. No significant difference was found in the mean age (t=0.87), gender composition (χ2=0.06), ocular laterality (χ2=2.58), and spherical equivalent (t=?0.81) between two groups, respectively (P＞0.05), except that the BCVA was significantly different (t=?2.11, P＜0.05). The SFCT and excavation width of eyes in both groups and the ICGA imaging characteristics of eyes in FCE complication group were analyzed. Risk factors of FCE with RPE complications were analyzed by logistic regression analysis.ResultsThirty-three excavations were identified in 31 eyes with FCE. The mean SFCT was 167.00±85.18 μm in FCE alone group vs. 228.36±67.95 μm in FCE complication group, while the excavation width was 645.00±231.93 μm vs. 901.00±420.55 μm and they were both significantly different (P＜0.05). Logistic regression analysis showed the SFCT (OR=1.016, P=0.026) and excavation width (OR=1.004, P=0.034) were risk factors for RPE complications of FCE. EDI-OCT showed the RPE at the excavation was impaired or vulnerable in all eyes of the FCE alone group, especially at the boundary area of excavation. The RPE damages were located at the boundary area of excavation in 10 eyes (71.4%) of FCE complication group. Constant choroidal hypofluorescence and filling defect were observed under the excavation in 3 eyes with ICGA imaging.ConclusionsSFCT and excavation width may be risk factors for RPE complications of FCE. Impairment of RPE at boundary area of excavation and focal choroidal ischemia or aberrant circulation under the excavation may correlate with the development of FCE complications.
ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) in the patients with acute ischemic stroke, in order to provide effective guidance for clinical prevention and treatment.MethodsFrom November 2016 to November 2019, 330 patients with acute ischemic stroke admitted to the Department of Neurology of West China Hospital of Sichuan University and the Department of Neurology of the Sixth People’s Hospital of Chengdu were selected as the research object. The clinical data of the patients were analyzed retrospectively. According to whether SAP occurred, they were divided into infected group and non-infected group. Multivariate logistic regression model was used to analyze the risk factors of SAP.ResultsA total of 71 cases of SAP occurred in patients with acute ischemic stroke, accounting for 21.52%. Logistic regression analysis showed that age≥70 years old [odds ratio (OR)=3.677, 95% confidence interval (CI) (1.452, 9.311), P=0.006], chronic lung disease [OR=4.985, 95%CI (1.558, 15.952), P=0.007], disturbance of consciousness [OR=7.147, 95%CI (1.617, 31.587), P=0.009], bulbar palsy [OR=5.909, 95%CI (2.668, 13.089), P<0.001], the use of nasal feeding tube [OR=7.427, 95%CI (1.681, 32.812), P=0.008] were independent risk factors for SAP in patients with acute ischemic stroke.ConclusionsAge≥70 years old, chronic lung disease, disturbance of consciousness, bulbar paralysis and use of nasal feeding tube are independent risk factors for SAP. It is necessary to strengthen the management of these risk factors in order to identify high-risk patients with SAP early, and develop intervention strategies for risk factors, so as to improve the prognosis.
ObjectiveTo investigate the role on adverse prognosis and risk factors of acute kidney injury (AKI) in hospitalized patients with chronic obstructive pulmonary disease (COPD). MethodsClinical data from hospitalized patients with COPD between January 2009 and June 2012 were studied retrospectively.AKI was diagnosed and classified by AKIN criterion. ResultsThree hundred and sixty-nine patients were enrolled,among whom 69(18.6%) were complicated with AKI.The patients with AKI were older,and had higher levels of hemoglobin,hematocrit value and sodium concentration,and higher rates of comorbidities of diabetes mellitus,proteinuria and shock,compared with the controls.Those with AKI had a 24.1% increased risk for ventilator,121.5% for intensive care,and 89.8% for death.And a higher AKI grade was related to a worse prognosis.The increased risk of AKI was 142.1% for every 5-year increase of age,155.7% for every 0.1 increase of hematocrit value,70.5% for every 0.1 increase of sodium concentration,and 49.1%,89.2%,148.2% and 685.7% for being complicated with proteinuria,coronary artery disease,diabetes mellitus and shock. ConclusionAKI is associated with adverse prognosis in hospitalized patients with COPD.Age,proteinuria,increased levels of hematocrit value and sodium concentration,and comorbidities of coronary artery disease,diabetes mellitus and shock are independent risk factors for AKI
【Abstract】ObjectiveTo investigate the relevant factors for fungal infection following pancreatoduodenectomy and offer the theoretical foundation for preventing the emergence of complications after operation． MethodsMedical records from 562 consecutive patients who underwent pancreatoduodenectomy in this hospital from 1995 to 2005 were retrospectively reviewed by using single factor and noncondition Logistic regression analyse. Results①Seventyeight patients (13.9%) developed invasive fungal infection. The most frequently isolated fungal were Candida albicans accounted for 67.0%， and followed by Candida glabrata, Candida papasilosis and Candida tropicalis and gastrointestinal tract was the most common infection site, followed by respiratory tract, abdominal cavity. ②Fungal infection occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use or abdominal cavity complications. Conclusion The most common infection site and isolated fungal associated with pancreatoduodenectomy were gastrointestinal tract and Candida albicans. Abdominal cavity complications such as pancreatic fistula， biliary fistula and abdominal infection and extended use parenteral nutrition and antibiotic are the most important factors leading to invasive fungal infection after pancreatoduodenctomy. Eliminating the various risk factors will decrease the incidence of fungal infection.
ObjectivesTo systematically review the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting.MethodsPubMed, EBCO, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies and cohort studies on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting from inception to December 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 20 articles were included, including 3 926 patients. The results of meta-analysis showed that: age (OR=2.94, 95%CI 0.81 to 5.07, P=0.007), body mass index (OR=1.94, 95%CI 0.77 to 3.12, P=0.001), smoking (OR=2.72, 95%CI 1.68 to 4.42, P<0.000 1), diabetes history (OR=1.63, 95%CI 1.37 to 1.93, P<0.000 01), preoperative lung diseases (OR=4.11, 95%CI 1.64 to 10.28, P=0.003), complicated ventricular aneurysm (OR=1.57, 95%CI 1.12 to 2.21, P=0.01), left ventricular end-diastolic diameter (OR=1.28, 95%CI 0.12 to 2.44, P=0.03), aortic occlusion time (OR=13.25, 95%CI 4.93 to 21.57, P=0.002), operation time (OR=9.33, 95%CI 5.36 to 13.30, P<0.000 01), number of bypass branches (OR=0.19, 95%CI 0.02 to 0.36, P=0.03), intraoperative infusion volume (OR=383.46, 95%CI 282.16 to 484.76, P<0.000 01) and postoperative pulmonary infection (OR=6.00, 95%CI 3.83 to 9.42, P<0.000 01) were the risk factors for postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Preoperative ejection fraction (OR=?2.60, 95%CI ?4.56 to ?0.64, P=0.009) and preoperative partial oxygen pressure (OR=?3.14, 95%CI ?4.72 to ?1.56, P=0.000 1) were the protective factors for postoperative hypoxemia.ConclusionsCurrent evidence shows that age, body mass index, smoking, diabetes history, preoperative lung diseases, complicated ventricular aneurysm, left ventricular end-diastolic diameter, aortic occlusion time, operation time, number of bypass branches, intraoperative infusion volume and postoperative pulmonary infection are risk factors for postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Due to limited quality and quantity of included studies, the above conclusion is required to be assessed by further studies.
ObjectiveTo explore the main risk factors related to the incidence of epilepsy and the cause of epilepsy, so as to provide basis for decision making on epilepsy prevention. MethodsSuch databases as PubMed (1980 to 2013.1.2), EMbase (1980 to 2013.1.2) and CNKI (1987 to 2013.1.2) were electronically searched to collect case-control studies on risk factors for epilepsy. Meanwhile, relevant studies were also manually retrieved. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.2 software. Results17 studies involving 6 641 participants (including 3 114 cases and 3 527 controls) were included. The results of meta-analysis showed that, family history of epilepsy, traumatic brain injury, febrile seizures, neonatal disease, and risk factors during pregnancy were associated with the incidence of epilepsy, with pooled OR (95%CI) values of 5.11 (3.19, 8.20), 4.14 (3.63, 4.73), 5.10 (2.64, 9.87), 3.33 (1.84, 6.05), and 3.23 (1.80, 5.78), respectively. ConclusionCurrently evidence shows that the risk factors influencing the incidence of epilepsy are family history of epilepsy, traumatic brain injury, febrile seizures, neonatal disease, and risk factors during pregnancy.
ObjectivesTo identify the clinical characteristics and prognosis for CRKP (Carbapenem-resistant Klebsiella pneumonia, CRKP) infection among ICU patients in the Second Affiliated Hospital of Anhui Medical University. MethodsWe conducted a retrospectively analysis in which 19 patients infected by CRKP with another 21 CSKP (Carbapenem-sensitive Klebsiella pneumoniae, CSKP) infected patients from January 2017 to April 2018. Risk factors for CRKP infection were assessed. ResultsThe lower respiratory tract is the most common site of CRKP infection in our department. CRKP infection was associated with several clinical symptoms, particularly a higher incidence of sepsis shock (χ2=8.338, P=0.004), more application of the combined medicine (χ2=26.3, P<0.001), prolonged hospital stays (χ2=–2.217, P=0.027) and more expenses on antibiotics (χ2=12.855, P=0.005), and the declined survival rates in 14 days (χ2=4.269, P=0.039) and 21 days (χ2 =5.647, P=0.017). The resistance rate of CRKP strains was high, however no resistance to tegafycline was found. The risk factors of CRKP infection included three generations of cephalosporin and/or hydrocarbonase antibiotics exposure (χ2 =6.388, P=0.041), exposure time of three generations of cephalosporin (U=–2.187, P=0.029), exposure time of hydrocarbonase antibiotics (U=–2.103, P=0.035), tracheal intubation (χ2=6.352, P=0.012), tracheotomy (χ2 =4.821, P=0.028), SOFA score (t=4.505, P<0.001) and Charlson comorbidity index (t=3.041, P=0.004). The SOFA score was the only factor independently associated with CRKP bacteremia (P=0.02). ConclusionsCRKP infections in ICU directly affect the course of disease, survival time and treatment expenses of patients. Therefore, monitoring bacterial resistance, rational use of antibiotics, and protection of the immune function are of great significance for prevention and treatment of CRKP infection.
ObjectiveTo investigate the risk factors, prognostic factors and prognosis of Multidrug-Resistant Acinetobacter Baumannii (MDR-AB) infection of lower respiratory tract in Intensive Care Unit (ICU) of the Second Affiliated Hospital of Anhui Medical University. MethodsUsing retrospective analysis, we reviewed and compared clinical data of 77 AB infections in lower respiratory tract cases in ICU from January 2013 to March 2015. According to the resistance, patients were divided into a MDR-AB group and a NMDR-AB group. Then the risk factors, prognostic factors and prognosis of MDR-AB infection were analyzed. ResultsA total of 58 cases in the MDR-AB group, 19 cases in the NMDR-AB group were included. The result showed that, the MDR-AB infection in lower respiratory tract could significantly prolong the length of ICU stay (18.5±16.0 vs. 10.6±9.3 days, P<0.05) and increase the mortality (44.8% vs. 11.1%, P<0.01). Logistic regression analysis showed that the independent risk factors for MDR-AB infection in lower respiratory tract included Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score >15 (OR=0.138, 95%CI 0.03 to 0.625, P=0.01) and use of carbapenems (OR=0.066, 95%CI 0.012 to 0.0346, P=0.001). The independent prognostic factors included placement of drainage tube (OR=8.743, 95%CI 1.528 to 50.018, P=0.015) and use of vasoactive drugs (OR=12.227, 95%CI 2.817 to 53.074, P=0.001). ConclusionThe MDR-AB infection in lower respiratory tract can significantly prolong the length of ICU stay and increase the mortality. The Apache Ⅱ score >15 and use of carbapenems are the risk factors, and the placement of drainage tube and use of vasoactive drugs can increase the mortality of MDR-AB infection of lower respiratory tract in ICU.
Objective To investigate the values of cytokines in evaluating the severity and prognosis of patients with coronavirus disease 2019 (COVID-19). Methods A total of 205 COVID-19 patients in Wuhan Leishenshan Hospital were retrospectively analyzed. According to the severity of the disease, patients were divided into common group (n=117), severe group (n=69) and critical group (n=19). The patients’ basic condition and cytokine related parameters were collected, the differences between the three groups were compared and their values in assessing the severity and prognosis of COVID-19 patients were analyzed. Results There were statistically significant differences in the age, severe acute respiratory syndrome coronavirus 2 nucleic acid test results, interleukin (IL)-6, IL-10, IL-2 receptor, IL-8, and tumor necrosis factor-α among the three groups of patients (P<0.05). Correlation analysis showed that the age, severe acute respiratory syndrome coronavirus 2 nucleic acid test continued to be positive for 20 days, IL-6 level, IL-10 level, IL-2 receptors level, IL-8 level and tumor necrosis factor-α level were related to the classification of COVID-19. The correlation coefficient rs was 0.354, 0.187, 0.366, 0.327, 0.329, 0.273 and 0.157, respectively (P<0.05). The levels of IL-6, IL-10, IL-2 receptor, IL-8, and tumor necrosis factor-α in dead patients with COVID-19 were higher than those in surviving patients (P<0.05). Multivariate analysis showed that age [odds ratio (OR)=1.034, 95% confidence interval (CI) (1.006, 1.063), P=0.016], IL-6 level [OR=1.030, 95%CI (1.006, 1.055), P=0.015], IL-10 level [OR=1.088, 95%CI (1.003, 1.179), P=0.042] and IL-2 receptor level [OR=1.003, 95%CI (1.001, 1.005), P=0.001] were independent risk factors for common COVID-19 to become severe or critical. Conclusion The levels of cytokines in COVID-19 patients are closely related to the severity and prognosis of the disease.
ObjectivesTo explore the clinical characteristics and risk factors for 30-day mortality of community-acquired pneumonia (CAP) patients with chronic obstructive pulmonary disease (COPD).MethodsThis was a multicentre, retrospective study. Data of patients hospitalized with CAP from four tertiary hospitals in Beijing, Shandong and Yunnan from January 1, 2013 to December 31, 2015 were reviewed. Patients with (COPD-CAP) and without (non COPD-CAP) COPD were compared, including demographic and clinical features, treatment and outcomes. Univariate analysis and multivariate Logistic regression analysis were performed to identify risk factors for 30-day mortality in COPD-CAP patients.ResultsThree thousand three hundred and sixty-six CAP patients were entered into final analysis, COPD-CAP accounted for 12.9% (435/3 366). Compared to non COPD-CAP patients, COPD-CAP patients were more male and more frequent with CURB-65 score 2 and pneumonia severity index (PSI) risk class Ⅲ to Ⅴ. Pseudomonas aeruginosa was the most common etiology and more common in COPD-CAP patients than non COPD-CAP patients. Though the proportion of respiratory failure and heart failure were higher in COPD-CAP patients, there was no significant difference in the 30-day mortality. The 30-day mortality of COPD-CAP patients was 5.7% (25/435). Logistic regression analysis confirmed aspiration (OR 9.505, 95%CI 1.483 - 60.983, P=0.018), blood procalcitonin ≥2.0 ng/mL (OR 5.934, 95%CI 1.162 - 30.304, P=0.032) and PSI risk class (OR 2.533, 95%CI 1.156 - 5.547, P=0.020) were independent risk factors for 30-day mortality in COPD-CAP patients.ConclusionsCOPD-CAP patients present specific characteristics. Besides PSI risk class, clinicians should pay high attention to the aspiration and blood procalcitonin, which could increase the 30-day mortality in COPD-CAP patients.