ObjectiveTo summarize and explore the clinical management and practical effect of ambulatory hysteroscopic surgery.MethodsThe annual operation volume, disease types, three- and four-grade operation proportion, complications, hospitalization expenses, patient satisfaction and average length of hospital stay of patients undergoing ambulatory hysteroscopic surgery in the First Affiliated Hospital of Chongqing Medical University between September 2014 and August 2019 were retrospectively analyzed.ResultsA total of 5 446 patients underwent hysteroscopic surgery during the five-year period, of whom 569 cases underwent the operation in conventional hospitalization mode in the first year and 4 877 cases did in ambulatory mode in the following four years. The quantity of hysteroscopy operations increased by stages (P<0.001) and the structure of disease types was optimized. The proportion of three- and four-grade complex operations increased from 48.15% to 79.15% stage by stage in ambulatory mode (P<0.05); ambulatory hysteroscopic surgery was proved to be safe and controllable with a low incidence of complications [0.43% (21/4 877)]; the average hospitalization cost of the patients was significantly lower than that of the conventional hospitalization mode (P<0.05); the score of patient satisfaction increased from 92.90±1.77 to 94.57±2.11 compared with the conventional hospitalization mode, and increased further with the construction of the specialized platform to 96.19±2.24 (P<0.05); the average length of hospital stay in ambulatory mode was significantly shortened than that in conventional hospitalization mode (P<0.05).ConclusionHysteroscopic surgery in ambulatory mode can improve the efficiency of medical services, ensure patient safety, improve patient satisfaction, reduce the average length of hospital stay, and reduce the economic burden of patients, so it could be widely promoted and standardized in clinical practice.
Abstract： Diseases prognosis is often influenced by multiple factors, and some intricate non-linear relationships exist among those factors. Artificial neural network （ANN）, an artificial intelligence model, simulates the work mode of biological neurons and has a b capability to analyze multi-factor non-linear relationships. In recent years, ANN is increasingly applied in clinical medical fields, especially for the prediction of disease prognosis. This article focuses on the basic principles of ANN and its application in disease prognosis research.
Objective To investigate the clinical effect and safety of balloon angioplasty (BAP) for patients with venous hypertension associated with autogenous arteriovenous fistula (AVF). Methods Thirty-three patients with venous hypertension associated with AVF were hospitalized between August 2012 and August 2014 in the Department of Nephrology, West China Hospital of Sichuan University. All of the patients received BAP therapy. The clinical characteristics and therapeutic effects were comparatively summarized before and after operation. Results Venous hypertension in all the 33 patients was caused by central venous stenosis or occlusion. Among them, there were 13 cases of stenosis on the site where the left innominate vein crossed the aorta, 10 cases of stenosis at the junction of the left innominate vein and superior vena cava, 4 cases of stenosis at the junction of the left subclavian vein and the innominate vein, 3 cases of right innominate vein stenosis, and 3 cases of innominate vein occlusion. The lesions were most common in the innominate vein. Innominate vein stenosis or occlusion occurred in 19 cases (57.6%), and stenosis at the junction of innominate vein and the superior vena cava or subclavian vein occurred in 14 cases (42.4%). Of the 33 patients, one patient with complete occlusion of the innominate vein did not receive BAP treatment because guide wire could not pass through the occlusion site. The other 32 patients underwent BAP treatment, among whom 30 (93.8%) were successful, and 2 (6.2%) failed. No obvious complications occurred. One day after BAP treatment, patients’ symptoms were significantly relieved. One to seven days later, swelling of the hands, pain, and other symptoms were relieved. In the 30 patients who underwent the treatment successfully, 29 were followed up for 3 to 24 months. Among them, 21 (72.4%) maintained clinical remission and the AVFs were functional, 6 patients (20.7%) got a restenosis later, and 2 patients died. Conclusions BAP is effective and safe for venous hypertension associated with AVF. However, the follow-up of patients has displayed the possible risk of restenosis in long-term outcomes.
ObjectiveTo study the antibacterial activity of ceftazidime/avibactam against carbapenem-resistant Klebaiella pneumoniae (CRKP) in vitro and detect the resistance genes of CRKP, so as to provide reference for the treatment of patients with CRKP infection.MethodsA total of 120 CRKP strains isolated from clinical specimens from May 2014 to November 2017 were collected. The activitis of 11 antimicrobial agents against those CRKP strains were detected by broth microdilution method, and the genes related to resistance to ceftazidime/avibactam were detected by polymerase chain reaction in the 120 CRKP isolates.ResultsThe resistance rate of the 120 CRKP isolates against ceftazidime/avibactam was 16.67% (20/120), which was significantly lower than that against cefotaxime (100.00%), aztreonam (98.33%), ceftazidime (95.83%), cefoperazone/sulbactam (95.83%), meropenem (95.83%), imipenem (95.00%), levofloxacin(92.50%), amikacin (54.17%), minocycline (39.17%), and tegacycline (23.33%). Among the 20 CRKP strains resistant to ceftazidime/avibactam, there were 12 Klebsiella pneumoniae carbapenemase (KPC)-2-producing strains, 3 KPC-3-producing strains, 1 New Delhi metallo-β-lactamase-1 (NDM-1)-producing strain, and 1 oxacillin β-lactamase-48-producing strain; none of the 20 strains had KPC mutation.ConclusionsCeftazidime/avibactam is an effective agent agianst CRKP, and its resistance rate is significantly lower than that of other commonly used antimicrobial agents, especially other β-lactam antibiotics. In terms of resistance genes, except for one isolate producing NDM-1, no other known gene resistant to ceftazidime/avibactam has been found.
ObjectiveTo explore the relationship between imipenem-resistant Pseudomonas aeruginosa (IRPA) and outer membrane porin protein OprD2 gene mutation.MethodsIRPA strains (n=30) and imipenem-sensitive Pseudomonas aeruginosa strains (n=30) isolated from the clinical specimens in the First Affiliated Hospital of Chengdu Medical College from December 2018 to December 2019 were collected. Bacteria identification and drug sensitivity experiments were performed by VITEK-2 Compact combined with Kirby-Bauer method. Quantitative real-time polymerase chain reaction was used to detect the expression levels of OprD2 gene in the imipenem-resistant group and the imipenem-sensitive group, and then the strains with decreased expression were sequenced.ResultsThe expression level of OprD2 gene in the imipenem-resistant group was significantly lower than that in the imipenem-sensitive group (P=0.048). Compared with the X63152 sequence, all the 11 Pseudomonas aeruginosa strains with significantly decreased OprD2 expression carried genetic variation, which occurred in coding regions. The variation sites presented diversity. The missense mutation of c.308C→G, c.344A→C, c.379G→C, c.471G→C, c.508T→C, c.553G→C, c.556-558CCG→GGC and c.565-566TG→AC caused amino acid change in the loop L2 and L3 of OprD2 porin, which affected the binding to imipenem. In addition, the mutations at 127, 169-171, 175, 177, 604, 628-630, 688, 719, 785, 826, 828, 842-843, 886, 901, 928-930, 934, 936, 944-945, 1039, 1041 and 1274 all resulted in the changes of amino acid. We also detected a deletion (c.1114-1115delAT) and other nonsense mutations. Large fragment deletion of OprD2 gene occurred in Strain 12. ConclusionsThe mutation and deletion of OprD2 gene can reduce the expression lever of OprD2 gene, leading to the resistance to imipenem of Pseudomonas aeruginosa. The variation of OprD2 gene of IRPA from clinical strains is diverse.
目的 研究自體動靜脈內瘺全程規范化護理的可實施性及優勢。 方法 制定自體動靜脈內瘺全程規范化護理工作流程及標準，將2011年6月－8月經自體動靜脈內瘺行維持性血液透析患者隨機分為觀察組（125例）和對照組（115例），分別予以全程規范化護理和普通護理，對比分析兩組之間內瘺不良事件發生率、患者滿意度、護士認同度等指標的差異。 結果 兩組內瘺不良事件發生率分別為8.0%和21.0%，患者滿意度分別為98.4%和84.3%，差異均有統計學意義（P＜0.05）；兩組護士對本組護理模式認同度均為90.0%，差異無統計學意義（P＞0.05）。 結論 自體動靜脈內瘺全程規范化護理模式能有效降低內瘺不良事件發生率并顯著提高患者滿意度，值得臨床推廣。
Objective To investigate the nutritional status of hospitalized patients with chronic kidney disease (CKD), analyze the influencing factors, and construct a predictive model to provide a localized theoretical basis and more convenient risk prediction indicators and models for clinical nutrition support and intervention treatment of CKD patients in China. Methods Convenience sampling was used to select hospitalized CKD patients from Department of Nephrology, West China Hospital, Sichuan University, from January to October 2019. General information questionnaires, the Nutritional Risk Screening 2002 scale, and the Huaxi Emotional-distress Index questionnaire were used for data collection. Single factor analyses and multiple logistic regression analysis were conducted to explore the risk factors for malnutrition in CKD hospitalized patients. A predictive model was established and evaluated using receiver operating characteristic (ROC) curve analysis and bootstrap resampling. Results A total of 1059 valid copies of questionnaires were collected out of 1118 distributed. Among the 1059 CKD hospitalized patients, 207 cases (19.5%) were identified as having nutritional risk. The multiple logistic regression analysis showed that CKD stage [odds ratio (OR)=1.874, 95% confidence interval (CI) (1.631, 2.152), P<0.001], age [OR=1.015, 95%CI (1.003, 1.028), P=0.018], and the Huaxi Emotional-distress Index [OR=1.024, 95%CI (1.002, 1.048), P=0.033] were independent risk factors for malnutrition in CKD hospitalized patients, while serum albumin [OR=0.880, 95%CI (0.854, 0.907), P<0.001] was an independent protective factor. The evaluation of the multiple logistic regression analysis predictive model showed a concordance index of 0.977, standard deviation of 0.021, and P<0.05. The area under the ROC curve was 0.977. Conclusions The prevalence of malnutrition is relatively high among CKD hospitalized patients. CKD stage, age, psychological status, and serum albumin are influencing factors for malnutrition in CKD hospitalized patients. The multiple logistic regression model based on the above indicators demonstrates good predictive performance and is expected to provide assistance for early nutritional intervention to improve the clinical outcomes and quality of life for CKD patients with malnutrition in China.