Objective To analyze the influencing factors of hemorrhagic transformation (HT) after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke (AIS). Methods AIS patients hospitalized in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University between June 2017 and June 2020 and receiving rt-PA intravenous thrombolysis were selected. Patients were divided into two groups according to whether they had HT, HT group and non-HT group. General data such as patient’s age, sex, past history, score of National Institute of Health Stroke Scale (NIHSS) before thrombolysis, and related biochemical examination indicators were collected, to analyze the difference between the patients with HT or not, and analyze the related factors affecting the HT of AIS patients after intravenous thrombolysis. Results A total of patients 323 were included. Among them, 46 cases (14.2%) had HT, and 277 cases (85.8%) had no-HT. Except for serum free triiodothyronine (FT3), atrial fibrillation, hypertension, cerebral infarction area, NIHSS score before thrombolysis, uric acid, blood glucose before thrombolysis, white blood cell count, albumin level, alanine aminotransferase, aspartate aminotransferase / alanine aminotransferase and C-reactive protein (P<0.05), there was no significant difference in other indexes between the two groups (P>0.05). Logistic regression analysis showed that NIHSS score≥13 before thrombolysis, aspartate aminotransferase / alanine aminotransferase, blood glucose before thrombolysis≥12.74 mmol/L, low FT3 level, massive cerebral infarction, and atrial fibrillation were independent risk factors for HT after thrombolysis in AIS. Conclusions FT3 and aspartate aminotransferase / alanine aminotransferase levels may be good biomarkers for predicting HT after intravenous thrombolysis. For patients with reduced albumin and uric acid levels, supplementation of exogenous uric acid and albumin may help reduce the risk of HT after AIS thrombolysis.
Objective To investigate the current situation and influencing factors of social phobia in patients with gastrointestinal neoplasms, and to provide evidence for psychological intervention and improving the quality life of patients with gastrointestinal neoplasms. MethodsGastrointestinal neoplasms patients admitted to the Colorectal Cancer Center Ward of West China Hospital, Sichuan University between December 2021 and March 2022 were continuously included. A self-made questionnaire, social phobia behavior professional test scale, and social support rating scale were used to investigate the included patients and analyze the possible influencing factors of social phobia in patients. Results A total of 483 patients were included. Among them, there were 299 males and 184 females. The median score of social support rating scale was 37 (31, 42), with 80.54% of patients received average levels of social support. The median score of social phobia behavior professional test scale was 14 (11, 17), with 98.34% of patients had mild social phobia symptoms and 1.66% had moderate social phobia symptoms. There were statistically significant differences in social phobia behavior professional test scale scores among patients with different levels of education and average monthly income. The results of multiple linear regression analysis showed that the average monthly income was a influencing factor for patients’ social phobia. Conclusions Generally, patients with gastrointestinal neoplasms have mild social phobia. However, patients with fixed income had a higher risk to suffer social phobia were compared to those without income. It is suggested that clinical workers should pay more attention to the mental health of gastrointestinal neoplasms patients and prevent the occurrence of anxiety and phobia.
ObjectiveTo investigate the short-term quality of life in patients after single-direction video-assisted thoracic surgery (VATS) for lung cancer, and explore the related influencing factors. MethodsPatients who underwent single-direction VATS for lung cancer in the Department of Thoracic Surgery, West China Hospital, Sichuan University from July 2020 to August 2021 were continuously selected. The QLQ-C30 and QLQ-LC13 were used to evaluate the quality of life of the patients after the surgery, and the influencing factors were analyzed. ResultsA total of 193 patients were collected. There were 73 males aged 59.44±11.40 years, and 120 females aged 53.73±11.15 years. The QLQ-C30 score of the patients after single-direction VATS for lung cancer was 69.09±20.21 points. Univariate analysis and Pearson correlation analysis showed that age, occupation, anesthesia time, postoperative complications, postoperative antibiotic use time, postoperative hospital stay, insomnia, economic stress, hemoptysis, chest pain, dysphagia, arm or shoulder pain were associated with the quality of life (P≤0.05). The results of multiple regression analysis showed that anesthesia time, economic pressure, insomnia and chest pain had a significant impact on the overall quality of life 30 days after the surgery (P≤0.05). ConclusionThe anesthesia time, economic pressure, insomnia and chest pain are independent influencing factors for the quality of life after the VATS lung cancer surgery.
ObjectiveTo explore the risk factors affecting operation treatment selection of acute adhesive small bowel obstruction (ASBO), and establish a prediction model of surgical treatment selection to provide a guidance for clinical decision-making. MethodsThe patients with acute ASBO admitted to this hospital and met the inclusion and exclusion criteria, from January 2019 to December 2022, were retrospectively collected, and the patients were assigned into the surgical treatment and conservative treatment according to the treatment selection. The differences in the clinicopathologic factors between the patients with surgical treatment and conservative treatment were compared. Meanwhile, the factors with statistical differences (P<0.05) or the factors with clinical significance judged based on professional knowledge were included to screen the influencing factors of surgical treatment selection using the multivariate logistic regression analysis, and the selected influencing factors were used to construct the logistic regression prediction model equation. The area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (95%CI) was used to evaluate the prediction efficiency of the prediction model equation. ResultsA total of 231 patients with acute ASBO were included, 117 (50.6%) of whom underwent surgical treatment and 114 (49.4%) underwent conservative treatment. In all 16 clinicopathologic factors between the patients with surgical treatment and conservative treatment had statistical differences (P<0.05) including the body mass index (BMI), preopeative high fever, intestinal type, sign of peritonitis, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score excluded age scoring, abdominal surgery history and times of abdominal surgery history, times of pre-admission seek medical advice and preoperative conservative treatment time, the air-liquid level by X-ray plain film, and severe small bowel obstruction and adhesive bands by CT examination, as well as the white blood cell count (WBC), neutrophil percentage, albumin (ALB), and urea nitrogen. The multivariate logistic regression analysis showed that the acute ASBO accompanied by sign of peritonitis (β=1.778, P=0.028), history of abdominal surgery (β=1.394, P=0.022), and adhesive bands (β=1.321, P=0.010) and severe small bowel obstruction (β=1.183, P=0.018) by CT examination, WBC (β=0.524, P＜0.001), APACHEⅡ score excluded age scoring (β=0.291, P＜0.001), and BMI (β=0.191, P=0.011) had positive impacts on adopting surgical treatment, while preoperative ALB (β=–0.101, P=0.023) and conservative treatment time (β=–0.391, P＜0.001) had negative impacts on adopting surgical treatment. The accuracy, specificity, and sensitivity of the logistic regression prediction model equation constructed according to these 9 influencing factors were 84.8%, 71.1%, and 77.7%, respectively. The AUC (95%CI) of the prediction model equation to distinguish selection of surgical treatment from conservative treatment was 0.942 (0.914, 0.970). ConclusionsAccording to the preliminary results of this study, surgical treatment is recommended for patients with acute ASBO accompanied by signs of peritonitis, history of abdominal surgery, adhesive bands and severe small bowel obstruction by CT, increased preoperative WBC, high APACHEⅡ score excluded age scoring, high BMI, preoperative low ALB level, and shorter preoperative conservative treatment time. And the logistic prediction model equation constructed according to these characteristics in this study has a good discrimination for patients with surgical treatment or conservative treatment selection.
ObjectiveTo retrospectively collect data on patients with stable chronic obstructive pulmonary disease (COPD), and explore the current status of medication adherence and its main influencing factors in China.MethodsAccording to the principle of convenience, 293 patients with COPD were enrolled in 16 tertiary hospitals located in Nanjing, Hefei, Wuhu, Xuzhou, and Chuzhou. The status quo and influencing factors of medication adherence in COPD patients were identified and analyzed by using the 8-item Morisky Drug Compliance Scale, Beliefs about Medicines Questionnaire, Hospital Anxiety and Depression Scale, General Self-Efficacy Scale, and modified British Medical Research Council. The analysis was based on the framework provided by the WHO’s "five-dimensional determinants" and the mathematical relationship was demonstrated through sequential logistic regression analysis. ResultsThe medication adherence of the target population is 11.95%. A higher socio-economic status [odds ratio (OR) 0.30, 95% confidential interval (CI) 0.10 - 0.91], patients’ general beliefs about the medication utility (OR 0.29, 95%CI 0.17 - 0.50) and overuse (OR 0.30, 95%CI 0.16 - 0.55) were associated with a lower chance of being adherent in patients with COPD. While disease severity (OR 2.01, 95%CI 1.11 - 3.64) and types of drug use (OR 1.91, 95%CI 1.07 - 3.41) presented opposite results. ConclusionsMedication adherence in domestic patients with COPD is not satisfactory at the present stage. Effective ways to improve patients’ medication adherence and quality of life could be proposed from the national, living environment and individual three dimensions.
ObjectiveTo analyze the influencing factors for postoperative thoracic drainage duration in patients with cavitary pulmonary tuberculosis and clinical nursing strategies. MethodsA retrospective analysis was conducted on the clinical data of patients with cavitary pulmonary tuberculosis who underwent surgical treatment in the Department of Thoracic Surgery at Public Health Clinical Center of Chengdu from December 2022 to December 2024. Patients with a drainage time ≤7 days were included in the recovery group, while those with a drainage time >7 days were included in the control group. Data on patients' preoperative Hamilton anxiety and depression scores, perioperative nursing conditions were collected, and factors affecting chest drainage time were analyzed. ResultsA total of 186 patients were included in this study, including 119 males and 67 females, with an average age of (36.10±15.20) years. The average chest drainage tube retention time was (10.59±9.24) days. Preoperative Hamilton anxiety and depression assessments showed that 47.31% (88/186) of patients were anxious, and 31.72% (59/186) were depressed. Multivariate analysis indicated that having a smoking history, undergoing open-chest surgery, prolonged postoperative use of analgesic pumps, preoperative anxiety, and depression were independent risk factors for chest drainage time >7 days (P<0.05); frequent coughing and longer average daily activity time postoperatively were protective factors for chest drainage time >7 days (P<0.05). ConclusionPatients undergoing surgery for pulmonary tuberculosis often experience anxiety and depression preoperatively. In the clinical nursing of patients with cavitary pulmonary tuberculosis, efforts should be made preoperatively to help patients adjust their anxious and depressed emotions, control smoking, and prefer minimally invasive surgery; postoperatively, reducing analgesic duration, increasing cough frequency, promoting effective coughing, and extending average daily activity time can effectively shorten the postoperative chest drainage time, facilitating the rapid recovery of patients after surgery for pulmonary tuberculosis.
Objective To observe the clinical characteristics of asthma patients with chronic duration stage combined with small airway dysfunction (SAD), and analyze the influencing factors of SAD and the cardiopulmonary function of such patients under exercise. Methods The patients with chronic duration of asthma admitted to Nanjing Affiliated Hospital of Traditional Chinese Medicine from July 2022 to April 2024 were divided into a SAD group and a non-SAD group according to the lung function results. Clinical data and relevant data of cardiopulmonary exercise test (CPET) were collected, the clinical data and cardiopulmonary function between the two groups were compared. The influencing factors of SAD were explored by multivariate logistic regression analysis. Results A total of 102 patients with chronic asthma duration, 59 (57.8%) in the SAD group and 43 (42.2%) in the non-SAD group were included. In the SAD group, age, body masss index, asthma duration were greater than those in the non-SAD group, and SAD score was lower than that in the non-SAD group; the proportion of patients with acute onset of asthma, history of smoking, allergic rhinitis, and asthma control test score were higher than those in the non-SAD group, the exhaled nitric oxide level of SAD group was higher than that in the non-SAD group, and the conventional lung function level was lower than that in the non-SAD group (P<0.05). CPET showed that the VE/VCO2 slope and CO2 equivalent in the SAD group were higher than those in the non-SAD group, and the peak kg oxygen uptake, peak heart rate, and respiratory reserve were lower than those in the non-SAD group, showing a statistically significant difference (P<0.05). Multivariate logistic analysis showed that age, increase of carbon dioxide equivalent at peak exercise, acute onset of asthma and allergic rhinitis were independent risk factors for SAD, and the increase of peak expiratory flow rate was the protective factor (P<0.05). Conclusions SAD in chronic persistent asthma is affected by various factors such as age, acute asthma attacks and history of allergic rhinitis. CPET indicates that patients with asthma who also have SAD have their cardiopulmonary function and aerobic capacity impaired to some extent.
Objective To develop and validate a nomogram for predicting the risk of weaning failure in elderly patients with severe pneumonia undergoing mechanical ventilation. Methods A retrospective analysis was conducted on the clinical data of 330 elderly patients with severe pneumonia undergoing mechanical ventilation who were hospitalized in our hospital from July 2021 to July 2023. According to their weaning outcomes, they were divided into a successful group (n=213 ) and a failure group (n=117). Univariate analysis and multivariate non-conditional logistic regression analysis were used to explore the factors influencing the weaning failure of mechanical ventilation in elderly patients with severe pneumonia. Results Univariate analysis showed that there were significant differences in age, smoking status, chronic obstructive pulmonary disease, ventilation time, albumin, D-dimer, and oxygenation index levels between the two groups (all P<0.05). Multivariate logistic regression analysis revealed that age ≥65 years, smoking, presence of chronic obstructive pulmonary disease, ventilation time ≥7 days, D-dimer ≥2 000 μg/L, and reduced oxygenation index were risk factors for weaning failure in the elderly patients with severe pneumonia. The nomogram model constructed based on these factors had an area under ROC curve of 0.970 (95%CI 0.952 - 0.989), and the calibration curve demonstrated good agreement between predicted and observed values. Conclusions Age, smoking status, chronic obstructive pulmonary disease, ventilation time, D-dimer, and oxygenation index are influencing factors for weaning failure in elderly patients with severe pneumonia receiving mechanical ventilation. The nomogram model constructed based on these factors exhibits good discrimination and accuracy.
Objective To explore the current situation and influencing factors of self-regulatory fatigue in maintenance hemodialysis (MHD) patients, so as to provide good dialysis treatment for MHD patients, reduce their level of self-regulated fatigue and improve their quality of life. Methods The convenient sampling method was used to select the MHD patients in the Wenjiang Hemodialysis Center of West China Hospital of Sichuan University between April 12 and April 30, 2022. The patients were investigated by self-made basic information scale and self-regulatory fatigue scale. Results A total of 131 patients were included. The average score of self-regulatory fatigue was 53.47±6.45, cognitive dimension was 20.21±2.39, emotional dimension was 20.85±2.85, behavioral dimension was 12.40±3.63. The results of multiple linear stepwise regression analysis showed that age, duration of dialysis and educational background could inversely predict the score of self-regulatory fatigue (P<0.05). Conclusions MHD patients have a high level of self-regulatory fatigue. Clinical nurses can make individual dialysis programs according to the actual situation of MHD patients, improve their self-regulated level and physical and mental health, and improve the quality of life of MHD patients.
Objective To investigate the influencing factors for the clinical remission of advanced esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemotherapy, establish an individualized nomogram model to predict the clinical remission of advanced ESCC with neoadjuvant chemotherapy and evaluate its efficacy, providing serve for the preoperative adjuvant treatment of ESCC.Methods The clinical data of patients with esophageal cancer who underwent neoadjuvant chemotherapy (nedaplatin 80 mg/m2, day 3+docetaxel 75 mg/m2, day 1, 2 cycles, 21 days per cycle interval) in the Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College from February 2016 to August 2020 were analyzed retrospectively. According to the WHO criteria for efficacy assessment of solid tumors, tumors were divided into complete remission (CR), partial remission (PR), stable disease (SD) and progressive disease (PD). CR and PR were defined as effective neoadjuvant chemotherapy, and SD and PD were defined as ineffective neoadjuvant chemotherapy. Univariate and multivariate analyses were used to analyze the influencing factors for the short-term efficacy of neoadjuvant chemotherapy. The R software was used to establish a nomogram model for predicting the clinical remission of advanced ESCC with neoadjuvant chemotherapy, and Bootstrap method for internal verification of the model. C-index, calibration curve and receiver operating characteristic (ROC) curve were used to evaluate the predictive performance of the nomogram.Results Finally 115 patients were enrolled, including 93 males and 22 females, aged 40-75 (64.0±8.0) years. After receiving docetaxel+nedaplatin neoadjuvant chemotherapy for 2 cycles, there were 9 patients with CR, 56 patients with PR, 43 patients with SD and 7 patients with PD. Among them, chemotherapy was effective (CR+PR) in 65 patients and ineffective (SD+PD) in 50 patients, with the clinical effective rate of about 56.5% (65/115). Univariate analysis showed that there were statistical differences in smoking history, alcoholism history, tumor location, tumor differentiation degree, and cN stage before chemotherapy between the effective neoadjuvant chemotherapy group and the ineffective neoadjuvant chemotherapy group (P<0.05). Logistic regression analysis showed that low-differentiation advanced ESCC had the worst clinical response to neoadjuvant chemotherapy, moderately-highly differentiated ESCC responded better (P<0.05). Stage cN0 advanced ESCC responded better to neoadjuvant chemotherapy than stage cN1 and cN2 (P<0.05). The C-index and the area under the ROC curve of the nomogram were both 0.763 (95%CI 0.676-0.850), the calibration curve fit well, the best critical value of the nomogram calculated by the Youden index was 70.04 points, and the sensitivity and specificity of the critical value were 80.0% and 58.0%, respectively.ConclusionThe established clinical prediction model has good discrimination and accuracy, and can provide a reference for individualized analysis of the clinical remission of advanced ESCC with neoadjuvant chemotherapy and the screening of new adjuvant treatment subjects.