ObjectiveBy analyzing the correlation between the clinicopathological features of patients with colorectal liver metastases (CRLM) and their postoperative survival, this study is aimed to identify new and accurate prognostic indicators on the prognoses to provide a reference of the treatment strategy selection for patients with CRLM. MethodsThe clinical data of 233 patients with CRLM who received operation treatments in the Eastern Hepatobiliary Hospital of the Second Military Medical University from January 2006 to December 2009 were retrospectively investigated, and their clinicopathological features, as well as their prognosis were analyzed. The survival curve was drawn by Kaplan-Meier method, and the survival rates were analyzed by log-rank test. Parametric survival analysis was used to identify predictors of cancer-specific survival. ResultsThe median survival time after cancer resection was 37.0 months, with cumulative 1-year, 3-year, and 5-year survival rates of 93.0%, 61.0%, and 17.0%, respectively. The median survival time, with cumulative 3-year, and 5-year survival rates of patients who had received radical operations was better than the others who received palliative operations:40.53 months vs 27.20 months, 59.0% vs 29.0%, and 20.0% vs 0(P < 0.05), respectively. In overall surviva, the results of univariate analysis showed that 13 factors, including surgical method, the first relapse after liver metastasis resection, the number of liver metastases, surgical margin, other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, whether any chronic liver disease was associ-ated, preoperative serum CEA level, preoperative serum CA19-9 leve, the position of the liver metastases, whether the liver metastasis capsule was complete, TNM stagethe of primary cancer, whether the liver metastasis was simultaneous liver metastases, and the maximum diameter of the liver metastases, were closely related to the clinicopathological features associated with prognosis and the differences were statistically significant (P < 0.05). The results of multivariate survival analysis demonstrated that received palliative operations, simultaneous liver metastases, there were other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, liver metastases without a complete capsule, the number of liver metastases appeared as multiple and widedistribution, unassociated chronic liver disease of the patients, the maximum diameter of the liver metastases>3 cm, were the independent risk factors affecting the postoperative survival of the patients with CRLM (P < 0.05). ConclusionsIt is important for long-term survival of patients with CRLM who were received operations. Received palliative operations, simultaneous liver metastases, there were other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, liver metastases without a complete capsule, the number of liver metastases appeared as multiple and widedistribution, unassociated chronic liver disease of the patients, the maximum diameter of the liver metastases>3 cm, were the independent risk factors affecting the postoperative survival of the patients with CRLM.
Objective To investigate the prevalence and related factors of diabetic retinopathy (DR) among residents with type 2 diabetes mellitus (T2DM) in Culai Town of Tai'an City in Shandong Province. Methods According to the DM management file database for community, 785 patients with T2DM were randomly selected by cluster sampling method. The questionnaires, routine general examinations, visual and fundus-free fluoroscopy were performed on all the patients. DR diagnosis and classification was according to the guidelines for clinical diagnosis and treatment of DR in China (2014). Both monocular and binocular DR were selected as DR patients, and the worse eye for binocular DR were treated as the DR classification of the patient. The patients were grouped by presence or absence of DR. GraphPad Prism 6, SigmaPlot 12.5, SPSS 20.0 and Excel were used to achieve data analysis. Also, SPSS 20.0 was used for multi-factor logistic regression analysis. Results A total of 699 patients (89.04%) were actually recorded. There were 122 eyes of 63 patients (9.01%) with DR (DR group), 1272 eyes of 636 patients (90.99%) without DR (NDR group). Among the 122 eyes of DR, there were 19 (15.57%), 17 (13.93%), 70 (57.38%), 10 (8.20%), 6 (4.92%) eyes in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ, respectively. The differences of mean age (t=15 290, P=0.002), DM duration (t=9075, P＜0.000) and diastolic blood pressure (t=15 810, P=0.006) between the two groups were statistically significant. There were 23 (36.51%) and 394 (61.95%) patients with hypertension history in the DR group and the NDR group, with the significant difference ( χ2=15.42, OR=0.35, 95%CI 0.21-0.60). There were 57 (90.48%) and 500 (78.62%) patients with fasting blood glucose larger than 6.11 mmol/L in the DR group and the NDR group, with the significant difference (OR=2.51, 95%CI 1.06-5.95, P=0.031). Logistic regression analysis showed that the age, fasting blood glucose and DM duration were influencing factors for DR (OR=1.039, 0.864, 0.898; P=0.021, ＜0.000, ＜0.000). Conclusion The prevalence of DR in patients with T2DM in Culai Town of Tai'an City is 9.01%. Age, DM duration, fasting blood glucose are associated to DR. Those with a history of hypertension may have a lower risk of DR than those without a history of hypertension.
ObjectiveTo observe the effect of intravitreal injection of conbercept in the treatment of retinopathy of premature (ROP) and to analyze the factors related to the therapy.MethodsA retrospective study. A total of 57 patients (57 eyes) with pre-threshold type 1 (30 patients, 30 eyes), threshold ROP (21 patients, 21 eyes) and acute aggressive posterior ROP (APROP, 6 patients, 6 eyes)) from premature infants by retinal screening in Henan Provincial People’s Hospital during October 2017 and June 2018 were enrolled in this study. All children were received routinely intravitreal injected 10 mg/ml conbercept 0.025 ml (0.25 mg) within 24 hours after diagnosis. Fundus examination was performed 7 days after injection. The interval of examination was 1−3 weeks according to fundus conditions. The mean follow-up was 30.1±4.6 weeks. For patients with relapse or no response to treatment, repeated intravitreal injection of conbercept or laser photocoagulation therapy was given. The retinal blood vessels of the affected eyes were observed. Logistic stepwise regression analysis was used for the correlation test of multiple factors.ResultsAmong 57 eyes, 49 eyes and 8 eyes were treated with 1 or 2 times of intravitreal injection of conbercept. After 24 weeks of treatment, in 57 eyes, 26 eyes were cured (45.6%), 22 eyes improved (38.6%), 8 eyes relapsed (14.0%), and 1 eye aggravated (1.8%). The recurrence time was 12.9±4.5 weeks after the first injection, and the corrected gestational age was 49.0±6.7 weeks. There were significant differences in initial injection time, lesion range among the cure, improved and recurrence eyes (F=5.124, 7.122; P＜0.01, ＜0.01). Parameters of ROP condition, including ROP diagnosis (pre-threshold type 1, threshold and APROP), zone (zone 1 and 2), stage (stage 2 and 3) and plus lesions, were significant different among the cure, improved and recurrence eyes (χ2=11.784, 14.100, 6.896, 9.935; P＜0.01, ＜0.01, ＜0.05, ＜0.01). Logistic stepwise regression analysis showed that the recurrence rate was correlated with ROP zone, more likely recurrence at zone 1 than zone 2 (Wald=9.879, OR=27.333, P=0.002). No injection-related complications such as endophthalmitis, cataract and glaucoma were found during treatment and follow-up period.ConclusionsIntravitreal injection of conbercept is effective in the treatment of ROP without obvious adverse reactions. Lesion zoning is associated with recurrence after treatment.
Objective To investigate the factors associated with vision and hole closure for idiopathic macular hole (IMH) after vitrectomy surgery. Methods Eighty-nine eyes of 89 patients with IMH were enrolled in this retrospective study. There were 15 males and 74 females. The patients aged from 42 to 82 years, with the mean age of (64.13±7.20) years. All subjects underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. The BCVA ranged from 0.01 to 0.4, with the mean BCVA of 0.12±0.09. The MH stages was ranged from 2 to 4, with the mean stages of 3.56±0.77. The basal diameter ranged from 182 μm to 1569 μm, with the mean basal diameter of (782.52±339.17) μm. The treatment was conventional 25G pars plana vitrectomy combined with phacoemulsification and intraocular implantation. Forty-one eyes received internal limiting membrane peeling and 48 eyes received internal limiting membrane grafting. The follow-up ranged from 28 to 720 days, with the mean follow-up of (153.73±160.95) days. The visual acuity and hole closure were evaluated on the last visit and the possible related factors were analyzed. Results On the last visit, the BCVA ranged from 0.02 to 0.8, with the mean BCVA of 0.26±0.18. Among 89 eyes, vision improved in 45 eyes (50.56%) and stabled in 44 eyes (49.44%). Eighty-six eyes (96.63%) gained MH closure but 3 eyes (3.37%) failed. By analysis, patients of early stages of MH and smaller basal diameter of MH will gain better vision outcome (t=2.092, 2.569; P＜0.05) and patients of early stage MH will gain high hole closure rate after surgery for IMH (t=−5.413, P＜0.05). However, gender, age, duration, preoperative BCVA, surgery technique, gas types and follow-up time had no relationship with the effect after surgery for IMH (P＞0.05). Conclusions Stages of MH and basal diameter of MH may be the factors associated with the visual outcome for idiopathic macular hole after surgery. However, age, gender, duration, surgery patterns, gas types and follow-up time showed no effects on operational outcomes.
Objective To investigate the association between environmental factors and nonsyndromic cleft lip and palate (NSCLP), and to explore the interaction of main risk factors in Chinese Guangdong population. Methods A hospital-based case-control study was used. NSCLP children were selected from Cleft Lip amp; Palate Treatment Centre of Second Affil iated Hospital of Medical College of Shantou University between September 2009 and March 2010 as cases. And controlswere chosen from other departments in the same hospital during the same period. The parents of cases and controls were inquired regarding the risk factors and the answers were filled in a unification questionnaire by physicians. These data were analysed with chi-square test and multivariate unconditional logistic regression analysis. Results A total of 105 cases and 110 controls with a mean age of 2.2 years and 3.0 years, respectively, were enrolled. Multivariate logistic regression analysis revealed that genetic family history (OR=4.210, P=0.039), mothers’ abnormal reproductive history (OR=2.494, P=0.033), early pregnancy medication (OR=3.488, P=0.000), and maternal stress (OR=3.416, P=0.011) were risk factors. There were positve interactions between genetic family history and mothers’ abnormal reproductive history as well as early pregnancy medication. Conclusion Certain influencing factors including genetic family history, mothers’ abnormal reproductive history, early pregnancy medication, and maternal stress are associated with NSCLP among Chinese Guangdong population. This study suggests that it may reduce the incidence rate of NSCLP through environmental intervention.
ObjectiveTo investigate the clinicopathological characteristics and prognosis of elderly patients with colon cancer. MethodsThe clinicopathological and followup data of patients with colon cancer were compared retrospectively between those older than 60 years (405 patients) and those younger than 40 years (146 patients). ResultsFamily history, comorbidities, preoperative intestinal obstruction, and differentiation grade were significantly different between two groups (P＜0.05). The 5-year survival rate of patients in elder group and younger group was 64.9% and 56.8% respectively, and there was significant difference （P＜0.05）. The multivariate analysis indicated that the independent predictors of survival were comorbidities, perioperative CEA level, preoperative intestinal obstruction, tumor gross type, lymph node metastasis, hepatic metastasis, and TNM stage. ConclusionPatients older than 60 years with colon cancer have unique clinicopathological characteristics and better prognosis. The independent predictors of survival are comorbidities, perioperative CEA level, preoperative intestinal obstruction, tumor gross type, lymph node metastasis, hepatic metastasis, and TNM stage.
目的 对烧伤层流病房多重耐药菌感染的相关因素进行分析，通过护理干预来预防和减少烧伤病房多重耐药菌感染的发生。 方法 回顾性分析2011年1月－12月收治的629例烧伤患者，其中发生多重耐药菌感染74例，感染率为11.8%。 结果 感染部位：创面分泌物培养感染占70.2%，痰液标本培养感染占9.4%，血液标本培养感染占16.2%，其他占4.2%。感染病原菌：以金黄色葡萄球菌为主，占77.0%；鲍曼不动杆菌占4.2%，铜绿假单胞菌占10.8%，肺炎克雷伯菌占6.7%，真菌感染占1.3%。 结论 对发生医院内多重耐药菌感染的原因进行分析并及时采取相应的护理干预措施，及可行的医院感染管理控制措施，对烧伤患者预后有重要的意义，可有效降低院内感染率的发生。
ObjectiveTo observe the clinical effect of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH).MethodsA prospective, non-randomized controlled case cohort study. Twenty eyes of 20 patients with IMH in Ophthamology Department of The Second Hospital of Jilin University from September 2016 to January 2017 were included in this study. There were 4 males (4 eyes) and 16 females (16 eyes), with the mean age of 60.60±9.50 years and the mean disease course of 9.55±15.5 months. The stage of macular hole ranged from Ⅱ to Ⅳ. All patients underwent BCVA, intraocular pressure, spectral-domain OCT (SD-OCT) and multifocal ERG examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The minimum diameter (MIN), bottom diameter (BD), height (H), the defective diameter of ellipsoid zone, the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg). Then the macular hole index (MHI=H/BD), hole traction index (THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated. The response density in P1 wave was detected by mf-ERG. The logMAR BCVA was 1.18±0.54. There were 5 eyes with less than 400 μm MIN, 13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN. All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade. According to the SD-OCT image features after surgery, IMH closure was divided into type Ⅰ closed, type Ⅱ closed and unclosed. The follow-up was equal or greater than 3 months. The closure rate of IMH, BCVA and the changes of microstructure parameters of macular area were observed. Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P1 before surgery and the efficacy after IMH surgery.ResultsClosure rate of IMH: 18 eyes (90.0%) were completely closed (all type Ⅰ closed). The closure rate of macular hole with the MIN less than 400 μm was 100.0% (5/5), 400-700 μm was 92.3% (12/13), and over than 700 μm was 50% (1/2). BCVA: the mean logMAR BCVA at 1 week, 1 month, 3 months after surgery were 0.83±0.54, 0.65±0.41, 0.48±0.34, and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382, 4.459, 5.250; P=0.003, 0.007, 0.004). The outcomes of SD-OCT at 3 months after surgery: 18 eyes (90.0%) with intact ELM. The defective diameter of ellipsoid zone was 260.34±272.08 μm, there was statistically significant difference between before and after surgery (t=13.545, P=0.002). The outcomes of mf-ERG: the P1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748, -6.151; P＜0.01,＜0.01). The results of Spearman correlation analysis: there was a positive correlation between postoperative BCVA and preoperative MIN, the defective diameter of ellipsoid zone and ELM, and postoperative the defective diameter of ellipsoid zone (r=0.56, 0.59, 0.68, 0.52; P=0.010, 0.006, 0.001, 0.019). The postoperative BCVA was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf-ERG (r=－0.34, －0.16; P=0.006, 0.020). The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM (r=－0.449, －0.449; P=0.047, 0.047). MHI and THI were positively correlated with the closure of the hole (r=0.474, 0.546; P=0.035, 0.013). Intraocular pressure increased in 2 eyes during the follow-up period, and returned to normal within 1 week after the administration of antihypertensive drugs. There were no complications during or after the operation.ConclusionsVitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective. The MIN, MHI THI are significantly correlated with the curative effect after IMH surgery, which could be used as the index to predict and evaluate the curative effect. The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery, and which is negatively correlated with BCVA.
Objective To analyze the risk factors for delirium of the Stanford A aortic dissection patients after surgery. Method We retrospectively analyzed the clinical data of 335 patients with type A aortic dissection in Guangdong Cardiac Institution from January 2012 through December 2014. There were 280 males and 55 females. The average of age was 48.5±10.3 years. Delirium status of the patients were evaluated based on confusion assessment method for intensive care unit (CAM-ICU). The patients were divided into two groups including a delirium group and a control group. We tried to find the risk factors for postoperative delirium. Results There were 169 patients of delirium with a incident rate of 50.4%. One-way analysis of variance and multivariate analysis indicated that pre-operative D-dimer level (OR=2.480, 95% CI 1.347-4.564, P<0.01), the minimum mean arterial pressure during operation (OR=0.667, 95% CI 0.612-0.727, P<0.01), the postoperative ventilation time (OR=2.771, 95% CI 1.506-5.101, P<0.01) and the postoperative acute kidney failure (OR=1.911, 95% CI 1.065-3.430, P<0.05) were the independent risk factors for delirium of the Stanford A aortic dissection patient after surgery. Conclusion The incident rate of postoperative delirium of the Standford A aortic dissection patient is relatively high. Patients in this study with elevated pre-operative D-dimer level, lower intraoperative mean arterial pressure, longer postoperative ventilation and combination of acute kidney failure have a higher rate of postoperative delirium. Better understanding and intervention of these factors are meaningful to reduce the occurrence of postoperative delirium.