Objective To investigate the medication adherence to antihypertensives, antidiabetics, and lipid-lowering agents and its influence on the prognosis of individuals at high risk of stroke. Methods A total of 16892 residents aged 40 years or above in eight communities in Sichuan participated in a face-to-face study from May to September 2015. A database of a high-risk population of stroke in Sichuan province was established, and data were collected via using a standardized structured questionnaire by experienced investigators, including the treatment status and medication compliance of participants with hypertension, diabetes, or dyslipidemia during the follow-up period. Multiple logistic regression analyses were performed to explore the influencing factors of medication adherence and its influence on the prognosis of individuals at high risk of stroke. Results A total of 2893 participants at high risk of stroke were enrolled. The treatment rates of hypertension, diabetes, and dyslipidemia were 50.1%, 49.2%, and 5.1%, respectively, when the high-risk individuals were identified. At the end of follow-up (with a median follow-up period of 4.8 years), the treatment rates of hypertension, diabetes, and dyslipidemia were 24.8%, 25.0%, and 7.9%, respectively. Medication adherence to antihypertensives, antidiabetics, and lipid-lowering agents were 27.8%, 25.5%, and 18.1%, respectively. Multiple logistic regression analyses showed that the education level of high school or above [odds ratio (OR)=2.134, 95% confidence interval (CI) (1.098, 4.147), P=0.025], medical insurance for urban residents [OR=1.556, 95%CI (1.086, 2.230), P=0.016] and urban employees [OR=2.325, 95%CI (1.362, 3.967), P=0.002], having fewer children [OR=0.819, 95%CI (0.719, 0.933), P=0.003], and family history of stroke [OR=1.559, 95%CI (1.066, 2.282), P=0.022] were associated with greater adherence to antihypertensives; medical insurance for urban employees was associated with greater adherence to antidiabetics [OR=2.494, 95%CI (1.173, 5.300), P=0.018]. After adjusting for confounding factors, failure to regular use of antihypertensives [OR=2.617, 95%CI (1.414, 4.842), P=0.002], antidiabetics [OR=3.909, 95%CI (2.394, 6.380), P<0.001], and lipid-lowering agents [OR=4.828, 95%CI (2.581, 9.033), P<0.001] in patients with hypertension, diabetes, and dyslipidemia, respectively were associated with increased risk of ischemic stroke during the follow-up period. Regular use of lipid-lowering agents in patients with dyslipidemia was associated with an increased risk of intracerebral hemorrhage during the follow-up [OR=4.371, 95%CI (1.156, 16.530), P=0.030]. Conclusions The prevalences of hypertension, diabetes, and dyslipidemia are high in high-risk individuals of stroke in Sichuan province. However, the treatment rates are unsatisfactory, and the medication adherence is poor. The medication adherence is affected by a variety of demographic and socioeconomic factors. Regular treatments of hypertension, diabetes, and dyslipidemia reduce the risk of ischemic stroke in individuals at high risk of stroke, but regular use of lipid-lowering agents in patients with dyslipidemia is associated with an increased risk of intracerebral hemorrhage during the follow-up.
目的:探讨经尿道前列腺电切术(TURP)治疗高危良性前列腺增生症(BPH)的术中、术后常见并发症的原因、预防及治疗,提高手术安全性和有效性。方法: 回顾性分析62例高龄合并心肺疾患的前列腺增生症患者行经尿道前列腺电切术(TURP)的临床资料。结果: 62例排尿困难症状均改善,其中1例出现暂时性尿失禁,2月后好转,尿路感染7例,消炎治疗后好转,5例出现肉眼血尿,做对症处理后血尿消失,无输血病例,无经尿道电切综合征(TURS)发生。结论:采用TURP是良性前列腺增生症安全有效的外科治疗方法,疗效满意,并发症少,安全性高,住院时间短,费用低。
Objective To develop an evaluation tool for the screening of high risk population for oral complications in critically ill patients, which can be performed accurately and scientifically. Methods Basing on the related foreign oral assessment scale, combined with the method of brainstorming, expert consultation, method of clinical status and so on, the item pool of the assessment scale was determined. Five nursing experts and two oral experts assessed the content validity and 50 ICU nurses were tested. Then, the screening accuracy of the assessment scale was proved by application in 100 critically ill patients selected randomly. Results The Cronbach’s a coefficient of final version of the High Risk Assessment Scale for Oral Complications in Critically Ill Patients (including seven parts contents of oral health assessment and oral pH value test) was 0.815, the content validity index (Sr-CVI/Ave) was 0.932. The results of 50 nurses to the 91.2% assessment items of the assessment scale were very important and important. For screening related indicators of oral complications in high-risk patients, the sensitivity of the assessment scale was 97.53%, the specificity was 94.11%, the positive predictive value was 98.75%, the negative predictive value was 88.89%, and the crude agreement was 95%. Conclusion There are good reliability, validity and a high accuracy of screening test in the High Risk Assessment Scale for Oral Complications in Critically Ill Patients. It can be used for screening patients at high risk for oral complications in critically ill patients, and help clinical nurses to complete the oral health status of the critically ill patients quickly.
目的:探讨早产儿呼吸暂停相关高危因素,指导临床防治工作。方法:对90例早产儿呼吸暂停进行回顾性分析。结果:胎龄越小,体重越低的早产儿,原发性呼吸暂停发生率越高,随着胎龄增加继发性呼吸暂停发生率亦增加,继发性呼吸暂停与缺氧、低体温、酸中毒、脑损伤、感染等因素有关,生后2～5d为发病高峰期。结论:呼吸暂停与胎龄、体重、缺氧、低体温、低血糖、酸中毒、感染、颅脑损伤等多因素有关。对有相关高危因素早产儿应足够重视,减少呼吸暂停发生。
ObjectiveTo explore the risk factors of recurrence of incisional hernia following incisional hernia tension-free repair. MethodsThe clinical data of 162 patients with incisional hernia underwent tension-free repair were retrospectively analyzed in this hospital from January 2005 to January 2011. The relationships of incisional hernia recur-rence to gender, age, body mass index, hernia size, abdominal wall defect site, preoperative chronic comorbidities, type of tension-free repair, operation time, and wound healing disorders were analyzed by univariate and multivariate analysis. ResultsOne hundred and sixty-two patients were followed up 7-70 months with mean 34.5 months. The rate of recur-rence following incisional hernia tension-free repair was 9.26% (15/162). The results of univariate analysis showed that recurrence following incisional hernia tension-free repair was associated with the age (P < 0.05), body mass index (P < 0.05), type of tension-free repair (P < 0.05), hernia size (P < 0.05), and wound healing disorders (P < 0.05). The results of multivariate logistic regression revealed that the body mass index, type of tension-free repair, hernia size, and wound healing disorders were the independent risk factors associated with recurrence following incisional hernia tension-free repair. Fifteen recurrent patients were reperformed successfully. There was no recurrence following up with an average 23 months. ConclusionsIt is necessary to become familiar with the risk factors for recurrence of incisional hernia in order to eliminate or decrease their effects on the positive outcome of incisional herniorrhaphy. The patients with fat, hernia ring bigger, incorrect opera-tion or wound healing disorders might be easy to relapse. Surgical approach should be individualized for recurrence.
ObjectiveTo compare clinical outcomes between coronary artery bypass grafting (CABG)and off-pump coronary artery bypass grafting (OPCAB)for high-risk coronary artery disease (CAD)patients with high European System for Cardiac Operative Risk Evaluation (EuroSCORE). MethodsA total of 211 CAD patients undergoing surgical treatment in the Department of Cardiovascular Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University from June 2007 to July 2013 were enrolled into this study, including 52 patients receiving CABG and 159 patients receiving OPCAB. Predicted risk of operative mortality (PROM)of each patient was calculated by EuroSCORE. Patients with PROM≥6 were stratified into high-risk subgroups. Clinical outcomes were compared between CABG and OPCAB patients, as well as incidence of cardiovascular events, angina and stroke within 30 postoperative days in high-risk subgroup patients. ResultsOPCAB and CABG group patients had similar left main disease. There was no statistical difference in the number of distal anastomosis between OPCAB (2.75±0.82)and CABG group patients (2.83±0.58) (P > 0.05). Operation time[ (3.92±0.79)hour vs. (6.83±1.53)hour], thoracic drainage[ (983.14±802.39)ml vs. (1 620.40±879.32)ml], blood transfusion[ (1 289.30±668.08)ml vs. (2 325.30±491.98)ml], length of ICU stay[ (3.90±1.33)days vs. (5.08±1.78)days], and mechanical ventilation time[ (9.63±3.32)h vs. (13.76±3.79)h] of OPCAB group patients were significantly shorter or lower than those of CABG group patients (P < 0.05). There was no statistical difference in 30-day mortality between OPCAB and CABG group patients (1.26% vs. 3.85%, P > 0.05). Among high-risk subgroup patients, the odds ratio of stroke within 30 postoperative days in CABG was 5.7 (95%CI 1.28-25.09, P < 0.05)compared with OPCAB group patients, and the incidence of cardiovascular events and angina within 30 postoperative days were similar between the 2 subgroups. ConclusionsPostoperative mortality and number of distal anastomosis are not significantly different between CABG and OPCAB patients, but OPCAB can significantly reduce operation time, thoracic drainage, blood transfusion, length of ICU stay and mechanical ventilation time compared with CABG. For high-risk patients with high EuroSCORE, OPCAB can better reduce the incidence of postoperative stroke compared with CABG.
Objective To analyze the clinical characteristics of the Guang’an Omicron epidemic and summarize the management experiences and practices in pandemic prevention and control of major infectious diseases.Methods Retrospective analysis was performed on patients infected with coronavirus disease (COVID-19), afterwards treated and observed in the isolation ward of Guang’an People’s Hospital and the shelter of Guang’an City from May 9 to June 26, 2022. The characteristics of patients at different age stages and the related factors affecting the severity, re-positive and negative conversion was analyzed. Results Finally 1 278 patients were collected, including 508 males and 770 females, with an average age of 41.3±22.6 years. Among them, 1 054 patients were asymptomatic carriers. The overall severe rate was 0.86%, the severe rate of the high-risk group was 3.06%. The median negative conversion time was 10.0 days and re-positive rate was 7.36%. Patients aged＞60 years were 2.589 times more likely to have a longer negative conversion time than those aged≤60 years (95%CI 1.921-3.489, P＜0.001). Conclusion The clinical characteristics of Guang’an COVID-19 epidemic are mainly that the elderly with high risk factors are more likely to develop severe cases, have longer clearance time, and re-positve is more likely to occur.
ObjectiveTo evaluate the pathological features of bilateral retinoblastoma (RB) and the relationship between different treatments and high-risk histopathologic features (HHF). MethodsRetrospective series of case studies. From 1999 to 2018, 73 patients with binocular RB diagnosed by pathological examination in Department of Ophthalmology, Peking University People's Hospital were included in the study. Among them, 50 patients were male (68.5%, 50/73), 23 patients were females (31.5%, 23/73); 11 patitents had a family history of RB. The mean age at the first diagnosis was 14.8±15.6 months. The average time between first diagnosis and first intervention was 3.97±4.74 months. According to the international classification standard of intraocular RB staging, among the 73 eyes, C, D and E stages were 2 (2.7%, 2/73), 15 (20.5%, 15/73), and 56 (76.7%, 56/73) eyes, respectively. Ocular images for each patient were obtained using a wide-angle contact fundus camera during examination under general anaesthesia. The treatment protocol (globe salvaging or enucleation) depended on the result of several clinical features. Globe salvaging treatment included chemotherapy combined with local therapy such as intra-arterial chemotherapy (IAC), intravitreal chemotherapeutics injection, cryotherapy, laser, transpupillary thermotherapy and radiotherapy. If globe salvaging failed, enucleation was offered and histopathologic analysis was conducted of the enucleated eye, the ophthalmic pathologist read and evaluated the presence of HHF. Independent samples t-test was performed to compare the continuous variables. The pathological features and the relationship between different treatments and HHF were analyzed. Group difference was calculated with chi-square. Results Among the 73 eyes, the first treatment was enucleation in 21 eyes (28.8%, 21/73); 52 eyes (71.2%, 52/73) were treated with eye protection. After enucleation, 9 cases (12.3%, 9/73) had recurrence and metastasis, and 7 cases (9.6%, 7/73) died. The intervention time of patients with recurrence and metastasis and those without recurrence and metastasis were 7.4±7.3 and 3.5±4.1 months respectively; the first intervention time of patients with recurrence and metastasis was significantly later than that of patients without recurrence and metastasis, but the difference was not statistically significant (t=－1.561, P=0.154). The pathological examination results showed that there were 26 eyes (35.6%, 26/73) with HHF, 4 (26.7%, 15/26) and 22 (39.3%, 22/56) eyes were in stage D and E, respectively. Those who received other treatments before enucleation had lower HHF percentages after enucleation than those who did not receive corresponding treatments, but the difference was not statistically significant (χ2=1.852, 0.074, 0.000, 1.007, 0.007, 2.729; P＞0.05). Among the 26 eyes, 5 (83.3%, 5/6) and 21 (31.3%, 21/67) eyes were treated with systemic chemotherapy combined with and without IAC, respectively, and there was a significant difference in the percentage of HHF (χ2=4.422, P=0.035). ConclusionsIAC eye-preserving therapy before enucleation has a significant effect on HHF.