Objective To investigate the clinical and pathological factors associated with simultaneity peritoneal metastasis of colorectal cancer. Methods Clinical data of 1 593 patients with simultaneity peritoneal metastasis of colorectal cancer who treated in Suqian People’s Hospital and Nanjing Drum Tower Hospital from 2010-2014 were collected to analyze the risk factors of simultaneity peritoneal metastasis of colorectal cancer. Results There were 40 patients (2.5%) suffered form simultaneity peritoneal metastasis of the 1 593 patients with colorectal cancer. The result of univariate analysis showed that, age, diameter of tumor, level of carcino-embryonic antigen (CEA), level of CA19-9, level of CA-125, T staging, differentiation, pathological type, and combining with diabetes were risk factors of simultaneity peritoneal metastasis of colorectal cancer, that incidence rates of simultaneity peritoneal metastasis in patients with ≥ 65 years old, diameter ≥ 5 cm, increase of CEA, CA19-9, and CA-125, later staging of T staging, poorly differentiated, signet ring cell carcinoma/mucinous adenocarcinoma, and combining with diabetes were higher (P<0.05). The result of logistic regression showed that, level of CA19-9, level of CA-125, T staging, combining with diabetes, differentiation, and pathological type were the risk factors of simultaneity peritoneal metastasis of colorectal cancer, that incidence rates of simultaneity peritoneal metastasis in patients with increase of CEA and CA-125, later staging of T staging, poorly differentiated (compared with well differentiated), mucinous adenocarcinoma (compared with adenocarcinoma), and combining with diabetes were higher (P<0.05). Conclusion Increase of CEA and CA-125, T staging, poorly differentiated, mucinous adenocarcinoma, and combining with diabetes are independent risk factors for simultaneity peritoneal metastasis of colorectal cancer.
ObjectiveTo analyze the influence factors of the stable angina pectoris patients' medication compliance based on health belief model. MethodsFrom January to December, 2013, 107 patients with stable angina pectoris were interviewed using the self-design questionnaires, and multiple stepwise linear regression statistical was used to analyze. ResultsThe influence factors of increasing medication compliance were as follows:"myocardial infarction can lead to death", "patients with stable angina pectoris may suffer a sudden myocardial infarction", "over the past year the number of the angina pectoris", "standard treatment is good for prevention of myocardial infarction", "suffering myocardial infarction, even if not dying, there is no more chance to live", "take medicine on time can get family's praise", and "among the people that I know there are patients who die of myocardial infarction". The partial regression coefficients were 0.245, 0.251, 0.248, 0.099, 0.234, 0.162, 0.095, respectively; while "worry about side effects of the drugs", "can't afford the medicine", the partial regression coefficients were -0.164 and -0.114. ConclusionHealth belief model is helpful for general practitioners to evaluate the effect factors of medication compliance on stable angina pectoris.
ObjectiveTo explore the risk factors of intraabdominal complications (IACs), pancreatic fistula (PF), and operative death after pancreatoduodenectomy (PD), and to provide a theoretical basis in reducing the rates of them. MethodsClinical data of 78 patients who underwent standard PD surgery in The Third People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from Jun. 2003 to Nov. 2011 were collected to analyze the influence factors of IACs, PF, and operative death. ResultsThere were 29 cases suffered IACs (13 cases of PF included), and 6 case died during 1 month after operation. Univariate analysis results showed that IACs and PF occurred more often in patients with soft friable pancreas, diameter of main pancreatic duct less than 3 mm, preoperative biliary drainage, no pancreatic duct stenting, and without employment of somatostatin (P < 0.05), no influence factor was found to be related to operative death. Multivariate analysis results showed that patients with no pancreatic duct stenting (OR=1.867, P=0.000), soft texture of remnant stump (OR=1.356, P=0.046), and diameter of main pancreatic duct less than 3 mm (OR=2.874, P=0.015) suffered more IACs; PF was more frequent in patient with no pancreatic duct stenting (OR=1.672, P=0.030), soft texture of remnant stump (OR=1.946, P=0.042), and diameter of main pancreatic duct less than 3 mm (OR=1.782, P=0.002);no independent factor was found to have relationship with operative death. ConclusionsSoft texture of remnant stump, diameter of main pancreatic duct less than 3 mm, and no pancreatic duct stenting are independent risk factors that should be considered in indications for PD surgery.
Objective To study traits and influencing factors of coping styles in the military groups of social emergency responders for special service and provide a theoretical basis for epidemiologic intervention. Methods A cross-sectional survey on coping styles and their influencing variables was carried out among 12 special service companies from Armed Police Forces and Fire Units of Public Security stationed in Chongqing by means of cluster sampling. Then, different coping styles were compared with general military personnel, the types and maturity degree of coping behaviors were evaluated, and major influencing variables were screened. Results Of 396 subjects, 86.36% had field experience in handling emergencies. The population’s average levels of coping styles are significantly higher than the military norm (P≤0.01), and the overall type of coping behaviors is mature. Although the relevance between the performance type and the number of 6 coping styles scores reaching the military masculine norm is significant (Plt;0.001), the Pearson contingency coefficient（c=0.23）represents a relatively limited maturity in coping styles. In view of direction and extent effects of various influencing factors, lack of survival skills, disaccord on self and experience, self-inferiority as well as self-stereotypes are negative factors. In addition to social support, self-flexibility responsibility may be positive factors. Use of social support, disaccord on self and experience, self-confidence and knowledge about danger-avoiding take universal impacts, and other factors take single impact on a certain coping style. Conclusion Coping styles in military groups of social emergency responders for special service are comparatively mature and stable, but there are significantly individual differences and a wide range of influencing factors. So, it is very necessary to advance maturity in coping styles through targeted interventions.
ObjectiveTo explore the prognostic factors of pancreatic cancer. MethodsClinical data of 71 patients of pancreatic cancer who treated in The First Hospital of Lanzhou University from January 2010 to December 2014 were retrospectively collected to analyze the prognostic factors of pancreatic cancer. ResultsSixty patients of the 71 patients were followed up for 5-36 months, with the median time of 16 months, and the 1, 2, and 3-year cumulative survival rates were 60.6%, 23.9%, and 1.4% respectively. Univariate analysis results showed that, gender (P=0.043), lymph node metastasis (P=0.002), distant metastasis (P=0.000), TNM staging (P=0.000), and peripancreatic invasion (P=0.000) were correlated with the prognosis of pancreatic cancer, that female patients, patients with the presence of lymph node metastasis, distant metastasis, later TNM staging, and peripancreatic invasion had worse prognosis. Cox proportional hazard model results showed that, distant metastasis (P=0.047), TNM staging (P=0.002), and peripancreatic invasion (P=0.016) were prognostic factors of pancreatic cancer, patients with the presence of distant metastasis, later TNM staging, and peripancreatic invasion had poor prognosis. ConclusionDistant metastasis, TNM staging, and peripancreatic invasion were independent prognostic factors of pancreatic cancer.
Objective To understand the prevalence of overweight and obesity and its influence factors in Zhuhai inhabitants. Methods Applying multi-stage cluster random sampling in the three administrative areas of Zhuhai including Xiangzhou, Doumen and Jinwan, A questionnaire-based survey was performed in conjunction of the measurement of height and weight among 961 inhabitants aged 15-69 years. In addition, a multivariate unconditional logistic regression model was employed to analyze the influence factors of overweight and obesity. Results The prevalence and standardized rates of overweight and obesity in the study population were 18.1%, 17.6%, 6.6%, 6.5%, respectively. The standardized rates of overweight and obesity in male and female were 18.4%, 5.8%, 16.5%, 7.2%, respectively. Age, drinking, smoking and regional difference were identified as the 4 risk factors of overweight and obesity, their OR values being 1.028, 1.683, 0.677, 1.404, Plt;0.05, respectively. Conclusion The prevalence of overweight and obesity in Zhuhai’s inhabitants was over the average level of Chinese residents, and overweight and obesity has become a major risk factor influencing the health of Zhuhai’s inhabitants. In view of the influence factors of overweight and obesity, timely and effective prevention and control measures should be taken.
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 evaluate the results of operative treatment of complex acetabular fractures and to investigate its influence factors. Methods From June 2000 to August 2006, 54 patients with complex acetabular fractures were treated, including 44 males and 10 females aged 20-75 years old (average 39.1 years old). Fractures were due to traffic accidentin 40 cases, fall ing from high places in 8 cases and crush by heavy objects in 6 cases. All cases were fresh and close fractures and the time from injury to operation was 5-72 days. There were 5 cases of posterior column and posterior wall fracture, 25 of transverse and posterior wall fracture, 2 of T-type fracture, and 22 of double column fracture. During operation, Kocker- Lagenbach approach was used in 23 cases, anterior il ioinguinal approach was appl ied for 3 cases and the combination of anterior and posterior approaches was performed on 28 cases. AO reconstructive plate and screw internal fixation were used in all the cases. Results Fifty-two cases were followed up for 12-74 months (average 31.3 months). Anatomical reduction was achieved in 23 cases, satisfactory reduction in 19 cases, poor reduction in 10 cases, and the excellent and good rate reached 80.77%. During operation, 1 case suffered from a tear in the external il iac vein and healed after vein repair; 2 cases had sciatic nerve injury and took mecobalamin as oral administration, one of them fully recovered, and the other had incomplete recovery at 18-month follow-up. At the final follow-up, there were 6 cases of severe heterotopic ossification, one of them received heterotopic bone resection and the rest 5 patients received conservative treatment; there were 9 cases of traumatic osteoarthritis, one of them received total hip replacement and the rest 8 patients received conservative treatment; there were 5 cases of avascular necrosis of the femoral head, two of them received total hip replacement, 1 received no further treatment because the femoral head didn’ t collapse, and the rest 2 patients gave up total hip replacement; 75.00% patients were graded as excellent and good according to the modified Merled’Aubigné-Postel hip score system. Patients’ qual ity of l ife was compared with local population normsmatched for age and sex by using SF-36 scales, their overall score were below the local population norms, and their general health, vital ity, role l imitation due to emotional problems and mental health were comparable to the local population norms. Logistic regression analysis revealed the time to reduce hip dislocation, qual ity of fracture reduction nd traumatic arthritis were independent risk factors affecting postoperative functional outcomes. Conclusion Applying open reduction and internal fixation in the treatment of displaced complex acetabular fractures has a satisfying therapeutic effect. Time to reduce hip dislocation, qual ity of fracture reduction as well as traumatic arthritis are independent risk factors affecting postoperative functional outcomes.
ObjectiveTo summarize the surgical treatment and explore factors which influencing prognosis of hilar cholangiocarcinoma. MethodsClinical data of 189 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2000 to Dec. 2010 and clinicopathological factors that might influence survival were analyzed retrospectively. A multivariate factor analysis was performed through Cox proportional hazard model. ResultsOf 189 cases, 62 cases received radical resection, 54 cases received palliative surgery, and 73 cases received non-resection surgery. Operative procedure (RR=0.165), differentiated degree (RR=2.692), lymph node metastasis (RR=3.014), neural infiltration (RR=2.857), and vascular infiltration (RR=2.365) were found to be the statistically significant factors that influenced survival by multivariate factor analysis through the Cox proportional hazard model. ConclusionsRadical resection is the best treatment for hilar cholangiocarcinoma. Skeletonized hepatoduodenal ligament, complete excision of infiltrated nerve and blood vessel are important influence factors to improve the prognosis of hilar cholangiocarcinoma.
Objective To investigate the medical charge of in-patients with diabetes and its influencing factors for effective hospital costs controlling. Methods The inpatients with diabetes (the first diagnosis was diabetes; the first three ICD-10 codes of which were between E10 to E14) in Fifth Peoples' Hospital of Chengdu during January to September of 2014 were analyzed for their hospital costs with descriptive statistical method, ANOVA and multiple linear regression method. Statistical analysis was conducted by using SPSS 18.0 software. Results A total of 1 389 cases of diabetes were included. The median of total medical costs and daily costs were 4 554.45 yuan and 446.46 yuan, respectively. The differences of total medical costs and daily costs between diabetes patients with different amount of complications were statistically significant (P<0.001). The factors including age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length were proved to be significantly correlated to total medical costs of diabetes inpatients (P<0.05). Conclusion Age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length are influence factors of medical costs of diabetes inpatients.