ObjectiveTo investigate the establishment of a risk nomogram model for predicting vagus excitatory response in patients with functional epilepsy after radiofrequency thermocoagulation.MethodsA total of 106 patients with epilepsy admitted to the neurosurgery department of our hospital from January 2016 to June 2020 were selected and divided into the Vagus excitatory response (VER) group and the non-VER group according to their occurrence or absence. Logistic regression analysis was used to screen out the risk factors of VER during SEEG-guided Percutaneous radiofrequency thermocoagulation (PRFT) in patients with functional epilepsy, and R software was used to establish a histogram model affecting VER in SEEG-guided PRFT. Bootstrap method was used for internal verification. C-index, correction curve and ROC curve were used to evaluate the prediction ability of the model.ResultsLogistic regression analysis showed that age [OR=0.235, 95%CI (0.564, 3.076)], preoperative fugl-meyer score [OR=4.356, 95%CI (1.537, 6.621)], depression [OR=0.995, 95%CI (1.068, 7.404)], and lesion range [OR=1.512, 95%CI (0.073, 3.453)] were independent risk factors for the occurrence of VER in PRFT under the guidance of SEEG (P<0.05), and were highly correlated with the occurrence of VER in PRFT. Based on the above six indicators, a SEEG-guided colograph model of VER risk in PRFT was established, and the model was validated internally. The results showed that the C-index of the modeling set and validation set were 0.779 [95%CI (0.689, 0.869)] and 0.782 [95%CI (0.692, 0.872)], respectively. The calibration curves of the two groups fit well with the standard curves. The areas under the ROC curve (AUC) of the two groups were 0.779 and 0.782 respectively, which proved that the model had good prediction accuracy.ConclusionFor patients with functional epilepsy requiring seeg-guided PRFT therapy, age, preoperative Fugl-meyer score, depression and lesion range should be taken into full consideration to comprehensively assess the incidence of VER, and early intervention measures should be taken to reduce and reduce the incidence, which has good clinical application value.
Objective To systematically review risk prediction models of in-hospital cardiac arrest in patients with cardiovascular disease, and to provide references for related clinical practice and scientific research for medical professionals in China. Methods Databases including CBM, CNKI, WanFang Data, PubMed, ScienceDirect, Web of Science, The Cochrane Library, Wiley Online Journals and Scopus were searched to collect studies on risk prediction models for in-hospital cardiac arrest in patients with cardiovascular disease from January 2010 to July 2022. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Results A total of 5 studies (4 of which were retrospective studies) were included. Study populations encompassed mainly patients with acute coronary syndrome. Two models were modeled using decision trees. The area under the receiver operating characteristic curve or C statistic of the five models ranged from 0.720 to 0.896, and only one model was verified externally and for time. The most common risk factors and immediate onset factors of in-hospital cardiac arrest in patients with cardiovascular disease included in the prediction model were age, diabetes, Killip class, and cardiac troponin. There were many problems in analysis fields, such as insufficient sample size (n=4), improper handling of variables (n=4), no methodology for dealing with missing data (n=3), and incomplete evaluation of model performance (n=5). Conclusion The prediction efficiency of risk prediction models for in-hospital cardiac arrest in patients with cardiovascular disease was good; however, the model quality could be improved. Additionally, the methodology needs to be improved in terms of data sources, selection and measurement of predictors, handling of missing data, and model evaluations. External validation of existing models is required to better guide clinical practice.
The pathogenesis of diabetic retinopathy (DR) is complex and there are many related risk factors. It is related to the course of diabetes, blood glucose, blood pressure, and blood lipids, among which the course of disease and hyperglycemia are recognized main risk factors. In addition, other factors which include heredity, gender, age, obesity, pregnancy, insulin use, can also affect the occurrence and development of DR, but there is no unified conclusion about its correlation. A comprehensive understanding of the risk factors that affect DR can provide new ideas for the prevention, diagnosis, treatment, and intervention of DR.
【Abstract】ObjectiveTo determine the risk factors associated with development of pancreatic fistula after pancreatoduodenectomy (PD). Methods The clinical data of 123 consecutive patients who underwent PD from Dec. 1994 to Dec. 2003 were analysed retrospectively. Results The incidence of pancreatic fistula was 11.4% (14/123). Univariate analysis showed history of upper abdominal operation, texture of pancreas, postoperative serum hemoglobin level, type of pancreatojejunostomy and diameter of pancreatic duct were significantly associated with pancreatic fistula after PD. Multivariate analysis using Logistic regression identified four variables as independent factors associated with the occurrence of pancreatic fistula: history of upper abdominal operation, texture of pancreas, postoperative serum hemoglobin level and type of pancreatojejunostomy. Conclusion History of upper abdominal operation, soft texture of pancreas, postoperative serum hemoglobin level less than 90 g/L and routine invaginated pancreaticojejunostomy are main risk factors associated with development of pancreatic fistula after PD.
Objective To investigate the relationship among central retinal vein occlusion (CRVO), major systemic diseases, ocular local diseases and related risk factors in Chinese population. Methods Seventeen-six patients with CRVO diagnosed by fundus fluorescein angiography (FFA) without any medical treatment were in CRVO group. Another 76 patients without CRVO or any vascular diseases of ocular fundus were in the control group who were matched with the ones in CRVO group to a one-to-one partnership according to the age and gender. The 2 groups were subdivided into le;45 years old (25 patients, 32.9%) and gt;45 years old (51 patients, 67.1%) subgroups according to the age, and 2 ischemia and non-ischema subgroups according to the results of FFA, respectively. The blood lipid, blood pressure, and fasting blood glucose were measured. The systematic diseases, ocular local diseases and the related risk factors were statistically analyzed and compared. Results The incidence of hypertension and hyperlipemia in CRVO group were significantly higher than that in the control group (Plt;0.001,P=0.001). There was no significant difference of cardiovascular diseases, cerebrovascular diseases, open-angle glaucoma, and smoking and drinking between the two groups(Pgt;0.05). In le;45 years old subgroups, there was no significant difference of each examination target between CRVO and control group(Pgt;0.05). In ischemia subgroups, except for the hypertension and hyperlipemia, the incidence of diabetes mellitus was obviously higher in CRVO group than that in the control group (hyperlipidemia:P=0.031; diabetes mellitus:P=0.024; diabetes mellitus: Plt;0.001). Conclusion Hypertension and hyperlipidemia are the systematic factors in Chinese population with occurrence of CRVO. In addition, diabetes mellitus is associated with ischemic CRVO. Timely diagnosis and treatment of the systematic diseases is important to the prevention and treatment for CRVO. (Chin J Ocul Fundus Dis, 2007, 23:159-162)
ObjectiveThe risk factors of relapse in 133 epileptic children after withdrawal were analyzed retrospectively and provide reference for clinical withdrawal.MethodsFrom January 2017 to March 2019, 133 children with withdrawal epilepsy were selected as the study object. According to whether there was recurrence during the follow-up period, the children with epilepsy were divided into recurrence group (42 cases) and non recurrence group (91 cases). The gender, age of onset, history of trauma, frequency of seizure before treatment, EEG before drug reduction, imaging, type of medication, family history, time of reaching control, course of disease before treatment, comorbidity, multiple attack types, withdrawal speed and EEG before treatment were observed and compared between the two groups. ResultsThere were significant differences in EEG (χ2 =7.621), medication type (χ2=8.760), time to control (χ2=6.618), course before treatment (χ2=6.435), multiple seizure types (χ2=5.443) and epilepsy comorbidity (χ2=42.795) between the two groups (P < 0.05). The results of Logistic multiple regression analysis showed that the recurrence of epileptic children after drug reduction / withdrawal was correlated with abnormal EEG before drug reduction [OR=9.268, 95%CI (2.255, 38.092)], combined drug treatment [OR=3.205, 95%CI (1.159, 8.866)] and course of disease > 1 year before treatment [OR=5.363, 95%CI (1.781, 16.150)] (P < 0.05).ConclusionsIn order to reduce the possibility of recurrence of epileptic children, the treatment time of epileptic children with abnormal EEG, combined medication and long course before treatment should be prolonged properly.
For a long time, the monitoring of ventilator-associated pneumonia (VAP) has many drawbacks, such as complex diagnostic criteria, high subjectivity, low comparability, low attributable mortality, and difficulty in automated monitoring. The U.S. Center for Disease Control and Prevention proposed a new monitoring definition of ventilator-associated event (VAE) in January 2013 to address the existing problems of VAP. VAE monitoring can better predict the adverse prognosis of patients, adopt objective diagnostic criteria, and realize automatic monitoring. However, VAE surveillance also has some shortcomings: poor identification of VAP patients, lack of sufficient evidence of preventive strategies so far, inconclusive application in neonates and children groups, as easy to be interfered with as VAP. The applicability of VAE in China, its risk factors and preventive strategies need to be further studied.
ObjectiveTo preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD).MethodsThirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department, West China Hospital of Sichuan University were selected. Relevant data such as age, height, and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤−2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed.ResultsThe DXA BMD of the 36 patients showed that 50.0% (18/36) had a T value≤−2.5, and 30.6% (11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values), and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%, respectively; and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%, respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis.ConclusionsPostmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients, and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work, for primary hospitals and dialysis centers lacking DXA, preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.
Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is defined as an acute and clinically significant respiratory deterioration characterized by evidence of new, widespread alveolar abnormality. In the past, AE-IPF was considered to be idiopathic, which was hard to be prevented and its prognosis was hard to be obviously improved; the latest researches have shown that AE-IPF can be triggered by known causes, including pulmonary infection, aspiration, etc. This review summarizes the etiology or risk factors, treatment and prevention of AE-IPF according to the latest researches.
ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.