ObjectiveTo explore the morbidity rate and risk factors of proliferative diabetic retinopathy (PDR) in type 2 diabetes.MethodsThe clinical data of patients, with PDR in 2739 consecutive cases of type 2 diabetes diagnosed in this hospital from 1994 to 2001 were analyed retospectively. The diagnosis of diabetic retinopathy (DR) was confirmed by ophthalmoscopy and fundus fluorescein angiography (FFA). Blood pressure, fasting and postprandial blood sugar, glycosylated haemoglobin（HbA1c）, total serum cholesterol, triglyceride, creatinine, and albumin excretion rate were measured.ResultsThe morbidity rate of type 2 DR was 27.8%（761/2739）, and the morbidity rate of PDR was 4.2%（114/2 739） occupying 15% of the patients with DR. The duration, fasting blood sugar, glycosylated haemoglobin, blood pressure and albumin excretion rate were much higher than those in the control（P＜0.01, glycosylated haemoglobin P＜0.05）. The independent risk factors of PDR were duration of the disease （r=0.15, P＜0.01） and albumin excretion rate （r=0.08, P＜0.05）. The risk factors of PDR were albumin excretion rate and fasting blood sugar (r=0.13, P＜0.05) in patients with longer duration(≥5 years). The morbidity rate of PDR was 2.3%, 5.9% and 12.4% in patients with duration less than 5 years, 5 to 10 years and over 10 years groups, respectively. The morbidity of PDR of the patients in normal albuminuria, microalbuminuria and overt albuminuria group was 2.1%、5.3% and 18.8% respectively.ConclusionsType 2 diabetes accompanied with PDR is relative to the duration of the diabetes, albumin excretion rate, fasting blood sugar, blood pressure, and glycosylated haemoglobin, in which the duration of the disease, albuminuria and fasting blood sugar are the risk factors of occurance of PDR. (Chin J Ocul Fundus Dis, 2003,19:338-340)
Epilepsy is one of the most common neurological diseases in children, about 2/3 can be seizure-free after anti-seizure medications (ASMs) treatment, but there are still some drug-resistant epilepsy (DRE) need surgical treatment, epilepsy surgery including excision surgery, dissociation surgery and palliative surgery, surgery can make 30%~40% DRE fully controlled. Clinicians usually choose to discontinue ASMs after seizure-free for 1 to 2 years after epilepsy surgery, but there has been controversy about whether to discontinue ASMs after surgery in children with epilepsy, how long to discontinue ASMs, the timing of ASMs withdrawal, and there is still a lack of unified guidelines. This article will comprehensively analyze and summarize the risk of recurrence after ASMs withdrawal in children with epilepsy.
ObjectiveTo investigate the clinical feature, prognosis and prognostic factors of early post-traumatic seizures in children. MethodsRetrospective review was performed on 101 individuals with early post-traumatic seizures (EPTS) who were diagnosed in Department of Neurosurgery in Children's Hospital of Chongqing Medical University from January 2008 to June 2013. The record was collected, which included patient's demographics, clinical and radiological presentation, management, and follow-up results of 12 months. The individuals were divided into late post-traumatic seizures (LPTS) group and control group according to the occurrence of LPTS or not. The SAS 9.2 was used for statistical analysis. ResultsDuring 101 cases in our study, male accounted for 60.4%, female accounted for 39.6%, and the ratio was 1.5 to 1. The percentage of patients who were under 6 years old was 74.3%, and the number of cases decreased with age. The peak time of EPTS was within 24 hours after traumatic brain injury. 55.4% of EPTS was the generalized seizures, 34.7% was the partial seizures, and 9.9% was the partial seizures and evolved to secondarily generalized seizures. The incidence of LPTS observed in our study was 26.7% within 12 months follow-up. The electroencephalogram displayed epileptiform discharges in 3 individuals who were without epileptic seizures. There was statistically significant difference in group LPTS compared to control group on these factors which included GSC score≤8(P=0.0064), complicated necrencephalus and/or encephalatrophy(P < 0.0001), multiple brain injuries(P=0.0210), subdural hemorrhage(P=0.0151) and intracranial operation(P=0.0029). The age, history, epileptic seizure type of EPTS, brain contusion, skull fracture and the early use of antiepileptic drugs (AEDs) had no statistically significant difference between LPTS group and control group(P > 0.05). ConclusionsEPTS is prone to occur in children under 6 years old. Male is obviously more than female, and the ratio is 1.5:1. The peak time of EPTS is within 24 hours after traumatic brain injury and most of EPTS are generalized seizures. The incidence of LPTS in children with EPTS exceeds those previously reported. Periodical electroencephalogram examination is essential to decrease the missed diagnosis of LPTS. The GSC score≤8 and complicated necrencephalus and/or encephalatrophy will dramaticlly increase the risk of LPTS. Multiple brain injuries, subdural hemorrhage and intracranial operation are also risk factors for the prognosis of EPTS. Although the use of AEDs is unable to decrease the incidence of LPTS after 12 months follow-up, it is probably beneficial to improving the cognition and brain development. The controversial finding in our study is whether intracranial operation can influence the prognosis of EPTS or not.
Objective To analyze the risk factors of hypertension combined with cerebral hemorrhage. Methods From May 2015 to October 2016, 92 hypertension patients with cerebral hemorrhage (group A) were enrolled; simultaneously, 110 hypertension patients without cerebral hemorrhage (group B) were included. We analyzed retrospectively the clinical data of two groups and the risk factors of hypertension complicated with cerebral hemorrhage. Results The results of univariate analysis showed that the ratios of patients in group A with the following indexes, >65 years old, body mass index >30 kg/m2, >7-year smoking history, triglyceride level >1.7 mmol/L, cholesterol level >5.72 mmol/L, high density lipoprotein level >0.9 mmol/L, and bad medication compiance, were much more higher than those in group B (P<0.05). The rusults of multivariate analysis showed that smoking history, diabetes mellitus history, hypertension history, triglycerides level, cholesterol level, bad medication compliance were the risk factors of hypertension combined with cerebral hemorrhage (P<0.05). Conclusions The risk factors of hypertension combined with cerebral hemorrhage include smoking history, diabetes mellitus history, hypertension history, triglyceride level, cholesterol level, and medication compliance. We shoud pay more attention to these factors in clinical practice.
ObjectiveTo summarize the progress of diagnosis and treatment in male breast cancer. MethodsThe literatures about the research progress of diagnosis and treatment in male breast cancer were reviewed. ResultsThe diagnosis of male breast cancer relied mainly on clinical manifestations and imaging manifestations, the main treatment of male breast cancer was modified radical operation, combining with radiotherapy, chemotherapy, endocrine therapy, and targeted therapy. ConclusionsThe treatment of male breast cancer is mainly reference the treatment of female breast cancer, which is lack of a clear standard of treatment. Indepth study on the molecular genetic level will provide more accurate care decisions for the treatment of male breast cancer.
Abstract： Quality of life （QOL） refers to an individual’s perception and subjective evaluation of their health and well-being, and has become an important index to evaluate the outcomes of clinical treatment in the last past decades. There are a large number of different instruments to evaluate QOL, and the 36-Item Short Form Health Survey （SF-36） is currently one of the most widely used instruments. In recent years, SF-36 has been used to evaluate QOL of valvular heart disease patients to investigate the risk factors those influence their postoperative QOL, provide more preoperative evaluation tools for clinical physicians, and improve postoperative outcomes of patients with valvular heart disease. However, it is now just the beginning to use SF-36 to examine QOL of valvular heart disease patients. Because of significant differences in sample size, follow-up period, country and culture, current research has some controversial results. This review focuses on the progress in evaluating QOL in postoperative patients with valvular heart disease using SF-36.
Objective To study the catheter-related infection (CRI) in cancer patients treated with central venous catheterization. Methods A prospective study with 196 cancer patients was conducted to analyze the types of catheter-related infection and pathogen, as well as the relationship between CRI and the following factors: insert location, gender, age, remained time, or bone marrow suppression. Results Of the total 196 cases, 16 cases were diagnosed as CRI and the CRI rate was 8.2%. The types of CRI were five cases of pathogen colonization, four cases of insert location infection and seven cases of catheter-related bloodstream infection. Of the total 244 specimens, 20 were positive including 7 pathogenic bacteria in either Gram positive or Gram negative types, the dominating pathogens were staphylococcus aureus, staphylococcus epidermidis, acinetobacter baumannii and klebsiella pneumoniae. CRI was related to both insert location and age which were both the independent risk factors. Conclusion The concept of prevention should be set up, and the comprehensive measures should be taken to reduce CRI, such as choosing an appropriate insert location and complying with a strict catheter insert standard.
ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
Objective The risk factors of noninvasive positive pressure ventilation (NPPV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with failure of respiratory failure were identified by meta-analysis, so as to provide a basis for early clinical prevention and treatment failure and early intervention. Methods PubMed, The Cochrane Library, EMbase, China National Knowledge Infrastructure, Wanfang, VIP and CBM Data were searched to collect studies about risk factors about failure of noninvasive positive pressure ventilation in AECOPD and respiratory failure published from January 2000 to January 2021. Two researchers independently conducted literature screening, literature data extraction and quality assessment. Meta-analysis was performed on the final literature obtained using RevMan 5.3 software. Results Totally 19 studies involving 3418 patients were recruited. The statistically significant risk factors included Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score, pre-treatment PCO2, pre-treatment pH, Glasgow Coma Scale (GCS), respiratory rate (RR) before treatment, body mass index (BMI), age, C-reactive protein (CRP), renal insufficiency, sputum disturbance, aspiration of vomit. Conclusions High APACHE-Ⅱ score, high PCO2 before treatment, low pH value before treatment, low GCS score, high RR before treatment, low BMI, advanced age, low albumin, high CRP, renal insufficiency, sputum disturbance, and vomit aspiration were the risk factors for failure of respiratory failure in patients with COPD treated by NIPPV. Failure of non-invasive positive pressure ventilation in COPD patients with respiratory failure is affected by a variety of risk factors, and early identification and control of risk factors is particularly important to reduce the rate of treatment failure.
ObjectiveTo compare the incidences of peritoneal dialysis (PD)-associated peritonitis among HIV and non-HIV patients, and to analyze the risk factors of PD-associated peritonitis. MethodsEnd-stage renal disease patients with HIV infection who newly started PD in West China Hospital of Sichuan University from 2012 to 2020 were retrospectively included, and non-HIV PD patients in the same period were included as controls at a ratio of 1 to 4. The risk factors of PD-associated peritonitis were analyzed by univariate analysis and multivariate logistic analysis. Kaplan-Meier survival analysis and COX regression analysis were used to compare the peritonitis-free survival between HIV group and non-HIV group. ResultsA total of 60 PD patients were included. The average follow-up time was 31.2±21.3 months. Peritonitis occurred in 7 HIV patients (58.33%) and 8 non-HIV patients (16.67%). Logistic regression analysis showed that HIV infection (P=0.018) and high platelet (>150×109/L) (P=0.032) were independent risk factors for PD-associated peritonitis. The incidence of PD-associated peritonitis in HIV patients significantly increased (HR=10.944, 95%CI 1.503 to 79.707). Kaplan-Meier survival analysis showed that the 5-year peritonitis-free survival of non-HIV group was significantly higher than that of HIV group (75.7% vs. 31.1%) (P=0.003). Multivariate COX survival analysis showed that the 5-year accumulative risk of peritonitis in HIV PD patients was 5.896 times (95%CI 1.508 to 23.043, P=0.01) higher than that of the non-HIV PD patients. ConclusionHIV infection is an independent risk factor for PD-associated peritonitis.