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Objective:To investigate the efficacy and safety of Rituximab (RTX) in the treatment of children with frequently relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS) and to analyze the factors influencing the efficacy.Methods:Case series study.The clinical data of children with FRNS/SDNS who received B-cell-guided RTX (single dose: 375 mg/m 2, maximum dose: 500 mg, one additional dose when peripheral blood CD19 + B lymphocytes ≥0.01) in the First Affiliated Hospital of Zhengzhou University from September 2019 to March 2022 were retrospectively collected.The frequency of relapse and cumulative dose of glucocorticoids before and after RTX treatment were compared.The Kaplan-Meier method was used to analyze relapse-free survival rate and FRNS/SDNS-free survival rate after RTX treatment.The influencing factors of relapse were analyzed using the Cox proportional hazards regression model. Results:Totally 47 children were enrolled, including 35 males and 12 females; the age of first application of RTX was 10.2 (6.9, 13.0) years; 33 children had used one type of immunosuppressant before, and 14 children had used two or more types of immunosuppressant before; the dose of RTX treatment was 3.0 (2.0, 3.0). The frequency of relapse[0(0, 0.55) times/year vs.1.62 (1.09, 2.40) times/year] and cumulative dose of glucocorticoids[0.12 (0.05, 0.21) mg/(kg·d) vs.0.40 (0.20, 0.56) mg/(kg·d)] after RTX treatment significantly decreased compared with previous immunosuppressive treatment ( Z=-5.56, -5.54, all P<0.001). The relapse-free survival rates at 6, 12, 18 and 24 months after treatment were 80.9%, 72.3%, 68.1% and 68.1%, respectively, and the FRNS/SDNS-free survival rates were 93.6%, 89.4%, 89.4% and 89.4%, respectively.Univariate Cox regression analysis showed that the high frequency of relapse during previous immunosuppressive therapy was a risk factor for relapse after RTX treatment ( P<0.05). Of the 14 children who relapsed, 6 occurred in children whose CD19 + B lymphocytes<0.01, and the frequency of relapse after RTX treatment was significantly higher than those whose CD19 + B lymphocytes≥0.01 ( Z=-2.84, P=0.005). No severe adverse reactions occurred during RTX treatment and follow-up. Conclusions:The B-cell-guided RTX is effective and safe in the treatment of FRNS/SDNS in children.The high frequency of relapse during previous immunosuppressive therapy is a risk factor for relapse after RTX treatment, and relapse in the state of B lymphocyte depletion predicts poor outcomes of RTX treatment.
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Objective:To explore the influencing factors of early postoperative complications after radical resection of congenital choledochal cyst (CCC) in a single center and provide some clinical basis and guidance for reducing postoperative complications.Methods:Case control study.Clinical data of 124 children (29 boys and 95 girls) with CCC diagnosed and radically treated at the Affiliated Hospital of Zunyi Medical University from September 2010 to October 2019 were analyzed.According to postoperative complications (bile leakage, gastrointestinal anastomotic fistula, bleeding, incision dehiscence, cholangitis, abdominal infection, pancreatitis, and lymphatic fistula), these children were divided into the complication group (group A) and non-complication group (group B). Age, laboratory indicators[preoperative white blood cell (WBC) count, hemoglobin, glutamic pyruvic transaminase, prealbumin, and postoperative albumin], and clinical factors, such as operation method, operation time, intraoperative blood loss, cyst type, cyst diameter, hepatic duct diameter, abdominal operation history, biliary sludge and calculus, hepatic duct anatomic variation, and pancreaticobiliary maljunction were statistically analyzed between the two groups.The t-test was performed for normal distribution of the measurement data, and the non-parametric rank sum test for non-normal distribution.Multivariate analysis was made using Logistic regression. Results:Among the 124 children, 25(20.16%) had complications, and 99(79.84%) had no complications.Bile leakage occurred in 14 children (11.29%), of whom 7 received operation again and 7 received conservative treatment.Gastrointestinal anastomotic fistula occurred in 2 children (1.61%), of whom 1 was re-operated and 1 was cured conservatively.One child (0.81%) was complicated with bleeding and cured by re-operation.Two children (1.61%) were complicated with incision dehiscence, of whom 1 was cured by re-operation and 1 was cured by conservative treatment.Cholangitis in 2 children (1.61%), abdominal infection in 2 children (1.61%), pancreatitis in 1 child (0.81%), and lymphatic fistula in 1 child (0.81%) were all conservatively cured.No significant difference was found in non-normal distribution indicators-age and WBC count-between the two groups (all P>0.05). Blood loss volume and cyst diameter were significantly different between the two groups (all P<0.05). Postoperative albumin[(27.84±4.62) g/L vs.(32.45±3.72) g/L] meeting the normal distribution showed a statistically significant difference between the two groups ( t=5.254, P<0.05). Logistic multivariate regression analysis suggested that preoperative anemia ( OR=7.922, 95% CI: 1.468-42.757) and biliary sludge and calculus ( OR=1.295, 95% CI: 1.075-4.359) were independent risk factors for postoperative complications; postoperative albumin ( OR=0.055, 95% CI: 0.012-0.244) was a protective factor for postoperative complications, and the differences were statistically significant (all P<0.05). Conclusions:The larger the cyst diameter, the more the intraoperative bleeding, and the higher the risk of operation.Treating anemia before operation, clearing sludge in the hepatic duct during operation, reducing bleeding, and strengthening the monitoring of albumin and hemoglobin during the perioperative period can prevent and reduce early complications after radical resection of CCC in children.
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To review the research status, assessment tools, influencing factors and intervention measures of social grooming in patients with gynecological malignant tumors, so as to provide a theoretical basis for improving the social alienation of patients with gynecological malignant tumors and better integrating into society.
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Objective:To explore the current situation of binary coping in patients with perimenopausal syndrome and analyze its influencing factors, in order to provide a basis for improving the level of binary coping.Methods:Using convenience sampling method, a total of 210 patients with perimenopausal syndrome and their spouses from the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine were cross-sectional surveyed by a general data questionnaire, the Binary Coping Scale, and the Modified Kupperman Score Scale. The influencing factors of binary coping level in patients with perimenopausal syndrome were explored by univariate analysis and variance decomposition model analysis.Results:A total of 200 valid questionnaires were retrieved.The patients aged (50.52 ± 2.89) years old. The binary coping score was (79.64 ± 22.74) points. The variance decomposition model analysis showed that marriage age, type of medical insurance, number of children, education level, family monthly income, spouse′s education level, presence of major comorbidities in spouse, modified Kupperman score, presence of generalized anxiety in spouse were the main influencing factors of binary coping in patients with perimenopausal syndrome (all P<0.05). Conclusions:The binary coping scores of patients with perimenopausal syndrome are lower than normal, and considering the influence and involvement of patients' spouses, nursing staff should pay special attention to patients who are married relatively early, have more children, have lower education levels, and have lower family monthly incomes. Additionally, attention should be given to spouses who experience widespread anxiety, have a lower level of education, and suffer from major chronic diseases. By developing and implementing comprehensive intervention measures aimed at improving the Kupperman score and the level of binary coping, both parties can be encouraged to support each other more effectively, thereby improving the marital relationships of patients during the perimenopausal period.
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Objective To understand the factors that affect the pulmonary rehabilitation behavior of elderly patients with lung cancer during the post-operative transitional period,and provide reference bases for formulating the pulmonary rehabilitation plan of elderly patients with lung cancer during the transitional period and improving the compliance of pulmonary rehabilitation.Methods Based on the capability,opportunity,and motivation-behavior model(COM-B model),12 elderly lung cancer patients who underwent surgery at a tertiary A tumor hospital in Tianjin from March to July 2022 were selected for semi-structured interviews using descriptive research methods and purposive sampling method.The data were analyzed using directed content analysis.Results The ability factors(physical strength and postoperative discomfort symptoms of the elderly limit lung rehabilitation exercise,lack of pulmonary rehabilitation knowledge and awareness of the importance of exercise in lung rehabilitation knowledge),opportunity factors(lack of grassroots medical and health services,limiting lung rehabilitation exercise;family and friends are important resources for promoting lung rehabilitation exercise;medical support is a guarantee for promoting lung rehabilitation exercise),motivational factors(high self-efficacy in exercise is the foundation for lung rehabilitation exercise,perception of lung rehabilitation effects increases motivation for lung rehabilitation exercise)and 7 sub themes were extracted.Conclusion There are certain obstacles and promoting factors in the transitional lung rehabilitation process for elderly lung cancer patients after surgery.It is necessary to improve their postoperative discomfort symptoms,increase their knowledge of lung rehabilitation,enhance their awareness of lung rehabilitation,face the social support role of family,friends,and medical staff,improve the infrastructure and lung rehabilitation system,increase community lung rehabilitation support,provide multi-channel high-quality lung rehabilitation resources,and promote the development of smart medical services,constructing a transitional lung rehabilitation strategy for elderly patients with lung cancer.
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Objective:To analyze the passive smoking exposure and its influencing factors in non-smokers aged≥18 in Tianjin.Methods:This was a cross-sectional study. Based on the 2018 Tianjin Adults Noncommunicable Disease and Nutrition Surveillance, non-smokers aged≥18 years old at 7 surveillance sites were selected as the research objects, taking 2018 population data of Tianjin as the standard population, the sample data were weighted to analyze the general demographic characteristics, the level of passive smoking exposure, the cognition of tobacco harm, and the influencing factors of passive smoking exposure. Pearson χ 2 test was used to compare the rate between groups, and the influencing factors were analyzed by unconditional logistic regression. Results:After weighted, the passive smoking exposure rate was 51.5%, among non-current smokers, the awareness rates of smoking related lung cancer and passive smoking related adult lung cancer were 83.3% and 80.0%, respectively. The awareness rates of smoking related stroke and passive smoking related heart disease in adults were 61.4% and 66.4%, respectively. The awareness rate that smoking related stroke was higher in the non-passive smoking exposed group than in the secondhand smoke exposed group (62.7% vs 60.3%, P<0.05). There was no statistical difference in the awareness rate of smoking related heart attacks and lung cancer as well as passive smoking related adult heart disease, adult lung cancer, and lung disease in children between the passive smoking exposed group and the non-passive smoking exposed group (all P>0.05). The awareness rate of smoking related three diseases (stroke, heart attack and lung cancer) was 57.9% and the awareness rate of passive smoking related three diseases (heart disease in adults, lung cancer and lung disease in children) was 64.9% in non-current smokers. Among men, undergraduate or above was a protective factor for second-hand smoke exposure. Heads, clerical and related personnel of state organs, party and mass organizations, enterprises and public institutions were risk factors for secondhand smoke exposure. Among women, age ≥60 years and high education were protective factors for secondhand smoke exposure. Conclusions:Non smokers aged 18 and above in Tianjin have a higher level of passive smoking exposure, and the awareness rate of tobacco exposure related cardiovascular diseases is low. In future, the health education of relevant knowledge should be strengthened.
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Abstract@#The choroid is a multifunctional dynamic structure located between the sclera and the Bruch membrane, which may be involved in the regulation of eye growth and the development of myopia. Choroidal thickness may serve as an important biomarker for predicting the development of myopia and the effectiveness of myopia control treatments in children and adolescents. The study reviews and summarizes the physiological structure and measuring methods of the choroid, and discusses its influencing factors including age, physiological changes, refractive status, axial length, drug effects, optical environment and so on. The review points out the potential applications of choroidal thickness in myopia research among children and adolescents.
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ObjectiveTo investigate the incidence of hypertension and its influencing factors in community-dwellers at risk for high blood pressure in Minhang District of Shanghai， and to provide scientific evidence for the community management. MethodsA retrospective cohort study was conducted using the electronic health records of community-dwellers at risk for high blood pressure in Minhang District， Shanghai from January 1， 2011 to December 31， 2017. The study end-point was the occurrence of hypertension，and the followup was finished in December 2021. A total of 17 265 community-dwellers at risk for high blood pressure were enrolled in our study. Log-rank test and Cox regression analysis were used to determine the influencing factors. ResultsAfter 6.04 years of follow-up， the hypertension incidence among community-dwellers at risk for high blood pressure in Minhang District of Shanghai was 25.5%. Family history of hypertension （HR=1.250， 95%CI： 1.168‒1.338）， family history of stroke （HR=1.295， 95%CI： 1.080‒1.553）， history of diabetes （HR=1.203， 95%CI： 1.076‒1.345）， daily smoking （HR=1.187， 95%CI： 1.087‒1.296）， overweight （HR=1.393， 95%CI：1.308‒1.484）， obesity（HR=1.903， 95%CI： 1.719‒2.106）， high values of normal blood pressure （HR=1.275， 95%CI： 1.195‒1.359） and advanced age （HR=1.033， 95%CI： 1.030‒1.036） were all risk factors. Emaciation （HR=0.649， 95%CI： 0.500‒0.840） was a protective factors. ConclusionBlood pressure monitoring should be strengthened for people elderly， with family history of hypertension， family history of stroke， diabetes or high values of normal blood pressure， so as to diagnose hypertension early. Timely intervention measures should be taken for community-dwellers with unhealthy lifestyles such as smoking， overweight and obesity.
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Background With the aging of China's population, cognitive impairment in the elderly is receiving increasing public attention. Screening and intervention of people with mild cognitive impairment (MCI) are of great significance to prevent and reduce the occurrence of cognitive impairment. Objective To understand the prevalence and explore potential influencing factors of MCI in the elderly in Songjiang District, Shanghai, and to provide scientific basis for promoting early screening of cognitive impairment and precise intervention of MCI in the elderly in this area. Methods A cross-sectional study design was adopted. From August to October 2022, using multi-stage random sampling, 1800 elderly residents aged 60 years and above were screened for cognitive impairment in 6 neighborhood/village committees in 6 towns in Songjiang District. The survey questionnaires included a sociodemographic questionnaire, a health status and lifestyle questionnaire, the Instrumental Activities of Daily Living (IADL), the Patient Health Questionnaire (PHQ-9), and the Mini-Mental State Examination (MMSE). Prevalence rates of MCI among the elderly by selected social demographic characteristics, health status, and lifestyle were estimated, and potential influencing factors of MCI were evaluated by binary logistic regression. Results A total of 209 elderly residents with MCI and 1591 healthy elderly residents were detected, and the prevalence of MCI in the elderly aged 60 and above was 11.6% in Songjiang District. Being physically active (OR=0.556, 95%CI: 0.399, 0.774) reduced the risk of MCI. Illiteracy (OR=1.810, 95%CI: 1.239, 2.644), primary school education level (OR=3.454, 95%CI: 2.342, 5.092), non-participation in social activities (OR=1.945, 95%CI: 1.360, 2.781), IADL damaged (OR=3.173, 95%CI: 2.137, 4.712), and depression (OR=1.957, 95%CI: 1.112, 3.443) increased the risk of MCI (P＜0.05). Conclusion The prevalence of MCI among the elderly in Songjiang District is lower than the national average. Educational level, physical activity, participation in social activities, IADL, and depression may be the influencing factors of MCI in the elderly. It is recommended to carry out early screening, early detection, and early intervention for cognitive impairment in the elderly. Improving involvement in physical exercise and increasing participation in social activities are encouraged. Special attention should be paid to the needs of vulnerable groups such as low education level and disabled elderly during a community MCI intervention program.
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Objective @#Objective To investigate the demand for health management and influencing factors among occupational population at high risk of stroke, so as to provide insights into the development of stroke health management strategies among occupational population.@*Methods@#Occupational population aged 40 to 60 years who participated in health examination were sampled from three tertiary hospitals in Luzhou City, Sichuan Province using a quota sampling method in the ratio of 4∶1∶1, from August to December 2020. Participants' blood biochemistry tests and health examination were collected through the examination reports, and the participants at high risk of stroke were screened using the assessment criteria for high-risk of stroke. Participants' general information and demand for health management were collected using questionnaire surveys. In addition, factors affecting the demand for health management were identified using a multivariable logistic regression model. @*Results@#A total of 3 003 people who participated in health examination were investigated, and 1 062 participants met the assessment criteria for high risk of stroke, accounting for 35.36%. There were 1 000 men (94.16%) and 62 women (5.84%), with a mean age of (49.26±4.97) years. There were 414 professional and technical staff (39.50%). There were 709 participants (66.76%) with demand for health management, with the top three in the demand as health checkups (915 participants, accounting for 86.16%), health consultation (601 participants, accounting for 56.60%) and exercise guidance (560 participants, accounting for 52.73%), and 210 participants (19.77%) received health management. Multivariable logistic regression analysis showed that occupational population at high risk of stroke who received health management were more likely to have the demand for health management (OR=2.158, 95%CI: 1.479-3.149). @*Conclusions@#The occupational population at high risk of stroke have the demand for health management. Having received health management may affect the demand for health management among occupational population at high risk of stroke.
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Objective @#To investigate the prevalence of occupational injury and identify its influencing factors among workers in a steel enterprise in Gansu Province, so as to provide insights into prevention of occupational injury among steel workers. @*Methods@#Workers were sampled from a steel enterprise in Gansu Province using a cluster sampling method from January to March 2022, and participants' demographics, occupational history and occupational injury were collected using questionnaire surveys. The type of job and site and type of injury were analyzed among workers with occupational injuries, and factors affecting workers' occupational injuries were identified using a multivariable logistic regression model. @*Results@#A total of 12 089 questionnaires were allocated and 10 725 valid questionnaires were recovered, with an effective recovery rate of 88.71%. The respondents included 9 412 males (87.77%) and 1 312 females (12.23%), and had a median age of 36.00 (interquartile range, 15.00) years. Junior college and above was the predominant educational level (6 056 workers, 56.47%), and the respondents had a median length of service of 10 (interquartile range, 11) years. The prevalence of occupational injury was 5.25% among respondents. Overhaul worker was the main type of job (11.90%), and object strike was the predominant type of occupational injury (18.25%), while the lower limb was the predominant site of injury (27.82%). Multivariable logistic regression analysis identified men (OR=2.464, 95%CI: 1.580-3.843), age (30 to 39 years, OR=2.561, 95%CI: 1.643-3.993; 40 to 49 years, OR=5.197, 95%CI: 2.679-10.079; 50 years and older, OR=10.620, 95%CI: 6.788-16.615), exposure to high temperature (OR=1.400, 95%CI: 1.165-1.683), operating equipment failure (OR=1.291, 95%CI: 1.048-1.591), absence of personal safety protection equipment (OR=1.555, 95%CI: 1.064-2.273) and safety behavior scores (OR=0.967, 95%CI: 0.937-0.996) as factors affecting occupational injuries among workers in a steel enterprise. @*Conclusions@#Men and overhaul workers are at a high risk of occupational injuries in this steel enterprise. Objectstrike is the predominant type of injury and lower limb is the main site of injury. The risk of occupational injuries is affected by gender, age, working environments, equipment status and safety behaviors.
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ObjectiveTo investigate the detection rate and main influencing factors of growth retardation in infants aged 0-3 in Minhang District， and to provide relevant evidence for early intervention， nutrition promotion and health guidance in the future. MethodsFrom September 1， 2020 to August 31， 2021， the height， weight， basic information of parents， feeding methods， and lifestyle habits of infants who received systematic healthcare aged 0‒3 in community health service centers and Minhang maternal child health hospital were collected， and the current situation and influencing factors of infant growth retardation were analyzed. ResultsAmong the 68 637 infants who underwent a systematic physical examination in Minhang District， the total detection rate of growth retardation was 5.03% （3 453/68 637）. The detection rates in the 0-year-old， 1-year-old， 2-year-old， and 3-year-old groups were 6.57% （1 636/24 885）， 3.90% （664/17 031）， 4.62% （827/17 905）， and 3.72% （326/8 773）， respectively. There was no difference in the detection rate of growth retardation between boys and girls （P>0.05）， and a multinomial logistic regression analysis of 13 influencing factors （infant birth weight， birth length， parental weight， height， education level， mother’s childbearing age， delivery mode， household registration， feeding mode within 6 months， infant sleep， etc.） in univariate analysis showed that birth weight <2 500 g （OR=3.99， 95%CI： 2.809‒5.674） or ≥4 000 g （OR=12.78， 95%CI： 8.868‒18.443）， maternal height <150 cm （OR=7.10， 95%CI： 4.294‒11.753）， paternal height <160 cm （OR=5.65， 95%CI： 2.792‒11.422）， maternal education level of junior high school and below （OR=1.31， 95%CI： 1.087‒1.588）， paternal education level of junior high school and below （OR=1.02， 95%CI： 0.838‒1.236）， mixed feeding （OR=1.15， 95%CI： 1.031‒1.288）， and sleep duration exceeding the recommended time （OR=1.58， 95%CI： 1.466‒1.710） were risk factors for growth retardation in infants aged 0‒3. Infants with a birth length <50 cm or with household registration in Shanghai had a higher incidence of growth retardation. ConclusionGrowth retardation in infants aged 0‒3 is influenced by a combination of genetic， environmental， and sleep factors. It is essential for parents to realize the impact of growth retardation on the future of their children early on and actively participate in the early detection， screening， and intervention of growth retardation.
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ObjectiveTo analyze the suicidal behavior in hospitalized patients with major depression and its influencing factors. MethodsA total of 1 000 patients with major depression admitted to our hospital from January 2017 to July 2021 were selected as the research subjects to investigate the status quo of suicidal behavior of the enrolled patients. According to the survey results， the patients were divided into suicidal behavior group and non-suicidal behavior group， and the related factors affecting their suicidal behavior. ResultsA total of 511 cases （51.10%） of the patients with major depression committed suicide in hospital， including 271 cases （27.10%） of suicidal ideation， 186 cases （18.60%） of attempted suicide， and 54 cases （5.40%） of suicide death. 489 patients （48.90%） did not commit suicide. Univariate analysis showed that there were significant differences in age， gender， marital status， loss of interest or pleasure， anxiety， sense of worthlessness or self-guilt， sleep status， personality， depressive episodes and paranoia between the suicidal behavior group and the non-suicidal behavior group （all P<0.05）. Logistic multifactorial regression analysis showed that age ≤28 years （OR=1.54）， female （OR=1.93）， anxiety （OR=1.61）， sense of worthlessness or self-guilt （OR=1.85） and paranoia （OR=2.15） were all independent predictors of suicidal behavior in the patients with major depression. ConclusionThe incidence of nosocomial suicide in patients with major depression is high. Early onset age， female， anxiety， sense of worthlessness or self-guilt， more depressive episodes and paranoia are independent risk predictors of suicide in patients with major depression. This finding can be used for clinical intervention to reduce the occurrence of suicide in patients.
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OBJECTIVE:The rabbit model of steroid-induced osteonecrosis of femoral head is the most commonly used animal model of femoral head necrosis.The pathological changes of the femoral head are close to clinical practice,however,the conditions,methods and evaluation standards of animal models reported in and outside China are not uniform,which leads to the low scientific value of animal models and is difficult to popularize.This study aimed to clarify the influence of different mold-making conditions on the establishment of steroid-induced osteonecrosis of femoral head rabbit model and analyze the appropriate conditions for the successful model establishment. METHODS:We searched the CNKI,WanFang,VIP,CBM,WoS,PubMed and EMbsae databases for the literature on the modeling of steroid-induced osteonecrosis of femoral head rabbits up to April 1,2022,completed the screening of the literature according to the inclusion and exclusion criteria and literature quality evaluation,and extracted the outcome index data in the literature.RevMan Stata and ADDIS statistical software were used to conduct a meta-analysis of the included data. RESULTS:(1)A total of 82 articles with 1 366 rabbits were included in the study.The steroid-induced osteonecrosis of femoral head modeling methods were divided into three types:steroid-alone method,steroid combined lipopolysaccharide method and steroid combined serum method.Among these,33 articles used steroid-alone method;20 articles used steroid combined lipopolysaccharide method;29 articles used steroid combined serum method.(2)Meta-analysis results showed that the three modeling methods significantly increased the rate of empty bone lacunae in the femoral head of steroid-induced osteonecrosis of femoral head rabbits(P<0.001),and significantly decreased the ratio of the trabecular bone area in the femoral head of steroid-induced osteonecrosis of femoral head rabbits(P<0.001).The order of empty bone lacunae rate of each modeling method was:steroid combined with lipopolysaccharide method>steroid-alone method>steroid combined with serum method>normal group,and the order of trabecular bone area rate of each modeling method was:normal group>steroid combined with serum method>steroid-alone method>steroid combined with lipopolysaccharide method.(3)The results of subgroup analysis suggested that the rate of empty bone lacunae in the rabbit model induced by steroid alone might be related to the rabbit variety and the type of steroid used for modeling(difference between groups P<0.05),in which the combined effect amount of New Zealand white rabbits was higher than that of Chinese white rabbits(P<0.05)and Japanese white rabbits,and the combined effect amount of dexamethasone was higher than that of other steroids.The rate of empty bone lacunae induced by steroid combined with lipopolysaccharide was related to the administration mode of lipopolysaccharide and the type of steroid(P<0.05),among which the combined effect of methylprednisolone sodium succinate was significantly higher than that of other steroids(P<0.05),and the combined effect of prednisolone was significantly lower than that of other steroids(P<0.05).The combined effect of lipopolysaccharide 100 μg/kg×twice was significantly lower than 10 μg/kg×twice and 50 μg/kg×twice(P<0.05).The rate of empty bone lacunae in the model induced by steroid combined with serum was related to serum dose and steroid type(P<0.05),among which the combined effect amount of dexamethasone sodium phosphate was significantly higher than other steroid types(P<0.05),and the combined effect amount of dexamethasone was significantly lower than other steroid types(P<0.05);the combined effect amount of serum"10 mL/kg+6 mL/kg"combined dose was lower than other serum doses(P<0.05). CONCLUSION:(1)With the rate of empty bone lacunae and the ratio of trabecular bone area as the judgment standard for the successful establishment of the model,the three modeling methods can successfully construct the rabbit steroid-induced osteonecrosis of femoral head model,of which the steroid combined with lipopolysaccharide method is the best.(2)New Zealand white rabbits and dexamethasone are recommended when selecting the steroid-alone method.Methylprednisolone sodium succinate and low-dose lipopolysaccharide are recommended when selecting the steroid combined with lipopolysaccharide method.Dexamethasone sodium phosphate is recommended when selecting the steroid combined with serum modeling method.
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BACKGROUND:Osteoporotic vertebral compression fractures have a high rate of recurrent fractures in adjacent vertebrae after percutaneous vertebroplasty,but the cause of their occurrence is still controversial. OBJECTIVE:To explore the influencing factors of adjacent vertebral re-fractures after percutaneous vertebroplasty in patients with single-segment osteoporotic vertebral compression fractures. METHODS:A retrospective analysis was performed in 210 patients admitted to the Fifth Hospital of Wuhan City,Second Affiliated Hospital of Jianghan University from June 2016 to June 2020,who had been diagnosed with new single-segment osteoporotic vertebral compression fractures by X-ray and MRI examinations,and received percutaneous vertebroplasty.The patients were followed up for more than 18 months.The general preoperative data and postoperative indicators were collected.The general preoperative data included age,sex,body mass index,fracture segment location,fracture days,fracture cause,whether accompanied by diabetes mellitus,whether accompanied by renal and thyroid dysfunction,and visual analogue scale score on admission.The postoperative indicators included recovery rate of anterior edge of the vertebral body after operation,degree of dispersion of bone cement,leakage of bone cement,use of bone material,single or bilateral injection of bone cement,recovery rate of the injured vertebral mid-column after operation,local Cobb angle of the injured vertebra after operation.According to their real conditions,the patients were divided into a group without adjacent vertebral re-fractures(n=190)and a group with adjacent vertebral re-fractures(n=20).The presence or absence of postoperative re-fracture of the adjacent vertebrae of the injured spine was used as the dependent variable and the categorical variables such as preoperative general data and postoperative indicators were used as independent variables for statistical analysis. RESULTS AND CONCLUSION:After percutaneous vertebroplasty,patients with adjacent vertebral re-fractures showed significant differences in age,body mass index,postoperative vertebral body anterior edge recovery rate,degree of cement dispersion,and cement leakage from those without adjacent vertebral re-fractures(P<0.05).However,sex,time of fracture,cause of fracture,presence of diabetes or kidney disease or thyroid disease,location of the initial vertebral fracture segment,mode of cement injection,local Cobb angle of the injured vertebra,recovery rate of the injured vertebral mid-column,and use of bone tissue were not statistically significant in relation to re-fracture of the adjacent vertebra after percutaneous vertebroplasty(P>0.05).Multivariate Logistic regression analysis showed that age,vertebral body anterior edge recovery rate and cement leakage were independent risk factors for re-fractures of the adjacent vertebra after percutaneous vertebroplasty.To conclude,age,vertebral body anterior edge recovery rate and leakage of bone cement are the influencing factors of adjacent vertebral re-fractures after percutaneous vertebroplasty.However,factors such as the degree of bone cement dispersion and the local Cobb angle of the injured vertebra were not correlated with adjacent vertebral re-fractures after percutaneous vertebroplasty.
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BACKGROUND:Internal fixation and open reduction with locking plate is the main treatment for proximal humeral fractures with medial column instability.However,reduction failure is one of the main postoperative complications,and accurate risk factor assessment is beneficial for screening high-risk patients and clinical decision selection. OBJECTIVE:To construct four types of prediction models by different machine learning algorithms,compare the optimal model to analyze and sort the risk variables according to their weight scores on the impact of outcome,and explore their significance in guiding clinical diagnosis and treatment. METHODS:262 patients with proximal humeral fractures with medial column instability,aged(60.6±10.2)years,admitted to Foshan Hospital of Traditional Chinese Medicine between June 2012 and June 2022 were included.All patients underwent open reduction with locking plate surgery.According to the occurrence of reduction failure at 5-month follow-up,the patients were divided into a reduction failure group(n=64)and a reduction maintenance group(n=198).Clinical data of patients were collected,and model variables and their classification were determined.The data set was randomly divided into a training set and a test set according to a 7:3 ratio,and the optimal hyperparameters were obtained in the training set according to a 5-fold cross-over test.Four machine learning prediction models of logistic regression,random forest,support vector machine,and XGBoost were constructed,and the performance of different algorithms was observed in the test set using AUC,correctness,sensitivity,specificity,and F1 scores,so as to comprehensively evaluate the prediction performance of the models.The best-performing model was evaluated using SHAP to assess important risk variables and to evaluate its clinical guidance implications. RESULTS AND CONCLUSION:(1)There were significant differences between the two groups in deltoid tuberosity index,fracture type,fracture end with varus deformity before operation,fragment length of inferior metaphyseal of humerus,postoperative reduction,cortical support of medial column of proximal humerus,and insertion of calcar screw(P<0.05).(2)The best-combined performance of the four machine models was XGBoost.The AUC,accuracy,and F1 scores were 0.885,0.885,and 0.743,respectively;followed by random forest and support vector machine,with both models performing at approximately equal levels.Logistic regression had the worst combined performance.The SHAP interpretation tool was used in the optimal model and results showed that deltoid tuberosity index,medial humeral column cortical support,fracture type,fracture reduction quality,and the status of the calcar screw were important influencing fators for postoperative fracture reduction failure.(3)The accuracy of using machine learning to analyze clinical problems is superior to that of traditional logistic regression analysis methods.When dealing with high-dimensional data,the machine learning approach can solve multivariate interaction and covariance problems well.The SHAP interpretation tool can not only clarify the importance of individual variables but also obtain detailed information on the impact of dummy variables in each variable on the outcome.
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BACKGROUND:There have been many studies on adjacent vertebral fractures in elderly female patients with osteoporotic vertebral compression fractures,but their related risk factors are still in debate.There are also few studies on how to intuitively present their risks for clinical application. OBJECTIVE:To analyze the risk factors of adjacent vertebral refracture in senile women with osteoporotic vertebral compression fracture and construct a Nomogram prediction model. METHODS:A total of 268 elderly female patients with osteoporotic vertebral compression fracture who came to Ganzhou People's Hospital for treatment from January 2018 to November 2022 were selected and divided into study group(adjacent vertebral refracture,n=31)and control group(no adjacent vertebral refracture,n=237)according to whether adjacent vertebral refracture occurred 3 months after percutaneous vertebroplasty.General clinical data were compared between the two groups.Multivariate Logistic regression analysis was conducted to analyze the independent risk factors of adjacent vertebral refracture in elderly women with osteoporotic vertebral compression fracture.A Nomogram prediction model was constructed by R software"rms"package. RESULTS AND CONCLUSION:(1)There were statistically significant differences in age,menopause age,body mass index,fracture history,number of fractured vertebra before surgery,bone cement leakage,bone density,postoperative kyphotic deformity angle,and preoperative Oswestry disability index between the two groups(P<0.05).(2)Multivariate logistic regression analysis results showed that age(>69 years old),menopause age(≤51 years old),body mass index(>24.7 kg/m2),fracture history(presence),number of fractured vertebra before surgery(≥2),and postoperative kyphotic deformity angle(>13°)were independent risk factors for adjacent vertebral refracture in elderly female osteoporotic vertebral compression fracture patients(P<0.05).(3)Nomogram prediction model decision curve results displayed that when the risk threshold was>0.09,this prediction model provided significant additional clinical net benefit.(4)These findings indicate that older age,lower menopause age,higher body mass index,history of fracture,more vertebra fractures before surgery,and larger kyphosis angle after surgery are independent factors for adjacent vertebral refracture in elderly women with osteoporotic vertebral compression fracture.This Nomogram prediction model will provide important strategic guidance for the prevention and treatment of adjacent vertebral refracture in elderly women with osteoporotic vertebral compression fracture.
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Objective To study the application effect of quality control circle(QCC)in reducing the dissatisfaction rate of physical examination clients in health management center.Methods To establish QCC,selected the health check-up popula-tion in our hospital in September-2019 and March-2020,through the questionnaire investigation and analysis,compare the dis-satisfaction of the clients before and after the quality control circle.Results After carrying out QCC activities,the dissatisfaction of physical examination clients was significantly lower than that before QCC,and the difference was statistically significant(P＜0.05).Conclusion The activities of QCC in the health management center can effectively improve the quality of the physical examination work and reduce the dissatisfaction of the customers in the physical examination.It is of great significance to the health management.
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Objective:To investigate the prognosis of patients with initially resectable gastric cancer liver metastasis (GCLM) who were treated by different modalities, and analyze the influencing factors for prognosis of patients.Methods:The retrospective cohort study was conducted. The clinicopathological data of 327 patients with initially resectable GCLM who were included in the database of a nationwide multicenter retrospective cohort study on GCLM based on real-world data from January 2010 to December 2019 were collected. There were 267 males and 60 females, aged 61(54,68)years. According to the specific situations of patients, treatment modalities included radical surgery combined with systemic treatment, palliative surgery combined with systemic treatment, and systemic treatment alone. Observation indicators: (1) clinical characteristics of patients who were treated by different modalities; (2) prognostic outcomes of patients who were treated by different modalities; (3) analysis of influencing factors for prognosis of patients with initially resectable GCLM; (4) screening of potential beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and Log-Rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX proportional hazard regression model. The propensity score matching was employed by the 1:1 nearest neighbor matching method with a caliper value of 0.1. The forest plots were utilized to evaluate potential benefits of diverse surgical combined with systemic treatments within the population. Results:(1) Clinical characteristics of patients who were treated by different modalities. Of 327 patients, there were 118 cases undergoing radical surgery plus systemic treatment, 164 cases undergoing palliative surgery plus systemic treatment, and 45 cases undergoing systemic treatment alone. There were significant differences in smoking, drinking, site of primary gastric tumor, diameter of primary gastric tumor, site of liver metastasis, and metastatic interval among the three groups of patients ( P<0.05). (2) Prognostic outcomes of patients who were treated by different modalities. The median overall survival time of the 327 pati-ents was 19.9 months (95% confidence interval as 14.9-24.9 months), with 1-, 3-year overall survival rate of 61.3%, 32.7%, respectively. The 1-year overall survival rates of patients undergoing radical surgery plus systemic treatment, palliative surgery plus systemic treatment and systemic treatment alone were 68.3%, 63.1%, 30.6%, and the 3-year overall survival rates were 41.1%, 29.9%, 11.9%, showing a significant difference in overall survival rate among the three groups of patients ( χ2=19.46, P<0.05). Results of further analysis showed that there was a significant difference in overall survival rate between patients undergoing radical surgery plus systemic treatment and patients undergoing systemic treatment alone ( hazard ratio=0.40, 95% confidence interval as 0.26-0.61, P<0.05), between patients undergoing palliative surgery plus systemic treatment and patients under-going systemic treatment alone ( hazard ratio=0.47, 95% confidence interval as 0.32-0.71, P<0.05). (3) Analysis of influencing factors for prognosis of patients with initially resectable GCLM. Results of multivariate analysis showed that the larger primary gastric tumor, poorly differentiated tumor, larger liver metastasis, multiple hepatic metastases were independent risk factors for prognosis of patients with initially resectable GCLM ( hazard ratio=1.20, 1.70, 1.20, 2.06, 95% confidence interval as 1.14-1.27, 1.25-2.31, 1.04-1.42, 1.45-2.92, P<0.05) and immunotherapy or targeted therapy, the treatment modality of radical or palliative surgery plus systemic therapy were independent protective factors for prognosis of patients with initially resectable GCLM ( hazard ratio=0.60, 0.39, 0.46, 95% confidence interval as 0.42-0.87, 0.25-0.60, 0.30-0.70, P<0.05). (4) Screening of potentinal beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment. Results of forest plots analysis showed that for patients with high-moderate differentiated GCLM and patients with liver metastasis located in the left liver, the overall survival rate of patients undergoing radical surgery plus systemic treatment was better than patients undergoing palliative surgery plus systemic treatment ( hazard ratio=0.21, 0.42, 95% confidence interval as 0.09-0.48, 0.23-0.78, P<0.05). Conclusions:Compared to systemic therapy alone, both radical and palliative surgery plus systemic therapy can improve the pro-gnosis of patients with initially resectable GCLM. The larger primary gastric tumor, poorly differen-tiated tumor, larger liver metastasis, multiple hepatic metastases are independent risk factors for prognosis of patients with initial resectable GCLM and immunotherapy or targeted therapy, the treatment modality of radical or palliative surgery plus systemic therapy are independent protective factors for prognosis of patients with initially resectable GCLM.
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Objective:To investigate the current situation of geriatric nursing ability of clinical nursing teachers and analyze the influencing factors, and to identify demands of geriatric nursing training.Methods:From May to June 2023, a cross-sectional study was conducted among 2 408 clinical nursing teachers in 50 tertiary hospitals from 9 provinces and cities in East China, South China, Central China, North China, and Southwest China using the general information questionnaire, Geriatric Nursing Competence Scale for Clinical Nurses, and Geriatric Nursing Training Demands Questionnaire.Results:Among the clinical nursing teachers surveyed, there were 269 (11.17%), 938 (38.95%), and 1 201 (49.88%) teachers at low, medium, and high levels of geriatric nursing ability, respectively. The results of multinomial Logistic regression analysis showed that age, years of working in geriatric nursing, geriatric nursing related training, satisfaction with clinical nursing work, and interest in geriatric nursing work were common influencing factors in the low and medium level groups ( P<0.05), and professional title was a specific influencing factor in the medium level group ( P<0.05). The top three demands of geriatric nursing training content were geriatric nursing service model, knowledge of chronic disease management, and comprehensive geriatric assessment techniques. The top three demands of training forms were live streaming, field visits, and offline lectures. Conclusions:For clinical nursing teachers, demand-oriented geriatric nursing training should be strengthened, and attention should be paid to the satisfaction and interest in nursing work, so as to improve the teachers' geriatric nursing ability and strengthen the level of geriatric service.