ObjectiveTo investigate the risk factors, prognostic factors and prognosis of Multidrug-Resistant Acinetobacter Baumannii (MDR-AB) infection of lower respiratory tract in Intensive Care Unit (ICU) of the Second Affiliated Hospital of Anhui Medical University. MethodsUsing retrospective analysis, we reviewed and compared clinical data of 77 AB infections in lower respiratory tract cases in ICU from January 2013 to March 2015. According to the resistance, patients were divided into a MDR-AB group and a NMDR-AB group. Then the risk factors, prognostic factors and prognosis of MDR-AB infection were analyzed. ResultsA total of 58 cases in the MDR-AB group, 19 cases in the NMDR-AB group were included. The result showed that, the MDR-AB infection in lower respiratory tract could significantly prolong the length of ICU stay (18.5±16.0 vs. 10.6±9.3 days, P<0.05) and increase the mortality (44.8% vs. 11.1%, P<0.01). Logistic regression analysis showed that the independent risk factors for MDR-AB infection in lower respiratory tract included Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score >15 (OR=0.138, 95%CI 0.03 to 0.625, P=0.01) and use of carbapenems (OR=0.066, 95%CI 0.012 to 0.0346, P=0.001). The independent prognostic factors included placement of drainage tube (OR=8.743, 95%CI 1.528 to 50.018, P=0.015) and use of vasoactive drugs (OR=12.227, 95%CI 2.817 to 53.074, P=0.001). ConclusionThe MDR-AB infection in lower respiratory tract can significantly prolong the length of ICU stay and increase the mortality. The Apache Ⅱ score >15 and use of carbapenems are the risk factors, and the placement of drainage tube and use of vasoactive drugs can increase the mortality of MDR-AB infection of lower respiratory tract in ICU.
Immune-mediated necrotizing myopathy (IMNM) is a rare type of autoimmune inflammatory myopathy, which can be divided into anti-signal recognition particle antibody positive IMNM, anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibody positive IMNM and serum antibody negative IMNM according to different autoantibodies. The prognosis of IMNM is worse than that of most other types of myositis. At present, there are differences in the studies of prognostic factors of IMNM at home and abroad, and there is a lack of large-scale clinical studies. This article will review the prognostic factors of IMNM.
Objective To explore the distribution characteristics and prognostic risk factors of critically ill patients who has long-term hospitalization in intensive care unit ( ICU) . Methods A retrospective study was carried out to evaluate 119 critically ill patients from January 2003 to July 2009 by extracting data from computerized hospital information system. The patients were divided into a survival group and a non-survival group based on discharging outcomes. A binary logistic regression analysis wasintroduced to investigate potential risk factors of prognosis. Results Age, type of payment, entity of disease,and length of ICU stay were significantly different between the two groups ( P lt; 0. 05) in independent-Samples T test. Logistic regressions indicated that age, length of ICU stay and plasma infusion were independent predictors for worse outcome. Conclusions Age, length of ICU stay and plasma infusion may directly influence the prognosis of patients with prolonged stay in ICU. Intensive therapies should be emphasized for those patients at high risk.
ObjectiveTo summarize the current status and progress of MR imaging in field of rectal cancer.MethodsThe recent literatures on this topic were reviewed and analyzed, then the key information they provide was integrated.ResultsBesides its measurement of tumor height and length, the MR imaging was also significant in the preoperative assessments of tumor staging and prognostic factors such as the extramural vascular invasion (EMVI), circumferential resection margin (CRM), and perineural invasion (PNI). However, some drawbacks couldn’t be neglected. For instance, the conventional MR imaging was of limited use in discriminating T1, T2 and borderline T3 rectal cancer. The similar limitation applies to situation between T3 and T4a rectal cancer as well. And its performances in the N staging prior to and post-neoadjuvant chemoradiation therapy were just average. Currently the functional MR imaging like the diffusion weighted imaging (DWI), some relatively novel modalities such as the dynamic contrast enhanced MRI and chemical shift have served in the radiological diagnosis of the rectal cancer.ConclusionsMR imaging is the most frequently used modality in preoperative assessment of rectal cancer. It can describe size and location of tumor, assist in tumor staging, and evaluate prognostic factors. And it is supposed to provide critical information on decision making and prognosis judging. Besides current value of conventional MR imaging in the field of rectal cancer, some innovative techniques have shown moderate potentials as well. Due to their promising future use, detection of new biomarkers regarding rectal cancer can be expected.
ObjectiveTo analyze perioperative prognostic factors of pediatric patients undergoing surgical correction of ventricular septal defect (VSD)and severe pulmonary arterial hypertension (PAH). MethodsForty pediatric patients with VSD and severe PAH (mean pulmonary artery pressure (PAPm) < 50 mm Hg)who underwent surgical repair in Beijing Anzhen Hospital from 2004 to 2012 were included in the study. There were 21 male and 19 female patients with their age of 7.2±3.3 years and body weight of 19.6±7.1 kg. All the patients were randomly divided into 2 groups:Group Ⅰ (Group=0, n=20, M/F:12/8, continuous nitroglycerin administration via central venous catheter (CVC)and GroupⅡ (Group=1, n=20, M/F:9/11, continuous prostaglandin E1 (PGE1)administration via CVC). The duration of intubation (Tintubation)was used as the dependent variable (Y). Patient age, cardiopulmonary bypass time (TCPB), postoperative PAPm, pulmonary vascular resistance index (PVRI), systemic to pulmonary pressure ratio (Ps/p), Group, left ventricular stroke work index (LVSWI)and right ventricular stroke work index (RVSWI)were used as independent variables (X). Multivariate liner regression analysis model was used to evaluate the influence of X on Y. ResultsThere was no perioperative death or severe complication in this group. Perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH included group[x1, P=0.004, 95% CI (-71, -16)], TCPB[x2, P=0.011, 95% CI (0.9, 5.8)], posto-perative PAPm (x3, P=0.004 with 95% CI 3.2 to 13.3), RVSWI (x4, P=0.003 with 95% CI-16.9 to-4.3)and PVRI (x5, P=0.03 with 95% CI-0.29 to-0.02). The standardized regression equation was:Y=-0.60x1+0.54x2+2.22x3-1.70x4-0.15x5. ConclusionPGE1 administration, TCPB, postoperative PAPm, RVSWI and PVRI are predominant perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH.
【Abstract】ObjectiveTo analyze the factors influencing the prognosis of patients with bile duct carcinoma after resection. MethodsThe clinical data of 120 patients with bile duct carcinoma receiving resection in our hospital from 1980 to 2004 were collected retrospectively and clinicopathologic factors that might influence survival were analysed. A multiple factor analysis was performed through Cox proportional hazard model. ResultsThe overall 1year, 3year and 5year survival rates were 71.7%, 32.5% and 19.2% respectively. The single factor analysis showed that the major significant factors influencing survival of these patients were histological type of the lesions, lymph node metastasis, pancreatic infiltration, duodenal infiltration, resected surgical margin, perineural infiltration, peripheral vascular infiltration and depth of tumor infiltration (P＜0.05). Lymph node metastasis, pancreatic infiltration and perineural infiltration were found to be the the statistically significant factors influencing survival by multiple factor analysis through the Cox model. ConclusionThe most important prognostic factors for bile duct carcinoma after resection were lymph node metastasis, pancreatic infiltration and perineural infiltration.
Objective To investigate the prognostic factors related to long-term survival after gastrectomy. Methods A total of 351 patients with gastric cancer who underwent gastrectomy were successfully followed-up in our hospital had been selected from January 2004 to December 2009. The clinicopathological and follow-up data were studied by univariate and multivariate analysis. Results The age, location of tumors, T stage, N stage, TNM stage, and differentiation were related with postoperative survival of patients with gastric cancer by using univariate analysis（P＜0.05）. By using multivariate analysis, location of tumors, T stage, N stage, and chemotherapy were independent prognostic factors（P＜0.05）. Conclusions Location of tumors, depth of tumor invation, lymph node metastasis, and chem-otherapy were independent prognostic factors for gastric cancer patients who underwent gastrectomy. Chemotherapy after surgery could increase the survival rate of gastric cancer patients with lymph node metastasis or in TNM stage Ⅲ.
ObjectiveTo analyze the outcome and prognostic factors of using locking plate for treating proximal humerus fracture. MethodsBetween January 2005 and January 2012, 45 aged patients with a displaced 3-part or 4-part fracture of the proximal humerus were treated by locking plate. Range of motion and Constant-Mudey score were observed during the follow-up. ResultsForty-three patients were followed up from 12 to 48 months with an average of 18 months. The mean final Constant-Mudey score was 72.3±9.5 and 6 of them needed a second surgery. In addition to fracture type, other prognostic factors included redisplacement (4 cases, 9.3%), nonunion (3 cases, 7.0%), crashing (3 cases, 7.0%), necrosis of the humeral head (6 cases, 14.0%) and screw cut-out (5 cases, 11.6%). Among the patients with disrupted medial calcar, 4 needed a second surgery at the final follow-up, 3 had redisplacement, 2 had nonunion, and 2 had screw cut-out. ConclusionLocked screw-plates provide more secure fixation of fracture in aged patients, but the complication rate remains high. We suggest anatomic reduction, and plate and screws position, length of the screws, the medial cortical contact and stability may be the chief prognostic factors affecting the shoulder function following a proximal humeral fracture.
Macular edema (ME) secondary to central retinal vein occlusion（CRVO) often cause severe visual impairment. Intravitreal anti-vascular endothelial growth factor agents and steroids can effectively eliminate ME and improve visual function, but the visual outcome is affected by multiple factors. Retinal blood flow, especially the macular microcirculation, has significant correlation with visual outcome. Ischemic CRVO, especially patients with severe damage in the deep and superficial vascular layer of the macular zone, usually have poor visual outcome. In addition, the integrity of the multi-layer retinal structure closely correlates with the visual outcome. Patients with intact ellipsoid zone, external limit membrane beneath the fovea have good visual recovery. Additionally, good baseline visual acuity, positive response to treatment in early phase, young age and timely treatment usually brings about better visual outcome.
Objective To establish a short-term mortality risk scoring standard for sepsis-associated acute respiratory distress syndrome (sARDS) and provide a reference tool for clinicians to evaluate the severity of sARDS patients. Methods A retrospective cohort study was conducted on sARDS patients admitted to the adult intensive care unit (ICU) of the First Affiliated Hospital, Hengyang Medical School, University of South China from January 1, 2013 to August 31, 2020. They were divided into a death group and a survival group according to whether they died within 28 days after admission to ICU. Clinical data of the patients was collected within 24 hours admitted to ICU. Related risk factors for mortality within 28 days after admission to ICU were screened out through univariate logistic regression analysis. A risk prediction model for mortality within 28 days after admission to ICU was established by multivariate logistic regression analysis. The Hosmer-Lemeshow χ2 test and the area under the receiver operating characteristic (ROC) curve were used to evaluate the model’s goodness-fit and accuracy in predicting 28-day mortality of the sARDS patients, respectively. Finally, the clinical prognosis scoring criteria 28-day mortality of the sARDS patients were established according to the weight coefficients of each independent risk factor in the model. Results A total of 150 patients were recruited in this study. There were 67 patients in the survival group and 83 patients in the death group with a 28-day mortality rate of 55.3%. Four independent risk factors for 28-day mortality of the sARDS patients, including invasive mechanical ventilation, the number of dysfunctional organs≥3, serum lactic acid≥4.3 mmol/L and the severity of ARDS. A risk prediction model for mortality within 28 days of the sARDS patients was established. The area under the ROC curve and 95% confidence interval (CI), sensitivity and specificity of the risk prediction model for 28-day mortality for the sARDS patients were 0.896 (95%CI 0.846 - 0.945), 80.7% and 82.1%, respectively, while that for acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were 0.865 (95%CI 0.805 - 0.925), 71.1% and 89.6%; for sequential organ failure assessment (SOFA) score were 0.841 (95%CI 0.7799 - 0.904), 68.7%, and 82.1%; for the prediction scores of lung injury were 0.855 (95%CI 0.789 - 0.921), 81.9% and 82.1%, respectively. It was indicated that the prediction accuracy of this risk prediction model of 28-day mortality maybe was better than that of APACHE-Ⅱ score, SOFA score and prediction score of lung injury. In addition, four risk factors were assigned as invasive mechanical ventilation (12 points), serum lactic acid≥4.3mmol /L (1 point), number of organs involved≥3 (3 points), and severity of ARDS (mild for 13 points, moderate for 26 points, severe for 39 points). Further more, the score of each patient was 13 - 55 points according to the scoring criteria, and the score grade was made according to the percentile method: 13 - 23 points for the low-risk group for 28-day mortality, 24 - 34 points for the medium-risk group for 28-day mortality, 35 - 45 points for the high-risk group for 28-day mortality, and over 45 points for the extremely high-risk group for 28-day mortality. According to the scoring criteria, the prognosis of the patients in this study was analyzed. The mortality probability of each group was 0.0% in the low-risk group, 13.8% in the medium-risk group, 51.9% in the high-risk group, and 89.7% in the extremely high-risk group, respectively. Conclusions The invasive mechanical ventilation, the number of involved organs≥3, serum lactic acid≥4.3 mmol /L and the severity of sARDS are independent risk factors for 28-day mortality of the sARDS patients. The scoring criteria may predict the risk of 28-day mortality for the sARDS patients.