ObjectiveTo establish a predictive model of surgical site infection (SSI) following colorectal surgery using machine learning.MethodsMachine learning algorithm was used to analyze and model with the colorectal data set from Duke Infection Control Outreach Network Surveillance Network. The whole data set was divided into two parts, with 80% as the training data set and 20% as the testing data set. In order to improve the training effect, the whole data set was divided into two parts again, with 90% as the training data set and 10% as the testing data set. The predictive result of the model was compared with the actual infected cases, and the sensitivity, specificity, positive predictive value, and negative predictive value of the model were calculated, the area under receiver operating characteristic (ROC) curve was used to evaluate the predictive capacity of the model, odds ratio (OR) was calculated to tested the validity of evaluation with a significance level of 0.05.ResultsThere were 7 285 patients in the whole data set registered from January 15th, 2015 to June 16th, 2016, among whom 234 were SSI cases, with an incidence of SSI of 3.21%. The predictive model was established by random forest algorithm, which was trained by 90% of the whole data set and tested by 10% of that. The sensitivity, specificity, positive predictive value, and negative predictive value of the model were 76.9%, 59.2%, 3.3%, and 99.3%, respectively, and the area under ROC curve was 0.767 [OR=4.84, 95% confidence interval (1.32, 17.74), P=0.02].ConclusionThe predictive model of SSI following colorectal surgery established by random forest algorithm has the potential to realize semi-automatic monitoring of SSIs, but more data training should be needed to improve the predictive capacity of the model before clinical application.
Objective To compare the advantages between SmartCare weaning and protocoldirected weaning in COPD patients regarding five aspects including comfort degree of COPD patients in weaning stage, workload of medical staff, weaning success rate, weaning time, and complications associated with mechanical ventilation. Methods COPD patients who’s planning to receive ventilation weaning were randomly divided into a SmartCare weaning group ( SC group) and a protocol-directed weaning group ( SBT group) . The comfort degree of patients and workload of medical staff were assessed by the visual analogue scale ( VAS) as the weaning plan started. 0 was for the most discomfort and maximal workload, and 10 was for the most comfort and minimal workload. Data fromthe following aspects had been recorded: times of blood gas analysis, weaning success rate, weaning time, self-extubation rate, the rate of re-intubation within 48 hours, and ventilator-associated pneumonia ( VAP) incidences. Results 40 patients were selected and divided into the SC group ( n =19) and the SBT group ( n =21) . There was no significant difference in the enrolled age and APACHEⅡ between two groups. The VAS scores was higher in the SC group than that in the SBT group in the first three days ( Plt;0.01) . The weaning time was shorter in the SBT group than that in the SBT group [ ( 4.7 ±2.7) days vs. ( 5.5 ±3.2) days] , without significant difference between two groups ( P gt;0.05) . There were no differences in times of blood gas analysis, weaning success rate, weaning time, self-extubation rate, the rate of re-intubation within 48 hours, and ventilator-associated pneumonia ( VAP) incidences between two groups ( P gt; 0.05) .Conclusion As compared with protocol-directed weaning, SmartCare weaning can increase comfort degree of patients and reduce the workload of medical staff with similar weaning success rate, weaning time, and complications associated with mechanical ventilation.
Objective To compare the efficacy of the single tube (ST) and double tube (DT) for closed thoracic drainage after lobectomy. Methods The PubMed, Medline, EMbase, Web of Science, CNKI, Wanfang Database, VIP database and CBMdisc from inception to March 30, 2018 were searched by computer to identify randomized controlled trial (RCT) about ST and DT drainage after lobectomy. Based on inclusion and exclusion criteria the literature was screened. Meta-analysis was performed using RevMan 5.3 software. Results Twelve RCTs were enrolled in this meta-analysis, including 1 442 patients. Compared with the patients using DT after lobectomy, the patients using ST had significantly less postoperative pain (MD=–0.64, 95%CI –0.71 to –0.56, P<0.000 01) and shorter duration of drainage (MD=–0.62, 95%CI –0.78 to –0.46, P<0.000 01) and hospital stay (MD=–0.55, 95%CI –0.80 to –0.29, P<0.000 1). Besides, there was no significant difference in postoperative complications (RR=1.11, 95%CI 0.83 to 1.49, P=0.49), air leaks (RD=0.03, 95%CI –0.02 to 0.08, P=0.19) and the redrainage rate (RR=0.89, 95%CI 0.51 to 1.54, P=0.67). ConclusionST drainage after lobectomy is effective, which reduces postoperative pain and duration of hospital stay and drainage, and moreover, does not increase the postoperative complications and redrainage rate.
ObjectiveTo investigate the clinical features, diagnosis and treatment of scedosporiosis in lung transplant patients.MethodsA retrospective analysis was carried out on a lung transplant patient with scedosporiosis admitted to the First Affiliated Hospital of Guangzhou Medical University. A literature review was performed with “scedosporium”/“scedosporiosis”+“lung transplant” or “scedosporium”/“scedosporiosis”+“lung transplantation” as the key words in Pubmed, Wanfang Database and China Knowledge Resource Integrated Database. The date of retrieval was up to May 2018. Related articles of scedosporiosis in lung transplant patients were retrieved. Clinical characters, diagnosis, treatment and outcome were analyzed.ResultsThe patient was a 65 years old male who received the right lung transplantation 7 months before. He presented with seizure, dyspnea and multiple organ failure. The CT scan illustrated right lower pulmonary nodular lesions. The culture and DNA sequencing of the bronchoalveolar lavage fluid established the diagnosis of scedosporium prolificans. The patient died finally despite the combined anti-fungal treatment. Literature review found 20 relative articles, and all of which were case report with a total of 35 patients. Scedosporium was always disseminated and with a high mortality, with no specificity in chest CT and bronchoscopy. The diagnosis always established by the culture and DNA sequencing, and the combination of anti-fugal agents was needed.ConclusionsScedosporium in lung transplant patient is a disseminated disease with high mortality. The high risk patients should be focused on and early diagnosis and treatment was demanded.
ObjectiveTo systematically review the diagnostic value of T-SPOT.TB and QuantiFERON-TB (QFT-GIT/QFT-Plus) in active tuberculosis (ATB). MethodsThe PubMed, Web of Science, Cochrane Library, EMbase, CNKI, WanFang Data, and CBM databases were electronically searched to collect diagnostic accuracy studies comparing QFT-GIT/QFT-Plus and T-SPOT.TB for diagnosing ATB from inception to February 8, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, then, meta-analysis was performed by using Stata 16.0 software. ResultsA total of 20 studies were included. The results of meta-analysis showed that the pooled sensitivity of T-SPOT.TB and QFT-GIT were 0.89 (95%CI 0.85 to 0.92) and 0.84 (95%CI 0.79 to 0.89), the pooled specificity were 0.85 (95%CI 0.68 to 0.93) and 0.86 (95%CI 0.72 to 0.94), the area under the curve (AUC) of summary receiver operating characteristic (SROC) were 0.93 (95%CI 0.84 to 0.97) and 0.90 (95%CI 0.56 to 0.99), respectively. The pooled sensitivity of T-SPOT.TB and QFT-Plus were 0.93 (95%CI 0.81 to 0.97) and 0.93 (95%CI 0.89 to 0.96), specificity were 0.99 (95%CI 0.39 to 1.00) and 0.94 (95%CI 0.67 to 0.99), the AUC of SROC were 0.99 (95%CI 0.67 to 1.00) and 0.98 (95%CI 0.65 to 1.00), respectively. ConclusionBoth T-SPOT.TB and QFT have high diagnostic accuracy for ATB, and the diagnostic sensitivity of T-SPOT.TB is better than QFT-GIT. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To evaluate the safety and diagnostic yield of transbronchial lung biopsy ( TBLB) performed in mechanically ventilated patients. Methods TBLB was performed in 19 mechanically ventilated patients form January 2001 to September 2007 in the ICU of Guangzhou Institute of Respiratory Diseases. The results of clinical data were retrospectively analyzed. Results A total of 19 patients were analyzed[ 9 female, 10 male, with amean age of ( 57. 94 ±15. 00) years] . Specific diagnoses were made in 9 cases ( 47. 4% ) by TBLB. The diseases included pulmonary aspergillus pneumonia in 4 cases ( 21. 0% ) ,lung cancer in 2 cases ( 10. 5% ) , radioactive pneumonia in 1 case( 5. 3% ) , Goodpasture’s syndrome in1case( 5. 3% ) , pulmonary tuberculosis in 1 case ( 5. 3% ) . Ten cases ( 52. 6% ) were not able to establish confirmed diagnoses including pulmonary interstitial fibrosis in 6 cases( 31. 6% ) and lung tissue nonspecific changes in 4 cases( 21. 0% ) . The treatment was adjusted according to the results of TBLB in 10 patients( 52. 6% ) . Complications associated with this procedure included episodes of bronchial hemorrhage of ≥30 mL in 4 cases ( 21. 0% ) , transient oxygen desaturation in 11 cases ( 57. 9% ) , hypotension in 5 cases ( 26. 3% ) , and transient tachycardia in 1 case ( 5. 3% ) without death and pneumothorax. Conclusions TBLB can be performed safely and has a diagnostic value in mechanically ventilated patients. TBLB should be considered as a diagnostic procedure before open lung biopsy.
Objective To investigate the correlation between dynamic intrinsic positive endexpiratory pressure ( PEEPidyn) and volume dependence of elastance and resistance of respiratory system ( Evd/Rvd) derived from nonlinear analysis of respiratory mechanics in COPD patients during pressure support ventilation ( PSV) . Methods Twenty-five COPD patients mechanically ventilated using mode of PSV were ventilated at a PSV level of no less than 20 cm H2O in a period of 15 minutes to attain so-callednear-relaxation state. The pressure( P) , flow( V′) and volume( V) data were analyzed by nonlinear mode of respiratory motion. PEEPidyn was determined by esophageal balloon-tipped catheter technique. The correlations between PEEPidyn and Evd, Rvd as well as Evd ×Rvd were analyzed. Results The correlation coefficients between PEEPidyn and Evd, Rvd as well as Evd ×Rvd were 0. 85,0. 80, and 0. 90, respectively. Conclusions Nonlinear mode of respiratory motion is suitable to analyze respiratory mechanics of COPD patients mechanically ventilated using mode of PSV. There are good correlations between PEEPidyn and Evd,Rvd as well as Evd ×Rvd which may be used to noninvasively monitor PEEPidyn in mechanically ventilated COPD patients using mode of PSV.
Objective To evaluate the effectiveness and safety of Endostar combined with chemotherapy for non-small cell lung cancer (NSCLC). Methods Randomized controlled trials (RCTs) on Endostar combined with chemotherapy for NSCLC were searched in The Cochrane Library, MEDLINE, EMbase, VIP, CNKI, CBMdisc and other electronic databases. The quality of RCTs meeting inclusion criteria was evaluated and the data were extracted; meta-analyses were performed with RevMan 5.1 software, and then the GRADE System was used to rate the level of evidence and strength of recommendation. Results Among the 18 RCTs involving 1 825 cases included, 1 816 cases met the inclusion criteria. Meta-analyses showed that: compared with the single chemotherapy, Endostar combined with chemotherapy could increase the total effective rate (RR=1.85, 95%CI 1.56 to 2.11, Plt;0.000 01), and the clinical benefit response (RR=1.21, 95%CI 1.14 to 1.29, Plt;0.000 01), but decrease the incidence risk of leukopenia (RR=0.89, 95%CI 0.82 to 0.97, P=0.006). There were no signficant differences between the two groups in decreasing thrombocytopenia (RR=0.87, 95%CI 0.74 to 1.03, P=0.10), impaired renal function (RR=0.96, 95%CI 0.69 to 1.34, P=0.82), nausea and vomiting (RR=0.92, 95%CI 0.84 to 1.01, P=0.08) and other side effects. Based on GRADE, the level of evidence was Grade C, and the strength of recommendation was 2. Conclusion The present results of clinical trials show that Endostar combined with chemotherapy for NSCLC is a safe and effective therapy without increasing the toxic reaction and side effects; and based on GRADE, the level of evidence was Grade 2C, and the strength of recommendation was 2. However, in view of the limitations of this study, it is suggested that large-scale, high-quality researches on basic and clinical fields should be performed to further verify the above conclusion by critical outcome indicators.
ObjectiveTo compare the impact of early enteral nutrition (EN) and parenteral nutrition (PN) on the postoperative efficacy of esophageal cancer through meta-analysis of relevant randomized controlled trial (RCT).MethodsPubMed, Medline, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to April 2018 to identify potential RCT which assessed clinical efficacy between EN and PN for postoperative patients with esophageal cancer. According to the inclusion and exclusion criteria, two researchers independently screened and evaluated literature. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 30 RCT studies were selected, including 3 969 patients. Meta-analysis results showed that: there was a significant difference between EN and PN in postoperative anastomotic fistulas (I2=0%, OR=0.67, 95%CI 0.45-0.99, P=0.04), postoperative pulmonary infections (I2=0%, OR=0.42, 95%CI 0.32-0.55, P<0.000 1), postoperative albumin levels (I2=38%, MD=0.78, 95%CI 0.51-1.06, P<0.000 01),time of first anal exhaust after operation (I2=0%, MD=–23.16, 95%CI –25.16-21.16, P<0.000 01) and postoperative incision infection (I2=0%, RR=0.36, 95%CI 0.21-0.64, P=0.000 5).ConclusionCompared with PN, early EN can significantly reduce the incidence of major postoperative complications and shorten the time of first anal exhaust after surgery. In addition, EN is superior to PN in improving nutritional status, increasing weight and reducing costs and side effects.
ObjectiveTo investigate the factors affecting enteral nutrition tolerance in patients accepting prone position ventilation.MethodsA retrospective study was conducted to analyze the tolerance of enteral nutrition in patients with prone position ventilation from January 2013 to December 2018. The single factor and multiple factors were used to analyze the influencing factors of enteral nutrition tolerance in patients accepting prone position ventilation.ResultsNinety-two patients who met the inclusion criteria were divided into 2 groups according to enteral nutrition tolerance table: 45 patients with good tolerance and 47 patients with poor tolerance. Univariate analysis showed age, use of muscle relaxants, albumin, prealbumin, feeding amount per unit time, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), nutrition risk in critically ill (NUTRIC) score and gastric residual volume were factors affecting the patient's tolerance (P<0.05). Logistic analysis showed that the factors affecting the patient's tolerance during the prone position were age, use of muscle relaxant, albumin, prealbumin, APACHEⅡ, SOFA, and NUTRIC scores (P<0.05).ConclusionFactors affecting enteral nutrition tolerance in patients accepting prone position ventilation are age, use of muscle relaxants, albumin, prealbumin, APACHEⅡ, SOFA and NUTRIC scores.