Objective To analyze the clinical characteristics and risk factors of noninfectious fever after endovascular repair of aortic dilatation diseases, and explore the management strategy. Methods We reviewed 468 patients who received endovascular aortic repair from January 2021 to October 2023. The patients who were selected were classified into a febrile group and an afebrile group according the fever after operation. The fever data were analyzed, and the demographics, operative data were researched to sieve out the correlation factors. Logistic regression analysis was conducted for the risk factors of postoperative fever if the P value≤0.05 in the univariate analysis, and receiver operating characteristic curve (ROC) was used to analyze the predictive indexes of postoperative noninfectious fever. Results75.08% (229/305) patients had noninfectious fever after aortic repair and 98.25% of them had fever within 2 days. There were 229 patients in the febrile group, mean age 65 (53.0,73.0) years (83.4% males , and 76 patients in the afebrile group, mean age 71(65.0,76.7) years(84.2% males). Univariate analysis showed that the number of patients with coronary heart disease, using statins before operation and aortic aneurysm in the febrile group were significantly lower than those in the afebrile group, and patients were younger in the febrile group. The logistic regression showed that age, surgical site, type of disease, preoperative hyperthermia, type of stent were positively correlated with noninfectious fever, while statin use was negatively associated with noninfectious fever. And age, surgical site, preoperative hyperthermia and stent type were analyzed by means of ROC curve (P<0.01). Conclusion Noninfectious fever is very common after aortic repair. The relationship between fever and infection should be comprehensively judged according to the risk factors of noninfectious fever and the disease status to promote rational use of antibiotics.
ObjectiveTo develop and validate a nomogram for predicting overall survival among patients with breast apocrine carcinoma (BAC). MethodsThe patients diagnosed with BAC from 2010 to 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database and then randomly divided into a training set and a validation set by a 7∶3 ratio. Additionally, external validation of the nomogram was conducted on BAC patients admitted to the Dongfeng Hospital Affiliated to Hubei Medical College from January 1, 2010 to December 31, 2018. The risk factors affecting the overall survival of BAC patients were determined by univariate and multivariate Cox regression analyses, which were used to develop the nomogram prediction model. The discriminative abilities of the nomogram for the 3- and 5-year overall survival rates were evaluated by the C-index and area under receiver operating characteristic curve (AUC), and the fit of actual data and nomogram-predicted data for calibrators should be evaluated. ResultsA total of 649 BAC patients who met the included criterion for this study were enrolled from the SEER database (including 454 in the training set and 195 in the internal validation set), and 21 BAC patients from the Dongfeng Hospital (external validation set) were included. The multivariate Cox regression analysis showed that the age, T stage, M stage, S stage, surgical method, and chemotherapy were the risk factors affecting the overall survival of BAC patients. The C-index values of the nomogram prediction model based on these risk factors was 0.76, 0.77, and 0.88 in the training set, internal validation set, and external validation set, respectively. The calibration curves of the actual 3- and 5-year overall survival rates and nomogram-predicted 3- and 5- year overall survival rates were close to the ideal curve. The AUCs (95%CI) of the nomogram prediction model for evaluating the 3-year and 5-year overall survival rates of BAC patients were 0.84 (0.78, 0.89) and 0.76 (0.71, 0.83) in the training set, 0.81 (0.73, 0.91) and 0.84 (0.77, 0.91) in the internal validation set, and 0.80 (0.70, 0.91) and 0.84 (0.76, 0.91) in the external validation set, respectively. ConclusionNomogram based on the SEER database to predict the overall survival of BAC patients has a good predictive effect for BAC patients.
Objective Using the evidence-based management to manage the flexible endoscope based on the data collected by information means, to reduce the rate of serious faults and control maintenance costs. Methods From January 2017 to December 2018, we collected and analyzed the flexible endoscope data of the use, leak detection, washing and disinfection, and maintenance between 2015 and 2018 from the Gastroenterology Department of our hospital. Three main causes of flexible endoscope faults were found: delayed leak detection, irregular operation, and physical/chemical wastage. Management schemes (i.e., leak detection supervision, fault tracing, and reliability maintenance) were enacted according to these reasons. These schemes were improved continuously in the implementation. Finally, we calculated the changes of the fault rate of each grade and the maintenance cost. Results By two years management practice, compared with those from 2015 to 2016, the annual rates of grade A and grade C faults of flexible endoscope from 2017 to 2018 decreased by 10.3% and 16.7% respectively, and the annual average maintenance cost fell by 53.2%. Conclusions The maintenance costs of flexible endoscope could be effectively controlled by enacting and implementing a series of targeted management schemes based on the data from the root causes of faults applying the evidence-based management. Evidence-based management based on data has a broad application prospect in the management of medical equipment faults.
ObjectiveTo explore the best timing of thyroid stimulating hormone (TSH) inhibition therapy by analyzing the trend of TSH level changes after unilateral thyroid lobectomy in patients with low-risk papillary thyroid microcarcinoma (PTMC).MethodsThe clinical data of patients with low-risk PTMC who underwent unilateral thyroid lobectomy in the Dongfeng Hospital Affiliated to Hubei Medical College from September 2016 to December 2018 were retrospectively analyzed. The TSH of all patients were measured before operation and in month 1, 3, and 6 after operation, respectively, and the change trend was analyzed.ResultsAccording to the inclusion and exclusion criteria, a total of 271 patients with low-risk PTMC were included in this study. The TSH level in month 1 after operation was higher than that of before operation [(2.93±1.09) mU/L versus (2.05±0.76) mU/L, t=19.9, P<0.001]. Among the 129 patients with TSHlevel ≤2.0 mU/L before operation, 56.6% (73/129) of them still had the TSH level ≤2.0 mU/L in month 1 after operation, 45.0% (58/129) in month 3 after operation and 39.5% (51/129) in month 6 after operation.ConclusionsTSH level of patient with low-risk PTMC is increased after lobectomy, so individualized TSH inhibition treatment should be formulated. For patients with TSH level>2.0 mU/L before operation, oral levothyroxine sodium tablets should be taken immediately after operation. For patients with preoperative TSH level ≤2.0 mU/L, TSH level should be dynamically monitored, and whether and when to start oral TSH inhibition therapy should be decided according to results of TSH level.
ObjectiveTo explore the relationship between the -2548 G/A functional polymorphism in the 5′ promoter region of the leptin gene and gallstones. Methods The -2548 G/A polymorphisms of leptin gene were determined by polymerase chain reactionrestriction fragment length polymorphism technology (PCRRFLP) in 118 patients with cholesterol gallstones and 53 normal control subjects. Then the allele and genotype distribution were studied. Results The distribution of leptin2458 G/A in two groups was statistically significantly different: the genotype frequency of AA+GA of patients in gallstone group was higher than that in control group (χ2=4.251, P=0.039). AA+AG genotype had 2.813 times greater risk for gallstone disease compared with GG genotype (OR=2.813, 95% CI=1.020-7.757). Allele frequency distribution in the two groups was different: the allele frequency of A of patients in gallstone group was higher than that in control group (χ2=5.791, P=0.016). The risk of gallstone disease in the A alleles carriers was 1.777 times as higher as the carriers of G alleles (OR=1.777, 95% CI=1.110-2.844). ConclusionThe -2548 G/A polymorphism in the 5′ promoter region of leptin gene is significantly correlated with the gallstones. The A alleles of leptin may be a genetic factor which contributes to individual susceptibility for gallstone, while the G alleles of leptin may be a genetic factor that prevents people from gallstone.
Objective To approach the effect of neck hyperextension position on hemodynamics of vertebral artery following thyroidectomy， and analyze the correlation between the change of hemodynamics and nausea and vomiting. Methods One hundred and fifty-eight patients with preparing for thyroidectomy （thyroidectomy group） and 89 patients with laparoscopic cholecystectomy （LC， LC group） were selected. The anesthesia method and the anesthesia drugs were the same in two groups. The indexes of hemodynamics of the bilateral vertebral artery at 6 h before and after thyroidectomy were measured. The difference of nausea and vomiting was observed and compared in two groups. Results The average blood flow velocity of the bilateral vertebral artery reduced and the blood flow decreased at 6 h after thyroidectomy as compared with at 6 h before thyroidectomy （P＜0.05）. The rates of nausea and vomiting of 0，2， 3， 4 times in the thyroidectomy group were significantly higher than those in the LC group （P＜0.05， P＜0.01）. The durations of nausea and vomiting of 1， 2， 3， 4 times in the thyroidectomy group were also significantly longer than those in the LC group （P＜0.01）. There was a positive correlation between the nausea and vomiting and the changes of blood flow velocity or blood flow （change of blood flow velocity：rs=0.697， P=0.03；change of blood flow：rs=0.897， P=0.01）. Conclusions There is a certain effect of the neck hyperextension position on hemodynamics of the bilatreal vertebral artery， and which might affect the nausea and vomiting following thyroidectomy.
Objective To investigate the optimal diagnosis and treatment strategy of occult carcinoma of the thyroid (OCT) with neck lymph node metastasis as the first symptom. Method In order to discuss the optimal diagnosis and treatment strategy of OCT with neck lymph node metastasis as the first symptom, we collected 35 cases and analyzed their characteristics, diagnostic methods, operative schemes, metastasis situation, and death situation. Results Of the 35 cases, 28 cases went to hospital because of swollen lymph nodes, and other 7 cases were discovered by color Doppler ultrasound in medical examination. Thyroid nodules were found by color Doppler ultrasound in 32 cases, 3 cases were found no thyroid nodule. Lymph node of 23 cases were determined by ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and 16 cases (69.56%) were diagnosed as metastasis of thyroid carcinoma or suspicious metastasis by US-FNAB. Thyroid biopsy were done in 21 cases, and 11 cases (52.38%) were diagnosed as thyroid carcinoma or suspicious thyroid carcinoma by fine needle aspiration biopsy. Of the 35 cases, 19 cases were performed total thyroidectomy and functional neck lymph node dissection, 11 cases were performed resection of unilateral thyroid and isthmus and regional neck lymph node dissection, 5 cases were performed nonstandard operations. All cases were followed up for 3–10 years after operation, and the median time was 7-year. During follow up period, 10 cases suffered from reccurrence. Among them, 3 cases reoccurred in the nonstandard operation group, 5 cases reoccurred in resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, 3 cases reoccurred in total thyroidectomy and functional neck lymph node dissection group. There were 3 cases died. Among them, there was 1 case in each group of nonstandard operation group, resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, and total thyroidectomy and functional neck lymph node dissection group. The recurrence rate of total thyroidectomy and functional neck lymph node dissection group was markedly lower than those of resection of unilateral thyroid and isthmus and regional neck dissection group (χ2=4.751,P<0.05) and nonstandard operation group (χ2=5.874,P<0.05). While there was no significance difference of the recurrence rate between the resection of unilateral thyroid and isthmus and regional neck dissection group and nonstandard operation group (χ2=0.291,P>0.05). There was no significance difference in the mortality among the three groups (P>0.05). Conclusion US-FNAB and intraoperation rapid frozen pathological section are important methods for diagnosis of OCT with neck lymph node metastasis as the first symptom, and standard operation is an principal treatment method for it.