Objective To investigate the risk factors of perioperative red blood cells transfusion for coronary artery bypass grafting (CABG) surgery. Method We retrospectively analyzed the clinical data of 534 patients underwent CABG in our hospital from January to March 2014 year. Those patients were divided into two groups:an on-pump coronary artery bypass grafting group (on-pump group) and an off-pump coronary artery bypass grafting group (off-pump group). There were 185 males and 54 females with a mean age of 59.1±9.4 years in the on-pump group. There were 233 males and 62 females with a mean age of 60.3±8.5 years in the off-pump group. Preoperative data, the relative parameters of extracorporeal circulation, the quantity of red blood cells transfusion of those two groups were compared. risk factors associated with red blood cells transfusion were evaluated by multivariate logistic regression analysis. Results The risk factors of perioperative red blood cells transfusion were age (OR=1.04, 95% CI 1.02-1.07, P=0.001) , weight (OR=0.95, 95% CI 0.93-0.97, P<0.001) , smoking (OR=0.61, 95% CI 0.39-0.94, P=0.027) , preoperative level of HCT (OR=0.90, 95% CI 0.85-0.96, P=0.001) and cardiopulmonary bypass (CPB) (OR=4.90, 95% CI 3.11-7.71, P<0.001) . During CPB, the nadir hemoglobin (nHb) (OR=0.63, 95% CI 0.47-0.84, P=0.002) was the only independent risk factor of red blood cell transfusion. Conclusions Age, weight, non-smoking, preoperative level of HCT, CPB are the risk factors for patients underwent CABG perioperatively and the lowest level of Hb in CPB is an independent risk factor of perioperative red blood cells transfusion.
ObjectiveTo systematically review the prevalence and risk factors of the chronic post-cesarean section pain (CPCSP). MethodsPubMed, EMbase, The Cochrane Library, CINAHL, PsycInfo, CBM, WanFang Data, VIP, and CNKI databases were electronically searched to collect studies on the prevalence and risk factors of CPCSP from inception to August 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 15.1 software. ResultsA total of 43 studies involving 12 435 participants were included. The results of meta-analysis showed that the prevalence of CPCSP for 2 to 5 months, 6 to 11 months, and at least 12 months were 19% (95%CI 15% to 23%), 13% (95%CI 9% to 17%), and 8% (95%CI 6% to 10%), respectively. The risk factors included preoperative pain present elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety, postpartum depression, etc. ConclusionsThe current evidence shows that the overall prevalence of CPCSP is high. Preoperative pain presents elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety and postpartum depression may increase the risk of CPCSP.
ObjectiveTo analyze risk factors of early outcomes of mitral valvuloplasty (MVP)for the treatment of degenerative mitral regurgitation (DMR). MethodsClinical data of 132 DMR patients who underwent MVP in Fu Wai Hospital between January 1, 2011 and November 1, 2011 were retrospectively analyzed. A total of 114 patients (86.4%)were followed up after discharge with their mean age of 51.21±12.78 years, including 76 males (66.7%). Preoperative risk factors of early outcomes of MVP were analyzed. ResultsAmong those patients, there were 25 patients with atrial fibri-llation (AF)(21.9%). Preoperative ejection fraction was 63.88%±6.93%. Preoperative echocardiography showed left ventricular end-diastolic diameter (LVEDD)was 31.61±5.51 mm/m2. There were 66 patients (57.9%)with tricuspid regurg-itation, and 34 patients (29.8%)underwent concomitant tricuspid valvuloplasty including 10 patients (8.8%)who received tricuspid annuloplasty rings. Two patients died postoperatively, 2 patients underwent re-operation of mitral valve replacement or MVP respectively. Postoperative echocardiography showed moderate or severe mitral regurgitation in 15 patients. Preoperative risk factors of early outcomes of MVP included AF (36.8% vs. 18.9%, P=0.035), large LVEDD (34.02±3.76 mm/m2 vs. 31.15±5.68 mm/m2, P=0.042)and functional mitral regurgitation (15.8% vs. 1.1%, P=0.007). Multivariate analysis showed greater postoperative LVEDD reduction significantly lowered the incidence of postoperative events (HR 0.002, 95% CI < 0.001-0.570, P=0.031). ConclusionsEnlargement of the left ventricle is an independent preoperative risk factor for early outcomes of MVP for DMR patients. Greater postoperative LVEDD reduction significantly lowers the incidence of postoperative events.
Objectives To evaluate the risk factors of nonarteritic a nterior ischemic optic neuropathy（NAION）in a population of China and to provide theory basis for clinical decision. Methods Demographic features and clinical data of NAION were recorded. Cerebral infarction (CI) patients were also collected as control group. Systemic evaluations including whole blood chemical test, brain MRI, carotid artery ultrasound and fundus photography were perfor med in NAION and CI patients. The fundus photography and cup/disk ratio were als o acquired in a healthy controlgroup with matched age and gender. Statistical a nalysis was done by SPSS11.5 software. Results Thirtyeight N AION patients and 40 CI patients with intact data were included. Fundus photography and cup/disk ratio were acquired in 41 healthy individuals. No statistically significant difference regard to incidences of diabetes, male gender and lipid metabolic abnormalities was found between NAION and CI patients (Pgt;0.05). H ypertension, clinical and subclinical cerebral vascular disease and carotid ar tery stenosis were statistically more commonin CI patients than in NAION patien ts (Plt;0.01, 0.05). Cup/disk ratio was statistically significant smaller in NAION than in CI patients while no statistical difference (Pgt;0.05) was fo und between the CI group and healthy individuals. Conclusions NAION shared similar risk factors with cerebral infarction, but exposure of these risk factors was different between NAION and cerebral infarction. Hypertension , cerebral vascular disease and carotid artery stenosis were more common in cere bral infarction while diabetes, male gender and lipid metabolic abnormalities were similar. Small cup/disk ratio was an independent and the most important risk factor for NAION. (Chin J Ocul Fundus Dis,2008,24:86-89)
ObjectiveTo investigate the establishment of a risk nomogram model for predicting vagus excitatory response in patients with functional epilepsy after radiofrequency thermocoagulation.MethodsA total of 106 patients with epilepsy admitted to the neurosurgery department of our hospital from January 2016 to June 2020 were selected and divided into the Vagus excitatory response (VER) group and the non-VER group according to their occurrence or absence. Logistic regression analysis was used to screen out the risk factors of VER during SEEG-guided Percutaneous radiofrequency thermocoagulation (PRFT) in patients with functional epilepsy, and R software was used to establish a histogram model affecting VER in SEEG-guided PRFT. Bootstrap method was used for internal verification. C-index, correction curve and ROC curve were used to evaluate the prediction ability of the model.ResultsLogistic regression analysis showed that age [OR=0.235, 95%CI (0.564, 3.076)], preoperative fugl-meyer score [OR=4.356, 95%CI (1.537, 6.621)], depression [OR=0.995, 95%CI (1.068, 7.404)], and lesion range [OR=1.512, 95%CI (0.073, 3.453)] were independent risk factors for the occurrence of VER in PRFT under the guidance of SEEG (P<0.05), and were highly correlated with the occurrence of VER in PRFT. Based on the above six indicators, a SEEG-guided colograph model of VER risk in PRFT was established, and the model was validated internally. The results showed that the C-index of the modeling set and validation set were 0.779 [95%CI (0.689, 0.869)] and 0.782 [95%CI (0.692, 0.872)], respectively. The calibration curves of the two groups fit well with the standard curves. The areas under the ROC curve (AUC) of the two groups were 0.779 and 0.782 respectively, which proved that the model had good prediction accuracy.ConclusionFor patients with functional epilepsy requiring seeg-guided PRFT therapy, age, preoperative Fugl-meyer score, depression and lesion range should be taken into full consideration to comprehensively assess the incidence of VER, and early intervention measures should be taken to reduce and reduce the incidence, which has good clinical application value.
Objective To explore the application of risk assessment of nosocomial infection control in outpatient departments, so as to find out the high-risk departments and high-risk links of nosocomial infection, and to provide basis for the formulation of nosocomial infection prevention and control measures in outpatient departments. Methods The improved risk assessment tool was used to evaluate the nosocomial infection management risk in the outpatient departments of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. We evaluated risk indicators and risk levels from three dimensions: likelihood of risk occurrence, severity of consequences, and integrity of the current system. Results Among the evaluated outpatient departments, the departments with extremely high risk levels included pediatric fever outpatient department (147.8 points), pediatric outpatient department (141.2 points), emergency internal medicine department (139.4 points), and pediatric emergency department (138.8 points). The departments with high risk levels included internal medicine outpatient department (138.4 points), dermatology outpatient department (136.0 points), otolaryngology-head and neck surgery outpatient department (135.6 points), and ophthalmology outpatient department (134.0 points). The risk assessment scores of 31 outpatient departments showed a normal distribution. The evaluation results of various risk indicators showed that among the 26 risk indicators, there were 2 extremely low risk, 4 low risk, 6 medium low risk, 7 medium high risk, 4 high risk, and 3 extremely high risk. The 3 extremely high risk indicators were lack of nosocomial infection prevention and control knowledge, patients with difficult to identify diseases (air/droplet transmission) seeking medical treatment, and crowded waiting areas for patients. Conclusions The comprehensive risk assessment of outpatient departments can screen out high risk outpatient departments and find out the main risk links. We can concentrate resources on key departments, prevent key risks, and improve the efficiency of nosocomial infection control.
ObjectiveTo investigate the factors related to recurrent coronary events in patients after coronary artery stent implantation. MethodsWe retrospectively studied the patients performing coronary angiography (CAG) who were admitted to the Department of Cardiology of the Second Affiliated Hospital of Guangzhou Medical University between January 2012 and June 2013. All of the enrolled patients had received CAG in our hospital, with complete coronary angiogram and clinical data. The patients were divided into two groups according to the coronary angiogram and clinical data: coronary event group and non-coronary event group. SPSS 16.0 software was employed for statistical analysis, and multivariate analysis was performed using binary logistic regression model to analyze the risk factors. ResultsA total of 115 patients were included, of which 50 patients had recurrent coronary events. Both the serum total bilirubin and unconjugated bilirubin in patients with coronary events were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05 or P < 0.01). The serum total bilirubin at baseline and the serum total bilirubin and unconjugated bilirubin at the time of CAG reexamination were significantly lower in patients with revasculization due to the progression of coronary artery lesions compared with the patients without coronary events (P < 0.05 or P < 0.01). The serum unconjugated bilirubin in patients with in-stent restenosis were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05). The results of logistic regression analysis showed that multi-vessel coronary artery disease (two-vessel coronary artery disease: OR=10.094, 95%CI 2.498 to 40.798, P=0.001; three-vessel coronary artery disease: OR=16.047, 95%CI 4.121 to 62.481, P=0.000) and low serum unconjugated bilirubin (OR=0.873, 95%CI 0.773 to 0.987, P=0.03) were independent risk factors of recurrent coronary events. ConclusionMulti-vessel coronary artery disease and low serum unconjugated bilirubin are independent risk factors of recurrent coronary events in patients after coronary artery stent implantation.
ObjectiveTo retrospectively evaluate the risk factors of mortality in postoperative acute kidney injury (AKI) patients undergoing continuous renal replacement therapy (CRRT) after cardiopulmonary bypass (CPB). MethodsWe retrospectively analyzed the clinical data of 66 patients (38 males and 28 females with mean age of 59.11±12.62 years) underwent CRRT after cardiovascular surgery in our hospital between May 2009 and June 2014. The patients were divided into a survival group (18 patients) and a death group (48 patients) according to treatment outcome at discharge. Univariate analysis for risk factors of death was carried out for preoperative characteristics and lab results among study population. Significant univariate factors were then further analyzed by multivariable logistic regression models. ResultsSignificant predictors of death included blood transfusion volume during operation, peak level of blood sugar and lactate during operation, the total bilirubin level and platelet count on the first day after operation, hypotension on the first day after operation, pulmonary infection, multiple organ dysfunction syndrome (MODS) and the interval time of oliguria and CRRT (P<0.05). Logistic regression showed that there were statistical differencs in hypotension on the first day after operation, postoperative platelet count, and interval time of oliguria and CRRT respectively (P<0.05). ConclusionImproving intraoperative management, reducing bleeding and blood transfusion, controlling blood sugar level, dealing with complications such as hypotension, pulmonary infection and MODS more aggressively, starting CRRT when needed may be helpful to reduce mortality. Monitoring of the blood pressure and platelet count on the first day after operation is useful for prognosis estimation.
ObjectivesTo systematically review the risk factors for intestinal injury induced by non-steroidal anti-inflammatory drugs(NSAIDs).MethodsWe comprehensively searched WanFang Data, CNKI, Web of Science, EBSCO, PubMed and The Cochrane Library databases to collect studies on risk factors of NSAIDs-induced intestinal injury. Two reviewers independently screened literature, extracted data and assessed risk of bias, and then, meta-analysis was performed by using RevMan 5.2 and STATA 12.0 software.ResultsA total of 6 case-control studies were included, in which 265 patients were in the case group and 301 patients in the control group. The results of meta-analysis showed that PPI was an independent risk factor for NSAIDs-induced intestinal injury (OR=1.59, 95%CI 1.07 to 2.35, P=0.02). In addition, patients with osteoarthritis (OR=2.44, 95% CI 1.11 to 5.36, P=0.03) or rheumatoid arthritis (OR=3.04, 95% CI 1.31 to 7.03, P=0.01) was associated with intestinal mucosal injury induced by NSAIDs. Gender, age, smoking history, drinking history, H2RA and rebamipide medication history, cardiovascular disease and cerebrovascular disease were not associated with intestinal injury.ConclusionsPPI is an independent risk factor for NSAIDs-induced intestinal injury. However, studies with high-quality, larger sample size are required to further verify that PPI increases the prevalence of intestinal injury.
Objective To compare the risk factors between multiple cerebral infarction (MCI) and single cerebral infarction (SCI). This would be beneficial for carrying out corresponding prevention and treatment. Methods We prospectively registered consecutive cases of ischemic stroke in the neurological wards and divided them into two groups: MCI group and SCI group according to their clinical and imaging data. Firstly, the single variable analyses of 24 factors that could be related to the onset of MCI were conducted, and then the multivariate non-condition stepwise logistic regression was performed. Results Significant differences were noted between MCI group and SCI group in terms of age, gender, hpertension, diabetes, heart valvular disease, smoking, cerebral infarction history and first systolic blood pressure after admission. The logistic regression analyses showed that factors of age (OR=1.014, 95%CI 1.003 to 1.026), hypertension (OR=1.566, 95%CI 1.185 to 2.068), smoking (OR=1.473, 95%CI 1.052 to 2.061), cerebral infarction history (OR=1.948, 95%CI 1.326 to 2.864) were independent risk factors for MCI. Conclusion Compared to SCI, age, hypertension, smoking and cerebral infarction history were independent risk factors for MCI patients.