Objective To investigate the correlation between grip strength and subjective cognitive decline (SCD) in maintenance hemodialysis (MHD) patients of different genders. Methods Patients who underwent outpatient MHD in the Wenjiang Hemodialysis Unit, Department of Nephrology, West China Hospital, Sichuan University between March and June 2024 were selected as the research subjects. Multiple linear regression analysis was used to explore the relationship between grip strength and SCD in MHD patients of different genders. Results A total of 171 patients were investigated, with 76 in the non-SCD group and 95 in the SCD group. The results of multiple linear regression analysis showed that educational level (P=0.039), nutritional status (P=0.026), and grip strength (P=0.042) were the influencing factors of SCD in male MHD patients. Work status (P=0.001) and nutritional status (P=0.011) were the influencing factors of SCD in female MHD patients. Conclusions Educational level, nutritional status, and grip strength are influencing factors of SCD in male MHD patients. Work status and nutritional status are influencing factors of SCD in female MHD patients. Grip strength may serve as an indicator for evaluating SCD in male MHD patients.
Objective To analyze the benign-malignant outcomes of pulmonary nodules in surgical patients and their influencing factors, and provide evidence and ideas for optimizing and improving the integrated management model of pulmonary nodules. Methods From October to December 2023, a convenience sampling method was used to select patients who underwent lung surgery at West China Hospital, Sichuan University between July 2022 and June 2023 for this study. The malignancy rate of postoperative pathological results of pulmonary nodules and its influencing factors were analyzed using univariate analysis and multiple logistic regression. Results A total of 4600 surgical patients with pulmonary nodules were included, with a malignancy rate of 88.65% (4078/4600) and a benign rate of 11.35% (522/4600). Univariate analysis showed significant differences in malignancy rates among different genders, ages, methods of pulmonary nodule detection, and smoking histories (P<0.05); however, no significant difference was found regarding place of birth or family history of lung cancer (P>0.05). Multiple logistic regression analysis indicated that females [odds ratio (OR)=1.533, 95% confidence interval (CI) (1.271, 1.850)], older age groups [61-75 vs. ≤30 years: OR=1.640, 95%CI (1.021, 2.634); >75 vs. ≤30 years: OR=2.690, 95%CI (1.062, 6.814)], and pulmonary nodules detected during physical examinations [OR=1.286, 95%CI (1.064, 1.554)] were high-risk factors for malignancy, with statistical significance (P<0.05). Conclusion In the integrated management of pulmonary nodules, it is crucial not to overlook females or older patients, as they may be more significant influencing factors than smoking; furthermore, lung examinations are effective means of early detection of malignant lung tumors and are worth promoting and popularizing.
Objective To document the effect of surgical steps, including penile degloving, plate transection, dorsal plication, and fasciocutaneous coverage, in primary hypospadias repair on penile length. Methods A consecutive series of 209 prepubertal boys with primary hypospadias repair was included with the age ranged from 10 to 97 months (mean, 31.7 months). Intraoperative stretched penile length (SPL) was measured before operation (n=209), and after each step, namely penile degloving (n=152), plate transection (n=139), dorsal plication (n=170), and fasciocutaneous coverage (n=209). SPLs before and after each steps or the entire operation were analyzed. The SPL was compared between plate transection group and plate preservation group, dorsal plication group and non-plication group, and plate preservation with plication group and plate preservation without plication group, respectively. Differences of SPL between before and after each steps were analyzed with factors including neourethra length, rest dorsal penile length, rest ventral penile length, preoperative SPL, and the degree of penile curvature after penile degloving, with multivariate linear regression analysis. ResultsAll the four steps resulted in SPL difference. The SPL increased after penile degloving and plate transection (P<0.05), and decreased after dorsal plication and fasciocutaneous coverage (P<0.05). The SPL increased after all steps were completed (P<0.05). In patients with plate transection, postoperative SPL increased when compared with that before operation (P<0.05). No significant difference was noted in patients without plate transection (P>0.05). And there was significant difference in the increased length of SPL between patients with and without plate transection (P<0.05). In patients with dorsal plication, a significant increase of postoperative SPL (P<0.05) was noted. No significant difference was noted in patients without dorsal plication (P>0.05). And there was no significant difference in increased length between patients with and without dorsal plication (P>0.05). When patients with plate transection were excluded, dorsal plication resulted in no significant difference on postoperative SPL (P>0.05). The increased length of SPL after penile degloving, dorsal plication, or cutanofascial coverage was not related to the neourethra length, the rest dorsal penile length, the rest ventral penile length, the preoperative SPL, and the degree of penile curvature (P>0.05). However, the neourethra length and preoperative SPL were the influencing factors for the increased length of SPL after plate transection (P<0.05). ConclusionThe main steps in primary hypospadias repair can change SPL. The lengthening effect of plate transection would not be counteracted by dorsal plication. Dorsal plication makes no significant difference on postoperative SPL.
ObjectiveTo explore effect of preoperative prognostic nutritional index (PNI) on clinically related postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP) and analyze its influencing factors in order to provide a basis for clinical prediction of CR-POPF. MethodsThe clinicopathologic data of patients who successfully completed DP in the Affiliated Hospital of Xuzhou Medical University and met the inclusion and exclusion criteria of this study from January 1, 2017 to January 31, 2021 were collected retrospectively. The preoperative PNI value was calculated and the optimal cut-off value was obtained according to the receiver operative characteristic (ROC) curve. The patients were divided into low and high PNI based on the optimal cut-off value. The clinicopathologic characteristics were compared between the patients with low and high PNI and CR-POPF or not. At the same time, multivariate logistic regression was used to analyze the influencing factors of CR-POPF. ResultsA total of 143 patients who met the inclusion and exclusion criteria were included in this study. The CR-POPF occurred in 33 cases (23.08%) after DP, and the average preoperative PNI was 52.26 (39.20–65.10), the optimal cut-off value of PNI was 50.55, with 49 cases in the low PNI group and 94 cases in the high PNI group. In patient with low PNI, the proportions of patients aged ≥65 years and with CR-POPF were higher than those with high PNI (P<0.05). In the patients with CR-POPF, the proportions of patients with soft pancreatic texture and with low preoperative PIN were higher than those without CR-POPF (P<0.05). Further, the multivariate logistic regression showed that the the preoperative low PNI (OR=5.417, P<0.001) and soft pancreatic texture (OR=4.126, P=0.002) increased the risk of CR-POPF. ConclusionLow preoperative PNI and soft pancreatic texture increase risk of CR-POPF after DP, and it is necessary to preoperatively evaluate PNI status of patients.
Objective To observate the influencing factors on circuit life during continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA), so as to provide data support for further optimization of RCA anticoagulation strategy. MethodsPatients who underwent CRRT with RCA in West China Hospital of Sichuan University between March 2021 and April 2022 were retrospectively selected. Analyze the basic information of patients and the impact of relevant indicators before or within 12 hours of treatment on the circuit life. Results A total of 116 patients were included. Among the included patients, a total of 225 cases were treated with CRRT for 11 051.7 hours, the median circuit life was 57.0 (25.4, 72.0) h. 142 cases (63.1%) were terminated due to coagulation, the median circuit life was 30.3 (20.5, 52.8) h. The results of multivariate Cox regression analysis showed that pH value [hazard ratio (HR)=0.002, 95% confidence interval (CI) (0.0001, 0.127), P=0.003], the maximam postfilter ionized calcium [HR=0.039, 95%CI (0.004, 0.437), P=0.008], blood flow [HR=1.051, 95%CI (1.027, 1.075), P<0.001] and catheter dysfunction [HR=5.701, 95%CI (3.777, 8.605), P<0.001] were the four influential factors affected circuit life. Kaplan Meier survival curve showed that RCA had the best effect when the postfilter ionized calcium was in the range of 0.25 ~ 0.35 mmol/L. Conclusions During CRRT treatment of RCA, pH value, postfilter ionized calcium, blood flow and catheter function are the independent influencing factors of circuit life. The above parameters should be carefully monitored and optimized in the treatment process to minimize the risk of coagulation, prolong the circuit life and maintain the continuty of CRRT treatment. The postfilter ionized calcium was recommended to be maitained at 0.25-0.35mmol/L, pH value maintained above 7.38, blood flow no more than 145 mL/min and catheter maitained patency to ensure the adequate anticoagulation.
Objective To explore the current situation and influencing factors of self-regulatory fatigue in maintenance hemodialysis (MHD) patients, so as to provide good dialysis treatment for MHD patients, reduce their level of self-regulated fatigue and improve their quality of life. Methods The convenient sampling method was used to select the MHD patients in the Wenjiang Hemodialysis Center of West China Hospital of Sichuan University between April 12 and April 30, 2022. The patients were investigated by self-made basic information scale and self-regulatory fatigue scale. Results A total of 131 patients were included. The average score of self-regulatory fatigue was 53.47±6.45, cognitive dimension was 20.21±2.39, emotional dimension was 20.85±2.85, behavioral dimension was 12.40±3.63. The results of multiple linear stepwise regression analysis showed that age, duration of dialysis and educational background could inversely predict the score of self-regulatory fatigue (P<0.05). Conclusions MHD patients have a high level of self-regulatory fatigue. Clinical nurses can make individual dialysis programs according to the actual situation of MHD patients, improve their self-regulated level and physical and mental health, and improve the quality of life of MHD patients.
Objective To analyze the influencing factors of delirium after endovascular aortic repair, and to provide a basis for clinical nursing and prevention of this condition. Methods Patients who underwent endovascular aortic repair at Fuwai Hospital, Chinese Academy of Medical Sciences from 2018 to 2019 were selected. The Chinese version of the Nursing Delirium Screening Scale (Nu-DESC) was used to assess whether postoperative delirium occurred. Patients with a Nu-DESC score ≥ 3 were assigned to the delirium group. Non-delirium patients who had the same surgeon and adjacent surgical order were selected at a 1 : 4 ratio to form the non-delirium group. Univariate analysis was performed on the clinical data of the two groups. Factors with P<0.1 in the univariate analysis and those considered clinically significant were included in a multivariate logistic regression analysis to identify the influencing factors of postoperative delirium. Stratified analysis was conducted based on thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR). Results A total of 213 patients were included, comprising 46 in the delirium group and 167 in the non-delirium group. The overall mean age was (60.3±12.0) years, and 183 (85.9%) were male. Univariate analysis showed that emergency admission, preoperative neutrophil percentage, lymphocyte percentage, operative duration, intubation time, and ICU stay might be associated with postoperative delirium. Multivariate analysis revealed that longer operative and intubation times were associated with a higher likelihood of delirium. In the stratified analysis, the results for the TEVAR group were consistent with the overall findings, whereas no significant differences were observed in the EVAR group. Conclusion Longer operative and intubation times are associated with a higher risk of delirium in patients undergoing TEVAR, while no significant association was found in patients undergoing EVAR.
In recent years, with the wide application of carbapenems, the resistance of Enterobacterium to carbapenems has become increasingly high, leading to a large number of carbapenem-resistant Klebsiella pneumoniae (CRKP). These bacteria are often resistant to many different types of antibacterial drugs, including carbapenems, which leads to clinical treatment failure and seriously threatens the life safety of patients. Currently, these bacteria have become an independent risk factor for patients’ death. This article reviews the drug resistance, infection status and influencing factors, and medication therapy of CRKP, in order to facilitate the clinical diagnosis, treatment, and disease process control of CRKP infection, and provide reference for curbing bacterial drug resistance.
ObjectiveTo investigate the use of opioid analgesics during the postoperative hospitalization in patients undergoing lung resection and analyse its influencing factors.MethodsThe clinical data of 450 patients undergoing lung resection in Sichuan Cancer Hospital among a multicenter symptom research database (CN-PRO-Lung 1) between November 2017 and January 2020 were analyzed. There were 248 males and 202 females with an average age of 54.7±10.3 years.ResultsA total of 448 (99.6%) patients used opioid analgesics. The average daily morphine equivalent dose during the postoperative hospitalization was 48.9 mg. There were statistical differences in postoperative morphine equivalent dose across patients with different sex, age, highest level of education, Charlson Comorbidity Index score, surgical approach, surgical type, operative time, postoperative hospital stay and grade of postoperative complications (all P<0.05). Multivariate analysis showed that sex, surgical approach and postoperative hospital stay were independent influencing factors for morphine use during the postoperative hospitalization in patients undergoing lung resection (all P<0.05).ConclusionIn clinical practice, attention should be paid to postoperative pain for male patients, as well as to promote the application of minimally invasive surgery, and to shorten the length of postoperative hospital stay, in order to ultimately reduce the use of opioids.
ObjectiveTo retrospectively collect data on patients with stable chronic obstructive pulmonary disease (COPD), and explore the current status of medication adherence and its main influencing factors in China.MethodsAccording to the principle of convenience, 293 patients with COPD were enrolled in 16 tertiary hospitals located in Nanjing, Hefei, Wuhu, Xuzhou, and Chuzhou. The status quo and influencing factors of medication adherence in COPD patients were identified and analyzed by using the 8-item Morisky Drug Compliance Scale, Beliefs about Medicines Questionnaire, Hospital Anxiety and Depression Scale, General Self-Efficacy Scale, and modified British Medical Research Council. The analysis was based on the framework provided by the WHO’s "five-dimensional determinants" and the mathematical relationship was demonstrated through sequential logistic regression analysis. ResultsThe medication adherence of the target population is 11.95%. A higher socio-economic status [odds ratio (OR) 0.30, 95% confidential interval (CI) 0.10 - 0.91], patients’ general beliefs about the medication utility (OR 0.29, 95%CI 0.17 - 0.50) and overuse (OR 0.30, 95%CI 0.16 - 0.55) were associated with a lower chance of being adherent in patients with COPD. While disease severity (OR 2.01, 95%CI 1.11 - 3.64) and types of drug use (OR 1.91, 95%CI 1.07 - 3.41) presented opposite results. ConclusionsMedication adherence in domestic patients with COPD is not satisfactory at the present stage. Effective ways to improve patients’ medication adherence and quality of life could be proposed from the national, living environment and individual three dimensions.