ObjectiveTo explore risk factors of blood transfusion during liver transplantation and construct its prediction model. MethodsThe patients underwent liver transplantation who met the inclusion and exclusion criteria of this study from March 2020 to December 2020 in the Beijing Youan Hospital of Capital Medical University were retrospectively collected. The univariate and logistic multivariate analysis were used to evaluate the risk factors of blood transfusion during liver transplantation and construct the prediction model for intraoperative blood transfusion. ResultsA total of 151 eligible liver transplantation patients were collected in this study, including 51 non-transfusion patients and 100 transfusion patients. The univariate analysis results showed that the differences of primary diagnosis, preoperative hemoglobin (Hb), platelet count, prothrombin time, international normalized ratio, Child-Turcotte-Pugh score, and end-stage liver disease (MELD) score were statistically different between them (P<0.05). The above variables selected by the univariate analysis were selected by stepwise method, then the preoperative Hb and MELD score were selected into the multivariate logistic regression analysis, the results showed that the preoperative Hb≤113 g/L and MELD score ＞14 increased the risk of blood transfusion during liver transplantation [Hb: OR=6.652, 95%CI (2.282, 19.392), P<0.001; MELD score: OR=16.037, 95%CI (6.336, 40.592), P<0.001]. The logistic regression model predicted the area under receiver operating characteristic curve was 0.873 [95%CI (0.808, 0.919), P<0.001], the sensitivity and specificity were 91.0% and 67.5%, respectively, Youden index was 0.674, the accuracy was 86.1%. ConclusionsResults of this study suggest that preoperative Hb ≤113 g/L and MELD score＞14 increase risk of blood transfusion during liver transplantation. Logistic regression model constructed according to preoperative Hb and MELD score has a better sensitivity and specificity of intraoperative blood transfusion.
ObjectiveTo summarize the risk factors of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury and to provide reference for the prevention and treatment of postoperative voice quality damages.MethodThe research progress of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was reviewed by reading the related literatures at home and abroad.ResultsEven if there was no obvious recurrent laryngeal nerve injury during the operation, the voice quality may change after the operation for the patients undergoing thyroidectomy. The change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was associated with various risk factors such as dysfunction of superior laryngeal nerve, injury of anterior laryngeal band muscles, endotracheal intubation, surgical methods, age, gender and special occupations.ConclusionsThe change of voice quality is a common complication after thyroidectomy, which seriously affects the quality of life of patients. In the absence of significant recurrent laryngeal nerve injury, many patients will still experience problems with voice quality. Understanding the related risk factors of voice quality change after thyroidectomy is helpful to optimize postoperative voice function, to prevent possible secondary injuries, and to improve the quality of life of patients.
Objective To investigate the risk factors for end-stage liver disease (ESLD) complicated with fungal esophagitis (FE). Methods The clinical data of ESLD patients who underwent gastroscopy during their hospitalization in the Second Affiliated Hospital of Chongqing Medical University between January 1, 2017 and December 31, 2023 were retrospectively analyzed. The ESLD patients with FE were selected as the study group, and the ESLD patients without FE during the same period were included as the control group by 1∶2 propensity score matching method. Multivariate logistic regression model was used to analyze the risk factors of ESLD complicated with FE. Results A total of 75 ESLD patients with FE and 150 ESLD patients without FE were enrolled. There was no significant difference in age, gender, decompensated cirrhosis, liver cancer, diabetes mellitus, or etiology of ESLD between the two groups (P>0.05). Multivariate logistic regression analysis showed that longer hospital stay [odds ratio (OR)=1.115, 95% confidence interval (CI) (1.069, 1.164)], with invasive procedures [OR=10.820, 95%CI (4.393, 26.647)], and higher total bilirubin [OR=1.015, 95%CI (1.005, 1.024)] were risk factors for ESLD complicated with FE (P<0.05). In the study group, 41 patients were treated with antifungal drugs, and 4 of them developed invasive fungal infection. Among the 34 patients who did not receive antifungal drugs, 10 developed invasive fungal infection. Conclusions ESLD patients with longer hospital stay, worse liver function, and invasive procedures are more likely to develop FE, and regular gastroscopy should be performed. Once FE is found, active antifungal treatment should be taken to reduce the occurrence of invasive fungal infection and improve the prognosis of patients.
ObjectiveTo analyze the prevalence and risk factors of metabolic syndrome (MS) after adult liver transplantation (LT) recipients. MethodsThe clinicopathologic data of patients with survival time ≥1 year underwent LT in the People’s Hospital of Zhongshan City from January 1, 2015 to August 31, 2020 were analyzed retrospectively. The logistic regression model was used to analyze the risk factors affecting MS occurrence after LT, and the receiver operating characteristic (ROC) curve was used to evaluate the optimal cutoff value of the index of predicting MS occurrence and its corresponding evaluation effect. ResultsA total of 107 patients who met the inclusion criteria were collected in this study. Based on the diagnostic criteria of MS of Chinese Medical Association Diabetes Association, the occurrence rate of MS after LT was 32.7% (35/107). Multivariate logistic regression analysis showed that the increased age of the recipient [OR (95%CI)=1.106 (1.020, 1.199), P=0.014], preoperative increased body mass index [OR (95%CI)=1.439 (1.106, 1.872), P=0.007] and blood glucose level [OR (95%CI)=1.708 (1.317, 2.213), P<0.001], and with preoperative smoking history [OR (95%CI)=5.814 (1.640, 20.610), P=0.006] and drinking history [OR (95%CI)=5.390 (1.454, 19.984), P=0.012] increased the probability of MS after LT. The areas under the ROC curve (AUC) corresponding to these five indexes were 0.666, 0.669, 0.769, 0.682, and 0.612, respectively. The corresponding optimal cutoff values of three continuous variables (recipient’s age, preoperative body mass index, and blood glucose level) were 53 years old, 23.1 kg/m2, and 6.8 mmol/L, respectively. The AUC of combination of the above five indexes in predicting occurrence of MS was 0.903 [95%CI (0.831, 0.952)], and the sensitivity and specificity were 80.0% and 90.3%, respectively. ConclusionsIncidence of MS after adult LT recipient is not low. For recipients with preoperative hyperglycemia, obese, elderly, histories of drinking and smoking before LT need to pay attention to the early detection and early intervention of MS.
Objective To investigate the prevalence of postoperative delirium (POD) in elderly patients undergoing major orthopedic surgery and analyze its influencing factors, so as to provide evidence for early screening and intervention of POD. Methods The medical records of elderly patients undergoing major orthopedic surgery in the Department of Orthopaedics of the First Medical Center, Chinese PLA General Hospital between January 2021 and December 2022 were retrospectively collected. The included patients were divided into POD group and non-POD group. The patients’ demographic characteristics, medical history, laboratory indicators, perioperative medication, intraoperative and postoperative indicators were collected to analyze the risk factors affecting POD. Results A total of 455 elderly patients were included. Among them, there were 75 cases in the POD group and 380 cases in the non-POD group. The incidence of POD was 16.5% (75/455). There were statistically significant differences in age, body mass index, number of combined underlying diseases≥3, albumin<35 g/L, American Society of Anesthesiologists (ASA) classification, intraoperative blood loss≥200 mL, intraoperative blood transfusion, postoperative Visual Analogue Scale (VAS) score, indwelling catheters, admission to intensive care unit (ICU), and length of ICU stay between the two groups (P<0.05). The results of logistic regression analysis showed that age≥79 years, number of combined underlying diseases≥3, albumin<35 g/L, intraoperative blood loss≥200 mL, ASA grade≥Ⅲ, postoperative VAS score, and postoperative admission to ICU (P<0.05) were independent influencing factors for POD occurrence in elderly patients undergoing major orthopedic surgery. Conclusions POD is one of the common postoperative complications in elderly patients undergoing major orthopedic surgery. Age≥79 years, number of combined underlying diseases≥3, albumin<35 g/L, intraoperative blood loss≥200 mL, ASA grade≥Ⅲ, postoperative VAS score, and postoperative admission to ICU are independent risk factors for POD in elderly patients undergoing major orthopedic surgery. Clinical staff should evaluate and screen these factors early and take preventive measures to reduce the incidence of POD.
ObjectiveTo identify the risk factors of bone metastasis in breast cancer and construct a predictive model. MethodsThe data of breast cancer patients met inclusion and exclusion criteria from 2010 to 2015 were obtained from the SEER*Stat database. Additionally, the data of breast cancer patients diagnosed with distant metastasis in the Affiliated Hospital of Southwest Medical University from 2021 to 2023 were collected. The patients from the SEER database were randomly divided into training (70%) and validation (30%) sets using R software, and the breast cancer patients from the Affiliated Hospital of Southwest Medical University were included in the validation set. The univariate and multivariate logistic regressions were used to identify risk factors of breast cancer bone metastasis. A nomogram predictive model was then constructed based on these factors. The predictive effect of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis. ResultsThe study included 8 637 breast cancer patients, with 5 998 in the training set and 2 639 (including 68 patients in the Affiliated Hospital of Southwest Medical University) in the validation set. The statistical differences in the race and N stage were observed between the training and validation sets (P<0.05). The multivariate logistic regression analysis revealed that being of white race, having a low histological grade (Ⅰ–Ⅱ), positive estrogen and progesterone receptors status, negative human epidermal growth factor receptor 2 status, and non-undergoing surgery for the primary breast cancer site increased the risk of breast cancer bone metastasis (P<0.05). The nomogram based on these risk factors showed that the AUC (95% CI) of the training and validation sets was 0.676 (0.533, 0.744) and 0.690 (0.549, 0.739), respectively. The internal calibration using 1 000 Bootstrap samples demonstrated that the calibration curves for both sets closely approximated the ideal 45-degree reference line. The decision curve analysis indicated a stronger clinical utility within a certain probability threshold range. ConclusionsThis study constructs a nomogram predictive model based on factors related to the risk of breast cancer bone metastasis, which demonstrates a good consistency between actual and predicted outcomes in both training and validation sets. The nomogram shows a stronger clinical utility, but further analysis is needed to understand the reasons of the lower differentiation of nomogram in both sets.
ObjectiveTo explore and analyze the risk factors for arrhythmia in patients after heart valve replacement.MethodsA retrospective analysis of 213 patients undergoing cardiac valve replacement surgery under cardiopulmonary bypass in our hospital from August 2017 to August 2019 was performed, including 97 males and 116 females, with an average age of 53.4±10.5 year and cardiac function classification (NYHA) grade of Ⅱ-Ⅳ. According to the occurrence of postoperative arrhythmia, the patients were divided into a non-postoperative arrhythmia group and a postoperative arrhythmia group. The clinical data of the two groups were compared, and the influencing factors for arrhythmia after heart valve replacement were analyzed by logistic regression analysis.ResultsThere were 96 (45%) patients with new arrhythmia after heart valve replacement surgery, and the most common type of arrhythmia was atrial fibrillation (45 patients, 18.44%). Preoperative arrhythmia rate, atrial fibrillation operation rate, postoperative minimum blood potassium value, blood magnesium value in the postoperative arrhythmia group were significantly lower than those in the non-postoperative arrhythmia group (P<0.05); hypoxemia incidence, hyperglycemia incidence, acidosis incidence, fever incidence probability were significantly higher than those in the non-postoperative arrhythmia group (P<0.05). The independent risk factors for postoperative arrhythmia were the lowest postoperative serum potassium value (OR=0.305, 95%CI 0.114-0.817), serum magnesium value (OR=0.021, 95%CI 0.002-0.218), and hypoxemia (OR=2.490, 95%CI 1.045-5.930).ConclusionTaking precautions before surgery, improving hypoxemia after surgery, maintaining electrolyte balance and acid-base balance, monitoring blood sugar, detecting arrhythmia as soon as possible and dealing with it in time can shorten the ICU stay time, reduce the occurrence of complications, and improve the prognosis of patients.
Objective To analyze the results of intra-aortic balloon pump (IABP) support in patients receiving coronary artery bypass graft (CABG) and the risk factors of postoperative death. Methods The clinical data of 334 patients undergoing CABG procedure and receiving IABP support in Fuwai Hospital from January 1999 to April 2012 were retrospectively analyzed. According to the IABP insertion timing, the patients were divided into three groups: pre-, intra- and postoperative IABP groups. There were 45 males and 11 females aged 60.5±10.7 years in the preoperative IABP group, 84 males and 23 females aged 61.1±8.4 years in the intraoperative IABP group and 119 males and 52 females aged 61.4±8.5 years in the postoperative IABP group.Outcomes of the three groups were compared, including mortality, major complications, ICU stay, hospital stay and total costs. Multivariable logistic regression analysis was used to predict independent risk factors for postoperative in-hospital death. Results The total in-hospital mortality was 16.8% (56/334). Mortality was significantly different among the pre-, intra- and postoperative IABP groups (3.6% vs.23.4%vs. 17.0%, P=0.006). There was no significant difference in complications among the three groups (P=0.960). Multivariable logistic regression analysis indicated that independent risk factors for postoperative mortality included old age (OR=1.05, P=0.040), female (OR=3.34, P<0.001) and increasing left ventricular end-diastolic diameter (LVEDD,OR=1.06, P=0.040). Preoperative IABP support was protective factor (OR=0.10, P=0.050). Conclusion The results of IABP support in CABG patients are satisfactory, and patients with preoperative IABP have a lower mortality. Risk factors for postoperative death include old age, female and increasing LVEDD. Preoperative IABP support is a protective factor.
Inadvertent perioperative hypothermia (IPH) is one of the common complications of surgery, which can lead to a series of adverse consequences. In recent years, with the deepening development of precision medicine concepts, establishing predictive models to identify the risk of IPH early and implementing targeted interventions has become an important research direction for perioperative management. This article reviews the current research status of IPH predictive models in adults, focusing on the research design, modeling methods, selection of prediction factors, and prediction performance of different predictive models. It also explores the advantages and limitations of existing models, aiming to provide references for the selection, application, and optimization of relevant predictive models.
Recently, World Health Organization/International Agency for Research on Cancer (WHO/IARC) published the World Cancer Report 2020. This report described the cancer burden of the world, the risk factors of cancer, biological process in cancer development and the prevention strategies of cancer. Based on current status of China’s cancer burden and prevention strategies, this paper briefly interpreted the key points of cancer prevention and control in the report.