Objective To compare surgical outcomes of Stanford type A acute aortic dissection between operations at midnight and daytime. Methods From January 2004 to March 2013，195 patients with Stanford type A acute aortic dissection received surgical treatment in Nanjing Hospital Affiliated to Nanjing Medical University （Nanjing Cardiovascular Disease Hospital）. Patients with identical or similar propensity scores were matched from 127 patients who underwent emergency operation at daytime and 68 patients who underwent emergency operation at midnight. A total of 58 pairs of matched patients which had the same or similar propensity score were selected in daytime surgery group （n=58，43 males and 15 females，47.7±14.6 years） and midnight surgery group （n=58，45 males and 13 females，48.3±14.6 years）. Operation time，postoperative chest drainage，mechanical ventilation time，postoperative incidence of dialysis and tracheostomy，length of ICU stay and in-hospital mortality were compared between the daytime group and midnight group. Results A total of 58 pair of patients were matched in this study. There was no statistical difference in postoperative incidence of tracheostomy ［19.0% （11/58） vs. 6.9% （4/58），P=0.053］ or in-hospital mortality ［8.6% （5/58） vs. 6.9%（4/58），P=0.729］ between the midnight group and daytime group. Operation time （485.7±93.5 minutes vs. 428.5±123.3 minutes，P=0.048），postoperative chest drainage （979.5±235.7 ml vs. 756.6±185.9 ml，P=0.031），mechanical ventilation time （67.9±13.8 hours vs. 55.7±11.9 hours，P=0.025），postoperative incidence of dialysis ［17.2% （10/58） vs. 5.2%（3/58），P=0.039］ and length of ICU stay （89.4±16.2 hours vs. 74.8±12.5 hours，P=0.023） of the midnight group weresignificantly longer or higher than those of the daytime group. A total of 107 patients were followed up for 4-6 months after discharge. During follow-up，there was no late death. Among the 13 patients who required postoperative dialysis，12 patientsno longer needed regular dialysis. Conclusion Emergency operation at midnight does not increase in-hospital mortalitybut increase some postoperative morbidity in patients with Stanford type A acute aortic dissection. Whether at midnight or daytime，better preoperative preparation and surgeons’ vigor are needed for timely surgical treatment for patients with Stanford type A acute aortic dissection.
ObjectiveTo explore the difference between minimally invasive direct and conventional thoracotomy off-pump coronary artery bypass surgery (CABG). MethodsWe selected 276 patients underwent off-pump CABG surgery in our hospital from June 2005 through June 2014. There were 55 patients with minimally invasive off-pump CABG surgery and 221 patients conventional thoracotomy surgery. By using the method of peopensity score matching, we selected 55 conventional thoracotomy patients as a control group in our study. There were 41 males and 14 females at age of 60.8±10.5 years with minimally invasive off-pump CABG surgery, 44 males and 11 females at age of 60.6±12.5 years with conventional thoracotomy. ResultsThere was no statistical difference in surgery time, stay in the intensive care unit (ICU) time between conventional thoracotomy surgery and minimally invasive off-pump CABG. Compared with conventional thoracotomy surgery, minimally invasive off-pump CABG patients had statistical improvement in post-operative hospital stay time (7.3±3.1 d vs. 8.8±3.9 d, P=0.01), postoperative drainage (684(0-2 790)ml vs. 739(50-4 460)ml, P=0.03), perioperative blood transfusion (1.91(0-20)U vs. 6.62(0-20)U, P=0.00), surgery incision length (5.6±1.1 cm vs. 26.3±4.5 cm, P=0.00). ConclusionOverlooking the learning curve, minimally invasive direct off-pump CABG surgery has more advantages than conventional thoracotomy surgery. It is a safe and effective procedure.
ObjectiveTo study the direct economic burden of hospitalization in patients with carbapenem-resistant Enterobacteriaceae (CRE) infection.MethodsPatients with CRE detected in Jianyang People’s Hospital between January 2017 and June 2019 were divided into infection group and colonization group, and multiple linear regression analysis was used to analyze the confounding factors, and then propensity score matching method was used to match the confounding factors of the two groups, finally the direct economic burden of hospitalization was compared between the two groups.ResultsA total of 2 013 patients were enrolled, including 507 CRE-infected patients and 1 506 CRE-colonized patients. Multiple linear regression results showed that factors affecting the direct economic burden of hospitalization included mechanical ventilation, intravenous catheterization, blood transfusion or use of blood products, urinary intubation, tracheotomy, gender, surgery, intensive care unit stay, main diagnosis, and the type of medical insurance, together with CRE infection (P<0.05). After propensity score matching, these confounding factors were well balanced between the infection group (n=249) and the colonization group (n=249), and the differences were not statistically significant (P>0.05). The median of total hospitalization cost of CRE-infected patients was 1.29 times (15 589.23 yuan more than) that of CRE-colonized patients and the difference between the two groups was statistically significant (Z=–3.116, P=0.002). The top two types of hospitalization cost with largest differences in the medians were the cost of Western medicine (4 850.21 yuan; Z=–3.460, P=0.001) and the cost of laboratory diagnosis (2 613.00 yuan; Z=–3.529, P<0.001), respectively. The cost of antimicrobial drugs differed significantly between the two groups (Z=–3.391, P=0.001), and it was 1.54 times in patients with CRE infection what it was in patients with CRE colonization.ConclusionsThere are many factors affecting the direct economic burden of inpatients, and it is necessary to avoid the influence of confounding factors as far as possible during analysis. The economic burden of patients with CRE infection is significantly greater than that of CRE-colonized patients, so active measures should be adopted to prevent and control CRE infection.
ObjectiveTo compare the outcomes of kidney transplantation (KT) between Tibetan and Han recipients.MethodsPatients greater than 18 years old, who had received the first ABO-compatible KT between April 2006 and March 2017, were retrospectively included. A propensity score matching (PSM) of Tibetans to Hans was performed by 1∶3 ratio. Survival, renal function and adverse events of the two groups were compared.ResultsOf the 1 820 patients who fit the screening criteria, 123 Tibetans and 357 Hans were included after PSM. The median follow-up time was 48 months. There was no statistically significant difference in death-censored grafts survival (P=0.061) or patients survival (P=0.440) between the two groups. The serum creatinine was higher in Tibetans than that in Hans within one year after KT (P<0.05), and the estimated glomerular filtration rate was lower in Tibetans than that in Hans within 5 years after KT (P<0.05), but no difference thereafter (P>0.05). The incidence of delayed graft function in Tibetan patients after operation was higher than that in Han patients (4.9% vs. 1.4%, P=0.037), but there was no significant difference in the incidence of acute rejection, infection, reoperation, or cancer between the two groups (P>0.05).ConclusionTibetans receiving KT achieve excellent and comparable long-term graft and patient survival to Hans, with similar long-term graft function.
ObjectiveTo explore the clinical efficacy of fascial manipulation (FM) treatment in patients with chronic ankle instability (CAI).MethodsThe clinical data of CAI patients who received rehabilitation treatment in the Department of Rehabilitation Medicine of the Second Hospital of Jilin University from October 2018 to December 2020 were retrospectively collected. According to different treatment methods, patients were divided into balance training (BT) group and FM group. The BT group received BT for 4 weeks, while the FM group received BT for 4 weeks after FM treatment. Propensity score matching (PSM) was used for 1∶1 matching to compare the effects of different treatment options on the dysfunction of CAI patients. Foot and Ankle Ability Measure (FAAM) [including FAAM-activity of daily living (FAAM-ADL), activity of daily living (ADL) self-scoring, FAAM-sports (FAAM-S), and sports self-scoring], center of pressure (COP), foot lift test (FLT) were used to evaluate the changes in balance function and symptoms pre-treatment and post-treatment.ResultsA total of 52 patients were included, including 24 cases in FM group and 28 cases in BT group. Finally, after PSM method, 34 patients were included, 17 cases in each group. Before intervention, there was no significant difference in FAAM, COP and FLT between the two groups (P>0.05). After the intervention, FAAM-ADL, ADL self score, COP and FLT in the FM group were better than those in the BT group (P<0.05); there was no significant difference between FAAM-S and exercise self score (P>0.05). Before and after the intervention, FAAM, COP and FLT were improved in both groups (P<0.05). The improvement of FAAM ADL, ADL self-score and the decrease of COP in FM group were higher than that of the BT group (P<0.05). Comparison of FAAM-S, exercise self score and FLT before and after intervention, there was no significant difference between the two groups (P>0.05).ConclusionBT can improve the function of patients with CAI, and the combination of FM is more effective in improving the ability of daily living and static balance.
Objective To analyze the effects of hyperuricemia (HUA) on the prevalence of dyslipidemia in the elderly. MethodsA total of 5 990 elderly people with complete and important variables from the China Health and Retirement Longitudinal Study (CHARLS) public database in 2015 were extracted. Their blood lipids, related physiological and biochemical indices, and basic demographic information were collected. The effects of HUA on the prevalence of dyslipidemia in the elderly were analyzed using the probit model, and empirical analysis was performed using the propensity score matching method (PSM). Results Among the 5 990 subjects, 13.6% of the elderly had HUA and the prevalence of dyslipidemia was 37.5%. After correcting the endogeneity among variables, the probability of dyslipidemia in elderly patients with HUA increased by 9.5%-11.7% (P<0.01), in which the probability of high triglyceridemia (TG), high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL-C), and low high-density lipoprotein cholesterol (HDL-C) increased by 10.4%-11.5% (P<0.01), 2.7%-3.8% (P<0.01), 1.7%-2.3% (P<0.05), and 4.3%-4.9% (P<0.05), respectively. Conclusion HUA is associated with various types of dyslipidemia, among which its relationship with high TG and low HDL-C is strong. Targeted interventions should be taken for elderly HUA patients, aiming to reduce the rate of dyslipidemia and promote the goal of "healthy ageing" in China.
ObjectiveTo compare the effectiveness of haemocoagulase agkistrodon and tranexamic acid and sodium chloride in the prevention and treatment of perioperative bleeding in a real world setting. MethodsA research database was constructed based on the records of inpatient visits using haemocoagulase agkistrodon and tranexamic acid and sodium chloride according to the SuValue® database from January 1, 2016 to December 31, 2020. The patients were divided into two groups according to the different interventions. After matching with a 1∶1 propensity score, the effectiveness of two groups was compared. ResultsA total of 858 patients were included in each of the two groups, and there was no statistically significant difference in baseline characteristics between the two groups (P>0.05). Research results showed that patients using haemocoagulase agkistrodon had significantly reduced length of hospital stay, decrease in hematocrit, average estimated surgical bleeding, and decrease in hemoglobin (P<0.01). ConclusionHaemocoagulase agkistrodon has better effectiveness than tranexamic acid and sodium chloride for reducing perioperative blood loss based on current real world evidence.