目的 了解老年患者住院期间睡眠影响因素及质量。 方法 对2009年7月－12月入住老年科的108例患者运用匹兹保睡眠质量指数（PSQI）和自编影响睡眠因素调查表进行调查分析。 结果 92.6%的老年患者有睡眠质量问题，病情不稳定患者比病情稳定者睡眠障碍发生率高，病房温湿度、气味、夜间光线、夜间查房等环境因素和担心家事、家人朋友不关心等社会因素，夜间喝浓茶、咖啡的不良习惯对睡眠质量的影响差异有统计学意义（P＜0.05）。 结论 多数老年患者住院期间睡眠质量差，医护人员应对此予以高度重视，针对性地采取有效治疗、护理措施及健康指导方式，改善老年患者睡眠质量。
目的 调查安置永久性人工心脏起搏器的老年患者术前焦虑状况，为制订护理对策提供依据。 方法 2004年7月-2008年7月收治需安置永久性人工心脏起搏器的心脏病患者78例，术前采用焦虑自评量表（SAS）对其进行问卷调查，并采用自制一般情况问卷调查了解情况。 结果 植入永久性心脏起搏器的老年患者术前SAS得分高于国内常模（Plt;0.05）。根据自制调查问卷结果，差异有统计学意义（Plt;0.05）的项目:老年患者随年龄增长焦虑量表评分降低；丧偶者焦虑评分高于有配偶者；完全公费、部分公费、自费的焦虑量表评分依次增高；老年患者对起搏器知识了解程度越少，焦虑评分越高；无家人陪伴者比有家人陪伴者焦虑评分高。而性别、文化水平差异无统计学意义。 结论 植入永久性起搏器的老年患者术前多数存在焦虑情绪，且焦虑与年龄、婚姻、费用支付方式、有无家人陪伴、相关知识等有一定关系，医护人员应针对性地做好患者术前护理，帮助患者面对现实，以积极的心态接受手术治疗。
【摘要】 目的 探讨3分法画钟测验（clock drawing test，CDT）对阿尔茨海默病患者（Alzheimer disease，AD）与血管性痴呆患者（vascular dementia，VD）的鉴别作用。 方法 收集四川大学华西医院神经内科门诊及住院部2009年9月-2010年6月就诊的认知功能障碍患者150例，进行病史采集及神经心理测试量表，筛选出AD患者57例及VD患者43例，共计纳入100例。在两者间进行CDT，分析两者间CDT有无差别、CDT与中文版简易智能量表（Chinese version of the mini-mental state examination，MMSE）及临床痴呆评定量表（clinical dementia rating scale，CDR）的相关性。 结果 AD患者及VD患者间CDT差异无统计学意义（Pgt;0.05）；CDT与MMSE及CDR有相关性，Spearman相关系数分别为0.573和-0.542（Plt;0.001）。 结论 3分法画钟测验无法准确区分AD和VD，但对粗略判断AD及VD程度可能有一定效果。【Abstract】 Objective To investigate the differential function of the three-point scoring system for the clock drawing test (CDT) between Alzheimer’s disease (AD) and vascular dementia (VD). Methods We analyzed the clinical data of 150 patients with cognitive impairment treated in the neurology and inpatient departments of our hospital from September 2009 to July 2010. Medical history of the subjects were collected. Through the assessment by neurological and psychological rating scale, we picked out 57 patients with AD and 43 with VD and tested them with CDT. The difference of CDT results between the two groups, and the correlation of CDT with Chinese version of the mini-mental state examination (MMSE) and clinical dementia rating scale (CDR) were analyzed. Results There was no statistical difference of CDT results between AD and VD patients (Pgt;0.005). CDT had a correlations with MMSE and CDR, the Spearman correlation coefficient being 0.573 and -0.542 respectively (Plt;0.001). Conclusion The three-point scoring system for the clock drawing test cannot differentiate exactly between Alzheimer Disease and Vascular Dementia, but it can make a gross judgment of the degree of AD and VD.
Objective To overview the systematic review(SR) of efficacy and safety of fecal microbiota transplantation (FMT) in clostridium difficile infection (CDI). Methods PubMed, The Cochrane Library, EMbase, CNKI, VIP, WanFang Data databases and related website (http://scholar.google.com/) were electronically searched to collect SR and meta-analysis on FMT of CDI. The quality of collected documents and evidences were evaluated by OQAQ (Overview Quality Assessment Questionnaire) and GRADE (Grading of Recommendations Assessment, Development and Evaluation), respectively. Results Eleven SRs were included, in which 4 were completed by meta-analysis. The results of OQAQ showed that the score of one review was 2, the others SR received scores from 5 to 9. There were 9 SRs had reported the CDI clinical resolution rate (CRR), of which one SR showed CRR was 36.2%, and the others showed CRR were about 90%. Compared to upper gastrointestinal FMT, all studies showed lower gastrointestinal FMT (colonoscopy, enemas, etc.) had a higher CRR. The outcomes of selection and random fecal donor had no significant differences, and authors suggested that there should be made a standardization of donor screening table for safe fecal. Present evidence showed FMT were safety, and the majority of adverse events of FMT appeared to be mild, self-limiting and gastrointestinal in nature. The GRADE quality level of SR indicated from very low to moderate. Conclusion FMT, as a treatment for CDI, shows significant efficacy and safety, but need more high-level evidences because of its clinical translation difficulties. The study also give a reference to develop standardized clinical pathways of FMT to policy researchers.
Objective To evaluate the association between N-acetyltransferase 2 (NAT2) gene polymorphisms and the risk of antituberculosis drug-induced liver injury (ATDILI). Methods We searched the PubMed, Embase, Wanfang, China National Knowledge Internet and VIP databases to find case-control studies, with the last updated search being performed on June 2017. Odds ratio (OR) with 95% confidence interval (CI) was calculated to evaluate the strength of association. Results A total of 29 studies, involving 1 382 cases and 5 967 controls were included. The results of the Meta-analysis indicated that NAT2 slow acetylators were associated with increased risk of ATDILI compared with fast and intermediate acetylators [OR=3.08, 95%CI (2.44, 3.88), P<0.000 01]. Similar results were also found in subgroup analysis when stratified by ethnicity, isoniazid dosage and diagnostic criteria of ATDILI. Conclusion Individuals with NAT2 slow acetylators may have increased risk of ATDILI.
ObjectiveTo systematically review the association between the level of plasma YKL-40 and obstructive sleep apnea hypopnea syndrome (OSAHS).MethodsWe searched PubMed, EMbase, MEDLINE, CNKI, WanFang Data, VIP database and supplemented by Google academic retrieval to collect case-control studies about the association between the level of plasma YKL-40 and OSAHS from inception to April 2017. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. And then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 5 case-control studies were included, involving 755 OSAHS patients and control population. The results of meta-analysis showed that the level of plasma YKL-40 in OSAHS patients was higher than that in control group (SMD=1.20, 95%CI 0.33 to 2.06, P=0.007). The subgroup analysis showed that the level of plasma YKL-40 in OSAHS patients from Asia was significantly higher than that in control group (SMD=1.79, 95%CI 0.83 to 2.75, P=0.000 2). The comparison between different severity of OSAHS showed that the wild-medium group had lower plasma level of YKL-40 than the severe group (SMD=–0.83, 95%CI –1.46 to –0.19, P=0.01).ConclusionYKL-40 may play an important role in the pathogenesis of OSAHS. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusions.
Objective To compare the difference in efficacy of early precut of pancreatic duct sphincter and pancreatic duct stent placement in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) during high-risk patients. Methods A prospective study was conducted on 61 eligible patients who underwent ERCP treatment in Department of Hepatobiliary Surgery of The First Affiliated Hospital of Xi’an Jiaotong University and Xianyang Hospital of Yan’an University, from November 2016 to November 2017. All cases were randomly divided into early pancreatic sphincterotomy group (n=30) and pancreatic duct stenting group (n=31) . The success rate of intubation, intubation, and incidence of complication were compared. Results There was no significant difference in the success rate of the first intubation between the 2 groups (P=0.580), but the intubation time of the early pancreatic sphincterotomy group was shorter than that of the pancreatic duct stenting group (P=0.007). In the early pancreatic sphincterotomy group, there was 1 case of post-ERCP pancreatitis, 1 case of biliary tract infection, and 1 case of postoperative bleeding. In the pancreatic duct stenting group, there was 1 case of post-ERCP pancreatitis, and 2 cases of biliary tract infection. No severe complications such as perforation or severe acute pancreatitis occurred in both 2 groups. There was no significant difference in the incidence of total complications and specified complication (included post-ERCP pancreatitis, biliary tract infection, and postoperative bleeding) between the 2 groups (P>0.05). Conclusions Thereis no significant difference in the incidence of postoperative pancreatitis after early precut of pancreatic duct sphincter and pancreatic duct stenting placement in patients with high-risk, but intubation time of early precut of pancreatic duct sphincter method is shorter than the pancreatic duct stenting placement method.
Objective To investigate the effect of different treatment methods on the vertebral stability of osteoporotic vertebral compression fracture (OVCF) by finite element analysis. MethodsTen patients with thoracolumbar OVCF admitted between January 2020 and June 2021 were selected, 5 of whom underwent operation (operation group), 5 underwent conservative treatment (conservative treatment group). Another 5 healthy volunteers were selected as the control group. There was no significant difference in gender and age between groups (P>0.05). The operation group and the conservative treatment group received CT examination of the fractured vertebral body and adjacent segments before and after treatments, while the control group received CT examination of T12-L2. By importing CT data into Mimics 10.01 software, the finite element model was constructed. After comparing the finite element model of control group with the previous relevant literature measurement results to verify the validity, the spinal structural stress and range of motion (ROM) in each group under different conditions were measured. Results The three-dimensional finite element model was verified to be valid. There were significant differences in spinal structural stress after treatment between groups under different conditions (P<0.05). Before treatment, the ROMs of operation group and conservative treatment group under difference conditions were significantly lower than those of control group (P<0.05), and there was no difference between conservative treatment group and operation group (P>0.05). After treatment, the ROMs of the control group and the operation group were significantly higher than those of the conservative treatment group (P<0.05), and there was no significant difference between the operation group and the control group (P>0.05). Conclusion For patients with OVCF, the minimally invasive operation can achieve better results. Compared with conservative treatment, it can reduce the effect on spinal stability, and can be as a preferred treatment method, which is helpful to improve the prognosis of patients.
Objective To evaluate the prognostic values of CURB-65 score and inflammatory factors in hospitalized patients with community-acquired pneumonia (CAP). Methods A retrospective study was conducted in hospitalized adult CAP patients in West China Hospital between January 1st, and December 31th, 2013. Data of CURB-65 score and serum levels of inflammatory factors (WBC, ESR, PCT, CRP, IL-6 and ALB) on admission and clinical outcomes were collected. The associations between CURB-65 score, inflammatory factors and clinical outcomes were examined. Logistic regression analysis was performed to develop combined models to predict in-hospital death of CAP patients, and ROC analysis was conducted to measure and compare the prognostic values of CURB-65 score, inflammatory factors or combined models. Results A total of 505 hospitalized CAP patients were included. 81 patients died during the hospitalization and the in-hospital mortality rate was 16.0%. Possible risk factors of in-hospital death included old age, male sex, hypertension, cardiovascular or cerebrovascular diseases, multi-lobular pneumonic infiltration, high risk scores, ICU admission, mechanical ventilation and severe pneumonia (all P values<0.05). Logistic regression analysis showed that CURB-65 score, ALB and IL-6 were the independent factors in predicting in-hospital death of CAP patients and the area under curve (AUC) of them while predicting in-hospital death were 0.75 (95%CI 0.69 to 0.81), 0.75 (95%CI 0.69 to 0.81) and 0.75 (95%CI 0.69 to 0.80), respectively. ROC analysis found that ALB and IL-6 could improve the AUC of CURB-65 score significantly while predicting the in-hospital death (P<0.05). When ALB and IL-6 were added to the CURB-65 score simultaneously, the AUC was improved to 0.84 (95%CI 0.80 to 0.87). When IL-6 or ALB was added to the CURB-65 score to form a new scale, the AUC of the new scale was significantly higher than that of the CURB-65 score in predicting in-hospital death (P<0.001). Conclusion The prognostic values of CURB-65 score and inflammatory factors may be not ideal when they are used alone in hospitalized CAP patients. IL-6 and ALB may significantly improve the prognostic value of CURB-65 score in predicting in-hospital death.
ObjectivesTo systematically review the prevalence of methicillin-resistant staphylococcus aureus (MRSA) in healthy Chinese population.MethodsPubMed, EMbase, WanFang Data and CNKI databases were electronically searched to collect cross-sectional studies of the prevalence of MRSA in China from inception to December 16th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, and then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 25 cross-sectional studies were included. The results of meta-analysis showed that: the pooled prevalence of MRSA in healthy population was 13.9% (95%CI 9.6% to 18.2%). The results of subgroup analysis showed that: the prevalence of MRSA in children was 16% (95%CI 8% to 24%), and that in adults (non-children) was 13% (95%CI 9% to 16%). The prevalence of MRSA in individuals with occupational livestock exposure was 28% (95%CI 5% to 51%), in medical staff it was 16% (95%CI 8% to 25%), in medical students it was 12% (95%CI 3% to 20%) and in community residents it was 5% (95%CI 2% to 8%).ConclusionsThe overall prevalence of MRSA in healthy Chinese population is approximately 13.9%. Effective prevention and control measures are required to reduce the spread of MRSA.