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Radical prostatectomy in patients aged 75 years or older:review of the literature
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作者 Philipp Mandel Thenappan Chandrasekar +2 位作者 Felix K Chun Hartwig Huland Derya Tilki 《亚洲男性学杂志:英文版》 SCIE CAS CSCD 2019年第1期32-36,共5页
Given the demographic trends toward a considerably longer life expectancy,the percentage of elderly patients with prostate cancer will increase further in the upcoming decades.Therefore,the question arises,should pati... Given the demographic trends toward a considerably longer life expectancy,the percentage of elderly patients with prostate cancer will increase further in the upcoming decades.Therefore,the question arises,should patients ≥75 years old be offered radical prostatectomy and under which circumstances? For treatment decision-making,life expectancy is more important than biological age.As a result,a patient's health and mental status has to be determined and radical treatment should only be offered to those who are fit.As perioperative morbidity and mortality in these patients is increased relative to younger patients,patient selection according to comorbidities is a key issue that needs to be addressed.It is known from the literature that elderly men show notably worse tumor characteristics,leading to worse oncologic outcomes after treatment.Moreover,elderly patients also demonstrate worse postoperative recovery of continence and erectile function.As the absolute rates of both oncological and functional outcomes are still very reasonable in patients ≥75 years,a radical prostatectomy can be offered to highly selected and healthy elderly patients. Nevertheless,patients clearly need to be informed about the worse outcomes and higher perioperative risks compared to younger patients. 展开更多
关键词 age FUNCTIONAL OUTCOME oncological OUTCOME PROSTATE cancer RADICAL prostatectomy
Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation myocardial infarction
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作者 Jin Si Xue-Wen Li +6 位作者 Yang Wang Ying-Hua Zhang Qing-Qing Wu Lei-Min Zhang Xue-Bing Zuo Jing Gao Jing Li 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第9期1028-1036,共9页
Background:The mortality of cardiovascular disease is constantly rising,and novel biomarkers help us predict residual risk.This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on progno... Background:The mortality of cardiovascular disease is constantly rising,and novel biomarkers help us predict residual risk.This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (STEMI).Methods:The 419 consecutive patients with STEMI,treated at one medical center,from March 2010 to December 2015 were retrospectively investigated.Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay.The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups.Short- and long-term outcomes were compared,as were age-based subgroups (patients aged 60 years and younger vs.those older than 60 years).Statistical analyses were mainly conducted by Student t-test,Chi-squared test,logistic regression,and Cox proportional-hazards regression.Results:The H-HCY group had more males (84.6% vs.75.4%,P=0.018),and a lower prevalence of diabetes (20.2% vs.35.5%,P<0.001),compared with the L-HCY group.During hospitalization,there were seven mortalities in the L-HCY group and 10 in the H-HCY group (3.3% vs.4.8%,P= 0.440).During the median follow-up period of 35.8 (26.9–46.1) months,33 (16.2%) patients in the L-HCY group and 48 (24.2%) in the H-HCY group experienced major adverse cardiovascular and cerebrovascular events (MACCE)(P=0.120).History of hypertension (hazard ratio [HR]:1.881,95% confidence interval [CI]:1.178–3.005,P=0.008) and higher Killip class (HR:1.923,95% CI:1.419–2.607,P<0.001),but not HCY levels (HR:1.007,95% CI:0.987–1.027,P=0.507),were significantly associated with long-term outcomes.However,the subgroup analysis indicated that in older patients,HCY levels were significantly associated with long-term outcomes (HR:1.036,95% CI:1.011–1.062,P=0.005).Conclusion:Serum HCY levels did not independently predict in-hospital or long-term outcomes in patients with STEMI;however,among elderly patients with STEMI,this study reveal 展开更多
关键词 HOMOCYSTEINE Acute ST-SEGMENT ELEVATION myocardial INFARCTION PERCUTANEOUS coronary INTERVENTION Clinical outcome
Comparing the effects of depression,anxiety,and comorbidity on quality-of-life,adverse outcomes,and medical expenditure in Chinese patients with acute coronary syndrome
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作者 Kun Xia Le-Feng Wang +5 位作者 Xin-Chun Yang Hong-Yan Jiang Li-Jing Zhang Dao-Kuo Yao Da-Yi Hu Rong-Jing Ding 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第9期1045-1052,共8页
Background:Depression and anxiety have been correlated with elevated risks for quality-of-life (QOL),adverse outcomes,and medical expenditure in patients with acute coronary syndrome (ACS).However,the relevant data ar... Background:Depression and anxiety have been correlated with elevated risks for quality-of-life (QOL),adverse outcomes,and medical expenditure in patients with acute coronary syndrome (ACS).However,the relevant data are lacking for Chinese ACS populations,especially regarding different effects of major depression,anxiety,and comorbidity.The objective of this study was to evaluate the dynamic changes of depression and/or anxiety over 12 months and examine the effects of depression,anxiety,and comorbidity on QOL,adverse outcomes,and medical expenditure in Chinese patients with ACS.Methods:For this prospective longitudinal study,a total of 647 patients with ACS were recruited from North China between January 2013 and June 2015.Among them,531 patients (82.1%) completed 12-month follow-ups.Logistic regression model was utilized for analyzing the association of baseline major depression,anxiety,and comorbidity with 12-month all-cause mortality,cardiovascular events,QOL,and health expenditure.Results:During a follow-up period of 12 months,7.3% experienced non-fatal myocardial infarction (MI) and 35.8% cardiac rehospitalization.Baseline comorbidity,rather than major depression/anxiety,strongly predicted poor 12-month QOL as measured by short-form health survey-12 (odds ratio [OR]:1.77,95% confidence interval [CI]:1.22–2.52,P = 0.003).Regarding 12-month non-fatal MI and cardiac re-hospitalization,baseline anxiety (OR:2.83,95% CI:1.33–5.89,P<0.01;OR:4.47,95% CI:1.50–13.00,P<0.01),major depression (OR:2.58,95% CI:1.02–6.15,P<0.05;OR:5.22,95% CI:1.42–17.57,P<0.03),and comorbidity (OR:6.33,95% CI:2.96–13.79,P<0.0001,OR:14.08,95% CI:4.99–41.66,P<0.0001) were all independent predictors,and comorbidity had the highest predictive value.Number of re-hospitalization stay,admission frequency within 12 months and medical expenditure within 2 months were the highest in patients with ACS with comorbidity.Conclusions:Major depression and anxiety may predict 12-month non-fatal MI and cardiac re-hospitalization.However,comorb 展开更多
关键词 Acute CORONARY syndrome Major DEPRESSION ANXIETY COMORBIDITY ADVERSE outcome
妊娠合并梅毒192例患者妊娠结局和子代随访研究 预览
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作者 陈艳 韩国荣 +1 位作者 王根菊 王翠敏 《东南国防医药》 2019年第4期348-351,共4页
目的探讨妊娠期合并梅毒螺旋体感染的患者在妊娠期间进行规范驱梅治疗对妊娠结局及新生儿血清学转归的影响。方法回顾性分析2009年1月至2014年2月在南京中医药大学附属南京医院妇产科收治的192例妊娠合并梅毒螺旋体感染孕妇的临床资料,... 目的探讨妊娠期合并梅毒螺旋体感染的患者在妊娠期间进行规范驱梅治疗对妊娠结局及新生儿血清学转归的影响。方法回顾性分析2009年1月至2014年2月在南京中医药大学附属南京医院妇产科收治的192例妊娠合并梅毒螺旋体感染孕妇的临床资料,所有患者经梅毒快速血浆反应试验(RPR)和梅毒螺旋体颗粒凝集试验(TPPA)筛查,根据孕妇孕期是否接受规范驱梅治疗,分为治疗组162例和未治疗组30例,对所有活产新生儿完成12个月的血清学RPR跟踪随访,比较妊娠期规范驱梅治疗对妊娠结局和分娩新生儿血清RPR转阴率的影响。结果治疗组与未治疗组孕母足月活产率(91.4%vs40.0%)、死胎死产率(0.6%vs10.0%)、畸形引产率(1.2%vs16.7%)、子代先天性梅毒率(0.6%vs13.3%)组间比较差异均有统计学意义(P<0.05)。治疗组与未治疗组子代血清RPR累积转阴率在9个月(96.2%vs75.0%)和12个月(97.4%vs80.0%)差异均有统计学意义(P<0.01)。结论妊娠期梅毒螺旋体的筛查及规范驱梅治疗能显著降低妊娠不良结局的发生,降低子代感染先天梅毒的风险,其影响可持续至出生后12个月。 展开更多
关键词 妊娠合并梅毒感染 驱梅治疗 结局 新生儿
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脑卒中延续性照护效果评价指标研究进展 被引量:1
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作者 赵庆 施雁 《中国护理管理》 CSCD 北大核心 2019年第1期108-112,共5页
从过程评价指标和结果评价指标两个方面对脑卒中延续性照护效果评价指标的相关研究进行综述。过程评价指标包括信息的延续性、管理的延续性和关系的延续性。结果评价指标包括患者的临床结局、医疗卫生资源利用率和患者满意度。提出了研... 从过程评价指标和结果评价指标两个方面对脑卒中延续性照护效果评价指标的相关研究进行综述。过程评价指标包括信息的延续性、管理的延续性和关系的延续性。结果评价指标包括患者的临床结局、医疗卫生资源利用率和患者满意度。提出了研究的不足和未来的研究方向,以期为今后构建统一、规范的脑卒中延续性照护效果评价指标提供参考。 展开更多
关键词 脑卒中 延续性照护 效果 指标 综述
平时火器伤的流行病学特征及救治 预览
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作者 陈海萍 俞文雅 +1 位作者 刘威 张鹭鹭 《解放军医院管理杂志》 2019年第1期5-8,20共5页
目的 分析平时火器伤的流行病学特征及救治特点,为医务人员改善火器伤的医疗救治水平提供科学性建议。方法 通过调查15例平时火器伤患者的病历数据,利用描述性统计方法进行分析。结果 平时火器伤中男女比例为6.5∶1,高发人群为35~44岁和... 目的 分析平时火器伤的流行病学特征及救治特点,为医务人员改善火器伤的医疗救治水平提供科学性建议。方法 通过调查15例平时火器伤患者的病历数据,利用描述性统计方法进行分析。结果 平时火器伤中男女比例为6.5∶1,高发人群为35~44岁和15~24岁。头部是最常见的伤部,异物存留的发生比例为46.7%。火器伤患者中皮肤软组织损伤的发生率为100.0%,骨折和骨关节损伤以及中枢神经系统损伤的发生比例分别为40.0%和13.0%。火器伤患者中重伤和危重伤所占比例分别为6.7%和13.3%。患者院前时间和住院天数普遍较长,53.3%的患者治愈出院。结论 火器伤的防控和救治时应综合考虑人口学特征、受伤特征和创伤救治因素,关注头部创伤和多发伤救护,缩短院前时间,早期预测和防治失血性休克和意识障碍等并发症。 展开更多
关键词 平时火器伤 流行病学特征 救治 转归
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Comparative outcomes of subcutaneous and transvenous cardioverter-defibrillators
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作者 Jin-Jun Liang Hideo Okamura +11 位作者 Roshini Asirvatham Andrew Schneider David O. Hodge Mei Yang Xu-Ping Li Ming-Yan Dai Ying Tian Pei Zhang Bryan C. Cannon Cong-Xin Huang Paul A. Friedman Yong-Mei Cha 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第6期631-637,共7页
Background: The comparative outcomes of subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous (T-ICD) have not been well studied. The aim of this study was to evaluate the safety and efficacy of ... Background: The comparative outcomes of subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous (T-ICD) have not been well studied. The aim of this study was to evaluate the safety and efficacy of currently available S-ICD and T-ICD. Methods: The study included 86 patients who received an S-ICD and 1:1 matched to those who received single-chamber T-ICD by gender, age, diagnosis, left ventricular ejection fraction (LVEF), and implant year. The clinical outcomes and implant complications were compared between the two groups. Results: The mean age of the 172 patients was 45 years, and 129 (75%) were male. The most common cardiac condition was hypertrophic cardiomyopathy (HCM, 37.8%). The mean LVEF was 50%. At a mean follow-up of 23 months, the appropriate and inappropriate ICD therapy rate were 1.2% vs. 4.7%(X^2= 1.854, P=0.368) and 9.3% vs. 3.5%(X^2 = 2.428, P = 0.211) in S-ICD and T-ICD groups respectively. There were no significant differences in device-related major and minor complications between the two groups (7.0% vs. 3.5%, X^2 = 1.055, P = 0.496). The S-ICD group had higher T-wave oversensing than T-ICD group (9.3% vs. 0%, X^2 = 8.390, P=0.007). Sixty-five patients had HCM (32 in S-ICD and 33 in T-ICD). The incidence of major complications was not significantly different between the two groups. Conclusions: The efficacy of an S-ICD is comparable to that of T-ICD, especially in a dominantly HCM patient population. The S-ICD is assodated with fewer major complications demanding reoperation. 展开更多
关键词 HYPERTROPHIC CARDIOMYOPATHY IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR Outcome SUBCUTANEOUS IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR
Prevention of macrovascular complications in patients with type 2 diabetes mellitus: Review of cardiovascular safety and efficacy of newer diabetes medications 预览
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作者 Ravi Kant Kashif M Munir +1 位作者 Arshpreet Kaur Vipin Verma 《世界糖尿病杂志:英文版(电子版)》 2019年第6期324-332,共9页
Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized cont... Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors. 展开更多
关键词 Newer antidiabetic MEDICATIONS Glucagon-like peptide-1 receptor agonist Sodium-glucose cotransporter-2 inhibitors Type 2 DIABETES MELLITUS Macrovascular complications CARDIOVASCULAR outcome trials Major CARDIOVASCULAR events HEART failure PREVENTION of HEART disease
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Eosinopenia is a predictive factor for the severity of acute ischemic stroke 预览
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作者 Hui-Min Zhao Wen-Qian Qin +1 位作者 Pei-Ji Wang Zhong-Min Wen 《中国神经再生研究:英文版》 SCIE CAS CSCD 2019年第10期1772-1779,共8页
Previous data have revealed an association between eosinopenia and mortality of acute ischemic stroke.However,the relationship of eosinopenia with infarct volume,infection rate,and poor outcome of acute ischemic strok... Previous data have revealed an association between eosinopenia and mortality of acute ischemic stroke.However,the relationship of eosinopenia with infarct volume,infection rate,and poor outcome of acute ischemic stroke is still unknown.The retrospective study included 421 patients(273 males,65%;mean age,68.0± 13.0 years)with first acute ischemic stroke who were hospitalized in the Second Affiliated Hospital of Soochow University,China,from January 2017 to February 2018.Laboratory data,neuroimaging results,and modified Rankin Scale scores were collected.Patients were divided into four groups according to their eosinophil percentage level(<0.4%,0.4-1.1%,1 1-2.3%,≥2.3%).Spearman’s correlation analysis showed that the percentage of eosinophils was negatively correlated with infarct volume(rs=-0.514,P<0.001).Receiver operating characteristic analysis demonstrated that eosinopenia predicted a large infarct volume more accurately than neutrophilia;the area under curve was 0.906 and 0.876,respectively;a large infarct was considered as that with a diameter larger than 3 cm and involving more than two major arterial blood supply areas.Logistic regression analysis revealed that eosinophil percentage was an independent risk factor for acute ischemic stroke(P=0.002).Moreover,eosinophil percentage was significantly associated with large infarct volume,high infection rate(pulmonary and urinary tract infections),and poor outcome(modified Rankin Scale score>3)after adjusting for potential confounding factors(P-trend<0.001).These findings suggest that eosinopenia has the potential to predict the severity of acute ischemic stroke.This study was approved by the Ethics Committee of the Second Affiliated Hospital of Soochow University,China(approval number:K10)on November 10,2015. 展开更多
关键词 nerve REGENERATION eosinopenia EOSINOPHIL ISCHEMIA stroke INFARCT volume infection clinical outcome neutrophilia risk factors PREDICTIVE factor neural REGENERATION
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两种微创手术方式治疗颈段食管癌的对比研究 预览
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作者 张葆勋 于磊 +4 位作者 伍冀湘 陈晓红 于涛 余振 柯冀 《中国医刊》 CAS 2019年第5期516-520,共5页
目的通过对比新辅助化疗后行无气腹腹腔镜下食管内翻拔脱手术(laparoscopic transhiatal esophagectomy,LTE)和胸、腹腔镜联合食管癌根治手术(combined thoracoscopic and laparoscopic esophagectomy,CTLE)后患者的总生存期、无病生存... 目的通过对比新辅助化疗后行无气腹腹腔镜下食管内翻拔脱手术(laparoscopic transhiatal esophagectomy,LTE)和胸、腹腔镜联合食管癌根治手术(combined thoracoscopic and laparoscopic esophagectomy,CTLE)后患者的总生存期、无病生存期、术后咽喉反流发生率及术后并发症发生率,探讨LTE在颈段食管癌治疗中的价值。方法回顾性分析2009年10月至2014年12月在北京同仁医院行微创手术治疗的83例颈段食管癌患者的临床资料,其中27例行LTE,56例行CTLE。结果两组均无手术相关死亡和中转开腹、开胸。与CTLE相比,LTE术中出血量较少,手术时间较短,差异有显著性(P<0.05)。两组患者中位总生存期、无病生存期差异无显著性(P>0.05)。术后1年24h食管pH监测和食管测压显示LTE组咽喉反流较CTLE组轻(P<0.05)。两组术后肺部感染发生率差异无显著性(P>0.05)。结论与CTLE相比,LTE治疗颈段食管癌更为安全、有效。 展开更多
关键词 颈段食管癌 微创手术 食管内翻拔脱术 疗效 咽喉反流
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现场非正式学习的内涵、测量及形成与作用机制研究
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作者 仲理峰 马玉 白利勇 《中国人力资源开发》 CSSCI 北大核心 2019年第7期6-23,共18页
现场非正式学习是一种非正式的、刻意的、以自我为导向的学习行为。作为工作场所中的一种自主学习形式,现场非正式学习不仅有利于员工自觉自愿地积累实际工作经验、提升与企业工作需要相契合的具体工作技能和技巧,还有助于提高工作绩效... 现场非正式学习是一种非正式的、刻意的、以自我为导向的学习行为。作为工作场所中的一种自主学习形式,现场非正式学习不仅有利于员工自觉自愿地积累实际工作经验、提升与企业工作需要相契合的具体工作技能和技巧,还有助于提高工作绩效、创新能力和组织承诺。本文首先通过梳理现场非正式学习的相关文献,阐述了现场非正式学习的概念、测量、影响因素与作用。然后,基于自我决定理论、扩展-建构理论和社会认知理论,论述了影响现场非正式学习的三个潜在心理机制,即:自主动机、积极情绪和自我效能感,并构建了现场非正式学习的整合模型。最后,在以上分析基础上,对现场非正式学习的未来研究提出了几点建议。 展开更多
关键词 非正式学习 现场非正式学习 形成机制 结果
Learning curve of enhanced recovery after surgery program in open colorectal surgery 预览
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作者 Varut Lohsiriwat 《世界胃肠外科杂志:英文版(电子版)》 2019年第3期169-178,共10页
BACKGROUND Enhanced recovery after surgery (ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients’ outcomes is unknown. AI... BACKGROUND Enhanced recovery after surgery (ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients’ outcomes is unknown. AIM To evaluate and establish a learning curve of ERAS program for open colorectal surgery. METHODS This was a review of prospectively collected database of 380 “unselected” patients undergoing elective “open” colectomy and/or proctectomy under ERAS protocol from 2011 (commencing ERAS application) to 2017 in a university hospital. Patients were divided into 5 chronological groups (76 cases per quintile). Surgical outcomes and ERAS compliance among quintiles were compared. Learning curves were calculated based on criteria of optimal recovery: defined as absence of major postoperative complications, discharge by postoperative day 5, and no 30-d readmission. RESULTS Hospitalization more than 5 d occurred in 22.6%(n = 86), major complication was present in 2.9%(n = 11) and 30-d readmission rate was 2.4%(n = 9) accounting for unsuccessful recovery of 25%(n = 95). Conversely, the overall rate of optimal recovery was 75%. The optimal recovery significantly increased from 57.9% in 1st quintile to 72.4%-85.5% in the following quintiles (P < 0.001). Average compliance with ERAS protocol gradually increased over the time - from 68.6% in 1st quintile to 75.5% in 5th quintile (P < 0.001). The application of preoperative counseling, nutrition support, goal-directed fluid therapy, O-ring wound protector and scheduled mobilization significantly increased over the study period.CONCLUSION A number of 76 colorectal operations are required for a multidisciplinary team to achieve a significantly higher rate of optimal recovery and high compliance with ERAS program for open colorectal surgery. 展开更多
关键词 Enhanced recovery after SURGERY ERAS COLON RECTUM SURGERY Learning curve OUTCOME COMPLIANCE
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Evaluation of age, weaning weight, body condition score, and reproductive tract score in pre-selected beef heifers relative to reproductive potential 预览
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作者 Sarah E.Dickinson Michelle F.Elmore +5 位作者 Lisa Kriese-ANDerson Joshua B.Elmore Bailey N.Walker Paul W.Dyce Soren P.Rodning Fernando H.Biase 《畜牧与生物技术杂志:英文版》 SCIE CAS CSCD 2019年第2期307-313,共7页
Background: Artificial insemination is a preferred breeding method for beef heifers as it advances the genetic background, produces a predictive and profitable calving season, and extends the heifer’s reproductive li... Background: Artificial insemination is a preferred breeding method for beef heifers as it advances the genetic background, produces a predictive and profitable calving season, and extends the heifer’s reproductive life span.As reproductive efficiency in heifers is key for the success of beef cattle production systems, following artificial insemination, heifers are exposed to a bull for the remainder of the breeding season. Altogether, up to 95% of heifers might become pregnant in their first breeding season. Heifers that do not become pregnant at the end of the breeding season represent an irreparable economical loss. Additionally, heifers conceiving late in the breeding season to natural service, although acceptable, poses serious losses to producers. To minimize losses due to reproductive failure, different phenotypic parameters can be assessed and utilized as selection tools. Here, we tested the hypothesis that in a group of pre-selected heifers, records of weaning weight, age at weaning, age at artificial insemination, and age of dam differ among heifers of varied reproductive outcomes during the first breeding season.Results: None of the parameters tested presented predictive ability to discriminate the heifers based on the response variable(‘pregnant to artificial insemination’, ‘pregnant to natural service’, ‘not pregnant’). Heifers categorized with body condition score = 6 and reproductive tract score ≥ 4 had the greatest proportion of pregnancy to artificial insemination(49% and 44%, respectively). Furthermore, it was notable that heifers presenting body condition score = 6 and reproductive tract score = 5 presented the greatest pregnancy rate at end of the breeding season(89%). Heifers younger than 368 d at the start of the breeding season did not become pregnant to artificial insemination. Those young heifers had 12.5% chance to become pregnant in their first breeding season,compared to 87.5% if the heifers were older than 368 days.Conclusion: Our results suggest that beef heifers with 展开更多
关键词 FERTILITY PHENOTYPIC selection PREGNANCY OUTCOME REPLACEMENT heifer
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Long-term outcomes after fractional flow reserve-guided percutaneous coronary intervention in patients with severe coronary stenosis 预览
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作者 Ying-Hua ZHANG Jing LI +9 位作者 Andreas J. Flammer Yoshiki Matsuo Moo-Sik Lee Ryan J. Lennon Malcolm R. Bell David R. Holmes John F. Bresnahan Charanjit S. Rihal Lilach O. Lerman Amir Lerman 《老年心脏病学杂志:英文版》 SCIE CAS CSCD 2019年第4期329-337,共9页
Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (... Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (FFR) assessment from 2002 to 2009,we identified 167 patients in whom FFR was measured in at least one 70%–89% stenotic lesion. These patients were subdivided into an FFR-defer group (n = 49) if PCI was deferred (FFR > 0.80),and an FFR-perform group (n = 118) if PCI was performed (FFR ≤ 0.80). Comparatively,an additional 1176 patients undergoing PCI in at least one lesion with 70%–89% stenosis but without measurement of FFR served as a control (angiography- guided) group. Clinical outcomes were compared during a median follow-up of 49.0 months. The 5-year Kaplan-Meier estimated revascularization rates were 16% in the FFR-defer group and 33% in the FFR-perform group (P = 0.046). The incidence of major adverse cardiac events were comparable in these two groups (HR = 0.82,95% CI: 0.37–1.82,P = 0.63). The number of stents placed was significantly lower in the FFR-guided group (0.9 ± 0.8 vs. 1.4 ± 0.8,P < 0.001). Conclusions Functional revascularization for lesions with visually severe stenosis is clinically safe and associated with fewer stents use. This study suggests that extending the use of FFR to more severe coronary lesions may be reasonable. 展开更多
关键词 Fractional flow reserve Outcome PERCUTANEOUS coronary INTERVENTION SEVERE STENOSIS STENT
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Clinical outcome after orbital floor fracture reduction with special regard to patient's satisfaction
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作者 Stefan Hartwig Marie-Christine Nissen +4 位作者 Jan Oliver Voss Christian Doll Nicolai Adolphs Max Heiland Jan Dirk Raguse 《中华创伤杂志:英文版》 CAS CSCD 2019年第3期155-160,共6页
Purpose: Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures. The aim of this study was to compare the findings of specific ophthalmologic assessment wi... Purpose: Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures. The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient's complaints after fracture reduction. Methods: A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil (ethisorb sheet or polydioxanone foil). A follow-up assessment including ophthalmological evaluation regarding visual acuity (eye chart projector), binocular visual field screening (Bagolini striated glasses test) and diplopia (cover test, Hess screen test) was conducted. Additionally, a questionnaire was performed to assess patients' satisfaction. Results: A total of 53 patients with a mean follow-up of 23 months (ranging from 11 to 72) after surgical therapy were included. Diplopia was present preoperatively in 23 (43.4%) and reduced in follow-up examination (n = 12, 22.6%). Limitations in ocular motility reduced from 37.7% to 7.5%. The questionnaire about the patient's satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters. Conclusion: Transconjunctival approach is a safe approach for orbital fracture therapy. Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment. 展开更多
关键词 ORBITAL FLOOR FRACTURES BLOW out FRACTURES Transconjunctival approach Clinical OUTCOME
儿童供者骨髓和外周血混合移植物组分对单倍型相合移植预后的影响
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作者 曹乐清 王昱 +15 位作者 许兰平 张晓辉 陈欢 陈育红 韩伟 闫晨华 莫晓冬 付海霞 张圆圆 王峰蓉 唐菲菲 韩婷婷 刘艳荣 刘开彦 黄晓军 常英军 《现代免疫学》 CAS CSCD 北大核心 2019年第2期103-109,154共8页
为探讨儿童供者移植物组分对单倍型相合造血干细胞移植(haploidentical hematopoietic stem cell transplantation,Haplo-HSCT)预后的影响,回顾性分析儿童供者骨髓(bone marrow, BM)和外周血(peripheral blood, PB)混合移植物组分对80... 为探讨儿童供者移植物组分对单倍型相合造血干细胞移植(haploidentical hematopoietic stem cell transplantation,Haplo-HSCT)预后的影响,回顾性分析儿童供者骨髓(bone marrow, BM)和外周血(peripheral blood, PB)混合移植物组分对80例接受Haplo-HSCT的血液病患者预后的影响。80例患者中性粒细胞和血小板(platelet, PLT)的植入率分别为100%和96.4%,中位植入时间分别为13 d(范围为10~28 d)和18 d(范围为9~180 d)。所有患者随访3年的总生存(overall survival, OS)率为66.7%,无白血病生存(leukemia-free survival, LFS)率为60.7%,移植相关死亡(transplant-related mortality, TRM)率为17.7%,复发率为21.9%。多因素分析显示供/受者关系为同胞(P=0.02)和输注高剂量CD34~+细胞(P=0.014)能促进PLT植入,PLT植入(P<0.001)和输注低剂量的CD14~+细胞(P=0.022)与LFS相关,PLT植入和发生慢性GVHD与OS(P<0.001,P=0.03)和TRM(P<0.001,P=0.004)相关。以上研究结果提示采用单倍型相合儿童供者来源的BM和PB混合移植物进行移植时,回输高剂量CD34~+细胞与促进PLT植入密切相关,而PLT快速植入与良好生存有关。 展开更多
关键词 单倍型相合造血干细胞移植 儿童供者 移植物组分 预后
Clinical characteristics and management of patients with fat embolism syndrome in level I Apex Trauma Centre
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作者 Richa Aggarwal Arnab Banerjee +2 位作者 Kapil dev Soni Atin Kumar Anjan Trikha 《中华创伤杂志:英文版》 CAS CSCD 2019年第3期172-176,共5页
Purpose: Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports ... Purpose: Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports and series describing FES. Here we describe the clinical characteristics, management in ICU and outcome of these patients in level I trauma center in a span of 6 months. Methods: In this prospective study, analysis of all the patients with FES admitted in our polytrauma intensive care unit (ICU) of level I trauma center over a period of 6 months (from August 2017 to January 2018) was done. Demographic data, clinical features, management in ICU and outcome were analyzed. Results: We admitted 10 cases of FES. The mean age of patients was 31.2 years. The mean duration from time of injury to onset of symptoms was 56 h. All patients presented with hypoxemia and petechiae but central nervous system symptoms were present in 70% of patients. The mean duration of mechanical ventilation was 11.7 days and the mean length of ICU stay was 14.7 days. There was excellent recovery among patients with no neurological deficit. Conclusion: FES is considered a lethal complication of trauma but timely management can result in favorable outcome. FES can occur even after fixation of the fracture. Hypoxia is the most common and earliest feature of FES followed by CNS manifestations. Any patient presenting with such symptoms should raise the suspicion of FES and mandate early ICU referral. 展开更多
关键词 Fat EMBOLISM TRAUMA CENTERS INTENSIVE care units Patient outcome assessment
丁苯酞联合阿替普酶治疗缺血性卒中临床疗效的观察性研究 预览
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作者 侯园园 梁志刚 +3 位作者 孙旭文 杨绍婉 李冰 胡银宝 《中国卒中杂志》 2019年第3期225-230,共6页
目的探讨丁苯酞联合阿替普酶静脉溶栓治疗缺血性卒中的临床疗效及安全性。方法回顾性分析青岛大学附属烟台毓璜顶医院急性缺血性卒中行静脉溶栓患者205例的队列,其中联合治疗组(阿替普酶+丁苯酞组)112例,阿替普酶组93例。分析两组患者... 目的探讨丁苯酞联合阿替普酶静脉溶栓治疗缺血性卒中的临床疗效及安全性。方法回顾性分析青岛大学附属烟台毓璜顶医院急性缺血性卒中行静脉溶栓患者205例的队列,其中联合治疗组(阿替普酶+丁苯酞组)112例,阿替普酶组93例。分析两组患者溶栓后即刻及14 d后NIHSS评分,90 d的mRS评分,并分析不同急性卒中治疗低分子肝素试验(Trial of Org 10 172 in AcuteStroke Treatment,TOAST)分型中的临床疗效。同时分析溶栓后14 d症状性颅内出血及死亡情况。结果①溶栓后两组NIHSS评分差异无统计学意义。溶栓后14 d联合治疗组NIHSS评分低于阿替普酶组,差异有统计学意义[(4.82±0.44)分vs(6.40±0.66)分,P=0.041]。联合治疗组90 d预后良好率高于阿替普酶组,差异有统计学意义(72.3%vs 55.9%,P=0.014);其中LAA亚型中联合治疗组患者NI HSS评分(P=0.023)及预后良好率(P=0.045)均高于阿替普酶组,差异有统计学意义。②治疗后90 d两组死亡率及14 d颅内出血率差异无统计学意义。③多因素回归分析结果显示丁苯酞是改善缺血性卒中溶栓患者预后的保护因素(OR 0.425,95%CI 0.216~0.835,P=0.013);年龄>60岁(OR2.233,95%CI 1.047~4.766,P=0.038)、入院时收缩压>160 mm Hg(OR 2.295,95%CI 1.126~4.679,P=0.022)、溶栓前NIHSS评分>10分(OR 9.354,95%CI 4.049~21.610,P<0.001)是预后的独立危险因素。结论丁苯酞联合阿替普酶静脉溶栓治疗缺血性卒中患者能改善90 d临床预后,对LAA患者可能更有效。 展开更多
关键词 缺血性卒中 溶栓 预后 出血转化 丁苯酞
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HIV抗体不确定带型与临床转归的研究
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作者 冯霞 娄金丽 +3 位作者 刘翠娥 刘意 马红丽 李健维 《北京医学》 CAS 2019年第6期448-450,454共4页
目的探讨免疫印迹法(Western blots, WB)检测HIV抗体不确定带型的转归及其与疾病分期的规律,为HIV感染的实验室诊断提供线索。方法回顾性分析2015年9月至2017年12月首都医科大学附属北京佑安医院艾滋病确证实验室131例首次HIV抗体WB检... 目的探讨免疫印迹法(Western blots, WB)检测HIV抗体不确定带型的转归及其与疾病分期的规律,为HIV感染的实验室诊断提供线索。方法回顾性分析2015年9月至2017年12月首都医科大学附属北京佑安医院艾滋病确证实验室131例首次HIV抗体WB检测结果为不确定的病例的临床资料,分析不同带型的临床转归,及其与初筛S/CO值、CD4~+ T细胞计数以及临床分期之间的关系。结果 WB不确定带型共10种,按条带个数分为1条带、2条带和3条带3种类型,其HIV阳转率差异有统计学意义(χ~2=30.31,P=0.00);WB不确定病按例临床转归结果分为阳性和阴性,两者初筛S/CO值分别为30.70±28.39和2.82±5.74(F=25.81,P=0.00),CD4~+ T细胞计数分别为(328.83±250.63)个/μl和(569.92±143.06)个/μl,差异均有统计学意义(F=4.75,P=0.03);将阳转病例分为急性期组和艾滋病期组,急性期组的不确定带型为p17、p24、gp160、p51p66、p24gp160、p17p24gp160,艾滋病期组带型为gp120gp160和gp41gp120gp160,两组初筛S/CO值和CD4~+ T细胞计数差异均有统计学意义(P <0.05),两组HIV-1 RNA定量差异无统计学意义(P> 0.05)。结论 WB不确定带型随条带数增加,阳转率增高,结合初筛S/CO比值和CD4~+ T细胞计数,根据WB不确定带型可判断其临床转归和分期。 展开更多
关键词 人类免疫缺陷病毒 免疫印迹实验 不确定结果 转归
早期足量蛋白质摄入对重症患者结局的影响
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作者 徐颖 梁培 +9 位作者 虞文魁 朱章华 刘宁 董丹江 唐健 尤勇 王妍 陈鸣 刘洋 顾勤 《中华临床营养杂志》 CAS CSCD 2019年第3期133-137,共5页
目的探讨疾病早期及晚期蛋白质摄入量对重症患者结局的影响。方法采用前瞻性观察研究的方法,将2016年9月至2018年3月收住南京大学医学院附属鼓楼医院ICU的重症患者326例纳入研究,根据28d结局情况分为死亡组和存活组,以入ICU前3d蛋白质... 目的探讨疾病早期及晚期蛋白质摄入量对重症患者结局的影响。方法采用前瞻性观察研究的方法,将2016年9月至2018年3月收住南京大学医学院附属鼓楼医院ICU的重症患者326例纳入研究,根据28d结局情况分为死亡组和存活组,以入ICU前3d蛋白质摄入量≥0.8g/(kg·d)定义为早期蛋白质达标(EPT),入ICU4~7d蛋白质摄入量≥0.8g/(Rg.d)定义为晚期蛋白质达标(LPT)。结果死亡组患者入ICU后D1、D3每日蛋白质摄入量以及D1~3累计蛋白质摄入量均明显高于存活组(P<0.05),但D2、D4、D5、D6、D7每日蛋白质摄入量以及D4~7、D1~7累计蛋白质摄入量两组差别无统计学意义(P>0.05).LPT达标组的死亡率最低,ERT+LPT均达标组的死亡率和ERT+LPT均不达标组的死亡率次之,EPT达标组的死亡率最高(P<0.05)。生存曲线分析显示仅EPT达标组生存时间明显低于仅LPT达标组(P<0.05)。年龄、性别、D1~7热量累计摄入量以及D1~7蛋白质累计摄入量均为死亡独立危险因素。结论重症患者早期低蛋白摄入有利于改善结局,联合后期足量蛋白质摄入可能进一步改善结局。 展开更多
关键词 重症患者 蛋白质摄入 热卡摄入 结局
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