共查询到17条相似文献,搜索用时 76 毫秒
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目的:通过利用POSSUM、P-POSSUM和APACHE-Ⅱ评分对我院行手术治疗的肝门部胆管癌病例的术后住院死亡率的预测进行预测,评价各评分的预测能力,为肝门部胆管癌术后死亡风险寻求有效的评估方法。方法:收集了2002年1月~2007年12月期间在东方肝胆外科医院接受手术治疗的348例肝门部胆管癌的病例资料,统计其手术后的住院死亡率;统计学方法:所有的数据通过SPSS15.0 for windows、Medcalc9.2.10 for windows进行分析处理,计量资料经t检验、计数资料以x2检验和Z检验,P<0.05为有统计学意义;O:E值和ROC曲线用来评价评分方法的判别能力。结果:348例患者的术后有6例发生住院期间死亡,死亡率为1.7%,POSSUM评分预测的住院死亡率为9.3%(33例),两者之间的差异有统计学意义(x2=19.80,df=1,P<0.01);P-POSSUM评分预测的住院死亡率2.8%(10例),两者之间的差异无统计学意义(x2=1.02,df=1,P>0.05);APACHE-Ⅱ评分预测的住院死亡率9.2%(32例),两者之间的差异有统计学意义(x2=18.82,df=1,P<0.01)。POSSUM、P-POSSUM和APACHE-Ⅱ评分对应的ROC曲线下面积分别为0.759、0741和0.608。结论:P-POSSUM评分能很好的预测肝门部胆管癌手术的术后住院死亡率,POSSUM和APACHE-Ⅱ评分不能准确的预测,明显高估了术后死亡风险。 相似文献
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目的:通过利用POSSUM、P-POSSUM和APACHE-Ⅱ评分对我院行手术治疗的肝门部胆管癌病例的术后住院死亡率的预测进行预测,评价各评分的预测能力,为肝门部胆管癌术后死亡风险寻求有效的评估方法。方法:收集了2002年1月~2007年12月期间在东方肝胆外科医院接受手术治疗的348例肝门部胆管癌的病例资料,统计其手术后的住院死亡率;统计学方法:所有的数据通过SPSS15.0 for windows、Medcalc9.2.10 for windows进行分析处理,计量资料经t检验、计数资料以x2检验和Z检验,P〈0.05为有统计学意义;O:E值和ROC曲线用来评价评分方法的判别能力。结果:348例患者的术后有6例发生住院期间死亡,死亡率为1.7%,POSSUM评分预测的住院死亡率为9.3%(33例),两者之间的差异有统计学意义(x2=19.80,df=1,P〈0.01);P-POSSUM评分预测的住院死亡率2.8%(10例),两者之间的差异无统计学意义(x2=1.02,df=1,P〉0.05);APACHE-Ⅱ评分预测的住院死亡率9.2%(32例),两者之间的差异有统计学意义(x2=18.82,df=1,P〈0.01)。POSSUM、P-POSSUM和APACHE-Ⅱ评分对应的ROC曲线下面积分别为0.759、0741和0.608。结论:P-POSSUM评分能很好的预测肝门部胆管癌手术的术后住院死亡率,POSSUM和APACHE-Ⅱ评分不能准确的预测,明显高估了术后死亡风险。 相似文献
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目的 帮助医院明确剖宫产手术中的高风险环节及关键流程,切实做好产科安全管理。方法 通过FMEA法与文献研究、头脑风暴、问卷调查及专家咨询相结合的方式,对剖宫产诊疗流程中的风险进行识别。结果 共识别出剖宫产诊疗流程中10项高风险环节,即产后出血、知情同意效果不佳、会诊不及时、羊水栓塞、切口感染、尿路感染、会诊诊断及治疗错误、术前宣教效果不佳、麻醉失误、检查结果有误。结论 FMEA法是一项有效的医疗风险识别工具,能够前瞻性的检测出剖宫产高风险环节.并有针对性地实施干预。 相似文献
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??????? 目的 基于失效模式与效应分析(FMEA)方法分析控制C形臂X线机的使用风险。方法 成立FMEA 5人小组,运用现场观察和访谈的方法,识别C形臂X线机使用的潜在失效模式,并对其发生的严重度、发生概率及检测的难易度进行评价打分,计算失效原因的风险优先指数。结果 FMEA小组找出了必须优先解决的C臂机使用的失效模式,制定并实施了改进措施,在不增加管理成本的基础上,取得了良好的管理效果。结论 FMEA可以评估医疗设备使用过程的失效,并能排序优先解决的问题,不增加管理成本就能预防问题的发生,是有效的过程管理工具。 相似文献
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目的:评价日常活动和手术应激评估(Estimation of physiologic ability and surgical stress,E-PASS)系统用于评估老龄患者消化道手术后并发症和转归的临床价值。方法:回顾性分析2011年7月至2013年7月西京医院消化外科所有65岁以上的患者的临床资料,计算其中行消化道手术者的E-PASS评分,并记录这些患者术后并发症的发生情况和患者术后的住院时间。分析E-PASS评分和几项该评分未涉及的因素与老龄患者消化道手术后并发症的发病率、死亡率、住院时间的相关性。结果:研究共纳入1236例老龄行消化道手术的患者,其中521例发生术后并发症(42.15%),8例死亡(0.65%)。患者术前E-PASS评分系统中,三项评分均与术后住院时间相关,术前风险评分(Preoperative risk score,PRS)和综合风险评分(Comprehensive risk score,CRS)与术后并发症的发病率和死亡率显著相关(P均0.05)。E-PASS评分系统未包含的指标中,麻醉方法与术后并发症发生和住院时间无关,术后入ICU、术中使用血管活性药物和急诊手术与术后发病率、死亡率和住院时间相关(P均0.05)。结论:E-PASS评分系统可用于预测老龄患者行消化道手术后并发症的发生情况和转归,纳入术后入ICU、术中使用血管活性药物和急诊手术三项指标可能进一步提高E-PASS评分系统的预测准确性。 相似文献
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摘要 目的:探讨系统性免疫炎症指数(SII)、血小板计数和中性粒细胞与淋巴细胞比值(COP-NLR)评分与局部晚期鼻咽癌患者临床病理特征和预后的关系。方法:选择2015年1月到2017年12月徐州医科大学附属医院收治的94例局部晚期鼻咽癌患者,计算SII和COP-NLR评分,受试者工作特征(ROC)曲线确定治疗前SII的最佳临界值,比较不同SII、COP-NLR评分局部晚期鼻咽癌患者临床病理特征的差异。绘制Kaplan-Meier生存曲线分析不同SII、COP-NLR评分的局部晚期鼻咽癌患者总生存期(OS)的差异,单因素和多因素Cox回归分析影响患者预后的危险因素。结果:根据SII最佳临界值、COP-NLR评分标准将局部晚期鼻咽癌患者分为低SII组(46例)和高SII组(48例),低COP-NLR组(0-1分,45例)和高COP-NLR组(2分,49例)。高SII组、高COP-NLR组TNM分期Ⅳa期、淋巴结转移、颅底侵犯比例高于低SII组、低COP-NLR组(P<0.05)。高SII组、高COP-NLR组的5年OS明显降低(P<0.05)。TNM分期Ⅳa期、SII升高、COP-NLR评分升高是局部晚期鼻咽癌患者预后不良的危险因素(P<0.05)。结论:局部晚期鼻咽癌患者高SII、高COP-NLR评分与恶性病理特征和低生存率有关,SII、COP-NLR评分可作为局部晚期鼻咽癌预后预测的潜在生物学标志物。 相似文献
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This article is crafted around assessment and analysis of health risks associated with domestic rooftop water harvesting in India, with the prime objective of bringing to the forefront the deterrent issues and challenges in rainwater harvesting in general and domestic rooftop water harvesting in particular. This is based on a study on health risk assessment of a domestic rooftop water harvesting project conducted in the Nagaur district of Rajasthan, India, providing a critical reflection and exemplifying the prevalent scenario in the arid regions of the world. The methodology used for deriving the conclusions is failure mode and effects analysis. A set of risks were graded according to their severity based on their risk priority number scores evolved, including various contaminants polluting the harvested rainwater. The findings bear implications for planning of reconstructive changes to be incorporated and thus providing the necessary outlook for effective alleviation of the deterrents and make rainwater harvesting the premium solution for realization of the Millennium Development Goals by providing access to safe drinking water to the populace chiefly in the developing countries where the problem of scarce safe water is grave. 相似文献
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Wen Ma Xiuhong Ding Jinlin Long Lihong Wang Hui Liu Shuwei Liu 《Soil & Sediment Contamination》2017,26(3):277-293
Polycyclic aromatic hydrocarbons (PAHs) are typically persistent organic pollutants with hypertoxicity and widespreading, attracting increasing attention in recent years. Six paddy land sites soils irrigated from different rivers in the Nansi Lake area of Shandong Province, China, were studied to analyze and assess the source and risk of PAHs.Analysis revealed total PAHs (TPAHs) concentrations in topsoil ranging from 57.49 to 2046.47 μg kg?1, meanwhile, Weishan County (WS) was highly contaminated primarily from coal combustion based on the Nemerow composite index and geochemical indices.Canonical correspondence analysis (CCA) suggested that bacterial species were affected by pH, TPAHs, and soil organic matter (SOM), while covariables analysis confirmed that most effects of PAHs on bacterial diversity were attributed to the PAHs effect alone rather than the combined effects of PAHs and soil properties. The average daily human exposure (ADE) in children was approximately 2 times higher than that in adults, and the exposure paths values followed a decreasing order, oral intake > skin contact > inhalation. Furthermore, the WS site and another rice test field (TF) presented potential cancer risks and required further investigation. Therefore, the study has important theoretical significance for the control of PAHs pollution in this field, providing a scientific basis for health assessment. 相似文献
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摘要 目的:基于Tilburg衰弱评估量表评价老年慢性心力衰竭(CHF)的衰弱状况,分析影响衰弱的危险因素,并探讨其对患者生活质量和预后的影响。方法:选取2020年3月~2022年3月我院收治的102例老年CHF患者,根据Tilburg衰弱评估量表分为衰弱组与非衰弱组。收集患者基线资料,采用明尼苏达州心力衰竭生活质量问卷(MLHFQ)评分评估患者的生活质量,采用多因素Logistic回归分析老年CHF患者合并衰弱的危险因素,Spearman相关性分析衰弱组Tilburg衰弱评估量表评分与MLHFQ评分的相关性,比较两组患者生活质量和90 d非计划再入院率、死亡率。结果:102例老年CHF患者合并衰弱的发生率为53.92%(55/102)。多因素Logistic回归分析显示:体质指数(BMI)降低、NYHA心功能分级Ⅲ~Ⅳ级、合并疾病数量增加、血红蛋白(Hb)降低、红细胞分布宽度(RDW)升高、白蛋白(Alb)降低、N末端B型脑钠肽前体(NT-ProBNP)升高为老年CHF患者合并衰弱的独立危险因素(P<0.05)。衰弱组MLHFQ身体领域、情绪领域、其他领域评分高于非衰弱组(P<0.05)。Spearman相关性分析显示,老年CHF患者合并衰弱患者Tilburg衰弱评估量表评分与MLHFQ身体领域、情绪领域、其他领域评分呈正相关(rs=0.505、0.424、0.526,P均<0.001)。随访90 d,衰弱组非计划再入院率高于非衰弱组(P<0.05)。结论:老年CHF患者衰弱状况发生率较高,BMI、NYHA心功能分级、合并疾病数量、Hb、RDW、Alb、NT-ProBNP为老年CHF患者合并衰弱的影响因素,衰弱可导致患者生活质量下降和预后不良。Tilburg衰弱评估量表能快速评价老年CHF患者合并衰弱状况,有助于指导临床及时采取干预措施改善患者生活质量和预后。 相似文献
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Chris Poulin Brian Shiner Paul Thompson Linas Vepstas Yinong Young-Xu Benjamin Goertzel Bradley Watts Laura Flashman Thomas McAllister 《PloS one》2014,9(1)
We developed linguistics-driven prediction models to estimate the risk of suicide. These models were generated from unstructured clinical notes taken from a national sample of U.S. Veterans Administration (VA) medical records. We created three matched cohorts: veterans who committed suicide, veterans who used mental health services and did not commit suicide, and veterans who did not use mental health services and did not commit suicide during the observation period (n = 70 in each group). From the clinical notes, we generated datasets of single keywords and multi-word phrases, and constructed prediction models using a machine-learning algorithm based on a genetic programming framework. The resulting inference accuracy was consistently 65% or more. Our data therefore suggests that computerized text analytics can be applied to unstructured medical records to estimate the risk of suicide. The resulting system could allow clinicians to potentially screen seemingly healthy patients at the primary care level, and to continuously evaluate the suicide risk among psychiatric patients. 相似文献
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《Endocrine practice》2023,29(3):206-213
ObjectiveThis study aims to determine whether elevated endogenous thyrotropin levels contribute to an increased risk of adverse outcomes, such as all-cause mortality in older adults with subclinical hypothyroidism.MethodsEight electronic databases were searched for relevant articles from inception until March 23, 2022. Cohort studies assessing the association between thyrotropin levels and the risk of mortality among older adults aged ≥60 years with subclinical hypothyroidism were eligible. The outcomes of interest were either all-cause or cardiovascular-related mortality. Two independent researchers assessed the eligibility of the studies and collected data through a previously defined data extraction form. The Newcastle-Ottawa Scale was used to evaluate the quality of evidence, and multivariate-adjusted hazard ratios (HRs) (95% Cl) were collected as the necessary risk estimate for synthesis. Random-effects models were applied for meta-analysis.ResultsOverall, 13 studies involving 44 514 participants were included in this meta-analysis. There were no significant differences in the risk of all-cause mortality (pooled HR: 1.18 [95% Cl: 0.95, 1.45], I2 = 94%) and cardiovascular-related mortality (pooled HR: 1.08 [95% Cl: 0.94, 1.23], I2 = 0%) between euthyroid older adults and older adults with subclinical hypothyroidism. The results remained the same when only older adults with thyrotropin ≥10 mIU/L were assessed (pooled HR for all-cause mortality and cardiovascular-related mortality, respectively: 1.53 [95% Cl: 0.81, 2.88], I2 = 22%, 1.35 [95% Cl: 0.63, 2.86], I2 = 43%).ConclusionHigh thyrotropin levels are not associated with increased risk for all-cause mortality as well as cardiovascular-related mortality in older adults aged ≥60 years with subclinical hypothyroidism, suggesting an unnecessity in initialing treatment. 相似文献
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Manfredi Rizzo Dragana Nikolic Angelo Maria Patti Carlo Mannina Giuseppe Montalto Brooke S. McAdams Ali A. Rizvi Francesco Cosentino 《生物化学与生物物理学报:疾病的分子基础》2018,1864(9):2814-2821
Type 2 diabetes mellitus (T2DM) is a metabolic condition with an elevated impact on cardiovascular (CV) risk. The innovative therapeutic approaches for T2DM - incretin-based therapies (IBTs), including glucagon-like peptide 1 (GLP-1) receptor agonists, have become popular and more widely used in recent years. The available scientific data from clinical studies and clinical practice highlights their beyond glucose-lowering effects, which is achieved without any increase in hypoglycaemia. The former effects include reduction in body weight, lipids, blood pressure, inflammatory markers, oxidative stress, endothelial dysfunction, and subclinical atherosclerosis, thus reducing and potentially preventing CV events. In fact, the introduction of IBTs is one of the key moments in the history of diabetes research and treatment. Such therapeutic strategies allow customization of antidiabetic treatment to each patient's need and therefore obtain better metabolic control with reduced CV risk. The aim of the present paper is to provide a comprehensive overview of the effects of GLP-1RA on various cardiometabolic markers and overall CV risk, with particular attention on recent CV outcome studies and potential mechanisms. In particular, the effects of liraglutide on formation and progression of atherosclerotic plaque and mechanisms explaining its cardioprotective effects are highlighted. 相似文献
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José Ramón Peregrina 《BBA》2010,1797(9):1638-1264
Two transient charge-transfer complexes (CTC) form prior and upon hydride transfer (HT) in the reversible reaction of the FAD-dependent ferredoxin-NADP+ reductase (FNR) with NADP+/H, FNRox-NADPH (CTC-1), and FNRrd-NADP+ (CTC-2). Spectral properties of both CTCs, as well as the corresponding interconversion HT rates, are here reported for several Anabaena FNR site-directed mutants. The need for an adequate initial interaction between the 2′P-AMP portion of NADP+/H and FNR that provides subsequent conformational changes leading to CTC formation is further confirmed. Stronger interactions between the isoalloxazine and nicotinamide rings might relate with faster HT processes, but exceptions are found upon distortion of the active centre. Thus, within the analyzed FNR variants, there is no strict correlation between the stability of the transient CTCs formation and the rate of the subsequent HT. Kinetic isotope effects suggest that, while in the WT, vibrational enhanced modulation of the active site contributes to the tunnel probability of HT; complexes of some of the active site mutants with the coenzyme hardly allow the relative movement of isoalloxazine and nicotinamide rings along the HT reaction. The architecture of the WT FNR active site precisely contributes to reduce the stacking probability between the isoalloxazine and nicotinamide rings in the catalytically competent complex, modulating the angle and distance between the N5 of the FAD isoalloxazine and the C4 of the coenzyme nicotinamide to values that ensure efficient HT processes. 相似文献
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《Endocrine practice》2022,28(11):1152-1158
ObjectiveTo evaluate the effects of diabetes and hyperglycemia on in-hospital mortality in critically ill patients older than 75 years.MethodsThis was a single-center retrospective cohort study of patients older than 75 years in the first intensive care unit stay. The patients were divided into the following 4 groups: time-weighted average glucose (TWAG) <140 mg/dL without diabetes (group 1), TWAG ≥140 mg/dL without diabetes (group 2), TWAG <180 mg/dL with diabetes (group 3), and TWAG ≥180 mg/dL with diabetes (group 4). Clinical and laboratory data were analyzed.ResultsA total of 6760 patients over 75 years of age were included, including 2089 patients previously diagnosed with diabetes. The patients in group 2 had the highest in-hospital mortality (27.4%). In the fully adjusted regression model, the risk of in-hospital mortality increased by 76% (odds ratio = 1.76, 95% CI: 1.49-2.08) in group 2 as compared with group 1. Those from groups 3 and 4 exhibited risks equivalent to the risks of those in group 1; similar results were observed in the subgroup analysis. A J-shaped curve relationship and threshold effect were observed in patients without diabetes. For those with diabetes, a flatter curve pattern with a small slope was observed.ConclusionStress hyperglycemia was more detrimental to short-term prognosis than diabetes status in these patients. Looser glucose control may be suitable for patients older than 75 years with diabetes but unnecessary for those without diabetes. Patients with diabetes may be more resistant to the detrimental effects of glucose variations. 相似文献