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Objective To develop a risk prediction model combining pre/intraoperative risk factors and intraoperative vital signs for postoperative healthcare-associated infection(HAI)based on deep learning. Methods We carried out a retrospective study based on two randomized controlled trials(NCT02715076,ChiCTR-IPR-17011099).The patients who underwent elective radical resection of advanced digestive system tumor were included in this study.The primary outcome was HAI within 30 days after surgery.Logistic regression analysis and long short-term memory(LSTM)model based on iteratively occluding sections of the input were used for feature selection.The risk prediction model for postoperative HAI was developed based on deep learning,combining the selected pre/intraoperative risk factors and intraoperative vital signs,and was evaluated by comparison with other models.Finally,we adopted the simulated annealing algorithm to simulatively adjust the vital signs during surgery,trying to explore the adjustment system that can reduce the risk of HAI. Results A total of 839 patients were included in this study,of which 112(13.3%)developed HAI within 30 days after surgery.The selected pre/intraoperative risk factors included neoadjuvant chemotherapy,parenteral nutrition,esophagectomy,gastrectomy,colorectal resection,pancreatoduodenectomy,hepatic resection,intraoperative blood loss>500 ml,and anesthesia time>4 h.The intraoperative vital signs significantly associated with HAI were in an order of heart rate>core body temperature>systolic blood pressure>diastolic blood pressure.Compared with multivariable Logistic regression model,random forest model,and LSTM model including vital signs only,this deep learning-based prediction model performed best(ACC=0.733,F1=0.237,AUC=0.728).The simulation via simulated annealing algorithm reduced the incidence of postoperative HAI.Moreover,the incidence decreased most in the case of reducing the initial annealing temperature and choosing the last 20% of surgery procedure. Conclusions This study developed a risk prediction model for postoperative HAI based on deep learning,which combined pre/intraoperative risk factors and intraoperative basic vital signs.Using simulated annealing algorithm to adjust intraoperative vital signs could reduce the incidence of postoperative HAI to some extent.
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Humans , Cross Infection , Deep Learning , Delivery of Health Care , Postoperative Period , Retrospective StudiesABSTRACT
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system predominantly targeting optic nerves and the spinal cord. The prevalence of the disease is much higher in Asia than in other parts of the world. Pain can be detected in more than 80% of NMOSD patients, with evoked pain mostly being caused by painful tonic muscle spasms and neuropathic pain as the most characteristic types. Depression is often comorbid with pain, and their comorbidity can severely influence quality of life. In recent years, studies have found considerable overlaps between the mechanisms of pain and depression; however, their association remains unclear. This article reviews the epidemiology, mechanism, evaluation and treatment of pain-depression comorbidity in NMOSD patients.
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Humans , Comorbidity , Depression/epidemiology , Neuromyelitis Optica/epidemiology , Pain , Quality of LifeABSTRACT
Objective To analyze the characteristics of high-risk maternal patients and evaluate the multidisciplinary medical care system we established correspondingly. Method We collected and analyzed the medical records of high-risk maternal patients who received medical care from January 1,2017 to December 31,2020 in Peking Union Medical College Hospital. Results Ninety-eight high-risk maternal patients were included in this study,and 84.7%(83/98)of them were combined with different severe systemic diseases.Under the multidisciplinary medical care system,91 patients showed improved conditions and were discharged,and the other 7 cases had poor prognosis. Conclusions General tertiary hospitals in Beijing are receiving maternal patients with more high-risk complications.Considering the high risk and diverse diseases of maternal patients admitted to our hospital,we established a medical care system composed of a multidisciplinary panel of experts for high-risk maternal patients to improve the medical care and prognosis of the patients with high efficiency.
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Humans , Hospitalization , Hospitals, General , Prognosis , Retrospective Studies , Tertiary Care CentersABSTRACT
BACKGROUND@#Whether regional anesthesia may help to prevent disease recurrence in cancer patients is still controversial. The stage of cancer at the time of diagnosis is a key factor that defines prognosis and is one of the most important sources of heterogeneity for the treatment effect. We sought to update existing systematic reviews and clarify the effect of regional anesthesia on cancer recurrence in late-stage cancer patients.@*METHODS@#Medline, Embase, and Cochrane Library were searched from inception to September 2020 to identify randomized controlled trials (RCTs) and cohort studies that assessed the effect of regional anesthesia on cancer recurrence and overall survival (OS) compared with general anesthesia. Late-stage cancer patients were primarily assessed according to the American Joint Committee on Cancer Cancer Staging Manual (eighth edition), and the combined hazard ratio (HR) from random-effects models was used to evaluate the effect of regional anesthesia.@*RESULTS@#A total of three RCTs and 34 cohort studies (including 64,691 patients) were identified through the literature search for inclusion in the analysis. The risk of bias was low in the RCTs and was moderate in the observational studies. The pooled HR for recurrence-free survival (RFS) or OS did not favor regional anesthesia when data from RCTs in patients with late-stage cancer were combined (RFS, HR = 1.12, 95% confidence interval [CI]: 0.58-2.18, P = 0.729, I2 = 76%; OS, HR = 0.86, 95% CI: 0.63-1.18, P = 0.345, I2 = 48%). Findings from observational studies showed that regional anesthesia may help to prevent disease recurrence (HR = 0.87, 95% CI: 0.78-0.96, P = 0.008, I2 = 71%) and improve OS (HR = 0.88, 95% CI: 0.79-0.98, P = 0.022, I2 = 79%).@*CONCLUSIONS@#RCTs reveal that OS and RFS were similar between regional and general anesthesia in late-stage cancers. The selection of anesthetic methods should still be based on clinical evaluation, and changes to current practice need more support from large, well-powered, and well-designed studies.
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Humans , Anesthesia, Conduction , Neoplasms , RecurrenceABSTRACT
Objectives To validate the reliability of the Chinese version of the Consultation and Relational Empathy (CARE) in physician-standardized patient (SP) encounter. We also tried to examine the agreement between video-based ratings and in-room ratings, as well as the agreement between the faculty ratings and SP ratings. Methods The CARE was translated into Chinese. Forty-eight anesthesia residents were recruited to make preoperative interview in SP-counter. Performance of each resident was graded by in-room raters, video raters and SP raters. Consistency between different raters was examined. Results The Chinese-CARE measure demonstrated high scale reliability with a Cronbach's alpha value of 0.95 and high consistency in the in-room ratings in intraclass correlation (coefficient=0.888,
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A 98-year-old male patient with history of hemiarthroplasty suffered periprosthetic fracture of right femoral shaft and developed acute coronary event in three days after hospitalization. Femoral nerve and lateral femoral cutaneous nerve blocks combined with general anesthesia were implemented for the internal fixation surgery. The recovery was uneventful after discharge. In this case report, we discussed the main considerations of anesthesia specifically for this complicated case.
Subject(s)
Aged, 80 and over , Humans , Male , Anesthesia, General , Femoral Fractures/surgery , Periprosthetic Fractures/surgeryABSTRACT
Objective To study the effect of electronic daily assessment on the application of standardized training for residents of anesthesiology department. Methods Compared the feedback rate of the previous paper evaluation form and the electronic daily evaluation submission,and summarized the results of the daily evaluation of residents of different grades and different sources through the electronic system. Results The feedback rate of the paper form and the electronic for was 59.5% and 96.7% separately. Comparing the scores of different grads, the total score and sub option scores gradually increased from grade one to grade three. The lowest score of sub options in all grades were anesthetic plan/crisis management scores. The worst overall rating(performance worse than expected)happened in the second-year residents. The best overall rating(performance better than expected) happened in the third-year resident. The residents form other hospitals had higher scores than PUMCH(Peking Union Medical Col-lege Hospital)'s residents and graduate students except for the score of theoretical knowledge. The PUMCH's resi-dents got lower score in overall rating.The teaching staff rescheduled and modified the training program according to the educational defect,so as to individualize resident training. Conclusions The daily electronic assessment helps to monitor daily performance of residents in a timely and comprehensive manner, so to adjust teaching methods, and contributes to conduct formative evaluation,which has a positive impact on improving teaching effectiveness.
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Standardized patients (SPs) are trained to portray a specific patient in a consistent, standardized fash-ion. SPs are widely used in many medical schools,and its efficacy for education and evaluation in the medical com-munity has been well established. Preoperative evaluation by anesthesiologist is a critical aspect of patient safety. But there are several defects in the current anesthesia education of preoperative evaluation and management. The residents are not provided with enough skills that are needed in the clinical practice and this sbortage may be com-pansated by SPs simulation. As a supplement of traditional teaching methods,SPs may improve the efficiency in the teaching of preoperative evaluation and enhance the competence of anesthesia residents.
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Objective To evaluate the application of adding ondansetron in morphine intravenous analgesia pump for prevention of postoperative nausea and vomiting(PONV)in women. Methods Data of surgical female inpatients who received general anesthesia and postoperative intravenous analgesia with morphine in our center from January 1st,2013 to December 31st,2014 were retrospectively analyzed. Based on whether ondansetron was added,patients were divided into the observation group(n=834) and the control group(n=856). Outcome variables including morphine consumption,visual analogue scale(VAS) score,nausea score,and total times of vomiting within 48 hours after surgery were collected and compared. Results Age(t=0.432,P=0.665),morphine consumption during the first post-operative day(t=0.599,P=0.548) and during the second post-operative day(t=0.236,P=0.813),maximum VAS score of postoperative pain during movement during the first post-operative day [3(2,4) vs. 3(2,5);Z=1.850,P=0.064] and at rest during the second post-operative day [0(0,1) vs. 0(0,1);Z=1.511,P=0.131] were not significantly different between two groups. While the maximum VAS score of postoperative pain at rest during the first post-operative day [0(0,2) vs.0(0,2);Z=2.435,P=0.015] and during movement during the second post-operative day [3(1,3)vs.3(2,4);Z=3.445,P=0.001] were significantly different between two groups. The maximum score of postoperative nausea(χ=9.810,P=0.020) and cumulative frequency of postoperative vomiting(Z=3.726,P=0.002)in the observation group were significantly lower than those in the control group during the first post-operative day;however,there was no significant difference during the second post-operative day(χ=5.017,P=0.170;Z=0.000,P=1.000). Logistic regression analysis showed that adding ondansetron in morphine intravenous analgesia pump was an independent influencing factor of reduced postoperative nausea. The probability of nausea during the first post-operative day was 0.781 time(P=0.015)of that in the control group and 0.736 time(P=0.030)during the second post-operative day. Conclusion Adding ondansetron in morphine intravenous analgesia pump may reduce PONV in women.
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Objective To investigate the efficacy and safety of continuous local anesthetic wound infiltration following open abdominal partial hepatectomy. Methods We performed a prospective, non-randomized, concurrent and controlled study. Patients undergoing open abdominal partial hepatectomy, according to their willingness, accepted one of the following managements for the postoperative pain: continuous wound catheter (CWC) infiltration, patient-controlled epidural analgesia (PCEA), patient-controlled intravenous analgesia of morphine (PCIAM), and patient-controlled intravenous analgesia of sufentanil (PCIAS). The primary outcome was postoperative visual analogue scale (VAS) scores at rest and on movement. Secondary outcomes included consumption of rescue medication, side effects, and complications associated with postoperative pain management. Results From August 2013 to December 2013, 80 patients were allocated to receive CWC (n=10), PCEA (n=22), PCIAM (n=29), or PCIAS (n=19). After adjusting for age, sex, body mass index, percentage of resected liver, operation time, and Amsterdam Preoperative Anxiety and Information Scale, there was no significant difference in the VAS scores at rest or on movement between Group CWC and the other groups, namely PCEA, PCIAM, and PCIAS, at 4, 12, 48, and 72 hours postoperatively (all P>0.05). The need for rescue medication was not significantly different between Group CWC and the other three groups at 48 and 72 hours postoperatively (all P>0.05). There was no significant difference in the incidence of postoperative nausea and vomiting or anal exsufflation time between group CWC and the other three groups (all P>0.05). No severe adverse effects associated with continuous wound infiltration were observed during the study period. Conclusions CWC has a comparable analgesic effect compared with traditional analgesia Methods at most time points postoperatively. CWC is a safe alternative for the postoperative analgesic management of open liver surgery.
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<p><b>OBJECTIVE</b>To observe the hemodynamic changes in patients undergoing pericardiectomy at different operational stages.</p><p><b>METHODS</b>Totally 16 consecutive patients receiving radical pericardiectomy were enrolled in this observational study. Hemodynamic variables were monitored continuously by pulse-indicated continuous cardiac output(PiCCO)system. Totally,three sets of intraoperative hemodynamic parameters were obtained at three different stages of pericardiectomy.</p><p><b>RESULTS</b>During the pericardiectomy,the cardiac index[CI,(1.9±0.6),(2.7±0.6),(3.0±0.5)L·min(-1)·m(-2);P<0.05]and stroke volume index[SI,(22.5±8.7),(29.9±8.5),(30.1±8.5)dyn·s·cm(-5)·m(2);P<0.05]showed significant improvement,whereas central venous pressure[CVP,(17.1±5.0),(13.3±3.9),(12.3±3.0)mmHg;P<0.05]decreased significantly. Global end-diastolic volume index[GEDVi,(533±156),(580±153),(559±144)ml·m(-2);P<0.05]increased and stroke volume variation[SVV,(15.6±6.1)%,(10.8±4.2)%,(9.4±5.4)%;P<0.05]decreased intra-operatively. The majority of the above-mentioned hemodynamic improvements occurred after the resection of pericardium over the left ventricular outflow tract(LVOT).</p><p><b>CONCLUSIONS</b>PiCCO system can serve as a reliable,less invasive hemodynamic monitoring method during pericardiectomy. Resection of the pericardium over the LVOT is the most important step of the pericardiectomy.</p>
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Humans , Cardiac Output , Heart , Heart Rate , Hemodynamics , Pericardiectomy , Stroke VolumeABSTRACT
<p><b>OBJECTIVE</b>To compare the results of detecting HIV-1 load by using NucliSens HIV-1 QT and Amplicor HIV-1 monitor 1.5 assays.</p><p><b>METHODS</b>Eighty-two clinical samples were collected and HIV viral load was determined with the above-mentioned two methods.</p><p><b>RESULTS</b>The number of samples in which values obtained by NucliSens HIV-1 QT and Amplicor HIV-1 monitor 1.5 differed by <0.5 log10 RNA copies/ml and in which the viral load was undetectable accounted for 88.9 percent of the measures. The correlation coefficient between the two methods was 0.956 in 56 samples of Deltalog10 VL<0.5.</p><p><b>CONCLUSION</b>The results of HIV-1 viral load determination with the two methods are highly comparable.</p>
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Humans , HIV Infections , Virology , HIV-1 , Genetics , Nucleic Acid Amplification Techniques , Methods , RNA, Viral , Genetics , Viral LoadABSTRACT
<p><b>BACKGROUND</b>By analyzing the CD4+ and CD8+ T lymphocyte count of whole blood from HIV/AIDS patients, which were stored at different temperatures for various durations, the authors studied the ideal preserving condition for whole blood and processed, in a purpose of guaranteeing the accuracy of clinical testing of CD4+ and CD8+ T lymphocyte count.</p><p><b>METHODS</b>Blood from 34 HIV carriers/AIDS patients, were kept at 4 degrees C for 2, 24, 48, or 72 h, and tested for CD4+ and CD8+ T lymphocyte count using cytometric analysis. Part of the blood was processed, and kept at degrees C or room temperature for 2, 24, 48, or 72 h, then tested for CD4+ and CD8+ T lymphocyte count. The results were compared statistically in parallel.</p><p><b>RESULTS</b>Whole blood and processed samples preserved at degrees C showed no statistical difference in CD4+ T lymphocyte count among different preserving durations (P greater than 0.05), but CD8+ T lymphocyte counts were significantly different at 72 h (P less than 0.05). Processed samples at 72 h were significantly different in CD4+ T lymphocyte count(P less than 0.05), and significantly different in CD8+ T lymphocyte count at 24 h (P less than 0.05). At room temperature, samples at different duration were not significantly different in CD4+ T lymphocyte count, but significantly different in CD8+ T lymphocyte count at 48 and 72 h (P less than 0.05).</p><p><b>CONCLUSION</b>There were stable results for performing analysis of the CD4+ and CD8+ T lymphocyte count of the anticoagulated blood within 48 h. At room temperature, there were stable results for performing the analysis of CD4+ and CD8+ T lymphocyte count of processed samples within 24 h. Between 24 h and 48 h, although CD4+ count was stable, CD8+ count showed significant changes, so the ratio of CD4 to CD8 changed accordingly.</p>