ABSTRACT
To analyze the extubation indications of tracheotomy patients with severe neuropathy by Meta-analysis in order to determine the effective indication parameters for successful extubation. Methods The literatures in databases including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Web of Science, PubMed and Cochrane Library were retrieved from their establishment to April 2019. The literatures were case-control studies, cohort studies, randomized controlled trials (RCTs) or surveys related to indication parameters for successful extubation in patients with severe neuropathy. Two researchers identified and extracted literatures and data independently. The quality of literatures was assessed by the Newcastle-Ottawa scale (NOS). Meta-analysis was performed by RevMan 5.3 software. The stability of the results were evaluated by assessing the statistical models (the fixed effects model or the random effects model) and literatures quality (inferior or superior), and by sensitivity analysis. The publication bias of literatures was assessed by funnel plot. Results Eleven studies involving 1 357 participants were enrolled, and the rate of successful extubation was 46.7%-97.5%. Nine studies defined successful extubation as no need of re-intubation, and other two did not explain. All studies were high quality research, with NOS score of 6-8. Meta-analysis showed that the correlation between the level of consciousness [Glasgow coma score (GCS) ≥ 8 vs. < 8: odds ratio (OR) = 3.34, 95% confidence interval (95%CI) was 2.22-5.03, P < 0.001], the amount of tracheal secretions (less vs. more: OR = 13.07, 95%CI was 5.64-30.32, P < 0.001), cough reflex (with vs. without: OR = 14.33, 95%CI was 6.36-32.28, P < 0.001), swallowing function (good vs. bad: adjusted OR = 18.56,95%CI was 8.16-42.21, P < 0.001) and successful extubation was statistically significant, and the correlation between the pulmonary infection (with vs. without: adjusted OR = 1.94, 95%CI was 0.87-4.35, P = 0.11), oxygen saturation (≥ 0.95 vs. < 0.95: OR = 2.34, 95%CI was 1.11-4.91, P = 0.12), tolerance of tube plugging (good vs. bad: OR = 2.12, 95%CI was 0.67-6.71, P = 0.20), method of tube drawing (gradually vs. abruptly: OR = 0.99, 95%CI was 0.95-1.04, P = 0.93) and successful extubation was not statistically significant. Sensitivity analysis showed that the results were stable. Funnel plot showed that the studies distributed in both sides of the funnel symmetrically, indicating the publication bias of literatures was small. Conclusion The effective indication of extubation is consciousness level (GCS score ≥ 8), less secretion, cough reflex and good swallowing function.
ABSTRACT
Objective@#To analyze the extubation indications of tracheotomy patients with severe neuropathy by Meta-analysis in order to determine the effective indication parameters for successful extubation.@*Methods@#The literatures in databases including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Web of Science, PubMed and Cochrane Library were retrieved from their establishment to April 2019. The literatures were case-control studies, cohort studies, randomized controlled trials (RCTs) or surveys related to indication parameters for successful extubation in patients with severe neuropathy. Two researchers identified and extracted literatures and data independently. The quality of literatures was assessed by the Newcastle-Ottawa scale (NOS). Meta-analysis was performed by RevMan 5.3 software. The stability of the results were evaluated by assessing the statistical models (the fixed effects model or the random effects model) and literatures quality (inferior or superior), and by sensitivity analysis. The publication bias of literatures was assessed by funnel plot.@*Results@#Eleven studies involving 1 357 participants were enrolled, and the rate of successful extubation was 46.7%-97.5%. Nine studies defined successful extubation as no need of re-intubation, and other two did not explain. All studies were high quality research, with NOS score of 6-8. Meta-analysis showed that the correlation between the level of consciousness [Glasgow coma score (GCS) ≥ 8 vs. < 8: odds ratio (OR) = 3.34, 95% confidence interval (95%CI) was 2.22-5.03, P < 0.001], the amount of tracheal secretions (less vs. more: OR = 13.07, 95%CI was 5.64-30.32, P < 0.001), cough reflex (with vs. without: OR = 14.33, 95%CI was 6.36-32.28, P < 0.001), swallowing function (good vs. bad: adjusted OR = 18.56, 95%CI was 8.16-42.21, P < 0.001) and successful extubation was statistically significant, and the correlation between the pulmonary infection (with vs. without: adjusted OR = 1.94, 95%CI was 0.87-4.35, P = 0.11), oxygen saturation (≥ 0.95 vs. < 0.95: OR = 2.34, 95%CI was 1.11-4.91, P = 0.12), tolerance of tube plugging (good vs. bad: OR = 2.12, 95%CI was 0.67-6.71, P = 0.20), method of tube drawing (gradually vs. abruptly: OR = 0.99, 95%CI was 0.95-1.04, P = 0.93) and successful extubation was not statistically significant. Sensitivity analysis showed that the results were stable. Funnel plot showed that the studies distributed in both sides of the funnel symmetrically, indicating the publication bias of literatures was small.@*Conclusion@#The effective indication of extubation is consciousness level (GCS score ≥ 8), less secretion, cough reflex and good swallowing function.
ABSTRACT
Objective To better understand the infection status of HIV in the patients seeking medical care in Peking Union Medical College Hospital.Methods The HIV detection data of the patients in the hospital from 2003-2014 were collected for a statistical analysis with software SPSS 19.0.Results A total of 715 421 patients were screened,and 1 012 (0.14％) patients were HIV positive,and HIV infection were confirmed in 776 (0.11％) patients by Western Blot testing.The detection rate of HIV infection increased from 0.05％ in 2003 to 0.17％ in 2014 (trend x2=66.83,P=0.000),and the increase during 2012-2014 was obvious.Of the 776 newly diagnosed HIV-infected individuals,631 (81.31％) were men and 145 (18.69％) were women.The percentage of the males infected with HIV increased from 50.00％ to 90.26％ (trend x2=58.41,P=0.000).The median age was 36 years (interquartile range:27-43),and the age group 18-50 years were mostly affected.In the 776 patients infected with HIV,634 (81.70％) were infected through sexual contacts,and the proportion of sexual transmissions increased with year (trend x2=126.38,P=0.000).The proportion of infected men who have sex with men (MSM) increased from 0％ in 2003 to 53.90％ in 2014 (trend X2=11.96,P=0.001),similar to the trend in western countries.The proportion of infected patients who were not married increased from 18.75％ to 42.21％ (trend x2=43.74,P=0.000).The top three source departments of HIV/AIDS cases were internal medicine (51.03％),emergency room (18.30％) and dermatology (13.53％).The proportion of the HIV/AIDS patients from department of gynecology and obstetrics declined from 18.75％ in 2003 to 2.60％ in 2014.No HIV/AIDS patients were detected in department of surgery,department of otorhinolaryngology,department of ophthalmology,department of stomatology and health examination center in 2003,but 14 cases (9.10％),11 cases (7.14％) and 4 cases (2.60％) were detected in these departments respectively in 2014.Conclusion The HIV detection rate increased with year in Peking Union Medical College Hospital,suggesting the necessity of strengthened HIV test in general hospitals.MSM are the population at high risk,to whom more attention should be paid.
ABSTRACT
Objective To better understand the infection status of HIV in the patients seeking medical care in Peking Union Medical College Hospital.Methods The HIV detection data of the patients in the hospital from 2003-2014 were collected for a statistical analysis with software SPSS 19.0.Results A total of 715 421 patients were screened,and 1 012 (0.14％) patients were HIV positive,and HIV infection were confirmed in 776 (0.11％) patients by Western Blot testing.The detection rate of HIV infection increased from 0.05％ in 2003 to 0.17％ in 2014 (trend x2=66.83,P=0.000),and the increase during 2012-2014 was obvious.Of the 776 newly diagnosed HIV-infected individuals,631 (81.31％) were men and 145 (18.69％) were women.The percentage of the males infected with HIV increased from 50.00％ to 90.26％ (trend x2=58.41,P=0.000).The median age was 36 years (interquartile range:27-43),and the age group 18-50 years were mostly affected.In the 776 patients infected with HIV,634 (81.70％) were infected through sexual contacts,and the proportion of sexual transmissions increased with year (trend x2=126.38,P=0.000).The proportion of infected men who have sex with men (MSM) increased from 0％ in 2003 to 53.90％ in 2014 (trend X2=11.96,P=0.001),similar to the trend in western countries.The proportion of infected patients who were not married increased from 18.75％ to 42.21％ (trend x2=43.74,P=0.000).The top three source departments of HIV/AIDS cases were internal medicine (51.03％),emergency room (18.30％) and dermatology (13.53％).The proportion of the HIV/AIDS patients from department of gynecology and obstetrics declined from 18.75％ in 2003 to 2.60％ in 2014.No HIV/AIDS patients were detected in department of surgery,department of otorhinolaryngology,department of ophthalmology,department of stomatology and health examination center in 2003,but 14 cases (9.10％),11 cases (7.14％) and 4 cases (2.60％) were detected in these departments respectively in 2014.Conclusion The HIV detection rate increased with year in Peking Union Medical College Hospital,suggesting the necessity of strengthened HIV test in general hospitals.MSM are the population at high risk,to whom more attention should be paid.
ABSTRACT
Objective To summarize and analyze the dynamic change of HBsAg levels in patients with chronic Hepatitis B (CHB) after receiving nucleos(t)ide analogues (NAs) as antiviral treatment.Methods Patients who were performed quantitative Hepatitis B surface antigen(qHBsAg) from July 30, 2012 to December 30,2016 in Peking Union Medical College Hospital were retrospectively enrolled.qHBsAg, HBV DNA, HBeAg were collected and analyzed at baseline and at 192-week follow-up every 24 weeks.qHBsAg and HBeAg were assessed with chemiluminesent microparticle immuno assay(CMIA).HBV DNA was assessed with PCR and COBAS Amplicor.Results 60 patients were included.Patients in HBeAg-positive group had higher HBV DNA than that in HBeAg-negative group (P<0.05)at baseline and the two groups both were under detection limit after 48 weeks.BaselineqHBsAg in HBeAg positive-group and negative-group were (3.43±0.73) log10 IU/mL, (3.08±0.47) log10 IU/mL respectively.qHBsAg in HBeAg-positive group was higher than that in HBeAg negative-group on all follow-ups(P<0.05) except 48weeks.However on 168 weeks and 192 weeks, difference between the two groups was statistically significant(P<0.05).In HBeAg-positive group,quantitative HBeAg dropped significantly during antiviral treatment.Conclusions HBV replication can be suppressed in the process of long-term NAs treatment in CHB patients.However qHBsAg decline is not so obvious, which indicates that HBsAg cleavence is difficult,and long-term NAs therapy is still necessary.
ABSTRACT
Objective s To investigate the positive rate of different hepatitis B virus (HBV) serological markers, and the demographic factors related to HBV infection.Methods We enrolled all patients tested for HBV serological markers, such as HBV surface antigen (HBsAg), HBV surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), HBV core antibody (HBcAb), and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital. The positive rate of each HBV serological marker was calculated according to gender, age, and de- partment, respectively. The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed.Results Among 27 409 samples included, 2681 (9.8%) were HBsAg positive. When patients were divided into 9 age groups, the age-specific positive rate of HBsAg was 1.2%, 9.6%, 12.3%, 10.9%, 10.3%, 9.7%, 8.0%, 5.8%, and 4.3%, respectively. The positive rate of HBsAg in non-surgical department, surgical department, and health examination center was 16.2%,5.8%,and 4.7%, respectively. The positive rate of HBsAg of males (13.3%) was higher than that of females (7.3%, P=0.000). Among the 2681 HBsAg (+) patients, 1230 (45.9%) had HBV-DNA test, of whom 564 (45.9%) were positive. Patients with HBsAg (+), HBeAg (+), and HBcAg (+) result usually had high positive rate of HBV-DNA Results (71.8%, P=0.000).Conclusions Among this group of patients in our hospital, the positive rate of HBsAg was relatively high. Age group of 20-29, males, and patients in non-surgical departments were factors associated with high positive rate of HBsAg.