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Objective:To investigate the association between Onodera's prognostic nutritional index (OPNI) and postoperative adverse outcomes in elderly gastrointestinal surgery patients and assess the predictive value.Methods:A total of 230 elderly patients who received gastrointestinal surgery were prospectively enrolled. Clinical data, including age, sex, preoperative laboratory parameters, surgery process and clinical outcomes, were collected. The optimal cut-off value of OPNI was obtained using NRS 2002, a well-recognized nutritional risk screening tool, as the standard. The associations of OPNI, geriatric nutritional risk index (GNRI) and albumin with in-hospital mortality, complication incidence and duration of postoperative hospital stay were evaluated using Chi-square test or nonparametric test as appropriate. Confounders were identified through univariate analysis and logistic and linear regression models were developed to validate the correlation and assess the predictive value of OPNI for postoperative clinical outcomes.Results:The optimal cut-off value for the OPNI was 41.25, which yielded a sensitivity of 72.7% and a specificity of 59.9% with area under the curve (AUC) at 0.682. The incidence of OPNI-based malnutrition (defined as OPNI < 41.25) was 50% (115/230). Univariate analysis indicated that patients with OPNI < 41.25 had a significantly higher mortality (8.70% versus 2.61%, P = 0.046) and complication incidence (20.00% versus 9.57%, P = 0.026) and significantly longer postoperative hospital stay (11.17 d versus 8.49 d, P = 0.009) than patients with OPNI ≥ 41.25. Patients with GNRI < 98 had a longer postoperative hospital stay than those with GNRI ≥ 98 (10.71 d versus 7.55 d, P = 0.001) while there was no significant difference in mortality or complication incidence between the two groups ( P > 0.05). As for subgroups divided according to albumin levels (< 35 g/L or ≥35 g/L), no significant differences in mortality, postoperative complications incidence, or duration of postoperative hospital stay were observed ( P > 0.05). Multivariate analysis verified that OPNI < 41.25 was an independent risk factor for the development of postoperative complications ( OR: 2.660, 95% CI: 1.079-6.557, P = 0.034) and prolonged postoperative hospital stay ( R2 = 0.135, regression coefficient = 2.73, P = 0.047), where the AUC of the regression model for complications was 0.812 (95% CI: 0.741-0.882). GNRI < 98 was the independent risk factor for prolonged postoperative hospital stay ( R2 = 0.134, regression coefficient = 2.797, P = 0.049). Conclusion:OPNI is an independent risk factor for adverse clinical outcomes after gastrointestinal surgery in elderly patients and demonstrates good predictive value with the cut-off value of 41.25.
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Objective@#This study used cardiac magnetic resonance imaging (MRI) to compare the characteristics of left ventricular remodeling in patients with primary aldosteronism (PA) with those of patients with essential hypertension (EH) and healthy controls (HCs). @*Materials and Methods@#This prospective study enrolled 35 patients with PA, in addition to 35 age- and sex-matched patients with EH, and 35 age- and sex-matched HCs, all of whom underwent comprehensive clinical and cardiac MRI examinations. The analysis of variance was used to detect the differences in the characteristics of left ventricular remodeling among the three groups. Univariable and multivariable linear regression analyses were used to determine the relationships between left ventricular remodeling and the physiological variables. @*Results@#The left ventricular end-diastolic volume index (EDVi) (mean ± standard deviation [SD]: 85.1 ± 13.0 mL/m2 for PA, 75.9 ± 14.3 mL/m2 for EH, and 77.3 ± 12.8 mL/m2 for HC; p = 0.010), left ventricular end-systolic volume index (ESVi) (mean ± SD: 35.2 ± 9.8 mL/m2 for PA, 30.7 ± 8.1 mL/m2 for EH, and 29.5 ± 7.0 mL/m2 for HC; p = 0.013), left ventricular mass index (mean ± SD: 65.8 ± 16.5 g/m2 for PA, 56.9 ± 12.1 g/m2 for EH, and 44.1 ± 8.9 g/m2 for HC; p < 0.001), and native T1 (mean ± SD: 1224 ± 39 ms for PA, 1201 ± 47 ms for EH, and 1200 ± 44 ms for HC; p = 0.041) values were higher in the PA group compared to the EH and HC groups. Multivariable linear regression demonstrated that log (plasma aldosteroneto-renin ratio) was independently correlated with EDVi and ESVi. Plasma aldosterone was independently correlated with native T1. @*Conclusion@#Patients with PA showed a greater degree of ventricular hypertrophy and enlargement, as well as myocardial fibrosis, compared to those with EH. Cardiac MRI T1 mapping can detect left ventricular myocardial fibrosis in patients with PA.
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Objective@#This study used cardiac magnetic resonance imaging (MRI) to compare the characteristics of left ventricular remodeling in patients with primary aldosteronism (PA) with those of patients with essential hypertension (EH) and healthy controls (HCs). @*Materials and Methods@#This prospective study enrolled 35 patients with PA, in addition to 35 age- and sex-matched patients with EH, and 35 age- and sex-matched HCs, all of whom underwent comprehensive clinical and cardiac MRI examinations. The analysis of variance was used to detect the differences in the characteristics of left ventricular remodeling among the three groups. Univariable and multivariable linear regression analyses were used to determine the relationships between left ventricular remodeling and the physiological variables. @*Results@#The left ventricular end-diastolic volume index (EDVi) (mean ± standard deviation [SD]: 85.1 ± 13.0 mL/m2 for PA, 75.9 ± 14.3 mL/m2 for EH, and 77.3 ± 12.8 mL/m2 for HC; p = 0.010), left ventricular end-systolic volume index (ESVi) (mean ± SD: 35.2 ± 9.8 mL/m2 for PA, 30.7 ± 8.1 mL/m2 for EH, and 29.5 ± 7.0 mL/m2 for HC; p = 0.013), left ventricular mass index (mean ± SD: 65.8 ± 16.5 g/m2 for PA, 56.9 ± 12.1 g/m2 for EH, and 44.1 ± 8.9 g/m2 for HC; p < 0.001), and native T1 (mean ± SD: 1224 ± 39 ms for PA, 1201 ± 47 ms for EH, and 1200 ± 44 ms for HC; p = 0.041) values were higher in the PA group compared to the EH and HC groups. Multivariable linear regression demonstrated that log (plasma aldosteroneto-renin ratio) was independently correlated with EDVi and ESVi. Plasma aldosterone was independently correlated with native T1. @*Conclusion@#Patients with PA showed a greater degree of ventricular hypertrophy and enlargement, as well as myocardial fibrosis, compared to those with EH. Cardiac MRI T1 mapping can detect left ventricular myocardial fibrosis in patients with PA.
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Objective@#To determine whether T1 mapping could monitor the dynamic changes of injury in myocardial infarction (MI) and be histologically validated. @*Materials and Methods@#In 22 pigs, MI was induced by ligating the left anterior descending artery and they underwent serial cardiovascular magnetic resonance examinations with modified Look-Locker inversion T1 mapping and extracellular volume (ECV) computation in acute (within 24 hours, n = 22), subacute (7 days, n = 13), and chronic (3 months, n = 7) phases of MI. Masson’s trichrome staining was performed for histological ECV calculation. Myocardial native T1 and ECV were obtained by region of interest measurement in infarcted, peri-infarct, and remote myocardium. @*Results@#Native T1 and ECV in peri-infarct myocardium differed from remote myocardium in acute (1181 ± 62 ms vs. 1113 ± 64 ms, p = 0.002; 24 ± 4% vs. 19 ± 4%, p = 0.031) and subacute phases (1264 ± 41 ms vs. 1171 ± 56 ms, p < 0.001; 27 ± 4% vs. 22 ± 2%, p = 0.009) but not in chronic phase (1157 ± 57 ms vs. 1120 ± 54 ms, p = 0.934; 23 ± 2% vs. 20 ± 1%, p = 0.109). From acute to chronic MI, infarcted native T1 peaked in subacute phase (1275 ± 63 ms vs. 1637 ± 123 ms vs. 1471 ± 98 ms, p < 0.001), while ECV progressively increased with time (35 ± 7% vs. 46 ± 6% vs. 52 ± 4%,p < 0.001). Native T1 correlated well with histological findings (R2 = 0.65 to 0.89, all p < 0.001) so did ECV (R2 = 0.73 to 0.94, all p < 0.001). @*Conclusion@#T1 mapping allows the quantitative assessment of injury in MI and the noninvasive monitoring of tissue injury evolution, which correlates well with histological findings.
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Objective@#To determine whether T1 mapping could monitor the dynamic changes of injury in myocardial infarction (MI) and be histologically validated. @*Materials and Methods@#In 22 pigs, MI was induced by ligating the left anterior descending artery and they underwent serial cardiovascular magnetic resonance examinations with modified Look-Locker inversion T1 mapping and extracellular volume (ECV) computation in acute (within 24 hours, n = 22), subacute (7 days, n = 13), and chronic (3 months, n = 7) phases of MI. Masson’s trichrome staining was performed for histological ECV calculation. Myocardial native T1 and ECV were obtained by region of interest measurement in infarcted, peri-infarct, and remote myocardium. @*Results@#Native T1 and ECV in peri-infarct myocardium differed from remote myocardium in acute (1181 ± 62 ms vs. 1113 ± 64 ms, p = 0.002; 24 ± 4% vs. 19 ± 4%, p = 0.031) and subacute phases (1264 ± 41 ms vs. 1171 ± 56 ms, p < 0.001; 27 ± 4% vs. 22 ± 2%, p = 0.009) but not in chronic phase (1157 ± 57 ms vs. 1120 ± 54 ms, p = 0.934; 23 ± 2% vs. 20 ± 1%, p = 0.109). From acute to chronic MI, infarcted native T1 peaked in subacute phase (1275 ± 63 ms vs. 1637 ± 123 ms vs. 1471 ± 98 ms, p < 0.001), while ECV progressively increased with time (35 ± 7% vs. 46 ± 6% vs. 52 ± 4%,p < 0.001). Native T1 correlated well with histological findings (R2 = 0.65 to 0.89, all p < 0.001) so did ECV (R2 = 0.73 to 0.94, all p < 0.001). @*Conclusion@#T1 mapping allows the quantitative assessment of injury in MI and the noninvasive monitoring of tissue injury evolution, which correlates well with histological findings.
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OBJECTIVE: To compare the image quality of three-dimensional time-of-flight (TOF) magnetic resonance angiography (MRA) with sparse undersampling and iterative reconstruction (sparse TOF) with that of conventional TOF MRA. MATERIALS AND METHODS: This study included 56 patients who had undergone sparse TOF MRA for intracranial artery evaluation on a 3T MR scanner. Conventional TOF MRA scans were also acquired from 29 patients with matched acquisition times and another 27 patients with matched scanning parameters. The image quality was scored using a five-point scale based on the delineation of arterial vessel segments, artifacts, overall vessel visualization, and overall image quality by two radiologists independently, and the data were analyzed using the non-parametric Wilcoxon signed-rank test. Contrast ratios (CRs) of vessels were compared using the paired t test. Interobserver agreement was calculated using the kappa test. RESULTS: Compared with conventional TOF at the same spatial resolution, sparse TOF with an acceleration factor of 3.5 could reduce acquisition time by 40% and showed comparable image quality. In addition, when compared with conventional TOF with the same acquisition time, sparse TOF with an acceleration factor of 5 could also achieve higher spatial resolution, better delineation of vessel segments, fewer artifacts, higher image quality, and a higher CR (p < 0.05). Good-to-excellent interobserver agreement (κ: 0.65–1.00) was obtained between the two radiologists. CONCLUSION: Compared with conventional TOF, sparse TOF can achieve equivalent image quality in a reduced duration. Furthermore, using the same acquisition time, sparse TOF could improve the delineation of vessels and decrease image artifacts.
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Humans , Acceleration , Arteries , Artifacts , Magnetic Resonance AngiographyABSTRACT
@#The establishment of an efficient performance management system is crucial for a rehabilitation institution. This article discussed the concept of performance, performance management and ways to establish an efficient performance management system.
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@#How to give full play to the advantages of rehabilitation institutions, and to improve service quality and administration efficiency are some of the complex issues faced by the high-level administrators of rehabilitation institutions. This paper studied a total of 67 institutions to investigate the operation and management model of rehabilitation institutions in China, as well as their advantages and disadvantages.
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How to give full play to the advantages of rehabilitation institutions, and to improve service quality and administration effi-ciency are some of the complex issues faced by the high-level administrators of rehabilitation institutions. This paper studied a total of 67 in-stitutions to investigate the operation and management model of rehabilitation institutions in China, as well as their advantages and disadvan-tages.
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The establishment of an efficient performance management system is crucial for a rehabilitation institution. This article dis-cussed the concept of performance, performance management and ways to establish an efficient performance management system.
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The practice of daily case discussion in the morning using slice show has been cartied out since orthopedic trauma department of Nanfang Hospital was set up.Bilingual ( Chinese and Englisl) discussion was hold in the department before and after the operation on the cases requiring three-level or higher level operation and those of special diseases.The bilingual case discussions will greatly improve the clinical thinking and accumulate the clinical experiences for doctors.The professional English proficiency of all doctors in the department have been improved because of the bilingual case discussions and the most effective treatment for patients was provided at the same time.