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Objective:To investigate the role of heparin-binding protein (HBP) as a predictor of early bacterial infections in patients with traumatic intracerebral hemorrhage.Methods:Patients with traumatic intracerebral hemorrhage admitted to the Emergency Department of the First Hospital of Shanxi Medical University from September 2021 to June 2022 were collected prospectively. Patients with bacterial infection diagnosed by pathogenic examination were classified as the infected group, and those with negative pathogenic examination were classified as the non-infected group. Peripheral blood HBP counts were measured within 48 h of admission, and general information and relevant laboratory tests were collected. The differences of the indicators between the two groups were compared, the receiver operating characteristic (ROC) curve was drawn, the predictive value of the indicators for patients with co-infection was assessed, and the valuable predictors were screened out using multivariate logistic regression analysis.Results:Eighty-five patients [44 males and 41 females, aged (55.09±1.18) years] , were included in the study. Among the patients included in the study, 39 patients had bacterial infection and 46 were non-infected. Patients in the infected group were older , and had more surgeries, higher respiratory rate and injury severity score, and higher levels of HBP [(33.00±3.49) ng/mL vs. (16.27±1.61) ng/mL, P<0.001], leukocytes, and neutrophils [(15.32±3.19) ×10 9/L vs. (6.69±0.57) ×10 9/L, P=0.005] than in the non-infected group, while the Glasgow Coma Scale [(8.72±0.63) vs. (11.37±0.48), P=0.001] was lower than that in the non-infected group, with statistically significant differences (all P<0.05). There was no significant differences in lymphocytes, red blood cells, platelets, calcium, procalcitonin and coagulation indexes between the two groups (all P>0.05). Logistic regression analysis showed that neutrophils ( OR=1.252, 95% CI: 1.075-1.457, P=0.004) and HBP ( OR=1.081, 95% CI: 1.025-1.141, P=0.004) were independent risk factors for infection in patients with traumatic cerebral hemorrhage. The area under ROC curve for HBP of diagnosing early co-infection in patients with traumatic intracerebral hemorrhage was 0.82 (95% CI: 0.71-0.88), the sensitivity was 92.31%, and the specificity was 52.17%. Conclusions:HBP is a valuable predictor of early traumatic intracerebral hemorrhage complicated with bacterial infection in the emergency department, and has a good supplementary value to the existing test indicators.
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Objective To investigate the risk factors and prognosis of the patients with malignant solid tumors complicated with the disseminated intravascular coagulation (DIC). Methods The clinical data of 54 malignant solid tumors patients complicated with DIC in Shanxi Provincial People's Hospital from January 2004 to December 2014 were analyzed retrospectively, which were compared with the malignant tumor patients without DIC. Multivariate logistic regression analysis was used to explore the risk factors of solid tumor complicated with DIC, and the effect of concurrent DIC on the prognosis of patients was analyzed. Results Multiple factor analysis showed that advanced tumor (OR = 0.252, P = 0.019), concurrent hypoproteinemia(OR=0.119,P=0.005),concurrent infection(OR=0.122,P=0.003)were the independent risk factors of the malignant solid tumor patients complicated with DIC. The case fatality rate of the patients with DIC was 85.2 % (46/54), which was higher than that of the control group (7.4 %, 4/54), and the difference was statistically significant(χ2=65.69,P <0.001).Conclusion Early detection of malignant solid tumors, positive correction of hypoproteinemia, and the effective control of infection as soon as possible can help to prevent the occurrence of DIC and reduce the death caused by DIC.
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Objective To evaluate the efficacy of Disposcope endoscope(DE)-guided nasotrache-al intubation in patients with difficult airway by comparing with fiberoptic bronchoscope(FOB). Methods One hundred and twenty American Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both se-xes, with body mass index<25 kg∕m2, aged 18-64 yr, with mouth opening<3 cm, of Mallampati classifi-cation Ⅲ or Ⅳ, undergoing maxillofacial surgery requiring nasotracheal intubation were divided into DE group(n=60)and FOB group(n=60)using a random number table.Nasotracheal intubation was per-formed under the guidance of DE or FOB after induction of anesthesia.Glottis exposure was evaluated using Cormack-Lehane grade.Epistaxis during intubation, successful intubation, time and degree of glottis expo-sure, intubation time and development of tachycardia and hypertension and requirement for assisted ventila-tion with face mask during intubation were recorded.The patients were followed up postoperatively, and the development of intubation-related complications was also recorded.Results Compared with group FOB, glottis exposure time and incubation time were significantly shortened(P<0.05), and no significant change was found in Cormack-Lehane grade, rate of successful incubation, rate of successful intubation at first attempt or intubation-related complications in group DE(P>0.05). Hypertension and tachycardia were not found and no patients required assisted ventilation with face mask during intubation in the two groups.Conclusion DE-guided nasotracheal intubation provides similar efficacy to that of FOB with shorter time and is an optimal selection for the patients with difficult airway.
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<p><b>OBJECTIVE</b>To explore the risk factors of acute lymphoblastic leukemia (ALL) recurrence in adult patients and establish a prognosis index (PI) calculation model in order to improve the prevention strategy of ALL in adults.</p><p><b>METHODS</b>104 adult ALL patients from Blood Diseases Hospital & Chinese Academy of Medical Sciences between August 2008 and November 2011 were enrolled. COX proportional hazards regression stratified by Dummy variable was used to set up the prediction model; Kaplan-Meier method and Log-rank test were used to estimate and compare the survival. After calculated individual PI value, patients' expected survival should be estimated by groups.</p><p><b>RESULTS</b>The overall median survival of adult ALL patients was 22.00 months (95% CI 17.00-27.00). COX regression analysis showed that chemotherapy group patients had a higher risk of recurrence than of ASCT group while setting treatment as the dummy variable (RR=2.052, 95%CI 0.877-4.799, P=0.007). Stratified Analysis showed that the risk factors of B-ALL recurrence in adult patients included HGB <100 g/L (RR=0.186, 95% CI 0.068-0.512, P=0.001), CNSL (RR=7.767,95% CI 2.951- 20.433, P=0.001), number of consolidation chemotherapy<3 (RR=0.445, 95% CI 0.211-0.940, P=0.034) and Ph chromosome positive (RR=2.771, 95% CI 1.353-5.674, P=0.005). Grouped by the PI value, the expected survival of each individual patient could be estimated as PI=0.58 base.</p><p><b>CONCLUSION</b>HGB, CNSL, number of consolidation chemotherapy and Ph chromosome were independent risk factors of B-ALL recurrence in adult patients. PI value could predict the survival of adult ALL patients and provide reference for individual therapy and prognostic evaluation.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Epidemiology , Pathology , Prognosis , Recurrence , Risk Assessment , Risk FactorsABSTRACT
Objective To introduce the Multi-state Markov model in studying the outcome prediction of mild cognitive impairment (MCI). Methods Based on the intelligence quotient (IQ)changes that reflecting the trends in cognitive function in the patients under follow-up program, we constructed a four states model and used Multi-state Markov model to analyze the patients. Results Among 600 MCI patients, there were 174(29.0%) males and 426(71.0%) females, with age range of 65-90 years-old (average 69.7±6.6). For univariate analysis, gender, age, education level, marital status, smoking, household income, cerebral hemorrhage, hypertension, high cholesterol, diabetes,LDL-C, SBP and DBP were found to be associated with cognitive function. For multivariate analysis,female, older age, cerebral hemorrhage and higher SBP were shown to be the risk factors for transition from the state of cognitive stability to the state of severe deterioration, and their coefficients were 0.762,0.366,0.885, and 0.069, respectively. Age (0.038) could influence the transition from the state of cognitive stability to slight deterioration. Higher education level was shown to be the protective factor for these transitions (-0.219 and-0.297). Transition intensity from the state of cognitive stability to the state of slight and severe deterioration was 1.2 times that of transition to the state of improving. Transition intensity from state of slight deterioration to cognitive stability was 11.4times that of transition to severe deterioration. Conclusion Multi-state Markov model was an effective tool in dealing with longitudinal data.