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Objective:To analyze the risk factors for postoperative delirium in patients with glioma, and construct and validate a nomogram prediction model.Methods:A total of 304 glioma surgery patients admitted to the Department of Neurosurgery of Shandong Provincial Hospital from January 2021 to January 2022 were involved in this research. The training set (234 patients) and the validation set (70 patients) were divided according to the leave-out method. Patients in the training set and validation set were divided into delirium and non-delirium groups using the confusion assessment method (CAM) as the criteria.Clinical data of patients in the two study groups in the training set were analyzed.The risk factors for postoperative delirium were clarified by Logistic regression analysis, and an early warning model for postoperative delirium in glioma was established. The calibration curve and ROC curve were used for internal and external validation in the training set and validation set to evaluate the accuracy and discrimination of the prediction model.Results:Multivariate Logistic regression analysis showed that age>60 ( OR=4.089, 95% CI=1.898-9.103, P<0.001), diabetes ( OR=2.825, 95% CI=1.316-6.186, P=0.008), hypertension ( OR=2.176, 95% CI=1.041-4.587, P=0.008), smoking ( OR=2.432, 95% CI=1.063-5.648, P=0.036), history of epileptic seizures ( OR=4.457, 95% CI=1.924-10.689, P=0.001), poor lung function ( OR=2.452, 95% CI=1.132-5.374, P=0.023), visual analog scale (VAS)>7 points ( OR=3.394, 95% CI=1.591-7.456, P=0.002), anxiety or depression ( OR=2.746, 95% CI=1.285-5.976, P=0.010) and operation duration>4 h ( OR=2.731, 95% CI=1.255-6.062, P=0.012) were the independent risk factors of brain glial postoperative delirium.Based on the above risk factors a nomogram nursing early warning model was established.The area under the ROC curve (AUC) of internal verification was 0.852, and AUC of external verification was 0.914. Conclusion:The early-warning model for postoperative delirium in glioma patients can effectively predict the risk of delirium after glioma surgery, and it has certain clinical promotion value.
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Objective@#To assess the effectiveness of radiofrequency ablation (RFA) in the treatment of multiple pregnancies.@*Methods@#In this retrospective study, 84 cases (total 174 fetuses) of complex monochorionic pregnancies treated with RFA for selective fetal reduction were analyzed. All cases were managed in the Guangdong Women and Children Hospital from January 2015 to January 2018. Indications for offering RFA, details of the procedure and pregnancy outcomes were collected and analyzed.@*Results@#(1)The rate of miscarriage and fetal intrauterine death was 21% (18/84), termination of pregnancy because of fetal malformation or oligohydramnion occurred in 10% (8/84) of cases. Total live birth rate was 69% (58/84) and the gestation age at delivery was (35.0±3.0) weeks. (2) The live birth rate of twin reversed arterial perfusion sequence (TRAPS) was the lowest (6/11), followed by twin to twin transfusion syndrome (TTTS; 66%, 27/41), structural or genetic abnormalities of one fetus in monochorionic twin pregnancy (10/14), triplet pregnancy reduction (4/6) and selective intrauterine growth restriction (sIUGR) (11/12). (3) The live birth rate was 67% (20/30) in stage Ⅲ of TTTS and 7/11 in the stage Ⅳ of TTTS (P>0.05). The average gestational age was (33.6±3.0) weeks in stage Ⅲ of TTTS compared with (36.5±2.4) weeks in the stage Ⅳof TTTS (P<0.05).@*Conclusions@#RFA appears to be a reliable option for selective fetal reduction in monochorionic multiple pregnancies. The indication of RFA is an influencing factor on its pregnancy outcomes. Type Ⅱand type Ⅲ sIUGR may choose this technique as a priority. Compared with stage Ⅲ of TTTS, the live birth rate and the gestation age at delivery in stage Ⅳ of TTTS, there are no significant differences.
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Objective To investigate the clinical value of ultrasound markers in screening fetal trisomy 21.Methods From Jan.2001 to Dec.2011,a retrospective study about sonographic information of 138 fetuses diagnosed as trisomy 21 was taken in the First Affiliated Hospital of Sun Yat-sen University.All fetuses were divided into 3 groups:isolated ultrasound markers,non-isolated ultrasound markers,and isolated structural malformations or other abnormalities.The relationship between trisomy 21 and ultrasound markers as well as structural anomalies or other abnormalities was analyzed.Results Sonographic anomalies were detected in 132 fetuses(95.7％,132/138),including ultrasound markers and structural malformations or other abnormalities.One hundred and twenty cases(87.0％,120/138)had ultrasound markers,38(31.7％,38/120)had one marker and 82(68.3％,82/120)had more than one marker (P ＜ 0.01).Fifty-one fetuses(37.0％,51/138)had isolated ultrasound markers and non-isolated markers were found in 69 fetuses(50.0％,69/138).Only 12 fetuses(8.7％,12/138)had isolated structural malformations or other abnormalities.In 20 fetuses on whom the first-trimester ultrasound screening were performed,all had ultrasound markers,95％(19/20)had thickened nuchal translucency and 55％ (11/20)had nasal bone hypoplasia.The most common ultrasound markers on the second-trimester screening were nasal bone hypoplasia,which accounted for 41.9％(52/124)cases,followed by thickened nuchal fold (25.0％,31/124),short fenurs and humerus(24.2％,30/124),echogenic intracardiac focus(16.1％,20/124),mild ventriculomegaly(15.3％,19/124),hyperechoic bowel(12.9％,16/124),mild renal pyelectasis(12.1％,15/124).Furthermore,thc common structural malformations or other abnormalities were as follows:cardiac defects(33.1％,41/124),digestive system(26.6％,33/124).Condusions Ultrasound markers are valuable for screening fetal trisomy 21.The fetuses of trisomy 21 usually had more than one ultrasound markers or associated with other abnormalities.Combinations of ultrasound markers with the results of serum screening and maternal age are necessary for evaluation.
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Objective To discuss the application effects of fast track surgery treatment in hysterectomy. Methods 120 patients underwent hysterectomy. They were randomly assigned to two groups,namely,fast track sur-gery group(60 cases) and control group(60 cases ). two groups underwent separately fast track surgery mode and tradi-tional mode therapy. To observe the duration of passing flatus, the hospital stay, the aching time, the complication rate after operation between two groups. Results All patients got recovery. The duration of passing flatus(29.2±7.9) h,the aching time 96.7% (58/60)、the hospital stay( 3.9±2.5 )d of fast track surgery group were significantly shorter than the duration of passing flatus (50.3±15.8 ) h 、the aching time 8.3% (5/60)、the hospital stay (6.7±2.8 ) d of control group( allP<0.01 ). there was no severe complication in two groups. Conclusion Fast track surgery treat-ment mode could accelerate postoperative rehabilitation of hysterectomy patients. It shoud be popularized.
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@#Objective To investigate the correlation of subtypes of the lymphocytes with metabolic syndrome in the aged.Methods 955 aged male and 150 aged female were recruited to a cross-sectional case-control study.CD3+,CD4,CD8+,CD19+,NK cell was measured with flow cytometry.ResultsCD3+,CD19+,NK cells showed no difference in cases and in controls.CD4+/CD8+ ratio declined in subjects with metabolic syndrome,and the ratio declined further with the more criteria.The analysis of multiple analysis regression showed that metabolic syndrome depressed CD4+/CD8+ ratio in the aged.Conclusion Metabolic syndrome was correlated with the disorder of immunity.
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@# Objective To investigate the change of the serum content of adiponectin in the elderly, and the relationship between hepatic steatosis and the serum content of adiponectin and metabolic syndrome.Methods 264 elderlies were divided into the hepatic steatosis group (87 cases) and control group (177 cases) after B type ultrasonograph examination. The height, weight, waist circumference and levels of serum lipid, glucose, insulin and adiponectin of all cases in the two groups were measured. The relationship between above variables and hepatic steatosis was analyzed. The multiple logistic regression analysis was used to test the efficacy of adiponectin and metabolic syndrome for predicting the probability of having hepatic steatosis in the elderly.Results For the hepatic steatosis group, the serum content of adiponectin was significantly lower than that of the control group ( P<0.01), the frequency of metabolic syndrome was significantly higher than that of the control group ( P<0.01), and the body mass index, waist circumference, blood glucose (fasting blood glucose and postprandial blood glucose), homeostasis model assessment-insulin resistance index, total cholesterol, triglyceride and low density lipoprotein cholesterol increased and high density lipoprotein cholesterol decreased. Logistic regression analysis showed that serum content of adiponectin and metabolic syndrome were associated with the probability of hepatic steatosis.Conclusion The serum content of adiponectin and metabolic syndrome are useful indices for the prediction of hepatic steatosis.