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Background: This study was done to report on adequate antenatal care services owing to the impact of IEC intervention among deprived Baiga tribal women. Methods: Intervention study of 367 tribal women having a reproductive age of 15 to 49 year of 24 villages from district-Dindori. Pre-tested, administered intervention tools were implemented in intervention groups (12 villages) to enhance women's knowledge for the use of ANC services (phase-I) and in phase-II impact evaluation survey of mother’s antenatal care utilization and related details were collected from mothers of both intervention and control group. Based on baseline indicators, a carry forward IEC-intervention study was taken considering the case-control design. Logistic regression analysis was used to identify the associated factors. Results: Use of ANC services 82.3% was found to have increased by 10.3% from baseline (72%); it was found significantly higher (88%) in the intervention group while lower (76.1%) in the control group. As regards 60% women received more than 3 ANC check-ups remarkably higher by 13% in the intervention group. Health institution child births 44.8% were found meaningfully improved by 36.8% from baseline (8%); also, it was revealed higher (49.7%) in the intervention group than lower (40%) in the control group. Women’s education and exposure of previous pregnancy has found strong association with adequate antenatal care in intervention groups. Conclusions: A comparatively high proportion of the use of ANC services and institutional child birth were found in the intervention group. Improving the access to more quality health services in other tribal communities may necessitate the intervention research.
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Objective To assess the risk of nosocomial infection in patients with multiple myeloma during their first hospitalization. Methods Totally 480 patients with multiple myeloma who were hospitalized for the first time in department of hematology of West China Hospital, Sichuan University from August 2021 to August 2022 were included, and the nosocomial infection during treatment was statistically analyzed. The patients were divided into infected group and uninfected group. The independent influencing factors of nosocomial infection were analyzed and a prediction model was established. The reliability of the prediction model was analyzed by receiver operating characteristic curve (ROC). Results The incidence rate of nosocomial infection was 31.2% among 480 patients hospitalized for the first time. There were statistically significant differences in age, ISS staging, controlling nutritional status (CONUT) score, agranulocytosis, hemoglobin, and albumin between the infected group and the uninfected group (P<0.05). Logistic multivariate regression analysis showed that age, ISS staging, CONUT score, agranulocytosis, hemoglobin level, and albumin level were all independent correlated factors of nosocomial infection in patients with multiple myeloma hospitalized for the first time (P<0.05). The area under the ROC curve (AUC), sensitivity and specificity of multivariate logistic regression prediction model were 0.88 (95%CI: 0.840-0.920), 85.00% and 76.36%, respectively. Conclusion The incidence rate of nosocomial infection is high among patients with multiple myeloma in the first hospitalization. The prediction model established according to independent correlated factors of nosocomial infection has high predictive value on the occurrence of nosocomial infection.
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Objective:The purpose of this study is to explore the clinical characteristics of Coronavirus Disease 2019 (COVID-19) in patients with type 2 diabetes mellitus (T2DM), and analyze the risk factors for adverse outcomes.Methods:2 052 patients diagnosed with COVID-19 who were hospitalized in Shanxi Bethune Hospital between December 1, 2022 and March 20, 2023 were included. They were divided into diabetes group ( n=70) and non-diabetes group ( n=1 982) according to the presence or absence of comorbid T2DM. The two groups were matched at 1:1 via propensity score matching. Clinical characteristics and laboratory examination results of the two groups were compared. According to the outcomes during hospitalization, the two groups were further divided into two subgroups respectively. Univariate analysis and subsequent binary Logistic regression was used to analyze the risk factors of adverse outcomes in patients with COVID-19 and type 2 diabetes. Results:After the propensity score matching, the most common comorbid condition in diabetes group and non-diabetes group was hypertension. The proportion of patients with severe or critical disease in diabetes group was higher compared with non-diabetes group. The levels of hemoglobin A1c (HbA1c), fasting blood glucose (FBG), blood urea, IL-4, IL-6, IL-10, IFN-γ and TNF-α were significantly higher in the diabetes group ( P<0.05). Logistic regression analysis within the diabetes group showed that hypertension ( OR=3.640, 95% CI: 3.156 to 4.290), FBG>11 mmol/L ( OR=3.283, 95% CI: 1.416 to 7.611), HbA1c>10% ( OR=2.718, 95% CI: 1.024 to 7.213) were independent risk factors for adverse outcomes in patients with COVID-19 and type 2 diabetes(all P<0.05). Conclusions:Compared with the non-diabetes group, patients with COVID-19 and T2DM have worse inflammatory response and higher levels of inflammatory cytokines. The elevated levels of FBG and HbA1c are related to the adverse outcome in patients with COVID-19 and T2DM.
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Objective:To investigate the cognitive function and its influencing factors among residents in Qingdao city.Methods:The 5 311 research subjects over 65 years old were selected from Qingdao by simple random sampling and stratified sampling. All subjects were investigated by AD8 dementia early screening questionnaire and community screening instrument dementia (CSI-D) to evaluate the prevalence of cognitive decline in this study.The score of AD8 dementia early screening questionnaire ≥2 points or the score of CSI-D ≤7 points was considered to be cognitive decline. Mann-Whitney U test, Chi-square test, Fisher exact probability method, univariate and multivariate Logistic regression analysis and Bootstrap verification were performed using SPSS 26.0 software. Results:Among 5 311 subjects, 1 899 subjects had normal cognitive function (35.76%) and 3 412 subjects had cognitive decline (64.24%). The age of the cognitive decline group was significantly higher than that of the normal group ( P<0.01). There were significant differences in gender, educational level, rural residents, marital status, chronic medical history, hypertension, rheumatoid arthritis, cerebrovascular disease, intervertebral disc disease, ischemic heart disease, monthly household income and alcohol consumption between the two groups (all P<0.05). Univariate Logistic regression analysis showed that female ( β=0.313, OR=1.367, 95% CI=1.221-1.530), age ( β=0.052, OR=1.053, 95% CI=1.043-1.063), rural residents ( β=0.850, OR=2.340, 95% CI=2.042-2.682), widowed ( β=0.557, OR=1.745, 95% CI=1.500-2.029), chronic medical history ( β=0.290, OR=1.336, 95% CI=1.191-1.498), hypertension ( β=0.134, OR=1.143, 95% CI=1.020-1.281), rheumatoid arthritis ( β=0.458, OR=1.581, 95% CI=1.222-2.046), cerebrovascular disease ( β=0.584, OR=1.794, 95% CI=1.352-2.380), intervertebral disc disease ( β=0.578, OR=1.782, 95% CI=1.370-2.319), ischemic heart disease ( β=0.501, OR=1.651, 95% CI=1.272-2.143) were the risk factors for cognitive decline. Higher education level, higher monthly household income and abstinence ( β=-0.244, OR=0.783, 95% CI=0.619-0.992) were protective factors for cognitive decline. Multivariate logistic regression analysis showed that age ( β=0.035, OR=1.036, 95% CI=1.025-1.047), rural residents ( β=0.215, OR=1.239, 95% CI=1.047-1.468), chronic medical history ( β=0.191, OR=1.210, 95% CI=1.067-1.372), cerebrovascular disease ( β=0.480, OR=1.616, 95% CI=1.195-2.187), intervertebral disc disease ( β=0.456, OR=1.578, 95% CI=1.190-2.094) were risk factors for Alzheimer's disease. Higher education level and higher monthly household income were protective factors for Alzheimer's disease. Conclusion:The elderly with chronic diseases, low income and low education level may be at the high risk of cognitive function decline, which should be paid attention to in early screening and intervention.
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BACKGROUND:Up to now,there is no literature on the relationship between blood laboratory tests and the course of nontraumatic osteonecrosis of femoral head in different stages.It is necessary to further explore and analyze so as to better clarify the influencing factors of nontraumatic osteonecrosis of femoral head. OBJECTIVE:To analyze the relationship between blood laboratory indicators and the course of nontraumatic osteonecrosis of the femoral head by the Association Research Circulation Osseous(ARCO),thus exploring the influencing factors of blood laboratory indicators on the course of nontraumatic osteonecrosis of the femoral head. METHODS:This study used a retrospective study design.A total of 2 103 patients with osteonecrosis of the femoral head were retrieved from Wangjing Hospital of China Academy of Chinese Medical Sciences database,and 1 075 patients with nontraumatic osteonecrosis of the femoral head were ultimately included based on inclusion and exclusion criteria.Patient age,gender,body mass index,and blood laboratory test results were collected.Blood laboratory tests included low-density lipoprotein,total cholesterol,triglycerides,high-density lipoprotein,apolipoprotein β,apolipoprotein α1,uric acid,total protein quantitative,alkaline phosphatase,activated partial thromboplastin time,prothrombin time,prothrombin time International Normalized Ratio,prothrombin time activity,fibrinogen quantitative,coagulation time of thrombin,D-dimer,total iron binding capacity,and platelet count.The indicators of patients with different age groups and different ARCO stages were compared,and multiple Logistic regression analysis was applied to explore the influencing factors of ARCO stages in osteonecrosis of the femoral head. RESULTS AND CONCLUSION:(1)There were statistical differences in total cholesterol,uric acid,prothrombin time,prothrombin time International Normalized Ratio,and D-dimer among ARCO stages in the young group(P<0.05).Among young patients in ARCO stage II,total cholesterol levels were higher than those in ARCO stage III(P<0.05).Uric acid levels in ARCO stage IV were higher than those in ARCO stage II and III(P<0.05).Prothrombin time and prothrombin time International Normalized Ratio were shorter in ARCO stage IV and II than in ARCO stage III(P<0.05).D-dimer levels were higher in ARCO stage III and IV than in ARCO stage II(P<0.05).(2)There were statistically significant differences in high-density lipoprotein,coagulation time of thrombin,and D-dimer among ARCO stages in the middle-aged group(P<0.05).Among middle-aged patients in ARCO stage IV,high-density lipoprotein levels were higher than those in ARCO stages II and III(P<0.05).Coagulation time of thrombin was shorter in ARCO stage IV than in ARCO stage III(P<0.05).D-dimer levels were higher in ARCO stages IV than in ARCO stages II and III(P<0.05).(3)The uric acid,activated partial thromboplastin time,D-dimer,and platelet count in the elderly group showed statistically significant differences(P<0.05).The uric acid level in ARCO stage IV was higher than that in ARCO stage II and III patients in the elderly group(P<0.05),while the activated prothrombin time in ARCO stage II patients was shorter than that in ARCO stage III patients in the elderly group(P<0.05).The D-dimer level in ARCO stage III and IV patients was higher than that in ARCO stage II patients in the elderly group(P<0.05).The platelet count in ARCO stage IV was lower than that in ARCO stage III patients in the elderly group(P<0.05).(4)Multiple logistic regression analysis showed that total cholesterol and platelet count may be protective factors for course of nontraumatic osteonecrosis of the femoral head,while D-dimer,uric acid,overweight,and young and middle age may be risk factors for course of nontraumatic osteonecrosis of the femoral head.(5)It is indicated that total cholesterol,high-density lipoprotein,uric acid,prothrombin time,prothrombin time International Normalized Ratio,and D-dimer are statistically significant among patients with different ARCO stages.Total cholesterol and platelet count may be protective factors for the course of nontraumatic osteonecrosis of the femoral head,while D-dimer,uric acid,overweight,and middle-aged and young age groups may be hazard factors for the course of nontraumatic osteonecrosis of the femoral head.
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Objective:To evaluate the predictive value of serum amyloid A (SAA) and neutrophil-lymphocyte ratio (NLR) for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team.Methods:A total of 105 patients with severe preeclampsia admitted to the ICU of Hangzhou First People's Hospital from October 2014 to July 2022 were retrospectively enrolled. They were divided into the adverse pregnancy outcome group ( n = 62) and the non-adverse pregnancy outcome group ( n = 43) according to the pregnancy outcome. SAA, NLR and other laboratory indicators and related clinical data of all patients were collected within 24 h after admission. The general clinical data of the two groups were compared, and multivariate Logistic regression analysis was used to find the risk factors affecting adverse pregnancy outcome of patients with severe preeclampsia. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SAA and NLR for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team. Results:The ICU length of stay [4.00 (3.00, 5.00) vs. 3.00 (3.00, 4.00), P=0.022], acute physiology and chronic health evaluationⅡ (APACHEⅡ) score [9.00 (7.00, 11.25) vs. 7.00 (5.00, 9.00), P=0.002], white blood cell count [(12.29±4.25) vs. (10.41±4.00), P=0.025], SAA [37.85 (11.00, 72.83) vs. 9.00 (8.00, 20.70), P<0.001] and NLR [7.95 (5.22, 12.37) vs. 5.20 (3.25, 8.77), P=0.002] in the adverse pregnancy outcome group were higher than those in the non-adverse pregnancy outcome group. The gestational weeks [30.00 (26.75, 31.00) vs. 33.00 (32.00, 35.00), P<0.001], direct bilirubin [2.10 (1.50, 2.50) vs. 2.20 (1.90, 4.60), P=0.019] and alkaline phosphatase (99.00 (74.00, 124.25) vs. 133.00 (95.00, 188.00), P<0.001] levels in the adverse pregnancy outcome group were significantly lower than those in the non-adverse pregnancy outcome group ( P<0.05). Multivariate Logistic regression analysis showed that earlier gestational weeks ( OR=0.564, 95% CI: 0.408-0.780, P<0.001), higher SAA ( OR=1.028, 95% CI: 1.002-1.055, P=0.036) and APACHE Ⅱ score ( OR=1.282, 95%CI: 1.048-1.569, P=0.016) were the risk factors affecting adverse pregnancy outcomes in patients with severe preeclampsia. The area under the curve of SAA, NLR and SAA, NLR combined with APACHE Ⅱ score were 0.770, 0.678, and 0.844, respectively. The combined prediction efficiency of SAA, NLR and APACHE Ⅱ score was higher than that of single prediction ( P<0.05). Conclusions:SAA and NLR have good predictive efficacy for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team. The predictive efficacy of SAA and NLR combined with APACHE Ⅱ score is higher than that of single index.
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Objective:To establish a mortality risk prediction model of severe bacterial infection in children and compare it with the pediatric early warning score (PEWS), pediatric critical illness score (PCIS) and pediatric risk of mortality score Ⅲ (PRISM Ⅲ).Methods:A total of 178 critically ill children were selected from the PICU of the Children's Hospital of Nanjing Medical University from May 2017 to June 2022. After obtaining the informed consent of the parents/guardians, basic information such as sex, age, height and weight, as well as indicators such as heart rate, systolic blood pressure and respiratory rate were collected from all children. A standard questionnaire was used to score the child 24 h after admission to the PICU. The children were divided into the survival and death groups according to their survival status at 28 d after admission. A mortality risk prediction model was constructed and nomogram was drawn. The value of the mortality risk prediction model, PEWS, PCIS and PRISM in predicting the risk of death was assessed and compared using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC).Results:Among the 178 critically ill children, 11 cases were excluded due to severe data deficiencies and hospitalization not exceeding 24 h. A total of 167 children were included in the analysis, including 134 in the survival group and 33 in the death group. A mortality risk prediction model for children with severe bacterial infection was constructed using pupillary changes, state of consciousness, skin color, mechanical ventilation, total cholesterol and prothrombin time. ROC curve analysis showed that the AUCs of mortality risk prediction model was 0.888 ( P<0.05). The AUCs of PEWS, PCIS and PRISM Ⅲ in predicting death in children with severe bacterial infection were 0.769 ( P< 0.05), 0.575 ( P< 0.05) and 0.759 ( P< 0.05), respectively. Hosmer-Lemeshow goodness-of-fit test showed the best agreement between risk of death and PEWS predicted morbidity and mortality and actual morbidity and mortality (χ 2 = 5.180, P = 0.738; χ 2 = 4.939, P = 0.764), and the PCIS and PRISM Ⅲ predicted mortality rates fitted reasonably well with actual mortality rates (χ 2= 9.110, P= 0333; χ 2 = 8.943, P= 0.347). Conclusions:The mortality risk prediction model for predicting the death risk has better prognostic value than PEWS, PCIS and PRISM Ⅲ for children with severe bacterial infection.
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【Objective】 To study the platelet transfusion predictive models in tumor patients and evaluate its application effect. 【Methods】 A retrospective study was conducted on 944 tumor patients, including 533 males and 411 females who received platelet transfusion in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, the Affiliated Cancer Hospital of Xinjiang Medical University and Kailuan General Hospital from August 2022 to January 2023. Multivariate Logistic regression analysis was used to establish the platelet transfusion predictive models, and Medcalc15.8 software was used to draw the receiver operating curve (ROC) to evaluate the application effect of the prediction model. The actual application effect of models was verified through 162 female clinical cases and 172 male clinical cases. 【Results】 The incidence of platelet transfusion refractoriness in tumor patients was 28.9% (273/944), with 33.2% (177/533) in males, significantly higher than that in females [23.4% (96/411)] (P<0.05). Platelet transfusion predictive models: Y1 (female) =-8.546+ (0.581×number of pregnancies) + (0.964×number of inpatient transfusion bags) + number of previous platelet transfusion bags (5-9 bags: 1.259, ≥20 bags: 1.959) + clinical diagnosis (lymphoma: 2.562, leukemia: 3.214); Y2 (male) =-7.600+ (1.150×inpatient transfusion bags) + previous platelet transfusion bags (10-19 bags: 1.015, ≥20 bags: 0.979) + clinical diagnosis (lymphoma: 1.81, leukemia: 3.208, liver cancer: 1.714). Application effect evaluation: The AUC (area under the curve), cut-off point, corresponding sensitivity and specificity of female and male platelet transfusion effect prediction models were 0.868, -0.354, 68.75%, 89.84% and 0.854, -0.942, 81.36%, 77.53%, respectively. Actual application results showed that the sensitivity, specificity, and accuracy of female and male model were 89.47%, 92.74%, 91.98% and 83.72%, 91.47%, 89.53%, respectively. 【Conclusion】 There is high incidence of platelet transfusion refractoriness in tumor patients, and the predictive model has good prediction effect on platelet transfusion refractoriness in tumor patients, which can provide reliable basis for accurate platelet transfusion in tumor patients.
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Objective To analyze the death-related factors of elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treated by sequential mechanical ventilation,so as to provide evidence for clinical practice. Methods The clinical data of 1204 elderly patients (≥60 years old) with AECOPD treated by sequential mechanical ventilation from June 2015 to June 2021 were retrospectively analyzed.The probability and influencing factors of death were analyzed. Results Among the 1204 elderly patients with AECOPD treated by sequential mechanical ventilation,167 (13.87%) died.Multivariate analysis showed that plasma procalcitonin ≥0.5 μg/L (OR=2.762, 95%CI=1.920-3.972, P<0.001),daily invasive ventilation time ≥12 h (OR=2.202, 95%CI=1.487-3.262,P<0.001),multi-drug resistant bacterial infection (OR=1.790,95%CI=1.237-2.591,P=0.002),oxygenation index<39.90 kPa (OR=2.447,95%CI=1.625-3.685,P<0.001),glycosylated hemoglobin >6% (OR=2.288,95%CI=1.509-3.470,P<0.001),and acute physiology and chronic health evaluation Ⅱ score ≥25 points (OR=2.126,95%CI=1.432-3.156,P<0.001) were independent risk factors for death in patients with AECOPD treated by sequential mechanical ventilation.Oral care>twice/d (OR=0.676,95%CI=0.457-1.000,P=0.048) and sputum excretion>twice/d (OR=0.492, 95%CI=0.311-0.776, P=0.002) were independent protective factors for death in elderly patients with AECOPD treated by sequential mechanical ventilation. Conclusions The outcomes of sequential mechanical ventilation in the treatment of elderly patients with AECOPD are affected by a variety of factors.To reduce the mortality,we put forward the following measures:attaching great importance to severe patients,restoring oxygenation function,shortening unnecessary invasive ventilation time,controlling blood glucose,preventing multidrug resistant bacterial infection,oral care twice a day,and sputum excretion twice a day.
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Humans , Aged , Middle Aged , Respiration, Artificial/methods , Retrospective Studies , Pulmonary Disease, Chronic Obstructive/therapy , SputumABSTRACT
Objective:To investigate the risk factors associated with post-thrombotic syndrome (PTS) within 2 years after the first diagnosis of deep venous thrombosis (DVT) of the lower extremities.Methods:The clinical data and 2-year follow-up data of 260 patients who were first diagnosed with DVT at our department from Jan 2017 to May 2019 were retrospectively analyzed.By Villalta score, the patients were divided into non-PTS group, mild PTS group and moderate-severe PTS group. Ordered multiple classification logistic regression was used to analyze the risk factors for the development of PTS.Results:The incidence of mild and moderate-severe PTS was 22.7% and 15.8%, respectively. Multivariate Logistic regression analysis showed that recurrence history of DVT ( OR=4.754, 95% CI 1.84-12.01, P=0.001), duration of oral anticoagulation treatment ≤6 months (0-3 months: OR=7.791, 95% CI 1.79-33.90, P=0.006; 4-6 months: OR=4.242, 95% CI 1.13-15.99, P=0.033), time length of stretch sock wearing≤ 12 months (0-6 months: OR=9.708, 95% CI 1.81-52.14, P=0.008; 7-12 months: OR=4.899, 95% CI 1.42-16.88, P=0.012) and exercise frequency ≤4 times/week (1-2 times/week: OR=7.691, 95% CI 1.92-30.72, P=0.004; 3-4 times/week: OR=4.284, 95% CI 1.33-13.80, P=0.015) were risk factors for PTS. Catheterized thrombolytic therapy ( OR=0.436, 95% CI 0.20-0.96, P=0.039) and low body mass index (BMI<18.5 kg/m 2: OR=0.142, 95% CI 0.02-0.81, P=0.028), central thrombus ( OR=0.322, 95% CI 0.15-0.72, P=0.005) and peripheral thrombus ( OR=0.020, 95% CI 0.01-0.07, P<0.001) were protective factors for PTS. Conclusions:Patients with DVT have a high risk of developing PTS within 2 years. Catheter-directed thrombolysis, no history of recurrence of DVT, low BMI (<18.5 kg/m 2), central or peripheral thrombosis, long-term oral anticoagulant therapy (≥7 months), longer wearing time of elastic socks (≥1 year), and higher exercise frequency (≥ 5-6 times/week) can be conducive to the reduction of incidence and severity of PTS.
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Objective: Cerebrovascular disease can be roughly divided into 2 subtypes: Cerebral ischemia (CI) and cerebral hemorrhage (CH). No scale currently exist that can predict the subtypes of cerebrovascular diseases. This study aims to establish a prediction scale for the subtypes of cerebrovascular diseases. Methods:A total of 1200 cerebrovascular disease patients were included in this study, data from 1081 (90％) patients were used to establish the CI-CH risk scale, and data from 119 (10％) patients were used to test it. Risk factors for the CI-CH risk scale were identified by 2 screens, with two-tailed student ' s t-test and two-tailed Fisher ' s exact test preliminarily and with logistic regression analysis further. The scores of each risk factor for CI-CH risk scale were determined according to the odds rate, and the cut-off point was determined by Youden index. Results: Nine risk factors were ultimately selected for score system, including age (≥75 years old was ?1, <75 years old was 0), BMI (<24 kg/m2 was 0, 24?28 kg/m2 was ?1,>28 kg/m2 was?2), hypertension grade (grade 1 was 1, grade 2 was 2, and grade 3 was 3), diabetes status (no was 0, yes was?1), antihypertensive drug use (no was 0, yes was?2), alcohol consumption (<60 g/d was 1, ≥60 g/d was 2), uric acid (less than normal was 0, normal was?1, high than normal was?2), LDL cholesterol (<2 mmol/L was 0, 2?4 mmol/L was?1, and>4 mmol/L was?2), and HDL cholesterol (<1.55 mmol/L was 0,≥1.55 mmol/L was 2). Patients with a score more than 0 were classified as the CH group, Conversely, they were assigned to the CI group;its sensitivity, specificity, and accuracy were 74.5％, 77.9％, and 76.4％, respectively. Conclusion: The CI-CH risk scale can help the clinician predict the subtypes of cerebrovascular diseases.
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The purpose of this paper was to introduce how to reasonably carry out the method of the multiple Logistic regression analysis by combining the ROC curve analysis. Firstly， it introduced two groups of the basic concepts related to the ROC curve analysis， that was， the statistical description of common diagnostic indicators and the ROC curve analysis method of the diagnostic data. Secondly， it introduced the core contents of the ROC curve analysis， that was， the calculation of the area under the ROC curve and the comparison of the area under multiple ROC curves. Thirdly， through an example of a diagnostic test， the whole process of how to use SAS software for the analysis was introduced， the contents were as follows： ① the analysis using only multiple Logistic regression analysis； ② the multiple Logistic regression analysis combined with the ROC curve analysis. The conclusion was that， for the diagnostic test data， combining the multiple Logistic regression analysis with the ROC curve analysis could obtain richer and more reasonable statistical analysis results.
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Objective:To investigate the risk factors for anti-tuberculosis drug-induced liver injury (ATB-DILI) in treatment-naive tuberculosis patients, and to provide evidence to avoid the occurrence of ATB-DILI in treatment-naive tuberculosis patients receiving anti-tuberculosis drug treatment.Methods:A retrospective case-control study was carried out in 177 treatment-naive tuberculosis patients admitted to the Third Hospital of Hebei Medical University from January 2014 to December 2019. According to whether developed ATB-DILI during anti-tuberculosis treatment, the patients were divided into non-ATB-DILI group and ATB-DILI group. General basic data of sex, age and body mass index, hepatic biological parameters, prothrombin time, serum ferritin level, basic liver condition and the number of first line hepatotoxic anti-tuberculosis drugs were collected. Mann-Whitney U test and chi-square test were used for statistical analysis, and multi-factor logistic regression analysis was adopted to analyze risk factors for ATB-DILI in treatment-naive tuberculosis patients. Results:The incidence of ATB-DILI was 20.3%(36/177) in the 177 treatment-naive tuberculosis patients. Alanine aminotransferase (ALT), aspartate aminotransferase, incidence of high serum ferritin and the number of first line hepatotoxic anti-tuberculosis drugs were significantly different between non-ATB-DILI group and ATB-DILI group ( Z=-2.13, Z=-2.08, χ2=9.08 and Z=-2.79, respectively, all P<0.050). Multivariate logistic regression analysis showed that chronic viral liver disease (odds ratio ( OR)=9.675, P<0.001), the number of first line hepatotoxic anti-tuberculosis drugs ( OR=4.863, P=0.001), baseline ALT level ( OR=1.016, P=0.011) and high serum ferritin level ( OR=3.336, P=0.018) were the independent risk factors for ATB-DILI. The number of first line hepatotoxic anti-tuberculosis drugs (regression coefficient was 1.582) and baseline ALT level (regression coefficient was 0.016) were both positively correlated with the occurrence of ATB-DILI. Conclusions:Chronic viral liver disease, the number of first line hepatotoxic anti-tuberculosis drugs, higher baseline ALT level and high serum ferritin level are the independent risk factors for ATB-DILI.
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Objective:To analyze the risk factors of the elderly patients with upper urinary tract stones treated by flexible ureteroscope lithotripsy affect the patients′ stone escape.Methods:A retrospective study of 160 patients with upper urinary tract calculi admitted to Baise People′s Hospital from January 2015 to January 2021, all patients were treated with flexible ureteroscopic lithotripsy, and they were 60-85 years old. According to whether the patients had escaped stones, the patients were divided into stone escape group ( n=53) and stone non-escape group ( n=107). Chi-square test was used for comparison of count data between groups. Multivariate Logistic regression analysis was used to analyze the independent risk factors for stone escape in patients; Use R3.3.2 software and software package rms to build a nomogram prediction model; receiver operating characteristic curve (ROC) was used to evaluate the discrimination of the nomogram model in predicting patients with stone escape, and the results were expressed as the area under the curve (AUC) and the 95% confidence interval (95% CI) of the area. Results:Flexible ureteroscope lithotripsy for the treatment of elderly patients with upper urinary tract stones has been found to have good efficacy, low risk of bleeding and fewer complications. In univariate analysis, compared with the stone not-escape group, in the stone escape group, the proportion of patients with mild or moderate preoperative hydronephrosis, the ureteral tube occluder was not used during the operation, intraoperative pump injection pressure of 0.9% sodium chloride injection >200 mmHg, number of stones >1, the location of the stones in the upper and lower calyces of the kidney were significantly increased ( P<0.05). Multivariate Logistic regression analysis found that the preoperative hydronephrosis was mild or moderate, the ureteral tube occluder was not used during the operation, and the intraoperative pump injection pressure of 0.9% sodium chloride injection >200 mmHg were independent risk factors for stone escape in patients. The consistency index (C-index) of the nomogram prediction model and the AUC of the ROC were 0.804 (95% CI: 0.746-0.862) and 0.821 (95% CI: 0.763-0.879), respectively, indicating that the model has good discrimination. Conclusion:Mild or moderate preoperative hydronephrosis, no ureteral tube occluder during operation, and intraoperative pump injection pressure of 0.9% sodium chloride injection >200 mmHg are all risk factors for stone escape in patients.
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Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.
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@#BACKGROUND: To investigate the clinical effectiveness of a pneumatic compression device (PCD) combined with low-molecular-weight heparin (LMWH) for the prevention and treatment of deep vein thrombosis (DVT) in trauma patients. METHODS: This study retrospectively analyzed 286 patients with mild craniocerebral injury and clavicular fractures admitted to our department from January 2016 to February 2020. Patients treated with only LMWH served as the control group, and patients treated with a PCD combined with LMWH as the observation group. The incidence of DVT, postoperative changes in the visual analogue scale (VAS) score, and coagulation function were observed and compared between the two groups. Excluding the influence of other single factors, binary logistic regression analysis was used to evaluate the use of a PCD in the patient's postoperative coagulation function. RESULTS: After excluding 34 patients who did not meet the inclusion criteria, 252 patients were were included. The incidence of DVT in the observation group was significantly lower than that in the control group (5.6% vs. 15.1%, χ2=4.605, P<0.05). The postoperative VAS scores of the two groups were lower than those before surgery (P<0.05). The coagulation function of the observation group was significantly higher than that of the control group, with a better combined anticoagulant effect (P<0.05). There were no significant differences between the two groups in preoperative or postoperative Glasgow Coma Scale scores, intraoperative blood loss, postoperative infection rate, or length of hospital stay (P>0.05). According to logistic regression analysis, the postoperative risk of DVT in patients who received LMWH alone was 1.764 times that of patients who received LMWH+PCD (P<0.05). The area under the receiver operating characteristic (AUROC) curve of partial thromboplastin time (APTT) and platelet (PLT) were greater than 0.5, indicating that they were the influence indicators of adding PCD to prevent DVT. Excluding the influence of other variables, LMWH+PCD effectively improved the coagulation function of patients. CONCLUSIONS: Compared with LMWH alone, LMWH+PCD could improve blood rheology and coagulation function in patients with traumatic brain injury and clavicular fracture, reduce the incidence of DVT, shorten the length of hospital stay, and improve the clinical effectiveness of treatment.
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【Objective】 To analyze the causes of staff burnout and various errors during group blood donation in blood centers, and to explore the significance of overall planning to improve above problems. 【Methods】 Various errors occurred during group blood donation from January 2016 to December 2020 in a blood center were selected as the research object. Job burnout related survey data including emotional exhaustion (MBI-EE), work attitude (MBI-DP), sense of achievement (MBI-PA) etc. were collected. The influence of six variables, including blood collection quantity, staff, order control, plan compliance, overload blood collection and over-stock blood collection, on the occurrence of errors was analyzed, and an ordered logistic regression model was established. After optimizing overall planning measures, the occurrence of errors and the improvement of burnout were compared. 【Results】 In addition to the volume of blood collected (P>0.05), the other five variables had significant influence on the occurrence of errors (P0.05). 【Conclusion】 Scientific inventory management and effective blood collection assessment measures are helpful to improve work quality, and the ordered Logistic regression model has a good fitting degree for error rectification. Analyzing the occurrence of errors during blood collection and supply from the influencing factors is conducive to formulate corrective and preventive measures and promote the continuous improvement of work quality.
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Objective:To explore the prevalence and influencing factors of mental violence in intimate partner violence.Methods:A total of 900 people, who aged 18 to 65 with marriage or love experience, were selected from Xinjiang Uygur Autonomous Region using stratification cluster method. A self-designed questionnaire for general information, the brief conflict tactics scale 2 (CTS-2), perceived stress scales (PSS) and personality diagnostic questionnaire-4+ (PDQ-4+ ) were used for questionnaire investigation. The influencing factors of mental violence were analyzed by binary logistic regression analysis model using SPSS 17.0 software.Results:The scores of CTS-2, PPS and PDQ-4+ were (21.46±6.38), (42.48±18.91), and (3.05±0.62), respectively. In the past one year, the incidence of abusing partners, emotional violence, destroying each other's goods and threatening to hit each other in mental violence were 41.67% (375/900), 33.44% (301/900), and 8.44% (76/900), respectively. Based on the scores of three items, the incidence of mental violence was 55.44% (499/900). Multi-factor logistic regression analysis showed age≤29 ( β=0.57, OR=2.53, 95% CI=1.11-5.99), male ( β=0.64, OR=3.68, 95% CI=1.22-4.56), rural ( β=0.12, OR=2.49, 95% CI=1.17-5.36), moderate and severe drinking ( β=0.33, OR=2.87, 95% CI=2.57-6.63), higher perceived stress level ( β=0.51, OR=1.05, 95% CI=1.03-1.09), personality factors deviate ( β=0.43, OR=2.26, 95% CI=2.13-2.39), lower marital satisfaction ( β=0.18, OR=2.05, 95% CI=1.03-8.76), behavior control over partner ( β=0.16, OR=2.55, 95% CI=1.68-3.69), economic control over partners ( β=0.19, OR=1.36, 95% CI=1.28-1.55) were risk factors of mental violence in intimate partner violence, while individual opposed attitude towards violence ( β=0.29, OR=0.88, 95% CI=0.80-0.94) was the protective factor of mental violence in intimate partner violence. Conclusion:The annual incidence of mental violence is high. Therefore, it is necessary to focus on the young, male, rural and personality deviant people. The incidence of mental violence may be reduced by reducing the individual's perceived stress level, drinking level, behavior control and economic control over partners, and strengthening the marital satisfaction and the individual's opposition to violence.
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Objective:To analyze the main related factors for undertaking the NSFC project among the in-service master and doctor in a third-grade First-class hospital in 2020.Methods:By collecting and comparing the age of the target population, the type of education and degree, SCI papers publication and experience as principal investigator of scientific research projects and other variables, the factors affecting the commitment of the NSFC project were analyzed.Results:A total of 743 feedbacks from the people with master′s degree and doctor′s degree in this survey, 69 of whom had undertaken the NSFC project (accounting for 9.3% of the total number). By the univariate analysis, age, education, age more than 55 years old, professional Dr. and academic Dr., published SCI paper publication, JCR1/JCR2/JCR3/JCR4 publication and experience as principal investigator of scientific research project should significantly improve the opportunity of undertaking the NSFC project. The multivariate analysis results show that the main factors influencing the commitment of the NSFC project are the professional Dr., the academic Dr. and having hosted projects.Conclusions:Professional or academic doctors and experience as principal investigator of scientific research projects have significant advantages in undertaking the NSFC project. Medical institutions should fully consider the advantages of different types of scientific research personnel and make clear their differences in professional fields, in order to develop more targeted programs to improve the capacity for scientific research.
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Objective @#To investigate the influence of abnormal occlusion factors on the incidence of temporomandibular disorders (TMDs) in junior college students and to provide an etiological basis for the prevention and treatment of TMDs.@*Methods @# We examined the temporomandibular joint (TMJ) and dental occlusion in 754 lower grade college students (male 354, female 400) at Zunyi Medical University (Zhuhai campus). A questionnaire was also administered. We analyzed the correlation between TMD and the other three factors (static abnormal occlusion, dynamical abnormal occlusion and oral parafunctional activity) from the perspective of multivariate unconditioned logistic regression and univariate unconditioned logistic regression with dummy variables.@*Results @#The prevalence of TMD was 31.7%. The incidence of TMD was significantly (P<0.05) associated with sleep bruxism (OR=2.070), clenching (OR=2.553), diurnal (OR=2.642) and anterior teeth overbite (OR=1.228). Univariate unconditioned logistics regression analysis by dummy variables was used to analyze the incidence of TMD at different deep overbites (mild, OR=1.558; moderate, OR=2.189; severe, OR=3.236; P<0.05). @*Conclusion@#The risk factors for TMD in lower grade college students included anterior teeth occlusion, sleep bruxism, clenching, and diurnal treatment. Worse deep overbite might increase the risk of TMD.