AIM: To elucidate the clinical, radiological and laboratory pro?les of renal abscess (RA) and perinephric abscess (PNA), along with related treatment and outcome.METHODS: Ninety-eight patients diagnosed with RA...AIM: To elucidate the clinical, radiological and laboratory pro?les of renal abscess (RA) and perinephric abscess (PNA), along with related treatment and outcome.METHODS: Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identi?ed from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition (ICD-10) codes (RA: N15.101, PNA: N15.102) between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients’ characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance pro?les, treatment approaches, and clinical outcomes were collected and analyzed.RESULTS: The mean age of the patients was 46.49 years with a male to female ratio of 41:57. Lumbar pain (76.5%) and fever (53.1%) were the most common symptoms. Other symptoms and signs included chills (28.6%), anorexia and vomiting (25.5%), lethargy (10.2%), abdominal pain (11.2%), fank mass (12.2%), fank ?stula (2.0%), gross hematuria (7.1%), frequency (14.3%), dysuria (9.2%), pyuria (5.1%) and weight loss (1.0%). Painful percussion of the costovertebral angle (87.8%) was the most common physical ?nding. The main predisposing factors were lithiasis (48.0%), diabetes mellitus (33.7%) followed by history of urological surgery (16.3%), urinary tract infections (14.3%), renal function impairment (13.3%), liver cirrhosis (2.0%), neurogenic bladder (1.0%), renal cyst (1.0%), hydronephrosis (1.0%), chronic hepatitis B (1.0%), post-discectomy (1.0%) and post-colectomy (1.0%). Ultrasound (US) and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice.Escherichia coli (51.4%), Staphylococcus aureus (10.0%) and Klebsiella pneumoniae (8.6%) were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders. CONCLUSION: Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.展开更多
Since the outbreak of the coronavirus disease 2019(COVID-19),various measures have been taken to protect against the infection.As droplet and contact transmission are the main routes of COVID-19 infection,endoscopy ce...Since the outbreak of the coronavirus disease 2019(COVID-19),various measures have been taken to protect against the infection.As droplet and contact transmission are the main routes of COVID-19 infection,endoscopy centers are considered to be high-risk areas for exposure to COVID-19.We have undertaken several countermeasures in our endoscopic center during the pandemic,and have gained significant experience in terms of prevention and control of COVID-19.We here present our experience and strategies adopted for preventing hospital infection in our endoscopy center during the COVID-19 pandemic.We describe our management of the environment,endoscope,patients,and medical staff,and our self-made masks.展开更多
The coronavirus disease 2019 was first reported in Wuhan in December 2019 and then spread rapidly throughout the world.On March 11,2020,the World Health Organization declared coronavirus disease 2019 a pandemic.In res...The coronavirus disease 2019 was first reported in Wuhan in December 2019 and then spread rapidly throughout the world.On March 11,2020,the World Health Organization declared coronavirus disease 2019 a pandemic.In response to the pandemic,the management division of West China Hospital oversaw the implementation of hospital-wide emergency measures.In accordance with these measures,the hospital's thoracic surgery ward implemented a new management system by reformulating staff training plans,patient admission procedures,and other systems for managing the ward and protecting perioperative patients.Overall,the ward was successful in restoring normal working order,protecting all staff from occupational exposures,and ensuring the safety of inpatients and their families.展开更多
To review the challenges and countermeasures in the hospital care for Wenchuan earthquake casualties and draw lessons for the protective response in the future. Medical records and laboratory findings of the victims a...To review the challenges and countermeasures in the hospital care for Wenchuan earthquake casualties and draw lessons for the protective response in the future. Medical records and laboratory findings of the victims admitted in West China Hospital (WCH) were retro- spectively analyzed. Related data were compared between beforemath and aftermath of the earthquake and between WCH and frontier county hospitals. One thousand and thirty-one earthquake survivors were hospitalized, 1 358 victims underwent surgery and 142 victims were transferred to intensive care unit. The incidence of infection, crush syndrome and multiple organ dysfunction syndrome (MODS) was 39.6%, 20,7% and 2.3% respectively. Wound classification showed that the incidence of extremity damage was 72%, while the incidence of chest trauma, abdominal trauma and brain trauma was less than 10% respectively. Isolating rates of environmental pathogens were increased in the aftermath of earthquake, and the spectrum of the pathogens and related antibiotic sensitivities were quite different from those in the beforemath of earthquake. The social economic and population conditions in the earthquake-stricken areas affected the composition of the victims and the geographic features restricted the efficiency of rescue. Trauma-induced MODS, crush syndrome and severe infections all constituted the dilemma for the hospital care, to resolve whether the multidiscipline team work was proved to be an optimizing choice. For a more effective disaster protective response in the future, the study on rescue plan and the ladder therapies for massive casualties should be potentiated.展开更多
The novel coronavirus pneumonia(COVID-19)epidemic has brought serious social psychological impact to the Chinese people,especially those quarantined and thus with limited access to face-to-face communication and tradi...The novel coronavirus pneumonia(COVID-19)epidemic has brought serious social psychological impact to the Chinese people,especially those quarantined and thus with limited access to face-to-face communication and traditional social psychological interventions.To better deal with the urgent psychological problems of people involved in the COVID-19 epidemic,we developed a new psychological crisis intervention model by utilizing internet technology.This new model,one of West China Hospital,integrates physicians,psychiatrists,psychologists and social workers into Internet platforms to carry out psychological intervention to patients,their families and medical staff.We hope this model will make a sound basis for developing a more comprehensive psychological crisis intervention response system that is applicable for urgent social and psychological problems.展开更多
Biotherapy Translational Medicine Center of West China Hospital, Sichuan University is one of the research centers in West China Hospital, which is located in High Tech Zone, Chengdu. It includes several core faciliti...Biotherapy Translational Medicine Center of West China Hospital, Sichuan University is one of the research centers in West China Hospital, which is located in High Tech Zone, Chengdu. It includes several core facilities, such as State Key Laboratory of Biotherapy/one of the National Research and Development (R&D) Platforms for Novel Drugs,展开更多
AIM:To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China.METHODS:A total of 265 patients clinically diagnosed with dry eye received a convenience su...AIM:To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China.METHODS:A total of 265 patients clinically diagnosed with dry eye received a convenience survey questionnaire at West China Hospital of Sichuan University.All participants completed the rating scale of health self-management skill for adults(AHSMSRS),Huaxi Emotional-Distress Index(HEI),e-health literacy scale(e-HEALS)and Brief Illness Perception Questionnaire(Brief-IPQ).A generalized linear model was employed to establish a multivariate linear model with demographic data,psychological state,e-HEALS,and illness perception as independent variables and health selfmanagement skill score as the dependent variable.RESULTS:The mean score for health self-management skill was 165.58±15.79.Multivariate analysis revealed that advanced age,better illness perception and improved psychological state were associated with better health selfmanagement ability among dry eye patients.Furthermore,the health self-management ability of patients with a disease duration less than 1y was found to be higher compared to those with a disease duration exceeding 1y.CONCLUSION:The health self-management ability of dry eye patients in west China is relatively high.Age,duration of disease,illness perception and psychological state are the influencing factors on the health selfmanagement ability of dry eye patients.展开更多
Transcatheter aortic valve implantation (TAVI) is a promising alternative, to surgical aortic vane replacement for patients with symptomatic severe aortic stenosis (AS) who were deemed at a high surgical risk. Thi...Transcatheter aortic valve implantation (TAVI) is a promising alternative, to surgical aortic vane replacement for patients with symptomatic severe aortic stenosis (AS) who were deemed at a high surgical risk. This novel technique has kept evolving rapidly throughout the world in the past decade, but was not introduced to China until recently. Here we report our clinical experience in TAVI based on the largest cohort of Chinese patients in a single center.展开更多
Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic ...Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.展开更多
The global population of liver cirrhosis is growing,and China harbors a large number of liver cirrhosis patients throughout the world.Portal hypertension(PHT)not only is the aftermath of liver cirrhosis but also impos...The global population of liver cirrhosis is growing,and China harbors a large number of liver cirrhosis patients throughout the world.Portal hypertension(PHT)not only is the aftermath of liver cirrhosis but also imposes a superimposed attack on the cirrhotic liver.It accounts for approximately one‐third of hospitalizations due to massive variceal bleeding,refractory ascites,and liver and extrahepatic organ failures in the Department of Gastroenterology,West China Hospital.The high shortterm mortality and long‐lasting torment of PHT in patients have been pushing us to try to improve the outcome of the disease since 2000.展开更多
Single-nucleotide polymorphisms in the brain-derived neurotrophic factor gene may affect the secretion and function of brain-derived neurotrophic factor, thereby affecting the occurrence, severity and prognosis of isc...Single-nucleotide polymorphisms in the brain-derived neurotrophic factor gene may affect the secretion and function of brain-derived neurotrophic factor, thereby affecting the occurrence, severity and prognosis of ischemic stroke. This case-control study included 778 patients (475 males and 303 females, mean age of 64.0 ± 12.6 years) in the acute phase of ischemic stroke and 865 control subjects (438 males and 427 females, mean age of 51.7 ± 14.7 years) from the Department of Neurology, Wes: China Hospital, Sichuan University, China between September 2011 and December 2014. The patients' severities of neurological defici:s in the acute phase were assessed using the National Institutes of Health Stroke Scale immediately after admission to hospital. The ischemic stroke patients were divided into different subtypes according to the Trial of Org 10172 in Acute Stroke Treatment classification. Early prognosis was evaluated using the Modified Rankin Scale when the patients were discharged. Genomic DNA was extracted from peripheral blood of participants. Genotyping of rs7124442 and rs6265 was performed using Kompetitive Allele Specific polymerase chain reaction genotyping technology. Our results demonstrated that patients who carried the C allele of the rs7124442 locus had a lower risk of poor prognosis than the T allele carriers (odds ratio [OR]= 0.67;95% confidence interval [CI]: 0.45-1.00;P = 0.048). The patients with the CC or TC genotype also exhibited lower risk than TT carriers (OR = 0.65;95% CI: 0.42-1.00;P = 0.049). The AA genotype at the rs6265 locus was associated with the occurrence of ischemic stroke in patients with large-artery atherosclerosis (OR = 0.5& 95% CI: 0.37-0.90;P = 0.015). We found that the C allele (CC and TC genotypes) at the rs7124442 locus may be protective for the prognosis of ischemic stroke. The AA genotype at the rs6265 locus is likely a protective factor against the occurrence of ischemic stroke in patients with large-artery atherosclerosis. The study protocol was approved by the Ethics Committee of West China Hospital of Sichuan University, China (approval ID number 2008,4]) on July 25, 2008.展开更多
AIM: TO evaluate the prophylaxis of chronic kidney dis- ease (CKD) after liver transplantation (LT) with low-dose calcineurin inhibitor (CNI) and mycophenolate mofetil (MMF).
Allergic rhinitis(AR),with an increasing uptrend of the prevalence in many developed and developing countries,is a global health problem that affects people of all ages and ethnic groups.However,data on the prevalen...Allergic rhinitis(AR),with an increasing uptrend of the prevalence in many developed and developing countries,is a global health problem that affects people of all ages and ethnic groups.However,data on the prevalence of self-reported AR in western China are rare.This study investigated the epidemiological features of self-reported AR in western China.In the cross-sectional,population-based study,a validated questionnaire survey on self-reported AR was carried out in 4 major cities in western China by multistage,stratified and cluster sampling,from January to December 2008.The total prevalence rate was 34.3%,with 32.3%(Chongqing),34.3%(Chengdu),37.9%(Urumqi),30.3%(Nanning),respectively.The prevalence presented to increase with age before 30 years old while decrease with age after 30 years old,and the highest prevalence was in 19-30 years group in Chongqing,Chengdu and Nanning which significantly showed "persistent and moderate-severe" type(P0.0001);In Urumqi,there wasn't a significant increasing or decreasing trend of prevalence rate with age but with an "intermittent and mild"predominance(P0.0001).There were no distinct sexual differences in prevalence rates in the 4 cities.The morbidity was positively related to monthly average temperature and sunshine(r=0.76645,P=0.0036;r=0.67303,P=0.0165),but negatively associated with relative humidity(r=-0.64391,P=0.0238) in Urumqi.Interestingly,the monthly morbidity was negatively associate with average temperature,sunshine and precipitation in Nanning(r=-0.81997,P=0.0011;r=-0.60787,P=0.0360;r=-0.59443,P=0.0415).Self-reported AR is becoming common in western China with a rapid development in recent years,affecting about three persons out of ten.The climatic factors may have an indirect impact on the prevalence rate through the effects on the local allergens.展开更多
The overall survival of patients with cervical cancer has improved due to detection at an early stage and availability of comprehensive treatments in China. As patients' lives prolonged, it is important to underst...The overall survival of patients with cervical cancer has improved due to detection at an early stage and availability of comprehensive treatments in China. As patients' lives prolonged, it is important to understand their health-related quality of life(QoL) during and after treatment. We used the EQ-5D questionnaire to assess QoL of 194 patients with cervical lesions at Sichuan University West China Second Hospital between May 2010 and January 2011. Patients were surveyed before primary treatment and at 1, 3, and 6 months after primary treatment. Results showed a consistent decline in EQ-5D scores in the spectrum of cervical lesions at each time point after treatment(all P < 0.05). For patients with precursor lesions, there was an increasing trend along the timeline of treatment(P < 0.01). For patients with early-stage cervical cancer, EQ-5D scores declined in the first month(P = 0.01) and gradually increased to higher levels at 6 months post-treatment than those before treatment(P < 0.01). EQ-5D scores followed a similar trend in patients with advanced cervical cancer(P = 0.04), though they did not statistically rebound after 6 months(0.84 ± 0.19 vs. 0.86 ± 0.11, P = 0.62). Regarding advanced cervical cancer, EQ-5D scores for women above 40 years of age appeared to recover more rapidly and reached higher levels than those for women below 40 years(P = 0.03). Caution and extra care are recommended in the early period of cervical cancer treatment given the slight deterioration in the QoL, and in particular, for younger cervical cancer patients. Our study implies that health care providers may need to improve the health-related QoL of cervical cancer patients.展开更多
BACKGROUND Few studies from developed countries have quantitatively characterized the clinical characteristics and outcomes of patients receiving contemporary intensive cardiac care.We sought to investigate these data...BACKGROUND Few studies from developed countries have quantitatively characterized the clinical characteristics and outcomes of patients receiving contemporary intensive cardiac care.We sought to investigate these data in patients admitted to a Chinese intensive cardiac care unit(ICCU).METHODS We conducted a retrospective study using data from 2,337 consecutive admissions to the ICCU at a large centre in China from June 2016 to May 2017.Data were captured after systematic inspection of individual medical records regarding current demographics,primary diagnosis,comorbidities,illnesses severity,and in-hospital outcomes.RESULTS The mean age was 65.6±14.2 years,and females accounted for 32.0%of patients.The Charlson Comorbidity Index and Oxford Acute Severity of Illness Score were 2.4±1.8 and 22.5±10.4,respectively.The top reason for admission was ST-segment elevation myocardial infarction(32.0%),and nonischaemic heart diseases accounted for 31.2%of all primary diagnoses.Noncardiovascular diseases were prevalent in the ICCU population,including chronic illnesses and acute noncardiovascular critical illnesses(ANCIs);in particular,21.7%of patients were marked by acute respiratory failure(14.6%),acute kidney injury(13.7%),sepsis(4.2%),or gastrointestinal bleeding(3.3%).The median length of stay in the ICCU and hospital were 1.1 days[interquartile range(IQR):0.8–2.6 days]and 6.3 days(IQR:3.8−10.9 days),respectively.The overall incidence of in-hospital death or discharge against medical advice under extremely critical conditions was 7.6%(n=177).Multivariate logistic regression analysis showed that the complexity of chronic illnesses and incident ANCIs were strong independent determinants for in-hospital outcomes.CONCLUSIONS Remarkable patient diversity and breadth of critical illnesses were observed in a Chinese ICCU population.Particularly,noncardiovascular diseases were prevalent and associated with adverse outcomes.Reformation of organization and staffing practices may be considered to adapt to the changed landscape.展开更多
BACKGROUND Gastrointestinal involvement in Behçet's disease(GIBD)and Crohn’s disease(CD)are inflammatory diseases sharing a considerable number of similarities.However,different from CD,the operative and pos...BACKGROUND Gastrointestinal involvement in Behçet's disease(GIBD)and Crohn’s disease(CD)are inflammatory diseases sharing a considerable number of similarities.However,different from CD,the operative and postoperative management of GIBD remains largely empirical because of the lack of comprehensive treatment guidelines.AIM To compare surgical patients with GIBD and those with CD in a medical center and identify notable clinical features and effective postoperative treatment for surgical patients with GIBD.METHODS We searched patients diagnosed with CD and GIBD who underwent operations for gastrointestinal complications from 2009 to 2015 at West China Hospital of Sichuan University.A total of 10 surgical patients with GIBD and 106 surgical patients with CD were recruited.Information including demographic data,medication,and operative and postoperative parameters were collected and analyzed.As the incidence of surgical GIBD is low,their detailed medical records were reviewed and compared to previous studies.Moreover,the prognoses of CD and GIBD were evaluated respectively between groups treated with biological and non-biological agents.RESULTS Indication for first surgery was often acute intestinal perforation for GIBDpatients (7/10 vs 0/106, P < 0.001), whereas intestinal fistulae (0/10 vs 44/106, P =0.013) and ileus (0/10 vs 40/106, P = 0.015) were the indications for surgical CDpatients. Approximately 40% of patients with GIBD and 23.6% of patients withCD developed postoperative complications, 50% of patients with GIBD and 38.7%of patients with CD had recurrence postoperatively, and 40% (4/10) of patientswith GIBD and 26.4% (28/106) of patients with CD underwent reoperations. Theaverage period of postoperative recurrence was 7.87 mo in patients with Behçet'sdisease (BD) and 10.43 mo in patients with CD, whereas the mean duration fromfirst surgery to reoperation was 5.75 mo in BD patients and 18.04 mo in CDpatients. Surgical patients with GIBD more often used corticosteroids (6/10 vs7/106, P < 0.001) and thalidomide (7/10 vs 9/106, P < 0.001) postoperatively,whereas surgical patients with CD often used infliximab (27/106), azathioprine,or 6-mercaptopurine (74/106) for maintenance therapy.CONCLUSIONPatients suffering GIBD require surgery mostly under emergency situations,which may be more susceptible to recurrence and reoperation and need moreaggressive postoperative treatment than patients with CD.展开更多
AIM:To investigate the current situation and influencing factors of fear of falling in glaucoma patients in western China.METHODS:In this cross-sectional study,glaucoma patients treated in the Ophthalmology Department...AIM:To investigate the current situation and influencing factors of fear of falling in glaucoma patients in western China.METHODS:In this cross-sectional study,glaucoma patients treated in the Ophthalmology Department of West China Hospital of Sichuan University were conducted to investigate the demographic data,visual acuity,visual field,activities of daily living,risk of falling,fear of falling and psychological states.Generalized linear model was used for multivariate analysis with fear of falling as dependent variable and other factors as independent variables.RESULTS:The mean score of the Chinese version modified Fall Efficacy Scale(MFES)was 7.52±2.09 points.Univariate analysis and multivariate analysis showed that the history of falls within one year,visual acuity,visual field,risk of falling,activities of daily living and psychological states had statistically difference on fear of falling(P<0.05).CONCLUSION:Glaucoma patients in west China have relatively high risk of fear of falling.History of falling within 1y,severe visual function impairment,high risk of falling,incapable of independence of daily living,and abnormal psychological state are risk factors of fear of falling among glaucoma patients.展开更多
The high prevalence of diabetes has become a major public health issue worldwide[1], particularly in middle-and low-income countries[2]. The prevalence of diabetes in China, the largest developing country,has more tha...The high prevalence of diabetes has become a major public health issue worldwide[1], particularly in middle-and low-income countries[2]. The prevalence of diabetes in China, the largest developing country,has more than quadrupled in recent decades, and many cases of diabetes are undiagnosed[3]. The problem with missed diabetes diagnoses is a challenge faced both by China and the rest of the world[4].展开更多
BACKGROUND Acute pancreatitis(AP)is a disease caused by abnormal activation of pancreatic enzymes and can lead to self-digestion of pancreatic tissues and dysfunction of other organs.Enteral nutrition plays a vital ro...BACKGROUND Acute pancreatitis(AP)is a disease caused by abnormal activation of pancreatic enzymes and can lead to self-digestion of pancreatic tissues and dysfunction of other organs.Enteral nutrition plays a vital role in the treatment of AP because it can meet the nutritional needs of patients,promote the recovery of intestinal function,and maintain the barrier and immune functions of the intestine.However,the risk of aspiration during enteral nutrition is high;once aspiration occurs,it may cause serious complications,such as aspiration pneumonia,and suffocation,posing a threat to the patient’s life.This study aims to establish and validate a prediction model for enteral nutrition aspiration during hospitalization in patients with AP.AIM To establish and validate a predictive model for enteral nutrition aspiration during hospitalization in patients with AP.METHODS A retrospective review was conducted on 200 patients with AP admitted to Chengdu Shangjin Nanfu Hospital,West China Hospital of Sichuan University from January 2020 to February 2024.Clinical data were collected from the electronic medical record system.Patients were randomly divided into a validation group(n=40)and a modeling group(n=160)in a 1:4 ratio,matched with 200 patients from the same time period.The modeling group was further categorized into an aspiration group(n=25)and a non-aspiration group(n=175)based on the occurrence of enteral nutrition aspiration during hospitalization.Univariate and multivariate logistic regression analyses were performed to identify factors influencing enteral nutrition aspiration in patients with AP during hospitalization.A prediction model for enteral nutrition aspiration during hospitalization was constructed,and calibration curves were used for validation.Receiver operating characteristic curve analysis was conducted to evaluate the predictive value of the model.RESULTS There was no statistically significant difference in general data between the validation and modeling groups(P>0.05).The comparison of age,gender,body mass index,smoking history,hypertension history,and diabetes history showed no statistically significant difference between the two groups(P>0.05).However,patient position,consciousness status,nutritional risk,Acute Physiology and Chronic Health Evaluation(APACHE-II)score,and length of nasogastric tube placement showed statistically significant differences(P<0.05)between the two groups.Multivariate logistic regression analysis showed that patient position,consciousness status,nutritional risk,APACHE-II score,and length of nasogastric tube placement were independent factors influencing enteral nutrition aspiration in patients with AP during hospitalization(P<0.05).These factors were incorporated into the prediction model,which showed good consistency between the predicted and actual risks,as indicated by calibration curves with slopes close to 1 in the training and validation sets.Receiver operating characteristic analysis revealed an area under the curve(AUC)of 0.926(95%CI:0.8889-0.9675)in the training set.The optimal cutoff value is 0.73,with a sensitivity of 88.4 and specificity of 85.2.In the validation set,the AUC of the model for predicting enteral nutrition aspiration in patients with AP patients during hospitalization was 0.902,with a standard error of 0.040(95%CI:0.8284-0.9858),and the best cutoff value was 0.73,with a sensitivity of 91.9 and specificity of 81.8.CONCLUSION A prediction model for enteral nutrition aspiration during hospitalization in patients with AP was established and demonstrated high predictive value.Further clinical application of the model is warranted.展开更多
Falling is the second leading cause of accidental injury to death worldwide.It is estimated that more than 80%of the people die each year in low and middle-income countries.Falling is also the leading cause of death a...Falling is the second leading cause of accidental injury to death worldwide.It is estimated that more than 80%of the people die each year in low and middle-income countries.Falling is also the leading cause of death among the elderly in China.Among them,the falling rate in 2016 increased by 5%compared with 2006.Although not fatal,those who fell and have a disability,which may face significant economic risks associated with subsequent long-term care needs,especially for the elderly[凹].It may be essential to use evidence-based guidelines for proving health education to address the issue of preventing hospitalization for the elderly.This article will combine the author's practical experience to examine the contribution of health education to prevent falls and explore its application and development in China.Lastly,it will explain barriers to health education.展开更多
文摘AIM: To elucidate the clinical, radiological and laboratory pro?les of renal abscess (RA) and perinephric abscess (PNA), along with related treatment and outcome.METHODS: Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identi?ed from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition (ICD-10) codes (RA: N15.101, PNA: N15.102) between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients’ characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance pro?les, treatment approaches, and clinical outcomes were collected and analyzed.RESULTS: The mean age of the patients was 46.49 years with a male to female ratio of 41:57. Lumbar pain (76.5%) and fever (53.1%) were the most common symptoms. Other symptoms and signs included chills (28.6%), anorexia and vomiting (25.5%), lethargy (10.2%), abdominal pain (11.2%), fank mass (12.2%), fank ?stula (2.0%), gross hematuria (7.1%), frequency (14.3%), dysuria (9.2%), pyuria (5.1%) and weight loss (1.0%). Painful percussion of the costovertebral angle (87.8%) was the most common physical ?nding. The main predisposing factors were lithiasis (48.0%), diabetes mellitus (33.7%) followed by history of urological surgery (16.3%), urinary tract infections (14.3%), renal function impairment (13.3%), liver cirrhosis (2.0%), neurogenic bladder (1.0%), renal cyst (1.0%), hydronephrosis (1.0%), chronic hepatitis B (1.0%), post-discectomy (1.0%) and post-colectomy (1.0%). Ultrasound (US) and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice.Escherichia coli (51.4%), Staphylococcus aureus (10.0%) and Klebsiella pneumoniae (8.6%) were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders. CONCLUSION: Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.
文摘Since the outbreak of the coronavirus disease 2019(COVID-19),various measures have been taken to protect against the infection.As droplet and contact transmission are the main routes of COVID-19 infection,endoscopy centers are considered to be high-risk areas for exposure to COVID-19.We have undertaken several countermeasures in our endoscopic center during the pandemic,and have gained significant experience in terms of prevention and control of COVID-19.We here present our experience and strategies adopted for preventing hospital infection in our endoscopy center during the COVID-19 pandemic.We describe our management of the environment,endoscope,patients,and medical staff,and our self-made masks.
文摘The coronavirus disease 2019 was first reported in Wuhan in December 2019 and then spread rapidly throughout the world.On March 11,2020,the World Health Organization declared coronavirus disease 2019 a pandemic.In response to the pandemic,the management division of West China Hospital oversaw the implementation of hospital-wide emergency measures.In accordance with these measures,the hospital's thoracic surgery ward implemented a new management system by reformulating staff training plans,patient admission procedures,and other systems for managing the ward and protecting perioperative patients.Overall,the ward was successful in restoring normal working order,protecting all staff from occupational exposures,and ensuring the safety of inpatients and their families.
文摘To review the challenges and countermeasures in the hospital care for Wenchuan earthquake casualties and draw lessons for the protective response in the future. Medical records and laboratory findings of the victims admitted in West China Hospital (WCH) were retro- spectively analyzed. Related data were compared between beforemath and aftermath of the earthquake and between WCH and frontier county hospitals. One thousand and thirty-one earthquake survivors were hospitalized, 1 358 victims underwent surgery and 142 victims were transferred to intensive care unit. The incidence of infection, crush syndrome and multiple organ dysfunction syndrome (MODS) was 39.6%, 20,7% and 2.3% respectively. Wound classification showed that the incidence of extremity damage was 72%, while the incidence of chest trauma, abdominal trauma and brain trauma was less than 10% respectively. Isolating rates of environmental pathogens were increased in the aftermath of earthquake, and the spectrum of the pathogens and related antibiotic sensitivities were quite different from those in the beforemath of earthquake. The social economic and population conditions in the earthquake-stricken areas affected the composition of the victims and the geographic features restricted the efficiency of rescue. Trauma-induced MODS, crush syndrome and severe infections all constituted the dilemma for the hospital care, to resolve whether the multidiscipline team work was proved to be an optimizing choice. For a more effective disaster protective response in the future, the study on rescue plan and the ladder therapies for massive casualties should be potentiated.
基金This paper is supported by the 13th Five-year Plan for Disciplines of Excellence,West China Hospital of Sichuan University,and the National Natural Science Foundation of China(grants No.81701328,81871061,and 81371484).
文摘The novel coronavirus pneumonia(COVID-19)epidemic has brought serious social psychological impact to the Chinese people,especially those quarantined and thus with limited access to face-to-face communication and traditional social psychological interventions.To better deal with the urgent psychological problems of people involved in the COVID-19 epidemic,we developed a new psychological crisis intervention model by utilizing internet technology.This new model,one of West China Hospital,integrates physicians,psychiatrists,psychologists and social workers into Internet platforms to carry out psychological intervention to patients,their families and medical staff.We hope this model will make a sound basis for developing a more comprehensive psychological crisis intervention response system that is applicable for urgent social and psychological problems.
文摘Biotherapy Translational Medicine Center of West China Hospital, Sichuan University is one of the research centers in West China Hospital, which is located in High Tech Zone, Chengdu. It includes several core facilities, such as State Key Laboratory of Biotherapy/one of the National Research and Development (R&D) Platforms for Novel Drugs,
文摘AIM:To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China.METHODS:A total of 265 patients clinically diagnosed with dry eye received a convenience survey questionnaire at West China Hospital of Sichuan University.All participants completed the rating scale of health self-management skill for adults(AHSMSRS),Huaxi Emotional-Distress Index(HEI),e-health literacy scale(e-HEALS)and Brief Illness Perception Questionnaire(Brief-IPQ).A generalized linear model was employed to establish a multivariate linear model with demographic data,psychological state,e-HEALS,and illness perception as independent variables and health selfmanagement skill score as the dependent variable.RESULTS:The mean score for health self-management skill was 165.58±15.79.Multivariate analysis revealed that advanced age,better illness perception and improved psychological state were associated with better health selfmanagement ability among dry eye patients.Furthermore,the health self-management ability of patients with a disease duration less than 1y was found to be higher compared to those with a disease duration exceeding 1y.CONCLUSION:The health self-management ability of dry eye patients in west China is relatively high.Age,duration of disease,illness perception and psychological state are the influencing factors on the health selfmanagement ability of dry eye patients.
文摘Transcatheter aortic valve implantation (TAVI) is a promising alternative, to surgical aortic vane replacement for patients with symptomatic severe aortic stenosis (AS) who were deemed at a high surgical risk. This novel technique has kept evolving rapidly throughout the world in the past decade, but was not introduced to China until recently. Here we report our clinical experience in TAVI based on the largest cohort of Chinese patients in a single center.
基金supported by the National Key Research and Development Project,No.2019YFA0112100(to SF).
文摘Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.
基金Technological innovation R&D project of Chengdu Science and Technology Bureau,Grant/Award Number:2021‐YF05‐01285‐SN1‐3‐5 Project for Disciplines of Excellence:Clinical Research Incubation Project,Grant/Award Number:2019HXFH024。
文摘The global population of liver cirrhosis is growing,and China harbors a large number of liver cirrhosis patients throughout the world.Portal hypertension(PHT)not only is the aftermath of liver cirrhosis but also imposes a superimposed attack on the cirrhotic liver.It accounts for approximately one‐third of hospitalizations due to massive variceal bleeding,refractory ascites,and liver and extrahepatic organ failures in the Department of Gastroenterology,West China Hospital.The high shortterm mortality and long‐lasting torment of PHT in patients have been pushing us to try to improve the outcome of the disease since 2000.
基金supported by the National Natural Science Foundation of China,No.81472162(to MKZ)
文摘Single-nucleotide polymorphisms in the brain-derived neurotrophic factor gene may affect the secretion and function of brain-derived neurotrophic factor, thereby affecting the occurrence, severity and prognosis of ischemic stroke. This case-control study included 778 patients (475 males and 303 females, mean age of 64.0 ± 12.6 years) in the acute phase of ischemic stroke and 865 control subjects (438 males and 427 females, mean age of 51.7 ± 14.7 years) from the Department of Neurology, Wes: China Hospital, Sichuan University, China between September 2011 and December 2014. The patients' severities of neurological defici:s in the acute phase were assessed using the National Institutes of Health Stroke Scale immediately after admission to hospital. The ischemic stroke patients were divided into different subtypes according to the Trial of Org 10172 in Acute Stroke Treatment classification. Early prognosis was evaluated using the Modified Rankin Scale when the patients were discharged. Genomic DNA was extracted from peripheral blood of participants. Genotyping of rs7124442 and rs6265 was performed using Kompetitive Allele Specific polymerase chain reaction genotyping technology. Our results demonstrated that patients who carried the C allele of the rs7124442 locus had a lower risk of poor prognosis than the T allele carriers (odds ratio [OR]= 0.67;95% confidence interval [CI]: 0.45-1.00;P = 0.048). The patients with the CC or TC genotype also exhibited lower risk than TT carriers (OR = 0.65;95% CI: 0.42-1.00;P = 0.049). The AA genotype at the rs6265 locus was associated with the occurrence of ischemic stroke in patients with large-artery atherosclerosis (OR = 0.5& 95% CI: 0.37-0.90;P = 0.015). We found that the C allele (CC and TC genotypes) at the rs7124442 locus may be protective for the prognosis of ischemic stroke. The AA genotype at the rs6265 locus is likely a protective factor against the occurrence of ischemic stroke in patients with large-artery atherosclerosis. The study protocol was approved by the Ethics Committee of West China Hospital of Sichuan University, China (approval ID number 2008,4]) on July 25, 2008.
基金Supported by Chinese Key Project for Prophylaxis and Treatment of Infection Diseases,No.2008ZX10002-025 and No.2008 ZX10002-026
文摘AIM: TO evaluate the prophylaxis of chronic kidney dis- ease (CKD) after liver transplantation (LT) with low-dose calcineurin inhibitor (CNI) and mycophenolate mofetil (MMF).
基金supported by the Science Research grants for the 10th 5-year plan to SL.H. (2004BA720A19-02)
文摘Allergic rhinitis(AR),with an increasing uptrend of the prevalence in many developed and developing countries,is a global health problem that affects people of all ages and ethnic groups.However,data on the prevalence of self-reported AR in western China are rare.This study investigated the epidemiological features of self-reported AR in western China.In the cross-sectional,population-based study,a validated questionnaire survey on self-reported AR was carried out in 4 major cities in western China by multistage,stratified and cluster sampling,from January to December 2008.The total prevalence rate was 34.3%,with 32.3%(Chongqing),34.3%(Chengdu),37.9%(Urumqi),30.3%(Nanning),respectively.The prevalence presented to increase with age before 30 years old while decrease with age after 30 years old,and the highest prevalence was in 19-30 years group in Chongqing,Chengdu and Nanning which significantly showed "persistent and moderate-severe" type(P0.0001);In Urumqi,there wasn't a significant increasing or decreasing trend of prevalence rate with age but with an "intermittent and mild"predominance(P0.0001).There were no distinct sexual differences in prevalence rates in the 4 cities.The morbidity was positively related to monthly average temperature and sunshine(r=0.76645,P=0.0036;r=0.67303,P=0.0165),but negatively associated with relative humidity(r=-0.64391,P=0.0238) in Urumqi.Interestingly,the monthly morbidity was negatively associate with average temperature,sunshine and precipitation in Nanning(r=-0.81997,P=0.0011;r=-0.60787,P=0.0360;r=-0.59443,P=0.0415).Self-reported AR is becoming common in western China with a rapid development in recent years,affecting about three persons out of ten.The climatic factors may have an indirect impact on the prevalence rate through the effects on the local allergens.
基金sponsored by a grant from the China Ministry of Health Special Funds for Public Sector Research (No. 2009020027)
文摘The overall survival of patients with cervical cancer has improved due to detection at an early stage and availability of comprehensive treatments in China. As patients' lives prolonged, it is important to understand their health-related quality of life(QoL) during and after treatment. We used the EQ-5D questionnaire to assess QoL of 194 patients with cervical lesions at Sichuan University West China Second Hospital between May 2010 and January 2011. Patients were surveyed before primary treatment and at 1, 3, and 6 months after primary treatment. Results showed a consistent decline in EQ-5D scores in the spectrum of cervical lesions at each time point after treatment(all P < 0.05). For patients with precursor lesions, there was an increasing trend along the timeline of treatment(P < 0.01). For patients with early-stage cervical cancer, EQ-5D scores declined in the first month(P = 0.01) and gradually increased to higher levels at 6 months post-treatment than those before treatment(P < 0.01). EQ-5D scores followed a similar trend in patients with advanced cervical cancer(P = 0.04), though they did not statistically rebound after 6 months(0.84 ± 0.19 vs. 0.86 ± 0.11, P = 0.62). Regarding advanced cervical cancer, EQ-5D scores for women above 40 years of age appeared to recover more rapidly and reached higher levels than those for women below 40 years(P = 0.03). Caution and extra care are recommended in the early period of cervical cancer treatment given the slight deterioration in the QoL, and in particular, for younger cervical cancer patients. Our study implies that health care providers may need to improve the health-related QoL of cervical cancer patients.
基金This study was supported by the National Natural Science Foundation of China(No.81900258)and the Key Research and Development Projects of Science&Technology Department of Sichuan Province(2019YFS0351).
文摘BACKGROUND Few studies from developed countries have quantitatively characterized the clinical characteristics and outcomes of patients receiving contemporary intensive cardiac care.We sought to investigate these data in patients admitted to a Chinese intensive cardiac care unit(ICCU).METHODS We conducted a retrospective study using data from 2,337 consecutive admissions to the ICCU at a large centre in China from June 2016 to May 2017.Data were captured after systematic inspection of individual medical records regarding current demographics,primary diagnosis,comorbidities,illnesses severity,and in-hospital outcomes.RESULTS The mean age was 65.6±14.2 years,and females accounted for 32.0%of patients.The Charlson Comorbidity Index and Oxford Acute Severity of Illness Score were 2.4±1.8 and 22.5±10.4,respectively.The top reason for admission was ST-segment elevation myocardial infarction(32.0%),and nonischaemic heart diseases accounted for 31.2%of all primary diagnoses.Noncardiovascular diseases were prevalent in the ICCU population,including chronic illnesses and acute noncardiovascular critical illnesses(ANCIs);in particular,21.7%of patients were marked by acute respiratory failure(14.6%),acute kidney injury(13.7%),sepsis(4.2%),or gastrointestinal bleeding(3.3%).The median length of stay in the ICCU and hospital were 1.1 days[interquartile range(IQR):0.8–2.6 days]and 6.3 days(IQR:3.8−10.9 days),respectively.The overall incidence of in-hospital death or discharge against medical advice under extremely critical conditions was 7.6%(n=177).Multivariate logistic regression analysis showed that the complexity of chronic illnesses and incident ANCIs were strong independent determinants for in-hospital outcomes.CONCLUSIONS Remarkable patient diversity and breadth of critical illnesses were observed in a Chinese ICCU population.Particularly,noncardiovascular diseases were prevalent and associated with adverse outcomes.Reformation of organization and staffing practices may be considered to adapt to the changed landscape.
基金National Natural Science Foundation of China,No.81270447.
文摘BACKGROUND Gastrointestinal involvement in Behçet's disease(GIBD)and Crohn’s disease(CD)are inflammatory diseases sharing a considerable number of similarities.However,different from CD,the operative and postoperative management of GIBD remains largely empirical because of the lack of comprehensive treatment guidelines.AIM To compare surgical patients with GIBD and those with CD in a medical center and identify notable clinical features and effective postoperative treatment for surgical patients with GIBD.METHODS We searched patients diagnosed with CD and GIBD who underwent operations for gastrointestinal complications from 2009 to 2015 at West China Hospital of Sichuan University.A total of 10 surgical patients with GIBD and 106 surgical patients with CD were recruited.Information including demographic data,medication,and operative and postoperative parameters were collected and analyzed.As the incidence of surgical GIBD is low,their detailed medical records were reviewed and compared to previous studies.Moreover,the prognoses of CD and GIBD were evaluated respectively between groups treated with biological and non-biological agents.RESULTS Indication for first surgery was often acute intestinal perforation for GIBDpatients (7/10 vs 0/106, P < 0.001), whereas intestinal fistulae (0/10 vs 44/106, P =0.013) and ileus (0/10 vs 40/106, P = 0.015) were the indications for surgical CDpatients. Approximately 40% of patients with GIBD and 23.6% of patients withCD developed postoperative complications, 50% of patients with GIBD and 38.7%of patients with CD had recurrence postoperatively, and 40% (4/10) of patientswith GIBD and 26.4% (28/106) of patients with CD underwent reoperations. Theaverage period of postoperative recurrence was 7.87 mo in patients with Behçet'sdisease (BD) and 10.43 mo in patients with CD, whereas the mean duration fromfirst surgery to reoperation was 5.75 mo in BD patients and 18.04 mo in CDpatients. Surgical patients with GIBD more often used corticosteroids (6/10 vs7/106, P < 0.001) and thalidomide (7/10 vs 9/106, P < 0.001) postoperatively,whereas surgical patients with CD often used infliximab (27/106), azathioprine,or 6-mercaptopurine (74/106) for maintenance therapy.CONCLUSIONPatients suffering GIBD require surgery mostly under emergency situations,which may be more susceptible to recurrence and reoperation and need moreaggressive postoperative treatment than patients with CD.
文摘AIM:To investigate the current situation and influencing factors of fear of falling in glaucoma patients in western China.METHODS:In this cross-sectional study,glaucoma patients treated in the Ophthalmology Department of West China Hospital of Sichuan University were conducted to investigate the demographic data,visual acuity,visual field,activities of daily living,risk of falling,fear of falling and psychological states.Generalized linear model was used for multivariate analysis with fear of falling as dependent variable and other factors as independent variables.RESULTS:The mean score of the Chinese version modified Fall Efficacy Scale(MFES)was 7.52±2.09 points.Univariate analysis and multivariate analysis showed that the history of falls within one year,visual acuity,visual field,risk of falling,activities of daily living and psychological states had statistically difference on fear of falling(P<0.05).CONCLUSION:Glaucoma patients in west China have relatively high risk of fear of falling.History of falling within 1y,severe visual function impairment,high risk of falling,incapable of independence of daily living,and abnormal psychological state are risk factors of fear of falling among glaucoma patients.
基金supported by the Szechwan Province Science and Technology Agency Fund Project [2009FZ 0027]Chengdu,China and the Population and Health Project of the Chengdu Municipal Science and Technology Bureau[10YTYB272SF-182]
文摘The high prevalence of diabetes has become a major public health issue worldwide[1], particularly in middle-and low-income countries[2]. The prevalence of diabetes in China, the largest developing country,has more than quadrupled in recent decades, and many cases of diabetes are undiagnosed[3]. The problem with missed diabetes diagnoses is a challenge faced both by China and the rest of the world[4].
文摘BACKGROUND Acute pancreatitis(AP)is a disease caused by abnormal activation of pancreatic enzymes and can lead to self-digestion of pancreatic tissues and dysfunction of other organs.Enteral nutrition plays a vital role in the treatment of AP because it can meet the nutritional needs of patients,promote the recovery of intestinal function,and maintain the barrier and immune functions of the intestine.However,the risk of aspiration during enteral nutrition is high;once aspiration occurs,it may cause serious complications,such as aspiration pneumonia,and suffocation,posing a threat to the patient’s life.This study aims to establish and validate a prediction model for enteral nutrition aspiration during hospitalization in patients with AP.AIM To establish and validate a predictive model for enteral nutrition aspiration during hospitalization in patients with AP.METHODS A retrospective review was conducted on 200 patients with AP admitted to Chengdu Shangjin Nanfu Hospital,West China Hospital of Sichuan University from January 2020 to February 2024.Clinical data were collected from the electronic medical record system.Patients were randomly divided into a validation group(n=40)and a modeling group(n=160)in a 1:4 ratio,matched with 200 patients from the same time period.The modeling group was further categorized into an aspiration group(n=25)and a non-aspiration group(n=175)based on the occurrence of enteral nutrition aspiration during hospitalization.Univariate and multivariate logistic regression analyses were performed to identify factors influencing enteral nutrition aspiration in patients with AP during hospitalization.A prediction model for enteral nutrition aspiration during hospitalization was constructed,and calibration curves were used for validation.Receiver operating characteristic curve analysis was conducted to evaluate the predictive value of the model.RESULTS There was no statistically significant difference in general data between the validation and modeling groups(P>0.05).The comparison of age,gender,body mass index,smoking history,hypertension history,and diabetes history showed no statistically significant difference between the two groups(P>0.05).However,patient position,consciousness status,nutritional risk,Acute Physiology and Chronic Health Evaluation(APACHE-II)score,and length of nasogastric tube placement showed statistically significant differences(P<0.05)between the two groups.Multivariate logistic regression analysis showed that patient position,consciousness status,nutritional risk,APACHE-II score,and length of nasogastric tube placement were independent factors influencing enteral nutrition aspiration in patients with AP during hospitalization(P<0.05).These factors were incorporated into the prediction model,which showed good consistency between the predicted and actual risks,as indicated by calibration curves with slopes close to 1 in the training and validation sets.Receiver operating characteristic analysis revealed an area under the curve(AUC)of 0.926(95%CI:0.8889-0.9675)in the training set.The optimal cutoff value is 0.73,with a sensitivity of 88.4 and specificity of 85.2.In the validation set,the AUC of the model for predicting enteral nutrition aspiration in patients with AP patients during hospitalization was 0.902,with a standard error of 0.040(95%CI:0.8284-0.9858),and the best cutoff value was 0.73,with a sensitivity of 91.9 and specificity of 81.8.CONCLUSION A prediction model for enteral nutrition aspiration during hospitalization in patients with AP was established and demonstrated high predictive value.Further clinical application of the model is warranted.
文摘Falling is the second leading cause of accidental injury to death worldwide.It is estimated that more than 80%of the people die each year in low and middle-income countries.Falling is also the leading cause of death among the elderly in China.Among them,the falling rate in 2016 increased by 5%compared with 2006.Although not fatal,those who fell and have a disability,which may face significant economic risks associated with subsequent long-term care needs,especially for the elderly[凹].It may be essential to use evidence-based guidelines for proving health education to address the issue of preventing hospitalization for the elderly.This article will combine the author's practical experience to examine the contribution of health education to prevent falls and explore its application and development in China.Lastly,it will explain barriers to health education.