Contamination assessment,source apportionment and associated health risks of PTEs in agricultural soil under five land-use patterns in Sanya,China

To understand the levels of potentially toxic elements(PTEs)contamination in soils and their effects on human health from different agricultural land use in Sanya,China.128 soil samples(64 topsoil samples and corresponding subsoil samples)were collected from the five representative land-use patterns.Inductively coupled plasma mass spectrometry(ICP-MS),Atomic fluorescence spectrometry(AFS),and Inductively coupled plasma optical emission spectrometry(ICP-OES)were used to determine the content of PTEs(As,Cd,Hg,Cu,Cr,Ni,Pb,Zn,Co,Mo,Sb,and V).Correlation analysis and factor analysis were used to determine the source of PTEs.Geo-accumulation index(I_(geo)),hazard quotient(HQ),and total carcinogenic risk index(TR)were used to measure the PTEs contamination and its relative health impacts.Results showed that the average values of 12 PTEs in topsoil were higher than the Hainan soil geochemical baseline,showing different degrees of PTEs accumulation effect.The concentration of PTEs in the topsoil was lower than those in the subsoil except for Cd and Hg.The I_(geo)revealed that the major accumulated element in soils was As followed by Mo.Source apportionment suggested that parent materials and agricultural practices were the dominant factors for PTEs accumulation in the topsoil.Noncarcinogenic risks of soil samples from five land-use patterns presented a trend of paddy field>dry field>woodland>orchard>garden plot.However,the HQ values of 12 PTEs were less than the recommended limit of HQ=1,representing that there are no non-carcinogenic risks of PTEs for children and adults in the study area.The TR values are within 6.95×10^(-6)-1.38×10^(-5),which corresponds to the low level.Therefore the PTEs in the agricultural soil of the study area show little influence on the health status of the local population.

Risk assessment of lead emissions from anthropogenic cycle

The risk assessment right from the source of emissions can effectively guide the pollution control. A model was established, consisting of four part： source estimation, environmental fate analysis, exposure analysis and risk assessment. The human health risk, ecological risk and total risk of lead emissions were assessed. The factors were estimated to indicate the environmental decrease and exposure probability. Of all the 1887 t emissions in China in 2010（quantified in the previous work）, it is turned out 1.3 t reached human bodies（0.9 mg/ca）, and 2.7 t reached the ecosystem. Lead mainly came from the Use stage for the source while lead causing risk mainly came from the Waste Management Recycling and Production stages. As for chemical forms, PbO contributed most to the human health risk and PbSO_4 contributed most to the ecological risk. PbSO_4, PbO and Pb altogether contributed 71% to the total risk, indicating these three chemicals should be taken priority for the risk management.

The Status Assessment and Preliminary Risk Assessment of Total Mercury in Sediments from Middle and Lower Reaches of the Yarlung Zangbo River

The occurrence and accumulation of total mercury (T-Hg) in sediments collected from the Yarlung Zangbo River (YLZB),the Lhasa River,the Niyang River and the Palongzangbu River were analyzed and the soil samples simultaneously collected from the bank were employed as control.Meanwhile,pollution status and potential ecological risk of Hg were calculated and assessed using index of geoaccumulation ( I geo ) and potential ecological risk assessment method (Er) in this study.The results showed that the T-Hg concentrations in sediments at eight sections of YLZB ranged from 4.23 to 48.1 μg/kg with mean concentration of 25.1 μg/kg,which was higher than background Hg value of soils in Tibet.T-Hg concentrations in sediments at three typical segments of YLZB were all significantly higher than those in soils collected from its bank (P<0.05).The Igeo and E r indexes revealed that the T-Hg pollution levels were slight pollution in two sections and moderate ecological risk in six sections of YLZB.Hg pollution risks also existed in the sediments of partial sections of the Lhasa River and the Niyang River,and slightly moderate Hg contamination with high ecological risk was presented in Lhasa urban district.The level of Hg in sediments of YLZB showed a notable spatial distribution characteristic with a trend of increasing firstly and then declining.Human activities played an important role in increasing Hg content in sediments of the river.

全髋关节置换后的低蛋白血症:危险因素及列线图预测模型建立

背景:患者接受全髋关节置换后多发低蛋白血症,影响术后愈合及康复。目的:探讨及筛选全髋关节置换后发生低蛋白血症的危险因素,建立列线图为临床中判断全髋关节置换后是否发生低蛋白血症提供指导。方法:共纳入行全髋关节置换患者355例,根据术后第1天是否出现低蛋白血症分为低蛋白血症组238例、正常组117例,低蛋白血症发生率为67%。收集患者年龄、性别、糖尿病、高血压、高尿酸血症、高血脂、麻醉方式、置换前白细胞、置换前红细胞、置换前血红蛋白、置换前血小板、置换前血浆凝血酶原时间、置换前活化部分凝血酶原时间、置换前国际标准化比值、置换前凝血酶时间、置换前纤维蛋白原、置换前血沉、置换前C-反应蛋白、置换前D-二聚体、置换前平均红细胞血红蛋白含量、置换前平均红细胞体积、手术时间、体质量指数、置换前降钙素原、置换前红细胞压积等资料。利用SPSS 27.0软件进行单因素分析,随后利用R语言(4.3.1)再次对观察指标进行最小绝对收缩和选择算子回归分析及10倍交叉验证,取二者危险因素交集,使用SPSS 27.0进行多因素二元Logistic回归分析得到最终危险因素,通过R语言构建全髋关节置换后低蛋白血症的预测模型,并构建受试者特征曲线曲线、校准曲线、临床决策曲线评估预测模型预测能力。结果与结论:①经过单因素分析、最小绝对收缩和选择算子回归、多因素二元Logistic回归,筛选出年龄(OR=1.024,P=0.023)、置换前血小板(OR=0.995,P=0.028)、置换前血沉(OR=1.031,P=0.045)在判断置换后是否会发生低蛋白血症方面具有统计学意义(P<0.05);②基于多因素Logistic回归所筛选出的最终危险因素构建列线图预测模型,并通过构建受试者特征曲线评估模型预测能力,经计算受试者工作特征曲线的曲线下面积达到0.835(95%CI=0.779-0.891),C-index=0.835,经临床决策曲线计算,模型在阈值为0-0.83可带来更好的临床效能,该预测模型具有良好的灵敏度与准确性,可为医护人员及患者在全髋关节置换前更好地识别置换后发生低蛋白血症的风险。

Socio-demographic factors impact time to discharge following total knee arthroplasty

AIM To determine social, logistical and demographic factors that influence time to discharge in a short stay pathway(SSP) by following total knee arthroplasty(TKA). METHODS The study included primary TKA's performed in a highvolume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay(LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index(BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies(PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS. RESULTS Eight hundred and six consecutive primary SSP TKA's were included in this study. Patients were discharged at a median of 49 h(post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer(P < 0.001)], female gender [4.3 h longer(P = 0.012)], age [3.5 h longer per ten-year increase in age(P < 0.001)], patient-reported allergies [1.1 h longer per allergy reported(P = 0.005)], later procedure endtimes [0.8 h longer per hour increase in end-time(P = 0.004)] and Black or African American patients [6.1 h longer(P = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter(P = 0.011)] and TKA's performed during holiday weeks [9.4 h shorter(P = 0.011)]. Non-significant factors included: BMI, median income, patient's living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery. CONCLUSION The cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.

On two actuarial quantities for the compound Poisson risk model with tax and a threshold dividend strategy

In this paper, we consider a compound Poisson risk model with taxes paid according to a loss-carry-forward system and dividends paid under a threshold strategy. First, the closed-form expression of the probability function for the total number of taxation periods over the lifetime of the surplus process is derived. Second, analytical expression of the expected accumulated discounted dividends paid between two consecutive taxation periods is provided. In addition, explicit expressions are also given for the exponential individual claims.

Identification and preoperative optimization of risk factors to prevent periprosthetic joint infection

Despite significant improvements over the past several decades in diagnosis,treatment and prevention of periprosthetic joint infection(PJI),it still remains a major challenge following total joint arthroplasty.Given the devastating nature and accelerated incidence of PJI,prevention is the most important strategy to deal with this challenging problem and should start from identifying risk factors.Understanding and well-organized optimization of these risk factors in individuals before elective arthroplasty are essential to the ultimate success in reducing the incidence of PJI.Even though some risk factors such as demographic characteristics are seldom changeable,they allow more accurate expectation regarding individual risks of PJI and thus,make proper counseling for shared preoperative decision-making possible.Others that increase the risk of PJI,but are potentially modifiable should be optimized prior to elective arthroplasty.Although remarkable advances have been achieved in past decades,many questions regarding standardized practice to prevent this catastrophic complication remain unanswered.The current study provide a comprehensive knowledge regarding risk factors based on general principles to control surgical siteinfection by the review of current literature and also share own practice at our institution to provide practical and better understandings.

Multivariate Analysis of Femoral Adductor Muscle Contracture after Total Hip Arthroplasty in Patients with Avascular Necrosis of Femoral Head

Objective:This study is to investigate the nisk factors of femoral head contracture after total hip arthroplasty(THA)in patients with avascular necrosis of femoral head.Methods:Retrospective analysis was perfomed in 361 cases of femoral head necrosis patients taking THA fom September 2016 to December 2017.A total of 179 patents with no significant preoperative adductor muscle contraction were finally enrolled in this study.These 179 patients were further divided into two groups:contracture group(64 cases)and noncompaction group(115 cases).The chi-square test was used to compare the differences between the two groups.Risk factors were identifed by logistic regession analysis.Results:of the patients included,64 patients (35.75%)developed into end adductor muscle contracture.There were signuificant differences in limb shortening.surgical history,whether taction,surgical approach,surgical methods,and fumctional training between the two goups(P<0.05).Logistic regression analysis showed that shortness of extremity,sugical approach,effective taction,surgical history,and etiology were the factors affecting femoral head contracture after THA in patients with avascular necrosis of femoral head.Conclusions:Preoperative traction therapy,surgical methods,and postoperative functional training are the factors that affect the adductor muscle contraction after THA.

下咽癌全喉切除术后咽瘘发生的危险因素分析

目的探讨下咽癌全喉切除术后咽瘘发生的危险因素。方法回顾性分析2009年1月至2019年12月南京医科大学附属肿瘤医院收治的89例下咽癌全喉切除患者的临床资料。根据术后是否发生咽瘘分为咽瘘组和无咽瘘组,分析患者相关、疾病相关及治疗相关的咽瘘发生的危险因素。结果89例患者中有20例术后出现咽瘘,69例未出现咽瘘,总体咽瘘发生率为22.5%。单因素分析显示,咽瘘组有糖尿病史(P=0.031)、术前行放化疗(P=0.021)、术前低白蛋白血症(P=0.008)、术后低白蛋白血症(P=0.002)及采用皮瓣修复(P=0.034)的患者占比高于无咽瘘组。多因素logistic回归分析显示,术后白蛋白水平是咽瘘发生的独立保护因素(OR=0.174,95%CI 0.048~0.626,P=0.007)。结论有糖尿病、围手术期低白蛋白血症或术前接受放化疗的下咽癌患者全喉切除术后更易发生咽瘘。

收储制度市场化改革能提升玉米生产效率吗?——基于玉米主产区247地级市数据实证分析

党的十九大要求,加快推动粮食收储制度改革,保障国家粮食安全。党的二十大进一步指出,全方位夯实粮食安全根基,确保中国人的饭碗牢牢端在自己手里。收储制度市场化改革能否有效激发市场机制作用、提升粮食生产效率,对稳定国内粮食供给、保障国家粮食安全具有重要影响。利用2011-2020年玉米主产区247地级市面板数据,构建DID模型和中介效应模型,基于市场扭曲和市场风险双重视角分析收储制度改革对玉米全要素生产率的影响,并探讨其影响机制。结果表明:(1)收储制度改革对东北三省一区玉米全要素生产率总体呈现正向影响,但是随着改革的深入,全要素生产率增长幅度呈现波动变化;(2)收储制度改革的影响存在较大区域差异性,改革对于内蒙古和黑龙江两地呈现较为明显正向影响,尤其是对该地区第一、第四和第五积温带区域影响最为显著,而对吉林和辽宁两省影响并不明显;(3)收储制度改革通过缓解市场扭曲和加剧市场风险两条路径影响玉米全要素生产率,其中市场扭曲的缓解有助于提升玉米全要素生产率,而市场风险的加剧则减缓了玉米全要素生产率的增长。政府应该关注收储制度改革后玉米生产效率,充分发挥市场机制功能,同时配套抗风险、防波动稳定机制,以确保玉米生产高质量发展,保障国家粮食安全。

以风险评估为基础的集束化护理结合针对性心理干预在子宫全切术患者中的应用效果

目的探讨以风险评估为基础的集束化护理结合针对性心理干预在子宫全切术患者中的应用效果。方法选择2020年2月至2023年4月于滨州医学院附属医院行子宫全切术的80例患者,按照随机数字表法分为两组。观察组(40例)实施以风险评估为基础的集束化护理结合针对性心理干预,对照组(40例)实施常规护理,比较两组下肢深静脉血栓(DVT)发生率、心理状态。结果观察组下肢DVT发生率低于对照组(P<0.05);护理后观察组心理状态各评分较对照组更低(P<0.05)。结论以风险评估为基础的集束化护理结合针对性心理干预在子宫全切术患者中的应用效果较好,可改善心理状态,降低术后下肢DVT发生率。

老年无症状颅内动脉延长扩张症与脑小血管病综合评分的相关性

目的探讨老年无症状颅内动脉延长扩张症(IADE)与脑小血管病(CSVD)综合评分的相关性。方法回顾性分析2019年1月至2021年12月北京医院神经内科门诊查体或就诊且完成3 T头部磁共振成像(MRI)平扫、头部磁共振血管造影(MRA)和头部磁敏感加权成像(SWI)的CSVD患者。通过影像学诊断IADE并进行CSVD综合评分。根据有无IADE,将所有患者分为IADE组与非IADE组;依据CSVD综合评分,将患者分为CSVD无-轻度组与中-重度组,分别比较各组患者的基线资料和影像学资料,采用多因素Logistic回归分析IADE与CSVD总负荷之间的关系。结果共纳入230例CSVD患者,其中IADE组86例、非IADE组144例,CSVD综合评分无-轻度组157例、中-重度组73例。与非IADE组相比,IADE组患者的脑梗死史〔16例(18.6%)比13例(9.0%)〕、口服抗血小板聚集药物〔45例(52.3%)比51(35.4%)〕及CSVD综合评分为中-重度的患者〔36例(41.9%)比37例(25.7%)〕比例更高(均P<0.05)。230例患者中,CSVD综合评分中-重度组IADE患者比例高于无-轻度组〔36例(49.3%)比50例(31.8%),χ2=6.495,P值=0.011〕。多因素Logistic回归分析显示年龄〔OR(95%CI)=1.777(1.124~2.808),P=0.014〕、脑梗死史〔OR(95%CI)=15.481(4.565~52.496),P<0.001〕、颅内外动脉狭窄/闭塞〔OR(95%CI)=0.961(1.003~6.804),P=0.049〕和IADE〔OR(95%CI)=0.037(0.879~2.563),P=0.037〕是中-重度CSVD综合评分的独立危险因素,血红蛋白(≥135.5 g/L)〔OR(95%CI)=0.283(0.114~0.701),P<0.01〕是中-重度CSVD综合评分的保护因素。结论CSVD伴IADE患者在颅内影像表现上全脑受损更明显,且IADE、脑梗死史及颅内动脉狭窄/闭塞是CSVD严重程度的独立危险因素。

Relationship between high dietary fat intake and Parkinson’s disease risk: a meta-analysis

OBJECTIVE: To assess whether dietary fat intake influences Parkinson’s disease risk. DATA SOURCES: We systematically surveyed the Embase and PubMed databases, reviewing manuscripts published prior to October 2018. The following terms were used:(“Paralysis agitans” OR “Parkinson disease” OR “Parkinson” OR “Parkinson’s” OR “Parkinson’s disease”) AND (“fat” OR “dietary fat” OR “dietary fat intake”). DATA SELECTION: Included studies were those with both dietary fat intake and Parkinson’s disease risk as exposure factors. The Newcastle-Ottawa Scale was adapted to investigate the quality of included studies. Stata V12.0 software was used for statistical analysis. OUTCOME MEASURES: The primary outcomes included the relationship between high total energy intake, high total fat intake, and Parkinson’s disease risk. The secondary outcomes included the relationship between different kinds of fatty acids and Parkinson’s disease risk. RESULTS: Nine articles met the inclusion criteria and were incorporated into this meta-analysis. Four studies scored 7 and the other five studies scored 9 on the Newcastle-Ottawa Scale, meaning that all studies were of high quality. Meta-analysis results showed that high total energy intake was associated with an increased risk of Parkinson’s disease (P = 0.000, odds ratio (OR)= 1.49, 95% confidence interval (CI): 1.26–1.75);in contrast, high total fat intake was not associated with Parkinson’s disease risk (P = 0.123, OR = 1.07, 95% CI: 0.91–1.25). Subgroup analysis revealed that polyunsaturated fatty acid intake (P = 0.010, OR = 1.03, 95% CI: 0.88–1.20) reduced the risk of Parkinson’s disease, while arachidonic acid (P = 0.026, OR = 1.15, 95% CI: 0.97–1.37) and cholesterol (P = 0.002, OR = 1.09, 95% CI: 0.92–1.29) both increased the risk of Parkinson’s disease. Subgroup analysis also demonstrated that, although the results were not significant, consumption of n-3 polyunsaturated fatty acids (P = 0.071, OR = 0.88, 95% CI: 0.73–1.05),α-linolenic acid (P = 0.06, OR = 0.86, 95% CI: 0.72–1.02), and the n-3 to n-6 ratio (P = 0.458, OR = 0.89, 95% CI: 0.75–1.06) were all linked with a trend toward reduced Parkinson’s disease risk. Monounsaturated fatty acid (P = 0.450, OR = 1.06, 95% CI: 0.91–1.23), n-6 polyunsaturated fatty acids (P = 0.100, OR = 1.15, 95% CI: 0.96–1.36) and linoleic acid (P = 0.053, OR = 1.11, 95% CI: 0.94–1.32) intakes were associated with a non-significant trend toward higher PD risk. Saturated fatty acid (P = 0.619, OR = 1.01, 95% CI: 0.87–1.18) intake was not associated with Parkinson’s disease. CONCLUSION: Dietary fat intake affects Parkinson’s disease risk, although this depends on the fatty acid subtype. Higher intake of polyunsaturated fatty acids may reduce the risk of Parkinson’s disease, while higher cholesterol and arachidonic acid intakes may elevate Parkinson’s disease risk. However, further studies and evidence are needed to validate any link between dietary fat intake and Parkinson’s disease.

子宫全切患者术后盆底功能障碍发生的危险因素分析

目的分析子宫全切患者术后盆底功能障碍发生的危险因素。方法选取2018年11月1日至2020年10月31日收治的80例行子宫全切除术治疗患者为研究对象。统计患者的年龄、体质量指数(BMI)、病程、原发疾病、凝血指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(DD)]、手术方式、子宫大小、分娩方式、分娩次数、手术时间、术后盆底功能相关知识、术后医生指导行盆底功能锻炼及术后盆底功能锻炼依从性。采用多因素Logistic回归分析法分析子宫全切患者术后盆底功能障碍发生的危险因素。结果80例患者中,10例(12.50%)发生盆底功能障碍,纳为发生组;70例(87.50%)未发生盆底功能障碍,纳为未发生组。发生组的年龄、BMI、分娩次数≥2次占比均显著高于未发生组,掌握术后盆底功能相关知识、术后医生指导行盆底功能锻炼及术后盆底功能锻炼依从性的占比均显著低于未发生组(P<0.05)。多因素Logistic回归分析结果显示,BMI、年龄及分娩次数是影响子宫全切患者术后盆底功能障碍发生的危险因素(P<0.05)。结论BMI、年龄及分娩次数是影响子宫全切患者术后盆底功能障碍发生的危险因素,临床应加强对该类患者的关注度,及时制定有效的干预措施,用于预防盆底功能障碍疾病。

THRIVE评分预测头颅MRI指导的静脉溶栓后脑出血

目的 评估血管事件健康风险(THRIVE)评分对头颅MRI指导的静脉溶栓后患者脑出血的预测价值。方法 根据溶栓后有无脑出血分为脑出血组和非脑出血组,分析两组间THRIVE评分有无统计学差异。结果 头颅MRI指导的静脉溶栓后脑出血组THRIVE评分明显高于非脑出血组(P=0.000),两组间心房颤动(P=0.000)和溶栓前NIHSS评分(P=0.000)差异有统计学意义。结论 THRIVE评分与头颅MRI指导的静脉溶栓患者脑出血相关,而心房颤动和溶栓前NIHSS评分独立相关。

步态运动学特征及MRI总负荷与脑小血管病步态障碍患者跌倒风险的相关性研究

目的:采用Logistic回归分析和ROC曲线评估步态运动学特征联合MRI总负荷对脑小血管病(cerebral small vessel disease,CSVD)步态障碍患者跌倒风险的预测价值。方法:选取2019年3月1日—2020年3月30日就诊于甘肃省人民医院中法神经康复科诊断为CSVD且以步态障碍为主要症状的43例患者为研究对象,统计临床数据,根据TUG测试时间将所有患者分为高跌倒风险(high risk of falling,HRF;TUG时间≥15s)组和低跌倒风险(low risk of falling,LRF;TUG时间<15s)组,采用Logistic回归分析和ROC曲线评估步态运动学特征联合MRI总负荷对CSVD步态障碍患者跌倒风险的预测价值。结果:研究共纳入43例患者,平均年龄(71.07±8.17)岁。其中女性26例(60.4%),高血压患者30例(69.8%),Logistic回归分析显示,在校正年龄和TUG后,步长(OR 0.821,95%CI 0.702—0.959,P=0.013)为CSVD步态障碍患者跌倒风险的独立保护因素,MRI总负荷(OR 4.217,95%CI 1.444—12.317,P=0.009)为CSVD步态障碍患者跌倒风险的独立危险因素。ROC曲线分析显示步长和MRI总负荷联合对CSVD步态障碍患者的跌倒风险具有较高的预测价值(AUC=0.904),敏感性为82.6%,特异性为90%。结论:步长联合MRI总负荷对CSVD步态障碍患者的跌倒风险有较高的预测价值。

老年单侧全髋关节置换术围术期输血风险预测模型的构建

目的分析老年单侧全髋关节置换术围术期输血危险因素并建立风险预测模型。方法回顾性收集于2013年1月至2021年10月在北京协和医院接受单侧初次全髋关节置换术的老年患者467例。将全部数据的70%划分为训练集,30%划分为测试集。根据是否接受围术期输血将训练集中的患者划分为输血组和非输血组。通过单因素与多因素Logistic回归分析患者的人口学特征、手术信息和术前实验室指标,识别围术期输血的危险因素,结合临床经验构建预测模型并绘制列线图。在测试集中使用受试者工作特征(ROC)曲线和校准曲线评估模型性能。结果在纳入的467例患者中,91例(19.5%)患者接受围术期输血。多因素Logistic回归分析显示合并冠心病、手术时间增加和术前低血红蛋白是围术期输血的危险因素(P<0.05)。根据统计分析结果与临床经验,纳入是否合并冠心病、手术时间、术前血红蛋白、年龄和是否美国麻醉医师协会(ASA)分级>Ⅱ级等因素构建预测模型,模型的受试者工作特征曲线下面积(AUC)为0.809。结论老年单侧全髋关节置换术围术期输血风险预测模型的表现良好,可以为临床工作提供帮助。

达芬奇机器人辅助全子宫切除术后患者正念影响因素的线性回归及改善策略分析

目的:分析达芬奇机器人辅助下广泛性全子宫切除术患者正念水平影响因素及相应护理对策。方法:回顾性收集2023年1月—2023年9月在西北妇女儿童医院接受达芬奇机器人辅助下广泛性全子宫切除术的80例患者的临床资料。收集患者人口学及临床资料,采用正念注意觉知量表(MAAS)评估患者正念水平,采用社会影响量表(SIS)、领悟社会支持量表(PSSS)评估患者社会支持度及病耻感。分析不同临床特征达芬奇机器人辅助下广泛性全子宫切除术患者正念水平的差异,评估患者正念水平与病耻感、社会支持的相关性,并采用多元线性回归分析影响达芬奇机器人辅助下广泛性全子宫切除术患者正念水平的危险因素。结果:不同文化程度、不同月收入患者的正念水平存在显著差异,多元线性回归分析发现,文化程度、病耻感、社会支持度是广泛性全子宫切除术患者正念水平影响因素,可解释总变异的84.2%(P<0.05)。结论:文化程度、病耻感、社会支持度是广泛性全子宫切除术患者正念水平的影响因素,临床还需采取针对性干预措施,提高患者的正念水平,促进患者术后恢复和心理健康。

肝硬化2/3级腹水患者短期不良临床结局的影响因素

目的 探讨因肝硬化2/3级腹水住院的患者短期不良临床结局的影响因素。方法 以昆明市第三人民医院2021年12月至2023年2月期间82例因肝硬化2/3级腹水住院的患者为研究对象,收集人口统计学及入院首次临床资料,随访患者入院后90 d内临床转归情况,包括住院时间超过28 d、距入院28 d内非计划再住院、90 d内病死(含28 d内病死),进行相应分组后通过单因素筛查、二元logistic回归分析探索上述不良临床结局的影响因素,最后用受试者工作(receiver operating characteristic curve,ROC)曲线,判断其影响因素的诊断效能。结果 (1)MELD-Na(model for end-stage liver disease-sodium,MELD-Na)评分(OR=1.087,95%CI:1.006~1.175)和r-谷氨酰基转肽酶(gamma glutamyl transferase,GGT)(OR=1.004,95%CI:1.002~1.007)分别是住院时间超过28 d、距入院28 d内非计划再住院和28 d内病死的独立危险因素(P <0.05);血尿素氮(blood urea nitrogen,BUN)同是上述3种情况的独立危险因素,OR分别为1.111(95%CI:1.005~1.227)、1.115(95%CI:1.003~1.214)和1.208(95%CI:1.057~1.382)(P <0.05);(2)低水平血清氯(chloride,Cl)离子(OR=0.875,95%CI:0.802~0.954)和低水平二氧化碳(carbon dioxide,CO_(2))(OR=0.821,95%CI:0.690~0.976)是90 d内病死的危险因素(P <0.05);(3)BUN联合GGT预测28 d内病死的ROC曲线下面积(area under the curve,AUC)为0.891;血清氯离子联合总CO_(2)预测90 d内病死的曲线下面积为0.821。结论 BUN联合GGT对28 d内病死、血清氯离子联合总CO_(2)对90 d内病死均具有较好的预测价值。