背景心血管疾病(CVD)是腹膜透析(PD)患者死亡的主要原因,而营养不良是PD患者发生CVD及死亡的重要危险因素之一。预后营养指数(PNI)作为一种综合评估患者免疫、炎症和营养状态的指标,因其具有便利性与可靠性等优点,在肿瘤等多种疾病的预...背景心血管疾病(CVD)是腹膜透析(PD)患者死亡的主要原因,而营养不良是PD患者发生CVD及死亡的重要危险因素之一。预后营养指数(PNI)作为一种综合评估患者免疫、炎症和营养状态的指标,因其具有便利性与可靠性等优点,在肿瘤等多种疾病的预后评估中得到了广泛应用。然而,不同时间点的营养状态与PD患者预后之间的关系仍有待进一步探究。目的探讨PD患者首年PNI与CVD死亡之间的关系。方法本研究为多中心、回顾性观察性队列研究,纳入2000-01-01—2019-07-01在南方医科大学南方医院、南方医科大学顺德医院、佛山市第一人民医院以及赣州市人民医院4所中心置管并开始接受PD治疗的1640例PD患者作为研究对象。对患者进行随访,随访截止时间为2021-07-01,终点事件为CVD死亡并记录患者生存时间及具体死亡原因。应用限制性立方条图(RCS)分析PNI与PD患者CVD死亡风险之间的非线性关联;采用Kaplan-Meier法绘制PD患者的生存曲线,绘制PNI预测PD患者CVD死亡的受试者工作特征(ROC)曲线,并根据最佳截断值(cut-off=40.46)将患者分为低PNI组703例与高PNI组937例;采用Log-rank检验和Cox风险回归模型分析探讨PNI对PD患者CVD死亡的影响。结果本研究中位随访时间为30个月,随访期间共148例患者死亡,其中CVD死亡73例(49.32%)。RCS结果表明,PNI与CVD死亡事件呈线性关联(P for Nonlinear=0.655)。ROC曲线显示,PNI预测PD患者CVD死亡的曲线下面积(AUC)为0.717(95%CI=0.659~0.775,P<0.001),灵敏度为74.0%,特异度为58.6%。Kaplan-Meier生存分析结果显示,低PNI组CVD生存率低于高PNI组(χ^(2)=26.685,P<0.001)。多因素Cox风险回归模型分析,校正性别、年龄及CVD病史等混杂因素后,低PNI组仍是CVD死亡的独立预测因素(HR=7.76,95%CI=1.72~35.06,P=0.008),亚组分析结果仍稳健,无明显交互作用。结论PNI降低是PD患者CVD死亡的独立影响因素,PD首年PNI评分在评估PD患者预后有一定的指导意义。展开更多
Objective The purpose of this study was to compare the costeffectiven ess of la paroscopic-assisted vaginal hysterectomy to traditional total abdominal hystere ctomy and total vaginal hysterectomy with regard not only...Objective The purpose of this study was to compare the costeffectiven ess of la paroscopic-assisted vaginal hysterectomy to traditional total abdominal hystere ctomy and total vaginal hysterectomy with regard not only to direct hospital cos ts but also to indirect costs. Study design This was a combined retrospective co hort study (Canadian Task Force classification II-2) that was conducted in a su burban private practice. The cases of 268 patients who underwent hysterectomies over a 27-month period were analyzed to include clinical outcomes, direct hospi tal costs, and indirect costs (time to return to normal function, time to return to work, and time away from work required by other family members). Results For all patients, length of hospital stay and time of return to normal function wer e shorter for laparoscopic-assisted vaginal hysterectomy than for total abdomin al hysterectomy and total vaginal hysterectomy. For working patients, time to re turn to work and time off for working family members were all significantly shor ter after laparoscopic-assisted vaginal hysterectomy when compared with both to tal abdominal hysterectomy and total vaginal hysterectomy. Operating times were similar for total abdominal hysterectomy and laparoscopic-assisted vaginal hyst erectomy, and complications were greater for total abdominal hysterectomy. In a comparison of all procedures, direct hospital costs were greatest for laparoscop ic-assisted vaginal hysterectomy and least for total vaginal hysterectomy. Conc lusion For most patients, laparoscopic-assisted vaginal hysterectomy provides a minimally invasive way to accomplish a hysterectomy with a lower cost to employ ers (payers) on the basis of lost work hours.展开更多
Objectives: To conduct a multi-national retrospective chart review with the purposes of assessing resource utilization, progression, and costs associated with treating glaucoma in Europe. Methods: Patient chart data w...Objectives: To conduct a multi-national retrospective chart review with the purposes of assessing resource utilization, progression, and costs associated with treating glaucoma in Europe. Methods: Patient chart data was reviewed to assign patients to all stages of glaucoma progression. The Bascom Palmer Glaucoma Staging System (GSS) was selected, as most adaptable because展开更多
目的探讨腹膜透析（peritoneal dialysis,PD）患者体质量指数（body mass index,BMI）与技术生存间关系。方法本课题是回顾性队列研究。研究人群为2000～2014年在北京大学深圳医院新入PD治疗并规律随访的348例患者,年龄（48.2±15....目的探讨腹膜透析（peritoneal dialysis,PD）患者体质量指数（body mass index,BMI）与技术生存间关系。方法本课题是回顾性队列研究。研究人群为2000～2014年在北京大学深圳医院新入PD治疗并规律随访的348例患者,年龄（48.2±15.5）岁,其中62%为男性。根据透析治疗2～6个月间首次记录的体质量及身高计算BMI,按照世界卫生组织的亚洲人推荐标准,对患者进行分组。患者均随访至死亡、转为血液透析、肾移植、失随访或至2014年10月31日。主要终点是技术失败（死亡或永久转为血液透析）,次要终点包括全因死亡、心脑血管死亡、心血管事件、脑卒中事件、首次发生腹膜炎。数据分析采用多因素Cox回归模型。结果调整年龄、性别、文化程度、原发病和心力衰竭后,低BMI组和高BMI组患者的技术失败风险比（95%可信区间,P值）分别是正常组的3.590[（1.526,8.447）,P=0.003]和0.932[（0.493,1.762）,P=0.829]倍。相较于正常BMI组,低BMI组的全因死亡率（HR5.462,95%可信区间1.743～17.110,P=0.004）与心脑血管死亡率[HR 9.403,95%可信区间2.409～36.700,P=0.001）亦显著升高,而高BMI组则未发现明显差异（P值均〉0.05）。BMI和冠状动脉粥样硬化性心脏病（冠心病）事件、脑卒中事件与腹膜炎等次要终点不存在统计学意义的关系（P值均〉0.05）。亚组分析提示BMI与技术生存的关系不受年龄、性别、文化程度、原发病、心脑血管并发症等因素影响（交互作用P值均〉0.05）。结论PD患者中,低BMI与技术失败、全因死亡、心脑血管事件死亡独立相关,但与冠心病、脑卒中和腹膜炎等无关联;高BMI与上述终点事件均无关联。展开更多
Objective: The purpose of this study was to examine whetherw omen with one elevated value of the 3- hour glucose tolerance test are at increased risk for adverse perinatal outcomes.Study design: This was a retrospecti...Objective: The purpose of this study was to examine whetherw omen with one elevated value of the 3- hour glucose tolerance test are at increased risk for adverse perinatal outcomes.Study design: This was a retrospective cohort study of singleton pregnancies that were screened for gestational diabetes mellitus with the use of the glucose loading test and with a glucose tolerance test for follow up, if screened values were positive. Perinatal outcomes in women with one elevated glucose tolerance test value were compared with the outcomes in women who screened negative by glucose loading test. The chi-square test was used to compare categorical outcomes, and multivariate logistic regression analysis was used to control for potential confounding factors; a P value of < .05 indicated statistical significance. Results:Of 14,036 women who met the study criteria, women with one elevated glucose tolerance test value exhibited higher rates of cesarean delivery (in nulliparous women only)- , preeclampsia, chorioamnionitis, birth weight > 4000 g and > 4500 g, and neonatal admission to the intensive care nursery as compared with women who screened negative (P < .05 for all). Conclusion: Although women with one elevated glucose tolerance test value are not diagnosed with gestational diabetes mellitus, they are still at risk for adverse perinatal outcomes.展开更多
OBJECTIVE: To estimate whether the acid-base status of neonates born to women with meconium-stained amniotic fluid varies across gestation. METHODS: We carried out a retrospective cohort study of all pregnancies that ...OBJECTIVE: To estimate whether the acid-base status of neonates born to women with meconium-stained amniotic fluid varies across gestation. METHODS: We carried out a retrospective cohort study of all pregnancies that were complicated by meconium-stained amniotic fluid in 2004. Cases were identified from a perinatal pathology database that contained data on all pregnancies complicated by meconium- stained amniotic fluid. Data abstracted from the charts included gestational age at delivery, umbilical arterial pH, birth weight, and the presence or absence of labor. Cases were stratified according to gestational age at delivery. The distribution of meconium-stained amniotic fluid across gestation was computed. The mean umbilical arterial pH values (with 95% confidence intervals) across gestation were assessed by analysis of variance. RESULTS: The mean umbilical arterial pH in women with meconium-stained amniotic fluid did not differ across gestation. The overall incidence of meconium-stained amniotic fluid was 12.0% (766 of 6,403 deliveries). The rates of meconium-stained amniotic fluid increased from 1.2% at 32 weeks to 100% at 42 weeks. CONCLUSION: The rising incidence of meconium-stained amniotic fluid with gestational age is consistent with the hypothesis that fetal maturation is a major etiologic factor in meconium passage. Also, the lack of variation of mean umbilical arterial pH across gestation suggests that fetal acidemia is not increased when meconium passage occurs earlier in pregnancy rather than at later gestational ages.展开更多
文摘背景心血管疾病(CVD)是腹膜透析(PD)患者死亡的主要原因,而营养不良是PD患者发生CVD及死亡的重要危险因素之一。预后营养指数(PNI)作为一种综合评估患者免疫、炎症和营养状态的指标,因其具有便利性与可靠性等优点,在肿瘤等多种疾病的预后评估中得到了广泛应用。然而,不同时间点的营养状态与PD患者预后之间的关系仍有待进一步探究。目的探讨PD患者首年PNI与CVD死亡之间的关系。方法本研究为多中心、回顾性观察性队列研究,纳入2000-01-01—2019-07-01在南方医科大学南方医院、南方医科大学顺德医院、佛山市第一人民医院以及赣州市人民医院4所中心置管并开始接受PD治疗的1640例PD患者作为研究对象。对患者进行随访,随访截止时间为2021-07-01,终点事件为CVD死亡并记录患者生存时间及具体死亡原因。应用限制性立方条图(RCS)分析PNI与PD患者CVD死亡风险之间的非线性关联;采用Kaplan-Meier法绘制PD患者的生存曲线,绘制PNI预测PD患者CVD死亡的受试者工作特征(ROC)曲线,并根据最佳截断值(cut-off=40.46)将患者分为低PNI组703例与高PNI组937例;采用Log-rank检验和Cox风险回归模型分析探讨PNI对PD患者CVD死亡的影响。结果本研究中位随访时间为30个月,随访期间共148例患者死亡,其中CVD死亡73例(49.32%)。RCS结果表明,PNI与CVD死亡事件呈线性关联(P for Nonlinear=0.655)。ROC曲线显示,PNI预测PD患者CVD死亡的曲线下面积(AUC)为0.717(95%CI=0.659~0.775,P<0.001),灵敏度为74.0%,特异度为58.6%。Kaplan-Meier生存分析结果显示,低PNI组CVD生存率低于高PNI组(χ^(2)=26.685,P<0.001)。多因素Cox风险回归模型分析,校正性别、年龄及CVD病史等混杂因素后,低PNI组仍是CVD死亡的独立预测因素(HR=7.76,95%CI=1.72~35.06,P=0.008),亚组分析结果仍稳健,无明显交互作用。结论PNI降低是PD患者CVD死亡的独立影响因素,PD首年PNI评分在评估PD患者预后有一定的指导意义。
文摘Objective The purpose of this study was to compare the costeffectiven ess of la paroscopic-assisted vaginal hysterectomy to traditional total abdominal hystere ctomy and total vaginal hysterectomy with regard not only to direct hospital cos ts but also to indirect costs. Study design This was a combined retrospective co hort study (Canadian Task Force classification II-2) that was conducted in a su burban private practice. The cases of 268 patients who underwent hysterectomies over a 27-month period were analyzed to include clinical outcomes, direct hospi tal costs, and indirect costs (time to return to normal function, time to return to work, and time away from work required by other family members). Results For all patients, length of hospital stay and time of return to normal function wer e shorter for laparoscopic-assisted vaginal hysterectomy than for total abdomin al hysterectomy and total vaginal hysterectomy. For working patients, time to re turn to work and time off for working family members were all significantly shor ter after laparoscopic-assisted vaginal hysterectomy when compared with both to tal abdominal hysterectomy and total vaginal hysterectomy. Operating times were similar for total abdominal hysterectomy and laparoscopic-assisted vaginal hyst erectomy, and complications were greater for total abdominal hysterectomy. In a comparison of all procedures, direct hospital costs were greatest for laparoscop ic-assisted vaginal hysterectomy and least for total vaginal hysterectomy. Conc lusion For most patients, laparoscopic-assisted vaginal hysterectomy provides a minimally invasive way to accomplish a hysterectomy with a lower cost to employ ers (payers) on the basis of lost work hours.
文摘Objectives: To conduct a multi-national retrospective chart review with the purposes of assessing resource utilization, progression, and costs associated with treating glaucoma in Europe. Methods: Patient chart data was reviewed to assign patients to all stages of glaucoma progression. The Bascom Palmer Glaucoma Staging System (GSS) was selected, as most adaptable because
文摘目的探讨腹膜透析（peritoneal dialysis,PD）患者体质量指数（body mass index,BMI）与技术生存间关系。方法本课题是回顾性队列研究。研究人群为2000～2014年在北京大学深圳医院新入PD治疗并规律随访的348例患者,年龄（48.2±15.5）岁,其中62%为男性。根据透析治疗2～6个月间首次记录的体质量及身高计算BMI,按照世界卫生组织的亚洲人推荐标准,对患者进行分组。患者均随访至死亡、转为血液透析、肾移植、失随访或至2014年10月31日。主要终点是技术失败（死亡或永久转为血液透析）,次要终点包括全因死亡、心脑血管死亡、心血管事件、脑卒中事件、首次发生腹膜炎。数据分析采用多因素Cox回归模型。结果调整年龄、性别、文化程度、原发病和心力衰竭后,低BMI组和高BMI组患者的技术失败风险比（95%可信区间,P值）分别是正常组的3.590[（1.526,8.447）,P=0.003]和0.932[（0.493,1.762）,P=0.829]倍。相较于正常BMI组,低BMI组的全因死亡率（HR5.462,95%可信区间1.743～17.110,P=0.004）与心脑血管死亡率[HR 9.403,95%可信区间2.409～36.700,P=0.001）亦显著升高,而高BMI组则未发现明显差异（P值均〉0.05）。BMI和冠状动脉粥样硬化性心脏病（冠心病）事件、脑卒中事件与腹膜炎等次要终点不存在统计学意义的关系（P值均〉0.05）。亚组分析提示BMI与技术生存的关系不受年龄、性别、文化程度、原发病、心脑血管并发症等因素影响（交互作用P值均〉0.05）。结论PD患者中,低BMI与技术失败、全因死亡、心脑血管事件死亡独立相关,但与冠心病、脑卒中和腹膜炎等无关联;高BMI与上述终点事件均无关联。
文摘Objective: The purpose of this study was to examine whetherw omen with one elevated value of the 3- hour glucose tolerance test are at increased risk for adverse perinatal outcomes.Study design: This was a retrospective cohort study of singleton pregnancies that were screened for gestational diabetes mellitus with the use of the glucose loading test and with a glucose tolerance test for follow up, if screened values were positive. Perinatal outcomes in women with one elevated glucose tolerance test value were compared with the outcomes in women who screened negative by glucose loading test. The chi-square test was used to compare categorical outcomes, and multivariate logistic regression analysis was used to control for potential confounding factors; a P value of < .05 indicated statistical significance. Results:Of 14,036 women who met the study criteria, women with one elevated glucose tolerance test value exhibited higher rates of cesarean delivery (in nulliparous women only)- , preeclampsia, chorioamnionitis, birth weight > 4000 g and > 4500 g, and neonatal admission to the intensive care nursery as compared with women who screened negative (P < .05 for all). Conclusion: Although women with one elevated glucose tolerance test value are not diagnosed with gestational diabetes mellitus, they are still at risk for adverse perinatal outcomes.
文摘OBJECTIVE: To estimate whether the acid-base status of neonates born to women with meconium-stained amniotic fluid varies across gestation. METHODS: We carried out a retrospective cohort study of all pregnancies that were complicated by meconium-stained amniotic fluid in 2004. Cases were identified from a perinatal pathology database that contained data on all pregnancies complicated by meconium- stained amniotic fluid. Data abstracted from the charts included gestational age at delivery, umbilical arterial pH, birth weight, and the presence or absence of labor. Cases were stratified according to gestational age at delivery. The distribution of meconium-stained amniotic fluid across gestation was computed. The mean umbilical arterial pH values (with 95% confidence intervals) across gestation were assessed by analysis of variance. RESULTS: The mean umbilical arterial pH in women with meconium-stained amniotic fluid did not differ across gestation. The overall incidence of meconium-stained amniotic fluid was 12.0% (766 of 6,403 deliveries). The rates of meconium-stained amniotic fluid increased from 1.2% at 32 weeks to 100% at 42 weeks. CONCLUSION: The rising incidence of meconium-stained amniotic fluid with gestational age is consistent with the hypothesis that fetal maturation is a major etiologic factor in meconium passage. Also, the lack of variation of mean umbilical arterial pH across gestation suggests that fetal acidemia is not increased when meconium passage occurs earlier in pregnancy rather than at later gestational ages.
