The index of casualties is introduced for the trapped that is still alive after a destructive earthquake to indicate his (her) injury degree. In order to describe the injury-developing process controlled by three fact...The index of casualties is introduced for the trapped that is still alive after a destructive earthquake to indicate his (her) injury degree. In order to describe the injury-developing process controlled by three factors: the initial injury degree, the trap surroundings and the physique of the cornered, a function SFC (State-Function of Casualties) can be naturally constructed. Through parameter analysis from eight pieces of figures, it can be found that the trapped with weaker physique and worse initial injury degree and in more adverse trap surroundings deserves sooner rescue.展开更多
Objective: The aim of the study was to review the management of ruptured hepatocellular carcinoma (HCC) in a single teaching hospital over 13-year period; to determine the prognostic factor of in-hospital mortality an...Objective: The aim of the study was to review the management of ruptured hepatocellular carcinoma (HCC) in a single teaching hospital over 13-year period; to determine the prognostic factor of in-hospital mortality and evaluate the safety and efficacy of liver resection. Methods: A retrospective collection of medical records of 87 patients with spontaneous ruptured HCC was carried out. The 28 patients underwent emergency intervention including transarterial chemoembolization (TACE) and laparotomy with/without liver resection. Conservative treatment was performed in 59 patients and 16 of which underwent delayed hepatectomy or TACE. Results: The overall in-hospital mortality and median survival time was 54% and 22 days respectively. Albumin level (OR = 0.874, 95% CI: 0.778-0.973, P = 0.024), number of tumors (OR = 5.011, 95% CI: 1.015-24.750, P = 0.048) and laparotomy (OR = 0.069, 95% CI: 0.012-0.406, P = 0.003) were all independent factors affecting overall in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level (OR = 1.138, 95% CI: 1.024-1.264, P = 0.016) was independent factor affecting overall in-hospital mortality. Age, total bilirubin level, maximum tumor size, number of tumors, portal vein tumor thrombosis and extra-hepatic metastasis were all significantly different between groups with laparotomy and without. There were no significant differences between emergency and delayed liver resection groups in in-hospital mortality (0 vs. 0), median survival time (788 vs. 750 days respectively) as well as 1-year and 3-year survival rates (66.7%, 44.4% vs. 70%, 30%, respectively) (P = 0.763, log-rank test). Conclusion: Both underlying chronic liver disease and tumor stage can affect the in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level is independent factor. Surgeons are more prone to choose patients with younger age, better liver function and earlier tumor stage to do surgery. In well selected patients, both emergency and delayed liver resections are safe and could achieve prolonged survival.展开更多
Purpose： The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fr...Purpose： The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years. Methods： This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients＇ demographics, prehospitalization residential status, pre- fracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded. Results： The average age was 83 years, 73% female, and 57% of them sustained a femoral neck fracture. In 62.8% of patients, the number of pre-fracture baseline comorbidities was 〉2. The in-hospital mortality rate was 11.4%. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed, Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality （c-statistic 0.77）. Conclusion： Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality.展开更多
文摘The index of casualties is introduced for the trapped that is still alive after a destructive earthquake to indicate his (her) injury degree. In order to describe the injury-developing process controlled by three factors: the initial injury degree, the trap surroundings and the physique of the cornered, a function SFC (State-Function of Casualties) can be naturally constructed. Through parameter analysis from eight pieces of figures, it can be found that the trapped with weaker physique and worse initial injury degree and in more adverse trap surroundings deserves sooner rescue.
文摘Objective: The aim of the study was to review the management of ruptured hepatocellular carcinoma (HCC) in a single teaching hospital over 13-year period; to determine the prognostic factor of in-hospital mortality and evaluate the safety and efficacy of liver resection. Methods: A retrospective collection of medical records of 87 patients with spontaneous ruptured HCC was carried out. The 28 patients underwent emergency intervention including transarterial chemoembolization (TACE) and laparotomy with/without liver resection. Conservative treatment was performed in 59 patients and 16 of which underwent delayed hepatectomy or TACE. Results: The overall in-hospital mortality and median survival time was 54% and 22 days respectively. Albumin level (OR = 0.874, 95% CI: 0.778-0.973, P = 0.024), number of tumors (OR = 5.011, 95% CI: 1.015-24.750, P = 0.048) and laparotomy (OR = 0.069, 95% CI: 0.012-0.406, P = 0.003) were all independent factors affecting overall in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level (OR = 1.138, 95% CI: 1.024-1.264, P = 0.016) was independent factor affecting overall in-hospital mortality. Age, total bilirubin level, maximum tumor size, number of tumors, portal vein tumor thrombosis and extra-hepatic metastasis were all significantly different between groups with laparotomy and without. There were no significant differences between emergency and delayed liver resection groups in in-hospital mortality (0 vs. 0), median survival time (788 vs. 750 days respectively) as well as 1-year and 3-year survival rates (66.7%, 44.4% vs. 70%, 30%, respectively) (P = 0.763, log-rank test). Conclusion: Both underlying chronic liver disease and tumor stage can affect the in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level is independent factor. Surgeons are more prone to choose patients with younger age, better liver function and earlier tumor stage to do surgery. In well selected patients, both emergency and delayed liver resections are safe and could achieve prolonged survival.
文摘Purpose： The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years. Methods： This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients＇ demographics, prehospitalization residential status, pre- fracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded. Results： The average age was 83 years, 73% female, and 57% of them sustained a femoral neck fracture. In 62.8% of patients, the number of pre-fracture baseline comorbidities was 〉2. The in-hospital mortality rate was 11.4%. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed, Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality （c-statistic 0.77）. Conclusion： Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality.
