Long-Term Outcome and Risk Factor Analysis of Surgical Pulmonary Valve Replacement in Congenital Heart Disease

Objectives:To establish long-term outcome of surgical pulmonary valve replacement(PVR)in congenital heart disease(CHD)and to identify risk factors for overall mortality,operative mortality,and repetitive PVR.Methods:This is a retrospective study of 375 surgical PVR in 293 patients who underwent surgical PVR for CHD between January 2000 and May 2020.We only included patients with index PVR with previous open-heart surgery regardless of the number of PVRs.The previous surgical history of patients who underwent PVR during the study period was also included.Patients who underwent the Rastelli operation,and those who underwent single PVR without previous open-heart surgery were excluded.Results:The median age of the patients at the time of surgical PVR was 14.9 years(Interquartile range,IQR,11.0–22.0).The median follow-up duration was 10.5 years(IQR,5.5–14.8 years).There were 3 patients with operative mortality(1.0%)and 15 patients with overall mortality(5.1%).The survival rate was 95.1%over 20 years follow-up period.Multivariate analysis demonstrated that more than 3 times of previous open-heart surgeries before surgical PVR,older age at the first operation,longer cardiopulmonary bypass(CPB)time and longer intensive care unit(ICU)stay were predictors for overall mortality.Patients who underwent surgical PVR after more than 3 times of previous open-heart surgeries had significantly higher mortality than those who underwent open-heart surgeries less than 3 times(P<0.001).Age younger than 10 years,male,multiple valve problems and longer ICU stay were significant predictors for repetitive PVR by multivariate analysis.Conclusions:Though surgical PVR has excellent long-term outcome,it should be performed with caution for those who previously underwent multiple open-heart surgeries,especially if patient received more than 3 times of open-heart surgeries.

Preoperative risk factor analysis in orthotopic liver transplantation with pretransplant artificial liver support therapy

AIM： To assess the value of pre-transplant artificial liver support in reducing the pre-operative risk factors relating to early mortality after orthotopic liver transplantation （OLT）. METHODS： Fifty adult patients with various stages and various etiologies undergoing OLT procedures were treated with molecular adsorbent recycling system （MARS） as preoperative liver support therapy. The study included two parts, the first one is to evaluate the medical effectiveness of single MARS treatment with some clinical and laboratory parameters, which were supposed to be the therapeutical pre-transplant risk factors, the second part is to study the patients undergoing OLT using the regression analysis on preoperative risk factors relating to early mortality （30 d） after OLT. RESULTS： In the 50 patients, the statistically significant improvement in the biochemical parameters was observed （pre-treatment and post-treatment）. Eight patients avoided the scheduled Ltx due to significant relief of clinical condition or recovery of failing liver function, 8 patients died, 34 patients were successfully bridged to Ltx, the immediate outcome of this 34 patients within 30d observation was： 28 kept alive and 6 patients died. CONCLUSION： Pre-operative SOFA, level of creatinine, INR, TNF-α, IL-10 are the main preoperative risk factors that cause early death after operation, MARS treatment before transplantion can relieve these factors significantly.

Porphyromonas gulae infection in canines,pet owners and veterinarians in China:an epidemiological study and risk factor analysis

Porphyromonas gulae is a clinically prevalent,anaerobic,oral bacteria in canines,that may be a causative agent of canine periodontal disease,and a potential threat to human oral health.Research on P.gulae pathogenicity in canines,their owners,and veterinarians is lacking in China.This study aimed to determine the isolation and detec-tion rates of P.gulae in gingival crevicular fluid(GCF)samples from 101 canines in Beijing,using anaerobic culture techniques and 16S rRNA gene sequencing.The main risk factors for the transmission of P.gulae from canines to humans were also analyzed through analyzing the statistical data on risk factor variables from 103 canine owners and 60 veterinarians in Beijing who tested positive for P.gulae detection in GCF samples.The isolation and detection rates of P.gulae in canines were 31.5%(29/92)and 92.1%(93/101),respectively,compared with detection rates of 24.3%(25/103)in canine owners,43.3%(26/60)in veterinarians,and 52.0%(13/25)in dentists.The degree of contact with canines(P=0.001,P<0.01)and smoking(P=0.021,P<0.05)were significant risk factors for P.gulae detection in owners.Moreover,the degree of contact during ultrasonic scaling(P=0.065,0.05<P<0.1)was the most important risk factor for the positive detection of P.gulae in veterinarians.These findings suggest that P.gulae may colonize the human oral cavity through intimate contact with canines or participation in dental ultrasonic scaling operations.

Analysis on Nutritional Risk Screening and Influencing Factors of Hospitalized Patients in Central Urban Area

Rational nutritional support shall be based on nutritional screening and nutritional assessment. This study is aimed to explore nutritional risk screening and its influencing factors of hospitalized patients in central urban area. It is helpful for the early detection of problems in nutritional supports, nutrition management and the implementation of intervention measures, which will contribute a lot to improving the patient＇s poor clinical outcome. A total of three tertiary medical institutions were enrolled in this study. From October 2015 to June 2016, 1202 hospitalized patients aged ≥18 years were enrolled in Nutrition Risk Screening 2002（NRS2002） for nutritional risk screening, including 8 cases who refused to participate, 5 cases of same-day surgery and 5 cases of coma. A single-factor chi-square test was performed on 312 patients with nutritional risk and 872 hospitalized patients without nutritional risk. Logistic regression analysis was performed with univariate analysis（P〈0.05）, to investigate the incidence of nutritional risk and influencing factors. The incidence of nutritional risk was 26.35% in the inpatients, 25.90% in male and 26.84% in female, respectively. The single-factor analysis showed that the age ≥60, sleeping disorder, fasting, intraoperative bleeding, the surgery in recent month, digestive diseases, metabolic diseases and endocrine system diseases had significant effects on nutritional risk（P〈0.05）. Having considered the above-mentioned factors as independent variables and nutritional risk（Y=1, N=0） as dependent variable, logistic regression analysis revealed that the age ≥60, fasting, sleeping disorders, the surgery in recent month and digestive diseases are hazardous factors for nutritional risk. Nutritional risk exists in hospitalized patients in central urban areas. Nutritional risk screening should be conducted for inpatients. Nutritional intervention programs should be formulated in consideration of those influencing factors, which enable to reduce the nutritional risk and to promote the rehabilitation of inpatients.

Analysis of risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis

Objective To analyse the risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Methods From January 2001 to December 2008,2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 females,the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group

A clinical analysis of risk factor with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy

Objective To investigate the risk factors with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy. Methods The subjects were 82 patients with pN0 esophagea cancer who underwent Ivor-Lewis esophagectomy from January 2001 to January 2005. By using RT-PCR,VEGF C mRNA was detected in tumor issues,and Mucin (MUC1) mRNA was detected in lymph nodes. The Kaplan-Meier method was used to calculate the survival

The analysis of relevant risk factors of traumatic arthritis resulting from the surgery of acetabular fractures

Objective To explore the relevant risk factors of tramatic arthritis resulting from the surgery of acetabular fractures. Methods From January 2000 to January 2009,88 patients aged from 20 to 60 years old with acetabular fractures

DCEFM Model for Emergency Risk Assessment of Ship Inflow

This paper proposes a risk assessment model considering danger zone,capsizing time,and evaluation time factors(DCEFM)to quantify the emergency risk of ship inflow and calculate the degree of different factors to the emergency risk of water inflow.The DCEFM model divides the water inflow risk factors into danger zone,capsizing time,and evacuation time factors.The danger zone,capsizing time,and evacuation factors are calculated on the basis of damage stability probability,the numerical simulation of water inflow,and personnel evacuation simulation,respectively.The risk of a capsizing scenario is quantified by risk loss.The functional relationship between the location of the danger zone and the probability of damage,the information of breach and the water inflow time,the inclination angle and the evacuation time,and the contribution of different factors to the risk model of ship water inflow are obtained.Results of the DCEFM show that the longitudinal position of the damaged zone and the area of the breach have the greatest impact on the risk.A simple local watertight plate adjustment in the high-risk area can improve the safety of the ship.

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.

An Interpretable Prediction Model for Stroke Based on XGBoost and SHAP

Objective:To establish a stroke prediction and feature analysis model integrating XGBoost and SHAP to aid the clinical diagnosis and prevention of stroke.Methods:Based on the open data set on Kaggle,with the help of data preprocessing and grid parameter optimization,an interpretable stroke risk prediction model was established by integrating XGBoost and SHAP and an explanatory analysis of risk factors was performed.Results:The XGBoost model’s accuracy,sensitivity,specificity,and area under the receiver operating characteristic(ROC)curve(AUC)were 96.71%,93.83%,99.59%,and 99.19%,respectively.Our explanatory analysis showed that age,type of residence,and history of hypertension were key factors affecting the incidence of stroke.Conclusion:Based on the data set,our analysis showed that the established model can be used to identify stroke,and our explanatory analysis based on SHAP increases the transparency of the model and facilitates medical practitioners to analyze the reliability of the model.

Analysis of clinical characteristics and risk factors for 92 cases of nosocomially acquired candidemia

Objective To investigate the clinical features and prognostic factors of nosocomially acquired candidemia.Methods A retrospective analysis was conducted for hospitalized patients with nosocomial candidemia between January 2012 and December 2014 at the First Affiliated Hospital of Anhui Medical University.The univariate

西石门铁矿开采主要危险因素辨识及防治措施

基于西石门矿山近十年所发生的井下安全生产事故统计数据,辨识分析了西石门铁矿井下开采所存在的主要危险因素。根据西石门铁矿的采矿方法及水文地质等因素,对井下安全生产进行了深入探讨,分析了导致地压灾害和水害等事故发生的原因、规律。针对不同的主要危险因素发生的条件,提出了相应的预防整治措施,对井下的安全生产起到了良好的促进作用,获得了较为满意的效果。

Pedestrian risk analysis at uncontrolled midblock and unsignalised intersections

Transportation is defined as port to port transfer of person or goods by a medium which can be a vehicle or a person. Pedestrians being the most neglected mode of transportation in terms of safety and facility, face difficult situations while crossing near intersections and midblock crossings. It becomes more of a risk when the place of crossing is uncontrolled.But if behaviour of pedestrians while crossing is analysed in such conditions, it might be possible to create suitable solution to lessen the risk and ensure safety. In most of the cities, accepting suitable gaps between vehicles in uncontrolled midblock and intersection crossings pose threat to pedestrians＇ safety. The present study examines the safety of pedestrian crossing behaviour at midblock and unsignalised intersection crossings.Crossing time, speed, stages of crossing, number of interruptions while crossing, and the type of vehicles for which pedestrians accept the gap were extracted from the video. The tendency to show rolling gap behavior was observed and examined for different age and gender groups to analyse the risk involved in such type of crossings. The risks analysed from the study in correlation with the pedestrian demand in such uncontrolled crossings will help in design of safer pedestrian facilities. It was observed that the size of the vehicle has a significant influence on gap acceptance and crossing behaviour of pedestrians. Male pedestrians take more risks than female pedestrians in crossing unsignalized intersections. Middle aged pedestrian category poses 60.1% more chances of interrupted crossing than the other elder and young age categories of pedestrians. Male pedestrian category and the middle aged pedestrian category are more tended to accept the smallest gap between the vehicles showing a risky nature of crossing.