New risk factors and new tendency for central nervous system relapse in patients with diffuse large B-cell lymphoma:a retrospective study

Background: In patients with difuse large B?cell lymphoma(DLBCL), central nervous system(CNS) relapse is uncom?mon but is nearly always fatal. This study aimed to determine the risk factors for CNS relapse in DLBCL patients and to evaluate the eicacy of rituximab and intrathecal chemotherapy prophylaxis for CNS relapse reduction.Methods: A total of 511 patients with newly diagnosed DLBCL treated at the Sun Yat?sen University Cancer Center between January 2003 and December 2012 were included in the study. Among these patients, 376 received R?CHOP regimen(rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) as primary treatment, and 135 received CHOP regimen(cyclophosphamide, doxorubicin, vincristine, and prednisone) as primary treatment. Intrathe?cal chemotherapy prophylaxis(methotrexate plus cytarabine) was administered to those who were deemed at high risk for CNS relapse. In the entire cohort and in the R?CHOP set in particular, the Kaplan–Meier method coupled with the log?rank test was used for univariate analysis, and the Cox proportional hazards model was used for multivariate analysis. Diferences were evaluated using a two?tailed test, and P < 0.05 was considered signiicant.Results: At a median follow?up of 46 months, 25(4.9%) patients experienced CNS relapse. There was a trend of reduced occurrence of CNS relapse in patients treated with rituximab; the 3?year cumulative CNS relapse rates were 7.1% in CHOP group and 2.7% in R?CHOP group(P = 0.045). Intrathecal chemotherapy prophylaxis did not confer much beneit in terms of preventing CNS relapse. Bone involvement [hazard ratio(HR) = 4.21, 95% conidence interval(CI) 1.38–12.77], renal involvement(HR = 3.85, 95% CI 1.05–14.19), alkaline phosphatase(ALP) >110 U/L(HR = 3.59, 95% CI 1.25–10.34), serum albumin(ALB) <35 g/L(HR = 3.63, 95% CI 1.25–10.51), treatment with rituxi?mab(HR = 0.34, 95% CI 0.12–0.96), and a time to complete remission ≤ 108 days(HR = 0.22, 95% CI 0.06–0.78) were independent predictive factors for CNS relapse in the entire cohort. Bone involvement(HR = 4.44, 95% CI 1.08–18.35), bone marrow involvement(HR = 11.70, 95% CI 2.24–60.99), and renal involvement(HR = 10.83, 95% CI 2.27–51.65) were independent risk factors for CNS relapse in the R?CHOP set.Conclusions: In the present study, rituximab decreased the CNS relapse rate of DLBCL, whereas intrathecal chemo?therapy prophylaxis alone was not suicient for preventing CNS relapse. Serum levels of ALB and ALP, and the time to complete remission were new independent predictive factors for CNS relapse in the patients with DLBCL. In the patients received R?CHOP regimen, a trend of increased CNS relapse was found to be associated with extranodal lesions.

Frequency of Cardiovascular Risk Factors in Systemic Lupus Erythematosus: A Case-Control Study in a Department of Internal Medicine in Sub-Saharan Africa

Background: The morbidity and mortality of systemic lupus erythematosus are largely due to accelerated atherosclerosis. This is partly related to the high prevalence of traditional cardiovascular risk factors. The aim of our study was to determine the frequency of these factors in lupus patients compared to a control population in a department of internal medicine. Methods: We realized a case-control study in patients with systemic lupus erythematosus according to ACR criteria in 1997. Patients were matched by age and gender with controls subjects without autoimmune disease. We studied the frequency of traditional cardiovascular risk factors in both populations. The study was done in the department of internal medicine of Aristide Le Dantec teaching Hospital, in Senegal, during the period from August 2017 to December 2018. The statistical analysis was performed with SPSS 23.0 software and the level of significance was retained for a p-value Results: We recruited 100 subjects including 50 patients and 50 controls. The mean age was 33.5 ± 11.3 years in cases and 33.3 ± 11.3 years in controls. Dyslipidemia was significantly associated with systemic lupus erythematosus (p = 0.009). Levels of triglycerides (p Conclusion: Traditional cardiovascular risk factors including dyslipidemia and hyperuricemia were more common in patients. Similarly, renal failure was associated with lupus.

A Review of Systemic Lupus Erythematosus (SLE): Symptoms, Risk Factors, Treatment, and Health Related Quality of Life Issues

In this paper, we present a thorough review of one of the most life-threatening autoimmune diseases, Systemic lupus erythematosus (lupus). Symptoms, risk factors, including genetic and epidemiological factors are discussed. Treatment, life expectancies, and Health Related Quality of Life of patients with SLE will be discussed as well. Special attention will be given to Lupus Nephritis.

Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy

BACKGROUND The available prediction models for clinically relevant postoperative pancreatic fistula (CR-POPF) do not incorporate both preoperative and intraoperative variables. AIM To construct a new risk scoring system for CR-POPF that includes both preoperative and intraoperative factors. METHODS This was a retrospective study of patients who underwent pancreaticoduodenectomy (PD) or pylorus-preserving PD (PPPD) between January 2011 and December 2016 at the First Affiliated Hospital of Soochow University. Patients were divided into a study (01/2011 to 12/2014) or validation (01/2015 to 12/2016) group according to the time of admission. POPF severity was classified into three grades: Biochemical leak (grade A) and CR-POPF (grades B and C). Logistic regression was used to create a predictive scoring system. RESULTS Preoperative serum albumin ≥ 35 g/L [P = 0.032, odds ratio (OR)= 0.92, 95% confidence interval (CI): 0.85-0.99], hard pancreatic texture (P = 0.004, OR = 0.25, 95%CI: 0.10-0.64), pancreatic duct diameter ≥ 3 mm (P = 0.029, OR = 0.50, 95%CI: 0.27-0.93), and intraoperative blood loss ≥ 500 mL (P = 0.006, OR = 1.002, 95%CI:1.001-1.003) were independently associated with CR-POPF. We established a 10-point risk scoring system to predict CR-POPF. The area under the curve was 0.821 (95%CI: 0.736-0.905) and the cut-off value was 3.5. Including drain amylase levels improved the predictive power of the model. CONCLUSION This study established a 10-point scoring system to predict CR-POPF after PD/PPPD using preoperative and intraoperative parameters. Ultimately, this system could be used to distinguish between high- and low-risk populations in order to facilitate timely interventions after PD.

基于系统动力学的危险化学品运输风险因素研究

为了降低危化品运输事故频次,规避危化品在运输过程中的风险,基于系统动力学模型,从人、机、环、管4个维度构建危化品运输风险因素指标体系,使用AHP法对指标权重进行赋值,结合风险因素间的因果关系构建参数方程,利用Vensim软件仿真模拟危化品运输风险水平的变化趋势,确定单因素变量值和人、机、环、管风险子系统权重的变化对危化品运输风险系统动力学模型的影响程度。结果表明:安全意识薄弱、设备故障等风险因素的变动以及人、机、环、管风险子系统的权重变动都会影响危化品运输风险水平,人、机、环、管4个子系统对危化品运输风险的影响程度从高到低依次是人、管、环、机。研究结果可为降低危化品运输过程中的风险和制定危化品运输事故预防策略提供一定参考。

Urologic Laparoscopic Surgeries in Elderly: Analysis of Pre-Operative Risk Factors and Postoperative Complications

Purpose: The aging of the population leads to increases in the prevalence of symptomatic urologic diseases. The aim of this study is the analysis of pre-operative risk factors and postoperative complications in patients over the age of 60 years undergoing elective laparoscopic urologic surgery. Patients and Methods: A retrospective study was conducted of 113 patients 60 years of age or older who underwent urologic laparoscopic surgery by a single surgeon (SP). The preoperative physical status and systemic complications, operation time, postoperative complications, postoperative hospital stay and other clinical features of the patients were reviewed. Complications were classified according to the recently revised Clavien classification system. Statistical analysis was done using Univariate analysis and the Fisher Exact test. Results: Laparoscopic urologic surgery was performed on 113 patients 60 years old and over, with an average age of 69.6 years. Associated diseases were found in 92% of them. Pelvic surgery (65;57.5%) was the main reason for surgery. There were 5 (4.4%) conversions to open surgery and 0% mortality. The overall complication rate was 10 patients (8.8%). Among 9 (7.96%) patients with post-operative complications;Grade I, II, IIIa, IIIb and IV complications were observed in 1.77%, 12.8%, 3.53%, 0.88% and 0.88% of cases, respectively. Sex with male, operative time ≥ 250 min and cancer had high risk ratio (2.76, 2.11 and 3.02, respectively);however the correlations of all of preoperative risk factors and postoperative complications showed no statistically significant differences. Conclusions: Laparoscopic surgical treatment of urologic disease in elderly patients performed is feasible and well tolerated, with low perioperative morbidity and a good overall survival rate. Pre-operative risk factors may not influence postoperative complications in patients over the age of 60 years undergoing elective laparoscopic urologic surgery.

颅脑外伤患者术后中枢神经系统感染的危险因素及病原菌特点分析

目的明确颅脑外伤患者术后发生颅内感染的危险因素、病原菌的分布特点及耐药性分析。方法回顾性分析2016年1月至2022年12月在首都医科大学附属北京天坛医院神经外科行手术治疗的颅脑外伤患者的临床资料,依据术后是否发生中枢神经系统感染分为感染组(335例)和非感染组(770例)。分析导致术后中枢神经系统感染发生的危险因素;通过分析感染组患者脑脊液的细菌培养及鉴定结果,了解病原菌的分布特点及耐药性。结果手术持续时间≥3 h、术中出血量≥400 mL、二次手术、有切口脑脊液漏、引流管留置时间≥3 d、重症监护室(ICU)滞留时间≥7 d、合并糖尿病、血清降钙素原升高、快速C反应蛋白升高是发生术后中枢神经系统感染的危险因素(P<0.05)。脑脊液送检标本共培养出细菌107株,其中革兰阳性菌46株,革兰阴性菌61株。常见革兰阳性菌对万古霉素、利奈唑胺、替加环素均敏感,革兰阴性菌大多为多重耐药菌。结论手术持续时间长、术中出血量大、再次手术、有切口脑脊液漏、引流管留置时间长、ICU滞留时间长、合并糖尿病是颅脑外伤患者术后中枢神经系统感染的危险因素,需注意对相关危险因素进行防控,尽可能减少术后中枢神经系统感染事件的发生。此外革兰阴性菌感染比率逐渐上升,应根据细菌培养结果及时调整抗菌药物使用,制定更有针对性的抗感染治疗方案。

急性脑梗死患者泌尿系统感染相关因素分析及预测模型建立

目的探讨急性脑梗死患者泌尿系统感染的危险因素,建立感染预测模型,为制定防控措施提供参考。方法回顾性分析2021年1月~2022年12月新乡医学院第一附属医院223例急性脑梗死患者的临床资料,其中泌尿系统感染者48例纳入感染组,未发生泌尿系统感染者175例纳入未感染组,采用Logistic回归分析筛选脑梗死患者发生泌尿系统感染的危险因素并构建预测模型,采用受试者工作曲线(ROC)评估模型判别效度和截点值。结果Logisitic回归分析显示女性、年龄≥60岁、糖尿病史、泌尿系统结石、留置导尿管是脑梗死患者发生泌尿系统感染的独立危险因素;根据多因素分析结果构建脑梗死患者泌尿系统感染概率值回归方程为:P=1/[1+e^(-(-3.883+1.001*性别+0.880*年龄+1.136*糖尿病+1.018*泌尿系统结石+1.957*留置导尿管))];建模组对模型进行内部验证ROC曲线下面积(AUC)为0.823,95%CI(0.762,0.884),灵敏度为87.50%,特异度为64.00%,区分度良好,根据约登指数最大原则选取cut-off点为0.120。结论建立的预测模型判别效度较佳,可用于识别脑梗死泌尿系统感染高危患者。

儿童系统性红斑狼疮并发糖尿病临床特点及相关因素分析

目的 分析儿童系统性红斑狼疮(SLE)并发糖尿病的临床特征,探讨SLE并发糖尿病的独立危险因素。方法 选取2016年1月至2022年6月于肾脏内科住院的SLE并发糖尿病患儿为糖尿病组,同期住院未合并糖尿病的SLE患儿为对照组,收集两组患儿的临床资料,分析SLE并发糖尿病的危险因素。结果 纳入SLE合并糖尿病患儿15例(7.4%),男5例、女10例。糖尿病中位发病年龄12.0(11.0~13.0)岁,发生糖尿病时SLE中位病程为25.5(11.5~92.5)天,中位空腹血糖为11.3(10.8~13.2)mmol/L。有糖尿病家族史6例。发生糖尿病时10例患儿足量激素(醋酸泼尼松2 mg·kg^(-1)·d^(-1),最大量≤60 mg/d)使用中。对照组纳入SLE患儿151例(男42例、女109例)。与对照组比较,糖尿病组年龄较大,收缩压和舒张压较高,胆固醇、尿酸水平较高,高密度脂蛋白水平较低;收缩压异常升高,胆固醇、尿酸异常升高,高密度脂蛋白异常降低以及有家族史的患儿比例较高;尿蛋白转阴时间较长,差异均有统计学意义(P<0.05)。多因素logistic回归分析发现,年龄,糖尿病家族史,尿酸、胆固醇水平升高,高密度脂蛋白水平降低是SLE并发糖尿病的独立危险因素(P<0.05)。结论 如SLE患儿年龄偏大,有糖尿病家族史,伴有高水平胆固醇、低水平高密度脂蛋白及高尿酸血症,需注意监测血糖,警惕继发性糖尿病的发生。

老年患者经尿道前列腺电切术后泌尿系统感染的危险因素分析

目的:探讨老年患者经尿道前列腺电切术(TURP)后发生泌尿系统感染的危险因素。方法:选取2022年2月—2023年2月于赣州市人民医院行TURP治疗的105例老年患者,收集并比较患者临床资料,根据是否发生感染分为感染组(n=26)和未感染组(n=79),并采用多因素logistic回归分析影响患者术后泌尿系统感染的危险因素。结果:105例老年患者TURP后发生泌尿系统感染的有26例,占比24.76%。两组年龄、体重指数、高血压史、糖尿病史、高血脂史、病程、术中出血量、术中电凝次数、引流管引流量比较,差异均无统计学意义(P>0.05);感染组逼尿肌功能不稳定、导尿管堵塞占比及国际前列腺症状评分(IPSS)、导尿管气囊注水量均高于未感染组,手术时间、留置尿管时间均长于未感染组,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,逼尿肌功能、手术时间、留置尿管时间是老年患者TURP后发生泌尿系统感染的危险因素(P<0.05)。结论:逼尿肌功能、手术时间、留置尿管时间是老年患者TURP后发生泌尿系统感染的危险因素,应加强针对性干预,以降低泌尿系统感染的发生率。

Behavioral Risk Factors for Chronic Non-Communicable Diseases in Adults and Elderly People in the City of Ribeirão Preto—SP

Aims: to analyze the presence and simultaneity of behavioral risk factors for chronic non-communicable disease (NCD) in adults and the elderly. Methods: quantitative, cross-sectional and observational study. Healthy and unhealthy eating are classified according to the frequency of food consumption. Smoking is expressed by the percentage of smokers. Harmful alcohol consumption by the percentage of individuals who consumed alcoholic beverages at least once in the last 30 days. Classification of the level of physical inactivity required to practice at least 150 minutes of physical activity. Results: the sample constituted 719 people, 535 adults and 184 elderly. The behavioral risk factor reported by most adults 499 (93.3%) and elderly 156 (84.8%) was unhealthy eating. Frequency 72% higher of smoking, four times higher of harmful alcohol consumption and 10% higher of unhealthy food among adults when compared to the elderly. The simultaneity between risk factors was 39% greater in adults than in the elderly. Discussion: risk factors evaluated in this study are key aspects of the development of NCDs. Adults have 2.43 times the chance of presenting two risk factors and 7.73 times the chance of presenting three in relation to the elderly. Conclusion: To achieve more effective and differentiated results, knowing and directing measures to control behavioral risk factors, whether isolated or concurrent, requires specific knowledge.

基于极值理论的地基增强系统完好性评估方法

针对地基增强系统(Ground Based Augmentation System,GBAS)完好性风险事件的极端性而导致的无法通过风险事件发生频率评估系统性能的问题,提出一种基于极值理论的GBAS完好性评估方法。根据机载端(位置域)输出的位置误差和保护级计算安全系数,并利用区间极大值模型对安全系数进行建模描述以获得其分布模型;利用极大似然法估计安全系数模型参数,进而利用模型外推法计算GBAS完好性风险值。给出GBAS完好性评估流程,并利用GBAS系统进行了验证实验。研究结果表明:对于C类GBAS进近服务而言,基于全球定位系统(Global Position System,GPS)增强GBAS和基于北斗卫星导航系统(Beidou Navigation Satellite System,BDS)增强GBAS可用性均大于99.9999%;对于F类GBAS进近服务而言,BDS GBAS可用性能要优于GPS GBAS;根据7 d观测数据外推得到的GPS GBAS垂直和侧向完好性风险值分别为4.557×10^(-8)/进近和5.152×10^(-8)/进近,BDS GBAS垂直和侧向完好性风险值分别为1.612×10^(-7)/进近和1.823×10^(-7)/进近,满足航空器终端区I类进近与着陆导航性能需求。

饮水系统中抗生素抗性基因赋存特征及健康风险评估

近几年抗生素抗性基因(ARGs)作为一种新型污染物在世界各地的水体、土壤中被频繁检出,其在环境中大量扩散和增殖十分容易导致微生物获得抗生素抗性,对人体健康产生潜在威胁。结合国内外文献报道数据,介绍了ARGs在城市饮水系统中污染现状,描述了其赋存特征,发现在国内外城市饮水系统中ARGs的数量不容小觑,数量最高可达1.38×105 copies·ml-1。其次对城市饮水系统中常用工艺对ARGs的赋存与传播影响因素进行了总结,发现城市常用水处理工艺对ARGs的灭杀效果差,甚至对其富集和繁殖往往起着促进作用;在不同的环境影响因素中,微生物群落结构是影响ARGs的主要驱动力,其次是重金属。最后提出ARGs对人体可能造成的健康威胁以及现有健康风险评估方法的局限性,并对未来ARGs的研究进行了展望。

基于STPA-BN的船舶航行人为风险因素分析与评估

人为因素是引发船舶事故的最主要因素之一,为了研究船舶人为风险因素的因果关系,从中国海事局发布的船舶事故报告出发,引入系统理论过程分析-贝叶斯网络(STPA-BN)模型对船舶航行人为风险因素进行分析和评估。采用系统理论过程分析(STPA)方法识别出船舶航行中存在的不安全控制行为,结合事故报告内容提取出12种人为风险因素,利用风险因素的内在因果关系和结构学习功能构建贝叶斯网络拓扑结构;将事故报告量化,并对网络进行参数学习,对模型进行验证。在此基础上,利用贝叶斯网络(BN)的推理功能得到船舶航行中7种突出的人为风险因素和3条事故核心致因链,为保障船舶安全航行与船员培训提供数据支持。

基于HFACS模型的军事演训活动风险评估指标体系构建

基于人因分析与分类系统(HFACS)分析军事演训活动的全面风险,考虑联合军事演训和新域新质作战力量的特点,并突出演训活动的战斗力标准。在改进HFACS模型分析框架的基础上,逐层次细化拆解,建立初步的风险评估指标库,并结合专家知识运用风险矩阵对指标库进行优化。构建人为因素视角下涵盖战斗力的风险、组织管理的风险、不安全行为的前提条件的风险和不安全行为的风险等4个方面以及包含战斗精神、新型主战武器、智能装备等在内的15项极高风险指标、20项高风险指标和8项中风险指标的风险评估指标体系。

多发性骨髓瘤化疗患者医院感染的危险因素研究

目的分析多发性骨髓瘤患者发生医院感染的影响因素,为护理干预提供参考。方法将168例多发性骨髓瘤患者按治疗期间是否发生医院感染分为感染组(n=80)和未感染组(n=88)。分析多发性骨髓瘤患者医院感染发生情况和危险因素。结果168例多发性骨髓瘤患者在院期间接受化疗188例次,其中医院感染患者80例,发生感染96例次,主要为呼吸道感染及消化系统感染。年龄、糖尿病、国际分期体系分期、Durie-Salmon分期、住院时间是多发性骨髓瘤化疗患者发生医院感染的影响因素(均P<0.05)。结论多发性骨髓瘤患者发生医院感染率较高,影响因素较多,医护人员可针对影响因素进行干预,降低医院感染发生率,改善预后。

起飞阶段民机驾驶舱人机系统风险分析方法研究

为了评估民机驾驶舱人机系统在起飞阶段的安全风险,识别危险节点,研究了1种基于节点弹性理论的人机系统风险分析方法。运用层次任务分析法(hierarchical task analysis,HTA)和功能共振事故模型(functional resonance accident model,FRAM),分析人机系统的主要功能,及功能之间的逻辑关系,构建人机系统功能网络模型;再分析功能间和功能内特征的影响因素及连接关系,识别功能失效模式,构建了人机系统风险传播网络模型;引入易感-感染-康复模型(susceptible-infectious-recovered,SIR)模型,模拟风险在系统网络中的动态传播过程。改进认知可靠性和失误分析方法(cognitive reliability and error analysis method,CREAM),识别民机驾驶舱人机系统失效模式和共同绩效条件,并计算了所提SIR模型中的失效概率、传播率和恢复概率。针对风险的动态传播过程,考虑系统受扰和恢复时间,提出1种改进的节点弹性度量方法,更准确地反应风险发生后系统性能变化和弹性表现。以1个起飞阶段民机驾驶舱人机系统为例,①所提方法识别了4种重大风险节点、7种一般风险节点、33种低风险节点以及48种微小风险节点;②在前3类风险节点中,人因失误占比分别为100%、42%及45%;③风险分析表明,包括飞行员疲劳程度和视觉负荷在内的人为因素更易形成安全事故;④分析结果与起飞阶段险情统计分析结果相互印证。此外,所提方法分析了人机系统性能变化过程,发现在系统恢复过程中存在的困难及二次风险的易发倾向。以上结论验证了本文所提方法的有效性,且有助于提出系统风险管理的相应策略。

系统性红斑狼疮并发股骨头坏死危险因素列线图预测模型的建立和验证

背景:股骨头坏死是系统性红斑狼疮患者常见的并发症,若能早期对其发生风险进行预测与验证,将有助于避免或延缓股骨头坏死的发展。目的:分析系统性红斑狼疮患者并发股骨头坏死的危险因素,构建系统性红斑狼疮患者并发股骨头坏死的列线图预测模型并进行验证。方法:回顾性分析2013年1月至2022年12月首次就诊于河南中医药大学第一附属医院的914例系统性红斑狼疮患者的病历资料,根据是否发生股骨头坏死分为发生股骨头坏死组(n=100)和未发生股骨头坏死组(n=814)。采用单因素、LASSO回归和多因素Logistic回归分析筛选和确定系统性红斑狼疮并发股骨头坏死的危险因素。同时将数据集按照7∶3的比例随机分为训练集和测试集,并基于多因素Logistic回归分析结果,构建系统性红斑狼疮并发股骨头坏死的列线图预测模型。同时,使用受试者工作特征曲线、Hosmer-Lemeshow校准曲线和决策曲线对列线图的性能进行评估。结果与结论:①股骨头坏死组与未发生股骨头坏死组患者在系统性红斑狼疮病程、系统性红斑狼疮疾病活动度评分、狼疮性肾炎、呼吸系统受累、胃肠道受累、干燥综合征、骨质疏松、抗核糖核蛋白抗体阳性、补体C3降低、环磷酰胺、吗替麦考酚酯、生物抑制剂、糖皮质激素最大日剂量、糖皮质激素冲击治疗方面差异有显著性意义(P<0.05);②采用LASSO回归分析方法筛选出10个与系统性红斑狼疮并发股骨头坏死风险相关的预测变量,将其纳入多因素Logistic回归分析,结果显示系统性红斑狼疮病程、呼吸系统受累、干燥综合征、骨质疏松、抗核糖核蛋白抗体阳性、环磷酰胺、吗替麦考酚酯、生物抑制剂、糖皮质激素最大日剂量是系统性红斑狼疮患者发生股骨头坏死的独立危险因素(P<0.05);③训练集中预测发生风险的受试者工作特征曲线下面积为0.802(95%CI=0.742-0.862),测试集预测发生股骨头坏死风险受试者工作特征曲线下面积为0.811(95%CI=0.745-0.876);Hosmer-Lemeshow校准曲线拟合度较好(训练集,P=0.447;验证集,P=0.870);决策曲线显示使用列线图预测模型预测系统性红斑狼疮患者发生股骨头坏死的风险是有益的;④月经异常为女性系统性红斑狼疮患者并发股骨头坏死的危险因素之一;⑤此次研究结果提示,系统性红斑狼疮并发股骨头坏死的危险因素是多因素的,同时建立了一个包含9个危险因素的列线图预测模型,可将其用于预测系统性红斑狼疮患者发生股骨头坏死的风险;此外,首次报道了月经异常为女性系统性红斑狼疮并发股骨头坏死的危险因素之一。

基于IRML-STAMP的舰船加油系统风险因素识别方法

为研究舰船加油系统遭受外界干扰后的系统功能状态变化情况和系统自身恢复能力,基于IRML-STAMP方法对舰船加油系统风险因素进行识别,定量评估舰船加油系统动态弹性,并与基于传统STAMP方法的评估结果进行比较。结果表明:利用基于IRML-STAMP的舰船加油系统风险因素识别方法可以精确找出失效后导致舰船加油系统动态弹性损失最多的STAMP模型的关键节点;以舰船加油系统加油作业设定故障场景为例,压力表等仪表是该系统的关键节点,压力表等仪表故障中断后,系统动态弹性大幅下降0.161;当故障传播路径中不包含关键节点时,系统动态弹性最大,当干扰出现在关键节点时,系统动态弹性最小,差值为0.101;与传统STAMP方法相比,IRML-STAMP方法评估结果可以准确定位系统风险,提高系统动态弹性。该研究结果可以帮助提高舰船加油系统的抗干扰性,对现场舰船加油系统的风险因素识别具有指导意义。

输尿管硬镜联合软镜碎石取石术治疗老年输尿管结石的临床效果及术后发生全身炎症反应综合征的危险因素

目的探讨输尿管硬镜联合输尿管软镜碎石取石术(FURL)治疗老年输尿管结石(UC)的临床效果及术后全身炎症反应综合征(SIRS)发生的危险因素。方法选取2018年1月至2022年12月在郑州市第三人民医院接受治疗的老年UC患者共计200例,以随机数字表法分为研究组(n=100)与对照组(n=100),对照组采用半硬性输尿管镜治疗,研究组采用输尿管硬镜联合FURL治疗,对两组一期清石率、围手术期指标及排尿功能进行比较,并统计术后SIRS发生情况,进行单因素分析与多因素Logistic回归分析以明确术后SIRS发生的危险因素。结果研究组一期清石率较对照组更高,术中出血量更少,血尿持续时间更短,但手术时间、住院时间更长,差异均有统计学意义(P<0.05);与术后1个月相比,两组术后3个月最大尿流量(Qmax)增加,国际前列腺症状评分量表(IPSS)评分下降,差异均有统计学意义(P<0.05),且研究组术后1个月、3个月的Qmax较对照组更高,IPSS评分更低,差异均有统计学意义(P<0.05);100例患者中,10例发生SIRS,发生率为10.00%;发生组术前白细胞计数(WBC)≥10×10~9/L、术前因结石发热、术中尿液浑浊与脓苔的患者比例较未发生组更高,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,术前因结石发热(OR=4.213)、术前WBC≥10×10~9/L(OR=2.122)、术中尿液浑浊与脓苔(OR=3.616)是输尿管硬镜联合FURL术后SIRS发生的独立危险因素,差异有统计学意义(P<0.05)。结论输尿管硬镜联合FURL应用于老年UC患者中,能够促进一期清石率提高及术中出血量减少,缩短血尿持续时间,提高排尿功能,但会延长手术时间、住院时间;术前WBC≥10×10~9/L、术前因结石发热、术中尿液浑浊与脓苔均为术后SIRS发生的危险因素。