Objective Sedation and/or analgesia is often applied during noninvasive positive pressure ventilation (NIPPV) to make patients comfortable, and thus improve the synchronization between patients and ventilator. Nevertheless, the effect of sedation and/or analgesia on the clinical outcome of the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation remains controversial. Methods A retrospective study was conducted on patients with AECOPD who received NIPPV after extubation in seven intensive care units in West China Hospital, Sichuan University between December 2013 and December 2017 . A logistic regression model was used to analyze the association between the use of sedation and/or analgesia and clinical outcomes including rate of NIPPV failure (defined as the need for reintubation and mechanical ventilation), hospital mortality, and length of intensive care unit stay after extubation. Results A total of 193 patients were included in the analysis, and 62 cases of these patients received sedation and/or analgesia during NIPPV. The usage of sedation and/or analgesia could result in failure of NIPPV (adjusted odd ratio [OR] 0.10, 95% confidence interval [CI] 0.02 - 0.52, P=0.006) and death (adjusted OR=0.13, 95%CI 0.04 - 0.42, P=0.001). Additionally, intensive care unit stay after extubation was longer in the patients who did not receive sedation and/or analgesia than those who did (11.02 d vs. 6.10 d, P< 0.01). Conclusion The usage of sedation and/or analgesia during NIPPV can decrease both the rate of NIPPV failure and hospital mortality in AECOPD patients after extubation.
Objective To investigate the application of delayed sternal closure (DSC) following arterial switch operation for neonates with transposition of great arteries (D-TGA). Methods We retrospectively analyzed clinical data of 172 neonates underwent arterial switch operation with transposition of great arteries (D-TGA) between June 1st 2009 and December 31st 2015. These neonates were divided into 2 groups including a DSC group (118 patients with 99 males and 19 females) and a non-DSC group (54 patients with 47 males and 7 females). The outcome of the two groups were compared. Results Preoperative mechanical ventilation(P<0.001), emergency surgery (P=0.023) and extracorporeal circulation time (P<0.001) were the risk factors for delayed sternal closure. The incidence of complications of median sternotomy incision in the DSC group was not higher than that in the non-DSC group. The mortality rate in the DSC group was markedly higher than that in the non-DSC group (P<0.001). However, DSC was not a risk factor for the death of the neonates. Conclusion Delayed sternal closure does not increase the incidence of complications of the median sternotomy incision, nor is it a risk factor for the death of the neonates. Reasonable application of delayed sternal closure is helpful for early postoperative recovery of the neonates.
Colorectal cancer is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide. In recent years, with the development and change of society and economy, the epidemiological characteristics of colorectal cancer related to geographic economy and health resources have caused its incidence to show a trend of regional differentiation. At present, the diagnosis, treatment, prevention and control of colorectal cancer in China are still facing great challenges, therefore, summarizing the risk factors related to the incidence of colorectal cancer in China from the global epidemiological characteristics of colorectal cancer can further guide the prevention, control and clinical diagnosis and treatment of colorectal cancer in China, and is of great significance to improve the heavy burden of colorectal cancer. Therefore, this paper discusses the epidemiological characteristics of colorectal cancer in recent years and the screening policies in different regions based on the report of the International Agency for Research on Cancer and related studies, so as to provide the relevant basis for the prevention and control of colorectal cancer in the new situation in the future.
Objective To investigate the 30-day mortality risk factors in elderly patients (≥70 years) with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024. Simple random sampling in R was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic stepwise regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. ResultsA total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training cohort, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression with stepwise selection, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065–11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269–67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057–46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997–6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000–2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: training set AUC was 0.898 (95%CI 0.831–0.966); validation set AUC 0.912 (95%CI 0.805–1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.
ObjectiveTo analyze the risk factors for postoperative mortality of elder patients with intertrochanteric fractures.MethodsPatients with intertrochanteric fractures who underwent proximal femoral interlocking intramedullary nail fixation between January 2014 and December 2015 were enrolled in the study. Among them, 135 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin, albumin, and total lymphocyte count (TLC), and nutritional status. Univariate analysis and Cox proportional hazards regression model were used to screen the risk factors for postoperative mortality.ResultsTwenty-seven patients (20.0%) died within 2 years after surgery, and 16 (11.9%) died within 1 year after surgery. Univariate analysis showed that age, coronary atherosclerotic heart disease, number of comorbidities, preoperative hemoglobin and albumin levels were the influencing factors of postoperative mortality in elder patients with intertrochanteric fractures treated with proximal femoral interlocking intramedullary nail fixation (P<0.05). Multivariate analysis showed that age (≥80 years), combined more than 2 medical diseases, and preoperative albumin (<35 g/L) were the independent risk factors for postoperative mortality (P<0.05).ConclusionTo improve the clinical outcomes, perioperative risk should be comprehensively evaluated and perioperative management strengthened in the elder patients with intertrochanteric fractures, especially those with advanced age, more combined diseases, and low albumin, for the high postoperative mortality.
Objective To explore clinical characteristics and risk factors for mortality of community-acquired pneumonia due to Enterobacteriaceae (EnCAP) . Methods This was a single-center, retrospective study. Baseline demographic, clinic, radiologic characteristcs, treatment and outcomes were compared between patients hospilized with EnCAP and community-acquired pneumonia due to Streptoccocus pneumoniae (SpCAP) during January 1, 2010 to December 31, 2015. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with 30-day mortality for EnCAP. Results In comparison with SpCAP, cerebrovascular disease, chronic hepatopathy, chronic renal disease, aspiration risk, confusion, pleural effusion and higher PSI risk class/CURB-65 score, lower leukocyte, hemoglobin, albumin, longer length of stay in hospital were associated with EnCAP. Multivariate logistic regression analysis demonstrated sepsis shock (OR 1.700, P=0.018, 95%CI 0.781 to 38.326), hemoglobin (OR 0.087, P=0.011, 95%CI 0.857 to 0.981) and appropriate empirical antimicrobial therapy (OR 0.108, P=0.002, 95%CI 0.011 to 0.151) were risk factor for 30-day mortality of EnCAP. Conclusions The clinical characteristics of EnCAP are different with SpCAP. Clinic physicians should pay much attention to the risk factors for 30-day mortality of EnCAP.
ObjectiveTo explore the risk factors for death within 7 days after admission in trauma patients undergoing surgery under general anesthesia, and provide evidence for predicting the outcomes of those patients and guidance for clinical practices.MethodsThe basic information and perioperative data of trauma patients who underwent surgery under general anesthesia between January 1st 2019 and December 31st 2020 were collected from the Hospital Information System and the Anesthesia Information Management System. Patients who died within 7 days after admission were assigned into the case group and the others were assigned into the control group, and then propensity-score matching method was used based on age, sex, and injury types. Univariate analyses and multivariate binary logistic regression analysis were used to identify the risk factors for death within 7 days after admission in these patients.ResultsThere were 2 532 patients who met the inclusion criteria, of whom 96 patients with missing follow-up information were excluded, and 2 436 patients remained for the study. After propensity-score matching, there were 19 patients in the case group and 95 patients in the control group. The result of multivariate logistic regression analysis showed that the coma state at admission [odds ratio (OR)=9.961, 95% confidence interval (CI) (1.352, 73.363), P=0.024], perioperative body temperature<36℃ [OR=23.052, 95%CI (1.523, 348.897), P=0.024], intraoperative mean arterial pressure<60 mm Hg (1 mm Hg=0.133 kPa) [OR=12.158, 95%CI (1.764, 83.813), P=0.011], serum calcium concentraion<2.0 mmol/L [OR=33.853, 95%CI (2.530, 452.963), P=0.008], and prothrombin time [OR=1.048, 95%CI (1.002, 1.096), P=0.042] increased the risk of death within 7 days after admission.ConclusionThe coma state, coagulopathy, perioperative hypothermia, intraoperative hypotension, and hypocalcemia are 5 independent risk factors for death in trauma patients after surgery under general anesthesia.
ObjectiveTo analyze the epidemic trend of thyroid cancer in China from 2005 to 2018, and understand the estimated epidemiological situation of thyroid cancer in China in 2022 based on the thyroid cancer registration data reported by the National Cancer Registration Center and the China Cancer Registration Annual Report. MethodsThe cases of new thyroid cancer and deaths in China were analyzed according to the data of approximately 700 cancer registries in 2018 and the data of 106 cancer registries from 2005 to 2018, then stratified by sex, age, urban and rural areas, and main regions in China. And the estimated incidence and mortality of thyroid cancer in China in 2022 were analyzed based on the population data in 2020. Results① The age standardized incidence rate (ASIR) and age standardized mortality (ASMR) of thyroid cancer in China from 2005 to 2018: in the whole population, the ASIR showed a relatively rapid upward trend and the ASMR showed a relatively slower upward trend; The ASIR and ASMR of men were lower than those of women and the trend of change was also slower than that of women; The ASIR of thyroid cancer in the whole urban population was markedly higher than that in the rural population and the average annual rising rate (AARR) in the urban and rural areas was 6.31% and 0.38% respectively, while the ASMR had no obviously difference between the urban and rural populations (the AARR was 3.23% and 2.33% respectively); The ASIR of thyroid cancer was the highest in the eastern region with a markedly rising, but its ASMR had a relatively lower rising rate, while the ASIR in the western region was relatively lower and the ASMR also showed a downward trend, and the ASMR in the central region had a relatively obvious rising rate. ② The estimated incidence and mortality of thyroid cancer in China in 2022: the estimated ASIR and ASMR of the whole population in 2022 was still rising as compared with in 2018 (ASIR: 24.64 per 100 000 vs. 12.01 per 100 000; ASMR: 0.45 per 100 000 vs. 0.37 per 100 000 ); The estimated ASIR and ASMR in women were still much higher than in men (ASIR: 36.51 per 100 000 vs. 13.25 per 100 000; ASMR: 0.55 per 100 000 vs. 0.35 per 100 000); Among the urban and rural populations, the estimated ASIR in urban was still higher than in rural areas (27.87 per 100 000 vs. 17.66 per 100 000), while the estimated ASMR had no marked difference between them (0.41 per 100 000 vs. 0.52 per 100 000). Compared with 2018, the development trend of the ASIR was still rising (urban: 27.87 per 100 000 vs. 15.58 per 100 000; rural: 17.66 per 100 000 vs. 8.95 per 100 000). The age specific ASIR of thyroid cancer showed a marked sex differences, that is, it began to rise rapidly from the 20–30 years old group, and reached the peak at the 45–50 years old group (the highest ASIR was 97.00 per 100 000) in women; However, which had been in a slower upward trend from the 0 to 20 years old group, while it had been rising rapidly from the 20 to 25 years old group, reaching the peak at the 30–35 years old group (the highest ASIR was 31.60 per 100 000) in men. The overall trend of age specific ASMR for thyroid cancer was similar for both males and females, with a slower increase starting from the 0–35 years old age group and continuous rising till 85 years old and above. ConclusionsThe incidence and mortality of thyroid cancer in China are rising, and the disease burden is still severe and the differences are existed in urban and rural areas, sex, age, and main regions. Overall, the prevention and control situation is complex and severe in China.
Objective To explore the causes of conversion to thoracotomy in patients with minimally invasive esophagectomy (MIE) in a surgical team, and to obtain a deeper understanding of the timing of conversion in MIE. Methods The clinical data of patients who underwent MIE between September 9, 2011 and February 12, 2022 by a single surgical team in the Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. The main influencing factors and perioperative mortality of patients who converted to thoracotomy in this group were analyzed. Results In the cohort of 791 consecutive patients with MIE, there were 520 males and 271 females, including 29 patients of multiple esophageal cancer, 156 patients of upper thoracic cancer, 524 patients of middle thoracic cancer, and 82 patients of lower thoracic cancer. And 46 patients were converted to thoracotomy for different causes. The main causes for thoracotomy were advanced stage tumor (26 patients), anesthesia-related factors (5 patients), extensive thoracic adhesions (6 patients), and accidental injury of important structures (8 patients). There was a statistical difference in the distribution of tumor locations between patients who converted to thoracotomy and the MIE patients (P<0.05). The proportion of multiple and upper thoracic cancer in patients who converted to thoracotomy was higher than that in the MIE patients, while the proportion of lower thoracic cancer was lower than that in the MIE patients. The perioperative mortality of the thoracotomy patients was not significantly different from that of the MIE patients (P=1.000). Conclusion In MIE, advanced-stage tumor, anesthesia-related factors, extensive thoracic adhesions, and accidental injury of important structures are the main causes of conversion to thoracotomy. The rate varies at different tumor locations. Intraoperative conversion to thoracotomy does not affect the perioperative mortality of MIE.
Objective To compare the epidemiological status and trends of colorectal cancer in China and the United States, and to summarize the respective prevention and screening strategies. MethodsBased on relevant data such as the Global cancer statistics (2022), Cancer statistics (2025), the China Cancer Burden of Disease Report (2022), and the China-United States colorectal cancer epidemiology report, the incidence, mortality and trends of colorectal cancer in China and the United States were analyzed. ResultsFrom 2000 to 2018, age-standardized incidence rate of colorectal cancer in China increased by an average of 2.7% per year for men and 1.1% per year for women, with an average annual mortality increase of 1.2% for men and a decrease of 0.3% per year for women. Colorectal cancer mortality decreased by an average of 1.2% per year in the United States in 2011–2021 and by an average of 1.7% per year in 2013–2022, and the 5-year relative survival rate for colorectal cancer increased from 50% in 1975–1977 to 64% in 2014–2020. ConclusionsThe incidence and mortality of colorectal cancer in the United States have shown a downward trend, and the survival rate of patients is increasing. The situation in our country is different: the incidence continues to rise, the mortality is higher than the United States, and although the survival rate has improved, it is still not at the level of the United States. China continues to face a heavy burden of colorectal cancer. To enhance colorectal cancer prevention and treatment, it is essential to establish a new multi-stakeholder collaborative framework for disease control, ultimately forming a colorectal cancer management system with Chinese characteristics, thereby effectively reducing the national colorectal cancer disease burden.