BACKGROUND: There is controversy regarding whether saddle main pulmonary artery(MPA) embolism represents a high risk of deterioration in non-high-risk acute pulmonary embolism(PE) patients. This study aims to address ...BACKGROUND: There is controversy regarding whether saddle main pulmonary artery(MPA) embolism represents a high risk of deterioration in non-high-risk acute pulmonary embolism(PE) patients. This study aims to address this issue by conducting a propensity score matching(PSM) study.METHODS: A total of 727 non-high-risk acute PE patients were retrospectively evaluated. We evaluated the Bova score and risk stratification to examine the risk of deterioration. Deterioration defined as any adverse event within 30 days after admission. Computed tomographic pulmonary angiography was used to identify the embolism type. All patients were matched into four subgroups by PSM according to age, sex, Bova score, and risk stratification:(1) MPA and non-MPA embolism;(2) non-saddle MPA and non-MPA embolism;(3) saddle MPA and non-saddle MPA embolism;(4) saddle MPA and non-MPA embolism. Correlations were analyzed using Cox regression analysis, and deterioration risk was compared between subgroups using Kaplan-Meier analysis.RESULTS: Cox regression analysis revealed that MPA embolism was correlated with deterioration, regardless of whether saddle MPA embolism was included or excluded. Saddle MPA embolism was not correlated with deterioration, regardless of comparison with non-saddle MPA embolism or non-MPA embolism. Patients with MPA and non-saddle MPA embolism presented a high risk for deterioration(logrank test=5.23 and 4.70, P=0.022 and 0.030, respetively), while patients with saddle MPA embolism were not at a high risk of deterioration(log-rank test=1.20 and 3.17, P=0.729 and 0.077, respetively).CONCLUSIONS: Saddle MPA embolism is not indicative of a high risk of deterioration in nonhigh-risk acute PE patients.展开更多
Background Disturbed circadian rhythm is a potential cause of delirium and is linked to disorganisation of the circadian rhythmicity. Dynamic light （DL） could reset the circadian rhythm by activation of the suprachi...Background Disturbed circadian rhythm is a potential cause of delirium and is linked to disorganisation of the circadian rhythmicity. Dynamic light （DL） could reset the circadian rhythm by activation of the suprachiasmatic nucleus to prevent delirium. Evidence regarding the effects of light therapy is predominantly focused on psychiatric disorders and circadian rhythm sleep disorders. In this study, we investi- gated the effect of DL on the total hospital length of stay （LOS） and occurrence of delirium in patients admitted to the Coronary Care Unit （CCU）. Methods This was a retrospective cohort study. Patients older than 18 years, who were hospitalized longer than 12 h at the CCU and had a total hospital LOS for at least 24 h, were included. Patients were assigned to a room with DL （n = 369） or regular lighting condi- tions （n = 379）. DL was administered at the CCU by two ceiling-mounted light panels delivering light with a colour temperature between 2700 and 6500 degrees Kelvin. Reported outcome data were： total hospital LOS, delirium incidence, consultation of a geriatrician and the amount of prescripted antipsychotics. Results Between May 2015 and May 2016, data from 748 patients were collected. Baseline charac- teristics, including risk factors provoking delirium, were equal in both groups. Median total hospital LOS in the DL group was 100.5 （70.8-186.0） and 101.0 （73.0-176.4） h in the control group （P = 0.935）. The incidence of delirium in the DL and control group was 5.4% （20/369） and 5.0% （19/379）, respectively （P = 0.802）. No significant differences between the DL and control group were observed in secon- dary endpoints. Subgroup analysis based on age and CCU LOS also showed no differences. Conclusion Our study suggests exposure to DL as an early single approach does not result in a reduction of total hospital LOS or reduced incidence of delirium. When delirium was diagnosed, it was associated with poor hospital outcome.展开更多
Objective: To investigate the knowledge level related to compliance in patients with epilepsy. Methods: Eighty-seven patients with epilepsy were tested in the city of Xi’an with a knowledge questionnaire containing 2...Objective: To investigate the knowledge level related to compliance in patients with epilepsy. Methods: Eighty-seven patients with epilepsy were tested in the city of Xi’an with a knowledge questionnaire containing 21 questions related to compliance. Results: Over 39.5% of patients did not know that epilepsy is the result of abnormal firing of neurons, while 29.9% were uncertain or did not realize that epilepsy attacks can bring up accidents such as traffic accidents, drowning and trauma. A total of 36.6% of responders thought that the best therapy for epilepsy could be found in Traditional Chinese Medicine. As many as 36.8% of tested patients were uncertain or did not know that frequent epilepsy attacks can affect their intelligence. Up to 36% were unaware of the possible consequence of sudden withdrawal of anti-epileptic drugs (AED). Among responders, 39.1% did not know the right treatment method of epilepsy. That AED can control seizure attacks were doubted in 57.5% of epileptic patients. Furthermore, 32.2% did not know whether the disease could be cured. Conclusion: In this group of epileptic patients, generally they do not have enough indispensable knowledge to cope with epilepsy. They urgently need for proper health education besides effective AED to control seizure attacks and improve their quality of life.展开更多
BACKGROUND It has previously been described that fall-associated injuries including fractures are commonly observed among patients with bradyarrhythmia.However,knowledge on the risk of pacemaker implantation after adm...BACKGROUND It has previously been described that fall-associated injuries including fractures are commonly observed among patients with bradyarrhythmia.However,knowledge on the risk of pacemaker implantation after admission due to femur fracture from large population-based epidemiologic data is lacking.Therefore,we investigated the risk of pacemaker implanta-tion following femur fracture in patients with and without a history of previous syncope.METHODS All patients with femur fracture between 2005-2017 were identified using the Danish Nationwide Patient Registry.Among these,patients already having a pacemaker were excluded.Primary outcome was one-year risk of pacemaker implanta-tion and secondary outcome was one-year all-cause mortality.Multivariable logistic regression was used to obtain absolute and relative risks of the study endpoint in relation to patients with versus without history of syncope and standardized to the age,sex,selected comorbidity and pharmacotherapy distribution of all patients.RESULTS Of 93,093 patients with femur fracture,5508(5.9%)had a history of syncope within five years.Patients with prior syn-cope were slightly older(84 vs.83 years),more often male(33.6%vs.29.4%),and had more often comorbidities relative to those without history of syncope.All-cause mortality was significantly higher among those with previous history of syncope com-pared to those without previous syncope(29.9%vs.28.6%,P=0.021).The relative mortality risk was 1.05(95%CI:1.01−1.09,P=0.021).A total of 695(0.8%)patients underwent pacemaker implantation within 5 years following femur fracture,and a signific-antly higher proportion of patients with syncope had a pacemaker implanted within one year(1.6%vs.0.7%,P<0.001;relative risk,2.01[95%CI:1.55−2.46]).CONCLUSIONS In patients with femur fracture,a history of syncope was significantly associated with a higher one-year risk of pacemaker implantation.展开更多
Background: Chronic exertional compartment syndrome(CECS) is a condition of pain induced by exercise, and it is characterized by muscle swelling and impaired muscle function in the lower leg. Given the diversity in th...Background: Chronic exertional compartment syndrome(CECS) is a condition of pain induced by exercise, and it is characterized by muscle swelling and impaired muscle function in the lower leg. Given the diversity in the diagnosis and treatment of CECS, it is desirable to determine variables pertaining to prognosis and recovery. The purpose of this study is to identify prognostic factors for conservative treatment outcomes in servicemen with CECS who were treated at a Military Rehabilitation Center.Methods: Patients from all military services were referred from the special unit for lower leg pain at the Central Military Hospital, Utrecht, the Netherlands. Descriptive analysis was used to report the characteristics of the participants and their baseline measurements. Group differences were analyzed using a Student's t-test or MannWhitney U test, according to the normality of the data distribution. Differences between the pre-and postintervention outcomes were evaluated using the Wilcoxon signed rank test. To evaluate the magnitude of prognostic factors, a univariate logistic regression analysis was performed. The prognostic factors included age, body mass index, body fat percentage, self-efficacy beliefs, foot malalignment, intramuscular pressure, other comorbidities, protein and creatine use, smoking, alcohol use, complaint duration, physical demands, and duration of military service.Results: After the rehabilitation period, we observed 25 patients with a successful outcome, which was defined as a reduction in pain(≥2 points) during the capacity test measured using a verbal rating scale and 20 patients with an unsuccessful outcome. Factors demonstrating a limited increased odds ratio for an unsuccessful outcome included smoking, alcohol use, intramuscular pressure, a complaint duration of more than 6 months, and physical demands of service. However, these factors did not reach significance.Conclusion: This study did not identify any prognostic factors that predict the outcome of a rehabilitation program for CECS. A larger sample using an identical design might provide further evidence regarding prognostic factors, which would facilitate development of a model that predicts the outcomes of a rehabilitation program for CECS.展开更多
基金supported by the 345 Talent Project,Shengjing Hospital of China Medical University。
文摘BACKGROUND: There is controversy regarding whether saddle main pulmonary artery(MPA) embolism represents a high risk of deterioration in non-high-risk acute pulmonary embolism(PE) patients. This study aims to address this issue by conducting a propensity score matching(PSM) study.METHODS: A total of 727 non-high-risk acute PE patients were retrospectively evaluated. We evaluated the Bova score and risk stratification to examine the risk of deterioration. Deterioration defined as any adverse event within 30 days after admission. Computed tomographic pulmonary angiography was used to identify the embolism type. All patients were matched into four subgroups by PSM according to age, sex, Bova score, and risk stratification:(1) MPA and non-MPA embolism;(2) non-saddle MPA and non-MPA embolism;(3) saddle MPA and non-saddle MPA embolism;(4) saddle MPA and non-MPA embolism. Correlations were analyzed using Cox regression analysis, and deterioration risk was compared between subgroups using Kaplan-Meier analysis.RESULTS: Cox regression analysis revealed that MPA embolism was correlated with deterioration, regardless of whether saddle MPA embolism was included or excluded. Saddle MPA embolism was not correlated with deterioration, regardless of comparison with non-saddle MPA embolism or non-MPA embolism. Patients with MPA and non-saddle MPA embolism presented a high risk for deterioration(logrank test=5.23 and 4.70, P=0.022 and 0.030, respetively), while patients with saddle MPA embolism were not at a high risk of deterioration(log-rank test=1.20 and 3.17, P=0.729 and 0.077, respetively).CONCLUSIONS: Saddle MPA embolism is not indicative of a high risk of deterioration in nonhigh-risk acute PE patients.
文摘Background Disturbed circadian rhythm is a potential cause of delirium and is linked to disorganisation of the circadian rhythmicity. Dynamic light （DL） could reset the circadian rhythm by activation of the suprachiasmatic nucleus to prevent delirium. Evidence regarding the effects of light therapy is predominantly focused on psychiatric disorders and circadian rhythm sleep disorders. In this study, we investi- gated the effect of DL on the total hospital length of stay （LOS） and occurrence of delirium in patients admitted to the Coronary Care Unit （CCU）. Methods This was a retrospective cohort study. Patients older than 18 years, who were hospitalized longer than 12 h at the CCU and had a total hospital LOS for at least 24 h, were included. Patients were assigned to a room with DL （n = 369） or regular lighting condi- tions （n = 379）. DL was administered at the CCU by two ceiling-mounted light panels delivering light with a colour temperature between 2700 and 6500 degrees Kelvin. Reported outcome data were： total hospital LOS, delirium incidence, consultation of a geriatrician and the amount of prescripted antipsychotics. Results Between May 2015 and May 2016, data from 748 patients were collected. Baseline charac- teristics, including risk factors provoking delirium, were equal in both groups. Median total hospital LOS in the DL group was 100.5 （70.8-186.0） and 101.0 （73.0-176.4） h in the control group （P = 0.935）. The incidence of delirium in the DL and control group was 5.4% （20/369） and 5.0% （19/379）, respectively （P = 0.802）. No significant differences between the DL and control group were observed in secon- dary endpoints. Subgroup analysis based on age and CCU LOS also showed no differences. Conclusion Our study suggests exposure to DL as an early single approach does not result in a reduction of total hospital LOS or reduced incidence of delirium. When delirium was diagnosed, it was associated with poor hospital outcome.
文摘Objective: To investigate the knowledge level related to compliance in patients with epilepsy. Methods: Eighty-seven patients with epilepsy were tested in the city of Xi’an with a knowledge questionnaire containing 21 questions related to compliance. Results: Over 39.5% of patients did not know that epilepsy is the result of abnormal firing of neurons, while 29.9% were uncertain or did not realize that epilepsy attacks can bring up accidents such as traffic accidents, drowning and trauma. A total of 36.6% of responders thought that the best therapy for epilepsy could be found in Traditional Chinese Medicine. As many as 36.8% of tested patients were uncertain or did not know that frequent epilepsy attacks can affect their intelligence. Up to 36% were unaware of the possible consequence of sudden withdrawal of anti-epileptic drugs (AED). Among responders, 39.1% did not know the right treatment method of epilepsy. That AED can control seizure attacks were doubted in 57.5% of epileptic patients. Furthermore, 32.2% did not know whether the disease could be cured. Conclusion: In this group of epileptic patients, generally they do not have enough indispensable knowledge to cope with epilepsy. They urgently need for proper health education besides effective AED to control seizure attacks and improve their quality of life.
文摘BACKGROUND It has previously been described that fall-associated injuries including fractures are commonly observed among patients with bradyarrhythmia.However,knowledge on the risk of pacemaker implantation after admission due to femur fracture from large population-based epidemiologic data is lacking.Therefore,we investigated the risk of pacemaker implanta-tion following femur fracture in patients with and without a history of previous syncope.METHODS All patients with femur fracture between 2005-2017 were identified using the Danish Nationwide Patient Registry.Among these,patients already having a pacemaker were excluded.Primary outcome was one-year risk of pacemaker implanta-tion and secondary outcome was one-year all-cause mortality.Multivariable logistic regression was used to obtain absolute and relative risks of the study endpoint in relation to patients with versus without history of syncope and standardized to the age,sex,selected comorbidity and pharmacotherapy distribution of all patients.RESULTS Of 93,093 patients with femur fracture,5508(5.9%)had a history of syncope within five years.Patients with prior syn-cope were slightly older(84 vs.83 years),more often male(33.6%vs.29.4%),and had more often comorbidities relative to those without history of syncope.All-cause mortality was significantly higher among those with previous history of syncope com-pared to those without previous syncope(29.9%vs.28.6%,P=0.021).The relative mortality risk was 1.05(95%CI:1.01−1.09,P=0.021).A total of 695(0.8%)patients underwent pacemaker implantation within 5 years following femur fracture,and a signific-antly higher proportion of patients with syncope had a pacemaker implanted within one year(1.6%vs.0.7%,P<0.001;relative risk,2.01[95%CI:1.55−2.46]).CONCLUSIONS In patients with femur fracture,a history of syncope was significantly associated with a higher one-year risk of pacemaker implantation.
文摘Background: Chronic exertional compartment syndrome(CECS) is a condition of pain induced by exercise, and it is characterized by muscle swelling and impaired muscle function in the lower leg. Given the diversity in the diagnosis and treatment of CECS, it is desirable to determine variables pertaining to prognosis and recovery. The purpose of this study is to identify prognostic factors for conservative treatment outcomes in servicemen with CECS who were treated at a Military Rehabilitation Center.Methods: Patients from all military services were referred from the special unit for lower leg pain at the Central Military Hospital, Utrecht, the Netherlands. Descriptive analysis was used to report the characteristics of the participants and their baseline measurements. Group differences were analyzed using a Student's t-test or MannWhitney U test, according to the normality of the data distribution. Differences between the pre-and postintervention outcomes were evaluated using the Wilcoxon signed rank test. To evaluate the magnitude of prognostic factors, a univariate logistic regression analysis was performed. The prognostic factors included age, body mass index, body fat percentage, self-efficacy beliefs, foot malalignment, intramuscular pressure, other comorbidities, protein and creatine use, smoking, alcohol use, complaint duration, physical demands, and duration of military service.Results: After the rehabilitation period, we observed 25 patients with a successful outcome, which was defined as a reduction in pain(≥2 points) during the capacity test measured using a verbal rating scale and 20 patients with an unsuccessful outcome. Factors demonstrating a limited increased odds ratio for an unsuccessful outcome included smoking, alcohol use, intramuscular pressure, a complaint duration of more than 6 months, and physical demands of service. However, these factors did not reach significance.Conclusion: This study did not identify any prognostic factors that predict the outcome of a rehabilitation program for CECS. A larger sample using an identical design might provide further evidence regarding prognostic factors, which would facilitate development of a model that predicts the outcomes of a rehabilitation program for CECS.
