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Morbidity analysis of left hepatic trisectionectomy for hepatobiliary disease and live donor

Hepatobiliary & Pancreatic Diseases International 2022年第4期21卷 362-369页

作者： Young-In Yoon Sung-Gyu Lee Deok-Bog Moon Shin Hwang Ki-Hun Kim Hui-Ju Kim Ki-Hoon Choi Division of Hepatobiliary Surgery and Liver Transplantation Department of SurgeryAsan Medical CenterUniversity of Ulsan College of Medicine388-1 Poongnap-dongSongpa-guSeoul 138-736Korea Department of Surgery Gold Coast University HospitalSouthportQLD 4215Australia

Background:Despite remarkable advances in surgical techniques and perioperative management,left hepatic trisectionectomy(LHT)remains a challenging procedure with a somewhat high postoperative Morbidity rate compared with less-extensive resections.This study aimed to analyze the short-and long-term outcomes of LHT and identify factors associated with the postoperative Morbidity of this technically demanding surgical procedure.Methods:The medical records of 53 patients who underwent LHT between June 2005 and October 2019 at a single institution were retrospectively reviewed.The independent prognostic factor of postoperative Morbidity was analyzed using the logistic regression model.Results:Hepatocellular carcinoma was the most common indication for surgery(n=21),followed by hilar cholangiocarcinoma(n=14),intrahepatic cholangiocarcinoma(n=10),and other pathologies(including colorectal liver metastasis,hepatolithiasis,gallbladder cancer,living donor,hemangioma,and multilocular biliary cyst;n=8).The rates of postoperative morbidities of Clavien-Dindo grade 3 or higher and 90-day mortality were 39.6% and 1.9%,respectively.The 1-,3-,and 5-year overall survival rates were 81.1%,61.4%,and 44.6%,respectively.Multivariate analysis revealed that preoperative jaundice[hazard ratio(HR)=6.15,95%confidence interval(CI):1.57-24.17,P=0.009]and operative time>420 min(HR=4.66,95%CI:1.27–17.17,P=0.021)were independent predictors of postoperative Morbidity.Conclusions:The in-hospital mortality of LHT surgery can be minimalized by a reliable preoperative evaluation of liver function and selection of the dominant anatomic features of right posterior sector,active and appropriate preoperative management for obstructive cholangitis and compensatory hypertrophy of the future remnant posterior sector,and the experience of the surgeon.

关键词： Left hepatic trisectionectomy Major hepatectomy Liver neoplasms Survival rate Morbidity

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Characterization of tungiasis infection and Morbidity using thermography in Kenya revealed higher disease burden during COVID-19 school closures

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Infectious Diseases of Poverty 2023年第2期12卷 120-121页

作者： Lynne Elson Abneel K.Matharu Naomi Riithi Paul Ouma Francis Mutebi Hermann Feldmeier Jürgen Krücken Ulrike Fillinger KEMRI-Wellcome Trust Research Programme Kilifi Kenya Centre for Tropical Medicine and Global Health Nuffield Department of Medicine University of Oxford Oxford UK International Centre of Insect Physiology and Ecology Human Health Theme Nairobi Kenya College of Veterinary Medicine Animal Resources and Biosecurity Makerere University Kampala Uganda Institute of Microbiology Infectious Diseases and Immunology Charité University Medicine Berlin Germany Institute for Parasitology and Tropical Veterinary Medicine Freie Universität Berlin Berlin Germany

Background Tungiasis is a neglected tropical skin disease caused by the sand flea Tunga penetrans.Female fleas penetrate the skin,particularly at the feet,and cause severe inflammation.This study aimed to characterize disease burden in two highly affected regions in Kenya,to test the use of thermography to detect tungiasis-associated inflammation and to create a new two-level classification of disease severity suitable for mapping,targeting,and monitoring interventions.Methods From February 2020 to April 2021,3532 pupils age 8–14 years were quasi-randomly selected in 35 public primary schools and examined for tungiasis and associated symptoms.Of the infected pupils,266 were quasi-randomly selected and their households visited,where an additional 1138 family members were examined.Inflammation was assessed using infra-red thermography.A Clinical score was created combining the number of locations on the feet with acute and chronic symptoms and infra-red hotspots.Results The overall prevalence of tungiasis among all the school pupils who were randomly selected during survey rounds 1 and 3 was 9.3%[95%confidence interval(CI):8.4–10.3].Based on mixed effects logistic models,the odds of infection with tungiasis among school pupils was three times higher in Kwale(coastal Kenya)than in Siaya[western Kenya;adjusted odds ratio(aOR)=0.36,95%CI:0.18–0.74];three times higher in males than in females(aOR=3.0,95%CI:2.32–3.91)and three times lower among pupils sleeping in a house with a concrete floor(aOR=0.32,95%CI:0.24–0.44).The odds of finding an infected person among the household population during surveys before the COVID-19 pandemic was a third(aOR=0.32,95%CI:0.19–0.53)of that when schools were closed due to COVID-19 restrictions and approximately half(aOR=0.44,95%CI:0.29–0.68)in surveys done after school re-opening(round 3).Infection intensity was positively correlated with inflammation as measured by thermography(Spearman’s rho=0.68,P<0.001)and with the clinical score(rho=0.86,P<0.001).Based on the two-level classificati

关键词： Tungiasis Neglected tropical diseases Thermography Morbidity Child COVID-19 Kenya

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Impact of urbanization on Morbidity of hepatitis A:a national panel study in China during 2005–2018

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Infectious Diseases of Poverty 2023年第3期12卷 41-50页

作者： Bo-Wen Ming Zhou Yang Ze-Lin Yan Chen Shi Xiao-Han Xu Li Li Chun-Quan Ou State Key Laboratory of Organ Failure Research Department of BiostatisticsGuangdong Provincial Key Laboratory of Tropical Disease ResearchSchool of Public HealthSouthern Medical UniversityGuangzhou 510515GuangdongChina

Background The effect of urbanization on the Morbidity of hepatitis A remains unclear. We aimed to estimate the association between various urbanization-related indices and hepatitis A Morbidity in China.Methods Data on the annual Morbidity of hepatitis A, urbanization-related measures (i.e., gross domestic product per capita, the number of hospitalization beds per 1000 persons, illiteracy rate, tap water coverage, motor vehicles per 100 persons, population density, and the proportion of arable land), and meteorological factors in 31 provincial-level administrative divisions of Chinese mainland during 2005–2018 were collected from the National Population and Health Science Data Sharing Platform, China Statistical Yearbooks, and the China Meteorological Data Sharing Service System, respectively. Generalized linear mixed models were applied to quantify the impacts of different urbanization-related indices on the Morbidity of hepatitis A in China after adjusting for covariates.Results A total of 537,466 hepatitis A cases were reported in China during 2005–2018. The annual Morbidity had a decline of 79.4% from 5.64 cases to 1.16 cases per 100,000 people. There were obvious spatial variations with higher Morbidity in western China. Nationally, gross domestic product per capita and the number of hospitalization beds per 1000 persons increased from 14,040 to 64,644 CNY and from 2.45 to 6.03 during 2005–2018, respectively. The illiteracy rate decreased from 11.0 to 4.9%. Gross domestic product per capita [relative risk (RR) = 0.96, 95% confidence interval (CI): 0.92–0.99], and the number of hospitalization beds per 1000 persons (RR = 0.79, 95%CI: 0.75–0.83) were associated with the declined Morbidity of hepatitis A. By contrast, the increased Morbidity of hepatitis A was linked to the illiteracy rate (RR = 1.04, 95%CI: 1.02–1.06). Similar influential factors were detected for children and adults, with greater effects witnessed for children.Conclusions People in the western region suffered the heaviest burden of hepatitis

关键词： Hepatitis A Morbidity Urbanization Generalized linear mixed model China

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Study on incidence of lamb Morbidity and mortality and associated risk factors in the mixed crop‑livestock production system of Gewata District, Kaffa zone, southwestern Ethiopia

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Animal Diseases 2023年第2期3卷 115-127页

作者： Haben Fesseha Gizaw Gebremichael Isayas Asefa Teshita Edaso School of Veterinary Medicine Wolaita Sodo UniversityWolaita SodoEthiopia Gewata District Animal Health Expert Kaffa ZoneBongaEthiopia

Lamb Morbidity and mortality cause significant loss in a smallholder production system. A longitudinal prospectivesurvey was conducted on 408 randomly selected farmers located in six purposefully selected kebeles in Gewataworeda from June 2020 to July 2021 to determine the incidence of Morbidity and mortality in lambs and to identifyrisk factors. For this purpose, 408 lambs from the Gewata district’s mixed crop-livestock production system wereexamined every day from birth to three months of age. The data was analyzed using the Kaplan-Meier (K-M) method,the log-rank test, and Cox proportional hazards regression. Results showed that the cumulative incidence of allcauseof Morbidity and mortality at the end of three month was 12.86% (95% CI: 10.26–16.13%), and 6.86% (95% CI:5.03–9.35%), respectively. Diarrhea was the leading cause of Morbidity and mortality, accounting for 49.33 and 50%Morbidity and mortality, respectively. Pneumonia was the second most frequent cause of Morbidity and death. In theK-M hazard analysis, the greatest risk of lamb Morbidity and mortality was observed during the first month of life, andthen the risk decreased significantly as the lamb grew. Of the 17 potential risk factors studied, the multivariable Coxproportional hazards regression model showed that lamb sex, birth weight, umbilical care, time and method of colostrumfeeding were the five predictors that were significantly associated with a higher risk of Morbidity, whereas birthweight, lambing difficulty, dams’ parity, method and time of colostrum feeding were the five predictors that weresignificantly associated with a higher risk of mortality. Moreover, a higher risk of Morbidity was observed in lambswith methods of colostrum feeding after birth (HR = 3.158;p = 0.000) and with variations in birth weight (HR = 1.418;p = 0.003). Similarly, the mortality risk was 4.926 (p = 0.047), 4.023 (p = 0.012), and 3.206 (p = 0.000) times higher inlambs with lambing difficulties, at the time of colostrum feeding, and by the method of colostrum feed

关键词： Gewata Incidence Lamb Morbidity Mortality Ethiopia

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Impaired immune reaction and increased lactate and C-reactive protein for early prediction of severe Morbidity and pancreatic fistula after pancreatoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 58-67页

作者： Mario Rodriguez-Lopez Francisco J.Tejero-Pintor Martin Bailon-Cuadrado Asterio Barrera-Rebollo Baltasar Perez-Saborido David Pacheco-Sanchez General and Digestive Surgery Department Rio-Hortega University Hospital

Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during rst and second postoperative days (POD1, POD2) may be early indi- cators of complications. Methods: This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lactate were compared between individuals presenting Clavien ≥ III Morbidity, pancreatic stula (PF) or clinically relevant PF (CRPF) and those without these morbidities. Common variables reaching signi cance were further analyzed in order to calculate a predictive score. Results: Severe Morbidity, PF and CRPF rates were 28.0%, 26.0% and 14.0%, respectively. Patients with severe Morbidity had lower leukocytes on POD2 (P=0.04). Patients with PF presented higher CRP on POD2 (P=0.001), higher lactate on POD1 (P=0.007) and POD2 (P=0.008), and lower lymphocytes on POD1 (P=0.007) and POD2 (P=0.008). Patients with CRPF had lower leukocytes and neutrophils on POD1 (P =0.048, P =0.038), lower lymphocytes on POD1 (P =0.001) and POD2 (P =0.003), and higher CRP on POD2 (P =0.001). Baseline parameters and procalcitonin obtained no statistical associations. Score was de ned according to lymphocytes on POD1 < 650/μL and CRP on POD2 ≥ 250 mg/L allocating patients in 3 risk categories. PF and CRPF rates were statistically higher as risk category increased (P<0.001). Receiver operating characteristic curves and Hosmer Lemeshow tests showed a good accuracy. Conclusions: Impaired immunological reaction during early postoperative period (lower leukocytes and, particularly, lymphocytes) in response to surgical aggression would favor complications after PD. Likewise, acidosis (higher arterial lactate) could behave as risk factor of PF. An elevated CRP on POD2 is also an early biomarker of PF. Our novel score based on postoperative lymphocyte count and CRP seems reliable for early prediction of PF.

关键词： Pancreatoduodenectomy Morbidity Pancreatic fistula Biomarker Prediction Score

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Road traffic injury mortality and Morbidity by country development status, 2011- 2017

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Chinese Journal of Traumatology 2021年第2期24卷 88-93页

作者： Jie-Yi He Wang-Xin Xiao David CSchwebel Mo-Tao Zhu Pei-Shan Ning Li Li Xun-Jie Cheng Jun-Jie Hua Guo-Qing Hu Department of Epidemiology and Health Statistics Xiangya School of Public HealthCentral South UniversityChangsha410078China Department of Psychology University of Alabama at BirminghamBirminghamAL35294USA Center for Injury Research and Policy Abigail Wexner Research Institute at Nationwide Children’s HospitalDepartment of PediatricsThe Ohio State UniversityColumbusOH43205USA Division of Epidemiology College of Public HealthThe Ohio State UniversityColumbusOH43210USA

Purpose:This research examined road traffic injury mortality and Morbidity disparities across of country development status,and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 e to halve the number of global deaths and injuries from road traffic accidents by 2020.Methods:Data for road traffic mortality,Morbidity,and socio-demographic index(SDI)were extracted by country from the estimates of the Global Burden of Disease study,and the implementation of the three types of national actions(legislation,prioritized vehicle safety standards,and trauma-related post-crash care service)were extracted from the Global Status Report on Road Safety byWorld Health Organization.We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017.Results:Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017(by 7.52%e16.08%).Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period,while age-adjusted Morbidity generally increased as SDI increased.Subgroup analysis by road user yielded similar results,but with two major differences during the study period of 2011 to 2017:(1)pedestrians in the high SDI countries experienced the lowest mortality(1.68e1.90 per 100,000 population)and Morbidity(110.45e112.72 per 100,000 population for incidence and 487.48e491.24 per 100,000 population for prevalence),and(2)motor vehicle occupants in the high SDI countries had the lowest mortality(4.07e4.50 per 100,000 population)but the highest Morbidity(428.74e467.78 per 100,000 population for incidence and 1025.70e1116.60 per 100,000 population for prevalence).Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries.Lower income nations comprise the he

关键词： Road traffic injury Mortality Morbidity Socioeconomic disparity Sustainable development goals

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Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia

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World Journal of Emergency Medicine 2020年第3期11卷 164-168页

作者： Rui-xue Sun Priscilla Song Joseph Walline He Wang Ying-chun Xu Hua-dong Zhu Xue-zhong Yu Jun Xu Emergency Department Peking Union Medical College HospitalBeijing 100010China Department of Anthropology Washington University in Saint LouisSaint Louis 63101USA Division of Emergency Medicine Saint Louis UniversitySaint Louis 63101USA Laboratory Department Peking Union Medical College HospitalBeijingChina

BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of Morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patients may provide ways to improve the clinical outcomes of these patients.METHODS:The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a singlecenter ED.Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.RESULTS:A significant risk factor for Morbidity was the presence of a central venous catheter(CVC)(PMorbidity and mortality.The presence of a CVC was associated with higher Morbidity and mortality in patients with AB bacteremia.Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.

关键词： Acinetobacter baumannii Bacteremia Morbidity Mortality

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Reversed vascularized second metatarsal flap for reconstruction of Manske type ⅢB and Ⅳ thumb hypoplasia with reduced donor site Morbidity

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Chinese Medical Journal 2019年第21期132卷 2565-2571页

作者： De-Di Tong Le-Hao Wu Peng-Cheng Li Yan-Bo Rong Bo Liu WPAndrew Lee Qi-Pei Wei Lu Liu He-Jia Miao Shan-Lin Chen Department of Hand Surgery Beijing Jishuitan HospitalBeijing 100035China Department of Plastic Surgery Plastic Surgery HospitalChinese Academy of Medical SciencesBeijing 100144China Department of Plastic Surgery Johns Hopkins HospitalBaltimoreMD 21287USA

Background:The predominant method for Manske type ⅢB and Ⅳ thumb hypoplasia is pollicization.However,for those who are not willing to sacrifice the index finger,a method that could reconstruct a functionally capable and aesthetically acceptable thumb remains desirable.This study aimed to investigate and assess the functional and radiographic outcomes of utilizing a reversed vascularized second metatarsal composite flap for thumb reconstruction as a new alternative.Methods:From May 2014 to January 2017,15 patients with Manske type ⅢB or Ⅳ thumb hypoplasia who were admitted to the Department of Hand Surgery,Beijing Jishuitan Hospital were included in this study.An osteocutaneous flap containing a section of second metatarsal and its distal head was transferred in reversed position to reconstruct carpometacarpal joint.The donor site was reconstructed by a split half of the third metatarsal.Various functional reconstructions were commenced at second stage.The reconstructed thumbs were evaluated using the Kapandji score,pinch force,and the capacities of performing daily activities through a detailed questionnaire.Results:Among these 15 patients(seven type ⅢB and eight type Ⅳ),there were ten boys and five girls with median age of 4.2 years(range:2.0–7.0 years).There were seven right,three left,and five bilateral thumbs for whom only the right thumb received surgery.There were 14 metatarsal flaps survived(14/15).With an average follow-up of 19.2 months,the reconstructed thumbs had acceptable functional and aesthetic outcomes and the donor foot presented in decent appearance without signs of impaired function.All 15 children have improved the Kapandji score(from 0 to an average of 6.7),pinch force(from 0 to an average of 1.5 kg),with ability of grip and pen holding.X-ray indicated continuous bone growth.Patients and parents had good acceptance of the new thumb.Conclusions:Reconstruction of an unstable hypoplastic thumb(Manske type ⅢB and Ⅳ)with use of a vascularized metatarsal is an effective strategy.It offers an altern

关键词： Thumb hypoplasia Second metatarsal flap Donor site Morbidity Microsurgery

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Prevalence of cognitive dysfunction,psychological Morbidity and abuse in the community-based elderly population in India

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上海精神医学 2020年第5期33卷 345-351页

作者： Manjeet Singh Bhatia Shruti Srivastava Vishali Moond Psychiatry University College of Medical Sciences and Guru Tegh Bahadur Hospital

Background The elderly population in India is expected to grow enormously by 2050 owing to an increase in life expectancy.Community-based data on the prevalence of psychological Morbidity,abuse and cognitive dysfunction are scarce.Aims To determine the prevalence of cognitive dysfunction,psychological Morbidity and abuse in the elderly population in a resettlement colony from East Delhi,India.Methods A cross-sectional study was conducted on the elderly population of a resettlement colony,in East Delhi,comprising 5 blocks and 12 subblocks with a total population of 65 000.The study was carried out within2 months from April to August 2017.The self-reported questionnaires were administered to detect cognitive dysfunction,psychological Morbidity,social support and pattern of abuse.Results The mean age of the study subjects was70.29 years(53.8% were males,78.8% were married,86.9% were Hindus and 75% were living with children).A total of 106 subjects(66.6%) belonged to the lower socioeconomic strata with 120(75%) living with children.Most of the subjects(70.6%) studied below the primary level of education.As detected on Goldberg General Health Questionnaire-12,56.9% of the subjects had psychological Morbidity.On Dementia Assessment by Rapid Test,33.1%of subjects were screened positive.The pattern of abuse reported was as follows:emotional abuse(16.9%),physical abuse(7.5%),sexual abuse(1.9%) and social neglect(1 8.1%).The social support score was found to be46.22(12.22).Conclusion The results of this community-based study signify that appropriate steps at the policy level need to be undertaken so that abuse as well as neglect can be prevented.In addition,screening the elderly population helps to detect early cognitive dysfunction,psychological Morbidity,abuse victims and individuals with poor support.

关键词： cognition disorders geriatric psychiatry mental health Morbidity psychological trauma

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Severe Morbidity after pancreatectomy is accurately pre dicte d by preoperative pancreatic resection score(PREPARE): A prospective validation analysis from a medium-volume center

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Hepatobiliary & Pancreatic Diseases International 2018年第6期17卷 559-565页

作者： Mario Rodriguez-Lopez Francisco J. Tejero-Pintor Baltasar Perez-Saborido Asterio Barrera-Rebollo Martin Bailon-Cuadrado David Pacheco-Sanchez General and Digestive Surgery Department Rio-Hortega University Hospital

Background: Major Morbidity in pancreatic surgery remains high. Different scores for predicting complications have been described. Preoperative pancreatic resection(PREPARE) score is based on objective preoperative variables and offers good predictive accuracy for Clavien ≥ III complications. This study aimed to validate this score and analyze other preoperative variables in a prospective study performed in a medium-volume center. Methods: A total of 50 pancreatic resections were included. Preoperative variables were registered and PREPARE was calculated. The main outcome was severe Morbidity(Clavien ≥ III) up to 30 days after discharge. The secondary outcomes were length of stay(LOS) and readmission. Statistical validation was performed to compare severe Morbidity rate among the scores categories. Association with other preoperative variables(not included in PREPARE) was also tested. Results: Of the 50 pancreatic resections, the severe Morbidity was 34.0%, with median LOS of 11 days. Readmission rate was 25.5%. Severe Morbidity rates according to PREPARE categories were 18.5% in lowrisk group, 41.7% in intermediate-risk group, and 63.6% in high-risk group, respectively( P = 0.023). The accuracy was 72%(Hosmer–Lemeshow, P = 0.86). ROC curve was obtained both for PREPARE score expressed as incremental values and categorized as the three risk groups, showing an area under curve(AUC) of 0.736(95% CI: 0.586–0.887; P = 0.007) and 0.712(95% CI: 0.555–0.869; P = 0.015), respectively. PREPARE was significant in multivariate analysis. Median LOS was statistically higher as PREPARE category increases(9, 11 and 15 days in low-, intermediate-and high-risk groups, respectively; P = 0.009). Readmission was not associated with any variables. Conclusions: PREPARE behaves as an independent risk factor for severe Morbidity after pancreatic surgery. Score validation shows good accuracy prediction. Increasing PREPARE category is also associated with longer LOS.

关键词： Pancreatic surgery Morbidity Complications Preoperative pancreatic resection score Validation

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