BACKGROUND:Peripherally inserted central catheters (PICCs) are widely used in cancer patients but carry a significant thrombosis risk. While body mass index (BMI) is recognized as a thrombogenic factor, the role of vascular morphology remains unclear. MATERIALS AND METHODS:A total of 338 adults with cancer requiring PICC insertion at our hospital were prospectively enrolled between January 11 and 30 December 2023. All study participants underwent ultrasound-guided PICC placement using a 4-Fr single-lumen catheter. Patients were monitored for thrombosis by serial ultrasonography. Demographic, clinical, and vascular characteristics were compared between patients who developed thrombosis and those who did not. RESULTS:PICC-related thrombosis developed in 35.5% of patients and was asymptomatic in 75.8% of cases. Bivariate analysis showed that BMI, vessel depth, arm circumference, vessel diameter, and blood flow velocity on the first post-insertion day were associated with the risk of thrombosis (P<0.05). Multivariate regression analysis identified shallower vessel depth (<1.0 cm, odds ratio [OR] 0.324, 95% confidence interval [CI] 0.120-0.874, P = 0.026) and smaller post-insertion vessel diameter (reduction <0.6 cm, OR 0.025, 95% CI 0.001-0.550, P = 0.019) as independent risk factors for thrombosis. Blood flow on the first post-insertion day was significantly slower in the thrombosis group (13.4 cm/s vs. 14.9 cm/s, P = 0.007). Blood flow velocity increased with increasing BMI, peaking at a BMI of 28.3 kg/m 2 before declining beyond this threshold. CONCLUSION:Low BMI and poor vascular morphology increase the risk of PICC-related thrombosis. The influence of BMI is likely mediated by vascular remodeling, with blood flow velocity peaking at 28.3 kg/m 2 before declining, reflecting a compensatory hemodynamic balance.

BackgroundCentral venous catheters (CVCs) are widely used in critically ill patients, including cancer patients, but are associated with complications such as catheter-related bloodstream infections (CRBSIs). This study evaluates the effectiveness of polyhexamethylene biguanide (PHMB)-coated CVCs in reducing catheter-tip bacterial colonization in cancer patients undergoing abdominal surgery.MethodsA prospective, randomized, monocentric clinical trial was conducted at Peking University Cancer Hospital from March 2017 to April 2019. Surgical cancer patients requiring CVCs were randomized into two groups: a PHMB-coated CVC group (Certofix® protect) and a standard CVC group (Certofix®). The primary outcome was catheter tip bacterial colonization, and the secondary outcomes included catheter retention time and hospital length of stay.ResultsA total of 1,185 patients were included in the analysis. The incidence of catheter tip bacterial colonization was 2.5% in the PHMB-coated group and 4.2% in the standard CVC group (p = 0.10). Hospital length of stay was significantly shorter in the PHMB-coated group (p < 0.001). Subgroup analysis showed reduced bacterial colonization in male patients in the PHMB-coated group (p = 0.04).ConclusionPolyhexamethylene biguanide-coated CVCs did not significantly reduce catheter tip bacterial colonization in the overall population but showed a beneficial effect in male cancer patients undergoing abdominal surgery. In clinical practice, it is necessary to consider various factors when selecting the type of catheter.Clinical trial registrationNo. chiCTR-IPR-16010027.

BackgroundThe purpose of this study was to clarify the incidence, risk factors, and clinical outcomes of septic acute kidney injury (AKI) in cancer patients with sepsis admitted to the intensive care unit (ICU).MethodsA total of 356 cancer patients admitted to the ICU due to sepsis from January 2016 to October 2021 were analyzed retrospectively. According to the incidence of septic AKI, all patients were divided into the non-AKI group (n = 279) and the AKI group (n = 77). The clinical data after ICU admission were compared between the above two groups, and the risk factors and the clinical outcomes of septic AKI in the ICU were identified.ResultsThe incidence of septic AKI in all patients was 21.6% (77/356). LASSO regression and logistic regression all showed that lactate, sequential organ failure assessment (SOFA) score and septic shock were closely related to the occurrence of septic AKI. In terms of clinical outcomes after ICU admission, the rate of mechanical ventilation (MV) and continuous renal replacement therapy (CRRT), MV time, hospitalization time and 28-day mortality in the ICU were significantly higher in the septic AKI group than in the non-septic AKI group. Among the three subgroups of septic AKI (AKI combined with septic shock, septic cardiac dysfunction or acute respiratory failure), the mortality of patients in the subgroup of AKI combined with septic shock was significantly higher than others. CRRT has no significant effect on the short-term outcome of these patients.ConclusionLactate level, SOFA score and septic shock were closely related to the occurrence of septic AKI in the ICU. The clinical outcomes within 28 days after ICU admission of cancer patients with septic AKI were worse than those without septic AKI. The short-term outcome was worse in patients with septic AKI complicated with septic shock. CRRT does not have any significant effect on the short-term prognosis of cancer patients with septic AKI in the ICU.

Haijun Wang, Hongzhi Wang, Wei Chen, Heling Zhao, Yuanyu Qian, Limin Shen, Shuangling Li, Jun Duan, Zhiqiang Wang, Keliang Cui, Quan Wang, Xiaoyan Xue, Xiyuan Li, Liwei Hua, Yingping Zhang, Yongshun Feng, Huaiwu He, Lei Li, Nan Zhang, Jun Dong, Weishuai Bian, Feiping Lu, Donghao Wang, Yun Long, Xuezhong Xing; on behalf of Critical Care Medicine Committee of Beijing Association of Oncology (CCMBAO)

Background: Much attention has been given to venous thromboembolism (VTE) disease, and many guidelines for prophylaxis have been published. However, there are few published data on patients who underwent thoracotomy. This study is to compare the effect of low molecular weight heparin (LMWH) combined mechanical approaches with mechanical approaches alone in prevention of VTE in the post thoracotomy cancer patients. Methods: This study used a prospective, randomized-controlled design. Patients with cancer who were scheduled for thoracotomy were divided into two groups: group A and group B. In group A, patients were given intermittent pneumatic compression (IPC) and elastic stockings (ES) postoperatively. Additionally, at 24 hours post-operation, patients were subcutaneously injected with LMWH calcium (nadroparin calcium; GlaxoSmithKline, China) for 7 days. In group B, patients were only given postoperative IPC and ES. The primary end points were incidence of pulmonary embolism (PE), deep vein thrombosis (DVT), and the PE severity index (PESI) of PE patients. The secondary end points were hemoglobin (HGB), platelet (PLT), D-dimer, the PO2/FiO2 ratio (P/F) at postoperative day (POD) 7, the chest drainage time (CDT) and the length of stay (LOS) in hospital after operation. Results: A total of 90 patients were included in the final data analysis (40 patients in group A and 50 patients in group B). At POD7, the incidence of PE, DVT and PESI was 17.50%, 5.00% and 102.14±9.87, respectively, in group A. And 8.00%, 8.00% and 97.00±4.24, respectively, in group B. There were no significant differences between two groups (all P values were >0.05). There were no significant differences of HGB, PLT, D-dimer and P/F between two groups at the 7th day post operation (all P value >0.05). Conclusions: LMWH combined mechanical prophylaxis did not significant reduced the rate of VTE in thoracotomy cancer patients.

PURPOSE:Cancer patients undergoing surgery are at high risk of venous thromboembolism (VTE). The occurrence of VTE in Chinese cancer patients admitted to intensive care unit (ICU) for postoperative care is poorly characterized. This study was designed to investigate the incidence of VTE in this population and to evaluate the utility of the Caprini score in risk stratification. METHODS:2127 consecutive adult patients admitted to a 10-bed surgical ICU (SICU) in a tertiary care academic hospital during a 4-year period (January 1, 2013 - December 31, 2016) were enrolled. Demographic and VTE data were collected. Data for the Caprini risk assessment model (RAM) was used to stratify patients on their risk of VTE. RESULTS:Of the 2127 patients admitted to ICU after cancer surgery, 66 (3.1%) developed symptomatic VTE. There were a total of 32 patients with pulmonary embolism (PE), 51 patients with deep vein thrombosis (DVT) and 17 patients with both conditions. Based on the original Caprini RAM, 99.5% of the patients scored in the "highest risk" category (score ≥5), all patients with VTE were in the "highest risk" category. Further substratification in the "highest risk" category showed the risk of developing VTE events was significantly higher among patients with Caprini score greater than 10, as compared with patients with Caprini score of 5 to 6 (OR 5.63;95%CI 1.27-24.94), 7 to 8 (OR 2.36;95%CI 1.23-4.52 ) or 9 to 10 (OR 2.28;95%CI 1.17-4.44). The percentage of patients receiving double prophylaxis was 16.8% (358/2127), 20 of the 66 VTE patients (30.3%) received double prophylaxis before VTE was diagnosed. Patients with higher Caprini score were more likely to receive double thromboprophylaxis than patients with lower Caprini score (23.4% of patients with Caprini score>10 vs 10.8% with Caprini score 5-6). CONCLUSIONS:Though accompanied with the subutilizing of chemoprophylaxis, the overall incidence of VTE was relatively low in Chinese cancer patients admitted to ICU for postoperative care. In contrast, the Caprini score was high in this population. The original Caprini RAM was limited to stratify this population, but further substratification of "highest risk" category demonstrated the risk of developing VTE events was significantly higher in patients with Caprini score greater than 10. Future research with high quality evidence should be performed targeting on the accurate risk stratification and optimizing VTE prophylaxis for this population.

OBJECTIVE:To explore the incidence and risk factors for the acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) after resection of esophageal carcinoma.METHODS:We retrospectively analyzed 422 consecutive patients admitted to the Department of Critical Care Medicine with esophageal carcinoma undergoing esophagectomy from January 2010 to December 2016 in Peking University Cancer Hospital. ALI/ARDS were diagnosed, the patients were divided into ALI/ARDS group and control group without ALI/ARDS, the differences of clinical features were contrasted between the two groups, and the multivariate Logistic regression modeling was used to identify the independent risk factors for ALI/ARDS.RESULTS:In the study, 41 ALI/ARDS cases were diagnosed, making up 9.7% (41/422) of all the enrolled patients undergoing esophagectomy. Comparisons of the ALI/ARDS group and the control group indicated significant statistical differences in the average length of their hospital stay [(18.9±9.7) d vs. (14.8±3.6) d, P=0.011], the proportion of the patients who needed mechanical ventilation support [51.2% (21/41) vs. 9.4% (36/381), P<0.001] and in-hospital mortality [31.7% (13/41) vs. 5.0% (19/381), P<0.001]. Univariate analysis showed significant differences between the patients with ALI/ARDS and without ALI/ARDS in smoking history (P=0.064), preoperative forced expiratory volume in one second/forced vital capacity (FEV1/FVC) (P=0.020), diffusing capacity of the lung for carbon monoxide (DLCO) (P=0.011), body weight index (BMI) (P=0.044), American Society of Anesthesiologists (ASA) physical status classification (P=0.049) and one lung ventilation duration (P=0.008), while multivariate Logistic regression analysis indicated that preoperative FEV1/FVC (OR=1.053, P=0.016, 95%CI 1.010-1.098), ASA physical status classification (OR=2.392, P=0.033, 95%CI 1.073-5.335) and one lung ventilation duration (OR=0.994, P=0.028, 95%CI 0.989-0.999) were the independent risk factors for ALI/ARDS after esophagectomy.CONCLUSION:ALI/ARDS was a serious complication in patients undergoing esophagectomy associated with increment in length of hospital stay and in-hospital mortality. Multivariate Logistic regression analysis indicated that preoperative FEV1/FVC, ASA classification and one lung ventilation duration were the independent risk factors for ALI/ARDS after esophagectomy. Carefully assessing the patient before operation, shortening one lung ventilation duration were the key points in preventing ALI/ARDS after esophagectomy.

Objective To discuss the application of implantation temporary cardiac pacing by balloon-tipped floating catheter for peroperative period patients. Method Thirty-three patients with severe bradyarrhythmia were received the balloon-tipped floating catheter to RV by Seldinger puncture technique.Meantime, the pacing signals of ECG were observed. The threshold and QRS waves to ensure the electrode position were determined. Result All of 33 cases were successfully punctured and 32 cases get paced, except 1 case had the electro - mechanical dissociation (EMD). Pacing threshold was less than 0. 9V, and mean remaining time was 12.47 ～ 161 (67. 05 ±34. 48) hours. Apical pacing was operated in 23 patients,and right ventricular outflow tract pacing in 10 patients. No severe complications were occurred. Conclusion The implantation method of temporary cardiac pacing by balloon-tipped floating catheter was convenient and safe. It could help the patients get safety in anesthesia and peroperative period.

In electricity markets,transmission expansion projects are influenced by various uncertainties and therefore difficult to obtain accurate calculation of key indices for decision making,such as the cash flow and internal rate of return,which increases the investment risk and complication in decision making.The fuzzy features of cash flow of transmission expansion projects were described based on the cloud theory.In contrast to the traditional application of fuzzy numbers,the cloud theory coincides with the decision-maker′s judgment better,and completely reflects the fuzziness of the uncertainty and its stochastic membership.On this ground,a new method of investment evaluation for transmission expansion projects was proposed based on real option theory.Furthermore,an investment decision model for transmission expansion based on both the cloud theory and the real option theory was given,and a case study was shown to prove its effectiveness and feasibility.

Based on the modern portfolio theory,the issue of portfolio optimization for grid projects is studied.With comprehensive considerations of capital,labor force,and material resource,the optimal model of grid project portfolio was constructed which takes achieving the maximum profits based on an acceptable risk as its target.The model is proved correct through calculation examples.

The standard electricity market scheme is a set of rules designed for the electricity market with the aim of providing the standard design to make the rule fare,transparent,and stable,and to guide the market to develop healthily.The principle and importance of establishing the standard electricity market scheme are discussed,and research on the standard electricity market both abroad and at home is introduced.According to the status quo of electricity market reform in China and the next step requirement,the method and content of the electricity market design for China are proposed.

Objective:To investigate and analyze the awareness rate of inpatients’physical examination result. Methods:A questionnaire survey was conducted in 1 071 inpatients in a major hospital in Beijing. The data were typed in Epi (.rec) and analyzed with SAS 6.12. Results:The awareness rate of inpatients’height,weight,waist,hip, blood pressure was 97.01%、 96.64%、62.37%、10.92%、67.79%, respectively. BMI of 38.35% of the inpatients was higher than the standard. The awareness rate of blood pressure was very low in most of the special department. Conclusions:It was pointed out that the measurement of inpatients' waist and hip should be taken as routine. The awareness rate of inpatients' health indicators and the meaning should be enhanced to guide the inpatients to control the indicators by themselves correctly.

OBJECTIVE To study the distinguishing features of methylprednisolone in the treatment of SARS. METHODS The medical information of 680 cases of SARS from May to Jun 2003 were collected and analyzed. RESULTSFour hundred and eight of 680 SARS patients were treated with methylprednisolone, which were 60%. The SARS patients were divided into 8 groups according to different medicine dosage, 291 SARS patients were treated with the medicine continuously from the first day on. The medicine dosage of 376 SARS patients was less than 80 mg on average. The length of time using the medicine was (11.1±7.5)d. CONCLUSIONS The use of hormonehas a regular pattern. In order to avoid sharpening the secondary infection, improve the rate of cure and reduce the rate of infection, the treatment with the medicine is determined by when the use of the medicine starts, the medicine dosage each time, frequency, the period of treatment and fashion.

好的医疗质量评价不但可以为医院管理服务,也可以满足患者、医疗保险和社会的需求,加深医护人员对质量的理解和实施的自觉性,但医疗质量评价也是费时费力的,特别没有适合的信息技术.因此,探索医疗质量评价的有效性、经济性、适用性就成为医院管理者、医疗服务的购买者共同关注的问题,国外在这方面作了很多工作和研究.

With the application of HIS in hospital,a great deal of data accumulate in database.It's very important to take advantage of these data for IT and managerial staffs.It is suggested that data mart be selected to process the data at the initial stage.

Objective:To estimate the effect of managing the quality for and costs of disease entities in the Orthopedics Department of PLA General hospital. Methods:Samples of cases were selected according to the ICD-9 classification of disease entities in six-digit category codes and a comprehensive evaluation of the medical quality for single disease entities was made by means of relevant software. Results:A calculation was made both of the average hospitalization day and costs for various types of cases and the average hospitalization day, drugs expenses and medical costs for disease entities ranking in the first 10 places with regard to the number of hospitalization. Conclusion:Quality and costs management of classified disease entities and cases fits in with the current demand for quality control in hospitals and the medical treatment quality for single disease entities in the Orthopedics Department is up to a high level.

Objective:To investigate and analyze the awareness rate of inpatients’ knowledge about prevention and treatment of chronic diseases. Methods:A questionnaire survey was conducted in 1 071 inpatients in a major hospital in Beijing. The data were typed in Epi (.rec) and analyzed with SAS 6.12. Results:Inpatients knew very little about diagnostic standards, treatment principles, risk factors and harms of hypertension, diabetes and hyperlipidemia. The inpatients in the department of Cardiovasology or Endocrinology knew a little more, but it was not ideal. Conclusions:Health education should be offered to inpatients during the medical treatment in every clinical department. The cure rate and control rate of patients with chronic diseases could be enhanced by improving the people’s awareness rate of risk factors and harms of chronic diseases.

Objective To set up the medical quality information statistics resource database of No.1 Military Medical Project by data warehouse technology. Method The front-end display tool of OLAP is applied to the setup of the database. Result OLAP platform is established and convenient query, statistics can be realized. Conclusion A great deal of aid decision making information can be got. Thus, the hospital resource utilization and medical quality management are improved.

合理、有效地进行医疗质量评价,对医院的健康、持续发展及医院管理决策均有积极的作用.随着医疗卫生制度改革的深入,医疗质量评价的目的、内容和评价单位都有了很大的变化[1],它不仅是医院管理的需要,也是患者、医疗保险和社会的需要.经过数十年的发展,国内医疗机构在质量评价方面积累了丰富的经验,目前主要包括医院评审、综合评价、满意度评价等方式.

随着我国医疗卫生体制改革不断深入,医院间竞争将更加激烈.门诊急诊是医院面向社会的窗口和前哨,门诊急诊工作质量好坏直接影响到医院整体竞争实力[1].寻求适合本医院整体发展需求的急诊医疗服务模式,制定合理、可行的持续质量监控标准和方法,是医院适应国家医疗卫生体制改革的迫切需要.企业流程重组(BPR)是针对企业经营管理结构和制度进行变革[2,3],借鉴BPR这一先进管理思想,研究完善医院急诊流程,并在此基础上进行医院急诊流程控制,可以促进急诊医疗质量的实时控制,提高医院急诊医疗质量.