BACKGROUND & AIMS: :We studied the use of the INNO-LIA syphilis score assay in the resolution of discordant positive screening results of the Murex ICE Syphilis enzyme immunoassay (EIA) with the confirmatory results of both the Serodia Treponema pallidum particle agglutination (TPPA) and the fluorescent treponemal antibody-absorption (FTA-Abs) assays, for the serological diagnosis of syphilis. This was an observational study on the serum samples received by the Syphilis Laboratory, Hong Kong, during the period from January 2006 to December 2012. A total of 801 serum samples with discordant positive screening EIA results were used. Consensus results of such serum samples were derived from results of the EIA, TPPA and FTA-abs assays. The age range of the individuals was 14 to 104 years (median of 52). There were 369 males and 432 females. Of 378 serum samples, 139 showed agreement among positive results, 23 of 310 showed agreement among indeterminate results and 277 of 465 showed agreement among negative results. The proportions of agreement among positive, indeterminate and negative results were 0.37 (95% CI 0.32-0.42), 0.07 (95% CI 0.05-0.11) and 0.60 (95% CI 0.55-0.64), respectively; kappa 0.55 (95% CI 0.49-0.60). There were 60 serum samples with positive consensus results but negative INNO-LIA syphilis score results and 10 with negative consensus results but positive INNO-LIA syphilis score results. Although the INNO-LIA syphilis score assay can be considered a valid alternative confirmatory test for the serological diagnosis of syphilis, the present study showed that its use in the resolution of discordant positive screening EIA results was moderate. A more extensive characterization of serum samples with discordant reactive screening treponemal test results is necessary.

背景与目标： : 我们研究了INNO-LIA梅毒评分测定法在解决Murex冰梅毒酶免疫测定法 (EIA) 的不一致阳性筛查结果中的使用，并确定了梅毒螺旋体颗粒凝集 (TPPA) 和荧光梅毒螺旋体抗体吸收 (FTA-Abs) 测定法，用于梅毒的血清学诊断。这是一项对2006年1月至2012年12月期间香港梅毒实验室收到的血清样本的观察性研究。总共使用了801份具有不一致阳性筛选EIA结果的血清样品。此类血清样品的共识结果来自EIA，TPPA和FTA-abs测定的结果。个体的年龄范围为14至104岁 (中位数为52)。有369名男性和432名女性。在378份血清样品中，139份阳性结果一致，310份23份不确定结果一致，277份465份阴性结果一致。阳性，不确定和阴性结果之间的一致性比例分别为0.37 (95% CI 0.32-0.42)，0.07 (95% CI 0.05-0.11) 和0.60 (95% CI 0.55-0.64); kappa 0.55 (95% CI 0.49-0.60)。有60份血清样本的一致性结果为阳性，但INNO-LIA梅毒评分结果为阴性，而10份的一致性结果为阴性，但INNO-LIA梅毒评分结果为阳性。尽管INNO-LIA梅毒评分测定法可被认为是梅毒血清学诊断的有效替代验证性试验，但本研究表明，其在解决不一致的阳性筛查EIA结果中的使用是中等的。需要使用不一致的反应性筛选密螺旋体测试结果对血清样品进行更广泛的表征。

BACKGROUND & AIMS: :Schistosomiasis control programs aim to reduce morbidity but are evaluated by infection prevalence and intensity reduction. We present baseline cross-sectional data from a nested cohort study comparing indicators of morbidity for measuring program impact. Eight hundred twenty-two schoolchildren 7-8 years of age from Nyanza Province, Kenya, contributed stool for diagnosis of Schistosoma mansoni and soil-transmitted helminths (STH) and blood smears for malaria, and were evaluated for anemia, quality of life, exercise tolerance, anthropometry, and ultrasound abnormalities. Schistosoma mansoni, STH, and malaria infection prevalence were 69%, 25%, and 8%, respectively. Only anemia and S. mansoni infection (adjusted odds ratio [aOR] = 1.70; confidence interval [CI] = 1.03-2.80), and hepatomegaly and heavy S. mansoni infection (aOR = 2.21; CI = 1.19-4.11) were associated. Though anemia and hepatomegaly appeared most useful at baseline, additional morbidity indicators may be sensitive longitudinal measures to evaluate schistosomiasis program health impact.

背景与目标： : 血吸虫病控制计划旨在降低发病率，但通过感染率和强度降低来评估。我们提供了一项嵌套队列研究的基线横断面数据，比较了发病率指标以衡量计划的影响。来自肯尼亚Nyanza省的82名7-8岁的学童为诊断曼氏血吸虫和土壤传播的蠕虫 (STH) 和血液涂片提供了粪便，并评估了贫血，生活质量，运动耐受性，人体测量学和超声异常。曼氏血吸虫，STH和疟疾感染率分别为69%，25% 和8%。仅贫血和曼氏沙氏菌感染 (调整后的比值比 [aOR] = 1.70; 置信区间 [CI] = 1.03-2.80)，以及肝肿大和重度曼氏沙氏菌感染 (aOR = 2.21; CI = 1.19-4.11) 相关。尽管贫血和肝肿大在基线时似乎最有用，但其他发病率指标可能是评估血吸虫病计划对健康影响的敏感纵向指标。

BACKGROUND & AIMS: The elderly in our society are required to make many social and psychologic adjustments. In addition, they have to cope with the inevitable physiologic changes associated with the aging process. These alterations in lifestyle and in body functioning call for modified dietary patterns during this phase of life. In particular, older persons should reduce caloric intake while maintaining a highly nourishing diet. Other recommended dietary modifications include a shift toward smaller meals eaten more frequently, and the use of generous amounts of fiber and liquid to avoid constipation. As a result of growing community awareness, some programs have been started to assist the elderly in overcoming problems that may cause poor nourishment.

背景与目标： 我们社会中的老年人需要进行许多社会和心理调整。此外，他们必须应对与衰老过程相关的不可避免的生理变化。生活方式和身体功能的这些改变要求在生命的这一阶段改变饮食模式。特别是，老年人应减少热量摄入，同时保持高度营养的饮食。其他建议的饮食调整包括转向更频繁地吃小餐，以及使用大量的纤维和液体来避免便秘。由于社区意识的提高，已经开始了一些计划，以帮助老年人克服可能导致营养不良的问题。

BACKGROUND & AIMS: OBJECTIVE:To develop a radiographic score for assessment of hand osteoarthritis (OA) that is based on histopathological alterations of the distal (DIP) and proximal (PIP) interphalangeal joints. METHODS:DIP and PIP joints were obtained from corpses (n=40). Plain radiographies of these joints were taken. Joint samples were prepared for histological analysis; cartilage damage was graded according to the Mankin scoring system. A 2×2 Fisher's exact test was applied to define those radiographic features most likely to be associated with histological alterations. Receiver operating characteristic curves were analysed to determine radiographic thresholds. Intraclass correlation coefficients (ICC) estimated intra- and inter-reader variability. Spearman's correlation was applied to examine the relationship between our score and histopathological changes. Differences between groups were determined by a Student's t test. RESULTS:The Interphalangeal Osteoarthritis Radiographic Simplified (iOARS) score is presented. The score is based on histopathological changes of DIP and PIP joints and follows a simple dichotomy whether OA is present or not. The iOARS score relies on three equally ranked radiographic features (osteophytes, joint space narrowing and subchondral sclerosis). For both DIP and PIP joints, the presence of one x-ray features reflects interphalangeal OA. Sensitivity and specificity for DIP joints were 92.3% and 90.9%, respectively, and 75% and 100% for PIP joints. All readers were able to reproduce their own readings in DIP and PIP joints after 4 weeks. The overall agreement between the three readers was good; ICCs ranged from 0.945 to 0.586. Additionally, outcomes of the iOARS score in a hand OA cohort revealed a higher prevalence of interphalangeal joint OA compared with the Kellgren and Lawrence score. CONCLUSIONS:The iOARS score is uniquely based on histopathological alterations of the interphalangeal joints in order to reliably determine OA of the DIP and PIP joints radiographically. Its high specificity and sensitivity together with the dichotomous approach renders the iOARS score reliable, fast to perform and easy to apply. This tool may not only be valuable in daily clinical practice but also in clinical and epidemiological trials.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:We aimed to evaluate the clinical usefulness of qSOFA as a risk stratification tool for patients admitted with infection compared to traditional SIRS criteria or our triage system; the Rapid Emergency Triage and Treatment System (RETTS). METHODS:The study was an observational cohort study performed at one Emergency Department (ED) in an urban university teaching hospital in Norway, with approximately 20,000 visits per year. All patients >16 years presenting with symptoms or clinical signs suggesting an infection (n = 1535) were prospectively included in the study from January 1 to December 31, 2012. At arrival in the ED, vital signs were recorded and all patients were triaged according to RETTS vital signs, presenting infection, and sepsis symptoms. These admission data were also used to calculate qSOFA and SIRS. Treatment outcome was later retrieved from the patients' electronic records (EPR) and mortality data from the Norwegian population registry. RESULTS:Of the 1535 admitted patients, 108 (7.0%) fulfilled the Sepsis2 criteria for severe sepsis. The qSOFA score ≥2 identified only 33 (sensitivity 0.32, specificity 0.98) of the patients with severe sepsis, whilst the RETTS-alert ≥ orange identified 92 patients (sensitivity 0.85, specificity 0.55). Twenty-six patients died within 7 days of admission; four (15.4%) of them had a qSOFA ≥2, and 16 (61.5%) had RETTS ≥ orange alert. Of the 68 patients that died within 30 days, only eight (11.9%) scored ≥2 on the qSOFA, and 45 (66.1%) had a RETTS ≥ orange alert. DISCUSSION:In order to achieve timely treatment for sepsis, a sensitive screening tool is more important than a specific one. Our study is the fourth study were qSOFA finds few of the sepsis cases in prehospital or at arrival to the ED. We add information on the RETTS triage system, the two highest acuity levels together had a high sensitivity (85%) for identifying sepsis at arrival to the ED - and thus, RETTS should not be replaced by qSOFA as a screening and trigger tool for sepsis at arrival. CONCLUSION:In this observational cohort study, qSOFA failed to identify two thirds of the patients admitted to an ED with severe sepsis. Further, qSOFA failed to be a risk stratification tool as the sensitivity to predict 7-day and 30-day mortality was low. The sensitivity was poorer than the other warning scores already in use at the study site, RETTS-triage and the SIRS criteria.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Cohen's κ coefficient is often used as an index to measure the agreement of inter-rater determinations. However, κ varies greatly depending on the marginal distribution of the target population and overestimates the probability of agreement occurring by chance. To overcome these limitations, an alternative and more stable agreement coefficient was proposed, referred to as Gwet's AC1. When it is desired to combine results from multiple agreement studies, such as in a meta-analysis, or to perform stratified analysis with subject covariates that affect agreement, it is of interest to compare several agreement coefficients and present a common agreement index. A homogeneity test of κ was developed; however, there are no reports on homogeneity tests for AC1 or on an estimator of common AC1. In this article, a homogeneity score test for AC1 is therefore derived, in the case of two raters with binary outcomes from K independent strata and its performance is investigated. An estimation of the common AC1 between strata and its confidence intervals is also discussed. METHODS:Two homogeneity tests are provided: a score test and a goodness-of-fit test. In this study, the confidence intervals are derived by asymptotic, Fisher's Z transformation and profile variance methods. Monte Carlo simulation studies were conducted to examine the validity of the proposed methods. An example using clinical data is also provided. RESULTS:Type I error rates of the proposed score test were close to the nominal level when conducting simulations with small and moderate sample sizes. The confidence intervals based on Fisher's Z transformation and the profile variance method provided coverage levels close to nominal over a wide range of parameter combination. CONCLUSIONS:The method proposed in this study is considered to be useful for summarizing evaluations of consistency performed in multiple or stratified inter-rater agreement studies, for meta-analysis of reports from multiple groups and for stratified analysis.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:There is no consensus on the pharmacological treatment of alcoholic hepatitis. The Glasgow alcoholic hepatitis score (GAHS) has been shown to be more accurate than the modified Maddrey's discriminant function (mDF) in the prediction of outcome from alcoholic hepatitis. This study aimed to determine whether the GAHS was able to identify those patients who would benefit from corticosteroids. METHODS:225 patients with an mDF greater than or equal to 32 from five hospital centres in the United Kingdom were reviewed. Patient survival relative to the GAHS and the use of corticosteroids was recorded. RESULTS:144 patients with an mDF greater than or equal to 32 (64%) also had a GAHS greater than or equal to 9. There was no difference in survival between untreated or corticosteroid-treated patients for those with a GAHS less than 9. For patients with a GAHS greater than or equal to 9 the 28-day survival for untreated and corticosteroid-treated patients was 52% and 78% (p = 0.002), and 84-day survival was 38% and 59% (p = 0.02), respectively. CONCLUSIONS:Among patients with an mDF greater than or equal to 32, there was no appreciable benefit from treatment with corticosteroids in patients with a GAHS less than 9. Patients with a GAHS greater than or equal to 9 have an extremely poor prognosis if they are not treated with corticosteroids, or if such treatment is contraindicated.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Hereditary haemorrhagic telangiectasia (HHT) is a rare disease characterized by a multisystemic vascular dysplasia and epistaxis, that is the most common cause of disability and social impairment. Patient management strictly depends on the severity of this symptom; therefore, it is of paramount importance for the clinicians to effectively grade epistaxis severity. The aim of this report was to validate the Frequency, Intensity and Duration score (FID) for grading epistaxis severity in patients with HHT; we studied repeatability and external validity comparing FID score with Epistaxis Severity Score (ESS). METHODS:This is a descriptive, observational study that included 264 adult HHT patients with epistaxis. Diagnosis of HHT was established with Curacao criteria or positivity at genetic testing. Nosebleed severity was evaluated according to the FID score and the ESS. The first 30 patients were included in the validation of the FID score, which was graded on days 0, 1, 3 and 7. In the remaining 234 patients, a comparison between the ESS and FID score was performed. RESULTS:The statistical analysis performed in order to validate the FID score showed very good agreement between scores calculated on different days; analysis comparing the FID score with the ESS revealed a high correlation between the two grading systems. CONCLUSIONS:The FID score is a quick, easy and precise tool for evaluating HHT-related epistaxis and could be a possible alternative to the ESS. The FID score meets the need for an intuitive and smart grading system that is easy to manage in clinicians’ hands.

背景与目标：

BACKGROUND & AIMS: BACKGROUND & AIMS:Recently, we developed the ART score (assessment for re-treatment with TACE) to guide the decision for a second transarterial chemoembolization (TACE-2) in patients with hepatocellular carcinoma (HCC). Patients with an ART score of 0-1.5 points gained benefit from a second TACE session, while patients with an ART score ≥2.5 points did not. Here, we investigated (1) the prognostic significance of the ART score prior to the third (TACE-3) and fourth TACE (TACE-4), and (2) the feasibility of an ART score guided re-treatment strategy by sequential assessment of the ART score in HCC patients treated with multiple TACE sessions. METHODS:109 patients, diagnosed with intermediate stage HCC and treated with ≥3 TACE sessions between January 1999 and December 2009 at the Medical Universities of Vienna and Innsbruck, were included. The ART score prior to each TACE session was assessed in comparison to the TACE naïve liver. The prognostic performance of the ART score before TACE-3 and 4 was evaluated with and without stratification based on the ART score prior to the respective last intervention. RESULTS:The pre-TACE-3 ART score discriminated two groups with different prognosis and remained a valid predictor of OS independent of Child-Pugh score (5-7 points), CRP-levels and tumor characteristics. Even in patients with an initially beneficial ART score (0-1.5 points) before TACE-2, repeated ART score assessment before TACE-3 identified a subgroup of patients with dismal prognosis (median OS: 27.8 vs. 10.8 months, p<0.001). Similar results were observed when the ART score was applied before TACE-4. CONCLUSIONS:The sequential assessment of the ART score identifies patients with dismal prognosis prior to each TACE session.

背景与目标：

BACKGROUND & AIMS: :Detection of anti-desmoglein-1 (anti-DSG-1) and anti-DSG-3 autoantibodies is widely used in the diagnosis of pemphigus. Two validated scoring systems, Pemphigus Disease Area Index (PDAI) and Autoimmune Bullous Skin Disorder Intensity Score (ABSIS), are used for the evaluation of clinical severity. The aim of this cross-sectional study was to interpret the titres of pemphigus autoantibodies in correlation with either total or location-dependent PDAI scores and ABSIS. A total of 35 pemphigus patients were selected and evaluated at 3 time points. Total PDAI and ABSIS seemed useful in pemphigus with cutaneous lesions or in the mucocutaneous form, while location-dependent PDAI and ABSIS scores were useful in the mucosal form. Anti-DSG-1 autoantibodies titres better showed the disease extent in pemphigus with cutaneous only or with mucocutaneous lesions. Anti-DSG-3 autoantibodies titres did not correlate to disease activity.

背景与目标： : anti-desmoglein-1 (anti-DSG-1) 和anti-DSG-3自身抗体的检测被广泛用于天疱疮的诊断。两种经过验证的评分系统，即天疱疮疾病面积指数 (PDAI) 和自身免疫性大疱性皮肤病强度评分 (ABSIS)，用于评估临床严重程度。这项横断面研究的目的是解释天疱疮自身抗体的滴度与总或位置依赖性PDAI评分和ABSIS相关。共选择35例天疱疮患者，并在3个时间点进行评估。总PDAI和ABSIS似乎在具有皮肤病变或粘膜皮肤形式的天疱疮中有用，而位置依赖性的PDAI和ABSIS评分在粘膜形式中有用。Anti-DSG-1自身抗体滴度更好地显示了仅皮肤或皮肤粘膜病变的天疱疮的疾病程度。Anti-DSG-3自身抗体滴度与疾病活动无关。

BACKGROUND & AIMS: OBJECTIVES:The venous clinical severity score (VCSS) and the Aberdeen varicose vein questionnaire (AVVQ) improve after treating chronic venous insufficiency (CVI). The aim was to examine how and why they improve by evaluating the change in each individual question. METHODS:This was an analysis on prospectively collected data from a clinical study on 100 patients (58% female) with CVI (C2 = 34, C3 = 14, C4a = 29, C4b = 9, C5 = 7, C6 = 7) who were randomized to endovenous laser ablation (n = 50) or foam sclerotherapy (n = 50). The change scores (performance) of each question of the VCSS (questions 1-10) and the AVVQ (questions 1-13) were calculated by subtracting the score at three weeks, and three months, from the pre-treatment score. RESULTS:Both the median, interquartile range (IQR), VCSS and the AVVQ scores improved from 6 (4) and 21.4 (15.1) at baseline to 3 (4) and 18.6 (12.1) at three weeks (P < 0.0005, P = 0.031) to 2 (3) and 8.8 (13.6) at three months, (P < 0.0005, P < 0.0005), respectively. The performance of the first three questions of the VCSS (pain, extent of varicosities, oedema) were the most contributory to the overall score. Questions 5, 7, 8, 9 on ulceration improved the most individually but did not contribute significantly to the overall score. Questions 5, 9 of the AVVQ on stocking use and ulceration failed to contribute statistically to the overall improvement at three months. CONCLUSION:The majority of the individual questions of the VCSS and AVVQ responded to change. However, the cause of a poor response was multifactorial with statistical dilution playing a significant role. Stratification of patients according to ulceration may allow better comparisons.

背景与目标：

BACKGROUND & AIMS: :In this work, we have examined contributions to the thermodynamics of calmodulin (CaM) binding from the intrinsic propensity for target peptides to adopt an α-helical conformation. CaM target sequences are thought to commonly reside in disordered regions within proteins. Using the ability of TFE to induce α-helical structure as a proxy, the six peptides studied range from having almost no propensity to adopt α-helical structure through to a very high propensity. This despite all six peptides having similar CaM-binding affinities. Our data indicate there is some correlation between the deduced propensities and the thermodynamics of CaM binding. This finding implies that molecular recognition features, such as CaM target sequences, may possess a broad range of propensities to adopt local structure. Given that these peptides bind to CaM with similar affinities, the data suggest that having a higher propensity to adopt α-helical structure does not necessarily result in tighter binding, and that the mechanism of CaM binding is very dependent on the nature of the substrate sequence.

背景与目标： : 在这项工作中，我们从目标肽采用 α-螺旋构象的内在倾向研究了钙调蛋白 (CaM) 结合热力学的贡献。人们认为CaM靶序列通常驻留在蛋白质的无序区域中。利用TFE诱导 α-螺旋结构的能力作为代理，研究的六个肽的范围从几乎没有采用 α-螺旋结构的倾向到非常高的倾向。尽管所有六个肽都具有相似的CaM结合亲和力。我们的数据表明，推导的倾向与CaM结合的热力学之间存在一定的相关性。这一发现意味着分子识别特征 (例如CaM靶序列) 可能具有广泛的采用局部结构的倾向。鉴于这些肽以相似的亲和力与CaM结合，数据表明，采用 α-螺旋结构的倾向较高并不一定会导致更紧密的结合，并且CaM结合的机制非常依赖于底物的性质。序列。

BACKGROUND & AIMS: :Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease with a high fatality rate. The risk factors for death are not clearly identified, and there is no clinical score model to predict the prognosis. We retrospectively collected the clinical information of clinical symptoms and laboratory parameters of SFTS patients on admission. After analyzing the clinical characteristics of 179 SFTS patients, we found that an elevated level of neurologic symptoms, respiratory symptoms, viral load, and a lower level of monocyte percentage were the critical risk factors for mortality. We used the 4 variables to assemble a score formula named the SFTS index [SFTSI = 5 × Neurologic symptoms-level + 4 × Respiratory symptoms-level + 3 × LG10 Viral load - 2 × LN Monocyte% - 7]. The AURC of this model was 0.964, which was higher than the AURC 0.913 of the viral load especially among the patients with higher viral loads (0.936 vs 0.821). We identified that the neurologic symptoms, respiratory symptoms, viral load, and monocyte percentage were the critical risk factors for SFTS mortality. The clinical score model of SFTSI provides a practical method for clinicians to stratify patients with SFTS and to adopt prompt effective treatment strategies.

背景与目标： : 严重发热伴血小板减少综合征 (SFTS) 是一种新出现的疾病，病死率很高。死亡的危险因素尚未明确，也没有临床评分模型来预测预后。我们回顾性收集了入院时SFTS患者的临床症状和实验室参数的临床信息。在分析179例SFTS患者的临床特征后，我们发现神经系统症状水平升高，呼吸道症状，病毒载量和单核细胞百分比水平降低是死亡的关键危险因素。我们使用4个变量组装了一个评分公式，称为SFTS指数 [sftsi   =   5  ×  神经症状水平 + 4  ×  呼吸道症状水平 + 3  ×   LG10病毒载量-2  ×  ln单核细胞 %-7]。该模型的AURC是0.964的，其高于AURC 0.913的病毒载量，特别是在病毒载量较高的患者中 (0.936 vs 0.821)。我们确定神经系统症状，呼吸道症状，病毒载量和单核细胞百分比是SFTS死亡率的关键危险因素。SFTSI的临床评分模型为临床医生对SFTS患者进行分层并迅速采取有效的治疗策略提供了实用的方法。

BACKGROUND & AIMS: UNLABELLED:In the absence of consensus over criteria for performing total knee arthroplasty, the variability of symptom burden, and limited resources, some ways to prioritize whether and when to treat would be useful. In the UK, some payers use the New Zealand score to determine access to an orthopaedic surgeon despite limited validation. We tested convergent validity of this score and ascertained its ability to discriminate between groups of patients with high or low disease burden as determined by a validated disease-specific measure. The sample included patients being considered for total knee arthroplasty at one hospital. Convergent validity was tested against the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The ability of the New Zealand score to discriminate between high and low disease burdens was tested by plotting a receiver operating characteristic curve. Correlations between the New Zealand score and WOMAC pain and function were moderate (0.5 and 0.54, respectively). The area under the receiver operating characteristic curve was 0.77, suggesting the New Zealand score was able to discriminate. This study supports the validity of the New Zealand score. However, additional multisite and extended evaluations are needed before we would recommend widespread implementation. LEVEL OF EVIDENCE:Level I, economic and decision analyses. See the Guidelines for Authors for a complete description of levels of evidence.

背景与目标：

BACKGROUND & AIMS: :We aimed to quantify the effect of avoiding cardiopulmonary bypass on outcomes in high-risk patients. Of the 2079 consecutive CABG's performed by three surgeons between April 1997 and September 2002, 389 were classified as high-risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification, with a score of >5. The off-pump group had 196 patients and the on-pump group had 193 patients. Multivariate logistic regression was used to assess the effect of off-pump on in-hospital outcomes, while adjusting for treatment selection bias with a propensity score. The incidence of hypertension, hypercholesterolaemia, and renal dysfunction were higher in the off-pump group. The median EuroSCORE for off-pump patients was 7 (6-8), while for the on-pump patients was 7 (6-8; P=0.31). After adjusting for the propensity score, off-pump patients were less likely to have stroke (OR 0.17; P=0.041), renal failure (OR 0.35; P=0.029), blood transfusion (OR 0.12; P<0.001), prolonged mechanical ventilation (OR 0.36; P=0.021), and inotrope support (OR 0.35; P<0.001). Off-pump patients also had significantly shorter post-operative hospital stays. There was no significant difference between off-pump and on-pump patients in terms of in-hospital and mid-term mortality. Off-pump CABG is justified in EuroSCORE high-risk cases.

背景与目标： : 我们旨在量化避免体外循环对高危患者预后的影响。根据欧洲心脏手术风险评估系统 (EuroSCORE) 风险分层，在三名外科医生在1997年4月至2002年9月之间连续进行的2079例CABG中，有389例被归类为高风险，得分> 5。非体外循环组有196例患者，体外循环组有193例患者。多因素logistic回归用于评估非体外循环对院内结局的影响，同时用倾向评分调整治疗选择偏倚。非体外循环组高血压，高胆固醇血症和肾功能不全的发生率较高。非体外循环患者的中位EuroSCORE为7 (6-8)，而在体外循环患者的中位EuroSCORE为7 (6-8; P = 0.31)。调整倾向评分后，非体外循环患者较少发生卒中 (或0.17; P = 0.041) 、肾功能衰竭 (或0.35; P = 0.029) 、输血 (或0.12; P<0.001) 、长时间机械通气 (或0.36; P = 0.021)，和inotrope支持 (或0.35; P<0.001)。非体外循环患者的术后住院时间也明显缩短。在住院和中期死亡率方面，非体外泵和体外泵患者之间没有显着差异。在EuroSCORE高风险病例中，非体外循环CABG是合理的。