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1.
摘要 目的:探讨不同病因肝硬化患者L3骨骼肌指数特征及其对患者营养状况的预测价值分析。方法:选取2019年6月-2022年6月在我院收治的120例肝硬化患者作为研究对象,其中乙肝肝硬化40例,酒精性肝硬化40例,自身免疫性肝炎肝硬化40例。比较乙肝肝硬化组,酒精性肝硬化组,自身免疫性肝炎肝硬化L3 SMI的特征。采用Pearson相关检验分析L3 SMI与肝硬化患者营养状况的相关性。采用Logistics回归模型构建影响肝硬化营养状况的独立危险因素。采用受试者工作曲线(ROC)评估L3 SMI对肝硬化营养状况的预测价值。结果:自身免疫性肝炎肝硬化组L3 SMI、25(OH)D、ALB、PA、TRF的表达水平均显著低于酒精性肝硬化组和乙肝肝硬化组(P<0.05),且酒精性肝硬化组显著低于乙肝肝硬化组(P<0.05)。肝硬化患者LSM与25(OH)D、ALB、PA、TRF均显著正相关(P<0.05)。以肝硬化患者营养状况作为因变量(营养正常=0,营养不良=1)纳入logistics回归模型,结果显示,25(OH)DALB、PA、TRF、L3 SMI是危险因素(P<0.05)。多因素分析结果显示,25(OH)DALB、PA、TRF、L3 SMI是影响肝硬化患者营养状况的独立危险因素(P<0.05)。L3 SMI预测评估肝硬化患者营养状况的Youden指数0.765,敏感度85.00(%),特异度82.00(%),AUC值0.810,95%CI:0.685~0.912。结论:不同病因肝硬化患者L3 SMI存在明显差异,临床可采用L3 SMI对肝硬化患者营养状况做出预测评估。  相似文献   

2.
摘要 目的:探讨老年男性腹股沟疝与肌肉质量、肌力及腹内压力(IAP)的相关性。方法:选取2021年1月-2023年1月在眉山市人民医院普外一科就诊的 86例老年男性腹股沟疝患者作为研究组,选取同期100名老年体检者作为对照组,对两组研究对象的腹部肌肉质量、肌力及IAP进行检测,并探讨其与腹股沟疝发病风险的相关性。结果:研究组患者腹部骨骼肌肉面积值(SMA)、骨骼肌指数(SMI)水平及右手握力、左手握力均低于对照组,腹内脂肪面积、SMI异常比例及直立加压时腹内压(OVIAP)、直立加压前后腹内压差(OVIAPD)、平卧与直立加压时腹内压差(OSVIAPD)均高于对照组,差异均有统计学意义(P<0.05)。Logistic多元回归模型分析结果显示,老年腹股沟疝的发生与SMI水平、SMI异常、右手握力、OVIAPD、OSVIAPD具有相关性(P<0.05)。结论:老年男性腹股沟疝患者存在腹部肌肉质量和肌力的下降,患者在直立做加压动作时可出现IAP水平的升高,上述指标均与腹股沟疝的发生具有相关性,临床可采用针对性的综合干预措施以降低老年男性人群腹股沟疝的发病风险。  相似文献   

3.

Background

Individuals with severe mental illness (e.g., schizophrenia, bipolar disorder) die 10–25 years earlier than the general population, primarily from premature cardiovascular disease (CVD). Contributing factors are complex, but include systemic-related factors of poorly integrated primary care and mental health services. Although evidence-based models exist for integrating mental health care into primary care settings, the evidence base for integrating medical care into specialty mental health settings is limited. Such models are referred to as “reverse” integration. In this paper, we describe the application of an implementation science framework in designing a model to improve CVD outcomes for individuals with severe mental illness (SMI) who receive services in a community mental health setting.

Methods

Using principles from the theory of planned behavior, focus groups were conducted to understand stakeholder perspectives of barriers to CVD risk factor screening and treatment identify potential target behaviors. We then applied results to the overarching Behavior Change Wheel framework, a systematic and theory-driven approach that incorporates the COM-B model (capability, opportunity, motivation, and behavior), to build an intervention to improve CVD risk factor screening and treatment for people with SMI.

Results

Following a stepped approach from the Behavior Change Wheel framework, a model to deliver primary preventive care for people that use community mental health settings as their de facto health home was developed. The CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness) model focuses on engaging community psychiatrists to expand their scope of practice to become responsible for CVD risk, with significant clinical decision support.

Conclusion

The CRANIUM model was designed by integrating behavioral change theory and implementation theory. CRANIUM is feasible to implement, is highly acceptable to, and targets provider behavior change, and is replicable and efficient for helping to integrate primary preventive care services in community mental health settings. CRANIUM can be scaled up to increase CVD preventive care delivery and ultimately improve health outcomes among people with SMI served within a public mental health care system.
  相似文献   

4.
The coronavirus disease-19 (COVID-19) has spread throughout the world, affecting many vulnerable populations including patients with severe mental illness (SMI). Recent studies have found that patients with SMI compared to the general population could have a greater risk of morbidity and mortality from COVID-19 due to cognitive impairment, poor awareness of risk, and difficulties in complying with infection control measures. Although some researchers have suggested that patients with SMI should be prioritized for COVID-19 vaccination to reduce the risk of infection, this issue remains controversial.  相似文献   

5.
6.
We developed a spermatophore-microinjection (SMI) technique that allows exogenous DNA fragments to be transferred easily into the giant freshwater prawn (Macrobrachium rosenbergii), an important aquacultural shellfish and aquatic invertebrate model. From 28 to 1, 000 ng of the circular plasmid pGL, in a total volume of 1 microl, were directly microinjected into spermatophores. Fertilization and hatching of prawns created with SMI were completed in vivo. Fertilization and hatching rates in the SMI treatments did not differ from those of the untreated control group. The genomes of free swimming, SMI-created larvae (21 days after fertilization) were analyzed using PCR and Southern blot analyses. A product with a molecular mass of 680 bp was amplified. It corresponded to amplifications of pGL, and Southern blot analysis revealed that the amplified band was positive. The gene transfer rate was primarily dependent on the concentration of DNA during SMI. The higher the concentration of pGL, the higher the rate of gene transfer. PCR and Southern blot analyses detected the existence of foreign DNA in 16 of 23 samples (70%) of genomic DNA isolated from hatched larvae in the 750 ng pGL SMI treatment. SMI, described here for the first time, is the simplest and most efficient method for mass producing transgenic giant freshwater prawns.  相似文献   

7.
魏娜  唐焕新  杨雪梅  冯力  吴蔚  佟达 《生物磁学》2013,(35):6933-6936
目的:探讨参麦注射液用于治疗慢性呼吸衰竭急性加重患者的临床效果。方法:选取2011年3月.2012年6月在我愿接受治疗的慢性呼吸衰竭急性加重的患者68例,随机分为参麦组和对照组,每组各34例。对照组采取常规方法进行治疗,参麦组在此基础上给予参麦注射液加以治疗。观察并比较两组患者的治愈率、住院时间、肺功能指标(FEVl)及血气分析情况等相关指标。结果:参麦组的治愈率为91.18%,与对照组的53.12%相比较,差异显著(X^2=10.8800,P〈0.05)。参麦组的住院时间显著短于对照组,其肺功能指标、血气分析结果包括氧分压值和二氧化碳分压值均明显优于对照组,具有统计学意义(P〈0.05)。结论:参麦注射液治疗慢性呼吸衰竭急性加重疾病不失为一种优良的治疗方案,不仅患者临床症状得到明显的改善,病情好转加快,还可以调节患者的免疫力,在临床上值得推广。  相似文献   

8.

Objective

Sarcopenia might be associated with bone fragility in elderly individuals. This study aimed to investigate the prevalence of sarcopenia and its association with fragility fracture sites in elderly Chinese patients.

Methods

Patients (322 men and 435 women) aged 65–94 years and with a history of fragility fractures in the ankle, wrist, vertebrae or hip, and healthy men (n = 1263) and women (n = 1057) aged 65–92 years without a history of fractures were enrolled. Whole-body dual energy X-ray absorptiometry was used to analyze skeletal muscle mass index (SMI), fat mass and bone mineral density. Sarcopenia was defined as SMI less than two standard deviations below the mean of a young reference group.

Results

Sarcopenia occurrence varied with fracture location. Sarcopenia was more common in females with vertebral and hip fractures and in men with hip and ankle fractures than in the non-fracture group). Sarcopenia was significantly more prevalent in men with wrist, hip and ankle fractures than in women. SMI was correlated with BMD in different fracture groups. Logistic regression analyses revealed that lower SMI was associated with an increased risk of hip fracture both in men and women and ankle fracture in men.

Discussion

Sarcopenia may be an independent risk factor for hip and ankle fractures in men, and for hip fractures in women.  相似文献   

9.
Sarcopenia has never been diagnosed based on site-specific muscle loss, and little is known about the relationship between site-specific muscle loss and metabolic syndrome (MetS) risk factors. To this end, this cross-sectional study aimed to investigate the relationship between site-specific muscle size and MetS risk factors. Subjects were 38 obese men and women aged 40–82 years. Total body fat and lean body mass were assessed by whole-body dual-energy X-ray absorptiometry (DXA) scan. Muscle thickness (MTH) was measured using B-mode ultrasound scanning in six body regions. Subjects were classified into general obesity (GO) and sarcopenic obesity (SO) groups using the threshold values of one standard deviation below the sex-specific means of either MTH or skeletal muscle index (SMI) measured by DXA. MetS risk score was acquired by standardizing and summing the following continuously distributed variables: visceral fat area, mean blood pressure, HbA1c, and serum triglyceride / high density lipoprotein cholesterol, to obtain the Z-score. Multiple regression analysis revealed that the MetS risk score was independently associated with abdominal MTH in all subjects, but not with MTH in other muscle regions, including the thigh. Although HbA1c and the number of MetS risk factors in the SO group were significantly higher than those in the GO group, there were no significant differences between GO and SO groups as defined by SMI. Ultrasound-derived abdominal MTH would allow a better assessment of sarcopenia in obese patients and can be used as an alternative to the conventionally-used SMI measured by DXA.  相似文献   

10.
BackgroundPeople with severe mental illness (SMI) have higher rates of a range of physical health conditions, yet little is known regarding the clustering of physical health conditions in this population. We aimed to investigate the prevalence and clustering of chronic physical health conditions in people with SMI, compared to people without SMI.Methods and findingsWe performed a cohort-nested accumulated prevalence study, using primary care data from the Clinical Practice Research Datalink (CPRD), which holds details of 39 million patients in the United Kingdom. We identified 68,783 adults with a primary care diagnosis of SMI (schizophrenia, bipolar disorder, or other psychoses) from 2000 to 2018, matched up to 1:4 to 274,684 patients without an SMI diagnosis, on age, sex, primary care practice, and year of registration at the practice. Patients had a median of 28.85 (IQR: 19.10 to 41.37) years of primary care observations. Patients with SMI had higher prevalence of smoking (27.65% versus 46.08%), obesity (24.91% versus 38.09%), alcohol misuse (3.66% versus 13.47%), and drug misuse (2.08% versus 12.84%) than comparators. We defined 24 physical health conditions derived from the Elixhauser and Charlson comorbidity indices and used logistic regression to investigate individual conditions and multimorbidity. We controlled for age, sex, region, and ethnicity and then additionally for health risk factors: smoking status, alcohol misuse, drug misuse, and body mass index (BMI). We defined multimorbidity clusters using multiple correspondence analysis (MCA) and K-means cluster analysis and described them based on the observed/expected ratio. Patients with SMI had higher odds of 19 of 24 conditions and a higher prevalence of multimorbidity (odds ratio (OR): 1.84; 95% confidence interval [CI]: 1.80 to 1.88, p < 0.001) compared to those without SMI, particularly in younger age groups (males aged 30 to 39: OR: 2.49; 95% CI: 2.27 to 2.73; p < 0.001; females aged 18 to 30: OR: 2.69; 95% CI: 2.36 to 3.07; p < 0.001). Adjusting for health risk factors reduced the OR of all conditions. We identified 7 multimorbidity clusters in those with SMI and 7 in those without SMI. A total of 4 clusters were common to those with and without SMI; while 1, heart disease, appeared as one cluster in those with SMI and 3 distinct clusters in comparators; and 2 small clusters were unique to the SMI cohort. Limitations to this study include missing data, which may have led to residual confounding, and an inability to investigate the temporal associations between SMI and physical health conditions.ConclusionsIn this study, we observed that physical health conditions cluster similarly in people with and without SMI, although patients with SMI had higher burden of multimorbidity, particularly in younger age groups. While interventions aimed at the general population may also be appropriate for those with SMI, there is a need for interventions aimed at better management of younger-age multimorbidity, and preventative measures focusing on diseases of younger age, and reduction of health risk factors.

In an observational analysis of primary care data from the UK, Naomi Launders and colleagues study the prevalence and clustering of physical health conditions and multimorbidity in individuals with severe mental illnesses.  相似文献   

11.
Most models of the spread of HIV/AIDS assume that the probability of transmission from an infected individual to a susceptible partner has some constant value per sexual act, compounding independently randomly (so that ten acts with one person chosen from a particular group has, on average, the same risk as one act with each of ten different people from that group). Guided by available data, other models treat the transmission process as being some characteristic (but highly variable) value per partnership, independent of the number of acts. This latter approach does not allow for the possible effects of concurrent partnerships, and therefore does not take account of the possibility that an initially uninfected partner of a given susceptible individual may become infected over the duration of their partnership. We present a new model, based on transmission per partnership, that takes account of partnership duration. If the number of overlapping partnerships is high enough (so that R0 greater than 1 among "standing crops" of partners), any initial infection will spread very fast--on the time scale of a few times the latent interval (a few months)--among existing networks of partners. After this initial "fast phase," the subsequent epidemic proceeds more slowly along conventional lines as new partnerships are formed. These properties of the model are illustrated numerically and by analytic studies (using singular perturbation theory). The possibility of such "two time-scale" phenomena could have implications for data analysis based on statistical back-projection.  相似文献   

12.
Nowadays, a consensus has been reached that designates the functional and structural reorganization of synapses as the primary mechanisms underlying the process of recovery from brain injury. We have reported that pontine noradrenaline (NA) is increased in animals after cortical ablation (CA). The aim of the present study was to explore the noradrenergic and morphological response after sensorimotor intervention (SMI) in rats injured in the motor cortex. We used male Wistar adult rats allocated in four conditions: sham-operated, injured by cortical ablation, sham-operated with SMI and injured by cortical ablation with SMI. Motor and somatosensory performance was evaluated prior to and 20 days after surgery. During the intervening period, a 15-session, SMI program was implemented. Subsequently, total NA analysis in the pons and dentate gyrus (DG) was performed. All groups underwent histological analysis. Our results showed that NA content in the DG was reduced in the injured group versus control, and this reduction was reverted in the injured group that underwent SMI. Moreover, injured rats showed reduction in the number of granule cells in the DG and decreased dentate granule cell layer thickness. Notably, after SMI, the loss of granule cells was reverted. Locus coeruleus showed turgid cells in the injured rats. These results suggest that SMI elicits biochemical and structural modifications in the hippocampus that could reorganize the system and lead the recovery process, modulating structural and functional plasticity.  相似文献   

13.

Background

There is increasing emphasis on primary care services for individuals with severe mental illnesses (SMI), including schizophrenia, bipolar disorder, and other non-organic psychotic disorders. However we lack information on how many people receive these different diagnoses in primary care. Primary care databases offer an opportunity to explore the recording of new SMI diagnoses in representative general practices.

Methods

We used data from The UK Health Improvement Network (THIN) primary care database including longitudinal patient records for individuals aged over 16 years from 437 general practices. We determined the annual GP recorded rate of first diagnosis of SMI by age, gender, social deprivation and urbanicity between 2000 and 2010.

Results

We identified 10,520 individuals with a first record of schizophrenia, bipolar disorder or other non-organic psychosis among 4,164,794 patients. This corresponded to a rate of first diagnosis of 46.4 per 100,000 person years at risk (PYAR) (95% CI 45.4 to 47.4) in the 16–65 age group. The rate of first record of schizophrenia was 9.2 per 100,000 PYAR (95% CI 8.7 to 9.6) in this age group, bipolar disorder was 15.0 per 100,000 PYAR (95% CI 14.4 to 15.5) and other non-organic psychotic disorder was 22.3 per 100,000 PYAR (95% CI 21.6 to 23.0).

Conclusions

The rates of GP recorded SMI in primary care records were broadly comparable to incidence rates from previous epidemiological studies of SMI and show similar patterns by socio-demographic characteristics. However there were some differences by specific diagnoses. GPs may be recording rates that are higher than those used to commission services.  相似文献   

14.
The formation of protein homodimer complexes for molecular catalysis and regulation is fascinating. The homodimer formation through 2S (2 state), 3SMI (3 state with monomer intermediate) and 3SDI (3 state with dimer intermediate) folding mechanism is known for 47 homodimer structures. Our dataset of forty-seven homodimers consists of twenty-eight 2S, twelve 3SMI and seven 3SDI. The dataset is characterized using monomer length, interface area and interface/total (I/T) residue ratio. It is found that 2S are often small in size with large I/T ratio and 3SDI are frequently large in size with small I/T ratio. Nonetheless, 3SMI have a mixture of these features. Hence, we used these parameters to develop a decision tree model. The decision tree model produced positive predictive values (PPV) of 72% for 2S, 58% for 3SMI and 57% for 3SDI in cross validation. Thus, the method finds application in assigning homodimers with folding mechanism.  相似文献   

15.
Recent studies of HIV RNA in infected individuals show that viral levels vary widely between individuals and within the same individual over time. Individuals with higher viral loads during the chronic phase tend to develop AIDS more rapidly. If RNA levels are correlated with infectiousness, these variations explain puzzling results from HIV transmission studies and suggest that a small subset of infected people may be responsible for a disproportionate number of infections. We use two simple models to study the impact of variations in infectiousness. In the first model, we account for different levels of virus between individuals during the chronic phase of infection, and the increase in the average time from infection to AIDS that goes along with a decreased viral load. The second model follows the more standard hypothesis that infected individuals progress through a series of infection stages, with the infectiousness of a person depending upon his current disease stage. We derive and compare threshold conditions for the two models and find explicit formulas of their endemic equilibria. We show that formulas for both models can be put into a standard form, which allows for a clear interpretation. We define the relative impact of each group as the fraction of infections being caused by that group. We use these formulas and numerical simulations to examine the relative importance of different stages of infection and different chronic levels of virus to the spreading of the disease. The acute stage and the most infectious group both appear to have a disproportionate effect, especially on the early epidemic. Contact tracing to identify super-spreaders and alertness to the symptoms of acute HIV infection may both be needed to contain this epidemic.  相似文献   

16.

Background

There is a surge of cardiovascular disease (CVD) in Africa. CVD is the leading cause of mortality among patients with severe mental illness (SMI) in developed countries, with little evidence from the African context.

Objective

To determine the prevalence and risk factors for MetS among South African patients with SMI.

Method

In a cross sectional study, individuals with SMI treated with antipsychotics and a control group without a mental illness, matched for age, gender and ethnicity were evaluated for MetS using the 2009 Joint Interim statement (JIS) criteria.

Results

Of the 276 study group subjects, 65.9% were male, 84.1% black African, 9.1% white, 5.4% of Indian descent and 1.5% coloured (mixed race) with a mean age of 34.7 years (±12.5). Schizophrenia was the most common diagnosis (73.2%) and 40% were taking first generation antipsychotics. The prevalence of MetS was 23.2% (M: 15.4%, F: 38.3%) in the study group and 19.9% (M: 11.9%, F: 36.3%) in the control group (p = 0.4). MetS prevalence was significantly higher in study subjects over 55 years compared to controls (p = 0.03). Increased waist circumference (p< 0.001) and low high density lipoprotein (HDL) cholesterol (p = 0.003) were significantly more prevalent in study subjects compared to controls. In study subjects, risk factors associated with MetS included age (OR: 1.09, 95% CI 1.06–1.12, p < 0.001), female gender (OR: 2.19, 95% CI 1.06–4.55, p = 0.035) and Indian descent (OR: 5.84, 95% CI 1.66–20.52, p = 0.006) but not class of antipsychotic (p = 0.26).

Conclusion

The overall MetS prevalence was not increased in patients with SMI compared to controls; however, the higher prevalence of the individual components (HDL cholesterol and waist circumference) suggests an increased risk for CVD, especially in patients over 55 years.  相似文献   

17.
Robustness of group testing in the estimation of proportions   总被引:1,自引:0,他引:1  
Hung M  Swallow WH 《Biometrics》1999,55(1):231-237
In binomial group testing, unlike one-at-a-time testing, the test unit consists of a group of individuals, and each group is declared to be defective or nondefective. A defective group is one that is presumed to include one or more defective (e.g., infected, positive) individuals and a nondefective group to contain only nondefective individuals. The usual binomial model considers the individuals being grouped as independent and identically distributed Bernoulli random variables. Under the binomial model and presuming that groups are tested and classified without error, it has been shown that, when the proportion of defective individuals is low, group testing is often preferable to individual testing for identifying infected individuals and for estimating proportions of defectives. We discuss the robustness of group testing for estimating proportions when the underlying assumptions of (i) no testing errors and (ii) independent individuals are violated. To evaluate the effect of these model violations, two dilution-effect models and a serial correlation model are considered. Group testing proved to be quite robust to serial correlation. In the presence of a dilution effect, smaller group sizes should be used, but most of the benefits of group testing can still be realized.  相似文献   

18.
People with severe mental illness (SMI) – schizophrenia, bipolar disorder and major depressive disorder – appear at risk for cardiovascular disease (CVD), but a comprehensive meta‐analysis is lacking. We conducted a large‐scale meta‐analysis assessing the prevalence and incidence of CVD; coronary heart disease; stroke, transient ischemic attack or cerebrovascular disease; congestive heart failure; peripheral vascular disease; and CVD‐related death in SMI patients (N=3,211,768) versus controls (N=113,383,368) (92 studies). The pooled CVD prevalence in SMI patients (mean age 50 years) was 9.9% (95% CI: 7.4‐13.3). Adjusting for a median of seven confounders, patients had significantly higher odds of CVD versus controls in cross‐sectional studies (odds ratio, OR=1.53, 95% CI: 1.27‐1.83; 11 studies), and higher odds of coronary heart disease (OR=1.51, 95% CI: 1.47‐1.55) and cerebrovascular disease (OR=1.42, 95% CI: 1.21‐1.66). People with major depressive disorder were at increased risk for coronary heart disease, while those with schizophrenia were at increased risk for coronary heart disease, cerebrovascular disease and congestive heart failure. Cumulative CVD incidence in SMI patients was 3.6% (95% CI: 2.7‐5.3) during a median follow‐up of 8.4 years (range 1.8‐30.0). Adjusting for a median of six confounders, SMI patients had significantly higher CVD incidence than controls in longitudinal studies (hazard ratio, HR=1.78, 95% CI: 1.60‐1.98; 31 studies). The incidence was also higher for coronary heart disease (HR=1.54, 95% CI: 1.30‐1.82), cerebrovascular disease (HR=1.64, 95% CI: 1.26‐2.14), congestive heart failure (HR=2.10, 95% CI: 1.64‐2.70), and CVD‐related death (HR=1.85, 95% CI: 1.53‐2.24). People with major depressive disorder, bipolar disorder and schizophrenia were all at increased risk of CVD‐related death versus controls. CVD incidence increased with antipsychotic use (p=0.008), higher body mass index (p=0.008) and higher baseline CVD prevalence (p=0.03) in patients vs. controls. Moreover, CVD prevalence (p=0.007), but not CVD incidence (p=0.21), increased in more recently conducted studies. This large‐scale meta‐analysis confirms that SMI patients have significantly increased risk of CVD and CVD‐related mortality, and that elevated body mass index, antipsychotic use, and CVD screening and management require urgent clinical attention.  相似文献   

19.
20.
乙型肝炎病毒动物模型研究进展   总被引:1,自引:0,他引:1  
乙型肝炎病毒感染是全球范围影响人类健康的重要问题,慢性感染人群存在肝硬化和肝细胞癌的高患病风险。尽管乙型肝炎病毒疫苗有效,但是在世界范围内慢性感染人数超过了3.5亿,占全球人数的5%。乙型肝炎病毒的生物学研究及新治疗发展进展缓慢是由于缺乏合适的动物模型,每一种动物模型都有其优势和特殊弊端。简要综述了各种动物模型在乙型肝炎病毒研究中的应用进展。  相似文献   

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