Clinical

临床
  • 文章类型: Journal Article
    老年人患有关节炎等慢性疾病的患病率很高,尤其是抑郁症高达40%-70%。因此,探讨患有关节炎的老年人的抑郁症很重要。
    本研究旨在确定是否有任何人口统计学和临床因素与在风湿病诊所就诊的60岁以上患有关节炎的老年人的抑郁症有关。
    这是一项为期6个月的横断面研究,在尼日利亚东北地区的一所大学教学医院中,对127名老年人进行了随访护理。
    带有关节炎类型信息的临床形式,疾病的持续时间,住院治疗,使用药物,合并症用于数据收集。老年抑郁量表(GDS-30),社会人口统计学问卷和临床形式。使用统计产品和服务解决方案(SPSS)版本26.0分析数据,显著性水平设定为0.05。
    平均年龄(±标准差[s.d.])为66.6(±5.5)岁,男性占57.5%。抑郁症患病率为57.8%。骨关节炎30.2%,而69.8%有类风湿性关节炎。与抑郁症相关的社会人口统计学因素包括年龄(p=0.049),婚姻状况(p=0.001),和教育水平(p=0.001)。疾病持续时间(p=0.02),住院(p=0.03),和用药数量(p=0.01)是与抑郁评分相关的临床因素。
    患有关节炎的老年人的抑郁症患病率很高,并且与女性有关,寡妇,没有正规教育;以及那些长期患病的人,那些使用多种药物的人,以及那些反复住院的人。
    这一发现可以增强对抑郁症的怀疑指数,以建立标准的操作程序,这将有助于改善照顾老年人群的治疗实践。
    UNASSIGNED: Older adults have a high prevalence of chronic conditions like arthritis with morbidities, especially depression ranging up to 40% - 70%. Therefore, it is important to explore depression in older adults with arthritis.
    UNASSIGNED: This study aimed to determine if any demographic and clinical factors are associated with depression in older adults aged ≥ 60 years with arthritis attending a rheumatology clinic.
    UNASSIGNED: This is a cross-sectional study conducted over 6 months among 127 older adults on follow-up care in a university teaching hospital in the North-Eastern region of Nigeria.
    UNASSIGNED: A clinical proforma with information about the type of arthritis, duration of illness, hospitalisation, use of medications, co-morbidity was utilised for the data collection. The Geriatric Depression Scale (GDS-30), sociodemographic questionnaire and clinical proforma were administered. Data were analysed using Statistical Product and Service Solutions (SPSS) version 26.0 with the level of significance set as 0.05.
    UNASSIGNED: The mean age (± standard deviation [s.d.]) was 66.6 (± 5.5) years, with males constituting 57.5%. The prevalence of depression was 57.8%. Osteoarthritis 30.2%, while 69.8% had rheumatoid arthritis. Sociodemographic factors associated with depression include age (p = 0.049), marital status (p = 0.001), and level of education (p = 0.001). Duration of illness (p = 0.02), hospitalisation (p = 0.03), and number of medications (p = 0.01) were clinical factors associated with depression score.
    UNASSIGNED: The prevalence of depression in older people with arthritis is high and was associated with females, the widowed, no formal education; and those with long duration of illness, those using multiple medications, and those with repeated hospitalisation.
    UNASSIGNED: This finding can enhance the suspicion index for depression to establish standard operating procedures, which will help to improve therapeutic practice for caring for the older adult age group.
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  • 文章类型: Journal Article
    作为霍乱,由于产毒细菌霍乱弧菌(血清群O1和O139),是非洲主要的公共卫生威胁,这项工作的目的是首先从人类粪便样本中研究潜在的致病性弧菌科细菌,其次来自塞内加尔圣路易斯市的各种环境用水点。
    一项基于医院的研究于2013年至2015年进行。从每天传入的患者或在圣路易斯地区医院因急性腹泻住院的患者中采集并培养粪便样本。对于环境,2016年1月至10月,在该市10个地点进行了每月纵向采样.我们使用从APW(碱性蛋白胨水)肉汤溶液和可疑细菌菌落中提取的总DNA进行PCRMultiplex靶向特定DNA片段以检测弧菌属和特定物种。在积极的情况下,进行单纯PCR检测霍乱毒素Ctx,以及副溶血性弧菌TRH和TDH。
    对43名患者进行筛查,在6%的病例中,细菌培养呈阳性,但没有霍乱弧菌或其他弧菌。被隔离。90个APW溶液的PCR对弧菌属呈阳性。(n=43),V.霍乱(n=27),V.拟态(n=16),五、副溶血病(8),V.溶藻(n=4),和V.创伤(n=2)。与大多数副溶血性弧菌(n=40)和非O1/O139霍乱弧菌(n=35)阳性的可疑菌落不同。6株副溶血性弧菌携带TRH基因,3个同时表达毒力TRH和TDH基因。对于物理化学参数,所有温度根据单峰季节性变化相似,以及盐度。
    尽管存在弧菌科的自然种群,甚至是产毒的,在水环境中被注意到,以及有利的栖息地条件,可以在圣路易斯人群中传播弧菌病,我们没有从医院筛查的患者中分离出任何一种.
    UNASSIGNED: as cholera, due to toxigenic bacteria Vibrio cholera (serogroups O1 and O139), is a major public health threat in Africa, the aim of this work was to investigate potentially pathogenic Vibrionaceae bacteria firstly from human stool samples, and secondly from various environmental water points of Saint-Louis city in Senegal.
    UNASSIGNED: a hospital-based study was conducted between 2013 and 2015. Stool samples were taken and cultured from daily incoming patients or hospitalized for acute diarrhea at Saint-Louis´ regional hospital. For environment, a monthly longitudinal sampling from January to October 2016 was carried out at 10 sites in the city. We used total DNA extracted from APW (alkaline peptone water) broth solutions and on suspect bacterial colonies to run PCR Multiplex targeting specific DNA fragments to detect Vibrio genus and specific species. In case of positivity, a simplex PCR was performed to test for cholera toxins Ctx, and V. parahaemolyticus TRH and TDH.
    UNASSIGNED: for 43 patients screened, bacterial culture was positive in 6% of cases but no strain of V. cholerae or other Vibrio sp. was isolated. PCR on 90 APW solutions were positive for Vibrio sp.(n = 43), V. cholera(n = 27), V. mimicus(n = 16), V. parahaemolyticus(8), V. alginolyticus(n = 4), and V. vulnificus(n = 2). Unlike for those on suspected colonies which were positive for a majority of V. parahaemolyticus (n = 40) and V. cholerae non-O1 / O139 (n = 35). Six strains of V. parahaemolyticus carried TRH gene, 3 of which expressed simultaneously virulence TRH and TDH genes. For physicochemical parameters, all temperatures varied similarly according to a unimodal seasonality, as well as salinity.
    UNASSIGNED: despite the presence of natural populations of Vibrionaceae, even toxigenic ones, was noted in water environment, along with favorable habitat conditions that could play a role in transmission of Vibriosis in the Saint Louis population, we did not isolate any of them from patients screened at the hospital.
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  • 文章类型: Journal Article
    暂无摘要。
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  • 文章类型: Journal Article
    这篇综述的目的是总结目前对干细胞疗法治疗效果的理解,包括造血干细胞,用于治疗缺血性心脏损伤。按照PRISMA准则,我们在MEDLINE进行了电子搜索,和EMBASE。我们筛选了592项研究,包括RCT,观察性研究,以及研究造血干细胞治疗对成年心力衰竭患者的影响的队列研究。涉及儿科患者的研究,间充质干细胞治疗,非心力衰竭(HF)研究被排除在我们的评价之外.在592项研究中,7项研究符合我们的纳入标准。总的来说,给予造血干细胞(通过冠状动脉内或心肌梗死)导致积极的心脏结果,例如病理性左心室重塑的改善,急性心肌梗死后的灌注,和NYHA症状分类。此外,合并死亡,因心力衰竭再次住院,在接受骨髓来源的造血干细胞治疗的患者中,梗死程度显著降低.我们的审查表明,造血干细胞管理可以导致HF患者的心脏结果阳性。未来的研究应旨在增加女性代表性和非缺血性HF患者。
    The purpose of this review is to summarize the current understanding of the therapeutic effect of stem cell-based therapies, including hematopoietic stem cells, for the treatment of ischemic heart damage. Following PRISMA guidelines, we conducted electronic searches in MEDLINE, and EMBASE. We screened 592 studies, and included RCTs, observational studies, and cohort studies that examined the effect of hematopoietic stem cell therapy in adult patients with heart failure. Studies that involved pediatric patients, mesenchymal stem cell therapy, and non-heart failure (HF) studies were excluded from our review. Out of the 592 studies, 7 studies met our inclusion criteria. Overall, administration of hematopoietic stem cells (via intracoronary or myocardial infarct) led to positive cardiac outcomes such as improvements in pathological left-ventricular remodeling, perfusion following acute myocardial infarction, and NYHA symptom class. Additionally, combined death, rehospitalization for heart failure, and infarction were significantly lower in patients treated with bone marrow-derived hematopoietic stem cells. Our review demonstrates that hematopoietic stem cell administration can lead to positive cardiac outcomes for HF patients. Future studies should aim to increase female representation and non-ischemic HF patients.
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  • 文章类型: Journal Article
    透析膜与人体血液不兼容,因为患者正在遭受血膜相互作用的副作用。两性离子结构显示出改善的血液相容性;然而,它们复杂的合成阻碍了它们的商业化。该研究的目的是实现羧基甜菜碱和磺基甜菜碱两性离子固定在PES膜上的快速功能化,同时比较稳定性和目标血液相容性。化学改性方法基于氨解反应。表征,计算模拟,并进行了临床分析以研究改性膜。原子力显微镜(AFM)图案显示,与纯膜(52.61nm)相比,羧基甜菜碱修饰(6.3nm)和磺基甜菜碱修饰(7.7nm)膜的平均粗糙度较低。膜的孔径从纯PES的高于50nm的值减小到两性离子膜的2至50nm之间的值。使用Brunauer-Emmett-Teller(BET)分析。更亲水的表面导致羧基甜菜碱的生长平衡水含量(EWC)为近6%,磺基甜菜碱改性膜的生长平衡水含量为10%。差示扫描量热法(DSC)测量值分别为羧基甜菜碱和磺基甜菜碱改性膜的12%和16%稳定水,分别。关于C5a,磺基甜菜碱膜显示出与血液更好的相容性,IL-1a,和IL-6生物标志物。发现基于氨基分解的两性离子适合于改善血液透析膜。本文介绍的方法可用于在生产设施变化最小的情况下修改当前的透析膜。
    Dialysis membranes are not hemocompatible with human blood, as the patients are suffering from the blood-membrane interactions\' side effects. Zwitterionic structures have shown improved hemocompatibility; however, their complicated synthesis hinders their commercialization. The goal of the study is to achieve fast functionalization for carboxybetaine and sulfobetaine zwitterionic immobilization on PES membranes while comparing the stability and the targeted hemocompatibility. The chemical modification approach is based on an aminolysis reaction. Characterization, computational simulations, and clinical analysis were conducted to study the modified membranes. Atomic force microscopy (AFM) patterns showed a lower mean roughness for carboxybetaine-modified (6.3 nm) and sulfobetaine-modified (7.7 nm) membranes compared to the neat membrane (52.61 nm). The pore size of the membranes was reduced from values above 50 nm for the neat PES to values between 2 and 50 nm for zwitterionized membranes, using Brunauer-Emmett-Teller (BET) analysis. More hydrophilic surfaces led to a growth equilibrium water content (EWC) of nearly 6% for carboxybetaine and 10% for sulfobetaine-modified membranes. Differential scanning calorimetry (DSC) measurements were 12% and 16% stable water for carboxybetaine- and sulfobetaine-modified membranes, respectively. Sulfobetaine membranes showed better compatibility with blood with respect to C5a, IL-1a, and IL-6 biomarkers. Aminolysis-based zwitterionization was found to be suitable for the improvement of hemodialysis membranes. The approach introduced in this paper could be used to modify the current dialysis membranes with minimal change in the production facilities.
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  • 文章类型: Journal Article
    背景:管状生物标志物,反映了肾小管功能障碍或损伤,与慢性肾脏病和肾功能下降有关。几种肾小管生物标志物也与常染色体显性多囊肾病(ADPKD)的进展有关。我们评估了参与两项临床试验(二甲双胍治疗和饮食诱导的体重减轻)之一的四组ADPKD患者中多种肾小管生物标志物的变化,基于证据表明这种干预措施可以减少小管损伤。
    方法:66名患有ADPKD且估计肾小球滤过率(eGFR)≥30ml/min/1.73m2的参与者(26M/40F)参加了二甲双胍临床试验(n=22二甲双胍;n=23安慰剂)或饮食体重减轻研究(n=10每日热量限制[DCR];n=11个间歇性肾KIM-1分子评估中包括[空腹]脂肪酸结合蛋白[FABP],白细胞介素-18[IL-18],单核细胞趋化蛋白-1[MCP-1],中性粒细胞明胶酶相关脂质运载蛋白[NGAL],clusterin,和人软骨糖蛋白-40[YKL-40];归一化为尿肌酐),在基线和12个月。基线肾小管生物标志物与基线和高度调整后的总肾脏体积(HtTKV;从基线到12个月的百分比变化)和估计的肾小球滤过率(eGFR;12个月时的绝对变化与基线),用协变量调整,还使用多元线性回归进行了评估。
    结果:平均±s.d.年龄为48±8岁,eGFR为71±16ml/min/1.73m2,基线BMI为30.5±5.9kg/m2。与安慰剂相比,任何干预都没有改变肾小管生物标志物。此外,基线肾小管生物标志物与基线或eGFR或HtTKV在12个月内的变化无关,在人口统计调整后,组分配,和临床特征。
    结论:肾小管生物标志物不会随着饮食诱导的体重减轻或二甲双胍而改变,它们也不与肾脏疾病进展有关,在这一ADPKD患者队列中。
    BACKGROUND: Tubular biomarkers, which reflect tubular dysfunction or injury, are associated with incident chronic kidney disease and kidney function decline. Several tubular biomarkers have also been implicated in the progression of autosomal dominant polycystic kidney disease (ADPKD). We evaluated changes in multiple tubular biomarkers in four groups of patients with ADPKD who participated in one of two clinical trials (metformin therapy and diet-induced weight loss), based on evidence suggesting that such interventions could reduce tubule injury.
    METHODS: 66 participants (26 M/40 F) with ADPKD and an estimated glomerular filtration rate (eGFR) ≥ 30 ml/min/1.73m2 who participated in either a metformin clinical trial (n = 22 metformin; n = 23 placebo) or dietary weight loss study (n = 10 daily caloric restriction [DCR]; n = 11 intermittent fasting [IMF]) were included in assessments of urinary tubular biomarkers (kidney injury molecule-1 [KIM-1], fatty-acid binding protein [FABP], interleukin-18 [IL-18], monocyte chemoattractant protein-1 [MCP-1], neutrophil gelatinase-associated lipocalin [NGAL], clusterin, and human cartilage glycoprotein-40 [YKL-40]; normalized to urine creatinine), at baseline and 12 months. The association of baseline tubular biomarkers with both baseline and change in height-adjusted total kidney volume (HtTKV; percent change from baseline to 12 months) and estimated glomerular filtration rate (eGFR; absolute change at 12 months vs. baseline), with covariate adjustment, was also assessed using multiple linear regression.
    RESULTS: Mean ± s.d. age was 48 ± 8 years, eGFR was 71 ± 16 ml/min/1.73m2, and baseline BMI was 30.5 ± 5.9 kg/m2. None of the tubular biomarkers changed with any intervention as compared to placebo. Additionally, baseline tubular biomarkers were not associated with either baseline or change in eGFR or HtTKV over 12 months, after adjustments for demographics, group assignment, and clinical characteristics.
    CONCLUSIONS: Tubular biomarkers did not change with dietary-induced weight loss or metformin, nor did they associate with kidney disease progression, in this cohort of patients with ADPKD.
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  • 文章类型: Journal Article
    背景:慢性应激在德国人群中非常普遍。已知它对心理健康有不良影响,如倦怠和抑郁。慢性压力的已知长期影响是心血管疾病,糖尿病,和癌症。
    目的:本研究旨在基于德国成人健康访谈和检查调查的全国代表性数据,得出一个可解释的多类机器学习模型,用于预测慢性压力水平和预防慢性压力的因素。这是国家健康监测计划的一部分。
    方法:来自德国成人健康访谈和检查调查研究的数据集,包括人口统计学,临床,分析了5801名参与者的实验室数据.构建了一个多类极限梯度提升(XGBoost)模型,将参与者分为3类,包括低,中间,和高慢性压力水平。使用接收器工作特性曲线下的面积评估模型的性能,精度,召回,特异性,和F1得分。此外,使用Shapley加法扩张来解释预测XGBoost模型并确定保护免受慢性压力的因素。
    结果:多类XGBoost模型显示了宏观平均分数,接收器工作特性曲线下面积为81%,精度为63%,召回52%,特异性为78%,F1得分为54%。低水平慢性压力的最重要特征是男性,良好的整体健康,对生活空间的高度满意,强大的社会支持。
    结论:本研究为德国成年人的慢性应激提供了一个多类可解释的预测模型。可解释的人工智能技术Shapley加法扩张确定了慢性压力的相关保护因素,在制定减少慢性压力的干预措施时需要考虑这一点。
    BACKGROUND: Chronic stress is highly prevalent in the German population. It has known adverse effects on mental health, such as burnout and depression. Known long-term effects of chronic stress are cardiovascular disease, diabetes, and cancer.
    OBJECTIVE: This study aims to derive an interpretable multiclass machine learning model for predicting chronic stress levels and factors protecting against chronic stress based on representative nationwide data from the German Health Interview and Examination Survey for Adults, which is part of the national health monitoring program.
    METHODS: A data set from the German Health Interview and Examination Survey for Adults study including demographic, clinical, and laboratory data from 5801 participants was analyzed. A multiclass eXtreme Gradient Boosting (XGBoost) model was constructed to classify participants into 3 categories including low, middle, and high chronic stress levels. The model\'s performance was evaluated using the area under the receiver operating characteristic curve, precision, recall, specificity, and the F1-score. Additionally, SHapley Additive exPlanations was used to interpret the prediction XGBoost model and to identify factors protecting against chronic stress.
    RESULTS: The multiclass XGBoost model exhibited the macroaverage scores, with an area under the receiver operating characteristic curve of 81%, precision of 63%, recall of 52%, specificity of 78%, and F1-score of 54%. The most important features for low-level chronic stress were male gender, very good general health, high satisfaction with living space, and strong social support.
    CONCLUSIONS: This study presents a multiclass interpretable prediction model for chronic stress in adults in Germany. The explainable artificial intelligence technique SHapley Additive exPlanations identified relevant protective factors for chronic stress, which need to be considered when developing interventions to reduce chronic stress.
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  • 文章类型: Journal Article
    背景:罕见疾病的低患病率对促进其理解提出了重大挑战。这项研究旨在描述西班牙罕见疾病患者注册中罕见眼病(RED)患者的临床和遗传特征。
    方法:纳入来自注册数据库的864例患者。疾病分为遗传性视网膜营养不良(n=688);眼前节疾病(n=48);先天性畸形(n=27);以及包括肌肉在内的眼部受累综合征(n=46)。神经学(n=34),或代谢(n=13);炎性疾病(n=4);和肿瘤(n=4)。视敏度(VA)和/或视野(VF)数据,症状和体征,综合征病例中的并发疾病,发病年龄和诊断年龄,受影响的基因,残疾评级,收集了无法工作和依赖等级识别。
    结果:观察到从症状发作开始的平均诊断延迟7年。常见的症状包括畏光,夜盲症,和进行性视力丧失(≥57%的患者)。白内障是最常见的继发性疾病(46%),假眼是最常见的眼科手术(26%)。听力损失和心血管疾病是最常见的并发全身性疾病(≥13%)。残疾证明书,丧失工作能力,依赖占87%,42%,19%的患者,分别。在有可用VA数据的719名患者中,193(27%)是盲人,和188(26%)有中度至重度视力障碍。超过一半的患者(54%)表现出VF缺陷,216例(25%)同心收缩≤5°或VF消失。大多数患有常染色体隐性遗传性疾病(55%),常染色体显性(30%),X-linked(9%),和线粒体(6%)模式。一名患者同时在隐性USH2A和显性RHO基因中都有突变。在接受基因检测的656名患者(75.7%)中,只有461例(70.3%)获得阳性结果(致病性或可能的致病性突变解释表型).我们发现了62个与RED相关的新基因变异,以前没有在与特定表型相关的遗传变异数据库中报道过。
    结论:本研究描述了西班牙RED的临床和基因型。遗传性疾病,特别是视网膜疾病,占主导地位,但是很大一部分受影响的患者仍未被基因诊断,阻碍潜在的基因治疗努力。尽管在减少诊断延迟方面取得了显著进步,它仍然很了不起。红色经常导致年轻人群的残疾和失明。
    BACKGROUND: The low prevalence of rare diseases poses a significant challenge in advancing their understanding. This study aims to delineate the clinical and genetic characteristics of patients with rare eye diseases (RED) enrolled in the Spanish Rare Diseases Patient Registry.
    METHODS: A total of 864 patients from the registry database were included. Diseases were categorized into inherited retinal dystrophies (n=688); anterior segment diseases (n=48); congenital malformations (n=27); and syndromic diseases with ocular involvement including muscular (n=46), neurological (n=34), or metabolic (n=13); inflammatory diseases (n=4); and tumors (n=4). Data on visual acuity (VA) and/or visual field (VF), symptoms and signs, concurrent diseases in syndromic cases, age of onset and at diagnosis, affected genes, disability rating, inability to work and dependency grade recognition were collected.
    RESULTS: A mean diagnostic delay of 7 years from symptom onset was observed. Commonly reported symptoms included photophobia, night blindness, and progressive vision loss (≥57% of patients). Cataract was the most prevalent secondary disease (46%), with pseudophakia being the most common ocular surgery (26%). Hearing loss and cardiovascular diseases were the most prevalent concurrent systemic diseases (≥13%). Certificates of disability, incapacity for work, and dependency were held by 87%, 42%, and 19% of patients, respectively. Among the 719 patients with available VA data, 193 (27%) were blind, and 188 (26%) had moderate to severe visual impairment. Over half of the patients (54%) exhibited VF defects, and 216 (25%) had concentric contraction ≤5° or abolished VF. Most had genetic diseases with autosomal recessive (55%), autosomal dominant (30%), X-linked (9%), and mitochondrial (6%) patterns. One patient had mutations in both recessive USH2A and dominant RHO genes simultaneously. Of the 656 patients (75.7%) who underwent genetic testing, only 461 (70.3%) received a positive result (pathogenic or likely pathogenic mutations explaining the phenotype). We found 62 new gene variants related to RED not previously reported in databases of genetic variants related to specific phenotypes.
    CONCLUSIONS: This study delineates the clinical and genotypic profiles of RED in Spain. Genetic diseases, particularly retinal disorders, predominate, but a significant proportion of affected patients remain genetically undiagnosed, hindering potential gene therapy endeavors. Despite notable improvements in reducing diagnosis delays, it is still remarkable. RED frequently lead to disability and blindness among young populations.
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