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1.
Artigo em Inglês | MEDLINE | ID: mdl-33821370

RESUMO

We aimed to further the understanding of maternal depressive symptoms on temporal dynamics of child emotion regulation by applying the process model of emotion regulation to preschoolers and incorporating insights from children's moment-to-moment emotional expressions. Following 108 mother-child dyads (57 girls; 72 mothers identified as White, 23 mothers as Black or African American, 10 mothers as multi-racial, 3 mothers did not report their race) from child age three (T1; Mchild age = 3.23; SD = 0.19) to four years old (T2; Mage = 4.21; SD = 0.15), we asked whether T1 maternal depressive symptoms predicted T2 boys' and girls' faster transitions into and slower transitions out of negative emotion displays when children were frustrated. The results from multilevel Cox Regression models for latencies and durations of emotion displays showed that child gender moderated the associations between maternal depressive symptoms and latencies of child emotion displays for sadness but not anger. Higher levels of maternal depressive symptoms predicted faster transitions into sadness only for girls but not for boys. The findings suggested that girls of mother with elevated depressive symptoms showed impairment in antecedent-focused emotion regulation of sadness.

2.
Ann Palliat Med ; 10(3): 3018-3027, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33849092

RESUMO

BACKGROUND: With the continuous development of modern society, the management of chronic diseases has become the focus of the medical community in China. In particular, diabetes is a chronic disease that cannot be ignored. China has built an integrated delivery system to deal with imminent health problems. The purpose of this study is to investigate the effects of integrated rural supply system in China. METHODS: We selected 1,061 patients with diabetes from the Zhili Town Health Center's hospital information system. We tracked and studied their outpatient and inpatient expenses, treatment behaviors, incidence of complications, and satisfaction over 5 years. We compared the data collected from 2014 to 2019 to determine the trends of these four factors and the effects of the integrated delivery system for patients with diabetes. RESULTS: We found that the average costs for diabetes patients in outpatient and inpatient departments were increasing slightly every year. The number of patients in tertiary hospitals has decreased significantly, while the number of patients in community hospitals (primary hospitals) has increased, and the number of patients in secondary hospitals has remained relatively unchanged. Meanwhile, the expenses per visit were also lower over this period in hospitals at all levels. Diabetes complications have been increasing marginally, and there is a relatively high degree of satisfaction among patients and doctors in primary hospitals, which is rising. CONCLUSIONS: Considering the various needs of people in different stages of life, the integrated delivery system provides and manages continuous services such as health promotion, disease prevention, diagnosis, treatment, rehabilitation, and management through cooperation between institutions at different levels of the health system.

3.
Micromachines (Basel) ; 12(3)2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33800963

RESUMO

Compared with a traditional optical system, the single-lens curved compound eye imaging system has superior optical performance, such as a large field of view (FOV), small size, and high portability. However, defocus and low resolution hinder the further development of single-lens curved compound eye imaging systems. In this study, the design of a nonuniform curved compound eye with multiple focal lengths was used to solve the defocus problem. A two-step gas-assisted process, which was combined with photolithography, soft photolithography, and ultraviolet curing, was proposed for fabricating the ommatidia with a large numerical aperture precisely. Ommatidia with high resolution were fabricated and arranged in five rings. Based on the imaging experimental results, it was demonstrated that the high-resolution and small-volume single-lens curved compound eye imaging system has significant advantages in large-field imaging and rapid recognition.

4.
Artigo em Inglês | MEDLINE | ID: mdl-33741616

RESUMO

Lactate-driven chain elongation (LCE) has emerged as a new biotechnology to upgrade organic waste streams into valuable biochemical and fuel precursor, medium chain carboxylate, n-caproate. Considering that a low cost of downstream extraction is critical for biorefinery technology, a high concentration of n-caproate production is very important to improve the scale-up of the LCE process. We report here that in a nonsterile open environment, the n-caproate concentration was increased from the previous record of 25.7 g·L - 1 to a new high level of 33.7 g·L - 1 (76.8 g COD·L - 1), with the highest production rate of 11.5 g·L - 1·d - 1 (26.2 g COD·L - 1·d - 1). In addition, the LCE process remained stable with an average concentration of n-caproate production of 20.2 ± 5.62 g·L - 1 (46.1 ± 12.8 g COD·L - 1) for 780 days. Dynamic changes in taxonomic composition integrated with metagenomic data reveal the microbial ecology for long-term production of high concentrations of n-caproate: 1) the core microbiome is related to efficient functional groups, such as Ruminococcaceae (with functional strain CPB6); 2) the core bacteria can maintain stability for long-term operation; 3) the microbial network has relatively low microbe-microbe interaction strength; and 4) low relative abundance and variety of competitors. The network structure could be shaped by hydraulic retention time (HRT) over time, and long-term operation at an HRT of 8 days displayed higher efficacy.IMPORTANCEOur research revealed the microbial network of LCE reactor microbiome for n-caproate production at high concentrations, which will provide a foundation for designing or engineering the LCE reactor microbiome to recover n-caproate from organic waste streams in the future. In addition, the hypothetical model of the reactor microbiome that we proposed may offer guidance for researchers to find the underlying microbial mechanism when they encounter low-efficiency n-caproate production from the LCE process. We anticipate that our research will rapidly advance LCE biotechnology with the goal of promoting the sustainable development of human society.

5.
Curr Opin Chem Biol ; 63: 28-37, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33684855

RESUMO

The messenger RNA (mRNA) methylations in mammalian cells have been found to contain N6-methyladenosine (m6A), N6-2'-O-dimethyladenosine (m6Am), 7-methylguanosine (m7G), 1-methyladenosine (m1A), 5-methylcytosine (m5C), and 2'-O-methylation (2'-OMe). Their regulatory functions in control of mRNA fate and gene expression are being increasingly uncovered. To unambiguously understand the critical roles of mRNA methylations in physiological and pathological processes, mapping these methylations at single base resolution is highly required. Here, we will review the progresses made in methylation sequencing methodologies developed mainly in recent two years, with an emphasis on chemical labeling-assisted single base resolution methods, and discuss the problems and prospects as well.

6.
Stem Cells ; 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33754392

RESUMO

Revascularization of the islet transplant is a crucial step that defines the success rate of patient recovery. Bone marrow-derived mesenchymal stem cells (BMSCs) have been reported to promote revascularization; however, the underlying cellular mechanism remains unclear. Moreover, our liquid chromatography-tandem mass spectrometry results showed that BMSCs could promote the expression of insulin gene enhancer binding protein-1 (ISL1) in islets. ISL1 is involved in islets proliferation and plays a potential regulatory role in the revascularization of islets. This study identifies the ISL1 protein as a potential modulator in BMSCs-mediated revascularization of islet grafts. We demonstrated that the survival rate and insulin secretion of islets were increased in the presence of BMSCs, indicating that BMSCs promote islet revascularization in a coculture system and rat diabetes model. Interestingly, we also observed that the presence of BMSCs led to an increase in ISL1 and vascular endothelial growth factor A (VEGFA) expression in both islets and the INS-1 rat insulinoma cell line. In silico protein structure modeling indicated that ISL1 is a transcription factor that has four binding sites with VEGFA mRNA. Further results showed that overexpression of ISL1 increased both the abundance of VEGFA transcripts and protein accumulation, while inhibition of ISL1 decreased the abundance of VEGFA. Using a ChIP-qPCR assay, we demonstrated that direct molecular interactions between ISL1 and VEGFA occur in INS-1 cells. Together, these findings reveal that BMSCs promote the expression of ISL1 in islets and lead to an increase in VEGFA in islet grafts. Hence, ISL1 is a potential target to induce early revascularization in islet transplantation.

7.
J Fam Psychol ; 2021 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-33661684

RESUMO

This study examined the prospective associations among the trajectories of maternal depressive symptoms, maternal sensitivity, and child executive function (EF) across early and middle childhood, and tested the mediating role of maternal sensitivity in the links between change in maternal depressive symptoms and the growth of child EF. Participants included 1,364 children and mothers from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (NICHD SECCYD). We found that maternal depressive symptoms (from 6 months to Grade 5) and sensitivity (from 36 months to Grade 5) decreased, whereas child EF (planning skills; from Grade 1 to 5) increased over time. We also found several direct associations: (a) lower maternal depressive symptoms at 36 months predicted higher sensitivity at 54 months; (b) higher sensitivity at 54 months and a faster decrease in sensitivity from 36 months to Grade 5 predicted higher child EF in Grade 1; and (c) higher sensitivity at 54 months predicted greater growth of EF from Grade 1 to 5. In addition, two mediation effects were found as follows: Lower levels of maternal depressive symptoms at 36 months predicted both higher levels of child EF in Grade 1 and greater growth of EF from Grade 1 to 5 through higher levels of maternal sensitivity at 54 months. The results suggest that early maternal depressive symptoms may have long-term effects on the growth of EF, especially planning skills, during middle childhood, and that one important pathway that maternal depressive symptoms affect child EF outcomes through maternal sensitivity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

8.
BMC Oral Health ; 21(1): 123, 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731068

RESUMO

BACKGROUND: The effect of rapid maxillary expansion (RME) on the upper airway (UA) has been studied earlier but without a consistent conclusion. This study aims to evaluate the outcome of RME on the UA function in terms of aerodynamic characteristics by applying a computational fluid dynamics (CFD) simulation. METHODS: This retrospective cohort study consists of seventeen cases with two consecutive CBCT scans obtained before (T0) and after (T1) RME. Patients were divided into two groups with respect to patency of the nasopharyngeal airway as expressed in the adenoidal nasopharyngeal ratio (AN): group 1 was comprised of patients with an AN ratio < 0.6 and group 2 encompassing those with an AN ratio ≥ 0.6. CFD simulation at inspiration and expiration were performed based on the three-dimensional (3D) models of the UA segmented from the CBCT images. The aerodynamic characteristics in terms of pressure drop (ΔP), maximum midsagittal velocity (Vms), and maximum wall shear stress (Pws) were compared by paired t-test and Wilcoxon test according to the normality test at T0 and T1. RESULTS: The aerodynamic characteristics in UA revealed no statistically significant difference after RME. The maximum Vms (m/s) decreased from 2.79 to 2.28 at expiration after RME (P = 0.057). CONCLUSION: The aerodynamic characteristics were not significantly changed after RME. Further CFD studies with more cases are warranted.

9.
PLoS Biol ; 19(2): e3001122, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33630828

RESUMO

The Hippo-YAP pathway responds to diverse environmental cues to manage tissue homeostasis, organ regeneration, tumorigenesis, and immunity. However, how phosphatase(s) directly target Yes-associated protein (YAP) and determine its physiological activity are still inconclusive. Here, we utilized an unbiased phosphatome screening and identified protein phosphatase magnesium-dependent 1A (PPM1A/PP2Cα) as the bona fide and physiological YAP phosphatase. We found that PPM1A was associated with YAP/TAZ in both the cytoplasm and the nucleus to directly eliminate phospho-S127 on YAP, which conferring YAP the nuclear distribution and transcription potency. Accordingly, genetic ablation or depletion of PPM1A in cells, organoids, and mice elicited an enhanced YAP/TAZ cytoplasmic retention and resulted in the diminished cell proliferation, severe gut regeneration defects in colitis, and impeded liver regeneration upon injury. These regeneration defects in murine model were largely rescued via a genetic large tumor suppressor kinase 1 (LATS1) deficiency or the pharmacological inhibition of Hippo-YAP signaling. Therefore, we identify a physiological phosphatase of YAP/TAZ, describe its critical effects in YAP/TAZ cellular distribution, and demonstrate its physiological roles in mammalian organ regeneration.

10.
Magn Reson Imaging ; 78: 119-126, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33588019

RESUMO

PURPOSE: Alzheimer's disease (AD) is a progressive and irreversible neurodegenerative disease. In recent years, machine learning methods have been widely used on analysis of neuroimage for quantitative evaluation and computer-aided diagnosis of AD or prediction on the conversion from mild cognitive impairment (MCI) to AD. In this study, we aimed to develop a new deep learning method to detect or predict AD in an efficient way. MATERIALS AND METHODS: We proposed a densely connected convolution neural network with connection-wise attention mechanism to learn the multi-level features of brain MR images for AD classification. We used the densely connected neural network to extract multi-scale features from pre-processed images, and connection-wise attention mechanism was applied to combine connections among features from different layers to hierarchically transform the MR images into more compact high-level features. Furthermore, we extended the convolution operation to 3D to capture the spatial information of MRI. The features extracted from each 3D convolution layer were integrated with features from all preceding layers with different attention, and were finally used for classification. Our method was evaluated on the baseline MRI of 968 subjects from ADNI database to discriminate (1) AD versus healthy subjects, (2) MCI converters versus healthy subjects, and (3) MCI converters versus non-converters. RESULTS: The proposed method achieved 97.35% accuracy for distinguishing AD patients from healthy control, 87.82% for MCI converters against healthy control, and 78.79% for MCI converters against non-converters. Compared with some neural networks and methods reported in recent studies, the classification performance of our proposed algorithm was among the top ranks and improved in discriminating MCI subjects who were in high risks of conversion to AD. CONCLUSIONS: Deep learning techniques provide a powerful tool to explore minute but intricate characteristics in MR images which may facilitate early diagnosis and prediction of AD.

11.
Food Chem ; 351: 129226, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-33639430

RESUMO

The effect of three drying methods (hot air, freeze and spray drying) on the solubility and amphiphilicity of gelatin were investigated and compared. Results showed spray drying gelatin (SDG) and hot air drying gelatin (HDG) showed the lowest and best solubility, respectively. This phenomenon was attributed to the degree of subunits degradation and hydrophobicity. The HDG showed an obvious degradation during the hot air drying and displayed the strongest hydrophilicity, while SDG showed a slight degradation and strongest hydrophobicity. The results of wettability showed that SDG had a better amphiphilicity (92.48°) in comparison with HDG (57.7°) and freeze drying gelatin (VDG, 77.53°), which can effectively reduce the interfacial tension of gelatin, thus significantly improving the stability of foam and emulsion (p < 0.05). These results suggested the drying methods can adjust the amphiphilicity of gelatin, and the SDG displayed a better amphiphilicity, showing good potential applications in foam and emulsion.


Assuntos
Dessecação/métodos , Congelamento , Gelatina/química , Gelatina/isolamento & purificação , Interações Hidrofóbicas e Hidrofílicas , Micro-Ondas , Solubilidade , Fatores de Tempo , Molhabilidade
12.
Int J Pharm ; 598: 120401, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33636327

RESUMO

The current study demonstrated that the presence of excipients can interfere with the measurement of particle size distribution (PSD), a critical quality attribute of ophthalmic suspensions, by laser diffraction (LD) and that a placebo background subtraction approach can eliminate the impact of excipients on the PSD measurement. Commercially available loteprednol etabonate and brinzolamide ophthalmic suspensions were used as model suspensions. The impact of excipients in these formulations on the LD measurements was determined using a one-factor-at-a-time experimental design approach, using National Institute of Standards and Technology (NIST) traceable polystyrene particle size standards as references. Among the evaluated excipients, polymers containing polyacrylic acid were found to interfere with the PSD analysis by creating the LD signals correspond to particles ranging from a few micrometers to a hundred micrometers in size. As a result, the measured PSD of active pharmaceutical ingredient (API) particles in the formulation overlapped with or superimposed on the excipient PSD signal, leading to erroneous interpretation of the API particle size. Additionally, dispersion of brinzolamide particles in unsaturated solutions led to rapid dissolution of brinzolamide particles during the measurement, resulting in underestimation of the particle size range. Here, a placebo background subtraction approach was developed to eliminate the interference of the excipients. This newly developed LD method was also evaluated using orthogonal methods, including polarized light microscopy and scanning electron microscopy (SEM). The strategy used in this study to eliminate the interference of excipients may also be useful for other heterogeneous dispersions where excipient interference may be of concern.

13.
J Stroke Cerebrovasc Dis ; 30(5): 105643, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33631473

RESUMO

OBJECTIVES: This study sought to assess whether the Population, Hypertension, Age, Size, Earlier Subarachnoid Hemorrhage, Site (PHASES) score can do risk stratification of patients with multiple aneurysms (MIAs). MATERIAL AND METHODS: Patients between January 1, 2016 and January 1, 2019 were recruited retrospectively. The PHASES score was applied to assess the theoretical risk of IA rupture. For patients-level analyses, four modes of the application of the score were used: largest IA PHASES score, highest PHASES score, sum PHASES score, and mean PHASES score. RESULTS: A total of 701 patients with 1673 IAs were included in this study. At aneurysm-level analysis, the average PHASES score was 3.0 ± 3.0 points, with 2.8 ± 3.0 points and 4.1 ± 2.9 points in the unruptured and ruptured groups, respectively (p < 0.001). At the patient-level analysis, for the largest IA PHASES score, the areas under the curves (AUC) was 0.572. The discrimination performance of the largest IA PHASES score decreases as IA number increases, with AUCs were 0.597, 0.518, and 0.450 in the 2 IAs, 3 IAs and, 4 or more IAs subgroups, respectively. For highest PHASES score, sum PHASES score, and mean PHASES score, the AUCs were 0.577, 0.599, and 0.619, respectively. CONCLUSIONS: In this study, PHASES score only serve as a weak tool in decision-making settings for MIAs patients; as such, more accurate models should be developed for MIAs patients and the cumulative effect of MIA may should be considered.

14.
Stroke Vasc Neurol ; 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33637615

RESUMO

BACKGROUND AND PURPOSE: Previous studies have reported about inflammation processes (IPs) that play important roles in aneurysm formation and rupture, which could be driven by blood flow. IPs can be identified using aneurysmal wall enhancement (AWE) on high-resolution black-blood MRI (BB-MRI) and blood flow haemodynamics can be demonstrated by four-dimensional-flow MRI (4D-flow MRI). Thus, this study investigated the associations between AWE and haemodynamics in unruptured intracranial aneurysms (IA) by combining 4D-flow MRI and high-resolution BB-MRI. MATERIALS AND METHODS: Between April 2014 and October 2017, 48 patients with 49 unruptured IA who underwent both 4D-flow MRI and high-resolution BB-MRI were retrospectively included in this study. The haemodynamic parameters demonstrated using 4D-flow MRI were compared between different AWE patterns using the Kruskal-Wallis test and ordinal regression. RESULTS: The results of Kruskal-Wallis test showed that the average wall shear stress in the IA (WSSavg-IA), maximum through-plane velocity in the adjacent parent artery, inflow jet patterns and the average vorticity in IA (vorticityavg-IA) were significantly associated with the AWE patterns. Ordinal regression analysis identified WSSavg-IA (p=0.002) and vorticityavg-IA (p=0.033) as independent predictors of AWE patterns. CONCLUSION: A low WSS and low average vorticity were independently associated with a high AWE grade for IAs larger than 4 mm. Therefore, WSS and average vorticity could predict AWE and circumferential AWE.

15.
Artigo em Inglês | MEDLINE | ID: mdl-33538571

RESUMO

To face the challenge of all-climate application, organic rechargeable batteries must hold the capability of efficiently operating both at high temperatures (>50 °C) and low temperatures (-20 °C). However, the low electronic conductivity and high solubility of organic molecules significantly impede the development in electrochemical energy storage. This issue can be effectively diminished using functionalized porphyrin complex-based organic cathodes by the in-situ electropolymerization of electrodes at elevating temperatures during electrochemical cycling. [5,15-bis(ethynyl)-10,20-diphenylporphinato]copper(II) (CuDEPP)- and 5,15-bis(ethynyl)-10,20-diphenylporphinato (DEPP)-based cathodes are proposed as models, and it is proved that a largely improved electrochemical performance is observed in both cathodes at a high operating temperature. Reversible capacities of 249 and 105 mA h g-1 are obtained for the CuDEPP and DEPP cathodes after 1000 cycles at 50 °C, respectively. The result indicates that the temperature-induced in situ electropolymerization strategy responds to the enhanced electrochemical performance. This study would open new opportunities for developing highly stable organic cathodes for electrochemical energy storage even at high temperatures.

16.
J Ethnopharmacol ; : 113916, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33571615

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: 25 flavors of the turquoise pill, a traditional Tibetan medicine for the treatment of various types of hepatitis, has not been investigated on its safety, especially the component mineral turquoise, which is believed to be essential but worried for its potential toxicity. AIM OF THE STUDY: To explore the potential acute toxicity and function of 25 flavors of the turquoise pill and turquoise, the possible mechanism of the effects of turquoise and 25 flavors of the turquoise pill were systematically studied based on 1H NMR metabolomics. MATERIALS AND METHODS: The rats were administered with turquoise and 25 flavors of the turquoise pill by gavage for 7 days, and samples of serum, liver, and kidney were collected. The potential toxicity and function of turquoise and 25 flavors of the turquoise pill on the liver and kidney of SD rats were evaluated by 1H NMR metabonomics, histopathology, and biochemical indexes. RESULTS: The results demonstrated that 25 flavors of the turquoise pill could scavenge free oxygen radicals, strengthen aerobic respiration and inhibit glycolysis in the liver. It did not cause oxidative stress in the kidney with no obvious damage. By modulation of branched-chain amino acids (BCAAs), 25 flavors of the turquoise pill can improve the utilization of glucose and promote aerobic respiration of the kidney. CONCLUSION: Considering the high dosage and short duration used in this study relative to their typical clinical usage, administration of 25 flavors of the turquoise pill and its component mineral turquoise are safe to livers and kidneys.

18.
Poult Sci ; 100(2): 1034-1048, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33518062

RESUMO

This study investigated the effect of berberine (BBR) on growth performance and composition and function of cecal microbiota in yellow-feathered broilers. A total of 360 1-day-old female broilers were assigned to 3 dietary treatments, each with 6 replicates of 20 birds. The dietary treatments consisted of a basal diet as negative control (NC), basal plus 200 mg/kg oxytetracycline calcium and 250 mg/kg nasiheptide as an antibiotic positive control (PC), and basal plus 250 mg/kg BBR. On day 21, 42, and 63, one chicken from each replicate was randomly selected for blood collection and cecal sampling. The 16S rRNA sequencing technology was used to analyze the community composition and function of cecal microbiota. Dietary supplementation with antibiotics or BBR increased the final body weight (BW) at day 63 and the average daily gain (ADG) during 1 to 21 d compared with the NC (P < 0.05). Supplementation with BBR improved the average daily feed intake (ADFI) at 22 to 42 d, 43 to 63 d, and 1 to 63 d (P < 0.05). Feed efficiency, indicated by feed to gain ratio (F/G), increased with PC during day 1 to 21 compared with NC (P < 0.05). The plasma concentrations of total protein at 42 d and uric acid at 21 d were increased, whereas creatine concentration at 63 d was decreased by BBR treatment (P < 0.05). The Chao 1 and Shannon index representing microbial α-diversity was reduced by BBR treatment (P < 0.05). The abundances of phylum Firmicutes and genera Lachnospiraceae, Lachnoclostridium, Clostridiales, and Intestinimonas were decreased, whereas the abundances of phylum Bacteroidetes and genus Bacteroides were increased with BBR treatment. Functional prediction of microbiota revealed that BBR treatment enriched pathways related to metabolism, organismal systems, and genetic information processing, especially DNA replication. The abundance of phylum Bacteroidetes, and genera Bacteroides and Lactobacillus in cecal contents were positively correlated with broiler growth performance. These results demonstrated dietary BBR supplementation improved the growth performance of yellow-feathered broilers, and was closely related to the significant changes in cecal microbiota composition.

19.
Stroke Vasc Neurol ; 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547231

RESUMO

BACKGROUND AND PURPOSE: Approximately 15%-45% of patients with unruptured intracranial aneurysms have multiple intracranial aneurysms (MIAs). Determining which one is most likely to rupture is extremely important for treatment decision making for MIAs patients. This study aimed to develop and validate a nomogram to evaluate the per-aneurysm rupture risk of MIAs patients. METHODS: A total of 1671 IAs from 700 patients with MIAs were randomly dichotomised into derivation and validation sets. Multivariate logistic regression analysis was used to select predictors and construct a nomogram model for aneurysm rupture risk assessment in the derivation set. The discriminative accuracy, calibration performance and clinical usefulness of this nomogram were assessed. We also developed a multivariate model for a subgroup of 158 subarachnoid haemorrhage (SAH) patients and compared its performance with the nomogram model. RESULTS: Multivariate analyses identified seven variables that were significantly associated with IA rupture (history of SAH, alcohol consumption, female sex, aspect ratio >1.5, posterior circulation, irregular shape and bifurcation location). The clinical and morphological-based MIAs (CMB-MIAs) nomogram model showed good calibration and discrimination (derivation set: area under the curve (AUC)=0.740 validation set: AUC=0.772). Decision curve analysis demonstrated that the nomogram was clinically useful. Compared with the nomogram model, the AUC of multivariate model developed from SAH patients had lower value of 0.730. CONCLUSIONS: This CMB-MIAs nomogram for MIAs rupture risk is the first to be developed and validated in a large multi-institutional cohort. This nomogram could be used in decision-making and risk stratification in MIAs patients.

20.
Ann Palliat Med ; 10(1): 434-442, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33545775

RESUMO

BACKGROUND: Since the implementation of the new medical reform in 2009, China has established and improved a series of medical security systems, established medical confederations based on four categories, and promoted the operation of the hierarchical diagnosis and treatment model. The purpose of this study is to analyze the effects of the matrix chronic diseases management platform developed from the integrated delivery system. To evaluate the effects of the matrix chronic diseases management platform developed from the integrated delivery system in China on expenses, medical seeking behaviors, compensation, and degree of satisfaction in hypertensive patients. A longitudinal and retrospective study was performed to investigate medical expenses, actual compensation ratios, medical behaviors, and the degree of satisfaction across different levels of medical institutions in hypertensive patients. METHODS: A total of 7,037 patients with hypertension aged 36-99 from Zhili Town Health Center were selected based on the diagnostic criteria of the Guidelines for Prevention and Treatment of Hypertension in China. Data was collected from the hospital's database and systems, and questionnaires were distributed to patients who attended the Department of Cardiology. Outcomes included inspection and drug expenses in the outpatient and inpatient departments, actual reimbursement ratios, number of visits across different levels of hospitals, expenditure per visit, medical behaviors, complications of patients, and the degree of satisfaction of both patients and doctors in primary hospitals. RESULTS: The average cost for hypertensive patients was shown to be increasing year by year in the outpatient and inpatient departments. The number of patients in tertiary hospitals decreased significantly, while the number of patients in community hospitals (primary hospitals) increased, and the number of patients in secondary hospitals has remained almost unchanged. Furthermore, expenses per visit in hospitals across all levels also decreased during the study period. The primary complications of hypertension were cerebrovascular disease and coronary heart disease, which showed a slightly increasing trend. The degree of satisfaction of patients and doctors in primary hospitals was relatively high, and rose from 2014 to 2019. CONCLUSIONS: The matrix chronic diseases management platform developed from the integrated delivery system built in Huzhou No.1 Hospital had a positive effect on improving the reimbursement and satisfaction of patients with hypertension.

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