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1.
Acupunct Med ; : 964528419900911, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32028783

RESUMO

BACKGROUND: Evidence for treating postprandial distress syndrome with acupuncture is limited. AIM: We aimed to evaluate the feasibility of verum acupuncture versus sham acupuncture in patients with postprandial distress syndrome. METHODS: A total of 42 eligible patients were randomly allocated to either verum acupuncture or sham acupuncture groups in a 1:1 ratio. Each patient received 12 sessions over 4 weeks. The primary outcome was the response rate based on the overall treatment effect (OTE) 4 weeks after randomization. Secondary outcomes included dyspepsia symptom severity and adverse events. RESULTS: In each group, 19 patients (91.5%) completed the study. Thirteen patients receiving verum acupuncture and seven patients receiving sham acupuncture were classified as responders according to OTE (61.9% vs 33.3%; rate difference 28.6%; p = 0.06). Dyspepsia symptom severity at the end of treatment also differed significantly between verum acupuncture and sham acupuncture groups (5.9 units vs 3.7 units; between-group difference 2.2 (95% CI, 0.2-4.2); p = 0.04). No serious adverse events occurred. CONCLUSION: Four weeks of acupuncture may represent a potential treatment for postprandial distress syndrome. The treatment protocol and outcome measures used in this trial were feasible. Since this was a pilot study, the efficacy of acupuncture still needs to be determined by a larger, adequately powered trial.

2.
Acupunct Med ; : 964528419900781, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32022581

RESUMO

OBJECTIVE: We aimed to explore the feasibility of evaluating the comparative effectiveness and safety of electroacupuncture (EA) relative to manual acupuncture (MA) for the treatment of knee osteoarthritis (KOA). METHODS: A multicenter randomized controlled clinical trial was conducted in Beijing from September 2017 to January 2018. A total of 60 participants with KOA were randomly allocated to either EA (n = 30) or MA (n = 30) groups. Participants in the EA group were treated with EA at six to seven local traditional acupuncture points or ah shi points, and two to three distal points. Participants in the MA group had the same schedule as the EA group except that the electrical apparatus featured a working power indicator without actual current output, constituting a sham EA procedure, in order to blind participants. Both groups received 24 sessions over 8 weeks. The primary outcome was response rate, defined as a change of ⩾50% from baseline in the total scores of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) after 8 weeks. Secondary outcomes included pain, stiffness, function, quality of life, and acupuncture-related adverse events (AEs) at 4 and 8 weeks. RESULTS: Of 60 participants randomized, 53 (88%) completed the study. Response rates were 43% for the EA group and 30% for the MA group by the intention-to-treat analysis. Although significant differences were observed in WOMAC pain, stiffness, and function scores within both groups, between-group differences at 8 weeks did not reach statistical significance (odds ratio = 1.75 (95% confidence interval = 0.593-5.162)). Rates of AEs were low and similarly distributed between groups. CONCLUSION: Both EA and MA interventions in KOA were feasible and appeared safe. Whether or not EA may have a stronger impact on pain and function requires further evaluation through larger, adequately powered, randomized controlled trials. TRIAL REGISTRATION NUMBER: NCT03274713.

3.
Mol Med Rep ; 21(3): 981-988, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31922216

RESUMO

Chemerin is a novel adipokine that regulates immune responses, adipocyte differentiation, and glucose metabolism. However, the role of chemerin in pancreatogenic diabetes mellitus (PDM) remains unknown. PDM is recognized as DM occurring secondary to chronic pancreatitis or pancreatic resection due to the loss of the loss of islet cell mass. The aim of the present study was to investigate the role of chemerin in PDM by collecting blooding samples from DM patients and establishing in vivo PDM model. The present study demonstrated that chemerin levels are decreased in the serum of patients with PDM and are negatively associated with the insulin resistance (IR) status. Chemerin levels also decreased during the development of PDM in C57BL/6 mice, together with increasing serum levels of interleukin­1 and tumor necrosis factor­α and decreasing mRNA expression levels of glucose transporter 2 (GLUT2) and pancreatic and duodenal homeobox 1 (PDX1). Treatment of PDM model mice with chemerin chemokine­like receptor 1 (CMKLR1) agonist, chemerin­9, elevated the serum levels of chemerin and mRNA expression levels of GLUT2 and PDX1, leading to the alleviation of glucose intolerance and IR in these animals. Together, the accumulated data indicated that chemerin may exert a protective function in PDM, perhaps by regulating perhaps by regulating GLUT2 and PDX1 expression, and that the restoration of the chemerin/CMKLR1 pathway may represent a novel therapeutic strategy for PDM.

4.
Curr Med Sci ; 39(6): 947-953, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31845226

RESUMO

Acupuncture is an alternative therapy for tinnitus in clinical practice. The mechanism by which acupuncture can alleviate tinnitus is still unknown. Autonomic nervous system was reported to be responsible for tinnitus. The aim of this study was to explore the effect of acupuncture on autonomic balance in adult tinnitus patients. Thirty patients were randomly assigned into either the deep acupuncture (DA) group or the shallow acupuncture (SA) group. Each patient received 6 acupuncture sessions (a-f phase) over three weeks. Measures of heart rate variability and Tinnitus Handicap Inventory (THI) were obtained at baseline and after the sixth acupuncture session in all patients. The results showed that the low frequency/high frequency (LF/HF) pattern was increased at b-f phase until the sixth acupuncture session when compared with that at the first acupuncture session in DA group. However, it continuously increased at b-f phase in SA group even at the sixth acupuncture session, which was not significantly different from that at the first acupuncture session. The decrease in THI in DA group was greater than that in SA group after 3-week treatment (P=0.043). Our preliminary study suggests three-week deep acupuncture can improve tinnitus symptoms in adult tinnitus patients, which may be related to the regulation of autonomic nervous system balance.

5.
Trials ; 20(1): 423, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296249

RESUMO

BACKGROUND: This study aims to determine whether 3 sessions per week of acupuncture treatment is superior to 1 session per week of acupuncture treatment for symptomatic outcomes in knee osteoarthritis. METHODS/DESIGN: This is a two parallel-group, assessor-blinded, randomized controlled trial. Sixty patients with knee osteoarthritis (Kellgren-Lawrence grade II or III) will be recruited and randomly allocated to receive 24 or 8 sessions (group M or group L) of acupuncture treatment in a 1:1 ratio. Patients in group M will receive 3 sessions per week of acupuncture for 8 weeks. Patients in group L will receive acupuncture once per week for 8 weeks. The primary outcome is the response rate-the percentage of patients achieving a decrease ≥ 2 points on a numerical rating pain scale and a decrease ≥ 6 points in the Western Ontario and McMaster Universities Osteoarthritis Index function score at 8 weeks compared with baseline. Secondary outcomes include pain, function, overall effect, quality of life, and treatment credibility and expectancy. DISCUSSION: Three sessions per week of acupuncture treatment may be superior to 1 session per week of acupuncture treatment for symptomatic outcomes in knee osteoarthritis. Results of the study will be of great importance for the guidelines of clinical therapy. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03359603 . Registered on 1 December 2017.


Assuntos
Terapia por Acupuntura/métodos , Osteoartrite do Joelho/terapia , Terapia por Acupuntura/efeitos adversos , Idoso , Pequim , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Projetos Piloto , Ensaios Clínicos Pragmáticos como Assunto , Fatores de Tempo , Resultado do Tratamento
6.
Trials ; 20(1): 394, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272488

RESUMO

BACKGROUND: Acupuncture is widely used for knee osteoarthritis (KOA), despite contradictory evidence. This study is designed to determine the efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for KOA. METHODS/DESIGN: This is a multi-center three-arm randomized controlled trial. It will enroll 480 participants with KOA in China. Participants will be randomly assigned 1:1:1 to receive 24 sessions of electro-acupuncture, manual acupuncture, or sham acupuncture over 8 weeks. The primary outcome is the response rate, which is the proportion of patients who achieve the minimal clinically important improvement in pain and function at 8 weeks. The primary outcome will be analyzed using the Z-test with the intention-to-treat set. Secondary outcomes include pain, function, global patient assessment, and quality of life. Full details of the statistical analysis plan for the primary and secondary outcomes will be described in this article. The statistical analysis plan was written and submitted without knowledge of the study data. DISCUSSION: The data will be analyzed according to this pre-specified statistical analysis plan to avoid data-driven analysis and to enhance the transparency of the trial. The aim of the trial is to provide high-quality evidence on the efficacy of acupuncture for KOA. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03366363 . Registered on 20 November 2017.

7.
Zhongguo Zhen Jiu ; 39(5): 565-70, 2019 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-31099232

RESUMO

OBJECTIVE: To summarize the research status and influencing factors of the time-effect of acupuncture and to explain and analyze the optimal effect timing of acupuncture, and provide reference for obtaining the best clinical therapeutic effect. METHODS: Literature regarding the studies of the time-effect of acupuncture published from January 2000 to August 2018 was searched, concluded and analyzed in CNKI, WANFANG, VIP and PubMed databases. RESULTS: A total of 43 papers were included. The time-effect relationship of acupuncture was studied from various aspects: immediate effect, post-effect and total time-effect. The influencing factors of time-effect of acupuncture included needle retention time, acupoint types, number of acupoints and frequency of acupuncture treatment. CONCLUSION: Even though preliminary achievements have been made in the study of the time-effect of acupuncture, there are many limitations and deficiency. These studies are mostly isolated and unsystematic, and the observation time of needle retention time and post-effect is not long enough to observe the exact best induction period, half-life period and residual effect period of acupuncture.In the future, we should combine the existing research experience and achievements to formulate a more reasonable research plan and observe the entire period of acupuncture in a longitudinal direction.


Assuntos
Terapia por Acupuntura , Pontos de Acupuntura , Agulhas , PubMed
8.
Trials ; 20(1): 204, 2019 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-30971318

RESUMO

After publication of the original article [1], the authors have notified us that the Trial registration number NCT03274713 should be replaced by NCT03366363 in the Abstract section of the paper.

9.
Artigo em Inglês | MEDLINE | ID: mdl-30906419

RESUMO

Hypertension is a global health problem. It has been reported that acupuncture at Taichong acupoints (LR3) decreases high blood pressure in spontaneously hypertensive rats. A transcriptome analysis can profile gene expression and its relationship with acupuncture. In this study, rats were treated with 2 weeks of acupuncture followed by regular recording of blood pressure (BP). The mRNA changes in the rostral ventrolateral medulla (RVLM) were evaluated to uncover the genetic mechanisms of acupuncture by using a whole transcript array (Affymetrix Rat Gene 1.0 ST array). BP measurements showed that acupuncture significantly decreased systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR). In the bioinformatics results, 2371 differentially expressed genes (DEGs) were identified, where 83 DEGs were overlapped among Wistar-Kyoto rats (WKYs), spontaneously hypertensive rats (SHRs), and SHRs + acupuncture rats (SHRs+Acu). Gene ontology (GO) and pathway analysis revealed that 279 GO terms and 20 pathways with significant differences were related to oxidative stress, inflammation, and vascular endothelial function. In addition, coexpressed DEGs networks indicated that Cd4 and Il-33 might mediate the cascade of inflammation and oxidative stress responses, which could serve as a potential target of acupuncture treatment. In conclusion, our study demonstrated that acupuncture is a promising therapy for treating hypertension and could regulate multiple biological processes mainly involving oxidative stress, inflammation, and vascular endothelial function.

10.
Trials ; 20(1): 79, 2019 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683147

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders. Although the available evidence for its efficacy is inconclusive, acupuncture is used as an alternative therapy for KOA. The aim of this trial is to determine the efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for KOA. METHODS/DESIGN: This is a study protocol for a randomised, three-arm, multicentre, clinical trial. A total of 480 patients with KOA will be randomly assigned to the electro-acupuncture group, the manual acupuncture group or the sham acupuncture group in a 1:1:1 ratio. All patients will receive 24 sessions over 8 weeks. Participants will complete the trial by visiting the research centre at week 26 for a follow-up assessment. The primary outcome is the success rate: the proportion of patients achieving a minimal clinically important improvement, which is defined as ≥2 points on the numerical rating scale and ≥6 points on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score at week 8 compared with baseline. Secondary outcomes include the numerical rating scale, WOMAC score, global patient assessment and quality of life at weeks 4, 8, 16 and 26 after randomisation. DISCUSSION: This trial may provide high-quality evidence for the efficacy of acupuncture in the treatment of KOA. The results of this study will be published in peer-reviewed journals. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03274713 . Registered on 20 November 2017.


Assuntos
Terapia por Acupuntura/métodos , Eletroacupuntura/métodos , Osteoartrite do Joelho/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia por Acupuntura/efeitos adversos , Idoso , Interpretação Estatística de Dados , Eletroacupuntura/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Projetos de Pesquisa , Tamanho da Amostra
11.
Trials ; 20(1): 65, 2019 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-30658669

RESUMO

BACKGROUND: Postprandial distress syndrome (PDS) has a considerable impact on quality of life. Our previous pilot trial suggested that acupuncture might be a potential treatment option for PDS. We will conduct this large trial to determine the efficacy of acupuncture versus sham acupuncture for PDS. METHODS/DESIGN: A total of 280 eligible patients who meet the Rome IV criteria for PDS will be randomly allocated to either the acupuncture group or the sham acupuncture group. Each patient will receive 12 sessions over four weeks. The primary outcomes will be the response rate of overall treatment effect (OTE) and the elimination rate of all three cardinal symptoms (postprandial fullness, upper abdominal bloating, and early satiation) at four weeks after randomization. Secondary outcomes will include assessments of the severity of dyspepsia symptoms and disease-specific quality of life at weeks 4, 8, and 16 after randomization. All patients who receive randomization will be included in the intent-to-treat analysis. DISCUSSION: The finding of this trial will provide high-quality evidence on the efficacy of acupuncture for treatment of PDS. Results of this research will be published in peer-reviewed journals. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN12511434 . Registered on 31 March 2017.


Assuntos
Terapia por Acupuntura , Dispepsia/terapia , Período Pós-Prandial , Adolescente , Adulto , Idoso , Pequim , Dispepsia/diagnóstico , Dispepsia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Síndrome , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Clin Rehabil ; 33(4): 642-652, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30672317

RESUMO

OBJECTIVE:: To evaluate the effectiveness of acupuncture in patients with vascular cognitive impairment no dementia (VCIND) in comparison with citicoline, an agent for cognitive disturbances associated with chronic cerebral disorders. DESIGN:: A randomized controlled multicenter trial. SETTING:: In three hospitals in Beijing, China. SUBJECTS:: A total of 216 patients with VCIND were recruited. INTERVENTIONS:: Patients with VCIND (mean age of 65.4 years) were randomized to receive acupuncture (two sessions per week) or oral citicoline (100 mg three times daily) over three months. MAIN MEASURES:: The primary outcome was the change from baseline to three months in cognitive symptom, measured by Alzheimer's disease Assessment Scale, cognitive subscale (ADAS-cog). Secondary outcomes included changes from baseline to six months in ADAS-cog, executive function measured by the Clock Drawing Test (CDT), and functional disability measured by the Ability of Daily Living (ADL) scale at three and six months. RESULTS:: At three months, the acupuncture group had a greater decrease in mean ADAS-cog score (-2.33 ± 0.31) than the citicoline group (-1.38 ± 0.34) with a mean difference of -0.95 (95% CI, -1.84 to -0.07, P = 0.035). The mean change from baseline to six months in ADAS-cog also significantly favored acupuncture treatments (acupuncture change -2.61 vs citicoline -1.25, difference: -1.36 points; 95% CI, -2.20 to -0.51; P = 0.002). There was no difference between the two groups on CDT and ADL scores at either time point. CONCLUSION:: Compared with citicoline, acupuncture has comparable and even superior efficacy with improved cognitive and daily living performance as a complementary and alternative medicine treatment for VCIND.


Assuntos
Terapia por Acupuntura , Disfunção Cognitiva/terapia , Idoso , China , Citidina Difosfato Colina/uso terapêutico , Avaliação da Deficiência , Feminino , Humanos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Nootrópicos/uso terapêutico
14.
Rev Assoc Med Bras (1992) ; 64(5): 454-461, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-30304146

RESUMO

OBJECTIVES: To evaluate the epidemiological characteristics of acute pancreatitis (AP) and explore potential relationships between these factors and severity. METHODOLOGY: Data-sets of 5,659 patients with AP from health statistics and the Information Center of Jiangsu province, between 2014 and 2016, were analyzed. A self-organizing map (SOM) neural network was used for data clustering. RESULTS: Biliary acute pancreatitis (BAP) (86.7%) was the most frequent etiological factor. A total of 804 (14.2%) patients had severe acute pancreatitis (SAP). The mean age of patients was 53.7 + 17.3 (range 12~94y). Most of the AP patients were married (75.4%); 6% of mild /moderately severe AP (MAP/MASP) patients were unmarried, which was less than SAP patients (P=0.016). AP patients with blood type AB in the general population (8.8%) was significantly lower than that of AP cases (13.9%) (P=0.019) and SAP cases(18.7%) (P=0.007). The number of AP patients in southern Jiangsu was much higher than that in northern Jiangsu province, especially in Nanjing (1229, 21.7%). The proportion of acute alcoholic pancreatitis (AAP) in the north of Jiangsu (Xuzhou 18.4%) was much higher than that in southern Jiangsu (Suzhou 2.6%). The whole sample was divided into five classes by SOM neural network. If BAP patients were male, old, divorced, and blood type AB or B, they were more likely to develop SAP. Middle-age, unmarried or divorced male patients with blood type B/AB who suffered from HAP or AAP were also more likely to develop SAP. CONCLUSIONS: The number of unmarried patients with MAP/MASP was smaller than that of SAP. Blood types AB and B were more frequent in AP, especially in SAP. The differences between southern Jiangsu and northern Jiangsu, in number of AP patients and the proportion of AAP, were significant. In class I and class IV, the ratio of SAP was much higher than in other classes and the whole sample.


Assuntos
Sistema do Grupo Sanguíneo ABO , Mineração de Dados/métodos , Pancreatite/epidemiologia , Doença Aguda , Adulto , Idoso , China/epidemiologia , Conjuntos de Dados como Assunto , Feminino , Sistemas de Informação em Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pancreatite/sangue , Pancreatite/diagnóstico , Índice de Gravidade de Doença
15.
J Pain Res ; 11: 2039-2050, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30310308

RESUMO

Background: Strategies for preventing the persistence of pain and disability beyond the acute phase in shoulder pain patients are critically needed. Conventional acupuncture therapy (CAT) or motion style acupuncture therapy (MSAT) alone results in relative improvements in painful conditions in shoulder pain patients; combined interventions may have more global effects. The aim of this study is to evaluate the efficacy and safety of MSAT vs CAT for shoulder pain. Methods: A randomized controlled trial using a factorial design was conducted from January 2014 to December 2015. Patients with a primary complaint of one-sided shoulder pain participated at three study sites. Eligible individuals were randomly assigned to receive MSAT plus minimal CAT (mCAT), CAT plus minimal MSAT (mMSAT), MSAT plus CAT, or mMSAT plus mCAT for 6 weeks in a 1:1:1:1 ratio. The primary outcome was change in shoulder pain intensity (measured using visual analog scale). The secondary outcomes included change in function of the shoulder joint (Constant-Murley score) and the health-related quality of life (Short Form-36 Health Survey). Moreover, perceived credibility of acupuncture was measured using the Treatment Credibility Scale. The outcomes were assessed at baseline and at 6, 10, and 18 weeks after randomization. Analysis of covariance with the baseline score adjustment had been used to determine the primary end point. The between-group differences of MSAT vs mMSAT and CAT vs mCAT were estimated, respectively, after tests of interaction between the two-dimensional interventions. All main analyses followed the intention-to-treat principle. Results: A total of 164 patients completed the study. MSAT was superior to mMSAT in alleviating pain intensity at 10 weeks (P=0.024), and it was maintained for 18 weeks (P=0.013). Statistically significant differences were found when comparing MSAT with mMSAT for improvement in shoulder function (6 weeks, P=0.01; 10 weeks, P=0.006; and 18 weeks, P=0.01), physical health (10 weeks, P=0.023 and 18 weeks, P=0.015), and mental health (18 weeks, P=0.05). No significant differences were found in CAT when compared with mCAT. Conclusion: After 18 weeks of treatment, pain and joint functions are improved more with MSAT than with minimal motion style acupuncture or conventional acupuncture in patients with shoulder pain.

16.
Clin Rehabil ; 32(12): 1666-1675, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30037276

RESUMO

OBJECTIVE:: To evaluate the effectiveness of acupuncture for pain relief and function improvement in patients with knee osteoarthritis and to determine the feasibility of an eight-week acupuncture intervention. DESIGN:: Pilot randomized controlled trial. SETTING:: Three teaching hospitals in China. SUBJECTS:: Patients with knee osteoarthritis (Kellgren grade II or III). INTERVENTIONS:: Patients were randomly assigned to an eight-week (three sessions per week) intervention of either traditional Chinese acupuncture or sham acupuncture. MAIN MEASURES:: The primary outcome was response rate-the proportion of patients achieving score ⩾36% decrease in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function at week 8 compared with baseline. Secondary outcomes included pain, function and quality of life. RESULTS:: Of 42 patients randomized, 36 (85.7%) completed the study. There was no significant difference in response rate between the traditional Chinese acupuncture and control groups: 61.9% (13 of 21) versus 42.9% (9 of 21) achieved score ⩾36% decrease in WOMAC pain and function at week 8 ( P = 0.217). The sum of WOMAC pain and function scores at week 8 was 11.6 (9.1) in the traditional Chinese acupuncture group compared with 16.3 (10.9) in the control group ( P = 0.183). There was no significant difference between groups. Three adverse events were recorded and were classified as mild. CONCLUSION:: It showed that three sessions per week acupuncture intervention of knee osteoarthritis was feasible and safe. No difference was observed between groups due to small sample size. Larger (sample size ⩾ 296) randomized controlled trials of this intervention appear justified.


Assuntos
Terapia por Acupuntura , Osteoartrite do Joelho/terapia , Idoso , China , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Recuperação de Função Fisiológica , Método Simples-Cego , Resultado do Tratamento
17.
Medicine (Baltimore) ; 97(22): e10713, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29851776

RESUMO

Endocrine pancreatic insufficiency secondary to acute pancreatitis (AP) drew increasing attention in the recent years. The aim of the present study was to assess the impact of pancreatic necrosis and organ failure on the risk of developing new-onset diabetes after AP.The follow-up study was conducted for patients recovered from AP in the treatment center of Jinling Hospital. Endocrine function was evaluated by simplified oral glucose tolerance test (OGTT). Pancreatic necrosis was examined by abdominal contrast-enhanced CT (CECT) scan during hospitalization. The data including APACHE II score, Balthazar's score, organ failure (AKI and ARDS) was also collected from the medical record database. All patients were divided into group diabetes mellitus (DM) and group non-DM according to the endocrine function and group pancreatic necrosis (PN) and persistent organ failure (OF), group PN and non-OF, group non-PN and OF, and group non-PN and non-OF according to the occurrence of pancreatic necrosis and persistent organ failure.Around 256 patients were included for the final analysis. 154 patients (60.2%) were diagnosed with DM (include impaired glucose tolerance, IGT), while 102 patients (39.8%) were deemed as normal endocrine function. APACHE II score and Balthazar score of the patients in the group DM were significant higher than those in the non-DM group (F = 6.09, P = .01; F = 10.74, P = .001). The incidence of pancreatic necrosis in group DM and group non-DM was, respectively, 64.7% and 53.0% (χ = 3.506, P = .06). The patients underwent necrosis debridement by percutaneous catheter drainage (PCD) and/or the operative necrosectomy (ON) were more likely to developed new onset DM than the patients without PCD or ON (χ = 2.385, P = .02). The morbidity of new-onset DM after AP gradually increased from group non-PN and non-OF, group non-PN and OF, group PN and non-OF to group PN and OF in order (χ = 4.587, P = .03). The value of HOMA-IR of patients at follow-up time was significant higher in group DM than group non-DM (F = 13.414, P = .000).Patients with both PN and persistent OF may were at increased risk of developing new-onset diabetes after AP. Insulin resistance could be the pivotal mechanism of the development of diabetes.


Assuntos
Diabetes Mellitus/diagnóstico , Insuficiência Pancreática Exócrina/diagnóstico , Pancreatite Necrosante Aguda/complicações , Índice de Gravidade de Doença , APACHE , Doença Aguda , Adulto , China/epidemiologia , Desbridamento/métodos , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Drenagem/métodos , Insuficiência Pancreática Exócrina/complicações , Insuficiência Pancreática Exócrina/etiologia , Feminino , Teste de Tolerância a Glucose/métodos , Humanos , Resistência à Insulina/fisiologia , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pancreatite Necrosante Aguda/diagnóstico por imagem , Pancreatite Necrosante Aguda/patologia , Pancreatite Necrosante Aguda/cirurgia , Risco , Tomógrafos Computadorizados
18.
Rev. Assoc. Med. Bras. (1992) ; 64(5): 454-461, May 2018. graf
Artigo em Inglês | LILACS-Express | ID: biblio-956470

RESUMO

SUMMARY OBJECTIVES To evaluate the epidemiological characteristics of acute pancreatitis (AP) and explore potential relationships between these factors and severity. METHODOLOGY Data-sets of 5,659 patients with AP from health statistics and the Information Center of Jiangsu province, between 2014 and 2016, were analyzed. A self-organizing map (SOM) neural network was used for data clustering. RESULTS Biliary acute pancreatitis (BAP) (86.7%) was the most frequent etiological factor. A total of 804 (14.2%) patients had severe acute pancreatitis (SAP). The mean age of patients was 53.7 + 17.3 (range 12~94y). Most of the AP patients were married (75.4%); 6% of mild /moderately severe AP (MAP/MASP) patients were unmarried, which was less than SAP patients (P=0.016). AP patients with blood type AB in the general population (8.8%) was significantly lower than that of AP cases (13.9%) (P=0.019) and SAP cases(18.7%) (P=0.007). The number of AP patients in southern Jiangsu was much higher than that in northern Jiangsu province, especially in Nanjing (1229, 21.7%). The proportion of acute alcoholic pancreatitis (AAP) in the north of Jiangsu (Xuzhou 18.4%) was much higher than that in southern Jiangsu (Suzhou 2.6%). The whole sample was divided into five classes by SOM neural network. If BAP patients were male, old, divorced, and blood type AB or B, they were more likely to develop SAP. Middle-age, unmarried or divorced male patients with blood type B/AB who suffered from HAP or AAP were also more likely to develop SAP. CONCLUSIONS The number of unmarried patients with MAP/MASP was smaller than that of SAP. Blood types AB and B were more frequent in AP, especially in SAP. The differences between southern Jiangsu and northern Jiangsu, in number of AP patients and the proportion of AAP, were significant. In class I and class IV, the ratio of SAP was much higher than in other classes and the whole sample.

19.
Ann Vasc Surg ; 47: 78-84, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28943487

RESUMO

BACKGROUND: Acute pancreatitis (AP) can induce portosplenomesenteric vein thrombosis (PVT), which may generate higher morbidity and mortality. However current diagnostic modalities for PVT are still controversial. In recent decades, artificial neural networks have been increasingly applied in medical research. The aim of this study is to predict the risk of AP-induced PVT by radial basis function (RBF) artificial neural networks (ANNs) model. METHODS: A retrospective or consecutive study of 426 individuals with AP at our unit between January 1, 2011 and July 31, 2016 was conducted. All individuals were subjected to RBF ANNs. Variables included age, gender, red blood cell specific volume (Hct), prothrombin time (PT), fasting blood glucose, D-Dimer, concentration of serum calcium ([Ca2+]), triglyceride, serum amylase (AMY), acute physiology and chronic health evaluation II score, and Ranson score. All outcomes were derived after subjecting the variables to a statistical analysis. RESULTS: In the RBF ANNs model, D-dimer, AMY, Hct, and PT were the important factors among all 11 independent variables for PVT. The normalized importance of them was 100%, 96.3%, 71.9%, and 68.2%, respectively. The predict sensitivity, specificity, and accuracy by RBF ANNs model for PVT were 76.2%, 92.0%, and 88.1%, respectively. There were significant differences between the RBF ANNs and logistic regression models in these parameters (95% CI: 110.9% [-0.4 to 15.8%]; 8.4% [-3.3 to 19.2%]; and 12.8% [1.6-20.7%], respectively). In addition, the area under receiver operating characteristic curves value for identifying thrombosis when using the RBF ANNs model was 0.892 ± 0.091 (95% CI: 0.805-0.951), demonstrating better overall performance than the logistic regression model (0.762 ± 0.073; 95% CI: 0.662-0.839). CONCLUSIONS: The RBF ANNs model was a valuable tool in predicting the risk of PVT following AP. AMY, D-dimer, PT, and Hct were important prediction factors of approval for AP-induced PVT.


Assuntos
Modelos Teóricos , Pancreatite/complicações , Veia Porta , Medição de Risco/métodos , Trombose Venosa/etiologia , APACHE , Doença Aguda , Adulto , Biomarcadores/análise , Feminino , Testes Hematológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
20.
Am J Surg ; 216(2): 304-309, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-28888465

RESUMO

OBJECT: Acute pancreatitis (AP) keeps as severe medical diagnosis and treatment problem. Early evaluation for severity and risk stratification in patients with AP is very important. Some scoring system such as acute physiology and chronic health evaluation-II (APACHE-II), the computed tomography severity index (CTSI), Ranson's score and the bedside index of severity of AP (BISAP) have been used, nevertheless, there're a few shortcomings in these methods. The aim of this study was to construct a new modeling including intra-abdominal pressure (IAP) and body mass index (BMI) to evaluate the severity in AP. METHODS: The study comprised of two independent cohorts of patients with AP, one set was used to develop modeling from Jinling hospital in the period between January 2013 and October 2016, 1073 patients were included in it; another set was used to validate modeling from the 81st hospital in the period between January 2012 and December 2016, 326 patients were included in it. The association between risk factors and severity of AP were assessed by univariable analysis; multivariable modeling was explored through stepwise selection regression. The change in IAP and BMI were combined to generate a regression equation as the new modeling. Statistical indexes were used to evaluate the value of the prediction in the new modeling. RESULTS: Univariable analysis confirmed change in IAP and BMI to be significantly associated with severity of AP. The predict sensitivity, specificity, positive predictive value, negative predictive value and accuracy by the new modeling for severity of AP were 77.6%, 82.6%, 71.9%, 87.5% and 74.9% respectively in the developing dataset. There were significant differences between the new modeling and other scoring systems in these parameters (P < 0.05). In addition, a comparison of the area under receiver operating characteristic curves of them showed a statistically significant difference (P < 0.05). The same results could be found in the validating dataset. CONCLUSIONS: A new modeling based on IAP and BMI is more likely to predict the severity of AP.


Assuntos
Cavidade Abdominal/fisiopatologia , Índice de Massa Corporal , Pancreatite/diagnóstico , Cavidade Abdominal/diagnóstico por imagem , Doença Aguda , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pancreatite/fisiopatologia , Valor Preditivo dos Testes , Pressão , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia
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