We determined the standardized mortality ratio (SMR) in our anorexia nervosa (AN) patient population.We used a cross-sectional design to study an inception cohort (1981-2000) drawn from the provincial tertiary care eating disorders program at St. Paul's Hospital (British Columbia, Canada). All patients who completed their initial assessment for an eating disorder were included in the study. Vital status, date and cause of death from British Columbia Vital Statistics Agency, date of assessment, date of birth, and diagnosis at the time of assessment were collected for each patient.Of 954 patients, 326 diagnosed with AN completed an assessment over the 20 years. The SMR was 10.5 (95% confidence interval [CI] = 5.5-15.5) for AN.Some studies in the literature report that AN has the highest mortality rate of any psychiatric disorder in young females. However, others dispute this fact and report an SMR lower than the normal population mortality (SMR = 0.71). Contrary to some reports in the literature, our study confirms a high mortality rate within the AN population.
Epilepsy and sleep are closely related, which is a hot research at home and abroad, the two of them influence each other.Sleep deprivation and sleep status can induce epilepticseizures; Epileptic seizures can lead to sleep disorders.We reviewed the interaction between epilepsy and sleep and the effects of antiepileptic drugs on sleep, which provide a new theoretical basis for improving sleep and improving the quality of life in patients with epilepsy and has important value to improve the level of prevention and treatment of epilepsy.
Key words:
Epilepsy; Sleep; Anti epileptic drugs
Abstract Aim This study aimed to synthesize qualitative evidence on experiences of patients with atrial fibrillation (AF) during the course of diagnosis and treatment. We addressed three main questions: (a) What were the experiences of patients with AF during the course of diagnosis and treatment? (b) How did they respond to and cope with the disease? (c) What were the requirements during disease management? Design In this study, qualitative evidence synthesis was performed using the Thomas and Harden method. Data Sources Electronic databases, including PubMed, the Cochrane Library, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the China Biomedical Database, the WanFang Database, Chinese National Knowledge Infrastructure and VIP, were searched. The databases were searched from inception to August 2021. Review Methods Two researchers independently selected studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis. Results A total of 2627 studies were identified in the initial search and 15 studies were included. Five analytical themes were generated: ‘Diagnosing AF’; ‘The impact of AF on the patients’; ‘Self‐reorientation in the therapeutic process’; ‘Living with AF and QoL’; and ‘External support to facilitate coping strategies.’ Conclusions Our findings point out unique experiences of patients across the trajectory of AF related to delayed diagnosis, feelings of nonsupport, disappointment of repeated treatment failure and multiple distress associated with unpredictable symptoms. Future research and clinical practice are expected to improve the quality of medical diagnosis and treatment, optimize administrative strategy and provide diverse health support for patients with AF. Impact Understanding the experiences and needs of patients with AF in the entire disease process will inform future clinical practice in AF integrated management, which would be helpful in improving the professionalism and confidence of healthcare providers. In addition, our findings have implications for improving the effectiveness of AF diagnostic and treatment services. Patient or Public Contribution This paper presents a review of previous studies and did not involve patients or the public.
To investigate the effect of recombinant human thrombogenin (rhTPO) on sepsis-associated thrombocytopenia.A prospective randomized controlled study was conducted. One hundred patients with sepsis-associated thrombocytopenia admitted to the department of critical care medicine of the First Affiliated Hospital of Zhengzhou University from August 2019 to October 2020 were enrolled. The enrolled patients were divided into rhTPO-using group (TPO group) and routine group (control group) by random number table method, with 50 cases in each group. Both groups were treated according to the guideline of Sepsis-3. In addition, TPO group received rhTPO 15 000 U, once daily for 7 days. Geneal information and acute physiology and chronic health evaluation II (APACHE II) were recorded. The levels of platelet count (PLT), blood coagulation function [prothrombin time (PT) and prothrombin activity (PTA)], myocardial enzyme indexes [troponin (Tn) and creatine kinase (CK)], liver and kidney function [aspartate aminotransferase (AST), total bilirubin (TBil) and creatinine (Cr)] and inflammatory biomarkers [procalcitonin (PCT) and C-reactive protein (CRP)] were recorded before treatment and 1, 3, 5 and 7 days after treatment. The infusion volume of blood components, duration of mechanical ventilation, length of stay in ICU, total length of hospitalization, total cost of hospitalization and 28-day outcome were recorded. According to whether the PLT was lower than 50×109/L, the patients in TPO group were divided into the TPO A group (PLT ≥ 50×109/L, 16 cases) and TPO B group (PLT < 50×109/L, 34 cases), and the absolute value of PLT increase, duration of mechanical ventilation, length of stay in ICU, total length of hospitalization, total cost of hospitalization and 28-day outcome of the two groups were compared.(1) In TPO and control groups, there were no statistically significant differences in gender, age, proportion of patients with primary infection site, APACHEII score, PLT, coagulation function, myocardial enzymes, liver and kidney function and inflammation indexes before treatment (all P > 0.05). (2) The PLT levels of the TPO group were significantly higher than those of the control group on the 5th and 7th day after treatment (×109/L: day 5, 63.94±44.01 vs. 49.85±29.26, day 7, 125.85±112.31 vs. 76.81±50.87, both P < 0.05), and there were no statistically significant differences in PT, PTA, Tn, CK, AST, TBil, Cr, PCT or CRP before and on the 1, 3, 5, 7 days after treatment between TPO and control groups (all P > 0.05). (3) The amount of platelet transfusion in the TPO group was lower than that in the control group [treatment amount: 0 (0, 0) vs 0 (0, 2.00), P = 0.001]. (4) There were no statistically significant differences in mechanical ventilation time, length of stay in ICU, total length of hospitalization, total cost of hospitalization or 28-day outcome between TPO and control groups (all P > 0.05). The mechanical ventilation time, ICU stay time and total hospitalization time of TPO A group were longer than those in TPO B group, but the differences were not statistically significant [mechanical ventilation time (hours): 131.00 (0, 311.00) vs. 50.00 (0, 192.00), ICU stay time (days): 14.44±8.57 vs. 11.73±9.24, total hospitalization time (days): 15.00 (6.00, 23.50) vs. 18.00 (8.00, 31.00), all P > 0.05]. The absolute value of PLT increase in TPO A group was higher than that of TPO B group, but the difference was not statistically significant [×109/L: 65.00 (16.50, 131.50) vs. 36.00 (18.00, 130.00), P > 0.05].RhTPO can significantly increase the PLT of patients with sepsis-related thrombocytopenia, thereby reduce the amount of platelet transfusion, but it cannot shorten the length of ICU stay time and total hospitalization time, and it cannot reduce 28-day mortality.
Abstract: One-to-one atrioventricular conduction (AVC) during atrial flutter (AFL) is one of the most life-threatening arrhythmias and hemodynamically perilous. We present the diagnostic and analytical strategy for a patient who developed a paroxysm of AFL with 1:1 AVC. We did Brugada’s stepwise approach and the ventricular tachycardia (VT) score for the diagnosis. Meanwhile, we did RS/QRS ratio in lead V6. Through observations of the dynamic changes during and after amiodarone treatment, we made the diagnosis. Firstly, we calculated the VT score, and the result showed score 1. Secondly, we made Brugada’s stepwise approach to exclude VT. Meanwhile, we did RS/QRS ratio in lead V6, and the result showed the rate of 0.369 (<0.41, cut off 0.41). The result also suggested that the wide QRS AV tachycardia was not VT. Finally, amiodarone was administered under the guidance of a cardiovascular physician. Through observations of the dynamic changes during and after amiodarone treatment, the electrocardiogram (ECG) showed AFL with 2:1 AVC. The AFL rate was the same as the rate of rapid arrhythmia attack. Retrospectively, the rapid arrhythmia ECG was diagnosed as AFL with 1:1 rapid wide QRS AVC. AFL with 1:1 AVC is an uncommon but challenging arrhythmia. Brugada’s stepwise approach and the VT score can assist clinical physicians in making the diagnosis. In our study, we also verify that the RS/QRS ratio in lead V6 is beneficial to differentiate supraventricular tachycardia (SVT) with a right bundle branch block (RBBB) pattern from VT. Through observation of the changes of ECG before and after amiodarone, we can make the diagnosis. One should be conscious of the different presentations of AFL with 1:1 wide QRS AVC to avoid misdiagnosis and mismanagement.
Purpose To evaluate the feasibility of T 1 rho mapping in myocardium at 3T and to determine whether T 1 rho mapping could better characterize myocardial injury in end‐stage renal disease (ESRD) patients compared to T 1 and T 2 mapping. Materials and Methods T 1 rho mapping, T 1 mapping, and T 2 mapping were performed at 3T on 35 healthy volunteers (15 males, 20 females, 40.7 ± 13.6 years) and 32 ESRD patients (16 males, 16 females, 48.6 ± 11.9 years). The mean T 1 rho, T 1 , and T 2 values were compared using Student's t ‐test and correlated with cardiac function parameters, including peak ejection rate (PER), short‐axis percent thickening (SAPT), peak filling rate (PFR), and time to peak filling (TTPF). Results The mean T 1 rho values (49.4 ± 2.6 msec vs. 52.2 ± 4.0 msec, P = 0.001) and T 2 values (50.5 ± 2.5 msec vs. 54.1 ± 4.0 msec, P < 0.001) were significantly different between the volunteers and patients, but there were no significant differences between the two groups in the T 1 values (1253.1 ± 71.6 msec vs. 1273.4 ± 41.7 msec, P = 0.157). The mean T 1 rho values were negatively correlated with the PER ( r = –0.397; P = 0.03), SAPT ( r = –0.688; P < 0.001), and PFR ( r = –0.537; P = 0.002), whereas positively correlated with the TTPF ( r = 0.677; P < 0.001). The mean T 2 values were negatively correlated only with the SAPT ( r = –0.427; P = 0.019) in the ESRD patients. Conclusion T 1 rho mapping of the myocardium is feasible at 3T. T 1 rho values are higher in ESRD patients and relate to cardiac function, which may better characterize myocardial injury than can T 1 and T 2 . J. Magn. Reson. Imaging 2016;44:723–731.
Chronic kidney disease-mineral and bone disorder (CKD-MBD) is one of the most complicated morbidities among patients with end-stage renal disease. At present, a specific questionnaire assessing relevant knowledge and behavior for patients with CKD-MBD is still unavailable.To develop and evaluate a valid and reliable questionnaire specific to patients with CKD-MBD.Both quantitative and qualitative analyses were combined to develop and estimate the CKD-MBD knowledge and behavior (CKD-MBD-KB) questionnaire. Three hundred thirteen and 295 patients, respectively, participated in the investigation during the period from November 2013∼October 2014. Reliability and validity testing were conducted to analyze the psychometric properties of questionnaire.The final version of the CKD-MBD-KB questionnaire encompasses two domains, five facets, and 50 items. Reliability analysis showed that the Cronbach alpha of the five facets ranged from 0.578 to 0.854. Retest correlation coefficients of the five facets ranged from 0.825 to 0.944. Nine common factors were extracted from exploratory factor analysis that interpreted the cumulative variation of 64.1%, and factor loadings of all items were greater than 0.4. The results of confirmatory factor analysis indicated that the model had a satisfactory goodness of fit; the root mean square error of approximation = 0.070. Meanwhile, a significant correlation was found between each item and its facet.This CKD-MBD-KB questionnaire has been confirmed to have adequate psychometric properties (good reliability and validity) and may be useful in the assessment of patient-related knowledge, intervention programs, and treatment protocols.
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