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Prevalence of Cesarean Section at Georgetown Public Hospital Corporation, Guyana: An Institution-Based Cross-Sectional Study
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作者 Gary Joseph Cecil Boston Gbenankpon Mathias Houvessou 《Open Journal of Clinical Diagnostics》 2023年第3期29-47,共19页
The International Healthcare Community recommends that countries do not exceed a 15% rate for cesarean section (CS). Our objective was to determine the prevalence and factors associated with CS at GPHC from July to Se... The International Healthcare Community recommends that countries do not exceed a 15% rate for cesarean section (CS). Our objective was to determine the prevalence and factors associated with CS at GPHC from July to September 2022. Methods: A cross-sectional study was carried out and data were collected from 1296 mothers, who met the inclusion criteria, through face-to-face interviews after obtaining prior informed consent. We performed descriptive analyses both for the outcome and independent variables. Bivariate and multiple logistic regression were used to identify factors associated with CS with a p-value Results: The prevalence of CS at GPHC was 28.9% (95%CI: 26.5-31.5). Factors associated factors with CS were mothers aged 20 to 34 years (AOR: 1.56, 95%CI: 1.02 - 2.39, P = 0.039);mothers who received more than three minimum wages (AOR: 1.95, 95%CI: 1.29 - 2.97, P = 0.002) and who attended prenatal care at both public and private health facilities (AOR: 2.49, 95% CI: 1.19 - 5.22, P = 0.022). Likewise, the highest Odds of CS were observed in mothers with gestational hypertension (AOR: 2.00, 95%CI: 1.35 - 2.96, P Conclusion: The prevalence of CS is higher than the ideal rate recommended by the International Healthcare Community. More studies are needed to understand the reasons for such high prevalence at GPHC. 展开更多
关键词 Cesarean Section Delivery Georgetown Public Hospital Corporation GUYANA
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血液透析患者血清成纤维细胞生长因子21与肌少症的关系及相关机制 被引量:1
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作者 李旻 张培 +4 位作者 王彬 张梦雨 刘舒苏 CROMWELL NIKITA 杨敏 《中华肾脏病杂志》 CAS CSCD 北大核心 2023年第3期188-199,共12页
目的探讨血液透析(hemodialysis, HD)患者血清成纤维细胞生长因子21(fibroblast growth factor 21, FGF21)与肌少症的关系, 并在细胞水平初步探索尿毒症状态下FGF21与骨骼肌代谢相关信号通路的关系。方法该前瞻性观察性研究搜集2018—2... 目的探讨血液透析(hemodialysis, HD)患者血清成纤维细胞生长因子21(fibroblast growth factor 21, FGF21)与肌少症的关系, 并在细胞水平初步探索尿毒症状态下FGF21与骨骼肌代谢相关信号通路的关系。方法该前瞻性观察性研究搜集2018—2019年苏州大学附属第三医院血液净化中心接受HD的患者资料。以ELISA法检测HD患者血清FGF21浓度, 同时根据第四胸椎(the fourth thoracic vertebra, T4)及第一腰椎(the first lumbar vertebra, L1)计算机断层扫描(computed tomography, CT)平面骨骼肌指数(skeletal muscle index, SMI)将患者分为肌少症组及非肌少症组, 分析FGF21与肌少症的关系。体外培养小鼠C2C12成肌细胞, 分别给予健康人血清、健康人血清+不同浓度FGF21、尿毒症血清、尿毒症血清+不同浓度FGF21干预细胞, 并采用Western印迹法检测各组肌肉环指蛋白-1(muscle ring finger protein-1, MURF1)、肌肉萎缩相关的F-box蛋白(muscle atrophy F-box, MAFbx/Atrogin-1)、成肌分化因子(myogenic differentiation, MyoD)、肌细胞生成素(myogenin, MyoG)的表达。结果共有118例HD患者被纳入此项研究, 其中男性64例(54.2%), 女性54例(45.8%), 年龄为(52.64±15.29)岁。118例HD患者有CT T4图像, 根据T4 SMI性别特异性最低四分位数(P25)为截点值分组(男性 < 59.92 cm^(2)/m^(2), 女性 < 46.75 cm^(2)/m^(2)), 肌少症组29例, 非肌少症组89例, 肌少症患者比例高达24.58%。82例患者有L1横断面图像, 根据L1 SMI性别特异性最低四分位数(P25)为截点值分组(男性 < 29.02 cm^(2)/m^(2), 女性 < 24.50 cm^(2)/m^(2)), 肌少症组20例, 非肌少症组62例, 肌少症患者比例高达24.39%。根据T4 SMI分组结果显示, 肌少症组患者血清FGF21水平高于非肌少症组, 但两组间差异无统计学意义[448.52(183.96, 1 684.08)ng/L比273.65(152.83, 535.54)ng/L, Z=-1.741, P=0.082]。根据L1 SMI分组结果显示, 肌少症组患者血清FGF21水平显著高于非肌少症组[460.95(188.91, 1 276.38)ng/L比239.10(133.25, 466.36)ng/L, Z=-2.170, P=0.030]。分别根据T4 SMI及L1 SMI进行分组, 二元Logistic回归分析结果均显示FGF21升高是HD患者发生肌少症的独立影响因素(根据T4 SMI分组:OR=4.085, 95%CI 1.778~9.388, P=0.001;根据L1 SMI分组:OR=7.327, 95%CI 1.841~29.160, P=0.005)。在T4和L1平面, FGF21预测HD患者发生肌少症的受试者工作特征曲线下面积分别为0.636(95%CI 0.494~0.779, P=0.036)和0.684(95%CI 0.535~0.833, P=0.018)。细胞实验结果显示, 在尿毒症血清中给予外源性FGF21干预后, 肌管细胞MURF1、Atrogin-1表达升高, 而MyoD、MyoG表达显著降低(均P < 0.05)。结论 HD患者血清FGF21升高与肌少症风险增加相关。FGF21在尿毒症状态下可能通过调节泛素蛋白酶体系统的表达, 减少骨骼肌细胞蛋白的合成及分化, 导致肌肉萎缩的发生。 展开更多
关键词 肾透析 成纤维细胞生长因子 肌减少症 尿毒症 骨骼 泛素蛋白酶体系统
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