艾滋病母婴阻断抗病毒治疗依从性及相关因素分析

目的探索艾滋病母婴传播阻断抗病毒治疗依从性的主要影响因素,为提高艾滋病母婴传播阻断抗病毒治疗依从性的方法提供依据。积极推广综合防治模式,动员和支持社会组织参与防治工作。方法收集2005~2013年,某县检出艾滋病抗体阳性的孕产妇105例,其中终止妊娠36例,分娩69例,对分娩的艾滋病抗体阳性的69例孕产妇及所生婴儿对艾滋病母婴传播阻断抗病毒治疗的依从性进行调查。结果69例阳性分娩的孕产妇中,抗病毒治疗依从性良好者占97.10%,所生婴儿服药率95.59%。结论艾滋病抗体阳性感染孕产妇母婴阻断抗病毒治疗依从性好坏受多种因素的影响。     

基于大数据技术的糖尿病临床决策支持系统分析与展望

糖尿病是一种慢性非传染性疾病,目前只能通过长期用药和自我管理来缓解病情,无法根治.临床决策支持系统能够模拟糖尿病医疗专家诊断疾病的思维过程,向医生提供常规诊疗方案,推荐最优方案.现有的临床决策支持系统大多基于临床指南、规则、案例推理以及本体.大数据技术可获取和处理多元异构的各类数据,提供更科学的个性化诊疗方案.近年来已有基于决策树、神经网络、模糊逻辑、支持向量机、APRIORI关联规则与多维分析和时序挖掘等多种大数据处理方法应用于糖尿病的临床诊断,但其尚处于起步阶段.对基于大数据技术的糖尿病临床决策支持系统的框架进行了分析,并展望了未来的诊疗方式.     

艾滋病抗病毒治疗48例死亡患者相关因素分析

目的分析本院艾滋病抗病毒治疗死亡患者的相关因素。方法利用国家统一使用的DataFax抗病毒治疗信息系统所收集的数据资料,对抗病毒治疗死亡患者的相关情况进行分析。结果共有315例艾滋病患者接受治疗,有48例抗病毒治疗患者死亡。治疗前所有患者出现艾滋病临床Ⅲ期或Ⅳ期表现,CD4细胞最小值为4个/μl,最大值为263个/μl,平均为36.4个/μl。接受治疗时间最短1d,最长2年半,其中39例的治疗时间小于3个月。死于艾滋病相关性疾病42例,其中9例系统治疗无效死亡,11例治疗过程中出现机会性感染,放弃治疗在家中死亡;22例在停药后0.5～8月出现艾滋病相关疾病死亡。自杀4例,死亡原因不明2例。结论艾滋病抗病毒治疗患者的主要死亡原因是艾滋病相关疾病,依从性困难是患者死亡的另一个原因,经济困难、歧视和药物副作用与病人死亡有直接关系。     

商丘地区艾滋病患者抗病毒药物治疗耐药的危险因素分析

目的:探讨商丘地区艾滋病患者抗病毒药物治疗失败的耐药检测结果,并分析其影响因素.方法:收集2016年3月至2020年3月期间商丘地区艾滋病抗病毒药物治疗失败的患者共382例,对所有患者进行基因型耐药检测结果和耐药危险因素分析.结果:382例治疗失败患者中,总耐药人数为236例,占61.78％.患者的性别、年龄、确诊至开始治疗时间以及人类免疫缺陷病毒(Human immunodeficiency virus,HIV)基因突变均是导致抗病毒药物治疗耐药的主要因素(P<0.05),而婚姻状况、HIV传播途径、CD4+值、治疗方案以及治疗持续时间与耐药无明显相关性(P>0.05).结论:在对艾滋病患者的抗病毒药物治疗过程中,应重点关注40岁以上男性患者从确诊至开始治疗的时间以及基因突变情况,以减少耐药导致的治疗失败.     

广东和云南部分地区艾滋病患者中隐孢子虫感染的调查分析

目的 了解艾滋病患者中隐孢子虫的感染状况.方法 收集广东和云南省部分地区艾滋病患者的粪便,采用改良的抗酸染色法和免疫荧光染色法检测隐孢子虫卵囊;并同时检测患者的CD4细胞计数.结果 212例艾滋病患者粪便标本中9例标本为阳性,感染率为4.25%.广东和云南的艾滋病患者隐孢子虫感染率分别为4.00%(5/126)和4.65%(4/86),两地之间差异无统计学意义(P＞0.05);稀便与软便中的隐孢子虫卵囊检出率分别为12.00%(3/25)和3.21%(6/187),其差异无统计学意义(校正χ2=2.31,P＞0.05);男性与女性艾滋病患者隐孢子虫感染率分别为5.07%(7/138)和2.70%(2/74),其差异无统计学意义(校正χ2=0.21,P＞0.05);50～59岁组隐孢子虫感染率高于30～39岁组的感染率(校正χ2=7.15,P＜0.01);接受抗病毒治疗组与未接受治疗组艾滋病患者隐孢子虫感染率分别为1.12%(2/179)和21.21%(7/33),两者差异有统计学意义(校正χ2=18.54,P=0.0000);艾滋病晚期,尤其是CD4细胞计数少于100个/μl的患者其发病率明显提高.结论 我国南方艾滋病患者中存在着隐孢子虫感染,但发病率明显低于国外报道;艾滋病患者的便形、性别及所处地区不能预示隐孢子虫感染率;抗病毒治疗能降低隐孢子虫病感染率,艾滋病患者的隐孢子虫感染多发生在疾病的终末期.     

健康画像在慢阻肺个性化健康管理系统中的应用研究

目的:旨在探讨个性化健康画像在慢性病健康管理中的应用,以慢性阻塞性肺疾病（COPD）为例,为COPD患者构建健康画像模型,并基于模型开发设计个性化的健康管理系统。方法:以基于知识的标签提取技术结合电子病历数据挖掘构建患者健康画像模型,并在模型基础上,根据COPD全球倡议设计针对COPD的评估方法、药物推荐算法及个性化健康推荐方法,设计开发了基于.NET平台和SQL技术C/S架构的COPD个性化健康管理系统。结果:从患者及疾病两个维度,构建出包含患者个人信息、诊断信息、并发症、用药数据及住院情况的患者群体画像模型,包含患者基本信息、主要临床表现、检查检验结果、诊断记录、治疗记录、疾病相关因素的个性化健康画像模型,并设计开发由患者主导、医生参与、能够全面展示患者群体画像及个性化健康画像并能进行个性化健康评估及推荐的COPD管理系统。结论:患者健康画像模型能为COPD的诊断、评估、治疗、病情监测、疾病预后、管理提供数据支撑。本研究基于COPD患者健康画像开发的健康管理系统从患者个性化需求的角度出发,为COPD稳定期患者提供了一个契合自身特点的实用的健康管理平台。     

艾滋病患者服用抗病毒药物治疗非依从性的原因分析和护理干预对策

目的 分析影响艾滋病患者口服抗病毒药物依从性的相关因素,并找出针对性护理干预对策进行干预.方法 针对性护理干预措施前后,对门诊治疗的389例艾滋病患者抗逆转录病毒高效治疗的服药的依从行为和抗病毒治疗疗效进行问卷调查.结果 389例患者中108例出现非依从性行为,依从性差的原因主要有对抗病毒治疗丧失信心或出现忧郁状态、医学知识缺乏或对药物的认知不清、药物的副作用、社会歧视、自我管理能力差等原因.通过健康教育和护理干预6个月后,与针对性护理干预前比较,患者的非依从性行为发生率（27.8%对5.6%,P＜0.001）和抗病毒治疗疗效即病毒载量达到检测不到水平的比例（24.4%对74.0%,P＜0.001）均得到显著改善.结论 针对性的对患者进行健康教育和护理干预,能显著提高患者的依从性和抗病毒治疗的疗效.     

基于故障树与贝叶斯网络的呼吸机故障智能诊断

为了快速准确地找出呼吸机故障原因,迅速排除故障,恢复设备的正常运行,本文采用基于故障树和贝叶斯网络的 方法对呼吸机常见故障进行分析。首先通过对呼吸机结构原理的综合分析,结合文献案例搭建呼吸机故障树,进行定性 分析;利用贝叶斯网络对呼吸机故障进行定量分析;最后用实际维修案例进行验证。结果表明,该方法得到的推理结果与 实际结果相符性达到84.54%,为建立呼吸机故障静态数据库并进行故障智能诊断提供了理论依据,具有一定的推广 价值。     

艾滋病的个体化用药与药物基因组学研究进展

艾滋病至今仍在全球猖獗,每年新增艾滋病病毒感染者270万.尽管越来越多的患者接受抗病毒治疗,使艾滋病及相关疾病死亡率明显下降,但仍有2500万人死于艾滋病相关疾病[1].增加获得治疗的人数、寻求有效的治疗途径和方案以及提高有效治疗率仍是面临的瓶颈问题.     

基于半监督学习的患者相似性度量研究

目的对数据类型多样的电子病历数据开展基于半监督学习的患者相似性度量研究,评估其可行性和有效性,并为后续个性化研究提供相似患者队列。方法对来自真实世界的电子病历数据,首先特异性计算特征相似性(年龄、性别、疾病、实验室检查),结合专家标注的部分监督信息构成标签集,在标签集中有监督地学习出最优距离度量。然后计算标签集与无标签集数据间的马氏距离,对无标签集中的每个样本,找出与其距离最近的标签集样本,并将其相似性分值作为该无标签样本的患者相似性预测值。最后将学习出的患者相似性作为聚类时评估患者亲疏程度的指标,并与基于传统欧氏距离和余弦距离的聚类结果进行比较。结果较欧氏距离和余弦距离,基于半监督学习出的患者相似性的聚类结果中,患者相似程度更高,聚类效果更好。结论对电子病历数据开展基于半监督学习的患者相似性度量研究是有效的。     

A multi-module case-based biofeedback system for stress treatment

Objective

Biofeedback is today a recognized treatment method for a number of physical and psychological problems. Experienced clinicians often achieve good results in these areas and their success largely builds on many years of experience and often thousands of treated patients. Unfortunately many of the areas where biofeedback is used are very complex, e.g. diagnosis and treatment of stress. Less experienced clinicians may even have difficulties to initially classify the patient correctly. Often there are only a few experts available to assist less experienced clinicians. To reduce this problem we propose a computer-assisted biofeedback system helping in classification, parameter setting and biofeedback training.

Methods

The decision support system (DSS) analysis finger temperature in time series signal where the derivative of temperature in time is calculated to extract the features. The case-based reasoning (CBR) is used in three modules to classify a patient, estimate parameters and biofeedback. In each and every module the CBR approach retrieves most similar cases by comparing a new finger temperature measurement with previously solved measurements. Three different methods are used to calculate similarity between features, they are: modified distance function, similarity matrix and fuzzy similarity.

Results and conclusion

We explore how such a DSS can be designed and validated the approach in the area of stress where the system assists in the classification, parameter setting and finally in the training. In this case study we show that the case based biofeedback system outperforms trainee clinicians based on a case library of cases authorized by an expert.     

Monitoring adherence to the therapy of asthma

Acceptance of current treatment guidelines by physicians and adherence to the recommended clinical regimens by patients are essential for effective asthma therapy. Treatment plans must be based on up-to-date management guidelines and should comprise a strategy for the evaluation and support of patient adherence. Monitoring of adherence with electronic devices enables physicians to base clinical decisions on reliable and objective data. Assessment of prescribing quality should be used to improve treatment of all patients.     

Minnesota Multiphasic Personality Inventory (MMPI) cluster groups among chronically ill patients: Relationship to illness adjustment and treatment outcome

Cluster analysis of the MMPI has been utilized widely in the chronic low back pain literature to try to identify reliable patient subtypes predictive of treatment outcome. We extended this methodology to patients with heterogeneous chronic medical conditions by replicating prototypic MMPI cluster group profiles and by relating cluster groups to clinical baseline and outcome data. Subjects were two independent samples (n=254 and n=263) of chronically ill patients admitted to an inpatient medicine/psychiatry unit. Using a four-cluster solution, similar cluster profile groups were replicated in both samples. Consistent differences emerged between cluster groups on functional impairment, psychiatric diagnoses, depression, and psychosomatic symptoms. Cluster group membership also predicted changes in functional impairment and depression six months after treatment. Results are discussed in terms of similarities between chronic low back pain and chronic illness and tailoring treatment to different patient types.This research was supported in part by a grant from the Henry J. Kaiser Family Foundation.     

不同治疗效果的艾滋病患者抗病毒治疗前HIV-1gp120准种特征差异

目的 探讨HIV-1 gp120准种在不同治疗效果的艾滋病患者抗病毒治疗前的特征差异.方法 回顾性收集治疗方案为AZT+NVP+3TC的艾滋病患者在抗病毒治疗前的血浆样本,包括病毒抑制(VS)组12例,治疗失败(TF)组12例.采用单基因组扩增技术获得gp120准种序列,分析比较遗传多样性、氨基酸长度、潜在糖基化位点及特征性氨基酸的特点.结果 本研究共获得gpl20序列365条序列,其中VS组168条(6-20条),TF组197条(7-28条).TF组的gp120准种复杂度高于VS组,差异有统计学意义(P=0.003);TF组的gp120准种dS及dN中位数均高于VS组(P=0.017;P=0.002).TF组HIV-1准种gpl20氨基酸长度长于VS组(P=0.00l).TF与VS组的gpl20准种相比共有9个氨基酸位点存在明显差异,多数分布在V1/V2区(6/9,66.6％).结论 不同治疗效果的艾滋病患者治疗前的HIV-1 gp120准种基因特征存在差异,TF组患者来源的HIV-1准种遗传多样性更高.     

Public health consequences of screening patients for adherence to highly active antiretroviral therapy

Improvements in HIV antiretroviral therapy (ART) have been accompanied by increasing recognition of the importance of adherence to treatment regimens for maximizing patient benefits while minimizing the emergence of drug-resistant virus. Whether clinicians should screen patients for adherence and only administer therapy to those believed likely to adhere has not been resolved. We first examine the implications of data drawn from a recent study reporting physicians' ability to predict whether patients will adhere to highly active antiretroviral therapy (HAART) or not. We then extend previously developed mathematical models of ART to include screening for adherence and focus on resulting drug resistance as well as on HIV and AIDS incidence at the population level. We show that although screening for adherence is likely to reduce the level of drug resistance compared with a policy of treating all HIV patients with HAART, rates of new HIV infections and AIDS cases in the population would likely increase unless screening accuracy is extremely (perhaps implausibly) high.     

Comparison of Mycobacterium avium isolates from Greek AIDS and human immunodeficiency virus-negative patients by pulsed-field gel electrophoresis

Objective To compare the chromosomal types of Mycobacterium avium strains infecting HIV-negative and AIDS patients in Greece.
Methods In total, 41 Mycobacterium avium isolates, 23 from AIDS and 18 from HIV-negative patients, were compared by pulsed-field gel electrophoresis of genomic DNA after Xba I digestion. The majority (87%) of AIDS isolates were from disseminated infection, while the majority (61%) of HIV-negative isolates were from children with cervical lymphadenitis.
Results   Pulsed-field gel electrophoresis classified strains whose electrophoretic patterns were at least 85% similar into three clusters, A (four isolates), B (12 isolates), and C (15), while 10 isolates remained outside of these clusters. There was no statistically significant correlation of any PFGE cluster with a specific patient group. Within each patient group, no significant correlation of PFGE type with time, place of residence or, in the case of AIDS patients, hospital attended was observed.
Conclusions   Genotypic similarities between isolates responsible for disseminated infection in AIDS patients and lymphadenitis in HIV-negative children suggest that related strains, possibly from an environmental source, cause both types of infections.