Distinct molecular targets of ProEGCG from EGCG and superior inhibition of angiogenesis signaling pathways for treatment of endometriosis

Endometriosis is a common chronic gynecological disease with endometrial cell implantation outside the uterus.Angiogenesis is a major pathophysiology in endometriosis.Our previous studies have demonstrated that the prodrug of epigallocatechin gallate(ProEGCG)exhibits superior anti-endometriotic and anti-angiogenic effects compared to epigallocatechin gallate(EGCG).However,their direct binding targets and underlying mechanisms for the differential effects remain unknown.In this study,we demonstrated that oral ProEGCG can be effective in preventing and treating endometriosis.Additionally,1D and 2D Proteome Integral Solubility Alteration assay-based chemical proteomics identified metadherin(MTDH)and PX domain containing serine/threonine kinase-like(PXK)as novel binding targets of EGCG and ProEGCG,respectively.Computational simulation and BioLayer interferometry were used to confirm their binding affinity.Our results showed that MTDH-EGCG inhibited protein kinase B(Akt)-mediated angiogenesis,while PXK-ProEGCG inhibited epidermal growth factor(EGF)-mediated angiogenesis via the EGF/hypoxia-inducible factor(HIF-1a)/vascular endothelial growth factor(VEGF)pathway.In vitro and in vivo knockdown assays and microvascular network imaging further confirmed the involvement of these signaling pathways.Moreover,our study demonstrated that ProEGCG has superior therapeutic effects than EGCG by targeting distinct signal transduction pathways and may act as a novel antiangiogenic therapy for endometriosis.

Endometriosis beyond the Pelvis: A Case Series of Cutaneous Endometriosis and Literature Review

Introduction: Cutaneous endometriosis is an uncommon but well-known skin disorder that represents about 0.5% to 1% of all endometriosis. The objective of this case series is to report clinical presentation, diagnosis, and management of various forms of cutaneous endometriosis. Material and Methods: It was an observational, retrospective and descriptive review of cases presenting with cutaneous endometriosis among Cameroonian women managed at the gynaecological outpatient department of Yaounde Gynaeco-Obstetric and Pediatric Hospital. All the following parameters were analysed: age, parity, previous pelvic surgery, presenting symptoms and duration, associated symptoms, localizations, imaging, size of the lesion, other localization of endometriosis, management and histopathological results. Results: we reported 4 cases of cutaneous endometriosis, with 3 umbilical endometriosis and 1 abdominal scar endometriosis. Patient age ranged from 28 to 39 years with an average of 33 years. All patients described infertility (two primary and two secondary) and two had a history of abdominal surgery. All patients presented local cyclical signs such as pain, swelling, color change and bleeding. The duration of symptoms varied from 2 to 3 years and the size of lesions ranged from 2 to 3.5 cm for umbilical lesions and was 9 cm for abdominal scar endometriosis. In all cases, no imaging was required for the diagnosis, which was suspected on the basis of patient’s history and the cyclical nature of local signs, followed by wide surgical excision and confirmation on histopathology. Conclusion: Cutaneaous endometriosis is a rare benign condition. Umbilical endometriosis seems to be the main cutaneous localization and can be described as primary or secondary. Even if its diagnosis must be confirmed by histopathology, it should be considered in patient with cutaneous cyclic signs such as pain, swelling or bleeding with or without history of abdominal surgery.

Can Tibetan medicine Honghua Ruyi pills relieve endometriosisassociated dysmenorrhea?Protocol for a randomized placebocontrolled trial

Objective:To provide high-quality clinical evidence of the efficacy of Tibetan medicine Honghua Ruyi(HHRY)pills for endometriosis-associated dysmenorrhea.Methods:This study constitutes a multicenter,randomized,double-blind,placebo-controlled trial encompassing a three-menstrual cycle intervention followed by a three-menstrual cycle follow-up period.A total of 164 eligible females with endometriosis-associated dysmenorrhea were randomly divided into HHRY pills and placebo groups in a 1:1 ratio.The primary outcome included dysmenorrhea symptoms assessed using Visual Analog Scale(VAS)scores and quality of life,whereas the secondary outcome measures included the maximum VAS for non-menstrual pelvic pain,duration of pain episodes(in days),frequency and quantity of the consumption of ibuprofen sustained-release capsules(or other non-steroidal anti-inflammatory drugs),and days off work/study for staff/student due to dysmenorrhea,ovarian cyst,and/or pelvic nodule size.The safety was monitored throughout the treatment period.All the analyses were based on the intention-to-treat principle.For continuous outcomes,simple or multiple linear regressions were used to estimate the differences between the HHRY pills and placebo groups,with categorical data expressed as the number and percentage of occurrences.Differences were compared using the chi-square test or Fisher's exact test.The predefined analysis was adjusted for concomitant treatment,a variable considered to be associated with outcomes but unaffected by treatment allocation.Estimates of treatment effects were reported with 95%confidence intervals.Two-tailed P values≤.05 were considered statistically significant.Conclusion:Positive results from this trial,upon completion would provide robust evidence for the efficacy and safety of HHRY pills in treating dysmenorrhea in patients with endometriosis.

Immune pathway through endometriosis to ovarian cancer

Endometriosis is an estrogen-dependent inflammatory disease,defined by the presence of functional endometrial tissue outside of the uterine cavity.This disease is one of the main gynecological diseases,affecting around 10%-15%women and girls of reproductive age,being a common gynecologic disorder.Although endometriosis is a benign disease,it shares several characteristics with invasive cancer.Studies support that it has been linked with an increased chance of developing endometrial ovarian cancer,representing an earlier stage of neoplastic processes.This is particularly true for women with clear cell carcinoma,low-grade serous carcinoma and endometrioid.However,the carcinogenic pathways between both pathologies remain poorly understood.Current studies suggest a connection between endometriosis and endometriosis-associated ovarian cancers(EAOCs)via pathways associated with oxidative stress,inflammation,and hyperestrogenism.This article aims to review current data on the molecular events linked to the development of EAOCs from endometriosis,specifically focusing on the complex relationship between the immune response to endometriosis and cancer,including the molecular mechanisms and their ramifications.Examining recent developments in immunotherapy and their potential to boost the effectiveness of future treatments.

Hupo powder promotes autophagy of menstrual blood-derived stem cells from patients with endometriosis

Objective:To explore the effect of Hupo powder(HP)on autophagy in menstrual blood-derived stem cells(MenSCs)with endometriosis(EMT).Methods:EMT MenSCs(E-MenSCs)and healthy MenSCs(H-MenSCs)were isolated from the menstrual blood of patients with EMT and healthy female participants,respectively.We identified their stem cells’characteristics via adipogenic and osteogenic differentiation.Twelve male SpragueeDawley rats received 0.9% NaCl and HP-dispensing granules by gastric irrigation to prepare blank serum and medicated serum,respectively.We used serum concentrations of 5%,10%,and 20%,each at administered times of 12,24,and 48 h to select the best condition.These cells were divided into three groups:blank serum of the control group,blank serum of the model group,and medicated serum of the HP group.H-MenSCs were used in the control group,while E-MenSCs were used in the model and HP groups.We analyzed cell viability using a cell counting kit-8 assay,observed cell morphology,evaluated the amounts of auto-phagosomes and autolysosomes by transmission electron microscopy,and detected the protein expression of autophagy markers(LC3-II and Beclin1)by Western blot.Results:E-MenSCs and H-MenSCs became long fusiform with a diffuse radial pattern,forming lipid droplets and calcium nodules after adipogenic and osteogenic differentiation.We then used the best conditiond 20% serum and 48 hdfor the subsequent experiments.In contrast to the model group,the HP group exhibited lower cell viability(=0.007),larger amounts of autophagosomes and autolysosomes(P<0.001 and P=0.001,respectively),and higher expression of LC3-II and Beclin1(P=0.021 and P=0.019,respectively).Conclusion:Hupo powder can promote autophagy in E-MenSCs,which might be one of the mechanisms underlying its therapeutic effects.

Difficulties Faced by Physicians in the Diagnosis of Endometriosis in the Brazilian Public Health System

Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age, 50% to 60% of adolescents and adults with pelvic pain, and up to 50% of women with infertility are pregnant from the condition. However, this proportion tends to be even greater due to the difficulty in diagnosing it: because it presents different symptoms, lack of information from health professionals, and a high-cost diagnostic test. Another aggravating factor is the average time from the onset of symptoms to the medical diagnosis, which even today ranges from five to ten years;this delay has consequences for disease progression, as it prevents early treatment, which is important for improving pain levels and physical and psychological well-being. Aware of these mishaps, it is therefore important to assess the difficulties faced by doctors in the diagnosis of endometriosis in the public health system, in Brazil, the Unified Health System (SUS). With this purpose, a cross sectional was carried out, developed in the virtual environment using traffic in Google forms, with the difficulties quantified in the Likert scale. Participating physicians pointed out a medium difficulty for patients with endometriosis to access the consultation (58%) and moderate difficulty (52%) to perform an ultrasound examination;also signaled great difficulty in performing magnetic resonance imaging (77%) and laparotomy (61%) in these patients. It is hoped that knowledge about the difficulties faced by physicians in the diagnosis of endometriosis in the SUS will give these physicians a voice and corroborate, even if minimally, so that there is more research that provokes the search for these difficulties, in order to improving the quality of life of these women.

Identification of EML4 as a key hub gene for endometriosis and its molecular mechanism and potential drug prediction based on the GEO database

Objective:Key genes were screened to analyze molecular mechanisms and their drug targets of endometriosis by applying a bioinformatics approach.Methods:Gene expression profiles of endometriosis and healthy controls were obtained from the Gene Expression Omnibus database.Significant differentially expressed genes were screened using the limma package.Correlation pathways were screened by Spearman correlation analysis on the echinoderm microtubule-associated protein-like 4(EML4)and enrichment in endometriosis pathways and estimated by the GSVA package.Immune characteristics were assessed by the“ESTIMATE”R package.Potential regulatory pathways were determined by enrichment analysis.The SWISS-MODE website was used in homology modeling with EML4 and EML4 protein activity was predicted.VarElect was employed in molecular docking for screening potential compound inhibitors targeting endometriosis.Results:Ten endometriosis and 10 normal samples were included.EML4 was significantly upregulated in endometriosis(p<0.05).Thirty significantly correlated pathways involving 18 positive and 12 negative correlations,including GLYCOSAMINOGLYCAN_BIOSYNTHESIS_HEPARAN_SULFATE and GLYCOSPHINGOLIPID_BIOSYNTHESIS_GANGLIO_SERIES were screened between EML4 and endometriosis.Immunocorrelation analysis showed a significant difference in immune-related pathways in endometriosis and normal samples(p<0.05).In endometriosis,EML4 was associated with T-cell CD4 resting memory,activated mast cells,plasma cells,activated NK cells,M2 macrophages,and follicular helper T cells(p<0.05).Molecular docking identified five potential inhibitors of EML4,and compound DB05104(asimadoline)bound well to EML4 protein to exert its physiological effects.Conclusion:Differential gene expression and immune correlation analyses revealed that EML4 may affect endometriosis through multiple targets and pathways,the mechanism of which involved immune cell activation and infiltration.Molecular docking and dynamics simulation verified DB05104 as a potential inhibitor of EML4 and a powerful target for endometriosis treatment.

Epidemiological Profile and Location of Lesions According to #ENZIAN of Patients Operated on for Endometriosis in a Public Endoscopic Surgery Centre, Yaounde, Cameroon

Introduction: Endometriosis is a chronic disease affecting approximately 10% of women. Our aim was to describe the epidemiological profile, clinical presentation and location of lesions in patients operated on for endometriosis. Methodology: We conducted an analytical cross-sectional study with retrospective data collection over a period of 05 years from 1 January 2017 to 31 March 2022. Our study population consisted of women who had undergone laparoscopy for endometriosis. Data analysis was performed using SPSS software version 23.0. Results: In total we included 159 patients who had undergone laparoscopy for endometriosis. The mean age was 32.9 ± 5.9 years, most of whom were nuligravida 61.6% (n = 99). Infertility was the most frequent reason for consultation, accounting for 72.3% (n = 115), followed by dysmenorrhoea in 60.8% (n = 96) of cases and chronic pelvic pain in 37.7% (n = 60). In addition, 46 (28.9%) patients complained of deep dyspareunia, 17 (10.7%) of dyschezia and nine (5.7%) of dysuria. Magnetic Resonance Imaging (MRI) was used in one patient. Diagnostic laparoscopy was performed directly in 77 (48.4%) patients. The lesions were multifocal, according to the #ENZIAN classification nomenclature. Tubal lesions were most frequently found 107 (67.3%) on the left, followed by compartment B (uterosacral ligaments, cardinal ligaments and lateral pelvic wall) 49.7% (n = 79), and endometriomas 40.9% (n = 65). Conclusion: Women operated on for endometriosis were of a more advanced age, and predominantly nulliparous. Infertility was the most frequent reason for consultation and tubal location most frequently encountered for superficial lesions and compartiment B for deep lesions according to #ENZIA.

Exploring the potential molecular mechanism of JinlingziSan in the treatment of endometriosis based on network pharmacology system

Background:Chinese herbal medicines have been proven to be effective in clinical treatment and disease prevention.Jinlingzi San is a herbal medicine used for the treatment of endometriosis.However,a comprehensive network pharmacology approach has not been used to understand the active ingredients and therapeutic mechanisms behind Jinlingzi San in the treatment of endometriosis.Methods:A network pharmacology approach and a molecular docking approach were used to predict the active ingredients and potential targets of Jinlingzi San in the treatment of endometriosis.Results:The integrated network pharmacology approach successfully identified 60 active ingredients and 540 key targets of action in Jinlingzi San dispersion.Among them,STAT3,TP53,MAPK3,RELA,MAPK1,JUN and other key genes were mainly regulated through pathways in cancer,lipid and atherosclerosis,AGE-RAGE signaling pathway in diabetic complications,pancreatic cancer,prostate cancer,PI3K-Akt signaling pathway,Th17 cell differentiation,and other signaling pathways in the cell body,receptor complexes,cytoplasm,nucleoplasm,and plasma membrane.Conclusion:Based on a systems network pharmacology approach,our work successfully predicts the active components and potential targets of Jinlingzi San for the treatment of endometriosis and helps to illustrate the mechanism of action at an integrative level.This demonstrates that Jinlingzi San for the treatment of endometriosis is regulated through a multi-component,multi-target,multi-system co-regulation.This study identifies key genes and pathways associated with endometriosis and pathogenesis from new insights,and also provides a viable approach to the chemical basis and pharmacological studies of Jinlingzi San.

基于EM-KF算法的微地震信号去噪方法

针对微地震信号能量较弱,噪声较强,使微地震弱信号难以提取问题,提出了一种基于EM-KF(Expectation Maximization Kalman Filter)的微地震信号去噪方法。通过建立一个符合微地震信号规律的状态空间模型,并利用EM(Expectation Maximization)算法获取卡尔曼滤波的参数最优解,结合卡尔曼滤波,可以有效地提升微地震信号的信噪比,同时保留有效信号。通过合成和真实数据实验结果表明,与传统的小波滤波和卡尔曼滤波相比,该方法具有更高的效率和更好的精度。

甲基磺酸乙酯(EMS)对谷子种子及幼苗活力的影响

为了探明甲基磺酸乙酯(EMS)诱变嫩选18种子构建突变体库的最适条件,加快品种选育进程,本研究对嫩选18种子进行了3种处理时间、3种EMS处理浓度的化学诱导,并对M1种子发芽及幼苗生长的诱变效应进行研究。结果表明:与对照相比,EMS处理在浓度0.4%下浸种6 h对嫩选18的发芽率及幼苗生长影响差异不显著,随着EMS浸种浓度、时间增加,种子萌发及幼苗生长逐渐受到抑制,在1.2%浓度下浸种14 h对种子萌发及幼苗生长抑制作用最强,极大降低了嫩选18的发芽势、发芽率、成苗率,并且导致幼苗生长缓慢。以存活率达到50%为标准,通过回归方程计算出在6 h、10 h、14 h浸种时间下,EMS浓度的半致死剂量分别为0.99%、0.72%、0.38%,可作为嫩选18 EMS诱变建立突变体库的适合条件。

双边定时截尾下Pareto分布的参数的极大似然估计的EM算法

给出了当寿命分布为Pareto分布时,双边定时截尾寿命试验下形状参数的极大似然估计。由于似然方程形式较复杂,无法得到参数的显式表达式。但可证明此极大似然估计是唯一存在的,并利用EM算法求出了此参数的一种估计。

EM菌发酵兔粪浸出液对小球藻生长及生化成分的影响

研究了EM厨余堆肥菌发酵处理的兔粪浸出液对小球藻(Chlorella vulgaris)的生长及蛋白质、可溶性糖、叶绿素等生化成分的影响。结果表明,兔粪浸出液处理组中,7%浓度组小球藻在第12天时达到最大现存量,为1.06×10^(7)个/mL,而对照组最大现存量只有6.45×10^(6)个/mL;7%浓度组的小球藻与对照组相比生长差异表现明显。5%、7%浓度组在第8天时其藻细胞密度已接近对照组的最大现存量,分别为6.02×10^(6)个/mL和6.80×10^(6)个/mL,表明适宜浓度的兔粪浸出液处理对小球藻的生长有刺激作用。低浓度组中3%浓度组的小球藻生长不理想,但蛋白质积累最高,含量达到17.31 mg/L,与对照组相比差异显著(P<0.05)。6%浓度组的可溶性糖含量最高,为332.7 mg/L,其叶绿素a、叶绿素b和类胡萝卜素含量分别为3.19、1.58 mg/L和0.57 mg/L,与对照组相比差异显著。

不同EMS处理时间对大豆诱变后代主要品质含量变化影响分析

为探究不同EMS处理时间对大豆诱变后代主要品质含量变化的影响,文章利用0.5%EMS溶液处理大豆高蛋白品系公交1057-1,分别浸泡4、7和10 h(清水冲洗处理为对照),对播种后获得的连续4代诱变后代主要品质含量变化进行分析。结果表明,与对照相较,经EMS处理后的植株成活率随处理时间延长而降低。其中,经EMS-4处理后的植株成活率最高,为43.5%;经EMS-10处理后的植株成活率最低,仅为16.0%。不同EMS处理时间对大豆诱变后代的蛋白质含量影响显著,对脂肪含量影响不明显。其中经EMS-4处理的诱变后代蛋白质含量高于其他3组处理;经EMS-4处理后的M2代蛋白质含量发生显著分离,并出现超亲个体,脂肪含量变化不显著。

膈下逐瘀汤抑制NOD1/RIP2/NF-κB通路调控EMT大鼠卵巢功能影响病灶修复的机制

目的:分析膈下逐瘀汤抑制NOD1(含核苷酸结合寡聚化域蛋白1)/RIP2(受体相互作用蛋白2)/NF-κB(核因子κB)信号通路继而调控气滞血瘀型子宫内膜异位症(EMT)模型大鼠卵巢功能,并最终影响病灶修复的可能机制。方法:将6只正常大鼠和30只成功造模的气滞血瘀型EMT大鼠进行分组:空白组、模型组、西药干预组,以及中药低、中、高剂量组,连续干预14 d,比较各组大鼠干预后信号通路指标、卵巢功能指标的差异。结果:与空白组相比,气滞血瘀型EMT造模大鼠的NOD1、RIP2、NF-κB均有增加,雌二醇(E2)、促黄体生成素(LH)对应增加、卵泡刺激素(FSH)降低(p<0.05)。与模型组相比,无论西药还是中药干预,NOD1、RIP2、NF-κB均下降,E2和LH对应下降、FSH增加(p<0.05)。中药组随着使用剂量的增加,NOD1、RIP2、NF-κB均有下降,E2和LH对应下降、FSH增加(p<0.05)。结论:膈下逐瘀汤能通过抑制NOD1/RIP2/NF-κB信号通路而导致E2和LH激素下降、FSH激素升高,且随着用药剂量增加,疗效相应增强。

达乌里胡枝子愈伤组织及种子EMS诱变研究

为优化达乌里胡枝子愈伤诱导培养基的激素含量及比例,明确甲基磺酸乙酯(EMS)诱变愈伤组织及种子的最佳条件,本研究以达乌里胡枝子种子为外植体,探究了不同激素配比对愈伤诱导的影响,并针对愈伤组织和种子处理分别设置了两时间两浓度(2 h和6 h,0.3%和0.9%)及三时间两浓度(6 h、8 h、10 h,0.4%、0.8%)的EMS处理时间和浓度的组合,研究各处理对愈伤分化系数和后期植株成活率以及种子发芽率、发芽势和幼苗表型变异的影响。结果表明,达乌里胡枝子种子愈伤的最佳激素配比为0.25 mg/L NAA+0.5 mg/L 6-BA+0.5 mg/L 2,4-D,此时达乌里胡枝子愈伤诱导率为94.9%。EMS诱变达乌里胡枝子愈伤组织的适宜浓度为0.3%,处理时间为6 h,分化系数和植株相对成活率分别为46.31%和47.78%,接近半致死范围,且生根数、根长和平均株高等指标与高浓度EMS处理相比受到的负面影响较小。EMS诱变达乌里胡枝子种子的适宜浓度为0.8%,处理时间10 h,发芽率、出苗率、成苗率分别为53.61%、51.06%和53.28%,均接近半致死量,同时发现多株幼苗叶片出现了明显的形态变异。本试验在达乌里胡枝子原有种质资源基础上,丰富了达乌里胡枝子突变体库,也为后续开展达乌里胡枝子诱变育种研究提供理论依据。

EMS诱变对鹰嘴紫云英种子萌发及幼苗表型特征的影响

【目的】筛选适宜鹰嘴紫云英的EMS诱变条件。【方法】以鹰嘴紫云英品种甘绿2号种子为试验材料,采用不同浓度(0、0.2%、0.4%、0.6%、0.8%)的甲基磺酸乙酯(EMS)进行不同时间(2、4、6、8 h)的诱变处理,探究EMS对鹰嘴紫云英种子萌发特征及表型变化的影响。【结果】低浓度和短时间EMS处理促进鹰嘴紫云英种子的萌发,随EMS浓度升高和诱变时间的增加,对鹰嘴紫云英种子萌发产生抑制作用。种子浸出液电导率随诱变条件的加深呈上升趋势,在2~6 h时,萌发期发芽率、发芽势、幼苗苗长和根长均随处理时间和诱变浓度的增加呈先升高后降低的趋势,在8 h处理下,随EMS浓度的增加呈逐渐降低趋势,EMS浓度在0.8%时,种子发芽率和发芽势均达到最低,较对照分别降低了54.45%和56.67%;经形态学筛选,发现有鹰嘴紫云英幼苗表现出幼苗矮小、停滞生长、叶片黄化、宽叶、窄叶、叶片发紫、诸多病斑等特殊变异性状。【结论】0.8%EMS处理6 h可作为最佳诱变组合;幼苗的生长随诱变时间和浓度增加而明显受到抑制,且表型变异类型也逐步增多。

Deep endometriosis with pericolic lymph node involvement: A case report and literature review

Deep infiltrating endometriosis is an often-painful disorder affecting women during their reproductive years that usually involves the structures of the pelvis and frequently the gastrointestinal tract.We present the case of a 37-year-old female patient with an endometrial growth on the sigmoid colon wall causing pain,diarrhea and the presence of blood in the feces.The histology of the removed specimen also revealed the involvement of the utero-vesical fold,the recto-vaginal septum and a pericolic lymph node,which are all quite uncommon findings.To identify the endometrial cells,we performed immunohistochemical staining for CD10and the estrogen and progesterone receptors.

Bowel endometriosis:Recent insights and unsolved problems

Bowel endometriosis affects between 3.8% and 37% of women with endometriosis.The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis.Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endometriosis and allows accurate determination of the presence of the disease.Radiological techniques (such as magnetic resonance imaging and multidetector computerized tomography enteroclysis) are useful for estimating the extent of bowel endometriosis.Hormonal therapies (progestins,gonadotropin releasing hormone analogues and aromatase inhibitors) significantly improve pain and intestinal symptoms in patients with bowel stenosis less than 60% and who do not wish to conceive.However,hormonal therapies may not prevent the progression of bowel endometriosis and,therefore,patients receiving long-term treatment should be periodically monitored.Surgical excision of bowel endometriosis should be offered to symptomatic patients with bowel stenosis greater than 60%.Intestinal endometriotic nodules may be excised by nodulectomy or segmental resection.Both surgical procedures improve pain,intestinal symptoms and fertility.Nodulectomy may be associated with a lower rate of complications.

基于EMS管理模式的延续性护理在学龄前喘息性疾病儿童中的应用观察

目的·探讨基于EMS[环境管理(environment management,E)、用药指导(medicine direction,M)与自我监测(self monitoring,S)]管理模式的延续性护理在学龄前喘息性疾病儿童中的应用效果。方法·选取2019年12月至2020年11月,在上海交通大学医学院附属儿童医院呼吸科收治的67例0~6岁喘息性疾病患儿,按照随机数字表分为观察组33例和对照组34例,其中失访3例,最终每组32例。观察组采用基于EMS管理模式的延续性护理,对照组给予常规护理和出院电话随访。2组患儿出院后1、3、6个月随访评估儿童呼吸和哮喘测试(Test for Respiratory and Asthma Control in Kids,TRACK)结果、喘息复发情况;出院后6个月随访采用支气管哮喘用药依从性评分表(Medication Adherence Report Scale for Asthma,MARS-A)和护理工作满意度调查表评估用药依从性及护理工作满意度。结果·2组患儿人口学特征及临床基线特征差异无统计学意义。重复测量方差分析结果显示,时间、组别、组别×时间的交互作用对TRACK总分的影响均有统计学意义;出院后1、3、6个月,观察组TRACK总分均显著高于对照组(均P=0.000);2组患儿TRACK总分均随时间推移逐渐上升(P=0.000)。观察组1、3、6个月随访发现喘息复发率分别为25.0%、18.7%、9.4%,均显著低于对照组(分别为50.0%、43.7%、31.3%,均P<0.05);广义估计方程分析显示组间比较差异有统计学意义(P=0.013),观察组干预效果优于对照组(OR=0.292)。出院后6个月观察组MARS-A得分为(4.519±0.395)分,显著高于对照组[(3.994±0.739)分,P=0.001]。护理工作满意度调查结果显示,观察组显著高于对照组(P=0.000)。患儿MARS-A得分与护理工作满意度呈中度正相关(r=0.389,P=0.001)。结论·基于EMS管理模式的延续性护理可显著提高学龄前喘息性疾病儿童的用药依从性和喘息控制水平,明显降低喘息复发率,以及提高护理工作满意度。