Eating Disorders and Pregnancy: The Case of Anorexia

The question of the link between pregnancy and eating disorders is an important question. At the moment, there are few concrete answers for these patients. Despite common fertility challenges, patients who suffer from ED are able to access maternity. ED and pregnancy can either have an easy evolution or experience a lot of trouble. Many studies describe obstetrical and foetal complications (low birthweight, inadequate intra-uterine growth, small head circumference, miscarriage, caesarean section). Those patients are frequently reluctant to address their disease with their specialist, who also often doesn’t know how to screen the signs. The lack of official data to train the specialists further increases these difficulties. However, ED are frequent in the general population and young patients are likely to eventually want to become mothers. It is thus essential to know how to screen those patients early and accurately to improve their treatment and care. Eating disorders impact the pregnancy, the delivery and the postpartum as well as the growth of the baby. It is an important public health problem. The evolution from being a woman to becoming a mother is a difficult one, and even more so when the women is suffering from ED. Those patients must handle their nutritional fears, the anxiety about their body changing with pregnancy and the daily challenges. The early interactions with their baby have consequences on their development. It seems necessary to evaluate how to improve the screening and the patient care in ED patients. Screening should begin from the pregnancy desire to the postpartum. This patient care should be based on a multidisciplinary care team.

Liu-Jun-Zi decoction alleviates chemotherapy-induced anorexia by regulating gut microbiota and TLR4/MyD88/NF-κB p65 signaling pathway

Background:Liu-Jun-Zi decoction(LJZD),a classical nourishing formula in China,has been proven to be effective in treating chemotherapy-induced anorexia.In this study,the mechanism of LJZD in alleviating chemotherapy-induced anorexia was discussed from the aspects of regulating gut microbiota,repairing intestinal barrier injury and inhibiting inflammatory pathways.Methods:A rat model of chemotherapy-induced anorexia was established using cisplatin.The study evaluated the therapeutic effects of LJZD by observing the weight,food intake,and intestinal pathology of rats.The impact of LJZD on gut microbiota and metabolites,specifically short-chain fatty acids,was investigated through gut microbiota analysis and targeted metabolomics.The anti-inflammatory and intestinal protective effects of LJZD were assessed by examining the expression of intestinal tight junction proteins associated with the inflammatory pathway.Results:LJZD alleviated cisplatin-induced inflammation and intestinal barrier disruption,as evidenced by upregulated expression of tight junction protein 1(TJ-1)and occludin,along with reduced serum levels of interleukin 6(IL-6),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),and lipopolysaccharide.Additionally,LJZD alleviated microbiota imbalance and regulated the levels of short-chain fatty acids,especially increased the relative abundance of Coriobacteriales Incertae Sedis,Lactabacillus johnsonii F19785,Parasutterella,and reduced the Tyzzerella.In the hypothalamus,LJZD exerts suppressive effects on the toll-like receptor 4(TLR4)/myeloid differentiation factor 88(MyD88)/nuclear factor-κB(NF-κB)p65 signaling pathway,leading to a downregulation in the transcriptional activity of IL-6 and IL-1β,as well as Interleukin 6 receptors(IL-6R)and Interleukin-1βreceptors(IL-1R1)mRNA expression levels.Conclusion:In summary,LJZD alleviate chemotherapy-induced anorexia by modulating the gut microbiota,repairing the intestinal mechanical barriers,and suppressing the TLR4/MyD88/NF-κB p65 signaling pathway.

The Outcome of Adolescent-Onset Anorexia Nervosa: A Study of 144 Cases

Objectives: To evaluate the long-term outcome of adolescents with anorexia nervosa and attempt to define prognostic factors for outcome. Methods: Transversal, descriptive epidemiological study with a strict methodology: minimum interval of 4 years since first admission, evaluation using clearly defined diagnostic criteria (EAT-40 self-evaluation, HSCL, global patient-driven self-evaluation and hetero evaluation: clinical interview and LECE). The 198 subjects are former adolescent anorexics treated at the Hôpital d’Enfants (Children’s Hospital) in Nancy (France). Results: Clinical evaluation of the 144 subjects traced showed positive outcome for 68.1%, intermediate outcome for 23.2% and poor outcome for 8.7%. 5 factors for a good prognosis were found (middle socioeconomic class of parents, no prior treatment, hospitalization > 1 month,

Anorexia nervosa:Outpatient treatment and medical management

Anorexia nervosa(AN)is a disabling,costly and potentially deadly illness.Treatment failure and relapse are common after completing treatment,and a substantial proportion of patients develop severe and enduring AN.The time from AN debut to the treatment initiation is normally unreasonably long.Over the past 20 years there has been empirical support for the efficacy of several treatments for AN.Moreover,outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients.Early intervention improves outcomes and should be a priority for all patients.Outpatient treatment is usually the best format for early intervention,and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable.Inpatient care is more disruptive,more costly,and usually has a longer waiting list than does outpatient care.The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult.The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN.The scientific essentials for outpatient treatment are described,including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated.The following aspects are discussed:early intervention,outpatient treatment of AN,including outpatient psychotherapy for severe and extreme AN,how to determine when outpatient treatment is safe,and when transfer to inpatient healthcare is indicated.Emerging treatments,ethical issues and outstanding research questions are also addressed.

Self-reported and behavioural impulsivity in anorexia nervosa

AIM To examine how self-reported and behavioural impulsivity are related in anorexia nervosa(AN).METHODS Twenty-four females with AN and 25 healthy controls(HC) participant in the study.Self-reported impulsivity was assessed with the Barratt Impulsiveness Scale(BIS-11).The scale yields three second-order factors:Attentional,motor and non-planning.Behavioural impulsivity was investigated with the continuous performance test(CPT),a computer-based task of sustained attention in which numbers are flashed briefly on screen and participants are required to click the mouse when the same number appears consecutively.The rate of commission and omission errors can be used a measure of behavioural imulsivity.RESULTS AN participants self-reported increased attentional [AN:20.67(3.64),HC:13.88(2.91),P = 0.001] and reduced motor impulsivity [AN:11.55(2.28),HC:14.08(2.78),P = 0.002].The rate of omission or commission errors on the CPT did not differ between groups(P > 0.05).BIS-11 and CPT measures did not significantly correlate,but attentional impulsivity was related to negative mood states in AN(depression:r = 0.52,P = 0.010,anxiety:r = 0.55,P = 0.006,stress:r = 0.57,P = 0.004).CONCLUSION The discrepancy between self-reported and behavioural impulsivity are discussed in terms of perfectionism in AN.Furthermore,it is suggested that improving negative mood states may resolve this inconsistency in AN.

Systematic review of evidence for different treatment settings in anorexia nervosa

AIM: To compare outcomes in anorexia nervosa(AN) in different treatment settings: inpatient, partial hospitalization and outpatient. METHODS: Completed and published in the English language, randomized controlled trials comparing treatment in two or more settings or comparing different lengths of inpatient stay, were identified by database searches using terms "anorexia nervosa" and "treatment" dated to July 2014. Trials were assessed for risk of bias and quality according to the Cochrane handbook by two authors(Madden S and Hay P) Data were extracted on trial quality, participant features and setting, main outcomes and attrition. RESULTS: Five studies were identified, two comparing inpatient treatment to outpatient treatment, one study comparing different lengths of inpatient treatment, one comparing inpatient treatment to day patient treatment and one comparing day patient treatment with outpatient treatment. There was no difference in treatment outcomes between the different treatment settings and different lengths of inpatient treatment. Both outpatient treatment and day patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was also cheaper than prolonged inpatient care for weight normalization also followed by evidence based outpatient care. CONCLUSION: There is preliminary support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting for anorexia nervosa.

Experience of Management of Anorexia Nervosa Patients with Extremely Severe Malnutrition in a Transdisciplinary Clinical Nutrition-Eating Disorders Inpatient Unit

Background: The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical complications that are not within their competences and that justify hospitalization in an internal medicine ward. On the other hand, medical doctors have to face psychic decompensations that would justify admission to a psychiatric ward. In this context, we share our experience of management of severely malnourished AN adult patients in a transdisciplinary specialized eating disorders (ED) unit, referral center for AN associated with somatic severity. Method: First, we described the modalities of care proposed to patients with AN hospitalized in the medical unit. Intensive medical care, both somatic and psychiatric, are provided thanks to a transdisciplinary therapeutic program, where objectives are to: medically stabilize the patient, initiate progressive refeeding and start supportive psychotherapy before being transferred to a psychiatric ED unit. Secondly, we conducted a retrospective descriptive study that included all adult patients with AN admitted for the first time to the unit, between November 1997 and January 2014, for severe malnutrition and/or complications of the ED. Objective was to specify patients’ characteristics: demographic, nutritional status, history of ED, care pathway. Results: Among a cohort of 386 adult patients with AN (21 males and 365 females) admitted for the first time in the unit, mean age was 29.4 (±11.5) years, mean BMI was 12.7 (±2.2) kg/m2. Before being supported in the unit, 78.2% of patients had already been hospitalized in other hospitals. Mean length of stay was 35.2 days. Patients were clinically serious and unstable because of life-threatening somatic complications due to a low BMI. During hospital stay, a temporary transfer to medical intensive care unit was necessary for 25.6% of patients. Average patient weight gain was 0.777 kg per week and 81.9% of patients benefited from enteral nutrition. Conclusion: This specialized transdisciplinary unit where physician nutritionists and psychiatrists coordinate medical care together, allow a better understanding and management of extreme malnutrition associated with AN. Thanks to their expertise, care teams are less critical and less rejecting towards patients. Thus, therapeutic alliance could be optimized.

Clinical Factors Influencing Quality of Life in Anorexia Nervosa Patients

Objective: The purpose of this study was to elucidate clinical factors influencing quality of life (QOL) in anorexia nervosa (AN) patients. Methods: Twenty female patients with AN (median age = 30.0 years, quartile deviation = 6.8) and forty female healthy controls (HC) (median age = 30.0 years, quartile deviation = 8.6) participated in the study. QOL was assessed with the 36-Item Short Form Health Survey (SF-36) and social support was evaluated using the Multidimensional Scale of Perceived Social Support (MSPSS). Clinical symptoms were evaluated with the Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D) and the Eating Disorder Inventory-2 (EDI-2). Results: Scores of the SF-36 Mental Component Summary (MCS) (U = 124.0, P U = 223.0, P = 0.006) and scores of total (U = 108.0, P < 0.0001) and subscales of the MSPSS were lower in AN group than HC group, and the SIGH-D score was higher (U = 46.0, P ρ = &minus;0.565, P < 0.05) and subscales of the EDI-2 Interoceptive Confusion (ρ = &minus;0.556, P ρ = &minus;0.581, P ρ = &minus;0.617, P < 0.05) were negatively correlated to MCS, and score of Interoceptive Confusion subscale showed a negative correlation to RCS (ρ = &minus;0.672, P < 0.05). Moreover, stepwise regression analysis showed that the SIGH-D score was an independent predictor of MCS and Interoceptive Confusion score predicted RCS. Conclusion: These results suggest that among a variety of clinical symptoms and psychopathologies, depressive symptoms, poor emotional awareness and impaired sense of control are the most important influencing factors on AN patients’ QOL.

Epidemiology of anorexia nervosa in a French community-based sample of 39,542 adolescents

Purpose: To assess the prevalence of DSM-IV anorexia nervosa criteria, anorexia nervosa and subthreshold subgroups, and their incidence between the ages of 12 and 17 years using Cole’s international thinness cut-offs, and to characterize these anorexic adolescents by parental socioeconomic status and whether or not they reported receiving treatment. Method: In all, a representative sample of 39,542 French adolescents (19,658 girls and 19,884 boys) was recruited in a cross-sectional study in 2008. Anorexia nervosa DSM-IV diagnosis was determined by a self-administered questionnaire. Results: Among females, 0.5% (n = 105) met criteria for anorexia nervosa between the ages of 12 and 17 years, whereas among males, the prevalence was 0.03% (n = 6). In females, the prevalence of sub-threshold anorexia nervosa was found to be between 1.2% (n = 216) and 3.3% (n = 618);more than 75% were of the restrictive subtype. The highest incidence of anorexia nervosa was at 16 years. There was also a greater prevalence of sub-threshold anorexia nervosa subgroups among subjects with high parental socioeconomic status. More than half of the female adolescents who met the anorexia nervosa criteria reported receiving treatment for their disorder, versus 23% to 40% of the adolescents in the sub-threshold subgroups (P sample of adolescents. Using Cole’s international thinness cut-off could improve international comparability among studies. Adolescents from the higher socioeconomic categories were more likely to be anorexic.

Psychotherapy in anorexia nervosa: What does the absence of evidence mean?

Psychological treatment in anorexia nervosa(AN) is disheartening. Psychotherapy is the "treatment of choice" for adults though this recommendation is grounded on the absence of good quality clinical studies. This paper seeks to address the question of why improvements in the psychological treatment of AN have been thwarted, and why one of the best treatments available for adult patients is specialist supportive clinical management that has entered the stage through the backdoor of nonspecific supportive treatments originally serving as a placebo treatment assigned in randomized clinical trials to control for non-specific aspects of true psychosocial treatments. The possibility that most of the psychopathological features that characterise the AN symptoms profile could be best understood as the direct consequences of emaciation would enhance the utility of research with animal models for generating new hypothesis to improve AN treatment.

Severe Sinus Bradycardia in Anorexia Nervosa-A Case Report

A case of anorexia nervosa complicated with severe sinus bradycardia and low T3 syndrome was reported.

Is osteoporosis risk in anorexia nervosa underestimated? A case report series

Introduction: Anorexia nervosa (AN) is a mental disorder whose features are deliberate weight loss, disordered body image, and intrusive overvalued fears of gaining weight. Long-term consequences of AN include endocrine dysfunctions leading to secondary amenorrhea, bone loss and/or osteoporosis with an increased risk of bone fracture. Therefore young women with AN may develop a risk for bone fractures comparable to that of postmenopausal women. Methods: In this case report series Bone Mineral Density (BMD) was examined by Dual energy X-ray Absorptiometry (DXA) in 19 hospitalized patients with diagnosis of AN and prolonged amenorrhea. Results: All patients showed a lumbar/femoral bone loss or osteoporosis, with an increased fracture risk comparable to that of postmenopausal women. Conclusions: Our observation suggests that DXA evaluation of anorexic patients with prolonged amenorrhea would be helpful to prevent fracture risk in this population of patients. However, although DXA is almost routinely recommended in women over 65, it is not in young AN patients with prolonged amenorrhea.

Balancing the Inpatient-Nurse Relationship in Anorexia Care

Background: Nurses play a central role in the treatment of inpatients with anorexia, where bonding is a key factor. The inpatient-nurse relationship is based on a confident alliance characterized by important factors such as trust, confidentiality, responsiveness, genuineness, and consistency. Aim and Research Question: The aim of this study was to describe patients’ in-depth experiences of their relationship with nurses when hospitalized for anorexia. The research question was: How do women hospitalized due to anorexia nervosa experience the nurse-patient relationship? Method: A hermeneutic approach with in-depth interviews was employed. Five women with previous experience of inpatient care for anorexia were interviewed. Findings: The findings summarized how the women experienced the relationship with professional nurses in a ward characterized by a high degree of structure. The main theme Balancing feelings of emotional contradictions in the patient-nurse relationship was described by two sub-themes;Opening up for a care relationship in a rigid and structured ward atmosphere and Fluctuating in a paradox of conflicting feelings. Discussion: From the patients’ perspective, balancing the patient-nurse relationship when an inpatient involves conflicting emotional challenges. Structured interventions are perceived as effective by the patients, although they may be ambivalent about them. Therefore, a good relationship depends on the establishment of emotional and stable interaction with the nurses. Implications for Nursing Practice: Patients need interventions based on safe and competent quality care. A hermeneutic approach may improve the nurses’ ability to meet these patients in their lifeworld and establish a confident relationship. Special education related to anorexia care should be a priority in nursing.

Liujunzi decoction ameliorats cisplatin-induced anorexia via adjusting metabolic disorders in rats

OBJECTIVE Cisplatin is a formidable chemotherapy agent widely applying in antineoplastic treatments,but its side effects often limit the clinical usage.Metabolic disorders are one of the side effects induced by cisplatin,which closely relate to the onset of chemotherapy-induced anorexia(CIA)in cancer patients but lacks effective controls.Liujunzi decoction(LJZD)is a traditional Chinese formula that has a promising effect in treating CIA.However,whether LJZD ameliorates CIA through adjusting cisplatin-induced metabolic disorders remain unknow.The present study evaluated the mechanism of cisplatin-induced metabolic disorders,and the effect of LJZD in ameliorating these disturbances.METHODS 42 male Sprague-Dawley(SD)rats(180-220 g)were randomly divided into 3 groups:normal control group(distilled water+saline),model group(distilled water+cisplatin),LJZD group(4.8 g·kg^(-1)Liujunzi decoction ingredients+cisplatin).Intragastrical administered each drug twice a day(7∶00-19∶00)since day 0 for 4 d,animals were intraperitoneal injected with cisplatin 6 mg·kg^(-1)1 h after administration while normal control groups were injected with same volume of saline.On day 3,each group was anesthetized with pentobarbital sodium 45 mg·kg^(-1)(ip),and blood samples were collected from aorta abdominalis.Then the samples were analyzed using an LC-ESI-MS/MS system.Significantly regulated metabolites between groups were determined by VIP≥1 and absolute Log2FC(fold change)≥1.Identified metabolites were mapped to Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway database using Metaboanalyst 5.0(https://www.metaboanalyst.ca/).RESULTS A total of 133,77 and 32 differential metabolites were filtrated in control vs model,control vs LJZD and model vs LJZD groups respectively.Comparing to control,the levels of hexadecanoic acid(Log2FC=6.3153),linoleic acid(Log2FC=5.3478),and 8,11-icosadienoic acid(Log2FC=5.2342)significantly increased,and the levels of N-acetyl-L-tyrosine(Log2FC=-2.6283),cinnamic acid(Log2FC=-2.3381),N-acetylphenylalanine(Log2FC=-2.2501)significantly decreased in model group.The KEGG pathway enrichments of these metabolites indicated that,cisplatin-induced metabolic disorders by disturbing metabolism pathways such as linoleic acid metabolism,biosynthesis of unsaturated fatty acids,and phenylalanine metabolism,which suggested that the onset of CIA was partly associated with the metabolic disorders of linoleic acid,unsaturated fatty acids,and phenylalanine.Compared to control,treatment of LJZD significantly increased the levels of 4-hydroxytryptamine(Log2FC=12.0186),hexadecanoic acid(Log2FC=5.7412),linoleic acid(Log2FC=5.1877)and significantly decreased the levels of N-acetylmethionine(Log2FC=-1.7317),2-aminoethanesulfinic acid(Log2FC=-1.6578),N-acetyl-L-tyrosine(Log2FC=-1.5355).And comparing to the model group,4-hydroxytryptamine(Log2FC=12.0186),7,12-diketocholic acid(Log2FC=2.0998),N-acetylneuraminic acid(Log2FC=2.0560)markedly increased,and 3-hydroxy-3-methylpentane-1(Log2FC=-1.9202),5-dioic acid(Log2FC=-1.7166),N-isovaleroylglycine,hexanoyl glycine(Log2FC=-1.4958)markedly decreased in LJZD group.It was worth noting that,there were 23 differential metabolites filtrated both in control vs model and model vs LJZD groups,which were the key metabolites of LJZD in treating CIA.Among these 23 common metabolites,there were 16 metabolites excluding the control vs LJZD group,that was,LJZD had no effect in normal rats while being able to ameliorated cisplatin-induced metabolic disorders by regulating these 16 metabolites.Cisplatin-induced downregulation of 11 metabolites such as hydrocinnamic acid,(±)12(13)epoxy-9Z-octadecenoic acid,cinnamic acid were upregulated after LJZD treatment,and cisplatin-induced upregulation of imidazoleacetic acid,2′-deoxycytidine-5′-monophosphate and other 5 metabolites were downregulated by LJZD.The KEGG pathway analysis indicated that the linoleic acid metabolism,histidine metabolism,and pyrimidine metabolism were the most enriched metabolic pathway.Thus,cisplatin-induced metabolic disturbances mainly by disturbing linoleic acid metabolism,histidine metabolism,and pyrimidine metabolism,and LJZD interacted with these metabolic pathways to reduce metabolic disorders and thus ameliorated CIA.CONCLUSION Cisplatin-induced anorexia was closely related to the metabolic disorders of linoleic acid metabolism,biosynthesis of unsaturated fatty acids,and phenylalanine metabolism.The mechanism of LJZD in ameliorating CIA was in concerned with the metabolic adjustments,relating to the regulation of linoleic acid metabolism,histidine metabolism,and pyrimidine metabolism.

Metaphors of Anorexia Analysis of Peony＇s Starved-for-loveSelf in Lisa See＇s Peony in Love

In Asian American writer Lisa See＇s novel Peony in Love （2007）, the love-sick maiden Peony commits anorexiawhich finally leads to her annihilation. Anorexia, as well as foot bonding, both of which are distortions of femalebody, convey various metaphors. The novel repeatedly presents the inability to eat or eating monotonous meals assymptoms of the nervous breakdown. Through a series of feminist psychological analysis, this paper is designed tofigure out these metaphors of anorexia within the text in the following three dimensions： anorexia as imitation of art,anorexia as failure in mother-daughter relationship and the anorexic female body as a language. After explanationsof the metaphorical meaning of anorexia, this paper aims to analyze Peony＇s starved-for-love self, and draw aconclusion about lovesickness during the whole process of Peony＇s maturation.

Study of the effect of Jian-Pi-Xiao-Shi formula on infantile rats with anorexia

Background:The objective of this study was to study the effect of Chinese patent drug Jian-Pi-Xiao-Shi formula on rats with infantile anorexia.Methods:The Sprague Dawley rats with 4 weeks old were divided into 5 groups:normal group,model group,large,medium,and small doses of sample group.Twelve rats were included in each group with half males and half females.In addition to the normal group,the rats in each group were free to take the special feed during 28 consecutive days,which results in the pretended anorexia model,being the rats in the normal group free to take the ordinary feed.Except for the normal group and the model group,the other groups were given Chinese patent drug Jian-Pi-Xiao-Shi formula by a gavage of 1 mL/100g once a day for 28 days.The distilled water was given to the normal group and the model group under the same conditions.After 28 days,the contents of theβ-endorphin,cholecystokinin octapeptide,gastrin,motilin and pepsin were measured.Results:The results demonstrated that the Chinese patent drug Jian-Pi-Xiao-Shi formula could significantly increase the body weight and the food intake of the infantile rats with anorexia,increase the pepsin activity,the content of motilin and the expression ofβ-endorphin,and in the other hand decrease the expression of the cholecystokinin.Conclusion:The Chinese patent drug Jian-Pi-Xiao-Shi formula can promote the appetite and the digestive function of infantile rats with anorexia.This study suggested that the Chinese patent drug Jian-Pi-Xiao-Shi formula can enhance the appetite of the children and to improve the overall digestive function.

Clinical Analysis of 60 Cases of Children's Anorexia Treated with Massage

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Ivan de Araujo团队揭示GLP-1如何通过肠脑轴神经环路调控机体行为和生理学效应

近期来自西奈山医学院IvandeAraujo课题组报道了小肠分泌的内生型胰高血糖素样肽1(GLP-1)通过交感神经通路控制食欲的器官间神经环路,该工作证实了远端回肠L细胞内分泌的GLP-1是由位于肌层的表达GLP-1R(胰高血糖素-1受体)的神经元监测,并通过腹腔交感神经节,进而介导胃动力减低和扩张。该文进一步深入研究并发现,位于脊髓的背根神经元,是感受胃扩张,并将感觉信息传导至延髓,从而引发下丘脑与脑干协同的降低摄食行为。这项研究为治疗腹胀,食欲减退等胃动力障碍的相关疾病提供了新的策略。

慢性心力衰竭患者厌食症现状及其影响因素

目的调查慢性心力衰竭患者厌食症现状及其影响因素。方法采用便利抽样法,选取160例慢性心力衰竭患者,使用临床资料调查问卷、中文版厌食症恶病质治疗功能性评估‑厌食恶病质分量表、匹兹堡睡眠质量指数(PSQI)量表、医院焦虑抑郁量表对其进行调查,采用多因素Logistic回归模型分析影响慢性心力衰竭患者厌食症发生的因素。结果160例慢性心力衰竭患者中,厌食症发生率为50.63%(81/160)。多因素Logistic回归分析结果显示,家庭人均月收入、美国纽约心脏病学会(NYHA)心功能分级、合并消化系统疾病情况、红细胞计数、血钾水平、PSQI量表总分是慢性心力衰竭患者发生厌食症的影响因素(P<0.05)。结论慢性心力衰竭患者厌食症发生率较高,家庭人均月收入、NYHA心功能分级、合并消化系统疾病情况、红细胞计数、血钾水平、睡眠质量是慢性心力衰竭患者发生厌食症的影响因素。

七大小儿推拿流派治疗小儿厌食症的研究进展

厌食症是小儿时期的一种常见病症,长期不愈会导致患儿抗病能力下降,严重影响生长发育或易患其他病证。厌食症治疗方法众多,其中推拿治疗小儿厌食症疗效确切,无毒副作用,容易被广大患儿和家长接受。目前常见推拿流派包括徐谦光三字经小儿推拿流派、张汉臣小儿推拿流派、孙重三小儿推拿流派、海派儿科推拿、刘开运小儿推拿流派、小儿捏脊流派、津沽小儿推拿流派,但七大推拿流派治疗小儿厌食症的临床研究较少,缺乏大样本试验,操作手法不统一,且推拿治疗厌食症的现代作用机制尚不明确。未来临床研究可以结合七大流派手法进行大样本的临床对照试验,以期规范操作,促进其在临床中广泛应用。