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Objective:To investigate the correlation between urinary 8-oxo-7, 8-dihydroguanosine(8-oxo-Gsn)and physical function in community-dwelling elderly people.Methods:A total of 210 community-dwelling elderly people aged 75 years and over were enrolled in this cross-sectional analysis.According to the scores of short physical performance battery(SPPB), subjects were divided into three groups: the high performance group(summary score 10-12), the intermediate performance group(summary score 7-9)and the low performance group(summary score 0-6). All participants received a comprehensive geriatric assessment.Urinary 8-oxo-dGsn, serum high-sensitivity C-reactive protein(hs-CRP)and white blood cell count were measured.The correlation between urinary 8-oxo-Gsn and physical function was analyzed by using Pearson correlation analysis and the ordered Logistic regression model.Results:The scores of activities of daily living(ADL), instrumental activities of daily living(IADL), grip strength and gait speed were lower in the low performance group than in the other two groups( H=47.002, 110.902, F=11.962, 235.952, all P<0.001). Levels of urinary 8-oxo-Gsn and serum hs-CRP were higher in the low performance group than in the other two groups( F=23.780 and 13.259, both P<0.001). There was no significant difference in levels of urinary 8-oxo-dGsn or white blood cell count between the three groups(both P>0.05). Urinary 8-oxo-Gsn was negatively correlated with gait speed, grip strength and SPPB score( r=-0.559, -0.302 and-0.450, all P<0.001)and was positively correlated with the time of five-times-sit-to-stand test( r=0.290, P<0.001). Adjusting for age, gender and Charlson comorbidity index, the ordered Logistic regression analysis showed that elevated levels of urinary 8-oxo-Gsn( OR=1.38, 95% CI: 1.06-1.77, P<0.05)and hs-CRP( OR=1.23, 95% CI: 1.04-1.48, P<0.05)decreased physical function. Conclusions:Urinary 8-oxo-Gsn is independently associated with the decline of physical function in community-dwelling elderly adults, suggesting that the oxidative stress level is increased in the elderly with poor physical function.
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Objective@#To explore the incidence and clinical characteristics of sarcopenia in hospitalized elderly patients with coronary heart disease and search for the related factors.@*Methods@#This study was a single-center observational study. According to the inclusion criteria, elderly patients hospitalized with coronary heart disease from Peking Union Medical College Hospital between December 2017 and December 2018 were enrolled. The patients were divided into sarcopenic group and non-sarcopenic group according to the diagnostic criteria of the Asian Working Group for Sarcopenia. Activities of daily living of the patients were assessed (including ADL and IADL) . Comorbidity of the patients was evaluated by the Charlson comorbidity index (CCI). Long-term medication use of the patients was recorded to assesse whether there was polypharmacy. The nutritional status of the patients was examined by the mini nutritional assessment-short form (MNA-SF). The full tandem stance time of the patients was evaluated. The history of falls over the previous year, urinary incontinence, and living conditions of the patients were also recorded. Multivariate logistic regression was used to analyze the related factors for sarcopenia of elderly patients with coronary heart disease.@*Results@#A total of 364 patients were enrolled in the study. The patients were aged 65-96 (74.6±6.5) years and there were 218 (59.9%) male patients. There were 264 cases of stable coronary heart disease and 100 cases of acute coronary syndrome. The median number of long-term used medication was 7. One hundred and fifty-two (41.8%) patients were complicated with type 2 diabetes, 38 (10.4%) patients were complicated with anxiety/depression, and 98 (26.9%) patients had the history of falls over the previous year. Eighty-two (22.5%) patients were complicated with urinary incontinence, 12 patients (3.3%) were complicated with malnutrition and 33 patients (9.2%) were living alone. There were 81 (22.3%) sarcopenic patients and 283 (77.7%) non-sarcopenic patients among all the hospitalized elderly patients with coronary heart disease. The sarcopenic patients were more older, with lower body mass index(BMI)(both P<0.001), higher CCI and more long-term used medication (both P<0.05), higher proportions of malnutrition, urinary incontinence, history of falls, and living alone (all P<0.05) compared to non-sarcopenic patients. ADL and IADL scores of sarcopenic patients were significantly lower than those of non-sarcopenic patients (both P<0.001). There was also a higher proportion of unable to accomplish full tandem stance among sarcopenic patients compared to non-sarcopenic patients (P<0.001). Moreover, higher hs-CRP level (P=0.047) , lower albumin level (P=0.004) and significantly lower prealbumin level (P<0.001) were observed in sarcopenic patients compared to non-sarcopenic patients. Stepwise multivariate binomial logistic regression analysis revealed that male (OR=5.036, 95%CI 1.782-14.230, P=0.002), low BMI (OR=0.883, 95%CI 0.796-0.980, P=0.019), as well as low prealbumin level (OR=0.990, 95%CI 0.980-1.000, P=0.045) were related factors for sarcopenia among elderly patients with coronary heart disease.@*Conclusions@#Sarcopenia is a geriatric condition commonly seen in hospitalized elderly patients with coronary heart disease. Male, low BMI, and low prealbumin level were the factors related to sarcopenia for older adults with coronary heart disease.
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Objective To explore the association between frailty and muscle performances of hospitalized elder adults with coronary artery disease.Methods A total of 122 hospitalized patients aged 65-85 years old with coronary artery disease from Department of Geriatrics and Cardiology,Peking Union Medical College Hospital between December 2017 and March 2018 were enrolled in the study.A comprehensive geriatric assessment was performed to evaluate existing comorbidity and geriatric syndromes of the patients.Frailty was assessed using the Clinical Fraity Scale.The patients were classified as frail and non-frail,according to the scale.Muscle performances were assessed using grip strength,gait speed,etc.Whole body and appendicular skeletal muscle mass was detected with bioelectrical impedance analysis in patients with reduced grip strength or slowed gait speed.Appendicular skeletal muscle index (ASMI) was calculated.Results Among all subjects,28 were with frailty (23.0％) and 94 were without (77.0％).The frail patients were older [(76.7±5.4) years vs.(72.2±5.6)years],had higher Charlson comorbidity index [2.0(1.0,2.75)vs.1.0(0,2.0)],and higher proportion of malnutrition (14.29％ vs.1.06％),urinary incontinence (39.29％ vs.15.96％),using walking-aid (28.57％ vs.6.38％),and more kinds of taken drugs (8.1±3.0 vs.6.6±2.7),than the non-frail patients.Prealbumin levels [(207.8±60.0)mg/L vs.(234.3±45.4)mg/L] were lower,and highly sensitive C-reactive protein levels [(5.89±9.57)mg/L vs.(1.89±2.49)mg/L] were higher in the frail patients than in the non-frail patients (all P＜0.05).Compared with non-frail patients,the frail patients had poorer grip strength [(19.67±7)kg vs.(29.23±8.29)kg] and slower gait speed [(0.54±0.2)m/s vs.(0.91±0.22)m/s](all P＜0.001).Spearman rank correlation analyses showed that grip strength was positively correlated with the appendicular skeletal muscle mass(r =0.811),whole body skeletal muscle mass(r =0.74) and the ASMI (r =0.783),respectively.Conclusions The incidence of frailty among hospitalized older adults with coronary artery disease is high.Poor muscle performances were common in these patients.Assessment of frailty and muscle performances can help to evaluate the overall function of older adults with cardiovascular disease in a comprehensive way.
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Objective To construct a rating scale on the knowledge,attitude,and practice of geriatrics for 8-year clinical medical students and undergraduate nursing students,and to test the reliability and validity of the scale.Methods The Knowledge,Attitude,Practice(KAP)theory was used as a guided framework,relative literatures were reviewed,and topics for question answering were discussed by experts group.Then,a questionnaire was initially constructed.Five methods,including discrete trend method,Cronbach coefficient,t-test,correlation analysis,and factor analysis,were used to screen the attitude and practice items.The knowledge items were evaluated by experts.Items with over three exclusion criteria were deleted when combining the literal questions.The construct validity of the integrated scale was assessed by factor analysis.A pilot research was conducted by 100 eight-year medical students and nursing undergraduates selecting question entries,and the reliability and validity of the scale were examined.Results The scale consisted of three dimensions.A 43-item initiate questionnaire on the scale included 13 items for knowledge,11 for attitude,and 19 for practice.Two knowledge items were deleted according to expert evaluation.Seven items with more than three exclusion criteria were deleted after statistical analyses.Eventually,34 items were included in the questionnaire.The Cronbach α coefficient of the questionnaire was 0.702.And three common factors were extracted according to exploratory factor analysis.Conclusions The reliability and validity of Geriatrics Knowledge,Attitude and Practice scale for eight year medical students and nursing undergraduates are acceptable,but the knowledge items should be recomposed.
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Objective To explore the effect of calories supplement or protein supplement on the skeletal muscle in the elderly.Methods The ambulatory elderly (≥65 yrs) with reduced handgrip strength and/or gait speed were enrolled,who did not suffer from any neurological or arthritic disease impairing mobility,or any severe pulmonary or heart disease,or chronic kidney failure.The subjects were recruited with their written informed consent from clinical practices in five hospitals in China.The subjects were randomized to control group(n=26),nutrition supplementation (Nutren 400 kcal/ d) group (n=27) or protein supplementation(Biopro Protein 20 g/d) group (n=21).All the subjects were given healthy lifestyle education.The physical performances i.e.gait speed and handgrip strength were measured at baseline and at 2 and 3 months of followed up.Lean soft tissue mass (muscle mass) was measured by BIA at baseline and at 3 months of follow-up.Results A total of 74 subjects completed the trial,including 26 in controls,27 in Nutren,and 21 in protein group.At the end of the trial,the changes from baseline in appendicular muscle mass were-490.0 g (95％CI:-801.9--245.5,P=0.001)in control group,90.0 g (95％CI:-346.8--442.0,P=0.241) in Nutren group,and 290.0 g (95％CI:-746.6-20.1,P=0.007) in protein group.There were no significant difference in above indices among the three groups (P=0.051),except between Nutren group and control group (P=0.020).The handgrip strength and gait speed in the three groups were improved obviously as compared with those at baseline,but not statistically significant between different groups.Conclusions Caloric supplementation group may have greater effect in maintaining muscle mass than the protein supplement group in the elderly.Both the caloric supplement and the protein supplement produce no additional effect on muscular function as compared with healthy lifestyle education.
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Objective To investigate the geriatric syndromes in the very elderly people in Beijing community,in order to provide the basis for management of geriatric syndromes and rational use of medical resources.Methods All community-dwelling residents aged 95 years and over living in Haidian district and some residents aged 85 years and over living in Haidian,Chaoyang and Xicheng districts were investigated in household in Beijing.The survey included the general condition,functional status and geriatric syndromes such as falls,senile urinary incontinence,chronic pain syndrome,chronic constipation and malnutrition occurrence.Results 336 seniors with the mean age of (96.0± 3.0) years were investigated.The percentage of people who had falls within 1 year,chronic pain,and chronic constipation was 27.2％ (88/324),37.3％ (122/327) and 47.6％ (160/336) respectively.The incidence of urinary incontinence was 37.1％ (118/318),with 33.3 ％ (46/138) in males and 40.0％ (72/180) in females,and there was no significant gender difference in the incidence of urinary incontinence (P=0.220).The incidences of malnutrition and malnutrition risks was 10.4％ (31/299) and 50.5％ (151/299).37.2％ of subjects could walk outdoor with a better physical function.The self-rated health satisfaction was lower in elderly people with malnutrition and urinary incontinence than in subjects without those diseases (40.0％ vs.70.4％,34.0％ vs.64.6％,x2 =25.20,25.30,both P＜0.001).26％ of them had never heard of geriatrics.Conclusions Geriatric syndromes are common in community-dwelling older seniors.It is urgent to spread the geriatric knowledge and set a reasonable goal for diagnosis and treatment in the seniors.
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Objective To analyze the clinical characteristics and prognosis of the overlap syndrome of dementia,depression and delirium coexistence in two or three of them (the 2D's or 3D's) in elderly patients,in order to raise awareness.Methods Clinical data of 16 patients aged ＞65 years diagnosed with the 2D's or 3D's admitted to Peking Union Medical College Hospital from 2010 to 2014 were analyzed and relevant literatures were reviewed.Results Patients with the 2D's or 3D' s accounted for 10％ of the elderly demented patients and 3％ of the elderly depressive patients.16 patients [11 females and 5 males,median age 82 years and mean age (80±6) years] were enrolled,with 7 cases of dementia with depression,6 cases of delirium superimposed on dementia,2 cases of the 3D's,and 1 case of coexisting depression and incident delirium.The Charlson comorbidity index of the 16 patients was (3.0± 1.5).(4.0± 1.6) kinds of geriatric syndromes were found,and the most common were falls (62％),sleep disorders (56％),frailty (50％),polypharmacy (43 ％),and malnutrition (37％).Disability was identified in 14 (88％) patients on admission.Delirium was observed in 9 patients (56 ％),with 7 cases of hyperactive delirium and 2 cases of hypoactive delirium.Coexisting underlying dementia was identified after episodes of delirium in 6 cases.16 patients all received corresponding intervention during hospitalization period.During a mean follow-up period of (15±13) months,62 ％ of the patients had more impaired physical function (ADL score reduction≥ 1),and 43％ of the patients had more impaired cognitive function (MMSE score reduction≥3).Two patients were transferred to long-term care facilities and one patient died during follow-up.The readmission rate was 50％ within 1 year after discharge.Conclusions The domestic report of overlap syndrome of dementia,depression and delirium is rare.Patients with the coexistence of the 2D's or 3D's are more commonly combined with geriatric syndromes,which results in further cognitive and physical function impairment with a higher re-admission rate.We should pay attention to the follow-up in elderly patients with delirium for screening dementia.
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Objective To prospectively analyze the impact of frailty on the short-term outcomes of coronary heart disease (CHD) and its related factors.Methods A total of 505 patients aged ≥65 years,with diagnosis of CHD in Cardiology Department and Geriatrics Department in our hospital were selected.Clinical data including geriatrics syndromes were collected by using Comprehensive Geriatrics Assessment (CGA).Frailty was defined according to the Clinical Frailty Scale (CFS).The impact of the comorbid conditions on the risk was quantified by the coronary artery disease-specific index.Patients were followed up by clinic visit or telephone consultation.Following-up items included recurrence of all-cause mortality,recurrence of cardiovascular events,and unscheduled returned visit.The impact of frailty on the prognosis of coronary heart disease was analyzed by Cox regression.Results Of the 505 patients,221 patients (43.76％) were considered to be frail elderly,in whom 126 patients (24.95％) were assessed as moderately to severely frail elderly.The incidences of comorbidities and geriatrics syndrome including incontinence,fall history,visual impairment,hearing impairment,constipation,chronic pain,sleeping disorder,dental problems,anxiety or depression,and delirium were higher in frail patients than in non-frail patients[51.1％ (113/221) vs.30.6％ (87/ 284),31.2％ (69/221) vs.19.0％ (54/284),43.9％ (97/221) vs.29.9％ (85/284),49.3％ (109/221) vs.29.6％ (84/284),60.2％ (133/221) vs.33.8％ (96/284),62.0％ (137/221) vs.46.8％ (133/284),49.3％ (109/221) vs.37.7％ (107/284),79.2％ (175/221) vs.55.6％ (158/284),11.3％ (25/221) vs.6.0％ (17/284),2.7％ (6/221) vs.0 (0/284),x2=21.831,10.053,10.510,20.519,34.894,11.481,6.886,30.695,4.624,7.803,respectively,all P＜0.05].After adjusting for sex,age,severity of illness and other coexist factors,the Cox survival analysis showed that frailty was the independent risk predictor for the all-cause mortality and unscheduled return visit in CHD patients (HR=2.881 and 1.835,95％CI:1.591-5.215 and 1.458-2.311,both P＜0.001).Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale are useful to evaluate the clinical features in elderly CHD patients.Frailty is the independent risk predictor for the short-term prognosis including all-cause mortality and unscheduled return visit in elderly CHD patients.
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Objective To investigate the prevalence of malnutrition and nutritional support and interventions in geriatric inpatients.Methods The elderly patients (aged ≥ 65 years)from the geriatric demonstration ward were consecutively enrolled from July 2010 to January 2012.MiniNutritional Assessment-short form (MNA-SF) was performed after admission,and data of nutritional support were collected.Results A total of 179 patients were enrolled in this study.According to MNA-SF,42 cases (23.5％)were rated as malnutrition,and 55 cases (30.7％) were rated as at risk of malnutrition.Totally,45 patients received nutritional support.50.0％ (21/42) patients with malnutrition,and 29.1％ (16/55) patients at risk of malnutrition received nutritional support.As to the route of nutrition therapy,the ratio of the enteral to parenteral to combination of enteral and parental nutrition was 4.4 ∶ 1.0 ∶ 1.0.Conclusions The incidence of malnutrition is high in the geriatric inpatients,and routine nutritional risk screening and assessment are essential for the elderly patients.Nutritional support and other comprehensive treatment are in great need,and the enteral nutrition is appropriate and preferred.
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Palliative and hospice care for patients suffering severe or end-stage illness with projected short life expectancy.Such services aim to improve patients' quality of life through prognosticating,prevention and treatment of their ailment.The main components include evaluation and treatment of symptoms,pain control,family care,alleviating and treating patients' psychological burden and depression,and offering comfort and dignity.Hospice and palliative care are different from euthanasia,because they neither hasten nor delay the dying process.Instead,they focus on patients'physical and psychological needs and helping patients to maintain their independence and make their own choice.As a new medical subspecialty,palliative and hospice care are considered one of the important frontier in modern medicine.They employ a multi-disciplinary team approach,and the team members require special skill sets including those in communication and symptom management.
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Double-stranded oligomeric nucleotide encoding PEP-1 peptides was synthesized, prokaryotic expression pET15b-pep-1-p27mt recombinant constructed, E. coli BL21 (DE3)pLysS transformed and induced with IPTG to highly express fusion protein PEP-1-P27mt. Fusion protein with an N-terminal His-tag could be purified by Ni2+-resin affinity chromatography and identified by SDS-PAGE and Western blotting. Cultured EC9706 cells treated with PEP-1-P27mt revealed that PEP-1-P27mt was transduced into cells after 15 min and reached maximal intracellular concentrations in 2 h. PEP-1-P27mt of 1 micromol/L final concentration could most strongly suppress the growth. It was suggested that PEP-1 can carry P27mt across membrane, which provides a new biological protocol for using cyclin dependent kinase inhibitors p27mt in suppressing the growth of tumor cells.
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Double-stranded oligomeric nucleotide encoding PEP-1 peptides was synthesized, prokaryotic expression pET15b-pep-1-p27mt recombinant constructed, E. coli BL21 (DE3)pLysS transformed and induced with IPTG to highly express fusion protein PEP-1-P27mt. Fusion protein with an N-terminal His-tag could be purified by Ni2+-resin affinity chromatography and identified by SDS-PAGE and Western blotting. Cultured EC9706 cells treated with PEP-1-P27mt revealed that PEP-1-P27mt was transduced into cells after 15 min and reached maximal intracellular concentrations in 2 h. PEP-1-P27mt of 1 μmol/L final concentration could most strongly suppress the growth. It was suggested that PEP-1 can carry P27mt across membrane, which provides a new biological protocol for using cyclin dependent kinase inhibitors p27mt in suppressing the growth of tumor cells.
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OBJECTIVE:To provide reference for perfecting the "Regulation of Drug Price Difference" issued by National Development and Reform Commission.METHODS:To review the drug price management course in China,analyze the effects and limitations since the initiation of "Regulation of Drug Price Difference" in 12 hospitals in Beijing and put forward suggestions for its improvement.RESULTS & CONCLUSIONS:"Regulation of Drug Price Difference" has contributed to the formation of unified and standard evaluation criterion and computation method or even the holistic evaluation system in drug pricing management,the lowering of the costs of human factors and administrative management in drug price management and the improvement of the governmental pricing efficiency.However,efforts should be taken to improve the unreasonable drug price difference coefficient and computation method and so on.
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In order to be in accordance with the development of college education,the contents and methods of the teaching of basic biochemical experiment as well as test evaluation were reformed.Experimental teaching was classified as three types: the element,the improvement and the research.Besides,contents was chosen and the order was reasonably arranged.Results showed that under the new teaching system,college students realized the importance of biochemical experiment and experimental skills were improved.