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With the rapid development of aging around the world， the incidence and prevalence of age-related dementia have increased significantly， leading to a huge burden on patients， families and society. So far， there are no drugs that can completely reverse degeneration of the nervous system. The core pathological mechanisms of dementia are not clear， and the occurrence and progression of degenerative diseases in the nervous system appears to be only rely on the prevention through lifestyle interventions. Among lifestyle interventions， a large amount of laboratory evidence and a small amount of epidemiological evidence suggest that time restricted feeding have excellent effects on preventing the occurrence and progression of degenerative diseases in the nervous system. However， due to the lack of evidence in human population， the application of time restricted feeding lacks scientific basis. By synthesizing the existing evidence， this review discussed the pathway network of time restricted feeding that antagonizes the nervous system degradation， suggesting that future studies should focus on population evidence and the combined effects of multiple effect pathways.
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ObjectiveTo analyze the effect of frailty status on the risk of mortality in a community-based population aged 45 years and above in Shanghai with different characteristics， and to provide further basis for population-based interventions for frailty and prevention of adverse outcomes. MethodsData were derived from baseline data from the Shanghai prospective study on AGEing and adult health （2009-2010） and cohort follow-up of causes of death up to October 30， 2021. Frailty index （FI） scores were constructed from 40 variables. Those with frailty index FI≥0.2 were judged to be in a frail state， and a multifactorial Cox regression model was used to calculate the hazard ratio （HR） to evaluate the effect of frailty status on the risk of death in different age groups by gender. Socioeconomic characteristics （age， residence， marital status， education and family economic level， etc.） and health-related behaviors （smoking， alcohol consumption， fruit and vegetable intake， social participation， etc.） were included as control variables. ResultsThe study included 7 978 subjects， 777 （9.7%） of whom were in a frail state. After （11.3±1.8） years of follow-up， 1 043 （13.1%） individuals were dead， including 214 （27.5%） who were frail. The results of the multifactorial Cox regression analysis showed that the effect of frailty on the risk of death in each subgroup was in descending order of men in the middle-aged group （45‒ years） （HR=2.92， 95%CI： 1.38-6.19）， women in the low-aged elderly group （60‒ years） （HR=1.68， 95% CI： 1.08-2.60）， and women in the old-aged elderly group （≥75 years and older） （HR=1.59， 95%CI： 1.22‒2.06）. ConclusionFrailty is associated with the risk of death， and we should focus on the frailty status of men aged 45~59 years and women aged 60 years and above. Early screening and assessment of frailty status and taking appropriate preventive interventions may reduce the occurrence of adverse outcomes and premature death.
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Objective@#To observe and compare the effects of two standards on the overweight trend in urban Shanghai infants and young children.@*Methods@#A cluster randomized controlled trial was conducted in 19 communities in two districts of Shanghai, and the subjects (n=15 019) were divided into S-group and W-group by sealed envelope randomization. The subjects were newborns born between November 2013 and December 2014. The 2005 Shanghai growth standard was applied in the S-group and the 2006 WHO growth standard was used in the W-group. At each follow-up time point age of 1, 2, 4, 6, 9, 12 and 18 months, the outpatient physician assessed the length and weight of the infants according to the standard adopted by each group and provided feeding guidance. The weight-for-age Z scores (WAZ), length-for-age Z scores (LAZ) and weight-for-length Z scores (WLZ) were calculated according to the WHO standard. Weight, length, WAZ, LAZ, WLZ and overweight ratio (WLZ≥2) were compared between the two groups using t test, Wilcoxon test and χ2 test.@*Results@#A total of 6 509 infants (3 391 were boys, 3 118 were girls) were in the W-group, and 8 510 infants (4 374 were boys, 4 136 were girls) were in the S-group. Among the boys, the weight values at the age of 4, 6, 9, 12, 18 months in the W-group were all lower than those in the S-group ((7.5±0.8) vs. (7.7±0.8) kg, (8.6±0.8) vs. (8.7±0.8) kg, (9.6±0.9) vs. (9.7±0.9) kg, (10.4±1.0) vs. (10.5±1.0) kg, (11.5±1.1) vs.(11.7±1.1) kg; t=4.329, 2.422, 3.739, 2.451, 2.736; P<0.01, 0.015,<0.01, 0.014, 0.009). The length had no significant difference between two groups at all months of age(all P>0.05). The overweight ratio in the W-group was lower than that in the S-group at the age of 9, 12, 18 months(3.3% (71/2 170) vs. 4.9% (143/2 927), 2.5% (51/2 037) vs. 4.5% (126/2 818), 0.8% (7/832) vs. 3.1% (39/1 266); χ2=6.520, 14.209, 12.350; P=0.011,<0.01,<0.01).Among the girls, except at the age of 2 months (W-group (5.6±0.6) vs. S-group (5.7±0.6), t=2.935, P=0.003), weight values had no significant difference between the two groups at other age months (all P>0.05).The length in the W-group was higher than that in the S-group at 12 and 18 months of age ((75.6±2.4) vs.(75.5±2.3)cm, (82.4±2.9) vs.(82.2±2.7) cm; t=2.351, 2.197; P=0.019, 0.028). The ratio of overweight in the W-group was lower than that of S-group at the age of 12 and 18 months (1.8% (33/1 871) vs.3.0% (80/2 658), 0.6% (5/790) vs.1.7% (20/1 178); χ2=6.764,4.276; P=0.009, 0.039).@*Conclusions@#The application of WHO growth standard can help to reduce the weight gain rate of boys, promote the linear growth of girls, and thus alleviate the overweight trend of infants within 18 months. It suggested that 2006 WHO growth standard should be applied to infants within 1 year of age in Shanghai.
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Objective@#To investigate the association between daily sedentary time and frailty among people aged 50 years and over.@*Methods@#Cross-sectional data was collected from the first wave of World Health Organization Study on global AGEing and adult health in China. A two-level (individual level and community level) logistic model was performed to identify the association between daily sedentary time and frailty. The dose-response relationship between them was analyzed by restrictive cubic spline curve.@*Results@#A total of 13 175 individuals aged 50 years and over were included for analysis. A positive association between daily sedentary time and frailty was noticed, both in urban (OR=1.22, 95%CI: 1.17-1.27) or rural areas (OR=1.11, 95%CI: 1.05-1.18) under study. The dose-response curve showed that daily sedentary time and frailty might present an approximate linear relationship.@*Conclusion@#Results from this study showed significant association exsited between daily sedentary time and frailty, approximately with a linear dose-response relationship.
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Objective@#To investigate the association between sleep duration and frailty among people aged 50 years and over.@*Methods@#Cross-sectional data was collected from the first wave of World Health Organization Study on global AGEing and adult health in China. Frailty index was constructed on the proportion of deficits, out of the 40 variables. A two-level (individual level and community level) linear model was performed to identify the related factors on frailty. All the models were stratified by age, gender, residence (urban/rural). Restricted cubic spline was performed to graphically evaluate the dose-response association between self-reported sleep duration and frailty.@*Results@#A total of 13 175 individuals aged 50 years and over participated in this study. Without adjusting on any confounding factors, shorter or longer sleep duration significantly increased the risk of weakness compared with normal sleep time (OR=2.05, 95%CI: 1.71-2.44; OR=1.35, 95%CI: 1.12-1.63). After adjusting for confounding factors such as gender, age, residence, education, family assets, vegetable, smoking, drinking and physical activity, a positive association between short sleep duration and frailty was noticed compared with normal sleep time (aOR=1.60, 95%CI: 1.27-2.01). The results of stratified analysis on sex, age and urban and rural areas showed that, after adjusting for gender, age, residence, education level, family assets, intake of vegetables and fruits, smoking, drinking and physical activity, only shorter sleep duration was positively correlated with the risk of weakness. In addition, among people aged 65 years and over, adjusted for confounding factors, the risk of weakness increased by 91%, compared with normal sleep time (aOR=1.91, 95%CI: 1.46-2.49). The dose-response curve also showed that the sleep duration and frailty present an approximate "U" shaped relationship.@*Conclusion@#Short sleep duration might be associated with frailty.
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Objective@#To explore the relationship between physical activity level and quality of life among people aged 50 years and over.@*Methods@#From October 2009 to June 2010, 8 872 middle-aged and elderly people aged 50 years and over, were selected from five districts of Shanghai, by multi-stage random cluster sampling method. Both Global Physical Activity Questionnaireand World Health Organization Quality of Life Scale (WHOQoL-8) were used to assess the physical activity, level and quality of life. A two-level (individual level and community level) linear model was used to analyze the relationship between physical activity level and quality of life in different age groups.@*Results@#A total of 8 454 individuals aged (63.16±9.74) years were included in this study. 59.95% of the people in this study were with low physical activity level, while 28.00% and 12.05% of them were with medium or high levels of physical activities. The WHOQoL-8 score appeared as 43.91±0.69. The higher the level of physical activity, the lower the WHOQoL-8 score was, referring to a better quality of life (P=0.00). After controlling the confounding factors of socio-economic factors, health status and social participation, the increase of physical activity level showed significant effect in improving the quality of life for the middle-aged and under 80 elderly (P<0.05). However, compared with the low-level, middle and high-level physical activities did not improve the quality of life among the people aged 80 years and over. The P values were 0.06 and 0.47, respectively.@*Conclusion@#Higher level of physical activity appeared its relations to a better quality of life among people aged between 50 and 80, in Shanghai.
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Objective@#To examine the association between long-term exposure to ambient PM2.5 combined with indoor air pollution and handgrip strength among people aged 50 and over.@*Methods@#Data were from the first wave of World Health Organization Study on global AGEing and adult health in China. Ambient annual concentration of PM2.5 was estimated by using the satellite data we also investigated the use of fuels and chimneys as indoor air pollution. A two-level (individual level and community level) linear model was applied to examine the association between long-term exposure to ambient PM2.5 combined with indoor air pollution and the handgrip strength.@*Results@#A total of 13 175 individuals aged 50 years and over were included for analysis. The handgrip strength was (26.67±0.54) kg. Ambient PM2.5 was found to be significantly associated with the risk of decreased handgrip strength. Outdoor PM2.5 concentration was negatively correlated with handgrip strength (β=-0.23, 95%CI: -0.31 - -0.14) decrease in handgrip strength after adjusting for gender, age, residence, education, household assets, intake of vegetables and fruits, smoking and drinking, physical activity. In rural area, compared to those who used solid fuel, use of clean fuel increased (β=1.41, 95%CI: 0.36-2.46) handgrip strength. But in urban area, we did not find any statistically significant association between the use of clean fuel and handgrip strength (β=0.19, 95%CI: -0.95-1.32).@*Conclusion@#This study found that long-term exposure to ambient PM2.5 combined with indoor air pollution was significantly associated with low handgrip strength among people aged 50 years and over, this suggested that ambient PM2.5 might serve as one of the risk factors for low physical function seen in the people aged 50 years and over.
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Objective@#To investigate the association between edentulism and cognition in people aged 50 and over in China.@*Methods@#Cross-sectional data was collected from the first wave of World Health Organization Study on global AGEing and adult health in China, among people aged 50 and over in China. A comprehensive cognitive test was used to assess cognitive functions, including verbal recall (VR), verbal fluency (VF), forward digit span (FDS) and backward digit span (BDS) among the subjects. Association between edentulism and cognition was examined by a two-level (individual level and community level) linear model.@*Results@#A total of 12 843 individuals aged 50 years and over were included for analysis, with an average age of (63.0±9.3) years. The overall prevalence of edentulism was 11.0%. The edentulous adults had lower mean scores of VR (4.55), VF (10.88), FDS (6.25), BDS (2.96) and overall cognition (49.15) (P<0.001). Edentulism was negatively associated with VR (β=-0.216, 95%CI: -0.370 - -0.062), FDS (β=-0.186, 95%CI: -0.293 - -0.078) and overall cognition (β=-1.703, 95%CI: -3.025 - -0.381) after adjusted for age, sex, residence, education level, marital status, household income, co-morbidity of chronic conditions, BMI, smoking and drinking alcohol.@*Conclusion@#Edentulism was related with lower cognition level in people aged 50 and over in China.
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With accelerating and rapid ageing in China, there is an urgent need to collect reliable, valid and cross-nationally comparable data on health in the elderly to provide basis for richer and empirical analysis on the changing health over one’s life course and compression of morbidity. To meet the demands of this growing special population, planning and preparing on related social protection mechanisms (health and pension systems) should also based on evidence-based decision-making process. Based on long-term follow-up, large scale cohort study is indispensible for the etiology of common chronic diseases and disabling conditions. This study aims to introduce the background, project objectives, contents, baseline characteristics, strength and weakness as well as prospect, related to the Study on global AGEing and adult health in China.
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Objective To evaluate the subjective well-being feelings of people aged ≥50 years in Shanghai by using the Day Reconstruction Method (DRM) and explore the related factors.Methods A cross-sectional survey was conducted from October 2009 to June 2010 among people aged ≥50 years selected through multistage random cluster sampling in Shanghai.DRM was used to assess participants' subjective well-being by net effect and U-index.Univariate and multivariate linear regression models were used to explore the related factors.Results A total of 8 075 participants were included,with average age of 63.1 years.The mean net effect value was 1.24 (95％CI:1.15-1.33),and the mean U-index was 1.55％ (95％ CI:1.10％-1.99％).After adjusted for demographic factors,univariate liner regression model indicated that age,education level,marital status,family wealth,residence,self-rated health status,WHODAS score and prevalence of chronic disease were associated with subjective well-being,and multivariate liner regression model indicated that higher WHODAS score was associated with lower net effect value (P＜0.05).Conclusion The subjective well-being feelings of people aged ≥50 years in Shanghai might be associated with age,education level,marital status,family wealth,residence,self-rated health status and WHODAS score.Enhanced social support and appropriate social security system might facilitate the improvement of the subjective well-being of the elderly.
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Objective To investigate the associations of obesity and physical activity with cognition in the elderly.Methods A cross-sectional survey was conducted from October 2009 to June 2010 among people aged ≥50 years selected through multistage random cluster sampling in Shanghai.The subjects' body weight,body height,waist circumference and hip circumference were measured to calculate body mass index (BMI) and waist-hip ratio (WHR),and the data on self-reported physical activity level were collected through questionnaire survey.A comprehensive battery of cognitive tests was conducted to assess subjects' cognitive functions,including verbal recall,forward digit span (FDS),backward digit span (BDS),and verbal fluency (VF).General linear model was used to examine the associations of BMI,WHR and physical activity with cognition.Results A total of 7 913 participants were included,with a median age of 60 years.Age,sex,education level,income level,BMI,WHR and physical activity level were significantly associated with cognitive scores in univariate analysis.After adjusted for age,sex,education level and income level,BMI was no longer significantly associated with cognitive scores in all cognitive functions (all P＞0.01).WHR was significantly associated with VF score (P＜0.01).Abdominally obese participants had lower VF score than non-abdominally obese participants (P＜0.01).Physical activity level was significantly associated with all cognitive functions (P＜0.01).Compared with participants with moderate physical activity level,participants with low physical activity level had lower scores in all cognitive functions (P＜0.01).Conclusion Abdominal obesity and low physical activity level were negatively associated with cognition level in the elderly,suggesting that waist circumference control and physical activity might help maintain cognition in the elderly.
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Objective To estimate the incidence and distribution characteristics of fall related injury in people aged ≥50 years in 8 provinces in China and related physiological,psychological and social risk factors.Methods Cross-sectional data were collected from adults aged ≥50 years participating in the World Health Organization (WHO) study on global ageing and adult health (SAGE) round 1 in China.Two-level hierarchical logistic model was used to identify the related factors for fall-related injury.All the models were stratified by living area (urban/rural).Results Estimated incidence of fall related injury (road traffic injury was not included) was 3.2％.Ageing and multiple chronic conditions (OR=2.55,95％CI:1.41-4.64) was significantly associated with the incidence of fall related injury in urban area.In rural area,depression (OR=4.33,95％ CI:2.52-7.42) and multiple chronic conditions (OR=2.46,95％CI:1.37-4.41) were associated with the incidence of fall related injury.Conclusions This study estimated the incidence of fall related injury in adults aged ≥50 years in 8 provinces in China.A significant association between multiple chronic conditions and fall related injury were found in both urban and rural residents.Targeted measures should be taken for the prevention and control of chronic diseases in elderly population.
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Objective To evaluate the subjective well-being feelings of people aged ≥50 years in Shanghai by using the Day Reconstruction Method (DRM) and explore the related factors.Methods A cross-sectional survey was conducted from October 2009 to June 2010 among people aged ≥50 years selected through multistage random cluster sampling in Shanghai.DRM was used to assess participants' subjective well-being by net effect and U-index.Univariate and multivariate linear regression models were used to explore the related factors.Results A total of 8 075 participants were included,with average age of 63.1 years.The mean net effect value was 1.24 (95％CI:1.15-1.33),and the mean U-index was 1.55％ (95％ CI:1.10％-1.99％).After adjusted for demographic factors,univariate liner regression model indicated that age,education level,marital status,family wealth,residence,self-rated health status,WHODAS score and prevalence of chronic disease were associated with subjective well-being,and multivariate liner regression model indicated that higher WHODAS score was associated with lower net effect value (P＜0.05).Conclusion The subjective well-being feelings of people aged ≥50 years in Shanghai might be associated with age,education level,marital status,family wealth,residence,self-rated health status and WHODAS score.Enhanced social support and appropriate social security system might facilitate the improvement of the subjective well-being of the elderly.
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Objective To investigate the associations of obesity and physical activity with cognition in the elderly.Methods A cross-sectional survey was conducted from October 2009 to June 2010 among people aged ≥50 years selected through multistage random cluster sampling in Shanghai.The subjects' body weight,body height,waist circumference and hip circumference were measured to calculate body mass index (BMI) and waist-hip ratio (WHR),and the data on self-reported physical activity level were collected through questionnaire survey.A comprehensive battery of cognitive tests was conducted to assess subjects' cognitive functions,including verbal recall,forward digit span (FDS),backward digit span (BDS),and verbal fluency (VF).General linear model was used to examine the associations of BMI,WHR and physical activity with cognition.Results A total of 7 913 participants were included,with a median age of 60 years.Age,sex,education level,income level,BMI,WHR and physical activity level were significantly associated with cognitive scores in univariate analysis.After adjusted for age,sex,education level and income level,BMI was no longer significantly associated with cognitive scores in all cognitive functions (all P＞0.01).WHR was significantly associated with VF score (P＜0.01).Abdominally obese participants had lower VF score than non-abdominally obese participants (P＜0.01).Physical activity level was significantly associated with all cognitive functions (P＜0.01).Compared with participants with moderate physical activity level,participants with low physical activity level had lower scores in all cognitive functions (P＜0.01).Conclusion Abdominal obesity and low physical activity level were negatively associated with cognition level in the elderly,suggesting that waist circumference control and physical activity might help maintain cognition in the elderly.
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Objective To estimate the incidence and distribution characteristics of fall related injury in people aged ≥50 years in 8 provinces in China and related physiological,psychological and social risk factors.Methods Cross-sectional data were collected from adults aged ≥50 years participating in the World Health Organization (WHO) study on global ageing and adult health (SAGE) round 1 in China.Two-level hierarchical logistic model was used to identify the related factors for fall-related injury.All the models were stratified by living area (urban/rural).Results Estimated incidence of fall related injury (road traffic injury was not included) was 3.2％.Ageing and multiple chronic conditions (OR=2.55,95％CI:1.41-4.64) was significantly associated with the incidence of fall related injury in urban area.In rural area,depression (OR=4.33,95％ CI:2.52-7.42) and multiple chronic conditions (OR=2.46,95％CI:1.37-4.41) were associated with the incidence of fall related injury.Conclusions This study estimated the incidence of fall related injury in adults aged ≥50 years in 8 provinces in China.A significant association between multiple chronic conditions and fall related injury were found in both urban and rural residents.Targeted measures should be taken for the prevention and control of chronic diseases in elderly population.
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Objective To analyze the prevalence rate and risk factors for aspiration pneumonia in elderly inpatients,and to identify a high-risk population for aspiration pneumonia.Methods Totally 398 inpatients aged ≥ 60 years in Beijing Hospital from April 2014 to April 2015 were selected.A questionnaire survey was performed for aspiration risk factors,including gender,age,smoking and drinking history,swallowing function,basal diseases,medication history,activities of daily living(ADL),occurrence of aspiration pneumonia over the past year.The patients were divided into aspiration pneumonia group and non-aspiration pneumonia group,and the prevalence rate and risk factors for aspiration pneumonia were studied.Results 364 cases with complete data were collected,and 14.3％ (52/364)were identified definitively as aspiration pneumonia over the past year.The ADL score was (77.0± 33.9) scales in aspiration pneumonia group,and (88.0 ± 22.2) scales in non-aspiration pneumonia group,with statistically significant difference (P＜ 0.05).The incidence rate of aspiration pneumonia was increased along with the increase of the age of patients.Risk factors for aspiration pneumonia were different in different age group.The proportion of patients aged 60-69,70-79 and over 80 years were 23.1％ (12 cases),36.5％ (19 cases),40.4％ (23 cases)in the aspiration pneumonia group,respectively.Under the condition of a propensity score-matched case-control pair design on 104 subjects with versus without aspiration pneumonia,the logistic regression analysis showed that smoking history,coronary heart disease,Parkinson's disease,dementia,chronic obstructive pulmonary disease(COPD),gastro-esophageal reflux disease(GERD),long-term uses of theophylline,calcium antagonists,nitrates,diazepam,antidepressants,anti-Parkinson drugs were the risk factors for aspiration pneumonia in elderly(all P＜0.05).Conclusions Smoking history,basal diseases and medication history are associated with the incidence rate of aspiration pneumonia in elderly.Assessment of these risk factors for aspiration pneumonia should be emphasized,and preventive measures should be considered conscientiously to lower the incidence rate of aspiration pneumonia in elderly.
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Objective To study the distinct clinical phenotype of chronic airway diseases by hierarchical cluster analysis and two-step cluster analysis.Methods A population sample of adult patients in Donghuamen community,Dongcheng district and Qinghe community,Haidian district,Beijing from April 2012 to January 2015,who had wheeze within the last 12 months,underwent detailed investigation,including a clinical questionnaire,pulmonary function tests,total serum IgE levels,blood eosinophil level and a peak flow diary.Nine variables were chosen as evaluating parameters,including pre-salbutamol forced expired volume in one second(FEV1)/forced vital capacity (FVC) ratio,pre-salbutamol FEV1,percentage of post-salbutamol change in FEV1,residual capacity,diffusing capacity of the lung for carbon monoxide/alveolar volume adjusted for haemoglobin level,peak expiratory flow (PEF) variability,serum IgE level,cumulative tobacco cigarette consumption (pack-years) and respiratory symptoms (cough and expectoration).Subjects' different clinical phenotype by hierarchical cluster analysis and two-step cluster analysis was identified.Results (1) Four clusters were identified by hierarchical cluster analysis.Cluster 1 was chronic bronchitis in smokers with normal pulmonary function.Cluster 2 was chronic bronchitis or mild chronic obstructive pulmonary disease (COPD) patients with mild airflow limitation.Cluster 3 included COPD patients with heavy smoking,poor quality of life and severe airflow limitation.Cluster 4 recognized atopic patients with mild airflow limitation,elevated serum IgE and clinical features of asthma.Significant differences were revealed regarding pre-salbutamol FEV1/FVC％,pre-salbutamol FEV1％ pred,postsalbutamol change in FEV1 ％,maximal mid-expiratory flow curve (MMEF)％ pred,carbon monoxide diffusing capacity per liter of alveolar(DLCO)/(VA)％ pred,residual volume(RV)％ pred,total serum IgE level,smoking history (pack-years),St.George' s respiratory questionnaire (SGRQ) score,acute exacerbation in the past one year,PEF variability and allergic dermatitis (P ＜ 0.05).(2) Four clusters were also identified by two-step cluster analysis as followings,cluster 1,COPD patients with moderate to severe airflow limitation;cluster 2,asthma and COPD patients with heavy smoking,airflow limitation and increased airways reversibility;cluster 3,patients having less smoking and normal pulmonary function with wheezing but no chronic cough;cluster 4,chronic bronchitis patients with normal pulmonary function and chronic cough.Significant differences were revealed regarding gender distribution,respiratory symptoms,pre-salbutamol FEV1/FVC％,pre-salbutamol FEV1 ％ pred,post-salbutamol change in FEV1 ％,MMEF％ pred,DLCO/VA％ pred,RV％ pred,PEF variability,total serum IgE level,cumulative tobacco cigarette consumption (pack-years),and SGRQ score (P ＜ 0.05).Conclusion By different cluster analyses,distinct clinical phenotypes of chronic airway diseases are identified.Thus,individualized treatments may guide doctors to provide based on different phenotypes.
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Objective To explore the clinical phenotype of airways disease in elderly patients using hierarchical cluster analysis.Methods A total of 67 elderly patients with respiratory symptoms were enrolled in a prospective study.Demographic and clinical data,such as respiratory symptoms,cumulative tobacco cigarette consumption,acute exacerbation,atopic symptoms and peak flow diary were collected.Pulmonary function tests,blood tests (total serum IgE level and blood eosinophil level) were performed in each patient during the stable stage.Then patients with different clinical phenotype were identified by hierarchical cluster analysis.Results Four clusters were identified with the following characteristics by hierarchical cluster analysis:cluster 1,atopic patients with no smoking,normal lung function,but increased total serum IgE levels and asthma symptom;cluster 2,patients with no smoking and normal pulmonary function with wheezing but without chronic cough;cluster 3,patients with chronic obstructive pulmonary disease and smoking,severe airflow limitation and poor quality of life;cluster 4,patients with asthma-chronic obstructive pulmonary disease overlap syndrome and smoking,airflow limitation and increased total serum IgE levels.The forced expiratory volume in 1 second (FEV1) / forced vital capacity (FVC) ratio,FEV1/predicted value,rate of FEV1 change,maximal mid-expiratory flow (MMEF)/ predicted value,the diffusion lung capacity for carbon monoxide (DLCO)/alveolar volume (VA)/predicted value,residual volume (RV)/ predicted value,total serum Ig E levels,cumulative tobacco cigarette consumption,the St.George's Respiratory Questionnaire (SGRQ) score had significant differences in patients before versus after treatment (all P＜0.05 or P＜0.01).Conclusions Based on hierarchical cluster analysis,distinct clinical phenotypes of airways disease in elderly patients can be identified.Conclusions With patients having asthma or COPD alone,patients with Asthma-COPD overlap syndrome (ACOS) always experience a more rapid decline in lung function and frequent exacerbations,having poor health-related quality-of-life (HRQOL) outcomes,which deserve our high attention.
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Objective To investigate certain risk factors for and their impact on abnormal liver function in middle-aged and elderly adults.Methods A case-control study was constructed based on the SAGE cohort of 8642 registered residents aged 50 years or over in Shanghai.Of them,137 individuals with abnormal liver function,defined as aspartate transaminase (AST)＞ 40 U/L or alanine aminotransferase (ALT)＞ 40 U/L,were randomly selected as the observation group,while 411 healthy controls were 3 ∶ 1 matched with the cases in the observation group by gender and age (1 year).Face-to-face administered questionnaires and physical examinations were conducted and serum samples were tested for ALT,AST,glucose (GLU),total cholesterol (TC),triglycreide (TG),hepatitis B surface antigen (HbsAg) and anti-hepatitis C virus antibody (anti-HCV Ab).Chi square test and rank sum test were used for single factor analysis,and logistic regression analysis was used for multiple factors.Results The prevalence of HBsAg positive patients was 12.4 ％ (68/548) Univariate analysis showed that hepatitis virus infection and body mass index (BMI) were associated with abnormal liver function (both P＜0.000).Multivariate logistic regression analysis showed that hepatitis virus infection (OR=1.85,95％ CI:1.04 3.29,P-0.036) and obesity (OR=3.60,95％CI:1.92-6.73,P＜0.001) increased the risk of abnormal liver function,whereas chronic medication (OR=0.51,95％ CI:0.32-0.80,P =0.004) decreased the risk of abnormal liver function.Conclusions Among the study population,hepatitis virus infection and obesity are risk factors for abnormal liver function in middle-aged and elderly people.After adjustment for potential confounders,chronic medication is negatively correlated with abnormal liver function and may be a protective factor for liver function.
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Objective To explore the characteristics of clinical features,diagnosis,treatment and prognosis in acute fibrinous and organizing pneumonia (AFOP) patients.Methods We described an 80-year-old woman who was diagnosed with AFOP and got better after treatment with glucocorticoids.Clinical data of 51 patients which have been published in literatures in China and abroad were retrospectively analyzed.The differences in characteristics of clinical features were compared between the elderly and non-elderly patients.Results The case reported herein,who was a 80-year-old female with latent autoimmune diabetes in adults (LADA),presented with fever,dry cough and progressive dyspnea.Chest CT scan showed bilateral multiple patchy consolidation.CT-guided needle aspiration was performed and the pathological examination finding was consistent with AFOP.The patient was treated with oral methylprednisolone and experienced a significant improvement in symptoms and imaging manifestations.But she presented with deterioration with relapsing clinical symptoms when she discontinued corticosteroid treatment by herself,and the clinical symptoms were improved by retreatment.Clinical data of 51 reported cases with AFOP including 27 males and 24 females aged 38 d to 80 years were enrolled and analyzed in the study.Patients aged 60 years and over accounted for 47.1％ (24 cases).No risk or predisposing factor was found in most of cases.Autoimmune diseases were the most common combined diseases in AFOP patients.The top three symptoms were dyspnea (80.4％,41 cases),cough (64.7％,33 cases) and fever (52.9％,27 cases).The incidence of dyspnea was lower in elderly patients than in non-elderly patients [66.7％ (16/24) vs.92.6％ (25/27),P＜0.05],and ground glass opacity in the chest image was also less in elderly patients than in non-elderly patients (P＜0.05).15 patients (29.4％) got definitive diagnosis by minimally invasive procedures including percutaneous lung puncture biopsy or transbronchial lung biopsy.Corticosteroids were the main drug treatment,and 39 cases (76.5 ％) received antibacterial drugs.The mortality rate of AFOP was 37.3％ (15 cases).The average time from symptom onset to final diagnosis was shorter in dead cases than in recovered patients (19 days vs.40 days,P＜0.05).The rate of using mechanical ventilation was higher in dead cases than in recovered patients [57.9 ％ (11/19) vs.9.4％ (3/32),P＜0.05].Conclusions There are no specific clinical and imaging features in AFOP,which is easily misdiagnosed as infectious diseases.AFOP is more common in elderly patients.Dyspnea and other symptoms can easily be ignored,and minimally invasive biopsy and pathological examination findings is helpful for diagnosis.The mortality rate of AFOP is high,and insufficient course of therapy is associated with the increased risk of AFOP relapse.Rapid progression of disease and the invasive mechanical ventilation predispose poor outcomes.