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Objective:To assess the reliability, constructive validity and item characteristics of the general self-efficacy scale (GSES) among Chinese medical postgraduates using classical test theory and item response theory.Methods:A questionnaire survey was conducted among 1 021 medical postgraduates from 6 comprehensive level Ⅲ A hospitals in Beijing. Demographic characteristics and general self-efficacy were investigated. SPSS 24.0 software was used for statistical analysis. Internal consistency of the GSES was evaluated using Cronbach’s α coefficient and intraclass correlation coefficient. Factor analyses were implemented to test the structure of the scale. An item response theory (IRT) framework with a graded response model was performed to estimate the parameters of each item. Results:The overall Cronbach’s α coefficient of the GSES was 0.92. Parallel analysis and confirmatory factor analysis supported the unidimensional structure of the GSES. The discrimination parameter of the 10 items ranged from 1.82 to 3.65, and the difficulty parameter ranged from -3.51 to 1.66, with a monotonically increasing trend. The maximum test information of the scale among medical postgraduates was 19.16. Conclusion:The GSES has good reliability, validity and measurement precision, showing a good applicability in the survey of medical postgraduates. However, the difficulty of specific items is relatively low, and the scale may be further optimized and improved.
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Objective:To assess the correlation between frailty and cardiac autonomic nervous system function in elderly patients.Methods:Elderly hospitalized patients aged 65 years and over were enrolled and assessed for frailty by using the clinical frailty scale.Cardiac autonomic modulation was evaluated by heart rate variability analysis through 24 h electrocardiogram recording.Results:A total of 180 elderly patients were enrolled in this study, including 66 patients with frailty and 114 patients without frailty.The mean age of the frailty group was higher than that of the non-frailty group(79.8±6.0 vs.75.0±6.3, t=5.030, P<0.001). The proportions of patients with hypertension, stroke/transient cerebral ischemia attack(TIA), heart failure and osteoarthritis were higher in the frailty group than in the non-frailty group(all P<0.05). Compared with the non-frailty group, the standard deviation of normal-to-normal intervals(SDNN)[103.0(76.0, 121.2) vs.107.5(92.0, 136.0), Z=-2.108, P=0.035], the standard deviation of the averages of NN intervals in all 5-min segments(SDANN)[86.0(67.7, 106.5) vs.97.5(78.0, 126.0), Z=-2.694, P=0.007], normalized low frequency(LFnorm)(53.1±13.0 vs.59.3±13.9, t=-3.024, P=0.003)and low frequency/high frequency(LF/HF)ratio[1.2(1.0, 1.4) vs.1.4(1.1, 1.7), Z=-3.041, P=0.002]were decreased and normalized high frequency(HFnorm)(36.8±9.2 vs.32.2±10.7, t=3.033, P=0.003)was increased in the frailty group.HFnorm in the frailty group was significantly higher than that in the non-frailty group.The incidents of SDANN<92 ms, LFnorm<50 nU, HFnorm>32 nU and LF/HF ratio<1.5 were higher in the frailty group than in the non-frailty group(59.1% or 39/66 vs.41.2% or 47/114, 42.4% or 28/66 vs.22.8% or 26/114, 72.7% or 48/66 vs.49.1% or 56/114, 84.8% or 56/66 vs.65.8% or 75/114, χ2=5.346, 7.660, 9.547, 7.664, P=0.021, 0.006, 0.002, 0.006). Logistic multivariate regression analysis showed that LFnorm, HFnorm and LF/HF ratio were correlated with frailty( OR=0.971, 1.039 and 0.333, all P<0.05), and HFnorm>32 nU and LF/HF ratio<1.5 were risk factors for frailty( OR=2.401 and 2.773, both P<0.05). Conclusions:Cardiac autonomic nerve system function is impaired in elderly frail patients, with the imbalance between the sympathetic and vagus nerves.Therefore particular attention should be paid to heart rate variability in elderly patients with frailty.
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Objective:To review the development and progress of geriatric research in China from the perspective of funding from the National Natural Science Foundation of China, and to provide supporting data for further development of the field.Methods:Based on project funding data of the National Natural Science Foundation of China for geriatric medicine from 2008 to 2017, the number and composition of projects, funding amount and funded institutions were statistically analyzed, and the overall trend of change was examined.The research hotspots in recent years were summarized by using word frequency analysis.Results:From 2008 to 2017, a total of 446 projects were approved in the field of geriatric medicine.Both the number of projects and the amount of funding showed an increasing trend.Project types were gradually expanded and the composition was constantly optimized.Since 2014, the fund types each year included 6 or more and breakthroughs in major projects were achieved.East China remained the leading region in the number of projects and amount of funding, with Beijing, Shanghai and Zhejiang receiving the highest numbers of project approvals and accounting for more than 10% of the national total in the number of project approvals and the amount of funding.During this period, 114 institutions received funding, with 74 winning 2 or more projects.In word frequency analysis, senescence(229 times), cell(161 times)and protein(120 times)were the three most frequently used keywords.Conclusions:In the field of geriatric medicine, the project approval level from the National Natural Science Foundation of China has significantly improved in quantity and quality, but it has always been under-represented in the branch of medical sciences.The regional and institutional distribution of projects is unbalanced and tends to skew in favor of institutions with prominent academic disciplines.Basic research is the main type of funded projects.Geriatric research is centered on the mechanisms of aging.
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Objective:To compare the prediction efficiency of traditional linear regression model and four machine learning models on the learning behavior of clinical medical postgraduates, and to explore the pros and cons and applicability of different prediction models.Methods:A total of 6,922 clinical medical postgraduates were surveyed, their comprehensive learning behavior scores were obtained through the learning behavior scale. In the training set, Lasso linear regression and artificial neural network, decision tree, Bootstrap random forest, and lifting tree were used to build prediction models respectively. The above models were used to predict the validation set data and compare the prediction efficiency.Results:The comprehensive learning behavior score of clinical medical postgraduates was (3.31±0.54) points, and the overall compliance rate was 74.02%. In the linear regression model, the influence of age, school level, degree type, learning interest, pressure and satisfaction on learning behavior were statistically significant. In the prediction of validation set, the sensitivity, specificity, and accuracy of the linear regression model were 0.484, 0.914, and 0.801, respectively. The indexes of the four machine learning models were higher than those of the traditional linear regression model, and the Bootstrap random forest had the highest elevation.Conclusion:The linear regression model has a good prediction effect on learning behavior, and machine learning is superior to linear regression model in terms of accuracy of prediction. However, traditional linear regression models are superior to machine learning models in computational efficiency and interpretability.
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Objective:To assess the cardiac autonomic nervous function in elderly patients with frailty.Methods:Patients aged ≥ 65 years old admitted in Beijing Hospital from September 2018 to August 2019 were enrolled in this study. Clinical frailty score was used to assess the frailty. The cardiac autonomic modulation was evaluated by sinus heart rate turbulence analysis through 24 h electrocardiogram recording.Results:A total of 129 elderly patients were finally enrolled in this study with a mean age of (77.5±6.4) years, 58.1% of them were male. There were 53 patients in frail group and 76 patients in non-frail group. The age of the frailty group was significantly higher than that of the non-frailty group [(80.5±5.5) vs.(75.3±6.2)]; the prevalence of hypertension [84.9%(45/53)], heart failure [32.1%(17/53)] and peripheral vascular diseases [32.1%(17/53)] in the frailty group was significantly higher than that in the non-frailty group [65.8%(50/76), 1.3%(1/76), 17.1%(13/76); t=5.001, χ 2=5.879, 24.606, 3.921; all P<0.05]. Compared with non-frailty group, turbulence onset (TO) [-0.05(-0.92, 0.82)% vs. -0.74(-1.58, 0)%; Z=2.616, P=0.009] was significantly higher in frailty group, while turbulence slope (TS) [2.34(1.30, 5.00)ms/RR vs. 4.34(2.66, 6.39)ms/RR; Z=-3.048, P=0.002] was significantly lower. The rate of TO abnormality [49.1% (26/53) vs. 26.3%(20/76), χ 2=7.038, P=0.008] and TS abnormality [34.7%(29/53) vs. 21.0%(16/76); χ 2=15.579, P<0.001] in the frailty group was significantly higher than that in the non-frailty group. Multivariate logistic regression analysis showed that TO abnormality( OR=2.970, P=0.010, 95 %CI:1.300-6.785) and TS abnormality( OR=3.618, P=0.003, 95 %CI:1.565-8.364) were correlated with frailty. Conclusion:Cardiac autonomic nerve function may be impaired in elderly frail patients, and decreased vagal nerve tension may be presented.
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Objective To investigate the effect of antithrombotic strategies on cerebrovascular events in aged patients with nonvalvular artial fibrillation(nvAF).Methods The clinic data of 101 patients aged 80 years and over with nvAF admitted from January 2005 to June 2016 were retrospectively analyzed.The stroke and transient ischemic attack (TIA) occurred in 29 patients (28.7％,stroke/TIA group) and the remaining 72 patients were assigned in non-stroke/TIA group.The antithrombotic schemes and the antithrombotic drug-related bleeding were compared between two groups.Results Among 101 patients,there were 70 cases receiving antiplatelet therapy,19 cases receiving anticoagulation therapy and 12 cases receiving no antithrombotic therapy.The nvAF history was longer in the stroke/TIA group than that in non-stroke/TIA group [15.0(8.0,17.5) vs.6.0(3.0,12.8),Z=-3.645,P＜0.01];the proportion of anticoagulation therapy was higher in non-stroke/TIA group than that in stroke/TIA group (18/72 vs.1/29,x2=5.778,P＜0.01).The occurrence of medication-related bleeding was 15.6％(14/90) in patients with antiplatelet therapy and 12.0％(3/25) in patients with anticoagulation therapy (x2=0.196,P=0.658).There was no significant difference in the first time of stroke/TIA attack among patients with different antithrombotic schemes(x2=0.859,P=0.651).Conclusion The aged patients with nvAF are in a high risk of thromboembolism,but the proportion of using antithrombotic therapy is low.Anticoagulation therapy has a protective effect against the occurrence of stoke/TIA without increasing the risk of bleeding,which makes anticoagulation therapy advisable in the elderly patients.
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The present clinical doctorate system has some irrationalities in the connection with professional qualification . According to analyses of main problems in recruitment , training objective , curriculum design and clinical examination, we proposed some suggestions for carrying forward the comprehensive pilot system: clarify the training objective and improve the overall understanding of reform;improve the examination condition and standardize the recruitment process; improve the curriculum system and reform the teaching method; strengthen the way of quality examination and supervision; attach more attention on constructing tutor teams and explore the way of joint guidance.
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Hyperuricemia is independently associated with hypertension.Hyperuricemia can promote the development and progression of hypertension via various mechanisms and cause damage to target organs.Uric acid-lowering drugs have small but significant effects on blood pressure in the elderly.
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Objective To explore the relationship between advancing age and the risk of developing coronary artery disease(CAD) ,type 2 diabetes mellitus(T2DM ) ,and both coronary artery disease and type 2 diabetes mellitus(CAD+ T2DM ). Methods A case-control study was conducted to investigate the relationship between advancing age and the risk of CAD ,T2DM ,and CAD+ T2DM in middle-aged and elderly patients. Results Aging was independently associated with increased risk of T2DM and CAD + T2DM (P＜0.05).Compared with patients aged below 60 ,the risk of T2DM was higher in patients aged 70 or over(OR＝3.80 ,95% CI :2.39-6.04 ,P＝0.000) ;The risk of CAD+ T2DM was lower in patients aged below 60 than in patients aged 60 to 69(OR＝4.14 ,95% CI :2.60-6.60 ,P＝ 0.000)and in patients aged 70 or over (OR ＝ 11.50 ,95% CI :7.18-18.42 ,P＝ 0.000) . Patients of older ages had a 2.78 times higher risk of developing CAD+ T2DM. Conclusions The onset of T2DM ,and CAD+ T2DM is associated with age.
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Objective To retrospectively analyze the treatments of nonvalvular atrial fibrillation (nvAF) in elderly patients aged 80 years and over,and to investigate the influencing factors for occurrence of stroke and transient ischemic attack(TIA)and relationships between antithrombotic therapy and stroke or TIA.Methods 101 elderly patients with nvAF were enrolled and grouped according to the occurrence of stroke/TIA and antithrombotic-correlated bleeding.The influencing factors were retrospectively analyzed and antithrombotic schemes were compared.Results Incidence rate of stroke/TIA was 28.7％ (29/101).Among all patients,70 cases were treated with antiplatelet therapy,19 cases were treated with anticoagulation therapy,while 12 cases received no antithrombotic (antiplatelet or anticoagulation) therapy before stroke.Both the nvAF time course and the antithrombotic strategy were significantly different between post-AF stroke/TIA group and non-postAF stroke/TIA group(both P＜0.05).The difference was reflected in ratios of antiplatelet therapy/anticoagulation therapy.The proportion of anticoagulation therapy was higher in non stroke/TIA group(x2 =5.778,P =0.016).Different antiplatelet therapy scheme significantly affected occurrence of stroke/TIA(P＜0.05).There was no significant effect of antithrombotic schemes on hemorrhagic events(x2=0.708,P =0.702).Multiple logistic regression analysis showed that hypertension,coronary heart disease,cancer,diabetes and previous stroke history,as well as nvAF duration were the independent risk factors for post-AF stroke/TIA(OR=1.351,95 ％CI:1.129-1.617).Conclusions Currently,the proportion using anticoagulation therapy is low,and single antiplatelet therapy is the main regimen in the elderly patients with nvAF.For elderly patients with nvAF,anticoagulation therapy has a protective effect against the occurrence of post-nvAF stroke/TIA,meanwhile there is no significantly increased risk of bleeding,which makes anticoagulation therapy advisable in the elderly.The nvAF time course is one of the risk factors,which is worth experts' attention in risk evaluation of thrombus in elderly patients.
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Objective To investigate the accuracy of transthoracic echocardiography (TTE) for diagnosing left cardiac valve calcification in elderly patients.Methods In this retrospective study,410 elderly patients died in Beijing Hospital from 1982 to 2015 were collected.They all had full pathological cardiac valve examination data in the autopsy examination and full mortem TTE data.They were classified into three groups according to the year of death:group 1982-1995,group 1996-2005 and group 2006-2015,as well as into three groups according to the age of death:group 60-75,group76-90 and group 91-106.Results The sensitivity,specificity,diagnostic coincidence rate,positive likelihood ratio (PLR),negative likelihood ratio (NLR),positive predictive value (PPV) and negative predictive value(NPV) of TTE versus autopsy pathological findings as golden standard for diagnosing left cardiac valve calcification were 88.6％,28.2％,43.7％,1.234,0.405,0.298 and 0.878.Compared with group 1982-1995,the group 1996-2005 and group 2006-2015 showed the sensitivity and PPV of TTE versus golden standard autopsy findings for diagnosing left cardiac valve calcification in the elderly were increased while the specificity,PLR,NLR and NPV were decreased.Compared with group 60-75,the group 76-90 and group 91-106 showed that the sensitivity and PPV of TTE versus golden standard autopsy findings for diagnosing left cardiac valve calcification were increased,while the specificity and diagnostic coincidence rate were decreased.The sensitivity,specificity,diagnostic coincidence rate,PLR,NLR,PPV,NPV of TTE versus golden standard autopsy findings for the diagnosis of aortic valve calcification and mitral valve calcification in the elderly were 88.2％ and 44.0％,30.8％ and 75.3％,42.7％ and 71.5％,1.275 and 1.780,0.382 and 0.744,0.250 and 0.198,0.909 and 0.906,respectively.Conclusions TTE provides high sensitivity for diagnosing left cardiac valve calcification in the elderly,especially for diagnosing the aortic valve calcification,but the specificity is not satisfactory.
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Objective@#To assess the immunogenicity and safety of recombinant B-subunit/whole cell cholera vaccine (rBS/WC) oral cholera vaccine (Ora Vacs) infused with antacids in healthy population at ages of 2-6 years.@*Methods@#Between December 2009 and January 2010, we recruited 900 volunteers aged 2-6 years od through giving out recruitment notice for the eligible children's parents from different vaccination clinics of Chongzuo city in Guangxi Zhuang Autonomous Region. This study was a randomized, double-blind, placebo-controlled trial, and subjects were randomly (2∶1) assigned to receive Cholera vaccine infused with antacids or placebo, and observed for safety. Serum samples of 300 subjects in immunogenicity subgroups (200 for vaccine groups, 100 for control groups) before the 1st dose and 49 d (±3 d) after immunization were collected, and determined for antibody levels against the cholera toxin (anti-CT) and cholera vibriocidal (anti-Vab) with Enzyme-linked immunosorbent assays (ELISA), based on which the GMT was calculated. There were 266 cases paired with the serum samples before and after immunization (177 for vaccine groups, 89 for control groups). The comparison of subjects' age at enrollment and the level of GMT before and after immunization between groups were analyzed by t test. The superiority test for the difference between seroconversion rates of vaccine groups and control groups were analyzed by χ2 test.@*Results@#Of 900 subjects enrolled, the number of males and females were 503 and 397 respectively (vaccine groups 335 vs. 265, control groups 168 vs. 132), the average ages of vaccine groups and control groups at enrollment were (4.8±1.2) years and (4.9±1.2) years respectively. There were no significant differences between groups in terms of gender and age (χ2=0.00, P=1.000; t=0.55, P=0.585). The 2 times increase rates of anti-CT and anti-Vab in vaccine groups after inoculation were 90.96% and 57.63% respectively, which were superiority to those of control groups (15.73% and 29.21%), and significant differences were observed between groups (χ2=15.89, χ2=3.85, P<0.001). There were significant differences between vaccine groups and control groups after inoculation in terms of GMTs of anti-CT (1∶647.56 vs. 1∶99.49) and anti-Vab antibodies (1∶16.19 vs. 1∶11.27) (t values were 15.82 and 3.43, respetively; both P values were<0.05), significant differences were observed in the growth rates when compared the GMTs of anti-CT (6.63 vs. 1.11) and anti-Vab antibodies (1.64 vs. 1.16) before inoculation between vaccine groups and control groups (t'=17.85 and 4.96, P<0.001). In terms of safety, the adverse reaction rates in vaccine groups and control groups were 37.67% (226/600) and 36.67% (110/300), respectively,the common adverse reaction including fever, nausea, vomiting, abdominal pain, diarrhea, headache, fatigue, allergies, rash, etc; and the severity degree were mainly for level 1.@*Conclusion@#Ora Vacs infused with antacids could produce an positive effect on immune response and safety.
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Objective@#To analyze the cardiac pathological features of elderly coronary artery disease (CAD) patients (60 years and over) and evaluate the pathological features at autopsy and risk factors of patients with acute myocardial infarction (AMI).@*Methods@#Data from 471 elderly patients (aged from 60 to 100 years old) with CAD confirmed by autopsy hospitalized in our hospital from April 1969 to October 2013 were retrospectively reviewed. Patients were divided into 2 groups: AMI group(n=128) with AMI as the primary cause of death and the rest served as control group(n=343). The pathological features of coronary lesion and related risk factors of AMI were analyzed.@*Results@#In patients aged 60 and over with CAD, 48.8%(230/471) had severe coronary stenosis, 18.7%(88/471) had three-vessel disease, 71.8% cases (338/471) had left anterior descending artery(LAD)grade Ⅲ and over stenosis, 29.9% (141/471) had LAD grade Ⅳ stenosis, 25.9%(122/471) had left main coronary artery(LM) grade Ⅲ and over stenosis, 9.6%(45/471) had LM grade Ⅳ stenosis, 27.1%(128/471) had AMI. The first AMI accounts for 39.1%(50/128), and 60.9%(78/128) had both AMI and old MI. Compared with the control group, AMI group were younger ((77.1±11.6) years vs. (83.2±9.1) years, P<0.01), had more severe coronary artery stenosis lesion (77.3%(99/128) vs. 38.2%(131/343), P<0.01), higher coronary index which reflects the overall arteriosclerosis (9.9±2.8 vs. 8.0±2.5, P<0.01), more three-vessel disease (30.3%(43/128) vs. 13.7%(45/343), P<0.01), heavier heart weight ((447.8±90.6)g vs. (426.6±99.1)g, P<0.05), higher prevlence of pulmonary congestion or edema (57.8%(74/128) vs. 39.9%(137/343), P<0.01). Twenty-three cardiac ruptures (23/128, 18.0%) were observed in AMI group. Logistic regression analysis showed that grade Ⅳ LAD stenosis (OR=3.55, 95%CI 2.05-6.17, P<0.01), three-vessel disease(OR=2.47, 95%CI 1.30-4.67, P<0.01) were the independent risk factors of AMI in elderly patients with CAD.@*Conclusions@#Severe coronary stenosis is common in CAD patients aged 60 and over. Patients aged 60 and over with AMI have more severe coronary artery stenosis lesion and heavier heart weight. Cardiac rupture is not uncommon in elderly patients with AMI. Severe LAD stenosis and three-vessel disease are the independent risk factors of AMI in the elderly.
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Objective To analyze the clinical characteristics of infective endoearditis complicated with intracranial hemorrhage.Methods The clinical characteristics,brain CT and MRI results and prognosis of 7 patients with infective endocarditis and intracranial hemorrhage admitted between January 1991 and May 2015 were retrospectively analyzed.Results All seven patients presented varying degrees of fever,cardiac murmur and neurological symptoms.The continuous fever lasted from 21 d to 227 d (average 91 d).Mitral valve (4 cases) and aortic valve (3 cases) were the most common affected ones.The brain CT or MRI scan presented intracranial hemorrhage in 6 cases.More than 2 hemorrhage locations were found in 5 patients and parietal lobe was most common one (4 cases).All patients were treated with antimicrobial agents and three patients underwent valve replacement surgery.Three patients were cured and another 2 died due to fatal hemorrhage.Conclusions Patients with long fever history and ineffective antimicrobial treatment are prone to intracranial hemorrhage.Brain CT or MRI scan need be performed in infective endocardits when neurological symptoms are present,and brain angiography should be also considered if necessary.
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Objective To investigate the prevalence rate of heart valve calcification and its relativity with pathological changes and clinical pathogenic factors in elder patients at autopsy Methods Pathology data at autopsy of 1047 patients with age from 60 to 106 years in Beijing Hospital from November 1954 to March 2016 were collected.Cases of heart valve calcification verified at autopsy were retrospectively reviewed.The prevalence of heart valve calcification and its relativity with age,clinical disease and coronary atherosclerosis was investigated.Results Among 1047 autopsies,aortic valve calcification(AVC)was found in 15.2 ％ (n=159),mitral valve calcification(MVC)in 9.6 ％ (n=101),both AVC and MVC calcification in 5.4 ％ (n =57)and heart valve calcification in 19.4 ％ (n =203).The prevalence of heart valve calcification was 6.4％ (15/234)at age of 60-69,12.8％(37/289)at age of 70-79,22.5％(70/311)at age of 80-89 and 38.0％ (81/213) at age of 90-106 years,respectively(tendency x2 =82.523,P＜0.01).Calcification prevalence was significantly increased when complicated with coronary artery stenosis,hypertension,coronary artery disease (CAD),diabetes and chronic kidney disease (CKD).Multivariate regression analysis showed that age and CAD were independently risk factors for heart valve calcification(OR=1.066,95％ CI:1.048-1.086,P＜ 0.01;OR =2.238,95％ CI:1.396-3.589,P＜0.01,respectively),while hypertension,diabetes and CKD were not independent risk factors(OR =1.223,95％ CI:0.859-1.741,P＞ 0.05;OR =1.053,95％ CI:0.700-1.586,P ＞0.05;OR =0.924,95％ CI:0.610-1.399,P＞ 0.05,respectively).As compared with patients without heart valves calcification,patients with heart valve calcification had more increased risk for coronary atherosclerosis(OR =2.983,95a％CI:1.868-4.765,P＜0.01).Conclusions Prevalence of heart valve calcification is increased in elder patients with increasing age.Prevalence of heart valve calcification is higher in CAD patients than in non-CAD patients.And heart valve calcification is sigmficantly associated with coronary atherosclerosis.
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Objective To observe the relationship of the red blood cell distribution width and white blood cell count with coronary heart disease and coronary artery lesions.Methods Totally 590 patients undergoing coronary angiography were selected and divided into two groups based on the results of coronary angiography:coronary heart disease group (n=383) and control group (n=207).Based on the number of coronary lesions,patients in coronary heart disease were divided into different subgroup.The Gensini scores of coronary lesions were assessed.The differences in red blood cell distribution and white blood cell count were compared among different groups,and the correlations of coronary lesions with red blood cell distribution and white blood cell count were analyzed.Results The red blood cell distribution and white blood cell count were higher in coronary heart disease group than in control group [(13.06±0.57)％ vs.(12.63±0.49)％,(6.33±1.56) 109/L vs.(5.86± 1.29) 109/L,t=9.771 and 3.728,both P=0.000].The red blood cell distribution and white blood cell count were increased along with the increasing number of coronary lesions (F=51.454 and 7.544,both P=0.000),and positively correlated with the Gensini score (r=0.414 and 0.111,P =0.000 and 0.030).The red blood cell distribution was positively correlated with white blood cell count (r=0.108,P=0.009).The receiver operating characteristic(ROC) curve for red blood cell distribution predicting coronary heart disease showed that the threshold value of red blood cell distribution was 12.75％ and the area under the ROC curve was 0.723 (95％ Cl:0.680-0.765) with a sensitivity of 67.6％ and specificity of 65.2％ for the diagnosis of coronary heart disease.Conclusions Red blood cell distribution and white blood cell count are significantly increased in patients with coronary heart disease and are independently correlated with the severity of coronary lesions.Red blood cell distribution and white blood cell count are independent predictiors for coronary artery disease.
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<p><b>OBJECTIVE</b>To define the pathological changes of coronary artery and compare the clinical diagnosis and pathological diagnosis differences in elderly patients aged 80 and over.</p><p><b>METHODS</b>A total of 909 autopsy cases aged 60-100 years in our hospital from April 1st 1969 to October 31th 2013 were analyzed. The prevalence and pathological features of coronary artery disease (CAD) in cases aged 80 years and over were compared with those aged 60-79 years old. The misdiagnosis and missed diagnosis rate were calculated.</p><p><b>RESULTS</b>The prevalence of CAD by autopsy (63.8% (289/453) vs. 39.9% (182/456), P<0.01), old myocardial infarction (OMI) by autopsy (63.0% (182/289) vs. 51.6% (94/182), P<0.05) and chronic myocardial ischemia by autopsy (22.5% (65/289) vs. 7.1% (13/182), P<0.01) were significantly higher while the prevalence of acute myocardial infarction (AMI) by autopsy was significantly lower (22.1% (64/289) vs. 42.9% (78/182), P<0.01) in aged 80 and over group compared to 60-79 years old group. The misdiagnosis rate of CAD was 65.2% (107/164), the missed diagnosis rate of OMI was 62.1% (113/182) and the missed diagnosis rate of AMI was 37.5% (24/64) in the aged 80 and over group.</p><p><b>CONCLUSIONS</b>The prevalence of CAD and misdiagnosis and missed diagnosis rate are high in dead inpatients aged 80 years and over. OMI is more common but often missed in this group. Thus, the diagnosis and evaluation of CAD should be enhanced in this patient group.</p>
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Aged , Aged, 80 and over , Humans , Middle Aged , Autopsy , Coronary Artery Disease , Pathology , Diagnostic Errors , Inpatients , Myocardial Infarction , Myocardial Ischemia , PrevalenceABSTRACT
Objective To understand the blood pressure variability (BPV) and the influencing factors through ambulatory blood pressure monitoring during hemodialysis (HD) in the end-stage renal disease (ESRD) patients.Method Eighty-one ESRD patients on maintenancing HD for more than three months were enrolled into the study.The patients were with properly dry body weight.The blood pressure was monitored using dynamic blood pressure monitor around the HD.BPV was estimated with the coefficient of variation (CV) and standard deviation (SD) of the systolic blood pressure (SBP-CV,SBP-SD).Patients were divided into two groups according to the mean of SBP-CV:high SBPV group and low SBPV group.The possible influencing factors such as age,dialysis duration,ultrafitration volume,ultrafiltration/body weight,therapy of antihypertensive,electrolyte,nutrition state,metabolic bone disease indexes,inflammatory state and serum lipid state were analyzed and compared between the two groups.And multivariate stepwise regression analysis was made between the SBP-CV,SBP-SD and the above observational parameters.Results The average SBP-CV of the 81 patients was (8.12± 3.16)％,SBP-SD was (11.22±4.55) mm Hg.The proportion of hypertention and hypotention in high SBPV(SBP-CV≥8.12％) group (20.0％,25.7％) was higher than that in the low SBPV(SBP-CV ＜8.12％) group (8.7％,6.5％)(P =0.009).Serum high-sensitivity c-reactive protein (hs-CRP) and alkaline phosphatase (ALP) were higher in high SBPV group than that in the low SBPV group[(7.19± 5.95) mg/L vs (3.35±2.78) mg/L,P =0.001 and (180.31±96.32) U/L vs (98.00±41.19) U/L,P =0.049].Serum creatinine and potassium were higher in the low SBPV group than that in the high SBPV group [(1015.83±276.20) μmol/L vs (893.63±216.61) μmol/L,P =0.034 and (5.27±0.78) mmol/L vs (4.80± 0.23) mmol/L,P =0.005].SBP-SD was positively correlated with hs-CRP (β =0.499,P ＜ 0.01),SBP-CV was positively correlated with hs-CRP and dialysis vintage (β =0.464 and 0.211,P ＜ 0.01 and P ＜ 0.05) by the multivariate stepwise regression analysis.Conclusions The SBP-CV during HD is 8.12％ in ESRD patients.Hypertention and hypotention are more often in the higher SBPV patients.SBPV is closely related to the serum hs-CRP.
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Objective To evaluate the prognostic values of leukocyte count,hemoglobin,biochemical parameters,erythrocyte sedimentation rate and immunoglobulin on mortality in patients aged 80 years and over.Methods Totally 342 patients(aged 85.6±4.0 years)were followed up for (82.0±36.9) months,and the cause and time of death were recorded.Results During the period of follow up,198 patients suffered from death.Compared with the survival group (132 cases),the death group had older age [ (86.5±4.4)years vs.(84.5±3.2)years,t=-4.86,P＜0.01 ],higher white blood cell [ (6.2± 1.7) ＞ 109/L vs.(5.5±1.3) × 109/L,t=-3.93,P＜0.01 ],lower hemoglobin [(134.4±14.4)g/L vs.(140.0± 12.6)g/L,t= 3.65,P＜0.01 ],slightly faster erythrocyte sedimentation rate [ 11 mm/h(15 mm/h) vs.9 mm/h (10 mm/h),U=- 3.31,P＜0.01 ],lower immunoglobulin M [ (0.9±0.5)mg/L vs.(1.1±0.8)mg/L,t =2.55,P＜0.05 ],slightly higher urea nitrogen [ (7.5±2.6) mmol/L vs.(6.8±1.6) mmol/L,t=2.81,P＜0.01]and creatinine [(113.0±32.5) μmol/L vs.(100.5±15.8) μmol/L,t=-4.65,P＜0.01 ].Cox multivariate analysis revealed that older age (RR=1.083,95％CI:1.040 1.127,P＜0.01),white blood cell count (RR=1.134,95％CI:1.021-1.260,P＜0.05),creatinine (RR=1.011,95％CI=1.0021.020,P＜0.05),hemoglobin(RR=0.835,95％CI:0.714-0.975,P＜0.05)andimmunoglobulin M(RR=0.710,95％CI:0.521-0.966,P＜0.03),aorticaneurysm(RR=2.144,95％CI:1.163-3.951,P ＜ 0.05 ) were the independent risk factors for death.Conclusions Aging,increased WBC count,decreased hemoglobin and immunoglobulin M,elevated creatinine and aortic aneurysm are the independent risk factors for death,which are powerful parameters for the prognostic evaluation in the elderly aged 80 years and over.