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Objective:To explore the main influencing factors for physical performance assessed by the short physical performance battery(SPPB)in the elderly in communities in Shanghai.Methods:A total of 500 elderly subjects from four communities in Shanghai who met the inclusion criteria with 165 males and 335 females aged 60-95 years(70.5±7.8)years were enrolled.A questionnaire was used to assess the general situation.International Physical Activity Questionnaire-Short Form(IPAQ-SF)was used to assess physical activity(PA). The appendicular skeletal muscle mass(ASM)was measured by bioelectrical impedance analysis, and the relative skeletal muscle mass index(RSMI). The lower extremity muscle strength(quadriceps strength, QS)was measured by a hand-held dynamometer.Lower body muscle quality(LB-MQ) was ascertained by taking the ratio of strength to muscle mass for lower extremity.SPPB score was used to assess physical activity, including full tandem test, 4-meter walking speed test and five timed chair stands test.Results:The age, RSMI, ASM and quadriceps strength were higher, and the body fat content was lower in males than in females(all P<0.001). There were no significant differences in BMI, SPPB scores, LBMQ, and PA between males and females( P>0.05). Pearson correlation analysis showed that SPPB score was negatively correlated with age( r=-0.615, P<0.001)and body fat content( r=-0.103, P=0.022), but SPPB score was positively correlated with quadriceps strength( r=0.351, P<0.001), RSMI( r=0.134, P=0.003), LBMQ( r=0.268, P<0.001)and amount of PA( r=0.204, P<0.001), however, SPPB score had no relationship with gender( r=0.068, P=0.132). Conclusions:Aging and frailty are the main factors for the decline of physical performance in the elderly.Participating physical activity, reducing body fat, maintaining muscle mass, and especially increasing muscle quality, may be the main interventions to prevent the further deterioration of physical performance in the elderly.
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Objective:To investigate the relationship between calf circumference and appendicular skeletal muscle mass (ASM) index, handgrip strength and gait speed in the elderly in Shanghai, and to explore the optimal cut-off point of calf circumference as a simple proxy marker of skeletal muscle mass, strength and function.Methods:A total of 2 294 participants were recruited from physical examination centers in Huadong Hospital Affiliated to Fudan University and 4 communities (954 males and 1 340 females) with an average age of (71.6±8.7) years. Appendicular skeletal muscle mass (ASM), Upper (UMM) and lower (LMM) limbs skeletal muscle mass were measured by bioelectrical impedance analysis (BIA). The ASM index (ASM/height 2) were calculated.Gait speed was measured.Muscle strength was measured by handgrip strength using an electronic hand dynamometer.Height, weight, right calf circumference and waist circumference were measured. Results:The age, body mass index (BMI), waist circumference and gait speed were not statistically different (all P>0.05) between both genders. Height, weight, ASM, ASM/height 2, UMM, LMM, handgrip strength, calf circumference were significantly higher in men than in women (all P<0.05). The calf circumference of the elderly with age ≥ 80 was significantly lower than that of the 70-79 age group and 60-69 age group ( P<0.05). The calf circumference of older women (age≥80) was significantly lower than that of the elderly women in the 70-79 age group and 60-69 age group ( P<0.05). Calf circumference was correlated negatively with age( P<0.01) and positively with ASM/height 2, height, weight, BMI, handgrip strength, UMM and LMM( P<0.01). There was no correlation between calf circumference and gait speed ( P>0.05). In the receiver operating characteristic curve (ROC), the cut-off value of calf circumference for low muscle mass was 35.1 cm for male(specificity, 0.721; sensitivity, 0.803, ROC, 0.809) and 33.6 cm for female(specificity, 0.774; sensitivity, 0.778; ROC, 0.827). Conclusions:Calf circumference decreases with ageing in the elderly. The optimal cut-off value of calf circumference for low muscle mass is 35.1 cm for males and 33.6 cm for females. We should pay attention to the importance of calf circumference in evaluation and diagnosis of sarcopenia.
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Purpose To investigate the prognostic value of whole-body magnetic resonance imaging (WB-MRI) for patients with multiple myeloma (MM).Materials and Methods Sixty-two newly diagnosed patients with MM confirmed by pathology during January 2010 and December 2016 were enrolled in this study.The patients were divided into five groups according to the infiltrative patterns on MRI:normal pattern,micro-nodular pattern,macronodular pattern,mixed pattern and diffuse pattern,and their overall survival were compared.Results Of all the patients,micro-nodular infiltrative pattern was found in 20 patients,macro-nodular pattern in 13 patients,mixed pattern in 7 patients and diffuse pattern in 17 patients,while 5 patients were normal.During the follow-up for a median of 39 months (ranged 30.9-47.1 months),overall survival with the mixed MM infiltrative pattern (median 17 months,95％ CI 12.6-21.3 months) was statistically shorter than those with other patterns (median 43 months,95％ CI 33.7-52.3 months;P＜0.05).Additionally,the clinical DurieSalmon (DS) and International Staging System (ISS) were applied to evaluate the stage of MM patients.DS system showed that 6 patients were at stage I,another 6 patients were at stage Ⅱ and the other 50 patients were at stage Ⅲ.While based on ISS system,15 patients were found at stage Ⅰ,22 patients were at stage Ⅱ and the rest 25 patients were at stage Ⅲ.Meanwhile,the correlation between the WB-MRI infiltrative pattems and DS system as well as ISS system had no significant correlation (P＞0.05).Conclusion Different infiltrative patterns in WB-MRI can predict the prognosis in patients with MM at the time of diagnosis.
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ObjectiveTo review the multislice computed tomography (MSCT) characteristics and treatment of pyogenic liver abscess in elderly patients. MethodsA retrospective analysis was performed on the clinical data of 42 elderly patients who were diagnosed with pyogenic liver abscess in our hospital from March 2001 to February 2014. The MSCT characteristics and clinical treatment of this disease were reviewed. Comparison between two groups was made by t test. ResultsAmong the 42 patients, 37 had the liver abscess in the right lobe, and 5 in the left lobe; 33 had single lesions, and 9 had grid- or honeycomb-like lesions. MSCT scan showed that all lesions had a lower density compared with normal hepatic tissues, and the CT values were approximately 6-40 Hu. In the arterial phase, 39 patients had lesions with peripheral rim enhancement, and 3 had no edge enhancement. Conservative treatment was given to 15 patients, among whom the diameter of abscess was 3.7±2.1 cm, the duration of fever was 11.7±4.1 d, and the average hospital stay was 22.6±5.3 d. Percutaneous drainage was performed in 27 patients, among whom the diameter of abscess was 6.3±2.8 cm, the duration of fever was 7.1±2.2 d, and the average hospital stay was 13.7±3.1 d. There were significant differences in the diameter of abscess, the duration of fever, and the length of hospital stay between the two groups (P=0.021, 0.026, and 0.006, respectively). ConclusionMSCT can accurately reveal the location and morphology of abscess, and correct diagnosis can be made in combination with the patient's medical history. Drainage guided by ultrasound or CT is an effective, minimally invasive, and safe treatment for controlling fever and promoting fast recovery in the elderly.
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Objective To review the multislice computed tomography (MSCT)characteristics and treatment of pyogenic liver abscess in elderly patients.Methods A retrospective analysis was performed on the clinical data of 42 elderly patients who were diagnosed with pyo-genic liver abscess in our hospital from March 2001 to February 2014.The MSCT characteristics and clinical treatment of this disease were reviewed.Comparison between two groups was made by t test.Results Among the 42 patients,37 had the liver abscess in the right lobe, and 5 in the left lobe;33 had single lesions,and 9 had grid-or honeycomb-like lesions.MSCT scan showed that all lesions had a lower density compared with normal hepatic tissues,and the CT values were approximately 6 -40 Hu.In the arterial phase,39 patients had le-sions with peripheral rim enhancement,and 3 had no edge enhancement.Conservative treatment was given to 15 patients,among whom the diameter of abscess was 3.7 ±2.1 cm,the duration of fever was 11.7 ±4.1 d,and the average hospital stay was 22.6 ±5.3 d.Percutane-ous drainage was performed in 27 patients,among whom the diameter of abscess was 6.3 ±2.8 cm,the duration of fever was 7.1 ±2.2 d, and the average hospital stay was 13.7 ±3.1 d.There were significant differences in the diameter of abscess,the duration of fever,and the length of hospital stay between the two groups (P=0.021,0.026,and 0.006,respectively).Conclusion MSCT can accurately reveal the location and morphology of abscess,and correct diagnosis can be made in combination with the patient's medical history.Drainage guided by ultrasound or CT is an effective,minimally invasive,and safe treatment for controlling fever and promoting fast recovery in the elderly.
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Objective To observe the lumbosacral plexus nerves by diffusion tensor tractography (DTT) and quantitatively evaluate them by using diffusion tensor imaging (DTI) in healthy volunteers.Methods A total of 60 healthy volunteers (30 males and 30 females) underwent DTI scanning.Mean FA values of the lumbosacral plexus nerves (both sides of lumbar roots L3 to S1,proximal and distal to the lumbar foraminal zone) were quantified.Differences among various segments of lumbar nerve roots were compared with ANOVA test and SNK test.Differences between two sides of the lumbar nerve roots at the same lumbar segment were compared with paired-samples t test.Differences between the proximal and the distal nerve to the the lumbar foraminal zone at the same lumbar segment were compared with paired-samples t test.The lumbosacral plexus nerve was visualized with tractography.Results (1) The lumbosacral plexus nerve was clearly visualized with tractography.(2) Mean FA values of the lumbar nerve roots L3 to S1 were as followings:proximal to the left lumbar foraminal zone 0.202 ± 0.021,0.201 ± 0.026,0.201 ± 0.027,0.191 ±0.016,distal to the left lumbar foraminal zone 0.222 ± 0.034,0.250 ± 0.028,0.203 ± 0.026,0.183 ± 0.020,proximal to the right lumbar foraminal zone 0.200 ± 0.023,0.202 ± 0.023,0.205 ± 0.027,0.191 ±0.017,distal to the right lumbar foraminal zone 0.225 ±0.032,0.247 ±0.027,0.205 ± 0.033,0.183 ±0.021.Mean FA values were significantly different between the proximal nerve to the distal nerve in lumbar nerve roots L3,L4,S1 (t =-9.114-2.366,P ＜ 0.05),but not significantly different in L5 (P ＞ 0.05).Differences were not found between the right and left side nerves at the same lumbar segment (P ＞ 0.05).(3) The whole length of the lumbar roots nerve L3 to S1 can be visualized clearly by using DTT.Conclusions Diffusion tensor imaging and tractography can show and provide quantitative information of human lumbosacral plexus nerves.DTI is a potential tool for the diagnosis of lumbosacral plexus nerve disease.
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Objective To evaluate the clinical application of CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules (SPNs) before video-assisted thoracoscopic resection.Methods CTguided localization the SPNs before resection in 56 patients and 60 nodules,then underwent video-assisted thoracic surgery (VATS) resection.Among 56 patients,19 males and 37 females,aged from 35 to 81 years,mean age was (61.1 ±8.9)years.Results SPNs diameter (6.80 ±4.12) mm,distance from the parietal pleura (15.38 ±4.63) mm.CT-guided localization success rate was 100％,positioning time (10.76 ± 8.17) min,8.9％ (5/56) had micro pneumothorax aftet positioning,7.1％ (4/56) occurrence of needle tract bleeding,no conservative treatment.VATS resection rate was 100％.The pathology of 60 lesions were shown:Bronchiolo-alveolar carcinoma(BAC) were 33 lesions(55.0％),BAC and adenocarcinoma were 11 lesions(18.3％),Atypicaladenomatous hyperplasia (AAH) were 7 lesions (11.8％),Inflammation were 4 lesions (6.7％),Harmatoma were 3 lesions(5.0％),Tuberculoses were 2 lesions(3.3％).Conclusion CT-guided localization with combination of methylene blue and a Hookwire system before video-assisted thoracoscopic resection is a promising technique for small solitary pulmonary nodules.It could play an important role in accurate localization of small pulmonary nodules,and it is a safe technique with clinical application.
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To study the effects of conjee and cooked rice on postprandial glucose and plasma insulin levels in type 2 diatetes,and to help diabetic patients select reasonably food.41 diabetes were divided into cooked rice group ( group A),conjee with steamed bread group ( group B),and oatmeal group ( group C ).At 1 h after meal,the values of postprandial plasma glucose (PPG) was significantly lower in group C than those in group A and group B [ ( 11.17± 2.30 vs 12.88 ± 1.29,13.29 ± 1.97 ) mmol/L,P ＜ 0.05 ].At 2 h after meal,the value of PPG was significantly lower in group C than in group A [ ( 8.88 ± 2.66 vs 10.87 ± 1.63 ) mmol/L,P ＜0.05 ].At 1 h and 2 h after meal,there was no significant difference between the value of PPG in goup A and group B ( P＞0.05 ).At 1 h after meal,the value of plasma insulin was significantly lower in group C than those in group B [ (46.02 ± 26.32 vs 88.56 ± 68.75 )μU/ml,P ＜0.05 ],and there was a littler higher in group B than group A ( P＞0.05 ).At 2 h after meal,there was no statistical difference of plasma insulin among group A,B,C [ ( 57.10 ± 33.56,62.26 ± 24.42,54.16 ± 41.35 )μU/ml,P＞0.05 ) ].Isocaloric oat food is potentially beneficial in sustaining blood glucose status and decreasing insulin secretion.It is the ideal choice for type 2 diabetes.Meanwhile,there were no statistical differences in PPG and insulin levels between the individuals taking conjee with steam bread and cooked rice.
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A total of 127 type 2 diabetic patients were divided into low glycemic index meal replacements (intervention) group and standard food-based diet (reference) group in an experiment for 12 weeks.The results showed that fasting plasma glucose,postprandial 2 h plasma glucose,fasting insulin,and homeostasis model assessment insulin resistance(HOMA-IR) in the intervention group decreased significantly after 12 weeks trial ( P＜0.05 or P＜0.01 ).However,there were no significant changes in lipid profile and HbA1C in intervention group.In addition,percentage of body fatty,visceral fatty area,and waist-hip ratio also decreased in intervention group( all P＜0.01 ).Superoxide dismutase and glutathione levels increased significantly in intervention group by the end of trial (both P＜0.01 ),while malondialdehyde was decreased (P＜0.01 ).There were no significant changes in the aforementioned indices in the reference group.Weight,body mass index,and waist circumferences were decreased in both groups,but without significant difference between the two groups.
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Objective To study the clinical value of using a four-point method (FP) in measuring joint angles.Method Methods Twenty-five subjects without knee dysfunction were studied.Every knee joint was tested in extension,below 90° of flexion and above 90° of flexion with the traditional three-point method (TP) and the new four-point method.X-rays were taken as a gold standard measurement.The reliability and validity were analyzed using Bland-Altman plots,which can yield 95% limits of agreement (LOA).Results (1) The joint axis centers moved with changes in joint angle.(2) The 95% LOA of inter-tester reliability was (-5.0,2.7) with the FP and (-6.5,4.4) with the TP.The 95% LOAs of intra-tester reliability were (-3.6,4.0) for tester A and (-4.1,4.8) for tester B with the FP,while (-5.0,6.4) for tester A and (-6.1,5.8) for tester B with the TP.(3) The 95% LOAs in the three positions were (3.5,2.6) in extension,(-3.3,3.6) in mild flexion and (-1.9,5.7) in greater flexion with the FP,and ( 6.8,1.1),(-4.0,7.1) and (0,8.5) with the TP.Conclusions The FP gives better reliability and validity than the TP in joint angle measurement.
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The association of serum uric acid ( SUA ) and urine albumin-to-creatinine ratio ( ACR ) in patients with type 2 diabetes mellitus was explored. The ACR abnormal rate was higher in hyperuricemia group( P＜0.01 ). ACR level was positively correlated with SUA( P＜0.01 ). The general linear model showed that SUA was a risk factor in ACR. Patients with hyperuricemia and type 2 diabetes mellitus were apt to have abnormal ACR and develop early renal damage.
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@#ObjectiveTo evaluate the usefulness of an ultrasonography-based method to examine quadriceps femoris contracting. MethodsThe thickness of bilateral rectus femoris (RF) and vastus intermedius (VI) and the cross-sectional area (CSA) of RF was measured in 10 healthy subjects （n=20） in a relaxed position and 3 isometric contraction states using ultrasonography by two examiners. The date was compared with paired t test. Half of these subjects （n=10） were also measured with MRI at rest. The date was also compared with paired t test. ResultsThere was no significant difference between MRI and static compound ultrasonography, nor between two examiners. There was a significant difference (P<0.05) in thickness of RF and VI between relaxed and isometric contraction conditions. There was no significant difference among isometric contraction conditions. There was no significant difference among measurements of RF-CSA. Conclusionultrasonography shows good validity and reliability in measuring quadriceps shape.
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Objective To investigate the relationship between glycemic index (GI) of mixed foods and glucose and lipid metabolism index in elderly patients with diabetes mellitus, and to analyze the effects of CI response with regard to sex and obesity. Methods Forty-three patients with diabetes mellitus were divided into two groups with randomly crossover methods: high CI group and low GI group. Mixed meals were given for ten weeks (washing time:2 weeks). The biochemistry index and anthropometric index at baseline,before and after the first and second phase were measured. At the same time,fasting blood glucose(FBG)and postprandial 2 h blood glucose (2hBG) were supervised thrice a week and the daily energy, three macronutrients, and GI were calculated during trial. Results GI was positively correlated with FBG, 2hBG, homeostasis model assessment of insulin resistance ( HOMA-IR) ,body mass index ( BMI), and low-density lipoprotein cholesterol ( r = 0. 097-0. 423, P = 0. 000 1-0.01). GI value was a strong associated factor for FBG and 2hBG in overweight male patients. Conclusions The GI of mixed foods can better reflect the level of glucose response, especially in obese men. And it had good correlations with other metabolic indexes.
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A randomized crossover study was performed to compare the effects of low glycemic index diets (LGI)and high glycemic index diets(HGI)on blood glucose,lipid profile and control of body weight in patients with type 2 diabetes.Compared with HGI group,the fasting serum insulin,Homa-IR,LDL-C and body weight significantly decreased in LGI group(P
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Objectives:To observe the relationship between 2 different ways of nasal tube nutrition supplement patterns and clinical patients'endurance and complication. Methods:Self contrast study was used in 8 cases of old patients supplied with nasal tube nutrition for 4 months(perfusion and dripping pattern 2 months each). Biochemical indices and enteric complications before and after nasal tube nutrition were observed. Results:Slowly dripping supplement pattern greatly decreased the incidence of inhalation pneumonia and other complications related with gastro enteric nutrition supplement,such as diarrhea,bloating,vomits and etc.The nutritional status was obviously improved when the continuous dripping supplement pattern was used. Conclusions:Continuous dripping supplement pattern is better than perfusion supplement pattern.
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Objective: To apply the NRS2002 to screen the nutritional status of preoperative patients and investigate the nutrition support in the perioperation and clinical outcomes. Methods: 127 selective operational cases(including general surgery,thoracic surgery,gynecology and orthopedic) were recruited to adopte the NRS2002 which issued by CESPN in 2006,and the nutrition support,energy and nutriment in the perioperation,complications,length of stay and drug costs were investigated. Result: 30.7% patients needed nutrition support,with general surgery(28.3%) being higher than thoracic surgery(2.4 %),gynecology(0%) and orthopedic(0%).The nutritional risk in elderly,carcinoma,abdominal operation patients were 18.1%,19.7% and 18.1% seperately,which was higher than others(P
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Objective: To study the glucose,insulin,Cpeptide response and relative safety after orally taking different doses of fructose in type 2 diabetes.Methods: 10 patients with type 2 diabetes,were given 50 g glucose,10 g fructose+40 g glucose,30 g fructose+20 g glucose,40 g fructose+10 g glucose,50 g fructose respectively,the serum glucose,insulin,C-peptide,lactic acid,uric acid,heart ratio and blood pressure were measured at 0 min,15 min,30 min,60 min,120 min and relative safety was observed at the same time.Results: The serum glucose,insulin,C-peptide were significantly lower than 50 g glucose group,the insulin,C-peptide decreased 14.30%,23.73%,40.42%,58.48% and 4.62%,14.32%,7.62%,29.33% in 10F+40G group,30F+ 20G group,40F+10G group and 50F group when compared with 50G group,which showed dose-response relationship.The glycemic index was 91.8,62.4,43.6,37.5 in 10F+40G group,30F+ 20G group,40F+ 10G group and 50F group.No adverse effect was observed during the test.Conclusion: It is beneficial to the protection ? cells of pancreas to orally take different doses of fructose.Fructose taken orally may influence the serum lactic acid.
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Objective: To measure the glycemic index of foods contained low carbohydratesand discuss the relationship between glycemic index and the amount of fat, carbohydrate, protein and diet fiber from these foods. Methods: According to the method of Wolver,the GIs of these kinds of foods had been determined and caculated by using 25 gram carbohydrates as control because of the low percent(10%)of carbohydrates in foods. Results: The results of GI in 13 kinds of the foods were worked out and there was negative correlation between diet fiber and GI. Conclusions: The inference factors of GI are not the kinds of carbohydrate but the amount of diet fiber in these foods.
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Objective: To try to find out the morbidity of elderly chronic pulmonary disease's malnutrition by means of MNA and analyze the consistency between traditionalindex and MNA score. Methods: According to the score of MNA,we divided the 143 elderly pulmonary disease patients into three groups: A group(malnutrition); B group(malnutrition risk);C group(well nourished).The records included anthropometry,biochemical markers,dietary intake as well as the occurrence rate of pneumonia and respiratory failure. Results: There were marked differences on anthropometry,biochemical markers,dietary intake and the occurrence rate of pneumonia and respiratory failure among three groups. And the dietary intake of all three groups did not reach the standard of normal people. Conclusion: MNA is a good method that can be used to evaluate the nutritional state in elderly pulmonary disease patients.