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OBJECTIVES@#The use of anticholinergic drugs in the elderly may lead to negative events such as falls, delirium, urinary retention and cognitive decline, and the higher the number of anticholinergic drugs use, the more such negative events occur. This study aims to analyze the risk factors associated with the prescription of total anticholinergic drugs in elderly outpatients and evaluate the rationality of anticholinergic drugs, and to provide a reference for reducing the adverse effects of anticholinergic drugs.@*METHODS@#A list of drugs with anticholinergic activity based on the Beers criteria was established. The basic information (such as age and gender), clinical diagnosis, and medications of elderly outpatient were extracted from hospital electronic medical records, and the Anticholinergic Cognitive Burden (ACB) Scale was used to calculate the anticholinergic burden for each patient. Logistic regression analysis was used to identify the potential risk factors for the occurrence of problems such as multiple medication and insomnia.@*RESULTS@#A total of 1 840 prescriptions for elderly patients were reviewed. Of these patients, ACB score was more than or equal to 1 in 648 (35.22%) patients. Number of prescription medication (95% CI: 1.221 to 1.336) and insomnia (95% CI: 3.538 to 6.089) were independent factors affecting ACB scores (both P<0.01). Medications for patients of ACB scores were most commonly treated with the central nervous system drugs (such as alprazolam and eszopiclone) and for the cardiovascular system drugs (such as metoprolol and nifedipine).@*CONCLUSIONS@#There is a high rate of ACB drugs use in geriatric patients, and the clinical focus should be on multiple medication prescriptions, especially on the central nervous system drugs (such as alprazolam and eszopiclone) and cardiovascular system drugs (such as metoprolol and nifedipine). The prescription review should be emphasized to reduce adverse reactions to anticholinergic drugs in elderly patients.
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Humans , Aged , Cholinergic Antagonists/adverse effects , Outpatients , Metoprolol , Alprazolam , Eszopiclone , Nifedipine , Sleep Initiation and Maintenance Disorders , Risk FactorsABSTRACT
Objective:To investigate the value of peripheral blood eosinophils (EOS) in predicting the therapeutic effect of sublingual specific immunotherapy (SLIT) in patients with allergic rhinitis (AR).Methods:From January 2018 to June 2020, 200 patients with AR who received SLIT in Dongguan Kanghua Hospital were evaluated for their symptoms before treatment and 6 months after treatment. The curative effect was evaluated according to the improvement of the total symptom score. The number of eosinophils, percentage of eosinophils in peripheral blood were measured before treatment. The correlation between curative effect and EOS count and EOS percentage was analyzed and the value of these two indicators in predicting the efficacy of SLIT was evaluated.Results:Of the 200 AR patients, 178 patients were confirmed to have completed the treatment course of 6months. 126 effective and 52 ineffective, the effective rates were 70.8%. There was a weak correlation between the number of EOS in peripheral blood and the percentage of EOS in peripheral blood before treatment and the efficacy of SLIT ( r=0.168, P=0.048; r=0.250, P=0.001). The area under the curve of peripheral blood EOS count was 0.380, and the percentage of peripheral blood EOS was 0.355, which were all less than 0.5. Conclusions:There was no significant correlation between the number of peripheral blood EOS count and peripheral blood EOS percentage and the efficacy of SLIT , therefore, both of blood EOS count and blood EOS percentage have no value in predicting the efficacy of SLIT.
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Objective:To investigate the effects of exogenous nitric oxide (NO) on radiation response of nasopharyngeal carcinoma 5-8F radiotherapy resistant cell line (5-8FRs) and to provide experimental basis for finding suitable radiosensitizer on nasopharyngeal carcinoma.Methods:5-8FRs cells were cultured in vivo and treated with sodium nitroprusside (SNP) of different concentrations. The inhibition rate of cell proliferation was detected by cell counting kit-8 (CCK8) method. A concentration of IC 01 SNP (1% SNP) which had no obvious effect on the proliferation of 5-8FRs cells was screened out. The 5-8FRs cells were intervened with 1, 2, 4, 6 Gy and 8 Gy radiation to determine the radiation dose of IC 15 (15% radiation dose). 5-8FRs cells were treated with IC 01 SNP concentration, IC 15 radiation dose and radiotherapy alone or in combination. The morphological changes of 5-8FRs cells were observed under microscope. The proliferation inhibition rate of each group was detected by CCK-8 method, the apoptosis was detected by flow cytometry, and the concentration of NO in cell supernatant was detected by nitrate reduction method. Results:⑴ The proliferation of 5-8FRs had been inhibited in a concentration-dependent manner by SNP and a dose-dependent manner by radiation. The SNP concentration of IC 01 was (513.89±14.69)μmol/L (SNP group). The radiation dose of IC 15 was (3.96±0.33)Gy (radiotherapy group); ⑵ Compared with single SNP group and radiotherapy group, the morphology of 5-8FRs cells in combination group (SNP+ radiotherapy) was significantly different, floating cells increased significantly, the number of adherent cells gradually decreased and lost their original morphology; ⑶ SNP concentration of IC 01 had no significant effect on the proliferation of 5-8FRs cells, but the inhibition rate of combined group was significantly higher than that of radiotherapy group ( t=7.708, P<0.01); The concentration of NO in the combined group was significantly higher than that in the single radiotherapy group [(310.03±5.76)μmol/L vs (77.34±2.60)μmol/L, P<0.05]; ⑷ The spontaneous apoptosis rate of 5-8FRs was (1.35±0.06)%, while the apoptosis rate in the group of IC 01SNP was (2.22±0.37)%, with no significant difference. The apoptosis rate of 5-8FRs in the combined group (50.27±2.24)% was significantly higher than that of the group of IC 15 radiation dose(15.37±0.65)%. Conclusions:Under no obvious toxicity to cells themselves circumstances, exogenous nitric oxide with appropriate concentration could significantly enhance the radiosensitivity on 5-8FRs.
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Objective To study the correlation between laryngopharyngeal reflux (LPR) and secretory otitis media (SOM).Methods A total of 294 adult patients with reflux-related symptoms were recruited in this study.The patients were evaluated with reflux symptom index (RSI) and reflux finding score (RFS).Tympanometry was conducted to all the patients.The 54 patients with the otitis media effusion with type B tympanograms were tested by auripuncture.Results Among the 294 patients,168 cases showed RSI＜13,in which 128 cases,31 cases and 9 cases had type A,type C,and type B tympanograms,respectively.The other 126 patients showed RSI＞13 in which 52 cases,29 cases and 45 cases had type A,type C,and type B tympanograms,respectively.Among the 294 patiems,172 patients showed RFS＜7,in which 131,32 and 9 cases had type A,type C,and type B tympanograms,respectively.The left 122 patients showed RFS＞7,in which 49,28 and 45 cases had type A,type C,and type B tympanograms,respectively.The ratio of type B tympanograms in the patients with RSI＞13 and RFS＞7 were both significantly higher than those in the patients with RSI＜13 and RFS＜7 (P＜0.05).The RSI scores of patients with type A,C,and B tympanogram were 8.6± 3.8,15.9±7.5,and 23.9±8.6,respectively,and the RFS score were 5.6±2.6,9.6±4.7,and 15.3±6.6,respectively.Compared with type A and C,the patients with type B tympanogram had significantly higher RSI and RFS score (P＜ 0.05).Among the 54 patients of type B tympanograms,those with RSI＜13 were found to have serous fluid,grume fluid,glue fluid as in 6 cases,2 cases,and 1 case,while the patient of the RSI＞ 13 had serous fluid,grume fluid,glue fluid in 13 cases,23 cases,and 9 cases,respectively.The otitis media effusion of the patients with the RSI＜13 were mainly serous,while those with the RSI＞13 were mainly sticky.Conclusion The correlation between LPR and SOM was significant.LPRmay accelerate the progress of SOM.
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Objective To investigate the clinicopathological features of gastrointestinal carcinoma with neuroendocrine differentiation (NED) and mixed adenocarcinoma of the pancreas and pancreas (MANEC). Methods Clinical and pathological data of 29 cases in Zhejiang Chinese medicine hospital with gastrointestinal pancreatic cancer with neuroendocrine branch and 7 cases with gastrointestinal pancreatic MANEC patients were analyzed retrospectively. Hematoxylin eosin staining of the tissue (HE) and immunohistochemistry (IHC) were observed, the relationship between IHC index and tumor distant metastasis and clinical pathological indicators between. Results Gastrointestinal pancreatic cancer with NED and MANEC in patients with various clinicopathological parameters and IHC expression rate difference was not statistically significant;neuroendocrine index expression difference between the positive rate and clinical pathological factors were not statistically significant; there was no significant difference between distant metastasis and clinical pathological factors. Conclusion Combined with morphological HE staining and immunohistochemical IHC staining, gastrointestinal carcinoma with NED and MANEC has high heterogeneity. Clinical staging and grading are the major prognostic factors. Early diagnosis and treatment can improve the prognosis of patients.
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Objective To study diagnosis significance of neutrophil surface adhesion molecules including CD11b,in type 2 diabetes mellitus patients with cytomegalovirus (CMV)infection.Methods Blood samples from 139 cases of type 2 diabetes mellitus patients were collected including 99 male and 40 female cases between Septem-ber 2011 and January 2015.Healthy male 20 cases and female 13 cases were collected as healthy control group from outpatients in the same period.Type 2 diabetes mellitus patients were divided into high active CMV infection group, CMV infection group and the negative control group,and healthy group as normal control group according to CMV -pp65 antigen detection.Neutrophil surface adhesion molecule CD11b was analyzed by flow cytometry and compared respectively.ROC curve of CD11b in 2 diabetes mellitus patients was made.Results The expression ratio of CD11b in high active CMV infection group and CMV infection group in type 2 diabetes mellitus patients was (41.25 ± 5.33)%.There was significant difference (P =0.019)compared with negative control group (61.13 ±5.28)% and there was significant difference (P =0.009)compared with negative control group (64.21 ±6.02)%;optimal cut -off value of CD11b in high active CMV infection group was 45.65%,the sensitivity was 100.00%,the specificity in high active CMV infection group was 60.12%,and the area under the receiver -operating curve(ROC)was 0.628;optimal cut -off value of CD11b in CMV infection group was 70.21%,the sensitivity of CD11b was 87.69%,the specificity of CD11b was 99.22%,and the area under of ROC of CD11b was 0.991.Conclusion The neutrophils CD11b expression in type 2 diabetes mellitus patients with CMV infection is down regulation.CD11b expression can be used as a laboratory diagnosis basis of CMV infection.
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Objective To evaluate the efficacy of intratympanic steroid therapy compared with systemic ster‐oid therapy on the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) patients with damaged glu‐cose tolerance .Methods Fifty first -diagnosed unilateral ISSNHL patients with damaged glucose tolerance were randomized devided equally to the intervention group (intratympanic steroid therapy) or the control group (systemic steroid therapy) ,all patients received conventional drug therapy simultaneously .Pure-tone hearing threshold tests were performed in all patients every 3 days after the first time ,and repeated measures anova was used to assess effects of hearing recovery accompanied with time .Results The mean hearing threshold in the control group de‐creased from 85 .4 ± 5 .6 dB to 48 .2 ± 4 .9 dB ,while in the intervention group it decreased from 84 .8 ± 5 .6 dB to 31 .7 ± 4 .6 dB .Total effective rate in the intervention group (84 .00% ,21/95) was higher than that in the control group (68 .00% ,17/25)(P<0 .05) .Conclusion The intratympanic steroid therapy is more effective than systemic steroid therapy in the treatment of ISSNHL patients with damaged glucose tolerance .
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Autologous red blood cells (RBC) labeled with fluorescence were immitted into microvessel of SD rat and observed under microscope. The movement of each individual labeled RBC was recorded by microscope video camera system. The recorded videotape is replayed to sample dark background fluorescent images through frame grabber. Sampled frame images were separated into odd and even field sequence images. Then these sequence images were analyzed to get the flow rate. The error between the actual flow velocity value and the flow velocity value of fluorescent globules in the chamber measured under the same system was below 7%. The upper limit was 9.6 mm/s. There are no obvious differences (P > 0.05). This system has been applied in the research of rat microcirculatory disturbance, and the temporal flow rate change in microvessel was obtained.