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Objective:To investigate the prevalence of the decline of intrinsic capacity(IC)and to explore the effect of intrinsic capacity decline on falls and hospital readmission during 1 year follow-up.Methods:A total of 311 elderly patients treated in Geriatrics Department of Zhejiang Hospital were enrolled.General information and intrinsic ability data, including cognitive(simple mental state inventory), motor(Tinetti-Balance Scale and 4 m test), vitality(grip strength and mini-nutrition assessment table), perception(self-rated vision or hearing impairment), and psychosocial(Geriatric depression scale), were collected at admission.Falls and hospital readmission within 1 year after discharge were followed up.Multivariate Logistic regression analysis was used to investigate the relationship of baseline intrinsic ability at admission with falls and hospital readmission during 1-year follow-up.Results:Of 311 elderly hospitalized patients, 282(90.7%)had intrinsic capacity decline.During 1 year follow-up, 38 elderly patients(12.2%)had falls and 69 elderly patients(22.2%)were hospital readmitted.After adjusting for confounding factors such as age, gender, education level, comorbidities, multiple medications, fear of falling, and assistive tool use and so on, Logistic regression analysis showed that decreased balance ability was a risk factor for falls within 1 year in elderly patients( OR=3.515, 95% CI: 1.089-11.346, P=0.036), and slow walking speed was a risk factor for one-year hospital readmission( OR=2.426, 95% CI: 1.181-4.983, P=0.016). Conclusions:Decreased motor capacity is closely associated with falls and hospital readmission within 1 year in older patients.Great attention should be paid to the assessment and intervention of motor ability in elderly patients.
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Objective:To explore the associations of malnutrition, sarcopenia and disability in older hospitalized patients.Methods:A retrospective study was conducted on 180 patients who were admitted to the department of geriatrics of our hospital from November 2015 to September 2020 and completed 1-year follow-up.Malnutrition and sarcopenia were diagnosed as the Global Leadership Initiative on Malnutrition(GLIM)criteria and the 2019 sarcopenia criteria issued by the Asian Working Group for Sarcopenia(AWGS2019).Disability was defined as a score of less than or equal to 95 on the Barthel Index(BI).At the end of the 1-year follow-up, a decrease of ≥5 points in the total BI score from baseline was defined as aggravation of the disability.Multivariate Logistic regression models were used to analyze the effects of malnutrition and sarcopenia on the occurrence and aggravation of the disability.Results:Among the 180 elderly patients, 27.2%(49/180)met the diagnosis of malnutrition and 39.4%(71/180)of sarcopenia, and 22.2%(40/180)of malnutrition and sarcopenia overlapped.The incidence of disability was 36.7%(66/180)at baseline and the incidence of an aggravation of disability was 31.7%(57/180)at 1-year follow-up.After adjustment for confounding factors, multivariate Logistic regression analysis showed that malnutrition( OR=3.70, 95% CI=1.27-10.80, P=0.017)and sarcopenia( OR=2.93, 95% CI=1.12-7.64, P=0.028)were risk factors for disability in elderly patients, and sarcopenia was a risk factor for aggravation of disability in elderly patients after a 1-year follow-up( OR=3.99, 95% CI=1.47-10.83, P=0.007). Conclusions:Malnutrition and sarcopenia are closely associated with the occurrence and development of disability in older hospitalized patients.
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Objective To establish the fingerprint spectrum and assay three active components (hesperidin, salvianolic acid B and chrysophanol) in Shenshuaining granule by HPLC method. Methods The chromatographic separation was achieved on SunFireTM C18 column with acetonitrile-0.1% formic acid aqueous solution as mobile phase. Gradient elution program was applied with flow rate of 1.0 ml/min, detection wavelength at 254 nm and the column temperature at 25 ℃. The fingerprint spectrum was established and three active components in Shenshuaining granule were assayed. Results There were 22 common peaks on the fingerprints after analyzing chromatograms from 10 batches of Shenshuaining granules. Good fingerprint similarities (≥0.9) between different batches and the control chromatogram were found. This method has great repeatability, stability and precision, which meets all the assay requirements. Conclusion A simple and reliable HPLC method was developed, which is suitable for the fingerprint establishment of Shenshuaining granules. It provides a method for the quality control of Shenshuaining granules.
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Objective:To investigate the impact of geriatric syndromes on physical performance and fall risk in elderly patients with type 2 diabetes mellitus.Methods:A total of 179 elderly inpatients and outpatients with diabetes mellitus in the geriatric department of Zhejiang Hospital were recruited in this cross-sectional study.According to the number of geriatric syndromes including frailty, cognitive impairment, malnutrition, depression, poly-pharmacy and co-morbidity, patients were classified into Group A(n=40, with ≤1 geriatric syndrome), Group B(n=84, with 2-3 geriatric syndromes)and Group C(n=55, with ≥4 geriatric syndromes). Clinical data and physical performance status, fall risk and one-year fall history were compared between the groups.Effects of each geriatric syndrome on disability in daily life, balance and gait ability, and increased fall risk in elderly patients were further analyzed.Results:Patients with more geriatric syndromes were older, had a higher proportion of using walking aids and a higher prevalence of disability in daily life, balance and gait impairment, and increased fall risk( P<0.05). Furthermore, univariate and multivariate Logistic regression indicated that frailty and malnutrition were risk factors for disability in daily life( OR=3.467 and 3.369, P<0.05)and balance and gait impairment( OR=3.031 and 3.266, P<0.05), and that cognition impairment was a risk factor for increased fall risk( OR=2.559, P<0.05)and balance and gait impairment( OR=3.930, P<0.05). Conclusions:Frailty, malnutrition and cognition impairment can lead to physical performance impairment and increased fall risk in elderly patients with type 2 diabetes mellitus.Clinical intervention should be conducted to improve the quality of life in elderly adults.
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Objective To investigate the detection rate of motoric cognitive risk syndrome (MCR)and explore the possible risk factors.Methods A total of 429 elderly patients from geriatric department of Zhejiang Hospital from October 2014 to September 2018 were recruited in the crosssectional study.General information and functional assessment including fall history,self-reported visual impairment and hearing impairment,depressive symptom,cognitive function and gait speed were collected.Patients with MCR were screened out according to the MCR diagnostic criteria.Multiple logistic regression analysis was used to analyze the associated risk factors.Results Seventeen patients(4.0％)met the MCR diagnostic criteria.The proportions of obesity,polypharmacy,cerebral vascular diseases,self-reported hearing impairment,depressive symptoms and slow gait were higher in MCR patients than in non-MCR patients(P＜0.05).Compared with non-MCR patients,MCR patients had lower mini mental state examination (MMSE) scores (P ＜ 0.01).After adjusting for associated confounding factors,multiple logistic regression analysis showed obesity (OR =3.74,95 ％ CI:1.14-12.23,P ＜ 0.05) and depressive symptoms (OR =5.79,95％ CI:1.76-19.06,P ＜ 0.01) were risk factors for MCR.Conclusions MCR is not uncommon in elderly patients.Obesity and depressive symptoms are closely associated with an increased risk of MCR.
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Objective To evaluate the effect and safety of drug-coated balloon (DCB) for treating femoropopliteal arteriosclerosis obliterans.Methods Totally 54 patients with femoropopliteal arteriosclerosis obliterans who underwent percutaneous translurninal angioplasty (PTA) were randomly divided into test group and control group after successful predilation during operation.Patients in test group were treated with DCB,while those in control group were treated with uncoated balloon (UCB) during PTA.A 6-month follow-up was performed after operation.The treatment effect and safety between the two groups were compared.Additional analysis among patients who had a non-flow-limiting dissection during PTA in each group was done.Results Six months after PTA,there were 26 patients in test group and 20 patients in control group after getting rid of 8 patients lost to follow-up.The ankle brachial index (ABI) and minimal lumen diameter (MLD) of target lesion were higher (both P＜0.05),and the Rutherford stage,degree of target lesion stenosis,late lumen lose (LLL),the rate of restenosis and target lesion revascularization (TLR) were lower (all P＜0.05) in test group than those in control group.There were 14 patients in test group (subgroup A) and 8 patients in control group (subgroup B) who had a non-flow-limiting dissection.Except for the ABI and Rutherford stage 6 months after PTA (both P＞0.05),the other effect indexes were statistically different between the two subgroups (all P＜0.05).The rates of major adverse events and amputation were similar between test group and control group (both P＞0.05).Conclusion DCB has better short-term effect than UCB for treating femoropopliteal arteriosclerosis obliterans as safe as UCB.Meanwhile,DCB is better than UCB in patients with a non-flow-limiting dissection during PTA.
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Objective To study effects of bitter almond on interstitial cells of Cajal (ICC) in old rats with slow-transit constipation (STC) and analyze mechanism of the gut purge of bitter almond.Methods Forty-five old SD rats were randomly divided into blank control group,model control group,bitter almond-treated group randomly (n=15,each).Compound phenanthroline was used to build the model of STC model.The bitter almond-treated group was given with bitter almond apozem,the other two groups were given with the same amount of saline.After 10 days,the carbon powder propulsion rates in the intestine were measured and specimens were taken.The ICC changes in terms of the number and distribution were observed by immunohistochemical method.The protein and mRNA expressions of c-kit in ICC were measured by Western blot and reverse transcription-polymerase chain reaction(RT-PCR).Results Compared with blank control group [(68.6 ± 6.0) ％,the carbon powder propulsion rates in the intestine in model control group[(47.7±± 1.7)％]were declined (P＜ 0.01).The areas of c-kit positive cell in colon were declined[(638.0 ± 23.5) μm2 vs.(723.7 ± 30.8)μm2]in model vs.blank control (P＜0.05).The mRNA expression of c-kit gene in ICC was declined [(0.3±0.1) vs.(1.0±0.1)] (P＜0.05),the expression of c-kit protein in ICC were declined[(0.2±0.2) vs.(0.5±0.2)] (P＜0.05).Compared with model control group[(47.7± 1.7)％],the carbon powder propulsion rates in the intestine in bitter almond group were increased[(63.4± 3.3)％ vs.] (P ＜0.01).The mRNA expression of c-kit gene in ICC were increased in bitter almond group (0.9 ±0.2) vs model control group[[(0.3±0.1)] (P＜ 0.01).The expression of c-kit protein in ICC were increased in bitter almond group[(0.5±0.3) vs.in model control 0.2±0.2)] (P＜0.01).Conclusions The bitter almond can promote the expression of c-kit mRNA and protein in colonic tissue of old STC rat interstitial and repair a fraction of ICC of STC rat interstitial,which promote intestinal peristalsis in slow-transit constipation rats.
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Percutaneous transluminal angioplasty is the preferred treatment of femoropopliteal arterial disease at present.But the high rate of restenosis needs to be solved rapidly.As a new treatment strategy,drug-coated balloon (DCB) can reduce the late lumen lose and the revascularization of target lesion by inhibiting intimal proliferation and inflammatory response,also it can treat femoropopliteal in-stent restenosis effectively.In addition,combining DCB and atherectomy or stenting can improve the outcomes for severe stenosis of femoropopliteal artery.The recent application progresses of DCB for femoropopliteal disease were reviewed in this article.
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Objective To discuss the clinical significance of the changes in plasma D-dimer levels in patients with primary hepatic carcinoma (PHC) after receiving transcatheter arterial chemoembolization (TACE).Methods The clinical data of 69 PHC patients were collected.According to mRECIST criteria,the patients were divided into disease-controlled group,i.e.(CR+PR+SD) patients,(group A,n=41) and disease progression group,i.e.PD patients,(group B,n=28).The plasma D-dimer levels were determined before and after TACE in all patients.The differences in plasma D-dimer levels were determined with ranksum test,and receiver operating characteristic (ROC) curve was used to evaluate the potency of D-dimer levels in judging TACE efficacy.Results The pre-TACE and post-TACE plasma D-dimer levels in group A were 124.00 μg/L (88.00-212.00 μg/L) and 190.00 μg/L (75.00-273.00 μg/L) respectively,the difference was not statistically significant (P＞0.05),while those in group B were 261.50 μg/L (138.25-559.50 μg/L) and 554.50 μg/L (398.25-1 080.00 μg/L) respectively.The pre-TACE plasma D-dimer level in group B was significantly higher than that in group A (P＜0.05),besides,in group B the plasma D-dimer level showed a further rise after TACE,the difference was statistically significant when compared with the pre-TACE level (P＜0.05).ROC curve analysis showed that the areas under ROC of pre-TACE and post-TACE plasma D-dimer levels used to determine the postoperative efficacy were 0.737 and 0.907 respectively.When taking 181.5 μg/L and 339.0 μg/L as the cut-off values,the sensitivity and specificity for judging the postoperative efficacy were 71.4％,70.7％ and 85.7％,87.8％,respectively.Conclusion The changes in plasma D-dimer levels have certain value in assessing PHC patient's condition as well as in evaluating the curative effect of TACE.The increase in plasma D-dimer level means that the patient's condition is serious and TACE efficacy will be poor.
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Objective To explore the associations of depressive symptoms with functional status and frailty in elderly outpatients.Methods A total of 297 geriatric outpatients(aged 65 years and over) from Zhejiang Hospital were recruited in the cross-sectional study from January 2014 to December 2015.We gathered general information,and evaluated depressive symptoms by Geriatric Depression Scale-15 (GDS-15),cognitive function by mini-mental state examination(M MSE),frailty by clinical frailty scale(CFS),activities of daily living (ADL)by Barthel index,instrumental activities of daily living (IADL),balance,POMA and gait by Tinetti-performance oriented mobility assessment (Tinetti-POMA),grip strength and 4m gait speed by 4-meter walk gait speed test.According to the GDS-15 scores,297 geriatric outpatients were divided into a depression symptom group(n=35,GDS-15 ≥6)and a nomdepressive symptom group(n=262,GDS-15＜6).The frailty and functional status were compared between two groups by SPSS 23.0.Results As compared with non-depressive symptoms,the depressive symptoms group had higher clinical frailty scale(CFS),lower body mass index(BMI),lower cognitive function and poorer grip strength and balance(all P＜0.05).There were significantly negative correlations of Geriatric Depression Scale-15 (GDS-15) with ADL,IADL,gait,balance,POMA and grip strength(r=-0.165、-0.154、-0.216、-0.291、-0.305、-0.314,All P＜ 0.05),while there were significantly positive correlations with CFS score,gait speed(r=0.256、0.198,both P＜0.05).The more severe the frailty was,the higher the risk of depressive symptoms was(OR=3.650,95％ CI 1.611-8.271).Conclusions The cognitive and physical functions in the elderly with depression symptoms are poorer as compared with the elderly without depression symptoms.Elderly outpatients with more severe frailty have a higher risk for depressive symptoms.
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MR cholangiopancreatography (MRCP) is widely used in biliary obstructive disease which is a commen disease in clinic,depending on its good ability of localized and qualitative diagnosis.With the development of MR technology,the applications of DWI in biliary obstructive disease is increasingly reported and most of them are focused on DWI application of the early diagnosis,qualitative diagnosis and the liver function evaluation of biliary obstructive disease.In this article,the application of MRCP,DWI and the combination of the two methods in biliary obstructive disease were reviewed.