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OBJECTIVE To study the ameliorative effect and potential mechanism of curcumin on diabetes model rats with depression based on cAMP response element binding protein （CREB）/brain-derived neurotrophic factor （BDNF） signaling pathway. METHODS The diabetes model rat with depression was established by high fat and high sugar diet+intraperitoneal injection of streptozotocin+chronic unpredictable stress-induced depression. The successfully modeled rats were randomly divided into model group， positive control group （0.18 g/kg metformin and 1.8 mg/kg fluoxetine， gavage）， curcumin low-dose and high-dose groups （30， 60 mg/kg， gavage） and curcumin high-dose+CREB inhibitor group [60 mg/kg curcumin （gavage）+5 mg/kg CREB inhibitor 666-15 （intraperitoneal injection）]， with 12 rats in each group. Another 12 healthy rats were selected as the normal group. Each group was given a corresponding intervention for 4 weeks， the fasting blood glucose level of rats was detected， and the depression of rats was assessed. The levels of corticosterone （CORT） and inflammatory factors [tumor necrosis factor-α （TNF-α）， interleukin- 1β （IL-1β）， IL-6] in serum， and the levels of norepinephrine （NE） and 5-hydroxytryptamine （5-HT） in hippocampal tissue were determined. The pathological changes and neuronal apoptosis were observed in the hippocampal tissue of rats in each group； the expression levels of CREB， BDNF mRNA and protein in hippocampal tissue were detected. RESULTS Compared with the normal group， the hippocampal tissue of rats in the model group was severely damaged， and neurons were scattered， while the fasting blood glucose， the forced swimming immobility time， the tail suspension immobility time， serum levels of CORT， TNF-α， IL-1β and IL-6， and neuron apoptosis indexes were all increased or prolonged significantly （P＜0.05）. The levels of NE and 5-HT， the number of surviving neurons， and the expression levels of CREB and BDNF mRNA and protein in hippocampal tissue were decreased significantly （P＜0.05）. Compared with the 的model group， the damage to hippocampal tissue was relieved in the positive control group and curcumin groups， while the above indexes were improved significantly （P＜0.05）. The improvement effect of curcumin high-dose group was better than that of curcumin low-dose group （P＜0.05）. CREB inhibitor could significantly reverse the ameliorative effect of high-dose curcumin on the model rats （P＜0.05）. CONCLUSIONS Curcumin can improve the depression of diabetes model rats with depression， and relieve neuronal damage and inflammatory response， the mechanism of which may be associated with activating CREB/BDNF signaling pathway.
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The experimental teaching of psychology is not only an important course in the undergraduate and graduate education of applied psychology, but also can assist the practical teaching of quite a few other subjects. It clearly divides three basic functions of experimental psychology teaching center: teaching, scientific research and service, which play an important role in facilitating teachers and students to understand corresponding courses. At the same time, it is discussed and proposed to strengthen the internal and external scientific linkage of the experimental center under the network background, and put forward the use of Internet technology, in order to improve the scientific use of the experimental teaching center, and reflect its maximum value, thereby achieving the purpose of university laboratory joint construction and serve the university to cultivate innovative and compound personnels.
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Objective:To summarize the application and effect of "Trinity" emergency chain in the management of patients with epidemic respiratory tract infection under the cooperation of multiple hospitals and districts, and to provide a reference for medical institutions to improve the risk response ability.Methods:Based on the collaborative management of multi-branches, the "Trinity" emergency chain of pre-hospital-emergency-critical care, identification-triage-treatment, expansion-training-dispatch was implemented to optimize and integrate medical resources.Results:During the two months, 43,000 patients were admitted to the fever clinic, with an increase of 36.08%. The average waiting time for treatment was 19.83 min, and the average admission time to ICU was 25.35 min.Conclusions:The "Trinity" emergency chain treatment scheme under the coordination of multi-branches can effectively deal with the public health events of respiratory tract infectious diseases, improve the efficiency of rescue and treatment, and enhance the risk response ability of medical institutions.
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In order to adapt to the development of higher medical education, it is imperative to carry out a student-centered teaching reform of pathophysiology guided by the cultivation of "clinical competence". The main contents of this teaching reform of pathophysiology include: the teaching content layout has been reconstructed to promote classroom teaching with clinical manifestation, new media means such as blackboard online teaching system, WeChat public platform and Chaoxing virtual classroom have been applied to assist students in their learning, and students are encouraged to conduct literature retrieval and reading, and then make presentation PPT for a literature of interest and report to all students to cultivate students' independent learning and sustainable development ability via flipped classroom. The practice shows that the student-centered teaching reform of pathophysiology guided by the cultivation of "clinical competence" has gained successful results.
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Objective:To retrieve and obtain relevant evidence of intra-abdominal pressure-oriented enteral nutrition assessment and management in patients with intra-abdominal hypertension, in order to provide evidence-based evidence for clinical medical staff to make enteral nutrition-related clinical decisions for patients with intra-abdominal hypertension.Methods:Systematic retrieval of Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature, UpToDate, PubMed, Cochrane Library, BMJ Best Practice and other English data, as well as domestic and foreign guidelines such as American Society for Parenteral and Enteral Nutrition, Scottish Intercollegiate Guidelines Network, etc. All evidence available on the Internet in both Chinese and English on intra-abdominal pressure-guided enteral nutrition strategies in adults with intra-abdominal hypertension, study types including clinical decision-making, systematic reviews/meta-analyses, evidence summaries, expert consensus, guidelines or related to the subject of this study closely related high-quality original research. The retrieval time was from the establishment of the database to November 2021. The literature evaluation tool was selected according to the research type. Two researchers trained in the evidence-based system independently evaluate the quality of the included literature, fully considering the clinical situation and expert opinions, and completed the evidence. Extracted and summarized.Results:Totally 13 articles were finally included, including 5 guidelines, 3 expert consensuses, 1 evidence summary and 4 original studies, and 29 evidence-based practice evidence of enteral nutrition in patients with intra-abdominal hypertension were collected, including the monitoring timing of enteral pressure, the pressure of enteral high pressure and the way of enteral nutrition, the pressure measurement of the abdominal cavity, the setting of abdominal pressure, the temperature conditions for early start of enteral nutrition, the selection of enteral pressure, the temperature setting of enteral nutrition nine aspects such as speed and regulation of internal nutrition and abdominal compartment syndrome prevention.Conclusions:This study summarizes the best evidence of intra-abdominal pressure management and enteral nutrition therapy in patients with intra-abdominal hypertension, and provides evidence-based basis for risk management, standardizing clinical practice, and ensuring treatment safety. In the stage of evidence transformation, clinical medical staff need to comprehensively weigh the benefits and risks of early enteral nutrition, and integrate evidence in combination with clinical practical application scenarios, so as to form a standardized early enteral nutrition management plan suitable for patients with intra-abdominal hypertension.
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Objective:To explore the different types and characteristics of rehabilitation exercise compliance of patients with first stroke at 2 weeks of onset, and analyze its influencing factors, so as to provide reference for the formulation of targeted health education.Methods:A cross-sectional investigation was conducted in Neurology Department of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to June, 2021. 276 patients with first-episode stroke were investigated by the Questionnaire of Exercise Adherence at 2 weeks of the onset. The potential profile analysis was conducted to explore characteristics classification of the rehabilitation exercise compliance. And the chi-square test was used to compare demographic differences among different categories and ordered multi classification Logistic regression was used to explore the influencing factors of rehabilitation exercise compliance.Results:The patients were divided into 109 cases with high rehabilitation exercise compliance (39.5%), 114 cases with moderate rehabilitation exercise compliance (41.3%), and 53 cases with low rehabilitation exercise compliance (19.2%). There were statistically significant differences in education level, consciousness level at admission, complications and limb muscle strength among the three types of patients ( χ2 values were 6.17-31.50, all P<0.05). Ordered multi classification Logistic regression showed that the patient′s education level, the patient′s consciousness level at admission, whether there were complications and limb muscle strength would affect the rehabilitation exercise compliance of stroke patients ( P<0.05). Conclusions:There are three potential categories of rehabilitation exercise compliance in patients with first stroke. Patients with illiteracy, drowsiness, complications and poor limb muscle strength have poor rehabilitation exercise compliance.
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Objective:To establish and apply the electronic further modified early warning score system (e-fMEWS), and explore its role in the condition evaluation and early warning of inpatients in non-critical units, so as to provide clinical nurses with an early and dynamic method to identify the potential deterioration risk of patients' condition.Methods:A retrospective analysis of 262 805 inpatients in multiple non-critical units of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to December 2018 and January to December 2020 was performed. The patients who were hospitalized from January to December 2018 were used as the control group, and the responsible nurse used the traditional single evaluation index to start the emergency response system; the patients from January to December 2020 were used as the research group, and the emergency response system was started using e-fMEWS. The inclusion criteria were as follows: (1) hospitalization time ≥24 h; (2) patient ≥14 years old. Exclusion criteria were as follows: (1) patients had cardiopulmonary resuscitation before admission; (2) patients discontinued treatment or were transferred to another hospital during treatment; (3) patients received palliative care; (4) patients were admitted to non-critical wards in grade I of emergency pre-examination and triage. The activation of the rapid response team (RRT), the activation of the cardiorespiratory arrest team, the incidence of cardiac and respiratory arrest, the number of cases of invasive mechanical ventilation, the number of cases admitted to the intensive care unit, the length of hospital stay and the prognosis were compared. Statistical software SPSS 22.0 was used for data analysis.Results:Under the e-fMEWS assessment, compared with the control group, the rate of initiation of the research group decreased by 0.03%. For patients who initiated RRT, the average length of hospital stay was shortened, and the number of in-hospital respiratory cardiac arrest decreased (12.2% vs. 13.2%) and the number of cases transferred to the intensive care unit was less (42.8% vs. 50.6%), the rate of improvement and recovary increased (58.4% vs. 56.1%).Conclusions:The application of e-fMEWS can help clinical nurses to quickly and accurately identify the potential risk of deterioration of the patient's condition. Through early identification of potentially critically ill patients in non-critical units, early intervention and timely treatment can avoid adverse events and improve the patient prognosis.
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Under the background of efficiency medical reform, the authors introduced the nursing efficiency management system of a large public hospital, which was divided into two dimensions: nursing resource allocation efficiency and nursing service efficiency. The specific four measures included the establishment of multi-campus unified management organization structure based on nursing management committee, nursing performance reform based on structured big data information platform, the construction of nurse-led patient whole process management model and the accelerated rehabilitation nursing practice from surgery to the whole hospital, so as to provide reference for the nursing efficiency management of large general public hospitals under the medical reform.
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Objective:To observe the effect of evidence-based early activity training on postoperative delirium in patients with brain tumor resection.Methods:This study used non-contemporary comparison method, a total of 238 patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine in 2019, were included. 121 patients who met the inclusion criteria and signed informed consent after craniotomy during January 1st,2019 to June 31th,2019 were included in the control group, and 117 patients who met the criteria and obtained informed consent after craniotomy during July 1 to December 31,2019, were included in the experimental group. Neurosurgical postoperative routine nursing care were given to the control group. The experimental group received evidence-based early activity training. The incidence of delirium, duration of delirium, Barthel Index (BI), delirium-related adverse events and other indicators of postoperative hospitalization were compared between two groups.Results:The incidence of delirium, duration of delirium and postoperative hospital stay in the experimental group were 9.5%, 2.0 (1,3) days and 7 (5,10) days, lower than 23.3%, 3.0 (1,5) days and 8 (6,11) days in control group, and the differences were statistically significant ( χ2 value was 8.17, Z value were 2.96 and -2.01, P<0.05). BI index 1 week and 1 month after discharge in the experimental group was 90 (85, 90), 100 (100, 100), higher than the control group of 90 (86, 90) and 100 (100,100), with statistically significant difference ( Z values were -2.41 and -2.46, P<0.05), the comparison of adverse events, 0 case in experimental group, 1 case in control group, there was no statistically significant difference ( χ2 value was 0.97, P>0.05). Conclusions:Early evidence-based activities in patients with brain tumor resection can reduce the incidence of postoperative delirium, shorten the duration of postoperative delirium and postoperative hospital stay, and improve the ability of patients to take care of themselves after surgery, which is safe and effective.
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Objective:To evaluate the efficacy and safety of camrelizumab combined with albumin paclitaxel in second-line treatment of advanced esophageal squamous cell carcinoma (ESCC).Methods:Seventy-two patients with advanced or metastatic ESCC who had failed first-line treatment admitted to the Department of Oncology of the Affiliated Hospital of West Anhui Health Vocational College from May 12, 2019 to August 20, 2020 were enrolled. The patients were given camrelizumab combined with albumin paclitaxel (the experimental group, n=45) or second-line chemotherapy (docetaxel or irinotecan, the control group, n=27) according to patients′ preference. Besides, the objective response rate (ORR), disease control rate (DCR), incidence of adverse events, overall survival (OS) and progress free survival (PFS) were assessed. Results:The ORR of the experimental group and the control group were 26.7% (12/45) and 7.4% (2/27) respectively, with a statistically significant difference ( χ2=3.996, P=0.046). The DCR of the two groups were 48.9% (22/45) and 29.6% (8/27) respectively, with no statistically significant difference ( χ2=2.575, P=0.109). In terms of adverse events, the experimental group was better tolerated, and the incidence of grade 3 or above adverse events was lower [28.9% (13/45) vs. 55.6% (15/27)], which was 48% lower than that of the control group, with a statistically significant difference ( χ2=5.049, P=0.025). One patient in the control group had a treatment-related death. The median OS was 8.9 months (95% CI: 7.9-9.8) in the experimental group and 6.5 months (95% CI: 5.6-7.3) in the control group, with a statistically significant difference ( χ2=5.068, P=0.024). The median PFS was 2.2 months (95% CI: 1.6-2.7) in the experimental group and 1.8 months (95% CI: 1.5-2.0) in the control group, with a statistically significant difference ( χ2=4.799, P=0.028). Conclusion:Camrelizumab combined with albumin paclitaxel in second-line treatment of advanced ESCC patients has proven efficacy and tolerable safety, which may be a potential second-line treatment for advanced ESCC.
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Neonatal critical illness score is a scoring system that assesses the severity of neonatal disease and predicts the risk of death.However, it also has an important reference value for the evaluation of neurological prognosis.Since various neonatal critical scores have different assessment contents, the evaluation performance of neurological prognosis is also different.Score for neonatal acute physiology, score for neonatal acute physiology, version-Ⅱ, score for neonatal acute physiology, perinatal extension, version-Ⅱ, nursery neurobiological risk score, et al, have good predictive value for long-term neurological prognosis.The predictive value of clinical risk index for babies, clinical risk index for babies and version-Ⅱ remains unproven.This article reviews the correlation between neonatal critical illness score and the neurological prognosis of very low birth weight infants(VLBWI), in order to provide references for the early identification and prognositic judgement of VLBWI nerve damage.
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Objective:To retrieve, appraise and synthesize the best available evidence on prevention and management of incontinence-associated dermatitis in adult inpatients.Methods:All the evidence on prevention and management of incontinence-associated dermatitis in adult inpatients was searched by computer from domestic and foreign electronic databases, guide.com and related professional websites from January 2010 to January 2020. Literature evaluation tools such as AGREEⅡ, AMSTAR were used for evaluation. Data extraction of documents that met the inclusion criteria.Results:A total of 28 pieces of relevant evidence were obtained. It includes 6 aspects: assessment and prevention, management of incontinence, cleaning, moisturizing and protection, treatment, monitoring and management.Conclusions:the 28 pieces of evidences in this study can better guide the medical staff in the prevention and management of incontinence-associated dermatitis in adult inpatients. It is suggested that the medical staff should carefully apply the evidence in combination with the specific clinical environment and the patient ′s will, and pay attention to the update of relevant evidence in time.
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Objective:To investigate the mediating and moderating effects of resilience on frailty and depression in the community-dwelling old adults.Methods:Totally 871 community-dwelling old adults chosen from different communities were investigated by the geriatric depression scale, Tilburg frailty indicator and 10-item Connor-Davidson resilience scale.SPSS 22.0 and AMOS 24.0 were used for data analysis, including descriptive analysis, correlation analysis, structural equation modeling and hierarchical regression analysis.Results:(1)The score of frailty (3.72±2.89)was positively correlated with the score of depression (2.63±2.57, r=0.16-0.58, P<0.01). The score of resilience(28.24±6.80) was negatively correlated with the score of frailty and depression ( r=-0.10~-0.49, both P<0.01), and frailty predicted 35% of the total variation of depression in the elderly.(2)The mediating effect of resilience was significant and the indirect effect was 0.10, accounting for 12.66% of the total variance.(3) Resilience moderated the relationship between frailty and depression ( β=-0.12, t=-4.11, R2=0.41, P<0.001). The frailty of old adults with lower resilience played a stronger predictive role in depression (simple slope=0.50, t=14.73, R2=0.01, P<0.001). Conclusion:There is a close relationship between frailty and depression in the community-dwelling older adults, and resilience plays both mediating and moderating role in the relationship.
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Objective To investigate the resilience characteristics of the elderly disabled,and the effects of individual,family and social factors on resilience.Methods A total of 138 disabled older adults from four districts of Chengdu City were investigated by 10 items Connor-Davidson resilience scale (CDRISC-10),the automatic thoughts questionnaire (ATQ),self esteem scale (SES),revised eysenck personnality questionnaire short scale for chinese(EPQ-RSC) and self-made population sociology questionnaire.Totally 194 community-dwelling older adults without disabilities,as a comparative population,were included in the analysis.Results Compared with the community-dwelling elderly without disability (35.58 ± 5.75,18.13±3.48,18.43±3.08),the scores of resilience(21.38±7.71),strength(10.50±4.08) and hardiness (10.88±4.07) of the elderly disabled were significantly lower(t=-19.56,-17.81,-18.34,P＜0.01).There were no significant differences in the resilience scores of the elderly disabled in terms of gender,urban and rural sources,marital status,education,disability level and family atmosphere.However,there were significant differences in age,disability causes,disability type and family economic conditions (age:thardiess =2.18,P＜0.05.disability causes:tresilience =-2.75,tstrength =-2.22,thardiness =-2.68,P＜0.05.disability type:Fhardiness =2.60,P＜ 0.05.family economic conditions:Fresilience =5.45,Fstrength =4.78,Fhardiness =5.21,P＜0.01).The resilience,automatic thoughts,self-esteem and personality were significant correlation with each other(r=-0.16-0.65,P＜0.05).After controlling age,disability causes,disability type and family economic conditions,self esteem(β=0.291,P＜0.01),extraversion (β=0.287,P＜0.01) and neuroticism (β=-0.254,P＜0.05) were important influential factors of resilience,explained 32.0％ variance in resilience.Conclusion It may be an important way to improve resilience level of the elderly disabled by enhancing their selfesteem,promoting their psychological adjustment and strengthening their emotional management.
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Objective The incidence and distribution of positional deformities ( PD) were studied by measuring cranial types of infants aged 0-6 months of 3 hospitals in Chongqing, and the recommended values of local PD were discussed. Methods Data of 3406 infants with 0-6 months head size measurements were col-lected from the Second Affiliated Hospital of Army Military Medical University, Yongchuan Maternal and Child Health Care Hospital and Wanzhou Maternal and Child Health Care Hospital from September 1, 2017 to August 31, 2018, cranial vault asymmetry ( CVA) and cranial index ( CI) were calculated. According to different age groups, observe the distribution of cranial types, and use the current international common diagnostic crite-ria to understand the incidence of cranial abnormalities, and analyze the distribution of percentile values of CVA and CI in infants in Chongqing. Results According to the current international standard diagnosis of PD, the incidence of simple brachycephaly was the highest ( 39. 9％) in the overall cranial abnormalities of infants, followed by brachycephaly with plagiocephaly was the second (36. 1％), simple plagiocephaly was the lowest (6. 9％), and normal cranial type only accounted for 17. 1％. The detection rates of plagiocephaly (36. 9％)and brachycephaly ( 67. 0％) were the lowest in the 0-2 months group, and the highest in the 3-4 months group (47. 3％/83. 3％), and then decreased in the 5-6 months group (46. 6％/80. 2％). Conclusion The basic values of cranial type measurement of full-term infants in chongqing were significantly different from inter-national reports, mainly due to the large CI value. The general international diagnosis standard for positional deformities do not conform to Chinese infants. We suggest that the reference value for positional deformities in this region is as follows: CVA≥0. 4 cm is abnormal, of which 0. 4 cm≤CVA<0. 6 cm for mild plagiocepha-ly, 0. 6 cm≤CVA<1. 0 cm for moderate plagiocephaly, CVA≥1. 0 cm for severe plagiocephaly; 82％≤CI≤91％ is abnormal, of which 91％≤CI <94％ for mild brachycephaly; 94％ ≤CI <99％ for moderate brachycephaly; CI≥99％ for severe brachycephaly. CI≤82％ is scaphocephaly.
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Objective To explore the current status and predictive factors of frailty among community-dwelling old adults.Methods A total of 1 012 community-dwelling older adults aged 65 years and above in Sichuan Province were enrolled and investigated by self-made general condition scale,Tilburg Frailty Indicator (TFI),Short Physical Performance Battery (SPPB),10-item Connor-Davidson Resilience Scale (CD-RISC-10),Mini-Mental State Examination (MMSE) and Geriatric Depression Scale Short-form (GDS-15).Results (1) The prevalence of frailty was 30.73％.(2) There were significant differences in the frailty scores of community-dwelling older adults in terms of gender,education,marital status,living condition,spouse support,children support,family economic conditions,self-perceived health status,number of chronic diseases,body mass index,number of falls in the past year,exercise state and sleep time at night(all P＜0.05).(3) The frailty (3.72±2.88) was significantly positively correlated with depression (2.69± 2.58;r=0.58,P＜0.01),and negatively correlated with the scores of balance ability(3.28± 1.01),walking speed (2.92± 1.05),chair rise test (2.92± 1.27),strength of resilience (13.99±3.57) and MMSE (23.71 ±5.55) (r=-0.33-0.43,P＜0.01).(4) Depression (β=0.416,P＜0.001),the number of chronic diseases (β=0.219,P＜0.001),balance ability (β=-0.166,P＜0.001),spousal support (β=-0.089,P＜0.01),strength of resilience(β =-0.097,P＜0.01),family economic status(β=0.093,P＜0.01) and gender(β=0.082,P＜0.01) significantly influenced frailty,with a combined explanation variance of 45.9％.Conclusions The rate of frailty of community-dwelling old adults is high,which is influenced by physiological,psychological and social factors.Therefore,it is necessary to adopt a comprehensive model of multi-disciplinary cooperation to carry out frailty intervention in community.
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OBJECTIVE@#To review the clinical features of a male twin affected with glutaric academia type I (GA-I) and analyze the variations of glutaryl-CoA dehydrogenase (GCDH) gene.@*METHODS@#Clinical data of the pair of twins and their parents were collected. Genomic DNA was extracted from peripheral blood samples, and variants of GCDH genes were detected by capture sequencing using a customized panel. Variants of the twins and their parents were verified by Sanger sequencing.@*RESULTS@#The level of glutaric acyl carnitine (C5DC + C6OH) was 3.26 μmol/L in the male twin. The relative level of glutaric acid in urine was 547.51 by gas chromatography mass spectrometry analysis. Cerebral ultrasonography showed that the patient had subependymal hemorrhage, but no serious clinical manifestation was noted. After treating with special formula milk powder and L-carnitine, the boy showed good growth and development. Two heterozygous variants of the GCDH gene were detected in the patient, among which c.416C>G was suspected to be pathogenic, while c.109_110delCA was unreported. The variants were respectively inherited from his parents. The twin girl only carried the c.416C>G variant.@*CONCLUSION@#GA-I can be diagnosed by mass spectrometry, urine gas chromatographic mass spectrometry, imaging as well as genetic diagnosis. Early diagnosis and intervention is important.
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Femenino , Humanos , Masculino , Errores Innatos del Metabolismo de los Aminoácidos , Genética , Encefalopatías Metabólicas , Genética , Glutaril-CoA Deshidrogenasa , Genética , Mutación , FenotipoRESUMEN
Objective@#To explore the current status and predictive factors of frailty among community-dwelling old adults.@*Methods@#A total of 1 012 community-dwelling older adults aged 65 years and above in Sichuan Province were enrolled and investigated by self-made general condition scale, Tilburg Frailty Indicator (TFI), Short Physical Performance Battery(SPPB), 10-item Connor-Davidson Resilience Scale(CD-RISC-10), Mini-Mental State Examination(MMSE) and Geriatric Depression Scale Short-form(GDS-15).@*Results@#(1) The prevalence of frailty was 30.73%.(2) There were significant differences in the frailty scores of community-dwelling older adults in terms of gender, education, marital status, living condition, spouse support, children support, family economic conditions, self-perceived health status, number of chronic diseases, body mass index, number of falls in the past year, exercise state and sleep time at night(all P<0.05). (3) The frailty (3.72±2.88) was significantly positively correlated with depression (2.69±2.58; r=0.58, P<0.01), and negatively correlated with the scores of balance ability(3.28±1.01), walking speed(2.92±1.05), chair rise test(2.92±1.27), strength of resilience(13.99±3.57) and MMSE(23.71±5.55) (r=-0.33-0.43, P<0.01). (4) Depression (β=0.416, P<0.001), the number of chronic diseases(β=0.219, P<0.001), balance ability(β=-0.166, P<0.001), spousal support(β=-0.089, P<0.01), strength of resilience(β =-0.097, P<0.01), family economic status(β=0.093, P<0.01) and gender(β=0.082, P<0.01) significantly influenced frailty, with a combined explanation variance of 45.9%.@*Conclusions@#The rate of frailty of community-dwelling old adults is high, which is influenced by physiological, psychological and social factors.Therefore, it is necessary to adopt a comprehensive model of multi-disciplinary cooperation to carry out frailty intervention in community.
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Objective@#The incidence and distribution of positional deformities(PD)were studied by measuring cranial types of infants aged 0-6 months of 3 hospitals in Chongqing, and the recommended values of local PD were discussed.@*Methods@#Data of 3 406 infants with 0-6 months head size measurements were collected from the Second Affiliated Hospital of Army Military Medical University, Yongchuan Maternal and Child Health Care Hospital and Wanzhou Maternal and Child Health Care Hospital from September 1, 2017 to August 31, 2018, cranial vault asymmetry(CVA)and cranial index(CI)were calculated.According to different age groups, observe the distribution of cranial types, and use the current international common diagnostic criteria to understand the incidence of cranial abnormalities, and analyze the distribution of percentile values of CVA and CI in infants in Chongqing.@*Results@#According to the current international standard diagnosis of PD, the incidence of simple brachycephaly was the highest(39.9%)in the overall cranial abnormalities of infants, followed by brachycephaly with plagiocephaly was the second(36.1%), simple plagiocephaly was the lowest(6.9%), and normal cranial type only accounted for 17.1%.The detection rates of plagiocephaly(36.9%)and brachycephaly(67.0%)were the lowest in the 0-2 months group, and the highest in the 3-4 months group(47.3%/83.3%), and then decreased in the 5-6 months group(46.6%/80.2%).@*Conclusion@#The basic values of cranial type measurement of full-term infants in chongqing were significantly different from international reports, mainly due to the large CI value.The general international diagnosis standard for positional deformities do not conform to Chinese infants.We suggest that the reference value for positional deformities in this region is as follows: CVA≥0.4 cm is abnormal, of which 0.4 cm≤CVA<0.6 cm for mild plagiocephaly, 0.6 cm≤CVA<1.0 cm for moderate plagiocephaly, CVA≥1.0 cm for severe plagiocephaly; 82%≤CI≤91% is abnormal, of which 91%≤CI<94% for mild brachycephaly; 94% ≤CI<99% for moderate brachycephaly; CI≥ 99% for severe brachycephaly.CI≤82% is scaphocephaly.
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Objective To evaluate the efficacy and safety of posaconazole for preventing invasive fungal disease (IFD) in the aplastic anemia patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Methods A total of 46 aplastic anemia patients received allogeneic HSCT. They were treated with oral posaconazole 200 mg, three times a day from HSCT pretreatment to granulocyte recovery after transplantation. G test and GM test were done 1, 2 and 4 weeks after the end of posaconazole treatment, and chest CT scan repeated 4 weeks after the end of posaconazole treatment. Posaconazole prophylaxis was defined as successful if there were no clinical manifestations indicative of fungal infection. Results All the 46 patients experienced neutropenia. The median of absolute neutrophil count (ANC) nadir was 0.02 (0-0.05)×109/L for a median time of 10 (8-19) days. The median duration of posaconazole prophylaxis was 26 (15-41) days. Neutropenic fever was reported in 45 patients, which lasted a median time of 5 (1-13) days. Six patients (13.3％ of the patients with neutropenic fever) failed to respond to the empirical treatment of broad spectrum antibiotics with persistent fever over 7 days. Their treatment was switched to short-term empirical treatment with broad spectrum antifungal agents. However, subsequent G test, GM test and chest CT showed negative results. None of the six patient was consistent with IFD diagnosis. Breakthrough fungal infection was not considered. Oral posaconazole solution was resumed for preventing IFD. G test, GM test and chest CT scan did not show any sign of fungal infection 1, 2 and 4 weeks after the end of posaconazole prophylactic treatment in all the 46 patients, proving the success of oral posaconazole in preventing IFD. Posaconazole was not discontinued due to adverse drug reaction in any patient. Conclusions Posaconazole is effective for preventing IFD in the aplastic anemia patients receiving HSCT with good safety profile and few adverse reactions.