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Objective:To evaluate liver functional reserve in healthy subjects of different age groups using the L-[1- 13C]-phenylalanine breath test( 13C-pheBT)and to investigate the patterns of changes in liver functional reserve with aging in comparison with elderly cirrhosis patients. Methods:Thirty-seven healthy volunteers were divided into a young and middle-aged group(n=10), an early elderly group(n=9), an advanced elderly group(n=9)and a longevity group(n=9). Eight elderly patients with liver cirrhosis were selected as the control group.An oral dose of 100 mg 13C-phe was administered to each subject.Expired breath samples were collected at pre-dose and at 12 different time points within 150 minutes post-dose.Isotope ratio mass spectrometer was used to measure the abundance of 13C.The percentage of the 13C excretion rate( 13CO 2ERt), the percentage of 13C cumulative excretion( 13Ccumt)at different time points, and the percentage of the 13C peak excretion rate( 13CO 2ERmax)after drug administration were calculated.In addition, associations between 13C-pheBT and common liver function parameters were analyzed. Results:Compared with healthy volunteers, 13CO 2ER 30, 13CO 2ER 45, 13CO 2ER 60, 13Ccum 45, 13Ccum 60, 13Ccum 75, 13Ccum 90 and 13Ccum 105, 13Ccum 120, 13Ccum 135, 13Ccum 150 showed significant differences in the longevity group, the young and middle-aged group and the young elderly group.There were statistically significant differences between the elderly cirrhosis group and the healthy volunteers in each subgroup(all P<0.05); The mean values of 13CO 2ERmax, 13CO 2ER 30, 13Ccum 45, 13Ccum 60, 13Ccum 75, 13Ccum 90, 13Ccum 105, 13Ccum 120, 13Ccum 135, 13Ccum 150 decreased following the order of the young and middle-aged group, the early elderly group, the advanced elderly group, the longevity group, and the elderly cirrhosis group(all P<0.05). In healthy volunteers, the 13CO 2 exclusion rate curve and the cumulative exclusion rate curve showed that the curves of the young and middle-aged group and the early elderly group almost overlapped, while the curves of the advanced group and the longevity group decreased with age, and the difference between the longevity group and the young and middle-aged group and between the longevity group and the early elderly group was markedly prominent. Conclusions:13C-pheBT is a safe, sensitive and reliable test for quantitation of liver function.Our recommendations include collecting samples within an hour of drug administration and using 13CO 2ERmax, 13CO 2ER 30, 13Ccum 45 and 13Ccum 60 as the main parameters.Overall, the functional reserve and compensatory capability of the liver are robust.The decline in liver functional reserve in healthy individuals is a gradual and slow process, with a significant decrease after age 80 and more so after age 90.
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Background: Colorectal polyp is a common lower gastrointestinal disease. Study of its risk factors is of great significance for prevention and treatment of colorectal polyps in clinical practice. Aims: To construct and verify a prediction model for risk of colorectal polyps. Methods: According to the inclusion and exclusion criteria, 254 subjects who were hospitalized for health examination in the Special Internal Medicine Ward of Shanghai Huadong Hospital from January 2019 to June 2021 were enrolled in the study. They were allocated into colorectal polyps group and non⁃polyp group based on the results of colonoscopy. The relevant risk factors of colorectal polyp were collected, including gender, age, cigarette smoking, alcohol drinking, hypertension, diabetes, hyperlipidemia, hyperuricemia, polyps/stones of gallbladder, fatty liver, etc. After screened by LASSO regression model, the selected factors were analyzed by multivariate Logistic regression to build the prediction model and nomogram. Furthermore, the prediction model was evaluated by ROC curve, C index, calibration curve and decision curve, and validated by internal samples. Results: Of the 254 subjects enrolled in the study, 116 cases were in colorectal polyps group and 138 in non⁃polyp group. The risk prediction model identified that gender (OR=2.11, 95% CI: 1.06⁃4.27), age (OR=2.76, 95% CI: 1.17⁃6.73), hypertension (OR=3.23, 95% CI: 1.52⁃7.12), diabetes (OR=4.37, 95% CI: 1.52⁃14.64), hyperlipidemia (OR=3.20, 95% CI: 1.74⁃5.95) and fatty liver (OR= 2.21, 95% CI: 1.13⁃4.35) were independent risk factors for colorectal polyps. The model showed good area under the ROC curve (0.807) and C index (0.807). The decision curve demonstrated that if the threshold probability of colorectal polyps was more than 12%, the model would be of clinical significance. Internal samples were randomly selected for validation, and the C index was 0.793. Conclusions: The prediction model and nomogram constructed by combination of risk factors including gender, age, hypertension, diabetes, hyperlipidemia and fatty liver have a substantial reference value for risk prediction of colorectal polyps.
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Objective:To investigate age-related histological and ultrastructural changes of the pancreas in Sprague-Dawley(SD)rats, and to provide a theoretical basis for the high incidence of pancreatic diseases in the elderly.Methods:Thirty 6-month-old specific pathogen-free male SD rats were fed until 6, 12, 18 and 25 months of age.Five rats of each age group were randomly selected, killed and then sampled to make histological(HE staining)and electron microscopic sections to observe age-related changes in pancreatic histology and ultrastructure.Results:The pancreatic tissue of rats showed increasing fibrosis with age, especially around the duct.Fat infiltration of the pancreatic tissue also increased with age( H=15.88, P=0.001). With the increase of age, the number(density)of pancreatic islets decreased gradually( F=3.55, P=0.039), but the average cross-sectional area of islets increased significantly( F=7.76, P=0.002), and the round and oval islets became irregular.Nuclear pyknosis, mitochondrial dehydration, mitochondrial swelling, and dilatation and loose organization of rough endoplasmic reticula were observed in the cytoplasm of pancreatic acinar cells and islet beat cells in aged rats.With the increase of age, the number of zymogen granules at the apical pole of pancreatic acinar cells of rats decreased( F=9.73, P<0.001), and the average area and total area of granules were significantly decreased( F=6.51, P=0.001; F=22.18, P<0.001); The number of non-senescent mitochondria and senescent mitochondria in the cytoplasm of acinar cells increased significantly( H=8.22, P=0.045; H=32.95, P<0.001); The amount of proinsulin in islet beta cells was significantly decreased( F=16.20, P<0.001). Conclusions:With aging, the rat pancreas exhibits a series of degenerative manifestations(stromal hyperplasia, adipose tissue infiltration, decreased numbers of zymogen granules in acinar cells, increases in the number of senescent mitochondria, reduced islets and reduced proinsulin in islet beta cells), while there are some compensatory phenomena(increasing numbers of islets and non-senescent mitochondria).
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The elderly are a special group, with their unique pathophysiology and disease characteristics.The measures and goals of diagnosis and treatment for the elderly are different from those for children, young and middle-aged people.Taking into consideration of the national and international literature, the insight from our long-term clinical practice and in-depth reflections, the authors have written this article as a reference for our colleagues in geriatric care.
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Objective:To investigate age-related morphological changes of the pancreas in healthy people using magnetic resonance imaging(MRI).Methods:From January 2017 to October 2019, people who took physical examinations at our hospital were enrolled and were divided into 7 groups according to age: 20-29 years old, 30-39 years old, 40-49 years old, 50-59 years old, 60-69 years old, 70-79 years old and ≥80 years.Also, the former four groups were classified as young and middle-aged(<60 years old)and the latter three as the elderly(≥60 years old). Morphological characteristics of the pancreas in each group were examined via MRI.Differences in parameters such as anteroposterior diameters of the head, body and tail and the pancreatic volume between the groups and the relationship between these parameters and age were analyzed.Results:A total of 191 cases who met the inclusion criteria were enrolled, including 96(50.3%)males and 95(49.7%)females, with 28 aged 20-29 years, 28 aged 30-39 years, 27 aged 40-49 years, 26 aged 50-59 years, 30 aged 60-69 years, 28 aged 70-79 years and 26 aged ≥80 years.There were 109 cases in the young and middle-aged category and 82 cases in the elderly category.MRI findings included pancreatic atrophy, which was most obvious in the tail; uneven and serrated edges of the pancreas and pancreatic lobulation; uneven signal intensity in the T 1-and T 2-weighted sequences; the "crispening effect" of pancreatic steatosis in the opposed-phase T 1-weighted sequences, and a trend of widening of the main pancreatic duct.The anteroposterior diameters of the pancreatic head, body and tail and the pancreatic volume reached the peak at(28.21±4.55)mm, (24.00±4.45)mm, (24.91±5.08)mm and(100.91±27.44)cm 3 between 30-39 years of age, and then gradually decreased to(18.87±3.82)mm, (15.63±3.96)mm, (13.70±3.70)mm and(43.88±10.47)cm 3 in those aged ≥80 years, with a decrease of 33.10%, 34.88%, 45.00% and 56.51%, respectively.The anteroposterior diameters of the pancreatic head, body, tail and the pancreatic volume in the elderly were(21.59±4.35)mm, (18.10±4.29)mm, (17.00±4.56)mm and(59.85±22.73)cm 3, which were smaller than those in the young and middle-aged category[(26.18±4.57)mm, (22.10±4.64)mm, (22.42±4.71)mm and(90.09±25.06)cm 3], and the differences were statistically significant( t=7.12, 6.19, 8.10 and 8.71, respectively, all P<0.001). The anteroposterior diameters of the head, body and tail and the pancreatic volume were negatively correlated with age( r=-0.52, -0.45, -0.56 and -0.57, respectively, P<0.001). Conclusions:The anteroposterior diameters of the head, body and tail and the pancreatic volume reach the peak between 30-39 years of age, and then gradually start to decline with the increase of age.After age 60, the decline become more evident, showing morphological signs of degeneration and dilatation of the main pancreatic duct.
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COVID-19 currently is a major pandemic disease in the world. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the β-coronavirus genus that has 79% homology with severe acute respiratory syndrome (SARS) virus and can lead to acute respiratory infection. While COVID-19 patients typically present with respiratory symptoms such as fever, cough, some patients also report symptoms of digestive system. Studies have identified the SARS-CoV-2 RNA in stool specimens of infected patients, and the viral receptor angiotensin converting enzyme 2 (ACE2) is found to be expressed in gastrointestinal epithelial cells, hepatic cells and pancreatic cells, suggesting that fecal-mouth route is a potential route for transmission of SARS-CoV-2. This article reviewed the digestive manifestations and pathogenesis of patients with COVID-19.
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Gastric cancer is a common malignant tumor in China, which seriously threatens the health of people. With the deepening of research on the prevention and treatment of gastric cancer in China, especially the effective control of risk factors related to gastric cancer and the continuous improvement of the level of screening and diagnosis and treatment of gastric cancer, the prevalence and mortality of gastric cancer in China are declining year by year. Although great progress has been made in the prevention and treatment of gastric cancer in China, due to the aging of population and large population base, gastric cancer is still the third most common malignant tumor and the second most lethal malignant tumor in China. It is still one of the major diseases endangering the health of Chinese people, and there is still a long way to go for its prevention and treatment, and further efforts should be made. This article reviewed the epidemiological changes and implications of gastric cancer in China.
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Anorexia of aging is one of the common clinical geriatric syndrome in clinic, characterized by the persistent and significant decreasing of appetite and/or by reducing a food intake in the elderly, which can cause various adverse consequences and increase the morbidity and mortality.However, clinicians have insufficient understanding of anorexia in the elderly, and often regard the anorexia of aging as the normal phenomenon of aging and might ignore it.This article reviews the domestic and foreign relevant literatures on anorexia of aging.
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Background: Irritable bowel syndrome with constipation (IBS-C) is a common functional gastrointestinal disorder. The current commonly used therapeutic drugs are not quite effective. Linaclotide is the globally first guanylate cyclase-C agonist, and provides a new selection for the treatment of IBS-C. Aims: To systematically evaluate the efficacy and safety of linaclotide in treatment of patients with IBS-C. Methods: Randomized controlled trials (RCTs) of linaclotide in the treatment of IBS-C were retrieved from CNKI, Wanfang Database, China VIP Database, PubMed, Embase, Cochrane Library. Literatures were independently screened by three reviewers, data were extracted and quality of the included studies was evaluated. The meta-analysis of efficacy of linaclotide on abdominal pain, complete spontaneous bowel movements (CSBM), spontaneous bowel movements (SBM)≤ 24 hours after first dose, adequate relief of IBS-C symptoms, constipation severity, IBS severity, and incidence of adverse reactions were conducted. Results: A total of six RCTs meeting the requirements were retrieved. Linaclotide could improve abdominal pain (RR=1.49, 95% CI: 1.15-1.92), CSBM (RR=3.03, 95% CI: 2.41-3.82), SBM≤ 24 hours after first dose (RR=1.60, 95% CI: 1.49-1.72), adequate relief of IBS-C symptoms (RR=1.63, 95% CI: 1.27-2.10), constipation severity (RR=1.45, 95% CI: 1.34-1.57), IBS severity (RR=1.44, 95% CI: 1.32-1.57). The incidences of diarrhea and bloat were significantly increased in linaclotide group than in placebo group, however, tolerance of the adverse reactions was well. Conclusions: Linaclotide has good efficacy, safety and tolerance in the treatment of IBS-C, and is a comparatively ideal drug for treatment of IBS-C.
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The incidence of colorectal cancer is increasing year by year in China, early screening and prevention is the key to improve the prognosis, but there is no ideal screening tool now. Non-invasive breath analysis based on volatile organic compounds (VOCs) has received much attention in recent years as a non-invasive diagnostic tool for a variety of cancers, including colorectal cancer. This article reviewed the current research status of the correlation between VOCs and colorectal cancer, aiming to evaluate the potential value of VOCs in the diagnosis of colorectal cancer, and provide theoretical basis for the exploration of early diagnosis of colorectal cancer.
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Hypoalbuminemia is a very common clinical finding, with the elderly population at high-risk, and is closely related to the onset, development and prognosis of the underlying diseases in the elderly.Elderly patients will benefit from asolid understanding and timely prevention of hypoalbuminemia.We review the causes, damaging effects, prevention and treatment of hypoalbuminemia in the elderly and recent research progress, based on national and international publications.
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Objective To investigate the intervention effect of 1,25(OH)2D3 on serum level of parathyroid hormone,bone metabolic markers and muscle strength in the community elderly with low bone mass.Methods A total of 132 residents aged 60 years and over from Shanghai communities diagnosed as osteopenia or osteoporosis were enrolled and treated with 0.5 μg/d calcitriol for 3 months.Serum levels of parameters in blood biochemistry and bone metabolic markers were determined by Cobas Diagnosis System of Roche before and after treatment,and the handgrip strength of both left and right hands were measured at the same time.Results The average age of 132 patients was(66.1 ± 6.3) years,4 cases (all female) terminated their medication in advance,and 128 patients completed the treatment for three months.The baseline serum levels of 25 (OH)D and PTH were 19.6 ± 7.9 μg/L and 41.0 μg/L respectively.According to the median value of serum PTH before treatment,patients were divided into the two groups:the high PTH group and the low PTH group.Compared with the low PTH group,the serum levels of 25OHD and serum calcium were decreased in the high PTH group[(17.1 ± 7.0) μg/L vs.(22.1 ± 8.2) μg/L,2.4 mmol/L vs.2.5 mmol/L,P＜0.05].After 3 months of intervention,serum levels of creatinine,urine calcium and left handgrip were significantly elevated[(68.2 ± 13.8) μmol/L vs.(65.2 ± 13.4) μmol/L,(5.9 ± 2.8)mmol/24 h vs.(4.4 ± 2.0) mmol/24 h,23.8 kg vs.21.0 kg,all P ＜0.05],while serum levels of PTH,eGFR,phosphorus were significantly decreased[35.5 ng/L vs.42.0 ng/L,(87.0 ± 17.0) ml/min vs.(93.1±17.9) ml/min,1.2 mmol/L vs.1.3 mmol/L,all P＜0.05).There was a significant negative correlation between serum 25(OH)D and PTH before treatment(r=-0.312,P＜0.05),but the negative correlation between them was no longer significant after 3 months of treatment (r =0.042,P ＞ 0.05).A multivariate logistic regression analysis revealed that the increment of left handgrip strength greater than 25％ (OR =0.138,95％ CI:-0.002-8.383),the increment of serum calcium levels(OR =2.578,95％CI:1.0345-8.693)and age(OR =0.103,95％CI:0.035-0.345) were significantly correlated with the decrement of serum PTH levels greater than 30 ％ after three months of treatment.Conclusions Vitamin D diminution or deficiency is common in the elderly.The shortterm treatment of calcitriol can obviously reduce serum PTH,inhibit bone absorption and increase muscle strength.The effect of calcitriol on serum PTH is closely related to promoting calcium absorption and improving handgrip strength.
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Objective To observe the efficacy and safety of rifabutin and furazolidone included triple regimen and minocycline plus furazolidone included quadruple regimen in eradicating refractory H.pylori infection.Methods A total of 146 patients who failed (≥ two times) to treat H.pylori with standard antiH.pylori therapy were selected and divided into esomeprazole,rifabutin and furazolidone treatment group (ERF group,n =74) and esomeprazole,minocycline,furazolidone and bismuth potassium citrate group (EMFB group,n =72).The duration of treatment were both 10 days.Liver and renal functions were examined within three days after therapy.13C or 14 C-urease breath test was performed one month after the medication withdrawal.The patients were followed up once every two weeks during the treatment period.The medication and adverse reactions were recorded in detail.The compliance and rates of adverse events in two groups were compared and analyzed.The eradication rates of the two groups and subgroups were compared by intention-to-treat (ITT) and per-protocol (PP) analyses.The cost-effectiveness of the two groups was evaluated with cost effectiveness analysis (CEA).The cost/effectiveness (C/E) ratio was calculated by PP.Chi-square test and t test were used for statistical analysis.Results There was no significant difference in complicance between ERF group and EMFB group (90.5％ vs.90.3％,P ＞0.05).There was no significant difference in H.pylori eradication rate between ERF group and EMFB group analyzed by ITT (82.4％ vs.84.7％,P ＞0.05).Analyzed by PP,there were no significant differences in H.pylori eradication rate between ERF group and EMFB group (91.0％ vs.93.8％),between male subgroup and female subgroup of ERF group (87.9％ vs.94.1％),between subgroup with age less than 60 years and subgroup with age over 60 years of ERF group (89.7％ vs.92.9％),between male subgroup and female subgroup of EMFB group (89.7％ vs.97.2％) and between subgroup with age less than 60 years and subgroup with age over 60 years of EMFB group (93.6％ vs.94.4％) (all P ＞ 0.05).There were no statistically significant differences in the rate of adverse events between ERF group and EMFB group (20.3％ vs.22.2％),between male subgroup and female subgroup of ERF group (25.0％ vs.15.8％),between subgroup with age less than 60 years and subgroup with age over 60 years of ERF group (26.2％ vs.12.5％),between male subgroup and female subgroup of EMFB group (19.4％ vs.24.4％) and between subgroup with age less than 60 years and subgroup with age over 60 years of EMFB group (24.5％ vs.15.8％)(all P ＞ 0.05).Fixed daily cost,total cost and C/E of ERF group was RMB 59.0 yuan,RMB 590.5 yuan and 648.9,respectively;and the eradication rate was 91.0％ (61/67).Fixed daily cost,total cost and C/E of EMFB group was RMB 32.9 yuan,RMB 329.1 yuan and 350.9,respectively;and the eradication rate was 93.8％ (61/65).Conclusions Rifabutin and furazolidone included triple regimen and minocycline plus furazolidone included quadruple regimen both have good efficacy,safety and compliance in the eradication of refractory H.pylori infection,and the latter is better.
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Objective@#To observe the efficacy and safety of rifabutin and furazolidone included triple regimen and minocycline plus furazolidone included quadruple regimen in eradicating refractory H. pylori infection.@*Methods@#A total of 146 patients who failed (≥two times) to treat H. pylori with standard anti-H.pylori therapy were selected and divided into esomeprazole, rifabutin and furazolidone treatment group (ERF group, n=74) and esomeprazole, minocycline, furazolidone and bismuth potassium citrate group (EMFB group, n=72). The duration of treatment were both 10 days. Liver and renal functions were examined within three days after therapy. 13C or 14C-urease breath test was performed one month after the medication withdrawal. The patients were followed up once every two weeks during the treatment period. The medication and adverse reactions were recorded in detail. The compliance and rates of adverse events in two groups were compared and analyzed. The eradication rates of the two groups and subgroups were compared by intention-to-treat (ITT) and per-protocol (PP) analyses. The cost-effectiveness of the two groups was evaluated with cost effectiveness analysis (CEA). The cost/effectiveness (C/E) ratio was calculated by PP. Chi-square test and t test were used for statistical analysis.@*Results@#There was no significant difference in complicance between ERF group and EMFB group (90.5% vs. 90.3%, P>0.05). There was no significant difference in H. pylori eradication rate between ERF group and EMFB group analyzed by ITT (82.4% vs. 84.7%, P>0.05). Analyzed by PP, there were no significant differences in H. pylori eradication rate between ERF group and EMFB group (91.0% vs. 93.8%), between male subgroup and female subgroup of ERF group (87.9% vs. 94.1%), between subgroup with age less than 60 years and subgroup with age over 60 years of ERF group (89.7% vs. 92.9%), between male subgroup and female subgroup of EMFB group (89.7% vs. 97.2%) and between subgroup with age less than 60 years and subgroup with age over 60 years of EMFB group (93.6% vs. 94.4%) (all P>0.05). There were no statistically significant differences in the rate of adverse events between ERF group and EMFB group (20.3% vs. 22.2%), between male subgroup and female subgroup of ERF group (25.0% vs. 15.8%), between subgroup with age less than 60 years and subgroup with age over 60 years of ERF group (26.2% vs. 12.5%), between male subgroup and female subgroup of EMFB group (19.4% vs. 24.4%) and between subgroup with age less than 60 years and subgroup with age over 60 years of EMFB group (24.5% vs. 15.8%) (all P>0.05). Fixed daily cost, total cost and C/E of ERF group was RMB 59.0 yuan, RMB 590.5 yuan and 648.9, respectively; and the eradication rate was 91.0%(61/67). Fixed daily cost, total cost and C/E of EMFB group was RMB 32.9 yuan, RMB 329.1 yuan and 350.9, respectively; and the eradication rate was 93.8%(61/65).@*Conclusions@#Rifabutin and furazolidone included triple regimen and minocycline plus furazolidone included quadruple regimen both have good efficacy, safety and compliance in the eradication of refractory H. pylori infection, and the latter is better.
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Objective To investigate the state of chronic low-grade inflammation in healthy elderly adults and its related factors.Methods A total of 762 healthy people aged 30-99 years were retrospectively analyzed and assigned into 2 groups:the young group(30-59 years old,n=272)and the elderly group(60-99 years old,n=490).Patients in the elder group were subgrouped into 2 groups:the 60 to 79-year-old group(n=288)and the 80 to 99-year-old group(n=202).The differences in levels of tumor necrosis factor(TNFa) and hypersensitive C-reactive protein (hsCRP) were compared between groups.Correlations of TNFα or hsCRP levels with age,body mass index(BMI)and metabolic indexes were analyzed.Results The levels of TNFα and hsCRP were higher in elderly male group than in the young male group[(16.03±2.32) ×1015 mol/L vs.(15.28±2.63) × 10-15 mol/L,(1.30±1.01mg/L) vs.(0.79±0.61) mg/L,P=0.019 and 0.048],while there was no obvious difference between the 60 to 79-year-old male group and the 80 to 99-year-old male group(P =0.957 and 0.937).TNFα and hsCRP levels were higher in the elderly female group than in the young female group[(15.76 ±2.66) × 10-15 mol/L vs.(14.43 ± 3.18) × 1015 mol/L,(1.30 ± 0.81) mg/L vs.(0.75 ± 0.74) mg/L,P =0.006 and 0.001],and no difference were observed between the 60 to 79-year-old female group and the 80 to 99-year-old female group(P=0.282 and 0.389).Spearman's rank correlation coefficient analysis showed that TNFα level was positively associated with age,total protein,albumin,totalcholesterol,glomerular filtration rate,uric acid (P ＜ 0.05) in man and positively associated with age,triacylglycerol and fasting blood glucose in woman,while hsCRP level was positively associated with age,body mass index,total-cholesterol and negatively associated with total bilirubin,direct bilirubin and indirect bilirubin(P ＜0.05)in man and was positively associated with age,alkaline phosphatase,triacylglycerol and fasting blood glucose and negatively associated with GFR(P ＜0.05)in woman.Conclusions Healthy elderly people are often in a state of chronic low-grade inflammation,which is closely related to several metabolic parameters.
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With the increase of elderly patients with cardiovascular and cerebrovascular diseases,dual anti-platelet therapy (DAPT) is becoming more and more commonly used in the elderly,and at the same time gastric mucosal damage induced by DAPT has become a common issue in clinical practice.Therefore,prevention of gastric mucosal injury induced by DAPT in elderly has turned to be a research hot-spot.Because of the degeneration of gastric mucosal barrier,the injury and invasive factors endured by the elderly were more severe and prominent,and gastric mucosal damage induced by DAPT will be more frequent and severe.Therefore,the gastric mucosal protective strategies for elderly with DAPT should be different from that of young and middle-aged patients.In this article,the gastric mucosal damage induced by DAPT and its protective strategies in elderly were briefly reviewed.
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Objective To learn the needs of family physicians for tertiary hospital support in the hierarchical medical system. Methods In July 2017 cluster sampling was made to 135 family physicians of Changning district of Shanghai for a " Family physicians needs questionnaire" . It covered such aspects as their demographic characteristics and their needs. The data so acquired were subject to descriptive and logical analysis. Results 99.3% of them need preferential appointment of specialists at tertiary hospitals;93.3% of them need preferential appointment of examinations; 82.2% of them need preferential outpatient visits; while 83.7% of them need preferential hospitalization and surgery scheduling. In terms of the approaches for preferential appointment of specialists, 84.4% of them prefer specialist appointment at short notice, and 73.3% of them need direct online appointment for large-scale device examinations at tertiary hospitals. In terms of mentoring scenarios, 62.2% of them prefer mentoring during outpatient rounds at fixed schedules of specialists in their community. Conclusions Tertiary hospitals are recommended to establish green pathways for referrals and priority measures in order to improve capabilities of family physicians and the shared platform in the hierarchical medical network. They are also expected to guide family physicians in their research paper writing, thus fully supporting the hierarchical medical system.
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Objective To investigate the prevalence and risk factors of vertebral fractures in the elderlys in Shanghai community. Methods Stratified sampling was performed according to the age distribution of the population in 3 urban and 2 suburban communities in Shanghai, and a total of 2 929 old people aged over 65 years were enrolled. The thoracic and lumbar radiographs and questionnaires were obtained in all the participants. The diagnosis of vertebral fractures were evaluated using Genant′s semi-quantitative method, and the prevalence of vertebral fracture was calculated. Logistic regression was used to analyze the risk factors of vertebral fracture. Results ( 1) The prevalence of vertebral fractures in community-dwelling elderly was 14.4%totally,and 20.1%in individuals above 80 years old,which was significantly higher than the others (P<0.05). The prevalence of vertebral fractures in females was significantly higher than that in males (18.5%vs 12.4%, P<0.05). (2) The most common vertebral fracture sites were T12 and L1. Grade 1 vertebral fracture was most common in our cohort. The proportions of grade 2 and grade 3 were significant higher in females than that in males (30.6% vs 17.0%, P<0.05). (3) Gender and sex had an interaction effect on the prevalence of vertebral fractures. Prevalence of vertebral fractures increased steadily with age in both genders, although the gradient was steeper for women (P<0.001). (4) Logistic regression analysis showed that: female, age, parental hip fracture history, previous fracture history, and alcohol consumption were risk factors of vertebral fractures in community elderly. Smoking, long-term use of glucocorticoid, various diseases associated with secondary osteoporosis had no significant correlation with vertebral fracture. Conclusion The vertebral fractures were more common and serious in women than in men in community elderly. Age was significantly correlated with the presence of vertebral fracture in women than that in men. Female, age, parental hip fracture history, previous fracture history, and alcohol consumption were risk factors of vertebral fractures in community elderlys.
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Malignant tumors are common diseases and leading causes of death for the elderly. The reserving function of organs reduces ,malignant tumors and many chronic diseases coexist in the elderly.Besides ,senectitude is a special stage of life in their later years. Therefore ,the malignant tumors in elderly patients have different clinical characteristics and special treatment principles as compared with those in young and middle-aged patients. This article reviews relevant studies from the perspective of modern geriatrics.
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Objective To analyze risk factors for the perioperative complications and death following hip fracture in the elderly. Methods The present study included 1352 elderly patients (≥65 years) who had received hip fracture surgery from January 2010 to June 2015 in Huadong hospital affiliated to Fudan University. Their clinical data were analyzed to determine risk factors for perioperative complications and death. Results Factors significantly affecting the perioperative complications included gender, preoperative serum albumin, ASA grade (≥Ⅲ), cardiac functional grade (≥Ⅲ), respiratory system disease and blood transfusion. Factors significantly affecting the death included preoperative serum albumin, ASA grade (≥Ⅲ), cardiac functional grade (≥Ⅲ) and blood transfusion. Multivariate Logistic regression analysis revealed that the independent risk factors for perioperative complications included gender (B=-0.686, P=0.019), preoperative serum albumin (B=-0.808, P=0.006), cardiac functional grade (≥Ⅲ, B=1.181, P=0.004), blood transfusion (B=0.890, P=0.004) and respiratory system disease (B=3.118, P=0.000);while the independent risk factors for death included preoperative serum albumin (B=-2.516, P=0.000) and blood transfusion (B=1.396, P=0.010). Conclusions In elderly patients undergoing hip fracture surgery, the independent risk factors for perioperative complications included gender, preoperative serum albumin, cardiac functional grade, blood transfusion and respiratory system disease, while the independent risk factors for death included preoperative serum albumin and blood transfusion. Perioperative risk assessment and prevention are the keys of better prognosis.