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Objective:To systematically evaluate the efficacy and safety between neoadjuvant chemoradiotherapy followed by surgery and immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer.Methods:Literature review was performed from PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang, CNKI and VIP from the inception date to February, 2020 using the key words including "pancreatic neoplasm, pancreatic cancer, surgery, preoperative chemoradiotherapy, neoadjuvant chemoradiotherapy" in both English and Chinese. The randomized controlled clinical trials (RCTs) of neoadjuvant chemoradiotherapy followed by surgery versus immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer were searches. Literature screening, data extraction and estimation of the risk of bias were independently conducted by two researchers. The HR and 95% CI were used for estimating the overall survival time. The R 0 resection rate, overall incidence of postoperative complications, and mortality rate throughout treatment were assessed by the RR and 95% CI. The heterogeneity of the studies was analyzed using the I2 test. Results:A total of 4 RCTs were included. Among 400 patients, 197 cases were assigned into the neoadjuvant chemoradiotherapy combined with surgery group and 203 in the immediate surgery group. The results of Meta-analysis showed that patients in the neoadjuvant chemoradiotherapy followed by surgery group obtained longer overall survival ( HR=0.76, 95% CI: 0.60-0.97, P=0.03) and higher R 0 resection rate ( RR=1.72, 95% CI: 1.40-2.13, P<0.01). Besides, the overall incidence of postoperative complications ( RR=1.02, 95% CI: 0.73-1.43, P=0.90) and mortality rate throughout treatment ( RR=1.19, 95% CI: 0.48-2.93, P=0.71) did not significantly differ between two groups. Conclusions:During the treatment of resectable or borderline resectable pancreatic cancer, neoadjuvant chemoradiotherapy followed by surgery may bring more survival benefits than immediate surgery and does not increase the incidence of postoperative complications and mortality rate throughout treatment. Therefore, neoadjuvant chemoradiotherapy followed by surgery can be used as a recommended treatment for patients with resectable or borderline resectable pancreatic cancer.
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Objective:To systematic review the clinical efficacy and safety of neoadjuvant chemotherapy and neoadjuvant concurrent chemoradiotherapy for resectable esophageal squamous cell carcinoma.Methods:Literature search was performed from Web of Science, Pubmed, Cochrane Library, Embase, CBM, Wanfang Data, CNKI and Chongqing VIP. The clinical controlled studies of neoadjuvant chemotherapy versus neoadjuvant concurrent chemoradiation in the treatment of resectable esophageal squamous cell carcinoma was searched. Relevant outcome indicators were analyzed by Revman 5.3 statistical software.Results:Nine studies were included, with a total of 1, 369 patients. Compared with the neoadjuvant chemoradiotherapy, the neoadjuvant chemotherapy had lower overall survival rates at 3 and 5 years( OR=0.68, 95% CI: 0.53-0.86, P<0.05; OR=0.51, 95% CI: 0.34-0.77, P<0.05) , lower pathological complete remission rate( OR=0.28, 95% CI: 0.18-0.45, P<0.05)and R0 resection rate( OR=0.39, 95% CI: 0.22-0.68, P<0.05), The total postoperative complication rate is similar( OR=1.07, 95% CI: 0.75-1.51, P>0.05). Conclusion:Neoadjuvant concurrent radiochemotherapy maybe superior to neoadjuvant chemotherapy among patients with resectable esophageal squamous cell carcinoma.
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Objective:To understand the utilization of clinical services provided through hospital-at-home to the elderly in Xuzhou City, and analyze patient satisfaction.Methods:The stratified cluster sampling method was used to select community elderly people aged 60 and above in Xuzhou city to conduct a face-to-face questionnaire survey.Descriptive analysis was used to examine the utilization and evaluation of home-based clinical services for the elderly.Multiple linear regression analysis was used to analyze associated factors for the satisfaction of the elderly in this care setting.Results:A total of 203 elderly people who had received this type of services were investigated.The overall satisfaction of the elderly in Xuzhou City with home-based clinical services was 79.3%(161/203), and the average satisfaction score of the comprehensive evaluation was(4.11±1.03)points.Age( β=-0.011), marital status( β=0.164), informed consent for service( β=0.162), doctors' bed-side services( β=0.146), service fee( β=0.346), and the home hospital bed assembling process( β=0.257)were the influencing factors for satisfaction with family hospital bed services, according to the patients involved in the comprehensive evaluation(all P<0.05). Conclusions:The utilization and evaluation with clinical services by elderly people in the hospital-at-home setting in downtown Xuzhou is relatively good, with relatively high satisfaction.Comprehensive measures should be taken in response to factors related to satisfaction to promote sustainable development of clinical services through hospital-at-home in China.
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Objective To systematically evaluate the efficacy and safety between neoadjuvant concurrent chemoradiotherapy followed by surgery and surgery alone in the treatment of resectable esophageal squamous cell carcinoma.Methods Literature review was performed from Embase,PubMed,Web of Science,Cochrane Library,CBM,Wanfang Data,CNKI and Chongqing VIP.The randomized controlled clinical trials of concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma were retrieved.The meta-analysis of survival data,R0 resection rate,incidences of postoperative complications and peritreatment mortality was conducted by using RevMan 5.3 software.Results A total of 1450 patients from 11 controlled clinical trials were included in this meta-analysis.The results of the meta-analysis showed that concurrent chemoradiotherapy followed by surgery group had significantly higher 2-and 5-year overall survival rate (RR=1.14,95％CI:1.05-1.23,P=0.00) and progression-free survival rate (RR=1.56,95％CI:1.05-2.32,P=0.03).R0 resection rate were also improved in concurrent chemoradiotherapy followed by surgery group (RR=1.10,95％CI:1.05-1.14,P=0.00).Compared with the surgery alone group,the incidence of arrhythmia in the concurrent chemoradiotherapy plus surgery group was.significantly higher (RR=2.45,95％CI:1.37-4.38,P=0.00).However,there was no significant difference in the overall incidence of postoperative complications (RR=1.12,95％CI:0.79-1.59,P=0.51) and incidence of peritreatment mortality (RR=1.78,95％CI:0.90-3.52,P=0.10) between two groups.Conclusions Neoadjuvant concurrent chemoradiotherapy followed by surgery improves the survival and R0 resection rate over surgery alone among patients with resectable esophageal squamous cell carcinoma,whereas it does not increase the risk of postoperative complications.Consequently,neoadjuvant concurrent chemoradiotherapy followed by surgery is an optimal treatment for patients with resectable esophageal squamous cell carcinoma.
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Objective@#To systematically evaluate the efficacy and safety between neoadjuvant concurrent chemoradiotherapy followed by surgery and surgery alone in the treatment of resectable esophageal squamous cell carcinoma.@*Methods@#Literature review was performed from Embase, PubMed, Web of Science, Cochrane Library, CBM, Wanfang Data, CNKI and Chongqing VIP. The randomized controlled clinical trials of concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma were retrieved. The meta-analysis of survival data, R0 resection rate, incidences of postoperative complications and peritreatment mortality was conducted by using RevMan 5.3 software.@*Results@#A total of 1450 patients from 11 controlled clinical trials were included in this meta-analysis. The results of the meta-analysis showed that concurrent chemoradiotherapy followed by surgery group had significantly higher 2-and 5-year overall survival rate (RR=1.14, 95%CI: 1.05-1.23, P=0.00) and progression-free survival rate (RR=1.56, 95%CI: 1.05-2.32, P=0.03). R0 resection rate were also improved in concurrent chemoradiotherapy followed by surgery group (RR=1.10, 95%CI: 1.05-1.14, P=0.00). Compared with the surgery alone group, the incidence of arrhythmia in the concurrent chemoradiotherapy plus surgery group was significantly higher (RR=2.45, 95%CI: 1.37-4.38, P=0.00). However, there was no significant difference in the overall incidence of postoperative complications (RR=1.12, 95%CI: 0.79-1.59, P=0.51) and incidence of peritreatment mortality (RR=1.78, 95%CI: 0.90-3.52, P=0.10) between two groups.@*Conclusions@#Neoadjuvant concurrent chemoradiotherapy followed by surgery improves the survival and R0 resection rate over surgery alone among patients with resectable esophageal squamous cell carcinoma, whereas it does not increase the risk of postoperative complications. Consequently, neoadjuvant concurrent chemoradiotherapy followed by surgery is an optimal treatment for patients with resectable esophageal squamous cell carcinoma.
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Objective The role of additional docetaxel chemotherapy in the treatment of localised high-risk prostate cancer (PCa) remains a controversy.This meta-analysis aimed to investigate the effect of additional docetaxel chemotherapy on localised high-risk PCa.Methods A computerized search was performed in Pubmed,Embase,Cochrane Library,Web of Science,CBM,CNKI,VIP and Wanfang Data to collect clinical controlled trails on localised high-risk PCa treated with docetaxel chemotherapy from the inception to April 2019.The Review Manager 5.3 software was used to perform meta-analysis of survival data and adverse events.Results Six literatures were enrolled,including 3 187 patients.Compared with the standard treatment (local treatment combined with endocrine therapy) group,the progression-free survival (PFS) was prolonged in the standard treatment plus docetaxel group,and the difference was statistically significant.[hazard ratio (HR) =0.75,95 ％ CI 0.65-0.86,P ＜ 0.01].Patients in the standard treatment plus docetaxel group had longer overall survival (OS) and biochemical recurrence-free survival (BRFS) in comparison with standard treatment group,but the difference was not statistically significant (HR =0.843,95％CI 0.68-1.01,P =0.06;HR =0.86,95％ CI 0.69-1.07,P =0.17).In terms of safety,the incidence of adverse reactions was increased in the standard treatment plus docetaxel group,including the incidence of grade ≥3 neutropenia (RR =44.14,95％ CI 19.15-101.71,P ＜0.01),the incidence of grade ≥ 3 febrile neutropenia (RR =13.4,95 ％ CI 7.93-22.65,P ＜ 0.01) and the incidence of grade ≥ 3 diarrhea (RR =13.43,95 ％ CI 3.21-56.16,P ＜ 0.01).Conclusions Additional docetaxel chemotherapy could significantly improve the PFS in localised high-risk PCa patients.OS and BRFS were prolonged,but the difference was not statistically significant.
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Objective@#The role of additional docetaxel chemotherapy in the treatment of localised high-risk prostate cancer (PCa) remains a controversy. This meta-analysis aimed to investigate the effect of additional docetaxel chemotherapy on localised high-risk PCa.@*Methods@#A computerized search was performed in Pubmed, Embase, Cochrane Library, Web of Science, CBM, CNKI, VIP and Wanfang Data to collect clinical controlled trails on localised high-risk PCa treated with docetaxel chemotherapy from the inception to April 2019. The Review Manager 5.3 software was used to perform meta-analysis of survival data and adverse events.@*Results@#Six literatures were enrolled, including 3 187 patients. Compared with the standard treatment (local treatment combined with endocrine therapy) group, the progression-free survival (PFS) was prolonged in the standard treatment plus docetaxel group, and the difference was statistically significant. [hazard ratio(HR)=0.75, 95%CI 0.65-0.86, P<0.01]. Patients in the standard treatment plus docetaxel group had longer overall survival (OS) and biochemical recurrence-free survival (BRFS) in comparison with standard treatment group, but the difference was not statistically significant (HR=0.843, 95%CI 0.68-1.01, P=0.06; HR=0.86, 95%CI 0.69-1.07, P=0.17). In terms of safety, the incidence of adverse reactions was increased in the standard treatment plus docetaxel group, including the incidence of grade ≥3 neutropenia (RR=44.14, 95%CI 19.15-101.71, P<0.01), the incidence of grade ≥3 febrile neutropenia (RR=13.4, 95%CI 7.93-22.65, P<0.01) and the incidence of grade ≥3 diarrhea (RR=13.43, 95%CI 3.21-56.16, P<0.01).@*Conclusions@#Additional docetaxel chemotherapy could significantly improve the PFS in localised high-risk PCa patients. OS and BRFS were prolonged, but the difference was not statistically significant.
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Objective@#To study the current situation and relevant risk factors for disability and dementia among the elderly in urban areas of Jiangsu province.@*Methods@#A stratified cluster sampling method was used to select representative elderly people aged 60 years and over in urban areas in Jiangsu Province, and a face-to-face questionnaire survey was conducted.The activities of daily living(ADL)scale and mini-mental state examination(MMSE)were used to assess the status of disability and dementia.And the relevant risk factors for disability and dementia were analyzed by univariate and multivariate Logistic regression methods.@*Results@#A total of 1 600 elderly people were investigated and 1 514 valid questionnaires were recovered.The effective recovery rate was 94.6%.The rates of disability and dementia were 17.9%(271/1 514)and 8.5%(129/1 514)respectively in the elderly in Jiangsu urban areas.Univariate analysis showed that age, marital status, education level, empty-nest, whether or not to suffer from chronic diseases, health status, medication, and whether or not to have dementia were significantly related with the disability in the elderly(P<0.01). And age, gender, marital status, education level, whether or not to suffer from chronic diseases, health status, medication, and whether or not to have disability were significantly related with the dementia in the elderly(P<0.01). Multivariate analysis showed that the risk factors associating with increasing disability in the elderly were advanced age(OR=16.371), non-marriage(OR=1.917), chronic disease(OR=2.256), poor health condition(OR=23.214), dementia(OR=4.067)and insufficient income(OR=1.607)(P<0.05). And the factors associating with increasing risks for dementia in the elderly were advanced age(OR=2.864), female(OR=1.610), poor health condition(OR=3.097), empty nest(OR=1.607)and disability(OR=4.026)(P<0.05). Therefore, comprehensive measures should be taken for intervention of disability and dementia in the elderly.@*Conclusions@#The incidence of disability and dementia is high among the elderly in urban areas of Jiangsu Province.Disability and dementia are the results of the interaction effect of health, family and social factors.Therefore, comprehensive measures against risk factors should be taken for intervention of disability and dementia in the elderly.
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Objective To study the current situation and relevant risk factors for disability and dementia among the elderly in urban areas of Jiangsu province.Methods A stratified cluster sampling method was used to select representative elderly people aged 60 years and over in urban areas in Jiangsu Province,and a face-to-face questionnaire survey was conducted.The activities of daily living (ADL) scale and mini-mental state examination(MMSE) were used to assess the status of disability and dementia.And the relevant risk factors for disability and dementia were analyzed by univariate and multivariate Logistic regression methods.Results A total of 1 600 elderly people were investigated and 1 514 valid questionnaires were recovered.The effective recovery rate was 94.6％.The rates of disability and dementia were 17.9 ％ (271/1 514) and 8.5 ％ (129/1 514) respectively in the elderly in Jiangsu urban areas.Univariate analysis showed that age,marital status,education level,empty-nest,whether or not to suffer from chronic diseases,health status,medication,and whether or not to have dementia were significantly related with the disability in the elderly(P ＜0.01).And age,gender,marital status,education level,whether or not to suffer from chronic diseases,health status,medication,and whether or not to have disability were significantly related with the dementia in the elderly(P ＜ 0.01).Multivariate analysis showed that the risk factors associating with increasing disability in the elderly were advanced age(OR =16.371),non-marriage(OR =1.917),chronic disease (OR =2.256),poor health condition(OR =23.214),dementia (OR =4.067) and insufficient income (OR =1.607)(P＜0.05).And the factors associating with increasing risks for dementia in the elderly were advanced age(OR =2.864),female(OR =1.610),poor health condition(OR =3.097),empty nest (OR =1.607) and disability (OR =4.026) (P ＜ 0.05).Therefore,comprehensive measures should be taken for intervention of disability and dementia in the elderly.Conclusions The incidence of disability and dementia is high among the elderly in urban areas of Jiangsu Province.Disability and dementia are the results of the interaction effect of health,family and social factors.Therefore,comprehensive measures against risk factors should be taken for intervention of disability and dementia in the elderly.
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Objective To systematically evaluate the clinical efficacy and safety between high-dose (74 to 80 Gy) and conventional-dose (64.0 to 70.2 Gy) conventionally fractionated external beam radiotherapy for stage T1b-4No-1M0 prostate cancer in this meta-analysis.Methods A literature search was performed in PubMea,ambasa,aochrane Librara,aeb of Scienca,aBa,aanfang Data,aNKI and Chongqing VIP to collect clinical trials on high-dose versus conventional-dose conventionally fractionated external beam radiotherapy of prostate cancer from the inception to July 1,2018.The included literatures were evaluated by Cochrane quality evaluation criteria and subject to meta-analysis by using Review Manager 5.3 statistical software.Results A total of 7 randomized controlled clinical trials involving 4 132 patients were included in the meta-analysis.The meta-analysis showed that the high-dose and conventional-dose groups yielded similar 10-year overall survival (RR=1.01,95％CI:0.96 to 1.07,P=0.64) and 10-year prostate cancer-specific survival (RR=1.01,95％CI:0.98 to 1.03,P=0.47).The biochemical failure rate in the high-dose group was significantly lower than that in the conventional-dose group (RR =0.78,95％CI:0.70 to 0.86,P＜0.01).Compared with the conventional-dose groua,ahe incidence of late grade ≥ 2 gastrointestinal and genitourinary adverse reactions (RR=1.48,95％CI:1.31 to 1.67,P＜0.01;RR=1.35,95％CI:1.06 to 1.73,P=0.02) was significantly higher in the high-dose group.Conclusion High-dose conventionally fractionated external beam radiotherapy has advantages in reducing the biochemical failure rate of patients with stage T1b-4N0-1M0 prostate cancer.Nevertheless,whether it can improve overall survival and prostate cancer-specific survival remains to be validated.High-dose radiotherapy also induce a higher incidence rate of late grade ≥ 2 gastrointestinal and genitourinary adverse reactions compared with conventional-dose radiotherapy.
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Objective To study the health status ,the current health service needs and the influencing factors concerning the rural elderly population in Northern Jiangsu. Methods Multi-stage stratified cluster sampling was conducted in elderly people over 60 in Xuzhou ,Lianyungang ,and Suqian.Participants were face-to-face interviewed with questionnaires.Information on health status and health service needs was collected and analyzed. Results A total of 2655 elderly people were enrolled in this study ,including 1252 males (47.2%)and 1403 (52.8%)females with a mean age of (70.9 ± 6.7)years.Self-assessed health was generally poor ,with the two-week morbidity at 26.6%and the prevalence of chronic diseases at 60.1%;46.5% of the participants regularly took medications ;4.1% of them had physical disability ;8.2% had impaired daily activities ;The two-week hospital visit rate was 29.4%;The one-year hospitalization rate was 18.5%;The rate of non-hospitalization for people in need of hospitalization was 27.6%.Multivariate analysis showed that old age(OR＝5.51) ,adequate income(OR＝2.29)and short journey to a medical institution (OR＝7.90) were associated with high two-week hospital visit rates ;old age(OR ＝ 1.76) ,female gender(OR ＝1.36) ,empty-nest(OR＝ 1.37 ) ,family harmony (OR＝ 1.91 ) ,having chronic diseases (OR＝ 3.49 ) , and high frequency in taking medications (OR＝1.69)were correlated with high hospitalization rates. Conclusions The elderly population in rural areas of Northern Jiangsu shows poor health ,has high needs for health services ,and lacks sufficient service utilization.
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treatment of LS-SCLC, two fractionation modes show similar short-term efficacy and survival benefits. However, hyperfractionated radiotherapy causes a higher incidence of radiation esophagitis than conventionally fractionated radiotherapy. Given that hyperfractionated radiotherapy is not superior to conventionally fractionated radiotherapy,conventionally fractionated radiotherapy is recommended for treating LS-SCLC.
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Objective To investigate the effect of liver kinase B1(LKB1) on the radiosensitivity of subcutaneous xenograft tumor of lung cancer H460 cells in nude mice.Methods Human lung cancer H460 cells were implanted into female nude mice (BALB/c-nu) to establish a subcutaneous xenograft tumor model of lung cancer.A total of 24 female nude mice in which the model was successfully established were equally and randomly divided into four groups:pEGFP-Ctrl plasmid (empty vector plasmid) group, irradiation (IR)+pEGFP-Ctrl plasmid group, pEGFP-LKB1 plasmid (overexpressing LKB1) group, and IR+pEGFP-LKB1 plasmid group.The growth of xenograft tumors was observed and the tumor inhibition rate and enhancement factor (EF) were calculated.The expression of LKB1 in each group was measured by immunohistochemistry and Western blot to analyze the relationship between LKB1 and radiosensitivity.Results Compared with the pEGFP-Ctrl plasmid group, the IR+pEGFP-Ctrl plasmid group, pEGFP-LKB1 plasmid group, and IR+pEGFP-LKB1 plasmid group showed varying degrees of inhibition of tumor growth, particularly in the IR+pEGFP-LKB1 plasmid group, and the tumor inhibition rates were 31.30%, 14.78%, and 43.48%, respectively.The EF of LKB1 in the IR+pEGFP-LKB1 plasmid group was 1.18.The immunohistochemistry and Western blot showed that LKB1 could be effectively expressed in the pEGFP-LKB1 plasmid group and IR+pEGFP-LKB1 plasmid group, but not in the other two groups.Conclusions The subcutaneous xenograft tumor model of human lung cancer H460 cells has been successfully established in nude mice.LKB1 has a radiosensitizing effect on the subcutaneous xenograft tumor of lung cancer H460 cells in nude mice.
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Objective To establish radiation?resistant lung carcinoma cell lines, and to investigate the changes in morphology, apoptosis, invasive migration, and epithelial?mesenchymal transition ( EMT) in cells. Methods The radiation?resistant lung carcinoma cell lines were obtained by exposure of lung carcinoma cell lines, A549 and H1299, to radiation with a low dose in fractions, a sublethal dose, or a gradually increasing dose. The morphological changes in cells, radiosensitivity, survival rates after exposure, apoptosis rates, changes in invasive migration, and expression of EMT marker proteins were evaluated using microscopy, colony formation assay, CCK?8 assay, flow cytometry, transwell migration assay, and Western blot, respectively. Results Radiation with a gradually increasing dose successfully induced the radiation?resistant cell lines, A549R and H1299R. The morphological study showed that the morphology of radiation?resistant cells was converted to the morphology of mesenchymal cells. Compared with A549 and H1299 cells, the values of D0 , Dq , and SF2 were significantly increased in A549R ( P=0.017,P=0.001,P=0.000) and H1299R (P=0.033,P=0.000,P=0.008) cells, respectively;the values of α and α/β were significantly reduced in A549R (P=0.018;P=0.007) and H1299R (P=0.001;P=0.009) cells, respectively. The survival rates in A549R and H1299R cells after exposure to radiation with various doses were significantly higher than those in the control groups (all P<0.05). After exposure, the apoptosis rates were significantly reduced in A549R and H1299R cells ( P=0.02,P=0.01);the invasion and migration rates were significantly increased in A549R (P=0.000;P=0.001) and H1299R (P=0.001,P=0.002) cells;the expression of E?cadherin was significantly down?regulated in A549R and H1299R cells (P=0.00,P=0.01), while the expression of vimentin was significantly elevated in A549R and H1299R cells ( P= 0. 02, P= 0. 01 ) . Conclusions The radiation?resistant lung carcinoma cell lines are successfully established. Both cell lines show enhanced invasion and migration, which may be associated with EMT.
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Objective To investigate the prevalence,characteristics and risk factors of fatigue in a large cohort of subjects with early Parkinson's disease (PD).Methods A total of 391 individuals with PD,recruited in Linzhi trial,were re-screened.Early,non-depressed subjects [Center for epidcmiological survey depression scale (CES-D)＜16]underwent further fatigue assessment.Subjects who scored＞4 on fatigue severity scale (FSS) were classified as fatigue.Motor symptoms and PD severity were assessed using the unified Parkinson's disease rating scale (UPDRS) and Hoehn-Yahr scale.Other clinical measures,including sleep disorder by Pittsburg sleep quality index (PSQ-Ⅰ),mental function by Alzheimer's Disease assessment scale-cognitive sections (ADAS-Cog) and quality of life by medical outcomes study short form 36 (SF- 36) were also evaluated.Results Among 204 subjects who completed fatigue measures,82 (40.2％) were classified as fatigue.The fatigue group had significantly more neurological impairment by higher scores on each subsets of UPDRS including mentation (P＜0.05),activities of daily living (P＜0.01) and motor (P＜0.01),while the subjects with fatigue had worse scores on SF-36 (P＜0.01).Multiple regression analyses showed that motor subset of UPDRS was the variable that had the predictive value for FSS score.The full model explained 6.4％ of the variance of the FSSscore (β=0.039,95％CI:0.019-0.059).However,other factors,including levodopa dosage,PSQ-Ⅰ,and ADAS-Cog score did not significantly contribute to the model.Conclusions Fatigue is a frequent symptom in carly,non-depressed patients with PD,affecting over 40％ of the patients in this cohort.The small correlation between fatigue and motor score,and the lack of association with dosage of dopaminergic treatment suggest that dopaminergic pathways might be only moderately involved in pathogenesis of fatigue.
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ObjectiveTo explore the treatment and economic burden of urine incontinence (UI) in the rural elderly,and provide evidences for preventive intervention.MethodsA cluster sampling was carried out in 743 people (aged 60 years and over) from 5 villages dominated by Yanliu and Dafengshang health centers,Jixian County,Tianjin from 2007 to 2008.The information about general state of health,treatment and economic burden of disease were analyzed. Results The prevalence of UI was 33.4％ (248 cases) among the 743 elderly people.Only 12 patients (4.8％) with UI ever visited community health-care service centers or hospitals for diagnosis and treatment,among whom only 1 case visited hospital within 1 year,8 cases during 1 to 5 years,and 3 cases over 5 years.And the method of treatment was all drug therapy.Among 248 cases with UI,there were 227 cases (91.5％) without any treatment,9 cases (3.6％) buying medicines by themselves.The direct cost for treatment of UI was 80-12000 yuan RMB,including 2 cases below 100 yuan RMB,2 cases 100-1000 yuan RMB,7 cases 1001-5000 yuan RMB and 1 case over 10000 yuan RMB. Conclusions Prevalence of UI is high while hospital-visiting rate is very low,and the financial burden of disease is serious,thus intervention measures for UI should be taken for the elderly people in rural areas of Jixian County,Tianjin.
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The stody explored the stalus and influential factors of Medical Marketing teaching and made some Droposition to teaching.The results showed that some students were dissatisfied with the teaching style,the curriculum,or the teaching effect,whose proportion was 42.6 percent,22.3 percent,14.3percent respectively.Main influential factors of Medical Marketing teaching were age,learning interest,evaluation to the curriculum and evaluation to the teaching.It was the findings through the study that the status of taaching was presented from two aspects,namely the students disliked the learning of curriculum and the teaching style was monotonous.Therefore it was urgent to develop the teaching reform and to arouse students'interest.
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Objective To evaluate the effectiveness of psychological health intervention in the elderly urban residents living on minimum subsistence allowances, and to search for a suitable psychological health intervention strategy. Methods The 112 elderly persons living on minimum subsistence allowances in Xuzhou were selected by stratified cluster sampling, and they were matched with 112 controls. The elderly persons living on minimum subsistence allowances were divided into intervention group and control group. A general intervention based on community involved psychological health and care lecture, psychodrama treatment and psychological consultancy was made on the intervention. The SCL-90 was used to evaluate the psychological health status and effectiveness of psychological health intervention. Results The elderly persons living on minimum subsistence allowances had higher SCL-90 scores compared with other residents, and their psychological health status was serious. After the psychological health intervention, the SCL-90 scores were all lower in intervention group than in control group [ interpersonal relationship sensitiveness: (1.13 ± 0. 39) vs.(1.26±0.26), t=2.12, P=0.04; gloom: (1.23±0.66) vs. (1.43±0.24), t=2.08, P=0.04;anxiety: (1. 18±0.50) vs. (1.38±0.34), t=2.17, P=0.03; hostility: (1.24±0.49) vs. (1.40±0.28), t=2.03, P=0.04; other factor: (1. 31±0.56) vs. (1.49±0.31), t=2.04, P=0.04; total score: (115.89± 17.21) vs. (122.64± 10.41), t=2.42, P=0.02]. Conclusions The psychological health parameters are improved by psychological health intervention.
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Objective To investigate the characteristics of health related quality of life(HR-QOL) in Chinese patients with early Parkinson' s disease(PD), to identify the motor and non-motor factors that are associated with a poorer quality of life in patients with early PD. Methods All 391 patients with early PD were identified in a clinical-based study. Motor functions were measured by Unified Parkinson' s Disease Rating Scale (UPDRS) and Hoehn-Yabr Scale. Non-motor variables were assessed by Center of Epidemiological Survey Depression Scale (CES-D) for depressive symptoms, Pittsburg Sleep Quality Index (PSQI) for sleep disturbance, Fatigue Severity Scale (FSS) for fatigue, Alzheimer' s Disease Assessment Scale-Cognitive Sections (ADAS-Cng) for cognitive function, and Constipation Severity Scale for constipation. HR-QOL was measured by SF-36. Motor and non-motor variables were collected at the baseline assessment of a clinical trial and determined during a structured interview and by clinical examination by movement disorder specialists. The results were compared with those in healthy elderly people. Multiple regression analyses were used to determine which variables were strongly associated with lower levels of quality of life. Results Patients with early PD had a lower score on all dimensions of SF-36, except bodily pain dimension. Motor factors, particular physical disability and disease severity, contributed to decreased HR-QOL, but to a lesser extent. The motor score of the UPDRS (23. 8±11.8), Hoehn-Yahr stage(2. 0± 0.7), together with the rigidity score (4.4 ± 3.1), only accounted for 18.9 % (R2=0. 189) of the variance of SF-36 total score. The variables that most strongly predicted a low total SF-36 score were non-motor factors, particularly depressive symptoms, sleep disorders and fatigue. When the CES-D, FSS, and PSQI score were included in the model, the R2 increased from 0. 189 to 0.617, indicating that 61.7% of the variance in HR-QOL could be explained if additional CES-D, FSS and PSQI scores were known. Depressive symptoms, as measured by CES-D, had an overwhelming impact on HR-QOL. When CES-D score was included, the R2 change was 0.433, which indicated that additional 43.3% of the variability in HR-QOL could be explained by adding depressive symptoms. Conclusions PD has a substantial impact on HR-QOL, even if in its early stage. Depressive symptoms, sleep disorders and fatigue correlated strongly with lower quality of life. Depressive symptoms appeared to be the strongest determinant of HR-QOL in early PD patients. Every effort should be made to recognize and treat these conditions, thus improving all aspects of PD and giving these patients as good a quality of life as possible.
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Objective To explore the value of Montreal Cognitive Assessment (MoCA) in the diagnosis of mild cognitive impairment. Methods Mini-mental state examination (MMSE) was used in 532 elderly persons aged 60 years and over in Xuzhou city Gulou county. The 69 healthy people and patients with mild cognitive impairment were chosen to undergo MoCA. Then the sensitivity and specificity of MoCA were analyzed. Results According to MMSE, there were 19 patients with mild cognitive impairment (27. 5 %), 50 healthy persons (72.5 %). While according to MoCA, there were 58 patients with mild cognitive impairment (84.1%), 11 healthy persons (15.9 %). The consistency of the two scales was not good. And compared with MMSE, the sensitivity of MoCA was 94.7%, and the specificity was 20. 1%. Conclusions In the diagnosis of mild cognitive impairment, MoCA is more sensitive than MMSE.