Age-associated decline of muscle mass, grip strength and gait speed: a 4-year longitudinal study of 3018 community-dwelling older Chinese.

AIMS: Studies about sarcopenia in Asia are fewer, and started later than in Europe and America. We attempted to examine the decline in muscle mass, grip strength and gait speed in a cohort of older Chinese prospectively over 4 years. METHODS: We recruited 4000 community-living Chinese older than 64 years, and measured their appendicular skeletal mass (ASM) by dual-energy X-ray absorptiometry, grip strength, and gait speed at baseline and after 2 years. Muscle mass and gait speed were additionally measured after 4 years. RESULTS: After 4 years, 3018 participants completed all the measurements. The annualized decline in grip strength (-0.798 kg/year vs -1.239 kg/year) and gait speed (-0.019 m/s/year vs - 0.025 m/s/year) was faster in women than in men. Muscle mass was relatively preserved in comparison with grip strength and gait speed. The percentage loss of ASM in 4 years was -1.59% and -2.02% in men and women, respectively. The percentage decline in gait speed after 4 years was -8.2% in men and -9.0% in women. However, the decline in grip strength was more rapid, particularly in women, which was -10.0% in 2 years and less so in men, -3.85% in 2 years. CONCLUSION: Compared with black people and white people, the older Chinese have less muscle mass, weaker grip strength and slower gait speed. Although the rate of loss of ASM was modest, the decline in gait speed was rapid and the decline in grip strength was particularly fast in older Chinese women.

Should nursing home-acquired pneumonia be treated as nosocomial pneumonia?

OBJECTIVES: It is contentious whether nursing home-acquired pneumonia (NHAP) should be treated as community-acquired pneumonia (CAP) or health care-associated pneumonia. This study aimed to compare NHAP with CAP, and to examine whether multidrug-resistant (MDR) bacteria were significantly more common in NHAP than CAP. DESIGN: A prospective, observational cohort study SETTING: The medical unit of a tertiary teaching hospital PARTICIPANTS: Patients 65 years and older, hospitalized for CAP and NHAP confirmed by radiographs from October 2009 to September 2010 MEASUREMENTS: Demographic characteristics, Katz score, Charlson comorbidity index (CCI), pneumonia severity (CURB score), microbiology, and clinical outcomes were measured. RESULTS: A total of 488 patients were recruited and 116 (23.8%) patients were nursing home residents. Compared with patients with CAP, patients with NHAP were older and had more comorbidities and higher functional dependence level. A larger proportion of patients with NHAP had severe pneumonia (CURB ≥2) than patients with CAP (30.2% vs 20.7%, P = .034). Similar percentages of patients had identified infective causes in the CAP and NHAP groups (27.7% vs 29.3%, P = .734). Viral infection accounted for more than half (55.9%) of NHAP, whereas bacterial infection was the most frequent (69.9%) cause of CAP. MDR bacteria were found in 6 patients of all study subjects. Nursing home residence and history of MDR bacterial infection were risk factors for MDR bacterial pneumonia, which had more severe pneumonia (CURB ≥2). Logistic regression analysis was limited by the small number of patients with MDR bacterial pneumonia. CONCLUSION: In both CAP and NHAP, MDR bacterial infections were uncommon. Most cases of NHAP were caused by unknown etiology or viral pathogens. We suggest that NHAP should not be treated as nosocomial infection. The empirical treatment of broad-spectrum antibiotics in NHAP should be reserved for patients with severe pneumonia or at high risk of MDR bacterial infection.

Antimicrobial peptides are present in immune and host defense cells of the human respiratory and gastrointestinal tracts.

Previous studies have implicated antimicrobial peptides in the host defense of the mammalian intestinal and respiratory tract. The aim of the present study has been to characterize further the expression of these molecules in non-epithelial cells of the human pulmonary and digestive systems by detailed immunohistochemical analysis of the small and large bowel and of the large airways and lung parenchyma. Additionally, cells obtained from bronchoalveolar lavage were analyzed by fluorescent activated cell sorting and immunostaining of cytospin preparations. hBD-1, hBD-2, and LL-37 were detected in lymphocytes and macrophages in the large airways, lung parenchyma, duodenum, and colon. Lymphocytes positive for the peptides revealed a staining pattern and distribution that largely matched that of CD3-positive and CD8-positive T-cells. Macrophages with positive staining for the antimicrobial peptides also stained positively for CD68 and CD74. In view of the morphology of the LL-37-positive and hBD-2-positive mucosal lymphocytes, they are probably also B-cells. Thus, antimicrobial peptides of the defensin and cathelicidin families are present in a variety of non-epithelial cells of mucosal organs. These findings confirm that antimicrobial peptides have multiple functions in the biology of the mucosa of these organs.