Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose...Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients （age 79.5 ＋ 6.7 years, male 63.8%） were recruited to the study. Comprehensive geriatric assessment （CGA）, including measurements about activity of daily living （ADL）, nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti perform- ance oriented mobility assessment （POMA） and history of fall in the recent years. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index （BMI）, and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease （COPD）, cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile （P 〈 0.01 T3 vs. T1, P 〈 0.01 T3 vs. T2）. Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale （P 〈 0.001）, as well as CGA and POMA （P 〈 0.001）. Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL im- pairment （OR： 2.748, 95%CI： 1.598-4.725）, （OR： 3.310, 95%CI： 1.893-5.788）. Decreased Tinetti POMA score was associated with Mini-Mental State Examination （MMSE） （OR： 4.035, 95%CI： 2.100-7.751）, ADL （OR： 2.380, 95%CI： 1.357-4.175） and shortened MNA form （MNA-SF） impairment （OR： 2.692, 95%CI： 1.147-6.319）. Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effec- tive interventions.展开更多
AIM： To explore portal hypertension and portosystemic shunts and to stage chronic liver disease （CLD） based on the pathophysiology of portal hemodynamics. METHODS： Per-rectal portal scintigraphy （PRPS） was perfo...AIM： To explore portal hypertension and portosystemic shunts and to stage chronic liver disease （CLD） based on the pathophysiology of portal hemodynamics. METHODS： Per-rectal portal scintigraphy （PRPS） was performed on 312 patients with CLD and liver angioscintigraphy （LAS） on 231 of them. The control group included 25 healthy subjects. We developed a new model of PRPS interpretation by introducing two new parameters, the liver transit time （LTT） and the circu-lation time between right heart and liver （RHLT）. LTT for each lobe was used to evaluate the early portal hypertension. RHLT is useful in cirrhosis to detect liver areas missing portal inflow. We calculated the classical per-rectal portal shunt index （PRSI） at PRPS and the hepatic perfusion index （HPI） at LAS. RESULTS： The normal LTT value was 24 ± 1 s. Abnormal LTT had PPV = 100% for CLD. Twenty-seven noncirrhotic patients had LTT increased up to 35 s （median 27 s）. RHLT （42 ± 1 s） was not related to liver disease. Cirrhosis could be excluded in all patients with PRSI 〈 5% （P 〈 0.01）. PRSI 〉 30% had PPV = 100% for cirrhosis. Based on PRPS and LAS we propose the classification of CLD in 5 hemodynamic stages. Stage 0 is normal （LTT = 24 s, PRSI 〈 5%）. In stage 1, LTT is increased, while PRSI remains normal. In stage 2, LTT is decreased between 16 s and 23 s, whereas PRSI is increased between 5% and 10%. In stage 3, PRSI is increased to 10%-30%, and LTT becomes undetectable by PRPS due to the portosystemic shunts. Stage 4 includes the patients with PRSI 〉 30%. RHLT and HPI were used to subtype stage 4. In our study stage 0 had NPV = 100% for CLD, stage 1 had PPV = 100% for non-cirrhotic CLD, stages 2 and 3 represented the transition from chronic hepatitis to cirrhosis, stage 4 had PPV = 100% for cirrhosis. CONCLUSION： LTT allows the detection of early portal hypertension and of opening of transhepatic shunts. PRSI is useful in CLD with extrahepatic portosystemic shunts. Our hemodynamic model stages the evolution of portal hypertension and portosystemic shunts. It may be of use in the selection of patients for interferon therapy.展开更多
Chronic renal disease is associated with advanced age,diabetes,hypertension,obesity,musculoskeletal problems and cardiovascular disease,the latter being the main cause of mortality in patients receiving haemodialysis(...Chronic renal disease is associated with advanced age,diabetes,hypertension,obesity,musculoskeletal problems and cardiovascular disease,the latter being the main cause of mortality in patients receiving haemodialysis(HD).Cooled dialysate(35 ℃-36 ℃) is recently employed to reduce the incidence of intradialytic hypotension in patients on chronic HD.The studies to date that have evaluated cooled dialysate are limited,however,data suggest that cooled dialysate improves hemodynamic tolerability of dialysis,minimizes hypotension and exerts a protective effect over major organs including the heart and brain.The current evidence-based review is dealing with the protective effect of cold dialysis and the benefits of it in aspects affecting patients' quality of care and life.There is evidence to suggest that cold dialysis can reduce cardiovascular mortality.However,large multicentre randomized clinical trials are urgently needed to provide further supporting evidence in order to incorporate cold dialysis in routine clinical practice.展开更多
Renal artery stenosis is a common cause of secondary hypertension and chronic kidney disease. We present here a case of fibromuscular dysplasia that was treated with surgical revascularization, resulting in recovery o...Renal artery stenosis is a common cause of secondary hypertension and chronic kidney disease. We present here a case of fibromuscular dysplasia that was treated with surgical revascularization, resulting in recovery of kidney function with eventual cessation of chronic dialysis. The case involves a 25-year-old female with coincidentally discovered hypertension, who underwent further investigations revealing a diagnosis of renal artery stenosis due to fibromuscular dysplasia. She subsequently developed two episodes of malignant hypertension, with flash pulmonary oedema and worsening renal failure that resulted in dialysis dependence. After evidence was obtained that the right kidney was still viable, a revascularization procedure was performed, improving blood pressure control and restoring kidney function, thereby allowing dialysis to be stopped. This case highlights the importance of evaluating patients with renal artery stenosis for revascularization before committing them to a life of chronic dialysis.展开更多
文摘Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients （age 79.5 ＋ 6.7 years, male 63.8%） were recruited to the study. Comprehensive geriatric assessment （CGA）, including measurements about activity of daily living （ADL）, nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti perform- ance oriented mobility assessment （POMA） and history of fall in the recent years. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index （BMI）, and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease （COPD）, cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile （P 〈 0.01 T3 vs. T1, P 〈 0.01 T3 vs. T2）. Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale （P 〈 0.001）, as well as CGA and POMA （P 〈 0.001）. Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL im- pairment （OR： 2.748, 95%CI： 1.598-4.725）, （OR： 3.310, 95%CI： 1.893-5.788）. Decreased Tinetti POMA score was associated with Mini-Mental State Examination （MMSE） （OR： 4.035, 95%CI： 2.100-7.751）, ADL （OR： 2.380, 95%CI： 1.357-4.175） and shortened MNA form （MNA-SF） impairment （OR： 2.692, 95%CI： 1.147-6.319）. Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effec- tive interventions.
文摘AIM： To explore portal hypertension and portosystemic shunts and to stage chronic liver disease （CLD） based on the pathophysiology of portal hemodynamics. METHODS： Per-rectal portal scintigraphy （PRPS） was performed on 312 patients with CLD and liver angioscintigraphy （LAS） on 231 of them. The control group included 25 healthy subjects. We developed a new model of PRPS interpretation by introducing two new parameters, the liver transit time （LTT） and the circu-lation time between right heart and liver （RHLT）. LTT for each lobe was used to evaluate the early portal hypertension. RHLT is useful in cirrhosis to detect liver areas missing portal inflow. We calculated the classical per-rectal portal shunt index （PRSI） at PRPS and the hepatic perfusion index （HPI） at LAS. RESULTS： The normal LTT value was 24 ± 1 s. Abnormal LTT had PPV = 100% for CLD. Twenty-seven noncirrhotic patients had LTT increased up to 35 s （median 27 s）. RHLT （42 ± 1 s） was not related to liver disease. Cirrhosis could be excluded in all patients with PRSI 〈 5% （P 〈 0.01）. PRSI 〉 30% had PPV = 100% for cirrhosis. Based on PRPS and LAS we propose the classification of CLD in 5 hemodynamic stages. Stage 0 is normal （LTT = 24 s, PRSI 〈 5%）. In stage 1, LTT is increased, while PRSI remains normal. In stage 2, LTT is decreased between 16 s and 23 s, whereas PRSI is increased between 5% and 10%. In stage 3, PRSI is increased to 10%-30%, and LTT becomes undetectable by PRPS due to the portosystemic shunts. Stage 4 includes the patients with PRSI 〉 30%. RHLT and HPI were used to subtype stage 4. In our study stage 0 had NPV = 100% for CLD, stage 1 had PPV = 100% for non-cirrhotic CLD, stages 2 and 3 represented the transition from chronic hepatitis to cirrhosis, stage 4 had PPV = 100% for cirrhosis. CONCLUSION： LTT allows the detection of early portal hypertension and of opening of transhepatic shunts. PRSI is useful in CLD with extrahepatic portosystemic shunts. Our hemodynamic model stages the evolution of portal hypertension and portosystemic shunts. It may be of use in the selection of patients for interferon therapy.
文摘Chronic renal disease is associated with advanced age,diabetes,hypertension,obesity,musculoskeletal problems and cardiovascular disease,the latter being the main cause of mortality in patients receiving haemodialysis(HD).Cooled dialysate(35 ℃-36 ℃) is recently employed to reduce the incidence of intradialytic hypotension in patients on chronic HD.The studies to date that have evaluated cooled dialysate are limited,however,data suggest that cooled dialysate improves hemodynamic tolerability of dialysis,minimizes hypotension and exerts a protective effect over major organs including the heart and brain.The current evidence-based review is dealing with the protective effect of cold dialysis and the benefits of it in aspects affecting patients' quality of care and life.There is evidence to suggest that cold dialysis can reduce cardiovascular mortality.However,large multicentre randomized clinical trials are urgently needed to provide further supporting evidence in order to incorporate cold dialysis in routine clinical practice.
文摘Renal artery stenosis is a common cause of secondary hypertension and chronic kidney disease. We present here a case of fibromuscular dysplasia that was treated with surgical revascularization, resulting in recovery of kidney function with eventual cessation of chronic dialysis. The case involves a 25-year-old female with coincidentally discovered hypertension, who underwent further investigations revealing a diagnosis of renal artery stenosis due to fibromuscular dysplasia. She subsequently developed two episodes of malignant hypertension, with flash pulmonary oedema and worsening renal failure that resulted in dialysis dependence. After evidence was obtained that the right kidney was still viable, a revascularization procedure was performed, improving blood pressure control and restoring kidney function, thereby allowing dialysis to be stopped. This case highlights the importance of evaluating patients with renal artery stenosis for revascularization before committing them to a life of chronic dialysis.
