The peri-operative changes of T-lymphocyte subsets in the elder esophageal carcinoma patients

Objective:The aim of the study was to observe and compare the trend of T-lymphocyte subsets in the elder and adult esophageal carcinoma patients postoperatively. Methods: Forty-four esophageal carcinoma patients, classified as ASA physical status I-II, were divided into two groups. Twenty-two patients aged than 65 years were grouped as elder patient group, and the rest twenty-two patients, served as adult patient group, were younger than 60 years old. The jugular venous blood samples were collected before induction of anesthesia (T1) as baseline, after completion of surgery (T2), on the first, second and fifth postoperative days (T3, T4 and T5), respectively. The blood counts of CD3+, CD4+ and CD8+T-lymphocyte were measured by flow cytometer. Results: Compared with the baseline level, the blood CD3+, CD4+ and CD4/CD8 levels were significantly decreased immediately after surgery, on the first and second postoperative days in the two groups (P<0.01), which returned to baseline values on the fifth postoperative day (P>0.05). On the fifth postoperative day, CD3+, CD4+ and CD4/CD8 levels in adult group were significantly higher than those in elder group (P<0.05). Conclusion: The postoperative immune function in elder patients recovered more slowly than that in adult.

Prognostic factors for community-acquired pneumonia in middle-aged and elderly patients treated with integrated medicine

OBJECTIVE:To identify prognostic factors in middle-aged and elderly patients with community-acquired pneumonia(CAP) who underwent integrated interventions involving traditional Chinese medicine(TCM) and modern medicine.METHODS:Patients aged ≥45 years and diagnosed with CAP were divided into a middle-aged cohort(45-59 years) and an elderly cohort(≥60 years),and clinical data comprising 75 predictor variables in seven classes were collected.After replacing missing data,calibrating multicenter differences and classifYing quantitative data,univariate and multivariate analysis were performed.RESULTS:On multivariate analysis,eight independent risk factors-respiration rate,C reactive protein(CRP),cost of hospitalization,anemia,gasping,confusion,moist rales and pneumonia severity index(PSI)-were correlated with the outcome "not cured" in the elderly cohort.Nine factors-neutrophil percentage(Neu%),blood urea nitrogen(BUN),time to clinical stability,appetite,anemia,confusion,being retired or unemployed,Gram-negative bacterial infection and educational level-were correlated with not cured in the middle-aged cohort.CONCLUSION:Independent predictive risk factors correlated with adverse outcomes in elderly patients were higher respiration rate,CRP≥four times the mean or median for the patient's center,cost of hospitalization>11,323 RMB and PSI>II,plus anemia,gasping,confusion and moist rales;those in middle-aged patients were higher Neu%,BUN≥mean or median,loss of appetite,anemia,confusion,being retired or unemployed and lower educational level.Gram-negative bacterial infection and time to clinical stability>9 days were protective factors.

Prevalence and risk factors of active pulmonary tuberculosis among elderly people in China:a population based cross-sectional study

Background:The problem of population aging is a critical public health concern in modern China,and more tuberculosis(TB)control efforts are needed to reach elderly people at high priority.In this study,we aim to determine the prevalence and identify the risk factors of TB among elderly people in China.Methods:A multistage cluster-sampled cross-sectional survey was conducted in 2013,and 27 clusters were selected from 10 counties of 10 provinces in China.All consenting participants greater than or equal to 65 years of age were screened for pulmonary TB with a chest X-ray(CXR)and a symptom questionnaire.Three sputum specimens for bacteriological examination by microscopy and culture were collected from those whose screening was positive.Prevalence was calculated,a multiple logistic regression model was performed to confirm the risk factors,and population attributable fraction(PAF)of each risk factor was calculated to indicate the public health significance.Results:Of 38888 eligible people from 27 clusters,34269 participants finished both questionnaire and physical examination.There were 193 active pulmonary TB cases,62 of which were bacteriologically confirmed.The estimated prevalence of active pulmonary TB and bacteriologically confirmed TB in those 65 years of age and older was 563.19 per 100000(95%CI:483.73-642.65)and 180.92 per 100000(95%CI:135.89-225.96),respectively.Male sex,older age,living in rural areas,underweight,diabetes,close contact of pulmonary TB(PTB)and previous TB history are all risk factors for TB.The risk of TB increased with increasing age and decreasing body mass index(BMI)after adjusting for other factors,and there is a positive dose-response relationship.Conclusions:In China,active case finding(ACF)could be implemented among elderly people aged 65 and above with underweight,diabetes,close contact history and previous TB history as a priority,which will get significant yields and be cost-effective.