Sustained heavy ethanol drinking affects CD4⁺cell counts in HIV-infected patients on stavudine (d4T), lamivudine (3TC) and nevirapine (NVP) treatment regimen during 9 months follow-up period

Sustained heavy ethanol drinking is a common problem globally and ethanol is one of the most abused drugs among individuals of different socio-economic status including the HIV-infected patients on antiretroviral drugs. Ethanol is reward drug and a CNS depressant especially at high doses. The study determined the effect of sustained heavy ethanol drinking by HIV-infected patients on d4T/3TC/NVP regimen on CD4+ cell counts in Uganda using WHO AUDIT tool and chronic alcohol-use biomarkers. A case control study using repeated measures design with serial measurements model was used. The patients on stavudine (d4T) 30 mg, lamivudine (3TC) 150 mg and nevirapine (NVP) 200 mg and chronic alcohol use were recruited. A total of 41 patients (20 in alcohol group and 21 in control group) were screened for chronic alcohol use by WHO AUDIT tool and chronic alcohol use biomarkers. They were followed up for 9 months with blood sampling done at 3 months intervals. CD4+ cell count was determined using Facscalibur Flow Cytometer system. Results were then sorted by alcohol-use biomarkers (GGT, MCV and AST/ ALT ratio). Data were analysed using SAS 2003 version 9.1 statistical package with repeated measures fixed model and the means were compared using student t-test. The mean CD4+ cell counts in all the groups were lower than the reference ranges at baseline and gradually increased at 3, 6 and 9 months of follow-up. The mean CD4+ cell counts were higher in the control group as compared to the chronic alcohol use group in both WHO AUDIT tool group and chronic alcohol-use biomarkers group though there was no significant difference (p > 0.05). Chronic alcohol use slightly lowers CD4+ cell count in HIV-infected patients on d4T/3TC/NVP treatment regimen.

Long-term albumin infusion improves survival in patients with cirrhosis and ascites: An unblinded randomized trial

AIM： To investigate the effects of long-term albumin administration on survival, recurrence of ascites and onset of other complications. METHODS： One hundred consecutive patients admitted for first-onset ascites were randomized to receive diuretics plus human albumin 25 g/wk in the first year and 25 g every two wk thereafter （group 1） or diuretics alone （group 2）. The primary endpoint was survival without liver transplantation. Secondary endpoints were recurrence of ascites and occurrence of other complications. RESULTS： Median follow-up was 84 （2-120） mo. Albu- min-treated patients had significantly greater cumulative survival rate （Breslow test= 7.05, P= 0.0078） and lower probability of ascites recurrence （51% versus 94%, P〈0.0001）. Chronic albumin infusion resulted in a mean increase in survival of 16 mo. CONCLUSION： Long-term albumin administration after first-onset ascites significantly improves patients＇ survival and decreases the risk of ascites recurrence.

Influence Factors of Mobility-Related Activities of Daily Living in Chronic Dialysis Patients Needing Long-Term Care: Analysis of Long-Term Care Eligibility Assessment Survey Data

Background: In the near future in Japan, chronic dialysis patients will likely face a situation where the aging and the lengthening of hemodialysis treatment periods will adversely affect the mobility-related activities of daily living (MR-ADL). The aim of this study was to investigate chronological change in MR-ADL among chronic dialysis patients in need of long-term care and the effect of admission to long-term care facilities on their MR-ADL. Methods: Data were analyzed from a long-term care eligibility assessment survey conducted in late March 2009 of 1000 individuals residing in Niigata City, Japan who were approved to receive long-term care. Then data from those individuals who had undergone the assessment survey ≥4 times over a period of ≥4 years were statistically evaluated. To reveal change in MR-ADL, this study performed a three-way analysis of variance with mean survey scores from assessment categories 2 - 5 containing questions related to MR-ADL as the independent variable and the number of eligibility assessment surveys (within-subjects factor), facility admission, and dialysis therapy (between-subjects factors) as dependent variables. Results: We observed the effect of facility admission in individuals aged >70 years for categories 2 - 5, and observed the effect of the number of assessment surveys taken only in women ≥80 years for categories 2 and 5. Regarding the effect of dialysis therapy, female dialysis patients aged ≥80 years and in need of long-term care scored significantly higher on survey items for transferring, grooming, toileting, eating, and instrumental activities of daily living, all of which are indicators of a moderate decline in ADL. Conclusions: Because dialysis is often initiated in women aged around 80 years, ADL in this group of individuals can be improved by the initiation and proper provision of dialysis.

Quantitative electroencephalography in predicting on outcome of awakening in long-term unconscious patients after severe traumatic brain injury

Objective To explore quantitative electroencephalography in unconscious patients after severe traumatic brain injury (TBI) to predict awakening. Methods All cases were divided into two groups(the awake group 19 cases and the unfavourable prognosis group 22 cases).Two weeks after admission the original EEGs were preformed in 41 patients suffering from severe TBI with duration of disturbance of

A comparative study of pancreatic endocrine function and related metabolism after long-term survival between the patients with combined kidneypancreas transplantation vs those with combined en bloc ' liver-pancreas transplantation

Objective To compare the effects of combined en bloc liver - pancreas transplantation ( LPT) with portal vein drainage and simultaneous combined kidney - pancreas transplantation ( KPT) with systemic venous drainage on the pancreatic endocrine function and related me-

Impact of admission blood glucose levels on prognosis of elderly patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention

OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients >65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction。 METHODS:We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ±5.4)。 Patients were divided into two groups according to admission blood glucose levels。 Group : low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose >168 mg/dL。 RESULTS:In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P <0.001)。 Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI <3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P <0.001)。 CONCLUSIONS:Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality。

A phase Ⅳ study of homoharringtonine, cytarabine, aclacinomycin and G-CSF(HCAG) regimen compared with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia patients

Objective · To compare the efficacy and prognostic factors of HCAG regimen with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia(AML) patients. Methods · Forty-one patients with AML(aged 55-71 years) were randomly divided into two groups(Group HCAG and Group IA) between 2014 and 2016 for induction and consolidation therapy. Multivariate analysis was applied to identify prognostic factors for relapse-free survival(RFS). Results · A total of 29 patients(70.7%) achieved complete remission(CR). The estimated 2-year overall survival(OS) was 66.8% in Group HCAG and 75.4% in Group IA(P=0.913). The estimated 2-year RFS was 61.8% in Group HCAG and 49.1% in Group IA(P=0.411). Age remained as the unfavorable prognostic factor, leading to significant differences in OS and RFS. In addition, RFS was influenced by cytogenetic/molecular risk stratification. Conclusion · Although HCAG seemed not to particularly benefit the group, the dose reduction of anthracyclines may be applied in elderly patients with comparable short-time outcome. Furthermore, the introduction of homoharringtonine resulted in an improvement of treatment response for more than 20% compared with CAG regimen.

Long-Term Patient-Aspect Outcomes of the Single-Port Laparoscopic Cholecystectomy

Background: Single port laparoscopic cholecystectomy (SPLC) is a widely performed advanced technique in laparoscopic surgery which has many benefits compare to conventional three port laparoscopic cholecystectomy (TPLC). The purpose of this study was to compare the patients’ satisfaction of SPLC and TPLC after one year of operation by using questionnaire which not only objective factors such as results of operation and hospital days but also subjective factor such as social and cosmetic quality of life. Materials and Methods: This study analyzed the data of 74 patients (SPLC = 42, TPLC = 32) who underwent the laparoscopic cholecystectomy between March and July 2013. The patients were asked to complete a patient-assessment questionnaire measuring the postoperative social and cosmetic quality-of-life values at the 12-month mark. Results: Statistically significant differences in the age, sex distribution, and body mass index are absent between the two groups. All the average scores of the different parameters of the social-activity aspect—satisfaction with physical condition, limitation of nutrition, stamina, postoperative pain level, returning to social life, impairment of social life, degree of complications, and cost-effectiveness of the surgery—are not statistically significant in both groups. Alternatively, all the results of the cosmetic aspect—scar influence on charms (p p = 0.015), and patient’s score of scars (p < 0.001)—show statistically significant differences. Conclusion: The SPLC is a safe and an attractive approach regarding the patients of this study. It offers a more effective cosmetic result that may be conveyed by a greater patient satisfaction.

Study on the quality of life and the factors influencing it in elderly patients

A society of advanced age is arriving with the increasing number of elderly patients. Little attention has been paid to the quality of life of elderly patients, which is decreasing gradually. This article aims to study the quality of life among elderly patients and explore the factors influencing it, in addition to exploring effective ways to improve the quality of life of elderly patients.

饮酒和体力活动对社区2型糖尿病患者血糖控制的影响

目的:了解饮酒和体力活动与南京市社区糖尿病患者血糖控制之间的关系。方法:采用多阶段分层整群抽样方法,随机抽取南京市5个区5663名18岁以上社区糖尿病患者作为研究对象,采用多因素Logistic回归分析饮酒和体力活动对糖尿病患者血糖控制的联合作用。结果:5663名糖尿病患者空腹血糖控制率为39.8%(95%CI:38.5%~41.1%),调整年龄、性别、规律服药、职业、受教育水平、体质量指数(BMI)、高血压、糖尿病家族史和吸烟后,过量饮酒患者空腹血糖控制率是不饮酒/适量者的0.73倍(95%CI:0.64~0.83,P<0.001)。与不饮酒/适量且体力活动充足者相比,过量饮酒且体力活动充足者的空腹血糖控制率为其0.76倍(95%CI:0.66~0.87,P<0.001),过量饮酒且体力活动不足者为其0.58倍(95%CI:0.41~0.84,P=0.003)。结论:饮酒和体力活动对血糖控制存在联合作用,过量饮酒者如体力活动不足会进一步降低其血糖控制率。

The prognosis of biopsy-proven lupus nephritis in Chinese patients: long-term follow-up of 86 cases

Objective To investigate the prognosis of lupus nephritis (LN) and its influencing factors in patients with lupus nephritis in China. Methods A retrospective study was carried out in 86 patients followed up for at least 5 years. Clinical features, serological and immunological tests were investigated. Renal biopsies were performed at the beginning of the study and repeated in some cases during the follow up period. All the 86 patients had serum creatinine (Scr) level less than 132.6 μmol/L at the inital presentation and were divided into three groups according to the level of Scr at the end of the study. Group Ⅰ: the patients with normal renal function (Scr<132.6 μmol/L); Group Ⅱ: the patients with mild～moderate renal insufficiency (132.6 μmol/L≤Scr≤530.4 μmol/L); Group Ⅲ: the patients with end stage real failure (ESRF) (Scr≥ 530.4 μmol/L). Results Forty seven patients reached clinical remission with normal renal function, 11 had with stabilization of renal function although the systemic lupus erythematosis (SLE) acti vity relapsed repeatedly, while 28 subjects developed renal insufficiency after 60～170 (mean 88.12±28.23) months of observation. ESRF rate was 11.6% in this group of patients. Eight patients died (2 died of infections and 6 died of ESRF) during the follow up period. At the beginning of the study the rates of hypertension, persistent anemia and hematuria in Group Ⅲ were 50%, 70% and 70% respectively, being much higher than those in Group I. The calculation of AI and CI in 60 patients revealed that there were 65% of patients with AI ≥7 and 70% of patients with CI≥3 in Groups Ⅱ and Ⅲ, while in Group I there were only 32% of patients with AI≥7 and 19% of patients with CI≥3. Sixteen cases had pathologic class changed in 48 repeated biopsies. Seven cases changed to Class Ⅳ, 5 to Class Ⅱ, 3 to Class Ⅴ from other classes and one to class Ⅲ from Class Ⅱ. Conclusions Factors associated with the development of renal insufficiency in these lupus patients included hypertension, anemia and hematuria. Renal biopsy evaluation offered additional prognostic information and showed that patients with severe active and chronic histologic changes were at risk for developing renal isufficiency. During the clinical course, the renal classification of LN changed in certain patients, thus the histologic classification of renal morphology at initial presentation did not fully predict the outcome.

化湿降浊饮对脾虚湿阻型痛风老年患者体质的影响

目的观察化湿降浊饮对脾虚湿阻型痛风老年患者体质的影响。方法选取2021年1月-2022年1月期间郑州市中医院门诊及住院收治的痛风老年患者80例,按照随机数字表法分为对照组和治疗组,每组各40例。对照组给予非布司他片,治疗组给予化湿降浊饮,两组患者疗程均为4周、8周、12周。观察比较两组患者临床疗效、痛风总发作率、安全性,治疗前后疼痛评分(Visualanaloguescale,VAS)、中医体质变化、中医证候积分、肾功[血尿酸(Blooduricacid,BUA)、血清肌酐(Serum creatinine concentration,SCR)、血尿素氮(Blood urea nitrogen,BUN)]、肝功[天冬氨酸氨基转移酶(Aspartate aminotransferase,AST)、丙氨酸氨基转移酶(Alanine aminotransferase,ALT)]。结果治疗4、8、12周后两组患者VAS评分均较治疗前降低,且治疗12周后治疗组VAS评分明显低于对照组,差异有统计学意义(P<0.05)。治疗组患者在受试期间总发作率18.92%(7/37)明显低于对照组40.00%(14/35),差异有统计学意义(P<0.05)。治疗前两组患者以痰湿质>湿热质>气虚质为多。治疗后治疗组较治疗前痰湿、湿热质明显减少,平和质增多;对照组较治疗前阳虚及瘀血质、平和质增多,湿热质、气虚质较前有所下降。治疗4周、8周、12周后两组患者中医证候积分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后治疗组临床总有效率94.59%(35/37)明显高于对照组74.29%(26/35),差异有统计学意义(P<0.05)。治疗组治疗4周后无明显差异,治疗8周后血尿酸成明显下降趋势,差异有统计学意义(P<0.05),治疗12周后血尿酸水平下降缓慢;对照组经治疗4周后降尿酸作用明显,差异有统计学意义(P<0.05),治疗8、12周后血尿酸下降不明显,差异无统计学意义(P>0.05)。治疗期间,两组患者胃肠道不适各2例,对照组尿常规异常1例,谷丙转氨酶异常对照组1例,治疗组2例,尿素氮异常治疗组1例,对照组2例,两组患者出现不良反应较轻,均未做相应处理。结论化湿降浊饮治疗脾虚湿阻型痛风能明显改善中医体质和总体疗效;其降尿酸作用较非布司他片更为平稳,可有效减少痛风发作和非甾体类抗炎药的使用,临床疗效可靠,使用安全。

An Elderly Patient with Advanced Lung Cancer Achieved Long-Term Survival Using Chinese Medicine:An Alternative Treatment Strategy for Cancer Patients Aged 80 or Older without A Tissue Confirmed Diagnosis

Lung cancer is the leading cause of cancerrelated mortality in China.（1＇2） Meanwhile, the average life expectancy in the aging population has increased from 46 years in 1950 to 75 years in 2010.

Effect of acute kidney injury on short-and long-term mortality of patients with acute myocardial infarction

Objective To evaluate the role of acute kidney injury(AKI)in predicting early(30-day)and late(30-day to5-year)mortality of acute myocardial infarction(AMI)patients during hospitalization.Methods A total of 1371adult patients diagnosed with AMI in the First People’s Hospital of Changzhou from January 2008 to December2012 were analyzed retrospectively while their

北京市地方性砷中毒分布调查

目的 了解北京地区是否存在地方性砷中毒 ,以及历史曾有高砷报道的顺义区地方性砷中毒现状。方法 在全市 10个远郊区县进行饮用水井水砷含量的调查 ,并在历史高砷地区进行砷中毒情况调查。结果 北京市 10个远郊区县除顺义外 ,水砷含量均小于 0 0 5mg/L。全市的超标率为 1 6 2 %。顺义地区的水砷含量超标率为 8 0 6 % ,最高浓度为 0 14 3mg/L。未发现砷中毒患者。结论 北京市未发现饮水型砷中毒病区和砷中毒患者 ,但仍有潜在型病区存在。

基于中医证候要素的消渴目病患者报告结局量表条目池设置及考评

目的制定基于中医证候要素的消渴目病(糖尿病视网膜病变)患者报告结局(PRO)量表,并对其进行初步考评。方法系统检索2006年1月—2015年12月中国知网和维普网中与消渴目病证候类型有关的文献,整理和归纳其中的消渴目病证型,并将复合证候分解为单一证素;于2015年7—10月在山东省中医院内分泌科病房对糖尿病视网膜病变患者30例、患者家属5例、内分泌科医护人员5例进行半结构化深度访谈。将文献研究结果与访谈结果相结合,设置消渴目病PRO量表初始条目池。采用抽签法,选取2014年3月—2015年11月山东中医药大学第一附属医院内分泌科和眼科、山东中医药大学第二附属医院内分泌科和眼科、济南市中医院内分泌科和眼科收治的糖尿病视网膜病变患者280例,采用初步设置的消渴目病PRO量表条目池对其进行调查,以对量表进行考评。共发放问卷280份,回收有效问卷270份,问卷有效回收率为96.4%。结果文献检索共纳入合格文献42篇,拆分出证素15种,结合访谈结果,初步设置成的消渴目病PRO量表共31个条目,其中生理维度18个条目(证候效应指标9个、特有症状指标9个),心理维度6个条目,社会维度5个条目,满意度维度2个条目。不同病情分级患者的生理维度证候效应指标、生理维度特有症状指标、心理维度、社会维度得分及总分比较,差异均有统计学意义(P<0.05)。总量表的Cronbach'sα系数为0.944,其中生理维度证候效应指标、生理维度特有症状指标、心理维度、社会维度的Cronbach'sα系数分别为0.909、0.901、0.890、0.857。因子分析共获得5个公因子,累计方差贡献率为66.755%。结论初步设置的消渴目病PRO量表信效度较好,可以用于中医药治疗消渴目病的疗效评估,建议在临床上推广应用。

通络复脉饮治疗女性糖尿病冠心病心绞痛35例临床观察

目的:观察通络复脉饮治疗女性糖尿病冠心病心绞痛的临床疗效。方法:将68例患者随机分为中西药治疗组35例,单纯西药对照组33例,治疗组比对照组药物加通络复脉饮,连续治疗8周后,观察心绞痛症状、心电图、血糖和血脂等指标的改善情况。结果:治疗组及对照组治疗前后心绞痛症状和心电图均有明显改善,治疗组心绞痛发作频率及持续时间的改善优于对照组(P<0.05),空腹血糖、高密度脂蛋白胆固醇改善率亦高于对照组(P<0.05)。结论:中西药联合治疗女性糖尿病冠心病心绞痛疗效显著。

长期饮酒对老年患者全麻腹腔镜术后认知功能及下肢深静脉血栓形成的影响

目的探讨长期饮酒对老年患者全麻腹腔镜术后认知功能及下肢深静脉血栓形成(DVT)的影响。方法选取2016年10月—2017年3月我院收治的长期饮酒老年患者80例为研究组,选取同期收治非长期饮酒老年患者80例为对照组,两组患者均行全麻腹腔镜手术治疗,对比两组患者的术后认知功能及DVT发生情况。结果手术前两组患者的MMSE(简易精神状态量表)评分无明显区别(P>0.05),手术后不同时间点研究组MMSE评分均显著低于对照组(P<0.05);手术前两组患者的凝血功能无明显区别(P>0.05),手术后研究组患者凝血酶原时间(PT)、活化凝血酶原时间(a PTT)下调、D二聚体(D-D)以及纤维蛋白原(Fbg)等高于对照组;术后DVT发生情况研究组高于对照组(P<0.05)。结论长期饮酒会导致老年患者全麻腹腔镜术后认知功能下降,同时DVT发生风险显著上升。

循证护理在全麻术后患儿早期饮水的临床效果

目的 探讨循证护理在小儿全麻术后早期少量饮水临床护理中的应用效果。方法 2017年7月~2018年1月解放军总医院第一医学中心小儿外科所收治的全麻手术患儿167例作为研究对象,按术后饮水护理方式将其划分为两组:对照组83例,为小儿全麻术后常规临床护理(术后6 h饮水);实验组84例,采用循证护理(全麻清醒后即饮水),比较两组术后早期少量饮水止闹效果及安全性。结果 实验组患儿饮水后哭闹率低于对照组,差异有统计学意义(P <0.05),实验组术后6 h内呕吐及发热率与对照组比较,差异无统计学意义(P> 0.05)。结论 将循证护理在小儿全麻术后早期少量饮水临床护理中的应用效果确切,可以有效减少患儿术后哭闹及其他不适,进一步降低术后不良反应的发生,值得在小儿术后护理中应用推广。