Survey on the Demand for Elderly Care Services of Community Residents in Beijing and Analysis of Influencing Factors

Objective: To investigate the current situation of the demand for geriatric care services of community residents in Beijing and analyze the influencing factors to provide a reference basis for meeting the demand for diversified and professional geriatric care services. Methods: A self-made questionnaire was used to randomly survey 1558 elderly individuals at community health service centers in 8 urban districts where elderly care centers were planned to be built. The influencing factors of the different characteristics of elderly care service needs from three aspects were analyzed using a dichotomous logistic regression model: predisposing, enabling, and, need factors. Results: 69.7% of the elderly required home care services, 22.8% wanted to get care services at elderly care centers, 15.9% wanted to get care services at nursing homes, 12.3% required community care services, and 7.4% didn’t know where to access care services. 68.5% of the elderly required care services for disabilities/semi-disabilities, 58.0% for dementia, 54.7% for common diseases, 34.9% for rehabilitation training, 33.0% for plumbing care, and 7.5% for hospice care. At the same time, there were urban- rural differences in the demand for elderly care services, with suburban elderly having a higher demand for care services than those living in urban areas (P < 0.05). The elderly’s demand for care services was mainly related to age, place of residence, and gender in the causative factors, mode of residence and physical condition among able factors, and mode of care services and care needs among need factors (P < 0.05). Conclusion: The demand for elderly care services was differentiated by factors including place of residence, age, and gender. It is crucial to accurately match the demand for elderly care services, innovate the mode of elderly care services, and improve the service quality to improve the elderly health service system.

Comprehensive therapeutic effect of the stroke rehabilitation unit in a medium-sized comprehensive community hospital

BACKGROUND： Acute stroke unit （stroke care unit） is developing in some domestic large-sized hospitals, but most stroke patients need stroke rehabilitation unit therapy, so setting stroke rehabilitation unit in medium-sized comprehensive community hospital （secondary hospital）, where medical facility is relatively insufficient, is a new pathway to satisfy stroke patients. OBJECTIVE： To observe the comprehensive effect of developing stroke rehabilitation unit based on the facility of secondary hospital and its feasibility. DESIGN： Non-randomized concurrent controlled observation SETTING： Department of Neurology, Beijing Longfu Hospital PARTICIPANTS： Totally 264 stroke reconvalescents who suffered stroke for 7 days and received treatment in the Department of Neurology, Beijing Longfu Hospital during June 2003 to June 2005 were involved in the study. All the involved patients were confirmed by CT or MRI. The patients were scored by using Modified Edinbergh-Scandinavia stroke scale （SSS） 〉 16 points. Written informed consents were obtained from all the patients. The patients were assigned into 2 groups according to the willing of patients and their relatives： （1）treatment group, in which, there were 134 patients, 76 males and 58 females, aged 43 to 74 years; cerebral infarction was found in 116 cases and cerebral hemorrhage in 18 cases;（2） control group, in which, there were 130 patients, 66 males and 64 females, aged 45 to 77 years, cerebral infarction was found in 115 cases and cerebral hemorrhage in 15 cases. There were significant differences in baseline data of the patients between two groups. METHODS： A same basic treatment was conducted in the patients of the two groups. （1） Patients in the treatment group admitted to stroke rehabilitation unit and received comprehensive rehabilitation treatment. The rehabilitation flow-sheet： randomization-letting the patients of treatment group go into the unit-making comprehensive assessment in the initial stage-making therapy plan-talking with patients and their other family members-general rehabilitation-making metaphase assessment-adjusting therapy plan-making final assessment-letting the patients discharge and doing follow-up visits. （2） The patients in the control group admitted to common wards, and they were encouraged to do activities by themselves in the early stage, but did not receive rehabilitation training under the instructions from professional physicians. MAIN OUTCOME MEASURES： The following assessments were conducted on admission and 7 and 28 days after admission： （1） Severity of stroke and motor function： scored as 0 to 45 points by SSS, the higher points, the severer damage. （2）Activities of daily living： Evaluated by Barthel index, 110 points in total, 110 points meant normal, 0 point meant extremely poor. （3）Mental status： evaluated by Hopkin＇s symptom scale with a 5-point scoring. The symptom was scored with low to high points. （4）Cognitive function： Quantification measurement was conducted with LOTCA method. The higher points, the better therapeutic effects. RESULTS： （1） Three cases dropped out and one died in the treatment group, 11 cases dropped out and 4 died in the control group. （2）The neurologic impairment points on 7 and 28 days after therapy in the treatment group were lower than those in the control group separately [7 days：（9.73±6.43） points vs. （12.63± 7.87） points, t =2.28, P〈 0.05;28 days：（7.88±4.81） points vs. （9.84±7.03）points, t =2.04, P〈 0.05]. Barthel index on 7 and 28 days after therapy in the treatment group were higher than those in the control group separately [7 days：（54.28±8.38） points vs. （39.76±7.31） points, t =2.206, P 〈 0.05; 28 days： （89.72±7.94） points vs. （67.34±8.63） points, t =2.812, P 〈 0.01]. （4） Patients were allocated into different age groups based on age and evaluated with LOTCA. Results showed that there were no significant differences among different age groups （P 〉 0.05）. （5） Totally 160 patients in the two groups accomplished the Hopkin＇s test, among them, 94 （58.7%） had different mental disorders; Among the patients with mental disorder, depression, obsessive-compulsive and anxiety were found mostly, being 53.8%, 52.5% and 46.2%, respectively. CONCLUSION： （1） Developing stroke rehabilitation unit therapy in the secondary hospital can obviously improve the motor function and activities of daily living of stroke reconvalescents. （2） More than half of the stroke reconvalescents accompany the symptoms of depression, obsessive-compulsive, anxiety and other mental disorders. （3） The cognitive function of stroke reconvalescents is not related to age.

The first attempt for closure of the patent foramen ovale under guidance of teleoperation ultrasonic robot:a case report

Patent foramen ovale(PFO)is a remnant of normal fetal anatomy,which occurs in about 20%–25%of cases.Patients with PFO are at increased risk for migraine,acute limb ischemia secondary to emboli and cryptogenic(no other identifiable cause)stroke.The traditional approach has been to use a fluoroscopically guided blocking device,but this is contraindicated in patients with severe allergies to contrast media or inability to undergo angiography.With the advancements in technology,ultrasonic robotic systems have become available for medical procedures.In the current study,we reported a case of using the ultrasonic robotic teleoperation system to achieve closure of PFO at the Chinese PLA General Hospital,Beijing,China.

Psychological problems affecting the prognosis of stroke patients

BACKGROUND： It is believed that mental disorder influences the morbility and prognosis of cardio-cerebrovascular disease by biological factors. OBJECTIVE： To observe the characteristics of stroke patients complicated by psychological problems and the prognosis of such patients. DESIGN： Observational study. SETTING： Department of Neurology, Beijing Longfu Hospital. PARTICIPANTS： Totally 160 inpatients （46 males and 114 females） with stroke admitted to Department of Neurology, Beijing Longfu Hospital between June 2005 and June 2006 were recruited in this study. The involved patients all corresponded to the diagnosis criteria of cerebrovascular disease formulated in the 1995 National Conference of Cerebrovascular Disease and confirmed by skull CT or MRI examination. The age range was between 43 and 74 years. They all signed the informed consent for the detection and therapeutic regimen, and the application of this technique also gave the approval of the Ethics Committee of the hospital. METHODS： On admission, the patients were investigated on psychological problems using Hopkin symptom checklist. After admission, all the patients received oral administration of aspirin anti-platelet drugs and intravenous infusion of Fufang Danshen. Motor relearning program was used in the rehabilitation treatment for disability rehabilitation. Mental intervention was carried out in the end of observation period. On day 30 after admission, the recovery of two groups of patients was compared using activities of daily living scale, Scandinanvian Stroke Scale （SSS） and disability level. MAIN OUTCOME MEASURES： The activities of daily living were assessed with Barthel index. Higher scores of patients suggested better activities of daily living. For SSS, the higher points, the severer defect degree. The reduction of scores of neurologic impairment suggested that neurological function improved. Disability level was graded according to the method formulated in the Second National Cerebrovascular Conference. RESULTS： All the 160 involved stroke patients participated in the final analysis. （1） Hopkin symptom checklist assessment results： Of the 160 stroke patients, 94 （58.7%） were assessed as having any psychological problems. In this study, psychological problems were more likely to be seen in female patients （74.4%） than in male patients （26.1%）. Major psychological problems were depression （53.8%）, compulsion （52.5%） and anxiety （46.2%）. （2） Comparison of prognosis of patients： Significant differences in activities of daily living-Barthel index, SSS scores and disability level were found between pre- and post-treatment periods. It indicates that stroke patients complicated by mental disorder had poor prognosis. CONCLUSION： The incidence of complicated psychologic obstacle is high in stroke patients, and its prognosis is inferior to that of patients who have no psychological problems.

Fifteen-year mortality and prognostic factors in patients with dilated cardiomyopathy:persistent standardized application of drug therapy and strengthened management may bring about encouraging change in an aging society

BACKGROUND There is scarce data on the long-term mortality and associated prognostic factors in patients with dilated car-diomyopathy(DCM).The study aimed to investigate the all-cause mortality up to 15 years(mean 7.9±5.7 years)in such patients,and the independent prognostic factors influencing their long-term mortality.METHODS One hundred and sixty-six consecutive patients with DCM were prospectively enrolled from 2002 to 2003.The mean age of patients was 59.5±10.4 years,and approximately 57%were male.They were followed up by telephone or outpa-tient visit at least every three months until 2019 or all-cause death occurred.Predictors of mortality were identified using mul-tivariate logistic regression analysis.RESULTS During the 15 years of follow-up,five patients were lost to follow-up,and the complete data records of 161 patients were included in the analysis.Patients were treated with angiotensin-converting-enzyme inhibitors(ACEI)or angiotensin-recept-or blocker(ARB),β-blockers,mineralocorticoid receptor antagonist(MRA),diuretics and digitalis from 2002 to 2004,and main-tained at the maximum tolerated doses between 2004 and 2019.Our safety targets to maintain heart rate and blood pressure at 60-80 beats/min and 90-120/60-80 mmHg,respectively.All-cause mortality in the first five years was 55.9%.The independent risk factors for the 5-year mortality were age≥70 years old(OR=5.45,P=0.006),systolic blood pressure(SBP)>120 mmHg(OR=3.63,P=0.004),6-minute walk distance(6MWD)<450 m(OR=3.84,P=0.001).15-year all-cause mortality was 65.8%.The inde-pendent risk factors for 15-year mortality were age≥70 years old(OR=16.07,P=0.009),LVEF≤35%(OR=5.69,P=0.003),and SBP>120 mmHg(OR=9.56,P<0.001).CONCLUSIONS This study was the first to demonstrate the 15-year survival rate of 34%in DCM patients.The DCM patients’first five-year all-cause mortality decreased significantly after continuous standardized treatment and intensive management.The mortality then plateaued in the following 10 years.Age≥70 years,LVEF≤35%,and SBP>120 mmHg were independent predict-ors of 15-year all-cause mortality.

肿瘤一体四元疗法简介及临床应用

通过继承传统中医肿瘤理论,结合当前中西医肿瘤临床治疗经验,以张林军主任医师为理事长的北京中西医慢病防治促进会全国中西医肿瘤防治专家委员会研发团队,提出了"虚、邪、郁、毒""毒结窠囊"的肿瘤中医病因病机,并结合"三结合、二选择、一结果"的中西医临床工作模式,根据中医"阴平阳秘、整体辨治"及归经引经传统理论,提出了一体四元疗法。一体四元疗法是以"一病必有一主症,一症必有一主证,一证必有一主方,一方必有一主药"为选方用药原则为主的中医肿瘤精准靶向治疗。经临床验证,在减轻肿瘤患者病痛、提高生活质量、延长生存期和抑瘤消瘤、带瘤生存方面,获得了比较满意的临床效果。

肿瘤一体四元疗法简介及临床应用

通过继承传统中医肿瘤理论,结合当前中西医肿瘤临床治疗经验,以张林军主任医师为理事长的北京中西医慢病防治促进会全国中西医肿瘤防治专家委员会研发团队,提出了"虚、邪、郁、毒""毒结窠囊"的肿瘤中医病因病机,并结合"三结合、二选择、一结果"的中西医临床工作模式,根据中医"阴平阳秘、整体辨治"及归经引经传统理论,提出了一体四元疗法。一体四元疗法是以"一病必有一主症,一症必有一主证,一证必有一主方,一方必有一主药"为选方用药原则为主的中医肿瘤精准靶向治疗。经临床验证,在减轻肿瘤患者病痛、提高生活质量、延长生存期和抑瘤消瘤、带瘤生存方面,获得了比较满意的临床效果。

Paeoniflorin,the Main Monomer Component of Paeonia lactiflora,Exhibits Anti-inflammatory Properties in Osteoarthritis Synovial Inflammation

Objective:To explore the mechanism of paeoniflorin(PF)on osteoarthritis(OA)synovial inflammation from network pharmacology to experimental pharmacology.Methods:Targets of OA were constructed by detecting the database of network database platforms(Therapeutic Target database,Drug Bank and Gene Cards),and the targets of PF were constructed by Pub Chem and Herbal Ingredients'Targets database.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis of these co-targeted genes were conducted via Database for Annotation,Visualization,and Integrated Discovery(DAVID)database,and protein-protein interaction(PPI)networks were conducted via the search tool for the retrieval of interacting genes(STRING)database.Cell counting kit-8(CCK-8)assay was performed to assess the potential toxicity of PF on human OA fibroblast-like synoviocytes(FLS),quantitative real-time polymerase chain reaction(q PCR),enzyme-linked immunosorbent assay(ELISA)and Western blot were used to verify the potential mechanism of PF in synovial inflammation.Results:Twenty-six co-targeted genes were identified.GO enrichment results showed that these co-targeted genes were most likely localized in the cytoplasm,and the biological processes mainly involved'cellular response to hypoxia''lipopolysaccharide(LPS)-mediated signaling pathway'and'positive regulation of gene expression'.KEGG pathway analysis indicated that these co-targeted genes may function through pathways associated with'hypoxia-inducible factor-1(HIF-1)signaling pathway'and'tumornecrosis factor(TNF)signaling pathway'.The PPI network showed that the top 3 hub genes were TP53,TNF,and CASP3.Molecular docking results showed that PF was well docking with TNF.CCK-8 showed no potential toxicity of 10,20 and 50μmol/L PF on human OA FLS.And PF significantly decreased the expression levels of interleukin-1β,interleukin-6,TNF-αmatrix metalloproteinase 13(MMP13),and a disintegrin and metalloproteinase with thrombospondin motifs 5(ADAMTS5)and TNF-αin LPS-induced OA FLS.Conclusion:PF exhibited potent anti-inflammatory effect in OA synovial inflammation.

Identification and analysis of key microRNAs derived from osteoarthritis synovial fluid exosomes

To the Editor:Osteoarthritis(OA)is one of the most common age-related diseases and is characterized by synovial inflammation and progressive degradation of cartilage.It was reported that one-third of 65-year-olds and 303 million people globally were affected by OA in 2017.[1,2]Although there is extensive research published on OA,its pathogenesis remains unclear and controversial.Cartilage degeneration is considered a key pathological factor that leads to disease progression.

De novo biosynthesis of liquiritin in Saccharomyces cerevisiae

Liquiritigenin(LG),isoliquiritigenin(Iso-LG),together with their respective glycoside derivatives liquiritin(LN)and isoliquiritin(Iso-LN),are the main active flavonoids of Glycyrrhiza uralensis,which is arguably the most widely used medicinal plant with enormous demand on the market,including Chinese medicine prescriptions,preparations,health care products and even food.Pharmacological studies have shown that these ingredients have broad medicinal value,including anti-cancer and antiinflammatory effects.Although the biosynthetic pathway of glycyrrhizin,a triterpenoid component from G.uralensis,has been fully analyzed,little attention has been paid to the biosynthesis of the flavonoids of this plant.To obtain the enzyme-coding genes responsible for the biosynthesis of LN,analysis and screening were carried out by combining genome and comparative transcriptome database searches of G.uralensis and homologous genes of known flavonoid biosynthesis pathways.The catalytic functions of candidate genes were determined by in vitro or in vivo characterization.This work characterized the complete biosynthetic pathway of LN and achieved the de novo biosynthesis of liquiritin in Saccharomyces cerevisiae using endogenous yeast metabolites as precursors and cofactors for the first time,which provides a possibility for the economical and sustainable production and application of G.uralensis flavonoids through synthetic biology.