Prognostic value of hematological parameters in older adult patients with acute coronary syndrome undergoing coronary intervention:a single centre prospective study

BACKGROUND Cardiovascular disease is a significant contributor to the disease burden in geriatric patients.Underlying systemic inflammation is thought to be the cause of age-related changes in the bone marrow and a major risk factor for atherosclerosis.The purpose of the study was to assess the accuracy of these hematological biomarkers in predicting 30-day mortality in older patients with acute coronary syndrome(ACS).METHODS This was a prospective observational study of 601 older adult patients(age>60 years)with ACS who underwent percutaneous coronary intervention over two years(2017-2019).The relationship between baseline hematological parameters and mortality was assessed during the 30-day follow-up.Logistic regression analysis and receiver operating characteristic curve analysis were done to evaluate for diagnostic accuracy of various hematological parameters.RESULTS The mean age of presentation was 77±17 years.The mean neutrophil-lymphocyte ratio(NLR)value was 5.07±4.90 and the mean platelet-lymphocyte ratio(PLR)value was 108.65±85.82.On univariate analysis,total leucocyte count[odds ratio(OR)=0.85,P=0.021],hematocrit(OR=0.91,P=0.018),NLR(OR=1.10,P=0.001)and PLR(OR=1.05,P=0.001)were associated with mortality.On receiver operating characteristic curve analysis,NLR predicted mortality with 68.1%and PLR with 65.7%accuracy.On multivariate analysis,NLR(OR=1.096,95%CI:1.006-1.15,P=0.035)was an independent predictor of 30-day mortality.CONCLUSIONS For the risk classification of all elderly ACS patients,we highly advise using NLR rather than the total white blood cell count.

Applicability of the PRECISE-DAPT score in elderly patients with myocardial infarction

Background Elderly patients with acute coronary syndromes(ACS)are at higher risk both for ischemic and bleeding complications.Current guidelines recommend the PRECISE-DAPT score for bleeding risk stratification in this setting,but no study assessed its applicability in elderly patients.This study aimed to assess the performance of the PRECISE-DAPT score in a series of non-selected elderly patients with ACS from routine clinical practice.Methods The IFFANIAM registry included prospectively patients aged>75 years with ST segment elevation myocardial infarction(STEMI).Main outcome measured was the incidence of relevant bleeding after discharge(bleeding leading to hospital readmission,need for transfusion,intervention,stop of antithrombotic drugs or death).Bleeding risk was classified:(A)according to PRECISE-DAPT values above or not the recommended cut-off point(>25);and(B)according to the quartiles of PRECISE-DAPT values observed in the IFFANIAM series(QI:<30;Q2:30-35;Q3:36-44;Q4:>45).Results A total of 208 patients were included.Mean age was 81.9±4.5 years.Most patients(92.6%)had a PRECISE-DAPT value>25.A total of 25 patients(12.0%)had bleeding events and 49 patients(23.6%)died.No significant differences regarding the incidence of bleeding were observed according to the recommended cutt of point>25.However,a progressive increase in the incidence of bleeding was observed across PRECISE-DAPT quartiles observed in this series(P=0.038).Conclusions The vast majority of elderly patients have PRECISE-DAPT values above the recommended cut-off point for bleeding risk.Using different cut-off points could be a more rational approach for predicting bleeding risk in these complex patients.

Treatment of type 2 diabetes mellitus in the elderly

The prevalence of type 2 diabetes is expected to increase gradually with the prolongation of population aging and life expectancy. In addition to macrovascular and microvascular complications of elderly patients of diabetes mellitus, geriatric syndromes such as cognitive impairment, depression, urinary incontinence,falling and polypharmacy are also accompanied by aging. Individual functional status in the elderly shows heterogeneity so that in these patients, there are many unanswered questions about the management of diabetes treatment. The goals of diabetes treatment in elderly patients include hyperglycemia and risk factors, as in younger patients. comorbid diseases and functional limitations of individuals should be taken into consideration when setting treatment targets. Thus, treatment should be individualized. In the treatment of diabetes in vulnerable elderly patients, hypoglycemia, hypotension, and drug interactions due to multiple drug use should be avoided. Since it also affects the ability to self-care in these patients, management of other concurrent medical conditions is also important.

Knowledge, Attitudes and Beliefs about Dementia in an Urban Xhosa-Speaking Community in South Africa

Background: Dementia, a debilitating condition, requires particular attention in Southern Africa where there is a dearth of prevalence data. Population ageing and other risk factors are driving an increasing incidence of dementia. However, limited knowledge and understanding may impact the attitudes and practices towards persons with dementia. Aim: To investigate the relationship between the knowledge of dementia, its effect on the attitudes and practices toward people with dementia in an urban community setting. To determine the perceived availability of services for those with dementia, the awareness of elder abuse and care-giver burden. Methods: A descriptive, cross-sectional study was performed in Khayelitsha. An interviewer administered questionnaire was used with assistance from isiXhosa speaking translators. A sample of 100 individuals was surveyed door-to-door from both the informal and formal housing settlements, using cluster random sampling methods. Results: There was deficient knowledge about dementia, with an average accuracy of 53.44% on the knowledge test. Only 10% reported knowing what dementia was. Participants had generally tolerant views about people with dementia. No significant relationship was found between knowledge and attitudes about dementia. There was a significant difference between people who would share their house with a family member with dementia or send them to nursing homes (p = 0.03). 64% of participants knew what elder abuse was. 19% knew of an elder who had been abused;amongst the most common forms reported were being locked alone in their house and being deprived of food. Conclusions: This study showed that knowledge about dementia was limited with no relationship to attitudes of high tolerance towards people with dementia. Elder abuse was well recognized, but poorly reported. Appropriate health promotion strategies and education should be conducted and further research should be done into dementia in South Africa.

Combination of allopurinol and hyperbaric oxygen therapy:A new treatment in experimental acute necrotizing pancreatitis?

瞄准：在试验性的老鼠在生物化学、组织病理学说的变化，氧化压力，和细菌的易位(BT ) 上调查 allopurinol 和高比重的氧(HBO ) 治疗的单个、联合的效果尖锐胰腺炎(AP ) 。方法：85 只 Sprague-Dawley 老鼠在学习被包括。85 只老鼠中的十五个被用作控制(假冒，组我) 。AP 在留下经由管内牛磺胆酸盐注入被导致七十只老鼠。幸存到尖锐引起坏死胰腺炎的正式就职的老鼠被使随机化进四个组。组 II 独自收到了 saline，组 III allopurinol，加 HBO 的组 IV allopurinol 和组 V HBO。浆液淀粉酶层次，氧化压力参数， BT 和组织病理学说的分数是坚定的。结果：浆液淀粉酶层次在与组 II 相比的组 III， IV 和 V 是更低的(974 +/- 110， 384 +/- 40， 851 +/- 56，和 1664 +/- 234 U/L，分别地 P 【 0.05，为所有) 。联合揭示的二种处理选择显著地降低 median [25-75 百分位数] 组织病理学说的分数什么时候与单个政府相比(13 [12.5-15 ] 在 allopurinol 组， 9.5 [7-11.75 ] 在 HBO 组，并且 6 [4.5-7.5 ] 在联合的组， P 【 0.01 ) 。氧化压力标记在与控制相比的所有处理组显著地更好。进胰和 mes 伤寒淋巴结的细菌的易位在与组 II 相比的组 III ， IV 和 V 是更低的(54%，23%，50%对为到胰的易位的100%，并且62%，46%，58%对为到 mes 伤寒淋巴节点的易位的100%，分别地 P 【 0.05 为所有)。结论：当在试验性的老鼠 AP 独立管理了时，现在的学习证实 HBO 和 allopurinol 处理的利益。这些处理选择的联合看起来更有效地阻止胰腺的损害参数的前进。

Clinical decision support for drug related events: Moving towards better prevention

Clinical decision support(CDS) systems with automated alerts integrated into electronic medical records demonstrate efficacy for detecting medication errors(ME) and adverse drug events(ADEs). Critically ill patients are at increased risk for ME, ADEs and serious negative outcomes related to these events. Capitalizing on CDS to detect ME and prevent adverse drug related events has the potential to improve patient outcomes. The key to an effective medication safety surveillance system incorporating CDS is advancing the signals for alerts by using trajectory analyses to predict clinical events, instead of waiting for these events to occur. Additionally, incorporating cutting-edge biomarkers into alert knowledge in an effort to identify the need to adjust medication therapy portending harm will advance the current state of CDS. CDS can be taken a step further to identify drug related physiological events, which are less commonly included in surveillance systems. Predictive models for adverse events that combine patient factors with laboratory values and biomarkers are being established and these models can be the foundation for individualized CDS alerts to prevent impending ADEs.

The Relation between Apolipoprotein E4 Genotype and Vascular Dementia

Most studies investigating genetics of dementia have focused on Alzheimer’s disease, but little is known about the genetics of vascular dementia (VD). The aim of this study was to identify the association between Apolipoprotein E4 (Apo E4) genotype and VD in cerebrally infarcted patients. The study was conducted on 100 patients with cerebral infarction: 50 had VD (cases) and 50 didn’t have dementia (controls). Diagnosis of VD was based on Mini-Mental State Examination, Cambridge Cognitive Examination (CAMCOG), the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria for the diagnosis of VD (DSM-IV), Hachinski Ischemic Score, and computed tomography of the brain (CT brain). Apo E4 allele was assessed through DNA genotyping. The study showed that hypertension (p = 0.027, OR = 4.71), diabetes mellitus (p = 0.003, OR = 6.05) and Apo E4 allele (p = 0.017, OR = 13.39) were the independent risk factors of VD among studied participants. The study concluded that cerebrally infarcted patients with Apo E4 genotype are at high risk of developing VD.

Prevalence of Hyperuricemia among Hospitalized Elderly Patients and Its Association with Metabolic Syndrome

There are few data available on the prevalence of hyperuricemia among elderly and its possible association with metabolic syndrome (MetS) so the aim of this study was to assess prevalence of hyperuricemia among hospitalized elderly patients as well as to assess its association with MetS. Cross sectional data from 200 hospitalized elderly patients were analyzed and the results were as follows: the prevalence of hyperuricemia was 21.0% in elderly men and 15.1% in elderly women. Multivariate logistic regression analysis revealed that BMI ≥ 30 (p = 0.031, OR = 1.1), hypertension (p = 0.019, OR = 1.8), high triglycerides level (p = 0.018, OR = 2.9) and hyperuricemia (p = 0.023, OR = 3.7) were independently associated with MetS. The study concluded that the prevalence of hyperuricemia among hospitalized elderly patients was 21.0% in elderly men and 15.1% in elderly women. There was an independent association between hyperuricemia and metabolic syndrome.

肥胖妇女减肥时运动训练强度对脂肪组织激素敏感脂酶基因表达的影响(英文)

激素敏感脂酶(HSL)是一种调节脂肪组织分解的酶,能在运动引发的脂肪组织代谢中的慢性变化发挥重要作用。本研究的目的是确定肥胖妇女减肥时,有氧运动强度是否对腹部HSL基因表达有影响。方法:30位女性(BMI=33.0±0.7 kg/m^2,年龄58±1岁)分3组各完成为期20周的干预实验:热量限制(n=8):热量限制加中等强度运动(心率储备45%-50%,每周3天,n=9);热量限制加高强度运动(心率储备70%-75%,每周3天,n=13)。各组规定的能量赤字相同:营养不良(仅热量限制状态时每周2800千卡),或者营养不良(每周2400千卡)加运动(每周400千卡)。测量身体组成和最大需氧量,在实验前之后分别采集腹部皮下脂肪组织样本,用实时RT-PCR测量脂肪组织HSL基因表达。结果:3种干预方式在减少体重、脂肪量、脂肪百分比以及腰部脂肪方面均效果显著(p【0.01)。3种方式均未改变绝对最大耗氧量,但都增加了相对最大耗氧量(p【0 05到p【0.01)。同干预实验前相比,只有热量限制加高强度运动使脂肪组织HSL基因表达显著提高(p【0.01),这组的HSL基因表达与另外两组有显著差异(只有热量限制p【0.05,热量限制加中等强度运动p【0.01)。整体来看,脂肪组织HSL基因表达的变化与绝对最大耗氧量(r=0.55,p【0.01)和相对最大耗氧量(r=0.32,p=0.09)成正相关。结论:这些结果支持肥胖妇女减肥过程中有氧运动强度对其脂肪组织代谢中HSL通路有潜在影响。

Magnetic iron oxide nanoparticles carrying PTEN gene to reverse cisplatin-resistance of A549/CDDP cell lines

To evaluate the feasibility of using magnetic iron oxide nanoparticle as wild PTEN gene carrier for transfection in vitro to reverse cisplatin-resistance of A549/CDDP cells, A549/CDDP cells were transfected with the wild PTEN gene expression plasmid (pGFP-PTEN) by magnetic iron nanoparticle and lipo2000. The transfection efficiency was detected by fluorescence microscope and flow cytometer. The expression levels of PTEN mRNA and protein were detected by reverse transcription polymerase chain reaction (RT-PCR) and immunocytochemistry analysis. The effect of PTEN transfection on cell cycle enhances the sensitivity of A549/CDDP to cisplatin and nanoparticle-mediated transfection has a higher efficiency than that of the liposome-mediated group. The apoptosis level was up-regulated in PTEN transfection group. The magnetic iron oxide nanoparticle could be used as one of the ideal gene carriers for PTEN gene delivery in vitro. PTEN can be an effective target for reversing cisplatin-resistance in lung cancer.

Health Literacy: Prevalence among Elderly Care Givers and Its Impact on the Frequency of Elderly Hospitalization and Elderly Health Related Quality of Life

Caring for the elderly is an extremely lonely and frustrating vigil. The care giver has the responsibility of caring for an elderly one to the myriad decisions on different topics such as diabetes care or cancer treatment. Care givers with low levels of health literacy have less health knowledge, worse management of chronic disease and lower use of preventive services. This study was conducted to determine the prevalence of health literacy among elderly care givers and its impact on the frequency of elderly hospitalization and elderly health related quality of life (QOL). The study was carried out on 200 elderly patients and their corresponding care givers. Rapid Estimate of Adult Literacy in Medicine (REALM) and Newest Vital Sign (NVS) were used to assess caregivers’ health literacy. Assessment of the elderly health related QOL was done by the use of short form-12 health survey (SF-12). The results were as followed, in elderly patients;92 were males and 108 were females. The mean elderly age was 69.4 ± 8.8. The mean age of caregivers was 42.1 ± 12.9 years. The prevalence of inadequate health literacy among elderly caregivers was 75.0%. There were significant associations between care givers, health literacy and the frequency of elderly hospitalization (p = 0.001), duration of hospital stay (p = 0.009), and the elderly health related QOL (p = 0.001). The study concluded that inadequate health literacy is a problem among elderly care givers in Egypt. Healthcare professionals must be made aware of this problem, which is to provide simplified educational materials to elderly care givers to maximize elderly care.

Risk stratification of patients who present with chest pain and have normal troponins using a machine learning model

BACKGROUND Risk stratification tools exist for patients presenting with chest pain to the emergency room and have achieved the recommended negative predictive value(NPV)of 99%.However,due to low positive predictive value(PPV),current stratification tools result in unwarranted investigations such as serial laboratory tests and cardiac stress tests(CSTs).AIM To create a machine learning model(MLM)for risk stratification of chest pain with a better PPV.METHODS This retrospective cohort study used de-identified hospital data from January 2016 until November 2021.Inclusion criteria were patients aged>21 years who presented to the ER,had at least two serum troponins measured,were subsequently admitted to the hospital,and had a CST within 4 d of presentation.Exclusion criteria were elevated troponin value(>0.05 ng/mL)and missing values for body mass index.The primary outcome was abnormal CST.Demographics,coronary artery disease(CAD)history,hypertension,hyperlipidemia,diabetes mellitus,chronic kidney disease,obesity,and smoking were evaluated as potential risk factors for abnormal CST.Patients were also categorized into a high-risk group(CAD history or more than two risk factors)and a low-risk group(all other patients)for comparison.Bivariate analysis was performed using a χ^(2) test or Fisher’s exact test.Age was compared by t test.Binomial regression(BR),random forest,and XGBoost MLMs were used for prediction.Bootstrapping was used for the internal validation of prediction models.BR was also used for inference.Alpha criterion was set at 0.05 for all statistical tests.R software was used for statistical analysis.RESULTS The final cohort of the study included 2328 patients,of which 245(10.52%)patients had abnormal CST.When adjusted for covariates in the BR model,male sex[risk ratio(RR)=1.52,95%confidence interval(CI):1.2-1.94,P<0.001],CAD history(RR=4.46,95%CI:3.08-6.72,P<0.001),and hyperlipidemia(RR=3.87,95%CI:2.12-8.12,P<0.001)remained statistically significant.Incidence of abnormal CST was 12.2%in the high-risk group and 2.3%in the low-risk group(RR=5.31,95%CI:2.75-10.24,P<0.001).The XGBoost model had the best PPV of 24.33%,with an NPV of 91.34%for abnormal CST.CONCLUSION The XGBoost MLM achieved a PPV of 24.33%for an abnormal CST,which is better than current stratification tools(13.00%-17.50%).This highlights the beneficial potential of MLMs in clinical decision-making.

Prevalence of Sarcopenia among Nursing Home Older Residents in Cairo, Egypt

Sarcopenia is highly prevalent in community dwelling older adults in many countries;however, the prevalence of sarcopenia in nursing home older residents is not well characterized. The aim of this study is to assess the prevalence of sarcopenia in nursing home older residents in Cairo. Cross sectional study was performed among 357 nursing home residents in Cairo. The European Working Group on Sarcopenia in Older People (EWGSOP) recommendation was used for diagnosing sarcopenia. The study showed that the prevalence of sarcopenia in nursing home older residents in Cairo was 17.7%, 22.2% in elderly men and 14.4% in elderly women. Age, underweight and lack of physical activity were found to be associated with sarcopenia among studied participants. The study concluded that sarcopenia is an emerging health problem in nursing home older residents in Cairo.

Erratum to “Prevalence of Sarcopenia among Nursing Home Older Residents in Cairo, Egypt” [Advances in Aging Research 3 (2014) 118-123]

Sarcopenia is highly prevalent in community dwelling older adults in many countries;however, the prevalence of sarcopenia in nursing home older residents is not well characterized. The aim of this study is to assess the prevalence of sarcopenia in nursing home older residents in Cairo. Cross sectional study was performed among 150 nursing homes residents in Cairo. The European Working Group on Sarcopenia in Older People (EWGSOP) recommendation was used for diagnosing sarcopenia. The study showed that the prevalence of sarcopenia in nursing home older residents in Cairo was 17.3%;22.6% in elderly men and 13.6% in elderly women. Age, underweight and lack of physical activity were found to be associated with sarcopenia among studied participants. The study concluded that sarcopenia is an emerging health problem in nursing home older residents in Cairo.

Ferritin,heavy polypeptide 1 interacts with fragile X-related protein 1

Fragile X-related protein 1（FXR1P） is a member of the FXR gene family,which also includes fragile X mental retardation protein and fragile X-related protein 2（FXR2P）.To understand the functions of FXR1P,we screened FXR1P-interacting proteins using a yeast two-hybrid system.FXR1P was fused to pGBKT7 and used as the bait to screen a human fetal brain cDNA library.This screening revealed 10 FXR1P-interacting proteins including FTH1.FTH1 encodes Homo sapiens ferritin,heavy polypeptide 1.The interaction between FXR1P and FTH1 was confirmed by retesting in yeast using both a β-galactosidase assay and growth studies on selective media.A co-immunoprecipitation assay in mammalian cells further confirmed the FXR1P/FTH1 interaction.Moreover,the results revealed that FTH1 colocalized with FXR1P in the cytoplasm around the nucleus in mammalian cells.The present findings suggest that FXR1P plays an important role in iron metabolism in the brain by interacting with FTH1.This provides clues for elucidating the relationship between FXR1P function and fragile X syndrome.

Cognitive and Functional Profiles in Mild-to-Moderate Alzheimer’s Disease and Mild Cognitive Impairment Compared to Healthy Elderly

Background: Amnestic mild cognitive impairment (aMCI) and mild-to-moderate Alzheimer’s disease (AD) are clinically distinct but impact cognitive and functional ability similarly. Comprehensive assessment of cognitive and functional deficits may prove useful in informing differential diagnosis in early stages of dementia and in informing endpoint selection in therapeutic AD trials. Objective: The objective of this study was to characterize patterns of cognitive and functional impairment in aMCI and mild-to-moderate AD subjects compared to cognitively intact healthy elderly (HE). Methods: Thirty-one healthy elderly, 20 aMCI and 19 AD participants were administered a cognitive test battery that included the ADAS-Cog and functional assessments. Z-scores were calculated for all endpoints based on the HE reference group. Results: Cognitive deficits were observed in AD and aMCI participants relative to the referent group. On average, aMCI participants performed 1 - 2 standard deviations below HE on cognitive tests, and AD participants performed 2 - 3 standard deviations below HE. Domain-specific functional deficits among AD participants (z- score -0.4 to -6.4) were consistently greater than those of aMCI participants (z-score 0 to -1.7). Conclusion: This study provides further support for comprehensive assessment and monitoring of cognitive and functional domain scores in the diagnosis and treatment of aMCI and mild AD. Domain-specific cognitive scores may be more useful than composite scores in characterizing impairment and decline. Measuring domains such as attention, processing speed and executive function may increase the sensitivity of detecting disease progression and therapeutic effects, particularly in mild-moderate AD where memory decline may be too slow to detect drug effects during a typical clinical trial.

Over-ground walking in Parkinson’s disease: A pilot study utilizing a portable metabolic analyzer

Alterations in gait biomechanics are common during early stages of Parkinson’s disease (PD), potentially elevating energy requirements of walking and leading to impaired economy of gait. Although gait economy is traditionally assessed during treadmill walking with simultaneous ox-ygen consumption (VO2) monitoring, treadmill gait mechanics, particularly in PD, may be different from over-ground walking mechanics, possibly providing a distorted picture of true gait economy. Currently, no studies have directly examined the energy cost of over-ground walking in PD patients. The purpose of this study was to test the feasibility of measuring energy expenditure during over-ground walking in mild to moderate PD using portable gas exchange monitoring technology. Additionally, we sought to determine whether energy expenditure, as assessed through VO2 measures, related to disease severity for PD. Seventeen PD patients underwent separate 6-minute walk (6MW) tests both with and without the COSMED K4b2 portable oxygen monitoring system. Gait economy was calculated as measured VO2 during 6MW divided by the predicted VO2 for non-PD age-matched subjects, according to a standard estimation equation utilizing ground speed. Distance covered during the 6MW with the portable system (420 ± 12 meters) was highly correlated (r = 0.96, p 2 peak for normal floor walking, and show impaired gait economy relative to prediction equations. Interestingly, the degree of elevated energy expenditure during gait did not relate to disease severity.

Gastric Outlet Obstruction by a Hydrocholecyst. A Very Rare Variant of Bouveret Syndrome: A Case Report

It is estimated that between 0.3% - 0.5% of patients with cholelithiasis have biliary ileus, of this small proportion, only between 1% - 3% is complicated by the syndrome described in 1896 by Leon Bouveret. Bouveret syndrome refers to the obstruction of the gastric outlet tract secondary to the passage and impactation of a gallstone in the duodenum, through a cholecystoduodenal fistula. It is most common in women, between the ages of 74 - 77 and is clinically characterized by pain, bloating, incoercible vomiting and anorexia.

Teaching Reform and Practice of Functional Experiment Based on the Cultivation of Excellent Medical Talents

In order to cultivate excellent clinical medical talents with a solid foundation, strong literacy, refined skills, excellent communication abilities, innovative thinking, and a strong focus on practicality, functional experiments have undergone a series of reforms in areas such as constructing new curriculum systems, improving teaching content, updating teaching equipment, introducing new teaching models, and enhancing teaching evaluation systems.