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 ma...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.展开更多
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 thi...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.展开更多
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 di...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.展开更多
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...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.展开更多
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 a...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.展开更多
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 Apo...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.展开更多
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 hospit...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.展开更多
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 w...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.展开更多
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 treat...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.展开更多
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 va...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.展开更多
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 t...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.展开更多
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 t...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.展开更多
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 screene...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.展开更多
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...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.展开更多
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 trad...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.展开更多
<span style="font-family:Verdana;">It is estimated that between 0.3% - 0.5% of patients with cholelithiasis have biliary ileus, of this small proportion, only between</span> 1<span style="...<span style="font-family:Verdana;">It is estimated that between 0.3% - 0.5% of patients with cholelithiasis have biliary ileus, of this small proportion, only between</span> 1<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">%</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> - 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.</span></span></span>展开更多
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...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.展开更多
文摘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.
文摘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.
文摘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.
文摘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.
基金Supported by The Agency for Healthcare Research and Quality,No.R18HS02420-01
文摘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.
文摘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.
文摘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.
基金Project(07JJ3055)supported by the Natural Science Foundation of Hunan Province,China
文摘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.
文摘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.
基金supported by the Clinical and Translational Science Award from the National Center for Advancing Translational Sciences,which has been awarded to the University of Kansas Clinical and Translational Science Institute.
文摘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.
文摘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.
文摘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.
基金the National Natural Science Foundation of China, No. 30370795
文摘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.
文摘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.
文摘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.
文摘<span style="font-family:Verdana;">It is estimated that between 0.3% - 0.5% of patients with cholelithiasis have biliary ileus, of this small proportion, only between</span> 1<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">%</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> - 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.</span></span></span>
文摘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.