[The effect of Ba Duan Jin on the balance of community-dwelling older adults: a cluster randomized control trial].

Objective: To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults. Methods: A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test. Results: A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95%CI: 2.23-3.88) points (P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95%CI: 4.03-5.37) points (P<0.001). Ba Duan Jin showed significant improvement (P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions: This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

The association between sociodemographic status and COPD and asthma mortality, DALY and YLD in southern China, 2005-2015.

BACKGROUND: Little is known about the disease burden of chronic obstructive pulmonary disease (COPD) and asthma in southern China. METHOD: We calculated the mortality, disability-adjusted life-years (DALY), years lived with disability (YLD) and years of life lost (YLL) for COPD and asthma in Guangdong province between 2005 and 2015. We examined the significance of trends of mortality, DALY, YLD and YLL rates for COPD and asthma with the Cochran-Armitage trend test. We also analyzed their association with sociodemographic factors by negative binomial models. RESULT: The age-standardized mortality, DALY, YLD and YLL rates of COPD and asthma decreased significantly in Guangdong, except for an increase of 11.3% in the age-standardized YLD rate of COPD between 2005 and 2015 (all P < 0.05). Compared with females, the respective adjusted mortality rate ratio of males was 2.11 for COPD, and 0.74 for asthma. Compared with other regions, the richest region, Pearl River Delta, had the lowest mortality, DALY, YLD and YLL rate ratios (RR) of COPD and asthma (all P < 0.05). COPD and asthma mortality, DALY, YLD and YLL rates increased substantially with age. Specifically, when compared with the 25-49 years age group, the respective adjusted DALY RR of asthma was 1.91, 2.02 and 22.21 for 0-24, 50-74 and ≥75 years age group; the respective adjusted YLD RR was 2.27, 1.33 and 7.17 for 0-24, 50-74 and ≥75 years age group. CONCLUSIONS: Disease burden of COPD and asthma decreased in Guangdong province in southern China between 2005 and 2015; however, a disproportionate burden of COPD and asthma in terms of age, sex and regions was observed. The relatively high disease burden and high rate of impaired public health from the less developed regions highlight the need for focused policy making to address the problem.

[Cancer incidence and mortality in Pearl River Delta Area, 2009-2013].

Objective: To estimate the incidence, mortality and characteristics of cancer in Pearl River Delta Area of Guangdong Province between 2009-2013. Methods: Based on five population-based cancer registration data from Guangzhou, Shenzhen, Zhongshan, Jiangmen and Sihui spanning from 2009 to 2013, along with those corresponding population data, the incidence and mortality rates were estimated by gender and age groups. Chinese standard population derived from the 2000 Population Census and Segi's standard population were used for age-standardized incidence and mortality rates. Results: Between 2009 and 2013, the crude cancer incidence rate was 262.50/100 000, 274.76/100 000 in male and 249.49/100 000 in female. After adjusting for Chinese and Segi's standard population, the age-standardized incidence rates were 225.63/100 000 and 219.88/100 000, respectively. The crude mortality rate was 175.51/100 000, 222.92/100 000 in male and 127.46/100 000 in female, respectively. After adjusting for Chinese and Segi's standard population, the age-standardized mortality rates were 116.02 /100 000 and 114.31/100 000, respectively. The incidence rates were at low levels in the population less than 40 years old, thereafter went up rapidly with age especially in male, and then reached the peak in the population aged 80 and above. As with incidence, the mortality rates kept at low levels in the population before their 50 s and then rose up steadily with age until peaking in the 85+ age group. The most common cancers were female breast cancer, lung cancer, colorectal cancer, liver cancer and nasopharyngeal cancer with descending incidence rate. Lung cancer, liver cancer, colorectal cancer, female breast cancer and nasopharyngeal cancer were the top five cancer-attributable causes of death. Conclusions: Currently, Pearl River Delta Area were faced with huge cancer burden. Lung cancer, colorectal cancer, nasopharyngeal cancer, female breast cancer and male liver cancer are predominant cancers and more efforts should be made to fight against them.

Unconventional superconductivity and electron correlations in the cobalt oxyhydrate Na0.35CoO2.yH2O from nuclear quadrupole resonance.

We report a careful 59Co nuclear quadrupolar resonance measurement on the recently discovered cobalt oxyhydrate Na0.35CoO2.yH(2)O superconductor from T=40 K down to 0.2 K. We find that in the normal state the spin-lattice relaxation rate 1/T(1) follows a Curie-Weiss type temperature (T) variation, 1/T(1)T=C/(T-theta), with theta=-42 K, suggesting two-dimensional antiferromagnetic spin correlations. Below T(c)=3.9 K, 1/T(1) decreases with no coherence peak and follows a T(n) dependence with n approximately 2.2 down to approximately 2.0 K but crosses over to a 1/T(1) proportional to T variation below T=1.4 K, which suggests non-s-wave superconductivity. The data in the superconducting state are most consistent with the existence of line nodes in the gap function.

A prospective study of the risk of an immediate adverse reaction to protamine sulfate during cardiopulmonary bypass surgery.

Protamine sulfate administration may cause life-threatening reactions. We prospectively examined the incidence of immediate adverse reaction after protamine in 243 patients who underwent cardiopulmonary bypass surgery. Twenty-six patients (10.7%) had reactions, and 1.6% had a precipitous drop in blood pressure immediately after protamine administration. Risk factors were previous exposure to protamine, diabetes, history of receiving protamine-containing insulin, and possibly vasectomy. However, neither a positive skin test nor a positive IgE ELISA for antiprotamine antibody predicted that a patient would have a reaction. C4a levels were increased in patients who had reactions as compared with age-, sex-, and cardiac disease-matched patients who did not have reactions, suggesting a role for complement in some reactions. Immediate adverse reactions to protamine are very common, and alternative therapies are urgently needed to eliminate the use of protamine.

Cryopreserved saphenous vein homografts for femoral-distal vascular reconstruction.

Cryopreserved saphenous vein homografts may serve as an alternative for femoral distal bypass conduits when suitable endogenous vein is not available. In a preliminary study, 6 patients underwent femoral distal bypass for limb salvage with cryopreserved saphenous vein with patency in 2 patients at 18 and 20 months, respectively. One graft, occluded at 14 months, was salvaged with thrombolytic therapy and percutaneous angioplasty, and is patent 7 months post intervention. Occlusion occurred in 3 grafts at 1 day, 7 days and 4 months, respectively. Reasons for reduced patency of cryopreserved grafts are related to destruction of the cellular components and fibrosis as a result of the cryopreservation and poor distal run-off present in these patients. Due to lower patency as compared to autogenous vein grafts, cryopreserved veins should be reserved for limb salvage when no autogenous vein is available for revascularization.

Experimental data acquisition and manipulation by microcomputer.

To improve experiment management, we developed a microcomputer system which automatically displays, collects, manipulates and stores data in real-time. Upon completion of all experiments, it automatically performs statistical analysis, prints graphs and stores the results. The components required to accomplish these tasks include: (1) a microprocessor and visual monitor; (2) transducers, each with preamplifier, filter and amplifier; (3) couplers from each amplifier to the computer; (4) software to direct display, manipulation, statistical analysis and storage of data; and (5) hardware to allow real-time graphic and hard copy display. The resulting system allows sampling rates up to 300 Hz and accuracy of 0.20% full scale, 0-200 mm Hg. It provides great flexibility, efficiency and reliability in data management, and thereby facilitates the organization and completion of research protocols. It simplicity of design and operation makes it easy to use, and it is extremely cost effective. We present a method of laboratory microcomputerization as a practical alternative for management of physiological experimentation.

Coronary artery bypass grafting in patients with a tracheostoma: use of a bilateral thoracotomy incision.

The performance of cardiac surgical procedures via median sternotomy in patients with a tracheostoma can present difficult problems, including stomal necrosis, mediastinitis, and inadequate operative exposure. Bilateral thoracotomy is an alternative approach in such patients. This approach separates the stoma from the operative field and provides satisfactory exposure for internal mammary artery dissection and performance of coronary artery bypass grafting.

Preoperative saphenous vein mapping for coronary artery bypass.

Saphenous vein mapping by real-time duplex ultrasound scanning allows for the confirmation of the presence of patent vein and determination of the anatomical course of the vein prior to aortocoronary bypass procedures. This technique has proven to be of value in patients whose veins are not evident by physical examination and in those whose length of conduit may be limited by previous vein stripping or thrombophlebitis.

Thrombosis of the left main coronary artery following percutaneous transluminal coronary angioplasty.

Thrombosis of the left main coronary artery complicating percutaneous transluminal coronary angioplasty has, to our knowledge, not previously been reported. This report describes iatrogenic left main thrombosis treated by operative thrombectomy and coronary artery bypass grafting.

Superconductivity at 52.5 k in the lanthanum-barium-copper-oxide system.

A superconducting transition with an onset temperature of 52.5 K has been observed under hydrostatic pressure in compounds with nominal compositions given by (La(0.9)Ba(0.1))(2) CuO4-Y. Possible causes for the high-temperature superconductivity are discussed.

Coronary artery bypass grafting in dialysis patients.

Cardiac disease continues to be a major cause of death in patients undergoing long-term hemodialysis. The results of coronary artery bypass grafting (CABG) for severe coronary artery disease in long-term hemodialysis patients have been studied in a group of 12 patients who underwent CABG between January 1979 and December 1983. Hospital mortality was 8% (1 of 12 patients). This patient died of ventricular arrhythmia. Two late deaths occurred, 1 from peritonitis in a patient undergoing long-term peritoneal hemodialysis and 1 from metastatic renal cell carcinoma. The two postoperative complications (morbidity 17%) consisted of a sternal dehiscence secondary to mediastinitis and a perioperative cerebrovascular accident. Ten of the 11 hospital survivors experienced complete relief from angina. In the other patient the angina became easier to control with medication. Combining this series of patients with those previously reported in the literature allows determination of actuarial survival in a group of 25 patients followed up for 1 to 79 months (mean, 33 months). Actuarial survival was 83% at one year, 69% at three years, and 48% at five years. This is not significantly different from the survival of long-term hemodialysis patients who have coronary disease but have not undergone CABG. It appears that CABG, when performed in long-term hemodialysis patients, is associated with an only slightly greater risk of mortality and morbidity than CABG performed in routine patients. Although CABG provides considerable symptomatic relief of angina, no statistically significant change in actuarial survival can be demonstrated.

Internal vessel occlusion: an improved technique for small vessel anastomosis.

During infragenicular bypass, internal occlusion of the distal vessel avoids unnecessary dissection and potentially damaging use of external clamps or vessel loops while improving exposure and patency. This technique is especially useful in patients with small or calcific vessels in whom distal reconstruction is necessary for limb salvage.

Left anterior descending coronary artery-right ventricle fistula complicating percutaneous transluminal angioplasty.

This case report describes the development of a false aneurysm at the site of percutaneous transluminal angioplasty of the left anterior descending coronary artery. Rupture of the aneurysm resulted in a coronary artery-right ventricle fistula.

Protamine-induced fatal anaphylaxis. Prevalence of antiprotamine immunoglobulin E antibody.

Protamine is used widely to reverse the anticoagulant effects of heparin and to delay the absorption of insulin. Although adverse reactions to protamine are reported infrequently and are usually mild, we recently observed the first fatal case of type I anaphylaxis resulting from protamine. This patient had previously been sensitized to protamine during cardiac catheterization and had high levels of protamine-specific immunoglobulin E in the serum. In a prospective study, we found that 10 of 19 diabetic patients (53%) who had received insulin containing insulin also had high levels of antiprotamine immunoglobulin E. In contrast, none of 27 nondiabetic healthy normal controls or 10 diabetics who had never received protamine or protamine-containing insulin had levels of antiprotamine immunoglobulin E over background. This study underscores the risks of routinely administering protamine to susceptible individuals and the need for alternative therapies.

Ask-Upmark kidney with contralateral renal artery fibromuscular dysplasia.

A case of Ask-Upmark kidney with coexistent contralateral renal artery fibromuscular dysplasia is presented with detailed light and electron microscopic findings. Both lesions are known to produce renin-mediated hypertension which was corrected in this patient by nephrectomy and contralateral renal artery bypass. Ask-Upmark kidney is briefly reviewed.

Survival following resection for second primary bronchogenic carcinoma.

A second resective procedure has been done on 64 patients with multiple primary bronchogenic carcinoma, and a third operation has been performed in six. Fifty-three initial resections and all repeat procedures were performed at Rush-Presbyterian-St. Luke's Medical Center. Six patients had synchronous primary cancers, and in the 58 with metachronous disease the cumulative probability of tumor-free interval was 47% at 3 years. The initial resection performed was pneumonectomy in seven, lobectomy in 40, and segmentectomy in 17 patients. At the second operation, segmental resection was done in 41, lobectomy in six, completion lobectomy in four, and completion pneumonectomy in 13 patients. At the third operation, segmentectomy was done in three, completion lobectomy in two, and completion pneumonectomy in one patient. Ten patients had a tumor of different histologic type identified at the second procedure, but all patients with three operations had the same tumor cell type in each specimen. Six patients died following the second operation (a postoperative mortality of 9.3%), but there were no deaths in the six patients undergoing three procedures. Cumulative survival following the second resection was 36% at 5 years, 22% at 10 years and 13% at 15 years. In summary, second or third surgical efforts for reappearing bronchogenic cancers are justified and have significantly prolonged survival. The use of segmental or subsegmental resective techniques have provided superior survival results.