Incidence and associated factors for single and recurrent falls among the elderly in an urban community of Beijing.

OBJECTIVE: To investigate the incidence of falls and recurrent falls, and explore associated factors for single and recurrent falls among urban community-dwelling elderly in Beijing. METHODS: A cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district, Beijing in 2009. Data regarding the incidence of fall and recurrent falls in the previous year, as well as associated factors were collected from the elderly through face-to-face interviews. RESULTS: The incidence of falls and recurrent falls was 17.8% and 6.1%, respectively, and it increased with age (χ2for trend=21.06, 19.20, P=0.001, 0.002). Binary logistic stepwise regression analysis showed that age (OR=2.20), living alone (OR=4.67) and gait disturbance (OR=1.27) were risk factors, while housing with elevators (OR=0.35), appropriate width/height of stair steps (OR=0.78), sufficient lighting for stairway (OR=0.45) and regular exercise (OR=0.12) could lower the risk for single fall; factors such as low monthly family income (OR=1.39), poor vision (OR=1.83), low physical ability (OR=4.47), abnormal static balance (OR=2.48), and fear of falls(OR=2.23) were risk factors, while appropriate width/height of stair steps (OR=0.49) and easiness of access to daily supplies (OR=0.41) were protective factors for recurrent falls. CONCLUSION: The incidence of falls in community-dwelling elderly people in Beijing is common, and falls and their related injuries have been associated with both intrinsic and extrinsic factors.

Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery.

BACKGROUND: Intracranial hemorrhage after spinal surgery is a rare and devastating complication. AIM: To investigate the economic burden, clinical characteristics, risk factors, and mechanisms of intracranial hemorrhage after spinal surgery. METHODS: A retrospective cohort study was conducted from January 1, 2015, to December 31, 2022. Patients aged ≥ 18 years, who had undergone spinal surgery were included. Intracranial hemorrhage patients were selected after spinal surgery during hospitalization. Based on the type of spinal surgery, patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage. The patients' pre-, intra-, and post-operative data and clinical manifestations were recorded. RESULTS: A total of 24472 patients underwent spinal surgery. Six patients (3 males and 3 females, average age 71.3 years) developed intracranial hemorrhage after posterior spinal fusion procedures, with an incidence of 0.025% (6/24472). The prevailing type of intracranial hemorrhage was cerebellar hemorrhage. Two patients had a poor clinical outcome. Based on the type of surgery, 30 control patients were randomly matched in 1:5 ratio. The intracranial hemorrhage group showed significant differences compared with the control group with regard to age (71.33 ± 7.45 years vs 58.39 ± 8.07 years, P = 0.001), previous history of cerebrovascular disease (50% vs 6.7%, P = 0.024), spinal dura mater injury (50% vs 3.3%, P = 0.010), hospital expenses (RMB 242119.1 ± 87610.0 vs RMB 96290.7 ± 32029.9, P = 0.009), and discharge activity daily living score (40.00 ± 25.88 vs 75.40 ± 18.29, P = 0.019). CONCLUSION: The incidence of intracranial hemorrhage after spinal surgery was extremely low, with poor clinical outcomes. Patient age, previous stroke history, and dura mater damage were possible risk factors. It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.

Intrapleural delivery of MSCs attenuates acute lung injury by paracrine/endocrine mechanism.

Two different repair mechanisms of mesenchymal stem cells (MSCs) are suggested to participate in the repair of acute lung injury (ALI): (i) Cell engraftment mechanism, (ii) Paracrine/endocrine mechanism. However, the exact roles they play in the repair remain unclear. The aim of the study was to evaluate the role of paracrine/endocrine mechanism using a novel intrapleural delivery method of MSCs. Either 1 × 10(6) MSCs in 300 µl of PBS or 300 µl PBS alone were intrapleurally injected into rats with endotoxin-induced ALI. On days 1, 3 or 7 after injections, samples of lung tissues and bronchoalveolar lavage fluid (BALF) were collected from each rat for assessment of lung injury, biochemical analysis and histology. The distribution of MSCs was also traced by labelling the cells with 4',6-diamidino-2-phenylindole dihydrochloride (DAPI). MSCs intrapleural injection significantly improved LPS-induced lung histopathology compared with PBS-treated group at day 3. There was also a significant decrease in total cell counts and protein concentration in BALF at day 7 in the MSCs -treated rats compared to PBS control group. Tracking the DAPI-marked MSCs showed that there were no exotic MSCs in the lung parenchyma. MSCs administration resulted in a down-regulation of pro-inflammatory response to endotoxin by reducing TNF-α both in the BALF and in the lung, while up-regulating the anti-inflammatory cytokine IL-10 in the lung. In conclusion, treatment with intrapleural MSCs administration markedly attenuates the severity of endotoxin-induced ALI. This role is mediated by paracrine/endocrine repair mechanism of MSCs rather than by the cell engraftment mechanism.

Intrapleural delivery of mesenchymal stem cells: a novel potential treatment for pleural diseases.

AIM: To develop a method to deliver mesenchymal stem cells (MSCs) into the pleural cavity for the treatment of pleural diseases. METHODS: MSCs were isolated from rat bone marrow of rats and labeled with 4',6-diamidino-2-phenylindole dihydrochloride (DAPI) or green fluorescent protein (GFP) using a lentiviral vector. Eighteen Sprague-Dawley (SD) rats were inoculated intrapleurally with 1×10(6) MSCs-DAPI. The distribution of the fluorescent cells was observed using fluorescent microscopy for the following 30 d. Another 12 rats inoculated intrapleurally with 1×10(6) MSCs-GFP were observed for 14 d. RESULTS: The isolated cells were typical MSC phenotypes and could differentiate into adipocytes, osteoblasts, and chondroblasts in vitro. Microscopic analysis revealed that the labeled cells adhered to the surface of the pleural cavity. The highest number of the labeled cells was found to be adhered to all specimens from the mediastinal pleura, but no labeled cells were detected in the lung parenchyma or other tissues/organs, such as the liver, kidney, spleen, and mesenterium. Incidentally, stomas were found in the mediastinal pleura. The recovered MSCs-GFP from the pleural cavity retained their ability to adhere and proliferate. CONCLUSION: We have established a novel method for intrapleural delivery of MSCs. The distribution of intrapleurally delivered MSCs was found to be limited to the pleurae and the pleural cavity, thereby providing us with a new approach to further investigation of the therapeutic roles of MSCs in pleural diseases.

Prevalence and related factors of falls among the elderly in an urban community of Beijing.

OBJECTIVE: To understand the prevalence, consequences and risk factors of falls among urban community-dwelling elderly in Beijing. METHODS: A cross-sectional study was conducted in Longtan Community, Beijing. A total of 1512 individuals aged 60 years or over were selected by stratified cluster sampling. Data regarding the frequency of falls in the previous year, as well as circumstances, consequence and related factors of falls were collected from the elderly through face-to-face interviews with questionnaires in their home. RESULTS: The prevalence of falls was 18.0% on the average among 1512 participants, higher in women (20.1%) than in men (14.9%) (P = 0.006), and increased with age (chi2(for trend) = 10.37, P = 0.001). The total rate of falls-induced injuries among the fallers was 37.7%. Falls usually resulted in soft-tissues bruises (58.7%), fear of repeated episodes of falls (58.8%), loss of independence and confidence in movement (35.7%) and even in hip fracture. In addition to the burden of medical care, falls also generated a big economic burden. Occurrence of falls was significantly associated with both intrinsic and extrinsic factors. The related factors of falls in the elderly included age > or = 60-70 years, femininity, less physical activities, fear of future falls, living alone, severely impaired vision, health problem-impacted activities of daily living, chronic diseases (diabetes, hypertension, postural hypotension, stroke sequela, cataract, arthritis, dementia and depression), medications (psychoactive, anti-diabetic), gait imbalance, high bed and faintly-lighted stairway. CONCLUSION: The prevalence of falls among urban community-dwelling elderly in Beijing is closely associated with significant associated with intrinsic and extrinsic factors. Efforts to prevent falls in the elderly should be made at community level.

Study of large medical equipment allocation in Xuzhou.

OBJECTIVE: To investigate the allocation and management of large medical equipment (LME) in Xuzhou, Jiangsu Province, China, in order to make the best use of LME to meet the medical needs of local people. METHODS: The research collected data from all hospitals that have LME in Xuzhou using questionnaire; 38 (97.4%) hospitals returned the questionnaire. RESULTS: In Xuzhou, there are a total of 71 pieces of LME, each serving 126 600 people in an area of 163 km(2). Sixty-two percent of them are allocated in urban areas, with Gini coefficient at 0.52, indicating imbalance and biased allocation of LME. CONCLUSION: The allocation of LME in Xuzhou is out of control and unfairly allocated.

[Physiologic response to proportional assist ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease].

OBJECTIVE: To investigate the effect of different assist levels during proportional assist ventilation (PAV) on patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). METHODS: Nine patients with acute exacerbation of COPD received different levels of assist ventilation during PAV. The change of inspiratory muscle effort and breathing pattern of the patients were observed. RESULTS: (1) The average tidal volume (V(T)), minute ventilation (V.(E)) and respiratory frequency (RR) were slightly higher during PAV, as compared to spontaneous breathing (SB). The change of breathing pattern of the patients was not significant at different assist levels during PAV. (2) The transdiaphragmatic pressure (Pdi), the pressure-time product (PTP) and work of breathing (Wi) reduced significantly during PAV as compared with SB (differently reduced 8.36 cm H2O, 11.49 cm H2O.s(-1).L(-1) and 0.53 J/L). The change in Pdi, PTP and Wi was small among different levels during PAV. (3) Dyspnea was improved during PAV. CONCLUSIONS: The present study confirms the feasibility of noninvasive ventilation PAV in treating patients with acute exacerbation of COPD. Based on the patient's assessment, the ventilatory support level which the patients could comfortably tolerate was (57 +/- 11)%. noninvasive ventilation PAV set at a level of comfort determined by the patient can unload inspiratory muscles; at the comfortable level of ventilatory support, Wi, Pdi and PTP decreased by 57%, 72% and 65% respectively. It also improved breathing pattern and dypnea.

[A prospective study on recurrent falls and related factors in elderly from the urban communities in Beijing].

OBJECTIVE: To investigate the incidence and risk factors for recurrent falls in community-dwelling elderly in Beijing. METHODS: A cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district,Beijing in 2009. Data on recurrent falls within the past 12 months were collected through face-to-face interview, with both single factor analysis and logistic regression analysis used to explore the related factors on recurrent falls in the elderly. RESULTS: The incidence of recurrent falls among 472 older adults was 6.1% (29) within the past 12 months. Results from logistic regression analysis showed that factors as higher family monthly income(OR = 1.39, 95% CI:0.67-2.16), afraid of being fallen(OR = 2.23, 95% CI:1.47-3.85)and abnormal static balance(OR = 2.48, 95% CI:1.84-4.05)were risk factors, while bench height in the surrounding environment(OR = 0.49, 95% CI:0.21-1.12)and easiness of access to daily supplies (OR = 0.41, 95%CI:0.14-1.16)were protective factors for recurrent falls. CONCLUSION: The incidence of recurrent falls among the elderly from the communities in Beijing was high. Since falls could be caused by various factors, intervention should be targeting on risk factors in a multi-dimensional way.

[Study on severity, status of awareness and therapy regarding urinary incontinence in elderly people from rural areas in Jixian county, Tianjin].

OBJECTIVE: To understand the prevalence of urinary incontinence (UI) and its severity in rural elderly people, as well as to investigate the awareness on UI in the elderly and health-care service seeking behavior. METHODS: A cross-sectional study was carried out in two townships of Jixian county, Tianjin. A total of 743 people aged 60 years and over were selected under cluster sampling method. All the information was collected with a standardized structured questionnaire by face-to-face interview. Prevalence, severity, the awareness on UI in the elderly and their utilization of health-care service for its diagnosis and treatment were analyzed. RESULTS: Prevalence of UI was 33.38% among people aged 60 years and over in two townships of Jixian, higher in females than in males (43.15% vs. 22.75%, χ(2) = 34.70, P < 0.0001). The prevalence rates of UI in 60- age group, 65- age group, 70- age group, 75- age group, 80- age group, 85 - 95 age group were 28.64%, 32.12%, 34.08%, 35.45%, 47.76%, 30.00%, respectively, and increased with age (for trend χ(2) = 2.19, P = 0.029). Stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were mild, while mixed urinary incontinence (MUI) were mainly moderate. The differences of severity of SUI, UUI, MUI between men and women did not show statistical significance (all P > 0.05). In 743 elderly people, more than half of the respondents had never heard of UI (50.20%, 373/743) and only 170(22.88%) elderly people considered UI as a disease. 630 (84.79%) and 665 (89.50%) elderly people in our research group did not know that such condition was curable and preventable. In 248 elderly people with UI, only 12 (4.84%) of them ever seeking community health-care services in the health-care centers or hospitals. For the ones who did visit the centers, the purpose was only to seek for drug treatment. CONCLUSION: Prevalence of UI appeared to be high among the elderly people in rural areas of Jixian county. Most of the elderly people were lack of knowledge about UI that hindered them from seeking for diagnosis and treatment in the clinics, plus the treatment program for UI was not standardized. Knowledge on UI and health care seeking behavior should be popularized and strengthened among elderly people living in the rural areas.

[Study on the relationship between chronic diseases and falls in the elderly].

OBJECTIVE: To explore the risk factors on chronic diseases related to falls in the urban-community elderly and to provide evidence for developing a three-tier program for prevention. METHODS: A cross-sectional study was conducted in one community of Beijing. People aged 60 years and over were selected, using a stratified cluster sampling method, and data on falls within the past 12 months and falls-related chronic diseases were collected through face-to-face interview. RESULTS: The incidence of falls was 18.0% within one year among the 1512 interviewees. Seven factors showed statistical significances through univariate analysis including diabetes mellitus (OR = 1.62), postural hypotension (OR = 1.84), hypertension (OR = 1.48), cerebral infarction (OR = 1.98), cataract (OR = 1.56), osteoarthritis (OR = 1.50), dementia (OR = 5.34) and depression (OR = 4.61). Data from multivariate logistic regression analysis showed that the risk factors for falls would include dementia (OR = 4.82), depression (OR = 4.27), postural hypotension (OR = 1.92) and suffering from several kinds of chronic diseases etc. CONCLUSION: The incidence of falls in an urban elderly community of Beijing was considered to be high. The risk of falls was higher among persons suffering from dementia and depression and having more than two kinds of chronic disease. The chances of falls would parallel the increase of several kinds of chronic diseases among the elderly, suggesting that measures should be actively taken to prevent from falls.