Comprehensive geriatric assessment of older patients with renal disease: a cross-sectional survey.

Multidimensional health function impairments are common in older patients with chronic kidney disease (CKD). The purpose of this study was to explore whether the risk or severity of geriatric syndrome increased with a decline in renal function. This survey was conducted for CKD patients aged ≥ 60 years and hospitalized at West China Hospital of Sichuan University (Center of Gerontology and Geriatrics, Nephrology, and Endocrinology) and Chengdu Kangfu Kidney Disease Hospital from September 01, 2013 to June 30, 2014. Patients underwent multidimensional individualized assessments by trained doctors. Logistic regression analysis found that the risk of assisted walking (P = 0.001) and urinary incontinence (P = 0.039) increased with a decline in renal function. Regression analysis revealed that the scores of activities of daily living (P = 0.024), nutritional status (P = 0.000), total social support (P = 0.014), and objective support (P = 0.000) decreased with a decline in renal function.

Assessment of palmitic acid toxicity to animal hearts and other major organs based on acute toxicity, network pharmacology, and molecular docking.

Palmitic acid is a common ingredient in many foods and traditional Chinese medicines. However, modern pharmacological experiments have shown that palmitic acid has toxic side effects. It can damage glomeruli, cardiomyocytes, and hepatocytes, as well as promote the growth of lung cancer cells. Despite this, there are few reports evaluating the safety of palmitic acid through animal experiments, and the mechanism of palmitic acid toxicity remains unclear. Clarifying the adverse reactions and mechanisms of palmitic acid in animal hearts and other major organs is of great significance for ensuring the safety of clinical application. Therefore, this study records an acute toxicity experiment on palmitic acid in a mouse model, and the observation of pathological changes in the heart, liver, lungs, and kidneys. It is found that palmitic acid had toxic and side effects on animal heart. Then the key targets of palmitic acid in regulating cardiac toxicity were screened using network pharmacology, and a "component-target-cardiotoxicity" network diagram and PPI network were constructed. The mechanisms regulating cardiotoxicity were explored using KEGG signal pathway and GO biological process enrichment analyses. Molecular docking models were used for verification. The results showed that the maximum dose of palmitic acid had low toxicity in the hearts of mice. The mechanism of cardiotoxicity of palmitic acid involves multiple targets, biological processes, and signaling pathways. Palmitic acid can induce steatosis in hepatocytes, and regulate cancer cells. This study preliminarily evaluated the safety of palmitic acid and provided a scientific basis for its safe application.

Do Fluctuations in Environmental Regulations Inhibit Investment: Evidence from China.

The trade-off between the goals of promoting economic growth and protecting the ecological environment makes it possible for the government to constantly adjust the intensity of environmental regulation, leading to sharp fluctuations in environmental regulation in the short term. Fluctuations in environmental regulations may trigger concerns among firms and change their investment decisions. The theoretical model of corporate investment decision is used to analyze the inhibitory effect of environmental regulation fluctuations on investment through expected profits, which is empirically validated in this study by data from 255 Chinese prefecture-level cities. The results indicate that environmental regulation fluctuations reduce investors' expected profits, which in turn inhibit investment. The heterogeneity analysis shows that environmental regulation fluctuations have no significant effect on investment in cities that are geographically closer to the provincial capital, while a greater inhibitory effect of it is revealed in other cities located further away. Therefore, this inhibitory effect should be weakened by reducing the intervention of administrative orders in environmental regulatory behavior, establishing environmental regulatory supervisory agencies, and taking into full consideration the public's response to fluctuations in environmental regulation. This study can provide policy implications for optimizing government environmental regulation.

Muscle Energy Technique plus Neurac Method in Stroke Patients with Hemiplegia Complicated by Diabetes Mellitus and Assessment of Quality of Life.

Objective: To analyze the role of muscle energy technique (MET) plus Neurac method in stroke patients with hemiplegia complicated by diabetes mellitus and the impact on quality of life. Methods: From January 2021 to December 2021, 100 stroke patients with hemiplegia complicated by diabetes mellitus treated in our institution and assessed for eligibility were recruited and randomly assigned (1 : 3) via the random sampling method to either the conventional rehabilitation group or the experimental group. The patients in the experimental group were randomized (1 : 1 : 1) into either the MET group (receives MET), the Neurac group (receives Neurac), or the joint group (receives MET plus Neurac). The primary endpoint is the clinical efficacy, and the second endpoint is the quality of life. Results: The eligible patients had similar pretreatment Barthel index scores, Visual Analogue Scale (VAS) scores, Berg balance scale (BBS) scores, Tinetti scores, Fugl-Meyer scores, and quality of life (QoL) scores (P > 0.05). The treatment herein achieved significant improvements in Barthel index scores, VAS scores (2.71 ± 0.28), BBS scores, Tinetti scores, Fugl-Meyer scores, and QoL scores (99.67 ± 10.62), and MET plus Neurac method obtained the best results versus both the conventional rehabilitation and monotherapy of either MET or Neurac (P < 0.05). Conclusion: Neurac method plus MET improves the independent mobility of stroke patients with hemiplegia and diabetes, relieves pain, enhances balance and stability, mitigates limb dysfunction, and boosts patients' quality of life, so it is worthy of clinical application.

Clinical characteristics and a decision tree model to predict death outcome in severe COVID-19 patients.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) spreads rapidly among people and causes a pandemic. It is of great clinical significance to identify COVID-19 patients with high risk of death. METHODS: A total of 2169 adult COVID-19 patients were enrolled from Wuhan, China, from February 10th to April 15th, 2020. Difference analyses of medical records were performed between severe and non-severe groups, as well as between survivors and non-survivors. In addition, we developed a decision tree model to predict death outcome in severe patients. RESULTS: Of the 2169 COVID-19 patients, the median age was 61 years and male patients accounted for 48%. A total of 646 patients were diagnosed as severe illness, and 75 patients died. An older median age and a higher proportion of male patients were found in severe group or non-survivors compared to their counterparts. Significant differences in clinical characteristics and laboratory examinations were found between severe and non-severe groups, as well as between survivors and non-survivors. A decision tree, including three biomarkers, neutrophil-to-lymphocyte ratio, C-reactive protein and lactic dehydrogenase, was developed to predict death outcome in severe patients. This model performed well both in training and test datasets. The accuracy of this model were 0.98 in both datasets. CONCLUSION: We performed a comprehensive analysis of COVID-19 patients from the outbreak in Wuhan, China, and proposed a simple and clinically operable decision tree to help clinicians rapidly identify COVID-19 patients at high risk of death, to whom priority treatment and intensive care should be given.

Predictive Value of Thyroid Hormones for Incident Hyperuricemia in Euthyroid Subjects: The Tianjin Chronic Low-Grade Systemic Inflammation and Health Cohort Study.

OBJECTIVE: Thyroid hormones (THs) play an important role in both serum uric acid (SUA) excretion and purine nucleotide metabolism. Past research mainly focused on the relationships between thyroid dysfunction and hyperuricemia. Although most subjects at risk for hyperuricemia are euthyroid, few studies have investigated the predictive values of THs on incident hyperuricemia in euthyroid adults. This study aimed to examine how free triiodothyronine, thyroxine, and thyroid-stimulating hormone are related to incident hyperuricemia in euthyroid subjects. METHODS: Participants without baseline hyperuricemia were recruited from Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study and followed up for ∼6 years. Thyroid function was determined by chemiluminescence immunoassay methods. Hyperuricemia was defined as SUA ≥416.5 µmol/L for males and ≥357.0 µmol/L for females. Thyroid function and SUA were assessed yearly during follow-up. Adjusted Cox proportional hazards regression models were used to assess the relationship between thyroid function and hyperuricemia. RESULTS: The incidence rates of hyperuricemia were 109 and 50 per 1000 person-years in males and females, respectively. In males, compared with the lowest quartile, the multivariable-adjusted hazards ratios for hyperuricemia in the highest quartiles of triiodothyronine, thyroxine, and thyroid-stimulating hormone were 0.57 (0.50-0.66), 0.63 (0.54-0.73), and 1.03 (0.90-1.19) (P for trend < .0001, < .0001, and .51), respectively. However, no statistically significant correlations between thyroid function and incident hyperuricemia in females were found. CONCLUSION: This cohort study is the first to demonstrate that higher THs are related to lower risk of incident hyperuricemia in a male population with euthyroid status.

Effects of self-monitoring devices on blood pressure in older adults with hypertension and diabetes: a randomised controlled trial.

BACKGROUND: Hypertension and diabetes frequently coexist, which results in the difficulty of hypertension control in community-dwelling elderly adults who lack effective prevention and control strategies. The aim of this study is to determine whether a combined pedometer and home blood pressure monitoring (HBPM) programme could improve blood pressure (BP) among community-dwelling elderly adults with hypertension and diabetes. METHODS: The trial was a 2×2 factorial randomised clinical trial that recruited 180 community-dwelling elderly people (aged ≥60) with hypertension and diabetes in Tianjin, China. Participants were randomly assigned to control, pedometer, HBPM, and pedometer+HBPM groups. Intervention period was 12 months. The coprimary outcomes of the study were systolic and diastolic BP; the secondary outcomes included the proportion of patients with controlled hypertension. BP was measured twice in the right arm using a mercurial sphygmomanometer. The mean of these two measurements was taken as the BP value. RESULTS: At 12 months, compared with the control group, the adjusted differences in least squares mean (95% CI) in systolic and diastolic BP changes for pedometer, HBPM, and pedometer+HBPM groups were -4.2 (-8.4 to 0.1), -2.7 (-6.9 to 1.5) and -8.1 (-12.3 to -3.9) mm Hg (p<0.01); -3.2 (-5.2 to -1.1), -0.1(-2.1 to 1.9) and -3.6 (-5.6 to -1.5) mm Hg (p<0.001), respectively; the adjusted difference in percentage (95% CI) in the controlled hypertension (BP <140/90 mm Hg) for pedometer, HBPM and pedometer+HBPM groups were 7.5 (-12.2 to 27.1), 9.9 (-10.4 to 30.3) and 23.1 (5.0 to 41.1) (p=0.09). CONCLUSION: Combination pedometer and HBPM interventions can significantly decrease BP levels in elderly adults with hypertension and diabetes. TRIALS REGISTRATION NUMBER: UMIN000021613.

The impact of carbapenem-resistant Pseudomonas aeruginosa on clinical and economic outcomes in a Chinese tertiary care hospital: A propensity score-matched analysis.

BACKGROUND: This study aimed to estimate the impact of carbapenem-resistant Pseudomonas aeruginosa (CRPA) on clinical and economic outcomes in a Chinese tertiary care hospital. METHODS: Patients were assigned to a carbapenem-susceptible P aeruginosa group or to a CRPA group and matched using propensity score matching. In-hospital mortality, length of stay (LOS), LOS after culture, total hospital costs, daily hospital cost, and 30-day readmission were comparatively analyzed. Subgroup analysis was performed to determine the associations between the subgrouping factors and in-hospital mortality in patients with CRPA isolates. RESULTS: Within the propensity-matched cohort, in-hospital mortality (12.6% vs 7.8%; P   =   .044), LOS (median 29.0 vs 25.5 days; P   =   .026), LOS after culture (median 18.5 vs 14.0 days; P   =   .029), total hospital costs (median $6,082.0 vs $4,954.2; P  =  .015), and daily hospital cost (median $236.1 vs $223.6; P  =  .045) were significantly higher in CRPA patients than in carbapenem-susceptible P aeruginosa patients. Subgroup analysis revealed a significant interaction between CRPA and age (P  =  .009). CONCLUSION: Prevention and control of CRPA among hospitalized patients, especially among those over the age of 65 years, is a good measurement for the reduction of mortality and medical costs derived from CRPA infection or colonization.

Dietary patterns are associated with depressive symptoms among Chinese adults: a case-control study with propensity score matching.

PURPOSE: Previous studies have indicated that consumption of particular foods or nutrients is associated with depressive symptoms, but little is known about the role of overall dietary patterns in depressive symptoms. We design this case-control study to evaluate the associations between dietary patterns and high depression symptoms in Chinese adults. METHODS: A total of 1351 participants with high depressive symptoms were matched with 1351 controls using the 1:1 ratio propensity score matching method. Dietary intake was assessed using a valid self-administered food frequency questionnaire, and high depressive symptoms were assessed with the Zung Self-Rating Depression Scale, wherein cutoff point of 45 was used as a definition of high depressive symptoms. RESULTS: Exploratory factor analysis revealed three dietary patterns (vegetables and fruits pattern; sweets pattern; and animal foods pattern) explaining 25.1 % of the total variance. Compared with the participants in the lowest quartile, the participants in the highest quartile of vegetables and fruits pattern, which was defined as a healthy pattern, were associated with reduced odds of high depressive symptoms (OR 0.65, 95 % CI 0.52-0.83, P for trend <0.001) while the sweets pattern (OR 1.33, 95 % CI 1.06-1.66) and the animal foods pattern (OR 1.79, 95 % CI 1.43-2.24, P for trend <0.0001) were associated with increased prevalence of high depressive symptoms, respectively. CONCLUSION: The present study adds to the evidence that the sweets pattern and animal foods pattern are positively associated with the prevalence of high depressive symptoms. In contrast, the dietary pattern rich in vegetables, fruits, and soya bean products, but low in animal foods, candied fruits, cakes, ice cream, sugared beverages, and alcoholic drinks is negatively associated with the prevalence of high depressive symptoms.

Long-term Tai Chi training is related to depressive symptoms among Tai Chi practitioners.

BACKGROUND: Due to the close association with physical and psychological health and quality of life, mood disorders, especially depressive symptoms, are an important global public-health issue. It is hypothesized that long-term physical training and mood adjustment may have a beneficial effect on the prevention of the onset of depressive symptoms. The aim of this study was to investigate the relationship between long-term Tai Chi training and depressive symptoms among Tai Chi practitioners. METHODS: This study analyzed a cross-sectional survey including 529 Japanese Tai Chi practitioners. Tai Chi training information, including total training time and a Tai Chi grade, was assessed using a structured questionnaire, and depressive symptoms were evaluated using the 15-item Geriatric Depression Scale (GDS) for subjects aged ≥65 and the 20-item Self-rating Depressive Scale (SDS) for subjects aged <65 with cut-off points: GDS ≥5 and SDS ≥11. RESULTS: The prevalence of depressive symptoms was 15.9%. After adjustments for potential confounding factors, the odds ratios of having depressive symptoms by increasing levels of Tai Chi training time were 1.00, 0.64 (0.37-1.11), 0.65 (0.37-1.13), 0.34 (0.18-0.65) (P for trend <0.01). LIMITATIONS: This is a cross-sectional study, and not for making a clinical diagnosis of depressive symptoms. CONCLUSIONS: This study has demonstrated that long-term Tai Chi training is independently related to a lower prevalence of depressive symptoms. These results suggest that long-term Tai Chi training may have a beneficial effect on the prevention of depressive symptoms. Further studies are needed to confirm these findings.

[Social functions of the longevous elderly population in Dujiangyan].

OBJECTIVE: To describe the social functions of the longevous elderly population in Dujiangyan. METHODS: A questionnaire survey was undertaken in Dujiangyan in 875 elderly people who were over 90 years old. RESULTS: Poor social economic status was prevalent in the longevous elderly population. The elderly people had limited social contacts except from their families. The daily lives of 65. 0% of the longevous elderly were taken care of by their families. More than 81. 8% of the longevous elderly people were financially supported by their families. About 89. 2% of the longevous elderly people had accessed to spiritual supports in difficult circumstances, among 88. 7% came from families. CONCLUSION: Thanks to the family supports, the longevous people in Dujiangyan have maintained good social functions.

[Assessment on effects of tongjiang granule on experimental reflux esophagitis in rats].

OBJECTIVE: To study the effects of tongjiang granule (TJG) on reflux esophagitis (RE) in rats. METHODS: Two rat models of RE were established respectively by cardioplasty + pyloric ligation + Roux-en-Y gastro-jejunum anastomosis and by placed a fixed steel ring into the gastric cardia, and the model rats were treated with various dosages of TJG or cisapride by gastric perfusion. RESULTS: Rat models were established successfully by both methods. The score of pathological changes of esophagus mucosa in the model rats, made by either method, after high-dosage TJG treatment was lower than that in the model rats (P < 0.05), but equal to that in the cisapride treated model rats. High and moderate dosages of TJG were shown by transmission electron microscope to have effects of alleviating heckle cells and inflammatory reaction. They could reduce the level of gastric acid, more significant in high and moderate dosage groups (P < 0.05), while cisapride couldn't. CONCLUSION: TJG is effective in treating experimental RE in rats to a certain extent.