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Objective:To explore the prognostic factors predicting the recovery of elderly patients with hospital-acquired pneumonia(HAP).Methods:Data of HAP inpatients aged over 60 years in the First Affiliated Hospital of Nanjing Medical University between October 2015 and October 2020 were collected.Body mass index(BMI), neutrophil/lymphocyte rate(NLR), Charlson Comorbidity Index(CCI), Combined Comorbidity Score(CCS)and other data were retrospectively analyzed.The predictive value of the related factors was evaluated by using the Student's t test, the Logistic regression model and the receiver operating characteristic curve(ROC). Results:A total of 200 cases were enrolled in this study, and grouped into survival group(n=158)and death group(n=42). There were significant differences between the death group and the survival group in length of age, BMI hospital stay, state of consciousness, swallowing function, indwelling gastric tube, the use of proton pump inhibitors, leukocyte count, lymphocyte count, neutrophil count, hemoglobin, NLR, albumin, alanine aminotransferase, aspartate aminotransferase, D-dimer, C-reaction protein, procalcitonin(all P<0.05). Scores of CCI and CCS were higher in the death group than in the survival group[(6.79±2.86) vs.(3.42±1.98), (6.21±3.08) vs.(1.66±1.94), t=-7.193, -9.116, both P<0.001]. Multivariate Logistic analysis showed that age>86 years( OR=1.155, 95% CI: 1.014-1.316), BMI<21.77 kg/m 2( OR=0.651, 95% CI: 0.480-0.883), neutrophil count>10.10×10 9/L( OR=1.208, 95% CI: 1.025-1.422), C-reaction protein>59.32 mg/L( OR=1.055, 95% CI: 1.018-1.093), CCS>6.21 scores( OR=2.859, 95% CI: 1.559-5.244)were risk factors for death inpatients aged 60 years and older with HAP.Area under the ROC curve showed that CCS could better predict the mortality of elderly patients than CCI, and the areas under the ROC curve were 0.831(95% CI: 0.753-0.909)and 0.898(95% CI: 0.850-0.946)respectively(both P< 0.001). Conclusions:The elderly patients with HAP are inclined to multiplecomplications and high mortality rates.Combined application of multiple assessment systems and clinical indicators can improve the ability to predict the outcome of HAP.
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Objective:To explore the application of immunotherapy and whole course management of immune-related adverse reactions in elderly patients with lung adenosquamous carcinoma.Methods:Clinical data of an 83-year-old patient with advanced lung adenosquamous carcinoma who underwent immunotherapy during hospitalization were retrospectively analyzed.Clinical features of immunotherapy for elderly patients with lung cancer were analyzed.Results:Compared with younger patients, immunotherapy for adenocarcinoma has similar clinical benefits and toxicity in the elderly.However, immunosenescence and comorbidity in the elderly and immune-related complications such as the progression of interstitial pneumonia, are common in the elderly.Conclusions:There is no evident age-related difference in the benefit of immunotherapy.For patients of advanced age with multiple complications and frailty, a comprehensive geriatric assessment may help improve clinical prognosis.
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Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.
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BACKGROUND@#Leptomeningeal metastasis (LM) is one of the most common causes of death in patients with advanced non-small cell lung cancer (NSCLC), which is defined as malignant cells spreading to meninges and cerebrospinal fluid (CSF). Therefore, early diagnosis and timely treatment are essential. CSF cytology is the gold standard for LM diagnosis, however, it has a low sensitivity for diagnosis and can't be used to evaluate the treatment effect. The aim of this study was to assess the clinical value of serum and CSF tumor markers (TM) in the diagnosis and treatment of NSCLC patients with LM.@*METHODS@#Nineteen patients with NSCLC-LM and 27 patients with nonmalignant neurological diseases (NMNDs) were included. We tested the levels and positive rates of carbohydrate antigen (CEA), carbohydrate antigen-125 (CA125), cytokeratin 19 fragments (CYFRA21-1) and neurone specific enolase (NSE) in CSF and serum, compared the sensitivity and specificity in the diagnosis of LM between different groups, and analyzed the correlation of detection between serum and CSF. Finally, we measured serum and CSF TM dynamically in 2 patients with NSCLC developing LM in an attempt to correlate these with the treatment response of extracranial and intracranial, respectively.@*RESULTS@#The levels and positive rates of TM in CSF and serum in LM group were higher than those in NMNDs (P0.05). In CSF, CYFRA21-1 has the highest sensitivity (88.2%) and CEA has the best specificity (92.3%) to distinguish patients between LM and NMNDs. For combined detection of CEA, CA125, CYFRA 21-1 and NSE in CSF, when at least CEA or NSE was positive in patients with LM, the sensitivity and negative predictive value were 100.0%, and the specificity was 74.1%. When both CYFRA21-1 and NSE were positive, the specificity and positive predictive value were 100.0%, and the sensitivity was 78.9%. Furthermore, subgroup analysis showed that the detection rates of TM in CSF cytology positive population was higher than that in typical abnormalities magnetic resonance imaging population, but there was no statistical difference (P>0.05). The detection of TM between serum and CSF in LM patients had no significant correlation. Moreover, biochemical properties of CSF from ventricle and lumbar puncture are similar, therefore evaluating the levels of TM in serum and CSF dynamically can be used to assess the extracranial and intracranial treatment effect, respectively.@*CONCLUSIONS@#Our study demonstrates that Serum and CSF TM can work as an auxiliary clinical diagnostic tool, which has a potential value in early diagnosis of NSCLC patients with LM. Serial measurement of TM may play an important role in the clinical management of NSCLC patients with LM, which is worthy of further promotion and clinical application.
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Objective To investigate the health status of centenarian hospitalized patients and analyze the risk factors for in-hospital death in Nanjing district.Methods All centenarians hospitalized patients who were discharged from wards of 10 upper first-class general hospitals in Nanjing district during the past five years were retrieved from their hospital information systems.Then,a retrospective study was performed on centenarians' data of general information,laboratory test results,Charlson comorbidity index (CCI),neutrophil to lymphocyte ratio (NLR) and shock index(SI),etc.were calculated and collected.Relevant risk factors for in-hospital death were analyzed by multivariate logistic regression analysis.Results A total of 156 patients aged 100 years and over,with an average age of (101.0±2.1)years,were enrolled during the past 5 years.The top 3 admitting diagnosis for the patients were pulmonary infection(30.1％,47/156 cases),coronary heart disease(10.9％,17/156 cases)and cerebrovascular disease(7.1％,11/156 cases).Fifty patients died during hospitalization,with a mortality of 32.1％ (50/156).Pneumonia was the most common admitting diagnosis(40.0％,20/50 case).Among causes of death,the combined admitting diagnosis with dementia,chronic renal insufficiency,one or more basic disease were significantly associated with death.There were statistically significant differences between bad vs.good vs.indifferent prognosis in heart rate,shock index,leukocyte count,neutrophil count,NLR,hemoglobin,albumin,albumin/globulin,fasting blood glucose,blood urea nitrogen,serum creatinine,C-reactive protein(CRP)and CCI levels.Multivariate logistic regression analysis suggested that NLR≥13.18,fasting blood glucose ≥7.56 mmol/L,blood urea nitrogen ≥20.74 mmol/L,CRP≥65 mg/L and CCI≥3 might be predictors for in-hospital death in the cohort(OR =48.91、3.43、1.22、6.55、1.55,all P＜0.05).Conclusions Pulmonary infection is the most common reason for admission and the cause of death in centenarian inpatients.Comorbidities increase the risk of death.To lower in-hospital mortality,CCI and other assessment indicators should be used to strengthen the comprehensive assessment and chronic disease management of hospitalized centenarians.Infectious diseases should be prevented beforehand.
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Objective To investigate clinical characteristics and prognostic factors for hospitalized patients aged 95 years and older with community-acquired pneumonia(CAP).Methods A retrospective study was conducted on CAP patients aged ≥95 years hospitalized in Jiangsu Province Hospital or Jiangsu Province Hospital of TCM between January 2014 and January 2018.Clinical characteristics were collected.The shock index (SI),Charlson comorbidity index (CCI),neutrophil/lymphocyte rate (NLR)and CURB-65 score were calculated.The predictive value of the related factors was evaluated by using the Logistic regression model and the subjects' receiver operating characteristic curve (ROC).Results A total of 205 cases were enrolled in this study.The hospital mortality rate was 36.1 ％ (73/205).The heart rate,white blood cell count,mononuclear cell count,neutrophil count (N),NLR,fasting blood glucose,blood urea nitrogen(BUN) and D-dimer results revealed significant differences between the death group and the survival group(all P＜0.05).Scores of CCI and CURB-65 were higher in the death group than in the survival group[(2.90 ±1.88) vs.(1.91 ± 1.81),(2.34 ±0.69)vs.(1.76±0.69),both P＜0.05].Multivariate Logistic analysis showed that heart rate≥84.73 beat per minute(OR =2.452,95％CI:1.054～5.702),NLR≥11.43(OR =5.499,95％CI:2.132～14.180),BUN≥12.95 mmol/L(OR =2.546,95％CI:1.025～6.319),CCI≥3(OR =4.453,95％CI:1.191～10.113),CURB-65≥2 scores(OR =3.888,95％CI..1.288～11.735)and respiratory failure (OR =2.875,95 ％CI:1.204～6.806)were risk factors for death in hospitalized elderly aged 95 years and older with CAP.ROC analysis showed that CCI combined with the CURB-65 score or CCI combined with the CURB-65 score plus NLR could better predict the in-hospital mortality of elderly patients than CCI or the CURB-65 score used alone.Conclusions Hospitalized patients aged≥95 with CAP are prone to multiple complications and high mortality rates.Combined application of multiple evaluation systems and indicators can improve the prognosis of outcomes for patients in this age group.
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Fibrosis as a pathogenic mechanism occurs in numerous organs and diseases.Persistent and severe fibrosis affect the function of the organ.Organ fibrosis is an important cause of patient morbidity and mortality.Aging is considered as a strong risk factor for development of organ fibrosis.Organ fibrosis is age-related disease and cellular senescence plays an important role in the occurrence and development of fibrosis,which provides a new strategy for the treatment of fibrosis.This review is focused on the progress in cellular senescence and organ fibrosis.
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BACKGROUND: Previous studies demonstrated that freeze-drying had great influence on internal heat transfer, such as pore distribution and void connectivity, however, the mechanisms involved in heat and mass transfer during drying is poorly understood.OBJECTIVE: Based on the previous studies, micro CT was served as analytical tool, to observe the movement characteristics of sublimation interface in freeze-drying process.METHODS: With aorta of pig, micro-CT scanning, image reconstruction and the technique of grey value analysis were used to observe and analyze the sublimation process in freeze-drying. RESULTS AND CONCLUSION: The slope of freeze-drying temperature curve was large at first, causing quick sublimation rate. The grey value of freeze-drying and ice crystal area was very different in second-dimensional cross-sectional reconstructed image.Sublimation interface was clear and sublimation took place simultaneously both in the outer'surface and inner surface. The movement of sublimation interface was obvious at this time. Along with the time, the slope of freeze-drying temperature curve became small, leading to slow sublimation rate. The movement of sublimation interface turned unciearly.For the vertically placed artery, when heated at the bottom, the sublimation takes place both in the outer surface and inner surfaceat the same time. The sublimation interface slowly approaches to the middle of vessel wall. With time prolonged, resistance for heat and mass transfer in freeze-drying is increased, and the sublimation rate becomes slowly.
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BACKGROUND: The freeze-drying blood vessel is an excellent material for vasotransplantation. However, the reports concerning freeze-drying are few, and the mechanical property changes of freeze-dried blood vessel remains poorly understood. OBJECTIVE: Using micro-CT to explore the morphological changes of blood vessel during procedure of freeze-drying. DESIGN, TIME AND SETTING: A single sample observation was performed at the Institute of Refrigeration and Cryogenics, University of Shanghai for Science and Technology. MATERIALS: Fresh pig aorta was obtained from Shanghai Slaughter House. The lyophilizer was produced by SP Industries (USA). TRAPEZIUM LITE texture analyzer was purchased from Shimadzu (Hong Kong) Co., Ltd.METHODS: The differences of mechanical property between fresh aorta and freeze-dried aorta were compared.MAIN OUTCOME MEASURES: ① Temperature curve of freeze-drying procedure. ②The reeze-drying procedure was scanned by micro-CT. ③ Changes of mechanical property were detected by TRAPEZIUM LITE texture analyzer and puncture experiments.RESULTS: During freeze-drying procedure, there were presented layer phenomenon in pig aorta. Compared to the fresh aorta, the freeze-dried aorta after recover water would reduce 40% axial tensile force, increase 45% circumferential tensile force, with 75% puncture stress.CONCLUSION: The freeze-dried blood vessel maintains mechanical property as fresh vessel, thus, freeze-drying can be used for vascular preservation.
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Aim To explore the role of cytoplasmic FKBP52 in AAV-mediated transduction.Methods Murine embryo fibroblasts(MEFs)cultures from FKBP52 wild-type(WT),heterozygous(HE),and knockout(KO)mice were established.The role of FKBP52 in intracellular trafficking of AAV was analyzed by fluorescence-activated cell sorting(FACS)analyses,electrophoretic mobility shift assays(EMSA),southern blot,immunoprecipitations and western blot analyses.Results Conventional AAV vectors failed to transduce WT MEFs efficiently,and the transduction efficiency was not significantly increased in HE or KO MEFs.AAV vectors failed to traffick efficiently to the nucleus in these cells.Treatment with hydroxyurea(HU)increased the transduction efficiency of conventional AAV vectors by～25-fold in WT MEFs,but only by～4-fold in KO MEFs.The use of self-complementary AAV(scAAV)vectors,which bypass the requirement of viral second-strand DNA synthesis,revealed that HU treatment increased the transduction efficiency～23-fold in WT MEFs,but only～4-fold in KO MEFs,indicating that the lack of HU treatment-mediated increase in KO MEFs was not due to failure of AAV to undergo viral second-strand DNA synthesis.Following HU treatment,～59% of AAV genomes were present in the nuclear fraction from WT MEFs,but only ～28% in KO MEFs,indicating that the pathway by which HU treatment mediates nuclear transport of AAV was impaired in KO MEFs.When KO MEFs were stably transfected with an FKBP52 expression plasmid,HU treatment-mediated increased in the transduction efficiency was restored in these cells,which correlated directly with improved intracellular trafficking.Intact AAV particles were also shown to interact with FKBP52 as well as with dynein,a known cellular protein involved in AAV trafficking.Conclusion These studies suggest that FKBP52,being a cellular chaperone protein,facilitates intracellular trafficking of AAV,which has implications in the optimal use of recombinant AAV vectors in human gene therapy.
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The use and management of medical implanting material is always the key point of the hospital material management. Questions existing in hospital management were investigated along with some suggestions in further management in the system and the process.