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Objective:To investigate the nutritional status and related influential factors in older adult malnourished patients undergoing maintenance hemodialysis.Methods:A total of 150 older adult patients who received maintenance hemodialysis for over 3 months between August 2016 and June 2019 in Zhejiang Xin'an International Hospital, China were included in this study. The general data of the patients including basic information, clinical characteristics, dietary status, and accompanied diseases were collected. The nutritional status of the patients was evaluated using the Objective Score of Nutrition on Dialysis (OSND). These patients were assigned to malnutrition and normal nutrition groups according to evaluation results. Blood biochemical indexes and nutritional diet data were compared between the two groups. The factors that caused malnutrition were analyzed using logistic regression method.Results:Among the 150 patients, 72 (48.00%) patients had a normal nutritional status (normal nutrition group), and 78 (52.00%) patients had malnutrition (malnutrition group). Mild malnutrition was found in 27 (18.00%) patients, moderate malnutrition in 35 (23.33%) patients, and severe malnutrition in 16 (10.67%) patients. Body mass index, the levels of albumin, hemoglobin, and blood urea nitrogen in the malnutrition group were (19.84 ± 3.06) kg/m 2, (33.48 ± 5.61) g/L, (85.39 ± 19.06) g/L and (32.69 ± 6.80) mmol/L, respectively, which were significantly lower than those in the normal nutrition group [(22.61 ± 3.79) kg/m 2, (38.25 ± 4.78) g/L, (99.53 ± 17.8) g/L, (36.14 ± 5.02) mmol/L, t = 4.942, 5.582, 4.681, -3.511, all P < 0.05]. The levels of serum creatinine (Scr) and parathyroid hormone (PTH) in the malnutrition group were (1 094.81 ± 219.03) μmol/L and (421.93 ± 210.09) pg/mL], respectively, which were significantly higher than those in the normal nutrition group [(871.04 ± 157.63) μmol/L, (318.84 ± 207.52) pg/mL, t = -24.254, 3.020, both P < 0.05). Univariate analysis results revealed that there were significant differences in age, duration of dialysis, diabetes mellitus, nutrition knowledge, protein and energy intake between malnutrition and normal nutrition groups ( t = 9.608, 5.883, 9.423, 17.910, 26.362, all P < 0.05). Multivariate logistic regression analysis showed that age, duration of dialysis, poor nutrition knowledge and inadequate energy and protein intake were independent risk factors for malnutrition in older adult maintenance hemodialysis patients ( χ2 = 10.796, 7.818, 8.154, 5.044, all P < 0.05). Conclusion:Older adult maintenance hemodialysis patients are more prone to develop malnutrition. In addition, age, duration of dialysis, poor nutrition knowledge and inadequate energy and protein intake are independent risk factors for malnutrition. Comprehensive intervention should be carried out according to the specific situation of patients in clinical nursing.
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Objective:To investigate the effect of different blood purification methods on inflammatory factors and nutritional status in patients with end-stage renal disease.Methods:From June 2017 to June 2019, 82 patients with end-stage renal disease were enrolled in Zhejiang Xin'an International Hospital.They were divided into group A and group B according to the random digital table method, with 41 cases in each group.High flux hemodialysis was used in group A, and routine hemodialysis was used in group B. The changes of inflammatory factors, nutritional status, renal function, parathyroid hormone(PTH) and complications before and 6 months after dialysis were compared between the two groups.Results:The levels of serum TNF-α[(153.24±20.98)ng/L], hs-CRP[(15.46±2.53)mg/L] and IL-6[(10.35±2.83)ng/L] in group A were lower than those in group B[(192.37±16.47)ng/L, (21.65±2.41)mg/L and (16.74±2.41)ng/L]( t=9.394, 11.343, 11.007, all P<0.05). The serum SF[(268.93±15.31)μg/L], ALB[(37.84±1.16)g/L] and Hb[(107.25±10.24)mg/L] in group A were higher than those in group B[(237.18±8.97)mg/L, (33.76±1.35)g/L and (95.32±7.53)mg/L]( t=11.457, 14.678, 6.010, all P<0.05). The serum creatinine[(146.71±17.37)μmol/L] and urea nitrogen[(14.37±2.18)mmol/L] in group A were lower than those in group B[(226.38±23.15)μmol/L and (20.93±2.63)mmol/L]( t=17.626, 12.296, all P<0.05). The serum PTH[(409.27±25.48)ng/L] in group A was lower than that in group B[(501.32±41.27)ng/L]( t=12.152, P<0.05). The incidence of complications in group A was lower than that in group B[12.20%(5/41) vs.39.02%(16/41), χ 2=7.746, P<0.05]. Conclusion:High flux hemodialysis is effective in the treatment of end-stage renal disease, which can reduce the micro inflammation, improve the nutritional status and reduce the complications.
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Objective To investigate the oropharyngeal microbial colonization in elderly patients.Methods Totally 618 elderly cases and 96 young and middle-aged cases were involved in this investigation.The colonization of bacteria and fungi on the oropharyngeal mucosa were obtained by throat swab cultures.Results There were 85.4％ of cases (82 cases) with Streptococcus viridans and Neisseria gonorrheae on the oropharynx mucosa in young and middle-aged group and the pattern of constitute was simple.3 to 5 bacterial species were isolated from the oropharyngeal mucosa in elderly group.There were only 25.7％ of cases (159 cases)with Streptococcus viridans and Neisseria gonorrheae on the oropharyngeal mucosa in elderly group.Biodiversity of the constitution pattern in the bacterial colonization was exhibited in the elderly.The colonization rate of Gramnegative bacilli was higher in elderly group than in young and middle-aged group [53.1％ (328/618)vs.6.3％ (6/96)].Staphylococcus aureus and Streptococcus pneumonia were the common Grampositive bacteria colonization in the elderly.The colonization rate of Candida fungus was 9.1 ％ (56/618) in the elderly.Conclusions The reduction of commensal bacteria,especially Streptococcus viridans may be the pathological basis of mode changes in bacteria colonization and opportunistic bacteria colonization on oropharyngeal mucosa in the elderly.The colonization rate of oropharyngeal Gram-negative bacili is obviously increased and Klebsiella Pneumoniae is the common bacteria on oropharyngeal mucosa in the elderly.Enterobacteriaceae,Pseudomonas aeruginosa and Acinetobacter baumannii are sensitive to common antibiotics.
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OBJECTIVE To investigate the significance of CNS in clinical infections.METHODS A total of 114 CNS strains isolated from our hospital were identified by conventional procedures and the icaD gene was amplified by PCR.RESULTS Of all CNS strains,the highest isolated rate was S.epidermidis(41.2%).CNS isolated from deep venous catheters,wound secretions and blood had a higher rate of carrying ica operon,accounted for 44.4%,42.1% and 36.8%,respectively,whereas 24.0% in respiratory secretions and 14.1% in urine.Among the ica operon positive CNS strains,the percentages of S.epidermidis and S.haemolyticus were 42.6% and 19.0%.CONCLUSIONS There is a wide range of CNS species carrying ica operon,especially in S.epidermidis.CNS isolated from different specimens might have different significances.It should be cautious to assess the results of isolated CNS from respiratory and urine specimens.The CNS isolates from blood specimens might be contaminated.The PCR method for the ica operon is simple and easy.