Dementia and the history of disease in older adults in community.

INTRODUCTION: Many studies have revealed the effect of medical history on dementia. The aim of this study was to explore the relationship between the history of disease and onset of dementia. METHODS: This was a multi-center, cross-sectional study, with 2595 older adults enrolled. The onset of dementia was evaluated with Revised Hasegawa Dementia Scale (HDS-R). The diagnosed diseases after the age of 40 of the participants were investigated, including respiratory system diseases, digestive system diseases, cardiovascular diseases, endocrine disorders, genitourinary system diseases, nervous system disease, sensory system diseases, dental/oral diseases, bone/joint diseases and mental illnesses. RESULTS: Data of 2458 older adults were analyzed. Univariate analysis showed that diabetes, thyroid disease, mental illness, hearing loss, stroke, dental/oral disease, Denture use, fracture/osteoporosis, kidney disease and number of diseases were risk factors for dementia. After controlling for demographic sociological variables, diabetes, dental/oral disease, and denture use were independent risk factors for dementia. Thyroid disease (P = 0.313), mental illnesses (P = 0.067), hearing loss (P = 0.595), stroke (P = 0.538), fractures/osteoporosis (P = 0.069), kidney disease (P = 0.168) were no longer significant to dementia. CONCLUSION: Diabetes, dental/oral disease and denture use were main risk factors for dementia.

Characterization of DOC and CDOM and their relationship in turbid waters of a high-altitude area on the western Loess Plateau, China.

Dissolved organic carbon (DOC) and chromophoric dissolved organic matter (CDOM) in rivers and reservoirs on the western Loess Plateau, which is an area of severe soil erosion, were investigated in September 2017 to analyze the CDOM characteristics and composition, DOC distribution and influence of environmental factors on these parameters. Great differences of water parameters were exhibited between different groups based on the analysis of variance (p < 0.01). The results indicated that rivers exhibited higher DOC concentrations (mean: 3.70 mg/L) than reservoir waters (mean: 2.04 mg/L). Artificial and agricultural lands exert a large influence on DOC concentrations, which verifies the hypothesis that intense anthropogenic activity results in high DOC concentrations. The CDOM absorption at 350 nm [aCDOM(350)] of tributary water samples was 2.73 m-1, which was higher than that in the Yellow River (1.71 m-1) and reservoir waters (1.33 m-1). The effects of DOC, TC and turbulence (Tur) on CDOM are positive and significant (p < 0.05) according to the multiple linear regressions. An analysis of the optical characteristics of CDOM indicated that waters on the Loess Plateau contained abundant humic acid and higher levels of allochthonous DOM with a higher molecular weight (MW) based on the spectral slopes (S) and specific UV absorbance (SUVA254) values.

Quality of Life in Chinese Persons Living With an Ostomy: A Multisite Cross-sectional Study.

PURPOSE: The aim of the study was to describe health-related quality of life (HRQOL) in persons with ostomies and to explore influencing factors. DESIGN: Secondary analysis of data from a cross-sectional survey. SUBJECTS AND SETTING: Eight hundred twenty-seven persons living with an ostomy were enrolled from 5 provinces and cities in China from October 2010 to November 2012; the final sample comprises 729 individuals who completed data collection. Their mean ± SD age was 62.59 ± 12.40 years (range 26-93 years). METHODS: Health-related quality of life was assessed using the Chinese language version of the City of Hope-Quality of Life-Ostomy Questionnaire-Chinese Version. Sociodemographic data, clinical characteristics, self-efficacy, adjustment to an ostomy, social support, and psychological state of patients were measured by a general information questionnaire. We also administered the Stoma Self-Efficacy Scale, Ostomy Adjustment Inventory-Chinese Version, the Social Support Revalued Scale, and Hospital Anxiety Depression Scale. RESULTS: Of the 729 ostomy patients, the overall HRQOL in ostomy patients was in the moderate range (mean score 5.19 ± 1.29); scores of physical domain, psychological domain, social domain, and spiritual domains also in the moderate range (5.00 ± 1.73, 5.97 ± 1.59, 4.86 ± 2.31, and 4.93 ± 2.08 respectively). Multivariate analysis found that multiple factors influenced HRQOL in persons with an ostomy; they were gender, religious belief, and marital status, psychological factors depression and anxiety, and specific components related to social support, self-efficacy in ostomy care, and adjustment to an ostomy. CONCLUSION: Health-related quality of life among Chinese patients with fecal ostomies was less than optimal and influenced by multiple demographic and psychosocial factors. Additional research is needed to design strategies to improve HRQOL in this population.

Lower rate of colonoscopic perforation: 110,785 patients of colonoscopy performed by colorectal surgeons in a large teaching hospital in China.

BACKGROUND: Colonoscopic perforation (CP) has a low incidence rate. However, with the extensive use of colonoscopy, even low incidence rates should be evaluated to identify and address risks. Information on CP is quite limited in China. OBJECTIVE: Our study aimed to determine the frequency of CP in colonoscopies performed by surgeons at a large teaching hospital in China over a 12-year period. METHODS: A retrospective review of medical records was performed for all patients who had CPs from 1 January 2000 to 31 December 2012. Iatrogenic perforations were identified mainly by abdominal X-ray or computed tomography scan. Follow-up information of adverse events post-colonoscopy was identified from the colorectal surgery database of our hospital. Patients' demographic data, colonoscopy procedure information, location of perforation, treatment, and outcome were recorded. RESULTS: A total of 110,785 diagnostic and therapeutic colonoscopy procedures were performed (86,800 diagnostic cases and 23,985 therapeutic cases) within the 12-year study period. A total of 14 incidents (0.012%) of CP were reported (seven males and seven females), of which nine cases occurred during diagnostic colonoscopy (0.01%) and five after therapeutic colonoscopy (three polypectomy cases, one endoscopic mucosal resection, and one endoscopic mucosal dissection). Mean patient age was 67.14 years. One case of CP (7.14%) after colonoscopy polypectomy was treated using curative colonoscopy endoclips. Other patients underwent operations: six cases (46.15%) of primary repair, four cases (28.57%) of resection with anastomosis, and two cases (15.38%) of resection without anastomosis. No obvious perforation was found in one patient (7.69%). Surgeons attempted to treat one case laparoscopically but eventually resorted to open surgery. The postoperative course was uncomplicated in eight cases (57.14%) and complicated in six cases (42.86%) but without mortality. CONCLUSION: CP is a serious but rare complication of colonoscopy. A perforation risk of 0.012% was found in our study. The optimal management of CP remains controversial. Treatment for CP should be individualized according to the patient's condition, related devices, and surgical skills of endoscopists or surgeons. Selective measures such as colonoscopy without intravenous sedation and decrease of loop formation can effectively reduce rates of perforation.

Symptom clusters in patients with colorectal cancer after colostomy: a longitudinal study in Shanghai.

OBJECTIVE: Research is lacking regarding the experiences of patients after colostomy, which is needed so as to take necessary specific actions. In this study, we aimed to describe the trajectory of symptom clusters experienced by patients after colostomy over time. METHODS: This was a longitudinal observational study using data from 149 patients with colorectal cancer after colostomy. We investigated symptoms and symptom clusters at 2 weeks, 1 month, 3 months, 6 months, and 1 year after colostomy. RESULTS: Four main symptom clusters were identified, including a psychological symptom cluster, digestive and urinary symptom cluster, lack of energy symptom cluster, and pain symptom cluster in patients after colostomy in the first year after surgery. We further explored the symptom trajectory. CONCLUSIONS: We explored symptom clusters and the trajectory of symptom resolution in patients after colostomy during the first year after surgery. Four stages were proposed to describe the different statuses of symptom clusters experienced by patients. Our findings may provide insight into how to improve symptom management and postoperative quality of life for patients after colostomy.

Online survey on healthcare skin reactions for wearing medical-grade protective equipment against COVID-19 in Hubei Province, China.

With the spread of Coronavirus Disease 2019 globally, more than 40,000 healthcare staff rushed to Wuhan, Hubei Province to fight against this threatening disease. All staff had to wear personal protective equipment (PPE) for several hours when caring for patients, which resulted in adverse skin reactions and injuries. In this study, we used an online questionnaire to collect the self-reported skin damages among the first-line medical staff in the epidemic. The questionnaire was designed by four front-line wound care nurses and then revised through Delphi consultants. Items mainly focused on the adverse skin reactions and preventive strategies. The survey was distributed through phone application from March 15th to March 20th and received 275 responses in total. The prevalence of skin reactions (212, 77.09%) was high in both head and hands. The common clinical symptoms of skin reactions were redness, device-like mark, and burning pain in face; and dryness, dermatitis, and itch/irritation in hands. Three risk factors included gender, level of protection, and daily wearing time of PPE were identified that caused skin reactions among medical staff. 150 of 275 (54.55%) participants took preventive strategies like prophylactic dressings, however, more than 75% users had little knowledge about dressings. We suggest the frontline staff strengthened the protection of skin integrity and reduced the prevalence of adverse skin reactions after professional education.

Construction and function of two Cys146-mutants with high activity, derived from recombinant human soluble B lymphocyte stimulator.

B lymphocyte stimulator (BLyS) is a novel member of tumor necrosis factor (TNF) ligand family that is important in B cell maturation and survival. Previous studies were almost related to the function or mechanism of its wild type. Here, we constructed two site-directed mutants of the recombinant human soluble BLyS, the BY-A and BY-V, and found that BY-V ranked the highest whenever in the process of promoting proliferation of B lymphocytes in vitro or stimulating total serum IgG and IgM secretion in vivo. Besides, assays for the biological responses of human leukemic cell lines to BLyS, BY-A and BY-V demonstrated that they could suppress the proliferation of Raji cells but promote the growth of THP-1. The discovery of BY-V with high activity will help come to a conclusion that the mutation of Cys146 to Val146 might improve the biological activity of BLyS.

[Clinicopathological features of typical and non-typical hereditary non-polyposis colorectal cancer and their germline mutation of hMLH1 and hMSH2].

OBJECTIVE: To study the clinicopathological features of the Chinese hereditary non-polyposis colorectal cancer and its germline mutation of hMLH(1) and hMSH(2). METHODS: Thirteen typical Chinese hereditary non-polyposis colorectal carcinoma (HNPC)C kindreds and 19 non-typical HNPCC families were registered and followed up. The germline mutation of the hMLH(1) and hMSH(2) of 12 index cases of 6 typical and 6 non-typical HNPCC were screened by PCR-SSCP. Samples with abnormal mobility were sequenced directly. RESULTS: The average age of typical HNPCC was 47, no difference existed between sexes. Location of the tumors of typical HNPCC represented 44.7% on the right half colon and non-typical HNPCC 65.8% on the rectum. The rate of the metachronos cancer was 11.5%. The 3-, 5-and 10-year survival rate was 64.0%, 45.3% and 31.2% respectively. Among 12 cases, 8 showed abnormal mobility. Except for an intron polymorphism, six exons abnormalities were found in 5 of 12 proband. Sequencing showed 4 missense, 7 insertion and a nonsense mutations. CONCLUSIONS: Chinese HNPCC is early onset, more common on proximal colon and better prognosis. Mutation of hMSH(2) is dominant in the Chinese typical HNPCC, but mutation of hMLH(1) is more common in the non-typical group.

Patients after colostomy: relationship between quality of life and acceptance of disability and social support.

BACKGROUND: The aim of this research was to explore quality of life (QOL) and acceptance of disability and social support of colostomy patients as well as the relationship between these factors. METHODS: A descriptive, correlational study was conducted using four scales: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and European Organization for Research and Treatment of Cancer Colorectal Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-CR38) scales, the Acceptance of Disability Scale (ADS), and the Social Relational Quality Scale (SRQS). A convenience sample of 111 colostomy patients from four hospitals in Guangzhou who underwent colostomy operation at least one month prior to the study and who visited the stoma clinic or association from August 2011 to February 2012 was evaluated for inclusion in the study. All statistical analyses were performed using SPSS 17.0 software (SPSS Inc., Chicago, IL, USA). RESULTS: The patients' general health status was better than the reference level recommended by European Organization for Research and Treatment of Cancer, and the overall ADS score was average. The SRQS score was similar to that found in a Hong Kong study. The general health status and dimensions of QOL were significantly correlated with ADS and all of its dimensions (P < 0.05). The general health status and dimensions of QOL were also significantly correlated with SRQS and all of its dimensions (P < 0.05). CONCLUSIONS: QOL, acceptance of disability, and social relational quality of colostomy patients were closely related. Our results emphasize that patients should work to form rational values and close bonds with families and friends to achieve a better QOL.

[Effect of colonoscopy combined with placement of metallic clips on selecting colonic surgery incision].

OBJECTIVE: To evaluate the accuracy and value of the placement of metallic clips during colonoscopy in the localization of colorectal cancer and incision selection. METHODS: A total of 30 patients received metallic clip placement by colonoscopy before operation. Abdominal plain film (supine and upright position) was taken and incision was determined by the projection of clips on the abdominal wall. RESULTS: The inaccuracy rate of localization by colonoscopy was 30%(9/30). Colonoscopy combined with the placement of metallic clips achieved an accurate incision rate of 100% (30/30). CONCLUSIONS: There is a considerable rate of inaccuracy for localization in colonic cancer by colonoscopy. Colonoscopy combined with placement of metallic clips should be considered in order to select a reasonable incision.