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Characteristics associated with falls among the elderly within aged care wards in a tertiary hospital： a retrospective case-control study

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Chinese Medical Journal 2010年第13期123卷 1668-1672页

作者： CHEN Xue-li LIU Yun-hu Daniel KY Chan SHEN Qing Huong Van Nguyen department of Rehabilitation Beijing Geriatric Hospital Beijing 100095 China aged care Bankstown-Lidcombe Hospital Sydney New South Wales Australia Faculty of Medicine University of New South Wales Sydney Anetralia

Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics. Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group： Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident Information Management System （IIMS）. Further details about the particular admission（s） were obtained from patients＇ medical records, e.g., patients＇ characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-railers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients＇ room and 18.9% in patients＇ bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9：00-11：00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination （MMSE） score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall. Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main causes leading to fall were intrinsic factors.

关键词： falls recurrent falls inpatients the elderly

Mortality Trend and Predictors of Mortality in Dysphagic Stroke Patients Postpercutaneous Endoscopic Gastrostomy

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Chinese Medical Journal 2015年第10期128卷 1331-1335页

作者： Yue-Long Jiang Nyoka Ruberu Xin-Sheng Liu Ying-Hua Xu Shu-Tian Zhang Daniel KY Chan department of Gastroenterology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China department of Gastroenterology Beijing HospitalBeijing 100730China Department of Aged Care and Rehabilitation Bankstown-Lidcombe HospitalBankstownNew South WalesAustralia department of Gastroenterology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

Background：Percutaneous endoscopic gastrostomy （PEG） feeding is widely used in stroke patients suffering from persistent dysphagia;however,predicting the risks and benefits of PEG insertion in the individual patient is difficult.The aim of our study was to investigate if candidate risk factors could predict short-term mortality risk in poststroke patients who had PEG tube insertion for persistent dysphagia.Methods：This was a retrospective study of 3504 consecutive stroke patients admitted to two metropolitan hospitals during the period January 2005 to December 2013 and who also underwent PEG insertion for feeding due to persistent dysphagia.Results：A total of 102 patients were included in the study.There were 22 deaths in 6 months after insertion of PEG tubes and 20 deaths of those occurred within 3 months post PEG.Those who survived beyond 6 months showed significantly lower mean age （75.9 ± 9.0 years vs.83.0 ± 4.9 years,P 〈 0.001）,a lower mean American Society of Anesthesia （ASA） score （3.04 ± 0.63 vs.3.64 ± 0.58,P 〈 0.001） compared to nonsurvivors.In multiple Logistic,age （P =0.004,odds ratio [OR] =1.144;95% confidence interval [CI]：1.044-1.255）;ASA （P =0.002,OR =5.065;95% CI：1.815-14.133） and albumin level pre-PEG insertion （P =0.033,OR =0.869;95% CI：0.764-0.988）were the independent determinants of mortality respectively.Conclusions：We propose that age,ASA score and albumin level pre-PEG insertion to be included as factors to assist in the selection of patients who are likely to survive more than 3 months post PEG insertion.

关键词： Age Albumin American Society of Anesthesia Mortality Percutaneous Endoscopic Gastrostomy Stroke

The association between frailty and vascular dementia

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中华老年医学杂志 2015年第12期34卷 1293-1299页

作者： Daniel KY Chan Vivek Srinivasan Ciaran Upton Xueli Chen Roman Romero-Ortuno 2052 Sydney Faculty of Medicine University of New South Wales Australia Department of Aged Care and Rehabilitation Bankstown HospitalNSW Australia 北京老年医院康复医学科 Addenbrooke's Hospital Hills Rd Cambridge England

Frailty is a clinically recognized syndrome that results from an age-associated decline in reserve and [unction across multiple physiological systems. There are two commonly used clinical definitions. The Rockwood definition (1994):27 is essentially a Cumulative Burden Index which includes health conditions and deficits (therefore embracing cognitive impairment).

关键词：临床症候群临床分析健康状况医学知识

Clinical features and risk factors associated with severe COVID-19 patients in China

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Chinese Medical Journal 2021年第8期134卷 944-953页

作者： Ning Jiang Yan-Nan Liu Jing Bao Ran Li Wen-Tao Ni Xing-Yu Tan Yu Xu Li-Ping Peng Xiao-Rong Wang Yi-Ming Zeng Dai-Shun Liu Qing Xue Jia-Shu Li Ke Hu Ya-Li Zheng Zhan-Cheng Gao department of Respiratory and Critical care Medicine Peking University People's HospitalBeijing 100044China department of Respiratory and Critical care Medicine The First Hospital of Jilin UniversityChangchunJilin 130021China department of Respiratory and Critical care Medicine Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430022China department of Respiratory and Critical care Medicine The Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujian 362000China department of Respiratory and Critical care Medicine The First People's Hospital of ZunyiZunyiGuizhou 563000China department of Respiratory and Critical care Medicine Ningde People's HospitalNingdeFujian 352000China department of Respiratory and Critical care Medicine The First People's Hospital of LianyungangLianyungangJiangsu 222061China department of Respiratory and Critical care Medicine Renmin Hospital of Wuhan UniversityWuhanHubei 430060China department of Respiratory Critical Careand Sleep MedicineXiang'an Hospital of Xiamen UniversityXiamenFujian 361111China

Background::Coronavirus disease 2019(COVID-19),which is caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has rapidly spread throughout the world.In this study,we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines.Methods::A multicenter,cross-sectional study was conducted on 313 patients hospitalized with COVID-19.Patients were classified into two groups based on disease severity(nonsevere and severe)according to initial clinical presentation.Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics.Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19.Results::A total of 289 patients(197 nonsevere and 92 severe cases)with a median age of 45.0(33.0,61.0)years were included in this study,and 53.3%(154/289)were male.Fever(192/286,67.1%)and cough(170/289,58.8%)were commonly observed,followed by sore throat(49/289,17.0%).Multivariate logistic regression analysis suggested that patients who were aged≥65 years(OR:2.725,95%confidence interval[CI]:1.317-5.636;P=0.007),were male(OR:1.878,95%CI:1.002-3.520,P=0.049),had comorbid diabetes(OR:3.314,95%CI:1.126-9.758,P=0.030),cough(OR:3.427,95%CI:1.752-6.706,P<0.001),and/or diarrhea(OR:2.629,95%CI:1.109-6.231,P=0.028)on admission had a higher risk of severe disease.Moreover,stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19(71.4%vs.28.6%,χ2=8.183,P=0.004).Conclusions::The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different.The elderly,male patients with COVID-19,diabetes,and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.

关键词： Clinical feature Coronavirus disease 2019 Diabetes Risk factor Severe acute respiratory syndrome coronavirus 2

Latest incidence and electrocardiographic predictors of atrial fibrillation:a prospective study from China

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Chinese Medical Journal 2023年第3期136卷 313-321页

作者： Yong Wei Genqing Zhou Xiaoyu Wu Xiaofeng Lu Xingjie Wang Bin Wang Caihong Wang Yahong Shen Shi Peng Yu Ding Juan Xu Lidong Cai Songwen Chen Wenyi Yang Shaowen Liu department of Cardiology Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghai 200080China Shihudang Community Health care Center Shanghai 201604China Dongjing Community Health care Center Shanghai 201619China Xinbang Community Health care Center Shanghai 201605China Maogang Community Health care Center Shanghai 201607China

Background:China bears the biggest atrial fibrillation(AF)burden in the world.However,little is known about the incidence and predictors of AF.This study aimed to investigate the current incidence of AF and its electrocardiographic(ECG)predictors in general community individuals aged over 60 years in China.Methods:This was a prospective cohort study,recruiting subjects who were aged over 60 years and underwent annual health checkups from April to July 2015 in four community health centers in Songjiang District,Shanghai,China.The subjects were then followed up from 2015 to 2019 annually.Data on sociodemographic characteristics,medical history,and the resting 12-lead ECG were collected.Kaplan–Meier curve was used for showing the trends in AF incidence and calculating the predictors of AF.Associations of ECG abnormalities and AF incidence were examined using Cox proportional hazard models.Results:This study recruited 18,738 subjects,and 351(1.87%)developed AF.The overall incidence rate of AF was 5.2/1000 person-years during an observation period of 67,704 person-years.Multivariable Cox regression analysis indicated age(hazard ratio[HR],1.07;95%confidence interval[CI]:1.06–1.09;Paged over 60 years in China.Among various ECG abnormalities,only APC,atrial

关键词： Atrial fibrillation Incidence Predictor Electrocardiogram

MicroRNA-30a inhibits cell proliferation in a sepsis-induced acute kidney injury model by targeting the YAP-TEAD complex

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Journal of Intensive Medicine 2024年第2期4卷 231-239页

作者： Junfeng Su Ying Wang Jing Xie Long Chen Xinxin Lin Jiandong Lin Xiongjian Xiao department of General Intensive care Unit The Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina department of Critical care Medicine The First Affiliated HospitalFujian Medical UniversityFuzhouChina department of Critical care Medicine National Regional Medical CenterBinhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina

Background Acute kidney injury(AKI)is a primary feature of renal complications in patients with sepsis.MicroRNA(miRNA/miR)-30a is an essential regulator of cardiovascular diseases,tumors,phagocytosis,and other physical processes,but whether it participates in sepsis-induced AKI(sepsis-AKI)is unknown.We aimed to elucidate the functions and molecular mechanism underlying miR-30a activity in sepsis-AKI.Methods The classical cecal ligation and puncture(CLP)method and lipopolysaccharide(LPS)-induced Human Kidney 2(HK-2)cells were used to establish in vivo and in vitro sepsis-AKI models.Specific pathogen-free and mature male Sprague-Dawley(SD)rats,aged 6–8 weeks(weight 200–250 g),were randomly divided into five-time phase subgroups.Fluid resuscitation with 30 mL/kg 37°C saline was administered after the operation,without antibiotics.Formalin-fixed,paraffin-embedded kidney sections were stained with hematoxylin and eosin.SD rat kidney tissue samples were collected for analysis by real-time quantitative polymerase chain reaction and enzyme-linked immunosorbent assay.HK-2 cells were transfected with hsa-miR-30a-3p mimics or inhibitors,and compared with untreated normal controls.RNA,protein,and cell viability were evaluated by quantitative reverse transcription-polymerase chain reaction(qRT-PCR),western blot,and cell counting kit-8 methods.A Dual-Luciferase Assay Kit(Promega)was used to measure luciferase activity 48 h after transfection with miR-30a-3p mimics.Results Expression levels of miR-30a-3p and miR-30a-5p in renal tissues of the sepsis group were significantly reduced at 12 h and 24 h(P<0.05).Tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)were significantly increased in renal tissue 3 h after the operation in rats(P<0.05),and gradually decreased 6 h,12 h,and 24 h after CLP.Levels of miR-30a-5p and miR-30a-3p were significantly down-regulated at 3 h after LPS treatment(P<0.05),and gradually decreased in HK-2 cells.One hour after LPS(10µg/mL)treatment,TNF-αand IL-1βlevels in HK-2 cells were significantly up-

关键词： MicroRNA-30a TEAD1 YAP-TEAD complex Sepsis Acute kidney injury

Living near a Major Road in Beijing： Association with Lower Lung Function, Airway Acidification, and Chronic Cough

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Chinese Medical Journal 2016年第18期129卷 2184-2190页

作者： Zhan-Wei Hu Yan-Ni Zhao Yuan Cheng Cui-Yan Guo Xi Wang Nan Li Jun-Qing Liu Hui Kang Guo-Guang Xia Ping Hu Ping-Ji Zhang Jing Ma Ying Liu Cheng Zhang Li Su Guang-Fa Wang department of Respiratory and Critical care Medicine Peking University First Hospital Beijing 100034 China department of Internal Medicine Shichahai Community Health Care Center Beijing 100035 China department of Respiratory and Critical care Medicine Beijing Jishuitan Hospital Beijing 100035 China

Background： The effects of near-road pollution on lung function in China have not been well studied. We aimed to investigate the effects of long-term exposure to traffic-related air pollution on lung function, airway inflammation, and respiratory symptoms. Methods： We enrolled 1003 residents aged 57.96 ± 8.99 years living in the Shichahai Community in Beijing. Distances between home addresses and the nearest major roads were measured to calculate home-road distance. We used the distance categories 1, 2, and 3, representing 〈100 m, 100-200 m, and 〉200 m, respectively, as the dose indicator for traffic-related air pollution exposure. Lung function, exhaled breath condensate （EBC） pH, and interleukin 6 levels were measured. As a follow-up, 398 participants had a second lung function assessment about 3 years later, and lung function decline was also examined as an outcome. We used regression analysis to assess the impacts of home-road distance on lung function and respiratory symptoms. As the EBC biomarker data were not normally distributed, we performed correlation analysis between home-road distance categories and EBC biomarkers. Results： Participants living a shorter distance from major roads had lower percentage of predicted value of forced expiratory volume in 1 s （FEV1% -1.54, 95% confidence interval [CI]： -0.20 to -2.89）. The odds ratio for chronic cough was 2.54 （95% CI： 1.57-4.10） for category 1 and 1.97 （95% CI： 1.16-3.37） for category 2, compared with category 3. EBC pH was positively correlated with road distance （rank correlation coefficient of Spearman [rs] = 0.176, P 〈 0.001 ）. Conclusions： Long-term exposure to traffic-related air pollution in people who live near major roads in Beijing is associated with lower lung function, airway acidification, and a higher prevalence of chronic cough. EBC pH is a potential useful biomarker for evaluating air pollution exposure.

关键词： Air Pollution Airway Inflammation Chronic Cough Exhaled Breath Condensate Lung Function

Relationship of calcitonin gene-related peptide with disease progression and prognosis of patients with severe traumatic brain injury

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Neural Regeneration Research 2018年第10期13卷 1782-1786页

作者： Li-Xiong Chen Wei-Feng Zhang Ming Wang Pi-Feng Jia department of Critical care Medicine North Hospital of Ruijin Hospital department of Neurosurgery North Hospital of Ruijin Hospital

Calcitonin gene-related peptide（CGRP） has been implicated in multiple functions across many bioprocesses; however, whether CGRP is associated with severe traumatic brain injury（TBI） remains poorly understood. In this study, 96 adult patients with TBI（enrolled from September 2015 to December 2016） were divided into a mild/moderate TBI group（36 males and 25 females, aged 38 ± 13 years） and severe TBI group（22 males and 13 females, aged 38 ± 11 years） according to Glasgow Coma Scale scores. In addition, 25 healthy individuals were selected as controls（15 males and 10 females, aged 39 ± 13 years）. Radioimmunoassay was used to detect serum levels of CGRP and endothelin-1 at admission and at 12, 24, 48, 72 hours, and 7 days after admission. CGRP levels were remarkably lower, but endothelin-1 levels were obviously higher in the severe TBI group compared with mild/moderate TBI and control groups. Levels of CGRP were remarkably lower, but endothelin-1 levels were obviously higher in deceased patients compared with patients who survived. Survival analysis and logistic regression showed that both CGRP and endothelin-1 levels were associated with patient mortality, with each serving as an independent risk factor for 6-month mortality of severe TBI patients. Moreover, TBI patients with lower serum CGRP levels had a higher risk of death. Thus, our retrospective analysis demonstrates the potential utility of CGRP as a new biomarker, monitoring method, and therapeutic target for TBI.

关键词： nerve regeneration calcitonin gene-related peptide severe traumatic brain injury prognosis biomarkers endothelin-1 mortality dynamic serum levels critical care medicine neural regeneration

PAI-1 genetic polymorphisms influence septic patients’outcomes by regulating neutrophil activity

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Chinese Medical Journal 2023年第16期136卷 1959-1966页

作者： Shaowei Jiang Yang Wang Liang Chen Honghua Mu Connor Meaney Yiwen Fan Janesh Pillay Hairong Wang Jincheng Zhang Shuming Pan Chengjin Gao department of Emergency Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghai 200092China Division of Rheumatology Department of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUTUSA department of Pathology Medicine Biology University Medical Center GroningenThe Netherlands department of Critical care University Medical Center GroningenThe Netherlands department of Critical care Medicine Zhongshan HospitalFudan UniversityShanghai 200032China

Background:Plasminogen activator inhibitor-1(PAI-1)plays an important role in the pathophysiology of sepsis,but the exact mechanism remains debatable.In this study,we investigated the associations among the serum levels of PAI-1,the incidence of 4G/5G promoter PAI-1 gene polymorphisms,immunological indicators,and clinical outcomes in septic patients.Methods:A total of 181 patients aged 18-80 years with sepsis between November 2016 and August 2018 in the intensive care unit in the Xinhua Hospital were recruited in this retrospective study,with 28-day mortality as the primary outcome.The initial serum level of PAI-1 and the presence of rs1799768 single nucleotide polymorphisms(SNPs)were examined.Univariate logistic regression and multivariate analyses were performed to determine the factors associated with different genotypes of PAI-1,serum level of PAI-1,and 28-day mortality.Results:The logistic analysis suggested that a high serum level of PAI-1 was associated with the rs1799768 SNP of PAI-1(4G/4G and 4G/5G)(Odds ratio[OR]:2.49;95%confidence interval[CI]:1.09,5.68).Furthermore,a high serum level of PAI-1 strongly influenced 28-day mortality(OR 3.36;95%CI 1.51,7.49).The expression and activation of neutrophils(OR 0.96;95%CI 0.93,0.99),as well as the changes in the expression patterns of cytokines and chemokine-associated neutrophils(OR:1.00;95%CI:1.00,1.00),were both regulated by the genotype of PAI-1.Conclusions:Genetic polymorphisms of PAI-1 can influence the serum levels of PAI-1,which might contribute to mortality by affecting neutrophil activity.Thus,patients with severe sepsis might clinically benefit from enhanced neutrophil clearance and the resolution of inflammation via the regulation of PAI-1 expression and activity.

关键词： Gene polymorphism Neutrophil Plasminogen activator inhibitor-1 PAI-1 Sepsis Single nucleotide polymorphism