Effect of a Simple Exercise Program on Hospitalization-Associated Disability in Older Patients: A Randomized Controlled Trial

ObjectiveHospitalization-associated disability [HAD, ie, the loss of ability to perform ≥1 basic activities of daily living (ADLs) independently at discharge] is a frequent condition among older patients. The present study assessed whether a simple inpatient exercise program decreases HAD incidence in acutely hospitalized very old patients.DesignIn this randomized controlled trial (Activity in Geriatric Acute Care) participants were assigned to a control or intervention group and were assessed at baseline, admission, discharge, and 3 months thereafter.Setting and ParticipantsIn total, 268 patients (mean age 88 years, range 75–102) admitted to an acute care for older patients unit of a public hospital were randomized to a control (n = 125) or intervention (exercise) group (n = 143).MethodsBoth groups received usual care, and patients in the intervention group also performed simple supervised exercises (walking and rising from a chair, for a total duration of ∼20 minutes/day). We measured ADL function (Katz index) and incident HAD at discharge and after 3 months (primary outcome) and Short Physical Performance Battery, ambulatory capacity, number of falls, rehospitalization, and death during a 3-month follow-up (secondary outcomes).ResultsMedian duration of hospitalization was 7 days (interquartile range 4 days). The intervention group had a lower risk of HAD with reference to both baseline [odds ratio (OR) 0.36; 95% confidence interval (CI) 0.17–0.76, P = .007] and admission (OR 0.29; 95% CI 0.10–0.89, P = .030). A trend toward an improved ADL function at discharge vs admission was found in the intervention group compared with controls (OR 0.32; 95% CI ‒0.04 to 0.68; P = .083). No between-group differences were noted for the other endpoints (all P > .05).Conclusion and ImplicationsA simple inpatient exercise program decreases risk of HAD in acutely hospitalized, very old patients.     

基于ITS2序列的翻白草与委陵菜分子鉴定

目的 应用DNA条形码技术对翻白草及易混品委陵菜进行分子鉴定,保障药材质量和临床用药安全。方法 提取翻白草及委陵菜的基因组DNA,扩增内转录间隔区2（ITS2）序列并双向测序,所得序列用SeqMan软件校对、拼接;在线双序列比对翻白草对照药材（F_R）及委陵菜对照药材（W_R）的ITS2序列,并预测其二级结构;从GenBank下载部分相关序列,运用MEGA X软件进行多序列比对,分析序列变异位点,计算种内、种间遗传距离,采用邻接法（NJ）构建系统进化树。结果 所有样品均成功扩增出ITS2序列,翻白草和委陵菜的ITS2序列长度均为210 bp。双序列比对结果表明,F_R与W_R的ITS2序列相似性为92.9%,二级结构存在明显差异。多序列分析结果表明,翻白草ITS2序列平均鸟嘌呤（G）+胞嘧啶（C）占比为63.0%,存在2个变异位点,种内遗传距离为0~0.009 6;委陵菜ITS2序列平均G+C占比为64.4%,存在5个变异位点,种内遗传距离为0~0.019 3;种间遗传距离为0.054 8~0.075 8。NJ树结果显示,翻白草、委陵菜聚为不同分支,可明显区分。结论 利用ITS2序列可以准确鉴别翻白草与委陵菜,为保障其安全用药提供了新的技术手段。     

基于Bevilacqua模型的乳腺癌保乳术患者术后淋巴水肿风险预测的临床研究

目的验证Bevilacqua乳腺癌术后淋巴水肿风险预测模型的临床适用性及可行性。方法回顾性分析2010年1月至2015年12月203例乳腺癌患者临床资料,临床数据分析使用统计学软件SPSS 24.0。Cox回归模型分析乳腺癌患者术后发生上肢淋巴水肿的危险因素,以P<0.05为有统计学意义;绘制ROC曲线,以曲线下面积检验模型预测效果;应用Hosmere-Lemeshow检验评估预测值与实际值的校准程度,以P>0.05为预测模型校准能力较好,预测与实际没有区别。结果所有患者随访共计62~86个月,中位随访时间70个月。术后5年内共发生上肢淋巴水肿患者45例(22.2%)。Cox回归模型分析结果显示,高身体质量指数(BMI)、接受过新辅助化疗、全腋窝淋巴结清扫、接受过放疗是上肢淋巴水肿的独立危险因素。Becilacqua上肢淋巴水肿风险预测模型ROC曲线分析结果显示,模型AUC值为0.711,95%CI(0.651~0.760),有较好的的预测效果。Hosmer-Lemeshow检验结果显示,风险预测模型预测风险与实际无明显差异(P=0.262),校准能力较好,与实际差别不大。结论Bevilacqua术后6个月淋巴水肿风险预测模型的准确性及适用性较高,可用于临床对乳腺癌保乳术后淋巴水肿的预测,可为预防淋巴水肿的发生制定干预决策提供参考。     

The mediating role of Mediterranean diet on the association between Lp(a) levels and cardiovascular disease risk: A 10-year follow-up of the ATTICA study

ObjectiveΤo evaluate the combined modifying effect of dietary habits and/or features of healthy aging, on the lipoprotein-alpha [Lp(a)] and CVD risk association.Design and MethodsΤhe ATTICA is a prospective, population-based study conducted in the greater metropolitan area of Athens (Attica, Greece). During 2001–2002, 3042 CVD-free adults (men/women: 1514/1528, 18–89 years) agreed to participate. In 2011–2012, the 10-year study follow-up was performed, recording the fatal/non-fatal CVD incidence in 2020 participants (mean follow-up: 8.41 years). Various bio-clinical characteristics [including low-density lipoprotein-cholesterol (LDL-C), Lp(a)] were derived through standard procedures. Dietary habits were assessed through the MedDietScore (an index assessing adherence to the Mediterranean diet with theoretical range 0–55). A validated successful aging index (SAI), ranging from 0 to 10, was used to assess healthy aging.ResultsLp(a) levels were positively associated with 10-year CVD incidence (Hazard Ratio: 1.02, 95%CI 1.01–1.04); when MedDietScore was included in the model the observed association between Lp(a) levels and CVD risk disappeared (1.00, 95%CI 0.98–1.01), and a mediating effect of Mediterranean diet was revealed (Sobel's test p < 0.001). In the model that included both MedDietScore and SAI, the interaction effect of these two features on 10-year CVD risk was highly protective (p < 0.001), whereas the association between Lp(a) levels and CVD risk was further mediated (Sobel's test p < 0.001).ConclusionsAdherence to a healthy dietary pattern, like the Mediterranean diet seems to mediate the association between Lp(a) with CVD risk whereas a successful aging together with a healthy diet seems to further explain the previously mentioned association.     

CXCR5+ CD8+ T cells could induce the death of tumor cells in HBV-related hepatocellular carcinoma

The follicular CXCR5⁺ CD8⁺ T cells have recently emerged as a critical cell type in mediating peripheral tolerance as well as antiviral immune responses during chronic infections. In this study, we investigated the function of CXCR5⁺ CD8⁺ T cells in HBV-related hepatocellular carcinoma patients. Compared to CXCR5⁻ CD8⁺ T cells, CXCR5⁺ CD8⁺ T cells presented elevated PD-1 expression but reduced Tim-3 and CTLA-4 expression. Upon anti-CD3/CD28 stimulation, CXCR5⁺ CD8⁺ T cells demonstrated higher proliferation potency than CXCR5⁻ CD8⁺ T cells, especially after PD-1 blockade. CXCR5⁺ CD8⁺ T cells also demonstrated significantly higher granzyme B synthesis and release, as well as higher level of degranulation. Tumor cells were more readily eliminated by CXCR5⁺ CD8⁺ T cells than by CXCR5⁻ CD8⁺ T cells. Interestingly, we found that B cells were more resistant to CXCR5⁺ CD8⁺ T cell-mediated killing than tumor cells, possibly through IL-10-mediated protection. In addition, the CXCR5⁺ CD8⁺ T cell-mediated cytotoxic effects on tumor cells could be significantly enhanced by PD-L1 blockade. Together, we presented that in patients with in HBV-related hepatocellular carcinoma, CXCR5⁺ CD8⁺ T cells could mediate tumor cell death more potently than the CXCR5⁻ CD8⁺ T cells in vitro while the autologous B cells were protected.     

玻璃体切割联合后巩膜加固术治疗高度近视眼黄斑裂孔性视网膜脱离

目的：探讨玻璃体切割联合后巩膜加固治疗高度近视眼黄斑裂孔伴视网膜脱离的方法与疗效。
　　方法：于2012-01/2013-12间收集高度近视性黄斑裂孔伴视网膜脱离患者45例45眼,分为玻璃体切割内界膜撕除联合后巩膜加固组( A组)28眼和玻璃体切割内界膜撕除组( B组)17眼。术前分别行视力、眼压、间接检眼镜、OCT检查,术后随访6~12mo,行视力、OCT检查,分别对视力、视网膜复位情况、黄斑裂孔闭合情况进行统计比较。
　　结果：(1)视力检查：术后视力：A 组1.19±0.39, B 组1.51±0.34,二者比较有显著性差异(P<0.05);(2)术后视网膜复位率：A组100%,B组88.24%,两者比较无统计学差异;(3)术后黄斑裂孔闭合率：A 组82%,B 组53%,两者比较有统计学差异(P<0.05)。
　　结论：玻璃体切割术联合后巩膜加固术治疗高度近视眼黄斑裂孔伴视网膜脱离的手术方法安全可行,可更好的改善视力,提高黄斑裂孔的闭合率。     

胰岛素样生长因子2通过磷酯酰肌醇-3激酶/蛋白激酶B信号通路调控人卵巢颗粒细胞增殖的机制

目的 检测胰岛素样生长因子2（IGF2）对人卵巢颗粒细胞（KGN细胞）增殖的调控作用及作用机制。 方法 将体外培养的KGN细胞,分不同浓度IGF2处理组（对照组和25 μg/L、50 μg/L、100 μg/L IGF2组)和磷酯酰肌醇-3激酶/蛋白激酶B(PI3K/Akt)信号通路干预组（以LY294002干预处理将细胞分对照组、100μg/L IGF2组、LY294002组和IGF2+LY294002组）。采用MTS和5-乙炔基-2’-脱氧尿苷(EdU)法检测IGF2对KGN细胞增殖的影响,ELISA法检测细胞培养液上清中雌激素、孕激素的含量,Western blotting法检测各组胰岛素样生长因子受体1（IGF1R）、蛋白激酶B（Akt）、磷酸化的蛋白激酶B（p-Akt）及CYP19A1蛋白表达。 结果 随着IGF2的浓度梯度增高,KGN细胞的增殖率及雌激素、孕激素的分泌量逐渐升高,以 100 μg/L IGF2处理组的细胞增殖率和激素水平最高 (P<0.01),而抑制PI3K/Akt信号通路,细胞增殖率和激素的分泌量均明显降低(P<0.01);Western blotting结果显示,IGF1R、p-Akt及CYP19A1 蛋白表达水平随着IGF2的浓度梯度逐渐升高(P<0.05),而干预PI3K/Akt信号通路可影响上述蛋白的表达,与对照组相比,IGF2组和IGF2+ LY294002组IGF1R及p-Akt蛋白表达均明显升高（P<0.01）,CYP19A1在IGF2组明显升高（P<0.01）,LY294002组p-Akt及 CYP19A1蛋白明显降低（P<0.05）,IGF1R的表达差异无统计学意义。与IGF2组相比,IGF2+LY294002组p-Akt及CYP19A1蛋白表达降低（P<0.01）,IGF1R的表达差异无统计学意义,LY294002组p-Akt 及CYP19A1蛋白表达量均显著降低（P<0.01）。 结论 IGF2 可能由IGF1R介导通过PI3K/Akt 信号通路促进人卵巢颗粒细胞的增殖及分泌功能。