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.     

系统康复治疗对年轻肩关节脱位患者肩关节稳定性的作用

目的对年轻患者肩关节脱位进行系统的康复治疗,以检验系统康复疗法疗效优于单纯固定的假设。方法根据所采用的治疗方法,将43例40岁以下的急性肩关节脱位患者分成实验组23例,对照组20例。实验组患者进行包括关节活动范围锻炼、发展肩胛骨周围肌的肌力训练、发展肩袖肌的肌力、适度的外展、外旋锻炼及耐力训练在内的系统康复治疗。对照组只进行单纯固定后未经系统康复治疗。对两组患者的临床效果进行比较。结果实验组复发率为17%(4/23),对照组复发率为45%(9/20),两组复发率比较差异有显著性意义(χ2=3.866,P<0.05);随访结果显示肩关节ASES评分实验组为90.9±4.87,对照组为75.4±4.94,两组差异有非常显著性意义(t=9.94,P=2.99×10-12<0.01)。结论肩关节脱位年轻患者进行系统的康复锻炼,可以提高患肩的稳定性。     

安体维康诱导肝细胞凋亡实验研究及临床观察

目的 :评价中药制剂安体维康 ( Antivirus Compound,ATVC)诱导人肝癌细胞凋亡的作用及临床疗效。方法 :采用 MTT(细胞毒 )实验培养人肝癌细胞株 BEL - 740 2细胞 ,加入不同浓度安体维康药液进行培养与对照组进行比较。临床给原发性肝癌 1 0例服用安体维康胶囊 3个月。结果 :安体维康能抑制人肝癌细胞株 BEL- 740 2细胞生长 ,有诱导肝细胞凋亡的作用。其作用强弱在一定程度上存在剂量和时间效应。服用安体维康的肝癌患者临床症状明显改善。结论 :安体维康可诱导人肝癌细胞调亡 ,对原发性肝癌有一定临床疗效     

膝关节置换随访护理质量评价指标体系的构建

目的构建膝关节置换患者随访护理质量评价指标体系,以期为临床评价膝关节置换患者随访护理质量提供参考依据。方法通过文献分析法及半结构式访谈,以“结构-过程-结果”三维质量结构理论为指导,拟定指标体系初稿,采用德尔菲法对19名专家进行2轮专家函询,初步构建膝关节置换术患者随访护理质量评价指标体系。结果两轮函询问卷回收率均为100%,专家权威系数分别为0.804和0.831,肯德尔和谐系数分别为0.234和0.303,均P<0.01。最终形成包括3项一级指标,13项二级指标,50项三级指标的膝关节置换患者随访护理质量评价指标体系。结论构建的膝关节置换患者随访护理质量评价指标体系具有较好的科学性与可靠性,为临床评价膝关节置换患者随访护理质量提供了参考依据。     

彩色多普勒组织显像在小儿病毒性心肌炎诊断中的应用

本文报告用彩色多普勒组织显像(DTI)测定正常小儿173名,病毒性心肌炎40例,发现DTI在正常小儿的规律。病毒性心肌炎二尖瓣环舒张早期运动速度(MVR-DeV)显著低于正常儿童,40例病毒性心肌炎MVR-DeV降低者占72.5％,经过治疗后MVR-DeV90％以上短期内恢复正常。MVR-DeV降低率显著高于心脏解剖、心功能、心脏血流参数、心电图和心肌酶的异常率。因此,MVR-DeV对病毒性心肌炎的诊断、病情了解以及疗效观察均有重要价值。     

肾炎合并乙型肝炎病毒感染患者激素与抗病毒药物的联合应用价值

目的对肾炎合并乙型肝炎病毒感染患者进行激素与抗病毒药物联合治疗，研究在该类疾病中的应用价值。方法选取在我院住院治疗的非乙型肝炎病毒携带的肾炎患者40例为对照组，给予甲基强的松龙40mg／d．1周后改为强的松1mg／（kg·d），后按照肾炎治疗标准减量。肾炎合并乙型肝炎患者45例为治疗组，加用拉米夫定100mg／d治疗。对所有患者治疗前后HBVDNA、肝肾功能、血尿常规进行测定。结果治疗组HBVDNA阴性者治疗后仍阴性；HBVDNA（滴度10^2-10^3）者治疗后41．2％转阴，52．9％滴度下降，5．9％滴度先下降后又上升；HBVDNA（滴度10^4-10^5）者治疗后33．3％转阴性，33-3％滴度下降，33-3％先下降后上升；HBVDNA（滴度10^6，10^7）者100％滴度下降。对照组治疗前后谷丙转氨酶、谷草转氨酶水平比较差异无统计学意义（P〉0．05）；治疗组治疗前后谷丙转氨酶、谷草转氨酶水平比较差异亦无统计学意义（P〉0．05）。对照组与治疗组药物治疗后，肾炎治疗疗效比较，对照组完全缓解率为55．O％，总有效率为80．0％；治疗组完全缓解率为57．8％，总有效率为86．7％。两组比较差异均无统计学意义（P〉0．05）。结论激素联合抗病毒药物拉米夫定治疗肾炎合并乙肝病毒感染的患者安全有效，HBVDNA及肝功能影响小，临床缓解率与非乙肝病毒感染的肾炎患者相当。     

Invasive pulmonary aspergillosis secondary to microwave ablation: a multicenter retrospective study

Purpose: Invasive pulmonary aspergillosis (IPA) is a life-threatening complication of microwave ablation (MWA) during the treatment of primary or metastatic lung tumors. The purpose of this study was to investigate the clinical, radiological and demographic characteristics and treatment responses of patients with IPA after MWA.

Materials and methods: From January 2011 to January 2016, all patients who were treated by MWA of their lung tumors from six health institutions were enrolled in this study. Patients with IPA secondary to MWA were identified and retrospectively evaluated for predisposing factors, clinical treatment, and outcome.

Results: The incidence of IPA secondary to lung MWA was 1.44% (23/1596). Of the 23 patients who developed IPA, six died as a consequence, resulting in a high mortality rate of 26.1%. Using computed tomography (CT), pulmonary cavitation was the most common finding and occurred in 87.0% (20/23) of the patients. Sudden massive hemoptysis was responsible for one-third of the deaths (2/6). Most patients (22/23) received voriconazole as an initial treatment, and six patients with huge cavities underwent intracavitary lavage. Finally, 17 patients (73.9%) achieved treatment success.

Conclusions: Lung MWA may be an additional host risk factor for IPA, particularly in elderly patients with underlying diseases and in patients who have recently undergone chemotherapy. Early and accurate diagnosis of IPA after MWA is critical for patient prognosis. Voriconazole should be given as the first-line treatment as early as possible. Bronchial artery embolization or intracavitary lavage may be required in some patients.     

Usefulness of hematopoietic progenitor cell monitoring to predict autologous peripheral blood stem cell harvest timing: A single-center retrospective study

IntroductionIn autologous peripheral blood stem cell harvest (APBSCH), CD34-positive cells have been measured to assess the numbers of hematopoietic stem cells, but measurement requires specialized equipment. Recently, there was a report that peripheral blood hematopoietic progenitor cells (HPCs) are useful indicators of the presence of hematopoietic stem cells. We examined the usefulness of HPC monitoring to predict APBSCH timing.MethodsWe retrospectively analyzed the relationship between HPC and collected CD34-positive cells in 84 consecutive patients who underwent APBSCH.ResultsAccording to the receiver operating characteristics curve for the collection of ≥2 × 106 CD34-positive cells/kg, the HPC cut-off value on the day before collection was 21/μL, while that on the day of collection was 41/μL. No significant factors were found in the univariate analysis except for the HPC count on the day before collection (p < 0.001) and the day of collection (p < 0.001). According to the multivariate analysis, the HPC count on the day before collection (p < 0.001) and the day of collection (p < 0.001) were also factors that strongly influenced the quantity of CD34-positive cells collected.ConclusionOur results suggest that the HPC count on not only the day of collection but also the day before collection is a good indicator for appropriate APBSCH timing.     

Assessment of Diffuse Thyroid Disease by Strain Ratio in Ultrasound Elastography

The goal of this study was to explore the value of strain ratio from real-time elastography in the semi-quantitative assessment of diffuse thyroid disease. Fifty-one patients with primary hyperthyroidism, 70 with Hashimoto's thyroiditis, 8 with subacute thyroiditis and 43 with normal healthy thyroids were recruited to measure the strain ratio (SR) of thyroid tissue and sternocleidomastoid muscle (on the same side of the thyroid). SR values of all groups were subjected to statistical analysis. The SRs (mean ± standard deviation) of patients with hyperthyroidism, Hashimoto's thyroiditis and subacute thyroiditis were 2.30 ± 1.08, 7.04 ± 7.74 and 24.09 ± 13.56, respectively. The SR of the control group was 1.76 ± 0.54. SR values ranked in ascending order were control group < hyperthyroidism group < Hashimoto's thyroiditis group < subacute thyroiditis group. There were statistically significant (p < 0.05) differences in thyroid hardness between groups with different diffuse thyroid diseases. SR values of the hyperthyroidism and control groups did not statistically differ (p > 0.05). It is feasible to assess diffuse thyroid disease with strain ratios obtained with ultrasound elastography.