老年骨髓增生异常综合征的临床特征分析

目的：探讨老年骨髓增生异常综合征(MDS)的临床特点，以利于有效诊治。方法：回顾性分析23例老年MDS患者确诊时的形态学改变以及症状、体征、伴发疾病和初次治疗反应等临床资料。结果：老年MDS起病较为隐匿，所有患者均有不同程度病态造血，95．7％的患者发生贫血，其中21．8％为重度贫血；30．4％的患者白细胞减低，其中21.8％的患者血小板减低．78．3％的患者伴发其他疾病。常规治疗措施对本组患者疗效极差。结论：目前尚无早期诊断和有效治疗老年MDS的满意策略，呼吁重视此方面研究。     

老年急性心肌梗死并发脑血管病22例临床分析

目的：探讨老年急性心肌梗死(AMI)并发脑血管病的机制及其临床特点。方法：回顾性分析22例老年AMI合并脑血管病患的临床资料。结果：老年AMI并发脑血管病发病率14．1％，其中并发脑梗死14例，短暂性脑缺血发作(TIA)7例，脑出血1例；并发脑血管病死亡5例。结论：老年AMI合并脑血管病是老年AMI特有合并症之一，并成为老年AM1重要的死亡原因之一。     

232例老年人重症肌无力的临床分析

目的:分析老年人重症肌无力(MG)的有关临床特点。方法:回顾性分析26年间诊治的232例老年MG患者的临床资料。结果:老年人MG占总MG病例数(3010例)的比例为7．7％。男性多于女性，男：女=1．3：1。老年人MG多在60～70岁间发病，在其常见首发症状中，眼症状184例(79．3％)、咽喉肌无力30例(12．9％)、肢体肌肉无力17例(7．3％)。老年人MG中，全身型的构成比多于眼型(62．9％对37．1％)，较少并存自身免疫性疾病和发生危象，常合并胸腺瘤(33例)及内外科其他疾病(87例)。结论:老年人MG具有独特的临床特点，了解这些特点将有利于指导临床诊断和治疗。     

综合性医院老年肺结核临床分析

目的 了解综合性医院老年人肺结核发病的临床特点。方法 对以例60岁以上老年肺结核患的临床资料进行研究，分析其基础疾病、起病和临床特征等。结果 本组以例老年肺结核思考有以下几个特点：1．基础疾病多，73．4％有基础疾病，其中主要为糖尿病、COPD、心血管疾病、肿瘤等；2．起病不典型，午后低热、盗汗等结核中毒症状不典型；3．临床症状不典型，主要表现为咳嗽、咳白痰、咯血、胸闷、发热、乏力、纳差等，发热仅占32．8％；4．思考营养状况差，有贫血35．9％，存在电解质紊乱28．1％，思考存在低蛋白血症32．8％；5．既往有结核病史多，占56．3％；6．误诊率高，主要为肺炎(41．4％)和肺癌(42．2％)。结论 近年来老年结核病疫情严重，临床症状不典型，误诊率高，临床上应及早诊断及治疗。     

老年哮喘控制不良的相关因素与对策

目的探讨老年哮喘控制不良的相关因素与对策。方法选择70例老年哮喘病人并完成了问卷调查。内容包括病人的基本情况、哮喘控制程度、用药依从情况；社会、家庭及经济的影响；伴发疾病等。结果70例全部为慢性持续期或急性发作期病人。60岁以前发病61例(87．1％)，有吸烟史48例(68．6％)，能坚持吸入激素治疗5例(7．1％)。问卷初步发现，有多种药物相关因素和非药物因素与老年哮喘控制不良有关。老年人平均患5种以上疾病，并影响着哮喘的控制。结论老年病人治疗依从性差，导致哮喘控制不良的相关因素较多。应加强对老年哮喘的预防、管理和规范化治疗。从而提高疾病的控制率。     

乌鲁木齐地区58例老年重症肺炎临床分析

目的总结老年重症肺炎临床及诊治特点。方法对我院收治的乌鲁木齐地区58例老年重症肺炎的临床资料进行分析。结果临床治愈：9例，占15．5％，好转：19例，占32．8％，死亡：30例，占51．7％。结论老年重症肺炎的临床症状不典型，死亡率高，早期诊断和及时给予经验性用药是有效治疗的关键。     

75例先天性心脏病感染性心内膜炎的临床分析

目的：探讨先天性心脏病(先心病)感染性心内膜炎(IE)的临床特点。方法：回顾性分析75例住院患者中各类先心病IE的并发率、临床特点、血培养、心内膜受累和治疗情况。结果：①先心病IE中主动脉瓣病变发病率最高(6．2％)；②手术证实累及多个瓣膜。病变多样；③尿检查改变、肝大和脾大的发生率及血培养阳性率(35．7％)较文献报道下降，可能与抗生素广泛应用和感染的主要致病微生物与过去不同有关；①手术治疗45例，治愈44例(97．8％)，死亡1例，内科治疗30例，治愈13例(43．3％)，因动脉栓塞或心功能恶化而出院14例，死亡3例。结论：适当的内科治疗与积极的外科治疗相结合对提高先心病IE存活率、降低病死率有重要意义。     

晚发老年性哮喘68例临床分析

目的通过对晚发老年性哮喘患者的临床诊疗分析，以提高晚发老年，陛哮喘的诊断率和治疗成功率。方法回顾性分析68例晚发老年性哮喘的临床资料，探讨其诊断、疾病特点及临床疗效等。结果初诊误诊23例（33．8％），重症哮喘26例（38．2％），合并两种以上疾病5l例（75％），不合理治疗28例（41．2％），好转出院63例（92．6％），无效5例（7．4％）。结论晚发老年性哮喘常合并其他疾病，临床症状不典型易漏诊、误诊或治疗不合理，重症哮喘病例多，临床疗效较差；认真分析病史和疾病特点，尽快明确诊断及时按哮喘原则处理改善机体缺氧，是提高临床疗效的关键。     

老年人药物性肝损害88例临床分析

目的 探讨致老年人药物性肝损害的药物种类、临床特点及防治原则。方法 对1998年1月。2001年12月我院老年病科88例发生药物性肝损害的住院病例临床资料进行回顾性分析。结果 药物性肝损害患病率为2．34％，老年患联合用药多，引起肝损害以心血管药物最多(28．41％)，其次是抗肿瘤药(23．86％)，再次是抗生素(18．16％)。主要临床症状为疲乏纳差、恶心呕吐(36．36％)，黄疸(9．09％)，低热(5．7％)，皮肤搔痒(4．5％)，无症状(61．4％)。临床治愈率75％，无一例出现肝衰竭。结论 心血管药，抗肿瘤药和抗生素是引起老年人药物性肝损害的常见药物。老年患肝功能受损后大多无明显症状。老年人肝损害与其肝药物代谢酶活性降低，长期联合用药有关。老年人应定期检测肝功能。     

老年肺部疾病住院患者523例临床分析

目的：了解老年肺癌疾病的特点及发病情况，方法：对我院2000年内科收住院的60岁以上的523例老年肺疾病患者进行临床分析，结果：523例老年肺部疾病住院患者，男327例，女196例；占同期住院患者1489例的35．12％，有并发症者223例，占42．64％，并发症所涉及的病种有49种之多，其中以呼吸系统并发症最多，为112例占50．2％，其次为心血管系统34例占15．25％，糖尿病19例占8．5％。病种分布以肺结核，肺癌，慢性支气管炎为前三位，分别占49．17％、18．93％和8．60％。结论：老年肺部疾病发病率高，病种包括广泛，并发症我，病情复杂，涉及到全身各个系统疾病。     

不同细胞类型咳嗽变异型哮喘的临床特征分析

目的比较不同细胞类型的咳嗽变异型哮喘患者的临床特征差别。方法选择2014年12月至2017年3月在本院咳嗽门诊就诊的慢性咳嗽患者,遵循中国慢性咳嗽指南(2015版)诊治流程,在询问病史、临床症状和获得体征的基础上,进行血常规、胸片、肺通气功能+气道反应性、诱导痰细胞学分类等相关检查,依据检查结果和治疗反应,确定病因诊断,筛选出咳嗽变异型哮喘,依据诱导痰细胞学分类计数检查结果进行分组,比较不同细胞类型的成人咳嗽变异型哮喘患者的临床特征差别。结果共收集诊断明确且病因单一的成人咳嗽变异型哮喘患者114例,占所有慢性咳嗽患者的32.95%,其中男性56例(48.7%),女性58例(51.3%)。按细胞类型分类:嗜酸性粒细胞增多型23例(20.2%),中性粒细胞增多型53例(46.5%),寡细胞型14例(12.3%),混合细胞型24例(21.1%);分组比较显示:中性粒细胞增多型年龄最长(P=0.042),而嗜酸性粒细胞增高型患者的FeNo值水平最高(P<0.001);混合细胞型患者咳嗽时间最长(P=0.012),与寡细胞型相比较,混合细胞型患者有明确体育锻炼史(P=0.007)。结论不同细胞类型的成人咳嗽变异型哮喘患者的临床特征存在较明显的差别,可以用于指导临床疾病管理。     

住院患者老年综合评估规范及初步效果分析

目的：探讨在老年住院患者中进行老年综合评估（CGA）对于老年人全面综合管理的作用。方法制定标准的CGA流程,采用标准流程对北京协和医院老年病房2013年9月至2014年9月连续入院的≥65岁患者进行CGA,分析其筛查老年综合征的效果。结果标准化的评估流程便于临床使用,接受评估的179例患者中,年龄（72.5±8.1）岁。通过CGA发现,视力异常患者占62.0%,睡眠障碍41.3%,听力异常40.8%,慢性疼痛34.6%,跌倒25.7%,多重用药23.5%,便秘21.8%,抑郁焦虑18.4%,尿失禁16.2%,谵妄10.6%。以不同主诉入院的15例患者最终诊断为老年综合征,占8.4%。结论老年综合征在老年患者中普遍存在,运用标准化的CGA方法可以进行有效筛查,有利于老年患者的全人管理。     

A Population-based Clinical Study of Allergic and Non-allergic Asthma

Background. The aim of this study was to describe differences between allergic and non-allergic asthma in a large community-based sample of Danish adolescents and adults. Methods. A total of 1,186 subjects, 14 to 44 years of age, who in a screening questionnaire had reported a history of airway symptoms suggestive of asthma and/or allergy, or who were taking any medication for these conditions were clinically examined. All participants were interviewed about respiratory symptoms, and furthermore skin test reactivity, lung function, and airway responsiveness were measured. Results. A total of 489 individuals had clinical asthma of whom 61% had allergic asthma, whereas 39% had non-allergic asthma. Subjects with non-allergic asthma were more likely to be females, OR = 2.24 (1.32–3.72), p = 0.003, and to have cough as the predominant symptom, OR = 1.96, (1.19–3.23), p = 0.008, but were less likely to have AHR, OR = 0.40, (0.24–0.66), p < 0.001, food allergy, OR = 0.28, (0.11–0.73), p = 0.009, and symptoms of rhinitis, OR = 0.08 (0.05–0.14) compared with subjects with allergic asthma. Subjects with non-allergic asthma had had persistent symptoms within the last 4 weeks more often than subjects with allergic asthma (68% vs. 53%), p = 0.001. Conclusions. Non-allergic asthma accounts for two in every five cases of asthma in adults and constitutes symptomatically, and in terms of lung function, a more severe form of disease than allergic asthma.     

The relationships between patients'' related variables in asthma: Implications for asthma management

OBJECTIVE: Understanding patients' personal characteristics is essential for better asthma management. This study assessed the relationships between patients' related variables in asthma and identified key associations relevant to asthma management. METHODOLOGY: Subjects were recruited from the Alfred Hospital Asthma and Allergy Clinic (Melbourne, Victoria, Australia) and general practices. Their clinical and demographic characteristics, asthma knowledge, impact of asthma on their quality of life, their self-management skills and attitudes to asthma were assessed. RESULTS: One hundred and sixty-nine subjects participated in the study. Fifty-seven per cent had one or more previous hospital admissions, 94% had either moderate or severe asthma, and 51% reported nocturnal symptoms in the last 6 weeks. Patients who spoke only English, had been admitted to an intensive care unit, had a peak flow meter, and an asthma action plan had significantly better asthma knowledge than those who did not. The impact of asthma was greatest in patients who had a peak flow meter, used oral steroids, had exercise limitation, and developed asthma between the ages of 31-45 years. Female patients had better self-management skills than males. Patients with asthma-related distress were more likely to use oral steroids or theophylline and to have a history of previous hospital admissions. Patient self-confidence was negatively correlated with age. CONCLUSIONS: There are significant relationships between many of patients' variables related to asthma, including their personal clinical, demographic and psychological characteristics. The findings have implications for optimizing asthma management.     

Geriatric medicine and geriatric psychiatry clinical services affiliated with U.S. academic medical centers

U.S. academic medical centers are providing many geriatric medicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non-VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non-VHA GM and GP services, affiliation with 21 Programs of All-Inclusive Care for the Elderly, and 12 other specialized services. The mean number+/-standard deviation of distinct clinical services at each medical center was 16.4+/-8.2. More geriatrics faculty full-time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu).     

Chronic cough at a non‐teaching hospital: Are extrapulmonary causes overlooked?

OBJECTIVE: To estimate the prevalence, assess the diagnostic approach and to identify specific causes and treatment response of chronic persistent cough (CPC) in consecutive adult patients attending the chest clinic at a non-teaching hospital in Riyadh, Saudi Arabia. METHODOLOGY: Chronic persistent cough was defined as cough persisting for more than 3 weeks. Patients were assessed clinically and investigated according to the suspected diagnosis. The specific causes were confirmed by appropriate investigations, as well as response to specific therapy. Improvement in cough following therapy was assessed subjectively by patients on a scale from 0 to 100%. RESULTS: Of 1332 patients seen in the chest clinic, 136 (10.2%; 95% confidence interval 8.6-11.8%) presented with CPC as the main complaint. One hundred patients (55% males) were assessed, after excluding 36 patients who were lost to follow up. The common presenting diagnoses (for the 81 patients who had previously consulted a physician) were upper respiratory tract infection (17.1%), asthma (15.9%), bronchitis (9.8%) and unknown in 30.8% of patients. Final diagnoses (as a sole or contributory cause) were established in 96% of patients and included rhinosinusitis (RS; 60%), asthma (26%), gastro-oesophageal reflux (GERD; 9%), postinfectious cough (8%) and bronchiectasis (5%). The agreement between the presenting and final diagnoses was generally poor, especially for extrapulmonary causes, which was as low as 5.3%. All patients, except for one, had complete or substantial improvement in the severity of cough. CONCLUSIONS: In a non-teaching hospital setting, CPC is a common benign disorder that rarely requires specialized investigations and is easily treated once the causes are identified. The multiplicity of causes and extrapulmonary triggers of CPC, particularly RS, are often overlooked. The principal causes in our series remain the same as in studies elsewhere, namely RS, asthma and GERD.     

Limited treatment adaptation despite poor asthma control in asthma patients treated with inhaled corticosteroids

Objective: Current asthma guidelines recommend use of inhaled corticosteroids (ICS) in patients with persistent disease. This study was designed to investigate (1) the proportion of patients prescribed ICS-containing maintenance treatment who achieve asthma control, (2) determinants of control and (3) how physicians adapt treatment to the level of control. Methods: General practitioners (GPs) and chest physicians (CPs) in France recruited patients consulting for asthma and prescribed an ICS. Over a 2-year follow-up period, asthma symptoms in the previous 3 months and treatments prescribed were documented at each visit. Variables independently associated with asthma control were determined by multiple logistic regression. Results: Data were available for 924 patients recruited by GPs and 455 recruited by CPs. Asthma control was acceptable in only 24% of patients at inclusion, and in 33.6% at the last follow-up visit. Five factors were independently associated with asthma control: age (or time since diagnosis), gender, smoking status, allergic aetiology of asthma and treatment. Most patients (56.3%) were prescribed the same ICS dose regimen at the end of follow-up as at inclusion. The intensity of controller therapy had been increased in only 12.2% of patients unacceptably controlled at inclusion. Conclusions: Asthma was unacceptably controlled in most patients receiving ICS-containing maintenance treatment and remained so during follow-up. Despite this, treatment adaptations by GPs and CPs were very infrequent. This unsatisfactory situation may be improved by adopting a more dynamic approach to tailoring controller therapy to the needs of the patient.     

Intravenous magnesium sulfate in acute severe asthma

OBJECTIVE: Intravenous magnesium sulfate (MgSO4), as an adjunctive medication to the standard treatment of acute asthma, improves admission rate or severity score in acute severe asthma patients. METHODOLOGY: We conducted a randomized double-blind placebo controlled trial with subjects from the emergency room, Ramathibodi Hospital, Bangkok, Thailand. Patients, aged 15-65 years with acute severe asthma attack, whose severity scores were greater than 4 and who were willing to be enrolled in a study during March to November 1997 participated in the study. Randomly allocated patients received either 2 g intravenous MgSO4 or placebo, sterile water, as an adjunctive medication to standard therapy for acute asthma. The medication was diluted in 50 mL of 0.9% normal saline. MEASUREMENT: Severity scores were measured by two investigators using Fischl's indices. The times interval of measurements were at the initial (0), 60, 120, 180, and 240 min from receipt of treatment. Patients were hospitalized if the severity scores at 240 min exceeded 1. Risk ratio (RR) and 95% confidence interval (CI) of RR were applied to estimate the risk of admission. Analysis of variance with repeated measurement on time was used to determine the severity score between two groups. RESULTS: Thirty-four patients with acute severe asthma were enrolled in the present study. One patient from the placebo group was excluded because he did not consent to undergoing peak expiratory flow rate. Seventeen patients received MgSO4 and 16 patients received placebo. The general characteristics between the two groups were not significantly different, which reflected the quality of randomization. The admission rates of the placebo and MgSO4 group were 25.00% and 17.65%, respectively. Patients who received MgSO4 had preventive risk to be hospitalized 0.71 times relative to patients who received placebo. However, this preventive risk did not reach statistical significance (95% CI of RR = 0.19-2.67). The severity score at any time between the two groups was also not statistically significantly different (P = 0.366). CONCLUSION: With the present evidence, the hypothesis was not confirmed. Magnesium sulphate as an adjunct to standard therapy did not improve either admission rate or severity score in patients with acute severe asthma.     

Efficacy and Tolerability of Budesonide Clickhaler® and Turbuhaler® in Adult Asthma

New dry powder inhalers should be clinically comparable with established devices to ensure the continuity of effective therapy for asthma patients. This randomized, open, parallel group study compared the clinical efficacy and tolerability of budesonide delivered via Clickhaler® or Turbuhaler® dry powder inhalers in adults with mild to moderate stable asthma. Following a 4-week stabilizing period using budesonide Turbuhaler adults aged 18 years or older, who had been treated with inhaled corticosteroids for at least the previous 12 weeks, were randomized to receive budesonide twice daily (≤ 1600 µg/day) via either Clickhaler (n = 110) or Turbuhaler (n = 112) for 12 weeks. Morning peak expiratory flow (PEF), evening PEF, asthma symptoms, and use of inhaled short-acting β₂-agonist were recorded daily by the patients on diary cards. Lung function and tolerability data were recorded at clinic visits following 4, 8, and 12 weeks' treatment. Efficacy was measured primarily by mean change from the run-in baseline in weekly morning PEF. Of the 222 patients randomized to treatment, 167 completed the study according to the protocol. Repeated-measures analysis of covariance indicated that the devices were clinically equivalent; a treatment difference of - 2.3 L/min separated the group mean changes in weekly morning PEF (95% confidence interval - 7.9 to 3.3). Secondary analyses also supported clinical comparability. This study demonstrates the comparable clinical efficacy and tolerability of budesonide Clickhaler and Turbuhaler devices in adult patients with stable asthma.