Usefulness of the Chinese Nutrition Screening (CNS) tool in predicting 12 month mortality in elderly Hong Kong Chinese living in institutions

Objectives  To determine the cut off score of the CNS in predicting 12 months mortality. Design  Data was collected and followed up from a previous study among elderly subjects (n = 515) living in community institutional setting. The risk of malnutrition and 12 months mortality was ranked by the CNS and compared with that by SGA. Reliability was assessed by the sensitivity and specificity of the prediction with SGA as well as BMI alone. Sensitivity and specificity was calculated to determine validity as well as using positive and negative predictive values in predicting mortality at 12 months. Results  All three tools (BMI, SGA, CNS) demonstrated significant difference of higher mortality rate (P<.001) in the malnourished group. CNS at score ≤ 21 showed comparable results to SGA tool and BMI at classifying malnutrition. And using cut off score ≤ 22 also show significant results with SGA in classifying patients with normal nutrition. CNS score at ≥ 22 sensitivity was 60.9% and specificity was 72.9% with a Negative Predictive value of 92.3% and a Positive Predictive value of 25.8%. Conclusion  CNS tool at cut off ≥ 22 is just as good as using BMI or SGA in identifying those who have a normal nutritional status. This is useful in particular, when biochemical or anthropometric data is not available. This further validates the use of ≥22 as the best cut off point with the CNS tool and just as good at predicting of mortality when compared with SGA and BMI assessments.     

Interstitial lung disease clinics for the management of idiopathic pulmonary fibrosis: a potential advantage to patients. Greater Manchester Lung Fibrosis Consortium.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) has a relatively poor prognosis with limited therapeutic intervention. This has led to varying practices, from a nihilistic approach at one end to more aggressive management at the other. However, a dedicated clinic with a multidisciplinary approach may offer advantages to patients with IPF. METHODS: A retrospective observational study was performed to compare patients with a diagnosis of IPF attending a general respiratory clinic between January 1988 and December 1996 to those attending a interstitial lung disease (ILD) clinic between January 1992 and December 1996. The notes were reviewed for (1) confirmation of diagnosis, (2) method of diagnosis, (3) date of initial consultation, and (4) survival. The end point was death, and the number of deaths that occurred up to October 1997 was recorded. RESULTS: The study identified 148 patients with a diagnosis of IPF. Ten patients underwent transplantation and were excluded. Of the remaining 138, 84 patients attended the general respiratory clinic (mean age 65 years: 53 men [63%], 31 women), and 54 attended the ILD clinic (mean age 56 years: 26 men [48%], 28 women). Patients attending the ILD clinic had a median survival of >3714 days. Patients attending the general respiratory clinic had a median survival of 1796 +/- standard error 437 days (CI 940-2652), p = .032 Breslow. Age was an important determinant of outcome. For patients less than 60 years of age (n = 60), the median survival for the ILD clinic was >3700 days, compared to 2535 +/- 577 days (CI 1404-280) in the general respiratory clinic, p = .037 Breslow. There was no difference in survival of patients over 60 years of age. CONCLUSIONS: The study suggests that a dedicated multidisciplinary clinic may result in an improved outcome for patients with IPF, particularly for patients younger than 60 years. This has implications that may facilitate the development of suitably powered therapeutic trials and may affect patient referral for transplantation.     

Endpoints of hepatitis B treatment

Summary. The goal of hepatitis B treatment is to prevent the development of cirrhosis, liver failure, and hepatocellular carcinoma. Ideally, clinical studies should demonstrate that hepatitis B therapies can prevent liver‐related complications; however, these clinical endpoints evolve over years or decades. Therefore, clinical trials have relied on intermediate endpoints to evaluate the efficacy of treatment and to determine when treatment can be stopped. Intermediate endpoints that have been used include biochemical, histological, virological, and serological endpoints. This review will discuss the validity of these intermediate endpoints as surrogates of clinical endpoints, and the rates at which these intermediate endpoints can be achieved with currently available therapies.     

应用Heath-Carter体型法分析辽西地区城市汉族儿童青少年1263名体型特征

目的:分析辽西地区城市汉族儿童青少年的体型发育规律和特点,为体质人类学补充必要的数据。方法:按整群分层抽样法,抽取2001-07/2003-09辽西地区城市7所中小学7～19岁经学校正常体质检查证明身体健康的汉族学生,按性别分两大组,每大组按年龄分12小组,7～18岁每岁为1个年龄组,18～19岁为1个年龄组,每小组45～86名,共分24组,搜集完整资料1263名(男657名,女606名)。采用Heath-Carter体型法,每项指标测量2次,取平均值,10项指标由专人负责,测试数据按年龄和性别在微机中建立数据库,依次计算出各年龄组的内因子、中因子和外因子,体型图上的X,Y坐标值,身高/体质量1/3,样本中平均体型点到所有体型点空间距离的均数,三维空间中两个体型点间的差异,体脂含量和各类体型分布频数。结果:参加调查1263名,均进入结果分析。①7～17岁儿童青少年身高、体质量随年龄的增加而增长。平均身高、体质量男生大于女生。身高/体质量1/3指数除14,16和17岁外,各年龄组女生>男生,平均值女生>男生。体脂含量11岁以前男生>女生,12岁以后女生>男生。②辽西地区城市汉族男生的平均体型值为3.9-3.5-3.4,属中间型,女生平均体型值为4.3-2.9-3.6,属偏外胚层的内胚层体型。体型频数的变化提示辽西城市汉族男生体型分布较散,女生分布较集中,主要在内胚层体型。③内因子男生在3.18～4.81,女生在3.05～5.33,11岁以前男生>女生,12岁以后女生>男生;中因子男生在3.02～4.23,女生在2.54～3.42,除16岁男女相差不多外,其他年龄组男生>女生,外因子男生在2.64～4.22,女生在2.92～4.14,13岁以前女生>男生,14岁以后男生>女生。因此,男生较女生骨骼粗壮,肌肉发达,随着年龄的增长,女生的皮下脂肪更发达,体态丰满,男生的身体相对瘦高程度增长,身材修长。男女各年龄组间体型比较,7～,8～,9～,10～,11～,12～,13～,14～,15～,16～,17～,18～19岁三维空间中两个体型点间的差异值分别为0.95,0.85,1.10,1.06,1.37,0.43,0.87,1.44,1.42,1.12,1.11,1.33,7～,8～,12～,14～,17～,18～19年龄组男女间体型差异有显著性(t=2.07,4.09,3.12,3.86,3.39,3.99,P<0.05)。④与国内汉族及其他少数民族相比,辽西汉族男生体脂最多,骨骼肌肉不发达,身体相对矮小;辽西地区汉族女生体脂较多,骨骼肌肉不发达,体型修长。结论:辽西地区城市男生较女生骨骼粗壮,肌肉发达,随着年龄的增长,女生的皮下脂肪更发达,体态丰满,男生的身体相对瘦高程度增长,身材修长。与国内汉族及其他少数民族相比,辽西地区城市汉族儿童青少年体脂发育较好,骨骼肌肉欠发达,青春期是形成健壮体型的关键时期,辽西地区城市儿童青少年应注意合理饮食和加强体育锻炼。     

大黄苷元联合溶栓对血栓栓塞性脑缺血大鼠肺胃损伤的保护作用

目的:观察大黄苷元联合溶栓治疗对大鼠脑缺血损伤肺胃组织的保护作用。方法:实验于2005-08/2006-07在河南中医学院老年医学研究所实验室完成。①260只SD大鼠采用随机数字法分为假手术组20只、模型组60只、尿激酶组60只、大黄苷元组60只、大黄苷元 尿激酶组60只;除假手术组外,其余各组根据缺血后动脉用药时间又各分为3,6,9h3个时间点,每个时间点20只。②自体血栓结合线栓阻塞大鼠大脑中动脉制备局灶性脑缺血动物模型。③各组大鼠均于术前4d灌胃用药,大黄苷元组、大黄苷元 尿激酶组用大黄苷元灌胃(灌胃体积为每100g大鼠1mL),假手术组、模型组和尿激酶组用等体积的生理盐水灌胃;动脉用药除假手术组外,其余各组分别于造模后3,6,9h经导管由区域动脉给药,尿激酶组与大黄苷元 尿激酶组用尿激酶(用药体积为20μL),模型组和大黄苷元组区域动脉用同等体积的生理盐水。④动脉给药后24h,观察大鼠脑组织病理损伤、颅内和胃出血率、脑和肺组织含水量、肺和胃病理损伤变化。结果:实验过程中因麻醉、操作等原因死亡及剔除大鼠156只,进入结果分析104只。①颅内和胃出血率:尿激酶组9h大鼠颅内出血率较模型组高(66.67%,28.57%,P<0.05);尿激酶组9h脑和胃出血率较3h高(脑:66.67%,18.75%;胃:41.18%,17.65,P<0.05);大黄苷元 尿激酶组9h颅内出血率较尿激酶组9h低(P<0.05)。②脑和肺及胃组织病理改变:各模型组大鼠脑、胃和肺组织病理损伤均较假手术组明显;各用药组脑和肺组织分别较相应时间模型组减轻;各组脑、胃和肺组织损伤9h均较其3h明显;大黄苷元 尿激酶组9h较相应时间点尿激酶组和大黄苷元组损伤减轻(P<0.05)。③脑和肺组织含水量:各模型组脑和肺组织含水量均较假手术组增高(P<0.01);尿激酶组和大黄苷元 尿激酶组各时间点均较模型组降低(P<0.01);各组9h分别较其3h脑和肺含水量增加(P<0.01,P<0.05);大黄苷元 尿激酶组6h脑组织和9h肺含水量分别较尿激酶组降低(P<0.05)。结论:脑缺血后延迟溶栓治疗可引起大鼠脑和胃出血率增高、脑组织和肺组织水肿加重,脑和肺及胃组织病理损伤明显;大黄苷元联合溶栓可降低脑出血率,改善神经细胞超微结构,降低脑和肺组织含水量,对脑缺血肺和胃组织损伤具有保护作用。     

A versatile family of degradable non-viral gene carriers based on hyperbranched poly(ester amine)s.

A variety of degradable hyperbranched poly(ester amine)s containing primary, secondary and tertiary amino groups, were synthesized and evaluated as non-viral gene carriers. The polymers were obtained in high yields through a Michael-type conjugate addition of diacrylate monomers with trifunctional amine monomers. Analysis of degradation products using liquid chromatography-mass spectroscopy (LC-MS) demonstrated that all poly(ester amine)s had a hyperbranched structure with a degree of branching of approximately 0.30. These poly(ester amine)s were readily water-soluble and degradable under physiological conditions (pH 7.4, 37 degrees C), in which more than 10% ester bonds were hydrolyzed within 4 h. Moreover, these hyperbranched poly(ester amine)s showed high buffering capacities between pH 5.1 and 7.4. Three out of nine synthesized polymers, i.e. p(HDDA-AEP), p(HDDA-AMP), and p(BDDA-AMP), were shown to effectively condense plasmid DNA into small-sized (approximately 94-135 nm) and positively charged complexes. Polymer/DNA complexes ('polyplexes') based on these three polymers, and larger complexes of p(BDDA-AEP) (approximately 497 nm) were able to transfect COS-7 cells in vitro. Importantly, the transfection activity of polyplexes was preserved in the presence of serum proteins. The highest transfection level was observed for p(HDDA-AEP) polyplex which had a transfection efficiency higher than or comparable to that polyplexes of polyethylenimine (PEI) and poly(2-(dimethylamino)ethyl methacrylate) (pDMAEMA). Furthermore, these poly(ester amine)s revealed no or low cytotoxicity. These results demonstrated that hyperbranched poly(ester amine)s can be applied as safe and efficient gene delivery polymers.     

The natriuretic peptides and their role in disorders of right heart dysfunction and pulmonary hypertension

Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are increased in conditions with cardiac ventricular volume and pressure overload. The general physiological and potential therapeutic roles of natriuretic peptides in respiratory disease, right ventricular (RV) dysfunction, and pulmonary arterial hypertension (PAH) are reviewed. BNP levels can be used to differentiate between dyspneic patients with a pure respiratory defect and those with RV dysfunction. BNP levels also correlate with mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) in patients with PAH (atrial septal defect, chronic thromboembolic disease, and scleroderma). BNP is a predictor of mortality in patients with primary pulmonary hypertension (PPH). These are important clinical implications in that a noninvasive blood test may be used to identify high-risk patients for more invasive procedures such as cardiac catheterization. BNP or NT-proBNP measurements may also be used to guide therapy (e.g., pulmonary vasorelaxants) in PAH since upregulation of the natriuretic peptide pathway has been shown to reduce cardiac hypertrophy and PAH. Additionally, there may be therapeutic potential via recombinant BNP or neutral endopeptidase inhibitors in RV dysfunction and PAH.