Prognostic Interplay of Functional Status and Multimorbidity Among Older Patients Discharged From Hospital

ObjectivesThe purpose of this study was to investigate the prognostic weight of multimorbidity and functional impairment over long-term mortality among older patients discharged from acute care hospitals.DesignA prospective multicenter observational study.Setting and ParticipantsOur series consisted of 1967 adults aged ≥65 years consecutively admitted to acute care wards in Italy, in the context of the Report-AGE project.MethodsAfter signing a written informed consent, all patients underwent comprehensive geriatric assessment by Inter-RAI Minimum Data Set acute care. The primary endpoint of the present study was long-term mortality. Patients were grouped into 3 functional clusters and 3 disease clusters using the K-medians cluster analysis. The association of functional clusters, disease clusters, and Charlson score categories with long-term mortality was investigated through Cox regression analysis and the intercluster classification agreement was further estimated. Finally, the additive effect of either disease clusters or Charlson score on predictive ability of functional clusters was assessed by using changes in Harrell’s C-index and categorical Net Reclassification Index (NRI).ResultsFunctional clusters, disease clusters, and Charlson score were significant predictors of long-term mortality, but the interclassification agreement was poor. Functional clusters predicted mortality with greater accuracy [C-index 0.66, 95% confidence interval (CI) 0.65–0.68] compared with disease clusters (C-index 0.54, 95% CI 0.53–0.56), and Charlson score (C-index 0.58, 95% CI 0.56–0.59). Adding multimorbidity (NRI 0.23, 95% CI 0.14–0.31) or Charlson score (NRI 0.13, 95% CI 0.03–0.20) to functional cluster model slightly improved the accuracy of prediction.Conclusions and ImplicationsFunctional impairment may better predict prognosis compared with multimorbidity, which may be relevant to optimally address individuals’ needs and to design tailored preventive interventions.     

Combined Effects of Cognitive Impairment and Nutritional Trajectories on Functional Recovery for Older Patients after Hip-Fracture Surgery

ObjectivesMalnutrition and cognitive impairment are associated with poor functional recovery in older adults following hip-fracture surgery. This study examined the combined effects of cognitive impairment and nutritional trajectories on postoperative functional recovery for older adults following hip-fracture surgery.DesignProspective longitudinal correlational study.Setting and ParticipantsThis study recruited 350 older adults (≥60 years of age) who received hip-fracture surgery at a 3000-bed medical center in northern Taiwan from September 2012 to March 2020.MethodsParticipant data were collected over a 2-year period after surgery for nutritional and cognitive status and activities of daily living (ADLs). Participants were grouped by type of nutritional trajectory using group-based trajectory modeling. Generalized estimating equations analyzed associations between trajectory groups/cognitive status at discharge and performance of ADLs.ResultsNutritional trajectories best fit a 3-group trajectory model: malnourished (19%), at-risk of malnutrition (40%), and well-nourished (41%). Nutritional status for the malnourished group declined from 12 months to 24 months following surgery; nutritional status remained stable for at-risk of malnutrition and well-nourished groups. Interactions for cognitive impairment-by-nutritional status were significant: the malnourished + intact cognition subgroup had significantly better ADLs than the malnourished + cognitive impairment subgroup (b = 27.1, 95% confidence interval = 14.0–40.2; P < .001). For at-risk of malnutrition and well-nourished groups, there were no significant differences between cognitive impairment and intact cognition in ADLs. These findings suggest that nutritional status may buffer the negative effect of cognitive impairment on ADLs.Conclusions and ImplicationsBetter nutritional status over time for older adults following hip fracture can protect against adverse influences of cognitive impairment on ADLs during postoperative recovery. Participants with malnutrition and cognitive impairment had the poorest ADLs. These findings suggest interventions tailored to improving nutritional status may improve recovery for older adults following hip-fracture surgery.     

高渗和低渗造影剂对大白鼠肾毒性的实验研究

目的 :研究高、低渗造影剂对甘油致肾损害大鼠和正常大鼠的肾毒性 ,观察山莨菪碱预防肾小管损害的作用。方法 :用 2 5 %甘油按 1ml/ 10 0 g制肾损害大鼠模型 ,然后从静脉注射高渗造影剂 (76 %复方泛影葡胺 ,1ml/ 10 0 g)或优维显 (1m l/ 10 0 g) ,2 4h后各组随机处死 10只大鼠 ,肾脏用 10 %福尔马林固定后做病理检查。结果 :在肾功能损害组 ,给高渗造影剂后 ,可使肾小管管型数和肾小管坏死数明显高于低渗造影剂组和甘油对照组 (P<0 .0 1) ,山莨菪碱可明显减轻肾小管损害 (P<0 .0 5 )。正常肾功能组高、低渗造影剂组之间肾小管损害无显著性差异。结论 :肾功能损害时用低渗造影剂对肾毒性较小 ,山莨菪碱对复方泛影葡胺的肾毒性有一定的预防作用。     

从发病机制概述针刺治疗血管性痴呆的研究进展

血管性痴呆是脑血管病变后所引起的认知功能障碍,是临床中较为常见的痴呆类型。其发病机制源于血管系统损害引起低脑血流灌注、氧化应激等一系列病理过程。针灸作为一种非药物疗法,在脑血管病及相关疾病中有较为广泛的临床应用,许多研究都显示了针灸对认知功能的改善作用,并涉及细胞凋亡、氧化应激、神经炎症、神经递质通路等方面的调节作用。因此,现从血管性痴呆的发病机制角度探讨针刺的治疗作用,以期为进一步揭示针灸在血管性痴呆治疗中的潜在机制提供参考。     

中国9个长寿地区65岁及以上人群血铅浓度与认知功能受损的关联研究

目的探讨65岁及以上人群血铅水平与认知功能受损的关联。方法研究对象来自2017-2018年在我国9个长寿地区开展的“老年健康生物标志物队列研究”,最终将1684名血铅和认知功能数据完整的65岁及以上人群纳入本研究。通过问卷调查和体格检测,收集调查对象的人口学特征、生活方式、健康状况及认知功能评分等信息;同时采集调查对象的静脉血以检测血铅水平。根据血铅水平的四分位数将调查对象分为4组(Q₁-Q₄组),采用多因素logistic回归模型分析血铅浓度与认知功能受损的关系,采用限制性三次样条检验血铅浓度与认知受损之间是否存在非线性关联。结果1684名研究对象年龄为(83.1±11.1)岁,其中女性843名(50.1%);认知功能受损者191名(11.3%)。调整相关混杂因素后,老年人血铅浓度每升高10μg/L,认知功能受损患病风险OR(95%CI)值为1.05(1.01~1.10);与血铅浓度Q1组老年人相比,血铅浓度较高者认知功能受损的患病风险较高,Q₂,Q₃,Q₄组的OR(95%CI)值分别为1.19(0.69~2.05)、1.45(0.84~2.51)和1.92(1.13~3.27)。结论我国9个长寿地区65岁及以上老年人血铅水平与认知功能受损患病风险存在关联。     

Factors influencing routine cognitive impairment screening in older at-risk drinkers: Findings from a qualitative study in the United Kingdom

Cognitive Impairment (CI) screening is recommended for those engaged in harmful levels of alcohol use. However, there is a lack of evidence on implementation. This paper explores the barriers and facilitators to CI screening experienced across a service specifically for older drinkers. The findings draw on data gathered as part of an evaluation of a multilevel programme to reduce alcohol-related harm in adults aged 50 and over in five demonstration areas across the United Kingdom. It is based on qualitative interviews and focus groups with 14 service providers and 22 service users. Findings are presented thematically under the section headings: acceptability of screening, interpretation and making sense of screening and treatment options. It is suggested that engagement with CI screening is most likely when its fit with agency culture and its purpose is clear; where service providers have the technical skills to administer and discuss the results of screening with service users; and where those undertaking screening have had the opportunity to reflect on their own experience of being screened. Engagement with CI screening is also most likely where specific intervention pathways and engagement practices can be accessed to respond to assessed need.     

Cognitive impairment in Parkinson's disease: amyloid plaques, neurofibrillary tangles, and neuropil threads in the cerebral cortex

Summary Sensitive silver methods for extracellular amyloid and intraneuronal cytoskeleton abnormalities (neurofibrillary tangles and neuropil threads) were employed to examine the cortical pathology in Parkinson's disease. In cases with cognitive impairment many plaque-like amyloid deposits were found in the cerebral cortex. Neuritic plaques were rare or absent. Neither the Ammon's horn nor the isocortex revealed a sufficiently large number of tangles to permit the diagnosis of a coexisting fully developed Alzheimer's disease. Large numbers of neurofibrillary tangles and neuropil threads were only found in layer Pre- of the entorhinal cortex. This layer gives rise to major portions of the perforant tract, a pathway which serves as a link in the transmission of data from isocortical association areas to the hippocampal formation. During the course of Parkinson's disease the hippocampal formation is thus endangered to become disrupted from isocortical influences. It is concluded that the cognitive impairment shown by many individuals suffering from Parkinson's disease may partly be caused by cortical lesions.     

A Dutch family with progressive sensorineural hearing impairment linked to the DFNA2 region

We studied a Dutch family with DFNA2-linked progressive sensorineural hearing impairment (SNHI). Recent audiograms were obtained from 18 of the affected persons (age 7–81 years) and were used in a gene-linkage analysis. Linear regression analysis of the audiograms, using binaural mean thresholds, disclosed on average a descending slope of approximately 10 dB/octave at any age and an annual threshold increase at any frequency of about 0.7 dB/year. There may have been substantial congenital impairment at higher frequencies, but longitudinal analysis of hearing impairment in the youngest case, who was followed from age 5 years, suggested that the most significant changes in hearing may have occurred in the first two decades of life. Linkage analysis was carried out with special attention to the DFNA2 region because hearing trends were very similar to families previously linked to DFNA2. Linkage to DFNA2 was established with maximum lod scores of 4.7 and 3.2 for the flanking markers of the DFNA2 region (D1S432;MYCL1). Received: 25 February 1999 / Accepted: 11 June 1999     

135例急性感染性疾病所致肝功能损害临床分析

目的　分析临床急性感染性疾病所致肝功能损害的特点及其恢复时间。方法　对 135例急性感染性疾病患者入院肝功能指标进行分析 ,观察治疗第 2周及第 4周时患者异常肝功能指标恢复情况。结果　除 6例死亡外 ,其余患者异常肝功能指标升高多在正常值上限 3倍以内 ,治疗第 4周异常肝功能指标治愈率分别为 AL T92 .4%、AST91.6 %、GGT75 .6 %、AL P91.3%、 SB10 0 %、 SB’ 10 0 %和 TBA 85 .7% ,HBs Ag ( )携带者与 HBs Ag (- )者治疗第 4周上述指标治愈率无显著差异。第 4周时 GGT仍升高者恢复缓慢或不易恢复正常。结论　急性感染性疾病致肝功能损害多呈轻度及一过性升高 ;HBs Ag ( )携带者肝脏应急储备及修复功能较正常人无明显下降 ;GGT恢复缓慢或不易恢复正常者可能留有持久性的肝内毛细胆管损伤