Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease

Objective

The advantage of arteriovenous fistulas (AVFs) in older patients requiring dialysis is controversial. We reviewed our vascular access experience in patients ≥70 years of age (older group) compared with younger patients.

Body composition in the elderly: Total body water and anthropometry

Body composition measured with isotopic dilution was compared with anthropometric measurements. The study was carried out in 47 subjects from both sexes, 65 to 92 years old. Total body water (TBW), anthropometric measurements, and dynamometry were assessed. TBW was significatively higher in men than women and decreased with age. Dynamometry and fatfree mass were well correlated (r=0.73 in males and r=0.58 in females) and significantly different between sexes. A negative correlation was found for dynamometry with age, being significant for women. Linear regression equations to predict TBW from anthropometric measurements in males and females were obtained: Males: TBW(I)=19.349+0.617 weight(kg) — 0.931 mid-arm circumference(cm)+0.122 dynamometry (kg) Females: TBW(l)=−5.531+0.343 weight(kg)-0.213 triceps skinfold (mm)+ 0.148 dynamometry(kg) + 3.424 wrist diameter (cm). This simple model is proposed for use in epidemiological and field studies where other more sophisticated methods can not be applied.     

A Study of Fluoxetine in Obese Elderly Patients with Type 2 Diabetes

In order to establish the safety and efficacy of fluoxetine in subjects over 60 years of age with Type 2 diabetes, a randomized, double-blind, parallel study of 30 obese subjects was undertaken, comparing the use of fluoxetine 60 mg daily with placebo. Subjects were diet controlled with an HbA₁ < 14% (reference range 6–9%) and BMI > 29 kg m². Those taking fluoxetine had a median weight loss of 2.6 kg at 3 months (p < 0.001) and 3.9 kg at 6 months (p < 0–02), compared with weight loss in the placebo group of 0.1 kg and 0.0 kg at 3 and 6 months, respectively. Improved glycaemic control was also demonstrated in the fluoxetine group compared with placebo, initial HbA₁ levels of 8.0% vs 8.7% (NS) falling at 4 months by 0.9% (p < 0.02) and at six months by 0.9% (p < 0.02). No sustained improvement in fasting blood glucose levels was demonstrated. Reporting of adverse events was similar in both groups. Fluoxetine in the short term aids weight loss and improves glycaemic control without a significant increase in adverse events in elderly Type 2 diabetic subjects.     

杭州市老年人主要食物摄入量与营养调查

目的了解杭州市老年人的年主要食物摄入量与营养状况,找出存在的主要问题,探讨解决的对策。方法随机抽样调查了杭州市老年大学学员的体质指数、年主要食物摄入量、营养相关疾病患病率及对营养与膳食知识的了解与需求程度。结果杭州市老年人体质指数为22.3±3.1,人均每年主要食物摄入量为:口粮98.6kg,豆类30.1kg,蔬菜110.1kg,水果63.3kg,食用植物油16.2kg,食糖5.0kg,肉类20.1kS,蛋类19.7kg,奶类56.8kg,水产品34.7kg。营养相关疾病患病率较高。结论接受调查的人群年主要食物摄入量基本达到2010年城乡居民食物与营养发展目标中的城市居民人均每年主要食物摄入量的要求,膳食结构基本合理,但仍需加强营养指导。     

高龄男性慢性肾病患者血清C-反应蛋白的临床意义

目的探讨慢性肾病(CKD)高龄男性患者血清C-反应蛋白(CRP)与营养指标及CKD进展之间的关系。方法回顾性分析曾在某院住院并门诊随访且尚未透析的72例高龄男性CKD 5期患者,分为高GRP组28例,低GRP组44例,观察血清CRP、营养评估及肾功能指标等,探讨微炎性状态与营养状况及CKD进展之间的关系。结果排除感染、创伤等因素后,所纳入对象的平均血清CRP水平为0.64mg/dl(四分位间距0.32,1.05 mg/dl)。以0.8mg/dl为分割点,将其分为高CRP组(CRP≥0.8mg/dl)和低CRP组(CRP<0.8mg/dl)。高CRP组患者占38.9%,较之低CRP组,高CRP组多伴随心血管及外周动脉粥样硬化等疾病(P<0.05),主观综合营养评估(SGA)评分明显降低(P<0.01),促红细胞生成素(EPO)用量显著增加(P<0.01)。随访18个月后,高CRP组估算肾小球滤过率下降幅度明显(P<0.01),转入透析治疗的例数较多(P<0.05),发生心血管事件的例数也显著增多(P<0.05)。结论进入CKD 5期的高龄CKD患者存在血清CRP值轻度升高的微炎性状态,高CRP患者伴随心血管病及外周动脉粥样硬化的比例显著高于低CRP患者;持续的高CRP水平多伴随营养状况的下降,且易导致EPO效力的降低;CKD的进展与血清高CRP水平具有相关性。     

老年骨质疏松患者骨折高危因素分析及护理对策

目的分析老年骨质疏松患者骨折高危因素并探讨其护理对策。方法选取2010年6月至2013年5月于本院进行诊治的385例老年骨质疏松患者为研究对象,将其中骨折发生率进行统计,并对不同性别、年龄、BMI、骨折家族史、饮食情况、基础疾病情况及社会支持情况者的骨折发生率进行比较,同时对上述因素与骨折的关系进行Logistic回归分析,针对高危因素对患者进行护理干预。结果女性、年龄较高、低BMI、有骨折家族史者、低钙饮食、并发症基础疾病及低社会支持者的骨折发生率高于其他老年患者（P〈0.05）,且经Logistic回归分析显示其均与骨折的发生有密切的相关性（P均〈0.05）。结论性别、年龄、BMI、骨折家族史、饮食情况、基础疾病情况及社会支持程度均对老年骨质疏松患者骨折的发生产生一定的影响,应针对上述因素给予患者针对性护理干预。     

老年慢性房颤患者血清热休克蛋白 70 和胱抑素 C 的表达及意义

目的:探讨老年慢性房颤患者血清热休克蛋白70(HSP70)及胱抑素C(CysC)表达水平及两者在房颤发生中的意义. 方法:选择2014年1月至2015年1月诊治的老年慢性房颤患者100例为房颤组,其中阵发性房颤28例,持续性房颤31例,永久性房颤41例. 另选取年龄、性别匹配的非房颤老年患者55例为对照组,检测两组血清HSP 70及CysC浓度. 结果:与对照组比较,房颤组患者血清HSP70及CysC水平明显升高(P<0.05),且在阵发性、持续性和永久性三种房颤亚型中,HSP70和Cysc浓度依次递增. Logistic回归分析显示HSP70(OR=0.629,P=0.023)和CysC(OR=1.206,P=0. 015)是房颤发生的独立预测因子,且两者呈正相关( r=-0.257,P<0.05). 结论:炎症因子HSP70 和CysC水平升高与房颤的发生发展密切相关.     

The Use of a Rehabilitation Team for Stroke Patients

A multidisciplinary team affiliated with a large urban hospital is described and evaluated with respect to its effects on stroke patients. Twenty-six patients who had been referred to the team in a 7-month period were compared with a group of 32 patients who had not been referred to the team. Patients were evaluated on the basis of their scores on a functional health scale mailed to them 3 months after their discharge from the hospital. The results of this project indicate that the patients seen by this team scored higher on functional health than those not seen by this team.