Effect of clinical factors on trajectory of functional performance in patients undergoing hemodialysis

PurposeThis study aimed to investigate the association between clinical factors and temporary changes in functional performance in patients undergoing hemodialysis.MethodsThis was a retrospective, longitudinal observational study conducted from 2015 to 2017. Eight-two patients undergoing hemodialysis in the outpatient clinic were enrolled. Functional performance was measured using the Karnofsky Performance Status (KPS) scale. Collected data for analysis included demographics, laboratory parameters, and KPS scale scores. All participants were grouped into a high KPS cluster and a low KPS cluster based on dynamic changes in KPS scales from 2015 to 2017.ResultsParticipants in the high KPS cluster demonstrated an approximate trend, and those in the low KPS cluster demonstrated a low pattern. By stepwise selection model analysis, age (OR 1.12, 95% CI 1.03–1.23, p = 0.011), serum BUN (OR 1.08, 95% CI 1.02–1.16, p = 0.015), calcium levels (OR 3.24, 95% CI 1.2–8.73, p = 0.02), and beta-2-microglobulin (OR > 1.0, CI >1.00-<1.01, p = 0.031) showed risk for the low KPS cluster. Male sex (OR 0.20, 95% CI 0.04–0.96, p = 0.045) and albumin level (OR 0.02, 95% CI 0–0.4, p = 0.009) showed a low risk for the low KPS cluster.ConclusionsA different trajectory pattern was observed between the high and low KPS clusters in a 3-year period. Risk factors for the low KPS cluster were age, serum BUN, calcium, and beta-2-microglobulin levels. Male sex and serum albumin levels reduced the risk for the low KPS cluster.     

Evaluation of depression in patients with alzheimer's disease according to the location of medical care

The objective of the study was to assess the severity of depression and to assess the level of self-sufficiency of patients with Alzheimer's disease, with particular emphasis on the place of residence and level of education. The study covered 90 people diagnosed with Alzheimer's disease. All respondents were persons over 65?years of age and residents of cities with a population over one-hundred thousand. The research method based on this work is the author's own questionnaire, the Zung Self-Rating Depression Scale (ZSDS) about depression and the Karnofsky Performance Scale Index (KPSI) for assessment of a patient's self-sufficiency. Regardless of residence, patients with Alzheimer's disease displayed signs of mild or moderate depression (100% in social welfare homes and hospital patients and 60% in those with caregivers at home). Patients with Alzheimer's disease have an unsatisfactory salary in social-economic terms. In those with Alzheimer's disease, quality of life is best for those in family homes under the care of their immediate family. People with a vocational education were the largest group of people diagnosed with Alzheimer's. Patients at home and in the hospital had a higher level of physical activity, but most patients in the hospital needed regular medical care, as did patients in social welfare homes.     

Karnofsky活动状态评分在肝癌介入治疗患者护理中的应用效果及对患者肝功能指标的影响

目的探讨Karnofsky活动状态评分在肝癌介入治疗患者护理中的应用效果及对患者肝功能指标的影响。方法选择2018年1月至2019年1月本院接受介入治疗的肝癌患者80例,按电脑数字表法随机分为对照组(40例)与试验组(40例)。对照组行常规护理,试验组通过Karnofsky活动状态评分展开护理。比较两组患者的疾病不确定感、癌因疲乏情况、并发症发生情况及肝功能指标。结果护理后,两组患者的MUIS、CFS评分均下降,且试验组低于对照组,差异具有统计学意义(P<0.05);试验组患者的并发症总发生率为5.00%,低于对照组的22.50%,差异具有统计学意义(P<0.05);护理后,两组患者的ALT、TBil水平均降低,且试验组低于对照组,差异有统计学意义(P<0.05)。结论通过Karnofsky活动状态评分展开护理可有效改善肝癌介入治疗患者的疾病不确定感、癌因疲乏,并减少并发症的发生,改善患者肝功能,值得临床推广应用。     

Association of Karnofsky Performance Status with waitlist mortality among older and younger adults awaiting kidney transplantation

Patients with end-stage renal disease (ESRD) have impaired functional status compared with the general population. We sought to explore the association between Karnofsky Performance Status (KPS) and death/delisting from the kidney transplantation waitlist and whether this association differed by age. Patients listed for single-organ kidney transplantation in the United Network for Organ Sharing/Organ Procurement and Transplantation Network from January 1, 2015, to January 1, 2018, were included. We performed competing-risk regression analyses to determine the association between KPS (“Severely impaired”, “Moderately impaired”, “Non-impaired”) and death/delisting, with deceased-donor kidney transplantation as a competing risk. We tested for interactions between age and KPS on death/delisting. Of the 89,819 patients analyzed, 39% were impaired (KPS < 80) and 20% were aged ≥ 65 years. Older age and lower KPS were independently associated with higher risk of death/delisting (age 45-64 years, HR 1.97 [95% CI 1.73-2.24]; age ≥ 65 years, HR 3.62 [95% CI 3.33-3.92] compared with age < 45 years; moderately impaired, HR 1.68 [95% CI 1.45-1.95]; severely impaired, HR 4.80 [95% CI 3.71-6.21] compared with non-impaired). Lower KPS was associated with higher risk of death/delisting among all ages, but this effect was slightly less pronounced among individuals aged ≥ 65 years. Performance status should be used when counseling patients with ESRD on their risks for death/delisting.     

参红胶囊联合化疗药物对393例肿瘤病人的影响

目的观察参红胶囊联合化疗药物对中晚期肿瘤病人的疗效、症状改善情况和免疫功能的影响。方法按照临床研究分组原则，将598例确诊的肿瘤患者随机分为两组，205例为单纯使用化疗组，393例为参红胶囊加化疗组。两组患者均分别连续给予治疗药物60天后，比较两组的疗效、症状改善情况、卡氏（Karnofsky）评分、免疫功能、外周血白细胞计数等数据。结果与对照组相比，参红胶囊联合化疗组肿瘤患者的总缓解率42．0％（对照组23．9％）；疼痛、咳嗽、乏力和食欲不振的平均改善率为71．9％（对照组48．3％）；Karnofsky评分提高了27．0％（对照组17．1％）；CD3^＋和CD4^＋数量增加11．6％和19．3％，CD8^＋则降低22．6％，CD4^＋／CD8^＋用药后增加54．2％；NK细胞活性和巨噬细胞功能也明显提高，IgG和IgA含量增加（P〈0．05），而白细胞的下降率两组无明显差异。该组患者均未出现肝肾功能的异常。结论参红胶囊联合化疗对中晚期恶性肿瘤的疗效显著高于单用化疗的对照组。这一作用可能与其提高患者免疫功能有关。     

Short course of radiation therapy in elderly patients with glioblastoma multiforme

PurposeThe optimal schedule of irradiation in elderly patients suffering from glioblastoma multiforme (GBM) is unsettled.Materials and methodsThis study reviewed the charts of 28 consecutive GBM patients aged 70 years or more with a Karnofsky Performance Status (KPS) greater than or equal to 70 who received a short course of radiotherapy (40 grays in 15 fractions over three weeks).ResultsThe median age at surgery was 74.6 years (range, 70.1–85.7). No patient received prior or concomitant chemotherapy. The median progression-free survival and overall survival were 21.6 weeks (95% CI, 17.0–39.9) and 50.6 weeks (95% CI, 26.3–62.0), respectively. Even within a narrow range (< 90 or ≥ 90), KPS remained a prognostic factor (p = 0.03). Tolerance appeared acceptable in terms of KPS changes and corticosteroid use during radiation therapy.ConclusionThese results support the efficacy of short schedule radiotherapy for GBM in elderly patients with a good KPS.     

甲地孕酮对肿瘤化疗不良反应的影响

目的观察甲地孕酮 (MA)在肿瘤化疗期间及化疗后对食欲、食量、体重、胃肠道反应及全身情况的影响。方法采用配对法将条件相仿的 46对恶性肿瘤患者分成MA组 (化疗合用MA)和对照组 (单纯化疗 ) ,观察两组患者治疗期间及化疗后食欲、食量和体重的变化、胃肠道反应 ,以及全身情况的变化。结果治疗后 ,MA组患者 5 2 .2 %食欲有改善 ,47.8%食量增加 ,45 .7%体重增加 ,5 0 %化疗期间无明显胃肠道反应 ,Karnofsky活动状况 (KPS)积分增加 >10分者占 5 0 % ;对照组仅 6.5 %食欲有改善 ,4.3 %食量增加 ,13 %体重增加 ,2 8.3 %无明显胃肠反应 ,KPS积分增加 >10分者占 15 .2 % ,两组间有非常显著性差异 (P <0 .0 1)。结论MA可减轻化疗所致的恶心、呕吐反应 ,提高食欲 ,增加体重 ,保护骨髓 ,提高患者的生活质量 ,且未见明显副作用。