OBJECTIVE:To provide reference for promoting smoothly implementation of deprescribing. METHODS:A total of 335 elderly patients with chronic disease were randomly selected from 4 communities and 9 village clinic of a Chongqing community health service center. Questionnaire survey was conducted about general information of respondents,disease and drug use condition and attitude to deprescribing by using Australian Patients'Attitudes Towards Deprescribing questionnaire as reference. The results of questionnaire survey were analyzed statistically. The cognitive function was assessed by Hastgawa Dementia Scale. The degree of weakness was evaluated by Chinese edition of Edmonton Frail Scale. The quality of life was evaluated by Chinese edition of European Five Dimensional Health (EQ-5D) Scale. RESULTS:Totally 311 valid questionnaires were obtained,with effective recovery rate of 92.8％. Overall,311 participants were recruited,with a median age of 70 years,5 types of median disease (hypertension was most common) and 5 types of median medication (mainly calcium channel blocker and non-insulin hypoglycemic agent);54.7％(170 cases)participants took multiple drugs. The attitudes towards deprescribing were that 39.5％ of respondents believed that they took too many drugs;73.9％ had a desire to reduce their drugs;83.6％ reported that they would be willing to reduce drugs if their doctor said it was possible. The patients taking multiple drugs preferred to use less drugs (P=0.001) and reduce current drugs (P=0.001),and were more willing to reduce drug cost by reducing drug use;they were also more worried about drug side effects than those without taking multiple drugs (P=0.005). CONCLUSIONS:The phenomenon of elderly chronic diseases patients with multiple diseases and multiple drug use are popular in community. It is necessary to simpilfy prescription. Most elderly patients would like to reduce their medications if doctors say it is possible;the patients with multiple drug use are more willing to simplify prescription than those without multiple drug use.

BACKGROUNDOn the afternoon of May 12, 2008, a 8.0-magnitude earthquake hit Sichuan Province, a mountainous region in Western China, killing about 70 000 people and leaving over 18 000 missing. What about the survivors motor functions and activities of daily living (ADL) capacity, especially for fractures? We need the data to guide the rehabilitation for the seismic wounded and it's important to collect the data for the future. We study the survivors to understand the motor functions and ADL capacity of patients with fractures sustained in the Wenchuan earthquake, to provide a basis for rehabilitation and treatment.

METHODSWe used the Manual Muscle Testing method to evaluate muscle strength, the joint angle scale to measure joint range of motion (ROM), and the Barthel index to evaluate the activities of daily living status. SPSS 13.0 software was used to analyze the data and the results were tested using one-way analysis of variance (ANOVA).

RESULTSThe number of seismic wounded amounted to 487; 81.1% of patients had fractures. Most of the injured had fractures in multiple regions (53.9% of all fracture patients), followed by fractures of the upper limb (34.0% of patients); cranial fractures were rare (2.3%). Totally 82.0% had restricted range of motion, 23.5% had decreased muscle force, and 72.2% of the patients had restricted activities of daily living capacities. With time the activities of daily living capacity of female increased (P < 0.05), compared with the male fracture patients who did not show any relative improvement (P > 0.05). The difference between the patients' ages and ADL capacities did not reach statistical significance (P > 0.05), nor was there a significant difference between their ages and the numbers of days in hospital (P > 0.05).

CONCLUSIONSFractures were the main issue in the seismic wounded, many of them had reductions in the ROM, muscle force and ADL capacities. The physicians involved in rehabilitation should pay greater attention to muscle force exercises, joint mobilization, and occupational therapy during the early phases post disaster.

Activities of Daily Living ; Adolescent ; Adult ; Age Factors ; China ; Earthquakes ; Female ; Fractures, Bone ; physiopathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo study the mutation feature of ganglioside-induced differentiation associated protein-1 (GDAP1) gene in Chinese Charcot-Marie-Tooth disease(CMT) patients.

METHODSMutation analysis was carried out by use of polymerase chain reaction-single strand conformation polymorphism(PCR-SSCP) combined with DNA direct sequencing of the six exons and their flanking regions of GDAP1 gene in twenty-three CMT patients, including 8 probands of autosomal recessive CMT families and 15 sporadic patients.

RESULTSA compound heterozygous mutation A533G and A767G were unveiled in one autosomal recessive CMT kindred. The homozygous and heterozygous T507G were common SNPs in Chinese population.

CONCLUSIONA533G and A767G of GDAP1 gene were new mutations firstly reported.

Adolescent ; Adult ; Charcot-Marie-Tooth Disease ; genetics ; Child ; Child, Preschool ; Female ; Humans ; Male ; Mutation ; Nerve Tissue Proteins ; genetics ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational ; Sequence Analysis, DNA

Objective To study the influence of age,gender and history of diabetes in maximum standardized uptake value (SUVmax) and standardized cerebral metabolic rate (SCMR) of glucose.Methods Seventy-nine healthy volunteers were recruited and evaluated by PET-CT examination.Region of interest (ROI) analysis was employed to measure the SUVmax in 13 ROIs of the brain and 13ROIs of the cerebellum.SCMR was amounted by left SUVmax/right SUVmax in the corresponding ROI point of each side in the same volunteer.The influences of age,gender and history of diabetes in SUVmax and SCMR were analyzed. Results No statistical significance of SUVmax was noted between the 2corresponding points in bilateral ROI (P＞0.05).Statistical significance of SUVmax was noted between each 2 points in the left and right ROI (left:F=14.280,right:F=14.680,P=0.000).Statistical difference of SUVmax was recorded in different age groups (P＜0.05).The female had significantly lower SUVmax in bilateral measurement points (2/26) as compared with the male (P＜0.05).Concerning the influence of history of diabetes,statistical significance of SUVmax was noted in almost all ROIs (18/26,P＜0.05).No statistical significance of SCMR in each ROI was noted in different groups of gender,age and diabetes (P＞0.05). Conclusion SCMRglu can eliminate the role of such influencing factors as age,gender and history of diabetes,which have been proved to exert some effect on the results of SUVmax; therefore,SCMRglu may provide a reliable indicator for further study.

ObjectiveTo investigate whether phosphodiesterase （PDE） 5 inhibitors sildenafil （SIL） or LW1646 prevented renal interstitial fibrosis induced by unilateral ureteral obstruction （UUO）. MethodsMale C57BL/6 mice were randomly divided into four groups （n =6）， namely the Sham group， 7UUO group， 7UUO+SIL group and 7UUO+LW1646 group. Sildenafil （SIL） or LW1646， or vehicle was administered 1 hour before surgery， and the mice were continuously treated once daily （i. g.， 50 mg/kg） for 7 days. The obstructed kidneys were harvested on day 7. Hematoxylin-eosin （HE） and Masson’s staining was used to examine renal histology. Immunoblotting and RT-qPCR were used to detect the expression levels of protein and mRNA for fibrosis， apoptosis， endoplasmic reticulum （ER） stress， autophagy， and pro-fibrotic factors. Human proximal tubule epithelial cells （HK-2） were treated with TGF-β1 for 48 hours or tunicamycin for 24 hours， respectively， to evaluate whether cyclic guanosine monophosphate （cGMP） or PDE5 inhibitors prevents ER stress and pro-fibrotic responses. ResultsAt the 7^th days after UUO， the body weight of the mice showed a significant decrease （P< 0.000 1） compared with that in the sham group. The obstructed kidneys showed a significant tubular dilation and interstitial inflammation. The levels of protein and mRNA expression in apoptosis， ER stress， autophagy-related protein and pro-fibrotic factors were also markedly increased in UUO mice （P <0.05）. In contrast， SIL or LW1646 treatment was associated with attenuated tubular dilation， infiltration of inflammatory cells and collagen content in the obstructed kidney of the mice. The protein and mRNA expression levels of renal TGF-β1 were markedly decreased， and the protein expression levels of apoptosis， endoplasmic reticulum stress， and autophagy markers were also significantly downregulated by PDE5 inhibitors. In HK-2 cells， TGF-β1 induced increased expression levels of fibronectin and BiP， which was at least partially reversed by cGMP， a product of PDE inhibition. Additionally， PDE5 inhibitors were found to modulate aberrant levels of autophagy and apoptosis. ConclusionIn conclusion， PDE5 inhibitors， in particular， LW1646， can alleviate the progression of fibrosis by improving ER stress， apoptosis and autophagy as well as downregulating protein and mRNA expression of TGF-β1.

ObjectiveTo investigate the role of bile acid receptor TGR5 activation in renal fibrosis induced by unilateral ischemia reperfusion injury and contralateral nephrectomy （uIRIx） model. MethodsIn vivo： C57BL/6J mice were randomly divided into Sham group， uIRIx group and uIRIx+ lithcholic acid （LCA） group with 6 mice in each group. Kidney fibrosis was induced by uIRIx model， kidney function was evaluated by blood and urine biochemical indexes， and the degree of kidney injury was evaluated by HE staining. Masson staining and immunohistochemistry were used to evaluate the degree of renal fibrosis， and Western Blotting was used to detect the expression of related index proteins of renal cortical fibrosis. Sham group and uIRIx group were set in TGR5^+/+ mice and TGR5^-/- mice respectively， with 6 mice in each group. The degree of renal fibrosis in each group was detected by Western Blotting. In vitro： TGF-β1 was administered to induce pro-fibrosis response in human renal tubular epithelial cell line （HK2 cells）， LCA was used for drug intervention， cytoskeleton was labeled with phalloidin-FITC staining and the expression of fibrosis related indicator protein in HK2 cells was detected by Western Blotting. ResultsIn vivo： Compared with the Sham group， plasma creatinine level （P=0.007） and urinary albumin/creatinine ratio （P=0.041） in uIRIx group were significantly increased， renal cortical protein TGR5 expression （P=0.002） was decreased， Fibronectin expression （P=0.020） and COL1A1 expression （P<0.001） were increased. At the same time， the kidney structure was damaged and collagen deposition was aggravated. LCA intervention effectively improved the kidney function and alleviated the degree of kidney injury and fibrosis. TGR5 gene knockout increased uIRIx-induced Fibronectin expression （P<0.001） and COL1A1 expression （P=0.001） compared with TGR5^+/+ mice. In vitro： TGF-β1 induced morphological changes of HK2 cells， cytoskeletal depolymerization and recombination， and promoted the up-regulation of fibrosis index protein. LCA effectively inhibited the morphological changes and skeletal depolymerization induced by TGF-β1， and down-regulated the expression of fibrosis related indicator proteins. ConclusionsLCA alleviated renal fibrosis induced by uIRIx model， and knockout of TGR5 gene aggravated uIRIx induced renal fibrosis； In HK2 cells， LCA alleviated fibrogenic reaction induced by TGF-β1. This indicates that activation of TGR5 alleviates renal fibrosis induced by uIRIx.

OBJECTIVE: To explore whether BAX plays a role in the development of Philadelphia chromosome-positive leukemia and related mechanisms. METHODS: Target-gene knockout mice were used as bone marrow cell donors. Retrovirus over-expressing BCR-ABL were packaged. BCR-ABL-induced B-ALL mouse model was established through donor's B cells transfected by the retrovirus and the B cells over-expressing BCR-ABL were given to the receptor mice by tail vein injection. Western blot was used to detect the protein express and flow cytometry was used to analyze the B cell subpopulations in BAX and WT mouse bone marrows. Kaplan-Meier analysis was used to estimate the survival of diseased mice. RESULTS: BAX deletion caused faster development of BCR-ABL-induced leukemia in vitro and in vivo. BCR-ABL increased BCL-2 expression and enhanced BCL-2/BAX heterodimer formation. CONCLUSION The BAX deletion can accelerate the disease progression of BCR-ABL induced B-ALL.