The management of frailty in elderly patients with chronic kidney disease (CKD) has been receiving increasing attention.Frailty in elderly patients with CKD has a high incidence and is used for risk prediction of adverse outcomes,including death,hospitalization,falls,dialysis and so on.A range of pathophysiological changes caused by CKD,aging and multimorbidity work together to promote the development of frailty.Treatment for CKD patients with frailty includes mainly nutritional support,exercise,drug therapy and comprehensive intervention.This article reviews recent research progress concerning frailty in elderly CKD patients.

Objective To analyze the frail status and influencing factors of inpatients in geriatrics department.Methods A total of 170 patients aged ≥ 65 years in Geriatrics Department in our hospital were selected.Frailty was defined according to the Clinical Frailty Scale (CFS),and patients were divided into non-frail group and frail group.The differences in comorbidity,physical function,nutrition,cognitive,psychological,geriatrics syndromes,medication,social support and other aspects were analyzed between the two groups by using Comprehensive Geriatrics Assessment(CGA),and correlationof the factors with frailty was evaluated.Results There were 83 (49.0％)patients in frail group and 87 (51.0％)in non-frail group.In frail group versus non-frail group,Charlson comorbidity index was(2.7±2.0)vs.(1.9±1.1),and cumulative illness rating scale was(10.8±3.7) vs.(8.0±2.6) (all P＜0.05);mini-nutrition assessment was(11.2±2.3)vs.(13.0±1.3),and simple cognitive score was(2.7±1.3)vs.(4.1±0.9)(all P＜0.05).Grip,five chair rising,timed get-up and go test,walking speed,SPPB showed statistically significant differences (all P＜ 0.05) between frail group and non-frail group:(20.7±6.6)kg vs.(27.96.7)kg,(30.4±17.5)vs.(12.9±4.1),(23.7± 9.9)vs.(11.7± 3.3),(0.5 ± 0.2)m/s vs.(0.9± 0.2)m/s,(5.6 ± 2.3) vs.(10.3±1.8)respectively.The incidences of incontinence,visual impairment,hearing impairment,sleeping disorder,oral problems,chronic pain,anxiety or depression and fall history were higher in frail patients than in non-frail patients.Living alone,the widowed,nursing staff employment proportion were higher in frail group than in non-frail group.Level of education was lower in frail group than non-frail group.Logistic regression analysis showed that BMI,the walking speed and the number of geriatrics syndromes had a significant impact on frailty(OR=0.789,0.000,2.745,all P＜0.05).Conclusions Incidence rate of frailty in elderly hospitalized patients is high.To identify frailty of hospitalized patients,comprehensive geriatric assessment can be used for understanding frail characteristics and its influencing factors for hospitalized old patients,so as to provide evidence for the reasonable treatment programs.

Objective To investigate the incidence and the relation between pulmonary hypertension (PH) and cardiac output in hemodialysis (HD) patients with PH. Methods The incidence of PH was estimated with Doppler echocardiography in 78 patients receiving HD. Left ventricular ejection fraction, cardiac volume, cardiac output and cardiac index were compared between patients with or without PH. Results PH was found in 20 patients (25.64%), among them15 had mild PH, 4 had moderate PH and 1 had severe PH. There was no statistical difference of ejection fraction, cardiac volume, cardiac output and cardiac index between the two groups. PH was not related to cardiac output. Conclusion HD can lead to PH, but cardiac output can not result in PH. Further investigations about the effect of elevated cardiac output induced by internal arteriovenous fistula and other factors on PH are needed.

Objective To investigate the prevalence ,clinical features and prognosis of pulmonary arterial hypertension (PAH) in maintenance bemodialysis (MHD) patients for early diagnosis and treatment. Methods Complete clinical data of 184 MHD patients in Beijing Chaoyang Hospital between January 2000 and December 2007 were retrospectively analyzed. PAH diagnosis depended on echocardiography. Results Sixty-five (35.3%) patients were found having PAH, including 31 females and 34 males, with mean (56.84±14.58) years old. The mean bemadialysis duration was (29.69±21.61) months. Among 65 patients with PAH, arteriovenous fistula was used in 61 patients and central venous catheter in 4 patients. The systolic pulmonary arterial pressure (SPAP) was (44.56±8.25) mm Hg (1 mm Hg=0.133 kPa) in PAH group, which was significantly higher than (30.28±3.92) mm Hg in non-PAH group. There were significant differences of interval dialysis weight gain (IDWG), Hb, Hct, right atrial diameter, pulmonary artery diameter and right ventricular diameter between PAH group and non-PAH group (all P<0.05). Multivariate analysis revealed anemia, IDWG and right atrial diameter were independent factors (P< 0.05). There were no significant differences of age, dialysis duration, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH) between two groups. Conclusions PAH is a common complication of MHD patients. Patients with mild PAH had few clinical manifestations and good therapeutic responses, but severe PAH may be associated with poor prognos is. Doppler echocardiography should be performed periodically to detect PAH in MHD patients.

OBJECTIVETo analyze partial deletion of the long arm of X chromosome in a family and explore the mechanism underlying its phenotypes.

METHODSG-banding technique was employed to analyze the karyotypes of the subjects, and fluorescence in situ hybridization (FISH) was used to analyze their X chromosomes with Xpter, Xqter and WCPX probes.

RESULTSThe karyotypes of the proband, her mother and her fetus were all 46,X,del(X)(q24). Combined FISH and karyotyping analysis suggested that the proband and her fetus both carried a Xq24q27.3 deletion.

CONCLUSIONThe Xq24q27.3 deletion carried by the family is closely related with premature ovarian failure but not with short stature, gonadal dysgenesis and primary amenorrhea.

Adult ; Chromosome Banding ; Chromosome Deletion ; Chromosomes, Human, X ; Female ; Humans ; In Situ Hybridization, Fluorescence ; Karyotyping ; Primary Ovarian Insufficiency ; genetics

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OBJECTIVE: To detect the roles of Livin and its relationship with bFGF in laryngeal squamous cell carcinoma (LSCC) through observing the expression of Livin and bFGF in laryngeal squamous cell carcinoma. METHOD: Expression of Livin and bFGF in 41 cases of LSCC (11 cases with lymph node metastasis) and 20 cases of normal soft palate mucosa were detected by immunohistochemistry. RESULT: Livin were positively detected in 29 (70.73%) cases of LSCC and negatively detected in all normal soft palate tissue. The positive rate of Livin was higher in LSCC than that in normal soft palate tissue and the expressions were significantly associated with lymph node metastasis status (P < 0.05) but not with histological grade, clinical stage and age (P > 0.05). The expression of Livin was positively correlated with the expression of bFGF. CONCLUSION The elevated expression of Livin in LSCC might play an important role in the development of laryngeal squamous cell carcinoma and bFGF might be involved in the process.
Adaptor Proteins, Signal Transducing ; metabolism ; Adult ; Aged ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Female ; Fibroblast Growth Factor 2 ; metabolism ; Humans ; Inhibitor of Apoptosis Proteins ; metabolism ; Laryngeal Neoplasms ; metabolism ; pathology ; Male ; Middle Aged ; Neoplasm Proteins ; metabolism

OBJECTIVE: To assess the application value of combined detection of HbA2 and HbF for the screening of thalassemia among a population of childbearing age in Quanzhou, Fujian, and determine the optimal cut-off values for the region. METHODS: Capillary hemoglobin electrophoresis and genetic testing for α and β globin gene mutations were simultaneously carried out on 11 428 patients with suspected thalassemia. Statistical methods were used to analyze the distribution of various types of thalassemia and compare the performance of HbA2 and HbF measurement for the screening of various types of thalassemia. The optimal cut-off values for HbA2 and HbF were determined with the ROC curves. RESULTS: 4591 patients with α, β, and αβ compound thalassemia were identified by genetic testing. The most common genotypes for α and β thalassemia included --SEA/αα and β654/βN, β41-42/βN, and β17/βN. The ROC curves were drawn to compare the performance of HbA2 screening for α-, β-, αβ-compound, static α-, mild α-, and intermediate α-thalassemia, and the maximum area under the curves was 0.674, 0.984, 0.936, 0.499, 0.731, 0.956, and the optimal cut-off values for HbA2 were 2.45%, 3.25%, 3.65%, 2.95%, 2.55%, 1.75%, respectively. CONCLUSION HbA2 is an efficient indicator for identifying intermediate types of α-, β-, and αβ compound thalassemia. The combination of HbA2 and HbF measurement can effectively detect carriers for β-thalassemia mutations.
Genotype ; Hemoglobin A2/genetics* ; Heterozygote ; Humans ; Mass Screening ; Mutation ; alpha-Thalassemia ; beta-Thalassemia/genetics*

Objective To investigate the screening and gene test of thalassemia in couples of childbearing age in Quanzhou City Fujian Province.Methods A prospective design was used to collect 41 026 pairs of marriage and excellent blood samples from 12 counties in Quanzhou City,Fujian Province from July 2017 to July 2018.To analyze screened the genetic test results and genotyping of positive thalassemia couples.Firstly,the erythrocyte mean corpuscular volume (MCV) and erythrocyte mean corpuscular hemoglobin (MCH) were used for primary screening.Both sides of the couple were performed hemoglobin electrophoresis when at least one of the couples was screened positive.Couples were performed thalassemia gene detection when blood routine or hemoglobin electrophoresis of the couples was positive.The characteristics of genotypes,homologous carriers and distribution of gene mutations in Quanzhou City were analyzed.Results Among 41 026 couples of childbearing age,4 470 couples had abnormal blood routine examination results in at least one of the couples,the rate of positive screening was 10.90％.There were 952 couples who represented abnormal blood routine or hemoglobin abnormal electrophoresis.Totally 658 cases were diagnosed as thalassemia after thalassemia gene detection,and the diagnosis rate was 34.56％.Totally 493 cases of α-thalassemia were detected,and the higher genotypes were:--SEA/αα,-α3.7/αα and ααQS/αα;and 155 cases of β-thalassemia were detected,and the higher genotypes were:IVS-Ⅱ-654/N,CD41-42/N,CD17/N,βE/N,-28/N;10 cases of α complex β thalassemia were detected.Totally 56 high-risk couples with homologous thalassemia gene were detected,including 50 pairs of homologous α-thalassemia,4 pairs of homologous β-thalassemia,and 2 pairs of homologous couples with α complex β thalassemia.The rate of diagnosis and detection rate of homologous thalassemia in different counties of Quanzhou were quite different (x2 =41.939,21.129,P ＜ 0.05).Among them,the rate of diagnosis in Dehua County was the highest (53.13％,85/160),followed by Yongchun County (39.38％,63/160) and Nan'an City (37.73％,123/326).In addition,the detection rate of homologous thalassemia in Dehua County was the highest (15.00％,12/80),followed by Anxi County (8.44％,13/154) and Yongchun County (7.50％,6/80).Conclusions The incidence of thalassemia in couples of childbearing age in Quanzhou is higher,mainly due to α-thahssemia.The high-risk type of homologous carrier is present in α-thalassemia,which should be paid attention to the prevention and control of thalassemia.

Objective:To establish and verify a dynamic web-based nomogram for predicting futile recanalization after thrombectomy in acute ischemic stroke.Methods:Three hundred and four acute ischemic stroke patients admitted to the Second Affiliated Hospital of Soochow University from May 2017 to April 2021 were retrospectively enrolled. All these patients underwent mechanical thrombectomy and obtained successful recanalization. The eligible patients were randomly divided into training group ( n=216) and test group ( n=88) by 7∶3. The nomogram was established and internally validated with the data of the training group, and externally validated with the data of the test group. For the training group, multivariate Logistic regression analysis was performed by including all variables with P<0.05 in univariate analysis, and the independent predictors of futile recanalization were screened out to construct a nomogram. In the training group and the test group, the performance of the nomogram was verified by C-index, calibration chart and decision curve analysis respectively. Results:No significant difference was detected between the training group and the test group in futile recanalization [134/216 (62.0%) vs 56/88 (63.6%), χ 2=0.07, P=0.794]. Multivariate Logistic regression analysis showed that age ( OR=1.04,95% CI 1.00-1.08, P=0.033), National Institutes of Health Stroke Scale (NIHSS) score on admission ( OR=1.11,95% CI 1.04-1.19, P=0.001), neutrophil to lymphocyte ratio ( OR=1.19,95% CI 1.07-1.32, P=0.001), glycated hemoglobins ( OR=2.02,95% CI 1.34-3.05, P<0.001), poor collateral status ( OR=10.87,95% CI 4.08-29.01, P<0.001), postoperative high density ( OR=11.38,95% CI 4.56-28.40, P<0.001) were independent risk factors for futile recanalization. The C-index of this nomogram in the training group and the test group was 0.92 (95% CI 0.877-0.954, P<0.001) and 0.93 (95% CI 0.87-0.98, P<0.001), respectively. Conclusion:This web-based nomogram, including age, NIHSS score on admission, neutrophil to lymphocyte ratio, glycated hemoglobin, poor collateral status and postoperative high density, predicted individual probability of futile recanalization after mechanical thrombectomy with good discrimination and clinical utility.