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Influence of psychological rehabilitation nursing on immune function in elderly patients with post-stroke depression

Yinghua XIA ; Weiwei SU ; Ying QI ; Xin JIN ; Yuan YAO ; Mingyi ZHANG ; Yun ZHANG

Chinese Journal of Geriatrics.2014;33(10):1056-1059. doi:10.3760/cma.j.issn.0254-9026.2014.10.005

Objective To investigate the influences of psychological rehabilitation nursing on immune function in post stroke depression patients.Methods A total of 80 elderly patients with post stroke depression were recruited from the inpatients in geriatric neurology department at Tianjin Medical University General Hospital.All patients were divided into two groups:the control group received only conventional and auxiliary exercise therapy for 3 months; rehabilitation group received psychological rehabilitation nursing added to the above therapy for 3 months.Barthel indexes,Hamilton Depression Scale (HAMD) scores and immune function were detected at recruit and three months after treatment.Results There were no statistically significant differences in clinical data between the rehabilitation group and control group (all P＞0.05).There were no statistically significant differences in Barthel indexes,Hamilton Depression Scale (HAMD) scores and immune function between rehabilitation group and control group before treatment (all P＞ 0.05).Compared with control group,the rehabilitation group showed that the Barthel Indexes were increased (P=0.000),Hamilton Depression Sale (HAMD) scores were decreased (P=0.000),the levels of T lymphocyte subpopulation (P＜ 0.05) and immunoglobulin (P＜ 0.01) were increased after three months treatment.Conclusions The combination treatment of psychological rehabilitation nursing,auxiliary exercise and drug are helpful to recover immune function and improve the quality of life in patients with post stroke depression.

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Current state of secondary prevention medication for patients with high risk of recurrent ischemic stroke in Changzhou city

Donglin HAO ; Bona WU ; Lihui WANG ; Yuanfeng XU ; Jiajia WANG ; Zhiqing LIU ; Aijin MA

Chinese Journal of Geriatrics.2014;33(10):1060-1063. doi:10.3760/cma.j.issn.0254-9026.2014.10.006

Objective To investigate the application of secondary prevention medication for patients with high risk of recurrent ischemic stroke in Changzhou city,analyze the reasons for decreased medication compliance,and evaluate the current secondary prevention medication.Methods We investigated 300 consecutive hospitalized patients with acute non-cardiogenic and ischemic stroke high risk.High risk of recurrent stroke was defined as ESSEN Stroke Risk Score (ESRS) ≥3.Different ESRS scales consisting of different parameters were analyzed.All of the patients received standard secondary prevention of ischemic stroke at discharge.After three months and a year follow up,antiplatelet therapy,therapy of risk factors (hypertension and diabetes mellitus),lipid lowering therapy,and medication compliance were investigated.Results Except for age (x2 =126.54,P =0.000) and previous cerebral ischemic stroke or transient ischemic attack (TIA) (x2 =21.27,P =0.000),there were no significant differences in other risk factors (hypertension,diabetes,previous myocardial infarction,heart diseases,smoke) in patients with different ESRS scale scores (all P＞ 0.05).Antiplatelet therapy utilization was 98.3％ (295/300),antihypertensive and antidiabetic drug use rates were 95.0％(255/268) and 100％(72/72),statin use rate reached to 99％ (297/300) at discharge.After three months follow up,medication compliance in hypertension and diabetes mellitus therapy was the best [88.1％(222/252)and 86.2％ (56/65)],followed by aspirin [82.0％ (228/278)],and clopidogrel [6.1％ (17/278)].The medication compliance in lipid lowering therapy was the worst [60.1％ (167/278)].After a year follow-up versus the previous three-month follow-up,the medication compliance in hypertension and diabetes mellitus therapy was increased,but had no significant difference [89.9 ％ (220/245) vs.88.1％ (222/252),93.4％(57/61)vs.86.2％(56/65),P＞0.05],and the medication compliances inantiplatelet therapy with aspirin and clopidogrel,and lipid lowering therapy were increased significantly [93.2％ (245/263)vs.82.0％ (228/278),30.8(81/263) vs.6.1％ (17/278),88.9％ (234/263) vs.60.1％ (167/278),all P＜0.01].The increment of use rate was higher in clopidogrel therapy than in aspirin therapy.Conclusions The secondary prevention medication achieves certain efficacies in patients with high risk of recurrent ischemic stroke in changzhou city.Long term follow-up and good communication between doctor and patient can effectively improve the medication compliance in secondary prevention,and can increase the use rate of antiplatelet therapy in patients with high risk of recurrent ischemic stroke.

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Effect of general anesthesia combined with epidural anesthesia on the short-term cognitive function in the elderly patients after orthopedics surgery

Limin JIN

Chinese Journal of Geriatrics.2014;33(10):1072-1074. doi:10.3760/cma.j.issn.0254-9026.2014.10.009

Objective To observe the effects of general anesthesia combined with epidural anesthesia on the short-term cognitive function in the elderly patients after orthopedics surgery.Methods 185 elderly patients undergoing orthopedics surgery were treated in our hospital from Jan.2011 to Jan.2014.The patients were divided into observation group (with general anesthesia combined with epidural anesthesia,n=94) and control group (with general anesthesia,n=91).The short term cognitive function,mean arterial pressure and heart rate were compared at 30 min before,during and at the end of the operation between the two groups.Results There were no statistically significant differences in awakening time,extubation time and response time between the two groups [(28.7±7.8) min vs.(30.9±8.1) min,(29.2±8.1) min vs.(32.2±8.4) min,(30.4±7.9) min vs.(33.1±8.6) min,t=1.881,2.472,1.943,respectively,P=0.031,0.007,0.027].The minimental state examination (MMSE) scores were higher in observation group than in control group at 6,12 and 24 hours after surgery [(26.1±1.4) vs.(24.9±1.5),(25.0±1.5) vs.(24.1±1.4),(27.9 ±1.4) vs.(26.3±1.3),t=5.627,3.279,8.049,all P＜0.001].The incidence of cognitive dysfunction was less in observation group than in control group at 6 and 12 hours after surgery (7.5％ vs.17.6％,8.5％ vs.19.8％,x2=4.363,4.862,respectively,P=0.037,0.027).Conclusions Compared with general anesthesia,the general anesthesia combined with epidural anesthesia can reduce the effects of anesthesia on cognitive dysfunction,and has a good effect of anesthesia.It is more suitable for the elderly patients with anesthesia for surgery.

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Perioperative application of ambroxolin elderly smoking patients undergoing lung cancer operation

Xin WANG ; Lei WANG ; Hao ZHANG ; Huayong WANG

Chinese Journal of Geriatrics.2014;33(10):1078-1080. doi:10.3760/cma.j.issn.0254-9026.2014.10.011

Objective To investigate the effect of perioperative application of ambroxol in elderly smoking patients undergoing lung cancer operation.Methods 220 long time smoker undergoing pulmonary lobectomy were randomized into two groups:the intervention group (n=112) and the control group (n =108).The intervention group received ambroxol injection 30 mg intravenously,thrice daily from five days before the surgery.The control group was given ambroxol injection 30 mg intravenously,thrice daily from one day after the surgery.The difficulty in expectoration,the nature of the sputum and the duration of antibiotic use were recorded.The postoperative lung complications and the adverse reactions of ambroxol were observed.Results There were significant differences in improvements of expectoration and the nature of the sputum on the third and seventh after operation between the intervention and control groups(x2 =6.77,6.08,8.12,12.61,P=0.034,0.049,0.017,0.002).After the surgery,the duration of antibiotic use was less in the intervention group than in the control group [(5.92 ± 0.72) d vs.(7.04 ± 0.87) d,t =10.33,P=0.000].The incidences of lung infections and atelectasis after the surgery were lower in the intervention group than in the control group [19.6％ (22/112) vs.33.3％ (36/108),6.3％ (7/112) vs.16.7％ (18/108),x2 =5.31,5.92,P=0.021,0.015].In both groups,two patients had mild nausea and vomiting (x2 =0.22,P=1.000).No other common adverse reactions of ambroxol were observed in the two groups.Conclusions Perioperative application of ambroxol can decrease the sputum viscosity,make expectoration easier and reduce the occurrence of postoperative lung complications and the duration of antibiotic use.It is worth wide application in clinical practice.

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Estimation of renal artery stenosis with MR IFIR-FIESTA renal artery angiography: a comparison with CT angiography

Xiaohui YIN ; Yan HAN ; Fengtan LI ; Renju BAI ; Dong LI

Chinese Journal of Geriatrics.2014;33(10):1081-1084. doi:10.3760/cma.j.issn.0254-9026.2014.10.012

Objective To prospectively assess the diagnostic accuracy of MR inflow inversion recovery (IFIR) fast imaging employing steady-state acquisition (FIESTA) for detection of renal artery stenosis (RAS),as compared with renal artery CT angiography (CTA) performed as the reference standard.Methods Thirty patients [18 males,12 females; mean age (65.0±12.1) years] with arterial hypertension and suspected RAS were examined by 3.0-T 3D MR IFIR-FIESTA and renal artery CTA within a week.The IFIR-FIESTA image quality,the IFIR-FIESTA and CTA in display of second-order and third-order branches of renal artery were assessed by two experienced readers.The sensitivity,specificity,accuracy,and negative predictive value (NPV) of IFIR-FIESTA were calculated on artery-by-artery and patient-by-patient bases by the two readers.The inter-observer agreement between the two readers in determining the presence and grade of renal artery stenosis was assessed.Results The scores of qualification of IFIR-FIESTA image quality by reader A and B were (2.16±1.02) and (2.00 ± 0.14),there was no significant difference between them (Z=-0.037,P=0.971).IFIR-FIESTA and CTA in display of second-order and third-order branches of renal artery had no significant difference (x2 =0.298,P=0.585).In the assessment of all 64 main renal arteries by reader A,IFIR FIESTA on artery-by-artery basis had sensitivity,specificity,accuracy,and NPV of 100％,96％,97％,and 100％,respectively; the above parameters assessed by reader B were 100％,90％,93％,and 100％,respectively.There was excellent inter-observer agreement (Kappa=0.803) with the presence or absence of hemodynamically significant RAS.In the assessment of all 30 patients by reader A,IFIR-FIESTA on patient-by-patient basis had sensitivity,specificity,accuracy,and NPV of 100％,95％,97％,and 100％; the above parameters assessed by reader B were 100％,85％,90％,and 100％,respectively; there was good inter observer agreement (Kappa=0.724) with the presence or absence of hemodynamically significant RAS.Conclusions Compared with CTA,MR IFIR-FIESTA can excellently assess RAS without contrast material and radiation exposure,therefore,it can be used for screening of RAS,especially should be widely applied to elderly patients with arterial hypertension.

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Effects of comprehensive geriatric assessment and health intervention on outcome in discharged patients

Yan LIN ; Leiyi WANG ; Zhen WANG ; Haifeng WANG ; Qi ZHOU

Chinese Journal of Geriatrics.2014;33(10):1089-1092. doi:10.3760/cma.j.issn.0254-9026.2014.10.014

Objective To investigate the effects of comprehensive geriatric assessment (CGA) and health intervention on outcome in discharged patients.Methods Discharged patients in geriatric ward from May to July 2012 were randomly assigned to control (n=36) and intervention (n=36) groups.Patients in the two groups were given comprehensive geriatric assessment (CGA) before discharging from hospital.Both groups were followed up for 3 months.Patients in intervention group received health intervention when leaving hospital,at 1 week,3 weeks and 3 months after discharge from hospital,while patients in control group were not given any intervention.The comprehensive illness condition (MCIRS-G),ability of daily life (ADL and IADL),rehospitalization and survival rate were compared between the two groups 3 months after the intervention.Results After 3 months,the scores of MCIRS-G,ADL and IADL were significantly better in intervention group than in control group[(29.06±4.51) vs.(33.09±4.34),(75.69±16.57)vs.(63.86±19.37),(11.72±3.20) vs.(9.77±2.52),respectively,t=3.84,2.77,2.85,all P=0.01].The total times ofreadmission and readmission length were less in intervention group than in control group [3 vs.17,x2 =8.79,P=0.02; (1.94±6.68) days vs.(8.81±14.09) days,t=2.64,P=0.01].There was no difference in survival rate between the two groups [100％ (36/36) vs.97.2％ (35/36),x2=1.01,P=0.30].Conclusions Comprehensive geriatric assessment and health intervention can alleviate symptoms and improve the ability of daily life.

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Charlson index combined with agestratification used to assess the tolerance of elderly patients with esophageal carcinoma to chemoradiotherapy

Xiaoxu LU ; Hui WU ; Hao CHENG ; Jianhua WANG ; Jing XU

Chinese Journal of Geriatrics.2014;33(10):1093-1096. doi:10.3760/cma.j.issn.0254-9026.2014.10.015

Objective To assess the tolerance of elderly patients with esophageal carcinoma to chemoradiotherapy through.Methods A retrospective analysis of 596 elderly patients with esophageal carcinoma receiving chemoradiotherapy was conducted.Patients were divided into radiachemotherapy group and radiotherapy group,and according to age,patients were divided into four age groups (aged 70-74,75-79,80 80 and 85years and over).The tolerance to treatment was assessed by Charlson index.Results 185 patients completed chemoradiotherapy,113 patients reduced the dose of chemotherapy (reduction group),81 patients unfinished chemoradiotherapy (unfinished CRT group),160 patients completed radical radiotherapy alone (unfinished RT group),and 57 patients incompleted radiotherapy.Further analysis found that the tolerance to treatment in reduction group had significant differences between patients aged ≥ 75 years and ＜ 75 years (x2 =6.815,P=0.009),and between WIC ≥ 1 and ＜ 1(x2 =10.636,P=0.001); the tolerance to treatment in unfinished CRT group had significantly differences between aged ≥ 80 years and ＜80 years (x2 =63.842,P=0.000),and between WIC =0,1 and ≥ 2 (x2 =21.153,P=0.000).Conclusions Further age re-grouping and WIC assessment is necessary before treating esophageal cancer patients.Reduction of therapy dosage is more beneficial for patients aged ≥ 75 years and WIC≥1,and greater caution is required in chemotherapy for patients aged ≥ 80 years and WIC＞1.

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Preliminary study on expression and significance of plasminogen activator inhibitor-1 in endometrial carcinoma

Shuai HUANG ; Mingfei ZHENG ; Sichen ZHANG ; Shaowei WANG

Chinese Journal of Geriatrics.2014;33(10):1097-1099. doi:10.3760/cma.j.issn.0254-9026.2014.10.016

Objective To research the relationship between the expression of PAI-1 and the clinical characteristics of the endometrial carcinoma.Methods We detected the level of the serum PAI-1 by ELISA in the patients with endometrial carcinoma,the patients with endometrial hyperplasia and the patients with normal endometrium.The expression of PAI-1 in endometrial carcinoma and normal endometrial tissues was observed by immunohistochemistry.Results The concentration of serum PAI-1 in patients with endometrial carcinoma was 18.64 ± 6.22 μtg/L,significantly higher than those of patients with endometrial hyperplasia (6.94 ± 2.87) μg/L and patients with normal endometrium (6.68 ± 2.13)μg/L (P=0.00).The expression rate of PAI-1 was 68.2％ (15/22) in endometrial carcinoma tissue,and 8.3％ (2/24) in normal endometrial tissue (P=0.00).Compared with the early endometrial carcinoma,the expression rate of PAI-1 in the advanced endometrial carcinoma was significantly higher (6/6 w 9/16,P=0.03).Conclusions The expression level of PAI-1 may be related to the stage of the endometrial carcinoma.

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The expression of lymphoid-associated antigens in elderly patients with acute myeloid leukemia and its clinical significance

Wenhui ZHANG ; Kaikai CHI ; Yuqing CHEN ; Yin ZHANG ; Kai SUN ; Baogen MA

Chinese Journal of Geriatrics.2014;33(10):1100-1103. doi:10.3760/cma.j.issn.0254-9026.2014.10.017

Objective To explore the expression of lymphoid-associated antigens in acute myloid leukemia and its clinical significance.Methods 84 patients with de nove (untreated) AML were classified by FAB classification and immunophenotype,of which 53 cases were analyzed by karyotype according to WHO standards.Patients were divided into 2 groups according to whether lymphoid antigen (Ly) was expressed or not.After all patients were treated with a standard remission-induction regimen for 1 course,bone marrow in 63 cases were re examined.Results 49 cases (58.3％) were classified into lymphoid surface antigen-positive acute myeloid leukemia (Ly+ AML) group,35 cases (42.7％) into lymphoid surface antigen-negative acute myeloid leukemia (Ly-AML) group.The incidences of hepatosplenomegaly and lymphadenopathy had significant differences between Ly+AML and Ly AML groups [55.1％ (27 cases) vs.22.9％ (8 cases),t=3.412,P=0.003].There were no significant differences in other indicators between the two groups.On the basis of equal intensity of chemotherapy,complete remission (CR) had no significant difference(x2 =1.995,P=0.158),the disease-free survival (DFS) in Ly + AML group was shorter than in Ly-AML group(t=2.427,P=0.019),the recurrence rate was higher in Ly + AML group than in Ly-AML group(x2 =4.132,P=0.044).Conclusions The expression of lymphoid associated antigens in acute myeloid leukemia is complex.Patients with Ly+AML show poor response to chemotherapy,and have poor prognosis.We should explore new chemotherapy for acute myeloid leukemia.

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Effect of transplantation of mesenchymal stem cells transfected with the human receptor activity modifying protein 1 gene on post-angioplasty proliferation and apoptosis of vascular smooth muscle cells in rabbits

Ranzun ZHAO ; Xianping LONG ; Guanxue XU ; Zhijiang LIU ; Dongmei WANG ; Tian YU ; Bei SHI

Chinese Journal of Geriatrics.2014;33(10):1127-1131. doi:10.3760/cma.j.issn.0254-9026.2014.10.025

Objective To explore the effect of transplantation of mesenchymal stem cells (MSCs) transfected with the human receptor activity modifying protein 1 (hRAMP1) gene on proliferation and apoptosis of vascular smooth muscle cells (VSMCs) after carotid balloon angioplasty was performed in rabbits with carotid atherosclerosis.Methods Density gradient centrifugation and adherent culture were carried out to obtain MSCs,which were then transinfected with an adenovirus vector carrying the hRAMP1 gene or an empty adenovirus vector.A rabbit model of atherosclerotic stenosis and balloon angioplasty was successfully established.Results were randomly divided into three groups:the hRAMP1-MSCs group,theadipose-derived MSCs (Ad-MSCs) group and the control group.MSCs were transinfected with Ad-EGFP-hRAMP1,Ad-EGFP or PBS by transplantation into the injured carotid arteries.Homing and differentiation were assessed with MSCs harvested at 7 d.With MSCs collected at 28 d,Western blotting was used to measure the expression of the hRAMP1 target gene in the carotid artery; the neointima and media area in the injured carotid arteries were estimated; carotid artery morphology was examined with H&E staining; and the proliferation and apoptosis of VSMCs were determined by immunohistochemistry and TUNEL.Results The expression of CD31 and EGFP was found in proliferating neointima lesions at 7d in the hRAMP1-MSCs group and the Ad-MSCs group.At 28d of MSC transplantation,the level of RAMP1 significantly increased in the hRAMP1-MSCs group,compared with the Ad-MSCs and control groups [(63.0±4.9) vs.(28.3±2.5) and (27.2±7.2),all P＜0.05],but there was no differencein the RAMP1 level between the Ad MSCs group and the control group (P＞0.05).Positive expression of the α-smooth muscle antibody (α-SMA) was found in all three groups at 28 d of MSC transplantation.The thickness of the hyperplastic neointima significantly decreased in the hRAMP1-MSCs group,compared with the other two groups (P＜0.05),and was lower in the Ad-MSCs group than in the control group (P＜0.05).The expression of proliferating cell nuclear antigen (PCNA) was lower in the hRAMP1-MSCs group than in the Ad-MSCs and control groups at 28d of MSC transplantation (P ＜0.05),while the PCNA level was lower in the Ad-MSCs group than in the control group (P＜ 0.05).The VSMC apoptosis rate significantly increased in the hRAMP1-MSCs group,compared with the Ad MSCs and control groups (P＜0.05),and was the lowest in the control group (P＜0.05).Conclusions Gene-modified stem cell therapy can effectively inhibit vascular intimal hyperplasia,thereby reducing restenosis after angioplasty.

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