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Study of factors relating to failure of vacuum assisted closure therapy in pressure ulcers

Liu LIU ; Shuhua NING ; Xue ZHANG ; Wentao ZHANG

Chinese Journal of Geriatrics.2013;32(9):983-985. doi:10.3760/cma.j.issn.0254-9026.2013.09.017

Objective To study the factors relating to failure of vacuum assisted closure (VAC)therapy for pressure ulcers control in order to guide the clinical indications.Methods A retrospective cohort study of 75 patients with pressure ulcers to undergo VAC therapy was conducted.Correlations between 12 risk factors and VAC therapy failure were analyzed.The statistical prognostic factors were screened and the sensitivity,specificity,positive predictive value and negative predictive value of them were analyzed.Risk factors for VAC failure were determined by using Logistic regression analysis.Results Among the 75 patients,17 patients failed to respond to the VAC therapy.The failure rate of VAC therapy had correlations with positive blood cultures,bony exposure,hypoalbuminemia (alb ＜25 g/L) and wound depths≥ 4 cm (70.0％,50.0％,38.5％ and 40.9％,respectively),but the Logistic regression analysis found that the 4 factors were not the independent risk factors for failure of VAC therapy.Conclusions Pressure ulcer patients with positive blood cultures,bony exposure,hypoalbuminaemia (alb ＜25 g/L),and wound depth≥4 cm tend to have a higher failure rate in VAC therapy,which are the relative indications for VAC therapy.

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Effects of CXC receptor 4 gene-modified bone marrow mesenchymal stem cells transplantation on repairment of carotid injure in rats

Zhijiang LIU ; Bei SHI ; Guanxue XU ; Ranzun ZHAO ; Changying SHEN ; Panke CHEN

Chinese Journal of Geriatrics.2013;32(9):996-1000. doi:10.3760/cma.j.issn.0254-9026.2013.09.022

Objective To investigate the effect of transplantation of CXC receptor 4 (CXCR4)gene-modified bone marrow mesenchymal stem cells (BMSCs) on repairment of carotid injure in rats.Methods BMSCs were cultured and transfected with lentivirus vector carrying CXCR4 gene to generate CXCR4 gene-modified BMSCs (CXCR4-BMSCs).CXCR4 expression was detected by Western blot.Rat model of carotid artery balloon injury was established.Rats were randomly divided into the PBS control group (n=12),CXCR4-BMSCs group (n=12) and BMSCs group (n=12).Two weeks after transplantation,the injured arteries were obtained.The homing of BMSCs was detected by immunofluorescence with green fluorescent protein (GFP).Platelet endothelial cell adhesion molecule (CD31) expression was detected by immunofluorescence staining.At 4 weeks after transplantation,proliferating cell nuclear antigen (PCNA) expression was determined by immunohistochemical staining,and the vascular morphological changes were observed by hematoxylineosin staining (HE).Results Compared with the control and BMSCs groups,the protein level of CXCR4 was increased in CXCR4-BMSCs group (both P＜0.05).The percentage of GFP-positive cells homing were much more in CXCR4-BMSCs group than in BMSCs group [(58.8±4.4)％ vs.(36.2±5.0) ％,P＜0.05].The CD31 expression were higher in CXCR4-BMSCs group than in BMSCs group [(58.8±4.3)％ vs.(28.8±4.2)％,P＜0.05].Compared to the control group,the PCNA expression was decreased in CXCR4-BMSCs and BMSCs groups [(21.0±4.2) ％,(36.5±4.9) ％vs.(78.3±3.5) ％,both P＜0.05].There was a significant difference in PCNA expression between the CXCR4-BMSCsgroupandBMSCs group [(21.0±4.2)％vs.(36.5±4.9)％,P＜0.05].The neointimal area and the ratio of neointimal/medial area were decreased in CXCR4 BMSCs and BMSCs group as compared with the control group [(0.205±0.018) mm2,(0.323±0.071) mm2 vs.(0.536 ± ±0.054) mm2; (1.039±0.123),(1.660±0.404) vs.(2.460±0.328); all P＜0.05],and there were significant differences in neointimal area and the ratio of neointimal/medial area in CXCR4-BMSCs group and BMSCs group [[(0.205±0.018) mm2 vs.(0.323±0.071) mm2,(1.039±0.123)vs.(1.660±0.404),both P＜0.05].Conclusions CXCR4 gene-modified BMSCs may increase the CXCR4 expression in BMSCs.CXCR4-BMSCs transplantation is more effective than BMSCs transplantation in increasing BMSCs homing capacity,reducing the reendothelialization and vascular restenosis.

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Neuregulin-1 inhibits myocardial cell apoptosis by attenuating mitochondrial stress in rats with heart failure after myocardial infarction

Yongfang GUO ; Yi AN ; Jian LI ; Xiaoxia ZHANG ; Xuesi WU

Chinese Journal of Geriatrics.2013;32(9):1001-1005. doi:10.3760/cma.j.issn.0254-9026.2013.09.023

Objective To study the effect of Neuregulin-1 (NRG) on rat heart failure(HF) after myocardial infarction,and to investigate the underlying mechanism involving in NRG-mediated cardioprotection.Methods 60 adult Wister rats underwent sham operation (n=12) or coronary ligation (n=48) to induce HF.Four weeks after ligation,28 animals with HF were randomly divided into NRG group (rats received rhNRG-1 10 μg · kg-1 · d-1 intravenously for 10 days) or HF group (rats received an equal volume of water intravenously for 10 days).Left ventricular function was detected by echocardiography.Mitochondrial ultrastructure in non-infarcted myocardium was observed by transmission electronic microscopy.Cell apoptosis was detected by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL) assay.Mitochondrial membrane potential was measured by immunofluorescence method.Caspase-3 activity was determined by commercial kit.The expression of cytochrome C protein in cytoplasm was detected by Western blot.Results Compared with HF group,the left ventricular end-systolic diameter was decreased,and left ventricular ejection fraction and fractional shortening were increased in NRG group (P＜0.05 or 0.01).Apoptosis index was reduced inNRG group as compared with HFgroup [(18.1±3.0)％ vs.(11.9±1.4)％,P＜0.01].Mitochondrial membrane potential was increased and the release of cytochrome c in cytoplasm was reduced in NRG group as compared with HF group [(249.8±7.4) mV vs.(222.2±7.5) mV,(0.356±0.024) vs.(0.664±0.085),both P＜0.01].Caspase-3 activity was decreased in NRG group as compared with HF group (P＜0.01).Conclusions NRG attenuats mitochondrial stress and inhibits myocardial cells apoptosis in heart failure rats after myocardial infarction,which may play an important role in the cardioprotection by NRG.

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Investigation of telomere length in buccal cells in longevity families in Bama area of Guangxi

Xiaoqiu LUO ; Huayu WU ; Chengwu LIU ; Junhua PENG ; Zeping LV ; Shangling PAN

Chinese Journal of Geriatrics.2013;32(9):1013-1016. doi:10.3760/cma.j.issn.0254-9026.2013.09.026

Objective To explore the telomere length (TL) in buccal cells and its possible implications for long-lived families of Zhuang nationality in Bama area of Guangxi.Methods Relative TL in buccal cells from Bama long-lived families (BLF,n=1250) was determined by real time PCR and compared between Bama non-long-lived families (BNLF,n=556) and Pingguo longlived families (PLF,n=630).All participants were Zhuang ethnic.Results The TL in buccal cells was negatively correlated with age (R=-0.215,P=0.000) and was independent of sex in all subjects (n=2436).There were no significant differences in TL between males and females in different of ages in BLF (all P＞0.05).Similar tendency was observed in most but not all age groups in the two other families.The TL was significantly longer in BLF aged over 65 years (the first offspring of the longlived individual) than in BNLF aged over 65 years (1.969 vs.1.622,P=0.004) and the TL of BLF aged over 90 years was comparable to that of BNLF aged over 65 years (1.662 vs.1.622,P=0.955),which indicating that the offspring of long-lived individuals inherited longer TL from their parental generation.Conclusions Telomere length is shorten with aging in long-lived families in Bama area.The TL of BLF has a tendency of inheritance,which may be one of the mechanisms of longevity in Bama area.

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The change and its clinical significance of serum cystatin C in elderly patients with obstructive sleep apnea hypopnea syndrome

Xiaobin ZHANG ; Qichang LIN ; Gongping CHEN ; Xuejun LIU ; Hansheng XIE ; Aizhong TANG ; Hua CHEN

Chinese Journal of Geriatrics.2013;32(10):1058-1061. doi:10.3760/cma.j.issn.0254-9026.2013.10.009

Objective To investigate the change of serum cystatin C (CC) level and its clinical significance in elderly patients with obstructive sleep apnea hypopnea syndrome (OSAHS),and to evaluate the diagnostic value of serum CC for renal impairment in elderly OSAHS patients.Methods Elderly snoring subjects (age ≥60 years) undergoing sleep apnea monitoring in our sleep laboratory were recruited.Patients were divided into simple snoring group,mild OSAHS group,moderate OSAHS group and severe OSAHS group according to the diagnostic criteria of American academy of sleep medicine.Anthropometric characteristics,lipid profiles,blood glucose,creatinine,estimated glomerular filtration rate (eGFR) and serum CC were compared between groups after age,gender and basic diseases were adjusted.The independent risk factors associated with serum CC were analyzed by Spearman's rank correlation and stepwise linear regression.Results Totally 89 elderly patients [70males and 29 females,aged (68.4±6.3) years in average] were collected.21 subjects were grouped as simple snoring,14 subjects as mild OSAHS,21 subjects as moderate OSAHS and 33 subjects as severe OSAHS.There were no differences in age,gender,basic diseases (hypertension and diabetes),lipid profiles,creatinine and eGFR among groups.The levels of body mass index,systolic blood pressure,diastolic blood pressure and serum CC were higher in severe OSAHS group than in simple snoring group [(28.3±3.9) vs.(24.6±5.9),(136.55±16.14) mm Hgvs.(122.43±16.64) mm Hg,(89.18±11.92) mm Hgvs.(78.10±9.55) mm Hg,(0.95±0.22) mg/L vs.(0.76±0.13)mg/L,respectively,all P＜0.05].Serum CC was significantly correlated with apnea hypopnea index (AHI),oxygen desaturation index,creatinine,eGFR,high sensitive C reactive protein (r=0.397,0.347,0.275,－0.354,0.254 respectively,all P％0.05).Regression analysis showed that AHI was an independent factor for serum CC (β=0.449,P＜ 0.001).Conclusions Serum CC level is increased in elderly patients with severe OSAHS.AHI is an independent factor for the increase of serum CC.Serum CC can be as an index for the early impairment of renal function in patients with OSAHS.

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Efficacy analysis of noninvasive positive pressure ventilation in acute respiratory failure in elderly patients with community-acquired pneumonia

Zhenqian LIU ; Huasong FENG ; Yi JIANG ; Chunyang ZHANG

Chinese Journal of Geriatrics.2013;32(10):1062-1065. doi:10.3760/cma.j.issn.0254-9026.2013.10.010

Objective To evaluate the efficacy of noninvasive positive-pressure ventilation (NPPV) on acute respiratory failure (ARF) in elderly patients with severe community-acquired pneumonia (CAP).Methods 321 CAP patients with ARF aged over 65 years [(75.6±12.2) years old in averag] were randomly treated with NPPV (n=162) and the standard oxygen therapy (n=159).Intubation rate,ARF control rate and total mortality were compared between the two groups,and the risk factors were analyzed.Results 90％ of 321 patients presented with hypoxemic respiratory failure.Compared with standard therapy group,the intubation rate was lower in NPPV group (46.9％ vs.64.2％,x2=9.652,P＜0.01).However,there were no differences in ARF control rate(77.9％ vs.72.3％,x2 =1.274,P＞0.05),overall 30-day mortality and 90-day survival between the two groups.The overall mortality in NPPV group was higher in treatment failure cases than in treatment success cases (48.7％ vs.11.6％,x2=26.900,P＜0.01).The independent risk factors for death were treatment failure in NPPV,higher simplified acute physiology score assessment,old age and mutilobar infiltrate.Conclusions NPPV can decrease the intubation rate in CAP patients with acute hypoxemic respiratory failure,but the overall efficacy is not significant.Delayed intubation should be avoided when NPPV is to be applicated.

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Diagnostic value of gram-stained sputum smear in elderly patients with ventilator-associated lower respiratory infection

Linlin ZHI ; Wei FENG ; Youhong LIU

Chinese Journal of Geriatrics.2013;32(10):1066-1068. doi:10.3760/cma.j.issn.0254-9026.2013.10.011

Objective To explore the diagnostic value of gram-stained sputum smears in elderly patients with ventilator-associated lower respiratory infection (VALRI).Methods 368 elderly patients undergoing mechanical ventilation over 48 hours in ICU were retrospectiely analyzed from Jun 2009 to Jun 2011.42 patients fulfilled the inclusion criteria (with good-quality sputa and presence of the same microorganism in sputum and blood cultures).58 gram-stained smears and sputum cultures were obtained and analyzed.Results The diagnostic sensitivity and specificity of Gram-positive bacteria and Gram-negative bacteria by gram-stained smears were 82.35％ and 78.05％,80.49％ and 82.35％,respectively.The positive and negative predictive value of Gram-positive bacteria and Gramnegative bacteria were 63.64％ and 91.43％,91.67％ and 60.87％,respectively.The coincidence rates in diagnosing Gram-positive bacteria and Gram-negative bacteria were 81.03％ and 79.31％,respectively.Conclusions Gram-stained sputum smear is reliable in diagnosing ventilator-associated lower respiratory infection in elderly patients,and has a certain clinical significance in guiding to the selection of antibiotics.

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Factor analysis of hepatic cirrhosis combined with hospital infection in elderly patients

Min MENG ; Xiumin WANG ; Peijie HUANG

Chinese Journal of Geriatrics.2013;32(10):1080-1082. doi:10.3760/cma.j.issn.0254-9026.2013.10.015

Objective To explore and analyze the related factors for cirrhosis patients with hospital infection.Methods Clinical data of 750 patients with cirrhosis in our hospital were retrospectively analyzed.Related factors for hospital infection including gender,age,length of hospital stay,Child-Pugh classification,accompanying invasive procedures,associating the underlying disease,using antibacterial drugs and the sites of hospital infection and pathogen distribution were analyzed.Results The infection rate was 20.7％ (155/750).The infections were mainly spontaneous bacterial peritonitis [54.8％ (85/155)],followed by respiratory,digestive,urinary tract and skin.Pathogenic bacteria were mainly Gram-negative bacteria [56.1％ (101/1)],followed by Gram-positive bacteria and fungi.Patients aged over 70 years,with hospital stay over 4 weeks,with higher Child-Pugh classification,associated with invasive procedures,combined with underlying diseases,and treated with antimicrobial drugs were much easier to get hospital infection (x2=12.2,16.3,49.46,55.2,20.95,26.24,all P＜0.05).Conclusions Patients aged over 70 years with long hospital stay and more severe liver damage,accompanied by invasive procedures,combined with basic diseases and treated with antimicrobial agents are the related factors for hospital infection in patients with cirrhosis.

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Analysis of factors relating to serum lutein level in elderly patients with early age-related macular degeneration

Mingfang WANG ; Le MA ; Yangmu HUANG ; Xin XIAO ; Xiaoming LIN

Chinese Journal of Geriatrics.2013;32(10):1083-1086. doi:10.3760/cma.j.issn.0254-9026.2013.10.016

Objective To explore the factors relating to serum lutein level in elderly patients with early age-related macular degeneration (AMD).Methods 102 early AMD patients diagnosed by international diagnostic criteria were selected.The level of serum lutein was measured by HPLC,and dietary intake was estimated by food-frequency questionnaire (FFQ).The factors relating to serum lutein level were analyzed by Pearson correlation and multiple regression analysis models.Results Serum lutein level was higher in female AMD patients than in male AMD patients [(0.33±0.31) μmol/L vs.(0.21 ±0.19) μmol/L,t=2.21,P＜0.05].Serum lutein level was positively correlated with dietary lutein (r=0.49,P＜ 0.001),but not correlated with age,BMI,and other nutrient intake after adjustment for caloric intake.Dietary lutein was mainly from corn,spinach,leeks,eggs,chrysanthemum,pumpkin,broccoli,lettuce,asparagus and peas.Intakes of spinach,pumpkin,asparagus were significantly associated with serum lutein level.Conclusions Elderly patients with AMD should increase the intakes of lutein-rich vegetables to increase the serum lutein level.

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Clinical significance of serum carbohydrate antigen 19-9 and its relationship with blood glucose in patients with type 2 diabetes

Xiuling WU ; Lei ZHANG ; Lili YIN ; Jingjing WU ; Yuanliang XIA ; Zhongkui HAN

Chinese Journal of Geriatrics.2013;32(9):960-963. doi:10.3760/cma.j.issn.0254-9026.2013.09.010

Objective To study the relationship between serum carbohydrate antigen 19-9 (CA19-9) and blood glucose level in patients with type 2 diabetes (T2DM).Methods Totally 784 T2DM patients and 197 healthy controls were enrolled in this study.Age,duration,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),levels of fasting blood glucose (FBG),postprandial blood glucose (PBG),hemoglobin A1c (HbA1c),total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C),blood uric acid,C peptide and CA 19-9 were recorded.Patients were divided into different groups according to the levels of HbA1 c and CA 19-9.The relationship between CA19-9 and influencing factors was analyzed.Results CA19-9 level was increased in T2DM patients compared with healthy controls [(22.08±14.94) U/mlvs.(10.24±6.31) U/ml,t=12.10,P＜0.001].The levels of SBP,DBP,FBG,PBG,C peptide,TC,TG,LDL and UA were higher and HDL C level was lower in T2DM patients than in healthy controls (all P＜0.05).The levels of FBG,PBG and CA19-9 were increased along with the increase of HbA1c level in T2MD patients with HbA1c level under 6.5％,T2MD patients with HbA1c level from 6.5％ to 7.5％,T2MD patients with HbA1c level over 7.5％ [FBG:(6.36±3.70) mmol/L,(9.01±4.01) mmol/L,(11.96±4.73) mmol/L;PBG:(9.69±3.21) mmol/L,(12.18±5.54) mmol/L,(15.27±5.08) mmol/L; CA19 9 (14.33±11.72) U/ml,(18.76±14.39) U/ml,(25.96±17.52) U/ml,respectively,all P＜0.05].The levels of FBG,HbA1c and pancreatic cancer incidence were higher in patients with elevated CA19-9 than with normal CA19-9 [(11.71±5.48)mmol/L vs.(9.78±4.38)mmol/L,(7.49±4.12)％ vs.(6.33±3.70)％,0％ vs.7.8％,t=-3.51,2.55,x2=83.58,allP＜0.05].Pearson correlation analysis showed that CA19-9 level was positively correlated with the levels of HbA 1 c and FBG in T2DM patients (r=0.281,0.134,both P＜0.05).Multiple Logistic regression analysis showed that the levels of FBG and HbA1c were correlated with the increase of CA19 9 in T2DM patients(OR=0.801,0.947,P=0.019,0.026).Conclusions Serum CA19-9 level is significantly increased in T2DM patients compared with the healthy people.Serum CA19-9 level is correlated with blood glucose control.

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