Objective:To investigate the effects of Comprehensive Geriatric Assessment(CGA)-guided multidisciplinary interventions on frail non-dialysis elderly patients with chronic kidney disease, while also assessing the influence of different levels of frailty.Methods:This study is a randomized controlled trial conducted between 2020 and 2021, involving 230 frail, non-dialysis elderly patients with chronic kidney disease stages 3-5, treated at our hospital.Participants were randomly assigned to either an intervention group or a control group using a random number table method, with 115 patients in each group.The intervention group received multidisciplinary treatment over a period of 12 months, while the control group received standard care.We compared Fried frailty scores, re-hospitalization rates, and all-cause mortality between the two groups, and documented changes in CGA both before treatment and 12 months after treatment.Results:After 12 months of treatment, the Fried frail phenotype score was significantly lower in the intervention group(2.7±1.2)compared to the control group(3.6±1.8, t=97.47, P<0.01).Additionally, grip strength in the intervention group was higher(20.6±8.5 kg)than in the control group(13.5±8.1 kg, t=6.57, P<0.01).The scores for the Mini Nutritional Assessment-Short Form(MNA-SF)(10.7±4.0 vs.9.1±4.2, t=29.03, P<0.01), Mini-Mental State Examination Scale(MMSE)(24.3±8.6 vs.19.3±9.6, t=96.35, P<0.01), and Short Physical Performance Battery(SPPB)(6.8±3.2 vs.3.5±2.9, t=71.97, P<0.01)were also significantly higher in the intervention group.Furthermore, the Activity of Daily Living(ADL)score was greater in the intervention group(5.4±1.6)than in the control group(3.9±1.6, t=5.75, P<0.01), as was weight(67.2±11.2 kg vs.64.0±11.8 kg, t=2.02, P=0.045).The frailty reversal rate was significantly higher in the intervention group(32.2% vs.8.0%, χ2=21.4, P<0.01), and the all-cause mortality rate was lower in this group(11.3% vs.22.6%, χ2=5.22, P=0.022).However, there were no significant differences observed in the Geriatric Depression Scale(GDS)(6.3±3.7 vs.6.0±4.3, t=24.29, P>0.05), estimated Glomerular Filtration Rate(eGFR)[(44.1±19.2)ml·(min·1.73m 2) -1vs.(39.8±19.0)ml·(min·1.73m 2) -1, t=1.76, P>0.05], Instrumental Activity of Daily Living(IADL)(5.2±2.2 vs.4.6±2.2, t=1.49, P>0.05), and the rate of readmission(25.2% vs.36.5%, χ2=3.44, P>0.05). Conclusions:Multidisciplinary interventions derived from a comprehensive geriatric assessment can ameliorate or even reverse frailty, reduce all-cause mortality, and enhance the prognosis of frail elderly patients with chronic kidney disease stages 3 to 5 who are not undergoing dialysis.

Objective:To investigate the effects of Comprehensive Geriatric Assessment(CGA)-guided multidisciplinary interventions on frail non-dialysis elderly patients with chronic kidney disease, while also assessing the influence of different levels of frailty.Methods:This study is a randomized controlled trial conducted between 2020 and 2021, involving 230 frail, non-dialysis elderly patients with chronic kidney disease stages 3-5, treated at our hospital.Participants were randomly assigned to either an intervention group or a control group using a random number table method, with 115 patients in each group.The intervention group received multidisciplinary treatment over a period of 12 months, while the control group received standard care.We compared Fried frailty scores, re-hospitalization rates, and all-cause mortality between the two groups, and documented changes in CGA both before treatment and 12 months after treatment.Results:After 12 months of treatment, the Fried frail phenotype score was significantly lower in the intervention group(2.7±1.2)compared to the control group(3.6±1.8, t=97.47, P<0.01).Additionally, grip strength in the intervention group was higher(20.6±8.5 kg)than in the control group(13.5±8.1 kg, t=6.57, P<0.01).The scores for the Mini Nutritional Assessment-Short Form(MNA-SF)(10.7±4.0 vs.9.1±4.2, t=29.03, P<0.01), Mini-Mental State Examination Scale(MMSE)(24.3±8.6 vs.19.3±9.6, t=96.35, P<0.01), and Short Physical Performance Battery(SPPB)(6.8±3.2 vs.3.5±2.9, t=71.97, P<0.01)were also significantly higher in the intervention group.Furthermore, the Activity of Daily Living(ADL)score was greater in the intervention group(5.4±1.6)than in the control group(3.9±1.6, t=5.75, P<0.01), as was weight(67.2±11.2 kg vs.64.0±11.8 kg, t=2.02, P=0.045).The frailty reversal rate was significantly higher in the intervention group(32.2% vs.8.0%, χ2=21.4, P<0.01), and the all-cause mortality rate was lower in this group(11.3% vs.22.6%, χ2=5.22, P=0.022).However, there were no significant differences observed in the Geriatric Depression Scale(GDS)(6.3±3.7 vs.6.0±4.3, t=24.29, P>0.05), estimated Glomerular Filtration Rate(eGFR)[(44.1±19.2)ml·(min·1.73m 2) -1vs.(39.8±19.0)ml·(min·1.73m 2) -1, t=1.76, P>0.05], Instrumental Activity of Daily Living(IADL)(5.2±2.2 vs.4.6±2.2, t=1.49, P>0.05), and the rate of readmission(25.2% vs.36.5%, χ2=3.44, P>0.05). Conclusions:Multidisciplinary interventions derived from a comprehensive geriatric assessment can ameliorate or even reverse frailty, reduce all-cause mortality, and enhance the prognosis of frail elderly patients with chronic kidney disease stages 3 to 5 who are not undergoing dialysis.

Objective To investigate the oral health of officers and soldiers in a navy unit.Methods From September to December 2022,a questionnaire survey and oral examination were conducted in 1 923 officers and soldiers of a navy unit.The incidence of caries,periodontal problem,the third molar impaction,and dental deficiency and defect were analyzed.Results Among the interviewees,51.79%took up smoking,79.88%brushed their teeth daily≥2 times,64.01%brushed their teeth≥3 min,32.97%used cleaning tools other than toothbrushes.The incidence of caries was 23.40%,the incidence of gingivitis and periodontitis was 28.97%,the detection rate of dental calculus was 64.33%,and the total detection rate of pigment teeth was 46.33%.The defect of dental body,residual roots,temporomandibular joint disorders,defect of dentition,and molar impaction accounted for 4.32%,2.81%,11.6%,40.72%,and 68.28%,respectively.Conclusion The oral health status of the shipboard personnel is still poor,so it should be targeted to further strengthen oral health care and popular science propaganda.

Objective:The aim of this study is to develop a comprehensive index system for assessing the key first aid skills required for aeromedical evacuation of infected patients, with the goal of enhancing our army's medical support capabilities.Methods:This study combined literature review and two rounds of Delphi expert correspondence to construct the key first aid skills index system of aeromedical evacuation for infected patients. 19 experts from relevant disciplines were selected purposively to conduct Delphi expert consultation.Results:Both rounds of Delphi expert correspondence achieved a 100% response rate, indicating high effectiveness. The degree of authority among the experts was determined to be 0.87. In the first round, there was a Kendall coordination coefficient value of 0.184 for assessing the importance of primary indicators, while secondary indicators showed coefficients of 0.289 and 0.380 for importance and feasibility respectively. In the second round, these values increased slightly to 0.263, 0.304 (importance) and 0.398 (feasibility), respectively. The final evaluation index system of key first aid skills applied to the aeromedical evacuation of infected patients was constructed, including 3 primary indicators of life support technology, intensive care technology and isolation protection technology, and 40 secondary indicators.Conclusion:The evaluation index system of key first aid skills applied to the aeromedical evacuation of infected patients constructed through two rounds of Delphi expert correspondence is scientific and reasonable, which can provide reference for the training and assessment of key first aid skills applied to the aeromedical evacuation of infected patients, so as to promote the development of aeromedical evacuation for infectious patients in China.

Objective To develop an expert consensus on subcutaneous injection nursing for allergic asthma in children,standardize nursing practice to reduce the occurrence of related adverse reactions.Methods The clinical guideline,expert consensus,systematic review,evidence summary and original research on subcutaneous injection of monoclonal antibody drug for children with allergic asthma were comprehensively searched in domestic and foreign databases.The time limit for retrieval was from the establishment of databases until August 2023.Combined with clinical practice experience,the first draft of the consensus was formed.From December 2023 to February 2024,27 experts were invited to conduct 2 rounds of expert letter consultation,revise and improve the contents of the first draft,and expert demonstration was conducted,and finally a consensus final draft was formed.Results The effective recovery rate of the 2 rounds of letter consultation questionnaires was 100％;the authority coefficient of experts was 0.88;the judging basis coefficient was 0.93;the familiarity coefficient was 0.83.In the 2 rounds of correspondence,the Kendall concordant coefficients of expert opinions were 0.241 and 0.252,respectively(P＜0.001 for both).The consensus includes 6 parts,including personnel management,environmental layout,indications and contraindications,subcutaneous injection operation norms,identification and treatment of adverse reactions,and health education.Conclusion The consensus is strongly scientific and practical,and can provide guidance for nursing practice of subcutaneous injection of monoclonal antibodies in children with allergic asthma.

Objective:To explore the correlation between protein energy wasting(PEW)and frailty in elderly patients on maintenance hemodialysis(MHD)and influencing factors of frailty.Methods:Clinical data of patients over 60 who had received regular hemodialysis treatment at Beijing Huairou Hospital between September to December 2021 were collected.According to Fried's evaluation criteria, patients were divided into a frailty group and a non-frailty group, and differences between the two groups were compared.Spearman correlation analysis was conducted to assess the correlation between protein energy wasting and frailty.Logistic regression was used to analyze the influencing factors of frailty in elderly patients on MHD.Results:A total of 81 MHD patients enrolled in this study, with 36 in the frailty group.The frailty group was older, had a higher proportion of patients with PEW, and underwent more months of dialysis, with a higher proportion of patients with diabetic nephropathy as the primary disease, having high levels of C-reactive protein(CRP), and having low KT/V, hemoglobin, albumin, body mass index(BMI), mid-arm circumference(MAC)and mid-arm muscle circumference(MAMC), and the differences with the control group were statistically significant(all P<0.05). The Fried frailty phenotype was positively correlated with age( r=0.021, P=0.047), but negatively associated with HGB( r=-0.329, P=0.003), albumin( r=0.021, P=0.047), BMI( r=0.021, P=0.047), TSF( r=-0.274, P=0.013), MAC( r=-0.554, P<0.001)and MAMC( r=-0.293, P=0.008). A Logistic regression equation was constructed using frailty as the dependent variable.The results showed that age, months of dialysis, KT/V, serum albumin and CRP were independent factors influencing the development of frailty in elderly patients with MHD. Conclusions:PEW and frailty coexist and interact with each other in elderly patients with MHD.Clinicians should place emphasis on the assessment of frailty and protein energy wasting in elderly dialysis patients and achieve early detection and intervention to avoid adverse clinical outcomes.

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 delineate a small supernumerary marker chromosome (sSMC) derived from chromosome 9 with combined cytogenetic and molecular methods. METHODS: For a pregnant woman with fetal ultrasound revealing left ventricular punctate hyperechoic echo, and a high risk for monosomy or partial deletion of chromosome 8, chromosome 9 trisomy, monosomy or partial deletion of chromosome 11 by non-invasive prenatal testing, and an abnormal MOM value revealed by mid-term serum screening, amniocentesis was performed for G banded chromosomal analysis and single nucleotide polymorphism array (SNP-array) assay. Peripheral blood samples of the woman and her spouse were also collected for the above tests. In addition, the woman was further subjected to C banding karyotyping analysis and fluorescence in situ hybridization (FISH) assay. RESULTS: The G-banded karyotype of the pregnant women was 47,XX,+mar[20]/46,XX[80], whilst C-banding analysis showed a deep stain in the middle of the sSMC (suggestive of centromeric region) and light stain at both ends (suggestive of euchromatism). FISH combined with DAPI banding analysis using 9pter/9qter probes revealed a karyotype of 47,XX,+mar.ish i(9)(9p10)(9p++)[2]/46,XX[18], whilst SNP-array has revealed a 68.1 Mb duplication in the 9p24.3q13 region. A database search has suggested the duplication to be likely pathogenic. No abnormality was found in her fetus and spouse by karyotyping and SNP-array analysis. CONCLUSION Through combined cytogenetic and molecular genetic analysis, a sSMC derived from chromosome 9 was delineated, which has enabled genetic counseling for the couple.
Female ; Humans ; Pregnancy ; Biomarkers ; Chromosomes, Human, Pair 9/genetics* ; Genetic Testing ; In Situ Hybridization, Fluorescence ; Monosomy

Objective:To compare the clinicopathological differences between elderly and non-elderly patients with idiopathic membranous nephropathy(IMN).Methods:Patients diagnosed with IMN via renal biopsy at Beijing Huairou Hospital, Beijing Changping Hospital of Traditional Chinese Medicine, and Beijing Hospital of Traditional Chinese Medicine from January 2017 to August 2021 were retrospectively enrolled.They were classified into the elderly group(≥65 years)and the non-elderly group(<65 years), and the clinicopathological differences between the two groups were compared.Results:A total of 207 IMN patients were included in the study, with a male to female ratio of 1.7∶1.0.There were 56 patients in the elderly group, aged(68.2±3.1)years, and 151 patients in the non-elderly group, aged(48.2±6.2)years.Compared with the non-elderly group, the elderly group had a longer time from onset to renal biopsy and a higher proportion of patients with renal insufficiency and hypertension( P<0.05). The elderly group had a lower eGFR, lower serum albumin, higher serum cholesterol, and higher low-density lipoprotein than the non-elderly group( P<0.05). The proportions of patients with glomerulosclerosis, renal tubular atrophy, and interstitial fibrosis in the elderly group were higher than in the non-elderly group( P<0.05). The positive rates of glomerular PLA2R antigen staining in the two groups were 90.6%(29/32)and 91.0%(111/122), respectively, and there was no statistically significant difference between the two groups.IgG4 deposition represented the most common IgG subtype, with 93.8%(30/32)in the elderly group and 94.3%(115/122)in the non-elderly group.There was no statistical significance between the two groups( P>0.05). Conclusions:Compared with non-elderly IMN patients, a higher proportion of elderly IMN patients has renal insufficiency, hypertension and chronic renal pathology.The glomerular deposition of pathogenic antigens in elderly IMN patients was similar to that in non-elderly IMN patients, suggesting no difference in pathogenesis between the two groups.The clinicopathological differences between the two groups may be related to age and complications.