Background: Older adults undergoing surgery frequently have multiple comorbidities and reduced physical and cognitive reserves. This study aims to assess the effect of physical and cognitive frailty on long-term mortality in older patients undergoing elective non-cardiac surgery in a tertiary center. Methods: Patients aged ≥65 years old admitted to surgical wards at the University of Malaya Medical Centre were recruited. Physical frailty and cognitive status were assessed using the Fried Frailty Index (FFI) and the Montreal Cognitive Assessment, respectively. Patients were stratified into six groups based on their frailty and cognitive status: Group 1, normal cognition and non-frail (reference group); Group 2, normal cognition and frail; Group 3, mild cognitive impairment (MCI) and non-frail; Group 4, MCI and frail; Group 5, dementia and non-frail; and Group 6, dementia and frail. Results: A total of 406 patients with a mean FFI score of 1.1±1.2 were recruited. Predictors of mortality include male sex (hazard ratio [HR]=1.96; 95% confidence interval [CI], 1.14–3.37; p=0.015), presence of active malignancy (HR=3.86; 95% CI, 2.14–6.95; p<0.001), and high FFI scores (1.8±1.2 vs. 1.0±1.1; p=0.013). Compared to Group 1, long-term mortality risk was significantly increased in Group 4 (HR=3.17; 95% CI, 1.36–7.38) and Group 6 (HR=3.91; 95% CI, 1.62–9.43) patients. Conclusion The combination of physical frailty and cognitive impairment was associated with long-term mortality risk among older patients who underwent elective non-cardiac surgery. This highlights the importance of assessing physical frailty and cognitive function of all older surgical patients to guide targeted intervention, especially for those with impairments which may be potentially reversible.

Background: Older adults undergoing surgery frequently have multiple comorbidities and reduced physical and cognitive reserves. This study aims to assess the effect of physical and cognitive frailty on long-term mortality in older patients undergoing elective non-cardiac surgery in a tertiary center. Methods: Patients aged ≥65 years old admitted to surgical wards at the University of Malaya Medical Centre were recruited. Physical frailty and cognitive status were assessed using the Fried Frailty Index (FFI) and the Montreal Cognitive Assessment, respectively. Patients were stratified into six groups based on their frailty and cognitive status: Group 1, normal cognition and non-frail (reference group); Group 2, normal cognition and frail; Group 3, mild cognitive impairment (MCI) and non-frail; Group 4, MCI and frail; Group 5, dementia and non-frail; and Group 6, dementia and frail. Results: A total of 406 patients with a mean FFI score of 1.1±1.2 were recruited. Predictors of mortality include male sex (hazard ratio [HR]=1.96; 95% confidence interval [CI], 1.14–3.37; p=0.015), presence of active malignancy (HR=3.86; 95% CI, 2.14–6.95; p<0.001), and high FFI scores (1.8±1.2 vs. 1.0±1.1; p=0.013). Compared to Group 1, long-term mortality risk was significantly increased in Group 4 (HR=3.17; 95% CI, 1.36–7.38) and Group 6 (HR=3.91; 95% CI, 1.62–9.43) patients. Conclusion The combination of physical frailty and cognitive impairment was associated with long-term mortality risk among older patients who underwent elective non-cardiac surgery. This highlights the importance of assessing physical frailty and cognitive function of all older surgical patients to guide targeted intervention, especially for those with impairments which may be potentially reversible.

Background: Older adults undergoing surgery frequently have multiple comorbidities and reduced physical and cognitive reserves. This study aims to assess the effect of physical and cognitive frailty on long-term mortality in older patients undergoing elective non-cardiac surgery in a tertiary center. Methods: Patients aged ≥65 years old admitted to surgical wards at the University of Malaya Medical Centre were recruited. Physical frailty and cognitive status were assessed using the Fried Frailty Index (FFI) and the Montreal Cognitive Assessment, respectively. Patients were stratified into six groups based on their frailty and cognitive status: Group 1, normal cognition and non-frail (reference group); Group 2, normal cognition and frail; Group 3, mild cognitive impairment (MCI) and non-frail; Group 4, MCI and frail; Group 5, dementia and non-frail; and Group 6, dementia and frail. Results: A total of 406 patients with a mean FFI score of 1.1±1.2 were recruited. Predictors of mortality include male sex (hazard ratio [HR]=1.96; 95% confidence interval [CI], 1.14–3.37; p=0.015), presence of active malignancy (HR=3.86; 95% CI, 2.14–6.95; p<0.001), and high FFI scores (1.8±1.2 vs. 1.0±1.1; p=0.013). Compared to Group 1, long-term mortality risk was significantly increased in Group 4 (HR=3.17; 95% CI, 1.36–7.38) and Group 6 (HR=3.91; 95% CI, 1.62–9.43) patients. Conclusion The combination of physical frailty and cognitive impairment was associated with long-term mortality risk among older patients who underwent elective non-cardiac surgery. This highlights the importance of assessing physical frailty and cognitive function of all older surgical patients to guide targeted intervention, especially for those with impairments which may be potentially reversible.

Humans ; Vascular Stiffness ; Coal Mining ; Occupational Diseases/epidemiology* ; Risk Factors ; Coal ; Miners

Objective The purpose of this study was to investigate the bacterial communities of biting midges and ticks collected from three sites in the Poyang Lake area,namely,Qunlu Practice Base,Peach Blossom Garden,and Huangtong Animal Husbandry,and whether vectors carry any bacterial pathogens that may cause diseases to humans,to provide scientific basis for prospective pathogen discovery and disease prevention and control. Methods Using a metataxonomics approach in concert with full-length 16S rRNA gene sequencing and operational phylogenetic unit(OPU)analysis,we characterized the species-level microbial community structure of two important vector species,biting midges and ticks,including 33 arthropod samples comprising 3,885 individuals,collected around Poyang Lake. Results A total of 662 OPUs were classified in biting midges,including 195 known species and 373 potentially new species,and 618 OPUs were classified in ticks,including 217 known species and 326 potentially new species.Surprisingly,OPUs with potentially pathogenicity were detected in both arthropod vectors,with 66 known species of biting midges reported to carry potential pathogens,including Asaia lannensis and Rickettsia bellii,compared to 50 in ticks,such as Acinetobacter lwoffii and Staphylococcus sciuri.We found that Proteobacteria was the most dominant group in both midges and ticks.Furthermore,the outcomes demonstrated that the microbiota of midges and ticks tend to be governed by a few highly abundant bacteria.Pantoea sp7 was predominant in biting midges,while Coxiella sp1 was enriched in ticks.Meanwhile,Coxiella spp.,which may be essential for the survival of Haemaphysalis longicornis Neumann,were detected in all tick samples.The identification of dominant species and pathogens of biting midges and ticks in this study serves to broaden our knowledge associated to microbes of arthropod vectors. Conclusion Biting midges and ticks carry large numbers of known and potentially novel bacteria,and carry a wide range of potentially pathogenic bacteria,which may pose a risk of infection to humans and animals.The microbial communities of midges and ticks tend to be dominated by a few highly abundant bacteria.

Objective To understand the current status and trends of research on the TCM treatment for stable phase of chronic obstructive pulmonary disease(COPD);To provide references for relevant research.Methods Literature about TCM treatment for stable phase of COPD was retrieved from China National Knowledge Infrastructure,Wanfang Data,VIP Information Chinese Journal Service Platform,and SinoMed from the establishment of the databases to Sep 1,2022.NoteExpress 3.4 was used to sort out the basic data of papers.Excel 2016 was employed to count first authors,syndrome type,prescription and draw a run chart of publication,determine the number of journals in the core area according to Bradford law.Core authors statistically were analyzed according to Price law.Author collaboration network and keyword co-occurrence analysis were conducted using VOSviewer 1.6.18.CiteSpace 5.3.R4 was exploited to construct institutional collaboration network and study burst terms,and knowledge map was drawn.Results A total of 3 360 articles were included,involving 445 journals,with 2 691 first authors.The overall number of publications in this field showed an increasing trend,with clinical research being the main research type.There were 21 journals in the core region and the most frequently published journal was New Chinese Medicine.There were 125 core authors,with Li Zhuying and Li Jiansheng posting the most articles.Author collaboration network analysis showed 10 major research teams and the largest of which was Li Jiansheng's team.There were 1 451 institutions,mainly were universities and affiliated hospitals.There were 62 types of syndromes in the stable phase of COPD,the most common of which was the syndrome of qi deficiency of lung and spleen.There were 541 kinds of prescriptions in total,and the most commonly used was Bufei Decoction.Keyword co-occurrence analysis showed 8 subjects,and the high-frequency keywords included lung function,clinical efficacy,quality of life,clinical observation and TCM treatment.22 burst terms were obtained,with Budesonide Fumotro,six-word songs,Yupingfeng Powder and inflammatory factors highly concerned at present.Conclusion The research fever of TCM treatment for COPD in stable period shows an increasing trend,and clinical research accounts for the largest proportion,but the general quality is not high,and basic research is relatively lacking.The research focuses on the inhibition of airway inflammation and immune regulation,and lung function and quality of life are the most commonly used evaluation indicators.

This study design of specific identification primers for the ITS2 sequence of F. ussuriensis. The reaction system and conditions were optimized, and PCR-nucleic acid test strips were constructed to realize the visual detection of F. ussuriensis Bark. Through molecular cloning and sequencing technology, we constructed a positive control for F. ussuriensis DNA and formulated quality standards. The established method was evaluated for sensitivity, specificity and reproducibility, and the authenticity of the commercially available samples was identified. Results demonstrated that based on the ITS2 sequences, F. ussuriensis and its mixed forgeries could be distinguished. The PCR products of the authentic F. ussuriensis on test strips showed two bands in the T and C lines, while the pseudo products and negative control showed only one band in the C line, which was consistent with the results of agarose gel electrophoresis. The specificity was 100%, and the sensitivity of the PCR-nucleic acid test strip was up to 0.1 ng·μL^-1, which was 10 times higher than that of the gel electrophoresis assay. 11 out of 16 commercially available samples of F. ussuriensis were qualified, and 5 were unqualified. Collectively, the PCR-nucleic acid test strip method established in this study is specific, rapid, accurate and visualized, which can provide a new technical idea for the detection of F. ussuriensis.

After entering the body from the drug delivery site, antitumor nanomedicines need to cross a series of physiopathological barriers to reach the target site of action to effectively exert antitumor therapeutic effects. The ligand modification strategy is a classic method to enhance the efficiency of nanomedicine delivery in vivo, but the contradiction between the single ligand modification strategy, which is characterized by unity and stage, and the in vivo delivery process, which is characterized by versatility and whole-process characteristics, determines that nanomedicines modified by a single ligand alone cannot satisfy the target efficacy requirements. Therefore, the use of multiligand combinatorial modification strategies by virtue of nanomedicine surface area advantages is key to advancing the next generation of smart nanomedicines. In this paper, on the basis of summarizing and classifying the commonly used functional ligands for in vivo delivery, the advantages and research progress of multiligand combination modification of antitumor nanomedicines are discussed with special focus, and the multiligand combination modification is classified as synergistic and complementary according to the combination of the ligands, which is of great significance to ensure that antitumor nanomedicines can overcome the multiple physiopathological barriers to achieve precise delivery.

Objective To compare the outcomes of transplant kidneys and patient survival between simultaneous pancreas-kidney transplantation(SPKT)recipients and deceased donor kidney transplant(DDKT)recipients in patients with type 2 diabetes mellitus(T2DM)complicated with end-stage renal disease(ESRD),and to analyze the risk factors affecting patient survival post-SPKT.Methods Clinical and prognostic data of patients who underwent kidney transplantation from January 27,2003,to January 1,2021,were retrieved from the United Network for Organ Sharing(UNOS)database.A total of 50 230 cases were selected based on inclusion criteria,with 48 669 cases in DDKT group and 1561 cases in SPKT group.Kaplan-Meier analysis was employed to compare transplant kidney and patient survival between the two groups,and propensity score matching(PSM)was utilized to balance confounding factors between the groups.Cox regression model was used to analyze independent risk factors affecting patient survival post-SPKT.Results Compared with DDKT group,recipients in SPKT group had a younger median age(P<0.001),a higher proportion of males(P<0.001),lower BMI(P<0.001),shorter dialysis and transplant waiting times(P<0.001),a higher percentage of private medical insurance(P<0.001),a lower proportion of previous transplants(P<0.001),a younger age at diabetes diagnosis(P<0.001),and a lower incidence of peripheral vascular disease(P=0.033).Compared with DDKT group,the donors in SPKT group had a younger median age(P<0.001),a higher proportion of males(P<0.001),lower BMI(P<0.001),and a lower prevalence of hypertension and diabetes history(P<0.001).In terms of transplant-related factors,the SPKT group had a shorter donor kidney cold ischemia time(P<0.001),a higher degree of HLA mismatch(P<0.001),and a lower Kidney Donor Profile Index(KDPI)(P<0.001)when compared with DDKT group.The SPKT group had lower serum creatinine levels at discharge(P<0.001),lower rates of postoperative delayed graft function(DGF)and acute rejection(AR)(P<0.001),but longer hospital stays(P<0.001)when compared with DDKT group.Kaplan-Meier survival analysis curves,both original and after propensity score matching(PSM),consistently showed significantly higher transplant kidney and patient survival rates in SPKT group compared with DDKT group(P<0.001).Cox regression model analysis indicated that recipient age,recipient race,donor age,and donor kidney cold ischemia time were independent risk factors influencing patient survival post-SPKT.Conclusions For ESRD patients with T2DM,SPKT offers improved long-term graft and patient survival rates compared with DDKT.Recipient age,recipient ethnicity,donor age,and cold ischemia time for the donor's kidney are independent risk factors affecting post-SPKT patient survival.

Objective To investigate the clinical characteristics and prognosis of pneumococcal meningitis(PM),and drug sensitivity of Streptococcus pneumoniae(SP)isolates in Chinese children.Methods A retrospective analysis was conducted on clinical information,laboratory data,and microbiological data of 160 hospitalized children under 15 years old with PM from January 2019 to December 2020 in 33 tertiary hospitals across the country.Results Among the 160 children with PM,there were 103 males and 57 females.The age ranged from 15 days to 15 years,with 109 cases(68.1% )aged 3 months to under 3 years.SP strains were isolated from 95 cases(59.4% )in cerebrospinal fluid cultures and from 57 cases(35.6% )in blood cultures.The positive rates of SP detection by cerebrospinal fluid metagenomic next-generation sequencing and cerebrospinal fluid SP antigen testing were 40% (35/87)and 27% (21/78),respectively.Fifty-five cases(34.4% )had one or more risk factors for purulent meningitis,113 cases(70.6% )had one or more extra-cranial infectious foci,and 18 cases(11.3% )had underlying diseases.The most common clinical symptoms were fever(147 cases,91.9% ),followed by lethargy(98 cases,61.3% )and vomiting(61 cases,38.1% ).Sixty-nine cases(43.1% )experienced intracranial complications during hospitalization,with subdural effusion and/or empyema being the most common complication[43 cases(26.9% )],followed by hydrocephalus in 24 cases(15.0% ),brain abscess in 23 cases(14.4% ),and cerebral hemorrhage in 8 cases(5.0% ).Subdural effusion and/or empyema and hydrocephalus mainly occurred in children under 1 year old,with rates of 91% (39/43)and 83% (20/24),respectively.SP strains exhibited complete sensitivity to vancomycin(100% ,75/75),linezolid(100% ,56/56),and meropenem(100% ,6/6).High sensitivity rates were also observed for levofloxacin(81% ,22/27),moxifloxacin(82% ,14/17),rifampicin(96% ,25/26),and chloramphenicol(91% ,21/23).However,low sensitivity rates were found for penicillin(16% ,11/68)and clindamycin(6% ,1/17),and SP strains were completely resistant to erythromycin(100% ,31/31).The rates of discharge with cure and improvement were 22.5% (36/160)and 66.2% (106/160),respectively,while 18 cases(11.3% )had adverse outcomes.Conclusions Pediatric PM is more common in children aged 3 months to under 3 years.Intracranial complications are more frequently observed in children under 1 year old.Fever is the most common clinical manifestation of PM,and subdural effusion/emphysema and hydrocephalus are the most frequent complications.Non-culture detection methods for cerebrospinal fluid can improve pathogen detection rates.Adverse outcomes can be noted in more than 10% of PM cases.SP strains are high sensitivity to vancomycin,linezolid,meropenem,levofloxacin,moxifloxacin,rifampicin,and chloramphenicol.[Chinese Journal of Contemporary Pediatrics,2024,26(2):131-138]