Objective: To explore the characteristics, patterns of multimorbidity and the impact on quality of life and the prognosis of middle-aged and elderly patients with chronic obstructive pulmonary disease (COPD). Methods: This is a cross-sectional study. From January 2012 to December 2021, 939 middle-aged and elderly COPD patients hospitalized in Beijing Hospital were selected by the convenient sampling method. The basic data of patients and the date of 16 common chronic diseases were collected. Patterns of multimorbidity were depicted by cluster analysis. Generalized linear regression model and logistic regression were used to evaluate the multimorbidity patterns and their prognosis. Results: At least one multimorbidity existed among 93.40% of COPD patients, and the median number of multimorbidity was 3. The top five multimorbidity among the patients were hypertension (57.93%, 544/939), coronary heart disease (33.76%,317/939), heart failure (31.95%,300/939), hyperlipidemia (31.63%,297/939) and arrhythmia (27.37%,257/939). Four multimorbidity patterns were identified, cardiometabolic and metabolic multimorbidity, kidney disease multimorbidity, respiratory-digestive-tumor multimorbidity and other multimorbidity. Cardiometabolic and metabolic multimorbidity was most common (590/939, 62.83%). Compared with non-cardiometabolic and metabolic multimorbidity, the incharge ADL score of patients with this multimorbidity decreased by 7 points (95%CI:-11.22- -3.34), Correspondingly, patients with kidney disease multimorbidity decreased by 14 points (95%CI:-24.12- -3.30) on the incharge score. The presence or absence of kidney disease multimorbidity had the greatest impact on discharge score, which was reduced by 12 points in comparison with patients without this multimorbidity (95%CI:-22.43- -2.40). ICU admission is mostly affected by the presence of cardiometabolic and metabolic multimorbidity (OR=2.44, 95%CI: 1.51-3.92) and kidney disease multimorbidity (OR=2.58, 95%CI: 1.01-6.60). The risk of death is the highest for cardiometabolic and metabolic multimorbidity (OR=2.24, 95%CI: 1.19-4.21). Conclusion: Multimorbidity is common in COPD patients. The most common pattern is cardiometabolic and metabolic multimorbidity. Cardiometabolic and metabolic multimorbidity and kidney disease multimorbidity significantly affect the quality of life and often associate with a poor prognosis.
Aged ; Middle Aged ; Humans ; Multimorbidity ; Inpatients ; Prevalence ; Cross-Sectional Studies ; Quality of Life ; Pulmonary Disease, Chronic Obstructive/epidemiology* ; Chronic Disease

Objective:To observe the effects of Da Chaihutang on Cyclic adenosine monophosphate （cAMP）-response element binding protein （CREB）/peroxisome proliferator-activated receptor-gamma coactivator-1 alpha （PGC-1α） pathway in nutritionally obese rats and the protective mechanism on liver mitochondria. Method:A total of 120 8-week-old male SD rats were randomly divided into a control group （n=20） and an experimental group （n=100）. The rats in the control group were fed on a normal diet， while those in the experimental group were administered with a high-fat feed. Successfully modeled rats were randomly divided into a model group， a positive drug （metformin） group， and low-， medium- and high-dose Da Chaihutang groups （4.25， 8.5， and 17 g∙kg^-1， respectively）， with 20 rats in each group. After treatment with Da Chaihutang， the body weight， Lee's index， liver mitochondrial membrane potential and mitochondrial ultrastructure， PGC-1α expression and CREB phosphorylation of each group were measured and compared. Result:Compared with the control group， the model group showed increased body weight and Lee's index （P<0.01）， whereas decreased mitochondrial membrane potential， PGC-1α expression， and CREB phosphorylation level （P<0.01）. As compared with the model group， Da Chaihutang significantly reduced the body weight and Lee's index of obese rats （P<0.05， P<0.01）， enhanced liver mitochondrial membrane potential （P<0.05， P<0.01） to protect the integrity of mitochondrial structure， up-regulated PGC-1α expression and promoted CREB phosphorylation （P<0.05， P<0.01）. Conclusion:Da Chaihutang protects the structure and function of mitochondria and inhibits weight gain in obese rats by activating the CREB/PGC-1α pathway.

OBJECTIVETo study the mechanism and clinical value of miR-373 in multiple myeloma.

METHODSThe expressions of miR-373 in multiple myeloma cells and normal plasma cells were detected by RT-PCR, and the biological function of miR-373 in tumor was analyzed by MTT assay, flow cytometry, luciferase experiment and tumorgenesis experiment.

RESULTSThe miR-373 expression levels in MM patients and multiple myeloma cell lines (H929, MM1S and U266) were significantly lower than that in normal plasma cells detected by using RT-PCR (P<0.05). The proliferations of U266 and H929 cells transfected with miR-373 were significantly suppressed (P<0.05); the cell cycle of H929 cell transfected with miR-373 was arrested in the G/G phase(P<0.05) and the cell apoptosis was induced (P<0.05). Luciferase experiment revealed that miR-373 could significantly inhibit the expression of FOXM1 (P<0.05). In mouse tumorigenesis experiments, overexpression of miR-373 significantly inhibited tumor growth by decreasing FOXM1 levels (P<0.05).

CONCLUSIONmiR-373 inhibits tumor growth in MM by direct targeting FOXM1, thus miR-373 shows an important clinical significance for the treatment of MM.

BACKGROUNDScreening on multidrug-resistant tuberculosis (MDR-TB) has been limited to the serious TB subpopulations excluding the new TB patients. This study aimed to examine MDR-TB burden among the new TB patients.

METHODSWe conducted a study in Zhejiang Province during 2009-2013 to screen for MDR-TB patients among the low MDR-TB risk patients and five subpopulations of high MDR-TB risk patients. The number, prevalence, and trend of MDR-TB were compared while the logistic regression model was used to examine risk factors related to MDR-TB.

RESULTSA total of 200 and 791 MDR-TB cases were, respectively, identified from the 9830 new TB cases and 2372 high-risk suspects who took MDR-TB screening from 2009 to 2013. The MDR-TB rates went down in both of the new TB patients and five MDR-TB high-risk groups over the study time, but the percentage of MDR-TB patients identified from the new TB patients in all diagnosed MDR-TB cases kept stable from 28.3% in 2011 to 27.0% in 2012 to 26.0% in 2013.

CONCLUSIONSThe study indicated that MDR-TB burden among new TB patients was high, thus screening for MDR-TB among the new TB patients should be recommended in China as well as in the similar situation worldwide.

OBJECTIVETo explore the role of dynamic monitoring the karyotype changes for evaluation of chemotherapy efficacy in patients with acute leukemia.

METHODSA total of 80 patients with acute leukemia were collected and according to FAB classification standards they were divided into 65 cases of acute myeloid leukemia (AML) and 15 cases of acute lymphoblastic leukemia (ALL); R banding technique was used taken to detect their chromosome and to analyze the relationship between chromosome and efficacy of chemotherapy.

RESULTSOut of 65 cases of AML, 31 cases showed abnormal karyotypes and their aberration rate was 47.7%; among 31 cases of AML with chromosome abnormalities, the t (15; 17) was found in 9 cases and they accounted for 29%; t (8; 21) was found in 7 cases and they accounted for 22.6%; other karyotype and complex karyotypes were found in 15 cases and they accounted for 48.4%; the remission rate of t (15; 17) group was 88.9%, remission rate of t (8; 21) group was 71.4%, remission rate of other karyotype group was 66.7%. The comparison of between different groups showed that remission rate of t (15; 17) group was significantly higher than that in T (8; 21) group, other karyotype group and normal karyotype group (χ2=9.625,14.267,7.768, P<0.05); the remission rate between t (8; 21) group, other karyotype group and normal karyotype group was no significant different (χ2=0.517, 0.111, P>0.05). In 15 cases of ALL, 8 cases with normal karyotype accounted for 53.3%, 7 cases with abnormal karyotype accounted for 46.7% of ALL; as compared with AML, no significant difference was shown (χ2=0.020, P>0.05); the remission rates of patients with normal karyotype and abnormal karyotype were 87.5% and 42.9% respectively, the difference between the two groups had statistical significance (χ2=43.834, P<0.01).

CONCLUSIONFor patients with AML, patients with t (15; 17) chromosomal abnormality can obtain better effect from chemotherapy, the clinical remission rate of ALL patients with normal karyotype is higher; the karyotype analysis has the important reference value for evaluating efficacy of chemotherapy in patients with leukemia.

The study is to investigate the effect of angiotensin II (Ang II) and its receptor blockers on migration and endothelin-1 (ET-1) expression of rat vascular adventitial fibroblast subpopulations. Vascular adventitial fibroblasts were individually expanded by using cloning rings, and the effects of Ang II on the migration of adventitial fibroblast subpopulations were evaluated by Transwell. Fluorescence quantitative-PCR detected the expression of preproET-1 mRNA induced by Ang II, and its receptor antagonists losartan and PD-123319. The concentration of ET-1 was determined by ELISA. It showed that spindle shaped and epithelioid shaped cells were isolated by using cloning rings, named as spindle cells and round cells. RT-PCR showed that fibroblast subpopulations did not have leukocytes, endothelial cells and smooth muscle cells, namely pure cell lines. Compared with respective control cells, two subpopulations had transferring ability. Ang II significantly improved round cells migration in a concentration-dependent manner, and had no obvious influence on spindle cells migration. Ang II (1 x 10(-8) - 1 x 10(-6) mol x L(-1)) significantly increased the expression of preproET-1 mRNA in round cells (P < 0.01), and had no significant effect on the expression of preproET-1 mRNA in spindle cells. Losartan blocked the expression of preproET-1 mRNA induced by Ang II in round cells, and had no significant effect on the expression of preproET-1 mRNA in spindle cells. The effects of Ang II and ET-1 receptor inhibitors on the release of ET-1 were similar to the expression of preproET-1 mRNA. The results indicate that there are two cell subpopulations: round cells and spindle cells in rat vascular adventitial fibroblasts. Ang II significantly improved cells migration, and increased the expression of ET-1 in round cell subpopulation. It suggested that there may be different migratory mechanisms in two cell subpopulations, and the two subpopulations may play a different role in vascular remodeling and reparative process.
Angiotensin II ; pharmacology ; Angiotensin Receptor Antagonists ; pharmacology ; Animals ; Cell Movement ; drug effects ; Cells, Cultured ; Endothelin-1 ; genetics ; metabolism ; Fibroblasts ; cytology ; metabolism ; Imidazoles ; pharmacology ; Losartan ; pharmacology ; Male ; Pyridines ; pharmacology ; RNA, Messenger ; metabolism ; Rats ; Rats, Sprague-Dawley ; Vasoconstrictor Agents ; pharmacology

Objective: To explore effects of using direct moxa at Guanyuan acupoint in palliative care for cancer patients during the chemotherapy Methods: In single blind, randomized controlled clinical trial, examined effects of using direct moxa at Guanyuan acupoint. 24 gastric cancer patients undergoing postoperative chemotherapy at National Cancer Center of Mongolia were recruited and randomized into 2 groups: control and intervention. The intervention consisted of 25 min direct moxa at Guanyuan acupoint once a day for 5 days. The EORTC QoL 30 questionnaires were filled by the patients and self-designed patient assessment questionnaire based on MD Anderson Symptom Inventory were filled by blinded medical personal, before and after the chemotherapy. Study was approved by Ethical Committee of MOH of Mongolia. Explored the relationship between moxa at Guanyuan acupoint and Connexin 43 (Cx43) expression in the cyclophosphamide treated mice stomach by IHC method. Results: The QoL of post-operative gastric cancer patients before chemotherapy were similar to EORTC reference value. Chemotherapy will significantly decrease patients QoL especially nausea & vomiting, appetite loss symptom scales. Moxa at Guanyuan had significantly decreased fatigue score of the post- operative chemotherapy gastric cancer patients (P<0.05) and positively regulated Global Health score and other symptom scales especially nausea & vomiting, appetite loss scores. During the treatment no adverse effects of moxa treatment were observed. IHC analysis of cyclophosphamide treated mice stomach reveals Strong connexin 43 expresion in gastric crypt. Conclusion: Guanyuan (CV 4) is Front-Mu Point of the Small Intestine, a crossing point of Three Yin Meridians of Foot, Stomach meridian of Foot Yang Ming and Conception Vessel. It is the one acupoint can gather qi of many meridians, which has Yin within the yang character and considered the physical center of gravity of the human body and seat of one\'s internal energy. Therefore it could warm the kidney to invigorate yang, tonify the Yuan- Primary qi, regulate Thoroughfare and Conception Vessels, thus can cultivate yuan- primary energy. Moxa is the non invasive treatment method of acupuncture and moxa at Guanyuan can be broadly used in cancer palliative care to reduce the side effects of chemotherapy and improve quality of life of cancer patients.

Objective To investigate the clinical features of aortic dissection (AD) and emergency treatments. Methods Data from 784 patients with aortic dissection were collected in the Department of Emergency from January 2000 through December 2009. A retrospective analysis was carried out to determine the survival rate, mortality rate and treatment efficiency. Results Pain was the most common onset symptom (77.7% , 609/784). The majority of patients (86.5%) had essential hypertension (678/784). All the patients with preoperative diagnosis of aortic dissection underwent emergency medical intervention by internists resulting in 81.5% survival rate (639/784) and 18.5% mortality rate (145/784). There were 157 patients without improvement (20.0% ) and the total efficiency rate was (83. 1% ). The efficiency rate of conventional treatment was 76.4% , while the efficiency rate of triple four-procedure treatment was 89. 8% (P<0.05). Of them, 139 patients (17. 7% ) died in the hospital. Among them,. 26 patients died within 24 hours (18.4% ) and 47 cases died within 48 hours (33. 8% ) and 66 patients died within 72 hours (47.2% ). There were 92 patients who refused treatments after diagnosis, and among them, 81 patients died within 72 hours (88.04% ). The difference in mortality rate between two groups was significant (P<0.05). Conclusions The diagnosis of aortic dissection depends on detailed history, physical examination and CT or MRI imaging. Analgesia, sedation and control of blood pressure are essential for emergency treatments. Early diagnosis and effective emergency treatments are the critical strategy for the early surgical intervention and time window for further treatment to improve the survival rate of AD.

Objective To study the etiology of nosocomial infection and the risk factors in senile patients with acute myelogenous leukemia who received chemotherapy, then to explore the preventive measure. Methods 9lcases of senile patients with AML received 304 times of chemotherapy, then to analyze the rate of nosocomial infection, the infection site, the result of etiological examination and the relationship between the rate of nosocomial infection and the absolute of neutrophil count in peripheral blood and the duration of agranulocytosis. And then the results were compared with the non-senile patients with AML. Results The statistical indicators of nosocomial infection in senile patients with AML was higher than those younger ones. The rate of infection in lower respiratory tract, oral, alimentary canal, skin, anal area and the rate of sepsis in senile people was higher than those younger ones.Positive rate of fungal infection of senile patients was higher. The nosocomial infection in the patients whose absolute neutrophil count in peripheral blood was no more than 0.5×l09/L,and prolonged over 7 days was specific higher. Conclusions Senile patients with AML is the high risk group for nosocomial infection. Age, chemotherapy, the neutrocytopenia level and prolonged time are related to the nosocomial infection in senile patients with AML. It is necessary to take positive measure to control nosocominal infection and advance life quality of senile patients.

Objective To study the efficacy and safety of recombinant human thrombopoietin (rhTPO)in the treatment of thrombocytopenia induced by chemotherapy in elder patients with acute myeloid leukemia. Methods 20 elder patients with acute myeloid leukemia who got CR received two cycles of consolidation chemotherapy. In the first cycle of chemotherapy(control cycle), they were transfused with platelet suspensions when they developed severe thrombocytopenia; In the second cycle of chemotherapy (treatment cycle), they were given subcutaneous injection of rhTPO 1.0μg·kg-2·d-1 for 14 days or until platelet count≥ 80×109/L with the treatment above all when platelet count ≤50×109/L. The efficacy and safety were evaluated. Results The duration of Plt count<100×109/L in the treatment cycle and the control cycle was (23.1±4.5)d and (25.8±5.7) d (P<0.005); the duration of Plt count≤20×109/L in the treatment cycle and in the control cycle was (6.8±2.6) d and (11.7±3.2) d (P<0.005). The minimal Plt count of the treatment cycle and the control cycle were (13.2±4.4)×109/L and (12.2±3.1)×109/L (P＝0.0967) respectively, and the maximal Plt count after its recovery were (239.3±48.7)×109/L and (163.5±32.4)×109/L (P<0.005) respectively. Platelet transfusion was (22.8±6.8) U in the treatment group, it was significantly lower than that in the control group (30.0±6.3) U (P<0.05).The changes of hemoglobin content, white blood cell count, Urine routine, the function of liver and kidney, the function of blood coagulation after chemotherapy in both groups were no obvious(P ＝0.0872). Transient adverse reaction was observed in 5 patients (25 %). No thrombotic incident had occurred. Conclusion rhTPO can significantly accelerate PLT recovery, reduce the degree and duration of thrombocytopenia induced by chemotherapy, and reduce platelet transfusion in the treatment of consolidation chemotherapy for the elder patients with acute myeloid leukemia. It is safe and can be recommended to use widely.