ObjectiveThis observational study examined the risk factors associated with recurrence in patients with mild ischemic stroke and determined the characteristics of high-risk groups.MethodsA total of 656 patients hospitalized for mild ischemic stroke were monitored for 1 year. Statistical analyses, including odds ratio calculations and K-means clustering, were conducted to examine risk factors for recurrence and the characteristics of high-risk groups.ResultsAfter 1 year of follow-up, 99 patients experienced recurrent mild ischemic stroke, resulting in a recurrence rate of 15.09%. The analysis revealed several significant risk factors, including type 2 diabetes mellitus, atrial fibrillation, smoking and alcohol consumption, carotid artery stenosis, cerebral vascular stenosis, and multiple lesions. Propensity score matching confirmed these associations, and K-means clustering revealed that older males with type 2 diabetes mellitus and hypertension were likely to be in the high-risk group.ConclusionsHealthcare professionals should focus on tailored treatment and prevention strategies for high-risk patients, prioritizing the management of the abovementioned risk factors to reduce recurrence and improve outcomes.

OBJECTIVES:To examine the association between friendly community environments and depressive symptoms among older adults in China and to investigate the potential mediating roles of happiness and confidence in this association. DESIGN:A nationally representative longitudinal study employing the parallel mediation model to estimate the direct association. Bootstrapping procedures were employed to test the hypothesised mediating effects. SETTING:The China Family Panel Studies (CFPS) database, a nationally representative survey. PARTICIPANTS:The analytical sample comprised 3182 individuals aged 60 years or older from the CFPS 2016, 2018 and 2020 waves. OUTCOME MEASURES:Depressive symptoms were measured using an eight-item version of the Center for Epidemiologic Studies Depression Scale. Higher scores indicated more depressive symptoms. Friendly community environment, happiness and confidence were assessed using corresponding survey items. RESULTS:The analysis revealed a significant direct negative association was observed between friendly community environments and depressive symptoms (β=-0.062, 95% CI -0.092 to -0.035, p<0.001). This effect was significantly mediated by increased happiness (indirect effect=-0.025, 95% CI -0.036 to -0.017, p<0.001) and increased confidence (indirect effect=-0.036, 95% CI -0.048 to -0.026, p<0.001). The urban-rural heterogeneity analysis demonstrates that the research findings remain robust across both urban and rural subsamples. CONCLUSION:Friendly community environments are negatively associated with depressive symptoms among older adults in China, primarily by enhancing happiness and confidence in life. To promote healthy ageing, it is crucial to create comfortable, clean and convenient community environments tailored to the older adult population.

Abstract Objective This study aims to construct and validate a scale for evaluating the quality of integrated medical and care services in elderly care institutions in Xiamen region. Methods A preliminary scale was constructed through literature review, expert selection and evaluation, and pre-survey. From May to November 2022, a proportional sample of elderly individuals was surveyed in seven care institutions across four districts in Xiamen city (Siming, Huli, Jimei, and Tong'an). Statistical methods, including critical ratio analysis, reliability and validity analysis, difference testing, and correlation analysis, were used to refine the scale items and assess its reliability and validity. Results The final scale comprised six dimensions: Health Education (10 items), Medical and Basic Nursing Care (14 items), Rehabilitation Services (7 items), Psychological/Spiritual Support Services (5 items), Medical-Related Safety Protection (6 items), and Others (6 items). The Cronbach's α coefficient was 0.991, and the α coefficients for the six dimensions were 0.974, 0.942, 0.951, 0.860, 0.901, and 0.930, respectively. Exploratory factor analysis demonstrated good validity (KMO = 0.942, χ2 = 13957.791, P < 0.001). Conclusion The constructed scale for evaluating the quality of integrated medical and care services in elderly care institutions in Xiamen demonstrated satisfactory reliability and validity. It can serve as a practical tool for evaluating the quality of such services and contribute to the standardization and professionalization of integrated medical and care services in the region.

Background Chinese aging population degree will transform mild to moderate. During addressing aging issues by proactive national strategies and healthy aging strategies, the sleep health of older peoplecannot be ignored. Objective To explore the effect of working after retirement on sleep quality in Chinese older people, providing relevant reference data for improving sleep quality in this group of people. Methods In August 2021, data of working after retirement prevalence and sleep health in subjects aged ≥60 years (n=7 862) were obtained from the 2018 China Family Panel Studies (CFPS) conducted by Peking University with permission. They were divided into working after retirement and non-working after retirement groups by working after retirement prevalence. Normal sleep duration (within 4 to 10 hoursper night) , abnormal sleep duration (≤4 or ≥10 hours per night) , sleeping late (going to bed after 23 o'clock) in accordance with relevant diagnostic criteria used in international studies on sleep health in middle-aged and older people. Self-reported perceptions of sleep quality were classified into optimistic and pessimistic according to subjective evaluation of sleep efficiency and effect. Binary Logistic regression model was used to explore the effect of working after retirement on sleep duration, perception of sleep quality and the time to go to sleep. Results Among the subjects, 5 705 (72.56%) had optimistic sleep quality, 6 508 (82.78%) had normal sleep duration, and 7 464 (94.94%) went to sleep earlier than 23: 00, and 4 005 (50.94%) still worked after retirement. After controlling for age, gender, maritalstatus, education level, personality traits and other factors, working after retirement was associated with increased probability of higher optimism with sleep quality〔OR (95%CI) =1.205 (1.069, 1.358) 〕, more normal sleep duration〔OR (95%CI) =1.306 (1.137, 1.499) 〕, and earlier time to go to sleep〔OR (95%CI) =1.596 (1.253, 2.033) 〕.Working after retirement was associated with increased probability of good sleep quality (P<0.05) . Conclusion As working after retirement may be contributive to good sleep quality in older people, it should be supported and guaranteed by governmental policies.

目的:分析颈内动脉系统短暂性脑缺血发作(transient ischemic attack,TIA)后再发脑卒中的相关影响因素.方法:回顾性分析 2018 年 1 月—2020 年 6 月收治于厦门大学附属第一医院的 79 例颈内动脉系统TIA患者的资料,并根据是否再发脑卒中分为无脑卒中组(n=48)和脑卒中组(n=31).对比两组患者的一般资料、临床资料及颈动脉内膜中层厚度(carotid intima-media thickness,CIMT),采用多因素logistic回归模型对颈内动脉系统TIA患者再发脑卒中的影响因素进行分析.结果:脑卒中组高血压、既往脑梗死病史比例高于无脑卒中组,差异有统计学意义(P<0.05);两组其余一般资料对比,差异无统计学意义(P>0.05).脑卒中组首次发作距就诊时间、症状持续时间长于无脑卒中组,CIMT大于无脑卒中组,差异有统计学意义(P<0.05);两组甘油三酯(triacylglycerols,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、总胆固醇(total cholesterol,TC)及高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)对比,差异无统计学意义(P>0.05).多因素logistic回归分析结果显示,既往脑梗死病史、首次发作距就诊时间、症状持续时间及CIMT是颈内动脉系统TIA后再发脑卒中的危险因素(P<0.05).结论:颈内动脉系统TIA后再发脑卒中的风险较高,既往脑梗死病史、首次发作距就诊时间、症状持续时间及CIMT是颈内动脉系统TIA后再发脑卒中的影响因素,同时还需注意高血压在风险评估时的重要性.

目的 观察埃克替尼联合TP方案治疗晚期非小细胞肺癌(NSCLC)的临床疗效及其对机体免疫功能的影响.方法 选取2019年11月—2021年12月厦门大学附属第一医院收治的晚期NSCLC患者81例,按照随机数字表法分为对照组(n=40)和观察组(n=41).对照组给予TP方案治疗,观察组在对照组基础上给予埃克替尼.2组均以3周为1个疗程,持续治疗2个疗程.比较2组临床疗效,治疗前、治疗6周后肿瘤标志物[细胞角质蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)]、免疫功能指标[CD4+、CD8+、自然杀伤(NK)细胞分数],不良反应.结果 治疗6周后,观察组总有效率为73.17％,高于对照组的50.00％(χ2=4.601,P=0.032).治疗6周后,2组血清CEA、CYFKA21-1水平较治疗前降低,且观察组低于对照组(P<0.05).治疗6周后,2组CD4+、NK细胞分数较治疗前降低,CD8+较治疗前升高,但观察组CD4+、NK细胞分数高于对照组,CD8+低于对照组(P<0.05).治疗期间观察组不良反应总发生率为24.40％,与对照组的32.50％比较,差异无统计学意义(χ2=0.322,P=0.570).结论 埃克替尼联合TP方案可有效减轻晚期NSCLC患者机体免疫抑制反应,降低肿瘤标志物水平,延缓病情进展,提高临床疗效且不增加不良反应.

目的 观察信迪利单抗联合白蛋白紫杉醇和顺铂治疗无驱动基因突变的晚期非小细胞肺癌的临床疗效及其对细胞生长因子、肿瘤标志物的影响.方法 选取2019—2021年厦门大学附属第一医院收治的无驱动基因突变的晚期非小细胞肺癌患者68例作为研究对象,采用信封随机法分为对照组与观察组,每组34例.对照组予以白蛋白紫杉醇联合顺铂治疗,观察组在对照组基础上加用信迪利单抗,2组患者均治疗4～6个疗程.比较2组临床疗效,治疗前后细胞生长因子[血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、基质金属蛋白酶-9(MMP-9)]水平、肿瘤标志物[癌胚抗原(CEA)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)]水平、免疫功能指标(CD4+、CD8+),不良反应.结果 观察组治疗总有效率为38.24％,高于对照组的14.71％(χ2=4.836,P=0.028).治疗后,2组VEGF、bFGF、MMP-9水平较治疗前均降低,且观察组低于对照组(P<0.01).治疗后,2组CEA、CYERA21-1水平较治疗前均降低,且观察组低于对照组(P<0.01).治疗后,2组CD4+高于治疗前,CD8+低于治疗前,且观察组CD4+高于对照组,CD8+低于对照组(P<0.01).2组肝功能损害、骨髓抑制、腹泻、蛋白尿、贫血发生率比较,差异无统计学意义(P>0.05).结论 信迪利单抗联合白蛋白紫杉醇和顺铂治疗无驱动基因突变的晚期非小细胞肺癌的临床疗效确切,可有效抑制肿瘤血管生成,降低肿瘤标志物水平,进而延缓病情进展,提高人体免疫功能,且不良反应可控,安全性较高.

BackgroundThe risk of recurrent stroke following a minor stroke or transient ischemic attack (TIA) is high, when inflammation might play an important role. We aimed to evaluate the value of neutrophil to lymphocyte ratio (NLR) in predicting composite cardiovascular events in patients with minor stroke and TIA.MethodsConsecutive patients with acute minor stroke or TIA admitted within 24 h of symptoms onset during a 5-year period in a prospective stroke registry were analyzed. We calculated the NLR dividing absolute neutrophil count by absolute lymphocyte count tested within 24 h of admission. NLR ≥4th quartile was defined as high NLR. A composite outcome was defined as stroke, acute coronary syndrome or vascular death within 1 year. We investigated associations between NLR and the composite outcome in univariate and multivariate analyses, among all patients and in those aged over 60 years (i.e., older patients).ResultsOverall, 841 patients (median age 68 years; 60.4% males) were recruited. No significant independent association was found between NLR and the composite outcome in multivariate analysis in the overall cohort. Among the 612 older patients (median age 73 years; 59.2% males), the median NLR was 2.76 (interquartile range 1.96−4.00) and 148 (24.2%) patients had high NLR. The composite outcome occurred in 77 (12.6%) older patients, who were more likely to have a high NLR (39.0% versus 22.1%; p = 0.001) than those without a composite outcome. In multivariate logistic regression, high NLR (adjusted odds ratio 2.00; 95% confidence interval 1.07−3.75; p = 0.031) was independently associated with the composite outcome in older patients.ConclusionIn older (aged ≥60 years) patients with acute minor stroke or TIA, a higher NLR, a marker of systemic inflammation that can be easily obtained in routine blood tests, is an independent predictor of subsequent cardiovascular events.

目的 探讨叶酸、维生素B6、甲钴胺治疗老年急性脑梗死伴高同型半胱氨酸(homocysteine,Hcy)血症患者的临床特点及预后分析.方法 收集66例老年急性脑梗死伴高Hcy血症患者,随机分为两组,试验组33例,对照组33例,两组均给予脑梗死的常规治疗,试验组在此基础上,加用B族维生素,即叶酸2.5mg qd,维生素B610mg tid,甲钴胺500μg bid,疗程3个月.观察两组患者入院时及治疗后3个月的血脂,即总胆固醇(Total Cholesterol,TC)、甘油三酯(Triglyceride,TG)、低密度脂蛋白胆固醇(Low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(High-density lipoprotein cholesterol,HDL-C)、血Hcy水平及颈动脉内膜中层厚度(intimamedia thickness,IMT).结果 治疗后3个月两组的TC(对照组P=0.021,试验组P<0.001)、LDL-C(对照组P=0.004,试验组P<0.001)较入院时均显著下降;试验组血Hcy(P=0.011)较入院时显著下降,并且明显低于对照组(t=-2.435;P=0.026);试验组颈动脉IMT(P=0.019)较入院时下降,并且低于对照组(t=1.124;P>0.05,无统计学意义).结论 叶酸、维生素B6、甲钴胺联合治疗对老年急性脑梗死伴高Hcy血症患者是安全、有效的,并能在一定程度上减轻动脉粥样硬化.

目的:探讨单硝酸异山梨酯应用于心力衰竭治疗的临床效果及对患者心功能的影响.方法:选取2017年6月-2018年6月笔者所在医院收治的心力衰竭患者60例为研究对象,随机分为研究组与对照组.对照组患者给予常规β受体阻滞剂、醛固酮受体拮抗剂、利尿剂等基础治疗,研究组在对照组的基础上给予单硝酸异山梨酯治疗.对比两组治疗效果、治疗前后血清细胞因子水平变化[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)]、心功能指标(心脏指数(CI)、左室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]变化,并观察不良反应发生情况.结果:与对照组对比,研究组患者的总有效率明显升高(P<0.05).治疗前,两组患者TNFα、IL-6、hs-CRP水平比较差异无统计学意义(P>0.05),治疗后,两组患者的TNFα、IL-6、hs-CRP水平均较治疗前明显降低,且研究组明显低于对照组(P<0.05).治疗前,两组患者CI、LVEDD、LVEF值比较差异无统计学意义(P>0.05);治疗后两组患者CI、LVEF值均较治疗前明显升高,LVEDD值较治疗前降低,且研究组均优于对照组(P<0.05).两组患者在治疗期间均未发生严重的不良反应.结论:在常规治疗的基础上应用单硝酸异山梨酯治疗心力衰竭可有效提高临床效果,改善心功能,减轻炎症反应,且安全性高,值得临床推广.

>老年痴呆患者后期可出现不同程度的吞咽障碍, 导致进食困难, 引起营养不良、吸入性肺炎等, 增加患者病死率和不良预后风险。目前认为鼻饲肠内营养具有经济、安全、效果明显等优点, 临床应用率较高[1], 但在临床鼻饲期间亦常出现肠内营养相关的并发症。本研究通过比较连续输注泵法和传统手工分次分量推注法, 了解不同鼻饲方法对老年痴呆伴吞咽障碍患者肠内营养相关并发症的影响。一、对象和方法1.对象:回顾性分析,

Objective To investigate the effects of glucagon like peptide 1（GLP-1）agonist on myocardial hypoxia reoxy-genation injury and its molecular mechanism.Methods H9C2 cells were divided into control group,hypoxia reoxygenation（H/R）group,H/R+GLP-1 group,and H/R+GLP-1+phosphatidylinositol-3-kinase（PI3K）inhibitor LY294002 group.The cell proliferation activity,apoptosis rate,enzyme contents in the medium and

目的 探讨不同肠内营养制剂对老年急性脑卒中伴吞咽障碍患者预后的影响.方法 收集70例老年急性脑卒中伴吞咽障碍患者,随机分为两组,试验组35例,对照组35例,在常规脑卒中治疗的基础上,试验组给予肠内高营养制剂,对照组给予自制匀浆流食.观察两组患者入院时及治疗后第10天、第21天的营养状态、免疫功能、美国国立卫生研究院神经功能缺损评分(NIHSS评分)及并发症发生率.结果 (1)治疗后第21天试验组血清白蛋白(ALB)、血清前白蛋白(PA)、血红蛋白(HGB)均出现回升,改善程度优于对照组(P<0.05),试验组总淋巴细胞计数(TLC)、IgA、IgG、IgM均较对照组升高(P<0.05).(2)治疗后第21天试验组NIHSS评分降低程度较对照组更明显(P<0.05).(3)试验组并发症发生率为45.7%(16/35)低于对照组并发症发生率71.4%(25/35)(P<0.05).结论 肠内高营养制剂可有效改善老年急性脑卒中伴吞咽障碍患者的营养状态及预后.

目的 探讨肺腺癌表皮生长因子受体(EGFR)基因突变情况与胸部CT影像学特点的相关性.方法 回顾性分析180例经气管镜活检、胸膜活检、经皮穿刺活检病理确诊的肺腺癌患者的CT影像学资料,分析两者的相关性.结果 180例患者中,60例EGFR基因突变阳性,突变率为33.3%.男性突变率24.19%,女性突变率53.57%,两者差异有统计学意义(P=0.036).在年龄、肿瘤大小、胸膜牵拉征、空气支气管征、分叶征、毛刺征、双肺转移方面,野生组与突变组差异无统计学意义;有胸腔积液者突变率较高(χ2=18.908,P=0.03).Logistics回归分析显示性别及胸腔积液与EGFR基因突变状态相关,突变组与野生组差异有统计学意义(P<0.05).结论 性别、胸腔积液可作为肺腺癌EGFR突变状态的预测因素.

目的：观察注射用尤瑞克林治疗老年急性脑梗死的临床疗效及安全性。方法84例老年急性脑梗死患者，随机分为治疗组(43例)和对照组(41例)。两组均给予急性脑梗死常规治疗，治疗组在此基础上加用注射用尤瑞克林。比较两组治疗前后美国国立卫生院神经功能缺损评分(NIHSS)评分、日常生活活动能力(ADL)评分及改良 Rankin 量表(mRS)评分，并评估安全性。结果经治疗后，两组患者 NIHSS 评分、ADL 评分及 mRS 评分均改善(P<0.05)；治疗组总有效率达79.1%，明显高于对照组的63.4%，差异具有统计学意义(P<0.05)。且治疗组无严重药物不良反应发生。结论注射用尤瑞克林治疗老年急性脑梗死可显著改善神经功能缺损程度，提高日常生活质量，具有较高安全性。

目的 高糖诱导血管平滑肌的增殖和迁移是糖尿病引起动脉粥样硬化的关键病理环节.小分子RNA在糖尿病血管并发症中的作用日益受到重视,本项目将对微小RNA-23b(miR-23b)在高糖诱导血管平滑肌的增殖和迁移中的作用进行研究.方法 首先,将血管平滑肌细胞株(VSMCs)与高糖(HG,40 mM)共同孵育24 h,qPCR检测高糖对VSMCs增殖及miR-23b的表达的影响.为了进一步证实miR-23b在高糖诱导VSMC增殖及迁移中的作用,转染过表达miR-23b载体及对照载体,构建过表达VSMCs(VSMCmiR-23b)及对照细胞(VSMCNC),将HG分别与VSMCmiR-23b及VSMCNC孵育24 h,CCK-8检测VSMCs的增殖,Transwel检测VSMCs迁移,qPCR检测miR-23b及其靶基因的PI3KR1、Smad3表达.结果 HG能浓度依赖性的促进VSMCs的增殖并抑制miR-23b的表达,与对照组比较差异均有统计学意义(P<0.05).VSMCmiR-23b组的细胞活力及迁移率均显著低于VSMCNC组(P<0.05).HG能升高VSMCNC及VSMCmiR-23b的细胞活力及迁移率,与对照组比较差异有统计学意义(P<0.05),VSMCmiR-23b+高糖组的细胞活力及迁移率均显著低于VSMCNC+高糖组(P<0.05).VSMCmiR-23b组的PI3KR1、Smad3的表达显著低于VSMCNC组(P<0.05).高糖能升高VSMCNC及VSMCmiR-23b的PI3KR1、Smad3的表达.VSMCmiR-23b+高糖组的PI3KR1、Smad3的表达均显著低于VSMCNC+高糖组(P<0.05).结论 miR-23b可能通过调控靶基因Smad3、PI3KR1参与HG诱导的血管平滑肌增殖及迁移.

目的:探讨培美曲塞及吉西他滨分别联合顺铂治疗非鳞非小细胞肺癌的安全性和有效性.方法:收治初治非鳞非小细胞肺癌患者78例,随机分成观察组和对照组各39例.给予对照组吉西他滨联合顺铂治疗,观察组培美曲塞联合顺铂治疗.比较两组的临床疗效.结果:两组治疗有效率和不良反应率的差异均有统计学意义(P＜0.05).结论:培美曲塞联合顺铂治疗非鳞非小细胞肺癌的临床效果理想,治疗后不良反应发生率低,安全性高.

目的:分析缺血性心力衰竭患者近期预后与血清胱抑素C(CysC)水平之间的相关性.方法:选取笔者所在医院2015年6月-2016年6月收治的缺血性心力衰竭患者70例设为心衰组,另选取同期体检的健康者70例设为对照组,患者入院后均检测CysC水平,心衰组依据CysC水平分为正常CysC组(31例)与高CysC组(39例),探讨CysC水平与缺血性心力衰竭患者近期预后的关联.结果:心衰组CysC、尿素氮(BUN)及血清肌酐(Scr)水平明显高于对照组,差异有统计学意义(P<0.05),且心衰组心功能越差,CysC水平越高,差异有统计学意义(P<0.05),但Scr与BUN水平比较差异无统计学意义(P>0.05);高CysC组(左心射血分数)LVEF明显低于正常CysC组,NYHA分级明显高于正常CysC组,差异均有统计学意义(P<0.05);高CysC组心血管事件发生率为59.0%,住院死亡率为15.4%,3个月内再入院率为48.7%,3个月内全因死亡率为25.6%,均明显高于正常CysC组,差异有统计学意义(P<0.05).结论:CysC水平与缺血性心力衰竭患者近期预后密切关联,可考虑作为缺血性心力衰竭患者的预测因子.

选取我院2013年11月~2014年11月收治的120例支气管哮喘患者的临床资料,根据数字随机分组法原则,将患者分为观察组与对照组各60例.对照组单纯采用糖皮质激素治疗,观察组采用糖皮质激素联合长效β2受体激动剂治疗,比较两组患者的治疗效果与不良反应发生情况.结果(1)观察组治疗总有效率为96.67%,对照组治疗总有效率为81.67%,观察组治疗有效率高于对照组,对比有统计学意义(P<0.05).(2)观察组中有2例患者发生不良反应,发生率为3.33%,对照组中有7例患者出现不良反应,发生率为11.67%,观察组的不良反应发生率低于对照组,对比有统计学意义(P<0.05). 通过给予糖皮质激素联合长效β2受体激动剂对支气管哮喘患者进行治疗,可以取得满意的疗效,不会增加患者不良反应发生率,安全性较高,值得临床推广应用.

Objective To retrospectively conclude the characteristics of interictal EEG of patients with intractable epilepsy,and then analyze their relationship with postoperative seizures.Methods 168 patients with intractable epilepsy in the epilepsy center of Beijing Tiantan Hospital that underwent strictly preoperative evaluations before surgery were collected and followed up for 2 and 5 years,the characteristics of their interictal EEG and postoperative seizures after 2 years and 5 years were concluded and analyzed.Results There was no significant difference between 2 years and 5 years postoperative seizures in 73 intractable epilepsy patients(P0.05).There was statistically differences in postoperative seizures between unilateral and bilateral abnormal discharges(P0.05).Conclusion Patients with unilateral abnormal discharges and located at temporal in interictal EEG predict better outcomes 2 years after operation.