INTRODUCTION:Frailty is thought to be associated with an increased risk of adverse health outcomes such as death and falls, but comparatively little is known about the impact of frailty transitions on the adverse health outcomes. Moreover, owing to insufficient sample size or a single-center study design, previous studies have not been sufficiently representative of elderly inpatients in China. This study aimed to provide estimates at the population level of the association between frailty transitions and adverse outcomes among elderly inpatients following discharge. METHODS:This was a large-scale multicenter cohort study conducted from October 2018 to February 2021. The FRAIL scale was used to estimate frailty status. Frailty transitions were derived by considering frailty status at baseline and the 3-month follow-up, which encompassed five patterns: persistent non-frailty, persistent pre-frailty, persistent frailty, improvement in frailty, and worsening of frailty. The outcome variables included mortality, falls, hospital readmissions, and Health-Related Quality of Life (HRQoL). Cox proportional hazard regression, generalized linear models and linear regression was used to examine the association between frailty transitions and adverse health outcomes. RESULTS:A total of 8,256 patients were included in the study, 40.70% of study participants were non-frail, 43.04% were pre-frail, and 16.27% were frail. Compared with patients who persistently non-frail patients, those who frailty improvement, persistent pre-frailty, worsening frailty, and persistent frailty showcased escalated risks of mortality within 2 years after enrollment [HR (95% CI): 1.32 (1.06-1.64)], 1.71 (1.37-2.13), 2.43 (1.95-3.02), and 2.44 (1.81-3.29), respectively. These groups also faced elevated hazards of 2-year falls [OR(95% CI): 1.586(1.13-2.23), 2.21(1.55-3.15), 1.94(1.33-2.82), 2.71(1.59-4.62)] and re-hospitalization risk within 2 years[OR(95% CI): 1.33(1.13-1.56), 1.56(1.32-1.86), 1.53(1.28-1.83), 2.29(1.74-3.01). The number of falls increased by 0.76 over 2 years in frailty-worsened patients and 0.81 in persistently pre-frail patients. The total days of rehospitalization increased by 0.35 over 2 years in frailty-improved patients, by 0.61 in frailty-worsened patients, by 0.66 in elderly in persistently pre-frail patients and by 0.80 in persistently frail patients. Moreover, patients exhibiting frailty-improved [-1.23 (95% CI: -2.12 to -0.35)], persistently pre-frail[-4.95 (95% CI: -5.96 to -3.94)], frailty-worsened [-3.67 (95% CI: -4.71 to -2.62)], and persistently frail [-9.76 (95% CI: -11.60 to -7.93)] displayed inverse correlations with the regression coefficients of HRQoL. DISCUSSION:Frailty-improved, worsened, persistently pre-frail, and frail inpatients face higher risks of mortality, falls, rehospitalization, reduced HRQoL than consistently non-frail inpatients. Screening for frailty among elderly inpatients can identify individuals at increased risk of adverse health outcomes.

This study aimed to investigate the impact of the ABCB1-rs1045642 gene polymorphism on the blood drug concentrations of voriconazole in patients with severe invasive fungal infections. A total of 101 patients treated with voriconazole were enrolled in this study. Polymerase chain reaction and Sanger sequencing were used to detect the genotype of ABCB1-rs1045642, and enzyme amplified immunoassay was used to detect the plasma trough concentration of voriconazole. We analyzed the impacts of patient genotype and the minimum concentration of voriconazole as well as investigated the treatment efficacy and rates of adverse reactions in patients with different genotypes. All subjects received standard-dose voriconazole treatment for 1 week, and the mean plasma concentration was found to be 4.5 (3.10, 6.90) mg/L. Three genotypes of ABCB1-rs1045642 were found in the study cohort, namely, wild type (CC type), heterozygous mutant type (CT type), and homozygous mutant type (TT type). There were 18 TT, 48 CT, and 35 CC type cases. Patients with different genotype groups and varying plasma trough concentrations did not differ statistically significantly in terms of the treatment efficacy or incidence of adverse events. Voriconazole plasma concentrations differed significantly among patients of different genders and ABCB1-rs1045642 genotypes. By incorporating gender into the multiple regression model, the regression equations were obtained as C1 = 6.09-1.33×Gender (male = 0, female = 1)-0.47× X1 (X1: T/T = 1, non-T/T = 0) and C2 = 6.09-1.33×Gender (male = 0, female = 1)-0.94×X1 (X1: T/T = 1, non-T/T = 0). The ABCB1-rs1045642 genotype was not found to affect voriconazole plasma trough concentrations in patients with invasive fungal infections admitted to the intensive care unit.

The escalating global prevalence of polypharmacy presents a growing challenge to public health. In light of this issue, the primary objective of our study was to investigate the status of polypharmacy and its association with clinical outcomes in a large sample of hospitalized older patients aged 65 years and over. A two-year prospective cohort study was carried out at six tertiary-level hospitals in China. Polypharmacy was defined as the prescription of 5 or more different medications daily, including over-the-counter and non-prescription medications. Baseline polypharmacy, multimorbidity, and other variables were collected when at admission, and 2-year outcomes were recorded by telephone follow-up. We used multivariate logistic regression analysis to examine the associations between polypharmacy and 2-year outcomes. The overall response rate was 87.2

ObjectiveTo develop and externally validate a frailty prediction model integrating physical factors, psychological variables and routine laboratory test parameters to predict the 30-day frailty risk in older adults with undernutrition.MethodsBased on an ongoing survey of geriatrics syndrome in elder adults across China (SGSE), this prognostic study identified the putative prognostic indicators for predicting the 30-day frailty risk of older adults with undernutrition. Using multivariable logistic regression analysis with backward elimination, the predictive model was subjected to internal (bootstrap) and external validation, and its calibration was evaluated by the calibration slope and its C statistic discriminative ability. The model derivation and model validation cohorts were collected between October 2018 and February 2019 from a prospective, large-scale cohort study of hospitalized older adults in tertiary hospitals in China. The modeling derivation cohort data (n = 2,194) were based on the SGSE data comprising southwest Sichuan Province, northern Beijing municipality, northwest Qinghai Province, northeast Heilongjiang Province, and eastern Zhejiang Province, with SGSE data from Hubei Province used to externally validate the model (validation cohort, n = 648).ResultsThe incidence of frailty in the older undernutrition derivation cohort was 13.54% and 13.43% in the validation cohort. The final model developed to estimate the individual predicted risk of 30-day frailty was presented as a regression formula: predicted risk of 30-day frailty = [1/(1+e−riskscore)], where riskscore = −0.106 + 0.034 × age + 0.796 × sex −0.361 × vision dysfunction + 0.373 × hearing dysfunction + 0.408 × urination dysfunction – 0.012 × ADL + 0.064 × depression – 0.139 × nutritional status – 0.007 × hemoglobin – 0.034 × serum albumin – 0.012 × (male: ADL). Area under the curve (AUC) of 0.71 in the derivation cohort, and discrimination of the model were similar in both cohorts, with a C statistic of nearly 0.7, with excellent calibration of observed and predicted risks.ConclusionA new prediction model that quantifies the absolute risk of frailty of older patients suffering from undernutrition was developed and externally validated. Based on physical, psychological, and biological variables, the model provides an important assessment tool to provide different healthcare needs at different times for undernutrition frailty patients.Clinical trial registrationChinese Clinical Trial Registry [ChiCTR1800017682].

目的:描述与评价头孢他啶阿维巴坦(cef-tazidime-avibactam,CZA)治疗多重耐药革兰阴性菌(multidrug-resistant gram-negative bacteria,MDR-GNB)感染患者的临床特征、治疗管理与临床结局.方法:选取2019年9月至2021年12月在徐州医科大学附属医院住院治疗的患者进行回顾性的队列研究.连续接受CZA治疗≥72 h的成人患者符合纳入条件.主要结局是临床失败,定义为30d全因死亡、微生物学疗效失败和/或在接受CZA治疗期间未能解决或改善感染迹象和症状的综合因素.结果:共计对198例MDR-GNB感染患者的数据进行描述与评估,其中耐碳青霉烯类肠杆菌科细菌(carbapenem-resistant Entero-batceriaceae,CRE)队列132例,假单胞菌属(Pseu-domonas spp.)队列66例.主要感染部位以肺部感染(92.42%)、腹腔感染(10.61%)、颅内感染(10.61%)最为常见,血培养阳性63例(31.82%).临床结局失败61例(30.81%),30 d全因死亡33例(16.67%),30 d微生物疗效失败11例(5.56%).体质量指数(BMI)、急性生理学及慢性健康状况评分(APACHEⅡ)、多种病原微生物感染与临床结局失败呈正相关(矫正OR 1.109,95%CI 1.017,1.209;矫正OR 1.071,95%CI 1.015,1.129;矫正OR 2.844,95%CI 1.391,5.814).入院后48h内启动CZA治疗与临床结局失败呈负相关(矫正OR 0.424,95%CI 0.205,0.879).共15例患者出现了与CZA可能相关的不良反应,其中皮疹2例,恶心呕吐6例,抗生素相关性腹泻7例.结论:CZA能够用于治疗一系列MDR-GNB导致的感染,包括Pseudomonasspp.和CRE.

This study aimed to identify reliable predictors of haemoglobin A1c (HbA1c) reduction and weight loss within 6 months after treatment with exenatide. A total of 343 patients with type 2 diabetes mellitus were examined and followed up for 12 months. The study patients were divided into two groups: responders and non-responders, which were defined based on their glycemic control (responders: HbA1c reduction of ≥ 1.0

目的 探讨制定徐州医科大附属医院急性卒中患者卒中相关性肺炎(SAP)的药物治疗模式,从而促进临床合理用药.方法 通过收集本院神经内科2019年5—10月急性缺血性脑卒中患者的病例资料,设计Word文档和Excel表格收集患者的情况.根据病原学监测与药敏试验结果总结徐州医科大学附属医院SAP的致病菌的分布及其耐药性,并通过单因素与多因素Logistic回归分析本院SAP患者可能的危险因素,制定本院SAP危险因素评分标准与危险程度分级.对新入院的急性缺血性脑卒中患者进行SAP危险程度分级并进行分级管理,规范患者的药物治疗.对2020年2月—4月收治的50例急性缺血性脑卒中患者进行前瞻性研究.结果 从研究对象分布情况得到SAP的发生率为24％;病原菌的分布是以耐甲氧西林葡菌球菌(23.8％)、鲍曼不动杆菌(16.3％)、金黄色葡萄球菌(13.9％)、肺炎克雷伯菌(12.2％)为主,真菌占据7％.SAP的多因素Logistic回归分析结果显示,患有糖尿病、合并COPD、有充血性心力衰竭、白细胞高、美国国立卫生研究院卒中量表(NIHSS)评分>6分均是SAP的危险因素.依据SAP危险因素评分标准和分级对新入院急性缺血性脑卒中患者进行干预,经过治疗后最终SAP的发生率为16％,远远低于临床药师干预前的24％.结论 根据病原菌的分布特点和SAP危险程度分级来规范急性缺血性脑卒中患者的药物治疗,降低SAP的发病率与死亡率,降低细菌耐药性的产生,促进临床合理用药.促进合理用药工作的推广应用,从而建立临床药师工作模式及医院合理用药长效改进机制,更好地为患者的生命健康服务.

目的:探讨艾塞那肽降低2型糖尿病(T2DM)患者体重的影响因素,为T2DM患者艾塞那肽精准治疗提供依据.方法:选取2017年1月至2020年12月连续使用艾塞那肽治疗12个月的T2DM患者,测量患者身高、体重,计算体重指数(BMI),检测患者用药前及用药3个月、6个月、12个月的糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后血糖(PPG)、空腹胰岛素(FINS)、餐后胰岛素(PINS)、血脂、联合降糖治疗方案等.根据患者体重下降是否超过3％,将使用艾塞那肽治疗患者分为治疗应答组和治疗不应答组,采用二分类Logistic回归分析方法,寻找艾塞那肽降低T2DM患者体重的预测因素.结果:治疗应答组T2DM患者病程明显短于不应答组(P<0.05);与治疗前临床指标相比,治疗应答组及不应答组体重、BMI、HbA1c、FPG、PPG、稳态模型胰岛素抵抗指数(HOMA-IR)均明显下降,而稳态模型胰岛功能(HOMA-B)明显升高(P<0.001);艾塞那肽治疗6个月后,T2DM患者体重下降与基线体重和基线HbA1c密切相关(P<0.05).结论:基线体重、HbA1c改善与艾塞那肽治疗6个月后体重下降呈正相关关系,是艾塞那肽治疗T2DM患者降低体重的可靠预测因素.

目的 形成《医院参与新冠病毒核酸检测样本采集管理专家共识》,规范采样管理.方法 在查阅国内外文献,依据相关政策的基础上,综合参与采样工作的操作实践及相关专家意见建议,撰写共识初稿,并通过会议讨论及函询征求专家意见,对共识稿进行修改,形成终版共识稿.结果 专家就采样前准备,采样点、采样台设置及采样人员配置,采样操作管理,标本管理及交接,医疗废物处理,支持督导管理,采样后续管理环节形成一致意见.结论 该共识具有一定的实用性和科学性,可为全员新冠病毒核酸检测样本采集管理提供参考.

Objective: The perspective of real-world study is especially relevant to newborns, enabling dosage regimen optimization and regulatory approval of medications for use in newborns. The aim of the present study was to conduct a pharmacokinetic analysis of cefotaxime and evaluate the dosage used in newborns with early-onset sepsis (EOS) using real-world data in order to support the rational use in the clinical practice. Methods: This prospective, open-label study was performed in newborns with EOS. A developmental pharmacokinetic-pharmacodynamic model of cefotaxime in EOS patients was established based on an opportunistic sampling method. Then, clinical evaluation of cefotaxime was conducted in newborns with EOS using real-world data. Results: A one-compartment model with first-order elimination was developed, using 101 cefotaxime concentrations derived from 51 neonates (30.1–41.3°C weeks postmenstrual age), combining current weight and postnatal age. The pharmacokinetic-pharmacodynamic target was defined as the free cefotaxime concentration above MIC during 70% of the dosing interval (70% fT > MIC), and 100% of neonates receiving the dose of 50 mg/kg, BID attained the target evaluated using the model. Additionally, only two newborns had adverse reactions possibly related to cefotaxime treatment, including diarrhea and feeding intolerance. Conclusion: This prospective real-world study demonstrated that cefotaxime (50 mg/kg, BID) had a favorable efficacy and an accepted safety profile for neonates with EOS.

BackgroundStudies are scarce in China that explore the association of nutritional status, measured using the Short-Form Mini Nutritional Assessment (MNA-SF) and biochemical data, on adverse clinical outcomes among older inpatients. In this study, we aimed to determine the prevalence of malnutrition in tertiary hospitals of China and the associations between malnutrition and adverse clinical outcomes.MethodsThis prospective study involved 5,516 older inpatients (mean age 72.47 ± 5.77 years) hospitalized in tertiary hospitals between October 2018 and February 2019. The tertiary hospitals refer to the hospital with more than 500 beds and can provide complex medical care services. The MNA-SF was used to assess nutritional status. Multiple logistic regression and negative binomial regression were used to analyze the relationship between nutritional parameters and risk of hospital length of stay (LoS), mortality, and rehospitalization.ResultsWe found that 46.19% of hospitalized patients had malnutrition or malnutrition risk, according to the MNA-SF. Death occurred in 3.45% of patients. MNA-SF scores 0–7 (odds ratio [OR] 5.738, 95% confidence interval [CI] 3.473 to 9.48) were associated with a six-fold higher likelihood of death, and scores 8–11 (OR 3.283, 95% CI 2.126–5.069) with a three-fold higher likelihood of death, compared with MNA-SF scores 12–14 in the logistic regression model, after adjusting for potential confounders. A low MNA-SF score of 0–7 (regression coefficient 0.2807, 95% CI 0.0294–0.5320;P< 0.05) and a score of 8–11 (0.2574, 95% CI 0.0863–0.4285;P< 0.01) was associated with a significantly higher (28.07 and 25.74%, respectively) likelihood of increased LoS, compared with MNA-SF score 12–14. MNA-SF scores 0–7 (OR 1.393, 95% CI 1.052–1.843) and 8–11 (OR 1.356, 95% CI 1.124–1.636) were associated with a nearly 1.5-fold higher likelihood of 90-day readmission compared with MNA-SF scores 12–14 in the logistic regression model. Moreover, hemoglobin level, female sex, education level, former smoking, BMI 24–27.9 kg/m2, age 75 years and above, and current alcohol consumption were the main factors influencing clinical outcomes in this population.ConclusionsMalnutrition increases the risk of hospital LoS, mortality, and 90-day readmission. The use of nutritional assessment tools in all hospitalized patients in China is needed. The MNA-SF combined with hemoglobin level may be used to identify older inpatients with a high risk of adverse clinical outcomes. These findings may have important implications for the planning of hospital services.

目的 探究血液肿瘤患儿应用大剂量甲氨蝶呤(HD-MTX)化疗后骨髓抑制与MTHFR和AB-CB1基因多态性的相关性,为临床个体化用药提供参考依据.方法 选取徐州医科大学附属医院2019-2020年收治的94例接受HD-MTX化疗的患儿,收集外周血,用直接测序法测定MTHFR和ABCB1的基因型,统计患儿化疗前后血常规信息.参照世界卫生组织推荐的化疗药物毒副反应分级标准,将骨髓抑制严重程度分为轻度(0～Ⅱ级)和重度(Ⅲ级以上).结果 94例患儿中,MTHFR C677T位点TT型的构成比为26.60％,CT为44.68％,CC为28.72％,ABCB1 C3435T位点的CC、CT和TT基因型的构成比分别为45.74％,36.17％ 和18.09％.共有45例(47.87％)患儿发生了Ⅲ级以上甲氨蝶呤相关的骨髓抑制.MTHFR C677T位点为野生型CC的患儿发生Ⅲ级以上骨髓抑制比率低于杂合型CT携带者,差异具有统计学意义(P<0.05).ABCB13435位点为CC的患儿率发生Ⅲ级以上骨髓抑制的比率显著低于TT型携带者和至少携带1个等位基因T(CT+TT基因型)的患者(P<0.05).结论 MTHFR C677T和ABCB1 C3435T位点的基因多态性与MTX骨髓抑制具有一定程度的相关性.

PurposeAlthough the association between cognitive impairment and mortality has been widely described among community-dwelling older adults, this association in hospitalized patients was limited.ObjectivesThis study's purpose was to explore the association between cognitive impairment and 30-day mortality after adjustment of factors among Chinese in-patients.MethodsThis was a large-scale prospective study based on a cohort of patients aged 65 years and older, whose cognitive function was assessed using the Mini-Cog instrument, followed up at 30-days for mortality. Multivariate logistic regression models were used to assess the association between cognitive impairment and 30-day mortality.ResultsThere were 9,194 inpatients in our study, with an average age of 72.41 ± 5.72. The prevalence of cognitive impairment using the Mini-Cog instrument was 20.5%. Multivariable analyses showed that patients with cognitive impairment have an increased risk of 30-day mortality, compared to those with normal cognitive function (OR = 2.83,95%CI:1.89–4.24) in an unadjusted model. In the fully adjusted model, Patients with cognitive impairment had an increased risk of 30-day mortality compared to those with normal cognitive function in the completely adjusted model (OR = 1.76,95% CI: 1.14–2.73). Additionally, this association still existed and was robust after performing a stratified analysis of age, gender, frailty and depression, with no significant interaction (P > 0.05).ConclusionsOur study found that older Chinese in-patients with cognitive impairment have a 1.76-fold risk of 30-day mortality compared to patients with normal cognitive function, suggesting that clinicians and nurses need to early implement cognitive function screening and corresponding interventions to improve clinical outcomes for older in-patients.

Introduction: Frailty has gained increasing attention as it is by far the most prevalent geriatric condition amongst older patients which heavily impacts chronic health status. However, the relationship between frailty and adverse health outcomes in China is far from clear. This study explored the relation between frailty and a panel of adverse health outcomes. Methods: We performed a multicentre cohort study of older inpatients at 6 large hospitals in China, with two-stage cluster sampling, from October 2018 to April 2019. Frailty was measured according to the FRAIL scale and categorized into robust, pre-frail, and frail. A multivariable logistic regression model and multilevel multivariable negative binomial regression model were used to analyse the relationship between frailty and adverse outcomes. Outcomes were length of hospitalization, as well as falls, readmission, and mortality at 30 and 90 days after enrolment. All regression models were adjusted for age, sex, BMI, surgery, and hospital ward. Results: We included 9,996 inpatients (median age 72 years and 57.8% male). The overall mortality at 30 and 90 days was 1.23 and 1.88%, respectively. At 30 days, frailty was an independent predictor of falls (odds ratio [OR] 3.19; 95% CI 1.59–6.38), readmission (OR 1.45; 95% CI 1.25–1.67), and mortality (OR 3.54; 95% confidence interval [CI] 2.10–5.96), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. At 90 days, frailty had a strong predictive effect on falls (OR 2.10; 95% CI 1.09–4.01), readmission (OR 1.38; 95% CI 1.21–1.57), and mortality (OR 6.50; 95% CI 4.00–7.97), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. There seemed to be a dose-response association between frailty categories and fall or mortality, except for readmission. Conclusions: Frailty is closely related to falls, readmission, and mortality at 30 or 90 days. Early identification and intervention for frailty amongst older inpatients should be conducted to prevent adverse outcomes.

目的 通过分析JAK2 rs10119004基因多态性对伏立康唑血药谷浓度(Cmin)及临床治疗效果的影响,为伏立康唑治疗重症监护室(ICU)侵袭性真菌感染个体化方案的制定提供参考.方法 利用PCR及Sanger测序方法检测JAK2 rs10119004位点的基因型,同时应用液相色谱串联质谱(LC-MS/MS)法检测伏立康唑血药谷浓度(Cmin),分析各基因型患者Cmin的特点及不同基因型患者用药后疗效及不良反应发生情况.结果 70例患者伏立康唑Cmin为0.12～12.23 mg/L,平均3.07(1.92,5.48)mg/L.70例患者JAK2 rs10119004位点基因型共3种:野生未突变型G/G 25例,杂合子突变型G/A 32例,纯合子突变型A/A 13例.不同Cmin和不同基因型分组患者的治疗有效率及不良反应发生率差异无统计学意义.不同年龄(Age)、血浆白蛋白(ALB)水平和JAK2 rs10119004基因型患者,其伏立康唑Cmin存在差异;将具有统计学意义的影响因素纳入多元回归模型,得到回归方程C1=7.479+0.048×Age-0.233×ALB+1.405×X1(X1:G/A=1,非G/A=0);C2=7.479+0.048×Age-0.233×ALB+1.208×X2(X2:A/A=1,非A/A=0).结论 JAK2 rs10119004基因型可影响ICU侵袭性真菌感染患者伏立康唑的Cmin.

Purpose: Studies exploring the association of cognitive frailty and mortality have been mainly based on community settings or nursing home settings. The aim of our study was to explore the association between cognitive frailty and 30-day mortality among older Chinese inpatients. Patients and Methods: A national cohort study was performed in different hospitals in China. A baseline survey was conducted from October 2018 and February 2019. Trained investigators collected the 30-day mortality. Cognitive impairment and frailty were defined by the Mini-Cog and FRAIL scale, respectively. Multivariate regression was used to explore the association between cognitive impairment and frailty status with 30-day mortality. Results: Of these participants, there were 3891 (41.91%) women and 5392 (58.09%) men, with an average age of 72.41 (SD = 5.72). The prevalence of cognitive frailty was 5.44%. After adjusting for age, gender, education, depression and activities of daily living (ADL), the odds ratios (ORs) for 30-day mortality among inpatients were 3.43 (95% CI: 1.80-6.55) for cognitive frailty, 1.85 (95% CI: 1.01-3.41) for frailty only, and 1.43 (95% CI: 0.77-2.65) for cognitive impairment only compared to the reference group (neither frailty nor cognitive impairment). In addition, the discrimination of 30-day mortality was higher among patients with cognitive frailty (area under the curve = 0.676 [95% CI: 0.621-0.731]) than either frailty (area under the curve = 0.644 [95% CI: 0.594-0.694]) or cognitive impairment (area under the curve = 0.606 [95% CI: 0.556-0.655]) separately. Stratified analysis showed that these associations still existed when grouped by gender. Conclusion: Our study found that Chinese inpatients with cognitive frailty had a higher risk of 30-day mortality than those without frailty and cognitive impairment, suggesting that clinicians should be encouraged to perform early screening of patients with frailty and cognitive impairment and carry out effective interventions to reverse cognitive frailty syndrome.

BACKGROUND:Previous reports suggest that the attributes of frailty are multidimensional and include nutrition, cognition, mentality, and other aspects. We aim to develop an early warning model of frailty based on nutritional risk screening and apply the frailty early warning model in the clinic to screen high-risk patients and provide corresponding intervention target information.METHODS:The proposed study includes two stages. In the first stage, we aim to develop a prediction model of frailty among older inpatients with nutritional risk. Study data were collected from a population-based aging cohort study in China. A prospective cohort study design will be used in the second stage of the study. We will recruit 266 older inpatients (age 65 years or older) with nutritional risk, and we will apply the frailty model in the clinic to explore the predictive ability of the model in participants, assess patients' health outcomes with implementation of the frailty model, and compare the model with existing frailty assessment tools. Patients' health outcomes will be measured at admission and at 30-day follow-up.DISCUSSION:This project is the first to develop an early prediction model of frailty for older inpatients according to nutritional risk in a nationally representative sample of Chinese older inpatients of tertiary hospitals. The results will hopefully help to promote the development of more detailed frailty assessment tools according to nutritional risk, which may ultimately lead to reduced health care costs and improvement in independence and quality of life among geriatric patients.TRIAL REGISTRATION:Chinese Clinical Trial Registry, ChiCTR1800017682 , registered August 9, 2018; and ChiCTR2100044148 , registered March 11, 2021.

目的 探索一种高成功率和高生存率的小鼠癫痫持续状态改良模型.方法 在传统匹鲁卡品诱导模型的基础之上,加用肌肉松驰药甲苯噻嗪,观察甲苯噻嗪不同剂量、不同给药时间对小鼠癫痫发作等级、造模成功率、死亡率与生存率的影响,并采用实时荧光PCR检测部分小鼠海马c-Fos mRNA的表达水平.结果 甲苯噻嗪4 mg·kg-1预处理组中,小鼠发作等级、海马c-Fos mRNA水平与传统模型组相比差异无统计意义,而生存率和成功率明显高于传统模型组;甲苯噻嗪8 mg·kg-1预处理组模型成功率明显低于传统模型组;而甲苯噻嗪后处理组动物生存率与成功率与传统模型组相比差异无统计学意义.结论 甲苯噻嗪4 mg·kg-1预处理能够显著提高模型的成功率和动物生存率,是一种高效、易于重复的构建小鼠癫痫持续发作状态模型的方法.

Background: The knowledge of the association between low handgrip strength and mortality among older Chinese inpatients is limited. Given China's aging society, a great number of older adults require hospital admission. Objective: To explore the association between low handgrip strength and 90-day mortality, providing evidence for clinicians to predict the risk of mortality and improve clinical outcomes for older inpatients. Materials and Methods: We conducted a national multicenter cohort study with a baseline survey from October 2018 to February 2019 and followed up for 90 days to record mortality outcomes. The assessment of handgrip strength was conducted using a hand dynamometer with the cutoff (handgrip strength < 28 kg for men and < 18 kg for women) to define low handgrip strength. Multivariable logistic regression analysis was applied to explore the association between low handgrip strength and 90-day mortality. Results: A total of 8,910 older Chinese inpatients [mean (SD) age, 72.39 (5.68) years; 3,750 women (42.09%)], with a prevalence of low handgrip strength, at 49.57%, were included. Compared to inpatients with normal handgrip strength, inpatients with low handgrip strength were older, had less education, more were female, had lower activities of daily living (ADL) score, had lower BMI, higher frailty, higher rates of depression, and poorer cognitive function (all p < 0.05). At 90 days, after adjusting for gender, age, education, frailty, depression, ADL score, malnutrition, and diagnosis, low handgrip strength was independently associated with 90-day mortality, compared to normal handgrip strength (OR = 1.64, 95% CI:1.14–2.37; P = 0.008). Additionally, subgroup and interaction analysis showed a significant interaction effect (P = 0.031) between two age groups (65–74 years older vs. ≥ 75 years old), with the OR being 3.19 (95%CI:2.07–4.93) and 1.49 (95%CI:0.87–2.55), respectively. Conclusion: Older Chinese inpatients with low handgrip strength had a 1.64-fold risk of 90-day mortality, compared to those with normal handgrip strength, indicating that clinicians need to screen early for handgrip strength and recommend corresponding interventions, such as resistance training and nutrition, as a priority for older inpatients. Clinical Trial Registration: Chinese Clinical Trial Registry, Identifier: ChiCTR1800017682.

Background To analyze whether the cytochrome P450 enzyme 2C9*3 (CYP2C9*3) and angiotensin II receptor 1 (AGTR1) (1166A>C) gene polymorphisms are associated with the risk of essential hypertension (EH) and the antihypertensive effect of irbesartan. Methods A total of 2,057 EH patients and 286 healthy controls were enrolled for genotyping in which 598 EH patients were given irbesartan 150 mg/day for 4 weeks. Blood pressure of all subjects were determined before and at the end of 4-week treatment. Results There was no significant difference in genotype frequencies of CYP2C9*3 and AGTR1 (1166A>C) between EH and control groups. Subjects with *1*3/*3*3 genotypes of the CYP2C9*3 gene had larger systolic and diastolic blood pressure reductions (34.9 ± 15.5 vs. 29.3 ± 10.2 mm Hg and 22.8 ± 9.0 vs. 19.6 ± 8.5 mm Hg, respectively) compared with the *1*1 genotype. For AGTR1 (1166A>C) polymorphisms, although there was no significant difference among AC, CC, and AA genotypes, male subjects with AC/CC genotypes had larger systolic and diastolic blood pressure reductions (32.3 ± 1.3 vs. 29.3 ± 0.5 mm Hg and 21.6 ± 0.8 vs. 19.4 ± 0.1 mm Hg, respectively, P < 0.05) in response to irbesartan treatment compared with the AA genotype. Conclusions Polymorphisms of CYP2C9*3 and AGTR1 (1166A>C) are not significantly different between EH and healthy controls. Male subjects with AC and CC genotypes of AGTR1 (1166A>C) show better antihypertensive effect of irbesartan than the AA genotype.