临床腋窝淋巴结阳性老年三阴性乳腺癌局部治疗策略

因老年乳腺癌患者多伴发基础疾病,在选择局部治疗方案时,除应考虑原发肿瘤本身因素外,还需评估患者重要器官功能及其对治疗的耐受能力。三阴性乳腺癌与其他亚型乳腺癌相比,主要表现为侵袭性强、预后不佳;而临床腋窝淋巴结阳性的老年三阴性乳腺癌患者,局部治疗的选择则更为棘手,对于此类特殊群体,尚需探索更为合理的个体化治疗方案。     

术前2h饮用碳水化合物对老年胃肠道手术患者胃容量及反流误吸风险的影响:前瞻性随机对照研究

目的应用床旁超声技术观察术前2 h饮用碳水化合物对老年胃肠道手术患者麻醉前胃容量的影响,并评估患者发生反流误吸的风险。方法前瞻性选取2017年12月至2018年10月,在四川省人民医院行胃肠道手术的老年患者(>65岁),随机分为试验组和对照组。试验组常规禁食8 h,术前2 h口服200 ml碳水化合物;对照组要求术前禁食8 h,禁饮4 h。麻醉前采用床旁超声技术测量45°半坐位及右侧卧位胃窦部头尾径及前后径,分别计算两种体位下的胃窦部横截面积(cross-sectional area,CSA)、胃容量(gastric volume,GV)及胃容量与体重比(GV/weight,GV/W)。采用GV超声半定量3分评估法及GV/W分级法评估患者发生反流误吸的风险。结果共纳入69例符合入选和排除标准的患者,其中试验组33例,对照组36例。两组基线资料、手术类别及美国麻醉医师学会分级无统计学差异(P均>0. 05)。半坐位下,试验组和对照组的GV/W分别为(0. 57±0. 23) ml/kg和(0. 44±0. 21) ml/kg;右侧卧位下,试验组和对照组的CSA分别为(578. 8±71. 5) mm2和(513. 3±53. 2) mm2,GV分别为(21. 2±11. 1) ml和(12. 9±6. 8) ml,GV/W分别为(0. 36±0. 17) ml/kg和(0. 20±0. 11) ml/kg,上述指标两组间均存在统计学差异(P均<0. 05)。GV超声半定量评分:试验组0分17例(51. 5%,17/33),1分15例(45. 5%,15/33),2分1例(3. 0%,1/33),对照组0分25例(69. 4%,25/36),1分11例(30. 6%,11/36),2分0例(0,0/33),两组评分构成比无统计学差异(P>0. 05)。反流误吸风险评估:试验组极低风险者占比81. 8%(27/33)、低风险18. 2%(6/33)、高风险0 (0/33),对照组极低风险者占比94. 4%(34/36)、低风险5. 6%(2/36)、高风险0 (0/33),两组间构成比亦无统计学差异(P>0. 05)。结论老年胃肠道手术患者术前2 h饮用200 ml碳水化合物虽可以增加麻醉前胃容量,但并不增加反流误吸的风险。     

自动多功能可调式便老轮椅的设计

针对老年人群体设计一种自动可调式轮椅，轮椅靠背通过不完全齿轮机构进行自动调整。靠背竖起可作为普通轮椅使用；靠背放平可实现平躺，可通过靠背和座椅安置的滚轴实现从轮椅到床和沙发等位置的移动。该轮椅工作稳定，性能可靠，功能实现效果较好。     

Comparison of discriminability of common food acceptance scales for the elderly

This study was aimed to compare four commonly used methods for evaluating consumer acceptance (the 5-point and the 9-point hedonic scales) and preference (the ranking scale and the best-worst scaling) in terms of their ability in discriminating samples and perceived ease of use by the elderly. Elderly (n = 100) and young adult (n = 100) consumers participated in this study. Each consumer evaluated five commercial orange juice samples in duplicate for hedonic rating and preference rank separately and then evaluated ten sets of three samples for the best-worst scale, following the balanced incomplete block design. Nonparametric tests were employed as normality of data was violated. A significant sample effect was observed in all four methods (P < .001). Discriminating power of the best-worst scaling was more pronounced in the elderly than in the young adults; however, the best-worst scaling was easy to use for the young adults than for the elderly.     

社区居家养老服务设施的规划配置研究

社区和居家养老是我国当前和未来的主要养老模式，然而，与机构养老设施相比较而言，我国社区居家养老服务设施的发展明显滞后，具体表现为设施的建成基础薄弱、空间资源的配置要素模糊、规范和管控手段缺位等。在概述现状与问题的基础上，系统地探讨了我国社区层面养老服务资源的配置主体、配置对象和配置思路。针对养老服务需求和供给主体日益多元化的挑战，提出结合社区实际情况灵活配置服务模块的建议，采用总量控制和复合设置的规划手段落实配建，从而实现服务设施综合效益最大化的建设目标。     

老旧煤矿健康老龄化环境建设路径分析

被关闭的低效率老旧煤矿,作为很多退休煤矿职工的家庭所在地,依然担负着为其提供正常生活条件和养老功能的任务。为了营造煤炭企业退休职工适老环境,对老旧煤矿健康老龄化环境建设路径进行了探讨。在分析健康老龄化的普遍性问题后,从公共服务、卫生健康服务、认同感、原有养老模式等方面论述了老旧煤矿存在的具体问题;针对现状及问题,从理顺养老服务管理机制和合理确定具体任务目标两方面提出了对策与建议。     

Housing quality perceptions in Finland: the elderly population

Housing and health issues can vary over time and between populations. The elderly population is increasing worldwide. Yet only limited information exists about housing conditions: changes over time, and the relationships between health and safety among the elderly. Based on repeated surveys (2007 and 2011), housing and health issues in Finland were assessed, especially among the elderly (more than 65 years old). From various housing factors studied, the largest differences between surveys were in thermal comfort. From the six outcomes studied – satisfaction with the dwelling, maintenance, indoor air quality (IAQ), perceived safety, general health, and sleeping difficulties – only satisfaction with the dwelling had significant temporal variation. Modelling the outcomes led to a selection of variables that were significantly associated with the outcomes. The models’ sensitivity was 65–81% for perceived safety and satisfaction with the dwelling, maintenance, and IAQ, whereas it was only 5% for sleeping difficulties and 32% for general health status. Among the elderly, higher odds ratios (ORs) were found for the associations between housing satisfaction and non-elevated radon concentrations, accessibility, dwelling size, and stuffy odour, as compared with the total population sample. The results are useful for developing policies that increase wellbeing, and for building owners wishing to increase housing satisfaction among occupants.     

Association of size‐fractionated indoor particulate matter and black carbon with heart rate variability in healthy elderly women in Beijing

Associations between size‐fractionated indoor particulate matter (PM) and black carbon (BC) and heart rate variability (HRV) and heart rate (HR) in elderly women remain unclear. Twenty‐nine healthy elderly women were measured for 24‐hour HRV/HR indices. Real‐time size‐fractionated indoor PM and BC were monitored on the same day and on the preceding day. Mixed‐effects models were applied to investigate the associations between pollutants and HRV/HR indices. Increases in size‐fractionated indoor PM were significantly associated with declines in power in the high‐frequency band (HF), power in the low‐frequency band (LF), and standard deviation of all NN intervals (SDNN). The largest decline in HF was 19% at 5‐minute moving average for an interquartile range (IQR) increase (24 μg/m³) in PM_0.5. The results showed that smaller particles could lead to greater reductions in HRV indices. The reported associations were modified by body mass index (BMI): Declines in HF at 5‐minute average for an IQR increase in PM_0.5 were 34.5% and 1.0% for overweight (BMI ≥25 kg/m²) and normal‐weight (BMI <25 kg/m²) participants, respectively. Moreover, negative associations between BC and HRV indices were found to be significant in overweight participants. Increases in size‐fractionated indoor PM and BC were associated with compromised cardiac autonomic function in healthy elderly women, especially overweight ones.     

老年人肠道乳酸菌的分离与鉴定及其来源发酵乳杆菌的遗传进化分析

首先对湖北襄阳和恩施地区的健康老年人肠道乳酸菌进行分离与鉴定，然后从中选择发酵乳杆菌（Lactobacillus fermentum）进行多位点序列分型（multilocus sequence typing，MLST）分析。结果显示，基于可培养方法，湖北襄阳与恩施地区老年人肠道乳酸菌可以鉴定为以乳杆菌属（Lactobacillus）为主的5 个菌属，15 个种。总的来说，发酵乳杆菌和唾液乳杆菌（L. salivarius）占老年人肠道源乳酸菌分离株总量的55%左右，表明人体肠道可以作为发酵乳杆菌的重要分离来源。基于8 个持家基因的MLST分析表明，25 株来源于肠道的发酵乳杆菌可以划分为25 个序列型，具有极高的遗传多样性；基于选择压力分析与phi-test，选用的8 个持家基因均受到纯化选择作用，且其中仅基因rpoB显著经历了基因重组事件；另外，基于Prim’s和goeBURST的进化分析表明，一半左右的肠道源发酵乳杆菌倾向于形成单独的分支，表明它们具有一定的宿主特异性，可能的原因是为适应肠道环境，这些发酵乳杆菌经历了有异于发酵食品生境的进化历程。