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In this paper, an optimal sizing and placement model for distributed generation (DG) is established, which includes active power losses, voltage profile, pollution emission, DG costs, and meteorological conditions. Since optimizing placement and sizing are discrete and continuous variables respectively, the model established is a highly nonlinear complex one with discrete optimization variables. Therefore, the adaptive manta ray foraging optimization (AMRFO) algorithm is applied to obtain the optimal Pareto front, which has a rich and diverse search mechanism, individual updating mechanism, and advanced Pareto solution selection mechanism. For this model, a better solution of high quality can be obtained. In order to avoid the influence of subjective setting of weight coefficient, the ideal point method based on Mahalanobis distance is used to make Pareto front decision. Finally, the simulation based on the IEEE 33, 69-bus distribution network and the IEEE 33, 69-bus distribution network in isolated network operation are implemented. The results show that compared with the traditional multi-objective intelligent optimization algorithm, AMRFO algorithm can obtain a more widely distributed and uniform Pareto front. While considering the economy, the optimized distribution network voltage profile and active power losses can be significantly improved.

Coronavirus disease 2019 (COVID‐19) has widely spread all over the world and the numbers of patients and deaths are increasing. According to the epidemiology, virology, and clinical practice, there are varying degrees of changes in patients, involving the human body structure and function and the activity and participation. Based on the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) and its biopsychosocial model of functioning, we use the WHO Family of International Classifications (WHO‐FICs) framework to form an expert consensus on the COVID‐19 rehabilitation program, focusing on the diagnosis and evaluation of disease and functioning, and service delivery of rehabilitation, and to establish a standard rehabilitation framework, terminology system, and evaluation and intervention systems based the WHO‐FICs.

Objective We conducted a systematic review to assess the effects of immunonutrition on chemoradiotherapy patients. Methods We searched the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science. We assessed the risk of bias using the Cochrane Risk of Bias tool. Our primary outcomes were the incidence of oral mucositis and diarrhea. The secondary outcomes were the incidence of esophagitis, grade ≥3 oral mucositis, grade ≥3 diarrhea, grade ≥3 esophagitis, and body weight loss. Results A total of 1478 patients and 27 studies were included. There were no significant differences in the incidence of oral mucositis (relative risk [RR] = 0.91; 95% confidence interval [CI], 0.79-1.05), diarrhea (RR = 0.89; 95% CI, 0.76-1.05), or esophagitis (RR = 0.55; 95% CI, 0.11-2.86) between the immunonutrition group and standard nutrition/placebo group. Nevertheless, immunonutrition significantly reduced the incidence of grade ≥3 oral mucositis (RR = 0.45; 95% CI, 0.22-0.92), grade ≥3 diarrhea (RR = 0.56; 95% CI, 0.35-0.88), grade ≥3 esophagitis (RR = 0.15; 95% CI, 0.04-0.54), and losing >5% body weight (RR = 0.34; 95% CI, 0.18-0.64). Conclusions In this study, immunonutrition failed to reduce the incidence rates of oral mucositis, diarrhea, or esophagitis but was conducive to significantly improving the severity of oral mucositis and diarrhea esophagitis and reducing the rate of body weight loss.

Background: Frailty in the elderly population is currently a frontier and focus in the field of health and aging. The goal of this study was to explore the frailty status among the elderly of different genders and its influence on the risk of death during 11 years.Methods: Frailty index (FI) was used to evaluate the frailty status in the elderly based on the baseline data conducted in 2009; and death as outcome variables collected in 2020 were analyzed. The difference of the frailty level and mortality of different genders was compared. Cox regression and Kaplan–Meier curves were applied to evaluate the influence on the risk of death and the 11-year survival of the elderly at different level of frailty, respectively.Results: Totally, 1,246 elderly people were recruited. The mortality in men (43.7%, 227/519) was statistically higher than that in women (34.3%, 249/727) (x2 = 11.546, P = 0.001). Deficits accumulated exponentially with age, and at all ages, women accumulated more deficits than do men on average (B = 0.030 vs. 0.028, t = 4.137, P = 0.023). For any given level of frailty, the mortality rate is higher in men than in women, and the difference in mortality between genders reached the peak when FI value was 0.26. Cox regression analysis showed that FI value had a greater impact on the risk of death in older men (HR = 1.171, 95%CI: 1.139~1.249)than that in older women (HR = 1.119, 95%CI: 1.039~1.137). Survival analysis showed that the median 11-year survival time in women was longer than that in men (95.26 vs. 89.52 months, Log rank = 9.249, P = 0.002). Kaplan–Meier curves showed that the survival rate decreased with the increase of frailty, and at the same level of frailty, survival time in older women was longer than that in older men, except for severe frailty (FI ≥ 0.5).Conclusion: The frailty status and its influence on mortality are different among the older people of different genders; therefore, specific interventions for frailty should be conducted in the elderly population of different genders, as well as of different degrees of frailty.

Population aging poses a serious challenge on a broad spectrum of issues for both developing and developed countries. For people in the fields of aging research and geriatric medicine, the critical tasks include elucidating the relationship between aging and disease development and finding models of care for the elderly that transcend conventional clinical practices and health‐care service delivery systems intended for the general population. It is now recognized that distinctions should be made between processes accompanying aging that may be adaptive and those that contribute to increased disease risks.1 Also, as comorbidities are very common in the elderly and often share underlying pathological processes, the approach to managing individual diseases separately needs to be reconsidered. All this relies on the integration of research findings on aging with understanding disease processes and how it can be translated into preventive and therapeutic strategies as well as clinical practice. That is where geroscience comes in. Aging biology research has generated a great deal of knowledge about cellular and molecular features and mechanisms underpinning aging. Meanwhile, geriatric medicine has evolved largely as a subspecialty of internal medicine, with a focus on care for the elderly but without much consideration given to how the aged body is different from its younger counterpart.2 Geroscience strives to bridge the gap between the two fields and facilitate the application of insights gained from basic biology aging research in the prevention and management of diseases commonly seen in the elderly. Geroscience is a relatively new concept, even more so in China. Its acceptance requires interdisciplinary team‐building and institutional reorganization, which has yet to happen in China. Therefore, when we talk about geroscience infrastructure building in China, it is not that conscious efforts have been made toward that end, but rather how progress in geriatric medicine and aging research achieved in recent years has the potential to be channeled into a geroscience‐oriented pursuit towards better understanding of mechanisms of aging and its contribution to age‐related chronic conditions in the future.

Background: Acute kidney injury (AKI) is a common and serious complication in critically ill patients. Patients who require renal replacement therapy (RRT) face a high mortality rate. Questions concerning the intensity of RRT in AKI patients led us to integrate direct and indirect evidence using a network meta-analysis to determine the optimal intensity and mode. Materials and Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Web of Science databases from 1990 to 2017 that included randomized controlled trials (RCTs) comparing different intensities of RRT to treat AKI in adults (18 years or older). Data regarding study characteristics, methods, and outcomes were extracted. We assessed the studies for eligibility, extracted the data, pooled the data, and used the GeMTC package in R to combine direct comparisons with indirect evidence. Results: Ten RCTs including 3354 participants were included in the network meta-analysis. The higher intensity continuous renal replacement treatment (CRRT) (to exceed 35 mL/kg/h) and the higher intensity IRRT (to exceed six times per week) both showed no statistical significance. Further analysis for higher intensity CRRT, lower intensity CRRT, higher intensity IRRT, and lower intensity IRRT also revealed no significance. Conclusions: This meta-analysis showed that increasing the intensity of CRRT to exceed 35 mL/kg/h and six times per week for intermittent RRT (IRRT) did not reduce mortality or the rate of dependence on dialysis among AKI patients.

Objectives To investigate the effects of a caregiver training program on the oral hygiene of caregivers and patients with Alzheimer's disease (AD) and to identify program components and parameters for accurate assessment of outcomes. Design Single-blinded prospective cohort study. Setting and participants Patients with AD and caregivers in nursing homes in the Greater Zhengzhou Area, China. Methods Initially 168 AD patient/caregiver pairs were recruited and randomly assigned to control, limited training, and comprehensive training groups. The mini-mental state examination, global deterioration scale, and Katz activities of daily living scale were conducted for patients with AD. Information on participants’ oral hygiene habits and general oral health was collected. The modified Quigley-Hein Plaque Index (PI) and Gingival Index (GI) were used to assess oral hygiene and gingival health. Intervention included (1) an educational video showing the role of dental plaque and the modified Bass technique; and (2) caregivers practicing toothbrushing on themselves and patients with AD under professional guidance. Changes in oral hygiene and correlations between patient PI/GI and caregiver PI/GI were analyzed. Results After 6 weeks, complete data for 146 AD patient/caregiver pairs were collected. Before enrollment, most patients with AD had very poor oral hygiene. Compared with controls and limited training, only comprehensive training was able to achieve steady reduction in PI and GI scores in patients with AD, which still fell short of desirable levels (PI: 2.46 ± 0.52, GI: 1.24 ± 0.24, week 6). PI and GI scores in caregivers saw steady improvement only through comprehensive training (PI: 1.41 ± 0.38, GI: 0.88 ± 0.19, week 6). Number of training sessions had the greatest influence on both patient PI and GI scores. Conclusions and implications Comprehensive caregiver training on toothbrushing skills is effective in improving the oral hygiene of caregivers and patients with AD in nursing homes. Additional evidence is needed to establish the optimal program structure.

Comprehensive geriatric assessment is the major approach in screening geriatric syndrome. The aim of this expert consensus is to supply standard operating procedures for clinical practice of comprehensive geriatric assessment in China.

Background Our goal was to conduct a network meta-analysis of randomized controlled trials to compare the effects of the long-axis (LAX), short-axis (SAX), and oblique-axis (OAX) ultrasound guidance approaches for vascular access cannulation. Methods We searched 5 databases, including the Cochrane Central Register of Controlled Trials in the Cochrane Library, Embase, MEDLINE, CINAHL, and Web of Science. Seven randomized clinical trials assessing ultrasound guidance for vascular access cannulation via the LAX, SAX, or OAX approach were included. The primary end point was the first-pass success rate. Secondary end points included the mean time to success and average number of attempts until success. We used random-effects models to calculate weighted mean differences with 95% confidence intervals for continuous outcomes and relative risks with 95% confidence intervals for dichotomous outcomes. Results There were no significant differences between the LAX, SAX, and OAX techniques with respect to the first-pass success rate, mean time to success, average number of attempts until success, or the incidence of hematoma. Conclusion There was insufficient evidence to definitively recommend the LAX, SAX, or OAX approach for patients undergoing ultrasound-guided vascular access cannulation.

The Chinese Association of Geriatric Medicine proposed a set of criteria, The Health Criteria for the Elderly, to measure senior health. These criteria have their origins in the efforts in the past several decades to define successful aging. Successful aging theories, including the disengagement theory, the activity theory, and the continuity theory, represent sets of constructs on what elements constitute satisfactory aging and how it can be achieved. Rowe and Kahn's framework for successful aging emphasizes the impact of lifestyle choices on aging outcomes. The proposed health criteria for Chinese seniors may be too restrictive to be used as clinical guidelines. Instead, they can be promoted as goals of healthy aging in public education programs or serve as parameters to evaluate the effect of health policies and healthcare delivery models on the elderly population.

Background Catheter-related blood-stream infections (CRBSIs) are the most common complication when using central venous catheters (CVCs). Whether coating CVCs under bundles could further reduce the incidence of CRBSIs is unclear. We aimed to assess the effectiveness of implementing the use of bundles with antimicrobial-coated CVCs for preventing catheter-related blood-stream infections. Methods In this systematic review and network meta-analyses, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library in addition to the EMBASE, MEDLINE, CINAHL, and Web of Science databases for studies published before July 2017. The primary outcome was the rate of CRBSIs per 1000 catheter-days, and the secondary outcome was the incidence of catheter colonization. Results Twenty-three studies revealed significant differences in the rate of CRBSIs per 1000 catheter-days between antimicrobial-impregnated and standard CVCs (RR 0.70, 95% CI 0.53–0.91, p = 0.008). Thirty-three trials were included containing 10,464 patients who received one of four types of CVCs. Compared with a standard catheter, chlorhexidine/silver sulfadiazine- and antibiotic-coated catheters were associated with lower numbers of CRBSIs per 1000 catheter-days (ORs and 95% CrIs: 0.64 (0.40–0.955) and 0.53 (0.25–0.95), respectively) and a lower incidence of catheter colonization (ORs and 95% CrIs: 0.44 (0.34–0.56) and 0.30 (0.20–0.46), respectively). Conclusions Outcomes are superior for catheters impregnated with chlorhexidine/silver sulfadiazine or other antibiotics than for standard catheters in preventing CRBSIs and catheter colonization under bundles. Compared with silver ion-impregnated CVCs, chlorhexidine/silver sulfadiazine antiseptic catheters resulted in fewer cases of microbial colonization of the catheter but did not reduce CRBSIs. Electronic supplementary material The online version of this article (10.1186/s13613-018-0416-4) contains supplementary material, which is available to authorized users.

Background: Volatile organic compound (VOC) analysis provides an elegant approach for colorectal cancer screening. An organic compound with a high vapor pressure or volatility can be detected in the headspace of cancer cells or blood samples. Therefore, analyzing VOCs in the blood of rats inoculated with colorectal cancer tissue and in SW480 medium from cultured colorectal cancer cells may provide accurate results. Methods: After collecting venous blood from rats inoculated with cancer cells at different times, the cancer tissue was removed from the inoculated rats, and the medium was harvested from the cancer cells and cultured in the presence or absence of a chemotherapy drug of intestinal epithelial cells. We used solid-phase microextraction-gas chromatography-mass spectrometry (SPME-GC-MS) to analyze the headspace of the blood and media to evaluate the VOC profiles. Statistical analysis was conducted using principal component analysis (PCA) and orthogonal partial least-squares analysis (OP-LSDA). Results: The in vivo and in vitro analyses of the colorectal cancer samples revealed a variety of compounds, such as cyclohexanone, 1-hexanol, 2-ethyl-, butylated hydroxytoluene, cyclotrisiloxane, hexamethyl-, pentanoic acid, 2,2,4-trimethyl-3-hydroxy-isobutyl ester and acetone. Butylated hydroxytoluene is unique with regard to its presence during tumor growth and resection; it is also present during tumor cell growth and necrosis. Acetone showed unique trends in the in vivo experimental group. Conclusions: By analyzing VOC fingerprints related to colorectal cancer (CRC), we found that butylated hydroxytoluene and acetone have unique signatures that may provide the basis for clinical diagnosis and disease assessment.

The aim of this study was to determine the efficacy of immunonutrition vs standard nutrition in cancer patients treated with surgery. Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, EBSCOhost, and Web of Science were searched. Sixty-one randomized controlled trials were included. Immunonutrition was associated with a significantly reduced risk of postoperative infectious complications (risk ratio [RR] 0.71 [95% CI, 0.64-0.79]), including a reduced risk of wound infection (RR 0.72 [95% CI, 0.60-0.87]), respiratory tract infection (RR 0.70 [95% CI, 0.59-0.84]), and urinary tract infection (RR 0.69 [95% CI, 0.51-0.94]) as well as a decreased risk of anastomotic leakage (RR 0.70 [95% CI, 0.53-0.91]) and a reduced hospital stay (MD -2.12 days [95% CI -2.72 to -1.52]). No differences were found between the 2 groups with regard to sepsis or all-cause mortality. Subgroup analyses revealed that receiving arginine + nucleotides + ω-3 fatty acids and receiving enteral immunonutrition reduced the rates of wound infection and respiratory tract infection. The application of immunonutrition at 25-30 kcal/kg/d for 5-7 days reduced the rate of respiratory tract infection. Perioperative immunonutrition reduced the rate of wound infection. For malnourished patients, immunonutrition shortened the hospitalization time. Therefore, immunonutrition reduces postoperative infection complications and shortens hospital stays but does not reduce all-cause mortality. Patients who are malnourished before surgery who receive arginine + nucleotides + ω-3 fatty acids (25-30 kcal/kg/d) via the gastrointestinal tract during the perioperative period (5-7 days) may show better clinical efficacy.

Objectives To investigate the effects of caregiver training on poststroke oral hygiene and to identify appropriate structures for training programs. Design Single-blind prospective cohort study. Setting Haikou, China. Participants Individuals in home care who have had a stroke (N = 150) and their caregivers (N = 150). Eligibility criteria were stable condition, no recent use of antibiotics or periodontal therapy, presence of Ramfjord teeth or neighboring substitutes, and satisfactory Montreal Cognitive Assessment and Burke Water Swallow Test scores. Intervention Limited (LOHI) or comprehensive (COHI) oral hygiene instructions. Measurements Plaque Index (PI) and Gingival Index (GI) scores (ranging from 0 to 3 for both). Results Twenty care recipients and their caregivers dropped out during the study. In the care recipient groups, PI and GI scores in the COHI group were lower than in the control and LOHI groups at the end of the second and third month (P

Our goal was to conduct a network meta-analysis of randomized controlled trials to compare the effects of the long-axis (LAX), short-axis (SAX), and oblique-axis (OAX) ultrasound guidance approaches for vascular access cannulation.We searched 5 databases, including the Cochrane Central Register of Controlled Trials in the Cochrane Library, Embase, MEDLINE, CINAHL, and Web of Science. Seven randomized clinical trials assessing ultrasound guidance for vascular access cannulation via the LAX, SAX, or OAX approach were included. The primary end point was the first-pass success rate. Secondary end points included the mean time to success and average number of attempts until success. We used random-effects models to calculate weighted mean differences with 95% confidence intervals for continuous outcomes and relative risks with 95% confidence intervals for dichotomous outcomes.There were no significant differences between the LAX, SAX, and OAX techniques with respect to the first-pass success rate, mean time to success, average number of attempts until success, or the incidence of hematoma.There was insufficient evidence to definitively recommend the LAX, SAX, or OAX approach for patients undergoing ultrasound-guided vascular access cannulation.

Geriatric medicine in China started to develop as a medical specialty in the 1950s and has now become an extensive national healthcare network for the elderly. As population aging accelerates and the number of senior citizens keeps rising, major issues of healthcare delivery for this segment need to be addressed. Inequality in access to quality health care continues to exist between the public and private sectors and between urban centers and rural areas. The education and practice of geriatric medicine also face a range of problems, such as inadequate teaching of geriatrics‐related subjects in the medical education curriculum, the design of residency and fellowship programs, and the integration of geriatric principles into clinical practice. Government commitment, investment from the private sector, and improvement in geriatric medicine professionals’ knowledge and skills are required to bring geriatric care to a higher level.

Additional file 1. Search strategy.

Background: Volatile organic compound (VOC) analysis provides an elegant approach for colorectal cancer screening. Many studies have focused on the relationship between VOCs in exhaled breath and cancer. However, many factors can affect the presence of VOCs in exhaled breath, such as smoking and diet. An organic compound with a higher vapor pressure or volatility can be detected in the headspace of cancer cells or blood samples. Therefore, analyzing VOCs in the blood of rats inoculated with colorectal cancer tissue and in SW480 medium from cultured colorectal cancer cells provides more accurate results. Methods: After collecting venous blood from rats inoculated with cancer cells at different times, removing cancer tissue from the inoculated rats, and harvesting the medium of cancer cells cultured in the presence or absence of chemotherapy drug and of intestinal epithelial cells, we used solid phase microextraction-gas chromatography-mass spectrometry (SPME-GC-MS) to analyze the headspace of the blood and media to evaluate the VOC profiles. Statistical analysis was conducted using principal component analysis (PCA) and orthogonal partial least squares(OP-LSDA). Findings: In the in vivo and in vitro analyses of the colorectal cancer samples, we found a variety of compounds, such as cyclohexanone; 1-hexanol, 2-ethyl-; butylated hydroxytoluene; cyclotrisiloxane, hexamethyl-; pentanoic acid, 2,2,4-trimethyl-3-hydroxy-isobutyl ester; and acetone. Among these compounds, butylated hydroxytoluene is unique with regard to its presence during the processes of tumor growth and resection; it is also present during the processes of tumor cell growth and necrosis. Acetone showed unique trends in the in vivo experimental group. Interpretation: By analyzing VOC fingerprints relating to CRC, we found that butylated hydroxytoluene and acetone have unique signatures that may provide the basis for clinical diagnosis and disease assessment. Funding Statement: The project is funded by the National Natural Science Foundation of China (No. 81402462); Nn10 program and Distinguished Young Scholars Fund of Harbin Medical University Cancer Hospital; The Yuweihan Fund for Distinguished Young Scholars of Harbin Medical University; Harbin Science and Technology Innovation Scholars Fund (2017RAXXJ087); Heilongjiang Province Postdoctoral Research Fund. Declaration of Interest: The authors declare no potential conflicts of interest. Ethics Approval Statement: This study’s protocol was approved by the Ethics Committee at the First Affiliated Hospital of Harbin Medical University (No.2017005).

Background: Whether cancer patients receive benefits from immunonutrition is unclear. We systematically reviewed the effect of immunonutrition versus standard nutrition on cancer patients. Methods: The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, EBSCOhost, and Web of Science were searched for studies reporting clinical outcomes comparing immunonutrition with standard nutrition from the date of database inception to May 28, 2018. We assessed the risk of bias using the Cochrane risk of bias tool and the quality of evidence using the grading of recommendations assessment, development, and evaluation approach. Findings: In total, 79 randomized controlled trials with a total of 6970 adult cancer patients were included in the final pooled analysis. Compared with standard nutrition, immunonutrition was associated with a significantly lower risk of postoperative infection complications (RR 0*71 [95% CI 0*64 - 0*79], p

Background: Stress ulcers can affect the prognosis of critically ill patients. However, is stress ulcer prophylaxis (SUP) necessary for critically ill patients? What is the best choice of SUP? There are no specific answers to these two questions. The aim of our study was to conduct a conventional pairwise meta-analysis to assess the effects of SUP versus no prophylaxis and to perform a network meta-analysis to evaluate the efficacy and safety of antiulcer drugs for SUP in adult critically ill patients. Methods: We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and the Web of Science using a combination of MeSH and text words relevant to SUP, critically ill patients, adults, proton pump inhibitors (PPIs), histamine-2-receptor antagonists (H2RAs), sucralfate, and antacids, together with randomized controlled trials from the date of database inception to July 5, 2017. We extracted relevant information using a predefined data extraction form and assessed the risk of bias using the Cochrane risk of bias tool. Our primary outcome was the incidence of gastrointestinal (GI) bleeding. The secondary outcome was all-cause mortality and the risk of pneumonia. Findings: A total of 73 randomized controlled trials, with a total of 10,509 adult critically ill patients, were identified in our study. In the pairwise meta-analysis, we found a statistically significant difference between SUP and no prophylaxis for GI bleeding (RR 0·45, 95% CI 0·38 to 0·53) but no statistically significant differences in mortality (RR 0·96, 95% CI 0·84 to 1·10) or the risk of pneumonia (RR 1·15, 95% CI 0·91 to 1·46). In a 5-node network meta-analysis, pooled effect sizes suggested that, compared to no prophylaxis, all interventions were associated with reduced GI bleeding. Additionally, compared to PPIs (RR 0·60, 95% CI 0·47 to 0·76) and H2RAs (RR 0·77, 95% CI 0·67 to 0·88), sucralfate was associated with a reduction in pneumonia. In an 11-node network meta-analysis, omeprazole was significantly more effective than cimetidine, ranitidine, and sucralfate in preventing GI bleeding, while compared to omeprazole, pantoprazole and ranitidine, sucralfate was associated with a decreased risk of pneumonia. In terms of mortality, the combined results showed no statistically significant differences in any comparisons. Interpretation: SUP is necessary for preventing GI bleeding in adult critically ill patients. We recommend sucralfate as a better choice for SUP in adult critically ill patients. Funding: This study was supported by grants from the National Natural Science Foundation of China (No. 81402462, 81571871 and 81770276) and the Yuweihan Fund for Distinguished Young Scholars. Declaration of interests: We declare no competing interests.

Previous studies from European and East Asian cohorts reported conflicting results over whether and how the frequencies of the three common alleles, ε2, ε3 and ε4, of the apolioprotein E gene (APOE), in long-lived individuals differ from those in younger age groups. This study was the first to analyse these frequencies of long-lived individuals from central China. Genotyping of APOE alleles and genotypes was carried out in 70 long-lived individuals and 204 younger controls. No difference in the frequency of any APOE allele or genotype was found between the long-lived participants and their younger controls, but the long-lived group seemed to have a higher ε4 frequency (15.71%) than the 24–50 and 51–75 age groups (10.2% and 11.32%, P > 0.05). Notably, when compared with two other Chinese studies, the central China long-lived group had a higher ε4 frequency than its southern and eastern China counterparts (15.71% vs. 2.82% and 2.54%, P APOE polymorphisms to longevity in the Han Chinese population may be achieved only through large scale studies with participants from well-defined regional clusters.

Objectives To evaluate transitions in health status and risk of death in older adults in relation to baseline health deficits and protective factors. Design Prospective cohort study with reassessments at 5, 8, and 15 years. Setting Secondary analysis of data from the Beijing Longitudinal Study on Aging. Participants Urban and rural community-dwelling people aged 55 and older at baseline (n = 3,275), followed from 1992 to 2007, during which time 51% died. Measurements Health status was quantified using the deficit accumulation–based frailty index (FI), constructed from 30 intrinsic health measures. A protection index was constructed using 14 extrinsic items (e.g., exercise, education). The probabilities of health changes, including death, were evaluated using a multistate transition model. Results Women had more health deficits (mean baseline FI 0.13 ± 0.11) than did men (mean baseline FI 0.11 ± 0.10). Although health declined on average (mean FIs increased), improvement and stability were common. Baseline health significantly affected health transitions and survival over various follow-up durations (odds ratio (OR) = 1.27, 95% confidence interval (CI) = 1.17–1.37 for men; OR = 1.24, 95% CI = 1.16–1.33 for women for each increment of deficits). Each protective factor reduced the risk of health decline and the risk of death in men and women by 13% to 25%. Conclusion Deficit accumulation–based transition modeling demonstrates persisting effects of baseline health status on age-related health outcomes. Some mitigation by protective factors can be demonstrated, suggesting that improving physical and social conditions might be beneficial.

Background. On average, as people age, they accumulate more health deficits and have an increased risk of death. The deficit accumulation–based frailty index (FI) can quantify health and its outcomes in aging. Previous studies have suggested that women show higher FI values than men and that the highest FI score (the “limit to frailty”) occurs at a value of FI ~ 0.7. Even so, gender differences in the limit to frailty have not been reported. Methods. Data for this analysis were obtained from the Beijing Longitudinal Study of Aging that involved 3,257 community-dwelling Chinese people, aged 55+ years at baseline. The main outcome measure was 5-year mortality. An FI consisting of 35 health-related variables was constructed. The absolute and 99% FI limits were calculated for different age groups and analyzed by sex. Results. The mean level of the FI increased with age and was lower in men than in women (F = 67.87, p < .001). The 99% FI limit leveled off slightly earlier with a relatively lower value in men (60 years; 0.44 ± 0.02) compared with that in women (65 years; 0.52 ± 0.04). The highest absolute FI value was 0.61 in men and 0.69 in women. In both groups, people with an FI greater than or equal to the 99% limit showed close to 100% mortality by 5 years. Conclusion. Compared with men, women appeared to better tolerate deficits in health, yielding both relatively lower mortality and higher limit values to the FI. Even so, the FI did not exceed 0.7 in any individual.

The ability of a natural product Monascus purpureus (red yeast) rice (cholestin3™) preparation to regulate serum lipids was assessed in a multicenter, single-masked clinical trial. A total of 446 patients with hyperlipidemia were randomly assigned to two groups: a group of 324 patients received a M purpureus (red yeast) rice preparation, and a positive control group of 122 patients received another Chinese herbal medicine, Jiaogulan ( Gynostemma pentaphylla ). After 8 weeks, serum total cholesterol decreased significantly by 22.7% and low-density lipoprotein cholesterol by 30.9% in the patients treated with a M purpureus rice preparation, and patients in the positive control group showed 7.0% and 8.3% reductions, respectively. M purpureus treatment also significantly increased high-density lipoprotein (HDL) cholesterol by 19.9%, which was a significantly larger increase than the 8.4% increase observed in the positive control group. Notably M purpureus rice preparation significantly lowered serum triglycerides by 34.1% after 8 weeks, which was a significantly greater decrease than the reduction of 12.8% observed in the positive control group. When the overall therapeutic effects of M purpureus rice were scored, with one or more lipid risk factors being reduced and HDL cholesterol being increased, according to criteria established by the Ministry of Public Health of China, 93.2% of patients in the treatment group benefited from M purpureus . This total efficacy rate was significantly better than the rate of 50.8% in the positive control group. Therefore, use of M purpureus rice preparation in conjunction with a proper diet produced a favorable lipid-lowering effect in hyperlipidemic patients. The patients experienced a few mild side effects (heartburn, flatulence, and dizziness) during the 8-week treatment with M purpureus rice preparation. We concluded that this traditional Chinese rice preparation used as a dietary supplement is extremely effective and well tolerated in reducing elevated serum cholesterol and triglycerides.

Background: all cardiometabolic disorders become more common with age. Frailty and increased vulnerability to adverse outcomes are also common with aging. Even so, how commonly elderly people who are affected by cardiometabolic disorders are also frail remains unclear. Objectives: (i) to evaluate the prevalence of cardiometabolic disorders in relation to frailty. (ii) To estimate to which extent cardiometabolic diseases, when compared with frailty, affects mortality. Methods: this is a secondary analysis of the Beijing Longitudinal Study of Ageing, a population-based representative cohort study (n= 3,257) assembled in 1992 and followed to 2007. The baseline frailty index (FI) considered 35 potential health deficits. People with an FI >0.22 were considered frail. The relationships between frailty and cardiometabolic disorders and mortality outcomes were evaluated using the Cox proportional hazard model, adjusted for baseline age, sex and education. Results: the mean FI was 0.11 in men (SD = 0.10) and 0.14 (SD = 0.11) in women. On average, the FI increased with each cardiometabolic disorder (e.g. in men, mean ± SD = 0.16 ± 0.11 with hypertension, 0.23 ± 0.14 with stroke). As the number of disorders increased, so did the mean FI, and the proportion with the FI >0.22. For each condition, people with the FI >0.22 had a higher mortality, even after adjusting for sex, age and education. Conclusion: cardiometabolic disorders do not occur in isolation and commonly increase not just together, but in the presence of other health deficits. Healthcare providers who work with older adults with such problems need to develop methods to adapt their treatments to the needs of frail older adults.

Background. Smoking is common in China, where the population is aging rapidly. This study evaluated the relationship between smoking and frailty and their joint association with health and survival in older Chinese men and women.Methods.Data came from the Beijing Longitudinal Study of Aging, a representative cohort study with a 15-year follow-up. Community-dwelling people (n = 3257) aged more than 55 years at baseline were followed between 1992 and 2007, during which time 51% died. A frailty index (FI) was constructed from 28 self-reported health deficits.Results.Almost half (1,485 people; 45.6%) of the participants reported smoking at baseline (66.8% men, 25.3% women). On average, male smokers were frailer (FI = 0.17±0.13) than male nonsmokers (FI = 0.13±0.10; p =. 038). No such differences were seen in women. Men who smoked had the lowest survival probability; female nonsmokers had the highest. Compared with female nonsmokers, the risk of death for male smokers was 1.58 (95% CI = 1.41-1.95; p

Differences in frailty between rural and urban older adults have been demonstrated in developed countries. It is not understood how the apparently greater differences in living conditions between different types of regions in China may affect health and outcomes of older Chinese adults. Here, a frailty index (FI) based on the accumulation of health deficits was used to investigate health and survival differences in older Chinese men and women. We studied rural (n = 1121) and urban (n = 2136) older adults (55–97 years old) in the Beijing Longitudinal Study of Aging (BLSA), of whom 48.9% (rural) and 35.4% (urban) died over 8 years of follow-up. The FI was generated from 35 self-reported health deficits. The mean FI increased exponentially with age (r² = 0.87) and was higher in women than in men. The death rate increased significantly with increases in the FI, but women showed a lower death rate than did men. The mean FI in urban older adults (0.12 ± 0.10) was lower than that in their rural counterparts (0.14 ± 0.12, p < 0.001). Urban dwellers showed better survival compared with their counterparts in the rural areas. Adjusted by age, sex, and education level, the hazard ratio for death for each increment of the FI was 1.28 for urban people and 1.27 for rural people. Chinese urban dwellers showed better health and survival than rural dwelling older adults. The FI readily summarized health and mortality differences among different geographic regions, reflecting the impact of the environment, socioeconomics, and medical services on deficit accumulation and on survival.

Background Frailty in individuals can be operationalized as the accumulation of health deficits, for which several trends have been observed in Western countries. Less is known about deficit accumulation in China, the country with the world's largest number of older adults. Methods This study analyzed data from the Beijing Longitudinal Study of Aging, to evaluate the relationship between age and deficit accumulation in men and women and to evaluate the impact of frailty on mortality. Community dwelling people aged 55+ years at baseline (n = 3275) were followed every two to three years between 1992 and 2000, during which time 36% died. A Frailty Index was constructed using 35 deficits, drawn from a range of health problems, including symptoms, disabilities, disease, and psychological difficulties. Results Most deficits increased the eight-year risk of death and were more lethal in men than in women, although women had a higher mean level of frailty (Frailty Index = 0.11 ± 0.10 for men, 0.14 ± 0.12 for women). The Frailty Index increased exponentially with age, with a similar rate in men and women (0.038 vs. 0.039; r > 0.949, P < 0.01). A dose-response relationship was observed as frailty increased. Conclusions A Frailty Index employed in a Chinese sample, showed properties comparable with Western data, but deficit accumulation appeared to be more lethal than in the West.

Purpose To assess the compliance of Chinese urologists with China's benign prostatic hyperplasia (BPH) clinical practice guideline and to explore the diagnosis and therapy modalities for geriatric patients with BPH. Methods A cross-sectional survey study was carried out in 33 medical centers in 11 different cities in China. A total of 190 urologists participated in a survey to record their preferences for diagnostic tests and treatment options for BPH outpatients. Diagnostic test results as well as health care demands were collected by surveying 2,027 outpatients aged 60 years and older. Results The survey response rate was 97.4%. The respondents generally used the diagnostic tests recommended in China's BPH clinical practice guideline at varying rates. The used rates for medical history, ultrasonography, and urinalysis were above 90.0%; that for uroflowmetry was 31.2%. In addition, the rate of use of recommended tests was higher among doctors in the north than among those in the south. Combination therapy with α-adrenoceptor antagonists and 5α-reductase inhibitors was the preferred treatment option for BPH, and was increasingly used with worsening lower urinary tract symptoms. Finasteride was the most prescribed medication (48.0%), followed by tamsulosin (22.7%). Conclusions This study assessed the preferences of urologists in the diagnosis and treatment of BPH, which will serve as an important reference for updating and improving China's current BPH clinical practice guideline.