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Abstract:Objective Acute coronary syndrome(ACS) is common in women,yet we have less gender-specific data in women than in men as a result of lower enrollment in clinical trials.The purpose of this study was to assess gender-based differences in presentation and outcome after ACS in clinical practice in China.Methods A total of 12 hospitals were represented in Chinese Registry of Acate Coronary Events.Data collection began in 2001,up to 2003,1301 patients with ACS enrolled into the study.We compared the clinical demographics,different therapies and outcome in hospital between female and male patients with ACS.Results Patients with age 27-93(63.13±10.89) years including 318 female and 983 male subjects were enrolled.Female subjects were older than male patients(67.23 yrs vs 61.80 yrs);the incidence of history of angina,heart failure,diabetes mellitus and hypertension in female group was significantly higher than that in male group(73.6% vs 62.3%,8.2% vs 5.7%,30.8% vs 18.6%,and 66.4% vs 56.8%,respectively),but the incidence of smoking in female group was significantly less than that in male group(6.6% vs 66.2%).More male patients were presented with ST segment elevation myocardial infarction(STEMI) compared with female patients(48.5% vs 39%).With the exception of β-blocker administration,no differences were found about medications including aspirin,angiotensin converting enzyme inhibitor,lipid lowering agents and low molecular weight heparin between female and male patients.Compared with male patients with non ST segment elevation ACS(NSTE-ACS),female subjects were prone to receive β-blocker(63.4% vs 75.1%).Not only for STEMI but also for NSTE-ACS patients,more female subjects received less reperfusion therapies compared with male subjects(37.1% vs 26.8% for STEMI;53.6% vs 37.2 % for NSTE-ACS);recurrent angina was more often in female group with the whole spectrum of ACS(25.0% vs 14.5% for STEMI;29.4% vs 20.2% for NSTE-ACS),and so did the occurrence of congestive heart failure.There was no difference of in-hospital death rate between the two groups with ACS(5.6% vs 7.1% for STEMI,and 2.1% vs 1.4% for NSTE-ACS).Conclusion Female patients with ACS are older than male subjects and thus more often have concomitant diseases but less often have a history of smoking.They less often receive reperfusion therapies,however,there is no difference about in-hospital mortality between the female and male patients.

Abstract:目的探讨女性急性心肌梗死(AMI)患者的危险因素、发病特点,以提高诊疗效果。方法回顾性分析2006年4月至2008年12月期间首都医科大学宣武医院收治的45岁以下女性AMI患者29例和45岁以上女性AMI患者189例,并对危险因素、临床表现、并发症、病死率和冠状动脉造影情况进行比较。结果45岁以下女性AMI组高胆固醇血症5例(17.2%),其总胆固醇〔(5.11±0.15)mmol/L〕和低密度脂蛋白胆固醇〔(2.34±0.59)mmol/L〕水平均明显低于45岁以上女性AMI组。与45岁以上女性AMI组相比,45岁以下女性AMI组有典型胸痛者多见。冠状动脉造影显示45岁以下女性AMI组非阻塞性病变多见,三支病变少见;27.6%的梗死相关血管表现为正常。结论45岁以下与45岁以上女性AMI患者具有不同的临床和冠状动脉病变特点,应注意采取针对性措施,积极预防。

Abstract:Objective To assess the safety and efficacy of 40mg daily simvastatin for the elderly female patients with acute myocardial infarction(AMI).Methods A total of 221 elderly female patients with AMI admitted to our hospital from Jan 2006 to Dec 2008 were assigned to simvastatin 40mg daily within 24h of hospitalization and continued till 6 months after discharge.Patients with LDL-C<2mmol/L or increased liver enzyme level at discharge received dose of reduced simvastatin,20mg daily.Lipid profiles,high-sensitive C-reactive protein(hs-RP) and liver enzyme level were measured at admission,discharge and 1,3 and 6 months after discharge.Results LDL-C was continuously decreased(mmol/L(3.18±1.02) at admission,(2.19±2.00) at discharge and(1.49±0.79) at 3 months after discharge).HDL-C was decreased from(1.56±0.41)mmol/L to(1.25±0.28)mmol/L at discharge,then increased to(1.75±1.85)mmol/L at 3 months after discharge.Total cholesterol(TC) and triglyceride(TG) were also significantly decreased from admission to discharge.hs-CRP level significantly decreased from admission to discharge and at 3 months after discharge(mg/L(48.92±46.39) vs(9.70±18.25) vs(2.63±2.18)).Increased ALT>120 U/L were found in 24(10.9%),AST>120 U/L were found in 3(1.4%) patients at discharge.There was still a patient with increased ALT>120 U/L at 1 month after discharge and returned to normal at 3 months after discharge.Conclusion Intensive simvastatin therapy with a dose of 40mg daily is safe and effective for the elderly female patients with AMI.

Abstract:目的基质金属蛋白酶(MMP)-9是一种基质降解酶,可能参与了血管的重构。本研究旨在探讨MMP-9基因C-1562T多态性与高血压及性别的相关性。方法采用聚合酶链反应结合限制性内切酶片段长度多态性分析,分别检测北京宣武医院门诊807例原发性高血压患者和同一地区509例正常对照的MMP-9基因C-1562T多态性。电泳判断基因型并测序。结果高血压组TT+CT基因型频率和T等位基因频率显著高于正常对照组(28.7%vs 22.6%,15.4%vs 12.7%;P<0.05)。女性中高血压组的TT+CT基因型频率和T等位基因频率显著高于正常对照组(31.0%vs 22.0%,16.6%vs 12.1%;P<0.05),T等位基因对高血压的OR值为1.442(CI:1.057～1.968)。男性中两组基因型无显著差别。老年女性高血压组的TT+CT基因型频率和T等位基因频率显著高于老年男性高血压组、老年女性正常对照组和非老年女性高血压组。结论MMP-9基因-1562T等位基因可能是老年女性原发性高血压的危险因素。

Abstract:Objective To summarize the experience of three different kinds of internal fixation,dynamic hip screw(DHS),proximal femoral nail(PFN) and proximal femoral nail anti-rotation(PFNA),for intertrochanteric fracture(ITF) in the elderly and to evaluate their merits and deficiencies.Methods We retrospectively reviewed 71 patients who were treated for intertrochanteric fracture with DHS,PFN and PFNA from Mar.2004 to Sept.2007.The patients were divided into three groups: DHS group(26 cases),PFN group(23 cases) and PFNA group(22 cases).The clinical parameters involved the mean operative time,the mean blood loss during operation and postoperation,incision length,etc.The LSD test was used.The other results which taken placed in operation or postoperative followed up were also analyzed.Results(1)The mean operative time:the PFNA group took the least time than the PFN and the DHS groups.(2) The mean blood loss during operation and postoperation: blood loss of the PFNA group was less than that in the DHS group.(3) Incision length: the mean lesion of the PFNA group was the least in three groups.Conclusion The PFNA is better for different fracture types and for elderly patients with ITF because of less operative time,less blood losts and less incision length,which show that the PFNA may be a faster and safe surgical methed for interrochanteric fracture in the elderly.

Abstract:Objective To evaluate the retrospective features of elderly patients with non-ST-segment elevation myocardial infarction(NSTEMI),investigate correlation factors for in-hospital death and summarize clinical characteristics of deceased patients in hospital.Methods A total of 428 patients presenting with NSTEMI between Jan 2001 to Apr 2008 were included.Patients were divided into elderly group(≥65 years,n=302) and non-elderly group(<65 years,n=126),32 patients deceased in hospital.Their clinical data were analyzed retrospectively,and correlation factors for in-hospital death were evaluated.Results Patients of elderly group were more likely to have history of diabetes mellitus,angina,myocardial infarction,renal function and atypic symptoms compared with non-elderly group,more likely to be with heart function of Killip grades Ⅲ-Ⅳ,and less experienced angiography,P<0.05 for all the above parameters;the age of death group was higher than alive group((76.22±5.02) years vs(68.89±11.9) years,P<0.01),pulmonary infection was the most frequent cause(37.5%) and complication(56.2%) in the death group;multifactorial logistic regression analysis showed that age(OR 1.095) and Killip grades Ⅲ-Ⅳ(OR 3.418),heart rate(OR 1.073),white blood cell count of peripheral blood(OR 1.213) and level of blood glucose(OR 1.399)on admission have independently correlated with the in-hospital death.Conclusion Patients of elderly group are more likely to have history of diabetes mellitus,angina,myocardial infarction,renal function and atypic symptoms compared with non-elderly group,and they are less experienced angiography;the age of death group is more likely to be higher than alive group,pulmonary infection is the most frequent cause and complication in the death group;age and Killip grades Ⅲ-Ⅳ,heart rate,white blood cell count of peripheral blood,level of blood glucose on admission may be the independent risk factors of in-hospital death of patients with NSTEMI.

Abstract:Objective To investigate the levels of von Willebrand factor(vWF),type 1 plasminogen activator inhibitor(PAI-1) and adiponectin in coronary heart disease patients with hyperglycemia.Methods Oral glucose tolerance test was carried out in the patients with coronary heart disease and different abnormal glucose metabolism,including diabetes mellitus(DM,n=44,26.99%),impaired glucose tolerance(IGT,n=59,24.38%),impaired fasting glucose(n=15,7.46%);and 40 patients(24.54%)with normal glucose tolerance(NGT) as the control group.The level of vWF,PAI-1 and adiponectin was measured by ELISA for all these patients.Results vWF level increased in DM and IGT groups compared with NGT group,and showed significant statistical signiticance;PAI-1 level increased in DM group with statistical significance;adiponectin level of IGT and DM groups was higher than that of NGT group,and showed significant statistical signiticance.Conclusion Hyperglycemia causes high vWF and PAI-1 level,low adiponectin level,and leads to severe endothelial lesion.It is essential to discover and control hyperglycemia as early as possible to prevent the onset and development of coronary heart disease.

Abstract:Objective To evaluate the perioperative safety and efficacy of hip arthroplasty in elderly(≥80) femoral neck fracture.Methods Seventy-eight patients over 80 years old who received hip arthroplasty,including total hip arthroplasty(THA,11 cases)and hemiarthroplasty(HA,67 cases),between Nov 1997 and Nov 2007 were analyzed retrospectively.Results Of the patients,aged(83.7±3.59) years in average,with Garden Ⅲ(42 cases) and Garden Ⅳ(36 cases) respectively,ASA classification showed that 80.8% patients belonged to high risk group preoperatively.There was no statistical difference between predicted values and observed values by Physiological and Operative Severity Score for the Enumeration of Mortality and Mobility scoring system(32 cases and 24 cases,P=0.205),and THA group or HA group had no statistical difference.The satisfaction index of easement of pain was 96.2%,and indoor activities with or without brace rate was 76.9% at two weeks after operation.Conclusion By the necessary intervention to the physiological status and operation methods for improving the prognosis,hip arthroplasty is a safe and effective procedure to treat the femoral neck fracture in elderly patients.

Abstract:Objective To approach the clinical effects of cardioversion for treatment of atrial fibrillation(AF) in the rheumatic cardial disease patients with large left atrium after valve replacement.Methods All 164 patients with persistent AF after valve replacement(left atrial diameter exceeded 50mm)were randomly divided into 3 groups: amiodarone group(n=20),combination of amiodarone and ramipril group(n=76),and combination of amiodarone and irbesartan group(n=68).Amiodarone was administrated iv in all patients,and cardioversion was used if AF was not returned.Amiodarone was administrated 200mg every day after successful cardioversion,ramipril was used 5mg every day at the same time in ramipril group,irbesartan was used 150mg every day in irbesartan group for 3-6 months.Results Immediate effective ratio was 92.7%(152/164 cases).Mean follow-up was(1.8±0.4) years;128 cases(78.0%) maintained sinus rhythm.Rate of sinus rhythm was 86.8%(66/76 cases) in ramipril group and it was 75.0%(51/68 cases)in irbesartan group with no significant difference between the two groups.It was 55.0%(11/20 cases)in amiodarone group,also without significant difference compared with ramipril or irbesartan group.Left atrial diameter detected in last follow-up significantly exceeded than before cardioversion in amiodarone group((60.5±3.8)mm vs(57.7±4.5)mm,P=0.04);but there was no significant difference between ramipril group((58.2±4.3)mm vs(57.3±5.8)mm,P=0.28)and irbesartan group((57.2.±5.5)mm vs(56.4±4.9)mm,P=0.37).Cardiac function was improved in 3 groups without conspicuous difference among them.Conclusion If methods of cardioversion and combined medicine approach are correct,the effective ratio is high in patients who had long time AF and large left atrium,the rate of maintenance of sinus rhythm is also high,and the cardiac function is improved.Amiodarone combined with ramipril or irbesartan can delay augmentation of left atrium and improve rate of maintenance of sinus rhythm.

Abstract:Objective To evaluate the related factors in elderly type-2 diabetes patients with pruritus in Beijing and provide some reliable information for the diagnosis,treatment,health care and nursing.Methods A total of 514 type-2 diabetic inpatients admitted to PLA General Hospital between Jan 2003 and Dec 2006 were retrospective analysed.The case group included 143 type-2 diabetes inpatients with pruritus.The control group consisted of 371 type-2 diabetes without dermatosis.Results Age,course of diabetes,fasting blood glucose level,smoking,blood fats and diabetic complications were different significantly between the two groups.Conclusion Age,course of diabetes,fasting blood glucose level,smoking,abnormal blood fats and diabetic complications are the related factors in elderly type-2 diabetes patients with pruritus.

Abstract:Objective To investigate the incidence and severity of discomforts experience,such as pain,anxiety and sleep deprivation in patients in the intensive care unit(ICU),in order to explore the relationship between the discomfort experience and therapeutic measures,nursing procedure and the environment of ICU.Methods A total of 142 critically ill patients,who stayed in ICU for>24 h between Jun 2006 and Dec 2007 were included in the analysis.All patients were interviewed 3 to 7 days after discharging from ICU.The incidence of discomfort experience such as pain,anxiety,thirst,sleep deprivation and subjective feeling of noise were recorded.The factors that influenced the discomfort experience were analysed.Results The incidences of pain,anxiety,thirst,sleep deprivation and subjective feeling of noise were 35.2%,51.9%,88.9%,55.8% and 47.2%,respectively in all these patients.The painful experience of using mechanical ventilation was recalled by 78.0% of the patients.Airway suctioning was experienced as discomfort by 52.5% of the patients.Pain was closely related to airway suctioning,intravenous injection and indwelling gastric tube.The anxiety was intimately related to the environmental noise,intravenous injection and mechanical ventilation.Sleep deprivation was caused by noise,mechanical ventilation,airway suctioning,indwelling gastric tube and intravenous injection,etc.Conclusion The incidence of discomfort experience in critically ill patients is high.Therapeutic intervention,nursing procedure and the environmental noise are the main causes of patients’ experience of discomforts.

Abstract:Objective To investigate the effect of lovastatin on rat bone marrow mesenchymal stem cells(MSCs) apoptosis induced by hypoxia and serum deprivation(Hypoxia/SD) in vitro,focusing in particular on regulation of mitochondrial apoptotic pathway,and to find the useful therapeutic methods to increase transplanted MSCs survival.Methods MSCs were isolated from bone marrow of Sprague-Dawley rats.The anti-apoptotic effects of lovastatin were detected using Hoechst33342 and Annexin V-FITC/PI binding assay by flow cytometric analysis.The cytochrome C and the activation of caspase-3 were detected by Western blot.Results Lovastatin(0.01-1μmol/L)remarkably prevented MSCs from hypoxia/SD-induced apoptosis through inhibition of the mitochondrial apoptotic pathway,leading to attenuation of caspase-3 activation.The loss of mitochondrial membrane potential and cytochrome C release from mitochondria to cytosol were significantly inhibited by lovastatin.Conclusion Lovastatin protects MSCs from hypoxia/SD-induced apoptosis via inhibiting mitochondrial pathway,suggesting that it may provide a useful therapeutic adjunct for transplanting MSCs into damaged heart after myocardial infarction.

Abstract:Objective To observe the effect of vascular endothelial growth factor(VEGF) on endothelial progenitor cells(EPCs) and to elucidate its possible mechanism.Methods Mononuclear cells(MNCs) isolated from bone marrow by density gradient centrifugation combined with adherent cell filtration were plated on fibronectin-coated culture dishes.After culturing for 7d,adherent cells were cultured with different concentrations of VEGF(25,50,75,100 μg/L) for 48 h.EPCs proliferation and migration ability were observed and adhesion assay was performed.The endothelial nitric oxide synthase(eNOS) mRNA expression of EPCs was measured by RT-PCR.Results VEGF dose-dependently increased the number of EPCs and promoted EPCs proliferation,migration and adhesive capacity.VEGF could upregulate eNOS mRNA expression of EPCs.Conclusion VEGF might affect the biological functions of EPCs through upregulation of eNOS mRNA expression of EPCs.

Abstract:Case presentationA male patient,86 years old,was admitted toour depart ment on Dec 13,2008 because of mele-na,fatigue and loss of appetite for 3 days.Present history:Three days ago,the patient’sfoodintake decreased significantly with no obviousincentives,and his complaints were left upper ab-dominal