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Abstract:Objective Obstructive sleep apnea(OSA) induces marked hemodynamic fluctuations that might be deleterious to the cardiovascular system.The influence of OSA and aging on short-term blood pressure(BP) variability in OSA patients was investigated.The standard deviation(SD) and coefficient of variation(CV) of BP during daytime and nighttime were assessed to estimate short-term BP variability.Methods Totally 143 subjects with newly-diagnosed untreated OSA were categorized into three groups: subjects aged <60 years with untreated hypertension(n=62);normotensive subjects aged<60 years(n=38);and normotension subjects aged>60 years(n=43).Twenty four-hour BP was recorded after polysomnography.Results The SD of systolic or diastolic BP during daytime and nighttime was significantly greater in hypertensives than in normotensives aged<60 years(18.5 vs 10.6mmHg,P<0.05,and 13.8 vs 10.6mmHg,P<0.05,daytime;20.5 vs 12.6mmHg,P<0.01 and 17.8 vs 12.6mmHg,P<0.01,nighttime),as was the CV of systolic or diastolic BP during daytime and nighttime(0.119 vs 0.078,P<0.01 and 0.139 vs 0.118,P<0.05,daytime;0.137 vs 0.111,P<0.01 and 0.195 vs 0.177,P<0.01,nighttime);compared to the group of normotensive aged>60 years,the SD of systolic or diastolic BP variations during daytime and nighttime were higher in hypertensives(18.5 vs 13.3mmHg,P<0.05 and 13.8 vs 10.2mmHg,P<0.05,daytime;20.5 vs 15.2mmHg,P<0.01 and 17.8 vs 14.2mmHg,P<0.01,nighttime),and as was the CV of systolic BP during daytime(0.119 vs 0.093,P<0.05) and systolic or diastolic BP during nighttime(0.137 vs 0.123,P<0.01 and 0.195 vs 0.179,P<0.01).Daytime systolic BP CV was increased in normotensive elderly patients than in patients aged<60years(0.093 vs 0.078,P<0.05).As to the target organ damage,hypertensive group had higher rate than the two normotensive groups(P<0.05),and the elderly group had more target organ damage than the patients aged<60years(P<0.05).Conclusion Systemic hypertension is associated with a more severe exacerbation of short-term variability and higher rate of target organ damage in the OSA patients.

Abstract:Objective To analyze the clinical features of chronic obstructive pulmonary disease(COPD) patients with or without obstructive sleep apnea-hypopnea syndrome(OSAHS)(overlap syndrome),and compare the status of sleep-disorder breathing between outpatients and inpatients of them.Methods A total of 300 patients with stable COPD were screened for sleep disorder breathing using questionnaire,Epworth sleepiness scale(ESS) and home pulse oximeter testing.Those with ESS≥10 or oxygen desaturation over 4% per hour sleep >5 times were under further PSG testing.Results there was significant difference on sleep-disordered breathing index,body mass index,heart rate in sleep,the percentage of the recording time spent with arterial oxygen saturation(SIT90),the nocturnal mean arterial oxygen saturation and the minimal arterial oxygen saturation between COPD outpatients and inpatients clinics.Conclusion Sleep-disordered breathing can affect and aggravate patient’s condition of COPD.

Abstract:Objective To investigate the effects of obstructive sleep apnea hypopnea syndrome(OSAHS) on the mortality among the elderly with coronary heart disease(CHD).Methods Based on the polysomnographyic results and whether nasal continuous positive airway pressure(CPAP) treatment was performed or not,132 elderly with both CHD and moderate-to-severe OSAHS were divided into non-treatment group(observation group,n =97) and treatment group(n =35).In addition,70 elderly with CHD but without OSAHS were recruited as control group.Results By the end of 4 years follow-up,22 patients died of cardiovascular events,stroke and coronary artery reconstruction.According to Cox regression analysis,the mortality in treatment group was significantly lower than that in observation group,but was not significantly different from that in control group.After adjusting age and body mass index,the mortality in observation group was still significantly higher than that in control group.Conclusion Among the elderly CHD patients,those with coexisting OSAHS have a significantly higher mortality than those without OSAHS.However,once CPAP treatment is performed in the elderly with both CHD and OSAHS,the mortality of the treatment group shows no significant difference from that of the patients without OSAHS.

Abstract:Objective To investigate the change of ambulatory blood-pressure in elderly hypertension patients combined with moderate to severe obstructive sleep apnea-hypopnea syndrome(OSAHS) and to explore the effect of OSAHS on the development of cardio-cerebrovascular diseases.Methods Seventy-two patients were divided into study group(moderate to severe OSAHS combined with hypertension,n=36,average age=(68±23.3) years,BMI=(27.7±2.3) kg/m2)and control group(hypertension without,n=36,average age=(64±18.5) years,BMI=(26.8±1.8) kg/m2),according to the clinical blood pressure,ambulatory blood pressure and polysomnogram.To compare the effect of different degree of OSAHS on the diurnal blood pressure between the two groups.Results There was no significant difference between these two groups in average age,gender and BMI.For the study group,the nocturnal systolic pressure was(143.2 ±10.7)mmHg,the ratio of non-dipper hypertension was 83.3%,and the morning systolic pressure was(146.9±16.1)mmHg.For the control group,the nocturnal systolic pressure was(132.2 ±13.1)mmHg,the ratio of non-dipper hypertension was 27.5%,and the morning systolic pressure was(137.2±20.1)mmHg.There was significant difference between these two groups.The data of study group were much higher than those of the control group.Conclusion Moderate to severe OSAHS can affect circadian rhythm of blood pressure.

Abstract:Objective To observe the clinical effect of Xuebijing in the treatment of gastrointestinal dysfunction among elderly cases with multiple organ dysfunction syndrome(MODS).Methods Multicenter,randomized and control test was applied to 58 elderly patients with MODS who were assigned randomly to administration of Xuebijing group or control group.The intestinal dysfunction score,acute physiology and chronic health evaluationⅡ score(APACHE Ⅱ) and Marshall score were calculated before and after the test respectively.The prognosis within 28 d was recorded.Results The intestinal dysfunction score,APACHE Ⅱ score and Marshall score of all patients were decreased in both groups,but they were significantly better in treatment group than those in the control group.The effect on intestinal dysfunction was better in Xuebijing group.There was significant difference on the mortality in treatment group compared with that in the control group when APACHE Ⅱwas between 8 and 20 scores.Conclusion Xuebijing can improve gut barrier function and the prognosis of the elderly patients with MODS.

Abstract:Objective To investigate the prognostic value of N-terminal pro-brain natriuretic peptide(NT-proBNP) combined with soluble CD40 ligand(sCD40L) in acute coronary syndrome(ACS) patients.Methods A total of 134 ACS patients were enrolled:seventy patients with ST elevation myocardial infarction,8 patients with non-ST elevation myocardial infarction,and 56 patients with unstable angina.Plasma NT-proBNP and sCD40L were measured by ELISA obtained between 12-24h after admission.According to the ROC curve,the cut-off value of NT-proBNP and sCD40L was 1 163.89 pmol/L and 915μg/L respectively.And,according to NT-proBNP combined with sCD40L results the patients were divided into 3 groups.In addition,the patients with ACS were evaluated during the in-hospital period and followed-up for(96.62±9.08)d for major adverse cardiac events(MACE).Results The incidence of MACE was significantly higher in high concentration(n=41) than that in low concentration of NT-proBNP group(n=93)(48.8% vs 4.3%,P<0.01).The incidence of MACE was higher in high concentration sCD40L group(n=57) than that in low concentration one(n=77)(28.1% vs 10.4%,P<0.01).The morbidity of MACE was 56.5%,19.2% and 1.7%,respectively,in positive group(high concentration of both NT-proBNP and sCD40L),weakly positive group(one marker with high concentration),and negative group(with low concentration of both markers).Conclusion The combination of NT-proBNP and sCD40L adds critical prognostic insight to the assessment of patients with ACS.

Abstract:Objective To determine the incidence and risk factors of stent thrombosis(ST) after sirolimus-eluting stent(SES) implantation.Methods A total of 156 patients who received percutaneous coronary intervention procedure with SES implantation between Apr 2006 to Aug 2007 in our hospital were evaluated.Angiographic and procedural outcome were documented by interventional cardiologist,the clinical outcome was recorded before discharge.Clinical follow-up was carried out for 6 months in 72 patients and for 1 year in 84 patients,to investigate the incidence,risk factors and outcome of ST.Results Four patients had suffered from ST: 3 patients(1.92%) were early ST,1 patient(0.64%) was late ST.From the 4 patients there were 2 multivessel diseases,2 bifurcation lesions and 2 long diffuse lesions patients.Six stents were implanted,mean stents diameter was(2.88±0.38)mm,mean stents length was(25.5±6.12)mm and mean release pressure of stents was(13.33±1.03)atm with 1 high-pressure post-dilation,TIMI grade 3 flow was achieved after procedure in all 4 patients.One patient presented acute ST-elevation myocardial infarction 3d after procedure and received rt-PA and IABP treatment,now survives without any events;3 patients suffered from sudden death 6 d,15d and 81d after the procedure respectively.Conclusion In our study,3 developed early ST and 1 late ST in 156 patients after SES implantation.The clinical presentation is acute myocardial infarction or sudden death.The development of ST after SES implantation is probably associated with the following factors:(1) acute coronary syndrome with multivessel diseases,bifurcation lesions or long diffuse lesions;(2) the presence of residual dissection or stent under-expansion without intravascular ultrasound assessments.Coronary ST is a catastrophic complication after percutaneous coronary intervention,and the mortality is high.

Abstract:Objective To investigate the effect of metabolic syndrome(MS) on old female patients with initial acute ST-elevated myocardial infarction(STEMI)and to analyze the influence of MS on prognosis of these patients so as to take more effective measures to prevent severe complications.Methods Ninety STEMI patients were registered to this study,who had been hospitalized in Xuanwu Hospital from March,2005 to June,2007.The zero time was defined as the date of hospitalization while the end-point was defined as the patient’s death.And then a two years follow-up was proceeded to investigate the outcome,including the recurrence of acute myocardial infarction or angina pectoris,the situation of cardiac function,the incurrence of re-hospitalization and cardiac death.Results Recurrence rates of angina pectoris and re-infarction in MS group were higher than those in the control group(P<0.05).There was no difference in incurrence of re-hospitalization and mortality between the two groups.Conclusion MS leads to higher recurrence rates of angina and re-infarction in old female acute myocardial infarction patients.MS should be treated more seriously and a comprehensive treatment should be proceeded to prevent the recurrence of cardiac events.

Abstract:Objective To investigate the relevance of genetic alterations in the Kv1.5 channel gene(KCNA5) to the development of idiopathic pulmonary arterial hypertension(IPAH) in Chinese Han nationality.Methods IPAH patients(n=86) were recruited from Chinese Han nationality.Randomized control samples(n=250) were obtained from the same population.Genomic DNA was extracted from peripheral blood of all samples.The coding,the noncoding regions and the enhancer region of the KCNA5 gene were amplified by using primers sets with optimal annealing temperature.All amplificants were directly sequenced.Hemodynamic data were compared between patients with and without KCNA5 gene variants.Results The frequency of the variant KCNA5 C-862G was found statistically different between the patients and the control samples.Moreover,there was marked difference between the patients with and without the variant.Conclusion Genetic variant KCNA5 C-862G may alter the expression and/or function of Kv1.5 channel,which may be associated with IPAH of phenotype.

Abstract:Objective To study the practical value of multidisciplinary integrated treatment and management model in the elderly patient’s medical management.Methods The prospective design methods in randomized control tests were used to compare the difference between the multidisciplinary integrated treatment management model and the traditional treatment model used in the medical care for 202 cases of elderly patients,including the analysis of medical and nursing quality,complication occurrence and the improved daily living ability,and the investigation for the treatment preference of the patients and their families.Results Comparing with the traditional treatment model,the multidisciplinary integrated treatment management model enhanced the quality of treatment and nusing,reduced medical defects,controlled the complication occurrence,improved the daily living ability of patients,decreased the patients’ economic burden to the society and families and enhanced the social satisfactory degree for hospital.Conclusion The multidisciplinary integrated treatment management model may be considered as a new and better model of treatment and nursing services for elderly patients to be popularized.

Abstract:Objective To discuss the incidence,pathogenesis,prevention and prognosis of with acute cerebral infarction(ACI) patients complicated with multiple organ dysfunction syndrome in the elderly(MODSE).Methods A retrospective review of the clinical data of 152 elderly patients with ACI was conducted;36 patients with MODSE were defined as MODSE group,116 patients without MODSE were defined as control group.We comparatively analyzed the data of the two groups.Results In the 152 elderly patients with ACI,there were 36 cases complicated by MODSE,the incidence rate was 27.08%.The mortality of MODSE group was 45.35%;and the motality in control group was 4.35%;there was a significant difference of mortality between the two groups(P<0.01).We found that the organ easily affected were the lungs,cardiovascular system,brain,kidneys,gastrointestinal tract,liver successively.The more the organ involved,the higher the motality and the larger the infected area was.The main reasons of death was secondary respiratory failure,cardiac failure,cardiac arrest,cerebral lesion and cerebral hernia and kidney failure.Conclusion The incidence rate of elderly patients with ACI complicated by MODSE is higher with higher mortality.The main reasons lead to death are secondary respiratory failure,cardiac failure,cardiac arrest,cerebral lesion and cerebral hernia,and kidney failure.

Abstract:Objective To investigate the feasibility of using new Doppler filling parameters(TE-Ea and IVRT/ TE-Ea) in estimating left ventricular(LV) filling conditions of patients with rheumatic mitral stenosis(MS).Methods Thiry-two subjects with rheumatic MS and sinus heart rhythm were enrolled,their average mitral valve area(MVA) was(1.45±0.40)cm2.The patients were divided into subgroups according to mean IVRT/ TE-Ea,and the diastolic filling parameters of each group were compared.Results Significant filling dysfunction was present in patients with rheumatic MS.After dividing the patients by mean IVRT/TE-Ea(group 1,5 cases,IVRT/TE-Ea<0;group 2,17 cases,IVRT/TE-Ea≥4.16;and group 3,10 cases,00 could finely discriminate clinical status and possible existing LV filling pressure abnormality.

Abstract:Objective To investigate the effect of the serum inflammatory factor on type 2 diabetes mellitus(T2DM) especially among elderly patients complicated with cardiocerebral vascular disease.Methods We studied 103 T2DM patients,and divided them into groups according to the age and whether complicated with cardiocerebral vascular disease or not.The levels of serum high sensitivity C-reactive protein(Hs-CRP),fasting blood glucose,glycosylated hemoglobin,cholesterol total,triglyceride(TG),and low density lipoprotein-cholesterol were detected with automatic biochemistry analyzer and serum tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) with ELISA in all patients.Results(1)Among them,the levels of serum Hs-CRP,TNF-α and IL-6 in patients of age≥65 years old were higher than those of age<65 years old(P=0.003,P=0.001,P=0.007,respectively).(2)The level of serum Hs-CRP in patients with T2DM complicated with cardiocerebral vascular disease was higher than those without it(P=0.015).And in patients of age≥65 years old,the level of serum Hs-CRP in patients complicated with cardiocerebral vascular disease was higher than that in the those without it(P=0.040).(3)The level of serum Hs-CRP was positively correlated with age and the level of serum TG(r=0.257,P=0.000;r=0.220,P=0.003).The impact factor on Hs-CRP was age,the regression equation was Y(Hs-CRP)=2.407+0.100X(age).(4)The incidence of cardiocerebral vascular disease in T2DM patients of age≥65 years old was higher than that in the patients of age<65 years old(P=0.000).Conclusion Inflammatory factors such as CRP,TNF-α and IL-6 are correlated with elderly T2DM patients complicated with cardiocerebral vascular disease;and age is a main impact factor on Hs-CRP.

Abstract:Objective To explore the possible mechanism of sleep apnea causing atherosclerosis by observe the oxidative stress reaction in the animal models with experimental obstructive sleep apnea syndrome.Methods Sixteen Chinese miniature pigs were equally divided into obstructive sleep apnea(OSA) group and control group.Animal models were made by gel injection method in OSA group.Before surgery and 12 weeks after surgery,venous blood was obtained from experimental animals to measure xanthine oxidase(XOD),superoxide dismutase(SOD) and malondialdehyde(MDA).Results(1) After surgery,the level of XOD was obviously elevated in OSA group,increasing from(3.71±0.07) to(4.82±0.08) U/L.Significant difference existed in the XOD level between before and after surgery.No significant change in the level of XOD was found in control group after surgery.There was significant difference in the XOD level between OSA and control groups after surgery.(2) After surgery,the level of SOD depressed from(142.33±6.82) to(121.21±1.93) NU/ml in OSA group.Significant difference existed in the SOD level between before and after surgery.The level of MDA was obviously elevated in OSA group after surgery,increasing from(3.66±0.47) to(5.59±0.75) μmol/L.Significant difference existed in the MDA level between before and after surgery.In control group,there were no significant changes in the levels of SOD and MDA after surgery.Significant differences existed in SOD and MDA between OSA and control groups after surgery(P<0.05).Conclusion Experimental obstructive sleep apnea can put the animals into oxidative stress state and produce a large amount of oxygen free radicals.Increased oxygen free radicals induce a series of pathophysiological reactions and promote the initiation and development of atherosclerosis.

Abstract:Objective To explore the relationship between uncoupling protein-2(UCP2) and apoptosis in pressure overload-induced cardiac hypertrophy.Methods The pressure overload animal model was established in rats by abdomial aorta coarctation and an equal number of sham-operated rats served as controls.The time course was 1,2,4,7,14,21 and 30 days after operation.The UCP2 mRNA expression was evaluated by RT-PCR.The TUNEL method was applied to detect the myocardial apoptosis.Results(1) Compared with control group,the expression of UCP2 mRNA was upregulated at 4 days,and developed progressively to 30 days.(2) The apoptosis increased significantly at d 1,and reached a plateau between d 4-d 7;afterwards,it decreased continuously to low level.However,the apoptosis was so rare that it was undetectable in control group.Conclusion Although the precise role for UCP2 need to be clarified in the future works,it may participate in the regulation of apoptosis during the pressure overload-induced cardiac hypertrophy.

Abstract:Objective To determine the effect of valsartan(val) on the migration of isolated rat vascular smooth muscle cell(VSMC) and the expression of phospho-42/44 mitogen-activated protein kinase(p42/44 MAPK)promoted by angiotensinⅡ.Methods VSMC from the rat thoracic aorta was cultured by attachment-block culture.VSMC migration was measured by migration chamber system.p42/44 MAPK expression was determined by Western blot.Results(1)AngiotensinⅡobviously promoted VSMC migration,the effect was inhibited by valsartan and PD98059.(2)Angiotensin Ⅱ obviously promoted p42/44 MAPK expression,and the expression was at maximal in 5 min,the effect was inhibited by val and PD98059.(3)Compared with the control,val didn’t inhibit VSMC migration and p42/44 MAPK expression.Conclusion The effect that val inbibits angiotensin Ⅱ-induced VSMC migration is related to its inbibiting angiotensin Ⅱ-induced p42/44 MAPK expression.

Abstract:1 病历摘要 　　患者王XX,61岁男性,因"反复胸闷26年,加重伴发作性晕厥9月余"于2009-5-18入院.1983年,患者在劳累时感胸闷、气短,心电图检查发现"完全性左束支传导阻滞",当地诊断为"心肌炎",未正规治疗.1986年以后逐渐出现劳累时心前区疼痛,每次历时十余分钟,症状轻,可自行缓解.当地医院诊断"冠心病",因平素一般体力活动尚可,仅剧烈活动时诱发上述症状,含服速效救心丸可使症状好转,仍未正规检查治疗.……

Abstract:胃癌是我国死亡率最高的恶性肿瘤之一.化疗是胃癌的主要疗法,特别是对于手术后残留癌细胞的清除、防止复发具有重要治疗价值.但是,目前应用的多种药物以及多种给药方案的总体评价疗效很不理想,甚至有报道称胃癌术后的化疗并不能降低复发率,也不能改善患者的预后[1].……