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Abstract:Objective To explore the effects of 24-hour dynamic blood pressure rhythm and insulin resistance metabolic disorder on postoperative cognitive dysfunction(POCD) in elderly hypertension patients. Methods Preoperative insulin resistance and 24-hour dynamic blood pressure in the elderly patients (age ≥60 years) undergoing noncardiac surgery were determined. Following WHO/ISH criteria for diagnosis of hypertension, 103 subjects were divided into four groups according to 24-hour dynamic blood pressure rhythm: dipper hypertension group (25 cases),dipper hypertension and insulin resistance metabolic disorder group (26 cases),non-dipper hypertension group (26 cases), and non-dipper hypertension and insulin resistance metabolic disorder group (26 cases). All subjects were evaluated by Mini-Mental State Examination (MMSE) preoperatively and on day 7 postoperatively. Results The MMSE score was significantly lower in non-dipper hypertension and insulin resistance metabolic disorder group than in dipper hypertension and insulin resistance metabolic disorder group, dipper hypertension group and non-dipper hypertension group (24.3±1.3, 27.3±1.7,28.3±0.6,26.8±1.3, respectively, P<0.05).Conclusion A reduction and disappearance of blood pressure circadian rhythm complicated with insulin resistance is associated synergistically with the damage of postoperative cognitive function in elderly hypertension patients.

Abstract:Objective To study the characteristics of target organ damage in very old hypertension patients complicated with diabetes mellitus (DM) and provide reference information for the control of target organ damage. Methods Totally 118 very old inpatients(mean age 86±6) were divided into 3 groups: essential hypertension group (EH, n=35), diabetes mellitus group (DM, n=39) and EH complicated with DM group (EH+DM, n=44). Carotid resistance index, intima-media thickness, left ventricular mass index (LVMI), urine microprotein, and creatinine clearance rate (Ccr) were compared between the 3 groups. Results Carotid resistance index and intima-media thickness in the EH+DM group were significantly increased compared with the EH and DM groups. Plaque index in EH+DM group was obviously higher than that in EH and DM groups. The LVMI and systolic aortic inner diameter (AO) were remarkably different among the DM, EH and EH+DM groups, and LVMI and AO were higher in EH+DM group than in the other 2 groups. The microalbuminuria in EH+DM group was higher, while Ccr was lower than that in EH and DM groups. Conclusion The risk of target organ damage increases significantly in very old EH patients complicated with DM.

Abstract:Objective To compare the ability of artificial neural networks(ANN) and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) to predict mortality for patients in geriatric intensive care unit (GICU). Methods The purpose of this retrospective case series was to compare ANN and APACHE Ⅱ in the mortality pridiction for a cohort of patients admitted to a seven-bed GICU in a Beijing teaching general hospital. All 177 patients were older than 65 years and consecutively admitted to our GICU from Jan 2005 to Dec 2006.The 22 variables used to obtain APACHE Ⅱ score and risk of death were collected from each patient on admission. All data were randomly allocated to either the training (n=117) or validation set (n=60). Three ANN models were developed using the data from the training set, namely ANN22 (trained with all the 22 variables), ANN10 (trained with the 10 highest information gain variables) and ANN8 (trained with the 8 highest information gain variables). Three ANN models and APACHE Ⅱwere used to predict mortality in the validation set. The accuracy of ANN and APACHE Ⅱ was assessed by area under the receiver operator characteristics curve (aROC). Results The aROC was 0.943 for ANN22 and 0.949 for APACHE Ⅱin predicting GICU mortality(P=0.829). For ANN10 and ANN8, the aROC was 0.968 and 0.926, respectively. Conclusion Both ANN and APACHE Ⅱhave similar performance in predicting GICU outcome. ANN uses fewer variables and yet is comparable to APACHE Ⅱ.

Abstract:Objective To explore the risk factors of multiple cerebral infarctions(MCI) in aged patients in order to provide basis for its prevention and treatment. Methods Based on clinical observation, the correlative factors were identified in 1416 cases of cerebral infarction from January 2000 to January 2008. Then non-condition logistic regression analysis was employed to determine the risk factors of MCI. Results The main risk factors of MCI included atrial fibrillation, carotid artery plaque formation, diabetes and hypertension. They were independent risk factors of MCI. And there were significantl differences among these risk factors. Conclusion Atrial fibrillation, carotid artery plaque formation, diabetes and hypertension are the most important risk factors of MCI. Targeting to the specific risk factor, the individualized prevention and treatment strategy may be carried out in clinical practice,which has significant value in reducing the occurrence of MCI.

Abstract:Objective By comparing the angiographic characteristics of coronary artery in patients with and without diabetes, the diagnostic value of computed tomography coronary angiography(CTCA) in diabetic patients with coronary artery diseases was investigated. Methods Totally 380 diabetes and 481 non-diabetic patients were examined by CTCA. Among them, 111 cases(41 diabetes and 70 non-diabetic patients) were also examined by invasive coronary angiography. The correlation of CTCA with invasive coronary angiography was evaluated.Results There was a good correlationship between the images of CTCA and invasive coronary angiography. There was a significant difference between diabetic and non-diabetic patients in the manifestation of coronary artery disease (45.8% vs 24.5%,P<0.05)and multi-vessel changes(P<0.05). Conclusion Diabetic patients have a high incidence of coronary artery disease. CTCA has a significant diagnostic value in these patients with coronary artery lesion.?更多

Abstract:Objective To compare the efficiency and safety of intracoronary peripheral blood stem cells(PBSC) transplantation between aged patients and non-aged patients with heart failure after myocardial infarction(MI). Methods Twenty-five patients with heart failure after MI were divided into aged group(≥60 years, n=13) and non-aged group(<60 years, n= 12)to receive intracoronary PBSC transplantation(PBSCT) following bone marrow cells mobilized by granulocyte colony-stimulating factor. The clinical data,coronary lesion characteristics, side effects,left ventricular shape and cardiac function between two groups were compared. Results Six months after PBSCT, the left ventricular ejection fraction and 6 min walk test distance increased significantly and left ventricular diastolic diameter decreased obviously. The area of myocardial perfusion decreased obviously in both groups. There were no significant differences between two groups in the above parameters change. Conclusion The present study demonstrates that autologous intracoronary PBSCT is safe and feasible for elderly patients with heart failure after MI, and the left ventricular function of the patients is significantly improved.The results have no significant difference between aged group and non-aged group.

Abstract:Objective To investigate the effects of benazepril on the blood pressure and urinary protein in AT1-adrenergic receptor positive hypertension patients with diabetic nephropathy(DN).Methods The synthesized epitopes of the second extracellular loop of AT1 receptor (165-191) was used to screen serum autoantibodies from hypertension patients with DN (n=71),diabetic mellitus(n=51) and from healthy blood donors (n=40, control) by ELISA. The patients in autoantibodies against AT1 receptor positive group (n=31)and negative group(n=40) were given the following drugs repectively: benazepril (10mg/d), aspirin(100mg/d), nitrendipine(10mg/d). The blood pressure reducing effect was compared between the groups.The 24-hour urinary protein were measured before and after treatment for 24 weeks.Results In hypertension patients with DN, the positive rate of the autoantibodies against AT1receptor was 43.7%(31/71), and was significantly higher than that in the diabetes mellitus patients(13.7%,7/51)and healthy blood donors(10%,4/40,P<0.01). The total efficiency rate of benazepril treatment in reducing blood pressue was significantly higher in autoantibodies against AT1 receptor positive group than that in negative group (85.6% vs 45.0%,P<0.01). The total efficiency rate of benazepril treatment in reducing urinary protein was significantly higher in autoantibodies against AT1 receptor positive group than that in negative group (87.1% vs 42.5%,P<0.01).Conclusion Benazepril can reduce urinary protein more significantly in hypertension patients with DN and positive autoantibodies against AT1 receptor than that in those with negative autoantibodies against AT1 receptor. Benazepril is effective and safe in the treatment of hypertension with DN.

Abstract:Objective To observe the characteristics of dipyridamole stress 201Tl SPECT myocardial imaging in adult patients with acute viral myocarditis, and to preliminarily explore its mechanism and clinical significance.Methods Four adults with acute viral myocarditis were chosen. Dipyridamole was administrated at 0.56mg/kg by intravenous injection within 4min. Images were acquired after 10min and 240min respectively.Three-dimensional reconstructions of the original images were analyzed by more than two experienced nuclear medicine physicians. Results In all of the four patients, three myocardial imagings showed the radioactive uniformity at stress stage but the radioactive defect at delayed stage in left ventriclar myocardium(one in inferior wall; one in apex, inferior and anterior wall; one in anterior wall),namely reverse redistribution. And the imaging of the other one showed the fixed radioactive defect in inferior wall both at stress and delayed stage. Conclusion Dipyridamole stress 201Tl SPECT myocardial imaging has certain value in the diagnosis of acute viral myocarditis of adults. The mechanism of reverse redistribution in dipyridamole stress 201Tl SPECT myocardial imaging is primarily relevant to the dysfunction of cardiac microcirculation.

Abstract:Objective To examine the circadian rhythms of acute myocardial infarction(AMI) in patients with type 2 diabetes. Methods From January 1994 to June 2007, 268 consecutive type 2 diabetes patients admitted to a coronary care unit with acute ST elevation myocardial infarction were studied. Another 268 age and sex matched AMI patients without type 2 diabets were taken as controls.Admission numbers were calculated at 6-hour interval within a day (circadian rhythm). The data were compared between the 2 groups.Results In diabetic group, number of patients in the first to fourth quarters was 60, 73, 64, 71 respectively, with no significant difference between different quarters.That in control group was 55, 90, 62, 61 respectively,with significant difference between the second quarter and other quarters(P<0.01). The difference between diabetic group and control group was significant. Conclusion There is significant circadian variation in the onset of AMI in the patients without diabetes,but there is no significant circadian variation in the onset of AMI in diabetic patients.

Abstract:Objective To investigate the use of titanium-nitride-oxide-coated stent (TITAN2) implanted in transulner or transradial approach for coronary revascularization in elderly patients with coronary heart disease(CHO). Methods Twenty-nine CHD patients(16 males and 13 females)who were about to undergo coronary revascularization were selected. All patients underwent coronary revascularization in trans-ulner or transradial approach. The passing rate of stent, early thrombosis in stent, and major adverse cardiac events(MACE) during 1-5 month follow-up were recorded. Results Coronary angiography revealed 43 lesions with stenosis >75% in 29 patients.Forty-two lesions were successfully revascularized by TITAN2. There was one failure in passing right coronary artery. The passing rate of stent was 97.7%. Remaining stenosis, stent dislocation, endarterium disection, early thrombosis in stent, and coronary rupture were not discovered after stent. No MACE was found during 1-5 month follow-up. Conclusion TITAN2 has significant efficacy on coronary revascularization in elderly CHD patients.?更多

Abstract:Objective To investigate the value of the establishment of chest pain center(CPC)in Emergency Department(ED) of hospital in improving the diagnosis-and-treatment time for patients with acute chest pain. Methods CPC was established in the ED and there were three open days weekly which were randomly selected. The patients were diagnosed and treated by ED physicians according to routine clinical procedures at the rest time of the week. The causes of chest pain and diagnosis-and-treatment time duration of the patients were recorded. Results Totally 696 nontraumatic chest pain patients visited ED/CPC from January 2006 to December 2007,of which 244(35%)were cardiac chest pain cases, including 141 (20%)cases of acute myocardial infarction(AMI),81(12%)cases of unstable angina pectoris,17(2.4%)cases of stable angina pectoris,2(0.3%)cases of acute aortic dissection, and 3 (0.4%)cases of acute pulmonary embolism.452 cases were noncardiac chest pain patients, including 41(6%)cases of respiratory diseases,70(10%) cases of digestive diseases,41(6%) cases of chest wall diseases and,299 (42%) cases of psychological-psychotic diseases or other undetermined clinical conditions. Time for diagnosis and treatment for chest pain patients who visited CPC was significantly shortened,AMI(70.1±31.7)min vs (115±40.5)min(P<0.01);unstable angina pectoris (228±54)min vs (264±78)min(P=0.02);noncardiac chest pain (108±66)min vs (126±96)min(P=0.03).Conclusion Among acute chest pain patients, cardiac causes account for 35%, mainly including AMI and unstable angina pectoris, noncardiac causes account for 65%.Time for diagnosis and treatment for chest pain patients is significantly shortened by CPC pattern.

Abstract:Objective To assess the psychological and clinical effect of transradial artery access for percutaneous coronary intervention(PCI) on elderly patients with acute myocardial infarction(AMI). Methods One hundred and seventy-two patients(>65years) with acute ST segment elevated myocardial infarction were enrolled from Jan,2005 to Jan, 2007.All the patients who underwent PCI were randomly divided into transradial artery group (n=84) and transfemoral artery group (n=88).The psychological changes of the subjects were determined by self-rating anxiety scale(SAS) and self-rating depression scale(SDS).The clinical outcome of the subjects were also observed.Results SAS and SDS indices were decreased significantly in transradial artery group compared to those in transfemoral artery group at 1,6 month after PCI procedure(P<0.05). Statistical analysis demonstrated that different approaches exerted different effects on depression or anxiety of AMI patients.There was no difference in major adverse cardiac events between the two groups. Conclusion Transradial artery access for percutaneous coronary intervention can significantly decrease the incidence of psychological problems in elderly patients with AMI.And also,it is safe and effective.

Abstract:Objective To investigate the effects of percutaneous coronary intervention(PCI) on the treatment and prognosis of heart failure derived from ischemic cardiomyopathy in aged patients. Methods The subjects were divided into 2 groups: treatment group(n=55)and control group(n=56).The patients in the treatment group received PCI as well as conservative medication,while the patients in the control group underwent conservative medication only. The short-term therapeutic effects and long-term prognosis were compared between the two groups. Results In PCI treatment group, the patients had a significant amelioration of physical signs, significant elevation of LVEF, significant reduction of rehospitalization frequency in 1-and 2-year follow-up visit,and cardiac death in 4-and 8-year follow-up visit.It was significantly different compared to the control group(P<0.05). Conclusion The application of PCI in treating heart failure resulting from ischemic cardiomyopathy in aged patients is feasible and fruitful if the patients can stand the procedure.Especially,the long-term prognosis is statisfactory.

Abstract:Objective To explore the relations between cytokines expression levels and activity of nuclear factor(NF-κB) in different tissue samples of congestive heart failure rat model. Methods Normotensive male Wistar rats weighed (250±20)g were used. Infarction of the left ventricle (LV) was obtained by ligation of the left descending coronary artery under artificial ventilation. Sham operated rats underwent the same surgical procedure with the exception of coronary ligation. At baseline, and 4 and 16 weeks after coronary ligation, all animals were assessed by echocardiography and cardiac catheterization. According to hemodynamic change, rats were divided into compensated and decompensated groups. Nuclear proteins from the lung, the heart, the liver and the spleen were extracted separately using EMSA to assay the activity of NF-κB in the tissue samples. Results Compared with other organs, the expression of TNF-α and IL-6 mRNA was significantly increased in the lung of rats with compensated heart failure, which was positively correlated with the activity of NF-κB,and negatively correlated with heart function of the rats. Conclusion Sustained activation of NF-κB and elevation of cytokines in chronic heart failure are correlated positively with deteriorated cardiac function. Lung is an important source of synthesis and storage of cytokines at the early stage in an experimental model of heart failure. It is an important organ that contributes to the development and progression of heart failure.?更多

Abstract:Objective To screen the differentially expressed genes related to lipid metabolisms in the mature adipocytes and to investigate the effect of telmisartan on the cells with microarray based high throughput gene expression profile.Methods The 3T3-L1 preadipocytes were induced into the mature adipocytes, which was then intervened with telmisartan (0.1mg/L). The total RNA was isolated from the cells with or without telmisartan intervention with Trizol method. After purification, reverse transcription was carried out to synthesize Cy3/Cy5 labeled cDNA probe. The probe was hybridized with microarray based high throughput gene expression profile (36 000 genes or gene fragments) to screen the differentially expressed genes in the cells with and without telmisartan intervention. The effect of telmisartan on the function of the mature adipocytes and the possible signal pathway were analyzed.Results A total of 157 differentially expressed genes were screened out, including 86 up-regulated genes and 71 down-regulated ones, which were involved in lipid synthesis, catabolism and transport in the adipocytes. The changes in the expression level of these genes might be related to the effects of telmisartan on function of mature adipocytes, such as cytokine-cytokine receptor interaction, cell adhesion molecules, adipocytokine signaling pathway, oxidative stress, etc. In addition, telmisartan played some roles in certain pathways related to the proliferation, differentiation, and lipid synthesis of mature adipocytes, such as Wnt, β-catenin, and Notch signaling pathways.Conclusion Telmisartan exerts its effect on mature adipocytes in a manner which is independent of AT receptor. Telmisartan may affect the lipid synthesis, catabolism and transport of the mature adipocutes.

Abstract:1 病历摘要 　　患者,男性,60岁,主因"咳嗽、呼吸困难1个月,发热半月"于2009年4月30日入院. 　　患者曾于2005年5月在解放军总医院诊断"慢性肾功能衰竭,尿毒症期",2005年11月在解放军总医院泌尿外科行"右肾同种异体移植术",术后长期服用抗排异药物,入院时服用西罗莫司和强的松片.2009年4月2日患者受凉后出现咳嗽、咳少量白色痰,时有气短,无胸痛,无发热,自服感冒药后稍好转,但仍有咳嗽.

Abstract:由中国人民解放军总医院老年心血管病研究所、<中华老年多器官疾病杂志>和英文版<老年心脏病学杂志>承办的第八届长城国际老年心脏病学论坛于2009年10月11日在北京国际会议中心成功举办.……