Abstract:21世纪全球进入老龄化阶段,从1950年到1980年,全球老龄人口所占的比重增加了50%以上,预计到2025年这一比例还会再增加一半以上.我国大部分城市也已进入高速发展的老龄化阶段.……

Abstract:Objective To evaluate the effects of "Prescription Automatic Screening System (PASS)" on adverse drug events (ADEs) and improvement of clinical safety in elderly patients.Methods Elderly in-patients (>65 years old) from Gerontology and Gastroenterology Departments,Dongfang Hospital Affiliated to Tongji Medical Universtiy from July 2007 to July 2009 were selected randomly.At phase Ⅰ,PASS was not used.At phase Ⅱ,PASS was used for patients from Gerontology Department,but not for patients from Gastroenterology Department.According to Naranjo score sheet,ADEs were determined.The incidence,distribution and severity of ADEs,and hospitalization duration and cost of preventable ADEs were compared between phase Ⅰ and phase Ⅱin the two departments.Results (1) The incidence of preventable ADEs and severe preventable ADEs decreased significanfly after PASS intervention (P<0.01) in Gerontology Department,but there was no significant difference in Gastroenterology Department (P>0.05).(2) The severe events accounted for a maximum of ADEs,which decreased most significantly after PASS intervention.(3) Hospitalization duration and hospitalization costs for preventable ADEs decreased significantly (P<0.01) in Gerontology Department after PASS intervention,but there was no significant difference (P>0.05) in Gastroenterology Department.Conclusion ADEs are common in elderly in-patients.The more severe the ADEs is,the more possible is it be prevented.For preventable ADEs,PASS intervention can achieve more clinical benefit,including significantly shortening the hospitalization duration,lowering hospital costs,reducing medical risks,reducing morbidity,and improving clinical safety.However,there are still some shortcomings.

Abstract:Objective To discuss the efficacy,qualification rate and costs of pharmacotherapy for elderly patients with metabolism syndrome.Methods The investigation was based on a descriptive analysis related to medical files of 206 elderly in-patients (>60-year-old) with metabolism syndrome (MS) during 2008 to 2009.The diagnosis was confirmed by the standards of Chinese Diabetes Association.The agents used for each component of MS,therapeutic effect,costs,and qualification rate were recorded.Results The efficiency rates of the pharmacotherapy for diabetes,hypertension,hyperlipidemia,hyperuricemia and anticoagulation were 98.0%,70.9%,85.0%,42.6% and 83.3% respectively.The qualification rates of control of HbA1c,fasting glucose,postprandial glucose,blood pressure,triglyceride,HDL,and uricemia were 45.1%,70.0%,52.9%,79.1%,80.2% and 40.0% respectively.The more satisfaction rates of control of these indices were 85.0%,88.9%,93.7%,99.4%,95.6%,77.5% and 97.0% respectively.The daily costs of all the agents used for metabolism syndrome <30 yuan,30-60 yuan,and >60 yuan accounted for 50.0%,38.3% and 11.7% respectively.Conclusion In order to get satisfactory qualification rate,as well as ideal cost-effectiveness ratio,the medications should be chosen reasonably according to the characteristics of elderly patients with metabolism syndrome and the principles of comprehensive therapy.

Abstract:Objective To investigate the expression level of urokinase plasminogen activator receptor (uPAR) in monocytes in coronary heart disease (CHD) patients before and after percutaneous coronary intervention (PCI) and to determine the relationship between uPAR and major adverse cardiac events (MACE).Methods A consecutive cohort of 136 CHD patients were enrolled,including 85 acute coronary syndrome (ACS) patients and 51 stable angina pectoris (SAP) patients.Twenty healthy volunteers were taken as control group.Peripheral blood samples were collected,and uPAR expression in monocytes was measured by flow cytometry at 24 h,48 h,and 3 months after PCI treatment.MACE were recorded during 2-year followe-up.Results Expression level of uPAR was significantly higher in ACS patients than in SAP patients and healthy controls(P<0.01).In ACS group,the expression level of uPAR decreased significantly at 3 months after PCI(P<0.01).Among 85 ACS patients who were followed up for an average of (20.46±2.45) months,24 MACE were reported.The expression level of uPAR in MACE group was significantly higher than that in non-MACE group(P<0.01).Ordinal logistic regression analysis revealed that the level of uPAR expression in monocytes was significantly correlated to MACE.Conclusion The level of uPAR expression in monocytes in ACS group is significantly higher than that in SAP group.Expression level of uPAR in ACS patients is significantly correlated to MACE.uPAR is a sensitive predictor for the severity of CHD,and is of great significance in evaluating the stability of atheromatous plaque and the outcome of CHD.

Abstract:Objective To investigate the clinical features and prognosis of coronary artery disease in patients with chronic renal failure.Methods A retrospective study was performed on 142 elderly patients with coronary artery disease diagnosed between June 2006 and December 2007.According to the complication of renal failure or not,the subjects were divided into chronic renal failure group (n=98) and non-chronic renal failure (control) group (n=44).The clinical characteristics,coronary artery lesions and main cardiac adverse events (MCAE) were compared between the two groups.Results (1) Compared with control group,the hypertension incidence was higher (79.6% vs 59.1%,P<0.05),and left ventricular ejection fraction was lower 〔(50.6±9.5)% vs (54.8±6.2)%,P<0.01〕in renal failure group.(2) There were more cases with triple vessel lesions,more cases with calcification,more cases receiving medication,and less cases receiving percutaneous coronary intervention in chronic renal failure group than in control group (69.4% vs 31.8%,P<0.001;57.1% vs 29.5%,P<0.01;70.4% vs 34.1%,P<0.001;24.5% vs 52.3%,P<0.001 respectively).(3)The incidence of acute coronary syndrome and incidence of acute heart failure were higher in renal failure group than in control group(53.1 % vs 27.3%,27.6% vs 11.4% respectively,P<0.05).(4)Logistic analysis showed that bedside systolic blood pressure (β=0.65,P<0.001) and glomerular filtration rate (β=-0.49,P<0.001) were independent risk factors for MCAE in patients with coronary heart disease.Conclusion There are more extensive coronary lesions,more obvious calcification,and lower percentage of revascularization in coronary artery disease patients with renal failure.They also have higher incidence of,but asymptomatic MCAE.Chronic renal failure is an important predictor for the development and prognosis of coronary artery disease.

Abstract:Objective To investigate the relationship between severity of coronary lesions and left ventricular diastolic function in patients with coronary heart disease(CHD).Methods Seventy-five consecutive patients with CHD confirmed by coronary angiography were divided into 4 groups according to extent of coronary lesions:mild stenosis,single vessel lesion,double vessel lesion and triple vessel lesion group.The systolic pressure and diastolic pressure in aorta,heart rate,left ventricular end-diastolic pressure (LVEDP),maximum and minimum value of the first derivative of left ventricular pressure (dp/dtmax,dp/dtmin),and the time constant of isovolumic pressure decay in early period of left ventricular relaxation(T) were determined by cardiac catheterization.The relationship between the severity of coronary stenosis and left ventricular diastolic function was analyzed.The left atrial dimension(LAD),left ventricular end-diastolic volume(EDV),left ventricular end-systolic volume(ESV),the early 1/3 filling volume (1/3V) and filling fraction (1/3 FF) of left ventricle were measured by left ventriculography and echocardiography.Left ventricular ejection fraction (LVEF) was also calculated.Peak systolic strain rate,peak early diastolic strain rate and peak late diastolic strain rate in each segment of left ventricles were measured with echocardiographic imaging.The correlation of the peak strain rates with the corresponding parameters derived with cardiac catheterization was analyzed.Results According to echocardiographic study,only the diameter of LAD was significantly larger in triple vessel lesion group 〔(38.74±4.57) mm〕 than in mild stenosis group 〔(33.87±3.80) mm〕 and single vessel lesion group 〔(33.77±3.94) mm〕.According to left ventriculography,the LVEDP,dp/dtmax,dp/dtmin,EDV and ESV were not significantly different between the groups.The T was significantly lower in mild stenosis group 〔(30.31±6.50) ms〕 than in single vessel lesion 〔(40.92±11.79) min〕,double vessel lesion 〔(43.02±15.83) ms〕 and triple-vessel lesion groups 〔(50.32±23.57) ms〕.The early filling 1/3V and 1/3FF was higher in mild stenosis group than in obvious stenosis groups.Conclusion The coronary lesion exerts certain effects on ventricular diastolic function in a coronary lesion severity dependent manner.Strain rate imaging in echocardiogram is accurate for evaluating diastolic dysfunction in patients with CHD.

Abstract:Objective To investigate the efficacy of indapamide/felodipine combination in decreasing blood pressure in elderly patients with hypertension.Methods A total of 150 consecutive elderly cases of hypertension,average age (65.4 ± 3.6) years,were randomized into 3 groups:indapamide group (1.5 mg/d),felodipine group (5 mg/d),and indapamide (1.5 mg/d)/felodipine (5 mg/d) combination group,with 50 in each group.The treatment duration was 3 months.The average 24-hour,daytime and night-time systolic blood pressure/diastolic blood pressure and systolic blood pressure/diastolic blood pressure load,as well as mean heart rate,were determined at baseline and after 3 months.Results The average 24-hour,daytime and night-time systolic blood pressure/diastolic blood pressure,and blood pressure load were significantly decreased in all groups after treatment for 3 months,which was more significant in combination group than in single drug treatment group.The mean heart rate showed no significant change after 3 months of treatment.Conclusion Combination of calcium antagonist with long-acting diuretics at low dose provides substantial and stable antihypertensive benefit,and has few side effects.The regimen is strongly recommended for elderly patients with hypertension.?更多

Abstract:Objective To evaluate the therapeutic effects of polyethylene glycol electrolyte powder combined with mosapride on chronic functional constipation.Methods Eighty-six patients with chronic functional constipation were randomly divided into 3 groups:mosapride plus polyethylene glycol electrolyte group (A),mosapride group (B),and polyethylene glycol electrolyte group (C).The treatment lasted for 4 weeks.Results After 4 weeks of treatment,the total effectiveness rates were 96.9%,39.2% and 73.2% respectively in group A,B and C.The difference was significant between group A and the other 2 groups(P<0.01).Conclusion Combined use of polyethylene glycol electrolyte powder with mosapride can provide satisfactory therapeutic effects on patients with chronic functional constipation,which is clinically superior to single drug usage.

Abstract:Objective To assess aortic compliance in mild chronic renal insufficiency (CRI) patients by non-invasive Doppler ultrasound technique and to analyze its risk factors.Methods The subjects consisted of 109 CRI patients and 50 age-and gender-matched healthy controls.Pulse wave velocity (PWV) in the aorta,as the parameter reflecting aortic compliance,was measured non-invasively using Doppler ultrasound technique.All subjects underwent physical examination,routine blood test,and biochemical blood test.Renal function was estimated by the serum creatinine level.Glomerular filtration rate was obtained by the Modification of Diet in Renal Disease formula.Results Aorta PWV was significantly faster in mild CRI patients than in controls 〔(9.36±0.27) m/s vs (7.15±0.18) m/s〕.Total cholesterol,systolic blood pressure(SBP)and serum creatinine level were significantly higher in mild CRI patients than in controls,while glomerular filtration rate(GFR)and hemoglobin level were significantly lower in mild CRI patients than in controls.Step-by-step multivariate regressive analysis demonstrated that age,SBP and GFR had close relationship with PWV (P< 0.05);and the regressive formula was PWV=0.592+0.06×age+0.12×SBP+0.076×GFR.Conclusion There is decreased aortic compliance in mild CRI patients,which is closely related with impairment of renal function.Early diagnosis and treatment of aortic compliance in mild CRI patients are beneficial to the prognosis and prevention of complications.

Abstract:Objective To investigate the optimal strategy for preventing contrast medium-induced nephropathy(CIN)in elderly diabetic patients undergoing percutaneous coronary intervention (PCI).Methods Two hundred and fifty-six consecutive elderly diabetic patients who underwent percutaneous coronary interventions were enrolled.Patients were randomized into iopromide (A,n=85),iopromide plus hydration therapy (B,n=87),and iodixanol (C,n=84)group.Serum creatinine (SCr) levels were assessed at baseline and 3 d after the procedure.The primary end point was the incidence of CIN,which was defined as a 25% increase of SCr concentration 48 h after the procedure.Results The amount of contrast medium used,baseline SCr levels,and SCr clearance were not significantly different among the 3 groups.CIN incidence was lower in group B than in group A (8.0% vs 18.8%,P<0.05),and was not significantly different between group B and group C (13.1%).Conclusion Compared with single use of contrast medium,the combined hydration therapy is extremely important for the prevention of contrast medium-induced nephropathy in the elderly diabetic patients who are scheduled to undergo PCI.

Abstract:Objective To evaluate the response and potential reasons of cardiac resynchronization therapy (CRT) in patients with refractory congestive heart failure (CHF) and atrial fibrillation (AF).Methods Five cases of CHF complicated by AF from March 2003 to March 2007 were enrolled.Among them,there were four cases of dilated cardiomyopathy and one case of ischemic myopathy,with NYHA class Ⅲ-Ⅳ.Left ventricular leads were successfully implanted via coronary sinus in 4 patients.It failed in one case,and then,the case was subjected to pacing at two sites of right ventricle,including high septum aspect of right ventricle and apex.Results The average follow-up duration was 12±13 months.At the final follow-up visit,improvements in symptoms,quality of life and exercise tolerance in all patients were observed,and NYHA class increased by 0+-2 grades.The average percentage of biventricular pacing (BiV-p) was (90±9)%.Case 2,4,and 5 suffered ventricular premature beat frequently,with lower percentage of BiV-p (77%-83%).The percentage of BiV-p in case 2 increased from 83% to 95% after administration of amiodarone.All 5 patients died within 1-33 months after implantation,among which,3 died of deterioration of heart failure and 2 of ventricular arrhythmias.Conclusion CRT is effective in treating CHF patients complicated by AF.High percentage of BiV-p is one of the key factors influencing the response of CRT in this group of patients.For CHF patients with AF,CRT may need to be considered in the earlier stage of CHF.CRT-defibrillator treatment may be more suitable in some of these patients.?更多

Abstract:Objective To compare patient’s comfort after hemostasis with arteriotomy closure device versus manual or device compression after percutaneous coronary interventions (PCI) in the elderly patients and evaluate their impact on nursing procedures.Methods A total of 396 elderly (aged 60 years or over) patients who underwent PCI were enrolled in this study.Patients were divided into 3 groups according to whether receiving manual compression (group A,n=162),Femostop device compression (group B,n=128) or arteriotomy closure with Perclose for hemostasis (group C,n=106) after PCI.Changes of heart rate,blood pressure,degree of insomnia,dysuria,gastrointestinal symptom score and bleeding or thrombotic events were recorded before and at 6 h,24 h after PCI procedure.Results Compared with those patients receiving either manual compression or Femostop compression,patients receiving Perclose vascular closure showed less fluctuation of vital signs and better indexes of post-procedure comfort,with lower rate of post-procedure bleeding,but no differences were observed between those receiving Femostop or manual compression.No difference in thrombotic complications was found among three groups.Conclusion Hemostasis with arteriotomy closure device may improve post-procedure comfort and reduce bleeding complications in elderly patients.Different nursing protocol should be adapted for patients receiving different hemostasis to improve efficiency and quality of nursing care.

Abstract:Objective To investigate the effects of procyanidins on human umbilical vein endothelial cells(HUVECs) lipid peroxidation induced by reactive oxygen species.Methods HUVECs were cultured in vitro with DMEM containing 100 g/L calf serum.Different concentrations of H2O2,as extraneous reactive oxygen species,were incubated with HUVECs.Effects of procyanidins on the proliferation of HUVECs were determined by 3H-TdR incorporation and cell cycle phase analysis.Results H2O2 exhibited concentration-dependent inhibitory effects on the proliferative activity of HUVECs.Procyanidins prohibited the lipid peroxidation injury of HUVECs induced by H2O2 in concentration-dependent manner.Conclusion Procyanidins protects HUVECs against lipid peroxidation injury induced by H2O2.It may have potential clinical implication in the prevention and treatment of the coronary restenosis after percutaneous coronary intervention.

Abstract:Objective To investigate the electrophysiological characteristics and atrial structures in the canine models of persistent atrial fibrillation (AF) prepared with rapid pacing of pulmonary vein.Methods Thirty canines were randomly divided into experimental group (n=15) and control group (n=15).Canines in experimental group underwent persistent pacing of pulmonary vein (PV) at 20 Hz to induce AF model (>24 h).Biatrial areas were measured using two-dimensional echocardiography before and after rapid pacing of PV.Six mapping electrodes patches were used to record the electrophysiological characteristics of four PVs,left atrium (LA) and right atrium (RA).Effective refractory period (ERP) and atrial fibrillation cycle length (AFCL) were also measured.Results Persistent AF (>24 h) was successfully induced in 11 canines in experimental group within (28.2±3.0) d.At the end of the pacing period,biatrial areas were enlarged significantly 〔LA:(6.9±1.1) cm2 vs (11.7±1.6) cm2 (P<0.001);RA:(4.3±0.8) cm2 vs (7.0±1.2) cm2 (P<0.001),respectively〕.Compared with the control group,the ERP of atriums and four PVs in the experimental group were shortened significantly.There was also an ERP/AFCL gradient on different positions in experimental group after pacing.ERP/AFCL in the RA free wall was significantly longer than that in the PVs and LA free wall (P<0.05).Conclusion In canine model of persistent AF induced by rapid pacing of PV,the changes of electrophysiological characteristics and atrial structures may be involved in mechanism of persistent AF.?更多

Abstract:Objective To investigate the effects of astragaloside Ⅳ (XGA) on metabolism of cardiac collagen in rats and its possible mechanisms.Methods The myocardial fibroblast cells (FBC) were isolated from rats by collagenase and trypsinase digestion method,and cultured stably.After incubation with different concentrations of XGA for various durations,the mRNA expression levels of typeⅠ,Ⅱ,Ⅲ collagens,matris metalloproteinase-1 (MMP-1),MMP-2,MMP-9,tissue inhibitor of metalloproteinase-1 (TIMP-1),and TIMP-2 in the cells were measured.The rat models of acute myocardial infarction were induced by ligation of left anterior descending coronary artery and the survivors were randomly divided into ischemic group and XGA group;meanwhile,normal group and sham-operated group were also established.After administration of different doses of XGA (0.5-10.0 mg/kg)for various durations (7-28 d),the serum concentrations of angiotensinⅡ (AngⅡ),endothelin (ET),carboxyterminal procollagen typeⅠpropeptide (Ⅰ-CTP) and aminoterminal procollagen typeⅢpropeptide (P-Ⅲ-NP) were measured.The alteration of myocardial collagen was observed with Masson’s staining,and the expression levels of MMP-2,MMP-9,and TIMP-1 in myocardial tissue were detected immunohistochemically.Results XGA reduced the mRNA expression levels of typeⅠ,Ⅲ and Ⅳ collagens,TIMP-1,and TIMP-2,and elevated the mRNA expression levels of MMP-1,MMP-2,and MMP-9 in FBC in a concentration-and time-dependent manner.After XGA administration,the serum levels of P-Ⅲ-NP,Ⅰ-CTP,AngⅡ,and ET decreased significantly in all dose groups except 0.5mg/kg group,and the ratio of MMPs/TIMP increased markedly in 5 and 10mg/kg groups compared with ischemic group,and the effects were in a dose-dependent manner.Except ET at all predetermined time points and the ratio of MMPs/TIMP on day 7,all the serum indices decreased markedly after XGA administration at a dose of 10 mg/kg,and the ratio of MMPs/TIMP increased significantly;the effects were in a time-dependent manner.Conclusion XGA can markedly reduce the myocardial collagen formation,and the mechanisms are possibly related with its roles in inhibiting collagen synthesis and promoting collagen degradation.?更多

Abstract:1 病历摘要患者男性,65岁,主因“晕厥1小时”于2009年12月29日入院。患者入院前无明显诱因出现左侧胸闷、胸痛(呈撕裂样痛)、憋气,伴心悸,随即晕厥,遂来北京军区总医院急诊。既往体健。查体:体温36 .1℃,脉搏110次/min,呼吸18次/min,血压60/30 mmHg。浅昏迷,烦躁状态,半卧位,左侧鼻唇沟变浅,口角向左偏斜。心率110次/min,律齐,各瓣膜区未闻及病理性杂音。辅助检查:血常规:白细胞26 .12×109/L,中性粒细胞0 .898。血生化:血糖12 .7 mmol/L,肌酐220μmol/L。凝血功能:血浆凝血酶原时间18 .8 s ,