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Abstract:Arrhythmia is a quite common disorder in elderly population, and presents with different characteristics from young people, such as with different severity of clinical manifestation, without malaise, showing cerebrovascular accident features, and so on. Better understanding of its characteristcis is significant in prevention and recovery of arrhythmia in elderly population.

Abstract:Atrial fibrillation is a serious clinical problem and its incidence increases with age. Embolism caused by atrial fibrillation can lead to a lot of complications with high mortality and disability rate. One-year incidence of stroke in patients with atrial fibrillation who receive no therapy is 5%. In clinical practice, age is an important factor for risk stratification of embolism and guidance of anticoagulation in atrial fibrillation patients. Anticoagulation intensity should be decreased appropriately to prevent hemorrhage in patients who are ≥75 years old, have abnormal kidney function and/or poorly controlled blood pressure.

Abstract:Objective To evaluate the efficacy and safety of catheter ablation for paroxysmal atrial fibrillation(AF) in elderly patients. Methods A cohort of 85 consecutive patients undergoing initial ablation procedure for drug-refractory AF was included in this study. Patients were divided into elderly group (≥60 years, 45 cases) and non-elderly group (＜60 years, 40 cases). All patients received circumferential pulmonary vein isolation procedure successfully. Recurrence of AF was observed. Results During (37.2±3.2) months follow-up, 23 cases(27.1%) had AF recurrence. No significant difference was found between elderly and non-elderly groups (12/45 vs 11/40, P = 0.931). No patient developed severe ablation-related complication. Conclusion Catheter ablation is an effective and safe treatment for paroxysmal AF in non-elderly patients, as well as in elderly patients.

Abstract:Objective To investigate the relationship between interleukin-18(IL-18)/interleukin-10(IL-10) ratio and the development of acute coronary syndrome(ACS) in stable angina pectoris(SAP) patients so as to provide new ideas for prevention of ACS. Methods The plasma IL-18 and IL-10 levels were measured by enzyme-linked immunosorbent assay in 215 SAP patients. The patients were divided into 2 groups: ACS group(group A, n=38) and non-ACS group(group B, n=173) according to the results of 24-month follow-up. Results Plasma IL-18 level and IL-18/IL-10 ratio were higher in group A than in group B[(229±77) vs (166±50) ng/L, (2.4±0.7) vs (1.6±0.6) respectively, P＜0.01]. Plasma IL-10 level was lower in group A than in group B[(101±37) vs (115±38)ng/L, P＜0.05]. Logistic regression analysis showed that high IL-18/IL-10 ratio increased the relative risk of ACS in SAP patients by 3.935 times(P＜0.01). Conclusion The plasma IL-18 and IL-10 levels are closely related to the development of ACS in SAP patients. Higher IL-18/IL-10 ratio is predictive of ACS development in SAP patients, which suggests that inflammation is an important enhancing factor for developing ACS, and anti-inflammatory treatment might be a new method for preventing ACS.

Abstract:Objective To evaluate the clinical value of N-terminal pro-brain natriuretic peptide (NT-proBNP) detection in elderly patients with acute dyspnea. Methods Based on the etiology, 202 elderly patients with acute dyspnea were divided into three groups: simple pulmonary disease(PD) group(A), simple congestive heart failure(CHF) group (B), and CHF and PD combination group (C). NT-proBNP levels, echocardiogram, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) classification were assessed in all subjects. NT-proBNP levels were compared between different groups. Correlations of NT-proBNP levels with NYHA classification and LVEF in group B and C were analyzed. Results NT-proBNP level was significantly lower in group A than in group B and C [(197.5±64.3) vs (1873.9±857.1) and (1952.4±914.8)ng/L, P＜0.01], and was not significantly different between group B and C (P＞0.05). This indicated that NT-proBNP level was significantly higher in patients with cardiac dyspnea than those with pulmonary dyspnea. NT-proBNP level increased gradually in patients with NYHA Ⅱ, Ⅲ and Ⅳ heart function [(562.37±102.4), (2736.72±81.67), (5873.19±127.73) ng/L respectively, P＜0.01], indicating that higher level of NT-proBNP in patients with higher heart functional class. Person linear correlation analysis showed that NT-proBNP level was negatively correlated with LVEF (r= ?0.689, P＜0.01), indicating that higher NT-proBNP level corresponds with lower LVEF and poorer heart function. Conclusion NT-proBNP plays a key role in differential diagnosis of cardiac and pulmonary dyspnea in elderly patients and its level is closely related with the severity of heart failure.

Abstract:Objective To explore the effect of homocysteine(Hcy) on the prognosis of coronary artery heart disease(CHD) and stroke. Methods Totally 234 patients with CHD or stroke were divided into control group and folic acid-therapy group randomly. Patients in control group were comprehensively treated with antihypertensive, lipid-adjusting, hypoglycemic and anti-platelet aggregation drugs, while patients in folic acid-therapy group were given oral folic acid tablets(10 mg per day) besides above treatment. Period of treatment was one year and patients were all followed up. Plasma Hcy levels were measured prior treatment, 6 months and 12 months post treatment and the incidences of clinical event with coronary artery heart disease(acute left heart failure, acute myocardial infarction, sudden cardiac death, angina pectoris attack and arrhythmia) and stroke(apoplexy, transient ischemic attack or reversible ischemic injury, cerebral hemorrhage) were also monitored. Results There was no significant difference in plasma, Hcy between control group and folic acid-therapy group at prior treatment and 6 months post treatment(P＞0.05). However, 12 months after treatment plasma, Hcy level in folic acid-therapy group was significantly lower than that in control group(P＜0.05). The incidences of clinical event with CHD and stroke were 11.02% and 26.92% respectively in control and olic acid-therapy group 12 months after treatment (P＜0.05). Logistic regression analysis showed that the incidences of clinical event with CHD and stroke were related with diabetes mellitus and Hcy (P＜0.05, P＜0.01); moreover, Hcy was a risk factor of CHD and Stroke. Conclusion Hcy is significantly correlated to clinical event with CHD and stroke; oral administration of folic acid can significantly decrease the incidence of clinical event with CHD and stroke through reducing plasma Hcy level and has great function in the secondary prevention of CHD and stroke.

Abstract:Objective To investigate the safety and efficacy of endovascular abdominal aortic aneurysm repair(EVAR)in nonagenarians. Methods From May 2003 to March 2011, 12 nonagenarian abdominal aortic aneurysm(AAA) patients, including 2 emergency cases, were treated with endovascular repair. Mean age was (91.7±1.5) years, ranging 90～95 years, and there including 2 emergency cases, were 11 males (91.7%). Technical success rate, perioperative complications and mortality were evaluated. Follow-up protocol consisted of computed tomography (CT) or ultrasound examinations performed at 3, 6, 9, 12 months, and annually thereafter. Results Seven patients were operated under general anesthesia and five under local anesthesia. The technical success rate was 100%, with no need for open conversion. Two Endurant endogafts, four Talent endografts and six Zenith endografts were used. Mean operatiion time was (3.4±1.3)h, mean procedural blood loss was (220.5±60.5)ml, and mean postoperative hospital stay length was (8.4±2.3)d. Mortality rates were 8.3% at 30 days, 16.7% at 1 year, 41.7% at 3 years and 75% at 5 year. Mean survival of the eleven patients who expired beyond the first 30 days was 28.5 months, ranging 9～73 months. Conclusion EVAR in nonagenarians is associated with acceptable procedural success and perioperative morbidity and mortality. The medium and long-term results suggest that EVAR may be of limited benefit in some patients who are aged over 90 years. So the individual patient selection is very important.

Abstract:Objective To explore risk factors for death among critically ill patients in comprehensive hospitals so as to improve the diagnosis and treatment level for these patients. Methods Data of 1735 patients who were admitted to intensive care unit (ICU) during the period of 2005 to 2010 were retrospectively analyzed. Among these patients, there was 198 ICU death and 135 post-ICU death. The characteristics of disease distribution were investigated in different age groups (＜60, 60-80, ≥60 years) among 198 ICU death patients. The death rate and number of organ failure were compared between ICU death and post-ICU death patients. The risk factors for death were analyzed. Results The death rate was significantly higher in elderly group than in non-elderly group, with difference between the two groups (P＜0.01). The death rate displayed an elevating tendency with age increase. Number of organ failure was positively correlated with death rate, which was almost up to 100% when there were more than five organ failures.When organ failure number was less than three, the ICU death rate was significantly less than post-ICU death rate (P＜0.01). According to the distribution of organ dysfunction, the incidence of cardiovascular dysfunction was the highest (51.8%), but with lower death rate. The death rate was comparatively higher in patients with blood system and renal dysfunction (59.3% and 58.7% respectively). The failure organ was different between ICU death and post-ICU death. Conclusion The reduction of death rate in elderly patients ≥60 years is fundamental for reduction of death rate of critically ill patients. To define the original disease and dysfunction organs, to actively control disease development into multiple organ dysfunction syndrome, and to protect main organ functions play important roles in the treatment of critically ill patients.

Abstract:Objective To evaluate the effect of the rehabilitation nursing procedure on linguistic function recovery in patients with broca aphasia after stroke. Methods Fifty patients with broca aphasia admitted to our hospital from February to October in 2010 were divided into rehabilitation group(admission on odd day) and control group(admission on even day). Linguistic function was evaluated before and four weeks after rehabilitation training. Results Compared with control group, linguistic functions, such as fluency, information, spontaneous talking, listening comprehension, retelling, writing and reading, were improved significantly in rehabilitation group[(65.1±6.1) vs (46.5±1.5), (61.2±2.7) vs (44.8±3.2), ( 61.4±2.3) vs (45.6±1.9), (64.8±6.1) vs (45.6±1.5), (62.6±2.8) vs (43.7±3.1), and (60.4±2.3) vs (46.1±1.8) respectively, P＜0.01]. Conclusion Patients with broca aphasia after stroke should undertake rehabilitation training procedure as early as possible, which can promote the recovery of linguistic function and improve life qualitg of patients.

Abstract:Objective To investigate cerebrovascular reserve(CVR) changes after carotid angioplasty and stenting(CAS) in patients with diabetes mellitus(DM). Methods Fifty-five patients with asymptomatic carotid artery stenosis(≥70%) or symptomatic carotid artery stenosis(≥50%) were divided into DM group(n=16) and non-DM group(n=39). Hypercapnia was induced by inhaling a mixture gas of 5% CO2 and 95% O2, and the changes of blood velocity were recorded in both sides of middle cerebral artery(MCA) before and after CAS. CVR was compared between the two groups before and after CAS. Results CVR was significantly lower in DM group than in non-DM group preoperatively [(8.43±12.80)% vs (29.65±18.23)%, P＜0.05]. After CAS, there was no significant difference in CVR between the two groups[(36.46±15.32)% vs (45.68±13.17)%, P＞0.05]. After CAS, CVR was significantly increased on both the stenosis side [(18.43±12.80)% vs (36.46±15.32)%, P＜0.05] and contralateral side in DM group[(30.40±16.48)% vs (38.28±15.00)%, P＜0.05]. In both two groups, CVR was improved more significantly in stenosis side than in the contralateral side(P＜0.01; P＜0.05). Conclusions DM worsens CVR of the patients with severe carotid artery stenosis. The DM patients and non-DM patients benefit equally from CAS. So, DM can not be a predictive factor for stent placement.

Abstract:Objective To investigate the clinicopathological features of basal-like breast carcinoma and its significance. Methods A total of 105 patients with breast carcinoma were enrolled in this study, including 22 cases of luminal type A, 23 of luminal type B, 20 of basal-like, 23 of HER2-enriched and 17 of normal breast-like. The expressions of p53, E-cadherin, matrix metalloproteinase-7(MMP-7), Ki-67 in tumour cells were examined immunohistochemically. The clinicopathological features were analyzed statistically. The follow-up period ranged from 6 to 60 months. Results For the five breast tumor subtypes, sequentially luminal A, luminal B, basal-like, HER2- over-expression, and normal breast-like, the mean age was 54.5, 51.1, 48.8, 52.0 and 56.0 years respectively, and the rate of elderly was 20.0%(5/20) in basal-like tumor; the mean tumor size was 3.4, 3.5, 2.1, 3.0 and 3.5cm respectively; the 5-year tumor-free survival rate was 78.3%(17/22), 73.9%（17/23）, 40.0%（8/20）, 65.2%（15/23） and 70.6%（12/17） respectively, significantly lower in basal-like subtype(P＜0.05); p53 positive expression rate was 22.7%, 26.1%, 60.0%, 56.5% and 23.5% respectively, significantly higher in basal-like and HER2-over-expression subtypes (P＜0.05); E-cadherin positive expression rate was 100.0%, 100.0%, 80.0%, 100.0%, and 100.0% respectively, lower in basal-like subtype(P＜0.05); MMP-7 positive expression rate was 40.9%, 52.2%, 85.0%, 69.6% and 64.7% respectively, higher in basal-like subtype than in luminal A and B subtypes(P＜0.05). Ki-67 index was divided into three levels (＜10%, 10%-30%, ≥30%) . The positivity rate of Ki-67＜10% was 59.1%, 39.1%, 25.0%, 30.4% and 29.4% respectively; that of Ki-67 10%-30% was 36.4%, 52.2%, 40.0%, 52.2% and 58.8% respectively; that of Ki-67≥30% was 4.5%, 8.7%, 35.0%, 17.4% and 11.8% respectively. The basal-like subtype had higher proliferation index in all three levels(P＜0.01). Log-rank analysis suggested that the genotyping was not related to the prognosis of the breast carcinoma(P＞0.05). Conclusions Compared to other subtypes, basal-like breast carcinoma is usually found in younger patients before menopause. The basal-like breast carcinoma has a poor prognosis and high invasion ability and high mutation rate of p53.

Abstract:Objective To explore the effects of different levels of exogenous testosterone on atherosclerosis，sex hormone, blood lipid and apolipoprotein in castrated rabbits. Methods Thirty-five male New Zealand white rabbits were randomly divided into sham operation group, placebo group, hypotestosteronemia group(3 mg/kg), physitestosteronemia group(6 mg/kg), hypertestosteronemia group(12 mg/kg), with 7 in each group. Total testosterone (TT), estradiol (E2), dehydroepian?drosterone(DHEA) lipids, total cholesterol(TC), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), triglyceride(TG), apolipoprotein A1(ApoA1), and apolipoprotein B(ApoB) were tested at 1 week before operation and 16 weeks after operation respectively. Atherosclerosis index(AI) was obtained(AI=(TC－HDL-C/HDL-C). After 16 weeks, the aorta was observed morphometrically and immunohistologically, and the aortic cholesterol content was examined. Results Average serum lipids, atherogenic lipoproteins and apolipoproteins were significantly higher in placebo group, hypoteststeronemia and hypertestosteronemia groups than in sham operation group and physitestosteronemia group(P＜0.01). The aortic cholesterol content was (75.8±5.9), (76.3±6.1) and (75.2±2.3)mmol/g protein respectively in placebo group, hypoteststeronemia group and hypertestosteronemia group, with no significant difference between the three groups (P＞0.05), which was 2.5 times of that of physitestosteronemia group[(21.0±5.6)mmol/g protein]. The aortic cholesterol content was (21.0±5.6) and (30.9±8.4) mmol/g respectively in physitestosteronemia group and sham operation group(P＜0.01). The ratio of intima/tunica media was (0.65±0.21), (0.62±0.24) and (0.65±0.25) respectively in placebo group, hypoteststeronemia group and hypertestosteronemia group respectively, with no significant difference between the groups(P＞0.05), which was higher obviously than that in sham operation group [(0.31±0.07), P＜0.01]. It was the lowest in physitestosteronemia group (0.26±0.08), which was significantly lower than that in sham operation group(P＜0.01). Conclusions Exogenous testosterone, only at physiological level, has beneficial effects on serum lipids, lipoproteins, apolipoproteins and atherosclerosis in castrated male rabbits.

Abstract:Objective To investigate the effects of tetrandrine(Tet) on expression of pro-inflammatory factors, including TNF-α, IL-1β and IL-6, in rat suffering from cardiac ischemia/reperfusion(I/R) injury, and the mechanism through which Tet attenuates cardiac I/R injury. Methods Totally 80 male Sprague-Dawley(SD) rats were randomly divided into 4 groups: sham group, I/R group, Tet group and simvastatin(Sim) group. The SD rats in I/R group were subjected to 30- min left anterior descending (LAD) coronary occlusion and 24-h reperfusion to make I/R injury model in vivo. The rats in sham group were not subjected to similar procedures except artery occlusion. The rats in Tet group received abdo minal injection of Tet at 20 min before I/R injury. The rats in Sim group received intragastric ad ministration of Sim (2 mg/kg) for 14 days before I/R injury. Cardiac function was assessed using two-dimensional(2-D) ultrasound, including left ventricular end-diastolic dimension(LVDd), left ventricular end-systolic dimension(LVDs), fractional shortening(FS), and left ventricular ejection fraction(LVEF). The serum levels of creatine kinase (CK) and lactate dehydrogenase (LDH) were detected. The expression levels of TNF-α, IL-1β and IL-6 in serum and myocardial tissue were detected by ELISA. The neutrophil infiltration degree in myocardium was deter mined by measuring the activity of myeloperoxidase (MPO) method. Azovan Blue/2,3,5-Tripheny-2H-Tetrazoliam Chloride (EB/TTC) dyeing method was used to measure the infraction size. Results The LDH and CK levels were significantly higher in I/R, Tet and Sim groups than in sham group (P＜0.01), and were much lower in Tet and Sim groups than in I/R group (P＜0.01); there was no difference between Tet and Sim groups (P＞0.05). Myocardial infarction size, ratio of infarction size to left ventricular myocardial size, and ratio of infarction size to ischemia size were lower in Tet and Sim groups than in I/R group (P＜0.01); there was no difference between Tet and Sim groups (P＞0.05). Compared with sham group, FS, LVEF and E/A were decreased significantly in I/R, Tet and Sim groups(P＜0.01), which was higher in Tet and Sim groups than in I/R group(P＜0.01). The activity of MPO was significantly higher in I/R, Tet and Sim groups than in sham group (P＜0.01), and in Tet group than in Sim group (P＞0.05); there was no difference between Tet and Sim groups (P＞0.05). The levels of TNF-α, IL-1β and IL-6 were significantly higher in in I/R, Tet and Sim groups than in sham group (P＜0.01), and in Tet and Sim groups than in I/R group (P＜0.01); there was no difference between Tet and Sim groups (P＞0.05). Conclusion Tet can attenuate myocardial I/R injury. It achieves this pharmacologic action through reducing the levels of harmful cytokines including TNF-α, IL-6 and IL-1β.

Abstract:Objective To investigate the effects of mesenchymal stem cells(MSCs) derived from recipients’ bone marrow on the acute rejection in rat models of cardiac transplantation and to study the possible underlying mechanisms. Methods Twenty Wistar rats bearing transplanted heart from Lewis rats were divided randomly into control group and MSCs treatment group, with 10 in each group. The rats in control group received 3ml 0.9%NaCl solution injection through tail vein at 24h after heart transplantation. The rats in treatment group received 2×106 MSCs suspended in 3ml 0.9%NaCl solution instead. One week after transplantation, 4 rats selected randomly from each group were sacrificed for detection of interleukin(IL)-2 and IL-10 levels in inferior canal vein by ELISA and immunohistolochemical examination. The left 6 rats in each group were used for determination of the grafts survival time. Results The survival time of allografts was (7.2±1.3)d in control group and (14.8±2.9)d in MSCs treatment group respectively(P＜0.01). Serum IL-2 concentration was (233.99±30.19) ng/L in control group and (249.11±20.34) ng/L in MSCs treatment group(P＞0.1). Serum IL-10 concentration was (81.44±11.01) ng/L in control group and (158.39±18.70) ng/L in MSCs treatment group(P＜0.01). In control group, there was 1 case with pathological grade 3B and 3 cases with grade 4. In MSCs group, there was 1 case with grade 2, 2 cases with grade 3A, and 1 case with grade 3B. MSCs treatment group had comparatively lower pathological grade than control group. Conclusion Intravenous infusion of MSCs derived from recipients could prolong the survival time of transplanted heart and reduce the acute rejection.

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Abstract:Ghrelin, a 28-amino-acid peptide, is an endogenous ligand for the growth hormone secretogogue receptor(GHS-R). It has been shown that the expression and function of ghrelin and its receptor change in heart failure. In addition to promoting growth hormone secretion, ghrelin has direct positive inotropic effect on cardiomyocytes, inhibit the apoptosis of cardiomyocytes and ventricular remodeling, protect myocardium directly, improve the disturbed myocardial energy metabolism and cardiac function, and attenuate the development of cardiac cachexia. It is suggested that ghrelin may have potential effects on the treatment of heart failure.

Abstract:With the progressive increase of aging population in recent years, the prevalence of ischemic bowel disease induced by arteriosclerosis has strikingly increased. However, this disorder has high rates of missed diagnosis and misdiagnosis because of its atypical clinical symptoms. Therefore, the early diagnosis of ischemic bowel disease needs further research. Intestinal fatty acid binding protein is abundant in small intestinal tissue and has the following characteristics: (1)a soluble protein in the cytoplasm; (2) high tissue specificity; (3) abundance in the tissue; (4) small molecular weight and easy detection. Currently, intestinal fatty acid binding protein is widely used in the research of diagnosis of ischemic bowel disease. In this paper, we summarized the definition and the mechanism through which intestinal fatty acid binding protein play its roles, and the research progress of its role in the diagnosis of ischemic bowel disease in view of animals experiments and clinical research.

Abstract:Chymase, as a serine protease, is mainly secreted by mast cells. It has multiple biological effects and is invloved in a variety of human diseases. Numerous studies indicated that chymase plays an important role in the pathogenesis of liver fibrosis. In this paper, we reviewed its structure, distribution characteristics, biological effects, and its close relationship with liver fibrosis, so as to understand its roles in the pathogenesis of liver fibrosis.

Abstract:Aspiration is defined as the inhalation of oropharyngeal or gastric contents into the lower respiratory tract, or the situation that substances from the outside environment are accidentally inhaled into the lungs. The elderly individuals are at high risk of aspiration, while asphyxiation and pneumonia caused by aspiration are two most common causes of death among the elderly. Aspiration can be clinically classified as dominant and occult. The dominant aspiration can be easily diagnosed based on typical clinical symptoms, while there is a high rate of missed diagnosis on occult aspiration because of its hidden clinical manifestation. In this paper, we summarized various diagnostic methods for aspiration, especially the occult aspiration in the elderly.

Abstract:Senile pruritus, a common chronic skin disease in the elderly, is a serious disease affecting the health of elderly patients because of its endurable itching and lack of effective treatment. The pathogenesis of senile pruritus is complex, which is mainly due to a series of physiological or pathological changes caused by aging, including the degeneration of the skin and the changes in immune function and endocrine system. Currently, the integrated traditional Chinese medicine and western medicine is ideal for therapy of senile pruritus. In this paper, we reviewed the etiology, pathogenesis and treatment of senile pruritus.

Abstract:Euthyroid sick syndrome(ESS) is a condition where the thyroid function is abnormal because of the systemic disease outside the thyroid gland, surgery, or fasting, etc. ESS can be seen in all ages, but is most common in the elderly, and the most common type is low-T3 syndrome. Mechanism of low-T3 syndrome includes bodily "protective" defense, selenium deficiency, hypothalamus-pituitary-thyroid axis abnormalities, thyroid hormone binding globulin (TBG) changes, and so on. The risk of low-T3 syndrome significantly increases in the elderly with diabetes, heart failure, chronic respiratory diseases and surgery, etc. These geriatric diseases complicated with low-T3 syndrome suggest more serious condition and worse prognosis, so it is very important to have an accurate judgement for the thyroid function. Whether low-T3 syndrome needs treatment or not is still highly controversial.

Abstract:The current diagnostic criteria for chronic kidney disease(CKD) has ignored the particularity of the aged in many aspects. On the assessment of renal function, serum creatinine is affected by many factors, such as the amount of muscle, diet, and so on. Thus all of the creatine-based glomerular filtration rate(GFR) estimations are prone to bias, especially for the elderly. Recently, it has been observed that Cys C may be a more precise endogenous maker of GFR, for it is affected by less factors. On the staging of CKD, one of the major problems is overdiagnosis of old people. It is suggested that stage 1 and 2 should be eliminated and stage 3 needs to be further splited into two parts. However, these considerations remain controversial. Besides, to improve the prognosis evaluation of CKD, it is necessary to combine albuminuria and GFR together to estimate the progression of end-stage renal disease and the risk of all-cause and cardiovascular mortality.