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Abstract:With the rapid population aging in China, the prevalence of rheumatic diseases in the elderly increases gradually. Compared with the young people, the incidence of osteoarthritis and polymyalgia rheumatica in the elderly people is higher. The clinical manifestations of rheumatoid arthritis, systemic erythematosus and spondyloarthropathy are different compared with the young patients. Individualized treatment strategy should be chosen based on the clinical characteristics and comorbidities in the elderly patients. Furthermore, adverse drug reaction should be emphasized specifically. This paper summarized the clinical features and therapeutic strategy of several common rheumatic diseases in elderly patients.

Abstract:Objective To investigate the relationship of bone mineral density(BMD) with age in ankylosing spondylitis(AS) patients, which might benefit prevention and treatment of low BMD or osteoporosis (OP) in AS. Methods Fifty AS outpatient (modified New York criteria) were selected and divided into two groups by age, ≤40 years and ＞40 years. BMD were measured by dual-energy X-ray absorptiometry, in lumbar (L1-L4), femoral neck and hip. T value not more than -1.0 was defined as lower bone density, including osteopenia (-2.5＜T＜-1.0) and osteoporosis (T≤-2.5). Results Based on measurement of lumbar, percentage of low BMD was higher in two AS groups than normal controls, and was higher in ＞40 years AS group than in ≤40 years group(P＜0.05). T value was lower in ＞40 years AS group than in ≤40 years group (P＜0.05). While based on measurement of femoral neck and hip, the incidences of low BMD and osteoporosis were not significantly different between two AS groups(P＞0.05). Conclusions AS patients may appear osteopenia or osteoporosis at early stage. The incidence of low BMD and the risk of fracture increase with aging. Vigilance to AS complicated with osteoporosis and timely calcium supplement are recommended clinically, to improve the patients￠ quality of life.

Abstract:Objective To analyze the profiles of antinuclear antibody(ANA) in senile primary biliary cirrhosis(PBC) patients. Methods Indirect immunofluorescence was used to test ANA in the serum samples of 70 senile PBC patients and of 360 aged-matched controls, including 120 health individuals, 80 patients with viral hepatitis, 40 with reumatoid arthritis, 30 with autoimmune hepatitis, 30 with mixed connective tissue disease, 30 with systemic lupus erythematosus, and 30 with systemic sclerosis. Immunoblot analysis was applied to examine AMA-M2, antinuclear dots pattern SP100 antibody and antinuclear membrane pattern gp210 antibody. Results In the 70 senile PBC patients, there were 66 positive with ANA (94%), with 43 cases of mixed immunofluorescence patterns. The positivity rate of AMA-M2 was 90%. For major immunofluorescence patterns of ANA in the senile PBC, the sensitivity was 88% (62/70), and the specificity was 91.6% (330/360). More over, 83.3% of senile PBC patients had ANA titer ≥1∶1000, which was significantly different from the controls (P＜0.01). Conclusion Immunofluorescence patterns of ANA in senile PBC patients are nuclear membrane pattern, nuclear dots pattern, centromere pattern and cytoplasm speckled pattern, and they usually present as mixed immunofluorescence pattern. ANA is of great value in the diagnosis of senile PBC.

Abstract:Objective To summarize the clinical performance of patients with polymyalgia rheumatica (PMR) and analyze the misdiagnosed cases to improve the diagnostic processes. Methods The clinical data, response to treatment and the spectrum of disease misdiagnosed at first visit in 38 patients with PMR were analyzed retrospectively. Results Sex ratio of male to female in the study population was 1︰2.8 and mean disease onset age±standard deviation (SD) was (68.2±10.4) years. Twenty-two patients (57.9%) presented with neck and shoulder pain. Shoulder and pelvic girdle aching were reported in 16 patients (42.1%). Tender in knee and hip joints were observed in 18 patients (47.3%). Seventeen patients (44.7%) accompanied with morning stiffness. Twenty patients exhibited fever. Eleven patients (28.9%) developed giant cell arteritis. Elevated erythrocyte sedimentation rate (ESR) [(85.8±30.2)mm/h] were observed in all patients. Twenty-four patients (63.1%) were misdiagnosed at first as respiratory infectious diseases or bone and joint disorders. Eighteen patients (47.3%) accepted glucocorticoid mono-therapy. Fifteen patients (39.4%) received combination therapy of glucocorticoid and methotrexate. Five patients (13.1%) were treated with glucocorticoid plus Tripterygium wilfordii. Conclusion PMR is a common rheumatic disease characterized by aching pain in the proximal muscle groups. It mainly affects middle aged people and elderly and is accompanied by fever, arthritis and marked elevation of ESR. Response to glucocorticoid treatment is rapid and dramatic in PMR. Improvement in the diagnosis and treatment of PMR should be pursued due to the increase of incidence in elderly population.

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Abstract:Objective To study the pharmacogenomic-associated factors of clopidogrel antiplatelet reactivity in Han Chinese elderly patients with acute coronary syndrome(ACS). Methods During September 1st, 2011 to September 1st, 2012, ACS patients over 60 years were continuously enrolled from hospitalized patients in Institute of Geriatric Cardiology, Chinese PLA General Hospital, following strict inclusion criteria. All of the enrolled patients were prescribed with normal dose of aspirin and clopidogrel. The adenosine diphosphate (ADP)-induced platelet aggregation rate on the 5th day was determined by light transmission aggregation (LTA). SnapShot method was applied to detect candidate gene variants, which related with clopidogrel metabolism and activity (including PON1 Q129R, CYP2C19*2, CYP2C19*3, CYP2C19*17 and ABCB1 C3435T). Results In the total 246 enrolled ACS patients, univariate analysis showed that only CYP2C19*2 variant was significantly related with ADP-induced platelet aggregation rate after stable clopidogrel treatment (P＝0.001). The CYP2C19*2 carriers showed an obviously higher platelet aggregation rate compared with the non-carriers [(46.1±21.25)% vs (39.38±19.44)%, P＜0.001]. After adjusting the impact of age, gender, body mass index, comorbidities, concomitant medications and so on, stepwise multiple regression showed that CYP2C19*2 was still significantly related with ADP-induced platelet aggregation rate after stable clopidogrel treatment, which could explain 22.2% variance of clopidogrel antiplatelet reactivity variance (P＝0.001). Conclusion CYP2C19*2 is the major pharmacogenomic determinant which affects clopidogrel antiplatelet reactivity in Chinese Han elderly patients with acute coronary syndrome.

Abstract:Objective To study the relationship of brachial ankle pulse wave velocity(baPWV) with cardiovascular risks and Framingham score, and to estimate the predictive value of baPWV in cardiovascular events. Methods Totally 144 subjects were enrolled and divided into coronary heart disease group (48 cases), non-CHD with cardiovascular risk group (50 cases) and non-CHD without cardiovascular risk group (46 cases). baPWV was detected by artery stiffness testing measurement equipment. Results There was significant difference in baPWV among three groups (P＜0.01). After adjusting age, the difference in baPWV between the three groups was still significant(P＜0.05). baPWV was positively correlated with conventional cardiovascular risks. Moreover, age and systolic blood pressure were independent indicators of baPWV. baPWV was also positively correlated with Framingham risk score. The predictive value of baPWV was reviewed by using receiver operating characteristic (ROC) curve. Area under ROC curve was 0.768 in CHD group and 0.944 in CHD high-risk group. Conclusion There is good relationship between baPWV and cardiovascular risk factors, and the value of baPWV is moderate in predicting CHD and high in screening population with high risk stratification of CHD.

Abstract:Objective To evaluate the clinical effectiveness of Centerpiece system in cervical expansive open-door laminoplasty in elderly patients. Methods Fifty-five patients with cervical spondylotic myelopathy (CSM) undergoing cervical expansive open-door laminoplasty by Centerpiece mini titanium plate fixation (n＝27, mean age 68.3) from Feb. 2009 to Jan. 2010 or by traditional suture suspension (n＝28, mean age 67.5) from Jan. to Dec. 2008 in Department of Orthopedics, West China Hospital, Sichuan University, were enrolled in this retrospective case-control study. The clinical effectiveness was assessed by Japanese Orthopaedic Association (JOA) score, post-operative axial symptoms, C5 nerve root palsy, value of cervical curvature on X-ray film or CT scan, lamina opened angle, and the reclose of opened laminae. Results All patients were followed up for 24 months. There was no significant difference with regard to the improvement rate of JOA score between two groups (51.9% vs 51.8%, P＞0.05). Centerpiece group had significantly higher score in the postoperative axial symptoms than control group (10.3±1.3 vs 9.0±1.9, P＜0.05). C5 nerve root palsy was seen in one case from Centerpiece group and two cases out of control group, and it was relieved by conservative treatment. No significant difference was found in cervical curvature angle in Centerpiece group before operation and at the final follow-up [(17.9°±2.2°) vs (18.1°±2.4°), P＞0.05)], whereas statistical difference was seen in the control group with the angle larger before operation than that at the final follow-up [(17.8°±2.4°) vs (15.7°±2.0°), P＜0.05)]. CT scanning showed that the angle of the opened laminae was maintained and no reclosed open-laminae was seen at the final follow-up. Screw loosening in the laminae was observed in one case from Centerpiece group, but no relative symptom was found. Conclusion Sound clinical outcome is achieved in the treatment of CSM in elderly patients with cervical expansive open-door laminoplasty with Centerpiece titanium miniplate. The fixation reduces postoperative axial symptoms and prevents the loss of cervical curvature.

Abstract:Objective To evaluate the correlation of renal function parameters with serum levels of leptin and adiponectin in patients with hyperlipidemia. Methods Totally 540 cases were enrolled, including 336 patients with hyperlipidemia and 204 cases as normal controls. All patients with hyperlipidemia were divided into 4 subgroups according to their clinical types, including hypercholesterolemia group, hypertriglyceridemia group, mixed hyperlipidemia group, and low high-density lipoproteinemia cholesterol (HDL-C) group. Blood urea nitrogen (BUN), serum creatinine (SCr) concentrations, serum levels of leptin and adiponectin were measured in each group. Results Compared with normal control group, BUN levels in all the groups of hyperlipidemia were higher to various extent, but only the mixed hyperlipidemia group had statistical significance (P＜0.05). BUN levels in the mixed hyperlipidemia group were significantly higher than those in hypercholesterolemia group and hypertriglyceridemia group (P＜0.05). SCr concentrations in hypertriglyceridemia group and low HDL-C group were significantly higher than those in normal controls, as well as than those in hypercholesterolemia group and the mixed hyperlipidemia group (P＜0.05). Adiponectin level in low HDL-C group was higher than that in normal control group (P＜0.05). Leptin concentration in hypertriglyceridemia group was lower than low HDL-C group (P＜0.05). Adiponectin level in hypercholesterolemia group was also lower than that in low HDL-C group (P＜0.05). Conclusion Elevated BUN and SCr levels are observed in patients with hyperlipidemia. Serum levels of leptin and adiponectin may serve as diagnostic and prognostic indicators of renal function injury in patients with hyperlipidemia.

Abstract:Objective To study the value of echocardiography-guided pacemaker parameters optimization in enhancing the efficacy of cardiac resynchronization therapy (CRT). Methods Thirty patients with chronic heart failure received biventricular resynchronous pacing therapy. An optimization procedure was performed with different AV and VV delays. Results The indices of heart function were significantly improved after CRT optimization. Left ventricular filling time (LVFT) was increased, mitral reflux (MR) was decreased, standard deviation of time to regional peak systolic velocity (Ts-12SD) was decreased, left ventricular outflow tract velocity time integral (VTILVOT) was increased, and the end of the left ventricular systolic volume (LVESV) was decreased. Conclusions Echocardiography-guided optimization of AV and VV delay can enhance the efficacy of CRT.

Abstract:Objective To evaluate the application of carbon nanoparticles suspension injection to the axillary lymph node dissection in breast cancer. Methods Sixty-four patients with breast cancer were divided into two groups, one group was given carbon nanoparticles suspension injection before operation, the other was blank control group. All patients received modified radical mastectomy. Lymph nodes were collected and recorded for pathologic examination. Results In the carbon nanoparticles group, lymph nodes and lymph tracts staining were found in the surgery, with an average lymph node detection number of 27.4±5.7 per patient. In the control group, the average number was 21.1±4.2. The difference between the two groups was statistically significant (P＜0.001). In the carbon nanoparticles group, the black staining rate of lymph nodes under naked eye was 84.6% (741/876). The rate of metastasis in black lymph nodes was 33.6% (249/741), in unmapping lymph nodes was 39.3% (53/135). There was no statistically difference between the two groups (P＝0.257). Conclusion Carbon nanoparticles suspension injection is helpful for axillary lymph node dissection and evaluation of metastatic status of the axillary lymph nodes in breast cancer.

Abstract:Objective Our previous study had proved that long-term atorvastatin administration notably improves the pathological aging changes of kidney. The aim of this study was to find the underlying mechanism of different doses atorvastatin in attenuation of the aging changes in the kidneys. Methods Twenty-month-old normal female Wistar rats were divided into 3 groups (n=9 for each group), that is, aged control group, large and small dosed atorvastatin groups. The rats from the corresponding groups were treated with normal saline, or atorvastatin at 10 or 1 mg/(kg?d) respectively through intragastrical injection for 4 months. All rats were sacrificed at the end of treatment, and another 9 rats at the age of 3 months served as normal controls. The expression of matrix metalloproteinase (MMP-9, -2), tissue inhibitors of metalloproteinase (TIMP-1, -2), transforming growth factor-b1 (TGF-b1) and peroxisome proliferators activated receptors (PPARs) at mRNA and protein levels in the kidney tissues were detected by RT-PCR and Western blotting respectively. Results The rats at 24 months old had significantly increased expression of MMP-9 and TGF-b1 than those at 3 months old (P<0.05, P<0.01). But no change was found in the expression of TIMPs and PRARs between them. Atorvastatin reversed these above changes. It resulted in a decrease in the increased expression of MMP-9 and TGF-b1, and an increase in the downregulated expression of TIMP-1, PPARα, PPARβ and PPARγ (P<0.01, P<0.01, P<0.05). Conclusion Imbalanced expression of MMPs/TIMPs exists in the aging rat kidney, with up-regulation of TGF-b1. Long-term treatment of atorvastatin rebalances MMPs/TIMPs expression through downregulating MMP-9, upregulating TIMP-1, and decreasing TGF-b1 expression, and thus attenuates the aging changes in the kidneys. Further study is needed to identify whether atorvastatin-induced activation of PRARs plays roles in the process.

Abstract:Objective To determine the effects of salidroside on the carbohydrate metabolism and the serum levels of inflammatory cytokines in rats under negative psychological stress induced by experimental navigation and intensive exercise. Methods A total of 30 6-week Sprague-Dawley rats (SD rats) were randomly and equally allocated into 3 groups, quiescent control group (group A), training control group (group B) and salidroside treatment group (group C). Rats from group A received no stimulation, and administered a 7-day intragastrical injection of normal saline. Rats from group B underwent a 10-day run training with increasing load on treadmill and received 7-day intragastrical administration of normal saline. Group C were subjected to the same procedure of run training as group B, and received 7-day intragastrical administration of 0.4g/kg salidroside. Then, all the rats underwent experimental navigation and intensive exercise. Blood samples were immediately obtained for detection of blood glucose and the levels of inflammatory response-related cytokines, high sensitive-C reactive protein (hs-CRP), tumor necrosis factor α (TNF-α), interleukin 6(IL-6), and endothelin 1 (ET-1) by ELISA. Results As compared with group A, the levels of blood glucose, hs-CRP, TNF-α, IL-6, ET-1 was significantly increased in group B (P<0.05), while, the levels of blood glucose was significantly increased (P<0.05), and those of hs-CRP, IL-6, and ET-1 were significantly decreased in group C (P<0.05). The levels of hs-CRP, TNF-α, IL-6, ET-1 in group C were also significantly decreased than in group B (P<0.05). The level of blood glucose in group C showed a decreasing tendency. Conclusion Negative psychological stress and intensive exercise lead to disorders of glucose metabolism and increase the production of inflammatory cytokines in rats. Salidroside therapy reduces the levels of blood glucose and inflammatory cytokines in rats under stress, and thus improve glucose metabolism and enhances anti-stress capacity.

Abstract:Objective To explore the effect of different levels of androgen in the vascular endothelial function of high-salt fed male rats. Methods Thirty-two Wistar rats were randomly assigned to 4 groups, sham-operation (Sham) group, castration (Cas) group, testosterone supplement after castration (TC) group, and flutamide-treated testosterone supplemented castrated (FTC) group, with eight rats in each. All animals were fed high-salt diet (8% NaCl) for 8 weeks. Animals in Sham group received sham operation, while those in Cas, TC and FTC group received surgical castration. Subcutaneous injection of testosterone propionate (TP) 2mg/(kg?2d) was performed in TC and FTC groups, and intragastric administration of flutamide 1mg/(kg? d) in FTC group continuously for 8 weeks. The blood of tail artery was measured at baseline, 4 and 8 weeks after experiment respectively. At 8 weeks after experiment, content of testosterone (T) and endothelin-1(ET-1) in serum were determined by enzyme-linked immunosorbent assay (ELISA), and colorimetric assay was used to detect the level of nitric oxide(NO) in plasma. Results (1) Compared with Sham group, blood pressure at 4 and 8 weeks declined significantly in Cas group and FTC group [Cas: (124.8±4.4) vs (135.9±3.7)mmHg, P＜0.01; FTC:(127.7±3.0) vs (135.9±3.7)mmHg, P＜0.01], while increased significantly (P＜0.01) from baseline in Sham and TC groups. (2) Compared with Sham group, serum T content obviously decreased in Cas group [(0.26±0.02) vs (3.15±0.54)μg/L, P＜0.01], and increased significantly in FTC groups [(5.47±1.29) vs (3.15±0.54)μg/L, P＜0.01]. (3) Compared with Sham group, serum ET-1 content declined significantly in Cas group and FTC group [Cas: (0.77±0.23) vs (1.08±0.15)μg/L, P＜0.01; FTC: (0.80±0.21) vs (1.08±0.15)μg/L, P＜0.05], and had no significant difference with TC group (P＞0.05). (4) NO content, compared with Sham group, increased significantly in Cas group and FTC group [Cas: (42.37±15.74) vs (17.20±7.32)mmol/L, P＜0.01; FTC: (33.44±8.50) vs (17.20±7.32)mmol/L, P＜0.01], and had no significant difference with TC group (P＞0.05). Conclusion Under high-salt diet, change of androgen can influence vascular endothelial function of male rats.

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Abstract:Geriatrics in China is still in its infancy, and lack of a geriatrics education system, in which a wide gap exists when compared with developed countries. In this article, we summarized our experiences in continuing education, resident education, staff training, teaching material compiling, community education and patient education during the last two years in Department of Geriatrics, Peking Union Medical College Hospital. Certain achievements had been made in the popularizing of concept of geriatrics, and the improvement of continuing education approaches. Furthermore, we brought forward to an initial idea on multi-level education for geriatric medicine. We appealed to standardize geriatrics education and establish a qualifying examination and qualification admittance system to improve career advancement.

Abstract:Nowadays, sepsis is associated with high morbidity and mortality, despite certain achievement has been made in its basic and clinical research. Because of its difficulty in the diagnosis and treatment, it is one of the most common health-threatening diseases. Over the past decade, many studies on septic animals and patients have highlighted immune cell apoptosis in the pathophysiological process of aggravating sepsis. Excessive apoptosis of dendritic cells, macrophages, T lymphocytes and other immune effector cells is the key aspect of immune dysfunction. In addition, accumulated evidence demonstrates that prevention of cell apoptosis can significantly improve the immune status and the survival rate in clinically relevant animal models of sepsis. Therefore, it is quite important to confirm the inducing factors and signaling pathways in the immune cell apoptosis. In this paper, we summarized the role of immune cell apoptosis in pathophysiology of sepsis, and the novel therapeutic strategies based on prevention of apoptosis.