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Abstract:Given the rise of elderly population and increased incidence of cerebrovascular disease(CVD), CVD has become a very important medical and social problem. CVD in the elderly is characterized as high incidence, serious symptoms, poor prognosis and easy recurrence. The long-term survivors also have high incidences of cognitive impairment, dementia and depression. It is very important to find out the risk factors for CVD, so as to take effective secondary preventive measures for it.

Abstract:Pneumonia is one of the most common complications for patients with stroke. Recently, more and more attention has been paid on the roles of immune system in pneumonia and immunosuppression after stroke has been regarded as an independent risk factor for infections. Experimental and clinical studies have identified a series of inflammation and immunosuppression after stroke, including the reduction of mononuclear phagocyte and natural killer cell function, induction of anti-inflammatory cytokines, apoptosis of lymphocyte and alteration of T lymphocyte activity. The mechanism is likely to be that immunosuppressive signals impact on the nervous system through the hypothalamus-pituitary-adrenal axis, sympathetic adrenergic axis, and the parasympathetic adrenergic axis, which lead to the changes of immune system and down-regulation of immune function as well. In addition, some other studies attested that stroke-induced immunosuppression had protective effect on the brain. The mechanism regarding immunosuppression remains unclear now but do exist. Obviously, the further research on the stroke-induced immunosuppression will have great significance on the prevention of pneumonia after stroke.

Abstract:With the aging population, the prevalence of vascular dementia is rising. Vascular dementia is a multi-factor process. Its risk factors include age, gender, education, cerebrovascular disease, hypertension, diabetes, high cholesterol, smoke and alcohol abuse, heart disease, anemia, ApoE gene, homocysteine, etc. Vascular dementia(VD) is the only kind of dementia that can be prevented. Its preventive measures can reduce the occurrence of vascular dementia. Therefore exploring the risk factors for VD is particularly important. This article aims to make a summary for the research on the risk factors of VD.

Abstract:Objective To analyze the differences of socio-economic characteristics, risk factors and TOAST subtype between very old patients and old patients with first-ever ischemic stroke (IS). Methods A total of 858 very old patients and 3818 old patients in CNSR were collected from September 2007 to August 2008. Demographic and socio-economic characteristics included age, gender, marital status, living condition, educational level, family income and health insurance types. Risk factors, including hypertension (HT), obesity, coronary heart disease (CAD), diabetes mellitus (DM), atrial fibrillation (AF), smoking, family history of stroke, hyperlipidemia, heavy drinking and so on, were analyzed. Results Compared with old group, significant differences were observed in very old group in demographic and socio-economic characteristics such as average age, gender, marriage, living conditions, educational levels and medical insurance(P＜0.05) except for monthly family income. Both two groups had the highest prevalence of HT. The rate of AF in very old group were higher than that in old group (P = 0.0002). However, very old patients were less likely to have metabolic disorders such as obesity(P = 0.0177), DM(P＜0.0001), hyperlipidemia(P＜0.0001) or bad behaviors such as smoking(P＜0.0001) and heavy drinking(P = 0.0004) compared with old patients. Cardiac embolism(CE) was significantly higher in very old patients(P＜0.0001). Conclusion There are differences on gender distribution and risk factors between old stroke patients below 80 and over 80 years. For very old patients, we should pay more attention to the risk of stroke in women and improve the understanding of AF and CE, so as to reduce the risk of recurrent stroke.

Abstract:Objective To investigate the characteristics of arterial stenosis in patients with cerebellar watershed infarction. Methods The clinical data, including clinical manifestation, magnetic resonance imaging (MRI), diffusion weighted imaging (DWI) and magnetic resonance angiography (MRA) / computerized tomographic angiography (CTA), of 178 cerebellar infarction cases were collected. According to lesion location on DWI, 178 cases were divided into cerebellar watershed infarction group and non-watershed infarction group. According to location of stenosis in MRA/CTA, vertebrobasilar artery stenosis can be divided into 4 types: intracranial, extracranial, combined, and not detected stenosis. The features of stenosis were compared between cerebellar watershed infarction and non-watershed infarction. Results Among the 128 cases, 42 met the diagnosis of cerebellar watershed infarction. The cerebellar watershed infarction cases had mild clinical features and benign prognosis. However, they had a higher incidence of stenosis (90.5%) than non-watershed infarction cases (74.3%). Intracranial, extracranial, combined, and not detected stenosis represented 14.3%, 52.4%, 23.8%, 9.5% in 42 cerebellar watershed infarction cases, and 33.8%, 16.2%, 24.3%, 25.7% in cerebellar non-watershed infarction. Conclusion Although cerebellar watershed infarction patients had more benign clinical features and prognosis, they had a higher incidence of large diameter arteries stenosis, especially stenosis in extracranial arteries and early endovascular treatment should be administrated.

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Abstract:Objective To investigate the influence of obstructive sleep apnea (OSAS) on circadian blood pressure variability and heart rate variability (HRV) in essential hypertensive patients. Methods A total of 91 patients admitted in our hospital were divided into three groups, according to the patients suffered from hypertension or/and OSAS, including normal group, pure hypertension group and hypertension complicated with OSAS group (complication group). The rate of non-dipper day-night blood pressure curve, time-domain indexes, frequency-domain indexes, average night blood oxygen level, apnea-hypopnea index (AHI) were compared among three groups. Results Compared with other groups, the rate of non-dipper day-night blood pressure curve, time-domain indexes, frequency-domain indexes, AHI were obviously higher in complication group (P＜0.01), and average night blood oxygen level were obviously lower in complication group (P＜0.01). Conclusion OSAS could make non-dipper day-night blood pressure curve, enhance HRV, descend average night blood oxygen level, and increase AHI, indicating that OSAS is an important risk factor to adverse cardiac events of essential hypertensive patients.

Abstract:Objective To investigate the association between two single nucleotide polymorphisms (SNPs＋45T＞G and SNPs＋276G＞T) of adiponectin gene and coronary artery diseases(CAD) in elderly patients without diabetes. Methods Coronary angiography were performed in 688 subjects ≥65 years without diabetes who were admitted to department of cardiology during November 2005 to December 2009. The subjects were divided into CAD group and control group according to coronary angiography. Genotype of two SNPs was measured by polymerase chain reaction/ligase detection reaction (PCR/LDR) assay. Results At＋45position, the risk rate of CAD in GG genotype was significantly increased compared with that in TT genotype(OR = 2.65, P＜0.01). At＋276position, the risk rate of CAD in GG or GT genotype was significantly higher than that in TT genotype(GG: OR = 2.36, P＜0.01; GT: OR =1.66, P＜0.05). Logistic regression analysis showed that GG genotype at SNPs＋45T＞G, GG genotype and GT genotype at SNPs＋276G＞T were independent risk factors of CAD. Furthermore, adiponectin gene SNPs＋45T＞G and SNPs＋276G＞T displayed strong linkage disequilibrium. GG genotype was shown at SNPs＋276G＞T when SNPs＋45T＞G genotype was GG and TT genotype was shown at SNPs＋45T＞G when SNPs＋276G＞T genotype was TT, that is GGGG and TTTT genotypes. Homozygous GGGG subjects showed a significantly higher risk of CAD(OR = 4.77, P＜0.01) than homozygous TTTT subjects. Conclusion In non-diabetic elderly subjects, those with GG genotype at SNPs＋45T＞G, GG genotype and GT genotype at SNPs＋276G＞T are the susceptible population of CAD.

Abstract:Objective To analyze the clinical features and causes of non-viral liver injury in elderly patients and improve the diagnosis and treatment. Methods Sixty-two aged patients(≥60 years) with abnormal liver function due to non-viral causes(instead of HAV~HEV, HSV, CMV, EBV and CSV) who were admitted to our hospital from January 2006 to June 2009 were analyzed retrospectively. The clinical data of these patients were compared with that of 98 non-aged patients (＜60 years). Results There was no special symptom in aged patients and the incidences of fatigue, nausea, and jaundice in aged patients were significantly higher than those in non-aged patients. In aged patients, 25 cases were diagnosed as drug-induced liver disease(DILD, 40.32%) which ranked first, 13 cases as non-alcoholic fatty liver disease (NAFLD, 20.97%), 11 cases as gallbladder disease (17.74%), and 6 cases were induced by cardiopulmonary insufficiency(9.68%). The serum levels of ALT and AST were highest in DILD. Compared with non-aged patients, the serum levels of ALT and AST were significantly higher in aged patients [ALT: (775.83±478.51) vs (526.44±401.54)U/L, AST: (663.61±464.85) vs (457.45±521.78)U/L; P＜0.01]. The main agents causing DILD in the elderly included herbal medicine(40%), nonsteroidal anti-inflammatory drugs(12%) and HMG-CoA reductase inhibitors(12%). Conclusion DILD is the most common non-viral liver disease in elerly patients, followed by NAFLD and gallbladder disease caused liver injury. Clinicians should pay more attention to DILD in the elderly.

Abstract:Objective To evaluate the safety and effectiveness of early atorvastatin sequential therapy in coronary heart disease (CHD) patients after percutaneous coronary intervention (PCI). Methods A total of 170 CHD patients ready to receive PCI were randomly divided into sequential dose group (group A: atorvastatin 80mg as loading dose, then 40mg/d for 1 month and 20mg/d subsequently, n=85) and ordinary dose group (group B: atorvastatin 20mg/d, n=85).Laboratory records, such as blood lipid, hepatic function, renal function, creatine kinase (CK), hypersensitive Creactive protein (CRP) were observed at different time points including 1 week, 1 month, 3 months and 6 months. Main adverse cardiac events and adverse effects were also analyzed. Results Compared with baseline, the level of low-density lipoprotein-cholesterol (LDL-C) and total cholesterol (TC) was significantly decreased at each time points in both two groups(P＜0.05). The decreasing degree of LDL-C and TC level at 1 week had significant differences between two groups(LDL-C:31.2% vs 12.5%;TC:29.2% vs 13.1%;P＜0.05); meanwhile, the decreasing degree was keeping enlarged at 1 month between two groups(LDL-C: 43.0% vs 17.6%;TC: 41.3% vs 22.3%;P＜0.05). The change in LDL-C and TC level was not significantly different between the two groups at 3 and 6 months (P＞0.05). The rate that LDL-C met predefined standard in group A was significantly higher than that in group B at 1 week, 1 month and 3 months respectively. The hsCRP level was significantly decreased in both groups, which was more significant in group A than in group B at 1 week and 1 month[group A: (8.17±5.69)mg/L at pretreatment, (4.23±2.43)mg/L at 1 week, and (1.96±0.77)mg/L at 1 month respectively; groupB: (7.75±4.31)mg/L at pretreatment, (4.87±2.70)mg/L at 1 week, and (3.21±1.27)mg/L at 1 month respectively; P＜0.05]. Incidence of main adverse cardiac events was significantly lower in group A than in group B at 6 months (5.9% vs15.3%, P＜0.05), which further decreased by 9.4% in group A. The adverse effects were very trivial and had no significant difference between two groups (P＞0.05). Conclusion The atorvastatin sequential therapy early used in CHD patients after PCI is superior to ordinary atorvastatin therapy in efficacy, which shows better clinical prognosis without increase of adverse effects.

Abstract:Objective To observe the changes of plasma brain natriuretic peptide(BNP) and norepinephrine(NE) levels in elderly patients with acute heart failure(AHF), and evaluate their roles to predict the prognosis. Methods Totally 117 elderly patients with AHF were enrolled. The plasma levels of BNP and NE were determined at admission, the third day and discharge respectively. All patients were followed up for three months to evaluate the cardiac events after discharge. Receiver operation characteristic(ROC) curves were used to analyze the abilities of plasma BNP and NE levels to predict the prognosis of the patients. Results Plasma BNP and NE levels markedly decreased on the third day in all patients [BNP: (781±580) vs (1368±939)ng/L; NE: 163(109,281) vs 295(174,509)ng/L; P＜0.05]. Plasma NE level decreased subsequently (P＜0.05). Before discharge, plasma levels of BNP and NE were correlated to patients￠ prognosis. Plasma levels of BNP and NE were significantly higher in event group than in non-event group(P＜0.05). Area under ROC curves was 0.721 for BNP and 0.739 for NE respectively. Plasma BNP and NE levels had moderate accuracy to predict cardiac events after discharge. Plasma NE level had better accuracy than plasma BNP level. The incidence of cardiac events and mortality were higher in decompensated congestive heart failure(CHF) patients than in AHF patients(P=0.008, P=0.035). Conclusion The plasma levels of BNP and NE before discharge are predictive of prognosis of elderly patients with AHF. NE has better accuracy than BNP. Decompensated CHF patients have higher plasma levels of BNP and NE, and higher incidence of cardiac events than AHF patients.

Abstract:Objective To investigate the information of pathogenic bacteria and drug resistance in patients with chronic heart failure and lower respiratory infections. Methods A retrospective review was adopted to analyze the results of sputum culture and susceptibility tests among 126 patients with chronic heart failure and lower respiratory infections. The pathogen distribution and drug resistance was analyzed statistically. Results Of 203 samples of sputum culture, 182 strains of pathogenic bacteria were found, including 139 strains of bacteria that consisted of 65.5% (91/139) Gram-negative bacteria and 34.5% (48/139) Gram-positive bacteria, and 43 strains of fungus. In 126 patients with chronic heart failure, 41 patients had the drug sensitivity in good agreement with empirical treatment, and 68 patients had poor infection controlled according to sputum culture or in combination with antibiotics after the replacement of the majority of infections under control, and 17 cases were dead as apparent drug resistance and infection without control, and the hospital mortality was 13.5%. Conclusion The lower respiratory infections in patients with chronic heart failure are mostly due to Gram-negative bacteria, and antimicrobial resistance was commonly evident. Rational use of antibiotics and avoiding drug abuse are the key for preventing bacterial resistance.

Abstract:Objective To analyze the relationships of different blood glucose levels with medical cost, hospitalization time and disease prognosis in hospitalized patients. Methods Totally 4868 patients were checked for their blood glucose immediately after admission into hospital (not over 24 hours ) and then divided into groups: non-hyperglycemia group(3429 cases) and hyperglycemia group(1439 cases) which included the patients with diabetes or with stress hyperglycemia (patients with hyperglycemia, without diabetes history and/or with normal HbA1c level, normal glucose level during follow-up in hospital). The patients were also divided into younger group (n=2532, age＜60yrs) and older group (n=2336, age≥60 yrs). Totally 278 patients with coronary heart disease?were further divided into hyperglycemia group (120 cases) and non-hyperglycemia group (158 cases). The hospitalization time, medical cost and diseases prognosis were compared between groups. Results There were 29.5% of these patients with hyperglycemia, including 11.4% with stress hyperglycemia. Patients with hyperglycemia had significant longer hospitalization (median: 15 vs 10 d, P＜0.01), higher medical cost (median: 14064.7 vs. 8980.9 Yuan RMB, P＜0.01) and higher mortality in hospital (2.92% vs 0.61%, P＜0.01). The mortality of patients with stress hyperglycemia was significantly higher than patients without hyperglycemia, but no significant difference was found compared with patients with diabetes in younger group. There was no significant difference in the mortality between the elderly patients with diabetes and stress hyperglycemia, but were both significantly higher than patients without hyperglycemia. No statistical difference of the age was found among the diabetes, stress hyperglycemic and non-hyperglycemic patients with coronary heart disease. Patients with diabetes or hyperglycemia had significant longer hospital stay, higher medical cost and higher mortality. Conclusion The patients with admission hyperglycemia have significant higher medical cost and poor prognosis.

Abstract:Objective To investigate the chemosensitization of Chk2 inhibition to 5-FU against nasopharyngeal squamous epithelial cell line SUNE-1. Methods Chk2 siRNA was designed according to the mRNA sequence of Chk2, and its effect was confirmed by RT-PCR and Western blotting in SUNE-1 cells. Cell growth assay was evaluated to determine the impact of Chk2 siRNA on the proliferation ability of SUNE-1 cells and MTT assay was used to determine the chemosensitization of Chk2 siRNA to 5-FU. Finally, apoptotic cells was stained with Annexin Ⅴ/PI and examined by flow cytometry. Results Chk2 siRNA significantly reduced mRNA and protein levels of Chk2 in SUNE-1 cells, which confirmed the knockdown effect of Chk2 siRNA. Cell growth assay showed that Chk2 siRNA did not influence the proliferation of SUNE-1 cells. However, Chk2 knockdown significantly enhanced the cytotoxicity and apoptosis of SUNE-1 cells caused by 5-FU. Conclusion Chk2 hinders the toxic effect of 5-FU on SUNE-1 cells, which can be enhanced by Chk2 inhibition. Therefore, Chk2 can be proposed as a target to increase the effect of chemotherapeutic agent, such as 5-FU, in clinical treatment on nasopharyngeal carcinoma.

Abstract:Objective To investigate the possible mechanisms of aging-associated vascular dysfunction by peroxynitrite (ONOO-) decomposition catalyst FeTMPyP. Methods Male Sprague-Dawlew (SD) rats were randomly divided into three groups: adult group (3-4-month-old, n=8), aging group (18-20-month-old, n=8), and FeTMPyP treatment aging group (n=6). The thoracic aorta was isolated for measurement of vascular diastolic function. Immunohistochemistry and Western-blot were performed to determine the expression of 3-nitrotyrosine (3-NT, a marker of ONOO- formation) in thoracic aortic arteries. Results (1) Comparing with adult group, the maximal vasodilation in aging rats induced by acetylcholine (ACh, an endothelium-dependent vasodilator, 10-9 to 10-5 mol/L) was significantly decreased from (69.52% ± 5.51%) to (29.74% ± 8.28%) (P＜0.001); the maximal vasodilation induced by sodium nitroprusside (SNP, an endothelium-independent vasodilator, 10-9 to 10-5 mol/L) was also decreased from (99.26% ± 1.33%) to (92.01% ± 3.19%) (P＜0.001). (2) The expression of 3-NT in aging vascular tissues was increased (P＜0.05) compared with adult group. (3) In aging rats treated with FeTMPyP, the expression of 3-NT was decreased (P＜0.01). Moreover, FeTMPyP significantly improved vascular endothelium- dependent and endothelium-independent vasodilations in aging rats. After inhibiting the generation of ONOO-, ACh-induced maximal vasorelaxation was markedly increased [(65.96%±11.36%) vs (29.74%±8.28%), P＜0.001] and SNP-induced maximal vasodilation was also increased [(98.15%±2.79%) vs (92.01%±3.19%), P＜0.001]. Conclusion FeTMPyP can improve vasodilation dysfunction in aging rats, suggesting that ONOO- may play an important role in aging-related vascular dysfunction.

Abstract:Objective To explore the chronic effects of excess glucose on INS-1E cells and isolated mouse islets. Methods Islets were isolated by the collagenase digestion from adult female NMRI mice (6-10 weeks) after induction of anesthesia by phenpbarbital. INS-1E cells and isolated mouse islets were cultured in RPMI 1640 supplemented with 11.1 or 25.0 mmol/L glucose for 72 h, respectively. Then the medium were changed to Krebs-Ringer buffer containing 3.3 or 16.7 mmol/L glucose and incubated for 1 h. Correspondingly upper medium was collected for insulin assay. Total RNA was extracted from INS-1E cells after 72 h incubation with different concentration of glucose, then cDNA was synthesized and mRNA expressions of Pdx1, insulin 1, insulin 2, and GLUT2 were determined by RT-PCR. Results After incubation with excess glucose, basal insulin secretion was increased in both INS-1E cells and isolated mouse islets [INS-1E cells: (10.47±0.78) vs (7.71±0.59) ng/10000 cells, P＜0.01; isolated mouse islets: (3.85±0.26) vs (2.18±0.21) mg/L, P＜0.001], and glucose-stimulated insulin secretion was impaired [INS-1E cells: (17.11±1.98) vs (30.76±2.20) ng/10000 cells, P＜0.001; isolated mouse islets: (14.78±1.03) vs (20.46±1.49)mg/L, P＜0.01]. Pdx1, insulin 1, insulin 2, and GLUT2 mRNA levels were reduced in INS-1E cells after treatment of excess glucose. Conclusion Long-term exposure to supraphysiologic glucose concentrations may cause dysfunction of pancreatic islet cells.

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Abstract:Coronary pressure measurement has emerged as one of the most promising tool to assist interventional cardiologist to make accurate clinical decisions. Fractional flow reserve(FFR) is a simple, fast, and safe method to achieve functional information about the coronary artery stenosis in the catheterization laboratory. The implementation of FFR program in the catheterization laboratory is simple, and the staff can be trained within a few cases. This review outlines the practical set up of FFR in the catheterization laboratory and also discusses the potential pitfalls in the measurement of FFR.

Abstract:Cancer is an age related disease and the leading cause of death in elderly people aged 60-79 years. Because the ageing process is highly individualized, elderly cancer patients require comprehensive geriatric assessment(CGA). Based on the CGA and the characteristics of the specific cancer, chemotherapy in elderly cancer patients should be individualized. In this paper, we reviewed the physiological and pharmacokinetic changes in elderly people, the influence of these changes on cancer chemotherapy, the CGA and the main points of cancer chemotherapy in elderly patients. Given that the population is ageing, it is important to improve the level of cancer chemotherapy in elderly cancer patients.