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Abstract:The histopathologic characters of gastric mucosa with aging are the loss of gastric glands at lamina propria and their replacement with hyaline-like connective tissue. The rate of glandular parenchyma in aged group was higher than that of non-aged adults, but there were no statistical difference of the parietal cell numbers between the two groups. The incidence of atrophic gastritis increases in elderly subjects, and the gastric acidity decreases with atrophy. However, aging is not the only cause of reduced gastric acid secretion; it has no effect on gastric hydrogen ion activity at fasting state. Reports about proton pump inhibitor (PPI) and clopidogrel combination treatment are still controversial. The observation of 109 octogenarian patients in China showed that PPI had no side effect on the clinical therapy when combined with clopidogrel. The shortages of the study are the limitation of case number and shorter treatment duration. Helicobacter pylori (Hp) infection plays a critical role in the development of some gastric diseases, especially atrophic gastritis and intestinal metaplasia. Histological changes of aging patients after H. pylori eradication indicated that inflammation was significantly improved compared with the patients without Hp eradication, with the improvement rate of chronic inflammation at 87.4%, and the improvement rate of acute active inflammation at 57.8%, respectively.

Abstract:Objective To investigate the age-associated histological changes of fundic gland and ultrastructure of gastric parietal cells. Methods Fifty subjects with a relative normal stomach were enrolled including 19 cases in younger group (aged 20-59) and 31 cases in elder group (≥60 years) . In the elder group, there were 11 cases aged from 60 to 69, 10 cases from 70 to 79 and 10 cases aged above 80. The histology and morphology of fundic gland was observed under a light microscope, including the lamina propria thickness (from the epithelium to the muscularis mucosa, without the muscularis mucosa) and the Np/Na ratio (Np means the number of gastric parietal cell, Na means the number of all cells in fundic gland), and the ultrastructure of gastric parietal cells was detected by electron microscope. Results No significant difference was showed in the histology and morphology of fundic gland. The average ratio of Np to Na did not differ between younger group and elder group. However, the thickness of lamina propria in elderly group（892±172）μm was significantly lower than that in younger group（1014±203）μm ( P＜0.05), while the average ratio Ap to Af (Ap means the area of parenchyma, Af means the area of high-power field) of elderly group （83±11）% was higher than that of younger group （80±7）% (P＜0.05). Furthermore, no significant difference was showed in the morphology of gastric parietal cell and acid-secretion-associated organelles among all the groups. Both the average ratio of Am to Ac (Am means the area of mitochondria, Ac means the area of cytoplasm of gastric parietal cell) and At to Ac (At means the area of secretory canaliculi and tubulovesicular system) do not associated with aging as there was no statistically significant difference between two groups [(48 ± 8)% vs (51 ± 8)%, P＞0.05; (14 ± 4)% vs (12 ± 5)%, P＞0.05)]. Conclusion The histology and morphology of acid-secretion tissue have no significant degeneration in the elderly. The results provide a scientific basis to clarify the well acid secretory function in the elderly.

Abstract:Objective To study the bowel cleanliness and safety in the elderly with different ways of bowel preparation before colonoscopy. Methods A total of 120 patients were divided randomizely into 4 groups (n=30). For bowel preparation, patients in the first group(A group) received polyethylene glycol electrolytes (PEG); the second group(B group) received PEG and 500ml enteral nutrient; the third group(C group) took magnesium sulfate (MgSO4); the forth group(D group) were given MgSO4 and 500 ml enteral nutrient. Bowel preparation quality of every patient was monitored, the change of body mass (BM), blood pressure (BP), fasting blood glucose (FBG), side effects on heart or brain were collected and analyzed. Results The total effective rate of bowel preparation was more than 80%, the intestinal cleanliness efficiency of each group was similar (P＞0.05); The patients in group B and group D who took enteral nutrient got less change in BM, FBG, BP, heart rate after bowel preparation than those in group A and group C (P＜0.05). No hypoglycemia, shock, dizziness, angina, or vomiting occurred in group B and D with the addition administration of nutrient solution, no patient required intravenous fluids administration, which was significantly better than the cases in group A and C. Conclusion Taking enteral nutrient for bowel preparation before colonoscopy can reduce patient’s side effect and keep the bowel preparation quality, it is a safe way for bowel preparation in the elderly patients.

Abstract:Objective To summarize and analyze the effect of multiple eradicative therapy for Helicobacter pylori (Hp) infection of elderly patients and its related factors. Methods We retrospectively analysed 332 elderly patients with Hp positive,who received multiple anti-Hp eradicative therapy according to the standard of eradication. We also checked every time with C-13 breath test after stopping drug a month, and had clear follow-up results. The collected cases were calculated with the statistical rate, multiple rate compared with Pearson chi-square test. Results Within 332 elderly patients cured by first anti-Hp eradicative therapy, 211 patients were confirmed that Hp was negative with C13 breath test;121 patients still tested positive after the first treatment ,and 117 patients received the second time of eradicative therapy,89 patients were confirmed that Hp was negative with C13 breath test; Testing is still positive for 28 patients, and 16 patients received the third time of eradicative therapy, 13 patients were confirmed that Hp was negative with C13 breath test after a month. Conclusions It is necessary to eradicate Hp timely and effectively for elderly patients with Hp infection eradication indication. To adjust regimens individually with quadruple regimens, and to extend the treatment time from one week to two weeks, may be beneficial for improving the rate of eradication.

Abstract:Objective To evaluate the safety and efficacy of endoscopic argon plasma coagulation (APC) in the treatment of elderly patients with colorectal polyps. Methods Colorectal polyps found in electronic enteroscopy were treated with argon plasma generated by ERBE APC (VIO 200D, ERBE Company, German) . Results A total of 525 polyps were detected in 258 elderly patients and all were cured by APC. According to the polyp size and morphology, 302 (57.5%) sessile flat polyps with diameter 0.2 cm to 0.5 cm were ablated with APC, 89 (17%) semi-pedunculated and pedunculated polyps were resected by high-frequency electrosection, and 134 sessile (25.5%) polyps with diameter 0.6 cm to 5.0 cm were resected after submucosal injection with epinephrine plus methylene blue normal saline on focal membrane. APC electric coagulation or titanium clip was employed when bleeding appeared in partial wounds. Minor bleeding occurred in two patients (0.8%) and was stopped after treated with hemostatic drugs; there were no serious complications such as perforations or bleeding requiring transfusion. Conclusion APC is a well tolerated and effective treatment for elderly patients with colorectal polyps.

Abstract:Objective To analyze the pathological changes of gastric mucosa in elderly patients with Helicobacter pylori(Hp) associated gastritis before and after eradication therapy, and to explore the importance of eradication treatment for these patients. Methods A total of 239 Hp associated gastritis cases, diagnosed with endoscopic biopsy, 13C-urea Breath Test and Hp stool antigen detection (HpSA) and had long-term follow-up data, were collected from April 1989 to June 2011. The pathological changes of gastric mucosa in these patients were observed before and after eradication therapy. Results Among 199 patients who underwent eradication therapy, the chronic inflammation was significantly alleviated in 179 patients; there were 64 patients who had active inflammation before treatment, and only 27 left after treatment. Among 66 patients who received incomplete eradication therapy, the chronic inflammation was significantly alleviated in 42 patients; there were 39 patients who had active inflammation before treatment, and only 22 left after treatment. Chronic inflammation and active inflammation were significantly alleviated in elderly patients receiving eradication therapy than in those receiving incomplete eradication therapy (P＜0.05). Conclusion Eradication therapy can significantly improve the histological chronic inflammation and active inflammation of gastric mucosa in elderly patients with Hp associated gastritis, and effectively reduce the incidence of chronic gastritis and alleviate the lesion.

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Abstract:Pancreas is the important gland with both endocrine and exocrine function, which plays a very important role in digestion, absorption and substance metabolism. The morphologic and functional changes of the aged pancreas appear to be concomitant decrease in functional capacity. In elderly population, dyspepsia is common with many reasons. This article describes the performance and functional changes in aging pancreas, explore the effects of pancreatic exocrine function on dyspepsia after pancreatic aging, and give a brief review about the relationship between pancreatic aging and dyspepsia.

Abstract:Objective To establish the scoring system for assessing senile patients with respiratory failure undergoing mechanical ventilation (SRFMVs), and to evaluate the clinical efficacy of the scoring system. Methods SRFMV scoring system was established base on the SRFMV mortality rate equation. Totally 138 hospitalized senile patients who had respiratory failure and required mechanical ventilation were evaluated with the scoring system prospectively. The SRFMVs and APACHEⅡscoring system were evaluated as measures of illness severity in our study. The area under the receiver operating characteristic curve (AUROC) and the correlation analysis of survival were used to compare the predictive value of each scoring systems. Results (1) For mortality rates in the first month among patients receiving mechanical ventilation, AUROC of SRFMVs [0.89 (95%CI 0.826-0.937)] was larger than that of APACHEⅡ0.75 (95%CI 0.675-0.825)], with a statistically significant difference between these 2 score systems (Z = 3.7, P＜0.001). (2) The mortality risk of patient was low when SRFMV score was less than 74, and the negative predictive value for predicting death rate in one month was 96.4% (95%CI 86.8-99.4). However the mortality risk of patient would be high with SRFMV score higher than 98, by which the positive predictive value for predicting death rate in one month was 91.3% (95%CI 71.9-98.7). The mortality risk of patient would be ranked as intermediate when his SRFMV score was between 74 and 98.3. (3) The SFRMV score was highly correlated to the mortality rate among patient receiving mechanical ventilation (RR = 1.05, 95%CI 1.04-1.06, P＜0.01), while APACHEⅡ score failed to show correlation (P＞0.1). A significant difference in the overall survival time was observed among different groups (χ2 = 66.26, P＜0.01). The higher was the risk the shorter was the survival time. In low risk group, the median survival time was 360 days, which was 30 days in intermediate risk group and only 3 days in high risk group. Conclusion SRFMVs has high sensitivity and high specificity for the risk assessment in senile patient undergoing mechanical ventilation, and can be used to evaluate the disease severity and the prognosis in patients, which has a guidance value in clinical practice.

Abstract:Objective To investigate the value of D-dimer in the early diagnosis of idiopathic venous thromboembolism. Methods We detected D-dimer and fibriogen levels in 62 hospitalized patients without history of thrombosis and 62 hospitalized patients with the idiopathic venous thromboembolism. Univariate analysis of the correlation between the D-dimer and fibriogen level and the idiopathic venous thromboembolism was performed. We used D-dimer＞0.5mg/L and fibriogen＞4.0g/L as the cutoff value to calculate the value of early diagnosis of idiopathic venous thromboembolism. Results The univariate analysis showed that the D-dimer and fibriogen levels were both higher in the thrombosis group than in the control group (P＜0.05). With fibriogen＞4.0g/L as the cutoff value, there was significant difference between the thrombosis group and the control group (P=0.00); the sensitivity was 89.29%; the specificity was 56.63%; positive predictive value was 40.98%; negative predictive value was 94.00%. With D-dimer＞0.5mg/L as the cutoff value, there was significant difference between the thrombosis group and the control group (P＜0.05); the sensitivity was 92.31%; the specificity was 96.61%; positive predictive value was 96.77%, negative predictive value was 91.94%. Conclusion Compared with fibriogen＞4.0g/L, D-dimer＞0.5mg/L has better performance for early diagnosis of idiopathic venous thromboembolism. By combination with the other clinically relevant factors, it may contribute to the early diagnosis of idiopathic venous thromboembolism.

Abstract:Objective To investigate the relationship between pulse wave velocity(PWV) and severity of coronary atherosclerosis. Methods Coronary angiography were performed on 324 patients admitted to Chinese PLA General Hospital for the chest pain between January 2008 and October 2010, including 213 males, 111 females, mean age (61.3±12.1) years. The patients were divided into two groups according to the result of coronary angiography: coronary artery disease (CAD) group and non-CAD group. CAD was diagnosed if at least 50% diameter stenosis was found in one or more coronary segment. The CAD group was divided into single-vessel group, dual-vessel group and multiple-vessel group in term of the numbers of coronary artery with lesion. Aortic flexibility was assessed by measuring brachial-ankle pulse wave velocity (baPWV). Results The logistic regression showed gender, smoking, PWV are the risk factors for CAD. PWV were found to have a positive correlation with severity of CAD (r＝0.307, P=0.005), but the result became negative after normalizing with multiple cardiovascular risk factors. When the severity of CAD was expressed as single-, dual-, or multiple-vessel disease, the multivariate odds of multiple-vessel disease in subjects with PWV≥1600cm/s was 5.734 times higher than those with PWV＜1600cm/s. Conclusions Aortic flexibility has a positive correlation with CAD. Patients with multiple-vessel disease has a more severe aortic stiffness.

Abstract:Objective To evaluate the therapeutic effect of PPI or bismuth triple therapy for eradication of Helicobacter pylori(Hp) and 10-day sequential therapy or quadruple therapy for remedy eradication of peptic ulcer in the aged (PUA). Methods A total of 261 elderly patients with Hp caused peptic ulcer diagnosed by rapid urease method under gastroscope from July 2009 to July 2010 were randomized to receive one week of PPI or bismuth triple therapy for Hp first eradication. The adverse reactions were observed. Four weeks of anti-ulcer therapy by PPI and mucosa protectant were carried out after the Hp first eradication. The curative effect on Hp eradication and ulcer healing were compared at one month afterwards. All the patients who failed in the first Hp eradication randomly received 10-day sequential therapy or PPI and bismuth quadruple therapy for Hp remedy eradication. The adverse reactions were observed and Hp infection status was assessed by 13C-urea rapid breath test at one month after the medications stopped. Per protocol(PP) cohort analysis and intention-to-treat(ITT) cohort analysis were used. Results Compared with bismuth triple therapy, PPI triple therapy had higher Hp eradication rate[ITT: 77.7% vs 62.6%; PP: 79.5% vs 64.1%; P＜0.05] and higher ulcer healing rate[ITT: 78.5% vs 64.9%; PP: 80.3% vs 66.4%; P＜0.05]. There was no obvious difference in adverse reaction between the two strategies[ITT: 10.8% vs 16.8%; PP: 11.0% vs 17.2%; P＞0.05]. For Hp remedy eradication, 10-day sequential therapy had better Hp eradication effect[ITT: 84.6% vs 61.5%; PP: 86.8% vs 63.2%; P＜0.05] and lower adverse reaction rate[ITT: 12.8% vs 35.9%; PP: 13.2% vs 36.8%; P＜0.05]. Conclusions PPI triple therapy is the main choice on PUA patients for its better Hp eradication and ulcer healing effects. Ten-day sequential therapy is recommended to patients who failed Hp first eradication by triple therapy.

Abstract:Objective To evaluate tracheostoma used in patients with abnormal posture. Methods A total of 96 critical patients admitted to our hospital from January 2005 to December 2010 were retrospectively analyzed. The patients all received normal clinical treatment and were divided into tracheal puncture group(48 cases with abnormal posture) and tracheotomy group(48 cases with normal posture). Patients received percutaneous rotation trachea puncture in tracheal puncture group and traditional surgical tracheostomy in tracheotomy group. Vital signs and medical indices of patients in the two groups were assessed. Results Compared with tracheostomy, percutaneous rotation trachea puncture had no requirement for posture, which was safe and rapid with small damage and simple operation. Vital signs in tracheal puncture group, such as mean artery pressure(MAP), heart rate(HR) and central venous pressure(CVP) were significantly lower than those in tracheotomy group[MAP: (90±12) vs (118±10)mmHg; HR: (85±9) vs (106±12)/min; CVP: (7±4) vs (9±3)cmH2O; P＜0.01]. Conclusion In critical patients with abnormal posture, percutaneous rotation trachea puncture is obviously superior to traditional surgical tracheostomy and is well worth recommded clinically.

Abstract:Objective To investigate the effects of flavopiridol on growth, cell apoptosis, and cell cycle of hepatocellular carcinoma cell(HCC) Huh7. Methods Huh7 cells were treated with flavopiridol, then cell proliferation, cell apoptosis and cell cycle were assessed. Protein expression of CDK4/CDK6/cyclinD1 complex was determined by western blot. Results Flavopiridol inhibited Huh7 cell growth. Flavopiridol induced dose-dependent cell apoptosis in Huh7 cells. Percentage of apoptotic cells increased from 2.65% in control cells to 14.17% in flavopiridol treating(550 nmol/L) cells. Flavopiridol significantly blocked Huh7 cell cycle at G1 phase and percentages of cell arrested at G1 phase increased from 51.06% in control cells to 57.53% in cells treated with 550 nmol/L of flavopiridol. Flavopiridol can inhibit protein expressions of CDK4, CDK6 and cyclinD1 in Huh7 cells. Conclusion Flavopiridol inhibits cell proliferation through regulating expressions of G1 phase protein complex CDK4/CDK6/cyclinD1, which lead to G1 phase arrest and apoptosis in HCC cells.

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Abstract:Effective expectoration or sputum aspiration can ensure sufficient draining of secretion from trachea, but it has no direct effects on drainage from bronchi and alveoli. Each step of cough reflex should be considered in order to deliver effective expectoration. Peak cough expiratory flow is the main indicator for cough efficiency. In patients who have artificial airways, inner diameter of tracheal catheter, management of cuff and high flow ventilation need to be carefully considered. The main methods to improve draining of bronchus are to decrease airway resistance and to improve airway ciliary movement. The key to maintain efficient pulmonary alveoli drainage is to prevent alveolar atelectasis, of which respiration and ventilation with large tidal volume are major maneuvers. As for implication of modern ventilators, we should pay more attention closely to deficiency of inspired tidal volume due to unsuitable setup of ventilation parameters. Other methods of keeping alveolar drainage include controlling FiO2 and keeping suitable spontaneously breathing.

Abstract:Heart failure is the serious stage in the process of cardiovascular diseases. Immune activation and cytokines regulate cardiovascular system and play important roles in the pathophysiological process of heart failure. There is a close relationship between levels of circulatory cytokines and cardiac function, prognosis and risk stratification of heart failure. The treatment of immune activation also shows significant therapeutic potential. In this paper, we summarize the relationship of cytokines and heart failure.

Abstract:Acute pulmonary embolism (APE) has high morbidity and mortality. So, it is very important for the APE patients to get an appropriate diagnosis and risk stratification as early as possible. Electrocardiogram (ECG) could finely reflect a series of pathological and physiological process caused by APE pulmonary hypertension, and has a good relation with the pulmonary perfusion defect, right ventricular dysfunction and severe in-hospital complications. In this paper, we review the correlation of various ECG waveforms and Daniel ECG score with the severity of pulmonary embolism. We aim to evaluate the roles of ECG in risk stratification of the pulmonary embolism.

Abstract:As an integral part of stress response，inflammatory processes are composed of several inflammatory mediators such as cytokines, prostanoids, free radicals, and some transcription factors, and are under the control of the neuroendocrine and autonomic nervous systems. During chronic inflammatory processes related to stress, the interaction between cytokines and the HPA axis results in GC resistance, which leads not only to the hyperactivation of the HPA axis (characterized by elevation of GCs and CRH) but also to a self-amplifying vicious cycle of inflammatory response. And these inflammatory processes within the context of stress also represent the common physiopathological mechanisms in stress-related diseases, such as psychiatric disorder and cardiovascular disease.

Abstract:Modern warfare has profound sensory impact on soldiers, and the military operations also require more for soldiers’ physical fitness. This paper not only summarized the definition and mechanisms of military fatigue, prevention and treatment measures, but also elaborated the importance of connotation, prevention and therapy of military fatigue, as well as the recent research topics. It is instructive for better understanding of military fatigue, and actively prevent the occurrence of this condition.