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Abstract:Chronic obstructive pulmonary disease (COPD) is one of the most common and frequently-occurring respiratory disease, the mortality rate of which ranked the 4th of all causes of death and there is a trend of increasing year by year. COPD is one of the major causes of disease death in China which ranked third～fourth, and the incidence rate shows an increasing trend. Elderly patients account for a large proportion in COPD patients, and the treatment is difficult with high mortality rate. Early diagnosis, early prevention, and standardized treatment can reduce the frequency of exacerbation and improve the prognosis as well.

Abstract:Objective To investigate the primary diseases, risk factors, therapy, prognosis and factors affecting prognosis of severe acute respiratory distress syndrome(ARDS). Methods Data of 34 patients with severe ARDS from January 2009 to January 2012 were retrospectively analyzed, including age, gender, history of chronic diseases, predisposing factors, vital signs within 24 h after diagnosis, laboratory tests (blood gas analysis, routine blood tests, renal function, electrolytes, procalcitonin, C-reactive protein, erythrocyte sedimentation, lactic acid, oxygenation index), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, therapeutic methods, occurrence of multiple organ dysfunction (MODS) and mortality within 21d after final diagnosis. Above indicators were compared between survival and death groups and their correlation with APACHEⅡscore was analyzed. Results Of the 34 patients with severe ARDS, there were 28 males and 6 females, ranging from 18 to 98 years [(54.09±18.34)years], including 24 death cases(70.6%). The statistics showed that APACHEⅡ score, lactic acid, procalcitonin in death group were higher than those in survival group[(23.42±4.59) vs (16.70±1.57), (4.83±3.60) vs (2.88±0.85)mmol/L, (3.02±2.87) vs (1.20±0.73)ng/L; P＜0.05], oxygenation index in death group was lower than that in survival group[(80.92±29.29) vs (112.30±24.49); P＜0.05]. APACHEⅡ score was positively correlated with blood lactic acid and procalcitonin (r=0.531, r = 0.527; P＜0.01). Conclusions Concentrations of blood lactic acid and procalcitonin were positively correlated with the severity of ARDS. The integrated therapy including treatment of primary diseases and protection of multiple organs can improve the prognosis of patients with ARDS.

Abstract:Objective Health care associated pneumonia (HCAP) has been proposed as a new category of pneumonia. This study aimed to analyze the clinical characteristics and risk factors for poor prognesis of HCAP in the elderly. Methods We conducted a retrospective observational study on 89 elderly HCAP patients. We compared the baseline characteristics, comorbidities, pathogen distribu-tion, antibiotics, and clinical outcomes between survival and dead patients. Multivariate logistic regression analysis was used to identify the risk factors for treatment failure of HCAP. Results A total of 89 HCAP patients were divided into survival group(61 patients, 68.5%) and death group (28 patients, 31.5%). The incidences of cerebrovascular diseases and chronic kidney diseases were higher in death patients than in survival patients. There were more patients with respiratory rate ≥30 breaths/min, heart rate ≥100 beats/min, systolic blood pressure ＜90 mmHg and altered mental station in death group than in survival group. There was no difference in fever, cough and expectoration. The most common causative organisms in both groups were pseudomonas aeruginosa, staphylococcus aureus and acinetobacter baumannii. Initial inappropriate antibiotics administration were more frequent in dead patients than in survival patients. Based on multivariate logistic analysis, respiratory rate≥30 breaths/min, systolic blood pressure<90 mmHg, class 5 pneumonia severity index(PSI), chronic kidney diseases, and inflammatory infiltration of two or more lobes of lungs were independent risk factors for treatment failure of HCAP in elderly patients. Conclusions HCAP in elderly patients is characterized by atypical symptoms, complex pathogens, high drug resistance, severe condition, and treatment difficulty. Its treatment and diagnosis need to be strengthened by further studies.

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Abstract:Objective To investigate the clinical data of hospitalized patients with chronic renal failure (CRF) so as to provide basis for clinical diagnosis and treatment. Methods All hospitalized patients with CRF in Nephrology Department of China-Japan Friendship Hospital from January 2009 to December 2010 were included. Results A total of 956 patients with CRF were investigated, accounting for 44.4% of the total hospitalized patients in the hospital. There were 527 males and 429 females; 670 cases from urban (city and municipal area) and 286 cases from countryside (county, town and village); 90 cases of chronic kidney disease 2(CKD2), 228 cases of CKD3, 160 cases of CKD4, and 478 cases of CKD5. Their age ranged from 16-89 years[(53.8±17.5) years], including 185 cases ≤35 years, 366 cases at age of 36-59 years, and 405 cases≥60 years. First diagnosis of CRF was established in 691 patients(72.3%), among which there were 357 patients needing dialysis treatment, accounting for 37.3%. The causes of CRF included chronic glomerulonephritis (23.8%), diabetic nephropathy (16.7%), hypertensive renal damage (8.2%), polycystic kidney disease (2.5%), lupus nephritis (1.4%). But, there were still 32.2% of patients with unknown cause. Conclusion There are more CRF patients from urban than from countryside. There are more middle aged or elderly CRF patients than young CRF patients. The main causes of CRF include chronic glomerulonephritis, diabetes, hypertension, polycystic kidney disease, etc. But there are still considerable number of patients without accurate cause. Near 3/4 patients get the first diagnosis of CRF.

Abstract:Objective To investigate the association between smoking and coronary atherosclerosis. Methods Totally, 539 healthy male volunteers aged between 31 to 65 years were divided into smoking and non-smoking group and their cardio-ankle vascular index (CAVI) were examined using VaseraVS-1000 vascular screening device. Results CAVI positivity rate was significantly higher in smoking group than in non-smoking group (21.7% vs 5.3%; P＝0.000) . By 5-year age grouping, CAVI values of smoking group were all higher than those of the same age non-smoking group(P＜0.05). When grouping according to daily smoking amount, we found that the larger daily smoking amount was correlated with higher CAVI, and there were significant differences between groups(P＜0.05). When grouping according to the smoking history, CAVI ??increased in long time smoking group but no significant difference was found(P＞0.05). Grouping according to smoking index, CAVI increased with the smoking index. Conclusion CAVI is correlated with smoking.

Abstract:Objective To compare the degree of glycemia variability(GV) and hypoglycemia incidence by dynamic glucose monitoring in elderly patients with type 2 diabetes mellitus (T2DM) who were treated with different premixed insulin. Methods A total of 64 patients (≥60 years ) with type 2 diabetes were included. The general data were matched, and all patients required insulin treatment. The patients were randomly divided into two groups, and treated with biphasic insulin aspart 30 or insulin lispro mix 25 respectively. Predicating the blood glucose concentrations within normal range, difference in GV and hypoglycemia incidence between the two groups were analyzed by dynamic glucose monitoring. Results When patients had normal level of blood glucose, there was no significant difference in total insulin between two groups [(38.0 ± 6.2) vs (40.0 ± 5.1) U/d, P＞0.05]. There was no statistical difference found in the mean blood glucose drift rate [(6.32 ± 1.43) vs (6.86 ± 1.51) mmol/L, P＞0.05] or glucose drift coefficient [(1.35 ± 0.22) vs (1.41 ± 0.13), P＞0.05]. Injection events in insulin lispro mix 25 hypoglycemic were less than that in insulin aspart 30 group, but the difference was not statistically significant (12% vs 8%, P＞0.05). Conclusion When the blood glucose was under good control, insulin aspart 30 and insulin lispro mix 25 have similar effects for elderly patients with type 2 diabetes, including the total amount of insulin, glucose rate of drift and the incidence of hypoglycemia.

Abstract:Objective To investigate the effects of hyper-cardiovascular reactivity (HCVR) on circadian rhythm of ambulatory blood pressure and heart rate variability(HRV) in middle-aged male patients with essential hypertension (EH). Methods A total of 60 voluntary male EH patients were divided into EH+HCVR group (n=35) and EH+normal cardiovascular reactivity group (NCVR group, n=25) according to cold pressor test (CPT). Related clinic information, ambulatory blood pressure monitoring and HRV between the two groups were compared and analyzed. Results (1)The proportion of HCVR in 60 EH patients was higher than that in 50 normotensive controls (58.3% vs 26.0%; P＜0.01). (2)Compared with EH+NCVR group, the 24h average systolic blood pressure (SBP) [(148.9±8.9) vs (143.6±8.5) mmHg; P＜0.05] and 24 h diastolic blood pressure (DBP) [(94.4±5.7) vs (90.5±6.0) mmHg; P＜0.05], the average SBP [(145.4±9.2) vs (135.2±6.4) mmHg; P＜0.01] and DBP [(92.7±5.8) vs (83.6±5.2) mmHg; P＜0.01] of night in EH+HCVR group were higher, and the latter was more obviously increased; the circadian rhythm of ambulatory blood pressure lost, circadian rhythm of non-dipper in EH+HCVR group was higher than that in EH+NCVR group (74.3% vs 28.0%; P＜0.01). (3)The HRV index was lower in EH+HCVR group than in EH+NCVR group [SDNN: (85.8±10.7) vs (118.6±13.8)ms; SDANN: (73.1±14.2) vs (106.1±15.2)ms; RMSD: (14.3±5.5) vs (22.3±9.5)ms; PNN50: (4.9±2.1)% vs (7.0±3.0)%; P＜0.01]. (4)The logistic regression analysis indicated that HCVR (OR=4.53; 95%CI 1.77~11.60) and HRV (OR=10.28; 95%CI 3.94~26.86) decreasing were the risk factors of the loss of circadian rhythm in EH patients (P＜0.01). Conclusion The proportion of HCVR is higher in EH patients. Circadian rhythm of non-dipper, loss of circadian rhythm and HRV decrease are common in EH patients with HCVR and may be related with the autonomic nerve damage.

Abstract:Objective To observe the pocket complications after permanent pacemaker implantation and to analyze the reasons and treatment strategies. Methods Pocket complications in 1368 cases of bradyarrhythmia or tachyarrhythmia in past 26 years were summarized. Results Of the 1368 cases, there were 80 cases of pocket hematoma (5.8%), among which, 27 cases underwent blood aspirate or surgical incision. Incidence of pocket hematoma was related to factors such as age, poor nutrition, preoperative use of anticoagulant drugs, low platelet count, and incorrect anatomical hierarchy or careless manipulation during the operation. The pacemaker type and weight had no influence on its occurence. Timely discovery, longer compression time and necessary blood aspirate usually worked, and sometimes surgical incision was needed. There were 6 cases (0.4%) of pocket ulceration, which was related to factors such as large pacemaker, mismatch between the pocket and the pacemaker in depth, location and size, abundant leads and wires above the pacemaker, and occasional rejection reaction. There were 3 cases of pocket infection (0.2%), which considered as secondary infection after pocket ulceration. Pocket translocation following thorough debridement, combined with general antibiotics application and nutrition improvement was effective. Electrode removal was required to thoroughly deal with the infection. Conclusions Pocket complications are associated with the patients￠ constitution. Inadequate preoperative preparation, careless manipulation and inappropriate postoperative treatment are also the risk factors. Incidence of pocket complications can be reduced by careful pre-operation preparation, standard manipulation, timely discovery and appropriate treatment.

Abstract:Objective To investigate the efficacy of coenzyme Q10(CoQ10) in patients with chronic cardiac dysfunction. Methods One hundred cases with New York Heart Association (NYHA) Class Ⅱ or Ⅲ heart failure were enrolled in this double-blind, placebo-controlled study. Patients were randomly divided into CoQ10 group (n＝50) and control group (n＝50), and were administrated with 100 mg/day of oral CoQ10 or placebo respectively for 3 months. Results All patients completed the trial. After 3 months of treatment, NYHA class in CoQ10 group showed a significant improvement compared with control group (P＝0.01). There was a significant (P＝0.045) increase of the 6-min walk-test distance in CoQ10 group but no change in control group (P＝0.63). A tendency of increase of left ventricular ejection fraction was observed in CoQ10 group (P＝0.059). There was a threefold increase of CoQ10 level in CoQ10 group [(0.70±0.06) vs (2.15±0.26) mg/L], but no change was observed in control group. There was a significant decrease in the serum brain natriuretic peptide level in CoQ10 group (P＝0.002), but not in control group (P＝0.31). Conclusions This pilot study suggests that CoQ10 therapy improves cardiac function in patients with NYHA class Ⅱ or Ⅲ heart failure.

Abstract:Objective To analyze the curative effect of linezolid and teicoplanin on aged patients with gram positive bacterium infection. Methods Clinical data of 58 cases [aged 84-98 years, mean(91.2±4.0) years] from January 2008 to August 2011 were retrospective analyzed. The patients were divided into linezolid group(30 cases) and teicoplanin group(28 cases) and standards of clinical evaluation (clarified as recovery, effective, proceeding and ineffective) and bacteriological evaluation (eliminated, presumptively eliminated, un-eliminated, substitutive, reinfective) were set to assess the curative effect as well as the adverse reaction of linezolid and teicoplanin. Results There was no no statistical difference in total clinical effective rate between linezolid and teicoplanin groups (93.3% vs 78.5%, P=0.103), while bacterial clear rate was significantly higher in linezolid group than in teicoplanin group (86.7% vs 53.6%, P＜0.05). The major adverse reaction of linezolid during treatment was thrombocytopenia and increased serum creatinine was observed in teicoplanin group. Conclusions Both linezolid and teicoplanin have good curative effects on aged patients that infected by gram positive cocci. Linezlid has superior clinical curative effect and bacteria clearance. It must be careful in medicine selection according to the indications, meanwhile pay more attention to platelets and serum creatinine monitoring.

Abstract:Objective To evaluate the effect of intensive insulin treatment on oxidative stress level at early stage of diabetic cardiomyopathy (DCM) in elderly patients. Methods Thirty elderly patients with early stage elderly DCM who received intensive insulin treatment between February 2009 and October 2011 were recruited. Superoxide dismutase(SOD), glutathione peroxidase (GSH-PX) and malondialdehyde(MDA) were measured before and after insulin pump therapy. Results After the treatment, SOD and GSH-PX had more significant improvement[(118.40±25.41) vs (171.16±27.76) U/ml, (120.53±46.26) vs (175.58±52.37) enzyme activity unit; P＜0.01]. MDA significantly decreased [(49.53±14.42) vs (22.65±12.54) nmol/ml, P＜0.01]. Fasting blood glucose [(5.64±0.53) vs (10.96±2.63) mmol/L], 2-hour-postprandial blood glucose [(7.74±1.46) vs (18.50±3.24) mmol/L], insulin resistence calculated according to the HOMA formula [(2.50±1.12) vs (5.90±1.82) mmol/L], total cholesterol [(4.40±0.45) vs (8.44±0.90) mmol/L], tryglyceride [(2.80±1.01) vs (6.84±1.83) mmol/L], low-density lipoprotein cholesterol [(3.01±0.73) vs (5.11±1.35) mmol/L], and free fatty acid [(0.34±0.11) vs (0.73±0.10) mmol/L] all decreased significantly (P＜0.05). Homa-b increased significantly [(73.32±12.20) vs (11.8±5.50) mmol/L, P＜0.05]. Cardiac diastolic function was significantly improved [(0.74±0.35) vs (1.09±0.23), P＜0.01]. Conclusions After subcutaneous insulin injection treatment, oxidative stress level significantly decreases and cardiac diastolic function significantly improves in elderly patients with early stage DCM.

Abstract:Objective To discuss the risk factors and pathogenic distribution of hospital-acquired pneumonia(HAP) in elderly patients and to perform the drug sensitivity analysis. Methods A total of 206 HAP patients were included from January 2006 to April 2012 in Chinese PLA 161st Hospital. Their clinical data and sputum culture results were analyzed retrospectively. Susceptibility test was carried out by Kirby-Bauer method according to CLSI2009. Results All 206 subjects suffered from multiple basic diseases and presented with many risk factors. Totally 215 strains were isolated, including gram negative bacteria(61.55%), gram positive cocci(26.63%) and Fungi(2.43%), respectively. Most bacilli were susceptible to imipenem and meropenem, and gram positive cocci to vancomycin and linezolid. Conclusions For elderly HAP patients, control of risk factors, detection of pathogens and use of antibiotics according to drug susceptibility will help to acquire satisfactory therapeutic effect and reduce the drug resistant strains.

Abstract:Objective To explore the effects and mechanisms of steady direct current (DC) electric fields (EFs) on neointimal hyperplasia after abdominal aorta balloon injury in rabbit model. Methods A total of 65 healthy Japanese white rabbits were randomly divided into control group, sham-operation group and experiment group. The experiment group was further divided into 3.0V group and 4.0V group, in which corresponding interventions of DC EFs were applied. The abdominal aorta balloon injury models were firstly established, and then the electrodes were implanted into the bilateral psoas major muscle in sham-operation and experiment groups. The rabbits were sacrificed after 1, 2 and 4 weeks, and the vascular specimens were collected. Neointimal hyperplasia was observed using HE staining. Expressions of type-I and type-Ⅲ collagen were detected by sirius red staining and Western blot. Results There was no difference in the tunica intima/media ratio between sham-operation group and experiment group at 1 week post-operatively. Two weeks and four weeks after the balloon injury, the tunica intima/media ratios in the 3.0V and 4.0V groups were smaller than those in control group (P＜0.01), but there was no significant difference between 3.0V and 4.0V groups (P＞0.05). Sirius red staining showed that the expressions of type-I and type-Ⅲ collagen protein in the neointimal of 3.0V and 4.0V groups were lower than those in control group. Western blot showed that there was no significant difference in type-I and type-Ⅲ collagen expression between experiment group and sham-operation group at 4 weeks after the operations. Conclusion Application of steady DC EFs can inhibit neointimal hyperplasia and reduce collagen expression after the abdominal aorta balloon injury in rabbit model. Steady DC EFs inhibits type-I and type-Ⅲ collagen expression in new formed neointima, but not in the vascular wall.

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Abstract:Resting heart rate is the quiet or inactive heart rate. When general condition is relatively stable, changes of heart rate directly reflect the functional state of heart and sympatheticus. Therefore, resting heart rate is not only involved in heart failure, acute myocardial infarction, hypertension and other cardiovascular diseases, but also has a direct causal relationship with cardiovascular events and death. Appropriate decrease of the heart rate by β-blockers can reduce the risk of cardiovascular death to some extent. For the elderly patients who cannot use β-blockers, ivabradine, which merely reduces heart rate, can improve not only myocardial remodeling and left ventricular systolic function, but also capillary density.

Abstract:MicroRNA(miRNA) is one of small non-coding single-stranded RNAs, which, not only is an important regulatory molecule, but also participates in regulation of growth and aging. In this paper, we review some possible pathways and the related mechanisms of aging in which miRNA may be involved, such as the regulation of telomerase expression, p53 signaling pathway, Rb pathway, and the abnormal expression of the enzyme which directly regulates the synthesis of miRNA. This article provides an overview of research achievements in the relationship of miRNA and aging.

Abstract:Aspiration is one of the most common manifestation of dysphagia. The incidence of pneumonia and mortality was significantly higher in patients with aspiration. Silent aspiration (SA) describes aspirations without any obvious signs of swallowing difficulty, which can be accompanied with many diseases. The pneumonia symptoms and onset caused by SA is not typical, which can easily lead to the delay of diagnosis and treatment. Video fluoroscopic swallowing and fiberoptic endoscopic evaluation of swallowing are the most frequently used techniques to diagnose SA, while more widely available simple detection methods are lack. It needs to improve the detection methods and thereby better define the prevalence and prognostic significance. This article summarized the recent progress on the research of SA, including the prevalence, etiology, significance, methods of diagnosing, prevention and treatment measures.

Abstract:Mitochondria are the cellular organelles which consists of 37 intronless genes that encode 13 subunits of the electron-transfer chain, 2 ribosomal RNAs (rRNA), and 22 transfer RNAs (tRNA). Mutations in mitochondrial DNA (mtDNA) may cause multiple human diseases. Recent researches have shown that reactive oxygen species caused by mitochondria can lead to mtDNA deletion or mutation, mutations of tRNA gene of conserved sequences resulting in defective contractile proteins and oxidative phosphorylation impairment that may increase the myocardial metabolic demands for ATP. Thus, these mitochondrial dysfunctions may contribute to the development of cardiomyopathy. This review summarized the association between mtDNA mutations and cardiomyopathy. These findings provide new insights into the molecular mechanism, management and treatment of cardiomyopathy.

Abstract:The endoplasmic reticulum stress (ERS) is a kind of adaptive response of cells to the alteration of internal and external environments, which contributes to the cells survival. However, it can eventually trigger cell apoptosis once ER dysfunction is severe or prolonged. ERS is intensively induced during ischemia/reperfusion by Ca2+ disturbance, oxidative stress, and so on. Ischemic preconditioning and Ca2+ homeostasis steadying can induce proper ERS, which enhances cell tolerance to prolonged ischemia stimulation, and leads to mitigation of I/R injury. This article reviewed the roles of the ERS in IRI, and proposed that ERS has become a possible target for IRI prevention and cure.