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Abstract:Incidence of geriatric lung cancer increased with aging. In China, the elderly patients with lung cancer deserve great attention regarding that the elderly population has been increasing and the life expectancy is expected to enhance. The elderly patients with geriatric lung cancer are characterized by vital organ dysfunction, multiple basic diseases, and poor drug endurance. Current diagnosis and treatment for geriatric lung cancer is far from being satisfactory. The evidence-based diagnosis and treatment of geriatric lung cancer is strongly recommended, which remains a great challenge currently.

Abstract:Objective Malignant grade and death rate are very high for non-small cell lung cancer (NSCLC), and gefitinib is a new molecule target anticancer drug. The aim of this meta analysis was to evaluate the clinical efficacy of gefitinib for NSCLC with mutation in epidermal growth factor receptor(EGFR). Methods We searched WP(2000—2011.06), wanfang (2000—2011.06), CNKI(2000—2011.06), OVID(2000—2011.06), Karger Online Jounals(2000—2011.06). Two reviewers independently evaluated the quality of the included studies and extracted the data. Meta-analyses were performed by RevMan 5.1 software. Results Ten studies involving 941 patients were included. The results of meta-analyses showed that: when gefitinib was used for NSCLC with mutation in EGFR compared to non-mutation, overall response rate increased(RR＝4.42, 95% CI: 3.49-5.60) and disease control rate also increased(RR＝1.79, 95% CI: 1.23～2.61) and the rate of disease progression decreased(RR＝0.24，95% CI: 0.18-0.32). Conclusion Gefitinib shows more superiority for NSCLC with EGFR mutation, and its clinical application is worthy to be advocated.

Abstract:Objective To investigate the clinical characteristics of invasive pulmonary mycosis(IPM) secondary to lung cancer. Methods The clinical data of 10 cases with IPM secondary to lung cancer in Beijing Institute of Respiratory Diseases from February 2010 to January 2012 were respectively analyzed. Results Average age of 10 patients was (64.5±14.7) years, and 5 cases were older than 70 years of age. There were 8 patients with non-small cell lung cancer, and 2 cases with small cell lung cancer. All the patients presented with clinical stage Ⅳ disease and received antitumor therapy. Definite IPM diagnosis was established in 7 cases and possible diagnosis in 3 cases. Aspergillus and candida were common pathogenic fungi in this group. The symptoms of IPM were mostly presented as dyspnea (8/10), fever (8/10), hemoptysis (5/10) and chest pain (5/10). The most frequent chest CT features included infiltrates and (or) consolidations (10/10), and cavities were found in 2 cases. All patients received antifungal therapy. Seven cases were improved and 3 cases died. Conclusion The elderly and advanced patients with lung cancer are more prone to secondary IPM after receiving antitummor therapy, which has a high mortality rate. Early diagnosis with prompt potent antifungal agents may be beneficial to these patients.

Abstract:Objective To explore the diagnosis and treatment of radiation recall pneumonitis(RRP) in elderly. Methods The diagnosis and treatment of two cases of RRP induced by targeted medicines and antibiotics after radiotherapy for lung cancer was reviewed. Results Diagnosis of RRP induced by erlotinib and levofloxacin after thoracic radiotherapy was established for the two elderly patients with lung cancer. Symptomatic and radiographic improvement was observed after withdrawal of induced drugs and application of corticosteroids. Conclusions Doctor should pay attention to RRP on the aged patients treated with antibiotics and antineoplastics after radiotherapy.

Abstract:Paradigm of chemotherapy for elderly patients with advanced non-small cell lung cancer (NSCLC) remains immature. High-level evidence of chemotherapy for geriatric advanced NSCLC, which contributes to the update of guideline for clinical practice worldwide, was reviewed and analyzed. In light of those evidence, it is generally accepted that single agent chemotherapy is recommended and platin-base doublet is an alternative for elderly patients with advanced NSCLC. In the meantime, it was also suggested that elderly patients with advanced NSCLC have heterogeneity and the management of those patients is de facto an issue of how to arrive at further sub-classification by virtue of their clinical features such as performance status, comorbidity, vital organ function, and so on.

Abstract:Lung cancer is a malignant tumor with the highest morbidity and mortality worldwide at present. As the global population is tend to aging, the morbidity and mortality of geriatric lung cancer is on the rise now, and the overall survival is poor. Therefore, early diagnosis is the key to improving the prognosis of lung cancer. This article discusses the status quo, advances and problems of diagnosis for lung cancer, and expIores the direction of future research.

Abstract:Objective To validate the performance of multiple warfarin pharmacogenetic algorithms in Chinese patients under low intensity warfarin anticoagulation. Methods We sought to compare the performances of 8 eligible pharmacogenetic algorithms in a cohort of Chinese patients (n＝282) under low intensity warfarin anticoagulation with target international normalized ratio (INR) ranged from 1.6 to 2.5. The performance of each algorithm was evaluated by calculating the percentage of patients whose predicted dose fell within 20% of their actual therapeutic dose (percentage within 20%), and the mean absolute error (MAE) between each predicted dose and actual stable dose. Results In the entire cohort, the pharmacogenetic algorithms could predict warfarin dose with the average MAE of (0.87±0.17) mg/d (0.73～1.17 mg/d), and the average percentage within 20% of (43.8%±8.1%) (29.1%～52.1%). By pairwise comparison, warfarin dose prediction was significantly more accurate with the algorithms derived from Asian patients (48.6%～50.0%) than those from Caucasian patients (29.1%～39.7%; OR: 1.61～3.36, P≤0.02). Algorithms with additional covariates of INR values or CYP4F2*3 performed better than those without the covariates (adding INR: OR＝1.71 (1.08～2.72), P＝0.029; adding CYP4F2*3: OR＝2.67(1.41～5.05), P＝0.004). Conclusions Algorithms derived from Asian patients (48.6%～50.0%) can predict more accurately than those from Caucasian patients in the Chinese patients. Construction of a refinement pharmacogenetic algorithm integrating 3 genotypes (CYP2C9, VKORC1 and CYP4F2) and INR data should be warranted to improve the warfarin dose prediction in such patients.

Abstract:Objective To investigate aging-associated changes in serum thyroid hormone levels and cellular immune function. Methods Three groups of healthy subjects were recruited based on SENIEUR protocol criteria: group A, aged over 80 years (n = 78); group B, aged 60-79 years (n = 128); and group C, aged 20-59 years (n = 60). Serum thyroid hormone level was determined by chemiluminescence method. Peripheral blood T cells, B cells, and NK cells numbers were evaluated by flow cytometry and T cell subsets CD4＋/CD8＋ ratios were also calculated. In addition, 10 subjects were randomly selected from each group and their T cells were isolated from peripheral blood mononuclear cells (PBMC); T cell proliferation after phytohemagglutinin (PHA) stimulation was determined by MTT assays. Results There was no significant difference in T3 thyroid hormone (T3), T4 thyroid hormone (T4), free T3 (FT3), free T4 (FT4) and thyroid stimulating hormone (TSH) among the three groups (P＞0.05). There was no marked difference in PBMC surface HLA-DR expression, as well as the absolute numbers of peripheral blood T cells, NK cells, or B cells among the three groups (P＞0.05). Moreover, no significant difference was observed in the numbers of CD4＋ cells, CD8＋ cells, or the CD4＋/CD8＋ ratios (P＞0.05). However, T cell proliferation was markedly increased after PHA stimulation, with the highest level in group C and the lowest level in group A (P＜0.05). Conclusion The study recruits subjects based on the SENIEUR protocol criteria, and our findings suggest that the levels of serum thyroid hormone and the numbers of immune cells remain unchanged with increasing age. However, there is a trend for decreased cellular immune function with increasing age.

Abstract:Objective We sought to determine the association between the single nucleotide polymorphism of cytochrome P450 2C19(CYP2C19) 681G>A and the occurrence of clopidogrel resistance (CR) in Chinese elderly patients. Methods Totally 614 hospitalized patients (aged over 60 years) in Shenyang General Hospital between June 2010 and April 2011 were enrolled. These patients underwent successful percutaneous coronary intervention with drug-eluting stents and received treatment with dual antiplatelet regimen (aspirin plus clopidogrel). All enrolled patients were given a loading dose of 600mg clopidogrel and 300mg aspirin. Twenty-four hours later, blood samples were collected ant 20μmol/L ADP-induced platelet aggregation ratio (PAR) was assessed. The maximum residual platelet aggregation (RPA) ≥70% was defined as CR, and the RPA<70% as non-CR (NCR). Genomic DNA was extracted from whole blood samples according to standard protocols, the single nucleotide polymorphism of the CYP2C19 681G>A was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in all cases. Results CR was found in 126 cases (20.5%). CYP2C19 681G>A polymorphism was observed in this population group. The frequencies of the three kinds of genotypes (GG，GA，AA) in CR group and NCR group were 32.6%, 47.6%, 19.8% and 47.9%, 45.0%, 7.0%, respectively. The frequency of AA genotype was significantly higher in NCR group than in CR group (OR=3.03, 95% CI：1.889-5.784, P=0.003). The A allele carriers were more likely to develop CR compared with that of G allele carriers (OR=1.85, 95% CI：1.392-2.459, P=0.002). Conclusion CYP2C19 681G/A polymorphism is associated with the risk of CR, and the A allele carriers may be a possible genetic susceptibility factor for elderly patients with CR.

Abstract:Objective To evaluate the efficacy and safety of triple antiplatelet therapy (cilostazol combined with clopidogrel and aspirin) in senile patients undergoing multiple drug-eluting stents (DES) implantation of complex coronary lesions. Methods Totally 128 senile patients (65-75 years old) undergoing multiple DES implantation for complex coronary lesions were enrolled from March 2006 to September 2009. After percutaneous coronary intervention, the patients were randomly divided into control group (clopidogrel 75 mg/d and asprin 100mg/d, n=67) and triple antiplatelet therapy group (cilostazol 100mg twice a day for 3 months in addition to aspirin 100mg/d and clopidogrel 75mg/d, n=61). From 3 months to 12 months after the operation, all patients received 75mg/d clopidogrel. The clinical data were analyzed, including the clinical characteristics, coronary lesion, paratmeter of multiple DES implantation and major cardiovascular event (MACE) of all the patients in a follow-up period of a mean (20.4±5.1) months. Results The ratios of fatal or non-fatal myocardial infarction (MI) and target vessel revascularization (TVR) were significantly lower in triple antiplatelet therapy group than in control group (6.56% vs11.94%, P=0.043; 6.56% vs 13.43%, P=0.042). So the overall incidence of primary end point including death, MI and TVR was obviously lower in triple antiplatelet therapy group than in control group (9.84% vs 17.91%, absolute risk reduction 8.07%, P=0.043). There was no significant difference in the incidence of all-cause death between the 2 groups(1.64% vs 2.99%, P=0.615). The incidence of stent thrombosis during 30 days and follow-up period was obviously lower in triple antiplatelet therapy group than in control group (0.00% vs 2.99%, P=0.050; 1.64% vs 4.48%, P=0.048). While for secondary end points such as major and minor bleeding events, no significant difference was found between the 2 groups(1.64% vs 0.00%, P=0.343; 3.28% vs 2.98%, P=0.846). Conclusion　Triple antiplatelet therapy for 3 months after PCI procedure significantly reduces the risk of adverse events and stent thrombosis in senile patients undergoing multiple DESs for complex coronary lesions and appears to be safe.

Abstract:Objective To observe the safety and effectiveness of different doses of atorvastatin calcium for patients with unstable angina pectoris (UA) and non-revascularization. Methods Thirty-eight elderly patients with UA and non-revascularization were randomly divided into 2 groups. One group received atorvastatin calcium 20mg daily, the other group 40mg instead. Total cholesterol(TC), triglyceride (TG), low-density lipoprotein cholesterol(LDL-C) and lipid profiles were measured at 1 and 3 months, as well as Holter examination results, main adverse cardiac events（MACE） and adverse drug reaction. Results After treatment, TC, TG and LDL-C in two groups were significantly reduced (P＜0.05). Compared with 20mg group, both the degree and the duration of ischemic ST segment depression were significantly decreased (P＜0.05), and the incidence of MACE, including nonfatal myocardial infarction, recurrent angina pectoris and rehospitalization due to symptomatic myocardial ischemia, was significantly lower in 40mg group (P＜0.05). There was no significant difference in the incidence of adverse drug reaction between the two groups (P＞0.05). Conclusion For elderly patients with UA and non-revascularization, atorvastatin calcium both the dose 20mg/d and 40mg/d can regulate effectively the blood lipid profiles. Atorvastatin calcium at the dose of 40mg/d has more significant effectiveness.

Abstract:Objective To determine the drug usage and risk factors control in elderly patients with chronic stable angina. Methods From Jun 1, 2010 to Dec 1, 2010, patients with coronary artery disease in Outpatient Department of Air Force General Hospital were surveyed. Totally 186 elderly patients with chronic stable angina were screened out and their data were statistically analyzed. Results The usage rates of anti-plate drugs, nitrate, statins, beta-blockers, angiotensin-converting enzyme inhibitors/ angiotensin-receptor blockers and calcium channel blocker were 87.1% (162/186), 84.9% (158/186), 68.8% (128/186), 54.8% (102/186), 50.0% (93/186) and 48.4% (90/186) respectively. There was no significant difference in these drugs usage and risk factors control rate between the males and the females (P＞0.05). The qualification rate for low density lipoprotein cholesterol in the subjects was 34.9% (65/186). The qualification rate for blood pressure in patients with complicated hypertension or chronic renal diseases was 58.3% (77/132). The qualification rate for HbA1c in patients complicated with diabetes or impaired glucose tolerance was 43.1% (25/58). There was no statistical difference between males and females (P＞0.05). Conclusions The drugs usage in elderly patients with chronic stable angina has not met the standard according to the guideline on chronic stable angina yet. It is urgent to improve the risk factors control status for elderly patients with chronic stable angina.

Abstract:Objective To assess the safety and comfort of colonoscopy with carbon dioxide(CO2) insufflation in elderly people. Methods This was a randomized controlled double-blind study. Totally 110 consecutive elderly participants undergoing colonoscopy were randomized into air insufflation group(n = 55) and CO2 insufflation group(n = 55). Patients’ experiences of abdo minal pain and bloat were registered using Visual Analog Scale (VAS). The degrees of pneumatosis in the intestinal canal were recorded by the X-ray exam. Transcutaneous partial CO2 pressure was continuously measured with a capnograph as a safety parameter. Above parameters were compared between air insufflation and CO2 insufflation group. Results VAS scores and pneumatosis scores in CO2 group were significantly lower than those in air group [(7.0±4.9) vs (9.0±3.7) min; P＜0.05] during and after examination. The questionnaire survey of abdominal pain and bloat at different time points (5, 10, 15, 20 min after colonoscopy) showed that the questionnaire score in CO2 group were significantly lower than that in air group [5min: (15.4±2.1) vs (63.5±13.5); 10min: (5.1±1.3) vs (60.3±10.9); 15min: (0.5±0.7) vs (58.6±11.6); 20min: (0.0±0.7) vs (50.4±8.2); P＜0.01]. The intestinal dilatation scores were significantly lower in CO2 group compared with that in air group [(1.2±0.5) vs (3.6±0.9); P＜0.05]. No significant changes of end-tidal CO2 pressure were found between CO2 and air groups. Conclusion Compared with air insufflation, colonoscopy with CO2 insufflation has the same safety and reliability. Furthermore, colonoscopy with CO2 insufflation possesses the significant advantages of less abdominal pain, shorter examination time and better toleration in elderly patients.

Abstract:Objective To study the senescence of glycometabolism(GM) with reduced hepatic clearance of insulin. Methods Totally 383 patients admitted in Chinese PLA 458th Hospital between March 2007 and October 2009 were recruited in the study, including 383 fasting cases and 87 oral glucose tolerance test(OGTT) cases. According to method of two factorial experiment, fasting patients were divided into type 2 diabetes(T2D), pre-diabetes(PD) and euglycemia group by GM; aged, middle and young group by age. Meanwhile, OGTT patients were divided into T2D and non-diabetes group by GM; aged and non-aged group by age. Biochemical assays including plasma glucose(PG), insulin(Ins) and C-peptide(C) were carried out for all patients. The quantitative data of assays were analyzed by SPSS13.0 software with ANOVA or S-N-K. Results In fasting state, patients of T2D group had highest level of plasma glucose, and PD group had the highest Ins and C-peptide levels (P＜0.05); middle age group had highest PG and C-peptide levels (P＜0.05), and the highest Ins was found in aged group; there was interaction of assays between GM and age (P＜0.05). With OGTT stimulation, early phase secretion of Ins was deficient in T2D group(P＜0.01); PG in aged group was lower than that in non-aged group, but Ins and C-peptide in aged group exceeded that in non-aged group 1-3 h after OGTT(P＜0.05). Conclusion There is senescence on GM: fasting Ins increases with age, and there is interaction between GM and senescence. More Ins released in blood is observed due to the reduced hepatic clearance in aged patients.

Abstract:Objective To explore the relationship of culprit artery lesion and clinical prognosis with different electrocardiogram(ECG) reciprocal ST segment depression(R-ST-D) types in patients with acute ST segment elevation myocardial infarction(STEMI). Methods Totally 967 cases of STEMI with completed data were enrolled in present study. The patients were then divided into four groups according to the amplitude of R-ST-D. GroupⅠconsisted of 143 patients with non R-ST-D; group Ⅱconsisted of 664 patients whose amplitude of R-ST-D were less or equal to the amplitude of the ST segment elevation in myocardial infarction area; group Ⅲ consisted of 93 patients whose amplitude of R-ST-D was larger than the amplitude of the ST segment elevation; group Ⅳ consisted of 67 patients whose corresponding ST segment and ST segment in myocardial infarction area were all elevated. The culprit artery lesion and clinical prognosis were compared between the four groups. Results The occurrence of R-ST-D were recorded, which were 14.8%, 68.7%, and 9.6% in group Ⅰ, Ⅱ, and Ⅲ, respectively, which mainly involved anterior descending branch. In group Ⅳ, the incidence was 6.9%, and it mainly involved complex anterior wall, anterior descending branch, circumflex branch, and right coronary artery. The prognosis indices included pump failure, low blood pressure, malignant arrhythmia, infarction extension, ventricular wall incoordination, left ventricular ejection fraction≤50%, and in-hospital mortality, which were 71.6%, 41.8%, 61.2%, 34.3%, 100.0%, 40.3%, and 16.4% respectively(P＜0.05 or P＜0.01). Conclusion Different ECG R-ST-D in patients with acute ST segment elevation myocardial infarction can forecast the culprit artery lesion and clinical prognosis.

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Abstract:Atrial fibrillation (AF) is the most common type of arrhythmia clinically, which has high morbidity and mortality, and needs early intervention. Radio-frequency catheter ablation (RFA) has been widely used to treat AF throughout the world, with the trend to become first-line treatment of AF. Numerous studies indicate that RFA has great advantages in treating AF and is free of side effects of drug-induced cardioversion. There is a total success rate of 73.3%, but still nearly 26.1% recurrence rate exists clinically. To reduce recurrence rate and investigate the recurrent predictors are significant for clinicians to identify patients and choose appropriate treatment strategy. In this paper, we reviewed the predictors of recurrence following RFA of AF in the following aspects: the basic indicators, clinical characteristics, pathological anatomy factors, clinical biochemical index, ablation procedures, postoperative management, and so on.

Abstract:Antiphospholipid syndrome (APS) is a systemic autoimmune disease involving multi-organs, characterized by recurrent arterial or venous thrombotic events, spontaneous abortion, thrombocytopenia and persistent positivity of antiphospholipid antibodies. The heart is one of the important target organs of APS. In this paper, we reviewed the cardiovascular manifestations of APS, such as valve disease, myocardial infarction, intracardiac thrombus, myocardial microthrombosis and therapeutic strategy.