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Abstract:With the increase of diabetes incidence rate, diabetes patients with heart failure are also gradually increased year by year. Diabetes is an important and independent risk factor for heart failure, which worsens the prognosis and causes significant increase in hospitalization rate and mortality of patients with heart failure. These two diseases often occur concomitantly with poor prognosis, which has become one of the major cardiac events in the elderly with diabetes. In this paper, we reviewed the pathogenesis, pathological changes, clinical manifestations and the management of diabetes patients with heart failure, so as to actively prevent, retard the progression, and improve the patients′ quality of life.

Abstract:Objective To investigate the difference of blood glucose fluctuation between type 2 diabetic patients with positive and negative insulin autoantibodies (IAA), and to analyze risk factors which would influence the productions of IAA. Methods Sixty-two hospitalized patients receiving IAA assay and glycemic excursions monitoring with continuous glucose monitoring system (CGMS) in Department of Endocrinology and Metabolism, West China Hospital from May 2009 to March 2012 were recruited. IAA was detected by enzyme-linked immunosorbent assay (ELISA). According to the results of IAA assay, the patients were divided into IAA positive group (n=31) and IAA negative group (n=31). The glucose excursions were assessed by the following parameters obtained from CGMS for 72h: the mean blood glucose (MBG) and its standard deviation (SD), the mean amplitude of glycemic excursion (MAGE), the mean of daily differences (MODD), the postprandial amplitude of glycemic excursion after breakfast (PPGEAB), the postprandial amplitude of glycemic excursion after lunch (PPGEAL), the postprandial amplitude of glycemic excursion after supper (PPGEAS), the mean amplitude of postprandial blood glycemic excursion (MPPGE), the large amplitude of glycemic excursion (LAGE). Glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) in two groups were also determined. Difference of glucose excursion between two groups was evaluated. The relation of age, sex, choice of therapy, body mass index(BMI) and histories of hypertension and hyperlipidemia with the production of IAA were also evaluated, and multiple logistic regression analysis was performed to analyze risk factors influencing the productions of IAA. Results LN(SD), MAGE, LAGE, PPGEAL in IAA positive patients were statistically significantly higher than those in IAA negative patients(P=0.031, P=0.010, P=0.021, and P=0.030; respectively). Multiple stepwise regression showed that choice of treatment was related to the production of IAA. Conclusion The inner daily glucose excursions was larger in patients with IAA positive than IAA negative, and no difference was found in inter daily excursions. Usage of exogenous insulin was positively related to the production of IAA, and the risk was 5.525 times in patients using subcutaneous insulin therapy than patients taking oral hypoglycemic agents.

Abstract:Objective To analyze the prevalence of metabolic syndrome (MetS) and its risk factors between the elderly Yi and Han nationality population in Sichuan Province. Methods A cross-sectional survey was carried out in a representative sample of persons aged ≥20 years in Sichuan region from June 2007 to August 2007 with stratified cluster sampling method．The data of elderly Yi and Han nationality people aged ≥60 years were analysed. Results The prevalence of MetS in elderly Yi and Han nationality population was 23.6% and 29.0%, respectively, which were both higher in females than in males. The prevalence of MetS in male Yi people was higher than than that in male Han people. Yi people in rural area had significantly lower prevalence of MetS than those in urban area. In rural areas, the prevalence of MetS was strikingly lower in the elderly Yi people than in Han people. Female, age and urban residence were independent risk factors for MetS in the elderly Han people, while only female was independently correlated to MetS in the elderly Yi people. Conclusion Regardless of race, the prevalence of MetS was higher in female than in male. The urban residents of Yi people had higher prevalence of MetS than in rural counterparts, whereas the gap was not noted in Han people. The implementation of health strategies needs extensive development in elderly Yi and Han population.

Abstract:Objective To observe the changes of body composition, metabolic profile, and morphology and secretary status of islet β/α cells with high-fat diet (HFD, calorie is 5.86 kcal/kg) and calorie restrict diet (CRD, calorie is 1.6 kcal/kg) from middle adulthood to later adulthood. Methods A total of 45 male SD rats, 14 to 16 months of age were randomly divided into normal diet (ND), HFD and CRD groups. At 0(14?16 months), 8(16?18 months), 16(18?20 months) weeks, body weight (BW), visceral fat, body fat ratio were measured as body composition; blood was collected to detect triglyceride and cholesterol as lipid profile, as well as free fatty acid (FFA), fasting blood glucose and insulin. HOMA-IR, HOMA-β and ISI were calculated according to the levels of fasting glucose and insulin. The secretary status of insulin and glucagon in islet were assessed by immunohistochemistry, and the area of α/β-cell was measured. Results In adult rats, BW, visceral fat, body fat ratio, lipid profile, FFA, fasting glucose and insulin were increased with aging, meanwhile HOMA-IR increased while HOMA-β and ISI were decreased (P＞0.05), and the areas and levels of insulin and glucagon within islet had no significant change. In HFD group, BW, visceral fat, body fat ratio, triglyceride, FFA, fasting glucose and insulin were significantly increased during the 16 weeks, HOMA-IR was increased while ISI decreased, and levels of insulin and glucagon within islet were dramatically increased(P＜0.05). In CRD group, BW, visceral fat, body fat ratio, triglyceride, FFA, fasting glucose, insulin and HOMA-IR were all decreased, while HOMA-β and ISI were increased, and levels of insulin and glucagon within islet were dramatically decreased(P＜0.05). Conclusion The age-related changes of increased insulin resistance, decreased insulin sensitivity were deteriorated by HFD, and improved by CRD. FFA was the earliest and most common impact factor in both HFD and CRD. As insulin levels in both serum and islet were increased in HFD group at 8 weeks, islet glucagon levels was decreased significantly at the same time in CRD group, β cell was the targeted cells by HFD whereas α cells by CRD.

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Abstract:The high prevalence of geriatric syndromes accompanied with type 2 diabetes mellitus in elderly, such as frailty syndrome, malnutrition, dementia, mood disorder, disability, is getting more and more concern. However geriatric syndromes were seldom taken into consideration in guidelines released by diabetic association. The epidemiology features of malnutrition, dementia, mood disorder, and disability were reviewed; the optimal individualized HbA1c value and the comprehensive strategy for elderly diabetic patient were also discussed.

Abstract:Objective To determine the clinical features of hyperuricemia and the association between hyperuricemia and accompanied disease in elderly male patients. Methods Elderly male hospitalized patients from 2002 to 2004 in Chinese PLA General hospital were retrospectively analyzed, including 225 patients with hyperuricemia and 225 without, and 110 patients accompanied with diabetes in each group. Demographic information and biochemical examination results were collected and the influential factors of hyperuricemia were analyzed. Results The 10.5% eldely male hospitalized patients presented with hyperuricemia. Significantly more patients were complicated with renal dysfunction in hyperuricemic group than in non-hyperuricemic group (27.6% vs 6.2%, c2＝36.47, P＝0.0000). The age, body mass, body mass index, blood pressure, triglyceride, total cholesterol, fasting glucose, blood creatinine, blood urea, creatinine clearance rate and high density lipoprotein cholesterol of hyperuricemic group were also significantly different with non-hyperuricemic group(P＜0.01). In hyperuricemic group, the morbidity rate of coronary heart disease, hypertension, hypertriglyceridemia, renal dysfunction was higher than those in non-hyperuricemic group(P＜0.01). In hyperuricemic group, the serum uric acid level was significantly associated with age, body mass, body mass index, blood pressure, triglyceride, total cholesterol, HbA1c, blood creatinine, blood urea and creatinine clearance rate (P＜0.01). Conclusions The prevalence of hyperuricemia was high in old male person. Less than 10% hyperuricemia patients had gout, but more (4.5 times) hyperuricemia patients complicated with renal dysfunction than those without hyperuricemia. Hyperuricemia often accompanied with obesity, glucose and lipid metabolic dysfunction and hypertension. Hyperuricemia may be a risk factor of hypertension, coronary heart disease, diabetes and hyperlipidemia. We should pay more attention to the patient with hyperuricemia, and try to diagnose and treat the disorder as early as possible.

Abstract:Objective To evaluate the relation between the myocardial pathological lesion and the outcome of cardiac resynchronization therapy ( CRT ) in patients with dilated cardiomyopathy ( DCM ) using 99mTc-methoxy-isobutylisonitrile (99mTc- MIBI) myocardial perfusion single photon emission tomography (SPECT) and JSF-fluoro-2-deoxy-D-glucose (18F-FDG) imaging. Methods Totally 13 cases of DCM patients with heart failure were successfully implanted with CRT device. SPECT imaging was performed 6-month before and after CRT. Left ventricular myocardial perfusion and metabolic changes were evaluated by semi- quantitative analysis method in all patients. Results Compared with preoperative left ventricular ischemia necrosis areas and mass percentage, significant decrease was observed postoperatively [(18.2%±12.7%) vs (31.8%±15.4%), P＜0.05; (22.3%±14.9%) vs (36.4%±14.3%), P＜0.05]. There was negative correlation between necrotic area mass percentage or total myocardial perfusion score before operation ( F value) and CRT response (r＝-0.578, P＜0.05; r＝-0.619, P＜0.05), and significant positive correlation of preoperative myocardial perfusion zero score（N0）with improved postoperative left ventricular systolic function (r＝-0.655, P＜0.05) or left ventricular reverse remodeling (r＝0.719, P＜0.05). Conclusion The greater the myocardial cell necrosis before CRT, the worse effects of CRT. CRT can improve the regional myocardial blood perfusion, increase myocardial cell metabolism and reduce the extent of myocardial necrosis.

Abstract:Objective To retrospectively investigate the clinical characteristics of drug-induced liver injury(DILI) in the elderly patients admitted to Chinese PLA 302nd hospital during 2003-2010. Methods DILI patients were divided into aged group (age＞60 years, n=139) and non-aged group(age＜60 years, n=105). Clinical features and biochemical indexes were compared between the two groups. Results Among 14 species causative agents which can induce DILI, the frequency ranging top five in aged group were Chinese herbal drugs(31.7%), antibiotics(13.7%), analgesics/antipyretics(12.2%), cardiovascular drugs(11.5%) and antitubercular drugs(6.5%), which were significantly different from non-aged group (Chinese herbal drugs: 43.8%, analgesics/antipyretics: 18.1%, antibiotics: 13.3%, antitubercular drugs: 6.7%, hyperthyroidism drugs: 4.8%). There were no statistical differences in incidence of jaundice and liver failure between aged and non-aged groups(77.1% vs 82.0% and 2.9% vs 4.8% ). However, the level of glutamyl transpeptidase and hospitalization time were higher and longer in aged group than in non-aged group. Liver injury types in aged group were cholestetic(45.9%), hepatocelluar(28.6%) and mixed(25.5%) DILD. In non-aged group, the percentage of above types was 39.3%, 34.8% and 25.8% respectively, with no significant difference with aged group. Conclusion Due to highly cholestetic icteric occurrence and sporadic liver failure of DILI in the elderly, it is necessary to prevent drug hepatotoxicity. We recommand to increase vigilance during pre-clinical drug option, especially for Chinese herbs, antibiotics and analgesics/antipyretics. Regular monitoring liver functions during administration is one of the effective preventive measures.

Abstract:Objective To prospectively investigate neurological complications (NC) after off-pump coronary artery bypass grafting (OPCAB), including types of NC, incidence rates, risk factors, prevention and treatment measures. Methods A total of 82 elderly patients with OPCAB admitted to Department of Cardiosurgery in Anzhen Hospital between June and October 2010 were evaluated. Firstly, risk factors of NC were collected before operation. Secondly, nervous system physical examination, cerebral perfusion examinations, cognitive tests and anxious and depression scale were performed before and after OPCAB; NC occurrence and types were determined after surgery. Thirdly, all patients were divided into two groups according to whether there was NC occurrence after operation, and univariate analysis was used to compare the two groups. Results The total incidence rate of postoperative NC was 17.01%(14/82), with no case dead. The incidence of postoperative cognitive dysfunction(POCD), anxiety and depression, hypoxic ischemic encephalopathy, and ischemic cerebrovascular disease were 14.63%(12/82), 6.10%(5/82), 3.66%(3/82) and 1.22%(1/82), respectively. Single factor analysis indicated that there were statistically significant differences in stroke history, CT scan lesions and diabetes between NC group and non-NC group. Statistical significance also observed in rTTP. Conclusion Preoperative screening is important for OPCAB patients. Improvement of the laboratory examination, performance cerebral perfusion and so on can help to screen out high-risk patients before surgery and provide them with appropriate prophylaxis. OPCAB is relatively safe for nerve system, but more clinical data is needed for further exploration.

Abstract:Objective To investigate the clinical significance of myeloperoxidase (MPO) and paraoxonase (PON) in coronary heart disease (CHD) patients. Methods According to the results of selective coronary angiography, 300 hospitalized patients were divided into coronary heart disease group (n=240) and control group (n=60). Coronary heart disease patients were further divided into stable angina pectoris (SAP) group (n=60) and acute coronary syndrome (ACS) group (n=180) according to the clinical diagnosis; and were divided into group A, B and C according to the type of pathological changes. The lesions of coronary artery were graded by means of Gensini coronary score system. Meanwhile, the serum MPO were evaluated by colorimetry method and the PON-1 concentration level was determined by pheny acetate method. Results The level of MPO in CHD group was significantly higher [(52.23±13.92) vs (22.49±8.81) U/L, P＜0.01], PON level was significantly lower [(114.10±35.84) vs (139.40±39.42) mkat/L, P＜0.05] than that in the control group. In ACS group, MPO level was also significantly higher [(58.84±17.93) vs (36.52±8.21) U/L, P＜0.01], and the PON-1 level was significantly lower than that in the SAP group [(93.10±27.68) vs (111.97±33.42) mkat/L, P＜0.05]. When the coronary artery disease type and the severity of coronary artery disease became aggravated, the MPO level was gradually increased and the level of PON-1 was gradually decreased. Multiple linear regression analysis showed that MPO, PON-1, high density lipoproptein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) concentrations were significantly correlated with the Gensini score of coronary lesions. Conclusion MPO, PON-1, HDL-C, LDL-C concentrations are significantly related with the Gensini score of coronary lesions. It may be involved in the development of atherosclerosis. MPO and PON-1 concentrations could be appropriate indicators to reflect the local inflammation of atherosclerotic plaque.

Abstract:Objective To investigate the relationship between ultrasonography score and clinical severity in elderly patients with acute cholecystitis, and acquire a quantifiable index of disease severity to provide reference for therapy. Methods According to clinical manifestation, 72 elderly acute cholecystitis cases were classified into mild, moderate and severe cases. These cases were scored based on pre-surgery ultrasonic image index (enlarged gallbladder, thickened gallbladder wall, double-layer image, gallbladder stones, incarcerated gall-stone, echo in gallbladder fluid, peri-gallbladder effusion or adherence), prediction and pre-surgery guidance value of which for severity of acute cholecystitis were evaluated. Results Of 72 cases, there were 36 mild cases, 21 moderate cases and 15 severe cases. The cases showing enlarged gallbladder, thickened gallbladder wall, double-layer image, gallbladder stones, incarcerated gall-stone, echo in gallbladder fluid, peri-gallbladder effusion or adherence were mostly moderate cases and severe cases with statistical significance compared with mild cases(P＜0.05). Twenty-eight cases with score ≤5 were mainly consisted of mild cases, which accounted for 92.9% (26/28). The cases with score 6-9 were mainly consisted of moderate cases, which accounted for 57.7% (15/26). The cases with score ≥10 were mainly consisted of severe cases, which accounted for 72.2% (13/18). It was shown that ultrasonography scores highly coincided with intra-surgery findings. There were significant differences among three groups in the number of cholecystostomy cases (P＜0.05). Conclusion Ultrasonography score could provide quantifiable index for clinical severity of acute cholecystitis in the elderly and has guidance value for clinical therapy. Ultrasonography score might be used as a reference for surgery intervention timing.

Abstract:Objective To investigate the clinical features of giant cell arteritis(GCA). Methods Data of 31 patients with GCA (diagnosed according to American College of Rheumatology classification standard) in Chinese PLA General Hospital from 2008 to 2011 were analyzed. The clinical manifestation, assistant examinations, response to steroid therapy and follow-up data were recorded and compared with results in literatures abroad. Results There were 17 male cases and 14 female cases and mean age was 67.1 years (range 47-92 years) and 20 cases were acute onset. There were 29 cases with headache, 27 cases with weakness, 25 cases with fever, 17 cases with rheumatic polymyalgia, 15 cases with weight loss, 12 cases with dysmasesia, and 15 cases with temporal artery abnormal morphology and pulsation. Brain CT showed infarctions(including lacunar infarction) in 21 cases and temporal artery ultrasound showed abnormity in 22 cases. Erythrocyte sedimentation rate at first visit was 98.3 mm/h(50—150 mm/h) and increased to 18.5 mm/h (20—43 mm/h). Incidence in male was higher than that in female according to reports in China, which was different from reports abroad, those in and constitutional symptoms, such as fever and weight loss are prominent. Conclutions Characteristis of GCA patients in China are different from those in other countries. The male incidence is higher than female, and fever, headache, rheumatic polymyalgia are more common. Ultrasound is an effective means in diagnosis and clinical evaluation.

Abstract:Objective To analyze the risk factors for stroke-associated pneumonia (SAP) in intensive care unit (ICU). Methods We retrospectively studied the clinical data of 101 patients with acute stroke who were admitted to ICU of First Affiliated Hospital of Nanjing Medical University between 1 March 2010 and 31 March 2011. Results Thirty out of 101 patients developed SAP (29.70%). One-way analysis of variance showed that differences of age, diabetes history, stroke history, dysphagia after stroke, mechanical ventilation, tracheotomy and length of stay between SAP and non-SAP group were significant (P＜0.05). According to the logistic regression model, male gender, diabetes history, dysphagia after stroke and tracheotomy were independent risk factors for SAP in east China. Conclusion The prevalence of SAP in acute stroke patients admitted to ICU was associated with multiple factors and prevention of SAP in acute stroke patients should be warranted. Other potential risk factors of SAP need to be evaluated in further studies.

Abstract:Objective To investigate the effect of ω-3 fish oil fat emulsion on monocyte chemoattractant protein-1(MCP-1) and cellular immunity in elderly patients with stroke associated pneumonia(SAP)．Methods Totally 60 elderly patients with SAP were randomly divided into routine treatment group and fish-oil group receiving ω-3 fish oil fat emulsion plus routine treatment. Meanwhile, 30 healthy elderly was selected as normal control. The levels of serum MCP-1 and T-cell subset were assessed before and 8 day after administration．Results The clinical effective rate of fish-oil group was higher than traditional treatment group(P＜0.05). The level of serum MCP-1 in elderly patients with SAP was increased greatly compared with normal control elderly(P＜0.01), while it was reduced after treatment(P＜0.01). The change of serum MCP-1 in fish-oil group was greater than that in routine treatment group (P＜0.01). Compared with the normal control elderly, the ratio of CD4+/CD8+ cells was significantly lower in elderly patients with SAP and was increased after treatment. The ratio of CD4+/CD8+ cells was increased significantly in fish-oil group than that in routine treatment group(P＜0.01). Conclusion ω-3 fish oil fat emulsion may play a protective role on senile patients with SAP by improving function of cellular immunity and reducing the level of serum MCP-1.

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