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Abstract:Age-related diseases have become more and more dominant with the coming era of aging. Elderly patients with mild cognitive impairment (MCI) are of high risk of Alzheimer's disease (AD). MCI is regarded as a clinical stage between normal cognitive aging and mild dementia. However, very little is known on how to recognize MCI in routine clinical practice. Strengthening the knowledge of early MCI, and improving its assessment and screening in the elderly can guarantee early intervention and prevention of AD.

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Abstract:Objective To survey the depression status accompanied with chronic diseases in elderly patients and the relative influencing factors. Methods Subjects were chosen from some hospitals and communities in Xi'an region, who were over 60 years old, without severe cardiopulmonary diseases or cognitive disorder druing January 2011 to May 2012. Geriatric depression scale (GDS) was used, and the results were evaluated and analyzed with their diagnosed chronic diseases and related factors. Results Among the 757 subjects, 40 were diagnosed with depression, with an incidence of 5.28%. Moreover, the women, illiterate and hard laborers had a higher incidence than the men, those with above elementary education and mental workers (P＜0.05). There was no statistical significance between different age groups (P＞0.05). The incidence of depression was positively related to chronic diseases in elderly patients. The depression incidence was significantly higher in the elderly with gastrointestinal diseases than those without (P＜0.05). However, there was no statistical difference among other system diseases (P＞0.05). Conclusion The depression of elderly people with chronic diseases is significantly related to chronic gastrointestinal diseases, suggesting that psychological counseling and care should be enhanced to prevent their depression.

Abstract:Objective To screen mild cognitive impairment (MCI) in Xi?an military retired cadres by using Montreal cognitive assessment (MOCA) scale. Methods A random sample of military retired cadres was selected from 9 Xi?an sanatoria by cluster sampling. Their personal information and MCI prevalence were collected and recorded. MOCA scale, Mini-mental state examination (MMSE) scale, Activities of daily living (ADL) scale, Center for epidemiologic studies depression scale (CES-D) and Pittsburgh sleep quality index (PSQI) scale were used to survey these selected cadres. Results There were 304 retired cadres sampled in this study. Among them, there were 64.8% having MCI, with the incidence significantly higher in those at age over 80 than those over 70 (P＜0.05). Those educated for less than 6 years had significantly higher incidence of MCI than those for 7 to 12 years education and those for over 12 years education (P＜0.05). The MCI incidence of those never taking exercise was significantly higher than that in those taking regular exercise (P＜0.01). So was that for those with brain stroke than those without (P＜0.05). The scores of MOCA had a positive correlation with those of MMSE (r＝0.81), and a negative correlation with those of ADL and CES-D, but had no correlation with those of PSQI. Conclusion The score of MOCA is correlated with those of related neuropsychiatry scales. The scale is easy and feasible to operate, and can be used to screen MCI for military retired cadres.

Abstract:Objective To determine the therapeutic effect of polyene phosphatidylcholine (PPC) combined with valproic acid magnesium(VPA-Mg) on cognitive function in patients with epilepsy. Methods A total of 42 outpatients with identified epilepsy in Xijing Hospital during December 2011 to September 2012 were randomly divided into 2 matched groups, that is, VPA-Mg+PPC group (n=20) and VPA-Mg group (n=22). Their clinical data before, and in 4, 12 and 24 weeks after treatment were observed and analyzed. The Beijing version of Montreal cognitive assessment and the Alzheimer￠s disease assessment scale-cognitive were used to evaluate their cognitive function. Results There was no significant difference in the course of disease, seizure types, monthly average seizure frequency and levels of education attainment between the two groups. Monthly average seizure frequency was significantly decreased in VPA-Mg+PPC group 24 weeks after treatment (1.2±1.1 vs 0.4±0.6, P＜0.05). The same was in VPA-Mg group (1.5±1.4 vs 0.6±0.6, P＜0.05). But no significant difference was found between the two groups (P＞0.05). Cognitive evaluation was more obviously improved in VPA-Mg+PPC group than in VPA-Mg group (P＜0.05). No severe complication was found during treatment, but there were mild adverse reactions and abnormal laboratory results in VPA-Mg group. There were 1 case of chest tightness, 1 case of alopecia, 1 case of abdominal pain, and 2 cases of mildly increased glutamic-pyruvic transaminase. There was no such adverse reaction in VPA-Mg+PPC group, and liver functions were restored to normal in some cases. Conclusion Combined therapy of VPA-Mg and PPC not only controls the seizures in patient with epilepsy, resists adverse reactions in the liver caused by VPA-Mg, but also improves their cognitive impairment.

Abstract:Objective To investigate the effects of combined therapy of probucol, atorvastatin, and aspirin (PAS) on carotid atherosclerosis. Methods A total of 73 ultrasonograhy-identified carotid atherosclerosis patients who admitted in our hospital from January 2011 to January 2012 were enrolled in this study. They were prospectively and randomly divided into 2 matched groups: PAS treatment group (n=37) and atorvastatin plus aspirin (AS) control group (n=36). The patients from PAS treatment group received a treatment of probucol 0.375g/times, twice daily, atorvastatin 10mg/d, and aspirin 100mg/d for 6 months, and those of AS control group were treated with atorvastatin 10mg/d, and aspirin 100mg/d for same duration. Before and after treatment, the serum levels of lipids, including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), oxidized low-density lipoproteins (ox-LDL) and C-reactive protein (CRP) were detected. Carotid intima media thickness (IMT) and plaque thickness were examined by ultrasonography. Results There was no significant difference in the serum levels of lipids, ox-LDL and CRP, and IMT and plaque thickness in PAS treatment group and the AS control group before treatment (P＞0.05). But after treatment, all above indicators were significantly decreased than those before treatment (P＜0.05). Except TG and HDL-C, PAS treatment group had more significant decrease in these indicators compared with AS control group (P＜0.05). Conclusion PAS combination therapy decreases the serum lipids, and simultaneously reduces the serum levels of ox-LDL and CRP significantly, with better effects than the AS combination. This treatment evidently attenuates IMT and total scores of plague. But its effect on carotid atherosclerotic plaque needs long-term intervention and follow-up.

Abstract:Objective To observe the therapeutic effect and prognosis of our comprehensive treatment regime on moderate to severe asymptomatic carotid artery stenosis. Methods A prospective study was carried out in the inpatients receiving carotid Color Doppler ultrasonography in Shanxi Provincial People￠s Hospital from Jan. 2008 to Jun. 2010. The inclusion criteria included: age over 45 years, carotid artery atherosclerotic plaques and stenosis >50%, and without cerebral ischemic stroke. A comprehensive treatment regime was given to the subjects, including anti-platelet agents, statins, anti-hypertensive drugs, anti-diabetics, and smoking cessation. They all were followed up for 2 years to observe their clinical end point events, such as death, stroke, heart infarction and so on. Results There were finally 175 patients enrolled this study except 5 who were lost during follow-up. During the follow-up, 38 (22.1%) had ischemic stroke with a median onset time of 18 months. Twenty-four of them (accounting for 63.2% of total stroke) occurred in the areas with blood supplying by stenosed artery, and 14 had ischemic stroke in the opposite hemisphere and blood supplying areas of posterior circulation. Eight patients died. The composite end point event rate was significantly lower in patients with integrated treatment regime than those without (17.5% vs 34.8%, P＝0.046). Conclusions Our comprehensive treatment regime, though does not reduce the rate of independent end point event for patients with moderate to severe asymptomatic carotid artery stenosis, dose reduce the composite clinical end point event. The composite clinical end point event will be increased if any one of these measures is not strictly followed.

Abstract:Objective To analyze the correlation between the platelet aggregation from thromboelastography (TEG) and light transmission aggregation (LTA) in patients with acute coronary syndrome (ACS) after dual antiplatelet therapy. Methods Ninty-three ACS patients who were prescribed with aspirin and clopidogrel in Institute of Geriatric Cardiology, Chinese PLA General Hospital during September 2010 to September 2012 were subjected in this study. They received LTA and TEG to determine platelet aggregation induced by adenosine diphosphate (ADP) and arachidonic acid (AA). Correlation and regression analysis were applied to analyze the relationship between detection indicators. Results The ADP-induced platelet aggregation were (59.3±21.34)% and (63.67±28.15)% respectively by LTA and TEG, with a correlation coefficient r＝0.814 (P＜0.0001), and the regression equation was ^YLTA＝0.2+0.617XTEG. The AA-induced platelet aggregation were (40.87±35.16)% and (46.02±39.26)% respectively with LTA and TEG with a correlation coefficient r＝0.965(P＜0.0001), and the regression equation was ^YLTA＝1.077XTEG+0.02. Conclusion Platelet function determined by LTA and TEG is in good correlation in ACS patients after dual antiplatelet therapy.

Abstract:Objective To investigate clinical value of respiratory support combined with nutrition support in elderly patients with severe pneumonia. Methods Clinical data of 48 elderly patients with severe pneumonia from February 2003 to December 2011 were retrospectively analyzed. They were divided into two groups. The control group contained 28 patients being treated before 2009, who were not treated actively with standard management or support of respiratory system, or nutrition support. Other 20 patients hospitalized between January 2009 and December 2011 were treated with the above measures(treatment group). Results The cure rate of treatment group was obviously higher than that of control group (90.0% vs 71.4%), and the mortality rate was lower (10.0% vs 28.6%). There were significant differences between two groups (P＜0.05 for all). Conclusion It is necessary for elderly patients with severe pneumonia to receive standard management and support of respiratory system, combined with nutrition support, which can improve the cure rate of severe pneumonia.

Abstract:Objective To investigate the relationship between the polymorphisms of endothelial nitric oxide syntheses (eNOS) gene G894T and senile calcific valve disease (SCVD). Methods Gene chip technique was used to detect eNOS G894T polymorphisms in 132 patients with echocardiography-identified valve degenerative changes but without rheumatic, congenital, or infectious valve diseases in our department from 2010 to 2011. Their age was ranging from 65 to 92 years (mean 79.2±6.3). Another 108 sex- and age-matched patients without valve degenerative changes or valve disease served as control. The genotype and allele frequency distribution were compared between the 2 groups. Binary logistic regression analysis was used to evaluate the relationship between eNOS G894T polymorphisms and SCVD. Results SCVD group had GT+TT genotypes and T allele frequency significantly higher than the control group (genotypes c2=8.486, P=0.004; allele c2=9.425, P=0.002). In Binary logistic regression analysis, eNOS G894T polymorphisms, levels of total cholesterol, low density lipoprotein and fasting glucose, body mass index, systolic blood pressure, and histories of hypertension, coronary heart disease and hyperlipidemia were all statistically associated with SCVD (P<0.05). Conclusion eNOS G894T may be the predisposing gene of SCVD.

Abstract:Objective To investigate the effects of different clinical factors on coagulation function in elderly patients with atrial fibrillation by detecting their coagulation factors. Methods Clinical data of 79 elderly patients with atrial fibrillation who were admitted to Department of Geriatrics, Bozhou Municipal People￠s Hospital from March 2011 to March 2012 were analyzed. Another 61 age-matched patients with normal sinus rhythm served as controls. Coagulation function was evaluated by prothrombin time (PT), activated partial thromboplastin time (APTT), and serum levels of fibrinogen (FG), D-Dimer (DDI) and glycosylated hemoglobin (HbAlc). Echocardiography was carried out for their left auricle internal dimension (LAID) and left ventricular ejection fraction (LVEF). Results The patients with atrial fibrillation had significantly higher levels on PT, APTT, FG and DDI than those with normal sinus rhythm (P＜0.05). Logistic regression analysis indicated that LAID, LVEF, and HbAlc were predictive factors for DDI, so was LVEF for FG. Conclusion Elderly patients with atrial fibrillation are in a prothrombotic state, and anticoagulant therapy should be strengthened for them.

Abstract:Objective To investigate the clinical characteristics of idiopathic pulmonary embolism for better diagnosis and treatment. Methods Thirty-three cases with identified pulmonary embolism but without acquired high-risk factors for embolism formation who admitted to Chinese PLA General Hospital from July 2010 to February 2012 were enrolled in this study. Their clinical data including general information, clinical signs and symptoms, examinations, mal-diagnosis and treatment were collected and retrospectively analyzed. Results There was no significant difference between male and female patients in the incidence of idiopathic pulmonary embolism. The cohort was at a mean age of (57.6±14.1) years and a mean body mass index of (26.4±3.2). Dyspnea (97.0%) and chest pain (30.3%) were the most common symptoms. In laboratory examination, 30 cases (90.9%) had D-Dimer over 0.5mg/L, 15 cases (57.7%) had BNP exceeding 150ng/L, and 15 cases (51.7%) had PaO2 lower than 75 mmHg. V1–V4 ST-T wave changes were common in electrocardiogram (60.6%), and elevated pulmonary arterial pressure was common in ultrasonic cardiogram. Vascular spiral computed tomography and pulmonary angiography showed filling defects at different degrees. The most common misdiagnosis of first visit was acute myocardial infarction and pneumonia, with a misdiagnosis rate of 69.7%. Anticoagulation was carried out for all the patients. Some patients accepted thrombolysis and/or interventional therapy. Conclusion Idiopathic pulmonary embolism is prone to be misdiagnosed because of lacking predisposing factors. Suspicious patients should be decided by combined consideration in terms of clinical manifestations, D-Dimer and imaging, and pulmonary angiography should be conducted as soon as possible to confirm the diagnosis .

Abstract:Objective To evaluate the therapeutic effect for high risk benign prostatic hyperplasia (BPH) in the elderly. Methods Clinical data of 1065 high-risk BPH elderly patients with age over 70 years (ranging from 70 to 99 years, mean 80.44 years) who were admitted in our department during March 2002 to February 2012 were collected and retrospectively analyzed. All patients averagely had at least 4 complications, such as diabetes, hypertension, hyperlipidemia, cardiovascular events, and so on. The therapeutic safety and reliability of non-surgical treatment, bladder fistulization, transurethral and suprapubic prostatectomy were evaluated. Results Totally 352 cases received non-surgical treatment, but in whom catheterization induced urinary tract infection and life inconvenience though having no effect on the complications. Among the 102 cases undergoing bladder fistulization, no complication was aggravated but urinary tract infection occurred in all patients due to catheterization. In 326 cases treated with transurethral prostatectomy, 11 of them suffered from severe complications, and 2 died. A total of 85 cases were treated with suprapubic prostatectomy. There were 14 cases suffering from severe complications and 1 died. Conclusion Non-surgical and bladder fistulization are safe, but can not improve patients￠ life satisfaction. The prostatectomy is effective, but is susceptible to aggravated complications in high-risk elderly patients.

Abstract:Objective To investigate the relationship between white matter lesions (WML) and ambulatory blood pressure in elderly essential hypertension. Methods Clinical and laboratory data of 130 patients (aged over 80 years) with essential hypertension who hospitalized in Department of Geriatric Neurology, Chinese PLA General Hospital during October 2007 to October 2011 were collected and retrospectively analyzed. They all received cerebral MR imaging and 24-hour ambulatory blood pressure monitoring. They were divided into 3 subgroups according to their white matter changes: mild WML, moderate WML and severe WML groups. Results There were significant differences in systolic and diastolic BP during night, and the percentage of nocturnal BP decline among the 3 groups of patients. Moreover, the prevalence of non-dipper was significantly higher in moderate and severe WML groups than mild WML group. Multiple logistic regression analysis showed that both diastolic BP at night and the percentage of nocturnal BP decline were independent risk factors of WML. Conclusion Elevated night-time BP and abnormal circadian blood pressure rhythm may play important roles in the development of WML in advanced aged patients with essential hypertension.

Abstract:Objective To investigate the effects of increased expression of Omi/HtrA2 on myocardial autophagy in aging myocardiocytes. Methods The rat embryonic myocardial cell line H9c2 was induced by D-galactose (8g/L) to establish aging model. Cell aging was detected by β-galactosidase staining. Cell viability was detected by CCK8 kits and lactic dehydrogenase (LDH) activity analysis. Ucf-101, a specific inhibitor of Omi/HtrA2, was used to inhibit the activity of Omi/HtrA2, and the H9c2 cells with stable transfection of Omi/HtrA2 was constructed to increase the expression of Omi/HtrA2. The expression of Omi/HtrA2, beclin1 and LC3-Ⅱ were detected by Western blotting. Results (1) D-galactose resulted in a significant increase in positive staining to β-galactosidase in the induced cardiacmyocytes than the H9c2 cells [(87.7±3.60)% vs (918.3±2.80)%, P＜0.01]. The cck8 results showed that there was no significant difference between the cells with and without D-galactose inducement (P＞0.05). LDH activity was increased in the induced H9c2 cells than those without (7.07±0.65 vs 5.93±3.36, P＜0.01). (2) The expression of Omi/HtrA2 was increased (P＜0.05), but the expression of beclin1 was decreased (P＜0.01) in cells induced by D-galactose, as compared with H9c2 cells. In cells treated with ucf-101, the expression of Omi/HtrA2 was significantly decreased (P＜0.05), but the expression of beclin1 was further decreased (P＜0.01).（3）The expression of LC3-Ⅱwas significantly increased in Omi/HtrA2-overexpressed cells, as compared with H9c2 cells (P＜0.05). But, ucf-101 resulted in the expression of LC3-Ⅱdecreased in the Omi/HtrA2-overexpressed cells (P＜0.05). Conclusion Increased expression of Omi/HtrA2 promotes autophagy in aging myocardiocytes.

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Abstract:Cardiogenic shock is one of the most serious complications of acute myocardial infarction with an incidence rate of 7% to 10%. In recent years, with the development of revascularization techniques, such as percutanous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the effective cooperation of dopamine and intraaortic balloon pumping (IABP), and the application of new drug-levosimendan, and mechanical circulatory assist devices, ventricular assist device (VAD) and extracorporeal membrane oxygenation (ECMO), the mortality rate has declined from 70%-80% in 1970s to 50% now. In this paper, we summarized the diagnostic criteria, pathophysiology and interventional measures for cardiogenic shock secondary to acute myocardial infarction.

Abstract:With the quick expanding of chronic kidney disease (CKD) in the elderly patients, it is of great significance to accurately and sensitively screen the vulnerable population. As the common kidney function markers, serum creatinine (SCr) and serum cystatin C have been publicly approved. But when applied in the elderly, cystatin C may be superior to SCr, and the equations for estimated glomerular filtration rate (GFR) are more accurate than the former two biomarkers. The accuracy of equations seems unrelated to the primary disease, but closely related to race, age and the development design of the equations. To develop a brand new GFR equation with large samples in multi-centers and uniform determination standard from different laboratories is of great urgency and importance. In addition, a special definition and classification of the elderly CKD patients could be conducive to distinguish the real ones.