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Abstract:In this article, we introduced the updating concepts of successful aging and the model of health care for the elderly. We strengthened that the focus of modern geriatrics has shifted from “disease” to “human being”. Thus, the goal of geriatrics is not only to prevent and treat geriatric diseases, but more importantly, to maintain the elderly’s body functions, such as their physiological and cognitive functions, and to sustain mental health through psychological rehabilitation, so as to realize “successful aging”. One of the step to attain the goal is to make a comprehensive geriatric assessment in the concept of modern geriatrics. We also discussed inappropriate medication prescribing, multimorbidity in the elderly, and the progress and challenges in the prevention and treatment of common geriatric diseases.

Abstract:Objective To investigate the clinical features of coronary lesions in the super-aged patients with coronary artery disease(CAD), and the correlation of the features with cardiovascular risk factors. Methods Totally 391 patients who were diagnosed as CAD undergoing pereutaneous coronary intervention (PCI) in our department from May 2011 to August 2012 were divided into aged group (71 to 79 years old, n＝275), and super-aged group (≥80 years old, n＝116). Their clinical and interventional procedure data were analyzed respectively. Results Compared with the aged group, the super-aged group had a higher incidence of heart failure (25.9% vs 11.3%), higher rate of preoperative positive troponin T (cTnT) (41.4% vs 28.4%), higher levels of high density lipoprotein cholesterol (HDL-C) [(1.19±0.35) vs (1.12±0.29)mmol/L], higher increase of creatinine concentration after the operation [(1.84±17.5) vs (-2.01±12.2)μmol/L], higher proportion of ST-segment elevation myocardial infarction (STEMI) (21.6% vs 13.5%), and higher Gensini score [(45.62±31.18) vs (40.48±28.12); P＜0.05 for all]. Among these 391 patients, male, diabetes, and high level of creatinine were positively related with the higher score of Gensini (P＜0.01 for all), so was serum level of lipoprotein a [Lp(a); P＜0.05], while HDL-C was negatively correlated with the score (P＜0.05). Serum cystatin C (Cys C) was negatively associated with estimated glomerular filtration rate (eGFR; r＝-0.509, P＜0.01). For those with eGFR≥60ml/(min·1.73m2), their serum level of Cys C was significantly lower than those with eGFR＜60ml/(min·1.73m2) [(1.30±0.26) vs (2.01±0.53)mg/L, P＜0.05]. Conclusion Super-aged patients with CAD are always complicated with heart failure, acute coronary syndrome, and severe coronary lesions.

Abstract:Objective To evaluate the long-term therapeutic effect of percutaneous coronary intervention (PCI) on revascularization in patients with coronary artery multi-vessel diseases (MVD). Methods A total of 429 patients who underwent successful PCI in our department from March 2010 to May 2011 were subjected in this study. Angiography was carried out on these patients one year after PCI. The rates of angina recurrence, angiographic restenosis and major adverse cardiac events (MACE) were retrospectively analyzed during the follow-up of 12.9 months (ranging from 8 to 15 months). Results Among the 429 patients, complete revascularization was seen in 95.8% of patients (411/429). There was no death in hospital and follow-up time. The rates of angina recurrence and angiographic restenosis were 10.1% and 4.4% respectively. The rate of MACE accounted for 3.5%, which was mostly found in those receiving revascularization within 1 year after PCI. Revascularization improved their heart function and frequency of angina obviously, and promoted their quality of life and survival rate. Conclusion The PCI revascularization is an effective approach in patients with coronary artery disease, especially MVD. PCI strategy and rational implantation of drug eluting stent (DES) play key roles in long-term prognosis in the patients.

Abstract:Objective To determine the correlations of metabolic syndrome (MS) with mild cognitive impairment (MCI) in the elderly, and investigate the role of matrix metalloproteinase 9 (MMP-9) activity in the process. Methods A total of 135 MS patients [MS group, with an age ranging from 65 to 76 (67.8±6.1) years] and 75 healthy control subjects [Control group, with an age ranging from 65 to 75 (66.3±5.9) years] admitted in our department from March 2009 to June 2012 were enrolled in this study. Mini-mental status examination (MMSE) was applied to evaluate their cognitive function. The plasma levels of MMP-9 and tissue inhibitor of metalloproteinase 1 (TIMP-1) were measured to estimate MMP-9 activity by calculating the ratio of MMP-9 to TIMP-1. Results MCI was more common in MS group than in control group (22.2% vs 9.33%, P＜0.05). The scores of MMSE were significantly lower in MS group than in control group [(26.12±1.15) vs (29.37±0.58), P＜0.05]. MS group had significant higher MMP-9 activity than the control group [(0.81±0.35) vs (0.59±0.27), P＜0.05]. In MS group, the MMP-9 activity was negatively correlated with MMSE score (r＝-0.519, P＜0.05). A high level of education was a protective factor of MCI (OR＝0.615, P＝0.023), while MS, diabetes and MMP-9 activity were independent risk factors of MCI (OR1＝6.981, P1＝0.011; OR2＝6.250, P2＝0.017; OR3＝3.262, P3＝0.031). Conclusion MS is an independent risk factor of MCI. In MS patients, MMP-9 activity is positively correlated with the severity of MCI.

Abstract:Objective To investigate the correlation of different options of treatment regimens with 1- and 3-year rehospitalization rate in the patients aged over 70 years with coronary heart diseases (CHD) diagnosed by coronary angiography. Methods A retrospective cohort study was carried out on the clinical data and follow-up phone calls in the inpatients over 70 years old hospitalized in our department from January 2008 to October 2011. The 211 enrolled patients were divided into four groups according to their vasculopathy and surgical approach. In group A(n＝38), the patients refused interventional therapy, with ≥70% stenosis in coronary artery. In group B(n＝40), the patients received percutaneous coronary angioplasty and stent implantation, with ≥50% stenosis in coronary artery. In group C(n＝106), the patients received percutaneous coronary angioplasty and stent implantation, without ≥50% stenosis in coronary artery. In group D(n＝27), the patients had no necessity for percutaneous coronary intervention though with 50% to 70% stenosis in coronary artery. In these four groups, patients hospitalized during January 2008 to October 2009 were subjected into four subgroups respectively, as group A1(n＝24), B1(n＝18), C1(n＝50) and D1(n＝16). Numbers of patients who rehospitalized due to heart event in the followed 1 or 3 years were noted and compared. Results There were 211 (108) patients enrolled into the four groups (subgroups). There was no significant difference in their age, gender, complicated with diabetes and hypertension, smoking, and serum levels of creatinine, cholesterol, hemoglobin and B-type natriuretic peptide (BNP) between the four groups (subgroups) at baseline (P＞0.05). The rehospitalization rate in followed one year was 28.9% (29.2%), 20.0% (22.2%), 6.6% (6.0%) and 7.4% (6.3%) respectively for the four groups (subgroups) respectively, with that of group A statistically different to total rate (13.3%, P＝0.026). The rehospitalization rate in followed 3 years was 41.6%, 27.8%, 10.0% and 25.0% respectively for the four subgroups, with those of subgroup A1 and C1 statistically different to the total rate (22.2%, P＝0.047，P＝0.048). Multivariate regression analysis indicated that diabetes and treatment regimens were risk factors for rehospitalization due to heart event. Conclusion The results suggest that, for the patients over 70 years old with coronary heart diseases, receiving percutaneous coronary angioplasty and stent implantation is recommended to avoid rehospitalization. While, for those with 50% to 70% stenosis but with no need for interventional therapy, medical education should be carried out for them to improve their drug compliance.

Abstract:Objective To determine the effect of different education levels on the prognosis of coronary heart diseases in the elderly. Methods Totally 165 elderly patients with coronary angiography-identified acute coronary syndrome (ACS) in our department from January 2005 to January 2010 were enrolled in the study. A self-questionnaire about coronary heart disease was used on the initial admission to obtain the education level, as well as their understanding of coronary heart disease. Patients were divided into two groups according to their education level, the primary school and lower education level group (group A) and the junior high school or higher education level group (group B). The follow-up compliance, treatment compliance, cardiac function, and heart morphological changes were evaluated during the follow-up visit. Results Group A had a poorer follow-up compliance and treatment compliance than group B (P＜0.05). With the elapse of follow-up, group A also had worse deterioration of cardiac function and heart morphological changes, with significant differences between the two groups (P＜0.05). Conclusion There are significant differences in the prognosis among the elderly coronary heart disease patients with different education levels. The higher the education levels, the better their follow-up compliance and treatment compliance are.

Abstract:Objective To evaluate the efficacy and safety of bivalirudin in selective percutaneous coronary intervention (PCI) in elderly patients with unstable angina. Methods A total of 90 elderly unstable angina patients with age ranging from 60 to 75 years who received PCI in our hospital from November 2010 to March 2013 were enrolled in this study. They were prospectively divided into two matched groups: bivalirudin group (n＝47) and heparin sodium group (control, n＝43). The patients from bivalirudin group were designed to receive 0.75mg/kg of bivalirudin as loading dose before PCI, then followed by another injection of 0.3mg/kg if activated coagulation time (ACT) shorter than 225 sec five minutes later, and an intravenous injection of 1.75mg/(kg·h) till the end of operation. While, the patients from heparin sodium group had heparin sodium 100U/kg instead of bivalirudin, then another injection of 3000U for shorter ACT, and the other injection of 1000U if the operation did not end within one hour. The safety and efficacy outcome were evaluated by bleeding events and major adverse cardiac events (MACE) in 30d after PCI and ACT during PCI. Results There was no significant difference in the bleeding events and MACE in 30d between the two groups (P＞0.05). The efficiency was similar in the two groups. Conclusion Bivalirudin is safe and efficient in selective PCI of senile patients with unstable angina.

Abstract:Objective To evaluate the predictive value of SYNTAX score (SXscore) and clinical SYNTAX score (CCS) in the primary endpoint events of coronary heart disease patients in 15 months after percutaneous coronary intervention (PCI). Methods A total of 547 patients undergoing selective or emergency PCI in our department from June 2009 to June 2011 were enrolled in this study. SXscore and CCS were carried out to grade the severity and extension of stenosis. The major adverse cardiac and cerebrovascular events (MACCE, including cardiac death, myocardial infarction, and revascularization and stroke from any cause), the secondary endpoint events (including target lesion failure, such as cardiac death and target-vessel driven myocardial infarction, and ischemia-driven target lesion revascularization), stent thrombosis, and hospitalization due to angina pectoris were observed during 15 months of follow-up by telephone or hospital visit. Results In the follow-up, the incidence of MACCE was 13.5%, 6.8% and 0.0%, respectively for those with high, medium and low scores in SXscore (P＜0.0001). After multivariable adjustment, the SXscore (RR=1.101, 95%CI 1.070～1.134; P＜0.0001) and CSS (RR=1.017, 95%CI 1.009～1.022; P＜0.0001) were both identified as independent predictor of MACCE. Conclusion Both SXscore and CSS are independent predictor of MACCE for coronary heart disease patients after PCI.

Abstract:Objective To investigate the clinical features and treatment strategy of acute drug-induced liver injury (DILI) in elderly Chinese patients. Methods Databases of CBM, VIP, Wanfang and CNKI were searched by retrieving from construction to 2011 with the key words “drug-induced liver injury or drug-induced liver disease, and elderly”. Data from retrieved literatures were summarized and analyzed by SPSS 14.0 software. Results There were 14 studies meeting the inclusion criteria, which included 879 elderly patients with acute DILI (583 males and 296 females). The main clinical manifestations were digestive symptoms (45.41%), jaundice (34.58%), fatigue (25.48%), and anorexia (21.84%), and so on. While, 308 patients (35.04%) were asymptomatic. Clinical classification indicated that hepatocellular type accounted for the largest proportion of acute DILI in the elderly (57.40%). The most common drugs causing acute DILI were antimicrobial agents (18.98%), Chinese traditional medicine (18.26%), cardiovascular drugs (17.90%) and antineoplastics (11.61%) in order. As for the prognosis, 692 of 774 cases (89.41%) were recorded being clinically cured or improved. Conclusion It is of great significance to diagnose and treat acute DILI early and properly, especially for the elderly patients so as to improve the prognosis and decrease mortality.

Abstract:Objective To investigate the correlation of the C242T polymorphism of NADPH oxidase p22-phox gene with left ventricular hypertrophy (LVH) in Chinese Han hypertensive subjects. Methods A total of 286 consecutive patients of Han nationality with newly diagnosed essential hypertension admitted in our hospital from January 2008 to December 2011 were enrolled in this study. They were all evaluated with echocardiography for left ventricular mass index, and were divided into hypertension with or without LVH. Body mass index (BMI), blood pressure, fasting blood glucose, triglycerides and total cholesterol were documented. P22-phox C242T polymorphism was analyzed by restriction fragment length polymorphism (RFPL). Results The frequencies of CT genotype and T allele were significantly higher in the patients with LVH patients than those without LVH (P＝0.002, P＝0.005), but no any case of TT genotype was found. Logistic analysis showed that the C242T polymorphism in NADPH oxidase p22phox, as well as female sex and systolic blood pressure were independent risk factors for LVH. Compared to patients with CC genotype, the risk of LVH was decreased by 63% in those with CT genotype (P＝0.007). Conclusion The C242T polymorphism in NADPH oxidase p22phox is correlated with LVH in Chinese hypertensive patients. The T allele might be protective factor for LVH.

Abstract:Objective To investigate the cardiac structure and function, and renal function in elderly hypertensive patients with diabetes mellitus. Methods A total of 206 over 60-year-old patients hospitalized in our department from April 2010 to May 2012 were enrolled in this study. They were divided into hypertension group [group A, n＝98, (72.1±7.3) years) and hypertension and diabetes group [group B, n＝108, (70.7±7.5) years]. And another 103 age- and sex-matched healthy individuals served as normal control. Hypertension and diabetes were confirmed by their international or national diagnostic criteria. All patients were observed for the systolic blood and diastolic blood pressure, fasting blood glucose (FBG), post blood glucose (PBG), glycated hemoglobin (HbA1c), triglycerides, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, serum uric acid, creatinine, serum cystatin, 24-hour urinary albumin. All patients received echocardiography for left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness (IVST) and left ventricular posterior wall thickness (LVPWT greater), relative wall thickness (RWT), left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and E/A ratio. Results The serum level of uric acid and urinary albumin-positive rate were significantly higher in group B than in the other two groups (P＜0.05). The patients of group B also had significantly higher levels of FBG, PBG and HbA1c than the other two groups (P＜0.05). The values of LVEDD, IVST, LVMI, RWT and PWT were significantly higher in group A and B than in group C (P＜0.05), and that of LVEDD, IVST, LVMI, PWT and RWT in group B even higher than in group A (P＜0.05). The E/A ratio were significantly lower in group A and B than in control (P＜0.05), with that of group B significantly lower than that of group A (P＜0.05). Conclusion For the elderly hypertensive patients with diabetes, glucose metabolic disorders may be associated with left ventricular hypertrophy and decreased diastolic function. In clinical practice for hypertensive patients with diabetes, better glucose control should be achieved, and intervention for multiple risk factors should be strengthened to reduce the incidence of cardiovascular complications and to improve prognosis.

Abstract:Objective To determine the plasma level of N-terminal pro-brain natriuretic peptide(NT-proBNP) between patients with systolic or diastolic heart failure (HF) and the relationship with age. Methods A total of 202 patients diagnosed with HF (104 cases with systolic HF, and 98 cases with diastolic HF) admitted in our department from January 2010 to October 2011 were enrolled in this study. They all presented the signs and symptoms of HF, and identified with echocardiography. These patients were divided into Ⅱ to Ⅳ class according to New York Heart Association Functional Classification (NYHA), plasma level of NT-proBNP was measured in the systolic and diastolic HF groups on admission, and the results were compared among different HF groups and age groups. Twenty sex- and age-matched healthy individuals served as normal control. Results The median NT-proBNP level was significantly higher in systolic HF and diastolic HF group than in healthy control (P＜0.01), and that of systolic HF group was significantly higher than that of diastolic HF group (P＜0.05). The level was increased with the increase of NYHA class, that is, significantly higher in NYHA class Ⅳ than in NYHA class Ⅲ and in NYHA class Ⅱ (P＜0.05) in every age group. The level was also in a trend of elevation along with aging, though without statistical significance (P＞0.05). Conclusion The median plasma NT-proBNP level is significantly higher in systolic HF than in diastolic HF, and it has a close relationship with NYHA class. NT-proBNP level is not significantly correlated with age.

Abstract:Objective To investigate the expression profiles of FOS protein in the mice brain subregions induced by subcutaneous formalin injection to one hindpaw. Methods After adult mice received an injection of 5% formalin in the hindpaw, their spontaneous pain behaviors were recorded within 60min. The expression, distribution and number of FOS-positive neurons in the ipsilateral dorsal horn and supraspinal regions were detected by immunohistochemical assay at two hours after formalin injection. Results These mice showed their biting/licking time and flinches in a typical two-phase manner within 60min. The immunohistochemical staining results showed that FOS-positive neurons were significantly increased in the ipsilateral spinal cord, paraventricular nucleus, medial dorsal thalamic nucleus, anterior cingulate cortex, insular cortex and amygdala. Meanwhile, the expression of FOS protein in the dentate gyrus of hippocampus was also slightly increased. Conclusion Not only spinal dorsal horn but also subregions sensitive to pain and stress, will be activated functionally to mediate defensive response when mice are exposed to nociceptive stimuli.

Abstract:Objective To investigate the effect of paclitaxel-loaded microbubbles (PLM) triggered with ultrasound irradiation on the apoptosis of rat vascular smooth muscle cells (VSMCs) and its mechanism. Methods Rat thoracic aortic VSMCs were treated by platelet derived growth factor-BB, and then randomly divided into five groups as follows: control group (group A), microbubbles combined with ultrasound irradiation group (group B), PLM combined with ultrasound irradiation group (group C), PLM treated group (group D), and paclitaxel treated group (group E). VSMCs from groups B and C were exposed to 1 MHz continuous wave ultrasound for 120s at intensity of 0.3W/cm2. The cell cycle, apoptoitc cells and the expression of Bax and Bcl-2 were detected by flow cytometry, AnnexinV/PI staining and immunocytochemical assay, respectively. Results Compared with group A, the number of the cells arrested at S phase was decreased significantly in other groups (P＜0.01). The percentage of the cells at G0/G1 phase was greatly increased in group B, that of G2/M phase cells was increased remarkably in group D and E (P＜0.01), and those of G0/G1 phase cells and G2/M phase cells were increased significantly in group C (P＜0.01). Apoptosis rate was significantly higher in group B and C than in group A (P＜0.01), while the expression of Bax was increased, and that of Bcl-2 decreased (P＜0.01). Conclusion Ultrasound triggered PLM induces rat VSMCs apoptosis, which might be due to upregulation of Bax and downregulation of Bcl-2 induced by microbubbles-mediated ultrasound cavitation.

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Abstract:We report a successful rescue of an 83-year-old male patient who took a supralethal dose of paraquat (50ml, 20% aqueous solution). According to literature and our own clinical experience, if some one taking 10ml paraquat, the mortality would be more than 90%. Our experience was early gastric lavaging, large doses of steroid and ambroxol, early and long-time blood purification. In addition, the patient’s family members were longevous, so they might be tolerant to paraquat.

Abstract:Elderly coronary heart disease (CHD) refers to the patients with coronary heart disease who aged ≥65 years. In the 21st century, China is growing into an aging society. The morbidity of CHD is getting higher, and the diseases also become one of the main diseases which lead to disability and death. In United States, CHD accounts for more than 1/2 among the death in the population aged ≥65 years, and more than 3/4 of the dead due to CHD are elderly people. The clinical manifestations and therapy of the elderly CHD has its own characteristics. In this paper, we briefly summarized the clinical features, diagnosis and therapy of the elderly CHD based on recent literature.

Abstract:Music may play important role in life quality improvement, and also have effects on the change of heart rate and heart rate variability. Cheerful music significantly reduced the level of peri-operative patients’ anxiety, and the effect was even better than oral administration of midazolam. Thus, except for oral administration of midazolam for sedation, listening cheerful music, another higher effective way with less adverse effects, was used as the sedation before operation. Listening to music, as a proposed regimen, was also beneficial to patients who needed resting in bed after cardiac surgical procedure, who would receive interventional management, and who had been implanted the permanent cardiac pace maker. After resting in bed for 30 min, the level of cortisol was significantly lower in music group(484.4mmol/L) than in non-music group (618.8mmol/L, P＜0.05). Vocal and orchestral music cause much stronger correlations between cardiovascular or respiratory system in comparison with music in more uniform emphasis (P＜0.05). Classical music and meditation music exert greatest benefit on health. Particularly composed by Bach, Mozart or Italian composers, the music improves the quality of life effectively, and keeps physical and mental health.