Abstract:

Abstract:

Abstract:

Abstract:Chronic diseases are referred to as the chronic non-infectious diseases. In the past 10 years, the death from chronic diseases in China shows a continuing upward trend in the total deaths. The deaths from cardiovascular diseases accounted for 41% of the deaths from chronic diseases, ranking the first place of all. The incidence of cardiovascular diseases in China is in a rising trend. The elderly persons are at high risks of cardiovascular diseases, including hypertension, coronary artery disease, degenerative valvular heart disease, diabetes, and so on. A variety of chronic diseases often coexist in s single old person. Unhealthy lifestyle contributes to the main reason for the high incidence of chronic diseases. Early prevention and treatment, as well as comprehensive interventions, are important measures for the prevention and control of chronic diseases.

Abstract:Objective To investigate the changes of plasma albumin (ALB) level and cellular immune function, and their relationship in elderly bed-ridden patients before and after nosocomial infection. Methods Seventy-eight elderly bed-ridden patients getting nosocomial infection during hospitalization in our department from January 2009 to December 2012 were enrolled in this study. The clinical data of the patients before getting nosocomial infection (group B, n＝78), suffering from infection for ≥5d (group C, n＝52) and for ≥10d (group D, n＝33), and having severe sepsis/septic shock (group E, n＝25) were collected and retrospectively analyzed. Another 40 elderly patients hospitalized in the same period without bed-ridden or infection served as control (group A). Plasma ALB level and cellular immune function, including peripheral blood mononuclear cell surface human leukocyte antigen-DR (HLA-DR) and T cell subsets, were compared among the patients at different periods. The group B were further assigned into group B1 (normal ALB level, n＝16) and group B2 (lower ALB level, n＝62) according to their ALB level. Results Plasma ALB level was significantly lower in group B than in group A (P＝0.000), and significantly lower in group C, D, and E than in group A and B (P＝0.000). Cellular immune function was similar in group B1 and group A. Patients of group B2 had significantly lower expression of HLA-DR, decreased absolute number of CD3+ T cells and CD4/CD8 ratio (P＝0.000), significantly increased percentage of CD8+ T cells among CD3+ T cells (CD8/CD3; P＝0.000), and unchanged percentage of CD4+ T cells among CD3+ T cells(CD4/CD3; P＞0.05). Compared with those of group A and B, HLA-DR expression, absolute number of CD3+ T cells, CD4/CD8 ratio, and CD4/CD3 ratio were significantly lower in group C, D and E (P＝0.000), and CD8/CD3 was significantly higher (P＝0.000). The changes of HLA-DR, absolute number of CD3+ T cells, and CD4/CD3, CD8/CD3 and CD4/CD8 ratios were all correlated with plasma ALB level (r1＝0.791, r2＝0.638, r3＝0.534, r4＝-0.575, r5＝0.580; P＝0.000). Conclusion Plasma ALB level has been significantly reduced in elderly bed-ridden patients before nosocomial infection, and the level declines steadily thereafter the infection. The decreased cellular immune function before and after nosocomial infection is closely associated with the declined plasma ALB levels.

Abstract:Objective To evaluate the clinical significance of serum levels of insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3) in the diagnosis of prostate cancer (PCa), as well as the significance of their combination with prostate-specific antigen (PSA) and free PSA (fPSA). Methods The serum levels of IGF-1, IGFBP-3, PSA and fPSA were measured with chemoiluminescence immunoassay (CLIA) in 52 patients of pathologically identified prostate cancer, 48 cases of benign prostatic hyperplasia (BPH) and 48 healthy individuals. Results The serum levels of IGF-1 was significantly higher in the PCa group than in the BPH and healthy control groups (P＜0.01). However, there was no statistically difference in the IGF-1 level between BPH and healthy control groups (P＞0.05). The serum concentration of IGFBP-3 was significantly lower in the PCa group than in the BPH and healthy control groups (P＜0.01), and there was also significant difference between BPH and healthy control group (P＜0.01). IGF-1 and IGFBP-3 had the sensitivity of 83.6% and 76.4% in the diagnosis of PCa respectively, and specificity of 84.0% and 74.0%, positive prediction value of 85.2% and 76.4%, and negative prediction value of 82.4% and 74.0%, respectively. Combined detection of serum levels of IGF-1 and PSA/fPSA increased the sensitivity of diagnosis significantly. Conclusion Serum levels of IGF-1 and IGFBP-3 are quite different in PCa patients when compared with normal healthy control. Combined application of IGF-1 and PSA or fPSA enhances their clinical value in diagnosis of PCa.

Abstract:Objective To investigate the general condition, death cause, life expectancy and relevant influencing factors of military retired cadres in order to provide information for their health guidance and disease control and prevention. Methods A retrospective study was carried out for all retired cadres from Shanghai region who died in Changhai Hospital from March 1985 to January 2013. Their clinical data, including medical records, death records, death registration, were collected and analyzed. A questionnaire was surveyed for the dead persons’ family members. Results The death age ranged from 59 to 98 (79.39±7.30) years. Compared with the baseline data (1 year before their death), the white blood cell (WBC) count, fasting plasma glucose (FPG), serum creatinine (SCr), blood urea (BU), and serum total bilirubin (TBIL) were significantly higher in their last hospitalization (P＜0.05), but the red blood cell (RBC) count, hemoglobin, total protein (TP), albumin (Alb), and A/G ratio were significantly decreased (P＜0.05). The 5 leading causes of death were tumor (41.9%), nervous system (16.9%), circulatory system (15.7%), respiratory system (10.5%), and endocrine and metabolic diseases (7.6%). The 5 leading disease entities of death were tumor (42.4%), coronary heart disease (12.8%), chronic obstructive pulmonary diseases (8.7%), cerebral infarction (8.1%) and type 2 diabetes (7.6%). The 2 leading causes of tumor death were lung cancer (35.6%) and pancreatic cancer (9.6%). Conclusion Advance aged people are the main proportion in this group. Lung cancer is the most primary tumor causing death. And cardiovascular and cerebrovascular diseases are the main cause for inpatient mortality. Hypertension and cerebral infarction are negatively, while regular exercises and drinking milk are positively correlated with life expectancy.

Abstract:Objective To evaluate the efficiency of levosimendan on the heart function in the elderly patients with acute left heart failure. Methods Seventy-two elderly patients with acute left heart failure hospitalized in our department from June 2011 to June 2013 were enrolled in this study. There were 49 males and 23 females, with an age of 65 to 87 (75.1±9.8) years. These patients were randomly assigned into 2 groups, control and levosimendan group (n＝36). Control group accepted conventional therapy to treat acute left heart failure. Levosimendan group accepted levosimendan besides the same conventional therapy as in control group. The difference of clinical symptoms and signs of acute heart failure, cardiac output stroke volume (SV), left ventricular ejection fraction (LVEF) and serum level of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were compared between the 2 groups. Results Clinical symptoms and signs of acute left heart failure were improved significantly after treatment. SV and LVEF were increased, while the serum level of NT-pro-BNP was decreased significantly in both groups (P＜0.05). But the total effective rate was significantly higher in the levosimendan group than in the control group (94.4% vs 69.4%, P＜0.05). Compared with control group, the increase of SV and LVEF, and the decrease of NT-pro-BNP was more significant in levosimendan group (P＜0.05). Conclusion Levosimendan controls the symptoms and signs of acute left heart failure with great efficiency and safety.

Abstract:Objective To investigate the relationship of cognitive function and the severity of periventricular leukoaraiosis (LA) by magnetic resonance imaging (MRI) in the elderly suffering from hypertension. Methods A total of 90 veteran cadres (≥60 years old) living in Shanghai city were subjected in this study, and were equally divided into 3 groups: Group A (normotension and normal cognitive function), Group B (hypertension and normal cognitive function), and group C(hypertension and impaired cognitive function). All subjects in the 3 groups were matched one to one, according to the following factors: age, gender, nationality, place of residence, years of education, and with type 2 diabetes or not. All subjects were assessed by the questionnaires of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Activity of Daily Living (ADL) for the prevalence rate of cognitive function impairment. Head MRI were operated in these patients, and 2 experienced physicians scored the periventricular white matter lesion in separated workstations independently. The correlation of the LA scores was analyzed with hypertension and cognitive function impairment. Results There were significant differences in the periventricular LA score among the 3 groups (Chi square＝-26.874, P＜0.001). Pairwise comparison showed that significant differences were also found in the score between 2 of these groups, that is, between Group A and Group B (Chi square＝-10.506, P＝0.033), Group B and Group C(Chi square＝-10.029, P＝0.040), and Group A and Group C (Chi square＝-25.112, P＜0.001). LA scores were increased significantly in the elderly with hypertension and cognitive impairment. Conclusion The elderly patients with hypertension and cognitive impairment usually are manifested as LA in MRI. LA score might be considered as one of early diagnostic indications of hypertensive patients with cognitive dysfunction.

Abstract:Objective To investigate the risk factors of heart failure in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods A total of 520 patients undergoing PCI due to ACS in our hospital from 2009 to 2012 were enrolled in this study. Then they were divided into heart failure group (n＝67) and control group (n＝453) according to the emergence of heart failure after PCI. Their clinical data were collected and retrospectively analyzed. The numbers of patients with histories of hypertension, diabetes, smoking, old myocardial infarction or prior history of heart failure were calculated. Their coronary angiography images, operation time, amount of contrast agent, and the levels of blood glucose, blood lipids, and other blood test indicators during hospitalization were analyzed between the 2 groups. Results Sixty-seven patients had heart failure after PCI. Compared to control group, they suffered a longer hospitalization and significantly higher mortality (P＜0.05). What’s more, the heart failure group had longer operation time, larger amount of contrast agent, higher ratio of diabetes, more lesions in anterior descending artery, less incidence of unstable angina pectoris, and higher incidence of myocardial infarction than the control group (P＜0.05). Blood test showed that the levels of low-density lipoprotein cholesterol, creatinine and uric acid, and the white cell count were significantly higher in the heart failure group than in the control group (P＜0.05). Linear logistic regression analysis showed that age, left anterior descending artery lesion, white blood cell count, uric acid level were the high risk factors of heart failure after PCI. Conclusion Elderly patients with anterior descending artery lesions combined with higher white blood cell count and uric acid level are in higher risk of heart failure after PCI.

Abstract:Objective To determine the clinical efficacy of Shensong Yangxin capsule (a traditional Chinese medicine) combined with amiodarone in treatment of premature ventricular contraction (PVC) in aged patients with coronary heart diseases. Methods A total of 68 patients with coronary heart diseases complicated with PVC hospitalized from January 2011 to December 2012 were recruited in this study. There were 62 males and 6 females, with age ranging from 67 to 80 (74.6±3.9) years. The patients were randomly divided into experimental group and control group, with 34 cases in each group. Both groups were treated with conventional therapy, and the control group was given amiodarone for 4 weeks, while, the experimental group received Shensong Yangxin capsule combined with amiodarone for 4 weeks. The clinical efficacy and adverse reactions in the 2 groups before and at 24h after treatment were observed by 24-hour dynamic electrocardiogram monitoring and signs and symptoms. Results After treatment, PVC in the experimental group was improved in 9 cases, effective in 21 cases, and invalid in 4 cases, with a total effective rate of 88.2%. While for the control group, PVC was improved in 5 cases, effective in 20 cases, and invalid in 9 cases, and the total effective rate was 73.5%. The total effective rate was significantly higher in the experimental group than in the control group (P＜0.05). After treatment, the symptoms in the experimental group was improved in 8 cases, effective in 21 cases, and invalid in 5 cases, and the total effective rate was 85.3%. While, the symptoms of the control group was improved in 4 cases, effective in 22 cases, and invalid in 8 cases, and the total effective rate was 76.5%. There was significant difference in the total effective rate between the 2 groups (P＜0.05). There were few adverse reactions found in the 2 groups, which was no significant difference between them (5.9% vs 8.8%, P＞0.05). Conclusion Shensong Yangxin capsule combined with amiodarone is safe and more effective than amiodarone alone in the treatment of PVC in aged patients with coronary heart diseases.

Abstract:Objective To investigate the relationship of formation of coronary collateral circulation(CCC) with serum levels of vessel reactive substances in patients with severe coronary arteries stenosis (SCAS). Methods A total of 80 consecutive senile patients, aged (70.23±7.86) years, who received coronary arteriography and identified with at lease 1 out of 3 main coronary arteries with over 95% stenosis in our department from June 2007 to January 2009, were subjected in this study. They were categorized into 2 groups according to their grading of collateral vessels: well-developed CCC group and proorly-developed CCC group. Vessel reactive substances, such as angiotensin-converting enzyme (ACE), angiotensin Ⅱ (Ang Ⅱ), aldosterone (ALD), endothelin (ET), and nitric oxide (NO), were measured in these patients. Results The activities or serum levels of ACE [(38.07±6.25) vs (27.02±4.15)U/L], Ang Ⅱ [(90.27±10.31) vs (70.13±7.30)ng/L], ALD [(170.75±23.46) vs (130.34±11.23)ng/L], and ET [(74.78±7.35) vs (57.23±6.04)ng/L] were significantly stronger or higher in poorly-developed CCC group than in well-developed CCC group (P＜0.05), while the level of NO was obviously lower in the poorly than the well-developed CCC group [(34.8±6.24) vs (49.34±6.67)μmol/L], P＜0.05). Conclusion The stronger activity of ACE and the higher serum levels of Ang Ⅱ, ALD, and ET are against the development of CCC in SCAS patients, but the higher level of NO is beneficial in the process.

Abstract:Objective To observe the application of comprehensive health education intervention in the patients after percutaneous coronary intervention (PCI) and evaluate the efficiency. Methods One hundred and six patients undergoing PCI in our institute from January 2012 to March 2012 were selected and divided into observation group and control group randomly (n=53). The patients in control group were given the routine treatment and traditional health education after surgery, while those from observation group were given the comprehensive health education intervention besides routine treatment. The efficiency of control of the risk factors of coronary heart diseases and the rate of rehospitalization were compared between the 2 groups at 6, 12 months after discharge from hospital. Results Blood pressure (BP), low density lipoprotein cholesterol (LDL-C) level and the rate of completing aerobic exercise were significantly better in observation group than in control group at 6 months after PCI(P＜0.05), while, there was no difference in body mass index (BMI), fasting plasma glucose, electrocardiogram (ECG) and rehospitalization rate between the 2 groups(P＞0.05). At 12 months after PCI, the BP value, LDL-C level, BMI, ECG, the rate of aerobic exercise, and rehospitalization rate were all well controlled in observation group than in control group, and the difference was statistically significant(P＜0.05). Conclusion Comprehensive health education intervention significantly controls the risk factors after PCI, and then decreases the rate of rehospitalization.

Abstract:Objective To observe cardiomyocyte necrosis in the rats induced by acute exhausted exercise and determine the protective effects of Xinfukang oral liquid (a traditional Chinese medicine) on the necrosis. Methods A total of 40 male Sprague-Dawley (SD) rats were randomly divided into 4 groups: control group, the low dose Xinfukang oral liquid [5ml/(kg·d)]＋acute exhaustive group, the high dose Xinfukang oral liquid [10ml/(kg·d)]＋acute exhaustive group, and acute exhaustive group (n＝10 for each group). The Xinfukang oral liquid groups were treated with Xinfukang oral liquid at corresponding doses for 6 weeks by intragastrical administration before model induction, and the rats from the control group and acute exhaustive group were given normal saline instead of Xinfukang oral liquid. Acute exhausted exercise was carried out according to the classical Thomas’ induction, and then identified by the rats’ behaviors and signs. Myocardial necrosis was observed by transmission electron microscopy. DNA ladder were detected to observe myocardial cell DNA degradation. Western blotting was used to analyze the expression of total extracellular signal-regulated kinase (ERK) and phosphorylated ERK (p-ERK) in all groups. Results Transmission electron microscopy indicated that exhausting exercise group showed significantly more serious mitochondria swelling, obvious myocardial necrosis and DNA degradation. Compared with exhausted group, pretreatment of Xinfukang oral liquid resulted in attenuated injury in both myocardial cells and DNA integrity, and a increased ratio of p-ERK expression(P＜0.05). Conclusion Pretreatment of Xinfukang oral liquid exerts a preventive effect on cardiomyocyte necrosis induced by acute exhaustive exercise.

Abstract:

Abstract:

Abstract:

Abstract:

Abstract:Serum procalcitonin (PCT) is propeptide of calcitonin, normally produced by thyroid C cells. And C-reactive protein (CRP) is a sort of acute phase protein secreted by hepatic cells in the induction of IL-6. Substantial studies have shown that the serum levels of PCT and CRP are increased remarkably in the patients who suffered from infectious diseases, and the levels are positively correlated with the severity of the infectious disorders. There is no apparent difference in the sensitivity of diagnosing infectious diseases between the 2 proteins, but the specificity of PCT is higher than that of CRP. It is of great clinical application value and promising application prospect when the 2 proteins are combined together in the differential diagnosis of infection and noninfectious diseases, the monitoring of critical illness and severe infection, the guiding of appropriate antibiotics usage, and the evaluation of curative effects and prognosis. However, how the PCT is produced and through what mechanism it exerts effect remain unclear and need further studies.

Abstract:Objective To investigate the value of vibration response imaging (VRI) in the assessment and monitoring of therapeutic efficiency of chronic obstructive pulmonary disease (COPD) in the elderly patients. Methods A total of 41 patients (over 60 years old) with acute exacerbations of COPD hospitalized in our department from January to June 2012 were recruited in this study. Dyspnea score, arterial blood gases analysis, lung function test and VRI were performed on them before and after treatment. Results Dyspnea grade was significantly reduced after treatment [(3.46±0.87) vs (2.17±0.80), P＜0.01]. PaO2, lung function and VRI results were improved significantly after treatment. Dynamic image grades were reduced from (3.61±1.09) to (2.85±1.26) (P＜0.01), graph grades from (10.54±2.91) to (6.15±2.23) (P＜0.01), and crack counts from (9.98±7.51) to (3.15±4.44) (P＜0.01). Conclusion VRI is helpful in the assessment and monitoring of therapeutic efficiency of COPD in elderly patients.

Abstract:Objective To explore the brachial-ankle pulse wave velocity (baPWV) in the same cohort longitudinally in order to investigate the decreasing rate of vasoactivity with aging. Methods Based on the people cohort in 2008 in Shenyang, the people were divided into ≤44-year-old, 45- to 54-year-old, 55- to 64-year-old, 65- to 74-year-old and ≥75-year-old groups according their age in the year of 2008. Biochemical methods were used to detect their blood lipid and glucose indices. A full-automatic arteriosclerosis detector was employed to measure blood pressures of bilateral brachial artery and anterior tibial artery (including systolic blood pressure, mean arterial pressure, diastolic blood pressure, and pulse pressure). Ankle-arm index (ABI and baPWV) were also calculated. The same tests were conducted again in 3 years later. There were totally 310 patients who fulfilled all detection. Self-control analysis on the vasoactivity was carried out. Results There were significant differences in baPWV and baPWV alteration among different age groups (P＜0.01 for all). There was positive correlation of baPWV and baPWV alteration with age (P＜0.01 for all). Self-control analysis showed baPWV was significantly different in the 2 times of examination (P＜0.01), and baPWV alteration was more significant with aging (P＜0.01). Conclusion There is association between getting older and change of baPWV. Progressively reduced vasoactivity caused by getting older becomes aggravated with aging.

Abstract:Objective To determine the effects of valsartan on the plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and copeptin in the elderly patients with chronic heart failure (CHF), and to investigate the possible mechanism of valsartan to prevent ventricular remodeling. Methods A total of 99 CHF elderly patients aged from 60～81(68±12)years who were hospitalized in our department from June 2011 to September 2012 were recruited in this study. They were randomly divided into 2 groups: valsartan and conventional treatment group (valsartan group, n=50), and conventional treatment (control group, n＝49). The plasma levels of NT-proBNP and copeptin, and the structural function of left ventricle were measured at the baseline, 1 and 6 months after valsartan treatment. Results The levels of NT-proBNP and copeptin were decreased in both groups at 1 month after treatment, and more significantly at 6 months (P＜0.05 or 0.01). Their levels were significantly lower in the valsartan treatment group than in the control group at 1 and 6 months after treatment respectively (P＜0.05 or 0.01). No significant difference was found in the left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD) and left ventricular end diastolic diameter (LVEDD) in the 2 groups at 1 month after treatment, and between the 2 groups before and at 1 month after treatment (P＞0.05). But at 6 months after treatment, the LVEF was significantly higher (P＜0.01), while the LVESD and LVEDD were significantly lower in the valsartan treatment group than in the control group (P＜0.01). Conclusion Angiotensin Ⅱ receptor antagonist valsartan could inhibit the secretion of NT-proBNP and copeptin in the plasma of elderly patients with CHF, and then suppresses neuroendocrine factors, prevents ventricular remodeling, and therefore improves the heart function.

Abstract:Objective To determine the safety of transnasal endoscopy for the elderly with coronary heart diseases (CHD). Methods A prospective study was carried out in 100 over-65-year-old patients undergoing gastroscopy in our department from January to December 2012. They were randomly and equally divided into conventional gastroscopy group (n＝50) and transnasal endoscopy group (n＝50), and then, every group was further divided into CHD subgroup (n＝25) and control subgroup (without heart diseases, n＝25). The heart rate, blood pressure, arterial oxygen saturation, myocardial oxygen consumption and electrocardiogram during performance of endoscopy were compared between groups. Results During conventional gastroscopy, the increases of heart rate, blood pressure, and myocardial oxygen consumption, and the decrease of arterial oxygen saturation were significantly more obvious in CHD subgroup than the corresponding control subgroup (P＜0.05). And, the incidences of arrhythmia and ST segment depression were higher in CHD subgroup than in control subgroup (P＜0.05). For those receiving transnasal endoscopy, CHD patients had significantly mild increases in heart rate, blood pressure, and myocardial oxygen consumption, lower arterial oxygen saturation, and decreased incidences of arrhythmia and ST segment depression than the CHD patients undergoing conventional gastroscopy (P＜0.05). Conclusion Transnasal endoscopy is well tolerated to elderly patients with CHD, and has fewer hemodynamic effects and higher safety.

Abstract:Objective To determine the protective effect of trimetazidine post-conditioning on cell apoptosis in rats induced by myocardial ischemia/reperfusion injury (MIRI). Methods Forty healthy adult Wistar rats were randomly assigned to sham-operation group, MIRI group, ischemic post-conditioning group and two trimetazidinee treatment groups (10 and 20mg/kg), with 8 rats in each group. MIRI model was established by ligation of coronary artery for 30min followed by 120min reperfusion. The rats in ischemic post-conditioning group were given another three times of ischemia/reperfusion for 30s at the interval of 30min ischemia and 120min reperfusion. Trimetazidinee or normal saline at same volume was given intragastrically to corresponding rats during the 30min ischemia. After MIRI, myocardial infarct area was measured, the expression of Bcl2 and bax was detected by immunohistochemical assays, and the myocardiocyte ultrastructure was observed with transmission electron microscopy. Results (1) Myocardial infarct area. No infarct was seen in the sham-operation group, but infarcts with different severities were found in the other groups, with those in the ischemic post-conditioning group and 20mg/kg trimetazidinee treatment group mildest (P＜0.01). (2) The expression of Bcl2/bax protein. The expression of Bax was very strong, while that of Bcl2 was very weak in the MIRI group, when compared with 20mg/kg trimetazidine group and ischemic post-conditioning group (both P＜0.01). (3) Morphology of cardiac muscle. Besides sham-operation group, ischemia/reperfusion injury and cardiocyte apoptosis were observed in other groups, with those in the ischemic post-conditioning group and 20mg/kg trimetazidinee treatment group most mildly. Conclusion Trimetazidine of 20mg/kg inhibits cardiocyte apoptosis in rats after MIRI.

Abstract:With the emergence of new technologies and drugs in treatment of atrial fibrillation, and the reports of clinical trails concerning this aspect, European Society of Cardiology (ESC) and Canadian Cardiovascular Society both have updated the guidelines for the management of atrial fibrillation. Especially, the ESC published the guidelines alone in 2010, and then published the update for the guidelines alone again in 2012. Under this situation, the American College of Cardiology and the American Heart Association only compiled and revised the recommends of the guidelines published in 2006 and in 2011. Their intention is worth pondering. This article focused on the interpretation of some contents which are closely related to clinical practice.