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Abstract:Multiple organ dysfunction syndrome in the elderly(MODSE) is quite different from MODS in other populations. China, now, is experiencing population aging, and it will certainly be a critical problem in the coming decades. As the forefront of hospital, the emergency department is facing a growing number of the elderly patients in seeking first aid. Emergency physicians have to make fully understanding of MODSE, and know very well its etiology, clinical features, and diagnosis and treatment principles. What’s more, the doctors should keep profound and active caution in their mind that the elderly would be very weak when they get MODSE, and must provide more timely, cautious and careful diagnosis and treatment for the elderly patients suspicious for MODSE or confirmed as MODSE than for younger population. Only in this way, it is possible to gain some time for follow-up treatment and guarantee successful rescue for the elderly.

Abstract:Objective To investigate the value of small dose of hydrocortisone sodium succinate in the treatment of systemic inflammatory reaction syndrome(SIRS) and multiple organ functional impairment in the elderly patients after viper snake bite. Methods A prospective trial was conducted on 60 elderly patients with SIRS and multiple organ functional impairment after viper snake bite admitted in our department from April 2009 to April 2013. They were randomly allocated into a control and a treatment group, with 30 patients in each group. Conventional treatment procedures were given to the patients in both groups. Additional low-dose of hydrocortisone sodium succinate was used to the patients in the treatment group. Inflammation-related indicators and clinical biochemical indices were determined for those patients before and in 1, 3, and 5d after the treatment. Results Before the treatment, there was no significant difference in above indicators between the 2 groups(P＞0.05). In the control group, significant differences were found in creatine kinase(CK) and CK isoenzyme(CK-MB) levels at 3d after the treatment and before the treatment(P＜0.05). While the differences in temperature(T), pulse(P), white blood cell(WBC), C-reactive protein(CRP), aspartate transaminase(AST), alanine transaminase(ALT) and lactate dehydrogenase(LDH) levels were seen at 5d after the treatment(P＜0.05). In the treatment group, the differences in T, and levels of CK and CK-MB were found at 1d after the treatment(P＜0.05), while those in WBC, CRP, AST, ALT and LDH levels were seen at 3d after the treatment(P＜0.05). Comparing the results from the control and the treatment groups, the statistical significant differences in CK and CK-MB levels appeared at 3d after treatment(P＜0.05), while those in AST, ALT and LDH levels at 5d after treatment(P＜0.05). Conclusion Low dose of hydrocortisone sodium succinate attenuates SIRS in the elderly patients after viper snake bite, and exerts protective effect on the functions of important organs.

Abstract:目的 分析地西他滨单药或联合低剂量化疗治疗老年急性髓系白血病医院内感染的临床特点及易感因素。方法 回顾性分析2009年9月至2012年10月接受地西他滨单药或联合低剂量化疗治疗的10例老年急性髓系白血病患者医院内感染发生率、感染部位、致病菌和易感因素等。结果 10例老年患者治疗后医院内感染率为70%，例次感染率为46.7%，感染部位以呼吸系统最多见（占52.4%），致病菌以革兰阴性杆菌为主。化疗后骨髓抑制、粒细胞减少者感染率明显增高；与地西他滨联合低剂量化疗方案比较，地西他滨单药方案骨髓抑制、粒细胞减少发生率和医院内感染率降低。结论 老年急性髓系白血病患者是医院内感染的易感人群，骨髓抑制、粒细胞减少是其易感因素。地西他滨单药方案治疗老年急性髓系白血病可降低医院内感染发生率。

Abstract:Objective To investigate the safe and effective dosage of enoxaparin in the elderly patients with coronary heart disease and renal insufficiency during interventional operation. Methods A total of 108 senile patients with above 2 disorders who received interventional treatment and perioperative enoxaparin for anticoagulation in our department from January 2009 to December 2012 were recruited in this study. They were divided into 3 groups according to the dose of enoxaparin, that is, group A (n＝31, 40mg enoxaparin, subcutaneous injection, once every 12 hour), group B (n＝35, 40mg enoxaparin, subcutaneous injection , once a day), and group C (n＝42, 40mg enoxaparin, subcutaneous injection, once every morning, and 20mg once every night). They all took the same doses of aspirin and clopidogrel. The bleeding and stent thrombosis rate were observed and compared among the 3 groups. Results No massive hemorrhage or stent thrombosis was found in the 3 groups. But the patients from group A had significantly higher prevalence of subcutaneous hemorrhage and gum bleeding than those from the other 2 groups. Conclusion It is quite safe and effective for the elderly coronary heart disease patients accompanied with renal insufficiency to be given 40mg enoxaparin, subcutaneous injection, once every morning, and 20mg once every night, for a total of 5 to 7d during interventional therapy.

Abstract:Objective To determine the efficiency and adverse reaction of the new targeted drug—Brentuximab vedotin, in treatment of patients with relapsed or refractory Hodgkin’s lymphoma(HL). Methods Twelve patients with relapsed or refractory CD30 antigen-positive HL confirmed by pathology and immunohistochemistry treated in our hospital were enrolled in this study. All patients had received the second- or third-line chemotherapy regimens, with median 13 courses of chemotherapy. Seven patients had been treated with autologous stem cell transplantation, among which, 2 cases also underwent allogeneic stem cell transplantation because of relapse after autologous stem cell transplantation. Brentuximab vedotin was given at a dose of 1.2 to 1.8mg/kg, via intravenous injection, for a treatment phase of 21d. Patients received 2 to 16 treatment courses, with a median number of 4 courses. Results Complete remission was achieved in 2 cases(17%), partial remission in 7 cases(58%). Two out of 12 cases(17%) reached a stable condition, and 1 case died(8%). Main adverse reactions included fatigue, leukocyte reduction, fever, hair loss, elevated transaminases, nausea, peripheral neuritis, pain, etc. All of them were tolerated by this cohort of patients. Conclusion Brentuximab vedotin has good clinical efficacy in relapsed or refractory HL and has mild adverse reactions, which is tolerable for the patients.

Abstract:Objective To determine the curative effects of sertraline in the treatment of the elderly benign prostatic hyperplasia(BPH) patients with depression and its influence on patients’ quality of life. Methods Totally 118 elderly BPH patients with depression admitted to our department from January 2011 to May 2012 were enrolled in this study, and randomly assigned into treatment group(n＝60) and control group(n＝58). All patients were treated with conventional drugs for BPH, while those from treatment group were additionally treated with sertraline for 12 weeks. All patients were evaluated with Hamilton Depression Rating Scale(HAMD-17), and Hamilton Anxiety Scale(HAMA) and Treatment Emergent Symptom Scale(TESS) before treatment and at the ends of 2, 4, 8, and 12 weeks after treatment, and at the same time with Generic Quality of Life Inventory(GQOLI-74) before treatment and at the ends of 12 weeks treatment. Results After 12 weeks treatment, great improvement was achieved in treatment group in their depressive and anxious symptoms(P＜0.01). And they also had higherscores in physical health, mental health and social function in quality of life than those before treatment and those in the control gourp(P＜0.05, P＜0.01). Conclusion Sertraline has significant effectiveness in the treatment of the elderly BPH patients with depression, and also significantly improves their quality of life.

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Abstract:Neuropathic pain is chronic, which imposes a substantial and unrelenting burden on patients who suffer from it. Nowadays, it is still of great difficulty in how to manage pain. As the evidence expands, new rules of the management of neuropathic pain have developed. Pharmacologic management of neuropathic pain includes antiepileptics, antidepressants, topical anesthetics, opioids, etc. In this paper, we reviewed the new development of pharmacologic management of neuropathic pain.

Abstract:Objective To investigate the clinical efficiency and adverse effects of terlipressin on septic shock in very old patients(≥80 years old). Methods Thirty-six very old septic shock patients hospitalized in our department from January 2010 to January 2013 were randomly divided into 2 groups. Eighteen patients in group A were treated with dopamine first, and then the ineffective patients received alternative terlipressin treatment. The other eighteen patients in group B were treated with terlipressin. Their heart rate, mean arterial pressure(MAP), urine volume, and shock index before and at 24h after treatment, and blood urea nitrogen and creatinine at 3d after treatment were observed and recorded. The efficiency and adverse effects were also compared and analyzed. Results After treatment, dopamine was effective for 10 cases in group A, and the left 8 ineffective patients in group A who received alternative terlipressin treatment got significantly elevated MAP, declined shock index, and raised heart rate(P＜0.05). In group B, the similar change was observed in the changes of MAP and shock index, but not in the heart rate, and all these were significantly different with those in group A(P＜0.05). There was no significant difference in the raised urine volumes between the 2 groups(P＞0.05). At 3d after treatment, the renal function of all the patients had no obvious change. Two patients in group B were observed with bedsore. None of adverse effects was observed in the other patients. Conclusion Terlipressin is superior to dopamine in treatment of septic shock in very old patients(≥80 years old), and has a good prospect of clinical application in septic shock treatment.

Abstract:Objective To investigate the pre-operative serum levels of glycosylated products in the elderly type 2 diabetes mellitus patients with stable angina undergoing selective percutaneous coronary intervention(PCI), and evaluate the relationship between the levels and short-term outcomes. Methods A total of 188 elderly patients with diabetes and stable angina who were treated with PCI in our hospital from January 2010 to December 2012 were consecutively enrolled in this study. The patients were divided into 2 groups according to onset of post-procedure outcome events, the control group(no event) and the event group(ischemic events: post-procedure angina, myocardial infarction and death). The profiles of clinical cardiovascular risk factors, levels of fasting blood glucose, glycosylated products [glycosylated hemoglobin A1c(HbA1c) and glycosylated serum protein(GSP)] and high sensitivity C reactive protein(hs-CRP) were collected before PCI and compared between 2 groups. Results There was no significant difference in the age, gender, body mass index, history of smoking, incidences of hypertension and hyperlipidemia, medication, and serum HbA1c level between 2 groups(P＞0.05). However, the patients in event group had significantly higher levels of fasting blood glucose, GSP and hs-CRP than those in control group(P＜0.01). The risk of complicating post-procedure ischemic events in the patients with higher GSP levels(＞220μmol/L) was much higher than that in patients having lower GSP levels(OR＝2.96, 95% CI＝1.50-5.81, P＝0.001). Conclusion Elevated GSP level before PCI may be a risk factor of post-procedure ischemic events in the elderly patients with diabetes and stable angina undergoing selective PCI.

Abstract:Objective To investigate the safety of transurethral 2-micron laser used to prostatic surgery in advanced aged patients(＞65 years). Methods A total of 114 males and 23 females with a median age of 71 years (ranging from 65 to 87 years) receiving transurethral surgery in our department from September 2010 to October 2012 were enrolled in this study. There were 83 males with benign prostatic hyperplasia (BPH) and 31 with non-muscle bladder cancer(BCa), and all 23 females suffered from BCa. There were 121 cases(88.3%) with comorbidity, and 85 cases having over two diseases. Selective transurethral resection by 2-micron laser was performed after judging the function of important organs. Operation time, duration of indwelling urethral catheter, obturator nerve reflex, bladder washing, urination after BPH surgery, and peri-operative complications were analyzed. Results All operation procedures were successfully carried out. The mean operaton time was 30min(ranging from 15 to 55min) for BCa and 65min(ranging from 35 to 130min) for BPH, respectively. Bladder washing was taken, and time for indwelling urethral catheter ranged from 5 to 7d. Post-operative complications occurred in 11 cases(8.03%), and they were all discharged after corresponding treatment. There was no death in the cohort of patients. Conclusion Transurethral resection by 2-micron laser is an approach with satisfactory outcome and minimal invasion, and is of high safety for advanced aged who needs surgical treatment but suffers from comorbidity.

Abstract:Objective To investigate the correlation of albuminuria with ambulatory blood pressure pattern in the very old patients with hypertension. Methods Seventy very old hypertensive subjects admitted to Beijing Friendship Hospital from June 2012 to June 2013 were enrolled in this study. Their clinical data, urinary albumin excretion rate, ambulatory 24-hour blood pressure monitoring results were collected. The patients were divided into albuminuria group (n＝32) and non-albuminuria group(n＝38) according to the results of urinary test. Day systolic blood pressure(dSBP) and day diastolic blood pressure(dDBP), night systo1ic blood pressure(nSBP) and night diastolic blood pressure(nDBP) were compared between the 2 groups. Night blood pressure descend and blood pressure pattern were also observed in the 2 groups. Results There was no significant difference in the age, gender, diabetes incidence, high sensitivity C reactive protein, ejection fraction between the 2 groups(P＞0.05). Estimated glomerular filtration rate(eGFR) was significantly lower in albuminuria group than in the non-albuminuria group(P＜0.05). Ambulatory 24-hour blood pressure monitoring indicated that the dSBP and dDBP were normal in the 2 groups, without significant difference(P＞0.05). The albuminuria group had significantly higher nSBP than the non-albuminuria group (P＜0.01). There was no significant difference in the non-dipper blood pressure between the 2 groups, but the albuminuria group had higher rate of reversed dipper blood pressure(P＜0.01). Conclusion Increased nSBP, that is, the reversed dipper blood pressure pattern, is closely related to albuminuria and decreased eGFR in the very old patients with hypertension.

Abstract:Objective To evaluate the clinical value of the serum level of high mobility group box-1 protein(HMGB1) in coronary heart disease(CHD) patients accompanied with type 2 diabetes mellitus(T2DM). Methods A cohort of 60 CHD patients diagnosed by coronary angiography, with age ranging from 43 to 80(66±8)years, who were admitted to our department from March to November 2009 were subjected in this study. They were divided into 2 groups according to whether they were complicated with DM or not, 30 cases with DM in group A and 30 cases without DM in group B. Their fasting venous blood samples were collected for the serum levels of HMGB1, high sensitivity C-reactive protein(hs-CRP), fasting blood glucose (FBG), glycosylated hemoglobin A1c(HbA1c), and blood lipids. Gensini score was used to assess the severity of coronary artery lesion. All the parameters were compared and analyzed between 2 groups. Results The serum levels of HMGB1, hs-CRP, FBG and HbA1c were significantly higher in those with DM than those without(all P＜0.05). The patients accompanied with DM also had significantly higher Gensini score and percentage of triple vessel lesion than those without DM(both P＜0.05). Simple correlation analysis indicated that the severity of the coronary artery lesion was significantly correlated with the serum levels of HMGB1, hs-CRP, triglycerides(TG), total cholesterol (TC), high density lipoprotein-cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), and body mass index(P＜0.01). Conclusion CHD accompanied with DM aggravates the severity of coronary artery lesions. Elevated serum level of HMGB1 is not only an important risk factor for diabetic patients with CHD, but also an important indicator to reflect the diffuse and severe lesions of coronary artery in CHD patients with DM.

Abstract:Objective To investigate the risk factors of difficult defecation in earthquake victims. Methods A total of 192 earthquake victims suffering from difficult defecation who were transported to the field hospital of our hospital after earthquake were subjected in this study. Univariate analysis was carried out for 15 items of non-repetitive characteristic clinical factors which possibly caused difficult defecation. Logistic regression model was used for multivariate analysis. Results The results of univariate analysis showed that there were 8 risk factors for difficult defecation in earthquake victims(P＜0.05), including age, difficult defecation before injury, fractures, surgery or not, the posture influencing defecation, and the first time to eat, to return to normal diet, and to defecation after earthquake(P＜0.05). Logistic regression model for multivariate analysis indicated that age(P＜0.05), difficult defecation before injury(P＜0.05), surgery or not(P＜0.01), and the first time to defecation after earthquake(P＜0.01) were the independent factors for difficult defecation. Conclusion The independent factors for difficult defecation in earthquake victims are age, difficult defecation before injury, surgery or not and the first defecation time.

Abstract:Objective To study the effect of cigarette smoke extract(CSE) on the diaphragm cells of rats in 8-hydroxydeoxyguanosine(8-OHdG) content and the relationship between 8-OHdG content and level of reactive oxygen species(ROS) and 8-oxoguanine DNA glycosylase-1(OGG1). Methods The diaphragm cells of rats were cultured and stimulated by CSE for different time periods and at different concentrations. 8-OHdG was detected by high performance liquid chromatography with electrochemical detection(HPLC-ECD). The level of ROS was determined by fluorescent probe of 2’, 7’-dichlorodihydrofluorescein diacetate (DCFH-DA). The expression of OGG1 mRNA was tested by real-time PCR. The expression of OGG1 protein was tested by Western blot. Results There was no significant difference in the 8-OHdG, ROS, OGG1 mRNA and protein levels after CSE treatment for different time periods. However, the 8-OHdG content of the diaphragm cells induced by 10.00% CSE and 20.00% CSE was significantly increased compared with the diaphragm cells induced by 5.00% CSE and control groups(P＜0.05). There was no significant difference in 8-OHdG content between 5.00% CSE and control groups(P＞0.05). Compared with control, the intracellular ROS level was dramatically increased in CSE-treated groups(P＜0.05), and the 8-OHdG content was increased according to the level of ROS(r＝0.826, P＝0.000). Compared with control, the expression of OGG1 mRNA and protein were dramatically increased in CSE-treated groups(P＜0.05), however, the 8-OHdG content has but not with the expression of OGG1 mRNA and protein(r＝0.373, P＝0.254; r＝0.329, P＝0.296). Conclusions CSE could increase the level of 8-OHdG in the diaphragm cells of rats. The 8-OHdG content has correlation with ROS level, but not with the expression of OGG1.

Abstract:Objective To investigate the effect of premixed sodium salicylate(NaSAL) solution on the survival and lung injury in rats after acute paraquat(PQ) intoxication. Methods A total of 59 Wistar rats were randomly divided into 6 groups as follows: normal control group(normal saline, n＝6), NaSAL control group(n＝6), 2 PQ groups and 2 pre-mixed PQ＋NaSAL groups. In PQ groups, rats were injected intraperitoneally with PQ of 25mg/kg (n＝11) or 35mg/kg(n＝12), and then, with 0.9% NaCl at 2h later. Pre-mixed PQ＋NaSAL groups were divided into pre-mixed 25mg/kg PQ and 200mg/kg NaSAL, (n＝12), and pre-mixed 35mg/kg PQ and 300mg/kg NaSAL(n＝12). In NaSAL control group, rats were administered with 0.9% NaCl solution, and then dosed with 300mg/kg NaSAL at 2h later. All groups were observed daily for survival rate and poisoning symptoms over a period of at least 28d. Lung tissues were collected from rats died in the acute stage and those survived over 28d, and then observed with HE and Masson staining for pathological changes. Results The survival rates were 36% and 50% respectively in the 25mg/kg PQ group and 35mg/kg PQ group, and 33% and 50% respectively in the two premixed groups respectively. No significant difference was observed in the 28-day survival rates between PQ groups and pre-mixed PQ＋NaSAL groups(P＞0.05). Pathological observation showed that the rats exposed to PQ showed apparent lung changes at day 4 (acute stage), including inflammatory cells infiltration into alveoli and alveolar septum, alveolar hemorrhage and effusion at the acute stage, and proliferation and accumulation of fibrotic tissues at the late stage. There was no significant difference in pathological changes between the PQ groups and pre-mixed PQ＋NaSAL groups. Conclusions Pre-mixed PQ with NaSAL shows no significant protective effect on rat lung injury induced by PQ intoxication. A pre-mixed PQ and NaSAL solution doesn’t counteract the toxic effect of PQ.

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Abstract:We reported a successful diagnosis and treatment of a 65-year-old male patient with pulmonary lesion caused by antineutrophil cytoplasmic antibody (ANCA) associated vasculitis. The main manifestations of the patient were chronic cough and pulmonary migratory shadows. He was once diagnosed as lymphocytic interstitial pneumonia, and received effective corticosteroid mono-treatment. MPO-ANCA was positive after the disease relapsed, and ultimately, the diagnosis of ANCA associated vasculitis was made after lung puncture biopsy. After combination administration of corticosteroid and cyclophosphamide, all signs and symptoms were relieved. According to literature and our clinical experience, ANCA associated vasculitis had complex, non-specific clinical manifestations, and thus, was often misdiagnosed. In order to facilitate the early diagnosis of this disease, respiratory physicians should be familiar with the characteristics of the pulmonary involvement of ANCA associated vasculitis, and pay more attention to serum ANCA screening.

Abstract:Generally, anthracyclines and taxanes are applied to treat metastatic breast cancer (MBC) as chemotherapeutic agents. However, some patients are over-sensitive to taxanes, or experience rapid relapse due to resistance to taxanes, for whom, anthracyclines and taxanes have poor therapentic efficacy. Fortunately, ixabepilone, a novel microtubules inhibitor, exerts great effects on MBC patients who are resistant to anthracyclines and taxanes. In this article, we reviewed the pharmacology of ixabepilone and its progress in clinical research.

Abstract:Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. It leads to not only heart insufficiency, but also thromboembolic complications, and thus increases the risk of morbidity and mortality. Atherosclerosis is the leading cause of coronary heart diseases and ischemic stroke. In recent years, some evidence has shown that atherosclerosis may predict the incidence, progression and recurrence of atrial fibrillation. In addition, atrial fibrillation also promotes the progression of atherosclerosis, and increases the risk of thromboembolism and atherothrombosis. However, the underlying mechanism between them remains unclear. By using medical imaging, electrophysiological, histopathological and immunological assays, recent studies have found that atherosclerosis and atrial fibrillation may both be related to inflammation, arterial endothelial injury and dysfunction, and have mutual interaction.