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Abstract:Impaired glucose tolerance (IGT) is closely associated with coronary heart disease (CHD), and significantly affects the incidence and outcome of CHD. This paper reviewed the definition and status of postprandial blood glucose, its monitoring and indications. This paper also discussed detection rates of IGT and relevant factors, the harm of IGT on cardiovascular system, and the intervention measures and effects.

Abstract:American Heart Association issued a statement in 1999 which put forward a point of view that “diabetes is a cardiovascular disease”, which made experts in cardiology and endocrinology pay more attention to the relationship between the two diseases. Then, studies on diabetes mellitus and cardiovascular diseases emerged one after another, but there was no consensus finally achieved in their conclusions. Diabetes is a cardiovascular risk factor. About 2/3 diabetic patients died of cardiovascular diseases, and the cardiovascular death of diabetic patients was 2?3 times higher than that of non-diabetic patients. About the relationship between diabetes and coronary heart diseases, there was a great deal of evidence, but the results of the studies were different. In this paper, we reviewed representative clinical trials, and discussed the relationship between diabetes and cardiovascular diseases in 3 aspects, that is, hyperglycemia and cardiovascular events, diabetes as cardiovascular risk equivalents, and diabetes is not a cardiovascular disease.

Abstract:Impaired glucose tolerance (IGT) is the most common form of impaired glucose regulation, and accounts for major proportion of people with prediabetes. People with IGT are at high risk for type 2 diabetes mellitus, and 10% to 15% of them will progress into diabetes every year if not receiving effective intervention. But if they are treated properly, this process can be delayed or even reversed to normal healthy state. People with IGT are also vulnerable for cardiovascular diseases. Clinical evidence shows that they are prone to suffer from cardiovacular events than those with normal glucose tolerance. So for the people with IGT, active and effective intervention must be carried out to prevent diabetes and cardiovascular events. Life style intervention should be of the first choice to intervene IGT, and drugs can be added if life style intervention fails to meet the target.

Abstract:Objective To investigate the relative features of heart valvular diseases (HVD) and pulmonary hypertension (PH), and the risk factors of PH by analyzing the clinical data of these patients. Methods A total of 256 HVD patients with complete clinical data receiving surgical treatment in our hospital from April 2010 to October 2011 were subjected in the study. A retrospective analysis was carried out on case history, signs and symptoms, results of echocardiography and others on. The patients were divided into non-PH group (n＝157, pulmonary pressure＜35mmHg; 1mmHg＝0.133kPa), suspected PH group (n＝50, pulmonary pressure 35 to 50mmHg) and PH group (n＝49, pulmonary pressure＞50mmHg). Different statistical methods including multiple regressive analysis were used between these HVD patients with PH and without PH. Results In all of the 256 HVD patients, 49 patients were diagnosed with PH according to the diagnostic criteria of the European Society of Cardiology 2009. The HVD patients complicated with PH had an average age of 50.2 years, in a ratio of male to female of 18∶31. The Heart function grade of New York Heart Association (NYHA; OR＝1.243), left atrial diameter (LAD; OR＝1.016) and the duration of heart failure (OR＝1.018) were the risk factors of PH in HVD patients. Conclusion HVD is an important cause of PH. Significant differences are seen between PH patients and non-PH patients in body mass index, NYHA grade, LAD, duration of heart failure and atrial fibrillation. The lower heart function grade of NYHA, the larger LAD, and the longer duration of heart failure are risk factors for PH.

Abstract:Objective To investigate the epidemiological characteristics of mild cognitive impairment (MCI) among the rural elderly peoples from Cili county, Hunan Province. Methods A multi-stage stratified cluster sampling method was adopted to subject the elderly aged 60 years or above living in the rural areas of Cili county from June to December 2011. After an interview was performed by trained interviewers to the sampled subjects for a general questionnaire and Mini Mental State Examination (MMSE), those with distinct cognitive impairment or dysmnesia and those with the scores less than the cut-off point of MMSE received tests including physical examination, global deterioration scale, Hachinski ischemic scale, clinical dementia rating, and neurological examination. Then MCI was diagnosed by the consensus of 2 neurologists. Results There were 1 367 subjects (678 males and 689 females) sampled and interviewed. Among them, 178(13.02%) were positive to MMSE, and 139(10.17%) were diagnosed with MCI, and the prevalence of MCI as significantly different among the subjects of different ages, education levels, occupations, living and culture conditions and life styles (P＜0.05 for all). Conclusion The older age, the lower education level, smoking, non-drinker or non-alcoholic, and the living alone may increase the incidence of MCI among the rural elderly.

Abstract:Objective To investigate the clinical characteristics of acute decompensated heart failure in elderly inpatients and analyze the related clinical data in order to predict the factors influencing the short-term prognosis. Methods A total of 417 inpatients with acute decompensated heart failure admitted in our department from January to December of 2012 were enrolled in this study. There were 190 males and 227 females, with an age of (78.7±6.6)years, and 50.6% of them were over 80 years. Their clinical data, such as underlying diseases, complications, New York Heart Association (NYHA) classification, number of dysfunctioned organs, and serum level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) were collected and retrospectively analyzed. Logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Results The length of hospital stay of the cohort was (12.4±8.6)d. The patients having more than 2 dysfunction organs accounted for 86.8%. There were 74 cases died in hospital, with a mortality of 17.7%. The mortality was increased with the increased number of dysfunctioned organs (P＝0.001). Serum level of NT-proBNP before hospitalization and the highest level during hospitalization were significantly higher in the death group than in the survival group (P＝0.001). The patients (43.2%, 35/81) with their serum NT-proBNP level in an increased trend after hospitalization had significantly higher mortality than those (11.6%, 39/336) with the level decreased or in a stable status (P＝0.000). Logistic regression analysis indicated that the independent predictors of mortality were the number of dysfunctioned organs, respiratory failure, NYHA grade, change trend of NT-proBNP, the highest level of NT-proBNP during hospitalization, acute myocardial infarction, and hypoproteinemia in turn. Conclusion Acute congestive heart failure in elderly patients is characterized with complicated causes, severe status, and is commonly associated with multiple organ dysfunction and poor prognosis. It is essential to diagnose the disease quickly and protect the organs function as early as possible.

Abstract:Objective To analyze the related risk factors of the patients with ventilator dependence. Methods A total of 372 patients with invasive mechanical ventilation admitted in our respiratory intensive care unit of the General Hospital of Shenyang Military Command from January 2008 to June 2012 were enrolled in this study. Their clinical data were collected and analyzed. Results Among the 372 patients, ventilator dependence occurred in 91 patients. The elder age (older than 70 years), history of chronic obstructive pulmonary disease (COPD), low heart function (heart function of NYHA Ⅲ or Ⅳ), cerebral accident and aspiration pneumonia, sepsis shock, multiple organ dysfunction syndrome (MODS), low body mass index (＜18.5 kg/m2), and motor neuron disease were the risk factors of ventilator dependence. Conclusion For the patients older than 70 years and having history of COPD, ventilator weaning should be done as early as possible, and sequential invasive ventilation to non-invasive ventilation treatment be carried out according to patient’s condition. What’s more, improving the heart function, strengthening the lungs and general infection control, improving the nutritional support, and preventiing the of MODS are effective measures to reduce ventilator dependence.

Abstract:Objective To investigate the effect of Bufeihuoxue (BH) capsule, a Chinese Traditional Medicine, on pulmonary function in patients with chronic obstructive pulmonary disease (COPD), and to explore its possible mechanism. Methods A total of 170 COPD patients admitted in our hospital from March 2010 to March 2012 were subjected in this study. They were randomly divided into 2 groups, one group of patients were given regular COPD treatment (routine treatment group, n＝50), and the others were given BH capsule combined with conventional therapy (combined treatment group, n＝120). The pulmonary function, including forced expiratory volume in one second (FEV1) and forced vital capacity rate of one second (FEV1/FVC) was tested in 2 groups of patients. Acute outbreak of COPD was recorded. Serum levels of C-reactive protein (CRP), fibrinogen (Fib) and D-dimer (D-D) were determined by enzyme-linked immunosorbent assay (ELISA) before and after treatment. Results Compared with routine treatment group, combined treatment group had significantly improved lung function, especially shown as elevated FEV1/FVC, and decreased times of acute outbreak, and reduced serum contents of CRP, Fib and D-D (P＜0.05). Conclusion BH capsule can improve lung function in patients with COPD, and its mechanism may be related to the improvement of patients’ inflammatory reaction and pulmonary microvascular blood flow.

Abstract:Objective To retrospectively analyze the clinical features and outcomes of diabetic foot ulcers(DFU), and investigate the effect of serum albumin(ALB) level on the amputation risk and medical cost of the disease. Methods A total of 789 inpatients with DFU in Center of Diabetes from January 2008 to December 2012 were enrolled and analyzed retrospectively in this study. They were divided into 3 groups based on their serum levels of ALB, moderate and severe hypoalbuminemia group (＜30g/L, n＝83), mild hypoalbuminemia group(30 to 35g/L, n＝163), and normal albumin group(≥35g/L, n＝543). These patients were also assigned into amputation group(n＝171), non-amputation group(n＝603), and death group(n=15) according to the clinical outcomes. Their clinical data, amputation rate, hospital days and medical cost were compared among those with different serum level of ALB. Results The total amputation rate was 21.7%, and the mortality was 1.9% in this cohort of patients. Of all these amputations, the major amputation rate(above-the-ankle amputation) was 22.8%, and the minor amputation rate was 77.2%(11.7% for below the ankle amputation and 65.5% for toe resection). For the patients without amputation, the average hospital stay was 30d and the medical cost was 26 610RMB, but for the patients with amputation, the stay was 49d and the cost was 49 456 RMB. The amputation rate, hospital stay, and medical cost in patients with mild, and moderate and severe hypoalbuminemia were 2.0-, 1.2- and 1.7-folds higher, and 2.9-, 1.5- and 2.3-folds higher, respectively, than those in patients with normal ALB level. Logistic regression analysis showed that the Wagner stage and severe infection were independent risk factors for amputation and the serum level of ALB was an independent protective factor. With the increase in serum ALB level, the amputation rate was lower, the hospital stay was shorter, and the medical cost decreased. Conclusion Serum ALB level is closely associated with amputation of DFU patients, and is a good predictor for the risk of amputation and medical cost.

Abstract:Objective To investigate the efficiency and safety of preoperational intravenous injection of tirofiban just before performing percutaneous coronary intervention (PCI) in emergency for myocardial infarction patients with acute ST-elevation myocardial infarction (STEMI). Methods Sixty cases with acute STEMI who were in accordance with our inclusion and exclusion criteria and received emergent PCI in our department from May 2011 to April 2013 were recruited in this study. They were prospectively divided into 2 groups by admission time, the group receiving intravenous injection of tirofiban before operation (observation group, n＝30), and the group receiving no tirofiban before operation (control group, n＝30). Basic information, forward blood flow of infarction related artery before and after operation, ST-segment resolution, serum cardiac markers and bleeding complications of the 2 groups were analyzed. Results There was no significant difference in basic clinical condition between 2 groups (P＞0.05). The forward flow of infarct-related artery was significantly different between the 2 groups before the operation (TIMI 0-1: 13 vs 15; TIMI 2: 12 vs 11; and TIMI 3: 5 vs 4, P＞0.05), but after the operation, the forward blood flow was significantly better in the observation group than in the control group (TIMI 0-1: 0 vs 2; TIMI 2: 2 vs 8; and TIMI 3: 28 vs 20, P＜0.05). No significant difference was found at the ST-segment resolution between the 2 groups [(77.32%±18.36%) vs (71.18%±19.22%), P＞0.05]. The value of serological heart muscle markers in 6h after the operation was significantly lower in the observation group than in the control group [creatine kinase MB (CK-MB): (118.4±55.8) vs (178.8±63.2)U/L, P＜0.05; and cardiac troponin T (cTnT): (2.18±0.69) vs (3.21±0.46)ng/L, P＜0.05]. There was no significant difference in the bleeding complications between the 2 groups after the operation (10.00% vs 6.67%, P＞0.05). Conclusion For emergent treatment of STEMI by performing PCI, preoperative intravenous injection of tirofiban improves postoperative myocardial perfusion, does not increase the risk of hemorrhage, and exerts great effect with sound safety in clinical application.

Abstract:Objective To evaluate the efficacy and safety of bilevel positive airway pressure (BiPAP) ventilation as adjuvant therapy in the aged patients with acute exacerbation of chronic heart failure. Methods A total of 40 aged patients with acute exacerbation of chronic heart failure admitted in our department from July 2011 to December 2012 were enrolled in this study. There were 22 males and 18 females, with the age of (79.0±5.5)years. Their respiratory rate, blood pressure, heart rate, pulse oxygen saturation, arterial blood gas analysis, serum level of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), and the class of New York Heart Association (NYHA) before and after BiPAP ventilation were recorded and compared. The rates of endotracheal intubation and complications after BiPAP ventilation were analyzed. Results After BiPAP ventilation, arterial partial pressure of oxygen, and arterial oxygen saturation were elevated compared with those before treatment (P＜0.001), but, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, NYHA class, and serum level of NT-pro-BNP were reduced (P＜0.01). Of all patients, 38 cases were effective to BiPAP ventilation, and 2 cases required endotracheal intubation. Two patients died in hospital. No breathing machine-related pneumonia, severe arrhythmia, or newly occurred myocardial infarction was found. Conclusion BiPAP, as an adjuvant therapy, improves the clinical symptoms in the elderly patients with acute exacerbation of heart failure, and promotes the heart and lung function rapidly and safely.

Abstract:Objective To determine the expression profiles of main molecules in Wnt signal pathway, β-catenin and glycogen synthase kinase-3β (GSK-3β), in the proliferation and differentiation process of neural stem cells (NSCs), and to investigate the possible regulating role of these molecules in the process. Methods The NSCs were isolated and primarily cultured from rat fetus at an embryonic age of 14 to 16d according to reported methods. At 12 to 24h after cultured in the medium containing 10% fetal bovine serum (FBS), the cells attached and grew gradually. Western blotting was used to measure the protein levels of β-catenin and GSK-3β in the cells treated in the FBS medium or control after 12, 24, 48 and 72 hours treatment. Results Immunofluorescence assay indicated that the cultured neurospheres or single cells were positive with nestin. Western blotting results revealed a continuous expression of β-catenin and GSK-3β in the differentiation of the cultured NSCs. β-catenin was in a gradual decreasing tendency, whereas GSK-3β showed an opposite change. Conclusions Wnt signaling pathway is involved in the proliferation and differentiation of NSCs, and is active first and then gradually inhibited. These confirm the NSCs biological property of the culturing cells and provide a model for studying the role of Wnt signaling molecules.

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Abstract:A very old patient (82 years old) with chronic proliferative disease was treated by hydroxyurea, and its dose was adjusted according to the counts of platelets and leukocytes. Subsequently, the disease transformed into acute myeloid leukemia (AML). When the dose of hydroxyurea is increased, agranulocytosis and infection appeared. Since the patient was very old and had a few multiple comorbid diseases, it was very difficult for his treatment. After a consultation attended by physicians from disciplines of hematology and respiratory diseases, The comprehensive adjustment was made to strengthen supporting treatment. In present, the condition of the patients is fair, and relatively stable, but the overall prognosis is poor. How to improve the treatment of hematological diseases in very old patients is the issue urgent to be solved by non-hematological geriatric physicians.

Abstract:Dual antiplatelet therapy with aspirin and clopidogrel is the standard care to prevent stent thrombosis and recurrent ischemic events after acute coronary syndrome or stent placement. However, there is a large inter-individual variability in biological anti-platelet responsiveness and clinical outcomes in patients after clopidogrel treatment. Apart from clinical and environmental factors, recently accumulated evidence strongly confirms the pivotal role of genetic factors for the variability of clopidogrel responsiveness. Several large-scale pharmacogenomic studies found that the loss-of-function alleles of CYP2C19 and the key enzyme in clopidogrel metabolism are the predominant genetic mediators of low clopidogrel responsiveness and recurrent cardiovascular events. Other genetic polymorphisms related with clopidogrel metabolism may also contribute to the variability of clopidogrel efficacy. On the basis of these observations, it is still in controversy whether CYP2C19-genotype-guided individualized clopidogrel therapy could overcome the high on-treatment platelet reactivity to clopidogrel. In the future, it is necessary to combine genotyping and platelet function testing to guide the individualized clopidogrel therapy.

Abstract:The transcription factor FoxO is a downstream target of PKB/Akt that regulates cell survival and proliferation. Phosphorylation of FoxO by Akt inhibits its own transcriptional function and thus promotes cell survival, growth and proliferation. Substantial evidence showed that FoxO plays vital roles in diverse cellular signaling pathways that are implicated in cancer. There are two means by which FoxO inhibited cell apoptosis and promoted cell growth. One means is to regulate the expression of members of mitochondrial Bcl12 family, Fas ligands and tumor necrosis factor related apoptosis inducing ligand (TRAIL). The other is to enhance the level of cyclin-dependent kinase inhibitors. In this paper, we reviewed the underlying mechanisms of the involvement of Akt/FoxO in the regulation of cell survival and growth in order to provide new options for anti-tumor therapy.

Abstract:Prospective memory(PM) plays an important role in human’s daily life. Its impairment may significantly affect the correct execution of common daily activities. Patients with Parkinson’s disease (PD) present with cognitive impairments in many aspects. Some recent studies indicate that PM is impaired early in individuals with PD. These patients are selectively impaired in time-based PM, event-based PM or different components of PM. The deficit might be related to dysfunction of prefrontal lobe. In this paper, we reviewed the studies on the characteristics and physiological mechanism of PM, the characteristics of PM in PD patients, and possible underlying physiological mechanism. The further studies will certainly help the daily life and improve quality of life for PD patients.

Abstract:Phosphatase of regenerating liver-3 (PRL-3) belongs to a protein tyrosine phosphatase family, and regulates the protein activity by modifying the phosphorylation of tyrosine residues. Previous studies reported that PRL-3 was closely involved in the occurrence, development, metastasis and prognosis of many kinds of malignant tumors. It probably participats in the reconstruction of the cytoskeleton, the regulation of cell adhesion, and the process of epithelial-mesenchymal transition. PRL-3 might be a promising target for developing drugs in cancer treatment. In this paper, we reviewed the research progress in the relationship between PRL-3 and cancer.