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Abstract:Chronic functional constipation (CFC) is a common disease in the elderly, and makes unignorable harm. There are many treatments of CFC, including lifestyle adjustments, drug interventions, biofeedback, surgery, etc. But the therapeutic effects among the elderly are unsatisfactory, so refractory constipation is not rare. To further improve the treatment efficiency of the elderly CFC, we should individualize treatment regimens according to every patient, and positively apply domestic and international recommended processes of CFC to regulate therapy. Meanwhile, profound research should be carried out on how to treat CFC in the elderly. Multi-center, double-blind, randomized, placebo-controlled clinical trials should be used to re-evaluate the efficacy and safety of CFC treatment in the elderly, mainly about conventional therapies, traditional medicines (especially traditional Chinese herbs) and newly listed drugs, in order to practice evidence-based-medicine more effectively for the CFC treatment in the elderly.

Abstract:Objective To summarize the clinical characteristics of the elderly ischemic colitis (IC) with constipation in order either to better instruct clinical practice or to avoid misdiagnosis or missed diagnosis. Methods A total of 160 elderly IC patients (35 males and 125 females) hospitalized in our department from 2008 to 2013 were observed and retrospectively analyzed. According to the presence of constipation, the 160 patients were divided into 2 groups: constipation group and non-constipation group. The underlying conditions, clinical manifestations, misdiagnosis, laboratory examination results, endoscopic findings, pathological observation, clinical course, and outcomes after treatment were analyzed and compared between the 2 groups. Results There were 92 patients out of 160 IC (57.5%) suffering from constipation. Compared with the IC patients without constipation, those with constipation were younger, and had atypical clinical manifestations, higher misdiagnosis rate (48.8%), and worse colonic lesions. After 2-week treatment, the rate of complete mucosal healing was lower in the patients with constipation than those without (63.0% vs 79.9%). The bowel lesions in the left colon accounted for 78.3% in the patients with constipation, and 75.0% in those without, and the amount was similar between the 2 groups. Conclusion Chronic constipation is quite common in the elderly IC patients, and is also an important risk factor for IC. The patients of IC with chronic constipation usually have atypical clinical manifestations. For the chronic constipation patients accompanied with multiple comorbid diseases, such as hypertension, coronary heart disease and/or diabetes, strong vigilance should be paid for their abdominal pain or hematochezia, and colonoscopy should be performed as early as possible to make correct diagnosis.

Abstract:Objective To observe the effect and adverse reactions of flupentixol/melitracen combined with lactulose on constipation and anxiety status in the elderly constipated patients with mild to moderate anxiety. Methods Eighty elderly constipated out-patients [aged (74.6±7.6) years] suffering from mild to moderate anxiety in our department from January 2011 to December 2012 were recruited in this study. They were randomly divided into treatment group and control group. The patients in treatment group were treated with flupenthixol melitracen tablets 1qd, and lactulose 15ml bid, while the patients in control group were given lactulose 15ml bid only. The regimen of treatment lasted for 4 weeks in both groups. The effective rate and self-rating anxiety scale (SAS) score was measured and recorded at the 2nd and 4th weeks after treatment. Results The constipation symptoms were alleviated in the 2 groups at the end of treatment. The total effective rate after 2 weeks treatment was significantly higher in the treatment group than in control group (P＝0.029). The SAS scores were decreased more significantly in the treatment group than in the control group at the 2nd and 4th week (P＝0.020, P＝0.012). No serious adverse reaction was found in the 2 groups of patients. The incidence of adverse reactions had no statistical difference between the 2 groups (P＞0.05). Conclusion Flupentixol/melitracen combined with lactulose is effective and safe in the treatment of functional constipation in the elderly patients with mild to moderate anxiety.

Abstract:Objective To investigate the relationship between constipation and intestinal diseases diagnosed by endoscopy in the elderly patients. Methods The colonoscopic results of 350 elderly patients [aged (72.29±15.71) years] with constipation in our department from July 2009 to July 2013 were collected and retrospectivley analyzed. The endoscopic features of intestinal diseases were analyzed with their disease course and gender. Results Among the 350 cases, the prevelance of intestinal diseases was 60.86% diagnosed by endoscopy, they were colorectitis (26.86%), melanosis coli (13.14%), colorectal polyps (12.00%), colorectal cancer (6.57%), inflammatory bowel disease (1.14%), colonic diverticula (0.57%), intestinal tuberculosis (0.29%) and telangiectasia (0.29%) in order. The prevalences of colorectal polyps and cancer were higher in the male constipation patients than in the female ones (P＜0.05). A higher incidence of melanosis coli was observed in the patients with constipation over 5 years (P＜0.05). Conclusions Constipation in the elderly patients is mainly caused by colorectal diseases. Thus, colonoscopy for these patients is recommended to ensure early detection and treatment, which may be of great help in improving the elderly patients’ life quality.

Abstract:Chronic constipation is a common clinical syndrome, and the elderly is one of its high-risk population. It not only brings harm to patients’ physical and mental health, and reduces their life quality, but also adds much more to the medical cost as well as the social and economic burden to these patients and the whole society. It is of great significance to conduct an in-depth survey on the epidemiology of chronic constipation aiming at revealing its epidemiological characteristics, especially its risk factors and high-risk populations, so as to establish prevention strategies and measures as well as to develop more comprehensive interventions in community. In this article, we reviewed recent progress in the epidemiology of chronic constipation in hope of providing some meaningful clues for clinical practices.

Abstract:As one of the most common gastrointestinal symptoms in the elderly, chronic constipation (CC) not only affects the seniors’ life quality, but also aggravates the risk of other diseases. Because of the complicated pathogenesis, CC in the elderly is difficult to cure. At present, comprehensive treatment is mainly based on the causes, classification and severity. Common treatments include adjusting life style, medication, psychological treatment, surgical treatment, biofeedback, etc. In this paper, the recent advances in the medication of CC in the elderly were reviewed, especially on the efficacy and safety of new drugs, such as 5-hydroxytryptamine (5-HT) receptor agonist, guanylate cyclase C agonist, chlorine ion channel activator, mu-opioid receptor antagonist, and so on.

Abstract:Chronic constipation is caused by a variety of different diseases. The main clinical goal of this disorder is effective purgation, rational drug use and maintenance of curative effect. Most western medicines contain laxatives. Chinese patent medicine is a member of traditional Chinese medicine, not only has the features of symptomatic treatment, blending invigoration in catharsis, and taking origin and superficiality into account, but also is convenient to use and widely accepted in clinical practice. According to related literatures and our clinical experiences, we divided the constipation in the elderly into 6 types, including syndrome of heat accumulation in the large intestine, syndrome of qi stagnation in the intestines, syndrome of dampness and heat in the large intestine, syndrome of lung-spleen qi deficiency, syndrome of yang-deficiency of both the spleen and the kidney, syndrome of depleted fluid and blood deficiency, To achieve satisfactory therapeutic effect and less side-effect, we gave individualized treatment based on an overall analysis of the illness and the patient’s condition.

Abstract:Objective To analyze the features of lower extremity arterial occlusive disease in the elderly patients by digital subtraction angiography (DSA), and the serum level of high-sensitivity C-reactive protein (hs-CRP) in order to evaluate the diagnostic significance of hs-CRP testing. Methods Clinical data of 41 elderly patients with lower extremity arterial occlusive disease in our department from January 2008 to December 2012 were collected in this study. The clinical characteristics, blood pressure, gender differences, DSA features and serum level of hs-CRP were retrospectively analyzed. The correlation of serum level of hs-CRP was analyzed with angiographic results. Results DSA results indicated that the cohort of patients were characterized as multi-vessel?and diffuse lesions, poor collateral circulation and severe symptoms. So conservative treatments were mainly carried out for them. No obvious change was found in male blood pressure, but female patients had higher systolic pressure than male patients. The serum level of hs-CRP was obviously higher in the elderly patients with lower extremity arterial occlusive disease. But no significant difference was seen in the level between male and female patients. It also had no correlation with the severity (P＜0.05). Conclusion DSA shows that the lower extremity arteries in elderly patients with occlusive lesions have unique features. The blood pressure of the patients is increased and has gender difference. Serum level of hs-CRP is elevated in most patients, but has no gender difference and no correlation with the severity of lesions.

Abstract:Objective To investigate the differences in the clinical features, polysomnographic characteristics and compliance with continuous positive airway pressure (CPAP) among elderly obstructive sleep apnea hypopnea syndrome (OSAHS) patients compared with those at young and middle ages. Methods A total of 220 PSG-diagnosed OSAHS patients in the Affiliated Hospital of Binzhou Medical College from January 2012 to July 2013 were subjected and retrospectively analyzed in this study. They were divided into the young group (aged 10 to 44 years, n＝89), middle-aged group (aged 45 to 59 years, n＝72) and elderly group (≥60 years old, n＝59). The clinica1 data, questionnaire, Epworth sleepiness scores and polysomnographic parameters were collected and compared. The 154 patients with apnea hypopnea index (AHI) ≥30 were followed up at 6 and 9 months, and 1 year. Totally 129 patients received CPAP. The application of noninvasive ventilator was also analyzed. Results The elderly patients had lower ratio of deep sleep at night (P＜0.05), and higher Epworth sleepiness scores (P＜0.01) when compared with young patients. They also had lower AHI than those weight-matched young patients (P＜0.05), but had severe sleep apnea at night (P＜0.05). The incidence of central sleep apnea was higher in the elderly group than in the other 2 groups (P＜0.05). The percentages of good compliance with CPAP at 6 months, 9 months and 1 year were 90%, 86% and 82% respectively in the elderly group, and were 89%, 87% and 79% respectively in middle-aged group, and 87%, 74% and 69% respectively in young group. The elderly patients had better compliance to CPAP than the other 2 groups(P＜0.05). Conclusion The elderly patients suffer more severe daily clinical manifestations, have worse sleep quality, and so, are more likely to have good compliance with CPAP.

Abstract:Objective To investigate the incidence and related factors of depression in patients with digestive cancer (DC). Methods A total of 321 (315 valid questionnaires) DC patients out of different departments in 2 tertiary hospitals from June 2008 to March 2011 were enrolled in this study. They were surveyed by Self-rating Depression Scale (SDS) and Hamilton Rating Scale for Depression (HAMD) to investigate the depression-related factors and the incidence of DC accompanied by depression. A correlation analysis was performed among the factors and incidence. Results The incidence of depression in patients with DC was 44.76%, mainly mild to moderate degree. The incidence was related with education levels and TNM stages. Conclusion The incidence of depression is quite high in patients with DC, and is correlated with education level and TNM stage. Special attention should be paid to the identification of depression in clinical practice.

Abstract:Objective To investigate the pathological features and their clinical significances in knee joints of middle-aged and elderly patients with knee pain. Methods A prospective sequential study was carried out on over-40-year-old patients undergoing arthroscopy due to knee pain in our department from January to December 2012. All cases were identified to be suffering from cartilage lesion (grade Ⅳ) by arthroscopy. Those with severe synovitis and needing synovectomy were excluded. Gender, age, affected side, body mass index (BMI) and Lysholm scores were recorded preoperatively. The joint surfaces where cartilage lesion (grade Ⅳ) existed on, medial/lateral meniscus tears, loose bodies, and anterior cruciate ligament (ACL) and/or posterior cruciate ligament (PCL) rupture were noted intraoperatively. All above items were statistically analyzed; and there was statistical significance when P＜0.05. Results There were 161 cases enrolled in the cohort. There were 31 males and 130 females (80.7%), with an age of (62.98±7.93) years, BMI of (26.39±3.41)kg/m2, and preoperative Lysholm scores of (45.34±15.65). For articular surface with grade Ⅳ cartilage degenerative lesion, patellofemoral compartment accounted for 88.8%, medial compartment for 57.8%, and lateral compartment for 24.8%. In the cohort, there were 70.8% patients suffering from medial meniscus tear, and 25.5% having lateral tear. In addition, the percentage of loose bodies, old ACL rupture and old PCL rupture were 47.8%, 3.7%, and 0.6%, respectively. Statistical analysis indicated that gender (P＝0.006), age (P＝0.040) and cartilage lesions (grade Ⅳ) on medial femoral condyle (MFC) (P＝0.032) were correlated with preoperative Lysholm scores. Medial meniscus tear (P＝0.002, r＝0.246) and grade Ⅳ cartilage lesion on medial femoral condyle (MFC) (P＝0.004, r＝0.223) had positive correlation with BMI. Conclusion In this cohort of knee pain patients with degenerative changes, cartilage lesion on patellofemoral compartment is the most common, while, old ACL/PCL ruptures are the least. Besides the cartilage degenerative lesion, the medial meniscus tear is probably one of the key factors that aggravate knee pain. Female, older-aged and suffering from grade Ⅳ cartilage lesion on MFC usually have lower preoperative Lysholm scores and more worse symptoms. The patients with higher BMI have high risk of medial meniscus tear and grade Ⅳ cartilage on MFC.

Abstract:Objective To analyze the reproducibility of nocturnal blood pressure pattern in the elderly hypertensive patients by ambulatory blood pressure monitoring (ABPM) and evaluate its significance in clinical practice. Methods A total of 70 elderly essential hypertensive patients [45 males and 25 females, aged (83.57±5.37) years] admitted in the Department of Geriatrics from the Sixth People’s Hospital of Shanghai Jiaotong University were enrolled in this study. They underwent ABPM over two 24-hour periods within 4 weeks and other routine examinations. Their dipping patterns were classified as dippers (D), non-dippers (ND) and reverse-dipper (RD) according to their average systolic blood pressure at night compared to daytime. The short-term reproducibility was evaluated when above 3 different patterns used as continuous variables or categorical variables, and the differences among the reproducible and variable modes were analyzed. Results When the dipping patterns used as continuous variables, Bland-Altman’s plot showed that the reproducibility was good. While as categorical variables, overall 65.7% of the total 70 subjects (46/70) showed consistent dipping pattern during the 2 periods of ABPM, including 50.0% (14/28) confirming the identical RD, 76.5% (13/17) the identical D, and 76.0% (19/25) the identical ND (kappa＝0.482). Subjects who had RD, D and ND on the first ABPM but changed to another pattern on the second time accounted for 20.0%, 5.7%, and 8.6%, respectively. No significant difference was found among the persistent RD (group 1), D (group 2), ND (group 3) and those with variable dippers (group 4) in main clinical characteristics. Conclusion The nocturnal blood pressure pattern is moderately reproducible in the elderly hypertensive patients, regardless of as continuous or categorical variable, but the reverse-dippers have higher variability when compared to dippers and non-dippers. Therefore, we should not confirm the dipping status based on single period of ABPM. This study has not found any factor that may affect the noctunal dipping pattern.

Abstract:Objective To explore the relationship between plasma level of high-molecular-mass adiponectin (HMM-ADPN, H-ADPN) and macrovascular diseases in patients with type 2 diabetes mellitus. Methods A total of 106 patients with type 2 diabetes admitted in our department and Department of Endocrinology from December 2010 to December 2012 were enrolled in this study. These patients were divided into type 2 diabetes group (group A, n＝66) and type 2 diabetes accompanied with macrovascular complications group (group B, n＝40). Their height, body mass index (BMI), blood pressure and high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), hemoglobin A1c (HbA1c), fasting blood glucose (FBG), fasting insulin (FINS), high-sensitivity C reactive protein (hs-CRP), total-adiponectin (ADPN), H-ADPN, carotid intima-media thickness (CIMT) and other indices were measured and calculated. And the results were compared between the 2 groups. Results Plasma H-ADPN was significantly lower in group B than in group A (P＜0.05). Multivariate regression analysis revealed that serum level of H-ADPN level was positively correlated with that of HDL-C (P＜0.05), but was negatively correlated with systolic blood pressure and CIMT (P＜0.05) after adjustment for age, gender, BMI and hs-CRP. Conclusion Plasma H-ADPN level might play an important role in the atherosclerosis in type 2 diabetes patients, and be involved in the incidence and development of macrovascular complications in them.

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Abstract:National Clinical Research Center of Kidney Diseases, Institute of Nephrology, Nanjing General Hospital, Nanjing Military Command, Nanjing 210016, China

Abstract:Arachidonic acid (AA) is one of the essential fatty acids for human beings, and its metabolites have strong biological activities and play important roles in regulating many physiological and pathological processes. AA is metabolized by three major pathways, including cyclooxygenases (COXs), lipoxygenases (LOXs) and cytochrome P450 (CYP). Recently, more and more evidences demonstrated that CYP pathway contributed to the pathogenesis of hypertension by regulating 20-hydroxyeicosatetraenoic acid (20-HETE) and epoxyeicosatrienoic acid (EET), the downstream products of ω-hydroxylase and epoxygenase. The mechanisms of molecular biology and genetics of the pathway become a hot-spot in recent years. In this article, we reviewed the role of the CYP pathway in the hypertension.

Abstract:Inflammation plays a key role in the process of myocardial ischemia caused by coronary atherosclerosis (CAS). The occurrence, development, patho-physiological changes, diagnosis, treatment and prognosis of ischemic heart disease are closely related to the inflammatory markers, such as C-reactive protein (CRP), cytokines, cell adhesion molecules, chemokines, and?so on. The patho-physiological basis of myocardial ischemia is due to instability of coronary atherosclerotic plaque, rupture followed by thrombosis, and partial or completed occlusion of the injured vessels. Then with various extensions, it will cause myocardial ischemic injury and lead to a series of pathological symptoms. In this article, we reviewed 4 inflammatory markers: CRP, interleukins (IL), tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β), and elucidated their research progress and clinical significances in the induction, mediation and maintenance of coronary atherosclerotic myocardial ischemia.

Abstract:N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an effective cardiac biomarker which has been widely applied in the research of cadiovascular diseases. Researchers have paid more and more attention to the relationship between the protein and atrial fibrillation. In this paper, we reviewed recent research progress on their relationship in order to elucidate the role of NT-proBNP in the prediction of incidence, guiding of treatment and evaluation of prognosis in atrial fibrillation.