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Abstract:Objective To investigate the association of rs7566605 polymorphism in the insulin-induced gene 2 (INSIG2) with obesity and lipid metabolism in Chinese elderly. Methods A total of 742 elderly receiving 2 surveys conducted during the years of 2001 and 2010 were subjected and longitudinally analyzed. All participants were asked to complete the health questionnaires and genotyping. The changes in body mass index (BMI), fasting blood glucose and blood lipid levels between the twice examinations were observed. The effects of aging and genetics on lipid metabolism were analyzed in the cohort. Moreover, the association between the rs7566605 genotypes with obesity and dyslipidemia, including hypercholesterolemia, hypertriacylglycerolemia or low high-density lipoprotein cholesterol (HDL-C) was analyzed with a variety of genetic models. Results Besides BMI, serum levels of fasting blood glucose, triglycerides (TG), HDL-C and the value of systolic blood pressure were increased in both male and female subjects during the 10 years. Serum total cholesterol was increased in the males but decreased in the females. Based on the data of 2001, the serum levels of fasting blood glucose and TG were higher in the males with allele C than with GG, while the females with allele C had lower level of HDL-C. No association was found between the rs7566605 genotypes with obesity. Logistic regression analysis indicated that allele C increased the risk of lower HDL-C (dominant model: P＝0.011, OR＝1.726; heterogeneous codominant model: P＝0.002，OR＝1.890), while it showed a protective effect on hypercholesterolemia (dominant model: P＝0.008, OR＝0.601; additive model: P＝0.040, OR＝0.753; heterogeneous codominant model: P＝0.015, OR＝0.634). Conclusion INSIG2 gene rs7566605 polymorphic allele C is associated with serum lipid metabolism in Chinese elderly population. Dominant and heterogeneous codominant model might be main genetic models for the gene.

Abstract:Objective To investigate the relationship of clinical classification of coronary heart diseases (CHD) with the expression of extracellular matrix metalloproteinase inducer (EMMPRIN) in peripheral blood mononuclear cells of CHD patients. Methods A total of 179 CHD cases diagnosed by coronary angiography in our department from September 2012 to May 2013 were recruited in this study. They were divided into 3 groups according to the clinical types: stable angina pectoris group (SAP, n＝35), unstable angina pectoris group (UAP, n＝76), and acute myocardial infarction group (AMI, n＝68). Another 30 healthy individuals at the same period served as normal controls. Mean fluorescence intensity (MFI) of EMMPRIN in peripheral blood mononuclear cells (PBMCs) were examined by flow cytometry. Serum level of high-sensitivity C-reactive protein (hs-CRP) was measured with immune velocity assay. The correlation of the expression of EMMPRIN was analyzed with the Gensini scores by coronary angiography. Results The expression of EMMPRIN in PBMCs was significantly higher in AMI, UAP and SAP groups than in the controls (P＜0.05). The expression was also positively correlated with the number of involved vessels, which was increased gradually in normal controls, single-vessel, double-vessel, and triple-vessel disease groups sequentially (P＜0.05). The EMMPRIN MFI of the PBMCs had positive correlation with the serum level of hs-CRP and Gensini scores in coronary arterial lesion. Conclusion The expression of EMMPRIN is correlated with the clinical classification of CHD.

Abstract:Objective To explore the distribution patterns of the elderly in-hospital patients in the number and type of multi-morbidity. Methods A total of 5 505 elderly hospitalized patients with multi-morbidity in our hospital from 2008 to 2013 were recruited and retrospectively analyzed. Their general condition and multi-morbidity were collected and analyzed. The patients were allocated into 3 groups according to their age: low old (65 to 74 years old), median old (75 to 84 years old) and high old (≥85 years old) aged groups. Results There were 3 772 males and 1733 females included, with age ranging from 65 to 104(80.7±6.4) years. The numbers of their diseases ranged from 2 to 23. The patients with 5 to 9 types of diseases accounted for 56.76% (3 125/5 505). The most common type of multi-morbidity was cerebrovascular disease (58.31%), followed by hypertension (52.97%), infective disease (51.57%), coronary heart disease (41.11%), diabetes (30.55%), heart failure (28.45%), renal disease (23.67%), bone and joint disease (21.91%), tumor (17.31%) and gastrointestinal disease (16.17%) in order. While for different age groups, infective disease was more common in ≥85 years patients than in＜85years patients (78.89% vs 27.15%, P＜0.05). Conclusion Most elderly patients with multi-morbidity have 5 to 9 types of diseass. Cerebrovascular disease, hypertension, infective disease, coronary heart disease, and diabetes are the most common diseases in this cohort. Their multi-morbidity has age diversity. Infective disease is more common in patients over 85 years.

Abstract:Objective To determine the effect of pre-operative serum albumin (ALB) level and total lymphocyte count (TLC) on the prognosis of hip fracture in the elderly patients. Methods Clinical data of 640 elderly patients (over 60 years old) with hip fracture undergoing surgical treatment in our department from July 2006 to December 2010 were collected and retrospectively analyzed in this study. Their serum ALB level and TLC were recorded at admission. Their hospitalization time, in-hospital complications, and mortality at hospital and at 3 and 12 months after surgery were analyzed. Cox regression analysis was carried out on these data. The clinical significance of serum ALB level and TLC was evaluated in the prediction of prognosis. Results Among the 640 patients, those with lower serum ALB level accounted for 44.2% (283), and those with lower TLC accounted for 68.0% (435). The patients with lower albumin and lower TLC had higher incidence of postoperative complications (13.3%), and higher mortalities at hospital (4.3%), 3-month (6.7%) and 12-month (16.7%) post-operatively compared to the patients who had normal values of the 2 laboratory parameters (all P＜0.05). Cox regression analysis indicated that serum ALB and TLC were predictive factors for mortality risk in the elderly with hip fracture. Conclusion Malnutrition at admission indicates poor clinical outcome after surgical treatment in the elderly patients with hip fracture. Lower serum ALB level and TLC are regarded as predictive factors for malnutrition and poor prognosis in these patients.

Abstract:Objective To evaluate the relationship of serum level of soluble suppression of tumorigenicity 2(sST2) with cardiac function in the elderly patients with acute myocardial infarction (AMI). Methods A total of 59 patients (≥60 years) with AMI within 24 h of symptom onset admitted in our department from March to December 2011 were subjected in this study. Immediately after admission, their serum levels of sST2 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured, Killip cardiac function class was analyzed, and echocardiography was performed within 48 h. Another 36 age-matched healthy subjects were recruited as normal controls. Results The serum level of sST2 was significantly higher in AMI patients than in control group [(36.2±21.3) vs (12.5±11.4)μg/L, P＜0.05]. In the AMI group, the sST2 level was positively correlated with NT-proBNP level (r＝0.585, P＜0.05), and negatively correlated with left ventricular ejection fraction (LVEF) (r＝-0.611, P＜0.05). Significant differences were seen in sST2 level between Killip Ⅰ and Ⅱ [(27.6±14.5) vs (38.0±20.6) μg/L, P＜0.05] and between Killip Ⅱ and Ⅲ＋Ⅳ [(56.5±25.0)μg/L, P＜0.05]. Conclusion The serum level of sST2 is significantly higher in AMI patients than in normal controls. The sST2 level is correlated with NT-proBNP level and LVEF, and also, in an increasing trend with the elevation of Killip grading, but NT-proBNP level has no such trend.

Abstract:Objective To investigate whether there exists difference in in-hospital outcomes between male and female elderly patients with coronary artery diseases after percutaneous coronary intervention (PCI). Methods In a single center, a total of 502 consecutive patients (aged ≥75 years, 36.5% women and 63.5% men) who underwent PCI from January 2005 to December 2010 were recruited in this cohort study. Clinical features and in-hospital outcomes were compared between males and females. Results The age of the 502 patients was (78.5±3.2) years. The in-hospital length was (23.2±6.5)d. The male patients presented higher prevalence of ST elevation myocardial infarction but lower incidence of heart failure than the female ones. There was no significant difference in the successful rate of in-hospital procedures (94.3% vs 94.5%, P＝1.000) and in mortality (1.3% vs 3.3%, P＝0.093) between the male and female patients. Conclusion For the patients over 75 years old with coronary artery diseases, PCI is a good choice with higher successful rate and acceptable mortality. Although males have worse baseline conditions, there is no difference in in-hospital outcome between males and females after PCI.

Abstract:Objective To investigate the relationship of serum autoantibodies against oxidized low-density lipoprotein IgM (ox-LDL-Ab IgM) with coronary lesions and clinical prognosis in patients with ST-segment elevation acute myocardial infarction (STEMI). Methods From August 2008 to May 2009, 95 patients with STEMI undergoing elective coronary angiography (CAG) and emergent percutaneous coronary intervention (PCI) were enrolled in the study. All patients were divided into single-, double- and triple-vessel lesion groups according to the numbers of vessels with significant stenosis. The ox-LDL-Ab IgM, maleic dialdehyde (MDA), serum lipids, body mass index (BMI), Gensini’s score, and cardiovascular events during hospitalization were recorded and calculated. The relationship of serum level of ox-LDL-Ab IgM with coronary lesions and short-term prognosis was analyzed. Results The serum level of ox-LDL-Ab IgM was reduced with the increase in stenostic vessel numbers in STEMI patients (P＜0.05), but had no correlation with Gensini’s score (P＞0.05). The serum level was negatively correlated with serum MDA (r＝-0.319, P＜0.05), but no obvious correlation was found with serum lipids and blood glucose (P＞0.05). There was negative correlation between the serum level of ox-LDL-Ab IgM and cardiovascular events during hospitalization (r＝-0.708, P＜0.05). Logistic linear regression analysis showed that ox-LDL-Ab IgM was a protective factor for patients with STEMI (OR＝-0.588, P＜0.05). Conclusion The serum level of ox-LDL-Ab IgM reflects the severity of atherosclerosis in patients with STEMI. ox-LDL-Ab IgM may reduce modification of LDL to ox-LDL through regulating oxidative stress, and then attenuates the coronary atherosclerosis area. It may play a protective role in the short-term prognosis in STEMI patients.

Abstract:Objective To investigate the relationship of subclinical hypothyroidism (SCH) with kidney function in patients with type 2 diabetes mellitus (T2DM). Methods A total of 472 hospitalized patients with T2DM receiving serum thyroid function test from January 2008 to December 2012 were subjected in this study. After 38 cases were excluded, the left 434 patients were divided into euthyroid group (n＝371) and SCH group (n＝63) according to serum thyroid function test. Their general condition and clinical data were collected and analyzed. An ordinal logistic regression analysis was conducted to determine the risk factors. Results Compared with the euthyroid group, the percentage of females (63.49%), body mass index [(25.57±3.25)kg/m2], and the prevalence of hypertension (69.84%) and cardiovascular disease (57.14%) were statistically higher in the SCH group (P＜0.05); and so did the glycosylated hemoglobin [HbA1c, (8.94%±1.03%)], serum creatinine [(97.70±20.80)μmol/L], blood urea nitrogen [(8.22±3.64)mmol/L], total cholesterol [(5.83±1.08)mmol/L] and low density lipoprotein cholesterol [(3.86±1.21)mmol/L, all P＜0.05]. Ordinal logistic regression analysis revealed that hypertension, elevated thyroid stimulating hormone and HbA1c were significantly associated with kidney dysfunction in T2DM patients (P＜0.05). Conclusion Besides hypertension and hyperglycemia, SCH is related to the severity of kidney dysfunction in T2DM patients.

Abstract:Objective To evaluate the value of the initial blood lactic acid monitoring in the elderly patients with multiple traumas. Methods A total of 78 elderly patients with multiple traumas admitted in our ICU from November 2012 to July 2013 were enrolled in this study and retrospectively analyzed. Immediately after hospitalization, their arterial blood samples were immediately collected for blood gas analysis. According to the arterial lactic acid level, these patients were divided into 3 groups: arterial lactic acid level ＜2mmol/L group, 2 to 4mmol/L group and ＞4mmol/L group. Based on the basic information and clinical data, their acute physiology and chronic health evaluation (APACHE) Ⅱ score within 24h, ICU stay duration, incidence of infection, number of failed organs, fluid intake within 24h and hospital mortality were compared among the different groups. Finally, all the patients were also divided into survival group and death group according to their prognosis. The risk factors influencing the prognosis were analyzed by univariate and multivariate logistic regression analysis. Results There was no significant difference in demographic and medical data in the above 3 groups after admission. Their APACHEⅡ score, fluid intake within 24h, number of failed organs, ICU stay duration, and hospital mortality were significantly different in the 3 groups (P＜0.05). There was no significant difference in the initial systolic blood pressure and incidence of infection (P＞0.05). Multivariate regression analysis showed that the number of failed organs and initial lactate level were independent risk prognostic factors in the elderly patients with multiple trauma. Conclusion The initial blood lactic acid is an important monitoring index in clinical treatment for the elderly patients with trauma, and is also of great importance to evaluate prognosis.

Abstract:Objective To investigate the role of endoplasmic reticulum stress?protein kinase R-like endoplasmic reticulum kinase (PERK) pathway in the transdifferentiation of SD rat aortic vascular smooth muscle cells (VSMCs) to osteoblast-like cells by high glucose. Methods The primary cultured VSMCs from rat’s aortic segments were divided into 5 groups, including normal control group (5mmol/L D-glucose), mannitol group (5mmol/L D-glucose plus 25mmol/L mannitol), high glucose group (30mmol/L D-glucose), high glucose＋PERK-small interference RNA (siRNA) group (30mmol/L D-glucose plus PERK siRNA transfection), and high glucose＋scramble RNA group (30mmol/L D-glucose plus scramble RNA transfection). At 48 and 72h after the corresponding treatment, the expression of endoplasmic reticulum stress markers, including GRP78, PERK, p-PERK, eukaryotic initiation factor (eIF)2α, and p-eIF2α, osteo inductive factors such as Cbfα-1, osteocalcin, and smooth muscle cells marker α-smooth muscle antibody (α-SMA) at messenger RNA (mRNA) and protein levels were detected by RT-PCR and Western blotting, respectively. The activity of alkaline phosphatase (ALP) was measured by ALP activity testing kit. Results When compared with the normal group and the mannitol group, high glucose in presence or absence of scramble RNA transfection resulted significant increases in the mRNA levels of PERK and eIF2α (P＜0.05), while PERK siRNA transfection decreased the expression (P＜0.05). High glucose also induced high protein expression of PERK, p-PERK, eIF2α, and p-eIF2α (P＜0.05), but PERK siRNA transfection decreased the expression (P＜0.05). The activity of ALP was enhanced by high glucose (P＜0.05), but partially blocked by PERK siRNA (P＜0.05). Conclusion Endoplasmic reticulum stress PERK pathway plays a role in the transdifferentiation of VSMCs from the contractile phenotype to osteoblast phenotype induced by high glucose, and the transformation process can partially blunted by suppressing the PERK pathway.

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Abstract:Myelodysplastic syndrome (MDS) is a group of malignant clone diseases owing to hematopoietic stem cell abnormality, which can transform to acute myeloblastic leukemia (AML). After MDS transforms to AML, the leukemia cells usually can not be effectively killed or inhibited, and bone marrow suppression becomes fairly severe. After chemotherapy, hemorrhage and infection in the period of bone marrow suppression are usually the main reasons for mortality. Therefore, the AML patients secondary to MDS usually have poor prognosis and are difficult to treat. Recently, we utilized decitabine and regimen of cytarabine, aclacinomycin and granulocyte-colony stimulating factor (CAG) combined with haploidentical lymphocyte infusion to treat a 62-year-old male with MDS-transformed AML. The symptoms were successfully remitted, with markedly shortened bone marrow suppression and favorable outcome.

Abstract:Generally, there is a significantly increased risk of secondary hip fracture in the elderly after primary osteoporotic hip fracture. The secondary hip fracture causes further impact on patients’ social independence and mobility, and increases mortality. However, the risk factors relative to secondary hip fracture are still not well known. Learning more knowledge on the factors will help clinicians to make effective prevention strategies for high risk population. In this paper, we reviewed the risk factors of secondary hip fracture based on patients’ characteristics, life style, and comorbidities, and some effective interventions.

Abstract:Much evidence shows that omega-3 polyunsaturated fatty acids (n-3PUFAs) protect the heart by reducing heart rate, increasing heart rate variability, decreasing atrial fibrillation, and preventing ventricular fibrillation arrhythmias and sudden cardiac death. However, some researches suggest that n-3PUFAs exert pro-arrhythmic action. The purpose of this review was to summarize the effects of n-3PUFAs on ion channels and anti-arrhythmic mechanism. Acute administration and long-term use of n-3PUFAs have quite different electrophysiological actions, indicating their anti- and pro-arrhythmic actions in different clinical settings.

Abstract:Intestinal mucosal barrier dysfunction is an important factor resulting in systemic inflammatory response syndrome, multiple organ dysfunction syndrome, and even multiple organ failure. So it is of great significance to assess intestinal mucosal lesion and make early effective intervention. Therefore, more efforts should be taken to study how to evaluate intestinal mucosal barrier function. In this paper, we reviewed some common indices indicating intestinal mucosal barrier function (fatty acid binding protein, citrulline and D-lactic acid), and the involved methods in clinical practice.

Abstract:The renin-angiotensin-aldosterone system (RAAS) plays a major role in blood pressure regulation, and is thus an important therapeutic target in the management of hypertension. Angiotensin receptor blockers (ARBs), which interrupt RAAS overactivity by blocking a specific receptor of angiotensin Ⅱ, act for the management of hypertension. Clinical evidence demonstrates that ARBs are effective in the management of hypertension as monotherapy or in combination with other agents. Although comparable to angiotensin-converting enzyme inhibitors and other major classes of antihypertensive agents in the treatment of hypertension, ARBs are attractive alternatives for many patients due to its favorable tolerability profile. Recent evidence suggests that treatment persistence with ARBs therapy during a 12-month period be typically higher than that with other antihypertensive classes, and fewer side effects are observed. The advantages of clinical efficacy and tolerability qualify the ARBs as major treatment alternatives for hypertension.

Abstract:Progressive decline in skeletal muscle mass and strength is associated with aging, and usually leads to poor outcomes of disability and fall in senior adults, as well as increases admission rates, institutional dwelling rates and clinical mortality. With the coming of aging society, more and more attentions were paid to researches on sarcopenia. Its diagnostic criteria and screening flow sheet have been improved. In this paper, we concluded the current status of the researches on sarcopenia in Asia.