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Abstract:Along with the coming of aging society, there are more and more people suffering from cognitive dysfunction or dementia. How to make early diagnosis and intervention for these diseases is an important subject in geriatric study in the new century. In recent years, new and standardized definitions and classifications for the elderly cognitive dysfunction and dementia were achieved, and the specific and practical neuropsychological scales were applied. Many retrospective and prospective epidemiological studies were carried out and then analyzed comparably. Systematic analysis was performed on the risk factors for the elderly cognitive dysfunction and dementia, including mild cognitive impairment. The results provided therapeutic targets for clinical drugs and behavior intervention, and also for research direction on fundamental study and drug development.

Abstract:Objective To investigate the correlation of polymorphism in cystatin C gene (CST3) with mild cognitive impairment (MCI) in the elderly with type 2 diabetes mellitus (T2DM) and to analyze the risk factors for MCI. Methods A total of 156 retired veteran cadres with identified T2DM living in Shanghai were recruited and divided into 2 groups: MCI group and normal cognition (NC) group based on Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-Ⅳ). All subjects were evaluated with cognition scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Self-Rating Anxiety Scale (SAS), Center for Epidemiogical Studies Depression Scale (CES-D), Screening Scale for Parkinson’s disease (SSPD), Activity of Daily Living (ADL), and Global Deterioration Scale (GDS). Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) was used to detect the polymorphism of CST3. Results The allele A frequency was 80.4% and 90.9% respectively in T2DM-MCI group and T2DM-NC group, and that of allele B were 19.6% and 9.1% respectively. There were significant differences between the 2 groups (Chi-square＝7.005, P＝0.008). CST3 B allele carrying was a risk factor for MCI in the T2DM elderly (OR＝2.279, 95% CI＝1.064 to 4.882, P＝0.034). Conclusion CST3 B allele carrying is one of the risk factors for MCI in the T2DM elderly. Detection of CST3 polymorphism is helpful in the early diagnosis of MCI for the elderly people with T2DM.

Abstract:Objective To determine the effect of hyperlipidemia on cognitive function by comparing cognitive function of elderly with or without hyperlipidemia in Shanghai, in order to provide a basis for early awareness and prevention of cognitive impairment in hyperlipidemia elderly. Methods The eligible candidates were recruited from veteran cadres station in Shanghai, China. The surveys were conducted face-to-face using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The results of cognitive function were compared between the patients with hyperlipidemia (hyperlipidemia group) and the matched normal controls (normal lipidemia group). Results and Conclusion The prevalence of cognitive impairment was significantly higher in hyperlipidemia group than in normal lipidemia group (29% vs 16.11%, P＜0.001). MMSE and MoCA scores were obviously lower in the elderly hyperlipidemia group than in normal lipidemia group (P＜0.001). The results indicated that the spatial orientation ability, and capacity of delayed recall, attention and calculation ability are significantly decreased in hyperlipidemia group (P＜0.05).

Abstract:Objective To investigate the relationship between the hearing function and cognitive function in the elderly. Methods A total of 90 veteran cadres older than 60 years living in Shanghai city were divided into 3 groups according to their hearing status: group A (normal hearing), group B (hearing loss with hearing-aid treatment), and group C (hearing loss without treatment), with 30 subjects in each group. Questionnaires and tests including Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clock Drawing Test (CDT) and Activity of Daily Living (ADL) scale were employed to assess their cognitive function. The cognitive function was compared among the different groups, and its relationship with hearing function was analyzed. Results Cognitive function scores in the 3 groups were described as follow by quartile descriptions in order. MMSE results: 26.00 (22.00, 28.00), 25.00 (21.00, 28.00) and 22.00 (16.00, 24.00); MoCA results: 27.00 (26.00, 28.00), 26.00 (25.00, 27.00) and 22.00 (19.00, 23.00); CDT results: 4.00 (3.50, 4.00), 4.00 (3.00, 4.00) and 2.00 (1.00, 3.00); ADL results: 20.00 (19.75, 21.25), 21.00 (19.50, 24.25) and 24.50 (22.00, 28.00). The nonparametric test showed there were significant differences among the 3 groups (P＜0.001). Significant difference was found between group A and group C (P＜0.001), and group B and group C (P＜0.001). Conclusion Cognitive function is decreased significantly in the elderly with hearing loss without hearing-aid treatment. Hearing disorder is one of important relative factors for cognitive impairment in the elderly. Hearing assistance is beneficial to their cognitive dysfunction.

Abstract:Objective To evaluate the clinical efficacy of trazodone in the treatment of sleep disorders (SD) in the senile dementia patients. Methods A total of 63 elderly dementia patients admitted in Changhai Hospital from January to December 2012, aged 60 to 80 (79.1±7.4) years, presenting SD, were randomly divided into trazodone group (n＝21), clonazepam group (n＝21) and amitriptyline group (n＝21). The course of therapy was 4 weeks for the 3 groups. The patients’ sleep status was assessed before and after treatment. The clinical efficacy was evaluated by Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale Rating (HAMD). The adverse effects were assessed by Treatment Emergent Symptom Scale (TESS). Results The total efficiency was 85.7% in trazodone group, significantly higher than that of amitriptyline group (76.2%) and clonazepam group (66.7%, Chi-sqaure＝6.860, P＜0.05). The HAMA and HAMD were dramatically lower in trazodone group than in clonazepam group (t＝4.21, 5.13; P＜0.05) and amitriptyline group(t＝6.47, 7.24; P＜0.05). The trazodone group had lower incidence of adverse reactions, milder side effects and better tolerance. Conclusion Trazodone can effectively relieve SD and accompanying anxiety and depression in the senile dementia patients only with mild side effect, which is worth to further clinical study.

Abstract:Objective To investigate whether there is preventive and treatment effect of aspirin on the rat model of Alzheimer’s disease (AD) and its influence on the expression of interleukin (IL)-6, IL-1β and tumor necrosis factorα(TNFα) in the models. Methods A total of 50 SD rats were randomly divided into 5 groups: control group, model group, and low-, middle- and high-dosed aspirin groups. After fed with normal saline containing aspirin at 0, 0.5, 1 and 2g/L respectively for the later 4 groups for 3 weeks, the rats model of AD was established by injecting 5 μl amyloid-beta protein 25?35 (Aβ25-35) into the lateral cerebral ventricle followed by another 3 weeks’ aspirin treatment, while those of control was given normal saline at same volume. The escape latency of the rats was tested in Morris water maze, and the levels of IL-6, IL-1β, TNFα in the brain were detected by enzyme linked immunosorbent assay (ELISA). Results The mean escape latency was significantly shorter in the high-, middle- and low-dosed aspirin groups than in the control group. The brain levels of IL-1β was the highest in the model group, the lowest in the control group, and in a decreasing order in the low-, middle- and high-dosed aspirin groups, with significant difference among them. The brain level of IL-6 was in a similar trend as that of IL-1β in the 5 groups, but there was no significant difference among them. The level of TNFα was also the highest in the model group, and the lowest in the control group, and those in the other 3 groups were between the 2 values. Among the 3 aspirin groups, the middle-dosed group had the highest level of TNFα, and the low-dose group had the lowest level, with significant difference between the 2 groups. Conclusion Lateral cerebral ventricle injection of Aβ25-35 causes short-term decrease in learning and memory abilities in rats. Aspirin intervention attenuates the induced decrease in the abilities. It might exert the protective effect on the learning and memory abilities through down-regulating IL-1β, IL-6, and TNFα in the brain.

Abstract:Objective To investigate the effect of on-pump and off-pump procedures on postoperative cerebral complications and survival rate after coronary artery bypass grafting (CABG). Methods From June 2003 to June 2013, a total of 159 patients [(67.0±7.5) years old, 118 males and 41 females] with carotid arteriostenosis and coronary heart diseases, accepted isolated CABG in our department. They were divided into on-pump group (n＝95) and off-pump group (n＝64). The prevalence of postoperative cerebral complications and the survival rate after CABG were compared and retrospectively analyzed. Results Follow-up was done for 146 patients with a rate of 93.6%, and a duration of (46.3±25.3) months, ranging from 6 to 120 months. Ten patients had neurological symptoms, including 2 of cerebral hemorrhage and 8 of stroke. Seventeen patients died during the follow-up (4 due to cerebral complications, 1 esophagus cancer, 1 lung cancer, and 11 cardiogenic reasons) within average 41 months postoperatively (ranging from 4 to 72 months). There was no statistical difference in prevalence of postoperative cerebral complications and the survival rate between on-pump and off-pump groups (P＞0.05). Conclusion On-pump and off-pump procedures have no significant difference in the effect on postoperative cerebral complications and survival rate in the patients with carotid arteriostenosis and coronary heart diseases.

Abstract:Objective To investigate the prevalence and risk factors of reduced renal function among the population over 80 years old living in the communities of Chengdu City. Methods A total of 826 subjects were sampled from residents over 80 years old in the urban and rural communities of Chengdu City by stratified cluster sampling in the years of 2012 to 2013. Data were collected through questionnaires, physical examination, and laboratory tests for reduced renal function and relative risk factors. Results The prevalence of reduced renal function was 19.6% among the elderly over 80 years, and increased with age. Among those with reduced renal function, their awareness rate was 24.1% and the treatment rate was 11.1%. Multivariate logistic regression analysis indicated that diabetes, age, hypertension, overweight or obesity were identified as independent risk factors associated with reduced renal function among the elderly. Conclusion Reduced renal function is quite common among the elderly over 80 years in Chengdu communities. It is of importance to strengthen the monitoring of renal function in the elderly. The awareness rate and the treatment rate of reduced renal function are very low in the elderly. It is of important significance to prevent and treat diabetes and hypertension, and to control overweight and obesity in the elderly, so as to lower the incidence and development of reduced renal function.

Abstract:Objective To investigate the changes in serum lactic acid level and its relationship with prognosis in the elderly patients with severe pulmonary infection in order to provide a basis for the diagnosis, treatment and monitoring of the disease. Methods A total of 76 hospitalized elderly patients with pulmonary infection between October 2011 to May 2013 were enrolled in this study, and another 35 healthy matched individuals chosen randomly from those taking physical examination at the same time period served as normal controls. Their serum levels of lactic acid were detected by lactate oxidase method, and the results were compared and analyzed. Results The serum level of lactic acid was significantly higher in pulmonary infection group than in control group [(3.68±1.43) vs (1.59±0.30)mmol/L, P＜0.05]. The percentage of the elderly with abnormal lactic acid was also higher in pulmonary infection patients than in controls (85.53% vs 5.70%, P＜0.05). The serum level was significantly increased in the patients ＞70 years old than in those between 60 to 70 years old [(4.64±2.05) vs (3.06±0.87)mmol/L, P＜0.05]. The level was also obviously higher in dead patients than in survival patients [(5.31±0.88) vs (3.01±1.02)mmol/L, P＜0.05]. Conclusion The serum level of lactic acid is significantly higher in the elderly patients with severe pulmonary infection. With the increase in the age, the serum level of lactic acid is elevated significantly, which is often associated with the disease prognosis. Serum level of lactic acid might be used as a comprehensive index of disease monitoring and prognosis in elderly patients with severe pulmonary infection.

Abstract:Objective To investigate the clinical features and complications of aged patients with pneumonia from our hospital in the past 3 years in order to provide a basis for the reasonable clinical comprehensive treatment of these patients. Methods Clinical data of 112 aged patients over 70 years old with pneumonia hospitalized in our department from January 2007 to December 2009 were collected and analyzed. The clinical features and complications were analyzed. Causative factors of pulmonary infection, common complications, symptoms, signs, and imaging characteristics were analyzed for community-acquired pneumonia and hospital-acquired pneumonia. Results The incidence of hospital-acquired pneumonia was in an increased trend in the cohort, accounting for 54.6%. The patients with hospital-acquired pneumonia had non-typical symptoms and signs, higher mortality, more complications, and severe pathogenic conditions and more changeful radiological features when compared with those of community-acquired pneumonia. The top 5 complications were multiple organ failure, heart failure, respiratory failure, multiple electrolyte disturbances, and alimentary anemia. The first 5 precipitating factors were aspiration, regurgitation, cerebral infarction, heart failure and surgical procedures. Conclusion The incidence of pneumonia especially the hospital-acquired pneumonia in the elderly is increasing year by year in the past 3 years in our hospital. Meanwhile, the hospital-acquired pneumonia usually has non-typical symptoms and signs, and is commonly combined with severe complications. It is of great importance to prevent precipitating factors and give reasonable combined treatment for these patients.

Abstract:Objective To identify the risk factors of pulmonary infection in the elderly patients with terminal-stage cancer in hospice. Methods Clinical data of 143 elderly patients with terminal-stage cancer hospitalized in our department from October 2012 to November 2013 were collected and retrospectively analyzed. A multivariate logistic regression analysis was carried out in the patients with pulmonary infection (n＝87) and those without (n＝56) for the risk factors of pulmonary infection. Results Variables significantly associated with increased risk of pulmonary infection included lung cancer [odds ratio (OR)＝4.137; 95% confidence interval (CI) 1.967 to 14.479), disturbance of consciousness (OR＝3.728; 95% CI 1.313 to 8.315), hypoalbuminemia (OR＝2.960; 95% CI 1.300 to 6.739), hospital stay (OR＝2.611; 95% CI 1.056 to 6.451), performance status (OR＝2.187; 95% CI 1.345 to 4.071), diabetes mellitus (OR＝1.937; 95% CI 1.159 to 3.238), and chronic obstructive pulmonary disease (COPD; OR＝1.823; 95% CI 1.056 to 3.891) in this elderly cohort with terminal stage cancer (all P＜0.05). Conclusion Pulmonary infection is common in the elderly patients with terminal stage cancer. Lung cancer, disturbance of consciousness, hypoalbuminemia, prolonged hospitalization, bedridden, and chronic comorbidity (diabetes mellitus and COPD) are risk factors for occurrence of pulmonary infection.

Abstract:Objective To detect the serum level of 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] in the elderly patients with gastric cancer, and further explore the correlations of the level with the clinical features and prognosis of the disease. Methods A total of 65 elderly patients (ranging 62 to 83 years old) with newly diagnosed gastric cancer pathologically in our hospital from September 2009 to September 2012 were enrolled in this study. Their morning fasting blood samples before and after treatment were collected for the determination of serum level of 1,25-(OH)2D3 by enzyme-linked immunosorbent assay (ELISA). The correlations of the levels with clinical pathological features and prognosis were analyzed. Results The original level of 1,25-(OH)2D3 was (18.26±4.13)μg/L in these 65 patients after pathological diagnosis before any treatment, and the advanced level became (9.26±3.21)μg/L after treatment, with statistical difference (P＝0.028). The original and advanced levels were significantly correlated with clinical stages and cell differentiation (P＜0.05), but not with tumor locations, depth of infiltration, lymph node metastases and distant metastases (P＞0.05). The patients with high levels of 1,25-(OH)2D3 (＞20μg/L) had a higher overall survival rate compared with those with lower levels (≤20μg/L; P＜0.05). Conclusion Serum level of 1,25-(OH)2D3 might be used as an prognostic index for gastric cancer of the elderly patients.

Abstract:Objective To investigate the underlying mechanism through which heme oxygenase-1 (HO-1) protects intestine against inflammation in rats with heart failure. Methods Heart failure model was established in male Wistar rats by myocardial infarction (MI) with coronary ligation. These model rats were randomized into 3 experimental groups (10 rats in each group): Myocardial infarction (MI), MI＋cobalt protoporphyrin(Copp), and MI＋stannum＋mesoporphyrin Ⅸ dichloride (SnMP; a HO-1 inhibitor) groups, receiving intra-peritoneal injection of saline, cobalt protoporphyrin solution, and stannum mesoporphyrin Ⅸ dichloride solution, respectively. Another 10 rats served as normal controls and received intraperitoneal injection of normal saline. After 8 weeks, the endotoxin level in portal vein and inferior vena cava, the expression of HO-1, and the contents of carbon monoxide (CO), tumor necrosis factor (TNF)-α, and interleukin-10 in the intestine were determined by Western blotting, colorimetry, and enzyme-linked immunosorbent assay (ELISA). Results Compared with MI group, MI+Copp group had significantly elevated HO-1 and CO expression, reduced endotoxin, milder inflammation in the intestine, and these benefits were abolished by SnMP, with obviously decreased CO, elevated endotoxin and severer intestinal inflammation. Conclusion HO-1 suppresses intestinal inflammation, which may be associated with CO.

Abstract:We reported an elderly female (76 years old) accompanied with paroxysmal atrial fibrillation (AF) who underwent the implantation of implantable cardioverter-defibrillator (ICD) due to ventricular tachycardia (VT) in our department. No peri-operative anticoagulation was given to her in consideration of risk for hemorrhage. The patient was found to have fever and abdominal pain at the 7th day after surgery, and then right renal infarction was confirmed after diagnosis. Then the patient was given standard anticoagulant therapy. In present, it is a controversial issue on the efficacy and safety of anticoagulation strategy during perioperation of implantation of cardiac rhythm device (CRD). Renal infarction due to AF is relatively rare and the atypical clinical manifestations make early diagnosis for this patient more difficult. The revelation of this case includes: for patients with AF and high risk of stroke, anticoagulation therapy is necessary, but the strategy of anticoagulation remains controversial; for patients with AF and moderate risk of stroke, acute embolic infarction of abdominal organs should be taken into account when acute abdominal symptoms occur without anticoagulation.

Abstract:MicroRNA (miRNA) are highly conserved, non-coding, short, single-chain RNA (～22 nt), and play essential roles in regulating gene expression. Many studies have shown that circulating miRNA profiles are significantly varied in different clinical types of coronary artery disease (CAD), which indicates that miRNA may be a new kind of diagnostic biomarker for CAD. In this paper, the research progress in circulating miRNA in diagnosing CAD was reviewed, so as to provide a basis for their application as promising diagnostic biomarker for CAD.

Abstract:As a non-invasive examination measure, radionuclide myocardial perfusion imaging (MPI) is of its own uniqueness in functional imaging rather than simply anatomic imaging. It can objectively and accurately assess pathophysiological changes caused by coronary artery lesions, including myocardial perfusion, myocardial cells function and ventricular dysfunction. In this paper, we reviewed the application of radionuclide MPI in the diagnosis, treatment decisions, efficacy prediction and prognosis judgment of coronary heart disease.

Abstract:Glucagon like peptide-1 (GLP-1) receptor agonists (GLP-1RA), exenatide and liraglutide, exert their hypoglycemic effects by enhancing the secretion of insulin, inhibiting the release of glucagon, reducing insulin resistance, suppressing appetite and inhibiting gastric emptying. These effects are in a glucose level-dependent manner so as to prevent severe hypoglycemia. In addition to these definite hypoglycemic effects, the agents also decrease blood pressure, protect heart and blood vessels, attenuate fatty liver and reduce body mass. In animal experiments, these GLP-1RA drugs protect the function of β cells, and are safely combined with metformin, sulfonylureas, thiazolidinediones and insulin in the treatment of diabetes. Exenatide and liraglutide, as representatives of GLP-1RA, are a good option to control blood glucose and reduce body mass for diabetic patients.

Abstract:Chronic kidney disease (CKD) is a global public health problem. In 2002, National Kidney Foundation (NKF)’s Kidney Disease Outcomes Quality Initiative (K/DOQI) published a guideline, which introduced a definition and classification system for CKD. This guideline plays an important role in the diagnosis, treatment and prognosis improvement for CKD. However, lots of evidence from clinical and epidemiological trials caused plenty of debates and controversies towards the applicability of present K/DOQI-CKD definition and classification system. These problems included high prevalence of CKD, disproportionately high prevalence in CKD stage 3, and high prevalence of CKD in the elderly. What’s more, whether patients with simple renal cyst should be diagnosed as CKD or not have not reached a consensus yet. So Kidney Disease: Improving Global Outcomes (KDIGO) published another guideline in 2012. The new one revised the definition of CKD, established a combined staging system concerning causes, glomerular filtration rate (GFR) and albuminuria, made a risk stratified model to estimate prognosis, and recommended the application of CKD-EPI to estimate GFR.