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Abstract:Osteoporotic fracture is a critical complication of osteoporosis. Fracture healing plays an important role in the function recovery and quality of life in the osteoporosis patients. Currently, the effect of anti-osteoporosis treatment on fracture healing is controversial. Some researchers believed that the anti-osteoporosis treatment will increase bone mineral density, relieve pain, and promote fracture healing, etc. However, the others argued that the anti-osteoporosis treatment has no effect on fracture healing, or even also might suppress the healing. Therefore, in this review, we focused on the effect of osteoporosis treatments on osteoporotic fracture healing, so as to guide the osteoporotic fracture therapy.

Abstract:目的 研究老年髋部骨折围术期输血与临床预后的关系。方法 回顾性地分析解放军总医院2010年～2012年期间连续性收治的所有老年髋部骨折患者，将最低血红蛋白（Hb）＞80g/L的患者按照围术期是否输血分为输血组及未输血组。比较两组患者术后并发症及术后1个月、12个月死亡率差异，分析围术期输血与术后死亡的相关性。结果 共纳入931例患者，706（75.8%）例患者接受输血治疗，输血组最低Hb浓度为（105.2±15.4）g/L，未输血组最低Hb浓度为（110.5±16.5）g/L。输血组术后心脑血管并发症发生率明显高于未输血组（7.5% vs 3.6%，P＝0.037），两组患者术后感染性并发症及死亡率差异均无统计学意义（均P＞0.05）。多因素分析结果显示高龄及低Hb浓度为术后死亡的独立危险因素，而输血并非影响死亡的独立因素。结论 高龄和低Hb浓度是老年髋部骨折患者术后死亡的独立危险因素，但围术期输血并不能明显改善患者预后。

Abstract:Objective To compare the clinical efficacy of locking plate for internal fixation and humeral head replacement in the treatment of comminuted fractures of the proximal humerus in senior patients. Methods Clinical data of 74 old patients at the age of (76.35±4.78) years with comminuted fractures of the proximal humerus admitted in our department from January 2008 to December 2012 were collected and retrospectively analyzed. Forty-seven patients were treated by locking plate for internal fixation and 27 cases operated with humeral head replacement for 3- and 4-part fractures according to Neer classification system. The 2 groups were compared in the operation time, blood loss and Neer Scores at the end of follow-up. Results The follow-up period was 23.7 months (ranging from 12 to 43 months), which was similar in the 2 groups. The operation time was (95.4±8.57)min in the internal fixation group and (72.60±9.45)min in the replacement group, blood loss was (277.50±31.65)ml and (287.20±42.51)ml, and the rate of excellent and good outcomes by Neer scoring system was 82.9% and 85.2%, respectively, in the 2 groups. The operation time was significantly longer in the internal fixation group than in the replacement group (P＜0.01). But there was no difference in blood loss and Neer score (P＞0.05). Conclusion Both locking plate for internal fixation and humeral head replacement show good efficacy and satisfactory clinical outcomes for comminuted fractures of proximal humerus in the elderly. We suggest that locking plate is suitable to the younger patients who are able to reach intraoperative repositioning. While for the elderly with serious comminuted fractures, especially accompanied with severe osteoporosis, humeral head replacement may be the best option. Surgeons should make individualized management according to the specific fracture condition.

Abstract:Objective To determine the effects of insulin resistance (IR) on bone metabolism and vitamin D metabolism in the elderly patients with diabetes mellitus(DM). Methods A total of 55 patients with type 2 DM at the age ranging from 65 to 89 years admitted in our department from January 2011 to December 2013 were recruited in this study. All of them were tested for oral glucose tolerance test, insulin release test and C-peptide release test. Serum levels of vitamin D3 (VitD3) and parathyroid hormone (PTH), and biomarkers for bone metabolism, including osteocacin (OCN) and carboxy-terminal β collagen crosslinks (β-CTX) were also detected. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. Correlation analysis was performed on the effects of glucose metabolism and IR on bone metabolism. Results In the cohort, the serum level of glycosylated hemoglobin (HbA1c) was negatively correlated with that of VitD3 (r＝-0.42, P＝0.019), but positively with PTH (r＝0.40, P＝0.05). PTH was also positively related to fasting C peptide (FCP)( r＝0.40, P＝0.015) and Homeostasis Model Assessment(HOMA-β) (r＝0.56, P＝0.004). Bone formation marker OCN was in a positive correlation with HOMA-calretnin (HOMA-CR, r＝0.461, P＝0.031), while PTH was positively related to HOMA-CR either (r＝0.43, P＝0.028). But no correlation was seen in T values of BMD from every region of the total body with blood glucose, HbA1c, HOMA-β, HOMA-CR and bone metabolic markers. Conclusion For aged patients with diabetes, it is of great clinical significance to ameliorate IR and timely treat VitD deficiency or insufficiency in order to prevent osteoporosis.

Abstract:Objective To observe the changes in bone mineral density (BMD) and bone metabolism indices in the elderly women in 6 to 12 months after lumbar vertebra fracture, and investigate their correlations so as to provide theoretical basis for the clinical application of bone metabolism indices to effectively prevent secondary fracture. Methods Forty-eight elderly women meeting our inclusion and exclusion criteria of lumbar vertebra fracture were recruited in this study. The standards for follow-up were set up to measure the BMD in the fractured vertebra, healthy vertebra and the hips in 3d, and 6 and 12 months after fracture, and to determine the serum levels of bone metabolism indices, including bone alkaline phosphatase (BAP), bone γ-carboxyglutamic acid containing proteins (BGP, osteocalcin), carboxy-terminal cross-linking telopeptide of type Ⅰ collagen (CTX-Ⅰ) and tartrate-resistant acid phosphatase 5b (TRACP5b) in 4h (as baseline), 3d, 6 and 12 months after fracture. CT scanning was used to evaluate the bone healing in 4 and 6 months after fracture. All the data were recorded, analyzed and processed with SPSS 17.0 statistical software. Results After fracture healing, the BMD value was significantly lower than the baseline value in the fractured and healthy vertebra (P＜0.01), and not statistically different with baseline value in the hips. In 6 months after fracture, the serum levels of BAP, BGP, CTX-Ⅰ and TRACP5b were significantly higher than the baseline values (P＜0.05). In 12 months after fracture, namely 6 months after fracture healing, the serum level of BGP was obviously higher than the baseline value (P＜0.01), while the other indices of bone metabolism showed no statistical difference with the baseline values. When the fracture healing reached the clinical and radiographic standards, the partial regression coefficient of delta-Zscore was maximal between the change in serum BGP level and the change in BMD of the fractured vertebra. Conclusion When the fracture reaching clinical healing, the serum level of BGP is of great value in the assessment of recovering speed of BMD. Monitoring corresponding bone metabolism indices after fracture healing improves the accuracy of judging BMD changes and reduces the risk of secondary fractures.

Abstract:Objective To determine the preliminary clinical effect of AO multiple-angle locking plate on the treatment for the distal radius type C fractures in elderly people. Methods Between March 2011 and February 2014, a total of 47 elderly patients who sustained distal radius type C fractures were admitted in our department and received open reduction and AO multiple-angle locking plate. They were 15 males and 32 females, with an average age of 67.5 years: 20 patients with type C1 fractures, 16 with C2 and 11 with C3. Disabilities of Arm, Shoulder, and Hand (DASH) and Gartland and Werley scoring system were used for clinical functional assessment of the grip strength and wrist motion range. Results Within the 47 patients, 43 were followed up for 6 to 12 (mean 8.3) months and got fully healed finally, with an average healing time of 7 weeks. Forty-two patients had excellent functional assessment and no complication occurred during the follow-up periods. Conclusion Open reduction and AO multiple-angle locking plate are effective approaches for osteoporotic unstable distal radius fractures for the elderly patients.

Abstract:Objective To compare the efficiency and safety of transforaminal endoscopic spine system (TESSYS) with open operation in the treatment of lumbar spinal stenosis accompanied by osteoporosis. Methods Seventy-eight patients with lumbar spinal stenosis accompanied by osteoporosis undergoing surgical treatment in our department from March 2010 to September 2013 were recruited in this study. They were divided into 2 groups, TESSYS group (n=43) and open operation group (n=35). The degree of pain and lumbar function improvement were assessed using Visual Analogue Score (VAS) and Japanese Orthopaedics Association Lumbago Score (JOA) respectively, before and immediately after operation and at the end of follow-up. Operation time, bleeding volume and incidence of complications were compared between the 2 groups. Results There was no significant difference in VAS and JOA scores between 2 groups preoperatively (P＞0.05). After operation, the VAS scores were decreased (P＜0.05), and those of JOA were increased in both groups (P＜0.05), but there was no difference in the 2 scores between them (P＞0.05). While, the operation time, bleeding volume and incidence of complications were obviously less in the TESSYS group than in the open operation group (P＜0.05). Conclusion TESSYS has similar efficiency as open operation in the treatment of lumbar spinal stenosis accompanied by osteoporosis, but the former is superior in operation time, bleeding, and incidence of complications.

Abstract:Objective To investigate the correlation between the level of serum uric acid (SUA) and recurrent cerebral infarction in elderly patients. Methods A total of 1 033 acute ischemic stroke patients from 4 hospitals in Shangdong Province from January 2006 to December 2008 were recruited in the study. Data on demographic characteristics, life style, history of disease, SUA at admission and history of cerebral infarction were collected for all participants. Multi-variate non-conditioned logistic regression analysis was used to analyze the correlation of SUA and recurrent cerebral infarction. Results The SUA 1evel was significantly higher in the patients with recurrence of cerebral infarction than in those with primary cerebral infarction. After adjustment for multivariate, the odds ratio (OD) [95% confidence interval (CI)] of recurrence was 1.002 (1.000?1.003) for every increased unit, indicating the association of SUA and recurrent cerebral infarction. Logistic analysis was then conducted according to quartile of SUA level. The results showed that the OD (95% CI) of recurrence was 1.951 (1.340?2.839) and 1.670 (1.140?2.448), respectively for the patients with SUA of 263 to 333μmol/L and ≥333μmol/L, when compared to those with SUA ＜211μmol/L. But there was no significant difference in those with SUA of 211 to 263μmol/L. Conclusion Elevated SUA is an independent predictor for the recurrence of cerebral infarction.

Abstract:Objective To observe the distribution and number of mast cells in the renal tissues of patients with membranous nephropathy at different pathological stages and to investigate the pathological significance of mast cells. Methods Renal tissue samples from 55 membranous nephropathy patients of different pathological stages with available full clinical and pathological data and from 8 normal kidney donors were collected in this study. The number and distribution of mast cells in each tissue section was observed by immunochemical staining for the cell specific marker C3aR. Then the mast cell density in the cortex was calculated. The correlation of mast cells with patients’ clinical and pathological indices was analyzed. Results Mast cells were mainly distributed in the tubular interstitial area, especially in the area with injured tubules and glomeruli. There were more renal mast cells in the patients with membranous nephropathy of all pathological types when compared with the normal controls. No significant difference in the number of renal mast cells was found between the groups of different pathological stages except stage Ⅰ group having less cells. The number of renal mast cells was correlated with indices reflecting renal injury, especially with the indices reflecting renal tubular and interstitial injury. Conclusion Our results indicate that mast cells are involved in the pathogenesis of membranous nephropathy, especially in the chronic tubular interstitial injury. As a possible new pathogenic factor and a new therapeutic target, renal mast cells deserve attention in the treatment of membranous nephropathy.

Abstract:Objective To determine the efficacy of small doses of levamlodipine, telmisartan and hydrochlorothiazide given at the same or different time points on anti-hypertension and reverse of non dipper hypertension. Methods Three hundred over-45-year-old patients with non-dipper hypertension [systolic blood pressure (SBP) ＜180mmHg and diastolic blood pressure (DBP) ranging from 90 to 109mmHg)] admitted in our out- and in-patient departments from May 2011 to October 2013 were prospectively subjected in this study. They were randomly divided into 2 groups, group Ⅰ (the drugs were given at different time, 40mg telmisartan and 10mg hydrochlorothiazide were given in the morning, while 2.5mg levamlodipine at night), and group Ⅱ (all 3 drugs were given at the morning). All cases received ambulatory blood pressure monitoring before and in 8 weeks after treatment. Results In 8 weeks after the treatment, the 24-hour SBP/DBP was reduced by 14.92/9.96mmHg and 15.04/10.66mmHg respectively for groups Ⅰ and Ⅱ, while the daytime SBP/DBP was decreased by 13.90/10.60mmHg and 16.06/11.70mmHg, respectively. These indices were all significantly lower than before treatment (P＜0.01), but there was no difference between the 2 groups (P＞0.05). The nighttime SBP/DBP was reduced by 25.44/19.48mmHg in group Ⅰ and by 17.68/14.76mmHg in group Ⅱ, and both were significantly lower than before treatment (P＜0.01, P＜0.05). The reversion of non-dipper hypertension was 88.16% and 55.41% for the 2 groups, with significant difference between them (P＜0.01). Conclusion No matter small doses of levamlodipine, telmisartan and hydrochlorothiazide are given at the same or different time points, they effectively control the 24-hour and daytime blood pressures. But the drugs given at different time points can reverse non-dipper hypertension better.

Abstract:Objective To investigate the value of plasma D-dimer level in predicting 30-day mortality for the elderly patients with severe community-acquired pneumonia (CAP). Methods A total of 152 elderly inpatients (over 60 years old) with identified severe CAP admitted in our department from August 2009 to August 2011 were enrolled in this study. Immediately after admission, their blood samples were obtained for plasma levels of D-dimer and C-reactive protein (CRP), and pneumonia severity index (PSI) was calculated. Clinical and laboratory variables and 30-day mortality were recorded. Receiver operating characteristic (ROC) curve was used to assess the value of D-dimer for predicting 30-day mortality, and the area under curve (AUC) was calculated. Results The D-dimer levels were (961.55±186.49)μg/L in the patients with PSI score in class Ⅳ, and (1 122.53±197.98)μg/L for those with score in class Ⅴ, respectively, with significant difference between them (t＝5.159, P＜0.001). The levels were significantly higher in non-survivors than in survivors [(1 112.59±215.25) vs (920.46±126.89)μg/L, t＝6.239, P＜0.001]. Pearson correlation analysis indicated that D-dimer level was significantly correlated with PSI score (r＝0.47, P＜0.0001). ROC curve showed that the AUC for D-dimer predictive value was 0.79 (95% CI＝0.72 to 0.85), having no significant difference with that of PSI score (0.85, 95% CI＝0.78 to 0.91, P＝0.095). Conclusion D-dimer level is of great value for predicting 30-day mortality in the elderly patients with severe CAP.

Abstract:Objective To investigate which one out of the 2 most commonly used tools for screening malnutrition, Mini Nutritional Assessment (MNA, specially designed for the elderly) and nutritional risk screening 2002 (NRS 2002, usually for inpatients) is more suitable for the geriatric inpatients. Methods A total of 179 inpatients over 65 years old from geriatric ward in our hospital from July 2010 to January 2012 were enrolled in this study. All the patients were assessed with MNA-short form (SF) and NRS2002 within 48h after admission. The coincidence of the 2 tools was studied, and their efficiency of guiding the patients for nutritional support was compared. Meanwhile, the relationship of the nutritional status screened by the 2 methods with traditionally used nutritional indicators, i.e. body mass index (BMI), serum albumin and pre-albumin was analyzed. Results By MNA-SF, 55 cases (30.7%) were rated as at risk of malnutrition, and 42 cases (23.5%) were as malnutrition, which were significantly different from the results by NRS2002 (69 cases as at risk of nutrition, 38.5%). MNA-SF had an efficiency of 29.1% for the patients at risk of malnutrition, and of 50% for those of malnutrition, and NRS 2002 had an efficiency of 49.3%. Besides, the commonly used nutritional indicators BMI, serum albumin and pre-albumin showed little correlation with the results rated by MNA-SF and NRS2002 (r＝0.09 to 0.48), indicating that these indicators had no reference value for nutritional risks screening. Conclusion In the nutritional risks screening for geriatric inpatients in department of internal medicine, MNA-SF is a relatively sensitive tool for screening nutritional risks, while, NRS2002 has a better value in the guidance for the patients needing for nutritional therapy. The conventionally used nutritional indicators such as BMI, serum albumin and pre-albumin are not reliable or effective factors for screening nutritional risks in the elderly.

Abstract:Objective To determine the clinical effects of glutamine (Gln) on central venous catheter-related blood stream infections (CRBSI) in the elderly patients with multiple organ dysfunction syndrome (MODS). Methods A total of 96 elderly patients with MODS and central venous catheters hospitalized in our intensive care unit (ICU) from January 2012 to December 2013 were recruited in this study. They were prospectively divided into 2 groups at random, Gln group and control group. The control group received conventional treatments for MODS, while the Gln group received these treatments plus glutamine treatment. The incidence of CRBSI was compared between the 2 groups. Results Compared with the control group, the Gln group had significantly lower incidence of CRBSI, and longer duration of catheter retention. Bacterial culture results indicated that the positivity rate of Gram-negative bacteria was significantly lower in Gln group than in control group, but there was no significant difference in Gram-positive bacteria and fungi between the 2 groups. Conclusion For the elderly MODS patients, fortified nutrition support with Gln significantly reduces the incidence of CRBSI, especially for Gram-negative bacterial infection, and extends the duration of catheter retention.

Abstract:Objective To investigate the association of endothelial lipase (EL) 584C/T polymorphism with essential hypertension (EH). Methods The EL 584C/T genotypes were detected using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis in 160 EH patients and 139 sex- and age-matched controls living in Changzhou region. Results The frequencies of the CC, CT and TT genotypes were respectively 56.3%, 42.5% and 1.1% in EH group, and 56.1%, 38.8% and 5.0% in control group, respectively. The frequency of T allele was 22.5% and 24.5% in EH and control groups, respectively. There was no significant difference between EH and control groups in genotypic and allelic frequencies. Logistic regression analysis showed that there was no significant correlation between the EL 584C/T gene polymorphism and EH after adjustment of traditional EH risk factors. There was no significant correlation between EL 584C/T genotypes and blood lipids levels. Conclusion There is no significant correlation of EL 584C/T polymorphism with Han nationality EH patients in Changzhou region.

Abstract:Objective To determine the serum concentrations of N-terminal pro-type (or brain) natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein (hs-CRP) and cystatin C (Cys-C) in the patients with reduced ejection fraction heart failure (HF-REF) or with preserved ejection fraction heart failure (HF-PEF) and investigate their relationship for clinical value. Methods A total of 106 outpatients with established diagnosis of heart failure (HF) in our department from November 2012 to May 2013 were prospectively subjected in this study. There were 58 cases of HF-REF (group A) and 48 cases of HF-PEF (group B). Blood samples were collected at their admission to determine the serum levels of NT-proBNP, Cys-C and hs-CRP, renal function, liver function, blood lipid, left ventricular ejection fraction (LVEF), etc. A cross-sectional study was performed in the above serum concentrations of NT-proBNP, hs-CRP and Cys-C between these 2 groups, and a correlation analysis was carried out on their heart failure indices. Results The serum levels of NT-proBNP and Cys-C were significanctly higher in the patients with HF-REF than in those with HF-PEF (both P＜0.05), but no significant difference was seen in the level of hs-CRP (P＞0.05). In patients with HF-REF, NT-proBNP was correlated with hs-CRP (r＝0.482，P＝0.009) and Cys-C (r＝0.450, P＝0.014), while hs-CRP was not correlated with Cys-C (r＝0.338, P＝0.079). In patients with HF-PEF, NT-pro BNP was only correlated significantly with Cys-C (r＝0.429, P＝0.041), but not with hs-CRP (r＝0.411, P＝0.051), while hs-CRP was correlated with Cys-C (r＝0.834, P＝0.000). Conclusion The serum concentrations of HF biomarker are different between HF-PEF and HF-REF patients. NT-pro BNP may be less useful in HF-PEF than in HF-REF.

Abstract:Objective To compare the outcome of ablation of atrial fibrillation (AF) between ganglionated plexi (GP) positive and negative and investigate the possible underlying mechanism. Methods Between September 2007 and May 2009, 209 patients (63 males and 146 females) with age of (53±10) (ranging from 24 to 77) years undergoing radiofrequency ablation for AF in our hospital were enrolled in this study. Intraoperative high-frequency stimulation showed that positive vagal reflex was seen in 103 patients and negative in 106 patients. Their average history of AF was (36±43) months. Preoperatively, 144 patients (68.9%) were in New York Heart Association (NYHA) functional class Ⅲ or Ⅳ. They were followed up for (18.9±9.0) (ranging from 6 to 34) months. Results There was no in-hospital death, and no significant difference in mortality or incidence of complications between the 2 groups during the postoperative or follow-up period. The Kaplan-Meier survival curve indicated that 60.8% of patients had freedom from AF, with a higher percentage in the patients with positive vagal reflex than those with negatives (68.2% vs 53.3%, P＝0.0004). Cox analyses identified positive vagal reflex as another predictor of late recurrence of AF besides left atrium size (Wald＝9.71, P＝0.002, 95% CI: 0.081 to 0.563]. ). Vagal reflex and left atrium size were 2 predictors affecting each other (Wald＝4.45, P＝0.035, 95% CI: 0.965 to 0.999). There were more patients with left atrial dimension ＞70mm in the patients with negative vagal reflex than in those with positives (48.1% vs 30.1%, P＝0.008). Conclusion Vagal reflex plays an important role in the maintenance of AF, and denervation will improve converting AF to a normal rhythm. Vagal reflex is another predictor of late recurrence of AF besides left atrium size, and is significantly correlated with the latter. The left atrium size is smaller in patients with positive vagal reflex than in those with negatives.

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Abstract:Colorectal cancer, with increasing prevalence year by year, is one of the most common encountered cancers with great threaten to people’s health. Recently, much evidence showed that the intestinal dysbacteriosis might play important roles in the pathogenesis of colorectal cancer through various various, including genetic changes in intestinal epithelial cells, inflammatory response of intestinal mucosa, and microenvironment disorder of intestinal tract. Many researches reported that some special microbiological species were found to be essential in the incidence of colorectal cancer, including Clostridium coccoides, Streptococcus bovis biotype I, Enterotoxigenic Bacteroides fragilis (ETBF), invasive Escherichia coli, human papillomavirus (HPV), and so on. In this paper, we reviewed the great significance and specific mechanisms of intestinal microbiota in the pathogenesis of colorectal cancer.

Abstract:How to treat chronic heart failure has always been a hot-point in the medical field. Medications are always the main measure in the treatment of heart failure to improve clinical symptoms and control the process. However, even though the new anti-heart failure drugs are created continuously, and the anti-heart failure therapy is gradually improved, the clinical observation found that heart failure is still having very poor prognosis, with a high prevalence. In recent years, studies showed that there is obvious association of repeated intermittent hypoxia in the whole night resulting from sleep disorder breathing disease (SDBD), with the cardiovascular diseases. The researches showed that SDBD complicated heart failure patients had significantly improved prognosis after SDBD was well controlled by noninvasive assisted ventilation. This article mainly reviewed the research progress in noninvasive assisted ventilation as a non-drug therapy for chronic heart failure.