Abstract:

Abstract:

Abstract:

Abstract:Due to organ dysfunction and comorbidity of chronic diseases, the elderly are more susceptible to multiple organ failure in the elderly (MOFE), under the circumstance of stimulus, such as acute exacerbation of lung infections and chronic diseases of heart, brain, kidney and other organs. Microcirculation disorder is currently considered not only as the most important underlying mechanism resulting in MOFE, but also as the core link of the process of concurrent MOFE. The modern viewpoint thinks that early microcirculation function monitoring and microcirculation as target for treatment have become new strategies for MOFE treatment in the elderly patients.

Abstract:Multiple organ dysfunction syndrome (MODS) is the most common cause of death for critically ill patients. Recently, remarkable progress has been made in the diagnosis and treatment of MODS, and early diagnosis and standard and high-quality life support therapy greatly improve the prognosis of patients with MODS. Nevertheless, patients’ condition is complex and variable clinically, and physicians are often required to make correct clinical decisions within a very short period of time. In fact, it is very important to establish a scientific and rational thinking for MODS, which could efficiently guide the appropriate diagnosis and treatment for the patients. Clinical physicians should strive to learn the dialectical thinking hardly and use it fully and flexibly in order to provide a rational thought for scientific clinical decision for the diagnosis and treatment of MODS.

Abstract:Objective To determine the correlation of serum uric acid (SUA) level with diabetic peripheral neuropathy (DPN) in the patients with type 2 diabetes mellitus (T2DM). Methods A total of 920 T2DM in- and out-patients in our department from March 2011 to March 2013 were enrolled in this cross-sectional study. Biochemical parameters, such as fasting blood glucose (FBG), glycosylated hemoglobin Alc (HbAlc), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and SUA were measured. DPN was diagnosed by neuropathy symptom score and neuropathy disability score. The subjects were stratified according to quartiles of SUA levels. Logistic regression analysis was used to analyze odds ratios between SUA and the prevalence of DPN. Results The adjusted logistic regression indicated that the level of SUA was a risk factor of DPN after 2nd quartile (＞3.5mg/dl); and with the increase in the level, its effect on prevalence of DPN from 2nd to 4th quartiles became more significant [OR=2.95 (2.02 to 8.76), 3.06 (1.75 to 6.45), and 4.15 (0.84 to 6.74), P＜0.05]. Conclusion Level of SUA is a risk factor for the prevalence of DNP in T2DM patients. In the clinical management of DPN, monitoring SUA should be one of important treatment in addition to controlling glucose and lowering blood pressure.

Abstract:Objective To determine the risk factors for peripheral arterial occlusive disease (PAOD) in the very old patients with hypertension. Methods Totally 121 very old hypertensive subjects with age over 80 years and systolic blood pressure ≥140mmHg admitted in our department from August 2012 to August 2013 were enrolled in this study. Their clinical data were collected. Lower extremity arteries ultrasonography and ambulatory 24-hour blood pressure monitoring were carried out. They were divided into PAOD group (n＝49) and non-PAOD group (n＝72) according to the results of lower extremity artery ultrasonography. Independent samples t-test, correlation analysis and logistic regression analysis were employed to analyze the risk factors. Results The morbidity of PAOD was 40.5% in the very old patients with hypertension. PAOD patients had significantly higher age, incidence of coronary heart disease (CHD), serum creatinine and glycosylated hemoglobin A1c (HbA1c) level (P＜0.05). Logistic regression analysis revealed that age, CHD, average day diastolic blood pressure (dDBP) and HbA1c were independent risk factors for PAOD (regression equation: PAOD＝-12.169＋0.131×age＋1.341×CHD -0.069×dDBP＋HbA1c×0.692). Conclusion The morbidity of PAOD is significantly higher in the very old patients with hypertension than in ordinary population. Age, CHD, dDBP and HbA1c are independent risk factors for PAOD.

Abstract:Objective To explore the heterogeneity of insulin sensitivity (IS) and the distribution of cardiovascular risk factors in the races of the Uygur and Han patients with coronary heart diseases (CHD) in Urumqi. Methods A total of 164 CHD patients (50 Uygurs and 114 Hans) hospitalized in the Autonomous Regional Hospital from 2001 to 2002 were recruited in this study. Another 71 healthy individuals (35 Uygurs and 36 Hans) served as normal controls. Oral glucose tolerance test (OGTT) and insulin release test were used to measure the concentrations of blood glucose and insulin before and after oral 75 g glucose in 0, 0.5, 1, 2 and 3h. The Homeostasis Model Assessment of Insulin Sensitivity (HOMA IS) was calculated by the HOMA model. Results The IS was significantly lower in the CHD patients than in the normal controls [the Uygurs: (204.02±180.43) vs (409.14±181.06); the Hans: (258.09±105.66) vs (479.09±200.97); P＜0.05]. The CHD patients also had higher morbidities of metabolic syndrome (the Uygurs: 54% vs 25.7%; the Hans: 66.7% vs 22.7%; P＜0.05) and of diabetes mellitus (the Uygurs: 52.0% vs 0.0%; the Hans: 64.0% vs 0.0%, P＜0.01) when compared with the normal controls. The CHD patients had significantly decreased 1h insulin and increased 2h glucose than the normal controls (P＜0.05). No significant difference was found in other indices between the CHD patients and normal controls. There was no difference in the morbidity of metabolic syndrome and IS between the 2 ethnics no matter for CHD patients or the normal controls. Significant differences were seen in the body mass [(78.06±12.69) vs (72.32±12.03)kg, P＜0.01] and body mass index [BMI(27.29±3.53) vs (25.61±3.42)kg/m2, P＜0.01] in the two ethnic patients with CHD. But no such difference was seen in the normal controls. Logistic regression analysis showed that alcohol drinking (OR=2.532), diabetes mellitus (OR=2.466), and hypertension (OR=2.355) had positive correlation with CHD (P＜0.05), and high-density lipoprotein cholesterol had negative correlation with CHD (P＜0.05). Conclusion Both Uygur and Han CHD patients in Urumqi have lower IS and higher morbidity of metabolic syndrome and diabetes mellitus. The Uygur CHD patients have higher prevalence of obesity. Alcohol drinking, diabetes mellitus, and hypertension are risk factors of CHD in the two ethnics in the Xinjiang Uygur Autonomous Region.

Abstract:Objective To evaluate the therapeutic effects of DL-3-n-butylphthalide (NBP) injection on acute cerebral infarction and its adverse reactions. Methods Seventy patients with acute cerebral infarction admitted in our hospital from September 2012 to November 2013 were randomly divided into standard treatment plus NBP (n＝35) and standard treatment (control, n＝35) groups. Before and in 14d after the treatment, the degree of neurological deficit was evaluated by National Institutes of Health Stroke Scale (NIHSS), daily living skills assessment were assessed by Barthel Index (BI) and modified Rankin Score (mRS), and adverse reactions were recorded. BI and mRS were also followed up in 90d after the treatment. Results In 14d after treatment, NIHSS were decreased in both NBP and control groups compared with pretreatment. The decrease in NIHSS was more significant in NBP group than in control group [NBP group: (13.60±4.26) vs (9.31±3.79); control group: (13.57±4.20) vs (11.23±4.06); P＝0.045]. No obvious change of BI was found in both 2 groups in 14 d after treatment. The BI at the follow-up of 90 d was significantly higher in NBP group than in control group [(NBP group: (54.57±24.17) vs (77.86±21.46); control group: (54.14±23.81) vs (67.0±23.30); P＝0.047)]. There was no significant change in mRS in both 2 groups after treatment for 14d. In 90d after the treatment, the decrease in mRS was more significant in NBP group than in control group [NBP group: (3.40±0.81) vs (2.80±0.96); control group: (3.49±0.82) vs (3.29±0.93); P＝0.035]. The incidence of adverse reactions was identical between the 2 groups. Conclusion NBP injection obviously improves neurological deficit resulting from acute cerebral infarction, and also improves 90-day outcome with sound safety.

Abstract:Objective To investigate the correlation of high homocysteine (Hcy) hypertension (H-type hypertension) with serum levels of uric acid (UA) and fibrinogen (FIB) in the elderly. Methods A total of 251 elderly in- and out-patients with essential hypertension admitted in our department from January 2013 to January 2014 were recruited in this study. They were divided into H-type hypertension group [n＝121, serum Hcy level ≥15μmol/L] and primary hypertension group (n＝130, serum Hcy level＜15μmol/L). Another 150 elderly individuals without hypertension taking physical examination in our hospital during same period served as controls. Serum levels of Hcy, UA and FIB were detected in all the patients, and the results were compared among different groups. Results For the H-type hypertension, primary hypertension and control groups, there were statistical differences in the levels of UA [(320.97±106.61), (280.74±71.27) and (261.01±71.80μmol/L)] and FIB [(3.22±0.52), (3.05±0.52) and (2.68±0.41)g/L] between any of the 2 groups (P＜0.01). Logistic regression analysis showed that H-type hypertension was positively correlated with the serum level of UA (OR＝3.896) and FIB (OR＝3.100) and with the reduced level of folic acid (OR＝2.776, all P＜0.05). Conclusion H-type hypertension is closely associated with UA and FIB. Monitoring their levels is of great significance in the management of H-type hypertension in the elderly.

Abstract:Objective To estimate the efficacy and safety of percutaneous coronary intervention (PCI) on the very old patients with acute myocardial infarction (AMI). Methods A retrospective analysis was carried out on 78 very old patients (≥80 years old) with AMI in our hospital in recent 5 years. Of them, 40 patients underwent PCI therapy and 38 patients received conservative drug treatment. The general clinical data, and clinical therapy efficacy during hospitalization and in 6 months of follow-up were collected and analyzed in 2 groups. Results Compared with the conservative drug treatment group, the relief rate of myocardial infarction symptoms was significantly increased (52.63% vs 75.00%, P＜0.05) and the incidence of heart failure during hospitalization was significantly decreased (39.47% vs 15.00%, P＜0.05) in PCI group. Moreover, the incidence of recurrence angina (42.86% vs 18.42%) and myocardial infarction (22.86% vs 5.26%) in 6 months after discharge were significantly decreased (P＜0.05), and cardiovascular events and sudden death were also reduced in PCI group compared with conservative drug treatment group (25.71% vs 10.52%, P＝0.09). Conclusion PCI therapy greatly improves the clinical symptoms and prognosis, and the quality of life in the very old patients with AMI. Therefore, PCI is a safe and effective treatment for the very old patients with AMI.

Abstract:Objective To evaluate the significance of Bedside Index for Severity of Acute Pancreatitis (BISAP) in the prediction of the severity and prognosis of acute pancreatitis (AP) in the elderly patients. Methods A total of 96 elderly patients with AP, admitted into Beijing Geriatric Hospital from Jan 2010 to Jun 2013 were recruited in this study. BISAP was used to predict the severity and prognosis of AP, and the results were compared with the results by Ranson’s criteria. Results Among the 96 patients, 63 patients were identified as mild AP, and 33 as moderate and severe AP. There was no significant difference in predicting the severity and prognosis of AP between BISAP and Ranson scores. BISAP had relatively high sensitivity in the prediction of moderate and severe AP. BISAP score had positive correlation with C reactive protein and blood glucose, and had negative correlation with serum calcium and albumin. Conclusion BISAP Score is a simple and practicable scoring system, and has significant value in predicting the severity and prognosis of AP in the elderly.

Abstract:Objective To investigate the alteration of central aortic systolic pressure (CASP) and vascular function in the patients with complicated hypertension. Methods A total of 344 volunteers undergoing noninvasive arterial pressure detection in the Department of Geriatrics of Ruijin Hospital from October 2009 to March 2013 were recruited in this study. They were divided into 3 groups: the normal control group (n＝124), controlled hypertension group (n＝67) and complicated hypertension group (n＝153). CASP, radial artery augmentation index of reflected wave (RAI), and peak relative time (PRT) were measured non-invasively by radial artery applanation tonometry BPro? (A-PULSE CASP? and corresponding software). Results CASP in the complicated hypertension patients whose blood pressure well-controlled was higher than that in the normal control group (P＜0.01), and had no significant difference with that of controlled hypertension group. There was no difference in vascular function between the 2 groups. For the complicated hypertension patients, CASP was significantly lower in those with well-controlled blood pressure than in those without (P＜0.01). Conclusion Well controlling blood pressure in the patients with complicated hypertension is helpful to reduce the CASP and improve the vascular function. And, monitoring CASP and vascular function can be used to predict clinical prognosis of blood pressure control.

Abstract:Objective To determine the effect of aldehyde dehydrogenase 2 (ALDH2) activation on the cardioprotection of ischemic preconditioning (IPC) in the elderly mice, and analyze the possible mechanism on aging-related IPC cardioprotection decline by investigating the difference of silent information regulator related enzyme 1 (SIRT1) activity during the IPC process between the adult and aged mice. Methods Male C57BL/6 adult (2 months old) and aged (20 months old) mice (6 in each group) were subjected to IPC (left anterior descending coronary artery was occluded for 3×5min, interspersed with 5min of reperfusion) and followed by ischemia/reperfusion (I/R, 30min ischemia/4h reperfusion) injury. Hearts from aged C57BL/6 mice were Langendorff-perfused and subjected to in vitro IPC and I/R injury for cardiac function recording. At the end of reperfusion, ALDH2 and SIRT1 activity and protein carbonylation in the myocardial tissue in vivo and in vitro were measured. Results Compared with the adult hearts, IPC treatment failed to decrease I/R injury nor increase SIRT1 activity in the aged myocardium (P＜0.05). A significant decrease in ALDH2 activity was observed in the aged hearts (P＜0.05), which then resulted in enhanced carbonyl stress in I/R aged hearts (P＜0.05). Also, IPC treatment failed to improve ALDH2 activity nor decrease carbonyl stress in the aged myocardium (P＜0.05). ALDH2 Activation inhibited the carbonylation level and restored the IPC-induced SIRT1 activation in aged hearts (P＜0.05), which further promoted the recovery of systolic and diastolic function after I/R injury in aged hearts. Conclusion Activating myocardial ALDH2 significantly improves the cardioprotection of IPC in aged hearts, which might be due to SIRT1 inactivation induced by suppressing carbonyl stress.

Abstract:Objective To investigate whether ischemic post-conditioning (IPost) can ameliorate acute myocardial ischemia/reperfusion (I/R) injury in senescent rats and to compare the cardioprotective effects of ischemic post-conditioning between aged and adult rats. Methods A total of 32 male F344 rats were divided into adult (6 to 8 months) group and aged (18 to 20 months) group. After the rats were subjected to 30min ischemia by ligating the left anterior descending coronary artery (LAD), their hearts from each group were further randomized to receive standard, abrupt reperfusion (I/R group), or were post-conditioned with 4 cycles of 10s ischemia interspersed by 10s reperfusion immediately at the end of the ischemia (IPost group). Hemodynamic changes, such as mean arterial pressure (MAP) and rate-pressure product (RPP), and electrocardiogram (ECG) were recorded. Infarct size was measured by Evans blue and triphenyltetrazolium chloride (TTC) staining. At 120min of reperfusion, serum levels of creatine kinase (CK) and lactate dehydrogenase (LDH) were assayed. Results After 2 hours reperfusion, MAP and RPP were significantly higher in IPost group than in the corresponding I/R group for adult rats (P＜0.05). However, no significance was achieved in aged rats (P＞0.05). During the first 30min reperfusion, in adult rats, the arrhythmia scores were 1.0 and 3.5 respectively for the IPost group and I/R group with significant difference (P＜0.05). However, in aged rats, the arrhythmia scores were 2.0 and 3.0 for the IPost group and I/R group, but without significant difference (P＞0.05). Post obviously decreased the infarct size in the IPost group than in corresponding I/R group in both adult (by 52%) and aged cohorts (by 44%; P＜0.05 for both). The serum levels of CK and LDH were markedly lower in IPost group than in I/R group from both adult and aged rats (P＜0.05 for both). Conclusion IPost, as same powerful as to adult rats, reduces infarct size and decreases the release of myocardial enzymes in aged rats. What’s more, the post-conditioning attenuates myocardial stunning and reperfusion arrhythmia in adult rats, but these effects are not seen in the aged rats.

Abstract:Objective To observe the ultrastructure change of the brain tissues in the rats with hepatic encephalopathy and determine the in vitro effect of ammonia on the ultrastructure of rat neurons in order to investigate the pathological mechanism of these changes. Methods Twelve healthy male SD rats were randomly divided into two groups: hepatic encephalopathy group and normal control group (with six in each group). Transmission electron microscopy was employed to observe the ultrastructure of the brain tissues in rats with hepatic encephalopathy induced by thioacetamide and of in vitro cultured rat neurons induced by ammonia. Results In rats with hepatic encephalopathy, the neurons were reduced in number, with swollen mitochondria, significantly decreased Nissl body quantity, and arrested in each stage of apoptosis. While, the cell organelles in glial were also decreased, and the ultrastructure changes were more serious in the nigra than in the basal nuclei. For in vitro injured rat neurons induced by ammonia, the neurons were decreased in number, with edema, swollen mitochondria, and significantly reduced Nissl body quantity, and displayed apoptosis at each stage. Conclusion Obvious changes are seen in the ultrastructure of nervous cells in rats with hepatic encephalopathy and in vitro injured neurons, which might be associated with neuron apoptosis caused by ammonia.

Abstract:

Abstract:We successfully rescued a patient suffering from extensive anterior wall ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock on the basis of diabetes mellitus. The initial symptom at onset was persistent chest pain, followed by blood pressure decline and profuse sweating soon after. Extensive anterior wall STEMI was confirmed by electrocardiography (ECG), myocardial enzymes test and coronary angiography. During the therapeutic process, he was found complicating with acute left ventricular failure, severe pneumonia, lactic acidosis and diabetic ketoaeidosis. Left anterior descending branch was reopened by emergency percutaneous coronary intervention (PCI). Intra aortic balloon pump (IABP) and noninvasive ventilator were employed for life support. Heart failure attacked repeatedly and pneumonia was protracted. Finally the patient got better and discharged after 41 days’ therapy in the coronary care unit.

Abstract:Surgery has been accepted as a new approach for the treatment of type 2 diabetes mellitus (T2DM). At present, gastric bypass is the high-profile operation method and gradually applied clinically. It showed significant effect in the treatment of T2DM, especially for the T2DM patients accompanied with obesity and even achieve the purpose to control blood glucose and its complications. However, the underlying mechanism of gastric bypass in treating T2DM is quite complex, including the changes in gastrointestinal hormones, the action of fat factor, bile acid metabolism, etc.

Abstract:Aspiration is defined as the abnormal process of inhalations through the throat of saliva, nasopharyngeal secretions, bacteria, foods and so on, and is a usual troublesome for the elderly in clinical practice. Complications resulting from aspiration, such as asphyxia and pneumonia, are common causes of death in the elderly. As the population aging, the incidence of aspiration in the elderly is increased. So, with the aim at effectively preventing and treating aspiration in the elderly, we analyzed its risk factors and reviewed its clinical management for diagnosis and treatments.

Abstract:Sarcopenia, also known as age-related sarcopenia, is defined as a degenerative syndrome characterized by progressive and generalized loss of skeletal muscle mass, strength and function. Sarcopenia involves complex mechanisms, including exercise lacking, neuromuscular function decline and motor unit restructuring, declining in adequate protein intake and synthesis, changing in hormone levels, expansion of fat tissue and chronic inflammation, apoptosis, skeletal muscle mitochondrial dysfunction, and different genes and ethnics, et al. Further study on the mechanisms of sarcopenia is of great significance in the prevention and treatment of geriatric sarcopenia.