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Abstract:Heart failure (HF) is a common and major disease in the elderly, in whom, the structures and functions of cardiac and other systems are degraded, and the cardiac reserve capacity is decreased. So, they are susceptible to hypertension, coronary heart diseases and other cardiovascular diseases and commonly accompanied with multi-organ diseases. When they suffer from infection, myocardial ischemia or other inducing factors, they are prone to HF. Because of the complicated, various and even atypical clinical signs and symptoms, the HF is easily misdiagnosed or missed in the elderly. It is of great importance to make a timely and accurate diagnosis and treatment. Comprehensive treatment measures should be carried out for the elderly with HF and be based on personalized therapeutic principle. It is necessary to strengthen the guidance of treatment and management, to relieve the symptoms, and improve quality of life and prognosis in the involved ones.

Abstract:Objective To analyze the etiological changes in the elderly hospitalized patients with heart failure (HF) and investigate the strategies to prevent and treat HF. Methods A retrospective study was performed on 6 288 patients (4 001 males and 2 287 females) with a primary diagnosis of validated HF who were consecutively admitted to our hospital during the years of 1993 to 2010. The patients were divided into groups A, B and C with 6 years as interval. The etiological features and 30-day in-hospital mortality were compared in different genders and ages from the above 3 groups. Results During the period of 18 years, the number of the inpatients was increased year by year, with the proportion of women increased and men decreased, and the percentage of age 60 to 69 years old declined and over 80 years old risen. Of the 6 288 patients, the proportion of accompanied hypertension and diabetes was increased, but that with coronary artery diseases, prior myocardial infarction and cor pulmonale decreased. There was no significant change in the proportions of acute myocardial infarction, rheumatic heart disease, congenital heart disease, anemia and hyperthyroid heart disease. In the inducing factors, the rate of pneumonia and atrial fibrillation was increased, but the rate of ventricular tachycardia and ventricular fibrillation reduced. The ratio of double, triple or more etiological factors was increased with aging, but there was no significant difference over the 3 different periods. The 30-day in-hospital mortality was decreased gradually, especially in males (P＜0.01). Conclusion During the 18 years, the proportions of patients with hypertension and diabetes as etiological factors are increased significantly, but those of coronary artery disease and cor pulmonale are decreased obviously, and those of pneumonia and atrial fibrillation risen in the elderly patients with heart failure at first hospitalization. There is a significant decline in the 30-day in-hospital mortality among the cohort. The reasons of these findings are worth of further study.

Abstract:Heart failure (HF) is one of the most common cardiovascular diseases in the elderly. The article reviewed the pathophysiological mechanisms of HF in the elderly, revealed the roles of excessive sympathetic activation and energy metabolic remodeling in the development of HF, and evaluated the efficacy of renal denervation, and drugs such as trimetazidine and coenzyme Q10. Meanwhile, we also introduced the roles of pulmonary artery hypertension, ventricular-arterial coupling stiffness and systemic inflammation in the development and progress of HF with preserved ejection fraction.

Abstract:With the increasing elderly population, geriatrics becomes more and more important. Unlike the young, geriatric syndromes exert major impacts on living quality and life expectance for the aged. We reviewed the common signs and symptoms of some geriatric syndromes (frailty, cognitive impairment, and depressive condition), introduced their assessments and elucidated the correlation of these major geriatric conditions with prognosis of heart failure.

Abstract:Heart failure (HF) is a common cardiovascular disease with higher morbidity and mortality in the aged population. Since the elderly have their own characteristics in the clinical manifestations and therapeutic measures of the disease, special attention should be paid to its clinical diagnosis and management. Generally speaking, ischemic cardiac disease and hypertension are the major causes of HF in the elderly. Because the HF in the elderly is often associated with multi-system, multi-organ diseases, its clinical symptoms are atypical, easily concealed by other clinical situations. With the aid of echocardiography and measurement of NT-proBNP, we can establish a diagnosis. The principles of HF treatment in the elderly are still to control clinical symptoms and improve the quality of life and prognosis. In clinical practice, medication should be modulated according to the specific conditions for each individual, taking the cause of HF, co-morbidities and overall functional status into consideration.

Abstract:With the increase of in aging population, the prevalence of diastolic heart failure (DHF) is gradually increased, and is a serious threat to the life of the elderly. The current diagnostic methods have certain limitations to the diagnosis of DHF, and its diagnostic criteria are not identical in the heart failure guidelines from different countries. What’s more, the existing therapeutic regime can not alter the natural course of DHF and improve its prognosis. Therefore, DHF becomes the a research focus. The This article aimed to introduce the new progress in the pathogenesis, diagnosis and treatment of DHF.

Abstract:The principles of the treatment for the elderly heart failure patients are as follows: (1) multimodality treatment, including correcting its causes and predisposing causes, relieving its symptoms, maintaining the stabilization of the hemodynamic and internal environment, and treating other clinical complications comprehensively; (2) individualized therapy, that is, taking individualized treatment regimen according to his/her own specific condition; (3) management in patient’s daily life and medical treatment.

Abstract:Heart failure (HF) is a terminal stage of various organic heart diseases and has relatively high mortality and morbidity. But, there are few interventions effectively improving its long-term outcomes during or soon after hospitalization. Recent studies showed that nonpharmacologic electrophysiology-based interventions have significant effect on chronic HF. Therefore, future studies should focus on the underlying mechanisms of electrophysiological interventions, clarify these nonpharmacologic methods, and investigate the possible adverse effects in order to explore more effective approaches for the treatment of chronic HF in the elderly.

Abstract:Objective To determine the risk factors for heart failure with preserved ejection fraction (HFpEF) in the elderly by retrospectively analyzing their clinical features and echocardiographic parameters of HFpEF patients and comparing with those of non-heart failure patients with asymptomatic diastolic dysfunction. Methods A total of 234 consecutive patients (≥60 years old) admitted in our department from December 2011 to December 2012 were enrolled in this study. They were divided into asymptomatic left ventricular diastolic dysfunction group (ADD group, n＝104) and HFpEF group (n＝130). Risk factors of HFpEF were analyzed by logistic regression. Results Compared with ADD group, the patients in HFpEF group were older and had a lower estimated glomerular filtration rate (eGFR) (P＜0.05). Logistic regression analysis indicated that coronary artery disease(CAD), hypertension, and chronic obstructive pulmonary disease (COPD) were independent risk factors of HFpEF (P＝0.001, 0.031, 0.003, respectively). Conclusion CAD, hypertension and COPD are associated with HFpEF in this cohort.

Abstract:Objective To investigate the relationship of one-hour postload plasma glucose (1h-PG) levels with atherosclerotic risk factors and metabolic syndrome (MS) between pre-menopause and post-menopause in a group of nondiabetic population, and to determine the possible cut point of 1h-PG for MS in postmenopausal women. Methods A cross-sectional study was performed in our hospital during August to October 2013, and the women (aged from 30 to 70 years) who were in hospital for routine check-up at the Medical Examination Center were enrolled. All subjects underwent laboratory examinations of oral glucose tolerance test (OGTT), lipid, and anthropometric measurements (height, body mass and waistline). Diabetes were excluded according to the results of OGTT. According to their menstrual status, the subjects were divided into 2 groups: premenopausal group (n＝143) and postmenopausal group (n=145). MS was defined according to the International Diabetes Federation (IDF) criteria. The relationship of 1h-PG and MS of women in different stage of menopause was analyzed, and the cut point of 1h-PG for MS in postmenopausal women was determined. Results (1) Triglycerides, total cholesterol, low density lipoprotein cholesterol, systolic and diastolic blood pressure were significantly higher in postmenopausal group than in premenopausal group (P＜0.05). (2) Subjects in postmenopausal group had higher plasma glucose and insulin levels in each time point of OGTT accordingly when compared with premenopausal group (P＜0.05). Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) was also significantly higher in the former group (P＜0.05). (3) The incidence of MS was 13.39% (22/143) in premenopausal group and 32.40% (47/145) in postmenopausal group, with significant difference between the 2 groups (Chi-square＝11.46, P＝0.01). (4) The logistic regression analysis for MS showed that MS was significantly associated with 1h-PG (OR＝1.849, 95% CI＝1.557?2.195, P＜0.001). (5) When the cut-off value of 1h-PG was defined at 8.70mmol/L, the sensitivity of 1h-PG for predicting MS was 87.50%, the specificity was 81.44%, the area under the receiver operating characteristic curve (ROC) was 0.907, and Youden index was 0.689 in post-menopausal group. Conclusion MS is closely related to 1h-PG in both pre-menopausal and post-menopausal nondiabetic women. When the cut point of 1h-PG is 8.70mmol/L, it is a selectable marker to predict MS in postmenopausal woman, and represents useful in clinical practice for early intervention or treatment.

Abstract:Objective To describe the profile of pulse pressure difference and its relevant factors in the elderly with hypertensive patients. Methods From May to June 2013, a household survey was carried out for retired military cadres with hypertension who were under the health support system of our hospital. Their blood pressure, heart rate, height and body mass index (BMI) were measured and calculated, and their general information, living styles and other relevant information were collected. The SPSS 19.0 software was used to process and analyze the data. Results Among the 102 elderly hypertensive patients enrolled in this study, their age ranged from 78 to 92 (84.6±3.14) years, and their pulse pressure difference ranged from 40 to 92 (62.86±10.01)mmHg. Univariate analysis showed that age, BMI, abdominal obesity, hypertension course, hypertension risk stratification, and duration of taking antihypertensives were significantly correlated with pulse pressure difference (P＜0.05). Multiple stepwise regression analysis indicated that hypertension risk stratification, hypertension course, age and BMI were related to pulse pressure difference (P＜0.001). Conclusion For the elderly hypertensive patients, the hypertension risk stratification, hypertension course, age and BMI are the main impact factors on pulse pressure difference.

Abstract:Objective To investigate the prevalence of diabetes mellitus and the characteristics of their comorbidities among the elderly hospitalized patients in order to supply epidemiological and clinical data. Methods The clinical data about the information on the first page of medical records of 22 374 elderly inpatients in Beijing Friendship Hospital during the past 5 years were reviewed and statistically analyzed. Results The prevalence of diabetes mellitus was 22.07% for the patients with the age younger than 60 years, while, with the growing of age, the prevalence was increased by 0.89% every 5 years. Thus, the total prevalence of diabetes mellitus of the cohort was increased up to 29%. The most common comorbidities of the cohort were hypertension, cardiovascular disease, cerebrovascular disease and hyperlipemia. Conclusion The prevalence of diabetes mellitus is obviously higher in the elderly than in non-elderly patients. Clinicians should pay more attention to the screening and prevention of common comorbidities in the elderly diabetic population.

Abstract:Objective To evaluate the nephrotoxic effects of domestic iodixanol injection in the elderly patients with coronary heart disease (CHD). Methods A multicenter, single blind, randomized controlled clinic trial was prospectively carried out in 5 hospitals in Liaoning Province from July 2013 to March 2014. Eighty-eight patients of 60 to 75 years old with CHD undergoing percutaneous coronary intervention (PCI) were divided into 2 groups: experimental group (domestic iodixanol injection group, n＝44) and control group [Visipaque (trade name of iodixanol) group, n＝44]. The clinical information including age, gender, body mass index (BMI), serum creatinine (SCr) and blood urea nitrogen (BUN) was recorded before PCI. Their SCr and BUN were determined in 48 h after PCI for renal function in the patients of the 2 groups. Results All of them underwent PCI smoothly, with a successful rate of 100%. There was no significant difference in the age, gender, BMI, SCr and BUN between the 2 groups before PCI (P＞0.05). No difference was found in the renal function in the 2 groups before and after PCI (P＞0.05). One patient of each group had nausea and vomiting respectively just in the day after operation, and recovered on the next day. None of patient had contrast-induced acute kidney injury or other adverse reactions. Conclusion Domestic iodixanol injection is safe for old patients with CHD underwent PCI.

Abstract:Objective To determine the efficacy of comprehensive geriatric assessment combined with psychiatric consultation on the recognition of mood disorders in general hospitals. Methods Elderly inpatients (over 65 years old) admitted to a geriatrics ward in a class AAA general hospital from August 2011 to March 2013 were assessed with comprehensive geriatric assessment [Zung’s Self-rated Depression Scale (SDS) and Geriatric Depression Scale (GDS) -15) at admission. Geriatric interdisciplinary team services and psychiatric consultation were offered when it was necessary. Mood disorders were diagnosed by a psychiatrist according to International Classification of Diseases-10 (ICD-10) criteria. Results Two hundreds and eighty-one patients over 65 years were enrolled during the study. They were 136 males and 145 females, with a mean age of (75.2±6.8) years. Forty-nine out of them were identified with mood disorders (the point prevalence of mood disorders was 17.4%), including 16 males and 33 females, with a mean age of (73.5±6.0) years. Among these 49 patients, 39 were depressive episodes, 5 dysthymic disorders, 2 bipolar disorders, 2 recurrent depressive disorders, and 1 depression disorder not otherwise specified (NOS). For these patients, the primary reasons asking for psychiatric consultation were relevant illness history in 7 patients, abnormal emotion recognized by the doctors in 23 patients, sleep problems in 2 patients, medical unexplained symptoms in 5 patients, and positive results in depression screening scales in 12 patients. Conclusion Mood disorders are very common mental disease in the elderly inpatients. Combining comprehensive geriatric assessment and psychiatric consultation is very efficient in the recognition of mood disorders in the elderly, which is a service model worthy of being popularization in more general hospital settings for geriatric psychological medicine.

Abstract:目的 观察人参皂苷Rg1对阿尔茨海默病（AD）大鼠脑片模型中磷酸化tau蛋白（P-tau）及钙调神经磷酸酶（CaN）表达的影响，探讨人参皂苷Rg1是否通过上调CaN表达从而抑制AD模型大鼠脑片tau蛋白磷酸化。方法 制备5周龄雄性SD大鼠脑片（含皮质和海马），随机分为4组：对照组、模型组和人参皂苷Rg1组，人参皂苷Rg1＋他克莫司（FK506）（一种CaN抑制剂）组，每组10张脑片。各组脑片首先置于人工脑脊液中孵育1h，之后人参皂苷Rg1组和人参皂苷Rg1＋FK506组分别加入人参皂苷Rg1作用2h，然后除对照组外的各组分别加入冈田酸作用3h。干预结束后脑片经多聚甲醛固定后做冰冻切片，采用免疫组织化学染色、图像分析技术等方法检测各组大鼠脑片P-tau、CaN的表达水平。结果 与对照组比较，模型组各脑区P-tau表达水平增加（P＜0.05），CaN表达水平减少（P＜0.05）；与模型组比较，人参皂苷Rg1组各脑区P-tau表达水平减少（P＜0.05），CaN表达水平增加（P＜0.05）；与人参皂苷Rg1组比较，人参皂苷Rg1＋FK506组P-tau表达水平增加（P＜0.05），CaN表达水平减少（P＜0.05）。结论 人参皂苷Rg1可能通过上调CaN蛋白表达途径抑制AD大鼠脑片模型tau蛋白磷酸化，从而发挥抗痴呆作用。

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Abstract:Chronic obstructive pulmonary disease (COPD), characterized by high prevalence, high morbidity and mortality, mainly involves the lungs, but also causes systemic adverse reactions, and osteoporosis is one of the common extra-pulmonary manifestation. In recent years, the prevalence of COPD combined with osteoporosis is increased significantly, and osteoporosis becomes one of the important factors of disability and death in COPD patients. In order to explore the relationship between the COPD and osteoporosis, in this paper, we focused on the new progress in the research of COPD-related aspects of osteoporosis so as to have a comprehensive understanding of its inducing factors, prevention and treatment.

Abstract:Vaspin is found predominantly from visceral adipose tissue in a rat model of type 2 diabetes mellitus, and is identified as an adipokine with insulin-sensitizing and insulin resistance improving roles. The present evidence not only confirmed a positive association of vaspin with obesity and diabetes, but also demonstrated the association with arteriosclerosis and osteoporosis. In recent years, there were more and more researches on vaspin. In this article, we reviewed recent research progress on vaspin.

Abstract:Stroke is the most common causes of disability and death. Statistical data showed that 2.5 million women and 3 million men died of stroke annually, and in some countries, stroke mortality might be doubled in 2030. So, effective prevention of stroke will significantly reduce medical cost and improve the life quality of the survival. In recent years, evidence found that dairy products are of certain significance to reduce the incidence of stroke. This article reviewed the role of dairy products in the primary prevention of stroke based on the classification of the products, stroke-related epidemiological investigation and mechanisms of various ingredients of the products in reducing the risk of stroke.