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Abstract:Objective To investigate the relationships between the cytochrome 2C19 gene (CYP2C19) loss-of-function (LOF) allele with clopidogrel platelet reactivity and cardiovascular end point events in the elderly patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). Methods Over-65-year-old consecutive CHD patients who accepted selective PCI in our department from September 1, 2011 to December 1, 2012 were recruited in this study. They were given clopidogrel loading dose therapy before PCI, and their peripheral blood samples were collected on the day of PCI to detect platelet aggregation. The candidate genetic variants, CYP2C19*2 and *3 LOF alleles, were determined by using SNaPshot assay, and the results were recorded in the clinical data. All patients received maintenance dose of aspirin and clopidogrel during 1 year’s follow-up after PCI, and the major adverse cardiovascular events were observed in this period. Results A total of 436 elderly CHD patients were recruited. Significant difference of platelet reactivity was found between CYP2C19*2 carriers and non-carriers (P＝0.001), but not for CYP2C19*3 (P＝0.884). The patients carrying CYP2C19*2 allele or at least one CYP2C19 LOF allele had significantly higher incidence of cardiovascular end point events than those non-carriers (P＜0.05). Compared with non-carriers, the risk of rehospitalization for angina was significantly higher in the CYP2C19*2 allele carriers [adjusted odds ratio (OR): 1.67, 95% confidence interval (CI): 1.05?2.65, P＝0.010]. What’s more, the risk of combined cardiovascular events (adjusted OR: 1.22, 95% CI: 1.03?1.98, P＝0.049) and the incidence of rehospitalization for angina (adjusted OR: 1.67, 95% CI: 1.04?2.68, P＝0.032) were significantly higher in the CYP2C19 LOF allele carriers than in non-carriers. Conclusion CYP2C19 LOF alleles are closely related to the platelet reactivity of clopidorgrel in the elderly CHD patients after PCI. The genetic variants significantly weakens the effect of antiplatelet therapy of clopidogrel, and thus significantly increases the risk of cardiovascular end point events after PCI.

Abstract:Objective To compare the outcomes between direct percutaneous coronary intervention (PCI) and PCI after intravenous thrombolysis in the elderly patients suffering from acute ST-segment elevation myocardial infarction (STEMI). Methods Fifty-three elderly patients with STEMI occurring within 12h and without any contraindications of thrombolysis hospitalized in our department during October 2011 and January 2012 were enrolled into this study and retrospectively analyzed. They were divided into 2 groups according to the intervention they received, that is, thrombolysis＋PCI group (group A, n＝23) and direct PCI group (group B, n＝30). The clinical outcomes were compared between the 2 groups. Results The percentage of Thrombolysis in Myocardial Infarction (TIMI) flow at grades 2 to 3 in infarction related artery (IRA) was 69.6% in group A (16 cases), which was significantly higher than that in group B (14.3%, 4 cases, P＜0.01). There was no significant difference in the successful rate of stent implantation in infarction related artery (IRA) between the 2 groups (82.6% vs 90.0%, P＝0.431). No severe hemorrhage complication was observed in both groups during the hospitalization. Left ventricular ejection fraction (LVEF) after intervention was significantly higher in group A than in group B [(56.8±1.12)% vs (51.7±1.00)%, P＝0.001]. Conclusion When compared with direct PCI, intravenous thrombolysis combined with PCI has the advantages of higher rate of early recanalization of IRA but not increasing related hemorrhage risk in the treatment of the elderly STEMI patients, and exerts certain effects on the restoration of blood flow in IRA as early as possible and on the protection of contractile function of left ventricule.

Abstract:Objective To assess the efficacy and safety of combined application of tirofiban with percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS) patients at different ages in perioperative period. Methods A retrospective study was carried out for consecutive ACS patients receiving low-dose tirofiban in perioperative period and undergoing PCI and drug-eluting stents (DES) implantation in our department from Jan. 2011 to Dec. 2012. A total of 302 patients (207 males and 95 females) were recruited in this study, and were divided into 2 groups according to their ages: the elderly group (≥65 years, n＝155) and the young and middle aged group(age＜65 years, n＝147). The incidences of primary and secondary end points of a major cardiovascular event were compared between the 2 groups within 30 d after the PCI. Multiple logistic regression analysis was used to analyze the risk factors for the endpoints. Results (1) Among the 302 patients, the incidence of primary end points was significantly higher in the elderly group than in the young and middle aged group [26(16.7%) vs 7(4.8%), P＝0.001]. (2) No serious acute intracranial bleeding occurred in the 2 groups. Each group had 1 case of gastrointestinal bleeding [1(0.7%) vs 1(0.6%), P＝1.000]. While, there were 24 patients (15.5%) having minimal bleeding events from the elderly group and 6 patients (4.2%) from the young and middle aged group (P＝0. 001). (3) Multiple logistic regression analysis indicated that aged over 65 years, female, history of smoking, diabetes mellitus, hyperlipidemia, and prior history of PCI were the independent risk factors of the primary end points in both groups during the 30-day follow-up. (4) Female, history of smoking, and diabetes mellitus were positively correlated with bleeding complications, while aging, hyperlipidemia, and prior history of PCI were not the independent predictive factors of bleeding events. Conclusion Combined application of tirofiban in perioperative period of PCI results in significant increases in the incidences of primary end points and minimal bleeding events in the elderly than in the young and middle aged patients, which suggests that the antiplatelet medication of tirofiban should be prudently conducted for the elderly.

Abstract:目的 应用国家早期预警评分（NEWS）系统对老年急危重症患者急诊病情进行评估，评价NEWS对老年患者病情的评估作用。方法 对我院急诊抢救室收治的361例≥60岁老年急危重患者进行NEWS评分，跟踪患者24h内病情变化、急诊转归停留期以及预后，绘制受试者工作特征（ROC）曲线，寻找最佳截点。以最佳截点为界分为低分组和高分组，比较两组间24h内病情变化、入住监护病房和急诊停留期间死亡，以及30d内死亡的发生率。结果 NEWS可预测患者24h内病情变化、急诊转归、预后的ROC曲线下面积（AUC）分别为（0.776±0.043），（0.970±0.011），（0.861±0.039），最佳截断点分别为7分，6分，8分。以6分为最佳截断点，分为高分组与低分组，比较两组之间24h内病情变化、入住监护病房和急诊停留期间死亡，以及30d内死亡的发生率，差异有统计学意义（P＜0.01）。结论 NEWS能有效评估老年急危重症患者病情。

Abstract:Objective To investigate the relationship of admission hyperglycemia with changes in infarct volume and in-hospital outcome (within 1 week after onset) in the elderly patients with acute ischemic stroke after the treatment of recombinant tissue plasminogen activator (rt-PA). Methods All consecutive elderly patients suffering from acute ischemic stroke and treated with rt-PA within 3h after onset in our hospital from 2010 to 2013 were enrolled in the study. They were divided into hyperglycemic group and normoglycemic group according to their blood glucose levels at admission. The recanalization and infarct volume at different time points after onset were evaluated with magnetic resonance scanning. The National Institute of Health Stroke Scale (NIHSS) scores of different time points were also evaluated and compared between the 2 groups. Results There were totally 44 patients enrolled in the study, and 24 of them had admission hyperglycemia. There was no difference in initial infarct volume between the normoglycemic and hyperglycemic groups [(29.5±56.2) vs (28.3±61.7), P＝0.90]. However, hyperglycemic patients had higher admission NIHSS scores [(17.7±6.6) vs (12.9±6.3), P＜0.01]. No difference was seen in the recanalization and hemorrhage rate between the 2 groups at 24h after onset. In 24h and 7d after onset, hyperglycemic patients had larger stroke volume [(121.7±101.1) vs (68.8±85.4), P＝0.03; (170.8±163.9) vs (92.5±113.6), P＝0.02], and higher NIHSS scores than normoglycemic patients [(14.3±6.9) vs (8.6±5.1), P＜0.01; (8.8±7.4) vs (4.3±3.9), P＜0.01]. Hyperglycemic patients also had higher rate of poor prognosis at 7d after onset than normoglycemic group patients (42% vs 15%, P＝0.05). Conclusion Admission hyperglycemia does not interfere the early recanalization and safety of rt-PA thrombolysis, but it is associated with in-hospital infarct volume expansion and poor outcome in the elderly acute ischemic stroke patients.

Abstract:Objective To evaluate the changes of serum level of D-dimer in the elderly essential hypertensive patients with or without coexisting benign prostatic hyperplasia (BPH) and compare the results with those of the healthy elderly people and the patients with simple BPH in order to investigate the clinical significance of serum D-dimer in the elderly essential hypertensive patients with coexisting BPH and its relationship with mortality. Methods A total of 157 elderly patients with primary hypertension admitted in our hospital from January 2009 to December 2012 were recruited in this study. They were divided into 2 groups according to whether coexisting BPH, that is, simple hypertension group (group H, n＝80) and coexisting group (group C, n＝77). Another 50 healthy elderly men (group N) and 50 elderly patients of simple BPH (group P) hospitalized during the same period served as control groups respectively. The serum level of D-dimer were measured and compared in all the 4 groups. In the meanwhile, the number of death was calculated in the cohort during the 4 years’ follow-up and the relationship between the mortality and serum D-dimer was analyzed. Results The serum levels of D-dimer were higher in groups H and C than in group N, while, that in group C was the highest among all groups. During the 4 years’ follow-up, there were totally 16 patients died in the cohort, and all of them were from group H and group C, with more in group C than in group H. For all these died patients, their serum D-dimer was obviously higher than the patients from the same group. What’s more, the increase even became more severely in 1 to 3d before death. Conclusion The serum D-dimer is increased in the elderly essential hypertensive patients than in normal old men, and it is more higher in the elderly hypertensive patients with coexisting BPH. Its increase is closely related to mortality. Our results suggest that we pay attention to the serum D-dimer for the elderly hypertensive patients, especially with coexisting BPH, and focus on the protection of vascular endothelial function, thus to decrease the mortality and improve the quality of life.

Abstract:Objective To evaluate the peri-operative anti-thrombotic strategy for the patients undergoing noncardiac surgery within 1 year after implantation of drug-eluting stent (DES). Methods A total of 48 patients who having taken dual antiplatelet therapy (DAPT) drugs (clopidogrel and aspirin) within l year after DES implantation and now undergoing operative treatment for the surgical diseases in our department from January 2010 to August 2013 were recruited in this study. They were randomly divided into heparin (enoxaparin) group and tirofiban group. In 5d before surgery, oral DAPT was stopped in both groups, and continuous intravenous infusion of 0.1μg/(kg·min) tirofiban or subcutaneous injection of enoxaparin (1mg/kg) twice per day, were performed respectively. In 12h before surgery, tirofiban or enoxaparin was stopped, and oral DAPT was returned as soon as possible after surgery according to the patients’ condition. Peri-operative cardiovascular events and bleeding were observed. Results There was no statistical significance in bridge time and surgery method between the 2 groups. No major adverse cardiac event (MACE) was observed in neither the enoxaparin nor the tirofiban group in perioperation. There were 2 cases of gingival bleeding and 1 of epistaxis in the enoxaparin group, and 1 of gingival bleeding and 1 positive occult test in the tirofiban group. But no difference was found in bleading incidence between the 2 groups. During the 3 months’ follow-up, 1 case of myocardial infarction and 2 of angina occurred in the enoxaparin group, and 1 of angina in the tirofiban group, with no difference in MACE in the 2 groups. Conclusion Low molecular weight heparin enoxaparin and Ⅱb/Ⅲa receptor antagonist tirofiban may be substitute for oral DAPT in the patients undergoing noncardiac surgery recently after implantation of DES.

Abstract:Objective To analyze the comprehensive influencing factors for occurrence of differentiation syndrome (DS) in the patients with acute promyelocytic leukemia (APL) undergoing induction therapy with all-trans retinoic acid (ATRA). Methods A total of 84 patients with freshly diagnosed APL and receiving induction treatment with ATRA in combination with arsenic trioxide (ATO) or anthracycline anticancer drugs in our department from 2005 to 2014 were enrolled in this study. According to the description of DS by Frankel, the subjects were divided into DS group (n＝35) and non-DS (normal) group (n＝51). Data were collected based on the potential risk factors. Univariate analysis and logistic regression analysis were used to study the risk factors for the occurrence and development of DS. Results The results of logistic regression analysis showed that white blood cell (WBC) count on initial diagnosis and genotype of promyelocyte leukemia-retinoic acid receptor alpha (PML-RARa) were independent risk factors for DS in APL patients (P＜0.05). Then chi-square analysis was carried out on these 2 items to exclude the mutual influence among multiple factors. The results indicated that there were significant differences in the WBC count on initial diagnosis and genotype of PML-RARa between the 2 groups (P＜0.05). Further chi-square analysis showed that type long (L) isoforms of PML-RARa was more significant than type short (S) isoforms of PML-RARa in the occurrence and development of DS. Conclusion WBC ≥10×109/L on initial diagnosis and carrying type L isoforms of PML-RARa are risk factors for DS in APL patients undergoing induction therapy with ATRA.

Abstract:Objective To observe the clinical efficacy of acupuncture treatment in the elderly type 2 diabetes mellitus (T2DM) patients with coexisting herpes zoster. Methods A total of 80 elderly T2DM patients complicated with herpes zoster admitted in our department from January 2010 to January 2013 were enrolled in this study. They were randomly assigned to 2 matched groups (n＝40 for each group), that is, treatment and control groups. Treatment group was treated with body acupuncture recuperation together with local surrounding acupuncture treatments, while control group with western medicine. The curative effects were compared between the 2 groups by clinical symptoms and other relative indices. Results There were 31 cases in the treatment group getting completely recovered, 4 getting improved, 2 encountering failure and 3 cases still suffering from postherpetic neuralgia, with a total efficiency of 87.5 %. While in the control group, 20 patients completely recovered, 6 turned better, 10 failed, and 4 had postherpetic neuralgia, and the total efficiency was 65.0%, which was significant lower than that of the treatment group (P＜0.05). The healing times for scabbing and skin lesion subsiding were obviously shorter in the treatment group than in the control group (P＜0.05). After treatment, the treatment group had remarkably lower fasting and 2-hour postprandial blood glucoses than the control group (P＜0.05). Conclusion Acupuncture treatment is a better option in treatment of herpes zoster for the elderly T2DM patients.

Abstract:Objective To investigate the regular pattern of spectra of critical diseases in the elderly in order to provide some reference for further treatment. Methods A retrospective analysis was performed on the clinical data of 423 elderly patients (mean age 76.79 years, ranging from 60 to 102 years) with critical diseases admitted in Bozhou People’s Hospital from February 2011 to February 2014. The constituent ratio of disease spectra, onset seasons, organ dysfunction and prognosis were analyzed. These 423 elderly patients (＞60 years old, elderly group) were divided into 3 subgroups according to their ages. The other 59 young and middle-aged patients (＜60 years old) were taken as controls (control group). The disease spectra and prognosis were compared among different subgroups. Results (1) In this cohort, circulation system disease (ESD) accounted for 55.8% (236 cases), taking the first place among other system diseases, followed by nervous system disease (NSO, 47.3%, 200 cases) and respiratory system disease (RSD, 40.2%, 170 cases). (2) There were significant differences in the spectra of RSD and digestive system diseases (DSD) and tumors among different age subgroups, but no such difference was found in other system diseases. (3) The RSD had obvious seasonal characteristics. (4) There were 167 (39.5%) patients with 2 and 81 patients (19.1%) with 3 dysfunctioned organs, totally accounting for 60%. The ratio of multiple organ dysfunction was significantly higher in the elderly group than in the control one. Lungs and heart dysfunction ranked the first top two places. (5) There was no significant difference in the prognosis among the different age subgroups. (6) A total of 285 senile patients (68.2%) got better prognosis. Mortality of the top three was cardio- cerebrovascular diseases, respiratory system disease, and cancer in this study. Conclusion Critical illness in the elderly is characterized with complicated disease spectra, quickly changed condition, multiple organ failure, and high mortality. Therefore, we should strengthen the underlying diseases and control of chronic diseases, actively treat the primary disease and pay attention to the protection of organ function at the same time, and timely manage organ dysfunction syndrome.

Abstract:Objective To investigate senile degenerative heart valvular diseases (SDHVD) and multiple organ diseases. Methods A multi-center study was carried out in some sanatoriums for retired veteran cadres and their couples from October 2008 to June 2014. There were 3 896 elderly patients recruited (all with full medical records and undergoing overall physical examination every year), including 2 884 males and 1 012 females, with age of (78±13) years (ranging from 60 to 103 years). Clinical data of their echocardiography, physical examination, and auxiliary examination were collected and analyzed for multiple organ diseases. Results Among the 3 896 elderly patients, there were 1 225 having SDHVD (31.4%). The incidences of multiple organ diseases in the SDHVD group and non-SDHVD group were as follows respectively: hypertension 49.3% vs 28.4%, coronary heart disease 38.5% vs 23.8%, heart failure 36.2% vs 17.3%, pulmonary heart disease 6.3% vs 3.1%, stroke 21.6% vs 9.6%, renal insufficiency 6.9% vs 3.2%, gastroesophageal reflux disease 21.3% vs 10.3%, and diabetes mellitus 11.2% vs 12.1%. Significant differences were found in all above incidences except for that of diabetes mellitus between the 2 groups (P＜0.05). Conclusion Multiple organ diseases are more common in the elderly suffering from SDHVD. It might be due to that SDHVD induces cardiac remodeling and abnormal hemodynamics, and thus triggers the occurrence and development of multiple organ diseases.

Abstract:Objective To investigate the effects of chronic intermittent hypoxia (CIH) on myocardiac remodeling and intervention role of adiponectin (Ad) in the process. Methods A total of 45 Wistar rats were randomly divided into 3 groups: normal control (NC) group, CIH group and CIH＋Ad group (10 μg Ad injection through caudal vein twice per week, for 5 weeks). After 35 days’ CIH exposure (in a chamber with 60 s nitrogen infusion to reduce the oxygen concentration to 5% followed by another 60 s oxygen infusion to increase the concentration to 20% for totally 8 h of each day), Masson analysis was used to detect the left ventricular fibrosis, and Western blot was used to measure the protein expression of collagen Ⅰ, collagen Ⅲ and pathway proteins TGF-β/smad2/3. RT-PCR was used to study the expression of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2). Results After CIH exposure, the left ventricular fibrosis was significantly more severe in CIH group than in NC group and CIH＋Ad group (P＜0.05), and there was statistical difference between the 2 latter groups (P＜0.05). In addition, the protein expression of collagen Ⅰ and collagen Ⅲ and the mRNA expression of MMP-2 and TIMP-2 were the highest in CIH group, the lowest in NC group, and CIH＋Ad group in the middle. There was a significant difference among 3 groups (all P＜0.05). The pathway proteins TGF-β/smad2/3 were most significantly expressed in CIH group (P＜0.05) , but there was still significant difference in their expression between NC group and CIH＋Ad group (P＜0.05). Conclusion CIH may cause may left ventricular remodeling, while Ad supplement may ameliorate the impairment via inhibiting TGF-β/smad2/3 pathway.

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Abstract:Essential hypertension (EH) is a major risk factor for cardiovascular and cerebrovascular diseases, and is seriously harmful to human health. Previous studies have noted that there is maternal inheritance of EH in some pedigrees. Consequently, mutations in mitochondrial DNA (mtDNA) have become a new target for the pathogenesis of EH. Currently studies have found many of mtDNA mutations associated with EH. These mutations have been confirmed to lead to the failure of oxidative phosphorylation function, deficit in ATP synthesis, increase in reactive oxygen species (ROS) and mitochondrial-mediated cell death. Therefore, the further study on mitochondrial dysfunction will provide new insights into the molecular mechanism of maternal inheritance of EH. These mtDNA mutations should be considered as genetic markers for future molecular diagnosis of maternally inherited EH. The present review summarized the mtDNA mutations associated with EH and the related molecular mechanism for EH.

Abstract:Various ion currents on the myocardial cell membrane take part in cardiac electric activity under both physiological and pathological conditions. Cardiac sodium current (INa) is involved in the depolarization and repolarization of cardiomyocyte action potential (AP), and exerts an important effect on the conduction of AP. So, it is of great importance to explore the interactions, effects, and especially, clinical significance of INa with other ion channel currents. This study reviewed the interaction of INa with other cardiac currents, and elucidated the mechanism of cardiac arrhythmias from the perspective of ion flow interaction.

Abstract:Thyroid cancer is the most common malignancy in endocrine system, and papillary thyroid carcinoma (PTC) accounts for about 80% of thyroid cancer. Papillary thyroid microcarcinoma (PTMC) refers to the PTC with the diameter less than 1.0 cm, with or without lymph nodes metastases or distant metastases. In recent years, with the rapid development and wide application of ultrasonic technology, its detection rate is in a trend of increasing. Generally, PTMC is considered to be in lower malignancy and with good prognosis. However, there are still some reports indicating PTMC have been regional or distant metastasis in lymph nodes when PTMC is diagnosed. In this paper, we reviewed the epidemiological, clinical, biological and molecular biological characteristics of PTMC.

Abstract:Obstructive sleep apnea syndrome (OSAS) refers to a common breathing and sleep disorder during sleep characterized by consequent decreases in oxygen saturation and arousals from sleep, with repetitive episodes of either complete (apnea) or partial (hypopnea) obstruction of the upper airway caused by structural abnormality of upper airway or nervous system disease, and is closely correlated to nervous system diseases. This article summarized the associations of OSAS with many nervous system diseases, including stroke, idiopathic intracranial hypertension, seizure, cognitive disorder, vestibular system dysfunction, cerebral venous thrombosis, autonomic nerve dysfunction, depression-anxiety, pain and cerebral white matter diseases, so as to arouse the clinical neurologists to concern and pay attention to OSAS.