Abstract:

Abstract:

Abstract:

Abstract:

Abstract:In this review, we elucidated the causes, diagnosis and treatment of post-stroke depression. Its incidence ranges from 20% to 60%. It mainly results from brain damage, neurotransmitter imbalance, and psychological imbalance after stroke. This disease may not only result in aggravated somatic symptoms, causing mental suffering, but also reduce the patients’ quality of life, further affecting their treatment and rehabilitation. Its treatment should adopt comprehensive intervention. The diagnosis and treatment for the disease should be strengthened in the future, and what’s more, more efforts should be paid on its management and prevention measures.

Abstract:Objective To evaluate the efficacy of modified electroconvulsive therapy (MECT) in the treatment of elderly depression and investigate its effect on heart rate and blood pressure. Methods A total of 70 elderly patients with depression undergoing MECT in the MECT center of our hospital in the year of 2013 were recruited in this study. Beside drug treatment, they all finished 6 times of MECT. Hamilton Depression Scale (HAMD) was used to assess the clinical symptoms before, and in 3 and 6 times after treatment. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded before treatment, after anesthesia, and in 0, 30 and 60 min after convulsion. Results Significant differences were found in HAMD scores in all patients between pre-treatment and 3 or 6 times after MECT (all P＜0.01), with an efficacy of 80.0% and 95.7% respectively. Compared with pre-treatment, SBP and DBP were significantly decreased while HR increased after anesthesia (all P＜0.01); SBP, DBP and HR were significantly increased after convulsion (all P＜0.01) and in 30 min after convulsion (all P＜0.01). However, SBP, DBP and HR returned to the levels of pre-treatment in 60 min after convulsion (all P＞0.05). Conclusion MECT combined with drug treatment is effective in the treatment of elderly depression, with rapid onset and good efficacy, and is worthy of being widely applied in clinical practice. In the process of MECT, blood pressure is reduced after anesthesia, and then obviously rises with HR after convulsion, but all these indices return to the levels before treatment in 60 min after convulsion. Continuous monitoring should be carried out during the whole process.

Abstract:Objective To determine the clinical efficacy and safety of magnesium valproate sustained release tablets and combination with quetiapine in treatment of manic episode in the elderly with bipolar disorder. Methods A total of 46 elderly patients (aged 60 to 78 years) who met the criteria of the International Classification of Diseases (ICD-10) for manic episode of bipolar disorder admitted in our hospital from May 2013 to May 2014 were enrolled in this study. They were randomly assigned to 2 groups, and treated with magnesium valproate sustained release tablets (control group) or combined with quetiapine (study group). In 6 weeks after treatment, Bech-Rafaelsen Mania Rating Scale (BRMS) and Treatment Emergent Symptoms Scale (TESS) were employed to evaluate the clinical efficacy and adverse effects respectively. Results BRMS scores were dropped significantly in both groups (P＜0.05). At the end of the second weeks, there were significant differences in the total score of BRMS and the factor points (noisy/speech, sleep) between the study and control groups (P＜0.05). At the end of 6 weeks’ treatment, there was no significant difference in the total score of BRMS between the 2 groups (P＞0.05). No severe adverse effect was seen in the both groups, and there was no significant difference in TESS score between them. Conclusion Magnesium valproate sustained release tablets combined with quetiapine show better efficacy and sound safety in the treatment of maniac episode in the elderly patients, especially in controlling excitement symptoms and improving sleep at the early stage of treatment (the end of 2 weeks).

Abstract:Objective To determine the effect of affective disorder on recurrence of cerebral infarction in the elderly. Methods A prospective study was carried out on 102 elderly patients with identified affective disorder who hospitalized in our Department of Neurology due to first attack of cerebral infarction from October 2012 to September 2013. They were assigned as the observation group (group A). Another 102 first-attacked cerebral infarction patients without affective disorder admitted during the same period were recruited and assigned as the pair-matched group (group B, without difference with group A in age, gender, severity of infarction, and comorbidity). These patients were followed up for 1 year. Recurrence of cerebral infarction was compared between the 2 groups. The compliance with anti-depressant or/and anti-anxiety agents was recorded in the patients of the group A. Results There were 23 patients suffering from relapsed cerebral infarction in group A, and 11 patients in group B, with the recurrence rate significantly higher in group A than in group B (22.5% vs 10.8%, P＜0.05). In group A, the recurrence rate was 36.8% in those who suffered from both coexisting depression and anxiety, significantly higher than those having depression (17.4%) or anxiety (21.6%) only. What’s more, the recurrence rate (30.4%) was comparatively higher in those with poor compliance with drug therapy. Conclusion Affective disorder is an important risk factor for recurrence of cerebral infarction in the elderly, and poor compliance with drug therapy increases the risk further.

Abstract:Objective To investigate the depressive status in the elderly schizophrenia patients who were hospitalized for a long period, and explore the depressive episode and characteristics of the symptoms. Methods A total of 60 elderly patients (30 males and 30 females) with schizophrenia who had been admitted in our hospital for more than 2 years were recruited in this study. Hamiltion Depression Rating Scale (HAMD) was employed to assess their depressive symptoms. The clinical features of the depressed mood were analyzed based the findings of this cohort. Results The incidence of depressive symptoms was 11.7% (male 0.0%, female 23.3%) in those long-term hospitalized elderly schizophrenia patients, with the female prevalence higher than that in males. In accordance with the severity of depressive symptoms, the characteristics were retardation, anxiety/somatization, cognitive impairment, hopelessness, and sleep disorder in order. Conclusion We shouldn’t ignore the depressive symptoms in the long-term hospitalized elderly patients with schizophrenia, and should take active and effective measures, even medication therapy, psychological treatment, rehabilitation treatment and other comprehensive treatment strategy when necessary.

Abstract:Basic and clinical researches have shown that diabetes mellitus is commonly coexisting with depression, and the symptoms of the comorbidity are quite complicated, thus increasing the difficulty in the treatment and nursing for both of them in clinical practice. These two diseases interact with each other, and one is risk factor for another at the same time. What’s more, the mechanism underlying their relationship remains unclear. The paper reviewed the possible mechanism of the comorbidity of diabetes and depression, their mutual influence and research progress in their treatment, and aimed to highlight the relevance between them, so as to provide theoretical basis for clinical individualized diagnosis and treatment.

Abstract:Objective To determine the hypoglycemic effect of pioglitazone and acarbose on the patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods A total of 150 diabetic patients (82 males and 68 females, age ranging from 61 to 89 years) with coexisting hypertension admitted in Xijing Hospital from May 2011 to May 2013 were enrolled in this study. They were randomly divided into 2 matched groups (n＝75 for each group), and treated by pioglitazone and acarbose respectively. Before and at 12 weeks after treatment, their systolic blood pressure (SBP), diastolic blood pressure (DBP), glycosylated hemoglobin (HbA1c), tumor necrosis factor-α (TNF-α), adiponectin (APN), Homeostasis Model Assessment Insulin Resistance (HOMA-IR), albumin excretion rate (AER), left ventricular hypertrophy(LVH), peripheral blood CD34 and vascular endothelial growth factor receptor 2 (VEGFR-2) levels, CD34+/VEGFR-2+ endothelial progenitor cells (EPC), nitric oxide (NO) and nitric oxide synthase (NOS) were determined or calculated, and compared between the 2 groups. Results After 12 weeks treatment of pioglitazone, the patients had their blood pressure lower than 140/90mmHg, significantly different from the acarbose group (P＜0.05). The pioglitazone group had significantly higher APN levels, and obviously lower HbA1c, TNF-α and HOMA-IR when compared with the acarbose group (P＜0.05). Compared with acarbose treatment, pioglitazone treatment resulted in markedly reduced BUN, SCr, AER and LVH (all P＜0.05), but remarkably increased CD34 and VEGFR-2 levels, and NO and NOS levels (all P＜0.01). Conclusion Pioglitazone treatment results in decreased HbA1c and increased APN to reduce renal damage; induces to lower LVH to protect heart function; decreases serum levels of CD34 and VEGFR-2 to protect EPC; and improves the contents of NO and NOS to exert a protective role in the hardening process of arteries.

Abstract:Objective To determine the strengths and weaknesses between parallel double plating and perpendicular double plating in the treatment of elderly distal humeral fractures. Methods Clinical data of 39 elderly patients (mean age 64 years, ranging from 60 to 81years) with distal humerus fractures who underwent parallel double plating (n=18) or perpendicular plating (n＝21) in Chinese PLA General Hospital from September 2008 and January 2013 were collected and retrospectively analyzed. Their surgical duration, blood loss, fracture healing time, flexion-extension arc, and the total range of flexion and extension were compared between the 2 groups. Mayo Elbow Performance Score (MEPS) was used to determine the elbow functional results. Results All patients were followed up for 12 to 25 months, with a mean duration of (17.0±1.5) months for perpendicular group and of (15.0±2.0) months for parallel group. For the former group, their mean MEPS was (82.0±5.6) points, and the rate of excellent and good results was 81.0%. While, for the latter, the mean MEPS was (83.1±5.5) points, and the rate of excellent and good results was 88.9%. No significant difference was seen in the surgical duration, blood loss, bone union time and functional results between the 2 groups. There were 2 cases of delay-union (finally healed after secondary operation) and 1 case of heterotopic ossification (mildly affecting postoperative outcomes) in the perpendicular group. Conclusion Although both methods provide sound anatomical reconstruction and stable fixation in the early term for distal humeral fractures in elderly patients, the parallel double plating is superior to perpendicular one in reducing the complications.

Abstract:Objective To investigate the relationship of transmural dispersion of repolarization (TDR) with cardiac function in the elderly patients with ischemic cardiomyopathy. Methods A total of 159 elderly patients with ischemic cardiomyopathy identified by coronary angiography were enrolled in this study as test group, and another 143 volunteers receiving physical examination during the same period were subjected as controls. According to the cardiac function equation based on the echocardiographic parameters of cardiac function combined with brain natriuretic peptide (BNP), the test group was divided into 3 subgroups: class Ⅰ-Ⅱ (n＝68), class Ⅲ (n＝55), and class Ⅳ (n＝36). With the aid of standard 12-lead ECG, their Tp-e interval (an interval from the peak to the end of the T wave), QTc interval, QTd (QT dispersion), and Tp-e/QTc ratio were measured and calculated, then the results were compared between the subgroups. Dynamic electrocardiograhy (Holter monitor) was employed to observe the incidence of ventricular arrhythmia. Results (1)The Tp-e interval (P＜0.01), QTc interval (P＜0.05), QTd (P＜0.01), and Tp-e/QTc ratio (P＜0.01) were more longer or higher in test group than in the control group. (2) There were significant differences in the above indices between the class Ⅳ and class Ⅰ-Ⅱ subgroups, class Ⅳ and class Ⅲ subgroups, and class Ⅲ and class Ⅰ-Ⅱ subgroups (P＜0.05). (3) The incidence of malignant arrhythmia was obviously higher in the ischemic cardiomyopathy group than in control group (15.7 vs 0.6%, P＜0.05). There were positive correlations of Tp-e interval, QTd, and Tp-e/QTc ratio with arrhythmia incidence in the test group (P＜0.05). While these indices had no relationship with malignant arrhythmia in control group. Conclusion (1) In the elderly with ischemic cardiomyopathy, the larger their TDR is, the higher risk of ventricular arrhythmia they have. (2) For these patients, the severity of heart failure significantly affects their TDR, with cardiac dysfunction severer, and the TDR larger. So, the extent of TDR can partly reflect the severity of cardiac muscle tissue.

Abstract:Objective To determine the effect of the combination of normobaric oxygen (NBO) and hyperbaric oxygen (HBO) on the serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble E-selectin (sE-selectin, sES) and matrix metalloproteinase-9 (MMP-9) in the patients with acute cerebral infarction. Methods A total of 168 patients with acute cerebral infarction within 24 h after onset hospitalized in our department from December 2011 to March 2014 were enrolled in this study as acute cerebral ischemia group. They were prospectively and randomly divided into 3 subgroups, that is, routine treatment subgroup, HBO subgroup and NBO+HBO subgroups. Their serum levels of sICAM-1, sES and MMP-9 were measured by enzyme-linked immunosorbent assay (ELISA) before and at 10d after treatment. The National Institutes of Health Stroke Scale (NIHSS) was employed to assess their neurological defects. The other 50 practical health persons were enrolled as control group. Results After 10 days’ treatment, the serum levels of sICAM-1, sES and MMP-9 were significantly decreased in all 3 treatment groups. (t＝8.754?11.351，P＜0.01), with those of HBO and NBO+HBO subgroups obviously lower than the routine group (t＝2.237?4.162, P＜0.05 or 0.01). Compared with the HBO subgroup, these levels were more significantly decreased in the NBO+HBO subgroup (t＝2.141?2.366, P＜0.01). The HBO and NBO+HBO subgroups had markedly lower NIHSS scores than the routine subgroup at 10d after treatment (t＝5.367, P＜0.01; t＝9.943, P＜0.01), and the scores of the NBO+HBO subgroup were more significantly decreased than that of HBO subgroup (t＝2.827, P＜0.01). Conclusion The combined therapy of NBO+HBO is superior to HBO monotheray in the inhibition of serum sICAM-1, sES and MMP-9 levels, and improves the clinical prognosis of the patients with acute cerebral infarction.

Abstract:Objective To evaluate the efficacy and safety of peginterferon alpha-2a (α-2a) for the elderly patients with chronic hepatitis B (CHB). Methods A total of 62 elderly CHB patients (age＞60 years) admitted in Wuhan Medical Treatment Center from April 2009 to April 2013 were recruited in this study and assigned into the elderly group. Another 65 CHB patients (age＜60 years) admitted during the same period were subjected to the control group. All the groups received a subcutaneous injection of α-2a at a dosage of 180 μg once per week for 48 consecutive weeks. Results The early virological responses (EVR) of HBeAg-positive and HBeAg-negative patients were significantly lower in the elderly group (4% and 5.4%) than in control group (25.92% and 21.05%), and so was the sustained virological response (SVR) in HBeAg-negative patients (28.00% vs 55.56%, P＜0.05). The HBeAg seroconversion rate was 32.00%(8/25) in the elderly group and was 33.33%(9/27) in the control group, without significant difference between them (P＞0.05). The incidence of main adverse effects, such as depression, ECG abnormalities and leucopenia, were significantly higher in the elderly group than in the control group (P＜0.05). Conclusion α-2a suppresses the replication of hepatitis B virus DNA, and results in HBeAg seroconversion in HBeAg-positive and -negative elderly CHB patients. It is more likely to achieve SVR to HBeAg-negative elderly patients. During the treatment, close attention should be paid to adverse reactions and timely intervention is necessary.

Abstract:Objective To determine the effect of acute myocardial ischemia on hemodynamic status and electrocardiogram (ECG) J-point displacement (⊿J) in rats and the intervention effect of Tongmai Ciwujia Capsule [a capsule mainly containing stem-leaf total flavonoid of Ciwujia, (Acanthopanax senticosus)] in the process. Methods Thirty rats with normal ECG were randomly divided into 3 groups according to the range of body mass, ie, sham operation group, model group and intervention group. The rats of the intervention group were orally administrated with Ciwujia suspension of 3.5ml/kg every day while the rats in the other 2 groups were given equal volume of normal saline for 14 consecutive days. Left anterior descending coronary artery (LAD) was ligated to establish the model of acute myocardial ischemia. The catheter of pressure transducer was put into the left ventricle to detect the changes of pressure in 15min after ligation. ECG was also monitored and ⊿J was recorded in 0.5, 1, 2, 4 and 6h after ligation to evaluate the intervention of Ciwujia Capsule. Results Compared with sham operation group, left ventricular end-diastolic pressure (LVEDP) and ECG ⊿J at 0.5, 1, 2, 4 and 6h after ligation were significantly increased (P＜0.05), while left ventricular systolic peak pressure (LVSP) and maximum rate of pressure change (±dp/dtmax) were decreased markedly (P＜0.05) in model group. Compared with model group, Ciwujia intervention resulted in significantly decreased LVEDP and ⊿J at the above time points except in 0.5 and 6 h after ligation (P＜0.05), and markedly increased LVSP and ±dp/dtmax (P＜0.05). Conclusion Ligation of LAD results in obviously impaired myocardial diastolic and systolic function and obvious J-point displacement ECG. Tongmai Ciwujia Capsule could effectively alleviate the impact of acute myocardial ischemia on ECG of rats.

Abstract:Objective To establish a rabbit model of atherosclerosis (AS) and acute myocardial infarction (AMI), and then to determine the effect of the extracts of Rhodobryum roseum Limpr., a Chinese herbal medicine on the rabbit AS and ischemic myocardial angiogenesis. Methods A total of 30 white rabbits were randomly and equally divided into 3 groups, that is, normal control group (fed with the full diet), high-fat feed group and R. roseum intervention group (fed with high fat diet and intra-gastric injection of the extract). At the end of the 9 weeks’ feeding, AMI was inflicted by opening chest and ligating the left anterior descending artery (LAD). At the end of experiment, the blood biochemical indicators were determined, and blood vessels and heart tissue were collected for pathological observation. Immunohistochemical staining was used to detect the expression of the cluster of differentiation 34 (CD34) and vascular endothelial growth factor receptor 2 (VEGFR2) in the myocardium. Results Compared with the control group, the high-fat group and the intervention group had significantly increased creatine kinase isoenzyme (CK-MB), troponin I (TnI), total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) (P＜0.01). The serum levels of TC, TG, CK-MB and TnI were very significantly decreased (P＜0.01), and that of LDL-C was obviously reduced (P＜0.05) in the intervention group than in the high-fat group. The pathological grade was very significantly higher in the high-fat group than in the control group (P＜0.01), and the grade of the intervention group was between those of the former groups (P＜0.05). CD34 and VEGFR2 were significantly expressed with stronger positive intensity in the high-fat group than in the control group (P＜0.01). Their expression levels in the intervention group were obviously lower than those of high fat group but higher than those of the control group (P＜0.05). Conclusion High fat feeding for 9 weeks and ligating LAD artery can successfully establish a rabbit model of AS and AMI. The extract of R. roseum attenuates AS and myocardial ischemic necrosis and inhibits the expression of CD34 and VEGFR2 in the myocardium.

Abstract:Objective To observe the efficiency of ezetimibe/simvastatin (ES) tablets on the regression of atherosclerotic plaque of abdominal arteries in rabbits. Methods Twenty-four healthy male New Zealand rabbits were randomly divided into 2 groups: control group (n＝8) and hypercholesterolemia group (n＝16). Control group was fed with normal diet for 12 weeks. The other group animals were given a cholesterol-supplemented diet (normal diet＋15g/L cholesterol＋100g/L lard＋150g/L egg yolk powder) for 2 weeks, and underwent catheter-induced arterial wall injury. These rabbits were then randomized to model subgroup (n＝8, for another 10 weeks of hypercholesterol diet) and ES treatment subgroup [n＝8, 5/10mg/(kg·d) for another 10 weeks]. Chinese russell’s viper venom was intra-peritoneally injected to trigger plaque rupture. Abdominal aortagraphy was carried out to measure the aorta stenosis. After 12 weeks’ feeding, all rabbits were sacrificed, and their abdominal arteries were isolated, paraffin-embedded and then sectioned. Blood lipid and lipoproteins were detected. The development of the atherosclerotic plaques was evaluated through the light microscopy. Finally, the expression of macrophage and smooth muscle actin in the abdominal arteries was measured by immunohistochemical analysis. Results The serum levels of total cholesterol (TC), triglycerides (TG) and low density lipoprotein-cholesterol (LDL-C) were significantly lower in the ES treatment subgroup than in the hypercholesterolemia model group (P＜0.01). One-way analysis of variance indicated that significant differences were found in the plaque diameter, plaque thickness and the intimal-medial thickness between the ES subgroup and hypercholesterolemia model subgroup by morphological observation (P＜0.05). Immunohistochemical analysis showed that lesser macrophages (P＜0.05) but more smooth muscle cells (P＜0.01) were found in the ES treatment subgroup than in the model group. Conclusion It may be through reducing the deposition of extracellular lipids that ES treatment decreases macrophage number and cholesterol level, increases the collagen and smooth muscle cells in the arterial intima and media, and thus exerts effect on plaque reversing.

Abstract:Objective To investigate the effect of colchincine on the aortic oxidative stress and endothelial dysfunction induced by exposure to sidestream cigarette smoke (SSCS). Methods The rat model was made by SSCS for 56 consecutive days, and the rats of the intervention group were given colchicine by intragastric injection at the same time. The rats with no smoking exposure and intervention served as normal controls. At the end of treatment, the activity of superoxide dismutase (SOD), and the contents of malondialdehyde (MDA), nitric oxide (NO) and endothelial nitric oxide synthase (eNOS) in the rat aorta were measured. The endothelium-dependent dilation (EDD) test was carried out on the rat aorta. The effect of colchincine on the aortic oxidative stress and endothelial dysfunction was observed. Results Compared with the normal controls, the SSCS model group had significantly increased content of MDA, obviously decreased activity of SOD, and remarkably reduced formation of NO and eNOS, and obviously impaired endothelium-mediated vascular relaxation of aorta. All these phenomena would be attenuated after 56 days’ colchicine treatment. Conclusion Exposure to SSCS induces aortic oxidative stress and endothelial dysfunction in rats. These deleterious effects can be abated by colchicine treatment.

Abstract:

Abstract:Thalassemia is a group of the most common human monogenic disorders. According to the World Health Organization, at least 7% of the population worldwide carries thalassemia associated genes. This disease is mainly distributed in Africa, Mediterranean, Southeast Asia and other tropical and subtropical regions. Hemolytic anemia caused by thalassemia is really harmful to human health. So it is of great importance to investigate the gene prevalence and spectrum of thalassemia in several areas with high incidences all over the world for the disease prevention, diagnosis and treatment. In this paper, we reviewed the research progress in molecular epidemiological analysis of thalassemias in multiple regions.

Abstract:Non-invasive positive pressure ventilation (NIPPV) is the most preferred treatment modality for adult patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Among all types of NIPPV, continuous positive airway pressure (CPAP) is the most popular one. Clinical trials have demonstrated that quite a few ischemic heart diseases (IHD) patients had OSAHS coexisted simultaneously, and these patients showed significant improvement in cardiac function after CPAP treatment. Besides, their cardiac structure displayed partial reversible changes. These findings made the association between OSAHS and IHD be a hot topic worthy of our thorough investigation. In order to further strengthen the understanding of this condition in respiratory physicians and cardiologists, we reviewed the progress in CPAP in the diagnosis and treatment of IHD patients with coexisting OSAHS.