Abstract:

Abstract:

Abstract:Objective To determine the values of ankle-brachial index (ABI) combined with carotid plaque scores (Crouse scores) for the prediction of coronary artery disease (CAD) in the elderly population. Methods A total of 153 elderly inpatients (over 60 years old) undergoing coronary angiography for the first time in our department from November 2013 to April 2014 were enrolled in this study. Their clinical data such as ABI and the Crouse scores were collected. They were divided into 4 groups according to the number of stenosed coronary arteries, that is, normal coronary arteries group (group 0), and the groups involving 1 (group 1), 2 (group 2) or 3-or-more vessels (group 3). Based on the severity of coronary artery stenosis (estimated by Gessini score), they were also assigned into severe group and non-severe group. Results There were significant differences in ABI among group 0, group 1, group 2 and group 3. The Crouse scores also had significant differences among the group 0, group 2 and group 3. Spearman analysis indicated that the relativities were significant in ABI, Crouse and the number of stenosed vessels when double-sided confidence level was 0.01, with the correlation coefficients of 0.484 and -0.491. With ABI ≤0.9 or Crouse score ≥1.9 as the cutoff value to predict severe stenosis, the sensitivity was 24% and 76% respectively, and the specificity was 96.1% and 21.4% respectively. Conclusion ABI and Crouse score are closely related to the severity of CAD. Combination of ABI with Crouse scores has more significant value in the prediction of the severity of the disease.

Abstract:Objective Usually, ischemic colitis has a good outcome, but when ischemia only involves the right side of the colon, the prognosis may be not so favorable. This study aimed to compare the prognosis of ischemia only involving the right side of the colon with those of involving other segments of the colon. Methods A retrospective study was performed on the 170 patients with colon ischemia hospitalized during the interval of January 1999 to December 2010. They were divided into 2 groups: those with isolated right colon ischemia (IRCI) and those with colon ischemia except IRCI (non-IRCI). Only the patients with colonoscopy-confirmed ischemic colitis were entered into our study. Results A total of 170 cases were enrolled in this study, of which 36(21.18%) were IRCI patients. Of these IRCI cases, 61.11% had an unfavorable outcome even after treatment, but the percentage was only 8.96% for those with non-ICRI. Eighteen IRCI patients (50.00%) required surgical treatment, but only 7.46% of non-IRCI patients need. The mortality was 16.67% in patients with IRCI and only 1.49% in patients with non-IRCI (2 cases). Conclusion Among 170 cases of colonoscopy-confirmed ischemic colitis, 36 (21.18%) involve only the right side of the colon. The patients with IRCI have a worse outcome than those with colon ischemia involving other colon segments.

Abstract:Objective To determine the effect of preoperative serum level of glycosylated hemoglobin (HbA1c) on the prognosis of elderly patients with acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI) and investigate the rationality of peri-operative use of tirofiban. Methods A prospective study was performed in our hospital from January 2012 to March 2014 on the consecutive elderly ACS patients with coexisting diabetes mellitus and planing to undergo PCI. For the admitted 648 patients, they were divided into 3 groups according to preoperative serum level of HbA1c, that is, group A (HbA1c＜6.5%, n＝152), group B (6.5%≤HbA1c≤7.5%, n＝245) and group C (HbA1c＞7.5%, n＝251). The cohort was also assigned into group X (not use of tirofiban, n＝351) and group Y (using tirofiban, n＝297). The incidences of primary and secondary endpoints were compared among these groups. Multivariate COX regression analysis was used to analyze the risk factors for the major endpoints. Results (1) Significant difference was found in the incidence of major endpoints among group A, B and C (P＜0.01). The incidence was obviously higher in group X than in group Y [68(21.9%) vs 33(15.4%), P＜0.05]. In group X, the incidence had remarkable difference among group A, B and C (P＜0.01), but no such difference was observed in group Y. (2) Significant difference was only seen in the incidence of minimal bleeding events (secondary end points) between group X and Y (P＜0.01). (3) Tirofiban reduced the incidence of nonfatal myocardial infarction (MI) and in-stent restenosis for those with HbA1c＞7.5% (group C). (4) Multivariate COX regression analysis indicated that previous MI, previous PCI or coronary artery bypass surgery (CABG), history of smoking, HbA1c level and application of tirofiban were the independent risk factors for major endpoints in elderly ACS patients with coexisting diabetes mellitus within 1 year. Conclusion Preoperative HbA1c level is an important predictor for major endpoints in elderly diabetic patients with ACS after PCI. Combined peri-operative application of tirofiban reduces the incidence of the major endpoints, but increases the risk for bleeding events.

Abstract:Objective Urine liver-type fatty acid binding protein (L-FABP) is emerging as an excellent biomarker for the early prediction of acute and chronic kidney injury. The aim of this prospective study was to determine the value of urine L-FABP in predicting the progression of nephropathy and the decline of estimated glomerular filtration rate (eGFR) in type 2 diabetic patients. Methods A longitudinal cohort study was conducted on 288 type 2 diabetic patients for 2 consecutive years, who were admitted to Department of Endocrinology of our hospital during January 2010 to June 2012. They were divided into normo-, micro- and macro-albuminuria groups according to their 24h-urinary albumin excreting rate (UAER). Urine levels of L-FABP, and UAER were determined. Results The follow-up levels of urinary L-FABP in both the micro- and macro-albuminuria groups were significantly higher than their baseline levels (P＜0.05), but only the macro-albuminuria group had the level of UAER higher than its baseline (P＜0.05). The results of Pearson correlations showed that urine L-FABP was correlated with UAER in the micro- and macro-albuminuria groups at both before and after follow-up (before: r＝0.573, r＝0.219, P＜0.05; after: r＝0.689, r＝0.203, P＜0.05). Multivariate stepwise regression analysis indicated that the urinary L-FABP levels before and after follow-up were significantly correlated with eGFR decline rate in both the macro- and micro-albuminuria groups (macro-albuminuria group: β＝-0.397, t＝-4.376, β＝-0.455, t＝-4.854, P＜0.05; micro-albuminuria group: β＝-0.327, t＝-2.987, β＝-0.378, t＝-4.298, P＜0.05). Conclusion Urine L-FABP is correlated with renal function in the patients with type 2 diabetes mellitus, and its dynamic monitoring may predict the progression of diabetic nephropathy. Urine L-FABP may independently predict the early decline of eGFR in type 2 diabetic nephropathy patients.

Abstract:Objective To evaluate the safety of batroxobin (defibrating therapy) in the treatment of sudden hearing loss in the elderly patients by detecting serum level of fibrinogen (FIB). Methods A total of 111 patients suffering from hearing loss or tinnitus admitted in the Department of Rehabilitation of our hospital from January to December 2014 were recruited in this study. They were divided into 2 groups according to their age, the elderly group (age ≥60 years) and the young and middle-aged group (aged from 20 to 59 years). Both of them received 10BU batroxobin on day 1 (if the patient was older than 70 years, the dose was 5BU) and other conventional therapies. The blood level of FIB was tested before, and at 1st or 2nd day after batroxobin treatment. Their systematic bleeding was also observed. Results At the beginning of the treatment, there was no difference in the FIB level between the elderly and young and middle-aged groups [(302.38±53.08) vs (297.13±97.62)mg/dl, P＝0.812]. During the treatment, no difference was seen in FIB level and decline of FIB between the 2 groups. The incidence of crisis on the 4th day was obviously higher in the elderly group than in the young and middle-aged group, but no such difference was seen at other time points. Conclusion There is no difference in the safety of batroxobin in treatment of sudden hearing loss between the elderly and young and middle-aged patients.

Abstract:Objective To determine the effect of antiplatelet drugs efficiency evaluated by thromboelastography on in-stent restenosis (ISR) in the patients after percutaneous coronary intervention (PCI). Methods A retrospective analysis was carried out on the patients undergoing successful coronary stenting and then coming back for angiography at Heart Center in Air Force General Hospital from September 2011 to June 2014. These patients were defined as ISR group and non-ISR group according to the results of coronary angiography. The possible factors that led to ISR were analyzed and compared between the 2 groups. Results There were a total of 86 patients with 118 drug-eluting stents implanted recruited in this study. ISR was found in 20 patients. There were significant differences in the lesion length [(27.20±3.19) vs (22.94±4.67)mm], the serum level of C-reactive protein [CRP, (6.36±2.69) vs (3.14±3.23)mg/L], the inhibitory rates of arachidonic acid (AA) pathway [(68.54±17.63) vs (78.59±20.39)] and adenosine 5￠-diphosphate (ADP) receptor [(35.80±15.58) vs (60.31±20.91)], the ratio of diabetes patients and the manifestations between the 2 groups (P＜0.05). Multivariate logistic regression analysis indicated that the lower inhibitory rate of ADP receptor was a risk factor of ISR (P＝0.011) after adjustment for other risk factors. Conclusion The inhibitory rate to ADP receptor is negatively related to ISR, indicating that hyporesponsiveness of clopidogrel plays an important role in the pathogenesis of ISR.

Abstract:Objective To investigate the relationship of nonthyroidal illness syndrome (NTIS) and chronic kidney disease (CKD) in the elderly hospitalized patients with type 2 diabetes (T2DM) and to assess the value of NTIS in T2DM prevention and treatment. Methods According to the thyroid function tests, 126 elderly patients hospitalized during October 2012 to September 2014 in our hospital were divided into NTIS group (n＝30) and non-NTIS (NNTIS) group (n＝96). The clinical data such as serum creatinine, urine albumin creatinine ratio (ACR) of the 2 groups were detected and compared. According to the modification of diet in renal disease (MDRD) equation, the diagnosis of renal insufficiency was established when estimated glomerular filtration rate (eGFR) ＜60ml/(min·1.73m2). Results (1) The incidence of NTIS in the 126 patients was 23.81% (30/126). (2) The incidence of renal insufficiency in the cohort was 57.94% (73/126). The incidence of renal insufficiency in NTIS group [76.67%(23/30)] was significantly higher than in NNTIS group [52.08% (50/96); P＝0.017]. (3) The patients in NTIS group were older than those in NNTIS group (P＜0.001). The level of total triiodothyronine (TT3; P＝0.001), total thyroxine (TT4; P＝0.005), free triiodothyronine (FT3; P＜0.001), free thyroxine (FT4; P＝0.036), thyroid-stimulating hormone (TSH; P＝0.012), albumin (ALB; P＜0.001), total cholesterol (TC; P＝0.027), triglycerides (TG; P＝0.034), low-density lipoprotein cholesterol (LDL-C; P＝0.032), eGFR(P＝0.004) and calcium (Ca; P＜0.001) were lower in NTIS group than in NNTIS group. (4) The Spearman univariate correlation analysis showed that NTIS was positively correlated with ACR (P＝0.011), age (P＜0.001) and renal insufficiency (P＝0.001), and was negatively correlated with ALB (P＜0.001) and Ca (P＜0.001). (5) The multivariate logistic regression analysis showed that ALB (OR＝0.246, P＝0.006) and renal insufficiency (OR＝5.346, P＝0.004) were the independent risk factors of NTIS in the elderly patients with T2DM. Conclusion NTIS in the elderly hospitalized patients with T2DM may indicate stage 3 or higher CKD, and may be an independent predictor for high severity and poor prognosis.

Abstract:Objective To investigate the relevant factors for anemia in elderly hospice inpatients in order to facilitate better preventation and control. Methods Clinical data of the hospice inpatients from Department of Internal Medicine in our hospital from May 2010 to December 2012 were collected in this study. A retrospective investigation was carried out on the 86 cases with anemia (experimental group) and 224 cases without anemia (control group). Results Multivariate logistic stepwise regression analysis showed that malignant tumors [odds ratio (OR)＝4.936; 95% confidence interval (CI)＝1.769 to 13.769), cardio-cerebral diseases (OR＝3.445; 95%CI＝1.267 to 9.368), antibiotic use (OR＝3.433; 95%CI＝2.049 to 5.752), hypoalbuminemia (OR＝3.385; 95%CI＝1.378 to 8.315), diabetes mellitus (OR＝3.064; 95%CI＝1.233 to 7.611), age (OR＝1.172; 95%CI＝1.105 to 1.244), length of stay in hospital (OR＝1.033; 95%CI＝1.021 to 1.045), nutrition support method (OR＝0.488; 95%CI＝0.267 to 0.892) were significant for anemia in elderly hospice inpatients (P＜0.05). Conclusions Anemia is quite common in the elderly hospice inpatients. Malignant tumor, hypoalbuminemia, prolonged hospitalization, senior age, and chronic comorbidity (cardio-cerebral diseases and/or diabetes mellitus) are risk factors for occurrence of anemia. Strengthening nutrition support will be helpful for elderly hospice inpatients to prevent anemia.

Abstract:Objective To investigate the kidney damage of the patients who have different severity of diabetic foot (Wagner grades 1 to 5) and investigate the relationship of diabetic foot with kidney disease in order to improve the clinical practice for diagnosis and treatment for diabetic foot. Methods A retrospective study was carried out on 622 type 2 diabetes mellitus (T2DM) patients with diabetic foot and 215 T2DM patients of non-foot disease admitted to the Department of Endocrinology of Chinese PLA Hospital No.306 from June 2009 to June 2014. Their clinical data were collected and biochemical indicators were measured. The patients with non-foot disease or Wagner grades l to 3 were assigned into a group, and those with Wagner grades 4 to 5 into another group. Urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were used to evaluate the kidney damage. The relationship of the renal function with varying degrees of diabetic foot was analyzed by SPSS19.0 software. Results The diabetic foot group had significantly higher UACR (78.00 vs 10.60mg/g, P＜0.05), but lower eGFR [(100.91±44.98) vs (114.27±35.88)ml/min·1.73m2, P＜0.05] when compared with the non-foot group. Multivariate stepwise regression analysis indicated that gender, diabetic retinopathy, serum albumin, uric acid, 2-hour postprandial plasma glucose (2hPPG), UACR were associated with the incidence and development of type 2 diabetic foot (β＝0.707, 0.850, -0.183, -0.006, 0.104, 0.003, all P＜0.05). The incidence of microalbuminuria (UACR 30?300mg/g) were significantly higher in the patients with Wagner grade 3 than those with grade 2 [49.7% (87/175) vs 39.2% (67/171), χ2＝3.885]. The ratio of renal insufficiency [eGFR＜60ml/(min·1.73m2)] was obviously higher in those with Wagner grades 4?5 compared with those with grade 3 [23.5% (43/183) vs 11.0% (24/220), χ2＝11.421, all P＜0.05]. Those with Wagner grade 3 had less incidences of macroalbuminuria (UACR≥300mg/g) and renal insufficiency than those with grade 2, but the incidences were increased again in those with Wagner grades 4?5. Conclusion The higher the Wagner classification grade is for diabetic foot, the more severe the kidney damage is. Microalbuminuria is superior to GFR to suggest kidney damage in diabetic patients. Wagner grade 3 is a turning point of the deterioration of kidney damage and clinical treatment. Clinicians should strengthen foot care and kidney protection when the patient is in Wagner grade 3.

Abstract:Objective To investigate the preferred velocity and time point of injecting sufentanil and propofol for elderly patients undergoing gastroscopy. Methods A prospective study was carried out on 90 elderly patients (70 to 86 years old) with America Society of Anesthesiologist (ASA) score of Ⅰ?Ⅲ undergoing scheduled gastroscopy in our hospital from March 2013 to October 2014 were enrolled in this study. They were randomly allocated into 3 groups (n＝30 for each group), that is, V1, V2 and V3 groups, according to different administration velocities and time points of sufentanil and propofol. The concentrations of sufentanil and propofol were 1mg/L and 10g/L respectively. In 2min after injection of 0.1μg/kg sufentanil, the patients of V1 and V2 groups were administered with 1mg/kg propofol. Sufentanil and propofol were delivered at the speed of 1ml/10s and 1ml/8s respectively in both V1 and V2 groups. In 30s after loss of eyelash reflex (LER), the patients received injection of 10～20mg propofol. After receiving injection of 0.1μg/kg sufentanil, the patients in V3 group were administered 1mg/kg propofol immediately. The 2 drugs were delivered at a velocity of 1ml/5s. After LER, the gastroscopy began. A bolus of 10～20mg propofol was administered in case of body movement. Their mean arterial pressure (MAP), heart rate (HR) and oxyhemoglobin saturation (SpO2) were observed among 3 groups before medication (T1), 2min after medication (T2), immediately after gastroscopy (T3), and 10min after gastroscopy (T4). Induction time, propofol dosage, palinesthesia time, as well as incidence of body movement and respiratory depression during gastroscopy were recorded and compared among the 3 groups. Results There was no obvious difference in terms of ASA physical status, age, gender, body mass, gastroscopy time and departure time among the 3 groups (P＞0.05). At T2, MAP, HR and SpO2 were significantly higher in V1 and V2 groups than in V3 group (P＞0.05). And these indices were lower in the 3 groups at T2 than at T1, T3 and T4. Compared with the V3 group, V1 and V2 groups had a significantly longer induction time (P＜0.05), smaller dosage of propofol (P＜0.05), shorter palinesthesia time (P＜0.05), and lower incidences of body movement and respiratory depression (P＜0.05). But, no obvious difference was seen in the above parameters between V1 and V2 groups (P＞0.05). Conclusion Sufentanil injected at speed of 1ml/8?10s followed by 10?20mg propofol in 2min later at the same speed can provide safe and effective anesthesia for gastroscopy in the elderly patients.

Abstract:Objective To compared the effect of different anaesthetic drugs on the serum levels of excitatory amino acids (EAA) in the elderly undergoing off-pump coronary artery bypass grafting. Methods One hundred and twenty patients at America Society of Anesthesiologist (ASA) Ⅱ or Ⅲ and aged 60 to 75 years who undergoing selective off-pump coronary artery bypass grafting in our department were enrolled in this study. They were randomly divided into propofol and remifentanil group (group P) and sevoflurane (group S) (n＝60 for each group). Group P received propofol and remifentanil to maintain anesthesia, and group S inhaled sevoflurane at the end-tidal concentration of 1.0%～1.5% during anesthesia. Blood samples were harvested from the internal jugular vein before anesthesia (T0), immediately after surgery (T1), at 24h (T2), 48h (T3) and 72h (T4) after surgery. Reverse-phase high-performance liquid chromatography with fluorescence was used to measure serum EAA concentrations. Results The serum concentrations of glutamic acid (Glu), asparagic acid (Asp) and glycine (Gly) were significantly higher at T2, T3 than at T0 (P＜0.05). The concentrations were significantly higher at T2 in group P than in group S (P＜0.05), and Glu concentrations was increased significantly at T3 (P＜0.05). But there was no significant difference in the Glu, Asp, Gly concentrations at T1 and T4 between the 2 groups (P＞0.05). Conclusions Anesthesia with propofol and remifentanil reduces the serum concentrations of EAA for the elderly undergoing off-pump coronary artery bypass, and thus protect them from postoperative cognitive dysfunction.

Abstract:

Abstract:

Abstract:In this article, we reported our successful treatment for a senile lymphoma patient (male, 98 years old) complicated by chylothorax. His initial symptoms were wheezing and trouble breathing at onset. We found he had left pleural effusion and enlarged left supraclavicular lymph nodes, and then he was diagnosed as chylothorax after thoracentesis and lymphoma by lymph node biopsy. After the lymphoma was treated by molecular target therapy and the chylothorax by dietetic treatment and pleurodesis, the left supraclavicular lymph nodes were significantly reduced, and the output of chylothorax was also decreased.

Abstract:Bone morphogenetic proteins (BMPs) belong to the superfamily of transforming growth factor-β (TGF-β), and are involved in multi-physiological functions, such as embryogenesis, bone metabolism, hemopoiesis, and neurogenesis. Recent studies suggest that BMPs be also closely associated with the metabolism of glucose, lipid and energy, and take part in the regulation of diabetes and its complications, including diabetic nephropathy, diabetic retinopathy, diabetic vascular lesions, and other processes. Therefore, BMPs can be used to regulate the development of diabetic obesity, and provide a new thought for the future treatment of diabetes.

Abstract:Adipocytokines, a series of bioactivie cytokines secreted by adipose tissue, are involved in energy homeostasis, immunity, endocrine regulation and other physiological activities, and play important roles in the regulation of metabolic balance. First-degree relatives of patients with type 2 diabetes mellitus, as higher-risk group of diabetes, are common to have abnormal adipocytokine secretion. This article reviewed the characteristics and influencing factors of adipocytokines levels in first-degree relatives of patients with type 2 diabetes mellitus.

Abstract:Abnormal glucose metabolism includes diabetes mellitus, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). A growing number of studies is showing that abnormal glucose metabolism may correlate with cognitive impairment, and increase the risk of Alzheimer’s disease (AD) at the same time. The abnormal glucose metabolism-related cognitive impairment may be associated with insulin resistance, blood-brain barrier transport of glucose disorders, and high glucose toxicity. Epigenetics is the study of heritable changes in gene expression or cellular phenotype caused by mechanisms other than changes in the underlying DNA sequence. The latest study found that improving insulin resistance and intervention at epigenetic aspects can prevent abnormal glucose metabolism-related cognitive impairment.

Abstract:Sleep deprivation leads to disturbance of the autonomic nervous system, which plays an important role in maintaining the stability of the cardiovascular system. Heart rate variability (HRV) analysis is a non-invasive and reliable tool in evaluating the activities of cardiovascular autonomic nervous system. In recent years, many studies focused on the evaluation of cardiac autonomic modulation in conditions of normal sleep and sleep deprivation by means of HRV analysis. Both acute and chronic sleep deprivations were proved to evoke dramatic and complex changes in HRV time-domain and frequency-domain indices. The changes of HRV were closely related to risks of cardiac events. The present article reviewed the studies on the fields mentioned above and brought forward an agenda for future research.

Abstract:“Revision” is a key link in paper publication, which deserves author’s great attention. From point of view of journal editors and reviewers, we introduced the importance and skills of paper revision, raised authors awareness on the practice, helped them for the satisfactory manipulation and to get papers published successfully and timely.