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Abstract:Objective To investigate the relationship of peri-operative cerebral oxygen saturation (rSO2) with post-operative cognitive function in the elderly patients under edaravone injection combined with intravenous and inhalation anesthesia in order to establish the guides for clinical anesthesia practice. Methods Sixty ASA Ⅰ-Ⅱ elderly patients (＞60 years old) who were scheduled for selective abdominal surgeries or surgeries on lower limb in our hospital from January 2013 to January 2014 were enrolled in the study. The patients were randomly divided into 3 groups (n＝20), edaravone group 1 (E1: 100ml 0.9% NaCl containing 30mg edaravone), edaravone group 2 (E2: 100ml 0.9% NaCl containing 60mg edaravone), and control group (C, 100ml 0.9% NaCl). The above fluids were intravenously infused in 30 min during operation. All patients were not premeditated before anesthesia and given with atropine 0.5mg until entering the operation room. Anesthesia was induced with intravenous infusion of propofol, fentanyl and cisatracurium slowly. After tracheal intubation, all patients were mechanically ventilated to maintain partial pressure of CO2 at end-tidal (PetCO2) at normal range. rSO2 was continuously monitored and recorded during operation. Mini-mental state examination (MMSE), trail-making test, and grooved pegboard test were used to access cognitive function at 24h before and at 4, 8, 12 and 24h after surgery. Results (1) There was no significant difference in the general status among the 3 groups (P＞0.05). (2) No obvious difference was found in the scores of MMSE, trail-making test and grooved pegboard test among the 3 groups at 24h before operation (P＞0.05). (3) The patients of groups E2 and E1 had higher scores of cognitive tests than those of group C (P＜0.05), but there was no difference in the value of rSO2 among the 3 groups (P＞0.05). Conclusion Edaravone injection combined with intravenous and inhalational anesthesia reduces the incidence of postoperative cognitive dysfunction in the elderly patients, which may be related to its unique neuroprotective effect, elimination of free oxygen radicals, inhibition of lipid peroxidation, regulation of the relative apoptotic genes, and enhancement of tolerance to ischemia and hypoxia in central nervous system.

Abstract:Objective To retrospectively analyze the clinical features and summarize comprehensive treatment and outcome for postherpetic neuralgia (PHN) in the aged patients. Methods Clinical data of all hospitalized elderly patients with PHN admitted in our hospital between January 2013 and December 2014 were collected and retrospectively analyzed for the clinical features, treatment and outcome of the disease. Results A total of 39 PHN patients were enrolled in this study, and they were 26 males and 13 females, at an average age of (71.3±8.3) years, and 33 of them were older than 60 years. Most PHN (74.4%, 29 cases) presented on the chest/rib cage. Their visual analogue score (VAS) was 6.9±0.8 at the time of admission and then decreased to 2.9±0.7 when being discharged after comprehensive treatment including systemic medication and nerve block anesthesia. Long-term follow-up indicated that 21% patients obtained a reduction in pain by 90%, and 56% of them by 50% relief. Conclusion The elderly are high-risk population for PHN. Systemic medication and nerve block show therapeutic effect on the disease in the elderly.

Abstract:Objective To evaluate the efficacy of the “Shamrock method”, ultrasound combined with stimulator guided continuous lumbar plexus nerve block for postoperative analgesia in the elderly after total knee arthroplasty by compared with continuous femoral nerve block. Methods An open, randomized, controlled trial was conducted on 80 ASA Ⅱ or Ⅲ patients (65 to 87 years old) undergoing total knee arthroplasty in our hospital from June to December 2014. The patients were randomly assigned to continuous lumbar plexus nerve block group (L group) and continuous femoral nerve block group (F group). The patients of the former group received continuous lumbar plexus nerve block by ultrasound guided “shamrock” and electronic nerve stimulator, and those of the latter group received continuous femoral nerve block by ultrasound guiding combined with stimulator. After the nerve block catheters were inserted and 30ml 0.2% ropivacaine was given, all patients received patient-controlled analgesia (PCA) after the surgery with 0.2% ropivacaine 5ml/h as the background dose. Visual Analogue Scale (VAS) was employed to evaluate the pain level at 6, 12, 24 and 48h, postoperatively. VAS pain scores were recorded at 24 and 48h, postoperatively, during functional excise and muscle strength. The toxic reaction, nausea and vomiting, and nerve damage were recorded after surgery. Results The VAS scores during rest and functional excise were significantly higher in F group than in L group (P＜0.05), but there was no difference in the muscle strength between the 2 groups (P＞0.05). No local anesthetic toxicity or nerve damage was founded in the both groups, and there was no statistical difference in the incidence of side effect such as nausea and vomiting during postoperative analgesia. Conclusion The ultrasound-guided “shamrock” combined with stimulator for continuous lumbar plexus nerve block is superior to continuous femoral nerve block in analgesia for postoperative analgesia in the elderly after total knee arthroplasty.

Abstract:Objective To determine the clinical efficacy of sustained release tablets of hydrochloride tramadol combined with pregabalin on the treatment of post-stroke thalamic pain in order to provide reference for clinical practice. Methods Forty patients with post-stroke thalamic pain admitted into our department from July 2010 to December 2014 were randomly divided into 2 groups, test group (tramadol and pregabalin, n＝22) and control group (tramadol alone, n＝18). Results Numerical Rating Scale (NRS) indicated that the pain level was significantly relieved in the test group after the treatment, and the relief was more significant than that of the control group. The effective rate and total effective rate of clinical treatment were significantly higher in the test group than in the control group (P＜0.05). Conclusion Combination of tramadol and pregabalin can effectively relieve the post-stroke thalamic pain and attenuate physical discomfort. Superior to simple tramadol, the treatment is of more ideal clinical efficacy and fewer adverse effects, and is worthy of clinical promotion.

Abstract:Objective To determine the effect of essential hypertension (EH) with different risk stratification on the morphology and function of bulbar conjunctival microcirculation in EH patients. Methods Blood pressure (grades 1, 2, and 3), other cardiovascular risk factors (age, smoking, blood cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, family history of premature cardiovascular diseases, body mass index, and high sensitivity C reactive protein), and target organ damage and complications were used to stratify 118 EH patients admitted in the hypertension clinic of our hospital from April 2014 to February 2015. Bulbar conjunctival microcirculation was monitored and analyzed in the patients and 20 healthy volunteers in the same period. Results Compared with the healthy volunteers, the low-risk patients had statistically sparser grid structure, less microvessels, and thinner venules (P＜0.05). While the moderate-, high-, and very high-risk patients displayed obvious changes in morphology, blood flow in microvessles, and surrounding loop state. The morphological changes were mainly characterized by blurred vision, reduced microvessels, thinner arterioles and venules, more microvessels of uneven diameters, grid structure and microaneurysm, cystic dilation and ischemic area. They also showed slowed blood flow velocity, increased erythrocyte aggregation and exudation, and hemosiderin deposition in surrounding loop. With the increase in risk stratification, there were gradually more grid structure density, decreased number of microvessels, reduced blood flow velocity, and enhanced erythrocyte aggregation (P＜0.05). Conclusion EH patients with different risk stratification show different alterations in bulbar conjunctival microcirculation.

Abstract:Objective To explore the risk factors for death due to lung cancer in retired military cadres from Xi’an city. Methods A cohort study was carried out on the retired male military cadres from 22 cadre’s sanitariums in Xi’an, China from 1987 to 2009. A total of 1 268 cadres aged 55 years or older were enrolled in 1987 and followed up in the next 23 years. The endpoint was settled as lung cancer death. Multivariate Cox proportional hazards model was employed to calculate relative risk (RR) and 95% confidence interval (CI) values. Results The total amount of person-year was 21 300.05 in the study until September 30, 2009, and the average person-year was 16.80 years. Among those suffering from lung cancer, 725 cadres died, 527 were alive and 16 lost of follow-up. Multivariate analysis of Cox model showed that smoking index, histories of chronic obstructive pulmonary disease (COPD) and other cancers were risk factors for lung cancer deaths (RR＝1.001, 95%CI: 1.001?1.002; RR＝1.966, 95%CI: 1.261?3.065; RR＝6.628, 95%CI: 2.399?18.317). The risks for deaths were increased significantly with the increasing amount and duration of smoking. Starting smoking before the age of 17 increased the risk of lung cancer by 90.8%. Conclusion Smoking and histories of COPD and other cancers are the risk factors for lung cancer deaths in the cohort of the elderly males, especially those starting to smoke before the age of 17.

Abstract:Objective Cognitive impairment is one of the most serious non-motor symptoms of Parkinson’s disease (PD), and appears even in early stage of the disease. Our study aimed to analyze the association of catechol-O-methyltransferase (COMT) polymorphism and related factors with cognitive impairment in Chinese PD population. Methods A total of 1 087 Chinese PD patients were recruited by Chinese Parkinson Study Group (CPSG) from 29 research centers throughout all over the country. They were divided into cognitive impairment group (n＝385) and non-cognitive impairment group (n＝702) according to their medical history and clinical data. COMT genotype was sequenced. Chi-square test and Fisher’s exact test were used to analyze the association between cognitive impairment and COMT polymorphism, and binary logistic regression model was used to screen the risk factors for cognitive impairment. Results There were no significant differences in the genotype and allele of the objective gene between the two groups (P＞0.05). Logistic regression analysis showed that age at onset, Hoehn-Yahr score, and Unified Parkinson’s Disease Rating Scale (UPDRS) Ⅲ score were positively correlated with cognitive impairment. The PD patients with older age at onset, higher scores in Hoehn-Yahr scale and UPDRS Ⅲ were prone to have cognitive impairment. Conclusion Cognitive impairment is related to the age at onset and severity of the disease.

Abstract:Objective To investigate the imaging features of subcortical ischemic vascular disease (SIVD) and their correlation with cognitive impairment in the elderly. Methods Clinical data of 99 elderly patients (60 to 75 years old) with SIVD admitted in our department from September 2014 to January 2015 were collected. According to the results of head magnetic resonance imaging (MRI), the patients were divided based on the number of lacunar infarction (LI) lesions in the basal ganglia and thalamus area, and on the severity of white matter lesion (WML) by Cholinergic Pathway High Signal Rating Scale (CHIPS). Montreal Cognitive Assessment (MoCA, Beijing version) and Alzheimer’s Diseases Assessment Scale-Cognitive (ADAS-Cog) were used as assessing tools to analyze the correlation of severity of LI or WML with cognitive function. Results MoCA and ADAS-Cog scale indicated that there was no difference in cognitive function between the moderate and mild LI or WML patients (P＞0.05), but significant difference was seen between the severe and mild patients (P＜0.05). For the patients with mild and moderate WML and severe LI (infarct lesions＜7), no cognitive impairment was observed (P＞0.05). While the number of infarct lesions ≥7, the mild and moderate WML patients suffered from cognitive impairment (P＜0.05). Conclusion Cognitive impairment is found in the elderly patients with severe WML or with multiple LI in the basal ganglia and thalamus area, and in those with mild and moderate WML and coexisting multiple LI.

Abstract:Objective To explore the changes in serum trace elements and its correlation with biochemical indicators and development of type 2 diabetes mellitus (T2DM) in patients with T2DM. Methods A total of 89 patients with confirmed T2DM admitted in the Endocrinology Department, Xuhui District Central Hospital of Shanghai from June 2012 to June 2014 were enrolled in this study. Another 97 non-T2DM patients (having no significant differences in age, sex, body mass index, and waist-hip ratio with the T2DM group) in our hospital at the same duration were recruited as control group. Fasting blood glucose (FBG), 2-hour postprandial glucose (2hPBG), glycosylated hemoglobin A1c (HbAlc), fasting insulin (FINS), and peptide C were measured. Inductively coupled plasma mass spectrometry (ICP-MS) was used to detect the serum levels of trace elements, Fe, Zn and Se. The correlation of serum trace elements with biochemical indicators and T2DM was analyzed. Results Serum levels of Fe, Zn and Se were significantly lower in T2DM group than in control group (P＜0.05), and also remarkably reduced in the T2DM patients with HbAlc ≥7.0% than in those with HbAlc ＜7.0% (P＜0.05). Pearson correlation analysis showed that there was positive correlation between Fe and Zn, Fe and Se, and Zn and Se, respectively (r＝0.668, 0. 725, 0.754, P＜0.05). Serum levels of Fe, Zn and Se were all highly correlated with HbAlc, FBG, 2hPBG, FINS and peptide C. Multivariate logistic regression analysis showed that Zn and Se were the protective factors for T2DM (β＝-1.302, -1.578; P＜0.05). Conclusion The serum levels of trace elements are generally low in T2DM patients, and the levels are closely related to the glycometabolism. So maintaining the balance of trace elements is of positive significance in the prevention or onset delay of T2DM.

Abstract:Objective To determine the efficiency of structured triglycerides [STG, with the ratio of medium-chain triglycerides to long-chain triglycerides (MCT/LCT) accounting for 36% to 64%] for total parenteral nutrition (TPN) in the elderly patients with gastrointestinal (GI) tumor operation. Methods Sixty-eight elderly pathologically-identified GI tumor patients undergoing surgical treatment and then being admitted to the Department of Geriatrics of our hospital from January 2012 to October 2014 were recruited in this study. The cohort was randomly divided into 2 groups, STG group (n＝35) and MCT/LCT group (the ratio accounting for 50% to 50%, n＝33). They were all given TPN for 6 d after their operations. The parameters of nutrition, lipid metabolism, glucose metabolism, liver enzymes, bilirubin, high sensitivity C-reactive protein (hs-CRP) and immunologic profiles at baseline and 3 and 6d after treatment were measured and recorded respectively. Results There was no significant difference in the above-mentioned parameters between the 2 groups before and immediately after surgery. The levels of total protein (TP), albumin (ALB) and total cholesterol (TC) in the both groups, that of prealbumin (PAB) in the STG group, and that of low-density lipoprotein-cholesterol (LDL-C) in the MCT/LCT group were significantly increased after 6 days’ isonitrogen isocaloric nutritional support (P＜0.05). The nutritional parameters were significantly higher in the STG group than in the MCT/LCT group at the same time points (P＜0.05), but the levels of TC and LDL-C were remarkably lower in the former than in the latter. At 3d after treatment, the level of hs-CRP was reduced significantly in STG group compared to that of before treatment (P＜0.05), and the reduction was greater than that in the MCT/LCT group (P＜0.05). The CD3+ and CD4+ cell counts were increased significantly than before treatment in both groups (P＜0.05), but the counts of CD3+ and CD4+ cells and the ratio of CD4+/CD8+ were much higher in the STG group than in the partner one (P＜0.05). No statistical difference was seen in glucose levels, liver function and bilirubin level between the 2 groups after treatment (P＞0.05). Conclusion STG is superior to the conventional MCT/LCT in promoting protein synthesis, stabilizing lipid profiles, ameliorating the inflammatory reaction, as well as regulating the immune system, for TPN in the elderly patients after GI tumor operation, and also has higher safety in clinical application.

Abstract:Objective To investigate the clinical significance of serum testosterone level in senile male patients with diabetic nephropathy (DN). Methods A total of 80 male diabetic patients over 75 years old admitted in our department from January 2013 to June 2014 were enrolled in this study. Thirty-four of them were diagnosed as DN and then assigned as DN group, and the other 46 without renal disease as non-diabetic nephropathy (NDN) group. Another 20 age-matched males without diabetes taking physical examination during same period served as controls. Their serum levels of testosterone, cystatin C (CysC) and urine microalbumin were detected. Their kidney ultrasound images were collected. The results were compared between the DN and NDN groups. Results Compared with control group, the serum level of testosterone was lower in diabetic male patients (P＜0.01). The serum level of testosterone was markedly lower [(13.18±3.29) vs (22.07±7.53)nmol/L, P＜0.01], but that of CysC was higher [(2.61±0.96) vs (1.09±0.34)mg/L, P＜0.01] in DN group than in NDN group. Serum level testosterone was negatively correlated with CysC (r＝-0.658，P＜0.01). Conclusion In the senile male diabetic patients, those with DN have lower serum testosterone level than those without, which is negatively correlated with CysC level. Serum testosterone level may be helpful to develop early intervention strategies to improve prognosis.

Abstract:Objective To determine the effect of intravenous amiodarone on the rapid ventricular rate in the patients with atrial fibrillation (AF) and congestive heart failure (CHF). Methods Seventy elderly patients with AF and CHF [ventricular rate ＞120beats/min, New York Heart Association (NYHA) class Ⅱ?Ⅳ] hospitalized in the Northern Jiangsu People’s Hospital from September 2012 to September 2013 were recruited in this study. They were randomized into 2 groups: amiodarone group (n＝35, loading dosage of 150mg followed by a dose of 1.5mg/min) and deslanoside group (n＝35, loading dosage of 0.4 or 0.2mg in slow injection, and more 0.2mg should be medicated if no effect occurred in 1h later). The ventricular rate, mean response time, successful cardioversion ratio, brain natriuretic peptide (BNP) level, the adverse effects and follow-up outcomes were recorded after medication. Results The ventricular rate was significantly decreased in 1, 2 and 24h after treatment than before in both groups (P＜0.01), even in 30 min in amiodarone group (P＜0.01). In 2h after treatment, the ventricular rate was reduced by 47% in amiodarone group and by 28% in deslanoside group when compared with the rate before treatment. Significant difference was found in the rate between the 2 groups in 30min, 1h, 2h and 24h after treatment (P＜0.01). The total effective rate on controlling rapid AF was 79.8% (amiodarone group) and 72.3% (deslanoside group) respectively (P＞0.05). In 3 months after discharged from hospital, the ratio of persistent AF after the medications (amiodarone, metoprorol and digoxin) was 60.0% (21/35) and 82.9% (29/35), respectively, and the rate of adverse effect was 8.6% and 11.4%, respectively, in the 2 groups (P＞0.05). Conclusion Amiodarone is of safety, rapid effect and mild adverse effect in treatment of CHF patients with coexisting AF.

Abstract:Objective To determine the effect of music therapy on the quality of life (QOL) of terminal elderly patients with advanced cancer. Methods A total of 155 patients aged over 60 years at terminal stage of advanced cancer were randomly divided into the study group (n＝58) and the control group (n＝97). The patients in both groups received the conventional basic nursing and symptomatic therapies. The patients of study group received music therapy additionally, for 30 to 50min per time, twice per day, 10 times per week, totally 4 consecutive weeks. The self-edited questionnaire survey and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were employed to assess the QOL of the patients before and after the study. Results After the therapy, the emotional function, cognitive function, social function and the total score of QLQ-C30 of the patients in study group were increased significantly (P＜0.05). Some symptoms such as fatigue, pain, insomnia, nausea and vomiting were getting better (P＜0.05). Conclusion Music therapy is easy, simple and operable in end-of-life care. It can significantly improve the QOL of terminal elderly patients with advanced cancer.

Abstract:Objective To analyze the efficiency of long-term oxygen therapy on the right ventricular function in the patients with chronic obstructive pulmonary disease (COPD). Methods A total of 40 COPD patients (22 males and 18 females) with pulmonary function level Ⅰ but normal two-dimensional electrocardiogram admitted in our hospital from October 2011 to March 2012 were enrolled in the study. They all insistently took oxygen uptake at a low flow rate of 2L/min, 10h per day for 1 year. Echocardiography and lung function test were performed in 1d before, in 3 and 6 months and 1 year after oxygen uptake, respectively. Results Speckle tracking echocardiography indicated that strain of basal segments of right ventricular free wall (Sbasfw), strain rate of basal segments of right ventricular free wall (SRbasfw), strain of middle segments of right ventricular free wall (Smidfw), and strain rate of middle segments of right ventricular free wall (SRmidfw) were all dramatically increased after 3 months’ oxygen uptake treatment than the values in 1d before treatment (P＜0.05). With the time elapse of oxygen uptaking, Sbasfw, SRbasfw, Smidfw and SRmidfw were obviously increased (P＜0.01). Right ventricular longitudinal shortening (Tm%) was elevated in 3 months after oxygen uptake, which were significantly higher than before treatment (P＜0.05), and continued to arise along with the treatment (P＜0.01). Tricuspid annular systolic peak displacement at right ventricular free wall (T1), tricuspid annular systolic peak displacement at interventricular septum (T2) and tricuspid annular systolic peak displacement at midpoint of tricuspid annulus (Tm) all began to increase after 6 month, which had statistical difference with the data before oxygen uptake (P＜0.05), and continued to elevate with oxygen uptake time. Forced expiratory volume in one second (FEV1) and percentage of FEV1 were obviously higher after 1 year’s treatment than before (P＜0.05). Conclusion Long-term oxygen therapy significantly improves the right ventricular systolic function in COPD patients, and its effect appears earlier on the improvement to right ventricular function than to lung function.

Abstract:Objective To investigate the effect of long-acting nitrate on the left ventricular function and the expression of α1- and β-adrenergic receptors subtypes in the lung tissue of rats with myocardial infarction-induced chronic heart failure (CHF). Methods Ninety inbred male Wistar rats were divided into normal control group (N group, n＝9), sham-operation group (SH group, n＝8) and heart failure (HF) model group (n＝73). The HF model was successfully induced by ligating left anterior descending (LAD) artery in 44 rats. In 4 weeks after operation, the rats from the model group were divided into 5 groups, HF group (HF group, n＝9), low-dose nitrate group (LN group, n＝9), high-dose nitrate group (HN group, n＝9), positive medicine (olmesartan) control group (OL group, n＝9) and high dose nitrate combined with positive medicine group (HN＋OL group, n＝8). The medication was given by gastric gavage for 6 weeks. Cardiac function was examined by echocardiography before and after the treatment, and the expression of β1-AR, β2-AR, β3-AR, α1A-AR, α1B-AR, and α1D-AR at mRNA and protein levels in the lung parenchyma was determined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. Results After the treatment, left ventricular ejection fraction (LVEF) was markedly higher in HN, OL and HN＋OL groups than in HF group (P＜0.05). Compared with SH group, the expression of α1A-AR, α1B-AR, and β2-AR was significantly up-regulated (P＜0.05), and that of β1-AR and β3-AR was down-regulated in HF group (P＜0.05). Compared with HF group, the expression of α1A-AR, α1B-AR, and β2-AR was significantly down-regulated, and the expression of β1-AR and β3-AR was significantly up-regulated in HN, OL, and HN＋OL groups (P＜0.05). Furthermore, there was significant difference in the expression of above subtypes between the OL group and HN＋OL group (P＜0.05). No obvious difference was seen in the expression level of α1D-AR among all groups. Conclusion Long-acting nitrate therapy remarkably improves LVEF in CHF rats induced by myocardial infarction, reverses the lung expression levels of α1- and β-AR subtypes to normal, and exerts a beneficial effect on the protection of lung function.

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Abstract:Mitochondrial DNA mutation is associated with a variety of diseases. Although only constituting 10% of the entire mitochondrial genome, the transfer RNA (tRNA) genes have become a hotspot in the study concerning the relationship of the mitochondrial gene mutation with diseases. Previous studies on the genetics of hypertension mainly concentrated in the nuclear genes, but recent studies found that mitochondrial DNA mutations may be involved in the occurrence and development of essential hypertension (EH). What’s more, much evidence indicated that close association was found between mitochondrial tRNA with the EH occurrence and development. In this article, we summarized the relationship between the mitochondrial tRNA mutation and pathogenesis of hypertension, and reviewed the underlying mechanism.