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Abstract:Probiotics are living microbes which may give health benefit to the host. Despite their wide usage, the clinical use of probiotics lacks support from reasonable big data. Dozens of clinical studies have reported that probiotics are a promising strategy for the prevention and treatment of antibiotic-associated diarrhea (AAD). However, based on data from recent randomized controlled trials, it is hard to give a positive answer to whether probiotics could decrease the incidence of AAD in the elderly. Up till now, probiotics have a very good safety record. The use of probiotics may be beneficial for certain elderly patients including AAD, while needs be considered individually.

Abstract:Some elderly hypertensive patients may manifest as diastolic blood pressure (DBP) lower than 60mmHg, a phenomenon known as isolated systolic hypertension (ISH) with low diastolic pressure. More and more evidence shows that DBP ＜70mmHg is detrimental to the body. What’s more, the ISH patients with lower DBP often have more risk factors and are of higher risk for cardiovascular events, which become a difficulty for the treatment of the elderly hypertension. Nitrates may be a good option.

Abstract:The elderly are at a much higher risk of atherosclerostic cardiovascular disease (ASCVD), while dyslipidemia is reported as an independent risk factor for ASCVD. Management of dyslipidemia, especially cholesterol-lowering therapy, exerts significant effect on the primary and secondary prevention for ASCVD with a good safety profile in the elderly. On the basis of improving lifestyle, statin is a prior choice for the management of dyslipidemia. Personalized therapeutic strategy for the elderly should include proper initial dosage of lipid-lowering drug according to the lipid levels and ASCVD risk stratification, and then titration of the dosage based on response to therapy for the purpose of reaching low-density lipoprotein cholesterol (LDL-C) target as the same as to young people.

Abstract:Cerebrovascular diseases are a group of brain dysfunctions related to disease of the blood vessels supplying the brain, and characterize by high incidence, high morbidity and high mortality. Acute cerebrovascular disease is also known as stroke. Elderly stroke patients have poor prognosis than those young. Standardized diagnosis and treatment of stroke are helpful to reduce the mortality and morbidity. Drug therapy is one of the main options in the treatment of the disease. However, the elderly patients have the characteristics of slow metabolism, poor elasticity of blood vessels and commonly co-existing multiple organ disorders. In this paper, we summarized and overviewed the rational use of medication for acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), the most common types of cerebrovascular diseases in the elderly.

Abstract:Alzheimer’s disease (AD) is the most common type of senile dementia. Though with more and more profound understanding of the disease, there are still relatively limited types of drug for its treatment, and the drug treatment is lack of overall standardization. In this paper, we discussed rational drug use for AD systematically, and hope to improve or delay its progression with rational drug therapy.

Abstract:Irrational drug therapy may appear during the whole therapeutic process and in every step. The irrational medication for asthma primarily manifests in the improper overall arrangement of medication and inappropriate design and implement of therapeutic schedule. Whether rational medication or not should be judged on the basis of the characteristics of the disease, the patient and the drug itself. We need to do our best to find out the irrational drug therapy, and then manage it actively by adjusting the direction and goal of medication, and/or adjusting the schedule and implement of medication. What’s more, we should be aware of the relativity of rational and irrational drug therapy. In the process of managing the irrationality, we must be flexible, and should assess the pros and cons, balance benefits and harms, avoid disadvantages, and then make appropriate decisions finally.

Abstract:Objective To investigate the clinical features of isolated systolic hypertension (ISH) in very elderly patients and their condition after drug therapy. Methods Clinical data of 403 very elderly hospitalized patients (≥ 80 years old) suffering from ISH in our hospital from January 2008 to October 2009 were collected. All of them were followed up for duration of 5 years. Their basic data, incidences of hypertensive and cardiovascular complications, the usage of antihypertensive drugs, including calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), angiotensin Ⅱ-receptors antagonist (ARB), β-receptor blocker, diuretics, α-receptor blocker, and nitrates were analyzed. Results Among the 403 patients, 83 patients (20.6%) were grade Ⅰ hypertension, 216 (53.5%) grade Ⅱ hypertension, and 104 (25.8%) grade Ⅲ hypertension. There were 375 cases (93.1%) having complications before treatment, and 397 cases (98.5%) after 5 years’ treatment. The patients with systolic blood pressure (SBP) above 150mmHg and diastolic blood pressure (DBP) below 60mmHg had the highest incidences of complications. No matter the patients were divided according to their age or blood pressure, the blood pressure was well-controlled. The rate of well-controlled blood pressure was 83.9% after 12 weeks’ treatment, and 84.4% in 5 years later, both with significant difference when compared with the pressure before treatment (SBP, P＜0.01; DBP, P＜0.05). There were 135 cases having SBP below 140mmHg, and 55 cases having DBP below 60mmHg. CCB was most commonly used antihypertensive drug (n＝182), followed by β-receptor blocker (n＝179), diuretics (n＝167), nitrates (n＝132), ACEI (n＝112), ARB (n＝112), and α-receptor blocker (n＝5) sequentially. Most of the patients used more than 1 kind of antihypertensive drugs (329, 81.6%). Among them, those took combination of 4 kinds were the least (53, 13.2%), and those administered combination of 2 kinds was the most (180, 44.7%). Only 74 patients (18.4%) used only 1 kind of antihypertensive drug. Conclusion It is quite common for the very elderly ISH patients to have complications. In clinical practice, antihypertensive drug should be selected according to the patient’s condition, and individualized therapy needs to be designed based on blood pressure and comorbidities. Most of the patients need combination of different drugs. During the treatment, clinician should control not only SBP, but also DBP. DBP below 60mmHg might increase the incidence of cardiovascular complications.

Abstract:Objective To determine the effect of circadian rhythm of blood pressure on cognitive function in the very old patients with hypertension. Methods A total of 96 senile hypertensive patients (older than 80 years old) admitted in our department from June 2013 to August 2014 were recruited in this study. According to the results of Mini-Mental State Examination (MMSE), the patients were divided into normal cognitive function group (control group, n＝61) and mild cognitive impairment group (MCI group, n＝35). The general conditions, complications and ambulatory blood pressure parameters were compared between the 2 groups. Results There was no significant difference in 24-hour systolic blood pressure (24hSBP) and 24-hour diastolic blood pressure (24hDBP) between the 2 groups [(131.14±12.61) vs (131.00±13.17)mmHg, and (65.74±7.35) vs (64.08±8.39)mmHg, P＞0.05). No difference was found either in day SBP (dSBP), day DBP (dDBP), night SBP (nSBP) and night DBP (nDBP) between the 2 groups (P＞0.05). However, morning surge in blood pressure was significantly higher in MCI group than in control group [(8.69±12.64) vs (4.08±12.78)mmHg, P＜0.05]. Conclusion Higher morning blood pressure is associated with cognitive impairment in the very old patients with hypertension.

Abstract:Objective To observe the clinical efficiency of batroxobin combined with methylprednisolone in the treatment of sudden hearing loss. Methods A retrospective analysis was performed on 110 patients with (118 ears) sudden deafness in the Hainan Branch of Chinese PLA General Hospital from August 2012 to October 2014. According to their treatment regimen, they were assigned into observation group (n＝57, 62 ears, conventional treatment plus batroxobin and methylprednisolone) and control group (n＝53, 56 ears, only conventional treatment). The cohort was also divided into 4 groups according to the pure tone hearing threshold graphics, that is, low frequency hearing loss (38 ears), high frequency hearing loss (51 ears), flat type (12 ears), and total deafness (17 ears). Results After treatment, the observation group had 11 ears (17.7%) recovered, 32 ears (51.6%) markedly effective, 16 ears (25.8%) effective, and 3 ears (4.8%) invalid, with a total efficiency rate of 95.16%. There were 6 ears (10.7%) recovered, 21 ears (37.5%) markedly effective, 20 ears (35.7%) effective, and 9 ears (16.1%) invalid in the control group (total efficiency rate 83.93%). Significant difference was seen in the total efficiency rate between 2 groups (P＜0.05). Low frequency hearing loss type deafness had better prognosis, flat type deafness had good, high frequency hearing loss type deafness had bad, and total deafness type hearing loss type deafness had worst prognosis. There were significant differences in the efficiency of different treatment regimen for different deafness types between 2 groups (P＜0.05). Conclusion Combination of batroxobin and methylprednisolone is efficient and safe in the treatment of sudden hearing loss, and worthy of clinical promotion. Different types of sudden deafness have widely various prognosis.

Abstract:Objective To determine the efficiency and safety of combined treatment of Zhenyuan capsule with lorazepam for anxiety symptoms in the elderly patients with chronic heart failure (CHF). Methods Hamilton Anxiety Scale (HAMA) was employed to assess 315 CHF patients (≥60 years old) admitted in our department from January 2013 to February 2015. Eighty-one of them with anxiety symptoms were screened out and then randomly divided into 2 groups, lorazepam alone group (control group, n＝40) and Zhenyuan capsule combined with lorazepam group (treatment group, n＝41). Besides these, conventional drug treatment, psychological intervention and rehabilitation training were given to both groups. In 4 weeks later, they were compared by scores of heart functions, HAMA scores, Self-rating Anxiety Scale (SAS) score, left ventricular ejection fraction (LVEF), and serum level of N-terminal B-type natriuretic peptide (NT-proBNP). Results The treatment group had better heart function, HAMA score and SAS score than the control group (P＜0.05). LVEF and NT-proBNP level were both improved in the 2 groups, with more obviously in treatment group, but there was no significant difference between the 2 groups (P＞0.05). Conclusion Zhenyuan capsule combined with lorazepam improves the curative effect on anxiety symptoms in elderly CHF patients, and has less adverse reaction, good compliance and better efficiency than lorazepam alone.

Abstract:Objective To determine the effect of percentage of atrial pacing on atrial fibrillation (AF) by observing AF burden in the elderly patients with sick-sinus syndrome (SSS) after dual-chamber pacemakers implantation. Methods A retrospective analysis was performed on 301 patients receiving dual-chamber pacemakers implanted in our center from January 2006 to January 2012. They were followed up for (3.9＋1.8) years, and finally 283 of them were enrolled in this study. The numbers of atrial premature, longest duration of AF, AF burden, and percentages of atrial and ventricular pacing were obtained through the pacemaker during follow-up, and the structure and function of heart were evaluated. The patients were divided into 2 groups according to the percentages of atrial pacing (66% as the median of atrial pacing): the high atrial pacing group (141 cases) and the low atrial pacing group (142 cases). Results When compared with the low atrial pacing group, the high atrial pacing group had significantly lower AF burden (including the longest duration of AF and the median of AF burden), and smaller numbers of atrial premature(both P＜0.05). But no difference was seen in the percentage of ventricular pacing between the 2 groups (P＞0.05). There was no obvious difference in the heart structure and function before and after implantation (P＞0.05). Conclusion High percentage of atrial pacing reduces the burden of AF for the elderly SSS patients implanted with dual-chamber pacemaker.

Abstract:Objective To observe the short-term efficacy, side effects, impact on quality of life (QOL) of capecitabine alone in treating elderly patients with advanced colorectal cancer. Methods Thirty-nine elderly patients [aged (73.2±2.5) years, ranging from 69 to 82 years] with pathological identified advanced colorectal cancer admitted in our hospital from October 2009 to February 2014 were enrolled in this study, and they all were treated with 2 500mg/(m2·d) capecitabine for 14 consecutive days and an interval of 7d (a cycle). The effectiveness and side effects were evaluated for every 2 cycles. Quality of Life Questionnaire (QLQ-C30), designed by European Organization for Research on Treatment of Cancer (EORTC), was conducted on the patients before and in 6 weeks after the therapy. Results Among the 39 patients, there were 1 case of complete remission, 11 cases of partial remission, 18 cases of stable disease, and 9 cases of progressive disease. The efficient rate was 30.76%, and tumor control rate was as high as 76.92%. The main side effects were hand-foot syndrome (61.54%), bone marrow depression (66.67%), and skin pigmentation (64.10%), and all these symptoms were mild. Their physical function, role function, social function and overall health score were increased significantly when compared with the conditions before treatment (P＜0.05). Conclusion Capecitabine therapy alone is effective and only causes mild side effects for the elderly patients with advanced colorectal cancer, and it also improves their QOL.

Abstract:Objective To investigate the clinical significances of blood glucose, blood lipids, uric acid (UA) and inflammatory factors between the patients with Alzheimer’s disease (AD) and vascular dementia (VD). Methods Mini-Mental State Examination (MMSE) was used to survey the elderly in-patients and out-patients in the Luwan Branch of Ruijin Hospital from January 2013 to February 2015. Finally, 27 AD patients, 32 VD patients and 30 sex- and age-matched normal individuals were enrolled in this study. Their body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), UA, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP) and interleukin-6 (IL-6) were measured. Results The SBP, FPG and HbA1c were markedly higher in the AD and VD patients than in the normal controls (P＜0.05). The UA level was lower in AD and VD patients than in controls, but there was no significant difference. The AD and VD patients had significantly higher TC, TG and LDL-C levels (P＜0.05) and obviously lower HDL-C level (P＜0.01) than the normal individuals, but there was no significant difference between the AD and VD patients (P＞0.05). Compared with normal controls, both AD and VD patients had markedly higher CRP and IL-6 levels (P＜0.05), and more obvious in the latter group (P＜0.05). Conclusion The elderly patients with AD and VD have abnormal metabolism of glucose and lipids and inflammatory reaction. Regulation of blood lipids and glucose may be one of the effective measures in the prevention and treatment of SD.

Abstract:Objective To evaluate the clinical efficiency of atorvastatin calcium in the treatment of senile cerebral arteriosclerosis. Methods A total of 124 elderly patients with cerebral arteriosclerosis admitted in our hospital from December 2012 to December 2014 were subjected in this study. They were randomly divided into test group and control group (n＝62). The control group was given conventional treatment, and the test group was administered by atorvastatin calcium besides of conventional treatment for 6 months. Blood lipids, intracranial artery elasticity index, size of carotid artery plaque and incidence of cerebrovascular diseases were measured and compared between the 2 groups. Results The blood lipids, intracranial artery elasticity index, and size of cerebral artery plaque were obviously improved in the 2 groups after treatment when compared with before the treatment (P＜0.05), and those in the test group were more significant than in the control group (P＜0.05). The total effective rate was 98.4% in the test group, remarkably higher than that of the control group (80.6%, χ2＝5.436, P＜0.05). The incidence of cerebrovascular disease was markedly lower in the test group than in the control group (3.2% vs 16.1%, χ2＝5.324, P＜0.05). Conclusion Atorvastatin calcium effectively attenuates the symptoms in the elderly patients with cerebral arteriosclerosis, and reduces the occurrences of cerebrovascular diseases.

Abstract:Objective To determine the effect of platelet-derived growth factor-C (PDGF-C) on vascular endothelial cells (VECs) and mesenchymal stem cells(MSCs) cultured in vitro. Methods The VECs were isolated from thoracic aorta of SD rats and then cultured in vitro. Cryopreserved MSCs were cultured after water bath at 37℃. Cell counting and MTT assay were used to detect the effect of PDGF-C (0, 10, 20, 30, 40 and 50μg/L) on cell proliferation. Flow cytometry was used to detect cell phases. Transwell assay and cell scratch test were used to detect cell migration. Results PDGF-C significantly promoted the proliferation of VECs and MSCs, and increased the percentage of the cells arrested at S phase. Its effect on the VECs proliferation was found in a dose-dependent manner. PDGF-C of 20μg/L promoted the MSCs proliferation at a summit. PDGF-C also promoted the migration ability of cultured VECs and MSCs, especially on MSCs. Conclusion PDGF-C promotes the proliferation and migration of cultured VECs and MSCs.

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Abstract:Dementia with Lewy bodies (DLB), also known as Lewy body dementia, is the second most commonly degenerative cause of dementia in the elderly. At present, there are few reports about DLB confirmed by autopsy in our country. The main clinical manifestations of the patient were progressive cognitive decline, intermittent mental and behavior disorder, visual hallucination, sensitive to antipsychotic drugs, and parkinsonism and/or autonomic nervous system dysfunctions along with the progress. Here we reported such 1 case. The results of autopsy pathology showed that α-synuclein positive Lewy bodies existed extensively in the cytoplasm of cortical and subcortical neurons, which verified the clinical diagnosis before the patient’s death. We hope to enhance the recognition of the disease and facilitate its early diagnosis through studying this case.

Abstract:Some researches have shown that type 2 diabetes mellitus may increase the risk of lung cancer. However, it is still lack of effective evidence on the underlying mechanism. This article reviewed that their epidemiological characteristics, hyperglycemia, insulin resistance and hyperinsulinemia, insulin and insulin-like growth factor, vascular endothelial growth factor, inflammatory cytokines, disorder of hormones regulating function, reduced immune system function, disorder of trace elements and the glucose-lowering therapies in diabetes patients may be associated with an increased incidence of lung cancer. However, more studies are needed to further investigate the mechanism urderlying type 2 diabetes mellitus promoting the incidence of lung cancer.