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Abstract:Pulmonary vascular diseases are common and detrimental diseases. Based on the pathological and physiological conditions, the clinical manifestations, treatment and prognoses in elderly patients are different from those in the young ones. Therefore, to make a correct diagnosis at an earlier stage and to investigate the effective treatment strategies are important in preventing fatal organ damage in the elderly patients.

Abstract:Objective To investigate the clinical features, prognosis and factors influencing survival for the elderly patients with pulmonary thromboembolism (PTE). Methods A total of 627 patients with identified acute PTE admitted in Beijing Chaoyang Hospital from January 2006 to March 2011 were enrolled in this study. They were divided into the ≥65 year-old group (n＝309) and the ＜65 year-old group (n＝318). Their clinical data were compared to analyze the influencing factors of prognosis and survival. Results There was no significant difference in recurrence of venous thromboembolism (VTE) between the two groups (P＝0.157). But the older group had obviously higher mortality than the younger one (P＜0.001). The analysis on cause of death indicated that there were more patients died of other definite causes (including severe infection, respiratory failure, renal failure, multiple organ failure, and so on) in the ≥65 year-old group than those in the younger group (P＝0.006). Univariate Cox analysis showed that age, body mass index (BMI), complication of malignant tumor, systolic pulmonary artery pressure (SPAP) ＞50mmHg, surgery secondary to PTE within 2 months, and long-term anticoagulant therapy were correlated with the occurrence of death. But further multivariate Cox analysis suggested that only age, malignant tumor, SPAP ＞50mmHg, surgery within 2 months after PTE, and long-term anticoagulant therapy be high risk factors for death. Conclusion The elderly PTE patients have poor long-term prognosis due to their complications of chronic comorbidities. Physicians should pay attention to this, and emphasize regular treatment for their complications in addition to the standard diagnosis and treatment of PTE.

Abstract:Objective To investigate the clinical features, outcome and influencing factors of microscopic polyangiitis (MPA) in the elderly patients. Methods Clinical data of 191 MPA patients admitted in our department from January 2007 to December 2012 were collected in this study. They were divided into ≥65 years old group and ＜65 years old group. Their clinical data were analyzed for the effect of age on the prognosis and survival. Cox regression analysis was employed to study the factors affecting survival. Results Diffuse alveolar hemorrhage (DAH) was more common in ＜65 years old group (P＝0.004), while interstitial lung disease in ≥65 years old group (P＝0.016) was more common. The incidence of renal failure (P＝0.033) and the serum level of C-reactive protein (CRP; P＝0.017) were significantly higher in ≥65 years old group than in ＜65 years old group . Kaplan-Meier survival analysis indicated that there was significant difference in the survival function between the 2 groups (Log-rank＝10.462, P＝0.001). Cox univariate analysis showed that age (HR: 1.04, P＝0.002), leukocytes (HR: 0.65, P＝0.000), CRP (HR: 1.01, P＝0.006), creatinine (HR: 1.00, P＝0.006), urea nitrogen (HR: 1.03, P＝0.002), pulmonary infection (HR: 5.57, P＝0.000), DAH (HR: 2.11, P＝0.007) and Birmingham Vasculitis Activity Score (BVAS; HR: 1.12, P＝0.000) were correlated with death. Cox multivariate analysis suggested that only age (HR: 1.02, P＝0.003), pulmonary infection (HR: 3.79, P＝0.040), DAH (HR: 5.02, P＝0.004) and BAVS score (HR: 1.10, P＝0.000) be high-risk factors for death. Conclusion MPA is common in the elderly, with no difference between genders. But the patients with older age have shorter survival time.

Abstract:Objective To determine the correlation of plasma level of D-dimer (DD) with clot burden of pulmonary embolism. Methods A prospective study was performed on 69 consecutive patients with acute pulmonary thromboembolism (PTE) confirmed by computed tomographic pulmonary angiography (CTPA) in our hospital from January 2009 to August 2011. A pulmonary artery obstruction index (PAOI, Mastora score) ＞21.3% indicated severe obstruction of PTE. A right ventricle/left ventricle (RV/LV) ＞0.9 indicated RV dysfunction. The plasma level of DD was determined by immunoturbidimetric assay. Results The median DD level was 765μg/L (95%CI: 750?1 205μg/L) and that of PAOI was 16.77% (95%CI: 16.32%?23.06%). Plasma DD level was positively correlated with PAOI (r＝0.417, P＝0.000). The patients with PAOI ＞21.3% had significantly higher DD levels than those with PAOI ≤21.3% (993 vs 663μg/L, Z＝-2.991, P＝0.003). DD level was positively correlated with RV/LV (r＝0.272, P＝0.024). The patients with RV/LV ＞0.9 had obviously higher DD levels than those with RV/LV ≤0.9 (880 vs 634μg/L, Z＝-2.070, P＝0.038). There was a positive correlation between PAOI and RV/LV (r＝0.390, P＝0.001). Negative correlation was found in the PTE onset time with DD level (r＝-0.407, P＝0.000), but not with PAOI (r＝-0.140, P＝0.245). There was no significant difference in the DD level and PAOI between the elderly patients (＞60 years old) and those younger (≤60 years old) (727.0 vs 792.5μg/L, Z＝-0.180, P＝0.857; 14.84% vs 20.97%, Z＝-1.382, P＝0.167). After 3 months’ standard anticoagulant therapy, both DD level and PAOI were decreased in the cohort (Z＝-6.976, P＝0.000; Z＝-7.009, P＝0.000), and their decreases were correlated (r＝0.609, P＝0.000). Conclusion DD level is positively correlated with CTPA clot burden and RV/LV respectively, and is helpful in illness assessment, management guidance and prognostic evaluation for the acute PTE patients. There is no significant difference in DD level and PAOI between the patients older and less than 60 years.

Abstract:Objective Simplified pulmonary embolism severity index (sPESI) is a practical validated tool aiming to stratify 30-day mortality risk in acute pulmonary thromboembolism (PTE). However, guidelines for PTE risk stratification are not concerning on age. The aim of our study was to determine the prognostic value of sPESI in the elderly patients with PTE. Methods A retrospective case-control study was carried out on 233 consecutive patients with identified PTE admitted in our hospital from April 2002 to May 2015. They were divided into the elderly group (≥65 years old, n＝132) and the non-elderly group (＜65 years old, n＝101). Their complications, clinical features, sPESI score, and 30-day mortality were compared and analyzed. Results The patients of the elderly group were at age of (76.32±6.77) years, and those of the non-elderly group were (51.93±10.39) years. The former group had a 30-day mortality of 22.73%, and the latter of 11.88%, with significant difference between the two groups (P＝0.033). The incidences of cardiac insufficiency, arrhythmia, cerebrovascular diseases, renal insufficiency, hypertension, diabetes and pneumonia were significantly higher in the elderly patients than in the non-elderly ones (all P＜0.05). There was no significant difference in the incidence of malignant tumors between the elderly and non-elderly groups (14.39% vs 13.86%, P＝0.908). But, the most common tumor was lung cancer in the elderly group, and bone tumor in the non-elderly group. The arterial partial pressure of oxygen was significantly lower in the elderly group than in the non-elderly group [(59.39±11.00) vs (66.44±13.77)mmHg, P＝0.002], but the pulmonary arterial pressure, serum levels of brain natriuretic peptide and cardiac troponin-I were obviously higher in the former than in the latter (P＝0.000, P＝0.003 and P＝0.041). Significant difference was observed in the percentage of patients with sPESI score ≥1 between the two groups (73.48% vs 48.51%, P＝0.000). In the elderly group, sPESI score ≥1 was found among 90.00% of the dead patients and 68.63% of the survival ones (P＝0.020). The mean sPESI score was 2.23±1.52 in the dead patients of the elderly group, significantly higher than those survived (1.18±1.11, P＝0.001). The area under the receiver-operating characteristic (ROC) curves was 0.704 [95% confidence interval (CI): 0.596?0.812] for the elderly patients and 0.723 (95%CI: 0.551?0.896) for the non-elderly ones. Conclusion sPESI is helpful for risk stratification in the elderly patients with acute PTE.

Abstract:Objective To analyze the clinical characteristics in the Uygur elderly patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary hypertension (PH). Methods Two hundred and eighteen Uygur elderly patients with stable COPD admitted in the People’s Hospital of Yarkant County from February 2014 to May 2015 were enrolled in this study. According to the results of echocardiography, they were divided into 3 groups, that is, the patients complicated with no PH (n＝96), suspected PH (n＝68) and identified PH (n＝54). Age, sex, body mass index, medical history, lung function, blood gas analysis, and serum levels of hemoglobin (HGB) and pro-brain natriuretic peptide (pro-BNP) were compared between those with identified PH and with no PH. Results The complicated PH group had significantly longer history of chronic cough and phlegm (P＜0.01), obviously higher incidence of diabetes (P＜0.05), and remarkably higher serum levels of HGB and pro-BNP (both P＜0.01) when compared with those with no PH. They also had significantly higher values in forced expiratory volume in one second percentage of predicted value (FEV1%pred), diffusing capacity percent predicted (DLCO% pred), and arterial partial pressure of oxygen (PaO2; P＜0.01), but not in other indices of lung function(P＞0.05). Conclusion Attention should be paid to the above abnormal features and standard treatment given correspondingly, which might delay the progression and improve the prognosis in the Uygur elderly patients of COPD combined with PH.

Abstract:Objective To analyze the coexisting diseases and death of hospitalized patients with pulmonary embolism (PE). Methods A retrospective study was carried out on 330 hospitalized PE patients admitted in our department from January 1, 2010 to December 31, 2014, and on 9 263 non-PE patients hospitalized in same period. Their clinical data were collected and analyzed. Results There were more female patients in the PE group than in the non-PE group in this study (P＜0.05). The incidences of type I respiratory failure, lower extremity deep venous thrombosis (DVT), pneumonia, liver dysfunction, cancer and fractures were significantly higher in the PE group than in the non-PE group (P＜0.05). Risk factor analysis indicated that DVT, fractures, pneumonia, cancer, type I respiratory failure, female and liver diseases were risk factors for PE. Conclusion Physicians should fully understand the risk factors and comorbidities of PE, and be alert to its occurrence.

Abstract:Objective To investigate the value of CT pulmonary angiography (CTPA) in the diagnosis and efficient assessment of pulmonary embolism (PE) in the elderly. Methods Fifty-five patients with acute PE admitted in Department of Cardiology in our hospital from January 2009 to January 2015 were enrolled in this study. They were divided into severe group (n＝24) and non-severe group (n＝31). Right/left ventricular short axis diameter ratio (RV/LV), superior vena cava and pulmonary artery diameter, and obstruction index were compared between the 2 groups before and after treatment. Results Compared with before treatment, RV/LV, superior vena cava and pulmonary artery diameter, and obstruction index were obviously decreased in the severe group (P＜0.05). But, for the non-severe group, only pulmonary artery diameter and obstruction index were significantly reduced after treatment (P＜0.05). Conclusion CTPA can be used for the diagnosis of PE, and it is a fast, effective, non-invasive way to evaluate the efficacy of thrombolysis treatment.

Abstract:Objective To investigate the diagnostic elements and characteristics of pulmonary vascular lesions in patients with Behcet’s disease by multislice spiral computed tomography (MSCT). Methods CT images and medical data of 13 patients with pulmonary vascular lesions of Behcet’s disease in Huadong Hospital and Pulmonay Hospital from March 2012 to April 2014 were collected and retrospectively reviewed. Their clinical characteristics and CT image features were analyzed. Results Among the patients, MSCT scanning showed that there were 11 cases of pulmonary embolism (10 of them complicated with pulmonary artery aneurysms), 1 case of diffuse capillary vasculitis and 1 case of pulmonary hemorrhage. Besides, there were 9 cases of pericardial effusion, 6 cases of pleural effusion, 8 cases of mediastinal enlarged lymph nodes, and 1 case of thrombosis in cardiac chambers and inferior vena cava. MSCT combined with computed tomographic pulmonary angiography and three-dimensional reconstruction techniques clearly displayed above lesions. The pulmonary artery aneurysm manifested as dilation of the pulmonary artery, which was similar to that of the normal pulmonary artery in enhancement. Filling defect in the pulmonary artery was found in CT images of pulmonary embolism. Diffuse pulmonary vasculitis manifested as multiple cotton-wool and ground glass appearance on CT image. The performance of pulmonary hemorrhage was the ground glass opacity around the bleeding site. Conclusion Behcet’s disease complicated with pulmonary vascular disease shows a variety of manifestations on CT images. MSCT is of great value in the diagnosis of Behcet’s disease complicated with pulmonary vascular disease, and should be used as the first option in its examination and regular follow-up.

Abstract:Objective To determine the effect of hydrogen sulfide donor, sodium hydrosulfide (NaHS), on caveolin-1 (Cav-1) expression in pulmonary artery smooth muscle cells from hypoxic rats. Methods The chronic hypoxic rat model was established by intermittent normobaric hypoxia exposure. The hypoxic rat pulmonary artery smooth muscle cells (PASMCs) were cultured under mixed gas conditions. Thirty-two Sprague-Dawley (SD) rats were randomly and equally divided into four groups (normoxia group, hypoxia group, normoxia＋NaHS group and hypoxia＋NaHS group). The pulmonary arteriole intima-media thickness, muscularization and PASMCs proliferation was measured by immunohistochemical assay. Reactive oxygen species (ROS) was assessed by fluorescent probe assays. Western blotting was used to detect the protein expression of Cav-1. Results Compared with control rats, right ventricular systolic pressure (RVSP), right ventricular mass index (RVMI), medial wall thickness, fully muscularized vessels and proliferation of PASMCs were significantly enhanced in response to hypoxia. The level of ROS was significantly higher and the expression of Cav-1 was decreased in the PASMCs of hypoxia group than in control groups. NaHS treatment resulted in improvement of pulmonary arterial blood flow, alleviation of medial wall thickness, inhibition of PASMCs proliferation, decrease of ROS production, and enhancement of Cav-1 protein expression. Conclusion NaHS treatment alleviates pulmonary vascular structural remodeling in chronic hypoxic rats by decreasing ROS production, up-regulating the expression of Cav-1, and inhibiting PASMCs proliferation.

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Abstract:The elderly are at high risk for pulmonary thromboembolism (PTE). Evidence shows that the prevalence of PTE is increased during aging, and its mortality, recurrence and hemorrhage rate are extremely high in the elderly than in the young people. Therefore, as an important global health issue, the elderly PTE draws attention from clinicians all over the world. In the past 2 decades, great progress has been achieved in the diagnosis and treatment of elderly PTE, including the establishment of new diagnostic strategy (Wells score and modified Geneva score), the application of age-adjusted D-dimer cutoff levels for excluding PTE, the use of new oral anticoagulants for older patients, etc. In this article, we mainly summarized the progress in the diagnosis and treatment of PTE and hoped this would be helpful to Chinese pulmonary vascular clinicians.

Abstract:The development of new oral anticoagulants (NOACs) has brought more convenience in treatment of venous thromboembolism. However, with regard to the elderly, due to their co-existing comorbidities and multiple medication use, there are some points needing special attention in the use of NOACs, such as drug adjustment in the patients with organ dysfunctions, switch among different anticoagulants, use of anticoagulants in course of invasive manipulations, management during hemorrhages and so on. This article aimed to illustrate some points, to which attention should be paid in the use of NOACs in the elderly so as to obtain more rational NOACs use and reduce the damages caused the improper use.

Abstract:Pulmonary thromboembolism (PTE) is a major complication in the elderly patients with chronic obstructive pulmonary disease (COPD), and is of high incidence, mortality and recurrence. The clinical manifestations of COPD and PTE were nonspecific and might overlap, and this may lead to delayed diagnosis or misdiagnosis for PTE. Therefore, it is very important to increase awareness of PTE diagnosis in clinical practice. For the elderly COPD patients complicated with PTE, physicians should give full consideration on the elderly’s pathophysiological characteristics and the impact of their complications to select thrombolytic or anticoagulant treatment, and carefully weigh the severity and risk of bleeding.

Abstract:Eosinophilic granulomatosis with polyangiitis (EGPA) is mainly characterized by eosinophil-rich and necrotizing granulomatous inflammation and necrotizing vasculitis, predominantly affecting small to medium vessels, often involving the respiratory tract (asthma). Its radiological manifestations are non-persistent patchy migratory pulmonary infiltrates, ground-glass opacities, consolidation, nodules, pleural effusion, and may be interstitial lung changes. EGPA is common in adults, without obvious sex predominance. Age is one of poor prognostic factors, and the aged patients tend more frequently to have complications and a higher mortality. In this article, we reviewed the literatures concerning EGPA in the elderly and summarized its clinical characteristics.

Abstract:Objective To determine the differences in renal function evaluation with different equations in the Chinese elderly. Methods A total of 111 aged people (60 to 94 years old, 53 males and 58 females) who took physical examination in the First Affiliated Hospital of Nanjing Medical University for 4 consecutive years from March 2008 to March 2012 were recruited in this study. Their baseline data in March 2008 and follow-up data in March 2012 were recorded. Four different equations, CKD-EPIscr-cys, BISscr, BISscr-cys and Cscr-cys, were used to evaluate their estimated glomerular filtration rate (eGFR) at the 2 time points. Results The age, systolic blood pressure, body mass index, serum creatinine, and uric acid were significantly higher in the males than in the females (P＜0.001). Their serum urea nitrogen, creatinine and uric acid were all increased in the participants when compared with baseline data (P＜0.001), while serum cystatin C(Cys C) decreased (P＜0.001). Their eGFR assessed by the 4 different formulas were obviously decreased (P＜0.001), but the declines had differences. The eGFR by Cscr-cys equation had the minimal reduction. The declining of eGFR had no significant differences between the male and female participants. Conclusion In the elderly, eGFR is declined with age, but the fall is different when evaluated by different equations. Physicians should be careful in selecting the equations for eGFR for the elderly.

Abstract:Alzheimer’s disease (AD), as the main cause of senile dementia, has become a serious threat to human health. Epidemiological evidence shows that curcumin is of g)reat effectiveness for AD, and it attracts much attention because of its great safety since it is derived from human food source. This article reviewed the therapeutic value of curcumin for AD based on the pathological changes of AD after curcumin treatment, the pharmacokinetics of curcumin and methods to increase its bioavailability.

Abstract:Due to the internal environmental changes, the decline of liver and kidney functions, and the coexistence of multiple diseases and multiple medication use , the elderly usually have higher incidence of adverse drug reaction. This indicates that physicians cannot be too careful in prescribing medication for the elderly. At the same time, the elderly should strengthen health consciousness, improve their physical conditioning so as to prevent illness and stay healthy. In this paper, we reviewed the main points which should be noted in taking medicines for the elderly, as well as the suggestions on health care by traditional Chinese medicines, in order to improve their quality of life and to live longer and healthier.