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Abstract:Coronary heart disease (CHD) is one of the leading causes of hospitalization and the most common cause of death in older adults with heart disease. Management of CHD in the elderly is frequently more difficult in virtue of chronic comorbid conditions and aging-intrinsic dynamics. With the development of technology and the accumulation of experience, the number of elderly patients undergoing percutaneous coronary intervention (PCI) is increasing. Clinical success with PCI in the elderly has also been improved. The solicited articles in this issue has focused on PCI in critically-ill elderly patients with CHD, including acute myocardial infarction and chronic total occlusion, as well as application of intravascular unltrasound in the treatment of such diseases. In conclusion, critically ill elderly patients with CHD benefits from interventional therapy.

Abstract:Objective To analyze and summarize the characteristics of clinical, imaging and percutaneous coronary intervention (PCI) data in the elderly with chronic total occlusion (CTO) of the coronary artery. Methods The clinical data of 3 957 patients (including 1 452 cases ≥65 years old, 36.7%) with CTO verified by coronary angiography admitted in our department from January 1995 to December 2014 were collected and analyzed retrospectively. Results The incidence of stable angina was significantly lower in the elderly group than in the non-elderly group, but that of unstable angina was higher (both P＜0.05). The elderly group had more patients suffering from hypertension and heart failure than the non-elderly group (both P＜0.001). The duration at cardiac care unit (CCU) and total length of hospital stay were longer in the former than in the latter group (both P＜0.001). The ratios of patients with multi-vessel lesion, left main coronary artery CTO, absolute occlusion, stump missing, CTO ≥15mm in length, CTO ≤2.5mm in diameter and bridging collaterals were significantly higher in the elderly group than in the non-elderly group (P＜0.001). The successful rate of PCI and complete revascularization was lower in the elderly than in the non-elderly group (P＜0.05). Conclusion The elderly CTO patients have higher rates of hypertension, heart failure and multi-vessel lesion, and are characterized by complex lesions and difficulty to PCI.

Abstract:Objective To evaluate the efficacy and safety of thrombin inhibitor, bivalirudin, in the patients with acute myocardial infarction (AMI) undergoing intra-aortic balloon pump (IABP) assisted percutaneous coronary intervention (PCI). Methods A retrospective study was performed on 92 AMI patients who received IABP-assisted PCI in our department from Jan 2013 to Sep 2015. Based on the anticoagulant therapy during perioperative period, the patients were assigned into bivalirudin group (n＝30) and heparin group (n＝62). The incidences of peri-operative bleeding and major adverse cardiac events (MACE) were compared between the 2 groups. Results The bivalirudin group had a lower rate of in-hospital bleeding, but without significant difference with the heparin group. However, the decline of platelet count after PCI was significantly lower in the bivalirudin group than in the heparin group (P＝0.002). In the follow-up period, there was no obvious difference in the incidence of MACE between 2 groups (P＞0.05). Conclusion Bivalirudin is effective and safe, and has mild effect on platelet count in AMI patients undergoing IABP-assisted PCI.

Abstract:Objective To determine the influence of different ages on the incidence of contrast-induced acute kidney injury (CI-AKI) in acute ST-segment elevation myocardial infarction patients after undergoing emergency percutaneous coronary intervention (PCI). Methods A retrospective study was carried out on 1 685 ST-segment elevation acute myocardial infarction patients undergoing emergency PCI and stent implantation in the ICU of our department from February 2006 to September 2012. They were divided into the ＜60 years old group (n＝932) and the ≥60 years old group (n＝753). The clinical data were compared between the 2 groups. Multivariate logistic regression analysis was used to detect the significant indicators obtained by univariate analysis to screen independent risk factors. The occurrences of major adverse cardiovascular events (MACE) and all-cause mortality were observed in 1 and 6 months, and 1 and 3 years after surgery. Results The incidence of CI-AKI was significantly higher in the ≥60 years old group than in the ＜60 years old group (14.7% vs 8.6%, P＜0.001). Age, previous myocardial infarction, and volume of contrast were independent risk factors for CI-AKI. During the 3 years’ follow-up after PCI, the cumulative all-cause mortality and cardiac mortality were significantly higher in the ≥60 years old group than in the ＜60 years old group (4.2% vs 1.5%, P＜0.001; 1.5% vs 0.2%, P＝0.011). Conclusion Clinicians should treat the elderly patients with caution, and fully assess their preoperative cardiac function and precisely determine contrast volume to prevent the occurrence of CI-AKI.

Abstract:Objective To explore the clinical features and coronary lesion characteristics in the elderly female patients diagnosed as acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods A retrospective study was conducted on 366 consecutive female patients who were first diagnosed as acute STEMI and underwent primary PCI in our hospital from 2006 to 2012. The patients were divided into the aged group (≥65 years old, n＝211) and the non-aged group (＜65 years old, n＝155). The clinical features and coronary lesion characteristics of the 2 groups were analyzed. Results Compared with the non-aged group, the aged group had significantly higher incidence of diabetes, higher fasting blood glucose, lower percentage of smokers, lower glomerular filtration rate, larger amount of triple-vessel disease, and less involved lesions in the left anterior descending branch (LAD) (all P＜0.05). The success rates of PCI in the aged group and the non-aged group were 98.58% and 98.87%, respectively. Conclusion Female STEMI patients have different characteristics in risk factors among different ages. The aged female elderly patients have more complicated coronary lesions than the non-aged ones.

Abstract:Objective To investigate the clinical characteristics of different plaques detected by intravascular ultrasound (IVUS). Methods From January 2010 to December 2013, 220 patients with coronary heart diseases confirmed by coronary angiography in our department were enrolled in this study. The patients were divided into 3 groups according to the ultrasound echo intensities of plaques in IVUS findings, that is, attenuated plaque group (n＝42), calcified plaque group (n＝63), and fibrous plaque group (n＝115). Their clinical baseline data and IVUS data were analyzed and compared. According to the results of IVUS findings, there were 140 case needing to undergo percutaneous coronary intervention (PCI), including 26, 41 and 73 cases respectively from the attenuated, calcified and fibrous plaque groups, with the ratio of PCI 62%, 65% and 63% in the three groups respectively. All were successful. The plaque types, PCI features and follow-up data were also analyzed in these 140 patients. Results The patients from the calcified plaque group had older age and lower levels of total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) when compared with those from the other groups (all P＜0.05). The attenuated plaque group had higher ratios in past histories of smoking, myocardial infarction, and coronary artery bypass surgery (CABG), and larger plaque burden and lesion vessel area when compared with the other 2 groups (all P＜0.05). Minimal lumen area and lesion vessel diameter were obviously smaller in the calcified plaque group than in the other 2 groups (all P＜0.05). For the 140 patients undergoing PCI, those from the attenuated plaque group had higher plaque burden than that from the other 2 groups (P＜0.05), and there were no significant differences in 1-year mortality, incidence of myocardial infarction and ratio of target vessel revascularization from the 3 groups (P＞0.05). Conclusion Past histories of smoking, myocardial infarction and CABG are correlated with the incidence of attenuated plaques. The patients with attenuated plaques have larger plaque burden than those with calcified or fibrous plaques. PCI has satisfactory therapentic effect on unstable plaques detected by IVUS.

Abstract:Objective To investigate the feasibility of retrograde percutaneous intervention in treatment of coronary chronic total occlusion (CTO) in the elderly. Methods All patients who undergoing retrograde percutaneous recanalization for coronary CTO in our hospital from January 2004 to May 2015 were enrolled in this study. They were divided into the elderly group (n＝119, ≥60 years old) and the non-elderly group (n＝136, ＜60 years old). Successful rate of retrograde PCI, efficacy and incidence of complications were compared and analyzed between the 2 groups. Results The elderly group had more comorbidities, such as hypertension, diabetes, cerebrovascular diseases (all P＜0.05), and higher score of European system for cardiac operative risk evaluation (EuroSCORE, P＜0.001) than in the non-elderly group. There were more patients having double and triple vessel coronary artery diseases in the former than in the latter group (both P＝0.000). While, the incidence of single-vessel disease was lower in the elderly group than in the non-elderly group (P＝0.000). The SYNTAX scores were higher in the former than in the latter group, with significant differences (P＜0.001). The proportion of patients having CTO for 3 to 12 months was significantly larger in the non-elderly group than in the elderly one, while that of those having CTO for 6 to 9 years or longer than 9 years was larger in the elderly group (both P＝0.000). Conclusion Retrograde percutaneous recanalization is a safe and effective approach for coronary CTO in the elderly.

Abstract:Objective To determine the influencing factors associated with ticagrelor-related dyspnea in the patients with coronary artery diseases (CAD), and investigate the impact of the side effect on compliance and clinical outcomes of ticagrelor treatment. Methods Consecutive CAD patients treated by ticagrelor in our department from January 2014 to February 2015 were recruited in this study. The in- and out-hospital incidence of ticagrelor-related dyspnea was recorded in 6-month follow-up, and the influencing factors for the side effect were analyzed by multivariate regression analysis. The influence of ticagrelor-related dyspnea on the occurrence of ischemic and bleeding events was observed during the 6 months’ follow-up. Results There were 647 CAD patients recruited in this study, and ticagrelor-related dyspnea was found in 85 patients (13.14%). The side effect was observed in 43 patients within 1 week after ticagrelor treatment, 35 patients within 1 month, and 7 patients after 1 month. Cessation of its administration was in 15 patients due to ticagrelor-related dyspnea. Concomitant therapy with tirofiban was associated with higher risk of ticagrelor-related dyspnea (OR＝2.45, 95%CI: 1.41?4.27, P＝0.001), while concomitant therapy with statins (OR＝0.20, 95%CI: 0.04?0.92, P＝0.04) and proton pump inhibitors (PPI; OR＝0.56, 95%CI: 0.32?0.97, P＝0.04) were with lower risk of the effect. For the patients (n＝353) continuously taking ticagrelor in the follow-up period, no significant difference was seen in the occurrences of ischemic and bleeding events between those with ticagrelor-related dyspnea and those without. Conclusion The side effect of ticagrelor-related dyspnea usually occurs within 1 month after ticagrelor treatment in CAD patients. Co-medication may be the main relevant factor influencing the occurrence. Ticagrelor-related dyspnea impacts the compliance of ticagrelor, but may have no effect on the clinical prognosis.

Abstract:Objective To evaluate the efficacy of the diagnosis and treatment mode named modified early warning score (MEWS) of pre-referral assessment followed by ward round by geriatric interdisciplinary team (GIT) on clinical outcomes in the patients after referral from emergency or observation room. Methods The elderly patients admitted in the emergency or observation room of Central Hospital of Songjiang District and Shanghai First People’s Hospital (South Hospital) and then transferred to the Department of Geriatrics of Ledu Hospital of Songjiang District from November 2012 to October 2013 were recruited in this study. The observation group was given our mode named MEWS of pre-referral assessment and ward round by GIT afterwards, while the control group was treated with the conventional medical mode. The mean hospital stay, recovery rate, mortality, medical expenses, rehospitalization rate and family satisfaction were compared between the 2 groups. Results Among the 306 referral patients, 156 patients were assigned randomly to the observation group and received our medical mode. Of them, 150 cases were discharged after improvement (96.2%), and 1 case died (0.64%). For the other 150 cases (control group), 134 cases were discharged after improvement (89.1%), and 3 cases died (2.0%). The observation group had an average hospital stay of (17.7±13.1)d, improvement rate of 96.2%, average medical cost of (8275.32±4680.33) yuans (RMB), the re-hospitalization rate of 1.28%, and the family satisfaction of 95.5%, which were all better than those in the control group (P＜0.05). Conclusion The elderly is in high demand for hospitalization. Our mode MEWS of pre-referral assessment followed by GIT ward round is an effective measure for medical management in the elderly with multiple co-morbidities, and will provide continuity of medical services and improve the satisfaction of patients and their families in clinical practice.

Abstract:Objective To analyze the correlation between body mass index (BMI) and all-cause mortality in the retired military cadres from the Second Military Medical University. Methods Clinical data of 237 retired military cadres hospitalized in our department from January 2000 to October 2013 were collected, and they were followed up until October 31, 2014. They were divided into 4 groups according to their BMI, that is, low body mass group (BMI＜20kg/m2), ideal body mass group (BMI 20.0?24.9kg/m2), overweight group (BMI 25.0?27.9kg/m2) and obesity group (BMI ≥28kg/m2). Cox regression analysis was used to investigate the all-cause mortality risks in the groups. Results The cohort of retired cadres were followed up for a median duration of 59 months, and no one was lost. All-cause mortality was 115 subjects when the follow-up ended. Cox regression analysis indicated that the all-cause mortality was decreased by 53.6% in ideal body mass group (HR＝0.464, 95%CI: 0.239?0.901, P＜0.05), 65.2% in overweight group (HR＝0.348, 95%CI: 0.162?0.749, P＜0.05) and 74.2% in obesity group (HR＝0.258, 95%CI: 0.103?0.644, P＜0.05) when compared with low body mass group after adjustments for confounders. Conclusion The increase of BMI is associated with the decreased risk of all-cause death in the retired military cadres.

Abstract:Objective To investigate the correlation of functional activities and lower limb muscle mass with muscle strength in the aged sarcopenic men. Methods According to the inclusion and exclusion criteria of Asian Working Group for Sarcopenia (AWGS), 87 men at an average age of (89.5±4.4) years were diagnosed as sarcopenia from those who took physical examination in Outpatient Department of our hospital from June 2014 to February 2015. Their average relative appendicular skeletal muscle mass index (RASMMI) was (6.04±0.62)kg/m2. Physical composition was measured by dual X-ray absorptiometry (DXA), grip strength by a dynamometer named JAMAR, and maximum isometric strength of iliopsoas, quadriceps femoris, tibialis anterior and hamstrings by a dynamometer named FET3. Physical composition, lower limb strength test, 6-min walking test, timed up and go test (TUGT), five times sit-to-stand test (FTSST), and one-legged stance test with eyes closed were performed respectively to investigate the correlations of above indices with the test results. Results The walking speed, TUGT, FTSST, and time for one-legged stance were correlated with age (r＝?0.567, P＝0.018; r＝0.742, P＝0.001; r＝0.632, P＝0.007; r＝?0.489, P＝0.047), muscle mass (r＝0.489, P＝0.045; r＝?0.579, P＝0.012; r＝?0.641, P＝0.003; r＝0.476, P＝0.048) and fat mass (r＝?0.517, P＝0.032; r＝0.513, P＝0.031; r＝0.528, P＝0.015; r＝?0.533, P＝0.012). In addition, the indices of walking speed, TUGT, FTSST, and time for one-legged stance showed correlation with maximum isometric strength of iliopsoas (r＝0.313, P＝0.000; r＝?0.887, P＝0.000; r＝?0.666, P＝0.003; r＝0.515, P＝0.035) and maximum isometric strength of quadriceps femoris (r＝0.251, P＝0.017; r＝?0.775, P＝0.000; r＝?0.612, P＝0.013; r＝0.671, P＝0.002). Conclusion There exists a high correlation of functional activities and physical composition with lower limb muscle strength in aged sarcopenic men. The elderly with high fat content and low muscle mass have relatively poor physical activity, and those with high lower limb muscle strength have good physical activity, especially for iliopsoas and quadriceps femoris muscle strength.

Abstract:Objective To observe the clinical efficacies of ticagrelor and clopidogrel and investigate their correlation with CYP2C19 gene polymorphisms. Methods A total of 450 hospitalized patients with acute coronary syndrome in our department from March 2013 to March 2014 were recruited in this study. According to their treatment regimes, the patients were randomly divided into the ticagrelor group (n＝227) and the clopidogrel group (n＝223). Their incidence of the major adverse cardiac events (MACE) was compared in the 6 months’ follow-up. The patients were also assigned into 2 subgroups according to their carrying CYP2C19*2/*3 loss-of-function allele or not. The incidence of the MACE and bleeding events were compared between the subgroups in the follow-up. Results Between the ticagrelor group and clopidogrel group, the incidence of MACE was 8.4% and 8.2% respectively for the non-carriers of CYP2C19*2/*3 loss-of-function allele, though without significant difference (P＞0.05), and was 9.1% and 15.2% separately for the carriers, with obvious difference (P＜0.01). However, there was no statistical difference in the incidence of bleeding events between the ticagrelor and clopidogrel groups and between the carriers and non-carriers (P＞0.05). Conclusion Ticagrelor is superior to clopidogrel in decreasing the risk of MACE in the patients with acute coronary syndrome, which may be associated with carrying CYP2C19 loss-of-function allele or not.

Abstract:Objective To investigate the efficiency and safety of infra-low-frequency transcranial magnetic stimulation (TMS) in the treatment of depressive symptoms in Alzheimer’s disease (AD) patients. Methods A randomized, controlled and single-blinded trial was conducted on 47 AD patients with depressive symptoms admitted in our hospital from August 2014 to August 2015. The patients were randomly divided into the treatment group (n＝23) and the control group (n＝24). The patients of the former group was treated by mirtazapine combined with infra-low-frequency TMS for 4 weeks, while those of the latter group received sham infra-low-frequency TMS and mirtazapine treatment. The geriatric depression scale (GDS) was used to assess the depressive symptoms before, and after 2 and 4 weeks treatment to evaluate the curative effect by the total efficacy. Results After 2 weeks’ treatment, GDS score was significantly lower in the treatment group than in the control group [(13.43±2.57) vs (16.08±3.96), P＜0.05], but there was no significant difference in the score between the 2 groups [(9.48±3.11) vs (9.67±3.95), P＞0.05] in 4 weeks. There existed significant difference in the total efficacy between the 2 groups after 2 weeks’ treatment (Chi square＝4.776, P＝0.029), but no difference after 4 weeks (Chi square＝3.297, P＝0.348). Conclusion Infra-low-frequency TMS combined with mirtazapine has a shorter onset time and better short-term efficacy than medication alone in the treatment of depressive symptoms in AD patients.

Abstract:Objective To determine the effects of chronic intermittent hypoxia (CIH) on the injury in genioglossal mitochondria and investigate the intervention role of adiponectin (Ad) in the process and associated mechanisms. Methods Forty-five adult Wistar rats were randomly divided into 3 groups, that is, normal control (NC) group, CIH group, and CIH＋Ad group, with 15 rats in each group. The rats in the 2 latter groups were exposed to the same CIH environment (8h/d for 5 weeks), while the rats in the NC group were exposed to normal air only. In addition, the rats in CIH＋Ad group were injected with Ad (10μg, twice a week). Results Compared with the NC group, reduced amount, damaged structure and decreased type Ⅰ fibers in the genioglossal mitochondria were observed in the rats of CIH group (P＜0.05). However, the conditions in the rats of CIH＋Ad group were much better (P＜0.05). Compared with the NC group, the protein expression of LKB1-AMPK-PGC1-α pathway was significantly lower in the genioglossum of CIH group, but such a reduction was less significant in CIH＋Ad group (P＜0.05). Conclusion CIH induces impairment in genioglossal mitochondria, while supplement of Ad will improve such genioglossal injuries possibly via modulation of AMPK pathway.

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Abstract:Endothelial cell dysfunction is an important initial event of diabetic vascular complications. Hyperglycemia induces various metabolic alterations, such as the elevation of oxidative stress, activation of abnormal metabolic pathways, accumulation of advanced glycation end products (AGEs) and activation of protein kinase C (PKC) pathways, and all of these alterations can lead to endothelial cell injury. Therefore, how to inhibit abnormal metabolism and improve the functions of endothelial cells is the key point of diabetic vascular complications. In this article, we reviewed the abnormal metabolism of endothelial cells in diabetic patients.

Abstract:Sodium channel can produce fast sodium current which is important for the occurrence and propagation of cardiac action potential, and also produce late sodium current (INaL) which contributes to action potential duration. Functional changes of sodium channel act as substrate for many cardiac diseases, and sodium channel may be remodeled in response to cardiac disease. Chronic heart failure (HF) is a common cardiac syndrome clinically. Sodium channel, especially concerning INaL and chronic HF, has become a hotspot in recent studies. We reviewed the relationship between the sodium channel and chronic HF in this article.

Abstract:Astrocytes are fundamental for homoeostasis, defence and regeneration of the central nervous system. Loss of astroglial function and decrease of astroglial reactivity lead to the physical aging of brain and incidence of neurodegenerative diseases. Astrocytes play an important role in cerebral aging and in the pathophysiogenesis of Alzheimer’s disease (AD), and also take part in the energy metabolism in the brain. Medication can regulate the morphology and functions of astrocytes, suggesting that astrocytes can be regarded as a target for the treatment of AD. In this article, we reviewed the roles of astrocytes in the physiological aging and the pathogenesis of AD.