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Abstract:Antithrombotic therapy, including antiplatelets and anticoagulation, is highly effective for prevention of thrombotic complications in patients with coronary artery disease or atrial fibrillation. However, antithrombotic therapy usually induces bleeding. As for the elderly patients, they usually suffer from multiple organ diseases and the risk of thrombosis and bleeding are both significantly increased. It is very important to choose the most beneficial antithrombotic regimen based on the balance of risk of thrombosis and bleeding.

Abstract:Objective To investigate the clinical efficiency and safety of hybrid revascularization, carotid artery stenting (CAS) with simultaneous or staging coronary artery bypass grafting (CABG), for the patients with coronary artery disease and concomitant severe carotid artery stenosis. Methods From July 2008 to September 2014, a total of 274 patients with coronary artery disease and concomitant severe carotid artery stenosis who underwent CAS and CABG at the same time or within next 7 days (simultaneous operation group, n=35) or with an interval of more than 7 days (staging operation group, n=239) were recruited in this retrospective single-center study. Their clinical data and prognosis were compared and retrospectively analyzed. Results The average numbers of bypass grafts, implanted stents in the stenotic inner carotid artery and in the renal artery were significantly larger, but the duration of mechanical ventilation was obviously shorter in the staging than in the simultaneous operation groups (P<0.05). During the median follow-up for 45.6 months (ranging from 28.1 to 65.4 months), only 1 patient died after stroke. There was no significant difference in the incidences of peri-operative adverse events between the 2 groups (P>0.05). Till the end of follow-up, Cox model analysis showed that whether simultaneous surgery or not had no obvious correlation with the incidences of composite endpoints (OR=0.679, 95%CI: 0.12-3.72; P=0.66). Conclusion CAS combined with CABG is a safe and effective micro-invasive measure for the patients with coexisting coronary artery disease and severe carotid artery stenosis.

Abstract:Objective To compare the efficiency and safety of rivaroxaban with those of warfarin in the treatment of acute venous thrombosis in the very old patients, in order to provide theoretical and clinical basis for the former’s application. Methods Eighty-two patients (81.5±5.6 years old) with ultrasonography-identified acute venous thrombosis in lower extremity treated in Chinese PLA General Hospital from March 2012 to March 2014 were enrolled in the study. They were randomized into rivaroxaban group (n=39) and warfarin group (n= 43). The rivaroxaban group was given low molecular weight heparin (enoxaparin, 1 mg/kg, subcutaneous injection, once per 12 h) and oral taking of 10 mg rivaroxaban, once per day for the first 3 days, and then followed by rivaroxaban alone at the same dose. The warfarin group was given warfarin plus above dose of low molecular weight heparin for the first several days until international normalized ratio (INR) stably ranged from 1.6 to 2.5, and then followed by oral warfarin with INR monitoring. All enrolled patients were followed up for 12 months. During that period, intravascular ultrasound examination (arteries and veins in upper and lower extremities), echocardiography, electrocardiography, chest and brain CT scanning, blood routine test, and blood biochemistry were carried out regularly, and hemoglobin, platelets, coagulation function, alanine aminotransferase （ALT） and serum creatinine （SCr） were measured at baseline, and 1, 3, 6 and 12 months respectively after treatment. Primary efficacy endpoint and safety endpoints were also observed and recorded. Results Thrombi all disappeared in both rivaroxaban and warfarin groups, and there were no recurrent or new venous thrombosis, pulmonary embolism and deaths in either group. At the 1st, 3rd, 6th and 12th months, the average INR was 201±051, 2.02±0.48, 205±052 and 203±055, separately in the rivaroxaban group, and was 1.98±0.44, 2.04±0.53, 2.03±0.49 and 201±0.46, respectively in the warfarin group. During the follow-up, no significant differences were seen in the efficiency and safety between the 2 groups. Hemoglobin, platelet, coagulation function, ALT and SCr had no significant changes in the 2 groups either. Conclusion Oral administration of rivaroxaban is an effective approach in the treatment of acute venous thrombosis in the very old patients. A dose of daily 10 mg is safety and effective for the treatment. Rivaroxaban has similar efficacy as warfarin, but is safer, more convenient to administer, as well as better compliance.

Abstract:Objective To evaluate the effect and safety of ticagrelor in the elderly patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods Two hundred and forty consecutive elderly STEMI patients undergoing primary PCI in our hospital from November 2012 to December 2014 were recruited in this study, and divided into ticagrelor group (n=94) and clopidogrel group (n=146). Thrombolysis in myocardial infarction (TIMI) grade 3 flow, post-operative ST segment resolution (STR), bleeding incidence by Bleeding Academic Research Consortium (BARC) scale, dyspnea incidence, medication and causes for withdrawal and discontinuation of drugs, intra-hospital and 12-month occurrence of major adverse cardiac events (MACE) were observed and compared between the 2 groups. Results The percentage of TIMI grade 3 flow was significantly higher in the ticagrelor group than in the clopidogrel group (90.5％ vs 80.8％, P=0.024). But there were no significant differences in the incidences of BARC types and dyspnea between the 2 groups (28.7% vs 24.0%, P=0.412; 12.8% vs 6.8%, P=0.121). Compared with the clopidogrel group, there were more patients with drug withdrawal or discontinuation of antiplatelet therapy in the ticagrelor group in the 12 months’ follow-up (P<0.001). The withdrawals of ticagrelor or clopidogrel mainly attributed to doctor’s preference, cost and severe dyspnea (500% vs 14%, P<0001; 128% vs 14%, P<0.001; 5.3% vs 0.7%, P=0.025). No significant difference was found in the incidence of MACE between the 2 groups during hospital staying and 12 months’ follow-up (5.3% vs 5.5%, P=0.957; 8.5% vs 8.9%, P=0.916). Conclusion Ticagrelor significantly improves blood flow in the elderly patients with STEMI after primary PCI and has no effect on the incidence of BARC bleeding. The reasons for withdrawal and discontinuation of ticagrelor are doctor’s preference, cost and dyspnea.

Abstract:Objective To investigate the incidence and risk factors of massive gastrointestinal hemorrhage (MGH) in the patients with coronary artery diseases treated with elective percutaneous coronary intervention (PCI). Methods Consecutive 4239 patients with non-ST elevation acute coronary syndrome successfully treated with elective PCI in Anzhen Hospital from January 2012 to December 2014 were enrolled in this study. According to the occurrence of MGH or not within 1 year after PCI, the subjects were divided into MGH group (n=47) and non-MGH group (n=4192). The clinical data, MGH events and mortality in 1 year of follow-up were compared between the 2 groups. Results The incidence of MGH was 1.11% (47/4239) in the subjects. The proportion of the patients with preoperative administration of warfarin and low-molecular-weight heparin was significantly higher in the MGH group than in the non-MGH group (P<005). Multivariate logistic regression analysis revealed that advanced age (>75 years, OR=125, P=0031), anemia (OR=118, P=0037), history of gastrointestinal hemorrhage (OR=149, P=0005) and chronic renal insufficiency (OR=227, P=0001) were independent predictors for MGH in the patients undergoing elective PCI. In 1 year’s follow-up, the mortality was obviously higher in the MGH group than in the non-MGH group (64% vs 32%, P<0001). Conclusion Clinicians should adjust the type and dosage of antiplatelet drugs based on the patient’s age, body mass and renal function, and correct anemia and protect renal function to decrease the occurrence of MGH.

Abstract:Objective Ischemic stroke is a severe complication following cardiac surgery, but its risk factors remain unclear and need further study. This study assessed the predictive value of CHADS2 scores for perioperative ischemic stroke among atrial fibrillation (AF) patients undergoing mitral valve replacement surgery. Methods A total of 805 AF patients, with females accounting for 524% and at a mean age of (53.7±10.5) years, undergoing mitral valve replacement in our hospital from January 2005 to December 2014 were recruited in this study. Their CHADS2 scores were used to stratify the risk for perioperative stroke. The incidence of stroke during hospitalization was observed and compared between those with the score ≥2 and the score＜2. Multivariate logistic regression analysis was performed to determine the risk fcrtors used to predict stroke. The correlation of the score with perioperative stroke was analyzed. Results The CHADS2 scores were as follows in the subjects: 0 point in 493 cases (61.2%), 1 point in 185 cases (23.0%), 2 points in 92 cases (11.4%), 3 points in 26 cases (3.2%) and 4 points in 9 cases (1.1%). There were 14 patients (1.7%) having stroke and 16 (2.0%) dying during hospital stay. Stroke occurred in 6 cases in the 0-point patients (1.2%), 2 cases in the 1-point patients (1.1%), 3 cases in the 2-point patients (3.3%), 2 cases in the 3-point patients (77%), and 1 case in the 4-point patients (111%). Compared with the patients with CHADS2 score <2, those with the score ≥2 had higher incidence of stroke duringhospitalization (47% vs 12%, P=0005). The patients with higher CHADS2 score had higher proportions of being complicated with carotid artery stenosis, undergoing coronary artery bypass grafting (CABG) simultaneously, receiving mechanical valve replacement, and taking longer mechanical ventilation time post-operatively when compared with those with lower score (P<0.05). But there were no differences in the ICU stay length and intra-hospital mortality between them (P>0.05). Multivariate logistic regression analysis showed that the CHADS2 score ≥2 (OR=4.164, 95%CI: 1.388-12.495; P=0.011) and application of recombinant human coagulation factor Ⅶa (OR=11.757, 95%CI: 2.909-47.520; P=0.001) were independent risk factors for stroke during hospitalization. Conclusion There is an increased risk for stroke in the AF patients with higher CHADS2 score after mitral valve replacement. CHADS2 score ≥2 is an independent risk factor for stroke during hospitalization. The score is of significant value in the prediction of perioperative ischemic stroke in the AF patients undergoing mitral valve replacement surgery and worth further study.

Abstract:Objective To investigate the efficacy and safety of ticagrelor in the treatment of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the very old patients. Methods Consecutive senior NSTE-ACS patients (≥75 years old) admitted in our hospital from January 2014 to June 2015 were enrolled in this study. According to the anti-platelet strategies, the 202 subjects were divided into ticagrelor group (n=86, initially oral loading dose of 180 mg and then continue with 90 mg twice daily) and clopidogrel group (n=116, initially oral loading dose of 300 mg and then continue with 75 mg daily). All patients were followed up for 12 months after percutaneous coronary intervention (PCI) for the incidences of major adverse cardiac and cerebral events (MACCE), recurrent myocardial ischemia and bleeding events. Results MACCE occurred in obviously fewer patients of the ticagrelor group (4 cases/4.7%) than in the clopidogrel group (16 cases/13.8%, P=0.030). Recurrent myocardial ischemia was observed in 4 cases (4.7%) from the ticagrelor group, and in 8 cases (6.9%) out of the clopidogrel group, but there was no significant difference between them (P=0.495). There were 7 cases (8.1%) of bleeding events in the ticagrelor group, and 8 cases (6.8%) in the clopidogrel group, though without significant difference between them (P=0.752). Conclusion Ticagrelor treatment can improve the prognosis and has no effect in increasing the bleeding risk in the very old NSTE-ACS patients after undergoing PCI.

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Abstract:As a sensitive and specific indicator for coagulation and secondary fibrinolysis, plasma D-dimer, a fibrin degradation product, can be used as an important indicator for the prediction of thrombosis. Evidence showed that the plasma D-dimer can not only predict thrombosis in the patients with atrial fibrillation, but also be of a certain value to guide the anticoagulant therapy. In this article, we reviewed the predictive role of plasma D-dimer for thrombosis and its clinical value in the patients with atrial fibrillation.

Abstract:Objective To analyze the incidence and risk factors of hospital acquired infection (HAI) in the elderly patients with orthopaedic implant surgery, and to investigate the prevention and control countermeasures. Methods Clinical data of 1338 elderly patients underwent orthopaedic implant surgery in Guangzhou General Hospital from July 2013 to June 2015 were collected and analyzed retrospectively. The incidence and risk factors of HAI were studied and analyzed. Results There were 103 patients suffering from HAI, with an infection rate of 7.7%. The common sites of HAI were lower respiratory tract (36.97%), followed by urinary system (35.29%) and deep surgical site (10.08%). In the 116 obtained strains of pathogenic bacteria, multidrug resistant bacteria accounted for 63.79%, and the top 5 strains were Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterococcus faecium. Univariate analysis showed gender, age, operation type, complicated basic diseases, operation time, intra-operative transfusion volume, length of hospital stay, preoperative hospitalization days, invasive procedure and American Society of Anesthesiologists (ASA) score were closely associated with HAI in the elderly receiving orthopaedic implants (P<0.05). Conclusion To decrease the incidence of HAI for the elderly patients with orthopaedic implant surgery, clinicians should pay attention to every aspect of orthopaedic surgery, that is, preoperatively, fully evaluating the conditions and effectively controling the underlying diseases in the patients; intra-operatively, trying to shorten the operation time and reducing blood loss and transfusion volume; and post-operatively, strengthening the process management for ventilator, central venous catheterization, urinary catheterization and other invasive procedures.

Abstract:Objective To investigate the awareness of combination of medical care and nursing service in geriatric personnel and its current status in China. Methods A cross-sectional survey was conducted in all the members of Chinese Geriatrics Society from September to December 2015. A total of 1232 valid questionnaires were included in the analysis. Results The 1232 respondents were from 31 provinces and municipalities. There were 724% of them aged ≥40 years, 703% having master degree or above, and 766% having senior professional titles. More than 2/3 of the respondents had certain awareness on the concept and content of combination of medical care and nursing service, and about half of them had been involved in the corresponding work. More than 95% of the respondents thought it was necessary to set up national unified teaching materials, training bases, and standardized and specialist training programs for medical staffs who were engaged in geriatric medicine. However, only 54.8% of the questioned hospitals had carried out specialist training for nurses, 36.7% for nursing assistants, and the amount of those with teaching materials was even lower. A total of 175 (34.9%) hospitals had carried out combination of medical care and nursing service, mainly in the forms of extension service after hospital discharge (62.3%), cooperation with nursing homes (57.1%), reservation of nursing home beds for the elderly (40.6%), providing family doctors (38.3%) and setting up nursing homes (36.6%). The service objects mainly consisted of discharged patients (77.7%), community elderly (69.7%) and elderly in the nursing homes (60.0%). Special services included chronic disease management (88.0%), guidance of medication (87.4%), physical examination (78.3%), rehabilitation and aids adaptation (571%), spiritual consolation (531%) and hospice care (526%). Most of the geriatric departments and their extended services were umable to make ends meet, and need local policy support. Conclusion Though the geriatric staffs have well awareness and understanding on the combination of medical care and nursing service, it is still lack of national supporting on the construction for the personnel, training bases and other aspects. There are still many medical institutes having not provided the combination of medical care and nursing service and lacking of training and personnel development system for geriatric staffs.

Abstract:Objective To investigate the relationship between polymorphism of IL-8+781 and risk of ovarian cancer. MethodsPatients with ovarian cancer and age-matched healthy people were enrolled in this study. The polymorphism of IL-8+781 was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results The individuals with genotype TT had higher risk of ovarian cancer, compared with those with genotype CC (OR=3.385, 95%CI: 1.361-8.418, P=0.009). The individuals carrying allele T had higher risk of ovarian cancer than those carrying allele C (OR=1.704, 95%CI: 1.122-2.590, P=0.013). Conclusion IL-8+781 polymorphism may exert an effect on the occurrence of ovarian cancer.

Abstract:Objective To investigate the status and influencing factors of metabolic syndrome (MS) among all faculty of a medical university in order to provide scientific references for prevention and control of the disease. Methods Cross-sectional survey was carried out to collect the physical examination results of all official serving employees from a medical university and their social demographic data. The physical examination results included their height, body mass, body mass index (BMI), blood pressure, blood glucose, blood lipids and other indices. Results There were 21 staffs having MS, with a prevalence of 6.5%, lower than the result of national survey (168%). They had significantly higher body mass, BMI, systolic blood pressure and diastolic blood pressure when compared with the non-MS subjects (P<005). Multivariate logistic regression analysis indicated that over 45 years old (OR=395, P<005) and male (OR=547, P<005) were independent risk factors for MS. Conclusion Multiple measures should be implemented to prevent and control MS. Paying attention to the changes of blood pressure, blood glucose, blood lipids and other indices, and timely diagnosing and treating MS are ideal measures.

Abstract:Objective To evaluate the clinical value of monitoring the level of procalcitonin (PCT) in the elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with bacterial infection. Methods A total of 140 elderly patients with AECOPD admitted in our hospital from July 2012 to January 2013 were enrolled in this study. They were randomly divided into the PCT guidance group (n=72) and the routine therapy group (n=68). On the basis of similar routine treatment, the patients of the PCT guidance group were treated with antibiotics according to their serum PCT level. While, for those in the routine therapy group, antibiotics were administered according to the physician’s clinical experiences combined with patient’s conditions. The duration of antibiotic therapy, clinical efficacy, costs of hospitalization and antibiotics, length of hospital stay, and inflammatory indices after antibiotic therapy［total white blood cell count (WBC) and C-reactive protein (CRP)］ were compared between the two groups. Results There were no significant differences in the WBC count and CRP level between the 2 groups (P>0.05), but the PCT guidance group had obviously shorter length of hospital stay (P<0.01), and lower costs of hospitalization and antibiotics when compared with the routine therapy group (P<0.05). In addition, the PCT guidance group had obviously shorter duration of antibiotic therapy, when compared with the routine therapy group (P<0.01). Conclusion Using PCT level to guide the antibiotic treatment strategies will improve the efficacy of the antibiotics, avoid the unnecessary antibiotic exposure, shorten length of hospital stay and lower the costs of hospitalization and antibiotics in the treatment of the elderly patients with AECOPD.

Abstract:Objective To determine the effect of long-term treatment of glucocorticoid on neuromuscular block of rocuronium bromide in the elderly patients undergoing operation. Methods Sixty elderly patients who were scheduled for elective cholecystectomy under general anesthesia in our hospital from January 2013 to December 2015 were enrolled in this study. According to taking glucocorticoid treatment (budesonide) for over 3 months or not, the patients were divided into glucocorticoid group (n=30) and non-glucocorticoid group (n=30). During the operation, 0.6 mg/kg rocuronium bromide was infused intravenously, and accelerography (TOF-WATCH SX) was used to measure muscle relaxation. The onset time, degree of maximum neuromuscular block, clinical action duration and recovery indices were recorded and compared between the groups. Results Compared with the non-glucocorticoid group, the onset time was significantly longer, while the degree of maximum neuromuscular block, clinical action duration and recovery indices were obviously reduced in the glucocorticoid group (P<005). Conclusion Long-term administration of glucocorticoid reduces neuromuscular block of rocuronium bromide in the elderly patients undergoing operation.

Abstract:Intensive glucose control can reduce the risk of microvascular and macrovascular complications in the patients with early type 2 diabetes mellitus (T2DM). However, elderly patients are characterized by being accompanied with multiple organ dysfunctions, coexistence of various diseases, complexity of medications, large fluctuations in blood glucose, and frequent hypoglycemia. Both excessive glucose fluctuations and severe hypoglycemia are closely associated with vascular complications. So a new treatment concept for the aged T2DM patients is that, on the basis of blood glucose controlling, we should reduce blood glucose fluctuation and occurrence of severe hypoglycemia, and thus, will reduce the occurrence and the development of chronic complications of T2DM.

Abstract:More and more studies indicate that oxidative stress is closely related to the occurrence of osteoporosis. But thioredoxin (Trx) system is a multifunctional small molecule protein system, consisting of Trx, thioredoxin reductase (TrxR), reduced coenzyme Ⅱ (NADPH) and thioredoxin interacting protein (TXNIP), and one of its important roles is involved in regulating cellular redox state against oxidative stress, and thus plays an important role in the occurrence and development of osteoporosis. This article reviewed the relationship between the thioredoxin system and osteoporosis.

Abstract:Osteoporosis is a systemic bone metabolism disorder characterized by reduced bone mineral content, damaged bone microstructure and compromised bone strength that may predispose to an increased risk of fracture and an increased bone fragility. Warfarin, a vitamin K antagonist, can inhibit carboxylation of osteocalcin, reduce bone calcium deposition, and thus interact with bone metabolism and induce osteoporosis or bone fracture, especially in the elderly patients. The osteoporosis risk related with the use of warfarin may be associated with dosage and time of duration. The basic principle to prevent drug-induced osteoporosis is the same as that for primary osteoporosis. Calcium and vitamin D should be used for prevention. Bisphosphonates, calcitonin, estrogens and parathyroid hormone analogues can be selected for the treatment of osteoporosis or fracture induced by warfarin according to the individual condition of patients. In this paper, we reviewed the advances on pathological mechanism, research progress and therapeutic strategy of osteoporosis induced by warfarin.