Abstract:Objective To compare the bleeding risk in the over-70-year-old patients with coronary artery diseases treated by ticagrelor or clopidogrel after discharge from hospital. Methods Consecutive 597 elderly patients who were admitted to our department due to acute coronary syndrome (ACS) and underwent percutaneous coronary intervention (PCI) from Jan. 2014 to Mar. 2015 were enrolled in this study. According to their dual antiplatelet therapy, they were divided into ticagrelor group (n=99, treated with ticagrelor combined aspirin) and clopidogrel group (n=498, treated with clopidogrel combined aspirin). After 1 year’s follow-up, their bleeding risk was compared, and the risk factors of bleeding events were analyzed. Results The incidence of bleeding events was significantly higher in the ticagrelor group than the clopidogrel group (25.3% vs 14.5%, P=0.008), and significant difference was seen in the ratio of type Ⅰ bleeding events(P=0.015), but not in the type Ⅱ bleeding events (P=0.261) between the 2 groups. During the medication period, 263 patients underwent thrombelastography (TEG), including 77 cases from the former and 186 from the latter group. ADP-induced inhibition of platelet aggregation was significantly increased [(80.29±20.67)% vs (61.65±26.81)%, P<0.001], but ADP-induced maximum amplitude (MAADP) was significantly reduced [(25.28±14.28) vs (36.41±16.20) mm, P<0.001] in the ticagrelor group than the clopidogrel group. The ticagrelor group had significantly larger percentage of patients with MAADP <31 mm than the clopidogrel group (68.8% vs 40.3%, P<0.001), and these patients had obviously higher occurrence of bleeding events as well (24.5% vs 10.7%,P=0.037).Multivariate logistic regression analysis indicated that low body mass index (BMI;OR=0.910,5%CI:0.842-0.984,P=0.018) and being complicated with hypertension (OR=1.301,5%CI:1.036-1.635,P=0.024) were the independent risk factors of bleeding events in the ≥70-year-old patients with coronary artery disease in treatment of dual antiplatelet therapy. Conclusion The risk of bleeding events is higher when taking ticagrelor than clopidogrel in the elderly patients with coronary artery disease. And those with low BMI and hypertension are prone to bleeding events. Therefore, full consideration should be given to the risk factors of bleeding, and TEG monitoring should be carried out in the treatment of dual antiplatelet therapy in order to reduce the incidence of bleeding events.

Abstract:Objective To study the serum level of cystatin C (Cys C) and plasma level of N-terminal pro-brain natriuretic peptide (NT-pro BNP) in the heart failure patients with preserved ejection fraction (HFpEF) and those with reduced ejection fraction (HFrEF), and investigate their relationships and clinical significances. Methods Seventy-five patients (≥60 years old) with established diagnosis of heart failure (at class Ⅱ, Ⅲ and Ⅳ respectively according to NYHA classification) admitted to Cadre’s Ward and Department of Cardiology in our hospital from January 2015 to June 2016 were recruited in this study. They were 55 cases of HFpEF and 20 cases of HFrEF. Another 50 patients (≥60 years old) without the history of cardiovascular disease served as controls. The clinical data were collected and compared in the 3 groups. Serum Cys C level, plasma NT-Pro BNP level and left ventricular ejection fraction (LVEF) were measured and their correlations were analyzed. The values of Cys C and NT-pro BNP in the diagnoses of 2 types of heart failure were investigated with receiver operating characteristic (ROC) curve. Results The patients of the HFpEF group were older than those from HFrEF group and control group (P<0.05). There were significant differences in the levels of Cys C and NT-Pro BNP among the 3 groups (P<0.05). The Cys C level of the HFpEF group was positively correlated with the levels of NT-Pro BNP, creatinine, blood urea nitrogen and uric acid (P<0.05), and the level was still correlated with that of NT-pro BNP after adjustment for the interference factors (r=0.460, P=0.001). The level of NT-pro BNP was negatively correlated with LVEF in the HFpEF group and HFrEF group (r=-0.277, P=0.041; r=-0.512, P=0.021). The ROC curve analyses showed that the cut-off level of NT-pro BNP was 355 ng/L for HFpEF diagnosis and 1835 ng/L for HFrEF diagnosis with the highest Youden’s indices and the sensitivity of 98.2% and 95.0% respectively, while the specificity of 60.0% and 78.1% separately. The cut-off level of Cys C was 1.765 mg/L for HFrEF, with the largest area under ROC curve and the sensitivity of 85.0% while the specificity of 75.2%. Conclusion The serum level of Cys C and plasma level of NT-pro BNP are different between the elderly heart failure patients with HFpEF and those with HFrEF. NT-pro BNP is a sensitive biomarker in the diagnosis of heart failure, and Cys C is more significant in the diagnosis of HFrEF than that of HFpEF.

Abstract:Objective To investigate the radiological findings of protruded nucleus pulposus(PNP) and vertebral subluxation at the involved segment in the aged patients with lumbar disc herniation(LDH),and explore their clinical significances. Methods Thirty aged LDH patients who were consecutively admitted in our hospital from December 2014 to December 2015 were recruited in this study and assigned as the observation group. They were all successfully and conservatively treated by Feng’s Spinal Manipulation (FSM). Another 30 age- and gender-matched patients diagnosed with asymptomatic LDH (ALDH) during their annual physical exam. were subjected as control group. The “T” value (the space occupation of lumbar PNP in vertebral canal), “AV” angle (the nerve root canal stenosis of PNP), vertebral rotation (VR) angle, vertebral tilt (VT) angle, Oswestry disability index (ODI) of lower limb, nerve root sign (NRS),and paraspinal sign (PS)at the involved segment were compared before and after the treatment, and between the 2 groups. A correlation analysis was also conducted between the radiological findings at involved segment and the clinical manifestations of the patients. Results Compared with the control group, the VR and VT angles were significantly higher in the observation group before the treatment (P<0.05), and that of VR was obviously increased after treatment (P<0.05). The VR and VT angles, NRS, PS and ODI were remarkably decreased in the observation group after the treatment than before (P<0.05). NRS, PS and ODI were positively correlated with the values of VR and VT angles (rNRS/VR=0.600, rNRS/VT=0.431, rPS/VR=0.386, rPS/VT=0.408, rODI/VR=0.814, rODI/VT=0.567, all P<0.05). Conclusion (1) Our study proves that the elderly LDH patients can live well with PNP, and conservative treatment doesn’t obtain its efficacy by changing the morphology of the herniated nucleus pulposus. (2) The signs of mechanical imbalance at the involved vertebrae are important indictors to evaluate the clinical severity of the manifestations. (3) Correcting of “vertebral subluxation” might be one of critical principles in treatment of the elderly LDH patients.

Abstract:Objective To evaluate the role of aspirin in primary prevention of cardiovascular diseases through a systematic review and meta analysis. Methods Computer retrieval was carried out in PubMed, EMBASE, Cochrane Library, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI), VIP database and WanFang Data, etc, in December 2014 for the literatures about aspirin, primary prevention, cardiovascular diseases and other search terms. The obtained literatures were screened according to the eligibility criteria. Then the quality of the literature was assessed with methodological evaluation, and the data such as baseline information, methodological characteristics, interventions and outcomes were extracted. According to the heterogeneity test, a fixed-effect model or a random-effects model was selected to perform meta-analysis in each study. Data analysis and charting were done using Stata 11.0 software. Results There were 10 studies incorporated in this study, including 59 365 cases of aspirin group and 57 720 cases of placebo group. The meta-analyses showed the incidence of major adverse cardiovascular events (MACE) was 3.74% (2222 cases) for the former group and 4.00% (2306 cases) for the latter. The results of the fixed-effect model indicated that aspirin reduced the risk of MACE by 10% (RR=0.90,5%CI:0.85-0.96, P<0.000), the risk of myocardial infarction by 16% (RR=0.84, 95%CI:0.72-0.98, P=0.023), the risk of stroke by 6% (RR=0.94,5%CI:0.86-1.04, P=0.211), the risk of all-cause death by 5% (RR=0.94,5%CI:0.90-1.01, P=0.075), and the risk of cardiovascular death by 2% (RR=0.98, 95%CI:0.89-1.09, P=0.776), but increased the risk of hemorrhea by 77% (RR=1.77, 95%CI:1.40-2.22, P=0.000). Conclusion Aspirin is not suitable for primary prevention of cardiovascular diseases, although it can reduce the incidences of MACE and myocardial infarction, but it will increase the risk of hemorrhea.

Abstract:Objective To investigate the current application and effectiveness of antiplatelet drugs in elderly people taking physical examination. Methods A total of 955 elderly patients (≥60 years old) who taking physical examination in our hospital from June to August 2015 were enrolled in this cross-sectional study. They were divided into 4 groups by treatment scheme, that is, aspirin group (n=368), clopidogrel group (n=115), dual-drug group (aspirin+ clopidogrel, n=43), and non-drug group (n=429). Their baseline clinical data and the results of thrombelastography (TEG) were collected. The application and effectiveness of the antiplatelet agents were analyzed, and the related clinical indicators influencing drug efficacy were investigated. Results Significant differences were found in the age distribution, proportions of smokers, and those with the medical history of stroke, coronary heart disease,diabetes mellitus, hyperlipidemia, as well as white blood cell count (WBC), platelet count (PLT), total cholesterol, low-density lipoprotein cholesterol (LDL-C), fasting blood glucose(FBG), creatinine, estimated glomerular filtration rate (eGFR) and glycosylated hemoglobin (HbA1c) (P<0.05), but not in the blood coagulation index (P>0.05). In aspirin group, the arachidonic acid (AA) pathway was nearly effective. The adenosine diphosphate (ADP) pathway was within the scope of effectiveness in the clopidogrel group. The ADP and AA pathway were both effective in the dual-drug group. The effectiveness was more significant in the clopidogrel group than in the aspirin group (76.52% vs 45.92%, P<0.05). Logistic regression analysis found that WBC, PLT, LDL-C and activated partial thromboplastin time (APTT) increased the risk of bleeding, while age, PLT, eGFR, HbA1c, and APTT increased the risk of thrombus. Conclusion The current application of antiplatelet agents is satisfying, which can bring benefit to the elderly.

Abstract:Objective To assess the efficacy and safety of dl-3-butylphthalide in the treatment of the patients with multiple system atrophy (MSA). Methods Totally 40 consecutive MSA patients admitted in our department from March 1st, 2014 to November 23rd, 2015 were prospectively subjected in this study. They were randomly assigned into the experimental group and the control group. The patients from the former group were given dl-3-butylphthalide injection (25 mg, iv, bid) besides routine therapy, and those from the latter group only received the routine therapy. Unified Multiple System Atrophy Rating Scale (UMSARS) was used to evaluate the symptom relief, curative effect and side effect at admission and in 2 weeks and 3 months after the treatment. All the subjects were also assessed with Barthel Index (BI) scale at the beginning and 12 months later for the effect of the treatment on their daily activities. Results (1) There were no significant differences in the age of onset, course and types of the disease, parameters of external anal sphincter electromyogram and cranial magnetic resonance image between the 2 groups (P>0.05), neither in the age, sex, proportions of the patients complicated with hypertension, diabetes and coronary heart disease and in the UMSARS and BI scores (P>0.05). (2) In 2 and 12 weeks after the treatment, the patients of the experimental group had their muscle tone, gait and muscle tremor improved at some extents, and the scores of UMSARS were significantly lower than the control group (P<0.05). But no obvious difference was seen in the BI scores between them even after the 12 weeks’ follow-up (P=0.13). (3) There were no severe side effects in all the subjects in 2 weeks and 3 months after the treatment. Conclusion dl-3-butylphthalide treatment exerts certain effect on the symptoms and UMSARS scores in the MSA patients, with safety and without severe side effect in clinical application.

Abstract:Objective To investigate the early efficacy and advantages of expansive intra-canal plasty (EICP) in the treatment of central lumbar spinal stenosis in the elderly. Methods A retrospective analysis was performed on 23 elderly patients with central lumbar spinal stenosis due to degeneration and with main manifestation of intermittent claudication admitted in our hospital from January to July 2015. They were all treated with EICP. The operation time, blood loss, intraoperative monitoring of spinal nerve, postoperative drainage, postoperative complications, postoperative images of lumbar spinal fusion of the lumbar spine and the cross-sectional area during follow-up, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), improvement of intermittent claudication were observed and recorded to evaluate clinical outcomes. Results All cases were followed up for 12 to 16(13.8±1.5) months. The average bleeding amount of single segment was (257.5±47.1)ml, the operation time (114.5±16.8)min, and postoperative drainage amount (150.0±37.6)ml. For double segments, the intraoperative blood loss was (344.5±55.6)ml, the operation time was (161.8±161.8)min, the postoperative drainage amount was (225.4±40.1)ml, and no abnormality was found in intraoperative spinal cord monitoring. There were 3 patients having postoperative complications. One case had dural sac tear, and the postoperative cerebrospinal fluid was stopped in 5 d after symptomatic treatment. Two cases had postoperative delayed healing of incision, and the incisions were healed well after 3 weeks’ active treatment. CT scanning showed that the cross-sectional area of narrowed space was significantly increased from preoperative (73.32±2.67)mm² to (213.33±3.26)mm² in 1 week postoperatively in L3-4 segments, and from (116.24±2.17) to (260.16±3.67)mm² in L4-5 segments (P<0.05). In 1 year after operation, the JOA score, ODI score and intermittent claudication were obviously improved (P<0.05). According to JOA score, the postoperative improvement rate was 90.05%. The fusion rate was 78.2%, 86.9% and 95.6%, respectively in 3 and 6 months, and 1 year postoperatively. Conclusion EICP is an innovation for the traditional resection of whole lamina and decompression in the treatment of central lumbar spinal stenosis, reflecting the concept of modern surgery, precise surgery and minimally invasive surgery. It can not only exert effective decompression in the narrow canal, but also protect the native structure behind the lumbar spine, maintain the stability of lumbar spine, increase the bone graft area, and elevate the rate of fusion. It exerts effective surgical efficiency and causes low incidence of complications, and is an effective approach for lumbar spinal stenosis.

Abstract:Objective To determine the efficiency of dopamine and norepinephrine in treatment of cardiogenic shock. MethodsSixty cardiogenic shock patients admitted in our hospital from June 2007 to June 2014 were subjected in this study, and then randomly divided into 2 groups (n=30), treated with 5~20 μg/(kg·min) dopamine and 0.05~2.0 μg/(kg·min) norepinephrine, respectively. The mortality, heart rate after 24 hours’ treatment, mean arterial pressure (MAP), blood lactic acid level and incidence of arrhythmia during the treatment were compared between the 2 groups. Results The mortality in Intensive Care Unit (ICU), HR after 24 hours’ treatment and incidence of arrhythmia were significantly higher in the dopamine group than in the norepinephrine group (P<0.05). But there were no significant differences in the in-hospital mortality and the mortalities in 28 d, 6 months and 1 year after discharge (P>0.05). No differences were seen in the MAP and blood lactic acid levels between two groups after 24 hours’ treatment (P>0.05), neither in the occurrences of ventricular tachycardia and fibrillation during the treatment (P>0.05). ConclusionCompared with dopamine, norepinephrine treatment can effectively lower ICU mortality, decrease HR and reduce atrial fibrillation, but doesn’t affect long-term mortality in treatment of cardiogenic shock.

Abstract:Objective To analyze the prognosis of the elderly patients with acute kidney injury (AKI) and those suffering from acute on chronic kidney injury. Methods A total of 147 patients (105 males and 42 females, at a mean age of 83.95±7.04) with acute on chronic AKI (AonC) and 270 cases (226 males and 44 females, at a mean age of 81.75±6.98) with denovo AKI admitted in our center from August 2009 to October 2013 were enrolled in this study. Their short-term outcomes (within 1 year) were analyzed. Results The 30-day mortality was significantly higher in the AKI than the AonC patients (P<0.05), but there were no differences in that of 90-day and 1-year (P>0.05). No difference was seen in the recovery of renal function between the survivals from the 2 group (P>0.05). There were no differences in the 30-day,90-day,1-year mortalities among the AonC patients with different estimated glomerular filtration rates (eGFR). COX multivariate regression analysis showed that complication with chronic kidney disease (CKD) had no relation with the 30-day mortality (P=0.068), but is associated with AKI stage, anemia,hypoalbuminemia,heart failure, cancer, and multiple organ dysfunction syndrome (MODS). Renal replacement therapy was the protective factor for AonC patients. Conclusion The incidence and mortality of AKI were quite high in the AKI elderly patients.Complication of CKD is not related with their short-term prognosis.

Abstract:Objective To determine the effect of ⁶⁰Co γ-ray irradiation on biological behaviors in cultured vascular endothelial cells in vitro. Methods Human umbilical vein endothelial cells (HUVECs) were exposed to ⁶⁰Co γ-ray irradiation at different doses. After irradiation, the proliferation of HUVECs was evaluated by cell growth curve and colony formation assay. Cell cycle was detected by flow cytometry. DNA damage and repair were analyzed by neutral single-cell gel electrophoresis, and the expression of related proteins was detected by Western blotting.Results After γ-ray irradiation, the proliferation of HUVECs was significantly inhibited in a dose-dependent manner. The cells were arrested at G₂/M stage after irradiation exposure. Obvious DNA double-strand breaks and enhanced expression of γH2AX and DNA-PKcs were observed in the HUVECs after irradiation. Conclusion ⁶⁰Co γ-ray irradiation inhibits the proliferation of HUVECs, induces the cells arrested at G₂/M stage, promotes DNA break, and enhances the expression of repair-related proteins in endothelial cells.

Abstract:Objective To determine the synergic effect of simultaneously blocking epidermal growth factor receptor (EGFR) and cyclooxygenase-2 on the growth inhibition of human lung cancer A549 cells. Methods The A549 cells were treated by gefitinib (5 μmol/L), celecoxib (25 μmol/L), or a combination of them at the same dosages respectively for 48 h, and the cells without treatment served as control. Cell growth was detected by trypan-blue exclusion assay, apoptosis rate and cell cycle were measured by flow cytometry and Hoechst33258 staining, expression of EGFR and COX-2 proteins was determined by Western blotting. Results With time and dose increase, both gefitinib and celecoxib showed stronger inhibitory effect on the growth of A549 cells, and the combination of them had more significant inhibitory effect than the gefitinib and celecoxib groups (P<0.01). The combination group also had obvious higher apoptosis rate than the monotherapy groups (32.40% vs 7.12% and 8.43%, P<0.01). The proportion of the cells at S stage was (3.2±0.9)% in the combination group, significantly decreased when compared with those in the gefitinib and celecoxib groups [(37.4±1.6)%, (21.0±3.1)%, P<0.01]. The combination group had obviously more cells arrested at G₀/G₁ stage than the monotherapy groups [(87.2±6.4)% vs (61.4±5.2)% and (51.8±4.7)%, P<0.01]. The protein levels of EGFR and COX-2 were significantly lower in the combination group than the other 2 groups (P<0.05). ConclusionThe combination treatment of gefitinib and celecoxib exerts inhibitory effect through blocking both EGFR- and COX-2-related pathways, and the regimen might provide a promising strategy for cancer therapy and chemoprevention in lung cancer.

Abstract:Atherosclerosis (AS) is one of important basic pathogeneses of cardiovascular diseases, with a variety of complex aspects of pathological processes involved. Chronic vascular inflammatory response, proliferation, migration, and apoptosis of smooth muscle cells and neovascularization are involved in the pathogenesis and development of AS. Many inflammation-related biomarkers have been confirmed as new targets for detection of AS and cardiovascular disease risk. In these biomarkers, oncostatin M (OSM) has attracted more and more attention. Evidence shows that OSM not only exerts biological effects on melanoma, liver regeneration and chronic inflammations such as rheumatoid arthritis, and lung and skin inflammatory diseases, but also plays important role in AS. In this article, we reviewed the roles of OSM in the pathogenesis and development of AS.

Abstract:There have been more and more type 2 diabetes mellitus (T2DM) patients in all over the world. T2DM is widely considered as a multifactorial disease, and family history of diabetes, as one of the independent risk factors in its development, represents the combination of genetic susceptibility and shared environmental factors on the incidence. In this review, we elucidated the recent progress in genetic susceptibilities and shared environmental factors involved in the association between the family history of diabetes and risk of T2DM.

Abstract:Angiogenesis is characterized by forming new blood vessels from existing capillaries, and is mutually regulated by angiogenic factors and antiangiogenic factors in a dynamically balanced process. As a severely debilitating pathological change of a variety of diseases, including tumor, retinopathy of prematurity and diabetic retinopathy, etc, angiogenesis is a severely disabling condition. Thus, establishing animal models of neovascularization is an important prerequisite to study the pathogenesis. This article reviewed 4 animal models of angiogenesis, that is, aortic ring assay, matrigel plug assay, oxygen-induced retinopathy and laser-induced choroidal neovascularization in animal models.

Abstract:Gout is one of the most common forms of arthritis, and its prevalence is gradually increasing. Improper treatment for the disease may lead to chronic pain, renal insufficiency, joint destruction and deformities, and thus, affect the quality of life in the patients. The main drugs for the treatment consist of those controlling the symptoms for acute gout and those managing hyperuricemia. Based on our experiences and clinical guidelines for gout at home and abroad, we reviewed the efficiency, safety and rational use of gout drugs.

Abstract:In recent years, with the acceleration of aging process in our country, the elderly becomes the main body of chronic diseases, which are closely associated with life styles. Drinking is quite common in the daily life of the aged. Intaking different types and different amounts of alcohol has different effects on the body. At the same time, bad drinking habits exert significant impacts on the pathogenesis and development of some chronic diseases in the old people, but good drinking habits can improve the occurrence and development of some diseases. Therefore, this article reviewed the relationship of the good and bad drinking habits.