Abstract:Objective To explore the efficacy of 2 frailty assessment methods, frailty phenotype and frailty index (FI) in assessment of frailty in the elderly so as to provide reference for clinical practice and scientific researches. Methods Totally 106 elderly individuals [at the age of(79.5±7.6)years] who took physical examination in our outpatient department of geriatrics in 2015, were enrolled in the study. After general examination, all the subjects underwent comprehensive geriatric assessment. FI value was calculated and frailty phenotype were assessed for each subject. The prevalence of frailty in the same population was measured by the above approaches, and the relevance or consistency were analyzed based on the results. Receiver operating characteristic (ROC) curves were used to evaluate the effects of FI cut-off points on frailty screening. Results The mean value of FI was 0.19±0.07 in this cohort. According to the results of frailty phenotype assessment, 65 cases (61.3%) were categorized as pre-frailty, 15 cases (14.2%) as frailty, and 26 cases (24.5%) as non-frailty. Both assessment methods indicated that the severity of frailty was increased with age. FI value was positively correlated with frailty level staged by phenotype assessment (r=0.433, P=0.000). When FI cut-off values ranged from 0.09 to 0.25, its consistency (Kappa value) with frailty phenotype was 0.143 (P=0.029), and the area under the curve (AUC) was 0.760 (95%CI:0.616-0.905, P=0.001). While the Kappa value was 0.178 (P=0.002) and the AUC was 0.774 (95%CI:0.629-0.919, P=0.001) when the cut-off value of FI was 0.20-0.35. The optimal cut-off point of FI was 0.19-0.27. Conclusion The elderly at pre-frailty accounts for a larger proportion in this study, and the frailty severity is increased with age. Moderate positive correlation is found between FI value and frailty level by phenotype. The 2 pairs of FI cut-off values can be used to screen frailty for Chinese elderly, but the accuracy is not quite satisfactory.

Abstract:Objective To determine the effect of epidural block on the incidence of postoperative complications in the patients undergoing video-assisted thoracoscopic surgery for non-small cell lung cancer (NSCLC). Methods A total of 396 NSCLC patients undergoing radical thoracoscopic surgery in our hospital from January 2014 to November 2015 were subjected in this study. They were randomly given general anesthesia and postoperative intravenous analgesia (GA group, n=198) and combined epidural-general anesthesia and postoperative epidural analgesia (EGA group, n=198). Except epidural block, the 2 groups received general anesthesia with same drugs intraoperatively and intravenous or epidural patient-controlled analgesia postoperatively for 3 d. The severities of pain at rest and with cough were assessed during the first 3 postoperative days with numeric rating scale (NRS). The patients were followed up from the 4th day postoperatively until hospital discharge for postoperative complications, hospital length of stay and in-hospital mortality. The primary end point was the incidence of postoperative complications during hospitalization. Results All 396 patients were included in the intention-to-treat analysis. The NRS pain scores both at rest and with cough were significantly lower in the EGA group than the GA group during the first 3 postoperative days (all P<0.0001). Compared with the GA group, the EGA group had significant lower incidences of atelectasis [1.0%(2/198) vs 4.5%(9/198), P=0.032], atrial fibrillation [2.0%(4/198) vs 5.1%(14/198), P=0.016], and overall cardiovascular complications [2.5%(5/198) vs 8.1%(16/198), P=0.014]. But there was no significant difference in the overall incidence of complications after surgery [15.2%(30/198) vs 12.6%(25/198), P=0.468]. The incidence of hypotension requiring intervention was obviously higher (P=0.021), whereas that of hypertension requiring intervention was lower (P<0.0001) in the EGA group than in the GA group during the perioperative period. Conclusion For the patients undergoing video-assisted thoracoscopic surgery for lung cancer, epidural block provides better analgesia and reduced the incidences of atelectasis and atrial fibrillation after surgery. However, it increases the occurrence of perioperative hypotension.

Abstract:Objective To investigate the safety and efficacy of mapping and ablating paroxysmal atrial fibrillation (PAF) by using remote magnetic navigation system (MNS, Niobe Ⅲ, Stereotaxis) vs manual navigation. Methods Totally 103 consecutive patients diagnosed as PAF in our department from October 2014 to November 2016 were enrolled in our study. They were randomly divided into MNS group [(n=53,7 males and 26 females, at an age of (65±13) years] and manual navigation group [(n=50,3 males and 27 females, at an age of (62±15) years]. Procedure time, ablation time, X-ray exposure time, and recurrence in 3 months’ follow-up were collected and compared between the 2 groups. Results Pulmonary vein isolation was accomplished in 52 cases from the MNS group, and in 49 cases of the manual navigation group. The success rate was 98% in both group, without significant difference (P>0.05). Compared with the manual navigation group, the MNS group had significantly longer procedure and ablation times, but obviously shorter X-ray exposure time (P<0.05). There was no notable difference in the recurrent rate between the MNS (10 cases) and manual navigation groups (12 cases) in 3 months after surgery (19% vs 24%, P>0.05). Conclusion In comparison with manual navigation, Niobe Ⅲ remote magnetic navigation system is safe and effective in mapping and ablation of PAF, and it reduces the X-ray exposure time.

Abstract:Objective To investigate whether death education can improve the emotional state and the quality of life in the elderly terminally ill cancer patients. Methods A total of 97 terminally ill patients (68.32±8.78 years old) with cancer admitted in our department from November 2010 to December 2012 were enrolled in this study. They all received individualized death education, once or twice per week, for 4 consecutive weeks. Profile of mood states POMS) and European Organization for Research and Treatment of cancer quality of life (EORTC QLQ-C30) were conducted on the patients before and after the education. Results After the death education, their scores of tension-anxiety, depression-dejection, anger-hostility, and confusion-bewilderment, and the scores of other emotional factors were all significantly reduced (P<0.001). Death education resulted in obvious improvements in the emotional function, cognitive function, social function and the total scores of EORTC QLQ-C30 in the participants (P<0.001). ConclusionDeath education mitigates the fear, worry and pessimism of death, and improves the quality of life in the elderly terminally ill cancer patients.

Abstract:Objective To observe the changes of blood glucose in the elderly with multiple organ dysfunction syndrome (MODSE) induced by pulmonary infection, and to analyze the correlation between blood glucose with the incidence and severity of MODSE. Methods A retrospective study was carried out on 625 patients (≥65 years old) with pulmonary infection admitted in our hospital from January 2005 to December 2014. According to the onset of diabetes, they were divided into diabetes group and non-diabetes group. According to whether pulmonary infection induced MODSE or not, each group was further divided into MODSE subgroup and non-MODSE subgroup. The highest fasting blood glucose was compared between the MODSE subgroup and non-MODSE subgroup from the diabetes group or from the non-diabetes group. Spearman rank correlation analysis was used to analyze the correlation of blood glucose with the incidence and severity of MODSE. Results Among the 196 diabetes patients, MODSE occurred in 89 cases, and in 95 cases among the 429 non-diabetes patients. The highest fasting blood glucose level in the MODSE subgroup and non-MODSE subgroup from the diabetes group were (13.720±4.863), (7.439±3.043) mmol/L, and that from the non-diabetes group were (8.656±2.664), (5.679±1.332) mmol/L respectively, with the level significantly higher in the MODSE subgroup than in the non-MODSE subgroup (P<0.001). The highest fasting blood glucose in elderly pulmonary infection patients was positively correlated with the incidence and severity of MODSE (P<0.001). Conclusion The highest fasting blood glucose level is obviously increased in the elderly patients with MODSE due to pulmonary infection, and its changes are positively correlated with the incidence and severity of MODSE.

Abstract:Objective To investigate the epidemiological risk factors profile for cardiovascular and metabolic diseases among the over-80-year-old community residents. Methods Stratified random sampling was used in this survey conducted from May 2013 to October 2015. Totally 2254 elderly residents (≥80 years old) were subjected from 44 communities. Field questionnaire survey, physical examination, electrocardiography and blood biochemical assays were carried out, with a response rate of 90.6%. All participants were divided into male group (n=1122) and female group (n=1132). Results The prevalence of smoking and drinking was 11.2% and 8.4%, respectively in the subjects, with that of the male group significantly higher than in the female (P<0.05). Hypertension was quite common in the participants, and only 6.6% of them had normal blood pressure. There were more males having impaired fasting glucose, elevated serum creatinine and arrhythmia, but they had lower prevalence of hyperuricemia, obesity, and increased non-high-density lipoprotein cholesterol when compared with the females (P<0.05). The subjects had their systolic blood pressure (SBP) and pulse pressure (PP) higher than the normal values, and their heart rate (HR), waist circumference, total cholesterol (TC) and serum creatinine (Scr) were closed to the critical values, and their body mass index (BMI), triglycerides (TG), serum uric acid and diastolic blood pressure (DBP) were in the normal ranges. The female group had significantly higher SBP, PP, heart rate, waist-to-height ratio, TG, TC, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and non-HDL-C, and obviously lower DBP, fasting blood glucose, serum uric acid, Scr and glomerular filtration rate when compared with the male group (all P<0.05).Conclusion Hypertension is quite common in the elderly aged 80 and older. Their many indicators are close to the critical values or even higher than normal values, indicating that there are individual differences among the population, and individualized treatment is needed.

Abstract:Objective To investigate the relationship between preoperative body mass index (BMI) and the risk of postoperative complications in elderly patients. Methods This was a secondary analysis on the data derived from the patients of the placebo group in a previously published randomized controlled trial. A total of 350 elderly patients (≥65 years old) who were admitted to intensive care unit (ICU) after noncardiac surgery were recruited in this study. The primary endpoint was the occurrence of postoperative complications. Logistic regression model was used to analyze the relationship between preoperative BMI grade and the risk of postoperative complications.Results There were 35.1% of patients (123/350) developing postoperative complications. Logistic multivariate regression analysis showed that, compared with the normal weight patients (BMI 18.5-23.9 kg/m²), the underweight (BMI <18.5 kg/m²) was associated with an increased risk of postoperative complications (OR=2.210,5%CI:1.069-4.570, P=0.032), whereas overweightness and obesity (BMI ≥24.0 kg/m²) had no such significant effect (OR=0.820,5%CI:0.497-1.354, P=0.438). Conclusion For the elderly who were admitted to ICU after noncardiac surgery under general anesthesia, low preoperative BMI is associated with increased risk of postoperative complications.

Abstract:Objective To investigate the efficacy of cardiac resynchronization therapy (CRT) and the correlation of red blood cell distribution width (RDW) with the response to CRT. Methods A retrospective analysis was carried out on 45 patients with chronic heart failure (CHF) undergoing implantation of CRT-pacing/defibrillation (P/D) in the Heart Center of the First Hospital of Lanzhou University from October 2007 to March 2016. According to their responses to CRT, they were divided into response group (n=27) and non-response group (n=18). Their clinical data before operation and in 6 months postoperatively were collected and analyzed. Multivariate logistic regression analysis was used to explore the factors influencing the response to CRT. Results There were 27 responders in the subjects, with a respondent rate of 60%. Significant differences were observed in the patients in different classes by the New York Heart Association (NYHA) functional classification from the both groups after CRT (P<0.05). In comparison to the data before treatment, the responder group got great improvements in the heart functional class, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), left ventricular end diastolic volume (LVEDV), QRS duration (QRSd), 6-minute walking distance (6MWD) and Minnesota quality of life questionnaire (MLHFQ) (all P<0.05). Obvious improvements were only seen in LVEF, LVEDD, and QRSd in the non-responder group (all P<0.05). Between these 2 groups, there were significant differences in the NYHA functional class and LVEF after CRT (P<0.05). Pre-operative NYHA functional class, QRSd before CRT≥150 ms, the amount of QRS shortening (ΔQRSd), RDW before CRT and CRT-D were the independent factors for the response to CRT (P<0.05). Conclusion Evaluating NYHA functional class, QRS complex and RDW is very important before the CRT treatment, and these indicators are of great significances for the response to CRT.

Abstract:Objective To compare the efficacy and safety of combining sitagliptinin to therapy type 2 diabetes mellitus (T2DM) of elderly patients with inadequate glycemic controlled by metformin monotherapy.Methods A total of 52 T2DM elderly patients [30 males and 22 females, at an age of (68.0±8.0) years, ranging from 65 to 78] with inadequate glycemic controled by metformin monotherapy admitted in our department from May 2015 to September 2016 were recruited in this study. They were randomly divided into sitagliptin group and acarbose group, with 26 ones in each. Besides oral administration of 500 mg metformin (3 times per day), the former group was treated with 100 mg sitagliptin (once per day), and the latter with 50 mg acarbose (3 times per day), for 12 consecutive weeks.Then fasting plasma glucose(FBG), 2-hour postprandial glucose(2hPG), hemoglobin A1c(HbA1c) and body mass index (BMI)were measured in the 2 groups. The incidences of hypoglycemia and gastrointestinal adverse reactions were observed. ResultsNo difference was seen in the FBG, 2hPG and HbA1c in the 2 groups before treatment (P>0.05). After the treatment, the above 3 indicators were significantly reduced (P<0.05). The declines of 2hPG and HbA1c were more obvious in the sitagliptin group than acarbose group (P<0.05). No hypoglycemia was observed during treatment. In acarbose group, 4 cases complained of abdominal distention and increased flatus passage. No statistical difference was observed in gastrointestinal adverse reactions between two groups (P>0.05). Conclusion Combined of sitagliptin with metformin shows significant efficacy and safety in treatment of T2DM elderly patients.

Abstract:Objective To investigate the alteration of carotid artery intima media thickness (C-IMT) in the elderly patients with type 2 diabetes mellitus (T2DM) and trace albumin in the urine (microalbuminuria, MAU). Methods A total of 180 elderly T2DM patients hospitalized in our department were recruited in this study. According to complication of MAU or not, they were divided into MAU group (n=60) and non-MAU group (n=120). Their clinical data and related indices were detected and compared between the 2 groups. Results Compared with the non-MAU group, the MAU group had significantly higher triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), serum creatinine (Scr), incidence of plaque, C-IMT, resistance index (RI) and pulsatility index (PI), but obviously lower glomerular filtration rate (GFR), lumen diameter, carotid peak systolic blood flow velocity (PSV) and end diastolic velocity (EDV) (all P<0.05).The level of MAU was increased with the increase of sclerotic plaque index (F=29.874, P<0.001). Multiple linear regression analysis indicated that C-IMT was positively correlated with the MAU level in the elderly T2DM patients complicated with MAU. Conclusion C-IMT and MAU are closely associated in the elderly T2DM patients complicated with MAU. Detection of MAU is of value in the early diagnosis of cardiovascular and cerebrovascular diseases in these patients.

Abstract:Objective To determine the effect of citalopram hydrobromide combined with conventional anti-heart failure therapy on the quality of life in the elderly patients with diastolic heart failure (DHF) and depression. Methods A total of 89 elderly DHF patients with depression admitted in our hospital from January 2014 to March 2015 were recruited in this study. According to their treatment, they were divided into citalopram hydrobromide group and amitriptyline hydrochloride group. On the basis of conventional anti-heart failure therapy, citalopram hydrobromide tablets were taken orally in the former group at 10-20 mg once, once to twice a day, with a daily dose not larger than 40 mg, and amitriptyline hydrochloride tablets were administered orally in the latter group at 25 mg once, twice to 3 times a day, with a daily dose no more than 300 mg (12 tablets), and maintenance dose of 50-150 mg (2 to 6 tables) for a continuous treatment for 8 weeks. Results Compared with before treatment, the value of left ventricular ejection fraction (LVEF) and the result of 6-minute walking test (6MWT) were improved after 8 weeks of treatment, the value of left ventricular end diastolic dimension (LVEDd) and score of Hamilton Depression Scale (HAMD) were decreased, and the scores of activities, daily life, health, recent support and general spirit were increased in the patients of both groups (P<0.05). Compared with the amitriptyline hydro-chloride group, the improvements of depression were more significant in the citalopram hydrobromide group (P<0.05). There was no significant difference in the incidence of adverse reactions between the 2 groups (Chi-square=0.362, P=0.547). Conclusion Citalopram hydrobromide combined with conventional anti-heart failure therapy can significantly attenuate the symptoms and improve the quality of life in the elderly DHF patients with depression.

Abstract:Objective To determine the effect of anxiety and depression on the incidence of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in the elderly patients with coronary heart diseases. Methods A total of 400 patients with coronary heart diseases who underwent PCI in our hospital from March 2012 to September 2015 were recuited in this study. According to the results of self rating anxiety scale and self rating depression scale in 7 to 14 d after PCI, the patients were divided into anxiety and depression group (with anxiety and/or depression, n=88) and control group (n=279). The incidence of MACE within 1 year after PCI was compared between the 2 groups. Multiple logistic regression analysis was used for the relationship of anxiety and depression with the occurrence of MACE. Results The MACE incidence was 25.00% in the anxiety and depression group, significantly higher than that in the control group (13.98%, Chi square=5.864, P=0.015). Stepwise forward logistic regression analysis indicated that high-density lipoprotein cholesterol reduction (OR=0.692), more branches of coronary artery lesions (OR=2.987), depression and anxiety (OR=2.164) were independent risk factors for MACE in the elderly patients with coronary heart disease after PCI (P<0.05). Conclusion Anxiety and depression increase the risk of MACE in elderly patients with coronary heart disease after PCI.

Abstract:Objective Osteopontin (OPN) is highly expressed in vulnerable atherosclerotic plaques and suggested to be a good bio-marker and imaging target. This study was aimed at designing poly lactic acid (PLA) nanoparticles coupled with OPN antibodies for OPN-targeted ultrasonic molecular imaging. Methods PLA-perfluorooctyl bromide nanoparticles (PLA-PFOB NPs) were prepared by oil-in-water emulsion process. Subsequently, amino polyethylene glycol carboxyl (NH2-PEG-COOH) was attached to PLA through carbodiimide method. OPN antibody was conjugated with PEG-PLA-PFOB NPs by amide bonds to obtain OPN-targeted nanoprobe for ultrasound imaging. The biocompatibility of PLA NPs was evaluated in RAW264.7 cells by CCK-8 assay. Morphological characterizations of the probes were detected by transmission electron microscopy and particle size analyzer. Sensibility of the probes was evaluated by cellular uptake assay under laser scanning confocal microscope. Ultrasonic imaging was conducted with enhanced ultrasonography with PLA NPs as contrast agent. Results The PLA NPs were sphere or spherical in shape, with a hydrodynamic size of(267.60±82.40)nm. CCK-8 assay revealed that the nanoprobes showed negligible cytotoxicity at a dose from 0.00 to 0.50 mg/ml in foam cells, and no significant difference was observed in cell viability in different groups of cells (P>0.05). Cellular uptake assay also showed there were obviously large amount of the nanoparticle in the foam cells (P<0.05). Ultrasound imaging showed the probes presented fine punctuate hyper echo with no attenuation for the rear echo in the latex tubes on the pulse inversion harmonic image. Conclusion Our prepared OPN-targeted ultrasound contrast nanoprobes are of high biocompatibility, and can specifically bind to OPN highly expressed foam cells, and have excellent ultrasound signals in contrast-enhanced ultrasound imaging.

Abstract:Chemokine C-C motif ligand 7 (CCL7) is widely expressed in mononuclear cells, T lymphocytes, dendritic cells and other immune cells. CCL7 was regarded as inflammatory factor at first, but with further studies, evidence shows that it may play significant roles in immune regulation, tissue regeneration, interaction with heparin sulfate, and promoting fibrosis. Therefore, it is of great significance to investigate the functions of CCL7 in the molecular mechanisms and treatment of disease. With the progresses of the multipotent stem cells and progenitor cells in clinical practice, CCL7, as an important factor to induce their differentiation, may has the potential to enhance the efficiency and therapeutic benefits of cell therapy. This article reviewed the structure and functions of this chemokine.

Abstract:Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by eosinophil-rich and necrotizing granulomatous inflammation in the peripheral blood and involved organs. According to whether antineutrophil cytoplasmic auto-antibodies (ANCA) can be detected in the serum of the patients or not, EGPA is assigned into ANCA-positive or -negative phenotypes. The ANCA-positive patients are prone to purpura, glomerulonephritis, peripheral neuropathy, and alveolar hemorrhage. Myocardial and lung involvement are more common in those with ANCA-negative. In this article, we reviewed the literatures concerning the differences in the clinical manifestations and involved organs between the ANCA-positive and -negative EGPA, and summarized their clinical characteristics.

Abstract:Non-invasive brachial ankle pulse wave velocity (baPWV), as an indicator of atherosclerosis, has been widely used in clinical practice. In present, there are no enough epidemiological data on baPWV in China, and the existing data vary wildly. This article reviewed the value of baPWV in cardiovascular diseases and analysis of the risk factors for the diseases in order to provide references for its clinical application.

Abstract:With the improvement of living standard and change of life style, the incidence of chronic kidney disease (CKD), and even that of end-stage renal disease were increasing day by day. There are various causes for the deterioration of renal function in the CKD patients. More and more evidences show that sympathetic nervous system (SNS) and rennin-angiotensin-aldosterone system (RAAS) activation are closely associated with the CKD progression. This paper briefly summarized the relationship of SNS and RAAS activation with progression of renal diseases, and introduced some studies concerning the relevant treatments.

Abstract:Asthma is a chronic disease. In present, a variety of hypotheses have been proposed to elucidate the relationship between obesity and asthma, including genetic factors, adipokines, inflammatory injury, and obesity related diseases, but the underlying mechanism remains unclear. The relationship of obesity and asthma is still a topic of interest to researchers. This article reviewed the latest researches on their relationship, in order to provide reference for clinical practice.