Abstract:Objective To investigate the value of adiponectin in evaluation of the severity and CT features of chronic obstructive pulmonary disease (COPD). Methods A total of 430 patients with stable COPD who were follow-up outpatients of our department from January 2015 to December 2016 were recruited in this study. According to the severity, they were divided into 4 groups. Group A (n=116) was scored from 0 to 1 by a modified version of British Medical Research Council (mMRC) respiratory questionnaire, with the ratio of forced expiratory volume in the first second (FEV1) to the expected value ≥50%, and the frequency of acute exacerbations during last year less than twice. Group B (n=83) was defined with mMRC score ≥2, the ratio ≥50%, and the frequency less than twice. Group C (n=92) had the mMRC score from 0 to 1, the ratio <50%, or the frequency more than twice. Group D (n=139) was assigned as mMRC score ≥2, the ratio <50%, or the frequency more than twice. Another 206 healthy subjects with normal pulmonary function were enrolled as control group. All underwent pulmonary function test, and high-resolution computed tomography (HRCT) for the percentage of lung voxels with low-attenuation areas (LAA%), the ratio of 2-fold airway wall thickness to outer diameter (2T/D) and the ratio of wall area to total airway area (WA) were mainly tested. Plasma adiponectin level was measured by enzyme-linked immunosorbent assay (ELISA). Results There were significant differences in fasting blood glucose (FBG), hemoglobin A1c (HbA1c), adiponectin, FEV1/FVC, LAA%, 2T/D, WA%, FEV1/Expected value (%), diffusing capacity of the lungs forcarbon monoxide (DLCO), and ratio of residual volume (RV) to total lung capacity (RV/TLC) among the 4 groups (P<0.05). The results of univariate analysis showed that gender, body mass index (BMI), the frequency of acute exacerbations in last year, lung function and LAA classification significantly affected the level of adiponectin (P<0.05). Correlation analysis indicated that plasma adiponectin levels in COPD patients were positively correlated with RV/TLC (r=0.002), LAA% (r=0.010), 2T/D (r=0.006), WA (r=0.011), smoking index (r=0.356), the score of COPD assessment test (CAT) (r=0.497), the frequency of acute exacerbations in last year (r=0.749) (P<0.05), and negatively correlated with BMI (r=-0.440), DLCO (r=-0.528), FEV1/FVC (r=-0.247), and FEV1/Expected value (r=-0.037, P<0.05). Conclusion Adiponectin may be used as a phenotype marker for pathological changes of COPD with different severity.

Abstract:Objective To investigate the correlation between serum uric acid and carotid-femoral pulse wave velocity (cf-PWV) in community-dwelling elderly. Methods A total of 840 retired old persons living in the cadre’s sanatorium from Hunan region who took physical examination in our hospital from March 2012 to June 2016 were recruited in this study. According to the results of cf-PWV, they were divided into <9 m/s group (n=520) and ≥9 m/s group (n=320). The clinical data and laboratory examination results were collected and compared between the 2 groups. SPSS17.0 software was used to perfom statistical analysis. Results Significant differences were seen in fasting plasma glucose (FPG), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), high sensitivity C-reactive protein (hs-CRP), homestasis model assessment of insulin resistance (HOMA-IR) and serum uric acid between the 2 groups (P<0.05). After adjusting for age, gender, body mass index (BMI), HOMA-IR and other interference factors, cf-PWV were positively correlated with systolic blood pressure (SBP, r=0.351, P=0.017), hs-CRP (r=0.250, P=0.033) and serum uric acid (r=0.647, P=0.000). Conclusion Serum uric acid is an independent risk factor for cf-PWV, and can indirectly reflect the progression of arterial stiffness.

Abstract:Objective To validate the accuracy and feasibility of acute physiology and chronic health evaluation (APACHE) Ⅳ model in critically ill elderly patients. Methods A total of 421 elderly critically ill patients admitted in our hospital from July 2011 to July 2015 were prospectively recruited in this study. Their APACHE Ⅳ scores were calculated within 24 h in ICU. Discrimination and calibration were respectively assessed by using area under the receiver operating characteristic curve (ROC AUC) and Hosmer-Lemeshow (HL) test. Standardized mortality ratio (SMR) was reported to quantify the mortality variation between observation and prediction and the brier score (BS) to represent the overall performance. Results The mortality rate of the 421 subjects was 33.3%(140/421). The discrimination of the APACHE Ⅳ model was good to excellent (AUC=0.82,5%CI:0.78-0.86), but the calibration was inadequacy according to the results of HL test (Chi square=20.49, P=0.009). The BS showed good accuracy of APACHE Ⅳ model (BS=0.18), but it may underestimate the in-hospital mortality (SMR=1.50,5%CI:1.30-1.70) in elderly critically ill patients. ConclusionThe APACHE Ⅳ model shows good discrimination in critically ill elderly patients, but has poor calibration and underestimated in-hospital mortality. Therefore, before we use the risk prediction models for geriatric patients, we should validate it and employ customized models to fit the population to be predicted.

Abstract:Objective To investigate the clinical efficacy of nicorandil and diltiazem in the recurrence of unstable angina pectoris (UAP) patients following postoperative percutaneous coronary intervention (PCI). Methods A total of 72 UAP patients who underwent PCI due to coronary heart disease in our hospital from January 2015 to August 2016 were enrolled in this study. They were randomly and equally divided into nicorandil (24 males and 12 females, at an age of 62.61±9.26 years, ranging from 48 to 80) and diltiazem groups (21 males and 15 females, at an age of 61.72±8.18 years, ranging from 48 to 79). The patients of the former group were given oral administration of 5 mg nicorandil, 3 times per day besides routine treatment, and those from the latter group received oral administration of 90 mg diltiazem, twice per day. During 60 days’ treatments, the frequency and duration of angina, nitroglycerin dosage, electrocardiographic changes, and adverse reactions every week were observed and compared between the 2 groups. ResultsThere were no significant differences in the age, gender, duration of disease, smoking history, comorbidity and score of Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) between the 2 groups (P>0.05). After 60 days’ treatment, the frequency and duration of weekly angina attack and nitroglycerin dosage were reduced, and the nicorandil group had obviously better outcomes than the diltiazem group (P<0.05). The total effective rate was 88.9%(32/36) in the nicorandil group, and 75.0%(27/36) in the diltiazem group, with no statistical difference between them (Chi square=2.347, P=0.126). Compared with the patients of nicorandil group, those of the diltiazem group were prone to headache (P<0.05). ConclusionNicorandil and diltiazem have curative efficacy in postoperative recurrence of UAP after PCI. Nicorandil is more significant in the treatment, with obvious improvement of angina symptoms and less adverse reactions.

Abstract:Objective To investigate the value of probiotics in the treatment of Helicobacter pylori (H.pylori) infection in the elderly. Methods A total of 120 elderly patients with H.pylori infection in our hospital from January to October 2014 were enrolled in this study, and they were randomly and equally divided into probiotics treatment group and control group according to age and gender. The patients in the control group were given standard quadruple therapy (amoxicillin+clarithromycin+rabeprazole+colloidal bismuth pectin), while those in the treatment group were given standard quadruple therapy in combination with triple clostridium butyricum enterococcus tablet. The course of treatment was 14 d for both groups. The eradication of H.pylori was redetermined by the ¹³C urea breath test (¹³C-UBT) in 4 weeks after treatment. The eradication rate of H.pylori and incidence of adverse drug reaction were observed and compared between the 2 groups. Results In total, 117 patients completed the study.Intention-to-treat (ITT) analysis indicated that the eradication rate of H.pylori was 83.33% and 71.67% respecitvely in the treatment and control groups, and that was 86.21% and 72.88% by per-protocol (PP) analysis. The eradication rate was higher in the treatment group than the control group by both ITT and PP analyses, though without significant differences between them (P>0.05). In 1 year after the treatment, the eradication rate was significantly higher in the treatment group than the other (P<0.05). The incidence of adverse reactions was 10.34% in the treatment group, significantly lower than that of the control group (27.12%, P<0.05). Drug tolerance of the treatment group was significantly better than that of the control group (P<0.05). Conclusion Probiotics combined with standard quadruple therapy effectively promotes the eradication rate of H.pylori, and obviously reduces adverse drug reactions.

Abstract:Objective To investigate the clinical effect and safety of transurethral columnar balloon dilation of prostate(TUDP) in the treatment of benign prostatic hyperplasia (BPH) in high risk elderly patients. Methods Totally 100 elderly patients with high-risk BPH undergoing elective surgical treatment in our hospital from January 2015 to October 2016 were enrolled in this study. They were randomly divided into bipolar plasmakinetic transurethral resection of prostate (BP-TURP)and TUDP group (50 cases for each group). The clinical efficacy and safety were observed and compared between the 2 groups. Results Compared with the BP-TURP group, the TUDP group had significantly less amount of intraoperative bleeding,and obviously shorter operation time, catheter retention time and postoperative hospital stay length (P<0.05). There were no significant differences in international prostate symptom score (IPSS), residual urine volume (RUV), quality of life scale (QOL) and maximum urinary flow rate (Qmax) between the 2 groups before and in 3 months after treatment (P>0.05). No significant differences were seen in the incidences of complications, such as hematuria, urethral stricture, and temporary urinary incontinence between the 2 groups (P>0.05). Conclusion TUDP has the advantages of small incision and quick recovery, and is a good option for high risk elderly BPH patients.

Abstract:Objective To investigate the characteristics of arrhythmia and heart rate variability in the patients with acute myocardial infarction (AMI) at different sites. Methods A retrospective study was carried out on the AMI patients admitted to our hospital from January 2015 to June 2016. According to the result of electrocardiogram, they were divided into non-ST-segment elevation myocardial infarction (NSTEMI) group, inferior-wall group, and anterior-wall group. The dynamic electrocardiogram data during hospitalization was analyzed, and the arrhythmia and heart rate variability were compared among the groups. Results A total of 239 patients with AMI were enrolled. There were no significant differences in the incidences of frequent ventricular premature beats (VPB), Lown’s degree ≥3-stage VPB and atrial arrhythmia among the 3 groups (P>0.05). However, the NSTEMI and inferior-wall groups had obviously higher incidence of bradyarrhythmia than the anterior-wall group (P<0.05). The standard deviation of all normal R-R intervals (SDNN), standard deviation of the average normal RR intervals(SDANN) and average of the standard deviations of normal RR intervals (ASDNN) were notably lower in the anterior-wall group than the other 2 groups (P<0.05). Conclusion Compared with anterior-wall AMI patients, NSTEMI and inferior-wall patients have higher incidence of bradyarrhythmia and reduced variability of heart rate.

Abstract:Objective To investigate the impact of smoking on the antiplatelet effect of clopidogrel by observing the rate of platelet inhibition between the smoking and non-smoking patients after the administration. Methods A total of 151 patients undergoing percutaneous coronary intervention (PCI) followed by monitoring of thrombelastography (TEG) in the General Hospital of PLA Rockets Force were enrolled in this study. They were divided into smoking group (n=72) and non-smoking group (n=79).The incidences of bleeding and major adverse cardiovascular events (MACE) were recorded in hospital stay and in 6 months after operation, and compared between the 2 groups. Results TEG demonstrated that the platelet inhibition rate (adinosine diphosphate pathway) was significantly higher in smoking group than in non-smoking group in 3 day and 1 month after PCI (80.94±22.57 vs 66.65±26.25,1.64±20.37 vs 69.15±22.89; P<0.05). In 6 months after operation, MACE was reported in 7 cases and minor bleeding in 3 cases in smoking group; MACE was reported in 9 cases and minor bleeding in 4 cases in non-smoking group; no severe bleeding was reported in either group; There were no obvious differences in the incidences of MACE and bleeding between the 2 groups (P>0.05). Conclusion Exposure to smoking may enhance the antiplatelet effect of clopidogrel.

Abstract:Objective To investigate the values of intervention and treatment of malnutrition in the elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 62 elderly AECOPD patients combined with malnutrition or risk of malnutrition admitted in the Jinqiu Hospital of Liaoning Province from August 2015 to August 2016 were recruited in this study. According to their own willingness, they were divided into nutrition treatment group (n=31) and control group (n=31). Besides conventional anti-infection and symptomatic therapies to both groups for 8 weeks, the patients from the treatment group were given professional consultation, nutrition education and enteral nutrition support, while those of the control group only received common dietary guidance. The body mass index (BMI), triceps skin fold (TSF) thickness, mid-arm circumference (MAC), serum contents of total protein (TP), serum albumin (ALB) and hemoglobin (Hb) were measured before and after treatment. The patient’s pulmonary function was evaluated using forced expiratory volume in the fisrt second (FEV₁), forced vital capacity, and ratio of actual FEV₁ to expected FEV₁ (FEV₁A/FEV₁E). St.George’s Respiratory Questionnaire (SGRQ) scores were used to evaluated the patient’s life quality. The above results were compared before and after treatment and between the 2 groups. Results After 8 weeks’ treatment, BMI, TSF, MAC, TP, ALB and Hb were all increased in both groups (P<0.05), and more significantly for those of the treatment group (P<0.05). The pulmonary function indices, including FEV_l, FVC, FEV₁A/FEV₁E, were improved in the 2 groups (P<0.05), and more significantly in the treatment group (P<0.05). The SGRQ scores were decreased in the 2 groups (P<0.01), and more significantly in the treatment group (P<0.01). Conclusion Timely and reasonable intervention and treatment for malnutrition can obviously improve the nutritional status, restore respiratory function, and improve the quality of life in the elderly AECOPD patients.

Abstract:Objective To investigate the characteristics of cerebral glucose metabolism in the patients with non-Hodgkin’s lymphoma (NHL). Methods A retrospective analysis was carried out in 95 patients with freshly diagnosed and untreated NHL and 60 healthy volunteers in our hospital from January 2015 to May 2016. The results of cerebral ¹⁸F-fluorodeoxyglucose positron emission computerized tomography and computer tomography (¹⁸F-FDG PET/CT scanning) were collected. Statistical parametric mapping (SPM) was performed under a certain significance level (P<0.001) and voxel threshold (K=125 voxel) for the changes of cerebral glucose metabolism and distribution in the healthy volunteers, and the NHL patients (14 patients over 60 years old, and 81 younger than 60 years). Results Compared with control group, increased glucose metabolism was not found in NHL patients. NHL patients showed the decreased glucose metabolism in the bilateral occipital lobes, left inferior frontal gyri, and bilateral precentral gyri. The area with decreased glucose metabolism was more extensive in the left brain than in the right brain. Compared with NHL patients aged ≤ 60 years, patients aged > 60 years had both increased and decreased glucose metabolism in the brain, with decreased glucose metabolism mainly in bilateral frontal lobe and increased glucose metabolism mainly in the bilateral cerebellum. Conclusion Patients with NHL could exhibit decreased glucose metabolism, which is not distributed in the whole brain, but regionally. The involved brain regions may be related to the mental and affective functions and changes of immune function. The decreased glucose metabolism is distributed more extensively in the NHL patients over 60 years, which might be associated with the aging changes in the brain.

Abstract:Metabolic alkalosis is a metabolic condition of increased alkaline substances in extracellular fluid and/or elevated pH due to loss of hydrogen ions (H⁺), and is characterized by an increase in plasma bicarbonate (HCO₃-). It may result in a compensatory elevation of arterial partial pressure of CO₂ (PaCO₂), which is rarely greater than 55 mmHg. However, the upper limit of PaCO₂ compensation can exceed 60 mmHg in severe metabolic alkalosis, though at present there are few such reports at home and abroad. In this article, we reported the successful rescue for a case of extreme metabolic alkalosis so as to raise the awareness of this rare clinical phenomenon.

Abstract:Atomic force microscopy (AFM) can not only obtain topographical information of samples, but also measure their mechanical properties at an atomic resolution. This leads to a better understanding of pathophysiological mechanisms of human diseases because the alterations of topographical information and biomechanical properties of cells and molecules can be correlated to diseases. In recent years, AFM has been widely used in cell biological studies and study of diseases like diabetes mellitus, showing great potential in the early diagnosis and treatment guidance of the diseases. This review mainly summarized the application of AFM in the pathogenetic studies of diabetes and its related complications.

Abstract:Chronic heart failure (CHF) is still a cardiovascular disease of high incidence rate, high readmission rate and high mortality. In recent years, a large number of clinical observational studies and basic animal studies have demonstrated that low vitamin D level is closely associated with the morbidity and mortality of CHF, but, the underlying mechanism between them remains unclear. The article reviewed the research progress of vitamin D and CHF in recent years so as to investigate the possible mechanism of vitamin D in the incidence and development of the disease.

Abstract:Many studies suggested that cholesterol level and statins use may be associated with the occurrence and development of Parkinson’s disease (PD). Although there are quite a few studies on the pathological mechanisms of neurodegenerative disease with cholesterol and statins, epidemiologic evidence shows inconsistent results.The confounding may be due to the unadjusted relationship of statins use and cholesterol level in the design of study protocol.In this article, we reviewed previous researches on the relationship of cholesterol and statins with PD.

Abstract:Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). As its incidence increases significantly with age, old people are at high risk. With the aging of population, there would be more and more elderly patients suffering from VTE.So, it is of great practical significance to identify the risk factors for VTE in the elderly so as to take effective preventive measures in time. In this review, some factors related to the occurrence of VTE in the aged have been summarized, including immobility-related risk factors, cancer, common chronic diseases in the elderly, chronic venous insufficiency and frailty syndrome, in order to find out their characteristics and provide reliable clinical references for the prevention of VTE in the elderly.

Abstract:Percutaneous coronary intervention (PCI) is an effective treatment for coronary heart disease, but myocardial injury and even myocardial infarction (MI) commonly happened after PCI, which severely influence the curative effect and prognosis of the patients. Therefore, it is a clinical practical problem concerning the causes, diagnosis and prevention of myocardial injury after PCI, which is worth of further discussion. In this article, we reviewed the above mentioned issues.

Abstract:Vascular access is the lifeblood of hemodialysis patients. Vascular remodeling develops after establishment of autogenous arteriovenous fistula (AVF), but some patients may have AVF stenosis in the vascular remodeling process, which then leads to access dysfunction and thus inadequate dialysis or failure in dialysis. Studies on the mechanism indicate that intimal hyperplasia is one of main pathological factors for AVF stenosis, while inflammation, uremia, hypoxia, shear stress and thrombus are the biological mechanism for intimal hyperplasia. In this paper, we reviewed the cell sources of intimal hyperplasia and the effects of inflammatory responses, inflammatory mediators and oxidative stress under different shear stresses produced by hemodynamic changes on intimal hyperplasia, and expected to bring forward new targets for the treatment of intimal hyperplasia.