Abstract:Objective To explore the effective laboratory markers for predicting adverse cardiovascular events in the patients with coronary slow flow phenomenon (CSFP). Methods A prospective study was carried out on 54 patients who underwent coronary angiography (CAG) and diagnosed with simple CSFP in our department from January 2013 to December 2014. According to the incidence of adverse cardiovascular events during the follow-up, they were divided into adverse events group (n=10) and adverse events-free group (n=44).The laboratory indicators and echocardiographic parameters were compared and analyzed between the 2 groups. Statistical data from univariate analysis and laboratory indicators predicting CSFP prognosis were included in the Cox regression model. The most significant independent risk factors were included in the receiver operating characteristic (ROC) curve analysis. Kaplan-Meiers survival analysis was used to compare the incidence of adverse cardiovascular events among the patients with different risk factors. Results The serum contents of triglycerides (TG), apolipoproteins B (ApoB), creatine kinase MB isoenzyme (CK-MB), and plasma prothrombin activity (PTA)were significantly higher in the adverse events group than the adverse events-free group(HR=1.193, 95%CI 1.036-1.374, P<0.05). Cox regression analysis showed that increased PTA was an independent risk factor for poor prognosis(P<0.05). Kaplan-Meiers survival analysis also indicated that those with higher PTA had higher incidence of adverse events than those with low PTA (P<0.05). The plasma PTA showed good correlation between the ROC curve and adverse cardiovascular events during the follow-up period after discharge (area under the curve=0.717, P=0.033). Conclusion PTA can be used as an indicator in the prediction of long term adverse events in CSFP patients.

Abstract:Objective To explore the changes of fasting blood glucose in elderly non-diabetic patients with pulmonary infection, and investigate its value in the diagnosis of multiple organ dysfunction syndrome in the elderly (MODSE). Methods A retrospective study was carried out on 429 non-diabetic patients (over 65 years old) with pulmonary infection in our hospital from January 2005 to December 2014. According to whether pulmonary infection induced the onset of MODSE, the patients were divided into MODSE group (n=95) and non-MODSE group (n=334). The highest level of fasting blood glucose was compared between the two groups. SPSS 17.0 software was used to analyze the data. The quantitative data were expressed as mean±standard deviation ([AKx-D]±s), and the results were compared with Student’s t test. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. The receiver operating characteristic (ROC) curve was used to determine the cut-off value of blood glucose levels for the MODSE diagnosis. Results The highest fasting blood glucose level in the MODSE group was significantly higher than that in the non-MODSE group [(8.656±2.664) vs (5.679±1.332)mmol/L, t=10.523, P<0.001]. When the cut-off value of fasting blood glucose was 6.875 mmol/L, the sensitivity was 83.2%, the specificity was 90.1%, the area under the ROC curve was 0.880, and 95%CI was 0.835-0.926 (P<0.001), with high diagnostic value. Conclusion The changes of fasting blood glucose are of value in the diagnosis of MODSE induced by pulmonary infection for the elderly non-diabetic patients. Fasting blood glucose ≥6.875 mmol/L can be used as an index in diagnosis of MODSE induced by pulmonary infection.

Abstract:Objective To evaluate mid-term efficacy of unicompartmental knee arthroplasty (UKA) for isolated compartmental osteoarthritis in the elderly. Methods A retrospective study was conducted on 23 patients (24 knees) suffered from isolated compart-mental osteoarthritis admitted in our department from January 2007 to January 2009. They were 4 males and 19 females, at mean age of 61.3 years (52-71 years), and weighted 62.4 kg (55-69 kg). All the patients were treated with endo-model sledge UKA by same surgeon. Preoperative and postoperative knee range of motion (ROM), knee society score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared to evaluate mid-term clinical outcomes. SPSS 17.0 software was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s). Preoperative and postoperative knee ROM, KSS and WOMAC were compared by paired t test. P<0.05 was defined as statistical difference. Results All patients had no contraindication for UKA, none of them turned to suffer knee arthroplasty, and all successfully completed surgery. The operation time was (93.8±11.6)min and the blood loss volume was recorded as (196.7±40.1) ml. No infection or deep vein thrombosis occurred in any patient. All surgical incisions healed well. These patients were followed up for 5-7 years (mean 6.3 years). The ROM, KSS and WOMAC were significantly increased when compared with the values preoperatively (P<0.001). During the follow-up, no prosthesis loosening or revision was found in the patients. Conclusion Under strict control of surgical indications, UKA achieves satisfactory mid-term clinical outcome in treatment of isolated compartmental osteoarthritis, with the advantages of minimal incision and quick recovery. But long-term efficacy needs further research.

Abstract:Objective To evaluate the impact of different time interval of staged percutaneous coronary intervention(PCI) on renal function of elderly patients. Methods Totally 417 elderly of multivessel disease (MVD) patients with unstable angina(UA)or non-ST segment elevation myocardial infarction(NSTEMI), who received staged PCI from January 2014 to June 2016,were analyzed retrospectively. They were divided into the short interval group (n=172) and the long interval group (n=245) by the time interval of staged PCI. The clinical data were recorded including age, gender, body mass, serum creatinine (SCr) before and after PCI. Body mass index(BMI), the risk score for prediction of contrast-induced acute kidney injury(CI-AKI),and the estimated glomerular filtration rate(eGFR) were obtained. Renal function in patients of the two groups was statistically analyzed. SPSS statistics 15.0 was used to perform the statistical analysis. Measurement data and enumeration data were compared with t test or Chi-square test respectively. Results The clinical data including age, gender, BMI, SCr and the risk score for prediction of CI-AKI were not significantly different between the two groups before PCI(P>0.05). There was no statistical difference of renal function in the two groups before and after PCI(P>0.05), neither in the incidence of CI-AKI between two groups (2.90% in the short interval group versus 2.45% in the long interval group, P=0.77). No serious adverse events, such as emergency dialysis, new-onset acute myocardial infarction, acute stroke, emergency revascularization, or death, was reported during hospitalization. Conclusion The difference in time intervals of staged PCI has no obvious impact on renal function of elderly MVD patients with UA/NSTEMI. It is safe and feasible for patients with low or moderate risk of CI-AKI to undergo staged PCI after a short time interval.

Abstract:Objective To investigate the clinical efficiency and value of adjuvant therapy with glucocorticoid in the treatment of the elderly patients with caseous pneumonia. Methods A total of92 old patients with caseous pneumonia admitted in our department from January 2015 to August 2016 were enrolled in this study. According to their treatment regimens, they were divided into the observation and control groups. The control group was only treated with conventional anti-tuberculosis therapy, while the observation group was given adjuvant therapy with glucocorticoid. The clinical conditions, such as symptoms, lesions absorption, sputum negative conversion and so on, were compared between the 2 groups at 4,6, 8 weeks after the treatment. SPSS 22.0 software was used to perform the statistical awalysis. The data were compared with t test or Chi-square test. Results Compared with the control group, the main symptoms were more significantly alleviated in observation group in 4,6 and 8 weeks after treatment (60.9% vs 28.3%, 73.9% vs 47.8%, 91.3% vs 71.7%; P<0.05). The observation group had better total absorption of pulmonary lesions than the control group (52.2% vs 28.3%, 76.1% vs 45.7%, 95.7% vs 73.9%; P<0.05), but no difference was seen in the sputum negative conversion rates between the 2 groups (34.2% vs 40.5%, 60.5% vs 52.4%, 71.1% vs 73.8%; P>0.05). Conclusion Short term application of glucocorticoid is safe for the elderly patients with caseous pneumonia. It is also beneficial to the absorption of inflammation in the lungs and to the reliefs of tuberculosis symptoms.

Abstract:Objective To investigate the commonness and differences between the parameters of thromboelastography (TEG) and those of conventional coagulation tests in critically ill patients from intensive care unit (ICU). Methods A total of 86 critically ill patients admitted in ICU between August 2014 and May 2017 were enrolled in this study and retrospectively analyzed. The parameters of TEG, such as R and K values, α-angle, maximum amplitude(MA), and the results of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and platelet (PLT) count were calculated. Fisher exact test and Kappa identity test were performed. Results The medians of PT and APTT in the patients were higher, while that of PLT was lower than the normal ranges, and those of FIB and TEG were in the normal ranges. Fisher exact test indicated there were significant differences among R value with PT and APTT, K value with APTT, FIB and PLT,α-angle with PT, APTT, FIB and PLT, MA with FIB and PLT (P<0.05). Kappa identity test showed that the correlation was weak between the TEG parameters and the results of conventional coagulation test. Conclusion The consistency is weak between TEG and conventional coagulation test in the critically ill patients from ICU. So, the 2 methods can’t replace each other.

Abstract:Objective To investigate the curative effect of music therapy in combination with olanzapine on behavioral and psychological symptoms of dementia (BPSD) in the patients with Alzheimer’s disease (AD).Methods A total of 89 AD patients suffering from BPSD admitted in our department between February 2014 and February 2016 were enrolled in this study. The patients were randomly divided into 2 groups:music therapy group (n=44) and control group (n=45). The patients in the former group took olanzapine and sung old songs as music therapy for 8 weeks, while those of the latter group only received administration olanzapine for same period. Their activities of daily living were accessed with activity of daily living (ADL), and BPSD symptoms was evaluated with Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD) before and after treatment. SPPS 18.0 software package was used to perform the statistical analysis. Quantitative data were expressed as mean±SD, and compared with t-test. Results Intra-group comparison showed that 8 weeks’ treatment resulted in significant increased ADL score and lower BEHAVE-AD score in music group, and obviously lowered BEHAVE-AD score in the control group (P<0.05). Intergroup comparison indicated that after the treatment, BEHAVE-AD score was significantly lower, while ADL scores were remarkably higher in the music therapy group than the control group (P<0.05). Conclusion Olanzapine combined with music therapy is superior to the drug alone in the treatment of BPSD symptoms in AD patients, and music therapy is helpful to improve the ability of daily life in the patients.

Abstract:Objective To investigate the value of multi-slice spiral CT (MSCT) scanning in the diagnosis of gastrointestinal stromal tumor (GIST) in the elderly. Methods From May 2014 to May 2016,8 elderly patients with suspected GIST admitted in our hospital were subjected in this study. According to the National Institutes of Health (NIH) consensus classification system for GIST in 2002, the pathologically confirmed patients were classified into low risk tumor (n=35), risk tumor (n=17) and high risk tumor (n=11). CT and MSCT scanning were carried out on all the patients, and the results were compared with the pathological results for the diagnostic accuracy. SPSS 19.0 software was used to perform the statistical analysis. Results In the 98 cases of suspected GIST patients, 63 cases were verified as GIST by pathological diagnosis. MSCT showed the diagnostic accuracy of 88.89%(55/63) and specificity of 88.57%(31/35), and the positive predictive value of 93.33%(56/60) and negative predictive value of 81.58%(31/38) in the diagnosis of GIST. While, the diognostic accuracy was 79.37%(50/63), specificity was 71.43%(25/35), positive predictive value was 83.33%(50/60), and negative predictive value was 65.79%(25/38) in diagnosis of GIST by CT scanning. The diagnostic accuracy of MSCT was significantly higher than that of normal CT (P<0.05). Compared with risk and high risk tumor, the tumor diameter ≤5 cm(71.43%, 25/35), in regular shape (65.71%, 25/35), and uniform enhancement of low risk tumor (48.57%,17/35) had high proportion. Lesions mainly occurred in the stomach. There was no significant difference in CT values of plain, arterial, venous and delayed phase among the tumors of different risk degree (P>0.05). Conclusion MSCT is of certain application value in GIST diagnosis for the elderly. MSCT images can be used to judge the risk degree of GIST, be helpful for preoperative evaluation, and provide the basis for clinician to make treatment plan.

Abstract:Objective To investigate the value of AIMS65 score in the prediction of rebleeding and death for acute non-variceal upper gastrointestinal bleeding (ANUGIB) in the elderly. Methods A retrospective study was carried out on 220 elderly patients with ANUGIB admitted in our department from March 2011 to November 2016. According to the results of AIMS65 score, they were divided into low-risk group (<2) and high-risk group (≥2). The AIMS65 scores of those dead and survival and of those with rebleeding or not were evaluated. SPSS statistics 19.0 was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and students’ t test was employed for the comparison between groups. The enumeration data were expressed as a percentage, and the correlations of AIMS65 score with rebleeding and death were analyzed by Chi-square test and Pearson correlation analysis. The area under receiver-operating characteristic (ROC) curve was calculated to evaluate the predictive values of AIMS65 in rebleeding and death. Results The AIMS65 score was obviously higher in the patients with rebleeding than those without [(3.82±1.55) vs (2.25±1.31); t=7.23,P＜0.05], so was in the dead than the survival [(4.65±1.23) vs (2.53±1.02); t=7.41,P＜0.05]. The AIMS65 score was positively correlated with the rates of rebleeding and death (r=0.620, r=0.863, P<0.01). AIMS65 score ≥2 showed good values in the prediction of rebleeding and death, with the sensitivity 85.71% and 100.00%, the specificty 34.04% and 32.69%, and area under curve (AUC) 0.719(95%CI:0.621-0.817) and 0.892(95%CI:0.858-0.952), respectively (P<0.01). Conclusion AIMS65 score has better predictive values for rebleeding and death in the elderly ANUGIB patients, and it deserves popularization in clinical practice.

Abstract:Objective To investigate the clinical efficacy of modified Buzhong Yiqi Decoction combined with conventional drug therapy in the treatment of stable chronic obstructive pulmonary disease (COPD), and determine the effect on respiratory muscle and lung function in the patients. Methods A total of 120 patients with stable COPD admitted in our hospital from August 2015 to August 2016 were prospectively enrolled in this study. They were equally and randomly divided into the treatment group (Buzhong Yiqi Decoction+Seretide Evohale) and control group (Seretide Evohale). After the treatment of 8 weeks, the predicted percentage of forced expiratory volume in one second (FEV1%), ratio of FEV1 to forced vital capacity (FEV1/FVC)) were used to evaluate the pulmonary function parameters of each group before and after treatment, and the score of the activity of accessory respiratory muscles and the Medical Research Council dyspnea scale (MRC) were employed to assess the respiratory muscle strength of the patients. Statistical analysis was performed using SPSS 16.0. Results After the treatment, when compared with the control group, Buzhong Yiqi Decoction group had obviously lower scores in cough, expectoration, gasp, spontaneous sweating, colds, shortness of breath and wheezing (P<0.05), significantly higher predicted FEV1% [(57.92±6.09) vs (52.84±6.64), P<0.05] and ratio of FEV1/FVC [(67.34±7.11) vs (63.01±6.95), P<0.05], and notably lower MRC [ (1.38±0.39) vs (1.61±0.49), P<0.05] and accessory respiratory muscle activity score[ (1.41±0.41) vs (1.79±0.50), P<0.05]. The total efficiency was higher in Buzhong Yiqi Decoction group than the control group (95.00% vs 81.67%, P<0.05). Conclusion Modified Buzhong Yiqi Decoction combined with conventional drug therapy can improve lung function, relieve respiratory muscle fatigue, and thus promote the clinical efficacy in the stable COPD patients.

Abstract:Objective To explore the specific injured signal pathways under the condition of hypoxia/reoxygenation (H/R) injury in primary cardiac microvascular endothelial cells (CMEC), and investigate the protective mechanisms of exenatide. Methods Primary CMEC cells were islolated from SD rats with double-enzyme digestion and cultured in vitro. Immunocytochemical staining of CD31 antibody and Ⅷ factors were used to identify the purity of the obtained cells. The injury model of H/R was established. MTT assay was used to detect cell viability for the optimal concentrations of exenatide. The changes of intracellular calcium under H/R condition was detected with the aid of Fluo-3AM fluorescence probe. Western blotting was employed to measure the expression of xanthine oxidase (XO). The level of intracellular reactive oxygen species (ROS) was measured by DCFH-DA labeled ROS probe. Confocal microscopy was performed to observe the JC-1 staining and cytochrome C(Cyt-C) release. After XO siRNA and exenatide pre-treatment were applied to intervent the cells, the above indices were studied again. The measurement data were expressed as mean ±standard deviation ([AKx-D]±s). Student’s t test was used for mutual groups comparison, and one-way ANOVA for multiple groups comparison. Results The optimal anti-apoptotic concentration of exenatide was 10 nmol/L. H/R injury induced the increases in the intracellular calcium level and calcium-dependent XO expression level, while exenatide pre-treatment could decrease the calcium level (P<0.05). Both siRNA and exenatide pre-treatment significantly suppressed the expression of XO, reduced the level of XO-induced ROS, decreased the H/R injury induced nitochrondrial membrane potential, reduced Cyt-C release, and decreased caspase-3 and caspase-9 activities (P<0.05). Conclusion H/R activates Ca²⁺-XO-ROS signaling pathway, leads to mitochondrial structural dysfunction, and finally induces cell apoptosis. exenatide pre-treatment can protect the CMEC cells by suppressing the signaling pathway and reduce apoptosis induced by H/R injury.

Abstract:It is quite complicated to diagnose and treat diabetes mellitus with multiple organ complications, especially in the cases complicated with cardiovascular disease, nephropathy and infection of pacemaker. Here we reported a patient suffering from diabetic nephropathy, but presenting with renal insufficiency, prior myocardial infarction, diabetic foot, further developed sepsis, pacemaker infection, substernal abscess, osteomyelitis and infective endocarditis as well. His condition turned stable after renal replacement therapy, debridement and dressing in his feet, removing pacemaker and full course of antibiotics. The diagnosis and treatment of the case remind us that for the diabetic nephropathy patients complicated with pacemaker infection, it is important to remove the pacemaker in time and prescript full course of antibiotics according to the results of antibiotic sensitivity test. Early renal replacement therapy may be beneficial to the prognosis of such cases.

Abstract:Although Acute Physiology And Chronic Health Evaluation (APACHE) and Simplified Acute Physiology Score (SAPS) show good predictive effect on critically ill patients, they may have predictive data migration or poor population calibration when being used in the elderly critically ill patients. However, the established special prediction models for elderly are not of enough accuracy and reliability. So, frailty syndrome has become the key point in geriatric comprehensive assessment. Current studies showed that frailty index (FI) and clinical frailty scale (CFS) can be used as the objective models to assess frailty syndrome, and have become hotspot in the studies on predictive assessment for critically ill elderly. This article reviewed the development process and research progress of these predictive models, with a view of clinicians for better application.

Abstract:We firstly introduced some characteristics of aging population in China. We must focus on the elderly disability problem as well as further strengthening the prevention and control of geriatric diseases. We introduced comprehensively the definition, epidemiology, economic burden, risk factors, assessment methods, diagnostic criteria and intervention measures of disability in the elderly.

Abstract:Inhaled corticosteroids (ICS) is the mainstay of therapy for persistent asthma. However, its effect in the treatment of severe asthma is limited. At present, several new therapies have been approved for the treatment of severe asthma, including long-acting anticholinergic drugs (LAMAs), bronchial thermoplasty, targeted therapy, biological agents and immunosuppressive agents. We gave a summarization in order to provide reference for clinicians.

Abstract:Exercise can help prevent and treat all of the sedentary chronic diseases such as cancer, diabetes and cardiovascular disease. This may be due to endocrine and paracrine functions of skeletal muscles. Contracted muscles can release some hormones-like myokines, such as interleukin-6 (IL-6), IL-15, brain-derived neurotrophic factor (BDNF) and others. These myokines play roles in organ cross talk, including interactive adjustment among body organs, muscle and fat. Some myokines exert endocrine function, regulate the oxidation of visceral fat or mediate direct anti-inflammatory effects. While, other myokines play roles in fat oxidation-related signal pathway within the skeletal muscles through paracrine mechanism.

Abstract:With the development of contemporary cardiology and the extensive application of contrast media, the incidence of contrast-induced acute kidney injury (CI-AKI) is increased gradually. In clinical practice, early diagnosis and intervention may reverse the disease. Serum creatinine is utilized as the diagnostic standard, but it can be influenced by many factors, and cannot well reflect the renal injury. Researchers have found some new biomarkers which can accurately reflect kidney damage in the early stage of CI-AKI. In this article, we reviewed the progress of these main biomarkers. It can be expected that they will play important roles in the early diagnosis of the disease, and provide effective evidences for diagnosis and treatment.