Abstract:Objective To analyze the correlation of serum vitamin D3 level with peripheral arterial sclerosis (PAS) in the very old patients with hypertension. Methods A total of 166 very old patients with primary hypertension (85.5±4.9 years old, 75-99) admitted in our department from September 2011 to November 2012 were enrolled in this study. With serum 25(OH)D3 level lower than 20 ng/ml as diagnostic criteria for vitamin D3 deficiency, these patients were divided into low level group (n=118) and normal group (n=48). Ambulatory 24-hour blood pressure monitoring and lower extremity arteries ultrasonography were performed to evaluate the severity of PAS. The correlation between serum vitamin D3 level and PAS severity was analyzed. SPSS statistics 16.0 was employed for data analysis. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Related risk factors of lower extremity arterial stenosis were analyzed by logistic regression analysis. Results Compared with the normal group, the low level group had higher level of low-density lipoprotein cholesterol (LDL-C), lower diastolic blood pressure (DBP), higher pulse pressure, and higher incidences of PSA and hyperlipidemia (P<0.05). The results of logistic regression analysis showed that PAS was negatively correlated with serum 25(OH)D3(OR=0.780,5%CI 0.670-0.890; P=0.039) and DBP(OR=1.030,5%CI 0.929-0.983; P=0.040), but positively correlated with LDL-C (OR=2.446,5%CI 1.138-1.312; P=0.043). Conclusion Serum vitamin D3 level is in obvious correlation with PAS in the very old patients with hypertension.

Abstract:Objective To investigate the characteristics of coronary lesions in the patients older than 80 years with coronary heart disease (CHD) in order to provide the clinical basis for the treatment of CHD. Methods A total of 48 senior patients (over 80 years old, the very aged group) and 260 old patients (65 to 79 years old, the aged group) with coronary heart disease admitted to our department from January 2013 to December 2015 were enrolled in this study. The risk factors, distribution of coronary lesions segments, Gensini scores of coronary lesions, and incidences of complications were compared between the 2 groups. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Results The incidence rates of acute myocardial infarction, old myocardial infarction, high blood pressure, diabetes, hypercholesteremia, and cerebral infarction were significantly higher in the males from the very aged group than the aged group(P<0.05). Most patients of the very aged group suffered from muti-vessel lesions, and had high incidences of left main coronary artery and chronic occlusion lesion, and higher Gensini score than the aged group(P<0.05). There were no significant differences in the occurrences of peri-operative and intra-operative complications between the 2 groups, but the very aged patients presented an increasing trend in peri-operative mortality rate. Conclusion The very aged patients with CHD have more clinical risk factors and underlying diseases than the aged ones, with complicated coronary lesions and more serious coronary artery stenosis. Comprehensive assessment should be carried out for the benefit and risk of surgery in the very aged patients with CHD in order to implement a safer and more effective treatment plan.

Abstract:Objective To analyze the clinical characteristics of the elderly patients with drug-induced liver injury (DILI). Methods Clinical data of the 528 DILI patients in our hospital from January 2011 to December 2013 were collected and retrospectively analyzed. The patients were divided into aged group (>60 years old, n=132) and non-aged group (≤60 years old, n=396). Clinical features, biochemical indices and treatment outcomes were compared between the 2 groups. SPSS statistics 16.0 was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Results The proportion of females was significantly lower in the aged group than the non-aged group (58.3% vs 73.4%, P<0.05). Chinese herbal medicine (including Chinese patent medicine) ranked first in the drugs causing DILI. And for the chemical agents, non-steroid anti-inflammatory drugs, antibiotics and hypotensors were the most common. Before the treatment, the serum levels of total protein (TP) and albumin (ALB) of aged group were significantly lower than those of non-aged group [(62.8±7.6) vs (64.6±8.5)g/L, (35.9±4.6) vs (38.0±5.2)g/L, both P<0.05]. The total effective rate was obviously lower in the aged group than in the non-aged group (91.7% vs 97.0%, P<0.05). Conclusion Chinese herbal medicines (including Chinese patent medicine) are the main drugs causing DILI in the elderly patients. Though the clinical manifestations are similar between the aged and young- and middle-aged patients, the clinical outcomes are better in the latter.

Abstract:Objective To investigate the efficacy of different dosage of tolvaptan in treatment of hyponatremia with chronic heart failure (CHF) for the elderly patients. Methods A total of 72 CHF elderly patients complicated with hyponatremia hospitalized in Yangzhou Friendship Hospital from October 2014 to February 2017 were recruited in this study. They were randomly divided into control group, low-dosage group and normal-dosage group (n=24 for each group). The patients of the control group was given conventional treatments including anti-heart failure therapy and slow venous infusion of 3% sodium chloride (250 ml/d). In addition to conventional treatment (without diuretic), the patients of the 2 treatment groups were given tolvaptan 7.5 and 15.0 mg/d respectively. In 7 d after the treatment, the clinical efficacy, serum sodium level, N-terminal B-type brain natriuretic peptide precursor (NT-proBNP), quality of life and length of hospital stay were compared among 3 groups. SPSS statistics 17.0 was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Results Compared to the indices before the treatment, the score of Minnesota Living With Heart Failure Questionnaire (MLHFQ), and serum levels of sodium and NT-proBNP were greatly improved after the treatment (P<0.05). Compared with the control group, the low- and normal-dosage treatment groups had significantly lower MLHFQ score and serum NT-proBNP level, and shorter length of hospital stay (P<0.05), and increased serum sodium level (P<0.05).Conclusion Both low (7.5 mg/d) and normal dosage (15.0 mg/d) of tolvaptan can significantly alleviate clinical syndromes of hyponatremia in elderly CHF patients.

Abstract:Objective To analyze the features of vascular access in the elderly patients receiving maintenance hemodialysis (MHD) (≥ 65 years old) in order to provide experiences for long-term vascular access patency. Methods Clinical data of MHD patients admitted in our department from March 2009 to March 2013 were collected and retrospectively analyzed in this study. According to their age, the patients were divided into the elderly group (≥65 years old, n=116), and the middle-aged group (< 65 years old, n=130). The types, construction and usage of vascular access were analyzed. SPSS statistics 15.0 was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Results The proportion of catheterization was significantly higher in the elderly group than in the middle-aged group (44% vs 10%, P=0.006), and it was more common in female patients regardless of the age. The elderly patients had obviously higher ratio of emergency (19.0% vs 5.4%, P=0.008), and higher prevalence of major comorbidities, such as diabetes, cardiovascular diseases and peripheral vascular diseases. But, the ratios of fistula establishment and catheterization were similar between the elderly complicated with diabetes or peripheral vascular disease (50.7% vs 49.3%, P=0.217). The nutritional status (BMI, hemoglobin and albumin) were significantly worse in the elderly catheterization group (P=0.007, P=0.006, P=0.007). In the elderly groups, there were more fistula established in the elbow than the middle-aged group (8.3% vs 0.9%, P<0.001). The primary patency of fistula was less in the elderly than the middle-aged group (P=0.009), but the cumulative patency was similar between the 2 groups, though with higher rate of interventions (P=0.006). The prevalence of fistula maturation failure was obviously higher in the elderly (10.0% vs 3.5%, P=0.008). There were more patients undergoing tunneled cuffed catheterization in the elderly group (30.4% vs 0.0%, P<0.05). No significant difference was seen in the catheter patency between the 2 groups, but the elderly group had higher incidence of catheter-related infections (21.7% vs 15.3%, P=0.006). Conclusion Compared with the middle-aged MHD patients, the elderly ones have higher prevalence of catheterization and catheter-related infections, but similar patency of catheter. Though they have higher rate of fistula in the elbow, worse patency and fistula maturation, active interventions will obtain better outcomes as in the younger patients.

Abstract:Objective To investigate the relationship of serum gastrin level with severity of coronary lesions in the elderly patients with coronary heart disease (CHD). Methods A total of 104 elderly CHD patients who received coronary artery angiography (CAG) in our hospital from October 2015 to December 2016 were recruited in this study. According to their coronary artery stenosis, they were divided into CHD group (n=82) and control group (n=22). By the number of involved branches, the former group were further assigned into 3 subgroups:single vessel subgroup (n=42), double vessel subgroup (n=27) and triple vessel subgroup (n=13). The severity of coronary arterial stenosis was evaluated by Gensini scoring system. Enzyme-linked immunosorbent assay was used to measure the levels of fasting serum gastrin (FG) and postprandial 1 hour serum gastrin (PG1h). The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Results There were no significant differences in age, sex, smoking, family history of CHD, gastrointestinal disease, serum level of creatinine (SCr), and usage of proton pump inhibitors (PPIs) between the CHD group and control group (P>0.05). The CHD group had significantly higher body mass index (BMI), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C), FG, and FG1h, and notably larger proportions of hypertension and diabetes when compared with the control group (P<0.05). The patients with triple vessel disease had remarkably higher PG1h, ratio of PG1h/FG and Gensini score than those with single and double vessel disease (P<0.05). Spearman correlation analysis showed that serum gastrin level had no correlation with sex, BMI, smoking, family history of CHD, TG and LDL-C, but was correlated with age, gastrointestinal disease, usage of PPIs, hypertension, SCr, number of lesioned branches and Gensini score (P<0.05). After partial correlation analysis and correction of confounding factors, serum gastrin level was positively correlated with the number of lesioned branches (r=0.58) and Gensini score (r=0.63). Conclusion Serum gastrin is positively correlated with the lesion severity of coronary artery disease in elderly CHD patients. It suggests that higher serum gastrin might negatively contribute to the occurrence and development of coronary atherosclerosis in the elderly.

Abstract:Objective To investigate the efficacy of glucocorticoid in treatment of nasal polyps in elderly patients and determine its effect on nasal mucosal expression of epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR). Methods A total of 60 elderly patients with nasal polyps (polyp group, budesonide nasal spray), and 20 patients with nasal septum deviation (control group, normal saline) admitted to our hospital from January 2014 to August 2016 were enrolled in this study. The expression levels of EGF and EGFR in the nasal polyp and mucosa tissues were detected with immunohistochemical staining and RT-PCR before and 12 weeks after the treatment in the polyp group and the control group. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Results The score of polypoid lesion in the polyp group was 2.48±0.77 before the treatment, and then declined to 2.11±0.68,1.57±0.49 and 1.29±0.64, respectively in 2,6 and 12 weeks after treatment, with significant differences between different time points (P<0.05). Both the protein and mRNA levels of EGF and EGFR were significantly higher in the polyp group than in the control group before and after the treatment (P<0.05). The glucocorticoid treatment for 12 weeks resulted in significant decreases in the protein and mRNA levels of EGF and EGFR in the polyp group (P<0.05). Conclusion Glucocorticoid therapy exerts curative effects on the eledrly patients with nasal polyps, which may be related to its inhibition on the expression of EGF and EGFR.

Abstract:Objective To investigate the analgesic effect and safety of propacetamol combined with patient controlled intravenous analgesia (PCIA) in the elderly over 75 years with hip fracture. Methods A total of 216 patients over 75 years suffering from hip fractures and undergoing surgical treatment in our hospital from June 2015 to June 2016 were recruited in this study. Then the patients were randomly divided into the observation group and control group, with 108 patients in each group. The patients of the observation group were given propacetamol combined with PCIA after operation, while those of the control group only PCIA. The analgesic effect, PCIA sufentanil consumption, and incidence of adverse reactions were observed within 12 h after operation. The effect of analgesia was evaluated by visual analogue scale (VAS) and Ramsay scores. SPSS statistics 17.0 was used to perform the statistical analysis. Quantitative data were compared with variance analysis, and categorical data with Chi-square test. Results In 2 h after surgery, VAS and Ramsay scores were not statistically different between two groups. In 6 h and 12 h after surgery, the observation group had significantly lower VAS and higher Ramsay scores compared with the control group (P<0.05). When compared with the control group, the observation group had significantly less PCIA sufentanil consumption in 2,6 and 12 h after surgery, with significant difference in 6 and 12 h time points (P<0.05). The observation group had obviously lower incidence of opioid-related adverse reactions than control group (8.7% vs 37.0%, P<0.05). Conclusion Combined application of propacetamol and PCIA can effectively offer better pain relief postoperatively, reduce sufentanil consumption, and especially decrease the adverse effects caused by opioids in the over-75-year-old patients after hip fracture surgery.

Abstract:Objective To explore the relationship of the serum level of omentin with oxidative stress in the elderly diabetic patients with hypertension. Methods A total of 127 elderly patients with type 2 diabetes mellitus (T2DM) in our department from June 2015 to December 2016 were recruited in this study. According to the complication of hypertension, they were divided into T2DM with hypertension group (n=69, hypertension group) and T2DM with normal blood pressure group (n=58, non-hypertension group). Another 30 healthy elderly individuals who taking physical examination in our hospital during the same period served as the control group. The serum levels of omentin, malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-px) were measured in the 3 groups. SPSS statistics 20.0 was used for statistical analysis, and Students’ t test was employed for the measurement data. Pearson linear correlation analysis was performed to test the relationship of the serum level of omentin with that of MDA, SOD and GSH-px in the elderly diabetic patients with hypertension. Results Before the treatment, the serum omentin, SOD, and GSH-px levels were significantly lower, while that of MDA level was obviously higher in the hypertension group than in the non-hypertension group (P<0.01). After the treatment, the hypertension group had the levels of omentin, SOD, and GSH-px notably increased, but those of MDA and MAP declined (P<0.01). In the diabetic patients with hypertension, their serum omentin level was negatively correlated with serum MDA (r=-0.587, P＜0.01) and MAP (r=-0.542, P＜0.01), and positively correlated with the serum levels of SOD (r=0.683, P＜0.01) and GSH-px (r=0.596, P＜0.01). Conclusion The decline of serum omentin level increases oxidative stress, and this may be one of important pathogenetic mechanisms of hypertension in the elderly diabetic patients.

Abstract:Objective To determine the effects of losartan on the plasma levels of heart-type fatty acid binding protein

Abstract:Objective To investigate the efficiency of alprostadil combined with conventional therapy on elderly type 2 diabetes mellitus (T2DM) patients complicated with chronic kidney disease (CKD). Methods A total of 90 elderly T2DM patients with CKD admitted in our hospital from February 2014 to February 2016 were recruited in this study. They were randomly divided into alprostadil group and control group (n=45). Conventional basic treatment was given to the patients of the 2 groups, and 10 μg/d alprostadil (once per day) was given to the alprostadil group by intravenous injection with 2 weeks as a course, for totally 3 courses. The indices of blood lipids, blood glucose, liver function and renal function were compared between the 2 groups. SPSS statistics 17.0 was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Results There were no significant differences in fasting plasma glucose (FPG), glycosylated hemoglobin A1c (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), homocysteine (Hcy), blood β2-microglobulin (β2-MG), serum creatinine (SCr), and urinary albumin excretion rate (UAER) and estimated glomerular filtration rate (eGFR) between the 2 groups before treatment (P>0.05). After the treatment, the levels of TG, TC, LDL-C, Hcy and β2-MG and UAER were significantly lower in the alprostadil group than in the control group (P<0.05). No significant differences were observed in prothrombin time (PT), platelet (PLT) count, and activated partial thromboplastin time (APTT) between the 2 groups before and after treatment (P>0.05). There were no any differences in the incidences of adverse reaction (Chi-square=0.212, P=0.645). Conclusion Combination of alprostadil and conventional therapy can significantly reduce urinary protein levels and exert protective effect on renal function in elderly T2DM patients with CKD.

Abstract:Objective To investigate the effect of transplantation of bone marrow mesenchymal stem cells (BMSCs) and anti-aging gene (Klotho gene) on cardiac remodeling in rats under chronic hypoxic condition. Methods Rat model of cardiac remodeling was established in a hypoxic chamber of 10% oxygen for 28 d. The rats were divided into model group, BMSCs group and Klotho group, and another normal control group for isolation, culture and identification of BMSCs. Recombinant lentival vector of Klotho gene was constructed. After the establishment of the model, the BMSCs and lentival vector of Klotho were transplanted into the chronic hypoxia rats by tail vein. In 4 weeks after the infusion, the contents of procollagenⅠcarboxy-terminal propeptide (PⅠCP) and PⅢCP in the serum and myocardial tissues were detected by ELISA. The morphology of cardiomyocytes was observed by HE staining, the content of myocardial collagen was detected by MASSON staining, and the apoptotic rate of myocardial cells was detected by Tunel. SPSS statistics 17.0 was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Results After 4 weeks’ transplantation of BMSCs and Klotho gene, the serum and myocardial contents of PⅠCP and PⅢCP, collagen volume fraction (CVF) and apoptotic rate of cardiomyocytes were significantly lower in the BMSCs group and Klotho group than the model group (P<0.01). Compared with the Klotho group, the BMSCs group had significantly lower apoptotic rate of myocardial cells (P<0.01). Conclusion BMSCs and Klotho gene transplantation can both effectively reverse cardiac remodeling, and BMSCs is superior to Klotho gene in resisting myocardial cell apoptosis.

Abstract:Adiponectin is an adipokine. With the deepening research on the molecule, it is found to play an important role as a part of the inflammatory response in a variety of diseases, such as cardiovascular disease, vascular endothelial dysfunction, type 2 diabetes mellitus, metabolic syndrome and rheumatic diseases. Osteoarthritis (OA) is a common degenerative joint disease in the elderly, but its pathogenesis remains unclear. In this paper, we reviewed the concentration of adiponectin in OA patients, and the relationships of adiponectin with its receptor, with OA, and with pain in the patients, in order to provide help for further study on the molecule and OA.

Abstract:Frailty is defined as a syndrome of reserve and function decline caused by various reasons, and is associated with adverse outcomes, such as falls, depression, disability, mortality, and so on. There is no gold standard for frailty yet, but frailty assessment tools can help to screen frailty and predict the health outcomes. The frailty tools have wide application, and each frailty tool is targeted to a specified population. Thus, assessment of frailty in clinical practice can provide physicians strategies for early screening and management of diseases, so as to avoid or delay the adverse outcomes.

Abstract:Diabetic cardiomyopathy is a disorder of the heart muscle in people with diabetes, and a specific cardiomyopathy that cannot be attributed to hypertensive heart disease, coronary atherosclerosis disease, heart valve disease or other heart diseases. In the occurrence and development of this disease, besides a series of metabolic changes in myocardial cells, endothelial cells, as an important part of heart, have metabolic disorders at the same time, which results in cardiovascular dysfunction as the pathophysiological foundation of diabetic cardiomyopathy. In this paper, we reviewed the researches on endothelial cell metabolism in diabetic cardiomyopathy.

Abstract:Hepatorenal syndrome (HRS) is a severe complication of advanced liver disease, and manifests as oliguria or anuria, hypoxemia, hyponatremia and low urine sodium, but shows no obviously pathological changes of renal damage. Its diagnosis need to exclude other reasons of renal injury. The onset was associated with hepatic dysfunction, portal hypertension, impaired blood volume and renal vasoconstriction. Based upon the rapid deterioration in kidney function, it is classified into 2 types. Therapeutic effect of vasoconstrictor drugs (terlipressin) plus albumin infusion is satisfactory, and liver transplantation is the best option for patients with end stage liver failure.

Abstract:Recent advances in cell biology show that silent information regulator 2 (SIR2)-related enzymes play important roles in the cardiac pathophysiology under various stress conditions.At present, SIR2 homologous genes were found in most species, and collectively referred as sirtuins (SIRT) family. Among the family members, silent information regulator T1 (SIRT1), the most widely studied, is a key regulator in the occurrence and progression of many cardiovascular diseases. In this review,we summarize and discuss the basic characteristics of SIRT1 and its role and possible mechanism in cardiovascular diseases, so as to provide new ideas for medical researchers in the prevention,diagnosis and treatment of the diseases.