Abstract:Objective To investigate the nutritional condition and the influencing factors in the elderly patients with different kidney function levels. Methods A total of 189 patients hospitalized in our department during September 2016 to February 2017 were enrolled and retrospectively analyzed in this study. According to their scores of the mini nutritional assessment short-form (MNA-SF), the patients were divided into normal nutrition group (12-14 points), malnutrition risk group (8-11 points) and malnutrition group (0-7 points). Clinical data were compared and analyzed by SPSS statistics 20.0. The differences were compared with t test or Chi-square test respectively. The risk factors of malnutrition were analyzed by logistic regression analysis. Results Among the 189 patients, MNA-SF scores showed that 10 patients (5.3%) were suffering from malnutrition, 58 subjects (30.7%) in malnutrition status and 121 participants (64.0%) in normal nutrition condition. Compared with the normal nutrition group, the body mass index (BMI), albumin, erythrocyte count, hemoglobin (Hb) and lymphocyte count were significantly lower in the malnutrition risk group and the malnutrition group(P<0.05), and the percentage of neutral cell counts was significantly higher in the malnutrition group(P<0.05). The age distribution, renal function and anemia status of the patients at different nutritional status were statistically significant (P<0.05). Multivariate regression analysis showed that the risk factors of malnutrition included aged (OR=1.06,5%CI:1.00-1.12), low estimated glomerular filtration rate (eGFR, OR=0.97,5%CI:0.94-1.00), low BMI (OR=0.76,5%CI:0.65-0.87), low albumin (OR=0.93, 95%CI:0.86-0.99) and anemia (OR=2.46,5%CI:1.60-3.32). ConclusionAging and renal insufficiency may increase the incidence of malnutrition risk and malnutrition, and malnutrition is also associated with BMI, albumin level, and anemia severity.

Abstract:Objective To summarize the characteristics of the patients who died after percutaneous coronary intervention (PCI) in our department during 2016. Methods Total number of patients receiving PCI and detailed clinical data of 7 died patients after PCI were collected. The clinical data of those died patients including their comorbidities, coronary characteristics and causes of death were collected and analyzed. Results There were 7419 patients receiving PCI, including 398 patients receiving emergency intervention. The total mortality was 0.1%(7/7419), markly lower than reported(0.59%), and the mortality after emergency intervention was 0.25%(1/398), significantly lower than reported(2.4%). The age of the 7 died patients was 37-80 (61±14) years old, all accompanied with two or even more comorbidities. The primary diagnosis was unstable angina or myocardial infarction(MI) and coronary angiography (CAG) showed severe or complicated lesions such as multiple or calcification lesions. Seven died cases received PCI, followed by enhanced anticoagulant and antiplatelet therapy owing to the complicated lesions. Among these,1 case complained chest pain postoperatively as well as fatigue, but due to lack of electrocardiogram(ECG)change, CAG was ignored for the better treatment. Among 7 died patients, 3 cases died during surgery, while 4 cases died 3 to 5 days after surgery. The majority of the dead underwent elective surgery, and the causes of death were cerebral hemorrhage, cardiac rupture, stent thrombosis as well as severe cardiac dysfunction. Conclusion The causes of death for the patients undergoing elective surgery are directly related with the severity of their lesions. Postoperative anticoagulation and antiplatelet treatment are the high risk factors for cerebral hemorrhage. For the patients with lesions at anterior descending artery and circumflex artery, elective surgery is recommended. What’s more, intravascular imaging, such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) should be carried out to improve the safety of interventional therapy for such patients.

Abstract:Objective To evaluate the efficacy and safety of a novel ultrafiltration device (FQ-16) in patients with acute decompensated heart failure and diuretic resistance. Methods A retrospective study was carried out on 35 patients with acute decompensated heart failure and diuretic resistance who were hospitalized in our department from November 2015 to June 2017. They were treated using a new ultrafiltration device (FQ-16). The body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine (SCr), blood urea nitrogen (BUN), heart rate (HR), hemoglobin (Hb), platelet (PLT) count, hematocrit (Hct), dyspnea score, central venous pressure (CVP), arterial oxygen saturation (SaO₂), N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF) before and after the ultrafiltration treatment, and the incidence of major adverse event were measured and observed to evaluate the clinical efficiency and safety. Clinical data were analyzed by SPSS statistics 17.0. The differences were compared with t test. Results No significant differences were found in SBP, DBP, HR, SCr, BUN, Hb, Hct, PLT, K⁺,Na⁺ and Cl- level before and after the last ultrafiltration (P>0.05). But body mass, dyspnea score, SaO₂, CVP and NT-proBNP were improved obviously (P<0.05). During and within 72 h after the ultrafiltration, no death, myocardial infarction or aggravation of heart failure was observed, neither treatment-required hypotension occurred. Two very old patients experienced conscious disturbance in the treatment, and relieved in 24 h after ultrafiltration. Conclusion The novel ultrafiltration device FQ-16 adequately relieves hypervolemia and dyspnea, but has no effect on blood pressure, electrolytes, and renal function in patients with acute decompensated heart failure and diuretic resistance. No serious adverse events were observed. It is an effective and safe therapeutic method.

Abstract:Objective To investigate the efficacy of ultra-sound guided lumbar plexus and sciatic plexus block combined laryngeal mask airway or nasopharygeal airway in the elderly patients undergoing proximal femoral nail antirotation. Methods A total of 42 very old patients scheduled for proximal femoral nail antirotation surgery in our hospital from July 2013 to November 2016 were randomly assigned into laryngeal mask airway group (group H) and nasopharyngeal airway group (group B, n=21). After lumbar plexus and sciatic plexus block under the ultra-sound guidance, spontaneous respirations were retained in the patients of group H with laryngeal mask airway, and those of group B were lightly sedated with nasopharyngeal airway. The intraoperative bispectral index (BIS) was maintained at 60-75. The surgery, anesthesia and peri-operative complications were observed and compared between the 2 groups. SPSS statistics 13.0 was used to analyze the data. The difference were compared with t test or Fisher exact test respectively. ResultsCompared with the group H, group B had lower dosages of propofol and vasoactive agents, lower incidence of hypotension, shorter period from end of surgery to extubation, and shorter length of hospital stay. There were 4 patients having pulmonary infection within 7 days after operation, and 2 of them were transferred to Intensive Care Unit. The incidence rate of postoperative cognitive dysfunction (POCD) was not statistically different between 2 groups (P>0.05). Conclusion For the elderly patients undergoing proximal femoral nail antirotation surgery, ultrasound-guided lumbar plexus and sciatic plexus nerve block combined with nasopharyngeal airway can reduce usage of propofol during operation, shorten the length of hospital stay, and benefit postoperative outcome in the patients when compared with laryngeal mask airway.

Abstract:Objective To investigate the changes of growth differentiation factor-15 (GDF-15) level and echocardiographic parameters to evaluate the left ventricular remodeling in the patients with chronic heart failure (CHF), and determine the effect of GDF-15 levels on the severity of the remodeling. Methods A total of 75 CHF patients admitted in our department from June 2015 to June 2016 were enrolled in this study, and their clinical data were collected and retrospectively analyzed. According to the causes of heart failure, they were divided into 4 subgroups, that is, hypertensive heart disease subgroup (n=22), coronary heart disease subgroup (n=28), valvular disease subgroup (n=17) and dilated cardiomyopathy subgroup (n=8). At the same time, another 80 healthy individuals were recruited as control group. The serum GDF-15 and other related laboratory indicators were measured. The left ventricular end diastolic diameter (LVEDD), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) were measured by type M ultrasound examination. SPSS statistics 13.0 was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and the Student’s t test was used for the comparison between the 2 groups. The enumeration data were expressed as percentages, and Chi-square test was used for the inter-group comparison. The correlation between the indicators of the 2 groups was analyzed by Pearson linear correlation analysis. Results The level of GDF-15 was significantly higher in the CHF group than in the control group[(1195.48±43.26) vs (345.28±42.25) ng/L, P<0.05]. But there were no significant differences in GDF-15 level in the 4 subgroups (P>0.05). The GDF-15 level was significantly positively correlated with LVEDD (r=0.63, P<0.05) and LAD (r=0.68, P<0.05), and negatively correlated with LVEF (r=-0.47, P<0.05) and total cholesterol (r=-0.36, P<0.05). Conclusion GDF-15 level is obviously higher in the CHF patients. GDF-15 level may be used as an indirect indicator of ventricular remodeling in the patients.

Abstract:Objective To investigate the correlation between low-density lipoprotein cholesterol (LDL-C) level and HAS-BLED score in elderly patients with comorbidities and non-valvular atrial fibrillation (AF), in order to provide new thoughts for clinical decision-making in lipid-lowering and anticoagulation therapy. Methods A retrospective analysis was carried out on 139 elderly patients with comorbidities and non-valvular AF, and CHA2DS2-VASc score ≥2 hospitalized in our department from January 2013 to December 2016. They were 85 males and 54 females, at an age of(78.9±8.2) years, and were divided into low-bleeding-risk group (HAS-BLED <3, n=74) and high-bleeding-risk group (HAS-BLED ≥3, n=65). Clinical features of comorbidities and poly-pharmacy and laboratory biochemical indices were compared between the 2 groups. The correlation of LDL-C level and HAS-BLED score was analyzed. Clinical data were analyzed by SPSS statistics 22.0. The differences were compared with t test or Chi-square test respectively. Binary logistic regression analysis was adopted for the correlation of LDL-C level and HAS-BLED score. Results The high-bleeding-risk group had significantly higher CHA2DS2-VASc score and LDL-C level, older age, and larger proportions of hypertension and ischemic cerebral stroke, but smaller proportion of heart failure when compared with the low-bleeding-risk group (P<0.05). After adjustment of many confounding factors for lipids level and HAS-BLED score, LDL-C level (OR=2.066,5%CI 1.089-3.921,P=0.026) and age (OR=1.072,5%CI 1.011-1.137, P=0.02) were positively correlated with HAS-BLED score. Conclusion For elder patients with comorbidities, and CHA2DS2-VASc score ≥2 non-valvular AF, higher LDL-C level and older age may increase the risk for bleeding events. So, LDL-C level should be closely monitored for such patients.

Abstract:Objective To determine the effect of pH value on the drug resistance and biofilm formation of Klebsiella pneumoniae (K. pneumoniae) strains isolated from respiratory tract in order to provide the theoretical reference for clinical anti-infective treatment. Methods Twelve strains of K. pneumoniae (named as K1 to K12) were isolated from the sputum samples in the patients hospitalized in the Department of Respiratory Diseases of our hospital. At different pH values (5.5,6.5 and 7.5), the minimal inhibitory concentration (MIC) of the 12 strains was determined respectively using the broth microdilution, the adhesion of K. pneumoniae was measured by flat colony counting, and the biofilm formation was observed with 96-well crystal violet staining. Clinical data were analyzed by SPSS statistics 17.0. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was used for comparison between groups. Results With the decrease of pH value, the MIC of ceftazidime to K. pneumoniae was decreased, whereas that of levofloxacin was increased. However, there was no correlation of the effects of pH value with the MIC of gentamicin. Compared with pH 5.5 value, the adhesion and biofilm formation were increased significantly in most K. pneumoniae isolates at pH 6.5 (P<0.05), while were enhanced remarkably in all the strains at pH 7.5 (P<0.05). Conclusion Different pH values affect the drug resistance and biofilm formation of K. pneumoniae strains.

Abstract:Objective To investigate whether exercise stress myocardial perfusion imaging (MPI) with technetium-^99m-labelled methoxyisobutyl isonitrile single photon emission computed tomography (^99mTc-MIBI SPECT) has value in the prediction of major adverse cardiovascular events (MACEs) in the patients with type 2 diabetes mellitus who are suspected of myocardial ischemia. Methods A retrospective study was carried out on 165 diabetic patients who were suspected of myocardial ischemia and underwent ^99mTc-MIBI SPECT stress MPI in our department from June 2013 to March 2016. According to summed stress score (SSS), the patients were divided into SSS 0-7 group and SSS ≥8 group. The survival and incidence of MACEs were followed up after discharge by telephone. Clinical data were analyzed by SPSS statistics 17.0. The differences were compared with t test, rank-sum test or Chi-square test respectively. Results Significant differences were observed in proportion of males, body mass index (BMI), left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), typical angina, revascularization, wall motion abnormalities, incidence of MACEs and hospitalization rate due to angina between the 2 groups (P<0.05). Cox univariate regression analysis showed that ventricular wall motion abnormalities, increased SSS, family history of coronary heart disease, previous history of vascular remodeling, old myocardial infarction are risk factors for MACEs. Cox multivariate regression analysis indicated that the family history of coronary heart disease (RR=2.964,5%CI 1.318-6.666, P=0.009) was a risk factor for MACEs, and the other variables had no predictive effect. Kaplan-Meier survival analysis showed that the incidence of MACEs was 1% in the SSS 0-7 group and 4% in the SSS ≥8 group, with the cumulative survival rate higher in the former than the latter group (P=0.005). Conclusion ^99mTc-MIBI SPECT stress MPI can be used for risk stratification and prognosis assessment in the diabetic patients with suspected myocardialischemia. Vascular reconstruction can be recommended for those high-risk patients with SSS ≥8.

Abstract:Objective To explore the injury characteristics in elderly patients with traumatic fracture and investigate the risk factors for deep vein thrombosis. Methods A total of 1046 elderly patients with traumatic fracture admitted in our hospital from January 2012 to June 2016 were enrolled in this study. According to the occurrence of deep vein thrombosis (DVT) within 1 week after operation, they were divided into DVT group (n=132) and non-DVT group (n=914). Clinical data were analyzed by SPSS statistics 17.0. The differences were compared by t test or Chi-square test respectively. Univariate and multivariate logistic regression analysis was used to analyze the risk factors of DVT in traumatic fracture patients. Preoperative D-dimer, fibrinogen (FIB) and C-reactive protein (CRP) levels were assessed for predictive value of DVT by using receiver operating characteristic (ROC) curve. Results Among the 1046 elderly patients, the top cause of injury was falling (20.9%,219/1046) and the incidence of DVT was 12.6% (132/1046). The main manifestations were limb swelling, varicosis, pain and tenderness. The statistically significant factors screened by single factor analysis were further analyzed by multivariate logistic regression analysis, and the results showed that ≥ 70 years old (OR=2.725, 95%CI 1.842-4.027), hypertension (OR=1.584,5%CI 1.163-2.158), falling injury (OR=3.142,5%CI 2.106-4.685), hip fracture (OR=2.847,5%CI 1.875-4.326), comminuted fracture (OR=2.054,5%CI:1.463-2.884), at least 3 fractures (OR=2.162, 95%CI 1.572-2.976), post fracture shock (OR=3.063,5%CI:2.074-4.527), operation time over 2 h (OR=2.151, 95%CI 1.518-3.046), D-dimer ≥3.5 mg/L (OR=2.396,5%CI:1.668～3.442), FIB ≥6.0 g/L (OR=1.638, 95%CI:1.274-2.106) and CRP ≥26.0 mg/L (OR=1.084,5%CI 1.012-1.468) were independent risk factors for DVT in senile patients after traumatic fracture. When the optimal threshold of D-dimer was 3.25 mg/L area under the curve (AUC)=0.736, 95%CI 0.672～0.806], the sensitivity and specificity were 87.2% and 58.3%, respectively. When FIB had the optimal threshold of 5.84 g/L (AUC=0.682,5%CI 0.617-0.754), the sensitivity and specificity were 78.5% and 62.5%, respectively. When CRP had the optimal threshold of 26.73 mg/L (AUC=0.705,5%CI 0.635-0.783), the sensitivity and specificity were 81.3% and 55.2%, respectively. Conclusion The incidence of DVT is quite high in the elderly patients with traumatic fracture. Since there are many risk factors for DVT, preventive measures should be taken to reduce the occurrence of DVT in high-risk groups.

Abstract:Objective To evaluate the influence of perioperative application of desmopressin (DDAVP) on the perioperative bleeding and thrombogenesis in great saphenous varicose vein surgery. Methods From January 2015 to September 2016,6 patients undergoing great saphenous varicose vein surgery from 6 medical centers were enrolled in this prospective randomized controlled trial, and randomly divided into the DDAVP group (n=81) and the blank control group (n=85). The indicators, such as hemoglobin (Hb), platelet (PLT), alanine aminotransferase (ALT), serum creatinine (SCr), activated partial prothrombin time (APTT), D-dimer, von Willebrand factor (vWF), postoperative ecchymosis area, and incidences of lower extremity deep venous thrombosis and major bleeding events, were compared between the 2 groups. Clinical data were analyzed by SPSS statistics 22.0. The differences were compared with t test, rank-sum test (Mann-Whitney U test), Chi-square test or Fisher exact test, respectively. Results The ecchymosis area was significantly smaller in the DDAVP group than the blank control group [1.92(0.42,0.83) vs 6.00(1.82,9.60)cm²; P<0.05]. DDAVP could effectively reduce the large ecchymosis in the elderly older than 60 years. One case of deep venous thrombosis occurred in the control group, but none in the DDAVP group. There were no significant differences in postoperative Hb, PLT, ALT, APTT, D-dimer and vWF between the 2 groups(P>0.05). Conclusion Perioperative DDAVP can efficiently decrease perioperative ecchymosis area in the patients treated with varicose vein surgery, and doesn’t increase the incidences of postoperative bleeding and venous thromogenesis.

Abstract:Objective To determine the intervention effects of adiponectin (Ad) on rat kidney injury induced by chronic intermittent hypoxia (CIH), and investigate the underlying mechanisms. Methods Sixty adult Wistar rats were randomly divided into 4 groups:normal control (NC group), normal control plus Ad supplement (NC+Ad group), CIH, and CIH plus Ad supplement (CIH+Ad group) groups. The rats in both CIH and CIH+Ad groups were submitted to a CIH environment for 4 months, while the rats in NC and NC+Ad groups were housed with the normal air for 4 months. In addition, the rats in NC+Ad and CIH+Ad groups were treated with an intravenous injection of Ad at a dosage of 10 μg per injection, twice a week, for 4 successive months. Fluorescence microscopy was used to observe the levels of reactive oxygen species (ROS). TUNEL staining was employed to detect the apoptosis of renal cells. Western blotting was adopted to measure the expression levels of GRP78, CHOP, IRE1, PERK and pro-ATF6 in renal tissues of rats in each group to indicate the stress of endoplasmic reticulum in rats. 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 used for the comparison between the groups. Results In the end of 4 months’ treatment, no significant differences were found in all the parameters between the NC and NC+Ad groups (all P>0.05). Compared with the NC and NC+Ad groups, our findings were as follows:(1) ROS levels were significantly higher in the CIH group, while the levels in the CIH+Ad group was though lower than those in the CIH group, but higher than those in the NC and NC+Ad groups (all P<0.05); (2) the percentage of apoptotic renal cells and protein levels of caspase-12 and caspase-3 were all significantly higher in the CIH group, while in the CIH+Ad group, they were lower than in the CIH group, but still higher than in the NC and NC+Ad groups (all P<0.05); (3) the protein levels of GRP78, CHOP, IRE1 and PERK in the renal tissues were all significantly higher in the CIH group, while in CIH+Ad group, the levels were lower than in the CIH group, but higher than in the NC and NC+Ad groups (all P<0.05); the protein level of pro-ATF6 in the renal tissues was lower in the CIH group, while in the CIH+Ad group, the level was higher than in the CIH group, but lower than in the NC and NC+Ad groups (all P<0.05). Conclusion CIH induces kidney injury through activation of ROS and ERS-associated cellular apoptotic pathway, while exogenous Ad supplement protects the renal cells by inhibiting ROS and then ERS.

Abstract:Retroperitoneal fibrosis (RPF), is a rare fibro-inflammatory disease that develops around the abdominal aorta and the iliac arteries, and extends into the adjacent retroperitoneum, where it causes ureteral obstruction and renal failure frequently. Most RPF occurs in the middle aged, and the male/female ratio is 3∶[KG-*2]1～2∶[KG-*2]1. Diagnosis depends on the abdomen ultrasound, CT and MRI, while, retroperitoneal mass biopsy can identify clear pathological types. In clinical practice, the aims of treatment are to relieve urinary obstruction and promote disease reversal. Glucocorticoids are recommended for first-line treatment. In this paper, we reported a case of retroperitoneal fibrosis in a 83-year-old male.

Abstract:Current standard therapy for acute coronary syndrome is dual antiplatelet therapy, combining aspirin with an inhibitor of ADP platelet receptor P2Y12, together with anticoagulants, heparin or anticoagulation pentose, and for some high-risk patients, platelet membrane glycoprotein (GP) Ⅱb/Ⅲa antagonists, if needed. Also, the secondary prevention of ischemic events requires a certain period of dual antiplatelet therapy, followed by life-long suitable dose of aspirin or clopidogrel. However, antiplatelet drug, a double-edged sword, its improved antiplatelet efficacy is offset by an increased risk of bleeding, such as stroke, severe visceral bleeding, and so on. Therefore, when selecting the anti-platelet drugs, clinicians should weigh the pros and cons and make comprehensive analysis, so as to obtain the best therapeutic effect and minimize the bleeding and other adverse reactions at the same time.

Abstract:Asthma may evolve into chronic obstructive pulmonary disease (COPD), or develop to symptoms and signs of incompletely reversible airway obstruction accompanied by increased and reversible airway obstruction. This is called as asthma-COPD overlap (ACO). In this article we reviewed the advanced researches on the diseases, and made a summary in the aspects of the definition, diagnostic criteria, incidence rate and the related factors, clinical phenotype and pathogenesis, clinical features, prognosis and treatment, in order to have a better awareness of this new type of disease and provide help for clinical diagnosis and treatment.

Abstract:In recent years, more and more attention has been paid to the relationship between vitamin D and cerebrovascular disease, however, few researches concern cerebral small vessel disease. Leukoaraiosis (LA), a cerebral small vessel disease, is regarded as an early marker of brain damage. Though its pathogenesis remains unclear, evidence shows that it is mainly associated with endothelial function. Vitamin D may take part in vascular response to inflammation and other means through affecting the function of vascular endothelium and blood brain barrier, and thus influence the LA patients. In this article we reviewed the progress on vitamin D and LA in order to provide reference for future studies to clinicians.

Abstract:There are various factors influencing coagulation function during operation. Nowadays, prothrombin time (PT), activated partial thromboplastin time (APTT), platelet (PLT) count, fibrinogen (FIB), parameters from other conventional coagulation tests and from thrombelastography (TEG) are common indicators for coagulation function assessment. However, tests for those traditional indicators can only monitor some parts of clotting, and thus, the indicators can not reflect the dynamic changes of blood coagulation. So it is impossible to determine the causes of abnormal coagulation. Thrombelastography, a rapid, accurate, all-sided, and dynamic method to monitor the whole process of coagulation, can evaluate the coagulation function rationally in perioperative period and provide theoretical basis for clinical treatment.

Abstract:Asthma is a common chronic inflammatory disease of the respiratory system. There are many kinds of biomarkers for asthma, but no specific ones have been found yet. Pulmonary surfactant-associated protein D (SP-D) is mainly located in the lung, but also mildly expressed in the other organ systems. SP-D plays important roles in body defense and immune surveillance, and is closely related to many pulmonary diseases. The protein is essentially involved in the development and progression of asthma, and can be used as a biomarker of bronchial asthma. In this we article reviewed the function of SP-D and its role as biomarker in asthma.