Abstract:Objective To investigate the efficacy and safety of metformin combined with insulin for treatment of elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 52 elderly T2DM patients (38 males and 14 females, aged from 75 to 89 years) hospitalized in our department from March 2016 to August 2017 were enrolled in this study. They were randomly divided into the metformin group and control group (n=26 for each group). Insulin detemir and insulin aspart were given to the control group, and the insulin dosage was adjusted according to the blood glucose level. In the metformin group, metformin was added to insulin therapy. The treatment continued for 12 weeks. Blood glucose control, blood glucose fluctuation, liver and kidney dysfunction were observed before and after treatment in order to evaluate the therapeutic effect and safety. SPSS statistics 19.0 was used to perform the statistical analysis. Student’s t test, Chi-square test, or Wilcoxon rank sum test was employed for comparison between groups. Results Compared to before treatment, the patients in the metformin group had their FBG [7.33(6.21,9.25) vs 8.33(6.23,0.89)mmol/L] and postprandial 2h blood glucose [8.35(7.31,9.80) vs 9.48(8.28,1.40)mmol/L] significantly decreased, so were those in the control group [7.60(6.10,0.10) vs 8.60(6.80,1.80)mmol/L, 10.32(7.31,1.20) vs 11.62(8.37,3.39)mmol/L] after 12 weeks of treatment (all P<0.05). In control group, there were no obvious differences in insulin dosage of 24 h, HbA1c, standard deviation of blood glucose (SDBG), mean amplitude of glycemic excursion (MAGE), largest amplitude of glycemic excursion (LAGE), and mean postprandial plasma of glycemic excursions (MPPGE) after treatment (P＞0.05). While, in the metformin group, HbA1c, SDBG, MAGE, LAGE, MPPGE, and insulin dosage of 24 h were remarkable decreased, and these indices were notably lower than those of the control group (P<0.05). During the treatment, hypoglycemic events occurred for 7 times in 6 cases. They all got remission after eating some food. No serious hypoglycemic event was observed. The incidence rate of hypoglycemia was significantly lower in the metformin group than the control group [7.69%(2/26) vs 19.23%(5/26), χ²=6.892, P<0.05]. Conclusion Metformin can be used in the elderly T2DM patients in case of blood glucose poorly controlled by insulin treatment, and it can control blood glucose effectively and stably, with high safety.

Abstract:Objective To analyze the clinical efficacy and safety of pemetrexed combined with cisplatin as first-line treatment in the elderly patients with lung adenocarcinoma. Methods A retrospective study was conducted on 76 elderly patients with lung adenocarcinoma admitted in the departments of geriatric respiratory diseases, medical oncology and thoracic surgery of the Shaanxi Provincial People’s Hospital from January 2010 to June 2016. They received the chemotherapy treatment of pemetrexed combined with cisplatin. Another 31 matched patients undergoing gemcitabine plus cisplatin and docetaxel plus cisplatin in the same period served as control. The short- and long-term efficacies were compared between the 2 groups. The data were processed by using SPSS statistics 22.0. Student’s t test, Chi-square test or Fisher exact test were used to compare the data between groups. Kaplan-Meier survival analysis was used to draw the survival curve, and Log Rank test to compare differences between groups. Results There was no case of complete remission (CR) in both group, and no significant difference in the ratio of partial remission (PR) between the 2 groups (P>0.05). For the pemetrexed group, the disease control rate (DCR) was 68.42% (52/76), the ratio of progression disease (PD) was 31.58% (24/76), the time to progression (TTP) was 12.8±2.9 months, and the 3-year survival rate was 31.58% (24/76). While, in the control group, the above indicators were 54.83% (17/31), 45.16% (14/31), 10.6±1.8 months, and 19.35% (6/31), respectively. The pemetrexed group had obviously higher DCR, lower ratio of PD, and better TTP and 3-year survival rate than the control group (P<0.05). Log Rank test showed that the pemetrexed group was superior to the control group in long-term survival rate (χ²=3.97, P<0.05). Conclusion For the elderly advanced lung adenocarcinoma patients carrying wild type epidermal growth factor receptor (EGFR), pemetrexed combined with cisplatin is an acceptable and better regimen, with lower risk for PD and longer survival rate than other chemotherapy regimens.

Abstract:Objective To investigate the value of bronchoscopic lavage in the treatment of severe pulmonary infection in the elderly.Methods A total of 118 elderly patients with severe pulmonary infection admitted in the Department of Respiratory Diseases and Intensive Care Unit of our hospital from May 2015 to May 2016 were recruited in this study. They were divided into observation group and control group according to the treatment they received, with 59 patients in each group. The patients in the control group were treated with routine therapy. The observation group was treated with bronchoscopic lavage besides the routine treatment. The baseline data and clinical efficacy (blood gas indices, time to normal body temperature and length of hospital stay) were compared between the 2 groups. SPSS statistics 19.0 was used to perform the statistical analysis. Student’s t test or Chi-square test was employed for different data types. Results There were no significant differences in baseline data between two groups before treatment (P>0.05). The blood gas indices changed significantly after the treatment in observation group compared with before treatment (PaO₂, SaO₂ and PaO₂/FiO₂ increased, while PaCO₂, CRP and WBC decreased). The levels of PaO₂[(86.30±4.27) vs (74.56±3.84) mmHg], SaO₂ [(94.06±1.38)% vs (88.56±1.25)%] and PaO₂/FiO₂ [(253.42±26.32) vs (227.34±20.01)] were significantly higher, while PaCO₂ [(45.57±1.46) vs (53.46±0.53) mmHg], CRP [(8.58±0.74) vs (12.52±0.96) mg/L], and WBC [(7.64±2.15)×10⁹ vs (10.38±2.58)×10⁹/L] were significantly lower in observation group than those in control group (all P<0.01). The observation group also had obviously shorter time to normal body temperature [(8.34±3.42) vs (11.52±5.03) d]and length of hospital stay [(15.32±3.28) vs (19.21±6.54) d] compared with the control group (P<0.05). The total effective ratewas 89.83% in the observation group, significantly higher than that in the control group (72.88%, P<0.05). All patients showed good tolerance to the surgery, and no serious complications occurred. Conclusion Bronchoalveolar lavage is effective in the treatment of severe pulmonary infection in the elderly, and has great clinical value.

Abstract:Objective To provide reference and theoretical basis for the medical care in retired military cadres by analyzing the physical examination results of 3247 cases. Methods A total of 3247 cadres retired from army who took physical examination in our hospital from March 2014 to March 2016 were enrolled in this study. They were 2684 males and 563 females, and at an age of 75.0±13.8 (50-95) years. According to their age, they were divided into 50-59,0-69,0-79 and 80-95 years groups (n=374, 1184,7 and 142). The results of physical examination, medical examination and laboratory test were collected and analyzed. Results Compared with other aged group, the 80-95 years group had higher ratios of females, more comorbidities of coronary heart disease, diabetes and hyperuricemia, higher proportion of medication, and lower 25-(OH)D3 level (P<0.05). Abdominal ultrasound results showed that fatty liver, hepatic cyst, gallbladder polyps, gallbladder stones and kidney stones were more common in the 80-95 years old group (P<0.05). Chest X-ray filming indicated there were more images of increased pulmonary markings, thoracic vertebra degeneration, obsolete pulmonary tuberculosis, pulmonary interstitial changes, arteriosclerosis, pulmonary emphysema, pulmonary patchy shadow and adhesion of the pleural cavity in the 80-95 years old group (P<0.05). Electrocardiogram indicated there were more images of ischemic change, bundle branch block,sinus arrhythmia,myocardial infarction,left ventricular hypertrophy, premature contraction, atrial ventricular block in the 80-95 years group(P＜0.05). At the same time, the incidence rates of mammary hyperplasia and uterine fibroids were higher in the females from the 60-69 years group, and those of prostate hypertrophy, prostatic calculus and prostatic calcification were common in the males of the 80-95 years group (P<0.05). Conclusion The abnormality rates of medical examination results are quite high in the retired cadres. So, pertinent health guidance should be carried out and related risk factors should be monitored and controlled for the senile patients, so as to get benefits from early discovery and active intervention. More attention should be paid to the health care in those aged 80-95 years.

Abstract:Objective To investigate the relationship of diabetic kidney disease (DKD) with glucose control in the patients with type 2 diabetes mellitus (T2DM) and to analyze the related risk factors. Methods A total of 142 T2DM patients who received con-tinuous glucose monitoring (CGM) in the Geriatric Department of Xijing Hospital from March 2010 to December 2016 were recruited in the study. The patients were divided into DKD group (n=54) and non-DKD group (n=88). The general clinical data, and laboratory indices and CGM data of the subjects were collected. The relationship between DKD and glucose control and the effect of risk factors were analyzed. SPSS statistics 19.0 was used to analyze the data. Student’s t test, non-parametric test or Chi-square test was employed for the comparison between groups. Spearman rank correlation analysis was adopted for the correlation of 2 variables, and stepwise binary logistic regression was used for multivariate analysis. Results Compared with the patients of the non-DKD group, those in DKD group were older, and had longer duration of DM, higher ratio of hypertension, lower level of high-density lipoprotein cholesterol (HDL-C), lower utilization ratio of guanidine, higher glycosylated hemoglobin (HbA1c) level, larger percentage of 24-hour hyperglycemia fluctuation time, larger area under hyperglycemic curve (AUC), higher postprandial 2-hour blood glucose (2h-PBG) and 24-hour mean blood glucose (24h-MBG) (all P<0.05). They also had higher levels of cystatin C (CysC), blood urea nitrogen (BUN), and serum creatinine (SCr), but obviously lower estimated glomerular filtration rate (eGFR) than the patients of the non-DKD group (P<0.001). Spearman’s correlation analysis showed that DKD was positively correlated with age, duration of the disease, hypertension history, HbA1c level, percentage of hyperglycemia fluctuation time, AUC of hyperglycemia, 24h-MBG and 2h-PBG, while negatively correlated with HDL-C (r=-0.205, P=0.014). Logistic regression analysis indicated that age (OR=1.048, 95%CI 1.022-1.074, P=0.000) and HbA1c (OR=1.569,5%CI 1.212-2.031, P=0.001) had positive correlation with DKD. Conclusion HbA1c is a major risk factor of DKD in T2DM patients, and the occurrence of DKD is not associated with glucose fluctuation.

Abstract:Objective To investigate the correlation between the neutrophil percentage(NP) and mortality in the very old patients with infection, and evaluate its application value. Methods A total 191very old patients aged at (86.0±2.0) years with infection admitted in our department between January 2013 and June 2017 were recruited in this study. According to whether they died within 30 d, they were divided into dead group (group A, n=120) and survival group (group B, n=71).The relationship of NP>90%,clinical indicators and complications with 30-day mortality rate was analyzed. SPSS statistics 18.0 was used to perform the statistical analysis. Student’s t test or Chi-square test was employed for different data types. Spearman correlation analysis was adopted for single factor correlation, and logistic regression for multivariate correlation analysis. Results There were no significant differences in age, sex, incidence of complications and white blood cell count (WBC) between the 2 groups (P>0.05). The group A had obviously more patients with NP>90%, higher proportion of sepsis, higher levels of high sensitivity C-reactive protein(hs-CRP), blood lactic acid and procalcitonin (PCT), higher scores of acute physiology and chronic health evaluation (APACHE) Ⅱand sequential organ failure assessment (SOFA), and larger ratios of mechanical ventilation and indwelling catheterization when compared with the group B (P<0.05). Spearman univariate correlation analysis found that 30-day mortality rate was positively correlated with NP>90% (r=0.223), APACHEⅡ score (r=0.156), SOFA score (r=0.316), blood lactic acid (r=0.453), hs-CRP (r=0.656), PCT (r=0.121), sepsis (r=0.286), mechanical ventilation (r=0.461),and indwelling catheterization (r=0.112). Multivariate logistic regression analysis showed that NP>90%, blood lactic acid, hs-CRP, PCT and sepsis were independent risk factors for 30-day mortality rate. Conclusion For the very old patients with infection, NP>90% indicates higher 30-day mortality rate. NP>90% is more sensitive to the extent and condition of infection than WBC.

Abstract:Objective To determine the effects of cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) on the prognosis of the very old patients with severe pneumonia (SP). Methods A total of 93 very old patients (≥80 years old ) with severe pneumonia admitted to our department from January 2013 to January 2017 were recruited in this study. According to the severity of the disease, they were divided into the SP group (n=40) and ordinary pneumonia group (n=53). The former group was further assigned into death subgroup (n=19) and improvement subgroup (n=21). The plasma cTnI and BNP levels were measured for all the SP patients on days 1,3, 5 and 7 after admission, and in the ordinary pneumonia group on day 1 after admission. SPSS statistics 23.0 was adopted for data processing. Student’s t test or Chi-square test was employed for different data types. Results The plasma levels of cTnI [99.35 (39.95,9.3) vs 7.00 (4.40,1.65) pg/ml] and BNP [566.10 (326.53,5.13) vs 49.10 (24.50,8.30) pg/ml]were significantly higher in SP group than in the ordinary pneumonia group (P<0.05). Compared with the values on day 1, the plasma levels of cTnI and BNP were decreased in the improvement group on days 3,5 and 7 (P<0.05), while those in the death group were increased on days 3,5 and 7 (P<0.05). The levels were obviously lower in the improvement group on days 1,3, 5 and 7 when compared with the death group (P<0.05). Conclusion The plasma levels of cTnI and BNP could be used as adjuvant indicators for assessment of myocardial damage and prognosis in very old patients with SP.

Abstract:Objective To investigate the correlation of serum levels of lactate, procalcitonin (PCT), and C-reactive protein (CRP) with the score of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) score in the elderly patients with sepsis, and to analyze the prognostic values of these levels. Methods A total of 186 cases of senile sepsis in our hospital from January 2012 to December 2016 were selected and followed up for 28 d. According to their survival outcomes, they were divided into survival group (n=110) and death group (n=76). The serum levels of PCT, CRP and lactate in the 2 groups were detected, and the scores of APACHE Ⅱ and SOFA were recorded. Student’s t test, repeated measures analysis of variance, and Chi-square test or Fisher exact test were adopted for the data. Receiver-operating characteristic (ROC) curve analysis was employed to evaluate the prognostic values of the serum PCT, CRP and lactate levels in the septic elderly. Correlations of serum PCT, CRP and lactate levels with APACHE Ⅱ and SOFA scores were analyzed in the death group by Pearson linear correlation analysis.Results The serum levels of PCT, CRP and lactate in the first, third and seventh days were significantly higher in the death group than in the survival group (P<0.05). What’s more, the serum levels in the seventh day of the death group were obviously higher than those of the first and third days (P<0.05), but the levels in the seventh day of the survival group were notably lower than those of the first and third days (P<0.05). Logistic regression analysis found that serum levels of PCT, CRP and lactate, and SOFA score were independent factors for poor prognosis in the elderly patients with sepsis. The ROC curve showed that the best cut-off values of PCT_d3, CRP_d3 and lactate_d3 were 9.83 μg/L, 86.42 mg/L and 3.72 mmol/L in the evaluation of prognosis, with the sensitivity and specificity of 81.7% and 85.3%, 77.5% and 79.8%, and 86.3% and 76.2%, respectively. Correlation analysis indicated that the serum PCT_d3 level was positively correlated with APACHE Ⅱ and SOFA scores in the death group (r=0.703, P<0.001; r=0.802, P<0.001). Conclusion Serum PCT, CRP and lactate levels are closely related to the severity and prognosis of sepsis in elderly patients, and serum PCT level in the third day shows the greatest predictive value in the prognosis.

Abstract:Objective To analyze the related factors impairing activities of daily living (ADL) in the hospitalized elderly patients in order to provide rational medical care services for them. Methods Comprehensive geriatric assessment was carried out on 100 elderly patients hospitalized in our geriatric department from October 2016 to March 2017. The relationship of ADL with chronic disease, home care, and results of comprehensive geriatric assessment was analyzed. SPSS statistics 22.0 was used to analyze the data. The measurement data were expressed as mean±standard deviation. Spearman correlation analysis was employed for single continuous variable, Chi-square test for binary variables, and logistic regression analysis for multiple factors. Results Among the 100 participants, 37 peoples had activity impaired, with a score of (5.22±1.36). Single factor correlation analysis showed that age, grip strength, fall history, and results of short-form Mini-Nutritional Assessment (MNA-SF) and Mini-Mental State Examination (MMSE) were independent factors for ADL (P<0.05). While multiple factors correlation analysis indicated that age, grip strength, and fall history were correlated with ADL (P<0.05). The severity of impaired ADL were correlated with gender and MMSE (P<0.05), but whether there was relationship with other items remained unclear. Conclusion For ADL impaired elderly people, they can prevent function decline by exercising grip strength, being cautious about fall, strengthening nutrition, and preventing dementia.

Abstract:Objective To investigate the clinical characteristics and diagnostic and treatment efficiency of acute pancreatitis (AP) for the elderly in recent years. Methods A retrospective analysis was performed on 102 elderly AP patients [≥60 years,(68.8±6.9)years, the aged group] admitted to our hospital from January 2014 to December 2016. Another 213 AP patients [<60 years,(46.7±4.4) years , the non-aged group] hospitalized in the same period served as controls. The causes of disease, ratio of severe AP, clinical manifestations, systematic and local complications, length of hospital stay after treatment, and mortality rate were collected and compared between the 2 groups. SPSS statistics 20.0 was used to perform the statistical analysis.Student’s t test or Chi-square test was employed for different data types. Results There were no differences in the ratios of systematic complications, local complications and severe AP between the 2 groups (P>0.05). The leading cause of AP was biliary tract disease, followed by hyperlipidemia, alcoholic cause and tumor, and the aged group had obviously higher ratios of biliary tract disease(70.6% vs 49.8%) and tumor (4.9% vs 0.0%), but lower ratio of hyperlipidemia (11.8% vs 20.2%) and alcoholic cause (6.9% vs 19.2%) when compared with the control group(all P<0.05). In clinical manifestations, the incidence of abdominal pain (84.4% vs 95.4%) was notably lower, while that of jaundice (66.7% vs 48.4%) was remarkably higher in the aged group than the non-aged group (P<0.05). There was no significant difference in the length of hospitalization time [(12.9±5.6) vs(11.7±4.6) d, P>0.05], but the mortality rate was significantly higher in the aged group (7.9% vs 1.4%, P<0.05). Conclusion The elderly AP patients have many basic diseases, and thus have high mortality rate. Clinicians should be cautious about biliary tract diseases and tumor for these patients.

Abstract:Objective To investigate the therapeutic effectiveness of holmium laser enucleation of the prostate(HoLEP)for benign prostatic hyperplasia and observe its safety.Methods A retrospective analysis was conducted on 100 patients with benign prostatic hyperplasia admitted in our department from February 2015 to December 2016. According to their surgical treatment, they were divided into HoLEP group and transurethral resection of prostate (TURP) group, with 50 patients in each group. The general situations of the 2 groups of patients were observed preoperatively and intraoperatively, the incidence of complications and postoperative International Prostate Symptom Score (IPSS), maximum flow fate (Qmax) and improvement of quality of life were studied and compared between the 2 groups. SPSS statistics 11.5 was used to perform the statistical analysis. Student’s t test and Chi-square test were adopted for the comparison between the 2 groups. Results There were no significant differences in age, Qmax, IPSS and postvoidurine residual (PVUR) volume between the 2 groups (P>0.05).The patients of the HoLEP group had shorter operation time[(52.13±5.78) vs (60.48±6.57)min], less volume of intraoperative blood loss[(78.22±7.83) vs (98.24±9.12)ml], larger amount of prostate tissue resected[(39.15±5.53) vs (30.26±4.68)g], and greatly improved Qmax and quality of life, when compared with those of the TURP group (P<0.05). The incidence rate of complications was 16%(8/50) in the TURP group, and 4%(2/50) in the HoLEP group, with significant difference between them (P=0.046). Conclusion HoLEP has good curative effectiveness for benign prostatic hyperplasia, and it can significantly reduce IPSS and improve the quality of life of patients.

Abstract:Objective To investigate the correlation between the patient’s awareness on cardiac rehabilitation with exercise compliance, and to find out the reasons for poor compliance in cardiac rehabilitation. Methods A total of 87 coronary heart disease (CHD) patients hospitalized in our department due to unstable angina from February 1, to April 1,7, and undergoing elective percutaneous coronary intervention (PCI) for the first time were enrolled in this study. During their re-hospitalization in 1 to 2 years after discharge, questionnaire survey was used to investigate their general information and awareness on cardiac rehabilitation. And semi-structured interview was employed for the items that could not be scored in the questionnaires. Pearson correlation analysis was employed to analyze the correlation of the score of exercise compliance with awareness level on cardiac rehabilitation. Results Most participants (66.7%) had the score of awareness on cardiac rehabilitation ranging from 30 to 45, and 74.8% had the similar range for the score of exercise compliance. Eight subjects (9.2%) knew well about cardiac rehabilitation, 23 (26.4%) knew some, and 56 (66.4%) had never known about it. There were 78 participants (89.6%) who considered cardiac rehabilitation very important or important. The score of exercise compliance was positively correlated with the score of the awareness (r=0.931) and exercise habit (r=0.334). For those who were proficient in mobile phones, they preferred mobile phone APP for the guidance of home rehabilitation. ConclusionLow awareness level on cardiac rehabilitation indicates poor scores of the awareness and exercise compliance, though most patients accept the importance of cardiac rehabilitation. Poor awareness also is the main reason for poor exercise compliance.

Abstract:Heart failure (HF) is a heterogeneous disorder with complex mechanisms. A thorough understanding of its pathophysiological mechanism reveals that neprilysin (NEP) plays an important role in its incidence and development. So inhibiting NEP provides a new direction and target for the treatment of HF. Recently, angiotensin receptor neprilysin inhibitor (ARNI) makes great progress in the management of heart failure with reduced ejection fraction (HFrEF), whereas no clinical trial to date has yet identified an effective therapy for heart failure with preserved ejection fraction (HFpEF). In the 2016 updated HF guidelines of American Heart Association and European Association of Cardiology, ARNI is recommend as a drug for chronic HFrEF. This article reviewed the research advance in HF and NEP.

Abstract:Elevation of high-sensitivity cardiac troponin is observed in myocardial injuries, which is caused by various mechanisms in the process of heart failure and commonly seen in acute heart failure, acute exacerbation of chronic heart failure, and ischemic and even non-ischemic heart failure. The level of high-sensitivity cardiac troponin is significantly related with mortality and rehospitalization rate in heart failure patients, and is regarded as a powerful prognostic factor for heart failure.