Abstract:Objective To investigate the therapeutic efficacy and adverse reactions of a modified DCEP for relapsed/refractory multiple myeloma (MM). Methods Enrolled in the study were 5 patients suffering from relapsed/refractory MM, who were treated with modified DCEP in the Department of Geriatric Oncology of the First Affiliated Hospital of Chinese PLA General Hospital. Their clinical data were retrieved, including age, gender, peripheral blood and bone marrow characteristics. The patients were treated with a modified DCEP, and its therapeutic efficacy and adverse reactions were evaluated. Results The 5 patients (1 man and 4 women) were aged from 51 to 75 years. All of them were administered with a modified DCEP with a median course of 2 (range from 2 to 5) and a median follow-up of 22 months. Partial remission was observed in 1 patient with progression-free survival of 2 months, minimal response in 1 patient with progression-free survival of 6 months, stable disease in 2 patients, and progression in 1 patient. The main adverse reactions were gastrointestinal symptoms (grade Ⅱ in 4) and fatigue (grade Ⅱ in 3). One patient developed myelosuppression (grade Ⅳ) complicated with pulmonary infection. Conclusion Modified DCEP is effective and well-tolerated in the patients with relapsed/refractory MM.

Abstract:Objective To investigate the correlation between plasma β-amyloid protein (Aβ) and its deposition on ¹¹C-PiB PET/CT.Methods A total of 69 elderly individuals were enrolled in the study from General Hospital of Shenyang Military Command, either with Alzheimer′s disease (AD) or with mild cognitive impairment (MCI) or with no dementia (normal controls,NC). All subjects underwent amyloid imaging with ¹¹C-PIB PET/CT and measurement of plasma Aβ42 and Aβ40. Five regions of interest (frontal, lateral temporal, parietal cortex, posterior cingulate/precuneus and anterior cingulate) were identified. The maximum standardized uptake value (SUVmax) was measured for the whole brain and each region of interest, and their correlations with plasma Aβ42 and Aβ40 were analyzed. SPSS statistics 18.0 was used for data analysis. Results Standardized uptake value ratio (SUVR) of Aβ42/Aβ40 decreased gradually in NC, MCI and AD groups, and ¹¹C-PIB SUVR increased gradually, with significant differences(P＜0.05). ¹¹C-PIB SUVR correlated negatively with plasma Aβ42 (r=-0.461) and Aβ42/Aβ40 (r=-0.633) ratio and positively with plasma Aβ40 (r=0.430), the difference being statistically significant (P<0.05). ¹¹C-PIB SUVR of brain regions increased gradually in three groups. Regression analysis showed that ¹¹C-PIB SUVR of frontal lobe, temporal lobe and precuneus could be predicted by plasma Aβ42/Aβ40 ratio with statistically significant difference (P<0.05), but ¹¹C-PIB SUVR and plasma Aβ42/Aβ40 ratio were of no statistical significance in the parietal lobe and posterior cingulate (P＞0.05). Conclusion The plasma Aβ42/Aβ40 ratio is able to predict brain amyloid deposition, and amyloid deposition on ¹¹C-PiB PET and plasma Aβ42/Aβ40 ratios have significant clinical potential as biomarkers.

Abstract:Objective To investigate the findings in the assessment and prognosis of the elderly cancer patients with comprehensive geriatric assessment (CGA) in 7 hospitals in Sichuan Province. Methods CGA was made for 488 elderly cancer patients (lung cancer, prostate cancer, colorectal cancer and malignant lymphoma) aged 65 years or over, who were treated in 7 hospitals in Sichuan Province from July 2012 to January 2014. An analysis was made of their geriatric syndrome, and a comparison was made of the prognosis between groups with different functional levels within 1-year follow-up. SPSS statistics 22.0 was used for data analysis, and Chi-square test for comparison groups. Results Severe complications were seen in 76.4%(373/488), impaired instrumental activities of daily living (IADL) in 68.6%(335/488), visual impairment in 68.2%(333/488), high risk for falling in 51.0%(249/488), and social support deficiency in 10.0%(49/488). Age group 65-75 years had higher risk and higher proportion of malnutrition than age groups of 76-85 and of >85 years, the difference being statistically significant (P<0.001). Progression or recurrence of cancer was observed in 37.5%(183/488) during the follow-up period. The rate of progression/recurrence was 41.5%(92/222) in dysfunctional group, 16.7%(4/24) in functionally independent group, and 36.0%(87/242) in disability group, the difference being statistically significant (P<0.05). The 1-year mortality rate was 11.9%(58/488) with no death in the functionally independent group. The mortality rate in the disability group was 21.1%(51/242), which was significantly higher than that in the dysfunctional group 3.4%(7/222) (P<0.001). Of 273 patients who received chemotherapy, 76.9%(210/273) did not complete the expected course of treatment. In the disability group, 100.0%(96/96) did not complete the expected course of treatment, which was higher than 67.1%(110/164) in the dysfunctional group and 30.8%(4/13) in the functionally independent group, the difference being statistically significant (P<0.001). Side effects of radio/chemotherapy were seen in 79.9%(218/273), of which 19.0%(52/273) were Grade 3 or above. There was no statistically significant difference in the incidence of side effects between groups (P=0.108). Conclusion Geriatric syndrome is common in hospitalized elderly tumor population, in which complications and IADL are the most common, and some dysfunctional patients are prone to tumor progression/recurrence. The proportion of those who did not complete the expected course of treatment and 1-year mortality were high in the disabled patients.

Abstract:Objective To investigate the clinical significance of Myrian post-processing system in the diagnosis of early-stage lung cancer in the elderly. Methods A total of 57 patients with complete data were retrospectively analyzed, who underwent surgery for pulmonary nodules in the Department of Thoracic Surgery of Cangzhou People′s Hospital of Hebei Province from November 2016 to November 2017. Preoperatively, all the patients underwent 64-slice spiral CT, and the nodules were evaluated and determined as malignant or benign by the physician. The imaging parameters were entered into Myrian system for 3D reconstruction, and the nodules were reevaluated accordingly by the physician. At the same time, the risk of early-stage lung cancer was obtained using built-in formula of Myrian system. Postoperatively, using pathological results as gold standard, Myrian system was evaluated in terms of sensitivity, specificity, positive predictive value, and negative predictive value. SPSS statistics 20.0 was used for data analysis. Chi-square test or Fisher exact probability test was performed for comparison between groups. Based on the receiver operating characteristic (ROC) curve analysis, cut-off value of Myrian system was determined for the risk assessment of early-stage lung cancer. Results Myrian system had a significantly higher detection rate than 64-slice spiral CT [71.93%(41/57) vs 52.63%(30/57),P=0.03]. The Myrian system showed a sensitivity of 85.42%(41/48), a specificity of 66.67%(6/9), a positive predictive value of 93.18%(41/44), and a negative predictive value of 46.15%(6/13) in the diagnosis of early-stage lung cancer in the elderly. The ROC curve indicated that cut-off value of risk in Myrian system was 26%, and that the area under the curve was 0.750 (95%CI 0.612-0.888, P<0.05). Conclusion Myrian post-processing system has diagnostic value for early-stage lung cancer in the elderly Chinese population, providing basis for clinical decisions in pulmonary nodules.

Abstract:Objective To investigate the pelvic floor ultrasound parameters in relation to the severity of stress urinary incontinence (SUI) in the elderly women to provide reference for determining the degree of SUI in clinical practice. Methods Included in the study were 378 SUI patients treated in the Department of Ultrasound of the First Hospital of Xi′an Jiaotong University from January 2016 to January 2018, of whom 167 were mild (mild group), 114 moderate (moderate group), and 87 severe (severe group). Also, 100 elderly women without SUI who had physical check-ups in the same hospital were randomly selected as the control group. The pelvic floor ultrasound parameters were observed at rest and in Valsalva maneuver. Statistical analysis was performed using SPSS statistics 19.0. Depending on data type, comparison among groups was made by variance analysis, LSD-t test or Chi-square test. Results There were no significant differences among the four groups in baseline data. At rest, patients in all SUI group had thinker detrusor, wider posterior urethra-vesical angle, greater incidence of urethral funnel formation, but lower vertical distance between bladder neck and synchondroses pubis (BN-S) than those in the control group (P<0.05), the differences being statistically significant. There was no statistically significant differences among the SUI groups in the above parameters (P>0.05). In Valsalva maneuver, posterior urethra-vesical angle, urethral rotation angle, bladder neck mobility, incidence of urethral funnel formation increased significantly in the SUI groups as compared with the control group (P<0.05), and BN-S was significantly lower in the former than in the latter, the diffe-rences being of statistical significance (P<0.05). The bladder neck mobility increased with the severity of SUI, and the differences wereof statistical significance among the mild, moderate and severe groups[(25.18±3.82) vs (29.80±3.78) vs (33.13±3.60)mm, P＜0.05]. Conclusion Pelvic floor ultrasound can be used to observe the differences in the pelvic floor structures between the elderly women with SUI and those without, and bladder neck mobility differs in patients with SUI of different severity, providing a reference for determining SUI severity.

Abstract:Objective To investigate the correlation between vascular calcification and osteoporosis (OP) in the elderly. Methods A retrospective analysis was made of 316 elderly patients admitted to the Department of Geriatrics of Chinese PLA Hospital No. 181 from March 2013 to September 2016. The bone mineral density (BMD) was measured by dual energy X-ray absorptiometry, and the patients were divided into OP group (135 cases) and non-OP group (181 cases) according to T value. The carotid artery, abdominal aorta, and lower-extremity arteries were examined for calcification by color Doppler ultrasound. SPSS statistics 18.0 was used for data analysis. Student′s t test or Chi-square test was performed for comparison between groups, and logistic regression for analysis of the correlation between carotid calcification, abdominal aortic calcification (AAC) and lower-extremity artery calcification (LEAC) and osteoporosis. Results The OP group had fewer male patients, lower ratio of diabetes mellitus and hypertension, lower body mass index (BMI) and lower BMD in the lumbar spine and hip, but higher total cholesterol level than the non-OP group, the differences being statistically significant (P<0.01). The incidence of AAC in the OP group was significantly higher than that in non-OP group [83.7%(113/135) vs 64.1%(116/181)], and the difference was statistically significant (P<0.01). Logistic regression analysis showed a positive correlation between OP and AAC (OR=3.25,5%CI 1.37-7.70; P=0.007). Conclusion AAC correlates with OP under non-invasive qualitative measurement, providing a pathway for the research of the correlation between vascular calcification and OP.

Abstract:Objective To investigate the influencing factors on the demand among the elderly for home-based care services in Cangzhou municipanity. Methods A questionnaire survey was conducted using stratified multistage random sampling among 1000 people aged over 60 years in Cangzhou municipality, and an analysis was made of the influencing factors on the demand for home-based care services among the elderly there. SPSS statistics 18.0 was used for data processing. χ² test was performed for comparison between groups, and a multiple logistic regression for screening independent risk factors. Results A total of 898 valid questionnaires were collected back with a recovery rate of 89.8%. A univariate analysis showed that age, education, occupation, marital status, family financial status and health status had significant influence on the demand among the elderly for home-based care services (P<0.05). A logistic regression analysis showed that college education or above (OR=0.267,5%CI=0.154-0.846), business services and technical staff (OR=0.352,5%CI=0.167-0.984), widowhood (OR=0.391,5%CI=0.224-0.855), annual family income per capita over RMB 5000 yuan (OR=0.384, 95%CI=0.208-0.931), poor health (OR=0.296,5%CI=0.052-0.366) are the influencing factors on the demand for home-based care services. Conclusion The factors that have a significant impact on the needs of the home-based care services among the elderly are education, occupation, marital status, family financial status and health status. The results form a basis on which the community workers can develop and implement home-based care services.

Abstract:Objective To investigate the distribution and clinical characteristics of multidrug-resistant (MDR) bacteria in the elderly patients with pulmonary infection. Methods Included in the study were 219 elderly patients with pulmonary infection attending the Department of Geriatrics of Xijing Hospital from January 2015 to December 2016. They were divided into MDR group (n=107) and non-MDR group (n=112) based on the presence of MDR bacteria. An analysis was made of the distribution of MDR bacteria in the former, the two groups were compared in the clinical indicators of the patients, and the risk factors were investigated for MDR infection. SPSS statistics 18.0 was used for data processing. Depending on data type, t-test or χ² test was performed for comparison between groups, and multivariate logistic regression for investigation of independent risk factors for MDR infection. Results Infections by Acinetobacter baumannii and Pseudomonas aeruginosa were more common in the MDR group. One-year mortality was significantly higher in the MDR group than that in the non-MDR group [30.2%(32/106) vs 8.0%(9/112), P<0.05]. Multivariate logistic regression showed that long hospital stay (OR=4.813,5%CI 1.234-5.554; P=0.032), long antibiotics medication (OR=3.124, 95%CI 2.126-10.314; P=0.001) and prolonged use of the invasive ventilator (OR=4.227,5%CI 1.470-6.879; P=0.041) were independent risk factors for the MDR infection. Conclusion Pulmonary MDR infections in the elderly are mostly caused by Acinetobacter baumannii and Pseudomonas aeruginosa. Patients with MDR infections have high mortality. Long hospitalization, long antibiotic medication, and prolonged use of the invasive ventilators are independent risk factors for MDR infections.

Abstract:Objective To compare the efficacy of percutaneous minimally invasive surgery and conventional open pedicle screw fixation for treatment of compression fracture of thoracolumbar spine in the elderly. Methods A total of 245 patients with compression fracture of thoracolumbar spine were enrolled in this study, who received the surgery in the Hainan Branch of Chinese PLA General Hospital from June 2013 to February 2017. They were divided into percutaneous minimally invasive surgery (PMIS) group (n=126) and open surgery (OS) group (n=119). The two groups were compared in the perioperative parameters, such as operation duration, length of hospital stay, hospitalization cost, intraoperative bleeding and incision length. The patients were followed up for at least 6 months and the anterior height of injured vertebral body, Cobb angle and sagittal index were measured. Data were analyzed using SPSS statistics 18.0. Depending on the data type, t-test or χ² test were used for comparison. Results Compared with OS group, PMIS group had significantly decreased operation duration[(95.2±16.3) vs(126.5±39.0)min], length of hospital stay[(10.8±4.0) vs(22.5±13.6)d], intraoperative bleeding[(82.7±39.9) vs(327.2±143.1)ml], postoperative drainage [(33.5±15.8) vs (301.5±110.8) ml], hospitalization cost [(5.1±0.3) vs(5.7±0.2)×10⁴ RMB yuan], and incision length [(9.3±0.6) vs(12.8±1.9)cm]. The differences were statistically significant (P<0.05 for all). Postoperative parameters were significantly improvedin both groups:anterior height of injured vertebrae [PMIS group:(11.2±7.3) vs(20.1±3.3) mm; OS group:(12.2±7.6) vs(21.7±2.4)mm], Cobb angle [PMIS group:(14.0±6.8)° vs(4.3±1.8)°; OS group:(14.8±7.0)° vs(4.6±2.8)°], and sagittal index [PMIS group:(64.5±12.6)% vs(93.8±13.9)%; OS group:(63.8±13.8)% vs(95.0±9.6)%] (P<0.05 for all). Conclusion Percutaneous minimally invasive surgery has better efficacy for treatment of compression fracture of thoracolumbar spine in the elderly than conventional open pedicle screw fixation with decreased operation duration, length of hospital stay, intraoperative bleeding, incision length and hospitalization cost. The procedure is therefore worthy of clinical promotion.

Abstract:Objective To investigate the efficacy and safety of intravesical hyperthermic perfusion with gemcitabine and pirarubicin in the elderly patients with superficial bladder cancer after transurethral resection of bladder tumor (TURBT). Methods A retrospective analysis was made of 90 elderly patients with superficial bladder cancer treated with TURBT in the Department of Urology Surgery of Beijing Geriatric Hospital from April 2012 to April 2015. They were divided into gemcitabine group and pirarubicin group, with 45 in each group. In the former, a plastic bag of 500 ml sodium chloride solution (0.9%) added with 1000 mg gemcitabine was heated to 50℃. In the latter, a plastic bag of 500 ml glucose solution (5%) added with 40 mg pirarubicin was heated to 50℃. All the patients were perfused at 300 ml/min within 6 hours after operation for 1 hour, then once a week for 8 times, and once a month for one year. The 2 groups were compared in the recurrence rate, recurrence-free survival time and adverse reactions. SPSS statistics 17.0 was used for data analysis, and Student′s t test or Chi-square test for comparison between groups. Kaplan-Meier survival curves were made for survival time without recurrence and Log-rank test was performed for comparison. Results All patients were followed up for 12-36 months. No significant differences were observed between the 2 group in recurrence rate at 12 months [8.89%(4/45) vs 15.56%(7/45), P=0.334] and at 36 months [15.56%(7/45) vs 28.89%(13/45), P=0.128]. Compared with pirarubicin group, the gemcitabine group had longer recurrence-free survival time [(32.99±1.53) vs (27.71±1.95) months] and lower incidence of total adverse reactions [42.2%(19/45) vs 97.8%(44/45), P<0. 05]. Statistically significant differences were observed between the 2 groups in the incidence of hematuria, urinary pain and cystitis (P<0.05). Conclusion Intravesical hyperthermic perfusion of gemcitabine after TURBT has satisfactory efficacy with mild adverse reactions, serving as an effective way to prevent postoperative recurrence in the elderly patients with superficial bladder cancer.

Abstract:Objective To compare the clinical efficacy of laparoscopic and open radical gastrectomy for the removal of lymph nodes. Methods Included in this study were 753 patients who underwent radical gastrectomy for gastric cancer in the Central Hospital of Tongchuan Mining Bureau of Shaanxi Province from October 2010 to October 2015, with 384 via laparoscopy (laparoscopic group), and 369 via laparotomy (laparotomy group). The two groups were compared in the operation time, bleeding volume, length of the incision, length of hospital stay and number of lymph node dissection. SPSS statistics 19.0 was used to process the data. Depending on the data type, independent sample t-test or Chi-square test were employed for comparison. Results The operation time in the laparoscopic group was significantly longer than that in the laparotomy group [(275.16±32.59) vs (208.72±27.37)min, P<0.001]. However, compared with the laparotomy group, the laparoscopic group had less bleeding [(151.62±28.43) vs (319.34±98.15)ml, P<0.001], shorter incision [(6.35±1.47) vs (17.53±1.78)cm, P<0.001] and shorter hospital stay [(9.17±3.24) vs (15.64±5.37)d, P=0.004], the difference being statistically significant. Lymph nodes removed totaled 9984 in the laparoscopic group with 15-41(25.86±5.47) each and 9372 in the laparotomy group with 15-46(26.47±6.12) each, without significant differences both in the total number and individual number (P>0.05). There were also no significant differences between the two groups in the number of lymph nodes removed under the similar condition in the region, depth of invasion into the gastric wall, operation method, tumor type, tumor size and degree of differentiation (P＞0.05). Conclusion With similar clinical and pathological characteristics, laparoscopic radical gastrectomy has no significantly different efficacy from laparotomy radical gastrectomy in removing lymph nodes, and the overall effect of the former is better than that of the latter in gastric cancer.

Abstract:Objective To investigate the protective effects of the specific inhibition of inward rectifier potassium current (IK1) on the ischemic heart in a transgenic mouse model with ischemic preconditioning (IPC). Methods Mice with genetic inhibition of IK1 were divided into 2 groups:observation group with positive expression and control group with negative expression. Arrhythmia was monitored in each group. With the isolated heart, the effects were observed of IPC on the myocardial infarct size and apoptosis following ischemia/reperfusion (IR). Western blot was employed to detect the expressed proteins. SPSS statistics 17.0 was used for statistical analysis, and t-test for comparison between groups. Results Compared with the control group, the observation group had significantly lower arrhythmia score [(3.50±0.67) vs (7.42±0.70)scores], ratio of myocardial infarct size to left ventricular area [(0.25±0.04)% vs (0.38±0.02) %] and cardiomyocyte apoptosis index [(202±93) ‰ vs (822.5±97.5) ‰, P<0.05]. Western blotting revealed significantly greater up-regulation in the observation group than in the control group of phosphorylated glycogen synthase kinase 3 [(1.41±0.16) vs (0.77±0.05)], AKT [(1.84±0.20) vs (0.81±0.14)], and p-AKT [(1.87±0.27) vs (1.08±0.22)]. Conclusion Transgenic inhibition of Kir2.1 can potentially reduce the occurrence of arrhythmia, myocardial cell apoptosis, and myocardial infarct size in myocardial infarction following IPC, and its mechanism may be partially related to the Reperfusion Injury Salvage Kinases (RISK) pathway.

Abstract:Muscular relaxants are important adjuvants used in general anesthesia, and one of the associating problems is postoperative residual neuromuscular blockade. Awareness of the factors influencing this effect facilitates communication among the surgeons, anesthesiologists, patients and their relatives, enhancing early recovery and improving prognosis of the patients. This article reviewed the factors associated with postoperative residual neuromuscular blockade.

Abstract:The emergence of aging society and increasing chronic diseases necessitate remote monitor system and early warning as a new medical paradigm. The former can be used in health monitoring, disease diagnosis, medical counseling, patient education, chronic disease management and long-term care in elderly population, patient referral, continuous medical care, and particularly the management of chronic heart failure, diabetes and other chronic diseases. The latter plays an effective role in saving the lives of those with acute illnesses, helping to meet the demand of care in the elderly and solve the problem of irrational allocation of medical resources. This article aims to evaluate the application of the two systems in the management of the chronic diseases in the elderly in China.

Abstract:Alcoholic liver diseases (ALD), the most common clinical consequences of alcohol abuse, include alcoholic fatty liver, alcoholic hepatitis, liver fibrosis and cirrhosis. Skeletal muscle loss or sarcopenia is a major complication of alcoholic liver diseases. Decreased muscle mass adversely affects clinical outcomes, including survival, quality of life, development of other complications, and post-transplant outcomes. In this review, we summarized progress made in pathogenesis of and treatment for alcoholic liver diseases with sarcopenia in the view of providing basis for further studies.

Abstract:Obstructive sleep apnea syndrome (OSAS), a common sleep-disordered breathing disorder, is characterized by repeated episodes of sleep apnea resulting from a variety of causes. OSAS patients have repeated upper airway collapse and obstruction and experience hypopnea and/or apnea during sleep, and all these can further lead to multisystem diseases. In recent years, much evidence has shown that multiple eye diseases are included in the complications of OSAS. The article reviewed the association between OSAS and eye diseases as follows.

Abstract:Osteoporotic vertebral compression fracture (OVCF) is one of the fragile fractures often occurring in the elderly. Vertebroplasty has become the most important treatment for OVCF because of its safety, effectiveness and minimal invasiveness, and it has been employed clinically and accepted by most patients. Bone cement is injected in the fractured vertebral bodies, and its characteristics are great of importance for the pain relief. This paper reviewed four characteristics that related research has focused over the last years, namely the injected volume, dispersion, distribution patterns, and cement viscosity.

Abstract:Bone fracture is a complete or partial break of the bone structure. Concomitant type 1 diabetes mellitus (T1DM) weakens the bone strength and increases the risk of fractures. Moreover, improper treatment is not conducive to the healing process of the fracture, resulting in the delayed healing, bone nonunion, infectious osteomyelitis and other complications. Hyperglycemia and hypoinsulinemia caused by diabetes mellitus (DM) may increase the expression of advanced glycation end products (AGEs) and inflammatory factors, altering the collagen functions, microvascular structures, bone absorption, reconstruction and biomechanical environment in the healing process of the fractured bone. These changes are not conducive to the healing of the fracture. At present, the molecular mechanism of the effects of T1DM on the healing fractures remains little known. This review is intended to investigate such effects, and thought to be beneficial for treating patients with diabetes mellitus combined with bone fracture.