Abstract:Objective To assess the multimorbidity spectrum, multiple organ dysfunction, polypharmacy and expenditure among elderly inpatients from five clinical centers (Chinese PLA General Hospital, etc) over last 10 years,so as to provide technical guidance and objective evaluation for the study of prevention and treatment of multimorbidity. Methods Data were collected from elderly in-patients aged over 65 years form five clinical centers in China from January 2008 to December 2017. We further assessed multimorbidity spectrum, mortality, polypharmacy,expenditure among the elderly inpatients classified by gender and age over the decade.Results There were 370 996 inpatients enrolled in this study and the total number of hospitalizations reached 694 138. The average age of patients was 72.25 years. The number of elderly inpatients has increased significantly over the last decade, and the average annual growth rate was 27.48%. Malignant tumors(37.18%), hypertension(36.69%), ischemic heart disease(29.18%), diabetes mellitus (20.75%) and cerebrovascular diseases (13.19%) ranked top of the list.Ischemic heart disease with hypertension was the most prevalent comorbidity disease, and malignant tumors with hypertension increased with the annual rate of 42.99%.The proportion of taking more than 5 kinds of medications reached 43.88%. Conclusion (1) The problem of chronic diseases and comorbidity are prominent in the elderly with the ageing of the population. (2)We should strengthen multidisciplinary joint diagnosis and make reasonablemedication and treatment strategies for chronic diseases in the elderly, including ischemic heart disease, hypertension, malignant tumors, diabetes, etc. (3)Malignant tumor is the first cause of in-hospital death, therefore it′s important to facilitate early diagnosis and increase survival rate, and improve consistency of medical resources.

Abstract:Objective The present study aimed to investigate the impact of early ticagrelor discontinuation (ETD) on clinical outcomes in the elderly patients (≥75) with acute coronary syndrome (ACS) or after percutaneous coronary intervention (PCI). Methods Recruited in the study were consecutive patients with ACS or after PCI treated with ticagrelor and aspirin in the Department of Cardiology of the Chinese PLA General Hospital from January 2014 to May 2016. The incidence and the reasons for ETD were recorded. Analysis was made of ETD (with 3 months of use), its reasons, and its influence on major ischemic events (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, emergency revascularization, early stent thrombosis, late stent thrombosis) and major bleeding events [Bleeding Academic Research Consortium (BARC)≥ type 3] during a 1-year period. Results A total of 190 eligible elderly patients were recruited [age(78.7±3.6) years], of whom 65 (34.2%) discontinued ticagrelor early. Within a 12-month follow-up, the incidence of major ischemic events was significantly higher in the ETD patients than in those with continued ticagrelor treatment (13.8% vs 5.7%; HR=3.57,5%CI 1.15-11.09; P=0.03). No significant difference was found for the major bleeding events (1.5% vs 2.4%; HR=0.57,5%CI 0.05-6.00; P=0.64). Conclusion ETD within 3 months of medication in the elderly patients (≥75) with ACS or after PCI might increase the risk of major ischemic events.

Abstract:Objective To systematically evaluate the prevalence of type 2 diabetes mellitus (T2DM) by meta-analysis in adult Chinese aged 20 years or over from January 1996 to October 2016. Methods A systematic literature search was conducted in China National Knowledge Internet(CNKI), VIP Chinese Journal Database (VIP), EMbase, Cochrane and Pubmed for the prevalence of T2DM among adult Chinese aged over 20 years from January 1996 to October 2016. I² test for heterogeneity among studies was performed using Comprehensive Meta-analysis (CMA, version 2.2). Fixed effect model or random effect model was employed to analyze the overall prevalence of T2DM and the differences between different population groups. Results A total of 30 pertinent articles were selected for the final analysis, with overall quality of the literature being good. The prevalence of T2DM in adult Chinese was 6.6%(95%CI 5.5-7.9). In terms of age, the prevalence was 1.7%(95%CI 1.2-2.2) among those aged 20-39, 6.7%(95%CI 5.2-8.6) among those aged 40-59, and 14.7%(95%CI 12.2-17.7) among those aged over 60 years, the difference being statistically significant (P＜0.05). In terms of locality, the prevalence was 6.8%(95%CI 5.0-9.3) in the urban areas as against 3.7%(95%CI 2.4-5.6) in the rural areas with no significant difference (P＞0.05). In terms of gender, the prevalence was 6.3%(95%CI 5.0-7.8) in men and 6.3%(95%CI 5.3-7.4) in women, with no significant difference (P＞0.05). In terms of economic zone, the prevalence was 3.2%(95%CI 2.5-4.2) in central economic zone, 5.9%(95%CI 4.3-7.9) in the western economic zone, and 6.5% (95%CI 5.1-8.1) in the eastern economic zone, that in central economic zone being significantly lower than that in western and eastern economic zones (P<0.05). However, there was no significant difference between the eastern and western zones (P＞0.05). In terms of educational level, the prevalence was 6.9%(95%CI 4.4-10.7) in those with an education of primary school and before, 4.6%(95%CI 3.3-6.4) in those with an education of secondary school, and 4.3%(95%CI 2.9-6.4) in those with an education of tertiary institution and beyond. The prevalence of T2DM decreased with the level of education, but there was no significant difference (P>0.05). Conclusion From 1996 to 2016, the prevalence of T2DM in adult Chinese aged 20 years and over increased with age and was lower in the central part of China than in the eastern and western parts. Measures for prevention and control of T2DM should be further strengthened according to the demographic and regional characteristics.

Abstract:Objective To investigate the association between potentially inappropriate medication (PIM) and comorbidity, frailty and disability in the hospitalized elderly inpatients. Methods Selected for the study were 372 inpatients aged ≥65 years old in the Integrated Department of Fu Xing Hospital of Capital Medical University from June 2016 to June 2017. According to the PIM list for the elderly Chinese (version 2017), the patients were divided into PIM group (n=238) and non-PIM group (n=134), and data were recorded of their general information, comorbidity, and Charlson comorbidity index (CCI), frailty and disability. SPSS statistics 23.0 was used to process data. Independent sample t-test, nonparametric test or χ² test was performed. Spearman correlation analysis was made to explore correlation between PIM and comorbidity, frailty and disability. Multivariate logistic regression was done to analyze the risk factors associated with PIM. Results The incidence of PIM was 64.0%(238/372), with top three being clopidogrel 27.2%(101/372), eszolam 26.9%(65/372) and rabeprazole 14.8%(55/372). Compared with the non-PIM group, the PIM group were more advanced in age and number of prescribed medicines, had higher frailty score and CCI, and greater decline in the 6-m walking speed , but lower ADL and IADL. The difference was statistically significant (P<0.05). Spearman correlation analysis showed that PIM positively correlated with age (r=0.152, P=0.003), drugs number (r=0.493, P<0.001), CCI (r＝0.126, P＝0.015), decline in 6-m walking speed (r＝0.110, P=0.034) and frailty scale (r＝0.141, P=0.006) but negatively correlated with ADL (r＝-0.131, P=0.011) and IADL (r＝-0.128, P=0.014). Multivariate logistic regression suggested that the drugs number was a risk factor for PIM (OR=1.604,95%CI 1.427-1.804;P<0.001). Conclusion The number of drugs administered is a risk factorfor PIM in the elderly inpatients, and accordingly, clinicians should pay more attention to PIM by strengthening rationality in medication and minimize the number of prescribed drugs.

Abstract:Objective To investigate the employment of sarcopenia in the assessment of the surgical risk and prognosis of intertrochanteric fracture in the elderly patients. Methods A total of 96 elderly patients were included in this study, who met the inclusion criteria and attended for intertrochanteric fractures from January 2013 to April 2016. The cross-sectional skeletal muscle area (cm²) was measured at the pedicle of the 12 thoracic vertebra on the chest CT scan. The skeletal muscle index (SMI) was calculated by muscle cross-sectional area/square of height (cm²/m²). Sarcopenia was defined by SMI cut-off values at T12 level:42.6 cm²/m² for men and 30.6 cm²/m² for women. Linear regression analysis was used to explore the relationship between SMI and the length of hospital stay and volume of blood transfusion, and t-test to analyze the difference in the length of hospital stay, volume of blood transfusion, peri-operative mortality and postoperative mortality at 1 year. Results Of 96 patients, 45 were diagnosed as sarcopenia, and SMI had statistically significant effect on the blood transfusion volume (P<0.05), but not on the length of hospital stay (P<0.05). There was no statistically significant difference between patients with and without sarcopenia in the length of hospital stay and perioperative mortality (P>0.05), but there was statistically significant difference in the volume of blood transfusion and postoperative mortality at 1 year (P<0.05). The intertrochanteric fracture patients with sarcopenia needed more blood transfusion with a higher postoperative mortality at 1 year; however, there was no significant increase in the length of hospital stay and perioperative mortality. Conclusion The diagnosis of sarcopenia based on SMI may be of some significance in assessing the surgical risks and prognosis of intertrochanteric fracture in the elderly patients.

Abstract:Objective To investigate the factors affecting recanalization of coronary chronic total occlusion (CTO) using ante-rograde technique in the elderly. Methods A total of 301 CTO patients were recruited, who had undergone anterograde percutaneous coronary intervention (PCI) in the General Hospital of Shenyang Military Command from January 2013 to December 2014. According to whether the operation was successful, the patients were divided into PCI success group(n=250) and PCI failure group(n=51). Data were retrieved and compared of their basic information, clinical characteristics and adverse events. SPSS statistics 21.0 was used for statistical analysis. Depending on data type, independent samples t-test or Chi-square test was employed for comparison between groups. Binary logistics regression was performed to analyze the factors associated with success rate of CTO PCI. Results The overall success rate was 83.1%(250/301). There were significant differences between two groups in body mass, body mass index, systolic blood pressure (SBP), diabetes, smoking, New York Heart Association (NYHA) class, tortuosity in the occluded segment, bridging collateral vessels, occlusive time grading, and CTO target vessel (P<0.05). There were no significant differences between two groups in mortality [0.8%(2/250) vs 1.9%(1/51)], heart failure [4.4%(11/250) vs 3.9%(2/51)], postoperative bleeding [3.2%(8/250) vs 3.9%(2/51)], stroke [0%(0/250)vs 0%(0/51)] and perioperative myocardial infarction [4.0%(10/250) vs 3.9%(2/51)] (P>0.05). Binary logistic regression analysis showed female (OR=5.608,5%CI 1.650-19.069, P=0.006), high SBP(OR=1.034,5%CI 1.004-1.064, P=0.024), previous acute myocardial infarction (AMI) (OR=7.213,5%CI 1.070-48.645, P=0.042), left anterior descending (LAD) branch target lesion (OR=2.943,5%CI 1.085-7.984, P=0.034), using the Fielder XT guidewire first (OR=2.570,5%CI 1.049-6.295, P=0.039) were factors that increased procedural success rate; however, diabetes (OR=0.219,5%CI 0.086-0.562, P=0.002), a history of renal insufficiency (OR=0.336, 95%CI 0.117-0.967, P=0.043), higher NYHA class (OR=0.238,5%CI 0.110-0.515, P=0.000), tortuosity of the target vessel (OR=0.130,5%CI 0.017-0.969, P=0.047) and bridging collateral vessels (OR=0.171, 95%CI 0.046-0.634, P=0.008) were factors decreasing procedural success rate. Conclusion The success rate of coronary CTO with anterograde technique increases in the elderly female with an AMI history, LAD target lesion, higher SBP, and using Fielder XT guidewire first, providing valuable clinical reference.

Abstract:Objective To investigate the effect of laparoscopic common bile duct exploration(LCBDE) in the elderly patients with choledocholithiasis using the concept of enhanced recovery after surgery (ERAS). Methods A total of 120 elderly patients were included in the study, who were treated for choledocholithiasis in the Department of General Surgery of the Third Affiliated Hospital of Inner Mongolia Medical University from February 2014 to March 2018. They were randomly divided into ERAS group and control group with 60 in each, with the former being treated with ERAS regimen and the latter with routine procedure. The two groups were compared in the postoperative efficacy, complications and analgesia. SPSS statistics 18.0 was used to process the data. Student′s t test, Chi-square test or rank sum test was performed. Results Compared with the control group, the patients in the ERAS group got out of bed earlier [(9.62±2.35) vs (22.51±3.32) h], passed gas earlier [(22.13±5.12) vs (37.51±6.43) h], started eating earlier [(18.75±3.28) vs (34.69±4.47) h], had shorter hospital stay [(9.73±1.48) vs (14.73±2.92) d] and less hospitalization cost [(1.68±0.23)×10⁴ vs (2.47±0.32)×10⁴ RMB￥], and had lower rates of pulmonary infection [5.00%(3/60) vs 13.33%(8/60)], of urinary tract infection [3.33%(2/60) vs 11.67%(7/60)] and of abdominal distention [8.33%(5/60) vs 20.00%(12/60)]. The differences were all statistically significant (P<0.05). The proportion of the patients with satisfactory postoperative analgesia in the ERAS group was 81.67%(49/60), which was significantly higher than that in the control group [48.33%(29/60), P<0.05]. Conclusion LCBDE in elderly patients with ERAS is safe and effective, and is worth popularizing.

Abstract:Objective To evaluate the efficacy of multidisciplinary medical intervention in the management of the elderly patients with acute-phase diseases and its effects on the prognosis. Methods Included as the study group were 122 elderly patients with acute-phase diseases and concomitant geriatric syndromes who received multidisciplinary medical intervention from September 2017 to March 2018, and as control group were 140 elderly patients with acute-phase diseases and concomitant geriatric syndromes treated from October 2016 to April 2017. The 2 groups were compared in the aspects of medications, patients′ satisfaction, hospitalization expenditure, Bathel activies of daily living (ADL) score on discharge, days of hospitalization, all-cause mortality and other outcome measures. SPSS statistics 22.0 was used for statistical analysis, and t test or Chi-square test for comparison between groups. Results Compared with control group, the applied drug species [(8.28±0.18) vs (9.33±0.22), P<0.05]and hospitalization length [(10.42±0.51) vs (11.21±0.73)d, P<0.05] decreased, patients′ satisfaction [(97.56±4.19) vs (91.22±3.71) score, P<0.05] increased, hospitalization expenditure [(7187.55±17.24) vs (7469.34±22.18) RMB￥, P<0.05] decreased, the Barthel ADL score [(83.36±4.29) vs (63.77±5.36), P<0.05] increased and all-cause mortality (1.64% vs 4.63%, P<0.05) decreased. Conclusion Multidisciplinary medical intervention in the elderly contributes to greater patient′s independence, shorter hospitalization and lower expenditure, the decreased mortality, and greater satisfaction of patients and their families.

Abstract:Objective To investigate the clinical efficacy of ziprasidone mesylate in the treatment of acute exacerbation of schizophrenia. Methods Enrolled in this clinical study were 72 elderly patients with schizophrenia treated in the Department of Psychiatry of Sichuan Provincial Guangyuan Mental Health Center from January 2016 to December 2017, who were randomly divided into ziprasidone mesylate group and haloperidol group with 36 patients in each group. In the former, ziprasidone mesylate 5-10 mg once, no more than 20 mg every day was administered intramuscularly. In the latter, haloperidol 5 mg once, no more than 10 mg every day was administered intramuscularly. The two groups were compared in the positive and negative symptoms scale (PANSS) and clinical global impression-severity of illness (CGI-SI) before and up to 72 h after treatment, and positive and negative symptoms scale-excited component (PANSS-EC) before treatment (T₀) and at 2 h (T₁), 8 h (T₂), 24 h (T₃), 48 h (T₄), and 72 h (T₅) after treatment. SAS statistics 9.0 was used for statistical analysis. Depending on data type, independent sample t test or Chi-square test was used for intergroup comparison, and paired t test for comparison before and after treatment. Results There was no significant difference in PANSS and CGI-SI scores between the two groups before treatment and up to 72 h after treatment (P>0.05). PANSS and CGI-SI scores for two groups at 72 h after treatment were significantly lower than those before treatment (P<0.05). There was no significant difference in PANSS-EC scores between two groups at each time point before and after treatment (P<0.05). PANSS-EC scores at T1-5 were significantly lower than those at T₀ (P<0.05), and PANSS-EC scores at T2-5 were significantly lower than those at T₁, the differences being statistically significant (P<0.05). Compared with haloperidol group, the ziprasidone mesylate group had significantly lowerincidence of side effects, including myotonia [2.78%(1/36) vs 16.67%(6/36)], tremor [2.78%(1/36) vs 19.44%(7/36)], rogue [5.56%(2/36) vs 22.22%(8/36)], and head and neck movement [2.78%(1/36) vs 19.44%(7/36)], the differences being statistically significant (P<0.05). Conclusion Ziprasidone mesylate has similar efficacy in the treatment of acute agitation symptoms of schizophrenia compared with conventional haloperidol treatment and has low incidences of side effects.

Abstract:Objective To analyze the changes of cerebral oxygen saturation and cognitive function after anesthesia in the elderly patients with humeral shaft fracture treated with dexmetomidine and fentanyl. Methods A retrospective analysis was made of 272 elderly patients with humeral shaft fractures in the Department of Anesthesiology, the Second People′s Hospital of Longgang District in Shenzhen from March 2013 to December 2016. According to the anesthesia type, they were divided into study group (dexmetomidine-fentanyl) and control group (sevoflurane-remifentanil) with 136 patients each. The 2 groups were compared in cerebral oxygen saturation at admission into operating room (T1), anesthesia preparation (T2), 30 min into the operation (T3) and the end of operation (T4) and in scores of Wechsler Adult Intelligence scale (WAIS-RC) at preoperative day 1 and postoperative day 1 and day 3. The data were analyzed with SPSS 22.0. Student′s t test, ANOVA or χ² test was employed for intergroup comparison. Results The study group were significantly better than the control group in terms of blink time, awakening, extubation time, time in resuscitation room, heart rate, respiratory frequency, mean arterial pressure and pain. The difference was statistically significant (P<0.05). The control group had no significant difference in cerebral oxygen saturation at different time points (F=2.04, P=0.11), but the study group had significant difference in the terms (F=41.57, P=0.00). Compared with the control group, the study group had lower cerebral oxygen saturation at T2 [(64.82±9.87)% vs (72.56±9.80)%], T3 [(62.03±11.05)% vs (70.23±11.25)%], and T4 [(69.20±9.47)% vs (72.47±9.88)%], with statistically significant difference (P<0.05). The study group scored lower than the control group in common sense, understanding, arithmetics, similarity, digit span, filling in the chart, block diagram, picture arrangement and graphic patchwork at postoperative day 1 and day 3, the difference being statically significant (P<0.05). Conclusion Dexmetomidine-fentanyl, with short-term reduction of cognitive function and cerebral oxygen saturation, can be a safe option for the treatment of humeral shaft fracture in the elderly patients, and it is necessary to observe and stabilize cerebral oxygen saturation in the procedure.

Abstract:Postmenopausal women are at increased risk of cardiovascular diseases due to decreased estrogen levels. The prevalence of chronic kidney disease (CKD) increases with age, and the disease is common among postmenopausal women. Postmenopausal women with CKD are vulnerable for heart failure. In this review, based on the clinical trials and basic research, we focused on CKD in relation to the mechanism of heart failure among postmenopausal patients, aiming at a better understanding of the condition, and future orientation for further studies.

Abstract:Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. The incidence of new-onset AF is higher among the patients after pacemaker implantation than among the average population. Age, hypertension, left atrial enlargement, sick sinus syndrome (SSS), pacing mode, atrial and ventricular pacing ratio, and pacemaker implantation mode are all risk factors for new-onset AF after pacemaker implantation. This article reviews the mechanism of the above factors, with a view to providing theoretical reference for clinical prevention of AF.

Abstract:Aging plays a central role in the development of atherosclerosis and the related diseases, which pose a great threat to the people′s health. Aging is associated with the onset of atherosclerosis by the following mechanisms:(1) endothelial dysfunction as a consequence of aging impedes renewal of damaged endothelial cells; (2) disordered lipid metabolism as a consequence of aging induces more production of oxidized low-density lipoprotein; (3) aging can also stimulate the migration of vascular smooth muscle cells, change their phenotype, and compromise their proliferation ability, thus increasing vulnerability of the plaques because of the thin fibrous cap. At present, anti-aging machineries can be beneficial against the above pathophysiological processes, such as telomere repair, correction of the mitochondrial function, repair of the damaged DNA or enhancement of the anti-aging protein expression, helping to prevent the development and onset of atherosclerosis.

Abstract:Lumbar spinal stenosis is common among the elderly, and its surgical treatment includes open surgery and minimally invasive surgery. Percutaneous endoscopic lumbar discectomy is the first-choice minimally invasive surgery for this condition because of its small wound, mild pain and rapid recovery. The procedure is performed via either percutaneous interlaminal or percutaneous transforaminal approach with their own indications, advantages and disadvantages. Clinically, choosing the optimal approach based on pathological types of lumbar spinal stenosis determines the success of the operation.

Abstract:In recent years, more and more attention has been drawn to the research on the association of micro ribonucleic acid(miRNA) with diseases using gene-chip technology. miRNA-21, a member of the miRNA family, has many biological functions and has been proven to be associated with the occurrence and development of a good number of diseases. Studies have suggested that miRNA-21 can be used as a biomarker for the progression of lung cancer, providing a possibility for early intervention in the progression of lung cancer. This paper reviewed the recent progress made in the research on miRNA-21 and lung cancer.

Abstract:Hydroxymethylglutaryl-coenzyme A reductase inhibitors (commonly known as statins) are among the most frequently used drug classes. Although primary and secondary prevention of cardiovascular diseases with statins can significantly reduce mortality and morbidity, adverse reactions occur in some patients taking statins, leading to concern about the negative consequences associated with their long-term use. It is therefore necessary to investigate the adverse reactions of statins with a view of seeking for effective management strategies, which will be conducive to the improved safety and increased patient compliance.