Abstract:Objective To compare the effect of different diagnostic criteria for acute kidney injury (AKI) from Kidney Disease Improving Global Outcomes (KDIGO) on short-term prognosis in the very elderly inpatients. Methods Clinical data of 652 AKI patients (≥75-year-old, median age 87, ranging from 84 to 91) admitted in our department between January 2007 and December 2015 were collected and retrospectively analyzed in this study. According to the diagnostic window, they were divided into 48-hour diagnostic window group (n=334) and 7-day diagnostic window group (n=318). These patients were also divided into survival (n=433) and death groups (n=219) by their outcomes within 90 d after AKI. Their general conditions and clinical characteristics were compared between the 2 groups. SPSS statistics 19.0 was used to perform the statistical analysis. Student’[KG-*3]s t test, Mann-whitney U test or Chi-square test was used for comparison of different data types between groups. Prognostic survival factors were identified using Cox regression analysis. Kaplan-Meier survival analysis was employed for accumulative survival rate. Results For these 652 enrolled patients, 308 (47.2%) were stratified into stage 1 AKI, 164(25.2%) into stage 2 AKI, and 180(27.6%) into stage 3 AKI according to KDIGO clinical practice guideline. While, 334 cases (51.2%) were diagnosed as AKI by 48-hour diagnostic window, and 318 cases (48.8%) by 7-day diagnostic window. The 90-day mortality was 42.5% in the patients of 48-hour diagnostic window group and 24.2% in those of 7-day diagnostic window group. Kaplan-Meier survival curves showed the 90-day mortality was better in the 7-day diagnostic window group than in the 48-hour diagnostic window group (P<0.001). With the increase of time for AKI occurrence, the 90-day mortality was significantly decreased (P<0.001). Multivariate analysis by the Cox model revealed that low body mass index (HR=0.928, 95%CI:0.886-0.973; P=0.002), low mean arterial pressure (HR=0.969,5%CI:0.959-0.979; P<0.001), low serum prealbumin level (HR=0.948,5%CI:0.920-0.977; P<0.001), low albumin level (HR=0.962, 95%CI:0.930-0.995; P=0.025), infection (HR=1.374,5%CI:1.027-1.840; P=0.033), oliguria (HR=2.069, 95%CI:1.341-3.192; P=0.001), high blood urea nitrogen level (HR=1.027,5%CI:1.015-1.038; P<0.001) and magnesium level (HR=2.485,5%CI:1.351-4.570; P=0.003), more severe AKI stages (stage 2:HR=4.035, 95%CI:2.381-6.837, P<0.001; stage 3:HR=7.184; 95%CI:4.301-11.997, P<0.001), and ≤48-hour window for AKI diagnosis (HR=1.818,5%CI:1.256-2.631; P=0.002) were independent risk factors for 90-day mortality in hospitalized elderly AKI patients. Conclusion The 90-day mortality is higher in 48-hour window AKI than in 7-day window AKI in the very old patients. ≤48-hour window for AKI diagnosis is an independent factor for 90-day mortality for the elderly.

Abstract:Objective To investigate the relationship between body mass index (BMI) and hypertension among the elderly based on physical examination results in Fuzhou City. Methods Physical examination data of the inviduals over 60 years old who took the examination in our hospital from January to December 2016 were collected and retrospectively analyzed for blood pressure level and the incidences of hypertension, overweight or obesity. Based on BMI stratification, blood pressure levels and incidence of hypertension were evaluated in different BMI-level groups. SPSS statistics 11.7 was adopted for data processing. Unpaired t test or Chi-square test was employed for different data types. Multivariate logistic regression analysis was used to analyze the influencing factors of hypertension, and receiver operating characteristic (ROC) curve was adopted to analyze the correlation of BMI and risk of hypertension. Results In the 1659 enrolled subjects with complete data of physical examination, the incidence of hypertension was 34.2%(568/1659), with that of males accounting for 36.2%(363/1003) and females for 31.2 %(205/656). In the cohort, 48.1%(798/1659) of them were overweight or obese, and the ratio was 48.4%(485/1003) in the males and 47.7%(313/656) in the females. With the increase of BMI, the levels of systolic (SBP) and diastolic blood pressures (DBP) and incidence of hypertension were gradually elevated (for BMI<18.5,8.5-<23.9,4.0-27.9, ≥28.0 kg/m², the incidence of hypertension was 17.0%, 27.4%, 40.4% and 55.5%, respectively). Multivariate logistic regression analysis found that overweight or obesity, high fasting blood glucose, high uric acid and hypertriglyceridemia were risk factors for hypertension. ROC curves analysis related to hypertension risk showed that the area under ROC curve (AUC) of male BMI was 0.601 (cut-off point=25.55 kg/m²) and that of female BMI was 0.609 (cut-off point=25.85 kg/m²) in the risk of systolic hypertension; for the risk of diastolic hypertension, the AUC was 0.665 for the male BMI (cut-off point=25.55 kg/m²) and 0.609 for female BMI (cut-off point=26.35 kg/m²). Conclusion The SBP and DBP levels and hypertension incidence are gradually increased with the increase of BMI level. Overweight or obesity, high fasting blood glucose, high uric acid and hypertriglyceridemia are risk factors for hypertension. BMI shows predictive value of hypertension risk.

Abstract:Objective To investigate the relationship of red cell distribution width (RDW) with 1-year outcomes in the elderly with acute decompensated heart failure with preserved ejection fraction (HFpEF). Methods A total of 125 consecutive patients (≥65 years old) admitted in the cardiovascular ward of health care center of our hosipatal from June 2013 to June 2015 were enrolled in this study. Their baseline data, comorbidities, drug uses, laboratory results and echocardiographic parameters, and RDW at admission were collected and recorded. After 1 year of follow-up, the patients were divided into events group (n=38) and control group (n=87) according to whether there was cardiac-related adverse events (composite endpoint of heart failure death and heart failure re-admission). Based on the interquartile range (IQR) of RDW, the patients were also assigned into 4 groups, the clinical data and endpoint events were compared among the 4 groups. SPSS statistics 16.0 was used to perform the statistical analysis. Logistic regression analysis was used to determine the independent risk factors of acute decompensated HFpEF. Receiver operating characteristic (ROC) curve was plotted to determine cut-off value of RDW to predict adverse outcomes of heart failure. Results Compared with the control group, the RDW value was significantly higher in the events group [13.30% (12.45%, 14.43%) vs 12.70% (11.50%, 13.60%);P=0.022]. Logistic regression analysis showed N-terminal pro-B-type natriuretic peptide (NT-proBNP) (OR=1.00,5%CI:1.00-1.00; P=0.010), RDW (OR=1.19,5%CI:1.05-1.35; P=0.005) and use of loop diuretics therapy (OR=6.64,5%CI:2.10-20.94; P=0.001) were independently correlated with composite endpoint of heart failure death and heart failure re-admission. With the increase of RDW, the incidences of endpoint events were elevated (P<0.05). The area under ROC curve was 0.629 in predicting composite endpoints (95%CI:0.521-0.737; P=0.022). Conclusion RDW is independently correlated with 1-year composite outcome of heart failure death and heart failure re-admission in the elderly patients with acute decompensated HFpEF.

Abstract:Objective To investigate the incidence of cognitive impairment in the elderly patients with chronic heart failure (CHF), and to analyze the clinical characteristics of those suffering from CHF accompanied with cognitive impairment. Methods A retrospective study was carried out on 180 elderly CHF patients who were hospitalized in our health care center from January 1,5 to March 1,6. According to Montreal cognitive assessment, they were divided into 3 groups:normal group (n=44), mild cognitive impairment group (MCI, n=75) and severe cognitive impairment group (SMI, n=61). The clinical characteristics were compared among the 3 groups. SPSS statistics 17.0 was used for data processing. The comparison between the groups was performed by F test or by Chi-square test. Multivariate logistic regression analysis was carried out for single factor analysis with statistical significance, and then independent risk factors were screened out. Results The incidence rate of cognitive impairment was 75.6% (136/180) in the subjected elderly CHF patients. Compared with the normal group, the ratio of those at New York Heart Association (NYHA) Ⅲ was significantly larger in the MCI and SMI groups (47.54% vs 21.33% vs 13.64%, P<0.05). The SMI group had obviously more female patients (55.74% vs 38.64%), higher percentage of patients with education level lower than high school (36.07% vs 13.64%), and higher blood glucose level [(5.88±2.38) vs (5.10±0.74) mmol/L, all P<0.05], but notably lower hemoglobin level[(131.50±15.89) vs (122.80±15.61)g/L, P<0.05]when compared with the normal group. The ratios of NYHA Ⅲ (47.54% vs 21.33%), female patients (55.74% vs 32.00%) and lower educational level than high school (36.07% vs 17.33%) were significantly larger in the SMI group than in the MCI group (P<0.05). Left ventricular ejection fraction (LVEF) in the SMI group was significantly lower than those of the normal group and MCI group [(61.72±7.81)% vs (64.89±6.58)% vs (64.07±5.88)%, P<0.05]. Multivariate logistic regression analysis showed that NYHA Ⅲ level (95%CI:1.21-13.61), and low hemoglobin level (95%CI:0.94-0.99) were independent risk factors for MCI (P<0.05), while NYHA Ⅲ level (95%CI:1.73-21.98), low hemoglobin level (95%CI:0.93-0.99), female (95%CI:0.15-0.96), lower educational level than high school (95%CI:1.36-13.76) and low LVEF (95%CI:1.00-1.15) were independent risk factors for SMI (P<0.05). Conclusion The elderly CHF patients commonly suffer declined cognitive function. Those patients with cognitive impairment are characterized by female, low educational level, poor heart function classification, high blood glucose, low hemoglobin level and LVEF.

Abstract:Objective To explore efficacy and therapeutic effect of different anticoagulant regimens in the elderly patients with pulmonary embolism. Methods A total of 70 consecutive elderly patients with pulmonary embolism admitted in our hospital from January 2010 to July 2015 were enrolled in the study. All of them received anticoagulation therapy with warfarin and low molecular weight heparin. According to whether obtaining the target value of international normalized ratio (INR), they were divided into high-anticoagulation group (n=23, INR>2.5) and low-anticoagulation group (n=47, INR ≤2.5). The warfarin dose adjustment, anticoagulation efficacy and therapeutic effects were compared between the 2 groups. The data were analyzed with SPSS statistics 19.0. Continuous data were expressed as mean±standard deviation after checking for normality of distribution, and Student’s t test was used for group comparison. The data not normally distributed were expressed with median and interquartile range, and intergroup comparison was conducted by Mann-Whitney U test. Enumeration data were expressed as percentage, and intergroup comparison was carried out with Chi-square test or Fisher exact test. Results Dyspnea (68.6%) and pulmonary hypertension (60.0%) were the main manifestations in the 70 patients. Compared with the low-anticoagulation group, the high-anticoagulation group had significantly increased target value of INR level [(2.94±0.33) vs (1.95±0.33), P<0.001], obviously decreased dosage of warfarin after adjustment [(1.61±0.51) vs (2.33±0.54)mg, P<0.001], and more common discontinuation and dose adjustment of warfarin (52.2% vs 12.8%, P<0.001). Meanwhile, there was no significant difference in clinical efficacy and incidences of bleeding events and gastrointestinal symptoms between the 2 groups (P>0.05). Conclusion For maintenance of anticoagulation therapy in the elderly with pulmonary embolism, low-anticoagulation regimen shows similar clinical efficacy as high dose, and it also can significantly decrease the incidence of discontinuation and dose adjustment of warfarin during the process.

Abstract:Objective To investigate the status of antithrombotic therapy in the extremely elderly patients with coronary heart disease (CHD) and atrial fibrillation (AF) from a military retired cadres’ sanatorium. Methods A total of 190 extremely elderly patients (≥80 years old) who lived in a military retired cadres’ sanatorium from July 2015 to July 2016 were recruited in this study. They were 167 males and 23 females, and at an age of 81-98 (87.8±3.6) years. Their clinical data, including different types of CHD and antiplatelet and anticoagulant therapy were collected and analyzed. SPSS statistics 18.0 was used to perform the statistical analysis. Chi-square test was employed for comparison between groups. Results Among the 190 elderly individuals, those with CHD accounted for 41.05% (78/190), AF for 14.74%(28/190), and AF accompanied with CHD for 4.21%(8/190). In the patients with CHD, 91.02%(71/78) received antithrombotic therapy, including 69.23%(54/78) with dual antiplatelet therapy (DAPT) and the other 17.95%(14/78) with aspirin or clopidogrel treatment; 1.28%(1/78) patients were treated with warfarin, 2.56%(2/78) patients used other antiplatelet drugs. 8.97%(7/78) patients did not receive any antithrombotic drugs, and no one was treated with novel potent antiplatelet agent ticagrelor. In the patients with AF, 28.57%(8/28) were administrated with anticoagulant agents, including 21.43%(6/28) with warfarin, and 7.14%(8/28) with new oral anticoagulation agent. Among them, 60.71%(17/28) were treated with antiplatelet agent, accounting for 21.43%(6/28) with DAPT, 7.14%(2/28) with ticagrelor and 32.14% (9/28) with aspirin alone, and 10.71%(3/28) were treated with neither antiplatelet nor anticoagulation agents. In the 8 patients with both AF and CHD, 2 cases was treated with warfarin or heparin combined with DAPT, 4 cases with DAPT, and 2 cases with aspirin alone. Amongthe patients with different types of CHD, aspirin alone was used in 25.00% (9/36) patients of stable coronary artery disease (SCAD), significantly higher than those with acute coronary syndrome (ACS), and those within 1 year after percutaneous coronary intervention (PCI, P=0.005). DAPT protocol was quite common in those (92.86%, 26/28) within 1 year after PCI when compared with those with SCAD and ACS (P=0.000). Conclusion Although the medical condition in military retired cadres’ sanatorium is very good, the antithrombotic therapy is not ideal in the extremely elderly patients with CHD and AF. The experience for novel antiplatelet and anticoagulation agents is insufficient.

Abstract:Objective To investigate the alteration characteristics and the influencing factors of the circadian rhythm of blood pre-ssure in the senile patients with well-controlled hypertension. Methods A total of 215 consecutive senile patients with hypertension well controlled who were hospitalized in our Department of Geriatrics from January 2016 to March 2017 were enrolled in this study. The 24-hour ambulatory blood pressure monitoring was performed on all patients, and according to their decline rate of nocturnal blood pre-ssure, they were divided into 3 groups:dipper blood pressure group (n=48), non-dipper blood pressure group (n=91) and anti-dipper blood pressure group (n=73). The baseline information, results of ambulatory blood pressure, results of biochemical blood examination, and target organ damage were compared among the 3 groups. SPSS statistics 17.0 was used to perform the statistical analysis. Student’s t test or Chi-square test was employed to analyze different data types. Multiple logistic regression analysis was used to screen the independent risk factors for dipper blood pressure. Results Compared with the dipper blood pressure group, the non-dipper and anti-dipper blood pressure groups had significantly older age [(78.96±6.86) vs (82.59±5.85) vs (75.75±7.43)years], higher body mass index [(25.23±3.57) vs (25.01±3.76) vs (22.43±2.62)kg/m²], higher ratio of patients with cerebrovascular disease history (17.6% vs 35.6% vs 14.6%), and higher nocturnal systolic [(123.04±15.67) vs (137.19±19.11) vs(111.31±12.30)mmHg, 1 mmHg=0.133 kPa] and diastolic blood pressure [(64.88±8.02) vs (69.18±9.76) vs (61.38±7.48)mmHg, all P<0.05]. Creatinine clearance rate (CCr) was obviously lower in the anti-dipper group than the dipper blood pressure group [(48.95±13.86) vs (57.59±12.89)ml/min, P<0.05]. There were more patients having carotid atherosclerotic plagues in the non-dipper and anti-dipper groups than the dipper blood pressure group (90.1% vs 97.3% vs 72.9%, P<0.05). Multiple logisticregression analysis showed that age (95%CI:1.35-5.95, P=0.006), BMI (95%CI:1.43-5.91, P=0.003) and carotid plaque (95%CI:1.25-5.12, P=0.010) were independent risk factors for dipper blood pressure. Conclusion Abnormal circadian rhythm of blood pressure are still seen in the elderly patients with well-controlled hypertension.

Abstract:Objective To evaluate the effect of horticultural therapy (HT) on cognitive function and quality of life in elderly patients with mild-to-moderate Alzheimer disease (AD). Methods A total of 130 in- and out-patients with mild-to-moderate AD in our hospital from December 2014 to December 2016 were recruited and randomly divided into HT group and control group, with 65 cases in each group. The patients of control group was given conventional therapy, oral administration of donepezil combined with nicergoline, while those in the HT group received HT on the basis of conventional treatment. Mini-mental state examination (MMSE) and generic quality of life inventory-74(GQOL-74) were used to evaluate the patients before treatment and in 3 and 6 months after the treatment. SPSS statistics 19.0 was used for data processing. According to the data types, the independent sample Student’[KG-*3]s t test or the Chi-square test were used for the intergroup comparison, and repeated measurement of variance analysis was used for comparison between groups. Results The total score of MMSE in the control group was increased significantly after 6 months compared with the score before treatment (P<0.05). In the HT group, the scores of language function, remembrance, recall and the total MMSE score were significantly increased after 3 and 6 months’ treatment compared with those before treatment (P<0.05). Compared with the scores of control group in 3 and 6 months after treatment, the scores of language function [(6.89±1.46) vs (5.21±2.36), (8.82±1.22) vs (6.80±1.49)], remembrance [(3.47±0.48) vs (2.04±0.65), (4.02±1.06) vs (2.92±0.86)], recall[(2.73±0.59) vs (1.03±0.78), (3.24±0.72) vs (2.24±0.92)]and the total score of MMSE [(20.82±1.35) vs (16.78±1.46), (24.02±2.20) vs (18.92±2.15)] was significantly increased in the HT group (P<0.05). Social function, psychological function, physical function and total score of GQOL-74 were significantly improved in the HT group after 3 and 6 months than before treatment (P<0.05). Compared with the control group, the social function score in HT group was improved significantly after 3 months treatment [(67.02±7.51) vs (63.28±9.52), P<0.05], while after 6 months treatment, social function [(69.33±6.94) vs (64.19±11.25)], psychological function [(57.12±13.07) vs (52.12±9.08)], physical function [(72.38±8.32) vs (66.85±10.08)] and the total score of GQOL-74 [(68.46±9.34) vs (63.95±10.11)] were significantly increased (P<0.05). Conclusion HT can effectively improve the cognitive function and quality of life in the patients with mild-to-moderate AD, and it has an importance to be popularized clinically.

Abstract:Objective To investigate the changes of proadrenomedullin (pro-ADM) and procalcitonin (PCT) in the elderly patients with severe community-acquired pneumonia (SCAP), and assess their prognostic value. Methods A total of 162 elderly SCAP patients who were admitted in Emergency Department of our hospital from January 2016 to September 2017 were retrospectively enrolled in this study. According to the 28-day survival, they were divided into survival group (n=114) and death group (n=48). The serum pro-ADM and PCT levels in the patients were measured in 1,3 and 7 d after SCAP diagnosis. SPSS statistics 19.0 was used to perform the statistical analysis. Student’[KG-*3]s t test or Chi-square test was employed for comparison between the 2 groups, and repeated measures analysis of variance for intragroup comparison. Receiver operating characteristic (ROC) curve was adopted to analyze the prognostic value of pro-ADM, PCT and combination for SCAP at various time points. Results The CURB-65 score, pneumonia severity index (PSI), and the score of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) were significantly higher in the death group than the survival group (P<0.05). When compared with the survival group, the serum pro-ADM level was significantly higher in the death group on 1st day [(4.66±1.83) vs (3.04±1.31) nmol/L], 3rd day [(5.47±1.96) vs (2.95±1.34) nmol/L] and 7th day [(6.81±2.17) vs (1.53±0.82) nmol/L, all P<0.05], but such diffe-rences of serum PCT level were only found on the 3rd day [(3.28±1.24) vs (1.05±0.53) ng/ml] and 7th day [(5.62±1.83) vs (0.26±0.12) ng/ml,both P<0.05 ]. The serum pro-ADM and PCT levels on the 7th day were obviously higher than those on the 3rd day in the death group [(6.81±2.17) vs (5.47±1.96) nmol/L, (5.62±1.83) vs (3.28±1.24) ng/ml, P<0.05]. The area under ROC curve of combined diagnosis was 0.942(0.883-0.998) for 28-day prognosis in elderly SCAP patients, significantly higher than that by pro-ADM alone (0.892, 0.830-0.951) or by PCT alone (0.857,0.793-0.924). The sensitivity and specificity were 95.2% and 86.4% respectively, suggesting good predictive value. Conclusion The changes in pro-ADM and PCT levels are associated with the severity of the disease and prognosis in elderly patients with SCAP, and combination of serum pro-ADM and PCT levels on the 3rd day shows good predictive value for 28-day prognosis.

Abstract:Objective To observe the efficacy and safety of enhanced external counter pulsation (EECP) therapy on cardiac function of patients with chronic heart failure (CHF). Methods A total of 240 CHF patients admitted in our department from January 2015 to January 2017 were recruited in this study. The patients were randomly divided into EECP group and control group, with 120 patients in each group. The patients of both groups were routinely treated according to the guidelines, and those from the EECP group were given EECP therapy. Heart rate, 6-min walking test, brain natriuretic peptide (BNP) level, left ventricular ejection fraction (LVEF) and Tei index were measured before and after treatment, and the results and incidences of adverse reactions were compared between the 2 groups. SPSS statistics 16.0 was used to perform the statistical analysis. Student’s t test or Chi-square test was employed for comparison between groups according to data types. Results Heart rate, 6-min walking distance, BNP level, LVEF and Tei index were improved in both groups after treatment (P<0.05). Compared with the control group, the EECP group showed significantly lower heart rate [(76.4±4.5) vs (80.7±5.7) beats/min], BNP level [(1309.0±1497.2) vs (2196.1±2586.6) pg/ml], and Tei index [(0.59±0.10) vs (0.62±0.11)], but prolonged 6-min walking distance [(446.20±31.92) vs (407.69±34.80) m] and increased LVEF [(47.9±2.8)% vs (47.1±3.5)%] after treatment (P<0.05). But no difference was seen in the adverse reactions between 2 groups (5.8% vs 6.7%, P>0.05). Conclusion EECP therapy improves the cardiac function in CHF patients.

Abstract:Objective To investigate the efficacy of continuous renal replacement therapy (CRRT) in elderly patients with sepsis. Methods A prospective study was carried out on 156 elderly sepsis patients admitted in our hospital from January 2014 to June 2017. They were randomly divided into CRRT group and control group, with 78 cases in each group. The control group was treated with conventional therapy, and CRRT group was treated with CRRT on the basis of conventional treatment. Peripheral blood immune indices, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and high sensitivity C-reactive protein (hs-CRP) before treatment and 3 and 7 days after treatment were measured and recorded. The curative effects after 28 days’ treatment and scores of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), multiple organ dysfunction syndrome (MODS) and sequential organ failure assessment (SOFA) were analyzed and compared between the 2 groups. SPSS statistics 19.0 was used to analyze the data. For different data types, Student’[KG-*3]s t test, repeated measures analysis of variances or Chi-square test was employed for the com-parison between two groups. Results In the 2 groups, the peripheral blood proportions of CD3⁺, CD4⁺ and CD14⁺ in the 7th day aftertreatment were significantly higher than those before treatment and in the 3rd day, and the proportions of CD3⁺ [(69.3±8.7)% vs (63.8±8.4)%], CD4⁺ [(36.8±13.3)% vs (31.5±10.6)%] and CD14⁺[(55.7±6.8)% vs (46.8±6.5)%] in the 7th day were obviously higher in the CRRT group than the control group (P<0.05). The serum levels of IL-6, TNF-α, PCT and hs-CRP were remarkably decreased in both groups in 7 days after treatment when compared with the levels before treatment and after 3 days’ treatment (P<0.05). Their levels in the CRRT group were notably lower than those in the control group in 3 and 7 days’ after treatment [IL-6:(40.7±3.8) vs (68.4±5.2) ng/L, (18.5±2.6) vs (37.8±3.5) ng/L; TNF-α:(28.4±10.7) vs (36.5±14.2) μg/L, (20.3±7.8) vs (27.9±11.4) μg/L; PCT:(4.3±1.7) vs (6.2±2.3) μg/L, (1.3±0.8) vs (3.6±1.4) μg/L, hs-CRP:(52.6±15.4) vs (71.3±18.4) mg/L, (22.5±9.3) vs (36.4±12.7) mg/L, all P<0.05]. The scores of APACHE Ⅱ, MODS and SOFA at the 7th day were significantly lower in the 2 groups than those before treatment (P<0.05). The CRRT group had obviously lower APACHE Ⅱ score [(10.8±4.2) vs (14.3±4.8)], MODS score [(4.5±1.9) vs (6.1±2.3)] and SOFA score [(3.6±1.4) vs (5.8±1.7)] in the 7th day when compared with the control group (P<0.05). After 28 days’ treatment, the curative rate was remarkably higher in the CRRT group than in the control group (70.5% vs 48.7%, P=0.006). Conclusion CRRT, in combination with conventional treatment, improves the clinical efficacy, promotes the immune function and reduces the inflammatory responses in elderly patients with sepsis.

Abstract:Objective To detect the expression profiles of 14-3-3η mRNA in different polarized macrophages, analyze the bioinformation, and construct the prokaryotic expression vector of 14-3-3η in order to provide an experimental basis for further study on macrophage polarization. Methods After the mRNA of bone marrow derived macrophages from C57BL/6 mice was extracted, real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression of 14-3-3η after reverse transcription. ProtParam tool, SOPMA and other online statistics were used to analyze the amino acid sequence of 14-3-3η. With mouse macrophage cDNA as template, PCR was employed to amplify the target genes, and the products were inserted into pGEX-4T-3 vector. After verification by double-enzymes digestion and sequencing, the correct recombinant plasmids were transformed into the Escherichia coli strain BL21. Then the bacteria were induced by isopropyl β-D-1-thiogalactopyranoside (IPTG), and the expressed proteins were purified and identified by SDS-PAGE and Western blotting. Graphpad prism 5 was used to perform the statistical analysis. Paired t test was employed for the comparison among different samples. Results The mRNA expression level of 14-3-3η was decreased in M1 macrophages, but it was increased in M2 macrophages. Bioinformatic analyses showed that α-helix (62.60%) was the main component of its secondary structure, and it had poor hydrophobicity (hydrophobic coefficient=-0.607). Enzymes digestion and sequencing indicated that the vector pGEX-4T-3-14-3-3η was successfully constructed. GST-14-3-3η protein was induced and identified by SDS-PAGE and Western blotting. Conclusion Primary bioinformatic analyses, successful expression and purification of fusion protein GST-14-3-3η are achieved in this study, which founds the experimental basis for 14-3-3η function in macrophage polarization.

Abstract:Aging is a normal physiological phenomenon, which is closely related to age-related diseases. In recent years, the mechanisms of aging and the development of anti-aging drugs have become the hotspot in scientific research. However, Establishing a suitable aging animal is complex and costly, so it is of great significance to make a suitable animal model. D-galactose-induced sub-acute aging animal model has been widely used by domestic and foreign scholars because of its advantages of low cost, simple and convenient operations, and stable and reliable results. In this review, we summarized the D-galactose-induced aging animal model and its possible mechanisms.

Abstract:Coronary artery calcification is a specific sign and an independent predictor for coronary atherosclerosis heart disease. Its mechanism is quite complicated, and is closely associated with gene, age, sex, personality, smoking, sleep, hypertension, hyperglycemia, hyperlipidemia, renal diseases, and so on. Early prediction and slowing the progression of coronary artery calcification are long-term, arduous task for diagnosis and treatment of coronary atherosclerosis heart disease in the future.

Abstract:Hyponatraemia is one of the most common electrolyte disturbances in clinical practice, serum sodium concentration <135 mmol/L is diagnosed with hyponatraemia, and the majority of chronic hyponatraemia are prone to be ignored or misdiagnosed by clinicians due to its mild symptoms or being covered by primary diseases. Accurate diagnosis and timely treatment can reduce mortality, shorten the length of hospital stay, and improve the quality of life. Its treatment mainly focuses on allevaiating the etiological factors. For the patients with syndrome of inappropriate antidiuretic hormone secretion (SIADH), limit of water, hypertonic saline, V2 receptor antagonist and other comprehensive treatment should be considered. In this article, we reviewed the progress of diagnosis and treatment of hyponatraemia.

Abstract:Nocturnal asthma is a common and important clinical phenotype of asthma. Its major manifestations are poor control of asthma, reduced sleep quality and daytime sleepiness, which severely affect life quality and increase asthma mortality. Therefore, it is of important significance to explore the pathogenesis of nocturnal asthma and to adjust time and dosage of anti-asthmatic drugs based on its onset pattern in nighttime.