Abstract:The risk of hypertension and frailty increases with aging. The association between hypertension and frailty in older adults remains unclear, so management of hypertension with frailty in the elderly, especially in those very old individuals, still has a long way to go. In this article, the author reviewed the update progress and limitations of clinical research about association between hypertension and frailty, and also proposed the future perspective in this field.

Abstract:Objective To determine the effect of frailty on the prognosis in the elderly hypertensive patients. Methods A total of 314 elderly hypertension patients who visited the Outpatient Department or took physical examination in our hospital from March 2015 to October 2016 were enrolled in this study. Their general demographic characteristics and medical history were collected by questionnaires. The comorbid conditions were evaluated with Charlson comorbidity index (CCI). Mini nutritional assessment-short form (MNA-SF) was used for nutritional assessment, and Barthel index for daily life ability. According to the state of weakness, they were divided into normal (n=65), pre-frialty (n=208) and frialty groups (n=41). Based on the occurrence of falls during the 18 months′ follow-up, the patients were also assigned into fall group (n=41) and non-fall group (n=273), and into hospitalization group (n=133) and non-hospitalization group (n=181) according to all-cause hospitalization. SPSS statistics 19.0 was used for data processing. Student′s t test or Chi-square test was employed for intergroup comparison with different data types. The factors with signi-ficant difference by univariate analysis were further analyzed by multivariate logistic regression analysis to identify independent risk factors. Results Fried standard identified 41 frail patients out of the 314 subjects, with a detection rate of 13.1%, and the rate was increased with age. After adjustment, the regression model showed that pace reduction was associated with increased risk for fall (OR=2.88, 95%CI 1.26-6.56, P<0.05), but not with all-cause hospitalization (OR=1.13,5%CI 0.57-2.22, P=0.726). Conclusion The prevalence of frailty in elderly hypertensive patients is increased with age. Pace reduction is an independent risk factor for incidence of fall in them.

Abstract:Objective To evaluate and compare the abilities of different cut-off points of frailty index (FI) in the prediction of adverse outcomes for patients who have been discharged for 6 months. Methods A total of 312 elderly inpatients (≥70 years old) hospitalized in our hospital from July 2015 to December 2016 were enrolled, and their frailty was evaluated to calculate FI. Based on 3 different cut-off points of FI (FI-1:0.20-0.45; FI-2:0.20-0.35; FI-3:0.12-0.25), the patients were assigned into non-frailty, pre-frailty and frailty groups. All of them were followed up for at least 6 months, and were divided into adverse outcome group and no adverse outcome group according to the adverse outcomes (falls, fractures, readmission and death). SPSS statistics 18.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for comparison between groups based on different data types. Cox regression model and area under receiver operating characteristic (ROC) curves (AUC) were used to evaluate the predictive abilities of different cut-off points of FI for adverse outcomes. Results The range of FI values was 0.06 to 0.61 in the 312 patients, and the incidence of frailty with different cut-off points of FI (FI-1:FI≥0.45; FI-2:FI＞0.35; FI-3:FI≥0.25) was 13.5%, 25.3% and 54.2%, respectively. For those having been discharged for over 6 months, 146(46.8%) of them experienced adverse outcomes, including falls in 31(9.9%), fractures in 12(3.8%), readmission in 123(39.4%), and death in 16 patients (5.1%). The patients with adverse outcomes had older age, larger number of comorbidities, and higher incidences of coronary heart disease, chronic kidney disease, atrial fibrillation, and chronic obstructive pulmonary disease when compared with those without adverse outcomes (P<0.01).After adjustment of age, gender, and number of comorbidities, frailty determined by critical value of FI-1 was an independent predictor for adverse outcomes in the elderly inpatients (HR=2.38,5%CI 1.35-4.19,P=0.003), while that determined by FI-2 (HR=1.63,5%CI 0.96-2.77,P=0.068) and FI-3 (HR=1.54, 95%CI 0.56-4.25,P=0.406) was not associated with the adverse outcomes. The AUC of FI-1,FI-2 and FI-3 which were used to predict adverse outcomes of elderly inpatients who were discharged after 6 months was 0.685,0.673 and 0.644, respectively (P＜0.05), and was 0.747,0.731 and 0.647, respectively when they were used to predict the mortality (P＜0.05).Conclusion FI can predict adverse outcomes in elderly inpatients who have been discharged for over 6 months.The predictive ability is associated with the cut-off point of FI that determines the frailty, with those of FI≥0.45(FI-1) and FI＞0.35(FI-2) better than that of FI≥0.25(FI-3). The former 2 cut-off points also are good at predicting mortality.

Abstract:Objective To investigate the effects of frailty and decreased estimated glomerular filtration rate (eGFR) on re-hospitalization in the elderly inpatients. Methods A total of 274 elderly inpatients (aged ≥65 years) admitted in our department from July 2015 to December 2016 were prospectively recruited in this study. Their status of frailty was evaluated with frailty phenotype (FP), and then they were assigned into the frail group, pre-frail group and non-frail group. Their general information and clinical data, medical history, comorbidity number, medication number and laboratory examination results were collected, and eGFR was calculated based on serum creatinine (SCr) level. The patients were also divided into eGFR >60 ml/(min·1.73 m²) group and ≤60 ml/(min·1.73 m²) group. All the patients were followed up for 1 year, and the endpoint event was re-hospitalization. SPSS statistics 18.0 was used to perform the statistical analysis. Analysis of variance or Chi-square test was employed for comparison on different data types. Cox regression analysis was adopted for the effects of frailty and decreased eGFR on re-hospitalization. ResultsOf the 274 patients, there were 76(27.7%) patients assigned into non-frail group, 114(41.6%) into pre-frail group, and 84(30.6%) into frail group. Compared with the non-frail group, the eGFR level was significantly lower (P=0.018), while the proportions of older age, hypertension, chronic obstructive pulmonary disease (COPD) and eGFR ≤60 ml/(min·1.73 m²) were obviously higher in the pre-frail and frail groups (P<0.05). What′s more, the frail group had largest numbers of comorbidities and of medications. After adjustment for age, sex and comorbidities, the patients with eGFR ≤60 ml/(min·1.73 m²) and frailty at the same time had an increased risk for re-hospitalization compared with those with eGFR >60 ml/(min·1.73 m²) and non-frailty (HR=2.40, 95%CI 1.39-4.16). Conclusion The frail elderly inpatients commonly have lower eGFR level, and those with decreased eGFR are prone to re-hospitalization.

Abstract:Objective To determine the effect of low-frequency whole-body vibration training (WBVT) at sitting position on muscle strength and walking ability of the elderly patients with lower limb disability. Methods Twenty elderly patients with lower limb disability (due to accidents, at a disable class of 42-44) who were volunteered to our study were recruited. They were 9 males and 11 females, at an age of (66.6±4.8)years. They all received WBVT at sitting position for 3 d per week, totally 8 weeks. Flexion and extensor strengths of the knee joint, 6-min walking test (6 MWT), 10-meter walking test (10 MWT) and timed up and go (TUG) test were measured before and after the training, and the results were compared. SPSS statistics 22.0 was used to perform the statistical analysis. Paired t test was employed for the comparison of the data before and after training. Results All the subjects successfully completed the training and measurement, and no loss, discomfortableness, or unsafe conditions occurred. After the training, knee flexion [(39.36±16.09) vs (37.37±16.12) Nm] and extension muscles strengths [(58.18±21.31) vs (56.49±21.69) Nm] were increased, while the results of TUG [(7.73±2.17) vs (9.70±2.22) s] and 10 MWT [(7.51±2.26) vs (7.86±2.30) s] were decreased, and that of 6 MWT [(438.74±125.10) vs (401.99±114.08) m] was elevated, with significant differences in all these data (P<0.05). Conclusion WBVT at sitting position for 8 weeks can obviously promote the flexion and extension muscles strengths of the knee joint, and improve the balance and speed of walking in the elderly with lower limb disability.

Abstract:Frailty is a complex age-related syndrome that can lead to reduced anti-stress capacity and ability to maintain homeostasis in the elderly and is associated with adverse outcomes such as falls, disability, and mortality. Cardiovascular diseases have a high incidence in the elderly population, and more and more studies have found that frailty and cardiovascular diseases are closely associated, and frailty can affect the prognosis of many cardiovascular diseases such as heart failure and hypertension. Therefore, clinicians should fully understand the relationship between frailty and cardiovascular diseases and the effect of frailty on the prognosis of cardiovascular diseases in clinical practice, which will be helpful to better disease management strategies in order to effectively postpone or avoid adverse outcomes.

Abstract:Sarcopenia is a syndrome characterized by progressive and systemic loss in volume and quantity (mass) of skeletal muscle fibers, skeletal muscle strength and function associated with aging. It increases the risks for other diseases in the elderly, and results in disability, decline in quality of life, and death. Physical exercise intervention shows good preventive and therapeutic effects on the syndrome. In this article, we reviewed the advances in physical exercise interventions for sarcopenia, and found that resistance training, aerobic training and whole-body vibration training are widely used, and exercise combined with nutrition intervention and medication has gradually become a new and effective way. Our aims are to provide evidence for the research and clinical treatment of sarcopenia and reference for individualized and scientifically effective exercise regimens for the elderly.

Abstract:Objective To investigate the correlation and the concordance of stenosis severity in patients with coronary artery disease (CAD) by physician′s visual assessment and quantitative coronary angiography (QCA). Methods Clinical data of 101 CAD patients with at least 1 lesion of ≥50% stenosis identified by coronary computed tomographic angiography (CCTA) and undergoing coronary angiography (CAG) at same period (<1 week) in our department from June 2016 to January 2017 were collected and retrospectively analyzed in this study. According to the lesion sites by CAG results, 2D-QCA software was employed to assess the coronary stenosis, and the results were analyzed for correlation with visual assessment. SPSS statistics 17.0 was used to analyze the data. Pearson linear correlation analysis was performed for correlation analysis, and Kappa test and Bland-Altman analysis for consistency test. ResultsThere were totally 164 target lesions in the 101 patients, accounting for 50.6%(83/164) in the left anterior descending branch, 18.9%(31/164) in the left circumflex branch, and 30.5%(50/164) in the right coronary artery. Pearson linear correlation analysis indicated significant positive correlation between the visual results and the QCA results (r=0.745, P<0.01). A weighted Kappa of 0.453 was found, suggesting not good enough concordance between the 2 measurements in assessment of stenosis. Bland-Altman analysis showed 4.9%(8/164) was beyond the concordance boundary, indicating unsatisfactory concordance. Conclusion There is good correlation in the assessment of coronary artery stenosis by visual assessment and QCA, but the concordance is unsatisfactory.

Abstract:Objective To observe and compare the analgesic effects and adverse reactions during patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) after thoracic surgery. Methods Sixty patients scheduled for elective thoracotomy in our department from January 2015 to June 2016 were prospectively recruited in this study. They were randomly divided into PCEA group (sufentanil 30 μg+ropivacaine 300 mg+0.9% NaCl to 250 ml, single dose 2 ml, continuous infusion 5 ml/h, lock time 15 min) and PCIA group (sufentanil 200 μg +0.9%NaCl to 250 ml, single dose 2 ml, continuous infusion 5 ml/h, lock time 15 min). The analgesic effects, including resting pain and motor pain, were assessed by visual analogue scale (VAS) at 4,4 and 48 h after surgery. Meanwhile, sedation status was observed by Ramsay sedation scale, and the adverse reactions (hypotension, respiratory depression, nausea and vomiting, weak cough, restlessness and delirium) were recorded. SPSS statistics 22.0 was used to perform the statistical analysis. Analysis of variance or Chi-square test was employed for comparison between groups in different data types. Results The VAS values of resting pain and motor pain were significantly lower in the PCEA group than in the PCIA group at 4,4 and 48 h after operation (P<0.05). At 4 and 24 h, the PCEA group had better Ramsay sedation score than the PCIA group, but no such difference was found at 48 h after operation between the 2 groups. The incidence rates of hypotension, respiratory depression, nausea and vomiting, weak cough restlessness and delirium were lower in the PCEA group than in the PCIA group, but there was no statistical difference. Conclusion For postoperative analgesia after thoracic surgery, PCEA with 0.12% ropivacaine combined 30 μg sufentanil shows better analgesic effect than PCIA with 200 μg sufentanil, and may has less adverse reactions at the same time.

Abstract:Objective To explore the relationship between large arterial elasticity and coronary events in patients with hypertension. Methods A total of 252 outpatients with hypertension admitted in Xuanwu Hospital from February 2011 to January 2012 were enrolled in this study. Their large arterial elasticity was assessed by the velocity of pulse wave propagation in the carotid and femoral arteries (cfPWV). All of them were followed up for average 5.5 (5.1 to 5.8) years. The patients were divided into coronary events group (n=25) and non-coronary events group (n=207) according to whether coronary events occurred or not. The differences of baseline data and clinical indices between the 2 groups were analyzed. SPSS statistics 17.0 was used to process the data. According to the data type, Student′s t test, Chi-square test or rank sum test were used for comparison between groups. Logistic regression analysis was carried out for multiple factors. Results In the 252 patients with hypertension, 20 cases were lost during follow-up, and the success rate of follow-up was 92.06%. In the successfully followed-up 232 patients, coronary events occurred in 25 cases. Compared with the non-coronary event group, the coronary event group had significantly older age, higher systolic blood pressure (SBP), more diabetes, and bigger ratio of hypertension (>10 years). They also had higher morbidity of cfPWV [(11.02±2.45) vs (9.27±2.16) m/s, P=0.014]. Multivariate logistic regression analysis showed that cfPWV (OR=2.033,5%CI 1.047-5.536, P=0.012) and diabetes (OR=2.626, 95%CI 1.065-6.471, P=0.032) were independent risk factors of coronary events in hypertensive patients (P<0.05). Conclusion cfPWV and diabetes mellitus have predictive value for coronary events in hypertensive patients and has a certain clinical significance.

Abstract:Objective To determine the effect of percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) on the prognosis of non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients with intermediate lesions. Methods A total of 100 NSTE-ACS with intermediate lesions patients allowing elective PCI indicated by coronary angiography (CAG) in our department from June 2016 to January 2017 were recruited in this study. They were randomly divided into IVUS group and fractional flow reserve (FFR) group, with 50 cases in each group. All patients were followed up for 12 months, and the incidence of major adverse cardiovascular events (MACEs) was compared between the 2 groups. Results There were no significant differences in the diameter of lesion vessel [(3.5±0.7) vs (3.0±0.5)mm], degree of stenosis [(62.6±5.0)% vs (57.2±7.5)%], lesion length [(20.2±8.8) vs (23.5±10.7)mm], and the incidence rates of PCI-related complications [8.0%(4/50) vs 4.0%(2/50)] between the IVUS group and FFR group (P>0.05). The stent implantation rate was higher in the IVUS group than the FFR group [56.0%(28/50) vs 38.0%(19/50)], though without statistical difference (P>0.05). There was no significant difference in the incidence of MACEs in 12 months after surgery between the 2 groups [18.8%(9/48) vs 14.3%(7/49), P=0.55]. ConclusionFor the NSTE-ACS patients with intermediate lesions, IVUS is not inferior to FFR in the guidance of revascularization therapy for the short-term prognosis.

Abstract:Objective To investigate the efficacy, safety and side effects of Saccharomyces boulardii (S. boulardii) in the prevention and treatment of antibiotic-associated diarrhea (AAD) in elderly patients with lower respiratory tract infections. Methods A total of 127 hospitalized older patients with lower respiratory tract infections admitted in our department from March 2016 to May 2017 were prospectively enrolled in this study, and they were randomly divided into intervention group (n=63, antibiotics+preventive oral administration of S. boulardii powder) and control group (n=64, antibiotics+same volume of placebo). The incidence rate of AAD, other abdominal symptoms, fecal coccus-bacillus ratio and drug side effects were compared between the 2 groups. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test, Chi-square test or Fisher exact test was employed for comparison between groups based on different data types. Results The incidence rate of AAD was 11.11%(7/63) and 26.56%(17/64) respectively in the intervention group and the control group. The daily stool frequency was (2.69±1.24) and (4.27±1.65) times, and the percentage of the subjects with watery stool were 1.59%(1/63) and 18.75%(12/64), all with significant differences between the 2 groups (P<0.05). There were less patients with fecal coccus-bacillus ratio >1/2 in the intervention group than the control group [3.17%(2/63) vs 18.75%(12/64), P<0.05]. No severe adverse reaction related to S. boulardii occurred in the intervention group. Conclusion Preventive administration of S. boulardii can reduce the incidence of ADD, lead to no more obvious side effects compared with routine therapy, and doesn′t cause severe adverse reaction relative to the bacteria in the elderly with lower respiratory infection.

Abstract:Objective To investigate the clinical features and related risk factors of chronic obstructive pulmonary disease (COPD) complicated with pulmonary hypertension (PH). Methods A retrospective analysis was carried out on 702 COPD patients admitted to our department of respiratory diseases from January 2015 to January 2016. According to complicated with PH or not, they were assigned into PH group (n=279) and non-PH group (n=423). The former group was further divided into mild PH subgroup (n=188) and severe PH subgroup (n=91) based on their systolic pulmonary arterial pressure (SPAP). Body mass index (BMI), type B brain natriuretic peptide (BNP), erythrocyte sedimentation rate (ESR), hematocrit (HCT), C-reactive protein (CRP), albumin (ALB), oxygenation index (OI), D-dimer (D-D), fibrinogen (FIB), lactic acid (LA), first second forced expiratory volume (FEV1) and carbohydrate antigen 125(CA125) were compared between the PH and non-PH groups and between the mild PH and severe PH subgroups. SPSS statistics 18.0 was used to analyze the data. Student′s t test or Chi-square test was employed for the comparison between groups. Pearson correlation analysis was used for the influencing factors for SPAP, and multivariate logistic regression analysis for risk factors. Results Compared with the non-PH patients, the PH patients had significantly lower FEV1/predictive value [(46.4±16.5)% vs (67.6±15.4)%] and OI [(226.7±56.9) vs (352.0±49.9)mmHg], and increased BNP [(575.9±53.2) vs (297.8±84.8)pg/ml], CA125 [(39.9±14.5) vs (15.8±12.2)U/L] and SPAP [(59.2±16.3) vs (30.4±9.1)mmHg](all P<0.05). The ratio of FEV1/predictive value [(37.4±16.7)% vs (59.8±14.1)%] and OI [(156.0±80.5) vs (267.7±98.9)mmHg] were obviously higher, while the levels of BNP [(698.0±125.6) vs (495.9±118.2)pg/ml], D-D [(2.9±1.2) vs (1.3±1.2)mg/L], FIB [(4.9±1.4) vs (3.7±1.5) g/L], LA [(3.5±1.8) vs (1.8±1.1)mmol/L], CA125 [(52.8±38.2) vs (32.9±17.5)U/L], and SPAP[(68.3±16.1) vs (55.2±14.3)mmHg] were elevated in the severe PH group than the mild PH group (all P<0.05). Pearson correlation analysis showed that SPAP was negatively correlated with OI (r=-0.459, P=0.021) and FEV1/predictive value (r=-0.442, P=0.035), and positively correlated with BNP (r=0.507, P=0.012), CA125 (r=0.375, P=0.048) and D-D (r=0.401, P=0.030). Multivariate logistic regression analysis indicated that BNP, CA125, D-D, FEV1/ predictive value and OI were risk factors for PH. Conclusion PH is a common complication of COPD. The detection of BNP, CA125, D-D, FEV1/predictive value and OI is helpful to its diagnosis and treatment.

Abstract:Cellular senescence is cell cycle stagnation caused by chronological aging or external stimulation. Atherosclerosis is regarded as the basic pathophysiological feature of coronary heart disease. Recent studies have found cellular senescence is an important mechanism for the development of atherosclerosis. Sirtuins, a family of cellular deacetylases, regulate the metabolism of cells and participate in the physiological functions of various cells. Previous studies have revealed the anti-ageing effect of Sirtuins, and suggested that Sirtuins are a group of longevity-associated proteins that can inhibit or reverse atherosclerosis by regulating cell aging. Herein, we reviewed the recent studies concerning Sirtuins, cellular aging and atherosclerosis, and discuss the feasibility of activating Sirtuins as a new strategy for combating atherosclerosis.

Abstract:Immune checkpoint inhibitors are fully humanized monoclonal antibodies, which mainly target programmed death-1 (PD-1), programmed death ligand-1 (PD-L1) and cytotoxic T-lymphocyte antigen-4 (CTLA-4). The inhibitors are approved for the treatment of patients with non-small cell lung cancer with effective and durable responses. This review summarized the mechanism and the clinical progress of these drugs in treatment of lung cancer, and the prognostic and predictive roles of related biomarkers.

Abstract:Long non-coding RNA (lncRNA) plays important roles in the pathogenesis of cancer. Increasing evidence in genome-wide association studies have demonstrated the implication of lncRNA with different types of cancer. Aberrant expression and mutation of lncRNA is associated with tumorigenesis, metastasis, and prognosis of cancer. lncRNA exerts effects on either tumor promotion or tumor suppression. Because of the diversity and specificity in genome expression, lncRNA is identified as new molecular markers and therapeutic targets for cancer. In this paper, the progress of lncRNA in cancer is reviewed with the latest reports at home and abroad.

Abstract:Circulating tumor cells (CTC) detection, due to its good sensitivity and specificity, less trauma, convenience and repeatability of obtaining materials, has gained clinical consensus for its advantages in early diagnosis, clinical staging, guiding treatment and predicting prognosis. However, it still remains unclear that the significance of CTC as an indicator for maintenance therapy. In this paper, we reviewed the extraction, isolation, detection and clinical application of CTC, and its value in maintenance therapy.

Abstract:The incidence of pancreatic disease is increasing year by year. Current treatments for these diseases are mainly control of symptoms,but there were not enough studies on pancreatic function recovery. Bone marrow mesenchymal stem cells (BMSCs)are a group of stem cells with high self-renewal capacity and multipotent stromal cells that can differentiate into a variety of cell types in bone marrow. The cells have special biological characteristics and tumor tropism. Great achievements have been obtained in vitro and in vivo for pancreatic diseases and diabetes mellitus, and these studies provide a theoretical and practical basis for the application of stem cell therapy. In the article, we reviewed the research progress of BMSCs in this field.