Abstract:Objective To investigate the prognostic significance of CD5 and B cell lymphoma/leukemia protein-2 (Bcl-2) in the elderly patients with diffuse large B cell lymphoma (DLBCL). Methods A retrospective cohort study was carried out on 35 patients(＞60 years old) who were diagnosed as DLBCL at Department of Hematology of Xijing Hospital from January 2007 to December 2013. The patients were followed up for 2 years. The clinicopathological data and prognosis were recorded, and the expression of CD5 and Bcl-2 was detected by immunohistochemistry. Patients were divided into groups according to the positive expression of CD5 and Bcl-2 (positive tumor cell >30%), central nervous system (CNS) involvement or not, clinical stage of the tumor, and survival of each group was compared. SPSS statistics 22.0 was used for data processing, Fisher test for intergroup comparison, Kaplan-Meier method for the survival curve, Log-Rank method for single factor analysis between the curves, and Cox regression model for multivariate analysis.Results Three cases were lost with a loss rate of 8.6%. The positivity rate were 21.9%(7/32) for CD5,6.9%(15/32) for Bcl-2 and 15.6%(5/32) for both. CNS involvement was found in 21.9%(7/32) patients. The tumor was stage Ⅲ in 10 patients and stage Ⅳ in 22 patients. The median overall survival (OS) was 24 months, and median progression free survival (PFS) was 18 months.The 1-year survival rate was 96.9%(31/32) and 71.9%(23/32) for 2 years. Univariate analysis showed that OS and PFS were lower in CD5⁺ and Bcl-2⁺ patients (P<0.05) than CD5- and Bcl-2- patients, but no significant difference was found between the patients at Stage Ⅲ and those at Stage Ⅳ in PFS (P=0.055) and OS (P=0.076). In addition, the rate of CNS involvement was significantly higher among CD5⁺ patients than that of CD5- patients (57.1% vs 12.0%; P=0.026), and significantly higher among Bcl-2⁺ patients than that of Bcl-2- patients (40.0% vs 5.9%; P=0.033). Multivariate Cox analysis showed that CD5⁺ was an independent risk factor for OS in patients with DLBCL (OR=11.205,5%CI 1.717-73.112; P=0.012). Conclusion CD5⁺ can be an independent risk factor for poor prognosis of the elderly DLBCL patients. It is of important clinical value for the prognosis and the choice of future treatment strategies.

Abstract:Objective To investigate the effects of Aescuven forte on microcirculation for the treatment of chronic venous insufficiency (CVI). Methods A total of 40 outpatients were enrolled in this study from Vascular Surgery Department of Peking Union Hospital and Chifeng Municipal Hospital from March 2016 to August 2017. They were divided into Aescuven forte group (n=23) and control group (n=17). In a course of 4 weeks, the former were treated with Aescuven forte and pressure (elastic stockings), while the latter only with pressure. Observation focused on the primary efficacy indicators [Venous Insufficiency Epidemiological and Economic Studies-quality of life/symptom score (VEINES-QOL/Sym), transcutaneous oxygen pressure (TcPO₂) and skin temperature],secondary efficacy indicators [temperature-controlled blood blow and post-occlusion reactive hyperaemia (PORH)] and adverse reactions, and efficacy and safety were evaluated. SPSS statistics 20.0 was used to perform the statistical analysis. Student＇s t test, Mann-Whitney U test or Chi-square test was employed for comparison between two groups. Results Totally 36 patients (22 in the Aescuven forte group and 14 in the control group) finished the course of the treatment. The readings before vs. after treatment in the Aescuven forte group were VEINES-QOL [(69.3±13.5) vs(76.7±11.9) scores], VEINES-Sym [(31.9±7.9)vs(36.0±7.4)scores], TcPO₂[(45.2±22.3) vs(56.3±16.5)mmHg], skin temperature [32.6(31.5,33.9)℃ vs 31.8(31.0,2.9)℃] and the temperature-controlled blood flow [(151.4±123.0)% vs(418.0±179.5)%], and the differences were statistically significant (P<0.05). The readings before vs. after treatment in the control group were VEINES-QOL [(64.0±16.1) vs(69.0±16.7)scores], VEINES-Sym [(29.3±7.7) vs(32.6±7.9)scores], and TcPO₂ [(39.6±16.8) vs(51.4±9.9)mmHg], and the differences were statistically significant (P<0.05). Significant difference was observed in temperature-controlled blood flow between two groups[(266.6±170.1)% vs(-110.1±160.5)%, P<0.05]. Conclusion Our findings indicated that Aescuven forte may improve the quality of life and relieve the symptoms of the patients with CVI, and that a correlation could be established between curative effects and the improved microcirculation. Parameters such as TcPO₂, skin temperature, temperature-controlled blood flow may indicate the changes of microcirculation, implying a relation between the pathogenesis of CVI and the alteration of microcirculation.

Abstract:Objective To explore the epidemiological and clincal features of venous thromboembolism (VTE) among the elderly in-patients in the Internal Medicine Department of Peking Union Medical College Hospital. Methods A retrospective analysis was made in 3115 hospitalized patients in the Department of Internal Medicine of Peking Union Medical College Hospital from May 2016 to September 2016. According to age, they were divided into elderly group (≥65 years old, n=771) and non-elderly group (<65 years, n=2344). Baseline information, the incidence of symptomatic VTE and VTE prophylaxis in 3 months after discharge was collected and compared, and the relative risk factors of VTE in the 2 groups were compared. SPSS statistics 23.0 was used for statistical processing. Student’s t test or Chi-square test were employed for different data types. Univariate analysis of variance was used for multigroup comparison. The risk factors of VTE were analyzed by logistic regression. Results The total morbidity rate of VTE was 2.50%(78/3115), and the incidence of VTE in the elderly and non-elderly group was 3.11%(24/771) and 2.30%(54/2344) without statistical significance (P=0.249). The incidence of VTE among the patients over 40 years old tended to increase with age, but no significant difference was observed among all age groups. The incidence of VTE in ICU was the highest (42.86%,3/7) and was significantly higher than that in other departments (P<0.05). A significant increase was seen in the elderly group against the non-elderly group in hypertension, high risk based on Padua model, active malignant tumor/chemotherapy, diabetes, coronary heart disease, heart and/or respiratory failure, acute myocardial infarction and/or ischemic stroke, while glucocorticoid treatment, inflammatory bowel disease and thrombophilic predisposition were significantly decreased (P<0.01). Multivariate logistic regression analysis showed that the history of VTE (OR=63.316,5%CI 19.355-207.127) coupled with the use of estrogen and progesterone (OR=133.278, 95%CI 9.660-1838.773) were independent risk factors for the elderly patients with VTE (P<0.001). Anticoagulant or mechanical prevention before onset was not administered in 48.72%(38/78) VTE patients and 54.17%(13/24) elderly VTE patients. Conclusion VTE incidence of in-patients in the Internal Medicine Department of Peking Union Medical College Hospital increases with age, warranting more emphasis on the prevention of VTE events in elderly patients, especially those with previous VTE history and those using estrogen and progesterone.

Abstract:Objective To explore the different effects of 10% and 20% human serum albumin (HSA)solutions on the renal functions of the patients after cardiopulmonary bypass (CPB). Methods Totally 100 patients with hypoalbuminemia were enrolled in this study who received CPB from March 2016 to December 2016 in our department. The patients were randomly divided into 2 groups (20%HSA and 10%HSA, n=50). HAS were administered in all patients until the albumin (ALB) concentration was>35 g/L. The two groups were compared postoperatively in the aspects of relevant clinical indicators, the renal functions, the amount of HAS administered, drug usage, urine output, length of stay in the ICU, and postoperative hospital stay. SPSS statistics 21.0 was used for statistical analysis. Non-paired t test and Chi-square test was adopted for comparison between groups according to the data types, and univariate analysis of variance was used for intragroup comparison. Results ALB in the 2 groups decreased significantly on the day of operation compared with before operation, and in the first and second day after CPB, the level of ALB had some increases, but still lower than that before operation (P<0.05). The increase of serum creatinine (SCr) level in 2 groups was not obvious immediately after the operation compared with before operation, but in the first and second day, SCr were significantly higher (P<0.05). Blood urea nitrogen (BUN) in the 2 groups showed an upward trend in the day of operation, the first and second day after the operation, and BUN in the first and second day were significantly higher than that before operation(P<0.05); hemoglobin (Hb) level in the 2 groups in the day of operation were obviously lower than that before operation, and there were some different increases in the first and second day after operation, but still lower than that before operation(P<0.05). There was no significant difference at the same time point between the 2 groups before and after the operation, such as ALB, SCr, BUN, uric acid (UA) and Hb (P>0.05). A smaller amount of HSA were administered in the patients in 20%HSA group than those in 10%HSA group [(21.20±8.81) vs (30.00±10.41)g, P<0.01]. Besides, compared with 10%HSA group, the postoperative urine output on the second day was higher in 20%HSA group [(2.62±0.67) vs (2.13±0.82)ml/(kg·h), P<0.05]. No significant differences were found in other relevant indices between groups (P>0.05). Conclusion There is no significant difference between two HSA solutions(10% and 20%)in their effects on the renal function in the patients with hypoalbuminemia who had undergone CPB. However, administration of 20%HSA can significantly reduce the amount of albumin used to treat hypoproteinemia. In terms of increased postoperative urine output, 20%HSA is superior to 10%HSA.

Abstract:Objective To investigate the influencing factors of the recurrences of the healed diabetic foot ulcers(DFUs) in the elderly. Methods A total of 165 elderly patients cured of DFUs from Apirl 2011 to January 2016 were observed and followed up for 2 years after discharge from the hospital. According to whether they had recurrence, the subjects were divided into recurrence group and non-recurrence group, and the related factors that may affect recurrence were analyzed. SPSS statistics 19.0 was used to perform the statistical analysis. Chi-square test was used for comparison between groups. Non conditional logistic regression analysis was carried out for multiple factors. Results The recurrence rate was 30.91%(51/165). Univariate analysis showed that the recurrence of healed DFUs was associated with the disease course (≥60 d), smoking, type of foot disease (ischemic), Wagner classification (Ⅲ,Ⅳ), multidrug resistant infection, incomplete debridement, ankle-brachial index (<0.9), blood glucose (≥11.1 mmol/L), plasma viscosity (≥1.5 mPa·s), serum albumin (<30 g/L), and glycosylated hemoglobin (≥8%). The difference was statistically significant (P<0.05). Non logistic regression analysis showed that the risk factors for the recurrence of healed DFUs included smoking [OR=2.836,5%CI 1.050-7.661; P=0.040], ischaemic diabetic foot [OR=9.796, 95%CI 2.794-34.351; P=0.000], Wagner scores (Ⅲ,Ⅳ )[OR=4.426,5%CI 1.665-11.760; P=0.003], multidrug resistant infections [OR=2.756,5%CI 1.011-7.515; P=0.048], ≥8% glycosylated hemoglobin [OR=6.366,5%CI 2.362-17.157; P=0.000], and plasma viscosity ≥1.5 mPa·s [OR=3.699,5%CI 1.332-10.269; P=0.012]. Conclusion The recurrences of the healed DFUs could be effectively reduced by thorough evaluation, classification, and grading of the patient′s condition (both general and local), early diagnosis, early debridement and drainage, effective control of blood glucose, rational use of antimicrobial agents, anticoa-gulant therapy, and effective correction of ischaemia.

Abstract:Objective To explore the risk factors of postoperative heart failure in the elderly who received operation for treatment of hip fracture. Methods Totally 329 patients (age>75 years) were analyzed who underwent operation for hip fracture in Beijing Fengsheng Special Hospital of Medical Traumatology and Orthopaedics from June 2010 to December 2013. They were divided into 2 groups:heart failure group (n=53), and non-heart failure group (n=276). The two groups were compared in their clinical features. SPSS statistics 17.0 was used for data processing, and χ² test for comparison. Logistic regression model was established to identify inde-pendent risk factors. Results No significant differences were found in gender, surgery occasion, surgery type, hypertension, type 2 diabetes mellitus and hypoalbuminemia between two groups(P＞0.05). Univariate analysis showed that patients with advanced age, cognitive dysfunction, complicated coronary heart disease, anemia, and intraoperative blood transfusion had higher risk of heart failure. Multivatiate logistic regression analysis revealed that anemia(OR＝3.030,5%CI 1.325-6.932; P＝0.009), cognitive dysfuction(OR＝5.707,5%CI 1.346-24.097; P＝0.018)and complicated coronary heart disease(OR＝3.653,5%CI 1.444-9.241; P＝0.006)were independent risk factors for postoperative heart failure. Conclusion Independent risk factors of heart failure in the elderly receiving operation for hip fracture include preoperative anemia, postoperative cognitive dysfunction and coronary heart disease.

Abstract:Objective To investigate the prognostic value of SYNTAX score and EURO score in the patients with left main and/or 3-vessel lesions, who received percutaneous coronary intervention (PCI) and conservative treatment because they were not indicated for coronary artery bypass grafting, thus providing clinical guide for individual treatment strategy. Methods Risk scoring systems (EURO score and SYNTAX score) were used for patients with left main and/or 3-vessel lesions confirmed by coronary artery angiography. A total of 115 patients with SYNTAX score> 27 and EURO score> 6 were randomly divided into PCI group and drug group with a follow-up of 18 months. The primary endpoint was the incidence of major adverse cardiovascular events (MACE), consisting of all-cause mortality, non-fatal myocardial infarction, and clinically driven target revascularization. The secondary endpoints included cardioversion, cardiac dysfunction and recurrent angina. Kaplan-Meier method was used for the measurement of survival rate, Log-rank test for survival time distribution, and Cox proportional hazards model for univariate and multivariate analysis. Results In the 18-month follow-up, 6 patients (11.76%) suffered MACEs in the PCI group against 17 patients (34.00%) in the drug group, with a significant higher proportion of non-MACEs in the former than in the latter. Survival curves obtained with the log-rank test in patients without adverse cardiovascular events after discharge showed a significant difference between the two groups (χ²=11.131, P=0.001). The average survival in the PCI group was 12.7 months, and 9.7 months in the drug group. The likelihood ratio test in Cox model showed that the treatment method had an impact on the MACE-free survival time (P=0.001, regression coefficient B=0.882,RR=2.416). Conclusion Mid-term follow-up showed that PCI was better than drug therapy for patients with left main and/or 3-vessel lesions, who were not indicated for coronary artery bypass grafting with a SYNTAX score>27.

Abstract:Objective To investigate the pathogen distribution in and risk factors for community-acquired pneumonia (CAP) in the elderly patients with heart failure (HF). Methods Sixty elderly patients with HF admitted to Hefei Women and Child Healthcare Hospital from January 2015 to May 2016 were included as study group, and the control group were forty-three patients with HF wor-sened by non-infectious factors admitted to the hospital during the same period. The clinical data and SF-36 health survey scale scores were collected for all patients. Sputum samples were collected and culture-based diagnosis and drug-resistance testing were performed. Statistical analysis was performed using SPSS statistics 23.0, t-test or χ² test was used for the comparison between groups according to the data type. Logistic regression analysis was conducted to explore the risk factors for CAP. Results In 60 patients with CAP, 71 strains of pathogens were isolated, of which 43(60.6%) were Gram-negative bacteria, 21(29.6%) Gram-positive bacteria, and 7(9.9%) fungi. The main Gram-negative bacteria had high rates of resistance to quinolones and third-generation cephalosporins but were sensitive to imipenem. Gram-positive bacteria were generally resistant to penicillin and clindamycin but sensitive to vancomycin. Logistic regression analysis showed that both smoking (OR 2.91, 95%CI 1.13-7.44; P=0.026) and poor quality of life at baseline (OR=0.98, 95%CI 0.97-0.99; P<0.001) were the risk factors for CAP (P<0.05). Conclusion CAP in elderly patients with HF was mainly caused by Gram-negative bacteria, which are resistant to cephalosporins and quinolones. Smoking and poor quality of life at baseline are risk factors for CAP in the elderly patients with HF.

Abstract:Objective To investigate the predictive value of early phase intra-abdominal pressure (IAP) for severe acute pancreatitis (SAP) complicated with acute kidney injury (AKI). Methods A total of 60 SAP patients were enrolled in this study who were treated in the Intensive Care Unit of the Emergency Department in our hospital from January 2016 to September 2017. The patients were divided into intra-abdominal hypertension (IAH) group and non-intra-abdominal hypertension (non-IAH) group, depending on whether 2 consecutive IAP measurements were higher than 12 mmHg (1 mmHg=0.133 kPa) within 72 h after admission. The 2 groups were then compared in the baseline data, incidence of AKI and proportion of continuous renal replacement therapy (CRRT). Receiver operating characteristic (ROC) curve was employed to analyze the predictive value of IAP in the early phase of SAP for AKI. SPSS statistics 17.0 was used for analysis. Student′s t test or Chi-square test was conducted for the comparison according to the data type. Results The IAH group had significantly higher readings than the non-IAH group in tumor necrosis factor-ɑ [(2.30±0.79) vs (1.88±0.55)mg/ml,P=0.04] and interleukin-6 [(217.04±77.16) vs (178.86±60.93)ng/L, P=0.02], and the difference was statistically significant. AKI [45.8%(11/24) vs 16.7%(6/36), P=0.02] and CRRT [29.2%(7/24) vs 5.6%(2/36), P=0.02] were significantly higher in the former than in the latter. The area under ROC curve was 0.728 (OR=4.231,5%CI 1.289-13.889, P<0.05) for IAP in the early phase of SAP in predicting AKI; the cut-off point of the IAP in the early phase of SAP was 12 mmHg with a sensitivity of 82.4% and a specificity of 34.9% and had a moderate accuracy. Conclusion Elevated IAP in the early phase of SAP has predictive value for AKI and can be used to assess the risk of AKI.

Abstract:Objective The aim of this study was to evaluate the relationship between proteinuria and cerebrocardiovascular diseases and all-cause mortality among the elderly. Methods This retrospective cohort study enrolled 20427 employers of Kailuan Group who received the 2006-2007 physical examination, the baseline being over 60 years old and no history of stroke and myocardial infarction, and with information for proteinuria test. Proteinuria was measured by urine dipstick test. The subjects were divided into three groups by their proteinuria levels:negative group (-, n=17740), microproteinuria group (±/+, n=1607), and macroproteinuria group (≥2+, n=1080). Follow-up continued till December 31,3. SAS software was used to analyze the data. Variance was used for comparing continuous variables among groups (SNK for the comparison between groups), and chi-square test for comparing categorical variables among groups. The Kaplan-Meier analysis was used to obtain the incidence of events. Cox proportional hazard regression model was used to evaluate the association between exposures and outcomes. Results Altogether, 20427 people were included for the analysis, with 1621 cerebrocardiovascular events and 2824 deaths occurring during the follow-up period. Multivariate analysis adjusted for major traditional cardiovascular risk factors showed a higher risk of cerebrocardiovascular events in microproteinuria group (OR=1.16, 95%CI 0.97-1.39) and macroproteinuria group (OR=1.30,5%CI 1.07-1.58) than negative group. An increased risk of all-cause mortality was also observed in microproteinuria group (OR=1.13,5%CI 1.16-1.50) and macroproteinuria group (OR=2.02, 95%CI 1.77-2.30). Conclusion Macroproteinuria is a risk factor for cerebrocardiovascular events and all-cause mortality in the elderly.

Abstract:Objective To investigate the application and efficacy of SuperPATH approach for hip arthroplasty in the elderly patients with femoral neck fracture. Methods A total of 39 elderly patients with unilateral femoral neck fracture admitted to the Orthopedic Department of Aidebao Hospital from September 2015 to March 2017 were enrolled in this study. They were divided into SuperPATH approach group (n＝14) and posterolateral approach group (n＝25) according to the approach they received. The operation time, intraoperative bleeding volume, postoperative drainage volume, and visual analogue scale (VAS) score within 24 h after operation were compared between the 2 groups. After 3 months′ follow-up, the independent walking time, complications and Harris hip joint score were compared between them. SPSS statistics 17.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison based on different data types. Results Compared with the posterolateral approach group, the patients with SuperPATH approach had less amounts of intraoperative blood loss [(101.4±16.7) vs (135.3±21.6)ml] and post-operative drainage [(70.4±10.2) vs (85.9±16.4)ml], shorter incision length [(6.8±0.7) vs (10.1±0.9)cm] and lower VAS score [(3.5±1.0) vs (6.8±1.7)scores, P<0.05]. At the end of the last follow-up, no dislocation, infection or loosening occurred in both groups. The independent walking time was significantly shorter in the SuperPATH group than in the posterolateral approach group in 3 months after operation [(2.8±1.2) vs (9.2±2.2)d, P<0.05]. Conclusion SuperPATH approach is a minimally invasive approach for hip replacement with the advantage of rapid recovery, especially suitable for the elderly patients.

Abstract:Heterotopic pancreas (HP) is a rare entity, defined as pancreatic tissue without a true anatomical or vascular connection to the pancreas. Gastric HP often has nonspecific clinical symptoms and is usually detected in the gastroscopy. Its diagnosis by gastroscopic biopsy is difficult as the lesion is mostly located in the submucosa. Its clinical diagnosis depends on ultrasonographic endoscopy and pathologic biopsy after endoscopic treatment. HP is sometimes surgically resected because it can be difficult to distinguish HP from neoplastic submucosal masses such as gastrointestinal stromal tumors. Although not common, HP should be given due consideration in the differential diagnosis of extramucosal gastric masses to avoid unnecessary intervention. We reported a case of gastric HP that was found incidentally as a gastric mass on gastroscopy.

Abstract:Osteoporosis is a common disease in postmenopausal women and older men. Bisphosphonates, the first-line drug for the osteoporosis, have a residual effect and can continue to exert a persistent inhibitory effect on osteoclast function after therapy is stopped. Although bisphosphonates are proven to be generally safe, concerns have emerged about potential adverse effects related to long-term use, such as atypical femoral fractures and osteonecrosis of the jaw. The purpose of drug holiday is to reduce the use of bisphosphonates with the guarantee of good bone mass and bone mineral density for osteoporosis patients, so to minimize the possible adverse effects of long-term use. During the drug holiday, relevant bone indexes should be properly monitored, and the therapy should be restarted immediately if there is a significant decrease in bone mineral density or new fractures.

Abstract:Patients over 80 years old with end-stage renal disease (ESRD) are increasing in recent years. Age is an independent risk factor for the survival of ESRD patients. However, studies on the choice of time and treatment approach for renal replacement therapy in these patients are limited. In this paper, we compared the effects of conservative and replacement therapy on survival rate and dialysis timing on life quality and prognosis, reviewed the options of different renal replacement approaches and the differences of therapeutic efficacies and complications between hemodialysis and peritoneal dialysis, in order to provide clinical evidence on the treatment decision-making for ESRD patients aged over 80 years.

Abstract:Sick sinus syndrome (SSS) is a group of clinical syndromes caused by lesions in sinoatrial node and its surrounding tissues. Its occurrence may be due to that a variety of reasons affect sinoatrial node cells and their surrounding tissues and thus lead to pacing and conduction dysfunction, which is mainly manifested as slow arrhythmia. In addition to the clinical treatment of electronic pacemakers, there are few studies on drug therapy. Studies show that ginsenosides and calcium dibutyryladenosine cyclophosphate can regulate myocardial cell metabolism and improve the function of the sinus node, and are effective drugs for SSS treatment. In this article, we reviewed the pathogenesis, etiology and drug treatment of SSS, so as to provide reference for clinical guidance of drug use.

Abstract:The rapid increase in the aging population in China results in a growing number of total knee arthroplasty (TKA) year by year. The cancellous bone osteotomy and soft tissue loosening in TKA can lead to blood loss or even postoperative anemia, often requiring allogeneic blood transfusion. Anemia can cause dizziness and other uncomfortable symptoms, hindering the rapid recovery of the patients and the restoration of the limb functions, while allogeneic blood transfusion has the risk of spreading disease. Therefore, reducing blood loss in TKA perioperatively is of great importance. At present, the common approaches include the treatment of preoperative anemia, administration of tranexamic acid in the operation, and postoperative drainage of the wound, etc.

Abstract:In recent years, there were more and more Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG) diagnosed and treated at early stage, and proximal gastrectomy is an optional excision range recommended by various guidelines. But esophagogastrostomy used in early reconstruction causes quite higher incidence of reflux esophagitis (RE), which seriously affect the quality of life in these patients. Therefore, multiple procedures were derived to solve this problem. However, all these procedures have their own advantages and disadvantages, and there is still controversies about which one is the best. In this paper, we reviewed the historical evolution of digestive reconstruction after proximal gastrectomy and the existing controversies of various procedures.