Abstract:Objective To explore the effect of integrated cardiac rehabilitation model (center- and home-based cardiac rehabilitation) on cardiopulmonary function and psychological status in patients with myocardial infarction. Methods A total of 84 cases of acute myocardial infarction within 3 months and referred to the Cardiovascular Rehabilitation Center of Chinese General Hospital of PLA from July 2017 to March 2018 were enrolled, and then randomized into treatment group and control group, with 42 patients in each group. The patients of the treatment group were treated with center-based exercise followed by health education of 15 min by medical staffs, twice a week for totally 18 weeks, and then home-based exercise for another 6 weeks. While, those in the control group were given health education for only once. Body mass index, waist-to-hip ratio, indices of cardiopulmonary exercise testing, and scores of generalized anxiety disorder (GAD-7) and patient health auestionnaire (PHQ-9) were compared before and after treatment between the 2 groups. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for different data types. Results After 24 weeks of integrated cardiac rehabilitation, the patients of the treatment group obtained significantly lower waist-to-hip ratio [(0.91±0.64) vs (0.93±0.51)], GAD-7 score [(2.60±3.02) vs (4.69±4.61)], PHQ-9 score [(4.14±2.54) vs (6.26±3.51)], and minute ventilation/carbon dioxide production (VE/VCO₂) slope [(23.46±5.09) vs (25.31±4.00)], and obviously increased peak oxygen uptake per kilogram [Peak VO₂/kg, (23.43±5.88) vs (20.70±4.13)ml/(min·kg)], maximal metabolism equivalents [MET_max, (6.62±1.68) vs (5.92±1.18)], and oxygen pulse [(13.25±4.06) vs (11.78±3.48)ml/beat] (all P<0.05). What′s more, the Peak VO₂/kg [(23.43±5.88) vs (19.48±4.47)ml/(min·kg)], MET_max [(6.62±1.68) vs (5.66±1.25)], oxygen pulse [(13.25±4.06) vs (11.76±0.70)ml/beat] were notably higher, while the waist-to-hip ratio [(0.91±0.64) vs (0.94±0.44)] were obviously decreased in the treatment group than the control group (P<0.05). Conclusion Integrated cardiac rehabilitation can promote cardiopulmonary exercise function, improve mental disorders such as anxiety and depression, and is worthy of clinical promotion for myocardial infarction population.

Abstract:Objective To investigate the effect of tele-monitored home-based cardiac rehabilitation on blood pressure and lipid in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). Methods A total of 266 patients from January 2016 to March 2018 in our department with coronary heart disease after PCI were enrolled. They were randomly divided into study group (tele-monitored home-based cardiac rehabilitation group) and control group, with 133 cases in each group. The control group received the basic 2-level prevention health education and drug therapy. On the basis of these treatments, the study group received exercise prescription and remote heart rate supervision and rehabilitation guidance from rehabilitation physicians, technicians and nurses with aid of smart phones. The patients were followed up for 12 months, and the blood pressure and lipid levels before and after rehabilitation were compared between the 2 groups. SPSS statistics 17.0 was used to analyze the data. Student′s t test orChi-square test was employed to compare the data between groups. Multiple linear regression analysis was applied to analyze the independent influencing factors of blood pressure and lipid changes. Results In the study group, rehabilitation resulted in significant declines in systolic blood pressure [SBP, (123.7±13.7) vs (128.2±14.5) mmHg] and diastolic blood pressure [DBP, (77.6±11.1) vs (80.7±10.3)mmHg], with increased proportion of those meeting SBP standard [72.9%(97/133) vs 58.6%(78/133)], and in low-density lipoprotein cholesterol (LDL-C) level [(1.64±0.42) vs (1.90±0.59)mmol/L], with larger proportion of normal level [42.1%(56/133) vs 26.3%(35/133)]. While, in the control group, the proportion of the patients meeting the SBP standard was decreased [48.1%(64/133) vs 59.4%(79/133)], and the LDL-C level [(2.23±0.84) vs (2.03±0.80)mmol/L] was increased, with less patients meeting the standard [17.3%(23/133) vs 22.6%(30/133)]. The proportions of the patients meeting DBP standard were increased in both groups [63.2%(84/133) vs 50.4%(67/133), 51.9%(69/133) vs 45.1%(60/133)]. More significant changes were seen in the declines of SBP [(-4.6±14.5) vs (0.2±15.0)mmHg] and LDL-C level [(-0.26±0.54) vs (0.20±0.63)mmol/L] in the study group than the control group. Multiple linear regression analysis showed that tele-monitored home-based cardiac rehabilitation (P=0.006) and age (P=0.010) were independent influencing factors of SBP changes, and tele-monitored home-based cardiac rehabilitation (P<0.001) and carbon dioxide ventilation equivalent (P=0.007) were independent influencing factors for LDL-C changes. Conclusion Tele-monitored home-based cardiac rehabilitation significantly reduces SBP and LDL-C in patients with coronary heart disease after PCI, improves the proportions of those meeting the standards, and helps the control of blood pressure and blood lipid.

Abstract:Objective To compare the clinical efficacy of rehabilitation care combined with acupuncture and monotherapy with moxibustion in treating lumbar disc herniation (LDH) with a view of providing evidence for clinical application of acupuncture combined with rehabilitation care for LDH. Methods The Cochrane systematic review was used to search for and retrieve the literature on the clinical efficacy of rehabilitation care combined with acupuncture and moxibustion for LDH in the databases of CNKI, VIP, SinoMed, PubMed and Cochrane Library as of February 2019. The literature was screened and the data were extracted independently by 2 researchers according to the inclusion and exclusion criteria. A meta-analysis was conducted using Comprehensive Meta-Analysis V2. Results A total of 16 randomized controlled studies were included, involving 1504 patients. The meta-analysis with fixed effect model showed that, compared with monotherapy, rehabilitation care combined with acupuncture resulted in a higher total effective rate and cure rate for LDH, the difference being statistically significant (RR total effective rate =1.197,5%CI 1.151-1.245, P<0.001; RR cure rate =1.347,5%CI 1.225-1.541, P<0.001). Egger test and Begg test suggested no significant publication bias. Conclusion Rehabilitation care combined with acupuncture has definite efficacy for LDH and can significantly improve the quality of life of the patients. It is worthy of clinical application.

Abstract:Objective To identify the distribution characteristics of cognitive frailty among the elderly inpatients with multiple comorbidities and explore its influencing factors. Methods Clinical data of 692 elderly patients (over 60 years old) with different comorbidities hospitalized in our department from November 2015 to January 2018 were collected and retrospectively analyzed. Com-prehensive geriatric assessment-frailty index (CGA-FI) was used to assess the state of senile frailty, and mini-mental state examination scale (MMSE) was employed to evaluate the cognitive status of these patients. Those with both frailty and cognitive impairment (CI) were defined as cognitive frailty. The severity of comorbidities was assessed by Charlson complication index (CCI). In this way, the patients were divided into cognitive frailty group (n=176), simple frailty group (n=176), simple CI group (n=74) and non-cognitive frailty group (n=266). The clinical data were compared among the 4 groups, and the distribution characteristics of cognitive frailty were analyzed. SPSS statistics 23.0 was used to analyze the data. Multivariate logistic regression analysis was employed to analyze the independent factors of cognitive frailty in these patients. Results There were totally 2-12 kinds of chronic diseases in the patients, and the CCI index was 5.5±1.9. The incidence rate of cognitive frailty was 25.4% (176 cases) in the cohort, and the rate was increased with older age, elevated CCI level and decreased Barthel index for activities of daily living (ADL) according to the results of trend test (P<0.001). Compared with the other 3 groups, the patients of the cognitive frailty group were older and hadsignificantly larger proportions of CCI, critical/severe conditions at admission, acute heart failure, chronic osteoarthritis, and geriatric syndrome (malnutrition, balance dysfunction, depression, sleep disorder and fall history), and obviously lower body mass index (BMI) and Barthel index (P<0.05). Multivariate logistic regression analysis showed that malnutrition (OR=5.022,5%CI 2.484-10.157; P＜0.001), at high risk of malnutrition (OR=2.272,5%CI 1.179-4.377; P=0.014), balance dysfunction (OR=4.803, 95%CI 2.898-7.960; P＜0.001), depression (OR=4.227,5%CI 2.271-7.866; P＜0.001), and osteoarthritis (OR=2.707,5%CI 1.332-5.501; P=0.006) were the independent factors of cognitive frailty in hospitalized elderly patients with different comorbidities. Conclusion Cognitive frailty is quite common in elderly inpatients with comorbidities. The older, the severer of comorbidities and the more disable of ADL are, the more obvious the cognitive impairment is. In clinical practice, attention should be paid to the elderly patients with comorbidities, such as nutrition deficiency, poor balance, osteoarthritis and depression.

Abstract:Objective To investigate the correlation between subclinical hypothyroidism (SCH) and bone mineral density and markers of bone metabolism in postmenopausal women. Methods The clinical data were collected of 138 postmenopausal women treated in Xijing Hospital of Air Force Medical University from January 2015 to June 2018, who were divided into SCH group (n=68) and control group with normal thyroid function (n=70). The two groups were examined for some biochemical markers and bone mineral density and were compared in the indices of bone metabolism including alkaline phosphatase (ALP), Ca²⁺, calcitriol [25-(OH)D₃] and bone mineral density T value (T<-1.0 stands for abnormal bone mineral density), and thyroid function related indices including parathormone (PTH), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), thyroxine (FT4) and positive rate of thyroid peroxidase antibody (TPOAb⁺). SPSS statistics 18.0 was used for data analysis. Results The abnormal rates of bone mineral density in SCH group and control group were 50.0%(34/68) and 25.7%(18/70), with significant difference between the two groups (P=0.003). Compared with the control group, TSH level and TPOAb⁺ ratio in SCH group increased significantly (P<0.05), but there were no significant differences in FT3, FT4, PTH and bone metabolism related indices (P>0.05). Spearman correlation analysis showed that TSH and TPOAb⁺ ratio were negatively correlated with ALP, 25-(OH)D₃ and T values, and TSH was highly negatively correlated with T values (r=-0.804, P<0.01). Conclusion SCH may cause abnormal bone mass and decrease of bone mineral density in postmenopausal women, which is probably related to the increased serum TSH level and the positive TPOAb.

Abstract:Objective To explore the correlation between mild cognitive impairment (MCI) and elderly type 2 diabetes mellitus (T2DM) and pre-diabetes (impaired glucose regulation, IGR). Methods The elderly T2DM patients (60-80 years old) admitted to our department from January to December 2018 were recruited, and 30 IGR patients and 30 healthy people (control group) for physical examination in the same period were enrolled. The incidence of MCI, general data and related clinical indices were collected and compared among the 3 groups. According to the existence of MCI, the T2DM patients were divided into MCI subgroup (n=39) and non-MCI subgroup (n=21 cases), and IGR patients were also assigned into MCI (n=14) and non-MCI subgroup (n=16). The clinical data were compared between the MCI and non-MCI subgroup in T2DM group and IGR group. SPSS statistics 17.0 was used for data processing. Multivariate logistic regression analysis was employed to explore the independent influencing factors of MCI in elderly patients with T2DM or IGR. Results Compared with that of the control group [30.0%(9/30)], the incidence rate of MCI was significantly higher in the IGR group [46.7%(14/30), P=0.002] and T2DM group [65.0%(39/60), P=0.004], and it was obviously higher in the latter group than the former group (P=0.006). Compared with control group, IGR group and T2DM group had significantly shorter educational length and lower score of Montreal cognitive assessment (MoCA) scale, and increased levels of low-density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin Alc (HbA1c), fasting blood glucose (FBG) and postprandial 2-hour blood glucose (PBG). What′s more, MoCA score was reduced while the levels of HbA1c, FBG and PBG were increased significantly in the T2DM group than the IGR group (P<0.05). Univariate analysis showed that age, systolic blood pressure (SBP), and levels of LDL-C, HbA1c and FBG were significantly higher, while education length was shorter and MoCA score was lower in the MCI subgroups than those of corresponding non-MCI subgroups in both T2DM group and IGR group (P<0.05). Multiple logistic regression analysis showed that age (OR=1.104,5%CI 1.026-1.132, P=0.023; OR=2.001,5%CI 1.296-2.134, P=0.038), FBG (OR=2.138,5%CI 0.283-6.132, P=0.042; OR=0.986,5%CI 0.010-2.448, P<0.001) and LDL-C (OR=3.382, 95%CI 1.613-8.206, P=0.008; OR=2.682,5%CI 1.983-5.751, P=0.022) were the same independent risk factors, while educational years was the same independent protective factors (OR=1.688,5%CI 0.172-3.394, P=0.002; OR=1.692, 95%CI 0.187-3.412, P=0.003) for MCI in the elderly T2DM and IGR patients. Conclusion The elderly T2DM patients are at high risk of MCI. This trend has appeared since the IGR stage. Therefore, it is necessary to control the levels of FBG and LDL-C in elderly patients with IGR as early as possible.

Abstract:Objective To know the current status and existing problems of hospice care services in long-term care facilities in Tianjing, and to bring forward to comments and suggestions for the development of hospice care in the long-term care facilities in China. Methods The family members of the aged who died in 6 long-term care facilities in Tianji from January 2016 to June 2017 were selected as the survey objects. General characteristics questionnaire and the Chinese version of family perception of care scale (FPCS) were employed to survey the family members of 135 old persons who died in the long-term-care facilities. SPSS statistics 20.0 was used for data analysis. Results The average score of each item in the FPCS scale was 5.09. The 5 items with lower scores were “religious services”, “individualized nursing”, “participating in the nursing plan”, “pain control” and “enough staffs”. The 3 items about which family members concerned most were “comfortable nursing”, “respect for the elderly” and “pain control”. Conclusion The results of Chinese version FPCS indicate that these family members are satisfied with the hospice services provided by the facilities. The facilities should strengthen the construction of inadequate aspects in the future.

Abstract:Objective To compare the efficacy and safety of compound reserpine triamterene tablets (No.0) with other anti-hypertensive drugs for the treatment of the elderly hypertensive patients. Methods From August 2018 to December 2018, a total of 1574 elderly hypertensive patients were recruited for the study from 26 community health service centers in 10 municipalities or provinces, namely, Tianjin, Henan, Anhui, Shandong, Jiangsu, Shanxi, Sichuan, Liaoning, Beijing, and Hebei. They were divided into No.0 group who took No. 0 (matched by an age difference ≤ 5 years and gender with a ratio of 1∶1) and Non-No.0 group who did not, with 787 patients in each. Of all the patients, 186 at advanced age (≥80 years) were divided into 2 sub-groups:aged No.0 subgroup (n=102) and aged non-No.0 subgroup (n=84). The two groups were compared in clinical data and the two sub-groups were compared in terms of the lab findings and mental status scores. Statistical analysis was performed using SPSS statistics 22.0. Results No significant difference was observed in hypertension grade and blood pressure on visits between the two groups (P>0.05). The No.0 group took significantly fewer anti-hypertensive tablets daily than the non-No.0 group [(1.33±0.63) vs (1.41±0.63) pills,P<0.05]; similarly, the former group took significantly less calcium channel blocker (CCB) (16.39% vs 70.14%), angiotensin converting enzyme inhibitors (ACEI) (4.07% vs 11.82%), angiotensin receptor blocker (ARB) (9.53% vs 34.18%), beta blockers (4.32% vs 13.09%) or diuretics (1.65% vs 6.86%) than the non-No.0 group (P<0.05). In terms of safety, there was no statistically significant difference between the 2 groups and the two sub-groups at advanced age in white blood cell, hemoglobin, platelets, liver function, renal function, fasting plasma glucose, serum lipid, depression and anxiety score (P>0.05). Conclusion Compound reserpine triamterene tablets have anti-hypertensive effect in the elderly patients with good safety, reducing the number of tablets taken daily and improve patient compliance.

Abstract:Objective To explore the correlation between salt intake and non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes mellitus (T2DM) patients in northern China. Methods A total of 978 T2DM patients hospitalized in our department from October 2016 to November 2018 were subjected in the study. They were assigned into non-NAFLD group (n=177) and NAFLD group (n=801). Their salt intake was assessed by 24-hour urinary sodium excretion.The clinical data such as body mass index (BMI), diastolic blood pressure (DBP), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), total insulin, glycosylated hemoglobin A1c (HbA1c), fasting C-peptide and fasting blood glucose (FBG) were collected and analyzed. SPSS statistics 17.0 was used to analyze the data. After the factors with statistical significance screened out by univariate analysis, the independent risk factors for NAFLD in T2DM patients were identified by multiple logistic regression analysis. Spearman correlation analysis was employed to identify the correlation between salt intake and NAFLD. Results Spearman correlation analysis showed that there was a positive correlation between salt intake and NAFLD in T2DM patients (r=0.129, P<0.001). The results of multiple logistic regression analysis indicated that BMI (OR=5.321,5%CI 3.514-8.057), HbA1c (OR=1.126,5%CI 1.006-1.260), fasting C-peptide (OR=1.656,5%CI 1.273-2.156), FBG (OR=1.697,5%CI 1.060-2.717) and salt intake >10.83g/d (10.83g/d< salt intake≤14.52g/d:OR=2.181,5%CI 1.225-3.882; salt intake ＞14.52g/d:OR=2.140,5%CI 1.167-3.926) were independent risk factors for NAFLD in T2DM patients (P<0.05). Conclusion High salt intake (>10.83g/d) is a risk factor for NAFLD in T2DM patients living in northern China.

Abstract:Objective To observe the clinical efficacy of theophylline sustained-release tablets in treatment of dyspnea in coronary heart disease (CHD) patients after administration of ticagrelor. Methods A total of 100 CHD patients who experienced breathing difficulty but had clear consciousness and normal comprehension after taking ticagrelor in the Department of Cardiology of our hospital from March 2018 to February 2019 were enrolled in the study. They were randomly divided into theophylline group and control group, with 50 cases in each group. Both groups were given anti-platelet aggregation and statins to stabilize plaque and improve heart ischemia. Theophylline sustained-release tablets were given to the theophylline group on the basis of the above treatment, 0.1 g orally, vitamin C were given to the control group, 1 g orally, twice a day for 1 month. Serum adenosine levels, score of clinical symptoms of dyspnea, modified British Medical Research Association dyspnea scale (mMRC), pulmonary function indicators, respiratory failure and incidence of major adverse cardiovascular and cerebrovascular events (MACCE) were compared between the 2 groups. SPSS statistics 19.0 was used for data analysis. Results The theophylline group had significantly lower serum adenosine concentration [(99.0±17.0) vs (160.0±30.0)μg/L], score of clinical symptom of dyspnea [(1.2±1.3) vs (6.5±1.7)], mMRC score [(1.0±0.7) vs (2.1±0.4)], forced expiratory volume in 1 second (FEV1) as a percentage of prediction [(85.2±5.3)% vs (76.9±7.0)%],FEV1/forced vital capacity [(89.3±3.9)% vs (77.9±4.4)%], and incidence of respiratory failure [2.0%(1/50) vs 18.8%(8/50)] when compared with the control group (P<0.05). There was no significant difference in the incidence of MACCE between the 2 groups [6.0%(3/50) vs 10.0%(5/50), P=0.715]. Conclusion Theophylline tablets effectively alleviate the dyspnea caused by ticagrelor, improve the ventilatory function, and have no effect on antiplatelet aggregation induced by ticagrelor in the CHD patients.

Abstract:Objective To investigate the effects of melatonin(MEL) on pulmonary artery pressure and expression of cyclooxygenase-2 (COX-2) in rats with monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). Methods Thirty-six rats were randomly divided into control group, model group (MCT), and intervention group (MCT+MEL). MCT of 2.5ml/kg (50mg/kg, dissolved in mixture of anhydrous ethanol and normal saline) was injected intraperitoneally into the rats of the model group and intervention group to establish PAH. The rats from the control group received intraperitoneal injection of 2.5ml/kg of the solvent. From the 1st day to the 28th day after the injection, MEL of 10ml/kg (10mg/kg, dissolved in mixture of anhydrous ethanol and normal saline) was injected intraperitoneally in the intervention group, once a day, and the control group and the model group were given same dose of the solvent. Mean pulmonary artery pressure (mPAP), right ventricular hypertrophy index (RVHI), vascular wall thickness/vascular external diameter (WT%), vascular wall area/total vascular area(WA%), and the average optical density(AOD) of COX-2 expression were measured and recorded. SPSS statistics 22.0 was used for data analysis. Results Compared with control group, the mPAP, RVHI, WT%, WA% and AOD were significantly higher in the model group, but the above indices were reduced in the intervention group when compared with those of the model group, but still higher than those in control group with statistical significance (P<0.001). Correlation analysis showed that AOD was positively correlated with mPAP, RVHIV, WT% and WA% (r=0.836,0.749,0.823,0.821 respectively, P<0.01). Conclusion MEL can reduce MCT-induced PAH and improve pulmonary vascular remodeling in rats, which may be associated with its inhibiting COX-2 expression.

Abstract:Pelvic fractures are mostly caused by high-energy violence such as falls from great heights and traffic accidents. Pelvic fractures are life-threatening because they may not only result in serious injuries of the pelvis itself but also are often accompanied by complex severe multiple injuries. This article reports the treatment of an elderly patient with multiple injuries complicated with unstable pelvic fracture and summarizes the concepts and strategies related to the diagnosis and treatment in each specialty. It provides a reference for clinical treatment of such patients.

Abstract:Myocarditis is still facing challenges clinically because of its complex pathogenesis and poor prognosis. Evidence shows that programmed cell death protein-1 (PD-1) is an important immunological checkpoint, and its binding to programmed cell death ligand-1 (PD-L1) can negatively regulate the immune response of the body and play an important role in the occurrence and development of myocarditis. This article reviews the roles of PD-1/PD-L1 in the pathogenesis of myocarditis in aspects of their regulation of T lymphocyte activation and inhibition of troponin antibody and myocardial inflammation in order to find a new target for the effective diagnosis and treatment of myocarditis.

Abstract:Coronary heart disease (CHD) has a high morbidity and mortality in China. The study of its risk factors has always been a hot focus. Studies have found type D personality as an independent risk factor for the occurrence and prognosis of CHD. This paper reviews the studies of personality and CHD, focusing on the introduction of type D personality, including its origin, characteristics and evaluation methods, and exploring the progress made both at home and abroad in clinical research of the effects of type D personality on CHD and its mechanism. It is expected to provide the basis for improving the prognosis in CHD patients of type D personality.

Abstract:Homocysteine, involved in the occurrence and development of atherosclerosis, is an independent risk factor of cardio-vascular diseases. Evidence shows that it is related to injury of vascular endothelial cells, increase of inflammatory response and oxidative stress response. This article summarizes the research progress of relationship between homocysteine and atherosclerotic heart disease, and hopes to provide reference for its prevention, early diagnosis and prognosis evaluation.

Abstract:Since the incidence and mortality of pulmonary thromboembolism (PTE) are quite high, early diagnosis and treatment become the key to improve the prognosis. However, the diversity and lack of specificity in its clinical manifestations lead to serious misdiagnosis and missed diagnosis. This article sums up and sorts out the occurrence and causes of delayed diagnosis of PTE based on 3 levels, patients, clinicians and hospitals, and focuses on the differential thinking between PTE and confusing diseases (coronary heart disease, pneumonia, chronic obstructive pulmonary disease) in order to improve the early diagnosis rate of PTE.