Abstract:Objective To investigate the effect of dyslipidemia on mild cognitive impairment (MCI) in the elderly with type 2 diabetes mellitus (T2DM). Methods From January 2018 to January 2019, a total of 378 elderly T2DM patients were selected from our department. According to their cognitive function, they were divided into two groups:normal group (n=302) and MCI group (n=76). Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were employed for cognitive screening, and baseline data and clinical parameters were collected. SPSS statistics 17.0 was used for data processing. Multivariate logistic regression was used to analyze the risk factors for MCI. Results The analysis with stratification by median age (70 years) showed that, in the group over 70 years old (n=180; 52 with MCI), low-density lipoprotein cholesterol (LDL-C) (OR=3.01,5%CI 1.37-6.96, P=0.006) and total cholesterol (TC) (OR=1.75,5%CI 1.16-2.64, P=0.008) were the risk factors for MCI in the elderly T2DM patients. When the patients were further stratified according the level of blood lipid, the results showed that TC≥5.2mmol/L increased the risk of MCI to 2.59 folds (P=0.019) and LDL-C≥ 3.4mmol/L to 3.24 folds (P=0.001) in T2DM patients. Conclusion The occurrence of MCI in the elderly T2DM patients may be closely associated with the increase of TC and LDL-C levels.

Abstract:Objective To explore the effect of early enteral nutrition (EEN) intervention on nutrition and pulmonary function in the elderly pulmonary inflammatory disease patients with malnutrition. Methods A total of 96 elderly pulmonary inflammatory disease patients accompanied with malnutrition admitted in the Nutrition Department of our hospital from May 2017 to December 2018 were recruited in this study. They were randomly divided into control group and research group, with 48 cases in each group. The patients of the control group were only given routine dietary intervention, while those of the study group were given EEN on the basis of the control group. Nutritional status [total serum protein (TP), albumin (ALB), hemoglobin (Hb)], pulmonary function [forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC], immune function (percentages of CD3⁺ and CD4⁺ cells, CD4⁺/CD8⁺, and IgA, IgG and IgM levels) and inflammatory indices [interleukin 10 (IL-10), IL-6 and tumor necrosis factor α(TNF-α)] were observed and compared between the 2 groups before and in 14 d after treatment. SPSS statistics 21.0 was used for data analysis. Independent sample t test was employed for comparison between groups. Results (1)Nutritional status. TP, Hb and ALB in control group were increased from (56.03±2.81), (28.53±2.85) and (109.74±10.97)g/L respectively before intervention, to (56.15±2.82), (28.92±2.89) and (123.86±12.39)g/L after intervention. For the research group, the indicators were increased from (56.17±2.82), (28.57±2.86) and (112.96±11.30)g/L respectively to (59.77±2.99), (32.47±3.25) and (131.07±13.11)g/L respectively. There was no significant differences in the levels between the 2 groups before intervention (P>0.05), and the levels were significantly higher in the research group than the control group after intervention (P<0.05). (2)Pulmonary function. FEV1, FVC and FEV1/FVC changed from (1.40±0.14)L, (2.33±0.42)L and (62.11±6.26)% before intervention to (1.63±0.18)L, (2.51±0.41)L and (66.93±6.70)% after intervention in the control group. In the research group, FEV1, FVC and FEV1/FVC were increased from (1.42±0.12)L, (2.41±0.37)L and (62.48±6.31)% to (1.93±0.27)L, (2.79±0.36)L and (72.54±7.23)% respectively. No significant differences was seen in the levels of FEV1, FVC and FEV1/FVC between the 2 groups before intervention (P>0.05), and the levels in the research group were significantly higher than those in the control group after intervention (P<0.05). (3)Immune and inflammatory indices. Before intervention, there were no significant differences in immune function related indices and inflammatory indices between the 2 groups (P>0.05). After intervention, the level of IL-10 was significantly increased, while those of IL-6 and TNF-α were obviously decreased in the research group when compared with the control group (P<0.05). Conclusion EEN intervention effectively improves the nutritional status in the elderly patients with pulmonary inflammatory diseases, improves the immunity and attenuates their inflammatory responses, and improves the cardiopulmonary function. It is worthy of clinical promotion.

Abstract:Objective To analyze the influencing factors for medication compliance in patients with first-episode acute ischemic stroke (AIS). Methods A total of 223 AIS patients admitted in our Neurology Department from September 2017 to March 2018 were enrolled in this study. According to Morisky medication adherence scale, they were divided into poor compliance group (score<6 points, n=107) and good compliance group (score≥6 points, n=116). The clinical features, recurrence and prognosis 1 year later were compared between the 2 groups. SPSS statistics 20.0 was used to analyze the data. Multivariate logistic regression analysis was employed to analyze the influencing factors of medication compliance. Results The proportion of patients with good compliance was 50.02% (116/223). Compared with the poor compliance group, the good compliance group had significantly higher proportions of medical insurance reimbursement, monthly income (>￥1500), urban household registration, hypertension, diabetes mellitus, taking antihypertensive drugs, and taking antidiabetic drugs, while obviously lower proportions of farmers, lower educational level, recurrence of stroke after 1 year and having the score of Modified rankin scale<3 (all P<0.05). Multivariate logistic regression analysis showed that medical insurance reimbursement (OR=0.289,5%CI 1.326-9.002; P=0.011), taking antihypertensive drugs (OR=2.451,5%CI 1.064-5.646; P=0.035) and hypoglycemic drugs (OR=9.515,5%CI 1.949-46.452; P=0.005) were protective factors for drug compliance, while farmers (OR=0.320,5%CI 0.146-0.702; P=0.004), monthly income less than ￥1500 (OR=0.471,5%CI 0.238-0.932; P=0.031), educational level of primary school or lower (OR=0.376, 95%CI 0.168-0.844; P=0.018) were risk factors for drug compliance. Conclusion The patients with good medication compliance have a lower recurrence rate and better prognosis 1 year later. Active attention should be paid to management of the patients without medical insurance reimbursement, with monthly income less than ￥1500, with educational level of primary school or lower, farmers, without hypertension or diabetes mellitus, and having not taken antihypertensive and antidiabetic drugs.

Abstract:Objective To investigate the clinical effects of oxiracetam in the treatment of elderly patients with craniocerebral brain injury, and its effects on inflammation and oxidative stress. Methods A total of 80 elderly patients with cranio-cerebral brain injury were randomly divided into observation group and control group (40 in each group). Both groups received routine treatment based on the patient′s condition, while the observation group received additional oxiracetam once a day for 12 days. ELISA was employed to measure the expression levels of malondialdehyde (MDA), lipoeroxides(LPO), superoxide dismutase (SOD), and total antioxidant capacity (TAOC), and cytokines interleukin-4 (IL-4), IL-10, IL-1β, and tumor necrosis factor-α (TNF-α). Meanwhile, the two groups were compared for sober time during treatment and consciousness recovery time. Data were statistically analyzed using GraphPad Prism 5.0. The comparison between the two groups was performed by t/χ² test. Kaplan-Meier survival analysis and Log-rank test were also performed. Results Compared with before the treatment, IL-4, IL-10, TAOC and SOD increased significantly, and TNF-ɑ, IL-1β, MDA and LPO decreased significantly (P<0.05) in both groups. After the treatment, SOD and IL-10 in the observation group were significantly higher than those in the control group (P<0.05), and the MDA was significantly lower than the control group (P<0.05). During the treatment, the recovery rate of consciousness in the observation group was significantly higher than that in the control group [85.0%(34/40) vs 67.5%(27/40), P<0.05], and the awake time in the former was also significantly longer than that in the latter [(7.56±1.52) vs (5.21±1.49)d, P<0.05]. The survival analysis showed that the survival rates of the observation group was higher than that of the control group, and the difference was statistically significant[92.5%(37/40) vs 65.5%(26/40),P<0.05]. Conclusion Oxiracetam is effective for craniocerebral brain injury in the elderly patients, and its mechanism may be related to inhibition of inflammatory reaction and oxidative stress.

Abstract:Objective To study the changes of serum myeloperoxidase (MPO) and amylin levels in elderly obstructive sleep apnea hypopnea syndrome (OSAHS) patients with different severities and its significances. Methods A total of 134 elderly OSAHS patients admitted to our hospital from February 2012 to October 2016 were retrospectively recruited in this study. According to their apnea hypopnea index (AHI), they were divided into severe group (n=55), moderate group (n=41) and mild group (n=38). Polysomno-graphy (PSG) indicators, MPO and amylin levels were compared among the 3 groups. Spearman correlation analysis was used to analyze the influencing factors of amylin and MPO levels. SPSS statistics 13.0 was employed to analyze the data. Analysis of variance or Chi-square test was applied to make intergroup comparison according to different data types. Results Compared with the severe group, AHI, oxygen desaturation index (ODI), apnea and hypopnea frequency were decreased significantly, and the lowest oxygen saturation (LSaO₂) and mean arterial oxygen saturation (MSaO₂) at night were increased obviously in the mild group and the moderate group (P<0.05). Before continuous positive airway pressure (CPAP) ventilation treatment, the severe group had notably higher serum levels of amylin [(47.85±6.41) vs (20.29±3.06) and (31.57±5.27)ng/ml] and MPO [(37.92±9.88) vs (7.61±2.04) and (23.33±4.56)ng/mg] than the mild and moderate groups (P<0.05). In 6 months and 1 year after the treatment, the serum levels of amylin [(34.17±4.96) and (27.14±3.86) vs (47.85±6.41)ng/ml] and MPO [(21.06±8.39) and (12.17±7.53) vs(37.92±9.88)ng/mg] were significantly lower in the patients of the severe group when compared with the levels before treatment (P<0.05). Spearman correlation analysis showed that MPO and amylin levels were negatively correlated with LSaO₂ and MSaO₂, and positively correlated with AHI and apnea frequency. Conclusion Serum amylin and MPO levels show reference values in evaluation of the risk for insulin resistance and of the therapeutic effect of CPAP in elderly OSAHS patients.

Abstract:Objective To investigate the association between the P-wave terminal force in lead V1 (PtfV1) and prognosis in the electrocardiogram (ECG) of the acute coronary syndrome (ACS) patients. Methods A total of 308 ACS patients were selected from Cadre′s Ward and the Departments of Cardiology of Beijing Aerospace Hospital, during May 2017 and June 2018. All patients underwent electrocardiogram examination, and they were divided into 3 groups according to the value of PtfV1:PtfV1<20mm·ms group (n=106), 20mm·ms≤PtfV1≤40mm·ms group (n=100) and PtfV1>40mm·ms group (n=102). All of the patients were followed up for at least 6 months. The clinical data and the incidences of major adverse cardiovascular events (MACEs) were compared in the 3 groups. SPSS statistics 20.0 was used for data analysis, and Kaplan-Meier survival analysis was applied to analyze the differences in survival rates between non-MACEs patients of the 3 groups. Results During the follow-up of 6-30 (12.5±7.2) months, the incidence of MACEs was 1.89% (2 cases) in the PtfV1<20mm·ms group, 7.00% (7 cases) in the 20mm·ms≤PtfV1≤40mm·ms group and 11.76% (12 cases) in the PtfV1>40mm·ms group. Kaplan-Meier analysis showed that significant difference were seen in the survival rate among the 3 groups (Chi-square=8.152, P=0.017), with that of the PtfV1<20mm·ms group obviously lower than that of the PtfV1>40mm·ms group (Chi-square=8.079, P=0.004). Conclusion PtfV1 is associated with the incidence of cardiovascular events in ACS patients, and can be used as a predictor for prognosis and the incidence of long-term cardiovascular events.

Abstract:Objective To investigate the relationship between the platelet-to-lymphocyte ratio (PLR) and prognosis of the patients who underwent thrombectomy for acute anterior circulation ischemic stroke. Methods A retrospective analysis was made of demographic data of 92 patients having undergone thrombectomy for acute anterior circulation ischemic stroke. On the basis of a PLR level cut-off value of 168 from receiver operating characteristic (ROC) curve, the patients were divided into two groups:PLR＞168 group (n=48) and PLR≤168 group (n=44). The two groups were compared in clinical indices including success rate of postoperative revascularization and modified Rankin scale (mRS) scores at postoperative 30 and 90 days. Data was processed using SPSS statistics 19.0. ROC curve was used to assess the correlation between PLR and prognosis. Results Successful revascularization were 70.8% in the PLR＞168 group against 90.9% in the PLR≤168 group (P=0.011). At postoperative 30 days, patients with mRS≤2 were significantly more in the PLR≤168 group (54.5%) than in the PLR> 168 group (18.8%, P=0.001). Compared with the PLR＞168 group at postoperative 90 days, the PLR≤168 group had significantly more patients with mRS≤2 (56.5% vs 22.9%, P=0.001) and significantly lower mortality rate (27.1% vs 9.1%, P=0.026). The PLR value predicted a cut-off point of 168 with a sensitivity of 68%, a specificity of 67%, and the area under the ROC curve of 0.738 for the prognosis of patients having undergone pre-circumferential mechanical thrombectomy for acute cerebral infarction complicated with large vascular occlusion. Conclusion High PLR is associated with the poor prognosis of the patients having undergone mechanical thrombectomy for with cerebral infarction caused by anterior circulation cerebral vascular occlusion.

Abstract:Objective To investigate the efficacy and safety of ticagrelor in the treatment of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients accompanied with obstructive pulmonary disease (COPD). Methods A retrospective analysis was made on 194 cases of NSTE-ACS combined with COPD from January to November 2018 in the Department of Cardiology of the Fourth People′s Hospital of Shaanxi Province. According to the usage of antiplatelet drugs, they were divided into ticagrelor group (n=96) and clopidogrel group (n=98). All of them underwent elective percutaneous coronary intervention (PCI). The patients of the ticagrelor group were given at a loading dose of 180 mg preoperatively, and at 90 mg, twice a day post-operatively or to those non-operative patients. While, those of clopidogrel group were given 300 mg preoperatively, 75 mg, twice a day post-operatively, and 75mg to the non-operative patients. In 1 month after administration, improvement of dyspnea, score of British Medical Research Council Scale (mMRC), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), percentage of FEV1 to the predicted value (FEV1% pred) and FEV1/FVC were evaluated and compared between the 2 groups. The incidence of major adverse cardio-cerebrovascular events (MACCE) and bleeding events were also compared after 6 months of follow-up. SPSS statistics 22.0 was used for data analysis. Student′s t test or Chi-square test was applied to make comparison between 2 groups according to the different data types. Results There were no significant differences in age, gender, body mass index, hypertension, diabetes, hyperlipidemia,unstable angina pectoris and proportion of patients undergoing PCI between the 2 groups (P>0.05). One month later, no significant differences were found in the score of clinical dyspnea symptoms (2.2±0.6 vs 1.4±0.8), mMRC score (3.4±0.5 vs 2.9±0.9), FEV1/FVC [(75.7±4.6)% vs (71.0±9.2)%] and FEV1% pred [(69.1±6.6)% vs (67.6±5.9)%] between the clopidogrel group and the ticagrelor group (P>0.05). After 6 months of follow-up, the incidence of MACCE was significantly lower in the ticagrelor group than the clopidogrel group [5.2%(5/96) vs 12.2%(12/98), P=0.043], but no difference was seen in that of bleeding events [19.8%(19/96) vs 10.2%(10/98), P=0.061]. Conclusion Ticagrelor does not affect the pulmonary ventilation function in patients with NSTE-ACS and COPD, and effectively reduces the risk of short-term MACCE, and has no effect on the incidence of bleeding events.

Abstract:Objective To determine the effect of tolvaptan on cardiac function and neuroendocrine factors. Methods A total of 84 elderly patients with heart failure (HF) admitted in Shaanxi People′s Hospital from January 2017 to January 2019 were retrospectively collected in this study. According to the diuretic drugs, they were divided into furosemide group and tolvaptan group (n=42). After 2 weeks of treatment, the cardiac function indicators and the levels of brain natriuretic peptide (BNP), endothelin (ET) and beta-endorphin were compared between the 2 groups. SPSS statistics 18.0 was used to analyze the data. Student′s t test or Chi-square test was employed for intergroup comparison. Results After treatment, left ventricular ejection fraction (LVEF) and 6-minute walking distance were increased, while left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), heart rate, and serum levels of BNP, ET and beta-endorphin were decreased in both groups. After treatment, the levels of LVEF [(45.77±3.41)% vs (40.82±4.09)%], 6-minute walking distance [(474.51±8.45) vs (395.90±6.48)m], LVESD [(41.09±3.47) vs (45.63±4.55)mm], LVEDD [(52.07±5.47) vs (58.61±6.11)mm] and heart rate [(80.47±8.22) vs (90.55±6.45)beats/min] were greatly improved, and the levels of BNP [(456.36±5.24) vs (684.80±6.35)ng/L], ET [(45.77±5.22) vs (66.03±5.76)ng/L] and beta-endorphin [(123.79±10.35) vs (140.82±11.64)ng/L] were notably decreased in the tolvaptan group than in the furosemide group (P<0.05). Compared with the furosemide group, the total effective rate of tolvaptan group was higher in tolvaptan group [90.48%(38/42) vs 78.57%(33/42), χ²=5.422, P=0.020], but no such difference was seen in the incidence of adverse reactions between the 2 group [(4.76%(2/42) vs 9.52%(4/42), P>0.05]. Conclusion Tolvaptan can improve cardiac function and reduce neuroendocrine factors in elderly patients with heart failure.

Abstract:Objective To investigate the effects of Wenshen Tongluo Decoction on the renal function, oxidative stress, angiogenesis and immune parameters in the patients with chronic kidney disease (CKD) stages 3 and 4. Methods A total of 98 CKD patients admitted to our hospital from January 2016 to June 2018 were enrolled, and randomly divided into study group and control group, with 49 cases in each group. The patients of both groups were given basic medical treatment of western medicine, and those of the study group were added with Wenshen Tongluo Decoction. Before and 8 weeks after treatment, their urea nitrogen (BUN), serum creatinine (SCr), uric acid (UA), serum cystatin C (Cys-C), Traditional Chinese Medicine (TCM) syndrome scores, malondialdehyde (MDA), superoxide dismutase (SOD), vascular endothelial growth factor (VEGF), endostatin (ES), and peripheral blood T lymphocytes were measured and compared between the 2 groups. SPSS statistics 21.0 was used to analyze the data. Student′s t test or Chi-square test was employed for comparison between groups. Results After treatment, the above levels and indicators were significantly improved in both group (P<0.05). The study group had significantly lower BUN [(7.20±1.33) vs (8.01±1.40)mmol/L], SCr [(126.0±15.3) vs (134.2±18.2)μmol/L], UA [(380.1±27.4) vs (395.8±24.0)μmol/L], Cys-C [(1.28±0.21) vs (1.43±0.23)mg/L], VEGF [35.2±5.0) vs (39.7±6.1)pg/ml] and ES [(37.2±6.8) vs (41.8±7.3)ng/ml], and obviously increased percentages of CD3⁺ [(59.6±4.0)% vs (57.3±3.5)%] and CD4⁺ cells [(38.8±3.0)% vs (36.9±3.3)%], higherCD4⁺/CD8⁺ ratio [(1.49±0.21) vs (1.33±0.18)] and SOD level [(90.6±13.8) vs (81.8±14.0)U/ml] when compared with the control group (all P<0.05). After treatment, the TCM symptom scores were notably lower in the study group than in the control group [(8.5±2.7) vs (11.0±3.0), P<0.05]. Conclusion Wenshen Tongluo Decoction can effectively improve renal function, oxidative stress indicators, angiogenesis and immune parameter in the patients with stages 3 and 4 CKD.

Abstract:Objective To investigate the effect of norcepharadion B (NB) extracted from Houttuynia cordata on the injury of hippocampal neurons induced by H₂O₂ and its possible mechanism. Methods Hippocampal nerve cells (HT22) in logarithmic growth phase were divided into control group, H₂O₂ group, H₂O₂+NB group, NB group and H₂O₂+NAC group. H₂O₂ group were incubated with H₂O₂ at a final concentration of 300μmol/L for 24h; the H₂O₂+NB group were treated with 100μmol/L NB and H₂O₂+NAC group with 5mmol/L NAC for 2 hours before incubation with H₂O₂ for 24h. To determine whether phosphatidylinositol-3 kinase/protein kinase B/heme oxygenase-1 (PI3K/Akt/HO-1) pathway is involved in the neuroprotection of NB, the neurons were pretreated with Ly294002, a PI3K inhibitor, for 30min before incubation with NB and H₂O₂ for 24h. Cell survival rate was detected by CCK-8 test and apoptosis by flow cytometry. Lactate dehydrogenase (LDH), superoxide dismutase (SOD), glutathione (GSH) and malondialdehydemalonic dialdehyde (MDA) were measured by biochemical kit. Western blotting was performed to detect the expression of B-celllymphoma/leukemia-2 (Bcl-2), Bcl-2 associated X protein(Bax), and phosphorylated Akt (p-Akt) and HO-1. SPSS statistics 19.0 was used for analysis. ANOVA or Tukey′s test was used for intergroup comparison.Results (1) Cell activity. Compared with control group, the survival rate of H₂O₂ group decreased significantly, LDH in the cell supernatant increased significantly, cell shrinkage, vacuole degeneration and cell reduction were observed. However, intervention with NB or NAC significantly increased cell activity, reduced LDH release, and significantly improved cell morphological damage. (2) Oxidative damage indicators. Compared with control group, MDA in H₂O₂ group increased significantly, and SOD and GSH decreased significantly; compared with H₂O₂ group, MDA leakage decreased significantly after the intervention with NB or NAC, and the SOD and GSH activities increased significantly. (3) Apoptosis. Flow cytometry showed that the apoptosis rate in the H₂O₂ group was significantly higher than that in the control group, and the apoptosis rate of H₂O₂ group was significantly lower than that in H₂O₂＋NB group and H₂O₂＋NAC group (P<0.05). Western blotting showed that compared with control group, Bcl-2 in H₂O₂ group decreased significantly, and the Bax level increased significantly; compared with H₂O₂ group, Bcl-2 in the H₂O₂+NB group or H₂O₂+NAC group increased significantly, and the Bax level decreased significantly. (4) Western blotting showed that p-Akt and HO-1 in H₂O₂ group were higher than those in control group, and p-Akt and HO-1 in the NB+H₂O₂ group were significantly higher than those in H₂O₂ group (P<0.05). There was no significant differences between control group and NB group in the indicators all above (P>0.05). In addition, the expression level of p-Akt and HO-1 in Ly294002+H₂O₂+NB group was significantly lower than that in H₂O₂₊NB group. Conclusion NB provides neuroprotection by mitigating the neural injuries induced by H₂O₂ through anti-oxidation and anti-apoptosis, whose underlying mechanism may be attributed to signaling pathway of the activation of the PI3K/Akt/HO-1.

Abstract:Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world with insidious early symptoms and poor prognosis. In clinical practice, there are some limitations in its early diagnosis. A wide array of studies have shown that micro ribonucleic acid-375 (miR-375) is closely related to the occurrence and development of HCC, exerting an effect by targeting oncogenic signaling pathways, thus serving as a marker of early diagnosis or prognosis of HCC. This article reviews the recent progress in the research on miRNA-375 and HCC, with a view of providing a theoretical basis for the early diagnosis, treatment and prognosis of HCC.

Abstract:With the aging society comes the increasing incidence of comorbidities. The number and the complexity of comorbid conditions increase with advancing age. Current clinical practice and research, however, mainly target single disease-specific care, without much attention to the complexities imposed by comorbid conditions. This review focuses on comorbidity management in the elderly in terms of the emerging concepts, clinical multidisciplinary decision-making in diagnosis and treatment, challenging issues, and highly sought-after research topics. Strategies are put forward for the management of comorbidities in the elderly.

Abstract:An obvious increase is witnessed in the incidence of type 2 diabetes mellitus (T2DM) in the elderly with changes in people′s lifestyles and the aging of the population. Compared with non-diabetic elderly patients, the risk of cognitive decline increased by 1.5 times in the elderly T2DM patients. Studies have shown that T2DM can affect cognitive function in the elderly, and increasing attention has also been drawn to the relationship between persistent hyperglycemia and cognitive impairment in the elderly with T2DM. However, few studies have focused on the relationship between blood glucose fluctuation and cognitive impairment and its mechanism in those patients. This article reviews the potential mechanism of glucose fluctuation and cognitive impairment in elderly T2DM patients.

Abstract:Trimethylamine oxide (TMAO), a metabolite of intestinal microorganisms, has been much focused on a marker of ischemic injury in recent years. With deepening research on the intestinal flora, researchers have found that TMAO is closely related to chronic diseases, especially cardiovascular and cerebrovascular diseases, diabetes, and chronic kidney disease. These diseases usually feature a long latent period, no obvious clinical symptoms, irreversible course, and poor prognosis. Therefore, early detection and treatment of these chronic diseases are particularly important. This article briefly summarizes the relationship between TMAO and the above chronic diseases and the main methods used to determine TMAO with a view of providing theoretical basis for early intervention of such chronic diseases.

Abstract:The risk for stroke in the patients with atrial fibrillation (AF) was five folds as high as in those without. Long-term effective anticoagulation is crucial in the AF patients with moderate to high risk for stroke. This article highlights the characteristics, advantages and disadvantages of vitamin K antagonists (VKAs) against direct oral anticoagulants (DOACs), and discusses the safety and effectiveness of VKAs for the prevention of stroke in patients with AF as compared with DOACs. The article then provides practical guidance whether to stay on VKAs or switch from VKAs to DOACs.