Abstract:Objective To evaluate the new mini nutritional assessment-short form (MNA-SF) in the assessment of nutritional status in the elderly inpatients with chronic diseases. Methods A total of 2 861 elderly patients aged 65 or older were selected in this study, who were hospitalized in Chengdu Elderly Care Hospital from March 2016 to May 2018. All the patients were assessed with the MNA-SF within 48 h after admission. Cronbach coefficient α was used to evaluate reliability of MNA-SF, and Kaiser-Meyer-Olkin (KMO) and Bartlett spherical test to evaluate its validity. According to MNA-SF score, the patients were divided into normal nutrition group (n=319), malnutrition risk group (n=1 046), and malnutrition group (n=1 496). The three groups were compared in nutrition-related indicators, and the nutritional status was predicted with the receiver operating characteristic (ROC) curve. SPSS statistics 22.0 was used for analysis. ANOVA, LSD-t test, rank sum test or χ² test was used for comparison.Results The incidence of malnutrition was 52.3% (1 496/2 861) in the inpatients with chronic diseases. Cronbach′s alpha of the MNA-SF was 0.711, showing a good reliability. KMO value was 0.827, indicating that factor analysis could be performed. Bartlett′s spherical test χ² was 27.616 (P<0.05), and the spherical hypothesis was rejected, indicating that factor analysis was possible. The eigenvalues of seven MNA items[dietary change, weight loss in recent three months, activity ability, stress or acute disease, neuropsychiatric disease, body mass index (BMI), calf circumference (CC)] were all greater than 1, and the cumulative variance contribution rate was 83.14%, indicating a reasonable validity of MNA-SF. The age of normal nutrition group, malnutrition risk group and malnutrition group tended to increase, while BMI, CC, albumin, prealbumin, transferrin and hemoglobin tended to decrease, with statistical significance (P<0.05). ROC curve showed that the best cut-off point for predicting nutritional status of the elderly inpatients with chronic diseases was 10 points, with a sensitivity of 78.93%, a specificity of 83.59%, and an area under curve of 0.797 (95%CI 0.781-0.811, P<0.05). Conclusion MNA-SF is applicable for nutritional assessment of the elderly inpatients with chronic diseases. With a high incidence of malnutrition, nutrition intervention in the elderly patients with chronic diseases should be implemented as soon as possible.

Abstract:Objective To investigate early renal injury in overlap syndrome (OS) and related indicators. Methods Enrolled in the study were 16 patients with OS (OS group) and 42 with chronic obstructive pulmonary disease (COPD; COPD group) treated in the Department of Respiratory and Critical Care Medicine of Nanjing First Hospital from January 2014 to August 2018. During the same period, 30 healthy people without hypoxic diseases were enrolled as control group. Measurement was made of the pulmonary indicators [percentage of predicted forced expiratory volume in 1 second (FEV1%), percentage of predicted forced vital capacity (FVC%), forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC)], blood gas analysis [partial pressure of oxygen (PaO₂) and partial pressure of carbon dioxide (PaCO₂)], indicators of renal function [blood urea nitrogen (BUN), serum creatinine(SCr), endogenous creatinine clearance rate (Ccr), cystatin C(Cys-C) and β₂-microglobulin (β₂-MG)]. The difference of the parameters among groups was observed. SPSS statistics 22.0 was used for statistical analysis. According to the data type, analysis of variance (ANOVA), LSD pairwise comparison or χ² test was used for comparison among groups, and Spearman rank correlation for the correlation between Cys-C or β₂-MG and other indicators. Results The OS and COPD groups scored significantly higher than the control group in COPD assessment test (CAT), PaCO₂, Cys-C and β₂-MG but significantly lower in PaO₂, FEV1%, FVC% and FEV1/FVC (P<0.05), but there were no significant differences in BUN, SCr and Ccr among the three groups (P>0.05). Compared with the COPD group, CAT, Cys-C and β₂-MG in the OS group were significantly higher(P<0.05). The correlation analysis showed that Cys-C and β₂-MG were positively correlated with CAT score(Cys-C:r=0.722,P=0.000；β₂-MG:r=0.287, P=0.029)and negatively correlated with PaO₂(Cys-C:r=-0.355, P=0.006；β₂-MG:r=-0.471, P=0.000), all with statistical significance(P<0.05).Conclusion Measurement of serum Cys-C and β₂-MG in OS patients can help monitor the degree of early renal injury, and Cys-C and β₂-MG are closely associated with hypoxia.

Abstract:Objective To investigate the association of the potentially inappropriate medications (PIM) with falls in the elderly patients. Methods A retrospective cross-sectional study was conducted of 280 inpatients aged ≥65 years who were divided into fall group (n=36) and non-fall group (n=244) based on a history of falling six months before admission. Patients′ general data were collected, and their clinical data such as hand-grip strength and walking speed were measured. Patients were assessed using Charlson comorbidity index (CCI) and mini nutritional assessment-short form (MNA-SF) scale. SPSS statistics 23.0 was used for statistical analysis, and t test, non-parametric test or χ² test was performed, depending on data types. Pearson correlation was used for the normal distribution, and Spearman correlation for the non-normal distribution data. Logistic regression was run to screen for independent risk factors. Results PIM among the enrolled patients were highly prevalent (69.3%,194/280), with psychotropic accounting for 36.1%(101/280), cardiovascular for 22.9%(64/280) and others for 8.9%(25/280). Significantly more patients using psychotropic PIM in the fall group than the non-fall group (58.3% vs 32.8%, P=0.005). Correlation analysis showed that falls were positively associated with osteoporosis (r=0.238, P<0.001), anxiety depression (r=0.170, P<0.004), use of ≥5 oral drugs (r=0.123, P=0.040), psychotropic PIM (r=0.178, P=0.004) and female (r=0.230, P=0.006), and negatively with hand-grip strength (r=-0.146,P=0.015)and walking speed (r=-0.134, P=0.025). Logistic regression showed falls correlated with osteoporosis (OR=3.973, 95%CI 1.759-8.973,P=0.001) and psychotropic PIM (OR=2.415,5%CI 1.141-5.114, P=0.021). Conclusion Psychotropic PIM was associated with falls in the elderly patients. Clinicians should be more mindful of rational prescrip-tions to avoid overuse of psychotropic PIM, particularly drugs of category A (high-alert), thus reducing the risk of fall in the elderly patients.

Abstract:Objective To explore the clinical significance of the serum level of procalcitonin (PCT) in assessment of infection severity and prognosis in the elderly patients with heart failure (HF) and pneumonia. Methods A total of 206 HF elderly patients (over 65 years old), who admitted to our hospital from February 2016 to February 2018 were enrolled in this study. They were assigned into HF plus pneumonia group (HF+P, n=156) and merely heart failure group (HF, n=50). Another 25 simple pneumonia inpatients in our department during the same period were randomly recruited and served as positive control group (P). Serum PCT levels of all the subjects were detected and compared among the 3 groups. For the patients of the HF+P group, they were further divided into 4 groups according to the serum PCT level, that is, <0.5,0.5≤PCT<2.0,2.0≤PCT<5.0 and ≥5.0 μg/L subgroups. The utilization ratio and time of intravenous antibiotic, length of hospital stay, incidence rate of multiple organ dysfunction syndrome (MODS), mortality and bacterial infection rate of these patients were recorded and analyzed. SPSS statistics 19.0 was used for data analysis. According to the data type, one-way analysis of variance, LSD-t test or Chi-square test was used for comparison among groups. Receiver operating characteristic (ROC) curve analysis was preformed to analyze the diagnostic effect of PCT on HT+P. Results The serum PCT level was (2.210±1.014)μg/L in the HF+P group, significantly higher than that of the HF group [(0.120±0.097)μg/L, t=13.583, P=0.000] and the P group [(1.031±0.425)μg/L, t=6.732, P=0.000]. The cut-off value of PCT was 0.32 μg/L in the diagnosis of HF+P for the elderly, with a sensitivity of 87.8% and a specificity of 96.0%. The positive and negative predictive values were 98.56%(137/139) and 71.64%(48/67), respectively. With the increase of serum PCT level in the HF+P group, the [JP+2]utilization ratio and time of intravenous antibiotic, length of hospital stay, morbidity of MODS, mortality and bacterial infection rate were increased significantly (P<0.05). Conclusion The serum PCT level has clinical values in assessment of infection severity, guiding the treatment of antibiotics, and evaluating the prognosis in the elderly HF+P patients.

Abstract:Objective To investigate the effects of holmium laser lithotripsy (HLL) and pneumatic lithotripsy (PL) under ureteroscope on the stress response and lithotripsy effectiveness in elderly patients with upper ureteral calculi (UUC). Methods Totally 100 elderly patients with UUC hospitalized in our department from June 2016 to June 2018 were recruited in this study. They were equally and randomly divided into HLL group and PL group. The effects of operation, lithotripsy, postoperative serum levels of cortisol (Cor) and adrenocorticotropic hormone (ACTH), and incidences of complications were compared between the 2 groups. SPSS statistics 22.0 was used to perform the statistical analysis. Chi-square test or Student′s t test was employed for comparison between the groups. Results The HLL group had significantly less volume of intraoperative bleeding [(60.97±7.02) vs (83.25±9.24)ml], shorter operative time [(66.43±6.81) vs (85.43±8.72)min], shorter lithotripsy time [(31.88±3.55) vs (40.45±4.22)min], less length of hospital stay [(6.42±1.07) vs (7.65±1.11)d], and lower serum levels of Cor [(387.11±40.12) vs (437.13±45.43) ng/ml] and ACTH [(14.02±1.54) vs (15.71±1.68)pmol/L] after operation when compared with the PL group (all P<0.01). What′s more, the success rate of single lithotripsy [100%(50/50) vs 88%(44/50), P=0.012] and stone removal rate [96%(48/50) vs 84%(42/50), P＝0.046] were obviously higher, while the incidences of complications were notably lower [6%(3/50) vs 20%(10/50), P=0.037] in the HLL group than the PL group. Conclusion HLL under ureteroscope effectively reduces the surgical trauma, complications and stress response in the elderly patients with UUC, with good lithotripsy effect. It is worthy of further clinical promotion.

Abstract:Objective To investigate the clinical efficacy of manual reduction combined with gastrodin and rehabilitation in the treatment of benign paroxysmal positional vertigo (BPPV) in the elderly patients. Methods A total of 90 BPPV elderly patients diagnosed in the Otolaryngology, Neurology and Geriatrics Departments of our hospital from September 2016 to February 2018 were prospectively recruited in this study. They were randomly divided into group A and group B, with 45 cases in each group. The patients of group A were treated with gastrodin and forced posture, while those from group B were given gastrodin treatment combined with manual reduction and rehabilitation. The clinical efficacy, vertigo score, and maximum blood flow velocity of basilar artery (BA), left vertebral artery (LVA) and right vertebral artery (RVA) were compared between the 2 groups. SPSS statistics 15.0 was used to perform the statistical analysis. Chi-square test or Student′s t test was employed for comparison between two groups. Results The total effective rate was 53.33%(24/45) in group A, and 91.11%(41/45) in group B, and the rate was significantly higher in group B than group A (P<0.05). The score of vertigo disability scale was obviously decreased in both groups after treatment, and statistical difference was seen between them[(17.3±3.3) vs (24.2±4.1), P＜0.05]. The treatment improved the maximum blood flow velocities of BA, LVA and RVA in the both group (P<0.05), and the changes in group B were more significant than those in group A (P<0.05). Conclusion Manual reduction combined with gastrodin and rehabilitation can obviously improve the clinical efficacy and clinical symptoms in treatment of elderly BPPV.

Abstract:Objective To investigate the molecular mechanism of mitochondrial mitochondrial ATP-sensitive potassium channels (mitoKATP) opener in improving myocardial oxidative stress/injury in rates with coronary heart disease (CHD). Methods A total of 40 SD rats were randomly divided into 4 groups with 10 in each:control group (without modeling and intervention of diazoxide drug), sham operation group (with skin cutting but without modeling), and model group (modeling of coronary heart disease but without intervention of diazoxide) and drug group (with modeling of coronary heart disease and intervention of diazoxide at 3 mg/kg). mRNA expression of angiogenic factors[fibroblast growth factor 2 (FGF-2) and vascular endothelial growth factor (VEGF)] and related proteins for each group were measured using real-time fluorescence quantitative polymerase chain reaction and Western blotting. The groups were compared in lactate dehydrogenase, mitochondrial membrane potential (MMP) and cell death rate. SPSS statistics 22.0 was used of data processing, and analysis of variance (ANOVA) or t test for comparison between groups. Results Compared with the model group, drug group had significantly lower mRNA transcription of FGF-2 [(100.21±12.33)×10³ vs (120.43±10.33)×10³ IU] and VEGF [(163.31±9.33)×10³ vs (181.33±11.13)×10³ IU] and expression of FGF-2 [(0.69±0.33) vs (1.32±0.33)], VEGF [(0.68±0.33) vs (1.20±0.13)], and lactate dehydrogenase [(49.32±3.51) vs (156.12±10.18)U/L]. Compared with the model group, the cell death rate in the drug group decreased [(30.32±3.48)% vs (66.12±3.23)%], but the fluorescence intensity increased [(780.12±9.20) vs (220.24 ±6.15)] (P<0.05). Conclusion mitoKATP channel opener can decrease MMP, cell death rate and myocardial oxidative stress/injury in rats with coronary heart disease by increasing vascular FGF-2 and VEGF and enhancing activity of lactate dehydrogenase.

Abstract:Cancer patients with concomitant coronary artery disease have been increasing, whose clinical management strategy has drawn much focus in oncology and cardiology. Different from pathophysiological mechanisms of coronary artery disease alone, cancer concomitant with coronary artery disease has unique pathophysiological mechanisms associated with oncogenesis and cancer treatment, posing challenges for the clinical management of such patients. First, comprehensive treatment for cancer and coronary artery disease has to be balanced with consideration of reducing morbidity and mortality due to the two diseases. Second, individual threat of the two diseases to the patient′s life has to be weighed to determine the choice between surgery for cancer removal first or intervention for coronary artery disease first followed by surgery for cancer removal. Moreover, pre- and post-operative interventions have to be considered to reduce overall risk. Those are all difficulties in clinical management of the cancer patients with coronary heart disease. This article reviews the pathogenesis of cancer patients with coronary artery disease, comprehensive management of coronary artery disease, management of coronary intervention, and optimization of evaluation and management of coronary artery disease before surgery for cancer removal, providing reference for clinical management strategy for cancer patients with coronary artery disease.

Abstract:Globally, both the incidence rates of diabetes mellitus and bladder cancer have continued to rise, which have seriously endangered human health. It has been found that there may exist some underlying mechanisms in the occurrence and development of these 2 diseases, which then may affect the incidence and prognosis of bladder cancer in diabetes mellitus patients. Some studies suggest that there is a complex relationship between them, but there are different opinions on the results at the same time. This article reviewed the epidemiological characteristics, common risk factors, effects of hypoglycemic drugs on bladder cancer, possible mechanism of diabetes affecting the occurrence of bladder cancer, and impact of diabetes on the prognosis of bladder cancer.

Abstract:More and more studies have shown that the intestinal microbiota are significantly associated with atherosclerosis. The nutrients such as lecithin, choline and carnitine in food are metabolized by the intestinal microbiota, and their metabolite trimethylamine-N-oxide (TMAO) may contribute to atherosclerosis. Its mechanism is not fully understood, but such a view provides a new orientation for research on atherosclerosis and other cardiovascular and cerebrovascular diseases. In this review, we summarized research on the mechanisms of TMAO-induced atherosclerosis in recent years.