Abstract:Objective To investigate the effect of dexmedetomidine (DEX) at different dosages on entropy index and hemodynamics during off-pump coronary artery bypass grafting (OPCAB). Methods From June 2016 to December 2017,0 patients undergoing OPCAB in the Department of Cardiothoracic Surgery of the First People′s Hospital of Yueyang were selected and randomized into groups A, B, C and D, with 20 in each group. Before anesthesia induction, groups B, C and D were given DEX at 0.5,0.7 and 1.0 μg/kg (50 ml, 10 min) respectively, and group A was given 50 ml saline. Subsequently, DEX was infused at 0.5,0.7, and 1.0 μg/(kg·h) respectively in groups B, C and D until chest closure, while group A was not treated. Mechanical ventilation was performed by anesthesia induction and followed by the right internal jugular vein puncture in 4 groups. The 4 groups were compared in the respects of response entropy (RE), state entropy (SE) and hemodynamics [central venous pressure (CVP), cardiac index (CI), intrathoracic blood volume index (ITBI) and systemic vascular resistance index (SVRI)]before administration (T₀), after intubation (T₁), after thoracotomy (T₂), after cardiac reposition (T₃). SPSS statistics 19.0 was used to analyze the data. According to the data type, single factor variance analysis, LSD-t test or χ² test was used for comparison among groups. Results Compared with T₀, RE and SE decreased significantly at T1-3 in all 4 groups, and compared with T₁, RE and SE decreased significantly at T2-3 in all 4 groups (P<0.05). RE and SE in group B, C and D were significantly lower than group A at T1-3, and RE and SE in group C and D were significantly lower than group B at T1-3 (P<0.05). Compared with T₀, CVP in group A, C and D increased significantly, and CI, ITBI and SVRI in 4 groups decreased significantly at T₁; CVP in group A, C and D increased significantly, and CI, ITBI and SVRI in group C and D decreased significantly at T2-3 (P<0.05). Compared with T₁, CVP in group A, C and D decreased significantly at T2-3, and CI, ITBI and SVRI in group C and D increased significantly, with significant difference(P<0.05). Compared with group A or B, CVP in group C and D increased significantly and CI decreased significantly at T2-3 (P<0.05). There was no difference between C and D in terms of those indices above all. Conclusion DEX is able to enhance anesthesia and entropy index of OPCAB, and a dosage at 0.7 μg/kg offers the best effect for hemodynamic stability.

Abstract:Objective To investigate the efficacy of different dosages of atrovastatin calcium on very elderly sarcopenia patients with moderate to severe frailty. Methods Ninety-eight very elderly patients with moderate to severe frailty admitted to our Department of Rehabilitation Medicine from April 2016 to April 2018 were recruited in this study. They were randomly divided into 3 groups, taking 20 mg group (n=34), taking 10 mg group (n=33) and drug withdrawl group (n=31). The levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in the peripheral blood, grip strength, 4.5-meter walking time, appendicular skeletal muscle mass index (ASMI), and frailty levels were detected and measured before and after treatment. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test, analysis of variance, or Chi-square test was employed for intergroup comparison on different data types. Results After 24 months of treatment, the patients from the 20 mg group had significantly lower TC [(3.84±0.96) vs (4.36±0.95)mmol/L] and LDL-C levels [(2.48±1.33) vs (3.19±1.30)mmol/L], decreased grip strength [(15.77±3.71) vs (18.58±3.43)kg] and ASMI [(13.90±2.33) vs (15.27±3.16)kg/m²] than those from the drug withdrawl group, and the levels of TC and LDL-C were still lower when compared with those of the 10 mg group [(4.26±1.03), (3.47±1.41)mmol/L, all P<0.05]. The grip strength was significantly lower in the 10 mg group than the drug withdrawal group [(15.31±4.71) vs (18.58±3.43)kg, P<0.05]. Moreover, the incidence of frailty level increasing by at least 1 level was 35.3%(12/34) in the 20 mg group, 18.2% (6/33) in the 10 mg group, and 9.7% (3/31) in the withdraw group (P=0.036). Conclusion Statins may further exacerbate age-related declines in muscle function and accelerate frailty.

Abstract:Objective To evaluate the role and efficacy of scanning acoustic microscopy (microscopic ultrasound) in the treatment of calcified atresia root canal in elderly patients. Methods A total of 264 calcified root canals from 159 elderly patients admitted in the Department of Oral Medicine of our hospital from October 2016 to April 2018 were subjected into this study. They were divided into experimental (n=95,2 calcified root canals) and control groups (n=64,2 calcified root canals) according to their own wills. In the experimental group, the calcified root canals were treated with microscopy combined with ultrasound technology, while for the control group, manual C file and hole drilling were used for probing and dredging of calcified root canals. The patients of both groups were prepared with nickel-titanium root canal, filled with hot gum root, and treated with root canal therapy. The dredging situation after treatment was compared between the 2 groups. SPSS statistics 23.0 was used for statistical analysis. Student′s t test or Chi-square test was employed for comparison of different data types. Results The success rate of root canal dredging was 86.18%(131/152) in the experimental group and 54.46%(61/112) in the control group. Compared with the control group, the dredging rates of different tooth positions and different calcified root canals were significantly higher, while the dredging time was shorter obviously in the experimental group, both with significant differences (P<0.05). In the control group, 51 cases of undredged teeth were further treated by micro-ultrasonic technique, and finally 39 cases were dredged, with a dredging rate of 76.5%. Conclusion Micro-ultrasonic technique is quite effective in probing and dredging the calcified root canals in the elderly, and it also improves the success rate of the treatment.

Abstract:Objective To investigate the clinical efficacy of strong oblique low position cannulated screw combined with sartorius muscle bone flap in the treatment of senile Garden Ⅲ and Ⅳ femoral neck fracture. Methods A total of 86 elderly patients with Garden Ⅲ and Ⅳ femoral neck fractures admitted in our department from June 2016 to August 2017 were recruited and randomly divided into control group (n=43) and study group (n=43). The patients of the control group were treated with conventional parallel compression cannulated screw internal fixation, and those of the study group were treated with strong oblique low tension cannulated screw combined with sartorius muscle bone flap. The intraoperative indices, visual analogue scale (VAS) score, Harris hip function score and incidence of adverse events were compared between the 2 groups. SPSS statistics 22.0 was used for data analysis. Student′s t test or Chi-square test was employed for comparison between groups. Results The control group had significantly shorter operation time [(72.56±10.48) vs (84.17±12.33)min] and less intraoperative bleeding [(125.48±11.52) vs (164.72±14.89)ml] than the study group (P<0.05). The VAS score was significantly lower in the study group than the control group on the 5th day [(4.82±1.02) vs (5.69±1.07)] and 10th day [(3.28±0.85) vs (4.34±0.94)] after operation (P<0.05). The Harris score was obviously higher in the study group than the control group in 1 month [(58.79±4.28) vs (51.25±3.63)], 3 months [(78.46±6.47) vs (70.54±5.89)] and 6 months after surgery [(84.07±6.98) vs (79.22±6.51), P<0.05]. The incidence of adverse events was notably higher in the control group than the study group [48.83%(21/43) vs 20.93%(9/43), χ²=7.371, P=0.007]. [JP+1]Conclusion Strong oblique low position cannulated screw fixation combined with sartorius muscle bone flap can effectively reducepostoperative pain, improve joint function and reduce the incidence of adverse events in the elderly patients with Garden Ⅲ and Ⅳ femoral neck fractures.

Abstract:Objective To observe the effectiveness of N-terminal pro-brain natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR) and high sensitivity C-reactive protein (hs-CRP) in risk stratification for the development of type 1 cardiorenal syndrome (CRS1) in patients with acute myocardial infarction (AMI). Methods A retrospective analysis was made of the available data of NT-proBNP, eGFR, and hs-CRP for 2 094 AMI patients in Cardiovascular Center of Beijing Friendship Hospital Database Bank (CBD BANK). The patients were divided into quartiles of an approximately equal number to assess the relationship of the three biomarkers with CRS1 incidence and in-hospital mortality. Statistical analyses were performed using SPSS 22.0. Kaplan-Meier survival analysis and COX proportional hazard regression were used to assess the effect of the number of abnormal biomarkers on in-hospital mortality. Results The incidence of CRS1 and in-hospital mortality increased in AMI patients as NT-proBNP and hs-CRP increased, and eGFR decreased (P<0.05). As CRS1 was aggravated, eGFR tended to decrease, and NT-proBNP and hs-CRP tended to increase before CRS1 became severe. Kaplan-Meier survival analysis showed that the in-hospital mortality in the AMI patients was correlated with the number of abnormal biomarkers (P<0.001). Abnormal biomarkers ≥2 was an independent risk factor for in-hospital death (RR＝2.452, 95%CI 1.105-5.440; P=0.027). Conclusion The combination of NT-proBNP, eGFR, and hs-CRP at presentation may assist risk stratification for the development of CRS1 in AMI patients.

Abstract:Objective To investigate the clinical value of preoperative ratio of C-reactive protein to albumin (CRP/Alb) in predict-ing 1-year mortality after hip fracture in the elderly patients. Methods A retrospective analysis was made of the clinical data of the elderly patients with hip fracture, who underwent orthopedic surgery at the Chinese PLA Central Theater General Hospital from January 2015 to August 2017. According to whether the patient died within 1 year after surgery, the patients were divided into survival group and death group. Multivariate logistic regression was performed to explore independent risk factors for death within 1 year after surgery. The receiver operating charactersitic (ROC) curve and Kaplan-Meier method were used to analyze the value of CRP/Alb in evaluating poor prognosis in the elderly patients with hip fracture. Results A total of 165 patients were enolled in the final study, and the cumulative mortality rate was 20.61% within 1 year after surgery. Univariate analysis showed that the survival group had significantly higher age, red blood cell distribution width, CRP, CRP/Alb, rate of concomitant chronic lung disease and ASA grade but lower Alb than the death group, the difference being of statistical significance (P<0.05). Multivariate analysis showed that CRP/Alb (OR=2.472,95％CI 1.100-5.554) was an important risk factor for predicting death in the elderly patients with hip fracture within 1 year after surgery. AUC of CRP/Alb in predicting the poor prognosis was 0.949 (P<0.001,5%CI 0.915-0.984), which was significantly higher than the single-index prediction of CRP or Alb. When CRP/Alb of 3.05 was set as the optimal cut-off value, the patients were divided into high-ratio group (n=37) and low-ratio group (n=128). The former had significantly shorter survival than the latter, the difference being statistically significant (χ²=48.607, P<0.001). Conclusion CRP/Alb is an independent risk factor for predicting death within 1 year after surgery in the elderly patients with hip fracture and can be used as an effective indicator for predicting adverse clinical outcomes.

Abstract:Objective To evaluate the predictive value of inferior vena cava variability (△DIVC) for weaning failure before and after spontaneous breathing test (SBT) after mechanical ventilation in patients with respiratory failure and cardiac insufficiency. Methods From November 2016 to February 2018,0 patients with respiratory failure and cardiac insufficiency were included, who underwent mechanical ventilation in the ICU of Xuzhou Central Hospital of Jiangsu Province. The patients were divided into successful withdrawal (SW) group (n=62) who did not need tracheal intubation and non-invasive ventilator within 48 h after successful 30-min SBT and failed-withdrawal (FW) group (n=58) who needed reintubation or non-invasive ventilator 48 h after successful or failed 30-min SBT. Clinical characteristics and △DIVC of the two groups were recorded and compared before SBT and 30 min after SBT. SPSS statistics 17.0 was used for analysis. According to the data type, independent sample t test, Mann-Whitney U test or χ² test was used for comparison between groups. [JP+1]Multivariate logistic regression was used to analyze the risk factors for weaning failure, and the predictive value of △DIVC on weaning failure was analyzed using receiver operating characteristic(ROC)curve. Results There were significant differences between the 2 groups (P<0.05) in chronic respiratory disease, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), duration from the first intubation to extubation, and hemoglobin levels. The partial pressure of carbon dioxide and N-terminal pro-brain natriuretic peptide were significantly higher and left ventricular ejection fraction (LVEF) significantly lower in FW group than in SW group before and 30 min after SBT (P<0.05). At 30 min after SBT, the △DIVC in the FW group was significantly higher than that in the SW group (P<0.05). Multivariate logistic regression showed that LVEF (OR=1.204,5%CI 1.133-1.381; P=0.015) and △DIVC at 30 min after SBT (OR=1.450,5%CI 1.102-2.026; P=0.009) were independent risk factors for weaning failure. The area under ROC curve (AUC) for △DIVC was 0.905, and the best cut-off point was 0.27,2.4% for sensitivity and 94.4% for specificity. AUC for LVEF was 0.806, and the best cut-off point was 42.0%, 54.5% for sensitivity and 86.8% for specificity. Conclusion △DIVC at 30 min after SBT has a high predictive value for weaning failure in the patients with respiratory failure and cardiac disease.

Abstract:Objective To investigate the correlation of peripheral blood monocyte percentage and count with behavioral and psychiatric symptoms of dementia (BPSD) in patients with Alzheimer disease (AD). Methods A total of 74 AD patients admitted in our department from January to October 2018 were recruited in this study. According to the results of neuropsychiatric inventory (NPI), they were divided into BPSD group (n=37) and non-BPSD group (control, n=37). Their venous blood samples were harvested at administration and in 1 month after treatment for monocyte percentage and count. SPSS statistics 19.0 was used to perform the stati-stical analysis. Student′s t test or Chi-square test was employed for comparison between groups, and Spearman correlation analysis was applied for the relationship. Results The BPSD group had significantly higher monocyte percentage [(8.56±0.92)% vs(5.36±0.32)%, (5.54±0.41)% vs (5.33±0.33)%] and count [(0.60±0.06)×10⁹/L vs (0.36±0.04)×10⁹/L, (0.38±0.03) vs (0.35±0.04)×10⁹/L] than the non-BPSD group at administration and in 1 month of treatment (P<0.05). The monocyte percentage (r=0.903) and count (r=0.729) were both positively correlated with NPI score. Conclusion The BPSD is correlated with monocyte percentage and count in peripheral blood of AD patients.

Abstract:Objective To evaluate the efficacy and safety of green laser and 2 μm laser in the treatment of benign prostatic hyperplasia (BPH) with a view to providing an effective reference for clinicians′ selection. Methods A total of 171 patients treated for benign prostatic hyperplasia in the Department of Urology of Longgang Central Hospital from May 2015 to May 2017 were divided into green laser group (n=80) and 2 μm laser group (n=91). The 2 groups were compared in the length of hospitalization, indwelling time of catheter, duration of operation, incidence of complications, maximum flow rate (MFR), quality of life (QOL) and the International Prostate Symptom Score (I-PSS) before and 6 months after operation. SPSS statistics 17.0 was used for data analysis, and Student′s t test or χ² test for comparison between groups. Results Duration of operation in the green laser group was longer than that in the 2 μm laser group [(62.8±18.5) vs (53.7±17.4)min], the difference being statistically significant (P<0.05). No significant differences (P>0.05) were found between the 2 groups in preoperative and postoperative MFR [(7.38±1.02) vs (5.59±0.87)ml/s; (16.5±1.8) vs (17.0±2.4)ml/s], QOL [(32.64±5.28) vs (33.62±4.17)score], (43.27±6.48) vs (44.28±6.71)score, I-PPS [(21.82±3.67) vs (22.19±2.83)score; (7.20±1.30) vs (7.40±1.30)score], and the incidence of complications [13.75%(11/80) vs 12.09%(11/91)] . Conclusion Both green laser and 2 μm laser are safe and effective in the treatment of benign prostatic hyperplasia, each with its own advantages. The clinician may make a choice according to the patient′s condition.

Abstract:Objective To investigate the effect of 24-hour average heart rate (AHR) on all-cause mortality in elderly patients with coronary heart disease (CHD). Methods A total of 262 elderly CHD patients admitted in our hospital from June 2010 to June 2012 were recruited in this study. According to the results of 24-hour ambulatory electrocardiography (Holter examination) before discharge, they were divided into 24 h AHR≥75 times/min group (n=71) and 24 h AHR<75 times/min group (n=191) at the cut point of 75 times/min. The follow-up was carried out from December 1,0 to June 31,6, at an interval of 6 months, with all-cause death as the main endpoint. Their baseline data and laboratory indicators 24 h before discharge and causes of death during follow-up were collected and compared. SPSS statistics 19.0 was used to analyze the data. According to the data type, Student′s t test, Wilcoxon rank sum test and Chi-sqaure test were used for comparison between groups. Kaplan-Meier survival curve was plotted to analyze the cumulative survival rate between groups. Multivariate Cox proportional hazard model was applied to evaluate the risk factors of all-cause mortality in CHD patients during follow-up. Results The median period of follow-up was 40.7 months, and whole data of these patients were collected. Compared with the 24 h AHR<75 times/min group, the 24 h AHR≥75 times/min group had signifi-cantly higher white blood cell count, serum level of low-density lipoprotein cholesterol and urinary content of microalbumin (P<0.05). The total mortality rate during follow-up was 6.87%(18/262). [JP+1]The all-cause mortality rate [15.49%(11/71) vs 3.66%(7/191); P=0.002] and CHD mortality [9.86%(7/71) vs 1.57%(3/191); P=0.005] was obviously increased in the 24 h AHR≥75 times/min group than the 24 h AHR<75 times/min group. Kaplan-Meier survival analysis showed that the cumulative survival rate of patients with 24 h AHR≥75 times/min was statistically lower than that of the patients with 24 h AHR<75 times/min (P=0.001). Multivariate Cox proportional hazard model analysis showed that after adjustment for confounding factors, 24 h AHR≥75 times/min (HR=4.604, 95%CI 1.343-15.784; P=0.015) and smoking (HR=3.943,5%CI 1.009-15.412; P=0.049) were determined as independent risk factors for all-cause death in the elderly CHD patients. Conclusion The all-cause mortality is significantly increased in the elderly CHD patients with 24 h AHR≥75 times/min. So, the mortality may be reduced by controlling 24 h AHR and quitting smoking.

Abstract:Objective To measure the expression of hypoxia inducible factor-1-alpha (HIF-1α) and hypoxia inducible factor-2-alpha (HIF-2α) in the elderly patients with gastric cancer and to analyze its clinical significance. Methods A total of 100 elderly patients with identified gastric cancer treated in the Yangluo Branch from February 2017 to March 2018 were enrolled as the study subjects, and another 100 healthy old individuals (over 65 years old) who received gastroscopy in our branch during the same period were recruited as the control group. The expression of HIF-1α and HIF-2α was detected in the 2 groups. SPSS statistics 17.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was applied for comparison between groups in difference data types. Multivariate logistic regression analysis was employed to screen the independent influencing factors for the expression of the 2 proteins in the patients. Results The positive expression rates of HIF-1α (85.0% vs 8.0%) and HIF-2α (82.0% vs 5.0%) in gastric cancer group were significantly higher than those in control group (P<0.001). Multivariate logistic regression analysis indicated that lymph node metastasis (HIF-1α:OR=5.132,5%CI 1.872-14.325, P=0.008; HIF-2α:OR=4.629, 95%CI 1.754-16.392; P=0.002) and clinical stage (HIF-1α:OR=3.957,5%CI 1.694-8.363, P=0.012; HIF-2α:OR=4.341,5%CI 2.312-10.052, P=0.010) were independent risk factors for the positive expression of HIF-1α and HIF-2α in gastric cancer patients. Conclusion The elderly patients with gastric cancer have higher positive expression rate of HIF-1α and HIF-2α, which may be related with clinical stage and lymph node metastasis.

Abstract:Objective To isolate human urinary stem cells (hUSC) with mesenchymal stem cells (MSC) characteristics from urine samples of healthy individuals, and determine the neurogenic differentiation capabilities of the cells in different neurogenic induction medium. Methods hUSC were isolated from the urine sample of normal individuals, and then cultured, passaged and identified with flow cytometry. Then, after 14 days′ induction with 4 kinds of neurogenic induction medium, cell morphology was observed under a light microscope, and the mRNA levels of Nestin, S100, β3-tublin and NF-200 were detected by RT-PCR. SPSS statistics 13.0 was used to perform the statistical analysis. Student′s t test and Chi-square test were employed for comparison among groups. Results The obtained cells derived from the urine samples of healthy adults could successfully express surface markers of MSC (CD27⁺, CD44⁺, CD73⁺, CD90⁺, CD31-, CD34-, CD45-, HLA-DR-). After 14 days′ induction with neural indution medium B, C and D, the hUSC showed spherical cell bodies with enhanced refraction and neuron-like processes. RT-PCR indicated compared with the medium A, the mRNA levels of Nestin and S100 were increased medium B, C, D induction, and those of β3-tublin and NF-200 were decreased after medium B and D induction. What′s more, medium C induced the highest Nestin level than medium B and D, while medium B induction obtained the highest level of S100 than medium C and D (P<0.05). Conclusion hUSC possess the characteristics of MSC. Medium B, C and D contribute to the differentiation of hUSC into neuron cells. Our results suggest that hUSC can be differentiated into neural stem cells and glial subpopulations under optimized induction conditions.

Abstract:Objective To investigate the value of surface-enhanced Raman spectroscopy (SERS) of peripheral erythrocytes in the diagnosis of geriatric cognitive disorder. Methods A total of 62 patients (aged >65 years) in the Department of Geriatrics of the Sixth People′s Hospital recieved neuropsychological and clinical assessment. Accordingly, they were divided into normal control (NC) group, mild cognitive impairment (MCI) group, and Alzheimer disease (AD) group. The baseline characteristics were collected and recorded. SERS was performed for erythrocytes. A fifth-order polynomial fitting algorithm was employed to process and extract effective SERS data, linear discriminant method to build a data model, and receiver operating characteristic curve to examine diagnostic value. Results Differences between groups were observed in the SERS of erythrocytes. Discriminant model for NC and AD groups can accuratly distinguish 71.8% patients with a sensitivity of 91.3% and specificity of 56.2%, discriminant model for NC and MCI groups can distinguish 58.7% patients with a sensitivity of 56.5% and specificity of 73.9%, and discriminant model for AD and MCI groups can accuratly distinguish 61.5% patients with a sensitivity of 75.0% and specificity of 65.2%. Conclusion SERS of erythrocytes proves to be of diagnostic value for cognitive impairment, inspiring the research on pathophysiology of erythrocytes in AD.

Abstract:Hydrogen sulfide (H₂S), an endogenous gas, succeeds after nitric oxide (NO) and carbon monoxide (CO) as the third gas signal molecule, neurotransmitter and cell protector. It plays an important role in many physiological processes of brain and surrounding tissues. Its role in the central nervous and cardiovascular system has been a focus of research in recent years. Its role has been partially proven in neurological diseases such as Alzheimer disease (AD), Parkinson disease (PD), cerebral ischemia, and febrile seizures (FS). This paper reviews the recent progress in the research of its role in those diseases, focusing on its neuroprotection and corresponding signal pathway, and its potential therapeutic value.

Abstract:Bisphosphonates, currently a first-line anti-osteoporosis drug, has been proven to have significant efficacy in reducing vertebral and non-vertebral fractures. However, studies in recent years have found that its long-term use is unable to produce additional benefits but rather may induce such serious adverse reactions as osteonecrosis of the jaw (ONJ) and atypical femoral fracture (AFF), hence the concept of a “drug holiday”. This article reviews the literature of the “drug holiday” published both at home and abroad in recent years with a view to providing reference for more reasonable medication for the patients with primary osteoporosis.

Abstract:ST-segment elevation myocardial infarction (STEMI) is commonly complicated with multivessel coronary artery disease (MVD), and this condition often exerts adverse effects on mortality and prognosis. Compared with single coronary artery disease, MVD is usually associated with poor prognosis. With the development of medical science and update of guidelines, the revascularization strategy for STEMI with MVD has changed dramatically. Emergency percutaneous coronary intervention (PCI) can treat non-infarct-related arteries simultaneously or separately by different stages. However, for those STEMI patients with unstable hemodynamics, complete revascularization increases the risk of complications, deterioration of heart failure and contrast-induced nephropathy. It is reasonable to treat infarct related artery (IRA) only in acute stage. This article reviews the revascularization strategies for STEMI complicated with MVD.