Abstract:Objective To investigate the potential biomarkers and key pathways in regulation implicated with diabetic cardiomyopathy (DCM) by analyzing the gene chips in gene expression omnibus (GEO) database. Methods GSE26887 was selected from GEO database to identify the differentially expressed genes (DEGs). DAVID was applied to perform gene ontology (GO) and the Kyoto encyclopedia of genes and genomes (KEGG) analyses. A protein-protein interaction (PPI) network was also constructed to visualize the interactions among these DEGs using bioinformatics statistics STRING 10.0. Results GSE26887 contained 7 DCM patients and 5 healthy individuals. A total of 236 DEGs were captured, including 134 upregulated and 102 downregulated genes. The top-5 upregulated DEGs were NPPA, SFRP4, DSC1, NEB and FRZB, and the top-5 of down-regulation were SERPINE1, SERPINA3, ANKRD2, XRCC4 and S100A8. The results of GO and KEGG disclosed that these DEGs were significantly enriched in inflammation, immune disorders, metabolic disturbance and mitochondrial dysfunction in the development of DCM. The top 15 hub genes with the highest connectivity in the PPI network were IL-6, MYC, ACTA2, SERPINE1, ASPN, SPP1, KIT, TFRC, FMOD, PDE5A, MYH6, FPR1, C3, CDKN1A and SOCS3 in order. Conclusion Our obtained DEGs are closely associated with inflammation, immune disorders and metabolic disturbance in DCM. The top 5 upregulated and the top 5 downregulated DEGs may be regarded biomarkers for DCM diagnosis, and the 15 hub genes be the target for the treatment.

Abstract:Objective To detect the expression of β-catenin and survivin proteins in colorectal adenocarcinoma tissues of elderly patients, and investigate the correlation of their expression with gender, lymph node metastasis and tumor-lymph node-metastasis (TNM) stage. Methods A total of 50 colorectal adenocarcinoma patients who underwent surgical resection in our hospital from January 2015 to December 2017 were recruited in this study. The obtained specimens were divided into cancer tissue group (n=50) and normal tissue group (n=50,2 cm away from the edge of the colorectal cancer mass, with microscopically normal tissue structure). The expression of β-catenin and survivin were detected by immunohistochemistry. SPSS statistics 22.0 was used for data analysis. Mann-Whitney U rank test was employed for comparison between 2 groups. Spearman test was applied to analyze the correlation of protein expression between β-catenin and survivin. Results β-catenin was mainly expressed in the membrane, cytoplasm and nucleus of colorectal adenocarcinoma cells, and its expression level was significantly higher in cancer tissues than normal tissues (64.0% vs 0.0%, P<0.05). Its expression was not related to gender (P>0.05), but was to lymph node metastasis and TNM stage (P<0.001). Survivin was located in the nuclei of colorectal cancer cells, and its expression was markedly higher in the colorectal cancer tissues than normal tissues (54.0% vs 0.0%, P<0.001). Its level had correlation with lymphatic invasion (P<0.05) but not with gender and TNM stage (P>0.05). Spearman correlation analysis showed that the protein expression of β-catenin was positively correlated to that of survivin in the elderly patients with colorectal adenocarcinoma (r=0.645, P<0.001). Conclusion Both of β-catenin and survivinare involved in the occurrence and development of colorectal cancer in elderly patients, and they may jointly promote its progression.

Abstract:Objective To systematically evaluate the efficacy of trimetazidine (TMZ) in the prevention of contrast-induced nephropathy (CIN) in patients with renal insufficiency. Methods The databases, including PubMed, Embase, Cochrane Library, EBSCO and Scopus from inception to December 2018 were searched for eligible trials evaluating the clinical efficacy of TMZ in the prevention of CIN. Meanwhile, we reviewed the relevant conference summary and websites. Meta-analysis was performed using RevMan 5.3 statistics. Results A total of 6 studies, involving 920 patients, with 456 patients in TMZ (+) group and 464 patients in TMZ (-) group were collected. Meta-analysis showed that the incidence of CIN in TMZ (+) group was significantly lower than TMZ (-) group (OR=0.31,5%CI 0.20-0.48; P<0.01). The serum creatinine (SCr) level was lower in TMZ(+) group than the other group within 3 d after procedure, but there was no statistical difference (MD=-0.22,5%CI -0.48-0.04; P=0.10). Conclusion TMZ shows a positive effect on the prevention of CIN in patients with renal insufficiency. However, more high-quality, large-sample randomized controlled trials are still needed to further confirm its efficacy.

Abstract:Objective To investigate the application value of Tri-Ball respiratory exerciser in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 86 AECOPD patients admitted in Gaochun People′s Hospital of Nanjing from June 2017 to June 2018 were recruited in this study. They were randomly divided into observation group (n=43) and control group (n=43). The observation group underwent breathing training with Tri-Ball respiratory exerciser device, while the control group accepted conventional pursed lips ventral breathing training. The pulmonary function indices [forced expiratory volume in the first second (FEV1), FEV1/forced vital capacity (FEVI/FVC), and FEV1/expected], blood gas parameters [arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂)], 6-minute walking distance (6MWD) and results of COPD assessment test (CAT) were compared between 2 groups. SPSS statistics 16.0 was used for analysis. According to the data type, Student′s t test or Chi-square test was used for intergroup comparison. Results After the treatment, significant improvements were achieved in pulmonary function, results of blood gas analysis, 6MWD and CAT scores in both groups (P<0.01). But the observation group obtained significantly greater improvements in PaO₂ [(63.98±2.61) vs (62.12±1.69)mmHg], PaCO₂ [(47.47±3.17) vs (48.88±3.00)mmHg], 6MWD[(229.67±46.38) vs (222.23±46.31)m] and CAT scores [(19.53±4.44) vs (20.19±4.48)] when compared with control group (all P<0.05). Conclusion Tri-Ball respiratory exerciser is helpful to restore respiratory function and improve the quality of life in early pulmonary rehabilitation for elderly AECOPD patients.

Abstract:Objective To investigate the effect of different doses of dexmedetomidine on cognitive function in elderly patients after endoscopic retrograde cholangiopancreatography (ERCP). Methods A total of 120 elderly patients (≥65 years old) undergoing elective ERCP in the General Hospital of Northern Theater Command from May 2014 to January 2015 were recruited in this study. They were randomly divided into control group (group C), 0.5 μg(group D1) and 0.8 μg dexmedetomidine group (group D2), with 40 cases in each group. Dexmedetomidine of 1.0 μg/kg were infused before induction to the patients of the latter 2 groups as loading dose for 10 min, and then were given at 0.5 μg/(kg·h) (group D1) or 0.8 μg/(kg·h) (group D2) by continued infusion until the end of surgery. The group C was infused with the same volume of normal saline. The clinical data, such as general condition, intraoperative dosage of propofol, and incidences of adverse reactions were recorded. Venous blood samples were collected to detect the levels of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and soluble protein 100-β (S-100β) by ELISA before operation (Ta), immediately after operation (Tb), and 24 h after operation (Tc). Mini-mental state examination (MMSE) was perfermed to test the occurrence of postoperative cognitive dysfunction (POCD) at 1 d before, 1 d and 3 d after operation. The data was analyzed by using SPSS statistics 19.0. Comparison among groups was performed by analysis of variance or Chi-square test. Results Compared with group C [(182.01±61.88)mg], the dosage of propofol was significantly lower in group D1 [(112.84±40.10)mg] and group D2 [(100.96±46.64)mg], both with significant difference (P<0.05). The plasma levels of TNF-α, IL-6 and S-100β were also obviously lower in group D1 and group D2 at Tb and Tc when compared with group C (all P<0.05). Statistical differences were seen in the incidences of body movement, hiccups and respiratory depression among the 3 groups (P<0.05). After operation there was 1 patient suffering from POCD in group D1, with the incidence rate of 2.5%, so was in group D2, and the rate was significantly lower than that of group C (8 cases, 20.0%, P=0.005). Conclusion Intraoperative infusion of dexmedetomidine can reduce the dosage of propofol and prevent adverse reactions in the elderly undergoing ERCP, and decrease the occurrence of POCD at the same time.

Abstract:Objective To evaluate the efficacy and safety of the modified sequential therapy with levofloxacin mesylate for curing Helicobacter pylori (H.pylori) infection in elderly patients. Methods A total of 120 elderly patients with benign H. pylori infection were included in the study, who were treated in Beijing Geriatric Hospital from January 2017 to June 2018. The patients were rando-mized into study group (sequential therapy) and control group (bismuth tetralogy). The study group received esomeprazole 20mg+amoxicillin 1000mg, twice a day for 5d and then esomeprazole 20mg+clarithromycin 500mg+levofloxacin mesylate 200mg, twice a day for 5d; the control group received esomeprazole 20mg+amoxicillin 1000mg+clarithromycin 500mg+bismuth potassium citrate 220mg, twice a day for 14d. Intention-to-treat (ITT) and per-protocol (PP) analysis were performed for the H.pylori eradication rate, and incidence of adverse reactions was compared between 2 groups. The cost-effectiveness analysis was performed to evaluate the economic benefits of two groups. SPSS statistics 17.0 was used for analysis, and t test or χ² test was used for comparison between 2 groups. Results In the study group, H.pylori was eradicated in 50 patients, with 6 cases being lost to follow-up; in the control group, H.pylori was eradicated in 46 patients with 5 being lost to follow-up and 4 failing to complete the treatment. ITT analysis showedan eradication rate of 83.3%(50/60) for the study group and 76.7%(46/60) for the control group, with no significant difference between 2 groups (χ²=1.944, P=0.378). PP analysis showed an eradication rate of 92.6%(50/54) for the study group and 90.2% (46/51) for the control group, with no significant difference between 2 groups (χ²=0.192, P=0.463). There were 7 adverse reactions (11.7%) but no serious adverse reactions in the study group, and 12(20.0%) adverse reactions and 4(6.7%) serious adverse reactions in the control group, with no significant difference in the incidence of adverse reactions (χ²=1.563, P=0.159) and severe adverse reactions (χ²=4.138, P=0.059) between 2 groups. One course of treatment costed 345.71RMB￥ in study group against 533.71RMB￥ in the control group. According to PP analysis, the cost-effectiveness ratio (C/E) of study group and control group were 373.3(345.71/92.6%) and 591.7(533.71/90.2%) with significant difference (P<0.05). ITT analysis showed a C/E of 415.0(345.71/83.3%) for the study group and 695.8(533.71/76.7%) for the control group also with significant difference (P<0.05). Conclusion The modified sequential therapy containing levofloxacin mesylate is effective in eradicating H. pylori in the elderly patients and can be one choice of therapy.

Abstract:Objective To evaluate the efficacy of minimally invasive catheter drainage surgery in the treatment of hypertensive intracerebral hemorrhage (HICH). Methods A retrospective analysis was made of 102 HICH patients treated in the Neurosurgery Department of Xi′an Northern Hospital from Feb. 2016 to Aug. 2017, of whom 34 (study group) underwent minimally invasive catheter drainage and 68 (control group) underwent microsurgical removal. The two groups were compared in the operation time, intraoperative bleeding volume, hematoma clearance rate, preoperative and postoperative neuron-specific enolase (NSE) and soluble protein 100-β (S-100β) levels, and activity of daily living (ADL) at 3 months after operation. SPSS statistics 19.0 was used for data analysis, and Studet′s t test or Chi-square test was used to compare between groups. Results Compared with the control group, the study group had shorter operation time [(2.31±0.83) vs (4.02±1.20)h], lower intraoperative bleeding volume[(43.29±9.17) vs (82.28±12.20)ml], and significantly higher clearance rate of hematoma [(88.39±9.12)% vs (79.54±10.21)%] (P<0.001). There was no significant difference in NSE [(23.05±2.78) vs (22.95±3.12)ng/L] and S-100β protein [(1.95±0.21) vs (1.88±0.26)ng/L], and incidence of complications [14.65%(6/34) vs 17.65%(12/68)] (P>0.05) between the two groups. The recovery rate of was 90.91%(30/33) in the study group against 72.73%(48/66) in the control group (P＝0.037). Conclusion Minimally invasive catheter drainage surgery is effective for HICH and is worth popularizing for its minimal invasiveness, speed and less bleeding.

Abstract:Objective To investigate the clinical characteristics and risk factors for death in the elderly patients with multiple organ dysfunction syndrome (MODSE) receiving long-term care and a combination of medical treatment and nursing care. Methods A retrospective study was conducted of 107 MODSE patients admitted to the Department of Geriatrics in Jianghan Oilfield General Hospital from January 2012 to July 2018, who were given a combination of medical treatment and nursing care. According to the outcome at day 28 after onset, the MODSE patients were divided into the survival group (n=34) and death group (n=73). The two groups were compared in the general clinical data, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, pulmonary infection score, Glasgow coma scale score of brain function and swallowing function score. SPSS statistics 17.0 was used for analysis, and t test or Chi-square test was applied for comparison between 2 guoups. Multivariate Cox regression was performed with statistically significant indices in the univariate analysis for independent risk factors affecting the mortality of MODSE patients. Results (1) Comparison of the general data found significant differences between the two groups in age, organ dysfunction number, systolic blood pressure, diastolic blood pressure, mean arterial pressure, partial pressure of carbon dioxide, oxygen partial pressure, oxygenation index, hemoglobin, albumin, fasting blood glucose, and blood urea nitrogen (P<0.01). (2) Comparison in the proportion of chronic diseases found significant differences between two groups in underlying diseases ≥4, chronic obstructive pulmonary disease (COPD), chronic heart failure, cerebrovascular disease, diabetes mellitus, dementia and cognitive impairment, pulmonary infection assessment scale≥6, Glasgow coma scale score, APACHE Ⅱ≥25, dysphagia grading scale ≤4, and lung, heart, kidney, brain and gastrointestinal insufficiency (P＜0.05). (3) Multivariate Cox regression showed that age, organ dysfunction number, APACHE Ⅱ score, Glasgowcoma scale score, pulmonary infection score and COPD, chronic heart failure, cerebrovascular disease and serum albumin were independent risk factors for death in the MODSE patients with long-term care. Conclusion Death is more likely in the elderly MODSE patients with a variety of underlying diseases accompanied with COPD, chronic heart failure, cerebrovascular disease, pulmonary infection, and low serum albumin, and early monitoring and prevention should be strengthened.

Abstract:Objective To investigate the clinical efficacy of electrophysiological therapy combined with swallowing-feeding training in the treatment of dysphagia after stroke. Methods A total of 135 patients with dysphagia after stroke who admitted to our hospital from June 2016 to December 2017 were recruited as the observation subjects, and were randomly divided into 3 groups, with 45 cases in each group. The patients from the rehabilitation training group were treated with only swallowing-feeding training, those of the electrophysiological therapy group were given electrophysiological therapy, and those of the combined treatment group underwent both the training and the therapy. After 4 weeks′ treatment, the effective rate, score of Gugging swallowing screen (GUSS), and results of functional oral intake scale (FOIS) were compared among the 3 groups, as well as the rate of complications. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed in inter-group comparison for different data types. Results The combined treatment group obtained significantly higher markedly effective rate (53.3%) and total effective rate (95.6%) when compared with the rehabilitation training group (33.3%, 73.3%) and electrophysiological therapy group (35.6%, 75.6%, all P<0.05). What′s more, the GUSS score [(14.26±2.59) vs(11.43±2.31) vs(11.98±2.40)] and FOIS score [(4.02±1.27) vs(2.91±0.75) vs(3.52±0.74)] were also obviously higher in the combined treatment group than the other 2 groups (all P<0.05). The total incidence of complications in the combined treatment group (4.4%) was also significantly lower than that in the rehabilitation training group (44.4%) and electrophysiological therapy group (26.7%, both P<0.05). Conclusion The combination of electrophysiological therapy and swallowing-feeding training is effective in the treatment of dysphagia after stroke, and can effectively improve the swallowing function and reduce occurrence of complications.

Abstract:Objective To investigate the effect of allicin (All) on the delayed afterdepolarization (DAD), triggered activity (TA) and ion currents in the ventricular myocytes of rats with heart failure and the related mechanism. Methods Heart failure models were established in 20 SD rats by abdominal aortic ligation, and sham operation was performed in 10 SD rats as control. Enzymic digestion was used to isolate ventricular myocytes in the 2 groups. According to the experimental design, the model cells were divided into heart failure group (without administration, HF) and administration group (200.0 μmol/L All, HF+All). Patch clamp technique was used to observe the occurrence of DAD and TA and to record the associated changes of ion currents [the transient inward current (I_ti), L-type calcium current (ICa,L) and sodium-calcium exchanger current (INCX)] in the 3 groups. Flou-4AM fluorescence technique was used to detect the changes of intracellular calcium concentration. SPSS statistics 17.0 was used for statistical analysis. ANOVA and SNK-q test were used for comparison among groups. Results (1)The incidences of DAD and TA in the control group, HF group and HF+All group were [13.3%(2/15), 0.0%(0/15)], [60.0%(9/15), 26.7%(4/15)] and [40.0%(6/15), 13.3%(2/15)] respectively. Compared with the control group, the incidences of DAD and TA in the HF group increased significantly. Compared with the HF group, the incidences of DAD and TA in the HF+All group decreased significantly by 20.0% and 13.4% respectively (n=15, P<0.01). (2) Compared with control group, I_ti,INCX and ICa,L density increased in the HF group, but compared withHF group, they decreased in the HF+All group, in which I_ti peak inward current density decreased from(-1.05±0.06)pA/pF to(-0.53±0.05)pA/pF (n=10, P<0.01) and INCX inward current density from (-5.8±0.7)pA/pF to (-4.2±0.4)pA/pF (n=10, P<0.01). At the same time, All accelerated the steady-state inactivation of channel currents and decreased the peak current density of ICa,L from (-17.2+0.9) pA/pF to (-13.5+1.0) pA/pF (n=15, P<0.01). (3) Compared with the control group, the resting calcium concentration, transient calcium amplitude and time for intracellular calcium concentrations to reach 50% of maximum value in the HF group were significantly higher, but those parameters were significantly lower in the HF+All group than in the HF group (n=15, P<0.01). The intracellular calcium transient attenuation rate in the HF group was significantly lower than that in the control group, but it recovered significantly after the application of All (P<0.05). Conclusion All may reduce the occurrence of DAD and TA by reducing intracellular calcium and blocking I_ti and INCX currents in ventricular myocytes of rats with heart failure.

Abstract:Objective To explore the role of C1q/TNF-related protein 3 (CTRP3) in senescence model of mesenchymal stem cells (MSCs) and explore the mechanism. Methods The senescence model of mouse MSCs was induced by hydrogen peroxide (H₂O₂) treatment, and then identified by CCK8 assay and β-galactosidase staining. After exogenous treatment of CTRP3 was given to the obtained MSCs for 24 h, CCK8 was used to detect cell proliferation, and β-galactosidase staining was employed to measure the senescence. The differentiation capacity of the aging MSCs were measured by differentiation induction assay, and the expression of apoptosis-related proteins were detected by Western blotting. Then, RT-PCR was applied for the expression changes of the senescence-related genes P16, P21 and the anti-aging gene SIRT1. ANOVA or LSD analysis was used for intergroup comparison. Results H₂O₂ inhibited the proliferation activity of MSCs in a concentration-dependent manner. After 200 μmol/L H₂O₂ treatment for 4 h, light microscopy displayed that the 3-dimensional impression of the MSCs disappeared, and the cells presented irregular shape. CCK8 assay results showed that the cell proliferation activity was significantly decreased (P<0.05); while the percentage of β-galactosidase positive cells was obviously elevated. After 24 h of CTRP3 treatment, the proliferation and differentiation capacities of senescent MSCs were increased. Western blotting indicated that CTRP3 significantly reduced the apoptosis of senescent MSCs. RT-PCR analysis showed that CTRP3 up-regulated the MSCs anti-aging gene SIRT1 and down-regulated the expression of aging-related genes P16 and P21 at mRNA level. Conclusion CTRP3 treatment inhibits the apoptosis of senescent MSCs, which might be related with the up-regulation of SIRT1 and down-regulation of P16 and P21.

Abstract:Sarcopenia and frailty are common geriatric clinical syndromes, commonly lead to falls, incapacity and death, and thus, affect the quality of life in the elderly. Therefore, sufficient attention should be paid to screening for sarcopenia and frailty. There are many screening methods for both of them at home and abroad, but there is still no unified golden standard. In recent years, with in-depth research, some new methods have been proposed for the screening of sarcopenia and frailty. This paper reviewed the research status and advancement of screening and evaluation methods for sarcopenia and frailty in order to discover and identify the 2 diseases early in clinical practice.

Abstract:Acute kidney injury (AKI) is a common critical condition with high mortality and poor prognosis. Currently, its diag-nosis relies on the increase in serum creatinine and the decrease in urine output. No specific therapy is available for it and renal replacement therapy is needed for severe patients. The AKI Guidelines and Consensus, updated four times from 2002 to 2017, exerted positive effect on early identification of AKI patients. However, the present definition of AKI does not make a distinction between transient and persistent AKI. This paper reviewed the progress in their pathology, clinical manifestations, diagnosis and treatment.

Abstract:Vitamin D is a steroid derivative, whose classical biological effect is to regulate calcium and phosphorus metabolism. Studies up to date have found that it can protect the integrity of vascular endothelium, prevent atherosclerosis, and inhibit oxidative stress, inflammation and activity of renin-angiotensin-aldosterone system. Vitamin D is negatively correlated with ischemic stroke, but its relationship with cerebral small vessel diseases remains unclear. This article reviewed the status of the research on the relationship of vitamin D and cerebrovascular diseases in view of providing basis for the prevention and treatment of cerebrovascular diseases.

Abstract:High tibial osteotomy (HTO) is one of the effective surgical options for knee osteoarthritis. It mainly transfers stress to the lateral compartment by changing the force line of the lower limbs, thus reducing the pressure of the medial compartment, alleviating pain and discomfort of the knee joint, and retaining the original structure of the knee joint. Its clinical efficacy is ascertained. This article reviewed the research progress of HTO in the respects of indications, contraindications, orthopedic mechanism, surgical techniques, fixation methods, post-operative rehabilitation, and survival rate.

Abstract:Quality of clinical research is related closely to the study design. Referees and editors from medical journals, as an essential part of medical research community, must shoulder the responsibility to have the most reliable and scientific evidence for medical sciences published, rather than the inferior studies with incorrect study design and unreliable results. The studies should be evaluated based on its nature. In this paper, we introduced the points on evaluating the medical papers about clinical trials from several aspects, like subjects enrollment, treatment measures, observed parameters, sample size, balance between statistical and clinical significance etc. We aimed to call attention from medical paper referees, editors, as well as researchers themselves.