Abstract:Objective To investigate the prevalence of cardiometabolic diseases (CMD) among elderly patients with esophageal cancer with a view to providing reference for their prevention and treatment. Methods The study enrolled 1591 elderly patients with esophageal cancer from January 2008 to March 2018. Analysis was made of the major CMD including diabetes, hypertension, ischemic heart disease and stroke. The prevalence of CMD, the number of concomitant CMD, and the risk factors of CMD in elderly patients with esophageal cancer were analyzed. SPSS statistics 23.0 was used for data analysis. Results Of the 1591 patients [average age(71.84±5.00) years; female 25.14%(400/1591)], 23.57%(375/1591) had at least one CMD, and 6.47%(103/1591) had two or more. The prevalence of CMD tended to increase with age without statistically significant difference. The prevalence was 6.60%(105/1591) for diabetes, 17.10%(272/1591) for hypertension, 5.34%(85/1591) for ischemic heart disease, and 1.76%(28/1591) for stroke. Increasing age, high body mass index, and non-farmer might be associated with the comorbidity of CMD and esophageal cancer. Conclusion More attention should be paid to elderly patients with esophageal cancer complicated with CMD. Strengthened multidisciplinary cooperation is recommendable, special attention being paid to the risk of CMD in elderly and overweight patients with esophageal cancer.

Abstract:Objective To investigate the correlation between the neuronal injury-related biomarkers and delirium in elderly patients after cardiac valve replacement surgery. Methods A total of 109 elderly patients undergoing elective open-heart valve replacement surgery in General Hospital of Western Theater Command from December 2018 to December 2019 were enrolled in the present study. The confusion assessment method for the intensive care unit was utilized to evaluate the delirium in patients after surgery. The serum concentrations of biomarkers for neuronal injury, neuron-specific enolase (NSE) and S100β were measured and compared before and after surgery. The baseline data of all the patients were collected, and univariate and multivariate logistic regression analyses were conducted to verify the correlations between NSE and S100β with delirium, respectively, and the other risk factors for delirium. Results The incidence of delirium was 30.3% (33/109) in the cohort of patients. The serum concentrations of NSE and S100β were significantly increased after surgery (all P<0.01). Multivariate logistic regression analysis indicated that diabetes (OR=1.76,95%CI 1.02-2.61; P=0.04), duration of mechanical ventilation (OR=3.11,95%CI 1.29-7.52; P<0.01), and serum concentrations of NSE (OR=5.94,95%CI 1.53-12.04; P<0.01) and S100β (OR=5.11,95%CI 1.38-10.14; P<0.01) were risk factors for postoperative delirium. Conclusion Neuronal injury biomarkers NSE and S100β are closely correlated with delirium in elderly patients after cardiac valve replacement surgery. The elevated serum concentrations of NSE and S100β might be potent predictors for delirium.

Abstract:Objective To evaluate the combined inhibitory effect of cefepime (FEP) and meropenem (MEM),FEP and ciprofloxacin (CIP) respectively on clinically isolated multidrug resistant pseudomonas aeruginosa (MDRPA) strains in vitro. Methods Combined inhibitory effect of FEP and MEM, FEP and CIP in vitro was assayed by detecting the minimum inhibitory concentration (MIC) and calculating the fractional inhibitory concentration index for 58 MDRPA strains with the agar dilution method. Results Combined FEP and MEM showed 32.8% synergic effect, 46.6% additive effect, 20.6% unrelated effect, no antagonistic effect on MDRPA strains. Combined FEP and CIP displayed 20.7% synergic effect, 51.7% additive effect, 27.6% unrelated effect and no antagonistic effect on MDRPA strains. The MIC₅₀ of these drugs was significantly lower when they were used in combination, with their concentration-accumulative inhibition curves shifted to the left. Conclusion FEP combined with either MEM or CIP, compared with respective use, showes an elevated drug sensitivity for MDRPA strains in vitro.

Abstract:Objective To observe efficiency of health management for elderly hypertensive patients through WeChat applet. Methods Out of 130 elderly hypertensive patients admitted to the Outpatient Cardiology Clinic and Physical Examination Center in Chinese PLA Hospital No.305 from January to December 2018,10 were lost to follow-up due to inability to return to the clinic or change of contact information. 120 were enrolled for the study [68 males and 52 females; aged 65-78 (68.2±2.6) years]. They were divided into two groups according to the first visit time successively:the intervention group (n =60) who received multidisciplinary health management using WeChat applet and the routine group (n =60) who received routine health education. The two groups were compared at 3 and 6 months in systolic blood pressure, diastolic blood pressure, body composition parameters, anthropological para-meters, patient compliance and self-efficacy. SPSS statistics 21.0 was used for data analysis. According to different data type,t test or χ² test was used for data comparison between the two groups.Results At 3 and 6 months as compared with pre-intervention, systolic and diastolic blood pressures were reduced in both groups. Systolic and diastolic blood pressures were more significantly reduced in the intervention group than in the routine group (P<0.05). Body mass index, waist circumference, waist-to-hip ratio, percentage of body fat, visceral fat area, and abdominal obesity were all reduced in the intervention group. Medication compliance and self-efficacy were improved in the intervention group with statistically significant difference (P<0.05). Conclusion Employment of WeChat applet for health management is conducive to controlling blood pressure, improving body fat distribution, improving medication compliance and self-efficacy in the elderly patients with hypertension.

Abstract:Objective To observe the effects of cardiorenal syndrome type 1(CRS1) of different severity on in-hospital mortality in patients with acute myocardial infarction(AMI). Methods A retrospective analysis was conducted of 2094 AMI patients in the Cardiovascular Center of Beijing Friendship Hospital Database Bank. The clinical data were collected for analysis, including demography, biochemical examination, previous medical history and treatment after admission. According to the heart and kidney function, patients were classified as mild, moderate and severe. The relationship between different severity of CRS1 and AMI in-hospital mortality was evaluated. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to assess the effects of CRS1 of different severity on AMI in-hospital mortality. Statistical analysis were performed using SPSS statistics 22.0. Results The all-cause in-hospital mortality increased in AMI patients as CRS1 aggravated (P<0.001). Kaplan-Meier survival analysis showed that the cumulative survival rate in CRS1 group was lower than that in the non-CRS1 group (P<0.001) and decreased with the severity of CRS1 (P<0.001). CRS1 occurrence was an independent risk factor for in-hospital death in AMI patients (RR=4.233,95%CI 2.013-8.901; P<0.001). Conclusion The presence of CRS1 adversely affects the prognosis of AMI patients. The risk of in-hospital death increases with the severity of CRS1.

Abstract:Objective To compare the effects of 3 different anesthesia methods (general anesthesia, peripheral nerve block combined with laryngeal mask general anesthesia, and peripheral nerve block combined with basal anesthesia) on intraoperative vital signs and postoperative recovery in elderly patients with hip fracture. Methods A total of 60 elderly patients undergoing elective hip fracture surgery admitted in Hainan Hospital of Chinese PLA General Hospital were subjected, and divided into 3 groups according to different anesthesia methods:general anesthesia group (G group), peripheral nerve block combined with laryngeal mask general anesthesia group (NL group) and peripheral nerve block combined with basal anesthesia group (NS group). Vital signs and dosages of anesthetic agents were observed and recorded during the surgery. Ramsay grade was used to evaluate the sedation levels at the time of awakening, 5 min after awakening and out of operating room. Visual analogue scale (VAS) was applied to evaluate analgesia levels at the above time points and 24 h postoperatively. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were employed to evaluate cognitive function in 1 d before and 5 d after the surgery. Postoperative feeding time (h) and time of getting out of bed (d) were also recorded. Results There were no significant differences in general data of patients among the 3 groups. The consumption of sufentanilin G group was significantly higher than that in NL group (P<0.001), and that in NL group was obviously higher than that in NS group (P<0. 001). After 10 min of anesthesia, MAP in G group (P=0.003) and NL group (P=0.007) was significantly lower than that in NS group, while MAP in G group was significantly higher than that in NL group and NS group (P=0.005; P=0.016) immediately after resuscitation and 5 min after resuscitation. Immediately after resuscitation, HR in G group was significantly higher than that in NS group (P=0.015). BIS in G group and NL group was significantly lower than that in NS group (P<0.05) at 5min and 10min after completion of anesthesia, at the beginning and the end of operation and after leaving the operating room. At the moment of awakening, Ramsay grade was significantly higher in G group than NS group (P<0.05), and VAS grade was significantly higher than NS group (P<0. 05). There were no differences in MMSE and MoCA points in 1 d before and 5 d after surgery among the 3 groups (all P>0.05). Postoperative feeding time (h) in G group was significantly longer than that in NS group (P=0.048) and NL group (P=0.012). Conclusion Peripheral nerve block combined with basal anesthesia can achieve better analgesic effectiveness, has light effect on the patient′s cognition, shortens postoperative feeding time significantly and promotes early postoperative clinical recovery in elderly patients under going hip fracture surgery.

Abstract:Objective To investigate the effects of different anesthesia depths on intraoperative glucose and lactate and postoperative cognitive function in elderly patients undergoing supratentorial tumor resection. Methods Totally 120 elderly patients undergoing supratentorial tumor resection admitted to 903 Hospital and Sichuan Provincial Cancer Hospital from February 2017 to June 2019 were selected and divided into group A (n=40) with bispectral (BIS) index 30-39, group B (n=40) with BIS index 40-49, and group C (n=40) with BIS index 50-59. Blood samples were taken from radial artery and jugular venous bulb simultaneously before induction of anesthesia (T1), at the intubation (T2), during separation (T3), at removal (T4), and at the closure of dura (T5). Glucose extraction rate (GluER) and cerebral lactate production rate (LacPR) were measured. At D1, D3 and D7, mini-mental state examination (MMSE) was adopted to evaluate cognitive function, and the serum S100β and neuron-specific enolase (NSE) were measured. Data were analyzed using SPSS statistics 19.0. Analysis of variance was used between multiple groups, and comparisons between the two groups were performed using LSD-t test. Results Compared with T1, GluER was significantly reduced at each time point after induction in group A and group C (all P<0.05), while GluER in group B had no difference before and after induction (all P>0.05). Compared with T1, the LacPR of group B decreased gradually from T2 to T5 (P<0.05), but there was no difference in the LacPR of group A and C (both P>0.05). At D1, D3 and D7, MMSE scores of group B were significantly higher than those of the other two groups (P<0.05), while serum S100β and NSE of the group B was significantly lower than those of the other two groups (P<0.05). Conclusion The anesthesia depth with BIS index 40-49 can control cerebral metabolism in the elderly patients undergoing supratentorial tumor resection, maintain blood glucose balance, and reduce LacPR, thereby improving postoperative cognitive function.

Abstract:Objective To explore the relationship between neutrophil/lymphocyte ratio (NLR) and lipoprotein-associated phospholipase A2 (LP-PLA2) and carotid intima-media thickness (CIMT) in elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 276 T2DM patients were enrolled in this study, who admitted to geriatric and endocrine departments of Taizhou People′s Hospital from January 2018 to January 2020 and were divided into two groups:normal CIMT group (CIMT<1.0 mm, NCIMT, n=138) and abnormal CIMT group (CIMT≥1.0 mm, ACIMT, n=138). Healthy individuals were enrolled as control group (NC, n=135). Clinical biochemical index, blood routine and plasma LP-PLA2 level were measured. SPSS statistics 20.0 was used for data analysis. Depending on different data types, one-way analysis of variance or Kruskal-Wallis H test was used for comparison between groups. Partial correlation was used to analyze the correlation between NLR and LP-PLA2 and each index. Multiple stepwise regression was performed for the risk factors of CIMT in the T2DM patients.Results NLR and LP-PLA2 levels were higher in NCIMT group and ACIMT group than in NC group [NLR:(2.51±0.82) vs (2.78±1.01) vs (2.23±0.77); LP-PLA2:(142.80±37.24) vs (154.78±45.92) vs (130.17±39.37) ng/ml; all P<0.05], and ACIMT group were higher than NCIMT group. Correlation analysis showed that NLR was positively correlated with systolic blood pressure, diastolic blood pressure, fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), and CIMT (P<0.05); LP-PLA2 was positively correlated with total cholesterol, low-density lipoprotein cholesterol (LDL-C), and CIMT (P<0.01); LP-PLA2 was positively correlated with NLR (P<0.01). Multiple stepwise regression analysis showed that the factors affecting CIMT were course of T2DM, FBG, HbA1c, LDL-C, NLR and LP-PLA2 (β=0.009, 0.028, 0.032,0.036,0.069,0.001, respectively; P<0.05 or P<0.01). Conclusion NLR and LP-PLA2 are risk factors of CIMT in elderly T2DM patients, and may be related to the occurrence and development of atherosclerosis in those patients.

Abstract:Objective To investigate the causes of death in patients with cardiovascular diseases in era of revascularization. Methods The consecutive patients were recruited in the study, who underwent coronary angiography (CAG) in the Department of Cardiology of Chinese PLA General Hospital from 2008 to 2014. They were divided into three groups based on CAG:the coronary artery bypass graft (CABG) group, the optimized medication (OMT) group, and the percutaneous coronary intervention (PCI) group. From 2017, they were followed up by telephone calls, case record screening and outpatient visits, the death being the endpoint of follow-up. The causes of all deaths were analyzed, and the three groups were compared. Statistical analysis was performed using SPSS statistics 19.0. Results Of the 1 645 patients recruited, 113 died during the follow-up, with 28 (24.78%) in CABG group, 22 (19.47%) in OMT group, and 63 (55.75%) in PCI group, and differences being not statistically significant (P>0.05). Except for the Syntax score, the basic clinical data of the deaths did not differ significantly among the three groups (P> 0.05). From the highest to the lowest, Syntax score was (33.45±17.89) points in CABG group, (31.23±12.99) points in OMT group, and (21.35±11.65) points in PCI group. The rate of death cause was, from the highest to the lowest, acute myocardial infarction 40 (35.40%), sudden death 21 (18.58%), cancer 17 (15.04%), heart failure 14 (12.39%), multiple organ failure 11 (9.73%), cerebrovascular accident 6 (5.31%), stent thrombosis 3 (2.65%), and bleeding 1(0.88%). The deaths caused by acute myocardial infarction and sudden death were higher in PCI group than in the other two groups, but the difference was not statistically significant (P>0.05). Non-cardiovascular deaths caused by cancer and cerebrovascular accidents accounted for 21.12%; delayed cardiovascular deaths caused by heart failure and multiple organ failure accounted for 22.1%; and accidental deaths including sudden deaths and those caused by acute myocardial infarction and acute stent thrombosis accounted for 56.6%, the differences being of no statistical significant difference (P>0.05). Conclusion Acute myocardial infarction, sudden death and stent thrombosis are common after PCI. Cancer ranked the second as the cause of death. The patients with multiple organ failure and heart failure had poor prognosis. With the widespread use of antiplatelet drugs, anticoagulants and thrombolytics, cerebral hemorrhage deserves attention.

Abstract:Objective To analyze the current situation and research trends in the field of frailty in the elderly in China in the past 10 years. Methods The CNKI database in the period from 2010 to 2019 was searched for articles indexed about senile frailty, with “‘old’ OR ‘aged’ OR ‘senile’ AND ‘frailty’”used as search term, and there were 323 articles retrieved. The scientific metrology tools, CiteSpace and Excel 2016, were used to make visual analysis of the volume of papers, authors, research institutions, and journals, and to map scientific knowledge in the field of senile frailty in China. Results From 2017, the number of related papers was increased rapidly. A total of 828 authors were involved, and 2 of them had published ≥10 articles, accounting for 0.24%(2/828). And there were 211 research institutions involved, and only 7 of them had >6 papers. Furthermore, the cooperation was mainly between medical universities and their affiliated hospitals. The results of the Keywords clustering analysis showed that Q=0.6621, with statistically significant clustering (Q>0.3). And in homogeneity, 10 clusters were highly credible (all S>0.7). Meanwhile, we summarized 4 hotspots in the field by analyzing the Keywords in each cluster, that is, epidemiological investigation, assessment, cognition and intervention measures for senile frailty. Conclusion The quantity and quality of literature concerning senile frailty in China should be improved. The results of clustering analysis should be taken as the research hotspot, cooperation in basic and clinical research be strengthened, and horizontal and vertical development in the field be deepened in order to form a research force for senile frailty.

Abstract:Objective To investigate the effects of roflumilast (RM) on cardiac remodeling induced by pressure overload in mice and its mechanism. Methods Aortic constriction (AB) was used to construct a mice model of cardiac remodeling. A total of 40 male C57/B6 mice (8-10 weeks) were randomly divided into sham group, AB group, AB + RM (1mg / kg) group, and AB + RM (3mg/kg) group (n=10each). At d 2 after AB surgery, the mice were given an intragastric administration of RM for 6 weeks. Echocardiography was performed to detect cardiac function in each group, including left ventricular ejection fraction (LVEF), left ventricular short axis fraction shortening (LVFS), left ventricular end systolic diameter (LVESD), and left ventricular end diastolic diameter (LVEDD). HE and Picrosirius Red staining were used to observe cardiac hypertrophy and fibrosis, and qPCR was used to detect the mRNA expression levels of cardiac hypertrophy, fibrosis and inflammation-related genes, including atriopeptin, brain natriuretic peptide, β-MHC, connective tissue growth factor, fibronectin, collagen 1,collagan 3, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Immunohistochemical markers CD45 and CD68 were used to detect leukocyte and macrophage infiltration in cardiac tissue. Western blot was used to detect the protein expression level of phosphorylated p38 (P-p38) and total p38 (T-p38). Results At week 6 after AB surgery, compared with the Sham group, LVEF and LVFS in the AB group were significantly reduced, the LVESD and LVEDD were significantly increased, the cardiac hypertrophy and fibrosis were significantly increased, and CD45 and CD68 in cardiac tissue, the expression levels of IL-6 and TNF-α were significantly increased (P<0.05). Compared with the AB group, the cardiac function of the AB+RM (1mg/kg) group and the AB+RM (3mg/kg) group was significantly improved, cardiac hypertrophy and fibrosis were significantly suppressed, and inflammation was significantly reduced (P<0.05). Western blot results showed that RM (1 and 3mg/kg) could significantly inhibit the p38 of cardiac tissue induced by AB surgery (P<0.05). Conclusion Roflumilast can reduce overload-induced cardiac hypertrophy and fibrosis in mice mainly through regulating the p38 MAPK signaling pathway and inflammatory response.

Abstract:Frailty refers to the decline in the physiological reserve or multi-system functions in the elderly. Adverse events in them such as upper respiratory infection, minimally invasive therapy and shift to new medication may lead to functional decline, reduced self-care ability, and shortened life expectancy. Studies have found that early intervention can be expected to reverse frailty, with exercise in particular showing a clear effect on alleviating frailty. This review aims to summarize the rescent research of exercise intervention for the elderly both in China and other countries in recent years with a view to providing scientific evidence for exercise intervention suitable for Chinese elderly with frailty.

Abstract:Hypertension is an important factor affecting the health of the elderly. Antihypertensive treatment can reduce the risk of stroke, cardiovascular events, and death in elderly hypertensive patients. Frailty often coexists with hypertension in elderly population, but few studies have focused on hypertension and frailty in the elderly. More importantly, conclusions vary in the studies about the antihypertensive treatment in elderly hypertensive patients with frailty. Still controversy are the starting values and target values of, the benefits from, and the strategies of the antihypertensive treatment in those patients. Therefore, this article reviews the antihypertensive treatment in elderly hypertensive patients with frailty.

Abstract:Atrial fibrillation is the most common arrhythmia in the elderly patients. The incidence of frailty in patients with atrial fibrillation increases with age as manifested by decreased physical functional reserve, increased complications, and effect on the safety of anticoagulation therapy. Considering the high risk of embolization in elderly patients with atrial fibrillation, it is necessary, in addition to assessment of embolism, to assess frailty and individualize anticoagulation regimen. Anticoagulation should not be refused for the elderly with frailty, and the gains might be better with new oral anticoagulants. This article reviews the anticoagulation strategies in elderly patients with atrial fibrillation.

Abstract:Frailty, one of the most common geriatric syndromes, increases mortality, adverse cardiovascular events, and bleeding risk in elderly patients with acute coronary syndrome ( ACS). Patients with frailty receive percutaneous coronary intervention (PCI) less frequently than those without, and frailty increases mortality of patients with PCI. There is a lack of evidence whether frail elderly patients can benefit from PCI and evidence to guide clinical decisions.

Abstract:The elderly are the vulnerable population of chronic kidney disease (CKD). Aging, comorbidities, polypharmacy are risk factors for poor prognosis of CKD. The elderly CKD patients are inclined to develop sarcopenia due to chronic inflammation, protein energy wasting, and reduced exercises. The adverse effect of sarcopenia on their prognosis has attracted the attention of nephrologists and geriatricians. Sarcopenia may increase incidence of cardiovascular events and all-cause mortality in the elderly CKD patients, which is closely associated with the poor prognosis of elderly CKD patients.

Abstract:Severe acute pancreatitis (SAP) is one of the most common critical illnesses clinically. Although great achievements have been made through total rehydration and active anti-infection in the early stage of the disease, the treatment outcome is still not satisfactory when infected pancreatic necrosis occurs in the later stage. With the rapid development of the concept of minimal invasiveness, the step-up strategy has gradually replaced the strategy of open debridement and achieved good therapeutic results. However, because of the individual differences of patients and the diversity of treatment methods, there is still no uniform standard for current treatment plans. In recent years, the step-up strategy will be further improved under the guidance of the emerging micro-non-invasive concept. This article introduces the current status of this strategy in treatment of SAP, and provides guidance and evidence for its surgical treatment.