Abstract:People are susceptible to the 2019 novel coronavirus pneumonia. The elderly has weakened immune function and often suffers from chronic underlying diseases. Once the elderly has been infected, the novel coronavirus pneumonia often progresses rapidly and usually severely. Death of the novel coronavirus pneumonia is also more common in the elderly. The current diagnosis and treatment protocols are mainly for ordinary adults, and there is no guide applicable to the elderly for prevention and control of 2019 novel coronavirus pneumonia. In this review, based on the guidelines for the prevention and control of 2019 novel coronavirus pneumonia in ordinary adults, and in the light of the characteristics of the elderly population, we sort out the key points of prevention and control of 2019 novel coronavirus pneumonia in geriatric ward and pension agency, aiming to provide reference for primary-level medical institutions.

Abstract:Objective To systematically evaluate the differences in efficacy and safety between laser combined with intravitreal ranibizumab and intravitreal ranibizumab alone in the treatment of branch retinal vein occlusion (BRVO) with secondary macular edema. Methods Data was collected about randomized controlled trial for the treatment of BRVO with secondary macular edema via a search conducted in PubMed, CNKI, Wanfang and other databases, time being set from their establishment to May 2019. A meta-analysis was performed of the included studies using RevMan 5.3 statistics. Results A total of 12 studies were included with 1081 patients. Compared with intravitreal ranibizumab alone, the combination of laser with intravitreal ranibizumab was able to effectively reduce the central macular retinal thickness (CMT) [95%CI(-135.44--15.54), P<0.001] on the followed-up visits at 1,3 and 6 months; but there was no statistically significant difference in the improvement of best corrected visual acuity (BCVA) [95%CI (-1.75-0.80), P>0.05] and in the incidence of adverse reactions between the two groups [OR=1.50,95%CI (0.97-2.30), P=0.07]. Conclusion Laser combined with intravitreal ranibizumab can significantly reduce the CMT in BRVO patients with secondary macular edema, with better early efficacy than intravitreal ranibizumab alone. However, the effects of the two methods on BCVA after treatment and the occurrence of adverse reactions is yet to be verified by a large number of randomized double-blind controlled studies.

Abstract:Objective To analyze the correlation between plasma homocysteine and coronary artery calcification. Methods A total of 329 patients undergoing coronary CT angiography were enrolled and grouped according to the coronary artery calcification score and the severity of coronary artery disease. The plasma homocysteine was measured, and an analysis was made of the correlation between homocysteine and coronary artery calcification. SPSS statistics 23.0 was used for statistical analysis, and depending on the type, data were analyzed using t test, analysis of variance, LSD test and χ² test. Results The concentration of homocysteine was higher in the calcification group than in the non-calcification group (P<0.05). In the calcificaton group, the homocysteine levels were (13.26±4.93)μmol/L in those with single lesion (n=53), (13.56±4.50)μmol/L in those with double lesions (n=63), and (14.49±4.16)μmol/L in those with multiple lesions (n=58), the difference being not statistically significant (F=1.915, P=0.151). Homocysteine concentrations increased with the increasing coronary artery calcification scores:(12.94±4.64)μmol/L in 1-99 group, (14.29±4.50)μmol/L in 100-399 group, (14.29±4.50)μmol/L in ≥400 group, the difference being statistically significant (F=3.581, P=0.030). The occurrence of coronary artery calcification was associated with the plasma homocysteine concentration (r=0.230,95%CI 0.150-0.349, P＜0.001). Conclusion Plasma homocysteine is related to the occurrence and severity of coronary artery calcification, suggesting that plasma homocysteine concentration may serve as a biomarker for coronary artery calcification.

Abstract:Objective To investigate the occurrence of unplanned readmission in the elderly patients with comorbidities and to explore the effect of geriatric syndrome on unplanned readmission. Methods From January 2015 to December 2017, a total of 443 elderly cases with comorbidities were selected, who were hospitalized in Department of Geriatrics of the Fifth People′s Hospital of Chengdu. Geriatric syndrome was screened by comprehensive geriatric assessment, the patients were followed up for two years after discharge, and data were collected of the unplanned readmission within the period. Statistical analysis was performed using SPSS statistics 24.0, and independent risk factors were screened out by multivariate logistic regression analysis. Results Within the two-year follow-up, 199 (44.92%) patients were readmitted without plan. The top 5 in the geriatric syndrome were the dependence for activity of daily living (ADL) (n=269,60.72%), risk of malnutrition (n=256,57.79%), high-risk of fall (n=246,55.53%), multiple medications (n=237,53.50%), and weakness (n=231,52.14%). Multivariate logistic regression found that malnutrition (OR=1.522, 95%CI 1.081-2.145; P=0.016), high-risk of fall (OR=1.855,95%CI 1.219-2.825; P=0.004), ADL impairment (OR =1.649,95%CI 1.074-2.533; P=0.022), polypharmacy (OR=1.597,95%CI 1.068-2.388; P=0.023) were independent risk factors for readmission within 2 years. Conclusion The readmission rate in elderly patients with comorbidities is high, and the geriatric syndrome has effect on the time and frequency of readmission.

Abstract:Objective To investigate the effect of the modified Tai Chi on the balance of stroke patients and on serum alkaline phosphatase (ALP), neuropeptide Y (NPY) and interleukin (IL)-6. Methods A total of 86 patients with stroke and hemiplegia were enrolled in the study, who were admitted to the Department of Neurology of Xuzhou Central Hospital from Sep. 2017 to Dec. 2018. They were randomly divided into two groups with 43 in each group. The control group received routine rehabilitation and the study group received additional training of modified Tai Chi 3 times a week for 12 weeks. The two groups were compared in the balance adjustment ability index, plantar pressure, Berg balance scale (BBS), simplified Fugly-Meyer motor assessment (FMA),timed up and go test (TUGT) and 6-minute walking test (6MWT), and serum ALP, NPY, and IL-6 as measured before treatment and after 12 weeks of treatment. SPSS statistics 23.0 was used for data analysis, and depending on data type, t test or χ² test was used for comparison between groups. Results After training, the peak pressure and average pressure of healthy foot, envelope ellipse area, ratio of envelope ellipse area to pressure center offset, ellipse trajectory length, TUGT, ALP, NPY and IL-6 decreased, while the peak pressure and average pressure of diseased foot, ellipse trajectory length of pressure center offset, BBS, FMA and 6MWT increased in both groups. (P<0.05). After training, the study group improved more significantly than the control group in the peak foot pressure of healthy foot[(207.54±31.20) vs (264.87±38.73) N], the average healthy foot pressure [(60.51±12.87)% vs (81.20±16.27)%], peak diseased foot pressure [(180.83±29.20) vs(163.52±26.30) N], average diseased foot pressure[(51.20±8.40) % vs (40.58±6.87)%], envelope ellipse area[(125.42±32.70) vs (170.26±38.05)mm²], elliptical trajectory length [(542.20±68.41) vs (425.21±48.23)mm], ratio of envelope ellipse area to elliptical trajectory length[(0.23±0.02) vs (0.40±0.04)], TUGT [(13.87±2.62) vs (17.52±2.86)s], ALP[(72.27±6.37) vs (77.81±7.05)U/L], NPY[(128.60±15.79) vs (150.24±17.98)μg/L], IL-6 [(6.68±0.87) vs (13.20±1.76)pg/ml], BBS[(28.05±3.41) vs (23.08±2.97) score], FMA[(29.26±3.50) vs (23.57±3.02) score], and 6MWT[(302.97±58.62) vs (256.52±49.67)m], the differences being statistically significant (P<0.05). Conclusion Modified Tai Chi can effectively improve balance, movement and walking in the stroke patients, and its mechanism may be related to the down-regulation of ALP, NPY and IL-6.

Abstract:Objective To investigate the effect and safety of enhanced recovery after surgery (ERAS) in the elderly patients undergoing laparoscopic-assisted radical gastrectomy. Methods From December 2015 to December 2018,80 patients undergoing laparoscopic-assisted radical gastrectomy were randomly divided into ERAS group and routine group (n=40 in each). The two groups were compared in postoperative indicators and complications. SPSS statistics 22.0 was used to analyze the data, and depending on data type, t test or χ² test was used for comparison between the two groups. Results Compared with the routine group, the ERAS group had shorter time before the first exhaust [(53.77±23.53) vs (64.24±22.44)h] and the first defecation [(60.92±22.15) vs (75.10±22.25)h]; earlier ambulation [(18.77±3.27) vs (26.67±4.29)h], oral feeding for liquids [(22.26±9.64) vs (89.47±13.39)h], postoperative parenteral nutrition[(5.43±1.57) vs (7.46±1.45)d] and removal of peritoneal drainage [(4.90±1.24) vs (6.60±1.04)d]; shorter postoperative hospital stay [(8.73±1.80) vs (10.83±2.07)d]; and lower postoperative hospitalization expenses [(5.35±0.58)×10⁴ vs (6.06±0.65) ×10⁴ yuan], all differences being statistically significant (P<0.05). ERAS group had significantly lower incidences than the routine group of sore throat [7.5%(3/40) vs 27.5%(11/40)], incision pain above grade Ⅱ[5.0%(2/40) vs 20.0%(8/40)], and postoperative complications of Clavien-Dindo grade Ⅰ [17.5%(7/40) vs 37.5%(15/40)], all differences being statistically significant (P<0.05). Conclusion ERAS is safe and effective in the elderly patients undergoing laparoscopic-gastric radical gastrectomy and can reduce postoperative Clavien-Dindo grade Ⅰ complications.

Abstract:Objective To determine the effects of dexmedetomidine and propofol on inflammatory response and S100β protein in patients with sepsis associated encephalopathy (SAE). Methods A total of 50 SAE patients undergoing mechanical ventilation admitted to the intensive care unit (ICU) of our hospital from July 2017 to December 2018 were prospectively enrolled in this study. They were randomly divided into propofol group and dexmedetomidine group, 25 cases in each group. The levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and central nervous system specific protein S100β at 1 (T1), 12 (T2) and 24 h (T3), and 3 d (T4) after the treatment, incidence of adverse reactions, mortality and length of ICU stay were compared between the 2 groups. SPSS statictis 20.0 was used to analyze the data. Student′s t test or Chi-square test was employed for intergroup comparison. Results The levels of TNF-α at T2, T3 and T4 [(17.83±2.09) vs (19.96±2.65)ng/L, (14.95±3.37) vs (18.83±4.46)ng/L, (8.62±3.07) vs(17.75±5.06)ng/L], those of S100β [(0.69±0.05) vs (0.61±0.04)μg/L, (0.62±0.03) vs (0.55±0.03)μg/L, (0.56±0.02) vs (0.42±0.01)μg/L] at the same time points, and those of IL-6 [(340.71±10.37) vs (390.89±12.26)ng/L, (240.62±10.54) vs (331.15±12.64)ng/L] at T3 and T4 were significantly lower in the dexmedetomidine group than the propofol group (P<0.05). There were 1 case of respiratory depression, 4 cases of bradycardia and 2 cases of hypotension in the dexmedetomidine group, and 2 cases of respiratory depression, 3 cases of bradycardia, and 4 cases of hypotension in the propofol group. No statistical difference was seen in the incidence of adverse reactions between the 2 groups [28%(7/25) vs 36%(9/25), P>0.05]. In the dexmedetomidine group, 4 patients died, and the length of ICU stay was (13.19±2.26)d. For the propofol group, 2 patients died, and ICU length was (13.07±2.16)d. There was no differences in the mortality and ICU length between the 2 groups (P>0.05). Conclusion Dexmedetomidine can attenuate inflammatory response to some extent and achieve ideal sedative effect in SAE patients.

Abstract:Objective To evaluate the efficacy and safety of tadalafil 5mg in the treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Methods Randomized controlled trials (RCTs) were collected via computer-based and manual retrieval. The computer retrieval was limited to the time of database establishment until October 2018, and no limit was set for langauge. The databases searched included Wanfang database, China Journal Full-text Database (CNKI), China Science and Technology Periodical Database (VIP), China Biomedical Literature Database (CBM), EMBASE, PubMed, Cochrane. Library, and Clinicaltrials.gov. Quality assessments were performed for studies that met the inclusion criteria, data were extracted, and a meta-analysis was performed using RevMan 5.3. Results Included for analysis were 9 RCTs with a total of 3501 patients, 1758 being treated with the tadalafil 5mg and 1743 with placebo. Compared with placebo, tadalafil 5mg reduced the International Prostate Symptom Score (IPSS) [MD=-1.79,95%CI (-2.19, -1.39)], improved quality of life (IPSS-Qol) [MD=-0.26,95%CI (-0.36, -0.16)], but did not lead to significant improvement in maximum urinary flow rate (Qmax) [MD=0.15,95%CI (-0.35,0.64), P=0.55]. The proportion of patients who withdrew due to adverse events was not significantly increased in the tadalafil 5mg group [RR=1.54,95%CI (0.96,2.49), P=0.08, I²=0%]. Conclusion Tadalafil 5mg can improve the LUTS in the patients with BPH and is well tolerated.

Abstract:Objective To study the efficacy of bivalirudine in emergency percutaneous coronary intervention (PCI) in the elderly patients with acute myocardial infarction. Methods Enrolled in the study were a total of 124 ST-elevation myocardial infarction (STEMI) patients who underwent PCI in Wuhan Asian Heart Hospital from April 2017 to December 2018. They were randomized into the study group and the control group, with 62 in each group.The two groups were given the same dose of aspirin and clopidogrel orally before operation, and the patients in the control group were given heparin intravenously and the patients in the study group bivalirudin during the operation. The two groups were compared in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), B-type natriuretic peptide (BNP), bleeding events and major adverse cardiovascular events (MACEs) during hospitalization, 30d and 60d after operation. SPSS statistics 18.0 was used for data analysis.Depending on the data type,t test or Chi-square test was used for comparison between groups. Results The two groups had no significant difference in preoperative LVEF, LVEDD and BNP (P>0.05). Compared with pre-operative levels, LVEF increased and LVEDD and BNP decreased at 30d after operation in both groups. Compared with the control group, the LVEF [(46.9±4.7)% vs (43.1±4.5)%] and BNP [(182.8± 83.4) vs (294.5±107.6)ng/L] improved significantly in the study group (P<0.05). Before operation, mild hemorrhage was observed in 1 patient in the study group and 1 patient in the control group, and 1 had moderate/severe hemorrhage in the control group. The difference was not statistically significant (P>0.05). At postoperative 30d, the incidence of hemorrhage in the study group was significantly lower than that in the control group[3.23%(2/62) vs 6.45%(4/62)]. The difference was statistically significant(χ²= 5.145; P<0.05). Therewas no significant difference in the incidence of MACEs[1.61%(1/62) vs 3.23%(2/62); 3.23%(2/62) vs 4.84%(3/62)]between the study group and the control group (χ²＝1.290,χ²＝0.112; P＞0.05). Conclusion Bivalirudine can improve cardiac functions in the patients with acute myocardial infarction undergoing PCI and significantly reduce the incidence of hemorrhage after PCI.

Abstract:Objective To investigate the efficacy and compliance of home noninvasive positive pressure ventilation (NPPV) in the elderly patients with chronic obstructive pulmonary disease (COPD) combined with respiratory failure. Methods A total of 100 elderly COPD patients with respiratory failure who were discharged after treatment in our department from January 2016 to December 2017 were recruited in this study. They were randomly divided into observation group and control group, with 50 cases in each group. The patients in the control group were given routine treatment at home, including expectoration, clearance of respiratory tract, anti-spasmodic and anti-asthmatic drugs, anti-infection and long-term oxygen inhalation. While those of the observation group received home NPPV on the basis of all above treatments as the control group. During 1 year′s follow-up, hospitalization, quality of life (SF-36 scale), dyspnea (St. George′s questionnaire), 6-minute walking test (6MWT), pulmonary function, arterial blood gas indices,compliance and incidence of adverse events before and after treatment were recorded and compared between the 2 groups. SPSS statistics 21.0 was used to analyze the data. According to the data types, Student′s t test or Chi-square test was employed for comparison between the two groups. Results During the follow-up of 1 year, the length of hospital stay was a little bit longer [(14.32±3.41) vs (13.33±2.54)d, t=1.646, P>0.05], while the hospital costs were significantly larger [(21.2±2.6) ×10³ vs (15.7±1.5) ×10³ yuan, t=12.956, P<0.05] in the control group than the observation group. The quality of life score, dyspnea score, 6MWT, forced expiratory volume in one second (FEV1), partial pressure of oxygen (PaO₂) and partial pressure of carbon dioxide(PaCO₂) were significantly improved in the both groups after treatment (P<0.05). The observation group had more significantly improved above indicators when compared with the control group (P<0.05). During the treatment period, there were no significant differences in the incidence of adverse events [26.0%(13/50) vs 34.0%(17/50), P=0.383] and the incidence of poor compliance [24.0%(12/50) vs 34.0%(17/50), P=0.271] between the observation group and the control group. Conclusion For the elderly COPD patients with respiratory failure, home NIPPV is worthy of promotion on the basis of routine therapies, because it relieves the symptoms, improves quality of life, and reduces hospital costs.

Abstract:Objective To observe the efficacy of rehabilitation training coupled with pharmacotherapy on the elderly patients with post-stroke depression (PSD) and its effects on neurological function and cognitive functions. Methods From May 2017 to February 2018, a total of 80 PSD elderly patients were selected for the study, who were treated at the Guangyuan Mental Health Center. The patients were divided into control group and observation group (40 patients each). Both groups were treated with drugs for 8 weeks, and the observation group were given additional rehabilitation training at the same time. The two groups were compared in indices measured before and after treatment, including Hamilton rating scale for depression (HAMD), National Institutes of Health neurological defective scale (NIHSS), stroke-specific quality of life scale (SS-QOL), mini-mental state examination (MMSE) and satisfaction. Statistical analysis was performed using SPSS statistics 13.0, and comparison between the two groups was performed using t test or χ² test. Results Compared with before treatment, HAMD, NIHSS, MMSE and SS-QOL of the two groups were significantly improved after treatment (P<0.05).Compared with the control group, HAMD [(16.22±2.06) vs (19.55±3.12)] and NIHSS [(6.04±1.03) vs (9.68±1.44)] of the observation group were significantly lower after treatment (P<0.05), and MMSE [(23.29±3.38) vs (18.15±3.23)] and SS-QQL [(178.62±3.66) vs (151.58±6.35)] significantly higher (P<0.05). The observation group rated the satisfaction significantly higher than the control group (97.5% vs 85.0%, χ²=3.914, P=0.048). Conclusion Rehabilitation training coupled with medications is effective in the treatment of senile patients with PSD, significantly improving the cognitive and neurological functions and quality of life of the patients, and the paradigm is worth clinical application.

Abstract:Objective To investigate the effect of polydatin(PD) on oxidative stress-induced mitochondrial damage in alveolar epithelium and its possible mechanism. Methods A549 cells were assigned to four groups:control group in which cells were treated with 0.1% DMSO for 60min; model group in which cells received the pretreatment of 0.1% DMSO for 30min and exposure to H₂O₂ (250μmol/L) for 30min; treatment group in which cells received the pretreatment of PD (50μmol/L) for 30min and exposure to H₂O₂ (250μmol/L) for 30min; and inhibitor group in which cells received the pretreatment of PD (50μmol/L) and mitochondrial division inhibitor 1 (mdivi-1,10μmol/L) for 30min, and exposure to H₂O₂ (250μmol/L) for 30min. Western blotting was performed for expression of mitochondrial membrane protein [translocase of outer mitochondrial membrane 20 (TOM20), translocase of inner mitochondrial membrane 23 (TIM23)] and mitogen regulatory factor [mitochondrial transcription factor A (mTFA), and peroxisome proliferator-activated receptor-gamma coactivator-1α (PGC-1α)]. At the same time, Keima method was used to detect the red/green fluorescent area of cells as a reflection of mitochondrial autophagy. ATP was measured by fluorescein-luciferase kits, mitochondrial membrane potential (MMP) was determined using the fluorescent dye JC-1, reactive oxygen species (ROS) level was evaluated by DCFH-DA, and cell viability was determined by cell count kit-8 (CCK-8). SPSS statistics 20.0 was used for analysis. Results (1) Mitochondrial autophagy level. The expression of TOM20 and TIM23 was significantly lower in the model group than in the control group, in the treatment group than in model group, but significantly higher in the inhibitor group than in the treatment group (<0.01). However, there was no significant differences in mTFA and PGC-1 α between the four groups (P>0.05). Keima method showed that the change of red/green fluorescent area ratio in the four groups trended conversely with the changes of expression level of TOM20 and TIM23. (2) MMP. MMP was (100.0±5.9)% in the control group, (54.2±4.8)% in the model group, (70.8±3.6)% in the treatment group, and (56.0±6.1)% in the inhibitor group. Compared with control group, MMP in the model group decreased significantly, MMP in the treatment group increased significantly, while MMP in the inhibitor group decreased significantly (P<0.01). (3) ROS, cell activity and ATP level. Compared with control group, ROS in the model group increased significantly, while cell activity and ATP decreased significantly.Compared with the model group, ROS in the treatment group decreased significantly, while cell activity and ATP increased significantly. Compared with the treatment group,ROS level in the inhibitor group increased significantly, while cell activity and ATP decreased significantly (P<0.01). Conclusion PD can significantly improve oxidative stress-induced mitochondrial damage in alveolar epithelium, and its mechanism may be related to the up-regulation of mitochondrial autophagy.

Abstract:Inclusion body myositis (IBM) is the most common inflammatory muscular disease in the elderly, but it has poor response to hormone or immune regulation therapy. Currently, exercise training intervention has taken an important role among the therapies of IBM. This paper summarizes the application of exercise training intervention in treatment of inclusion body myositis, and the progress of mechanism involved in the intervention.

Abstract:Sarcopenia, a common geriatric syndrome, is a progressive and generalized skeletal muscle disorder associated with increased likelihood of adverse outcomes including falls, fractures, and physical disability. Early screening of sarcopenia and implementation of relevant interventions help the health maintenance in the elderly and improve long-term prognosis. Currently, sarcopenia screening in China remains in its infancy. This article reviews simple screening tools for sarcopenia, such as SARC-F score, SARC-CalF score, Ishii score and MSRA scale, and their applications in the population.

Abstract:The serious risk of atrial fibrillation (AF) is stroke and other thromboembolic events caused by local thrombosis that sheds off and travels in blood circulation to blood vessels throughout the body. Platelet activation is an important part of the mechanism of thrombosis, where mean platelet volume (MPV) serves as one of the markers of platelet activity. Its testing is simpler, more economical, more widely available, and more convenient than others. A number of studies at home and abroad have shown that MPV is related to AF itself, the occurrence of AF, and the risk of AF-related stroke. This review aimed to provide a more complete theoretical basis for the prevention of AF-related stroke.