Abstract:Objective To evaluate the predictive value of pre-endoscopy Rockall score (pRS), Full-Rockall score (fRS), Glasgow-Blatchford score (GBS) and AIMS65 scoring system for blood transfusion, endoscopic or surgical treatment, death and rebleeding in the elderly patients with acute non-varicose upper gastrointestinal bleeding (ANVUGIB). Methods The data were collected of 284 elderly patients (≥ 65 years old) with ANVUGIB in Huadong Hospital Affiliated to Fudan University from January 2013 to December 2018. The patients were divided into blood-transfusion (BT) group, non-blood-transfusion (NBT) group, endoscopic-or-surgical (EoS) group, and drug therapy (DT) group. Each patient was scored using the above-mentioned four scoring systems. The area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of the four scoring systems for blood transfusion, endoscopic or surgical treatment, death and rebleeding in the elderly ANVUGIB patients. SPSS statistics 19.0 was used for data analysis. Results The scores of pRS, fRS, GBS and AIMS65 were (2.73±1.39), (4.77±1.44), (8.17±1.62) and (1.60±0.69) points in transfusion group, and (1.96±1.08), (3.37±1.55), (4.68±3.29) and (1.12±0.32) points in non-transfusion group (all P<0.05). The scores of fRS and GBS were (6.69±1.75) and (7.69±2.39) points in endoscopic or surgical treatment group, and (3.58±1.60) and (5.20±3.34) points in drug-treated group (all P<0.05). The scores of pRS and AIMS65were (2.46±1.39) and (1.31±0.48) points in endoscopic or surgical treatment group, and (2.08±1.17) and (1.20±0.45) points in drug-treated group (all P>0.05). The predictive value of GBS for blood transfusion therapy was better than that of pRS, fRS, AIMS65 (0.817 vs 0.668,0.749,0.689; P＜0.05). The predictive value of GBS for endoscopic or surgical treatment is better than that of pRS, fRS, AIMS65(0.717 vs 0.577,0.680,0.562; P＜0.05). The predictive value of GBS for death was the same as that of fRS (0.785 vs 0.774; P＞0.05). There was no significant difference in the predictive value of pRS, fRS, GBS, AIMS65 for rebleeding (0.551 vs 0.545 vs 0.542 vs 0.551; P>0.05). Conclusion The GBS has good predictive value for the blood transfusion, endoscopic or surgical treatment and death of ANVUGIB in the elderly, and it is worthy of clinical promotion.

Abstract:Objective To investigate the prevalence of frailty in diabetic patients and determine the predictive validity of frailty assessment instrument in poor outcome. Methods The cohort studies about poor outcomes of frailty in diabetic patients were searched during January 2001 and April 2019 in the following electronic bibliographic databases, PubMed, Embase, Web of Science, PEDro, and the Cochrane Library, CINAHL, CNKI, Wanfang, CBM and VIP Data. The data were extracted according to inclusion and exclusion criteria. Meta-analysis was conducted by STATA 15.1 software, and descriptive analysis was conducted for data that cannot be combined. Results A total of 12 cohort studies, containing 563221 participants were included. The reported prevalence of frailty ranged from 0.3% to 74.0%. The frailty condition identified by frailty assessment tools were significantly associated with poor outcomes, such as mortality, hospitalization, disability and fall. The meta-analysis revealed that compared with other tools, FRAIL Scale scores were the most widely used tool in diabetic patients, and showed good predictive value for death and hospitalization risks. Conclusion The prevalence of frailty by different tool assessments varies widely in elderly patients with diabetes mellitus. The FRAIL scale is preferred for primary screening for elderly frail patients with diabetes in the community. However, due to limited studies included, prospective cohort study with large sample is still needed to verify the conclusion.

Abstract:Objective To explore the application value of peak strain dispersion (PSD) for assessment of left ventricular (LV) synchronization in patients with esophageal carcinoma before and after radiotherapy. Methods A total of 60 patients with esophageal carcinoma who received chest radiotherapy for the first time in the Northern Jiangsu People′s Hospital from October 2017 to July 2018 were enrolled in this study. Another 25 age-and sex-matched health volunteers at the same period served as control. Routine echocardiography examinations were performed before, in the middle of (after 14 times of radiotherapy), after and in 1 month after radiotherapy, and the obtained parameters were compared between the two groups. SPSS statistics 25.0 was used to analyze the data. Spearman correlation analysis was employed for correlation analysis. Results There were no significant differences in the echocardiographic parameters before and in the middle, end and in 1 month after radiation (P>0.05). In the above time points, the time to peak longitudinal strain (TTPLS) in basal segment was (361.0±29.0), (376.6±35.1), (382.7±33.8) and (370.6±36.9) ms, respectively, maximum difference of TTPLS (Tls-dif) in basal segment was (92.86±7.39), (105.67±25.18), (124.57±31.61) and (110.98±29.93) ms,respectively, and it in middle segments was (66.57±23.64), (87.56±20.13), (101.57±17.48) and (84.32±23.81) ms. The differences were gradually extended from the middle to the 1 month after radiotherapy (P<0.05). Compared with the end of radiotherapy, the above parameters showed a shortening trend in 1 month after radiotherapy (P<0.05). Compared with the values before radiation,PSD was increased gradually from the middle to the 1 month after radiotherapy [(33.20±7.65) vs (36.83±8.20) vs (40.91±8.36) vs (38.53±9.89) ms], while the absolute value of global longitudinal peak strain (GLPS) was decreased gradually (P<0.05). The PSD and GLPS values gradually recovered to the pre-radiotherapy levels in 1 months after radiation when compared with those at the end of radiotherapy (P<0.05). Spearman correlation analysis indicated that the absolute value of GLPS was negatively correlated with PSD (r=-0.61, P<0.01). Conclusion PSD can be used to evaluate the left ventricular contraction synchronization in esophageal carcinoma patients before and after radiotherapy, and is helpful for monitoring their cardiac function and timely adjusting radiotherapy regimen in clinical practice.

Abstract:Objective To investigate the imaging features of gastric neuroendocrine carcinoma (G-NEC) and gastric stromal tumor (GST) under multi-slice spiral CT scan. Methods A retrospective study was carried out on the pathologically identified G-NEC (n=21) and GST patients (n=34) who were hospitalized in our hospital from May 2010 to July 2019. The clinical data and CT features (including tumor location, tumor longest diameter, tumor growth pattern, tumor number and tumor morphology) were compared between the two groups. SPSS statistics 22.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for comparison between groups, and logistic regression analysis was applied to screen the independent differentiators between GST and G-NEC. Results In general data, G-NEC was more common in men, while GST was more common in women. Gender can be used as an independent distinguishing factor between GST and G-NEC (OR=0.02, P=0.015). G-NEC group (60.9±10.7 years old) and GST group (60.5±13.3 years old) had no statistical significance in age (P>0.05). Through the analysis of the CT findings of the two groups of patients, the location of the tumor (P<0.001), lymph node metastasis (P=0.012), liver metastasis (P=0.006), tumor growth pattern (P=0.014), tumor morphology ( P<0.001), mucosal integrity (P=0.001), and tumor boundary (P<0.001) were all significant differences in clarity. Subsequently, a multivariate analysis of the above characteristics was performed. Gender (OR=0.02, P=0.015) and tumor morphology (OR=18.61, P=0.022) can be used as independent distinguishing factors between GST and G-NEC, and tumor morphology was the most significant distinguishing factor between GST and G-NEC. Conclusion CT scan is of certain clinical significance for differential diagnosis between G-NEC and GST.

Abstract:Objective To investigate the factors affecting 24-hour high blood lactate in patients with septic shock. Methods A total of 150 patients with septic shock admitted to our department of critical care medicine from July 2014 to April 2019 were enrolled in this study. According to their blood lactate level within 24h, they were divided into control group (<4mmol/L, n=75) and observation group (≥4mmol/L, n=75). Their demographic data, clinical data and results of laboratory tests were collected. SPSS statistics 22.0 was used for data analysis. Cox regression model was used to analyze the factors affecting 24h lactate level. Kaplan-Meier survival analysis was employed to draw survival curve and compare the survival rate between the two groups. Results The results of multivariate Cox proportional-hazards regression analysis showed that the score of acute physiology and chronic health evaluation (APACHE Ⅱ) was an independent risk factor (HR=1.452,95%CI 1.103－1.901, P=0.008), while albumin level was an independent protective factor (HR=0.889,95%CI 0.886－0.999, P=0.001) for early hyperlactaemia in septic shock patients. Kaplan-Meier survival curve indicated that the 28-day cumulative survival rate was significantly lower in the observation group than the control group (χ²=15.632, P<0.001). Conclusion Blood lactate level within 24h can effectively evaluate the prognosis of septic shock patients. Higher APACHEⅡ score and lower albumin level are the important factors influencing the increase of lactate level.

Abstract:Objective To investigate the efficacy of salvianolic acid for injection (SAFI) in acute cerebral infarction and its effect on oxygen free radicals. Methods The patients with acute cerebral infarction were collected from February 2017 to November 2017. The control group (n=76) received routine treatment of cerebral infarction and the study group (n=67) additional SAFI (0.13g), both groups for 2 weeks. The two groups were compared before and after treatment in the respects of degree of neurological deficit, including National Institute of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, Barthel index (BI) and change of serum malondialdehyde(MDA) and superoxide dismutase(SOD). SPSS statistics 17.0 was used for statistical analysis. Depending on data type, data comparison was made using t test, rank-sum test,or χ² test. Results There was no significant difference in baseline data between the two groups before treatment (P>0.05). After treatment, the overall effective rate of the study group was significantly higher than that of the control group(89.55% vs 67.11%), the difference was statistically significant (χ²=43.64, P<0.01). After treatment, NIHSS score [1(1,2) vs 2(1,4) points], mRS score [1(1,2) vs 2(1,3) points], BI index [100(85,100) vs 90(76,100) points] and scores improvement rate[0.7(0.4,0.8) vs 0.3(0.1,0.5); 0.5(0.3,0.8) vs 0.3(0.0,0.5); -0.4(-0.6, -0.1) vs -0.1(-0.2,0.0)] of the study group were improved compared with the control group, the differences are statistically significant (P<0.01). After treatment, the MDA of the study group decreased compared with the control group [1.5(1,2) vs 2(1,3)nmol/ml], the difference was statistically significant (P<0.01). After treatment, SOD [145.8(131.3,160.8) vs 143.6(128.7,153.9)U/ml] did not increase significantly in the control group, the difference was not statistically significant (P>0.05); while SOD increased significantly after treatment in the study group, [162.1(139.3,188.4) vs 149.9(131.3,167.3)U/ml], and compared with the control group, SOD [162.1(139.3,188.4) vs 145.8(131.3,160.8)U/ml] were significantly higher in the study group, the differences were statistically significant (P<0.05, P<0.01). Conclusion SAFI can significantly improve the score of neurological deficit and the ability of daily life of patients with acute cerebral infarction.SAFI might play antioxidant roles and eliminate free radicals by decreasing MDA and increasing SOD activity, thereby improving clinical prognosis.

Abstract:Objective To investigate the effect of unidirectional barbed suture in transabdominal preperitoneal prosthetic (TAPP) laparoscopic hernioplasty in the elderly patients. Methods A retrospective analysis was made of the clinical data of 120 elderly patients undergoing TAPP from November 2016 to June 2019 in the General Surgery Department of the Third Affiliated Hospital of Inner Mongolia Medical University. Unidirectional barbed suture was used in half of them (n=60) and Vicryl suture in the other half (n=60). The two groups were compared in baseline data, the suturing time, operation time, intraoperative bleeding volume, hospital stay, visual analogue scale (VAS) of pain on the first day after operation, and postoperative complications. The data was processed using SPSS statistics 20.0. Depending on data type, comparison was made using t-test or χ² test. Results There was no significant difference in baseline data, intraoperative bleeding volume, hospital stay, VAS score of pain on the first day after operation, and postoperative complications between the two groups (P＞0.05). Unidirectional barbed suture group had shorter suturing time [(10.4±1.6) vs (15.4±4.8)min] and operation time [(53.8±4.6) vs (66.2±5.4)min] than Vicryl suture group, the differences being statistically significant (P<0.05). Conclusion Continuous suture of peritoneum with unidirectional barbed suture in TAPP simplifies the operation and shortens the operation time, which is of great significance to the elderly patients and is worthy of clinical application.

Abstract:Objective To investigate the effect of dexmedetomidine (DEX) combined with remifentanil on hemodynamic changes, clinical anesthesia efficacy and postoperative comfort in patients undergoing thyroid surgery. Methods Fifty patients undergoing thyroid surgery under general anesthesia in Third Affiliated Hospital of Jinzhou Medical University from December 2018 to April 2019 were recruited in this study. They were randomly divided into DEX group (DEX+remifentanil, n=25) and propofol group (propofol+remifentanil, n=25). The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and blood oxygen saturation (SPO₂) were recorded at the time of entry (T0), intubation (T1), skin incision (T2), beginning (T3) and end of operation (T4), eye opening (T5), extubation (T6), and leaving the post-anesthesia care unit (PACU, T7). The score of observer′s assessment of alertness/sedation scale (OAA/S), time to PACU Aldrate score more than 9 points, and Steward recovery score at T5, T6, time of orientation recovery and 10min after extubation, and the score of visual analog scale (VAS) on the first day post-operatively were investigated and recorded. The adverse reactions after extubation were observed. 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 two groups. Results No intraoperative awareness was observed among the 50 patients. There were significant differences in SBP, DBP, and HR from T2 to T7 (P<0.05), and in SPO₂ at T5 and T7 in the 2 groups (P<0.05). DEX group had obviously shorter T5 [(1.08±0.81) vs (6.56±1.87)min], T6 [(2.04±1.10) vs (8.48±1.81)min], time of orientation recovery [(1.56±0.87) vs (10.32±2.93)min], time to PACU Aldrate score more than 9 points [(5.28±1.10) vs (12.48±4.44)min], statistically less cases of restlessness (0 vs 3 cases), cough (2 vs 11 cases), respiratory depression (0 vs 10 cases), remarkably lower scores of OAA/S [(1.12±0.33) vs (2.12±0.67)] and VAS[(5.20±0.77) vs (2.72±1.10)], and notably higher score of awareness [(4.12±0.73) vs (5.80±0.41)] when compared with propofol group(all P<0.05). Conclusion Compared with propofol treatment, DEX treatment causes more stable hemodynamics during anesthesia maintenance, and has better advantages in improvement of the quality of recovery.

Abstract:Objective To evaluate efficacy of morphine sulfate sustained-release tablets and morphine hydrochloride tablets titrated in patients with moderate or severe cancer pain. Methods A total of 140 patients with moderate or severe cancer pain, who had never taken opioid drugs before, were randomized into study group (n=70) and control group (n=70). In the study group, morphine sulfate sustained-release tablets were titrated, and morphine hydrochloride tablets were used during pain evaluation. In the control group, morphine hydrochloride tablets were initially titrated. Both groups were observed for the dose, pain relief rate, adverse effects and changes in Karnofsky Performance Status (KPS). SPSS statistics 21.0 was used for data analysis. According to different date type, t test, rank-sum test or χ² test was used for data comparison between two groups. Results The time to effective pain relief in the study group was significantly shorter than that in the control group (Z=1.985,P=0.047). In 1-3h of titration, pain relief rate of the control group was higher than that of the study group (P<0.05). After 4 hours, pain relief rates were of no significant differences. Severe cancer pains in the first to second day of titration were less frequent in the study group than in control group (P<0.05) and were as frequent in both groups in the third day. Medication frequency was lower in the study group than in the control group (P<0.05) in the first day and was the same in both groups after the first day (P>0.05). The common adverse reactions were nausea, vomiting, constipation, dizziness, drowsiness, and dysuria in both groups without significant difference between two groups (P>0.05). Karnofsky performance status(KPS) was not significantly different between two groups from the first to third day (P>0.05) but was improved on the previous day in each group (P<0.05). Conclusion Morphine sustained-release tablets used for initial titration was no worse than morphine ready-release tablets and was worth being used for cancer pain.

Abstract:Objective To analyze the characteristics of age, sex and causes of hip fractures in the elderly patients with a view of developing a preventive protocol. Methods Enrolled in this study were the elderly patients treated for hip fractures at the Trauma Emergency Department of Beijing Jishuitan Hospital from September 2018 to December 2018. All the selected patients were investigated by a questionnaire covering age, gender, diagnosis, time and month of the fracture, external force, location of fracture, and whether the fall occurred in the bathroom at night. SPSS statistics 22.0 was used for data analysis. The data were analyzed by t-test, analysis of variance, and χ² test. Results A total of 414 patients were included in the analysis, with an average age being (80.7±7.7) years, the highest proportion (50.2%) of age group being of 80-89 years old, and female being significantly more than male. The patients with femoral neck fracture were more than those with intertrochanteric fracture, the former being younger than the latter and the difference being statistically significant(P<0.05). More patients were injured during the day than at night, and those injured during the day were younger than those injured at night, but with no significant difference(P>0.05). Fractures incurred at falls at home featured prominently, and using bathroom at night was the main cause of fractures at night. The older the patient, the more obvious the characteristics (P<0.05). Conclusion Hip fractures in the elderly have their own characteristics in the respects of age, gender, and cause, and prevention protocol can be proposed accordingly to reduce their occurrence.

Abstract:Objective To explore the difference of the therapeutic effects among different treatment methods for hyperlipidemia. Methods A total of 183 hyperlipidemia patients treated in the Hospital of Troop 75600 from January 2016 to January 2018 were enrolled as the research subjects, and were randomly divided into drug group, non-drug group and combined group, with 61 cases in each group. The patients from the drug group received atorvastatin treatment, those of the non-drug group received non-pharmaceutical interventions, such as health education, dietary adjustment and lifestyle optimization, and those of the combined group received both drug and non-drug interventions. After 12 weeks′ intervention, the treatment efficiency and blood levels of triglyceride (TG), total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) before and after the intervention were observed and evaluated for the improvement of symptoms and for therapeutic safety. SPSS statistics 16.0 was used to perform the statistical analysis. F-test or Chi-square test was employed for comparison between groups. Results The treatment efficiency was significantly higher in the combined group than in the drug group and the non-drug group (98.36% vs 81.97% and 73.77%, both P<0.05). And the combined group obtained obviously lower levels of TG [(1.41±0.35) vs (1.64±0.31) and (1.59±0.29)mmol/L], TC [(5.06±0.19) vs (5.96±0.68) and (6.11±0.51)mmol/L] and LDL-C [(2.56±0.43) vs (3.96±0.61) and (3.42±0.51)mmol/L], and decreased clinical symptom score [(3.16±0.51) vs (5.23±0.26) and (6.03±0.51)] when compared with the other 2 groups (P<0.05). The incidence of adverse reactions was significantly lower in the combined group than the drug group (4.92% vs 14.75%, P<0.05). Conclusion The combined intervention of drugs and non-drugs can significantly improve the clinical symptoms of hyperlipidemia patients, improve the efficiency of treatment, and have higher safety.

Abstract:Objective To investigate whether miR-200c can alleviate fibrosis in renal tubular epithelial cells induced by transforming growth factor-β1 (TGF-β1-induced) via the regulation of autophagy. Methods HK2 cells were stimulated with TGF-β1 at different concentrations (0,5, 10,15, 20,30ng/ml) for 48h, the cell morphology was observed under an inverted microscope, and the cell proliferation was detected by CCK-8. The concentration (c) of TGF-β1, which induced the most rapid proliferation of HK2 cells, was selected for transfection. The cells were transfected with 40nmol/L nonsense RNA (NC group), being treated with 40nmol/L nonsense RNA (NC+T group) for 48 h, with 40 nmol/L miR-200c mimics (M group), and with 40nmol/L miR-200c mimics (M+T group). qRT-PCR was used to detect the transfection efficiency of mir-200c. Western blotting was used to detect the expression of Smad pathway protein Smad2 and Smad3, α-smooth muscle actin(α-SMA), E-cadherin (E-cad), autophagy-related protein LC3 and p62. Results HK2 cells stimulated by TGF-β1 at 10ng/ml proliferated the fastest 48h later. Microscopic morphology of HK2 cells changed from normal oval paving stone to long fusiform with the most obvious fibrosis. qRT-PCR showed that the expression of miR-200c in group M was(212.42±12.25) times higher than that in group NC (t=24.41, P=0.000), indicating that the transfection was effective. Western blotting showed that expression of Smad2, Smad3 and α-SMA in HK2 cells in NC+T group increased and E-cad protein expression decreased compared with NC group (P<0.05). Compared with NC+T group, the expression of Smad2, Smad3 and α-SMA in M+T group decreased, and the expression of E-cad increased (P<0.05), suggesting that the increase of miR-200c expression inhibited fibrosis. It was further found that the expression of LC3-Ⅱ/LC3-Ⅰin M group was higher than that in NC group, and the expression of p62 was lower, suggesting increased autophagy; the expression of LC3-Ⅱ/LC3-Ⅰ in M+T group was higher than that in NC+T group, and the expression of p62 was lower, suggesting that the increased expression of miR-200c alleviated fibrosis. Conclusion miR-200c may alleviate TGF-β1-induced renal tubular epithelial fibrosis by activating autophagy.

Abstract:Heart failure is a complex clinical syndrome that seriously harms human health. The deepening studies found biomarkers play an increasingly important role in the field of heart failure, especially in heart failure with preserved ejection fraction (HFpEF). Biomarkers of different pathways (including neurohormone activation, myocardial injury, inflammation and fibrosis) have clinical effects beyond the diagnostic range for HFpEF. This article reviews the advances of natriuretic peptide and new biomarkers (lactose agglutinin-3 and growth differentiation factor-15) in the diagnosis and prognosis of HFpEF patients.

Abstract:Fragility fractures of the pelvis (FFP) are rare in the elderly, but thier incidence is increasing with the aging population. Their mechanism is different from that of the pelvic fracture caused by high energy injury. A new comprehensive classification system can distinguish different degrees of pelvic instability and different types of posterior pelvic ring fracture. The main principles for treating FFP are early activity, pain relief and anti-osteoporosis therapy. An anterior pelvic ring fracture alone is a stable injury and is usually conservatively treated. Pelvic ring injuries involving the posterior pelvic ring are unstable and should be stabilized if the patient′s condition permits. As one of the main goals of treating FFP is functional recovery, restoring pelvic stability is more important than anatomical reduction. Minimally invasive stabilization is superior to open reduction and internal fixation in the treatment of instable posterior and anterior pelvic rings. However, few reports are available about the optimal treatment of FFP, which requires much clinical and biomechanical research.

Abstract:The rising of aged tendency of the population results in a huge number of the disabled and semi-disabled elderly people in China. It has become a focus of the whole society how to provide better services to meet the physical or mental needs for the elderly who lose their self-care ability. This article summarizes the demand for care and quality evaluation system for the disabled elderly at home and abroad in recent years.

Abstract:Sepsis, one of the leading causes of death during hospitalization, has a severe prognosis with a mortality rate of more than 30% mainly due to insufficient understanding of the condition and lack of effective treatment. High-density lipoprotein cholesterol (HDL-C) is an important component of the blood and plays a crucial role in regulating endothelial function and immune function. Clinical trials and animal studies have shown that a decrease in HDL-C levels is a risk factor for sepsis. This review discusses the changes in the composition and structure of HDL-C in sepsis and its effects.