Abstract:Objective To investigate the correlation between glycosylated hemoglobin A1c (HbA1c) and reactive hyperemia index (RHI) in the patients with type 2 diabetes mellitus (T2DM). Methods A total of 608 T2DM patients admitted to the Endocrinology Department of First Affiliated Hospital of Nanjing Medical University from January 2017 to February 2019 were enrolled in this study. During the hospitalization, all patients were evaluated by using Endo-PAT non-invasive vascular endothelial function detection technology to calculate RHI. The patients with RHI≥1.67 were assigned into the control group, and those with RHI＜1.67 were into the study group. According to the HbA1c level, they were divided into HbA1c <7% group, HbA1c 7%-9% group and HbA1c >9% group. Their general data, biochemical indices, blood glucose level and insulin resistance index were compared among the groups. Spearman correlation analysis was used to evaluate the correlation between HbA1c and RHI. The relationship was evaluated by multiple linear regression analysis on the factors affecting endothelial function. Results HbA1c level was significantly higher in the study group than in the control group (P=0.001), but no statistical significances were seen in age, body mass index, blood lipid, blood glucose, and homeostatic model assessment of insulin resistance (HOMA-IR) and of β-cell function (HOMA-β) between two groups. With the increase of HbA1c, RHI was decreased in the groups of different HbA1c level (P=0.004). Spearman correlation analysis showed that HbA1c level was negatively correlated with RHI in T2DM patients, and multivariate regression and logistic regression analysis indicated that HbA1c was an independent and significant predictor for vascular endothelial function assessment index (OR=0.864,95%CI 0.786-0.950, P=0.002). Conclusion For T2DM patients, HbA1c can be used to evaluate the recent endothelial function. Actively controlling the blood glucose can improve vascular endothelial dysfunction, and thus the damage to peripheral vessels and other target organs will be thereby reduced and cardiovascular events be prevented.

Abstract:Objective To investigate effects of comprehensive evaluation of frailty and corresponding intensive education on the health outcomes in the elderly patients with cardiovascular disease during hospitalization and after discharge. Methods A total of 100 consecutive elderly patients with cardiovascular disease were selected for the study, who were admitted to the Department of Cardiology of Chinese PLA General Hospital from February to September 2019. Fried frailty phenotype and comprehensive evaluation of the elderly were analyzed. Intensive education was conducted from multiple time points, and the efficacy was observed. Results Of all the included patients, 24 had frailty and 76 did not. Logistic regression analysis of the factors affecting frailty showed that 3-meter timed up & go test (OR=1.151,95%CI 1.029-1.288, P=0.014),angina (OR=8.510,95%CI 1.753-41.307, P=0.008) and D-dimer (OR=2.925, 95%CI 1.161-7.369, P=0.023) were risk factors of frailty. Our study showed that frailty had no effect on the complications in patients hospitalized with cardiovascular disease, and no adverse events such as death, falls, or fractures occurred in all patients. The incidence of falls, fractures and readmission within 6 months after discharge occurred in 9 frailty patients and 19 non-frailty patients without significant difference. The scores of depression assessment at 3 months after discharge in both groups were lower than that on hospitalization, and the number of long-term oral medicines was lower than that during hospitalization in the non-frailty group (P<0.05). The FRAIL score and BMI in the non-frail group decreased at 6 months after discharge compared with that during hospitalization (P<0.05), and the frailty group did not change significantly. There was no significant difference between the two groups in basic activities of daily living (BADL) score (P>0.05). Conclusion Comprehensive evaluation of frailty and corresponding intensive education in the elderly inpatients with cardiovascular disease contribute significantly to the reduction in the incidence of adverse events after hospitalization and discharge, which has more significant effects on modifying frailty, depression, body mass index and multiple medication in the non-frailty group than in the frailty group.

Abstract:Objective To validate the application of dual antiplatelet therapy (DAPT) score for the antiplatelet treatment in patients with coronary chronic total occlusion (CTO) after percutaneous coronary intervention (PCI). Methods A total of 497 patients with the consecutive CTO who underwent PCI in Bethune International Peace Hospital from January 2014 to June 2017 and then treated with DAPT for 12 months (the standard group) or prolonged to 12-58 months (the prolonged group)were enrolled in this study. The incidences of bleeding and major cardiovascular and cerebrovascular events (MACCE) were observed and compared between the patients with DAPT score ≥2points and <2points, and between those from the standard and prolonged groups. SPSS statistics 22.0 was used for data analysis. Results A total of 405 patients were enrolled in the final analysis, with follow-up period of 34 (28-44) months. (1) In the patients with DAPT score ≥2points, the incidence of MACCE was significantly lower in the prolonged group than in the standard group (5.5% vs 14.0%, P=0.040). The prolonged group had obviously lower rate of cardiac death (1.8% vs 8.6%, P=0.046) and incidence of target vessel revascularization (1.8% vs 8.6%, P=0.046) when compared with the standard group. Kaplan-Meier analysis showed that there was statistical difference in the MACCE-free survival rate between the prolonged and standard groups (P=0.046). (2) In the patients with a DAPT score <2points, there was no significant difference in the incidence of MACCE between the 2 groups. But the occurrence of Bleeding Academic Research Consortium (BARC) type 2,3,5 bleeding was significantly lower in the standard group than in the prolonged group (3.4% vs 12.8%, P=0.018). Kaplan-Meier analysis that indicated the standard group obtained notably higher bleeding-free survival rate than the other group (P=0.034). Conclusion DAPT score can be used to guide DAPT in CTO patients after PCI. The patients with the score ≥2points might benefit from prolonged DAPT, while for those with the score <2points, standard treatment should be carried out to decrease the risk of bleeding events.

Abstract:Objective To evaluate the efficacy of iliac vein stent in the treatment of acute deep venous thrombosis (DVT) in the lower limbs with iliac vein stenosis or occlusion. Methods A retrospective analysis was made of 80 patients hospitalized for acute DVT in the lower extremities with iliac vein stenosis or occlusion at Weifang People′s Hospital of Shandong Province from January 2016 to January 2018. According to the implantation of iliac vein stent, they were divided into observation group (n=45) and control group (n=35). The observation group underwent implantation of inferior vena cava filter, catheter-directed thrombolysis (CDT), and iliac vein stent; the control group were treated with an inferior vena cava filter and CDT. The two groups were compared for the postoperative effect, detumescence rate of the affected limbs, venous patency rate, and scores on Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) questionnaire. Statistical analysis was performed using SPSS statistics 18.0. Results Before operation, circumference differences in the thigh and calf between the two groups were not statistically significant (P>0.05 for both); after operation, circumference differences in the thigh and calf and difference in the detumescence rate between the two groups was statistically significant (P<0.05 for all). The observation group had higher venous patency rates than the control group at 1,3, 6, and 12 months of follow-up [45(100.0%) vs 29(82.8%), 43(95.5%) vs 27(77.1%), 41(91.1%) vs 26(74.2%), and 41(91.1%) vs 25(71.4%) respectively], the differences being statistically significant (P<0.05 for all). There was a statistically significant difference in the incidence of sequelae of DVT between the observation group and the control group [0(0.00%) vs 4(11.43%),P<0.05]. There was no significant difference in the rate of thrombosis recurrence between the two groups [4(8.89%) vs5(14.28%), P>0.05]. VINENES-QOL/SYM questionnaire scores of the two groups were not significantly different before the treatment (P>0.05) but were significantly different after the treatment (P<0.05). Conclusion Implantation of iliac vein stent is more effective than catheter-directed thrombolysis in the treatment of DVT of the lower extremity with iliac vein stenosis or occlusion.

Abstract:Objective To explore the applicaton of pulse-indicated continuous cardiac output (PICCO) in the elderly acute myocardial infarction (AMI) patients with cardiogenic shock (CS). Methods A retrospective analysis was made of 60 AMI patients with CS, who were admitted to the intensive care unit (ICU) of our hospital from June 2013 to June 2018. The patients were divided into PICCO group (n=30) and control group (n=30). A central venous catheter was inserted into the patient of control group to measure the central venous pressure. The following items were observed and recorded before and after the treatment:lactic acid, urine volume, blood pressure, and serum B-type natriuretic peptide (BNP). Record was made of ICU admission time, mechanical ventilation time, administration time of vasoactive drug, and prognosis. The PICCO group was further divided into the survival group and the death group. The two groups were compared before and after treatment in cardiac index (CI), extravascular lung water index (EVLWI), global end-diastolic volume (GEDVI), systemic vascular resistance index (SVRI), and global ejection fraction (GEF). The above indicators were evaluated of the predictive value for the prognosis in the AMI elderly patients with CS. SPSS statistics 13.0 was used for data processing, and the receiver operating characteristic (ROC) curve was used to analyze the predictive ability of the relevant indicators for the patient′s prognosis. Results At 12,24 and 48h after the treatment, lactic acid and BNP in PICCO group were lower, and the mean hourly urine volume was higher than those in the control group, the differences being statistically significant (P<0.05 for all). The PICCO group had shorter ICU stay, mechanical ventilation and vasopressor use than the control group with statistically significant differences (P<0.05 for all). The 7-day fatality rate in the PICCO group was significantly lower than that in the control group; however, there was no statistical difference with 14-day and 28-day fatality rate. After the treatment, CI and GEF were significantly higher and EVLWI and SVRI significantly lower than those before the treatment in both survival and death groups. At 48h after the treatment, CI and GEF were significantly higher,and SVRI significantly lower in the survival group than in the death group before treatment (P<0.05 for all). ROC curve analysis suggested that CI, GEF, SVRI before the treatment and CI, GEF, SVRI, EVLWI at 48 hours after the treatment can effectively predict the 28-day prognosis. Conclusion Employment of PICCO is more effective than the traditional treatment in guiding the recovery of the elderly acute myocardial infarction patients with cardiogenic shock, and the indicators of PICCO contribute to predict prognosis.

Abstract:Objective To explore the predictive value of quick sequential organ failure assessment (qSOFA) combined with red blood cell distribution width (RDW) for prognosis in the elderly patients with sepsis. Methods Totally 124 the elderly septic patients (≥60 years) with laboratory data, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and quick sequential organ failure assessment (qSOFA) admitted in First Affiliated Hospital of Hebei North University from June 2016 to June 2019 were enrolled in this retrospective study. According to the prognosis in 30 d after hospitalization, they were divided into the survival group (78) and the death group (46). The differences of clinical data between the two groups were compared by student′s t test, non-parametric test and Chi-square test. The influencing factors of prognosis were analyzed by Cox regression model. Kaplan-Meier curve was used to analyze the differences of prognosis among the patients with different qSOFA and RDW. The predictive value of qSOFA and RDW on prognosis were analyzed by receiver operating characteristic (ROC) curve. Results Compared with the survival group, the dead group had significantly wider RDW, higher levels of creatinine and procalcitonin, and higher points of APACHE Ⅱ and qSOFA (P<0.05). Cox regression model showed RDW, APACHE Ⅱ and qSOF were prognostic factors for sepsis (P<0.05). Kaplan Meier curve analysis indicated that the prognosis of patients with different qSOFA and RDW differed from each other statistically (P<0.05). Logistic regression model displayed that combined qSOFA and RDW was a new index in the prognosis prediction of the elderly septic patients (-5.728+0.505×qSOFA+0.339×RDW), and ROC curve analysis indicated that the best cutoff value of this index was -0.6144, with the sensitivity and specificity of 60.87% and 79.49%, respectively, which were better than single index. Conclusion qSOFA and RDW are the influencing factors of the prognosis of the elderly septic patients, and qSOFA combined with RDW has better sensitivity and specificity in prognostic evaluation of the elderly septic patients.

Abstract:Objective To explore the effect of remote patient management on the prognosis of elderly patients with chronic heart failure. Methods A total of 256 elderly patients with chronic heart failure treated in the geriatric department of our Sixth Medical Center from June 2014 to December 2018 were enrolled, and according to their hospital discharge order, they were divided into a remote management group (n=125) and a routine management group (n=131). SPSS statistics 25.0 was used to perform the statistical analysis. Kaplan-Merier survival curve was performed for all-cause death analysis between groups. Results During a median follow-up time of 25.0 (17.0～38.8) months, 51 patients (19.9%) experienced all-cause death, including 28 deaths due to respiratory infections. All cause mortality was 12.8% (16/125) in the remote management group and 26.7% (35/131) in the routine management group. Compared with the conventional management, telemonitoring could reduce patients′ all-cause mortality (HR=0.403,95%CI 0.210-0.773; P=0.006). The death rates of cardiovascular disease and respiratory infection were lower in the remote management group[4.0%(5/125),7.2%(9/125)] than the routine management group [9.9%(13/131)14.5%(19/131)], though none of the differences were statistically significant(P>0.05). There was no significant difference in the incidence of all-cause rehospitalizations between the two groups (P>0.05). The median time of all-cause rehospitalization and cardiovascular rehospitalization in the remote group were 49.0 and 28.0 d, respectively, which were higher than those of the routine group(28.0 and 0.0 d), respectively, with obvious difference between the two groups (P<0.05). Conclusion Remote patient management could reduce all-cause mortality but increase all-cause rehospitalization and cardiovascular rehospitalization in elderly patients with chronic heart failure.

Abstract:Objective To investigate the status of activity of daily life (ADL) in the elderly living in rural area of Shaanxi Pro-vince, and its relationship with common chronic diseases. Methods A total 3 307 elderly people with registered permanent residence as agricultural type were subjected from 24 administrative villages of 11 counties in Shaanxi Province by multi-stage stratified random cluster sampling. Questionnaire on ADL, including physical ADL (PADL) and instrumental ADL (IADL) were used to survey their conditions. Chi-square test and binary logistic regression analysis were used to analyze the correlation between their ADL status and common chronic diseases. Results The dependence rate of ADL in the elderly was 34.20%(1131/3307), and that of PADL was 17.00%(526/3307), and of IADL was 33.78%(1117/3307). Logistic regression analysis showed that number of chronic diseases ≥2, coronary heart diseases, joint diseases, cataract and deafness were dependent risk factors for PADL (P<0.05), and hypertension, coronary heart diseases, chronic obstructive pulmonary disease (COPD), joint diseases and deafness were dependent risk factors for IADL (P<0.05) in the elderly in rural area of Shaanxi Province. Conclusion The dependent rate of ADL is quite high in the elderly in rural area of Shaanxi Province. The number of chronic diseases is not an important influencing factor for ADL. Some specific diseases, such as senile deafness, joint diseases, coronary heart disease, COPD and so on should be paid more attention to.

Abstract:Objective To investigate the influencing factors of endothelial dysfunction in patients with non-obstructive coronary atherosclerosis. Methods A total of 110 consecutive patients with suspected coronary artery diseases and then diagnosed with non-obstructive coronary atherosclerosis (coronary stenosis <50%) by coronary angiography in Xuanwu Hospital, Capital Medical University from June 2013 to June 2015 were recruited in this study. Flow mediated dilatation (FMD) was measured by echocardiography, and circulating endothelial progenitor cells (EPCs) were enumerated by flow cytometry as mononuclear cells expressing a combination of KDR⁺, CD34⁺ and/or CD133⁺. The patients were divided into control (FMD >10%) and endothelial dysfunction group (FMD ≤10%). SPSS statistics 19.0 was used to perform the statistical analysis. Logistic regression analysis was employed to analyze the influencing factors for endothelial dysfunction. Results There were no significant differences in the cell counts of circulating EPCs, defined as CD34⁺/KDR⁺,CD133⁺/KDR⁺ or CD34⁺/CD133⁺/KDR⁺ cells between the 2 groups (P>0.05). Logistic regression analysis revealed that age was an independent risk factor for endothelial dysfunction (95%CI 1.004-1.104, P=0.033). Conclusion Age, not the count of circulating EPCs, is an independent influencing factor of endothelial dysfunction in patients with non-obstructive cornary atherosclerosis.

Abstract:Objective To investigate the relationship between the degree of insulin resistance (IR) and skeletal muscle mass in the elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 83 elderly T2MD patients in Nanjing Hospital Affiliated to Nanjing Medical University from April 2018 to August 2019 were enrolled. They were divided into two groups:the control group without muscle reduction and the study group with muscle reduction. The two groups were compared in the basic data, blood lipid index, blood glucose and insulin resistance index. SPSS statistics 19.0 was used for statistical analysis. Data comparison between two groups was perfomed using χ² test or t test depending on data type. Logistic regression was used to analyze the risk factors of skeletal muscle loss. Results The age of the study group were significantly higher than that of the control group (P<0.05). The body mass index of the study group was significantly lower than that of the control group (P<0.05). The study group had significantly lower homeostasis model assessment-β (HOMA-β) but significantly higher homeostasis model assessment of insulin resistance (HOMA-IR) than the control group (P<0.05). The appendicular skeletal muscle mass index (ASMI) values were positively correlated with HOMA-β (r=0.441, P<0.05) and negatively correlated with HOMA-IR (r=-0.463, P<0.05). Logistic regression analysis showed that age and IR were independent risk factors of skeletal muscle loss in the T2DM patients (P<0.05). Conclusion Age, HOMA-β, and HOMA-IR are associated with ASMI in the T2DM patients, and age and IR are independent risk factors of muscle loss in the T2DM patients.

Abstract:ObjectiveTo investigate the effect of frankincense on the proliferation, apoptosis and migration of human gastric cancer SGC7901 cells and the possible mechanisms. Methods After the SGC7901 cells were treated with frankincense at different doses for different time periods, the proliferation of the cells was determined by MTT assay. Flow cytometry was used to detect the apoptosis of the cells treated by 0.0,0.5,1.0,2.0,4.0 or 8.0 mg/ml frankincense for 24 h. Western blotting was employed to detect the expression of phosphatase and tensin homolgy deleted on chromosome ten(PTEN), phosphatased Akt(p-Akt), protein kinase B(PKB, also named Akt), and cyclooxygenase-2(COX-2) in the cells after frankincense treatment (0,2 and 4 mg/ml) for 24 h. Wound-healing test was performed to assess the effect of frankincense on the migration of SGC7901 cells. A xenograft nude mice model of human gastric cancer was established to evaluate the anti-cancer effect of frankincense in vivo. Graphpad Prism 6.0 software was used to perform data analysis. Results Frankincense significantly inhibited the proliferation and migration of SGC7901 cells in a dose-and time-dependent manner. It also induced the apoptosis of the cells dose-dependently. Frankincense treatment resulted in the up-regulation of PTEN and down-regulation of p-Akt and COX-2 at a protein level. It could also inhibit the tumor growth in the xenograft nude mice model of human gastric cancer. Conclusion Frankincense may inhibit the proliferation and migration and promote the apoptosis of SGC7901 cells through the PTEN/Akt/COX-2 signaling pathway.

Abstract:Heart failure and diabetes are two most frequent conditions in the modern times that interact with each other. Comorbidity of heart failure and diabetes is clinically common, posing new challenges to the safety of clinical medication. This paper provides a systematical review of the status quo of research on the comorbidity in the aspects of epidemiology, clinical symptoms and risk of prognosis, physiological and pathological mechanism, and drug selection, focusing on the safety and effectiveness of using drugs for heart failure and diabetes for patients with the comorbidity, to provide guidance for decision making in clinical medication.

Abstract:Countries all over the world are facing great challenges brought by the aging of the population, and our country will also enter the stage of rapid aging. Multimorbidity is quite common among the elderly, and shows profound impact on the quality of life and life expectancy. With the improvement of medical care and the continuous extension of life expectancy, there are more and more medical staffs who provide medical services to the elderly with multimorbidity. In this paper, we review the prevalence of multimorbidity, related senile syndrome, influence of disease combination on prognosis and other issues concerning health management, and hope to provide reference for health management for the elderly with multimorbidity.

Abstract:As one of the most common cancers in men, prostate cancer seriously threatens their health and safety. There are many challenges of prostate cancer in prediction, diagnosis and prognosis. Although biomarkers for the prostate cancer have shown certain clinic significance, they still have limitations when used alone. Accurate diagnosis, prevention of excessive biopsies, and construction of a diagnostic system of combined biomarkers are still trending research topics in the detection of prostate cancer. Here we analyze the cha-llenges in the detection of prostate cancer and review the research progress in biomarkers and related detection systems of prostate cancer.

Abstract:Both vitamin D deficiency and chronic obstructive pulmonary disease (COPD) are worldwide health problems. COPD ranks the fourth leading cause of death worldwide, with its prevalence and mortality rates increasing year by year. In recent years, a large number of basic animal studies and clinical observational studies have demonstrated that vitamin D deficiency is associated with COPD. In this article, we review the role of vitamin D in pathogenesis of COPD so as to provide evidence for the prevention and treatment of the disease.