Abstract:Objective To explore the changes of kidney function with aging in a large-scale physical examination population in a county of north part of Jiangsu Province. Methods A retrospective cross-sectional study was performed based on the data of 31 593 people taking physical examination at the Sheyang County People′s Hospital from February 2018 to December 2019. They were divided into 6 age groups:18-29,30-39,40-49,50-59,60-69, and 70+ years old groups. Eestimated glomerular filtration rate (eGFR) was obtained using the Chronic Kidney Disease Epidemiology Collaboration equation based on serum creatinine equation. The decline slope of eGFR with aging was assessed by linear regression analysis. Chi-square test was used to compare the annual average rate of decline between groups. The incidence of eGFR <90 ml/(min·1.73 m²) in different age groups was compared by linear trend Chi-square test. SPSS statistics 26.0 was used for statistical analysis. Results A total of 29 167 adult participants were included finally. eGFR was decreased with age at an average annual rate of(0.82±0.00) ml/(min·1.73 m²). The annual decline rates were(0.64±0.07),(0.69±0.04),(0.78±0.03),(0.78±0.03),(0.87±0.06) and(1.03±0.06) ml/(min·1.73 m²), respectively in the age groups. The rate of decline was increased significantly in the 70+ years old group (P<0.05). For the subjects with serum creatinine(SCr)and blood urea nitrogen(BUN) in the normal reference ranges, the incidence of eGFR <90 ml/(min·1.73 m²) were 14.73% and 12.27%, respectively. The prevalence of eGFR <90 ml/(min·1.73 m²) was increased with aging, and was 13.00% for overall subjects. The incidence was 0.27%, 0.86%, 5.43%, 13.28%, 32.30% and 86.45% for each age group, respectively, with statistical differences according to the results of linear trend Chi-square test (P<0.05). The incidence of eGFR <60 ml/(min·1.73 m²) in the 70+ years old group was 10.84%. Conclusion eGFR is significantly decreased with aging. The incidence of eGFR <90 ml/(min·1.73 m²) is higher in the elderly. An integrated application of SCr, BUN and eGFR is recommended for the assessment of kidney function.

Abstract:Objective To investigate the characteristics of mild cognitive impairment (MCI) in the elderly patients with non-valvular atrial fibrillation and its affecting factors. Methods We retrospectively analyzed the clinical data of 104 elderly inpatients in the Department of General Medicine of Tongji Hospital of Huazhong University of Science and Technology from October 2018 to September 2019, with 52 cases in atrial fibrillation group (AF group) and non-atrial fibrillation group (non-AF group)respectively. Cognitive function was assessed using mini-mental state evaluation (MMSE) and Montreal cognitive assessment (MoCA) for the detection rate, clinical characteristics and risk factors of MCI in both groups. SPSS statistics 26.0 was used for data analysis. According to the data type, t-test, non-parametric rank sum test or χ² test was used for comparison between groups. Logistic regression model was used for multivariate analysis. Results Compared with the non-AF group, the AF group had lower total MMSE [(27.37±1.53) vs (28.33±1.01)] and MoCA [(24.71±1.54) vs (26.29±1.63)]; and significantly higher detection rate of MCI (MMSE:38.5% vs 7.7%; MoCA:61.5% vs 30.8%), the difference being statistically significant (P<0.05). Evaluation of 7 sub-cognitive domains using the MoCA showed that the orientation ability, visual space and executive function, language ability, and abstract generalization in the AF group were worse than in the Non-AF group, the difference being statistically significant (P＜0.05). MCI patients were defined as MoCA being positive, and five risk factors (atrial fibrillation, hypertension, hyperlipidemia, age, education level) that had an impact on MCI both by the MMSE and MoCA were selected as independent variables for logistic regression analysis. The results showed that longer schooling years were protective factors for MCI, while atrial fibrillation, advanced age and hypertension were independent risk factors for MCI, of which atrial fibrillation was a stronger risk factor (OR=3.163,95%CI1.190-8.406; P＜0.05). Conclusion Detection rate of MCI increases significantly in the elderly patients with non-valvular atrial fibrillation, and their cognitive impairment mainly affects orientation, visual space and executive function, language ability and abstract generalization. Atrial fibrillation, age and hypertension have an impact on MCI, and effective management of risk factors such as atrial fibrillation can play a positive role in the prevention and treatment of MCI.

Abstract:Objective To analyze the risk factors of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea hypopnea syndrome (OSAHS) by observing the clinical characteristics of patients with COPD-OSAHS overlap syndrome (OS). Methods A total of 123 COPD patients from October 2018 to December 2019 were selected in the Department of Respiratory Diseases of Yan′an University Affiliated Hospital. They were divided into COPD group (n =64) and OS group (n =59). SPSS statistics 22.0 was used for data analysis. According to different data type, t test or χ²test was used for data comparison between two groups. Pearson correlation coefficient and multivariate logistic regression were used to analyze factors of OSAHS in the COPD patients. Results The apnea hypopnea index (AHI) of the OS group was correlated positively with neck circumference, body mass index (BMI), arterial partial pressure of carbon dioxide (PaCO₂) (r=0.774,0.905,0.761, P<0.05) and negatively with forced expiratory volume in the first second to forced vital capacity(FEV₁/FVC), arterial partial pressure of oxygen(PaO₂) (r=-0.597, -0.856, P<0.05). Neck circumference (OR=3.453,95%CI 2.004-5.948; P=0.000), BMI (OR=3.467,95%CI 2.268-6.696; P=0.000), snoring (OR=5.925,95%CI2.622-13.386; P=0.000), and smoking (OR=2.503,95%CI 1.076-5.822; P=0.033) were independent risk factors of COPD-OSAHS overlap syndrome. Conclusion Increased neck circumference and BMI, smoking, and snoring are risk factors of COPD-OSAHS overlap syndrome, and patients with overlap syndrome are more likely to have hypoxia and hypercapnia than COPD patients.

Abstract:Objective To investigate the epidemiological data of postoperative venous thromboembolism (VTE) in elderly surgical patients in Peking Union Medical College Hospital in order to explore the risk factors for the disease. Methods Clinical data of 4 819 patients who underwent surgery in Peking Union Medical College Hospital from May 2016 to July 2016 were collected and retrospectively analyzed. Their baseline information, and VTE prophylaxis and incidence of symptomatic VTE after the operation and in 3 months after discharge were recorded. According to their age, the patients were divided into the elderly group (≥65 years old, n =925) and the young and middle-age group (<65 years old, n =3 894). The differences in the occurrence and prevention of VTE were compared between the 2 groups, and the risk factors related to the occurrence of VTE were analyzed. SPSS statistics 26.0 was used for statistical analysis. Student′s t test, U test, Chi-square test or Fisher exact test was employed for intergroup comparison depending on different date types. Results The incidence of postoperative VTE was 2.59% (24/925) in the elderly group and 0.33% (13/3 894) in the young and middle-age group, with the incidence in the elderly group about 8 times higher than that in the young and middle-age group (RR=7.952,95%CI:4.033-15.678, P<0.001). The incidence in the department of neurosurgery was the highest (16.67%, 4/24), significantly higher that in other departments (P=0.003). The proportion of 19 risk factors in the elderly group was obviously higher than that in the young and middle-age group, and the most-accounted top 3 risk factors were major surgery (>45 min), malignancy, and obesity (body mass index>25 kg/m²). Multivariate logistic regression analysis showed that swollen legs, current smoking, and duration of surgery >2 h were independent risk factors for postoperative VTE in elderly patients (P<0.05). The proportions of receiving mechanical prophylaxis and pharmacologic prophylaxis for high-risk patients were statistically higher in the elderly group than the young and middle-age group [51.42% (399/776) vs 39.21% (567/1 446), P<0.01; 31.44% (244/776) vs 20.95% (303/1 446), P<0.01]. Among the elderly patients with VTE, 70.83% (17/24) did not receive pharmacologic prophylaxis before onset, and 58.33% (14/24) only received mechanical prophylaxis, but still had symptomatic VTE. Conclusion The incidence of postoperative VTE is high in elderly patients than the young and middle-age ones. Physicians should strengthen perioperative pharmacologic prophylaxis for VTE to the elderly patients with swollen legs, current smoking or duration of surgery >2 h.

Abstract:Objective To clarify the current status of disease uncertainty in patients with coronary artery stenting and their families and explore the influencing factors of the uncertainty and their mutual influence. Methods A total of 182 patients who underwent coronary artery stent implantation in the Department of Cardiology of the First Affiliated Hospital of Air Force Military Medical University from May to December 2020 were subjected by cluster sampling, and their 182 family members were enrolled at the same time. Mishel uncertainty in illness scale for adults (MUIS-A) and Mishel uncertainty in illness scale for family member (MUIS-FM) were used to understand the current status of the disease uncertainty of patients and family members. Multiple linear regression analysis was employed to clarify its influencing factors. SPSS statistics 20.0 was applied for statistical analysis. Data comparison between two groups was performed using student′s t test, Fisher exact test or Chi-square test depending on date type. Results The MUIS-A was (77.77±11.68) points in the patients after coronary stent implantation, and the MUIS-FM was (95.31±11.76) points in the family members. Uncertainty was an important factor affecting patient′s disease uncertainty, and unpredictability was an important factor affecting family member′s disease uncertainty. The influencing factors for the patient′s disease uncertainty were educational level (junior high school vs elementary school), complications, patient′s income, and family member′s income, knowledge on the disease and total score of uncertainty (all P<0.05). The influencing factors of family member′s disease uncertainty were total score of patient′s disease uncertainty, family member′s income, family members in poor health, and place of patient′s residence (rural vs urban areas) (all P<0.05). Conclusion The patients with coronary artery stenting and their family members have varying degrees of disease uncertainty, and there is a strong interaction between them. Our results suggest that medical staffs should pay special attention to the patients and their family members at the same time when implementing interventions to achieve the optional outcomes.

Abstract:Objective To investigate the status quo of the frailty of the elderly in Haikou municipality and its influencing factors, and to explore the intervention strategies. Methods By convenient sampling, 700 elderly were selected from 10 communities in Haikou Municipality. The general information questionnaire and the Fried Phenotype (FP) were used for frailty screening, and 600 valid responses were collected. Based on the FP results, the respondents were divided into frail group and non-frail group. SPSS statistics 22.0 was used for statistical analyses. Data comparison between two groups was perfomed using t test, Mann-Whitney U test or Kruskal-Wallis H test depending on date type. Univariate analysis and logistic regression analysis were used to analyze the influencing factors of frailty. Results Of all the respondents, there were 215 cases (35.8%) in frailty group, who were (75.28±6.92) years old, and had FP of (3.48±0.63) points；there were 385 cases (64.2%) in non-frailty group, who were (71.99±7.11) years old, and had FP of (1.39±0.70) points. Univariate analysis showed that age, marital status, educational level, housework, family income, number of children, dwelling state, accompani ment during medical care, use of auxiliary tools, total number of diseases, and types of medication were the influencing factors of frailty(P<0.05). Logistic regression analysis showed that, except the factor of family income, the other factors mentioned above were the influencing factors of frailty(P<0.05). Conclusion Haikou municipality, a tropical city, has a high incidence of frailty among the elderly. Community medical workers should strengthen early screening for frailty and provide targeted interventions.

Abstract:Objective To analyze the value of Caprini risk assessment model in the prediction of deep venous thrombosis (DVT) in very old patients with chronic heart failure. Methods A total of 44 elderly patients with chronic heart failure and DVT who were treated in our department from January 2018 to December 2020 were enrolled as the DVT group, and another 88 elderly patients with chronic heart failure but without DVT during the same period served as the control group. The clinical data of all patients were collected, and all of them were evaluated with Caprini risk assessment model for scoring and risk classification. SPSS statistics 18.0 was used for data analysis. Logistic regression analysis was employed to analyze the risk factors for DVT in elderly patients with chronic heart failure. Receiver operating characteristic (ROC) curve was plotted to analyze the diagnostic value of Caprini risk assessment model for DVT in elderly patients with chronic heart failure. Results The Caprini score was significantly higher in the DVT group than the control group [(7.77±1.96) vs (5.77±1.36), P<0.001]. Multivariate logistic regression analysis showed that Caprini score was the independent risk factor for DVT in elderly patients with chronic heart failure (OR=1.733, 95%CI 1.193-2.519, P<0.05). ROC curve analysis showed that the area under the curve for Caprini risk assessment model was 0.801 in the prediction of DVT in elderly patients with chronic heart failure (95%CI 0.723-0.879). Conclusion The Caprini risk assessment model has a good predictive value for DVT in elderly patients with chronic heart failure, and can be used to assess the risk of thrombosis for them.

Abstract:Objective To explore the dynamic changes of procalcitonin (PCT) and D-dimer (D-D) and investigate their values in the prognosis for severe pneumonia in the elderly patients. Methods A total of 78 elderly patients with severe pneumonia admitted in our hospital from January 2019 to June 2020 were recruited in this study. Their clinical outcome, PCT and D-D levels before treatment on the 3rd and 7th days of treatment, and immediately before out of ICU (or death) were recorded, and change rate of PCT (PCTc) and D-D (D-Dc) were calculated. Their score of Acute Physiology Age Chronic Health Evaluation Ⅱ (APACHE Ⅱ) were also recorded. Receiver operating characteristic (ROC) curve was drawn to assess the values of PCTc and D-Dc on the clinical outcome of the severe pneumonia patients. SPSS statistics 22.0 was used for statistical analysis. Data comparison between two groups was perfomed using χ² test, t test or Fisher exact test depending on date type. Results Among the 78 elderly patients, 31 cases (39.7%) were transferred out of ICU after treatment, and the other 47 (60.2%) patients died. The survival group had significantly younger age [(77.30±6.72) years] and lower APACHE Ⅱ score [(19.29±2.69) points] than the death group [(83.84±5.54) years, (21.02±2.72) points; P<0.05]. There were no obvious differences in PCT level between the survival group and the death group before and in 3 d after treatment (P>0.05). But the level was statistically lower in the survival group than the death group in 7 d after treatment and before transference from ICU or death [(2.57±0.65) vs (7.18±1.91) ng/ml, (0.62±0.25) vs (10.37±2.47) ng/ml; P<0.01]. Before and in 3 d after treatment, no significant difference was seen in D-D level between the 2 groups (P>0.05). Its level was in a decreasing trend in the survival group but in an increasing trend in the death group, and the former group had obviously lower level than the latter group in 7 d after treatment and transference from ICU or before death [(0.75±0.15) vs (3.78±0.85) mg/ml, (0.40±0.09) vs (4.89±0.69) mg/ml, P<0.001]. Statistical difference was seen in PCTc level between the 2 groups in 3 and 7 d after treatment and before out of ICU or death [5.56 (3.28,8.22) vs -3.17 (-4.55,0.00),53.73(49.12,58.93) vs -31.75(-40.91,-21.05),89.29(86.36,91.78) vs -96.86(-119.40,-68.00),all P<0.001]. The D-Dc level maintained at a high level and gradually turned to elevation with the condition better in the survival group. But the level differed from the 2 groups in 3 and 7 d after treatment and before out of ICU or death [0.00 (0.00,6.25) vs 0.00(-7.69,0.00),58.33(55.29,64.21) vs -95.24(-128.50,-60.87),77.22(74.29,83.64) vs -161.10(-218.70,-114.20); all P<0.001]. ROC curve analysis showed that PCTc, D-Dc and APACHEⅡ were of prognostic significances for the elderly with severe pneumonia [area under curve (AUC)=0.974,0.779, 0.337; P<0.05]. PCTc had an AUC of 0.974, a 95% confidence interval of 0.940 to 1.010, cutoff value of 0.658, a sensitivity of 93.5%, and a specificity of 97.9%. Conclusion PCTc and D-Dc could predict the clinical prognosis of elderly patients with severe pneumonia, and show good value in clinical application.

Abstract:Objective To explore the prognostic value of serum procalcitonin/albumin ratio (PCT/ALB) combined with sequential organ failure assessment (SOFA) in septic patients. Methods A retrospective analysis was made of 75 patients with sepsis, who were treated in the Emergency Department of Bethun Hospital Affiliated to Shanxi Medical University from January 2019 to January 2020. The patients were divided into survival group (n=65) and death group (n=10) according to 28d outcomes. On admission, the patients were monitored for clinical indicators, PCT/ALB ratios and SOFA were calculated. SPSS statistics 26.0 was used for data analysis. t-test and χ² were used for comparison. Cox regression was used to analyze the independent risk factors of sepsis, and receiver operating characteristic (ROC) curve was made to do the predictive analysis of risk factors in patients with sepsis. Results PCT, PCT/ALB, SOFA were higher in the survival group than in the death group, and ALB was lower in the death group than in the survival group, the difference being statistically significant (P<0.05 for both). PCT/ALB (HR＝4.527, 95%CI 1.321-15.512 ), SOFA (HR＝1.287, 95%CI 1.081-1.534) were independent risk factors for 28 d mortality risk. PCT/ALB combined SOFA was superior to other indicators in predicting patients with sepsis at 28 days, with an AUC of 0.825, the best cut-off point of 1.824, a sensitivity of 80.0% and a specificity of 81.5%. Conclusion PCT, ALB, PCT/ALB, SOFA are helpful for the assessment of septic patients condition. PCT/ALB and SOFA are independent risk factors for 28 d mortality. PCT/ALB combined with SOFA is superior to single indicator for prognosis of septic patients.

Abstract:Objective To investigate the status of hypoxia in the elderly patients with hip fracture at admission and analyze the related risk factors for hypoxia. Methods Clinical data of 1 599 elderly patients with hip fracture treated in Jishuitan Hospital from May 2017 to March 2019 were collected and analyzed retrospectively. According to their oxygenation index and presence of pulmonary disease or not, the patients were divided into pulmonary disease+hypoxemia group (group A, n=136), pulmonary disease+non-hypoxemia group (group B, n=362), non-pulmonary disease+hypoxemia group (group C, n=112) and non-pulmonary disease and non-hypoxemia group (group D, n=989). SPSS statistics 24.0 used. Independent sample t test, one-way ANOVA or Chi-square test was adopted for intergroup comparison based on the data type. The risk factors of hypoxemia were analyzed by binary multivariate logistic regression in the elderly patients. Results About 15.5% (248/1 599) of elderly patients with hip fracture had hypoxemia at the time of emergency treatment. The patients in the hypoxemia groups were significantly older and had obviously higher incidences of pulmonary diseases [54.8%(136/248)vs 26.8%(362/1 351)] and myocardial injury [5.6% (14/248) and 1.7% (23/1 351)] when compared with the non-hypoxemia groups (all P<0.05). There was significant difference in the incidence of fracture between the hypoxemia and non-hypoxemia groups (P<0.01). After exclusion of the factors of lung diseases, the patients in group A were older and had higher incidence of femoral neck fracture [66.9% (91/136) vs 47.8% (173/362)] than those in group B (P<0.01). The level of D-dimer and incidence of femoral neck fracture [62.5% (70/112) vs 52.2% (516/989)] were higher in the group C than the group D (P<0.05). Multivariate logistic regression analysis showed that older age, higher D-dimer level, femoral neck fracture and lung disease were the risk factors of hypoxemia in elderly patients with hip fracture (OR=1.04,1.01,2.04,2.97; all P<0.05). Conclusion Advanced age, high D-dimer level, femoral neck fracture and pulmonary disease are risk factors for hypoxemia in elderly patients with hip fracture. The hypoxic elderly patients with hip fracture are prone to myocardial injury, and hypoxia may increase the risk for adverse myocardial events.

Abstract:Objective To analyze the influence of Wechat technology on education in rational drug use and medication compliance in the elderly hypertensive patients in Wanshou Road Community Health Service Center in Beijing Haidian District Methods A total of 256 elderly patients with hypertension, who were treated in Wanshou Road Community Health Service Center in Beijing Haidian District from January 2018 to January 2020, were divided into the control and study groups with 128 in each. The control group were given routine health education, and the study group Wechat intervention. The two groups were compared in rational drug use, drug compliance and blood pressure control. SPSS statistics 18.0 was used for data analysis. According to the data type, t-test orχ² test was performed for comparison between groups. Results After intervention, the study group outperformed the control group in drug awareness, taking medicine on time, administration of medicines, and monitoring adverse reactions. The patients′ compliance for hypertension treatment in study group was higher than that in control group. Systolic blood pressure and diastolic blood pressure in study group were lower than those in control group. Fasting plasma glucose, total cholesterol and triglyceride in study group decreased by greater degrees, the differences being statistically significant(all P＜0.05). Conclusion The follow-up education of the hypertensive elderly patients through Wechat can effectively improve their awareness of rational drug use, medication compliance, and blood pressure control. It is worthy of clinical application.

Abstract:Chronic heart failure (CHF) has a high incidence rate and mortality rate, seriously affecting the quality of life of patients with heart failure. Prolonged action potential duration (APD) resulting from abnormal ion channels and consequent abnormal triggering activity constitutes the main mechanism of arrhythmia in heart failure. Transient outward potassium current (I_to) is mainly involved in the repolarization of AP in cardiomyocytes and plays an important role in prolonging APD in heart failure. Potassium channel interacting protein 2 (KChIP₂) is an important functional subunit of I_to channel and plays a key role in regulating I_to. I_to almost completely disappears in cardiomyocytes in KChIP₂-knockout rats, and the susceptibility to arrhythmia increases significantly. This article reviews the progress in potassium channel mechanism of arrhythmia in chronic heart failure with a view to providing new pathways for the treatment targets of arrhythmia in heart failure.

Abstract:Recently, the morbidity and mortality of coronary heart disease have been persistently increasing in China, posing a threat to the health and lives of people. Coronary artery and carotid artery share a similar atherosclerotic mechanism. A myriad of studies have confirmed the significance of carotid intima-media thickness and plaque in the diagnosis of coronary heart disease and the prediction of cardiovascular events. Ultrasound is a common non-invasive tool for detecting the condition of carotid artery. It can provide carotid atherosclerosis-related indicators economically and quickly. With more comprehensive exploitable indicators, studies on the relationship between these indicators and coronary heart disease go further. This article reviews the recent research progress on carotid atherosclerotic indicators detected by ultrasound in the diagnosis of coronary heart disease and the risk assessment of cardiovascular disease.

Abstract:Atherosclerotic cardiovascular disease (ASCVD) is one of the most important chronic noncontagious diseases that does harm to human health. Although lots of previous studies have reported that fasting lipid profiles are closely related to the occurrence and prognosis of ASCVD, fasting lipid test has some limitations in clinical practice. In recent years, evidence shows that non-fasting lipid profiles also play an important role in the occurrence and prognosis of ASCVD. Compared to fasting lipid test, non-fasting lipid test can reflect the blood lipid levels of human body at most of the time, more rapidly and conveniently. Therefore, this article reviews the definition, relative merits and scope of application of non-fasting lipid profiles, research progress of the relationship between the profiles and the occurrence and prognosis of ASCVD, and possible mechanism for atherosclerosis, in order to provide guidance in clinical practice.

Abstract:Hypertrophic cardiomyopathy (HCM) is a hereditary cardiomyopathy. Most HCM patients develop mild symptoms throughout their lives. However, they also are at risk of ventricular arrhythmia and sudden cardiac death (SCD), with a prevalence of 80/100000 in Chinese adults, and SCD is the most serious complication. Identifying the risk of SCD in HCM patients can improve their prognosis outcome. In this article, based on the current guidelines and recent studies on HCM and SCD, we review the pathological mechanism, identification of risk factors and prevention of SCD in HCM patients.

Abstract:Endometrial polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity, and caused by overgrowth of the cells in the endometrium. They vary in size and can be single or multiple in number. They are mainly composed of endometrial glands, fibrous interstitium and thick-walled blood vessels. About 70%－80% of endometrial polyps show intermenstrual bleeding, excessive menstruation, prolonged menstrual period or irregular bleeding, and very few polyps can develop malignant changes. The pathogenesis of endometrial polyps may be related to abnormal hormones and receptors, imbalance between cell proliferation and apoptosis, heredity and inflammation. Symptoms, gynecological examination and ultrasound examination can make a preliminary diagnosis, and the final diagnosis needs to be made based on pathological examination after hysteroscopic resection. There are no unified standards for their treatment, including conservative treatment and surgical treatment. This paper reviews the progress of diagnosis and treatment of endometrial polyps.