Abstract:Objective To explore the characteristics and influencing factors in patients with Parkinson′s disease (PD) complicated with nocturnal hypertension (NH). Methods From January 2017 to January 2020, a total of 150 PD patients admitted to Beijing Tiantan Hospital were consecutively recruited. The patients received 24-hour ambulatory blood pressure (BP) monitoring and were divided into PD with NH (PD-NH) group and PD with no NH (PD-nNH) group. The patient′s demographic data was recorded, and the scales for outcomes in Parkinson′s disease-autonomic (SCOPA-AUT) was used to evaluate the patient′s autonomic symptoms. The standard deviations of systolic BP and diastolic BP in the daytime, at night and during the whole day were collected. Echocardiography was performed, and data were recorded of the left atrium diameter, the left ventricular end-diastolic diameter, the left ventricular posterior wall thickness, end-diastolic interventricular septal thickness and left ventricular ejection fraction. SPSS statistics 21.0 was used for data analysis. Results Among 150 PD patients, 96 were complicated with NH. Compared with the PD-nNH group, more patients had hypertension and higher SCOPA-AUT score in the PD-NH group (P<0.05). The standard deviations of all-day systolic BP, night-time systolic BP and night-time diastolic BP in the PD-NH group were significantly higher than those in the PD-nNH group (P<0.05). The end-diastolic interventricular septal thickness and the left ventricular posterior wall thickness in PD-NH group were significantly greater than those in PD-nNH group (P<0.05). Logistic regression analysis showed that the standard deviation of night-time systolic BP (OR=1.160,95%CI 1.010-1.332, P=0.035) and the end-diastolic interventricular septal thickness (OR=1.589,95%CI 1.059-2.384, P=0.025) were independent influencing factors of PD-NH. Conclusion The incidence of NH is high in PD patients. The increased standard deviation of systolic BP at night and the increase of end-diastolic interventricular septal thickness are independent influencing factors of PD-NH.

Abstract:Objective To develop the preliminary version of function impairment screening tool (FIST) for the elderly Chinese population. Methods We selected the scales related to function assessment for the elderly by searching and reviewing literature and established an item pool after panel discussion. Then we filtered the items using the Delphi Method. A FIST questionnaire was emailed to 25 experts who evaluated the items in terms of their importance and feasibility and provided basis of judgement and familiarity. A preliminary version of FIST was determined after the items were screened according to the opinions of experts as specified by the average value and coefficient of variation. Results Literature searching and expert panel resulted in a secondary level of 25 items. In the first and second rounds of panel discussion, the coefficients of positivity were 80% and 100% and the degree of authority 0.94 and 0.90, respectively. The Kendall′s concordance coefficient of importance was 0.26 (P<0.001) for the first round and 0.39 (P<0.001) for the second round. The Kendall′s concordance coefficient of importance of applicability was 0.28 (P<0.001) for the first round and 0.37 for the second round (P<0.001). Based on the scores and expert opinions, 3 first-level and 18 second-level indicators were finally retained. Conclusion The preliminary version of the FIST for the elderly with 3 first-level and 18 second-level indicators was established using Delphi method.

Abstract:Objective To investigate the correlation between blood pressure and thickness of retinal nerve fiber layer (RNFL) in type 2 diabetes mellitus (T2DM). Methods A total of 123 patients with T2DM were selected for the study, who visited the Endocrinology Department of the First Hospital Affiliated to Harbin Medical University between January 2017 and December 2018. Based on the fluorescein fundus angiographic findings, the patients were divided into a group without diabetic retinopathy (NDR group, n=65) and a group with non-proliferative diabetic retinopathy (NPDR group, n=58) according to the International Clinical Grading Scale for Diabetic Retinopathy (2002). The general clinical data of the enrolled patients were collected, and the results of the blood tests, such as glycated hemoglobin A1c (HbA1c) and fasting C-peptide, were recorded. Systolic blood pressure (SBP), diastolic blood pressure (DBP) were measured, and mean arterial pressure (MAP) was calculated. RNFL thickness was measured with optical coherence tomography (OCT). SPSS statistics 22.0 was used for statistical analysis. The correlation between RNFL thickness and blood pressure in each quadrant was analyzed by Spearman rank correlation. Univariate and multivariate linear regression were performed to analyze the independent factors of RNFL thickness in each quadrant. Results SBP and MAP were significantly higher in the NPDR group than those in the NDR group (P<0.05). Correlation analysis revealed significantly negative correlation between age and RNFL thickness in both the supratemporal (r=-0.184, P=0.041) and infratemporal (r=-0.224, P=0.013) quadrants, between the body mass index (BMI) and the lower nasal retina (r=-0.256, P=0.004), between SBP and RNFL thickness in the upper nasal (r=-0.203, P=0.024), infratemporal (r=-0.272, P=0.002) and temporal (r=-0.286, P=0.001) quadrants, between MAP and RNFL thickness of the upper nasal (r=-0.185, P=0.041), infratemporal (r=-0.264, P=0.003) and temporal (r=-0.253, P=0.005) quadrants, and between HbA1c and RNFL thickness of the supratemporal (r=-0.234, P=0.009) and infratemporal (r=-0.201, P=0.025) quadrants, the difference being statistically significant for all (P<0.05). The univariate and multivariate linear regression analysis showed SBP as an independent factor of RNFL thickness in the upper nasal, infratemporal, and temporal quadrants. Conclusion Elevated blood pressure accelerates degenerative change in the retina, suggesting early attention to changes in blood pressure may help to avoid early nervous degeneration of the retina.

Abstract:Objective To investigate the effect of neutrophil-to-lymphocyte ratio (NLR) combined with sequential organ failure assessment (SOFA) score on the prognosis of the elderly patients with sepsis. Methods Clinical data of 124 elderly patients with sepsis admitted in Chinese PLA Hospital No.305 from January 2017 to August 2019 were collected and retrospectively analyzed. According to the prognosis, they were divided into survival group (n=58) and death group (n=66). Their sex, age, underlying diseases, primary disease, NLR and SOFA scores were compared between two groups. Multivariate logistic regression analysis was used to explore the risk factors affecting the prognosis. Receiver operating characteristic (ROC) curve was plotted to assess the predictive values of the risk factors for the elderly patients with sepsis. Results There were no significant differences in gender ratio, age, underlying diseases and primary disease between two groups. But, the NLR and SOFA scores in the survival group were significantly lower than those in the death group (P<0.001). Multivariate logistic regression analysis indicated that NLR (OR=1.163,95%CI 1.090－1.241, P<0.001) and SOFA scores (OR=1.406,95%CI 1.199－1.649, P<0.001) were independent risk factors for the prognosis of elderly sepsis patients. The area under ROC curve (AUC) of NLR was 0.918 (95%CI 0.872－0.964, P<0.001), and the cut-off value was 30.68 (sensitivity 86.2%, specificity 81.8%). The AUC of SOFA score was 0.844 (95%CI 0.771－0.916, P<0.001), and the cut-off value was 12.5 (sensitivity 81.0%, specificity 80.3%). However, AUC of their combination was 0.964 (P<0.001), which was better than either of them. Conclusion NLR and SOFA scores are the risk factors of death in the elderly patients with sepsis. Their combination can greatly improve the accuracy of prognosis estimation and provide guidance in clinical practice.

Abstract:Objective To investigate the cognitive function and apolipoprotein E (ApoE) genotype and risk factors of cognitive impairment in the long-lived individuals in Zhongxiang, Hubei Province. Methods From January 2013 to March 2019, we visited the long-lived individuals, conducting face-to-face questionnaire survey, performing physical examination and ApoE genotype detection, and evaluating cognitive function with the mini-mental state examination. Mann-Whitney U test, Pearson chi-square test or Fisher′s exact test were used to compare cognitive normal group and cognition-impaired group. Logistic regression analysis was used to explore risk factors of cognitive impairment. Results A total of 320 long-lived individuals (median age, 94.0 years; 104 males, and 216 females) were enrolled in the analysis. Their ApoE genotype was ε2ε2 (0.6%), ε2ε3 (15.3%), ε3ε3 (66.2%), ε2ε4 (1.3%), ε3ε4 (16.3%), ε4ε4 (0.3%). Cognitive impairment was found in 65.6%(210/320) of the long-lived individuals. Multivariate logistic regression and analysis indicated that male (aOR=0.495,95%CI 0.260-0.940; P=0.032), being educated (aOR=0.365,95%CI 0.183-0.726, P=0.004), carrying ε2 allele (aOR=0.501,95%CI 0.252-0.996; P=0.049), and ε2ε2 or ε2ε3 (aOR=0.472,95%CI 0.231-0.964; P=0.039) were the protective factors of cognitive impairment; and that visual impairment (aOR=3.769, 95%CI 1.887-7.528; P＜0.001) and hearing impairment (aOR=2.691,95%CI 1.435-5.043; P=0.002) were the risk factors of cognitive impairment. However, age, history of smoking, history of drinking alcohol, carrying ε4 allele, and ε2ε4, ε3ε4 or ε4ε4 relative to ε3ε3 were not significantly associated with cognitive impairment (P＞0.05). Conclusion The ApoE genotype was mainly ε3ε3 in the long-live individuals in Zhongxiang, Hubei Province. Cognitive impairment was associated with female, being uneducated, visual impairment, hearing impairment, and non-ε2 allele carrier. Compared with ε3ε3 genotype, ε2ε2 or ε2ε3 significantly reduces the risk of cognitive impairment but ε2ε4, ε3ε4 or ε4ε4 don′t significantly increase the risk.

Abstract:Objective To investigate the prognostic value of neutrophil-to-platelet ratio (NPR) and mean platelet volume-to-platelet ratio (MPV/PC) in the elderly patients with sepsis. Methods A total of 113 elderly septic patients admitted in our department from January 2018 to May 2019 were recruited in this study. They were divided into survival group (n=78) and death group (n=35) according to their 28-day survival. The clinical data were compared between the two groups. SPSS statistics 25.0 was used for statistical analysis. Cox proportional hazard regression model was applied to analyze the factors affecting the prognosis of patients. Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive values of NPR and MPV/PC for 28-day mortality in the cohort. Spearman correlation analysis was employed to make correlation analysis. Results There were no significant differences in white blood cell count (WBC) and procalcitonin (PCT) and C-reactive protein (CRP) levels between the two groups. But NPR and MPV/PC were obviously higher in the death group than in the survival group (P<0.05). Cox proportional regression risk analysis showed that septic shock, high acute physiology and chronic health evaluation Ⅱ (APACHE II) score, high sequential organ failure assessment (SOFA) score, high NPR, high MPV/PC and low platelet (PLT) count were independent risk factors for the prognosis of sepsis in the elderly. ROC curve analysis indicated that the areas under the curve (AUC) of NPR and MPV/PC for predicting 28-day mortality was 0.654 and 0.657, respectively, and the cutoff values were 0.17 (P=0.009) and 0.07 (P=0.008), respectively. Spearman correlation analysis displayed that NPR was positively correlated with APACHE Ⅱ score (r=0.268, P=0.004) and SOFA score (r=0.417, P<0.001), and MPV/PC was positively correlated with SOFA score (r=0.435, P<0.001). Conclusion NPR and MPV/PC have predictive value for the prognosis of the elderly patients with sepsis. These two items are easy to obtain and suitable for early auxiliary initial diagnosis and emergency examination.

Abstract:Objective To investigate and analyze the distribution of rheumatic diseases among the elderly patients in the rheumatology department in a tertiary hospital. Methods A total of 2360 inpatients in the Department of Rheumatology and Allergy of Xuanwu Hospital of Capital Medical University were selected for the study, who were divided into the young and middle-aged group (<60 years, n=1293) and the elderly group (≥60 years, n=1067). Data were recorded about their gender, age, discharge diagnosis, admission time, discharge time, and complications. SPSS statistics 21.0 was used for data analysis, and the difference between groups was analyzed with the four-fold table χ² test. Results The proportion of males with systemic lupus erythematosus and rheumatoid arthritis in the elderly group was higher than that in the young and middle-aged groups. The proportion of females with gout in the elderly group was higher than that in the young and middle-aged groups. The proportion of the males and females with dermatomyositis and severe osteoarthritis in the elderly population was opposite to that in the young and middle-aged group. There was no elderly male patients with arteritis and systemic sclerosis. Conclusion The distribution of rheumatism in the elderly is different from that in the young and middle-aged, and the distribution of rheumatism in different genders has its own characteristics. In the clinical practice, attention should be paid to the distribution of rheumatism in the elderly, which is helpful for a better understanding of the characteristics of rheumatism in the elderly.

Abstract:Objective To observe the expression levels of growth differentiation factor-15 (GDF-15) and interleukin-12 (IL-12) in the serum and their correlation with pulmonary infection after mechanical ventilation in the elderly patients in intensive care unit (ICU). Methods From July 2016 to August 2019,169 elderly patients who underwent mechanical ventilation in the ICU of the First Affiliated Hospital of Harbin Medical University were selected as the observation group, among whom 71 had pulmonary infection and 98 did not; 102 elderly people without lung disease were selected as the control group. The expression levels of GDF-15 and IL-12 in serum were measured and compared by enzyme-linked immunosorbent assay (ELISA). SPSS statistics 21.0 was used for data analysis. Logistic analyses were performed for the risk factors of pulmonary infection after mechanical ventilation, and receiver operating characteristic (ROC) curve was used to evaluate the diagnostic values of serum GDF-15 and IL-12 expression levels in pulmonary infection. Results The expression levels of serum GDF-15 and IL-12 were (862.08±263.33) pg/ml and (70.88±14.61) pg/ml in the group without pulmonary infection and(1 431.42±310.50) pg/ml,(93.02±20.05) pg/ml in the group with pulmonary, which were all higher than those in the control group [(564.98±133.38), (46.90±20.14) pg/ml; q=12.443,13.097,33.211,23.052; P<0.05]. The expression levels of GDF-15 and IL-12 in the group with pulmonary infection were higher than those in the group without (q=21.643, 10.975; P<0.05). Logistic regression analysis showed that the high levels of serum GDF-15 and IL-12 were the risk factors of pulmonary infection after mechanical ventilation. In the diagnosis of pulmonary infection after mechanical ventilation, the area under ROC curves (AUC) of serum GDF-15 was 0.895 with a sensitivity of 76.1% and a specificity of 95.9%, AUC of serum IL-12 was 0.747 with a sensitivity of 54.9% and a specificity of 85.7%, and AUC for them in combination was 0.940 with a sensitivity of 81.7% and a specificity of 98.0%. Conclusion GDF-15 and IL-12 are highly expressed in the serum of the elderly patients with pulmonary infection after mechanical ventilation in ICU. The combined detection of serum GDF-15 and IL-12 has a high diagnostic value for pulmonary infection after mechanical ventilation in the elderly patients.

Abstract:Objective To investigate the efficacy and safety of total colpocleisis in treatment of elderly women with pelvic organ prolapse (POP). Methods A total of 78 elderly women with POP quantification (POP-Q) stage of Ⅲ－Ⅳ undergoing total colpocleisis in gynecologic department of Foshan Maternal and Child Health Hospital from January 2012 to January 2018 were recruited in this study. All patients were followed up for 1 year, and preoperative and postoperative POP-Q stages, pelvic symptoms and satisfaction were recorded and analyzed. Preoperative and postoperative quality of life were evaluated using the pelvic floor distress inventory short form-20 (PFDI-20) [including urinary distress inventory-6 (UDI-6), colorectal-anal distress inventory-8 (CRADI-8), pelvic organ prolapse distress inventory-6 (POPDI-6)] and pelvic floor impact questionnaire-7 (PFIQ-7). Chi-square test was used to compare the preoperative and postoperative POP symptoms, and student′s t test was applied to compare the life quality between preoperation and post-operation. Results The overall efficacy was 98.71% (≤stage Ⅰ), and 1 case experienced recurrence (≥stage Ⅱ). POP symptoms, such as vulvar mass prolapse, pelvic distension, frequent urination and urgent to urinate, dysuria, stress urinary incontinence, and defecation difficulty were significantly reduced postoperation (P<0.05). The subjective satisfaction was 100%. The points of PFDI-20 (UDI-6, CRADI-8, POPDI-6) and PFIQ-7 preoperatively were significantly lower than those preoperatively, with statistical differences (P<0.05). Conclusion Total colpocleisis can significantly decrease the POP-Q stage and pelvic symptoms, and obtain postoperative satisfaction and quality of life in elderly POP patients.

Abstract:Objective To investigate the diagnostic value of single test and combined test of tumor markers (TM), including carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), and alpha fetoprotein (AFP), for cirrhosis in the elderly patients. Methods A total of 116 elderly cirrhotic patients diagnosed at the outpatient and inpatient departments of our hospital from March 2017 to March 2019 were enrolled and assigned into the cirrhosis group, while 90 healthy individuals taking physical examination during the same period were selected as the control group. Serum levels of CA125, CA19-9, CEA, and AFP were measured by electrochemiluminescence assay, and the results were compared between the cirrhosis and control groups, between the cirrhotic patients with normal and elevated biochemical parameters of liver function, and among the patients with cirrhosis of different Child-Pugh scores. The sensitivity, specificity, and diagnostic concordance rates of single test and combined test of these TM indicators were compared to analyze the diagnostic significance of the tests for the detection of cirrhosis in the elderly. The data were analyzed by SPSS statistics 19.0. Results Serum levels of CA125, CA19-9, CEA and AFP were significantly higher in the cirrhotic group than the normal group (P<0.05), and in those with Child-Pugh class B and C than those with A (P<0.05). Similar trends were seen in those with elevated ALT, DBiL and TBA levels than those with normal indicators of liver function, but no statistical differences were seen. The sensitivity of single TM indicator test ranged from 42.4% to 62.1%, the specificity from 80.0% to 92.0%, and the diagnostic concordance rate from 64.7% to 74.1%. The combined detection of CA125, CA19-9, CEA and AFP had a sensitivity of 83.3%, a specificity of 96.0%, and a diagnostic concordance rate of 91.4%, and the combined detection of each TM indicator showed a higher diagnostic value for elderly patients with cirrhosis (P<0.05). Conclusion The combined test of serum CA125, CA19-9, CEA and AFP could obviously improve the detection rate of cirrhosis in the elderly, and indicate the severity of the cirrhosis condition. The combined test has a high diagnostic value.

Abstract:Objective To investigate whether extracellular matrix metalloproteinase inducer (EMMPRIN) regulates autophagy in macrophages via the Toll-like receptor-4 (TLR4) pathway. Methods Human monocytic leukemia cell line (THP-1) monocytes were induced with phorbol ester (PMA) at a final concentration of 5 ng/ml for 48 h, and the successfully differentiated macrophages were tested. The cells were divided into the control group, EMMPRIN group and TAK-242 group. The expressions of TLR4, NF-κB, LC3-II, Beclin1 and P62 were detected by Western blot. The expressions of LC3-II, Beclin1 and P62 were detected by immunofluorescence. SPSS statistics 22.0 was used to process the data. Results Western blot showed that the EMMPRIN group had higher expression of TLR4, NF-κB, LC3-Ⅱ(P<0.05) than the control group and the TAK-242 group.Beclin1 protein expression level also increased in the EMMPRIN group, but with no significant difference compared with the control group (P>0.05), and with significant difference compared with the TAK-242 group(P<0.05). Expression of P62 were lower in the EMMPRIN group than the control group and the TAK-242 group(P<0.05). Expression of P62 were lower in the EMMPRIN group than the control group and the TAK-242 group (P<0.05). Immunofluorescence found that, the fluorescent expression of LC3-Ⅱ and Beclin1 protein were significantly higher in the EMMPRIN group than that in the control group and TAK-242 group (P<0.05), but the difference in the expression of P62 was not statistically significant. Conclusion EMMPRI may regulate excessive autophagy in human THP-1 macrophages through the TLR4 signaling pathway.

Abstract:

Abstract:Frailty is associated with decreased physiological reserve, and is considered as an important indicator of adverse events in the elderly population. Therefore, increasing evidence shows that the syndrome should be diagnosed, and interventions should be carried out as early as possible, but its pathogenetic mechanism remains unclear. Chronic inflammation, as a pathophysiological mechanism, is related to the decline of physical functions, and consequently, can increase risk of diseases. Many studies suggest that chronic low-grade systemic inflammation may probably be an important cause of frailty. In the present paper, we review the research progress concerning syndrome and chronic systemic inflammation.

Abstract:The advances in medical technology, the increasing incidence of cardiovascular diseases and the aging of the world population contribute to a rising prevalence of heart failure year by year with such problems as low 5-year survival rate, high readmission rate, and poor prognosis. The rapid development of exercise-oriented cardiac rehabilitation shows particular importance of adopting exercise therapy as a non-drug treatment for patients with heart failure. Exercise rehabilitation training include aerobics exercises,resistance training, respiratory muscle training and neuromuscular electrical stimulation. However, such exercises programs are problematic for many patients receiving clinical treatment because they either dare not exercise or do not know how to exercise. Accordingly, this article reviews the research progress in exercise rehabilitation for patients with chronic heart failure.

Abstract:Iliac vein compression syndrome (IVCS), also known as May-Thurner disease or Cockett′s syndrome, is venous reflux disorder in the lower limbs and pelvic caused by the compression of the iliac veins and presence of adhered structures in the pelvic cavity. It is not only one of the causes of venous valvular insufficiency and superficial varicose veins in the lower limbs, but also a potential risk factor for the occurrence of venous thrombosis. At present, the main modalities for its clinical examination include color Doppler ultrasound (CDFI), computed tomography venography (CTV), magnetic resonance venography (MRV), and venography, but they are limited for their inaccuracy and convenience in evaluating IVCS. Intravascular ultrasound (IVUS) serves as an ideal assessment method for IVUS with a diagnostic sensitivity of over 90% and ability to better display abnormal structures in the iliac vein and surrounding side branches and to provide real-time guidance during the operations. However, its application in this field is rarely reported in China due to its invasiveness and high price.

Abstract:The elderly have a decline in the regulation of neuro-humoral-cardiocerebrovascular changes, and abnormal fluctuations of blood pressure are likely to cause damage in the target organ in the elderly with hypertension. Studies show that abnormal blood pressure variability (BPV) is a risk factor of stroke, cognitive dysfunction, cardiovascular disease, diabetes, and kidney disease. At the same time, BPV results in difficulty in steady reduction of blood pressure; therefore, it is necessary to monitor clinically the blood pressure variation in the elderly. This article reviews the research progress in BPV, associated diseases and influence of anti-hypertensive drugs in the elderly.

Abstract:Nutrients are substances that maintains life activities by being obtained from food through digestion, absorption and metabolism. Recent studies have shown that some of these nutrients play important roles in immunity regulation, anti-fatigue, sleep regulation and other aspects in addition to maintenance of life activities. Improving the immunity of the body is of great benefit to resist the invasion of viruses, bacteria and other microorganisms. This paper reviews the research progress of immune-enhancing nutrients in order to provide reference for the correct selection of immune-enhancing agents.