Abstract:Objective To explore the value of relative percentage washout (RPW) on enhanced CT in the differential diagnosis of renal cell carcinoma (pRCC) and hypervascular pancreatic neuroendocrine tumor (pNET) by comparing their imaging manifestations. Methods A retrospective analysis was made of the enhanced CT findings and RPW of 16 patients with 36 pRCCs confirmed by post-operative pathology and 25 patients with 28 hypervascular pNETs at the First Affiliated Hospital of Nanjing Medical University from January 2008 to December 2019. The two groups were compared in enhanced CT imaging features and RPW. SPSS statistics 25.0 was used for statistical analysis. Results There were statistically significant differences between the two groups in the tumor number, extrapancreatic metastasis and arterial enhanced CT value (P<0.05), but no statistically significant differences in the largest diameter, location, boundary, shape, intra-lesion necrosis, dilatation of the pancreatic duct and enhanced CT in the venous phase ( P>0.05 for all). RPW of the pRCC group (0.313±0.070) was significantly higher than that of the pNET group (0.195±0.096) (P<0.05). When the cut-off value was 0.21, receiver operating characteristic curve of RPW had good detection performance with area under the curve of 0.81, and sensitivity of 97.2% and specificity of 53.6%Conclusion pRCC and hypervascular pNET have distinctive imaging features and different RPW, which are helpful for their differential diagnosis.

Abstract:Objective To explore the correlation between constipation and frailty in the elderly in order to provide the evidence for clinical intervention. Methods A retrospective analysis was carried out on the comprehensive data from 473 hospitalized elderly patients admitted to Department of Geriatrics, Peking Union Medical College Hospital from September 2016 to June 2019. Constipation was diagnosed by symptoms, and status of frailty was assessed by FRAIL scale and physical function evaluation. SPSS statistics 20.0 was used for data analysis. According to different data type, t test, variance analysis orχ² test was used for data comparison, and logistic regression was used to analyze the correlation between frailty and constipation.Results The prevalence of constipation was 20.1% (49/244) in the non-frailty patients, 31.5% (51/162) in the pre-frailty patients, and 47.8% (32/67) in the frail patients, and the differences were statistically significant among the three groups (χ²=21.58, P<0.001). The constipation patients had poor physical function, with longer time in 5-times sit-stand test [(14.0±8.8) vs (11.7±5.4) s], lower maximum handgrip strength [(23.8±8.5) vs (26.2±9.0) kg], and lower points of short physical performance battery (SPPB) [(9.1±3.1)vs (10.2±2.6)points] when compared with the patients without constipation (P<0.05). In addition, multivariate logistic regression showed that constipation was related to frailty, depression and falls (P<0.05). Conclusion In the elderly, constipation is closely related to frailty, and comorbid with declined physical function and geriatric syndromes, needing comprehensive care.

Abstract:Objective To evaluate the effectiveness and the accuracy of partial pressure of end-tidal carbon dioxide (PetCO₂) monitoring of the new nasopharyngeal airway in the application of ultrasound-guided nerve block anesthesia in orthopedic lower extremity surgery. Methods A total of 40 patients scheduled for orthopedic lower extremity surgery were included. Lumbar plexus and sciatic nerve block were conducted first followed by placement of a new nasopharyngeal airway under mild sedation. After connection with the oxygen tube, radial artery puncture was performed with monitored PetCO₂. Blood gas analysis was monitored, and the bispectral index(BIS) was maintained between 60-70 intraoperatively by continuous pumping small doses of propofol. Blood gas analysis and PetCO₂ were recorded at the placement of nasopharyngeal airway, at the beginning of the surgery, at 1 hour after the beginning of the surgery, and at 20 minutes before the end of surgery. GraphPad Prism 6.0 was employed for data analysis. Pearson correlation analysis and Bland-Altman consistency analysis were used to compare PetCO₂ measured by the new nasopharyngeal airway with PaCO₂ obtained in blood gas analysis. The change of intraoperative PaO₂ was also recorded to evaluate the effectiveness of the new nasopharyngeal airway. Intraoperative and postoperative nasopharyngeal and pulmonary complications were recorded. Results Operations were successful in all the patients. PetCO₂ monitored by nasopharyngeal airway at different time points(at the placement of nasopharyngeal airway, at the beginning of surgery, at 1 hour after the beginning of surgery, and at 20 min before the end of surgery) correlated with PaCO₂ with good consistence (r=0.918,0.906,0.824 and 0.875; all P＜0.05). Bland-Altman method comparison showed that only two difference points were outside the 95% agreement bound at the four time points, and the consistency was 95%. No patient had hyoxemia in the surgery or postoperative pulmonary complications.Conclusion The new nasopharyngeal airway can be used for nerve block anesthesia in orthopedic lower extremity surgery.

Abstract:Objective To investigate the effects of chronic heart failure (CHF) with comorbid type 2 diabetes mellitus (T2DM) on cognitive function in elderly. Methods A total of 116 elderly patients with CFH and (or) T2DM were selected, who underwent inpatient rehabilitation in Jiangsu Rongjun Hospital and home-based rehabilitation in Liangxi District of Wuxi City from October 2019 to May 2020. They were divided into three groups according to the comorbidity of CHF and T2DM:CHF group (n=47), T2DM group (n=29), and CHF-T2DM group (n=40). General data of the patients were collected, and their cognitive function was assessed using the Montreal Cognitive Assessment Scale (MoCA). Based on MoCA score (< 26), the included 116 patients were classified as having cognitive impairment (CI, n=55) and having no cognitive impairment (NCI, n=61). Statistical analyses were performed using SPSS statistics 25.0. Logistic regression was used to analyze the affecting factors of CI in CHF patients with comorbid T2DM. Results The CHF-T2DM group had a significantly lower MoCA score and a significantly higher incidence of CI than the CHF and T2DM groups (P<0.05 for both). The CI group had significantly lower left ventricular ejection fraction (LVEF) and significantly higher score than the NCI group in smoking, course of CHF and T2DM, family history of dementia, CHF and T2DM, comorbid hypertension, comorbid atrial fibrillation, systolic blood pressure, glycosylated hemoglobin Alc (HbA1c), urea nitrogen, NT-proBNP, Hamilton depression scale score, and Pittsburgh sleep quality index score (all P<0.05). Multivariate logistic regression analysis showed that course of CHF, family history of dementia, comorbid atrial fibrillation, glycated hemoglobin, amino terminal pro-brain natriuretic peptide, and left ventricular ejection fraction were independent risk factors for the development of CI in CHF patients with T2DM (P<0.05 for all). Conclusion Compared with T2DM alone and CHF alone, CHF with comorbid T2DM would aggravate CI in the elderly.

Abstract:Objective To investigate the relationship between skeletal muscle mass and vitamin D level in the elderly male inpatients. Methods A total of 152 elderly male patients were collected, who were admitted to the Geriatric Ward of Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical College from January 2018 to December 2019. General data, including height, body mass and age, were collected. Body mass index (BMI) was calculated. Appendicular skeletal muscle mass (ASM) was measured via bioimpedance analysis (BIA). Appendicular skeletal muscle index(ASMI) was calculated. Serum 25-hydroxy vitamin D [25 (OH) D]was measured. SPSS 25.0 was used for data analysis. χ² test was used for data comparison.Results The average of serum 25 hydroxyvitamin D was (45.2 ± 21.4) nmol / L with 18 cases (11.8%) in the severely deficient group, 80 cases (52.6%) in the deficient group, 41 cases (27.0%) in the insufficient group and 13 cases (8.6%) in the sufficient group. The muscle mass decreased in 90 cases (59.2%) and was normal in 62 cases (40.8%). The appendicular skeletal muscle mass index of the four groups were 6.3 (5.9,6.9), 6.1 (6.1,7.4), 6.9 (6.4,7.4), and 7.6 (7.0,7.8) respectively, the difference being statistically significant (H=14.189; P=0.003), and the differences between the sufficient group and the other 3 groups being statistically significant (P=0.002,0.008). Serum 25(OH)D (OR=0.976,95%CI 0.958-0.994; P=0.009) was positively correlated with ASMI (r=0.168, P=0.040) and was an independent risk factor of ASMI. Further analysis showed that it had no correlation with the muscle mass of the upper limb (r=- 0.014, P=0.863), but was positively correlated with the muscle mass of the lower limbs (r=0.191, P=0.020). Conclusion The skeletal muscle mass is related to nutritional status of vitamin D in the elderly males, and the skeletal muscle mass of both lower limbs is more affected by vitamin D levels.

Abstract:Objective To understand the crude prevalence of Parkinson′s disease (PD) and Parkinson′s disease with its cognitive impairment (PD-CI) in the retired veteran cadre of the Chinese army and to analyze the prevalence of PD and the characteristics of neuropsychological assessment of its cognitive impairment. Methods This nationwide cross-sectional survey included 9 676 people in the platform study, of whom 227 (2.35%) were diagnosed with PD. Face-to-face surveys were used to improve sociodemographic data and various neuropsychological scales, to analyze the prevalence of PD and related cognitive impairments, and the characteristics of PD cognitive impairments. SPSS statistics 19.0 was used for data analysis. Data comparison among three or four groups was performed using χ ² test or Fisher exact test; and Dunn′s test was employed for the intra-group comparison.Results Among 227 PD patients, 104 (45.8%) had PD mild cognitive impairment (PD-MCI) and 71 (31.3%) had Parkinson′s disease dementia (PDD). The incidence of PD-CI increased with age and decrease in the schooling years (P<0.05). PD-MCI and PDD patients had significant difference in attention, language function, executive function impairment, memory function and visuospatial function (P<0.05) but no significant difference in calculation function (P>0.05). The difference in the scores on different scales for PD cognitive impairment in patients with language function and executive function was statistically significant (P<0.05). Intra-group comparison suggested the highest detection rates of the positivity by the naming test and the drawing clock test (P<0.05). There was no statistically significant difference in the incidence of naming, word fluency, and difficulty in observing instructions in patients with PDD (P>0.05). There was a statistically significant difference in the incidence of difficulty in coordination among multiple scales of executive function (P<0.05). The intra-group comparison suggested that the clock drawing test has a statistically significant difference in the incidence of difficulty in coordination with the other 4 groups (P<0.05). Conclusion The prevalence of cognitive dysfunction is high in patients with Parkinson′s disease. It is important to understand the characteristics of PD and to choose appropriate neuropsychological assessment scale.

Abstract:Objective To evaluate left ventricular myocardial work (LVMW) in predicting response to cardiac resynchronization therapy (CRT) using innovative two-dimensional speckle tracking imaging (2D-STI) technology. Methods From December 2017 to October 2019,75 patients with heart failure received CRT in Northern Jiangsu People′s Hospital were selected. Conventional echocardiography was performed before and 6 months after CRT, and global LVMW index (LVMWI) was analyzed with 2D-STI. Patients were defined as responders if a reduction over 15% was observed in left ventricular end-systolic volume(LVESV) after CRT. SPSS statistics 25.0 was used for statistical analysis, and the correlation between variables was analyzed using Spearman correlation. The receiver operating characteristic (ROC) curve was employed to analyze the predictive value of different parameters for the therapeutic effects of CRT. Results The effective rate of CRT was 65%(49/75). Compared with before operation, the responders had lower left ventricular end-diastolic dimension (LVEDD), left ventricular end-diastolic volume (LVEDV) and LVESV, higher left ventricular ejection fraction (LVEF), higher myocardial work index (GWI), higher global effective work (GCW), higher global work efficiency (GWE), and lower overall invalid work (GWW) after the intervention (P<0.05). There were no statistically significant differences in those parameters in the non-responders. Preoperative GCW and GWW were higher in the responders than the non-responders (P<0.05). GCW was linearly correlated with △LVESV and LVEF (r=0.58,0.64; P<0.05 for both). The area under the ROC curve was 0.78 for GCW and 0.85 for GWW in predicting CRT responders (P<0.05). Conclusion The left ventricular myocardial work index can evaluate the left ventricular systolic function in the CRT patients and can be used to predict the response to CRT.

Abstract:Objective To investigate the effect of proprioception training on rehabilitation of the elderly patients with decreased walking ability. Methods A total of 68 elderly patients with decreased walking ability were selected for the study, who were hospitalized in Xijing Hospital of Air Force Medical University from March 2017 to July 2019, and they were randomized into study group and control group (34 patients each). The control group received conventional training in walking ability, while the study group received additional proprioception training. The two groups were compared in changes in Holden′s functional ambulation classification (FAC), Berg balance scale (BBS), passive position sense (PAPS) and gait speed (GS) before and 8 weeks after the treatment. SPSS statistics 23.0 was used for data analysis. Student t-test, rank test andχ² test were performed for comparison between the two groups. Results FAC, BBS, PAPS and GS of the two groups were significantly improved after treatment (all P<0.01), and there was no statistically significant difference in the incidence of falls (P＞0.05). After treatment, FAC [4(3,5) vs 3(3,4)points; P=0.023] and BBS [(48.5±3.5) vs (45.6±4.2)points; P= 0.002] of the study group were significantly higher than those of the control group. After 8 weeks of treatment, the required walking time of 10m in the study group was significantly lower than that of the control group [ (11.0±2.1) vs (12.4±2.5)s; P=0.014]. The study group had significantly lower PAPS value than the control group [1(1,1) vs 2(2,3)degree; P＜0.001]. Conclusion Proprioception training combined with conventional treatment is more effective than conventional treatment in the elderly patients with decreased walking ability and can effectively improve their walking function, balance ability and proprioception of lower limb joints, contributing to the reduced risk of fall and the improved rehabilitation of the elderly patients.

Abstract:Objective To investigate the diagnosis accuracy of chest pain characteristics for coronary artery disease. Methods All the consecutive inpatients (n=240) with chest pain undergoing coronary angiography (CAG) and coronary fractional flow reserve (FFR) determination in First Medical Center, Chinese PLA General Hospital, during June 2012 to June 2016 were enrolled in this study. According to their medical history, they were divided into non-chest-pain group (n=55), atypical chest pain group (n=79), typical effort angina group (n=64) and coronary stent implantation group (n=42). The correlations of different chest pains with the results of CAG and FFR were analyzed. SPSS statistics 19.0 was used to perform the statistical analysis. According to different data type, analysis of variance or χ² test was used for comparison. Results The results of CAG indicated that the average stenosis was (70.82±13.39)%, (69.62±9.96)%, (73.52±12.87)%, and (67.98±14.27)%, respectively in the non-chest-pain group, atypical chest pain group, typical effort angina group and coronary stent implantation group (P>0.05). And their FFR value was (0.84±0.08) , (0.84±0.08), (0.79±0.11) and (0.82±0.08), respectively (P<0.05). Significant difference was seen between the atypical and typical chest pain groups (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the accuracy of predicting FFR with CAG identified stenosis was quite high, and CAG identified 72.00% stenosis had an area under ROC of 0.854 and a Youden index of 0.60, asensitivity of 87% and a specificity of 73%. Conclusion Typical chest pain has a quite high accuracy in the diagnosis of myocardial ischemia of coronary artery disease. Typical angina, coronary stenosis >80.00%, FFR<0.80 can be used as a reference for revascularization treatment.

Abstract:Objective To investigate the distribution and clinical characteristics of multidrug-resistant organisms (MDROs) in the elderly patients with hospital-acquired pneumonia (HAP) to provide the basis for formulating prevention and control strategies. Methods A retrospective survey was conducted among 82 elderly HAP patients admitted to the Department of Internal Medicine of Joint Service Support Force Hospital No.904 from January 2018 to December 2019. Deep sputum specimens were collected for bacterial isolation and culture. The patients were divided into MDROs group (n=42) and non-MDROs group (n=40). Distribution and clinical characteristics of MDROs specimens were analyzed. The two groups were compared in clinical indicators, and analysis was performed for the risk factors of MDROs infection. SPSS statistics 22.0 was used for data processing. Depending on data type, t-test or χ² test was performed for comparison between groups, and multivariate unconditional logistic regression for investigation of independent risk factors of MDROs infection. Results Infections by pseudomonas aeruginosa and acinetobacter baumannii were more common in MDROs group. Incidence and mortality of ventilator-associated pneumonia were higher in MDROs group than in non-MDROs group. Multivariate unconditional logistic regression showed that age (OR=1.147,95%CI1.029－1.279;P=0.013), long hospital stay (OR=1.139,95%CI1.049－1.238;P=0.002), long antibiotic use (OR=1.081,95%CI 1.014－1.153;P=0.017), prolonged use of the invasive ventilator (OR=1.172,95%CI 1.029－1.334;P=0.016), and C-reactive protein (CRP) (OR=1.144,95%CI 1.047－1.250;P=0.003)were independent risk factors of MDROs infection. Conclusion Pseudomonas aeruginosa and acinetobacter baumannii are common pathogens in the elderly patients with hospital-acquired pneumonia with high incidence and mortality rate of ventilator-associated pneumonia.

Abstract:Objective To observe and explore the effect of ruscogenin (Rus) on doxorubicin (DOX)-induced cardiomyopathy in mice and its probable mechanism with a view of providing clinical proof for the prevention and treatment of DOX-induced cardiotoxicity.Methods A single intraperitoneal injection of DOX (15 mg/kg) was performed to construct a mouse model of acute DOX-induced cardiotoxicity. Using random number table, 32 male C57BL/6 mice (8-10 weeks) were divided into Sham group, Rus group, DOX group, DOX+Rus group (n=8/group). The DOX group and the DOX+Rus group were given DOX(15 mg/kg) injection, and from the day of DOX injection, the Rus group and the DOX+Rus group were given additional Rus 10 mg/(kg·d) for 7 consecutive days. At day 7, echocardiography was performed to evaluate the cardiac function, including ejection fraction (EF), fraction shortening (FS), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), and heart rate. qRT-PCR was done to detect the expression levels of pyrolysis markers Caspase 1, interleukin-1β(IL-1β), and IL-18. Western blotting was performed to detect the expression of apoptosis-related protein, NO-like-binding domain-like receptor protein 3 (NLRP3) inflammatory body-related protein and p38 mitogen-activated protein kinase (p38MAPK) related protein in cardiac tissue. SPSS statistics 22.0 was used for statistical analysis. One-way ANOVA was performed for data comparison.Results Compared with the Sham group, the DOX group had significantly lower EF and FS level but significantly higher LVEDD and LVESD, Bax/Bcl-2 ratio, NLRP3 and ASC expression, mRNA expression of Caspase 1, IL-1β and IL-18, and phosphorylation level of P-p38 (P<0.05 for all). Compared with the DOX group, the DOX+Rus group had significantly better cardiac function, decreased myocyte pyrolysis (P<0.05), decreased expression level of NLRP3 and P-p38 (P<0.05 for both), and no significant difference in ASC expression level (P>0.05). Conclusion Ruscogenin can improve the cardiac function of mice with DOX-induced cardiomyopathy by inhibiting the NLRP3 inflammasome and p38MAPK pathway.

Abstract:Falls are the leading cause of death from injuries in the elderly. The incidence of falls is high in the patients with Alzheimer′s disease due to cognitive impairment. Specific measures to prevent falls can be divided into non-drug-related and drug-related, and the former can be divided into stimulation-oriented and behavior-cognition-oriented. Pharmacological measures include drug dosage changes, drug combination and immune-related measures aiming at reducing amyloid protein.

Abstract:The severity of coronary artery disease is closely related to the prognosis of patients with coronary heart disease, and it is also an important influencing factor in the development of clinical management strategies for these patients. At present, a series of coronary scoring systems have been developed in order to quantitatively assess the severity of coronary atherosclerotic lesions based on the results of coronary angiography or coronary computed tomography angiography in order to evaluate the prognosis of the patients and guide clinical treatment. Different scoring systems have their own advantages, disadvantages and application scopes. The article reviews different scoring systems, and hopes that it will be helpful to understand the characteristics and application scope of the systems so as to better evaluate the prognosis of patients and formulate more beneficial treatment strategies.

Abstract:Aging problem is becoming more and more serious, which has brought new challenges to the diagnosis and treatment of diseases for the elderly. Comprehensive geriatric assessment is the core technology in geriatric researches, and it is to make a comprehensive individualized evaluation of physical functions, mental psychology, social environment, quality of life, polypharmacy and other aspects in the elderly patients. However, polypharmacy is one of the common conditions for the aged, and it increases the risk of adverse drug reactions. Therefore, effective evaluation and intervention of polypharmacy for the elderly has become an urgent issue. In this review, we evaluate the current status of polypharmacy in the elderly and the research progress on evaluation tools for prescriptions in elderly individuals.

Abstract:Shenxian Shengmai (SXSM) oral liquid is a Chinese patent medicine with proven curative efficacy and safety. Evidence from modern pharmacological studies with various animals and cells show that SXSM can accelerate the heart rate and improve the clinical symptoms of patients with bradycardia by increasing the concentration of cyclic adenosine monophosphate in cells, promoting the opening of calcium channels, improving the degree of pathological damage, delaying fibrosis of sinus node in patients with sick sinus syndrome, increasing I_f current and regulating gene expression. A large number of clinical studies have shown that SXSM has a better efficacy on heart rate improvement than other traditional Chinese patent medicines and western medicines that increase heart rate.

Abstract:Endothelial cells are one kind of the epithelial cells that widely adhere to the lumen of the heart, blood vessels, and lymphatic vessels. They are involved in important processes such as hemostasis, regulation of blood vessels, and angiogenesis in human physiological homeostasis. In addition, recent studies have found that endothelial cells contribute to the pathological progress of various cardiovascular diseases and also have unique capability of multi-directional differentiation. Endothelial-mesenchymal transition is closely related to myocardial fibrosis. This article focuses on vascular endothelial cells, mainly exploring their physiological characteristics and their role in ischemic heart disease and heart failure with a view to providing new ideas for the treatment of cardiovascular disease.