Abstract:Objective To analyze the correlation of genetic polymorphism of miR-126 rs4636297 derived from platelet with anti-platelet reactivity of clopidogrel and clinical outcome in patients with acute coronary syndrome (ACS). Methods Consecutive ACS patients who were treated with clopidogrel and aspirin and underwent platelet reactivity test in 3d after stable antithrombotic therapy in Department of Cardiology, First Medical Center, Chinese PLA General Hospital from November 2015 to February 2017 were recruited in the study. Their peripheral blood samples were harvested to extract DNA to detect the polymorphism of miR-126 rs4636297. All patients were followed up for primary ischemic events within 1 year from discharging. SPSS statistics 22.0 was used for data analysis. Logistic regression analysis was used to study the independent influencing factors related to antiplatelet reactivity of clopidogrel and primary ischemic events within 1 year. Results A total of 364 patients were enrolled finally, and 193 of them were assigned into high on-treatment platelet reactivity (HTPR) group and the other 171 into the low on-treatment platelet reactivity (LTPR) group according to the results of platelet reactivity test. After adjustment, multivariate analysis indicated that the proportion of rs4636297 A allele was significantly larger in the HTPR group than the LTPR group (OR=1.85,95%CI:1.16-2.96; P=0.010). In the 1-year follow-up observation, the risk of primary ischemic events was obviously higher in the A allele carriers than the non-carriers (OR=4.09,95%CI:1.25-13.35; P=0.020). Conclusion The functional gene polymorphism rs4636297 of platelet-derived miR-126 may affect the response and outcome of clopidogrel antiplatelet therapy in ACS patients.

Abstract:Objective To investigate the correlation of body mass index (BMI) with the severity of obstructive sleep apnea hypopnea syndrome (OSAHS) in the elderly. Methods The medical records of 609 elderly patients (≥60 years old) suffering from OSAHS diagnosed by standard polysomnography in Chinese PLA General Hospital, Peking University International Hospital and the Affiliated Hospital of Gansu University of Traditional Chinese Medicine from January 2015 to October 2017 were collected and analyzed retrospectively. The subjects were divided into the normal weight (n=154), overweight (n=228) and obese (n=227) groups according to their different levels of BMI. The main indicators of polysomnography were compared among the three groups. SPSS statistics 25.0 was used for data analysis. Spearman rank correlation analysis was used to study the correlation between BMI and these main indicators, and multivariate logistic regression analysis was applied to explore the correlation between different BMI levels and OSAHS severity in the elderly. Results There were no significant differences in levels of apnea hypopnea index (AHI), time of oxygen saturation(SaO₂)<90%, oxygen desaturation index (ODI) , mean pause time, lowest oxygen saturation, mean oxygen saturation and percentage of the times for SaO₂ <90% in total monitoring time during overnight sleep (T90) among the 3 groups (P<0.05). BMI was positively correlated with AHI, maximum pause time, ODI, T90 and time of SpO₂<90% (r =0.294,0.113,0.313,0.413,0.411, all P<0.05), but negatively correlated with mean oxygen saturation and minimum oxygen saturation in the elderly OSAHS patients (r =-0.173, -0.229, all P＜0.05). The risk of severe OSAHS in the overweight group was 1.690 times higher than that of the normal weight group (OR=1.690), and the risk was even higher in the obese group (OR=3.685). A stratified analysis between the hypertension and non-hypertension subjects found that the correlation between obesity and severe OSAHS existed in both hypertensive and non-hypertensive subgroups, and the correlation between obesity and severe OSAHS was greater in non-hypertensive subjects. Conclusion In the elderly, the greater BMI is, the more severe OSAHS is. The correlation between BMI and severity of OSAHS is stronger for the non-hypertensive elderly people.

Abstract:Objective In the absence of a functional impairment assessment scale, this study aims to develop the formal version of function impairment screening tool (FIST) for the Chinese elderly based on the preliminary version of FIST using Delphi method. Methods A total of 305 elderly adults were assessed using the preliminary version of FIST. With correlation coefficient method, Cronbach coefficient method and factor analysis method, we calculated the correlation coefficient between the score of each item and the total score, the corrected item-total correlation (CITC), the Cronbach′s α after deleting an entry, the common factor variance and the factor loadings. Based on the results, the formal version of FIST was developed. Results A total of 300 valid questionnaires were received. According to the statistical results, the “social activities” item was deleted. Although the statistical results revealed that “eating”, “washing”, “dressing”, “continence”, and “physical exercise” should be deleted, these items except “continence” were retained after panel discussion. The FIST was finalized with 3 first-level indicators and 16 second-level indicators. Conclusion Based on the results of a piloting investigation using its preliminary version, the FIST was finalized after item screening with classical statistical methods and the experts′ suggestions.

Abstract:Objective To investigate the status of self-perceived burden in the elderly with acute stroke and analyze its effect on self-management behaviors in 1 month after stroke. Methods A questionnaire survey was performed among 216 elderly inpatients with stroke from 3 upper first-class hospitals in Xi′an during January and September 2017, including general data questionnaire, self-perceived burden scale, and stroke self-management behavior rating scale. Finally, 209 valid questionnaires were collected, and the correlation between self-perceived burden at the acute phase and self-management behavior at recovery phase was analyzed by Spearman correlation analysis with SPSS statistics 23.0. Results Among the 209 elderly stroke patients, 98.56% (206/209) of them had a self-perceived burden in the acute phase of the disease, and 75.60% (158/209) had moderate and severe self-perceived burden. The total score of self-management behavior and the scores of its 2 dimensions of emotion and social function and interpersonal management were negatively correlated with the total score of self-perceived burden in the acute phase in the patients (r=-0.190,-0.422, -0.270; P<0.05). And the total score was weakly negatively correlated with the emotional and economic self-perceived burden scores in the acute phase (r=-0.175, -0.203; P<0.05), and the emotional management dimension had the greatest correlation with the self-perceived burden and its 3 dimensions in the acute phase (r=-0.422, -0.214, -0.457, -0.328; P<0.01). Conclusion The elderly patients with acute stroke generally have moderate or severe self-perceived burden during the acute phase. It interacts with self-management behaviors in the early stage of rehabilitation. The stronger the self-perception burden is, the worse the self-management behaviors are. Medical staffs and patients′ relatives and friends should strengthen psychological counseling in the acute phase, instruct the patients to actively carry out rehabilitation exercise in the early stage of rehabilitation, do a good job in self-management of disease and daily life, promote rehabilitation and improve the quality of life.

Abstract:Objective To investigate the correlation between different personality traits and mild cognitive impairment (MCI) in the elderly. Methods A self-developed questionnaire of general information, Geriatric Depression Inventory, and Eysenck Personality Questionnaire were used to screen 300 randomly selected elderly people in Qiqihar for MCI. SPSS statistics 20.0 was used to perform the statistical analysis. Pearson correlation and multiple linear stepwise regression were used to investigate the correlation between personality traits and MCI. Results Gender, age, education level, marital status and income level were significantly different (P<0.05). Introversion and extroversion were negatively correlated with geriatric depression scale (GDS) scores (r=-0.468, P<0.01), and neuroticism and psychoticism were positively correlated with GDS scores (r=1.962,0.268; P<0.05). Difference in multiple stepwise regression analysis, extroversion, neuroticism, and psychoticism with MCI was statistically significant (P<0.05). Conclusion MCI in the elderly people is correlated with Eysenck personality, and inward and outward personalities, neuroticism and psychoticism are not only susceptibility factors of MCI but also affect the degree of MCI in the elderly people.

Abstract:Objective Age is an important factor influencing the prognosis of anti-neutrophil cytoplasmic antibody-associated vasculitis. This study aimed to investigate the clinical features and prognostic factors influencing the treatment outcome of eosinophilic granulomatosis with polyangiitis (EGPA) in the elderly. Methods Clinical data of all patients diagnosed with EGPA at Peking Union Medical College Hospital from January 2000 to December 2015 were collected and retrospectively analyzed. The patients were divided into the elderly group (≥ 60 years old at diagnosis) and the non-elderly group (< 60 years old at diagnosis). Clinical features, results of laboratory tests, and all-cause mortality were compared between the 2 groups by independent samples t test, Mann-Whitney U test, Chi-square test according to different types of data. Cox proportional hazards modeling was used to assess the prognostic factors for mortality, and Kaplan-Meier survival analysis to estimate cumulative survival rate and draw survival curve. SPSS statistics 25.0 was used for data analysis. Results A total of 181 patients were enrolled, including 45 elderly patients (elderly group) and 136 non-elderly patients (non-elderly group). The elderly group had significantly higher serum creatinine concentration [(91.3±57.6) vs (79.0±75.6) μmol/L; P=0.022], lower hemoglobin level [(120.5±20.1) vs (134.7±50.0) g/L; P=0.007], higher erythrocyte sedimentation rate [(51.5±37.0) vs (35.5±36.8) mm/h; P=0.004], higher incidence of renal failure (24.4% vs 5.1%; P<0.001), and higher score of Birmingham vasculitis activity [(17.1±6.7) vs (14.2±6.9) points; P=0.016] when compared with the non-elderly group. The proportion of the patients with five-factor score ≥ 2 was significantly greater (40.0% vs 8.8%; P<0.001) in the elderly group than the non-elderly group, so was all-cause mortality (24.4% vs 9.6%; P=0.011). Age ≥60 years, cardiomyopathy, central nervous system involvement, gastrointestinal bleeding and immunosuppressive therapy were risk factors for mortality in the EGPA patients. Pulmonary embolism and methylprednisolone pulse therapy were associated with death for those ≥60 years old. Conclusion Age ≥ 60 years is an independent risk factor for death in EGPA patients. Clinicians should concern the adverse effects of pulmonary embolism and methylprednisolone pulse therapy in elderly EGPA patients.

Abstract:Objective To determine the effects of home-based cardiac rehabilitation (HBCR) and center-based cardiac rehabilitation (CBCR) on cardiopulmonary fitness in patients with coronary heart disease (CHD). Methods The CHD patients (18-80 years old) who visited the Clinic of Cardiac Rehabilitation Center of Chinese PLA General Hospital from November 2018 to October 2019 were subjected in this study, and were randomly divided into HBCR and CBCR groups. They were given the HBCR program or CBCR program respectively for 3 months. Then peak oxygen uptake (peak VO₂) were compared before and after the intervention and between the 2 groups. Statistical analyses were conducted by SPSS statistics 25.0. Intergroup differences were analyzed by Chi-square test, student′s t test, or Mann-Whitney U test for different data types. Results For the 191 enrolled patients, 92 were assigned into HBCR group and 99 into CBCR group. There were no statistical differences in the baseline data between the 2 groups. After intervention, peak VO₂ level was significantly increased in the HBCR group [(20.5±4.7) vs(19.2±3.9) ml/(kg·min); P=0.002] and the CBCR group [(21.2±4.8) vs (19.9±4.4) ml/(kg·min); P=0.001]. But no statistical difference was seen in the level between HBCR and CBCR groups after the intervention (P=0.331), in the improvement of the level after the intervention [1.2 (-1.2,3.5) vs 1.1 (-0.5,3.5) ml/(kg·min); P=0.630], or in the ratio of the improvement after the intervention to the level before [0.1 (- 0.1,0.2) vs 0.1 (0.0,0.2); P=0.610]. Conclusion Both HBCR and CBCR can improve the cardiopulmonary fitness in the CHD patients. And the improvement of the cardiopulmonary fitness by HBCR is equal to that of CBCR.

Abstract:Objective To evaluate the anticoagulant efficacy and safety of bivalirudin in patients with acute coronary syndrome (ACS) and stage 4 chronic kidney disease (CKD) during percutaneous coronary intervention (PCI). Methods A retrospective analysis was made of the clinical data of 39 ACS patients with CKD stages 2 to 4 who underwent PCI in Hankou Hospital of Wuhan from April 2017 to October 2019. The patients were divided into control group (CKD stages 2 to 3) and observation group (CKD stage 4) according to the CKD clinical staging criteria. The two groups were compared for the activated clotting time (ACT) in the perioperative period, activated partial thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT) at 24 h after operation, bleeding at 30 d after operation, and major adverse cardiac and cerebrovascular events (MACCE). Data were analyzed using SPSS statistics 20.0. Comparisons between groups were performed using t tests orχ² tests. Results There were no significant differences between the control and observation groups in ACT at 10 min after drug administration[(438.38±76.79) vs (413.61±66.49) s], at immediate postoperative period [(457.38±73.13) vs (425.28±60.96) s], and at 2 h after drug withdrawal [(184.21±48.15) vs (171.39±38.86) s] (P>0.05 for all). Control and observation groups did not have significant differences in APTT [(37.67±5.51) vs (39.50±9.04) s], TT [(37.52±8.21) vs (38.44±7.04) s], and PT [(14.76±3.13) vs (15.00±3.01) s] at 24 h postoperatively (P>0.05 for all). At 30-d follow-up, there was no significant difference between control and observation groups in the incidence of BARC type 1 bleeding events [14.29% (3/21) vs 11.11% (2/18)] and BARC type 2 bleeding events [4.76% (1/21) vs 5.56% (1/18)] (P>0.05 for both), and no patients had a BARC type 3 to 5 bleeding event. There was no significant difference between the two groups in the incidence of MACCE [9.52% (2/21) vs 11.11% (2/18)] (P>0.05). Conclusion Bivalirudin had good efficacy and safety in anticoagulation in patients with ACS and CKD4 during PCI.

Abstract:Objective To observe the effect of astragaloside IV (AST) on oxidative stress of uterus in female rats with hypothyroidism. Methods A total of 60 female rats [4 weeks old, weighing (110±10) g] were randomly divided into control group, model group, AST treatment groups (20,40 and 80 mg/kg) and positive drug group (levothyroxine sodium, 9×10-3 mg/kg). The rat model of thyroid dysfunction was induced with intragastric infusion of 0.1% propylthiouracil at a dose of 10 ml/kg. Then the serum contents of related indicators were detected with corresponding test kits, including myeloperoxidase (MPO), catalase (CAT) and nitric oxide (NO). The activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), the contents of malondialdehyde (MDA), lactate dehydrogenase (LDH) and Ca²⁺ in the uterine tissues were measured with corresponding test kits, and the level of high energy phosphates (HEP) was detected with high performance liquid chromatography. The contraction tension (CT) and contraction frequency (CF) of the smooth muscle samples derived from isolated uterine were measured, and uterine motility (UM) was calculated. Statistical analysis were performed by SPSS statistics 17.0. ANOVA was used for comparison among groups, and adjusted SNK test was used for comparison between two groups. Results MPO activity and NO level were decreased significantly, and CAT activity was enhanced obviously in AST treatment groups than the model group (P<0.05). The activities of 3′-adenylate triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), total adenine nucleotides (TAN), SOD and GSH-Px were also increased, and the contents of LDH and MDA were reduced significantly (P<0.05). AST treatment also resulted in significant elevations in CT, CF and UM of the isolated uterine smooth muscle and the concentration of Ca²⁺when compared with the model group (P<0.05), especially when the dose of AST was 80 mg/kg. Conclusion AST inhibits the effects on oxidative stress injury of uterus in female rats induced by hypothyroidism, which may be related to its enhancing the activity of antioxidant enzymes, opening Ca²⁺ channel and promoting energy metabolism.

Abstract:Diabetes is a global epidemic, and poor blood glucose control has been one of the primary causes of death for patients with cardiovascular diseases. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), a novel hypoglycemic agent, has attracted extensive attention due to their prominent protective action on cardiovascular system in addition to the hypoglycemic effect demonstrated in experimental and clinical studies. Previous large randomized controlled trials for SGLT2i (EMPA-RED, CANVAS, DELCARE TIMI-58) confirmed that SGLT2i, either as primary prevention or as secondary prevention, could significantly reduce the risk of cardiovascular deaths, non-fatal myocardial infarction and non-fatal stroke in patients with coronary artery disease and diabetes mellitus. However, there have been limited findings on the actions of SGLT2i, particularly their direct effects, in atherosclerotic cardiovascular disease (ASCVD). This review summarizes the research progress in the role of SGLT2i in ASCVD with diabetes, in an effort to provide more evidence for the clinical treatment of these patients.

Abstract:Cardiac fibrosis is involved in the occurrence and development of various cardiac diseases, leading to cardiac remodeling, dysfunction, heart failure and even death. The pathological bases of cardiac fibrosis are the proliferation and differentiation of cardiac fibroblasts and the excessive deposition of extracellular matrix. Transient receptor potential (TRP) channels are non-selective cationic channels, regulating cell functions mainly via Ca²⁺+ influx. Increasing studies have shown that TRP channels are involved in the regulation of many physiological functions and the occurrence and development of cardiac fibrosis. This article reviews the mechanism of cardiac fibrosis and TRP channels seen as a new target for its treatment.

Abstract:Acute cor pulmonale (ACP) is one of the serious complications of acute respiratory distress syndrome (ARDS). Its occurrence can not only cause congestion of the systemic circulation but also affect the contraction and diastolic function of the left heart, further aggravating circulatory failure. At present, significant progress has been made in the lung protective ventilation strategy for ARDS, but the mortality of patients with moderate to severe ARDS remains high. The author reviews ACP in ARDS patients in the respects of epidemiology, pathophysiology, diagnostic methods, and mechanical ventilation strategies.

Abstract:Cardiovascular disease remains one of the major public health problems worldwide with high morbidity and mortality, and myocardial infarction remains the leading cause of death. The rapid development of microarray technology and high-throughput sequenc-ing technology helps to gradually reveal the role of long non-coding RNA (lncRNA) in the occurrence and development of cardiovascular disease. LncRNA regulates gene expression at transcriptional and post-transcriptional levels through epigenetic action. A large number of studies have shown that lncRNA plays an important role in the regulation of atherosclerosis, acute myocardial infarction, and other cardiovascular diseases. This article reviews the biological mode of lncRNA and research progress in its role in the pathogenesis, diagnosis and treatment of coronary heart disease.

Abstract:A lot of evidence indicates that lipoprotein(a) is related closely to coronary heart disease, stroke, calcified aortic valve disease and other cardio-cerebrovascular disease. With further research, the relationship between LP(a) and diabetic nephropathy (DN) is also discovered. LP(a) may play a certain role in the occurrence, development, clinical diagnosis and treatment of DN. In this article, we review the recent research progress in LP(a), in aspects of its structure properties, genetics, metabolism, and correlation with DN.