Abstract:Objective To explore the clinical efficacy and safety of acupuncture at triggering points in the treatment of diabetic peripheral neuropathy. Methods A total of 52 patients with diabetic peripheral neuropathy (DPN) were selected in the Pain Management Department of the Affiliated Hospital of Xuzhou Medical University from September 2018 to January 2020. The patients were randomized into study group and control group. Both groups actively received basic treatment. The study group was treated with acupuncture at triggering points and oral medication, while the control group with oral medication. Data were recorded of the patient′s numeric rating scale (NRS), nerve conduction velocity (NCV), and Toronto clinical scoring system (TCSS) before treatment, 1 week, 1 month, 3 months and 6 months after treatment to evaluate the treatment effect, and calculate the total efficiency rate of the two groups of patients, and the adverse reactions during the entire treatment period. Data analysis was performed using SPSS statistics 23.0. Depending on the data type, t test, variance analysis, Mann-Whitey U test, and χ² tests were used for inter-group comparison. Results After the treatment, NRS in the study group was significantly lower than that before the treatment (P<0.05), and NRS of the study group was significantly lower than that of the control group at the same time (P<0.05). NCV in the study group increased as compared with before the treatment (P<0.05), and the nerve conduction velocity at each time point after 1 week was higher than that in the control group (P<0.05). TCSS of the study group was significantly improved as compared with that before the treatment (P<0.05), and the improvement of the TCSS score of the experimental group was better than that of the control group (P<0.05). After the treatment, the total efficiency rate in the study group was higher than that in the control group (92% vs 64%,P<0.05). All patients had no serious adverse events during the entire treatment period. Conclusion It is safe and effective to treat diabetic peripheral neuropathy by acupuncture at triggering points, which is worthy of clinical application.

Abstract:Objective To evaluate the potential inappropriate medication (PIM) for elderly inpatients based on the Beers criteria of 2019 edition in order to provide the references for rational clinical medication for the elderly. Methods A retrospective study was carried out on 728 elderly patients who were discharged from the Yan′an Hospital Affiliated to Kunming Medical University from May to November 2019. Their PIM status was assessed with 2019 Beers criteria. SPSS statistics 23.0 was used for data analysis. According to different data type, t test or χ² test was used for data comparison between two groups.Results Among the 728 enrolled patients, 308 of them had at least one type of PIM problems, involving a total of 490 times of drug use. Among the 490 times, 256 times were drug-related PIM, with proton pump inhibitors and benzodiazepines most common. There were 10 times of PIM related to the disease state. There were 176 times of drugs that should be used with caution being used, and 16 drug interactions in these elderly patients. Thirty-two times of medications, which should be used with caution in elderly patients with renal insufficiency, were identified. Conclusion Our identified PIM problems in this study involve all evaluation contents in the 2019 Beers criteria and many clinical issues which deserve attention. Therefore, the criteria are reasonable and effective in the evaluation of PIM for elderly inpatients.

Abstract:Objective To investigate the best pacing sites of right ventricular septum (RVS) by comparing QRS wave width, serum N-terminal pro B-type natriuretic peptide (NT-proBNP) level and hemodynamic indicators in the patients undergoing different electrode positions in RVS. Methods A total of 177 patients who met the indications for artificial permanent pacemaker implantation and underwent single-chamber pacemaker implantation in our hospital from July 2014 to February 2018 were recruited in this study. According to the implantation site of active fixation electrode compared with height of vertebral shadow under X-ray at the posteroanterior position, they were divided into right ventricular high-septal (n=54), median-septal (n=68), and low-septal groups (n=55). The width of QRS complex, serum NT-proBNP level and hemodynamic indicators were recorded before and after operation. Left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), stroke volume (SV) and left ventricular fractional shor-tening (LVFS) were measured before and 6 months and 1 year after pacemaker implantation. SPSS statistics 26.0 was used for statistical analysis. One-way analysis of variance, non-parametric test, Chi-square test or Fisher exact probability test was adopted for intergroup comparison depending on different data types. Results There was no statistical difference in preoperative QRS width, serum NT-proBNP level, LVEDD, LVEF, LVFS and SV in the three groups (P>0.05). After operation, QRS width was increased in all groups, and it was the narrowest in the median-septal group, and widest in the low-septal group (P<0.05). Post-operative NT-proBNP was significantly lower in the median-septal groups than before(P<0.05), and both the low-septal group and high-septal group increased significantly at 6 months and 1 year after operation (P<0.05).The LVEDD of high-septal group and low-septal group was greater than that of median-septal group at 6 months and 1 year after operation (P<0.05); LVEDD of median-sptal group was less than that before operation; LVEDD of low-sptal group was more than that before operation. There was no significant difference between preoperative and postoperative LVEF, LVFS and SV in the median-septal group(P>0.05). Compared with low-septal group, the SV at 6 months, and LVEF, LVFS, and SV at 1 year postoperatively of median-septal group were significantly increased; compared with high-septal group, only LVEF at 1 year after operation was significantly increased (P＜0.05). Conclusion Median-septal site for RVS pacing shows little effect on cardiac function, and is the optimal site for RVS.

Abstract:Objective To investigate the correlations between dysphagia and physical disabilities in order to provide reference for occurrence of dysphagia in frail elderly inpatients. Methods A total of 422 frail elderly patients hospitalized in the Second Medical Center of Chinese PLA General Hospital from February to October 2019 were subjected in this study. According to Fried frailty phenotype criteria, they were divided into pre-frailty group and frailty group. They were also assigned into dysphagia group and normal swallowing group based on the results of water swallow test. Short physical performance battery (SPPB) was employed to assess lower extremity functioning in them, including body balance, walk speed and chair-stand time. Spearman correlation analysis was performed to evaluate the associations of dysphagia with above indicators. SPSS statistics 26.0 was used for statistical analysis. Chi-square test or student′s t test was employed to make intergroup comparison depending on different date types. Results There were 278 patients in the pre-frailty group and 44 patients in the frailty group, and 58 patients in the dysphagia group and 264 patients in the normal swallowing group. The SPPB score, score of standing for 10 s with feet in tandem position, score of walk speed in a 4-meter walk, and score of time to rise from a chair for 5 times were (6.31±2.69), (2.39±1.37), (2.28±1.12) and (1.10±0.21) points in the dysphagia group, respectively, significantly lower than those in the normal swallowing group [(8.48±2.77), (3.42±1.17), (2.70±1.22) and (2.36±1.09) points; all P<0.05)]. Dysphagia was negatively correlated with above 4 scores (r=-0.263, -0.142, -0.127, -0.293; all P<0.05). Conclusion Decline in physical performance, including decreased body balance, reduced walk speed and longer chair-stand time, might be indicators for dysphagia in frail elderly patients.

Abstract:Objective To screen potentially inappropriate medication (PIM) in the community-dwelling elderly with Chinese criteria and investigate the correlation of PIM, especially nervous system PIM with frailty. Methods Elderly people was recruited from a community in Beijing from December 2018 to March 2019. Their general condition, illness and medications were recorded. Edmonton frailty scale (EFS) was used to assess frailty and its level. PIM were evaluated according to the Lists of PIM for older adults in China, a country-specific Chinese PIM criteria. The severity of comorbidities was assessed according to the Charlson comorbidity index (CCI). SPSS statistics 24.0 was used to perform the statistical analysis. The measure data were expressed as mean±standard deviation (±s), and enumerate data were expressed as percentage (%). Data comparison between two groups was perfomed using t test,nonparametric test or χ² test depending on date type. Logistic regression analysis was employed to analyze the relationships between PIM and frailty, and between nervous system PIM and frailty. Results A total of 562 elderly patients were finally enrolled in this study. They were 65 to 97 years old, with a median age of 85 (82,88) years, and the males accounted for 33.4% (188/562). The prevalence of PIM was 69.6%(391/562). PIM differed in age, gender, care situation, income, number of drugs, polypharmacy, CCI and EFS scores (P<0.05). The use rate of nervous system PIM was 23.8% (134/562). The 5 most commonly used nervous system PIMs were estazolam, zolpidem, diazepam, nicergoline and lorazepam. Among the 314 frail elderly patients (55.9%), 32 (5.7%) suffered from severe frailty. Logistic regression analysis showed that the level of frailty was significantly different from advanced age, CCI score, polypharmacy, and the number of PIM used (P<0.001). Multivariate analyses showed that nervous system PIM was significantly and independently correlated with frailty (OR=1.597,95%CI 1.051-2.428). Conclusion The prevalence of PIM is relatively high among the elderly in the community, and many of them have severe frailty. Nervous system PIM is significantly and independently related to frailty.

Abstract:Objective To explore the current situation and influencing factors of self-neglect in the elderly inpatients and provide a scientific basis for the prevention and intervention. Methods A total of 320 elderly inpatients were selected from 3 hospitals in Linyi City by convenient sampling during June and September 2019, and were investigated for their statuses of self-neglect with self-neglect scale. The influencing factors were analyzed. SPSS statistics 25.0 was used to analyze the data, and logistic regression was employed to analyze the related factors of self-neglect. Results Cronbach′s α coefficient was 0.886 when the self-neglect scale was applied to our selected inpatients, and the cumulative contribution rate of extracting 5 common factors was 75%. The total score of self-neglect in elderly inpatients was 11.00(5.00,15.00). Among the five aspects, health self-neglect had the highest score[3.00(0.00,4.00)], followed by emotion self-neglect [2.00 (1.00,4.00)], medical service self-neglect [2.00 (0.75,4.00)], safety self-neglect [1.50(0.00,4.00)], and social interaction self-neglect [1.00(0.00,3.00)], respectively. Logistic regression analysis showed that, age, gender, economic pressure, education level, and living alone were the risk factors of self-neglect of elderly inpatients.Conclusion The self-neglect scale for the elderly is reliable and valid in elderly inpatients. The level of self-neglect is quite high in these patients. Relevant medical departments should take measures to strengthen prevention and intervention, reduce the level of self-neglect and promote the physical and mental health in the elderly inpatients.

Abstract:Objective To retrospectively analyze the related factors of hospitalized death in patients with bronchiectasis complicated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 111 patients with bronchiectasis complicated with AECOPD admitted in our hospital from January 2015 to June 2020 were enrolled in this study. According to their prognostic outcomes, they were divided into survival group and death group. The general information, clinical manifestations, lung function, results of laboratory examinations and length of hospital stay were collected and analyzed to screen the related factors affecting the in-hospital mortality in the two groups. SPSS statistics 24.0 was used for the data analysis. According to the data types, Chi-square test, student′s t test or Mann-Whitney rank sum test were employed for intergroup comparison. Logistic regression analysis was adopted to analyze the risk factors of death. Results A total of 31 risk factors were screened out for analysis. Univariate analysis showed that there were significant differences in age, underlying comorbidities, body mass index (BMI), granulocyte/lymphocyte ratio (NLR), serum albumin (ALB), pseudomonas aeruginosa infection, forced expiratory volume in one second as percentage of predicted volume(FEV₁%pred), blood gas analysis(BGA), partial pressure of carbon dioxide(PCO₂), oxygenation index (OI), Bhalla score of chest imaging and annual symptom duration between the two groups (P<0.05). Multivariate logistic regression analysis indicated that NLR, FEV₁%pred and Bhalla score were risk factors for death in patients with bronchiectasis complicated with AECOPD. Conclusion Increased NLR, decline of FEV₁%pred and low Bhalla score of chest imaging are independent risk factors for death in patients with bronchiectasis complicated with AECOPD.

Abstract:Objective To analyze the related factors for cardiovascular events (CVE) in the elderly patients with ventilator-associated pneumonia (VAP). Methods The clinical data of 297 elderly VAP patients admitted in our hospital from January 2017 to September 2020 were collected and retrospectively investigated. They were divided into CVE group and non-CVE group according to whether CVE occurred, and the related factors that may affect the occurrence were analyzed. SPSS statistics 25.0 was used for statistical analysis. Chi-square test or student′s t test was performed for data comparison between 2 groups depending on date types. Logistic multivariate regression analysis was applied for further analysis. Results Among the 297 elderly VAP patients, 104 (35.02%) experienced CVE, and 193 (64.98%) did not. In the elderly VAP patients with CVE, new onset heart failure, new onset heart failure+atrial tachycardia, and deterioration of heart failure were quite common. Logistic regression analysis showed that the history of chronic cardiovascular disease, acute physiology and chronic health evaluation scoring system score, blood glucose, serum creatinine, procalcitonin were independent risk factors for CVE in elderly VAP patients (P<0.05). The timing of extubation (immediately), body position (semi-recumbent position), arterial blood pH value and antibiotics selection based on drug sensitivity test were the independent protective factors for CVE in elderly VAP patients (P<0.05). Conclusion Attention should be paid to the elderly with the history of chronic cardiovascular disease and in critical condition. Anti-infective treatment, blood glucose control, protection of kidney function, and maintenance of acid-base balance can reduce the incidence of CVE in elderly VAP patients.

Abstract:Objective To explore the risk factors affecting the prognosis of elderly severe or critically ill patients infected with 2019 novel coronavirus. Methods A total of 61 old patients (over 60 years old) infected with 2019 novel coronavirus who were admitted to a ward of a designated hospital in Wuhan from January to March 2020 were selected as the research subjects, and their clinical data were collected and retrospectively analyzed. SPSS statistics 22.0 was used for data analysis. According to data types, student′s t test, rank sum test or Chi-square test was used for intergroup comparison. Cox regression model was used to analyze the survival of patients. Results The elderly patients with severe and critical illness had a mortality rate of 55.7% (34/61). The death group showed the following features:very old, female, longer time of onset, high proportion of dyspnea, higher levels of aspartate transaminase, alkaline phosphatase, lactate dehydrogenase, urea nitrogen, creatinine, creatine kinase isoenzyme, C-reactive protein and neutrophilic granulocyte count, and low levels of albumin, calcium and lymphocyte count. The independent risk factors influencing the prognosis of elderly patients with severe and critical diseases were creatine kinase isoenzyme (P=0.000, HR=1.065,95%CI1.034-1.096), albumin (P=0.001, HR=0.867,95%CI 0.797-0.943), calcium (P=0.000, HR=0.089,95%CI 0.028-0.279), and dyspnea (P=0.004, HR=6.538,95%CI 1.840-23.237). Conclusion High creatine kinase isoenzyme, low albumin, low blood calcium, and dyspnea are independent risk factors for elderly severe and critically ill patients infected with 2019 novel coronavirus.

Abstract:Objective To explore the values of plasma levels of soluble semaphore 4D (sSema4D) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in the diagnosis and prognosis of the elderly patients with acute decompensated heart failure (ADHF). Methods A total of 102 elderly ADHF patients admitted to our hospital from June 2018 to June 2019 were enrolled as the ADHF group, and another 85 elderly patients undergoing physical examination during the same period were recruited as the control group. The plasma levels of sSema4D and NT-proBNP were compared between the two groups, and the receiver operating characteristic (ROC) curve was drawn to analyze the areas under the curve (AUC) of plasma sSema4D and NT-proBNP levels in the diagnosis of ADHF. After 1 year′s follow-up, according to the 1-year survival or death outcome, the DCHF patients were divided into survival group (n=79) and death group (n=23). ROC curve analysis was performed to analyze the prognostic value of plasma sSema4D and NT-proBNP levels. The correlation of the plasma levels with left ventricular ejection fraction (LVEF) was analyzed with Pearson linear analysis, and the prognostic risk factors were studied with Cox multivariate analysis. Results The plasma sSema4D and NT-proBNP of the ADHF patients were significantly higher than those of the control group, and the levels at discharge in the ADHF group were obviously higher than those on admission (P<0.05). The AUC of plasma sSema4D and NT-proBNP levels for the diagnosis of ADHF alone and in combination were 0.771,0.817, and 0.902, respectively. The plasma sSema4D and NT-proBNP levels were notably higher in the death group than the survival group (P<0.05). The AUC of plasma sSema4D and NT-proBNP alone and in combination to assess the prognosis of ADHF were 0.762,0.787,0.878, respectively. Pearson linear analysis showed that the plasma sSema4D and NT-proBNP levels were negatively correlated with LVEF in the ADHF patients (r=-0.726,－0.567; P<0.05). Cox multivariate analysis suggested that cardiac function classification, LVEF, plasma sSema4D and NT-proBNP levels were risk factors for the prognosis of patients with ADHF (P<0.05). Conclusion Plasma sSema4D and NT-proBNP levels are increased in ADHF patients, and they can be used as important indicators for the diagnosis and prognosis of the disease.

Abstract:Objective To investigate the correlation between self-perceived aging and frailty in the elderly patients with multimorbidities to provide a theoretical basis for clinical intervention. Methods This study enrolled 401 elderly patients with multimorbidity in 3 communities of Shihezi City, who were selected by the convenience sampling. The simplified self-perceived aging scale (B-APQ) and the frailty screening scale (The FRAIL Scale) were used for questionnaire surveys. SPSS statistics 20.0 was used for data analysis, and Spearman correlation analysis was performed on the total scores and scores of each dimension of the self-perceived aging scale and the frailty scale. Results The self-perceived aging score in the elderly patients with multimorbidities were (49.73±7.50); the prevalence of frailty was 21.70% (87/401) and pre-frailty 53.12% (213/401). Spearman correlation analysis showed that the total score of self-perceived aging was significantly positively correlated with the total score of frailty (r=0.568, P<0.05). Conclusion The self-perceived aging of elderly patients with multimorbidities in the community is at a low level and needs to be improved. At the same time, the incidence of frailty is higher in the elderly patients with multimorbidities. Therefore, community medical staff should adopt effective interventions to reduce their negative self-perception of aging to reduce the incidence of frailty in those patients.

Abstract:Objective To observe the effectiveness of Shiguanning (SGN) decoction, a traditional Chinese medicine (TCM) formula, on reflux esophagitis (RE). Methods A total of 60 male SD rats were randomly divided into sham operation group (sham group), model group (M group), low- and high-dose SGN groups (1 and 2 g/ml SGN, L and H groups), and the positive control group (esomeprazole magnesium enteric-coated tablet 0.24 mg/ml, W group), each with 12 rats. The rat model of RE was established with pyloric ligation and lower esophageal sphincter incision operation. The sham group only underwent open and closed abdominal surgery. Then the histopathological score, plasma content of motilin (MTL) and mRNA levels of interleukin-17 (IL-17) and tumor necrosis factor-α (TNF-α) of esophageal tissues were compared among the groups. SPSS statistics 22.0 was used to perform the statistical analysis. Chi-square test or rank sum test was employed for intergroup comparison depending on different data types. Results The M group had the highest histopathological score of esophageal mucosa, lowest plasma content of MTL, and highest mRNA levels of IL-17 and TNF-α when compared with the other 4 groups (all P<0.05). Conclusion SGN can elevate the plasma content of MTL, thereby increasing the pressure of the lower esophageal sphincter; inhibit the mRNA expression of IL-17 and TNF-α in esophageal tissue, thus alleviating the inflammatory response. SGN have therapeutic effects on RE.

Abstract:The incidence and prevalence of heart failure (HF) gradually increase with age. Studies have shown that aging can cause myocardial injury independent of other diseases and eventually lead to HF. This article reviews structural, functional and phenotypic changes of heart caused by aging with emphasis on the research progress in the mechanism of HF caused by aging, including cardiomyocyte senescence, vascular senescence, extracellular matrix remodeling, neuroendocrine imbalance, and non-coding RNA changes. It also introduces several new therapeutic measures for aging-related HF.

Abstract:Alzheimer′s disease (AD) is the most common cause of dementia. The population of AD patients is numerous in China, so its prevention and treatment are imperative. The failure of therapies targeted to amyloid plaques has made the theory of neurotoxic amyloid β-protein oligomers (AβOs) more striking. In vivo and in vitro experiments have proved that the neurotoxicity of AβOs may be the cause of pathological changes in AD. This article mainly reviews the latest advances in the pathogenesis of AβOs and treatment strategies, and aims to better understand the relationship between AD and AβOs and provides references for further researches.

Abstract:Dizziness is a common symptom of the elderly aged 65 years old and above. Dizziness falls into two categories:narrow and broad. Dizziness defined by Barany Society is a narrow one which refers to spatial disorientation without motor illusion. We reviewed recent literature and found that the common causes of narrow dizziness in the elderly are hemodynamic orthostatic dizziness/vertigo, benign paroxysmal positional vertigo, psychologically related dizziness, decreased vestibular function, vestibular migraine, etc. We review those causes for clinicians′ reference.

Abstract:Parkinson disease (PD) is a common neurodegenerative disease which has diverse clinical manifestations, mainly, motor and non-motor symptoms. However, its non-motor symptoms are very easy to be misdiagnosed or missed diagnosis in the early stage of PD. PD related sleep disorders can even be a prodromal phase of PD. Therefore, further understanding the pathophysiology of these sleep disturbances will be helpful in preventive delay of PD progression. This paper mainly reviews the clinical classification, possible pathogenesis, and treatment strategies of PD related sleep disorder, so as to provide a new treatment idea for PD.