Abstract:Objective To evaluate the success rate of glycosylated hemoglobin (HbA1c) control in the elderly patients with comorbid type 2 diabetes mellitus (T2DM) and its influencing factors in a Shanghai tertiary hospital. Methods According to clinical guidelines, a questionnaire was designed for a cross-sectional study to investigate 284 elderly patients with comorbid T2DM, who were admitted to the Internal Medicine Department of Huadong Hospital Affiliated to Fudan University from September to December 2020. Data analysis was performed using SPSS statistics 23.0. According to the data type, t-test or χ² test was used for comparison between groups. Logistic regression was performed to analyze the factors affecting the success rate of HBA1c control. Results The number of comorbidities was (2.04±0.88) in the 284 cases of patients, and metformin was the most widely used hypoglycemic drug. 61.6% patients (175/284) were treated with oral anti-diabetic only, and the success rate of HbA1c control was 68.0% (193/284). Logistic regression analysis showed that the course of T2DM, the number of comorbidities and the route of administration of hypoglycemic drugs were risk factors of success rate of HbA1c control (P<0.05). Conclusion The rate with target HbA1c level in elderly patients with comorbid T2DM needs to be further improved, warranting strengthened management of comorbidities, an individualized treatment plan and rational medication in clinical practice.

Abstract:Objective To investigate the efficacy of sodium-dependent glucose transporters 2 inhibitor (SGLT-2i) Empagliflozin in the treatment of type 2 diabetes mellitus (T2DM)in a management mode of the internet plus mobile medicine. Methods From January 2017 to December 2019, a total of 97 T2DM patients with poorly controlled blood glucose in the Outpatient of Endocrinology Department of Chinese PLA General Hospital were randomly divided into the care group (n = 49) and the control group (n = 48). The patients were treated with Empagliflozin in addition to the basic hypoglycemic regimen. The care group were managed in a mode of the internet plus mobile medicine, and the control group in the routine outpatient clinics. After 6 months, the two groups were compared in the clinical indexes, self-management abilities featuring diet control, medication compliance, blood glucose monitoring and smoking cessation qualified rate, and the scores of self-rating anxiety scale (SAS). SPSS statistics 16.0 was used for statistical analysis. Data comparison between two groups was performed using t test or χ² test depending on data type. Results After management, the care group and control group differed in fasting blood glucose [ (6.2±0.3) vs (7.9±0.4) mmol/L], 2 h postprandial blood glucose [(9.5±0.5) vs (10.7±0.7) mmol/L], hemoglobin A1c [(7.0±0.3) vs (7.9±0.7)%], triglyceride [(1.41±0.57) vs(2.09±0.62) mmol/L], urine albumin/creatinine [(14.4±8.4)vs (19.3±10.5) mg/mmol], and body mass index [(24.2±2.7) vs (25.7±2.5) kg/m²] (P<0.05 for all). The care group had higher qualified rates of diet control [38(77.6%) vs 12(25%)], medication compliance [47(95.9%) vs 36(75%)], blood glucose monitoring [44(89.8%) vs 31(64.6%)], and smoking cessation [39(79.6%) vs29(60.4%)] than the control group, and the differences were statistically significant (P<0.05). The SAS scores between two groups was statistically significant(P<0.05). Conclusion The mode of internet plus mobile medicine can improve the clinical indicators of T2DM patients who take orally Empagliflozin, reduce anxiety scores, and enhance the patient′s self-management. It is suitable for long-term management of chronic diseases.

Abstract:Objective To investigate the correlation between osteoporosis and sarcopenia in elderly patients with type 2 diabetes mellitus (T2DM). Methods Totally 579 patients aged ≥60 years with T2DM were enrolled from the Department of Endocrinology of Xuanwu Hospital. Bone mineral density (BMD) of lumbar vertebrae, left femoral neck and left total hip were measured. Hemoglobin A1c (HbA1c), appendicular skeletal muscle mass (ASM), grip strength and walking speed were also measured. The appendicular skeletal muscle mass index (ASMI) was calculated. The participants were divided into two groups according to osteoporosis and sarcopenia, with 180 cases in osteoporosis group and 399 cases in nonosteoporosis group, 52 cases in sarcopenia group and 527 cases in nonsarcopenia group. The correlation between osteoporosis and sarcopenia was assessed. SPSS 24.0 was used for data analysis. According to the different data type, t-test, Mann-Whitney U test or χ² test was used for comparison between groups. Multivariate logistic regression was used to analyze the association between sarcopenia and osteoporosis. Results Body mass index (BMI), BMD and T values of left femoral neck, left total hip in the sarcopenia group were significantly lower than those in the nonsarcopenia group (P<0.05). BMI, ASMI, grip strength and walking speed in the osteoporosis group were significantly lower than those in the nonosteoporosis group (P<0.05). Multiple logistic regression analysis showed that sarcopenia was a risk factor for osteoporosis (OR=2.16,95%CI 1.131-4.125, P=0.02) and that osteoporosis was a risk factor for sarcopenia (OR=2.27,95%CI 1.121-4.596, P=0.023) in old adults with T2DM. Conclusion Osteoporosis and sarcopenia can interplay each other in the elderly patients with T2DM.

Abstract:Objective To investigate the current diagnosis and treatment status of elderly patients with community acquired pneumonia (CAP) in an upper first-class hospital in Beijing, and compare the obtained data with Chinese 2016 CAP Diagnosis and Treatment Guidelines in order to explore the problems existing in the process of diagnosis and treatment. Methods A total of 295 elderly patients suffering from CAP admitted in our hospital from January to December 2020 were recruited in this study. According to their CURB-65(confusion, urea, respiratory rate, blood pressure, and age≥65 years) score for pneumonia severity assessment and pneumonia severity index (PSI), they were divided into outpatient and inpatient groups. The general information, admission site, pathogenic bacteria and initial antibiotic use were analyzed and compared between the two groups. SPSS statistics 23.0 was used to perform the statistical analysis. Student′s t test, Rank sum test or Chi-square test was employed for intergroup comparison based on different data types. Results For the 295 elderly CAP patients, there were 34 cases meeting the criteria for hospitalization according to the CURB-65 score (3-5 points), and 147 cases meeting the criteria based on the PSI score (grade Ⅳ-Ⅴ). The patients from the inpatient group were mostly of advanced age and admitted from emergencies, and had longer length of hospital stay and worse prognosis when compared with those from the outpatient group. There were 94.6% (279/295) receiving pathogenic test after admission, and the results indicated the positive rate of sputum smear was 79.9% (155/194), with Gram-positive cocci taking the top[29.7% (46/155)], the positive rate of sputum culture was 32.1% (70/218), with Fungi accounting for 20.0% (14/70), and positive rate of mycoplasma was 28.4% (21/74). On the basis of CURB-65 score, the proportions of third-generation cephalosporin usage [21.8%(57/261)]and quinolone usage [21.5% (56/261)] were quite high in the outpatient treatment group. The proportions of carbapenems [35.3% (12/34)] and carbapenems combined with other antibiotics [23.5% (8/34)] were significantly higher in inpatient group than outpatient group (P<0.05). Conclusion More than half of the elderly patients with CAP have low admission score and mild conditions, and did not meet the criteria for hospitalization recommended by the guidelines. Therefore, we need to further strengthen compliance with the guidelines. The CURB-65 scale has some limitations in the assessment of CAP severity in the elderly, and PSI has a higher value in evaluation of mortality risk of these patients. For the CAP elderly patients who meet the criteria for hospitalization, the type of their initial antibiotic use basically meet the requirements of the guidelines.

Abstract:Objective To analyze the distribution of ApoE and SLCO1B1 genes in intracranial atherosclerotic stenosis in the elderly patients with cerebral infarction and investigate the relationship between the degree of arterial stenosis and blood lipids. Methods From February 2018 to February 2019,200 patients with cerebral atherosclerosis in Oriental Hospital of Beijing University of Chinese Medicine were selected, and atherosclerotic stenosis was classified according to the North American Symptomatic Carotid Endarterectomy Trial (no stenosis, mild stenosis, moderate stenosis, severe stenosis); ApoE and SLCO1B1 gene polymorphisms were detected by gene chip technology, the distribution of each gene in different degrees of intracranial artery stenosis was analyzed, and the factors affecting the occurrence of arterial stenosis in the elderly patients with cerebral infarction were summarized. SPSS 23.0 was used for statistical analysis. Data comparison between the two groups was performed using LSD-t test, χ² test or Fisher exact test depending on data type. Logistic regression analysis was used to analyze the influencing factors of atherosclerotic stenosis.Results The history of hypertension, diabetes mellitus, smoking, low-density lipoprotein cholesterol (LDL-C), ApoE, and SLCO1B1 in the cerebral infarction group were higher than those in the control group, while high-density lipoprotein cholesterol (HDL-C) was lower than in the control group (P<0.05). ApoE had the highest rate of atherosclerosis stenosis in ε4 and ε3/ε3, and the difference was significant (P<0.05). The 1b/1b stenosis rate in the combination of SLCO1B1*1b and SLCO1B1*5 genotypes was the highest, but the difference was not significant (P>0.05). With the aggravation of atherosclerotic stenosis, the concentration of total cholesterol, triglyceride, and LDL-C gradually increased, and the concentration of HDL-C gradually decreased (P<0.05). Logistic regression analysis confirmed that LDL-C, ApoE ε4, ApoE ε3/ε3 were risk factors for intracranial atherosclerotic stenosis in the elderly patients with CI. Conclusion LDL-C, ApoE ε4, ApoE ε3/ε3 are associated with intracranial atherosclerosis and stenosis, and SLCO1B1 gene and gene combination are not.

Abstract:Objective To investigate the change of corrected QT interval (QTc) of electrocardiogram (ECG) and associated risk factors of its prolongation in the elderly patients with heart failure. Methods A total of 532 old patients with left cardiac insufficiency, who had a sinus rhythm and no clear bundle branch block, were enrolled in the study in Wuxi Huishan District No.2 People′s Hospital from January 2018 to January 2021. All patients had received cardiac function assessment, ECG, and cardiac ultrasound examination ebefore the treatment. They were divided into QTc≥440 ms group and QTc＜440 ms group. Analyses were made of the changes of QTc and the risk factors of its prolongation in elderly patients with heart failure in relation to classification of New York Heart Association (NYHA), age, left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter (LVEDd), lipoprotein phospholipase A2 (Lp-PLA₂), amino-terminal brain natriuretic peptide (NT-proBNP), comorbidities of two or more diseases such as hypertension, diabetes mellitus, coronary heart disease and other heart-related diseases. SPSS statistics 21.0 was used for statistical analysis. Depending on data type, comparison between two groups was performed using t-test, χ² test or Fisher exact test. Logistic regression analysis was used to determine the risk factors of the prolonged ECG QTc. Results The patients fell into NYHA Class I-IV were 71,130, 245, and 86, and the means of QTc in the four class groups was (415.34±22.80), (423.72±38.95), (433.45±37.33) and (465.74±37.69)ms respectively (P <0.05). The mean QTc was (433.69±39.35)ms, with 207 patients in the QTc≥440 ms group [mean=(472.63±31.40) ms] and 325 in the QTc<440 ms group [mean= (408.89±18.02) ms]. The difference between the two groups was significant in age [(78.32±7.55) vs (75.03±8.07) years], LVEDd [(51.89±9.77) vs (48.95±8.69) mm], LVEF[(48.01±9.98)% vs (56.75±8.50)%], Lg(NT-proBNP) [(3.33±0.74) vs (3.03±0.68)], but not significant in ln(Lp-PLA₂)[(4.87±0.65) vs (4.79±0.84), P>0.05]. Logistic regression analysis showed that the LVEDD, LVEF, NT-proBNP and comorbidities of two or more heart-related diseases were the risk factors for QTc prolongation. Conclusion The prolonged ECG QTc in elderly patients with heart failure is correlated with cardiac insufficiency, and heart-related diseases and cardiac structural change are the risk factors.

Abstract:Objective To investigate the efficacy of Qishenhuanwu capsule in treatment of Parkinson′s disease (PD) patients with Qi and Blood Deficiency and its effect on Unified Parkinson′s disease rating scale (UPDRS) scores and balance ability. Methods A total of 130 PD patients with Qi and Blood Deficiency treated in our hospital from March 2018 to December 2019 were recruited in this study, and were divided into control group (n=65, simple Basizide tablet) and Qishenhuanwu treatment group (n=65, Qishenhuanwu capsule plus Basizide tablet). All of the patients were treated for 3 months. The treatment efficiency, traditional Chinese medicine (TCM) symptom score, UPDRS score, Berg Balance Scale score, the Parkinson′s disease questionnaire-39 score, and adverse reactions were compared before and after treatment between 2 groups. SPSS statistics 23.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test or χ² test depending on data type. Results In 3 months after treatment, the total effective rate was 92.31% (60/65) in the Qishenhuanwu treatment group, significantly higher than that of the control group [80.00% (52/65), P<0.05]. After treatment, the TCM symptom score, UPDRSⅡ score, UPDRSⅢ score, and PDQ-36 score were all decreased, and the BBS score were increased in both groups (all P<0.05). The Qishenhuanwu group obtained better TCM symptom score, UPDRSⅡ score, and UPDRSⅢ score than the control group (all P＜0.05). The adverse reaction rate was 3.08% (2/65) in the Qishenhuanwu group and 7.69% (5/65) in the control group, but there was no statistical difference between them (P>0.05). Conclusion Qishenhuanwu capsule shows significant effectiveness in treatment of PD patients with Qi and Blood Deficiency, with less adverse reactions, and can improve daily activities, motor function, balance function and the life quality of the patients.

Abstract:Objective To analyze the correlation of expression levels of serum micro-ribonucleic acid-92a-1-5p (miR-92a-1-5p) and miR-92a-2-5p with post-stroke depression in elderly patients. Methods A total of 129 elderly stroke patients admitted in our hospital from February 2018 to October 2020 were selected as the study group, and another 110 healthy subjects who took physical examination at the same period were recruited as control group. The expression of serum miR-92a-1-5p and miR-92a-2-5p of all the subjects were detected with quantitative real-time polymerase chain reaction. Hamilton depression scale-17 was used to evaluate the depression in the study group within 1 month after admission. SPSS statistics 23.0 was used for data analysis. According to the data type, one-way analysis of variance or Chi-square test was employed for comparison between groups. Logistic regression analysis was adopted to analyze the influencing factors of depression in elderly stroke patients. Results The expression levels of miR-92a-1-5p and miR-92a-2-5p were significantly higher in the study group than the control group (P<0.05). In the study group, 37.98% (49/129) patients were complicated with depression in 1 month after admission. And the depressive patients had obviously higher levels of the two molecules than those without depression (P<0.05). Female, National Institutes of Health stroke scale score, basal ganglia lesions, left frontal lobe lesions, education level above high-middle school, decreased family support, and elevated serum levels of miR-92a-1-5p and miR-92a-2-5p were risk factors of post-stroke depression in elderly patients (P<0.05). Conclusion Higher expression levels of serum miR-92a-1-5p and miR-92a-2-5p indicate increased risk for depression in elderly stroke patients.

Abstract:Objective To explore the electrocardiography (ECG) characteristics in Kazak population in Gansu Province, and investigate the related risk factors for abnormal changes of ECG parameters. Methods A total of 846 Kazak people (study group) and 846 Han people (control group) were recruited from the over 40-year-old participants who taking physical examination in Aksai People′s Hospital from January to December 2020. The baseline data and characteristics of ST-segment and T-wave changes in routine 12-lead ECG were analyzed in the two groups. The prevalence of ST-segment shift and prolongation and T-wave changes in the study group was compared in each age group. SPSS statistics 22.0 was used for statistical analysis. Data comparison between two groups was performed using student′s t test or Chi-square test depending on different data types. Multivariate logistic regression analysis was employed to analyze the risk factors for ST-segment shift and prolongation and T-wave changes. Results There were significant differences in body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), total bilirubin (TBIL), direct bilirubin (DBIL), uric acid (UA), homocysteine (Hcy), history of drinking and incidence rates of ST-segment shift and prolongation and T-wave changes between two groups (all P<0.05). In the Kazak group, the incidence of ST-segment and T-wave changes was increased with 10 years of age increase. Multivariate logistic regression analysis showed that age increased by 10 years, increased BMI, SBP, DBP, TC, LDL-C, UA and Hcy levels, decreased TBIL and DBIL levels and history of alcohol drinking were independent risk factors for ST-segment shift and prolongation and T-wave changes in Kazakh group (P<0.05). Conclusion The detection rate of ST-segment shift and prolongation and T-wave abnormality in Kazak people is quite higher than that of Han people. The risk factors of abnormal changes are age increase of 10 years, obesity, abnormal blood pressure and biochemical indicators. Attention should be paid to the abnormal changes of ECG in the population, and combining biochemical examination and clinical data has an important clinical value for screening ischemic heart disease.

Abstract:Objective To explore the mechanism of leisure activities between cognitive frailty and depression of the elderly in the community so as to provide scientific basis for the prevention and intervention of depression in them. Methods From December 2020 to March 2021, convenience sampling was used to select 315 elderly people in a community in Shihezi City, Xinjiang Uygur Automomous Region. The leisure activities questionnaire, FRAIL scale, Montreal cognitive assessment scale and depression scale were used to conduct a questionnaire survey. SPSS statistics 25.0 was used to perform the statistical analysis. Stepwise regression analysis was employed to determine the effect of leisure activities on the relationship between cognitive frailty and depression in the elderly. Results Among the 315 elderly in the community, 33 elderly people (10.48%) developed cognitive frailty, with a score of leisure activities of (31.72±4.37) points and a depression score of (2.89±2.43) points. Cognitive frailty was positively correlated with depression scores (r=0.371, P＜0.01), and cognitive frailty (r=-0.401, P＜0.01) and depression scores (r=-0.487, P＜0.01) were negatively correlated with score of leisure activities. Leisure activities played a partially mediating role between cognitive frailty and depression, and the mediating effect accounted for 33.88% of the total effect. Conclusion Leisure activities play a partial mediating effect between cognitive frailty and depression of the elderly in the community. Attention should be paid to cognitive frailty and leisure activities of the elderly in the community to reduce the occurrence of depression.

Abstract:Objective To study the effect of Huatan Chushi Decoction on the ultrastructure of thymus cortex and oxidative damage in aging rats. Methods A total of 40 Wistar rats (weighing 130-170 g) were randomly divided into normal control group, aging group, decoction group and positive control group, with 10 rats in each group. After receiving subcutaneous injection at nape of neck with 1 ml/(kg·d) normal saline in the normal control group and 48 mg/(kg·d) D-galactose in the other 3 groups, the rats of above groups were gavaged distilled water at 10 ml/(kg·d) in the former 2 groups, 20 g/(kg·d) decoction in the decoction group, and 0.3 g/(kg·d) vitamin E solution in the positive control group. At the end of 40 days′ intervention, all rats were sacrificed, and the contents of total antioxidation capacity (T-AOC), lipid peroxide(LPO) and lactate dehydrogenase (LDH) in the serum were detected. The ultrastructure of thymus cortex was observed with transmission electron microscopy. SPSS statistics 20.0 was used to perform the statistical analysis. One-way analysis of variance was applied for multi-group comparison, and Bonferroni test for comparison between groups. P<0.05 was regarded as statistical significance. Results The body mass of rats in each group was increased significantly on the 14th, 28th and 41st days, and the growth rate was slightly lower in the decoction group than the other 3 groups, but there was no significant difference among the groups (all P>0.05). On the 41st day, the T-AOC level was significantly lower while the contents of LDH and LPO were obviously higher in the aging group than the control group (P<0.01). The T-AOC level was remarkably increased while the content of LDH was notably decreased in the decoction group and positive control group than the aging group (P<0.05). The serum LPO content was decreased in the decoction group and the positive control group, but statistical difference was only seen in the former group (P<0.01). The decoction group had higher T-AOC level but lower LPO content when compared with the positive control group (P<0.01), but no such difference was observed in the content of LDH (P>0.05). In the aging group, the epithelial cells and lymphocytes in the thymus cortex were significantly reduced, and displayed obviously destroyed cell structure, with shrunk and deformed nucleus, decreased mitochondria, endoplasmic reticulum and other organelles and increased lysosomes in the cytoplasm. The decoction group and the positive control group showed larger numbers of epithelial cells and lymphocytes in the thymus cortex and obviously improved cell structure when compared with the aging group. Conclusion The decoction can improve the body′s antioxidant capacity, reduce oxidative damage and accumulation of oxidative products, increase the numbers of epithelial cells and lymphocytes in the thymus cortex, and protect cell morphology and mitochondrial ultrastructure. Huatan Chushi Decoction has an intervening anti-aging and immune function

Abstract:Diabetes is one of the biggest health problems in the world, and has quite high incidences of disability and mortality, which increase the cost of health care to countries and financial burden on patients. In the past decade, many studies have shown that there is an association between changes in the intestinal flora and various systemic diseases, including diabetes. It is well known that factors such as lifestyle, increased intake of fat and high-sugar foods, and host genes may all contribute to type 2 diabetes mellitus (T2DM). Some recent studies have shown that changes in the composition of intestinal flora can trigger T2DM. In this paper, we reviewed the current research status of the correlation between T2DM and intestinal flora.

Abstract:The mainstream holds subjective cognitive decline (SCD) as more than ten-year latent preclinical stage of Alzheimer′s disease (AD). Due to its normal objective neuropsychological function and the presence of pathological changes in the brain, SCD has been regarded as a key period for the prediction and early intervention of Alzheimer′s disease in recent years. Since pharmacologic interventions in the SCD stage is not applicable, active non-pharmacologic interventions and effective prevention have become the main orientation of the current research. This paper aims to summarize and evaluate the latest research progress of non-pharmacologic interventions in SCD both in China and in other countries to provide effective strategies for AD prevention and treatment clinically.

Abstract:Neprilysin (NEP) is a ubiquitous metallopeptidase that can hydrolyze a variety of peptides in the body. Current studies have shown that NEP can affect the progression of heart failure by regulating the natriuretic peptide system, renin-angiotensin-aldosterone system, and kinin-kallikrein system, etc. Because the benefits of angiotensin receptor neprilysin inhibitor has also been confirmed in clinical applications, NEP can be used as a new target for the treatment of heart failure. However, because of the wide application of NEP′s effects, it has aroused widespread concern about its safety in the clinical treatment of heart failure.

Abstract:The incidence of diabetes is getting higher and higher, and it has become a global problem. With the introduction of the concept of strengthening glucose control and the wide application of insulin, the incidence of diabetes-related hypoglycemia has increased gradually. Sustained hypoglycemia will lead to various acute cardiovascular and cerebrovascular diseases. However, recent studies have found that after insulin induced hypoglycemia, increased blood sugar by exogenous glucose will lead to more serious cardiovascular and cerebrovascular damage than the hypoglycemia state, especially to the brain. Similar to ischemia-reperfusion injury, the concept of “glucose reperfusion injury” is proposed. However, the mechanism of cerebral injury caused by glucose reperfusion remains unclear, and it may be related to oxidative stress, autophagy, calcium ion overload, activation of calpain, and polyadenylic acid diphosphate ribose transferase-1, etc.

Abstract:Atherosclerotic diseases and cancer pose a serious threat to human health. Clinical studies have shown that atherosclerotic diseases are significantly correlated with the pathogenesis of cancer. Patients with atherosclerosis have a higher probability of developing cancer than those without, and the cancer population has a remarkably higher probability of developing atherosclerotic diseases when compared with the non-cancer population. Atherosclerotic diseases and cancer seem to be two independent diseases, but there are certain association in their pathogenesis. The two not only have common risk factors, but also have related molecular mechanisms. Because of the importance of the two diseases to human health, the correlations between them and their mechanisms have attracted increasing attention.

Abstract:According to statistics, the global incidence of chronic obstruction pulmonary disease (COPD) in the population aged over 40 years old is as high as 9%-10% at present. According to the latest data by Word Health Organization, lung cancer accounts for 11.6% of all new cancer cases in the world, with a case fatality rate of 18.4%. The lung cancer has the highest incidence rate and case fatality rate in China and even in the world. The annual incidence of COPD with lung cancer is 16.7% and is still rising. COPD with lung cancer is difficult to treat because a treatment plan should be considered both diseases. With a high fatality rate, the comorbidity poses a great burden on medical resources. The pathogenesis of COPD with lung cancer is complex, and COPD itself is a risk factor for lung cancer. In this paper, we reviewed the recent progress in the pathogenesis of COPD with lung cancer.