Abstract:Objective To analyze clinical manifestations and renal histopathological typing in the elderly patients with renal diseases. Methods A retrospective study was made of the elderly patients who underwent renal biopsy in Xijing Hospital of Air Force military Medical University from January 2016 to December 2020 in their epidemiological characteristics, clinical manifestations and renal histopathological typing. SPSS statistics 19.0 was used for statistical analysis. Results Among the 4 386 patients who underwent renal biopsy, there were 360 elderly renal diseases patients (male 231, female 129). The average age was (70.04±4.59) years. Nephrotic syndrome (42.22%, 152/360)was the most common indication of renal biopsy. The most common histopathological diagnosis was still primary glomerular disease (62.78%, 226/360), of which membrane nephropathy was the most common(59.29%, 134/226), followed by IgA nephropathy (19.91%, 45/226) and minimal-change disease(12.39%, 28/226). The incidence of secondary glomerular disease was 31.11%(112/360), diabetic nephropathy accounts for the first place (23.21%, 26/112), followed by anti-neutrophil cytoplasmic antibody-associated small-vessel vasculitis and amyloidosis, both accounting for 19.64%(22/112). Conclusion The clinicopathological manifestations of elderly patients with renal disease have their own characteristics. For the elderly patients with renal disease of unknown etiology, renal pathological biopsy should be performed as soon as possible, which is helpful to make a clear diagnosis and early treatment and improve the prognosis of the patients.

Abstract:Objective To investigate the chronic diseases and comorbidity status in long-lived elderly (aged 90 years or older) in order to provide evidence for the management of multimorbidity in the patients. Methods Clinical data of 172 aged 90 years and over patients in the Research Center for Geriatrics of our hospital from January to December 2017 were collected and analyzed. Based on the presence of 25 most common chronic diseases (including geriatric syndrome), these chronic diseases and characteristic of multimorbidity were investigated. SPSS statistics 24.0 was used for statistical analysis. Intergroup comparison was performed with student′s t test or Chi-sqaure test depending on data type. Logistic regression analysis was adopted to analyze the actual and theoretical prevalence of diseases. Results Among the subjects, 156 (90.70%) of them had 2 or more comorbidities, with a mean number of (6.53±3.69). In the 25 screened chronic diseases, the top 5 with the highest prevalence were hypertension (128 cases, 74.42%), cerebrovascular disease (123 cases, 71.51%), coronary heart disease (91 cases, 52.91%), bone and joint disease (78 cases, 45.35%) and diabetes (70 cases, 40.70%). When 2 comorbidities were combined into a disease pair, the top 5 disease pairs were hypertension/benign prostatic hyperplasia (80 cases, 64.00%), hypertension/cerebrovascular disease (98 cases, 56.98%), cerebrovascular disease/benign prostatic hyperplasia (64 cases, 51.20%), hypertension/coronary heart disease (85 cases, 49.42%), and cerebrovascular disease/bone and joint disease (72 cases, 41.86%). The observed prevalence of specific disease pairs was higher than the expected prevalence, including hypertension/coronary heart disease (OR=2.452,95%CI 1.570-3.831), hypertension/benign prostatic hyperplasia (OR=2.757,95%CI 1.652-4.602), and coronary heart disease/cardiac insufficiency (OR=2.024,95%CI 1.249-3.280) (all P<0.05). Conclusion The incidence of chronic diseases and multimorbidity is quite high in long-lived elderly patients, and these multiple chronic conditions are associated.

Abstract:Objective To investigate the status quo and influencing factors of cognitive function in the disabled elderly in China. Methods Using 2018 China Health and Retirement Longitudinal Study(CHARLS 2018),1044 people aged ≥ 60 years were selected for the study, whose disability was assessed with instrumental activity of daily living (IADL) and cognition with mini-mental state examination (MMSE). SPSS statistics 22.0 was used for data analysis. Depending on the data type, comparison between groups was performed using t-test or analysis of variance. Multiple linear regression model was employed to analyze the influencing factors of the cognitive function in the disabled elderly. Results Cognitive function among the disabled elderly averaged (18.84±6.53) points, with a cognitive impairment of 56.13%. Multivariate regression analysis showed that education level, depression, marital satisfaction, air quality satisfaction and pension insurance were predictive of the cognitive function in the disabled elderly (P＜0.05). Conclusion The cognitive function in the disabled elderly in China is not optimistic. We need to take active measures to prevent cognitive decline in the disabled elderly, promote the realization of healthy aging.

Abstract:Objective To observe the effects of integrated interventions on muscle mass, physical functions, and quality of life in the elderly individuals with possible sarcopenia in a community hospital. Methods A total of 64 elderly individuals with possible sarcopenia were randomly divided into control group (CON group,n=30) and integrated intervention group (INT group, n=34). The CON group received complication management and health education, and the INT group received integrated interventions of medication, exercise and nutrition. After 12 weeks, the effects of intervention were observed on the calf circumference, upper limb grip strength, body composition, physical function and self-assessment of healthy behaviors in the two groups. SPSS statistics 23.0 was used for data analysis. Depending on the data type, t-test, rank-sum test, or χ² test were used for comparison between groups. Results Compared with the same group before intervention and the CON group after intervention, the INT group had lower body fat percentage, higher muscle mass of upper or lower limbs and calf circumferences, stronger grip strength, and shorter timed up and go (TUG) duration, and the differences were statistically significant (P<0.05 ). There was no significant changes in the indexes of CON group before and after intervention (P＞0.05). Conclusion The integrated interventions can improve muscle mass, muscle strength and physical functions of the elderly with possible sarcopenia, thus reducing sarcopenia occurrence and enhancing their quality of life.

Abstract:Objective To compare the influence of roxadustat on hemoglobin and its variability in the patients undergoing hemo-dialysis at different age and to observe the adverse reactions. Methods A retrospective cohort analysis was made of the clinical data of 55 patients with low responsiveness to erythropoietin in maintenance hemodialysis in the Beijing Aerospace General Hospital from July 2019 to October 2020. The patients were divided into two age groups:the elderly group (n=28; age>60 years) and the non-elderly group (n=27; age<60 years). Roxadustat was administered for 6 months according to body mass. No iron was used in either group. Hemoglobin (Hb), serum ferritin (SF) and transferrin saturation, the triglyceride and total cholesterol (TC) were tested before and 6 months after roxadustat administration. The hemoglobin variability (Hb-Var) and the adverse events were recorded. SPSS statistics 25.0 was used for statistical analysis. Comparison between two groups was performed using t-test or χ² test depending on data type. Results Hb before and after the treatment differed significantly in both the elderly group [(100.20±14.26) vs (114.47±7.70) g/L] and the non-elderly group [(96.05±11.45) vs (112.42±14.60) g/L] respectively. Hb-Var was lower in the elderly group [(8.84 ± 4.13) g/L] than in the non-elderly group [(12.47 ± 3.87) g/L] ( P<0.05). SF decreased significantly after 6 months of treatment in the elderly group [(947.0±715.6) vs (694.3±369.9) ng/ml] and in the non-elderly group [(850.9±668.6) vs (640.6±174.4) ng/ml] (P<0.05 for both). After treatment, TC decreased significantly in the elderly group [(3.98±1.01) vs (3.45±0.61) mmol/L] and in the non-elderly group [(3.61±0.66) vs (3.26±0.80) mmol/L] (P<0.05 for both). There were no significant differences in other indexes (P>0.05). The incidence of adverse events was 14.28% (4/28) in the elderly group and 11.11% (3/27) in the non-elderly group, and the difference was not statistically significant (P>0.05). Conclusion Roxadustat can increase Hb in the hemodialysis patients with low responsiveness to recombinant human erythropoietin, the responses to roxadustat in patients at different age are various, especially in non-elderly group. Roxadustat can significantly increase the utilization rate of iron and decrease TC.

Abstract:Objective To explore the influencing factors of cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Enrolled in the study were 175 OSAHS patients (96 severe and 79 mild to moderate) diagnosed by polysomnography in the Sleep Center of Respiratory Department of Nanjing First Hospital from January 2018 to December 2019. According to the Epworth Sleepiness Scale (ESS) score and sleepiness symptoms, the patients were divided into OSAHS patients with excessive daytime sleepiness (EDS) and patients without EDS. The general information was collected, and the Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive impairment of the patients. OSAHS patients with and without EDS were compared in the cognitive impairment scores, and the related factors were analyzed. SPSS statistics 22.0 was used for statistical analysis. Comparison between the two groups was performed using t test or χ²test depending on data type. Correlation analysis was performed using Pearson test. Multivariate regression analysis was used to evaluate the factors related to MoCA and ESS.Results Oxygen desaturation index (ODI), lowest nocturnal oxygen saturation (LSaO₂) and percentage of total sleep time with oxygen saturation <90% (TS90%) were significantly different between severe OSAHS patients with and without EDS (P＜0.05). Oxygen desaturation index (ODI) and TS90% in mild to moderate OSAHS patient with EDS were higher than those without EDS (P＜0.05). Visual spatial executive ability, attention, delayed memory, abstract ability and orientation ability in the severe OSAHS patients were lower than mild to moderate OSAHS patients(P＜0.05). In severe OSAHS patients, MoCA in patients with EDS was lower than that in patients without EDS, and there was significant differences in attention and delayed memory(P＜0.05). MoCA in mild to moderate OSAHS patients with EDS was lower than that of patients without EDS, and difference with statistical significance was only seen with attention(P＜0.05). MoCA was found to be negatively correlated to ESS, AHI, ODI and TS90% but positively to LSaO₂, the differences being statistically significant (r=-0.432, -0.511, -0.539,-0.420、0.458) (P＜0.01 for all). ESS was positively correlated with body mass index, abdominal circumference, waist-to-hip ratio, ODI and TS90%, and negatively with LSaO₂, the differences being statistically significant (r=0.262,0.299,0.460,0.538,0.498, -0.417) (P < 0.05 for all). Multivariate linear regression analysis showed that MoCA was independently correlated with ESS and ODI (R²=0.325,P＜0.05). Conclusion EDS is closely related to cognitive impairment in OSAHS patients. MoCA is lower in severe OSAHS patients or mild to moderate OSAHS patients with EDS than that of patients without EDS, and attention deficit is the most obvious. Therefore, early identification of cognitive impairment early intervention such as CPAP in the OSAHS patients can avoid further deterioration of cognitive function.

Abstract:Objective To investigate the risk factors of non-dipper hypertension in elderly patients with sleep-disordered breathing. Methods A total of 124 elderly inpatients with hypertension associated with sleep-disordered breathing in Clinical Medical College of Yangzhou University from July 2019 to December 2020 were recruited in this study, and then divided into dipper hypertension group (n=61) and non-dipper hypertension group (n=63) according to the rate of blood pressure decrease during day and night. SPSS statistics 23.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison based on different data types. Logistic regression analysis was adopted to analyze the risk factors for non-dipper hypertension. Results As compared with the dipper hypertension group, the non-dipper hypertension group had significantly larger neck circumference and body mass index (BMI), and higher 24-hour mean systolic blood pressure (24h MSBP), nocturnal mean SBP (nMSBP), 24h mean pulse pressure difference (24h MPP), apnea hypopnea index (AHI), times of apnea, oxygen desaturation index (ODI),pulse oxygen decline rate, and carotid intima-media thickness (CIMT, with the left side more obvious than the right one in same group), but remarkably lower lowest oxygen saturation (LSaO₂) at night (P<0.05). The results of logistic regression analysis showed that ODI (OR=1.423,95%CI 1.230-2.566, P<0.001), CIMT (OR=1.965,95%CI1.031-2.752, P<0.001)and pulse oxygen decline rate (OR=1.676,95%CI1.007-2.889, P<0.001) were risk factors for non-dipper hypertension in elderly patients with sleep-disordered breathing. Conclusion Sleep disordered breathing is significantly related to the change of nocturnal blood pressure rhythm. ODI, CIMT and pulse oxygen decline rate are important risk factors for no-dipper hypertension in elderly patients with sleep-disordered breathing. Reducing nocturnal hypertension, djusting non-dipper to dipper circadian rhythm, and improving sleep quality are of great benefit to these patients.

Abstract:Objective To observe the effects of dapagliflozin versus saxagliptin on inflammatory markers and renal function in elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 144 elderly T2DM patients admitted to the Affiliated Hospital of Xuzhou Medical University during September 2018 to November 2020 were prospectively recruited, and then randomly divided into dapagliflozin group and saxagliptin group. Excluding the cases withdrawn from the study or lost to follow-up, 50 patients in the dapagliflozin group and 67 patients in the saxagliptin group were finally included in the statistics. The changes of body mass, blood pressure, blood glucose, inflammatory markers, renal function and adverse events were compared between the two groups. SPSS statistics 23.0 was used for statistical analysis. Data comparison was performed using student′s t test, Mann-Whitney U test, Wilcoxon signed-rank test, Chi-square test, or Fisher exact probability test depending on date types. Spearman nonparametric correlation analysis was adopted to evaluate the relationship of neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), and monocyte/high-density lipoprotein cholesterol ratio (MHR) with renal function. Results After 24 weeks of treatment, more obvious declines of body mass, body mass index, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, 2h postprandial blood glucose, glycosylated hemoglobin A1c, MHR, and C-reactive protein (CRP) level were observed in the dapagliflozin group than the saxagliptin group (P<0.05). The incidence of adverse events was 6.0% (3/50) in the dapagliflozin group, and 4.5% (3/67) in the saxagliptin group, and there was no statistical difference between the two groups (P>0.05). NLR was positively correlated with age, CRP and serum creatinine (SCr) (r=0.229,0.214,0.223, P＜0.05). LMR had negative correlation with age, body mass, CRP and SCr (r=-0.261, -0.202, -0.184, -0.188, P<0.05). There was positive correlation of MHR with age, body mass, CRP, SCr, serum uric acid and Cystatin C (r=0.256,0.305,0.265,0.291,0.204,0.298, P<0.05). Conclusion For the elderly T2DM patients, both dapagliflozin and saxagliptin effectively control the blood glucose, with few adverse events. Dapagliflozin is superior to saxagliptin in body mass loss, decrease of blood pressure, reduction of inflammatory reaction and improvement of renal function.

Abstract:Objective To investigate the clinical effects and safety of high-frequency chest wall oscillation (HFCWO) in the elderly bedridden patients. Methods A retrospective analysis was conducted of 82 elderly bedridden patients admitted to Xijing Hospital of Air Force Medical University from October 2019 to October 2020. According to intervention, the patients were divided into HFCWO group (n=39) and CPT group (n=43). Comparisons were made between the pre- and post-intervention breathlessness, cough and sputum scale (BCSS), 24h sputum volume, pulmonary ventilation function and incidence of pulmonary infection (PI). The two groups were observed in heart rate (HR), systolic blood pressure (SBP), respiratory rate (RR) and pulse oxygen saturation (SPO₂) 10 min before, during, and 10 min after the initial HFCWO treatment. SPSS statistics 23.0 was used for data analysis. Depending on data type, t-test, χ²test, rank-sum test were performed for comparison between the two groups. Results The HFCWO group received 1 118 times of HFCWO treatment, of which 1 003 (89.7%) times were well tolerated and 64 (5.7%) times were not. There were no significant differences in HR, SBP, RR and SPO₂ 10 min before, during, 10 min after the HFCWO treatment (P>0.05 for all). After treatment, BCSS of the HFCWO group were significantly lower than those of the CPT group [3.0 (2.0,3.0) vs 4.0 (3.0,5.0), P<0.001]. The sputum volume also decreased significantly on the fifth and seventh day [(28.9±3.9)vs(33.2±3.3)ml, (19.9±3.4) vs (27.2.9±3.3) ml; P<0.001]. Compared with the CPT group, pulmonary ventilation function in HFCWO group was significantly improved with forced vital capacity (FVC) [(2.150±0.134) vs (2.067±0.185) L, P=0.021] and forced expiratory volume in 1 second (FEV1) [(1.404±0.063) vs (1.348±0.105) L, P=0.004]. There was no significant difference in the PI rate between the two groups (P>0.05). Conclusion HFCWO is safe and well tolerated in elderly bedridden patients, and it can significantly improve dyspnea, cough and sputum, promote the discharge of bronchial secretions and improve the pulmonary ventilation, and to a certain extent, reduce the pulmonary infection.

Abstract:Objective To explore the correlation of frailty and cognitive function with fear of falling in the elderly inpatients with type 2 diabetes mellitus (T2DM). Methods A total of 199 elderly T2DM patients in the Department of Endocrinology and Geriatrics of First Affiliated Hospital of Dalian Medical University were selected for the study. A self-designed general data questionnaire, the FRAIL screening questionnaire, the modified fall efficacy scale (MFES) and the mini-mental state examination(MMSE)were used for investigation. SPSS statistics 22.0 was used for data analysis, descriptive analysis for general data, and Pearson analysis for correlation analysis. Results The score of modified fall efficacy scale (MFES) was (7.37±1.39)points, and the incidence of fear of falling was 64.32% (128/199). The mini-mental state examination (MMSE) score was (22.71±5.10)points, and the overall incidence of cognitive impairment (mild, moderate and severe) was 72.86% (145/199). FRAIL score was (2.23±0.11) points, and the incidence of frail was 36.18% (72/199). Pearson correlation analysis showed that fear of falling had significant positive correlation with frailty (r=0.570, P<0.01), and significant negative correlation with cognitive function (r=-0.706, P<0.01). Conclusion The incidence of fear of falling, cognitive impairment and frailty was higher in the elderly T2DM patients, and there is a significant correlation between fear of falling and cognitive function and frailty, suggesting that clinical staff should strengthen the early screening of frailty and cognitive function in T2DM patients to provide theoretical basis for reducing fear of falling.

Abstract:Objective To explore the mechanism of vasohibin 2 (VASH2) on angiogenesis of glioma by regulating the proliferation, migration and tube formation of glioma microvascular endothelial cells. Methods After cell model of human glioma microvascular endothelial cells (GECs) was obtained, VASH2 overexpression and silencing cell lines were established by stable transfection. In the follow-up experiment, they were divided into control group, VASH2 overexpression negative control empty plasmid[VASH2(+)NC] group, VASH2 overexpression [ VASH2(+) ]group, VASH2 expression silencing negative control empty plasmid [VASH2 (-) NC ]group and VASH2 expression silencing [VASH2(-)] group. Cell counting kit-8 (CCK-8) assay was used to detect cell proliferation, tube formation assay was employed to observe the changes of cell tube formation, and transwell assay was adopted to measure cell migration ability. GraphPad Prism v5.01 statistical software was used for data analysis. One-way ANOVA was employed for comparison between multiple groups and Newman-Keuls analysis was used for pairwise comparison between groups.Results When the expression of VASH2 was up-regulated in GECs, there was significant difference between VASH2(+) group and VASH2(+)NC group (P<0.05). The cell proliferation ability, migration ability and tube formation ability were significantly enhanced. It showed that VASH2 overexpression can promote the angiogenesis of glioma. When the expression of VASH2 was down-regulated, there was significant difference between VASH2(-) group and VASH2 (-) NC group (P<0.05). The proliferation ability, migration ability and tube formation ability of cells were significantly weakened, indicating that VASH2 silencing can inhibit the angiogenesis of glioma. Conclusion VASH2 plays an important role in the regulation of glioma angiogenesis. VASH2 may be considered as a potential target in the therapy for glioma in the future.

Abstract:A 72-year-old atypical-multiple-myeloma patient, who visited the hospital for long-term persistent back pain and multiple fractures was reported. The patient had undergone treatment in several hospitals for back pain, with about 17 months of disease course. Several CT, MRI, and laboratory tests had been performed. The results showed that there was multiple bone destruction, and severe osteoporosis was considered. Lumbar 2nd/4th vertebral-body-fracture balloon kyphoplasty and lumbar 2nd vertebral-body biopsy were performed to treat the patient′s lumbar vertebral compression fractures. No tumor cells were found by the pathology examination. The patient was hospitalized in the Second Medical Center of Chinese PLA General Hospital for the persistently-aggravated back pain. According to the comprehensive evaluation, the patient had severe emaciation (cachexia state), anorexia, bedridden state, multiple pain, inability to stand and walk, anemia, hypercalcemia, multiple bone destruction, and no M-proteinemia. The results were considered as multiple myeloma, tumor′s bone metastasis (such as lung cancer, prostate cancer, carcinoid, etc.), histiocytosis X and severe osteoporosis. However, no tumor cells (including notable diagnostically-significant abnormal-plasma-cell proliferation) were found in both the trans-iliac puncture & biopsy and PET/CT-based rib-damaged-site CT-guided puncture & biopsy. Finally, multiple myeloma was definitely diagnosed by trans-sternal puncture. The patient then received the 6-consecutive-course of bortezomib combined with dexamethasone (PD or BD regimen) and 2-course of bortezomib and dexamethasone combined with doxorubicin liposome (PAD regimen). Furthermore, a therapeutic evaluation was performed every two courses. It showed the disease had got partially remitted (VGPR). Currently, the patient recovers to the self-care state before the illness.

Abstract:Cardiac aging and cardiac senescence-associated cardiovascular diseases continue to be a serious problem that increases the social burden. Revealing the molecular mechanisms of cardiac aging and cardiac senescence-associated cardiovascular diseases provides a new opinion for the early diagnosis and treatment of delaying aging and diseases. A microRNA (miRNA) is a small single-stranded non-coding RNA molecule that has been found to be involved in the regulation of gene expression at the post-transcriptional level. This paper focuses on the structure and function of miRNA, and its regulatory effects on the characteristics and molecular mechanisms of aging hearts and on age-related cardiovascular diseases.

Abstract:Frailty, a common geriatric syndrome, is a serious problem in healthy aging. However, its pathogenesis remains unclear. It is a general agreement that frailty is caused by multiple factors, in which immune dysfunction and chronic inflammation play an important role. Because gut microbiota is associated with immune function and chronic inflammation, the correlation between gut microbiota and frailty has drawn increasing attention in recent years. This article mainly introduced the progress in the research of gut microbiota in the frail elderly, providing the reference for the pathogenesis of frailty.

Abstract:circRNA is a new type of non-coding RNA. Due to its stable circular structure in various organisms and its involvement in metabolic regulation of organisms, circRNA is involved in the occurrence and development of a variety of diseases and is closely related to a variety of respiratory diseases. Chronic obstructive pulmonary disease (COPD) is a complex respiratory disease associated with gene and environment. Some studies have found that circRNAs play an important role in the pathogenesis of COPD and may become a diagnostic marker or a new therapeutic intervention target for COPD. The correlation between circRNAs and the pathogenesis mechanism of chronic obstructive pulmonary disease is reviewed to summarize the biological role of circRNAs in chronic obstructive pulmonary disease.

Abstract:Vestibular migraine (VM) is a disabling disease characterized by recurrent vestibular symptoms and often accompanied by migraine. The pathogenesis of VM is not completely clear. Most studies believe that it is related to ion channel defects, cortical spreading depression, inflammation and genetic susceptibility. Clinical examinations such as cranial magnetic resonance, audiology and vestibular function examination have no specificity for the diagnosis of VM, but they are helpful to exclude other diagnoses. According to type of its attack, VM is commonly given acute treatment and preventive treatment. Clinically, individualized treatment should be carried out based on patient′s actual condition. This paper reviews the pathogenesis, clinical characteristics, auxiliary examination, diagnosis and treatment of VM in order to help clinicians further understand VM.