Abstract:Objective To investigate the correlation between low triiodothyronine syndrome (LT3S) and degree of coronary artery lesions in the patients with acute coronary syndrome (ACS). Methods A retrospective study was made on clinical data of 204 ACS patients in Eastern Theater General Hospital of Chinese People′s Liberation Army from August 2018 to December 2019. After excluding those with hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, and subclinical hypothyroidism based on thyroid function, the remaining 189 patients were divided into normal thyroid function group (control group, n=153) and LT3S group (n=36). SPSS 25.0 was used for data analysis. Depending on the data type, t-test, rank sum test or χ² test was used for comparison between groups. Spearman correlation analysis was used to determine the correlation between free triiodothyronine (FT3) and Gensini score, number of stents and B-type natriuretic peptide. Unconditional logistic regression analysis was employed to analyze the correlation between FT3 and severe coronary artery lesions, and the receiver operating characteristic (ROC) curve was drawn to determine the value of FT3 in predicting the degree of coronary lesions. Results Gensini score, number of stents and proportion of main lesions≥50% in the LT3S group were significantly higher than those in control group (P<0.05 for all). FT3 and a history of diabetes mellitus were independent risk factors for severe coronary stenosis in ACS patients (P<0.01). Area under the ROC curves of FT3 in predicting severe coronary stenosis was 0.697, with a best truncation value of 4.195 pmol/L, a sensitivity of 69.8%, and a specificity of 70.0%. Conclusion LT3S is closely associated with the degree of coronary artery lesions in ACS patients, and FT3 can be used as an independent index to predict the degree of coronary artery lesions in them.

Abstract:Objective To explore the effect of thrombelastography (TEG) guided dual antiplatelet therapy (DAPT) on clinical prognosis of in-stent restenosis (ISR) patients after percutaneous coronary intervention (PCI). Methods A total of 275 patients diagnosed with ISR after PCI by coronary angiography (CAG) who were admitted to the Department of Cardiology, First Medical Center of Chinese PLA General Hospital from January 2017 to January 2020 were recruited in this study. All of them received TEG examination, and according to adenosine diphosphate pathway-induced platelet inhibition rate (ADP inhibition rate) and maximum amplitude of ADP (MA-ADP), the patients were divided into control group (n=184), clopidogrel group (n=57) and ticagrelor group (n=34), being given aspirin combined with clopidogrel or ticagrelor for treatment. All of the patients were followed up every 6 months after discharge, and their long-term prognosis were compared among the 3 groups. SPSS 25.0 software was used for statistical analysis. Logistic regression analysis was employed to screen the risk factors for the prognosis of ISR patients. Results The follow-up time was 15-52 [26 (18,34)] months. The control group exhibited significantly higher ADP inhibition rate than the clopidogrel group and ticagrelor group [(85.64±13.57)% vs (37.60±8.19)% and (22.74±9.76)%; P<0.05). The MA-ADP was significantly higher in the ticagrelor group than the control group and the clopidogrel group [(52.16±4.82) vs (17.01±9.08)and (38.69±4.68)mm; P<0.05]. In the ticagrelor group, the ADP inhibition rate was increased from (22.74±9.76)% to (81.04±15.01)%, and the MA-ADP was decreased from (52.16±4.82) to (17.06±9.26) mm after drug change (P<0.05). The incidence of major adverse cardiovascular events (MACE) and all-cause mortality were significantly higher in the clopidogrel group than the other 2 groups (P<0.05). ADP inhibition rate was a protective factor for re-admission, coronary angiography, re-PCI and cardiovascular death and MACE in patients with ISR after treatment. With the increase of ADP inhibition rate, the MACE rate was decreased obviously (OR=0.56, 95%CI 0.42-0.76; P<0.001). Conclusion The ADP inhibition rate is a protective factor for MACE after ISR treatment. TEG-guided effective DAPT treatment can significantly reduce the incidence rate of MACE and improve the prognosis in ISR patients.

Abstract:Objective To analyze the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) and intracranial arterial atherosclerotic plaques in order to investigate whether Lp-PLA2 can be a clinical marker for predicting the properties of the plaques for the elderly with stroke. Methods A total of 184 elderly patients with ischemic stroke diagnosed in our hospital from January 2017 to December 2019 were enrolled in this study. According to the results of head and neck CT angiography (CTA), 102 of them with moderate or severe middle cerebral artery or basilar artery stenosis (≥50%) were assigned into the experimental group, and the other 82 with normal CTA results into the control group. High-resolution MRI (HRMRI) examination was performed for the patients from the experimental group, and then they were divided into unstable plaque subgroup (n=52) and stable plaque group (n=50). Based on whether the target blood vessel of the plaque source was a responsible blood vessel for neurological symptoms, they were also assigned into responsible vascular subgroup (n=48) and non-responsible vascular subgroup (n=54). The general clinical data of all patients were collected, and the serum Lp-PLA2 level was measured by enzyme-linked immunosorbent assay (ELISA). SPSS statistics 20.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test or χ² test depending on data type. Results The Lp-PLA2 level was significantly higher in the experimental group than the control group [(198.1±59.85) vs (130.22±59.35) ng/ml, P<0.05], and in the unstable plaque subgroup than the stable plaque subgroup [(227.32±45.89) vs (172.29±47.97) ng/ml, P<0.05]. But there was no statistical difference in the level between the responsible vascular subgroup and non-responsible vascular subgroup [(208.27±36.58) vs (211.54±57.18) ng/ml, P>0.05]. In the patients from the responsible vascular subgroup, no obvious difference was seen in the level between those with stable and those with unstable plaques [(210.92±54.01) vs (212.67±91.06) ng/ml, P>0.05]. Similar result was observed in the patients with stable and those with unstable plaques from the non-responsible vascular subgroup [(207.58±65.23) vs (209.36±50.36) ng/ml, P>0.05]. Conclusion Based on the characteristics of intracranial atherosclerotic plaques identified by HRMRI, serum Lp-PLA2 level is closely associated with the stability and vulnerability of the plaques, and may be regarded as an important marker in assessment of the stability and vulnerability of plaques in the future.

Abstract:Objective To investigate the risk factors for postoperative hypothermia in patients after transurethral resection of the prostate (TURP). Methods A total of 1 193 patients who underwent TURP in our hospital from January 2008 to January 2021 were retrospectively recruited based on the clinical data from the medical database. According to the occurrence of postoperative hypothermia or not, they were divided into hypothermia group (group H, n=83) and normal group (group N, n=1110). Age, height, body mass, body mass index, preoperative and postoperative hemoglobin level, operation duration, anesthesia method, anesthesia duration, and infused volumes of crystalloid, colloidal fluid and irrigation fluid were compared between the 2 groups. SPSS statistics 22.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test, χ² test or rank sum test depending on data type. Logistic regression analysis was used to study the risk factors of postoperative hypothermia. Results There were significant differences in age, anesthesia method and anesthesia duration between the 2 groups (all P<0.05), but no statistical differences were seen in other indicators (all P>0.05). Logistic regression analysis found that older age (OR=1.041,95%CI 1.009-1.074) and epidural nerve block (OR=2.829,95%CI1.594-5.023) were risk factors for postoperative hypothermia in TURP patients (all P<0.05). Conclusion Analysis on the large samples from medical database indicates that the risk factors for postoperative hypothermia are older age and epidural nerve block in TURP patients.

Abstract:Objective To investigate the values of mycobacterium tuberculosis/rifampicin resistance gene(Xpert MTB/RIF) detection, T cell spot test ( T-SPOT.TB) and adenosine deaminase (ADA) assay in detection of pleural fluid in the diagnosis of pleural tuberculosis. Methods A total of 167 patients with pleural fluid admitted to Department of Infective Diseases of Beijing Geriatric Hospital from January 2009 to April 2021 were recruited in this study, and 114 of them were diagnosed with tuberculous pleurisy (TBP group) and 53 cases were not (non-TBP group). Every patient was tested with Xpert MTB/RIF detection, T-SPOT.TB and ADA assays in pleural effusion. 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 The highest sensitivity was observed in ADA assay (73.68%), followed by Xpert MTB/RIF assay (37.72%) and then Roche culture (23.68%), with statistical differences among them (χ²=29.880,5.277; P<0.05). There was no significant difference in the sensitivity between T-SPOT.TB (81.58%) and ADA assays (73.68%,χ²=2.046; P＞0.05).The specificity was significantly higher in Xpert MTB/RIF assay (100.00%) and Roche culture (100.00%) than T-SPOT.TB assay (81.13%, χ²=11.042,11.042; P＜0.05),and also higher than that of ADA assay (71.70%, χ²=17.473,17.473; P＜0.05). But there was no significant difference in the specificity between T-SPOT .TB (81.13%) and ADA assays (71.70%, χ²=1.309; P＞0.05). When the three methods were connected in series, the detection sensitivity of T-SPOT.TB and ADA assays was obviously higher than that of Xpert MTB/RIF and ADA assays (60.53% vs 35.96%, χ²=20.081, P＜0.001). In parallel connection, the sensitivity of T-SPOT.TB or ADA assays (94.74%) was notably higher than that of ADA assay alone (73.68%) or T-SPOT.TB assay alone (81.58%, χ²=19.000,9.453; P<0.05). No statistical differences were seen in the sensitivity of T-SPOT.TB or ADA or Xpert MTB/RIF (96.49%) with sensitivity of T-SPOT.TB or ADA (94.74%,χ²=0.418, P＞0.05). There was no significant difference in specificity between the two or three tests in series (P＞0.05).In parallel connection, T-SPOT.TB or ADA(62.26%) and T-SPOT TB or ADA or Xpert MTB/RIF had the same specificity (62.26%), which were lower than that of Xpert MTB/RIF or T-SPOT TB (81.13%), and the difference was statistically significant(χ²=4.649,4.649; P＜0.05); and there was no significant difference in other groups in pairwise comparison of specificity (P＞0.05). Conclusion T-SPOT.TB and ADA assays for pleural fluid patients obtain higher sensitivity and specificity in the diagnosis of tuberculous pleurisy, while Xpert MTB/RIF has lower diagnostic value. Combined detection of pleural fluid with T-SPOT.TB and ADA assay can improve the sensitivity and better reduce the missed diagnosis rate of tuberculous pleurisy.

Abstract:Objective To investigate the predictive value of heparin binding protein (HBP) for acute kidney injury (AKI) in sepsis patients. Methods A retrospective analysis was carried out on 70 sepsis patients admitted to the emergency department of the Third Hospital of Shanxi Medical University from May 2020 to May 2021. According to being complicated with AKI on admission or not, they were divided into AKI group (n=41) and non-AKI group (n=29). HBP level and other clinical data were compared between the 2 groups. SPSS statistics 19.0 was used for statistical analysis. Data comparison between 2 groups was carried out using student′s t test, rank sum test or Chi-square test depending on different data types. Spearman correlation analysis was employed to analyze the correlation between HBP and other clinical data. Logistic regression analysis was adopted to analyze the risk factors for AKI in sepsis patients, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive values of the risk factors. Results Significant differences were observed between the AKI group and non-AKI group in HBP [176.24 (100.77,255.92) vs 44.02 (23.15,100.92) ng/ml], serum creatinine (SCR) [204.50 (137.10,363.35) vs 92.30 (70.70,109.25) μmol/L], acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score [(25.22±8.17) vs (17.45±5.05) points], sequential organ failure assessment (SOFA) score [(14.63±3.75) vs (7.48±3.80) points] and procalcitonin [PCT, 26.00 (14.39,71.03) vs 3.73 (0.63,11.99) ng/L] (all P<0.05). HBP was positively correlated with SCR, APACHE Ⅱ score, SOFA score and PCT (r=0.538,0.341,0.566,0.444; all P＜0.05), and negative correlated with estimated glomerular filtration rate (eGFR, r=-0.546, P<0.001). Logistic regression analysis showed that both HBP (OR=1.024,95%CI 1.012-1.036) and SOFA score (OR=1.581,95%CI 1.294-1.932) were risk factors for AKI in sepsis patients (P<0.05). ROC analysis indicated that HBP had predictive value for AKI in sepsis patients, with a cut-off value of 79.895, a sensitivity of 92.7%, and a specificity of 72.4%. Conclusion HBP can be regarded as an effective predictor of AKI in patients with sepsis.

Abstract:Objective To observe the correlation between the dosimetric constraints for pelvic bone marrow (PBM) and the occurrence of acute myelosuppression in elderly patients with cervical cancer undergoing pelvic volumetric modulated arc therapy (VMAT), and to provide reference for clinical determination of the dose/volume parameter standards of PBM sparing. Methods A retrospective analysis was performed on 76 elderly patients with cervical cancer who were treated in Qingdao Central Hospital from January 2016 to January 2020. They were classified into stage IB to IVA with International Federation of Gynecology and Obstetrics (FIGO) staging system and all received VMAT treatment. According to whether PBM sparing was performed (pelvic bone dose/volume parameters V20≤70%, V30≤50%, Vx refers to the volume of the pelvis receiving a dose ≥ xGy), they were divided into PBM sparing group (nn=35) and non-PBM sparing group (n=41). SPSS statistics 22.0 was used for data analysis. Student′s t test, rank sum test or Chi-square test was used for comparison between groups depending on the data type. Results The incidence of myelosuppression with leukopenia≥grade 2 was significantly lower in the PBM sparing group (68.6%, 24/35) than the non-PBM sparing group (87.8%, 36/41, P=0.042). So was the incidence of neutropenia≥grade 2 in the 2 groups [45.7% (16/35) vs 70.7% (29/41), P=0.028]. There were no statistical differences in the conformity index (0.835±0.059 vs 0.854±0.072) and homogeneity index (0.090±0.005 vs 0.086±0.005) between the 2 groups (P>0.05). Conclusion PBM dosimetric constraints with V20≤70% and V30≤50% can significantly reduce the incidence of myelosuppression≥grade 2 in elderly patients with cervical cancer, and show no effect on the target volume dose conformity and homogeneity. V20≤70% and V30≤50% can be used as the dose/volume standards of PBM dosimetric constraints.

Abstract:Objective To investigate the effects of recombinant human brain natriuretic peptide (rhBNP) combined with sacubitril valsartan sodium tablets on ventricular remodeling and cardiac function of patients with acute myocardial infarction and heart failure. Methods A total of 60 patients with acute ST-segment elevation myocardial infarction complicated with heart failure admitted to our department from May 2019 to May 2021 were prospectively recruited in the clinical trial. They were randomly divided into control and observation groups, with 30 patients in each group. The control group was treated with rhBNP alone. The observation group was treated with rhBNP+sacubitril valsartan sodium tablets. Other anti-heart failure measures were the same in the 2 groups. After 1 month of treatment, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-proBNP) level, and 6-minute walking distance (6MWD) were compared between the 2 groups. SPSS statistics 19.0 was used for statistical analysis. Data comparison between 2 groups was conducted using student′s t test, rank sum test or Chi-square test depending on data types. Results After 1 month of treatment, LVEDD and LVESD were decreased and LVEF was increased in both groups when compared with those before treatment (P<0.05). The levels of LVEDD [(42.25±4.28)vs (48.61±4.47) mm] and LVESD[(38.60±4.06) vs (44.20±4.15)mm] were significantly lower, and that of LVEF [(49.25±4.19)% vs (44.38±3.87)%] was obviously higher in the observation group than the control group (all P<0.05). The treatments also resulted in statistically lower NT-proBNP level [(353.15±66.23) vs (389.46±54.21) pg/ml] and longer 6MWD [(441.17±32.18) vs (334.76±31.16) m] in the observation group than the control group (both P<0.05). Conclusion RhBNP combined with sacubitril valsartan sodium tablets can effectively improve the cardiac function and reversal of ventricular remodeling of acute myocardial infarction patients complicated with heart failure.

Abstract:Objective To investigate the effect of compound diisopropylamine dichloroacetate combined with ornithine aspartate in the treatment of non-alcoholic steatohepatitis (NASH) in the elderly. Methods A total of 95 elderly patients with NASH hospitalized in Sichuan Forestry Central Hospital from January 2019 to December 2019 were prospectively recruited and then randomly divided into control group and observation group, with 46 cases in each group. The control group was treated with atorvastatin, and the observation group was treated with compound diisopropylamine dichloroacetate combined with ornithine aspartate on the basis of atorvastatin. The indicators of liver function, blood lipid, ultrasonic imaging score, NASH activity score (NAS), inflammatory factors and adverse reactions were compared between the 2 groups. SPSS statistics 26.0 was used for data analysis. According to the data types, independent sample t test or Chi-square test was employed for intergroup comparison. Results After treatment, the observation group had significantly lower indicators in liver function, including alanine aminotransferase [(53.29±6.84) vs (65.73±7.25) U/L], aspartate aminotransferase [(34.61±4.27) vs (45.73±5.12) U/L] and γ-glutamyltransferase [(41.25±3.59) vs (64.74±5.52) U/L] (all P<0.05), decreased blood lipid indicators, such as total cholesterol [(4.12±0.64) vs (4.87±0.66) mmol/L], triglyceride [(1.42±0.31) vs (1.63±0.42) mmol/L] and low-density lipoprotein cholesterol [(2.27±0.61) vs (3.04±0.59) mmol/L] (all P<0.05), reduced ultrasound imaging score [(6.18±1.34)vs (7.25±1.46)] and NAS score [(3.27±0.54) vs (3.85±0.73)](both P<0.05), and lower inflammatory factors, that is, serum interleukin-6 [(109.43±11.87) vs (129.75±10.96) μg/L], tumor necrosis factor-α [(51.26±6.05)vs (63.18±6.72) μg/L) and transforming growth factor-β [(6.03±1.92) vs (8.45±2.21) μg/L) (all P<0.05) when compared with the control group. There was no significant difference in the incidence of adverse reactions between the 2 groups (P>0.05). Conclusion Compound diisopropylamine dichloroacetate combined with ornithine aspartate shows effective efficacy in the adjuvant treatment of NASH in the elderly, and has a certain clinical value in clinical practice.

Abstract:Objective To evaluate the predictive value of serum uric acid level for vascular dementia. Methods A total of 47 patients with vascular dementia treated in our health service center from June 2020 to May 2021 were enrolled in this retrospective study and assigned into the observation group, and another 46 healthy volunteers subjected during the same period served as control group. The severity of dementia was assessed with the clinical dementia rating (CDR) scale. SPSS statistics 24.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison depending on different data types. Binary logistic regression analysis was adopted to analyze the risk factors of vascular dementia, and Spearman correlation analysis was performed to analyze the correlation of serum uric acid level and CDR score. Receiver operating characteristic (ROC) curve was drawn to assess the predictive value of the serum uric acid level for vascular dementia. Results The serum uric acid level was significantly higher in the observation group than the control group [(314.03±118.49) vs (228.20±65.24)mmol/L; P<0.01]. Serum uric acid level was positively correlated with CDR score (r=0.797, P<0.01). Serum uric acid level (OR=1.025, P=0.000,95%CI 1.014-1.036) and carotid intima media thickness (OR=0.055, P=0.003,95%CI 0.008-0.369) were risk factors for vascular dementia. ROC curve analysis revealed that the serum uric acid level (cut-off value=284.52 mmol/L, sensitivity=53.29%, specificity=91.31%) was a predictor of vascular dementia with an area under the curve of 0.768. Conclusion Serum uric acid level can be used as a predicative indicator for vascular dementia, and is positively correlated with its severity.

Abstract:Objective To investigate the effect of aquatic exercise combined with Chinese medicine internal treatment on apoptosis of aortic cells in diabetic atherosclerosis rats and the possible mechanism. Methods A total of 125 male SD rats were randomly divided into blank group, model group, aquatic exercise (AE) group, Chinese medicine internal treatment (CMIT) group, aquatic exercise with Chinese medicine internal treatment(AE+CMIT,) group. Except the blank group, the diabetic atherosclerosis model was established in the other groups with the injection of streptozotocin and high-fat feeding. The successfully modeled rats were given 2 ml normal saline or 2 ml Chinese medicine solution respectively. Besides, AE group and AE+CMIT group performed aquatic exercise six times a week. After eight weeks of treatment, blood glucose, blood lipids, inflammatory factors, glucose-regulated protein 78 (GRP78) and CCAAT/enhance-binding protein homologous protein(CHOP) mRNA expression levels and the apoptosis index of arterial cells were measured. SPSS statistics 19.0 was used for data analysis. One-way ANOVA was used for comparison between multiple groups, while LSD-t test was used for comparison between two groups. Results Compared with blank group,triglycerides (TG), low-density lipoprotein cholesterol (LDL-C),glycosylated hemoglobin (GHb), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), GRP78 mRNA, CHOP mRNA, and cell apoptotic index(CAI) in other groups increased, and high-density lipoprotein cholesterol (HDL-C) decreased, the differences being statistically significant (P ＜0.01). Compared with the model group,TG,LDL-C,GHb, IL-6, TNF-α, CRP, GRP78 mRNA, CHOP mRNA, CAI in treatment groups decreased,and HDL-C increased, the differences being statistically significant (P ＜0.05). Compared with the AE group, TG, LDL-C, GHb, IL-6, TNF-α, CRP, GRP78 mRNA, CHOP mRNA, and CAI in the AE+CMIT group decreased,and HDL-C increased, the differences being statistically significant (P ＜0.05). Conclusion Both aquatic exercise and Chinese medicine internal treatment can regulate metabolism disorder of blood glucose and blood lipid and inflammatory response, inhibit endoplasmic reticulum stress of arterial cells, reduce the level of apoptosis of arterial cells, and they provide a synergistic effect to each other.

Abstract:Conventional coronary angiography is unable to assess coronary artery lesions precisely in patients with coronary heart disease. Fractional flow reserve (FFR) is a “golden standard” for the diagnosis of coronary ischemic lesions. However, use of pressure guide wire and vasodilator will increase the risk for invasive operation, operation time and medical costs, which limits the application of FFR in clinical practice. In recent years, several noninvasive FFR techniques are developed based on fluid dynamics, which measure FFR with coronary CT or coronary angiography images, and avoid the need for wire manipulation and hyperaemic stimulus. And these techniques also show good diagnostic efficacy in clinical trials. This article reviews these noninvasive FFR techniques.

Abstract:NK2 homeobox 5 (NKx2.5) is an earliest transcription factor related to the development and maturation of the heart, which may affect the abnormal development of the embryonic heart, and ultimately lead to the abnormal cardiac structure and conduction function, or even death. In this article, we review the biological characteristics of NKx2.5 and its mechanism of action in cardiac development, and introduce the newly discovered mutations in patients in recent years. The gene acts synergistically with other transcription factors during heart development to promote the development of precursor cardiomyocytes. Early detection of the gene will help to screen hereditary congenital heart disease and prevent sudden cardiac death caused by bradycardia or tachycardia.

Abstract:Normal people have periodic circadian rhythms of sleep-wake, and changes in circadian rhythms will cause sleep loss or disturbance. Immune dysfunction can also lead to abnormal changes in cytokine levels, leading to insomnia. Physical therapy is gradually accepted by the population because of its good adaptability. In this article, we summarize the regulating effects of various physiotherapies on the cytokines so as to provide new ideas and methods for the related treatment of insomnia disorder.

Abstract:Chronic kidney disease (CKD) is an important health problem in the elderly, whose prognosis is affected by multiple factors. Frailty is an important geriatric syndrome prevalent in patients with CKD. Frailty is associated with an increased risk for all-cause death and cardiovascular disease, acute kidney injury and CKD progression. Frailty is a significant predictor of adverse health outcomes, and its early detection and timely interventions are of great significance in improving the prognosis of the elderly CKD patients.

Abstract:Triglyceride glucose index has been proposed as a simple and sensitive alternative indicator of insulin resistance, and some studies have shown that it is positively correlated with the risk of cardiovascular disease, which has potential ability for early screening, risk stratification and prognosis judgment of patients with cardiovascular disease. Therefore, this article reviewed the clinical application value of triglyceride glucose index in cardiovascular diseases and the latest research progress.