Abstract:Objective To optimize the interventional treatment of coronary in-stent restenosis (ISR) by three-step algorithm with the precise guidance of optical coherence tomography (OCT). Methods This retrospective study was conducted in 32 ISR patients in the First Medical Center of Chinese PLA General Hospital from February 2019 to February 2021. A retrospective analysis was made of the clinical baseline data, surgical data, OCT data and follow-up outcomes. SPSS 13.0 was used for statistical analysis. Data comparison between groups was performed using t-test or χ² test depending on data type. Results The average age of 32 patients (30 males, 2 female) was (59.8±11.1) years. The mean left ventricular ejection fraction of all patients was (58.3±7.6)%. Percutaneous coronary intervention (PCI) targeted 27 left anterior descending arteries, 4 left circumflex arteries, and 5 right coronary arteries. According to Mehran′s classification, 13 was of pattern I, 9 of pattern Ⅱ, 10 of pattern Ⅲ, and 4 of pattern Ⅳ. The success rate of OCT-guided "three-step method" for ISR was 100.0% (32/32). OCT showed that the preoperative minimum lumen was (1.9±0.8) mm² with an area stenosis rate of (67.0±11.0)%, and the postoperative minimum lumen area was (5.0±1.3) mm² with an area stenosis rate of (24.0±10.5)%. Intraoperative DCB was used in 25 cases, DES in 10 cases, and ordinary balloon dilation in 1 case. No postoperative complications, postoperative cardiovascular adverse events, myocardial infarction and death occurred during the postoperative hospitalization. Among the 32 patients, 5(15.6%) developed angina within 6 months, including 1(3.1%) revascularization. One patient (3.1%) died of non-cardiac causes. Conclusion The three-step OCT guided interventional therapy for in-stent restenosis is safe and effective.

Abstract:Objective To investigate the relationship of frail status with readmission and death in senile patients with primary osteoporosis. Methods A prospective cohort study was conducted to include 227 osteoporosis patients (≥65 years old) admitted to the General Department of Fuxing Hospital from January 2017 to December 2019. According to the results of Clinical Frailty Scale (CFS-09) after admission, they were divided into frailty group (CFS ≥5) and non-frailty group (CFS <5). General data, such as gender, age, medical history and oral medication were collected, and comprehensive geriatric assessments, including Mini-Mental State Examination and Mini-Nutritional Assessment-Short Form were performed for their cognitive function and nutritional risk. After discharge, all patients were followed up for 1-3 (1.8±0.7) years, and their readmission and death were recorded. SPSS statistics 23.0 was used for statistical analysis. Data comparison between 2 groups was performed using student′s t test, Wilcoxon test or Chi-square test depending on data types. Cox regression analysis was used to investigate the relationship of frailty with readmission as well as death. Results The subjected patients were at a mean age of 67-100 (85.1±5.0) years, with a frailty prevalence of 53.3% (121 cases). The frailty group had older age (P<0.001), higher Charlson comorbidity index (CCI) (P<0.001), more types of oral medications (P=0.004), larger number and types of potentially inappropriate medication (PIM) (P=0.004,0.001), and larger proportions of nutritional risk (P<0.001), cognitive dysfunction (P<0.001) and impaired activities daily living (P<0.001) when compared with the non-frailty weak group. Cox regression analysis showed that after adjusting for age, comorbidity and PIM, frail state (CFS≥5) had no significant effects on death and re-hospitalization. When the patients were further assigned into moderate or above frailty subgroup (CFS≥6) and mild or non-frailty group (CFS<6), moderate or above frailty state (CFS≥6) significantly increased the risk of all-cause death (HR =3.260,95%CI 1.626-6.538, P=0.001) and readmission (HR =1.727,95%CI 1.213-2.458, P=0.002) after adjustment for age, comorbidity and PIM. Conclusion Moderate or above frailty as defined by CFS-09 (CFS≥6) increases the risk of death and readmission in elderly patients with primary osteoporosis. Clinicians should pay attention to the frailty assessment of osteoporosis patients and take intervention measures as early as possible to reduce the risk of death and readmission.

Abstract:Objective To study the status quo of frailty and disability and to explore their correlation in the community-dwelling elderly. Methods A total of 664 elderly people aged 80 years and above living in a community in Beijing from November 2018 to November 2019 were selected. A structured questionnaire, Fried frailty phenotype and Katz ADL were used to investigate and evaluate the respondents. SPSS 22.0 was used for data analysis. Depending on the data type, t-test or Chi square test was used for comparison between groups. Spearman correlation analysis was performed to test the correlation between frailty and disability. Results Among 664 elderly people in the community, there were 636 cases of valid result of frailty assessment, and 655 cases of valid result of disability assessment. The incidences of frailty and disability among the elderly were 17.1% (109/636) and 42.4% (278/655). The incidence of frailty was higher in groups of more advanced age, coronary heart disease and type 2 diabetes mellitus (P<0.05). The incidence of disability was higher in females, patients with low education and coronary heart disease (P<0.05). Spearman correlation analysis showed a positive correlation between frailty and disability (r＝0.400, P<0.01) and a general correlation between its internal components (P＜0.05 or P＜0.01). Conclusion The incidences of frailty and disability among the community-dwelling elderly are high. Age, gender, education level and chronic diseases affect their incidences. There is a significant correlation between frailty and disability and wide correlation among the internal components.

Abstract:Objective To evaluate the role of distal stabilization in the treatment of elderly osteoporotic unstable femoral intertrochanteric fractures with the Asian-type proximal femoral nail antirotation-Ⅱ (PFNA-Ⅱ). Methods A retrospective analysis was performed on the clinical data of 110 elderly patients with osteoporotic unstable femoral intertrochanteric fractures admitted to Tangshan Second Hospital and Tangshan Workers Hospital from May 2018 to May 2020. According to the length of implanted PFNA-Ⅱ main nail, the patients were divided into short intramedullary nail group (n=54, a nail of 240 mm in length to ensure 3-point fixation) and long intramedullary nail group (n=56, a nail of 325 mm to ensure 4-point fixation). The surgical indicators, incidence of complications and follow-up data were compared between the two groups. SPSS statistics 25.0 was used for data analysis, and the intergroup diffe-rences were compared with student′s t test or Chi-square test for different data types. Results There were no statistical differences in operation time, intraoperative bleeding loss and length of hospital stay between the two groups (P>0.05). Long intramedullary nail group showed better results in intraoperative fluoroscopy time, complication incidence, partial weight-bearing time, full weight-bearing time, fracture healing time, proportion of recovery to preoperative walking ability, refracture rate of femoral shaft when compared with the short intramedullary nail group (P<0.05). At six months after operation and at the last follow-up, the neck-shaft angle [(103.53°±6.29°) vs (90.37°±5.88°), (139.47°±6.5°) vs (116.01°±6.52)°] and Harris score [(71.40±4.15) vs (62.33±4.01), (85.79±4.81)vs (74.98±4.58)] were better in the long than the short intramedullary nail group (P<0.05). Conclusion The fourth point distal fixation factor can ensure the 4-point fixation of intramedullary nail fixation in the treatment of elderly osteoporotic unstable intertrochanteric fractures, and achieve the overall distal stability of the intramedullary nail. For these patients, the treatment effect of long intramedullary nails is better than that of short nails, which can reduce the refracture rate of the femoral shaft.

Abstract:Objective To explore the effect of intensive statin therapy on clinical outcomes in patients with acute coronary syndrome (ACS). Methods A total of 546 ACS patients diagnosed at the First Medical Center of Chinese PLA General Hospital between April 2013 and April 2014 were enrolled in this study. According to their initial statin dose, they were divided into common treatment group (n=431) and intensive treatment group (n=115). The general data and clinical outcomes were compared between the 2 groups. SPSS 17.0 was applied for statistical analysis. Depending on the data types, student′s t test or Chi-square test was employed for intergroup comparison. Cox regression model was used to analyze the risk factors affecting the prognosis of patients. Results The longest follow-up period was 5 years, and the median time was 4.3 years. There were 13 (2.38%) patients who died during follow-up, including 12 (2.20%) due to cardiac causes and 1 (0.18%) to pulmonary infection. The incidences of angina [6.96% (8/115) vs 28.54% (123/431)] and major adverse cardiovascular events (MACE) [18.26% (21/115) vs 32.71% (141/431)] was significantly lower in the intensive treatment group than the common treatment group (all P <0.05). Cox multiple regression analysis showed that history of diabetes (OR=1.533,95%CI 1.131-2.077; P =0.006) and age (OR=1.003,95%CI1.001-1.031; P =0.037) were significant risk predictors for MACE in ACS patients. Conclusion ACS patients complicated with diabetes mellitus are at high risk of MACE, and intensive statin therapy can reduce the incidence.

Abstract:Objective To investigate the treatment delay in the management of diabetic foot ulcers and its associated predictive factors. Methods Clinical data of 476 patients hospitalized for the first time in the diabetic center of our department due to diabetic foot ulcers between January 2013 and February 2019 were collected and retrospectively analyzed. Their treatment delays included patient delay (time interval between ulcer detection by the patient and the first consultation of a health care professional) and professional delay (time interval between the first consultation of a health care professional and admission to our hospital). The highest quartile of 32 d in patient delay and that of 40 d in professional delay were defined as severe patient delay and severe professional delay, respectively. SPSS statistics 25.0 was used for statistical analysis. Data comparison between 2 groups was performed using student′s t test or Chi-square test depending on data types. Logistic regression analysis was performed to identify the predictors for severe patient delay and severe professional delay. Results The median patient delay was 14 (1-354) d, and 33.2% (158/476) of patients saw a doctor within 1 week after the occurrence of diabetic foot ulcer, and 48.7% (232/476) of them did so within 2 weeks. The median professional delay was 16 (1-359) d, and 74.3% (171/230) of patients referred to our center after 1 week of treatment, and 54.8% (126/230) did so after 2 weeks. Age (P=0.010) was positively correlated and hemoglobin A1c (P=0.029) was negativelycorrelated with patient delay, while hemoglobin A1c was also negatively correlated with professional delay (P=0.007). Conclusion At present, there are still delays in many links in the process from treatment-seeking to receiving professional diagnosis and treatment for patients wity diabetic foot ulcer. It is necessary to establish a standardized time frame for its diagnosis and treatment to shorten the delays.

Abstract:Objective To determine the effect of simdestatin on the blood lipid level, liver damage and clinical prognosis of elderly patients with coronary heart disease carrying hepatitis B virus (HBV). Methods A total of 110 elderly HBV carriers with coronary heart disease admitted in our hospital from December 2018 to December 2019 were recruited in this study. They were randomly divided into control group (comprehensive treatment of Western medicine) and treatment group (added with simvastatin treatment). After 6 consecutive months′ treatment, the blood lipid levels, liver damage, HBV DNA load and reactivation were compared between the 2 groups, and the impact on the prognosis was further analyzed. SPSS statistics 23.0 was used for data analysis, and one-way analysis of variance, student′s t test or Chi-square test was performed for comparison between groups depending on different data types. Results The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) were decreased and that of high-density lipoprotein cholesterol (HDL-C) was increased in the 2 groups after treatment and during follow-up. The levels of TC and LDL-C were significantly lower and the HDL-C level was significantly higher in the treatment group than the control group during follow-up (P<0.05). After 3 and 6 months of treatment and during follow-up, the treatment group obtained obviously lower HBV DNA load than the control group [(2.82±0.46)×10⁶ vs (6.63±1.58)×10⁶copies/ml, (2.52±0.38)×10⁶vs (6.54±1.55)×10⁶copies/ml, (2.11±0.20)×10⁶vs (6.88±1.78)×10⁶copies/ml, P＜0.05]. The HBV DNA reactivation rate were significantly lower (7.27% vs 45.45%, P<0.05) and prognosis results were better in the treatment group than the control group in follow-up period. But there was changes in treatment regimens (P<0.05), but no significant difference in liver and kidney damage between the 2 groups (P>0.05). Conclusion Simvastatin not only exerts good effectiveness in regulating lipids, but also inhibits the replication and reduces the reactivation rate of HBV DNA in the treatment of elderly HBV-carrying patients with coronary heart disease. It has no effect on aggravating liver damage, and shows good safety.

Abstract:Objective To investigate the mid- and long-term effects of total hip arthroplasty and percutaneous compression plate for displaced femoral neck fractures. Methods A retrospective analysis was made of medical data on 128 patients with displaced femoral neck fracture treated in the Beijing Electric Power Hospital from January 2016 to May 2018, of whom 68 were treated by total hip arthroplasty (THA group) and 60 by percutaneous compression plate (PCP group). The two groups were compared in the perioperative indexes, hip function improvement on Aubigné-Postel score, quality of life, occurrence of postoperative complications, and cost of treatment. SPSS 19.0 was used for data analysis. Depending on the data type, t-test or χ² test was used for comparison between groups. Results The THA group had more intraoperative blood loss and intraoperative blood transfusion, and longer postoperative hospital stay than PCP group, the difference being statistically significant (P<0.005). The postoperative 3-year follow-up showed significantly higher Zuckerman functional recovery scale(FRS) score and lower rates of total complications in the THA group than PCP group (P<0.005). There was no significant difference in European quality of life 5-dimensions (EQ-5D) between the two groups (P>0.05). During postoperative 3 years, the costs for initial surgery and all associated treatment were higher in the THA group than those in the PCP group, and the cost for the second surgery and associated medical services were lower in the THA group than those in the PCP group (P<0.05), the differences being statistically significant. Conclusion In the treatment of displaced femoral neck fractures, total hip arthroplasty has better hip recovery and fewer mid- and long-term postoperative complications but longer operation time, more blood loss, larger trauma surface, and higher cost than percutaneous compression plate. The choice should be made after considering the patient′s own situation.

Abstract:Objective To construct recombinant plasmid pCDH-Myc-UBR5 and then explore the biological function of ubiquitin protein ligase E3 component N-recognin 5 (UBR5) in regulating angiogenesis. Methods Using the complementary DNA (cDNA) of Michigan cancer foundation-7(MCF7) cells as a template, we divided the UBR5 gene coding region into two segments and amplified them by polymerase chain reaction (PCR). Then the two amplified fragments were inserted into the eukaryotic expression vector pCDH-Myc. Bacterial liquid PCR and DNA sequencing were adopted to identify the inserted fragments. The recombinant plasmid was tran-siently transfected into human embryonic kidney cells 293 SV40 LT(HEK293T) and the expression of Myc-UBR5 protein was detected by Western blotting. Co-immunoprecipitation (Co-IP) assay was employed to verify whether UBR5 interacts with dyskeratosis congenita 1 (DKC1). Results The recombinant plasmid pCDH-Myc-UBR5 was successfully constructed. The amplified sequence of UBR5 was successfully inserted into pCDH-Myc vector and expressed in HEK293T cells, which was confirmed by bacterial liquid PCR and DNA sequencing. The results of Co-IP assay indicated the interaction between UBR5 and DKC1. Conclusion The plasmid pCDH-Myc-UBR5 is successfully constructed by molecular cloning and expressed correctly in cells. UBR5 interacts with the angiogenic regulatory protein DKC1.

Abstract:Sarcopenia is a common complication of elderly patients with chronic heart failure and one of the most important risk factors affecting the prognosis of patients. Research studies in recent years indicate that malnutrition, physical inactivity, low muscle blood flow, inflammation, hormonal changes, ubiquitin proteasome system, autophagy, apoptosis and oxidative stress play roles in the pathogenesis of sarcopenia induced by chronic heart failure, and exercise therapy is the effective treatment way. The research progress of these fields was reviewed in this paper, hoping to provide reference experience for clinical medical workers.

Abstract:Hypertension, a common disease with a high incidence in the world, is a major risk factor for many cardiovascular and cerebrovascular diseases, which brings a huge economic burden to society. In recent years, the incidence of anxiety and depressive disorders has increased, and the number of hypertensive patients with comorbid anxiety and/or depression is also increasing. Studies have shown that they may mutually reinforce each other and have some commonalities in the pathogenesis. However, the mechanism of comorbidities has not been fully elucidated. Therefore, this article reviews the definition and diagnostic scale, epidemiology, interaction mechanism and treatment of primary hypertension with anxiety and/or depression to provide guidance for clinical practice.

Abstract:Circular RNAs (circRNAs) are a novel class of RNA, cyclized by linking the 3′ end of the RNA to the 5′ end to form a covalently closed ring structure without a polyadenylic acid tail. CircRNAs are widely distributed, and can be found in various species and in different subcellular compartments. It has been found that circRNAs are closely related to the occurrence and development of cardiovascular diseases, neurological diseases, cancer and other diseases. Its mechanisms of action include acting as miRNA sponges, interacting with RNA-binding proteins, regulating gene expression, and encoding proteins. This article reviews the biogenesis and functions of circRNAs, and research progress in cardiovascular diseases.

Abstract:With ageing, the function of organs and tissues declines, the physical function of the elderly gradually decreases, and some of them show a decline in activities of daily living or even disability. The World Health Organization put forward the concept of healthy ageing to break traditional stereotype of disease-free model, and focuse on maintaining functional ability, especially intrinsic capacity. In the paper, we summarize the multidimensional concept of intrinsic capacity, its relationship with frailty and resilience, and its effect on prediction for adverse health outcomes, so as to provide the references for its more appropriate screening, evaluation and intervention to support to be self-reliant at home for older people in communities.

Abstract:Coronary heart disease (CHD) is a major cause of death in the world, and acute myocardial infarction is the most common cardiovascular disease. There may be a correlation between myocardial infarction and cognitive impairment, but the exact mechanism of cognitive decline remains unknown. Myocardial infarction with comorbid cognitive impairment negatively affects the prognosis, and the poor long-term prognosis may be associated to inadequate treatment. Population aging and increasing medical interventions necessitate specific strategies to improve therapeutic effect. This paper reviews the mechanism of cognitive impairment in patients with myocardial infarction, the influence of endpoint events and the research progress in treatment strategies.

Abstract:Cardiovascular disease (CVD) is the main cause of death in women, and is more common in those after menopause. Over the past two decades, the effect of menopausal hormone treatment (MHT) on cardiovascular health remains controversial. Recent studies showed that the use of MHT in younger women or in early postmenopausal women had a beneficial effect on the cardiovascular system. Hence, intervention in the critical period is crucial in the reduction of the risk for CVD in post-menopausal women. This article reviews the research progress of MHT in postmenopausal women.

Abstract:Inflammatory bowel disease (IBD) is a chronic and recurrent non-specific intestinal inflammatory disease, and its pathogenesis is related to many factors. Although the etiology of IBD remains unclear, intestinal flora is considered to be an important factor in the pathogenesis of IBD. Intestinal flora has been proven to play an important role in the development and activation of the intestinal immune system. Dysbiosis of the gut microbiota may induce or aggravate IBD, but the underlying mechanism is not yet fully illustrated. Evidence shows that treatment regimens based on regulation of intestinal flora have a certain positive effect on IBD. In this article, we review the recent researches on dysbiosis-implicated IBD and related treatments.