Abstract:Objective To analyze the relationship between left atrial appendage (LAA) structure and thrombus formation in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 283 NVAF patients who are undergoing selective radiofrequency ablation in our hospital from January 2012 to January 2021 were enrolled in this study. The medical history and imaging results were collected. The patients were divided into thrombus and non-thrombosis groups based on the results of transesophageal echocardiography. The risk factors of thrombosis were analyzed. SPSS statistics 24.0 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. Univariate analysis was used to identify variables with predictive power, followed by multivariate analysis to explore independent risk factors for thrombosis. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each risk factor for thrombosis. Results There were statistical differences in body mass index, course of atrial fibrillation, CHA2DS2-VASc score, proportion of persistent atrial fibrillation, uric acid and brain natriuretic peptide levels, left ventricular ejection fraction, left atrial diameter (LAD), left atrial appendage volume (LAA-V), left atrial appendage length (LAA-L), left atrial appendage first curvature and left atrial appendage lobes between the thrombus and non-thrombosis groups (P＜0.05). Multivariable logistic regression analysis indicated that CHA2DS2-VASc score (OR=1.898,95%CI 1.223-2.944), LAD (OR=1.214,95%CI1.087-1.355), LAA-V (OR=1.230,95%CI 1.023-1.480), LAA-L (OR=1.154,95%CI 1.005-1.326), left atrial appendage first curvature (OR=1.032,95%CI 1.003-1.063) and left atrial appendage lobes (OR=2.024,95%CI1.331-3.077) were independent risk factors for thrombosis. ROC curve analysis showed that CHA2DS2-VASc scores ≥4 (sensitivity 0.575, specificity 0.844), LAD ≥39.5 mm (sensitivity 0.825, specificity 0.716), LAA-V≥7.155 cm³(sensitivity 0.850, specificity 0.724), LAA-L≥25.01mm (sensitivity 0.775, specificity 0.938), LAA first curvature≥121.5°(sensitivity 0.450, specificity 0.951) and LAA lobes ≥3 (sensitivity 0.900, specificity 0.646) significantly increased the risk of LAA thrombosis. Conclusion LAA structure is a good predictor of thrombosis. In anticoagulation decision-making for NVAF patients, clinicians should take the complexity of LAA structure into consideration on the basis of CHA2DS2-VASc score.

Abstract:Objective To evaluate the prophylactic effect of perioperative use of moderate-dose intravenous dexamethasone on postoperative nausea and vomiting, and pain after total knee arthroplasty in the elderly patients. Methods This study, a prospective, randomized, controlled trial, selected a total of 160 patients of American Society of Anesthesiologists (ASA) grade Ⅰ or Ⅱ, who were admitted to the Joint Surgery Department of the Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from January to May 2021 and scheduled for total knee arthroplasty under general anesthesia. They were randomly divided into dexamethasone group (n=80) and saline group (n=80). Intravenously, 2 ml dexamethasone (10 mg) or 2 ml saline was injected 20 min before the induction of general anesthesia. Six patients whose operation exceeded 200 min were excluded, leaving 78 cases in the dexamethasone group and 76 cases in the saline group for statistical analysis. The primary outcome measures were a visual analogue scale (VAS) at postopera-tive 4,12, 24 and 36 h to assess the pain and a verbal rating scale (VRS) to assess the severity and incidence of nausea and vomiting. The secondary indicator were the use of analgesics and antiemetics, blood glucose levels, length of hospital stay, and infection rate at postoperative 30 days. SPSS statistics 22.0 was used for data analysis. Depending on the type of data, analysis of variance, t test, χ² test, or Fisher′s exact test was used for intergroup comparison. Results Nausea, vomiting, and pain occurred mostly within 24 hours after total knee arthroplasty. The VRS scores, incidence of postoperative nausea and vomiting (PONV) and VAS scores in the dexamethasone group were significantly lower than those in the saline group at postoperative 4,12, 24 h (P<0.05), but the difference was not significant at postoperative 36 hours (P>0.05). The blood glucose in dexamethasone group was significantly higher than that in saline group at postoperative 1 day [(8.5±1.7) vs (5.9±1.4) mmol/L; P<0.05], but the difference at postoperative 3 days was not significant (P>0.05). The mean postoperative hospitalization stay was significantly shorter in the dexamethasone group than in the saline group [(3.0±0.8) d vs (4.8±1.5) d; P<0.05]. There was no significant difference between the two groups in the infection rate at postoperative 30 d (P>0.05). Conclusion Preoperative prophylactic intravenous injection of 10 mg dexamethasone can effectively reduce the severity and incidence of nausea and vomiting in the elderly patients after knee arthroplasty, significantly alleviate postoperative pain, reduce postoperative use of analgesics and antiemetics, and shorten hospital stay.

Abstract:Objective To compare the efficacy of transurethral plasmakinetic resection of prostate (PKRP) versus transurethral vaporization of prostate (TUVP) in the treatment of benign prostatic hyperplasia (BPH). Methods A total of 126 patients with BPH admitted in our hospital from January 2019 to January 2021 were enrolled, and randomly divided into PKRP group and TUVP group. Data were processed using SPSS statistics 19.0. Student′s t test or Chi-square test was applied for comparison between the two groups depending on different data types. Results The postoperative bladder irrigation time, indwelling catheter time, time of postoperative painful urination, postoperative bleeding time and postoperative length of hospital stay were significantly shorter in the PKRP group than the TUVP group (all P<0.05). There were no statistical differences in operation time, weight of resected tissue and incidence rates of intraoperative and postoperative complications between the two groups (all P>0.05). In 1 year after surgery, the scores of international prostate symptom score (IPSS) and quality of life score (QOL), as well as maximum urinary flow rate (Qmax), residual urine volume (RUV) and prostate weight were decreased in both groups when compared with the levels before operation (P<0.05), but no significant differences were seen in the above indicators between the two groups at 1 year after surgery (P>0.05). Conclusion Both TUVP and PKRP can effectively improve lower urinary tract symptoms and quality of life in BPH patients. But PKRP has the advantages of precise surgical procedures, better hemostatic effectiveness, high intraoperative safety and mild postoperative pain.

Abstract:Objective To investigate the related factors influencing restenosis after common femoral artery endarterectomy (CFAE) in treatment of arteriosclerosis obliterans at common femoral artery (CFA). Methods A total of 136 patients with arteriosclerosis obliterans at CFA who underwent CFAE in our hospital from January 2011 to September 2019 were retrospectively subjected in this study. The patients with restenosis of common femoral artery > 70% were included in the restenosis group (n=47), and those of restenosis≤ 70% in the patency group (n=89). The clinical data were compared between the 2 groups. Cox proportional hazards regression model was used to analyze the influencing factor for restenosis after endarterectomy. SPSS statistics 21.0 was used for statistical analysis. Data comparison between 2 groups was performed using student′s t test or Chi-square test depending on data type. Results Forty-seven of 136 patients (34.6%) suffered from restenosis. There were significant differences in proportions of diabetes and smoking history and level of low-density lipoprotein cholesterol between the patency group and the restenosis group [30 (63.8%)vs 35 (39.3%), 29 (61.7%) vs 29 (32.6%), (1.79±0.58) vs (1.54±0.46) mmol/L, all P<0.05]. Obvious difference was seen in the situation of below-the-knee run-offs between the 2 groups (P<0.05). In both groups, 1 case of inguinal hematoma occurred in 1 d after operation and 1 case of local lymphatic leakage occurred in 3 d after operation. All patients were cured after symptomatic treatment. Results of Cox proportional hazard model showed that diabetes mellitus (RR=2.339,95%CI 1.273-4.296, P=0.006), smoking history (RR=1.931, 95%CI 1.063-3.507, P=0.031) and below-the-knee run-offs (RR=0.412,95%CI 0.217-0.783, P=0.007) were independently related with restenosis after CFAE. Conclusion Comorbidity of diabetes mellitus and smoking history are independent risk factors of restenosis in patients after CFAE. Initiative management of below-the-knee run-offs may reduce the incidence of restenosis.

Abstract:Objective To investigate the current status and influencing factors of cognitive frailty in the elderly inpatients. Methods A total of 158 elderly patients (≥60 years) receiving comprehensive geriatric assessment in Department of Geriatrics of our hospital from January 2018 to May 2021 were recruited in the study. According to the results of mini-mental state examination (MMSE) and Fried frailty phenotype assessment, the participants were divided into cognitive frail group (n=34) and non-cognitive frail group (n=124). Their general data, results of laboratory tests and scores of comprehensive geriatric assessment were compared between the 2 groups. SPSS statistics 26.0 was used for statistical analysis. Student′s t test, Rank sum test or Chi-square test was employed for intergroup comparison based on different data types. Binary logistic regression analysis was applied to analyze the factors affecting cognitive frailty in hospitalized patients. Results The cognitive frail group had older age, poorer nutritional status, and more dependent on others for daily living when compared with the non-cognitive frail group (all P<0.05). Binary logistic regression analysis showed that older age (OR=0.921,95%CI 0.847-0.981), declined instrumental activities of daily living (OR=4.611,95%CI 1.725-12.328) and hypoalbuminemia (OR=1.127,95%CI 1.007-1.262) were influencing factors of cognitive frailty in the elderly inpatients. Conclusion The prevalence of cognitive frailty is quite high in elderly patients. Clinicians should pay attention to comprehensive geriatric assessment, timely and effective screening, and active measures to prevent the development of cognitive frailty in the elderly in order to promoting the realization of successful aging.

Abstract:Objective To explore the influencing factors of β2 microglobulin (β2M) and its correlation with cognitive function in the elderly patients with diabetes mellitus. Methods A total of 300 elderly diabetic patients hospitalized in the departments of endocrinology and geriatrics of Xuanwu Hospital from May 2018 to May 2019 were recruited in this study. General clinical data, inflammatory indicators, and results of biochemical tests were collected. The cognitive function was evaluated using Montreal cognitive assessment (MoCA). The patients were divided into high and low β2M groups (149 and 151 patients respectively) according to β2M level. Statistical analyses were performed using SPSS statistics 22.0. Data comparison between two groups was performed using t test, Mann-Whitney U test or Chi-square test depending on data types. The correlation of β2M level with clinical indicators was analyzed by Pearson correlation analysis and multiple liner regression analysis. Logistic regression analysis was employed to analyze the affecting factors of cognitive impairment (CI) in the elderly diabetic patients. Results Compared with the high β2M group, the low β2M group had younger age, shorter diabetic duration, and lower levels of interleukin 6 (IL-6), homocysteine (HCY), triglyceride (TG), creatine, blood urea nitrogen (BUN) and uric acid (P<0.05). Multiple linear stepwise regression equation showed that β2M had positive correlations with creatine, BUN, IL-6 and uric acid (P<0.05). Univariate logistic regression analysis indicated that age, β2M, stroke, creatine and BUN were risk factors for CI in elderly patients with diabetes mellitus(P<0.05). Multivariate logistic regression analysis suggested that age, β2M and stroke were independent risk factors of CI in the elderly patients with diabetes mellitus (P<0.05). Conclusion β2M in elderly patients with diabetes mellitus is not only associated with declining renal function, but also an independent risk factor of CI.

Abstract:Objective To investigate the current situation of falls in frail retired veteran cadres and to clarify the influencing factors of falls in them. Methods A total of 442 retired veteran cadres hospitalized in our medical center from February to October 2019 were subjected as the research subjects, and according to whether pre-frail or frail had fallen in the past 12 months, they were divided into the fall group and the non-fall group. Their general data and physical function were compared between the 2 groups of old cadres. SPSS statistics 22.0 was used for statistical analysis. Data comparison between 2 groups was performed using student′s t test, rank sum test, or Chi-square test depending on data types. Fried Frailty Scale was used for frailty screening, and logistic regression model was used to analyze the risk factors for falls among the frail retired veteran cadres. Results Finally, 322 (72.0%) frail retired veteran cadres were enrolled in this study, and they were at a mean age of 76.91±9.23 (63～98) years. There were 60 patients in the fall group and 262 patients in the non-fall group. The results of one-way ANOVA showed that frail score, age, body mass index (BMI), emotional state, Short Physical Performance Battery score, tandem standing test score, and sitting-rising test score had significant influences on whether falls occurred (P<0.05). Logistic regression analysis indicated that age (OR=1.043,95%CI 1.003-1.085) and BMI<18.5 kg/m² (OR=3.704, 95%CI 1.024-13.391) were the main influencing factors for falls in frail old cadres (P<0.05). Conclusion The incidence of falls is relatively high among frail retired veteran cadres. It is necessary to strengthen the assessment and screening of the fall risk of this group of people, and formulate effective preventive measures for the high-risk group of falls.

Abstract:Objective To analyze the status of percutaneous coronary intervention (PCI) and prognosis in patients aged 75 years or older with acute ST-elevation myocardial infarction (STEMI). Methods The clinical data of 425 acute STEMI patients aged≥75 years admitted to our hospital from April 2009 to December 2018 were retrospectively analyzed. According to their treatment during hospitalization, they were divided into emergency PCI group (n=112), elective PCI group (n=80) and conservative treatment group (n=233). Their basic clinical data, treatment during hospitalization and incidence of complications were collected. All patients were followed up regularly every 1-3 months by clinical visits or phone interview till December 2019. SPSS statistics 26.0 was used for data analysis. Multivariate logistic regression was used to analyze the factors influencing the clinical decision-making strategy. Kaplan-Meier survival curve was drawn, and log-rank test was employed to analyze the differences in survival rates among the groups. Results The rates of emergency coronary angiography and emergency PCI were 31.5% (134/425) and 26.4% (112/425), respectively for the acute STEMI patients aged ≥75 years. Multivariate logistic regression analysis revealed that symptom-onset-to-treatment time (OR=0.841,95%CI 0.792-0.893;P<0.001) and initial Killip class ≥Ⅱ (OR=0.440,95%CI 0.238-0.814;P<0.01) were independent influencing factors of emergency PCI; age (OR=1.259,95%CI 1.129-1.405;P<0.001), creatinine clearance rate (OR=0.972,95%CI 0.952-0.993;P<0.01) and initial Killip class≥Ⅱ (OR=2.958,95%CI 1.420-6.163;P<0.01) were independent factors for elective PCI. The in-hospital all-cause mortality was 13.4% (15/112), 3.8% (3/80) and 18.9% (44/233), respectively in the emergency PCI, elective PCI and conservative treatment groups, with significant differences among them (P<0.05). The incidence of ventricular fibrillation was statistically lower in the elective PCI group than the emergency PCI group [0.0% (0/80) vs 8.9% (10/112), P<0.05]. During a median follow-up of 31 (12～53) months, the cumulative survival rate was remarkably lower in the conservative treatment group than the emergency and elective PCI groups [44.6% (104/233) vs 71.4% (80/112), 78.8% (63/80); all P<0.05]. Conclusion Elderly STEMI patients aged ≥75 years have a lower rate of undergoing emergency PCI. Symptom-onset-to-treatment time, advanced age, impaired cardiac and renal functions are associated with clinical decision-making strategy. The patients undergoing PCI will achieve significantly higher short- and long-term survival rates than those taking conservative management.

Abstract:Objective To investigate the protective effect of pirinixic acid (Wy-14643) on myocardial ischemia/reperfusion injury (MI/RI) in rats and its underlying mechanism. Methods Forty rats were randomly divided into 5 groups, with 8 rats in each group:sham operation group (sham group), ischemia-reperfusion group (MI/RI group), and low-, middle- and high-dose pirinixic acid groups (W1, W2, W3 groups, at a concentration of 1,4 and 8 mg/kg, respectively). MI/RI model was established by ligation and reperfusion of anterior descending coronary artery. Serum creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were determined by enzyme-linked immunosorbent assay (ELISA). Myocardial infarction area was measured and pathological changes of myocardial tissue were observed under a light microscope. The protein expression of toll-like receptor 4(TLR4) and nuclear factor-κBp65 in myocardium was detected with Western blotting. SPSS statistics 23.0 was used for statistical analysis. Data comparison between two groups was perfomed using ANOVA analysis and Bonferroni test depending on data type. Results Serum contents of CK-MB [(94.81±8.41), (82.41±7.20) and (69.40±6.52) vs (119.91±12.71) U/L], LDH [(750.73±86.44), (654.94±79.25) and (565.26±86.00) vs (911.48±87.15) U/L], IL-6 [(176.75±11.89), (162.67±8.18) and (146.13±10.48) vs (194.93±13.91) pg/ml] and TNF-α [(80.67±7.38), (69.67±5.15) and (51.22±7.00) vs (90.44±6.68) pg/ml] were significantly lower, the area of myocardial infarction (28.00%, 16.93% and 8.38% vs 35.88%) was obviously smaller, and the expression levels of TLR4 [(1.00±0.03), (0.92±0.03) and (0.69±0.04) vs (1.33±0.03)] and nuclear factor-κBp65 [(1.01±0.03), (0.94±0.03) and (0.72±0.04) vs (1.12±0.04)] were down-regulated in the W1, W2, W3 groups when compared with the MI/RI group (P<0.05). Conclusion Preconditioning with pirinixic acid protects MI/RI myocardium by inhibiting inflammation mediated by the nuclear factor-κB signaling pathway.

Abstract:As a member of the protein phosphatase type 2C (PP2C) family, wild-type p53 induced phosphatase 1(Wip1) is encoded by PPM1D. Previous researches have shown that overexpressed in various types of human tumors, Wip1 serves a major role in tumorigenesis, progression, invasion and distant metastasis. At the molecular level, Wip1 plays an important role in the spatial and temporal regulation of protein phosphorylation in numerous signaling pathways. Many recent studies have found that Wip1 also participates in several biological processes, such as neurogenesis, haematopoietic stem cell homeostasis and cardiovascular disease. In this article, we review the research progress of roles of Wip1 in the molecular mechanism of neoplasm, haematopoietic stem cell homeostasis, adult neurogenesis, and cardiovascular disease.

Abstract:Sarcopenia is a geriatric syndrome characterized by reduced muscle mass combined with decreased muscle strength and/or decreased physical performance. In recent years, sarcopenia has become a hot topic in geriatric research, and new achievements have been made in the exploration of serum biomarkers for sarcopenia. In this article, we review the serum biomarkers associated with sarcopenia, and focus on muscle-specific biomarkers, oxidative stress-related biomarkers, nutrition-related biomarkers, endocrine-related biomarkers, neuromuscular junction (NMJ)-dysfunction-related biomarkers, and microRNA markers in addition to traditional inflammation-related biomarkers. The phenotype and pathogenic mechanisms of sarcopenia are complex, therefore, it is difficult to identify sarcopenia based on a single biomarker. Clinical prediction models based on integrating multiple biomarkers and other clinical features are the direction of future research.

Abstract:Functional gastrointestinal disorders are a group of diseases classified by gastrointestinal symptoms, whose symptoms are mainly related to abnormal brain-intestinal axis, motility disorders, visceral hypersensitivity, changes in mucosal and immune function, changes in intestinal flora, and abnormal processing of the central nervous system. The prevalence of functional gastrointestinal disorders is quite high in the elderly patients. It is difficult to relieve the symptoms with conventional drugs alone, while neuromodulators of central nervous system can significantly improve the symptoms. However, the elderly often have comorbid conditions. Therefore, when using central nervous system modulators, attention should be paid to the type, dosage and drug-drug interactions to avoid toxic and side effects. In this paper, we mainly review the regulatory mechanism and effect, clinical application and side effects of the neuromodulators of central nervous system on different transporters and receptors in order to provide reference for their application for elderly patients with functional gastrointestinal disorders.

Abstract:Atrial fibrillation (AF) is the most common type of arrhythmia clinically, and previous AF management has focused on the prevention of AF-related embolism and the control of ventricular rate and rhythm. In recent years, the concept of integrated management of AF is gradually popularized. Integrated management of AF emphasizes the prevention of AF-related embolism and symptom control, as well as the improvement of patients′ quality of life and the treatment of complications at the same time, so as to further improve the prognosis of patients. This article reviews the anticoagulant therapy, symptom management, and control of risk factors in patients with nonvalvular atrial fibrillation.

Abstract:The focus and difficulty in endovascular aortic arch repair is how to maintain the blood flow of the supra-aortic branches with total isolation of the lesion. In situ fenestration can quickly and effectively reconstruct the blood flow of the supra-aortic branches, and its application has gradually expanded the indications of thoracic endovascular aortic repair in the treatment of aortic arch diseases. The development of endovascular technology and the emergence of devices suitable for aortic arch have led to satisfactory short- and medium-term results of the clinical applications of fenestration on a single branch to three branches. The methods of fenestration are mainly mechanical and physical. The former is to use various needles to puncture the fabric, while the latter mainly includes use of thermal energy of laser and radiofrequency to ablate the fabric. This article aims to review the application and progress of in situ fenestration in the treatment of aortic arch diseases.

Abstract:Rheumatoid arthritis (RA) is a clinically common autoimmune disease with complex and diverse etiology and pathogenesis and with a high disability rate and mortality. Besides frequent joint swelling and tenderness,cardiac involvement is a common extra-articular manifestation of RA,which is closely related to the prognosis of RA patients. Compared with the general population, RA patients have a significantly increased risk of developing cardiovascular disease (CVD), further increasing the risk of death. In addition to conventional cardiovascular risk factors, such as hypertension,hyperlipidemia,smoking,obesity,diabetes mellitus,and chronic kidney disease, some other cardiovascular risk factors, such as inflammation, immunity, and the use of anti-rheumatic drugs, have been found to play an important role in the incidence of CVD in RA patients. This paper intends to review the clinical manifestations and risk factors of cardiac damage in RA, aiming to provide theoretical suggestions for the diagnosis and treatment of such patients.

Abstract:Histological type is an important factor affecting survival in the malignant tumors of the parotid gland, and that the biological behaviors and clinical characteristics of the tumors change with different histological types. Primary squamous cell carcinoma of the parotid gland is rare but highly malignant. Approximately 40% of the squamous cell carcinoma of the parotid gland is clinically transferred from the skin to the parotid rather than originate from the parotid tissue. At present, clinical research on the clinical characteristics and treatment of primary squamous cell carcinoma of the parotid gland is at the primary stage. This article systematically reviews the biological characteristics, diagnosis, treatment and prognosis of primary squamous cell carcinoma of the parotid gland.