Abstract:Objective To explore the influence of baseline blood pressure on the long-term development of frailty in community-dwelling older adults with hypertension to provide a basis for scientific blood pressure management of elderly hypertension patients. Methods The elderly non-frailty hypertension patients who had complete sociodemographic data and results of comprehensive geriatric assessment in a community in Beijing from January to June 2019 were subjected in this study, and they were followed up by telephone from January 1 to February 14,2023. Finally, 372 elderly hypertension patients were enrolled in this study. FRAIL scale was used to evaluate frailty in the follow-up, and those with the score ≥3 points were classified as frailty. Binomial logistic regression analysis (input method) was adopted to calculate the OR and 95%CI between baseline blood pressure level and long-term occurrence of frailty. The dose-response relationship between the baseline level and the occurrence was analyzed by generalized additive model using smooth curve fitting and threshold effect analysis. Empower Stats and SPSS 25.0 were used for statistical analysis. Data comparison between two groups was performed using student′s t test, Mann-Whitney U test or Chi-square test depending on data type. Results Multivariate adjusted logistic regression analysis showed that baseline systolic and diastolic blood pressure levels were not significantly correlated with occurrence of frailty, while baseline pulse pressure was negatively with the occurrence (OR=0.983, 95%CI 0.968-0.998; P<0.05). Smooth curve fitting and threshold effect analysis indicated that the relationship between baseline systolic blood pressure level and frailty was U-shaped, with an inflection point of the U-shaped curve of 140 mmHg(1 mmHg=0.133 kPa). When systolic blood pressure <140 mmHg, the OR (95%CI) was 0.957 (0.925-0.990; P<0.05), and when systolic blood pressure >140 mmHg, the OR (95%CI) was 1.006 (0.985-1.028; P>0.05).Conclusion In community-dwelling older adults with hypertension, baseline systolic blood pressure level has a long-term effect on occurrence of frailty, in a U-shaped relationship, with an inflection point of 140 mmHg.

Abstract:Objective To explore the correlation between dynamic-static balance function and other various physical fitness indicators in community-dwelling elderly patients with sarcopenia. Methods Using convenient sampling method, 178 elderly patients with sarcopenia in the community were recruited for outpatient treatment and physical examination at multiple health service centers around Suzhou University. After informed consent, they received the test, and 110 patients ultimately completed all the test items. Static balance function was evaluated using a eye-closed and single legged standing test, and dynamic balance function was evaluated using a stand-up and go test (TUGT). The 6-minute walking test (6MWT), biceps flexion and lift test, 30-second seat standing test, back grasping test, seat forward tilt test, and body mass index measurement were performed on the subjects. SPSS statistics 23.0 was used for data analysis. Spearman correlation analysis and multiple linear regression analysis were used to analyze the relationship between dynamic-static balance function and other physical fitness indicators. Results The standing time of elderly patients with sarcopenia in the community with eye-closed and single legged standing was (2.66±0.64) seconds, and the TUGT time was (7.68±0.22) seconds. Compared with patients without other chronic diseases, patients with other chronic diseases significantly reduced the duration of eye-closed and single legged standing [1.83 (1.03,2.88) vs 2.83 (1.41,3.81) s], with statistically significant differences (P<0.05). Compared with patients with irregular exercise, the patients with regular exercise had significantly reduced duration of TUGT [7.27 (6.43,8.29) vs 7.73 (7.03,8.76) s], with statistically significant differences (P<0.05). The duration of eye-closed and single legged standing was significantly positively correlated with the distance between 6MWT, back grip test, and seat forward tilt distance (r=0.607,0.286,0.361; P<0.05), and negatively correlated with age (r=-0.300; P<0.05). The duration of TUGT was significantly positively correlated with age (r=0.413; P<0.001), and negatively correlated with 6MWT, biceps flexion and lift frequency, 30-second seat standing frequency, back grasping test distance, and seat forward tilt distance(r=-0.538, -0.605, -0.759, -0.274, -0.366; P<0.05). The results of multiple linear regression analysis showed that the combination of other chronic diseases and a distance of 6MWT were the influencing factors for the duration of eye-closed and single legged standing (β=1.181,0.008; P<0.05). The factors affecting the duration of TUGT included the combination of other chronic diseases, the frequency of biceps flexion and lift, the frequency of 30-second seat standing, and the distance of back grasping test (β=-0.859, -0.197, -0.342, -0.053; P<0.05). Conclusion Among community-dwelling elderly individuals with sarcopenia, comorbidity with other chronic diseases is a significant influencing factor for dynamic-static balance function; walking ability is a significant influencing factor for static balance function; upper and lower limb muscle strength and flexibility are significant influencing factors for dynamic balance function.

Abstract:Objective To explore the incidence of newly diagnosed malignant tumors and its association with all-cause death in the patients with coronary artery disease (CAD) to provide evidence for optimizing their comprehensive clinical management strategies. Methods According to the inclusion and exclusion criteria, a total of 4625 CAD patients were randomly selected using SPSS 25.0 from those who were admitted to the Department of Cardiology of the First Medical Center of Chinses PLA General Hospital from January 1,2011 to December 31,2015, and underwent coronary artery angiography for the first time. The patients′ baseline data were collected, and they were followed up after discharge for information about the newly diagnosed tumor and survival. They were divided into survival group (n=3385) and death group (n=335) based on outcome over the follow-up period. Cox regression analysis was used to determine the association between the newly diagnosed tumor and all-cause death in CAD patients. SPSS 25.0 was used for statistical analysis. Data comparison between two groups was performed using t-test, Nonparametric test or χ² test depending on data type. Results Among the 4625 patients included, 3720 (80.4%) were followed up with a median follow-up time of 9(8,10) years. Among them, 150 patients (4.0%) developed malignant tumors, and 335 (9.0%) died. Among those who died, 40 (11.9%) were diagnosed with malignant tumors; among those who survived, 110 (3.2%) were diagnosed with malignant tumors.There was a significant difference in the incidence ofnew tumors between two groups (P<0.001). There were statistically significant differences in age ≤65 years, body mass index≥24 kg/m², stenosis degree of left main, left anterior descending, left circumflex branch and right coronary artery, and Gensini score (>20 points) between the death group and the survival group (P<0.05). The differences were statistically significant in the patients with hypertension, hyperlipidemia, renal insufficiency, bronchitis/emphysema ratio (P<0.05). There were statistically significant differences in hemoglobin level, neutrophil-lymphocyte ratio, triglyceride, prothrombin activity, plasma fibrinogen, international normalized ratio, urea nitrogen, creatinine, alanine aminotransferase, left ventricular ejection fraction, troponin T and brain natriuretic peptide between the two groups (P<0.05). The Log-rank test showed that CAD patients with a tumor had significantly lower cumulative survival rate than those without (P<0.001) over the follow-up period. Multivariate Cox regression analysis showed that newly diagnosed tumors increased the risk of all-cause death for CAD patients by 3.815 times (95%CI 2.362-6.164; P<0.001). Conclusion The incidence of tumors in deceased coronary heart disease patients is significantly higher than that in surviving coronary heart disease patients. Newly diagnosed malignant tumors significantly affect the prognosis of long-term survival in the CAD patients.

Abstract:Objective To investigate the distribution of different apolipoprotein E (ApoE) genotypes in hyperlipidemia patients living in central and southern Jiangsu province so as to provide evidence and reference for clinical use of statins in these patients. Methods A retrospective study was conducted on 676 hyperlipidemia patients admitted in Northern Jiangsu People′s Hospital and the First Affiliated Hospital of Soochow University from August 2019 to January 2022. Polymorphisms of ApoE 388T>C (rs429358) and 526C>T (rs7412) were detected, and the patients were divided into three groups according to genotyping:ApoE2, ApoE3 and ApoE4 groups. The relevant medical records of the patients were collected and retrospectively analyzed, and the distribution of ApoE polymorphisms and genotypes were also analyzed in the whole population and between different genders. SPSS statistics 26.0 was used for data analysis. Analysis of variance or Chi-square test was employed for intergroup comparison depending on data type. Results For the three groups of hyperlipidemia patients, there were six ApoE gene phenotypes detected in this study, sequentially as E3/E3 (458 cases, 67.75%), E3/E4 (109 cases, 16.12%), E2/E3 (86 cases, 12.72%), E4/E4 (11 cases, 1.63%), E2/E4 (10 cases, 1.48%) and E2/E2 (2 cases, 0.30%). The observed value of ApoE gene mutation was consistent with Hardy-Weinberg genetic equilibrium (P>0.05), and all the participants were from the same Mendelian inheritance. No significant difference was found in the distribution of ApoE genotypes between males and females (P>0.05). Conclusion The distribution of ApoE gene in central and southern Jiangsu province is not uniform, and there is no difference between genders. The characteristics of ApoE gene polymorphisms have reference value for precise lipid-lowering therapy in clinical practice.

Abstract:Objective To explore the impact of hemoglobin (Hb) levels on the prognosis of the elderly male inpatients, and to analyze the optimal Hb range for those with renal insufficiency. Methods A retrospective analysis was made of the clinical data of 1 623 elderly male patients admitted to the National Geriatric Clinical Medical Research Center of Chinese PLA General Hospital from January 2008 to December 2010. The patients were divided into four groups based on Hb levels:413 in the Hb≤110 g/L group, 139 in the 110 g/L130 g/L group. According to the baseline renal function on admission, the patients were divided into a renal insufficiency group [eGFR<60 ml/(min·1.73m²); n=357] and a normal renal function group [eGFR≥60 ml/ (min·1.73) m²; n=1266]. SPSS 25.0 was used for data analysis, and Kaplan Meier survival curve for the difference in cumulative survival rate and cumulative incidence of acute myocardial infarction between the patients with different Hb levels. The correlation analysis was conducted using a Cox proportional risk regression model. Results During the 5-year follow-up, all-cause mortality occurred in 617 patients (38.0%), and acute myocardial infarction in 254 (15.7%). Kaplan Meier survival curve analysis showed that the cumulative all-cause mortality rate and incidence of acute myocardial infarction were the lowest in the Hb>130 g/L group, and the highest in the Hb≤110 g/L group. There were statistically significant differences in log rank tests between the two groups (P<0.05 for both). Cox proportional risk regression analysis of patients with renal insufficiency showed that, compared with the Hb≤110 g/L group, the 120g/LHR=0.43,95%CI 0.25-0.73; P=0.002) and Hb>130 g/L group (HR=0.46,95%CI 0.24-0.87; P=0.017) had a significantly reduced risk of all-cause mortality, and the 120 g/LHR=0.31,95%CI 0.14-0.69; P=0.004) had a significantly reduced risk of acute myocardial infarction. Conclusion Higher Hb levels in the elderly male inpatients can reduce all-cause mortality and the incidence of acute myocardial infarction. For patients with renal insufficiency, there is an optimal Hb range. Hb>120 g/L is associated with a lower risk of all-cause mortality, and 120 g/L

Abstract:Objective To clarify the frailty status of elderly hospitalized patients with chronic diseases in Haikou City and its influencing factors. Methods A total of 356 patients admitted to two Class A tertiary hospitals in Haikou City were collected by convenient sampling from August 2021 to February 2022, and then surveyed and evaluated with self-designed general data questionnaire and Fried frailty phenotype assessment. SPSS statistics 25.0 was used for data analysis. According to data type, Chi-square test was employed for comparison between groups. Multivariate logistic regression analysis was adopted to analyze the influencing factors of frailty. Results Among the 356 questionnaires, 349 were valid, with an effective recovery of 98.03%. The mean age of the 349 participants was (69.21±7.05) years. There were 107 cases (30.7%) without frailty, 117 cases (33.5%) at pre-frail stage and 125 cases (35.8%) with frailty. Multivariate logistic regression analysis showed that age (OR=0.386,95%CI 0.149-0.995; P<0.05), gender (OR=0.514,95%CI 0.279-0.947; P<0.05), personal monthly income (OR=1.772,95%CI 0.879-3.574; P<0.05), confirmed chronic disease (OR=0.419,95%CI 0.158-1.110; P<0.05), sleep status (OR=0.821,95%CI 0.252-2.668; P<0.05), medications (OR=0.464,95%CI 0.206-1.044; P<0.05) were all factors affecting frailty in the elderly inpatients. Conclusion The incidence of frailty is high in elderly hospitalized patients with chronic diseases living in our tropical city, Haikou. Medical staff should pay attention to the evaluation of frailty in the population, and take relevant interventions timely and effectively to reduce its occurrence and delay its progress in them.

Abstract:Objective To detect the contents of neuron-specific enolase (NSE) and phosphorylated tau (P-tau) in serum-derived exosomes of the elderly patients with type 2 diabetes mellitus (T2DM), and explore the correlation of them with mild cognitive impairment (MCI). Methods A total of 114 elderly T2DM patients admitted in our hospital from Jan. 2019 to Dec. 2020 were enrolled and assigned as the study subjects (study group), and another 100 healthy volunteers taking physical examination in the same period were assigned as the control group. Exosomes in the blood samples from the study subjects were extracted by ExoQuick-TC. Enzyme linked immunosorbent assay(ELISA) was used to detect the contents of NSE and P-tau in serum-derived exosomes. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were employed to evaluate the cognitive status of the subjects. SPSS statistics 19.0 was used for data analysis. The data difference between groups was analyzed by student′s t test and Chi-square test. Spearman rank correlation analysis was adopted to study the correlation of NSE and P-tau contents in serum-derived exosomes with the severity of cognitive impairment. Receiver operating characteristic (ROC) curve was plotted to analyze predictive value of NSE and P-tau levels in serum-derived exosomes for MCI. Results The study group had significantly larger proportion of cognitive impairment, lower MMSE and MoCA scores, and higher incidence of MCI than the control group (all P<0.05). Based on the MoCA score, the 114 patients in the study group were further divided into MCI group (n=71) and non-MCI group (n=43). The levels of NSE and P-tau in serum-derived exosomes in MCI group were (13.27±1.61) μg/L and (17.14±2.45) pg/ml, which were significantly higher than those of the non-MCI group [(10.86±1.43) μg/L and (14.49±2.25) pg/ml; t=5.728,6.154; P<0.05]. Correlation analysis showed that the levels of NSE and P-tau in serum-derived exosomes were negatively correlated with MMSE score (r=-0.547, -0.562; P<0.05) and MoCA score (r=-0.583, -0.597; P<0.05) in the elderly T2DM patients. ROC curve analysis indicated that the area under the curve (AUC) of NSE level to predict MCI in elderly T2DM patients was 0.729, and that of P-tau level was 0.741. And, the AUC of their combination was 0.827, which was significantly higher than that of NSE (t=3.836, P<0.05) and p-tau (t=3.478, P<0.05) in the prediction of MCI. Conclusion Higher levels of NSE and P-tau in serum-derived exosomes are closely associated with the occurrence of MCI in elderly T2DM patients. Their combination has higher predictive value for the occurrence of MCI in the patients.

Abstract:Objective To study the efficacy and safety of retroperitoneal laparoscopic ureterolithotomy (RLUL) and mini-percutaneous nephrolithotomy (MPCNL) in the treatment of upper ureteral calculi. Methods A retrospective analysis was made of the clinical data of 84 patients with upper ureteral calculi, who were treated at the Urology Department of Qionghai People′s Hospital from January 2021 to January 2022. According to the surgical interventions employed, they were divided into RLUL group (n=40) and MPCNL group (n=44). The two groups were compared in the perioperative indicators. SPSS statistics 19.0 was used for data analysis, and independent sample t test,χ²test or Fisher exact test was performed for inter-group comparison, depending on data type. Results Compared with MPCNL group, the RLUL group had longer surgical time [(64.06±10.74) vs (40.53±9.52) min], higher hemoglobin level after surgery [(145.69±15.33) vs (136.76±14.86) g/L], shorter ambulation time [(2.03±0.43) vs (4.46±0.94) d] and retention time of drainage tube [(5.21±0.89) vs (7.36±1.25) d], and lower incidence of postoperative high fever (0.00% vs 13.64%), the difference being statistically significant (P<0.05). There were no statistical differences between the two groups in stone clearance rate (100.00% vs 97.73%), urethral catheter retention time [(5.46±1.07) vs (5.71±1.32) d] and postoperative hospital stay [(6.15±1.65) vs (6.53±1.49) d; P>0.05]. No ureteral stricture or stone recurrence occurred in the two groups during post-operative follow-up of 6-10 (7.58±1.06) months. Conclusion Both MPCNL and RLUL have good effects and high safety in the treatment of incarcerated upper ureteral calculi. It is recommended to select the appropriate surgical mode according to the specific conditions of patients.

Abstract:Objective To verify whether sodium-glucose cotransporter 2 inhibitor (SGLT2i) can regulate the activation of cardiac fibroblasts (CFs) by changing macrophage paracrine under hypoxic/reoxygenation (H/R) condition, and thus attenuate myocardial fibrosis. Methods A total of 27 C57BL/6 male mice were randomly divided into sham group, ischemia-reperfusion injury (IRI) group and IRI+SGLT2i group, with 9 animals in each groups. In 28 d later, echocardiography and immunofluorescence assay were used to detect myocardial fibrosis and adverse remodeling. RAW264.7 cells were assigned into negative control (NC) group, H/R group and H/R+SGLT2i group. M2 polarization were observed with immunofluorescence assay and Western blotting. Secretion of transforming growth factor beta (TGF-β), interleukin-1 beta (IL-1β), tumor necrosis factor alpha (TNF-ɑ), interleukin 6(IL-6), and platelet-derived growth factor-a (PDGF-a) were measured with enzyme linked immunosorbent assay (ELISA). Primarily cultured mouse CFs were divided into NC group, H/R group and H/R+SGLT2i group. Then macrophage supernatant was added into the culture medium of the CFs to observe the cell activation. GraphPad Prism 8 statistics was used for statistical analysis. Multiple group comparisons were conducted using one-way analysis of variance, while data comparison between two groups was conducted using Tukey′ post hoc test. Results In vivo, echocardiographic findings at 28 d postoperatively showed that the IRI+SGLT2i group exhibited higher left ventricular ejection fraction and left ventricular shortening fraction, whereas lower left ventricular end-systolic volume, left ventricular end-diastolic volume, left ventricular internal systolic diameters, and left ventricular internal diastolic diameters when compared with the IRI group (all P<0.05). Immunofluorescence assay indicated that the IRI+SGLT2i group had reduced contents of type I and type Ⅲ collagen, and Sirius red staining showed a decreased ratio of type I to type Ⅲ collagen compared with the IRI group (P<0.05). In vitro, Western blotting showed that the H/R+SGLT2i group had increased ratio of M2 marker, Arg1, and less ratio of M1 marker, iNOS, compared to the H/R group (P<0.05). ELISA indicated less abundant TGF-β, IL-1β, TNF-ɑ , IL-6 and PDGF-a, were observed in the H/R+SGLT2i group than the H/R group (P<0.05). Western blotting results confirmed that the expression of α-SMA and collagen in the CFs in the H/R+SGLT2i group was lower than that in the H/R group (P<0.05). Conclusion SGLT2i ameliorates IRI-induced myocardial fibrosis. It can inhibit M1 polarization, promote M2 polarization, and suppress the secretion of inflammatory and fibrosis-related cytokines. Its treatment for RAW264.7 cell supernatant can inhibit the activation of CFs. Our findings confirm that SGLT2i suppresses the activation of CFs and improves poor ventricular remodeling by regulating the paracrine secretion of macrophages.

Abstract:Objective To analyze genes related to coronary heart disease (CHD) patients and to explore potential new mechanisms for CHD using Gene Expression Omnibus (GEO) database. Methods The gene expression profile dataset of CHD patients and healthy controls was searched and retrieved from the GEO database. Differentially expressed genes (DEGs) between CHD patients and controls were identified using GEO2R analysis of the processed GSE71226 dataset. Visual correlation analysis was performed using the R language ggplot2 package. Results A total of 575 DEGs were screened. A protein-protein interaction (PPI) network was further constructed to visualize the DEGs and identify the genes. Gene ontology pathway enrichment analysis showed that the top 15 signaling pathways upregulating and downregulating DEGs were involved in biological processes, including insulin secretion, cardiac conduction system, growth hormone secretion, etc. Kyoto encyclopedia of genes and genomes pathway enrichment analysis showed that upregulating and downregulating DEGs were mainly related to sequence-specific DNA replication, cyclic adenosine monophosphate (cAMP), fat digestion and absorption, and other related signaling pathways. PPI network interaction diagram showed five central genes (SST, BBS10, CCK, POMC, HSPA9), among which SST was closely related to the pathogenesis of CHD. Conclusion The hub regulatory genes of CHD include SST, BBS10, CCK, POMC, HSPA9, probably participating in the pathogenesis of CHD through DNA replication, cAMP, fat digestion and absorption, and other related signal pathways.

Abstract:Radiotherapy is widely used in clinical practice as one of the main treatment modalities for thoracic malignancies. Due to the special anatomical location of the heart, radiotherapy inevitably exerts adverse effects on the cardiovascular system, causing radiation-induced heart disease (RIHD). Clinically, no effective drugs are available to prevent and treat RIHD, and the side effects of Western Medicine are obvious. However, Traditional Chinese Medicine has shown great potential in its prevention and treatment. Therefore, this article summarizes the progress of Chinese Medicine in the prevention and treatment of RIHD.

Abstract:Lung cancer is the cancer with the highest morbidity and mortality in China, posing huge pressure on the healthcare system. The elderly have a high incidence of lung cancer. Elderly lung cancer patients are prone to frailty, which will increase post-operative complications, adverse reactions to radiotherapy and chemotherapy, the risk of all-cause death, length of hospital stay and readmission rate, and seriously affect prognosis. Frailty is reversible, and early detection and intervention are crucial. In this article, we reviewed the risk factors of frailty, its correlation with adverse health outcomes, and its intervention strategies in the elderly lung cancer patients, for its early identification and timely interventions clinically, thus improving patients′ prognosis.

Abstract:As a common geriatric syndrome, frailty is characterized by multiple system dysfunction. Heart failure(HF) is a group of syndromes caused by various structural or functional diseases of the heart, leading to impaired ventricular filling and/or blood ejection capacity,which often complicate with frailty and relate to decreased physical function, falls, disability, and cognitive decline.Frailty is common in older patients with heart failure, and both frailty and heart failure share common mechanistic features, including strong relations with a high burden of comorbidities, inflammation, and sarcopenia. Frailty is associated with worse clinical symptoms, organ function, and life quality in older patients with heart failure, so it is critical to develop simple, easy-to-use, and well-validated assessment tools to identify frailty. These assessment tools can efficiently and quickly identify frail patients with HF in routine clinical settings to better inform prognosis.In older patients with heart failure and frailty, novel management strategies, such as those addressing multiple domains through multidisciplinary assessment and intervention, should be investigated further. Raising awareness of the shared mechanism of HF with frailty and managing frailty may help improve quality of life and have a substantial impact on prognosis in HF patients.

Abstract:At present, China has entered an aging society, the incidence of senile vertigo complicated with cardiovascular and cerebrovascular diseases is increasing year by year, and the number and complexity of the complicated diseases are also increasing with age. In recent years, senile vertigo has been found to be associated with hypertension, stroke, coronary heart disease, atrial fibrillation, and other cardiovascular and cerebrovascular diseases. This article focuses on the incidence, etiology, pathophysiological mechanism, and risk factors of senile vertigo, expounding the relationship and interactive mechanism between senile vertigo and cardiovascular and cerebrovascular diseases,and reviews the latest research progress in and clinical medication of senile vertigo complicated with cardio-cerebrovascular diseases.