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Objective To explore the difference of the clinical manifestations between the elderly and non-elderly patients with non-massive pulmonary thromboembolism (PTE) and the significance of D-dimer in the diagnosis of PTE and its dynamic change after anticoagulant therapy.Methods The clinical manifestations of 83 cases with PTE were retrospectively analysed and divided into two groups:39 elderly and 44 non-elderly.The dynamic changing of D-dimer content was determined by immunoturbidimetry(ITM) method before and 3 d after anticoagulant therapy in the two groups.Results There were no significant statistical differences in the incidence of the main symptoms:dyspnea,cough,emptysis,syncope,palpitations between the elderly and the non-elderly (x2 =2.74,0.06,0.10,0.49,0.01,P＞0.05) except for the incidence of chest pain [14 cases (35.9 ％) vs.30 cases (68.2 ％),x2 =4.95,P ＜ 0.05].No differences were found in the the main signs:shortness of breath,tachycardia,accentuation or split of second pulmonary valve sound,cyanosis,and engorgement of neck veins between the two groups (x2 =2.60,0.03,0.61,0.06,0.33,0.11,P＞0.05).D-dimer content was lower in the elderly than in the non-elderly [(1.89±1.21) mg/L vs.(4.93±3.88) mg/L,Z=-2.55,P=0.01] before anticoagulant therapy.But there was no difference in D -dimer content between the two groups 3 d after anticoagulant therapy [( 1.28 ±1.11) mg/L vs.(2.09±2.22) mg/L,Z=-7.07,P=0.50].The decreasing level of D-dimer was less prominent in the elderly than in the non-elderly [(0.61±1.01) mg/Lvs.(2.84±2.95) mg/L,Z=-3.54,P=0.001].Conclusions The main clinical manifestations are similar between the elderly and non-elderly with non-massive PTE,but the incidence of chest pain is less in the elderly than in the non-elderly.The content of D-dimer is lower in the elderly than non-elderly after PTE and its decrements are less prominent in the elderly than the non-elderly after anticoagulant therapy.
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Objective To explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and metabolic syndrome (MS) in obese middle-aged and older men. Methods We selectively recruited 154 obese middle-aged and older men matched for body mass index (BMI) and age. The polysomnography was performed for diagnosing OSAHS and for discriminating disease severity. The BMI, waist circumference, blood pressure, plasma glucose and lipid profiles were measured and analyzed in all subjects. Appropriate statistical methods were used to compare the components of MS in each group. Logistic regression was taken to elucidate the relationship between OSAHS and MS. Results Compared to control group, severe OSAHS group had significantly lower high density lipoprotein cholesterol level [( 1.03 ± 0.29 ) mmol/L vs. ( 1.31 ± 0. 38) mmol/L,P＜0. 05] and higher fasting glucose [(6.61±1.76) mmol/L vs. (5.47±0.64) mmol/L, P＜0. 05]as well as higher systolic blood pressure [( 133 ± 13) mm Hg vs. ( 125 ± 12) mm Hg, P＜0. 05] and diastolic blood pressure [(99±10) mm Hg vs. (80±5) mm Hg, P＜0. 05]. The prevalence of MS was significantly higher in OSAHS group than in control group (mild OSAHS group: 25.7%,moderate OSAHS group: 46. 5%, severe OSAHS group: 84.4%, control group: 16. 1 %, all P＜0. 01). OSAHS was independently associated with an increased prevalence of MS Odds ratio, 6.16).Conclusions OSAHS is independently associated with MS in obese middle-aged and older men.
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Objective To establish a canine model with pulmonary thromboembolism(PTE) of selective lobar pulmonary artery embolization mimicking chronic thromboembolism, to assess the effects of an inhaled nitric oxide (NO) 20 ppm on vital signs, blood gas, hemodynamic parameters and neutrophils in the alveolar of the canine model. Methods Twenty canines were divided into four groups: group 1: sham group (n=5); group 2; ischemic lung group (PTE group without embolectomy, n=5); group 3; reperfusion lung group (PTE group with embolectomy, n=5); group 4: reperfusion lung group with inhaled NO (PTE group inhaled 20 ppm NO after embolectomy, n=5). And central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary arterial wedge pressure (PAWP) and carbon monoxide (CO) were recorded, pulmonary vascular resistance (PVR) was also calculated. Vital signs, blood gases were measured before embolectomy and at 2, 4, 6 hours after the operation. Albumin in bronchoalveolar lavage fluid (BALF) was measured by chromatometry of Coomassie brilliant blue. Lung wet to dry weight ratio(W/D) was also measured. Lung tissue pathology and alveolar PMN in the left lower lobar were observed by optical microscopy. Results MPAP increased significantly at 2 hours after reperfusion [(3. 20±0.53)kPa vs. (2. 27±0. 67)kPa,F=63,P=0.02]; At 6 hours after reperfusion as compared with baseline,HR increased significantly [(175±8) beats/min vs. (155±5) beats/min, F=38.72, P=0.01],PaO_2/FiO_2 also decreased significantly (41.70±8.04 vs. 54.71±3.78,F=48.36,P=0.03). MPAP decreased significantly in group 4 as compared with group 3 at 2 hours after reperfusion [(2.53±0.4)kPa vs. (3. 20±0. 53)kPa,F=55,P=0.04]. At 4 hours after reperfusion,PaO_2/FiO_2 raised in group 4,but there was no significant difference as compared with group 3 (49.17±7.37 vs. 39.71±7.31, F=2.36, P=0. 11). The quantities of alveolar PMN infiltration in group 4 decreased significantly as compared with group 3 (19±6/10 HPF vs. 31±11/10 HPF, F=98, P=0.01).Conclusions Lung ischemia-reperfusion injury can be induced by embolectomy from lower pulmonary artery in the PTE model embolized for one week. An inhaled NO 20 ppm can decrease the elevated pulmonary artery pressure induced by ischemia-reperfusion injury and may alleviate the injury by reducing the PMN immigration into the alveoli.
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Objective To explore the relationship of pulmonary mycoplasma pneumoniae(MP) infection with acute exacerbated stages of chronic obstructive pulmonary disease(COPD) and community acquired pneumonia(CAP)in the elderly,comparing different serum concentrations of IFN -? ,IL-6,TNF-? in these patients. Methods Serologic analysis through ELISA method was used to detect MP-IgM and MP-IgG to determine the presence of MP and the serum concentrations of IFN-?、IL-6、TNF-? in 30 elderly healthy subjects,39 elderly patients with acute exacerbated stage of COPD and 40 elderly patients with CAP. PCR method was also used to determine the presence of MP from the patients ,sputum. Results (1)The positive rates of MP were much higher in the COPD patients than in the CAP and healthy ones according to PCR or MP-IgM method( P