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Two hundred and eleven aged patients with type 2 diabetes were enrolled in the study.Blood glucose levels were monitored with continuing glucose monitoring system (CGMS) for 3 days and the cognitive function was evaluated with Mini-Mental State Examination(MMSE) scale.The correlation between hypoglycemia(or nocturnal hypoglycemia) and MMSE scores was evaluated.CGMS recorded hypoglycemia in 47％ patients (100/211),82％ of whom (82/100) had nocturnal hypoglycemia.Patients with hypoglycemia had lower MMSE scores than those without hypoglycemia (25.1 ± 5.1 vs.26.8 ± 3.0,P ＜ 0.05).Furthermore,the incidence of hypoglycemia(or nocturnal hypoglycemia) was higher in patients with MMSE≤24 than that in patients with MMSE ＞ 24(P ＜0.05).The median of hypoglycemia maximal time and nocturnal hypoglycemia maximal time were longer in patients with MMSE ≤ 24 than those with MMSE ＞ 24 (P ＜ 0.05).Stepwise regression analysis showed that the total time and maximal time of hypoglycemia(or nocturnal hypoglycemia),age,and education level were the main factors influencing MMSE scores in aged type 2 diabetic patients(all P ＜0.05).
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Objective To investigate the guiding value of serum procalcitonin (PCT) level in antibiotic treatment of stroke-associated pneumonia (SAP) after spontaneous intracerebral hemorrhage. Methods A total of 120 patients with SAP after acute cerebral hemorrhage were enroled and were randomly divided into either a conventional treatment group ( n=59) or a PCT guided group ( n=61). In accordance w ith the guidelines for the use of antibiotics in China, the conventional treatment group w as treated w ith antibiotics and the course of antibiotics w as determined by the treating physician. The serum PCT of the PCT group w as monitored continuously after using antibiotics for 5 days. When PCT w as 2 w as poor outcome. They were folowed up for 6 months after discharge. A Kaplan-Meier survive curve was use to compare the survival rate of both groups. Results The course of antibiotics ( 8.95 ±2.73 d vs.13.26 ± 4.11 d;t=6.407, P<0.001) and the length of hospitalization ( 15.64 ±2.63 d vs.18.36 ±4.27 d; t=3.967, P<0.001) of the PCT group w ere significantly shorter than those of the conventional treatment group. There w ere no significant differences in the proportions of 30 d mortality ( 9.8%vs.10.1%; χ2 =0.003, P=0.951) and 90 d good outcome ( 60.6%vs.59.3%; χ2 =0.022, P=0.881) betw een the PCT guided group and the conventional treatment group. At the end of the 6-month folow-up period, a total of 13 patients (12.0%) died, including 6 in the conventional treatment group and 7 in the PCT group. The Kaplan-Meier analysis show ed that there w as no significant difference in the 6-month survival rate betw een the 2 groups (χ2 = 0.070, P= 0.791 ). Conclusions Monitoring the serum PCT level for guiding antibiotic treatment of SAP after spontaneous intracerebral hemorrhage is safe, and it may shorten the course of antibiotics and reduce the length of hospitalization.
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Objective To evaluate the value of D-dimer in assessing severity and predicting longterm prognosis in patients with community acquired pneumonia (CAP).Methods From June 2009 to December 2010,a total of 189 patients with CAP were enrolled.After admission,D-dimer,procalcitonin (PCT) and C-reactive protein (CRP) were measured,and Pneumonia Severity Index (PSI) was calculated.They were assigned into two groups according to their D-dimer levels:high D-dimer levels group (D-dimer levels≥500 μg/L) and normal D-dimer levels group (D-dimer levels ＜ 500 μg/L).The followup time was one year.A Kaplan-Meier survive curve was constructed to assess the 1-year mortality,and multivariate logistic regression analysis were used to assess the value of D-dimer for predicting long-term prognosis.Results D-dimer levels increased with increasing PSI class [class Ⅰ-Ⅲ:378.37 μg/L (216.74,649.50) μg/L; class Ⅳ:673.41 μg/L (544.77,866.85) μg/L; class Ⅴ:831.58 μg/L (591.78,1066.39) μg/L,x2 =56.58,P ＜ 0.01].The Kaplan-Meier survival curve showed that 1-year mortality rate of high D-dimer levels group was higher than normal D-dimer levels group (log-rank test,x2 =52.51,P ＜ 0.01).The multivariate logistic regression analysis showed an independent relationship between higher D-dimer levels and long-term mortality (OR =2.05,95％ CI:1.48-2.61,P ＜ 0.01).Conclusion D-dimer is an independent predictor of severity and long-term prognosis in patients with CAP.
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Objective To evaluate the efficacy and safety of Fosfomycin trometamol(FMT)versus Norfloxacin(FPA)in elderly diabetic patients with acute urological tract infections.Methods From Jan.2012 to Mar.2013,eighty-six patients with uncomplicated and complicated urinary tract infection were randomized into FMT group(n =43)and FPA group(n =43).Patients in both groups were balanced with regard to baseline urinary tract symptoms,fever,leukocytosis,positive urinary culture and disease type(P＞0.05).Patients received FMT 3 g daily and Norfloxacin 0.4 g twice daily for a week.Extended treatment was given to 35 patients not cured within a week.Total treatment course should not exceed two weeks.Patient's symptoms,signs,complete blood count,urinalysis,urine culture,pharmacological sensitivity tests,renal and liver function tests were performed.Results After one week of FMT treatment,28(65.1％)cases were cured and 10 cases were improved(1 was with abnormal urinalysis,9 had positive urine culture).In total,in 38(88.4％)patients treatment was as effective;In FPA group,23(53.5％)were cured and 7 cases were improved(7 had positive urine culture).In total,there were 30(69.8％)patients classified as effective.Difference was statistically significant(P＜0.05 =.After 2 weeks of FMT treatment,38(88.4％)cases were cured and 2 patients were improved(1 was with abnormal urinalysis,1 had positive urine culture).In total,40(93.0％)patients were classified as effective.In FPA group,25(58.1％)cases were cured and in 8 patients were improved(8 had positive urine culture).In total,there were 33(76.7％)patients classified as effective;Difference was statistically significant(P＜0.05 =.Bacterial clearance rate in FMT and FPA group was 88.9％ and 72.7％,respectively.Difference was statistically significant(P＜0.05 =.The adverse reaction rates were 9.3％ and 14.0％,respectively.Difference was not statistically significant(P＞0.05).Conclusions FMT is an effective and safe antibiotic in the treatment of urinary tract infections in elderly diabetic patients.
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Objective To evaluate efficacy and safety of fixed combination of nitrendipine and atenolol in treatment for patients with mild to moderate essential hypertension and their optimal dosage matching.Methods Totally,275 patients with essential hypertension were selcted from seven hospitals in Shanghai,Nanjing and Suzhou,China and randomized into five groups with same proportional probability in a double-blind,double-dummy,parallel active-controlled,multi-center clinical trial,receiving fixed combination of nitrendipine and atenolol at three different dosage matching (nitrendipine/atenolol 5/12.5 mg,5/10 mg,5/7.5 mg for groups 1,2 and 3),and nitrendipine (10 mg for group 4) or atenolol (25 mg for group 5),respectively for eight weeks.Results Mean reduction of diastolic blood pressure (DBP)was (17±7) mm Hg,(18±9) mm Hg and (17±7) mm Hg for groupl,2 and 3,respectively from the baseline,significantly greater than that in groups 4 and 5[(13±7) mm Hg and (12±6) mm Hg,respectively].Mean reduction of systolic blood pressure (SBP) was (21 ±11)mm Hg,(24±12) mm Hg,(23±11) mm Hg,(19±13) mm Hg and (18±9) mm Hg,respectively for the five groups from the baseline,and the reduction in group 2 was significantly greater than that in group 5,with an overall efficacy of 94.4%,98.1% and 88.2% for groups 1,2 and 3,respectively,all statistically higher than that in group 5 (71.4%) with P＜0.01,eight weeks after treatment.The ratio of patients with increased dose of antihypertensive agents in week 5 was lower in group 2 than that in the other four groups,with mild adverse reaction only,no obvious change in laboratory biochemical examinations,and no needs in special management.Conclusions Fixed combination of atenolol and nitrendipine with an optimal doses of 5 mg and 10 mg respepctively was effective and safe for mild and moderate hypertension with good tolerance.
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Objective To investigate the relationship between hypertension, depression and cognitive function in elderly. Methods General conditions and health status were surveyed in 207 individuals, which were divided into hypertension group, depression group, hypertension and depression group and controls. Patients cognitive function was assessed by the mini-mental state examination (MMSE), depression severity was detected by Hamilton rating scale for depression (HAMD) , other relative data were collected. Results Elderly patients with depression were more inclined to live alone. Comparing with control, hypertension patients had lower attention and calculation. Depression patients had lower orientation, attention, calculation and linguistic ability ( P < 0.05). Compared with hypertension patients, patients combined with depression had significantly lower MMSE scores, orientation, recall and language ( P <0. 05). Patients with hypertension and depression had lower attention and calculation, compared with hypertension a-lone patients ( P <0. 05 ). MMSE scores of depressed patients were negatively related to HAMD scores ( r = -0. 706, P <0.01). Logistic regression revealed depression or combination of hypertension and depression were related to impairment of cognitive ability ( P < 0.01). Conclusion Both hypertension and depression in the elderly impaired cognitive function. The cognitive function impairment in elderly was closely associated with hypertension and depression. Prevention and control of hypertension and depression might be helpful in slowing down impairment of cognitive function in elderly.
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Objective To explore relationship between excursion of blood glucose levels and cognitive performance in diabetic patients over aged 60 years.Methods A total of 108 diabetic patients over aged 60 years were recruited in this study and they wore under continuous blood glucose monitoring system (CGMS) for three days to evaluate excursion of their mean blood glucose (MBG) level and its standard deviation (SD).All the participants accepted cognitive function tests during continuous blood glucose monitoring, including mini mental status examination (MMSE), Montreal cognitive assessment (MOCA) and clock drawing test (CDT).Relationship of the SD of blood glucose level and cognitive performance in the three cognitive tests was assessed.Data were analyzed with CGMS software version 3.0.Results The SD reversely correlated with scores of MMSE (r = - 0.324, P ＜ 0.01 ) and CDT ( r =-0.325, P = 0.001 ), but they did not significantly correlate with MOCA scores (r = -0.212, P =0.081 ).Statistically significant difference was observed between the SD and scores of all three cognitive tests adjusted for glycosylated hemoglobin Alc (HbAlc) level (r = -0.387, -0.046 and -0.292, P =0.029, ＜0.001 and ＜ 0.001, respectively).The SD reversely correlated with scores of MMSE, MOCA and CDT adjusted for MBG (r= -0.314, -0.466 and -0.345, P ＜0.01, respectively).Results of multivariate linear regression analysis showed that the SD reversely correlated to scores of MMSE, MOCA and CDT (β = - 0.378, - 0.224 and - 0.346, all P ＜ 0.05).Conclusions Excursion of blood glucose levels can influence their cognitive performance in diabetic patients over aged 60 years, leading to decrease in their overall cognitive function and activities as its excursion large enough.
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Objective To investigate the relationship between 24-hour ambulatory blood pressure and urine microalbumin(UMA)level in the elderly with non-diabetic essential hypertension.Methods One hundred elderly cases with essential hypertension were selected from the Department of Geriatrics,the Sixth People's Hospital,Shanghai and divided into two groups,one with UMA less than 30 mg/24h,and the other with UMA equal to or greater than 30 mg/24h.Ambulatory blood pmssure,serum level of creatinine (sCr),UMA and other characteristics were measured for all the subjects studied and compared to find possible relationship between blood pressure and UMA.Results Level of sCr,diastolic blood pressure at night (nDBP),24-hour average blood pressure,average blood pressure at night were all significantly higher in the group with UMA equal to or greater than 30 mg/24h than that with UMA less than 30 mg/24h(P<0.05 or P<0.01). Multivariate logistic regression analysis indieated that both sCr and nDBP were indispensable predictors for high microalbuminuria in patients with essential hypertension.Conclusions Ambulatory blood pressure monitoring,especially blood pressure variation at night,has more important predictive value for severity of renal damage caused by hypertension in the elderly with non-diIlbetic essential hypertension.
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Objective: To investigate the efficacy and safety of naftopidil on patients with mild-to-moderate essential hypertension. Methods: A prospective, open study was performed in patients with hyp ertension. Forty patients were administered naftopidil for 8 weeks. Results:BP decreased significantly 2 weeks after administration an d reached to its trough at week 4. The magnitudes were 2.28 kPa (17.1 mmHg) and 1.43 kPa (10.7 mmHg) for SBP and DBP, respectively. The effect lasted to the end of experiment. HR had no change.The total effective rate was 82.05%.There was n o significant change in liver and renal function and electrocardiograph. Conclusion: Naftopidil has a stable hypotensive effect and the complia nce is good.
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Objective: To investigate the effects of pravastatin o n atherosclerotic plaque and cardiovascular events. Methods: Fifty- seven patients with coronary artery disease (44 male and 13 female, 58.4±11.3 y ears) were randommized into pravastatin and control groups. The patients in prav astatin group were administered 10 mg of pravastatin from the night of coronary angiography day. After 7.3 months (mean) of follow-up, plasma lipid parameters and coronary angiograph were repeated. Results: (1) A favorable effect on plasma lipid parameters was found. After administration, total choles terol(TC), low density lipoprotein cholesterol (LDL-C) and triglyceride(TG) red uced by 15.0% (P<0.01), 18.0% (P<0.01) and 6.0%, respectively. High den s ity lipoprotein cholesterol(HDL-C) increased by 10.6%. However, in control grou p, TC and LDL-C showed a tendency to reduce, but no significant difference was found between those of pre- and post-administration. (2)There was no significa nt difference in luminal diameter between pre- and post-administration in both groups. (3) Cardiovascular events in pravastatin group was significantly lower than those in control (P<0.05). (4) Pravastatin had no significant effect on HR, BP and left ventricular ejection fraction in both groups. Conclusio n: Pravastatin can stabilize coronary atherosclerostic plaque and reduce the incidence of cardiovascular events by improving plasma lipid parameters.
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Objective: To assess the effect of balloon angiopl asty on circulating endothelin (ET) and TNF-α levels and tissue endothelin in experimental atherosclerosis in rabbits. Methods: After 20 New Z ealand rabbits had a high cholesterol diet for at least 8 weeks, successful ball oon angioplasty was performed in rihgt iliac arteries in 18 rabbits. Circulatin g levels of ET and TNF-α were measured before as well as immediately and 24 h after balloon angioplasty. Tissue endothelin immunoreactivity in atherosclerotic iliac artery wall after balloon angioplasty was assessed by immunohistochemica l technique. Results: Plasma levels of ET and TNF-α were signi ficantly increased immediately after ballon angioplasty (76.40±13.58)pg/ml vs (92.67±11.38) pg/ml and (31.35±6.23) U/ml vs (56.26±7.37) U/ml, resp ectively (P<0.05) .There was no change in plasma ET and TNF-α levels 24 h after balloon angioplasty (77.13±12.87) pg/ml vs (76.40±13.58) pg/ml and (33.41±6.79) U/ml vs (31.35±6.23) U/ml， respectively (P>0.05). T issue endothelin immunoreactiuvity was markedly increased in right iliac artery wall after balloon angioplasty than that in opposite iliac artery wall. Conclusion: The increase of plasma ET, TNF-α levels and tissue ET-IR in iliac artery wall after balloon angioplasty may be associated with the injury of l ocal vascular intima, suggesting that ET and TNF-α may take part in the corona ry constriction and the development of coronary restenosis after percutaneous tr ansluminal coronary angioplasty.
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Objective:To observe the effect of percutaneous tr ansluminal coronary angioplasty (PTCA) on coronary circulating tumor necrosis fa ctor-α (TNF-α) activity. Methods: Plasma TNF-α levls were measured with radioimmunoassay and bioactive assay respectively. Result s: Plasma TNF-α activity in femoral artery (AO) was significantly incr eased immediately after PTCA ［(15.86±3.75) U/ml vs （41.32±4.36） U/ml， P<0.01］, and plasma TNF-α activity in coronary sinus was remarkably incre ased immediately after PTCA ［(16.72±4.14） U/ml vs （65.61±6.25） U/ml, P<0.01］. There was no change in plasma TNF-α activity in AO 24 h after PT CA ［(18.32±5.12） U/ml vs （15.86±3.75） U/ml, P>0.05］. Conclu sion: The increase in plasma TNF-α activity after PTCA may be associat ed with the injury of coronary artery caused by PTCA, suggesting that TNF-α ma y be involved in the coronary occlusion and the development of coronary restenos is after PTCA.
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Objective: To investigate the changes of myo cardial contractile function during myocardial stunning in calcium overload rats and the protective effects of tetrandrine. Methods: Forty-six rats were randomized into control, myocardial ischemia, myocardial stunning, low and high dose of tetrandrine groups. Another 10 rats were used to identify the calcium overload. vitamin D3 (0.3 million Unit/kg) and nicotinic acid were adm inistered. After 16 d when calcium overload occured, left anterior descending ar tery was ligated. Twenty minutes of myocardial ischemia followed by 60 min of re perfusion was induced. The contractile function parameters were determined dynam ically. At the end of experiment, myocardial cytosolic ［Ca2+］i was deter mined in various groups. In tetrandrine groups, tetrandrine (62.2 or 93.6 μmol/ kg ) was administered by gastrogavage daily.After 16 d, the rats undergone the e xperiments mentioned above. Results: Sixteen days after vitamin D3 , nicotinic acid were given, ［Ca2+］i increased by 2.6 folds (146.8±10.8 ) vs (368.5±22.6) nmol/L, (P<0.01). Whereas, ［Ca2+］i in tetrand rine groups were (210.8±16.4) and (198.6±15.3) nmol/L, which were significantl y lower than that of calcium overload group. Twenty minutes of myocardial ische mia resulted in the decrease of dp/dtmax and Vmax in all groups with the most si gnificant in stunning and calcium overload groups. The contractile function rest ored gradually after reperfusion. At all time points, dp/dtmax and Vmax in both tetrandrine groups were higher than those in both stunning and calcium overload groups. And effect with higher dose of tetrandrine were more significant than in low dose of tetrandrine. After 60 min of reperfusion, dp/dtmax in stunning, cal cium overload, low and high dose of tetrandrine groups were 49.7%, 51.5%, 71.0% and 83.4% of that in control, respectively， and Vmax were 55.0%, 49.8%, 73.9% and 77.5% of that in control, respectively. Conclusion: T he myocardial contractile function in vitamin D3-induced calcium overload gro up is impaired. On basis of myocardiocyte calcium overload, transient ischemia l eads to myocardial stunning. At the stage of ischemia, the impaired degree of my ocardial contractile function is similar to that in stunning group, suggesting a t this stage the effect of ischemia on myocardial function is greater than that of calcium overload. Tetrandrine chronically improves the myocardial function in Vitamin D3-induced calcium overload rats.
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Objective: To investigate the effect of doxazosin on mild to moderate essential hypertension. Methods: A prospective, randomized, double blind study was carried out in 80 patients with hypertension. Forty patients were randomly given doxazosin (doxazosin group) or terazosin (control group) for 8 weeks. The others 40 were given doxazosin (open group), 10 of them for 6 months. Results: BP decreased significantly after administration of both doxazosin and terazosin, and reached its peak at week 4. The effect continued at the end of experiment. HR was slightly increased. In open group, the results was similar and the total effective rate was 90.0%. There were no significant changes in liver and renal functions and electrocardiography. The incidence of adverse effects like dizziness, palpitation and somnolence in doxazosin group was 30.0% . No significant difference between doxazosin and control group was found. Conclusion: Doxazosin has stable hypotensive effect and the patients compliance is good.
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Objective:To investigate the relation between the angiotensinⅡ(AngⅡ)levels in thoracic aorta and plasma and atherosclerosis(AS).Methods:Totally40healthy male Wistar rats were randomly divided into4groups(n=10).Four different feeding methods,including normal diet,high lipid,high lipid+vitamin D overload,and high lipid+vitamin D over-load+endothelium injury,were used for inducing AS in rats.The thickness of intima was taken as the index of AS severity, radio-immunity analysis was used to assay AngⅡin each group in thoracic aorta and plasma.Results:Only rats in high lipid diet group did not develop AS plaque;high lipid+vitamin D only resulted in AS fibrous plaque with VSMC proliferation;high lipid+vitamin D+endothelium injury formed ripe AS plaque.The thickness of intima and AngⅡof thoracic aorta in-creased gradually compared with control group(P
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Objective:To investigate the effects of chitosan on experimental rabbit atherosclerosis(AS).Methods:The models of rabbit AS were produced by a high fat diet.The rabbits were randomly assigned into normal diet(ND) group,high fat diet(HFD) group,chitosan and high fat diet(CHFD) group,chitosan and normal diet(CND) group.Fasting blood samples were collected for serum lipid assay on 0,4,8 weeks;the animals were killed on the 8th week to make aorta samples.AS plaque areas were estimated in the descending aorta dyed with oil red O and the ascending aorta dyed with H E.Results:TG,TC,LDL C in the CHFD group were lower than those in HFD group on 4 and 8 weeks;serum lipid concentration in ND group was similar with that in CND group;plaque areas in CHFD group were smaller than those in HFD group;intima thickness in CHFD group was thinner than that in HFD group.Conclusion:Chitosan reduces AS degree in rabbits of HFD group,which might be related to the decrease of serum lipid.