Analysis of sarcopenia and influencing factors in hospitalized elderly patients / 中华老年医学杂志

Objective:To analyze features of sarcopenia and its influencing factors in hospitalized patients at our department.Methods:This was a cross-sectional study.A total of 180 patients aged 80.3±6.7 years admitted to the geriatrics department of our hospital were consecutively recruited.Patients were divided into the non-sarcopenia group(n=80, 44.4%)and the sarcopenia group(n=100, 55.6%)based on the diagnostic criteria for sarcopenia of the Asian Sarcopenia Working Group.All subjects were evaluated by using the comprehensive geriatric assessment.Differences in comorbidity, physical function, nutrition, cognitive function, psychological characteristics, geriatric syndromes, medication and other aspects were analyzed between the two groups.The correlation of the above factors with sarcopenia was analyzed.Results:Scores on the Charlson comorbidity index and the cumulative illness rating scale were higher in the sarcopenia group than in the non-sarcopenia group(2.6±1.7 vs.2.1±1.1, 11.3±4.1 vs.7.9±1.8, P<0.05). Scores on mini-nutrition assessment and mini-cog, grip, chair-rising test(five times), timed get-up and go test(3 m), walking speed, and short physical performance battery were lower in the sarcopenia group than in the non-sarcopenia group[(12.8±2.1) vs.(11.2±1.7), (2.3±1.0) vs.(4.4±0.9), (21.2±5.8)kg vs.(27.6±6.2)kg, (31.4±15.3)s vs.(13.2±4.0)s, (24.2±9.5)s vs.(12.0±2.9)s, (0.6±0.2)m/s vs.(0.9±0.3)m/s, (6.1±1.9) vs.(9.8±1.3), respectively, P<0.05]. The incidences of geriatric syndromes such as incontinence, visual impairment, hearing impairment, sleeping disorders, oral problems, chronic pain, anxiety, depression and falls were higher in sarcopenia patients than in non-sarcopenia patients.Logistic regression analysis showed that body mass index, walking speed and the number of geriatric syndromes were risk factors for sarcopenia( OR=1.401, 1.286 and 3.654, P<0.05). Conclusions:The incidence of sarcopenia is high in hospitalized elderly patients.Comprehensive geriatric assessment can be used to achieve a more complete understanding of the characteristics and influencing factors for patients with sarcopenia and will help provide a basis for appropriate treatment plans.

Relationship between changes in cellular immune function and rehospitalization rate in elderly patients / 中华老年医学杂志

Objective To observe the differences in T-lymphocyte subsets between patients with sepsis,non-sepsis and healthy controls with different ages,and to investigate the effect of cellular immune function on readmission rate.Methods The 337 patients with sepsis,350 patients with non-sepsis and 141 healthy controls were enrolled in this prospective study from general department and intensive care unit(ICU)of emergency department in Beijing Chaoyang Hospital during May 2017 to April 2018.The effects of ages on T lymphocyte subsets and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)and the effects of T lymphocyte subsets and APACHE Ⅱ on 30-day rehospitalization rate were comparatively studied.Results In patients with non-sepsis,the values of CD3+T,CD4+T,CD8+ T,natural killer(NK)cell count were lower in elderly group than in the non-elderlygroup(956.0±85.8)×10-6/L vs.(1363.3±46.7)×10 6/L,(647.3±59.9)×10-6/L vs.(875.8±33.4) × 10-6/L,(288.9± 31.1)× 10-6/L vs.(451.2±21.2)× 10-6/L and (14.5±0.64)％vs.(15.4±0.6)％,respectively,P＜0.01.In patients with sepsis group,the values of CD3+ T,CD4+T,NK cells count were decreased and APACHE Ⅱ were increased in the elderly group as compared with the non-elderly group.The 30-day readmission rate was higher in elderly patients than in the non-elderly patients(74 cases vs.39 cases,P ＜0.01).Compared with the non-elderly patients,the elderly patients had decreased values of CD3+ T,CD4+ T,CD8+ T,NK cells,CD4+/CD8+ cell count and an increased APACHE Ⅱ (P ＜0.05).Conclusions The cellular immune function is decreased in elderly patients,which is more obvious in elderly patients with sepsis.Age,CD3+ T,CD4+ T,CD8+T and APACHE Ⅱ could be used as an independent predictor for 30 day readmission rate.

Analysis of factors related to fear of falling in community-dwelling elderly patients with type 2 diabetes / 中华老年医学杂志

Objective To investigate the influence of fear of falling on clinical ,functional ,and gait variables in elderly patients with type 2 diabetes and to identify predictive factors for fear of falling in this population. Methods A total of 238 community-dwelling older persons with type 2 diabetes (aged 65 to 89 years ) were divided into two groups according to Falls Efficacy Scale-International scores.Participants with a score<23 were assigned to the no-fear group (n=118) and those with a score≥ 23 were assigned to the fear group (n= 120 ).Demographics ,anthropometrics ,number of diseases and medications ,physical activity level ,history of falls ,frailty level ,cognition ,depressive symptoms ,fasting glucose level ,and disease progression were collected. Timed Up and Go test (TUG) ,five times sit-to-stand test (5-STS) ,and tests for grip strength and pace were run. Results Participants in the fear group were more frail and presented more depressive symptoms and worse performance in the TUG and 5-STS tests than in the no-fear group.The fear group also showed a slower pace ,a shorter step length ,a longer step time ,and a longer swing time.Multivariate regression analysis revealed that the likelihood of having fear of falling increased by 1.32 times (OR :1.32 ,95％CI :1.09-1.58) for every one-point increase in the Geriatric Depression Scale (GDS-15) score and by 1.35 times (OR :1.35 ,95％ CI :1.06-1.70) for every one-second increase in TUG. Conclusions The fear of falling in community-dwelling elderly patients with type 2 diabetes mellitus is associated with frailty ,depressive symptoms ,dynamic balance ,functional mobility ,and abnormal gait. Furthermore , both GDS-15 and TUG test can predict fear of falling in this population.

Effects of health education intervention in elderly patients with osteoporosis / 中华老年医学杂志

Objective To examine changes in bone mineral density,serum bone turnover markers and serum cytokines after health education intervention in elderly patients with osteoporosis.Methods Two hundred and twenty elderly patients with osteoporosis were randomly divided into two groups.The control group(n=110)was given routine treatment,including anti-osteoporosis drugs and daily supplements of calcium and vitamin D.In addition to routine drug treatment,the observation group(n=110)also underwent health education intervention,which included instructions on lifestyle,diet,and exercise.After one year follow up,levels of bone mineral density(BMD),propeptide of type Ⅰ procollagen(PINP),β crosslaps (β-CTX),parathyroid hormone (PTH),25-dihydroxyvitamin D [25(OH) VD],interleukin-2 (IL-2),and insulin-like growth factor-1 receptor (IGF-1 R) were analyzed.Results After one year follow-up,all indicators,except the β-CTX level,were significantly improved in the observation group compared with those in the control group(all P＜0.05).Mean while,compared with pre-treatment levels,both groups had significantly increased levels of BMD(both P＜ 0.05),which were markedly higher in the observation group (P ＜ 0.05).Furthermore,improvement was achieved in cognitive ability and lifestyle in the observation group (both P ＜ 0.05).Conclusions Health education intervention can effectively improve BMD in elderly patients with osteoporosis,significantly improve lifestyle,and play an important role in integrated management of osteoporosis.

Clinical study onDuhuo-Jisheng decoction combined with traditional manipulation for lumbar intervertebral disc herniation / 国际中医中药杂志

Objective To evaluate the efficacy of Duhuo-Jisheng decoction combined with traditional manipulation for the patients with lumbar intervertebral disc herniation.Methods A total of 126 patients with orthopedic inpatients were enrolled and divided into two group by random number table method: the treatment group (63 patients) and the control group (63 patients).The control group was treated with loxoprofen sodium dispersible tablets, while the treatment group was treated with Duhuo-Jisheng decoction and traditional manipulation. Both groups were treated for 2 courses. After treatment, the patients were evaluated by VAS. The clinical effect was evaluated by Oswestry ODI.Results After treatment, the VAS scores (2.8 ± 0.3 vs. 3.5 ± 0.7, t=7.296) and ODI (10.5% ± 3 .2% vs. 15.5% ± 6.2%,t=5.688) in the treatment group were significantly lower than those in the control group. The time of symptoms relief (2.3 ± 0.5 dvs. 5.3 ± 0.7 d,t=27.681) and the time of symptoms disappearance (28.6 ± 5.7 dvs. 54.4 ± 8.2 d,t=20.506) in the treatment group were significantly less than those in the control group (both Ps<0.01). The total effective rate (95.2% vs. 87.3%) of the treatment group was significantly better than the control group (χ2=3.938,P=0.047). Team of the incidence of adverse reactions (14.2% vs. 41.2%) in the treatment group was significantly lower than that in the control group (χ2=10.128,P=0.002). Conclusions TheDuhuo-Jisheng decoction combined with traditional manipulation can alleviate the symptoms, shorten the treatment time, reduce adverse reactions for the patients with lumbar intervertebral disc herniation.

Protective effect of atorvastatin on blood vessels in early stage of atherosclerosis / 心血管康复医学杂志

Objective:To explore protective effect of atorvastatin on blood vessels in early stage of atherosclerosis (AS).Methods:A total of 120 patients without AS plaques,who had >2 cardiovascular risk factors and received control cardiovascular risk factors therapy,were randomly divided into four groups:control group (did not receive atorvastatin),atorvastatin 5mg group,10mg group and 20mg group (received corresponding dose of atorvastatin). All patients were followed up for six months,changes of thromboxane B2 (TXB2),6-Keto-prostaglandin F1α (6-Keto-PGF1α),brachial-ankle pulse wave velocity (baPWV),ankle brachial index (ABI)and intima-media thickness (IMT)were observed.Results:There were no significant changes in ABI and IMT between before and after treat-ment among four groups (P >0.05 all).Compared with baseline,TXB2、baPWV levels significantly rose,6-Keto-PGF1αlevel significantly decreased after treatment in control group and 5mg group;in contrast,TXB2、baPWV lev-els significantly decreased,6-Keto-PGF1αlevel significantly rose after treatment in 10mg group and 20mg group(P <0.05~ < 0.01).After treatment six-month,compared with control group and 5mg group,the TXB2 [(148.3 ± 29.2)pg/ml,(142.3±30.6)pg/ml vs.(111.5±22.8)pg/ml,(104.9 ± 17.4)pg/ml]、baPWV[(1621.1 ± 136.1) cm/s,(1597.7±125.3)cm/s vs.(1232.9±132.3)cm/s,(1178.2±155.1)cm/s]levels significantly decreased,6-Keto-PGF1α[(104.7±66.1)pg/ml,(102.2±70.3)pg/ml vs.(132.8±48.3)pg/ml,(139.1±66.3)pg/ml]level significantly rose(P <0.05~<0.01)in 10 mg group and 20 mg group.Conclusion:Atorvastatin has protective effect on blood vessels in early stage of atherosclerosis,and 10mg atorvastatin may be the minimum effective dosage to protect blood vessels.

Application of high-frequency color Doppler in the diagnosis of acute appendicitis / 中国基层医药

Objective To explore the application value of high frequency probes in ultrasonic diagnosis of acute appendicitis.Methods Using high frequency probe to detect 356 patients with right lower quadrant abdominal ultrasound,and the results were analyzed.281 cases were confirmed by operation and pathology.Results 240 cases of 356 patients were detected low frequency transducer,and the detection rate was 67.4％.Application of high frequency probe were detected in 322 cases,and the detection rate was 90.4％.Pathological progress of appendicitis with appendicitis,display rates have increased,there was a significant correlation between the two.Conclusion The use of high frequency color ultrasound imaging for suspected acute appendicitis in patients has definite diagnosis and differential diagnosis.

Effects of ischemic postconditioning on myocardial infarction sizes and protein kinase C expression in aged rats with post-ischemia reperfusion injury / 中华老年医学杂志

Objective To observe the effects of ischemic postconditioning (IPTC) on myocardial infarction sizes (IS) and protein kinase Cα (PKCα) expression in aged rats with post-ischemia reperfusion injury,and to explore the mechanism.Methods A total of 120 male Wistar rats were divided into aged group and adult group.The aged group was randomly divided into control group (n=12,30-min ischemia and 3-h reperfusion),5 s,10 s,30 s and 60 s IPTC groups [n= 12,each;after 30 min occlusion of left coronary artery (LCA),three cycles of 5 s,10 s,30 s,60 s reperfusion respectively followed by the same interval LCA re-occlusion were applied at the beginning of reperfusion].The IS was measured with TTC dye,and PKC expression was investigated by immunohistochemistry.Results Different IPTC intervals had different effects on IS and PKC expression,10 s and 30 s IPTC could reduce IS both in aged rats and adult rats [(55.9±6.0)% and (47.4±5.5)%],IS in 10 s IPTC group in aged rats was (48.1±5.3)%,in adult rats was (39.2±5.7) %;IS in 30 s IPTC group in aged rats was (48.8 ± 6.8) %,in adult rats was (40.2 ± 6.1 ) %.PKCα expression increased in aged and adult rats (all P<0.05).5 s IPTC could increase IS [IS in 5 s IPTC group in aged rats was (63.5±5.4)%,and PKCα expression reduced in aged rats (all P<0.05)].Conclusions IPTC has cardio-protective effect in aged rats suffering from acute myocardial injury during reperfusion,the effect of IPTC is related to reperfusion-reocclusion interval.

Expression of vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 in rat bone marrow mesenchymal stem cells / 中国组织工程研究

BACKGROUND: Following bone marrow mesenchymal stem cells (BMMSCs) infusion therapy, which factor promotes BMMSCs migrated to correct position is a key point, currently, adhesion molecule is thought to be playing an important role in mediating BMMSCs migration. OBJECTIVE: To investigate the expression of vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1) in rat BMMSCs. METHODS: BMMSCs were in vitro separated from rat bone marrow by directly adherence method. The expression of VCAM-1 and ICAM-1 were identified by using immunocytochemical staining, and the expression rates of antigen were tested by flow cytometry, in addition, their mRNA expressions were measured by RT-PCR. RESULTS AND CONCLUSION: Immunocytochemistry demonstrated that BMMSCs weakly expressed VCAM-1, but strong expressed ICAM-1. Flow cytometry showed that the expression rate of VCAM-1 was 6%, and the expression rate of ICAM-1 was 100%. RT-PCR showed that BMMSCs expressed a low level of VCAM-1 mRNA but a high level of ICAM-1 mRNA. It revealed under physiological condition, BMMSCs expressed a low level of VCAM-1, whereas they expressed a high level of ICAM-1.

Differentiation potential of monocytes into lymphatic endothelial cells / 中国组织工程研究

BACKGROUND:Previous studies have shown that monocytes can transdifferentiate into vascular endothelial cells under the induction of various factors including vascular endothelial growth factor(VEGF).It remains poorly understood whether monocytes can be induced to transdifferentiate into lymphatic endothelial cells in vitro.OBJECTIVE:To explore the possibility of the transdifferentiation of monocytes into lymphatic endothelial cells under inflammatory condition.METHODS:Fresh monocytes from peripheral blood were collected by Ficoll density gradient centrifugation and cultured in an endothelial cell medium,followed by incubation in fibronectin-plated well or treated with tumor necrosis factor a for 24 hours,respectively.The expression of specific markers of lymphatic endothelial cells,such as LYVE-1,Podoplanin,Porx-1 and VEGF receptor 3(VEGFR-3),as well as the endothelial cells markers,such as vWF,endothelial nitric oxide synthase(eNOS)and VEGFR-2,were detected by RT-PCR and immunochemical methods.RESULTS AND CONCLUSION:Prior to induction,monocytes were positive to LYVE-1,but negative for Podoplanin,Porx-1,and VEGFR-3,vWF,eNOS,as well as VEGFR-2.Following induction,the cultured mononcytes were positive for Podoplanin,Prox-1 and VEGFR-3,but remained negative for vWF,eNOS and VEGFR-2.It suggested that monocytes can be induced to express the markers of lymphatic endothelial cells stimulated by fibronectin or tumor necrosis factor a.

Influence of aging on the expressions of Bcl-2 and Bax protein in rat hearts after acute myocardial infarction / 中华老年医学杂志

Objective To compare the influence of aging on apoptosis and the expression of apoptosis-related protein in adult and aged male Wistar rat hearts after acute coronary artery occlusion. Methods The acute myocardial infarction rat model was established by left anterior descending(LAD)occlusion.A total of 115 adult and aged rats,aged 6-24 months,were included in the study.The rats were divided into 4 groups:aged model group,aged control group,adult model group and adult control group.Animals were killed 1,3,5 hours,1 and 7 days after coronary occlusion.Hemodynamic parameters[heart rate(HR),left ventricular systolic pressure(LUSP),left ventricular end-diastolic pressure(LVEDP),±dp/dtmax)]were obtained from each group at every time points.The apoptosis and necrosis of myocardium were detected with TUNEL way and TTC stain.The expressions of Bcl-2 and Bax were analyzed with immumohistochemical stain. Results DNA fragmentation occured 1 hour after coronary occlusion and apparently peaked earlier in the aged than in the adult rat hearts.At 3 hour,the apoptotic index of aged model group was obviousily higher than that in adult model group[(51.90±23.15)%us.(18.67±17.15)%,P<0.01].The basal levels of Bcl-2 and Bax were higher in the aged than in the adult rat hearts.The expression of Bcl-2 in aged model group and adult model group were 2.7±0.9 and 1.8±0.8,P<0.05.The expression of Bax in aged model group and adult model group were 6.2±2.9 and 4.2±1.5,P<0.05. Conclusions The ability of aged rats to resist ischemia is poor,aging may alter the expressions of Bcl-2 and/or Bax,increase cardiomyocyte apoptosis,thereby,enhance the myocardial dysfunction during acute myocardial infarction.

TNF-? accelerates the adhesion of MSCs in the ischemia hepatic tissue / 中国现代普通外科进展

Objective: To study the influence of inflammatory cytokine TNF-? on the expression of adhesion molecules and specific markers of rat MSCs, and to study the optimal stimulation of MSCs with inflammatory factors in inducing adhesion molecule expression which promotes migration of MSCs to the ischemic area in liver. Methods: The MSCs stimulated with different concentration of TNF-? were detected for adhesion molecules and stem cells markers on cell surface with the method of flow-cytometry, MSCs which were stimulated with the optimal concentration of TNF-? and labeled with 1, 1-Dioctadecyl-3, 3, 3, 3-tetramethylindocarbocyanine Iodade(DiI)were delivered intravenously to the rats whose liver was injured by ischemia, the liver function of the experimented animals were tested, and liver samples in the ischemic area were obtained, the number of MSCs was counted under a fluorescent microscope. Results: Stimulated with TNF-?, MSC ex-pression of VCAM-1 increased, while that of stem cell markers did not change markedly. Exposed to lower concentration of TNF-?, the adhesion ability of MSCs obviously increased and more MSCs rested in the ischemic areas in the rat liver, compared to the control groups. Conclusions: TNF-? can increase the expression of VCAM-1 on rat MSCs while exert little effect on the stem cell character of MSCs. Suitable concentration of TNF-? can promote MSCs migration to the damaged tissue, which provides rationale for the treatment of liver disease.