The relationship between serum klotho and cognitive performance in a nationally representative sample of US adults.

Purpose: Aging is the primary risk factor for cognitive decline. Serum klotho, as an anti-aging protein, may be involved in cognitive decline. Thus, we aim to explorer the correlation between serum klotho and cognitive performance among an older adult population in the United States. Methods: We performed a cross-sectional study using data from NHANES 2011-2014. Serum klotho was analyzed by ELISA. Cognitive function was measured by Establish a Registry for Alzheimer's Disease (CERAD) test, Animal Fluency test and Digit Symbol Substitution Test (DSST) score. The relationship between serum klotho and cognition was analyzed by a multivariable regression model. Results: A total of 2,171 participants aged 60-79 years were included. Median serum klotho concentration was 851.52 pg./ml (SD = 294.07). We also categorized serum klotho concentrates into quartiles. After fully adjusting pertinent variables, compared to those with lowest klotho levels (206.3-658.4 pg./ml), individuals with highest klotho concentrates (983.3-3,456 pg./ml) had a higher CERAD score [ß (95%CI): 0.97 (0.25, 1.69) p = 0.008] and DSST score [ß (95%CI): 1.86 (0.25, 3.47), p = 0.024]. Conclusion: Our findings indicated that, among the general population of American older adults, serum klotho concentrates may serve as a marker of cognitive health. The benefits of klotho on aging process and neurodegenerative disorders should be paid more attention.

Activity of curcumin against human cytomegalovirus infection in vitro / 生物医学工程学杂志

This study aimed to investigate the effect of curcumin (Cur) against human cytomegalovirus (HCMV) in vitro. Human embryonic lung fibroblasts were cultured in vitro. The tetrazolium salt (MTS) method was used to detect the effects of Cur on cell viability. The cells were divided into control group, HCMV group, HCMV + (PFA) group and HCMV + Cur group in this study. The cytopathic effect (CPE) of each group was observed by plaque test, then the copy number of HCMV DNA in each group was detected by quantitative polymerase chain reaction (qPCR), and the expression of HCMV proteins in different sequence was detected by Western blot. The results showed that when the concentration of Cur was not higher than 15 μmol/L, there was no significant change in cell growth and viability in the Cur group compared with the control group (P>0.05). After the cells were infected by HCMV for 5 d, the cells began to show CPE, and the number of plaques increased with time. Pretreatment with Cur significantly reduced CPE in a dose-dependent manner. After the cells were infected by HCMV, the DNA copy number and protein expression gradually increased in a time-dependent manner. Pretreatment with Cur significantly inhibited HCMV DNA copies and downregulate HCMV protein expression levels in a concentration-dependent manner, and the difference was statistically significant (P<0.05). In conclusion, Cur may exert anti-HCMV activity by inhibiting the replication of HCMV DNA and down-regulating the expression levels of different sequence proteins of HCMV. This study provides a new experimental basis for the development of anti-HCMV infectious drugs.

Nutritional status of elderly inpatients in China: a multicenter survey / 中华老年医学杂志

Objective:To investigate the nutritional status of elderly inpatients in China, and to assess its relationship with clinical outcomes.Methods:A prospective, multicenter, parallel investigation was organized and conducted by the Chinese Medical Association's Group of Geriatric Nutrition Support.Patients aged ≥65 years from 30 major hospitals of 14 cities in China were evaluated by the Nutritional Risk Screening 2002(NRS2002)and the Mini-Nutritional Assessment-Short Form(MNA-SF), in order to understand the nutritional status and nutritional risk of elderly inpatients in China.The indicators of clinical outcomes were summarized, and the correlation between nutritional status and clinical outcomes was analyzed.Results:A total of 10 184 elderly patients who met the inclusion criteria were enrolled in this study, aged 65-112(74.81±7.01)years, with a body mass index(BMI)of 17.80-35.50(23.32±3.83)kg/m 2.Grip strength of the dominant hand was(16.95±18.42)kg, upper arm circumference was(25.68±3.70)cm, and calf circumference was(32.07±3.89)cm.BMI, grip strength, upper arm circumference and calf circumference decreased significantly with age( F=13.74, 97.47, 28.31 and 88.68, all P<0.001). NRS2002 was conducted on 10 182 patients.Of them, 10.14%(895/10 182)suffered malnutrition(BMI≤18.5 kg/m 2), and 46.42%(4 726/10 182)were at nutritional risk(NRS2002 score≥3). Nutrition deficiency and nutritional risk showed upward trends with age( F=43.41 and 177.05, both P<0.001). A total of 9 755 patients(95.79%, 9 755/10 182)completed the MNA-SF.Of them, 14.67%(1 431/9 755)had malnutrition, 35.04%(3 418/9 755)were at risk of malnutrition, and 50.29%(4 906/9 755)had normal nutritional status.The incidence of malnutrition and the risk of malnutrition significantly increased with age( F=172.79, 12.10 and 152.42, all P<0.05). Nutritional risk(NRS2002 score≥3)was related to age, BMI, mortality, infectious complications, length of hospital stay and total hospital cost(all P<0.05). Conclusions:The incidence of malnutrition and the risk of malnutrition are high in elderly inpatients in China.Nutritional risk is an influencing factor for adverse clinical outcomes.

The Association Between Leukocyte Telomere Length and Cognitive Performance Among the American Elderly.

BACKGROUND: Age-related cognitive decline begins in middle age and persists with age. Leukocyte telomere length (LTL) decreases with age and is enhanced by inflammation and oxidative stress. However, whether shorter LTL correlates with cognitive decline remains controversial. AIMS: We aimed to investigate the relationship between LTL and cognitive decline in the American elderly. METHODS: We used data from the 1999 to 2002 U.S. National Health and Nutrition Examination Survey (NHANES). We included participants aged 65-80 with available data on LTL and cognitive assessments. The cognitive function assessment used the digit symbol substitution test (DSST). We applied multivariate modeling to estimate the association between LTL and cognitive performance. Additionally, to ensure robust data analysis, we converted LTL into categorical variables through quartile and then calculated the P for trend. RESULTS: After adjusting for age, cardiovascular disease (CAD) score, gender, race, body mass index (BMI), and educational level, LTL showed a positive correlation with DSST score (odds ratio [OR] 3.47 [0.14, 6.79], P = 0.04). Additionally, to further quantify the LTL-DSST interaction, we found a similar trend when LTL was regarded as a categorical variable (quartile) (P for trend = 0.03). CONCLUSION: LTL was associated with cognitive capabilities among the elderly, implying that LTL might be a biomarker of cognitive aging.

Mesenchymal stem cells in experimental autoimmune encephalomyelitis model of multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND/AIMS: Mesenchymal stem cells (MSCs) transplantation has been considered a possible therapeutic method for Multiple Sclerosis (MS). However, no quantitative data synthesis of MSCs therapy for MS exists. We conducted a systematic review and meta-analysis to evaluate the effects of MSCs in experimental autoimmune encephalomyelitis (EAE) animal model of MS. METHODS: We identified eligible studies published from January 1980 to January 2017 by searching four electronic databases (PubMed, MEDLINE, Embase and Web of Science). The outcome was the effects of MSCs on clinical performance evaluated by the EAE clinical score. RESULTS: 36 preclinical studies including 675 animals in MSCs treatment group, and 693 animals in control group were included in this meta-analysis. We found that MSCs transplantation significantly ameliorated the symptoms and delayed the disease progression (SMD = -1.25, 95% CI: -1.45 to -1.05, P < 0.001). However, no significant differences in effect sizes were unveiled relative to clinical score standard (P = 0.35), type of MSCs (P = 0.35), source of MSCs (P = 0.06), MSCs dose (P = 0.44), delivery methods (P = 0.31) and follow up period (P = 0.73). CONCLUSIONS: The current study showed that MSCs transplantation could ameliorate clinical performance in EAE animal model of MS. These findings support the further studies translate MSCs to treat MS in humans.

Exploration of influencing factors for comprehensive geriatric assessment carried out in geriatric departments of comprehensive hospitals in Sichuan province / 中华老年医学杂志

Objective To investigate influencing factors for comprehensive geriatric assessment carried out in geriatric departments of comprehensive hospitals in Sichuan province and its influential factors ,in order to verify whether education affects CGA and to raise medicine quality of senile disease. Methods The self-designed questionnaires were distributed to 40 hospitals in difference downs and cities in Sichuan province. The data were collected ,including items of CGA carried out in each hospital ,structure of staff ,scale ,bed distribution ,numbers of bed in geriatric department ,etc. The correlations of CGA items with the related factors were analyzed by using multiple linear regression analysis. Results The items of CGA carried out was positively related with hospital grade (β= -5.4 ,P=0.03) ,the staff-attending three times or more of geriatric training course (β=0.2 ,P=0.05) , the number of nurses per bed(β=15.6 ,P=0.03) ,the number of physicians with master's degree(β=-0.2 ,P=0.04) ,and the lower average age of medical staff (β= -0.6 ,P=0.05). Conclusions The grade of hospital ,attending actively geriatric training course ,the number of the nurses per bed ,the number of physicians with master's degree ,and the younger average age of medical staff were positively associated with the items of CGA carried out in hospitals.

The validity and reliability of the Chinese version of 3D-CAM for the detection of delirium in the elderly / 中华老年医学杂志

Objective To translate the 3-minute diagnostic confusion assessment method(3D-CAM)into Chinese,to revise it,and to test its reliability and validity in elderly patients.Methods We translated and culturally adapted 3D-CAM into Chinese.The sample was formed by 230 elderly patients over 65 years of age.We tested inter-assessors reliability and criterion validity (diagnostic validity)and then computed the sensitivity,specificity,positive predictive value,and negative predictive value of the Chinese version of 3D-CAM.Results Correlation analyses between each item and its total score showed that the correlation coefficients ranged between 0.290 and 0.724,all reaching statistical significance(P＜0.01).Inter-assessor reliability in a sample size of 30 patients resulted in a kappa value of 0.78 (P ＜ 0.001).Compared with the gold standard,the diagnostic and statistical manual of mental disorders(DSM-5)by American Psychiatric Association(APA),the sensitivity of the Chinese version of 3D-CAM was 94.73％,the specificity was 97.92％,the positive predictive value was 90.00％,and the negative predictive value was 98.95％.Conclusions The Chinese version of 3D-CAM has achieved satisfactory reliability and validity through pilot runs in surgery and internal medicine inpatients,proved to be easy and convenient to administer,and can be used as an assessment tool for delirium in elderly surgery and internal medicine patients.

Association of frailty syndrome with serum inflammatory biomarkers and geriatric parameters / 中华老年医学杂志

Objective To investigate the association of frailty with serum inflammatory biomarkers and geriatric parameters.Methods A total of 299 elderly people aged 60 and over were recruited,received frailty and comprehensive geriatric assessment,and were tested on serum levels of interleukin-10 (IL-10),interleukin-1β (IL-1β),monocyte chemoattractant protein-1 (MCP-1),monocyte chemoattractant protein-3 (MCP-3),macrophage inflammatory protein 1a (MIP-1α),macrophage inflammatory protein-1β (MIP-1β),tumor necrosis factor α (TNF-α),nuclear factor-κB (NF-κB) and sirtuin-1 (SIRT-1).Potential association of frailty with these biomarkers and several geriatric parameters was analyzed.Results Statistical differences in serum levels of MCP-1,MIP-1α and MIP-1β were detected between the frailty group and the non-frailty group (H=10.766,10.766 and 8.217,respectively;P =0.005,0.043 and 0.016,respectively).Logistic regression analyses showed that MCP-1 and MIP-1β were associated with frailty after adjustment for age,sex,body mass index (BMI),smoking,drinking,comorbidity and comprehensive geriatric assessment (OR=2.493,2.531,both F＜0.05).Conclusions MCP-1 and MIP-1β are risk factors for frailty.

New perspective of the international geriatric medicine: Acute care for the elderly / 中华老年医学杂志

Older patients often experience a loss of physical,cognitive and social functioning during an acute illness-caused hospitalization.The loss of function could be due to a traditional model of hospital care,which focuses only on diagnosis and treatment of acute disease.Restoration of elderly patients' lost functions is important for better prognosis of hospitalized elderly patients and would reduce the cost of additional medical treatment.Acute care for the elderly (ACE) is a new model of care aiming at function restoration by practicing a geriatric assessment in the special ACE unit of hospital.The ACE intervention includes interdisciplinary team rounds,discharge planning of hospital,medical care review,a prepared environment,and patient-centered care.Multiple randomized control trials have demonstrated that ACE unit can improve the functional status and prognosis of old patients,reduce the cost of hospitalization,and improve patients' satisfaction.Currently,ACE care model is poorly known by Chinese hospitals and doctors.This article introduces the concepts of ACE unit,technical elements and the clinical evidence of its effectiveness.

An 11-site cross-section survey on the prevalence of nutritional risk, malnutrition (undernutrition) and nutrition support among the diagnosis-related group of elderly inpatients younger than 90 years old with coronary heart disease in North and Central China / 中华临床营养杂志

Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.

Current research progress on mouse model of frailty / 中华老年医学杂志

Frailty is a common state or syndrome with a decline in physiological reserves and an increase in an individual's vulnerability for stress in the elderly.Frailty can increase the risk of disability,falls,hospitalization,delirium and mortality.However,the intervention of frailty is under the scarcity and its effectiveness is not satisfied.We need to find new targets to treat frailty according to the pathophysiology of frailty.Human physiology is very similar to that of mouse,thus,mouse can be an ideal animal model of human disease.Mouse models can provide insight into pathogenesis of frailty by reducing the influence of genetic and environment factors and provide more basic data for further studies of frailty.At present,the research on a mouse model of frailty is still in its infancy and still needs further study.This review will summarize the related studies and propose some new ideas for future studies on mouse model of frailty.

Intervention researches on frailty / 中华老年医学杂志

Frailty is an age-related non-specificity status caused by a decline of physiological reservation,which leads to an increase of vulnerability in body and decrease of ability in stress resistance.The pathophysiology of frailty involves multiple systems including neuromuscular system,metabolism and immune system.Studies have showed that frailty is closely related with negative events of elder people.People with frailty are subject to higher risks for fall,hospitalization,and mortality.However,the development of frailty can be delayed if early prevention or interventions are performed.Prospective cohort studies have showed that the risk factors for frailty include age,gender,family history of obesity,BMI,waist circumference,blood pressure,hyperglycemia,smoking and lack of exercise.Among them,nutrition,exercise and therapeutic drugs are hot spots in prevention study.Here,we reviewed the intervention studies by focusing on nutrition,exercise and therapeutic drugs in frail population.

Evidence-based screening for abdominal aortic aneurysms in elderly / 中华老年医学杂志

Abdominal aortic aneurysms(AAAs) is the most common aneurysm,and usually characterized by less symptom.While ruptured AAAs leads to high mortality.Abdominal ultrasonography can effectively detect AAA,decrease the AAAs-related mortality.However,screening AAAs causes some adverse outcomes,including psychological distress and immediate harms in treatment.Meanwhile,the prevalence of AAAs in sex and age is significantly different.Therefore,a reasonable and effective screening strategy is very important.This article search random control trials,systematic reviews,meta-analysis and guidelines in screening AAAs to obtain a reasonable screening strategy.

Disability in older adults: a review of current research / 中华老年医学杂志

Disability is one of the common geriatric syndromes.Researches addressing elderly disability are still in starting stages.Both opportunities and challenges occur in this field.In this review,we summarized the definition and diagnostic criteria popular assessment tools for the diagnosis of elderly disability,the disease burden and relevant studies regarding elderly disability.

Advances of Research on Ataxia Telangiectasia Mutated Gene and Risk Factors of Cardiovascular Disease / 生物医学工程学杂志

Cardiovascular disease is a severe threat to human health and life. Among many risk factors of cardiovascular disease, genetic or gene-based ones are drawing more and more attention in recent years. Accumulated evidence has demonstrated that the loss or mutation of ataxia telangiectasia mutated (ATM) gene can result in DNA damage repair dysfunctions, telomere shortening, decreased antioxidant capacity, insulin resistance, increased lipid levels, etc., and thus can promote the occurrence of cardiovascular risk factors, such as aging, atherosclerosis and metabolic syndrome. In this review, we discusses the possible mechanisms between ATM gene and cardiovascular risk factors, which could be helpful to the related research and clinical application.

High prevalence of obstructive sleep apnea in Marfan's syndrome / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To review the current evidence about the prevalence of obstructive sleep apnea in patients with Marfan's syndrome, and discuss some proposed potential mechanisms for this relationship.</p><p><b>DATA SOURCES</b>The data in this review were mainly from Medline and PubMed articles published in English from 1990 to 2013. The search term was "Marfan's syndrome and sleep apnea".</p><p><b>STUDY SELECTION</b>Clinical evidence about the epidemiology of obstructive sleep apnea in patients with Marfan's syndrome; the mechanism that causes obstructive sleep apnea; interventional therapy for patients with Marfan's syndrome, and coexisting obstructive sleep apnea.</p><p><b>RESULTS</b>A high prevalence of obstructive sleep apnea exists in patients with Marfan's syndrome. The potential reasons are craniofacial abnormalities and lax upper airway muscles, which lead to high nasal airway resistance and upper airway collapse. Obstructive sleep apnea mechanically deteriorates aortic dilatation and accelerates progression of aortic aneurysms. The condition is reversible and rapid maxillary expansion and adequate continuous positive airway pressure therapy are possible effective therapies to delay the expansion of aortic diameter in patients with Marfan's syndrome.</p><p><b>CONCLUSIONS</b>Obstructive sleep apnea is strongly associated with Marfan's syndrome. Craniofacial abnormalities and lax upper airway are the main mechanisms. Untreated obstructive sleep apnea accelerates progression of aortic dissection and rupture. Effective therapies for obstructive sleep apnea could postpone the aortic dilatation in patients with Marfan's syndrome.</p>

Effects of simvastatin on lower urinary tract symptoms in patients with metabolic syndrome coexisting with benign prostate hyperplasia / 中华老年医学杂志

ObjectiveTo determine whether simvastatin alleviates lower urinary tract symptoms (LUTS) in patients with metabolic syndrome (MS) coexisting with benign prostate hyperplasia (BPH) and explore an optimized scheme of treatment. MethodsFrom February to June in 2011,30 male subjects with MS and LUTS caused by BPH in out-patients and in-patients from geriatric department were recruited.The patients were randomly assigned to receive orally simvastatin (40 mg) and tamsulosin (0.2 mg) quaque noete as combination treatment group or only tamsulosin (0.2 mg,quaque nocte) as single treatment group for 8 weeks.International prostate symptoms score (IPSS),quality of life (QOL),maximum flow rate (MFR) and prostate volume (PV),liver enzymes,creatinine and routine urine test were monitored to evaluate the effectiveness and safety before and after the treatment.Results In the two groups,the significant differences were found in the levels of IPSS,QOL and MFR,while there was no difference in PV between pre-treatment and post-treatment.The scores of IPSS after treatment were (6.4 ± 4.4) in combination treatment group and(4.2±3.3)in single treatment group (P＜0.05),and there were significant difference in scores of IPSS before and after the treatment between two groups (P＜0.05),suggesting better improvement in combination treatment group than in single treatment group.In two groups,there were no adverse events,and no changes were found in liver and kidney function,muscle enzymes and routine urine test.Conclusions Combined tamsulosin and simvastatin treatment may alleviate LUTS caused by BPH and are well tolerated with no adverse events.