Clinical Characteristics of Elderly Patients with COVID-19 in Hunan Province, China: A Multicenter, Retrospective Study.

BACKGROUND: The aim of this study was to analyze and summarize the clinical characteristics of elderly patients with coronavirus disease 2019 (COVID-19) and compare the differences of young-old patients (60-74 years old) and old-old patients (≥75 years old). METHODS: In thisretrospective, multicenter study, the medical records of elderly patients who were diagnosed with COVID-19 in Hunan province, China, from January 21 to February 19, 2020 were reviewed. The characteristics of young-old patients and old-old patients were compared. RESULTS: Of the 105 elderly patientsconfirmed withCOVID-19, 81.0% were young-old patients, and 19.0% were old-old patients; 54.3% of elderly patients were females. Overall, 69.5% of elderly patients had underlying diseases, and the most common comorbidities included hypertension (43.8%), diabetes (25.7%), and cardiac disease (16.2%). Of the elderly patients, 22.9% were severe and 10.5% were critical severe cases. On admission, the most frequent symptoms in elderly patients included fever (66.7%), cough (64.8%), and fatigue (33.3%). Lymphopenia (31.4%), increased D-dimer (38.1%), depressed albumin (36.2%), elevated lactate dehydrogenase (41.0%), and a high level of C-reactive protein (79.0%) were common among elderly patients with COVID-19. The median prothrombin time (PT) and the activated partial thromboplastin time (APTT) were longer in old-old patients than young-old patients (PT median 12.3 vs. 13.1 s, p = 0.007; APTT median 39.0 vs. 33.5 s, p = 0.045). Young-old patients showed fewer complications (14.1%) than old-old patients (40.0%; p = 0.0014) and fewer received invasive ventilator support (3.5 vs. 25.0%, p = 0.006). As of March 11, 2020, 85.7% of elderly patients had been discharged, 3 deaths had occurred, and 11.4% were still hospitalized. CONCLUSIONS: Elderly patients usually have chronic medical illness and are likely to have a severe or critically severe condition. They could show atypical symptoms without fever or cough and multiple organ dysfunction. Old-old patients tend to have more complications than young-old patients during hospitalization. Careful nursing, observation, and systemic treatment are very important in elderly patients.

[Protection of noninvasive limb ischemic preconditioning on myocardium in patients undergoing heart valve surgery under cardiopulmonary bypass].

OBJECTIVE: To determine the mechanism of protective effect of noninvasive limb ischemic preconditioning (NIPC) on myocardium of patients with rheumatic heart disease undergoing heart valve surgery under cardiopulmonary bypass (CPB). METHODS: A total of 32 patients with rheumatic heart disease undergoing heart valve surgeries under CPB were randomly divided into 2 groups: a control group(n=16)and an NIPC group(n=16).Tourniguet was used for each patient in the NIPC group around both the upper extremities in turn, inflated for 8 min and deflated for 5 min for 3 cycles. After the anesthesia, the remaining procedures were the same as in the control group. Blood samples were collected from the central vein after the induction of anesthesia (T(1)), 5 min before aortic clamp (T(2)),30 min after aortic opening (T(3)), 6 h after the operation (T(4)), and 24 h after the operation (T(5)) to measure the concentration of cardiac troponin I and creatine kinase MB in the plasma and CGRP and ET-1 in the serum. Pathologic change of the right auricle of the heart tissue during the superior vena cave intubation and extubation was detected. RESULTS: The content of cardiac troponin I and creatine kinase MB at T(4) and T(5) in the 2 groups was higher than that of other time points in the same group, and it reached the peak at T(5). Comparison of the content of cardiac troponin I and creatine kinase MB at T(4) and T(5) in the 2 groups showed significant difference, and that of the NIPC group was lower than the control group(P<0.05).CGRP and ET-1 contents reached the peak at T(2) in the NIPC group and at T(3) in the control group, but the peak of CGRP in the NIPC group was higher than that in the control group(P<0.01).The peak of ET-1 content in the NIPC group was lower than that in the control group(P<0.01). After the CPB, myocardial and mitochondrion impairment was lighter in the NIPC group than in the control group. CONCLUSION: Noninvasive limb ischemic preconditioning can protect the myocardium through increasing CGRP, inhibiting ET-1, and advancing the peak of CGRP and ET-1.

Effect of morphine preconditioning on mitochondrial permeability transition pore after myocardial ischemia-reperfusion injury in rats.

OBJECTIVE: To investigate the effect of morphine preconditioning on mitochondrial permeability transition pore (MPTP) and its protective mechanism after myocardial ischemia-reperfusion injury. METHODS: A rat model of ischemia-reperfusion injury was established. Forty rats were injected with 2-(3)[H] DOG and then divided into 4 groups randomly: a sham operation (S) group, an ischemia-reperfusion injury (IR) group, a morphine preconditioning (Mp+IR) group, and a cyclosporine A preconditioning (CsA+IR) group. We monitored the concentrations of serum creatine kinase-Mb (CK-Mb) and cardiac troponin I (cTnI), and measured myocardial mitochondrial 2-(3)[H] DOG, cytochrome c content, Ca(2+) concentration ([Ca(2+)]m), the velocity of Ca(2+) intake and reaction half time of mitochondrial permeability transition pore (MPTP t(1/2)) in the 4 groups. RESULTS: The concentrations of serum CK-Mb and cTnI decreased more in the Mp+IR group and the CsA+IR group than those of the IR group. The concentrations of 2-(3)[H]DOG and [Ca(2+)]m in the IR group were evidently higher but the level of cytochrome c was lower than those of the sham operation group. The concentrations of 2-(3)[H] DOG and [Ca(2+)]m in the Mp+IR group decreased whereas the concentration of cytochrome c increased compared with those in the IR group. Mitochondrial 2-(3)[H]DOG content was positively correlated with the concentration of calcium (r=0.797, P<0.01). The 2-(3)[H]DOG and [Ca(2+)]m content were negatively correlated with cytochrome c in the IR group (r=-0.805 and r=-0.648, respectively, P<0.01). MPTP t(1/2) in the IR group was shortened evidently, and that in the Mp+IR and CsA+IR group was significantly lengthened. CONCLUSION: Morphine preconditioning may have myocardial protective effect through unburdening the calcium overload and lengthening the MPTP t(1/2).

[Value of promoter methylation of RASSF1A, p16, and DAPK genes in induced sputum in diagnosing lung cancers].

OBJECTIVE: To determine the aberrant methylation status of RASSF1A,p16 and DAPK gene promoter region in induced sputum from lung cancer patients and the value of their combined detection in diagnosing lung cancers. METHODS: Methylation-specific PCR (MSP) was used to detect the promoter methylation status of RASSF1A, p16, and DAPK genes in induced sputum and pathological tissues from 82 patients with lung cancers and 25 patients with pulmonary benign lesion. We also analyzed the relation between methylation status and clinical pathological data. RESULTS: The positive rates of promoter methylation of RASSF1A, p16, and DAPK genes in pathological tissues from patients with lung cancers were 63.4%, 59.8%, and 58.5%, respectively,and those in induced sputum were 54.9%, 48.8%, and 51.2%, respectively. The promoter methylation of RASSF1A,p16, and DAPK genes were not detected in patients with pulmonary benign lesion. There was a significant difference between the lung cancer group and pulmonary benign lesion group (P<0.05). The methylation rate of RASSF1A gene was significantly lower in the middle and high differentiation and non-metastastic lymph node of lung cancer tissues than that in the poor differentiation and the metastatic lymph node of lung cancer tissues(P<0.05), and was not correlated with age, sex, smoking index, clinical stage, and pathological types.The methylation rate of p16, and DAPK genes was not significantly correlated with all the above mentioned factors (P>0.05). The methylation rate of joint detecting RASSF1A, p16, and DAPK genes was 73.2%. CONCLUSION: Joint detection for promoter hypermethylation of RASSF1A, p16, and DAPK genes in induced sputum may be used as a simple and effective index of the diagnosis and prognose of lung cancers, and can improve the positive rate.

[Expression of VHL and HIF-1alpha and its clinical significance in the lung cancer tissue].

OBJECTIVE: To investigate the expression of von Hippel-Lindau (VHL) protein and hypoxia inducible factor-1alpha (HIF-1alpha) in the lung cancer tissue and to detect their clinical significance. METHODS: EnVisionTM immunohistochemistry was used for detecting the expression of VHL and HIF-1alpha in routinely paraffin-embedded sections from the specimens of lung cancer (n=80) and normal lung tissues (n=20). We also analyzed the relation between the expression of VHL and HIF-1alpha and the clinical stage,differentiation,and with or without lymphatic metastasis. RESULTS: The positive rate of VHL was significantly lower in lung cancer (56.3%) than that in normal lung tissues (90.0%)(P<0.01).The positive rate of HIF-1alpha was significantly higher in lung cancer (65.0%) than that in normal lung tissues (20.0%)(P<0.01). The positive rate of VHL was significantly higher in the middle and high-differentiated, StageI~II, and no-metastasis of lymph node lung cancer tissues than that in the poorly-differentiated, Stage III~IV, metastasis of lymph node lung cancer tissues (P<0.01~0.05) .But the expression of HIF-1alpha in the lung cancer tissues was just the opposite as compared with that of VHL (P<0.05) .VHL and HIF-1alpha expression levels showed highly negative correlation (P<0.01). CONCLUSION: The expression of VHL and HIF-1alpha may be important biological markers for carcinogenesis, progression, clinical biological behaviors, and prognosis of lung cancer.

Expression of ubiquitin and cullin-1 and its clinicopathological significance in benign and malignant lesions of the lung.

OBJECTIVE: To investigate the expression of ubiquitin and cullin-1 (cul-1) in benign and malignant lesions of the lung and to determine their clinicopathological significance. METHODS: EnVison immunohistochemistry was used to detect the expression of ubiquitin and cul-1 in the conventional paraffin-embedded sections from the specimens of lung cancer (n = 80) and benign lesion tissues of the lung (n = 20). We also analyzed the relation of the expression of ubiquitin and cul-1 with the clinical stage, differentiation, and with or without lymphatic metastasis. RESULTS: The positive rates of ubiquitin and cul-1 were significantly higher in lung cancer (51.3% and 60.0%) than those in benign lesion tissues of the lung (20.0% and 30.0%; P < 0.05). Positive rates of ubiquitin and cul-1 were all significantly lower in the middle and high-differentiated, Stage I approximately II, and no lymphatic metastasis patients with lung cancer than those in no- or low-differentiated, Stage III approximately IV, and lymphatic metastasis patients with lung cancer tissues (P < 0.01 approximately 0.05). High consistency was found between the positive expression of ubiquitin and cul-1 in lung cancer tissues (chi(2) = 4.04, P < 0.05). CONCLUSION: Expression of ubiquitin and cul-1 in lung cancer tissues may be closely related to the carcinogenesis, progression, clinical biological behaviors, and prognosis of lung cancer.

[Study of gene expression difference in lung carcinogenesis by cDNA microarray].

BACKGROUND & OBJECTIVE: Lung cancer is a kind of disease with high incidence and mortality, however its molecular mechanism is not clear yet. This study was designed to investigate gene expression differences among lung cancer tissues, lung paracancerous tissues,matched peripheral normal lung tissues and the metastases of lymph nodes, and to seek the relatively high expressed genes in lung carcinoma tissues, providing possible theoretical basis for early diagnosis and treatment of pulmonary carcinoma. METHODS: Fresh lung cancer tissue, lung paracancerous tissue, matched normal lung tissue and metastases of lymph nodes were deep-frozen in liquid nitrogen; their total RNA were extracted for reversed transcription cDNA probes, which were labeled and subsequently used to hybridize with cDNA microarray with 588 genes. Different gene expression profiles were obtained by analyzing the integrated density (ID) of spot images on the X-ray. RESULTS: In lung cancer tissues, 40 genes were detected to be differentially expressed, 36 of which such as early growth response protein 1 (EGR1), secreted apoptosis related protein 1 (SARP1) were upregulated while the others such as myeloid cell leukemia protein 1 (MCL1) were downregulated. The upregulated genes were mainly oncogene/suppressor gene, cell cycle regulatory gene, growth factors and apoptosis-related genes. In lung paracancerous tissues, 33 genes had different expression, 20 of which such as matrix metalloproteinase-9 (MMP-9) were upregulated, and the other 13 such as MCL1,endothelin 2 (ET2) were downregulated. In metastases of lymph nodes, there were 21 genes found to be differently expressed, 15 of which such as CD40 receptor-associated factor 1 (CRAF1) were downregulated while the rest were upregulated, and the upregulated genes (6 in 15) were mainly the genes associated with adhesion molecules, matrix metalloproteinases and collagen. CONCLUSION: EGR1, SARP1, NDKA, etc. may be the key genes in pulmonary carcinogenesis course. At the same time, MMP9, thrombospondin 2 (TSP2), etc.may play an important role in pulmonary cancer metastasis and infiltration.

[Clinical value of hypertonic glucose injection in the treatment of recurrent pneumothorax].

OBJECTIVE: To investigate the clinical value of the 50% hypertonic glucose injection in the treatment of recurrent pneumothorax. METHODS: Forty-five patients with recurrent pneumothorax were injected with 60-80 ml of 50% hypertonic glucose into the pleural cavity after air discharge and then were instructed to turn their body to the right and the left quickly. RESULTS: The curative rate was 100% and the curative effect was satisfactory. There was no other complication except for slight stimulative chest pain in 7 patients. The recurrent rate was 4.4% in a 2-7 year follow-up. CONCLUSION: Treating recurrent pneumothorax with the 50% hypertonic glucose injection is safe, effective, and less recurrent.

[Expression of MMP1 and TIMP1 proteins in lung cancer and its biological significance].

OBJECTIVE: To investigate the expression of MMP1 and TIMP1 proteins in lung cancer tissues and its biological significance. METHODS: MMP1 and TIMP1 proteins were detected with the immunohistochemical method of avidin-biotin complex in formalin-fixed and routinely paraffin-embeded specimens of 46 patients. RESULTS: There was no correlation in MMP1 protein expression between normal lung tissues (20%) and lung cancer (52.2%); The positive rate of TIMP1 protein expression was significantly lower in lung cancer (41.3%) than that in normal lung tissues (80%); There was a significant correlation among MMP1 and TIMP1 protein expression and differentiation, TNM stages, and lymph node metastases of lung cancer. There was a significant negative correlation between MMP1 and TIMP1 protein expressions in lung cancer. CONCLUSION: There is a correlation between MMP1 and TIMP1 protein expressions in lung cancer and the invasion and metastasis of lung cancer. The factors may be used as important biological markers in lung cancer.