Objective To evaluate the incidence of aortic valve calcification,and the correlation between valve function and commonly encountered disease in the aged patients.Methods Totally 996 patients who underwent ultrasonic cardiography (UCG) in our hospital were included.They were divide into elderly group and non elderly group,and the elderly group was divided into calcification subgroup and non calcification subgroup.The calcification,stenosis and regurgitation of aortic valve were detected by UCG,and risk factors of calcification were evaluated by Logistic regression analysis.Results The incidence of calcification was higher in elderly group than in non elderly group [71.8％ (526/733) vs.14.6％ (34/233),x2＝237.10,P＜0.01].In elderly group,the incidence of aortic valve stenosis was 2.1％ (11/526) in calcification subgroup and 1.9％ (4/207) in non calcification subgroup (x2＝0.81,P＞0.05).In elderly group,the incidence of aortic valve regurgitation was 63.3％ (333/526) in calcification subgroup and 19.3％ (40/207) in non calcification subgroup (x2＝116.10,P＜0.01).The hazard ratio of aortic valve calcification in different diseases were as follows:hypertension (OR＝2.06,95％CI:1.400-3.031),coronary heart disease (OR＝3.46,95％CI:2.217-5.384),diabetes mellitus (OR ＝ 2.66,95％CI:1.652-4.278),renal dysfunction (OR＝ 2.34,95％ CI:1.415-3.869),osteoporosis (OR＝ 2.33,95％CI:1.119-4.838).Conclusions The incidence of calcification,mainly causing aortic valve regurgitation,is high in elderly patients.Patients with hypertension,coronary heart disease,diabetes mellitus,renal dysfunction and osteoporosis are prone to the development of aortic valve calcification.

Objective To investigate the value of brain natriuretic peptide (BNP) detection in the diagnosis and treatment of heart failure patients with normal ejection fraction.Methods Totally 78 elderly patient were selected in our hospital,with left ventricular ejection fraction (LVEF) ≥45 ％,among which 52 cases of patients were consistent of heart failure criteria (heart failure group),27 cases with normal left ventricular diastolic function as control group.The echocardiographic indices of diastolic function and the change of the concentration of BNP were compared.Results As compared with heart failure group,BNP concentration (108.7 ± 32.2) ng/L vs.(190.3 ± 41.5) ng/L,left ventricular posterior wall thickness (11.3 ± 1.7) mm vs.(13.6 ± 1.4) mm,left ventricular mass index (119.3±10.2)g/m2 vs.(130.7±8.9)g/m2 were elevated in heart failure group (all P＜0.01).Conclusions BNP detection can be used for a diagnosis of heart failure as a simple and easy method.The BNP and ultrasound heart beat graph combination can improve heart failure diagnostic accuracywith normal ejection fraction in elderly patients.

Objective To detect the relationship of blood pressure variability (BPV) and angiotensinogen(AGT) T235M polymorphism with Binswanger's disease (BD).Methods Totally 122 cases with BD and 108 cases with essential hypertension had been enrolled.Ambulatory blood pressure monitoring was used to get the data of BPV and mean blood pressure (MBP).PCR-RFLP was applied to detect genotype of AGT T235M.Results Distribution of MM+MT genotype and frequency of M allelic were higher in BD group (51.6％,29.9％) than in hypertension group(27.8％,16.2％)(x2 ＝13.543,11.995,P＜0.01).The variability of night time blood pressure (11.8±2.8,9.1±2.5) and 24 hours diastolic blood pressure(11.6±6.0) in BD group were increased compared with those in hypertension groups(10.9±2.4,8.2±3.2,10.1±4.6)(t＝2.59,2.64,2.09,all P＜0.05).Prevalence of anti-dipper was higher in BD group (32.8％) than in EH group (16.7％)(x2 ＝7.894,P＜0.01).Among BD patients,anti-dipper who carried MM or MT genotypes (44.4 ％) was more than that who carried TT genotype (20.3％) (x2 ＝ 8.760,P＜ 0.01).Conclusions Fluctuations of nighttime blood pressure and diastolic pressure are higher in patients with BD,and the relative frequency of MM or MT genotype is higher.Moreover,among patients with BD who carried MM or MT genotypes are apt to have anti-dipper.MM or MT genotype is related to BD by means of affecting blood pressure circadian rhythms probably.

Objective To investigate the effects of carbon monoxide poisoning on the long-term cognition in elderly patients.Methods Totally 53 patients with carbon monoxide poisoning and 51 healthy persons at our Hospital from June 2005 to June 2008 were enrolled.Mini-mental state examination(MMSE) and activities of daily living(ADL) scale were utilized to evaluale the life quality of the elderly patients through a cross-sectional study on July 2011.Results MMSE score showed that the attention calculation score,delayed recall score,and total score were higher in control group (4.9±0.4,2.9±1.0,28.3±2.3,respectively) than in carbon monoxide poisoning group (4.5±0.8,2.6±0.6,25.5±3.5,respectively) (t＝3.138,3.607,4.802,all P＜0.05).ADL score of carbon monoxide poisoning group was 26.7±7.3,and that of the control group was 2.04±7.6 (t＝1.827,P＞0.05).Conclusions Elderly patients with acute carbon monoxide poisoning may cause long-term cognitive impairment with decreasing attention calculation and delayed recall.

Objective To investigate the risk factors of pneumonia associated to elderly patients with cerebral stroke.Methods Totally 248 elderly patients with stroke were retrospectively analyzed on medical history,treatment and prognosis.Results In 248 cases of senile stroke patients,78 cases had an associated pneumonia,accounting for 31.5％.The onset with admission period ≥48 h was in majority (48 cases),less than 48 h in 30 cases (38.5％).12 patients (15.4％)were involved blood culture,38 cases sputum culture,accounting for 48.7％.In the univariate correlation analysis,older age,consciousness,basic diseases,stroke location,NIHSS score of nasal feeding therapy were associated with associated pneumonia (all P＜0.05).As compared to patients without no associated pneumonia,the patients with associated pneumonia had more aged and higher proportions of bulbar paralysis and impaired consciousness,more underlying diseases.At the time of admission,increased occurrences of National Institute of Health Stroke Scale (NIHSS) score,brainstem stroke and multiple feeding treatment appeared in most of patients.Multivariate Logtistic regression analysis showed that age≥ 65 years,history of pulmonary disease,bulbar paralysis,disturbance of consciousness,nasal treatment among older stroke were the associated pneumonia risk factors.The hospitalized time was prolonged [(31.3±20.4)d and(17.6±8.1)d,t＝7.57,P＝0.001] and fatality rate increased (41.0％ vs.4.1％) in patients with pneumonia than without pneumonia(x2＝ 54.96,P＝ 0.000).The independent factors of death were aged ≥ 75 years(OR＝1.6,95％CI:1.0-2.6),NIHSS＞13 (OR＝5.0,95％CI:1.7-24.6) and pulmonary infection(OR＝5.2,95％ CI:1.8-17.3).Conclusions The occurrence of associated pneumonia in elderly patients with cerebral stroke is related with age,underlying disease,state of consciousness and NIHSS scores.The prevention and treatment of relevant factors can improve prognosis.

Objective To investigate the relationship between mean amplitude of glycemic excursions (MAGE) and cognitive impairment in elderly patients with type 2 diabetes.Methods Totally 80 patients (aged ＞ 60 years) with type 2 diabetic were selected.According to the Montreal Cognitive Assessment (MoCA) score,the patients were divided into two groups:cognitive impairment group (31cases) and non-cognitive impairment group (49 cases).Then all subjects were observed by continuous glucose monitoring for 3 days including the mean blood glucose (MBG) and its standard deviation (SD),MAGE and numbers of glycemic excursion (NGE).Results Compared with noncognitive impairment group,diabetic course,fasting blood glucose,2 h postprandial glycemia,glycosylated hemoglobin (HbA1c) and body mass index (BMI) were significantly different with the cognitive impairment group (P＜0.05).Furthermore,MAGE,MBG and SD were obviously higher than those in the non-cognitive impairment group [(5.89 ± 2.17) mmol/L vs.(3.15 ± 0.60) mmol/L,t＝8.37,P＝0.00; (11.85±3.45) mmol/L vs.(8.23±1.73)mmol/L,t＝6.23,P＝0.00; (3.16±1.29)mmol/L vs.(1.26±0.42)mmol/L,t＝9.57,P＝0.00].MoCA scores of patients with type 2 diabetes were negatively correlated with MAGE (r ＝-0.891,P ＜ 0.01).After multiple linear regression analysis,diabetic course,2 h postprandial glycemia,MAGE and SD remained independently associated with cognitive impairment in type 2 diabetic patients (R2 ＝0.835,P＜0.05)Conclusions MAGE during a daily period is associated with cognitive impairment independent of fasting blood glucose,postprandial glycemia and HbA1c.

Objective To observe the clinical effectiveness of alprostadil combined to pancreatic kininogenas in the treatment of gerontal diabetic peripheral neuropathy.Methods Totally 90 gerontal patients with diabetic peripheral neuropathy were randomly divided into three groups,the first group received the treatment of mecobalamin,the second group received mecobalamin plus pancreatic kininogenas,the last group received mecobalamin,alprostadil and pancreatic kininogenas (30 cases for each).The course of treatment was 4 weeks,the nerve conduction and effective rate of 3 groups were compared after treatment.Results Compared with the first group(53.3％),the total effective rate was significantly improved in the second group (80.0％)and the third group(100.0％) (P＜0.05).After treatment,the therapeutic effect of every group was boosted,and the second group was better than the first group,and the last group was best(P＜0.05).Conclusions Alprostadil combined to pancreatic kininogenas is effective and safe for the treatment of elderly diabetic peripheral neuropathy.

Objective To compare the results of aspiration pneumonia and upper digestive tract bleeding before and after percutaneous endoscopic gastrostomy(PEG),and to evaluate and predicate risk of death that can help to decide PEG by means of critical parameter score system.Methods A total of 52 patients undergoing PEG feeding due to persistent deglutition disorders during the period of 6 months were retrospectively consecutive studied.Parameter means as critical points were created as scoring system,and the scores were calculated to analyse the difference between survival group and death group.Results No statistic difference was found in rates of aspiration pneumonia[50.0％(26/52) vs.34.6 ％ (18/52),x2 ＝ 2.52,P ＝ 0.164] and upper gastrointestinal hemorrhage[5.8 ％ (3/52)vs.7.7％ (4/52),x2 ＝0.15,P＝1.000] between before PEG and after PEG.There was significant difference in total scores between the death group (16 cases) and survival group (36 cases) (10.9 ±0.3 vs.9.4±0.2,t＝3.81,P＝0.001).Conclusions PEG can't reduce morbidities of aspiration pneumonia and upper gastrointestinal hemorrhage.Scoring system may guide clinicians for selecting patients for PEG.

Objective To evaluate the effects of ginsenoside Rg3 combined with XELDX regimen on advanced carcinoma of stomach.Methods Totally 93 postoperative patients with advanced gastric cancer were randomly divided into two groups:control group(n ＝ 53) who received only XELDX regimen,and study group (n＝ 40) who were treated with ginsenoside Rg3 + XELDX.The objective response rate,KPS score and serum VEGF levels in the two groups were detected.Results (1) Before treatment,treatment group and control group showed that serum VEGF levels were (387.63±159.74) μg/L and (378.56± 169.36) μg/L,respectively (P＜0.05).After 8 weeks of treatment,serum VEGF of the treatment group decreased to (207.74 ± 115.71) μg/L,the level of the control group VEGF decreased to (246.53 ±107.63) μg/L(P＜0.05).(2) The efficacy rate was 57.5％ (23/40) in treatment group and 45.3％(24/53) in the control group (P＞0.05).(3) KPS score increasing rate was higher in treatment group (65.0％) than in control group (39.6％)(x2＝5.87,P＜0.05).Conclusions Ginsenoside Rg3 combined with chemotherapy in advanced gastric cancer patients can reduce serum VEGF levels and improve the quality of life of patients.

Objective To explore the relationship between glycosylated hemoglobin and pulse wave velocity in non-diabetic elderly people.Methods Totally 163 subjects were included after exclusion of liver or kidney disfunction,diabetes mellitus or malignant tumor.They were divided into two groups:group A (HbA1c＜5.7％) (n＝54) and group B (HbA1c 5.7％-6.4％)(n＝109).The age,pulse wave velocity,systolic blood pressure,diastolic blood pressure,blood chemistry and hypertension were compared between the two groups.Multi factor analyse was conducted to analyze the relative factors for pulse wave velocity.Results Systolic blood pressure was higher in group B than in group A (P ＜ 0.05).Multi-linear stepwise regression analyses suggested that age,hypertension,glycosylated hemoglobin were positively related to pulse wave velocity in non-diabetic elderly people (β values were 20.382,144.061,93.195,all P＜0.10).Conclusions Glycosylated hemoglobin is related to arterial stiffness in non-diabetic elderly people,it can be used as a predictive and control target of cardiovascular and cerebrovascular disease in old people.