Diabetes mellitus is particularly prevalent among aging people in recent years.Compared with diabetes in young and middle aged,geriatric diabetes has specific pathophysiology.Macrovascular complications of Type 2 diabetes including coronary heart disease,myocardial infarction,heart failure,stroke and peripheral artery disease,cause increased disability and mortality in aged populations.In order to prevent macrovascular complications,management strategies should be taken in treating hyperglycemia,hypertension,dyslipidemia,and hypercoagulability.

Spontaneous intracerebral hemorrhage (ICH) refers to primary non-traumatic parenchymal hemorrhage.Its mortality and disability are extremely high.A simple and easy clinical grading scale for ICH can not only evaluate the prognosis of patients,but also has an important guiding significance for clinical treatment and clinical research.This article reviews the contents of major intracerebral hemorrhage scales,external validation,advantages and disadvantages,and explains its scope of application and clinical application.

Objective: To evaluate the structure and function of left atrium (LA) in patients with essential hypertension by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI). Methods: Totally 70 essential hypertension patients and 35 healthy volunteers (control group) were enrolled. The patients were divided into no left atrial enlargement (NLAE) group and left atrial enlargement (LAE) group (each n=35) according to left atrial index. Using RT-3DE, the maximal, minimal and pre-systolic LA volume (LAVmax, LAVmin and LAVpre) were measured, the stroke volume, total ejection fraction, active ejection fraction and passive ejection fraction of LA (LASV, LAEF, LAaEF, LApEF) were calculated. Using 2D-STI, the mean peak strain rates in systolic, early-diastolic, end-diastolic phase (mSRs, mSRe, mSRa) of LA were calculated. The parameters among the 3 groups were compared, the correlation between 2D-STI and RT-3DE measurement parameters were analyzed. Results: Compared with control group, LAaEF and mSRa increased, while LApEF, mSRs and mSRe decreased in NLAE group (all P<0.05). Compared with NLAE group, LAVmax, LAVpre, LAVmin, LASV, LAaEF and mSRa increased, while LAEF, LApEF, mSRs and mSRe decreased in LAE group (all P<0.05). Significant positive correlations were found between mSRs and LAEF (r=0.70, 0.77), mSRe and LApEF (r=0.80, 0.82) as well as mSRa and LAaEF (r=0.87, 0.89) in NLAE and LAE group (all P<0.01). Conclusion: LA function has changed before LA geometry changes in essential hypertension patients. RT-3DE and 2D-STI play important role in assessing LA function of essential hypertension patients.

Objective To explore the correlation between acute gastrointestinal side effects caused by radiotherapy in pancreatic cancer and degree of gastroduodenal radioactive injury under gastoendoscopy.Methods From February 2010 to May 2015,112 patients with pancreatic cancer and received radiotherapy were enrolled.The correlation between gastroscopic findings and degree of gastrointestinal side effects (grade zero to five) was analyzed.The effects of different radiotherapy on the formation of radiation ulcers were also investigated.Chi-square test and Spearman correlation analysis were performed for statistically analysis.Results The incidence of radioactive gastroduodenitis was 57.1 ％ (64/112).The incidence of radiation-induced ulcer was 42.0 ％ (47/112).Among the 112 patients with pancreatic cancer and received radiotherapy,patients with over grade two nausea,vomiting,dyspepsia and constipation received symptomatic treatment.Thirty-one patients (27.7 ％) of them received appetitestimulating treatment,53 patients (47.3％) were given anti-nausea treatment,39 patients (34.8％)received therapy of promoting digestion,and 24 patients (21.4 ％) received therapy of relieving constipation.The incidence of radiation-induced ulcer in patients with grade one acute gastrointestinal side effects was 25.8 ％ (8/31),lower than that of patients with over grade two acute gastrointestinal side effects (48.1％,39/81),and the difference was statistically significant (x2 =4.595,P=0.032).The grade of acute gastrointestinal side effects was positively correlated with that of radiation-induced injury under gastroendoscopy (r=0.295,P =0.002).The incidences of radiation-induced ulcer of gamma knife radiotherapy and helical tomotherapy were 50.0 ％ (15/30) and 39.2 ％ (31/79),respectively,and the difference was not statistically significant (x2 =1.032,P =0.301).Conclusions The occurrence of radiation ulcers should be alerted if over grade two acute gastrointestinal side effects presented in patients with pancreatic cancer and received radiotherapy.The radiotherapy caused gastrointestinal side effects can not be evaluated just according to clinical symptoms.Endoscopic findings and pathological diagnosis are the gold standard.

Objective To analyze the endoscopic observation of gastroduodenal ulcer radioactive injury induced by pancreatic cancer radiotherapy, and to preliminary investigate the risk factors of radiation-induced ulcer after radiotherapy in patients with pancreatic cancer. Methods A total of 112 patients with pancreatic cancer who accepted gastroscopy before and after radiotherapy at Air Force General Hospital were collected. Self-comparative study of gastroscopic findings was performed on these patients. Single factor analysis and the logistic regression analysis model were used to analyze whether the clinical factors were likely to affect the radiation-induced ulcer or not. Results The total incidence of radiation-induced ulcer was 42.0 % (47/112) in 112 patients. The history of ulcer and grade 2 or more acute gastrointestinal symptoms (P= 0.036, P= 0.030) were the independent risk factors of radiation-induced ulcer. The rest clinical factors had no influence on the radiation-induced ulcer (all P>0.05). Conclusion In the radiotherapy of pancreatic cancer, patients who has the history of ulcer or grade 2 or more acute gastrointestinal symptoms should be alert to the occurrence of radiation-induced ulcer.

Objective To evaluate the predictive value of fracture risk assessment tool (FRAX) for determining fracture probabilities in middle-aged and elderly patients with type 2 diabetes.Methods Retrospective analysis was carried out on 153 type 2 diabetic patients aged over 50 years undergoing dual energy X-ray absorptiometry measurements.Fracture risk factors including age,gender,height,weight,body mass index,history of previous fragility fractures,parental history of hip fracture,history of smoking,excessive drinking,long-term use of steroid hormone,history of rheumatoid arthritis,the history of secondary osteoporosis diseases,and femoral neck T-score of bone mineral density (BMD) were recorded.FRAX scores with BMD (FRAX/BMD) and without BMD (FRAX/-) were calculated.Therapeutic interventions were recommended if the 10-year risk of fractures was more than 3％ for hip osteoporotic fractures and more than 20％ for other major fractures.Subjects were separated into the identical treatment recommendation group and the different treatment recommendation.Fracture risk factors were compared between groups.Results 133 (6.9 ％) patients had identical fracture risk predictions in the FRAX calculation,regardless of whether BMD join in or not.Age,gender and femoral neck T scores had significant differences between the two groups (all P＜0.001),while other risk factors had no statistical differences between the two groups (all P＞0.05).Conclusions In most middle-aged and elderly patients with type 2 diabetes,the FRAX/-provides the same prediction as FRAX/BMD value for predicting fracture risk,which shows that fracture risks can be predicted without bone density examination.The FRAX/-has higher predictive values on fracture for people who are younger,male,and has higher BMD.

Objective Using Morris water maze test to evaluate the effects of guanosine and curcumin on cognitive function of APPswe/PS1dE9 double transgenic mice .Methods 3-month old APPswe/PS1dE9 dtg mice were randomly di-vided into model group , donepezil HCL group , guanosine group , curcumin group , curcumin and guanosine group ( n=12), with age-matched Wild C57BL/6J mice of the same genetic background as normal control group .Medication was giv-en once a day for 1 month.Using Morris water maze to test the spatial learning and memory ability of mice .Results Guanosine and curcumin could improve spatial learning and memory disorders of AD mice , particularly in the group of cur-cumin.Conclusion Guanosine and curcumin improve the cognitive ability of APPswe /PS1dE9 double transgenic mice with early cognitive impairment .

Objective To evaluate the clinical performance of INNOVANCE D-Dimer,and provide information for clinical application.Methods 402 cases of sodium citrate anticoagulant blood were tested with INNOVANCE assay and PLUS assay on CA7000 analyzer to measure plasma D-Dimer levels.VIDAS-30 immunology analyzer was also used to validate the two assays.4 patients with elevated D-Dimer were monitored continuously during 5 days using INNOVANCE assay and PLUS assay respectively,then the consistency of trend between 2 assays was analyzed.Plasma specimens added with hemoglobin,bilimbin and triglyceride were used to verify the anti-interference capability of INNOVANCE D-Dimer assay.Results In 402 specimens,the result ranges of INNOVANCE D-Dimer and PLUS D-Dimer were [2.15 (0.33,8.63)]mg/L FEU and [325.50 (123.75,974.00)] μ,g/L DDU,respectively.The consistency between two assays was poor (Z =-17.375,P =0.000),especially the results in the range of PLUS D-Dimer (201-300) μg/L DDU and (301-400) μg/L DDU,the coincidence rates were only 25％ and 15％,respectively; the coincidence rate was up to 85％ during PLUS D-Dimer (500-600) μg/L DDU; the coincidence rate was close to 100％ when PLUS D-Dimer over 700 μg/L DDU.Totally 47 of 402 cases were unmatched between two assays.Verified by VIDAS 30,83.0％ (39/47) was false negative for PLUS assay,4.3％ (2/47) was false negative for INNOVANCE assay,12.7％ (6/47) was false positive for PLUS assay.There were 5 false positives and 39 false negative for PLUS assay,totally 45 cases; Two false negative for INNOVANCE assay.Four patients with elevated D-Dimer were monitored and the results showed similar trend between 2 assays.For INNOVANCE assay,the capacity of anti-interference to free bilirubin,unconjugated bilirubin,hemoglobin,and triglyceride was up to 217 μmol/L,337 μmol/L,41.04 g/L,18.35 mmol/L,respectively.Conclusions INNOVANCE assay can markedly reduce false negative results of D-Dimer compared with PLUS assay.INNOVANCE D-Dimer has good performance on anti-interference to jaundice,hemolysis and lipemia samples.

Objective To analyze the correlation between anterior circulation artery stenosis and lacune or lacunar infarct(LI) in elderly patients.Methods A retrospective analysis of data was performed in 111 patients with intracranial artery atherosclerosis,ischemic cerebral infarction or transient ischemic attack from January to December 2016 in our hospital.All the patients underwent non-contrast brain MRI or CT scan,as well as one-stop dynamic whole brain 4D CT angiography and CT perfusion scan(CTA-CTP/ perfusion).Imaging data were retrospectively analyzed.Intracranial 4D CTA was produced by using MIP and CPR post processing.The correlation of intracranial internal carotid artery(ICA)and middle cerebral artery (MCA)stenosis with lacunar infarct or lacune was analyzed by chi-square test using IBM SPSS Statistics 22.0 software.Results The average age of 111 patients was(68.4± 6.8)years.A total of 19 phases with 6080 images were obtained by one-stop scanning.The optimal phase of artery visualization was selected from 19 phases for evaluating artery stenosis.Intracranial ICA and/or MCA stenosis were revealed in 94 patients,including 73(65.8％)patients with LI or lacune and 21 patients(18.9％)without LI or lacune.17 patients without intracranial ICA or anterior circulation of MCA stenosis included 7 patients(6.3 ％)with LI or lacune and 10 patients(9.0％)without LI or lacune.Anterior circulation vessels stenosis was positively correlated with lacunar infarction or lacune(x2 =7.794,P=0.005).94 patients with anterior circulation vessels stenosis were further divided into 2 subgroups:unilateral and bilateral stenosis.39 cases showed unilateral vessels stenosis,including 25 cases (26.6 ％) with LI or lacunein,and 14 cases (14.9 ％) without LI or lacunein.And 55 cases showed bilateral vessel stenosis,including 48 cases (51.1％)with LI or lacune,and 7 case (7.4 ％) without LI or lacune.The risk for LI or lacunein was statistically higher in bilateral vessel stenosis than in unilateral vessel stenosis(x2 =7.061,P=0.008).Patients with anterior circulation vessels stenosis combined with LI or lacune were 73 cases,including 31 cases of grade Ⅰ,19 cases of grade Ⅱ,14 cases of grade Ⅲ,and 9 cases of grade Ⅳaccording to Trial criteria(NASCET)classification,with no significant difference between the different grades of anterior circulation vessels stenosis.Conclusions A correlation between ICA or MCA stenosis and lacunar infarction or lacune may exist.Risk for lacunar infarction or lacune is higher in patients with bilateral artery stenosis than in patients with unilateral artery stenosis.

Objective To describe the endoscopic observation of pancreatic cancer radiotherapy induced gastro-duodenal radioactive injury, and investigate the influence of radiation-induced ulceration by concurrent chemoradio-therapy with S-1 (Tegafur Gimeracil Oteracil Potassium Capsule) and gemcitabine. Methods Self-comparative study of endoscopic performance were performed on patients received endoscopy before and after pancreatic cancer Chemoradiotherapy with S-1 or gemcitabine or radiotherapy only, from February 2010 to May 2015. Pearson chi-square test was used to analyze whether Concurrent Chemoradiotherapy groups and radiotherapy group are different in radiation-induced ulceration occurrence rate. Results The incidence of radiation-induced ulceration of radiother-apy group, S-1 group and gemcitabine group are 44.1 % (26/59), 50.0 % (10/20) and 46.7 % (7/15), respectively. Radiation-induced ulceration incidence was no statistical difference among the three groups. Conclusion From the angle of safety, patients can according to their self-condition for choosing S-1 or gemcitabine chemotherapy. Wether the concurrent chemoradiotherapy treatment was adopted or not, the occurrence rate of radiation-induced ulceration has no significant difference.