The clinical symptoms of functional constipation in the elderly are more unique which represents as over concern about their bowel movement,excessive straining and worse feelings to the constipation.The intestinal physiological function declining with age,reductions of enteric neurons and interstitial cells of Cajal,neuronal degeneration and injured contractibility of intestinal smooth cells are enrolled in the pathogenesis of functional constipation.More attention should be paid to drug interactions and adverse effects in clinical practice due to more underlying disease and concomitant medication in the elderly.

Objective:To explore epidemiologic features of primary aldosteronism (PA) in northern Jiangsu and using plasma aldosterone/renin activity ratio (ARR) combined plasma aldosterone level to screen PA patients among pa-tients with hypertension .Methods:A total of 2014 inpatients and outpatients with hypertension were collected from our hospital .Radioimmunoassay was used to measure plasma levels of renin and aldosterone and blood biochemical indexes ,then ARR was calculated .PA was diagnosed when ARR>240 and aldosterone>150 pg/ml .Results:A to-tal of 239 patients (11. 87% ) were complicated with PA among the 2014 patients with hypertension ,and it occupied 23.69% (145/612) among patients with refractory hypertension .Compared with pure hypertension group ,there were significant reductions in renin activity [ (2.18 ± 2.54) ng?ml-1 ?h-1 vs .(0.68 ± 0.49) ng?ml-1 ?h-1 ] and serum potassium level [ (3.96 ± 0.45) mmol/L vs .(3.54 ± 0.45) mmol/L] ,significant rise in aldosterone level [ (132.99 ± 104.25) pg/ml vs .(272.55 ± 154.68) pg/ml] and ARR [ (118.40 ± 109.4) vs .(463.19 ± 251.85)] ,P<0.05 or <0.01 ,and significant reduction in onset age of hypertension [ (49.37 ± 9.31) years vs .(39.69 ± 7.59) years] ,P<0.01. Patients complicated with hypokalemia occupied 33.47% among PA patients ,linear correlation a-nalysis indicated that serum potassium level was correlated with aldosterone level (r= -0.706 , P=0.001) .Conclu-sion:In northern Jiangsu ,PA occupies 11.87% among patients with hypertension and it occupies 23.69% among pa-tients with refractory hypertension .Therefore ,plasma ARR should be regularly detected to screen PA patients in patients with hypertension ,especially those with refractory hypertension .

Aim To study the effect of rosiglitazone(RGZ)on expression and excretion of connective tissue growth factor(CTGF) in renal tissue and urinary of diabetic nephropathy rats.Methods Three groups of rats were studied:normal control group(n=8),STZ-induced diabetic model group(n=8),diabetes RGZ-treatment group(n=8).Urinary CTGF was measured at the 1 st,4 th,6 th and 8 th week,as well as the expressions of CTGF protein(by histochemical staining)at the 8 th week by ELISA.Results The urinary excretion rates of CTGF at 4 th、6 th、8 th weeks and the expressions of CTGF protein in renal cortex at 8th weeks significantly increased in STZ-induced model group compared with those in normal group(P

Objective To analyze symptomatic characteristics and the factors related to severity of irritable bowel syndrome (IBS).Methods Total 516 IBS patients met Rome Ⅲ criteria were enrolled in the study from June 2009 to February 2016.A questionnaire survey was conducted in face-to-face manner,including intestinal and extra-intestinal symptoms,sleeping and psychological status.Severity of IBS was determined by symptom scores.Results Among 516 patients,there were 135 cases with mild symptoms (26.2％),267 with moderate symptoms (51.7％) and 114 with severe symptoms (22.1％).Periumbilical pain/discomfort associated with defecation was a common symptom location (34.6％,178/516),however,53.3％ (275/516) patients also reported having abdominal pain/discomfort during non-defecation period.In IBS patients,51.2％ (264/516) were coexisted with gastroesophageal reflux disease (GERD),59.1％ (305/516) with functional dyspepsia (FD),and 46.9％ (242/516) with depression.The prevalence of ordinary abdominal pain/discomfort [57.0％ (217/381) vs.43.0％ (58/135),x2 =7.841],sensation of incomplete defecation[74.5％ (284/381)vs.61.5％ (83/135),x2 =8.277] and coexisted GERD[54.1％ (206/381) vs.43.0％(58/135),x2 =4.920],FD[64.0％(244/381)vs.45.2％ (61/135),x2 =14.664],headache[50.7％ (193/381)vs.38.5％ (52/135),x2 =5.889] and depression[52.2％ (199/ 381)vs.31.9％ (43/135),x2 =16.623] in patients with moderate to severe symptoms were significantly higher than that in patients with mild symptoms (all P ＜ 0.05).The predictors to moderate-severe IBS symptoms were coexisted FD (OR =1.798,95％ CI:1.162-2.783,P =0.010) and depression (OR =1.696,95％ CI:1.043-2.759,P =0.014).Conclusion The symptoms of IBS patients are various,and patients coexisted with FD and depression are more likely to have more severe symptoms.

Objective To evaluate the efficacy and safety of testa triticum tricum purif for the treatment of functional constipatiofi(FC) in the late middle-aged and elderly patients.Methods This study was designed as a multicenter randomized controlled trial.Patients who met Rome Ⅲ diagnostic criteria of FC were enrolled,with age between 55-85 years old.Those with organic diseases were excluded.The patients were randomly allocated to receive testa triticum tricum purif (3.5 g bid) or polyethylene glycol 4000 powder (PEG4000,10g bid) for 8 weeks,followed by single dose of maintenance therapy for 4 weeks.Follow-up visits were at 4 and 12 weeks after treatment discontinuation.The independent investigators in each center evaluated the constipation symptoms scores.The primary endpoints included rates of significant improvement,improvement and overall improvement at the end of 2,4 and 8 weeks of therapy,which were calculated by the reduction of symptom scores ≥ 75 ％,50％-74％,≥ 25 ％ respectively.Results A total of 127 FC subjects were enrolled from 3 centers,and 122 cases valid for final analysis.The mean age was (69.4 ± 6.9) years old,including 62 cases in testa triticum tricum purif group and 60 cases in PEG4000 group.The demographic data,constipated symptoms scores and proportion of FC subtypes at baseline were comparable.The rates of significant improvement,improvement and overall improvement in testa triticum tricum purif and PEG4000 groups at the end of 2,4 and 8 weeks were 37.70％ (23/61) vs 59.32％(35/59) (P=0.018),57.38％ (35/61)vs74.14％ (43/58) (P=0.054),and64.41％ (38/59)vs 79.31％ (46/58) (P =0.073) respectively.Testa triticum tricum purif therapy significantly improved the proportion of spontaneous bowel movement (SBM) ≥ 3 times/week from 43.55％ (27/62) to 80.33％ (49/61),83.61％ (51/61) and 93.22％ (55/59) at 2,4,and 8 weeks respectively (all P＜0.01),which were comparable with PEG4000 group (all P ＞ 0.05).The proportion of normalized stool forms in study group was significant higher than that of control group at the end of 8 weeks [86.44％ (51/59) vs 67.24％ (39/58),P =0.014].Only one patient complained mild abdominal distension during testa triticum tricum purif therapy.Conclusions The efficacy of testa triticum tricum purif for the treatment of FC in late middle-aged and older patients is comparable with osmotic laxatives PEG4000,which has significant effect on normalization of fecal forms and reliable safety.

Objective To analyze the consistency between constipated symptoms and the parameters of gastrointestinal transit time (GITT),anorectal manometry (ARM) in elderly patients with functional constipation.Methods Total 111 patients (54 males and 57 females) with an average age of (70.2±6.5) years,who met Rome Ⅲ criteria of functional constipation were enrolled from June 2010 to October 2012.After enrollment,patients took two-week diary,recording the spontaneous bowel movements per week,stool type of Bristol Stool Form,the frequency and severity of defecation straining,sensation of anorectal obstruction,manual maneuvers and sensation of incomplete evacuation.The GITT and ARM tests were performed,and the consistency between symptoms and test results were analyzed.Results Patients with symptoms of slow transit,defecation disorder and mixed symptoms were 19.8％ (22/111),16.2％ (18/ 111) and 59.5％ (66/111) respectively;and 4.5％ (5/111) patients had scattered symptoms.Based on results of GITT,slow transit subtype,defecation disorder subtype and mixed subtype were 54.1％ (59/109),1.8％ (2/ 109) and 29.4％ (32/109) respectively;and 14.7％ (16/109) patients were with normal transit time.ARM results showed that 38.0％ (41/109) of patients had dyssynergic defecation.The percentage of slow transit in GITT test showed no significant difference between patients with slow transit symptoms and mixed symptoms [50.0％ (11/22)vs.57.9％(33/57),x2=0.401,P=0.527].The consistency of predominant symptom with GITI subtype was low (κ=-0.013).The percentage of dyssynergic defecation detected with ARM showed no significant difference between patients with defecation disorder-predominant symptom and with mixed symptom [23.1％ (6/24)vs.38.2％ (21/55),x2=1.813,P=0.178].The consistency of defecation disorderpredominant symptom with dyssynergic defecation in ARM was low (κ=-0.019).Conclusion The mixed subtype symptoms are the most common presentations of elderly patients with functional constipation,and the consistency of predominant constipated symptoms with GITI,ARM test results is poor.

Objective To analyze the efficacy of drug-coated balloon in the treatment of hetero-geneous in-stent restenosis.Methods A total of 118 patients who received treatment and diagnosed with heterogeneous in-stent restenosis were selected as study objects,and were divided into two groups using a random table method.The experimental group(n=59)received drug-coated balloon thera-py,and the control group(n=59)received drug-eluting stent therapy.The therapeutic effects of the two different treatment methods on heterogeneous in-stent restenosis were compared.Results There was no significant difference in the incidence of in-stent restenosis in the right coronary artery,cir-cumflex artery,and anterior descending artery between the two groups(P＞0.05).There was no sig-nificant difference between the two groups in the preoperative reference vessel diameter,lesion length,lumen stenosis degree,and localized restenosis(P＞0.05).The postoperative residual ste-nosis rate in the experimental group was significantly higher than that in the control group(P＜0.05).There was no significant difference between the two groups in the preoperative lumen area,neointimal load,stent inner area,neointimal area,incidence of neoatherosclerosis and thrombus(P＞0.05).Operative lumen area of the experimental group was smaller than that of the control group(P＜0.05).No target vessel reconstruction,stent thrombosis,nonfatal myocardial infarction,or cardiac death occurred in two groups during 12 months of follow-up.Conclusion Drug-coated balloons are effective and safe in the treatment of heterogeneous in-stent restenosis,and can obtain similar effects to drug-eluting stents.

Objective To analyze the dynamic changes in serum adiponectin(APN)levels after acute myocardial infarction(AMI)and its relationship with heart failure(HF)and major adverse cardiovascular events(MACE).Methods A total of 124 AMI patients who underwent percutaneous coronary intervention(PCI)in our hospital from January 2021 to December 2023 were enrolled as AMI group.Additionally,30 patients with non-AMI coronary artery disease and 30 healthy individu-als were included in non-AMI coronary artery disease group and healthy group,respectively.General information such as age,gender,smoking,alcohol consumption,hypertension,diabetes,and blood lipids were recorded for all subjects.Serum APN levels were measured using the enzyme-linked im-munosorbent assay(ELISA)method;plasma brain natriuretic peptide(BNP)levels were determined by immunofluorescence;and left ventricular ejection fraction(LVEF)was assessed using echocardio-graphy.Changes in serum APN levels and its relationship with BNP,LVEF,and MACE were recor-ded during a one-year follow-up period.Results AMI patients had lower serum APN levels than those in the non-AMI coronary artery disease group and the healthy group,while levels of total choles-terol(TC),low-density lipoprotein cholesterol(LDL-C);Lipoprotein-associated phospholipase A2(Lp-PLA2),and the proportions of smokers and diabetics were higher(P＜0.05).A one-year follow-up of AMI patients revealed an upward trend in serum APN and BNP levels and a downward trend in LVEF levels at one week,one month,three months,six months,and one year postoperatively(P＜0.05).APN and BNP levels peaked one month after PCI,while LVEF reached its lowest level at the same time point.However,there were no statistically significant changes in these indicators in the subsequent 11 months(P＞0.05).The incidence of MACE in AMI patients at one,three,six,and twelve months postoperatively was 2.8％,3.2％,4.6％,and 8.8％,respectively.Both preoper-ative and one-month postoperative serum APN levels had high predictive value for the occurrence of HF and MACE within one year in AMI patients,and the area under the curve for predicting HF and MACE one month postoperatively was larger than that preoperatively(P＜0.05).Conclusion Ser-um APN levels in AMI patients show an upward trend after PCI,peaking one month postoperatively.At this time point,serum APN levels have the highest predictive value for the occurrence of HF and MACE.

Background/Aims: A strong correlation between depression and irritable bowel syndrome with diarrhea (IBS-D) has been identified. The aim of this study is to identify the correlations among depression, structural factors, gastrointestinal (GI) and extra-GI symptoms, and efficacy of neuromodulators in patients with IBS-D. Methods: Patients meeting the Rome III Diagnostic Criteria for IBS-D were enrolled. The intestinal symptoms and psychological states were evaluated using IBS-specific symptom questionnaires and Hamilton Depression Rating Scale. Results: In total, 410 patients with IBS-D were enrolled, 28.8% (118/410) had comorbid depression. Patients with depression did not readily experience improvement in abdominal pain/discomfort after defecation, and had a higher prevalence of passing mucus, overlapping functional dyspepsia, and extra-GI symptoms. The structural factor “mental disorders” significantly correlated with main bowel symptom score and degree of pre-defecation abdominal pain/discomfort. No structural factor significantly correlated with bowel movements or stool form. Patients who had passing mucus, overlapping functional dyspepsia and extra-GI painful symptoms have higher score of “anxiety/somatization.” Patients with sexual dysfunction have higher score of “retardation symptoms.” In total, 28.3% of patients with IBS-D were prescribed neuromodulators. Baseline scores of “anxiety/somatization” and “retardation symptoms” positively correlated with improvement of diarrhea after paroxetine, and “sleep disturbances” positively correlated with improvement of abdominal pain/discomfort and diarrhea after mirtazapine. Conclusions Comorbid depression and higher scores of structural factors might aggravate GI and extra-GI symptoms other than bowel movements and stool form. Structural factors of Hamilton Depression Rating Scale correlated with efficacy of paroxetine and mirtazapine in patients with IBS-D.

Objective To analyze the efficacy of drug-coated balloon in the treatment of hetero-geneous in-stent restenosis.Methods A total of 118 patients who received treatment and diagnosed with heterogeneous in-stent restenosis were selected as study objects,and were divided into two groups using a random table method.The experimental group(n=59)received drug-coated balloon thera-py,and the control group(n=59)received drug-eluting stent therapy.The therapeutic effects of the two different treatment methods on heterogeneous in-stent restenosis were compared.Results There was no significant difference in the incidence of in-stent restenosis in the right coronary artery,cir-cumflex artery,and anterior descending artery between the two groups(P＞0.05).There was no sig-nificant difference between the two groups in the preoperative reference vessel diameter,lesion length,lumen stenosis degree,and localized restenosis(P＞0.05).The postoperative residual ste-nosis rate in the experimental group was significantly higher than that in the control group(P＜0.05).There was no significant difference between the two groups in the preoperative lumen area,neointimal load,stent inner area,neointimal area,incidence of neoatherosclerosis and thrombus(P＞0.05).Operative lumen area of the experimental group was smaller than that of the control group(P＜0.05).No target vessel reconstruction,stent thrombosis,nonfatal myocardial infarction,or cardiac death occurred in two groups during 12 months of follow-up.Conclusion Drug-coated balloons are effective and safe in the treatment of heterogeneous in-stent restenosis,and can obtain similar effects to drug-eluting stents.