Objective To investigate changes and the significance of Th17/Treg immune imbalance in secondary systemic infection in patients with severeacute pancreatitis.Methods We selected 21 patients with severe acute pancreatitis and secondary systemic infection (infection group),25 patients with severe alone (non-infection group),20 healthy cases undergoing annual health checkup (control group) in this study.The expression levels of Th17/Treg cells and related cytokines were compared between groups.Results There were significant differences in mortality rate and duration of ICU stay between infection group and non-infection group [23.8％ vs.4.0％,(11.3±3.4) d vs.(7.5±2.8) d,x2=3.949,t=2.890,P=0.047 and0.045].The percentages of Th17 cell andTreg cell,Th17/Treg ratio,mRNA expressions of IL-6,IL-17,IL-23,TGF-β and orphan receptor γt were higher in infection and non infection groups than in control group [(26.4 ± 1.2) ％,(12.8 ± 0.9)％ vs.(3.1±0.8) ％;(6.7±1.6)％,(4.2±1.3)％ vs.(1.3±0.4)％;(4.3±1.0)％,(3.2±1.1)％ vs.(2.4±0.9)％;(7.1±0.8)ng/L,(5.3±0.7)ng/L vs.(0.2±0.1)ng/L;(22.9±2.4)ng/L,(15.6±2.8)ng/L vs.(10.3± 1.5)ng/L;(15.7±2.1)ng/L,(10.2± 1.5)ng/L vs.(8.3± 1.4)ng/L;(23.6±2.2)ng/L,(16.3±1.7)ng/L vs.(11.6±1.1)ng/L;(0.052±0.014),(0.035± 0.010) vs.(0.004±0.001);F=15.761,55.745,9.437,102.788,21.038,16.239,36.957,23.924,respectively,P=0.555,0.000,0.014,0.000,0.002,0.004,0.000,0.000].The mRNA expressions of IL-10 and Foxp3-T were lower in infection and non-infection groups than in control group [(6.4±1.1)ng/L,(10.5 ± 2.1) ng/L vs.(15.4±2.0)ng/L;(0.005±0.001),(0.020±0.007) vs.(0.032±0.009),F=18.995 and 20.608,P=0.003 and 0.002].Conclusions The secondary infection can aggravate the Th17 / Treg immune imbalance in patients with severe acute pancreatitis,and extend the ICU hospitalization days.

Objective To evaluate the diagnostic value of bedside lung ultrasound on severe pneumonia in elderly patients.Methods Bedside lung ultrasound lung ultrasound and chest CT were performed in 104 elderly patients admitted to the emergency department for suspected severe pneumonia,from November 2010 to January 2013.According to the characteristics of the chest CT image,patients were divided into consolidation group (big leaf or lung segment distribution density shadow) and the unconsolidation group (for the performance of the cable sample,ground glass sample,or small patch sample changes).Differences in ultrasonic characteristics were compared between the two groups.Results Ultrasonic image characteristics were pulmonary consolidation,subpleural lesion,pleural changes and parapneumonic effusions in patients with severe pneumonia.Among 65 patients with chest CT image of pulmonary consolidation in consolidation group,60 patients were found pulmonary consolidation by lung ultrasound,and all 39 patients in unconsolidation group were not found pulmonary consolidation by lung ultrasound,and there was a significant difference in detect rate by lung ultrasound between the two groups (x2 =87.546,P＜ 0.001).The number of subpleural lesion and pleural changes were (1.16 ± 1.07) and (3.14 ± 2.20) respectively in consolidation group and (3.85 ± 1.93) and (11.73 ± 3.69) respectively in unconsolidation group,which had significant differences between the two groups (t=7.439,12.133,both P＜0.001).There was no significant difference in the incidence of parapneumonic effusions between the two groups (45/65 vs.29/39,x2 =0.086,P=0.496).Conclusions Ultrasound image characteristics of severe pneumonia in elderly patients included pulmonary consolidation,pleural lesions,pleural changes and parapneumonic effusions.Ultrasonic characteristics will be pleural lesions,pleural changes in severe pneumonia patients without chest CT image of pulmonary consolidation.

Objective To Analyze the immunity to secondary infection in the elderly with severe acute pancreatitis.Methods Totally 105 old patients were included in the present study.The ratio of CD4+ to CD8+,and serum levels of tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),interleukin-10 (IL-10),and interleukin-4 (IL-4) were determined by flow cytometer analysis or ELISA within 3 days after diagnosis of secondary infection.Results Among 105 old patients,58 cases experienced secondary infection.At 3th day after severe acute pancreatitis,the levels of TNF-α,IL-6,IL-4,IL-10,CD4+,CD8+ and CD4+/ CD8+ were (81.3±5.5)ng/L,(141.2±13.7)ng/L,(61.1±7.4) ng/L,(153.8 ±15.2) ng/L,(43.5±5.5)％,(20.7±2.9)％ and (2.4±0.3) in infection group,as compared with those of (50.8±4.7)ng/1,(81.4±11.7)ng/L,(30.8±7.8)ng/L,(100.3± 13.8)ng/L,(31.6±4.6)ng/L,(29.7±3.5)and (1.1±0.4)in control group,respectively,with statistically significant differences betwveen the two groups (t=7.30,6.51,4.87,4.52,2.88,3.41,4.26,all P＜0.05).At 28th day after SAP,the levels of TNF-α,IL-6,IL-4,IL-10,CD4+,CD8 ± and CD4+ /CD8+ were (29.3±5.8)ng/L,(51.7±7.9)ng/L,(33.8±5.1)ng/L,(82.6±9.5)ng/L,(22.1±3.3)％,(47.1±4.3)％ and (0.6±0.3) in infection group,as compared with those of (44.4±5.5)ng/L,(82.2±7.1)ng/L,(65.3±5.5)ng/L,(109.1±9.5)ng/L,(40.5±2.7)ng/L,(33.4±4.5)ng/L and (1.8±0.4) in control group,respectively,showing statistically significant differences between the two groups(t=3.26,4.93,7.32,3.43,7.41,3.81,4.33,all P＜0.05).Conclusions An early excessive immune response and subsequent immune injury is closely related to secondary severe acute pancreatitis.

Objective: To compare the clinical characteristics and plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) between the patients with hypertensive hypertrophic cardiomyopathy in elder age (HHCME) and the patients with hypertensive left ventricular hypertrophy (HTN-LVH).
Methods: Our work included 2 groups, HHCME group,n=47 and HTN-LVH group,n=44. Duplex Doppler echocardiography was performed to determine left atrial diameter (LAd), left ventricular end-diastolic dimension (LVEDd), interventricular septal thickness (IVST), left ventricular ejection fraction (LVEF), velocity of early diastolic period (VE) and velocity of end-diastolic period (VA) in mitral valve oriifce. Plasma level of NT-proBNP was measured by ELISA. The above indexes were compared between 2 groups.
Results:①Compared with HTN-LVH group, HHCME group presented decreased LVEDd and increased IVST, LVEF, allP<0.001. There were no signiifcant differences in VE/VA ratio and LAd between 2 groups, allP>0.05.②Plasma level of NT-proBNP was higher in HHCME group,P<0.01. With the adjusted age, gender, history of hypertension, LAd, IVST, left ventricular systolic and diastolic function, the level of NT-proBNP in HHCME group (1317.19 fmol/ml) was still signiifcantly higher than that in HTN-LVH group (526.19fmol/ml),P<0.01.
Conclusion: The plasma NT-proBNP level was higher in HHCME patients than that in HTN-LVH patients which indicated that HHCME patients may have worse prognosis. NT-proBNP might be helpful for differencing HHCME.

Objective To explore the clinical prognostic significance of arterial blood lactate level and early lactate clearance rate in elderly septic patients. Methods Totally 82 elderly septic patients who were admitted into emergency department were enrolled.Their arterial blood lactate levels were tested at admission and 6 hours later. Early lactate clearance rate was calculated as following:(lactate level of admission minus lactate level of 6 hours later) /lactate level of admission ×100 ％. Heart rate and blood pressure were recorded at admission,and the acute physiology and chronic health evaluationⅡ (APACHE Ⅱ ) score was evaluated in the first 24 hours.28 days after admission was the end of research.Patients were divided into survival group (n=59) and death group (n=23).Taking 10％ as cut-off,patients were divided into high lactate clearance (≥ 10％) group (n=59) and low lactate clearance (＜10％) group (n=23).Values of arterial blood lactate level,APACHE Ⅱ score and early lactate clearance to predict the prognosis of elderly septic patients were determined by ROC curves. Results Arterial blood lactate level was lower in survival group than death group[(2.4± 1.7)mmol/L vs.(3.9±3.2)mmol/L,P＜0.01].Early lactate clearance was higher in survival group than death group [(339.0 ± 28.0) ％ and (300.0 ± 81.0) ％,P ＜ 0.01].Mortality of high lactate clearance group was decreased as compared with low lactate clearance group [18.6％ (11/59) and 52.2％ (12/23),P＜0.01].The thresholds of early lactate clearance to predict mortality of elderly septic patients were 24.0％ (sensitivity 72.9％,specificity 65.2％) which was more valuable than APACHE Ⅱ score ( sensitivity 65.2 ％,specificity 57.6 ％). Conclusions Arterial blood lactate level and early lactate clearance were meaningful predictors for prognosis of elderly septic patients.

Objective To investigate the level of platelet activating factor (PAF) in acute myocardial infarction (AMI) in minipig model and patients, and to study the relationship between PAF and lethal arrhythmia referring to ventricular fibrillation and ventricular tachycardia. Method ( 1 ) The levels of PAF in minipig models ( n = 20) were measured by using ELISA before and 1h after occlusion of left anterior descending coronary artery with balloon at the junction of 1/3 middle and distal portion. The lethal arrythmia was recorded by using electrocardiography. (2) In patients with AMI (n = 72), the levels of PAF were measured on arrival, and 24 h,48 h and 72 h later. The lethal arrythmia, acute heart failure and cardiogenic shock were documented. Results ( 1 ) In minipigs with occlusion of coronary artery for one hour, the mean level of PAF increased from (4.66± 2.89)ng/mL to (6.00±2.82) ng/mL,and thus the increment in PAF was (1 .34± 1.40) ng/mL (P ＜ 0.05). In 13 minipigs with lethal anythmia after occlusion of coronary artery for one hour, the increment in mean level of PAF was ( 1.92 ± 1 .34) ng/mL, whereas the increment in mean level of PAF in other 7 minipigs without lethal arrythmia after occlusion of coronary artery for one hour was as low as (0.28 ± 0. 74 ) ng/mL ( P ＜ 0. 05 ). ( 2 ) In patients, the mean levels of PAF on arrival, 24 h,48 h,and 72 hous after admission were (0.47 ± 0.05) ng/mL,(2.38±0.12) ng/mL,(3.65±0.15) ng/mL and (3.02±0.10) ng/mL, respectively. Of 72 ACI patients, 40 (55%) had complication of lethal arrythnia, heart failure or cardiogenic shock and their mean level of PAF 48 h after admission was (4.72 ± 0.16) ng/mL, whereas mean level of PAF in other 32 (44.44%) without complications was (2.31 ±0.03) ng/mL ( P ＜0.05). Conclusions The level of PAF increased after acute myocardial infarction, and the minipigs and AMI patients complicated with lethal arrythmia had higher levels of PAF.

Objective To explore the prognostic value of B-type natriuretic peptide (BNP) for 28-day mortality of elderly patients with non-cardiac critical ill in emergency intensive care unit (EICU). Methods A total of 70 elderly non-cardiac critically ill patients (age≥60 years) in EICU were enrolled, and the blood samples were collected to detect BNP level after the patients' admission to EICU. After 28 days, the mortality was assessed. Results Twenty-two patients (31.4 %) died during 28 days observation, whose BNP levels were significantly higher than that of the survivors [ln BNP: (6.4 ± 1.2) ng/L vs. ( 5. 1 ± 1.5 ) ng/L, P＜ 0. 05] ; BNP level had an area under the receiver operating characteristic curve of 0. 759 (95% CI: 0. 636-0. 882, P＜0.05) for predicting mortality,and the optimal cut point of BNP was 342 ng/L (sensitivity 77.3%, specificity 68.7%).Conclusions BNP level could be a predictor for 28-days mortality for elderly non-cardiac critically ill patients.

Objective:To assess the feasibility and effectiveness of transnasal ultra-thin gastrointestinal endoscope-guided ileus tube insertion for the treatment of adhesive intestinal obstruction in the elderly.Methods:Randomized controlled trial, a total of 81 elderly patients with adhesive intestinal obstruction were enrolled, with 46 receiving transnasal ultra-thin gastroscope-assisted tube placement(observation group)and 35 receiving conventional transoral gastroscope-assisted tube placement(control group). Tube insertion was carried out.Data on the time needed for tube placement, incidents of oral or nasal bleeding, rates of successful tube placement, physical signs of symptom relief and imaging signs of symptom relief were recorded and compared between the two groups.Results:The symptom remission rate within 3 d was 93.5%(43/46)in the observation group and 88.6%(31/35)in the control group, and the rate for imaging signs of symptom remission was 82.6%(38/46)in the observation group and 74.3%(26/35)in the control group.The differences in symptom remission and imaging signs of symptom remission within 3 d were not statistically significant between the two groups( χ2=0.144, 0.830, all P>0.05). In the observation group, the time needed for tube placement was(15.4±4.2)min, which was significantly shorter than that in the control group(21.3±3.1)min( t=6.984, P<0.01). The rate of successful tube placement was 100% in both groups.In terms of adverse reactions, the observation group had 1 patient with nasal bleeding, 2 with nausea and vomiting, and 1 with a sore throat, with an overall adverse reaction rate of 8.7%(4/46), while the control group had no patient with bleeding, 18 with nausea and vomiting, and 4 with a sore throat, with an overall adverse reaction rate of 62.9%(22/35). There was no statistically significant difference in nasal bleeding(Fisher's exact probability P=0.568)or a sore throat( χ2=1.559, P=0.212), but the differences in the incidence of nausea and vomiting as well as the incidence of total adverse reactions were statistically significant( χ2=23.694, 26.752, both P<0.01)between the two groups. Conclusions:Transnasal ultra-thin gastroscope-assisted tube placement can reduce discomfort such as nausea and vomiting during tube placement, the time needed for the procedure is short with a high success rate, and therefore has very good clinical value, especially for elderly patients.

Objective Dilated cardiomyopathy (DCM) is generally considered to be accompanied by both left and right ventricular dysfunction,but most studies only analyze the left ventricular function. In this study, we evaluated the effect of arotinolol on right ventricular function in patients with DCM. Methods Right ventricular ejection fraction (RVEF) and right ventricular diameter (RVD) were measured by two-dimensional echocardiography (2-DE) in 33 DCM patients; RVEF measured by first-pass radionuclide angiography (FPRA) was compared with that by 2-DE. Results The treatment with arotinolol for one year resulted in a reduction in the right ventricular diameter (baseline, 23.0 ± 8.3 mm vs after one-year treatment, 20.7 ± 5.4 mm; P=0.004 ) and an associated increase in ejection fraction (baseline, 36.9 ± 10.3% vs after one-year treatment, 45.8 ± 9.6%; P ＜ 0.001 ); there is a high correlation between the 2-DE method and radionuclide ventriculographic method. The correlation coefficient is 0.933 (P＜0.001). Conclusion Arotinolol therapy could not only improve left ventricular function, but also improve right ventricular function in DCM patients.

Objective:To evaluate the frailty status, and to explore its related factors among the community-dwelling elderly people in Beijing, so as to provide scientific basis for taking corresponding measures to delay the frail process of the elderly.Methods:From November 2015 to January 2016, a cross-sectional study was performed among elderly adults of Longtan Community in Dongcheng District, Beijing.Persons aged 60 years and over were selected using a stratified cluster sampling method, and the geriatric frailty-related information was collected through face-to-face household interview.The frailty index(FI)was used to evaluate the frailty status.Multivariate linear regression analysis was used to explore influencing factors on FI value among the elderly.Results:Of the 1 557 interviewees, the median(quartile)value of FI was 0.09(0.08); and women had a higher FI median value than men[0.10(0.08) vs.0.08(0.07)]( Z=5.376, P=0.000). The FI value increased with age( H=329.698, P=0.000). In addition, multivariate linear regression analysis showed that female, older age, disability, being hospitalized in the previous year, being hospitalized during the past 3 years, being unsatisfied to living conditions had relatively higher FI value than the control group( β=0.082, 0.236, 0.336, 0.065, 0.089, 0.193, all P<0.05); and people with high education level, family harmony, a large number of friends who gave support and help, more frequency of participating in organization activities, regular physical examination, and routine exercise had lower FI value than the control group( β=-0.049, -0.052, -0.089, -0.047, -0.045, -0.219, all P<0.05). For FI value, physiological disability was the greatest influencing factor, followed by ageing and not often physical exercise. Conclusions:Similar to foreign studies, the FI method is an effective method to evaluate the frailty status and characteristics among older adults, and is also applicable for the elderly in China.Frailty in elderly people is related not also to intrinsic factors, such as physiology and disease, but also to interventionable factor, such as society, psychology and behavior.Therefore, comprehensive measures should be adopted to delay the process of frailty among the elderly.