With the emerging of aging society and advances of information sciences, telemedicine has gradually become a new medical model.Telemedicine can be used in health monitoring, disease diagnosis, counseling, education, chronic disease management and long-term care in elderly population;particularly in management of chronic heart failure, diabetes and other chronic diseases, as well as in referral and continuous medical care.To promote telemedicine in the elderly population can break the physical limitations of different health care settings, so that geriatrician and the allied team members are enable to maximize their values in providing corresponding health services.This article reviews the progress of telemedicine in foreign countries, which would be of reference value for development of telemedicine for elderly people in China.

Objective To investigate the differences of four equations to estimate glomerular filtration rate (GFR) and their impacts on chronic kidney disease (CKD) prevalence in communitydwelling elderly people in Beijing.Methods A total of 489 participants aged above 70 years were enrolled.The GFR was estimated using the Cockcroft Gault (CG) equation,Chronic Kidney DiseaseEpidemiology Collaboration (CKD-EPI) equation,Modification of Diet in Renal Disease (MDRD) equation and Berlin Initiative Study (BIS) equation respectively.The internal-consistency check was made on the four equations for the GFR (ml min 1 1.73m 2) estimates.Results The mean age of participants was (81.8±7.6) years.The mean GFR estimated using the CG,CKD-EPI,MDRD and BIS equation was 58.4± 17.2,71.9± 15.3,76.7± 19.1 and 62.7± 12.7,respectively.And the prevalence of CKD was 56.2％,22.7％,17.8％ and 41.7％,respectively.The greatest differences of equations to estimate GFR were seen in elderly people aged 90 and above,and those with body mass index＜ 20.0 kg/m2 or serum creatinine concentration＜ 88.4 μmol/L.Conclusions The GFR estimated using different equations has a large difference which has a significant effect on CKD classification in elderly people.The equation to estimate GFR for the elderly is urgently needed.Until then,the eGFR and CKD classification estimated using different equations should be regarded with caution.

Objective To determine whether the different pathological types of astrocytic tumours can be differentiated by diffusion tensor MR imaging. Methods In this study, diffusion tensor MR imaging was performed preoperatively in 67 patients with different pathological types of astrocytic tumours. Furthermore , T1WI, T2WI, FLAIR and T1WI enhancement scanning by GD-DTPA were performed preoperatively in all patients. The Mean diffusivity (ADC) values in the tumor parenchyma and normal white matter from different pathological types of astrocytic tumours were measured and analyzed. The ADC with the tumor parenchyma and normal white matter from the tumours were statistically analyzed by SPSS 19.0. The results were expressed as ± s and P < 0.05 was regarded as statistically significant differences. Results There were many differences with ADC (< 10-9 mm2/s) in the tumor parenchyma between fibrillary astrocytoma (1.48 ± 0.12、0.72 ± 0.05) from fat cell astrocytoma (1.31 ± 0.07, 0.69 ± 0.03), There were also many differences with ADC ( < 10-9 mm2/s) in the tumor parenchyma between fibrillary and fat cell astrocytoma from anaplastic astrocytoma (1.06 ± 0.11, 0.71 ± 0.04) and giant cell glioblastoma (0.98 ± 0.09, 0.73 ± 0.04). There were not differences with ADC in the tumor parenchyma between anaplastic astrocytoma from giant cell gliobastona. Conclusion Measurement of tumor parenchyma′s ADC values can identify different pathological types of astrocytic tumours , but not between anaplastic astrocytoma and giant cell glioblastoma. DTI is essential to preoperative evalution of astrocytic tumours.

Objective To investigate CT and MRI imaging of Warthin tumor of parotid gland.Methods CT and MRI character-istics of 5 1 patients confirmed as Warthin tumor by operation and pathology were analyzed retrospectively.Results Among 5 1 cases, 43 patients were males,and 8 patients were females.A total of 84 lesions were found in all cases,20 cases had at least 2 lesions.The margins of lesions were well-defined.68 lesions were round or elliptical.45 lesions located in the posterior and inferior quadrant of the parotid gland completely or premodinantly.The density and signal of most lesions were homogeneous.The parenchymal area of most lesions showed an early moderate-remarkable enhancement.Small blood vessels surrounded the lesions in 1 9 cases.Conclusion CT and MRI are important and valuable for the diagnosis of Warthin tumor.

On October 23, 2017, a 52-year-old male patient with 3 recurrences of dermatofibrosarcoma protuberans in the left shoulder and chest was admitted to the Department of Burns and Plastic Surgery of Dali Bai Autonomous Prefecture People′s Hospital. Dermatofibrosarcoma protuberans on the skin were completely resected, leaving wound defect of 10 cm×10 cm. The wound was planned to be repaired by the transplantation of right anterolateral thigh perforator free flap. However, the anterolateral thigh perforator branch was absent during flap removal, and only one small perforating branch was found. Moreover, it was difficult to separate. Therefore, this flap cutting was given up. The anteromedial thigh perforator was explored through the same incision, and a thicker perforator was found, which was supplied by an independent iatrogenic artery. The length and diameter of the vascular pedicle matched with the blood vessels in the receiving site. An anteromedial thigh perforator flap (10 cm×10 cm) was cut to repair the defect. The postoperative 9-month follow-up revealed that the color, texture, and thickness of the flap were good, the two-point discrimination distance was 30 mm, and the linear scar remained at the donor site of right thigh.

From November 2015 to July 2017, six patients with skin and soft tissue defects of vulva, vagina, and buttock after resection of vulvar tumors were hospitalized in our unit. All patients were female, aged 45-70 years. Among them, four patients had bilateral defects, and two patients had unilateral defect. The defect area on each side ranged from 6 cm×4 cm to 12 cm×6 cm. Internal pudendal artery perforator " angel wing" island flaps were used to repair and reconstruct the defects. The area of flaps ranged from 7 cm×5 cm to 14 cm×7 cm. The donor sites were sutured directly. All 10 flaps of 6 patients survived. Two patients had local incision infection 3 days after operation. One of the two patients was healed 2 weeks after dressing change, and the other one underwent debridement and suture 1 week after dressing change and was healed 1 week after surgery. Follow-up for 6-12 months after surgery showed no recurrence of tumors, no eversion of vagina, better shape of vulva in bilateral reconstruction cases, and slightly worse symmetry in unilateral reconstruction cases. The skin of the reconstructed area was soft, with sensations of pain, temperature, and touch recovered in varying degrees. The distance of a two-point discrimination was 20-30 mm. Linear scars were left in the flap donor sites, with no impact on squatting or striding. In vaginal examination, 1.5 to 2.0 fingers could be inserted in bilateral reconstruction cases, while 2.0 to 3.0 fingers could be inserted in unilateral reconstruction cases. The anus functioned well during defecation.

Objective To study the rate of kidney function decline and the influencing factors in the aged population. Methods This was a prospective population-based study of 468 participants aged 65 years and older. All participants’ general health information and serum creatinine levels were collected as the baseline. After a 3-year follow-up ,the serum creatinine level of each participant was measured again.Kidney function was assessed with estimated glomerular filtration rate (eGFR) calculated using the Chronic Kidney Disease-Epidemiology Collaboration ( CKD-EPI ) equation. Outcomes of interest were mean eGFR decline and rapid decline in eGFR (annual eGFR loss≥3 ml·min－1·1.73 m －2).Risk factors were analyzed with Logistic regression. Results At baseline ,the mean age of participants was(78.4 ± 8.7)years and the mean eGFR was(74.8 ± 14.5)ml ·min－1·1.73 m －2.Annual eGFR decline was 1.5 ml·min－1·1.73 m －2,with rapid declines in 149 (32%) participants and stable kidney function in 319 (68%) individuals. The rate of kidney function loss slowed down as the age increased.Baseline eGFR was an independent predictor for rapid kidney function decline. The incidence of rapid kidney function decline in individuals with eGFR ≥ 60 ml· min－1·1.73 m －2was 2.40 times (95% CI :1.16-4.98) higher than that of participants with eGFR＜60 ml·min－1·1.73 m －2after adjustment for confounders. Conclusions Kidney function changes in the community-dwelling elderly in China are heterogeneous. Most elderly individuals do not show appreciable kidney function decline over a 3-year period.

Objective To analyze the effect of health check-up feedback style (HCFS) on the blood glucose level and weight of type 2 diabetes patients aged 75 years and older.Methods 120 consecutive patients with type 2 diabetes and aged 75 and older who were taking annual health check-up and receiving paper-based medical examination reports at Peking Union Medical College Hospital were enrolled into this study.The patients were randomly divided into two groups (control group and study group).All patients received annual health check-up between November 2014 and October 2015 (baseline health check-up).Patients in control group were given paperbased feedback as usual,while those in study group received feedback via face-to-face or telephone conversations.All patients received their second annual health check-up between November 2015 and October 2016.The patients' blood glucose and weight at the second health check-up were compared between the two groups.Results In baseline health check-up,the levels of HbA1c and BMI showed no difference between the two groups.In the second health check-up,HbA1c and BMI of study group were lower than control group [(7.17±0.58)％ vs.(7.44±0.72)％,P=0.027;(24.3±3.8) kg/m2 vs.(25.0±4.2) kg/m2,P=0.049].Fast blood glucose and waist circumference showed no difference between the two groups.Conclusions Combination of paper-based reports and face-to-face or telephone conversations to feedback on health check-up results led to better blood glucose and BMI control in old aged type 2 diabetes patients.HCFS is of vital importance.

Objective To compare differences among measured rest energy expenditure (REE) by using indirect calorimetry (IC) and predictive REE from predictive equations (PE) and human body component analyzer (HBCA).Methods Young and middle-aged healthy volunteers of light manual labor were recruited in this study.REEs were obtained from IC,PE (WHO-Schofield and Harris-Benedict equations) and HBCA.Results A total of 30 healthy participants were included,of whom 12 were males (25-46 years old) with an average age of (37.8±7.4) and 18 were females (26-52 years old) with an average age of (40.4±7.8).Measured REE of the males was (1 848.33± 155.01) kcal/d,which was significantly different from the predictive REE result of H-B equation (P=0.003) but not from results of WHO-Schofield equation and HBCA.In females,however,measured REE was (1 294.44± 134.23) kcal/d,which was significantly different from predictive REE results of both equations and HBCA,P=0.002 (WHO-Schofield),P=0.031 (H-B) and P=0.002 (HBCA).Results of measured REE were related to weight (P=0.033) and percentage of body fat (P=0.036) in males,and to height and muscle mass (P=0.003) in females.Conclusion In young and middle-aged healthy females of light manual labor,IC represented a more accurate way to measure REE,while in males WHO-Schofield equation and HBCA could be considered as alternative choices to predict REE.

Objective To explore the relationship between the body weight and the structure and function of the left ventricle in the elderly inpatients,in order to emphasize the importance of body weight in the health management for elderly patients.Methods A total of 152 elderly inpatients meeting the enrollment criteria and providing informed consent were consecutively recruited.The height,body weight,body mass index (BMI),liver and kidney function,glycosylated hemoglobin,blood lipid,blood uric acid and structure and function of left ventricular were measured by anthropometry,biochemical examination and echocardiography respectively.The clinical characteristics,metabolic parameters,structure and function of left ventricular were compared among the low/normal weight,overweight and obesity groups.The correlation between left ventricular diastolic dysfunction (E/A ≤ 0.7) and the metabolic factors was analyzed.Results The incidences of lower/ normal weight,overweight and obesity in elderly inpatients were 29.6％ (45/152),52.6％ (80/152) and 17.8％ (27/152) respectively.Compared with the lower/normal weight group,the level of systolic blood pressure,glycosylated hemoglobin (P=0.005),left atrial diameter (P =0.000),left ventricular posterior wall dimension (P=0.010),left ventricular diastolic diameter (P=0.010),left ventricular mass (P=0.000),relative wall thickness and septal thickness increased significantly in overweight and obesity groups (all P＜ 0.05).A higher proportion of left ventricular diastolic dysfunction was observed in overweight and obesity groups in the patients aging 60-69 years (P=0.028).There was positive correlation between left ventricular diastolic dysfunction and BMI (P=0.022).Conclusions Overweight/obesity increases the risk of left ventricular diastolic dysfunction among elderly inpatients.The body weight management needs to be strengthened in health management for the elderly patients.