Objective To investigate hemoglobin A1c(HbA1c) and homocysteine (Hcy) in nondiabetic elder patients with coronary heart disease (CHD),and explore their clinical value.Methods Eighty-six non-diabetic elder patients with CHD [45 cases with acute coronary syndrome (ACS) and 41 cases with stable angina pectoris (SAP)] and sixty elder patients without diabetes mellitus and coronary heart disease as control group were selected.The plasma levels of HbA1c and Hcy in all groups were detected and analyzed.Results The levels of HbA1c and Hcy in CHD group were significantly higher than those in control group (P ＜0.05),and levels of HbA1c and Hcy in ACS group were both higher than SAP group (P＜0.05).The change of HbA1c and Hcy had positive correlation (r =0.34,P ＜0.05).Conclusions The levels of HbA1c and Hcy were higher in non-diabetic elder patients with CHD than those without CHD,and might correlate with atherosclerosis.HbA1c and Hcy might be markers of cardiovascular risk.

Objective To investigate the prevalence of vitamin D deficiency in patients in geriatric intensive care unit and the impact of vitamin D deficiency on the prognosis.Methods 213 hospitalized patients admitted into geriatric intensive care unit of Xinhua Hospital,Shanghai from June 2012 to December 2013 were included in the historical cohort study.Serum 25-hydroxyvitamin D [25 (OH)D] was examined in all the subjects.Main laboratory findings,the incidence of multiple organ dysfunction syndrome (MODS),Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score and mortality rate of 30-day kept in hospital were compared among patients with different serum 25-hydroxyvitamin D level.Potential risk factors for mortality were analyzed by multivariate logistic regression analysis.Results 25(OH)D deficiency was identified in 82 patients (38.5％),25(0H)D insufficiency in 90 patients (42.3％),and 25(OH)D sufficiency in 41 patients (19.2％).Compared with 25(0H)D sufficiency group,25(0H)D deficiency group showed the increased levels of APACHE Ⅱ score,plasma lactic acid,C reactive protein (CPR),the incidence of MODS and mortality rate (21.65±-8.89 vs.17.05±8.03,1.89±0.76 mmol/L vs.1.86±1.03 mmol/L,101.08±48.23 mg/L vs.92.48±38.56 mg/L,42.7％ vs.19.5％,30.5％ vs.9.8％,all P＜0.05).Multiple logistic regression analysis suggested that 25 (OH)D deficiency was an independent risk factor for mortality.25(OH)D levels were negatively correlated with length of stay in geriatric intensive care unit (r=0.18,P＜0.05).Conclusions Vitamin D deficiency is highly prevalent among patients admitted into geriatric intensive care unit.Vitamin D deficiency is associated with disease severity and may be an independent risk factor for mortality.

Objective To explore the relationship between the level of morning blood pressure surge (MBPS) and High-sensitivity C-reactive protein( hs-CRP) in acute coronary events among old patients and to evaluate their clinical value. Methods One hundred and twenty - three patients with coronary disease were divided into two groups, each of which was old myocardial infarction(OMI, n = 55) and old myocardial infarction with acute cardiovascular syndrome (OMI + ACS, n =68). The control group includes the patients without coronary disease( n =50). The patients who have infection, malignant tumors, liver and kidney dysfunction, blood diseases, valvular heart diseases, congenital heart diseases, aortic dissection,secondary hypertension were not included. All groups were received 24 hours ambulatory blood pressure monitoring to calculate MBPS and the determination of hs-CRP in serum. Results Compared with each two groups, the levels of MBPS and hs-CRP in OMI group were significantly higher than those of the control group (0. 01 ＜ P ＜0. 05) , and had more significance in the other groups ( P ＜0.01). The levels of MBPS and hs-CRP had positive relationship in coronary events in the elderly ( r =0. 76, P ＜0. 01) . Conclusion The level of MBPS is positively correlated with serum hs-CRP which is one of key risk factors of inflammatory reactions by impairing vessels in body. The two factors both play important roles in the occurrence and the development of coronary events among old patients. They both have important clinical value in recurrent acute coronary events among old patients.

Objective To explore the possible risk factors that influence bone mineral density (BMD) in elderly men with type 2 diabetes. Methods A total of 80 elderly men with type 2 diabetes were included in this study. The BMD of lumbar vertebrae and femur were measured by dual-energy X-ray absorptiometry (DXA). And fasting blood and urine samples were taken to check the biochemical levels of bone metabolism and blood glucose. The correlations between BMD and other related factors were analyzed. Results In this group, the prevalence rates of osteoporosis and osteopenia were 18. 6% and 53.8%, respectively. Body mass and body mass index (BMI) were positively correlated with BMD at all sites (r=0. 202～0. 298, P<0. 05 or P<0. 01). However, age and glycosylated hemoglobin (HbAlc) were negatively correlated with BMD of lumbar and femoral neck (r=-0. 172～-0. 211 ,all P<0. 05). Leptin was not only positively correlated with the BMD of femoral neck and Ward's triangle, but also with body mass, BMI, fasting blood glucose (FBG), total cholesterol and HbAlc (r=0. 219 ～ 0. 509, P<0.05 or P<0.01). Using stepwise regression analysis, body mass was the predictor of BMD at all sites assessed, while the HbAlc and leptin levels could respectively influence BMD at femoral neck and Ward's triangle (r~2= 0. 196 ～ 0. 276, all P< 0. 01). Conclusions It may suggest that differential factors predict the variance of BMD at different sites in elderly men with type 2 diabetes.

Objective To study the relationship between morning blood pressure surge with carotid artery intima-media thickness in good controlled elderly hypertensive patients.Methods A total of 151well controlled elderly hypertensive patients was selected in this study.Through the ABPM examination,the morning blood pressure peak was calculated,and then these patients were divided into two groups according to the morning blood pressure peak.The patients whose morning blood pressure peak ≤30 mmHg were divided into non-morning blood pressure surge group (NMS group),and the patients whose morning blood pressure peak ＞ 30 mmHg were divided into morning blood pressure surge group (MS group).The carotid IMT of these patients was measured with ultrasonic detection.The hypertension-related factors with blood pressure and morning peak phenomenon and the impact of IMT were analyzed,and the relationship between the morning blood pressure peak and IMT was analyzed with linear regression analysis.Results Two groups of 151 cases were well-controlled hypertension,76 patients with morning blood pressure showed peak phenomenon,accounting for 50.3％.Age,gender,body mass index,blood lipids,blood glucose,the maximum systolic blood pressure,average systolic blood pressure,minimum systolic blood pressure,maximum diastolic blood pressure,average diastolic blood pressure and minimum diastolic blood pressure had no difference between the two groups ( P ＞ 0.05 ).However,the morning blood pressure peak in patients with MS group [ (42.34 ± 7.10)mmHg] and IMT [ (0.89 ± 0.13 )mm] was higher than the NMS group [ (21.16 ±5.23) mmHg,(0.84 ±0.14) mm,P ＜0.01 orP ＜0.05],and carotid IMT and peak morning blood pressure was positively correlated ( r =0.56,P ＜0.01 ).Conclusions Good controlled elderly hypertensive patients remained the phenomenon of the morning blood pressure surge,the morning blood pressure peak might lead to carotid atherosclerosis.

Objective To observe the serum levels of homocysteine (Hcy) and hypersensitivity C-reactive protein(hs-CRP) in elderly patients with cerebral infarction and to investigate their relationship and clinical significance by National Institutes of Health Stroke Scale (NIHSS).Methods The serum levels of Hcy and hs-CRP were by enzymatic cycling method and scattering turbidimetry in the elderly patients ( 116 cases with cerebral infarction and 100 cases of healthy control).Those 116 cases with cerebral infarction were divided into three groups by the degree of NIHSS.The three groups were compared with each other.Results The levels of serum Hcy and hs-CRP in elderly patients with cerebral infarction were significantly higher than that of healthy control group ( t =6.97,P ＜0.01 ; t =14.96,P ＜0.01 ).There has significant difference among those three groups with cerebral infarction by comparing with each other( F =23.49,P ＜0.05; F =28.19,P ＜0.05).A positive correlation was found between Hcy and degree of NIHSS( r=0.54,P ＜0.05),and between hs-CRPand degree of NIHSS( r =0.58,P ＜0.05).Conclusions Serum levels of Hcy and hs-CRP are correlated with the occurrence of cerebral infarction and its severity.There has positive clinical significance to evaluate the effect of cerebral infarction by measuring the serum levels of Hcy and hs-CRP dynamic.

We retrospectively reviewed the tongue images and related clinical data of 118 AIDS patients treated in Shanghai Public Health Clinical Center Affiliated to Fudan University. The tongue images included: cyanotic and purplish tongue ( 33, 28.0% ), light-reddish tongue ( 32, 27.1% ), light-whitish tongue (21, 17.8% ) , bulgy tongue(19, 16.1% ), dark-red tongue (7, 5.9% ) and fissured tongue (6,5.1% ). There were significant differences in counts of CD4+T lymphocytes, white blood cells and red blood cells among different tongue imagine groups. The tongue image can indicate the pathogenic factors of disease as well as the functions of viscera in AIDS patients.

Objective Alterations in vascular structure and function and impairment of associated endothelial cells with aging are one of the independent risk factors in the process of atherosclerotic vascular diseases.The study of age-related endothelial dysfunction plays a critical role in preventing as well as treating heart and cerebral vascular diseases in the elderly.Methods The healthy male rats were divided into the young group (3-month-old),the adult group (9-month-old) and the middle-aged group (15-monthold).The indicators associated with vascular endothelial function,including plasma NO,eNOS,iNOS,ET-1 and aortic NO,eNOS,iNOS,were quantified to evaluate the endothelium-dependent and non-endothelium-dependent vasodilating function of isolated aortic rings.These morphological changes of rat aorta helped to find out the group in which endothelial function changed in the early stage.Results Plasma NO,eNOS,iNOS and aortic NOS activity in the young group,the adult group and the middle-aged group gradually decreased with increasing age (P ＜ 0.05).NO,eNOS and iNOS respectively displayed a negative correlation to age.ET-1 gradually increased with aging (P ＜ 0.05) and showed a predominantly positive correlation to age.Acetylcholine-induced greatest vasodilation of aortic rings lessened with increasing age (P ＜ 0.05).Vasodilation in each group reacted generally consistently with nitroprusside sodium (P ＞0.05).Aortic morphology,including intima media thickness (T),diameter (D) and intima media thickness / inner diameter (T / D),gradually enhanced with aging (P ＜ 0.05).T,D was positively correlated with age.NO,eNOS,iNOS,ET-1 of the adult group showed maximum slope (P ＜0.05 respectively) according to group regression analysis,suggesting that vascular endothelial function changed in this group.Meanwhile,T and D of the middle-aged group showed maximum slope (P ＜ 0.05 respectively),suggesting that age-related vascular structural changes predominantly occurred in this period and vascular function changed earlier than the structure.Conclusion Our study demonstrated vascular endothelial dysfunction with aging.Early evident changes of endothelial function occurred in the adult group,which impaired endothelium-dependent vasodilating function.Vascular function changed earlier than the structure.

Objective To explore the impact of hyperglycemia on Hypersensitive C-reaction protein (hsCRP),B-type natriuretic peptide(BNP) and ventricular remodeling in elder patients with acute myocardial infarction(AMI).Methods One hundred and twenty elder patients with AMI are divided into hyperglycemia group(blood sugar in admission ＞ 7.8 mmol/L) and non-glycemia group(blood sugar in admission ≤7.8 mmol/L).The levels of blood sugar in admission,hsCRP,BNP were detected.LVEF,LVEDD,LVESD,WMS were observed by cardiac echo in admission and two weeks after therapy.Results The blood sugar in admission,hsCRP and BNP of the patients in hyperglycemia group were (9.6 ± 0.6) mmol/L,(1 750.6 ±677.1) ng/L,(56.1 ±38.6) ng/L,higher than those in non-glycemia group (t =38.679 and P =0.000; t =11.941 and P =0.000; t =3.288 and P ＜0.01,respectively).LVEF,LVEDD,LVESD and WMS of patients in hyperglycemia group didn't show statistical significance before and after therapy.However,there were significant in hyperglycemia group (t =2.049 and P =0.043,t =2.836 and P =0.005,t =3.814 and P =0.000,t =2.086 and P =0.039,respectively).Conclusion Hyperglycemia can reduce the increase of hsCRP and BNP,which has an impact on hsCRP,BNP and ventricular remodeling in elder patients with acute myocardial infarction,but the mechanism need to further research.

Objective To investigate the correlation of serum ferritin (SF) and hypersensitive C-reactive protein (hs-CRP) with carotid intima-medium thickness (CIMT) in aged type 2 diabetes mellitus ( T2DM) patients.Methods sixty patients with T2DM, 60 with impaired glucose regulation (IGR) and 60 normal control subjects were recruited .SF, hs-CRP, fasting blood glucose (FBG), 2h postprandial blood glucose(2h PBG) along with glycosylated hemoglobin (HbA1c), fasting insulin (FINS), triglyceride (TG) and total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were assayed, while CIMT of the participants were measured using B mode colorful Doppler ultrasonography .Results FBG, 2hPBG, HbA1c, FINS, homeostasis model assessment insulin resistance (HOMA-IR), TG, TC and LDL-C showed significant difference be -tween patients with T2DM and normal controls ( P <0.05).FBG, 2hPBG, HbA1c, FINS, HOMA-IR showed significant difference between patients with IGR and normal controls ( P <0.05).FBG, 2hPBG, HbA1c, FINS, HOMA-IR, TG and LDL-C showed sig-nificant difference between patients with T 2DM and IGR (P <0.05).Compared with patients with IGR and controls , SF、hs -CRP and bilateral CIMT were found significantly increased in the T 2DM group (P <0.05), the similar differences which was also found comparing IGR group and normal control group .Besides, SF had positive correlation with hs -CRP and bilateral CIMT in both T2DM group ( r =0.89, P <0.05; r =0.82, P <0.05) and IGR group ( r =0.79, P <0.05; r =0.75, P <0.05).Conclusions SF and hs -CRP might contribute to the pathogenesis of diabetic macroangiopathy ,which means they could be useful clinically as vascular risk factors.