Objective To measure serum ghrelin level in elderly Chinese, and investigate the relationship of the serum ghrelin level with age, obesity and other metabolic disorders. Methods A total of 109 men aged over 60 years without history of smoking and alcohol consumption from health examination were enrolled in this study. Subjects were excluded if they had serious diabetic complications, coronary artery disease and hepatic or renal dysfunction. A cross sectional study was made on ghrelin level and the correlated metabolic disorders. Results Compared with ghrelin level in subjects with normal BMI [(823. 57±410.40) ng/L], the ghrelin level was significantly decreased in overweight and obese elderly male, [(442.42 ± 171.10) ng/L and (434.64 ± 177.65) ng/L respectively]. ghrelin was significantly lower in subjects with three or more metabolic disorders (420.84±165.91) ng/L than in those with less disorder. Single factor analysis showed ghrelin was inversely associated with BMI, TG and uric acid (r=-0.359,-0.243,-0.189), but it was not associated with age, blood pressure, fasting glucose and insulin levels. Multivariate analysis revealed only BMI significantly affected the level of ghrelin (β =-0.386). Conclusions BMI is closely associated with ghrelin in elderly male,ghrelin is significantly lower with increased number of metabolic disorders.

Objective To assess the distribution of vaginal microflora in healthy women and investigate their cognition of lower reproductive tract infection-related knowledge as well as personal hygiene habits and character of behavior in seeking medical treatment. Methods Total of 1660 healthy women who had physical check-ups at the Medical Center of Renji Hospital were selected and received gynecologic examination, as well as routine examination, pH examination and bacterial culture of the vaginal discharge. In addition, 860 of them were randomly selected for questionnaire survey, in which reproductive tract infection -related knowledge and personal hygiene habits as well as behavior in seeking medical treatment were involved. Results Among the 1660 eensused women, vaginal average pH was 4. 16±0.21. The positive rate of Candida in vaginal discharge routine examination was 3.86% (64/1660), which was lower than that in aerobes culture 7.71% (128/1660). Candida alhicans was the most populous species 78.9% (101/128) ,followed by 7.8% (10/128) and 7.0% (9/128) for the Candida glabrata and Candida krusei respectively. The most populous species of vaginal microflora were hemolytic streptococcus A (63.80%, 1059/1660), Staphylococcus epidermidis (14.28%, 237/1660), and Enterococcus faecalis (D) group ( 11.44%, 190/1660). The questionnaire survey showed that 88.4% (760/860) of 860 women took active treatment when feeling unwell, 92.1% (792/860) of them had good hygiene practices, and only 21.2% (182/860) had the habit of vaginal douching. In addition, 50.0% (430/860) of them had the desire to obtain reproductive health knowledge through out-patient consultation. Conclusions Vulvovaginal Candida disease ranks the first in all types of vaginitis, among which, Candida albicans is the most populous species followed by the Candida glabrata and Candida krusei. Hemolytic streptococcus A and Staphylococcus epidermidis are the most common species of vaginal mieroflora in healthy women. The censused women have high awareness of reproductive health care and pay mueh attention to common gynecologic diseases such as lower reproductive tract infection. Nevertheless, we should strengthen the public education of reproductive health-related knowledge.

Objective To study the effects of health management on cardiovascular events in the elderly patients with hypertension. Methods A total of 182 elderly patients with hypertension were randomly assigned to the control group (n = 61 ), pharmacologic therapy group (n = 61 ) or health management group ( n = 60). Serum biomarkers, brachial-ankle pulse wave velocity ( baPWV ), and blood pressure were tested at baseline and after intervention. Results There were no differences between the 2 groups in clinical characteristics at baseline. The average following-up period was (21 ± 7 ) months. The improvement of systolic blood pressure ( t = 3.915, P = 0. 000 ), pulse pressure ( t = 3. 966, P = 0. 000), and baPWV ( t = 3. 093, P = 0. 002) in the health management group was more significant than the control group;the systolic blood pressure ( t = 2. 008, P= 0. 046 ) was bitterly improved than the pharmacologic therapy group. The accumulative survival rate of the health management group (96. 7% ) was higher than the control group (83.6%; x2 =5. 921 ,P =0. 015) ,similar to the pharmacologic therapy group (93.3%; x2 =2. 821,P=0.091 ). Decreased systolic blood pressure, diastolic blood pressure, pulse pressure and baPWV were protective factors. After adjusted by age and gender,the improvement of systolic blood pressure was found to be an independent protective factors ( RR = 0. 75, P ＜ 0. 05 ). Conclusion Health management in elderly patients with hypertension could more significantly reduce the risk of cardiovascular diseases.

Objective To explore whether brachial-ankle pulse wave velocity (baPWV) can be used as a predictor of recurrent cardiovascular events in elderly male patients with acute coronary syndrome (ACS). Methods The baPWV and biochemical indicators were measured in 118 elderly men with ACS, aged 61-92 years (mean age 76.6±6.7 years). During the follow-up period (617±297 days), all cardiovascular events (unstable angina, heart failure, cardiac death and stroke, etc.)were recorded. Results The baPWV was (17.48±3.54)m/s in non-event group(n=90),(21.91±4.86) m/s in event group and (24.48±4.39) m/s in major endpoint event group, respectively (both P＜0. 05). There were 30 cardiovascular events that occurred in 28 patients, including 12 major endpoint events. The receiver operating characteristic curve demonstrated that the cut-off point of baPWV for predicting a cardiovascular event was 19.51 m/s and that for predicting a major endpoint event was 20.52m/s. The multivariate Cox proportional hazards model demonstrated that the above cut-off points had significantly relative risk for cardiovascular event: 1.37(95% CI: 1.16-1.63)and for major event:1.71(95% CI: 1.23-2.36). Conclusions The baPWV can be used as a predictor of recurrent cardiovascular events in elderly men with ACS.

BACKGROUNDHigh uric acid (UA) levels and metabolic syndrome (MS) are risk factors for atherosclerotic diseases. Brachial-ankle pulse wave velocity (baPWV) is a valid and reproducible measurement by which to assess arterial stiffness and a surrogate marker of atherosclerosis. However, little is known about the relationship between them, especially in elderly Chinese with MS components who are at high risk for atherosclerotic diseases.

METHODSOne thousand and twenty Chinese subjects (159 women) older than 60 years of age (mean age (70.6 ± 5.7) years) with at least one MS component underwent routine laboratory tests, and baPWV measurements were analyzed.

RESULTSParticipants were divided into four groups by MS components. The mean age did not significantly differ among the MS component groups. We found that not only the diagnostic factors (blood pressure, body mass index (BMI), lipids, glucose) of MS but also baPWV, UA, insulin, homeostasis model of assessment for insulin resistence index (HOMAIR) levels increased, and high density lipoprotein (HDL)-C decreased with an increased number of MS components (test for trend P < 0.05). The association between UA and baPWV was observed after adjustment for gender, age, blood pressure, BMI, serum creatinine and high density lipoprotein, and insulin resistance (r = 0.186, P < 0.0001). There were increases in the odds ratios for the association between the number of components of MS, UA and baPWV, even after adjustment for traditional risk factors. However, after adjustment for insulin or HOMA-IR, there were no significant differences in the multivariate odds ratios among the number of MS components for UA.

CONCLUSIONSThe UA level is positively associated with baPWV and MS, but the association between UA and MS is dependent on insulin resistance. Furthermore, baPWV is independently associated with MS in our study population.

Aged ; Aged, 80 and over ; Body Mass Index ; Brachial Artery ; physiopathology ; Cholesterol, HDL ; blood ; Female ; Humans ; Insulin Resistance ; Male ; Metabolic Syndrome ; physiopathology ; Middle Aged ; Uric Acid ; blood ; Vascular Stiffness ; physiology

ObjectiveTo study the effects of health management on elderly patients with metabolic syndrome and lower extremity arterial disease.Methods A total of 118 metabolic syndrome( MS ) patients with ankle-brachial index (ABI) ＜ 0.9 and no intermittent claudication were randomly assigned to the control group( n =60,receiving pharmacologic therapy ) or health management group ( n =58,receiving intensive health management + pharmacologic therapy).Blood pressure,ABI,total cholesterol (TC),and fasting blood glucose(FBS) were tested before and 12 after the intervention.Results Clinical data were comparable between the two groups at baseline.After 12-months' intervention,systolic blood pressure(SBP) and FBS in both groups were significantly decreased,especially in the health management group[SBP:(141 ± 10)mm Hg(1 mm Hg=0.133 kPa) vs(146±11) mm Hg,t =2.581,P=0.011; FBS:(5.32 ±1.33) mmol/L vs ( 5.92 ± 1.61 ) mmol/L,t =2.231,P =0.028].TC ( 5.51 ± 0.51 ) mmol/L vs ( 5.11 ± 0.49 ) mmol/L,(t=4.307,P=0.000) and ABI(0.77 ±0.17 vs 0.84 ±0.19,t=2.091,P=0.039) of the health management group were significantly improved at 12 months.Patients in the health management group also showed higher SF-36 scores than those in the control group( physical functioning:72.2 ± 12.4 vs 65.2 ±20.1,t =2.268,P =0.025 ; emotion:73.9 ± 18.0 vs 65.6 ± 21.1,t =2.295,P =0.023 ; mental health:63.9 ± 13.3vs 58.3 ± 12.5,t =2.358,P =0.020 ).Conclusion Compared with medication,health management and pharmacologic therapy could significantly improve clinical parameters and quality of life of elderly MS patients combined with peripheral arterial disease.

Objective To study the effects of health management on blood pressure and lifestyle of hypertensive outpatients.Methods A total of 319 hypertensive outpatients were randomly assigned to the control group (n =160) or the health management group (n =159).Pharmacologic therapy was given to the control group,while in the health management group,intensive health management combined with pharmacologic therapy was conducted.Blood pressure,height,body weight (BW),total cholesterol (TC),and fasting blood glucose (FBG) of the participants were measured and compared at baseline and 12 months.Results There were no significant differences of clinical characteristics between two groups at baseline.After 12 months' intervention,more significant decrease of systolic blood pressure and diastolic blood pressure was found in the health management group (t values were 2.701 and 2.306,respectively;both P ＜ 0.05).There were statistically significant differences of body mass index (BMI) and serum TC levels between the control and the health management group (t values were 2.111 and 2.227,respectively ;P ＜ 0.05).After the intervention,two groups showed no significant difference in current cigarette smoking (x2=2.787,P ＞ 0.05).The participants in the health management group showed improved physical exercises,diet,and adherence to treatment at the end of the observation (x2 values were 59.459,52.018,6.321 and 5.392,respectively; all P ＜ 0.05).Conclusion Compared with pharmacologic therapy,health management combined with pharmacologic therapy could significantly improve clinical parameters and life style of hypertensive patients.

Objective To study such clinical characteristics as number of circulating endothelial progenitor cells (EPCs), cerebral blood flow velocity (CAFV) and platelet count in patients with Alzheimer' s disease (AD). Methods A total of 78 patients were recruited from the outpatient and inpatient departments of our hospital. Patients with AD (n=23), patients with vascular dementia (VaD,n=25) and healthy elderly controls with normal cognition (n=30) were enrolled after matching for clinical data, carotid intima-media thickness (IMT) and Mini Mental State Examination (MMSE). The CAFV was examined with transcranial Doppler (TCD). Peripheral blood EPCs were counted by flow cytometry.Results No statistical significant differences were noted between patients with AD and VaD, and controls on gender, age, body mass index, blood pressure, total cholesterol, triglycerides, platelet and IMT (P＞0.05). Compared with those in control group, the number of circulating EPCs and scores of MMSE and CAFV in patients with AD and VaD were significantly decreased (P＜0.05). After the adjustment of traditional risk factors, thc number of circulating EPCs had a positive correlation with the scores of MMSE (r=0.541, P=0.000). Liner regression analyses showed that body mass index, diastolic pressure,platelet and scores of MMSE were positively correlated to the circulating EPCs number in patients with AD (P＜0.05). Conclusion The reduction of number of circulating EPCs, decreasing the repair capability of cerebrovasculars and inducing poor cerebral perfusion, plays important roles in the cognitive dysfunction of patients with AD.

BACKGROUNDEndothelial dysfunction is thought to be critical events in the pathogenesis of Alzheimer's disease (AD). Endothelial progenitor cells (EPCs) have provided insight into maintaining and repairing endothelial function. To study the relation between EPCs and AD, we explored the number of circulating EPCs in patients with AD.

METHODSA total of 104 patients were recruited from both the outpatients and inpatients of the geriatric neurology department at General Hospital, Tianjin Medical University. Consecutive patients with newly diagnosed AD (n = 30), patients with vascular dementia (VaD, n = 34), and healthy elderly control subjects with normal cognition (n = 40) were enrolled after matching for age, gender, body mass index, medical history, current medication and Mini Mental State Examination. Middle cerebral artery flow velocity was examined with transcranial Doppler. Endothelial function was evaluated according to the level of EPCs, and peripheral blood EPCs was counted by flow cytometry.

RESULTSThere were no significant statistical differences of clinical data in AD, VaD and control groups (P > 0.05). The patients with AD showed decreased CD34-positive (CD34(+)) or CD133-positive (CD133(+)) levels compared to the control subjects, but there were no significant statistical differences in patients with AD. The patients with AD had significantly lower CD34(+)CD133(+) EPCs (CD34 and CD133 double positive endothelial progenitor cells) than the control subjects (P < 0.05). In the patients with AD, a lower CD34(+)CD133(+) EPCs count was independently associated with a lower Mini-Mental State Examination score (r = 0.514,P = 0.004). Patients with VaD also showed a significant decrease in CD34(+)CD133(+) EPCs levels, but this was not evidently associated with the Mini-Mental State Examination score. The changes of middle cerebral artery flow velocity were similar between AD and VaD. Middle cerebral artery flow velocity was decreased in the AD and VaD groups and significantly lower than the normal control group (P < 0.01). There was no significant difference of the blood flow velocity between the AD and VaD patients (P > 0.05).

CONCLUSIONSThe results provided evidence that patients with AD have reduced circulating EPCs. Endothelial function is impaired in patients with AD and vascular factors have a role in the pathogenesis of AD. CD34(+)CD133(+) EPCs may be a novel biomarker of AD dementia.

AC133 Antigen ; Aged ; Alzheimer Disease ; metabolism ; pathology ; Antigens, CD ; metabolism ; Antigens, CD34 ; metabolism ; Dementia, Vascular ; metabolism ; pathology ; Endothelial Cells ; cytology ; metabolism ; Female ; Glycoproteins ; metabolism ; Humans ; Male ; Peptides ; metabolism ; Stem Cells ; cytology ; metabolism

OBJECTIVEThough myasthenia gravis (MG) is a typical autoimmune disorder, there was some controversy on the treatment of the childhood-onset MG. By observing the efficacy of different therapies, the authors analyzed the affecting factors of prognosis in childhood-onset MG.

METHODThe retrospective data of 155 patients with childhood-onset MG (age of MG onset was less than 15 years) were collected from Department of Neurology, Beijing Tongren Hospital (January 2000 - February 2010). The patients were non-randomly divided according to their treatment into 3 groups (glucocorticoid, thymectomy and glucocorticoid combined with thymectomy groups). Postintervention status meeting the criteria of Myasthenia Gravis Foundation of America (MGFA) "complete stable remission, CSR", "pharmacologic remission, PR", "minimal manifestations, MM", or "Improved, I" was regarded as desirable response, which was used as primary indicator of observation. The authors assessed the efficacy of three therapies and analyzed the influencing factors of prognosis by using Chi-square test and Logistic regression.

RESULTAt 3 months of treatment, glucocorticoid group showed the highest effective rate. At the end of 1 year or 2 years of treatment, glucocorticoid combined with thymectomy group showed the highest effective rate respectively. The generalization rate of MG at 2 years, 10 years and 20 years in childhood-onset ocular MG patients were 4.3%, 10.7%, and 41.5%, respectively. Of patients with generalization of MG, 48.1% occurred within 2 years, 92.6% within 20 years. Univariate analysis showed that in childhood-onset ocular MG patients, variables such as age at onset (> 10 years), LG-MG and with chronic fatigue were significantly associated with general MG conversion. Whereas multivariate analysis showed that patients with age at onset (> 10 years) and chronic muscle fatigue were apt to convert to generalized MG.

CONCLUSIONGlucocorticoid appeared to have an effect that leads to early remission of symptoms in childhood-onset MG patients and glucocorticoid combined with thymectomy appeared to have better long-term effect. For those childhood-onset ocular MG patients with longer course of disease, older age of onset, chronic fatigue, or LG-MG, physicians should try to prevent the generalization of MG by immunosuppressive therapies.

Adolescent ; Child ; Child, Preschool ; Female ; Glucocorticoids ; therapeutic use ; Humans ; Male ; Myasthenia Gravis ; diagnosis ; therapy ; Prognosis ; Retrospective Studies ; Thymectomy ; Young Adult