Objective To explore the clinical feature of multiple organ dysfunction syndrome in the elderly (MODSE) induced by pulmonary infection. Methods The clinical sign of 169 cases with MODSE induced by pulmonary infection admitted from January 2001 to September 2006 were reviewed. Results All cases complicated more than one chronic disease. 82.9% cases complicated more than 4 chronic diseases. The first failure organ of MODSE induced by pulmonary infection included lung, heart, kidney or gastrointestinal tract, and the respiratory failure was the most commonly. The incidence of primary failure in organs dysfunction group was significantly higher than those in organs normal function group (P<0.001). Binary Logistic stepwise regression showed that clinical stage of MODSE, renal failure and circulatory failure were the high risk factors for mortality （P＜0.05）. Conclusion Lung or other dysfunction organs is the first failure organ in MODSE induced by pulmonary infection in most cases. Clinical stage of MODSE, renal failure and circulatory failure were the high risk factors for mortality. The mortality of MODSE may be reduced by preventing renal failure and circulatory failure.

: ObjectiveTo explore the clinical features of senile hypertension.MethodsThe clinical manifestations of 296 cases with senile hypertension admitted from January 2001 to September 2004 were analyzed retrospectively.ResultsThere were 16 cases in stage 1 (5.4%), 100 cases in stage 2 (33.8%), 180 cases in stage 3 (60.8%). came on with Hypertension had been found before 60 years old in 143 cases (48.3%), after 60 years old in other 153 cases (51.7%). 63 cases presented systolic hypertension(21.3%), other 233 were mixed type hypertension (78.7%). Comparing the type of senile hypertension came on before 60 years with the type of senile hypertension came on after 60 years, The ratio of different type of senile hypertension was significant difference between the patients who were found to have hypertension before or after 60 years old(χ2=18.87,P<0.01).ConclusionSome of senile hypertension happened in middle age. Most of them were in stage 2～3. The type of senile hypertension was related to pathogenic time.

BACKGROUND: In recent years, the effects of cytokines on osteoporosis have Received much attention, and of these cytokines, interleukin-6(IL-6) is considered to play an important role in the regulation of bone absorption.OBJECTIVE: To observe the changes of bone mineral density(BMD) and serum IL-6 rats with in senile osteoporosis after reperfusion with kidney and spleen-tonifying and blood flow-promoting prescription of traditional Chinese medicine.DESIGN: A randomized controlled experimental study based on the experimental animals.SETTING: Second Department of Cadre, Bethune International Peace Hospital of Chinese PLA; department of regimen and rehabilitation in a college of traditional Chinese medicine.MATERIALS: The experiment was conducted in the Center of Experimental Animals, Hubei College of Traditional Chinese Medicine between May and August 2003. Thirty 15-month-old Wistar rats(15 males and 15 females) were provided by the Experimental Animal Center of Tongji Medical College,Huazhong University of Science and Technology.METHODS: According to random number table method, 30 rats were divided into normal control group, pathological control group and traditional Chinese prescription treatment group. Rat models of senile osteoporosis were established in the latter two groups by injection with 2.5 mg/kg dexamethasone given twice a weeks for 6 consecutive weeks. Rats in normal control group and pathological control group were given oral administration of saline,and those in the treatment group were treated with the traditional Chinese prescription. After 6 weeks of treatment, blood samples were obtained from all rats by removing the eyeballs and the serum was separated by centrifugation,followed by truncation of the right hindlimb for dissection of the femoral bone. Serum IL-6 was measured by radioimmunoassay and BMD determined by means of displacement of acetone.MAIN OU TCOME MEASURES: BMD of the femoral bone and serum IL-6 level.RESULTS: The BMD of the pathological control group was significantly lower ( P < 0.01), but the serum IL-6 level was significantly higher( P < 0.01 ) than those of the normal control group. The BMD of the treatment group was significantly higher but serum IL-6 level significantly lower than those of the pathological control group ( P < 0.01 for both comparisons).CONCLUSION: The traditional Chinese prescription can decrease the production of IL-6 and lower serum IL-6 level to reduce the bone loss in senile rats.

Objective To evaluate the early prediction score system for multiple organ dysfunction syndrome in the elderly (MODSE) induced by pulmonary infection. Methods A total of 316 patients with pulmonary infection aged over 60 were admitted from 2007 Jun to 2009 Jun. All patients were scored by the early prediction score system for MODSE and then classified as high-risk group and non high-risk group. χ2 test was used to analyze the difference in morbidity of MODSE between high-risk group and non high-risk group. Receiver operating characteristic (ROC) curve was drawn, and the area under the curve, sensitivity and specificity was calculated. Results The morbidity of MODSE in high-risk group was higher than that in non high-risk group(χ2=87.569,P＜0.01).The area under the ROC curve was 0.864(P＜0.01).The sensitivity and specificity of the early prediction score system of MODSE were 84.2% and 72. 1%, respectively. Conclusion The early prediction score system for MODSE can be used to predict MODSE induced by pulmonary infection and to screen for the high risk population.

Objective To establish the scoring system for early prediction of multiple organ dysfunction syndrome (MODSE) induced by pulmonary infection in the elderly. Methods A total of 393 inpatients with pulmonary infection, aged 60 years and over, were enrolled in this study and the data of them from January 2001 to December 2006 were analyzed retrospectively. All patients were divided into MODSE group and non-MODSE group. The effects of age, chronic disease and blood test items of healthy examination on the pathogenesis of MODSE were explored. The early prediction indexes which were selected from age, 21 chronic diseases and 15 blood test items of healthy examination were scored to establish the scoring system for early predicting MODSE. Results The age, chronic obstructive pulmonary disease, chronic respiratory failure, pulmonary fibrosis, chronic cardiac insufficiency, cerebrovascular disease, diabetes, chronic renal failure, hemoglobin, albumin,urea nitrogen and fasting blood glucose were selected to establish the scoring system for early predicting MODSE. Conclusions The scoreing system for early predicting MODSE may be used to screen the high risk population of MODSE induced by pulmonary infection, which is valuable in early prediction of MODSE.

Multiple organ dysfunction syndrome in the elderly (MODSE) is an important research topic of geriatrics. This article would review the advance of study in MODSE.

Objective To evaluate the prediction value of the early prediction score system of multiple organ dysfunction syndrome in the elderly (MODSE). Method A total of 393 patients with pulmonary infection, who were above60 years old, were divided into non MODSE(n =224) and MODSE group(n = 169) and were scored by the early prediction score system of MODSE. Independent-samples t Test was used to analyze the difference of forecast score between MODSE and non MODSE group. Receiver operating characteristic (ROC) curve was drawn,and the area under the curve was calculated. The prediction accuracy of scores for MODSE was assessed using sen-sitivity and specificity, and the optimal forecast point for MODSE was found. Results The score of MODSE group was higber than that of non MODSE[(19.38±12.049) vs. (45.78±20.257), P <0.001]. The area under the ROC curve was 0.889 (P <0.001) ond 95% (0.857～0.920). As the value of forecast score was 27.5, the sensitivity of the early prediction score system of MODSE was 82.8 %, the specificity of the early prediction score system of MODSE was 80.3 %. Conclusions The early prediction score system of MODSE is valuable in predic-tion of MODSE, which may be used to forecast MODSE and find the high risk population of MODSE.

Objective To evaluate the clinical value of fasting blood glucose (FBG) in the diagnosis of multiple organ dysfunction syndrome (MODS) caused by pulmonary infection in elderly patients with diabetes. Methods Patients over 65 years old with diabetic pulmonary infection admitted to Department of Cadres Ward of Bethune International Peace Hospital of PLA from July 2015 to December 2016 were enrolled. According to the patient's highest FBG level during pulmonary infection, all patients were divided in two groups. The cases whose FBG ≥8.83 mmol/L were served as suspicious multiple organ dysfunction syndrome in the elderly (MODSE) group, and those had FBG < 8.83 mmol/L were served as suspicious non-MODSE group. The incidence of MODSE in suspicious MODSE group and suspicious non-MODSE group was compared. The receiver operating characteristic curve (ROC) was drawn, and the clinical value of highest FBG in the diagnosis of MODSE caused by pulmonary infection in elderly patients with diabetes was assessed. Results 119 elderly patients with diabetes and pulmonary infection were enrolled in the analysis. All patients were male, with age of 76-105 years with an average of (89.41±4.16) years. Among 119 patients, 55 of them with suspected MODSE, 64 of them with suspected non-MODSE. The incidence of MODSE in suspicious MODSE group was significantly higher than that in suspicious non-MODSE group (78.2% vs. 12.5%), with statistically significant difference (χ2 = 52.108, P = 0.000). The area under the ROC curve of the highest FBG for diagnosis of MODSE was 0.895, and 95% confidence interval (95%CI) was 0.839-0.951 (P < 0.001). When using FBG ≥ 8.83 mmol/L to diagnose MODSE induced by pulmonary infection in elderly patients with diabetes, the sensitivity was 84.3% and the specificity was 82.4%. Conclusion FBG ≥ 8.83 mmol/L, as an indicator reflecting the changes of metabolic function, have a diagnostic value for MODSE caused by pulmonary infection in elderly patients with diabetes.

Objective To determine the persistence time of genotype 4 hepatitis E (HE) viremia after the onset of clinical symptoms in HE patients and provide essential data for study on HE epidemiologieal transmission, so that to evaluate potential contagiousness of HE patients after clinical stage. Methods The first serum samples from 162 HE patients after hospitalized in Eastern China were collected and tested for hepatitis E virus (HEV) RNA by nested reversed transcription- polymerase chain reaction (RT-PCR). The persistence time of HEV viremia after the onset of clinical symptoms was estimated with Kaplan-Meier survival analysis. Results HEV RNA was detectable in 101 out of 162 serum samples with positive rate of 62.35%, which was all grouped to genotype 4 by homology analysis. Furthermore, HEV RNA was detectable in 74 (64.91%) out of 114 male and 27 (56.25%) out of 48 female, which was not significantly different (χ2 = 1.08, P=0. 30). Kaplan-Meier survival analysis showed that the median persistence time of HEV genotype 4 viremia was 24 days after the onset of clinical symptoms (95% CI: 18-30 days), which meant that the viremia of 50% HE patients remaining detectable up to 24 days after the onset. The 75% and 25% percentiles were 14 days and 31 days, respectively. There was no significant difference of viremia persistence time between male and female (Breslow test: P=0.98, Tarone-Ware test: P=0.91). Conclusions The viremia of 75% patients with HEV genotype 4 infection could persistent until 2 weeks after the onset of clinical symptoms and that of some patients could persistent over 1 month. It is indicated that the viremia is still persistent and HE patient could be a reservoir even after the clinical symptoms disappeared and biochemical marks normalized.

Objective To understand epidemic characteristics of human influenza A and the genetic and antigenic variations of H1N1 influenza A isolates in Shanghai area in 2009. Methods Throat swabs were collected from patients with influenza-like illness in the sentinel surveillance clinic in Shanghai area in 2009, then inoculated in Madin-Darby canine kidney (MDCK) cell lines. The types of influenza were identified by direct immunofluorescence assay (DIF) and the subtypes were determined by reverse transcriptase-polymerase chain reaction (RT-PCR). Segments of hemagglutinin (HA) and neuraminidase (NA) genes of some 2009 H1N1 influenza A isolates were amplified and sequenced. HA and NA gene mutations of 2009 H1N1 influenza A isolates were analyzed. Results Seasonal H1N1 and H3N2 influenza A viruses co-circulated during the spring of 2009 in Shanghai area. Seasonal H3N2 began to co-circulate with 2009 H1N1 in August (the 32nd week) and finally2009 H1N1 became dominate since the 40th week. The phylogenetic tree of 2009 H1N1 HA segment revealed that the isolates from different regions and months were interspersed with each other, but all were clustered into one branch which closed to strains in Spain, Russia, Denmark and other European countries. Mutations were found in some HA amino acid sites, but none of them was in the antigenic determinant region. No change was observed in the 274 NA amino acid residues which were related to the drug resistance to oseltamivir. PB2 protein analysis showed that the 627 and 701 amino acid residues were glutamic acid and aspartic acid respectively, which were the same encoded amino acid with avian flu PB2 protein. Conclusions Seasonal H1N1 and H3N2 co-circulated in the spring of 2009, then both 2009 H1N1 and seasonal H3N2 were prevalent in Summer and Autumn, and 2009 H1N1 finally became dominate in Autumn. Compared to early 2009 H1N1 strains, variations are detected in H1N1 influenza A viruses, but none of them has epidemiological influence, and viruses still show high affinity with human and low-pathogenic characteristics.