Objective To investigate the application of the mini nutritional assessment (MNA)in the malnutrition risk eval-uation of elderly inpatients with cardiovascular disease(CVD).Methods The MNA method was adopted to detect the MNA scores in 316 elderly inpatients with CVD.The inpatient′s nutritional status was evaluated according to the MNA scores.Results Among 316 cases,52 cases(16.46%)were malnutrition,60 cases (18.99%)had the malnutrition risk and 204 cases (64.56%)were in a good nutritional status;the occurrence rate of malnutrition and malnutrition risk in the female elderly patients were higher than those in the male patients,the differences were statistically significant(P <0.01);the occurrence rate of malnutrition and malnutri-tion risk in the elderly inpatients(≥80 years old)were higher than those in the low age patients(60~<80 years old),but the differ-ences had no statistical significance(P >0.05);the occurrence rate of malnutrition and malnutrition risk in the rural patients were higher than those in the patients lived in city,the differences were statistically significant(P <0.05).Conclusion Elderly inpatients with CVD have the higher prevalence of the malnutrition risk,the MNA can be applied in elderly inpatients with CVD for conduc-ting the nutritional status monitoring and early screening the malnutrition risk.

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Objective To investigate the relationship between the serum homocysteine(Hcy) level and heart rate variability in elderly patients with metabolic syndrome.Methods Retrospective analysis of 162 elderly patients with metabolic syndrome aged 60 and above was conducted in our hospital from January 2013 to August 2016.And the level of serum homocysteine and other biochemical indicators were measured.The 162 cases were divided into three groups of 42 cases in Hcy normal group(Hcy,5-15 μmol/L),70 cases in Hcy mildly high group(Hcy,16-30 μmol/L),50 cases in Hcy moderately high group (Hcy,31 ～ 100 μmol/L).Simultaneously 24-hour rhythm in ambulatory heart rate variability spectrum was used to detect HRV.And the relationship between heart rate variability(HRV) and Hcy levels were analyzed.Results Normal RR interval standand deviation (SDNN),5 min mean heart rate standard deviation (SDANN),Edinburg index (PNN50),root mean square value of adjacent RR interval difference(RMMSD)were all lower in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group (P＜0.05).Low-frequency(LF) and highfrequency(HF)were lower in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group(P ＜ 0.05).Sympathetic-vagal balance indicators (LF/HF) were higher in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group (P＜ 0.05).The HRV indexes were lower in Hcy high groups than in the Hcy normal group.Hcy was negatively correlated with SDANN,RMSSD,LF,HF,and LF/HF at night(r=-0.578、-0.651、-0.531、-0.662、-0.729,all P ＜ 0.01).Conclusions The elevated homocysteine level and metabolic syndromecombined with decreased HRV in the elderly patients suggest that cardiac autonomic nervous system might be injuried.Enhancing the detection of HRV and homocysteine level in elderly patients with MS is clinically useful for early detection of autonomic neuropathy.

OBJECTIVETo investigate the changes of genetic damage in patients with arsenism caused by coal-burning in 9 years. To analyze the relationship between the changes of genetic damage and disease progression and provide a basis for condition monitoring.

METHODSOf 206 arsenism patients from the area with endemic arsenism in Guizhou province were tracking surveyed in February 1998 and divided into 4 groups, including suspicious, mild, moderate and severe poisoning group. Another 67 healthy residents from a neighbour township 12 km away where arsenic was not prevalent were surveyed. Over a 9-year follow-up, 131 arsenism patients and 45 controls with the complete biochemical indexes among them were selected as subjects in December 2006. Arsenic (As) concentration of urine and hair were detected by silver diethyldithiocarbamate spectrophotometry (Ag-DDC). Micronucleis (MN) and chromosome aberrations (CA) were analyzed by conventional methods. DNA single-strand breaks of peripheral blood were measured by single cell gel electrophoresis (SCGE), and the tail lengths of comet were used to measure DNA damage.

RESULTSAmong the control, suspicious, mild, moderate and severe arsenic poisoning group, the As contents of urine and hair were respectively (34.16 ± 10.25), (52.35 ± 22.41), (62.26 ± 31.13), (71.43 ± 49.92), (78.45 ± 50.64) µg/L and (1.37 ± 0.56), (3.69 ± 1.78), (4.88 ± 3.49), (5.21 ± 3.10), (6.25 ± 4.04) µg/g in 2006, which were lower than that 9 years before (urine as contents were (36.07 ± 20.70), (73.65 ± 41.33) , (90.92 ± 82.14) , (126.55 ± 107.31) and (139.44 ± 90.90) µg/L, and hair As contents were (1.41 ± 1.18), (4.85 ± 4.20), (5.72 ± 4.07) , (6.43 ± 4.32) and (7.19 ± 4.68) µg/g, respectively, F value was 10.63, 7.72, 14.66, 11.00 respectively, all P values were < 0.05). Except for suspicious poisoning group, the differences of urine As contents in the other groups all showed significance (P < 0.05). The incidences of MN were (0.238 ± 0.130) %, (0.268 ± 0.192) %, (0.283 ± 0.157) % and (0.391 ± 0.233)%; the incidences of CA were (14.36 ± 5.44) %, (18.09 ± 6.49) %, (19.38 ± 5.63)% and (19.83 ± 5.84) %; the tail lengths of comet were (29.88 ± 13.81) , (29.84 ± 12.80) , (34.50 ± 9.88) and (41.58 ± 12.98) µm respectively in 2006 for all poisoning groups; which were higher than that 9 years before(the incidences of MN were (0.163 ± 0.051) %, (0.186 ± 0.117) %, (0.196 ± 0.104) % and (0.273 ± 0.142) %; the incidences of CA were (13.18 ± 5.17)%, (14.48 ± 6.61)%, (15.67 ± 8.49) % and (16.90 ± 8.38) %; the tail lengths of comet were (15.07 ± 12.93) , (19.57 ± 8.80) , (27.03 ± 10.77) and (34.71 ± 14.95) µm) , except for the incidences of MN and CA in suspicious poisoning group and of MN in mild poisoning group , the differences of the three indexes in the other groups were significant (P < 0.05) . The state of illness of arsenic poisoning patients aggravated 9 years later. With the increase of urine and hair As contents and the development of arsenism, the incidences of MN, CA and the tail lengths of comet of all poisoning groups increased. There were positive correlations among them (r values were respectively 0.212, 0.316, 0.232, 0.263, 0.321, 0.654 and 0.760) (P < 0.05).

CONCLUSIONThe exacerbation of genetic damage was related to constantly high arsenic loads. The accumulation of genetic damage and its irreversibility might be one of the important reasons of the development of arsenism and cancer.

Arsenic ; Arsenic Poisoning ; Coal ; DNA Damage ; Follow-Up Studies ; Humans

OBJECTIVETo determine the prevalence of sleep-disordered breathing in patients with stable, optimally treated chronic congestive heart failure and the effect of short-term oral theophylline therapy on periodic breathing in these patients.

METHODSPatients with stable, optimally treated chronic congestive heart failure were monitored by polysomnography during nocturnal sleep. The effects of theophylline therapy on periodic breathing associated with stable heart failure were observed before and after treatment.

RESULTSPatients were divided into two groups. Group I (n = 21) consisted of individuals with 15 episodes of apnea and hypopnea [as determined by the apnea-hypopnea index (AHI)] per hour or less; Group II (n = 15, 41.7%) individuals had an index of more than 15 episodes per hour. In group II, the AHI varied from 16.8 to 78.8 (42.6 +/- 15.5) in which the obstructive AHI was 11.1 +/- 8.4 and the central AHI was 31.5 +/- 9.6. Group II had significantly more arousals (36.8 +/- 21.3 compared with 19.4 +/- 11.2 in group I) that were directly attributable to episodes of apnea and hypopnea, lower arterial oxyhemoglobin saturation (76.7% +/- 4.6% compared with 86.5% +/- 2.8%) and lower left ventricular ejection fraction (24.2% +/- 8.8% compared with 31.5% +/- 10.6%). Thirteen patients with compensated heart failure and periodic breathing received theophylline orally (at an average dose of 4.3 mg/kg) for five to seven days. After treatment, the mean plasma theophylline concentration was (11.3 +/- 2.5) micro g/ml. Theophylline therapy resulted in significant decreases in the number of AHI (20.8 +/- 13.2 vs. 42.6 +/- 15.5; P < 0.001) and the number of episodes of central apnea-hypopnea per hour (10.1 +/- 7.6 vs. 31.5 +/- 9.6; P < 0.001). Furthermore, the percentage of total sleep time during which arterial oxyhemoglobin saturation (SaO(2)) was less than 90 percent (8.8% +/- 8.6% vs. 23.4% +/- 24.1%; P < 0.05) and the arousals per hour (18.7 +/- 21.2 vs. 36.8 +/- 21.3; P < 0.05) were also lower. There were no significant differences in the characteristics of sleep or obstructive AHI before and after theophylline treatment.

CONCLUSIONSThe prevalence of sleep-disordered breathing (mainly periodic respiration or cheyne-stokes respiration with central sleep apnea) is high in patients with stable chronic congestive heart failure. The sleep-disordered breathing episodes are associated with severe nocturnal arterial blood oxyhemoglobin desaturation and excessive arousals. In these patients, oral theophylline therapy may reduce the number of episodes of central apnea and hypopnea and the duration of arterial oxyhemoglobin desaturation during nocturnal sleep.

Aged ; Chronic Disease ; Female ; Heart Failure ; complications ; Humans ; Male ; Middle Aged ; Sleep Apnea Syndromes ; drug therapy ; Theophylline ; therapeutic use ; Treatment Outcome

Objective To investigate the relationship between serum homocysteine (Hcy) level and heart rate variability (HRV) in patients with acute cerebral infarction.Methods A retrospective study was conducted in 76 elderly patients with acute cerebral infarction in the Second Affiliated Hospital of Nanjing Medical University from January 2015 to December 2016,and the patients were monitored by 24 hours electrocardiogram within three months.According to age and Hcy level,the patients were divided into three groups:normal Hcy low age group (5-15μmol/L,60-80 years old),high Hcy low age group (＞ 15μmol/L,60-80 years old),high Hcy high age group (＞15μmol/L,≥80 years old).The correlation between Hcy and HRV was analyzed.Results The standard deviation of the normal-to-normal RR intervals (SDNN),the mean standard deviation of 5-minute RR intervals means (SDANN),the root mean square of successive differences in RR intervals (RMSSD),adjacent RR intervals greater than 50 ms (PNN50) in the high Hcy low age group were (108.75 ±34.18)ms,(97.63 ±31.34) ms,(22.04 ±6.97) ms,(3.78 ± 4.07) ％,respectively,which in the high Hcy high age group were (81.43 ± 27.68) ms,(71.46 ±25.45) ms,(23.82 ± 7.59) ms,(3.95 ± 3.56) ％,respectively,which were significantly lower than those in the normal Hey low agc group[(127.21 ± 22.21) ms,(114.75 ± 23.55) ms,(29.17 ± 9.71) ms,(7.68 ± 6.17) ％](t =2.219,2.140,2.920,2.585,t =6.502,6.328,2.227,2.722,all P ＜ 0.05).The levels of SDNN and SDANN in the high Hcy low age group were lower than those in the high Hcy low age group (t =3.185,3.322,all P ＜ 0.05).The low frequency (LF) and high frequency (HF) values in the high Hcy low age group were (11.86 ± 5.39) ms,(8.47 ± 3.25) ms,respectively,which in the high Hcy high age group were (9.29 ± 4.98) ms,(71.46 ± 25.45) ms,respectively,which were lower than those in the normal Hcy low age group[(15.15 ±4.56) ms,(11.36 ±4.36) ms] (t =2.281,2.612,t =4.392,2.900,all P ＜ 0.05).The LF/HF value of high Hcy high age group (1.09 ± 0.3) was lower than (1.42 ± 0.36) in normal Hcy low age group and (1.41 ± 0.40) in the high Hcy low age group (t =3.569,3.339,all P ＜ 0.05).Logistic regression analysis showed that SDNN,SDANN,RMSSD,nocturnal HF and nocturnal LF/HF were correlated with hyperhomocysteinemia (r =-0.037,-0.132,-0.087,-0.468,-3.746,all P ＜ 0.05).Conclusion Hyperhomocysteinemia with acute cerebral infarction in elderly patients is more likely to have cardiac autonomic nerve dysfunction.And clinically we should strengthen HRV detection of elderly patients with acute cerebral infarction and hyperhomocysteinemia.

Objective To explore the MRI features of acute optic neuritis with positive aquaporin?4 (AQP4) antibodies and myelin oligodendrocyte glycoprotein (MOG) antibodies during the first attack. Methods Eighty five patients (105 affected nerves) with first?episode AQP4?seropositive optic neuritis (AQP4?ON; n=58; 64 affected nerves) and MOG?seropositive optic neuritis (MOG?ON; n=27; 41 affected nerves) diagnosed by our hospital Neuro?ophthalmology Department between April 2014 and December 2017 were retrospectively analyzed. Double seronegative patients or double seropositive patients were not included. All patients underwent orbital conventional MRI; 29 patients also underwent RESOLVE?DWI and 55 underwent brain T2 fluid?attenuated inversion recovery (T2FLAIR). Theclinical features (age, gender, disease duration) and MRI features (T2WI, bilateral involvement, the degree and extent of enhancement, the extent of involvement, the affected segment and ADC values of nerve; demyelinating lesions of brain) were analyzed by 2 doctors. The qualitative parameters were compared with χ2 test or Fisher exact test and the quantitative parameters were compared with two independent sample t test (normal distribution) or the Mann?Whitney U test (skewed distribution). The Kappa test was used to test the consistency of the qualitative characteristics of the images evaluated by the 2 doctors. The interclass correlation coefficient (ICC) was used to test the consistency of the ADC obtained by the 2 doctors. Results There were no significant differences in the distributions of age and disease duration between 2 groups (t=1.911, Z=-1.054, P>0.05). AQP4?ON had a higher female proportion (χ2=13.911, P<0.05) and showed mainly unilateral involvement. MOG?ON more commonly showed bilateral involvement (χ2=17.640, P<0.05), but there were no significant differences in the demyelinating lesions of brain (χ2=0.000)and the presence/absence of optic tract involvement (both P>0.05). There was a higher probability of optic nerve swelling, long segmental lesions and optic nerve head involvement in MOG?ON(χ2=16.845, 13.525, 13.264, P<0.05). Moreover, the rate of obvious enhancement and the involvement of optic chiasm was higher in AQP4?ON(χ2=7.152, 5.088, P<0.05). RESOLVE?DWI showed the ADC values of the AQP4?ON were significantly lower than those of MOG?ON (t=-3.300, P<0.05). The qualitative features of image evaluated by the 2 doctors were consistent well (Kappa=0.712-0.932, P<0.001).The ADC values obtained by the 2 doctors were consistent well (ICC=0.942, P<0.001).Conclusions For the first?episode acute optic neuritis, AQP4?ON hasobvious female predilection and the trend of unilateral involvement and obvious enhancement, while MOG?ON isoften involved bilaterally with longitudinally extensive lesions. The ADC values of the AQP4?ON are significantly lower than those of MOG?ON and AQP4?ON are more vulnerable to involve the optic chiasm. Conventional MRI and RESOLVE?DWI are helpful for differentiating AQP4?ON from MOG?ON during the early stage of the disease course.

Objective: To analyze the influence of malnutrition in the elderly patients with acute coronary syndrome on related factors and short-term prognosis. Methods: 415 elderly patients with acute coronary syndrome were selected.Comprehensive geriatric assessment was used to investigate the risk of acute coronary syndrome by examining coexisting diseases and using the NRS2000 score.The mortality and emergency visits were followed up. Results: The patients were divided into two groups according to NRS2000 score: malnutrition group (n=179) and non-malnutrition group (n=236). (1) In malnutrition group, the proportions of female, over 85 years old, more than 3 kinds of coexisting diseases were 47.5%(85/179), 11.7%(21/179), 62.6%(112/179), respectively, which were higher than those of the non-malnutrition group[36.9%(87/236), 4.7%(11/236), 41.9%(99/236)](χ²=4.732, 7.152, 17.318, all P<0.05). (2) In malnutrition group, the incidence rates of geriatric syndromes such as uracratia, falls, visual disorder, hearing disorder, constipation, sleep disorders, oral problems were 47.5%(85/179), 30.2%(54/179), 40.2%(72/179), 41.9%(75/179), 54.7%(98/179), 52.0%(93/179), 76.5%(137/179), respectively, which were higher than those of the non-malnutrition group[31.4%(74/236), 14%(33/236), 29.2% (69/236), 29.7% (70/236), 30.5%(72/236), 36.0%(85/236), 53.0%(125/236)](χ²=11.206, 16.092, 5.477, 6.707, 24.732, 10.577, 24.297, all P<0.05). (3) In malnutrition group, the incidence rates of coexisting chronic diseases such as hypertension, chronic obstructive pulmonary disease, heart failure, severe renal insufficiency, cerebrovascular disease, dementia, anemia, osteoporosis were 77.1%(138/179), 16.2% (29/179), 22.9%(41/179), 17.9%(32/179), 46.9%(84/179), 6.7%(12/179), 27.4%(49/179), 26.8%(48/179), respectively, which were higher than those of the non-malnutrition group[61.9%(146/236), 7.6%(18/236), 14.4%(34/236), 7.2%(17/236), 32.2%(76/236), 1.3%(3/236), 13.1%(31/236), 17.4%(41/236)](χ²=10.931, 7.451, 4.965, 11.137, 9.315, 8.624, 13.262, 5.388, all P<0.05). (4)Cox regression analysis showed that malnutrition risk score was the independent risk predictor for all-cause mortality (HR=0.034, 95% CI: 0.072-0.904) and emergency department visits (HR=0.328, 95% CI: 0.197-0.548) in elderly patients with acute coronary syndrome. Conclusion Comprehensive geriatric assessment and nutritional assessment are useful to evaluate the clinical features of acute coronary syndrome in elderly patients.Malnutrition risk score is an independent predictor of all-cause mortality and emergency treatment in elderly patients with acute coronary syndrome.

Objective To analyze the influencing factors of pressure ulcers in bedridden patients from the view of caregivers.Methods We used convenience sample method to investigate primary the caregivers of 306 bedridden patients from January 2015 to June 2015.General information questionnaire,self-efficacy scale of caregivers for preventing pressure ulcers and scale of preventing pressure ulcers were used in this investigation.Patients were divided into the group with pressure ulcers (n =57) and the group without pressure ulcers (n =249).General data,self-efficacy and score of preventing pressure ulcers of caregivers in two groups were compared,and losgistic regression analysis was used to analyze the influencing factors of pressure ulcers in bedridden patients.Results The Braden score was (12.07±2.07) points in the group with pressure ulcers,and was (12.94±2.44) points in the group without pressure ulcers (t=2.34,P＜0.05).The scores of self-efficacy and preventing pressure ulcers of caregivers in the group with pressure ulcers were (57.23 ±8.01) points and (3.38±0.40) points,while those in the group without pressure ulcers were (53.53±8.46) points and (3.01± 0.37) points (t =2.87,5.18;P＜ 0.05).Logistic regression analysis showed that the influencing factors of pressure ulcers were the score of caregivers' measures to prevent pressure ulcers,whether caregivers received training about preventing pressure ulcers and the Braden score of patients (P＜ 0.05).Conclusions It is suggested that the nursing staff should be united with community to educate the caregivers for preventing pressure ulcers,and improve caregiver's prevention behavior,so as to reduce the incidence of pressure ulcers.

Objective To explore the predictors of reperfusion arrhythmia (RA) after PCI in patients with acute myocardial infarction (AMI) using Meta-analysis, and to provide evidence for clinical diagnosis and treatment of RA.Methods Firstly, the inclusion and exclusion criteria were restricted and the search strategy was planned. The clinical trials that related to emergency PCI treatment in AMI patients and published before 31st December 2016 were included by two researchers in this study by searching PubMed, CINAHL Database, MEDLINE, Web of Science, Cochrane Libraray, CBM, VIP, CNKI and Wanfang Database. After evaluating the quality of the literature, the Review Manager 5.3 software was used for Meta-analysis.Results A total of 10 studies including 13923 participants were enrolled. The Meta-analysis showed that the risk factors for RA after PCI in AMI patients included: smoking (OR=1.73; 95％CI 1.17-2.56;P<0.01), TIMI0 flow grade (OR=2.74; 95％CI 2.15-3.49;P<0.01), inferior MI (OR=4.52; 95％CI 2.47-8.42;P<0.01), right coronary artery infarction (OR=3.19; 95％CI 1.07-9.58;P=0.04), multi-vasculopathy (OR=3.05; 95％CI 1.83-5.09;P<0.01), renal failure (OR=2.81; 95％CI 1.45-5.43;P< 0.01), time from symptom onset to PCI≤6 h (OR=2.41; 95％CI 1.43-4.07;P<0.01), and duration of operation >1 h (OR=4.03; 95％CI 1.60-10.15;P<0.01). The protective factors included hypertension history (OR=0.76; 95％CI 0.63-0.93;P<0.01) and pre-infarction angina (OR=0.20; 95％CI 0.13-0.30;P<0.01). There were no significant differences in age (OR=1.03; 95％CI 0.95-1.11;P=0.48), history of diabetes (OR=1.26; 95％CI 0.29-5.47;P=0.75), and Killip grade>1 (OR=2.22; 95％CI 0.90-5.48;P=0.08).Conclusions The risk factors for RA after PCI in AMI patients include smoking, TIMI0 flow grade, inferior MI, right coronary artery infarction, multi-vasculopathy, renal failure, time from symptom onset to PCI ≤6 h, and duration of operation >1 h. The hypertension history and pre-infarction angina are protective against RA after PCI in AMI patients.