Objective To explore the clinical characteristics and causes of death in patients with acute heart failure at aged 75 and over.Methods The prospective study collected 175 patients with acute heart failure from January 2012 to December 2014.They were divided into ≥75 years old group and＜75 years old group and the general clinical data were recorded.Follow-up was performed mainly by telephone with supplemented hospitalization follow-up and outpatient follow-up.Survival rates were assessed by Kaplan-Meier method.The survival rate difference between the two groups was compared using the log-rank test.Multivariate Cox proportional hazards regression analysis was used to determine the independent risk factors for death.Results The proportions of ischemic heart disease,hypertension and old myocardial infarction were higher in the elderly group than in the young group with a higher proportion of male,diabetes and body mass index in ＜75 years old group.Elderly group had a higher level of left ventricular ejection fraction(LVEF)and a lower level of total cholesterol,triglycerides and low density lipoprotein cholesterol(LDL-C).Kaplan-Meier curves showed that allcause mortality(x2 =4.005,P =0.045) and non-cardiovascular mortality(x2 =4.418,P =0.041) were significantly higher in the elderly group than in the younger group,whereas cardiovascular mortality had no significant difference between the two groups (x2 =0.754,P =0.385).In patients with noncardiovascular mortality,12 cases (63.2％)died of pulmonary infection in elderly group,3 cases(25.0％) died of lung infection in younger group,and the difference was statistically significant between the 2 groups (x2 =4.288,P =0.038).Multivariate Cox proportional hazards regression analysis showed that age≥75 years was an independent predictor for both non-cardiovascular mortality [HR(95％CI):2.71(1.50-6.55),Wald x2 =2.266,P=0.038]and all-cause mortality[HR(95 ％CI):1.75(1.28-3.13),Wald x2 =2.914,P=0.026]in patients with acute heart failure.Conclusions Age ≥75 years is an independent risk factor for all dead patients with acute heart failure and noncardiovascular death,but it is not the independent risk factors for cardiovascular death,which is of great significance to establish a more rational treatment strategy for senile heart failure.

Objective To investigate the clinical efficacy of dog days' acupoint application in treating allergic rhinitis and assess its safety.Methods Two hundred and forty-nine patients were randomly allocated to a dog days' acupoint application group of 166 cases and a placebo group of 83 cases. The two groups were received treatment at the first day of the first, second and last periods of the hot season The dog days' acupoint application group received acupoint application of Chinese herbal medicine and the placebo group, acupoint application of non-medicinal placebo. In the two groups, the symptoms and signs were scored and the VAS score was recorded before and after treatment and during the follow-up period, and adverse reactions and relapses were observed and the clinical therapeutic effect of acupoint application and its safety were assessed after treatment and during the follow-up period.Results The total efficacy rate was 69.8% in the dog days' acupoint application group and 44.4% in the placebo group. The therapeutic effect was significantly better in the dog days' acupoint application group than in the placebo group (P<0.01). The totalefficacy rate was 89.4% at the 6-month follow-up and 90.7% at the 12-month follow-up in the dog days' acupoint application group and 4.9% and 1.2% in the placebo group. The long-term therapeutic effect was significantly better in the dog days' acupoint application group than in the placebo group (P<0.01). In the dog days' acupoint application group, the symptom score, the sign score and the VAS score were significantly lower after treatment and during the follow-up period than before treatment (bothP<0.01). In the placebo group, those scores only had significant pre-/post-treatment differences (P<0.01). There were statistically significant differences in the symptom score, the sign score and the VAS score between the two groups at different times. The adverse reaction rate was 4.3% in the dog days' acupoint application group and 2.5% in the placebo group; there was no statistically significant difference between the two groups (P>0.05). The relapse rate was 46,6% at the 6-month follow-up and 62.1% at the 12-month follow-up in the dog days' acupoint application group and 85.2% and 95.1% in the placebo group; there were statistically significant differences between the two groups (P<0.01).Conclusions Dog days' acupoint application has better short-term and long-term therapeutic effect on allergic rhinitis with a low relapse rate and high safety.

ObjectiveTo study the distribution,location and hemodynamics of perforating branches of the ulnar artery with color Doppler flow imaging (CDFI).MethodsPerforating branches of ulnar arteries were examined in 80 healthy volunteers in both forearms using CDFI.Following parameters were detected:number,diameter,jumping-off point,course,location and peak blood velocity.All the parameters data were analyzed statistically.ResultsThree hundred and forty-five perforating branches were detected in total 160ulnar arteries.These branches were classified into three types:type Ⅰ,myocutaneous perforator (10.3 ％);type Ⅱ,septocutaneous perforator(87 ％ ) ; type Ⅲ,direct cutaneous perforator (2.7 ％ ).The most dominant branches were located in the mesial of the upper third,middle third and lower third of the forearm.There was no significant difference among all age groups and no difference in peak blood velocity between left side and right side( P ＞0.05).The peak blood velocity was higher in male than that in female.( P ＜0.05).In relaxing period,the blood flow rate was almost disappeared and the frequency spectrum showed the characteristics of single direction,lower blood velocity and higher blood resistance.ConclusionsCDFI with high resolution showed better results of distribution and location of perforating branches of the ulnar artery and a better quality evaluation of the these branches.CDFI was helpful to design the skin flap containing cutaneous perforators of ulnar artery.

Objective:To investigate the clinical features and prognosis of patients with pancreatic metastasis from clear cell renal cell carcinoma(CCRCC).Methods:From Jan 2000 to May 2020, the clinical data of patients pathologically diagnosed as CCRCC with pancreatic metastasis and admitted in Cancer Institute and Hospital of Tianjin Medical University were analyzed retrospectively. The gender, age, metastasis time, relapse time, metastatic sites, numbers of metastatic lesions and whether metastatic pancreatic lesions should be surgerically removed were recorded and the influencing factors were analyzed.Results:Among the 20 patients, there were 12 males and 8 females. The median age of diagnosis was 50 years. There were 12 patients(60%) of left renal carcinoma and 8 patients(40%)of the other side. 12 cases(60%) had single pancreatic metastatic lesion and the other 8 cases(40%) had multiple metastatic lesions. Seven patients(35%) had other organs metastasis besides pancreatic metastasis. Two patients(10%) had simultaneous pancreatic metastasis and renal cancer, and the other eighteen patients(90%) had pancreatic metachronous metastasis after being diagnosed as renal cancer. The median time from the diagnosis of CCRCC to pancreatic metastasis was 102 months. Thirteen patients(65%)had recurrences within 10 years and the other seven patients(35%)had recurrences after 10 years. Pancreatectomy was performed in nine patients(45%) and targeted therapy was conducted in thirteen patients. The mean follow-up was 122.9 months (1-256 months). Three patients (15%) died and 17 patients (85%) survived. The median overall survival was 75.9 months, and the 5 year-survival rate was 66.7%. Simultaneous metastasis and extra-pancreatic metastasis were prognostic factors in patients with CCRCC with pancreatic metastasis.Conclusions:Pancreatic metastases from renal clear cell carcinoma were rare, but the prognosis was good, especially in patients with only pancreatic metastases several years after renal carcinoma was diagnosed.

Objective To investigate the availability and safety of pulmonary rehabilitation for hospitalized patients with acute exacerba-tion of chronic obstructive pulmonary disease (COPD). Methods Seventy-two hospitalized patients with acute exacerbation of COPD were randomly included into test group (n=36) and control group (n=36) from June, 2015 to June, 2016. All the patients accepted management of anti-infection, phlegm elimination, antiasthma, etc., as well as the guidance of expectoration and health education; while the test group ac-cepted pulmonary rehabilitation from the third day of admission to discharge. Their strength of hand grip, 1-minute sit-to-stand test (STST), the days of hospitalization, lung function parameters, modified Medical Research Council (mMRC) scores and COPD Assessment Test (CAT) scores were measured before and after treatment. Results Compared with the control group, the strength of hand grip (t=2.985, P<0.01) and number of STST (t=2.024, P<0.05) increased, while the scores of CAT (t=3.222, P<0.01) and mMRC (t=2.212, P<0.05) de-creased in the test group. The hospital stay seemed to be shorter in the test group than in the control group, but there was no significant dif-ference (t=1.433, P>0.05). There was no significant difference in lung function after treatment in both groups (Z<1.031, P>0.05). Conclu-sion Pulmonary rehabilitation is effective on hospitalized patients with acute exacerbation of COPD in muscle strength, capability of activi-ties, and relieve the symptoms.

This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients' ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months (with a mean of 5.2 months). Of them 5 had cervical spondylotic myelopathy and 7 had cervical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases received two-level replacement. Operation time of the single-level surgery averaged 130+/-50 min and the time of two-level surgery was 165+/-53 min on average (from skin incision to skin suturing). Neurological or vascular complications during or after surgery was not observed. Japanese Orthopedic Association scores (JOA scores) increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially restored, being 4.68 degrees (3.6 degrees -6.1 degrees ) in flexion and extension position and 3.51 degrees (2.5 degrees -4.6 degrees ), 3.42 degrees (2.6 degrees -4.3 degrees ) in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm) in 2 of 14 levels and between 1.5 mm and 3 mm) in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recovery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.

Objective To evaluate the abstinence rate and relapse rate of smoker with ACS after discharged from hospital, to evaluate the effect of simple smoking cessation interventions.Methods 150 smokers with ACS were collected and was divided into simple intervention group ( n = 87) and control group (n = 63) , respectively, followed up for 6 months.2 months, 6 months abstinence rate, relapse rate were compared between two groups, logistic regression model was used to analyzed the relevant factors for relapse.Results The smoking rate in patients with ACS was 31.14% , 6-month continuous abstinence rate and 6-month relapse rate was 64.6% , 36.4% , respectively.6-month continuous abstinence rate and relapse rate between simple quit-smoking intervention group and control group showed no difference.Nicotine dependence score more than 4 points can be used as predictor of relapse.Conclusions The smoking rate and the abstinence rate of smoker with ACS is higher than the general population, simple quit-smoking intervention do not increase the success rate of quit-smoking, indicated the need to strengthen the intervention in patients with ACS and smoking.

Objective To explore the safety and feasibility of coronary angiography (CAG) via percutaneous left radial artery approach (LRA) compared with right radial artery approach (RRA) in aged patients, and determine whether LRA is a valid alternative for CAG. Methods A total of 502 consecutive patients who were aged 65 or older underwent diagnostic CAG were recruited and randomized to the LRA group (240 patients) or RRA group (262 patients). The study end points included total procedural duration, coronary time, fluoroscopy time, dose of radiation including cumulative air kerma and dose area product, contrast volume, and the incidence of vascular complications. Results Coronary procedural success rate was 96.2%(231/240) in LRA group and 96.2%(252/262) in RRA group. There was no significant difference (P>0.05). The radial cannulation time, fluoroscopy time, look through time, dose of radiation, contrast volume and the percentage of hydrophilic wire used in two group had no significant difference (P > 0.05). The catheter in place time in LRA was significantly shorter than that in RRA group:(2.7 ± 2.5) min vs. (3.3 ± 3.3) min, P=0.036). There was a trend toward shorter procedural duration in LRA group than that in RRA group, but there was no significant difference: (13.3 ± 6.1) min vs. (14.3 ± 6.2) min, P=0.075. Conclusions LRA approach has similar safety and feasibility in terms of performing coronary angiography compared with RRA.It seems to be a feasible alternative for CAG in aged patients.

Objective To understand the Oncomelania hupensis snail distribution in the working areas of Yangtze River hy?drologic agencies located in the middle and lower reaches of the Yangtze River in 2016,so as to provide the evidence for assess?ing the risk of schistosome infection of hydrological workers and establishing the control strategies. Methods The suspicious en?vironments with O. hupensis snails in the above working areas were selected as study areas,and the snail situation was surveyed by the system sampling method combined with the environmental sampling method. The survey data were collected and analyzed statistically. Results Totally 19 working areas from 17 hydrological agencies were selected as the investigation sites,among which,10 working areas from 9 agencies were found with O. hupensis snail distribution. The constituent ratio of the areas with snails reached to 38.81%of the investigation areas,the occurrence rate of frames with snails was 3.08%,and the average densi?ty of living snails was 0.07/0.1 m2. By comparison,the average density of living snails and occurrence rate of frames with snails in hydrological agencies under the jurisdiction of the Middle Reaches Administrative Bureau were the most serious among three administrative bureaus of the Yangtze River Water Resources Commission. Conclusions There are various degrees of O. hupen?sis breeding in the working areas of hydrological agencies located in the middle and lower reaches of the Yangtze River ,and the hydrological workers are facing with the risk of schistosome infection.

Objective To understand the clinical distribution characteristics of Acinetobacter baumannii in our hospital and the change situation of drug resistance rates to provide a basis for the clinical rational drug use and the nosocomial infection manage-ment.Methods The Acinetobacter baumannii strains isolated in our hospital from January 2005 to December 2013 were performed the retrospective analysis on its department distribution,specimen distribution and change of drug resistance rates.Results 964 strains of Acinetobacter baumannii were isolated during these 9 years,in which 713 strains were multi-drug resistant.The isolated strains were less during 2005 -2008,which were 30,26,22,19 strains respectively.The isolated strains began to increase during 2009-2010,which were 65,50 strains respectively.The detection rate began to enormously increase from 2011,which were 157, 229,366 strains respectively from 2011 to 2013.The top three departments of the highest isolation rates during these 9 years were ICU,neurosurgery department and respiratory department.The specimen source was always dominated by the respiratory tract specimens,followed by the secretion samples,in recent years,the detection rates of blood,urine and drainage specimens were in-creased to some extent.The drug resistance rates in 13 kinds of drugs totally showed the increasing trend,the resistance rate of par-tial drugs was decreased to some extent.Conclusion Acinetobacter baumannii easily cause nosocomial infections,which is difficult to be eliminated and has high occurrence in the departments centralized with critical patients.The respiratory infection is the main pathogenic type.Its drug resistance is serious,multi-drug resistant and pan-resistant strains have the higher proportion.Clinic should rationally use the drugs based on the drug susceptibility test results,coordinates with the infection control departments for doing disinfection and isolation well and prevent ing the outbreak of nosocomial infections.