Objective To explore the relationship between non-high density lipoprotein cholesterol(non-HDL-C)level and leptomeningeal collateral circulation in patients with acute middle cerebral artery occlusion.Methods A total of 85 patients with first-onset acute cerebral infarction with middle cerebral artery M1 segment occlusion were enrolled.According to the results of DSA,LMC circulation was assessed by American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Circulation Assess-ment System.All patients were assigned to better LMC circulation group(score 2～4,n = 30)and worse LMC circulation group(score 0～1,n = 55),and the levels of non-HDL-C were compared between the two groups.Results The levels of LDL-C and non-HDL-C in worse LMC circulation group were significantly higher than those of the better LMC circulation group(P = 0.026,P = 0.010).non-HDL-C was an independent risk factor for the worse LMC circulation(OR = 3.019,95%CI:1.053～8.658,P = 0.04).LMC circulatory score of patients was negatively correlated with the levels of non-HDL-C level(r =-0.228,P = 0.036).The AUC of non-HDL-C predicted for the worse LMC circulation was 0.638(95%CI:0.521～0.755,P = 0.036).Conclusions non-HDL-C in patients with acute cerebral infarction was significantly related to worse LMC circulation,and was a risk factor for worse LMC circulation.It is suggested that the higher expression of non-HDL-C could be used to predict worse LMC circulation as a serological indicator.

Objective:To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death.Methods:It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results:Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; ≥80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male ( OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 ( P<0.001), 0.724 ( P<0.001) and 0.514 ( P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ2=6.136, P=0.013; 8.90% vs. 11.44%, χ2=11.662, P<0.001; 2.01% vs. 3.37%, χ2=10.713, P=0.001, respectively). Conclusion:The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.

Chronic atrophic gastritis (CAG) and gastric intestinal metaplasia (GIM) significantly increase the risk of gastric cancer. Blocking the development of CAG and GIM would help to decrease the incidence of gastric cancer. It was revealed that eradication of Helicobacter pylori could reverse gastric mucosa atrophy. Recent studies reported that GIM could be reversed to a certain extent. Clinical studies demonstrated that Lamb′s tripe extract and vitamin B12 capsule exhibited significant reversal effects on GIM. The present study systemically reviewed the diagnosis and treatment of CAG and clinical application of Lamb′s tripe extract and vitamin B12 capsule, and established the specialist instruction that would guide the reversal treatment of CAG and GIM.

Chronic atrophic gastritis (CAG) and gastric intestinal metaplasia (GIM) significantly increase the risk of gastric cancer. Blocking the development of CAG and GIM would help to decrease the incidence of gastric cancer. It was revealed that eradication of Helicobacter pylori could reverse gastric mucosa atrophy. Recent studies reported that GIM could also be reversed to a certain extent. Clinical studies demonstrated that Lamb’s tripe extract and vitamin B12 capsule exhibited significant reversal effect on GIM. The present study systemically reviewed the diagnosis and treatment of CAG and clinical application of Lamb’s tripe extract and vitamin B12 capsule, and established the specialist instruction that would guide the reversal treatment of CAG and GIM.

Objective:To investigate the impact of non-alcoholic fatty liver disease (NAFLD) on the incidence of type 2 diabetes mellitus (T2DM) in an elderly population.Methods:A rural elderly population of Kunshan city, Jiangsu Province were used as the research subject. Prior diabetes mellitus, heavy alcohol consumption and incomplete data were excluded from prospective cohort study analysis. Annual physical examination and follow-up were conducted from 2007 to 2016. T2DM onset, death and loss to follow-up visits were observed as the research subject end points. According to the baseline physical examination results, the study subjects were divided into NAFLD and control groups, and further baseline data of both groups were analyzed whether there were match. The cumulative incidence rate of T2DM were statistically analyzed and compared between the two groups. Simultaneously, the relationship between the two groups of various indexes and the newly developed T2DM were analyzed using Kaplan-Meier. The variables with P < 0.1 were selected and incorporated into the Cox proportional hazard regression model. The impact of NAFLD on the incidence of T2DM was analyzed in an elderly population. Results:At baseline, there were statistically significant differences in the distribution of age, sex, waist circumference, body mass index, systolic blood pressure, diastolic blood pressure, direct bilirubin, blood urea nitrogen and triglycerides between NAFLD and non-NAFLD groups. However, fasting blood glucose, serum creatinine, total bilirubin, total cholesterol, low density lipoprotein cholesterol and high-density lipoprotein cholesterol had no statistically significant differences between the two groups. After nine years of follow-up, 207 newly developed T2DM cases, 52 NAFLD cases and 155 control group were selected as the study subjects. The cumulative incidence rates were 4.25%, 10.34%, and 3.55%, respectively. Kaplan-Meier analysis result showed that there were statistically significant differences in the cumulative incidence rates between the two groups from five-year. NAFLD had increased the T2DM risk in an elderly population by approximately 2.14 times (2.14 CI: 1.132 ~ 4.047) at five-year, and then had increased year by year thereafter. Univariate analysis showed that T2DM risk was 2.76 times higher in NAFLD than non-NAFLD groups (95% CI: 2.015 ~ 3.777). After adjustment for gender, age, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, serum creatinine, triglyceride, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, T2DM risk ratio was 1.68 times higher in NAFLD than control groups (95% CI: 1.163 ~ 2.425). Conclusion:NAFLD is an independent long-term risk factor for the T2DM onset in an elderly population.

Objective: To explore the cause and type of pigmentation in the livers and kidneys of rats caused by a compound Chinese medicine preparation. Methods: The experiment consist of low, medium, and high dose groups and a control group, the Sprague-Dawley rats in these groups were orally given 1.0, 2.0 and 4.0 g/kgbw of a compound Chinese medicine preparation of gardenia and distilled water for 30 days, respectively. The body weight, diet, hematology and histopathology of the rats in each group were observed for changes in pigment metabolism. Results: In the first and second weeks of the experiment, the rats in the low, medium, high dose groups and the control group showed no abnormal symptoms or signs. From the third weekend, the urine of the rats in the high dose group turned thick yellow and green, and the stool color became light. During the experiment, no rats died. There were statistically significant differences in body weights and weight gains among these groups ( P<0.05 ) . There were statistically significant differences in total food utilization, direct bilirubin, r-glutamyl transferase, alkaline phosphatase, and liver/body ratios among these groups ( P<0.05 ). Gross examination revealed that the livers and kidneys of rats in the high dose group were dull and green. Microscopic examination revealed changes in dark pigment particles in the livers and kidneys of rats in the high dose group. Histochemical staining confirmed that pigments in the livers and kidneys were bile pigments. Conclusions At a dosage of 4.0 g/kgbw, a compound Chinese medicine preparation of gardenia can lead to bile pigment deposition in the livers and kidneys of rats due to cholestasis.

Objective:To explore the effectiveness of an information system on the prevention and control of venous thromboembolism(VTE)in elderly inpatients.Methods:Through retrospectively reviewing medical records of Beijing Shijitan Hospital and files of all patients admitted to the geriatric department of our hospital before and after an information management system was instituted, data of those diagnosed with deep venous thrombosis of the lower extremities, intermuscular venous thrombosis and/or pulmonary thromboembolism(PE)at discharge were collected.General information, prognosis of disease, risk factors for VTE, the detection rate and assessment rate of VTE and other factors were analyzed.Methods:A total of 146 patients were enrolled, and they were mainly elderly patients from the respiratory, cardiology and integrative medicine wards.Diabetes mellitus, cancer and chronic heart failure were the top-three high-risk diseases, and most patients were at high risk or very high risk.The rate of elderly patients assessed as at high risk for VTE on admission was higher after the institution of the information system than that before the institution(93.22% vs.24.66%, P<0.05). The rate of VTE patients receiving standard diagnosis and anticoagulant treatment procedures had an upward trend since the information system became available, compared with before(8.47% vs.5.48%, P>0.05). There was a downward trend in the incidence of PE and all-cause mortality with the use of the information system(3.39% vs.9.59%, 5.08% vs.9.59%, P>0.05). Conclusions:The use of information systems can effectively increase the risk assessment rate for VTE and reduce the incidence of related adverse events in hospitalized elderly patients.

Objective To understand and analyze the incidence rate,risk factors,independent risk factors and the causes of death in elderly population with non-alcoholic fatty liver disease (NAFLD).Furthermore,analyze the relationship between metabolic syndrome (MS) and mortality rate in patients with NAFLD to provide evidence for the prevention and control of NAFLD in the elderly population.Methods A total of 7 619 elderly people aged over 60 years,and local household registered in Kunshan city,Jiangsu province in 2016 were included as subjects to analyze the incidence rate,influencing factors and causes of death in patients with NAFLD and the relationship between MS and mortality rate in patients with NAFLD.According to different data,using Kruskal-Wallis H test,analysis of variance,t-test,chi-square test or logistic regression analysis were performed.Results The prevalence of NAFLD was14.10％ (1 074/7 619) among the elderly over 60 years in Kunshan city,Jiangsu province in 2016,and the female prevalence rate was significantly higher than that of males (P ＜ 0.05).When the body mass index (BMI) was ＜ 32 (kg/m2),the prevalence of NAFLD increased with the increase of BMI index.When BMI was 18.5-23.9 kg/rn2,24-27.9 kg/m2 and ＞ 32 kg/m2,the prevalence of NAFLD was significantly higher in females than males (P ＜ 0.05).There was no significant difference in prevalence between males and females with BMI ＜18.5 kg/m2 and 28～31.9 kg/m2 (P＞ 0.05).BMI gradually decreased (P ＜ 0.05) with the increase of age,and the incidence of NAFLD showed a downward trend (P ＜ 0.05).An independent risk factors for NAFLD (P ＜ 0.01) were gender (OR =0.616),age (OR =0.970),waist circumference (OR =1.065),triglycerides (OR =1.162),BMI (OR =1.238),and diastolic blood pressure (OR =1.012).The probability of NAFLD combined with three and four kinds of MS was significantly higher than control group (P ＜ 0.05).Subjects' mortality rate during the follow-up period was 1.94％,2.23％ in the NAFLD group,and 1.89％ in the control group.Average life expectancy was 75.58 years in NAFLD group and 78.68years in the control group.All deaths in NAFLD groups were associated with MS,and 70.83％ combined with three or more MS.The primary canse of death in NAFLD group was tumors (37.5％),followed by cardiovascular disease (16.67％) and three cases died directly from MS.Conclusion The prevalence of NAFLD in the elderly population in Kunshan city,Jiangsu province is relatively low,which may be associated with local diet and highintensity workouts.MS disorders represented by obesity and diabetes mellitus are closely associated to the onset of NAFLD.Obesity is the most important risk factor for the incidence of NAFLD in the local elderly population over 60 years old.However,the risk of NAFLD should not be neglected in people with normal BMI,especially in aged women,and the weight control should be the most important means to prevent and control NAFLD.NAFLD may increase mortality rate and reduce life expectancy in the elderly population.The main reason to cause death in the elderly with NAFLD is cardiovascular disease and malignant tumors.Simultaneously,multiple MS development may increase the death rate in elderly with NAFLD.

To analyze the clinical features of deep venous thrombosis(DVT) in hospitalized patients and evaluate the effectiveness of Padua risk assessment model. The clinical data of DVT patients were retrospectively analyzed in Beijing Shijitan Hospital from April 1 2017 to June 30, 2017. Padua risk assessment scale was used to evaluate the risk score of DVT in the departments of internal medicine and surgery. Effectiveness of predicting DVT was analyzed by receiver operating characteristic curve (ROC). Logistic regression analysis was used to evaluate the related factors of DVT. In DVT group, age ( OR=0.96), acute infection( OR=8.23),prothrombin time( OR=0.76),D dimer(OR=1.00),erythrocyte sedimentation rate( OR=1.02) and platelet count( OR=1.01) were significantly associated with thrombosis(all P<0.05). The specificity of Padua model to predict DVT in internal medical patients was better than the sensitivity(80.7% vs. 50%,P<0.05).Surgical patients reported similar findings with specificity to sensitivity of 87.5% vs. 67.5%(P<0.05). The area under curve of ROC in internal medical patients was more than that in surgical patients[0.62 (95% CI 0.59-0.67)vs. 0.61(95% CI 0.56-0.66),P<0.05]. Padua model is more specific than sensitive to predict DVT in hospitalized patients.It has better predictive value of DVT in internal medical patients than surgical patients.

Objective To evaluate the effectiveness of American College of Surgeons (ACS) National Surgical Quality Improvement Program(NSQIP)surgical risk calculator in the evaluation of postoperative complications of elderly patients undergoing prosthetic femoral head replacement.Methods Three hundred and forty five elderly patients(＞60 years)who had underdone femoral head replacement from January 2013 to December 2015 were recruited.Data on twenty-one parameters(age,sex,functional status,etc.)were collected for the ACS NSQIP surgical risk calculator and predictive values for complications were also obtained.The ROC curve was compared with the actual complication.The Pearson correlation coefficient was used to analyze the correlation between serious complications and the 21 parameters,and the correlation between different complications.Results There were 12 complications,including death,urinary tract infection,venous thrombosis,cardiovascular events,renal failure,pneumonia,surgical site infection,any complication,serious complications,readmission,return to OR,and discharge to nursing or rehab facilities.The ACS NSQIP surgical risk assessment calculator was able to predict postoperative complications(AUC＞0.5,except surgical site infection,for which AUC=0.47).The predictive value for discharge to nursing or rehab facilities was the highest(AUC=0.62).Moreover,there was a significant correlation between complications and the 21 parameters(P＜0.05).Cardiovascular events were significantly associated with the occurrence of pneumonia in common complications (Person correlation coefficient:0.91,95 ％ CI:0.86 ～ 0.94,P ＜0.05).Conclusions The ACS NSQIP calculator is effective in predicting postoperative complications inelder patients with prosthetic femoral head replacement.