Objective: To analyze the clinical characteristics of early organ injury in elderly patients with severe burns and the effects on the prognosis of patients. Methods: From January 2010 to August 2018, 62 patients with severe burns (43 men and 19 women, aged from 60 to 89 years at the time of admission) who were hospitalized in the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as the author′s affiliation), meeting the inclusion criteria, were included in elderly (E) group, and 124 patients with severe burns (86 men and 38 women, aged from 18 to 59 years at the time of admission) at the same term were included in young and middle-aged (YM) group. Treatment of patients in the 2 groups followed the conventional procedures of the author′s affiliation. The following data of patients in the 2 groups were retrospectively analyzed. (1) Fluid replacement volume and urine volume within the first and second post injury hour (PIH) 24 were recorded. The levels of hemoglobin, haematocrit, and blood lactic acid at admission, PIH 24 and 48 were recorded. (2) The creatine kinase isozyme-MB (CK-MB), total bilirubin, blood creatinine, oxygenation index, and blood platelet count at admission, at shock stage, and on post injury day (PID) 3 to 7 were collected. (3) The days of seriously or critically ill and deaths were recorded. Data were processed with chi-square test, group t test, Mann-Whitney U test, analysis of variance for repeated measurement, and Bonferroni correction. Results: (1) There were no statistically significant differences in fluid replacement volume within the first and second PIH 24, and urine volume within the second PIH 24 between patients in the 2 groups (t=0.351, 1.307, 1.110, P>0.05). The urine volume of patients in group E within the first PIH 24 was significantly less than that in group YM (t=5.628, P<0.05). There were no statistically significant differences in levels of hemoglobin (t=0.011, 1.075, 0.239), haematocrit (t=0, 0.033, 0.199), and blood lactic acid (t=0.017, 1.002, 0.739) at admission, PIH 24 and 48 between patients in the 2 groups (P>0.05). (2) There were no statistically significant differences in levels of CK-MB at admission and on PID 3 to 7 between patients in the 2 groups (t=0.069, 0.001, P>0.05). The level of CK-MB of patients in group E at shock stage was significantly higher than that in group YM (t=4.017, P<0.05). There were no statistically significant differences in levels of total bilirubin at admission and on PID 3 to 7 between patients in the 2 groups (t=0.227, 0.002, P>0.05). However, the level of total bilirubin of patients in group E at shock stage was significantly higher than that in group YM (t=6.485, P<0.05). The levels of blood creatinine of patients in group E at admission and shock stage were significantly higher than those in group YM (t=4.226, 12.299, P<0.05 or P<0.01), while there was no statistically significant difference between them on PID 3 to 7 (t=0.693, P>0.05). The oxygenation indexes of patients in group E at admission and shock stage and on PID 3 to 7 [(371±16), (263±16), and (228±18) mmHg (1 mmHg=0.133 kPa)] were lower than (420±13), (327±13), and (281±17) mmHg of patients in group YM, respectively (t=5.650, 9.782, 4.856, P<0.05 or P<0.01). There were no statistically significant differences in levels of blood platelet count at admission and shock stage between patients in the 2 groups (t=0.038, 0.588, P>0.05), while the level of blood platelet count of patients in group E on PID 3 to 7 was significantly lower than that in group YM (t=6.636, P<0.05). (3) The days of seriously or critically ill and death rate of patients in group E were respectively longer or higher than those in group YM (Z=-2.303, χ²=13.676, P<0.05 or P<0.01). Conclusions In the case of the same tissue perfusion at shock stage, injuries in heart, liver, kidney, lung, and coagulation system in elderly patients with severe burns are more obvious than those in young and middle-aged patients, with more severe illness and higher mortality.

Objective To investigate the effect of FT3 on the long-term mortality of patients with acute myocardial infarction (AMI) complicated with non-thyroidal illness syndrome (NTIS).Methods A total of 1 809 patients with AMI were divided into NTIS group and normal group.The patients were followed up for 1 to 8.5 years.The multivariate COX regression analysis was used to study the effect of FT3 on long-term all-cause mortality and cardiovascular mortality in AMI patients.Results The incidence rate of NTIS in AMI patients was 21.7％.Compared with the normal control group,the in-hospital mortality,long-term all-cause mortality and long-term cardiovascular mortality in the NTIS group were significantly higher (14.3％ versus 1.8％,23.1％ versus 14.5％,14％ versus 7.6％,P ＜ 0.05).The level of FT3 (HR =0.304,95％ CI:0.134 ～ 0.693,P =0.005) was correlated with long-term all-cause mortality in patients with AMI,and FIT3 level (HR =0.241,95 ％ CI:0.093-0.622,P =0.003) is an independent risk factor for long-term cardiovascular death in patients with AMI.Conclusion NTIS exists in AMI commonly.FT3 level is an independent risk factor for long-term all-cause death and cardiovascular death in patients with AMI.

Objective To investigate the effect of FT3 on the long-term mortality of patients with acute myocardial infarction (AMI) complicated with non-thyroidal illness syndrome (NTIS).Methods A total of 1 809 patients with AMI were divided into NTIS group and normal group.The patients were followed up for 1 to 8.5 years.The multivariate COX regression analysis was used to study the effect of FT3 on long-term all-cause mortality and cardiovascular mortality in AMI patients.Results The incidence rate of NTIS in AMI patients was 21.7％.Compared with the normal control group,the in-hospital mortality,long-term all-cause mortality and long-term cardiovascular mortality in the NTIS group were significantly higher (14.3％ versus 1.8％,23.1％ versus 14.5％,14％ versus 7.6％,P ＜ 0.05).The level of FT3 (HR =0.304,95％ CI:0.134 ～ 0.693,P =0.005) was correlated with long-term all-cause mortality in patients with AMI,and FIT3 level (HR =0.241,95 ％ CI:0.093-0.622,P =0.003) is an independent risk factor for long-term cardiovascular death in patients with AMI.Conclusion NTIS exists in AMI commonly.FT3 level is an independent risk factor for long-term all-cause death and cardiovascular death in patients with AMI.

Two hundred and eleven aged patients with type 2 diabetes were enrolled in the study.Blood glucose levels were monitored with continuing glucose monitoring system (CGMS) for 3 days and the cognitive function was evaluated with Mini-Mental State Examination(MMSE) scale.The correlation between hypoglycemia(or nocturnal hypoglycemia) and MMSE scores was evaluated.CGMS recorded hypoglycemia in 47％ patients (100/211),82％ of whom (82/100) had nocturnal hypoglycemia.Patients with hypoglycemia had lower MMSE scores than those without hypoglycemia (25.1 ± 5.1 vs.26.8 ± 3.0,P ＜ 0.05).Furthermore,the incidence of hypoglycemia(or nocturnal hypoglycemia) was higher in patients with MMSE≤24 than that in patients with MMSE ＞ 24(P ＜0.05).The median of hypoglycemia maximal time and nocturnal hypoglycemia maximal time were longer in patients with MMSE ≤ 24 than those with MMSE ＞ 24 (P ＜ 0.05).Stepwise regression analysis showed that the total time and maximal time of hypoglycemia(or nocturnal hypoglycemia),age,and education level were the main factors influencing MMSE scores in aged type 2 diabetic patients(all P ＜0.05).

Objective To investigate the guiding value of serum procalcitonin (PCT) level in antibiotic treatment of stroke-associated pneumonia (SAP) after spontaneous intracerebral hemorrhage. Methods A total of 120 patients with SAP after acute cerebral hemorrhage were enroled and were randomly divided into either a conventional treatment group ( n=59) or a PCT guided group ( n=61). In accordance w ith the guidelines for the use of antibiotics in China, the conventional treatment group w as treated w ith antibiotics and the course of antibiotics w as determined by the treating physician. The serum PCT of the PCT group w as monitored continuously after using antibiotics for 5 days. When PCT w as < 0.25 μg/L and the body temperature of the patients w as normal, the antibiotics w ere stopped. When PCT w as ≥0.25 μg/L, the antibiotics w ere used continuously. When PCT w as <0.25 μg/L, but stil had a fever, and the antibiotics w ere used continuously til the temperature w as normal. The course of antibiotics, length of hospitalization, and 30-d mortality of both groups w ere compared. At day 90 after treatment, the modified Rankin scale (mRS) w as used to evaluate the neurological outcome. The mRS score 0-2 w as good outcome and >2 w as poor outcome. They were folowed up for 6 months after discharge. A Kaplan-Meier survive curve was use to compare the survival rate of both groups. Results The course of antibiotics ( 8.95 ±2.73 d vs.13.26 ± 4.11 d;t=6.407, P<0.001) and the length of hospitalization ( 15.64 ±2.63 d vs.18.36 ±4.27 d; t=3.967, P<0.001) of the PCT group w ere significantly shorter than those of the conventional treatment group. There w ere no significant differences in the proportions of 30 d mortality ( 9.8%vs.10.1%; χ2 =0.003, P=0.951) and 90 d good outcome ( 60.6%vs.59.3%; χ2 =0.022, P=0.881) betw een the PCT guided group and the conventional treatment group. At the end of the 6-month folow-up period, a total of 13 patients (12.0%) died, including 6 in the conventional treatment group and 7 in the PCT group. The Kaplan-Meier analysis show ed that there w as no significant difference in the 6-month survival rate betw een the 2 groups (χ2 = 0.070, P= 0.791 ). Conclusions Monitoring the serum PCT level for guiding antibiotic treatment of SAP after spontaneous intracerebral hemorrhage is safe, and it may shorten the course of antibiotics and reduce the length of hospitalization.

Objective To evaluate the value of D-dimer in assessing severity and predicting longterm prognosis in patients with community acquired pneumonia (CAP).Methods From June 2009 to December 2010,a total of 189 patients with CAP were enrolled.After admission,D-dimer,procalcitonin (PCT) and C-reactive protein (CRP) were measured,and Pneumonia Severity Index (PSI) was calculated.They were assigned into two groups according to their D-dimer levels:high D-dimer levels group (D-dimer levels≥500 μg/L) and normal D-dimer levels group (D-dimer levels ＜ 500 μg/L).The followup time was one year.A Kaplan-Meier survive curve was constructed to assess the 1-year mortality,and multivariate logistic regression analysis were used to assess the value of D-dimer for predicting long-term prognosis.Results D-dimer levels increased with increasing PSI class [class Ⅰ-Ⅲ:378.37 μg/L (216.74,649.50) μg/L; class Ⅳ:673.41 μg/L (544.77,866.85) μg/L; class Ⅴ:831.58 μg/L (591.78,1066.39) μg/L,x2 =56.58,P ＜ 0.01].The Kaplan-Meier survival curve showed that 1-year mortality rate of high D-dimer levels group was higher than normal D-dimer levels group (log-rank test,x2 =52.51,P ＜ 0.01).The multivariate logistic regression analysis showed an independent relationship between higher D-dimer levels and long-term mortality (OR =2.05,95％ CI:1.48-2.61,P ＜ 0.01).Conclusion D-dimer is an independent predictor of severity and long-term prognosis in patients with CAP.

Objective To observe the effects of telmisartan treatment on the abdominal fat deposit in metabolic syndrome (MS) combined with essential hypertension (EH).Methods Sixty patients of MS combined with EH were divided into two groups according to random number table method,with 30 cases in each group.The patients in experimental group were given telmisartan orally 40 mg once a day,and in control group were given valsartan 80 mg once a day,until average ambulatory blood pressure monitoring blood pressure was ＜ 140/90 mmHg (1 mmHg =0.133 kPa) in 24 weeks.The visceral fat area (VFA) and subdermal fat area (SFA) was measured by multislice CT,at the same time the body mass index (BMI),blood pressure,blood glucose,homeostasis model assessment of insulin resistance (HOMA-IR) and glyeosylated hemoglobin (HbA1c) of the subjects was measured.Results The blood pressure,BMI,blood glucose,HbA1c,and blood lipids between two groups before treatment had no statistical significance (P ＞0.05).VFA in experimental group after treatment was lower than that before treatment [(127.8 ± 16.6) cm2 vs.(150.5 ± 15.4) cm2] (P ＜ 0.05).But there was no statistical significance of VAF in control group before and after treatment (P ＞0.05).The SFA in experimental group and control group had no statistical significance before and after the treatment (P ＞ 0.05).The HOMA-IR in experimental group after treatment was reduced compared with that before treatment (1.9 ± 0.3 vs.4.2 ± 0.9),and adiponectin was increased [(5.77 ±0.71) mg/L vs.(3.16 ±0.72) mg/L] (P ＜0.05).Conclusion Compared with valsartan,telmisartan can significantly reduce the visceral fat deposition in MS combined with EH patients and improve insulin resistance.

Objective To evaluate the efficacy and safety of Fosfomycin trometamol(FMT)versus Norfloxacin(FPA)in elderly diabetic patients with acute urological tract infections.Methods From Jan.2012 to Mar.2013,eighty-six patients with uncomplicated and complicated urinary tract infection were randomized into FMT group(n =43)and FPA group(n =43).Patients in both groups were balanced with regard to baseline urinary tract symptoms,fever,leukocytosis,positive urinary culture and disease type(P＞0.05).Patients received FMT 3 g daily and Norfloxacin 0.4 g twice daily for a week.Extended treatment was given to 35 patients not cured within a week.Total treatment course should not exceed two weeks.Patient's symptoms,signs,complete blood count,urinalysis,urine culture,pharmacological sensitivity tests,renal and liver function tests were performed.Results After one week of FMT treatment,28(65.1％)cases were cured and 10 cases were improved(1 was with abnormal urinalysis,9 had positive urine culture).In total,in 38(88.4％)patients treatment was as effective;In FPA group,23(53.5％)were cured and 7 cases were improved(7 had positive urine culture).In total,there were 30(69.8％)patients classified as effective.Difference was statistically significant(P＜0.05 =.After 2 weeks of FMT treatment,38(88.4％)cases were cured and 2 patients were improved(1 was with abnormal urinalysis,1 had positive urine culture).In total,40(93.0％)patients were classified as effective.In FPA group,25(58.1％)cases were cured and in 8 patients were improved(8 had positive urine culture).In total,there were 33(76.7％)patients classified as effective;Difference was statistically significant(P＜0.05 =.Bacterial clearance rate in FMT and FPA group was 88.9％ and 72.7％,respectively.Difference was statistically significant(P＜0.05 =.The adverse reaction rates were 9.3％ and 14.0％,respectively.Difference was not statistically significant(P＞0.05).Conclusions FMT is an effective and safe antibiotic in the treatment of urinary tract infections in elderly diabetic patients.

Objective To explore relationship between excursion of blood glucose levels and cognitive performance in diabetic patients over aged 60 years.Methods A total of 108 diabetic patients over aged 60 years were recruited in this study and they wore under continuous blood glucose monitoring system (CGMS) for three days to evaluate excursion of their mean blood glucose (MBG) level and its standard deviation (SD).All the participants accepted cognitive function tests during continuous blood glucose monitoring, including mini mental status examination (MMSE), Montreal cognitive assessment (MOCA) and clock drawing test (CDT).Relationship of the SD of blood glucose level and cognitive performance in the three cognitive tests was assessed.Data were analyzed with CGMS software version 3.0.Results The SD reversely correlated with scores of MMSE (r = - 0.324, P ＜ 0.01 ) and CDT ( r =-0.325, P = 0.001 ), but they did not significantly correlate with MOCA scores (r = -0.212, P =0.081 ).Statistically significant difference was observed between the SD and scores of all three cognitive tests adjusted for glycosylated hemoglobin Alc (HbAlc) level (r = -0.387, -0.046 and -0.292, P =0.029, ＜0.001 and ＜ 0.001, respectively).The SD reversely correlated with scores of MMSE, MOCA and CDT adjusted for MBG (r= -0.314, -0.466 and -0.345, P ＜0.01, respectively).Results of multivariate linear regression analysis showed that the SD reversely correlated to scores of MMSE, MOCA and CDT (β = - 0.378, - 0.224 and - 0.346, all P ＜ 0.05).Conclusions Excursion of blood glucose levels can influence their cognitive performance in diabetic patients over aged 60 years, leading to decrease in their overall cognitive function and activities as its excursion large enough.

Objective To investigate the relationship between hypertension, depression and cognitive function in elderly. Methods General conditions and health status were surveyed in 207 individuals, which were divided into hypertension group, depression group, hypertension and depression group and controls. Patients cognitive function was assessed by the mini-mental state examination (MMSE), depression severity was detected by Hamilton rating scale for depression (HAMD) , other relative data were collected. Results Elderly patients with depression were more inclined to live alone. Comparing with control, hypertension patients had lower attention and calculation. Depression patients had lower orientation, attention, calculation and linguistic ability ( P < 0.05). Compared with hypertension patients, patients combined with depression had significantly lower MMSE scores, orientation, recall and language ( P <0. 05). Patients with hypertension and depression had lower attention and calculation, compared with hypertension a-lone patients ( P <0. 05 ). MMSE scores of depressed patients were negatively related to HAMD scores ( r = -0. 706, P <0.01). Logistic regression revealed depression or combination of hypertension and depression were related to impairment of cognitive ability ( P < 0.01). Conclusion Both hypertension and depression in the elderly impaired cognitive function. The cognitive function impairment in elderly was closely associated with hypertension and depression. Prevention and control of hypertension and depression might be helpful in slowing down impairment of cognitive function in elderly.