杂说“年关”

年是一个关。大概在我六七岁的时候，看了歌剧《白毛女》，喜儿有一段唱词：“北风吹，雪花飘，雪花飘飘年来到。爹出门去躲债整七天，三十晚上还没回还……”过年了，杨白劳面临的就是这样一个关头，最终还是因还不上黄世仁的债，喜儿被抢走了。

岁末,当心“年关不适症”

随着生活节奏的加快,人们在工作生活中需要面对的问题越来越 多,压力越来越大,经常让他们变得郁闷、烦躁,甚至是产生这样那 样的心理疾病,直接地影响着工作和生活。而更让人不安的是,他们 明知道自己的心理状态不对劲,却抹不开面子,讳疾忌医。就此,本 刊与山西太原新医医院合开此专栏:《心理诊室》,通过各种形式如案 例、专家分析等对各种症状加以剖析,给读者提个醒儿,支个招儿。 年关前夕,笔者走访了几家专科医院和综合医院门诊,发现前去 进行心理咨询的人员似乎比平日增加了不少。

Contrasting the Indian and western North Pacific summer monsoons in terms of their intensity of interannual variability and biennial relationship with ENSO

The intensity of interannual variability(IIV)of the monsoon and monsoon–ENSO biennial relationship(MEBR)were examined and compared for both the Indian summer monsoon(ISM)and western North Pacific summer monsoon(WNPSM)during 1958–2018.Covariability of the IIV and MEBR were identified for the two monsoons.When the MEBR was strong(weak),the IIV of the monsoon was observed to be large(small).This rule applied to both the ISM and WNPSM.Out-ofphase relationships were found between the ISM and the WNPSM.When the IIV and MEBR of the ISM were strong(weak),those of the WNPSM tended to be weak(strong).During the period with a stronger(weaker)ENSO–Atlantic coupling after(before)the mid-1980 s,the IIV and MEBR of the WNPSM(ISM)were observed to be stronger.The increasing influences from the tropical Atlantic sea surface temperature(SST)may trigger the observed seesaw pattern of the ISM and WNPSM in terms of the IIV and MEBR multidecadal variability.The results imply that tropical Atlantic SST may need to be given more attention and consideration when predicting future monsoon variability of the ISM and WNPSM.

Effect of advanced age on plasma homocysteine levels and its association with ischemic stroke in non-valvular atrial fibrillation

Background Elevated homocysteine （Hcy） has been reported to be associated with cardiovascular events in atrial fibrillation （AF） pa- tients, while the age-related expression pattern of plasma Hcy in AF remains unknown. The study was aimed to investigate the effect of ad- vanced age on plasma Hcy levels and its association with ischemic stroke in non-valvular AF patients. Methods A total of 2562 consecu- tive patients with non-valvular AF and 535 controls were enrolled and divided into six age groups. Plasma Hcy levels were analyzed among different age groups, and the effect of advanced age on Hcy was investigated. Results Plasma Hcy levels did not show any difference among groups aged below 65 years, while it increased sharply in patients aged 65-74 years and aged over 75 years （15.7 ±4.6 μmol/L, 17.1 ±4.9 μmol/L, both P 〈 0.01 compared with the first four age groups）. Hcy was much higher in AF patients than in controls at the same age group （all P 〈 0.05）. The proportion of patients with hyperhomocysteinemia increased gradually with age from 32.3%, 29.2%, 31.2%, 32.4%, 45.9%, to 51.4% in six age groups. The concentration of Hcy in AF patients with ischemic stroke increased progressively with age, and was higher than those without stroke at the same age. Logistic regression analysis demonstrated that age 65-74 years [odds ratios （OR）： 1.742, 95% confidence interval （CI）： 1.223-2.482, P = 0.002] and age ≥ 75 years （OR： 2.637, 95% CI： 1.605-4.335, P 〈 0.001） were significantly independent predictors of elevated plasma Hcy levels. Conclusions Advanced age was significantly associated with elevated Hcy levels, which may provide a possible explanation for the progressive increase in ischemic stroke especially in elderly AF patients.

Age-related Changes of Carbon Accumulation and Allocation in Plants and Soil of Black Locust Forest on Loess Plateau in Ansai County, Shaanxi Province of China

The effects of reforestation on carbon （C） sequestration in China＇s Loess Plateau ecosystem have attracted much research attention in recent years. Black locust trees （Robinia pseudoacacia L.） are valued for their important use in reforestation and water and soil conservation efforts. This forest type is widespread across the Loess Plateau, and must he an essential component of any planning for C sequestration efforts in this fragile ecological region. The long-term effects of stand age on C accumulation and allocation after reforestation remains uncertain. We examined an age-sequence of black locust forest （5, 9, 20, 30, 38, and 56 yr since planting） on the Loess Plateau to evaluate C accumulation and allocation in plants （trees, shrubs, herbages, and leaf litter） and soil （0-100 cm）. Allometric equations were developed for estimating the biomass of tree components （leaf, branch, stem without bark, bark and root） with a de- structive sampling method. Our results demonstrated that black locust forest ecosystem accumulated C constantly, from 31.42 Mg C/ha （1 Mg = 106 g） at 5 yr to 79.44 Mg C/haat 38 yr. At the ＇old forest＇ stage （38 to 56 yr）, the amount of C in plant biomass significantly decreased （from 45.32 to 34.52 Mg C/ha） due to the high mortality of trees. However, old forest was able to accumulate C continuously in soil （from 33.66 to 41.00 Mg C/ha）. The C in shrub biomass increased with stand age, while the C stock in the herbage layer and leaf litter was age-independent. Reforestation resulted in C re-allocation in the forest soil. The topsoil （0-20 cm） C stock increased constantly with stand age. However, C storage in sub-top soil, in the 20-30, 30-50, 50-100, and 20-100 cm layers, was age-independent. These results suggest that succession, as a temporal factor, plays a key role in C accumulation and re-allocation in black locust forests and also in regional C dynamics in vegetation.

Use of Cataract Surgery in Urban Beijing: a Post Screening Follow-up of the Elderly with Visual Impairment due to Age-related Cataract

Objective To understand the perception for the use of cataract surgical services in a population acceptors and non-acceptors of cataract surgery in urban Beijing. Methods From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery. Results At the follow-up examination 116 of the 158 patients were available and 36 （31.0%） had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery （OR=2.64, 95% CI： 1.08-6.63, P=0.02）. There were no significant differences in vision function （P=0.11） or quality of life scores （P=0.16） between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need （50.0%）, feeling of being ＂too old＂ （19.2%）, and worry about the quality of surgery （9.6%）. Cost was seeking surgery. cited by 1 （1.9%） subject as the main reason for not

Age-dependent impact of the SYNTAX-score on longer-term mortality after percutaneous coronary intervention in an all-comer population

Background The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery （SYNTAX）-score is a validated tool for risk stratification and revascularization strategy selection in patients with complex coronary artery disease. The aim of this study was to analyse its age-related prognostic value. Methods SYNTAX-score was calculated in 1331 all-comer patients undergoing percutaneous coronary intervention （PCI）： 463 patients ≥ 75 years and 868 patients 〈 75 years. Outcomes of interest were all-cause mortality at one and two years. Results A significant interaction of age and SYNTAX-score for mortality was observed at two-year （Pinteraction= 0.019） but not at one-year follow-up （Pinteraction= 0.594）. In multivariable analysis, SYNTAX-score independently predicted 1-year mortality in both age groups （〈 75 years, hazard ratio （HR）： 1.43, 95% confidence intervals （CI）： 1.03-2.00, P = 0.034; and 〉 75 years, HR： 1.37, 95% CI： 1.01-1.85, P = 0.042）, but only two-year mortality among younger patients （〈 75 years, HR： 1.33, 95% CI： 1.01-1.76, P = 0.041; and ≥ 75 years, HR： 1.11, 95% CI： 0.87-1.41, P = 0.394）. SYNTAX-score tertiles were useful to stratify 1-year mortality in both, patients 〈 75 years （SYNTAX-score 〈 9, 3.8%; 9-20, 5.3%; 〉 20, 10.3%; P = 0.004） and 〉 75 years （SYNTAX-score 〈 11, 5.7%; 11-22.5, 16.1%; 〉 22.5, 18.7%; P = 0.003）, but two-year mortality only among patients 〈 75 years （SYNTAX-score 〈 9, 6.5%; 9-20, 7.6%; ≥ 20, 15%; P 〈 0.001） and not among ≥ 75 years old patients （SYNTAX-score 〈 11, 19.4%; 11-22.5, 26.3%; _〉 22.5, 27.9%; P = 0.138）. Conclusions Age modi- fies the impact of the SYNTAX-score on longer-term mortality after PCI. Among patients 〈 75 years, the SYNTAX-score independently predicts the risk of death at one and two years after PCI, while among patients 〉 75 years its predictive role is limited to the first year after PCI. Further studies are needed to evaluate the value of SYNTAX-score for selecting the most appropriate revascularization strategy among elderly patients.

Intermediate and Late Rheumatoid Arthritis Treated by Tonifying the Kidney, Resolving Phlegm and Removing Blood Stasis

Eighty-seven cases of intermediate and late rheumatoid arthritis were treated with Instant Shu GuanWen Jing Granules(疏关温经冲剂 Relaxing Joints by Warming Channels)and Instant Shu GuanQing Luo Granules(疏光清络冲剂 Relaxing Joints by Removing Heat from the Lung Channel)totonify the kidney resolve phlegm and remove blood stasis,and compared with 41 cases treated withInstant Wang Bi Granules(尪痹冲剂 Prescription for Arthralgia-syndrome).The treatment produceda clinical cure rate of 54.0% and a total effective rate of 90.8% as in against 29.3% and 73.2%respectively in the control group.The difference was significant(P<0.01).Improvement in mainsymptoms and laboratory findings in the treatment group was all more marked than that in thecontrol group (P<0.05 or P<0.01),with no side effects observed.

Incremental age-related one-year MACCE after acute myocardial infarction in the drug-eluting stent era （from KAMIR-NIH registry）

Objectives To evaluate the age-related one-year major adverse cardiocerebrovascular events （MACCE） after percutaneous coronary intervention （PCI） in acute myocardial infarction （AMI）. We analyzed the association between age and one-year MACCE after AMI. Methods A total of 13,104 AMI patients from Korea Acute Myocardial Infarction Registry-National Institue of Health （KAMIR-NIH） between November 2011 and December 2015 were classified into four groups according to age （Group I, 〈 60 years, n = 4199; Group II, 60-70 years, n = 2577; Group III; 70-80 years, n = 2774; Group IV, ≥ 80 years, n = 1018）. Patients were analyzed for one-year composite of MACCE （cardiac death, myocardial infarction, target vessel revascularization, cerebrovascular events） after AMI. Results The one-year MACCE in AMI were 3.5% （Group I）, 6.3% （Group II）, 9.6% （Group III） and 17.6% （Group IV）. After adjustment for confounding para- meters, the analysis results showed that patients with AMI had incremental risk of one-year MACCE [Group II, adjusted hazard ratios （aHR） = 1.224, 95% CI： 0.965-1.525, P = 0.096; Group III, aHR = 1.316, 95% CI： 1.037-1.671, P= 0.024; Group IV, aHR = 1.975, 95% CI： 1.500-62.601, P〈 0.001） compared to Group I. Especially, cardiac death in the composite of primary end point played a major role in this effect （Group II, aHR = 1.335, 95% CI： 0.941-1.895, P= 0.106; Group III, aHR = 1.575, 95% CI： 1.122-2.210, P= 0.009; Group IV, aHR = 2.803, 95% CI： 1.937-4.054, P 〈 0.001）. Conclusions Despite advanced techniques and medications for PCI in AMI, age still exerts a powerful influence in clinical outcomes. Careful approaches, even in the modem era of developed cardiology are needed for aged-population in AMI intervention.

The association between Tai Chi exercise and safe driving performance among older adults： An observational study

Background: Age-related cognitive and physical decline can impair safe driving performance. Tai Chi exercise benefits cognitive and physical function and may influence safe driving performance in older adults. The primary aim of this observational study was to compare cognitive processes and physical function related to safe driving performance among older adult Tai Chi practitioners to normative reference values.Secondary aims were to examine relationships between Tai Chi exercise habits, cognitive processes, and physical function related to safe driving performance and to explore potential predictors of safe driving performance.Methods: The Driving Health Inventory, the Driving Scenes Test, other driving-related cognitive and physical measures, and self-reported measures including the Mindful Attention Awareness Scale(MAAS) and the Vitality Plus Scale(VPS) were collected from current Tai Chi practitioners(n = 58; age 72.9 ± 5.9 years, mean ± SD) with median >3 years Tai Chi practice.Results: Compared to normative reference values, participants performed better on numerous cognitive measures including the Driving Scenes Test(p < 0.001, d = 1.63), maze navigation(p = 0.017, d = 0.27), the Useful Field of View Test(p < 0.001, r = 0.15), and on physical measures including the Rapid Walk Test(p < 0.001, r = 0.20), and the Right Foot Tapping Test,(p < 0.001, r = 0.35). Participants scored higher than normative reference values on MAAS and VPS(p < 0.001, d = 0.75; p = 0.002, d = 0.38, respectively). Statistically significant correlations were found between several study measures. The digit span backward test was the strongest predictor of safe driving performance(β = 0.34,p = 0.009).Conclusion: Tai Chi exercise has the potential to impact cognitive processes and physical function related to safe driving performance. Further study using randomized controlled trials, structured Tai Chi exercise doses, and driving simulator or on-road driving performance as outcome measures are warranted.

Role of insulin/insulin-like growth factor 1 signaling pathway in longevity

The insulin/insulin-like growth factor 1 (IGF-1) signaling pathway is evolutionary conserved in diverse speciesincluding C.elegans, saccharomyces cerevisiae, Drosophila melanogaster, rodents and humans, which is involved in many interrelated functions that are necessary for metabolism, growth and reproduction. Interestingly, more and more research has revealed that insulin/IGF-1 signaling pathway plays a pivotal role in the regulation of longevity. Generally, disruption of the power of this pathway will extend longevity in species ranging from C.elegansto humans. The role of insulin/IGF-1 in longevit yis probably related to stress resistance. Although the underlying mechanisms of longevity are not fully understood, the Insulin/IGF-1 signaling pathway has attracted substantial attention and it will be a novel target to prevent or postpone age-related diseases and extend life span. In this review, we mainly focus on the similar constitution and role of insulin/IGF-1 signaling pathway in C.elegans, saccharomyces cerevisiae, rodents and humans.

Body mass index is associated with age-at-onset of HCV-infected hepatocellular carcinoma patients

AIM: To identify factors associated with the age at onset of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC). METHODS: Five hundred and fifty-six consecutive patients positive for HCV antibody and treatment-nafive HCC diagnosed between 1995 and 2004 were analyzed. Patients were classified into three groups according to age at HCC onset: < 60 years (n = 79), 60-79 years (n = 439), or ≥ 80 years (n = 38). Differences among groups in terms of sex, body mass index (BMI), lifestyle characteristics, and liver function were assessed. Factors associated with HCC onset in patients < 60 or ≥ 80 years were analyzed by logistic regression analysis. RESULTS: Significant differences emerged for sex, BMI, degree of smoking and alcohol consumption, mean bilirubin, alanine aminotransferase (ALT), and γ-glutamyl transpeptidase (GGT) levels, prothrombin activity, and platelet counts. The mean BMI values of male patients > 60 years old were lower and mean BMI values of female patients < 60 years old were higher than those of the general Japanese population. BMI > 25 kg/m2 [hazard ratio (HR), 1.8, P = 0.045], excessive alcohol consumption (HR, 2.5, P = 0.024), male sex (HR, 3.6, P = 0.002), and GGT levels > 50 IU/L (HR, 2.4, P = 0.014) were independently associated with HCC onset in patients < 60 years. Low ALT level was the only factor associated with HCC onset in patients aged ≥ 80 years. CONCLUSION: Increased BMI is associated with increased risk for early HCC development in HCV-infected patients. Achieving recommended BMI and reducing alcohol intake could help prevent hepatic carcinogenesis.

Limb symmetry index in competitive alpine ski racers:Reference values and injury risk identification according to age-related performance levels

Purpose： The aims of this study were to assess differences of limb symmetry index （LSI） in strength- and coordination-related tasks between high-level, competitive, noninjured ski racers of different age-related performance levels and to prospectively assess limb differences as a possible risk factor for traumatic and overuse injury in youth ski racers. Methods： The study （Study 1） included 285 high-level competitive ski racers （125 females, 160 males） of 3 age-related performance levels and based on the school system： 95 youth （10-14 years, secondary modem school）, 107 adolescent （15-19 years, grammar school）, and 83 elite athletes （20-34 years）. To investigate the second aim （Study 2）, 67 of the 95 youth athletes were included and any traumatic or overuse injuries were prospectively recorded over 2 seasons. All athletes performed 4 unilateral tests （strength related： one-leg counter movement jump （OL-CMJ） and one-leg isometric/isokinetic press strength test （OL-ILS）; coordination related： one-leg stability test （OL-ST） and one-leg speedy jump test （OL-SJ））. The LSI was calculated by dividing the dominant leg by the nondominant leg and multiplying by 100. Kruskal-Wallis H tests and binary logistic regression analyses were conducted. Results： There were significant differences between the LSI of the 3 age-related performance-level groups only in the strength-related tests： the OL-CMJ （X^2（2, 285） = 9.09; p = 0.01） and the OL-ILS （X^2（2,285） = 14.79; p 〈 0.01）. The LSI for OL-ILS was found to be a significant risk factor for traumatic injury in youth ski racers （Wald = 7.08; p 〈 0.01）. No significant risk factors were found for overuse injuries. Conclusion： Younger athletes display slightly greater LSI values only in the strength-related tests. The cut-off value of limb differences of 〈 10% for return to sport decisions seems to be appropriate for elite athletes, but for youth and adolescent athletes it has to be critically discussed. It seems to be necessary to define thresholds based on specific performance tasks （strength vs. coordination related） rather than on generalizations, and age-related performance levels must be considered. Limb differences in unilateral leg extension strength represent a significant injury risk factor in youth ski racers.2018 Published by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license. （http：//creativecommons.org/licenses/by-nc-nd/4.0/）.

Predisposing factors for atrial fibrillation in the elderly

Atrial fibrillation （AF） in the elderly occurs as a consequence of cardiovascular aging and an age related increase of comorbidity. Several predisposing factors for AF have been identified for the overall AF population. Most of them, cardiovascular disease in particular, play a role in younger and older patients. The longer time period during which these risk factors can cause structural changes that ultimately lead to AF may, at least in part, explain the association between age and AF. In addition, less well defined age-related changes in cellular electrophysi- ologic properties and structure predispose to AF in the elderly.

Comparison between the interannual and decadal components of the Silk Road pattern

The Silk Road pattern（SRP）, which is a teleconnection pattern along the Asian upper-tropospheric westerly jet in summer, exhibits both interannual and decadal variabilities. Through the nineyear Gaussian filtering method and regression analyses, this study compares the interannual and decadal components of the SRP. The results indicate that the interannual SRP corresponds to a well-organized wave train of alternate cyclonic and anticyclonic anomalies across the Eurasian continent along the Asian westerly jet, resulting in a similar wave-like pattern of cold and warm surface temperature anomalies. This pattern of temperature anomalies differs from that associated with the original SRP, which is characterized by warmer or cooler temperatures mainly over Europe–West Asia and Northeast Asia, depending on the phase of the SRP. On the other hand, the decadal SRP shows a similar pattern to the interannual one from Europe to Central Asia, but the meridional wind anomalies tend to be weak over East Asia. These circulation anomalies are responsible for the significant temperature anomalies over Europe–West Asia and Northeast Asia but weak anomalies between these two domains.

Factors associated with balance function in patients with knee osteoarthritis:An integrative review

This integrative review is to identify the factors associated with balance function in patients with knee osteoarthritis and explore the relationship between these factors and balance function.Osteoarthritis commonly occurs in elderly people.Patients with knee osteoarthritis have balance impairment,and maintaining knee stability is important for such patients to prevent accidental injuries caused by falling.Therefore,it is important to clarify the factors related to balance function in patients with knee osteo-arthritis.The PubMed,Science Direct,CINAHL,Ovid,ProQuest,CNKI,WanFang databases were searched,and relevant articles published up to December 2015 were included.Twenty articles were included in the analysis.Age,gender,dominant limb,foot length,knee alignment,diurnal variation,and meniscus tears were the non-modifiable factors,whereas body mass index,knee pain,muscle strength,joint range of motion,severity,and cognitive loading were the modifiable factors.Knee sleeve and custom-molded insoles showed protective effects against knee osteoarthritis.

Update on pharmacological treatment of acute coronary syndrome without persistent ST segment elevation myocardial infarction in the elderly

The increase in cardiovascular disease prevalence with ageing has been attributed to several age-related changes such as changes in the vascular wall elasticity, the coagulation and haernostatic system and endothelial dysfunction, among other causes. There is a 50% increased mortality risk per 10-year increase in age starting at 65 years old. Here, we aimed to discuss pharmacological treatment in acute coronary syndrome （ACS） without persistent ST segment elevation myocardial infarction in the elderly. The main aim of ACS treatment in elderly people is at preventing ischemia, myocardial damage and complications. A meta-analysis suggests that invasive revascularization therapy is probably most useful in older patients. Dual antiplatelet therapy is currently the standard of care post-ACS. Platelet P2Y12 inhibitors are among the most commonly used medications worldwide, due to their established benefits in the treatment and prevention of arterial throm- bosis. The main recommendation is to tailor antithrombotic treatment, considering body weight, renal function （Class I, level C） and careful evaluation of life expectancy, comorbidities, risk/benefit profile, quality of life and fxailty when invasive strategies are considered （Class IIa, level A） on top of the different recommendations given for a general non ST elevation ACS population. It is obvious that potent P2Y12 in- hibitors will continue to play an important role in pharmacological treatment for elderly ACS patients in the future.

Effect of ageing on colonic mucosal regeneration

The physiologic and pathologic cellular and molecular changes occurring with age in the human colon affect both the inflammatory process leading to mucosal injury and the regenerative capacity of the epithelium.On the one hand,age-related telomere shortening and inflamm-ageing may lead to the development of colonic inflammation,which results in epithelial damage.On the other hand,the altered migration and function of regenerative stem cells,the age-related methylation of mucosal healing-associated genes,together with the alterations of growth factor signaling with age,may be involved in delayed mucosal regeneration.The connections of these alterations to the process of ageing are not fully known.The understanding and customtailored modification of these mechanisms are of great clinical importance with regard to disease prevention and modern therapeutic strategies.Here,we aim to summarize the age-related microscopic and molecular changes of the human colon,as well as their role in altered mucosal healing.

Simulated and projected relationship between the East Asian winter monsoon and winter Arctic Oscillation in CMIP5 models

Interdecadal change in the relationship between the East Asian winter monsoon(EAWM)and the Arctic Oscillation(AO)has been documented by many studies.This study,utilizing the model outputs from phase 5 of the Coupled Model Intercomparison Project(CMIP5),evaluates the ability of the coupled models in CMIP5 to capture the intensified relationship between the EAWM and winter AO since the 1980s,and further projects the evolution of the EAWM–AO relationship during the 21st century.It is found that the observed evolution of the EAWM–AO relationship can be reproduced well by some coupled models(e.g.,GFDL-ESM2M,GISS-E2-H,and MPI-ESM-MR).The coupled models’simulations indicate that the impact of winter AO on the EAWM-related circulation and East Asian winter temperature has strengthened since the 1980s.Such interdecadal change in the EAWM–AO relationship is attributed to the intensified propagation of stationary planetary waves associated with winter AO.Projections under the RCP4.5 and RCP8.5 scenarios suggest that the EAWM–AO relationship is significant before the 2030s and after the early 2070s,and insignificant during the 2060s,but uncertain from the 2030s to the 2050s.

Use of antiarrhythmic drugs in elderly patients

Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intmcellular Ca2＋ overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhytbanics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient＇s physiology, disease processes, and medication regimen.