80岁及以上急性心肌梗死患者介入治疗进展

冠状动脉疾病是80岁及以上人群心血管死亡的主要原因,随着人口老龄化日益加深,老年患者在心血管疾病患者中的比例快速增长,由于其年龄和临床特点,其再灌注治疗面临更高的风险和挑战。目前,关于这类人群的临床试验数据有限,针对80岁及以上患者是否应该接受介入治疗目前仍存在争议,本文就80岁及以上急性心肌梗死患者介入治疗进展进行阐述。

Clinical characteristics and outcomes of octogenarians presenting with ST elevation myocardial infarction in the Australian population

AIM To investigate the characteristics and outcomes of octogenarians who presented with ST-elevation myocardial infarction(STEMI) compared to non-octogenarians and to investigate the outcomes of octogenarians that received primary percutaneous coronary intervention(PCI) compared to those managed conservatively.METHODS We performed a single center retrospective case controlled study. All octogenarians who presented with STEMI to a tertiary referring hospital between 2007 and 2012 were included. The subsequent non-octogenarian patient who presented with a STEMI following the octogenarian patient was assigned to the control group in a 1:1 manner. The outcomes measured were peri-procedural cardiac arrest, death on table, cerebrovascular accidents(CVA), in-hospital and 30-d mortality. RESULTS A total of 146 patients were analyzed. The octogenarian group had a higher percentage of females, higher overall comorbidities, higher Charlson Comorbidity Index score, worse renal function and were more likely to require residential care and home help. The octogenarian group were also less likely to have PCI attempted and had a longer symptom onset to PCItime. Mortality rate was high amongst octogenarians who presented with STEMI. However, those managed conservatively had a higher in-hospital and 30-d mortality rate CONCLUSION Octogenarians who presented with STEMI that were managed conservatively had a higher mortality rate compared to those who had primary PCI. Therefore,we propose that revascularization may be beneficial to patients in this age group.

Elderly patients(≥80 years)with acute calculous cholangitis have similar outcomes as non-elderly patients(<80 years):Propensity score-matched analysis

BACKGROUND Acute cholangitis(AC)is a disease spectrum with varying extent of severity.Age≥75 years forms part of the criteria for moderate(Grade II)severity in both the Tokyo Guidelines(TG13 and TG18).Aging is associated with reduced physiological reserves,frailty,and sarcopenia.However,there is evidence that age itself is not the determinant of inferior outcomes in elective and emergency biliary diseases.There is a paucity of reports comparing clinical outcomes amongst elderly patients vs non-elderly patients with AC.AIM To investigate the effect of age(≥80 years)on AC's morbidity and mortality using propensity score matching(PSM).METHODS This is a single-center retrospective cohort study of all patients diagnosed with calculous AC(January 2016 to December 2016)and≥80 years old(January 2012 to December 2016)at a tertiary university-affiliated teaching hospital.Inclusion criteria were patients who were treated for suspected or confirmed AC secondary to biliary stones.Patients with AC on a background of hepatobiliary malignancy,indwelling permanent metallic biliary stents,or concomitant pancreatitis were excluded.Elderly patients were defined as≥80 years old in our study.A 1:1 PSM analysis was performed to reduce selection bias and address confounding factors.Study variables include comorbidities,vital parameters,laboratory and radiological investigations,and type of biliary decompression,including the time for endoscopic retrograde cholangiopancreatography(ERCP).Primary outcomes include in-hospital mortality,30-d and 90-d mortality.Length of hospital stay(LOS)was the secondary outcome.RESULTS Four hundred fifty-seven patients with AC were included in this study(318 elderly,139 non-elderly).PSM analysis resulted in a total of 224 patients(112 elderly,112 non-elderly).The adoption of ERCP between elderly and non-elderly was similar in both the unmatched(elderly 64.8%,non-elderly 61.9%,P=0.551)and matched cohorts(elderly 68.8%and non-elderly 58%,P=0.096).The overall in-hospital mortality,30-d mortality and 90-d mortality was 4.6%,7.4%and 8.5%respectively,with no statistically significant differences between the elderly and non-elderly in both the unmatched and matched cohorts.LOS was longer in the unmatched cohort[elderly 8 d,interquartile range(IQR)6-13,vs non-elderly 8 d,IQR 5-11,P=0.040],but was comparable in the matched cohort(elderly 7.5 d,IQR 5-11,vs non-elderly 8 d,IQR 5-11,P=0.982).Subgroup analysis of patients who underwent ERCP demonstrated the majority of the patients(n=159/292,54.5%)had delayed ERCP(>72 h from presentation).There was no significant difference in LOS,30-d mortality,90-d mortality,and in-hospital mortality in patients who had delayed ERCP in both the unmatched and matched cohort matched cohort:in-hospital mortality[n=1/42(2.4%)vs 1/26(3.8%),P=0.728],30-d mortality[n=2/42(4.8%)vs 2/26(7.7%),P=0.618],90-d mortality[n=2/42(4.8%)vs 2/26(7.7%),P=0.618],and LOS(median 8.5 d,IQR 6-11.3,vs 8.5 d,IQR 6-15.3,P=0.929).CONCLUSION Mortality is indifferent in the elderly(≥80 years old)and non-elderly patients(<80 years old)with AC.

Undescended epididymo-testicular metastasis from prostatic carcinoma

Dear Sir, Metastasis of prostatic carcinoma to testis is un- common in the clinical situation, and the involvement of the epididymis is even rarer. Heidrich et al. [1] found only 80 cases of testicular involvement in prostate cancer in published reports. In 1993, Wiebe et al. [2] found only 14 previous cases of epididymal metastasis from prostatic carcinoma in published work. The simulta- neous involvement of testis and epididymis was reported by Suhler and Blanchard in 1980 [3]. To our knowledge, this was the first documented case of a prostatic carcinoma metastasizing to undescended testis and epididymis.

Risk of connective—tissue disease in men with testicular or penile prostheses：a preliminary study

AIM: To help clarifying the possibility of connective-tissue diseases in men with penile or testicular prostheses. METHODS: Eight patients underwent inflatable penile prostheses and 15, testicular prostheses consented to the study. Their medical records were reviewed and a follow-up interview and physical and serological examinations were performed. RESULTS: In patients with penile prostheses, there was no abnormal antinuclear antibody (ANA) or IgM elevation. The serum levels of the rheumatoid factor (RF), C4, IgA and IgG were abnormal in one patient, and the levels of erythrocyte sedimentation rate (ESR) and C3, abnormal in two. Four had elevated IgE. In patients with testicular prostheses, there was no abnormal RF, ANA or IgM. The serum levels of ESR and IgA were abnormal in two, and three had abnormal C4, ten abnormal C3, and eleven decreased IgG. All had increased IgE. Men with penile prostheses had higher serum levels of IgG and IgM than those with testicular prostheses (P=0.001, P=0.016, respectively). The rates of abnormal values of IgE and IgG were higher in men with testicular prostheses than in men with penile prostheses (P=0.008, P=0.009, respectively). Physical examination was normal in all patients and nobody had documented symptoms pertinent to connective-tissue diseases. CONCLUSION: Our findings suggest that the risk of connective-tissue diseases is not higher in patients wearing prostheses as the ANA is negative and there is no apparent manifestation suggestive of connective-tissue diseases.

Exploring the Implementation of Individual Care Plans in Relation to Characteristics of Staff

The aim was to explore the implementation of individual care plans in municipal elderly care in relation to characteristics of staff. Data regarding characteristics of staff were derived through a questionnaire distributed to all staff working in the care for older people, (N = 908, n = 245) in four municipalities in Sweden. The number of care plans established during a one-year period was collected through a contact person in each municipality. In total 47 individual care plans were established during the study year. Significantly more staff in the municipality that had the most number of established individual care plans agreed that there had been sufficient education (p = 0.017), sufficient time (p = 0.002) and routines established regarding individual care plans (p = 0.014) and had a significantly better job satisfaction (p = 0.001), compared to staff in the other municipalities. Implementation leaders may need to take the working conditions and the perception of available resources among staff into consideration in the on-going process of implementing individual care plans.

Transurethral prostate vaporization using an oval electrode in 82 cases of benign prostatic hyperplasia

OBJECTIVE: To present our initial experience in transurethral vaporization of the prostate (TVP) using an oval electrode for the treatment of benign prostatic hyperplasia (BPH). METHODS: A total of 82 patients underwent TVP procedures with the oval electrode. The newly designed oval-shaped electrode can work with a High Frequency Electrosurgery Unit. Prostate gland tissue was vaporized through an Fr 24 percutaneous nephroscope transurethrally. The operation procedure was similar to transurethral resection of the prostate (TURP) or transurethral laser prostatectomy (TULP). Power setting ranged from 240 W to 320 W. Local vaporization temperature reached 120 degrees C. RESULTS: Urination was recovered in all 82 patients after TVP. Mean post-treatment International Prostate Symptom Score (I-PSS) reduced from 27.10 to 5.05; mean bladder residual urine volume dropped from 147.71 ml to 33.2 ml; and mean urine flow rate (MFR) increased from 4.45 ml/s to 14.57 ml/s (P

Effects of Xinkeshu combined with levosimendan on perioperative heart failure in oldest-old patients with hip fractures

OBJECTIVE:To investigate the clinical effects of Xinkeshu combined with levosimendan on perioperative heart failure in oldest-old patients with hip fractures.METHODS:Oldest-old patients over 80 years old with perioperative heart failure and hip fractures were randomly divided into the control and observation groups,with 50 patients in each group.All patients in both groups were treated with conventional anti-heart failure therapy and levosimendan,whereas patients in the observation group additionally received Xinkeshu tablets.Clinical manifestations;left ventricular ejection fraction(LVEF);left ventricular end-diastolic dimension(LVEDD);left ventricular end-systolic dimension(LVESD);B-type natriuretic peptide(BNP),superoxide dismutase(SOD),malondialdehyde(MDA),nitric oxide(NO),and endothelin-1(ET-1)levels;and self-rating anxiety scale(SAS)and self-rating depression scale(SDS)scores were compared between before and after treatment to evaluate the curative effects of Xinkeshu combined with levosimendan.RESULTS:After treatment,the efficacy rate was significantly higher in the observation group than in the control group.LVEF and the levels of SOD and NO were higher in the observation group than in the control group after treatment.However,LVEDD;LVESD;BNP,MDA,and ET-1 levels;and the SAS and SDS scores were lower after treatment in the observation group than in the control group.CONCLUSION:Levosimendan combined with Xinkeshu can improve cardiac function,alleviate oxidative stress,and relieve anxiety and depression in oldest-old patients with perioperative heart failure and hip fracture.

Mannitolum infusion on cirrhotic patients with tense ascites treated by paracentesis

OBJECTIVE: To investigate whether albumin can be substituted by mannitolum in cirrhotic patients with tense ascites treated by paracentesis. METHODS: Sixty-eight patients admitted to this therapeutic procedure were randomly assigned to receive intravenous albumin (36 patients) and mannitolum (32 patients) infusion. In repeated large-volume paracentesis (3-6 L/day), intravenous albumin 20 g or intravenous 20% mannitolum 250 ml were added. RESULTS: In 24 and 48 hours after paracentesis the mean value of electrolytes, liver and renal functions and various indicators of systemic circulation either in Group 1 or in Group 2 cases were found without changes (P > 0.05). As compared with that before paracentesis, the diameter of spleen vein was increased significantly (P

Association of low cadmium and mercury exposure with chronic kidney disease among Chinese adults aged≥80 years:A cross-sectional study

Background:The heavy metals cadmium(Cd)and mercury(Hg)are known to be widespread environmental contaminants and high occupational exposure adversely affects the risk of chronic kidney disease(CKD).However,evidence from epidemiological studies linking low Cd and Hg exposure(or non-industrial)to the risk of progression to CKD are conflicting.This study aimed to explore the association of low Cd and Hg exposure with the risk of CKD in Chinese adults aged≥80 years.Methods:The participants were recruited for the Healthy Aging and Biomarkers Cohort Study in 2017,an ongoing perspective survey conducted in longevity areas in China initially involving 3016 older adults.We used logistic regression models to estimate odds ratios(ORs)with 95%confidence intervals of CKD setting Cd and Hg as categorical variables.Logistic regression with restricted cubic spline was used to characterize a dose-response relationships between Cd or Hg concentrations and the risk of CKD in the study population.Results:The ORs for the risk of CKD comparing the fourth to the first quartile of blood Cd,blood Hg,urine Cd,and urine Hg were 1.77,1.57,2.03,and 1.50,respectively.Restricted cubic spline models showed that blood Cd and urine Hg were significantly linearly correlated with the risk of CKD,while blood Hg and urine Cd were non-linearly correlated with the risk of CKD with a steeper slope at concentrations<2.30μg/L and 3.30μg/g creatinine.Conclusions:Our findings suggest that even low Cd and Hg exposure(or non-industrial)were associated with increased risk of CKD in Chinese oldest old,although we did not find a significant multiplicative and additive interaction between Cd and Hg levels in relation to the risk of CKD.

Treatment of in stent coronary restenosis with excimer laser angioplasty

OBJECTIVE: To evaluate the efficacy and safety of excimer laser coronary angioplasty (ELCA) with adjunctive balloon angioplasty in patient with in-stent restenosis. METHODS: ELCA was performed in 20 patients of instent restenosis. All patients were symptomatic and had class III-IV angina. ELCA was performed with the Spectranetics CVX-300 System. The laser catheter of Vittesse C (concentric) and E (eccentric) with diameter of 1.4-2.0 mm was used. RESULTS: Laser catheter crossed all stenotic stents without difficulty. The lesion length was 4.6-51.2 mm, mean 20.7 +/- 13.7 mm, including 14 lesions > 10 mm. Laser treatment alone increased minimal lumen diameter (MLD) from 0.3 +/- 0.3 mm to 1.4 +/- 0.3 mm (P

Neuroendocrine differentiation in ovarian mucinous tumors

OBJECTIVE: To investigate the relationship between neuroendocrine differentiation in ovarian mucinous tumors and its genesis. METHODS: A morphologic study of seventy-three cases of ovarian mucinous tumors (32 benign, 20 borderline, 21 malignant) using immunohistochemical and immunohistochemical/histochemical double staining techniques. RESULTS: The study showed that in tumors of benign, borderline and malignant types, the incidence of chromogranin A (CgA) positive cells was 62.5%, 75%, 76% and that of 5-hydroxytryptamine (5-HT) positive cells was 31.3%, 40% and 39%, respectively. Neuroendocrine cells (NEC) were not evenly distributed in any tumor. In four cases of the benign tumors, the number of CgA positive cells was more than 30 percent, localizing between the glandular basement membrane and the mucinous epithelial cells, with many intermediate cells containing both CgA and periodic acid-schiff (PAS) positive granules. CONCLUSION: The occurrence of both neuroendocrine and exocrine granules within the same cell has been previously described as 'intermediate' in pancreatic hyperplasia, pancreatic tumors and lung signet-ring cell carcinoids. This has not previously been observed in benign ovarian mucinous tumors. Finding both endocrine and exocrine granules within a single cell seems to indicate a histogenetic relationship between the ovarian endocrine and exocrine cells. The four cases of the benign tumors might be originated from a common stem cell, such as the so-called amphocrine cell. The relationship between these four tumors and neuroendocrine differentiation in ovarian mucinous tumors needs to be further clarified.