Particularities of Anemia in the Elderly: Experience in a Geriatrics Department in Senegal

Background/Objective: Anemias are frequent conditions in geriatric practice. The etiologies are numerous, overlapping chronic and acute pathologies. it is also associated with high morbidity and mortality. In our context, few studies have addressed this issue, and none have been carried out in geriatric units with integrated geriatric dimensions. The aim of this study was to describe the particularities of anemia in old people in a geriatric short-stay service in Senegal. Materials and methods: This was a retrospective, descriptive study from 01 May 2019 to 31 December 2021, involving people aged 60 or over, hospitalized in the geriatrics department of Fann Hospital (Senegal) and presenting with anemia. Epidemiological, clinical and evolutionary characteristics were collected and analyzed using SPSS 24.0 software. Results: The prevalence of anemia was 32.3%. The mean age of our sample was 78.7 ± 8.5 years. Arterial high blood pressure (59.3%), diabetes mellitus (22.8%), prostate disease (12.3%) were the most frequent comorbidities. Clinical manifestations were dominated by physical asthenia (80%) and severe alteration of general condition (72%). The geriatric syndromes were essentially represented by the loss of Activities Daily Living (ADL) autonomy (65%), undernutrition (59%) and frailty (46%). The mean hemoglobin level was 8.4 g/dl ± 2.1. The main etiologies were infections (32.7%), chronic kidney disease (20.9%), iron deficiency (7.4%). The mean hospital stay was 8 days ± 3.7 days and the mortality rate was 19%. Conclusion: Anemia is a frequent occurrence in geriatric medicine, with a high morbidity and mortality rate;its expression is often atypical, with frequent geriatric syndromes;the etiologies are multiple and often interrelated, requiring an exhaustive and multidimensional approach.

Interaction between systemic iron parameters and left ventricular structure and function in the preserved ejection fraction population:a two-sample bidirectional Mendelian randomization study

BACKGROUND Left ventricular(LV)remodeling and diastolic function in people with heart failure(HF)are correlated with iron status;however,the causality is uncertain.This Mendelian randomization(MR)study investigated the bidirectional causal relationship between systemic iron parameters and LV structure and function in a preserved ejection fraction population.METHODS Transferrin saturation(TSAT),total iron binding capacity(TIBC),and serum iron and ferritin levels were extracted as instrumental variables for iron parameters from meta-analyses of public genome-wide association studies.Individuals without myocardial infarction history,HF,or LV ejection fraction(LVEF)<50%(n=16,923)in the UK Biobank Cardiovascular Magnetic Resonance Imaging Study constituted the outcome dataset.The dataset included LV end-diastolic volume,LV endsystolic volume,LV mass(LVM),and LVM-to-end-diastolic volume ratio(LVMVR).We used a two-sample bidirectional MR study with inverse variance weighting(IVW)as the primary analysis method and estimation methods using different algorithms to improve the robustness of the results.RESULTS In the IVW analysis,one standard deviation(SD)increased in TSAT significantly correlated with decreased LVMVR(β=-0.1365;95%confidence interval[CI]:-0.2092 to-0.0638;P=0.0002)after Bonferroni adjustment.Conversely,no significant relationships were observed between other iron and LV parameters.After Bonferroni correction,reverse MR analysis showed that one SD increase in LVEF significantly correlated with decreased TSAT(β=-0.0699;95%CI:-0.1087 to-0.0311;P=0.0004).No heterogeneity or pleiotropic effects evidence was observed in the analysis.CONCLUSIONS We demonstrated a causal relationship between TSAT and LV remodeling and function in a preserved ejection fraction population.

Psycho-Social Hazards for Staff in Geriatrics and Geriatric Psychiatry

Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by difficulties inherent in the French hospital management system and the way people feel it, lead to a risk of burnout. One illustration of this is the rise in suicides at work. Quality of life at work, harassment and psycho-social risks are intimately linked. Affective factors, such as suffering for the medical carers in response to the distress of their patients aggravate the risk of burnout. Methods: We have evaluated these parameters using a self-filled questionnaire form sent to all staff and filled in by computer, anonymously, in 4 establishments, in December 2012 and over the first semester of 2013. After the three factors studied by the ProQOL scale of quality of life at work, to do with burnout, satisfaction compassion and fatigue compassion, 5 other questions were added, connected with a feeling of harassment and several social and demographic matters. Burnout risk was retained on reaching a threshold of 30 for this ProQOL scale item. Results: After multivariate analysis including the parameters of the Stamm scale, harassment and the socio-demographic factors studied, (age, sex, seniority, profession, and work departments) 4 factors are significantly associated with the risk of burnout, one negatively, compassion satisfaction, three positively, compassion fatigue, harassment experience and seniority. Conclusions: The risk of burnout is linked to subjective factors—the way quality of life at work is perceived and harassment experienced. Some professions, such as nurses, are particularly exposed and require these risk factors to be foreseen.

Exosomal miR-23b from bone marrow mesenchymal stem cells alleviates oxidative stress and pyroptosis after intracerebral hemorrhage

Our previous studies showed that miR-23b was downregulated in patients with intracerebral hemorrhage(ICH). This indicates that miR-23b may be closely related to the patho-physiological mechanism of ICH, but this hypothesis lacks direct evidence. In this study, we established rat models of ICH by injecting collagenase Ⅶ into the right basal ganglia and treating them with an injection of bone marrow mesenchymal stem cell(BMSC)-derived exosomal miR-23b via the tail vein. We found that edema in the rat brain was markedly reduced and rat behaviors were improved after BMSC exosomal miR-23b injection compared with those in the ICH groups. Additionally, exosomal miR-23b was transported to the microglia/macrophages, thereby reducing oxidative stress and pyroptosis after ICH. We also used hemin to mimic ICH conditions in vitro. We found that phosphatase and tensin homolog deleted on chromosome 10(PTEN) was the downstream target gene of miR-23b, and exosomal miR-23b exhibited antioxidant effects by regulating the PTEN/Nrf2 pathway. Moreover, miR-23b reduced PTEN binding to NOD-like receptor family pyrin domain containing 3(NLRP3) and NLRP3 inflammasome activation, thereby decreasing the NLRP3-dependent pyroptosis level. These findings suggest that BMSC-derived exosomal miR-23b exhibits antioxidant effects through inhibiting PTEN and alleviating NLRP3 inflammasome-mediated pyroptosis, thereby promoting neurologic function recovery in rats with ICH.

Association of bone turnover biomarkers with severe intracranial and extracranial artery stenosis in type 2 diabetes mellitus patients

BACKGROUND Intracranial and extracranial artery stenosis is associated with cerebral infarction.Vascular calcification and atherosclerosis are the main causes of stenosis and major risk factors for cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus(T2DM).Bone turnover biomarkers(BTMs)are associated with vascular calcification,atherosclerosis,glucose,and lipid metabolism.AIM To investigate the association of circulating BTM levels with severe intracranial and extracranial artery stenosis in patients with T2DM.METHODS For this cross-sectional study including 257 T2DM patients,levels of the BTMs serum osteocalcin(OC),C-terminal cross-linked telopeptide of type I collagen(CTX),and procollagen type I N-peptide were measured by electrical chemiluminescent immunoassay,and artery stenosis was assessed by color Doppler and transcranial Doppler.Patients were grouped according to the existence and location(intracranial vs.extracranial)of artery stenosis.Correlations between BTM levels,previous stroke,stenosis location,and glucose and lipid metabolism were analyzed.RESULTS T2DM patients with severe artery stenosis had a higher frequency of previous stroke and levels of all three tested BTMs(all P<0.05)than patients without.Some differences in OC and CTX levels were observed according to the location of artery stenosis.Significant associations were also observed between BTM levels and some glucose and lipid homeostasis parameters.On multivariate logistic regression analysis,all BTMs were significant predictors of artery stenosis in T2DM patients with and without adjustment for confounding factors(all P<0.001),and receiver operating characteristic curve analysis demonstrated the ability of BTM levels to predict artery stenosis in T2DM patients.CONCLUSION BTM levels were found to be independent risk factors for severe intracranial and extracranial artery stenosis and were differentially associated with glucose and lipid metabolism in patients with T2DM.Therefore,BTMs may be promising biomarkers and potential therapeutic targets for artery stenosis.

Infectious Pneumonitis Revealing an Anal Imperforation with Recto-Vaginal Fistula: A Case of Late Discovery in a 70-Year-Old Woman

Introduction: Anorectal malformations concern all anomalies of the terminal part of the digestive tract often diagnosed in the perinatal period. We report a clinical case of anorectal malformation discovered incidentally and very late at 70 years, following complications from the infectious syndrome. Observation: 70-year-old female patient, housewife, uneducated was referred to the hospital for acute febrile, cough, and mental confusion associated with chronic pelvic pain. The genito-anal examination showed an anal imperforation associated with a recto-vaginal fistula complicated by cervico-vaginitis. The evolution during hospitalization was favorable, but the patient died at home, 3 weeks after discharge. Conclusion: The discovery of anorectal malformation in adults is rare and exceptional in an elderly subject. This case demonstrates once again the challenges encountered in developing countries on the socio-economic and health levels.

基于信息寻求风格术前健康教育对经皮冠状动脉介入治疗患者焦虑和抑郁影响的研究

目的 旨在探讨基于信息寻求风格的术前教育方式在降低经皮冠状动脉介入治疗患者术前焦虑和抑郁的效果.方法 本研究为单盲随机对照试验.2020年4-9月,从中国西南部昆明市1所三级医院的心内科选取114例经皮冠状动脉介入治疗患者,并随机分配到干预组(n=57)和对照组(n=57).所有患者均获得口头的术前健康教育和纸质版的术前健康教育手册,并在干预前采用中文版米勒应对风格量表监测维度子量表(the Chinese Version of the Monitoring Subscale of the Miller Behavioral Style Scale,C-MMBSS)将患者分为"监测型"和"非敏感型".干预组实施基于信息寻求风格的术前健康教育,对照组实施常规术前健康教育.采用状态-特质焦虑量表(State-Trait Anxiety Inventory,STAI)和抑郁自评量表(Self-rating Depression Scale,SDS)在患者入院时和术前1 h时测量其焦虑和抑郁水平,并在出院时测量术前健康教育满意度和住院时间.结果 共有104例患者完成研究(干预组和对照组各52例).基于信息寻求风格的术前健康教育方式在缓解患者术前焦虑(21.5±2.1比23.1±3.1)、抑郁(21.9±2.1比23.1±2.5)和提高术前健康教育满意度(94.4±6.8比85.2±9.8)方面的效果优于常规术前健康教育(P<0.01).干预组和对照组患者住院时长比较[(8.2±3.2)d比(7.8±3.3)d],差异无统计学意义(P>0.05).对照组患者在常规术前健康教育后术前焦虑水平稍有提高(22.6±3.2比23.1±3.1,P<0.05).结论 研究结果显示,基于信息寻求风格的术前健康教育方式可以降低患者术前焦虑、抑郁水平,提高术前健康教育满意度.

Causal effects of circulating vitamin levels on the risk of heart failure:a Mendelian randomization study

BACKGROUND Observational studies suggest inverse associations between serum vitamin levels and the risk of heart failure(HF). However, the causal effects of vitamins on HF have not been fully elucidated. Here, we conducted a Mendelian randomization(MR) study to investigate the causal associations between genetically determined vitamin levels and HF.METHODS Genetic instrumental variables for circulating vitamin levels, including vitamins A, B, C, D, and E, which were assessed as either absolute or metabolite levels were obtained from public genome-wide association studies. Summary statistics for single-nucleotide-polymorphisms and HF associations were retrieved from the HERMES Consortium(47,309 cases and 930,014controls) and FinnGen Study(30,098 cases and 229,612 controls). Two-sample MR analyses were implemented to assess the causality between vitamin levels and HF per outcome database, and the results were subsequently combined by meta-analysis.RESULTS Our MR study did not find significant associations between genetically determined circulating vitamin levels and HF risk. For absolute vitamin levels, the odds ratio for HF ranged from 0.97(95% confidence interval [CI]: 0.85–1.09, P = 0.41) for vitamin C to 1.05(95% CI: 0.61–1.82, P = 0.85) for vitamin A. For vitamin metabolites, the odds ratio ranged between 0.94(95% CI:0.75–1.19, P = 0.62) for α-tocopherol and 1.11(95% CI: 0.98–1.26, P = 0.09) for γ-tocopherol.CONCLUSION Evidence from our study does not support the causal effects of circulating vitamin levels on HF. Therefore,there may be no direct beneficial effects of vitamin intake on the prevention of primary HF.

Bushen Yizhi Formula regulates the IRE1αpathway to alleviate endoplasmic reticulum stress in an Alzheimer’s disease rat model

While the Bushen Yizhi Formula can treat Alzheimer’s disease(AD),the yet to be ascertained specific mechanism of action was explored in this work.Methods:Different concentrations of the Bushen Yizhi Formula and amyloid-beta peptide(Aβ)were used to treat rat pheochromocytoma cells(P12)and human neuroblastoma cells(SH-SY5Y).Cell morphological changes were observed to determine the in vitro cell damage.Cell Counting Kit(CCK)-8 assay and flow cytometry were employed to identify cell viability and apoptosis/cell cycle,respectively.Western blotting and immunohistochemistry were employed to measure the expressions of endoplasmic reticulum stress(ERS)-related proteins(GRP78 and CHOP),p-IRE1α,IRE1α,ASK1,p-JNK,JNK,Bax,Bcl-2,XBP-1,and Bim.Fura 2-acetoxymethyl ester(Fura-2/AM)was used to determine the intracellular calcium(Ca^(2+))concentration.Also,an AD model was constructed by injecting Aβinto the CA1 area of the hippocampus in Sprague Dawley rats.AD model rats were gavaged with different concentrations of Bushen Yizhi Formula for 14 consecutive days.The Morris water maze experiment was conducted to test the learning and memory of rats.Hematoxylin&Eosin(H&E)and Terminal-deoxynucleotidyl Transferase(TdT)-mediated dUTP Nick-End Labeling(TUNEL)staining were done to determine histopathological changes in the brain.Results:Bushen Yizhi Formula relieved the Aβ-induced effects including cell injury,decreased viability,increased apoptosis,G0/G1 phase cell cycle arrest,upregulation of GRP78,CHOP,p-IRE1α,p-JNK,Bax,XBP-1 and Bim,as well as down-regulation of Bcl-2.These results were also seen with IRE1αsilencing.While Aβsuppressed the learning and memory abilities of rats,the Bushen Yizhi Formula alleviated these effects of Aβ.Brain nerve cell injury induced by Aβcould also be treated with Bushen Yizhi Formula.Conclusion:Bushen Yizhi Formula could influence ERS through the IRE1αsignaling pathway to achieve its therapeutic effects on AD.

Evaluation of Post-Surgical Complications of Lower Limb Arteriopathy in the Elderly in a Geriatric Short-Stay Unit in Senegal

Background/Objectives: Global ageing is associated with an increase in the frequency of peripheral arterial disease (PAD), which is often complex to manage postoperatively. The aim of this study was to describe postoperative complications of Lower limb arteriopathy in geriatric units. Materials and Methods: This was a retrospective, descriptive study from July 2019 to June 2022 of patients aged at least 65 years hospitalized in the geriatric unit of the FANN hospital for postoperative management of a Lower limb arteriopathy. Sociodemographic, clinical and evolutionary characteristics were collected and analyzed using Epi info version 7.2.6 software. Results: Forty patients met the criteria, representing 7.69% of hospital admissions. The average age was 77.5 years, with women in majority (75%). The mean time to geriatric admission after surgery was 9 ± 3 days. Poly pathologies (≥3 comorbidities) were present in 55% of patients. Cardiovascular risk factors were dominated by high blood pressure (85%), followed by mellitus diabetes (52.5%) and dyslipidemia (12.5%). Other associated comorbidities were dominated by heart disease (40%), followed by ischemic stroke (27.5%) and major cognitive impairment (27.5%). Excessive chronic arterial disease of the limbs was the predominant vascular diagnosis (80%) and amputation was the most common surgical procedure (62.5%), especially of the thigh (42.4%). Symptoms included refusal to eat (70%) and mental confusion (70%). The geriatric syndromes were mainly acute loss of functional independence (97.5%) and malnutrition (77.5%). The average number of acute diagnoses on admission was 4 ± 1, represented mainly by infectious diseases (31.5%), dominated by superinfection of the amputation stump (55%) and pulmonary infection (25%). Mortality rate was 22.5%. Conclusion: Post-surgical complications are frequent in the geriatric population, with a high mortality rate. Prior geriatric assessment would optimize postoperative results.

Application of cross-migration theory in limb rehabilitation of stroke patients with hemiplegia

BACKGROUND Stroke is a common cause of neurological dysfunction,often resulting in hemiplegia.Thus,rehabilitation of limb function in stroke patients is an important step towards accelerating recovery and improving quality of life.AIM To investigate whether unilateral strength training in hemiplegic stroke patients could lead to cross-migration,an increase in bilateral muscle strength,and an improvement in lower limb motor function.METHODS We randomly divided 120 patients with hemiplegic stroke into two groups:Eexperimental and control groups,with 60 patients in each group.Both groups received routine rehabilitation treatment,while the experimental group additional-ly received ankle dorsiflexion resistance training on the healthy side for 6 wk.We measured the maximum voluntary contract(MVC),changes in surface electromyography(EMG),and the lower limb motor function using the simplified Fugl Meyer Motor Function Assessment Scale(FMA)before and within 1 wk after training.RESULTS The FMA score in the experimental group improved significantly compared to both their pre-training score and the control group's post-training score(P<0.05).The integrated EMG of the anterior tibialis muscle and pulmonary intestine muscle in the experimental group were significantly different after training than before(P<0.05).Furthermore,the MVC of the anterior tibialis muscle on both the healthy and affected sides and the MVC of the pulmonary intestine muscle on both sides showed significant improvement compared with before training and the control group(P<0.05).CONCLUSION Our findings suggest that ankle dorsiflexion resistance training on the healthy side in hemiplegic stroke patients can increase strength in the opposite tibialis anterior muscle and antagonist's muscle,indicating a cross-migration phenomenon of strength training.Furthermore,this type of training can also improve lower limb motor function,providing a new exercise method for improving early ankle dorsiflexion dysfunction.

Is frailty associated with short-term outcomes for elderly patients with acute coronary syndrome？

BackgroundFrailty 由于老化并且逐渐地是在心血管的药的一个新预示的因素老病人的复杂自然。有希望地分析在哪个脆弱与 .MethodsPatients 变老的急性冠的症候群(交流) 为老病人预言短期的结果的方式有用、有意义 &#x02265；65 年，与从心病学的交流的诊断，部门和医学部门被包括从单个中心。包括医学症候群的临床的数据用全面医学评价被收集。脆弱根据临床的脆弱规模被定义，风险上的合作病态的影响被冠的动脉疾病(CAD ) 确定 &#x02014；特定的索引。病人们被跟随在上面由临床的访问或电话，咨询和中部的后续时间是 120 天。后面起来项目包括了所有原因死亡， unscheduled 回来访问，在里面医院和周期性的主要不利心血管的事件。Multivariable 回归幸存分析用考克斯 regression.ResultsOf 被执行 352 个病人，(43.18%) 152 根据学习仪器被认为脆弱(5 &#x02212； 7 在规模上) ，并且(26.42%) 93 中等或严重地被考虑脆弱(6 &#x02212； 7 在规模上) 。包括不能自制，秋天历史，视觉缺陷，听觉缺陷，便秘，长期的疼痛，睡觉混乱，牙齿的问题，焦虑或消沉的医学症候群，和谵妄比在非脆弱的病人更经常在脆弱的病人( P = 0.000 ， 0.031 ， 0.009 ， 0.014 ， 0.000 ， 0.003 ， 0.022 ， 0.000 ， 0.074 ，和 0.432 ，分别地)。为性别调整了，年龄，冠的动脉疾病的严厉(离开了主要冠的动脉损害) 并且由考克斯幸存分析的合作病态(CAD 特定的索引) ，脆弱被发现到强烈并且独立地为主要合成结果与风险被联系：所有原因死亡[危险比率(HR )= 5.393；95% CI：1.477 &#x02212； 19.692， P = 0.011 ] 并且 unscheduled 回来访问(HR = 2.832；95% CI：1.140 &#x02212； 7.037， P = 0.025 ).ConclusionsComprehensive 医学评价和临床的脆弱的规模在有交流的老病人的评估是有用的。脆弱强烈并且独立地与交流为老病人与短期的结果被联系。

Sex Hormones and Androgen Receptor:Risk Factors of Coronary Heart Disease in Elderly Men

Objective To investigate the variation of sex hormone and its receptor level in elderly male patients with coronary heart disease (CHD) and to evaluate the correlations between CHD and sex hormone as well as sex hormone receptor. Methods Altogether 139 male CHD patients (CHD group) aged 60-92 years and 400 healthy men (control group) aged 60-90 years were included in this cross sectional study. The plasma concentrations of dehydroepiandrosterone sulfate (DHEAS),total testosterone (TT),free testosterone (FT),estradiol (E2),sex hormone binding globulin (SHBG),luteinizing hormone (LH),and follicle-stimulating hormone (FSH) were measured. The androgen receptor (AR) was tested by flow cytometry. Correlations between CHD and levels of sex hormones and AR were analyzed. Results Compared with the control group,the levels of DHEAS,TT,FT,SHBG,and the fluorescence intensity of AR in the CHD group significantly reduced (P<0.05),while the levels of FSH and E2 significantly increased (P<0.01). Age was negatively correlated with TT (r=-0.28,P=0.00) and FT (r=-0.17,P=0.01),while it was positively correlated with SHBG (r=0.14,P=0.04) and E2 (r=0.33,P=0.00). AR fluorescence intensity was negatively correlated with systolic blood pressure (r=-0.12,P=0.01). Binary logistic regression analysis showed that TT,SHBG,and AR were all negatively correlated with CHD (P<0.05). Conclusions Elderly male patients with CHD are found to have low levels of DHEAS,TT,FT,SHBG,and AR,while high concentrations of E2 and FSH. Low levels of TT and SHBG may be the potential risk factors of CHD in elderly men.

Prevalence of and risk factors for postprandial hypotension in older Chinese men

ObjectiveTo 估计流行并且冒险因素因为在旧、很旧的中国 men.MethodsThe 学习之中的饭后的低血压(PPH ) 65 包括了 349 个中国人并且更旧，组织了进二个年龄范畴：组 1 (旧) 65 ～ 80 年包括了 163 个人；组 2 (很旧) 超过 80 年包括了 186 个人。在饭以后的血压变化被估计由监视的回廊血压的每 15 min。在饭摄取以后并且在相对血压变化处于基线条件站起来和变化以后的症状连续地被观察。另外的基线数据包括了身体团索引，病历，和 PPH 的药 use.ResultsThe 流行总的来说是 59.3% 并且比组织 1 在组 2 是显著地更高的(63.4% 对 54.6% ， P &#x0003c；0.05 ) 。在组 2，在早餐(33.8%) 和午餐(32.1%) 以后的 PPH 的流行在晚饭(20.9%) 以后比那高， P &#x0003c；0.05。高血压和年龄是为 PPH 的重要风险因素(或 = 2.188， 95% CI：1.134 &#x02212； 4.223， P = 0.02；或 = 1.86， 95% CI：1.112 &#x02212； 3.11， P = 0.018，分别地) 。相反， acarbose 使用对 PPH 是保护的(或 = 0.4， 95% CI：0.189 &#x02212； 0.847， P = 0.017 ) 。在血压的减少在 PPH 期间是 20 &#x02212； 40 mmHg 和最大值是 90 mmHg。 PPH 通常发生在 30 &#x02212 ；在饭以后的 60 min 并且持续了 30 &#x02212 ； 120 min.ConclusionsThese 调查结果证明在超过 80 年的人的 PPH 的流行比在 65～80 年的人的那些显著地高，并且血压衰落为超过 80 年的人也是更高的。另外，高血压和年龄是为在老人的 PPH 的主要风险因素，它建议那阻止并且对待的 PPH 是值得的。

Cardiovascular and cerebrovascular outcomes in elderly hypertensive patients treated with either ARB or ACEI

变换酶禁止者(ACEI ) 和血管收缩素受体 blockers (ARB ) 的 BackgroundAlthough 血管收缩素在高血压的治疗是同等地重要的，有更少的证据他们是否有相等的心血管、脑血管的保护的效果，特别在年长的高血压的病人。这研究试图澄清代表性的学习包括了的这未解决的 issue.MethodsThis 收到了 ARB 或 ACEI 在 2007 年 1 月和 2011 年 5 月之间的超过二个月的有高血压的 933 个年老的男病人上的临床的数据。主要结果是心血管的死亡，非致命的心肌的梗塞，和非致命的击合成。第二等的端点是不稳定的咽峡炎，新 atrial 纤维性颤动，和中部的后续时间是的短暂 ischemic attack.ResultsThe 24 个月。年龄，药类型，服的梗塞历史，肾的机能障碍历史是主要端点的独立预言者。一个主要端点事件的出现的风险比 ACEI 组在 ARB 组是更高的[P = 0.037，危险比率(HR ) ：2.124， 95% 信心间隔(95% CI ) ：1.048-4.306 ] 。Kaplan-Meier 方法也建议主要端点出现的率比 ACEI 组在 ARB 组是更高的(P = 0.04 ) 。关于第二等的端点，二只治疗手臂之间没有重要差别(P = 0.137， HR：1.454， 95% CI：0.888-2.380 ) 。耐心的年龄和冠的心疾病历史是第二等的 endpoint.ConclusionACEI 的独立预言者是比在与高血压在年老的病人减少心血管、脑血管的病态和死亡的 ARB 更有效的。

Additive Benefits of Twice Forest Bathing Trips in Elderly Patients with Chronic Heart Failure

长期的心失败(CHF ) ，源于各种各样的心血管的疾病(CVD ) 的后果的临床的症候群，逐渐地正在成为病态和死亡的一个全球原因。我们更早证明了洗旅行的一个 4 天的森林能在病人上向附属治疗学的影响提供 CHF。为了进一步调查影响和森林洗澡的最佳的频率的持续时间，与 CHF 在病人摔倒，我们招募了经历了在 4 个星期以后再洗旅行的第一个森林并且也就是，随机把他们分成了二个组的那些对象城市的控制组(城市)和洗组(森林)的森林。在洗旅行的第二个 4 天的森林以后，我们象氧化应力一样在大脑 natriuretic 肽层次，心失败的 biomarker，和稀释煽动性的回答观察了稳定的衰落。因此，这探索研究表明了添加剂好处两次，森林洗澡与 CHF 在老病人摔倒，它能进一步为在 CVD 分析如此的干预的效果铺平道路。

Ultrasound-assessed non-culprit and culprit coronary vessels differ by age and gender

AIM: To investigate age-and gender-related differences in non-culprit versus culprit coronary vessels assessed with virtual histology intravascular ultrasound (VH-IVUS). METHODS: In 390 patients referred for coronary angiography to a single center (Luzerner Kantonsspital, Switzerland) between May 2007 and January 2011, 691 proximal vessel segments in left anterior descending, circumflex and/or right coronary arteries were imaged by VH-IVUS. Plaque burden and plaque composition(fibrous, fibro-fatty, necrotic core and dense calcium volumes) were analyzed in 3 age tertiles, according to gender and separated for vessels containing non-culprit or culprit lesions. To classify as vessel containing a culprit lesion, the patient had to present with an acute coronary syndrome, and the VH-IVUS had to be performed in a vessel segment containing the culprit lesion according to conventional coronary angiography. RESULTS: In non-culprit vessels the plaque burden increased significantly with aging (in men from 37% ± 12% in the lowest to 46% ± 10% in the highest age tertile, P < 0.001; in women from 30% ± 9% to 40% ± 11%, P < 0.001); men had higher plaque burden than women at any age (P < 0.001 for each of the 3 age tertiles). In culprit vessels of the lowest age tertile, plaque burden was significantly higher than that in non- culprit vessels (in men 48% ± 6%, P < 0.001 as compared to non-culprit vessels; in women 44% ± 18%, P = 0.004 as compared to non-culprit vessels). Plaque burden of culprit vessels did not significantly change during aging (plaque burden in men of the highest age tertile 51% ± 9%, P = 0.523 as compared to lowest age tertile; in women of the highest age tertile 49% ± 8%, P = 0.449 as compared to lowest age tertile). In men, plaque morphology of culprit vessels became increasingly rupture-prone during aging (increasing percentages of necrotic core and dense calcium), whereas plaque morphology in non-culprit vessels was less rupture-prone and remained constant during aging. In women, necrotic core in non-culprit vessels was very low at young age, but increased during aging resulting in a plaque morphology that was very similar to men. Plaque morphology in culprit vessels of young women and men was similar. CONCLUSION: This study provides evidence that age-and gender-related differences in plaque burden and plaque composition significantly depend on whether the vessel contained a non-culprit or culprit lesion.

Homocysteine, hypertension, and risks of cardiovascular events and all-cause death in the Chinese elderly population: a prospective study

BACKGROUND Increased homocysteine levels are associated with the risk of cardiovascular disease(CVD)and death.However,their prevention has not been effective in decreasing CVD risk.This study investigated the individual and combined associations of hyperhomocysteinemia and hypertension with incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.METHODS This prospective study was conducted among 1,257 elderly participants(mean age:69 years).A questionnaire survey,physical examinations,and laboratory tests were conducted to collect baseline data.Hyperhomocysteinemia was defined as homocysteine level≥15μmol/L.H-type hypertension was defined as concomitant hypertension and hyperhomocysteinemia.Multivariate Cox regression analysis was used to evaluate individual and combined associations of hyperhomocysteinemia and hypertension with the risks of incident CVD events and all-cause death.RESULTS Over a median of 4.84-year follow-up,hyperhomocysteinemia was independently associated with incident CVD events and all-cause death.The hazard ratios(HRs)were 1.45(95%CI:1.01−2.08)for incident CVD events and 1.55(95%CI:1.04−2.30)for all-cause death.After adjustment for confounding factors,H-type hypertension had the highest HRs for incident CVD events and all-cause death.The fully adjusted HRs were 2.44 for incident CVD events(95%CI:1.28−4.65),2.07 for stroke events(95%CI:1.01−4.29),8.33 for coronary events(95%CI:1.10−63.11),and 2.31 for all-cause death(95%CI:1.15−4.62).CONCLUSIONS Hyperhomocysteinemia was an independent risk factor,and when accompanied by hypertension,it contrib-uted to incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.

The Effect of Home-Based Cardiac Rehabilitation on Functional Capacity,Behavior,and Risk Factors in Patients with Acute Coronary Syndrome in China

Aim:To investigate the effect of home-based cardiac rehabilitation on functional capacity,health behavior,and risk factors in patients with acute coronary syndrome in China.Methods:Eighty patients with acute coronary syndrome were enrolled in this prospective randomized controlled study.Patients in the cardiac rehabilitation group(n=52)received home-based cardiac rehabilitation with a heart manual and a home exercise video for 3 months and patients in the control group(n=28)received only routine secondary prevention.The 6-min walk distance,laboratory test results,healthy behavior(questionnaire),quality of life(12-item Short Form Health Survey),anxiety(7-item Generalized Anxiety Disorder Questionnaire),and depression(9-item Patient Health Questionnaire)were evaluated at the beginning and after treatment for 3 months.Results:Compared with baseline data,52 patients who participated in cardiac rehabilitation had longer 6-min walk distance(515.26±113.74 m vs 0.445.30±97.92 m,P<0.0002),higher proportions of“always exercise”(78.26% vs.28%,P<0.05),“always limit food with sugar”(65.22% vs 12%,P<0.05),“always eat fruits 200–400 g every day”(82.61% vs.4%,P<0.05).and“always eat vegetables 300–500 g every day”(21.74%vs.12%,P<0.06)after treatment for 3 months.The low-density lipoprotein cholesterol control rate(52.17% vs.28%,P<0.05)and the systolic blood pressure control rate(100%vs.68%,P<0.05)were also signifi cantly increased after treatment for 3 months in the cardiac rehabilitation group.No signifi cant increase was found in the control group after treatment for 3 months.No cardiac-event related to home exercise was reported in both groups.Conclusion:Home-based cardiac rehabilitation is a feasible and available cardiac rehabilitation mode in China.

Fractal lacunarity of trabecular bone and magnetic resonance imaging:New perspectives for osteoporotic fracture risk assessment

Osteoporosis represents one major health condition for our growing elderly population. It accounts for severe morbidity and increased mortality in postmenopausal women and it is becoming an emerging health concern even in aging men. Screening of the population at risk for bone degeneration and treatment assessment of osteoporotic patients to prevent bone fragility fractures represent useful tools to improve quality of life in the elderly and to lighten the related socio-economic impact. Bone mineral density(BMD) estimate by means of dual-energy X-ray absorptiometry is normally used in clinical practice for osteoporosis diagnosis. Nevertheless, BMD alone does not represent a good predictor of fracture risk. From a clinical point of view, bone microarchitecture seems to be an intriguing aspect to characterize bone alteration patterns in aging and pathology. The widening into clinical practice of medical imaging techniques and the impressive advances in information technologies together with enhanced capacity of power calculation have promoted proliferation of new methods to assess changes of trabecular bone architecture(TBA) during aging and osteoporosis. Magnetic resonance imaging(MRI) has recently arisen as a useful tool to measure bone structure in vivo. In particular, high-resolution MRI techniques have introduced new perspectives for TBA characterization by non-invasive non-ionizing methods. However, texture analysis methods have not found favor with clinicians as they produce quite a few parameters whose interpretation is difficult. The introduction in biomedical field of paradigms, such as theory of complexity, chaos, and fractals, suggests new approaches and provides innovative tools to develop computerized methods that, by producing a limited number of parameters sensitive to pathology onset and progression, would speed up their application into clinical practice. Complexity of living beings and fractality of several physio-anatomic structures suggest fractal analysis as a promising approach to quantify morphofunctional changes in both aging and pathology. In this particular context, fractal lacunarity seems to be the proper tool to characterize TBA texture as it is able to describe both discontinuity of bone network and sizes of bone marrow spaces, whose changes are an index of bone fracture risk. In this paper, an original method of MRI texture analysis, based on TBA fractal lacunarity is described and discussed in the light of new perspectives for early diagnosis of osteoporotic fractures.