不同浓度肝素封管液对老年病人中心静脉导管封管的效果

目的 观察不同浓度肝素封管液运用于老年病人中心静脉导管封管的效果,为临床上老年病人使用最佳浓度的封管液提供理论依据.方法 将495例留置中心静脉导管的老年病人随机分成A、B、C组,每组165例.A、B、C组分别采用10.00U/mL、31.25 U/mL、62.50 U/mL浓度的肝素液进行正压封管.观察3组病人留置中...     

Ageing does not influence the sleep-related decrease in the hypercapnic ventilatory response.

In young people, a sleep-related reduction in the gain of the ventilatory chemoreflex feedback loop occurs; in the elderly, it has been reported that no sleep-related reduction occurs. A relatively high loop gain could contribute to periodic breathing and central sleep apnoea in the elderly. This study tested the hypothesis that ageing is associated with a reduction in the magnitude of the sleep-related decrease in the hypercapnic ventilatory response (HCVR). The HCVR was measured using a steady state method, awake and asleep, in groups (n = 10) of elderly (66-81 yrs) and young (23-35 yrs) nonapnoeics. Upper airway resistance was maintained close to wakefulness levels using continuous positive airway pressure (mean sleep-related increase in resistance: elderly 1.6 +/- 1.2 cmH2O L x s(-1), young 1.2 +/- 0.8 cmH2O x L x s(-1)). The sleep-related decrease in the HCVR was similar in the elderly and young groups (elderly: wake 0.14 +/- 0.06 and sleep 0.06 +/- 0.02 L min(-1) x kPa and young, wake 0.19 +/- 0.07 and sleep 0.10 +/- 0.04 L x min(-1) x kPa). Ageing per se was shown not to change the magnitude of the sleep-related decrease in hypercapnic ventilatory response. The authors speculate that age-related changes in the hypercapnic ventilatory response are unlikely to contribute to the increased prevalence of central sleep apnoea in the elderly.     

Central nervous system side effects of nonsteroidal anti-inflammatory drugs. Aseptic meningitis, psychosis, and cognitive dysfunction

A review of the literature regarding central nervous system side effects of the nonsteroidal anti-inflammatory drugs (NSAIDs) revealed three general categories: aseptic meningitis, psychosis, and cognitive dysfunction. Aseptic meningitis is found most commonly in patients with lupus treated with ibuprofen, but it should be considered in any patient with meningitis if the patient has used NSAIDs. Psychosis, although infrequently reported with NSAIDs, should be suspected in an elderly patient started on a regimen of indomethacin who acutely develops disorientation, paranoia, or hallucinations. Finally, there appears to be some potential for memory dysfunction and attention deficits in elderly patients treated with NSAIDs. Until further studies are available on the incidence and severity of these cognitive changes, physicians should use low doses of NSAIDs in the elderly and remain alert to the possibility of such adverse side effects.     

The effect of propranolol on the functional condition of the central and autonomic nervous system in persons of various ages

The effect of propranolol (0.6 mg/kg b.w.) on the functional state of the central and vegetative nervous system was studied in 60 apparently healthy of different age by means of electroencephalography and spectral analysis of the cardiac rhythm. In the young subjects propranolol produced inhibitory effects on the central nervous system, while in the elderly and very elderly subjects it was predominantly an activating one. The elderly versus young subjects showed a more marked impairment of the sympathetic effects on the cardiac rhythm due to propranolol administration. It was a characteristic feature of propranolol action to display a disaccord between its effects on the central nervous system and vegetative control of the cardiac rhythm in the very elderly people.     

Physical therapy intervention (PTI) increases plasma brain-derived neurotrophic factor (BDNF) levels in non-frail and pre-frail elderly women

Biomarkers are important factors in the identification of the frail elderly (higher risk of developing disease) and in assessing the impact of PTI. On the other hand, BDNF has been related to neuroprotection in a series of central nervous system diseases in older age. The levels of BDNF in groups of elderly women classified according to Fried phenotype (non-frail and pre-frail) were compared. We assessed the impact of a PTI on BDNF levels. A convenience sample of 48 elderly women was randomly selected. The PTI group was composed by 20 elderly women selected from this group. Plasma neurotrophic factors, such as BDNF, glial-derived neutrophic factor (GDNF), and nerve growth factor (NGF) were measured by enzyme-linked immunosorbent assay (ELISA). Timed-up-and-go (TUG) test, hand-grip and work/body weight were evaluated before and after the intervention. Plasma concentrations of BDNF were significantly higher in non-frail in comparison to pre-frail elderly women. After the PTI, higher levels of BDNF were found in elderly women (before 351±68 pg/ml and after 593±79 pg/ml; p<0.001). Both groups had an increase in BDNF levels after the PTI. The low levels of BDNF in pre-frail elderly women suggest that this neurotrophic factor may be a key pathophysiological mediator in the syndrome of frailty. The fact that PTI increased BDNF levels in both groups suggests that it may be possible to modify this phenotype.     

Posturography measuring instability in vestibular dysfunction in the elderly

Balance dysfunction may be a cause of falling in the elderly. Disturbance of the vestibular system may have a repercussion upon balance performance, causing instability. Unilateral vestibular hypofunction (UVH) and its disturbing influence upon the vestibulospinal reflex (VSR), measured by the postural sway, has been studied. This influence is dependent on the interfering action of central adaptive and compensatory mechanisms. This central compensation may be different for vestibulo-ocular reflex (VOR) and the VSR. This comparative study shows that the elaboration of compensation in elderly people is less efficacious at the VSR level than at the VOR level. The influence of visual fixation is also stressed by comparing the posturographic recordings made with eyes open and eyes closed.     

Sleep disorders in geriatric patients.

The elderly have more organic sleep problems disturbing sleep and contributing to insomnia than younger individuals. The most common disorders afflicting the elderly are obstructive sleep apnea, restless legs syndrome, and nocturnal myoclonus. Poor sleep habits often aggravate or contribute to the ongoing difficulty with sleeping. In the depressed elderly, characteristic EEG changes occur that may help distinguish major depression from pseudodementia; however, it should be considered that pseudodementia may be a harbinger of primary dementia. A careful sleep history and often evaluation by polysomnography are central to the management of sleep problems in the elderly. In conjunction with treatment of any underlying organic sleep disorders, brief administration of short-acting benzodiazepine sedatives for sleep onset insomnia or rapid-acting intermediate half-life benzodiazepines for sleep maintenance insomnia can be quite helpful in the elderly, especially if behavioral techniques also are employed. Elimination of medications, alcohol, and caffeine, which disturb sleep, is also an important part of the treatment approach.     

16排螺旋CT肺血管造影及重建技术在老年人肺动脉栓塞诊断中的应用

目的 研究16层螺旋CT肺血管造影及重建技术在老年人肺动脉栓塞(肺栓塞)诊断中的应用.方法 24例疑为肺栓塞的老年患者应用16层螺旋CT行肺动脉成像.CT后重建技术包括最大密度投影(MIP)、多平面重建(MPR)及容积再现(VR).结果 24例老年患者共发现肺动脉栓子161个,肺栓塞的直接CT征象:完全闭塞27支(占16.8%),不规则的充盈缺损109支(67.7%),中心性充盈缺损(轨道征)25支(15.5%).横断面图像共检出栓子161个,MPR像共检出153个(95.0%),MIP像检出113个(70.2%),VR像检出69个(42.9%).MIP和VR图像对栓子的显示效果相对较差,尤其是对肺叶及其以下肺动脉分支内栓子的显示效果明显低于横断面组(x2值分别为235.36和243.4l,均P＜0.05).结论 16层螺旋CT肺血管造影无创、快速、敏感性高,应当作为老年人肺栓塞的首选检查方法.

Abstract：

Objective To study the application of pulmonary angiography and reconstruction techniques with 16-detector row spiral CT in the diagnosis of pulmonary embolism (PE) in the elderly.Methods Twenty-four elderly patients with suspected pulmonary thromboembolism received detection of CT and pulmonary artery angiography ( CTPA ) on 16-detector MSCT.Post-reconstruction techniques included maximum intensity projection (MIP), volume rendering (VR)and multiple planar reformation (MPR). Results A total of 161 pulmonary artery thrombi were detected in 24 elderly patients. The direct signs of pulmonary embolism included total occlusion (16.8%, 27/161), partial filling defect (67.7%, 109/161) and central filling defect or track sign (15.5%, 25/161). A total of 161 pieces of pulmonary thrombi were detected in transect image, 153 (95.0%) in MPR, 113 (70.2%) in MIP and 69 (42.9%) in VR. The transect image excelled evidently MIP and VR image in displaying pulmonary thrombi, especially the thrombi in pulmonary lobe and pulmonary artery branch (χ2 =235.36 and 243.41, P＜0.05). Conclusions The 16-detector row spiral CT pulmonary angiography is non-invasive, fast and high sensitive, it should be the first choice for the diagnosis of PE in the elderly.     

A whole blood method for measurement of intracellular TNF-alpha, IFN-gamma and IL-2 expression in stimulated CD3+ lymphocytes: differences between young and elderly subjects.

Cytokines, the central regulators of leucocyte growth and differentiation, are produced by a wide variety of cell types, target various cell subsets and exhibit numerous biological activities. Cytokine dysregulation is believed to play a role in the remodelling of the immune system in old age, however, previous reports of cytokine levels in elderly subjects have been conflicting, possibly due to methodologies employed. We used the relatively new technique of intracellular cytokine detection by flow cytometry to measure cytokine production in CD3+ lymphocytes from young and elderly subjects, but applied it to whole blood, thereby eliminating the need for laborious cell separation techniques and maintaining cells in their normal physiological environment. We found the assay to be very reproducible with acceptable intra- (2.9%) and inter- (6.3%) assay CVs. The percentages of CD3+ cells producing TNF-alpha and IFN-gamma were significantly higher in elderly compared to young people (p=0.0049; p=0.0026, respectively) after stimulation with PMA and ionomycin. Absolute counts of CD3+IFN-gamma+ and CD3+TNF-alpha+ cells were also significantly higher in the elderly group (p=0.039; p=0.051) respectively. There was no significant difference between the age groups for the percentage or numbers of IL-2-producing CD3+ cells on stimulation. CD3+ cells expressing TNF-alpha were highly associated with CD3+ cells expressing IFN-gamma in both elderly and young people. In contrast, IL-2 secreting CD3+ cells were associated with TNF-alpha and IFN-gamma producing CD3+ cells in young but not elderly subjects providing further evidence for the remodelling of the cytokine network associated with old age.     

Frail elderly, nutritional status and drugs

This review focuses on the interactions between nutritional status and drugs in frail elderly persons. Impairment of nutritional status, a component of clinical presentation in the frail elderly, has a major impact on the pharmacology of many drugs devolving from the physiological alterations it generates. Food itself plays a central role in nutritional status and in possible interactions with drugs. Conversely, drugs have often, directly and indirectly, a deleterious effect on the nutritional state of the elderly. However, research in this domain is scarce, and future clinical studies will need to include more elderly and frail elderly individuals, to help clinicians to better understand these interactions.     

Hepatitis C treatment in the elderly: New possibilities and controversies towards interferon-free regimens

Due to the progressive aging of the hepatitis C virus (HCV) population which have acquired the infection during its maximum spread after the Second World War, the management of the elderly HCV-infected patient is emerging as a hot topic. Unfortunately, although it is recognized that the progression of HCV-related liver disease gets faster with aging, and that even extra-hepatic manifestations of HCV infection are probably worse in the elderly, till now, treatment attempts in this population have been significantly limited by the well-known contraindications and side effects of interferon (IFN). The arrival of several new anti-HCV drugs, and the possibility to combine them in safe and effective anti-viral regimens, is relighting the hope of a cure for many elderly patients who had been cut out of IFN-based treatments. However, although these new regimens will be certainly more manageable, it should be underscored that IFN-free doesn’t mean free from any contraindication or side-effect. Moreover, one issue which promises to become central is that of the possible interactions between antiviral therapy and the multiple drugs frequently assumed by elderly patients because of comorbidities. In this review, we will revise the epidemiology pointing to HCV as an infection of the elderly, the evidences that HCV harms the health of the aged patient more than that of the young one, and the available experiences of HCV treatment in the elderly with the “old” IFN-based regimens and with the newer drugs. We will conclude that the availability of IFN-free regimens should prompt us to change our mind and consider a significantly larger number of possible candidates among elderly patients, who would take significant advantage from viral eradication. Rather than the anagraphic age, drug-drug interactions and, mainly in case of economic restrictions, an evaluation of life expectancy dependent on liver disease with respect to that dependent on comorbidities, are likely to be the key issues guiding treatment indication in the next future. The sooner we will change our mind with respect to an a priori obstacle for anti-HCV treatment in the elderly, the sooner we will begin to spare many aged HCV patients from avoidable liver-related complications.     

The Sacubitril/Valsartan,a First-in-Class,Angiotensin Receptor Neprilysin Inhibitor (ARNI): Potential Uses in Hypertension,Heart Failure,and Beyond

Purpose of Review

Sacubitril/valsartan (LCZ696) is a first-in-class, novel-acting, angiotensin receptor neprilysin inhibitor (ARNI) that provides inhibition of neprilysin and the angiotensin (AT₁) receptor. A recent clinical trial PRARDIGM-HF demonstrated that this drug is superior to angiotensin-converting enzyme (ACE) inhibitors for improving the prognosis in the patients with heart failure, and this has resulted in the drug being included in clinical practice guidelines for the management of heart failure with reduced ejection fraction (EF). In addition, sacubitril/valsartan has been developed for the management of hypertension, because it has unique anti-aging properties. However, the clinical evidence of mechanism has not been well validated.

Recent Findings

A recent mechanistic study PARAMETER demonstrated that sacubitril/valsartan (LCZ696) is superior to angiotensin receptor blocker (ARB) monotherapy for reducing central aortic systolic pressure (primary endpoint) as well as for central aortic pulse pressure (secondary endpoint) and nocturnal BP preferentially.

Summary

Considering these results, sacubitril/valsartan may be an attractive therapeutic agent to treat the elderly with age-related hypertension phenotypes, such as drug-uncontrolled (resistant) hypertension characterized as systolic (central) hypertension (structural hypertension) and/or nocturnal hypertension (salt-sensitive hypertension). These are the high-risk hypertension phenotypes which are prone to develop heart failure with preserved EF and chronic kidney disease. Sacubitril/valsartan may be effective to suppress the age-related continuum from hypertension to heart failure, and it could be clinically useful not only for secondary prevention, but also as primary prevention of heart failure in uncontrolled elderly hypertensive patients.

     

不同类型老年急性肺血栓栓塞症患者临床特征比较

目的 探讨不同类型老年急性肺血栓栓塞症(APTE)患者的临床特征.方法 将2012年1月-2018年5月上海市第五人民医院收治的78例APTE老年住院患者分为中央型组(n=42)和周围型组(n=36),比较2组的一般情况、危险因素、临床症状体征、实验室检查、影像学表现、危险分层和预后因素评分.结果 2组一般情况和临床症...     

Antirheumatic agents: CNS toxicity and its avoidance

Altered drug metabolism, polypharmacy, multiple diseases, and errors in self-medication are all factors seen in the elderly which increase the risk for side effects from antirheumatic drug therapy. The geriatric presentation of central nervous system (CNS) toxicity, which is common yet frequently overlooked, is reviewed as it pertains to various drugs commonly used to treat rheumatic disease. Practical advice on avoiding common pitfalls in antirheumatic prescribing is offered.     

Hypogonadism and androgen replacement therapy in elderly men

The decrease in testosterone levels with age is both central (pituitary) and peripheral (testicular) origin. Because serum levels of sex-hormone-binding globulin increase with aging, the decrease in free testosterone is of even greater magnitude. Recent long-term studies of testosterone therapy in hypogonadal elderly men have shown beneficial effects on bone density, body composition, and muscle strength without any substantial adverse effects on lipids and the prostate. Total testosterone level is the test of choice for initial screening of elderly men who present with signs and symptoms of hypogonadism. If the level is below 300 ng/dL, replacement therapy should be initiated. If the level is normal in a symptomatic patient, free or bioavailable testosterone should be determined. The pros and cons of testosterone therapy should be discussed in depth with every patient, and decisions should be made on an individual basis. This review summarizes the trials of testosterone replacement therapy in elderly men and outlines a diagnostic approach to these patients.     

Psychomotor retardation associated to depression differs from that of normal aging

Psychomotor retardation (PMR) is a main symptom of depressive illness. In the elderly, it is associated with the severity of depression and poor prognosis. However, PMR is also commonly associated with normal aging, Therefore, depressive PMR is frequently misinterpreted as the age-related slowing in the elderly, which contributes to poor recognition of depression. Moreover, neurobiological and neuroanatomical studies on PMR hardly allowed to discriminate geriatric depression from normal aging. Reaction time experiments have rarely been tested in elderly population although they are particularly suited for examining PMR. We performed two reaction time experiments using an additive factor analysis in healthy and depressed old individuals with the hypothesis that PMR associated to depression differed from that of normal aging. Results showed that age-related PMR affected all stages of central nervous system information processing, while PMR associated with depression is limited to the components of response-selection and motor-adjustment. These results clearly show that PMR in geriatric depression differed from the age related slowing. Depression also spares stimulus preprocessing in old individuals as it did in younger adults.     

Relationship between central and autonomic nervous system activity: correlates of psychomotor performance in elderly men.

The relationship between heart rate deceleration (HRD) and the contingent negative variation (CNV) was evaluated in 12 healthy, elderly men during performance of a signaled reaction time task. While amplitude of the CNV and HRD did parallel RT, CNV alone was found to be predictive of individual differences in speed of response indicating that phasic concordance of these physiological responses is probably not an important factor in age changes in RT. The results indicate the probable importance of central physiological indices such as the CNV over peripheral events such as HRD in the evaluation of RT performance in elderly individuals.     

中枢神经调节剂在老年功能性胃肠病中的应用现状

功能性胃肠病是一组根据胃肠道症状分类的疾病,其症状产生主要与脑-肠轴功能异常、动力紊乱、内脏高敏感、黏膜和免疫功能的改变、肠道菌群的改变、中枢神经系统处理功能异常相关,在老年患者中发病率较高。单用常规药物治疗该病多难以缓解症状,辅以中枢神经调节剂则可明显改善症状。然而老年人多存在共病状态,因此在应用中枢神经调节剂时,应注意药物种类、剂量和药物间相互作用,避免毒副作用。本文主要对中枢神经调节剂在老年功能性胃肠病患者中对不同转运蛋白和受体的调节机制和作用、临床应用及副反应进行综述,以期对老年功能性胃肠病患者应用中枢神经调节剂提供参考依据。     

Prevalence of overweight and obesity in non‐institutionalized people aged 65 or over from Spain: the elderly EXERNET multi‐centre study

Coupled with the growth of the older population, an increase in the prevalence of overweight and obesity in this age group has occurred in the last decades. The main aims of the present study were (i) to provide an updated prevalence of overweight and obesity in a representative sample of the Spanish elderly population; (ii) to calculate the prevalence of sarcopenic obesity (SO) and (iii) to analyse the relationships between adiposity measurements and lifestyle. A cross‐sectional study was carried out in a sample of 3136 persons representative of the non‐institutionalized population ≥65 years of age. Anthropometric measurements were obtained using standardized techniques and equipment. Overall, 84% of the population can be categorized as overweight and/or obese. The present study indicates that 67% of the Spanish elderly population has an increased percentage of fat mass and more than 56% suffer from central obesity. Moreover, SO is present in 15% of the Spanish elderly population. Finally, a strong relationship between both physically active and sedentary lifestyles and the level of adiposity was found. Prevalence of overweight and obesity among elderly people in Spain is very high and is still increasing. Lifestyle seems to be a determinant factor in the development of obesity among elderly people.