A torus source and its application for non-primary radiation evaluation.

Objective. Non-primary radiation doses to normal tissues from proton therapy may be associated with an increased risk of secondary malignancies, particularly in long-term survivors. Thus, a systematic method to evaluate if the dose level of non-primary radiation meets the IEC standard requirements is needed.Approach. Different from the traditional photon radiation therapy system, proton therapy systems are composed of several subsystems in a thick bunker. These subsystems are all possible sources of non-primary radiation threatening the patient. As a case study, 7 sources in the P-Cure synchrotron-based proton therapy system are modeled in Monte Carlo (MC) code: tandem injector, injection, synchrotron ring, extraction, beam transport line, scanning nozzle and concrete reflection/scattering. To accurately evaluate the synchrotron beam loss and non-primary dose, a new model called the torus source model is developed. Its parametric equations define the position and direction of the off-orbit particle bombardment on the torus pipe shell in the Cartesian coordinate system. Non-primary doses are finally calculated by several FLUKA simulations.Main results. The ratios of summarized non-primary doses from different sources to the planned dose of 2 Gy are all much smaller than the IEC requirements in both the 15-50 cm and 50-200 cm regions. Thus, the P-Cure synchrotron-based proton therapy system is clean and patient-friendly, and there is no need an inner shielding concrete between the accelerator and patient.Significance. Non-primary radiation dose level is a very important indicator to evaluate the quality of a PT system. This manuscript provides a feasible MC procedure for synchrotron-based proton therapy with new beam loss model. Which could help people figure out precisely whether this level complies with the IEC standard before the system put into clinical treatment. What' more, the torus source model could be widely used for bending magnets in gantries and synchrotrons to evaluate non-primary doses or other radiation doses.

Scutellaria barbata Flavonoids Improve the Composited Aß-induced Abnormal Changes in Glial Cells of the Brains of Rats.

AIM: It has been reported that glial cells are involved in Alzheimer's disease (AD). In our previous research, Scutellaria barbata flavonoids (SBFs) were found to protect the AD-like rats from neuronal disorder and memory impairment; however, the effect of SBFs on the glial cells disorder in AD-like rats has been less studied. The effects of SBFs on astrocytes (ASs), microglial cells (MGs), and oligodendrocytes (Ols), as well as heat shock protein 70 (Hsp70) and apolipoprotein E (ApoE), were investigated in the present study. METHODS: The successful model rats, screened by Morris water maze, were orally administrated daily with 35, 70, and 140 mg/kg SBFs for 36 d. The number of brain astrocytes (ASs), microglial cells (MGs), and oligodendrocytes (Ols) was examined by immunohistochemistry. The expressions of cortical glial fibrillary acidic protein (GFAP), leukocyte common antigen (LCA) (CD45), Claudin 11, and heat shock protein 70 (Hsp70) protein were assayed by Western blotting, and the expression of apolipoprotein E (ApoE) mRNA was analyzed by real-time quantitative polymerase chain reaction (qPCR). RESULTS: Compared with the sham-operated group, the number of ASs and MGs in the brain was significantly increased in the model group (P<0.05, P<0.01), accompanied by an increase in the expressions of GFAP, CD45, Hsp70 protein, and ApoE mRNA (P<0.05, P<0.01). Both Ols number and the expression of Claudin 11 protein decreased in the brain in the model group (P<0.05, P<0.01). However, the above-mentioned abnormal changes induced by composited Aß were differently reversed by the treatment of SBFs at three doses of 35, 70, and 140 mg/kg (P<0.05, P<0.01). CONCLUSION: SBFs can dramatically improve the abnormal changes in glial cells of the brains of rats, induced by composited Aß, which may be utilized as a helpful treatment for neurodegenerative diseases.

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 ≥ 15 µmol/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 contributed to incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.

Diagnostic Value of Cerebrospinal Fluid T-SPOT.TB for Tuberculousis Meningitis in China.

The aim of this study was to evaluate the diagnostic value of the cerebrospinal fluid (CSF) T-SPOT.TB test for the diagnosis of TB meningitis (TBM). A retrospective analysis of 96 patients with manifested meningitis was conducted; T-SPOT.TB test was performed for diagnosing TBM to determine the diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A receiver operating characteristic (ROC) curve was also drawn to assess the diagnostic accuracy. The sensitivity, specificity, PPV, and NPV of CSF T-SPOT.TB test were 97.8%, 78.0%, 80.3%, and 97.5%, respectively, for 52 patients (54.2%) of the 96 enrolled patients. The area under the curve (AUC) was 0.910, and the sensitivities of CSF T-SPOT.TB for patients with stages I, II, and III of TBM were 96.7%, 97.2%, and 98.9%, respectively. CSF T-SPOT.TB test is a rapid and accurate diagnostic method with higher sensitivity and specificity for diagnosing TBM.

[Effect evaluation of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for lumbar degenerative diseases].

OBJECTIVE: To evaluate the clinical effects of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion(TLIF) in treating lumbar degenerative diseases. METHODS: The clinical data of 24 patients with lumbar degenerative disease underwent unilateral pedicle screw fixation with transforaminal lumbar interbody fusion from March 2007 to October 2009, were retrospectively analyzed. There were 13 males and 11 females, aged from 34 to 68 years old with an average of 52 years. Postoperative pain and functional results were analyzed by the visual analogue scale(VAS) and Oswestry Disability Index(ODI). Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and general complications. RESULTS: All patients were followed up from 5 to 8 years with an average of 6.7 years. VAS scores of low back pain and leg pain decreased from preoperative 7.82±0.71, 8.42±1.24 to postoperative 1.87±0.81, 2.23±1.62, respectively(P<0.05). ODI decreased from preoperative(53.42±8.26)% to postoperative(12.45±7.67)%(P<0.05). Postoperative intervertebral space height in different segments were improved than preoperative(P<0.05), but in final follow up it was decreased than 3 months after operation(P<0.05). There was no significant difference in the postoperative intervertebral space height between the operated side and non operated side. But at final follow up, the intervertebral space height of non operated side was obviously loss. At final follow up, the fusion rate was 95.8%. The incidence of adjacent segment degeneration was 45.8%. The paraspinal muscle fibrosis incidence was 8.3%. No complications such as secondary scoliosis, intervertebral height loss, cage slippage, screw loosening and internal fixation breakage were found. CONCLUSIONS: Unilateral pedicle screw fixation with TLIF is a satisfactory method and can obtain good effects in treating lumbar degenerative diseases according to over 5 year follow up, however, its indications should be well considered. But the problems such as intervertebral space height of operated side loss and adjacent segment degeneration after unilateral pedicle screw fixation need further clinical study.

Flavonoids from Scutellaria attenuate okadaic acid-induced neuronal damage in rats.

PRIMARY OBJECTIVE: To study the effect of flavonoids isolated from aerial parts of Scutellaria baicalensis Georgi (SSF) on cerebral damage induced by okadaic acid (OA) in rats. METHODS AND PROCEDURES: OA was microinjected into the right lateral ventricle of male rats at a dose of 200 ng kg(-1) twice with a 3-day interval between injections to establish a model of Alzheimer's-disease-like cerebral damage. Neuronal morphology was observed with thionin staining and the expressions of glial fibrillary acidic protein (GFAP) and ß-amyloid peptide 1-40 (Aß1-40) were monitored via immunohistochemistry. The level of malondialdehyde (MDA) and the activities of glutathione peroxidase (GSH-Px) and lactate dehydrogenase (LDH) were measured using spectrophotometry. MAIN OUTCOMES AND RESULTS: The results showed that OA-treated rats exhibited marked neuronal damage accompanied by increased levels of Aß1-40 peptide and MDA accumulation, decreased GFAP protein expression and reduced GSH-Px and LDH activity in the brain. SSF at three doses (25, 50 and 100 mg kg(-1)) dramatically reversed the OA-induced changes in the brains of rats. CONCLUSION: SSF-mediated amelioration of OA-induced neuronal damage in rats provides a rationale for assessing SSF as a means of to reducing tau hyperphosphorylation and Aß expression in the treatment of Alzheimer's disease.

A pilot study on the correlation of tongue manifestation with the site of cerebral infarction in patients with stroke.

OBJECTIVE: To discuss the correlation of tongue manifestation with the site of cerebral infarction in patients with acute cerebral infarction. METHODS: From March 2008 to February 2009, 200 cases of hospitalized patients with first unilateral cerebral infarction were chosen in the Department of Neurology, Xuanwu Hospital. The correlation of different tongue color, fur texture, fur color with the site of cerebral infarction was analyzed. RESULTS: The site of cerebral infarction in patients were compared between different tongue color by Chisquare test (P=0.314), and further correspondence analysis demonstrated that there was correlation between red tongue and cortical-subcortical infarction group. The site of cerebral infarction in patients were compared between thick fur group and thin fur group, cortical-subcortical infarction occurred more frequently in the former (P=0.0008). The site of cerebral infarction in patients were compared between dry fur group, moist fur group and smooth fur group, correspondence analysis demonstrated there was correlation between dry fur and cortical-subcortical group. The site of cerebral infarction in the patients were compared between white fur group, white-yellow fur group and yellow fur group (P=0.010), and correspondence analysis demonstrated there was correlation between white fur and brainstem infarction; white-yellow fur has relationship with cortical infarction; subcortical infarction was weakly related with white-yellow fur; there was closer relationship between yellow fur and cortical-subcortical infarction. CONCLUSION: The change of tongue manifestation was associated with the site of cerebral infarction in patients, providing a new combining site for diagnosing cerebrovascular diseases by integrative medicine.

A pilot study on the relationship between tongue manifestation and the degree of neurological impairment in patients with acute cerebral infarction.

OBJECTIVE: To discuss the relationship between tongue manifestation and the degree of neurological impairment in the patients with acute cerebral infarction. METHODS: Two hundred patients with first unilateral cerebral infarction were recruited. The relationship between different tongue manifestation and National Institute of Health Stroke Scale (NIHSS) were analyzed. RESULTS: NIHSS scores in the patients from different tongue color groups were analyzed and further analysis demonstrated that the NIHSS score was higher in the patients with red or bluish-purple tongue than that of those with the pink (P <0.01). On tongue fur, the NIHSS score in the patients with thick fur was higher than that of those with the thin (P=0.003). NIHSS score in patients with slippery, moist or dry fur was significant different (P=0.003), Further analysis demonstrated that the NIHSS score was higher in the patients with dry fur than that of those with moist fur, and had statistical significance (P=0.01). The NIHSS score was higher in patients from greasy fur group than that of the non-greasy (P=0.002). There was significant difference of NHISS score in the patients with different fur color (P=0.000), and further analysis demonstrated that the NHISS score in white-yellow, yellow fur group were higher than that of the white (P=0.06 or 0.000). CONCLUSION: The changes of tongue manifestation might be associated with the degree of neurological impairment in the patients with acute cerebral infarction.

[A cohort study on mortality and risk of death among population diagnosis as dementia, at base-line survey, in Beijing].

OBJECTIVE: To study the mortality and risk of death on dementia among ageing population. METHODS: A random sample including 2788 elderly residents was studied. Dementia was diagnosed under the two-phase procedure in 1997. In phase 1, questionnaire was administered, including the Mini-Mental State Examination (MMSE) tested. In phase 2, all the elderly who showed low MMSE score and some with normal MMSE score, were examined by neurologists. The clinical diagnosis of dementia was set up by two neurologists according to the criteria of DSM-III-R and NINCDS-ADRDA. The same sample was followed up in 2000 and 2004 the same way and data on deaths and causes was gathered. The overall time for follow-up was 7.25 years. RESULTS: 171 cases with dementia were diagnosed from 2788 subjects in 1997, with a crude death rate (CDR) of dementia was 7.8 per 1000 person-years and age-standardized CDR as 5.5 per 1000 person-years. The death rate was increased exponentially with age. In the dementia group, the total number of deaths was 133, with the CDR as 236 per 1000 person-years and the age-standardized CDR as 206 per 1000 person-years, in the end of the survey. In the non-dementia group, the total number of deaths was 680, with CDR as 40 per 1000 person-years and the age-standardized CDR as 31 per 1000 person-years. The difference in the two groups was statistically significant. The hazard ratio (HR) of dementia death appeared to be the biggest in the 60 - 74 - year group than the other groups. Data was analyzed with the Cox proportional hazards model after making necessary adjustment on potential covariates with the HR of dementia as 2.181 (95%CI: 1.751 - 2.717). The HRs were 2.524 (95%CI: 1.964 - 3.243) in Alzheimer's disease and 1.859 (95%CI: 1.213 - 2.850) in vascular dementia. CONCLUSION: The CDR and HR of dementia were higher than the non-dementia group in the aging population, showing that dementia was one of the most important risk factors on death in the aging population.

[Feasibility analysis of wavelet index for monitoring the depth of anesthesia in patients undergoing general anesthesia].

OBJECTIVE: To evaluate the value of wavelet index (WLI) in general anesthesia through a comparison of WLI with bispectral index (BIS). METHODS: A total of 53 patients scheduled for elective surgery with ASA (American Society of Anesthesiologists) I-II were selected to undergo general anesthesia. The monitoring probes of BIS, WLI and muscle relaxation were connected in awaking patients. The values of WLI and BIS were recorded at 10 min (T1) entering OR (operating room), immediate before anesthesia induction (T2), when the OAA/S (observer's assessment of alertness/sedation) score declined gradually to 5(T3), 4(T4), 3(T5), 2(T6), 1(T7) after the infusion of propofol, after vecuronium given when the TOF value decreased to 100 (T8), 75(T9), 50 (T10), 25 (T11), 0 (T12) after the injection of vecuronium, tracheal intubation (T13), 1 min (T14), 3 min (T15) and 5 min (T16) after the completion of tracheal intubation, immediate before initiating surgical procedure (T17), beginning the operation (T18), 1 min (T19), 3 min (T20), 5 min (T21) post-operation, skin suturing (T22), end of surgery (T23), tracheal extubation (T24), 1 min (T25) and 5 min (T26)cd post-extubation, immediate before exiting OR (T27). RESULTS: The value of WLI at T10-T13, T22-T27 was more than BIS (P < 0.05). The Bland-Altman analysis showed that WLI was accepted comparing with BIS during the period of anesthesia. The bias was -2.99, 95% limits of agreement -29.97% to 21.56%. The correlation coefficients of OAA/S score with BIS and WLI were: r(BIS) = 0.884, r(WLI) = 0.757 (P = 0.000). CONCLUSION: WLI index is feasible for monitoring the depth of general anesthesia.

[Study on the incidence and risk factors of dementia in elderly residents from communities in Beijing].

OBJECTIVE: To study the incidence of dementia and its risk factors among the elderly living in the community of Beijing. METHODS: A sample of 2788 elderly residents from Beijing were investigated regarding the incidence of dementia which was diagnosed using two-stage method in 1997. In the first stage, questionnaire was filled, including MMSE checked up. In the second stage, all the elderly who had lower MMSE score and some with normal MMSE score were examined by neurologists. The clinical diagnosis of dementia was set up by two neurologists according to the criteria of DSM-III-R and NINCDS-ADRDA. The same sample was followed up on 2000 and 2004 by the same way, with the overall time for following-up as 7.25 years. RESULTS: 171 dementias cases were diagnosed among the 2788 elderly in 1997. At the end of the survey, another 180 new cases developed. The average weighted incidence was 0.84/100 person year, adjusted by age (it's same followed), with 0.64/100 person year in males and 1.01/100 person years in females. The incidence of vascular dementia was 0.35/100 person years, with male as 0.39/100 person year and female as 0.32/100 person years. The incidence of dementia was increasing with age, but decreasing with time of education by Multinomial Logistic Regression Analysis. Old age and illiterate appeared to be the risk factors for dementia. People with stroke history and elevated systolic blood pressure were risk factors for vascular dementia. CONCLUSION: The incidence of dementia in the elderly in Beijing was higher than in other areas of China. Old age and illiterate were risk factors for dementia. Being male, illiterate, with stroke history and elevated systolic blood pressure were risk factors for vascular dementia.

[Effect of BuYangHuanWu recipe on cerebral microcirculation in gerbils with ischemia-reperfusion].

OBJECTIVE: To explore the protective mechanism of BuYangHuanWu recipe on neurofunction in gerbils with cerebral ischemia- reperfusion. METHODS: Gerbils (n = 48) were divided randomly into three groups: animal model group, BuYangHuanWu recipe group, and sham control group. The animal model of cerebral ischemia was established using bilateral common carotid artery occlusion followed by unclamp 45 min after occlusion. The microcirculation was observed with a Laser Doppler. The density of microvascular was measured using Tannic acid ferric chloride mordant dyeing. The BBB (blood brain barrier) permeability was assessed using evan's blue (EB) dye. The water content in brain tissues was tested with wet and dry method. The learning and memory function test was performed with a 4-PTT dry path maze. RESULTS: Compared with the animal model group, BuYangHuanWu recipe increased blood flow in the hippocampal region at 1 and 5 min after occlusion, inhibited hypoperfusion at 15 min after reperfusion, increased blood flow at 30, 60 and 120 min after reperfusion. Meanwhile, BuYangHuanWu recipe inhibited the increase of BBB permeability and water content in brain tissues after reperfusion (P < 0.05). BuYangHuanWu recipe also improved the scores of learning and memory function of the gerbils. CONCLUSION: BuYangHuanWu recipe protects the neurofunction in gerbils with ischemia-reperfusion through modulating cerebral microcirculation damages.

[Role of enzyme-linked immunospot assay and tuberculin skin test in the auxiliary diagnosis of initial pulmonary tuberculosis].

OBJECTIVE: To compare enzyme-linked immunospot assay (ELISPOT) and tuberculin skin test (TST) and explore their roles in the auxiliary diagnosis of initial pulmonary tuberculosis. METHODS: Totally 123 patients with initial pulmonary tuberculosis (tuberculosis group) and 102 patients with non-tuberculosis pulmonary disease (control group) were enrolled. The peripheral blood mononuclear cells of all participants were co-cultured with early secretiny antigen target-6/culture filtrate protein-10 fusion protein (ESAT-6/CFP-10), and spot forming cells (SFCs) were enumerated by ELISPOT (ESAT-6/CFP-10-ELISPOT). TST was also performed simultaneously. RESULTS: ESAT-6/CFP-10-ELISPOT showed significantly higher numbers of SFCs after stimulation in tuberculosis group than in control group (P = 0.000). The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value of ESAT-6/CFP-10-ELISPOT were 91.1% (111/123), 81.4% (82/102), 4.60, 0.12, 0.85, and 0.87 respectively, while the above values of TST were 65.6% (59/90), 45.1% (46/102), 1.31, 0.76, 0.51, and 0.60, respectively. The sensitivity and specificity of ESAT-6/CFP-10-ELISPOT were significantly higher than those of TST (all P = 0.000). The number of SFCs were not significantly different between smear-positive tuberculosis subgroup and smear-negative tuberculosis subgroup (P = 0.166). The sensitivities were 91.8% (67/73) and 88.0% (44/50) in these two subgroups, respectively, (P = 0.448). CONCLUSIONS: ESAT-6/CFP-10-ELISPOT may be a more accurate approach for the auxiliary diagnosis of initial pulmonary tuberculosis; meanwhile, it offers certain diagnostic evidences for smear-negative tuberculosis. However, its specificity may be affected by latent tuberculosis infection. On the contrary, TST has poor value in the auxiliary diagnosis of initial pulmonary tuberculosis.

[The comparison of different antigens in enzyme-linked immunospot assay for the diagnosis of tuberculosis.].

OBJECTIVE: To compare different Mycobacterium tuberculosis antigens in enzyme-linked immunospot assay (ELISPOT) for the auxiliary diagnosis of active tuberculosis. METHODS: The peripheral blood mononuclear cells (PBMC) from patients with tuberculosis and controls were co-cultured with the following antigens: purified protein derivative (PPD), early secretory antigenic target-6 (ESAT-6) and early secretory antigenic target-6/culture filtrate protein-10 fusion protein (ESAT-6/CFP-10). Spot forming cells (SFC) were enumerated by ELISPOT. RESULTS: PPD-ELISPOT, E/C-ELISPOT and ESAT-6-ELISPOT showed significantly higher SFC counts in active tuberculosis [255(93-526), 148(40-354) and 28(10-116) respectively] as compared to the controls [10(5-41), 10(0-20) and 5(0-15) respectively], u values were 1479.5, 1390.5 and 2510.5 respectively, all P < 0.01. Compared with the sensitivity of ESAT-6-ELISPOT (62.1%), that of E/C-ELISPOT and PPD-ELISPOT was higher (90.3% and 84.8%), chi(2) = 17.496 and 28.541, all P < 0.01. Compared with the specificity of PPD-ELISPOT (68.9%), that of E/C-ELISPOT and ESAT-6-ELISPOT was also higher (84.4% and 88.9%), chi(2) = 6.807 and 10.808, P < 0.05 and P < 0.01 respectively. CONCLUSIONS: E/C-ELISPOT is a promising approach to the auxiliary diagnosis of tuberculosis, but its specificity could be affected by latent tuberculosis infection.

[Study on the relationship between somatic health and incidence of depression in the elderly].

OBJECTIVE: In order to explore the risk factors of geriatric depression, a longitudinal follow-up study was conducted on elderly population living in the community so as to provide evidence for the development of depression prevention and control. METHODS: A sampled population consisting 2506 elderly was selected from urban and rural communities in Beijing, using well-established sampling techniques as cluster, stratification and random selection. Data was collected by trained staff members, using standard survey instruments in 2000 and 2004. RESULTS: Longitudinal study showed that the four-year cumulative incidence of the geriatric depression in Beijing was 10.58%. Difference on were evident intelligence/education, with the rates for illiteracy (15.2%) and primary school (10.5%) significantly higher than that of junior high school and above (5.1%) (chi2 = 26.587, P = 0.000). Rates also varied substantially with place of residence, individuals living in rural areas had a substantially higher rate of depression (15.4%) than those individuals dwelling in urban district (6.1%) (chi2 = 31.163, P = 0.000). Poor self-rated health condition (chi2 = 23.385, P = 0.000), cognitive impairment (chi2 = 11.947, P = 0.001) and limitations in physical functioning (ADL: chi2 = 15.930, P = 0.000; IADL: chi2 = 9.501, P = 0.002) were related to the worsening of depressive symptoms. Results from logistic regression analysis indicated that education level, dwelling area, self-rated health condition and ADL were the independent risk factors. CONCLUSION: Lower educational level, dwelling situation, poor self-rated health condition as well as ADL damage might increase the incidence of depression, suggesting more attention needs to be paid to improve somatic function of elderly in order to decrease the incidence of geriatric depression and to improve the prognosis of the disease and the quality of life.

[Study on the isolated systolic hypertension and its prognosis among 2866 elderly residents at the community level in Beijing].

OBJECTIVE: We followed a group of community residents above 60 years old to investigate how isolated systolic hypertension (ISH) could influence the prognosis in the long run among the elderly. METHODS: A selected sample of 60 year olds and over from the Beijing residential communities was randomized ascertained to a longitudinal study. Baseline data was collected in 1993 and 11 years later in 2004, the all-cause death, mortality of cardiovascular and cerebrovascular diseases were observed and analyzed. RESULTS: (1) The morbidity of hypertension(HT) was 61.7% and ISH was 27.8% seen in baseline survey while the SBP was increasing with age. (2) The longitudinal study showed that the total mortality and the mortality of cardiovascular and cerebrovascular diseases in HT group were higher than in the normal blood pressure(BP) group. The total mortality in the group ISH was higher than in normal BP group (55.2%: 46.2%; P < 0.01). The mortality OR for group ISH/group normal BP was 1.4 and group DSH/group normal BP was 1.6. The level of SBP was related to prognosis too which showed that the mortality appeared the lowest in 120-139 mm Hg group, and increased when the level of SBP was above 140 mm Hg. CONCLUSION: SBP was an independent risk factor on the all-cause mortality and the mortality of cerebrovascular diseases in eldevly. ISH also appeared a risk factor on the prognosis among the elderly, suggesting that more attention should be paid to it and treatment be carefully addressed.

[The relationship between coronary atherosclerotic stenosis and cerebral atherosclerotic stenosis].

OBJECTIVE: To observe the relationship between coronary and carotid/cerebral atherosclerotic stenosis. METHODS: Carotid/aortocranial angiography and coronary angiography were performed in 34 CAD patients complicated with symptomatic cerebral ischemia. Patients were divided into 3 subgroups according to the extent of arterial stenosis determined by angiography. There were 5 light, 4 moderate and 25 severe stenosis determined by coronary angiography and there were 6 light, 6 moderate and 24 severe stenosis determined by carotid/aortocranial angiography. RESULTS: The extent of coronary artery stenosis was parallel to the carotid artery or vertebral artery stenosis. Twenty-four patients out of 25 patients with severe coronary stenosis had severe cerebrovascular stenosis (P = 0.873). The coincident rate was as high as 92% for patients with moderate or severe cerebrovascular stenosis whose Califf risk scores of coronary artery were more than or equal to 2. The follow-up study showed the incidence of cardiovascular event and cerebrovascular event increased significantly in the patients with moderate to severe coronary and cerebral arteries stenosis and 3 patients with severe stenosis found in both coronary and cerebral arteries died during follow up. CONCLUSION: The incidence and severity of coronary artery stenosis is parallel with carotid artery or vertebral artery stenosis.

[A comprehansive evaluation on stroke prevalence among elderly in urban and rural areas of Beijing, 2002].

OBJECTIVE: To describe the prevalence and disability of stroke as well as the stroke-related diseases among elderly in urban and rural regions of Beijing. METHODS: In 2002, three communities were selected from urban, suburb and rural regions from Beijing areas, respectively. Twenty percent of the elderly were randomly selected from three communities. The information about history of stroke, hypertension, heart diseases and diabetes, self-rated health (SRH), activity of daily living (ADL) and instrumental ADL (IADL), smoking and drinking habits, knowledge about cardiovascular diseases prevention were collected. RESULTS: A total of 2487 elderly were interviewed and the prevalence of stroke was 12.9% (321/2481). Eighty-seven of the stroke patients were diagnosed by CT/MRI. 19.9% of stroke patients had experienced 2 or more attacks. The highest prevalence of stroke was in the urban region and the lowest in the rural region (16.9% vs. 8.5%, P for trend < 0.01) while it was higher in males than in females (P < 0.05). The prevalence of stroke tended to increase with age in urban and 34.6% of the stroke patients had recovered completely. The proportions of poor SRH, ADL and IADL dependence, as well as the prevalences of hypertension, heart diseases and diabetes were higher among the elderly with stroke than those without. Although rates of awareness and treatment of hypertension were at the high levels among the elderly with stroke , the control rate was low, especially in the rural region (as low as 4.3%). The level of knowledge on the prevention of cardiovascular diseases, and the rates of smoking and drinking were similar between the elderly with or without stroke. CONCLUSION: The prevalence of stroke had increased dramatically during the past decade in Beijing. The proportion of poor SHR, ADL and IADL dependence, prevalence rates of stroke related diseases were higher among the elderly with stroke than those without. Secondary prevention of stroke among Beijing elderly called for urgent action.

[Evaluation of predictive effect of some health-related indices on deaths among ageing residents through a 8-years' follow-up study in Beijing].

OBJECTIVE: To study the predictive effects of some health status indicators to deaths in the elderly population. METHODS: In 1992, a cohort of 3257 people older than 55 years old was formed from Beijing urban and suburb area. Demographic and information of activity of daily living (ADL), self-rated health (SRH), chronic diseases history and other related variables were collected at baseline survey in 1992. MMSE and CES-D were studied in 2101 on 3257 elderly people. Follow-up surveys were conducted in 1994, 1997 and 2000, to find that a total number of or= 75), resident place (suburb) and education level (illiteracy). The functional disability, poor self-rated health status, history of chronic diseases and abnormal cognition function were the major predictors of deaths. Multinomial logistic regression analysis showed that after adjustment for sex, age, residential place, education level and history of chronic diseases, functional disability, poor self-rated health status and abnormal cognition function remained as significant independent predictors to death. CONCLUSIONS: Functional disability, poor self-rated health status and abnormal cognition function were the most valuable indicators of death. Not only they had joined predictive effects to death, but also remained relatively independent. They had important value in the evaluation on healthy prognosis and the life quality of the elderly.

[Study on the relationship between self-rated health situation and health status in the elderly-an 8-year follow-up study from Multidimentional Longitudinal Study of Aging in Beijing].

OBJECTIVE: To study the relationship between self-rated health (SRH) and prevalence of chronic diseases, and all-cause mortality in the elderly population. METHODS: In 1992, a cohort of 3257 people > or = 55 years old was selected from Beijing, the information of SRH and other related variables were collected from 3 157 subjects at the baseline survey. Three follow-up surveys were conducted in 1994, 1997 and 2000, respectively. RESULTS: The SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Comparing the subjects with excellent SRH, the prevalence rates of chronic diseases, stroke, heart diseases and respiratory system diseases were almost doubled among those with average and poor SRH. By 2000, 993 death occurred. All-cause mortality was negatively associated with SRH, i.e. the risk of death was 12% which was 53% higher for the subjects with average SRH (HR = 1.12, 95% CI: 0.93 - 1.35) and poor SRH (HR = 1.53, 95% CI: 1.25 - 1.88) than those with excellent SRH, respectively. The risks of death from stroke and heart disease were 2.25 (HR = 2.25, 95% CI: 1.67 - 3.04) and 2.22 (HR = 2.22, 95% CI: 1.61 - 3.07) times higher among the subjects with poor SRH than those with excellent SRH respectively. After adjustment for age, gender, resident place, marriage status, education, satisfaction on their own economic condition, seeing doctors or hospitalized within the last 1 year, history of chronic disease, cognition function, body mass index, activities of daily living and depression, as well as deleted the subjects died within first or third year of the baseline survey respectively, poor SRH remained a significantly independent predictor to all-cause death as well as to the death of stroke and heart diseases. CONCLUSIONS: The frequency of poor SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Poor SRH was associated with the prevalence of chronic conditions and mortality among the elderly. The findings suggested that SRH might have served as an important indicator in the evaluation on health status among the elderly.