Clinical Efficacy In Elderly Patients Research Articles

Clinical effect of recombinant human brain natriuretic peptide in the treatment of heart failure in elderly patients

BackgroundHeart failure in elderly individuals poses significant challenges due to the decline in cardiac function associated with aging. This study aimed to investigate the clinical efficacy of recombinant human brain natriuretic peptide (rhBNP) for the treatment of heart failure, especially in elderly patients.MethodsThis was a retrospective case control study of the medical records of 60 elderly patients with heart failure admitted to our hospital between December 2020 and December 2023. Patients were divided into two groups based on treatment. The control group (n = 30) received diuretics, digitalis, and β receptor blockers, while the observation group (n = 30) received lyophilized rhBNP in addition to the control group treatment. Changes in BNP levels and clinical outcomes were compared between the two groups.ResultsPosttreatment BNP levels were significantly lower in the observation group than in the control group (p < 0.05), and the total clinical effective rate was greater in the observation group (p < 0.05). Additionally, the left ventricular diameter, left atrial diameter, left ventricular shortening fraction, diastolic flow signal and cardiac output in the observation group were lower than those in the control group (p < 0.05), while the thickness of the aortic root diameter in the observation group was greater than that in the control group (p < 0.05).ConclusionRhBNP demonstrated ideal clinical efficacy in elderly patients with heart failure, improving symptoms and indicating potential for widespread use in the future.

Clinical Efficacy of Elderly Patients with Pulmonary Heart Disease Complicated with Coronary Heart Disease

Clinical Efficacy of Elderly Patients with Pulmonary Heart Disease Complicated with Coronary Heart Disease

Effects of somatostatin on the clinical efficacy of elderly patients with severe acute pancreatitis

Objective To investigate the effect of somatostatin on the clinical curative effect, prognosis and the level of inflammatory cytokines in senile severe acute pancreatitis (SAP). Methods From January 2011 to December 2015, a total of ninety elderly patients with severe acute pancreatitis in Liuzhou Railway Central Hospital of the Guangxi Zhuang Autonomous Region were enrolled in the study.The patients were randomly divided into the observation group (45 cases) and control group (45 cases), the two groups were given routine symptomatic treatment, at the same time, the control group was given omeprazole intravenous drip treatment.While on the basis of the control group, the patients in the observation group were treated with continuous intravenous infusion of somatostatin within 24 h after admission, 7 d as a course.The clinical effect of two groups of patients was compared, and serum amylase level was measured during the treatment of two groups, and the levels of serum inflammatory factors were compared between the two groups before and after treatment. Results The total effective rate was 100% (45/45)in the observation group and 80.00% (36/45)in the control group (χ2=10.000, P=0.002), while the incidence of elevated abdominal pressure, MODS and high amylase in the observation group were lower than those in the control group(2.22%(1/45)vs.17.78%(8/45); 0 vs.13.33%(6/45); 2.22%(1/45) vs.17.78%(8/45)). The differences were statistically significant (χ2=6.049, 2, 6.429, 6.049, P=0.014, 0.011, 0.014), and the rates of drug adverse reactions in the two groups were 20% (9/45) and 15.56 (7/45)%), the difference was not statistically significant (x 2=0.304, P=0.581). Abdominal pain relief time, gastrointestinal function recovery time, serum amylase returned to normal time, ventilator weaning time and the average length of hospitation in the observation group were shorter than those in the control group((1.85±0.48) d vs.(3.79±0.86)d; (2.78±0.72)d vs.(4.56±0.96)d; (2.10±0.62)d vs.(4.69±1.02)d; (3.25±0.82) d vs.(5.82±0.62)d; (7.82±1.10) d vs.(10.22±1.25)d)(t=13.502, 10.290, 14.919, 17.839, 10.076, P<0.001). High-sensitivity C reactive protein(hs-CRP)and interleukin-8 after treatment in the observation group were significantly lower than those in the control group((12.25±3.26) mg/L vs.(26.78±4.33) mg/L; (4.52±0.85) ng/L vs.(7.89±1.36) ng/L)(t=21.446, 16.810, P<0.001). Conclusion Somatostatin can effectively decrease the levels of inflammatory cytokines in SAP patients, improve the therapeutic effect of SAP patients and reduce the occurrence of related complications, which is helpful to promote the prognosis of patients with SAP. Key words: Somatostatin; Elderly; Severe acute pancreatitis; Clinical efficacy; Inflammatory factor

Research on the effects of compound matrine injection combined with chemotherapy on elderly patients with colorectal cancer

Objective To study the effect of compound matrine injection combined with chemotherapy on the immune function and life quality of elderly patients with colorectal cancer. Methods Seventy patients with colorectal cancer treated in Shanghai Jiao Tong University Affiliated Sixth People′s Hospital South Campus from January 2010 to December 2013 were involved in this survey.They were divided into the control group and the observation group randomly, each group had 35 cases, the control group was treated with chemotherapy only, the observation group was treated with compound matrine injection combine with chemotherapy.The curative effect, life quality and immune function in the two groups were compared. Results The number of complete remission patients in the observation group was 8 cases (22.86%), the number of partial remission cases was 16 cases (45.71%), the effective rate was 68.57%, while the control group had 4 cases of complete remission (11.43%), 11 cases of partial remission (31.43%), the effective rate was 42.86% (Z=-2.259, P=0.024). In the observation group, life quality was significantly improved in 10 cases (28.57%), improved in 19 cases (54.29%), the effective rate was 82.86%, while in the control group, life quality was significantly improved in 4 cases (11.43%), and improved in 10 cases (28.57%), the effective rate was only 40%.The improvement rate of the two groups was statistically significant (Z=-3.497, P=0.000). Before treatment, the immune function indexes of patients in the two groups were close (P>0.05), after treatment, the immune function in both groups were significantly improved, CD3+ , CD4+ , CD4+ /CD8+ levels of patients in the observation group were higher than those in the control group, while the CD8+ level in the observation group was lower than that of the control group (t=-3.968, P=0.000; t=-5.351, P=0.000; t=-5.474, P=0.000; t=6.407, P=0.000). The follow-up time of the two groups was 36 months.After 36 months, the survival rates of the observation group and the control group were 85.7% (30/35) and 80.0% (28/35) respectively, and the difference was not statistically significant (χ2=0.402, P=0.526). Conclusion Compound matrine injection combined with chemotherapy can significantly improve the clinical efficacy of elderly patients with colorectal cancer, improve the immune function and quality of life, it is worthy of clinical application. Key words: Compound matrine injection; Chemotherapy; Elderly colorectal cancer; Immune function; Life quality

Different surgical approaches and their clinical efficacy in elderly patients with multi-level cervical spondylosis

Objective To investigate the clinical effect of different surgical approaches on multi-level cervical spondylosis in elderly patients. Methods A total of 53 aged patients with multi-level cervical spondylosis (≥70 years old) who received operation in our department during May 2007 to May 2014 were retrospectively studied, and divided into anterior cervical surgical group (n=22) and posterior cervical group (n=31), according to the surgical approach. The operation duration, intra-operative blood loss, hospitalization time, postoperative complications, Japanese orthopedics association (JOA) scores, Neck disability index (NDI), postoperative subjective improvement of clinical symptoms and spinal fusion of the two groups were evaluated and compared respectively. Results The mean operative time was longer in the anterior surgical group than in the posterior surgical group〔(2.7±0.5)h vs. (1.9±0.3) h, P 0.05〕. NDI score was lower in anterior surgical group than in posterior surgical group 3, 6, 12 months after operation and at the last follow-up. Among the 41 patients, radiographic outcomes showed that there were 16 cases of anterior surgical group with no bony fusion at the follow-up 3 months after operation, and all the 16 patients achieved bony fusion at the follow-up 1 year after operation, and there were 4 cases with titanium mesh subsidence (<3 mm). Conclusions Both anterior cervical decompression and fusion and posterior cervical single open-door laminoplasty have good efficacy in the treatment of multilevel cervical spondylosis in elderly patients, which have advantages on the limb functional recovery time and cervical function assessment. When anterior cervical surgical contraindications were excluded, the anterior cervical decompression and fusion may be a good choice for the treatment of multilevel cervical spondylosis in aged patients. Key words: Cervical spondylosis; Spinal fusion; Verterbroplasty

Effect of fast tract surgery on immune and inflammatory reaction of elder patients with colorectal cancer

To compare the effect of rapid rehabilitation surgery (FTS) with the traditional operation method on postoperative immune function recovery, inflammatory reaction and the clinical efficacy in elderly patients with colorectal cancer. A total of 144 elderly patients (older than 65 years) diagnosed as colorectal cancer in our department from February 2010 to August 2013 were prospectively enrolled in the study. According to the order of admission, patients were randomly divided into the fast track surgery group (72 cases, study group), and the traditional operation group (72 cases, control group). Preoperative and postoperative T cell subsets, inflammatory index and organ functional parameters were detected and compared. Basal clinical data of the two groups had no significant differences (all P>0.05). Three days after operation, CD4+ and CD8+ in both groups increased compared to preoperative levels (P<0.05), while the study group had greater increasing amplitude of CD4+ (t=1.685, P=0.003), and lower CD8+(t=1.145, P=0.005) than the control group. CD4+/CD8+ increased in the study group compared to preoperation and significantly higher than that in the control group (P=0.001). Inflammatory stress indexes were significantly increased, while study group had smaller amplitude than the control group. Serum creatinine, B-natriuretic peptide and Troponin-T increased after operation, while the study group had smaller amplitude than the control group (P<0.05). The study group showed faster resumption of oral intake, quicker bowel function return, time to first defecation, hospital stay, lower incidences of nausea, vomiting, incision infection, and less cost of hospitalization. All the differences were significant (all P<0.05). Fast track surgery can effectively protect the perioperative organ function, increase postoperative immune function, decrease inflammation stress reaction, reduce perioperative morbidity of complication, improve efficacy for elderly colorectal cancer patients.

Impact of Comorbidities In Patients with Myelodysplastic Syndrome (MDS) or Acute Myeloid Leukemia (AML) Treated with Azacitidine (AZA)

AbstractAbstract 4973 Background:Comorbidity in older patients with AML or high risk MDS is frequent, and usually affects the therapeutic decision making. The hematopoietic cell transplantation specific comorbidity index (HCTCI) developed by Sorror et al, is widely used in predicting post-transplantation outcome in patients with AML and MDS. Recently, the HCTCI showed prognostic impact in a cohort of patients with high risk MDS treated only with supportive care. AZA have shown clinical efficacy in elderly patients with high risk MDS. However, it is not clear if AZA is safe and effective in patients with comorbidities. Purpose:To study the impact of comorbidity, determined by the HCTCI, in a retrospective cohort of patients with MDS or AML treated with AZA Patients:Between October 2007 and July 2010, 30 patients diagnosed with MDS or AML received AZA 75 mg/m2 /d × 7d/4 weeks, or less intensive schedules (7d/4w n=2, 5d/4 weeks n= 12, 5-2-2 n= 16).Median age was 71 years (range 44–88), 16M/14F. Regarding HCTCI, 17 patients were classified in low-intermediate risk, score 0–2, and 13 patients in high risk (score ≥ 3). Patients with HCTCI of 0–2 were classified as: 8 patients with MDS (High/ Int2 MDS n= 4, Intermediate-1 MDS n= 4), 8 patients with AML in first relapse after intensive chemotherapy (IC) or stem cell transplantation (SCT) and <20% of marrow blasts, and 1 patient with AML with MDS related changes. The group of patients with HCTCI ≥3 included: 7 MDS (high/int2 MDS n=5, secondary MDS n=1, Int-1 MDS n =1), 6 AML (AML with MDS related changes n= 3, AML in relapse after IC or SCT and <20% blasts n=3).Response to treatment was estimated according to the International Working Group. Results:The median number of cycles of AZA was 7 (1-26); 5 cycles in the HCTCI of score 0–2 and 7 cycles in the HCTCI>= 3.There were three patients who received only 1 cycle due to progression (n=1) and early death, caused by infection (n=2). Both patients showed neutropenia before starting AZA, one showed HCTCI of low risk.Responses were evaluated when 3 or more cycles were administered. Overall response rate (ORR) was 48% (14/27), with 13% complete response (CR). In the group of patients with HCTCI of 0–2, ORR was 40% (6/15) including 2 CR, 1 marrow CR, 2 partial response (PR), and 1 patient with haematological improvement (HI). Median overall survival (OS) for responders with low risk by HCTCI was 18 months (4-28). Transformation to AML was seen in two responding patients, after 16 and 18 months. Allo SCT was performed in one patient.Regarding patients with HCTCI ≥3, ORR was 66% (8/12), including 2 CR, 2 PR, 4 HI, 3 of them with transfusion independence. Median OS for responders was 11 months (range 5–33 months). Transformation to AML was seen in a patient after 23 months of treatment, and relapse with 10% of blasts was observed in a patient with CR after six months of AZA.Grade 3–4 toxicity according to WHO was observed in 5 patients, 3 of them with HCTCI low (1 bleeding event, 4 respiratory tract infections). One patient with HCTCI ≥3 died after 8 months of HI, because no treatment-related event. One patient with HI and HCTCI≥3 did not continued AZA after 5 cycles because frequent respiratory tract infections. ConclusionsIn this preliminary cohort, AZA was well tolerated and active in patients with HCTCI≥3. The response rate was in accordance with results observed with a similar cohort of patients without significant comorbidities. These results might be confirmed with larger number of patients in further studies. Disclosures:Font:Celgene: Membership on an entity's Board of Directors or advisory committees.