Abstract:Objective To survey the health-related quality of life (HRQoL) among the stroke patients living in rural areas of Western China and analyze the influencing factors. Methods From November 2018 to March 2019, stratified sampling was used to select the stroke patients in Hancheng, Shaanxi Province, and Pingluo, Ningxia Hui Autonomous Region. The basic information of stroke patients in the selected areas was collected by questionnaire, and the HRQoL of the participants was investigated by EuroQol Group′s 5-domain (EQ-5D) scale. Results Among the 362 distributed questionnaires, 349 pieces(96.4%) were collected as valid. The participants were at a mean age of (67.48±10.21) years, body mass index (BMI) of (23.77±3.00)kg/m², and health state utility value of 0.645±0.310. In the 5 dimensions of EQ-5D, the daily activity capacity was the most difficult, accounting for 63.3%. Univariate analysis showed that the main caregivers, family monthly income, and stroke type were the influencing factors for EQ-5D score (P<0.05). Tobit regression model indicated that EQ-5D score differed statistically in those at ages, with occupations and stroke types (P<0.05). Conclusion The stroke patients in rural areas of Western China are in poor quality of life. Age, occupation, main caregivers, family monthly income, and stroke type have significant effects on HRQoL.

Abstract:Objective To evaluate the correlation of frailty status with severity and short-term prognosis of community-acquired pneumonia (CAP) in elderly patients. Methods One hundred and seventeen CAP patients aged ≥80 years admitted to our geriatrics department from September 2017 to December 2018 were enrolled in this study. FRAIL scale was used to assess whether the subjects were frail or not, and all-cause mortality was recorded within 30 days of admission. Receiver operating characteristic (ROC) curve was used to evaluate the predictive values of indices.Results The body mass index (BMI), short-form mini-nutritional assessment (MNA-SF) score, activities of daily living (ADL) score, instrumental activity of daily living (IADL) score, and albumin and hemoglobin levels were significantly lower (all P<0.001), but the Charlson comorbidity index (CCI), prevalence of malnutrition, the CURB-65 score and incidence of severe pneumonia were obviously higher (all P<0.001) in the frailty group than the non-frailty group. Six patients (5.13%) died within 30 days of admission. Multivariate logistic regression analysis showed that only severe pneumonia was an independent risk factor for 30-day mortality in the elderly CAP patients (OR=9.76,95%CI 1.03-92.67, P=0.047). The accuracy of FRAIL scale predicted severe pneumonia was 0.868, and 95%CI ranged from 0.787 to 0.948 as measured by the area under the ROC curve.When the cut-off point was 3.5 points, the sensitivity and specificity were 85.7% and 70.9%, respectively. Conclusion Among elderly hospitalized patients with CAP, frailty patients are more likely to develop severe pneumonia and have poor short-term prognosis.

Abstract:Objective To compare the frailty index of accumulative deficits (FI-CD), frailty phenotype (FP), frailty scale (FS), and clinical frailty scale (CFS) in evaluating frailty in the elderly inpatients and predicting their all-cause mortality after discharge from hospital. Methods In a cohort study, FI-CD, FP, FS, and CFS were used for frailty assessment. The subjects were followed up for over 3 months after discharge with death denoted as the observation endpoint. The Cox regression model was employed for assessing the relationships between frailty identified by different assessment methods and all-cause mortality, and the receiver operating characteristic (ROC) curve for comparing their predictive ability of death. Results Totally, 630 patients aged ≥65 years were recruited in the present study, of whom 14 were lost to follow-up. The average follow-up time was 24.8 months. The frailty evaluated by FI-CD, FP, FS and CFS were 31.7%, 33.8%, 23.5% and 23.5%, respectively, with 90 deaths (14.6%). In the Cox regression model adjusted for age, sex and other variables, FI-CD, FP, FS and CFS identified an increased risk of death after discharge in the frail patients against non-frail patients (HR=5.78,6.21,2.16 and 5.61; 95%CI 2.40-13.90,2.18-17.68,1.12-4.17 and 3.11-10.11 respectively, all P＜0.05). After adjustment for age and sex, pre-frailty as determined by FI-CD, FP and CFS was significantly associated with the increased risk of death (HR =2.96,3.93 and 2.58; 95%CI 1.22-7.22,1.38-11.14 and 1.36-4.92, P=0.017,0.010 and 0.004, respectively). Area under the ROC curves (AUC) for FI-CD, FP, FS, and CFS for death prediction were 0.726,0.684,0.621 and 0.750, respectively (all P<0.001). Conclusion The assessed rates of frailty ranged from 23.5% (FS, CFS) to 33.8% (FP). Frailty is a risk factor of death. FI-CD and CFS are able to predict death in the elderly inpatients, and CFS outperforms the other methods.

Abstract:Objective To observe the effects of vitamin D combined with resistance training on skeletal muscle mass, activities of daily living (ADL), and serum monocyte chemotactic factor-1 (MCP-1), interleukin-1β (IL-1β) and C-reactive protein (CRP) in the elderly patients with sarcopenia. Methods From January 2017 to May 2018,112 elderly patients with sarcopenia complicated with vitamin D deficiency were enrolled in the study, who were treated in Second Division of Geriatrics Department, Hebei Gerneral Hospital. They were randomized into control group (T1 group, n=30), resistance training group (T2 group, n=41) and resistance training plus vitamin D group (T3 group, n=41). T1 group were provided with education on sarcopenia, T2 group were given resis-tance training (twice a week, 30min each time) in addition to education on sarcopenia, and calcitriol (0.25μg, twice daily) was added for T3 group on the basis of the treatment for the T2 group. All three groups were observed for 24 weeks. The serum 25(OH)D3, MCP-1,IL-1β, CRP, grip strength, pace, ADL, and skeletal muscle mass index (SMI) of the limbs were measured before intervention and after 24 weeks of intervention for all the participants, and the changes of the above indicators were compared at the 0 week and 24 weeks. Pearson correlation analysis was made for the relationship between serum 25(OH)D3 and MCP-1, IL-1β, CRP, SMI and ADL. Results After 24 weeks of intervention, T2 and T3 groups had higher levels of serum 25(OH)D3, SMI, grip strength, pace and ADL but lower levels of MCP-1, IL-1β and CRP than those before the intervention and those of the T1 group (all P<0.05). The changes of the above indices in the T3 group were greater than those in the T2 group (all P<0.05). Pearson correlation analysis showed that serum 25(OH)D3 was positively correlated with SMI and ADL (r=0.537,0.439, all P<0.05), and negatively correlated with MCP-1, IL-1β and CRP (r=-0.544, -0.618, -0.496, all P<0.05). Conclusion Vitamin D combined with resistance training can increase muscle mass and improve daily activities in the elderly patients with sarcopenia and is better than single resistance training. The mechanism may be related to the reduction of inflammatory factors MCP-1, IL-1β and CRP.

Abstract:Objective To understand chronic pain self-efficacy in the elderly patients with lumbar disc herniation (LDH) and to explore its influencing factors. Methods From March 2018 to December 2018, a total of 231 elderly patients with LDH were sampled from 3 hospitals in Xi′an, who were to be treated with removal of nucleus pulposus, bone graft fusion and internal fixation. An analysis was made using Chronic Pain Self-efficacy Scale (CPSS), self-rated anxiety scale, illness behavior questionnaire and visual analog scale. Statistical analysis was performed using SPSS statistics 17.0, and multivariate linear stepwise regression analysis was performed for influencing factors of self-efficacy. Results The chronic pain self-efficacy in the patients with LDH scored 41-74 (60.33±8.88)points. Of the three dimensions, the highest score was for pain management [(3.05±0.46)points], and the lowest was for physical function [(2.63±0.35)points]. Multivariate linear stepwise regression analysis showed that anxiety, level of illness behavior, severity of pain in the lumbar and legs, comorbidity of other chronic diseases, and degree of education were closely related to the self-efficacy level of the elderly LDH patients (P<0.05). Conclusion Patients with LDH have a moderate overall chronic pain self-efficacy. Self-efficacy is the highest for pain management and the lowest for physical function. Anxiety, illness behavior, pain level, comorbidity of other chro-nic diseases are risk factors of the chronic pain self-efficacy in the patients with LDH, and high education level is its protective factor.

Abstract:Objective To determine the effect of early antihypertensive therapy on 1-year outcome of the acute ischemic stroke patients categorized by Trial of Org 10172 in Acute Stroke Treatment (TOAST). Methods A total of 597 hypertension patients with image-diagnosed ischemic stroke (without thrombolysis treatment) within 48 h of disease onset admitted to Tai′an Branch of Chinese PLA Hospital No.960 and Feicheng People′s Hospital from August 2009 to May 2013 were recruited in this study. According to TOAST classification, they were assigned into large artery atherosclerosis subtype (LAA group, n=261), cardio-embolism subtype (CE group, n=91), small artery occlusion subtypes (SAO group, n=225) and other subtypes (n=20). Then every subtype group was further divided into the antihypertension (AH) treatment subgroup and the non-antihypertension (non-AH) treatment subgroup, with those of LAA group containing 126 cases in the former and 135 cases in the latter subgroups, those of CE group containing 46 and 45 cases, those of SAO group containing 115 and 110 cases, and those of other subtypes containing 7 and 13 cases, respectively. In all the AH subgroups, blood pressure must be decreased by 10% to 20% within 24 h of enrollment. The mortality, mortality/disability rate and recurrence rate were evaluated at one year after discharge. SPSS statistics 20.0 software was used for statistical analysis, and Student′s t test or Chi-square test was employed for comparison between the two groups. Results The results of 1-year follow-up showedthat there were no statistical differences in mortality, mortality/disability rate and recurrence rate between the AH and non-AH subgroups from the LAA, SAO and other subtypes groups (P>0.05). In the CE group, the 1-year mortality/disability rate was significantly lower in the AH than the non-AH treatment subgroups (45.6% vs 66.7%, P<0.05), while no such differences were seen in 1-year mortality and stroke recurrence rate between the two subgroups (P>0.05). Conclusion Antihypertensive therapy in the acute phase after ischemic stroke shows no obvious effect on 1-year outcome in the LAA and SAO patients, but it can effectively reduce the 1-year mortality/disability rate for the CE patients.

Abstract:Objective To explore the value of simplified Pulmonary Embolism Severity Index (sPESI) in the risk stratification in the patients aged 80 years or over with non-high risk pulmonary embolism (PE). Methods A total of 141 patients with non-high-risk PE hospitalized in Beijing Tongren Hospital in the last eight years were divided into low-risk group (n=53), middle-low-risk group (n=75) and middle-high-risk group (n=13). The patients were assessed using PESI, sPESI, Bova score, PREP score and pulmonary embolism risk score (PERS). The five scales were compared, and their prognostic effects were judged based on the 30-day mortality. Results Among 141 patients, 10(7.09%) died at 30 days. The area under the receiver operating characteristic (ROC) curve (AUC) were 0.687 for PESI, 0.802 for sPESI, 0.786 for Bova, 0.769 for PREP, and 0.668 for PERS, with statistical significance among five scales (P<0.05), the AUC for sPESI being the largest. sPESI had the highest sensitivity of 0.951, PREP had the highest specificity of 0.905, and PESI had the highest Youden index of 1.526. Conclusions sPESI, PREP, and PESI have advantages and disadvantages, but sPESI, the most sensitive with the largest AUC, can be used for the early risk stratification in the population ≥80 years old. However, it is advisable to use it together with other methods because of its low specificity.

Abstract:Objective To investigate the efficacy of batroxobin combined with hyperbaric oxygen in treatment of sudden sensorine hearing loss (SSHL) in the elderly and the influencing factors on the prognosis. Methods A total of 209 elderly SSHL patients admitted to our medical center from June 2017 to June 2019 were recruited, and randomly divided into control group (n=104) and study group (n=105). The former group was treated with batroxobin, and the latter was treated with hyperbaric oxygen besides batroxobin. The clinical efficacy and incidence of adverse reactions were compared between the two groups, and the prognostic factors were analyzed. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for comparison between the groups. Binary logistic regression analysis was applied to analyze the independent factors affecting the prognosis. Results After treatment, the total effective rate was 80.95% in the study group, significantly higher than that (68.26%) of the control group(P<0.05). The hemodynamic parameters and antioxidant enzyme activity were significantly improved in both groups (P<0.05), and the improvements were more obvious in the study group (P<0.05). There was no statistical difference in the incidence of adverse reactions between the study group and control group (37.14% vs 34.62%, P>0.05). Age, diabetes, side of affected ear, interval from symptom onset to medical consultation, incidence, sense of ear fullness, and type of hearing loss curve were influencing factor on the prognosis. The results of binary logistic regression analysis showed that the type of hearing loss curve and the time from symptom onset to consultation were independent prognostic factors. Conclusion Batroxobin combined with hyperbaric oxygen is effective and safe in the treatment of elderly SSHL, and the type of hearing loss curve and the time from onset to consultation can be used as independent prognostic factors to predict its treatment effect.

Abstract:Objective To compare the effect of ultrasound-guided superficial cervical plexus (SCP) block combined with general anesthesia versus general anesthesia alone on early recovery quality and cognitive function in patients undergoing carotid endarterectomy (CEA). Methods A total of 60 patients undergoing elective CEA in our affiliated hospital from November 2018 to August 2019 were enrolled, and randomly divided into the observation group (ultrasound-guided SCP block combined with general anesthesia) and control group (general anesthesia), with 30 cases in each group. The quality of recovery score (QoR-15), score of mini-mental state examination (MMSE), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were recorded at different time points in both groups. The incidence of adverse events, use of vasoactive drugs and dose of anesthetics were compared between the two groups. SPSS statistics 19.0 was used for data analysis. Student′s t test or Chi-square test was employed for comparison between the two groups. Results The total score of QoR-15 at 1d after surgery was significantly higher in the observation group than the control group [(102.67±10.16) vs (91.87±10.13), P<0.05]. But there were no statistical differences in MMSE scores at different time points between the 2 groups (P>0.05). The observation group had obviously lower SBP[(125.56±9.55) vs (135.86±13.68)mmHg], DBP [(66.92±9.32) vs (76.77±11.73)mmHg], MAP [(86.47±9.02) vs (96.47±11.50)mmHg], and HR [(65.77±6.64) vs (70.50±4.93)beats/min] at moment of incision than the control group (P<0.05). There were notably less patients having hypertension (40.0% vs 70.0%), experiencing nausea and vomiting (13.3% vs 36.7%) and hypoxemia (3.3% vs 23.3%), and using antihypertensive drug (40.0% vs 66.7%) in the observation group than the control group (P<0.05). Less dosages of sufentanil [(0.14±0.03) vs (0.23±0.03)μg/kg], remifentanil [(13.56±2.35) vs (22.13±2.31)μg/kg] and propofol [(7.64±1.04) vs (9.01±1.18)mg/kg] were used in the former than the latter groups (P<0.05).Conclusion For CEA, ultrasound-guided SCP block combined with general anesthesia can improve short-term postoperative QoR-15 score, stabilize perioperative hemodynamics, decrease the dosages of anesthetics and vasoactive drugs, and reduce postoperative adverse events.

Abstract:Objective To investigate the efficacy and safety of rivaroxaban in prevention of lower limb venous thrombosis after total knee arthroplasty in the elderly. Methods A total of 356 patients underging total knee arthroplasty in Liaocheng Second People′s Hospital from March 2017 to March 2018 were randomly divided into the control group and study group (n=178 each). The control group were given low-molecular-weight heparin to prevent venous thrombosis, and the study group were given rivaroxaban to prevent lower limb venous thrombosis. The two groups were compared in the incidence of deep venous thrombosis in the lower limbs, hemorrhage, and death within one year after operation. Changes of inflammatory factors [tumor necrosis factor α(TNF-α), interleukin-6 (IL-6), IL-1β] and coagulation parameters [(D-Dimer, fibrinogen (FIB), activated partial thromboplastin (APTT), prothrombin time (PT), thrombin time (TT), platelet (PLT)] were also compared between two groups before and after treatment. Data analysis was performed using GraphPad Prism 5.0. The t test or χ² test was used for comparison between the two groups. Survival analysis was estimated by Kaplan-Meier method and Log-rank test. Results Compared with before treatment, TNF-α, IL-6, IL-1β, PLT, D-Dimer and FIB were significantly decreased in the elderly patients after knee arthroplasty (P<0.05), while APTT, PT and TT were significantly increased (P<0.05). The D-Dimer of the study group was significantly lower than that of the control group (P<0.05). After 1 year, the incidence of deep venous thrombosis in the lower limbs was significantly lower in the study group than in the control group (χ²=5.838, P=0.016). Adverse reaction occurred in 2 cases(1.12%) of the study group and 19 cases (10.67%) of the control group with statistically significant difference (χ²=8.865, P=0.003). The 1-year survival rate of the study group was significantly higher than that of the control group (χ²=4.614, P=0.032). Conclusion Rivaroxaban outperformed low-molecular-weight heparin in the efficacy and safety in the prevention of lower limb venous thrombosis after total knee arthroplasty in the elderly, and its mechanism may be related to the inhibition of inflammatory response.

Abstract:Objective To investigate the role of trafficking colony stimulating factor-1 (CSF-1) from dorsal root ganglion to spinal cord in neuropathic pain induced by vincristine and its mechanism. Methods A total of 30 healthy male SD rats were randomly divided into 3 groups (10 in each):control group, chemotherapy-induced neuropathic pain (CINP) group (modeled by intraperitoneal injection of vincristine every other day), DRR group (modeled after dorsal root transection). Mechanical allodynia was evaluated with mechanical withdrawal threshold (MWT), and heat hyperalgesia with thermal withdrawal latency (TWL). Western blotting was used to detect the expression of CSF-1 in dorsal root ganglion and spinal cord, immunofluorescence assay to detect the expression of Iba1 in spinal cord, and reverse transcription-polymerase chain reaction to detect the expression of CSF-1mRNA in dorsal root ganglion and spinal cord. Data were analyzed with SPSS statistics 19.0, and one-way analysis of variance was used for comparison between groups. Results MWT and TWL in CINP and DRR groups were significantly lower than those in the control group at 3,5 and 7 days after the first injection of vincristine (P<0.01). MWT and TWL in the DRR group were significantly higher than those in the CINP group. Significant up-regulation was found in the CINP group as compared with the control group in the expression of CSF-1 in dorsal root ganglion [(0.21±0.04) vs (1.08±0.15)] and spinal cord [(0.22±0.05) vs (1.17±0.14)], the expression of Iba1 in the spinal cord [(100±0)% vs (250±19)%], and the expression of CSF-1mRNA in dorsal root ganglion [(0.20±0.05) vs (1.02±0.10)] (P<0.01). Significant down-regulation was observed in the DRR group as compared with the CINP group in the protein expression of CSF-1 [(1.17±0.14) vs (0.45±0.06)] and Iba1 [(250±19)% vs (130±16)%] in the spinal cord. Conclusion The mechanism of neuropathic pain induced by vincristine may be related to the trafficking of CSF-1 from dorsal root ganglion to spinal cord and activation of spinal microglia.

Abstract:With the increasing prevalence of Alzheimer′s disease (AD), its pathogenesis has become an urgent problem in the medical community. microRNA involves in epigenetic regulation of protein synthesis and is a biological marker associated with a number of states, including AD. This paper mainly introduces progress made in the research of miRNA in AD in the respects of the newly discovered expression changes and regulatory pathways in vivo and in vitro and exosomes found recently to be able to preserve morphology of the miRNA secretion in the nervous system. The exosomes not only improve the detection rate of miRNA but also contribute to the damage in AD through inflammatory mediators.

Abstract:Frailty exerts serious consequences on health and quality of life of the elderly, which warrants due attention to the identification and prevention of frailty at early stage to avoid its progression and resultant disability. Functional rehabilitation is crucial for the prevention of and recovery from frailty, and the current approaches mainly include exercise rehabilitation and cardiac rehabilitation, and gradual extension to pulmonary rehabilitation and swallowing rehabilitation. Nursing staff should play an active role in frailty rehabilitation of the elderly, leading a frailty rehabilitation system, practicing proactive health, taking preventive interventions earlier, and putting more emphasis on those with moderate to severe frailty. A comprehensive strategy may be adopted for rehabilitation nursing, and a paradigm combining the Internet and caregivers′ company can improve the compliance and safety of older people.

Abstract:With population aging, age-related diseases have posed a great challenge for governments around the world. Typically age-related cardiovascular diseases increases year by year. Exercise is an important approach to the prevention of and rehabilitation from cardiovascular diseases, and the reduced exercise capacity and quantity are associated with their incidence in the elderly population. Sarcopenia, characterized by reduced muscle mass and/or reduced function, is closely related to cardiovascular diseases. This review summarizes the recent studies focusing on sarcopenia and cardiovascular diseases in the respects of pathophysiology, interaction, potential mechanism, clinical manifestation diagnostic criteria and treatment with a view of providing a clear insight into those diseases.

Abstract:Sarco-osteopenia is a common comorbidity cluster in the elderly population, resulting from aging, diseases, behaviors, nutrition, genetics and other factors, which seriously affects their health and quality of life. Therefore, screening and evaluation of the two diseases is of great importance, and early identification and intervention constitute the key to the improved prognosis. In terms of prevention and treatment, exercises, nutrition and drug therapy were mainly adopted as comprehensive intervention for the bones and muscles. This article reviews the comorbidity cluster in the respects of its incidence, adverse outcomes, risk factors, screening, evaluation and intervention.

Abstract:Recently, the incidence of coronary heart disease has been increasing in China year by year. As a major component of the inflammatory response, white blood cells play an important role in the pathogenesis of coronary heart disease. Recent studies have shown that some leukocyte-derived inflammatory markers have crucial clinical value in predicting the diagnosis and treatment of coronary heart disease. This article reviews clinical predictive value of neutrophil/lymphocyte ratio, lymphocyte/monocyte ratio or monocyte/lymphocyte ratio, platelet/lymphocyte ratio, and monocyte/high-density lipoprotein cholesterol ratio in the diagnosis and treatment of coronary heart disease.