Abstract:Objective To investigate the correlation of fasting plasma glucose(FPG) and glycated hemoglobin A1c(HbA1c)with the severity of coronary artery lesion in the patients diagnosed with acute coronary syndrome (ACS). Methods A retrospective analysis was made of 166 ACS patients admitted to the Department of Geriatrics of the Chinese PLA General Hospital of Eastern Theater Command. According to the degree of coronary artery lesion on Gensini assessment, the patients were divided into mild, moderate and severe stenosis groups. An analysis was made of the correlation of FPG and HbA1c with the degree of coronary artery lesion. SPSS statistics 19.0 was employed for data analysis. Spearman and partial correlation were used for correlation analysis. Logistic regression was performed to analyze the risk factors of severe coronary artery stenosis. Results FPG and HbA1c differed significantly between patients with mild, moderate and severe coronary stenosis (P<0.05). Spearman correlation analysis (r=0.331, P<0.001) and partial correlation analysis (r=0.379, P<0.001) showed that FPG was positively correlated with Gensini score, there was no significant correlation between HbA1c and Gensini score in Spearman correlation analysis (P=0.096), but HbA1c had correlation with Gensini score (r=0.191, P=0.049) performed by partial correlation analysis after controlling related factors. Logistic regression analysis showed that both FPG and HbA1c were independent risk factors for severe coronary stenosis in ACS patients (P<0.05). The area under receiver operating characteristic curve of FPG and HbA1c for predicting severe coronary stenosis were 0.637 and 0.581, respectively, with a sensitivity of 46.0% and a specificity of 86.6% for FPG=7.0 mmol/L, and with a sensitivity of 56.4% and a specificity of 62.5% for HbA1c=6.0%. There was no significant difference in the predictive value of the two indexes (P=0.534). Conclusion FPG and HbA1c are independent risk factors for the degree of coronary artery lesion without significant difference in predicting the occurrence of severe coronary artery lesion.

Abstract:Objective To investigate the charges of lymphocyte subset counts [CD4⁺ T cells, CD8⁺ T cells and natural killer (NK) cells] and the ratio of neutrophils to lymphocytes (NLR) in patients at the early phase of sepsis and its predictive values for the prognosis. Methods A total of 62 sepsis patients admitted to the First Hospital of Shanxi Medical University from December 2019 to December 2020 were included in this study. These patients were divided into survival group and death group according to their conditions of 28-day follow-up. T lymphocyte subsets, NK cell count, NLR, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score at day 1 and 3 after admission were measured and recorded, and the relationship of these indexes with patient prognosis and their predictive values were analyzed. SPSS statistics 26.0 was used to perform the statistical analysis. Student′s t test, Rank sum test or Chi-square test was employed for intergroup comparison depending on different data types. Results Compared with the survival group, the death group had significantly higher APACHEⅡ and SOFA scores on both day 1 and day 3 (P<0.05), obviously lower counts of lymphocytes, T lymphocytes, CD4⁺ T cells, CD8⁺ T cells and NK cells on day 3 (all P<0.05), whose counts were negatively correlated with SOFA score (r=-0.19, -0.16, -0.17, -0.18, -0.26; P<0.05), and notably higher NLR (P<0.05), which was positively correlated with APACHEⅡ score (r=0.45, P<0.05). The area under receiver operating characteristic curve (AUC) for APACHEⅡ score, SOFA score, NLR, lymphocyte count, T lymphocyte count, CD4+ T cell count, CD8+ T cell count, and NK cell count on day 3 for predicting patient′s 28-day prognosis were 0.84,0.73,0.76,0.84,0.83,0.81,0.82 and 0.78, respectively. Conclusion Immunosuppression occurs in the early phase of sepsis. T lymphocyte subset counts, NK cell count and NLR show good predictive values for prognosis in septic patients.

Abstract:Objective To establish an indicator pool for clinical trials on nutritional and functional food interventions for the elderly with sarcopenia as the basis of subsequent core outcome set. Methods CNKI, VIP, WANFANG DATA, Ovid-Embase, Cochrane Library and PubMed databases were electronically searched to collect randomized control trials on nutritional and functional food interventions for the elderly with sarcopenia. The outcome indicators were extracted as set A. Chi-CTR and the Clinical Trials were then searched to collect the related registration schemes, and the outcome indicators were extracted to form set B. Using the convenience sampling, a semi-open questionnaire survey was conducted among the clinicians and patients in 17 first-class tertiary hospitals with great influence in this field to collect the set (C) of outcome indicators concerned by the doctors and the set (D) of outcome indicators concerned by the patient. A 5-dimension indicators pool of 64 end-class indicators was initially constructed by integrating the sets A, B, C and D. Results A total of 16 randomized control studies and 15 clinical trial protocols were included, yielding 95 outcomes in set A and 86 in set B. A total of 86 doctors and 85 patients′ opinions were investigated, and 38 and 35 outcome indicators were collected in set C and set D. According to inclusion and exclusion standard of indicators, a final pool of 64 terminal indicators was established. Conclusion This study established an indicator pool for the elderly patients with sarcopenia and found heterogeneity and inconsistencies in the outcome indicators of clinical trials in this field. It is of great significance to continue constructing the core outcome set on nutritional and functional food interventions for those patients.

Abstract:Objective To investigate the dietary pattern and its influence on frailty in the elderly from a community in Xi′an. Methods From November 2018 to August 2019, a cross-sectional survey was conducted among the people aged 65 years or older dwelling in a community of Xi′an. According to the results of Fried phenotype of frailty, they were divided into three groups, that is, non-frail group, pre-frail group and frail group, with 100 people randomly selected from each group for further dietary survey. The general socio-demographic characteristics were investigated for the three groups. Dietary questionnaire and factor analysis were employed to investigate the types and quantity of food in the last 3 days and dietary patterns, respectively. SPSS statistics 25.0 was used for data analysis, rank sum test or Chi-square test was used for intergroup comparison based on different data types. Multivariate logistic regression analysis was used to analyze the correlation between dietary pattern and frailty. Results There were 1 693 elderly people subjected in this study, including 724 in the non-frail group, 694 in the pre-frail group, and 275 in the frail group. The total prevalence of frailty was 16.2% (275/1 693), but no significant difference was seen between males and females (15.7% vs 16.6%, P>0.05). Two dietary patterns, ordinary and meat-legume-oil diets, were identified through the survey. Compared with the ordinary dietary pattern, the elderly taking the meet-legume-oil dietary pattern consumed more meat, beans and oil, and significantly higher amounts of iron, vitamin E and unsaturated fatty acids (P<0.05). For those taking ordinary dietary pattern, the scores of dietary factors were obviously higher in the frail group than the non-frail group [-0.08 (-0.40,0.36) vs -0.32 (-0.59, 0.06), P<0.05], so as the pre-frail group and the non-frail group[-0.14(-0.43,0.21) vs -0.32(-0.59,0.06), P<0.05], respectively. But for the elderly taking meet-legume-oil dietary pattern, there were no significant differences in the scores of dietary factors among the three groups (P>0.05). Multivariate logistic regression analysis showed that the score of ordinary dietary pattern was positively correlated with frailty, and the results were consistent after adjustment for age, gender, number of children, chronic disease, surgical history, and exercise frequency. Conclusion Frail elderly people are more inclined to the ordinary dietary pattern, which is positively correlated with the risk of frailty. The elderly should strengthen their intake of nutrients such as protein, fat and dietary fiber.

Abstract:Objective To investigate the efficacy and safety of continuous venous-venous hemofiltration (CVVH) in the treatment of multiple organ failure in the elderly (MOFE). Methods Clinical data of 33 elderly patients with MOFE who underwent CVVH treatment in our hospital from January 2010 to December 2020 were collected and retrospectively analyzed in this study. According to their survival time longer than 15 d or not, they were divided into survival group (n=18) and death group (n=15). Their age, number of failed organs, blood biochemical indicators, arterial blood gas parameters, treatment methods, death time and other indicators were analyzed. SPSS statistics 22.0 was used for statistical analysis. Results All patients had femoral vein catheterization, and 4 cases experienced catheter infection. There were no significant differences in age, serum levels of urea nitrogen, creatinine, electrolytes and pro-brain natriuretic peptide, arterial blood pH value, and residual alkali between the two groups (all P>0.05). Obvious differences were seen in lactic acid level [(2.32±1.17) vs (5.00±4.35) mmol/L], 24-hour urine volume [(501.17±229.62) vs (220.33±191.68) ml] and number of failed organs [(3.33±1.14) vs (4.33±1.15), all P<0.05]. Urea nitrogen [(34.27±13.54) vs (15.77±9.15) mmol/L], serum creatinine [(347.57±170.22) vs (165.55 ± 89.32) μmol/L], pro-brain natriuretic peptide [(2 128.27±1 416.08) vs (1 181.86±1 305.17) pmol/L], blood potassium [(4.78±1.03) vs (4.12±0.56) mmol/L], arterial blood pH value [(7.28±0.12) vs (7.33±0.12)] were statistically significant before and after CVVH treatment (all P<0.05). But no such differences were found in blood sodium, calcium, phosphorus, residual alkali and lactic acid before and after treatment (P>0.05). Conclusion CVVH treatment is significantly helpful for improving the prognosis, reducing the heart loading, accelerating the removal of small molecule toxins, and maintaining the balance of electrolytes and pH value in the elderly patients with MOFE.

Abstract:Objective To determine the prevalence of sarcopenia among the elderly inpatients with type 2 diabetes mellitus (T2DM) and investigate its influencing factors. Methods According to our inclusion and exclusion criteria, consecutive elderly T2DM inpatients (≥65 years old) in Geriatrics Department of Peking Union Medical College Hospital between January 2018 and December 2019 were enrolled in this study. Geriatric assessment was performed to evaluate their existing comorbidities and geriatric syndromes. SPSS statistics 24.0 was used to perform the statistical analysis. For different data types, student′s t test, Wilcoxon rank sum test, Chi-square test, or Fisher exact test was employed for intergroup comparison. Multivariate logistic regression model was applied to analyze the influencing factors of sarcopenia in the elderly type 2 diabetes mellitus (T2DM) patients. Results A total of 225 patients were finally enrolled in the study, including 59 cases complicated with sarcopenia (sarcopenia group) and 166 without (non-sarcopenia group). Compared with the patients from the non-sarcopenia group, those of the sarcopenia group were older, and had longer hospital stay, higher ratios of fall history, assisted walking, diabetic target-organ lesions and urinary incontinence, longer time of 5-times sit-to-stand, and proportion of being unable to achieve a tandem stance, and higher level of serum creatinine (all P<0.05). Lower ratio of males, lower body mass index (BMI), lower scores of mini nutritional assessment short form, activities of daily living and instrumental activities of daily living were seen in the sarcopenia group than the non-sarcopenia group (all P<0.05). There were no significant differences in the levels of fasting blood glucose, glycosylated hemoglobin, serum albumin, prealbumin and other hematological indicators (all P>0.05). Multivariate logistic regression analysis showed that low BMI (OR=0.716,95%CI 0.609-0.842, P<0.001) and assisted walking (OR=4.391,95%CI 1.167-16.512) were influencing factors of sarcopenia in elderly T2DM patients. Conclusion The prevalence of sarcopenia is quite high in hospitalized elderly T2DM patients, and it was further increased with age. For the elderly diabetic patients with low BMI and reduced physical function, attention should be paid to the screen and corresponding intervention for sarcopenia.

Abstract:Objective To explore the clinical value of target-oriented therapy of monitoring regional cerebral oxygen saturation (rScO₂) in the elderly patients with severe traumatic brain injury (sTBI). Methods A total of 60 patients aged over 60 years with severe craniocerebral injury treated in the neurosurgical intensive care unit (NSICU) of our hospital from April 2018 to November 2020 were enrolled, and then randomly divided into study group and control group, with 30 patients in each group. The control group was given traditional neurosurgical intensive care management, and the study group was given targeted therapy under the direction of monitoring rScO₂ on the basis of conventional neurosurgical intensive care management. Glasgow coma score (GCS) and Glasgow outcome score (GOS), NSICU length of stay, mortality, and modified Rankin scale scores were compared between two groups. SPSS statistics 24.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison based on different data types. Kaplan-Meier survival curve was used for survival analysis. Results At discharge, the Glasgow coma score (GCS) was increased than that at admission in both groups, but no statistical difference was observed between them (P>0.05), though the score in the study group higher than that of control group (P>0.05). The length of stay in NSICU was significantly shorter in the study group than the control group (P<0.05). After 6 months of follow-up, the study group had obviously lower score of Modified Rankin Scale (mRS), higher GOS, longer survival time and lower mortality when compared with the control group (all P<0.05). Conclusion The targeted therapy under the direction of monitoring rScO₂ can effectively shorten the length of NSICU stay, improve the prognosis and reduce the mortality rate in the elderly sTBI patients.

Abstract:Objective To explore the value of percentage of forced expiratory volume in the predicted value in the first second (FEV₁%pred) combined with sleep apnea clinical score (SACS) in primary screening for patients with chronic obstructive pulmonary disease (COPD) complicated with obstructive sleep apnea (OSA). Methods A total of 299 patients diagnosed with COPD in our department from January to December 2020 were selected as the research objects. All patients completed FEV₁%pred examination of pulmonary function and SACS evaluation, and were monitored by overnight polysomnography (PSG). According to their sleep apnea hypopnea index (AHI), the patients were divided into simple COPD group and COPD combined with OSA (overlap syndrome, OVS). SPSS statistics 23.0 was used for statistical analysis. According to the data types, independent sample t-test or Chi-square test was adopted for intergroup comparison. Pearson′s correlation coefficient was used to analyze the correlation in FEV₁%pred, SACS and AHI. Receiver operating characteristic (ROC) curve was employed to analyze the value of FEV₁%pred combined with SACS in prediction of OVS in COPD patients. Results FEV₁%pred [(53.4±15.1) vs (43.6±13.9)%, P<0.05] and SACS [(19.1±3.9) vs (7.3±2.1) points, P<0.05] were significantly higher in the OVS group than the COPD group. Correlation analysis showed that AHI was positively correlated with FEV₁%pred (r=0.631, P<0.05) and SACS (r=0.689, P<0.05). ROC curve suggested that the best cut-off value of FEV₁%pred in the diagnosis of OVS was 48.3%, and the sensitivity and specificity were 81.3% and 75.4%, respectively. The best cut-off value of SACS for the diagnosis of OVS was 16, and the sensitivity and specificity were 83.2% and 79.3%, respectively. Taking FEV₁%pred ≥48.3% and SACS ≥16 points as joint indicators, the area under the curve for the diagnosis of OVS was 0.812 (95%CI 0.781-0.903), and the sensitivity and specificity were 85.2% and 79.5%, respectively. Conclusion FEV₁%pred combined with SACS has good predictive value in the screening of OVS in COPD patients.

Abstract:Objective To observe the effect of urinary albumin on skeletal muscle mass in middle-aged and elderly male patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods A total of 96 middle-aged and elderly male patients (≥45 years old) with newly diagnosed T2DM for less than 1 year in our hospital from March 2019 to August 2020 were enrolled in this study. According to the presence or absence of albuminuria, they were divided into non-albuminuria group (n=50) and albuminuria group (n=46). Their fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), serum creatinine (SCr), limb muscle mass, and limb appendicular skeletal muscle mass index (ASMI) and other clinical indicators were measured. SPSS statistics 19.0 was used to perform the statistical analysis. Multiple linear regression was used to analyze the independent correlation between urinary albumin and ASMI. Results Fasting insulin (FINS), homeostatic model assessment of insulin resistance (HOMA-IR), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), SCr, and urinary albumin creatinine ratio (UACR) were significantly higher (t=2.762-13.343, all P<0.05), but limb muscle mass, ASMI and glomerular filtration (GFR) were obviously lower (t=5.539-6.953, all P<0.05) in the albuminuria group than the non-albuminuria group. UACR was positively correlated with HOMA-IR, UA and SCr (r=0.223-0.426, all P<0.05), and negatively with limb muscle mass, ASMI and GFR (r=-0.287--0.490, all P<0.05). Multiple linear regression analysis showed that UACR was an independent influencing factor of ASMI (β=0.389, P=0.014). Conclusion UACR is negatively correlated with ASMI in middle-aged and elderly male patients with T2DM. Urinary albumin is an independent factor for ASMI in those with newly diagnosed T2DM.

Abstract:Objective To investigate the correlations of thromboelastography (TEG) maximum amplitude (MA) and platelet parameters with the 3-vessel lesions in the elderly patients with acute coronary syndrome (ACS). Methods A total of 129 elderly patients with ACS confirmed by coronary angiography admitted in the Center of Geriatrics of Lianyungang Clinical College from June 2018 to December 2020 were enrolled in this study. According to the number of involved coronary artery lesions, they were divided into 1- (n=34), 2- (n=41) and 3-vessel groups (n=54). The TEG (MA) and platelet parameters were compared among different groups. SPSS statistics 19.0 was used for statistical analysis. ANOVA analysis of variance, Chi-square test or Kruskall-Wallis test was applied for comparison among the groups, and Chi-square test or LSD test was employed for comparison between groups depending on date type. Multivariate logistic regression analysis was used to analyze the independent risk factors of 3-vessel disease. Results TEG (MA) level of the elderly patients in the 1-vessel group was significantly lower than that in the 2- and 3-vessel groups [(58.60±7.17) vs (61.41±7.44) and (62.07±6.50) mm, P<0.05]. The mean platelet volume (MPV) level of the ACS elderly patients was in a decreasing order from the 1-vessel group to the 2-vessel group and then the 3-vessel group [(9.37±1.21), (10.19±1.34) and (10.95±1.25) fL, P<0.05]. Multiple logistic regression analysis showed that age, TEG(MA), MPV, platelet count (PLT) and platelet hematocrit (PCT) were risk factors for 3-vessel lesions of coronary artery. Receiver operating characteristic curve analysis indicated that the sensitivity and specificity of TEG (MA) combined with MPV were 82.43% and 67.18%, respectively, in the prediction of 3-vessel lesions in the patients. In the high MPV group (n=78), the incidence of MACE was 17.9% and the all-cause mortality was 2.6% during hospital and in 3 months after discharge. While the incidence was 7.8%, and no death cases were found in the low MPV group (n=51), with statistical difference between the 2 groups (P<0.05). Conclusion MPV at admission is not only associated with, but also an independent risk factor for, and shows predictive value for 3-vessel lesions in elderly ACS patients. It is also correlated with the high incidence of MACE events in the patients during hospital and in 3 months after discharge. TEG(MA) at admission is associated with multivessel coronary artery disease in them.

Abstract:Peripheral hearing loss is quite prevalent in senior population, while Alzheimer′s disease (AD) is the most frequent neurodegenerative disease. Evidence showed that peripheral hearing loss is an independent risk factor of AD. The hypotheses regarding the mechanism of their relationship include cognitive reserve, social isolation and common etiology. Intervention of peripheral hearing loss attenuates the cognitive decline of senior population, and improves emotional and behavioral symptoms of AD patients.

Abstract:In recent years, the high incidence rate and potential risk of sleep disordered breathing have been widely concerned. Obstructive sleep apnea syndrome (OSAS), as the most common sleep-related breathing disorders of all ages, has seriously threatened human health. Oral microecology is an important part of Human Microbiome Project. Its biological community structure and function are closely related to the occurrence and development of OSAS and its complications. This paper reviews the research on oral microecology and OSAS so as to provide reference for further clinical studies.

Abstract:Falls are common among the elderly, often leading to severe outcomes. Vestibular dysfunction is one of the main causes of the falls. A variety of chronic diseases affect vestibular function, and the elderly are at high risk of chronic diseases. This paper reviews the effects of some common chronic diseases on vestibular functions in the elderly and the mechanisms with a view to adding a possible new perspective to the assessment and prevention of fall risks.

Abstract:Since the proportion of elderly inpatients grows year by year, the incidence of fall, a common injury in these patients, is increasing with age. Therefore, early recognition of falls in elderly inpatients is essential. This review summarizes the risk factors and risk assessment methods of hospitalized elderly patients, in order to provide some guidance and suggestions for clinical fall prevention and nursing work and to improve the safety of the patients and quality of hospital nursing management.