Abstract:Objective To explore the risk factors of frailty in the elderly with type 2 diabetes mellitus (T2DM). Methods A total of 310 elderly T2DM patients who admitted to the Department of Endocrinology, XuanWu Hospital of Capital Medical University, were included in the study. The levels of fasting glucose, fasting insulin, glycosylated hemoglobin(HBA1c), blood lipid and 25-hydroxyvitamin D₃ (25-OHD₃) were measured, and the past histories were recorded. The mini-nutritional scale (MNA) for nutritional status assessment was used to assess the nutritional status, and the FRAIL scale to assess frailty. The patients were divided into three groups based on frailty. SPSS statistics 20.0 was used for data analysis. Depending on the data type, χ² test, Fisher exact probability method, analysis of variance, LSD test and rank sum test were used for comparison between groups. Results There were 45 patients in the frail group, 132 in the pre-frail group, and 133 in the normal group. Age, risk of malnutrition and stroke in the frail group were significantly higher than those in the normal group,but the glomerular filtration rate and 25-OHD3 levels were significantly lower (P＜0.05). The multivariate logistic regression analysis showed that having risk of malnutrition and stroke were independent risk factors of frailty in the elderly with T2DM (OR=3.80,2.38; P＜0.05), and 25-OHD₃ level was a protective factor of frailty (OR=0.91, P=0.001). Conclusions Having risk of malnutrition and stroke increases the risk of frailty in the elderly with T2DM, and high 25-OHD₃ level decreases the risk of frailty.

Abstract:Objective To determine the effect of type D personality on depression in the elderly and investigate the role of social support and resilience between them. Methods A total of 208 elderly patients aged 60 and above admitted in the outpatient Departments of Cardiology, Neurology and Psychology of the First Medical Center of Chinese PLA General Hospital were recruited in this study. Patient health questionnaire(PHQ-9), Connor-Davidson resilience scale (CD-RISC), social support rating scale(SSRS), type D personality scale-14(DS14) and mini-international neuropsychiatric interview(MINI) were used to investigate type D personality characteristics and depression. The data was analyzed with SPSS statistics 23.0. Pearson correlation analysis was used to analyze the correlation of type D personality, resilience, social support and depression. For the correlation, process Plug-in was applied to analyze the mediating effect of social support and resilience in type D personality and depression, and Bootstrap method was adopted to test whether the mediating effect was statistically significant. Results Among the total of 208 subjects, the risk of depressive disorder of subjects with type D personality was 4.18 times higher than that of those without (95% CI 2.01-8.69). Type D personality could directly affect depressive symptoms, with a direct effect value of 3.83 (95% CI 1.60-6.06). Type D personality could regulate depression through social support and psychological resilience, with a mediating effect value of 1.92 (95% CI 0.97-3.06). Specifically, the mediating effect was mainly composed of 3 parts:the mediating effect value of type D personality-social support-depression was 0.86 (95% CI 0.24-1.73); type D personality-resilience-depression was 0.81 (95% CI 0.19-1.62), and that of type D personality-social support-resilience-depression was 0.25 (95% CI 0.05-0.55). Conclusion Type D personality is a risk factor for depression in the elderly. Its mechanism includes 2 parts, direct effect and mediating effects of social support/resilience/social support-resilience.

Abstract:Objective To investigate the long-term effects and mechanism of endometriosis (EMT) on subclinical cerebrovascular disease and cognitive function by comparing the postmenopausal women with physician-diagnosed endometriosis and those without. Methods From May 2018 to August 2020,154 outpatients and inpatients in the Department of Obstetrics and Gynecology in the General Hospital of Eastern Theater Command were selected. According to the history of endometriosis, postmenopausal women were divided into EMT group (77) and control group (77). Magnetic resonance angiogram (MRA) were performed on the brain to assess cerebral white matter lesion (WML), lacunar infarct (LI) and intracranial artery stenosis. The carotid artery plaque was measured by carotid duplex scans. Cognitive functions were evaluated in both groups. SPSS statistics 22.0 was used for data analysis, χ² test or paired t test for intergroup comparison. Logistic regression was performed to analyze the risk factors of neck arterial plaques and WML. Results The EMT group had more WMLs [40.3%(31/77) vs 22.1%(17/77)] and carotid artery plaques [36.4 %(28/77) vs 19.5%(15/77)] than the control group (P<0.05). In the logistic regression models, endometriosis was an risk factor for WML (OR=3.041,95%CI 1.405-6.586) and carotid artery plaque (OR= 2.971,95%CI 1.340-6.483) after adjusting for age, hypertension and dyslipidemia (P<0.05). The EMT group scored lower than the control women in tests of word learning, symbol digit substitution, animal category fluency (P<0.05). Conclusion EMT is a risk factor for WML and carotid plaques and has a long-term impact on subclinical cerebrovascular diseases and cognitive functions in the postmenopausal women.

Abstract:Objective To investigate the influence of hypertension with impaired glucose tolerance (IGT) on the risk of all-cause mortality in the elderly males. Methods The study included the elderly males with IGT and normal glucose tolerance (NGT) detected by oral glucose tolerance test in the Chinese PLA General Hospital from May 2005 to May 2007. According to the baseline history, they were divided into four groups (NH+NGT, H+NGT, NH+IGT, and H+IGT) and followed up at least once a year. SPSS statistics 13.0 was used for data analysis and Cox regression model for the analysis of the differences in all-cause mortality risk between the four groups. Results Compared with the NH+NGT group, the risk of incidental type 2 diabetic mellitus in the H+IGT group (HR=2.55,95%CI 1.56-4.16; P<0.001) and the NH+IGT group (HR=2.40,95%CI 1.35-4.25; P=0.003) significantly increased. Univariate Cox proportional hazard regression indicated that the risk of all-cause mortality in the H+IGT group (HR=2.59,95%CI 1.34-5.01; P=0.005) was significantly higher than the NH+NGT group, while there was no significant difference in H+NGT group and NH+IGT group as compared with NH+NGT group (P>0.05). After adjustment of related risk factors at baseline, multivariate Cox proportional hazard regression showed that the trend of all-cause mortality risk in H+IGT group (HR=1.83,95%CI 0.90-3.70; P=0.095) still increased as compared with NH+NGT group (P>0.05). Conclusion Hypertension with impaired glucose tolerance is closely associated with the risk of all-cause mortality in the elderly males. The coexistence of hypertension and IGT can further increase the risk of all-cause mortality.

Abstract:Objective To evaluate Bristol Stool Form Scale (BSFS) in the quality assessment of bowel preparation for colonoscopy in the elderly, and determine the effectiveness and tolerance of our intensive bowel preparation for those with Bristol stool types 1 and 2. Methods A total of 240 patients who made an appointment for colonoscopy in our endoscopy center from March to December 2019 were enrolled in this study. The patients with Bristol stool types 1 and 2 were randomly divided into group A and group B, and the other with types 3-7 into group C. The patients from groups A and C were treated with polyethylene glycol electrolyte powder for standard intestinal preparation, and those out of group B were given the above powder combined with Mosapride as enhanced intestinal preparation. The quality of intestinal preparation was evaluated by success rate of intestinal preparation, Boston intestinal preparation score (BBPS), polyp detection rate, time between intubation and extubation, and success rate of cecal intubation. The occurrence of adverse reactions, satisfaction with intestinal preparation and willingness to repeat intestinal preparation were recorded. SPSS statistics 19.0 was used for data analysis, and one-way ANOVA or Chi-square test was applied for intergroup comparison. Results Compared with group A, the success rates of intestinal preparation and cecal intubation, BBPS, and polyp detection rate were significantly higher, and the time between intubation and extubation was obviously shorter in groups B and C (all P< 0.05). The patients of group C had higher satisfaction level with intestinal preparation and willingness to repeat intestinal preparation scheme when compared with those of group A (all P<0.05). There were notable differences in the incidences of nausea and abdominal distention, satisfaction level with intestinal preparation and willingness to repeat intestinal preparation between groups A and B (all P<0.05). Conclusion BSFS has certain guidance value for the quality of intestinal preparation in elderly patients undergoing colonoscopy. Our intensive intestinal preparation scheme for the elderly with Bristol stool type 1 and type 2 has good effect and tolerance.

Abstract:Objective To explore the interaction between health literacy, emotional distress and self-management in type 2 diabetes mellitus. Methods A total of 239 patients with type 2 diabetes were selected by convenience sampling, who were admitted to the Department of Endocrinology and Metabolism of 2 level-A tertiary hospitals in Zhenjiang from September 2019 to April 2020. An investigation was made of the relationship between health literacy in type 2 diabetes, emotional distress and self-management. Using AMOS 24.0, Pearson correlation analysis established a structural equation model to verify the mediating effect. Results The score of health literacy was 61.91. Pearson correlation analysis showed that emotional distress was negatively correlated to self-management (r=-0.352, P<0.001) and health literacy (r=-0.479, P<0.001), and that health literacy and self-management had positive correlation (r=0.345, P<0.001). In the mediation test, health literacy was a mediating variable between emotional distress and self-management, with a mediating effect value of 41.67%. Conclusion Health literacy partially mediates emotional distress and self-management in the patients with type 2 diabetes mellitus. Clinicians should pay attention to improving the health literacy of patients with emotional distress to improve the patients′ self-management.

Abstract:Objective To investigate the nutritional status of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and to analyze the impact of nutritional status on chronic obstructive pulmonary disease(COPD)patients. Methods A total of 122 AECOPD patients admitted to the Second Affiliated Hospital of Anhui Medical University from June 2018 to December 2019 were selected for the study. Using Nutritional Risk Screening tool (NRS2002), the patients were divided into the group with nutritional risk (NR group, n=75) and the group without nutritional risk (non-NR group, n=47). The two groups were compared in the body mass index, biochemical indexes, blood gas analysis indexes, incidence of respiratory failure, and hospital stay. SPSS statistics 23.0 was used for statistical analysis. Depending on date type, comparison was performed using χ² test or t test. Results The PaCO₂ and COPD assessment test (CAT) scores in the NR group were higher than those in non-NR group [(54.15±14.17) vs (48.78±11.83) mmHg (1mmHg=0.133kPa), (15.43±4.18) vs (11.67±3.37) points], the difference being statistically significant (P<0.05 for both). There was no statistically significant difference in PO₂ and pH between the NR group and the non-NR group [(77.42±23.65) vs (72.76±19.01) mmHg, (7.39±0.61) vs (7.38±0.58) mmHg; P>0.05 for both]. The incidence of respiratory failure in the NR group was 60.0% (45/75), and 38.3% (18/47) in the non-NR group, with significant difference between the two groups (P<0.01). The length of hospital stay in the NR group [(14.43±6.23)d] was higher than that of the non-NR group [(10.19±3.37)d], with significant difference between the two groups (P<0.01). Conclusion The hospitalized AECOPD patients have a high rate of nutritional risk, with a high CAT score, a high rate of respiratory failure and long hospitalization.

Abstract:Objective To determine the effect of abdominal obesity on skeletal muscle mass and function in the middle-aged and elderly males with normal body mass index (BMI). Methods A total of 96 inpatients (≥45 years old) admitted in our department from March 2019 to July 2020 were enrolled as subjects. According to having abdominal obesity or not, they were divided into abdominal obesity group[AO(+) group, n=46] and non-abdominal obesity group [AO(-) group, n=50]. Biochemical indexes, inflammatory indexes, visceral fat area (VFA), mass and strength of skeletal muscle, and physical function were measured and compared between the two groups. SPSS statistics 19.0 was used for data analysis. According to data types, student′s t test or Chi-square test was employed for comparison between groups. The independent correlation between abdominal obesity and appendicular skeletal muscle index (ASMI) was analyzed by multiple linear regression analysis. Results The prevalence of sarcopenia, BMI, VFA, and serum levels of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), fasting insulin (FINS), homeostatic model assessment for insulin resistance index (HOMA-IR), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were significantly higher, and lower limb muscle mass, ASMI and 6-meter walking speed (6MWS) were obviously lower in AO(+) group than in AO(-) group (all P<0.05). Correlation analysis showed that VFA was positively correlated with BMI, TC, LDL-C, IL-6, CRP, FINS and HOMA-IR (r= 0.526-0.886, all P<0.05), and negatively with lower extremity muscle mass, ASMI and 6MWS (r=-0.640, -0.727, -0.622, all P<0.05). Multiple linear regression analysis indicated that abdominal obesity (β=0.124, P<0.001) and HOMA-IR (β=0.013, P=0.092) were independent factors for ASMI. Conclusion VFA is positively correlated with ASMI in middle-aged and elderly males, and abdominal obesity is an independent factor affecting ASMI in those with normal BMI.

Abstract:Objective To explore the efficacy of Cefoperazone/Sulbactam combined with Tanreqing injection in the elderly patients with the nosocomial Pseudomonas aeruginosa (PA) pneumonia. Methods A total of 80 elderly patients were selected for the study, who developed PA pneumonia after 48 hours of hospitalization in the Second Department of Internal Medicine, Henan Provincial Armed Police Corps Hospital from June 1,2016 to November 30,2020. They were divided into Supushen group (cefoperazone/sulbactam, n=25), Tanreqing group (n=20), and Tanreqing + Shupushen group (n=35). The three groups were compared in the clinical efficacy, fever degree, sputum secretion, neutrophils (NE), white blood cells (WBC), procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 ( IL-6) level. SPSS statistics 20.0 was used for statistical analysis. Depending on date type, comparison between the groups was performed using χ² test or t test. Results PA was identified in 95.00% (285/300) of the sputum specimens obtained in the 80 patients, and in vitro drug sensitivity test showed that the selection of cefoperazone and sulbactam was the most reasonable. The effectiveness in the Shupushen group was 92.00% (23/25), significantly higher than 85.00% (17/20) in the Tanreqing group but lower than 97.20% (34/35) in the Tanreqing + Shupushen group, the difference being statistically significant (all P<0.05). The number of patients with body temperature recovery in the Shupushen group (80.00%, 20/25) was higher than that in the Tanreqing group (70.00%, 14/20) but lower than that in the Tanreqing + Shupushen group (91.43%, 32/35); the number of the patients with sputum secretion <50 ml in the Shupushen group (84.00%, 21/25) was higher than that in the Tanreqing group (75.00%, 15/20) but lower than that in the Tanreqing + Shupushen group (85.71%, 30/35), the differences being statistically significant (all P<0.05). NE, WBC, PCT, CRP and IL-6 in the Tanreqing group was significantly higher than those in the Shupushen group but significantly lower than those in the Shupushen group (all P<0.05). Conclusion Tanreqing injection combined with cefoperazone/sulbactam can effectively relieve pulmonary inflammation and infection caused by PA and is significant in clinical application.

Abstract:Objective To investigate the clinical outcomes of radiofrequency ablation in elderly patients with paroxysmal atrial fibrillation and its effect on prognosis. Methods A total of 450 patients with paroxysmal atrial fibrillation who underwent radiofrequency ablation in our hospital from September 2014 to September 2019 were recruited in this study. According to their age, they were divided into non-elderly group (<60 years, n=240) and elderly group (≥60 years, n=210). After radiofrequency catheter ablation, the patients from the both groups were given routine anticoagulation and antiarrhythmic drugs. The ablation time, operation time, intraopera-tive exposure time, length of hospital stay, conversion rate and immediate success rate were observed for both groups. The P-wave maximum duration (Pmax), P-wave dispersion (Pd) and left atrial diameter (LAD) by echocardiography before and after surgery, incidence of operative complications during hospitalization and outcomes within 1 year after surgery were compared between the two groups. SPSS statistics 22.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison on different data types. Results There were no statistical differences in ablation time, operation time, intraoperative exposure time, hospital stay length, conversion rate, and immediate success rate between two groups (P>0.05). The Pmax, Pd and LAD were significantly decreased in both groups after operation (P<0.05); but there were no significant differences in above indicators between two groups at the same time points (P>0.05). The total incidence of complications was 8.75% (21/240) and 21.43% (45/210), respectively, in the non-elderly group and elderly group, with significant difference (P<0.05). The incidence of bradycardia and recurrence were 10.00% (24/240) and 7.50% (18/240) in the non-elderly group, which were significantly lower than those in the elderly group [22.86% (48/210) and 17.14% (36/210), P<0.05]. But there were no obvious differences in the incidence of secondary hospitalization [11.25% (27/240) vs 15.71% (33/210)] and secondary surgery [7.50% (18/240)vs 11.90% (25/210)] between two groups (P>0.05). Conclusion Age difference does not affect the short-term clinical efficacy of radiofrequency ablation in patients with atrial fibrillation and the improvement of P wave, but the elderly patients may have higher incidence of complications and recurrence, and poor long-term prognosis, which deserves attention from clinicians.

Abstract:Coronary heart disease (CHD) is one of the major diseases that seriously threaten human health, and its most commonly used treatment is percutaneous coronary intervention (PCI). However, in-stent restenosis (ISR) after stent implantation is always a complication that confuses doctors and patients. At present the occurrence of ISR is believed to be associated with vascular intimal hyperplasia and neo-atherosclerosis, but its specific progression mechanism is still inconclusive. Therefore, preventive and therapeutic strategies for ISR remain unavailable. Studies have found that risk factors of ISR include lesion-related, interventionist-related and patient-related factors. Among them, ISR is especially associated with metabolic disorders such as diabetes, dyslipidemia and hyperuricemia in patients undergoing PCI after coronary heart disease. The risk of ISR in these patients is significantly increased but its early detection is still limitated. Development of technology and emerging technologies such as metabolomics in recent years have been widely used clinically and may play a more important role in the early diagnosis of ISR in the future.

Abstract:Coronary CT angiography (CCTA) is a first-line diagnostic tool for coronary artery disease, can not only quantitate the severity of coronary artery stenosis, but also further evaluate the plaque composition, morphology and vulnerability. The quantitative detection of perivascular fat based on CCTA imaging can be served as vessel inflammation state for comprehensively evaluation of long-term risk of cardiovascular events. With development of artificial intelligence and radiomics technology, machine learning is more and more applied to individual risk stratification and treatment decision-making of coronary artery diseases. Machine learning can deeply mine histological imaging markers, integrate clinical, biological and CCTA imaging information, generate accurate non-invasive prediction model, and provide support for further evaluation of cardiovascular risk. This article reviews the role of CCTA in the detection and quantification of plaque vulnerability and inflammation, and briefly summarizes the research advance of machine learning algorithm combined with radiomics in the evaluation of atherosclerotic plaque risk.

Abstract:Aging of population is a major problem for all over the world. Since physiological functions are declining with aging, preventing age-related damage of physiological functions can increase healthspan. Physical dysfunctions can be “compressed” to a shorter period later in life through dietary restrictions, physical activity/physical exercise, cognitive training, drugs, etc. That is, prolonging healthspan and compressing morbidity are helpful in achieving optimal longevity.

Abstract:Oxygen therapy is the first-line treatment strategy for acute respiratory failure. Non-invasive oxygen therapy includes non-invasive positive pressure ventilation (NPPV), standard oxygen (oxygen inhalation through nasal cannula), and high-flow nasal cannula (HFNC) humidified oxygen therapy. HFNC is a new type of assisted breathing and has been rapidly popularized in clinical practice in recent years. However, HFNC is a new respiratory support technique, but how to standardize its use in clinical practice and to clarify its applicable scope still needs further clinical research. In order to better save patients′ lives and actively promote patients′ early recovery, this paper clarifies the therapeutic advantages of HFNC by comparing its efficacy with that of standard oxygen and NPPV.

Abstract:Hip fractures in the elderly patients have a high risk of surgery and a high incidence of postoperative delirium (POD) , seriously affecting the postoperative rehabilitation and long-term prognosis and thus warranting multidisciplinary cooperation of the departments of orthopedic, anesthesiology, geriatrics, internal medicine, intensive medicine, rehabilitation, nutrition, and psycho-psychology and in the perioperative management. POD-related risk factors should be comprehensively evaluated, and individualized comprehensive preventive measures should be formulated before operation. Special problems such as anesthetic mode and minimally invasive surgical selection should be paid attention during the operation. Pain control, nutritional support, prevention of postoperative complications and early postoperative rehabilitation should be effectively managed after operation to ensure medical continuity. This review by the clinicians from the First Hospital of Xi′an Jiaotong University aims to promote the perioperative management and to prevent POD in the elderly patients with hip fractures.