Abstract:Objective To analyze the diagnostic significance of preoperative neutrophil-to-lymphocyte ratio (NLR) for papillary thyroid microcarcinoma (PTMC) in elderly patients with Hashimoto′s thyroiditis (HT). Methods The clinical data of 120 elderly HT patients with thyroid nodules admitted in our hospital from March 2018 to January 2020 were collected and retrospectively analyzed. According to their postoperative pathological results, these patients were divided into PTMC+HT group (60 cases) and thyroid benign nodules+HT group (60 cases). SPSS statistics 26.0 was used for statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison depending on data type. Spearman correlation analysis was applied to analyze the correlation of NLR, neutrophil count and lymphocyte count with the benignancy or malignancy of thyroid nodules. Receiver operating characteristic (ROC) curve was plotted to evaluate the significance of NLR for the diagnosis of PTMC in elderly HT patients. Results Significant differences were observed in neutrophil count [(3.57±0.99)×10⁹/L vs (2.95±1.00)×10⁹/L], lymphocyte count [(1.89±0.41)×10⁹/L vs (2.19±0.62)×10⁹/L], and serum free thyroxine (FT4) level [(16.40±2.18) vs (15.17±2.35 pmol/L] between the PTMC+HT group and benign nodules+HT group (P<0.05). NLR and neutrophil count were positively correlated (r=0.478,0.301; P<0.05), while lymphocyte count was negatively correlated (r=-0.240, P=0.008) with benign and malignant thyroid nodules, with cut-off value of 1.44, the area under the curve (AUC) of NLR in the diagnosis of PTMC in the elderly HT patients was 0.776, with a sensitivity of 85% and a specificity of 60%. Conclusion NLR can be used as one of the indicators for differentiating benign and malignant thyroid nodules in elderly patients with HT. With the increase of NLR, it is more likely to diagnose malignant thyroid nodules, which provides a certain guiding significance for clinicians in screening, diagnosis and treatment of the disease.

Abstract:Objective To investigate the CYP2C19 polymorphism in the patients with coronary heart disease (CHD) in the central and southern Jiangsu province of China and to compare its distribution in different geographical populations, so as to provide guidance for the rational use of drugs in CHD patients. Methods A total of 2926 patients with coronary heart disease who were admitted to Clinical Medical College of Yangzhou University and First Affiliated Hospital of Soochow University from August 2019 to December 2022, and have completed CYP2C19 gene polymorphism detection, were selected as the study objects. The CYP2C19 gene loci were sequenced by pyrosequencer, and its polymorphism distribution in different regions was compared. SPSS statistics 26.0 was used for data analysis. According to the data type, t test or χ² test was used for comparison between groups. Results A total of 2 926 patients were enrolled in this study. According to the genotype, they were divided into three groups:extensive metabolizer (*1/*1), intermediate metabolizer (*1/*2, *1/*3), and poor metabolizer (*2/*2, *3 and *3), with a frequency of 38.21% (1118/2926), 45.80% (1340/2 926), and 15.99% (468/2 926), respectively. There was no statistically significant difference in the distribution of CYP2C19 alleles and genotypes between male and female CHD patients (P>0.05). The distribution of CYP2C19 allele in CHD patients in central and southern Jiangsu Province was significantly different from that in Shaanxi Province (P<0.05). There was statistical significance in the distribution of CYP2C19 metabolic types in CHD patients in central and southern Jiangsu Province compared with Shaanxi, Guangzhou, Huaihai and Henan regions (P<0.05).Conclusion There are differences in the distribution of CYP2C19 gene polymorphisms in CHD patients in the central and southern of Jiangsu, mainly with the medium and fast metabolic type, and there is no significant difference between genders, which can help the precise medication for the patients with coronary heart disease.

Abstract:Objective To explore the influencing factors of intraoperative complications and short-term postoperative major adverse cardiovascular events (MACE) in rotational atherectomy (RA) among the elderly patients with coronary artery calcification (CAC). Methods From January 2017 to December 2020,188 elderly CAC patients who underwent RA in the Third People′s Hospital of Yibin were collected. The operation was performed according to the Chinese Expert Consensus on Rotational Atherectomy. The patients were followed up for MACEs for 12 months after operation and were divided into study group and control group based on the occurrence of MACEs within 12 months. SPSS 25.0 was used for statistical analysis. Comparison between groups was made using t-test or chi-square test according to the data type. Multivariate logistic regression was used to analyze the influencing factors of the intraoperative complications and postoperative MACE within 12 months. Results The incidence was 17.02% (32/188) for the intraoperative complications and 18.62% (35/188) for MACE within 12 months after the operation. There were statistically significant differences between MACE and non-MACE patients in body mass index, history of smoking, history of heart failure, history of hypertension, history of previous myocardial infarction, diseased vessels, SYNTAX score, prothrombin time, glycosylated hemoglobin A1c (HbA1c), minimum lumen diameter (MLD), cross section area (CSA), and ratio of rotary burr to vessel diameter (P<0.05 for all). Multivariate analysis showed that the history of heart failure, angiopathic vessels (double, triple vessels and left main branch compared with single vessel), SYNTAX score, MLD, and ratio of rotary burr to vessel diameter were the influencing factors of intraoperative complications[OR=0.518, (1.660,2.311 and 3.089), 3.893,0.794,0.641；all P<0.05]. The influencing factors of MACE within 12 months after operation were the history of heart failure, history of hypertension, SYNTAX score, HbA1c and MLD (OR=0.481,0.812,2.777,0.762,0.721；all P<0.05). Conclusion Complications of RA may be related to the history of heart failure, angiopathic vessel, SYNTAX score, MLD, and ratio of rotary burr to vessel diameter; the history of heart failure, history of hypertension, SYNTAX score, HbA1c and MLD may be independent predictors of short-term postoperative MACE.

Abstract:Objective To summarize the clinical characteristics of death from novel coronavirus pneumonia (COVID-19 pneumonia) in the advanced elderly. Methods Clinical data of 31 patients over 80 years old diagnosed with COVID-19 and then dead due to the infection in our hospital from November 4,2022 to January 8,2023 were collected and analyzed retrospectively. SPSS statistics 23.0 was used for statistical analysis. Multivariate linear regression was employed to analyze the specific indicators for the progression of COVID-19 in them. Results The average age of the 31 deceased patients was (92.61±4.40) years. There was one case (3%) of mild to severe illness, nine cases (29%) of ordinary to severe illness, 12 cases (39%) of severe to severe illness, and nine cases (29%) of severe illness at onset. The time from first onset to admission was 1-20 (5.81±4.28) d, and the course of the disease was 2-25 (10.42±5.81) d. All patients had underlying diseases, including 27 cases of coronary heart disease (87%), 24 cases of encephalopathy (77%), and 23 cases of lung disease (74%). All patients experienced multiple organ dysfunction, mainly in the lungs. When compared with the levels at admission, their white blood cell count (WBC), neutrophil count, pH value, partial pressure of carbon dioxide, blood oxygen saturation, and levels of procalcitonin, C-reactive protein, D-dimer (D-D), lactate dehydrogenase and B-type natriuretic peptide were significantly increased, while the absolute value of lymphatic cells, lymphocyte percentage, platelet (PLT) count, and arterial blood oxygen pressure were obviously reduced in the last test before death (all P<0.05). Multivariate linear regression analysis indicated that WBC count (β=0.482, P<0.05) showed a positive effect on neutrophil-to-lymphocyte ratio (NLR), while D-D (β=-0.421, P<0.05) and PLT (β=-0.423, P<0.05) had a negative effect on it. Conclusion The advanced elderly infected with COVID-19 are characterized by acute onset, severe illness and short course of disease. Old age and underlying diseases are important factors for mortality in advanced elderly with COVID-19 infection. They also often have bacterial infection at the same time. WBC, PLT and D-D levels are specific indicators of disease progression in the advanced elderly.

Abstract:Objective To explore the influencing factors of recovery of renal function in the elderly septic patients with acute kidney injury (AKI). Methods A retrospective analysis was made of the clinical data of 137 elderly septic AKI patients in Danzhou People′s Hospital from January 2019 to September 2022. According to the recovery of renal function on 90 days after the diagnosis of AKI, they were divided into recovery group (n=62) and non-recovery group (n=75). The two groups were compared in baseline data, biochemical indicators, routine blood indicators, and infection indicators. SPSS statistics 22.0 was used for data analysis. According to the data type, comparisons between the two groups were performed by t-test or Mann-Whitney U test. Logistic regression was used to analyze the independent risk factors of non-recovery of renal function in the elderly septic AKI patients, and receiver operating characteristic (ROC) curve was drawn to evaluate the value of each independent risk factor in predicting non-recovery of renal function in them. Spearman correlation analysis was used to analyze the correlation between blood magnesium level and clinical indicators. Results Multivariate logistic regression analysis showed that old age (OR=1.982,95%CI 1.376-3.150), companied with anemia (OR=4.938,95%CI 4.152-13.290), high urea (OR=1.772,95%CI 1.195-2.716), high serum creatinine (SCr) (OR=2.105,95%CI 1.419-3.702), high red blood cell distribution width (RDW) (OR=5.370,95%CI 4.826-14.353), hypomagnesemia (OR=4.712,95%CI 3.973-12.650), long duration of continuous renal replacement therapy (CRRT) (OR=1.942,95%CI 1.308-3.025), long duration of oliguria or anuria (OR=1.873,95%CI 1.306-2.980), use of nephrotoxic drugs (OR=5.520,95%CI 4.973-16.228), high acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score (OR=2.183,95%CI 1.552-3.894), high lactic acid (OR=3.115,95%CI 2.317-9.913),high C-reactive protein (CRP) (OR=2.773,95%CI 1.985-6.214) and high procalcitonin (PCT) (OR=4.928,95%CI 4.105-14.106) were independent risk factors of the failed recovery of renal function in the elderly septic AKI patients (P<0.05) . The ROC curve analysis showed that 10 risk factors in combination had the highest area under ROC curve (0.962,95%CI 0.901-0.998) in predicting the failed recovery of renal function with a sensitivity of 98.6% and a specificity of 85.2%. Conclusion The old age, companied with anemia, high urea, high SCr, high RDW, hypomagnesemia, long duration of CRRT, long duration of oliguria or anuria, use of nephrotoxic drug, high APACHEⅡscore, high lactic acid, high CRP and high PCT are the risk factors of the non-recovery of renal function in the elderly septic AKI patients, and the combination of the 10 factors has high predictive value.

Abstract:Objective To study the quality of life and its influencing factors in the elderly patients with pruritus.Methods A total of 140 elderly patients with pruritus admitted to the General Hospital of Medical Community of Chengmai People′ s Hospital from June 2021 to June 2022 were enrolled as the study subjects. The patients were evaluated using dermatology life quality index (DLQI), and the factors affecting their quality of life were analyzed by binary logistic regression model. SPSS 19.0 was used for data analysis. inter group comparison was perfomed using χ² test. Results The mean DLQI score in the elderly patients with pruritus was the highest at (1.51±0.36) points for symptom perception, followed by (1.37±0.21) points for work and study. The total DLQI score was (10.27±2.38) points, and the disease had a mild impact on the life of 15.71% (22/140) patients, a moderate impact on the life of 62.86% (88/140) patients and a huge or very huge impact on the life of 14.29% (20/140) patients. Binary logistic regression analysis indicated that the course of pruritus (OR=2.201, 95%CI 1.743-2.779), duration of single pruritus (OR=1.756, 95%CI 1.161-2.655), accompanying symptoms (OR=3.404, 95%CI 1.152-10.063), pruritus site (OR=4.716, 95%CI 1.881-11.825), lesion area (OR=1.744, 95%CI 1.144-2.658), pruritus degree (OR=2.199, 95%CI 1.610-3.003), anxiety (OR=2.349, 95%CI 1.250-4.415) and sleep disorders (OR=1.952, 95%CI 1.182-3.224) were independent factors affecting the patients′ quality of life(P＜0.05). Conclusion Pruritus in the elderly can have adverse effects on the quality of life of patients to varying degrees, and the long course of illness, severe pruritus, private pruritus, and comorbid anxiety and sleep disorders are independent factors affecting the patients′ quality of life. It is suggested that, in addition to active measures to relieve pruritus symptoms, attention is necessary to adverse emotions and sleep disorders.

Abstract:Objective To investigate the expression and clinical significance of DNA methylation/hydroxymethylation in peripheral blood of elderly patients with thyroid nodules and diabetes mellitus. Methods A total of 136 elderly diabetes patients complicated with thyroid nodules admitted to our hospital from January 2021 to December 2022 were recruited as the study group, and another 135 elderly healthy age-matched individuals who took physical examination at the same time served as the control group. Their general data were collected, and serum levels of fasting blood glucose (FBG), 2h postprandial blood glucose (2hPBG), glycosylated hemoglobin A1c (HbA1c), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (TGAb) and thyroid peroxidase antibody (TPOAb) were detected and recorded. The levels of whole genome 5-methylcytosine (5-mC), 5-hydroxymethylcytosine (5-hmC), intercellular cell adhesion molecule-1 (ICAM-1) and ten-eleven translocation-2 (TET2) in the peripheral blood were measured with enzyme linked immunosorbent assay (ELISA). SPSS statistics 21.0 was used for data analysis. Depending on data type, student′s t test, Mann-Whitney U test or Chi-square test was used for intergroup comparison. Spearman correlation analysis was employed to analyze the relationship between 5-mC and 5-hmC levels in peripheral blood and thyroid nodules with diabetes mellitus. Results The serum levels of FBG, 2hPBG, HbA1c, TSH, TgAb and TPOAb were significantly higher, while that of FT3 was obviously lower in the study group than the control group (P<0.05). Higher levels of 5-mC and 5-hmC in peripheral blood were observed in the study group than the control group [6.64%(3.53%, 8.53%) vs 4.28%(1.70%, 7.20%), 50.41%(35.00%, 63.27%) vs 36.51%(17.81%, 50.06%); P<0.001], and so were the levels of TET2 and ICAM-1 [9.37(5.70,13.56) vs 4.56(1.52, 6.99) pg/ml, 4.98(2.35,7.01) vs 0.97(0.15,1.60) ng/ml; P<0.001]. Spearman correlation analysis showed that 5-mC was positively correlated with TgAb, TPOAb and HbA1c (r=0.413,0.348,0.405; P<0.05), 5-hmC was positively correlated with TgAb, TPOAb, FPG and 2hPG (r=0.375,0.406,0.376,0.311; P<0.05), and 5-mC was positively correlated with 5-hmC (r=0.256; P<0.05). Conclusion The level of DNA methylation and hydroxymethylation in the whole genome of the peripheral blood is significantly higher in the elderly diabetes patients with thyroid nodules than the normal population. Peripheral blood levels of 5-mC and 5-hmC are significantly related to the incidence of thyroid nodules and diabetes mellitus in the elderly.

Abstract:Objective To investigate the relationship of the length of the left main coronary artery (LM) and left anterior descending artery-left circumflex artery (LAD-LCX) bifurcation angle with the atheromatous plaque formation. Methods A retrospective analysis was made of the clinical data of 372 patients admitted to the Second Hospital of Qinhuangdao from January 2020 to January 2022, who underwent CT angiography (CTA) and had clear results. According to CTA findings, the patients were divided into group with lesion at the left coronary artery (lesion group) (n=244) and normal group (n=128). The groups were compared in LMCA length, LMCA area, LM-LAD angle of the left coronary artery origin, LM-LCX angle and LAD-LCX angle. The relationship between LMCA and LAD-LCX bifurcation angle and atheromatous plaque formation was analyzed. SPSS statistics 22.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test or χ²test depending on data type. Results The LAD-LCX angle in the normal group (77.70°±5.78°) was lower than the proximal group (79.23°±5.11°) and the distal group (81.24°±6.96°), and the LAD-LCX angle in the proximal group was lower in the distal group, the differences being statistically significant (P<0.05 for all). Additionally, the LAD-LCX angle in the normal group (77.70°±5.78°) was lower than the mild stenosis group (79.10°±5.05°) and the moderate to severe stenosis group (81.07°±6.32°), and the mild stenosis group had a lower LAD-LCX angle than the moderate to severe stenosis group, the differences being statistically significant (P<0.05 for all). Conclusion The greater the LAD-LCX bifurcation angle, the higher the risk of arterial plaque formation.

Abstract:Objective To investigate the oral health status and related quality of life in community-dwelling elderly population and analyze the related influencing factors. Methods Totally 1020 elderly people from 5 communities in Haikou City were selected as the subjects of investigation by multi-stage random sampling method. According to the standards of the Fourth National Oral Health Epidemiological survey, the oral health status of the elderly population was examined, and Geriatric Oral Health Assessment Index (GOHAI) was used to evaluate the oral health-related quality of life (OH-QoL). SPSS statistics 20.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test, analysis of variance or χ² test depending on data type. The meaningful indicators in univariate analysis were used as independent variables and the GOHAI index score was used as the dependent variable, and multivariate linear regression model analysis was applied to analyze the related factors affecting the OH-QoL in community elderly population. Results Among 1020 questionnaires distributed, 920(95.25%) valid questionnaires were collected in this study, and the total average score of GOHAI in the elderly was (53.79±11.17) points. Multivariate linear regression analysis showed that 9 variables such as the number of missing teeth, status of missing teeth deep periodontal pocket, the number of crown caries, the number of root caries, the convenience of medical treatment, the number daily teeth brushing frequency, the use of toothpick or dental floss, and the habit of dental visit might affect the OH-QoL of the elderly(P<0.05), and the fitting model could explain 54.30% of the total variation. Conclusion Oral health status is an important factor affecting OH-QoL in elderly population, and good oral hygiene habits can enhance the OH-QoL in the elderly.

Abstract:Objective To investigate the role of nicotinamide mononucleotide (NMN) in D-galactose (D-gal) induced aging kidney in mice and its possible anti-inflammatory mechanism. Methods Twenty-four male C57BL/6 mice were randomly divided into control group, NMN group, D-gal group and D-gal+NMN group. The mouse model of renal aging was established by subcutaneous injection of D-gal. The body mass of each group was recorded. All mice were sacrificed and the kidneys were removed and sectioned for HE staining and Masson staining to observe pathological changes and detect the severity of renal interstitial fibrosis. Senescence-related β-galactosidase(SA-β-gal) staining was used to evaluate renal aging. Immunohistochemistry (IHC) staining and Western blot were employed to observe the distribution and abundance of p16 and p21 in the kidneys. The protein levels anti-aging gene silent information regulator 1 (SIRT1), and inflammatory indicators, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and nuclear factor-κB (NF-κB) in the kidneys were also detected by Western blot. Results NMN had no significant effect on body mass of the mice from the D-gal group (P>0.05). Compared with the control group, the D-gal group presented glomerular atrophy, tubule swelling and dilatation, and renal interstitial fibrosis, increased expression of p16 and p21, which mainly located in the renal tubules, as well as enhanced SA-β-gal activity (all P<0.05). Western blot showed that the expression levels of p16 and p21, and those of TNF-α, IL-1β and NF-κB were obviously up-regulated, while that of SIRT1 was decreased in the D-gal group (P<0.05). NMN treatment remarkably attenuated glomerular atrophy, tubule swelling and dilatation, and renal interstitial fibrosis, reduced the indicators related to aging and inflammation, and alleviated the down-regulation of SIRT1 and increase of SA-β-gal activity in the D-gal group (all P<0.05). Conclusion NMN may delay D-gal-induced renal aging by promoting SIRT1 expression and inhibiting NF-κB pathway mediated inflammatory response.

Abstract:The coexistence of cognitive impairment and frailty in the elderly patients with diabetes mellitus is called cognitive frailty, which has become a new complication of the elderly diabetic patients, increasing the risk of adverse outcomes such as falls, disabilities, hospitalization, and death. Taking timely intervention measures can delay or even prevent the development of dementia and reduce the risk of adverse outcomes. However, there has not been a consensus on the diagnostic criteria and evaluation methods of cognitive frailty in the elderly diabetic patients. In this paper, we reviewed the concept, status quo, evaluation, and intervention of cognitive frailty in elderly patients with diabetes mellitus to provide reference for future research.

Abstract:Postoperative delirium (POD) is a common acute central nervous system syndrome after surgery. Due to the physiological degeneration, POD occurs more frequently among the elderly patients than among the children and adults and has serious impact on their postoperative outcomes. The population aging and the increasing annual volume of procedurals performed on the elderly patients have caused POD to become one of the most popular issues in the field of anesthesiology. In this article, we reviewed the recent clinical studies on POD in four respects:risk prediction, prognosis assessment, prevention strategies and treatment protocols, with a view to providing a basis for its clinical prevention and treatment among the elderly.

Abstract:Antiplatelet therapy is the cornerstone of secondary prevention of coronary artery disease but potentially increases the risk of bleeding. A process of shared decision-making for perioperative antiplatelet therapy must balance an individual′s thrombotic and bleeding risk, and the potential unintended consequences of delaying non-cardiac surgery. Perioperative management of antiplatelet therapy should be individually tailored based on consensus from multidisciplinary team and patient to minimize both thrombotic and bleeding risks. Current guidelines do not provide consistent recommendations on this topic, and the optimal approach in these patients is yet to be determined.

Abstract:The pathophysiological mechanism of type 2 diabetes mellitus (T2DM) is quite complicated, and its core pathogenesis is insulin resistance along with the decrease of β-cell mass (BCM) and function. Ageing will lead to a gradual decrease in the precise regulation of glucose homeostasis, and thus, the prevalence of T2DM increases with ageing. Evidence shows that ageing can lead to decreased peripheral insulin sensitivity. However, the changes in BCM and function during ageing have not been fully understood till now. The study about β-cell biology during ageing will help us to understand its contribution to age-related T2DM deeply. In this article, we review the age-related changes in β cells at the molecular, morphological and functional levels, in order to provide more aspects and therapeutic ideas for the prevention and treatment of T2DM.

Abstract:Against the backdrop of the accelerating trend of social aging, the proportion of surgical procedures among the elderly population continues to rise. Despite the continuous advances in surgery, anesthesia technology, and perioperative medicine, the elderly patients undergoing surgical treatment still suffer from poor postoperative outcomes. Frailty indicates the decline in the physiological reserves of multiple systems in elderly people, which can cause rapid and drastic changes in physiological functions due to mild external harmful stimuli. It is an important risk factor for postoperative adverse events. In this article, we review relevant literature on the relationship between frailty and perioperative adverse events in recent years, and provide a review on the concept of frailty, evaluation tools for frailty, impact of frailty on perioperative outcomes, and perioperative optimization strategies for frail patients, so as to provide theoretical support for optimizing the physical functions of frail elderly patients in clinical practice and avoiding perioperative adverse outcomes.