Abstract:Objective To explore the status quo and risk factors of venous thromboembolism (VTE) in the elderly patients with advanced lung cancer. Methods A total of 270 elderly patients with advanced lung cancer admitted to the Second Hospital of Air Force Medical University between January 2019 and January 2022 were enrolled as the study subjects. The incidence rate and clinical characteristics of VTE were statistically analyzed. SPSS 20.0 was used for data analysis. According to the data type, t test or χ² test was used for comparison between the groups. Multivariate logistic regression model was employed to analyze the influencing factors of the VTE occurrence in the elderly patients with advanced lung cancer. Results Among 270 elderly patients with advanced lung cancer, VTE occurred in 78 (28.89%), among whom most [62(79.49%)] developed simple DVT, and most of them [52(66.67%)] were located in the lower extremities. VTE was found in most patients [71(91.02%)] within 6 months after the diagnosis of lung cancer, presenting various clinical manifestations. Most patients [54(69.23%)] were treated with low molecular weight heparin injection. Multivariate logistic regression analysis revealed that lung adenocarcinoma (OR=2.177,95%CI 1.515-3.129), chemotherapy (OR=11.531,95%CI 2.988-44.498), central venous catheterization (OR=4.531,95%CI 1.524-13.474), D-dimer (OR=5.562,95%CI 2.796-11.067) and performance status(PS) score (OR=2.149,95%CI 1.301-3.549) were risk factors affecting the VTE occurrence in the elderly patients with advanced lung cancer, and that serum albumin (OR=0.430,95%CI 0.227-0.813) was a protective factor. Conclusion The elderly patients with advanced lung cancer have a high incidence rate of VTE, presenting no specific manifestations. The VTE occurrences peak within 6 months after the diagnosis of lung cancer. In addition, lung adenocarcinoma, chemotherapy, central vein catheterization and high PS score increase the risk of VTE. Active detection of plasma D-dimer and serum albumin is significant in the early diagnosis of VTE and improved prognosis of the patients.

Abstract:Objective To analyze the correlation between nutritional risk and prognosis in the elderly stroke patients. Methods A total of 88 elderly stroke patients admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2020 to December 2022 were selected as the study objects. Their baseline data, nutritional level, neurological impairment level, prognosis and other information were collected. A comparison was made of nutrition-related indexes in elderly stroke patients between on admission, on day 7 after admission and on the day of discharge. A multivariate logistic regression analysis was performed for the factors with statistical significance in the univariate analysis. SPSS 22.0 was used for statistical analysis. Data comparison between two groups was performed using t test, Fisher exact test or χ² test, depending on the data type. Results Malnutrition was recorded in 14 (15.9%) cases on admission, 35 (39.8%) on day 7 after admission, and 33 (37.5%) on the day of discharge. The proportion of serum albumin <35 g/L on the 7th day after admission and on the day of discharge was higher than that on admission, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that malnutrition on admission was an independent risk predictor of malnutrition on day 7 after admission (OR=0.57,95%CI 1.49-13.71; P<0.05), that National Institutes of Health Stroke Scale (NIHSS) scores on admission (OR=1.05,95%CI 1.02-1.08) and on day 7 after admission (OR=6.54,95%CI 1.16-36.87) were independent risk predictors of adverse events (both P<0.05), and that malnutrition on day 7 after admission (OR=1.76, 95%CI 1.14-2.72) and NIHSS score on admission (OR=2.08,95%CI 1.30-3.33) and day 7 after admission (OR=4.28,95%CI 1.12-16.36) were independent risk predictors of poor prognosis (all P<0.05). Conclusion Due emphasis should be laid on the assessment of nutritional risk factors in the elderly stroke patients, and timely attention should be paid to the correlation between nutritional risk factors and individual prognosis.

Abstract:Objective To compare the therapeutic efficay of percutaneous transhepatic gallbladder drainage (PTGD) combined with delayed laparoscopic cholecystectomy (LC) versus early LC, and to explore the application strategy of ultrasonic intervention in the perioperative period of difficult cholecystectomy. Methods A total of 78 patients who underwent difficult cholecystectomy in the Affiliated Hospital of Inner Mongolia Medical University from January 2019 to December 2022 were recruited as the study subjects. According to different treatment plans, they were divided into study (n=30, LC surgery in 2-4 weeks after PTGD) and control (n=48, LC immediately after preoperative preparation) groups. Ultrasound was used for bile duct exploration intraoperatively and for treatment of bile leakage postoperatively. The perioperative related indicators were compared between the two groups. SPSS statistics 26.0 was used for statistical analysis. Data comparison between two groups was performed using independent sample t-test, χ² or Fisher test depending on data type. Results The study group had more advanced age [(66.2±13.0) vs (56.5±15.0) years], higher ratio of those ≥60 years old [76.7% (23/30) vs 45.8% (22/48)], and shorter duration of postoperative abdominal drainage [(2.7±0.8) vs (3.4±2.0) d] when compared with the control group (all P<0.05). Open conversion happened in one patient (3.3%) in the study group and four patients (8.3%) in the control group. There were seven patients in both groups having unclear anatomical structures of the Calot triangle, and the surgery was successfully completed after ultrasound exploration for the biliary tract to clarify the anatomical conditions. Only one patient from the study group developed bile leakage on the 2nd day after operation and was discharged after ultrasound-guided puncture and drainage. Conclusion PTGD combined with LC can shorten postoperative abdominal drainage time. The application of ultrasound intervention in the perioperative period of difficult cholecystectomy can significantly reduce surgical difficulty, improve surgical safety, and effectively manage postoperative complications, which is worthy of clinical promotion and application.

Abstract:Objective To draw and validate a predictive nomogram for 1-year readmission for patients with heart failure (HF) receiving sakubatril/valsartan treatment. Methods A retrospective study was conducted on the medical records of HF patients at the First Hospital of Shanxi Medical University from June 2018 to December 2021. Cox multifactor analysis was performed on variables screened by least absolute shrinkage and selection operator regression analysis, and then a nomogram was plotted based on obtained results. The prediction ability was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curve and calibration curve. SPSS statistics 26.0 and R 4.1.3 software were used for statistical analysis. Data comparison between two groups was performed using student′s t test, Mann-Whitney U test or Chi-sqaure test depending on data type. Results Multivariate Cox regression analysis showed that white blood cell count (HR=1.125,95%CI 1.016-1.245; P=0.023), levels of total cholesterol (HR=1.522,95%CI 1.080-2.144; P=0.016), triglyceride (HR=1.619,95%CI 1.109-2.363; P=0.013) and high-density lipoprotein cholesterol (HR=0.273,95%CI 0.125-0.598; P=0.001) were prognostic factors in HF patients, and then a nomogram model was build based on these indicators. The C-index value of the training set was 0.749 (0.678-0.820), with area under the ROC curve (AUC) of 0.821 (0.700-0.893) and 0.771 (0.575-0.836) for 6 and 12 months respectively. And the C-index value of the testing set was 0.851 (0.641-0.809), with AUC of 0.851 (0.692-0.940) and 0.847 (0.679-0.995) for 6 and 12 months respectively. These results suggested that the model had moderate predictive value, and the calibration curves indicated the model had good consistency. Conclusion Based on clinical electronic medical records, white blood cell count, total cholesterol, triglyceride and high-density lipoprotein cholesterol levels are prognostic factors in HF patients after sakubatril/valsartan treatment (P<0.05). Our nomogram has good predictive value and clinical utility, and is helpful for the assessment of short-term prognosis.

Abstract:Objective To analyze the risk factors for early lower respiratory tract infection (LTRI) after lung transplantation and to summarize the common pathogens and drug resistance. Methods A retrospective study is made of data of the patients transferred to the intensive care unit (ICU) of China-Japan Friendship Hospital after lung transplantation from August 2021 to April 2022. The patients were divided into LTRI (n=40) and control groups (n=20) according to the development of LRTI within 1 week after lung transplantation. Binary logistic regression was used to analyze risk factors for LTRI . Common pathogens and the patients with drug resistance of the early LTRI after the lung transplantation were counted. SPSS 22.0 was used for statistical analysis. Data comparison between two groups was performed using t-test, Mann-Whitney U test, χ²test or Fisher test, depending on data type.Results LRTI occurred in 67% (40/60) of the lung transplant recipients in the early post-transplant period, and the duration (d) of using restricted antibiotics was longer in the LRTI group than in the control group (P<0.05). Low body mass index (BMI) (OR= 0.838,95%CI 0.710-0.989), presence of multiple bacteria in the postoperative lungs (OR= 5.100,95%CI 1.267-20.528), connective tissue disease (OR= 15.016,95%CI 1.364-165.276), and low serum albumin (OR=0.878,95%CI 0.783-0.984) were independent risk factors for LRTI within 7 d after lung transplantation (P<0.05). The pathogens were predominantly bacteria (89.34%, 109/122). Acinetobacter baumannii [16(13.11%)], Pseudomonas aeruginosa [17(13.93%)] and Klebsiella pneumoniae [17(13.93%)] were the most common gram-negative bacteria. Testing for drug susceptibility showed resistance in 54.55% (12/22) of Pseudomonas aeruginosa, 60.87% (14/23) in Klebsiella pneumoniae, and 84.21% (16/19) in Acinetobacter baumannii. Conclusion Improving patients′ malnutrition and enhancing screening lung donors are conducive to early detection and prevention of LRTI. Pathogens causing early lung infections after the lung transplantation are predominantly bacteria with a high rate of drug resistance, and clinicians should pay special attention to rational anti-infective treatment regimen.

Abstract:Objective To investigate the diagnostic efficiency of portable handheld 12-lead electrocardiogram signal acquisition device (PH-ECG) in elderly patients with cardiovascular diseases. Methods A total of 315 elderly outpatients and inpatients diagnosed with cardiovascular diseases such as myocardial infarction and atrial fibrillation (AF) in the Department of Cardiology, Second Medical Center of Chinese PLA General Hospital from February 2020 to December 2022 were recruited in this study. All of them received conventional 12-lead electrocardiography (CL-ECG) and PH-ECG respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PH-ECG with different cardiovascular diseases were calculated. SPSS statistics 26.0 was used to perform the statistical analysis. Chi-square test was employed for intergroup comparison on enumerate data. The consistency of obtained results was tested by Kappa and paired Chi-square test. Results The sensitivity, specificity and accuracy of PH-ECG in detecting ST segment changes were 75.0%, 98.6% and 97.1%, respectively, and the Kappa value was 0.754, P=0.000 for consistency when compared with CL-ECG. In detecting abnormal T wave, the sensitivity, specificity and accuracy were 75.0%, 97.9% and 95.6% respectively in PH-ECG, and the Kappa value was 0.750 when compared with CL-ECG. For detecting atrial fibrillation, the sensitivity, specificity and accuracy were 95.5%, 99.1% and 98.1% respectively, and the Kappa value was 0.949, P=0.000. The sensitivity and specificity for the detection of myocardial infarction, premature ventricular contraction and other cardiovascular diseases were all above 90%, and there was good consistency (Kappa values >0.800) between PH-ECG and CL-ECG. Conclusion PH-ECG has the advantages of portability, real-time performance and easy operation, and has an important prospect in out-of-hospital electrocardiogram examination.

Abstract:Objective To investigate the quality of life upon discharge and its relationship with prognosis in the elderly patients undergoing surgery for primary colorectal cancer (CRC). Methods A total of 250 elderly patients surgically treated for primary CRC from January 2017 to January 2020 in the First Affiliated Hospital of Hainan Medical University were enrolled as the study subjects, and 10 cases were excluded. Upon discharge, the quality of life of patients was evaluated using the specific scale for quality of life of cancer patients. The 240 patients were divided into high life quality group (n=94) and low life quality group (n=146) based on quality of life scores. SPSS statistics 20.0 was used for data analysis. t test or chi-square test was used for data comparison between two groups. Binary logistic regression model was used to analyze the factors affecting postoperative quality of life in the elderly CRC patients. Pearson linear correlation analysis was performed to analyze the correlation between the quality of life upon discharge and survival time in the elderly CRC patients. Results The overall quality of life of elderly patients surgically treated for CRC upon discharge was at a moderate level. Kaplan-Meier curve after 3 years of follow-up found that the survival status of the patients in the good life quality group at 3 years after surgery was better than that in the poor life quality group (Rank=4.708, P=0.030). Pearson linear correlation analysis suggested that the dimensions of physical function, psychological function, and symptom/side effects were positively correlated with the survival time of patients (r=0.327,0.241,0.311; P<0.05). Binary logistic regression analysis showed that the self-rated economic burden caused by disease (OR=2.396,95%CI 1.240-4.630), self-rated sleep quality (OR=2.077,95%CI 1.250-3.451), malnutrition (OR=1.404,95%CI 1.099-1.793), Eastern Cooperative Oncology Group (ECOG) grading (OR=1.547,95%CI 1.017-2.352), and tumor metastasis (OR=1.818,95%CI 1.127-2.934) were independent factors affecting the quality of life, and that education (OR=0.556,95%CI 0.407-0.759) and social support (OR=0.527,95%CI 0.320-0.867) were protective factors for the quality of life. Conclusion The quality of life of the elderly CRC patients upon discharge is at a moderate level, and the quality of life upon discharge has a certain impact on the long-term prognosis of patients. Actively improving the sleep quality during hospitalization, strengthening the nutritional support and social support, and enhancing the quality of life during hospitalization are of some significance in improving the prognosis of the patients.

Abstract:Objective To investigate the current states of negative emotions, quality of life and major adverse cardiovascular events (MACE) in advanced elderly patients with chronic heart failure (CHF) and analyze the influencing factors. Methods A total of 180 very old hospitalized patients (80 years old and over) with heart failure from January 2021 to June 2022 in the First Affiliated Hospital of Xinjiang Medical University were enrolled as the study subjects. Minnesota living heart failure questionnaire (MLHFQ) was used to investigate the negative emotions and quality of life of the participants. SPSS statistics 20.0 was used for statistical analysis. Data comparison between two groups was performed using student′s t test, analysis of variance or Chi-square test depending on data type. Pearson or Spearman correlation analyses were applied to analyze the correlations of negative emotions and quality of life with occurrence of MACE. Multivariate linear regression model was constructed to analyze the related factors affecting the quality of life in the advanced elderly patients with heart failure. Results The effective recovery rate of questionnaires was 96.11% (173/180). Our survey found that the total score of MLHFQ was (55.67±10.24) points, and the detection rates of anxiety and depression were 50.87% (88/160) and 41.62% (88/160), respectively, in the subjected advanced elderly patients. Multivariate linear regression analysis showed that the course of CHF >5 years, number of comorbidities >3, and cardiac function grade Ⅳ were influencing factors affecting the MLHFQ score of the patients (Β=6.435,5.151,4.022; all P<0.05). Follow-up revealed that 36 patients (22.50%) experienced MACE events. Correlation analyses indicated that anxiety/depression was positively correlated with MLHFQ score and incidence of MACE events(r=0.377, 0.352；P<0.05), and MLHFQ score was also positively correlated with the incidence of MACE events (r=0.356；P<0.05).Conclusion The advanced elderly patients with heart failure had overall poor quality of life, and anxiety and depression are quite common. Interaction is observed in their quality of life with anxiety/depression symptoms, which is closely associated with MACE events after discharge.

Abstract:Objective To investigate the clinical characteristics and test results of the elderly patients with coronavirus disease 2019 so as to provide reference for their diagnosis and treatment. Methods A retrospective analysis was conducted of the clinical data of 73 COVID-19 inpatients over 80 years old treated in the Cadre′s Ward of First Affiliated Hospital of Naval Medical University from December 7 to December 31,2022. According to COVID-19 Diagnosis and Treatment Protocol(9^th Trial Version),the patients were divided into the light and medium group (n=34) and the severe and critical group (n=39).The test results on admission and 48 h later were compared. SPSS statistics 26.0 was used for data analysis. Data comparison between two groups was performed using t test, Mann-Whitney U test or χ² test depending on the data type. Multivariate logistic regression was employed to analyze the independent risk factors for the severe and critical COVID-19 in the elderly. Results The severe and critical group had longer pre-hospital home treatment and larger number of underlying comorbid chronic diseases but lower saturation of blood oxygen (SpO₂) without oxygen inhalation than the light and medium group, the differences being statistally significant (P＜0.05). Lymphocyte count, lymphocyte percentage, albumin, glomeruar filtration rate(GFR), SpO₂ and partial pressure of oxygen (PO₂) in the severe and critical group were lower than those in the light and medium group, and fibrinogen, D-dimer, creatinine, urea nitrogen and lactate dehydrogenase in the former were higher than those in the latter, and the differences were statistically significant. Logistic regression analysis showed that the pre-hospital home treatment time (OR=0.265,95%CI 0.085-0.830) and SpO₂ without oxygen inhalation (OR=1.717,95%CI 1.016-2.901) were the independent risk factors of the severe and critical COVID-19 infection in the elderly. Conclusion The elderly with long pre-hospital treatment and low SpO₂ without oxygen inhalation are the high-risk groups for severe or critical COVID-19 infection. Attention should be paid to the changes in lymphocyte count and percentage, coagulation, liver and kidney function, myocardial zymogram, arterial blood gas analysis and other indicators, and intervetion should be taken as soon as possible to improve the prognosis.

Abstract:Objective To investigate the clinical value of geriatric nutrition risk index (GNRI), systemic immune inflammation index (SII) and triglyceride glucose (TyG) index in elderly patients with acute pancreatitis (AP). Methods A total of 161 elderly AP patients admitted to our hospital from January 2020 to December 2022 were recruited, and according to their severity, they were divided into mild (MAP, n=73), moderate severe (MSAP, n=42) and severe AP (SAP, n=46) groups. Based on the outcomes, the 46 SAP patients were further divided into death (n=17) and survival (n=29) subgroups. The GNRI, SII, and TyG index were compared among each group and subgroup. SPSS statistics 22.0 was used for data analysis. Depending on data type, one-way ANOVA, SNK-q test, student′s t test, or Chi-square test was used for inter group comparison. Receiver operating characteristic (ROC) curve was plotted to analyze the value of GNRI, SII and TyG index in predicting SAP occurrence and death in the elderly. Results The SAP group had significantly lower GNRI [(84.62±3.73) vs (88.75±6.10) and (92.80±8.06)], and higher SII [(2 738.74±1 068.15) vs (1950.42±987.82) and (1 293.27±719.50)] and TyG index [(7.92±1.26) vs (6.47±1.02) and (4.60±0.53)] when compared with the MSAP and MAP groups (all P<0.001). Significantly lower GNRI [(82.40±3.10) vs (87.53±4.92)], but higher SII [(3 160.94±1 207.15) vs (2 318.50±1002.53) ]and TyG index [(9.36±1.42) vs (6.75±1.16)] were observed in the death subgroup than the survival subgroup (all P<0.001). ROC curve analysis showed that area under the curve (AUC) of the three indicators combined together in predicting SAP occurrence and death were 0.857 (95%CI 0.798-0.916) and 0.910 (95%CI 0.848-0.971), respectively. Conclusion GNRI, SII, and TyG index are related to the severity and prognosis of AP, and the combination of these three indictors has high clinical value in diagnosis of SAP and prediction of death in elderly AP patients.

Abstract:The trajectory theory is one of the well-developed theories in the field of chronic disease management, and it has been applied to various extents in both domestic and abroad clinical practice. In this paper, we summarized the main content, development and implementation of the trajectory theory for chronic disease management. In combination with its current development trend, the theory should be further integrated with the culture and reality in China, and applied in the program development of information technology so as to provide new ideas for the development of chronic disease management in the future.

Abstract:Aspiration is one of the most common clinical problems in elderly,characterized by a high prevalence, serious harm and difficult diagnosis. Long-term repeated aspiration can lead to dehydration, malnutrition, aspiration pneumonia, and other adverse consequences. Age, disease, treatment, medication, feeding, and other factors jointly contribute to the occurrence of aspiration in the elderly, and a variety of instruments and bedside screening methods can be used to assess the risk of aspiration. In this paper, we reviewsed influencing factors and risk assessment of aspiration in the elderly, aiming to provide preferences for early detection, scientific evaluation, and timely intervention of aspiration in the elderly.

Abstract:Chronic obstructive pulmonary disease (COPD) is one of common respiratory diseases, characterized by persistent and progressive airflow obstruction. It is a major cause of morbidity and mortality worldwide and imposes enormous economic and social burdens. With the continuous progress and development of scientific technology, high-resolution computed tomography (HRCT) of the chest has important application value in the diagnosis and evaluation of COPD patients. In this article, we reviewed the relevant researches on the quantitative HRCT parameters in the diagnosis and evaluation for acute exacerbation and complications among COPD patients.