Abstract:Objective To investigate the correlation of low-density lipoprotein cholesterol/lymphocyte (LDL-C/LYM) ratio with carotid plaque stability and stenosis in patients with acute ischemic stroke (AIS). Methods The study was conducted on 336 AIS patients treated in the Department of Neurology of Qinghai Provincial People′s Hospital from April 2021 to April 2022. According to the results of ultrasound examination, they were divided into non-plaque group (n=42), stable plaque group (n=63), and vulnerable plaque group (n=231). Based on the severity of stenosis, they were also assigned into non-stenosis group (n=42), mild (n=177), moderate (n=67) and severe stenosis group (n=50). The general data, LDL-C level, lymphocyte count, and LDL-C/LYM ratio were compared among different groups. SPSS statistics 23.0 was used for data analysis. Student′s t test, Kruskal-Wallis H test or Chi-square test was employed for intergroup comparison depending on different data type. Spearman correlation analysis was adopted to analyze the correlation between LDL-C/LYM ratio and severity of carotid stenosis, and multivariate logistic regression analysis was performed for risk factors of plaque vulnerability. Results Older age, larger proportions of hypertension and diabetes mellitus, and higher D-dimer and LDL-C/LYM ratio were observed in the stable and vulnerable plaque groups than the non-plaque group (all P<0.05). The vulnerable plaque group had larger proportion of diabetes mellitus, higher total cholesterol and LDL-C levels, and increased LDL-C/LYM ratio, but lower lymphocyte count when compared with the stable plaque group (all P<0.001). Multivariate logistic regression analysis showed that diabetes mellitus and LDL-C/LYM ratio were independent risk factors for carotid plaque vulnerability (OR=1.948,95%CI 1.01-3.77, P=0.048; OR=4.543,95%CI 1.10-18.69, P=0.036). Receiver operating characteristic (ROC) curve analysis indicated that the area under the curve (AUC) of LDL-C/LYM ratio for diagnosing plaque stability was 0.676 (95%CI 0.605-0.748; P<0.001), the optimal critical value was 1.54, the sensitivity was 61.5%, and the specificity was 69.8%. Spearman correlation analysis suggested that LDL-C/LYM ratio was positively correlated with the severity of carotid stenosis (r=0.654; P<0.001). Conclusion Increased LDL-C/LYM ratio is an independent risk factor for carotid plaque instability, and is positively correlated with the severity of carotid stenosis in AIS patients.

Abstract:Objective To analyze the current status and its influencing factors of medication compliance in elderly patients with chronic diseases, and explore relevant interventions to provide reference for promoting rational drug use and implementing high-quality pharmaceutical services. Methods A stratified sampling was used to select elderly patients with chronic diseases from 15 medical institutions at different levels in many regions of China. Questionnaire surveys and Morisky medication adherence assessment were conducted for their general information, medication cognition, and medication compliance to analyze the influencing factors of medication adherence. SPSS statistics 27.0 was used for data analysis. Student′s t test or Chi-Square test was used for intergroup comparison depending on different data type. Logistic regression analysis was adopted to analyze the influencing factors of medication compliance in elderly patients with chronic diseases. Results A total of 1 007 valid questionnaires were collected, and the medication compliance rate of the elderly patients was 44.2%. Logistic regression analysis showed that marital status, education level and drug recognition level were the influencing factors of medication compliance in these elderly patients ( OR=0.653,95%CI 0.454-0.941, P=0.022; OR=0.740,95%CI 0.550-0.994, P=0.046; OR=0.591,95% CI 0.438-0.797, P=0.001). Conclusion The medication compliance is quite poor in elderly patients with chronic diseases, and the reasons for this are complex and varied. Medication education and strengthening follow-up visits can improve the medication cognition and treatment attention of the elderly patients, and thereby improve medication adherence and promote rational medication use.

Abstract:Objective To explore the influencing factors of frailty and pre-frailty in the elderly patients with chronic obstructive pulmonary disease (COPD). Methods Using the convenient sampling method, a total of 326 elderly COPD patients hospitalized in the Department of Respiratory Diseases of the People's Hospital of Xinjiang Uygur Autonomous Region from November 2021 to May 2022 were selected as the research subjects. A questionnaire survey was conducted, and the patients′ related laboratory indicators were collected using the general information questionnaire, Morse fall scale, COPD assessment test, Pittsburgh sleep quality index, short-form mini-nutritional assessment, 15-item geriatric depression scale, and social support rating scale. Unordered multinomial logistic regression analysis was performed to explore the influencing factors of frailty in the elderly COPD patients. SPSS 26.0 was used for statistical analysis. Depending on data type, variance analysis, rank sum test or χ² test were used for data comparison between two groups. Results The prevalence of frailty and pre-frailty was 39.57% (129/326) and 34.05% (111/326) in the elderly COPD patients. The unordered multiple logistic regression analysis showed that being female, multiple medications, sleep problems, malnutrition and high B-type natriuretic peptide were the common influencing factors. However, age (OR=1.090,95%CI 1.027-1.157; P=0.004), body mass index <23.9 kg/m²(OR=0.109,95%CI 0.042-0.283; P＜0.001), social support (OR=4.621,95%CI 1.222-17.470; P=0.024) and high hemoglobin (OR=1.042,95%CI 1.007-1.078; P=0.018) only affected pre-frailty. COPD assessment test score (OR=11.962,95%CI 3.056-46.831; P＜0.001), pulmonary function GOLD grade (OR=8.094,95%CI 1.862-35.188; P=0.005) and depression (OR=27.177,95%CI 2.811-262.705; P=0.004) only affected the frailty. Conclusion The incidence of frailty and pre-frailty in the elderly COPD patients is relatively high, and different influencing factors affect frailty in different degrees. Different personalized intervention measures should be taken to prevent the occurrence of pre-frailty, and to control and reverse frailty at the same time.

Abstract:Objective To explore the influence of high-sensitivity cardiac troponin T (hs-cTnT) on the prognosis of frail and pre-frail elderly hospitalized patients without acute coronary syndrome (ACS). Methods The elderly patients who were admitted to our department and identified as frailty or pre-frailty by Fried Frailty Phenotype assessment from January 2017 to December 2019 were enrolled in this study. Their hs-cTnT level, general information, laboratory indicators and echocardiographic indicators were recorded. Follow-up was conducted each three months through phone call after discharge and all-cause deaths of the patients were observed. These patients were divided into low-, median-, and high-value groups according to hs-cTnT tertiles. The survival curves of the three groups were compared using Kaplan-Meier method (K-M curve). Cox proportional hazard-regression model was used to analyze the effect of 3 hs-cTnT groups on the risk of death. SPSS statistics 18.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test, Fisher exact test, Wilcoxon test or χ² test depending on data type. Results A total of 450 frail and pre-frail elderly inpatients were subjected in this study, 72.4% (326/450) of them had hs-cTnT levels exceeding the cut-off value of 0.014 μg/L. There were significant differences in age [(83.67±5.72)vs (86.06±4.93) vs (87.67±5.23)years], male ratio [62 (41.3%) vs 94 (62.7%) vs 108 (72.0%)], chronic heart failure ratio [4 (2.7%)vs 5 (3.3%) vs 22 (14.7%)], hypertension ratio [116 (77.3%) vs 119 (79.3%) vs 133 (88.7%)], arrhythmia ratio [41 (27.3%) vs 38 (25.3%) vs 60 (40.0%)], chronic kidney disease ratio [27 (18.0%) vs 38 (25.3%) vs 61 (40.7%)], comorbid conditions [≥4,72 (48.0%) vs 73 (48.7%) vs 99 (66.0%)], hemoglobin level [(125.11±16.03)vs (121.50±18.08) vs (115.38±16.97)g/L], estimated glomerular filtration rate [(87.91±30.74)vs (76.73±23.08) vs (66.69±27.80)ml/(min·1.73m²)], albumin level [(38.15±3.81)vs (37.60±3.98) vs (36.04±4.41)g/L], total cholesterol level [(4.01±0.98)vs (3.62±0.88) vs (3.70±0.85) mmol/L], low-density lipoprotein cholesterol level [(2.42±0.88)vs (2.05±0.73) vs (2.19±0.77)mmol/L], N-terminal pro-brain natriuretic peptide level [163.5 (104.8,398.9) vs 314.7 (171.4,683.8) vs 547.3 (288.3,1568.3) pg/ml], interventricular septal thickness [(11.30±0.83)vs (11.42±0.79) vs (11.71±1.07)mm], left ventricular post-wall depth [(11.31±0.83)vs (11.46±0.75) vs (11.65±0.83)mm], left ventricular mass index [(107.38±13.32)vs (109.90±13.86) vs (112.72±19.29)g/m²] and left ventricular ejection fraction [(60.65±2.97)% vs (59.58±3.91)% vs (58.54±5.08)%] among 3 groups (all P <0.05). Cox regression model analysis showed that after adjustment for gender, age, comorbidities, laboratory indicators and echocardiographic indicators, the mortality risk was significantly higher in the patients of the high-value group than those in the low-value group (HR=3.133,95%CI 1.381-7.109, P <0.01). Survival curve analysis indicated that median survival time was estimated at 53,51 and 48 months in the low-, median- and high-value groups, respectively. And in 10-20 months after discharge, the survival rate of the high-value group was significantly lower than that of the other two groups, and even in 20-30 months after discharge, the rate of the high-value group and the median-value group was obviously lower than that of the low-value group. Log-Rank test showed that the survival rates of the three groups was significantly different (P <0.001). Conclusion For the frail and pre-frail elderly inpatients without ACS, higher hs-cTnT level, higher than the cut-off value, indicates higher risk of death. The increment exerts adverse effect on all-cause death, with the higher the level, the higher risk of death.

Abstract:Objective To investigate the clinical characteristics and risk factors of postoperative venous thromboembolism (VTE) in patients after thoracoscopic surgery. Methods Clinical data of the patients who underwent video-assisted thoracic surgery (VATS) in our hospital from January 2014 to August 2020 were collected and analyzed retrospectively. The demographic characteristics, surgery related data and length of hospital stay were collected and compared between the VTE patients and those without, cumulative incidence rate of VTE in different ages, body mass index (BMI), and operation time were analyzed. SPSS statistics 28.0 was used for statistical analysis. Data comparison between two groups was performed using U test, Chi-square test or Fisher exact test depending on data type. Results A total of 21 227 patients who underwent minimally invasive surgery were enrolled in this study. In the 17 213 patients who underwent laparoscopic surgery, the incidence of VTE was 0.43% (74/17 213). In 2 133 patients who underwent VATS, VTE occurs in 1.22% (26/2 133), and deep vein thrombosis (DVT) covered 34.62% (9/26), while pulmonary thromboembolism (PTE) covered 65.38% (17/26). Compared with the non-VTE group, older age [65 (60,73) vs 54 (43,62) years, P<0.001], larger BMI [25.46 (24.61,28.67) vs 23.83 (21.51,26.03) kg/m², P<0.001], higher incidence of malignancy [22(84.62%)vs 1203(57.10%),P=0.005] and longer operation time [165 (119,214) vs 95 (67,134) min, P<0.001] and length of hospital stay [10 (8,18) d vs 6 (4,7) d, P<0.001] were observed in the VTE group. When the VATS patients were divided into four aged groups:<60,60-<65,65-<70, and ≥70 years, and the incidence of VTE was 0.43% (6/1 391), 1.75% (6/342), 2.12% (5/236), and 5.49% (9/164), respectively. Independent risk factors for VTE occurrence after VATS included ≥65 years old (OR=2.917, 95%OR 1.253-6.788, P=0.013), BMI >25 kg/m²(OR=2.484, 95%OR 1.089-5.667, P=0.031), and operation time≥120 min (OR=4.683, 95%OR 1.762-12.241, P=0.002). Compared with patients <65 years old, BMI≤25 kg/m², and operation duration <120 min, the incidence of VTE within 30 d after VATS was higher in patients≥65 years old [9/164(5.49%) vs 17/1 969(0.86%), P<0.001], BMI>25 kg/m²[15/757(1.98%) vs 11/1376(0.80%), P=0.012] and operation duration≥120 min [2.86%(20/699) vs 0.42%(6/1 434), P<0.001]. Conclusion The incidence of postoperative VTE is higher in patients who underwent VATS than laparoscopic surgery in Peking Union Medical College Hospital. Age ≥65 years, BMI >25 kg/m² and operation time longer than 120 min are the independent risk factors of the incidence of VTE in patients after undergoing thoracoscopic surgery.

Abstract:Objective To analyze the association between postoperative pulmonary complications (PPCs) and diaphragm function in the elderly patients undergoing hepatobiliary surgery. Methods Clinical data were collected of 16 elderly patients who underwent hepatobiliary surgery at the Department of General Surgery of the Second Medical Center of Chinese PLA General Hospital. According to postoperative pulmonary complications, they were divided into six patients in the PPCs group (n=6) and non-PPCs group (n=10). Bedside ultrasound was used to monitor diaphragmatic mobility (DE) on the right side of the patients on the preoperative day 1 and the postoperative day 1,3, and 7. The two groups were compared in preoperative DE and postoperative minimal DE, ΔDE, operation time, and surgical approach. SPSS 23.0 were used for data analysis and multivariate logistic regression for analysis of the risk factors affecting PPCs. Receiver operating characteristic (ROC) curves were drawn to evaluate their predictive value for PPCs. Results There was no significant difference between the two groups in the preoperative DE and surgical approach (P>0.05). Compared with the non-PPCs group, the PPCs group had longer operation time [(247.500±68.099) vs (162.300±66.111) min], smaller postoperative minimal DE [(1.071±0.202) vs (1.414±0.236) cm] and greater ΔDE [(0.536±0.106) vs (0.343±0.139) cm], the differences being all statistically significant (P<0.05 for all). Multivariate logistic regression analysis revealed that operation time and minimal postoperative DE were independent risk factors for PPCs. The area under the ROC curve for predicting PPCs was 0.825 (95%CI 0.670-0.980) by operation time and 0.867 (95%CI 0.693-0.974) by postoperative minimum DE, and the optimal cut-off points were 210 min and 1.19cm (sensitivity 83.33% vs 90.00%; specificity 80.00% vs 83.33%). Conclusion The decline of diaphragm function after operation and prolonged operation are risk factors affecting PPCs in the elderly patients undergoing major hepatobiliary surgery. PPCs can be predicted by monitoring diaphragm function through ultrasound.

Abstract:Objective To analyze the influencing factors of Clostridium difficile infection (CDI) in elderly hospitalized patients. Methods The clinical data of 114 inpatients with abdominal pain, abdominal distension and diarrhea admitted to our department from November 2013 to September 2021 were collected and retrospectively analyzed. Clostridium difficile toxin was detected with multiplex polymerase chain reaction. According to the results, the patients were divided into a toxin-negative group (n=47) and a toxin-positive group (n=67). Their general data and results of laboratory tests were compared between the two groups. SPSS Statistics 25.0 was used for statistical analysis. Based on data types, independent sample t test, rank sum test or Chi-square test was employed for comparison between groups. Multivariate binary logistic regression analysis was applied to analyze the influencing factors of CDI. Results The patients from the negative group had significantly higher aspartate aminotransferase [29.0(22.0,49.0) vs 20.0(15.0,34.0) U/L], alanine aminotransferase [21.0(14.0,41.0) vs 16.0(8.0,20.0) U/L], albumin [(33.22±4.94) vs (31.53±3.49) g/L], alkaline phosphatase [113.0 (69.0,163.0) vs 74.0 (56.0,101.0) U/L] and γ-glutamyl transpeptidase [64.0 (23.0,157.0) vs 35.0 (22.0,76.0) U/L], and obviously longer thrombin time [18.6(17.6,20.4) vs 17.8(16.7,18.9) s] when compared with the patients of the positive group (all P<0.05). Lower incidence of coronary heart disease [8(17.0%) vs 32(47.8%)] and usage ratios of proton pump inhibitor [16(34.0%) vs 42(62.7%)] and antibiotics [9(19.1%) vs 39(58.2%)] were observed in negative group than positive group (all P<0.05). Multivariate binary logistic regression analysis showed that albumin level was a protective factor for CDI (OR=0.894,95%CI 0.802-0.996; P=0.041), while use of antibiotics was an independent risk factor for CDI (OR=18.398,95%CI 1.225-276.346; P=0.035). Conclusion The incidence of CDI is negatively correlated with albumin level, and positively with use of antibiotics in the elderly inpatients. Because antibiotic use increases the incidence of CDI, dynamic monitoring and timely intervention should be implemented for the elderly hospitalized patients.

Abstract:Objective To explore the correlation between preoperative frailty and postoperative complications in the elderly colorectal cancer patients undergoing radical surgery. Methods A total of 147 elderly patients who underwent elective laparoscopic radical surgery for colorectal cancer in the Affiliated Tumor Hospital of Guangxi Medical University from May to August 2021 were selected as the research subjects. The general data questionnaire, the grading standard of the American Society of Aneshesiologists (ASA) and the Tilburg frailty index (TFI) were used to investigate the patients′ frailty and grading. At the same time, the patients′ complications were recorded. Data analysis was performed using SPSS statistics 26.0. According to the data type, χ² test was used for comparison between groups. Binary logistic regression was used to analyze the risk factors of complications, and Spearman rank correlation was used to analyze the correlation between preoperative frailty and postoperative complications. Receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of preoperative frailty assessment, predictive value of ASA classification and combined application on postoperative complications. Results Logistic regression analysis showed that activity of daily living (ADL) score, frailty score, and ASA grade were the influencing factors of postoperative complications. Spearman correlation analysis showed that preoperative frailty was positively correlated with postoperative complications (r=0.427). The area under ROC curve of frailty assessment combined with ASA classification is larger than that of frailty assessment alone or ASA classification (AUC=0.797,0.740,0.697). The sensitivity and specificity of joint application were 92.3% and 51.9%, respectively. Conclusion Preoperative frailty is an independent risk factor and predictor of postoperative complications, and preoperative frailty assessment combined with ASA classification can enhance the predictive ability of postoperative complications, providing basis for the patients′ perioperative safety management.

Abstract:Objective To investigate the regulation of β-adrenoceptor on sodium-calcium exchange current (I _NCX) and its possible signal transduction pathway. Methods The NCX1.1 plasmid was transfected into human embryonic kidney-293 (HEK-293) cell by immunomagnetic-bead-based positive expression system. Transfected HEK-293 cells totaling 103 with positive transfection were selected and randomly divided into blank control group (n=20), isoproterenol (ISO) group (n=20), pertussis toxin (PTX) plus ISO group (n=20), forskolin plus ISO group (n=22), and H89 [protein kinase A (PKA) inhibitor] plus ISO group (n=21). I NCX changes in each group were recorded with whole-cell patch clamp technique. SPSS statistics 21.0 was used for statistical analysis. According to data type, t-test was used for comparison between two groups, and ANOVA was used for comparison between multiple groups. Results Against control group, ISO increased the inward I_NCX density from (-6.07±1.53) pA/pF to (-7.89±1.61) pA/pF (n=20,P<0.05), with an average increase of about 30%. However, the effect of ISO on I_NCX current was significantly changed after pre-administration of key molecular agonists or inhibitors of Gi-cAMP-PKA pathway. PTX and forskolin, significantly enhanced the effect of ISO, had a more significant effect on I_NCX density increase, the current density increased to (-10.02±1.99) pA/pF and (-10.78±1.77) pA/pF, respectively. Compared with ISO alone, there was a significant difference (n=20, P<0.01), suggesting that both the inhibition of Gi protein and activation of cAMP can enhance the effect of ISO. However, the effect of pre-treatment with PKA inhibitor H89 showed no enhancement on I_NCX , and the current density was about (-6.22±1.70) pA/pF, which was not significantly different from that of the control group (n=20,P>0.05). It suggested that PKA inhibition can basically block the effect of ISO on I_NCX. Conclusion β-adrenoceptor activation may enhance the NCX1.1 inward current, probably through stimulating G protein-cAMP-PKA signaling pathway.

Abstract:Fear of falling is quite common among stroke survivors, which can lead to avoidance behavior and then further increases fall risk, forming a vicious circle finally. Different from the inclusive interventions targeted to healthy older people, interventions for stroke survivors intend to improve certain functions and balance confidence. In this review, we summarized the characteristics and effectiveness of different interventions based on concerning foreign studies in recent years in order to help medical staff to optimize the measures and then break the vicious circle of fear of falling in stroke patients.

Abstract:The incidence of Alzheimer′s disease (AD) increases with the aging of population, posing a great threat to the health of the elderly and becoming a major global public health problem. Therefore, active exploration of its pathogenesis is of great significance to its early screening, prevention, diagnosis and treatment. This paper reviews the research progress in the AD-related pathogenesis in recent years, and it is believed that age is the most important risk factor for the development of AD and that factors such as β-amyloid deposition and high tau phosphorylation, gene mutation, inflammation, microangiopathy, metabolic disorders, and cholinergic system damage constitute the important pathogenesis of AD.

Abstract:Dementia with Lewy bodies (DLB), the second most common neurodegenerative dementia after Alzheimer′s disease (AD), is caused by the accumulation of α-synuclein in brain neurons and is characterized by fluctuating cognitive dysfunction, Parkinson′s disease, visual hallucinations and other symptoms. It has an earlier mortality and a higher incidence than AD. Currently, the disease has become a medical tough problem to be solved urgently with the limited public understanding of it, the inadequate academic research, unclear pathogenesis, and unavailability of treatments. Chinese medicine and modern medicine have different understandings of DLB, but both can achieve good clinical results. In this article, we summarized the status quo of treatment of Lewy body dementia with integrative Chinese and Western medicine in recent years and presented the outlook for clinical treatment and related research.

Abstract:Obstructive sleep apnea-hypopnea syndrome (OSAHS) is closely associated with hypertension. Studies claim OSAHS as the most common cause of secondary hypertension and an important cause of refractory hypertension. The mechanism of hypertension caused by OSAHS is complex, and multiple mechanisms are involved in the occurrence of hypertension, among which the enhancement of sympathetic nerve activity and intermittent hypoxia (IH)in patients with OSAHS may be an important cause. The diagnosis of OSAHS-associated hypertension depends on polysomnography and blood pressure. Continuous positive airway pressure (CPAP) is the preferred treatment for OSAHS patients. In OSAHS patients with hypertension, aldosterone antagonists, mandibular advancement devices (MAD) and inspiratory muscle training (IMT) should be considered in clinical practice.

Abstract:Chronic diseases are characterized by complex etiology, long course and heavy economic burden, and have become the main cause of death and disease burden all over the world. The diseases not only cause physical burden, but also lead to negative psychological effects on these patients. Rumination is behavior of continuous, repeated and passive thinking of negative feelings and low emotions, which will increase the risk of various psychological problems and hinder the rehabilitation of chronic diseases. In this paper, we reviewed rumination status, adverse effects and intervention strategies in patients with chronic diseases, aiming to improve the understanding of rumination in these patients and provide evidence of targeted intervention.

Abstract:Alzheimer′s disease (AD), a neurodegenerative disease with high morbidity, wide affection and complex pathogenesis, has become hot spot of scientific researches over the latest forty years. For β amyloid protein, the key protein to AD, and its precursor, amyloid precursor protein (APP), plaque deposition and oligomer were successively hypothesized as the pathogenesis for AD. However, with the development of research technology in recent years, the correlation between β amyloid plaque and β amyloid oligomer has been found, which makes the correlation between the two pathogenesis hypotheses of AD improved. In this paper, we reviewed the research results on the pathogenesis of β amyloid protein and its precursor protein in recent years, compared and analyzed the two hypotheses, and proposed possible directions and hot spots for future research related to the pathogenesis of AD.