Abstract:Objective To observe the status of antithrombotic drug therapy and its influence on clinical outcome in elderly patients with coronary artery disease (CAD) complicated with atrial fibrillation (AF) and malignant tumor. Methods Elderly patients ≥65 years old who were diagnosed with CAD combined with AF and malignant tumor during hospitalization in Chinese PLA General Hospital from January 2010 to December 2017 were continuously recruited, and their clinical baseline data and condition of oral antithrombotic drug treatment were collected. All of the patients meeting our inclusion criteria were followed up for 1 year, the incidences of major adverse cardiovascular events (MACEs) and major bleeding events [bleeding academic research consortium (BARC) class ≥2]. On this basis, the effects of oral antithrombotic therapy on the above clinical outcomes were analyzed in these patients. SPSS statistics 17.0 was used for data analysis. According to the data type, student′s t test, Mann-Whitney U test or Chi-square test was used for comparison between groups. Multivariate logistic regression model was used for correction to determine the independent prediction ability of antithrombotic drug therapy for efficacy and safety of adverse clinical outcomes. Results A total of 135 elderly patients with CAD complicated with AF and malignant tumor who met the inclusion criteria were enrolled in this study. Acute coronary syndrome (ACS) was diagnosed in 40% of patients (54/135) and stenting was performed in 7.4% (10/135). Breast cancer (17.0%, 23/135) and lung cancer (15.6%, 21/135) accounted for the largest proportion most common. The patients were divided into antithrombotic treatment group (n=71) and non-antithrombotic treatment group (n=64). The antithrombotic treatment group had younger age [(77.4±5.7) vs (80.3±6.8)years] and lower plasma D-dimer level [1.03(0.34,1.42) vs 1.82(0.51,2.43) mg/L], and higher platelet count [(199.9±65.0)×10⁹/L vs (176.7±59.8)×10⁹/L] and larger proportion of administration of proton pump inhibitors [59.2%(42/71) vs 29.7%(19/64)]when compared with the non-antithrombotic treatment group (all P<0.05). In the antithrombotic treatment group, 38.0% (27/71) of patients were treated with oral anticoagulant drugs, 32.4% (23/71) with single antiplatelet agents, and 29.6% (21/71) with dual antiplatelet agents (all aspirin combined with clopidogrel). Logistic regression analysis showed that antithrombotic therapy was an independent protective factor for MACEs in elderly CAD patients with AF and malignant tumor (OR=0.111, 95%CI 0.026-0.473; P<0.05); the risk of bleeding events with BARC≥2 was not significantly different between the two groups (OR=0.724,95%CI 0.059-8.826; P>0.05). Conclusion Antithrombotic therapy significantly reduces the incidence of MACEs and does not increase the risk of bleeding events in elderly CAD patients with AF and malignant tumors. It is necessary to strengthen the individualized antithrombotic therapy for elderly patients with CAD complicated with AF and malignant tumor.

Abstract:Objective To analyze the effects of red blood cell distribution width (RDW) and gamma-glutamyltransferase (GGT) on the prognosis of the advanced aged patients with coronary heart disease (CHD) complicated with pulmonary infection. Methods A retrospective analysis was made of the clinical data of 256 elderly CHD patients (age>80 years) complicated with pulmonary infection admitted to Xijing Hospital Affiliated to the Air Force Medical University from January 2018 to January 2021. According to the clinical prognosis, they were divided into the good prognosis group (n=192) and the poor prognosis group (n=64), and binary multivariate logistic regression was performed to analyze the prognostic factors. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of RDW, GGT and their combined predictors in the elderly CHD patients with pulmonary infection. SPSS 19.0 was used for data analysis, and depending on data type, independent sample t -test, Mann-Whitney U test or Chi-square test for the comparison between two groups. Results The poor prognosis group was significantly higher than the good prognosis group in age, neutrophil-to-lymphocyte ratio, N-terminal pro-B type natriuretic peptide, creatinine, procalcitonin, mean arterial pressure, RDW, and GGT, the differences being statistically significant (P < 0.05 for all). Binary multivariate logistic regression analysis showed that RDW (OR=4.167,95%CI 1.579-10.995; P=0.004) and GGT (OR=1.011,95%CI 1.001-1.021; P=0.039) were independent risk factors for poor prognosis in the elderly CHD patients complicated with pulmonary infection. The area under ROC curve (AUC) of RDW for the prognosis was 0.824 with a cut-off value of 15.15, a sensitivity of 82.5%, and a specificity of 81.3%. The AUC of GGT for prognosis was 0.748 with a cut-off value of 40.15,a sensitivity of 87.5%, and a specificity of 67.5%. The AUC of the combined predictors was 0.860 with a cut-off value of 0.239, a sensitivity of 81.3%, and a specificity of 80.4%. Conclusion The elderly CHD patients complicated with pulmonary infection are prone to have a poor prognosis because of their atypical symptoms and insidious onset. RDW or GGT can be used as one of the indicators to predict their poor prognosis.

Abstract:Objective To explore the risk of osteoporosis in elderly males with obstructive sleep apnea syndrome (OSAS).Methods From January 2015 to October 2017,623 male patients diagnosed with OSAS were collected from the sleep centers of 6 tertiary hospitals in Beijing and Gansu Province, and then divided into osteoporosis risk group (n=302) and control group (n=321) according to the results of One-Minute Risk Osteoporosis Test of International Osteoporosis Foundation. All patients were followed up regularly, and the follow-up endpoint was occurrence of risk of developing osteoporosis. SPSS statistics 25.0 was used for data analysis. Student′s t test, Mann-Whitney U test, or Chi-square test was employed for intergroup comparison. Cox regression analysis was applied to analyze risk factors for the development of osteoporosis in elderly OSAS males. Results Out of 623 male OSAS patients, 48.5% (302/623) were screened for osteoporosis risk. Compared with the control group, the osteoporosis risk group was older and had significantly lower diastolic blood pressure, smaller waist circumference, larger smoking ratio, lower average pulse oxygen saturation in sleep parameters, lower levels of triglyceride, uric acid, C-reactive protein, red blood cell count and haemoglobin level, and the incidences of carotid atherosclerosis and chronic obstructive pulmonary disease when compared with the control group (P<0.05). Cox proportional risk regression analysis showed that during a median follow-up period of 55 months, age (HR=1.029,95%CI 1.013-1.045) and carotid atherosclerosis history (HR=1.547,95%CI 1.157-2.068) were independent risk factors for the risk of osteoporosis in older males with OSAS, while larger waist circumference (HR=0.983,95%CI 0.976-0.990) and mean pulse oxygen saturation (HR=0.941,95%CI 0.904-0.979) were protective factors (P<0.05). Conclusion OSAS patients are prone to secondary osteoporosis, especially for the male OSAS patients with senior age and history of carotid atherosclerosis. Larger waist circumference and higher mean pulse oxygen saturation are protective factors for the risk of osteoporosis.

Abstract:Objective To analyze the predictive value of the Charlson comorbidity index (CCI) for postoperative complications of femoral intertrochanteric fractures in the elderly. Methods A retrospective cohort study was conducted on 378 elderly patients who underwent hip surgery for femoral intertrochanteric fractures between January 2017 and January 2018 in our hospital. Taking CCI=4 points as standard, they were divided into high-risk group (CCI ≥4 points) and a low-risk group (CCI＜4 points). The primary study endpoint was occurrence of complications within 30 d postoperatively. SPSS statistics 22.0 was used for statistical analysis. Student′s t test or Chi-square test was performed for comparison between two groups depending on data type. Cox regression analysis was adopted to determine the relationship between CCI and postoperative complications. Results Of the 378 patients, there were 67 patients in the high-risk group and 311 in the low-risk group. The high-risk group had significantly higher incidence of postoperative complications [64.2% (43/67) vs 49.8% (155/311)], ratio of postoperative admission to ICU [29.9% (20/67) vs 16.7% (52/311)], and proportion of general anaesthesia [50.7% (34/67) vs 37.6% (117/311)] than the low-risk group (all P<0.05). In the multivariate model, CCI was significantly associated with postoperative complications (RR=1.13,95%CI 1.011-1.253, P=0.026). Other risk factors included general anesthesia (RR=1.59,95%CI 1.373-1.943, P=0.026) and postoperative ICU stay (RR=1.34,95%CI 1.180-1.642, P=0.001). Conclusion CCI can be used to assess and predict postoperative complications in elderly patients with intertrochanteric femoral fractures.

Abstract:Objective To investigate the usual dose and safety of rivaroxiban in super-elderly patients with non-valvular atrial fibrillation (NVAF). Methods A total of 150 super-elderly NVAF patients were enrolled as subjects, who were hospitalized in the Department of Cardiology, Air Force Medical Center from August 2017 to April 2021. The initial oral dose of rivaroxiban was determined according to the HAS-BLED score, and the patients were divided into low-dose group (10mg/d; n=78))and medium-dose group (15mg/d; n=72). Routine blood test results, coagulation, liver functions, and kidney functions were monitored before and after the treatment. The patients were followed up for 12 months for bleeding events, incidence of adverse reactions, and incidents of new ischemic strokes. SPSS statistics 19.0 was used for data analysis. Depending on data types, t test, analysis of variance (ANOVA) or χ² test was employed for intergroup comparison. Results Five patients died of severe pneumonia in each group during one-year follow-up, the difference being not statistically significant (P>0.05). Comparison between the two groups at 1,3, 6, and 12 months found no statistically significant differences (P>0.05) in hemoblobin, platelet counts, plasma prothrombin time (PT), activated partial thromboplastin time (APTT) , fibrinogen (FIB), D-dimer (DD), liver functions, and kidney functions. Recurrence of acute cerebral infarction and severe bleeding was not recorded. Symptoms with mild bleeding disappeared after adjusting dose. Conclusion Rivaroxaban (10 mg/d) is effective and safe for the super-elderly NVAF patients.

Abstract:Objective To investigate the characteristics of patients with intrapancreatic accessory spleen (IPAS) and the reasons for misdiagnosis to improve the understanding of the disease and reduce misdiagnosis and unnecessary surgery. Methods A retrospective analysis was made on 10 patients (12 lesions in total), who were admitted to the Department of Hepatobiliary Surgery of First Medical Center or Department of General Surgery of Second Medical Center of Chinese PLA General Hospital from January 2012 to August 2022, and were preoperatively diagnosed as pancreatic neuroendocrine tumor and postoperatively confirmed as intrapancreatic accessory spleen by pathology. Their CT, MRI, ⁶⁸Ga-dotatate PET/CT images, pathological characteristics and clinical data were investigated. Results Out of 10 patients, nine had single lesion, and one had three lesions; 12 lesions were located in the tail of the pancreas, having clear borders with surrounding tissues, being nodules with rich blood supply, and having a maximum diameter of 0.30-3.00 (1.43±0.75) cm. On MRI, all lesions showed hypointensity on T1W1, eight hyperintensity on T2W1 (80%), seven hyperintensity on DWI (70%), six uniform enhancement in arterial phase, and one "patina-like" uneven enhancement. The lesions in the three patients who underwent ⁶⁸Ga-dotatate PET-CT all showed hypermetabolism, and the maximum standard uptake value (SUVmax) was about half of that of the spleen. Conclusion IPAS is generally located in the tail of the pancreas, with less than 3 cm and a clear boundary. The lesions show hypointensity on MRI T1W1 sequence, hyperintensity on T2W1 and hyperintensity on DWI sequence. The typical "patina-like" uneven enhancement is rarely seen in the arterial phase, venous phase and delayed phase display uniform enhancement mostly, and hypermetabolism may occur during ⁶⁸Ga-dotatate PET/CT examination.

Abstract:Objective To determine the median effective dose (ED₅₀) of remimazolam to prevent etomidate-induced myoclonus in elderly male and female patients. Methods A total of 43 elderly patients who underwent general anesthesia surgery in our hospital from January 2022 to June 2022 were recruited in this study. There were 21 cases assigned in the male group and 22 cases in the female group. The dose of remimazolam was determined through sequential administration, with an interval of 0.05 mg/kg. Remimazolam was given intravenously at a dose of 0.2 mg/kg for the first time, and etomidate was given at 3 mg/kg in 1.5 min later, followed by 0.2 μg/kg sufentanil and 0.4 mg/kg rocuronium after disappearance of patient′s consciousness. Then laryngeal mask was placed after induction. Mean arterial pressure (MAP), heart rate and pulse oxygen saturation of patients in the two groups were recorded before induction of etomidate anesthesia (T0), immediately after intravenous infusion (T1), 1 min after intravenous infusion (T2) and 3 min after intravenous infusion (T3). The occurrence of adverse reactions such as nausea, vomiting and aspiration was recorded. SPSS statistics 28.0 was used to process the data. Based on data type, independent sample t-test or rank sum test was adopted for inter-group comparison. ED₅₀, 95% effective dose (ED₉₅) and corresponding 95% confidence interval (CI) were calculated with Probit model to establish a linear regression equation. Then GraphPad software was adopted to draw a dose-effect relationship diagram. Results The ED₅₀ of remimazolam in prevention of myoclonus induced by etomidate was 0.12 (95%CI 0.067-0.169) and 0.17 mg/kg (95%CI 0.127-0.215) respectively for the elderly male and female patients, and the ED₉₅ was 0.19 (95%CI 0.153-0.665) and 0.24 mg/kg (95%CI 0.202-0.580), respectively. In the male group, MAP at T3 was decreased significantly than that at T0 (87.10±6.53 vs 99.99±7.84 mmHg; P<0.05). In the female group, both MAP [(85.50±7.03) vs (102.95±4.03) mmHg] and heart rate [(69.6±5.41) vs (76.00±6.65) beats/min] were obviously reduced at T3 than T0 (P<0.05). However, the decline was not larger than 20% of the base value at T0 before anesthesia. No adverse reactions such as nausea, vomiting and aspiration occurred at T1, T2 and T3. Conclusion The ED₅₀ of remimazolam for preventing etometon-induced myoclonus is 0.12 and 0.17 mg/kg respectively in elderly male and female patients during induction of general anesthesia, and the dose is lower in eldly male than in elderly female. The hemodynamics is stable and no adverse reactions occur during induction.

Abstract:Objective To observe the two-year prognosis of elderly patients with acute myocardial infarction (AMI) after coronary artery bypass graft (CABG), and investigate the factors that influence the prognosis. Methods A total of 70 patients suffering from AMI after CABG admitted in our hospital from June 2017 to June 2020 were recruited in this study. Their clinical data were collected, and the incidence of cardiovascular events were observed in a two-year follow-up. SPSS statistics 27.0 was used for data analysis. Student′s t test, Chi-square test, or Fisher exact test was employed for intergroup comparison depending on data type. Multivariate logistic regression model was adopted to analyze the factors influencing the prognosis of patients. Results There were 31 (44.3%) patients experiencing cardiovascular events during the two years′ follow-up. Logistic regression analysis showed that age >75 years (OR=6.465,95%CI 1.454-28.734), smoking after CABG (OR=5.874,95%CI 1.457-23.674), and thrombolysis in myocardial infarction (TIMI) flow grade <3 after percutaneous coronary intervention (PCI) (OR=9.353,95%CI 1.279-68.371) were risk factors for cardiovascular events, while PCI in native coronary artery (OR=0.153,95%CI 0.043-0.540) was a protective factor for the events in the elderly. Conclusion For the elderly patients suffering from AMI after CABG, age >75 years, smoking after grafting, and TIMI flow grade<3 after PCI increase the incidence, while PCI in native coronary artery reduces the incidence of cardiovascular events.

Abstract:Objective To investigate the pathogenesis of hepatocellular carcinoma (HCC) and provide the basis for its diagnosis and clinical treatment. Methods Differentially expressed miRNA and mRNA between HCC samples and adjacent tissue samples were identified based on the cancer genome atlas (TCGA) database. The target genes with differentially expressed miRNA were predicted by miRDB and TargetScan databases, and the intersection of miRNA with differentially expressed mRNA was determined. Prediction of potential transcription factors in differentially expressed miRNA in HCC using FunRich software. Functional annotation and pathway enrichment analysis were performed using the clusterProfiler package in Bioconductor. The protein-protein interaction network was constructed using a STRING database, and the miRNA-mRNA regulatory network was mapped by Cytoscape. Twenty miRNA with the most significant differential expression was verified and correlated survival analysis was performed. Results A total of 300 differentially expressed miRNA was identified in 375 HCC samples and 50 paracancerous samples by differential miRNA analysis. Totally 1106 diffe-rentially expressed mRNA was identified in differential mRNA analysis on 374 HCC samples and 50 paracancerous samples. Twenty miRNA with the most significant differential expression was selected from the up-regulated and down-regulated miRNA for target gene prediction. Functional enrichment analysis indicated that 131 candidate genes were mainly related to the regulation of valine, leucine and isoleucine degradation, carbon metabolism and prolactin signaling pathway. Conclusion The abnormally expressed miRNA-mRNA pathway in HCC may become a new biomarker for the diagnosis and provide the basis for diagnosis and clinical treatment.

Abstract:The main treatments for end-stage renal disease (ESRD) include dialysis and palliative treatment, and the former has obvious survival advantages over the latter. However, it is not clear whether there are differences in symptom clusters associated with the two treatments. This article makes a retrospective analysis of the symptom clusters associated with dialysis and palliative treatment for elderly ESRD patients and reviews the concepts related to symptom cluster, symptom associated with the two treatments in all dimensions, and the comparison between the symptom clusters, with a view to providing reference for clinical diagnostic and therapeutic decisions and the related research on the symptom cluster in the elderly ESRD patients.

Abstract:The care of the disabled elderly has become a key issue of adaptive aging in China as the country has fully evolved into an aging society. How to correctly understand and evaluate disability forms the basis of establishing a service system for the long-term care needs of the elderly in China and is also the focus of gerontology and social attention. This paper reviews the concept of disability, disability assessment tools in China and abroad, and the status quo of research on disability assessment in China, with a view to provid-ing a reference for future disability studies.

Abstract:Osteoporosis is a systemic metabolic disease with the defective coupling of bone resorption and bone reconstruction, resulting in imbalance of calcium and phosphorus metabolism and gradual reduction of bone density. Purinergic ligand-gated ion channel 7 receptor (P2X7R) are highly expressed in osteocyte, regulating continuous absorption and remodeling of the skeletal system. P2X7R activation is associated with osteoclast formation and reabsorption and with osteoblast differentiation. P2X7R can also influence bone loss by stimulating immune cells during inflammatory response. This article reviews the research progress of P2X7R in osteoporosis in recent years, providing evidence for the pathogenesis of osteoporosis and the development of new drugs.

Abstract:From the perspective of collateral disease theory, we expounded the correlation between the theory and cognitive dysfunction. Centering on the basic therapeutic principle of “unblocking collaterals”, we discussed the pathological mechanism of cognitive dysfunction regarding toxic damage to brain collaterals, phlegm and blood stasis, kidney deficiency and marrow reduction. In view of the above pathogenesis, the treatment methods such as detoxicating and unblocking collaterals, resolving phlegm and removing blood stasis, tonifying the kidney and activating the marrow were introduced respectively. In this review, we gradually clarified the ideas and methods for understanding and diagnosing cognitive dysfunction based on collateral disease theory, and provided TCM ideas for its pathogenesis, diagnosis and treatment.

Abstract:With aging, muscles begin to show signs of aging and atrophy. Skeletal muscle, as an important power part of the human body′s motion system, will have a direct impact on the motion ability once the declines of muscle strength and muscle mass occur. Proper exercises can improve muscle strength and muscle quality, help to delay and improve muscle aging symptoms, and restore exercise capacity. In this article, we reviewed the research progress of exercise rehabilitation therapy in the clinical treatment of senile sarcopenia patients in order to provide reference for the disease.

Abstract:As China is entering the aging society, the impact of psychological problems of the elderly on health has attracted increasing social attention. In the elderly population, fluctuations of blood pressure can lead to diseases such as sudden cardiac death and myocardial infarction, and negative emotions such as anxiety and depression are independent risk factors of blood pressure fluctuations in patients. Orthostatic blood pressure changes coexisting with anxiety-depression result in more complicated condition and worse prognosis in the elderly. However, the correlation between the two and their main mechanisms are not yet fully understood with a dearth of relevant studies, warranting further research and elucidation of the role that potential modifiable factors play in the development of such a complex condition. This article reviews the correlation and possible mechanisms between orthostatic blood pressure changes and anxiety-depressive events in the elderly, providing research directions for the diagnosis and treatment of orthostatic blood pressure changes and anxiety-depression in the elderly.