Abstract:Objective To explore the risk factors of recurrent fracture in elderly patients with osteoporotic fracture in order to provide theoretical basis for prevention of recurrent fracture. Methods The clinical data of 1 315 inpatients (aged ≥60 years) with osteoporotic fracture admitted in Department of Orthopaedics of Second Affiliated Hospital of Dalian Medical University from January 2015 to December 2019 were collected. According to the previous history of fracture, they were divided into first fracture group and refracture group (n=277). General data and blood biochemical parameters were compared between the two groups. SPSS statistics 25.0 was used to perform the statistical analysis. Student′s t test, Mann-Whitney U test or Chi-square test was employed for intergroup comparison depending on data type. Multivariate logistic regression analysis was adopted to analyze the risk factors affecting refracture in elderly patients with fragility fracture. Results The patients from the first fracture group were younger [(73.31±9.01) vs (76.26±8.11) years]and had lower proportion of females (74.40% vs 83.00%) than those in the refracture group (P<0.05). The most common causes of fracture were fall (81.29%), no inducement (7.07%), low-back load (6.24%) and change in body posture or sprain (5.40%). The overall diagnosis rate of osteoporosis was 13.00% in elderly patients with osteoporotic fracture during hospitalization. The utilization rate of calcium, vitamin D and bisphosphate drugs was 12.50%, 8.80% and 4.90%, respectively. The risk factors of refracture include advanced age (OR=1.022), elevated blood phosphorus (OR=3.220), low hemoglobin (OR=0.983), hypoglycemia (OR=0.938), low serum creatinine (OR=0.995), hypoalbuminemia (OR=0.950) and complicated with chronic obstructive pulmonary disease (COPD) (OR=2.214). Conclusion The elderly with advanced age, higher blood phosphorus, lower hemoglobin, hypoglycemia, low serum creatinine, hypoalbuminemia and complicated with COPD are at high risk for refracture. The diagnosis and treatment rates of osteoporosis are quite low in the elderly patients with osteoporotic fractures during hospitalization.

Abstract:Objective To investigate the correlation between preoperative free triiodothyronine (FT3) to free thyroxine (FT4) (FT3/FT4) ratio and post-contrast acute kidney injury (PC-AKI) in the patients with acute coronary syndrome (ACS). Methods A retrospective analysis was performed of the clinical data of 10101 ACS patients undergoing percutaneous coronary intervention (PCI) in the General Hospital of Northern Theater Command from January 2016 to December 2017. The FT3/FT4 ratio was calculated based on the laboratory tests, and the patients were divided into three groups according to the FT3/FT4 ratio:low FT3/FT4 group (FT3/FT4＜0.233, n=3152),intermediate FT3/FT4 group(0.233≤FT3/FT4＜0.304, n=3636), and high FT3/FT4 group (FT3/FT4≥0.304, n=3313). The endpoint of the study was defined as the incidence of PC-AKI in the ACS patients undergoing PCI. SAS 9.4 was used for statistical analysis. Depending on data type, data comparison among three groups were performed by analysis of variance, Kruskal-Wallis test orχ²test. The correlation between preoperative FT3/FT4 ratio and the occurrence of PC-AKI was analyzed using restricted cubic spline. Results There were statistically significant differences among the three groups in age, proportion of men, proportion of hypertension, proportion of diabetes mellitus, history of previous PCI, smoking, left ventricular ejection fraction, hemoglobin level, FT3 and FT4 levels, proportion of radial artery approach, target vessel at the anterior descending branch, and intraoperative use of contrast agent (P<0.05 for all). The incidence of PC-AKI was 2.95% (93/3152), 1.27% (46/3636), and 1.54% (51/3313) in the low, intermediate, and high FT3/FT4 group, respectively, and the differences were statistically significant (P<0.001). Preoperative FT3/FT4 ratio and the incidence of PC-AKI in ACS patients showed a U-shaped relationship. Using the FT3/FT4 ratio of 0.305 as the reference value, the risk of PC-AKI tended to increase with either lower or higher FT3/FT4 ratios. Conclusion FT3/FT4 ratio is closely related to the occurrence of PC-AKI in ACS patients, and the risk of PC-AKI increases with either lower or higher FT3/FT4 ratios.

Abstract:Objective To investigate the clinical implications and application value of triglyceride-glucose (TyG) index in late recurrence after radiofrequency catheter ablation (RFCA) in the non-diabetic patients with persistent atrial fibrillation (PeAF). Methods The clinical data were retrospectively reviewed of 242 non-diabetic PeAF patients, who received RFCA for the first time at Cardiology Department in Seventh People′s Hospital of Zhengzhou and Henan Provincial Chest Hospital from January 2020 to August 2021. The patients were regularly monitored for recurrence at 1,3, 6 and 12 months following the procedure, and according to recurrence within 3-12 months, they were divided into non-recurrence group (n=190) and recurrence group (n=52). Statistics and graphics were performed using SPSS statistics 26.0 and GraphPad 9.0. Depending on data type, t test, Mann-Whitney U test, χ² test or adjusted χ² test was used for comparison between groups. Multifactorial Cox regression was used for analyzing independent risk factors for late recurrence and the predictive value of TyG index for postoperative recurrence in the non-diabetic PeAF patients. Results The recurrence group had a longer PeAF history with a higher tendency to develop coronary artery disease (CAD), a significantly larger left atrial diameter (LAD), a higher TyG index, and a higher proportion of patients not treated with angiotensin receptor neprilysin inhibitor (ARNI) (P<0.05). PeAF history, CAD, LAD, postoperative ARNI treatment and TyG index were independent risk factors for recurrence (P<0.05). Non-diabetic PeAF patients with higher TyG index were more prone to recurrence. Conclusion TyG index has a good predictive value for late recurrence after RFCA in non-diabetic PeAF patients, providing significant guidance for their comprehensive management.

Abstract:Objective To investigate the efficacy and dosimetric characteristics of different radiotherapy modalities in the elderly patients with multiple brain metastases from non-small-cell lung cancer with a view to providing a basis for clinical decision on radiotherapy modalities for such patients. Methods A total of 115 elderly patients with multiple brain metastases from non-small-cell lung cancer admitted to Qingdao Central Hospital Affiliated to Qingdao University from August 2018 to August 2021 were retrospectively analyzed. According to the radiotherapy modalities employed, they were divided into whole-brain radiotherapy group (n=40), sequential boost group (n=33), and simultaneous integrated boost group (n=42). SPSS 26.0 was used for statistical analysis. Analysis of variance, t test or Chi-square test was used for inter-group comparison depending on the data type. Results The effective rate was 47.5% (19/40) in the whole-brain radiotherapy group, 60.6% (20/33) in the sequential boost group, and 76.2% (32/42) in the simultaneous integrated boost group. The local control rates were 72.5% (29/40), 87.9% (29/33) and 95.2% (40/42), respectively. The effective rate and disease control rate in the simultaneous integrated boost group were higher than those in the whole-brain radiotherapy group, and the differences were statistically significant (P<0.05). The one-year intracranial progression-free survival (IPFS) rates were 25.0% (10/40), 69.7% (23/33) and 73.8% (31/42), and the one-year overall survival (OS) rates were 47.5% (19/40), 75.8% (25/33) and 78.6% (33/42) in the whole-brain radiotherapy group, sequential boost group, and simultaneous integrated boost group, respectively. The IPFS rate and OS rate at 1 year were higher in the sequential boost group and simultaneous integrated boost group than those in the whole-brain radiotherapy group, and the differences were statistically significant (P<0.01). Conformation number (CN) and prescription isodose volume to target volume ratio (PITV)(0.88±0.04,1.06±0.06) of planning tumor volume (PTV) in the simultaneous integrated boost group were better than those in the whole-brain radiotherapy group (0.86±0.07,1.11±0.13), which were better than those in the sequential boost group (0.81±0.05,1.21±0.08), and the differences were statistically significant (P<0.01). Target coverage (TC) of PTV in the sequential boost group (0.99±0.01) was better than that in the whole-brain radiotherapy group (0.97±0.17) and that in the simultaneous integrated boost group(0.97±0.02), and the difference was statistically significant (P<0.05). Homogeneity index (HI) of PTV in the whole-brain radiotherapy group (0.06±0.02) was better than that in the simultaneous integrated boost group (0.25±0.07), which was better than that in the sequential boost group (0.36±0.12), and the differences were statistically significant (P<0.01). CN and PITV of plan gross tumor volume in the simultaneous integrated boost group (0.79±0.10,1.25±0.21) were better than those in the sequential boost group (0.67±0.13,1.54±0.45), and the diffe-rences were statistically significant (P<0.01). Number grade 3 or higher adverse reactions occurred in any of the three groups. Conclusion The whole brain radiotherapy combined with simultaneous integrated boost can be the optimal treatment for the elderly patients with multiple brain metastases from non-small-cell lung cancer.

Abstract:Objective To explore the value of 6-minute walk test (6MWT) combined with serum cytokines in evaluating the prognosis of chronic heart failure (CHF). Methods A total of 82 CHF patients admitted to our hospital from January 2020 to January 2021 were selected as the study subjects. Their clinical data and cardiac function indicators such as left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, and serum N-terminal pro-brain natriuretic peptide(NT-proBNP) levels were collected. 6MWT test was conducted on all of them after admission. The serum levels of cytokines, including interleukin-22 (IL-22), tumor necrosis factor-α (TNF-α) and nuclear factor-kappa B (NF-κB) were detected and recorded. SPSS statistics 19.0 was used for data processing. Pearson or Spearman correlation analyses were employed to analyze the correlation of 6MWT results and serum cytokine levels with cardiac function indicators. Receiver operating characteristic (ROC) curve was plotted to assess the predictive values of various indicators for the prognosis of CHF patients. Cox risk proportional regression model was applied to analyze independent risk factors affecting the prognosis. Results During 1-year follow-up, 2 patients were lost. The other patients were divided into event group (n=36) and non-event group (n=44) according to the occurrence of adverse end points. The patients in the event group had significantly shorter 6MWT distance [(301.25±36.78) vs (413.51±42.36) m], and obviously higher serum levels of IL-22 [(643.51±53.69) vs (511.07±60.11) pg/ml], TNF-α [(412.15±56.69) vs (284.55±35.79) ng/L] and NF-κB [(96.67±13.69) vs (70.05±12.57) pg/ml] when compared with those in the non-event group (all P<0.05). Opposite results [6MWT distance:(390.52±45.87) vs (346.47±43.15) m; IL-22:(540.09±60.33) vs (589.01±58.77) pg/ml; TNF-α:(325.21±53.69) vs (352.02±54.77) ng/L; NF-κB:(78.07±10.85) vs (84.04±11.33) pg/ml] were observed in the patients of NYHA class Ⅱ than those of NYHA class Ⅲ (all P<0.05). Correlation analysis showed that 6MWT result was positively correlated with LVEF in the CHF patients (r=0.511, P<0.001), and negatively with NYHA class (r=-0.405, P=0.012) and serum NT-proBNP level (r=-0.456, P<0.001); serum IL-22 level was negatively correlated with LVEF (r=-0.383, P=0.016) and positively with NT-proBNP level (r=0.296, P=0.037); serum TNF-α level was negatively correlated with LVEF (r=-0.425, P=0.008), and positively with NYHA class (r=0.305, P=0.030) and serum NT-proBNP level (r=0.377, P=0.017); Serum NF-κB level was negatively correlated with LVEF (r=-0.317, P=0.028), and positively with NYHA class (r=0.304, P=0.031) and serum NT-proBNP level (r=0.246, P=0.043). The TNF-α level was negatively correlated with 6MWT result (r=-0.369, P=0.018), and positively with serum IL-22 (r=0.413, P=0.010) and NF-κB levels (r=0.356, P=0.021). ROC curve analysis found that the area under the curve of combined 6MWT result and serum TNF-α and NF-κB for predicting poor prognosis in CHF patients was 0.991 (95%CI 0.939-1.000), with a sensitivity of 0.972, and a specificity of 0.977, and all these values were superior to those of a single indicator. Cox risk proportional regression analysis indicated that 6MWT result and serum TNF-α level were independent risk factor for adverse end points in CHF patients within 1 year after discharge. Conclusion 6MWT result combined with TNF-α, IL-22 and NF-κB levels shows good predictive value for the prognosis of CHF patients.

Abstract:Objective To analyze the epidemiological characteristics of the elderly patients in the emergency department of a grade-A tertiary hospital in Beijing and to explore the optimal medical service process of diagnosis and treatment. Methods A retrospective study was conducted of the general information and visit data of 30 900 elderly patients who visited the Emergency Department of Xuanwu Hospital of Capital Medical University from January 2017 to December 2020, analyzing their general characteristics, visit distribution, distribution of visit time, and epidemiological characteristics. SPSS statistics 24.0 was used for data analysis. Depending on data type, analysis of variance or Kruskal-Wallis test was used for comparison between groups. Results Of 305 900 elderly patients, the mean age was (72.34±9.27) years, the male/female ratio was 0.86∶1.00, and 54.85% (16 778/305 900) were from other areas than Xicheng District, where the hospital is located. The elderly patients in Grade Ⅰ,Ⅱ and Ⅲ numbered 263 635, accounting for 0.37% (1132/305 900), 5.97% (18 265/305 900) and 79.84% (244231/305 900), respectively. The visits peaked from October to December and from January to February. Patients accompanied by family members or others accounted for 77.29%(236 430/305 900), and 3.70% (11 318/305 900) were transported to hospital by ambulance. The top three departments visited were the Department of Internal Medicine [46.66% (231 272/305 900)], the Neurology Department [31.55% (96 507/305 900)], and Surgical Department [11.15% (34 107/305 900)]. Cerebrovascular diseases, cardiovascular diseases and trauma ranked the top three on the disease spectrum, and the data collection rate was 100.00%. Conclusion The number of emergency visits by the elderly patients increases year by year with distinctive distribution characteristics. It is necessary to optimize the process of visit and rational allocation of resources at the emergency department. In the meanwhile, the overall treatment experience of the elderly emergency patients needs to be improved by strengthening education of the elderly patients in the disease knowledge and promoting the rational application of medical resources.

Abstract:Objective To explore the predictive ability of nomogram for the incidence of type 2 diabetes mellitus (T2DM) in the elderly for 5 and 7 years. Methods This study was based on the data published by the Dryad website of individuals who underwent physical examination in a physical examination center from 2004 to 2015. Finally 712 elderly people without T2DM were enrolled at the baseline, with a follow-up period of 5 and 7 years. According to the T2DM diagnosis at the end of follow-up, all participants were divided into diabetes group (n=679) and non-diabetes group (n=33). The two groups were compared in the demographic and clinical characteristics. Univariate and multivariate Cox regression analysis were used to determine independent risk factors. Based on the findings of Cox regression multivariable analysis, a nomogram was constructed to predict the 5- and 7-year incidence of T2DM in the elderly in China. The receiver operating characteristic (ROC) curve and the concordance index were used to evaluate the differentiation of the model, and the calibration curve was used to evaluate the calibration of the nomogram model. R software was used for statistical analysis, nomogram (4.2.0) was generated based on multivariate prediction model(http://www.r-project.org/). Data comparison between two groups was perfomed using t test, Kruskal-Wallis rank sum test or χ² test depending on data type. Results There were statistically significant differences in fasting blood glucose (FBG), triglyceride (TG), high-density lipoprotein cholesterol, glycosylated hemoglobin Alc (HbA1c) and alanine aminotransferase (ALT) between the two groups (P<0.05 for all). According to Cox regression multivariable analysis of the participants and previous studies, gender, age, body mass index, ALT, TG, HbA1c, FBG were finally included in the nomogram. The area under the ROC curve (AUC) for 5-year was 0.905, and for 7-year was 0.835. The concordance index was 0.850 (95%CI 0.772-0.929), indicating a good discrimination of the model. The calibration curve showed good consistency between the estimated probability and the actual result. Conclusion Our nomogram is a simple and reliable tool for predicting the 5- and 7-year risk of T2DM in the elderly in China. Using this model, early identification of high-risk groups helps to timely intervene and reduce the incidence of T2DM.

Abstract:Objective To explore the association of serum uric acid (UA) with local muscle mass in the elderly males in a view to providing a new perspective and basis for the prevention and control of sarcopenia. Methods A total of 350 males aged 60 years and over in the Department of Geriatrics in Affiliated Hospital of Nanjing University Medical School from January 2019 to December 2021 were selected as subjects. According to serum UA, they were divided into four groups:Q1 (0-<320 μmol/L), Q2 (320-<360 μmol/L), Q3 (360-<420 μmol/L), and Q4 (≥420 μmol/L) (Q=quadrant). The four groups were compared in the muscle percentiles of the hip and spine, and blood lipids. SPSS statistics 20.0 was used for data analysis. According to data type, comparison between groups was performed using Nonparametric Kruskal-Wallis H test. After adjusting for age, body mass index, blood lipid and other confounding factors, partial correlation was used to analyze the correlation between serum UA and local muscle mass. Results With higher UA, total cholesterol, triglyceride, serum creatinine increased significantly in Q4 group (P<0.05). There was no significant difference in the hip muscle mass between the four groups (P=0.641), and serum UA levels showed a reverse J-shaped curve with hip muscle mass. Pinal muscle mass in the Q4 group was significantly lower than that in the Q1 group (P=0.024). There was a significant negative correlation between UA level and the hip muscle mass in the Q4 group (r=-0.239, P=0.006), but no correlation was found between UA and the waist muscle mass in the same group. Conclusion Hyperuricemia can cause a decrease in local muscle mass, especially of the hip, in the males aged 60 years or over. It is advised to keep serum UA at an optimal level (UA<420 μmol/L) to help maintain skeletal muscle mass and hip muscle percentile.

Abstract:Objective To investigate whether liraglutide plays a protective role in diabetic nephropathy (DN) by inhibiting the activation of NOD-like receptor pyrin domain containing 3 (NLRP3). Methods Twenty-two male Wistar rats (4 weeks old) were randomly divided into normal control group (n=6), liraglutide group (n=8) and normal saline group (n=8). After DN model was established, the rats of the liraglutide group were subcutaneously injected with 200 μg/(kg·d) liraglutide, those from the normal saline group were subcutaneously injected with same volume of normal saline, and those of the normal control group received no treatment. After 4 weeks′ treatment, body mass, 24 h urinary total protein (UTP), fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), blood urea nitrogen (BUN), serum creatinine (SCr) and other biochemical indexes were detected. Hematoxylin-eosin(HE) staining was used to observe the pathological changes of renal tissue. The expression of NLRP3 inflammasome-related proteins in renal tissue was measured by Western blot, and the serum levels of interleukin-18 (IL-18) and interleukin-1β (IL-1β) were detected by enzyme-linked immunosorbent assay (ELISA). SPSS statistics 26.0 and Graph Prism 9.0 software were used for analysis and mapping. One-way ANOVA was employed for intergroup comparison for measurement data, and Tukey test was adopted for intra-group comparison. Results Liraglutide intervention improved the levels of FBG, UTP, BUN, SCr, TC and TG when compared with those in normal saline group (P<0.01). Pathological observation displayed that normal structure of glomeruli and tubules were observed in the normal control group, increased glomerular volume and structure, extramembranous matrix, and significant thickening in basement membrane were seen in the normal saline group, and the pathological changes of the kidneys were alleviated in the liraglutide group. Western blot assay indicated that the protein expression levels of NLRP3 inflammasome-related proteins were significantly lower in the liraglutide group than the normal saline group. The results of ELISA showed that the levels of IL-18 and IL-1β were significantly increased in the normal saline group, but decreased after liraglutide intervention. Conclusion Liraglutide alters disease progression in DN rats, which may be related to its inhibition of NLRP3 inflammasome activation.

Abstract:Osteoporosis is a systemic bone disease characterized by decreased bone mass and damage of bone tissue microstructure, resulting in increased bone fragility and prone to fracture. Its treatment methods mainly include drug therapy and physical therapy. Drug therapy is effective, but there are some problems such as long treatment period and poor compliance. In this review, we mainly describe the application of physical therapy in osteoporosis, and explore its feasibility, seeking a suitable physical treatment for osteoporosis in China.

Abstract:Diabetic nephropathy (DN) has been one of the major public health problems in China, and most patients eventually develop end-stage renal disease. In the context of research in "gut-kidney axis" in recent years, increasing evidence supports the dual influence of gut microbiota and kidney. This article elaborates the effects of gut microbiota of its metabolites (short-chain fatty acids axis, bile acids axis, and endotoxin axis) on insulin secretion and inflammatory response in different DN stages, and summarizes the different pathways of gut microbiota in early and middle/late DN stages in a view to providing new research orientations for multi-target therapy of DN.

Abstract:Atrial fibrillation (AF) is closely associated with cognitive impairment. Evidence from clinical research reveals that AF increases the risk of cognitive impairment by 1.5-2.5 times; the functional and structural abnormalities of the brain tissues caused by AF are the major cause of cognitive impairment; anticoagulation, ventricular rate control rhythm control, and other therapeutic strategies can significantly reduce the risk of cognitive impairment. However, AF-associated cognitive impairment has not received adequate clinical attention and is often overlooked. This article reviews the relationship between the two to provide data for preventing and treating AF-associated cognitive impairment.

Abstract:Elderly patients with type 2 diabetes mellitus have multiple physical impairments and a higher risk of falls than the healthy elderly people. Type 2 diabetes mellitus can induce muscle atrophy, osteoporosis, decreased tendon strength, central and peripheral neuropathy, vestibular dysfunction, optic neuropathy and retinopathy, further affecting the patient′s balance, coordination and proprioception that lead to gait instability and eventually increasing risk of fall. This paper reviews the triggering factors of falls and the exercise rehabilitation prevention in the elderly patients with type 2 diabetes mellitus, adding new perspectives to fall prevention in them.

Abstract:Frailty, a complex geriatric syndrome, can reduce the ability to resist stress and maintain homeostasis, having association with adverse outcomes such as falls, disability and death. Exercise intervention, as an efficacious, easy-to-implement, and low-cost anti-frailty approach, receives wide attention. Many trials in China and other countries have confirmed the effectiveness of different exercise types, but most of them have limitations. Therefore, we summarize and discuss those trials to provide ideas for designing and conducting more rigorous and effective trials and a theoretical basis for better exercise intervention prescriptions for frail elderly patients in clinical practice.

Abstract:Community-acquired pneumonia is a common disease with high mortality in China. The elderly people are more susceptible to pneumonia, and its death rate increases with age. Therefore, strengthening the comprehensive prevention of pneumonia in the elderly is of important social and economic significance. The preventive are measures multifactorial, including those to strengthen immune functions like vaccination and immunostimulants, as well as lifestyle changes, oral hygiene and management of underlying diseases, and optimization of functional status.