Abstract:Objective To investigate the influencing factors of delayed extubation after arthroplasty under general anesthesia and develop a nomogram model. Methods A retrospective analysis was performed of the electronic medical records of 377 elderly patients with hip or knee arthroplasty under general anesthesia from January 2016 to December 2020. According to whether the extubation time of tracheal catheter exceeded 1 h, the patients were divided into normal group (n=297 ) and delayed group (n=80). R Vision 3.6.1 and SPSS statistics 25.0 were used for data analysis. Depending on data type, t test, Mann-Whitney U test, χ² test or Fisher′s exact probability method were used for comparison between groups. Multivariate Lasso regression analysis was used to screen the risk factors of postoperative delayed extubation, and a nomogram was developed and validated. Results Multivariate Lasso regression analysis showed that being aged, hyperlactacidemia, and coefficient of variation (CV) were positively correlated with delayed extubation in arthroplasty (OR>1; P<0.05), and correction of hypokalemia and intraoperative blood glucose control (final blood glucose ＜8.3 mmol/L) were negatively correlated with delayed extubation (OR<1; P<0.05). A nomogram was developed, and Harrel′s C-index [the area under the receiver operating characteristic curve (AUC), 0.800,95%CI 0.745-0.854) and Hosmer-Lemeshow deviation test (χ²=3.000; P=0.600) confirmed good prediction efficiency of the model, with stable internally validated AUC value and calibration curve. The decision curve of the model showed significant net benefit and good clinical practicability. Conclusion Being aged, hyperlactacidemia, and CV were independent risk factors for delayed extubation after arthroplasty, while correction of hypokalemia and blood glucose control were protective factors. The nomogram is of high clinic reference value for delayed extubation.

Abstract:Objective To investigate the effect of dietary habits on comorbid sarcopenia occurrence in patients with chronic respiratory diseases and develop a risk model in order to provide reference for development of future intervention programs. Methods A total of 328 patients (age ≥45 years) with chronic respiratory diseases admitted to the outpatient and inpatient departments of respiratory diseases of the First Affiliated Hospital of Xinjiang Medical University from May to September 2021 were recruited in the study. SPSS statistics 25.0 and the glm and rms software packages in R 4.0.5 software were applied for data analysis. Chi-square test or Fisher′s exact probability test was used for intergroup comparison depending on different data type. Logistic regression model was employed to analyze the factors influencing comorbid sarcopenia in the patients with chronic respiratory diseases. The predictive value of each risk factor for comorbid sarcopenia was analyzed with receiver operating characteristic (ROC) curves, and a Nomogram was plotted for visualization. Results The prevalence of sarcopenia was 25.0% in the cohort. Logistic regression analysis showed that female (OR=18.44,95%CI 8.05-42.24), advanced age (≥70 years, OR=6.26,95%CI 2.51-15.61); BMI <18.5 kg/m² (lean; OR=6.26,95%CI 2.51-15.61), pure juice/vegetable juice intake for 1 to 3 times per week (OR=13.34,95%CI 2.16-82.60), nuts intake for 1 to 3 times per month (OR=0.25,95%CI 0.09-0.70), and nuts intake for once per day (OR=0.16,95%CI 0.03-0.80) were influencing factors for comorbid sarcopenia in patients with chronic respiratory disease. Conclusion Female, advanced age, low BMI (lean), fruit and vegetable juice/pure juice, and nuts are all closely associated with sarcopenia. These results provide a scientific basis for accurate assessment and rational dietary intervention in patients with respiratory diseases combined with sarcopenia.

Abstract:Objective To investigate the incidence of frailty and analyze its influencing factors in the elderly patients undergoing maintenance hemodialysis (MHD). Methods A cross-sectional study was conducted in 130 elderly inpatients or outpatients receiving regular MHD in the Second Affiliated Hospital of Anhui Medical University from October 2021 to April 2022. The general information, laboratory indicators, and anthropometric parameters were collected. Fried frailty phenotype was used to assess frailty. The two groups were compared in the general information, laboratory indicators, fall risk, activities of daily living, nutrition status, and anthropometric parameters. SPSS statistics 26.0 was used for data analysis. Depending on data type, comparison between groups was performed using t test, Man-Whitney U test, orχ² test. Partial correlation analysis was used to analyze the correlation between frailty score and each index, and multivariate stepwise logistic regression analysis to explore the influencing factors of frailty in the elderly MHD patients. Results The incidence of frailty was 40%(52/130) in the elderly MHD patients. Correlation analysis showed that frailty was positively correlated with malnutrition-inflammation score (MIS), Morse falling scale (MFS), C-reactive protein (CRP) (r=0.521,0.330,0.236; P<0.05) and negatively with Barthel index (BI), mid-arm muscle circumference (MAMC), serum albumin (Alb), and hemoglobin (Hb) (r=-0.424, -0.438, -0.478, -0.332; P<0.001) . Multivariate logistic stepwise regression analysis showed that MIS score (OR=1.156,95%CI 1.002-1.333; P=0.047), Alb (OR=0.851,95%CI 0.687-0.931; P=0.013), BI (OR=0.972,95%CI 0.947-0.988; P=0.032), and age (OR =1.107,95%CI 1.018-1.204; P=0.017) were influencing factors for frailty in the elderly MHD patients. Conclusion The incidence of frailty is high in the elderly MHD patients. MFS, MIS score and CRP are positively correlated with frailty, while the BI, Hb, Alb and MAMC are negatively correlated with frailty. Alb and BI are protective factors of frailty, and age and MIS score were risk factors of frailty.

Abstract:Objective To observe the volume changes incurred by sacubitril/valsartan and its effects on cardiac structure and functions in patients with chronic heart failure (CHF) complicated with renal insufficiency. Methods A total of 84 CHF patients complicated with renal insufficiency were consecutively enrolled, who were admitted to the First Hospital of Qinghuangdao from December 2020 to March 2022. They were divided into sacubitril/valsartan group (n=48) and control group (n=36). The sacubitril/valsartan group received sacubitril/valsartan and the control group valsartan alone. On the follow-up visit after 6 months of medication, 24-hour urine volume, diuretic dose, and brain natriuretic peptide (BNP) level were measured, New York Heart Association (NYHA) classification was performed, and cardiac structure and functions were evaluated by echocardiography in the two groups. Results Compared with the control group, 24-hour urine volume in sacubitril/valsartan group increased significantly [(1514.38±694.73) vs (1003.33±178.92) ml; P<0.01], and NYHA classification was significantly improved (P=0.032) after therapy. Compared with the baseline, the dose of diuretic [(19.38±7.55) vs (23.75±7.89) mg] and the level of BNP [811 (250,1481) vs 1 980 (727,5014) pg/ml] decreased significantly (P<0.01), and the urine volume in 24 h [(1514.38±694.73) vs (890.63±121.45) ml] increased significantly (P<0.01) at 6 months in the sacubitril/valsartan group. Compared with the control group, stroke output (SV) [(102.39±20.85) vs (77.98±18.51) ml], cardiac output (CO) [(7.39±2.18) vs (5.84±1.72) L/min], left ventricular ejection fraction (LVEF) [(36.87±6.16)% vs (33.08±7.59)%], mitral diastolic blood flow velocity E peak and A peak ratio (E/A) [1.30 (1.25,1.82) vs 1.04(0.59,2.53)] increased significantly ( P<0.05 for all), and left atrium (LA) [(42.97±6.01) vs (48.17±5.17) mm]decreased (P<0.05) in the sacubitril/valsartan group after therapy. The left ventricular end-diastolic diameter (LVEDD) [(64.9±10.3) vs (69.0±12.1) mm], left ventricular end-systolic diameter (LVESD) [50.5 (50.0,56.1) vs 54.0 (48.3,61.9) mm] and LA [(42.97±6.01) vs (47.61±8.06) mm] in the sacubitril/valsartan group decreased significantly and SV [(102.39±20.85) vs (68.13±29.96) ml], CO [(7.39±2.18) vs (5.66±2.49) L/min], E/A [1.30 (1.25,1.82) vs 0.93 (0.88,1.10)] and LVEF [(36.87±6.16)% vs (27.26±6.24)%] increased significantly at 6 months compared with the baseline (P<0.01 for all). Conclusion Compared with valsartan alone, sacubitril/valsartan can significantly relieve the volume overload in the CHF patients complicated with renal insufficiency, optimize the volume management measures, and enhance cardiac systolic and diastolic function.

Abstract:Objective To determine the effect of dapagliflozin and sacubitril/valsartan on prognosis of patients with heart failure based on propensity score matching. Methods Clinical data of 369 patients with heart failure diagnosed in the First Hospital of Shanxi Medical University from June 2018 to December 2021 were collected and analyzed retrospectively in this study. According to the treatment they received, the subjects were divided into dapagliflozin group and sacubitril/valsartan group. After propensity score matching, the prognosis of the two groups was compared and the influencing factors were analyzed. SPSS statistics 26.0 and R Studio (version 4.1.2) were used for data analysis. Data comparison between two groups was conducted using student′s t test, rank sum test, Chi-square test or Fisher exact probability method depending on data type. Cox regression models were used to analyze the influencing factors for prognosis in two groups of patients, and Kaplan-Meier curves were plotted. Results There were 70 patients in each group after propensity score matching. Kaplan-Meier survival analysis showed no statistical difference in first heart failure rehospitalization after discharge between the two groups (P=0.190). Cox multivariate analysis showed that the New York Heart Association (NYHA) classification (HR=6.923,95%CI=1.032-46.426; P=0.046), left ventricular end diastolic diameter (LVEDD) (HR=1.139,95%CI=1.004-1.293; P=0.044) and Z score of N-terminal pro-B-type natriuretic peptide (NT-proBNP) (HR=1.825,95%CI=1.075-3.097; P=0.026) were prognostic risk factors for patients with heart failure. Alcohol drinking (HR=0.086,95%CI=0.018-0.413; P=0.002) and high-density lipoprotein cholesterol (HDL-C) (HR=0.012,95%CI=0.000-0.642; P=0.029) were prognostic protective factors in the dapagliflozin group. For the sakubatril/valsartan group, smoking (HR=14.376,95%CI=1.657-124.748; P=0.016) was a risk factor, while drinking (HR=0.082,95%CI=0.012-0.578; P=0.012) and hemoglobin (Hb, HR=0.953,95%CI=0.912-0.995; P=0.030) were protective factors. Conclusion After propensity score matching, NYHA classification, LVEDD, Z score of NT-proBNP, HDL-C and alcohol drinking are factors influencing the prognosis of patients with heart failure in the dapagliflozin group. Smoking, Hb and alcohol drinking are prognostic factors in the sakubatril/valsartan group. There is no significant difference in prognosis for heart failure in comparison of dapagliflozin and sakubatril/valsartan.

Abstract:Objective To investigate the correlation between small dense low-density lipoprotein cholesterol (sdLDL-C) and peri-operative myocardial injury (PMI) in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) and the predictive value of sdLDL-C for PMI. Methods A total of 141 CHD patients, 98 with angina and 43 with acute myocardial infarction, were retrospectively selected as the research subjects, who received elective PCI from January 2021 to June 2022, and 66 non-CHD individuals were selected during the same time. The clinical baseline data were collected, the distribution pattern of coronary lesions were recorded intraoperatively, and indexes such as the preoperative blood lipids and postoperative cardiac tropomom I (cTnI) were routinely tested. According to the postoperative cTnI value, the PCI patients were divided into the observation group with elevated cTnI level (n=86) and the control group with normal cTnI level (n=55). The two groups were compared for all the collected parameters, and the non-CHD group, the angina group and the acute myocardial infarction group were compared for sdLDL-C levels. SPSS 16.0 was used for statistical analysis. Data comparison between groups was performed using t-test orχ² test, depending on data type. Analysis of variance and trend testing were used for pairwise comparison among the three groups. The relationship between sdLDL-C and postoperative cTnI elevation was evaluated using binary logistic regression analysis. Results sdLDL-C, total cholesterol, low-density lipoprotein cholesterol (LDL-C), numbers of implanted stents, and total length of the stents in the observation group were significantly higher than those in the control group[(0.74±0.26) vs (0.56±0.27)mmol/L,(4.51±1.17) vs (3.90±1.04)mmol/L,(2.77±0.80) vs (2.25±0.73)mmol/L,(1.74±0.91) vs (1.33±0.62),(52.52±27.93) vs (36.92±19.41)mm,all P<0.05]. The logistic regression analysis showed that sdLDL-C (OR=14.798, 95%CI 1.112-196.904) and LDL-C (OR=3.074, 95%CI 1.138-8.302) were the independent risk factors of PMI (P<0.05). The area under ROC curve for sdLDL-C was 0.727 (95%CI 0.637-0.817; P<0.05) with the best cut-off point of 0.518 mmol/L, and a sensitivity of 86.0% and a specificity of 56.4% for the diagnosis of PMI, and the Youden index was 0.424. sdLDL-C was (0.541±0.144) mmol/L in the non-CHD group, (0.621±0.257) mmol/L in the angina group, and (0.776±0.289) mmol/L in the acute myocardial infarction group, with significant differences between groups (P<0.05) and a significant upward trend (P<0.05). Conclusion The preoperative high level of sdLDL-C is a risk factor of PMI after PCI in the CHD patients, and sdLDL-C has a positive correlation with the severity of the disease.

Abstract:Objective To explore the predictive value of brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI) for major adverse cardiac and cerebrovascular events (MACCE). Methods Clinical data of 242 patients admitted to the Department of Geriatric Cardiology of First Affiliated Hospital of Nanjing Medical University from August 2008 to September 2014 were retrospectively analyzed, and the occurrence of MACCE was followed up. Patients were divided into MACCE group (n=125) and non-MACCE group (n=117) according to the occurrence of MACCE, and the clinical characteristics of the two groups were analyzed.The independent and combined predictive value of baPWV and ABI for MACCE were analyzed. SPSS statistics 29.0 was used for data analysis. Student′s t test or Mann-Whitney U test was employed for intergroup comparison according to data type, and Kaplan-Meier curve was adopted for survival comparison. Results The median follow-up time was 3.3 (2.6,4.2) years for the 242 patients, and 125 of them (51.7%) reached the main endpoint. Compared with non-MACCE group, the paitients of MACCE group were older, had higher baPWV, pulse pressure, blood uric acid, higher incidence of coronary heart disease and higher use of diuretic; while, ABI, toe brancial index (TBI) and diastolic blood pressure were lower, and the differences were statistically significant (P＜0.05). Multivariate Cox regression analysis indicated that baPWV (HR=1.000, P=0.012), ABI (HR=0.080, P=0.002) and diastolic blood pressure (HR=0.981, P=0.012) were independent predictors for MACCE. After ABI was added to the prediction model, both the area under ROC curve for predicting MACCE (0.674 and 0.717 respectively) and net reclassification index (NRI, 95%CI 0.029-0.061; P<0.001) were increased. Conclusion BaPWV and ABI are independent predictors for MACCE in elderly people, and their combination shows higher predictive value for MACCE occurrence.

Abstract:Objective To investigate the effects of acute liver injury on the elderly patients with sepsis in intensive care unit (ICU) and analyze its risk factors. Methods A retrospective analysis was made on the clinical data of 123 elderly septic patients admitted to the Intensive Care Unit (ICU) of Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University from September 2019 to August 2022. According to the presence of acute liver injury, they were divided into observationer group (sepsis complicated with acute liver injury, n=53) and control group (sepsis without acute liver injury, n=70). SPSS statistics 25.0 was used for data analysis, and according to the type of data, t-test, Mann-Whitney U test orχ² test were used for comparison between groups. Binary logistic regression was used to analyze the risk factors of senile sepsis complicated with acute liver injury. Results Compared with control group, the observation group showed a significant increase in acute physiology and chronic health evaluation (APACHE) Ⅱ score, direct bilirubin, total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), serum myoglobin (MB), prothrombin time, activated partial thrombin time, thrombin coagulation time, white blood cells, neutrophil percentage, and procalcitonin levels (P<0.05). The mortality in the observation group were significantly higher than that in the control group (P<0.05). Logistic regression analysis showed that ALT, GGT, procalcitonin level and APACHE Ⅱ score were risk factors of sepsis complicated with acute liver injury,while C-reactive protein level was protective factor. Conclusion Transaminase, coagulation index, infection index,and in-hospital mortality in the elderly septic patients complicated with acute liver injury increase significantly. Increased ALT, GGT, procalcitonin and APACHE Ⅱ score are risk factors of elderly septic patients complicated with acute liver injury.

Abstract:Objective To analyze the clinical efficacy of Jinlida granules combined with dapagliflozin for treatment of elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 142 elderly T2DM patients admitted in our hospital from December 2020 to December 2021 were recruited and then randomly divided into study and control groups, with 71 patients in each group. Those from the control group were treated with dapagliflozin, while those in the study group were given dapagliflozin and Jinlida granules. The therapeutic efficacy, indicators of glucose metabolism, pancreatic islet function, oxidative stress and levels of inflammatory factors were observed and compared between the two groups. SPSS statistics 22.0 was used for statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison depending on data type. Results The study group had significantly higher therapeutic effective rate than the control group [67 (94.37%) vs 58 (81.69%), P<0.05). Statistical differences were observed in 2-hour postprandial plasma glucose [(8.4±1.6) vs (9.5±2.4) mmol/L], fasting blood glucose [(6.1±0.3) vs (6.6±0.8) mmol/L], and glycosylated hemoglobin A1 [(6.2±0.7)% vs (6.8±0.3)%] between the two groups (all P<0.05). The insulin resistance index [(2.2±0.5) vs (2.7±0.4) ]was obviously lower, while the function of pancreatic β cells [(69.9±8.2) vs (60.7±8.4)] was stronger in the study group than the control group (both P<0.05). The study group had notably higher content of superoxide dismutase [(92.5±7.5 vs (84.5±7.4) U/ml], but lower levels of malondialdehyde [(2.4±0.6) vs (3.6±0.3) μmol/L] and C-reactive protein [(2.2±0.7) vs (3.2±0.8) mg/L] when compared with the control group (all P<0.05). No significant difference was seen in occurrence of adverse reactions between the two groups. Conclusion Combination of dapagliflozin with Jinlida granules shows better clinical efficacy in the treatment of elderly T2DM patients. It can effectively regulate the glucose metabolism of the body, improve the function of pancreatic islets, and reduce the inflammation and oxidative stress in the patients.

Abstract:Objective To study the changes in mitochondrial adenosine triphosphate (ATP) sensitive potassium channel Kir6.1 and mitophagy in cardiomyocyte hypertrophy. Methods The primary cardiomyocytes derived from 24-hour-old neonatal rats born were randomly divided into control group and model group. The control group was cultured in a high glucose medium containing 10% fetal bovine serum, while for the model group, 140 μmol/L isoproterenol (ISO) was added to the medium for 48 h to establish a cellular model of cardiomyocyte hypertrophy. The concentration of N-terminal pro brain natriuretic peptide (NT-proBNP) in the culture supernatant of cardiomyocytes was detected by enzyme linked immunosorbent assay. The mRNA expression of atrial natriuretic peptide (ANP) mRNA, brain natriuretic peptide (BNP) mRNA, β-myosin heavy chain (β-MHC) mRNA, inward rectifyimg potassium channel 6.1 (Kir6.1) mRNA and autophagy related gene 8 (Atg8) mRNA were detected by quantitative real-time polymerase chain reaction (qRT-PCR). The expression of Kir6.1, microtubule-associated protein 1 light chain 3 (LC3) and FUN14 domain-containing protein 1 (FUNDC1) were detected by Western blotting. GraphPad Prism statistics v9.0.0 was used for statistical analysis. Data comparison between two groups was performed using student′s t test. Results The supernatant concentration of NT-proBNP was significantly higher in the model group than the control group [(1699.43407.01) vs (808.6891.46) pg/ml, P<0.05]. When compared with the control group, the model group had obviously increased ANP, BNP and β-MHC expression and decreased Kir6.1 and Atg8 expression at mRNA level, and reduced expression of Kir6.1 as well as LC3 and FUNDC1 at protein level (all P<0.05). Conclusion The expression of mitochondrial ATP sensitive potassium channel and the level of mitophagy are decreased in cardiomyocyte hypertrophy.

Abstract:Hip replacement surgery has been regarded as one of the most commonly performed orthopaedic surgeries, with significant effectiveness in relieving pain and improving joint function. As the development of the concept of enhanced recovery after surgery, research on enhanced recovery of patients after hip arthroplasty are emerging, but still in its infancy. In this article, we reviewed the factors related to the enhanced recorery of patients following hip arthroplasty, in order to promote medical staffs to identify relevant factors, implement interventions and accelerate the recovery process of the patients.

Abstract:Familial hypercholesterolemia (FH) refers to a disease characterized by a significant increase in plasma low-density lipoprotein cholesterol levels caused by genetic mutations. FH patients have clinical manifestations such as skin and tendon xanthoma or corneal arch and may also experience cardiovascular involvement, even leading to acute myocardial infarction and other diseases in severe cases. Therefore, early identification, diagnosis, and treatment of FH are particularly important. This article provides a review of the molecular pathological basis of FH and the research progress in its diagnosis and treatment.

Abstract:Cognitive frailty (CF) has been regarded as a key factor affecting the quality of life and life health among the elderly population in the social context of large elderly population and accelerated aging globally. It is gradually receiving attention in the field of medical care at home and abroad. However, due to a late start, the research results on its conceptual framework, influencing factors, screening evaluation, and intervention methods have not reached a consensus yet. Its concerning with health outcomes are basically a research gap. In this article, we reviewed the above key points about CF, with the aim of helping medical care scholars in China understand the current status of its research and limitations it faces, so as to clarify research directions, help to optimize the current CF problems, and provide reliable data support for healthy aging in the future.

Abstract:The diaphragm, the most important respiratory muscle, is responsible for about 75% of the work of breathing. Diaphragmatic function can be assessed by measuring its thickness excursion by ultrasound, thereby assisting clinicians in making corresponding decisions. Diaphragmatic ultrasound has potential value in predicting the outcome of weaning in patients with mechanical ventilation, assisting the diagnosis of chronic obstructive pulmonary disease, predicting residual muscle relaxation after general anesthesia, predicting postoperative pulmonary complications, and assessing the effect of rehabilitation training. This article reviewed the ultrasound assessment methods of the diaphragm and its clinical application, thus providing guide for the clinicians to assess diaphragm function using ultrasound-related indicators and helping clinical work.

Abstract:Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common disease that affects patients′ quality of life and work productivity and increases risk of cardiovascular disease morbidity and mortality. Continuous positive airway pressure (CPAP) therapy is currently the first-line treatment for medium and severe OSAHS with positive effects in relieving symptoms such as snoring and daytime sleepiness and reducing the risk of complications such as hypertension and coronary heart disease. Clinically, however, it is difficult for some patients to undergo long-term treatment due to poor compliance, resulting in unsatisfactory efficacy and disease control. Therefore, compliance has become an important issue in CPAP therapy. Factors affecting compliance with CPAP are large in number and differ greatly among individuals, with common ones including patient′s general conditions (e.g., gender, age, race, education, smoking status), illness, psychological factors, and CPAP side effects. Intervening measures such as enhancing education in CPAP use, modifying patient′s cognitive behaviors, applying telemedicine monitoring, and reducing CPAP side effects are important in improving compliance with CPAP in OSAHS.