Abstract:Objective To investigate the application value of geriatric nutritional risk index (GNRI) in predicting postoperative delirium (POD) in elderly patients after noncardiac surgery. Methods A retrospective analysis was conducted on 479 elderly patients undergoing noncardiac surgery under general anesthesia in Xuzhou Central Hospital from October 2022 to September 2023. According to clinical outcomes, they were divided into a delirium group (n=140) and a non-delirium group (n=339). Basic information, preope-rative laboratory indicators and results of evaluation scales were compared between the two groups. Multivariate logistic regression anslysis was applied to identify the independent risk factors for POD, and receiver operating characteristic (ROC) curve was drawn to evaluate the value of GNRI and its fitting model in predicting POD in elderly patients undergoing noncardiac surgery. SPSS statistics 26.0 and R4.2.3 were employed for statistical analysis. Student′s t test, Mann-Whitney U test orχ² test was employed for intergroup comparison depending on data type. Results Significant differences were observed between two groups in terms of age, body mass index (BMI), GNRI, education level, admission to intensive care unit, operative category, degree of anaemia, Charlson comorbidity index (CCI), operation time, intraoperative fluid balance, and preoperative hemoglobin and uric acid levels and neutrophil to lymphocyte ratio (NLR). Multivariate logistic regression showed that GNRI, age, CCI, NLR, and operation time were independent risks for POD in the elderly patients (P<0.05). Based on the results of multivariate logistic regression analysis, the fitted Model 3 had an ROC area under the curve value of 0.893 (95%CI 0.862-0.919) in predicting POD, with a specificity of 81.4% and a sensitivity of 79.4%. Conclusion GNRI is an independent predictor of POD in elderly patients undergoing noncardiac surgery, and has good predictive value for the occurrence of POD.

Abstract:Objective To explore the correlation of macrophage migration inhibitory factor (MIF) and postoperative delirium. Methods A total of 109 elderly patients (≥65 years) undergoing lower extremity fracture surgery under combined spinal-epidural block in our hospital from June 2022 to June 2023 were prospectively enrolled. Before operation, mini-mental state examination (MMSE) was used to evaluate the cognitive function of each participants, and their blood and cerebrospinal fluid (CSF) samples were harvested to detect MIF level by enzyme linked immunosorbent assay (ELISA). After operation, confusion assessment method Chinese reversion (CAM-CR) was used to assess delirium, and according to the results, they were divided into delirium group (POD group, n=13) and non-delirium group (NPOD group, n=96). SPSS statistics 26.0 was used for data analysis. Depending on data type, student′s t test or Mann-Whitney U test was used for comparison between groups. Multivariate logistic regression model was used to analyze the risk factors of lower limb surgery in elderly patients. Receiver operating characteristic (ROC) curve was plotted to calculate the area under the ROC curve (AUC) to evaluate the diagnostic value of MIF. Spearman correlation analysis was employed to analyze the correlation between MIF and MMSE score. Results Among the 109 elderly patients, the incidence of delirium was 11.93% (13/109). Before operation, the MIF levels in the CSF and blood were significantly higher in the POD group than the NPOD group (P<0.05). Multivariate logistic regression analysis showed that preoperative MIF levels in CSF (OR=1.273,95%CI 1.120-1.446; P<0.001) and blood (OR=1.016,95%CI 1.001-1.031; P=0.032) were independent risk factors for postoperative delirium in elderly patients after lower limb fracture surgery. The AUC value of CSF and blood MIF levels in predicting POD was 0.877 (95%CI 0.799-0.956) and 0.884 (95%CI 0.819-0.949), the sensitivity was 81.50% and 76.84%, and the specificity was 84.62% and 100.00%, respectively. The Youden index was 0.66 and 0.77, which were statistically significant (P<0.0001). Spearman correlation analysis showed that CSF and blood MIF levels were negatively correlated with MMSE score (r=-0.335, -0.286; P<0.05). Conclusion Preoperative MIF level is closely associated with the occurrence of POD in elderly patients after surgery, and has the potential to be used as a biomarker to predict POD. MIF can reflect cognitive level, and is negatively correlated with MMSE score. The higher the CSF and blood MIF levels, the lower the MMSE score.

Abstract:Objective To determine the influence of chemotherapy-induced liver injury on quality of life in elderly patients with breast cancer, and to analyze the risk factors for liver injury. Methods A total of 226 elderly patients with breast cancer who underwent standard chemotherapy in our hospital from January 2021 to September 2022 were enrolled, and according to their liver injury evaluated with common terminology criteria for adverse events version 4.0 (CTCAE4.0) of United States Department of Health and Human Services, they were divided into liver injury group (58 cases) and non-liver injury group (168 cases). Functional assessment of cancer therapy-breast (FACT-B) was applied to compare the quality of life between the two groups of patients. The one-year survival rate was also compared between them. SPSS statistics 24.0 was used for data analysis. Depending on data type, Chi-square test, student′s t test or rank sum test was employed for intergroup comparison. Logistic regression analysis was applied to assess the influencing factors for chemotherapy-induced liver injury in elderly patients with breast cancer. Results The scores of physiological status, functional status and breast cancer-specific module and total score of FACT-B were significantly lower in the liver injury group than the non-liver injury group (P<0.05). Logistic regression analysis showed that intensive chemotherapy (OR=5.425,95%CI 3.227-9.120; P<0.05) and chemotherapy regimen of anthracyclines + taxanes (OR=3.367,95%CI 1.881-6.028; P<0.05) were the risk factors for chemotherapy-induced liver injury in elderly patients with breast cancer. After one year of follow-up, 14 cases of missing follow-up were eliminated, and the one-year survival rate was 86.79% (46/53) in the liver injury group and 94.97% (151/159) in the non-liver injury group, but there was no statistical difference between them (P>0.05). Conclusion Chemotherapy-induced liver injury cause a decrease in the quality of life of elderly breast cancer patients. Intensive chemotherapy and combined chemotherapy of anthracyclines and taxanes may increase the risk of liver injury. But further observation is needed to determine the effect of chemotherapy-induced liver injury on prognosis in future.

Abstract:Objective To investigate the mental and physical state of elderly patients with sudden deafness during hospitalization (SD), and to analyze its influence on therapeutic effect. Methods A total of 150 elderly SD patients admitted to our hospital from June 2021 to June 2023 were recruited and served as SD group, and another 50 age-matched individuals who took physical examination during the same period and had no hearing impairment were enrolled and subjected as control group. The short-form-36 health survey (SF-36) was used to investigate the quality of life (QOL) of SD group, and based on the average SF-36 total score, the elderly SD patients with the total score≥ the average score were assigned into a high QOL group (n=66), and those with the total score < average score into a low QOL group (n=84). The efficacy of their treatment was evaluated in 1-3 courses of treatment. SPSS 22.0 was used for data analysis. Depending on data type, student′s t test or Chi-square test was performed for intergroup comparison. Multivariate logistic regression model was employed to determine the related factors affecting the QOL of the patients. Spearman correlation analysis was utilized to evaluate the correlation between QOL and therapeutic efficacy in the elderly SD patients. Results Before treatment, the scores of dimensions of physiological function (PF), bodily pain (BP), social function (SF), mental health (MH) and total score of SF-36 scale were all significantly lower in the SD group than the control group (P<0.05). After treatment, the total effective rate of treatment was 48.67% (73/150) in the SD group, and the rate was 59.09% (39/66) in the high QOL group, which was obviously higher than that of the low QOL group (40.48%, 34/84, P<0.05). Spearman correlation analysis showed that the total SF-36 score was positively correlated the therapeutic efficacy in the elderly SD patients (r=0.211; P=0.023). Multivariate logistic regression analysis suggested that time from onset to treatment ＞7 d (OR=3.084,95%CI 1.529-9.463), dizziness (OR=2.125,95%CI 1.245-3.629), sleep disorder (OR=4.768,95%CI 2.122-10.713), anxiety (OR=1.923,95%CI 1.330-2.780), type A personality characteristics (OR=5.714,95%CI 1.481-22.053) and acute stress disorder (ASD) (OR=4.191,95%CI 1.518-11.568) were risk factors for poor QOL, and positive coping style (OR=0.389,95%CI 0.200-0.760) was a protective factor in elderly SD patients. Conclusion The QOL is significantly lower in the elderly SD patients than the individuals of same age, and there is a correlation between QOL and therapeutic effect in them. In addition to the necessary interventions, it is recommended to pay more attention to the QOL of the patients, and to improve their QOL during hospitalization in aspects of sleep improvement, emotion regulation, adjustment of coping styles and others.

Abstract:Objective To analyze the influence of post-intensive care syndrome(PICS) on symptom recovery, functional status and quality of life in elderly patients with severe pneumonia. Methods Using a systematic sampling method, a questionnaire survey was conducted on 155 elderly patients with severe pneumonia who were admitted to the intensive care unit (ICU) and successfully transferred from January 2020 to July 2023. A total of 148 valid questionnaires were collected, with an effective recovery rate of 95.48%. According to whether post-ICU syndrome occurred or not, the patients were divided into PICS group (n=69) and non-PICS group (n=79). The two groups were compared in the duration of clinical symptoms, lung function [forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and percentage of peak expiratory flow to predicted value (PEF%)], and quality of life [short-form 36-item health status questionnaire (SF-36)] at 4 weeks after ICU transfer. SPSS 24.0 was used for data analysis. According to the data type, t test or Chi-square test was employed for comparison between groups. Multivariate logistic regression analysis was used to evaluate the risk factors of PICS in elderly patients with severe pneumonia. Results There were no statistically significant differences in duration of fever, cough, expectoration and lung rales between the two groups of the patients (all P>0.05). There were significant differences in age, scores on acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) on the day of admission to ICU and ICU stay between the two groups (P＜0.05 for all). Multivariate logistic regression analysis showed that age >70 years old (OR=2.373,95%CI 1.173-4.800; P<0.05), APACHEⅡ score ≥ 20 points on the day of admission to ICU (OR=3.547,95%CI 2.123-5.925; P<0.05) and ICU stay ≥ 10 d (OR=2.992,95%CI 1.644-5.446; P<0.05) were risk factors of PICS in elderly patients with severe pneumonia (P<0.05). The FEV1, FVC, PEF%, and scores of physical health and mental health on SF-36 in the PICS group were lower than those in the non-PICS group at 4 weeks after ICU transfer (P<0.05 for all). Conclusion PICS can cause a decline in lung function and quality of life of patients with severe pneumonia. Patients with older age, critical illness on admission to ICU and longer ICU stay have a higher risk of PIUS, and it is clinically necessary to formulate targeted prevention and control measures.

Abstract:Sarcopenia is a group of syndromes characterized by age-related declines in skeletal muscle mass, strength, and function, which leads to a series of adverse outcomes such as falls, frailty, disability, and even death in the elderly. It also poses a significant burden on healthcare systems. Currently, there is no specific medication for sarcopenia, and exercise intervention is mainly used for its prevention and treatment. In this article, we reviewed the pathophysiological mechanism of exercise intervention and the recommendations for forms, intensity, and frequency of exercise for the elderly with sarcopenia in order to provide guidance for its prevention and treatment in clinical practice.

Abstract:Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease, and it often merges with multiple extrapulmonary manifestations, including malnutrition and amino acid metabolism disorders. Recently, amino acid metabolomics has been extensively studied in the pathogenesis, treatment and prognosis of COPD. Thus,deeply understanding the role of amino acid metabolism in COPD and exploring the application of amino acid supplements are instructive for the systemic management of COPD. Therefore, this review addressed the role of amino acid metabolism in COPD.

Abstract:As an emerging concept, oral frailty in the elderly has attracted more and more attention from scholars. Recent evidence has shown oral frailty is closely associated with various adverse health outcomes, including disability, falls, sarcopenia, and death. Poor oral health increases the risk of frailty in the elderly, and frailty also exacerbates oral health, forming a vicious cycle. Early identification and intervention of oral frailty can help improve the overall health status of elderly people. Therefore, in this article, we reviewed the concept of oral frailty, its research status and evaluation tools, and its impact on adverse health outcomes in elderly people, so as to draw the attention of Chinese scholars to oral frailty and promote the realization of healthy ageing for the elderly.