Abstract:Objective To investigate the correlation between circadian rhythm of blood pressure and vascular stiffness in elderly hospitalized patients with essential hypertension (EH). Methods The clinical data of 440 elderly EH patients admitted in Chinese PLA General Hospital from January 2022 to June 2023 were retrospectively analyzed. Their general information, medication history, biochemical test indicators, and results of ambulatory blood pressure monitoring (ABPM) and brachial-ankle pulse wave velocity (baPWV) were collected. According to the baPWV value, these patients were divided into normal (<1400 cm/s, n=108), low-risk (1400-＜1800 cm/s, n=200), and high-risk (≥1800 cm/s, n=132) groups. SPSS statistics 27.0 was used for data analysis. Depending on data type, student′s t test, one-way ANOVA, Mann-Whitney U test, or Chi-square test was employed for intergroup comparisons. Logistic regression analysis was applied to identify the risk factors for increased vascular stiffness in elderly EH inpatients. A vascular aging risk prediction model was constructed, and its predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results Among the 440 elderly EH patients, their average age was (68.6±6.4) years, and there were 235 (53.4%) male cases. The age, 24h systolic blood pressure(SBP), daytime SBP, nighttime SBP, fasting blood glucose(FBG) and glycosylated hemoglobin A1c of patients in the high-risk group were significantly higher than those in the normal and low-risk groups; 24 h diastolic blood pressure (DBP), daytime DBP, nighttime DBP, standard deviation of 24hSBP and daytime SBP of patients in the low- and high-risk groups were significantly higher than those in the normal group, and the difference was statistically significant (P<0.05). Trend Chi-square test showed that the proportion of reverse dipper pattern was increased significantly in the patients with increased vascular stiffness (χ²=17.626, r=0.168； P<0.01). Multivariate logistic regression analysis indicated that age (OR=1.112,95%CI 1.070-1.156; P<0.001), body mass index (BMI)(OR=0.870,95%CI 0.797-0.950; P=0.002), FBG (OR=1.201,95%CI 1.071-1.347; P=0.002), 24h SBP (OR=0.574,95%CI 0.409-0.806; P=0.001), daytime SBP (OR=1.599,95%CI 1.242-2.058; P<0.001), nighttime SBP (OR=1.157,95%CI 1.052-1.273; P=0.003) and reverse dipper blood pressure pattern (OR=2.435,95%CI 1.306-4.540; P=0.005) were independent risk factors for elevated baPWV in the elderly EH patients. Incorporating the above seven indicators to construct a vascular aging risk prediction model, the area under the ROC curve was 0.804,and the model had good predictive efficacy. Conclusion Reverse dipper blood pressure pattern is directly associated with increased vascular stiffness in elderly patients. ABPM and assessment of circadian rhythm is helpful for predicting vascular aging in elderly patients with hypertension.

Abstract:Objective To analyze the risk factors for malnutrition in elderly patients with colorectal cancer (CRC) during chemotherapy, and construct a prediction model for malnutrition in the patients. Methods A retrospective study was conducted on 354 elderly CRC patients admitted in our hospital from January 2022 to February 2023. They were divided into training set and verification set in a ratio of 2∶1. In the training set, univariate and multivariate logistic regression analyses were used to screen the risk factors of malnutrition in the patients during chemotherapy, and a prediction model was then constructed. In the verification set, receiver operating characteristic (ROC) curve was drawn to verify the prediction performance of the model. Data analysis was performed by using SPSS 22.0 software, and Chi-square test and independent sample t test were applied for intergroup comparison in enumeration and measurement data, respectively. Results There were 236 cases in the training set and 118 cases in the validation set. No significant differences were observed in general demographic data and clinical baseline data between two groups (P>0.05). In the training set, univariate analysis revealed that age, clinical stage, average monthly family income, mid-arm muscle circumference, BMI, protein intake and total energy intake were related factors for malnutrition in elderly CRC patients during chemotherapy (P<0.05). Multivariate logistic regression analysis showed that age, average monthly family income <5 000 yuan and clinical stage Ⅳ were independent risk factors (P<0.05), and protein intake was a protective factor of malnutrition in these patients (P<0.05). Based on the results of multivariate logistic regression analysis, a prediction model of malnutrition in elderly CRC patients during chemotherapy was constructed. Hosmer-Lemeshow fit test indicated that the model had good calibration (χ²=4.763, P=0.689). In the verification set, the area under the curve, sensitivity and specificity of the model was 0.805,81.61% and 85.48%, respectively. Conclusion The incidence rate of malnutrition is quite high among the elderly CRC patients during chemotherapy, and its influencing factors include age, average monthly family income, clinical stage and protein intake. The prediction model established on this basis has certain reference value to screen high-risk patients with malnutrition.

Abstract:Objective To investigate standard-reaching rate of blood pressure reduction in patients with mild to moderate primary hypertension after treatment of amlodipine besylate. Methods Based on the data from a prospective self-controlled trial, the patients with mild to moderate primary hypertension who met our inclusion criteria were enrolled and then treated with a single drug therapy of amlodipine besylate tablet with 5 mg dose for 8 weeks. The efficacy and safety of amlodipine besylate tablet were evaluated, and the standard-reaching rate of blood pressure reduction was calculated with 140/90 and 130/80 mmHg (1 mmHg=0.133 kPa) as blood pressure targets, respectively, and for the patients of different ages. SPSS statistics SAS 9.3 and Graphpad Prism 9.5.1 were used for statistical analysis. Intergroup comparison was performed using student′s t test, Fisher′s exact probability test or Chi-square test depending on data type. Results For the 120 patients included in this study, the decline in systolic (SBP) and diastolic blood pressure (DBP) was (16.7±12.9) and (12.9±7.5) mmHg, respectively, after treatment, with an effective rate of 72.5% (87/120), and an overall effective rate of 91.7% (110/120). Statistical significance was observed in the decrease in blood pressure before and after treatment of amlodipine besylate tablet (P<0.05), which was consistent with literature reports. With 140/90 and 130/80 mmHg as blood pressure targets, the standard-reaching rate was 51.6% (49/95) and 5.0% (6/119), respectively after 8 weeks of treatment (P<0.05). Subgroup analysis showed that the rate was 4.1% (4/98) and 9.5% (2/21), respectively in the younger and older age groups. The incidence of adverse events and adverse reactions was 15.8% (19/120) and 3.3% (4/120), respectively during the treatment period. Conclusion Amlodipine besylate is safe and effective in treatment of mild to moderate primary hypertension. However, when taking the intensified blood pressure reduction target of 130/80 mmHg as the standard, the achievement rate is only 5%. This suggests that monotherapy with commonly used antihypertensive drugs may face challenges in reaching the intensified blood pressure reduction target in clinical practice.

Abstract:Objective To make a longitudinal study on postoperative quality of life (QOL) in elderly patients with non-small cell lung cancer (NSCLC) and analyze its influencing factors. Methods Convenience sampling was used to subject the elderly NSCLC patients at 1 month after radical resection. A total of 190 questionnaires were distributed, and 182 valid ones were collected for their general data and QOL. According to the total score of functional assessment of cancer therapy-lung (FACT-L), the patients were divided into good (≥ average score) and poor (< average score) QOL groups. Then the patients were followed up, and their QOL was investigated again at 3 and 6 months after surgery. SPSS statistics 24.0 was employed for data analysis. Student′s t test, one-way repeated measures analysis of variance or Chi-square test was adopted for intergroup comparison depending on different data type. Logistic regression analysis was performed to identify the influencing factors for poor QOL in elderly NSCLC patients at 1 month after surgery. Results Among the 182 elderly NSCLC patients, 3 patients were excluded because of no second survey for QOL due to not cooperating with the reexamination or lost to follow-up at 3 months after surgery. Another 8 patients were lost to follow-up at 6 months after surgery, and only 171 valid questionnaires were obtained. With the elapse of postoperative time, the scores of dimensions and total score of FACT-L were gradually increased in elderly patients with NSCLC (P<0.05). The proportion of smoking history, rate of conversion to thoracotomy, incidence of postoperative pulmonary complications and rate of cancer-related fatigue were significantly higher in the poor QOL group than the good QOL group (P<0.05). Logistic regression analysis showed that smoking history (OR=3.074,95%CI 1.461-6.468), conversion to thoracotomy (OR=2.377,95%CI 1.099-5.145), postoperative pulmonary complications (OR=4.088,95%CI 2.193-7.621) and cancer-related fatigue (OR=3.016,95%CI 1.535-5.927) were risk factors for poor QOL in the elderly patients with NSCLC at 1 month after surgery (P<0.05). Among 171 elderly NSCLC patients, the total score of FACT-L at 6 months after surgery was significantly lower in those with cancer-related fatigue at 1 month after surgery than those without (P<0.05). Conclusion The elderly NSCLC patients with smoking history, conversion to thoracotomy, postoperative pulmonary complications and cancer-related fatigue are prone to poor QOL in the early postoperative period, but with the elapse of postoperative time, their QOL can be gradually improved. Cancer-related fatigue can have a continuous adverse effect on the postoperative QOL.

Abstract:Objective To investigate the survival status in the elderly patients with pulmonary interstitial fibrosis and analyze its related factors. Methods A total of 246 elderly patients with pulmonary interstitial fibrosis admitted to the First Affiliated Hospital of Xinjiang Medical University from June 2020 to June 2022 were included in the elderly group, and 160 non-elderly patients with pulmonary fibrosis in the non-elderly group. The quality of life of patients was investigated with the Chinese version of the Tool to Assess Quality of Life in Idiopathic Pulmonary Fibrosis (cATAQ-IPF) and the patients′ attitude towards death with the Chinese version of the Death Attitude Profile-Revised (DAP-R). The clinical characteristics were compared between the elderly group and the non-elderly group, and binary logistic regression model was employed to analyze the factors affecting the patients′ quality of life in the elderly group. Pearson correlation analysis was performed to analyze the correlation between quality of life and patients′ attitude towards death in the elderly group. SPSS 22.0 was used for statistical analysis. Depending on data type, data comparison between two groups was performed using t test orχ² test. Results In total, 220 patients in the elderly group and 150 in the non-elderly group completed the survey. Age, proportions of hypertension, diabetes mellitus and coronary heart disease, disease course and interstitial lung disease-gender-age-physiology (ILD-GAP) index in the elderly group were higher than those in the non-elderly group, and the education level and total score on cATAQ-IPF scale were lower than those in the non-elderly group, the differences being statistically significant (P<0.05). The total score on cATAQ-IPF in the elderly patients with pulmonary interstitial fibrosis was (264.64±36.78) points, the three dimensions most severely impaired being dyspnea, death sensitivity and social activity and the least impaired being interpersonal relationship. Binary logistic regression analysis suggested that disease course (OR=2.323,95%CI 1.382-3.906), ILD-GAP index (OR=3.725,95%CI 1.285-10.797), forced vital capacity (FVC) (OR=2.404,95%CI 1.514-3.817), modified medical research council scale (mMRC) (OR=2.102,95%CI 1.555-2.843), anxiety (OR=1.774,95%CI 1.143-2.751) and depression (OR=1.610,95%CI 1.124-2.304) were the risk factors of quality of life in the elderly patients with pulmonary interstitial fibrosis, and having a spouse (OR=0.619,95%CI 0.474-0.809) and medical coping style (OR=0.489,95%CI 0.355-0.673) were the protective factors of quality of life (P<0.05). Pearson correlation analysis showed that the patients′ quality of life was positively correlated with death fear and death avoidance (r=0.246,0.233；P=0.036,0.043), and was negatively correlated with natural acceptance (r=-0.278, P=0.021). Conclusion Compared with non-elderly patients, the elderly patients with pulmonary interstitial fibrosis have more underlying diseases, longer duration of pulmonary interstitial fibrosis, more serious condition and lower quality of life. In addition to disease-related factors, psychological factors have an impact on their quality of life. It is suggested to increase the attention to and intervention in psychological health in the elderly patients with pulmonary interstitial fibrosis in clinical practice.

Abstract:Objective To investigate the influencing factors for abnormal bone mass in elderly hypertension patients in a community of Taiyuan City in order to provide theoretical basis for the prevention and treatment of osteoporosis in these patients. Methods Clinical data of 198 elderly patients with hypertension registered in a community health service center of Taiyuan City from January 2021 to December 2022 were collected and retrospectively analyzed. According to the results of bone mineral density test, they were divided into normal bone mass group (T≥-1.0, n=97) and abnormal bone mass group (T<-1.0, n=101). The relevant biochemical indicators 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. Spearman correlation analysis was performed on the correlation of common biochemical indicators and bone mass. Binary logistic regression analysis was applied to analyze the independent influencing factors for abnormal bone mass. Results There were significant differences in terms of gender, age, systolic blood pressure (SBP), diastolic blood pressure (DBP), albumin, 25-hydroxyvitamin D [25 (OH)D] and blood calcium level between the normal and abnormal bone mass groups (P<0.05). Lumbar bone density was negatively correlated with gender, age, SBP, DBP and blood urea nitrogen (BUN) (r=-0.287, -0.293, -0.479, -0.201, -0.208; P<0.05), and positively with 25 (OH) D and albumin (r=0.346, 0.151; P<0.05). Binary logistic regression analysis showed that age, gender, SBP and DBP were independent influencing factors for lumbar bone density (P<0.05). Conclusion Gender, age and blood pressure are independent risk factors for abnormal bone mass in hypertension patients. Blood pressure and bone mineral density should be closely monitored in elderly hypertension patients in order to minimize the risk of osteoporotic fractures.

Abstract:Objective To compare the value of fenestration discectomy and percutaneous transforaminal endoscopic surgery in elderly patients with lumbar disc herniation. Methods A retrospective study was conducted on 156 elderly patients with lumbar disc herniation undergoing surgical treatment in our hospital from May 2020 to May 2022. According to their surgical techniques, they were divided into fenestration group (n=75) and transforaminal endoscopic surgery group (endoscopy group, n=81). The surgical indicators and surgical efficacy were compared between the two groups. SPSS statistics 22.0 was used for data analysis, and student′s t test or Chi-square test was employed for intergroup comparison depending on data type. Results Smaller incision length, less intraoperative bleeding volume and shorter length of hospital stay, but longer operation time were observed in the fenestration group than the endoscopy group (P<0.05). In three, six, and twelve months after surgery, both groups obtained declined visual analogue scale (VAS) and Oswestry disability index (ODI) and increased Japanese Orthopaedic Association (JOA) score in the lower back (P<0.05). But there were no statistical differences in the three items between the two groups at different time points (P>0.05). No significant differences were observed in the excellent and good rates, incidence of complications or revision rate between the two groups (P>0.05). But higher recurrence rate was found in the endoscopy group when compared with the fenestration group (6.17% vs 0.00%, P<0.05). Conclusion Percutaneous transforaminal endoscopic surgery shows similar efficacy as fenestration discectomy in the treatment of elderly lumbar disc herniation. And the former technique has the advantages of smaller length of incision, less amount of intraoperative bleeding, and shorter length of hospital stay, but the recurrence rate and revision rate are inferior to that of the latter technique, so percutaneous transforaminal endoscopic surgery should not be blindly adopted.

Abstract:Objective To investigate the influencing factors for comorbid sarcopenia in community-dwelling older patients with type 2 diabetes mellitus (T2DM) in order to provide a reference for developing individualized and practical interventions. Methods A total of 408 elderly T2DM patients subjected by cluster sampling from the communities of Urumqi City, Xinjiang, were enrolled during May to August, 2022. General data were collected through questionnaires, and clinical data and physical functions were measured and recorded. Univariate and multivariate binary logistic regression analyses were applied to identify the influencing factors for sarcopenia in T2DM patients. T2DM patients were divided into sarcopenia group and non-sarcopenia group. SPSS statistics 25.0 was used for statistical analysis. Student′s t test, Mann-Whitney U test or Chi-square test was utilized for intergroup comparison depending on data type. Results The incidence of sarcopenia was 20.6% (84/408) in the elderly T2DM patients. Significant differences were observed between those with sarcopenia and those without in terms of age, body mass index (BMI), education level, monthly income, fasting blood glucose (FBG), 2-hour postprandial blood glucose, duration of diabetes mellitus, sedentary time, and sleep time (P<0.05). The sarcopenia group had obviously lower skeletal muscle mass index, basal metabolic rate, total body water amount, protein, inorganic salts, skeletal muscle content, and body fat, percentage of body fat, right upper limb fat mass, right lower limb fat mass, left lower limb fat mass, left upper limb muscle mass, right upper limb muscle mass, left lower limb muscle mass, right lower limb muscle mass, and grip strength (left and right) than the non-sarcopenia group (P<0.05). The sarcopenia group had statistically longer results in 5 times sit-to-stand test and 6-meter step speed test when compared with the non-sarcopenia group (P<0.05). Multivariate analysis showed that BMI 18.5-<23.9 kg/m² (OR=0.201,95%CI 0.03-1.338), BMI ≥27.9 kg/m² (OR=0.019,95%CI 0.002-0.208), T2DM duration (OR=1.095,95%CI 1.025-1.171), daily sedentary time (OR=1.704,95%CI 1.299-2.235), sleep duration (OR=0.682,95%CI 0.48-0.969), postprandial blood glucose (OR=1.261,95%CI 1.056-1.506), 6-meter step speed (OR=1.224,95%CI 1.072-1.398), result of five times sit-to-stand test (OR=1.377,95%CI 1.204-1.576), and right lower limb muscle mass (OR=0.369,95%CI 0.253-0.583) were all influencing factors for sarcopenia in elderly T2DM patients (P<0.05). Conclusion Duration of T2DM, postprandial blood glucose, daily sedentary time, 6-meter step speed, result of five times sit-to-stand test, increased BMI, right lower extremity muscle mass, and sleep duration are strongly associated with sarcopenia occurrence in the elderly T2DM patients.

Abstract:Objective To explore the rehabilitation effects of jaw retraction resistance exercise combined with early VitalStim electrical stimulation on dysphagia patients after stroke. Methods A total of 124 elderly patients with dysphagia after stroke treated in our hospital from January 2021 to January 2023 were enrolled and divided into observation group (n=60) and control group (n=64) according to different rehabilitation intervention programs after admission. The observation group received jaw retraction resistance exercise combined with early VitalStim therapy, while the control group received early VitalStim therapy alone. The rehabilitation efficacy, as well as the differences in swallowing function, surface electromyography (sEMG) parameters, nutrition-related indicators, and quality of life scores before and after intervention, were compared between two groups. SPSS statistics 22.0 was used for statistical analysis. Student′s t test orχ² test was performed for intergroup comparison depending on data type. Results The total effective rate was significantly higher in the observation group than the control group (95.00% vs 82.81%, P<0.05). The observation group obtained obviously lower scores of video fluorescence swallowing study (VFSS) and drinking water test after intervention when compared with the scores before intervention and those of the control group after intervention (P<0.05). The average sEMG amplitude was notably higher, while the sEMG swallowing duration was remarkably shorter in the observation group after intervention than those before intervention and in the control group after intervention (P<0.05). The serum levels of albumin and prealbumin, and the score of short-form mini-nutritional assessment in the observation group after intervention were significantly higher than those before intervention and those in the control group after intervention (P<0.05). The observation group also had higher scores of all dimensions of the World Health Organization quality of life assessment scale after intervention when compared with the scores before intervention and those in the control group after intervention (P<0.05). Conclusion Jaw retraction resistance exercise combined with early VitalStim electrical stimulation shows a good rehabilitation effect on elderly stroke patients with dysphagia. It can not only improve swallowing disorders but also enhance nutritional status and improve quality of life.

Abstract:Objective To investigate the effects of radiofrequency target ablation combined with ozone injection on pain and functional rehabilitation of patients with lumbar disc herniation. Methods A retrospective analysis was made of the clinical data of 103 patients with lumbar disc herniation admitted to Nanchong Central Hospital from March 2021 to March 2023. According to treatment methods, the patients were divided into the control group receiving radiofrequency target ablation (n=51) and the study group receiving radiofrequency target ablation combined with ozone injection (n=52). After 6 months, the therapeutic effect, pain score before and after treatment and lumbar function score of the two groups were evaluated. SPSS statistics 20.0 was used for data analysis. According to the data type, t test orχ² test was used for data comparison between two groups. Results After treatment, the visual analogue score of study group was lower than that of control group [(3.27±0.84) vs (5.31±1.32) points], and the Oswestry disability index of study group was lower than that of control group [(15.26±2.64)% vs (19.32±3.57)%]. The low back pain score of Japanese Orthopaedic Society in study group was higher than that of control group [23.81±3.52) vs (20.37±2.81) points], and the total effective rate in the study group was higher than that of control group (92.31% vs 78.43%). The differences were statistically significant (P<0.05). Conclusion Radiofrequency target ablation combined with ozone injection can significantly reduce pain and promote functional recovery in the patients with lumbar disc herniation.

Abstract:Objective To investigate emotional disorders and quality of life (QOL) in elderly patients with hyperthyroidism, and analyze the factors influencing their quality of life. Methods A total of 134 elderly patients with hyperthyroidism admitted to our hospital from January 2022 to April 2023 were enrolled in this study. Their thyroid hormone levels were measured, and questionnaires were conducted, including demographic information, self-assessment anxiety scale (SAS), self-assessment depression scale (SDS), and 36-item short-form health survey (SF-36). SPSS statistics 26.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test, or analysis of variance depending on data type. Pearson correlation analysis was used to examine the correlation between emotional disorders and quality of life in patients. Multiple logistic regression analysis was used to investigate the influencing factors of quality of life in elderly patients with hyperthyroidism. Results The SAS, SDS and QOL scores were (52.97±4.33), (54.89±4.68) and (5.25±6.39) points, respectively, in the elderly patients with hyperthyroidism. There were statistically differences in QOL score among these elderly patients with different education levels, living conditions, household per capita monthly income, and free thyroxine (FT4) and free triiodothyronine (FT3) levels (P<0.05). Pearson correlation analysis showed a negative correlation between QOL score and SAS and SDS scores in them (r=-0.403, -0.361; both P<0.05). Multivariate logistic regression analysis indicated that education level, household per capita monthly income, FT3 and FT4 levels, as well as SAS and SDS scores were influencing factors for QOL in elderly patients with hyperthyroidism (P<0.05). Conclusion Elderly patients with hyperthyroidism are prone to emotional disorders and have poor QOL. Education level, household per capita monthly income, FT3 and FT4 levels, as well as emotional disorders are important factors influencing their QOL.