Abstract:Objective To investigate the status quo and influencing factors of atrial fibrillation (AF) recurrence in the elderly patients after radiofrequency catheter ablation (RFCA). Methods A sample of 794 AF patients who received RFCA treatment in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2019 to December 2019 were selected in this study. The patients were followed up with 24-hour dynamic electrocardiogram for 1 year, and they were divided into recurrence group and control group according to whether there was recurrence. The risk factors of postoperative recurrence were analyzed. A logistic regression model was established, and its predictive value was evaluated. SPSS statistics 23.0 was used for statistical analysis. Data comparison between two groups was performed using t test orχ² test depending on data type. Multivariate logistic regression analysis was performed to investigate the influencing factors of AF recurrence in elderly patients after RFCA. Results During 1-year follow-up, 8 (1.01%) of the 794 patients were lost to follow-up, and 104 (15.25%) of the 786 patients who completed the follow-up had recurrence. Multivariate logistic regression analysis showed that age (OR=1.113,95%CI 1.041-1.190), diabetes mellitus (OR=1.697,95%CI 1.018-2.831), left atrial diameter (LAD; OR=1.135,95%CI 1.025-1.257), low-density lipoprotein cholesterol (LDL-C; OR=1.229,95%CI 1.044-1.446) and high-sensitivity C reactive protein (hs-CRP; OR=1.096,95%CI 1.004-1.197) were independent risk factors of AF recurrence in elderly patients after RFCA (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve in the logistic regression model for predicting the AF recurrence risk in the patients after RFCA was 0.939 (95% CI 0.885-0.973; P<0.00), and Hosmer-Lemeshow test indicated a good consistency between the predictive value and the observed value (χ²=1.279; P=0.461). Conclusion The AF recurrence rate after RFCA is high in elderly patients, and age, diabetes mellitus, LAD, LDL-C and hs-CRP are independent risk factors of postoperative recurrence. A logistic regression model based on the above factors has a good reference value in predicting recurrence.

Abstract:Objective To investigate the clinical efficacy of interventional therapy with balloon stent kissing technique (BSKT) and jailed wire technique (JWT) for coronary bifurcation lesions (CBL) in the elderly. Methods A retrospective analysis was conducted on 124 elderly CBL patients treated in our hospital from August 2019 to April 2021. Their clinical data were collected and analyzed, and those receiving JWT interventional therapy were assigned into the control group (n=64), while those undergoing BSKT interventional therapy were included in the observation group (n=60). SPSS statistics 20.0 was used for data analysis, student′s t test was employed for intergroup comparison. Results In 6 months after operation, the minimum lumen diameter (MLD) of the main vessel was increased, and the stenosis, diameter stenosis rate (DS) and lesion length were decreased in both groups (P<0.05), but there were no significant differences in the above four indicators between the two groups (P>0.05). For the branch vessels, the MLD was increased, and the stenosis, DS and lesion length were decreased in 6 months after surgery in both groups (P<0.05). The MLD of branch vessels was significantly higher, and the stenosis, DS and lesion length were lower in the observation group than the control group (P<0.05). In 72 h after surgery, the levels of high-sensitivity cardiac troponin I (hs-cTnI), high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (LP-PLA2) were significantly lower, while those of angiotensin Ⅱ (AngⅡ) and von Willebrand factor (vWF) were significantly lower in observation group than the control group (P<0.05). Conclusion BSKT interventional therapy is superior to JWT in treatment of CBL in the elderly patients, with the advantages of effectively reducing the myocardial function injury and endothelial function injury, and exerting a good protective effect on branch blood vessels, and therefore, it is worthy of promotion in clinical practice.

Abstract:Objective To explore the occurrence of no-reflow during percutaneous coronary intervention (PCI) in the elderly patients with acute coronary syndrome (ACS) and identify the associated factors. Methods A retrospective analysis was conducted on the clinical data of 510 elderly ACS patients who underwent PCI in Aoyang Hospital Affiliated to Jiangsu University from April 2020 to April 2023. Based on the occurrence of no-reflow during PCI, the patients were divided into the no-reflow group (n=110) and the non-no-reflow group (n=400). Differences in baseline characteristics and laboratory indicators between the two groups were compared. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of preoperative stenosis, intercellular adhesion molecule-1 (ICAM-1), and endothelial cell-specific molecule-1 (ESM-1) for the occurrence of no-reflow during PCI in the elderly ACS patients, and multivariable logistic regression analysis was conducted to identify the associated risk factors. SPSS statistics 20.0 was used for statistical analysis. Data comparison between two groups was performed using t test orχ² test depending on the data type. Results The proportion of preoperative thrombolysis in myocardial infarction (TIMI) grade ≤2, balloon dilation ≥3 times, high thrombus burden, and non-usage of GPB/A receptor antagonists was significantly higher in the no-reflow group than in the non-no-reflow group. Preoperative stenosis degree, ICAM-1, and ESM-1 levels were significantly higher in the no-reflow group than in the non-no-reflow group, with statistical significance (P<0.05). ROC curve analysis of preoperative stenosis degree, ICAM-1, and ESM-1 showed good predictive value for the occurrence of no-reflow during PCI in the elderly ACS patients, and the combined predictive value was even higher, with a respective area under the curve of 0.869,0.952,0.866, and 0.980 (P<0.05 for all). Multivariable logistic regression analysis confirmed that preoperative TIMI grade ≤2, balloon dilation ≥3 times, high thrombus burden, non-usage of GPB/A receptor antagonists, pre-stenosis degree ≥89.345%, ICAM-1 ≥3.705 ng/ml, and ESM-1 ≥5.890 ng/ml were risk factors of the occurrence of no-reflow during PCI in the elderly ACS patients. Conclusion The occurrence of no-reflow in the elderly patients with acute coronary syndrome during elective PCI was influenced by various factors, and ROC analysis confirmed that preoperative stenosis ≥ 89.345%, ICAM-1≥3.705 ng/ml, and ESM-1≥5.890 ng/ml could be used to predict the occurrence of no-reflow.

Abstract:Objective To evaluate the application efficay of different approaches of laparoscopic surgery in the treatment of prostate cancer (PCa) in the elderly and analyze the influencing factors for postoperative biochemical recurrence. Methods Clinical data of 164 elderly PCa patients undergoing laparoscopic radical prostatectomy in our hospital from January 2019 to June 2021 were collected, and 88 cases of them received bladder anterior approach treatment (anterior approach group) and 76 cases with bladder posterior approach (posterior approach group). Perioperative indicators, complications and postoperative biochemical recurrence were compared between two groups. SPSS statistics 24.0 was used for statistical analysis. Data comparison between two groups was performed using student′s t test or Chi-square test depending on data type. Log Rank test was applied to analyze the survival time of non-biochemical recurrence. Logistic regression analysis was conducted to identify the influencing factors for biochemical recurrence after laparoscopic radical prostatectomy in elderly PCa patients. Results The operation time, duration of urinary catheter retention and length of hospital stay were significantly shorter in the anterior approach group than the posterior approach group (P<0.05). There were no statistical differences in the total incidence rate of complications and the survival time of non-biochemical recurrence between two groups (P>0.05). Logistic regression analysis showed that preoperative prostate specific antigen (PSA) ≥10.0 μg/L (OR=2.924,95%CI 1.753-4.877), postoperative Gleason score >7 points (OR=3.068,95%CI 1.852-5.081) and positive surgical margin (OR=2.547, 95%CI 1.417-4.578) were risk factors of biochemical recurrence after laparoscopic radical prostatectomy (P＜0.05). Conclusion Bladder anterior approach in laparoscopic radical prostatectomy is more conducive to postoperative recovery and has shorter surgical time for elderly PCa patients. The patients with high preoperative PSA level, high postoperative Gleason score and positive surgical margin are more prone to biochemical recurrence, and should be closely monitored in clinical practice.

Abstract:Objective To explore the correlation between quality of life and lower urinary tract symptoms (LUTS) and emotional disorders in the elderly patients with benign prostatic hyperplasia (BPH). Methods We enrolled 155 elderly BPH patients admitted to Chengmai County People′ s Hospital from January 2021 to January 2023. Their quality of life, LUTS and anxiety were investigated using revised version of quality-of-life scale for benign prostatic hyperplasia (BPHQLS), international prostate symptom score (IPSS), overactive bladder symptom scale (OABSS) and self-rating anxiety scale (SAS). SPSS statistics 19.0 was used for data processing, and t test or Chi-square test was performed for inter-group comparisons according to the data type. Pearson correlation was performed to analyze the correlation between LUTS, emotional disorders and quality of life. A structural equation model was constructed using AMO 25.0 for the mediating effect of anxiety on LUTS and quality of life in the elderly BPH patients (standardized). Results The valid questionnaire recovery rate was 96.13% (149/155) with six invalid questionnaires. The elderly BPH patients averaged (97.45±12.16) points on QLS-BPH, (12.21±2.79) points on IPSS, (8.96±2.03) points on OABSS and (48.56±8.89) points on SAS, and the incidence of anxiety was 71.14% (106/149). SAS score in the elderly BPH patients was higher than that of Chinese norm [(48.56±8.79) vs (37.22±9.72) points], and the difference was statistically significant (P < 0.05). The QLS-BPH score in the mild-to-moderate IPSS group was higher than that in the severe group [(107.12±13.45) vs (86.25±12.05) points], the SAS score was lower than that in severe group [(44.14±7.96) vs (56.59±8.87) points], and the differences were statistically significant (P< 0.05). Compared with the BPH patients without anxiety, those with anxiety had lower QLS-BPH score [(92.34±12.58) vs (110.06±14.16) points], but higher scores on IPSS [(13.29±2.69) vs (9.56±2.94) points] and OABSS [(9.50±2.17) vs (7.65±2.26) points], and the differences were statistically significant (P<0.05). Pearson correlation analysis indicated that the QLS-BPH score in the elderly BPH patients was negatively correlated with IPSS score for LUTS, OABSS score and SAS score (r=-0.411, -0.395, -0.406; P<0.05). IPSS and OABSS score were positively correlated with SAS score (r=0.443,0.451; P<0.05). LUTS had a direct negative predictive effect on the quality of life (β=-0.321; P<0.05) and an indirect (negative) effect on the quality of life through anxiety (β=-0.196; P<0.05), with a total effect of -0.517. Anxiety had a direct (negative) effect on the quality of life (β=-0.269; P<0.05). After repeated sampling of data, Bootstrap method was used for mediating effect, and the 95%CI of each model did not include 0, suggesting that the mediating effect was statistically significant (P<0.05). Conclusion Effectively easing emotional disorders and taking effective measures to improve LUTS as soon as possible are of great significance in improving the quality of life in the elderly BPH patients.

Abstract:Objective To investigate the correlation between potentially inappropriate medication (PIM) and decline of intrinsic capacity (IC) in the elderly inpatients. Methods A total of 215 elderly inpatients admitted to the Fu xing Hospital Affiliated to Capital Medical University from January 2022 to June 2022 were analyzed. The patients were divided into PIM group (125 cases) and non-PIM group (90 cases) according to the PIM categories for the elderly in China. The comorbidity, types of oral drugs, IC and other indicators of patients were recorded. SPSS statistics 23.0 was used to analyze the data. Independent sample t test, Mann-Whitney U test or Chi-square test was used for comparison between groups. Spearman correlation analysis was used to analyze the correlation between PIM and intrinsic capacity decline. Multivariate logistic regression was used to analyze the related risk factors of PIM. Results The patients were aged 60-109 (84.0±7.0) years, and 134 (62.3%) were males. The patients scored 2.0 (1.0,3.0) points for intrinsic capacity. Decreased intrinsic capacity was seen in 93.0% (200/215) patients, and decreased motor ability in 75.8% (163/215). Intrinsic capacity decline ≥ 3 accounted for 40.0% (86/215). The types of oral drugs ranged from 0 to 17, with 6.0 (3.0,8.0) types per person, and 63.3% (136/215) patients took more than 5 oral drugs. The rate of PIM use was 58.1% (125/215). Charlson comorbidity index (CCI) was 7.0 (6.0,9.0) points. Compared with the non-PIM group, the PIM group had significantly increased age, CCI, insomnia, constipation and choking, polypharmacy,more types of oral medication and IC score (P<0.05), but among the five scoring criteria of IC, exercise capacity decreased, the difference being statistically significant (P<0.05). Spearman correlation analysis showed that PIM was positively correlated with age, intrinsic capacity score, polypharmacy and CCI (r=0.167,0.205,0.468,0.214; P＜0.05). Multivariate logistic regression analysis showed that decreased IC score (OR=1.567,95%CI1.102-2.228; P＜0.05) was a risk factor for PIM after adjusting for age, gender, disease severity and polypharmacy. Conclusion Decreased IC is a risk factor for PIM in the elderly inpatients, and PIM should be screened in the elderly inpatients with decreased intrinsic capacity to reduce PIM use.

Abstract:Objective To investigate the status quo of postoperative recurrence of gastric cancer and to analyze factors affecting it in the elderly patients with radical gastrectomy. Methods The study included 428 patients who underwent radical gastrectomy in Qionghai Hospital of Traditional Chinese Medicine from January 2015 to January 2020, and they were divided into the elderly group (age≥60 years; n=207) and the middle-aged and young group (18 years ≤ age <60 years; n=221). The patients were followed up until January 2023, and the recurrence rate of gastric cancer was statistically analyzed. Cox proportional hazard regression model was used to analyze the factors affecting the postoperative recurrence in the elderly patients with gastric cancer. Flow cytometry was employed to detect the Th1/Th2 of peripheral blood CD4⁺ cells in the elderly patients with or without recurrence of gastric cancer, and Pearson or Spearman correlation analysis was employed to analyze the relationship between Th1/Th2 cytokines levels of peripheral blood CD4⁺ cells and risk factors of recurrence of gastric cancer. SPSS 19.0 was used for statistical analysis. Data comparison between two groups was preformed using t test or χ² test depending on data type. Results The recurrence (30.43%) rate of gastric cancer in the elderly group was higher than that in the young and middle-aged group (16.29%; P<0.05). Cox multivariate regression analysis suggested that anesthesia risk (HR=1.162, 95%CI 1.021-2.744), T staging (HR=3.877, 95%CI 1.516-9.854), N staging (HR=4.211, 95%CI 1.543-11.574), TNM staging (HR=8.241, 95%CI 1.547-40.559) and postoperative adjuvant chemotherapy (HR=0.501, 95%CI 0.324-0.774) were factors affecting the recurrence in the elderly patients with gastric cancer after radical gastrectomy (P<0.05). The levels of Th1 cytokines and Th1/Th2 in peripheral blood were lower and the levels of Th2 cytokines were higher in the recurrence group than those in the non-recurrence group, and the differences were statistically significant (P<0.05). Correlation analysis indicated that Th1/Th2 of peripheral CD4⁺ cells in the recurrent gastric cancer was negatively correlated with recurrence high-risk factor TNM staging (r=-0.358, P<0.001), and was positively correlated with postoperative adjuvant chemotherapy (r=0.326, P<0.001). Conclusion The recurrence rate in the elderly patients with gastric cancer after radical surgery is higher than that in the middle-aged and young patients. Besides the common clinicopathological features, the risk of preoperative anesthesia and presence or absence of postoperative adjuvant chemotherapy are also factors affecting postoperative recurrence of the elderly gastric cancer. In addition, there is a significant shift from Th1 to Th2 in the elderly patients with gastric cancer recurrence. It is speculated that TNM staging and postoperative chemotherapy may be involved in gastric cancer recurrence by affecting Th1/Th2 drift.

Abstract:Objective To explore the influencing factors of thyroid function recovery in the elderly patients undergoing unilateral thyroid lobectomy. Methods A total of 346 patients receiving unilateral thyroid lobectomy in Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Sciences from June 2020 to June 2022 were enrolled as the study subjects, and they were divided into young and middle-aged group (18-<60 years, n=113) and elderly group (≥60 years, n=233). The postoperative thyroid function recovery was compared between age groups, and the incidence rate of hypothyroidism was counted. The patients with hypothyroidism in the elderly group were included in the hypothyroidism group (n=65) and those with normal thyroid function were selected as the control group (n=168). SPSS 19.0 was used for data analysis. According to the data type, t test, analysis of variance or Chi-square test was used for comparison between groups. Binary logistic regression model was used to analyze the influencing factors of the postoperative thyroid function in the elderly patients undergoing unilateral thyroid lobectomy. Results At two months after surgery, the level of free triiodothyronine (FT3) in the young and middle-aged group was lower than that before surgery, and the level of thyroid stimulating hormone (TSH) was higher than that before surgery, the differences being statistically significant (P<0.05). The two indicators returned to the preoperative levels at six months after surgery. There was no significant change in the level of free thyroxine (FT4) at different time points after surgery as compared before surgery with no statistically significant difference (P>0.05). In the elderly group, at two months, six months, and one year after surgery, the levels of FT3 and FT4 were lower, and the TSH level was higher than those before surgery, the differences being statistically significant (P<0.05). The level of FT4 in the elderly group at each time point after surgery was lower than that in the young and middle-aged group, and the level of FSH before surgery and at each time point after surgery was higher than that in the young and middle-aged group, the differences being statistically significant (P<0.05). The incidence of hypothyroidism at one year after surgery in the elderly group (27.90%) was higher than that in the young and middle-aged group (8.85%) (χ²=4.225, P<0.05). Binary logistic regression analysis suggested that age (OR=2.199,95%CI 1.099-4.401), body mass index (OR=1.793,95%CI 1.275-2.522), preoperative TSH (OR=2.404,95%CI 1.419-4.072), positive thyroid peroxidase antibody (TPOAb) (OR=1.988,95%CI 1.081-3.657) and serum interleukin-6 (IL-6) level (OR=1.624,95%CI 1.232-2.141) were factors affecting postoperative hypothyroidism. Conclusion The elderly patients have a poorer thyroid function recovery after unilateral thyroid lobectomy than the young and middle-aged patients and are more prone to hypothyroidism. Preoperative TSH elevation, positive TPOAb, age, body mass index and serum IL-6 level are factors affecting hypothyroidism in the elderly after unilateral thyroid lobectomy.

Abstract:Objective To explore the value of acupuncture at “relative point” combined with isometric contraction training of quadriceps femoris (QF) for knee osteoarthritis (KOA) in the elderly patients. Methods Clinical data of 106 elderly KOA patients admitted to our hospital from May 2021 to May 2023 were collected and retrospectively analyzed. According to their rehabilitation treatment regimens, they were divided into observation group (n=51, acupuncture at “relative point” combined with QF isokinetic contraction training) and control group (n=55, QF isokinetic contraction training). The rehabilitation efficacy, visual analogue scale (VAS) score, score of ability of daily living (ADL) scale, Lysholm score, serum levels of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF), and peak torque value, total muscular work and average muscular power of QF were compared between the two groups. SPSS statistics 22.0 was used for data analysis. Based on data type, student′s t test orχ² test was employed for intergroup comparison. Results The total effective rate of rehabilitation efficacy was significantly higher in the observation group than the control group (90.20% vs 70.91%, P<0.05). The observation group had obviously lower VAS and ADL scores after intervention [(2.04±0.67) and(2.08±0.80)points] when compared with the scores before intervention [(6.18±1.51) and (7.56±1.49)points], and with those in the control group after intervention [(3.88±1.05) and (3.97±1.22)points], and notably higher Lysholm score (75.19±10.15) after intervention than that before intervention (55.95±6.53) and that of the control group (69.44±8.36) after intervention (all P<0.05). The levels of IL-1β, TNF-α and VEGF in synovial fluid of the observation group after intervention [(6.19±1.00) pg/ml, (1.14±0.46) pg/ml, (320.36±37.12) ng/ml] were significantly lower than those before intervention [(15.81±3.19) pg/ml, (5.50±1.03) pg/ml, (557.15±84.06) ng/ml] and control group after intervention [(9.16±2.12) pg/ml, (2.88±0.73) pg/ml, (411.50±50.27) ng/ml, all P<0.05]. Statistical increments were observed in the observation group after intervention in terms of QF peak torque value, total muscular work and average muscular power than before intervention and in the control group after intervention [(70.22±14.11) vs (52.14±10.36) and (63.28±13.06) N.m; (418.94±73.15) vs (249.28±67.30) and (355.24±70.27) J; (42.57±11.19) vs (30.69±8.25) and (38.14±10.26) W; P<0.05]. During rehabilitation treatment, adverse reactions occurred only in the observation group, including subcutaneous hematoma in one case and needle stagnation in two cases. All these symptoms disappeared after symptomatic treatment, and no pain or swelling of knee joint was observed. Conclusion Acupuncture to “relative point” combined with QF isometric contraction training can alleviate pain and improve joint function in elderly KOA patients.