Abstract:Objective To explore the influencing factors for gastrointestinal intolerance after enteral nutrition (EN) treatment in elderly patients with acute cerebral infarction (ACI), and analyze the correlation between the intolerance and quality of life (QoL). Methods A retrospective study was conducted on 160 elderly ACI patients undergoing EN support therapy in our hospital from January 2021 to December 2023. After EN treatment, they were assigned into an observation group (with gastrointestinal intolerance, n=69) and a control group (gastrointestinal tolerance, n=91). The general clinical data and QoL status were recorded in the two groups. SPSS statistics 22.0 was used for data analysis. Depending on data type, t test orχ² test was employed to compare the data between the groups, and multivariate logistic regression analysis was utilized to identify the related factors affecting gastrointestinal intolerance after EN treatment in the ACI elderly patients. Spearman rank correlation analysis was applied to analyze the correlation between gastrointestinal intolerance and QoL in the patients. Results There were significant differences between the two groups before EN treatment in terms of 2-hour postprandial plasma glucose (2hPG), serum albumin, use of sedative drugs and vasoactive drugs, intra-abdominal pressure (IAP), central venous pressure (CVP), start time of EN, neurological dysfunction, emotional stress, and secondary infection after cerebral infarction (P<0.05). After treatment, the observation group had obviously higher scores of material living state, psychological function, physical function, and social function than the control group (P<0.05). Multivariate logistic regression analysis showed that 2hPG ≥11.1 mmol/L (OR=6.253,95%CI 1.604-24.367), serum albumin <35 g/L (OR=4.679,95%CI 1.189-18.413), IAP ≥15 mmHg (OR=3.823,95%CI 1.207-12.103), CVP ≥12 cmH₂O (OR=4.683,95%CI 1.209-18.144), start time of EN ≥3 d (OR=3.939,95%CI 1.164-13.331), neurological dysfunction (OR=5.468,95%CI 1.331-22.470), emotional stress (OR=3.995,95%CI 1.180-13.519), and secondary infection after cerebral infarction (OR=4.100,95%CI 1.209-13.903) were independent risk factors for gastrointestinal intolerance in elderly ACI patients after EN treatment (P<0.05). Spearman rank correlation analysis found that gastrointestinal intolerance was negatively correlated with material living state, psychological function, physical function, and social function in the patients (r_s=-0.734, -0.664, -0.484, -0.628; P<0.05). Conclusion 2hPG ≥11.1 mmol/L, serum albumin <35 g/L, IAP ≥15 mmHg, CVP ≥12 cmH₂O, start time of EN ≥3 d, neurological dysfunction, emotional stress, and secondary infection after cerebral infarction are independent risk factors for gastrointestinal intolerance after EN treatment in elderly ACI patients. Clinically, management of the above-mentioned factors needs to be strengthened to lay a foundation for nutritional support and improvement of the QoL in the patients.

Abstract:Objective To analyze the influence of early enteral nutrition (EN) on postoperative rehabilitation, quality of life and prognosis in elderly patients with primary liver cancer (PLC). Methods A total of 120 elderly PLC patients who underwent partial hepatectomy in Zhongnan Hospital of Wuhan University from June 2019 to June 2022 were randomly divided into an observation group (early EN, n=60) and control group (routine dietary intervention, n=60) using the random number table method. The liver function and immune function of the two groups were compared before surgery, and at 7 and 14 days after surgery. The perioperative indicators were statistically analyzed. The quality of life of the two groups was assessed with the fourth edition of functional assessment of cancer therapy-hepatobiliary (FACT-Hep) at discharge. The patients were followed up for one year after surgery, and the prognosis of patients was statistically analyzed. Cox risk proportional regression model was employed to analyze the factors affecting the prognosis of patients. SPSS 22.0 was used for statistical analysis. Data comparison between two groups was performed using t test, χ² test or analysis of variance depending on data type. Results At 7 days after surgery, the albumin (ALB) level in the observation group was higher than that in the control group, and the differences were statistically significant (all P<0.05). At 14 days after surgery, the cholinesterase (CHE), ALB, CD4⁺cell ratio and CD4⁺/CD8⁺ ratio in the observation group were higher than those in the control group, the direct bilirubin (DBIL) level was lower than that in the control group, and the differences were statistically significant (P<0.05 for all). The time to the first postoperative flatus, abdominal drain removal time, and discharge time were shorter in the observation group than in the control group, the incidence of postoperative complications and hospitalization expenses were lower than those in the control group, and the scores of each dimension and total score of the quality of life in the observation group were lower than in the control group, and the differences were statistically significant (P<0.05 for all). Cox multivariate analysis suggested that early postoperative EN was a protective factor for one-year survival after surgery (95%CI 0.144-0.793; P<0.05). Conclusion Early EN therapy can promote the recovery in elderly PLC patients after partial hepatectomy and enhance their quality of life. Early EN is an independent factor affecting the prognosis of patients one year after surgery.

Abstract:Objective To explore the influencing factors for fear of falling in the elderly in order to provide a reference for develop-ing precise intervention programs to reduce the fear of falling in them. Methods With continuous sampling, 207 elderly patients who attended the Outpatient Clinic of Falling of First Medical Center of Chinese PLA General Hospital were subjected from July 2023 to February 2024. They were investigated by using a general information questionnaire, falls efficacy scale international, Connor-Davidson resilience scale, social support rating scale, simplified coping style questionnaire, and Pittsburgh sleep quality index. Based on their score for fear of falling, the participants were stratified into low-, moderate-, and high-level fear of falling groups (113,48 and 46 cases, respectively). Statistical analyses were conducted using SPSS 29.0. Intergroup differences were compared via AVOVA, Kruskal-Wallis H test, Chi-square test or Fisher′s exact probability test depending on data type. Multinomial logistic regression analysis was employed to identify the influencing factors for fear of falling at different levels. Results The 207 patients had a median score of 21.0 (17.0,32.0) for fear of falling. The participants of low-, moderate-, and high-level fear of falling accounted for 54.59% (113/207), 23.19% (48/207), and 22.22% (46/207), respectively. Significant differences were observed among the three groups in terms of falling history within one year, fracture due to falls, neurological disorders, using walking aids, hearing impairment, somatosensory impairment, psychological resilience, and sleep quality (P<0.05). Multinomial logistic regression analysis indicated that fracture due to falls, neurological disorders, somatosensory impairment, and low psychological resilience were risk factors for moderate-level fear of falling (P<0.05); falling history within one year, fracture due to falls, hearing impairment, somatosensory impairment, using walking aids, low psychological resilience and poorer sleep quality were risk factors for high-level fear of falling (P<0.001). Conclusion Heterogeneity exists in fear of falling among older adults. Healthcare professionals should focus on those with lower psychological resilience and higher risk for falls, incorporate resilience assessment into fear management, and develop individualized interventions to reduce the fear of falling.

Abstract:Objective To explore the quality of life (QoL) in elderly patients with maintenance hemodialysis (MHD) and analyze its influencing factors. Methods A total of 140 elderly MHD patients admitted to the First Hospital Affiliated to Nanjing Medical University from March 2021 to June 2023 were selected as the study subjects. The 36-item short form health survey (SF-36) was used to assess QoL, the Pittsburgh sleep quality index (PSQI) was used to assess sleep status, and Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) were used to assess depression and anxiety. SPSS 26.0 was used for data analysis. According to the data type, t test or one-way analysis of variance (ANOVA) was used for inter-group comparison. Spearman correlation analysis was used to analyze the relationships between the influencing factors of QoL and physical health and mental health. Multiple linear regression was used to analyze the influencing factors of QoL. Results The SF-36 score was (213.85±17.19) points for physical health and (156.24±11.73) points for mental health in the 140 elderly MHD patients. Univariate analysis showed that the physiological health scores were significantly different in age, education, marital status, working status, family per capita monthly income, hemodialysis frequency, sleep quality and anxiety (P<0.05), and that mental health scores differ significantly in family per capita monthly income, payment method of medical expenses, social support, anxiety and depression (P<0.05). Spearman correlation analysis showed that family per capita monthly income and sleep quality were positively correlated with physical health score (r=0.396,0.462; P<0.001), and age was negatively correlated with physical health (r=-0.371; P<0.001). Family per capita monthly income and social support were positively correlated with mental health (r=0.387,0.525; P<0.001), and anxiety and depression were negatively correlated with mental health (r=-0.403, -0.369; P<0.001). Multiple linear regression analysis showed that age, family per capita monthly income and sleep quality were the influencing factors of the physiological health (P<0.05), and that family per capita monthly income, social support, anxiety and depression were the influencing factors of mental health in elderly MHD patients (P<0.05). Conclusion QoL of elderly MHD patients is suboptimal age; family per capita monthly income, sleep quality, social support, and anxiety and depression are the influencing factors.

Abstract:Objective To investigate the factors influencing bowel preparation failure in elderly patients with painless gastroentero-scopy and establish a risk prediction model. Methods A retrospective analysis was made of the clinical data of 412 elderly patients who underwent painless gastrointestinal endoscopy at 940th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army from June 2020 to September 2023. The patients were divided into a test group (n=275) and a validation group (n=137) at a ratio of 2∶1. According to the quality of bowel preparation, the test group were divided into two subgroups:a success group (n=178) and a failure group (n=97). SPSS 20.0 was used for data analysis. According to the data type, t test orχ² test was used for data comparison between groups. Multivariate logistic regression analysis was used to analyze the influencing factors of bowel preparation failure, a risk prediction model was established based on the risk factors, and tailored intervention strategies were proposed. Hosmer-Lemeshow test was used to verify the prediction efficiency. Results Significant differences were seen between the success group and the failure group in body mass index, walking status, constipation, history of colorectal surgery, first colonoscopy, use of tricyclic antidepressants, massive ascites, history of abdominal/pelvic surgery, and type of underlying diseases (P<0.05). Logistic regression analysis showed that constipation (OR=4.384,95%CI 1.136-16.919), history of colorectal surgery (OR=4.043,95%CI 1.392-11.743), and use of tricyclic antidepressants (OR=5.013,95%CI 1.237-20.317), and underlying diseases ≥2 kinds (OR=4.973,95%CI 1.335-18.526) were independent risk factor for bowel preparation failure in elderly patients with painless gastroenteroscopy. The risk prediction model incorporating these factors demonstrated a predictive sensitivity of 67.18%, a specificity of 85.69%, and an area under the receiver operating characteristic curve (AUC) of 0.739. The validation test showed a sensitivity of 66.54%, a specificity of 82.37%, and an AUC of 0.709. Conclusion Constipation, history of colorectal surgery, use of tricyclic antidepressants, and underlying disease ≥2 kinds affect the quality of bowel preparation in elderly patients with gastroenteroscopy, and the risk prediction model based on the above factors exhibits a good predictive efficacy for bowel preparation failure in this population. Tailored intervention plans should be proposed according to the actual situations in clinical practice to improve the quality of bowel preparation.

Abstract:Objective To investigate the correlation between quality of life and coping style in elderly patients with intracranial aneurysm after operation and the influencing factors. Methods A retrospective study was conducted on 140 elderly patients with intracranial aneurysms undergoing surgical treatment in our hospital from March 2021 to May 2023. The coping styles of the patients were assessed by social coping style questionnaire, and their quality of life was assessed by quality of life questionnaire core 30 (QLQ-C30) before and after surgery. SPSS statistics 20.0 was used for statistical analysis. Data comparison between two groups was performed using t-test orχ² test depending on data type. Pearson correlation analysis was used to analyze the correlation between quality of life and coping style, and logistic regression was employed to analyze the influencing factors for postoperative quality of life in elderly patients with intracranial aneurysm. Results After treatment, the total score of quality of life, scores of social function, emotional function, role function, cognitive function, and physical function, and face-to-face score in coping strategies were all higher, while the avoidance and yield scores in coping strategies were lower than the corresponding scores before operation (all P<0.05). Correlation analysis showed that the postoperative quality of life of the elderly patients with intracranial aneurysm was positively correlated with face-to-face coping, and negatively correlated with avoidance and yielding coping (r=0.840, -0.646, -0.487; P<0.05). Multivariate logistic regression analysis indicated that clamping as surgical treatment (OR=3.912,95%CI 1.406-10.882), posterior circulation aneurysm (OR=4.811,95%CI 1.348-17.168), postoperative complications (OR=3.939,95%CI 1.405-11.045), aneurysm diameter >25 mm (OR=4.948,95%CI 1.376-17.794), Hunt-Hess Grade Ⅲ (OR=4.336; 95%CI 1.291-14.560), and negative coping style (OR=4.581,95%CI 1.304-16.093) were independent risk factors affecting postoperative quality of life in elderly patients with intracranial aneurysm (P<0.05). Conclusion In elderly patients with intracranial aneurysms, their postoperative quality of life is significantly correlated with coping styles. Surgical treatment of clamping, having aneurysm at posterior circulation artery, postoperative complications, aneurysm diameter >25 mm, Hunt-Hess grade Ⅲ, and negative coping styles are independent risk factors affecting their postoperative quality of life. Clinicians should pay more attention to these factors and take measures actively.

Abstract:Objective To investigate the short-term quality of life (QoL) and coping styles in elderly patients with coronary heart disease (CHD) after emergency percutaneous coronary intervention (PCI). Methods A total of 136 elderly CHD patients undergoing emergency PCI in our hospital from September 2020 to September 2023 were recruited and served as the emergency group, and another 140 elderly CHD patients receiving scheduled PCI during the same period were included in the scheduled group. At one month after surgery, the QoL and coping styles were investigated with 36-item short-form health survey (SF-36) and medical coping modes questionnaire (MCMQ). According to the total score of SF-36 scale in the emergency group at one month after surgery, they were divided into good QoL group (total score ≥ average score, 64 cases) and poor QoL group (total score < average score, 72 cases). SPSS 19.0 was used for statistical analysis. Depending on data types, independent sample t test or Chi-square test were performed for intergroup comparison. Pearson linear correlation analysis was applied to analyze the relationship between SF-36 score and MCMQ score in patients in the emergency group. Binary logistic regression model was adopted to identify the related factors affecting the postoperative QoL in emergency patients in one month after PCI. Results At one month after PCI, the scores of vitality (VT), role emotional (RE) and (MH) dimensions and total score of SF-36 scale were significantly lower, while the scores of avoidance and yielding of MCMQ scale were obviously higher in the emergency group than the elective group (P<0.05). Pearson correlation analysis showed that the facing dimension was positively correlated with the VT and RE scores of SF-36 scale (r=0.341,0.279, all P<0.001), avoidance dimension was negatively correlated with RE and MH scores (r=-0.293, -0.311, all P<0.001), while yielding dimension was negatively correlated with VT and RE scores (r=-0.366, -0.374, all P<0.001). Binary logistic multivariate regression analysis suggested that female (OR=1.878,95%CI 1.166-3.023), diabetes mellitus (OR=3.971,95%CI 1.690-9.333) and postoperative residual stenosis (OR=3.391,95%CI 2.094-5.491) were risk factors affecting the QoL, while education level of junior college or above was a protective factor (OR=0.460,95%CI 0.274-0.774) for QoL at 1 month after PCI. Conclusion Compared with the elderly CHD patients undergoing scheduled PCI, those undergoing emergency PCI have worse QoL in terms of psychological status dimensions such as VT, RE and MH at one month postoperatively, and there is a weak correlation between the scores of these dimensions and coping styles. In clinical practice, attention should be paid to the QoL among the high-risk patients, such as women, having diabetes mellitus and postoperative residual stenosis.

Abstract:Objective To investigate the quality of life (QoL) in elderly patients with gallstones after cholecystectomy and its influencing factors. Methods A retrospective analysis was conducted of the clinical data of 130 elderly patients with gallstones who underwent cholecystectomy in Nantong Hospital Affiliated to Nanjing University of Chinese Medicine from January 2022 to January 2023. Gastrointestinal quality of life index (GIQLI) was used to assess the QoL of all patients one month after surgery. Patients with GIQLI score < 121 points were included in the observation group (n=37), and those with GIQLI score ≥121 points were included in the control group (n=93). SPSS 20.0 was used for statistical analysis of the data. According to the data type, the t test orχ² test was used for comparison between groups. Multivariate logistic regression model was used to analyze the influencing factors of QoL one month after cholecystectomy. Results There were significant differences between the two groups in calculus characteristics, number of catheter insertions, gallbladder wall thickness, adhesion of the surrounding organs, Calot triangle adhesion, operative methods, and complications (χ²=10.569,10.013,4.134,4.767,5.121,8.353,8.190, P<0.05). Multivariate logistic regression analysis found silty calculi (OR=3.916, 95%CI 1.157-13.252), number of catheter insertions > 3 (OR=4.632,95%CI 1.143-18.773), gallbladder wall thickness > 5 mm (OR=4.125,95%CI 1.071-15.887), adhesion of surrounding organs (OR=3.854,95%CI 1.154-12.864), Calot triangle adhesion (OR=4.609,95%CI 1.237-17.170), and postoperative complications (OR=4.108,95%CI 1.214-13.903) were an independent risk factor for QoL in elderly patients with cholecystectomy (P<0.05). Conclusion Silty calculi, number of catheter insertions, gallbladder wall thickness, adhesion of the surrounding organs, Calot triangle adhesion, and postoperative complications are significantly associated with poor quality of life in patients after cholecystectomy. Preoperative comprehensive evaluation of these factors and targeted measures should be taken to improve their postoperative quality of life.

Abstract:Objective To investigate the perioperative quality of life (QoL) and to analyze the risk factors of poor early postoperative QoL in elderly patients with lung cancer. Methods A total of 155 elderly lung cancer patients who received surgical treatment in the Department of Thoracic and Cardiovascular Surgery of the First Hospital Affiliated to Hebei North University from September 2021 to September 2023 were enrolled. A questionnaire survey was conducted among the patients before, one week after, and one month after surgery, and valid questionnaires were finally collected from 142 patients. Age-adjusted Charlson comorbidity index (aCCI) was used to assess overall functional status. The Chinese version of functional assessment of cancer therapy-lung cancer (FACT-L) was employed to assess QoL before, one week after, and one month after surgery. The Chinese version of Anderson symptom assessment scale-lung cancer module was used to evaluate the characteristics of symptom cluster one week after surgery. According to total score of FACT-L one week after surgery, the patients were divided into a good QoL group (n=74; ≥ average) and a poor QoL group (n=68; < average). SPSS 24.0 was used for statistical analysis, and logistic regression analysis was used to evaluate the risk factors of poor QoL one week after surgery. Results The scores of each dimension and total score of FACT-L in elderly lung cancer patients one week after surgery were significantly lower than those before surgery and one month after surgery (P<0.05), but there were no statistically significant differences in the these scores between one month after surgery and before surgery (P>0.05). The proportions of smoking history and aCCI>5, and the incidence of shortness of breath and fatigue in the poor QoL group were significantly higher than those in the good QoL group (P<0.05). Logistic regression analysis found that smoking history (OR=3.425,95%CI 1.980-5.922; P<0.05), aCCI>5 (OR=2.627,95%CI 1.455-4.744; P<0.05), shortness of breath (OR=2.545,95%CI 1.284-5.043; P<0.05) and fatigue (OR=3.086,95%CI 1.730-5.508; P<0.05) were risk factors of poor QoL in elderly lung cancer patients one week after surgery. Conclusion QoL in elderly lung cancer patients declines during the early postoperative period but recovers to the preoperative level one month after surgery. The poor QoL one week after surgery is closely related to smoking history, poor basic status and postoperative symptoms of shortness of breath and fatigue.

Abstract:Objective To analyze the factors related to postoperative pain and quality of life in elderly patients with multiple rib fractures. Methods A total of 122 elderly patients undergoing surgery for multiple rib fracture in Suzhou First People′s Hospital, Anhui Province from March 2019 to October 2023 were included. The visual analogue scale (VAS) was used to investigate the pain at seven days after surgery, and the 36-item short-form health questionnaire (SF-36) was used to investigate the postoperative quality of life. Multivariate linear regression model was used to analyze the independent factors related to postoperative pain and quality of life. SPSS 22.0 was used for statistical analysis. Data comparison was performed using t test or χ² test depending on data type. Results The VAS score in elderly patients with multiple rib fractures at seven days after surgery was (3.63±0.76) points. There were 73 cases with mild pain, 40 cases with moderate pain and 9 cases with severe pain. The scores of dimensions and total score of SF-36 after surgery were lower than those of the domestic norms (P<0.05). Multivariate linear regression analysis showed that preoperative severe pain (β=0.285; P<0.001), duration of surgery >3 hours (β=0.169; P=0.009) and poor psychological resilience (β=3.482; P=0.001) positively predicted postoperative pain, and that preoperative severe pain (β=-0.322; P<0.001), duration of surgery >3 hours (β=-0.189; P=0.003), poor psychological resilience (β=-0.238; P=0.001), and low social support (β=-0.167; P=0.017) negatively predicted postoperative quality of life in elderly patients with multiple rib fractures, and the regression equation was significant (F=12.834,16.497; P<0.001). Pearson correlation analysis revealed that the total score of postoperative SF-36 was negatively correlated with VAS score (r=-0.507; P<0.001) and was positively correlated with social support rate scale score and connor-davidson resilience scale score (r=0.479,0.524; P<0.001) in elderly patients with multiple rib fractures. Conclusion Preoperative severe pain, surgical duration >3 hours and poor psychological resilience can significantly affect postoperative pain and quality of life in elderly patients with multiple rib fractures. In addition, the quality of life of the patients is also affected by social support and is related to the degree of postoperative pain, social support and psychological resilience.

Abstract:Objective To investigate the impact of uric acid (UA) and waist circumference (WC) on the risk of major adverse cardiovascular events (MACE) in elderly male patients with obstructive sleep apnea (OSA). Methods From January 2015 to October 2017, a total of 671 male patients were enrolled, who were diagnosed with OSA for first time at outpatient clinics or sleep centers of six tertiary hospitals, including the Chinese PLA General Hospital and Peking University International Hospital. Demographic data, sleep respiration parameters, biochemical indicators, and clinical histories were collected. Patients were divided into four groups based on UA and WC levels:control group (n=290), hyperuricemia group (n=54), abdominal obesity group (n=276), and hyperuricemia-waist (HUAW) group (n=51). Follow-ups were conducted every three months, with MACE as the primary endpoint. Data analysis was performed using SPSS 26.0. Intergroup comparisons were conducted using ANOVA, nonparametric tests, or the Chi-square test based on data types. Kaplan-Meier curves were used to analyze the cumulative MACE incidence in the four groups. The Cox proportional hazards regression model was used to assess the impact of UA and WC on the risk of MACE in elderly male OSA patients. Results Statistically significant differences were observed among the four groups of patients in age, smoking, body mass index, WC, high-density lipoprotein cholesterol, UA, apnea-hypopnea index, oxygen desaturation index, average blood oxygen saturation, minimum blood oxygen saturation, and hypertension (P<0.05 for all). Kaplan-Meier survival analysis indicated that the cumulative survival rate for MACE in the HUAW group was lower than that in the other three groups (PLog-rank=0.001). Univariate Cox regression analysis revealed that, compared to the control group, the risk of MACE was significantly higher in the abdominal obesity group (HR=1.968,95%CI 1.106-3.503; P=0.021) and HUAW group (HR=3.811,95%CI 1.811-8.019; P<0.001). After adjusting for confounders, the conclusion remained consistent. The hazard ratio for the abdominal obesity group was 2.737 (95%CI 1.343-5.581; P=0.006) and 4.228 (95%CI 1.783-10.026; P=0.001) for the HUAW group after adjustment. Additionally, age (HR=1.048,95%CI 1.013-1.084; P=0.006) and hypertension (HR=2.547,95%CI 1.312-4.945; P=0.006) were identified as risk factors for MACE in elderly male OSA patients. Subgroup analysis showed significantly increased risk of MACE in patients aged ≥70 years [(HR=3.039,95%CI 1.008-9.165) and (HR=4.703,95%CI 1.158-19.090)] as well as in those with comorbid hypertension [(HR=2.606,95%CI 1.183-5.740) and (HR=4.747,95%CI 1.898-11.870)] in the abdominal obesity and HUAW groups (P<0.05 for all). Moreover, the risk of MACE also increased in patients under 70 years of age in the HUAW group (HR=4.530,95%CI 1.379-14.878; P<0.05). Conclusion Elderly male OSA patients with HUAW and abdominal obesity have higher risk for MACE. OSA patients should focus on body mass index control, overall body fat distribution, and early UA screening.

Abstract:Objective To evaluate the status of subglottic secretion retention in elderly patients with tracheal intubation following esophageal cancer surgery and analyze its influencing factors. Methods A retrospective study was conducted on 120 patients with endotracheal intubation undergoing surgery for esophageal cancer in our department from April 2022 to December 2023. According to having subglottic secretion retention or not, they were divided into a retention group (75 patients) and a non-retention group (45 patients). The general information and perioperative data were collected to analyze the relative factors with logistic stepwise regression analysis. SPSS statistics 27.0 was used for statistical analysis. Data comparison between two groups was performed using t test orχ² test depending on data type. Results The retention group had significantly advanced age, larger ratio of smoking history, longer operation time and duration of tracheal intubation, more patients having gastric tube indwelling, and larger numbers of experiencing recurrent laryngeal nerve injury and gastroesophageal reflux when compared with the non-retention group (P<0.05). Regression analysis showed that advanced age (OR=2.380,95%CI 1.076-5.264), smoking history (OR=2.323,95%CI 1.040-5.189), preoperative indwelling gastric tube (OR=3.040,95%CI 1.543-5.990), and gastroesophageal reflux (OR=2.732,95%CI 1.247-5.983) were independent risk factors for subglottic secretion retention in the elderly patients with endotracheal intubation (P<0.05). Conclusion For the elderly patients with tracheal intubation after surgery for esophageal cancer, they are at a risk of subglottic secretion retention. Smoking, advanced age and digestive diseases are high-risk factors. Thus, timely intervention measures should be taken for the high-risk patients after comprehensive clinical evaluation.

Abstract:Objective To investigate the influence of interaction effect between depression and lipid metabolism on postmenopausal women with osteoporosis. Methods A total of 510 postmenopausal women admitted to our hospital from June 2022 to June 2023 were recruited, and the occurrence of osteoporosis was screened. SPSS statistics 22.0 was used for data analysis. Depending on data type, Chi-square test was performed for comparison between groups. Binary logistic regression analysis was applied to analyze the related factors affecting osteoporosis in the participants. After taking depression and dyslipidemia as two interaction factors and adjusting confounding factors, the influence of interaction effect between the two factors on osteoporosis in postmenopausal women was evaluated. Results Among the 510 participants, 169 of them (33.14%) had osteoporosis. Binary logistic regression analysis suggested that depression (OR=2.843,95%CI 1.366-5.918) and dyslipidemia (OR=2.683,95%CI 1.660-4.337) were independent risk factors for osteoporosis in post-menopausal women. There was an additive interaction effect between depression and dyslipidemia, with a relative excess risk of interaction (RERI) of 1.151 (95%CI 0.379-1.768), an attributable proportion of interaction (API) of 0.425 (95%CI 0.173-0.743) and a synergy index (SI) of 2.264 (95%CI 1.077-5.157). Conclusion Depression and dyslipidemia are risk factors for osteoporosis in postmenopausal women, and they have an additive interaction effect on osteoporosis in postmenopausal women.

Abstract:Objective To investigate the role of insulin (INS) in lipopolysaccharide (LPS)-induced acute lung injury (ALI) and the underlying mechanism. Methods Male C57BL/6 mice (6-8 weeks) were randomly divided into four groups (6 mice per group):control (WT), LPS, LPS+INS, and LPS+INS+ML385 (Nrf2 inhibitor) groups. Mouse model of ALI was established with intratracheal LPS instillation, and the mice were sacrificed to collect lung tissues in 12 h after modelling. HE staining was used to observe the severity of lung injury, Giemsa staining was employed to detect the inflammatory cells in bronchoalveolar lavage fluid (BALF), enzyme-linked immunosorbent assay was ultilized to measue the contents of pro-inflammatory cytokines and ferroptosis-related indicators in lung tissues, and Western blotting was applied to determine the expression of ferroptosis-related proteins. SPSS statistics 19.0 and GraphPad Prism 8 were used for statistical analysis. Student′s t test was conducted for comparison between two groups, and one-way analysis of variance was performed for comparison among multiple groups. Results Compared to the WT group, the LPS group exhibited significantly severer lung injury, more BALF inflammatory, and pro-inflammatory cytokines in lung tissues (all P<0.05). INS treatment resulted in decreased malondialdehyde and increased glutathione contents, and elevated protein levels of Nrf2 and GPX4 in lung tissues when compared with the LPS group (P<0.05). Compared with the LPS+INS group, the protein levels of Nrf2 and GPX4 in the LPS+INS+ML385 group decreased significantly (P<0.05). Conclusion Insulin alleviates ferroptosis in ALI by activating the Nrf2/GPX4 pathway, suggesting a promising therapeutic target for ALI treatment.

Abstract:Insulin resistance (IR), a prevalent complication in the perioperative period, significantly impacts patient outcomes, and its pathogenesis may be related with insulin signaling pathways disrupted by surgical stress, inflammatory responses, and metabolic changes. Effective nutritional management is critical for reversing IR during this period. In this article, we elucidated the epidemiology and pathophysiology of perioperative IR, discussed the impact of different nutrition intervention strategies on the condition, such as preoperative nutritional assessment, hypoglycemic agents, and enhanced recovery after surgery protocols, and focused on the role of fatty acids in modulating the resistance. Furthermore, we reviewed the recent progress on perioperative nutritional management, aiming to provide reference for the prevention and management of perioperative IR.

Abstract:Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease characterized by airflow limitation and an accelerated progressive decline in lung function, with manifestations of hypersecretion of mucus, thickening of the airway walls and destruction of alveolus, and its common outcome is pulmonary heart disease. Conventional treatments are not effective in inhibiting its progression. Mesenchymal stem cells (MSCs) can be induced to differentiate into type Ⅱ alveolar epithelial cells, and have the functions of multi-directional differentiation, anti-inflammatory, immune regulation, manipulation and recovery of adjacent cell function, showing application value in the treatment of COPD. In this article, we reviewed and analyzed the action mechanism, administration routes and clinical studies of MSCs in the treatment of COPD in order to better understand the potential and the feasibility of clinical application of MSCs.