Abstract:Objective To analyze the incidence and influencing factors of major adverse cardiovascular events (MACE) caused by the interventional intra-aortic balloon pump (IABP) for ST-segment elevation myocardial infarction(STEMI)in the elderly with cardiogenic shock, and to explore its impact on quality of life. Methods A retrospective analysis was made of the clinical data of 150 elderly patients with STEMI complicated with cardiogenic shock, who underwent IABP for interventional treatment at the Interventional Center of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from February 2020 to January 2023. Based on the occurrence of MACE within one year after surgery, the patients were divided into MACE group (n=45) and non-MACE group (n=105). The general information of patients and the occurrence of MACE were statistically analyzed. The Minnesota living with heart failure questionnaire (MLHFQ) was used to evaluate the quality of life of patients. SPSS 22.0 was used for statistical analysis. Data comparison between two groups was performed using t test, analysis of variance orχ² test depending on data type. Multivariate logistic regression analysis was conducted to analyze the influencing factors of MACE. Spearman correlation analysis was used to analyze the correlation between MACE and quality of life. Results Among 150 patients, 45 (30.00%) developed MACE. The total MLHFQ score was (39.84±2.05) points for the MACE group and (33.27±2.06) points for the non-MACE group. There were significant differences between the non-MACE group and the MACE group in age, smoking, diabetes mellitus and hyperlipidemia, left ventricular ejection fraction (LVEF), low-density lipoprotein cholesterol (LDL-C), serum high-sensitivity C-reactive protein (hs-CRP), hemoglobin, cardiac muscle calcium and protein I (cTnI), lipoprotein a (P<0.05). Logistic regression analysis showed that age, smoking, diabetes mellitus, hyperlipidemia, LVEF, LDL-C, hs-CRP, hemoglobin, cTnI, Lp(a) were risk factors for MACE in the elderly undergoing interventional IABP for STEMI with cardiogenic shock (P<0.05). Recurrent angina, severe heart failure, recurrent myocardial infarction, and stroke were negatively correlated with total quality of life scores (r=-0.432, -0.527, -0.563, -0.413; P<0.05). Conclusion The incidence of MACE in the elderly undergoing interventional IABP for STEMI with cardiogenic shock is high, and their quality of life is low. Age, smoking, diabetes mellitus, hyperlipidemia, LVEF, LDL-C, hs-CRP, hemoglobin, cTnI, and Lp(a) are the risk factors for MACE, and the occurrence of MACE in patients is negatively correlated with the quality of life.

Abstract:Objective To investigate the influencing factors for positive pressure ventilation failure and its effect on quality of life in elderly patients with chronic obstructive pulmonary disease (COPD) complicated with chronic respiratory failure (CRF). Methods A retrospective analysis was conducted on 150 elderly COPD patients with concomitant CRF admitted to our hospital from January 2020 to December 2023. All of them received positive pressure ventilation, and according to the treatment efficacy, those with effective treatment were assigned into an effective group (n=108), and those without into an ineffective group (n=42). St. George′s respiratory questionnaire (SGRQ) was used to evaluate their quality of life. The general clinical data and score of quality of life were compared between the two groups. SPSS statistics 20.0 was used for data analysis. Depending on data type, student′s t test or Chi-square test was employed for comparison between groups. Logistic regression analysis was utilized to identify the influencing factors for positive pressure ventilation failure in these patients. Spearman correlation analysis was applied to analyze the linear relationship of positive pressure ventilation failure and quality of life in elderly COPD patients with CRF. Results There were significant differences between the two groups in terms of APACHEⅡ score and GCS score at admission, PaO₂, PaCO₂, heart rate, pH value and respiratory rate before treatment, and levels of blood lactic acid, C-reactive protein (CRP) and B-type natriuretic peptide (BNP) before treatment (all P<0.05). Multivariate logistic regression analysis showed that baseline APACHEⅡ score ≥15 (OR=4.778,95%CI 1.398-16.329), PaCO2 before treatment ≥75 mmHg (OR=3.971,95%CI 1.166-13.518), blood lactic acid ≥1.7 mmol/L (OR=5.099,95%CI 1.258-20.665), CRP ≥85 mg/L (OR=3.377,95%CI 1.188-9.599) and BNP ≥250 ng/L (OR=4.468,95%CI 1.183-16.876) before treatment were independent risk factors for positive pressure ventilation failure in elderly COPD patients with CRF (P<0.05). The dimension scores of disease impact, activity limitation and respiratory symptoms, and total score of SGRQ were significantly lower in the effective group than the ineffective group (all P<0.05). Spearman correlation analysis indicated that the failure of positive pressure ventilation was positively correlated with the score of quality of life in the elderly COPD patients with CRF (r=0.923, P<0.05). Conclusion APACHEⅡ score ≥15 at admission, and PaCO₂ ≥75 mmHg, blood lactate ≥1.7 mmol/L, CRP ≥85 mg/L and BNP ≥250 ng/L before treatment are independent risk factors for the failure of positive pressure ventilation in elderly COPD patients with CRF. In clinical practice, it is necessary to strengthen the monitoring of the above indicators and put forward targeted countermeasures, which is of great significance to improve the effectiveness and quality of life among the patients.

Abstract:Objective To construct a risk model of postoperative delirium (POD) after radical resection of lung cancer in elderly patients and evaluate its efficiency. Methods A total of 618 elderly patients with radical resection of lung cancer in the Department of Intensive Care Medicine of the Tumor Hospital Affiliated to Xinjiang Medical University were selected from March 2022 to August 2022 as the research subjects. The patients were divided into a training set (n=433) and a validation set (n=185) in a 7∶3 ratio using simple random sampling. At 1-3 days after surgery, the occurrence of POD was evaluated by the qualified staff using confusion assessment method. General demographic data, preoperative, intraoperative and postoperative indicators were collected. SPSS 26.0 was used for data processing. According to the data type, t test or Chi-square test was performed. Factors affecting the occurrence of POD in the training set were screened by binary logistic regression model. A POD prediction model was constructed, and receiver operating characteristic (ROC) curve was drawn. The validation set was used to verify the efficiency of the prediction model. Results Of 618 elderly patients with lung cancer, 119 (19.26%) developed POD, with 88 (20.32%) in the training set and 31 (16.76%) in the validation set, and there was no statistically significant difference between the two groups (χ²=1.061, P=0.303). With presence or absence of POD in the training group as the dependent variable, binary logistic regression analysis indicated that age > 79 years (OR=2.221, 95%CI 1.642-3.004), Charlson comorbidity index (CCI) score ≥ 2 points (OR=1.540, 95%CI 1.011-2.348), thoracotomy (OR=1.902, 95%CI 1.177-3.075), and propofol dosage (OR=1.413, 95%CI 1.133-1.764) were independent influencing factors of POD occurrence in elderly patients undergoing radical resection of lung cancer. ROC curve showed an area under the curve (AUC) of 0.832 (95%CI 0.746-0.917) for the prediction model constructed on the above results in predicting POD risk in the validation set, with a sensitivity of 0.710 and a specificity of 0.838. Conclusion Age, CCI score, surgical method and propofol dosage are independent risk factors for POD in elderly patients after radical resection of lung cancer. The risk prediction model based on these factors demonstrates good performance in predicting POD in patients. In order to ensure the reliability of the conclusion, external verification is necessary with increased samples.

Abstract:Objective To evaluate the application of Warfarin genetic testing in individualized anticoagulant therapy for patients with non-valvular atrial fibrillation (NVAF). Methods NVAF patients undergoing Warfarin treatment at the Outpatient Department of Northern Jiangsu People′s Hospital between January 2021 and January 2023 were enrolled. According to whether Warfarin genetic testing was performed, they were divided into a genetic testing group and a routine follow-up group. The clinical data were collected, and adverse events were statistically analyzed. The two groups were compared in initial international normalized ratio (INR), time to achieve therapeutic INR, time to reach stable warfarin dose, percentage of time INR in therapeutic range (TTR) at different times, and adverse reactions. SPSS 27.0 was used for statistical analysis. Data comparison between two groups was performed using t test, Wilcoxon test,χ² test or Fisher exact test depending on data type. Results A total of 200 patients were enrolled in this study, includ-ing 110 patients in the genetic testing group and 90 in the routine follow-up group. In the genetic testing group, 90.00% (99/110) were of AA wild type, 8.18% (9/110) of AC heterozygous, and 1.82% (2/110) of CC homozygous at the CYP2C9 3 locus; 86.36% (95/110) of AA mutation homozygous, 11.82% (13/110) of GA heterozygous, and 1.82% (2/110) of GG mutation homozygous for the VKORC1 gene. Minor bleeding occurred in two patients (1.81%) in the genetic testing group without major bleeding, and minor bleeding occurred in six patients (6.67%) and major bleeding in two patients (2.22%) in the routine follow-up group. There was no significant difference in the cumulative incidence of minor and major bleeding between the two groups (P>0.05) The time to reach the therapeutic INR was (28.09±31.21)d in the genetic testing group, and (45.47±45.33)d in the routine follow-up group, with a statistically significant difference (P<0.05). At one month, TTR in the genetic testing group was higher than that in the routine follow-up group, with a statistically significant difference (P<0.05), but there was no significant difference between the two groups at 3,6 and 12 months. The gene testing group had a notably lower incidence rate of INR<1.2 events and INR>3.5 events than the routine follow-up group, with a statistically significant difference (P<0.05). Conclusion Genetic testing can identify individual sensitivity to Warfarin, helping patients to reach target doses quickly and maintain INR within the optimal therapeutic range and thereby reducing the adverse events such as bleeding and thromboses.

Abstract:Objective To explore the correlation of meaning in life, cognitive ability and quality of life (QoL) with disease severity among elderly lung cancer patients. Methods A retrospective analysis was performed of the clinical data of 120 lung cancer patients admitted to the Department of Respiratory and Critical Care Medicine at Beijing Chest Hospital Affiliated to Capital Medical University from August 2021 to March 2024. According to the disease stage, the patients were divided into stage Ⅰ group (n=36), stage Ⅱ group (n=41), stage Ⅲ group (n=32), and Stage Ⅳ group (n=11). The China-meaning in life questionnaire (C-MLQ) was used to assess meaning in life, the Chinese version of the functional assessment of cancer therapy-cognitive function (FACT-Cog) was used to assess the patients′ cognitive function, and the functional assessment of cancer therapy-lung (FACT-L) was used to assess the patients′ QoL. SPSS 20.0 was used for data processing. Analysis of variance, t test orχ² test was performed according to the type of data. Spearman correlation analysis was used to analyze the correlation between meaning in life, cognitive ability and QoL and disease severity in elderly lung cancer patients. Pearson correlation analysis was used to analyze the correlations between meaning in life, cognitive ability and QoL in elderly lung cancer patients. Results There were statistically significant differences in the scores of life goals, acceptance and adaptation, interpersonal relationships, self-control, life attitude, and the total scores among the four groups of patients (F=205.837,143.057,155.002,141.778,163.193,323.901; P<0.05). There were also statistically significant differences in the perceived cognitive impairment, impact on QoL, evaluation by others, perceived cognitive function, and the total scores among the four groups of patients (F=355.352,215.467,180.125,110.522,390.671; P<0.05). Moreover, there were statistically significant differences in the scores of functional status, physical status, family status, emotional status, lung-cancer-specific symptoms, and the total scores among the four groups of patients (F=300.062,292.805,300.995,261.993,264.919,312.498; P<0.05). There were significant negative correlations between meaning in life, cognitive ability, and QoL, and disease severity among elderly lung cancer patients (r=-0.756, -0.695, -0.619; P<0.05). There were positive correlations between meaning in life and cognitive ability as well as between meaning in life and QoL (r=0.534,0.464; P<0.05). There was a positive correlation between cognitive ability and QoL (r=0.421; P<0.05). Conclusion As disease severity increases, patients′ perception of cognitive impairment and the impact on meaning in life and QoL increases, suggesting the need for targeted management to address the above-mentioned factors in clinical practice.

Abstract:Objective To investigate the incidence and related influencing factors of Acinetobacter baumannii (AB) and multidrug-resistant AB (MDRAB) infections in the elderly patients after surgical treatment of lung cancer. Methods A retrospective study was conducted on 394 elderly patients undergoing lung cancer resection in our hospital from April 2016 to March 2021. The infection incidence of AB and MDRAB within 8 weeks after surgery were statistically analyzed, and univariate and multivariate logistic regression analyses were used to identify the relevant influencing factors for AB and MDRAB infections. SPSS 22.0 was employed to perform data staticitical analysis. Chi-square test was utilized for inter-group comparison. Results Among the 394 subjected elderly patients, 61 of them (15.48%) developed AB infection, including 28 cases (7.11%) of MDRAB infection. Univariate analysis showed that age, diabetes mellitus, combined use of antibiotics, postoperative stress ulcer, mechanical ventilation and chemoradiotherapy, length of postoperative intensive care unit (ICU) stay, bed-ridden time, and hospital stay length were all associated with MDRAB infection (P<0.05). Multivariate analysis indicated that age, diabetes mellitus, postoperative stress ulcer, mechanical ventilation and chemoradiotherapy, postoperative ICU stay length, length of hospital stay ≥15 d, and postoperative bed-ridden time ≥5 d were independent risk factors for AB infection (P<0.05); diabetes mellitus, postoperative ICU stay length, postoperative stress ulcer, mechanical ventilation and chemoradiotherapy, combined antibiotic use, hospitalization time ≥15 d, and postoperative bed -ridden time ≥5 d were independent risk factors for MDRAB infection (P<0.05). Conclusion The incidence of MDRAB infection is relatively high in elderly lung cancer patients after resection. Its influencing factors include diabetes mellitus, postoperative ICU stay length, combined use of antibiotics, postoperative stress ulcer, mechanical ventilation and chemoradiotherapy, hospitalization time ≥15 d, and postoperative bed-ridden time ≥5 d. In clinical practice, it is necessary to strengthen the control of comorbidities, reduce invasive procedures, and emphasize anti-infection interventions to reduce the incidence of postoperative MDRAB infection in the patients.

Abstract:Objective To explore the impact of physical activity and negative emotions on quality of life (QoL) in elderly patients with chronic kidney disease (CKD). Methods A retrospective analysis was conducted of the clinical data of 325 elderly CKD patients treated in the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2023. The patients were divided into a control group (n=184) with a mild damaged glomerular filtration rate (GFR) (CKD stage 1-2) and an observation group (n=141) with a moderate or severe damaged GFR (CKD stage 3-5). Upon admission, QoL of the patients was assessed using the kidney disease quality of life-short form 1.3 (KDQOL-SFTM 1.3), physical activity using the physical activities questionnaire of the National Health and Nutrition Examination Survey of the United States, anxiety and depression using Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). SPSS 20.0 was used for data processing. According to the data type, t test orχ² test was used for comparison between groups. Pearson correlation analysis was used to evaluate the correlation between physical activity and QoL, and between negative emotions and QoL in elderly CKD patients. Results The observation group had significantly lower total scores of kidney diseases targeted areas (KDTA) [(56.72±6.14) vs (80.14±9.26) points] and 36-item short form survey (SF-36) [(52.72±6.14) vs (82.70±9.33) points] than the control group, and the difference was statistically significant (t=10.974,25.442; P<0.05). The scores of the 2-minute step test (2MST), hand grip strength, and the number of 30-second chair stand test (30CST) were significantly lower in the observation group than those in the control group, the HAMA score and HAMD score in the observation group were significantly higher than those in the control group, and the differences were statistically significant (t=40.084,19.396,28.033,47.766,45.030; P<0.05). Pearson correlation analysis showed that the KDTA score was significantly positively correlated with 2MST, handgrip strength, and the number of 30CST in physical activities (r=0.583,0.457,0.591; P<0.05), and were negatively correlated with HAMA score and HAMD score (r=-0.616, -0.590; P<0.05). The SF-36 score was positively correlated with 2MST, hand grip strength and the number of 30CST (r=0.801,0.670,0.806; P<0.05), and were negatively correlated with HAMA score and HAMD score (r=-0.824, -0.906; P<0.05). Conclusion Physical activity is positively correlated with quality of life, and negative emotions are negatively correlated with quality of life in elderly CKD patients. Therefore, in clinical practice, attention should be paid to physical exercise and mental health intervention to improve their QoL.

Abstract:Objective To explore the influencing factors of nosocomial infections in elderly patients with liver failure (LF) during hospitalization and analyze their prognosis. Methods A retrospective analysis was conducted of the clinical data of 110 elderly LF patients admitted to the Infectious Diseases Department of the Third Hospital of Hebei Medical University from July 2021 to June 2023. According to the occurrence of nosocomial infections during hospitalization, they were divided into an infection group (n=29) and a non-infection group (n=81). Hospital stay length, hospitalization costs, and 30-day mortality rates were compared between the two groups. SPSS statistics 20.0 was used for data analysis. According to the data type, t-tests or χ² tests was used for inter-group comparisons. A multiple logistic regression model was used to analyze the influencing factors of nosocomial infections in elderly LF patients. Results Among 29 patients with nosocomial infections, 12 (41.38%) were of pulmonary infection, 3 (10.34%) of gastrointestinal infection, 3 (10.34%) of upper respiratory tract infections, 8 (27.59%) of spontaneous bacterial peritonitis, 2 (6.90%) of urinary tract infections, and 1 (3.45%) of sepsis. A total of 34 pathogenic strains were detected, including 26 Gram negative bacteria, 6 Gram positive bacteria, and 2 fungi, with Klebsiella pneumoniae (44.12%) being most frequent. Multivariate logistic regression analysis showed that length of hospital stay (OR=5.409,95%CI 1.055-27.733), invasive procedure (OR=5.692,95%CI 2.132-15.195), albumin (OR=0.380,95%CI 0.157-0.919), diabetes mellitus (OR=3.995,95%CI 1.919-8.315), and moldel for end-stage liver disease (MELD) score (OR=5.447,95%CI 1.572-18.871) were the influencing factors of nosocomial infections in elderly LF patients (P<0.05). The infection group had longer hospital stay, higher hospitalization costs, and higher mortality within 30 days than the non-infection group (P<0.05). Conclusion Nosocomial infections in elderly LF patients during hospitalization are mainly influenced by the length of hospital stay, invasive procedures, albumin, diabetes mellitus, and MELD scores. Patients with infection have longer hospital stay, higher hospitalization costs, and higher mortality within 30 days. Early intervention targeting the above factors is needed to control the risks of nosocomial infection in clinical practice.

Abstract:Objective To investigate the corelation between mental resilience, St. George′s respiratory questionnaire (SGRQ) and quality of life (QoL) in elderly patients with acute respiratory failure (ARF). Methods A retrospective analysis was conducted of general clinical data of 120 elderly ARF patients admitted to the Emergency Department of First Hospital Affiliated to Nanjing Medical University from April 2020 to December 2023. According to the severity of respiratory failure, the patients were divided into a mild group (n=46), a moderate group (n=49), and a severe group (n=25). Connor-Davidson resilience scale (CD-RISC) was used to assess the mental resilience of patients with different disease severity. SGRQ was used to assess the impact of respiratory status on QoL. WHO QoL scale was used to assess the patients′ QoL. SPSS 20.0 was used for data analysis. According to the data type, t test orχ² test was used for inter-group comparison. Pearson correlation analysis was used to analyze the corelation between mental resilience, SGRQ and QoL in elderly ARF patients. Results There were statistically significant differences in strength, tenacity, optimism and total score between the three groups (F=66.821,89.754,171.296,125.123; P<0.05), and the scores decreased with severity (severe group < moderate group < mild group). There were statistically significant differences in disease impact, symptoms, activity ability, and total score between the three groups (F=154.007,126.710,302.986,166.768; P<0.05), and the scores increased with severity (severe group ＞ moderate group ＞mild group). There were statistically significant differences in social relation, physiology, psychology, environment, and total scores among patients with ARF (F=40.169,52.961,35.241,26.253,35.139; P<0.05), and the scores decreased with severity (severe group < moderate group < mild group). Pearson correlation analysis showed that psychological resilience was significantly negatively correlated with SGRQ (r=-0.730; P＜0.05) and positively correlated with QoL (r=0.495; P<0.05), while SGRQ was significantly negatively correlated with QoL (r=-0.608; P<0.05). Conclusion There is a significant correlation between mental resilience, SGRQ and QoL in elderly ARF patients, suggesting that comprehensive consideration of psychological factors is crucial to their rehabilitation and QoL improvement.

Abstract:Objective To explore the value of hyperbaric oxygen therapy (HBOT) on relieving the clinical symptoms in elderly coronary heart disease (CHD) patients with unstable angina (UA), and to investigate its impact on peripheral blood D-dimer (D-D), blood lipid metabolism and vascular inflammatory factors. Methods A total of 146 elderly CHD patients with UA admitted to our hospital from June 2021 to December 2023 were recruited and randomly divided into HBOT group (HBOT+ basic treatment, n=73) and control group (basic treatment, n=73). Both groups of patients were continuously intervened for 15 d. The therapeutic effect, as well as peripheral blood levels of D-D, blood lipids and vascular inflammatory factors [high-sensitivity C-reactive protein (hs-CRP), lipoprotein-associated phospholipase A2 (Lp-PLA2), homocysteine (Hcy)] before and after treatment were determined and compared between two groups. The frequency and duration of angina pectoris on the second day after admission and on the first day before discharge were counted in both groups. SPSS 26.0 was used for data analysis, and t test or χ² test was carried out depending on data type. Results In the HBOT group, six patients withdrew due to poor adaptation to HBOT treatment and cost of HBOT, and the remaining 67 patients completed 15 d of treatment. All the patients in the control group completed 15 d of treatment. After treatment, the levels of blood lipids, TG and plasma D-D in the HBOT group were decreased than the levels before treatment, while the HDL-C was enhanced than the levels before treatment; the plasma D-D were significantly lower while the HDL-C were significantly higher in the HBOT group than the control group (P<0.05). The levels of blood lipid indicators and plasma D-D in the control group were not notably improved after treatment (P>0.05). After treatment, the levels of vascular inflammatory factors hs-CRP, Lp-PLA2 and Hcy were decreased in both groups, and the average daily frequency of angina pectoris attacks and duration of angina pectoris in both groups were reduced on the first day before discharge compared with those on the second day after admission. The levels of vascular inflammatory factors and average daily frequency and duration of angina pectoris attacks were significantly lower in the HBOT group than the control group after treatment (P<0.05). The effective rate of treatment was significantly higher in the HBOT group than the control group [92.54% (62/67) vs 80.82% (59/73), P<0.05]. Conclusion HBOT has good efficacy in reducing the frequency of angina pectoris attacks and the duration of angina pectoris. Besides the traditional mechanism, HBOT may also play a therapeutic effect by reducing the releases of vascular inflammatory factors and improving the lipid metabolism disorder and hypercoagulable state.

Abstract:Objective To explore the interaction between health beliefs and health behaviors in stroke patients and caregivers. Methods A total of 253 groups of stroke patients and their main caregivers admitted to the First Affiliated Hospital of Air Force Military Medical University and Xi′an Hospital of Traditional Chinese Medicine from August 2023 to March 2024 were selected as the study objects. General demographic questionnaire, health belief scale and Chinese health promotion lifestyle scale were used to survey the health belief and health behavior levels of 253 stroke patients and their caregivers. SPSS statistics 26.0 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 employed to evaluate the correlation between health beliefs and health behaviors of the patients and their caregivers. AMOS28.0 software was used to establish a subject-object interaction model to analyze the subject-object effects of the health beliefs of the stroke patients and their caregivers on themselves and their caregivers′ health behaviors. Results There was a positive correlation between health beliefs and health behaviors in stroke patients (r=0.414; P<0.01), between patient′s health belief and caregivers′ health beliefs (r=0.480; P<0.01), between patient′s health belief and caregivers′ health behaviors (r=0.339; P<0.01), between patient′s health behavior and caregivers′ health beliefs (r=0.134; P<0.05), between patient′s health belief and caregivers′ health behaviors (r=0.532; P<0.01), and between caregivers′ health beliefs and health behaviors (r=0.357; P<0.01). In the subjective effect, the health belief level of stroke patients and their caregivers positively affected their own health behaviors (β=0.557,0.440; P<0.001). In terms of object effect, only patient′s health belief positively affected caregivers′ health behaviors (β=0.181; P<0.05). Conclusion In view of the relationship between health beliefs and health behaviors in stroke patients and caregivers, it is necessary to take caregivers as a whole in intervention to improve the health behaviors of stroke patients in the future.

Abstract:Objective To explore the effect of nivolumab combined with anlotinib in the treatment of elderly advanced gastric cancer. Methods A total of 120 elderly patients with advanced gastric cancer who received third-line treatment in our hospital from January 2021 to January 2023 were enrolled, and 60 of them received nivolumab treatment (single drug treatment group), and the other 60 ones received nivolumab combined with anlotinib treatment (combined treatment group). After four continuous courses of treatment, the objective remission rate (ORR) and disease control rate (DCR) were calculated. The peripheral blood levels of vascular endothelial growth factor A (VEGF-A), carcinoembryonic antigen (CEA), matrix metalloproteinase-2 (MMP-2) and MMP-9 and the percentages of peripheral blood T lymphocyte subsets were detected before and after treatment. The occurrence of adverse reactions was observed. SPSS statistics 22.0 was used for data analysis, and t test or Chi-square test was employed for between-group comparison depending on data type. Kaplan-Meier survival analysis was applied to analyze the cumulative survival rate of each group, and Log-rank test was conducted to analyze the difference in survival rate between the two groups. Results The DCR and ORR in the combined treatment group was 76.67% (46/60) and 43.33% (26/60), which were higher than those of the single drug treatment group [58.33% (35/60) and 25.00% (15/60), P<0.05]. After treatment, the combined treatment group had significantly lower serum VEGF-A, CEA, MMP-2 and MMP-9 levels, higher percentages of CD3⁺, CD4⁺ T cells and CD4⁺/CD8⁺ ratio, but lower percentage CD8+ T cells when compared to the single drug treatment group (P<0.05). There was no statistical difference in occurrence of adverse reactions between the two groups (P>0.05). The patients were followed up until February 2024, and the results showed that in the combined treatment group and single drug treatment group, the median progression-free survival (PFS) was 6.10 months (95%CI 4.607-7.593) and 4.00 months (95%CI 3.059-4.941), and the median overall survival (OS) was 9.25 months (95%CI 8.394-10.099) and 6.19 months (95%CI 5.583-6.789), respectively, with statistical differences between them (χ²=6.298,4.943, P<0.05). Conclusion Nivolumab combined with anlotinib, as a third-line treatment regimen, can effectively prolong the survival time and improve the tumor control effect in elderly patients with advanced gastric cancer. However, its efficacy needs to be further verified by multi-center, large-sample prospective studies.

Abstract:Objective To analyze the influencing factors for renal diseases secondary to heart diseases and to construct a risk prediction model for this comorbidity. Methods Based on the China Health and Retirement Longitudinal Study (CHARLS), the baseline data were collected from the initial follow-up and blood tests conducted in 2011, and the conditions of chronic diseases were investigated in the subsequent follow-ups in 2013,2015, 2018 and 2020. A cohort of 1 087 middle-aged and elderly patients with cardiac disease, aged 45 years and above, were finally enrolled. Based on whether they developed secondary renal diseases during the follow-up period, the participants were divided into non-renal disease group (908 cases) and renal disease group (179 cases). R Project for Statistical Computing 4.3.2 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. Logistic regression analysis was applied to identify factors influencing the development of renal disease secondary to cardiac disease. Furthermore, a risk prediction model was constructed, and its predictive efficacy was evaluated by using receiver operating characteristic (ROC) curve and calibration curve analyses. The clinical utility of the model was assessed with decision curve analysis (DCA). Results Till the final follow-up in 2020,179 individuals had developed secondary renal diseases, accounting for 16.47% of the participants. Multivariate logistic regression analysis revealed that smoking (OR=1.56,95%CI 1.01-2.43), central obesity (OR=2.33,95%CI 1.32-4.12) and creatinine (OR=9.87,95%CI 2.62-37.21) were risk factors, whereas duration of sleep (OR=0.87,95%CI 0.80-0.94) appeared to exert a protective effect for the development of secondary renal diseases (P<0.05). Then, a risk prediction model for renal disease secondary to heart disease was constructed based on predictive variables, including smoking, central obesity, total daily sleep duration, creatinine level, glycated hemoglobin, and metabolic syndrome. The area under the curve of our model was 0.711 (95%CI 0.67-0.75; P<0.001). Decision curve analysis indicated that the model offered clinical benefit across varying thresholds of intervention willingness. Conclusion Smoking, central obesity, creatinine level, and sleep duration are significant factors influencing the development of renal disease subsequent to cardiac disease. Our risk prediction model for renal disease secondary to cardiac disease based on the clinical and laboratory indicators has the advantages of objective indicators, easy to detect and calculate, and good predictive performance and clinical application, and is helpful for physicians to make more precise risk assessment and therapeutic decision.

Abstract:With the acceleration of China′s aging process, there were more and more stroke patients year by year. Attention dysfunction is one of the common cognitive disorders after stroke, and also a key factor affecting the recovery of limb motor function after stroke. Attention deficits not only interfere limb movement function by exacerbating disorders in balance and postural control, but also reduce the compliance of stroke patients in treatment, thereby delaying the overall rehabilitation process. In addition, studies have found that attention function training can promote the recovery of motor function in stroke patients, but its potential mechanism has not been elucidated. The prefrontal cortex is the central hub of the attention and motor function networks, with a wide range of connecting fibers closely associated with multiple brain regions. Taking the prefrontal cortex as the entry point and utilizing techniques such as magnetic resonance imaging and quantitative electroencephalography, exploring the neural connectivity between the attention and motor function networks becomes an important breakthrough direction for future research. In this article, we review the correlation between attention dysfunction and motor function, introduce restorative rehabilitation strategies for attention dysfunction, and aim to increase clinical attention to the attention dysfunction patients so as to identify them early and provide targeted rehabilitation treatment.

Abstract:Chronic obstructive pulmonary disease (COPD) has become a global public health problem due to its high prevalence, high disability rate, and high mortality. More and more studies focus on the pulmonary abnormalities in the pre-COPD period. People with preserved ratio impaired spirometry (PRISm) can be regarded as pre-COPD because they are more prone to COPD or acute exacer-bation. The prevalence of PRISm is high worldwide, but there are no clear clinical guidelines for its evaluation, treatment, and manage-ment. PRISm is associated with a rapid decline in lung function. Over time, people with PRISm not only have the risk of developing COPD but also have a significant increase in the risk of cardiovascular and cerebrovascular complications, diabetes, and even death. Therefore,it is crucial to improve the understanding of PRISm. At present, PRISm is understudied despite a common incidence. In this paper, we summarized the literature on PRISm in recent years and reviewed the risk factors, examination methods, and prognosis of PRISm, so as to provide reference for further research.

Abstract:Obstructive sleep apnea (OSA) is a potentially fatal disease with global prevalence, and its pathogenesis involves a complex interaction of anatomical abnormalities and dysfunction of the upper airway. Recent studies have shown that oral microecological imbalance may have synergistic effects with airway anatomical abnormalities through up-regulation of inflammatory mediators and muscle function impairment. This review systematically describes:(1) mechanical obstruction caused by rigid structure malformation of upper airway and soft tissue hyperplasia; (2) the OSA characteristic oral microflora changes and the decreased microbial diversity; (2) the mechanism underlying interaction between airway anatomy and microecology, including nuclear factor-κB-mediated inflammatory cascade, tissue remodeling driven by matrix metalloproteinases, dilator dysfunction caused by necroptosis and other pathological processes. Studies have confirmed that intermittent hypoxia environment can induce flora imbalance, and abnormal microbial metabolites aggravate local inflammation by activating related signaling pathways such as Toll-like receptors, forming a vicious cycle of “hypoxia-flora-inflammation”. Based on this, this paper proposes a synergistic intervention strategy integrating anatomic correction, microbial regulation and anti-inflammatory therapy to provide reference for the development of novel biomarkers and precision therapy. In-depth analysis of the combined mechanism of anatomical structure and microbiome has important clinical significance for breaking through the current challenges and limitations of OSA treatment.