Abstract:Objective To investigate the correlation between lipid metabolism and frailty in elderly inpatients with hypertension. Methods A total of 305 elderly patients with hypertension admitted to our hospital from January 2021 to January 2024 were recruited, and according to the results of FRAIL scale, they were divided into a frailty group and a non-frailty group. The lipid metabolism indicators were compared between two groups. 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 performed to analyze the correlation between lipid metabolism indicators and frailty score in elderly patients with hypertension. Binary logistic regression model was adopted to analyze the related factors affecting frailty in the patients. Results The frailty group had significantly higher levels of triglyceride (TG), total cholesterol (TC) and apolipoprotein B (ApoB), but lower levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (ApoA1) than the non-frailty group (P<0.05). Pearson correlation analysis showed that the FRAIL scale score was positively correlated with TG, TC and ApoB levels (r=0.216,0.304,0.229; all P<0.05), and negatively with HDL-C and ApoA1 levels (r=-0.443, -0.389; both P<0.001). Binary logistic regression analysis with presence or absence of frailty in elderly hypertension patients as the dependent variable suggested that age (OR=1.514, 95%CI 1.098-2.088), coronary heart disease (OR=1.430, 95%CI 1.096-1.867) and multiple drug use (OR=1.461, 95%CI 1.039-2.055) were risk factors for frailty in elderly patients with hypertension, and the levels of HDL-C (OR=0.598, 95%CI 0.392-0.911), albumin (OR=0.773, 95%CI 0.663-0.900) and ApoA1 (OR=0.743, 95%CI 0.624-0.885) were protective factors (P<0.05). Conclusion Blood lipid metabolism disorder is more serious in elderly hypertensive inpatients with frailty than those without. Blood lipid metabolism indicators HDL-C and ApoA1 are protective factors for frailty in the patients.

Abstract:Objective To explore the application value of levocarnitine in elderly patients with diabetic kidney disease (DKD) on maintenance hemodialysis (MHD). Methods A total of 252 elderly DKD patients receiving MHD treatment in our hospital from January 2023 to December 2023 were recruited and then randomly divided into a levocarnitine group (routine treatment + levocarnitine, 126 cases) and a control group (routine treatment, 126 cases). After three months of continuous treatment, the changes in laboratory indicators were compared before and after treatment and between the two groups. The incidence of adverse reactions during treatment were observed and recorded. SPSS statistics 24.0 was used for data analysis, and t test or Chi-square test was used for between-group comparison depending on data type. Results Among 252 patients, three cases in each group were excluded. After three months of treatment, the levels of serum β₂-microglobulin (β₂-MG), serum creatinine (SCr), blood urea nitrogen (BUN), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), lipoprotein-associated phospholipase A2 (Lp-PLA2), C-reactive protein (CRP) and interleukin-6(IL-6) were significantly reduced in both groups when compared with those before treatment, and these above levels were obviously lower in the levocarnitine group than the control group (P<0.05). Serum albumin (ALB), geriatric nutritional risk index (GNRI) and high-density lipoprotein cholesterol (HDL-C) were significantly risen in the two groups than those before treatment, and these indicators were notably higher in the levocarnitine group than the control group (P<0.05). The levels of fasting blood glucose (FBG), 2h postprandial blood glucose (2hPG) and glycosylated hemoglobin (HbA1c) were significantly declined in both groups after three months of treatment than the levels before treatment (P<0.05), but there were no statistical differences between groups after treatment (P>0.05). No notable difference was observed in the incidence of adverse reactions between the levocarnitine group and the control group (3.25% vs 0.00%, P>0.05). Conclusion Levocarnitine combined with routine symptomatic treatment has high application value in the elderly DKD patients on MHD. It can improve lipid metabolism and nutritional status, and relieve inflammatory response, and may be beneficial to protecting renal function in the patients.

Abstract:Objective To explore the impact of personality traits on the quality of life(QoL) in elderly patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). Methods A retrospective analysis was conducted on the clinical data of 138 elderly CHD patients who received PCI treatment for the first time in the First Hospital of Zhangjiakou from March 2021 to March 2023. The Eysenck personality questionnaire (EPQ) was used to assess the personality traits of the patients before PCI. The 36-item short-form health survey (SF-36) was used to evaluate QoL of patients before PCI and 12 months after the operation. SPSS 22.0 was used for statistical analysis. Data comparison between two groups was performed using t test orχ² test depending on data type. A multiple linear regression model was employed to analyze the factors affecting QoF in elderly CHD patients 12 months after PCI. Results A total of 138 questionnaires were distributed in this study, and 130 (94.20%) were retrieved. EPQ scores of 130 patients before PCI were (42.78±6.47) points. The scores of physical health and mental health, and the total score of the SF-36 at 12 months after the operation were all higher than those before PCI (P<0.001). Multiple linear regression analysis showed that female gender unmarried/divorced/widows, living alone, phlegmatic temperament, choleric temperament, melancholic temperament, ≥ 3 comorbid underlying diseases, and smoking after surgery (β=-0.147, -0.171, -0.137, -0.847, -1.008, -1.120, -0.121, -0.390; P<0.05 for all ) were risks factor affecting QoL in patients 12 months after PCI, and receiving health education or physical exercise (β=0.191; P<0.001) were protective factors. Conclusion Personality traits are risk factors that affect QoL in elderly CHD patients 12 months after PCI, and early evaluation of personality characteristics is conducive to improving it.

Abstract:Objective To investigate the status quo of frailty level and social participation ability in elderly patients with chronic obstructive pulmonary disease (COPD), and to analyze the relationship between them. Methods A total of 203 elderly patients with stable COPD admitted in our hospital from January 2021 to January 2024 were enrolled and served as COPD group, and the age-matched individuals without COPD who taking health checkup in Department of Physical Examination in the same period were subjected as control group. The social participation ability of the participants was evaluated by Elderly Ability Assessment Scale of the Ministry of Civil Affairs of the PR China, and the occurrence of frailty was assessed by Fried frailty scale. Pearson correlation analysis was used to analyze the correlation between social participation ability and frailty in elderly patients with stable COPD. Taking whether the social participation ability was impaired as the dependent variable, binary logistic regression model was adopted to analyze the related factors leading to the impairment of social participation ability in elderly COPD patients. SPSS statistics 26.0 was used for statistical analysis. Data comparison between two groups was performed using t test or χ² test depending on data type. Results The scores of living ability dimension and work ability dimension and total score of social participation scale were significantly higher, and the proportions of having impaired living ability, work ability and overall social participation ability were obviously greater in the COPD group than in the control group (P<0.05). The COPD group had notably higher score of Fried scale and detection rate of frailty than the control group (P<0.05). The detection rate of frailty was in an upward trend in the elderly COPD patients with intact, mild, moderate and severe social participation impairment in turn, and the difference between groups was statistically significant (P<0.05). Pearson correlation analysis showed that the scores of living ability dimension and work ability dimension in social participation ability were positively correlated with score of Fried scale in the elderly COPD patients (r=0.411,0.511; P<0.05). Taking the social participation ability of elderly COPD patients as the dependent variable (intact social participation ability=0, impaired social participation ability=1), binary logistic multivariate regression analysis revealed that living alone (OR=2.939, 95%CI 1.075-8.032), concurrent chronic diseases ≥2 types (OR=2.201, 95%CI 1.427-3.395) and visual impairment (OR=1.914, 95%CI 1.032-3.548) were independent risk factors for impaired social participation ability in elderly COPD patients (P<0.05). Conclusion The impairment of social participation ability and detection rate of frailty are higher in the elderly patients with COPD than the age-matched individuals without COPD. Living alone, types of concurrent chronic diseases and visual impairment are the related factors affecting the social participation ability. In addition, with the aggravation of social participation ability impairment, the detection rate of frailty is gradually increasing in COPD patients.

Abstract:Objective To investigate the incidence and influencing factors of postoperative fatigue syndrome (POFS) in elderly patients with esophageal cancer at different time points and to analyze its influence on the quality of life of patients after discharge. Methods A total of 132 elderly patients with esophageal cancer in Huai′an First People′s Hospital from January 2020 to January 2023 were enrolled in the study. The incidence of POFS and severity of fatigue were assessed by Christensen fatigue scale on days 3 and 7 after radical resection of esophageal cancer and at discharge. Binary logistic regression model was used to analyze the independent factors affecting the occurrence of POFS at discharge. The quality of life was measured by 36-item short-form health survey (SF-36) at the 1-month post-discharge follow-up, and the influence of POFS on the quality of life of patients at discharge was analyzed. SPSS 22.0 was used for statistical analysis. Comparison between two groups was performed using t test, χ² test or Fisher exact test depending on data type. Results The detection rate of POFS in the 132 elderly patients with esophageal cancer was 59.85% (79/132) on postoperative day 3,34.85% (46/132) on postoperative day 7, and 18.94% (25/132) at discharge. As hospitalization prolonged, the average scores of Christensen fatigue scale and fatigue grades showed downward trends (day 3 > day 7 > at discharge), with statistically significant differences (P<0.05 for all). With complication of POFS at discharge as the dependent variable, multivariate logistic regression analysis suggested that age >79 years (OR=2.568,95%CI 1.457-4.524), right thoracoparietal anastomosis (OR=2.330,95%CI 1.349-4.026), postoperative sleep disorders (OR=3.796,95%CI 1.310-11.004), severe postoperative pain (OR=3.241,95%CI 1.858-5.656), postoperative hypoproteinemia (OR=3.916,95%CI 1.115-13.754), and postoperative anxiety/depression (OR=2.323,95%CI 1.498-3.604) were independent risk factors for POFS at discharge (P<0.05). The scores in dimensions of general health, vitality and mental health and the total score of SF-36 scale in patients with POFS at discharge were significantly lower than those without POFS at 1 month after surgery (P<0.05). Conclusion The incidence and severity of POFS in elderly patients with esophageal cancer during hospitalization after radical resection show downward trends with time. However, the short-term quality of life of the patients with POFS at discharge is lower than that of those without POFS.

Abstract:Objective To investigate the risk and prevention strategies of rebleeding after minimally invasive hematoma removal in elderly patients with hypertensive intracerebral hemorrhage (HICH). Methods A total of 142 elderly HICH patients who underwent minimally invasive hematoma removal in Xingtai Central Hospital from June 2021 to December 2023 were enrolled. According to rebleeding after surgery, they were divided into a rebleeding group (n=21) and a control group (n=121). Clinical data of patients were collected, and binary logistic regression model was used to analyze the factors affecting rebleeding after minimally invasive hematoma removal in elderly HICH patients. SPSS 22.0 was used for data analysis. Data comparison between two groups was performed using t test orχ² test depending on data type. Results Among the 142 elderly HICH patients after minimally invasive hematoma removal, 21 had rebleeding, with an incidence of 14.79%. Univariate analysis suggested that diabetes mellitus, preoperative systolic blood pressure (SBP), preoperative diastolic blood pressure (DBP), preoperative aspirin use, hematoma volume, preoperative cerebrospinal fluid/intra-cerebroventricular volume (CSF/ICV), time from onset to surgery, and rate of initial hematoma aspiration were factors affecting rebleeding after minimally invasive hematoma removal in elderly HICH patients. With rebleeding as the dependent variable (Y; no=0, yes=1) and statistically significant indicators in univariate analysis as independent variables, binary logistic multivariate regression analysis indicated that the preoperative SBP > 200 mmHg (1 mmHg=0.133 kPa; OR=3.171,95%CI 1.362-7.380), preoperative DBP > 120 mmHg (OR=2.838,95%CI 1.582-5.089), preoperative aspirin use (OR=2.330,95%CI 1.178-4.609), hematoma volume>60ml (OR=5.463,95%CI1.446-20.633), and preoperative CSF/ICV > 0.35 (OR=2.573,95%CI 1.150-5.758) were risk factors for rebleeding after minimally invasive hematoma removal, and that the initial hematoma aspiration rate of 40%-60% (OR=0.550,95%CI 0.415-0.728), and time from onset to surgery of 6-24h (OR=0.555,95%CI 0.367-0.839) were the protective factors. Conclusion Rebleeding after minimally invasive puncture hematoma removal in elderly HICH patients is related to multiple factors. It is recommended to actively control the preoperative blood pressure and to inject platelet products for long-term aspirin users to buffer the effect of drugs on coagulation. The initial hematoma aspiration rate should be maintained at 40%-60%. In the absence of cerebral herniation, it is best to operate within 6-24 h after onset, and attention should be paid to the prevention and treatment of postoperative rebleeding in patients with hematoma volume > 60 ml and preoperative CSF/ICV > 0.35.

Abstract:Objective To explore the factors influencing physical resilience (PR) in elderly male patients with obstructive sleep apnea (OSA). Methods A multicenter cohort study enrolled 520 elderly male patients (≥60 years) diagnosed with OSA through polysomnography at six tertiary hospitals in China, including Chinese PLA General Hospital, from January 2015 to October 2017. PR was reflected by the difference between functional capacity and actual performance. Patients were categorized into three groups by PR levels from the highest to the lowest:resilience group (n=56), expected-resilience group (n=271), and decreased-resilience group (n=193). Their general information, hematologic indicators, and sleep parameters were collected. SPSS 26.0 was used for data analysis. Depending on the data type, Kruskal-Wallis test orχ² test was employed for intergroup comparison. Multivariate Cox regression analysis was used to explore the factors influencing the PR decline. Results The decreased-resilience group had significantly higher age than the resilience group; the expected-resilience group and decreased-resilience group had significantly higher coronary heart disease prevalence than the resilience group, and the differences were statistically significant (P<0.05). The expected-resilience group demonstrated higher total cholesterol (TC) levels than the resilience group, and the decreased-resilience group showed significantly elevated low-density lipoprotein cholesterol (LDL-C) compared to both other groups (P<0.05). Both decreased-resilience and expected-resilience groups had significantly higher apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) than the resilience group; the time with oxygen saturation < 90% (T90) was significantly longer in the decreased-resilience group compared to both other groups, and both the lowest oxygen saturation (LSpO₂) and mean oxygen saturation (MSpO₂) were significantly lower in the decreased-resilience group than in the other two groups, with the differences being statistically significant (P<0.05). Multivariate Cox regression analysis revealed that prolonged T90 (HR=1.002,95%CI 1.000-1.004) and LDL-C ≥3.40mmol/L (HR=1.420,95%CI 1.204-1.675) were independent risk factors for PR decline. Conclusion Elevated T90 and LDL-C ≥3.40 mmol/L are risk factors for PR decline in elderly male OSA patients.

Abstract:Objective To explore the predictive value of age, creatinine and ejection fraction (ACEF) Ⅱ score, and serum retinol binding protein 4 (RBP4) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels for the prognosis in elderly patients with type 2 diabetes mellitus (T2DM) complicated with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods Clinical data of 128 elderly T2DM patients with ACS undergoing PCI in our hospital from January 2022 to September 2023 were collected. According to whether major adverse cardiovascular and cerebrovascular events occurred, they were divided into good prognosis group (99 cases) and poor prognosis group (29 cases). SPSS statistics 24.0 was used for data analysis. Depending on data type, t test, Mann-Whitney U test,χ² test or Fisher′s exact probability test was applied for comparison between groups. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of ACEFⅡ score and serum RBP4 and NT-proBNP levels for poor prognosis, and binary logistic regression analysis was used to determine the influencing factors of prognosis in these patients after PCI. Results Among the 128 elderly T2DM patients with ACS, 29 (22.66%) had major adverse cardiovascular and cerebrovascular events at 6 months after PCI, including 7 cases of heart failure, 5 cases of stroke, 7 cases of myocardial infarction, 9 cases of secondary revascularization, and 1 case of cardiac death. The poor prognosis group demonstrated significantly lower postoperative administration rate of dapagliflozin, but higher ACEFⅡ score and serum levels RBP4 and NT-proBNP than the good prognosis group (all P<0.05). ROC curve analysis showed that the areas under the curve (AUC) of ACEFⅡ score and serum RBP4 and NT-proBNP levels in predicting poor prognosis after PCI in elderly T2DM patients with ACS was 0.745 (95%CI 0.640-0.850, P<0.05), 0.871 (95%CI 0.803-0.939, P<0.05) and 0.796 (95%CI 0.697-0.902, P<0.05), respectively. Binary logistic regression analysis suggested that ACEFⅡ score ≥1.59 (OR=3.357,95%CI 1.688-6.676, P<0.05), RBP4 ≥42.71 mg/L (OR=3.873,95%CI 2.206-6.800, P<0.05), and NT-proBNP ≥603.58 ng/L (OR=3.725,95%CI 2.114-6.562, P<0.05) were all independent risk factors for poor prognosis in elderly T2DM patients with ACS after PCI, and postoperative use of dapagliflozin (OR=0.380,95%CI 0.011-0.782, P<0.05) was an independent protective factor. Conclusion ACEFⅡ score, serum RBP4 and NT-proBNP levels can play a certain role in predicting the prognosis of elderly T2DM patients with ACS after PCI, and the postoperative use of dapagliflozin may be beneficial to improving the prognosis of the patients.

Abstract:Objective To study the risk factors and prognosis of immune checkpoint inhibitor-related pneumonitis ( ICI-P) and provide effective strategies for its prevention and treatment. Methods A retrospective investigation was conducted of the medical record of 753 non-small cell lung cancer cases treated with immune checkpoint inhibitors (ICIs) at Chinese PLA General Hospital from January 2018 to September 2023. According to whether or not ICI-P occurred, the patients were divided into ICI-P group (102 cases) and non-ICI-P group (651 cases), and the clinical characteristics of the two groups were compared. According to severity of ICI-P, the patients with ICI-P were divided into a mild group (69 cases) and severe group (33 cases), and survival analysis was performed for the two groups. t test, Mann-Whitney U test orχ² test was used for comparison between groups. Logistic regression analyses were employed to determine the risk factors of ICI-P. Kaplan-Meier method was used to calculate the overall survival (OS) for the mild and severe groups, and Log-rank test was used to compare the survival of the two groups. Results The incidence of ICI-P was 13.5% (102/753). Its independent risk factors included interstitial lung disease (ILD) (OR=3.85,95%CI 1.99-7.46; P<0.001), history of chest radiotherapy (OR=2.65,95%CI 1.56-4.48; P<0.001), concurrent chest radiotherapy (OR=3.56,95%CI 1.69-7.47; P<0.001) and the use of programmed cell death 1 (PD-1) inhibitors (OR=3.54,95%CI 1.05-11.98; P=0.04). The expected OS of the mild group was 927 d against 573 d in the severe group, and the difference was statistically significant (P=0.033). Conclusion ILD, prior or concurrent chest radiotherapy and the use of PD-1 inhibitors are risk factors of ICI-P. Focusing on the assessment of patients with ILD and a history of chest radiotherapy before treatment and avoiding concurrent radiotherapy are feasible strategies for preventing ICI-P.

Abstract:Objective To investigate the risk factors of hematoma enlargement (HE) in elderly patients with spontaneous intracerebral hemorrhage (sICH) and analyze the value of laboratory indicators such as vascular injury markers, platelet aggregation function, and inflammatory factors in predicting HE. Methods A total of 142 elderly sICH patients admitted to the Department of Neurosurgery of Xingtai Central Hospital from March 2023 to March 2024 were enrolled. According to the results of head CT reexamination, they were divided into a HE group (n=30) and a control group (n=112). Thromboelastography-platelet mapping (TEG-PM) was used to measure platelet aggregation parameters. On admission, peripheral venous blood was collected, and interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), matrix metalloproteinase-9 (MMP-9) and nitric oxide (NO) levels were measured. Binary logistic regression model was used to analyze the factors affecting HE in elderly sICH patients, and receiver operating characteristic (ROC) curves were plotted to analyze the value of platelet aggregation, vascular endothelial injury and inflammatory factors in predicting HE. Data analysis was performed using SPSS 26.0, and t test or Chi-square test was performed according to the data type. Results HE occurred in 30 of 142 patients, with an incidence of 21.13%. The HE group showed higher inhibition rates of platelet aggregation indicators such as AA and ADP, serum levels of IL-6, TNF-α, MMP-9, and NO than the control group, and the differences were statistically significant (P<0.05). With HE as the dependent variable, binary logistic regression analysis identified the following risk factors for HE:Glasgow coma score (GCS) on admission (OR=2.575,95%CI 1.505-4.406), baseline edema volume (OR=2.614, 95%CI 1.729-3.953), irregular hematoma margin density sign (OR=2.377, 95%CI 1.658-3.410), time from onset to initial CT (OR=2.147, 95%CI 1.389-3.317), AA inhibition rate (OR=2.759, 95%CI 1.287-5.915), ADP inhibition rate (OR=1.645, 95%CI 1.270-2.131), IL-6 (OR=2.065, 95%CI 1.448-2.944), and MMP-9 level (OR=1.784, 95%CI 1.150-2.768)(P<0.05). ROC curve found that AA inhibition rate (AUC=0.870, 95%CI 0.775-0.965), ADP inhibition rate (AUC=0.761, 95%CI 0.670-0.851), serum IL-6 (AUC=0.816, 95%CI 0.711-0.921) and MMP-9 level (AUC=0.724, 95%CI 0.598-0.850) had value in predicting the occurrence of HE in elderly sICH patients (P<0.05). Conclusion The inhibition rates of platelet aggregation indicators AA and ADP, as well as serum IL-6 and MMP-9 levels, have predictive value for HE and are expected to be laboratory indicators for predicting HE, but it needs to be verified with larger samples.

Abstract:Heart failure complicated with cognitive frailty is a group of clinical syndromes with complex mechanisms and high incidence. The risk of comprehensive adverse outcomes is 1.55 times higher than that of the general population. Forkhead box protein O3a (FOXO3a) is a core replication genetic factor related to human aging diseases. In recent years, studies have found that it plays an important role in regulating cellular stress response, metabolic homeostasis, and neuroprotection. It can participate in the pathogenesis and progression of heart failure and cognitive frailty through multiple pathways. Investigating the mechanisms of FOXO3a in heart failure complicated with cognitive frailty is of great significance for the establishment of preventive measures and targeted treatment.

Abstract:The prevalence of dual difficulties of depression and frailty is quite high in the elderly, often occurring concurrently, and leading to a series of adverse health outcomes that seriously affect their physical and mental health. Group-based trajectory modeling provides a new research perspective for identifying the heterogeneous developmental trajectories between depression and frailty and analyzing their longitudinal causal relationship, which is of great significance for addressing the comorbidity situation in the elderly. Therefore, in this article, we reviewed the concept connotation based on the group-based trajectory model, current status, correlation mechanism, association, influencing factors and intervention measures of the dual trajectories of elderly depression and frailty, aiming to provide methodological supplements for the precision of clinical decision-making.

Abstract:Shoulder pain, as one of the common clinical symptoms after stroke, has a high incidence and low cure rate and can occur at any stage after stroke, with complex causes. Since its clinical evaluation methods are limited, its early diagnosis is difficult, which seriously affects the progression of the disease. In recent years, musculoskeletal ultrasound has been extensively applied in the interventional treatment of shoulder pain after stroke. In this article, we reviewed the application of musculoskeletal ultrasound during different stages for diagnosis and related interventional treatment in shoulder pain after stroke.