Abstract:Objective To investigate the expression of platelet-derived circular RNA hsa_circ_0001535 and to analyze its correlation with antiplatelet reactivity in patients with acute coronary syndrome (ACS) after dual antiplatelet therapy. Methods A total of 169 consecutive ACS patients hospitalized in the Department of Cardiology of Chinese PLA General Hospital between October 2020 and March 2022 and treated with aspirin combined with a P2Y12 receptor antagonist were enrolled. All patients underwent thromboelasto-graphy (TEG) after receiving a single dose of dual antiplatelet therapy. Adenosine diphosphate (ADP)-induced platelet-fibrin clot strength (MA_ADP) of platelet-fibrin clot strength and ADP-induced platelet inhibition rate (PI_ADP) were used to reflect antiplatelet reactivity. With PI_ADP 75% as the cutoff value, patients were divided into a low on-treatment platelet reactivity group (LTPR group, n=106, PI_ADP > 75%) and a high on-treatment platelet reactivity group (HTPR group, n=63, PI_ADP≤ 75%). Platelet RNA was extracted from peripheral whole blood, and the relative expression level of hsa_circ_0001535 in platelets was detected by fluorescent quantitative multiplex polymerase chain reaction (PCR). Data analysis was performed using SPSS 27.0 and R language version 4.4.2. Based on data type, intergroup comparisons were conducted using the t-test, Wilcoxon rank-sum test, orχ² test. Multivariate logistic regression analysis revealed that age (OR=1.07,95%CI 1.02-1.13; P=0.0071), body mass index (OR=0.82,95%CI 0.72-0.94; P=0.0030), platelet-derived hsa_circ_0001535 (OR=1.22,95%CI 1.04-1.43; P=0.0160) , clopidogrel (OR=2.45,95%CI 1.12-5.35; P=0.0242), and CYP2C19 loss-of-function (OR=1.24,95%CI 1.01-1.51; P=0.0421) were independent factors affecting antiplatelet reactivity after dual antiplatelet therapy in ACS patients. Results In the 169 patients, the median relative expression level of platelet-derived hsa_circ_0001535 was 1.47 (0.83,2.66), the median MA ADP was 19.40 (10.63,31.18), and the median PI ADP was 88.20% (55.04%, 94.55%), all showing a skewed distribution. Spearman correlation analysis found that the relative expression level of platelet-derived hsa_circ_0001535 was negatively correlated with PI ADP (r=-0.16, P=0.039). The expression level of platelet-derived hsa_circ_0001535 was significantly higher in the HTPR group than that in the LTPR group [1.94 (1.15,3.76) vs. 1.28 (0.59,2.14); P=0.0006)]. Multivariate logistic regression analysis revealed that platelet-derived hsa_circ_0001535 was an independent factor affecting antiplatelet reactivity after dual antiplatelet therapy in ACS patients (OR=1.22,95%CI 1.04-1.43; P=0.0160). Conclusion The relative expression level of platelet-derived hsa_circ_0001535 is independently correlated with antiplatelet reactivity in ACS patients after dual antiplatelet therapy.

Abstract:Objective To investigate the relationship of chemotherapy-related cognitive impairment and cancer-related fatigue with quality of life in elderly patients with non-Hodgkin lymphoma at different stages. Methods A cross-sectional study was conducted on 350 elderly patients with non-Hodgkin lymphoma admitted to the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People′s Hospital) from August 2023 to May 2024. They were grouped according to disease stage. Because of the small number of stage Ⅳ patients, stage Ⅲ and Ⅳ patients were included in one group, resulting in stage Ⅰ group, stage Ⅱ group, and stage Ⅲ-Ⅳ group. The Chinese version of the functional assessment of cancer therapy-cognitive function (FACT-Cog) was used to assess chemotherapy-related cognitive impairment, the cancer fatigue scale (CFS) was used to assess the degree of cancer-related fatigue, and the quality of life questionnaire (QLQ-C30) was used to assess the patients′ quality of life. Pearson correlation analysis was used to analyze the correlation of chemotherapy-related cognitive impairment with cancer-related fatigue and quality of life in elderly patients with non-Hodgkin lymphoma. SPSS 20.0 was used for statistical analysis. Data comparison between two groups was performed using t test, F test orχ² test depending on data type. Results Patients at different disease stages had statistically significant differences in perceived cognitive impairment, impact on quality of life, evaluation of others, cognitive function scores, and total scores (F=116.472,246.146,282.293,191.500,231.825; P<0.05). There were statistically significant differences in the score of physical fatigue, affection and cognition, and total scores among patients at different disease stages (F=369.548,101.615,97.400,370.149; P<0.05). There were statistically significant differences in scores of emotional function, role function, cognitive function, social function and physical function scores, and total scores among patients at different disease stages (F=80.100,80.106,52.536,60.791,91.967,75.300; P<0.05). Chemotherapy-related cognitive impairment in elderly patients with non-Hodgkin lymphoma was significantly positively correlated with cancer-related fatigue (r=0.571, P<0.05) and negatively correlated with quality of life (r=-0.360, P<0.05), and cancer-related fatigue was significantly negatively correlated with quality of life (r=-0.376, P<0.05). Chemotherapy-related cognitive impairment and cancer-related fatigue were positively correlated with disease stage (r=0.751,0.781; P<0.05), while quality of life was negatively correlated with disease stage (r=-0.497, P<0.05). Conclusion Chemotherapy-related cognitive impairment and cancer-related fatigue are significantly correlated with quality of life of elderly patients, particularly among those at different disease stages. This finding emphasizes the importance of comprehensive assessment of elderly patients with non-Hodgkin′s lymphoma, suggesting that clinicians should comprehensively consider cognitive function and fatigue when formulating treatment regimens to optimize patients′ quality of life.

Abstract:Objective To investigate the status quo of chemotherapy-induced peripheral neuropathy (CIPN) in elderly patients with breast cancer and to analyze the effect of non-drug intervention on CIPN. Methods A prospective study was conducted on 160 elderly patients with breast cancer who received chemotherapy in our hospital from January 2023 to December 2023. At the end of the first chemotherapy cycle, 96 patients developed CIPN. The CIPN patients were randomly divided into an observation group (n=48) and a control group (n=48). The control group were only given health education for CIPN, while the observation group received non-drug intervention (exercise therapy + acupoint massage + acupuncture and moxibustion) on basis of health education. The scores of CIPN assessment tool (CIPNAT) and Berg balance scale (BBS) were compared between groups before and after intervention. SPSS 26.0 was used for data processing, and t test or Chi-square test was performed for between-group comparison depending on data type. Binary logistic regression model was employed to identify the related factors affecting the occurrence of CIPN. Results Among the 160 elderly patients, the detection rate of CIPN was 60.00% (96/160). Multivariate logistic regression analysis suggested that age ≥80 years (OR=2.487, 95%CI 1.265-4.890), obesity (OR=2.065, 95%CI 1.105-3.858), diabetes mellitus (OR=3.074, 95%CI 1.691-5.589), sleep disorder (OR=1.270, 95%CI 1.048-1.539), breast cancer pathological stage Ⅲ-Ⅳ (OR=1.726, 95%CI 1.104-2.699) and combined radiotherapy (OR=1.756, 95%CI 1.271-2.426) were risk factors for CIPN occurrence in elderly patients with breast cancer, and exercise frequency ≥4 times/week (OR=0.708, 95%CI 0.565-0.887) was a protective factor. After intervention, the observation group had significantly lower total score of CIPN symptom experience and score of influence of CIPN symptoms on activities of daily living (ADL), while higher BBS score when compared with the control group (P<0.05). Conclusion The incidence of CIPN is quite high in the elderly patients undergoing breast cancer chemotherapy, and it is related to age, obesity, diabetes mellitus, breast cancer stage and combined radiotherapy. Active exercise and good sleep have certain potential in reducing the risk of CIPN, while combined non-exercise intervention can effectively relieve the clinical symptoms of CIPN, improve ADL and enhance the balance abilities.

Abstract:Objective To explore the influencing factors for analgesic efficacy in elderly patients with malignant tumors complicated with cancer pain. Methods A total of 226 elderly patients with malignant tumors and concomitant cancer pain admitted to our hospital from January 2022 to January 2024 were enrolled as the research subjects. All of them received standardized analgesic therapy according to the National Comprehensive Cancer Network (NCCN) Guidelines for Cancer Pain Control in Adults. The pain intensity was evaluated by numerical rating scale (NRS) every day during treatment. After one week of analgesic treatment, the patients getting a pain relief rate of ≥50% were included in a good analgesia group (196 cases), and those with the rate <50% in a poor analgesia group (30 cases). The demographic data, cancer-related data and analgesia-related data were collected. SPSS statistics 26.0 was performed for data analysis. Chi-square test was carried out depending on data type. Binary logistic regression model was employed to analyze the related factors affecting the analgesic efficacy of cancer pain in the patients. Results The proportions of patients with knowing own conditions, lymph node metastasis, cancer stage Ⅲ-Ⅳ, severe initial pain intensity at admission, breakthrough pain, adverse analgesic reactions and anxiety in poor analgesia group were higher than those in good analgesia group, the differences were statistically significant. (P<0.05). Binary logistic regression analysis revealed that awareness of their own conditions (OR=1.376, 95%CI 1.167-1.622), lymph node metastasis (OR=1.976, 95%CI1.218-3.206), cancer stage Ⅲ-Ⅳ (OR=2.046, 95%CI 1.424-2.941), severe initial pain intensity at admission (OR=1.647, 95%CI 1.216-2.232), breakthrough pain (OR=2.173, 95%CI 1.096-4.306), analgesics-induced adverse reactions (OR=1.322, 95%CI 1.080-1.617) and anxiety (OR=1.215, 95%CI 1.111-1.330) were risk factors for poor analgesic effect. Conclusion Analgesic efficacy of elderly inpatients with cancer pain is affected by many factors, such as tumor related factors, characteristics of cancer pain, analgesics-induced adverse reactions and social psychological factors. For the patients with poor analgesic efficacy, it is necessary to adjust appropriately analgesic regimens to enhance the efficacy.

Abstract:Objective To investigate the related factors affecting the physical activity in elderly patients with knee osteoarthritis (KOA). Methods A prospective study was conducted on 300 elderly KOA out- and in-patients admitted to our department from January 2021 to January 2024. International physical activity questionnaire (IPAQ) was used to evaluate the physical activity level of the partici-pants. SPSS statistics 27.0 was employed for statistical analysis. Data comparison was performed using t test or Chi-square test depending on data type. Binary logistic regression model was adopted to analyze the related factors affecting the physical activity volume in the elderly patients. Results After 300 questionnaires were distributed, 291 valid ones were collected, with an effective recovery rate of 97.00%. Among the subjected 291 elderly patients, 67 (23.02%), 131 (45.02%) and 93 cases (31.96%) had high, medium and low levels of physical activity, respectively. Binary logistic regression analysis suggested that age ≥80 years (OR=4.923, 95%CI 2.082-11.640), female (OR=2.583, 95%CI 1.288-5.180), bilateral knee disease (OR=3.418, 95%CI 1.418-8.240) and depression (OR=1.852, 95%CI 1.366-2.509) were risk factors for low physical activity level in elderly patients with KOA, and regular exercise habit (OR=0.323, 95%CI 0.119-0.882) and exercise self-efficacy (medium-to-high) (OR=0.845, 95%CI 0.743-0.959) were protective factors. ConclusionFor elderly KOA patients, age, gender, disease location, depression, regular exercise habit and exercise self-efficacy are related factors affecting the physical activity volume. It is suggested that the above factors should be taken into consideration to improve the physical activity volume and ensure the prognosis of the elderly KOA patients.

Abstract:Objective To investigate the mediating effect of nutritional status on tooth number and frailty in elderly stroke patients. Methods Convenience sampling was used to subject 419 elderly patients with stroke admitted in our hospital from June to December 2023. According to Tilburg frailty indicator (TFI), the patients with the score ≥5 were assigned into a frail group (n=231), while those scoring <5 into a non-frail group (n=188). Statistical analysis was conducted using SPSS 25.0. Depending on data type, Chi-square test was employed for intergroup comparison. Binary logistic regression model was utilized to identify independent risk factors for frailty in elderly stroke patients. Spearman rank correlation analysis was applied to analyze the correlations of number of teeth, nutritional status, and frailty in the patients. R package for mediation analysis was utilized to assess the mediating effect of nutritional status between number of tooth and frailty in the patients, and Bootstrap test was employed to verify the significance of this mediation. Results Statistical differences were observed between the two groups in terms of age, type of stroke, number of teeth, National Institute Health stroke scale (NIHSS) score and nutritional status (P<0.05). Binary logistic regression model showed that age 70-80 years (OR=2.184, 95%CI 1.258-3.793), age≥80 years (OR=7.996,95%CI 2.409-26.539), hemorrhagic stroke (OR=5.071,95%CI 2.801-9.182), moderate to severe stroke (OR=2.836,95%CI 1.307-6.152), malnutrition (OR=4.443,95%CI 2.188-9.021), number of teeth 0-9 (OR=3.181,95%CI 1.305-7.752), and number of teeth 10-19 (OR=1.945,95%CI 1.113-3.396) were associated with high risk of frailty in elderly stroke patients (P＜0.05). Spearman rank correlation analysis indicated that number of teeth was positively correlated with nutritional status (r=0.270, P<0.001), and negatively with frailty score (r=-0.352, P<0.001), and nutritional status was negatively correlated with frailty (r=-0.380, P<0.001). The results of the mediation analysis showed that nutritional status had a partial mediating effect between the number of teeth and frailty in elderly stroke patients, with a mediating effect value of -0.090, contributing 51.14% to the total effect. Conclusion Nutritional status has a partial mediating effect between tooth number and frailty in elderly stroke patients. Early nutritional intervention and promoting the preservation of natural teeth can delay the process of frailty in elderly stroke patients.

Abstract:Objective To investigate the relationship between body mass index (BMI) and intrinsic capacity (IC) in elderly inpatients with cardiovascular diseases (CVD). Methods A total of 409 elderly CVD patients hospitalized in Nanshan District People′s Hospital from April to October 2023 were consecutively included as study subjects, and according to their IC score, they were divided into a high IC group (n=174) and a low IC group (n=235). General condition questionnaire, intrinsic capacity measurement scale, handgrip strength meter, and Charlson comorbidity index (CCI) index scale were used to survey the included patients. Multivariate logistic regression analysis was applied to explore the relationship between BMI and IC, and restricted cubic spline model was employed to analyze the dose-response relationship between BMI and IC. SPSS statistics 25.0 and R 4.4.1 were used for statistical analysis. Data comparison between two groups was performed using t test, rank-sum test orχ² test depending on data type. Results Univariate analysis showed that IC is correlated with gender, education level, smoking, alcohol consumption, place of residence, BMI, handgrip strength, diastolic blood pressure (DBP), and age-adjusted CCI (a-CCI) (P<0.05). Multivariate logistic regression model revealed that underweight was negatively associated with IC (RR=10.110,95%CI 1.270-80.484; P=0.029), and overweight (RR=0.383,95%CI 0.234-0.628; P<0.001) and obesity (RR=0.473,95%CI 0.226-0.989; P=0.047) were positively correlated with IC. Restricted cubic spline model showed a nonlinear association between BMI and IC (nonlinear P=0.001 6, overall association P＜0.001), and the risk of IC decline was reduced when BMI was greater than 23.9 kg/m². Conclusion In elderly CVD patients, their BMI shows a nonlinear dose-response relationship with IC, and overweight and obesity can reduce the risk of IC decline.

Abstract:Objective To analyze the effect of thyroid hormone levels and the sensitivity indicators on occurrence of postoperative delirium (POD) in elderly patients after colorectal cancer (CRC) surgery. Methods A total of 165 elderly patients undergoing elective CRC surgery in our hospital from January 2022 to September 2024 were recruited in the study. Their preoperative serum levels of free triiodo-thyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) were measured. The FT3/FT4 ratio was calculated to reflect the sensitivity of peripheral tissues to thyroid hormones, and the thyroid stimulating hormone index (TSHI), thyroid stimulating hormone resistance index (TT4RI) and thyroid feedback quantile index (TFQI) were collected to indicate the sensitivity of central nerve system to thyroid hormones. The patients were categorized into a POD group (n=34) and a non-POD (NPOD) group (n=131) according to the occurrence of delirium. Logistic regression model was performed to identify the risk factors for POD. Receiver operating characteristic (ROC) curve was plotted to determine the cut-off values of the risk factors. SPSS statistics 23.0 was used for statistical analysis. Data comparison between two groups was performed using t test, Mann-Whitney U test,χ² test or Fisher exact test depending on data type. Results The incidence of POD was 20.6% (34 cases) among the 165 participants. The POD group exhibited significantly lower levels of hemoglobin, hematocrit, FT3 and TSH, advanced age, higher urea nitrogen level, longer operation time, time to extubation and length of post-anesthesia care unit (PACU) stay, and increased values of TFQI, TT4QI and TSHI when compared with the NPOD group (P<0.05). Logistic regression analysis showed that FT3, TSHI, age and length of PACU stay were independent risk factors for POD (P<0.05). ROC curve analysis revealed that the area under the curve of FT3, TSHI, age and length of PACU stay was 0.707,0.711,0.652 and 0.681, respectively, with a cut-off value of 4.3 pmol/L, 2.38,72 years and 45 min, separately. ConclusionFT3, TSHI, age and length of PACU stay are independent risk factors for POD in elderly patients undergoing CRC surgery, which providing clinical reference for early prevention and treatment of POD.

Abstract:Objective To explore the value of peripheral blood neutrophil-to-platelet ratio (NPR), interleukin-6 (IL-6) and procalcitonin (PCT) in predicting the prognosis of elderly patients with acute respiratory failure. Methods A total of 126 elderly patients with acute respiratory failure admitted to our hospital from December 2022 to December 2023 were recruited, and according to the survival status within 28 d after admission, they were divided into a death group (n=34) and a survival group (n=92). The general clinical data and peripheral blood NPR, IL-6 and PCT levels at admission were compared between groups. SPSS 22.0 was used for data analysis. Depending on data type, t test or Chi-square test was performed for comparison between groups. Logistic regression model was applied to identify the independent influencing factors of prognosis. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of NPR, IL-6 and PCT on prognosis. Results The death group exhibited significantly advanced age, higher acute physiologic and chronic health evaluation Ⅱ (APACHEⅡ) score and levels of peripheral blood NPR, IL-6 and PCT than the survival group (P<0.05). Pearson correlation analysis showed that the levels of NPR, IL-6 and PCT in peripheral blood were positively correlated with APACHEⅡ score (r=0.522,0.609,0.482; all P<0.05). Binary logistic regression analysis suggested that APACHEⅡ score (OR=1.170, 95%CI 1.059-1.293, P=0.002), and peripheral blood NPR (OR=1.331, 95%CI 1.096-1.616, P=0.004), IL-6 (OR=1.049, 95%CI 1.017-1.083, P=0.003) and PCT (OR=1.962, 95%CI 1.200-3.209, P=0.008) were independent influencing factors for death within 28 d after admission in elderly patients with acute respiratory failure. ROC curve analysis revealed that the cut-off values of peripheral blood NPR, IL-6 and PCT levels in predicting the death of elderly patients with acute respiratory failure within 28 d after admission were 0.15,55.41 pg/ml and 2.32 ng/ml respectively, with the corresponding areas under the ROC curves (AUCs) of 0.897(95%CI 0.818-0.975), 0.902 (95%CI 0.833-0.972) and 0.871(95%CI 0.784-0.957) respectively, and the AUC value of the three indicators combined was 0.968 (95%CI 0.940-995). Conclusion Peripheral blood levels of NPR, IL-6 and PCT are independent influencing factors for predicting the death of elderly patients with acute respiratory failure within 28 d after admission. The combined detection of the three indicators has high expected value for the prognosis.

Abstract:Objective To analyze the changes in T helper 17 cells (Th17) and regulatory T cells (Treg) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and evaluate the predictive value for short-term prognosis of the patients. Methods Clinical data of 152 elderly AECOPD patients admitted to our hospital from March 2021 to March 2024 were collected. The changes in peripheral blood proportions of Th17 and Treg and Th17/Treg ratio, and serum levels of chemokine CXC ligand 10 (CXCL10), interleukin-13 (IL-13) and interleukin-17 (IL-17) at admission and at discharge were recorded. According to the acute rehospitalization condition at one month after discharge, the patients were divided into a poor prognosis group (rehospitalization due to acute exacerbation) and a good prognosis group (no acute exacerbation). The differences in Th17, Treg and Th17/Treg, CXCL10, IL-33 and IL-17 were compared between two groups at admission. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of the above indicators for the poor short-term prognosis in elderly patients with AECOPD. SPSS statistics 24.0 was used for statistical analysis. Data comparison between two groups was performed using t test, Chi-square test or rank sum test depending on data type. Results At discharge, Th17 proportion, Th17/Treg ratio, and CXCL10, IL-33 and IL-17 levels in the elderly AECOPD patients were significantly decreased than those at admission (P<0.05), while Treg proportion was obviously increased (P<0.05). Among the 152 elderly patients, 26 patients (17.11%) were re-hospitalized due to acute exacerbation at one month after discharge, and they were included in the poor prognosis group, and the other 126 patients (82.89%) without acute exacerbation rehospitalization were enrolled in the good prognosis group. There were no statistical differences in Th17 and Treg proportions between two groups (P>0.05). The poor prognosis group exhibited notably higher Th17/Treg ratio and CXCL10, IL-33 and IL-17 levels than the good prognosis group (P<0.05). ROC curve analysis showed that Th17/Treg [(area under the curve, AUC)=0.823,95%CI 0.739-0.908, P<0.05], CXCL10 (AUC=0.730,95%CI 0.612-0.848, P<0.05), IL-33 (AUC=0.833,95%CI 0.739-0.927, P<0.05) and IL-17 (AUC=0.848,95%CI 0.750-0.947, P<0.05) were all statistically significant in predicting poor short-term prognosis in elderly patients with AECOPD (P<0.05), with a cut-off value of 1.77,130.14 pg/ml, 41.69 pg/ml and 17.38 pg/ml, respectively, and the AUC value of the four indicators combined together was as high as 0.960 (P<0.05). Conclusion In elderly AECOPD patients, the immune disorder and inflammatory response are significantly relieved after admission. The detection of Th17/Treg ratio and CXCL10, IL-33 and IL-17 levels is beneficial to predict the acute exacerbation rehospitalization at one month after discharge, which may provide new ideas for the clinical management of elderly patients with AECOPD.

Abstract:Objective To investigate the correlation between age-adjusted Charlson comorbidity index (aCCI) and the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) within one year after discharge in older adults with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods A retrospective cohort study was conducted on 528 inpatients enrolled from Cardiovascular Center and Department of Geriatrics in our hospital between January 2020 and November 2021. The participants were categorized into a low aCCI group and a high aCCI group based on the aCCI value. The incidence of MACCE at different aCCI patients was estimated by Kaplan-Meier method. Multivariate Cox regression analysis was conducted to assess the correlation between different aCCI groups and occurrence of MACCE within one year after discharge in these patients. SPSS statistics 27.0 was used for statistical analysis. Data comparison between two groups was performed using t test, nonparametric test or χ²test depending on data type. Results The participants had a median age of 72 (68,76) years, and 58.3% of them (308) were males. The cohort comprised 251 patients in the high aCCI group and 277 patients in the low aCCI group. The high aCCI group exhibited advanced age, higher levels of cardiac injury biomarkers, and larger proportions of frailty, polypharmacy, and lower scores of Activities of Daily Living when compared with the lower aCCI group (P<0.05). During one-year of follow-up, the risk of MACCE was significantly higher in the high aCCI group (log-rank P=0.000 2). After adjusting for various confounding factors, when aCCI was treated as a continuous variable, each one-unit increase in aCCI was associated with 21.3% increase in the risk of MACCE (HR=1.213,95%CI 1.043-1.412; P=0.012), and when aCCI was analyzed as a categorical variable, high aCCI group increased 85.8% risk of MACCE (HR=1.858,95%CI 1.119-3.083; P=0.017). Conclusion In older adults with NSTE-ACS, higher aCCI is associated with increased risk of MACCE. Early assessment of aCCI can improve unfavorable prognosis in these elderly patients.

Abstract:Objective To investigate the incremental value of three-dimensional transesophageal echocardiography (TEE) in predicting the occurrence of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). Methods A total of 100 patients who underwent CABG at Beijing Aerospace General Hospital from March 2021 to March 2024 were selected as the study subjects. According to occurrence of AF within 2 to 3 days after surgery, the patients were divided into an AF group (n=33) and a non-AF group (n=67). The TEE parameters [number of left atrial appendage (LAA) lobes, left atrial appendage volume, left atrial appendage ejection fraction, left atrial appendage emptying velocity] and coronary microcirculation indicators [coronary flow reserve (CFR), index of microcirculation resistance (IMR)] were observed in both groups. Data analysis was performed using SPSS 23.0, and t test orχ² test was used for intergroup comparison based on the data type. A generalized additive model (GAM) was used to analyze the correlation between TEE parameters and coronary microcirculation indicators. Multivariate linear regression analysis was used to explore the association between TEE parameters and postoperative new-onset AF. The predictive value of TEE parameters for postoperative AF occurrence was evaluated by the receiver operating characteristic (ROC) curve. Results The number of LAA lobes, LAA volume, and IMR in the AF group were higher than those in the non-AF group; LAA ejection fraction, LAA emptying velocity and CFR were lower than those in the non-AF group, with statistically significant differences (P<0.05). Multivariate linear regression analysis showed that the number of LAA lobes (β=0.462,0.562,1.011; P<0.05) and LAA volume (β=0.316,0.498,0.627,1.126; P<0.05) were risk factors for postoperative new-onset AF. LAA ejection fraction (β=-0.853, -0.512, -0.489, -0.362; P<0.05) and LAA emptying velocity (β=-0.801, -0.625, -0.562, -0.440; P<0.05) were protective factors against postoperative new-onset AF. ROC curve analysis showed that TEE parameters had good predictive value for postoperative new-onset AF, and that the combination of four parameters had a higher predictive value for postoperative new-onset AF [cut-off value was 35.27; sensitivity was 80.12%; specificity was 73.02%; AUC was 0.902 (95%CI 0.796-0.987; P=0.015). Conclusion Parameters measured by TEE can not only independently predict new-onset AF after CABG, but also their combined application can significantly enhance the predictive efficacy, providing incremental value for clinical risk assessment.

Abstract:With the extension of life expectancy, the incidence of cholangiopancreatic diseases is gradually increasing in very old adults (≥ 80 years). Endoscopic retrograde cholangiopancreatography (ERCP) has the advantages of less trauma and fast postoperative recovery, etc. However, due to the declines in physiological functions, elderly patients often have multiple underlying diseases and may also have changes in anatomical structures, which might make the endoscopic treatment of cholangiopancreatic diseases more difficult for the elderly. Nowadays, clinical studies on the application of ERCP in elderly patients with cholangiopancreatic diseases are still limited. In this article, we reviewed the indications, treatment strategies, and adverse events of ERCP for elderly patients, aiming to provide a reference for clinical practice.

Abstract:Chronic kidney disease (CKD) is a significant public health issue globally. Its early diagnosis and progression monitoring are crucial for improving patients′ prognosis. In recent years, ultrasound shear wave elastography (SWE), as a novel non-invasive imaging technique, has been widely used in the assessment of CKD due to its excellent ability to quantitatively assess renal tissue stiffness. In this article, we reviewed the specific SWE applications in different types of CKD, including diabetic nephropathy, ischemic nephropathy, chronic glomerulonephritis, and hypertensive nephropathy.

Abstract:Acute respiratory distress syndrome(ARDS)is the most serious respiratory complication in trauma patients, particularly those with traumatic brain injury and pulmonary contusion, and is a critical factor leading to exacerbation and even death. The main cause of ARDS after thoracic trauma is pulmonary contusion, while the causes of ARDS after traumatic brain injury include neurogenic pulmonary edema and systemic inflammatory responses. The mechanisms underlying ARDS in these two types of trauma are distinctly different. The protective pulmonary ventilation strategy characterized by low tidal volume and high positive end-expiratory pressure is the mainstay treatment for ARDS. For ARDS patients after thoracic trauma, strict adherence to protective pulmonary ventilation strategy is essential. However, for ARDS patients after traumatic brain injury, the protective pulmonary ventilation strategy should be used cautiously under the monitoring of intracranial pressure and cerebral perfusion pressure. Prone positioning ventilation and recruitment maneuver are not suitable for the above two types of patients with post-traumatic ARDS. More research is needed for the use of time-controlled adaptive ventilation mode in patients with post-traumatic ARDS.

Abstract:Cognitive frailty is a syndrome that incorporates cognitive impairment with physical frailty, and has attracted increasing attention in the elderly population in recent years. Elderly patients with liver cirrhosis, due to their complex pathophysiological mechanism, are at risk of cognitive frailty. In this article, we reviewed the clinical characteristics and staging differences, assessment methods and related intervention strategies of cognitive frailty in elderly patients with liver cirrhosis, aiming to provide evidences for clinical staff to identify and intervene cognitive frailty at an early stage.