Abstract:Objective To investigate the diagnostic value of magnetocardiography (MCG) in assessing the severity of coronary microvascular dysfunction (CMVD). Methods The consecutive patients hospitalized for exertional chest pain in the Department of Cardiology, First Medical Center of Chinese PLA General Hospital between September 2022 and March 2025 were enrolled. All patients underwent coronary angiography and MCG. Coronary angiography images were analyzed for Murray-law-based quantitative flow ratio (QFR) and angio-based microvascular resistance (AMR). Patients with coronary artery stenosis < 50%, QFR>0.8, and AMR >250 (mmHg·s)/m (1mmHg=0.133kPa) were included in the study as CMVD, and their clinical data were collected. They were randomly divided into a training group (n=303) and a validation group (n=60) using a random number table. Statistical analysis was conducted using SPSS (28.0.1.1). According to the data types, t test, Wilcoxon test orχ² test was used for inter-group comparisons. Spearman correlation coefficients were used to screen parameters strongly associated with CMVD, and a multivariate linear regression model was constructed and validated. Results Hypertension, glycosylated hemoglobin Alc (HbA1c), electrocardiographic QTc, echocardiographic A-wave peak, MCG parameters (R-wave/T-wave of maximum magnetic field values, maximum R-wave current density, and sum of positive magnetic pole positions during TT-interval) were associated with AMR (P<0.05). Variance analysis of the multivariate linear regression model showed a significant correlation between the variables and the severity of CMVD (P<0.001). Coefficient testing of regression analysis revealed that A peak (β=52.44, P=0.049), maximum R-wave current density (β=36.70, P=0.023), and the sum of positive magnetic pole positions during TT-interval (β=0.895, P=0.003) had significant independent and positive effects on AMR. The model achieved an accuracy of 71.7% in predicting CMVD severity in the validation group, with a comparison of predicted versus actual AMR curves showing consistent overall trends. Conclusion The predictive model integrating clinical data and MCG parameters can be used to evaluate the CMVD severity.

Abstract:Abstract Objective To investigate and analyze the cognitive frailty status in elderly population with comorbidity in department of general medicine, and to evaluate its influencing factors. Methods The clinical data of 206 elderly patients with comorbidity admitted to department of general medicine of Dongguan People’ s Hospital were collected from January 2023 to December 2024. According to the criteria for cognitive frailty proposed by the International Institute of Nutrition and Aging, frailty assessed by Frail scale, cognitive dysfunction by mini-mental state scale and suspected dementia by clinical dementia rating scale could be judged as cognitive frailty. 206 elderly patients with comorbidity were divided into cognitive frailty group and non-cognitive frailty group. The types of chronic diseases, comorbidity severity [age-adjusted Charlson comorbidity index (aCCI)], serum homocysteine (Hcy) on the next day of admission and other general data were compared between the two groups. SPSS 25.0 software was used to analyze the data. Mean data were compared by t test, and categorical data were analyzed by chi-square test. Multivariate Logistic regression analysis was used to evaluate the influencing factors of cognitive frailty in elderly patients with comorbidity. Results Among 206 elderly patients with comorbidity in department of general medicine, heart disease was the most common chronic disease (56.80%), followed by hypertension (38.35%) and cerebrovascular disease (21.36%), and asthma was the least common (0.97%), and the incidence rate of cognitive frailty was 33.50% (69/206). The proportion of cerebrovascular disease, aCCI score, proportion of poor self-efficacy of chronic disease management, proportion of poor nutritional status and serum Hcy level on the next day of admission in cognitive frailty group were significantly higher than those in non-cognitive frailty group (P<0.05). Multivariate Logistic regression analysis showed that cerebrovascular disease [OR=2.683, 95%CI 1.409-5.111, P<0.05], aCCI score [OR=4.272, 95%CI 2.516-7.253, P<0.05], poor self-efficacy of chronic disease management [OR=2.872, 95%CI 1.606-5.136, P<0.05], poor nutritional status [OR=2.705, 95%CI 1.442-5.072, P<0.05] and serum Hcy on the next day of admission [OR=3.225, 95%CI 1.835-5.667, P<0.05] were all risk factors of cognitive frailty in elderly patients with comorbidity in department of general medicine. Conclusion Cognitive frailty in elderly patients with comorbidity in department of general medicine is affected by chronic disease type, comorbidity severity, poor nutritional status, serum Hcy on the next day of admission and chronic disease management self-efficacy. Clinically, the occurrence and development of cognitive frailty can be delayed through physiological and psychological interventions.

Abstract:Objective To explore the status quo of treatment decisional conflict in elderly inpatients with solitary pulmonary nodules (SPN) and analyze its influencing factors. Methods A total of 148 elderly inpatients with SPN admitted to our hospital from February 2023 to February 2025 were enrolled, and finally 146 valid questionnaires were collected. Decisional conflict scale (DCS) was used to investigate the treatment decisional conflict of patients. According to the DCS score, 146 participants were divided into a high score group (score ≥37.5 points, 37 cases) and a non-high score group (score <37.5 points, 109 cases). SPSS 25.0 was employed for data processing, and t test or χ² test was applied for comparison between groups depending on data type. Multivariate logistic regression analysis was performed to identify the influencing factors for severe decisional conflict in elderly SPN inpatients. ResultsAmong the 148 patients, 146 questionnaires were effectively recovered, with an effective rate of 98.65%. The final total score of DCS was (29.42±5.09) points in the 146 participants. There were 69 cases (47.26%) with effective decision, 77 cases (52.74%) with decisional conflict, and 37 cases (25.34%) with severe decisional conflict. The high score group exhibited significantly larger proportions of patients with anxiety tendency, depression tendency, frailty and poor family function, while smaller proportions of history of lung disease and asymptomatic condition than the non-high score group (P<0.05). Multivariate logistic regression analysis suggested that anxiety tendency (OR=3.031,95%CI 1.686-5.450; P<0.05), depression tendency (OR=4.047,95%CI 2.604-6.290; P<0.05), frailty (OR=5.562,95%CI 3.645-8.488; P<0.05) and poor family function (OR=4.660,95%CI 3.054-7.111; P<0.05) were risk factors of severe decisional conflict in elderly SPN inpatients, and history of lung disease (OR=0.384,95%CI 0.020-0.811; P<0.05) and asymptomatic condition (OR=0.375,95%CI 0.017-0.799; P<0.05) were protective factors. Conclusion The situation of decisional conflict is severe in elderly SPN inpatients. Clinically, it is necessary to assess decisional conflict by evaluating the anxiety tendency, depression tendency, frailty, family function, history of lung disease and clinical symptoms, and implement the decisional conflict support strategy in time to improve the decision-making quality.

Abstract:Objective To investigate the correlation of triglyceride glucose (TyG) index, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC) index, TyG-waist-to-height ratio (TyG-WHtR) index with sarcopenia in elderly inpatients, and to evaluate the diagnostic value of above each index for sarcopenia. Methods A total of 369 elderly inpatients in our department between January and December 2022 were enrolled, and based on the presence of sarcopenia or not, they were assigned into a sarcopenia group (n=54) and a non-sarcopenia group (n=315). Demographic data, results of routine blood test, and sarcopenia-related indicators were collected. SPSS statistics 27.0 was used for statistical analysis. Multivariate logistic regression analysis was employed to identify factors influencing sarcopenia. Pearson or Spearman correlation analysis was performed to assess the correlations between TyG-related indices and sarcopenia-related indicators, including appendicular skeletal muscle mass (ASM), appendicular skeletal muscle mass index (ASMI), BMI, grip strength, and 6 m gait speed. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic value of TyG-related indices for sarcopenia, and Delong test was applied to compare the differences in the area under the curve (AUC) across models. Results Multivariate logistic regression analysis identified age as a risk factor (OR=1.113,95%CI 1.058-1.170; P<0.001), and BMI as a protective factor (OR=0.657,95%CI 0.551-0.783; P<0.001) for sarcopenia. Correlation analysis indicated that all TyG index and its related indices were positively correlated with BMI, TyG-BMI, TyG-WC and TyG-WHtR indices were positively correlated with ASM and ASMI; TyG-BMI and TyG-WC indices were positively correlated with grip strength (P<0.05). However, TyG index showed no correlation with grip strength, ASM or ASMI. After adjusting for gender, age and blood urea nitrogen, TyG-BMI (OR=0.960,95%CI 0.947-0.972), TyG-WC (OR=0.991,95%CI 0.988-0.995), and TyG-WHtR (OR=0.351,95%CI 0.207-0.595) indices were all independently and negatively correlated with sarcopenia risk (P<0.001). ROC curve analysis revealed that the AUC values of TyG index, TyG-BMI, TyG-WC index and TyG-WHtR index in predicting sarcopenia were 0.652 (95%CI 0.571-0.732), 0.835 (95%CI 0.779-0.892), 0.725 (95%CI 0.653-0.796), and 0.655 (95%CI 0.574-0.737), respectively. Delong test suggested that both TyG-BMI and TyG-WC indices exhibited significantly superior diagnostic performance than TyG index (P<0.05). Conclusion TyG index and its related indices are negatively correlated with sarcopenia, TyG-BMI and TyG-WC indices demonstrate better diagnostic value for sarcopenia than TyG index.

Abstract:Objective To evaluate the impact of nutritional risk-screening, assessment and support action (NRASA plan) on the initiation time of nutritional therapy, nutritional status and clinical outcomes in elderly patients with respiratory diseases. Methods A single-center, prospective, non-randomized controlled cohort study was conducted. A total of 284 elderly patients admitted to Department of Respiratory and Critical Care Medicine of a tertiary hospital from June to December 2022 were consecutively enrolled, and divided into a NRASA group (n=140) and a conventional consultation group (n=144) based on the nutritional management protocol. The initiation time of nutritional therapy, changes in nutritional indicators, hospitalization costs and prognostic indicators were compared between the two groups. SPSS statistics 27.0 was used for statistical analysis. Data comparison between two groups was performed using t test, Mann-Whitney U test, χ² test or Fisher′s exact probability test depending on data type. Results The initiation time of nutritional therapy in the NRASA group was significantly shorter than that in the conventional group [3.0 (2.0,4.0) vs 6.0 (3.0,11.5) d, P<0.05]. After nutritional therapy, the levels of total protein (TP), albumin (Alb), and high-density lipoprotein cholesterol (HDL-C) in the NRASA group were obviously higher than those in the conventional group [(65.76±8.10) vs (62.11±9.08) g/L, (36.64±5.11) vs (34.17±5.02) g/L, (1.02±0.48) vs (0.86±0.52) mmol/L; all P<0.05)]. Nutritional therapy resulted in significant increases in the levels of TP, Alb, total cholesterol (TG), and HDL-C in the NRASA group [(65.76±8.10) vs (59.32±9.45) g/L, (36.64±5.11) vs (32.27±6.10) g/L, (3.66±1.11) vs (3.29±1.19) mmol/L, (1.02±0.48) vs (0.84±0.44) mmol/L; all P<0.05]. While, in the conventional group, the level of hemoglobin (Hb) was notably decreased, while those of TP and Alb were increased after treatment [(102.00±21.64) vs (107.81±21.82) g/L, (62.11±9.08) vs (59.89±8.77) g/L, (34.17±5.02) vs (32.57±5.87) g/L; all P<0.05)]. The NRASA group had remarkably lower total hospitalization cost, parenteral nutrition cost, length of hospital stay, and incidence of gastrointestinal bleeding than the conventional group [5.52 (3.08,10.59) ×10⁴ vs 5.95 (2.37,10.46) ×10⁴ yuan, 0.15 (0.08,0.32) ×10⁴ vs 0.22 (0.09,0.45) ×10⁴ yuan, 19.0 (14.0,28.0) vs 21.5 (16.0,31.0) d, 1.4% (2/140) vs 6.3% (9/144); all P<0.05]. Conclusion The NRASA plan, through multidisciplinary collaboration and standardized processes, effectively reduces the delay of nutritional treatment, improves the nutritional and metabolic indicators of patients and decreases medical costs, providing practical evidence for standardized nutritional management in elderly patients with respiratory diseases.

Abstract:Objective To investigate gender differences in risk factors and auxiliary examination findings among elderly patients with acute myocardial infarction (AMI). Methods A retrospective analysis was conducted on the clinical data from 532 elderly AMI patients (357 males and 175 females) admitted to Department of Cardiology of General Hospital of Central Theater Command from May 2023 to April 2025. Differences in personal history, laboratory indicators, echocardiographic (ECG) parameters, and coronary angiography results were compared between different sexes. SPSS statistics 26.0 was used for statistical analysis. Depending on data type, t test, Mann-Whitney U test, or Chi-square test were applied for intergroup comparisons. Results The proportions of smoking history and drinking history were significantly higher in the elderly male patients than the females (P<0.001). The female patients had lower red blood cell counts, and hemoglobin and serum potassium levels but higher total cholesterol, low-density lipoprotein cholesterol, blood glucose, N-terminal pro-brain natriuretic peptide and D-dimer levels compared to the males (P<0.05). ECG finding revealed that smaller left atrial diameter and left ventricular diameter, and thinner interventricular septum thickness were observed in the female patients (P<0.001), while no such differences were seen in the indicators of left ventricular systolic function (P>0.05). In terms of coronary artery lesions, there was no significant difference in the proportion of three-vessel disease or in the Gensini score for coronary arteries between the female and male patients (P>0.05). Conclusion Significant differences exist in risk factors and laboratory indexes between elderly male and female AMI patients. Risk factors for AMI in elderly men are mainly smoking and alcohol consumption, whereas women are more affected by metabolic abnormalities. Clinical management should implement targeted interventions based on sex differences.

Abstract:Objective To explore the effects of new antiepileptic drugs levetiracetam (LEV) and lamotrigine (LTG) on bone mineral density, cognitive function, and sleep breathing in elderly patients with epilepsy. Methods A total of 112 elderly patients with new-onset epilepsy admitted to the First Affiliated Hospital of Hainan Medical University from January 2024 to June 2024 were selected as study subjects. They were divided into an LEV group (n=38), an LTG group (n=38), and a carbamazepine (CBZ) group (n=36) by a random number table method. All three groups of elderly patients with new-onset epilepsy were treated with monotherapy for 6 months. The three groups were compared in the clinical efficacy and bone mineral density (BMD), serum indicators [intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), brain-derived neurotrophic factor (BDNF)], cognitive function [mini-mental state examination (MMSE)], and sleep breathing parameters [apnea hypopnea index (AHI), mean arterial oxygen saturation (MSaO₂), lowest arterial oxygen saturation (LSaO₂)] before treatment and after 6 months of treatment. The incidence of adverse reactions during treatment was assessed. SPSS 25.0 was used for data analysis. According to the data type, one-way analysis of variance or Chi-square test was used for comparison between groups. Results The effective rates of treatment in the LEV group, LTG group, and CBZ group were 89.47%, 86.84%, and 86.11%, respectively, with no statistically significant difference (P>0.05). There were no statistical differences in femoral neck and greater trochanter BMD and MSaO₂ among the three groups before and after treatment (P>0.05). After 6 months of treatment, lumbar spine BMD and AHI in the three groups decreased compared with those before treatment, while iPTH, ALP, BDNF, MMSE score and LSaO₂ significantly increased compared with before treatment. Furthermore, lumbar spine BMD, BDNF, MMSE scores, and LSaO₂ in the LEV group and LTG group after treatment were higher than those in the CBZ group, while iPTH, ALP, and AHI after treatment were significantly lower than those in the CBZ group, all differences being statistically significant (P<0.05). The total incidence rates of drug-related adverse reactions in LEV group, LTG group and CBZ group were 7.89%, 7.89%, and 11.11%, respectively, with no statistically significant difference (P>0.05). Conclusion For elderly patients with new-onset epilepsy, LEV, LTG and CBZ monotherapy for 6 months all demonstrate good efficacy with few adverse reactions. However, the new antiepileptic drugs LEV and LTG have greater advantages in improving cognitive function, alleviating sleep-disordered breathing, and reducing the impact on bone metabolism.

Abstract:Objective To investigate the correlation of serum miR-132-3p, miR-501-3p, and miR-29c-3p with cognitive function and prognosis in patients with vascular dementia (VaD). Methods A study was conducted on 66 VaD patients (study group) treated at Beijing Friendship Hospital, Capital Medical University from January 2022 to December 2023 and 65 healthy individuals (control group) who underwent physical examinations in the same hospital during the same period. Spearman correlation analysis was used to analyze the relationship between serum miR-132-3p, miR-501-3p, miR-29c-3p and the mini-mental state examination (MMSE) score. Logistic regression analysis was used to analyze factors affecting the prognosis of VaD patients. Receiver operating characteristic (ROC) curves were used to determine the prognostic value of serum miR-132-3p, miR-501-3p, miR-29c-3p in VaD patients. SPSS 25.0 was used for statistical analysis. Comparison between groups was performed using t test, one-way ANOVA, orχ² test, depending on data type. Results miR-132-3p, miR-29c-3p, and MMSE scores in the study group were significantly lower than those in the control group, while miR-501-3p was significantly higher (P<0.05). Serum miR-132-3p and miR-29c-3p levels were significantly lower in the moderate and severe dementia groups than those in the mild dementia group, while serum miR-501-3p levels were significantly higher than that in the mild dementia group, and the differences were statistically significant between the moderate and severe dementia groups (P<0.05). In the study group, miR-132-3p and miR-29c-3p were positively correlated with MMSE score, and miR-501-3p was negatively correlated with MMSE score (P<0.05). VaD patients with good prognosis had significantly higher levels of serum miR-132-3p and miR-29c-3p and significantly lower miR-501-3p level than those with poor prognosis (P<0.05). There were statistically significant differences (P<0.05) in the incidence of hypertension, coronary heart disease, and MMSE scores among VaD patients with different prognoses (P<0.05). Complication with hypertension and coronary heart disease, and miR-501-3p were risk factors and MMSE score, miR-132-3p, and miR-29c-3p were protective factors for the prognosis of VaD patients (P<0.05). The sensitivity in predicting the prognosis of VaD patients was 80.00% for miR-132-3p, 76.00% for miR-501-3p, 68.00% for miR-29c-3p, and 96.00% for their combination, the specificity was 87.80%, 82.93%, 82.93%, and 80.49%, respectively, and the AUC was 0.855,0.837,0.839, and 0.952, respectively. The Z-values for the combination versus miR-132-3p, miR-501-3p, and miR-29c-3p were 2.175 (P=0.030), 2.117 (P=0.034), and 2.249 (P=0.025), respectively. The AUC and sensitivity of the combination in predicting the prognosis of VaD patients were higher than those of individual prediction. Conclusion Serum levels of miR-132-3p, miR-501-3p, and miR-29c-3p are associated with cognitive function in VaD patients, and the combination of the three has a better predictive effect on the prognosis of VaD patients than individual prediction.

Abstract:Objective To explore the risk factors of wound infection in elderly patients with open fractures. Methods A retrospective analysis was conducted on 160 elderly patients with open fractures admitted in our department from February 2022 to February 2024. Based on the occurrence of wound infection during hospitalization, they were divided into an infection group (n=34) and a non-infection group (n=126). The general demographic data, laboratory indicators, disease conditions and treatment-related data were collected and compared between the two groups. SPSS 26.0 was used for data analysis, and t test or χ² test was performed depending on data type. Binary logistic regression analysis was employed to identify the risk factors of wound infection in the patients. Results The incidence of wound infection was 21.25% (34/160) in the cohort. Bacterial culture of wound secretion in the 34 infectious patients revealed that 28 cases (82.4%) were positive for bacterial culture. There were 28 strains of pathogenic bacteria detected, including 15 strains of Staphylococcus aureus (53.57%), 7 strains of Pseudomonas aeruginosa (25.00%), 4 strains of Escherichia coli (14.29%), and 2 strains of Acinetobacter baumannii (7.14%). Taking presence or absence of wound infection in elderly patients with open fractures during hospitalization as the dependent variable, binary logistic regression analysis showed that diabetes mellitus (OR=3.442, 95%CI 1.254-9.444), hypertension (OR=3.065, 95%CI 1.583-5.933) and Gustilo-Anderson type Ⅲ (OR=7.367, 95%CI 1.711-31.728) were independent risk factors for infection in elderly patients with open fractures, and the time from injury to first debridement <3 h (OR=0.838, 95%CI 0.761-0.922) was a protective factor (P<0.05). Conclusion Diabetes mellitus, hypertension, Gustilo-Anderson type, and time from injury to first debridement are influencing factors of wound infection in elderly patients with open fractures.

Abstract:Objective To investigate the status quo of kinesiophobia and exercise efficacy in elderly patients with diabetic peripheral neuropathy (DPN) at discharge and analyze their influencing factors. Methods A total of 102 elderly DPN patients admitted to Fuyang People′s Hospital of Anhui Medical University from January 2023 to July 2024 were enrolled as a DPN group, and 50 hospitalized patients with type 2 diabetes mellitus (T2DM) but without DPN admitted during the same period were selected as a control group. One day before discharge, the Tampa scale for kinesiophobia (TSK) was used to investigate the status quo of kinesiophobia, and the detection rate of kinesiophobia was compared between the DPN group and the control group. Exercise self-efficacy scale (ESE) was used to investigate the status quo of exercise efficacy in the elderly DPN group. Pearson correlation analysis was used to analyze the correlation between TSK score and ESE score. A binary logistic regression model was used to analyze the factors affecting the kinesiophobia in elderly DPN patients at discharge. SPSS statistics 27.0 was used for statistical analysis. Data comparison between two groups was performed using t test orχ² test depending on data type. Results A total of 102 questionnaires were distributed, and 96 (94.12%) valid questionnaires were recovered. All 50 questionnaires distributed in the control group were recovered. The TSK score and detection rate of kinesiophobia were higher in DPN group than those in control group [(35.45±5.13) vs (19.58±2.29) points, 44.79% (43/96) vs 4.00% (2/50), P<0.05)]. The TSK score [(35.45±5.13) vs (19.58±2.29) points] and the detection rate of kinesiophobia [(44.79%(43/96) vs 4.00%(2/50)] in DPN group at discharge were higher than those in the control group, and the differences were statistically significant (P<0.05). The ESE score in the DPN group at discharge was 16-69 (50.36±8.19) points, including 30 (31.25%) patients with low efficacy, 48 (50.00%) with middle efficacy, and 18 (18.75%) with high efficacy. Pearson correlation analysis indicated a negative correlation between TSK score and ESE score (r=-0.493; P<0.001). Using occurrence of kinesiophobia in elderly DPN patients as the dependent variable, binary logistic regression analysis suggested that comorbid cardiovascular disease (OR=1.752, 95%CI 1.132-2.713), history of falls in the last 1 year (OR=1.344, 95%CI1.231-1.468), sleep disorder (OR=1.206, 95%CI 1.143-1.271), visual analogue scale (VAS) score ≥4 points (OR=1.531, 95%CI 1.208-1.941), Toronto clinical scoring system (TCSS) score of 12-19 points (OR=1.418, 95%CI 1.195-1.681), and previous monthly frequency of hypoglycemia >6 times (OR=1.914, 95%CI 1.347-2.718) were risk factors, and that exercise ≥3 times/week (OR=0.733, 95%CI 0.592-0.907), diabetes mellitus and DPN-related health education (OR=0.760, 95%CI 0.660-0.876), and exercise efficacy (OR=0.742, 95%CI 0.625-0.879) were the protective factors(P<0.05). Conclusion The detection rate of kinesiophobia is high in elderly DPN patients at discharge, and comorbid cardiovascular disease, history of falls in the past 1 year, sleep disorder, VAS score ≥ 4 points, TCSS score of 12-19 points, and previous monthly frequency of hypoglycemia > 6 times are risk factors of kinesiophobia, and exercises ≥3 times/week, diabetes mellitus and DPN-related health education, and exercise efficacy are its protective factors.

Abstract:Objective To investigate the cognitive frailty in elderly population with comorbidity in the Department of General Medicine and to evaluate its influencing factors. Methods A retrospective analysis was conducted of the clinical data of 206 elderly patients with comorbidity admitted to the Department of General Medicine of Dongguan People′s Hospital from January 2023 to December 2024. According to the diagnostic criteria for cognitive frailty proposed by the International Academy of Nutrition and Aging, the 206 elderly patients were divided into a cognitive frailty group (n=69) and a non-cognitive frailty group (n=137). The types of chronic diseases, comorbidity severity [age-adjusted Charlson comorbidity index (aCCI)], and serum homocysteine (Hcy) on the day after admission were compared between the two groups. SPSS 25.0 was used for data analysis, and t test or Chi-square test was used for comparison between groups according to the data type. Multivariate logistic regression analysis was used to evaluate the influencing factors of cognitive frailty in elderly patients with comorbidity. Results Among the 206 elderly patients with comorbidity in the Department of General Medicine, heart diseases were the most common chronic disease (56.80%), followed by hypertension (38.35%) and cerebrovascular disease (21.36%), and asthma was the least common (0.97%). The incidence of cognitive frailty was 33.50% (69/206). The proportion of cerebrovascular disease, aCCI scores, proportion of poor self-efficacy of chronic disease management, proportion of poor nutritional status, and serum Hcy levels on the day after admission in the cognitive frailty group were significantly higher than those in the non-cognitive frailty group, with statistically significant differences (P<0.05). Multivariate logistic regression analysis showed that cerebrovascular disease (OR=2.683,95%CI 1.409-5.111; P<0.05), aCCI score (OR=4.272,95%CI 2.516-7.253; P<0.05), poor self-efficacy of chronic disease management (OR=2.872,95%CI 1.606-5.136; P<0.05), poor nutritional status (OR=2.705,95%CI 1.442-5.072; P<0.05), and serum Hcy on the day after admission (OR=3.225,95%CI 1.835-5.667; P<0.05) were all risk factors of cognitive frailty in elderly patients with comorbidity in the Department of General Medicine. Conclusion Cognitive frailty in elderly patients with comorbidity in the Department of General Medicine is affected by chronic disease types, comorbidity severity, poor nutritional status, serum Hcy levels on the day after admission, and self-efficacy of chronic disease management. In clinical practice, special attention should be paid to elderly patients with comorbidity who have the aforementioned high-risk factors.

Abstract:Objective To analyze the occurrence status of hypoalbuminemia (HA) in elderly patients with post-stroke dysphagia (PSD) and to evaluate its related influencing factors. Methods Clinical data of 138 elderly PSD patients admitted in our hospital from January 2023 to March 2024 were collected, and according to their serum albumin level <30 g/L or not, they were divided into a HA group and a non-HA group. The baseline data were compared between two groups. Nutritional risk screening 2002 (NRS2002) scale was used to assess the nutritional risk. Modified rankin scale (mRS) was adopted to evaluate the prognosis at three months of follow-up. SPSS statistics 25.0 was used for statistical analysis. Data comparison between two groups was performed using t test or χ² test depending on data type. Logistic regression analysis was applied to identify the influencing factors of HA in elderly PSD patients. Pearson correlation analysis was utilized to analyze the correlation between albumin level with nutritional risk and prognosis. Results The incidence rate of HA was 30.43% (42/138) in the 138 elderly patients with PSD. Statistical differences were observed between the HA and non-HA groups in terms of age, frailty, pulmonary infection, National Institutes of Health Stroke Scale (NIHSS) score at admission, result of water swallow test, eating method and total bilirubin level (P<0.05). Logistic regression analysis suggested that aged ≥75 years (OR=3.593,95%CI 1.939-6.658), frailty (OR=4.141,95%CI 2.380-7.207), pulmonary infection (OR=2.625,95%CI 1.198-5.750), NIHSS score at admission ≥9 points (OR=3.340,95%CI 1.749-6.380), water swallow test grade 5 (OR=4.627,95%CI 2.775-7.716), nasogastric tube feeding (OR=4.491,95%CI 2.697-7.477), and total bilirubin level ≥26 μmol/L (OR=3.105,95%CI 1.585-6.083) were risk factors for HA in the elderly PSD patients (P<0.05). The HA group exhibited significantly higher NRS2002 score and 3-month mRS score than the non-HA group (P<0.05). Pearson correlation analysis showed that serum albumin level was negatively correlated with NRS2002 score and 3-month mRS score in elderly PSD patients (r=-0.721, -0.539; P<0.05). Conclusion The occurrence of HA can increase the risk of poor prognosis in elderly PSD patients. HA is not only related to the nutritional risk of patients. Age, frailty, pulmonary infection, NIHSS score at admission, water swallow test grade assisted feeding method and total bilirubin level can also affect the risk of HA.

Abstract:Objective To explore the risk factors of pulmonary infection in elderly convalescent patients with spontaneous intracerebral hemorrhage (sICH) during hospitalization in Department of Rehabilitation Medicine. Methods A total of 127 elderly convalescent patients with sICH admitted to Department of Rehabilitation Medicine of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from January 2023 to November 2024 were selected as the study subjects. According to the occurrence of pulmonary infection during hospitalization in Department of Rehabilitation Medicine, they were divided into an infection group (n=26) and a non-infection group (n=101). Sputum samples were collected before antibiotic treatment for pathogenic bacteria analysis. The detection results of pathogenic bacteria were counted. SPSS 26.0 was used for data processing, and t test was performed for between-group comparison according to the data type. A binary logistic regression model was used to analyze the factors affecting the pulmonary infection of patients, and a prediction model was constructed. Receiver operating characteristic (ROC) curves were plotted to analyze the application value of the prediction model. Results Among the 127 patients, the pulmonary infection rate was 20.47% (26/127). A total of 29 strains of pathogenic bacteria were isolated from the lower respiratory tract sputum of 26 patients with pulmonary infection, mainly Gram-negative bacteria (63.33%, 26/29). The three pathogenic bacteria with the highest detection rates were Acinetobacter baumannii (34.48%, 10/29), Pseudomonas aeruginosa (27.59%, 8/29), and Klebsiella pneumoniae (24.14%, 7/29). Binary logistic regression analysis indicated that age ≥ 75 years (OR=2.212, 95%CI 1.545-3.167), diabetes mellitus (OR=2.568, 95%CI 1.460-4.515), acute stage tracheotomy (OR=4.255, 95%CI 1.616-11.204), swallowing dysfunction (OR=4.043, 95%CI 2.130-7.675), and indwelling nasogastric feeding tube (OR=4.568, 95%CI 1.898-10.991) were risk factors of pulmonary infection in elderly convalescent patients with sICH during hospitalization in the Department of Rehabilitation Medicine, and the use of electric standing bed (OR=0.412, 95%CI 0.270-0.628) was a protective factor (P<0.05). A prediction model of pulmonary infection was constructed based on logistic regression analysis results. ROC curves plotted showed that the model had an area under the ROC curve of 0.864 (95%CI 0.789-0.940), a sensitivity of 0.808, and a specificity of 0.822 in predicting pulmonary infection during hospitalization in the Department of Rehabilitation Medicine. Conclusion The rate of pulmonary infection remains high in elderly convalescent patients with sICH during hospitalization in the Department of Rehabilitation Medicine, and the main pathogenic bacteria are Gram-negative bacteria. Age, diabetes mellitus, tracheotomy in the acute phase, swallowing dysfunction, indwelling nasogastric tube, and the use of electric standing bed are factors affecting pulmonary infection. The prediction model constructed based on the results of the study has good efficiency in predicting pulmonary infection in patients during hospitalization in the Department of Rehabilitation Medicine.

Abstract:Aortic dissection is a pathological condition in which blood enters the media layer through a tear in the aortic intima, resulting in the coexistence of a true and a false lumen. It is one of the most critical emergencies in the cardiovascular system. Pericardial tamponade refers to the accumulation of fluid in the pericardial cavity, causing an increase in intrapericardial pressure that compresses the heart and affects its filling function. In severe cases, it can lead to circulatory failure. The mortality rate of aortic dissection complicated with pericardial tamponade is extremely high, and early identification and intervention are crucial. This article systematically reviews progress in the risk factors and treatment of pericardial tamponade in aortic dissection. By integrating risk stratification and individualized treatment pathways, it aims to provide a basis for clinical identification of high-risk patients and optimization of emergency strategies, thus improving patient survival rates and long-term prognosis.

Abstract:As global population aging accelerates, medication safety for the elderly becomes increasingly critical. Accurately assessing their medication literacy and implementing personalized interventions are crucial for enhancing medication safety management. This article reviews the concepts, core elements, and applications of medication literacy assessment tools for the elderly globally, aiming to provide a reference for the development, application, innovation, or localization of such tools in China.