Abstract:ObjectivesTo investigate the impact of major adverse cardiovascular events (MACEs) on the risk of catastrophic health expenditure (CHE) among middle-aged and older adults in China. Methods Based on the Harmonized China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2018, a prospective cohort study was constructed on 3 715 participants aged ≥45 years at baseline and without CHE. MACEs and CHE were identified based on self-reported data. R software (version 4.4.2) was used for statistical analysis. Kaplan-Meier survival curve was plotted to analyze the cumulative incidence risk of CHE across different MACEs statuses. Cox proportional hazards regression model was employed to examine the association between MACEs and CHE. Subgroup analyses were conducted to assess the effects of age, gender, health insurance, and urban or rural household registration on the association between MACEs and CHE. Results The median follow-up was 83 months, during which 1 981 participants developed CHE and 1 734 did not; There were 442 cases of MACEs and 3 273 cases without. The CHE group exhibited significantly higher median age, larger proportion of education level below high school, increased incidence of MACEs, and increased prevalence rates of hypertension, diabetes mellitus, lung disease, arthritis, and liver and kidney diseases, but obviously lower ratio of rural household registration compared with the non-CHE group (all P<0.05). Kaplan-Meier survival curve analysis showed a significantly higher cumulative incidence of CHE in the MACEs group than the non-MACEs group (log-rank P<0.001). Cox proportional hazards regression analysis indicated that, after adjusting for confounding factors, MACEs was an independent risk factor for CHE (HR=1.23,95%CI 1.08-1.41). Subgroup analyses showed no significant interactions were observed (all P-interaction>0.05), indicating that the association between MACEs and CHE risk was consistent across different age, gender, health insurance, and urban or rural household registration subgroups. Conclusion Among Chinese middle-aged and older adults, MACEs is an independent risk factor for CHE, and this association remains consistent across various sociodemographic subgroups.

Abstract:Objective To investigate the clinical characteristics of patients with essential hypertension complicated with persistent atrial fibrillation (EHP-PeAF). Methods A retrospective analysis was conducted of the clinical data of 384 EHP-PeAF patients who were hospitalized in the Department of Cardiology and Neurology of the Chinese PLA General Hospital from January 2010 to December 2019. Based on age, the patients were divided into five groups:≤50 years (n=17), 50-60 years (n=59), 60-70 years (n=108), 70-80 years (n=144), and >80 years (n=56). The patients were also divided into quartiles based on the CHA₂DS₂-VASc score:Q1 group (≤1 point, n=43), Q2 group (2-3 points, n=131), Q3 group (4 points, n=71), and Q4 group (5-9 points, n=139). The demographic characteristics, laboratory indicators, comorbidities, and medication use were analyzed, and the patients were compared in gender, age, and CHA₂DS₂-VASc score. Data analysis was performed using R 4.5.2 statistical software. Comparisons between two groups were conducted using independent sample t tests, Mann-Whitney U tests, χ² tests, or Fisher′s exact probability method, and pairwise comparisons among multiple groups were corrected using the Bonferroni method. Trend analysis of ordinal categorical variables was performed using the Cochran-Armitage trend test. Results The median age of the patients was 71.00 (63.00,77.00) years, the average body mass index (BMI) was (26.21±3.86) kg/m²,62.00% patients were male , 38.50%had a history of smoking, and 38.00% had a history of drinking. Gender-stratified analysis showed that female patients had higher age, CHA₂DS₂-VASc score, high-density lipoprotein cholesterol, D-dimer, and prevalence of coronary artery disease (CAD) than male patients. Height, Body weight, BMI, alanine aminotransferase, creatinine, hemoglobin, and uric acid levels were lower in female patients, and the differences were statistically significant (all P<0.05). Among comorbidities, the prevalence of CAD was the highest (66.40%), followed by heart failure (HF, 38.30%) and stroke (CS, 32.80%). The prevalence of CAD, HF, CS, and peripheral arterial disease (PAD) increased significantly with age (all P for trend <0.05), and the prevalence of CAD in the 70-80 years and >80 years groups was significantly higher than that in ≤50 years group (P<0.005). The prevalence of HF, diabetes mellitus, CS, CAD, chronic kidney disease, and PAD increased significantly with the increase in CHA₂DS₂-VASc score (all P for trend <0.005), and the multiple comorbidity burden in the high-score group was significantly higher than that in the low-score group. In terms of medication use, 52.10% of the patients used at least one antihypertensive drug, including 151 patients (39.30%) on monotherapy and 49 (12.80%) on combine therapy (≥2 medications). Calcium channel blockers were the most commonly used antihypertensive drugs (31.50%), followed by angiotensin Ⅱ receptor blocker (20.60%). The usage rate of oral anticoagulant (OAC) was only 7.30%, indicating significant insufficiency in both antihypertensive and anticoagulant standardized treatment. OAC usage rate increased significantly with age, and the usage rates of other antihypertensive drugs decreased significantly with age (P for trend=0.024,0.012). The usage rate of diuretics increased with the increase in CHA₂DS₂-VASc score (P for trend=0.047), while OAC usage rate did not significantly increase. Conclusion EHP-PeAF patients have a high incidence of cardiovascular comorbidities and receive insufficient anticoagulation and antihypertensive treatments. Clinically, it is necessary to standardize drug therapy and strengthen comprehensive management of comorbidities.

Abstract:Objective To investigate the current status and related influencing factors of chronic obstructive pulmonary disease (COPD) specific treatment in elderly patients with lung cancer (LC) and COPD (LC-COPD) comorbidity. Methods A total of 210 elderly LC patients admitted to Peking University People′s Hospital from January to May 2025 were enrolled. Demographic data, clinical information, and imaging findings were collected. All patients underwent comprehensive pulmonary function tests, and were divided into a LC-COPD group and a LC group based on whether COPD was present. The current status of specialized COPD treatment was analyzed in the LC-COPD patients, and the LC-COPD group was further assigned into a treated subgroup and an untreated subgroup. SPSS 26.0 statistics was used for data analysis. Data comparisons between two groups was conducted using independent samples t test orχ² test depending on data type. Logistic regression model was employed to analyze influencing factors for LC-COPD comorbidity and for whether receiving specialized COPD treatment among the LC-COPD patients. Results Among the 210 elderly LC patients, pulmonary function tests confirmed that 128 patients (60.95%) also had COPD. Logistic regression analysis revealed that male (OR=2.102,95%CI 1.278-3.459; P=0.004), smoking index ≥400 cigarettes/year (OR=1.560,95%CI 1.067-2.282; P=0.022) and emphysema (OR=1.725,95%CI 1.198-2.483; P=0.004) were risk factors for LC-COPD comorbidity in elderly LC patients. Of the 128 patients with LC-COPD, 44 patients received COPD-related treatment, including 22 patients who followed the preferred treatment regimens recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), while the remaining 22 patients did not adhere to the guideline recommendations. With whether LC-COPD patients received COPD treatment as the dependent variable, logistic regression analysis revealed that GOLD stage 3-4 (OR=2.168,95%CI 1.160-4.052; P=0.016), dyspnea index score ≥2 points (OR=1.738,95%CI 1.234-2.450; P=0.002), COPD assessment test score ≥10 points (OR=1.972,95%CI 1.199-3.244; P=0.008), physical status score ≥2 points (OR=1.404,95%CI 1.060-1.858; P=0.018) and anxiety (OR=1.335,95%CI 1.091-1.634; P=0.005) were influencing factors for receiving specialized COPD treatment in LC-COPD patients. Conclusion Elderly LC patients exhibit high comorbidity rate of COPD. Lung function assessment should be particularly emphasized among male patients, those with a smoking index ≥400 cigarettes/year and those with emphysema. Additionally, the rate of specialized COPD treatment is quite low among patients with LC-COPD comorbidity, and there are considerable instances of non-adherence to prescribed therapies. Patients with severe COPD, poor physical condition, or comorbid anxiety are more likely to receive targeted COPD treatment. It is recommended that clinicians should conduct comprehensive COPD assessments and provide appropriate pharmacological interventions for patients with LC-COPD comorbidity.

Abstract:Objective To investigate the clinical and psychological characteristics of elderly patients with bronchiectasis-chronic obstructive pulmonary disease overlap syndrome (BCOS). Methods A total of 215 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to our hospital from May 2023 to June 2024 were enrolled, and based on the findings of high-resolution CT (HRCT), they were divided into a chronic obstructive pulmonary disease (COPD) group (n=128) and a BCOS group (n=87). Clinical data, laboratory indicators, results of blood gas analysis, pulmonary function indicators and sputum pathogenic culture results were compared between two groups. Distress thermometer (DT) was used to assess psychological distress, and the hospital anxiety and depression scale (HADS) was employed to evaluate anxiety and depression. SPSS statistics 26.0 was used for statistical analysis. Data comparison between two groups was performed using t test, χ² test and rank-sum test depending on data type. Results The BCOS group exhibited significantly more patients experiencing ≥ twice of acute exacerbations of COPD in the past year, higher grade in Global Initiative for Chronic Obstructive Lung Disease (GOLD) grading, increased peripheral blood C-reactive protein (CRP), and elevated systemic immune-inflammation index (SII) and partial pressure of carbon dioxide (PaCO₂), but lower prognostic nutritional index (PNI), decreased partial pressure of blood oxygen (PaO₂) and forced expiratory volume in one second as a percentage of the predicted value (FEV1%pred) than the COPD group (P<0.05). The detection rate of Pseudomonas aeruginosa and incidence of hemoptysis were obviously higher in the BCOS group than in the COPD group (P<0.05). The score of DT scale, detection rate of significant distress, as well as anxiety scores and the detection rate of anxiety, were higher in the BCOS group than in the COPD group (P<0.05). Conclusion Compared with patients with simple COPD, BCOS patients have a higher incidence of hemoptysis and more frequent COPD acute exacerbations within 1 year, poorer oxygenation capacity and pulmonary function, more severe ventilatory dysfunction, a higher detection rate of Pseudomonas aeruginosa in sputum, stronger systemic inflammatory response, and poorer nutritional status, as well as higher detection rates of psychological distress and anxiety. It is recommended that clinicians actively screen for bronchiectasis in COPD patients with these characteristics and provide appropriate psychological intervention for BCOS patients.

Abstract:Objective To investigate the clinical value of targeted therapy combined with immune neoadjuvant regimen in the treatment of elderly patients with advanced hepatocellular carcinoma (HCC) and to analyze the value of monitoring eosinophil (EOS) and vascular endothelial growth factor (VEGF) levels during treatment. Methods A retrospective analysis was conducted on 160 elderly patients with advanced HCC admitted to Yichang Central People′s Hospital from January 2020 to January 2023. According to the treatment regimens, the patients were divided into group A (targeted therapy alone, n=51), group B (immunotherapy alone, n=43), and group C (targeted therapy combined with immunotherapy, n=66). The modified response evaluation criteria in solid tumors (mRECIST) was used to evaluate the therapeutic efficacy. The treatment-related adverse events were recorded. The patients were followed until December 2024. The overall survival (OS) and progression-free survival (PFS) were recorded. The levels of peripheral blood EOS and serum VEGF were measured before treatment and after 3 medication cycles. Receiver operating characteristic (ROC) curves were plotted to analyze the value of differences of peripheral blood EOS and serum VEGF levels before and after treatment in predicting the disease control rate (DCR). SPSS 26.0 was used for statistical analysis. Data comparison between two groups was performed using One-way ANOVA, χ² test or Fisher′s exact probability test depending on data type. Results The objective response rate (ORR) and DCR in group C were significantly higher than those in groups A and B (P<0.05), but there were no statistical differences in ORR and DCR between group A and group B (P>0.05). There were no statistically significant differences in the incidence of ≥ Ⅲ adverse events among the three groups (P>0.05). The OS was 10.46 months (95%CI 0.340-9.794) in group A, 10.88 months (95%CI 0.389-10.115) in group B, and 14.18 months (95%CI 0.323-13.543) in group C , without statistical significance between groups A and B (Log-rank χ²=10.446, P=0.504) and with longer OS in group C than those in groups A and B (Log-rankχ²=31.030, P<0.001). PFS was 5.06 months (95%CI 0.367-4.432) in group A, 5.19 months (95%CI 0.361-4.486) in group B, and 6.36 months (95%CI 0.294-5.784) in group C, without statistically differences among the three groups (Log-rank χ²=3.987, P=0.136). No statistical differences were found in peripheral blood EOS and serum VEGF levels among the three groups before treatment (P>0.05). After 3 medication cycles, the peripheral blood EOS levels in all groups were enhanced as compared with those before treatment (P<0.05), while serum VEGF levels decreased as compared with those before treatment (P<0.05). Moreover, after treatment, group C had higher EOS level and lower VEGF level than groups A and B; Group C had greater difference in EOS and VEGF levels before and after treatment than groups A and B; the differences were statistically significant (P<0.05). EOS difference (best cut-off value=1.24, AUC=0.845,95%CI 0.778-0.911, sensitivity 0.780, specificity 0.845, P<0.001) and VEGF difference (best cut-off value=49.26, AUC=0.786,95%CI 0.713-0.859, sensitivity 0.700, specificity 0.755, P<0.001) before and after treatment had certain value in predicting whether patients would achieve DCR after treatment. The combination of the two had the highest predictive value (AUC=0.894,95%CI 0.842-0.947, sensitivity 0.920, specificity 0.818, P<0.001). Conclusion Targeted therapy combined with immunotherapy can effectively enhance therapeutic efficacy and prolong the survival time in elderly patients with advanced HCC without increasing adverse events. The differences in peripheral blood EOS and serum VEGF levels before treatment and after 3 medication cycles have certain value in predicting whether patients will achieve DCR, and can be used as predictors of treatment response in elderly patients with advanced HCC.

Abstract:Objective To investigate the prevalence of frailty in elderly patients with congestive heart failure (CHF) and analyze its correlation with immune function. Methods Clinical data of 152 elderly CHF patients admitted to our hospital of Jiamusi University from January 2023 to December 2024 were retrospectively collected. Frailty was defined as a Fried frailty phenotype (FFP) score ≥3 points, and then these patients were divided into a frailty group and a non-frailty group. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), N-terminal pro-B-type natriuretic peptide (NT-proBNP), 25-hydroxyvitamin D₃ [25-(OH)D₃], and immune function indicators [systemic immune inflammation index (SII), T lymphocyte subsets (CD4⁺, CD8⁺, CD4⁺/CD8⁺ ratio] were compared between two groups. Pearson correlation analysis was used to evaluate the correlation between FFP score and immune function in elderly CHF patients. Multivariate linear regression analysis was employed to further analyze the correlation after adjusting for confounding factors. The changes in immune function indicators at admission and discharge were recorded. All patients were followed up regularly after discharge. The incidence of unplanned readmission at 6 months after discharge was compared between two groups. SPSS statistics 25.0 was performed for statistical analysis. Data comparison between groups was applied using t test orχ² test depending on data type. Results The prevalence of frailty was 53.29% (81/152) in the cohort. LVEF, 25-(OH)D₃, CD4⁺ and CD4⁺/CD8⁺ were significantly lower, while LVEDD, NT-proBNP, SII and CD8⁺ were obviously higher in the frailty group than the non-frailty group (P<0.05). Pearson correlation analysis revealed that FFP score was negatively correlated with LVEF, 25-(OH)D₃, CD4⁺ and CD4⁺/CD8⁺ (P<0.05), and positively with LVEDD, NT-proBNP, SII and CD8⁺ (P<0.05). Multivariate linear regression analysis found that, after adjusting for confounding factors such as gender, age and comorbidities, FFP score remained positively correlated with LVEDD (β=0.327,95%CI 0.103-0.592; P=0.008), NT-proBNP (β=0.362,95%CI 0.150-0.609; P=0.005), SII (β=0.289,95%CI 0.089-0.565; P=0.012) and CD8⁺ (β=0.307,95%CI 0.097-0.586; P=0.009), and was still negatively correlated with LVEF (β=-0.239,95%CI -0.486-0.032; P=0.015), 25-(OH)D₃ (β=-0.208,95%CI -0.423--0.021; P=0.009), CD4⁺ (β=-0.231,95%CI -0.472--0.029; P=0.014) and CD4⁺/CD8⁺ (β=-0.224,95%CI -0.452--0.025; P=0.011). At discharge, SII and CD8⁺ in both the frailty group and non-frailty group were reduced compared with those at admission (P<0.05), while CD⁴⁺ and CD4⁺/CD8⁺ were increased than the baseline levels (P<0.05). At 6 months after discharge, the incidence rte of cardiac unplanned readmission (35.80% vs 21.13%) and total incidence of unplanned readmission (38.27% vs 22.54%) in the frailty group were statistically higher than those in the non-frailty group (P<0.05). Conclusion The prevalence of frailty in elderly CHF patients is severe, and frailty is significantly correlated with 25-(OH)D₃ level, cardiac function and immune function. Frailty may increase the risk of unplanned readmission in elderly CHF patients. Active screening for frailty, monitoring 25-(OH)D₃ level and implementation of targeted interventions may be beneficial for improving the clinical management of elderly CHF patients.

Abstract:Objective To explore the factors affecting upper limb dysfunction in elderly patients with breast cancer at 6 months after surgery. Methods A total of 148 elderly female patients who received surgical treatment for breast cancer at Mianyang Central Hospital from January 2021 to February 2024 were selected as study subjects. At 6-month follow-up visit after surgery, the Rewe shoulder function score was used to evaluate the presence of upper limb dysfunction on the affected side. According to the evaluation results, the patients were divided into a dysfunction group and a control group. SPSS 26.0 was used for data analysis, and t test, Chi-square test, or Fisher′s exact test was performed for comparisons between groups according to the data type. Binary logistic regression model was used to analyze the factors affecting upper limb dysfunction in elderly breast cancer at 6 months after surgery. Results At 6 months after surgery, 140 (94.59%) patients returned for follow-up on time, among whom 41 (29.29%) had upper limb dysfunction and were included in the dysfunction group, with Rewe shoulder function scores ranging from 51 to 68 (57.45±12.07) points; the remaining 99 patients were assigned to the control group. Binary logistic regression analysis showed that TNM stage Ⅲ (OR=3.054,95%CI 1.428-8.599), total mastectomy (OR=2.044,95%CI 1.133-3.688), axillary lymph node dissection (OR=1.941,95%CI 1.150-3.275), number of axillary lymph nodes dissected ≥ 10 (OR=1.680,95%CI 1.169-2.415), postoperative radiotherapy (OR=1.525,95%CI 1.012-2.297), and kinesiophobia at discharge (OR=1.408,95%CI 1.060-1.870) were the risk factors (P<0.05), while good functional exercise compliance (OR=0.349,95%CI 0.179-0.677) and adherence to preventive measures (OR=0.578,95%CI 0.349-0.959) were the protective factors (P<0.05). Conclusion The detection rate of affected upper limb dysfunction is high in elderly patients with breast cancer at 6 months after surgery. TNM stage Ⅲ, total mastectomy, axillary lymph node dissection, number of axillary lymph, nodes dissected ≥10, and postoperative radiotherapy are risk factors for upper limb dysfunction. In addition, the risk of upper limb dysfunction can be reduced by alliviating kinesiophobia, enhancing functional exercise compliance, and implementing preventive measures.

Abstract:Objective To investigate the relationship between the severity of coronary artery lesions and blood lipid levels as well as left ventricular diastolic function in patients with coronary heart disease (CHD) based on coronary computed tomography angiography (CTA). Methods A total of 148 CHD patients admitted to the Anhui No.2 Provincial People′s Hospital from January 2023 to July 2025 were enrolled. All patients underwent blood lipid testing, color Doppler ultrasound and coronary CTA examination. They were divided into four groups according to the severity of coronary artery stenosis:mild, moderate, severe and occlusion groups. SPSS 25.0 software was used for data analysis. Chi-square test and one-way analysis of variance were applied for comparison among different coronary lesion severity groups according to data types. Spearman correlation coefficient was used to analyze the correlation between the severity of coronary lesions and blood lipid levels as well as left ventricular diastolic function in CHD patients. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of blood lipid and left ventricular diastolic function parameters for severe coronary stenosis or occlusion in CHD patients. Results Among the 148 CHD patients evaluated by CTA, there were 34,50, 46, and 18 cases with mild, moderate, severe coronary artery stenosis and occlusion, respectively. With the increase of coronary stenosis severity, triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), lipoprotein(a) , left ventricular end-diastolic diameter (LVEDd), ratio of early diastolic peak flow velocity to late diastolic peak flow velocity at mitral orifice (E/A), and ratio of early diastolic peak flow velocity at mitral orifice to early diastolic peak flow velocity at mitral annulus (E/e′) were increased, while high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (ApoA1), apolipoprotein A1/apolipoprotein B (ApoA1/ApoB) and left ventricular ejection fraction (LVEF) were decreased (all P＜0.05). The patients were also divided into calcified plaque group (31 cases) and non-calcified plaque group (117 cases) according to plaque calcification degree. TG, LDL-C, Lp(a), LVEDd, E/A and E/e′ in the calcified plaque group were all higher than those in the non-calcified plaque group (all P＜0.05), while HDL-C, ApoA1, ApoA1/ApoB and LVEF were all lower (all P＜0.05). The severity of coronary lesions in CHD patients was positively correlated with TG, LDL-C and E/e′, but negatively correlated with HDL-C, ApoA1/ApoB and LVEF (all P＜0.05). ROC curve results showed that the area under the ROC curve for the combined diagnosis of severe coronary stenosis or occlusion in CHD by TG, LDL-C, E/e′, HDL-C, ApoA1/ApoB and LVEF was 0.863 (P＜0.05), which was higher than the diagnostic efficacy of each single index. Conclusion The severity of coronary lesions in CHD patients diagnosed by coronary CTA is closely related to blood lipid levels and left ventricular diastolic function, which has certain reference value for the screening of CHD and evaluation of coronary lesion severity.

Abstract:Objective To investigate the spatiotemporal distribution characteristics, allocation equity, and regional matching of traditional Chinese medicine (TCM) medical resources for the elderly in Beijing under the background of population aging, and to provide scientific evidence for optimizing the allocation of TCM resources and improving the TCM health service system for the elderly in the capital. Methods Based on official statistical data from the Beijing Health Development Statistical Bulletin and Beijing Statistical Yearbook from 2019 to 2023, core indicators such as the elderly population (aged ≥ 65 years), number of TCM hospitals, authorized bed capacity, actual bed capacity, and number of licensed (assistant) physicians in 16 districts of Beijing were collected. The resource allocation level per thousand elderly people was calculated. Pearson correlation analysis was used to examine the correlation between the proportion of the elderly population and TCM medical resource indicators. The Gini index (G) was adopted to evaluate the equity of TCM medical resources based on the distribution of the population aged 65 and above. The Health Resource Density Index (HRDI) was employed to assess the matching of TCM medical resource allocation in each district from both geographical and demographic dimensions. R 4.2 was used for statistical analysis. Results From 2019 to 2023, the population aged 65 and above in Beijing increased from 2.804 million to 3.469 million, with the proportion rising from 12.80% to 15.87%, indicating that Beijing has entered a moderately aging society. The highest aging rate was in Xicheng District (21.75%), while the lowest was in Changping District (10.43%). The total volume of various TCM medical resources maintained continuous growth, all showing a strong positive correlation with the proportion of the population aged 65 and above (all P<0.05). The Gini coefficients based on the distribution of the elderly population aged 65 and above revealed that the number of TCM hospitals (G=0.27) fell within the relatively equitable range, whereas authorized bed capacity (G=0.31), actual bed capacity (G=0.33), and the number of licensed (assistant) physicians (G=0.34) were all at alert levels. The HRDI results demonstrated that the comprehensive allocation in central urban districts was better, while remote suburban districts such as Yanqing, Miyun, and Mentougou suffered from poorer resource density and accessibility. ConclusionTCM medical resources in Beijing present a synchronous upward trend with the aging process, yet prominent disparities exist in the allocation equity across regions, and there is a mismatch between resource provision and the demands of the elderly population. It is urgent to optimize the resource distribution based on the distribution of the elderly population, increase investment in remote suburban districts, and improve the equity and accessibility of TCM medical resources for the elderly.

Abstract:Objective To investigate the role of sphingolipid metabolism disorder and its key regulatory pathways in the pathogenesis of Takayasu arteritis (TA). Methods A total of 60 TA patients admitted to Department of Rheumatology and Immunology of Beijing Anzhen Hospital from January 2016 to December 2020 were enrolled as the TA group, while 60 age- and gender-matched healthy individuals taking routine physical examinations during the same period were selected as the health control (HC) group. Plasma samples were collected from both groups, and targeted sphingolipid metabolomics was performed to measure the levels of sphingomyelin (SM), ceramide (Cer), and sphingosine-1-phosphate (S1P). Peripheral blood mononuclear cells (PBMCs) were isolated to detect the expression levels of S1P synthase (SPHK1) and its receptor (S1PR1). Immunohistochemical staining was used to detect the protein expression of SPHK1 and S1PR1 in the arterial tissues from both groups. In vitro experiments were conducted by stimulating macrophages with the inflammatory cytokine interleukin-6 (IL-6). Quantitative real-time PCR (qPCR) and Western blotting were applied to detect the mRNA and protein expression levels of SPHK1 and S1PR1, respectively. GraphPad Prism 8 was employed for statistical analysis. Data comparison between two groups was carried out using t test orχ² test depending on data type. Results Compared with the HC group, the TA group exhibited significantly higher plasma S1P levels [(3.23±0.81 vs (2.78±0.53) μmol/L, P<0.01], whereas obviously lower levels of SM and several Cer species (C16, C24) (P<0.05). The expression levels of SPHK1 and S1PR1 in PBMCs and arterial tissues were significantly increased in the TA patients than health controls (P<0.05). In vitro experiments demonstrated that IL-6 significantly induced the upregulation of SPHK1 and S1PR1 expression in macrophages at both mRNA and protein levels (P<0.05). Conclusion TA patients exhibit obvious dysregulation of sphingolipid metabolism and disruption in sphingolipid homeostasis, and elevated S1P levels are closely associated with aberrant activation of the SPHK1/S1P/S1PR1 signaling pathway. This pathway may serve as an important metabolic target for investigating the pathogenesis of TA and developing targeted therapeutic interventions.

Abstract:Objective Investigate the expression of SORT1 in elderly pancreatic cancer tissues and its impact on patient prognosis and the underlying mechanisms. Methods Pancreatic cancer tissues and adjacent normal tissues were obtained from 39 elderly pancreatic cancer patients. The expression levels of SORT1 were detected using immunohistochemical staining, and its correlation with various clinical-pathological characteristics and prognosis was analyzed. SORT1 co-expressed genes were screened using data from the Gene Expression Omnibus Database, the Gene Expression Profiling Interactive Analysis Database, and the GeneCards genomic annotation platform, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis and Gene Ontology (GO) functional annotation were performed on these genes using the Sangerbox bioinformatics analysis platform. Results The expression rate of SORT1 in pancreatic cancer tissues (71.8%, 28/39) was significantly higher than that in adjacent normal tissues (7.7%, 3/39), with a statistically significant difference (χ²=33.46,P<0.001). The expression level of SORT1 was correlated with tumor size and pathological grade (P<0.05). Cox proportional hazards regression analysis indicated that high SORT1 expression was an independent risk factor for poor prognosis in elderly pancreatic cancer patients (HR=2.354,95%CI 1.062-5.213; P=0.036). Kaplan-Meier survival analysis demonstrated that the survival rate of patients with high SORT1 expression was significantly lower than that of those with low expression, with a statistically significant difference (66.7% vs 81.8%; χ²=6.443, P=0.011). The venn analysis identified 221 SORT1 co-expressed genes. KEGG analysis revealed that these genes were primarily enriched in the endocytosis pathway (P=0.000 19). GO analysis revealed that SORT1 was primarily localized in the cytoplasm (P<0.000 1), bound to enzymes (P<0.000 1), and participated in vesicle trafficking (P=0.000 3). Conclusion SORT1 is highly expressed in pancreatic cancer tissues of elderly patients , and its expression level shows significant correlated with tumor size and pathological grade. High SORT1 expression is an independent risk factor influencing the prognosis of elderly pancreatic cancer patients. SORT1 may regulate the pancreatic cancer progression through such as vesicle-mediated transport and endocytosis. SORT1 is expected to become a potential target for prognostic evaluation and treatment of pancreatic cancer in elderly patients.

Abstract:Against the backdrop of accelerating global aging, fractures have become a major issue confronting the elderly population. Compared with the biological damage fractures inflict on the elderly, the psychosocial problems they trigger are gradually becoming key factors influencing prognosis. Psychological resilience, as a core psychological trait enabling individuals to cope with adversity, has drawn growing attention for its protective role. The mean resilience score among elderly fracture patients is lower than that of the general adult population, and is influenced by psychological, social, and disease-related factors.

Abstract:Alzheimer′s disease (AD) is a complex neurodegenerative disorder of the central nervous system. Increasing evidence indicates that copper metabolism plays a critical role in its pathogenesis. Copper exerts dual functions in maintaining neuronal activity and redox homeostasis, while its dysregulation may accelerate AD progression by promoting amyloid β-protein (Aβ) aggregation, tau hyperphosphorylation, oxidative stress, and neuroinflammation. In recent years, a newly recognized form of programmed cell death, known as “cuproptosis”, has also been implicated in the neuropathological processes of AD. In this article, we review the physiological mechanisms of copper metabolism and its interactions with Aβ, tau, apolipoprotein E, and other pathogenic factors in AD, with a focus on potential therapeutic strategies targeting copper homeostasis, aiming to provide novel insights into early diagnosis and precise intervention for AD.

Abstract:Traditional Chinese medicine (TCM) has accumulated extensive experience in treating anal fistula. Guided by the holistic view of TCM, anal fistula is regarded as a local manifestation of the systemic imbalance of qi, blood and yin and yang, which is predominantly associated with spleen-stomach dysfunction. On this basis, medicated thread therapy is performed on the patients, exerting multi-target and multi-level regulatory effects on accelerating postoperative wound healing, such as promoting drainage, purulent discharge, and tissue regeneration, thereby facilitating accelerated tissue healing. In this article, based on the holistic view of TCM as the theoretical foundation, we comprehensively analyze relevant literature at home and abroad to explore the classification of medicated threads, therapeutic effects, and operational essentials, provide a review of the application of medicated thread therapy in anal fistula treatment, and summarize its therapeutic efficacy with the aim of accumulating clinical experience for anal fistula management.