Due to aging, elderly patients experience gradual deterioration in organ functions and weakened gastrointestinal absorption capacity. After falling ill, they often suffer from gastrointestinal dysfunction, which can increase mortality and infection rates, prolong hospitalization duration, lead to poor clinical prognosis, and reduce quality of life. Elderly critically ill patients often cannot eat independently and require enteral nutrition (EN) and parenteral nutrition (PN) support. For this vulnerable geriatric population with critical conditions, nutritional support therapy plays a crucial role in improving malnutrition, yet may simultaneously induce various nutrition-related complications. This article summarizes the complications associated with EN and PN, introduces preventive measures and therapeutic approaches for these complications, aiming to enhance nutritional support efficacy for elderly critically ill patients, ultimately improving their clinical outcomes and quality of life.

Elderly patients with critical illness are at high risk of malnutrition, which can exacerbate organ failure and increase the rates of infection, hospitalization, and mortality. Therefore, nutritional therapy is extremely important. Given that elderly critical patients often have reduced gastrointestinal function, multiple complications, and organ dysfunction. This article reviews the optimal timing and routes of nutritional support for elderly critically ill patients and explores strategies for nutritional support that balance safety and efficacy.

With the increasing aging population, the number of elderly critically ill patients is rising, making nutritional support issues urgent. This review provides an in-depth analysis of the metabolic characteristics of energy and protein metabolism in the elderly critically ill patients, explores the establishment of clinical nutritional goals, and emphasizes the importance of individualized nutritional therapy. Research has demonstrated significant heterogeneity in energy metabolism among the elderly critically ill patients, along with the phenomenon of “anabolic resistance” in protein metabolism, highlighting the need for optimization of traditional nutritional support strategies. Based on recent studies and clinical guidelines, this review emphasizes that energy and protein intake should be precisely adjusted according to the patient’s condition. In the future, individualized, precision-based, phased, and multidisciplinary collaborative nutritional treatment strategies will become the mainstream approach, promising better clinical outcomes for the elderly critically ill patients and reducing the burden on public healthcare systems.

The gut microbiota is the second genome of the human body, which plays a crucial role in maintaining host health through its diversity and functional homeostasis. Elderly populations are more prone to gut microbiota imbalance due to physiological decline, diseases such as sepsis and medication use, which can affect immune regulation, metabolic homeostasis, and inflammatory responses, significantly increasing the incidence and mortality of critical illnesses. This article systematically reviews the core functions of the gut microbiota in immune modulation, metabolic balance, and barrier protection, analyzes the epidemiological characteristics of microbiota dysbiosis in the elderly and its association with critical illnesses, and focuses on the research progress of how microbial metabolites (such as, short-chain fatty acids, bile acids, and tryptophan derivatives) regulate the pathological processes of severe condition via the “gut-organ axis.” Finally, it looks forward to the clinical potential of targeted microbiota interventions for preventing and managing critical illnesses in the elderly.

Objective To explore the prevalence of autoimmune thyroiditis (AIT) in rural elderly and to analyze the correlation between serum vitamin D level and AIT. Methods The research subjects were derived from the study of Thyroid Diseases in Older Population: Screening, Surveillance, and Intervention (TOPS study) from May to July 2021 in iodine-adequate areas of Jiangsu Province. A total of 2460 elderly aged ≥65 years were enrolled. The general data including age, gender, height and weight were collected, and relevant laboratory indicators such as thyrotropin (TSH), thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), urinary iodine, blood glucose, blood lipids, and serum 25(OH)D were detected. The prevalence characteristics of AIT was analyzed, and a binary logistic regression model was established to analyze the correlation between serum 25(OH)D level and AIT. Results Among 2460 participants, 290 cases presented with AIT (11.79%). The prevalence rate of AIT in women was significantly higher than that in men (15.14% vs 8.55%, P<0.001). The median 25(OH)D level in the participants was 30.80 ng/mL. Women had a significantly lower median 25(OH)D level than men (25.80 ng/mL vs 36.00 ng/mL, P<0.001). Additionally, the elderly with AIT had a significantly lower median 25(OH)D level than those without AIT (28.40 ng/mL vs 31.15 ng/mL, P<0.001). In the elderly rural women, serum 25(OH)D level was an independent risk factor for AIT (OR=0.980, 95%CI: 0.961－0.998), but serum 25(OH)D level was not associated with AIT in the elderly rural men. Conclusions There is a correlation between vitamin D level and AIT in the elderly rural women.

Objective To evaluate the changes in retinal structure and function in the patients with Alzheimer’s disease (AD) in high-altitude regions using pattern visual evoked potential (PVEP) and optical coherence tomography (OCT), and to analyze their diagnostic value for AD. Methods Sixty AD patients (AD group) and 30 elderly individuals with normal cognition (HC group) admitted to Xining First People’s Hospital from January 2021 to March 2023 were enrolled. The latency and amplitude of the P100 wave were measured by PVEP. Retinal nerve fiber layer (RNFL) thickness and subfoveal choroidal thickness (SFCT) were tested by OCT. The differences in these indicators were compared between the two groups, and receiver operating characterisitc (ROC) curve analysis was performed to evaluate their diagnostic value for AD. Results There were no statistically significant differences in age, gender and intraocular pressure between the two groups (P>0.05). Compared to HC group, AD group showed significantly prolonged P100 wave latency (P<0.01), reduced P100 wave amplitude (P<0.01), thicker RNFL in the temporal quadrant (P<0.05), thinner PNFL in the superior and inferior quadrants (P<0.01), and thinner SFCT (P<0.001). The thickness of RNFL in superior quadrant and SFCT showed a significant thinning trends with AD progression (P<0.05). Logistic regression analysis showed that P100 latency, P100 amplitude and SFCT were independent factors for AD. ROC curve analysis revealed that the combined diagnostic value of P100 latency, P100 amplitude, and SFCT for AD (AUC=0.99) was superior to the parameters alone (AUC=0.81, 0.94 and 0.76, respectively). Conclusions AD patients in high-altitude regions present with distinct retinal structural and functional changes. Retinal parameters assessed by PVEP and OCT may serve as potential biomarkers for diagnosing AD in these populations.

Objective To compare the effects of ropivacaine combined with different concentrations of methylene blue for fascia iliaca block on postoperative analgesia, cognitive function and hip joint function recovery in the patients undergoing hip arthroplasty. Methods A total of 81 patients undergoing hip arthroplasty were enrolled and divided into three groups using a random number table: L group was given 30 mL of 0.25% ropivacaine;Y₁ group was given 30 mL of mixture of 0.25% ropivacaine with 20 mg methylene blue;Y₂ group was given 30 mL of mixture of 0.25% ropivacaine with 40 mg methylene blue.All the groups received ultrasound-guided fascia iliaca block before the induction of general anesthesia.The scores of pain Visual Analogue Scale(VAS) at rest and activity 1, 3 and 7 days after surgery, the scores of Mini-Mental State Examination(MMSE) 1 day before surgery and 7 days after surgery, the Harris score 7 days safter surgery,the distance of the first postoperative walk, the number of activities to get out of bed within 7 days postoperatively, the number of cases requiring intravenous rescue analgesia, and the incidence of adverse reactions within 7 days postoperatively were recorded. Results Among the initial 81 patients, 4 cases were lost to follow-up, and 2 cases were excluded for voluntarily requesting intravenous patient-controlled analgesia. Ultimately, 75 patients were included, with 25 cases in each group.Compared with L group, the scores of VAS at rest and activity 1, 3 and 7 days after surgery were significantly lower in Y₁and Y₂ groups(P<0.05);Compared with Y₁ group, the scores of VAS in Y₂ group were significantly lower at rest 1 day after surgery and at activity 1, 3 and 7 days after surgery (P<0.05).Compared with L group, the Harris scores were significantly higher 7 days after surgery, the first walk distance after surgery was significantly longer, the number of activities to get out of bed within 7 days postoperatively was significantly higher, and the number of patients requiring intravenous rescue analgesia after surgery was less in Y₁ and Y₂ groups(P<0.05).There were no statistically significant differences in preoperative and postoperative MMSE scores,and the incidence rate of postoperative adverse reactions among the three groups. Conclusions Iliofascial block with ropivacaine and methylene blue for postoperative pain relief after hip replacement is more effective than ropivacaine alone, and the analgesic time is longer, which is more conducive to the rapid recovery of postoperative hip joint function, and the analgesic effect of methylene blue shows dose-dependence with a certain extent.

Objective To explore the clinical effect of immediate implantation combined with osteotome sinus floor elevation (OSFE) without bone grafting at the posterior maxilla in the elderly patients with insufficient residual bone height (RBH < 5 mm) after tooth extraction. Methods A retrospective study was conducted on 40 elderly patients who underwent immediate implantation combined with OSFE at the posterior maxilla at Department of Implantology, Nantong Stomatological Hospital from June 2019 to June 2021, with a total of 40 implants. The patients were divided into no-bone-grafting group (20 implants) and bone-grafting group (20 implants). The implant survival rate, implant stability quotient (ISQ) immediately after surgery and 6 months after surgery, and the changes in RBH and bone volume at the implant neck 6, 12, and 24 months after surgery were compared between the two groups. Results Among the 40 implants, 39 were successful (97.5%), including 20 in the no-bone-grafting group (100.0%) and 19 in the bone-grafting group (95.0%), with no significant difference between the two groups (P>0.05). There was no significant difference in the ISQ value immediately after surgery and 6 months after surgery between the two groups (P>0.05). Both groups achieved effective sinus floor elevation. The bone height increase in the bone-grafting group was significantly greater than that in the no-bone-grafting group 6, 12, and 24 months after surgery (P<0.05). There was no significant difference in the bone volume at the implant neck 6, 12, and 24 months after surgery between the two groups (P>0.05). Conclusions For the elderly patients, immediate implantation combined with OSFE without bone graft has good clinical effect and meets the needs of elderly patients.

Objective To explore the current status of depression and its influencing factors among the elderly with cognitive frailty in the community. Methods A convenience sampling method was used to select elderly individuals with cognitive frailty from six communities in Beijing as the subjects of the study from July to December 2023. Montreal Cognitive Assessment (MoCA) combined with Fried frailty phenotype was used to assess cognitive frailty, and the geriatric depression scale (GDS-15) was used to assess depressive status. Basic information of the subjects including gender, age, marital status, education level, economic status, living situation, comorbidity, sleep quality, social support, nutritional status, activities of daily living and loneliness was recorded. Logistic regression analysis was used to analyze the influencing factors of depression in the community elderly with cognitive frailty. Results A total of 539 questionnaires were distributed and 529 valid questionnaires were collected, with an effective response rate of 98.15%. Among the 529 elderly individuals with cognitive frailty, 128(24.2%) presented with depression,and the average GDS-15 score was 3.4±2.0. Multiple logistic regression analysis showed that ability of daily living, sleep quality, and loneliness were independent influencing factors of depression in the community elderly with cognitive frailty. Conclusions The depressive status of the community elderly with cognitive frailty is not optimistic. Ability of daily living,sleep quality and loneliness are independent influencing factors for depression in the population.

Objective To investigate the status of nutrition and its relationship with major adverse cardiovascular events (MACEs) in the elderly patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI). Methods A total of 361 elderly patients with STEMI who underwent emergency PCI from 2018 to 2021 were consecutively enrolled. Nutritional Risk Screening 2002 (NRS-2002) was used to evaluate the risk of malnutrition (NRS-2002 ≥3 was defined as being at risk of malnutritional). The main study endpoint was the occurrence of MACEs within one year of follow-up,including all-cause death, recurrent myocardial infarction, stent thrombosis, and unplanned repeat revascularization. Cox regression analysis was used to investigate the influencing factors of MACEs. Results Among 361 patients, 108 patients (29.92%) had an NRS-2002 score of ≥3. After one year of follow-up, 21 cases (5.82%) were lost to follow-up, and a total of 66 patients presented with MACEs (66/340, 19.41%). The elderly STEMI patients with NRS-2002≥3 were more prone to MACEs than those with NRS-2002<3 (P<0.001). Multivariate Cox proportional hazards analysis showed that NRS-2002≥3 is an independent risk factor for MACEs in the elderly STEMI patients who underwent PCI (OR=2.868, 95%CI: 1.395-5.897, P=0.004). Conclusions The elderly patients with STEMI should pay attention to malnutrition.NRS-2002≥3 is an independent risk factor for poor prognosis in the elderly STEMI patients who underwent PCI.

Objective To investigate the safety and effectiveness of the combination therapy of sacubitril/valsartan and cyclic adenosine monophosphate in the elderly patients with heart failure with reduced ejection fraction (HFrEF). Methods A prospective, randomized, controlled study was conducted. A total of 213 elderly patients with HFrEF admitted to Department of Cardiovascular Medicine, Jianhu Hospital Affiliated to Xinglin College of Nantong University from February 2021 to February 2023 were enrolled in this study and divided into experimental group (106 cases) and control group (107 cases)using the random number table method. The experimental group received the combined treatment of sacubitril/valsartan and cyclic adenosine monophosphate, while the control group received sacubitril/valsartan treatment.Both groups were treated for 14 d. The levels of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), serum creatinine (SCr), aldosterone(ALD) and N-terminal pro-brain natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) cardiac function classification and 6-minute walk distance(6MWD) were compared between the two groups before and after treatment. A 6-month follow-up was conducted, and the occurrences of heart failure readmission, all-cause death, and major adverse cardiovascular events (MACE) were recorded and compared between the two groups. Results Before treatment, there were no significant differences in the clinical data between the two groups (P>0.05). After treatment, the levels of LVEDD, LVESD, SCr, ALD and NT-proBNP were significantly decreased, and the levels of LVEF, eGFR and 6MWD were significantly increased in both groups, especially in the experimental group(P<0.05).The NYHA grade were improved in both groups, especially in the experimental group (P<0.05). Compared with the control group, the incidence rates of MACE, heart failure rehospitalization and all-cause mortality were significantly lower in the experimental group (P<0.05) during the follow-up period. Conclusions The combination therapy of sacubitril/valsartan and cyclic adenosine monophosphate can significantly improve the cardiac function and prognosis in the elderly patients with HFrEF, reduce all-cause mortality, heart failure readmission rate and MACE incidence, which is a safe and effective therapeutic option.

Objective To analyze the predictive value of serum levels of peroxisome proliferator activated receptor gamma coactivator-1α (PGC-1α) and Omentin-1 for postoperative hip joint dysfunction in the elderly patients with intertrochanteric fractures of the femur (IFF). Methods A total of 114 elderly patients with IFF who underwent surgical treatment in the Orthopedics Department of Shijiazhuang Third Hospital from June 2017 to June 2023 were enrolled in this study. Based on an 8-month follow-up after surgery, the patients were divided into poor prognosis group (30 cases) and good prognosis group (84 cases). The serum levels of PGC-1α and Omentin-1 were measured by enzyme linked immunosorbent assay. Multiple logistic regression (step forward method) was applied to analyze the influencing factors of postoperative hip joint dysfunction in the elderly patients with IFF. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of PGC-1α and Omentin-1 for postoperative hip joint dysfunction in the elderly patients with IFF, and the area under the curve (AUC) was calculated. Results The serum levels of PGC-1α and Omentin-1 in poor prognosis group were significantly lower than those in good prognosis group (P<0.01). There were significant differences in age, preoperative AO classification between the two groups (P<0.05). Multivariable logistic regression analysis showed that preoperative AO classification,the levels of PGC-1α and Omentin-1 were independent influencing factors for postoperative hip joint dysfunction in the elderly patients with IFF. The AUC of serum PGC-1α combined with Omentin-1 in predicting postoperative hip joint dysfunction was 0.942 (95%CI: 0.899-0.984), which was superior to those of PGC-1α alone(AUC=0.825, Z=2.468, P=0.014) and Omentin-1 alone (AUC=0.819, Z=2.500, P=0.012). Conclusions Serum levels of PGC-1α and Omentin-1 are down-regulated in the elderly IFF patients with postoperative hip joint dysfunction. The combination of the two indicators can improve the predictive value for hip joint dysfunction and provide clinical reference for prognosis.

Objective To investigate the value of plasma calcitonin gene-related peptide (CGRP) for predicting morning blood pressure surge (MBPS) after medication in the elderly patients with primary hypertension. Methods A total of 112 elderly hospitalized patients with primary hypertension were enrolled in this study.According to the 24 h ambulatory blood pressure monitoring (ABPM) results after medication, the patients were divided into non-morning peak group (MBPS＜35 mmHg, 53 cases) and morning peak group (MBPS≥35 mmHg, 59 cases). In addition, 14 elderly patients with normal blood pressure were enrolled as control group. The clinical data were collected, and the plasma level of CGRP was detected and compared among the three groups. The related factors of MBPS≥35 mmHg after clinical medication in the elderly patients with primary hypertension were analyzed by binary logistic regression, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of plasma CGRP for MBPS≥35 mmHg. Results The levels of CGRP, clinic systolic blood pressure (SBP), 24-hour SBP (24hSBP), daytime SBP (dSBP), morning SBP and morning diastolic blood pressure (DBP) in morning peak group were significantly higher than those in control group and non-morning peak group (P＜0.05). And the prevalence of diabetes in morning peak group was significantly higher than that in non-morning peak group (P＜0.05). Binary logistic regression analysis showed that CGRP, morning SBP and 24hSBP were the independent influencing factors for MBPS≥35 mmHg after clinical medication in the elderly patients with primary hypertension (P＜0.05). ROC curve analysis showed that the area under the curve of CGRP combined with morning SBP, and 24hSBP for predicting MBPS≥35 mmHg after clinical medication in the elderly patients with primary hypertension was 0.819, and the cut-off value of CGRP was 89.52 pg/mL. Conclusions Plasma CGRP combined with morning SBP and 24hSBP can predict the occurrence of MBPS≥35 mmHg after clinical medication in the elderly patients with primary hypertension.

Objective To investigate the relationship between serum levels of galanin, alkaline phosphatase (ALP), S100β and cognitive dysfunction in the elderly patients with acute cerebral infarction (ACI) combineed with cerebral microbleeds (CMBs). Methods A total of 110 ACI patients with CMBs (CMBs group) and 136 ACI patients without CMBs (non-CMBs group) admitted to Department of Neurology of Cangzhou People’s Hospital from June 2020 to June 2024 were enrolled in this study. The ACI patients with CMBs were divided into cognitive impairment group (47 cases) and non-cognitive impairment group (63 cases) according to the presence of cognitive dysfunction. The level of serum ALP was measured by the p-nitrophenyl phosphate assay, and the serum levels of galanin and S100β were determined by enzyme-linked immunosorbent assay.The correlation between serum levels of galanin, ALP, S100β levels and cognitive function score were evaluated by Pearson coefficients, and the influencing factors of cognitive dysfunction in ACI patients with CMBs were analyzed by multivariate logistic regression. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of galanin, ALP and S100β for cognitive dysfunction in ACI patients with CMBs. Results The levels of galanin, ALP and S100β in CMBs group were higher than those in non-CMBs group (P<0.01). The levels of galanin, ALP and S100β in cognitive impairment group were higher than those in non-cognitive impairment group (P<0.01). The serum levels of galanin, ALP, S100β were negatively correlated with the scores of Montreal Cognitive Assessment and Mini-Mental State Examination in the cognitive impairment group (P<0.01). High score of National Institutes of Health Stroke Scale, and high levels of galanin, ALP and S100β were the risk factors for cognitive dysfunction in ACI patients with CMBs. The area under the curve (AUC) of galanin, ALP and S100β in diagnosing cognitive dysfunction in ACI patients with CMBs was 0.802, 0.773 and 0.762, respectively, and the AUC of combination of the three indicators was 0.948, which was higher than that of the single indicator (all P<0.05). Conclusions Serum levels of galanin, ALP and S100β are significantly increased in ACI patients with CMBs, and are related to cognitive dysfunction. The combination of the three indicators has high value in the diagnosis of cognitive dysfunction in ACI patients with CMBs.

Objective To investigate the expression of S-phase kinase-associated protein 2 (SKp2), P27Kip1, and human leukocyte antigen (HLA)-DRA protein in cancer tissues of elderly patients with colorectal cancer (CRC) and their relationship with prognosis. Methods From January 2019 to May 2021, 154 elderly CRC patients who were adimitted to Linxi Hospital of Kailuan General Hospital were enrolled in this study. Immunohistochemistry was applied to detect the expression of SKp2, P27Kip1, and HLA-DRA proteins in the cancer tissues and adjacent tissues of elderly CRC patients. Patients were followed up for 3 years, and Kaplan-Meier method was used to plot the survival curves of the patients with positive expression and negative expression of SKp2, P27Kip1 and HLA-DRA in the cancer tissue. Multivariate Cox regression was applied to analyze the influencing factors of prognosis in the elderly CRC patients. Results Compared with adjacent tissues, the positive expression rates of SKp2 and HLA-DRA proteins were higher, and the positive expression rate of P27Kip1 was lower in CRC cancer tissues (P<0.001). The expression of SKp2 and HLA-DRA in the elderly CRC patients was related to the degree of tumor differentiation in the cancer tissue (P<0.01), the expression of P27Kip1 was related to the maximum tumor diameter in the cancer tissue (P<0.05), and the expression of SKp2, P27Kip1, and HLA-DRA was related to TNM staging in the cancer tissue (P<0.01). During the 36-month follow-up, 5 cases were lost to follow-up, 97 patients survived (survival group), and 52 patients died (death group). Compared with the survival group, the proportions of poorly differentiated, TNM stage Ⅲ-Ⅳ, SKp2 positive expression, and HLA-DRA positive expression in the death group were significantly higher (P<0.05), while the proportion of P27Kip1 positive expression was significantly lower (P<0.01). The 3-year overall survival rate of the patients with SKp2 positive expression was lower than that of the patients with SKp2 negative expression (57.38% vs 84.38%, P<0.01); the 3-year overall survival rate of the patients with P27Kip1 positive expression was higher than that of the patients with P27Kip1 negative expression (77.55% vs 56.19%, P<0.01); the 3-year overall survival rate of the patients with positive expression of HLA-DRA was lower than that of the patients with negative expression (57.52% vs 78.05%, P<0.01). Multivariate Cox regression showed that low differentiation (HR=1.213), TNM stage Ⅲ-Ⅳ (HR=1.837), SKp2 positivity (HR=1.465), and HLA-DRA positivity (HR=1.224) were independent risk factors for poor prognosis in the elderly CRC patients, while P27Kip1 positivity (HR=0.952) was a protective factor. Conclusions The positive expression rates of SKp2 and HLA-DRA are high in the cancer tissues of elderly patients with CRC, while the positive expression rate of P27Kip1 is low. The expression of SKp2, P27Kip1 and HLA-DRA is closely related to the pathological characteristics and prognosis of the patients with CRC.

Objective To investigate the influencing factors of in-hospital death in the elderly patients with type 2 diabetes mellitus (T2DM) complicated with severe pneumonia (SP), and to establish a prediction model. Methods A retrospective observational study was conducted on 208 elderly patients with T2DM complicated with SP admitted to Intensive Care Unit of the Second Affiliated Hospital of Naval Medical University from May 2019 to May 2024. The patients were divided into death group and surviving group based on the 28-day survival status during hospitalization. Multivariate logistic regression analysis was used to determine the risk factors for in-hospital death in the elderly patients with T2DM complicated with SP and to construct a prediction model. Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of the model, and Hosmer-Lemeshow (H-L) test was used to evaluate the calibration of the model. Results Among 208 patients, 85 cases died within 28 days of admission (40.87%). The number of T2DM-related complications≥2, high levels of neutrophil-to-lymphocyte ratio (NLR), brain natriuretic peptide (BNP), blood lactic acid,and low level of partial pressure of oxygen (PaO₂)/fraction of inspired oxygen (FiO₂) ratio were the independent risk factors for in-hospital death in elderly patients with T2DM complicated with SP. The area under the curve of the prediction model constructed based on the five risk factors was 0.862, and the sensitivity and specificity were 87.06% and 83.74%, respectively. H-L test showed P=0.112. Conclusions The number of T2DM-related complications, PaO₂/FiO₂ ratio, NLR, BNP and blood lactic acid are influencing factors for in-hospital death in the elderly patients with T2DM complicated with SP. The in-hospital death prediction model for elderly patients with T2DM complicated with SP based on these factors has a high predictive value.

Objective To observe the effect of immediate weight-bearing and early ambulation for intertrochanteric fractures after InterTAN nail surgery. Methods From March 2023 to January 2024, a total of 61 patients diagnosed with Jensen type Ⅱ intertrochanteric fractures and postoperative reduction as positive medial cortical support (PMCS) after InterTAN nail surgery were randomly divided into control group (n=31) and experimental group (n=30). The control group was allowed to weight-bearing and ambulation as tolerated 6 weeks after surgery, while the experimental group was allowed to weight-bearing and ambulation within 48 hours after surgery. The length of stay, hospitalization costs, time of clinical fracture healing and the incidence rate of complications 3 months after surgery were recorded. Harris Hip Score(HHS) and Visual Analog Scale (VAS) were evaluated regularly 2 days and 3 months after surgery. Results During the treatment and follow-up stages, 3 patients dropped out from each group, resulting in a final total of 55 patients being included. There was no statistically significant difference in general information such as age, gender and body mass index between the two groups (P>0.05). There were no significant differences in VAS scores between the two groups 2 days and 3 months after surgery (P>0.05). Compared with the control group, the length of stay and time of clinical fracture healing were shorter, and hospitalization costs were lower in the experimental group, with significant differences (P<0.05). There was no statistically significant difference in HHS score between the two groups 2 days after surgery (P>0.05). HHS scores in both groups 3 months after surgery showed significant improvement compared to those 2 days after surgery (P<0.01), especially in the experimental group (P＜0.05). There were no significant differences in the incidence rate of complications between the two groups (17.9% vs 3.7%, χ²=2.833, P=0.092). Conclusions Immediate weight-bearing and early ambulation as tolerated within 48 hours for patients with Jensen type Ⅱ intertrochanteric fractures and postoperative reduction with PMCS after InterTAN nail surgery could shorten the length of stay, reduce hospitalization costs, promote fracture healing and recovery of hip function, without increasing postoperative pain and the failure rate of internal fixation.

Objective To investigate the risk factors for dysphagia in the elderly and to construct a dysphagia risk assessment model. Methods A total of 251 elderly people in 18 military cadre retirement centers in Chengdu were enrolled in this study. The Eating Assessment Tool (EAT-10) was used to evaluate the occurrence of swallowing disorders in the elderly, and comprehensive geriatric assessment including sarcopenia, Barthel index and nutritional risk screening were conducted. Logistic regression analysis was used to analyze the risk factors for dysphagia in the elderly, and a dysphagia risk assessment model was constructed. Results The prevalence rate of dysphagia in the enrolled elderly was 42.23% (95%CI:36.12%-48.34%). Multivariable logistic regression analysis showed that long term use of sedatives and hypnotics, history of coughing upon drinking water, and low Barthel index were the risk factors for dysphagia in the elderly. The area under the curve of the nomogram model constructed by the above risk factors was 0.796 (95%CI: 0.738-0.855). Bootstrap method was used for internal validation, with a C-index of 0.593 and an average absolute error of 0.020, indicating that the model had good discrimination and calibration. Conclusions Long term use of sedatives and hypnotics, history of coughing upon drinking water, and low Barthel index can increase the risk of swallowing disorders in the elderly. The dysphagia risk assessment model developed using the three risk factors has good predictive ability in the elderly.

Objective To investigate the etiology, clinical manifestations and prognosis of rhabdomyolysis (RM)in the elderly. Methods The clinical data of RM patients admitted to Jiangsu Province Hospital from July 2016 to October 2023 were retrospectively analyzed, and the patients were divided into the elderly group (≥60 years old, 54 cases) and the non-elderly group (<60 years old, 160 cases).The baseline characteristics, etiological distribution, clinical manifestations, incidence of acute kidney injury (AKI), and 30-day prognosis were compared between the two groups. Results There were no signicant differences in gender, and the levels of uric acid and potassium between the two groups (P>0.05), while the differences in the levels of creatine kinase, hemoglobin, blood urea, serum creatinine, and phosphorus were statistically significant (P<0.01 or P<0.05). The primary risk factors were different between the two groups. In the elderly group, the top three etiologic factors were infection (42.59%), other physical injuries (22.22%) and poisoning (12.96%), while in the non-elderly group, they were strenuous exercise (49.37%), infection (16.25%) and poisoning (10.62%), respectively. There were 32 patients (59.26%) presenting with at least one manifestation of the triad in the elderly group, which was lower than that in the non-elderly group (120 cases, 75.00%), and the difference was statistically significant (P=0.042). The proportion of patients presenting with fever in the elderly group was significantly higher than that in the non-elderly group (25.93% vs 7.50%, P<0.001). The incidence rate of AKI in the elderly group was significantly higher than that in the non-elderly group (59.26% vs 24.38%,P<0.001). A total of 11 patients died within 30 days of hospitalization, including 8 cases of AKI-related death in the elderly group and 1 case in the non-elderly group.Patients with RM and a poor prognosis were significantly associated with concomitant AKI (χ²=0.024,P<0.001), and the 30-day mortality rate of elderly patients with RM complicated with AKI was significantly higher than that of non-elderly patients (χ²=7.993, P=0.005). Conclusions Elderly RM patients differ from non-elderly RM patients in terms of etiology and clinical presentation, and elderly patients are less likely to present with the classic triad, but are more likely to have concomitant AKI and have a worse prognosis.

Frailty is a common geriatric syndrome that significantly affects the efficacy and safety of treatment in the patients with multiple myeloma. Screening for frailty is particularly important for the selection of treatment methods and the prediction of adverse event risks for multiple myeloma. This article summarizes the conceptual model and potential biomarkers of frailty, and frailty assessment tool for the patients with multiple myeloma, and analyzes the advantages, disadvantages and clinical application value of various assessment methods for multiple myeloma. It points out that frailty can be used as a predictor of risk in the patients with multiple myeloma. However, future studies still need to further refine the evaluation indicators of frailty in the patients with multiple myeloma, and to improve its application value for multiple myeloma.