Table of Content

20 July 2022, Volume 36 Issue 7 Previous Issue    Next Issue

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Relationship between frailty degree and intestinal microbiome in elderly patients with hypertension complicated with type 2 diabetes mellitus in community ZHANG Bing-shan, YU Jie, YANG Ying, WANG Zhuo, LU Shou-rong, LU Wen-wei, YU Zhi-ming, HONG Kan 2022, 36 (7):  663-669.  doi: 10.3969/j.issn.1003-9198.2022.07.005 Abstract ( 174 )   PDF (1698KB) ( 924 )   Save Objective To investigate the relationship between intestinal microbes and frailty degree in the elderly patients with hypertension complicated with type 2 diabetes mellitus (T2DM) in community. Methods A cross-sectional survey of 181 elderly residents with hypertension complicated with T2DM was conducted in Xin'an Community of Wuxi. According to the result of Fried Frailty Phenotype, the patients were divided into the control group (112 patients presenting with non-frailty), pre-frailty group (46 cases) and frailty group (23 cases). 16S high-throughput sequencing technology was used to detect the composition of intestinal microbiota, and the composition of intestinal microbiota were compared among the patients with different frailty degrees. Results The incidence rate of frailty and pre-frailty in the community elderly patients with hypertension complicated with T2DM was 12.7% and 25.4%, respectively. There were significant differences in age, course of diabetes, number of complications, varieties of medicine, the scores of Activity of Daily Living (ADL), mini-nutritional assessment short-form (MNA-SF), Montreal Cognitive Assessment (MoCA) and Social Support Rating Scale (SSRS), and the level of albumin between the control group and frailty group (P<0.05). Compared with the control group, the α diversity of intestinal microbe was not changed significantly in frailty group, but the β diversity was increased significantly (P<0.05). At the phylum level, the relative abundance of Actinobacteria increased, and the relative abundance of Fusobacteria decreased in frailty group compared with the control group (P<0.05). At the genus level, the abundance of Bifidobacteria and Lactobacillus increased, and the abundance of Adlercreutzia, Clostridium, Coprococcus, Faecalibacterium, Phascolarctobacterium, Roseburia and Turicibacter decreased in frailty group compared with the control group (all P<0.05); Compared with pre-frailty group, the abundance of Eggerthella in the control group decreased, the abundance of Lactobacillus in frailty group increased, and the abundance of Clostridium, Coprococcus and Eggerthella decreased in frailty group (P＜0.05 or P＜0.01); Other unclassified bacteria were significantly less in frailty group than those in pre-frailty group and the control group(P<0.05). Conclusions More than one eighth of the community elderly patients with hypertension complicated with T2DM present with frailty. The intestinal microbiome composition of the patients with frailty differs from that of the patients who don't have frailty. References | Related Articles | Metrics

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Effects of butylphthalide on NLRP3 and IBA-1 expression in substantia nigra striatum of mice with Parkinson's disease and depression YANG Hao-hui, LIU Bin, LI Bing-han, FAN Shao-kai, ZHANG Yan-shu 2022, 36 (7):  670-674.  doi: 10.3969/j.issn.1003-9198.2022.07.006 Abstract ( 191 )   PDF (1580KB) ( 1139 )   Save Objective To observe the effects of butylphthalide on depressive behavior and the expression of NOD-like receptor protein 3 (NLRP3) and ionised calcium binding adaptor molecule 1 (IBA-1) in the substantia nigra striatum of mice with Parkinson's disease (PD) and depression. Methods Forty male adult C57 mice were divided into normal control group (n=10) and model group (n=30). The model group was given intraperitoneal injection of MPTP first, and then given chronic unpredictable mild stress to construct the PD combined with depression model. Among the 30 model mice, 10 mice were not treated (PD with depression group), 10 mice were administered with metopar (6.25 mg/kg) for one week (metopar group), and the other 10 mice were administered with metopar (6.25 mg/kg) combined with butylphthalide (120 mg/kg) for one week ( metopar combined with butylphthalide group). The behavior of mice was evaluated by forced swimming test, tail hanging test and sugar water preference test. The expression of NLRP3 and IBA-1 in the substantia nigra striatum was detected by Western Blot. Immunofluorescence was used to observe the activation of microglia and the damage of dopamine neurons in the substantia nigra striatum. Results Compared with normal control group, the forced swimming rest time and tail suspension rest time in PD with depression group were prolonged, the preference rate of sugar water was decreased, and the expression of NLRP3 and IBA-1 was increased, with statistically significant differences (all P<0.05). Compared with PD with depression group, the forced swimming resting time and suspended tail resting time were shortened, the sugar water preference rate was increased, and the expression of NLRP3 and IBA-1 was decreased in metobar group and metobar combined with butylphthalide group, especially in metobar combined with butylphthalide group, with statistical differences (all P<0.05). Compared with normal control group, the number of abnormally activated microglia in PD with depression group was significantly increased, the cell body was enlarged and the axon was decreased; The number of dopamine neurons was decreased, and the cell body was atrophied. Compared with PD with depression group, the number of activated microglia was significantly decreased and the number of dopamine neurons was increased in tmedoba combined with butylphthalide group. Conclusions Butylphthalide can improve the depressive symptoms of PD mice with depression by inhibiting the activation of microglia and inflammatory bodies, and reducing the inflammatory response. References | Related Articles | Metrics

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Correlation between frailty status at discharge and unplanned readmission within 90 days in elderly survivor from sepsis CHEN Yu-lin, LI Fen, XING Bo 2022, 36 (7):  675-679.  doi: 10.3969/j.issn.1003-9198.2022.07.007 Abstract ( 152 )   PDF (1129KB) ( 900 )   Save Objective To investigate the correlation between different frailty status at discharge and unplanned readmission within 90 days after discharge in the elderly survivors from sepsis. Methods A total of 331 elderly survivors from sepsis admitted to the Second Affiliated Hospital of Hainan Medical University from January 2020 to June 2021 were enrolled as the prospective follow-up cohort. The follow-up was carried out consecutively for 90 days, and the observation ended at the first unplanned readmission or completion of follow-up. Based on whether unplanned readmission occurred within 90 days after discharge, the elderly survivors from sepsis were divided into readmission group (n=107) and non-readmission group (n=224). According to the frailty status at discharge, the elderly patients were divided into non-frailty group (n=150), pre-frailty group (n=141) and frailty group (n=40). The clinical data of all the patients were collected. Univariate analysis, Kaplan-Meier curve analysis, multivariate Cox risk proportional regression were used to explore the correlation between frailty status at discharge and unplanned readmission within 90 days after discharge. Results The age, body mass index (BMI), Sequential Organ Failure Assessment (SOFA) score, and the proportion of cerebrovascular disease, pre-frailty and frailty in readmission group were significantly higher than those in non-readmission group (P＜0.05). The accumulated incidence of unplanned readmission within 90 days after discharge increased with the increase of frailty status in the elderly survivors from sepsis (Ptrend<0.001). Kaplan-Meier curve analysis showed that the difference of accumulated incidence of unplanned readmission within 90 days after discharge were statistically significant among the patients with different frailty status (χ2=80.800, P<0.001). Taking the non-frail group as the reference, multivariate Cox risk proportional regression showed that after adjusting for age and other related indicators, pre-frailty (HR=2.008, 95%CI:1.225-3.291, P<0.05) and frailty (HR=6.419, 95%CI:3.416-12.061, P<0.05) were the influencing factors of unplanned readmission within 90 days after discharge in the elderly survivors from sepsis. Conclusions The frailty status shows significant influence on unplanned readmission within 90 days after discharge in the elderly survivors from sepsis at a degree-dependent manner. References | Related Articles | Metrics

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Study on the efficacy of ipratropium bromide combined with low molecular weight heparin calcium in elderly patients with chronic obstructive pulmonary disease and pulmonary heart disease MA Xiao-yu, LI Peng-fei, TAI Na, ZHAO Yue, SU Jie-xue, AN Fu-cheng, SUO Shuang 2022, 36 (7):  680-683.  doi: 10.3969/j.issn.1003-9198.2022.07.008 Abstract ( 159 )   PDF (1044KB) ( 1010 )   Save Objective To investigate the effects of ipratropium bromide combined with low molecular weight heparin calcium on the cardiac function, pulmonary function and myocardial enzymogram in the elderly patients with chronic obstructive pulmonary disease (COPD) combined with pulmonary heart disease (PHD). Methods A total of 80 patients with COPD combined with PHD admitted to our hospital from January 2019 to July 2020 were prospectively enrolled, and were divided into control group and study group by random number table method, with 40 cases in each group. The control group was treated with ipratropium bromide, while the study group was treated with ipratropium bromide combined with low molecular weight heparin calcium. The heart function, lung function, serum levels of creatine kinase (CK) and CK-MB of the two groups were compared before and after treatment. The effective rate and the incidence rate of adverse reactions were observed and compared between the two groups. Results The effective rate of the study group was significantly higher than that of the control group (97.50% vs 77.5%, χ2=7.314, P<0.01). After treatment, the levels of end-diastolic ventricular volume (EDV), end-systolic ventricular volume (ESV), CK and CK-MB in both groups were significant lower, and the levels of right ventricular ejection fraction (RVEF), forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC), FVC and peak expiratory flow (PEF) in both groups were significantly higher than those before treatment, especially in the study group (P＜0.05). There was no significant difference in the incidence rate of adverse reactions between the two groups (χ2=0.220, P=0.823). Conclusions Ipratropium bromide combined with low molecular weight heparin calcium is effective in the treatment of the elderly patients with COPD and PHD, which can improve their heart function and lung function, and significantly reduce the levels of CK and CK-MB. References | Related Articles | Metrics

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Associations of angiotensin Ⅱ level with cognitive function and medial temporal atrophy in elderly WANG Bian-rong, ZHENG Hui-fen, XU Chang, ZHANG He-di, HUANG Dan-qing, TIAN Qi, CHEN Chun-miao 2022, 36 (7):  684-687.  doi: 10.3969/j.issn.1003-9198.2022.07.009 Abstract ( 166 )   PDF (1051KB) ( 982 )   Save Objective To investigate the associations of angiotensin Ⅱ (AngⅡ) level with cognitive function and medial temporal atrophy (MTA) in the elderly. Methods Forty elderly patients with Alzheimer's disease (AD group) and 40 elderly with normal cognitive function (control group) were enrolled. All the subjects were evaluated by Chinese version of Addenbrooke's Cognitive Examination Ⅲ (ACE-Ⅲ), Mini-Mental State Examination (MMSE) and Activities of Daily Living Scale (ADL), and 24-hour blood pressure was measured. All the subjects were rated by medial temporal atrophy (MTA) scale on MRI. The level of AngⅡ was measured by enzyme-linked immunosorbent assay. Pearson correlation analysis was performed to evaluate the associations of AngⅡ level with cognitive function and MTA. Results The age, AngⅡ level, MTA score were significantly higher, and the scores of MMSE, ACE-Ⅲ and ADL were significantly lower in the AD group than those in the control group (P<0.05). There were no significant differences in the levels of systolic blood pressure and diastolic blood pressure between the two groups (P>0.05). The level of AngⅡ was not related to the scores of MMSE, ACE-Ⅲ and ADL (P<0.05), but positively correlated with MTA (r=0.228, P<0.05), and further study showed the correlation was not mediated by blood pressure. Conclusions The level of AngⅡ in the elderly patients with AD is higher than that in the normal elderly, and the increased level of AngⅡ is associated with MTA. References | Related Articles | Metrics

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Application of three assessment scales in screening for frailty in elderly outpatients YANG Cun-mei, HU Yi-xin, SHU Gang-ming, MA Hong-ying, ZHOU Ying, WANG Yi-dan, Jin Nan-nan 2022, 36 (7):  688-692.  doi: 10.3969/j.issn.1003-9198.2022.07.010 Abstract ( 220 )   PDF (1061KB) ( 1566 )   Save Objective To compare the consistency and applicability of FRAIL scale, Fried frailty phenotype (FP) and Short Physical Performance Battery (SPPB) in the screening of frailty in the elderly outpatients. Methods The elderly outpatients in the elderly frailty and cognitive management clinic of Chinese PLA General Hospital from October 2020 to May 2021 were selected as the subjects. FRAIL scale, FP and SPPB were used to screen the frailty among the patients, respectively. The Kappa value was calculated to evaluate the consistency of the three scales. The patient's ability of daily living was used as the evaluation standard, and the validity and applicability of the three scales was evaulated by receiver operating characteristic (ROC) curve and Bayes discriminant analysis, respectively. Results There were 218 patients undergoing the evaluation, and 188 cases were effective, with an effective evaluation rate of 86.23%. Among the three scales, the proportion of frailty patients screened by FP was the highest (17.55%), followed by SPPB (15.96%), and FRAIL scale (14.36%); The proportion of pre-frailty patients screened by FP was the highest (58.98%), followed by FRAIL scale (52.66%), and SPPB (25.00%). The Kappa value of FRAIL scale vs FP, FRAIL scale vs SPPB, FP vs SPPB was 0.565, 0.401 and 0.447, respectively (all P<0.001). ROC curve analysis showed that the area under the curve (AUC) of FRAIL scale, FP and SPPB in predicting the decline of ability of daily living in the elderly outpatients was 0.717, 0.728 and 0.786, respectively (all P<0.001); Bayes discriminant analysis showed that the cross-verification accuracy rate of FRAIL scale, FP and SPPB was 57.4%, 75.0% and 76.7%, respectively. Conclusions FRAIL scale, FP and SPPB are moderately consistent in the screening results of frailty among the elderly outpatients. Among the three assessment scales, FP is more suitable for screening the frailty and pre-frailty of the elderly outpatients, and FP and SPPB have a good predictive effect on the decline of ability of daily living in the elderly outpatients. References | Related Articles | Metrics

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Value of red blood cell distribution width and neutrophil/lymphocyte ratio in predicting the poor prognosis of elderly patients with type 2 diabetes mellitus LI Chun-hui, CHENG Jing, PENG Shuang, YAN Xiao-hong 2022, 36 (7):  693-696.  doi: 10.3969/j.issn.1003-9198.2022.07.011 Abstract ( 134 )   PDF (1097KB) ( 792 )   Save Objective To explore the predictive value of red blood cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) on the poor prognosis of elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 316 elderly patients with T2DM in our hospital from January 2015 to January 2018 were enrolled. All patients were followed up by telephone to record whether all-cause deaths occurred. According to the follow-up results, the patients were divided into death group and survival group, and the general data of the two groups were compared. Pearson correlation coefficient was used to describe the correlation of RDW and NLR with other laboratory indicators. Receiver operating characteristic (ROC) curve was drawn to analyze the value of RDW and NLR in predicting the all-cause mortality risk of the elderly T2DM patients. According to the cut-off value of the ROC curve, the preditive value of RDW and NLR for the complications of elderly patients with T2DM was analyzed. Results The follow-up time of this study was 46.22±11.48 months, and 303 patients were enrolled in this study. There were 71 cases occurring all-cause deaths. There were no significant differences in age, gender, body mass index, and duration of diabetes between the two groups (P>0.05). There were statistically significant differences in the levels of fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), albumin (ALB), creatinine (Cr), RDW and NLR between the two groups (P<0.05). Pearson correlation analysis showed that RDW and NLR were positively correlated with FPG, HbA1c and Cr, but negatively correlated with ALB (P<0.05). ROC curve analysis showed the area under the curve of RDW, NLR alone and combination of the two indicators for predicting the risk of all-cause mortality in the elderly T2DM patients was 0.795 (sensitivity: 78.87%; specificity: 68.10%; cut-off value: 13.2%), 0.838 (sensitivity: 88.73%; specificity: 64.66%; cut-off value: 6.13%) and 0.903 (sensitivity: 81.69%; specificity: 85.78%). Compared with the patients with RDW≤13.2% and NLR≤6.13%, the patients with RDW>13.2% and NLR>6.13% were prone to presenting with diabetic nephropathy, diabetic retinopathy, diabetic foot and diabetic neuropathy (P<0.01). Conclusions RDW and NLR can be used as independent predictors of all-cause mortality in the elderly patients with T2DM, and the combination of the two indicators has higher predictive value. Elderly T2DM patients with elevated levels of RDW and NLR are more prone to presenting with the complications of diabetes. References | Related Articles | Metrics

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Value of HER2, Cyr61 and IGFBP3 expression in predicting the prognosis in elderly patients with endometrial cancer LI Jiang-pei, KONG Xiang-bo, SUN Yin, LI Zhan-qing 2022, 36 (7):  697-701.  doi: 10.3969/j.issn.1003-9198.2022.07.012 Abstract ( 167 )   PDF (1063KB) ( 836 )   Save Objective To investigate the expression of human epidermal growth factor receptor 2 (HER2), cysteine-rich 61 (Cyr61) and insulin-like growth factor binding protein 3 (IGFBP3) and the value in predicting the prognosis of the elderly patients with endometrial cancer. Methods From January 2015 to January 2017, 124 elderly patients with endometrial cancer admitted to Department of Obstetrics and Gynecology of our hospital were selected as endometrial cancer group, 120 elderly patients with benign uterine lesions selected as benign lesion group, and 120 elderly women undergoing physical examination in the same period selected as the control group. The expression of HER2, Cyr61 and IGFBP3 among the three groups were detected by immunohistology. The patients with endometrial cancer were followed up for 5 years. Results In the control group, benign lesion group and endometrial cancer group, the positive expression rate of HER2 was 7.5%, 18.3% and 69.4%, respectively; The positive expression rate of Cyr61 was 10.0%, 12.5% and 76.6%, respectively; The positive expression rate of IGFBP3 was 59.2%, 51.7% and 29.0%, respectively, with significant differences among the three groups(P＜0.01). The positive expression of HER2 was correlated with age, pathological stage, tissue differentiation, lymph node metastasis, depth of muscle layer invasion and pathological type (all P<0.05). The positive expression of Cyr61 was correlated with pathological stage, lymph node metastasis, depth of muscle layer invasion and pathological type (all P<0.05). The positive expression of IGFBP3 was correlated with lymph node metastasis, depth of muscule layer invasion and pathological type (all P<0.05). The 5-year survival rates of the patients with negative expression of HER2 and Cyr61 were higher than those in the patients with positive expression, and the 5-year survival rate of the patients with positive expression of IGFBP3 was higher than that in the paitents with negative expression. Conclusions The abnormal expression of HER2, Cyr61 and IGFBP3 in the elderly patients with endometrial cancer is closely related to lymph node metastasis, depth of muscle layer invasion, pathological type and the prognosis. References | Related Articles | Metrics

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Analysis of influencing factors of postoperative delirium in elderly patients with anemia after laparoscopic hysterectomy JI Wei-wei, LIU Wei, RAO Li-hua, MIAO Min, CHEN Bin, HU Bei 2022, 36 (7):  702-705.  doi: 10.3969/j.issn.1003-9198.2022.07.013 Abstract ( 155 )   PDF (1038KB) ( 990 )   Save Objective To investigate the incidence and the influencing factors of postoperative delirium (POD) in the elderly patients with hemoglobin of 70-110 g/L who underwent laparoscopic hysterectomy. Methods A total of 297 elderly patients with preoperative hemoglobin of 70-110 g/L receiving laparoscopic hysterectomy under general anesthesia in our hospital from January 2019 to May 2021 were enrolled. The incidence of POD in the patients within 7 days after operation was observed and its influencing factors were analyzed. Results Among the 297 patients, 76 patients presented with POD after operation, and the incidence rate of POD was 25.59%. Multivariate Logistic regression analysis showed that aged ≥70 years old, combined intravenous and inhaled anesthesia, preoperative hemoglobin ranging 70-89 g/L, carbon dioxide (CO2) pneumoperitoneum time > 90 min, no application of dexmedetomidine during operation, oxygen saturation (SpO2) ≤ 95% within 6 hours after operation and postoperative visual analogue score (VAS) > 3 were the independent risk factors of POD in the elderly patients with hemoglobin of 70-110 g/L who underwent laparoscopic hysterectomy. Conclusions The incidence of POD in the elderly patients with hemoglobin of 70-110 g/L receiving laparoscopic hysterectomy under general anesthesia is high, which is closely related to the patient's age, anesthesia mode, preoperative hemoglobin level, intraoperative CO2 pneumoperitoneum time, postoperative SpO2, postoperative pain and intraoperative use of dexmedetomidine. References | Related Articles | Metrics

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Effect of pelvic girdle control combined with lower limb rehabilitation robot assistance on balance function and walking efficiency in elderly stroke patients with hemiplegia WANG Xiao-ling, MA Ying, HUA Yong-ping, HU Yong-lin, HUANG Yang, XIAO Yu-hua 2022, 36 (7):  706-709.  doi: 10.3969/j.issn.1003-9198.2022.07.014 Abstract ( 146 )   PDF (1094KB) ( 1128 )   Save Objective To explore the effect of pelvic girdle control combined with lower limb rehabilitation robot assistance on the balance function and walking efficiency in the elderly stroke patients with hemiplegia. Methods A total of 80 elderly stroke patients with hemiplegia who were admitted to our hospital from January 2017 to January 2021 were selected and divided into the control group and the experimental group according to random number table, with 40 cases in each group. The control group received routine rehabilitation training and pelvic girdle control training, while the experimental group received lower limb rehabilitation robot-assisted training on the basis of the control group. Both groups received continuous training for 12 weeks. Before and after treatment, the balance function, coordination function, lower extremity motor function, walking efficiency and activities of daily living of the two groups were evaluated. Results Compared with those before treatment, the scores of Berg balance scale (BBS), balance and non-balance coordination test, simplified Fugl-Meyer Assessment (FMA), modified Barthel index (MBI) and integrated electromyogram (iEMG) of tibia anterior muscle surface were significantly increased in both groups (P<0.01), and especially in the experimental group (P<0.01). After treatment, the proportion of functional walking classification (FAC)≥3 grades in the experimental group was significantly higher than that in the control group (P=0.045), and the maximum walking speed of 10 m was significantly faster than that in the control group (P<0.01). Conclusions Pelvic girdle control combined with lower limb rehabilitation robot-assisted training can improve the balance function, walking efficiency, coordination function, lower limb motor function and activities of daily living of the elderly stroke patients with hemiplegia. References | Related Articles | Metrics

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Effect of two extracapsular cataract extraction methods on patients with hard nucleus cataract and low corneal endothelial cell density XU Yan, ZHAO Yun-nan, CHEN Dong-mei, QIN Jia-yin 2022, 36 (7):  710-714.  doi: 10.3969/j.issn.1003-9198.2022.07.015 Abstract ( 144 )   PDF (1067KB) ( 786 )   Save Objective To observe the efficacy and safety of extracapsular cataract extraction with double incision or single incision in the elderly patients with hard nucleus cataract and low corneal endothelial cell density. Methods From January 2017 to March 2020, 65 elderly patients (65 eyes) with hard nucleus cataract and low corneal endothelial cell density were enrolled in our hospital. They were divided into two groups according to surgical methods. Group A (33 patients, 33 eyes) underwent double incision extracapsular cataract surgery. Group B(32 patients, 32 eyes) underwent single incision extracapsular cataract surgery. The intraoperative maintenance of anterior chamber in both groups was observed. All the patients were followed up for 6 months, and the best corrected visual acuity (BCVA), the density of corneal endothelial cell, central corneal thickness (CCT) and the degree of corneal astigmatism were compared between the two groups. Results The anterior chamber of group A was more stable than that of group B at irrigating-aspirating (P<0.05). There was no difference in operation time between the two groups. One day after operation, there was significant difference in the proportion of patients with BCVA≥0.5 between the two groups (χ2=4.481, P=0.034), but there were no significant differences in visual acuity between the two groups 1 week, 1 month and 3 months after operation. Six months after operation, there were significant differences in the density of corneal endothelial cell and the rate of corneal endothelial cell loss between the two groups (P<0.05). The level of CCT of both groups 1 day after operation was significantly higher than that before operation (P<0.05), but there were no significant differences in CCT between the two groups at each observation point after operation. There were no significant differences in postoperative astigmatism degree and surgical-induced astigmatism degree between the two groups at each observation point. Conclusions Compared with single incision extracapsular cataract surgery, double incision extracapsular cataract surgery has less corneal injury and faster postoperative visual acuity recovery in the patients with hard nucleus cataract and low corneal endothelial density. References | Related Articles | Metrics

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Effect of load deep breathing rehabilitation training on cardiopulmonary function and quality of life in elderly patients with chronic obstructive pulmonary disease at remission stage YANG Cheng, SUN Xiao-jing, ZHANG Zhen-ying, ZHANG Liu, XU Zhi-ping, WANG Li-zhong 2022, 36 (7):  715-719.  doi: 10.3969/j.issn.1003-9198.2022.07.016 Abstract ( 224 )   PDF (1060KB) ( 1151 )   Save Objective To investigate the effect of load deep breathing rehabilitation training on cardiopulmonary function and quality of life in the elderly patients with chronic obstructive pulmonary disease (COPD) at remission stage. Methods A total of 82 elderly patients with COPD at remission stage from July 2017 to June 2020 in our hospital were selected, and they were divided into observation group and control group by random number table method, with 41 patients in each group. The control group received routine treatment, and the observation group was given load deep breathing rehabilitation training on the basis of the control group. The pulmonary function indexes [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, oxygen saturation (SaO2)], cardiac function indexes [stroke volume (SV), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD)], St. George's Respiratory Questionnaire (SGRQ) scores and the result of 6-minute walk test (6MWT) were compared between the two groups before and after treatment. Results Compared with the control group, the levels of FVC, FEV1, FEV1/FVC, SaO2, SV and LVEF were higher, and the levels of LVEDD and LVESD were lower in the observation group after 3 months of treatment (P<0.05). Compared with the control group, the SGRQ scores of the observation group 1, 2, 3 and 4 months after treatment were significantly decreased (P<0.05) at a time-dependent manner. After 3 months of treatment, the 6 minutes walk distance of the observation group was significantly longer than that of the control group (P<0.05). Conclusions Load deep breathing rehabilitation training shows a value in improving the cardiopulmonary function in the elderly patients with COPD at remission stage, which could improve the quality of life and the exercise performance of the patients. References | Related Articles | Metrics

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Effect of intraspinal anesthesia on postoperative cognitive function and NLRP3 inflammasome in elderly patients undergoing hip replacement ZHANG Chun-li, XU Zhi-xin, HUANG Yu-yuan, CHEN Ding-zhong 2022, 36 (7):  720-724.  doi: 10.3969/j.issn.1003-9198.2022.07.017 Abstract ( 154 )   PDF (1068KB) ( 982 )   Save Objective To explore the effects of intraspinal anesthesia on the postoperative cognitive function, nucleotidebinding oligomerization domain-like receptor protein 3 (NLRP3) inflammasomes in the elderly patients undergoing hip replacement surgery. Methods A total of 115 elderly patients who underwent elective hip replacement surgery in our hospital from September 2018 to April 2021 were selected. All the patients underwent intraspinal anesthesia. The Mini-mental State Examination (MMSE) was used to evaluate the cognitive function of the patients before and 3 days after operation. According to the occurrence of postoperative cognitive impairment, the patients were divided into cognitive impairment group and non-cognitive impairment group.The risk factors of postoperative cognitive impairment were analyzed by multivariate Logistic regression analysis. The expressions of serum NLRP3 mRNA and cysteine-containing aspartate proteolytic enzyme 1 (Caspase-1) mRNA, and the levels of interleukin (IL)-1β and IL-8 of the two groups were compared before and 3 days after operation. The correlations of MMSE score with the expressions of NLRP3 mRNA and Caspase-1 mRNA and the levels of IL-1β and IL-8 were described by Pearson correlation coefficient. Results The postoperative MMSE score of the patients was significantly lower than that before operation (22.01±3.62 vs 27.45±1.01, P<0.001). The incidence rate of postoperative cognitive impairment was 30.43% (35/115). Multivariate Logistic regression analysis showed that age≥68 years old, diabetes and hypotension during the operation were the risk factors for postoperative cognitive impairment, and education years≥7 years was the protective factor for postoperative cognitive impairment. After operation,the expressions of serum NLRP3 mRNA and Caspase-1 mRNA, and the levels of IL-1β and IL-8 in cognitive impairment group were higher than those before operation and those in non-cognitive impairment group (P＜0.05). In non-cognitive impairment group, there were no statistically significant differences in the levels of the above indicators before and after operation (P>0.05). Pearson correlation analysis showed that postoperative MMSE score was negatively correlated with the expressions of serum NLRP3 mRNA and Caspase-1 mRNA and the levels of IL-1β and IL-8 (r=-0.601, -0.652, -0.501, -0.519, all P<0.05). Conclusions Intraspinal anesthesia has a certain influence on postoperative cognitive function of the elderly patients undergoing hip replacement surgery. The levels of NLRP3 inflammasome indexes in the patients with cognitive impairment after surgery are significantly increased, and the NLRP3 inflammasome-IL-1β signal axis may be involved in the occurrence of postoperative cognitive impairment. References | Related Articles | Metrics

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Value of relative skeletal muscle mass index in predicting bone fracture of elderly patients undergoing maintenance hemodialysis YU Xue-xue, YANG Zhao, SHANG Si-yu, HOU Meng, LI Sha 2022, 36 (7):  725-728.  doi: 10.3969/j.issn.1003-9198.2022.07.018 Abstract ( 156 )   PDF (1048KB) ( 798 )   Save Objective To investigate the predictive value of relative skeletal muscle mass index (RSMI) for bone fracture in the elderly patients undergoing maintenance hemodialysis. Methods A total of 163 elderly patients with maintenance hemodialysis treated in our hospital from April 2018 to January 2021 were selected as the subjects. The clinical data of the patients were collected within 24 hours after admission. The levels of serum parathyroid hormone (iPTH), albumin (ALB) and appendicular skeletal muscle mass (ASMM) were measured, and RSMI was calculated according to ASMM. All the patients were followed up for 12 months, and they were divided into fracture group and non-fracture group according to whether they suffered from non-external traumatic bone fracture. The influencing factors of bone fracture in the elderly patients undergoing maintenance hemodialysis were analyzed by multivariate Logistic regression. The receiver operating characteristic (ROC) curve was drawn to analyze the value of RSMI in predicting the bone fracture of the patients. Results No patient was lost to follow-up. During the follow-up period, 21 patients (12.88%) presented with bone fracture. There were no significant differences in gender, age, body mass index, smoking history, drinking history, duration of hemodialysis, T score of bone mineral density, and the proportion of the patients with hypertension between the two groups (P>0.05). There were significant differences in the proportion of patients with diabetes, the levels of RSMI, serum ALB and iPTH between the two groups (P<0.05). Multivariate Logistic regression analysis showed that diabetes, low levels of RSMI and serum ALB, iPTH＜150 ng/L were the independent risk factors of bone fracture in the elderly patients undergoing maintenance hemodialysis. ROC curve analysis showed that the sensitivity of RSMI in predicting the bone fracture of the elderly patients undergoing maintenance hemodialysis was 71.43%, the specificity was 78.87%, the area under the curve was 0.802 (95%CI: 0.697-0.907), and the cut-off value was 6.44. Conclusions RSMI can effectively predict the risk of bone fracture in the elderly patients undergoing maintenance hemodialysis. RSMI should be closely monitored regularly in clinical treatment. References | Related Articles | Metrics

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Analysis of risk factors for pressure injury in emergency elderly patients ZHANG Li, ZHAO Qing, LI Jin-lin 2022, 36 (7):  741-744.  doi: 10.3969/j.issn.1003-9198.2022.07.022 Abstract ( 147 )   PDF (1065KB) ( 920 )   Save Objective To explore the risk factors of pressure injury in the emergency elderly patients, and to provide the guidance for taking preventive nursing measures. Methods A total of 90 elderly patients admitted to the Emergency Department of Nanjing Meishan Hospital from June 2020 to May 2021 were enrolled in this study. The demographic data, comorbidities and biochemical results of the patients were collected. The risk of pressure injury in the emergency elderly patients was assessed by Braden scale, and the occurrence of pressure injury was observed daily until the patients left the Emergency Department. The risk factors of pressure injury in the emergency elderly patients were analyzed by binary Logistic regression. Results There were 15 patients presenting with pressure injury, with an incidence rate of 16.67%. There were statistically significant differences in the time of emergency admission, albumin level, Braden scale total score, nutritional status score, friction and shear force score between the occurrence group and the non-occurrence group (P<0.05). Multivariate Logistic regression analysis showed that low Braden scale total score and low albumin level were the risk factors of pressure injury in the emergency elderly patients. Conclusions Emergency nurses should timely monitor the level of albumin in the elderly patients, and take targeted preventive nursing measures according to the score of Braden scale, so as to reduce the incidence of pressure injury in the emergency elderly patients. References | Related Articles | Metrics