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20 August 2023, Volume 37 Issue 8 Previous Issue    Next Issue

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Value of soluble podoplanin in early diagnosis, severity and prognosis assessment for elderly patients with septic lung injury HENG Jun-feng, ZHENG Kai-ming, WU Ding-ye 2023, 37 (8):  767-771.  doi: 10.3969/j.issn.1003-9198.2023.08.004 Abstract ( 115 )   PDF (1037KB) ( 871 )   Save Objective To study the clinical value of plasma soluble podoplanin(sPDPN) in the early diagnosis, severity and prognosis evaluation for the elderly patients with septic lung injury. Methods A total of 95 elderly patients with sepsis admitted to Department of ICU, Wuxi People's Hospital from January 2018 to December 2020 were selected and divided into sepsis group(n=40) and septic lung injury group(n=55). The patients in the septic lung injury group were subdivided into sepsis combined with acute respiratory distress syndrome(ARDS) subgroup(n=29) and septic shock combined with ARDS subgroup(n=26) according to the severity of the complications, and were subdivided into survival subgroup(n=40) and death subgroup(n=15) according to the 28-d outcome. Thirty healthy subjects from physical examination center of our hospital during the same period were enrolled in control group. The general condition, APACHE Ⅱ score, SOFA score and extravascular lung water(EVLW) were observed and recorded, and the levels of C-reactive protein(CRP), procalcitonin(PCT), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and sPDPN were detected on the day of admission to ICU. Results The expression level of sPDPN, the levels of CRP, PCT, IL-6 and TNF-α, SOFA score and APACHE Ⅱ score showed statistical differences among all the groups and subgroups(P<0.05). The level of sPDPN was positively correlated with the above inflammatory indexes, EVLW, SOFA score and APACHE Ⅱ score in each group. The area under the curve(AUC) of receiver operator characteristic(ROC) of sPDPN in predicting the outcome of the septic lung injuny patients was 0.867. Conclusions sPDPN is a potentially valuable target for early diagnosis, evaluation of disease condition and prognosis, and selection of possible therapeutic targets in the patients with sepsis combined with acute lung injury. References | Related Articles | Metrics

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Establishment of prediction model of unplanned readmission within 30 days after discharge in elderly patients receiving total knee arthroplasty CHEN Xiang-yu, LI Kai, WANG Xu, YIN Jun-xiang, XU Kui-xin, LI Jian-xing, YAN Lian-qi 2023, 37 (8):  772-776.  doi: 10.3969/j.issn.1003-9198.2023.08.005 Abstract ( 119 )   PDF (1377KB) ( 782 )   Save Objective To explore the risk factors affecting early unplanned readmissions in the elderly patients undergoing total knee arthroplasty(TKA), and to construct a clinical prediction model in the form of nomogram. Methods A retrospective study was conducted to collect 919 elderly patients who underwent TKA for primary knee osteoarthritis at Northern Jiangsu People's Hospital from January 2020 to April 2022. All patients were divided into readmission group and control group according to whether they were readmitted within 30 days after discharge. Multivariate Logistic regression analysis was performed to screen the risk factors of readmission. And the risk factors were used to construct a clinical prediction model in the form of nomogram, and receiver operator characteristic(ROC) curve was plotted to evaluate the performance of the nomogram. Results The incidence rate of unplanned readmission within 30 days after discharge was 5.11%(47/919) in the elderly patients with TKA. Binary Logistic regression analysis showed age, body mass index(BMI), literacy, payment type, age-adjusted Charlson comorbidity index(AACI), operation time, intraoperative bleeding, and discharge destination were the independent risk factors for unplanned readmission within 30 days after discharge in the elderly patients with TKA, and a clinical prediction model was established in the form of a nomogram. The area under the ROC curve of the nomogram was 0.834(95%CI: 0.776-0.892), with a specificity of 78.7%, and a sensitivity of 78.0%. Conclusions The nomogram established in this study has good predictive efficacy for the readmission risk in the elderly patients with TKA. References | Related Articles | Metrics

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Association of five-times sit-to-stand test with cardiac function and quality of life in elderly patients undergoing PCI BAI Xiao-yu, ZHANG Jun, ZHAO Peng, WEI Mei, QIU Ya-hui, FENG Xue-juan 2023, 37 (8):  777-780.  doi: 10.3969/j.issn.1003-9198.2023.08.006 Abstract ( 90 )   PDF (1011KB) ( 628 )   Save Objective To investigate whether five-times sit-to-stand test (FTSST) can be used as a predictor of cardiac function and quality of life (QoL) in the elderly patients after percutaneous coronary intervention (PCI). Methods A total of 143 elderly patients aged 65-80 years who underwent PCI were enrolled in the study. The changes of FTSST time and cardiac function before and after PCI were observed, and the score of QoL was recorded before and 3 months after PCI. Results After PCI, FTSST time was significantly reduced, and QoL score was significantly improved after 3 months of follow-up. There were no significant differences in the levels of LVEF and NT-ProBNP before and after PCI. FTSST time was positively correlated with QoL score after PCI. After adjusting other factors, FTSST time after PCI was independently associated with improved QoL 3 months after PCI. Conclusions FTSST can be used as a simple predictor of QoL in the elderly patients after PCI. References | Related Articles | Metrics

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Analysis of influencing factors of tricuspid regurgitation after pacemaker implantation in elderly patients LU Miao, LU Xiao-wei, WANG Ying-ying 2023, 37 (8):  781-784.  doi: 10.3969/j.issn.1003-9198.2023.08.007 Abstract ( 97 )   PDF (1062KB) ( 1027 )   Save Objective To analyze the factors affecting the occurrence of tricuspid regurgitation(TR) after pacemaker implantation in the elderly patients. Methods A retrospective analysis of the clinical data of 264 elderly patients who were implanted with pacemakers in our department from January 2012 to January 2021 was performed. All patients were divided into lead induced tricuspid regurgitation (LITR)group and no LITR group according to whether they experienced an exacerbation of TR or a new TR occurred after surgery or not. The pre-operation clinical data and the indexes of two-dimensional echocardiographic measurements between the two groups were compared. The influencing factors of LITR in the elderly patients were analyzed by multivariate Logistic regression model. Results LITR occurred in 87 out of 264 elderly patients with pacemaker implantation, and the incidence rate of LITR was 33.0%. There were significant differences between the two groups in age, the rates of mild preoperative TR, right ventricular apical pacing, and years of implantation(P<0.01). The left atrial diameter(LAD) and right atrial diameter(RAD) in LITR group were significantly higher than those in no LITR group(P<0.01). Multivariate Logistic regression analysis showed that higher RAD, mild preoperative TR, right ventricular apical pacing and years of pacemaker implantation were the influencing factors of the occurrence and exacerbation of TR after pacemaker implantation(P<0.05). Conclusions Increased RAD, pacing electrodes located in the right ventricular apex and long years of pacemaker implantation are risk factors, and mild preoperative TR is a protective factor for postoperative TR. References | Related Articles | Metrics

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Analysis of the characteristics and influencing factors of nutrition in hospitalized patients with late-life depression TIAN Jin-chang, LYU Jian, XU Yu 2023, 37 (8):  785-788.  doi: 10.3969/j.issn.1003-9198.2023.08.008 Abstract ( 113 )   PDF (1012KB) ( 665 )   Save Objective To explore the charateristics and influencing factors of nutrition in the hospitalized patients with late-life depression(LLD). Methods A total of 106 hospitalized patients with LLD admitted to our hospital from January 2020 to March 2022 were enrolled in this study. The nutritional status of all patients was assessed by Mini Nutritional Assessment Scale(MNA). The clinical data were collected and analyzed retrospectively. The influencing factors of nutritional status in LLD patients were analyzed by Logistic regression. Results The MNA scores of 106 hospitalized patients with LLD ranged from 7 to 27, with an average score of(16.64±4.72), and 30 cases(28.30%) presented with malnutrition, 60 cases(56.60%) with risk of malnutrition, and 16 cases(15.09%) with good nutrition. Logistic regression analysis showed that low per capita monthly household income, severe depression, low exercise frequency, poor masticatory function, low nutritional support of caregivers, and diabetes were the independent risk factors for the nutritional status of hospitalized patients with LLD(P<0.05). Conclusions Hospitalized patients with LLD have a high risk of malnutrition, which may be related to low per capita monthly household income, low exercise frequency, poor chewing function, low nutritional support of caregivers, diabetes and severe depression. References | Related Articles | Metrics

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Value of systemic immune inflammation index in predicting hemorrhage transformation after thrombolysis in elderly patients with stroke YANG Dan-dan, JIANG Lin-zhi, LI Li-yan, GENG De-qin, LI Lei 2023, 37 (8):  789-793.  doi: 10.3969/j.issn.1003-9198.2023.08.009 Abstract ( 87 )   PDF (1237KB) ( 1074 )   Save Objective To evaluate the predictive value of systemic immune inflammatory index(SII) on hemorrhage transformation(HT) after intravenous thrombolysis(IVT) in the elderly patients with acute ischemic stroke(AIS). Methods A total of 347 elderly patients with AIS undergoing IVT in our hospital from August 2019 to February 2022 were retrospectively collected. They were divided into HT group and NHT group according to whether there was bleeding after thrombolysis, and the clinical data of the two groups were compared. SII value was calculated and the patients were divided into high SII group and low SII group according to the best cut-off value of ROC curve. Logistic regression was used to explore the risk factors of HT. The short-term functional prognosis of the elderly patients with AIS after IVT was evaluated by the modified Rankin scale(mRS), and the relationship between SII and functional prognosis was evaluated by the restricted cubic spline (RCS) model. Results There were 52 cases(15%) with HT. The value of SII in HT group was significantly higher than that in NHT group [1000.56(651.68,1531.38) vs 508.80(338.49,793.41), P<0.001]. The rate of poor short-term prognosis in high SII group was higher than that in low SII group(P<0.001). RCS showed a dose-dependent relationship between short-term poor prognosis and SII. Logistic regression showed that SII was independently associated with HT. Compared with low SII group, the risk of HT in high SII group increased by 6.65 times. ROC curve showed that when the value of SII was 721, the predictive value on HT in the elderly patients with AIS was the highest [AUC = 0.784(95% CI: 0.715-0.853), P<0.001]. Conclusions SII increases the risk of HT in the elderly patients with AIS after IVT, and is associated with poor short-term functional prognosis. References | Related Articles | Metrics

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Biomarkers and etiological analysis of the bronchoalveolar lavage fluid in elderly patients with aspiration pneumonia SHI Ming-wei, ZHOU Chao-e, WANG Li-na, SUN Chun-ping, LI Jun, LIU Xin-min 2023, 37 (8):  794-797.  doi: 10.3969/j.issn.1003-9198.2023.08.010 Abstract ( 105 )   PDF (1439KB) ( 878 )   Save Objective To explore the value of amylase and pepsin in bronchoalveolar lavage fluid (BALF) in the diagnosis of aspiration pneumonia (AP), and to analyze the etiological characteristics of AP in the elderly patients. Methods A total of 65 subjects admitted to Peking University First Hospital from September 2021 to January 2022 were enrolled and divided into AP group and non-aspiration pneumonia(no-AP) group according to clinical diagnosis. The levels of pepsin and amylase and the pathogenic bacteria in BALF were detected and compared between the two groups. Results There was no significant difference in the level of pepsin between the two groups(P>0.05), but the level of amylase in AP group was significantly higher than that in no-AP group(878.0 IU/L vs 88.6 IU/L, P＜0.001). Receiver operating characteristic (ROC) curve showed that amylase in BALF could predict AP with an area under the curve(AUC) of 0.83. The main pathogens detected in AP group were Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii. The level of amylase of BALF in bacteria-positive patients was significantly higher than that in bacteria-negative patients (408.9 IU/L vs 48.4 IU/L,P＜0.001). Conclusions The level of amylase in BALF helps to timely diagnose AP in the elderly patients. References | Related Articles | Metrics

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A survey of prospective memory in elderly patients undergoing maintenance hemodialysis LI Meng-ting, ZHANG Liu-ping, XIE Qing-lei, WANG Yue, WANG Li-juan 2023, 37 (8):  798-802.  doi: 10.3969/j.issn.1003-9198.2023.08.011 Abstract ( 100 )   PDF (1034KB) ( 785 )   Save Objective To explore the characteristics of prospective memory (PM) in the elderly patients undergoing maintenance hemodialysis (MHD), and to explore the influencing factors. Methods A total of 60 elderly patients in Blood Purification Center of Zhongda Hospital were enrolled as the MHD group, and 60 elderly community residents matched by age who did not receive MHD were enrolled as the control group. All subjects in the two groups underwent the neuropsychological assessments, including Mini-Mental State Examination (MMSE), verbal fluency test (VFT), digital span test (DST), Rey auditory verbal learning test (RAVLT), Stroop color-word test (SCWT), event-based prospective memory (EBPM) and time-based prospective memory (TBPM). Results There was no significant difference in the DST score between the two groups (P>0.05). However, compared with the control group, the MMSE score was lower (P<0.01), SCWT reaction time was longer, RAVLT and VFT (fruit) scores were lower, EBPM and TBPM scores were lower, and the number of clock checking was significantly lower in the MHD group (P<0.01). Conclusions EBPM and TBPM are impaired in the elderly MHD patients. PM assessment may be useful in screening cognitive impairment and improving the treatment compliance and prognosis. References | Related Articles | Metrics

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Study on the predictive value of Padua score for venous thromboembolism in elderly inpatients GAO Wei-fei, LI Peng, QIAO Zhen, MA Li-na 2023, 37 (8):  803-805.  doi: 10.3969/j.issn.1003-9198.2023.08.012 Abstract ( 113 )   PDF (1045KB) ( 2231 )   Save Objective To assess the predictive value of Padua score for venous thromboembolism(VTE) in the elderly inpatients. Methods A retrospective analysis was performed and 150 elderly inpatients in Department of General Practice of Hangzhou Third People's Hospital from January 2018 to June 2021 were included. All of them underwent CT pulmonary angiography or venous ultrasound of both upper(lower)limbs, and were divided into VTE group and non-VTE group. The baseline data including age, gender, underlying disease, Padua score, D-dimer, mean platelet volume(MPV), albumin were collected and compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of VTE. Receiver operating characteristic (ROC) curve analysis was carried out to assess the predictive value of Padua score. Results There were statistically significant differences in Padua score, age, hypertension, acute infection, D-dimer, MPV and albumin between the two groups. Multivariate Logistic regression analysis showed that aged ≥85 years old was the independent risk factor for VTE of elderly inpatients. The area under the curve (AUC) of Padua score to predict the incidence of VTE was 0.631, with a cut-off value of 4.5, and the Youden index was 0.36. Conclusions The predictive value of Padua score for VTE in elderly inpatients is limited. References | Related Articles | Metrics

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Predictive value of fibrinogen to albumin ratio on the severity of coronary lesions in elderly patients with suspected coronary artery disease WANG Zhao-yang, ZHAO Li-na, LIANG Hao, CHEN Shu-xia, GU Jian 2023, 37 (8):  806-810.  doi: 10.3969/j.issn.1003-9198.2023.08.013 Abstract ( 88 )   PDF (1050KB) ( 616 )   Save Objective To investigate the value of fibrinogen to albumin ratio(FAR) in predicting the severity of coronary artery lesions in the elderly patients with suspected coronary artery disease(CAD). Methods Five hundred and thirty-three elderly patients with suspected CAD who underwent coronary angiography for the first time in Hebei General Hospital from January 2018 to May 2022 were selected. All patients were divided into the group with severe coronary lesions(Gensini score>48) and the group with mild to moderate lesions(Gensini score≤48) according to the Gensini score. Receiver operating characteristic (ROC) curve was used to get the cut-off point of FAR to predict severe coronary artery lesions in the elderly patients with suspected CAD. Spearman correlation analysis was used to assess the correlation between FAR and Gensini score. The risk factors for severe coronary artery lesions were analyzed by multivariate Logistic regression. Results The best cut-off value of FAR to predict severe coronary lesions in the elderly patients with suspected CAD was 0.076, with the area under the curve(AUC) of 0.710, sensitivity of 61.1%, specificity of 76.2%(P<0.001). There was a positive correlation between FAR and Gensini score(r=0.440, P<0.001). Multivariate Logistic stepwise regression analysis showed that FAR >0.076, high levels of apolipoprotein B, lipoprotein(a), and a history of diabetes were risk factors of severe CAD (P<0.05), whereas high levels of high density cholesterol(HDL-C) and left ventricular ejection fractions (LVEF) were protective factors of severe CAD (P<0.05) in the elderly patients with suspected CAD. Conclusions There is a significant correlation between FAR and the degree of CAD in the elderly patients with suspected CAD, and FAR>0.076 is an independent risk factor for severe CAD. References | Related Articles | Metrics

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Analysis of influencing factors of deep medullary vein visual score and its correlation with total burden of cerebral small vessel disease YAO He-ling, WANG Yu, WANG Xin, FENG Li-na, YANG Yue-qing, ZHAO Tong-tong, HAN De-chang, MA Meng-hua 2023, 37 (8):  811-814.  doi: 10.3969/j.issn.1003-9198.2023.08.014 Abstract ( 86 )   PDF (1013KB) ( 809 )   Save Objective To explore the influencing factors of deep medullary vein(DMV) visual score and the correlation between total burden of cerebral small vessel disease(CSVD) and DMV visual score. Methods A total of 180 CSVD patients admitted to Tangshan Workers' Hospital were enrolled in this study. The correlation between DMV visual score and the total burden of CSVD was analyzed by Spearman correlation analysis. Multivariate ordinal Logistic regression analysis was performed to analyze the relevant factors of DMV visual score. Results DMV visual score was positively correlated with the total burden of CSVD(r=0.760, P<0.001). Multivariate ordinal Logistic regression analysis showed that age(OR=1.280, 95%CI: 1.208-1.355, P<0.001), lacune of presumed vascular origin(LPVO)(OR=4.679, 95% CI: 2.234-9.800, P<0.001), cerebral microbleed(CMB)(OR=3.605, 95%CI: 1.855-7.003, P<0.001), perivascular space(PVS)(OR=2.588, 95%CI: 1.179-5.682, P=0.018), and white matter hyperintensity(WMH)(OR=7.440, 95%CI: 3.279-16.880, P<0.001) were the independent influencing factors of DMV visual scores. Conclusions There is a strong correlation between DMV visual score and the total burden of CSVD, and the worse the visibility of DMV is, the more severe the overall brain damage of CSVD is. Age, LPVO, CMB, PVS, and WMH show significant influence on DMV visual score. References | Related Articles | Metrics

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Value of total tetraiodothyronine combined with D-dimer and uric acid in predicting the 28-d prognosis in elderly patients with septic shock ZHANG Jian, LI Quan-rui, TIAN Geng 2023, 37 (8):  815-818.  doi: 10.3969/j.issn.1003-9198.2023.08.015 Abstract ( 85 )   PDF (1326KB) ( 524 )   Save Objective To explore the value of total tetraiodothyronine(TT4) combined with D-dimer and uric acid in predicting the 28-d prognosis in the elderly patients with septic shock. Methods A retrospective study was conducted to collect the clinical data of the elderly patients with septic shock. According to the 28-d prognosis, all patients were divided into survival group(46 cases) and death group(32 cases). Multivariate Logistic regression was used to analyze the risk factors of prognosis. A prediction model was established, and the discrimination and calibration of the model were calculated; Receiver operator characteristic(ROC) curve was used to assess the predictive value of the prediction model and the Sequential Organ Failure Assessment(SOFA) score. Results Logistic regression showed TT4, D-dimer and uric acid were the independent risk factors of the 28-d prognosis in the elderly patients with septic shock(P<0.05) and a predictive model was established: Y=-3.811-0.553×TT4+0.289×D-dimer+0.013×uric acid. ROC curve showed that the sensitivity and specificity of the predictive model was 91.67%, 94.12%, respectively, with discrimination of 0.961, calibration curve r2=0.991(P=0.887). The area under the ROC curve (AUC) of the model for predicting the prognosis was 0.961(95%CI: 0.889-0.991), which was higher than that of SOFA score (AUC=0.833,95%CI: 0.706-0.959)(P<0.05). Conclusions TT4-related prediction model has a good predictive value for the 28-d prognosis in the elderly patients with septic shock. References | Related Articles | Metrics

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Epidemiological characteristics of metabolic syndrome in the elderly aged 60 years and above in Nanjing, China DENG Tian-rui, YAO Zhu-ling, WANG Zhi-yong, YE Qing, TANG Wei, XU Fei 2023, 37 (8):  819-822.  doi: 10.3969/j.issn.1003-9198.2023.08.016 Abstract ( 110 )   PDF (1055KB) ( 1089 )   Save Objective To investigate the characteristics of metabolic syndrome(MS) in the elderly population aged 60 and over in Nanjing, and to investigate the influencing factors of MS. Methods From April to October 2017, a total of 15 545 residents aged ≥60 years were selected in Nanjing by multi-stage stratified cluster sampling method. The prevalence characteristics of MS was descriptively analyzed, and the influencing factors of MS were analyzed by Logistic regression model. Results The prevalence of MS in the elderly aged ≥60 years was 28.3%(95%CI: 27.6%-29.0%) in Nanjing. The prevalence was higher in those aged 70-79 years than that in those aged 60-69 years and ≥80 years, being higher in urban areas than that in suburban areas, being higher in those with insufficient physical activity than that in those with adequate physical activity, being higher in those with family history of hypertension or diabetes than that in those without. Among the five components of MS, hypertension had the highest prevalence(60.8%), followed by central obesity(39.1%), hypertriglyceridemia(33.9%), hyperglycemia(33.3%) and low high-density lipoproteinemia(14.7%). Logistic regression analysis showed that aged 70-79 years, family history of hypertension and diabetes were the risk factors for MS, while living in suburban area and sufficient physical activity were the protective factors. Conclusions The prevalence of MS in the elderly population in Nanjing is high. Tailored interventions are encouraged for people aged 70-79 years or those with family history of hypertension and diabetes. References | Related Articles | Metrics

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Clinical characteristics of stroke combined with sarcopenia and the effect of early microecological enteral nutrition intervention YANG Wen-jie, LI Yan-li, ZHOU Yan-jun, LI Lan, MU Bin, WANG Jie 2023, 37 (8):  823-827.  doi: 10.3969/j.issn.1003-9198.2023.08.00 Abstract ( 112 )   PDF (1025KB) ( 1171 )   Save Objective To investigate the clinical characteristics of stroke combined with sarcopenia, and to investigate the effect of early intervention of microecological enteral nutrition. Methods A total of 60 patients with stroke combined with sarcopenia who were admitted to Department of Neurology, PetroChina Central Hospital from May 2020 to December 2021 were enrolled in the stroke with sarcopenia group, and 60 patients with stroke who did not present with sarcopenia were enrolled in the control group. The clinical characteristics of the two groups were compared. The patients with stroke combined with sarcopenia were divided into the early microecological group and the conventional group according to whether they received early microecological enteral nutrition intervention or not, with 30 patients in each group. After 3 months intervention, body mass index(BMI), prognosis-related scores such as Mini-Mental StateExamination(MMSE) score and modified Rankin scale(mRS) score, muscle grip strength, muscle mass, 5-times sit-to-stand test(FTSST) and modified Romberg test were detected and compared. Results The age and National Institutes of Health Stroke Scale(NIHSS) score in the stroke with sarcopenia group were higher than those in the control group, and the levels of BMI, MMSE score, activities of daily living(ADL) score, mRS score were lower than those in the control group(P<0.05). BMI, MMSE score, ADL score, skeletal muscle index (SMI) of limbs, muscle grip strength, total muscle mass, eye closing time of front and back half of foot and eye opening time of front and back of feet in the early microecological group after treatment were higher than those before treatment and those in the conventional group, while FTSST time, NIHSS score and mRS score were lower than those before treatment and those in the conventional group. Conclusions Sarcopenia can reduce the ability of daily living of the patients with stroke and cause serious neurological deficits, but early microecological enteral nutrition intervention can improve muscle strength, promote the recovery of physical ability, and improve daily life. References | Related Articles | Metrics

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Effects of medium/low-dose sacubitril/valsartan on cardiac remodeling and readmission in elderly patients with heart failure with reduced ejection fraction HU Jing-wen, JIANG Wan-ying, HUO Jun-yu, WANG Lan, WANG Xiao-zhi 2023, 37 (8):  828-833.  doi: 10.3969/j.issn.1003-9198.2023.08.018 Abstract ( 113 )   PDF (1055KB) ( 966 )   Save Objective To evaluate the safety and efficacy of sacubitril/valsartan in the elderly patients with heart failure with reduced ejection fraction(HFrEF). Methods A total of 215 elderly patients with HFrEF treated with either sacubitril/valsartan(ARNI group, n=110) or angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB)(control group, n=105) from September 2017 to September 2019 in our hospital were enrolled in the single-center observational cohort study. The indexes of echocardiography 6 months after treatment and the re-hospitalization rate due to heart failure within 1 year were compared between the two groups. Results After 6 months of treatment, the levels of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left atrial diameter (LAD), and the beats of premature ventricular contractions (PVCs) in the two groups were significantly decreased, while the level of left ventricular ejection fraction (LVEF) was significantly increased (P<0.05). The level of LVEF in ARNI group was significantly higher than that in the control group (P<0.05). The rate of readmission due to heart failure within 1 year was lower in ARNI group than that in the control group (29.1% vs 54.3%, P<0.05). After adjusting age, sex, body mass index, atrial fibrillation, hypertension and other factors, Logistic regression analysis showed that the risk of re-hospitalization due to heart failure within 1 year in the patients using ARNI was only 0.23 times of that in the patients using ACEI/ARB (P=0.008). No severe adverse event was recorded. Conclusions Low dose sacubitril/valsartan can induce beneficial cardiac reverse remodeling and improve ventricular systolic and diastolic function in the elderly patients with HFrEF without severe adverse effect. References | Related Articles | Metrics

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Diagnostic value of serum and urine CN1 for diabetic nephropathy in elderly patients HE Ye-nan, SUN Ming-xia, SONG Dan-dan, ZHAO Xiao-lan 2023, 37 (8):  834-838.  doi: 10.3969/j.issn.1003-9198.2023.08.019 Abstract ( 99 )   PDF (1239KB) ( 633 )   Save Objective To study the clinical value of serum and urine carnosine dipeptidase 1 (CN1) in the diagnosis of diabetic nephropathy (DN) in the elderly. Methods A total of 168 elderly patients with type 2 diabetes mellitus (T2DM) in our hospital were enrolled and divided into control group (n=46) and DN group (n=122) according to whether the level of urinary albumin creatinine ratio (UACR) was≥30 mg/g. The serum and urine levels of CN1 and the serum levels of the clinical biochemical indicators were compared between the two groups, and were analyzed by Pearson correlation. Multivariate Logistic regression analysis was used to analyze the influencing factors of DN. The diagnostic value of each index for DN was analyzed by the receiver operating characteristic (ROC) curve. Results Compared with the control group, the level of estimated glomerular filtration rate (eGFR) was lower, while the UACR, the serum levels of creatinine, urea nitrogen, uric acid and cystatin C, and the serum and urine levels of CN1 were significantly higher in the DN group (all P<0.05). Serum and urine levels of CN1 were significantly positively correlated with UACR, serum levels of creatinine and urea nitrogen, and significantly negatively correlated with eGFR (all P<0.05). The levels of eGFR, cystatin C, serum and urine CN1 were the independent influencing factors of DN. The area under the ROC curve (AUC) of eGFR, cystatin C, serum CN1, urine CN1 and combined detection for the diagnosis of DN were 0.851, 0.760, 0.838, 0.849 and 0.944, respectively. The AUC of combined detection was significantly better than that of single indicator (P<0.05). Conclusions The increased serum and urinary levels of CN1 in diabetic patients are independent risk factors affecting the occurrence of DN in the elderly. Combined detection of eGFR, cystatin C, serum and urinary CN1 has high diagnostic value for DN. References | Related Articles | Metrics

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Effects of cognitive emotion regulation strategies on frailty in elderly patients with comorbidities MIAO Yu-fei, QIAN Xiang-yun 2023, 37 (8):  839-842.  doi: 10.3969/j.issn.1003-9198.2023.08.020 Abstract ( 133 )   PDF (1063KB) ( 4488 )   Save Objective To explore the cognitive emotion regulation strategies adopted by the elderly patients with comorbidities in response to events and its relationship with frailty. Methods From May to December 2021, the convenience sampling method was used to select 300 elderly patients with comorbidities in Nantong Third People's Hospital as the research subjects. Questionnaires conducted using the patient general information questionnaire,Chinese version of Tilburg Frailty Assessment Scale, and Chinese version of Cognitive Emotion Regulation Questionnaire(CERQ-C). The incidence rate of frailty and the relationship of cognitive emotion regulation strategy with frailty were analyzed. Results The incidence rate of frailty in the elderly patients with comorbidities was 57.0%(171/300). There were significant differences in age, residence status, marital status, recent memory, smoking, drinking and cognitive emotional regulation between the frailty group and the non-frailty group. Binary Logistic regression analysis showed that aged, recent memory decline and non-adaptive cognitive emotional regulation were risk factors for frailty, while adaptive cognitive emotion regulation, refocus planning and drinking were protective factors. Conclusions The prevelence of frailty in elderly patients with comorbidities is high. Elderly patients with comorbidities tend to adopt non-adaptive cognitive emotion regulation strategies in response to negative life events. Cognitive emotional regulation strategies, age, recent memory and drinking can affect frailty. References | Related Articles | Metrics

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Effect and prognosis of dual anti-platelet therapy based on cilostazol in elderly patients with acute cerebral infarction combined with clopidogrel resistance YU Dong-qing, CHE-Lu 2023, 37 (8):  843-847.  doi: 10.3969/j.issn.1003-9198.2023.08.021 Abstract ( 108 )   PDF (1043KB) ( 714 )   Save Objective To compare the clinical effect and the prognosis of dual anti-platelet therapies between cilostazol plus aspirin and cilostazol plus ticagrelor in the elderly patients with acute cerebral infarction(ACI) combined with clopidogrel resistance. Methods A total of 90 elderly patients with ACI combined with clopidogrel resistance were enrolled and randomly divided into the aspirin group(dual anti-platelet therapy with cilostazol plus aspirin) and the ticagrelor group(dual anti-plaelet therapy with cilostazol plus ticagrelor). The serum levels of malondialdehyde(MDA) and superoxidase dismutase(SOD), the hemorheological indexes of plasma viscosity, whole blood viscosity at high shear rate, whole blood viscosity at low shear rate, fibrinogen(Fbg) and platelet aggregation rate(PAR), the coagulation indexes of prothrombin time(PT), international normalized ratio(INR), plateletⅡb/Ⅲa complex(CD61), platelet fibrinogen receptor(PAC-1) were compared between the two groups. The adverse reactions in both groups were recorded and compared as well. After 2 years of followed-up, the scores of Barthel indexes(BI), modified Rankin scale(mRS) and National Institute of Health Stroke Scale (NIHSS) and the incidence rate of end-point events were compared between the two groups. Results Compared to the aspirin group, the serum levels of MDA, the hemorheology indexes, CD61 and PAC-1 after therapy were lower and the level of SOD was higher in the ticagrelor group. The incidence rate of headache in the ticagrelor group was significantly higher than that in the aspirin group(P<0.05). After 2 years of followed-up, compared to the aspirin group, the incidence rate of the main and secondary end-point events were lower in the ticagrelor group(P<0.05). There were no significant differences in the scores of BI, mRS and NIHSS between the two groups(P>0.05). Conclusions The dual anti-platelet therapy with cilostazol plus ticagrelor can improve the effect and prognosis in the elderly patients with ACI combined with clopidogrel resistance. References | Related Articles | Metrics

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Effect of glycemic control degree on cisatracurium-induced neuromuscular block in elderly diabetic patients undergoing general anesthesia during perioperative period FENG Hai-mei, WEI Xue-mei, XU Zhi-xin 2023, 37 (8):  848-852.  doi: 10.3969/j.issn.1003-9198.2023.08.022 Abstract ( 105 )   PDF (1032KB) ( 538 )   Save Objective To analyze the effect of the degree of glycemic control on cisatracurium-induced neuromuscular block in the elderly diabetic patients undergoing general anesthesia during perioperative period. Methods A total of 150 elderly patients with diabetes mellitus receiving operation under general anesthesia in our hospital were enrolled and divided into good-control group(n=88, HbA1c≤6.0%) and poor-control group (n=62, HbA1c＞6.0%) according to the value of glycated hemogloglobin (HbA1c) during perioperative period. Seventy contemporary elderly patients without diabetes mellitus who received the operations under general anesthesia were selected as control group. After induction of intravenous anesthesia, all patients received intravenous cisatracurium 0.15 mg/kg, and the degree of neuromuscular block was monitored. The onset time, clinical action time, maximum inhibition degree of muscle convulsions, clinical recovery time, recovery index and 90% recovery index were compared among the three groups. The correlations of HbA1c with the above indexes were analyzed by Pearson linear correlation analysis. The risk factors of neuromuscular block in the elderly diabetic patients were investigated by multivariate Logistic analysis. Results Compared with the other two groups, the onset time was shorter and the levels of clinical action time, maximum inhibition degree of muscle convulsions, clinical recovery time, recovery index and 90% recovery index in the poor-control group were higher(P<0.05). There were no signifcant differences in the level of HbA1c, onset time and maximum inhibition degree of muscle convulsions between the good-control group and the control group (P>0.05). But the clinical action time, clinical recovery time, recovery index and 90% recovery index of the good-control group were higher than those in the control group (P<0.05). The level of HbA1c was positively correlated with clinical action time, recovery index and 90% recovery index (r=0.825,P=0.025;r=0.725,P=0.047; r=0.802, P=0.030), and negatively correlated with onset time (r=-0.912,P=0.009). Multivariate Logistic analysis showed that HbA1c was an independent risk factor of neuromuscular block in the elderly diabetic patients undergoing general anesthesia (OR=2.895, P=0.024). Conclusions High glycemic level can enhance the cisatracurium-induced neuromuscular block in general anesthesia during perioperative period, and inhibit the recovery of the muscle relaxation. References | Related Articles | Metrics

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Relationship of serum levels of AGEs and RAGE with dementia severity in elderly patients with vascular dementia after cerebral infarction LIU Li-juan, JIANG Man, CHENG Yong, MAO Gao-feng, FANG Huang 2023, 37 (8):  853-857.  doi: 10.3969/j.issn.1003-9198.2023.08.023 Abstract ( 108 )   PDF (1182KB) ( 731 )   Save Objective To investigate the relationship of serum advanced glycation end products (AGEs) and receptor of AGEs (RAGE) with dementia severity in the patients with vascular dementia after cerebral infarction. Methods A total of 96 elderly patients with vascular dementia after cerebral infarction (CI-VD group) and 84 elderly patients with simple cerebral infarction (CI group) who were admitted to the Central Theater Command General Hospital from January 2020 to June 2021 were enrolled. The serum levels of AGEs and RAGE were compared between the two groups. According to the severity of dementia, the CI-VD patients were divided into mild group (n=25), moderate group (n=39) and severe group (n=32), and the serum levels of AGEs and RAGE were compared among the three groups. Spearman correlation was used to analyze the correlation of serum AGEs and RAGE levels with disease severity. Multivariate Logistic regression analysis was used to analyze the influencing factors of the severity of dementia. Receiver operating characteristic (ROC) curve was used to analyze the value of serum AGEs and RAGE levels in predicting severe dementia in the elderly CI-VD patients. Results The serum levels of AGEs and RAGE in CI-VD group were higher than those in CI group (P<0.01), and significantly increased with the severity of dementia (P<0.05). Spearman correlation analysis showed that serum AGEs (r=0.446, P<0.001) and RAGE (r=0.469, P<0.001) were positively correlated with dementia severity. Multivariate Logistic regression analysis showed that education level, serum NSE, AGEs and RAGE levels were associated with the severity of dementia in the elderly CI-VD patients (P<0.05). ROC curve analysis showed that the optimal cut-off points of serum AGEs and RAGE levels for predicting the severity of dementia in elderly CI-VD patients were 33.07 μg/mL and 550.31 μg/mL, and the AUC of the combination of serum AGEs and RAGE levels was higher than that of AGEs or RAGE alone (P<0.05). Conclusions Serum levels of AGEs and RAGE are related to the severity of dementia in the elderly CI-VD patients, which can be used for predicting the severity of dementia. References | Related Articles | Metrics