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20 April 2024, Volume 38 Issue 4 Previous Issue    Next Issue

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Impact of Atrial Fibrillation Better Care (ABC) pathway on outcome of ischemic stroke in elderly patients with atrial fibrillation: a case-control study ZHOU Lili, WANG Wei, DOU Yu, XIONG Yaqing 2024, 38 (4):  338-342.  doi: 10.3969/j.issn.1003-9198.2024.04.004 Abstract ( 102 )   PDF (1104KB) ( 555 )   Save Objective To investigate the impact of Atrial Fibrillation Better Care (ABC) pathway on the outcome of ischemic stroke in the elderly patients with non-valvular atrial fibrillation (AF). Methods A case-control study was conducted. A total of 129 elderly patients with non-valvular AF who experienced a new ischemic stroke were enrolled as the case group, and 258 elderly patients with non-valvular AF without ischemic stroke during the same period were enrolled as the control group. The two groups were matched in terms of gender, age ±2 with a ratio of 1∶2. The management of AF, baseline characteristics, clinical indicators, comorbidities and medication use were compared between the two groups. Multifactorial Logistic regression analysis was used to analyze the impact of anticoagulation management and the ABC pathway on the outcome of ischemic stroke in the elderly patients with non-valvular AF. Results Between the two groups, the differences in AF management, the usage rates of beta blocker, statin and non-vitamin K antagonists, the levels of blood pressure and low-density lipoprotein cholesterol(LDL-C), and the rates of coronary heart disease and stroke were statistically significant (P<0.05). Conditional Logistic regression analysis showed that after adjusting coronary heart disease, previous stroke/transient ischemic attack and LDL-C level, anticoagulation management was a protective factor of ischemic stroke (OR＝0.37, 95%CI: 0.17-0.82), and ABC pathway was a better protective factor of ischemic stroke (OR＝0.19, 95%CI: 0.08-0.47). Conclusions Compared with anticoagulation management, the ABC pathway shows a further trend of reducing the risk of ischemic stroke in the elderly patients with non-valvular AF. References | Related Articles | Metrics

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Association of self-reported visual and hearing impairment and their interaction with frailty in the elderly LI Shuang, YUAN Xiaoli, JIANG Zhixia, YANG Xiaoling, ZHAO Xiaoling, LIANG Heting, WANG Chaoping 2024, 38 (4):  343-347.  doi: 10.3969/j.issn.1003-9198.2024.04.005 Abstract ( 103 )   PDF (1088KB) ( 604 )   Save Objective To explore the association of self-reported visual and hearing impairment and their interaction with frailty in the elderly. Methods From October 2022 to March 2023, a total of 5925 elderly patients from 6 medical institutions in Zunyi City were selected by convenience sampling method for investigation. The general information was collected, and the frailty screening scale was used to evaluate frailty, and the sensory function self-rating scale was used to evaluate audio-visual function in all subjects. Multivariate Logistic regression analysis was used to evaluate the association of vision and hearing impairment and their interaction with frailty in the elderly. Results After controlling the confounding factors, Logistic regression analysis showed that visual impairment (OR=2.814, 95%CI: 2.422-3.270) and hearing impairment (OR=1.899, 95%CI: 1.603-2.249) were the influencing factors of frailty in the elderly. The visual impairment and hearing impairment had additive interaction on the occurrence of frailty in the elderly (OR=5.709, 95%CI: 4.507-7.231), with relative excess risk due to interaction (RERI) =2.515(95%CI: 1.241-3.790), attributable proportion (AP)=0.441 (95%CI: 0.298-0.583), the synergy index (S) =2.147(95%CI: 1.532-3.008). Conclusions Visual impairment and hearing impairment are the influencing factors of frailty in the elderly, and they have a combined interaction on the occurrence of frailty in the elderly, which suggests that attention should be paid to the screening and management of audiovisual function in the elderly, and taking targeted intervention as early as possible can prevent or delay the frailty process in the elderly and promote healthy aging. References | Related Articles | Metrics

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Value of METTL3 and galectin 3 in peripheral blood in predicting postherpetic neuralgia in elderly patients with acute phase of herpes zosfer ZHANG Yulin, FANG Qifan, ZHAO Yongming, WU Zeyu, YANG Ying 2024, 38 (4):  348-352.  doi: 10.3969/j.issn.1003-9198.2024.04.006 Abstract ( 91 )   PDF (1091KB) ( 456 )   Save Objective To study the expression of methyltransferase-like factor 3 (METTL3) and galectin 3 (Gal-3) in peripheral blood of elderly patients with acute phase of herpes zoster (HZ) and the predictive value for postherpetic neuralgia (PHN). Methods A total of 190 elderly patients with acute HZ treated in our hospital from January 2019 to January 2022 were enrolled in this study. They were divided into PHN group (n=44) and NPHN group (n=146) according to whether the patients presented with PHN. Another 50 healthy subjects who underwent physical examination were enrolled as control group. Fluorescence quantitative PCR and enzyme linked immunosorbent assay were used to detect the expression of METTL3 mRNA in peripheral blood mononuclear cells (PBMC) and serum level of Gal-3 protein, respectively. Logistic regression analysis was used to analyze the influencing factors of PHN in the elderly patients with HZ, and ROC curve was used to investigate the predicting value of the influencing factors. Results The relative expression of METTL3 mRNA in PBMC was significantly lower and the serum level of Gal-3 protein was significantly higher in the patients with HZ than that in control group (P<0.05). The level of METTL3 mRNA was negatively correlated with visual analogue score (VAS), while the serum level of Gal-3 protein was positively correlated with VAS (r=-0.612, 0.604, P<0.05) in the elderly patients with PHN. The course of disease (OR=1.756, 95%CI:1.253-2.460) and the level of Gal-3 protein (OR=1.318, 95%CI:1.025-1.693) were risk factors of the occurrence of PHN in the elderly, while the level of METTL3 mRNA (OR=0.742, 95%CI:0.581-0.948) was a protective factor. The area under ROC curve of METTL3 mRNA combined with Gal-3 protein for predicting PHN was 0.924 (0.843-0.958), compared with 0.812 (0.774-0.861), 0.859 (0.811-0.897) of the two parameters alone (Z=4.312, 3.363, P<0.05). Conclusions The combination of METTL3 mRNA expression in PBMC and serum Gal-3 protein expression has high predictive value for the occurrence of PHN in the elderly patients with acute HZ. References | Related Articles | Metrics

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Construction and validation of a risk prediction model for motoric cognitive risk syndrome in the elderly in rural areas GAO Na, XU Mengru, ZHANG Li, LIU Yuwen, WEI Xing 2024, 38 (4):  353-357.  doi: 10.3969/j.issn.1003-9198.2024.04.007 Abstract ( 83 )   PDF (1560KB) ( 426 )   Save Objective To construct and validate a risk prediction model for motoric cognitive risk syndrome (MCRS) in the elderly in rural areas. Methods From October 2022 to May 2023, 752 rural elderly people were surveyed using General Information Questionnaire, Pittsburgh Sleep Quality Index Scale, Social Support Rating Scale, Simplified Geriatric Depression Scale-15(GDS-15), Mini-Mental State Examination(MMSE) and 4-meter walk test. According to the occurrence of MCRS, they were divided into MCRS group and non-MCRS group. The relevant variables of MCRS were screened by Lasso regression, and then the nomogram prediction model of MCRS in the elderly in rural areas was constructed by multi-factor Logistic regression. The ROC curve and calibration curve were drawn to evaluate the model's discrimination and calibration,and a bootstrap was further conducted to internally validate the model. Results The incidence rate of MCRS in 752 rural elderly people was 14.89% (112/752). Age, sedentary behavior, polypharmacy, poor sleep quality, social support and depression were the influencing factors of MCRS in the elderly in rural areas (P＜0.05). The area under the ROC curve of the nomogram prediction model was 0.844 (95%CI: 0.804-0.883). Bootstrap internal verification results showed that the average absolute error was 0.009, and the model performance was in good agreement with the ideal model. Conclusions The nomogram model of MCRS constructed in this study has a good predictive effect, which provides a reference for early identification of high-risk groups of MCRS. References | Related Articles | Metrics

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Establishment of a nomogram prediction model for the risk of heart failure during perioperative period in elderly patients undergoing hip replacement SHI Pengfei, LI Na, YE Shuo, LIU Yaoming, BAI Jie 2024, 38 (4):  358-361.  doi: 10.3969/j.issn.1003-9198.2024.04.008 Abstract ( 87 )   PDF (1588KB) ( 532 )   Save Objective To analyze the risk factors of heart failure (HF) during perioperative period in the elderly patients undergoing hip replacement, and to establish a nomogram prediction model. Methods A total of 198 elderly patients who underwent hip replacement in the 940th Hospital of the Joint Support Force were enrolled and divided into heart failure group (56 patients)and non-heart failure group (142 patients) according to whether the patients presented with HF during perioperative period. The clinical data of the patients were collected and compared between the two groups. Multiple Logistic regression analysis was used to examine the influencing factors of perioperative HF in the elderly patients undergoing hip replacement. R language software package was used to construct the nomogram prediction model which was verified by Bootstrap method. The area under the receiver operator characteristic (ROC) curve was used to test the predictive efficacy of the nomogram model. Results The proportions of aged ≥70 years old, hypertension, preoperative American Society of Anesthesioloogists (ASA) grade Ⅲ-Ⅳ, the volume of intraoperative blood transfusion ≥400 mL and the time of postoperative bed rest ≥4 days in the heart failure group were obviously higher than those in the non-heart failure group (P<0.05). Logistic regression analysis showed that age, history of hypertension, preoperative ASA classification, intraoperative blood transfusion volume and postoperative bed rest time were independent risk factors for perioperative HF in the elderly patients undergoing hip replacement (P<0.05). The predicted value of nomogram model for HF in the elderly patients undergoing hip replacement during perioperative period was basically consistent with the measured value. The area under the ROC curve of the nomogram model was 0.901, with high predictive efficiency. Conclusion The nomogram based on the risk factors of AHF in the elderly patients undergoing hip replacement during perioperative period has a high predictive efficacy. References | Related Articles | Metrics

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Efficacy and safety of transcatheter arterial chemoembolization combined with lenvatinib in the treatment for hepatocellular carcinoma in elderly patients KONG Jie, JIANG Rui, LIU Zhengli, HE Xu, ZHAO Boxiang, GONG Maofeng, WANG Xiaoping, LU Zhaoxuan, GU Jianping, ZHANG Lei 2024, 38 (4):  362-366.  doi: 10.3969/j.issn.1003-9198.2024.04.009 Abstract ( 82 )   PDF (1460KB) ( 460 )   Save Objective To investigate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with lenvatinib in the treatment for intermediate-to-advanced hepatocellular carcinoma (HCC) in the elderly patients. Methods The clinical data of the elderly HCC patients treated at Nanjing First Hospital from June 2018 to August 2020 were collected. All patients were divided into TACE group (n=63) and TACE plus lenvatinib group (n=76) according to treatment methods. The tumor response, survival outcomes, and adverse events were compared between the two groups. Results The Objective response rate (ORR) and disease control rate (DCR) were significantly higher in TACE plus lenvatinib group than those in TACE group (P<0.001). The median progression-free survival (PFS) was 7.5 months in TACE group, compared with 12.5 months in TACE plus lenvatinib group (P<0.05). The median overall survival (OS) was 9.6 months in TACE group, compared with 15.8 months in TACE plus lenvatinib group (P<0.05). The adverse events during follow-up were grade I-II and effectively controlled with symptomatic treatment. Conclusions In the elderly patients with intermediate-to-advanced HCC, the combination of TACE and lenvatinib can significantly improve efficacy and prolong survival time, and is well-tolerated. References | Related Articles | Metrics

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Effects of lateral decubitus position on bone cement distribution in elderly patients with osteoporotic vertebral compression fracture undergoing unilateral percutaneous kyphoplasty BAI Yunfeng, LI Mingzhe, SONG Ruijia, YUAN Ruoting, LEI Zhixuan, SHI Mohan, CAO Shuchang, WU Tao 2024, 38 (4):  367-371.  doi: 10.3969/j.issn.1003-9198.2024.04.010 Abstract ( 82 )   PDF (2019KB) ( 682 )   Save Objective To study the effects of the lateral decubitus position on the bone cement distribution in the elderly patients with osteoporotic vertebral compression fracture (OVCF) undergoing unilateral percutaneous kyphoplasty (PKP). Methods A retrospective analysis was conducted in the patients who underwent unilateral PKP treatment for OVCF in the Department of Spine Surgery of our hospital from January 2018 to January 2022. All patients were divided into the lateral decubitus group and the prone position group according to the decubitus position during cement injection. The imaging information and symptom indexes of the two groups were compared during treatment and follow-up. Results A total of 190 patients were enrolled in this study. Ninety-four patients received cement injections in the lateral decubitus position, while 96 patients were in the prone position. Compared with the prone position group, visual analogue scoring of pain (VAS scores) one week after surgery was significantly lower, grading distribution of cement distribution was better and cement leakage rate was significantly lower in the lateral decubitus group (P<0.05). At the last follow-up, the contralateral vertebral height in the lateral position group was significantly higher than that in the prone position group [(18.3±1.08) mm vs (17.4±1.03) mm, P<0.05]. Conclusions The lateral decubitus position can efficiently improve the distribution of cement in the elderly patients undergoing unilateral PKP, relieve acute pain better, reduce the incidence of cement leakage and the extent of the contralateral vertebra collapse in the long term. References | Related Articles | Metrics

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Relationship of neutrophil to lymphocyte ratio with prognosis of elderly patients undergoing maintenance hemodialysis XIAO Wen, HU Xiu, LI Jun, SONG Bin 2024, 38 (4):  372-376.  doi: 10.3969/j.issn.1003-9198.2024.04.011 Abstract ( 88 )   PDF (1250KB) ( 624 )   Save Objective To investigate the relationship of neutrophil to lymphocyte ratio (NLR) with adverse outcomes in the elderly patients undergoing maintenance hemodialysis (MHD). Methods A total of 140 elderly patients who received MHD treatment at Blood Purification Center of Deyang People's Hospital from January 2017 to December 2021 were retrospectively enrolled in this study. According to whether the patients died during the follow-up period, they were divided into the death group and the survival group. The clinical data and laboratory indicators of the patients before MHD were compared between the two groups. Cox proportional risk regression model was used to analyze the risk factors affecting the survival time of elderly patients undergoing MHD, and receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of the risk factors for prognosis of the patients. Results Compared with the survival group, the death group had shorter dialysis time, lower levels of hemoglobin and lymphocytes, and higher levels of NLR, platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and hypersensitive C-reactive protein (P<0.05). After adjusting multiple confounding factors, multivariate COX regression analysis showed that NLR, diabetes and low level of hemoglobin were independent risk factors affecting the survival time of elderly patients undergoing MHD. ROC curve results showed that 7.66 was the best cutoff point of NLR in predicting the poor prognosis of the patients (P<0.01), with a sensitivity of 60%, a specificity of 91%, and an area under the ROC curve of 0.756 (P<0.01). Conclusions NLR is an independent risk factor that affects the survival time of the elderly MHD patients, and could effectively predict the risk of adverse prognosis in the patients. References | Related Articles | Metrics

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Relationship of systemic immune-inflammation index, albumin, alpha-fetoprotein with prognosis in elderly patients with liver metastasis from gastric adenocarcinoma HU Yun, WANG Shuhong, XU Ji 2024, 38 (4):  377-381.  doi: 10.3969/j.issn.1003-9198.2024.04.012 Abstract ( 123 )   PDF (1156KB) ( 557 )   Save Objective To explore the correlation of systemic immune inflammation index (SII), albumin (ALB) and alpha-fetoprotein (AFP) with the prognosis in the elderly patients with liver metastasis from gastric adenocarcinoma. Methods A total of 94 elderly inpatients with gastric adenocarcinoma and liver metastasis from October 2019 to October 2022 were enrolled in this study and followed up to February 2023. The clinical data of all patients were collected, and blood routine [hemoglobin (Hb), peripheral blood plate (PLT), neutrophil (NC), lymphocyte count (LY)], liver and kidney function [ALB, prealbumin (PALB)], coagulation function (D-dimer) and related tumor markers [AFP, carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125)]were detected and SII was caculated. Kaplan-Meier survival curve and Cox regression analysis were used to analyze the influencing factors of the prognosis in the elderly patients with liver metastasis from gastric adenocarcinoma. Results The follow-up time of all patients was 4.4-33.5 months, with a median follow-up time of 12.7 months. The 1-year and 2-year survival rates of the elderly patients with liver metastasis from gastric adenocarcinoma were 57.41% and 6.38% respectively. Univariate Cox regression analysis showed that age, marital status, histological grade, treatment style, the levels of SII, ALB, PALB, AFP and CA199 were correlated with the prognosis in the elderly patients with gastric adenocarcinoma and hepatic metastasis (P<0.05). Multivariate Cox regression analysis showed that chemotherapy combined with local treatment, low level of SII, high level of ALB and low level of AFP were protective factors of the prognosis in the elderly patients with gastric adenocarcinoma and liver metastasis (P<0.05). Kaplan-Meier survival curve showed that the median survival time of the patients with chemotherapy combined with local therapy, low SII, high ALB, and low AFP was significantly longer than that in the patients with other therapeutic interventions, high level of SII, low level of ALB and high level of AFP (all P<0.05), respectively. Conclusions The levels of SII, ALB and AFP are associated with the prognosis, and may be good prognostic indicators in the elderly patients with liver metastasis from gastric adenocarcinoma. References | Related Articles | Metrics

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Association of FT3 with readmissions due to heart failure in elderly patients with ischemic cardiomyopathy and heart failure CHEN Shan, ZHONG Chongxia, LIU Yihai, ZOU Renfang, XU Biao, NI Jie, SHA Dujuan 2024, 38 (4):  382-385.  doi: 10.3969/j.issn.1003-9198.2024.04.013 Abstract ( 77 )   PDF (1067KB) ( 643 )   Save Objective To investigate the correlation between serum level of free triiodothyronine (FT3) and readmission due to heart failure in the elderly patients with ischemic cardiomyopathy and heart failure. Methods A total of 89 elderly patients with ischemic cardiomyopathy and heart failure admitted to Department of Vasculocardiology, Nanjing Drum Tower Hospital from March 2018 to December 2019 were enrolled. According to whether the readmission was due to heart failure, the patients were divided into heart failure readmission group (group A, n=24) and non-heart failure readmission group (group B, n=65). The baseline data, serological indexes and echocardiographic indexes of the two groups were compared during hospitalization. Multivariate Logistic regression was used to analyze the related factors of readmission due to heart failure. Results The proportion of male patients in group A was lower than that in group B, the levels of BNP and globulin were higher than those in group B, and the level of FT3 was lower than that in group B (all P<0.05). Multivariate Logistic regression analysis showed that after adjusting ejection fraction (EF), left ventricular end-diastolic diameter(LVEDD), BNP, globulin, gender, stroke and other factors, decreased FT3 was an independent risk factor for readmission due to heart failure (OR=0.198, 95%CI: 0.040-0.966). Conclusions Decreased FT3 is an independent risk factor for readmission due to heart failure in the elderly patients with ischemic cardiomyopathy and heart failure. References | Related Articles | Metrics

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Effects of driving pressure-guided lung protective ventilation strategy on postoperative pulmonary complications in elderly patients undergoing elective colorectal surgery SHEN Po, FENG Yue, ZHONG Yi, GUO Yaoyi, JIANG Fan, MA Mingtao, HU Yuping, SHI Hongwei, SI Yanna 2024, 38 (4):  386-391.  doi: 10.3969/j.issn.1003-9198.2024.04.014 Abstract ( 71 )   PDF (1567KB) ( 615 )   Save Objective To explore the effects of driving pressure-guided lung protective ventilation strategy (LPVS) on postoperative pulmonary complications (PPCs) in the elderly patients undergoing colorectal surgery. Methods A total of 80 elderly patients scheduled to undergo elective colorectal surgery were randomly divided into fixed positive end-expiratory pressure (PEEP) group (group C) and driving pressure-guided PEEP titration group (group T), with 40 cases in each group. After induction of general anesthesia, all patients received volumetric ventilation with a tidal volume of 6 mL/kg. Group C was treated with a PEEP of 5 cmH2O LPVS during ventilation after the initial recruitment manoeuvre (RM). Group T was treated with driving pressure-guided LPVS. Lung ultrasonography was used to evaluate the score of lung ultrasound at 12 regions of bilateral lung. The score of each region was accumulated as lung ultrasound score (LUS). The occurrence of PPCs within 7 days after surgery and driving pressure, oxygenation index, LUS during and after operation were compared between the two groups. Results The incidence rate of PPCs within 7 days was 32.5% in group C and 12.5% in group T, with statistically significant difference (P <0.05). Compared with group C, driving pressure decreased, oxygenation index increased at the time of 2 hours from surgery beginning and at the end of surgery, and LUS decreased from 2 hours after the beginning of surgery to 1 day after operation in group T (P<0.05). Conclusions Compared with 5 cmH2O PEEP, the elderly patients undergoing driving pressure-guided LPVS can obtain individualized, appropriate PEEP values, which can reduce lung injury induced by mechanical ventilation and surgical trauma. References | Related Articles | Metrics

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Effect of individualized ABCDE-based bundle care on postoperative delirium in elderly patients with acute type A aortic dissection QI Ping 2024, 38 (4):  418-421.  doi: 10.3969/j.issn.1003-9198.2024.04.021 Abstract ( 98 )   PDF (1070KB) ( 506 )   Save Objective To explore the effect of individualized nursing plan based on ABCDE bundle on postoperative delirium in the elderly patients with acute type A aortic dissection(ATAAD). Methods A total of 121 elderly patients with ATAAD who underwent surgery and admitted to intensive care unit (ICU) in our hospital from January 2018 to December 2021 were enrolled in this study. Among them, 60 patients admitted from January 2018 to December 2019 who received the conventional ABCDE bundle care were enrolled in the control group, and 61 patients admitted from January 2020 to December 2021 who received individualized postoperative care plan based on ABCDE bundle were enrolled in the intervention group. The incidence of postoperative delirium, the time point of delirium occurrence, the duration of delirium, the duration of mechanical ventilation, the length of ICU stay and the total length of hospital stay were compared between the two groups. Results The incidence of postoperative delirium, the duration of delirium, the duration of mechanical ventilation and the length of ICU stay were significantly lower, and the time point of delirium occurrence was significantly later in the intervention group than that in the control group(P<0.05). The total length of hospital stay showed no significant difference between the two groups. Conclusions The individualized postoperative nursing plan for elderly ATAAD patients based on ABCDE bundle can effectively delay the occurrence of postoperative delirium, reduce the incidence and duration of postoperative delirium, shorten the duration of mechanical ventilation and ICU stay, which is worthy of clinical application. References | Related Articles | Metrics

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Preliminary construction of modified Otago exercise programme for elderly patients with hip fracture combined with sarcopenia WANG Qi, XU Huiping, SHI Muhua, ZHANG Min, ZHU Jinyu, BO Yun 2024, 38 (4):  422-426.  doi: 10.3969/j.issn.1003-9198.2024.04.022 Abstract ( 77 )   PDF (1160KB) ( 502 )   Save Objective To construct modified Otago exercise programme for the prevention of falls during rehabilitation period in the elderly patients with hip fracture combined with sarcopenia. Methods A project team was set up to form the first draft of the scheme on the basis of literature research. After two rounds of Delphi method, various items were modified to form the final version of the programme. Results A total of 6 randomized controlled trials were included, and 15 experts conducted two rounds of Delphi method. The experts authority coefficient was 0.943. The enthusiasm of experts was 100% in the first round and 93.3% in the second round. Items with importance scores>4.0 and coefficient of variation <0.2 were retained, and Kendall's W for two rounds of inquiry were 0.244 and 0.334, respectively, with statistically significant differences (P<0.001). The final exercise plan included 3 primary items such as warm-up exercise, muscle strength training and balance training, 23 secondary items and 4 postoperative exercise time nodes. Conclusions The preliminary exercise programme has a strong pertinency, high degree of experts authority, and good coordination of experts' opinions, which can provide a reference for the prevention of falls in the elderly patients with hip fracture and sarcopenia during postoperative rehabilitation. References | Related Articles | Metrics