Table of Content

20 June 2024, Volume 38 Issue 6 Previous Issue    Next Issue

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Analysis of status and influencing factors of intrinsic capacity in elderly patients receiving maintenance hemodialysis YAN Xiaowei, LI Mengting, PAN Mengjiao, ZHANG Liuping 2024, 38 (6):  541-544.  doi: 10.3969/j.issn.1003-9198.2024.06.001 Abstract ( 95 )   PDF (1050KB) ( 625 )   Save Objective To explore the status and influencing factors of intrinsic capacity (IC) in the elderly patients receiving maintenance hemodialysis (MHD), and to provide evidence for improving the quality of life. Methods Convenience sampling was used to select the elderly MHD patients from the outpatient department of Blood Purification Center of Zhongda Hospital Southeast University from January to June 2023. The general information and clinical data of the patients were collected. The level of IC was evaluated, including the Short Physical Performance Battery(SPPB), Mini Nutritional Assessment short-form(MNA-SF), Mini-Mental State Examination (MMSE), Zung’s Self-rating Depression Scale and self-reported visual/hearing impairment. Results A total of 175 elderly MHD patients were enrolled in this study, with an average age of 69.78±6.92 years, with an average dialysis age of 66.91±55.36 months. Among them, there were 105 males (60.00%), 53 cases (30.29%) with good IC (≥ 3 points) and 122 cases (69.71%) with poor IC (<3 points). The total average score of IC was 2.25±1.03 points. Multiple Logistic regression analysis showed that albumin was a protective factor, and age and β2-microglobulin were independent risk factors for IC in the elderly MHD patients. Conclusions The decline of IC is common in the elderly MHD patients, and high level of albumin could improve the level of IC in the patients. References | Related Articles | Metrics

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Effects of traditional Chinese medicine constitution dialectical nursing on fatigue and quality of life in elderly patients receiving dialysis HU Yangyang, WANG Yue, XIE Qinglei 2024, 38 (6):  545-548.  doi: 10.3969/j.issn.1003-9198.2024.06.002 Abstract ( 91 )   PDF (1105KB) ( 477 )   Save Objective To explore the effects of traditional Chinese medicine constitution dialectical nursing on fatigue and quality of life in the elderly patients receiving maintenance hemodialysis. Methods A total of 146 patients who underwent maintenance hemodialysis at two blood purification centers of Zhongda Hospital Southeast University from June to December 2022 and met the inclusion and exclusion criteria were randomly divided into the control group and the observation group, with 73 patients in each group. The control group received routine nursing, while the observation group received traditional Chinese medicine constitution dialectical nursing, including traditional Chinese medicine dietary adjustment and acupoint massage, on the basis of routine nursing. The intervention lasted for 24 weeks. The revised Piper Fatigue Scale (RPFS) and the 36 item short form health survey (SF-36) were assessed and compared between the two groups before and after nursing intervention. Results After 24 weeks of intervention, the scores of cognitive dimension, emotional dimension and sensory dimension, and total score of RPFS in the observation group were significantly lower than those in the control group (P<0.05), the scores of sensory dimension, cognitive dimension, emotional dimension and total score of RPFS in the observation group were significantly lower than those before intervention (P<0.05), while the fatigue level in the control group was not significantly improved after intervention (P>0.05). The physiological function, overall health, energy, social function, emotional function, and total score of SF-36 in the observation group were significantly higher than those in the control group and those before intervention (P<0.05), while there was no significant change in SF-36 score in the control group after intervention (P>0.05). Conclusions Dialectical nursing of traditional Chinese medicine constitution has positive significance in improving the fatigue state and quality of life of the elderly patients undergoing maintenance hemodialysis. References | Related Articles | Metrics

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Study on risk factors of intra-dialytic hypotension in elderly patients undergoing maintenance hemodialysis YAN Xiaohong, XIE Qinglei, WANG Yue, ZHOU Hongyun 2024, 38 (6):  549-552.  doi: 10.3969/j.issn.1003-9198.2024.06.003 Abstract ( 74 )   PDF (1047KB) ( 712 )   Save Objective To analyze the risk factors for the occurrence of intra-dialytic hypotension (IDH) in the elderly patients undergoing maintenance hemodialysis (MHD). Methods The clinical data of the elderly MHD patients in Blood Purification Center of Zhongda Hospital Southeast University from June 2022 to June 2023 were retrospectively collected and analyzed, including general data, incidence of dialysis-related hypotension and laboratory indicators. Logistic regression was used to analyze hypotension-related risk factors in hemodialysis, and ROC curve was drawn to explore the predictive value of hypotension-related factors. Results A total of 128 elderly patients were enrolled, of which 52 elderly patients presented with a total of 682 times of IDH, with an incidence rate of 7.78%. According to the occurence of IDH, all the patients were divided into IDH group and non-IDH group, and Logistic regression analysis showed that long-term catheter (intra-arteriovenous fistula as reference, OR=7.94, 95%CI: 2.76-22.87, P <0.001), ultrafiltration rate＞8.8 mL/min (≤8.8 mL/min as reference, OR=5.40, 95%CI: 1.55-18.75, P=0.008) were independently associated with IDH. ROC curve analysis showed that the area under the curve (AUC) of the ultrafiltration rate predicting IDH was 0.712, Youden index was 0.357, the optimal cut-off value was 9.0 mL/min, the sensitivity was 67.3% and the specificity was 68.4%. Conclusions Long-term catheter access and ultrafiltration rate > 8.8 mL/min are risk factors for IDH in the elderly MHD patients. Ultrafiltration rate has certain predictive value for IDH in elderly MHD patients. References | Related Articles | Metrics

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Prevalence and risk factors of chronic constipation in elderly patients receiving maintenance hemodialysis TANG Fang, ZHANG Kaidi, LI Zuolin, ZHANG Liuping, LI Mengting 2024, 38 (6):  553-556.  doi: 10.3969/j.issn.1003-9198.2024.06.004 Abstract ( 70 )   PDF (1055KB) ( 535 )   Save Objective To investigate the prevalence and risk factors of chronic constipation in the elderly patients receiving maintenance hemodialysis (MHD). Methods A total of 116 elderly patients undergoing MHD in Blood Purification Center of Zhongda Hospital from January to June 2023 were enrolled in this study. The constipation assessment sacle(CAS) was used to evaluate the level of constipation in the elderly patients receiving MHD.Pearson correlation analysis was used to explore the correlation between chronic constipation and related indicators. Logistic regression analysis was used to explore the risk factors for chronic constipation in the elderly patients receiving MHD. Results In this study, 58 (50.0％) elderly patients receiving MHD presented with constipation. Pearson correlation analysis found that the total constipation score was positively correlated with the levels of BMI, total cholesterol (TC), triglyceride (TG), total body water (TBW), body fat mass content (BFM) and obesity degree (P<0.05). Binary Logistic regression analysis showed that TC, TG, TBW, BFM and obesity degree were the independent risk factors for constipation in the elderly patients receiving MHD (P<0.05). Conclusions The prevalence of constipation in the elderly patients receiving MHD is high. The levels of TC, TG, TBW, BFM and obesity degree show significant effects on constipation in the elderly patients receiving MHD. References | Related Articles | Metrics

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A Meta-analysis on the efficacy of His-Purkinje system pacing in elderly patients with pacing-induced cardiomyopathy CHENG Rong, ZHOU Haoyang, LI Ying, ZHANG Cheng, LI Chunyu, CHEN Yan 2024, 38 (6):  557-563.  doi: 10.3969/j.issn.1003-9198.2024.06.005 Abstract ( 83 )   PDF (3268KB) ( 627 )   Save Objective To evaluate the efficacy and clinical benefit of upgrading to His-Purkinje system conduction system pacing (HPCSP) in the elderly patients with pacing-induced cardiomyopathy (PICM) after right ventricular pacing (RVP). Methods The literatures on Hirsch-Purkinje system (Hirsch-Purkinje system) pacing in the patients with PICM were searched from PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang Data and VIP Database, based on inclusion and exclusion criteria. The relevant data on clinical efficacy and safety were extracted from the studies, and were analyzed by RevMan 5.4 software. Results A total of 8 literatures were enrolled in this study, and 185 patients were included. The successful rate of HPCSP was 95%. The results of Meta-analysis showed that, compared with baseline, patients’ left ventricular ejection fraction(MD=-11.73, 95%CI:-14.74--8.72, P<0.01)was significantly increased, QRS duration(MD=59.84, 95%CI:55.98-63.70, P<0.01)was shortened, cardiac function classification of New York Heart Association(MD=1.05, 95%CI: 0.70-1.41, P<0.01)was significantly increased. No significant differences were observed in pacing threshold (MD=-0.11, 95%CI: -0.24-0.02, P=0.08) and R-wave(MD=-0.35, 95%CI: -1.94-1.24, P=0.66) before and after the upgrading operation. Conclusions For the elderly patients with PICM, upgrading the pacing mode to HPCSP should be considered. HPCSP can correct electrical dissynchronization and ventricular remodeling caused by long-term right ventricular pacing, and can improve clinical cardiac function and reduce surgery-related complications. References | Related Articles | Metrics

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Efficacy and safety of regional citrate anticoagulation during daily continuous venovenous hemodialysis in elderly patients LIU Ziyun, LI Ningxu 2024, 38 (6):  564-567.  doi: 10.3969/j.issn.1003-9198.2024.06.006 Abstract ( 97 )   PDF (1054KB) ( 647 )   Save Objective To investigate and evaluate the efficacy and safety of regional citrate anticoagulation (RCA) in elderly patients undergoing daytime continuous venovenous hemodialysis (CVVHD). Methods A total of fifty elderly patients who received daytime RCA-CVVHD treatment from March 2022 to February 2023 in Blood Purification Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology were studied retrospectively. Renal function and electrolytes were detected before and after the treatment, and the venous blood gas indicators of the extracorporeal circulation were monitored during the treatment process.The clotting grade of the filter and extracorporeal circulation pipeline was recorded after the treatment. Results (1) All CVVHD in the 50 patients were successfully completed, with no coagulation occurring in the filters and venous pots. (2) The level of ionized calcium (iCa2+) after the filter one hour after the treatment was (0.36±0.05) mmol/L.(3) The blood iCa2+ level was decreased(P<0.05), while the levels of pH, bicarbonate ion (HCO3-), base excess (BE) were increased 2 and 5 h after treatment compared to pre-treatment levels(P<0.05).Sodium ion (Na+) level showed no significant change (P>0.05).(4) The levels of blood urea nitrogen (BUN), serum creatinine (Cr), potassium ion(K+), chloride ion(Cl-), blood phosphate (P) and calcium(Ca2+) were decreased, while the level of HCO3-was increased after treatment (P<0.05). There was no significant change in Na+ level after treatment (P>0.05).(5) There was one case of sodium citrate accumulation during the treatment process. Conclusions The application of daytime RCA-CVVHD in elderly patients is safe and effective. To avoid sodium citrate accumulation or overdose, dynamic monitoring of venous blood gas indicator is necessary during treatment. References | Related Articles | Metrics

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Risk factors for early neurological deterioration in elderly patients with spontaneous intracerebral hemorrhage ZHANG Yaotian, ZHOU Yong, WANG Junbao, MA Changbao 2024, 38 (6):  568-571.  doi: 10.3969/j.issn.1003-9198.2024.06.007 Abstract ( 80 )   PDF (1047KB) ( 464 )   Save Objective To explore the risk factors of early neurological deterioration (END) in the elderly patients with spontaneous intracerebral hemorrhage (SICH). Methods A retrospective analysis was conducted on the clinical data of 100 elderly patients with SICH admitted to our hospital from January 2019 to September 2022. According to the results of the National Institutes of Health Stroke Scale (NIHSS), all patients were divided into non-END group (n=60) and END group (n=40). The general information and laboratory indicators including homocysteine (Hcy) and C-reactive protein (CRP) were collected and compared between the two groups.Multivariate Logistic regression analysis was used to analyze the influencing factors of END in the elderly patients with SICH. Results The incidence rate of END in 100 patients with SICH was 40.00％ (40／100). The proportion of hypertension, hemorrhage breaking into the ventricle, hematoma volume, and the levels of CRP and Hcy in the non-END group were lower than those in the END group (P<0.05). The results of multivariate Logistic regression analysis showed that hypertension, hematoma volume, intraventricular hemorrhage, CRP and Hcy were risk factors for the occurrence of END in the elderly patients with SICH. Conclusions The occurrence of END in patients with SICH is influenced by multiple factors. When the volume of hematoma, CRP and HCY increase, attention should be paid to the occurrence of END. References | Related Articles | Metrics

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Analysis of reliability, validity and predictive value of three fall risk self-assessment tools in elderly inpatients LIU Yating, CHEN Qiong, KONG Yanjie, PENG Yun, HONG Dan, PENG Linlin, HU Lan, CHEN Xia, ZHANG Xing, LIU Lihua, NAN Yayun 2024, 38 (6):  572-576.  doi: 10.3969/j.issn.1003-9198.2024.06.008 Abstract ( 82 )   PDF (1334KB) ( 586 )   Save Objective To explore the reliability, validity and predictive value of three fall risk self-assessment tools in hospitalized elderly patients. Methods A total of 420 hospitalized elderly patients who met the inclusion and exclusion criteria in Xiangya Hospital of Central South University from January to June 2023 were selected by convenient sampling method. The Chinese version of Self-Assessment of Fall Risk Questionnaire (CSAFR ), the Chinese version of the i Engaging fall self-assessment tool and the Chinese version of the Self-rated Fall Risk Questionnaire (CFRQ ) were used to evaluate the risk of fall. The intra-group correlation coefficient was used to evaluate the investigator reliability of the three tools. Cronbach’ s α coefficient was used to evaluate the internal consistency of the three tools. Factor analysis was used to evaluate the construct validity of the three tools. With the Chinese version of the Morse Fall Scale (CMFS) as the standard, the correlation coefficient of the measured scores of the three tools with CMFS was analyzed. The receiver operating characteristic (ROC) curve was used to analyze and compare the predictive effects of the three scales on falls. Results The intraclass correlation coefficients of CSAFR, the Chinese version of the i Engaging fall self-assessment tool and CFRQ were 0.862, 0.804 and 0.926, respectively. The Cronbach’s α coefficients were 0.515,0.726 and 0.742, and the validity KMO values were 0.618,0.662,0.831 (P<0.01). Orthogonal rotation transformation was performed, and two common factors were extracted from CSAFR, with a cumulative variance contribution rate of 47.4 %. Seven common factors were extracted from Chinese version of i Engaging fall self-assessment tool, with a cumulative variance contribution rate of 58.2%. Three common factors were extracted from the CFRQ, with a cumulative variance contribution rate of 43.3%. The correlation coefficients of CSAFR, i Engaging fall self-assessment tool and CFRO with CMFS were 0.398, 0.376, and 0.478, respectively. The results of ROC curve analysis showed that the AUC values of three tools were 0.814, 0.689 and 0.821, respectively. When the cut-off points of the three tools were 3.5, 5.5 and 4.5 respectively, the Youden indexes were 0.469, 0.259 and 0.503, respectively. The sensitivity was 64.9%, 88.3% and 81.8% respectively, and the specificity was 82.1%, 37.6% and 68.5%, respectively. Conclusions This study suggests that the three fall risk self-assessment tools have certain reliability and validity, and have certain predictive value for the falls in hospitalized elderly patients. The reliability, validity and predictive value of CFRQ for the elderly are highest, and the evaluation time is not long. It is an effective tool and can provide important reference for the self-assessment of fall risk in the hospitalized elderly patients in China. References | Related Articles | Metrics

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Study on the correlation of cognitive function with swallowing function and nutritional status in the elderly patients with Alzheimer’s disease LI Qingyang, WANG Chanjuan, WANG Zheng 2024, 38 (6):  577-581.  doi: 10.3969/j.issn.1003-9198.2024.06.009 Abstract ( 81 )   PDF (1070KB) ( 530 )   Save Objective To investigate the relationship between swallowing function,nutritional status and cognitive function in the elderly patients with Alzheimer’s disease (AD). Methods A total of 56 elderly patients with AD hospitalized in Department of Geriatrics of the First Affiliated Hospital of Nanjing Medical University (AD group) and 60 normal elderly matched for gender, age from October 2019 to November 2021 (control group) were enrolled in this study. The data of the laboratory indexes including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), uric acid (UA), albumin and hemoglobin (Hb) were collected and compared between the two groups. Two groups underwent the assessment of short-form micronutrient assessment (MNA-SF), Water Swallowing Test, Swallowing Disorder Scale and The Mini-Mental State Examination (MMSE) scale. The relationship of cognitive function with swallowing function and nutritional status in the elderly AD patients was explored. Results The levels of Hb, albumin and the MNA-SF score in AD group were significantly lower than those in control group (P<0.05). The nutritional status of AD patients decreased with the increase of the degree of swallowing disorder (P<0.05). Spearman correlation analysis showed that there was a positive correlation between MMSE score and MNA-SF score (r=0.554, P<0.05). Conclusions The swallowing function and nutritional status of the elderly AD patients are significantly decreased, and there is a positive correlation between the nutritional status and the cognitive function in the elderly AD patients. In clinical work, we should strengthen the screening of the swallowing function, enhance the nutritional support, and actively improve the cognitive function and living conditions of the elderly AD patients. References | Related Articles | Metrics

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Value of serum levels of Aβ1-42 and Bcl-2 in predicting the pathogenesis of Alzheimer’s disease in elderly patients with cognitive impairment LIU Tian, YANG Rongli, HAN Huiping 2024, 38 (6):  582-586.  doi: 10.3969/j.issn.1003-9198.2024.06.010 Abstract ( 76 )   PDF (1082KB) ( 428 )   Save Objective To investigate the preditive value of serum levels of β-amyloid protein 1-42 (Aβ1-42) and B-cell lymphoma factor-2 (Bcl-2) in the pathogenesis of Alzheimer’s disease (AD) in the elderly patients with cognitive impairment. Methods A total of 141 elderly patients with cognitive impairment admitted to the Affiliated Hospital of Xuzhou Medical University from 2017 to 2019 were retrospectively enrolled in the study. The patients were followed up for 3 years to observe the occurrence of AD, and were divided into AD group and non-AD group. The clinical data of the two groups were compared. Multivariate analysis was used to analyze the influencing factors of AD. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of Aβ1-42 and Bcl-2 for the occurrence of AD in the elderly patients with cognitive impairment. Results Among 141 patients, 24 patients were lost to follow-up. The incidence rate of AD in 117 patients with effective follow-up was 24.79% (29/117). The level of Aβ1-42 was significantly higher and the level of Bcl-2 was significantly lower in AD group than that in non-AD group (P<0.01). There were no significant differences in gender, body mass index, hypertension, coronary heart disease, hyperlipidemia, marital status, caregivers and smoking between the two groups (P>0.05). Compared with non-AD group, AD group had higher age, higher proportion of patients with diabetes, higher proportion of patients with an education level of junior high school or below, and a lower Montreal Cognitive Assessment (MoCA) score (P<0.05). Binary Logistic regression analysis showed that age (OR=3.614) and Aβ1-42 (OR=4.823) were risk factors for AD, while Bcl-2 (OR=0.311) was a protective factor (P<0.05). ROC curve showed that the sensitivity of Aβ1-42, Bcl-2 and their combination to predict AD in the elderly patients with cognitive impairment was 75.90%, 65.50% and 89.70%, respectively, and the specificity was 71.60%, 72.70% and 90.90%, respectively. The area under the curve (AUC) was 0.784, 0.729 and 0.920, respectively. Conclusions The serum level of Aβ1-42 is a risk factor for AD in the elderly patients with cognitive impairment, and the serum level of Bcl-2 is a protective factor. The detection of Aβ1-42 and Bcl-2 can effectively predict the occurrence of AD in the elderly patients with cognitive impairment, and the combination of the two indexes has a better predictive value. References | Related Articles | Metrics

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Effect of pancreatic kallidinogenase on mild cognitive impairment in elderly patients with type 2 diabetes mellitus SHI Wen, ZHU Ping, ZHOU Jie, YAN Ting, HUANG Yujie, YAN Yan 2024, 38 (6):  587-591.  doi: 10.3969/j.issn.1003-9198.2024.06.011 Abstract ( 83 )   PDF (1072KB) ( 453 )   Save Objective To explore the efficacy of pancreatic kallidinogenase in the elderly patients with type 2 diabetes mellitus (T2DM) combined with mild cognitive impairment (MCI). Methods Ninety-six elderly T2DM patients with MCI admitted to our hospital from June 2021 to June 2023 were enrolled in this study, and they were divided into the control group and the observation group by random number table method, with 48 cases in each group. The control group received routine treatment (metformin combined with donepezil hydrochloride). The observation group received pancreatic kallidinogenase treatment on the basis of the control group. The levels of blood glucose control, cognitive function, inflammatory factors, renal function, islet function and medication safety were compared between the two groups. Results After treatment, the levels of fasting blood glucose and glycosylated hemoglobin in both groups were lower than those before treatment (P<0.05), but there were no statistical differences between the two groups (P>0.05). After treatment, the levels of insulin resistance index (HOMA-IR), S100β protein, tumor necrosis factor-α, interleukin-6, serum creatinine and cystatin C in both groups were lower than those before treatment, and the levels of fasting C-peptide and insulin secretion index (HOMA-β), and the score of Montreal Cognitive Assessment (MoCA) in both groups were higher than those before treatment, especially in the observation group (P<0.05). There was no statistically significant difference in the total incidence rate of adverse reactions between the two groups (P>0.05). Conclusions Pancreatic kallidinogenase in the clinical treatment of elderly patients with T2DM and MCI can effectively improve the cognitive function, renal function and islet function, reduce the level of inflammation, and the medication is safe and controllable. References | Related Articles | Metrics

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Development of a 6-month risk prediction model for hypoglycemia in elderly patients with type 2 diabetes mellitus: a longitudinal study GUO Chun, YI Mengting, ZONG Qianxing, ZHOU Yi, WU Haidi, MO Yongzhen 2024, 38 (6):  592-597.  doi: 10.3969/j.issn.1003-9198.2024.06.012 Abstract ( 72 )   PDF (2020KB) ( 786 )   Save Objective To construct a risk prediction model for hypoglycemia within 6 months in the elderly patients with type 2 diabetes mellitus (T2DM). Methods Convenience sampling was used to select 277 elderly patients with T2DM in Affiliated Geriatric Hospital of Nanjing Medical University from February to August 2022. According to whether hypoglycemia occurred within 6 months of follow-up, the patients were divided into hypoglycemia group (69 cases) and non-hypoglycemia group (208 cases). LASSO regression and multivariate Logistic regression analysis were used to determine the influencing factors, and a nomogram prediction model was constructed and evaluated. Results 24.91% (69/277) of the patients presented with hypoglycemia within 6 months. History of hypoglycemia (OR=6.989, 95%CI: 3.671-13.844, P<0.001) was the risk factor, while high MMSE score (OR=0.890, 95%CI: 0.820-0.959, P=0.003) and triglyceride ≥1.7 mmol/L (OR=0.268, 95%CI: 0.083-0.708, P=0.014) were the protective factors for hypoglycemia in the elderly patients with T2DM within 6 months. The area under the receiver operating characteristic curve (AUC) of the model was 0.801 (95%CI: 0.742-0.860), with a sensitivity of 0.841, a specificity of 0.673, and an accuracy of 71.48%. In the internal validation, the corrected AUC was 0.783, indicating that the model had good discrimination. The Hosmer-Lemeshow goodness of fit test showed that the model had a good calibration (χ2=10.81,P=0.212). The results of clinical decision curve analysis showed that when the prediction threshold of the model was between 0.02 and 0.69, the net clinical benefit level of the patients was the highest. Conclusions The constructed model has good discrimination, calibration and clinical applicability, which can provide a basis for medical staff to identify high-risk group of hypoglycemia and take preventive intervention. References | Related Articles | Metrics

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Predictive value of hypoperfusion intensity ratio combined with systemic immune-inflammation index for early neurological deterioration after thrombolysis in elderly patients with acute ischemic stroke YOU Jiaxiang, LI Xiaoxi, XIA Jun, LI Haopeng, WANG Jun 2024, 38 (6):  598-602.  doi: 10.3969/j.issn.1003-9198.2024.06.013 Abstract ( 73 )   PDF (1077KB) ( 612 )   Save Objective To investigate the predictive value of hypoperfusion intensity ratio (HIR) combined with systemic immune-inflammation index (SII) for the occurrence of early neurological deterioration (END) in the elderly patients with acute ischemic stroke (AIS) after thrombolysis. Methods A total of 185 patients with AIS admitted to Department of Emergency of Nanjing Drum Tower Hospital from January 2020 to December 2022 were retrospectively enrolled in this study, and they were divided into END group and non-END group. The baseline data of the two groups were statistically analyzed. Logistic regression model was used to analyze the risk factors for the occurrence of END. The predictive value of HIR and SII for END in the elderly patients with AIS was analyzed by using receiver operating characteristics (ROC) curve. Results There were 41 patients presenting with END, with an incidence rate of 22.2%. The levels of HIR and SII, National Institutes of Health Stroke Scale (NIHSS) score at admission and blood glucose in END group were significantly higher than those in non-END group (P<0.05); Logistic regression analysis showed that higher HIR (OR=1.065, 95% CI: 1.038-1.092), higher SII (OR=1.001, 95% CI: 1.000-1.001), higher NIHSS score at admission (OR=1.063, 95% CI: 1.003-1.127) and higher blood glucose (OR=1.186, 95% CI: 1.039-1.354) were the independent risk factors for the development of END in elderly AIS patients (P <0.05). The results of the ROC curve analysis of the indicators predicting the occurrence of END in the elderly patients with AIS showed that the AUC of HIR, SII, NIHSS score, blood glucose and HIR combined with SII at admission were 0.861, 0.658, 0.728, 0. 665, and 0. 885. Conclusions HIR and SII have important influences on the occurrence of END in the elderly patients with AIS, and the combined detection of HIR and SII has a higher predictive value for the occurrence of END. References | Related Articles | Metrics

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Correlation of frailty with serum leptin and 25-hydroxyvitamin D in elderly hemodialysis patients ZHU Bei, HANG Lejia, GAO Fei, YUAN Haichuan, ZHAO Weihong 2024, 38 (6):  603-606.  doi: 10.3969/j.issn.1003-9198.2024.06.014 Abstract ( 78 )   PDF (1055KB) ( 695 )   Save Objective To investigate the levels of serum leptin and 25-hydroxyvitamin D [25(OH)D], and to analyze their correlation with frailty in the elderly hemodialysis patients. Methods A total of 150 elderly hemodialysis patients admitted to our hospital from April 2021 to April 2023 were enrolled in this study. The patients were divided into non-frailty group (51 cases), pre-frailty group (74 cases) and frailty group (25 cases) according to Fried phenotype. The general data, serum leptin, 25(OH)D and cardiac function of the three groups were compared. Multivariate Logistic regression was used to analyze the influencing factors of frailty in the elderly hemodialysis patients. Results There were significant differences in age, proportion of diabetes mellitus, dialysis age, left ventricular end-diastolic diameter, albumin, magnesium, IL-6, leptin and 25(OH)D levels among the three groups (P<0.01). Multivariate Logistic regression analysis showed that age, dialysis age, diabetes, magnesium, IL-6, albumin, leptin, 25(OH)D and left ventricular end-diastolic diameter were the independent factors of frailty in the elderly hemodialysis patients (P<0.05). Conclusions It is important to intervene the low level of albumin, high level of leptin and low level of 25(OH)D to delay the progression of frailty in the elderly hemodialysis patients. References | Related Articles | Metrics

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Value of serum TIMP-1 and M-CSF levels in early diagnosis of post-hepatitis B cirrhosis in elderly patients SHI Hua, HE Zhiwei, GAN Ke 2024, 38 (6):  607-611.  doi: 10.3969/j.issn.1003-9198.2024.06.015 Abstract ( 68 )   PDF (1068KB) ( 293 )   Save Objective To investigate the value of serum tissue inhibitors of metalloproteinase-1 (TIMP-1) and macrophage colony-stimulating factor (M-CSF) levels in the early diagnosis of post-hepatitis B cirrhosis in the elderly patients. Methods A total of 97 elderly patients with post-hepatitis B cirrhosis admitted to our hospital from March 2020 to May 2022 were enrolled as the study group, and 125 elderly patients with hepatitis B during the same period were enrolled as the control group. According to the degree of cirrhosis, the study group was divided into 39 patients with grade A cirrhosis, 33 patients with grade B cirrhosis and 25 patients with grade C cirrhosis. The serum TIMP-1 and M-CSF levels were compared between the two groups and the patients with different grades of cirrhosis, and the correlation between serum TIMP-1 level and serum M-CSF level was analyzed. The influencing factors of cirrhosis in the elderly patients with hepatitis B were analyzed, and the diagnostic value of serum TIMP-1 and M-CSF levels for post-hepatitis B cirrhosis in the elderly patients was analyzed. Results The levels of total bilirubin (TBIL), alpha-fetoprotein (AFP) and prothrombin time (PT) in the study group were higher than those in the control group (P<0.01), and the level of albumin (ALB) was lower than that in the control group (P<0.01). The levels of TIMP-1 and M-CSF in the study group were higher than those in the control group (P<0.01). The serum levels of TIMP-1 and M-CSF in the patients with grade C cirrhosis were highest, followed by grade B and grade A (P<0.05). Serum TIMP-1 level was positively correlated with serum M-CSF level (P< 0.05). Logistic regression analysis showed that TBIL, PT, TIMP-1, M-CSF and ALB were the influencing factors for cirrhosis in the elderly patients with hepatitis B (P<0.05). The area under the curve (AUC) of serum TIMP-1, M-CSF and combination in diagnosing liver cirrhosis in the elderly patients with hepatitis B was 0.821, 0.813 and 0.896, respectively (P<0.05), and the AUC of combination of TIMP-1 and M-CSF was higher (P<0.05). Conclusions Serum TIMP-1 and M-CSF levels have important value in early diagnosis of post-hepatitis B cirrhosis in the elderly patients, and their combination has higher diagnostic value. References | Related Articles | Metrics

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Reliability and validity of the Chinese version of Assessment of Swallowing Ability for Pneumonia in Chinese elderly patients with central nervous system diseases CHANG Xinxin, PAN Bei, KUANG Wen, DU Wenjin, LIU Wei, LI Yumeng, GUO Xiumin, CHEN Dawei 2024, 38 (6):  612-616.  doi: 10.3969/j.issn.1003-9198.2024.06.016 Abstract ( 78 )   PDF (1071KB) ( 431 )   Save Objective To translate Assessment of Swallowing Ability for Pneumonia (ASAP) from English into Chinese and to evaluate the reliability and validity of Chinese version in Chinese elderly patients with central nervous system diseases. Methods Eight experts were invited to evaluate the content validity of the Chineses version of ASAP. Fifty elderly inpatients with central nervous system diseases were evaluated using the Chinese version of ASAP and Standard Swallowing Assessment (SSA) by one nurse and one rehabilitation doctor, respectively. The evaluation time was compared and the relationship between the two scales was analyzed. Twenty patients were randomly selected, and they were evaluated using the Chinese version of ASAP by the rehabilitation doctor on the same day, and were evaluated again by the nurse on the second day. The internal and external intraclass correlation coefficients (ICC) were calculated. All patients were guided to adjust the eating patterns according to their ASAP grades, and the incidence of aspiration pneumonia (AP) was observed. Results ASAP Chinese version showed good internal consistency among intra-evaluators consistency (ICC=0.93, P<0.001) and inter-evaluator consistency (ICC=0.91, P<0.001); The Cronbach’s α coefficient of each item was 0.913-0.945, while the Cronbach’s α coefficient of the scale was 0.938; Each item content validity index (I-CVI) was 0.875-1.000, and the scale content validity index (S-CVI) was 1, and the average S-CVI was 0.984. ASAP Chinese version was negatively correlated with SSA (r=-0.93, P<0.001), and the evaluation time of ASAP Chinese version was less than that of SSA (7.1±1.8 min vs 19.3±3.0 min, P=0.02). The incidence rate of AP among the patients with moderate abnormal ASAP was significantly higher than that among the patients with normal ASAP or mildly abnormal ASAP (P<0.01). Conclusions ASAP Chinese version shows good reliability and validity in Chinese elderly patients with central nervous system diseases. It is easy, safe and reliable to operate, and needs less evaluation time. Furthermore, the scale can also guide the patients to adjust their eating patterns and reduce the incidence of AP. References | Related Articles | Metrics

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Application of transrectal shear wave elastography in differentiating benign and malignant prostatic nodules in the elderly LI Yating, WANG Hui, LIU Xiaojing, HE Ping, REN Airong, HE Rui, WANG Meijuan, JIANG Xuezhong 2024, 38 (6):  617-620.  doi: 10.3969/j.issn.1003-9198.2024.06.017 Abstract ( 65 )   PDF (1283KB) ( 304 )   Save Objective To explore the value of transrectal shear wave elastography (TRSWE) in differentiating benign and malignant prostatic nodules in the elderly patients. Methods Young’s modulus of benign and malignant prostate diseases was compared in 83 patients with prostate diseases who underwent biopsy after TRSWE examination. The relationship between Young’s modulus and Gleason of prostate cancer was analyzed. Results The age, maximum value (Emax), minimum value (Emin) and the average value (Emean) of Young’s modulus of the malignant lesions were higher than those of benign lesions, and the difference was statistically significant (P<0.05). AUC and 95%CI of Emax, Emean and Emin to predict prostate cancer were 0.794 (0.691-0.875), 0.740 (0.632-0.830), and 0.634 (0.521-0.737), respectively. The cutoff value of Emax, Emean and Emin was 69.2 kPa, 50.8 kPa and 30.7 kPa, respectively. The Emax and Emean values in the high-risk group score were higher than those in the low-risk group (Gleason score was 6) and the benign group (all P<0.05). The differences in Emax and Emean between the benign group and low-risk group were not statistically significant, and the difference in Emin among all groups was not statistically significant (all P>0.05). Conclusions TRSWE shows high value in the diagnosis of prostate cancer, and it can also indicate the pathological grade of the tumor and provide an imaging evidence for the formulation of clinical treatment plans for prostate cancer. References | Related Articles | Metrics

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Comparison of the therapeutic effects of continuous suture and intermittent suture in the treatment of elderly patients with choledocholithiasis by primary suture HU Yuanchang, SHI Yi, BAI Jianfeng, GAO Ji 2024, 38 (6):  621-624.  doi: 10.3969/j.issn.1003-9198.2024.06.018 Abstract ( 69 )   PDF (1050KB) ( 520 )   Save Objective To explore the operation skills and clinical effects of continous suture and intermittent snture for laparoscopic common bile duct exploration with primary suture in the treatment of elderly patients with common bile duct stones. Methods The clinical data of 276 elderly patients with common bile duct stones treated by laparoscopic common bile duct exploration with primary suture in our center from January 2020 to January 2023 were retrospectively analyzed, including 181 cases of continuous suture with barb suture (continuous suture group) and 95 cases of intermittent suture with vicryl suture (intermittent suture group). The general data, perioperative related indexes and the incidence of postoperative complications were compared between the two groups. Results All laparoscopic surgery had been successfully completed, without any case of conversion. There were no statistical differences in general data, the diameter of common bile duct, the thickness of common bile duct wall and the diameter of stones between the two groups (P>0.05). The operation time, the time of bile duct suture and operation bleeding volume in continuous suture group were better than those in intermittent suture group (P<0.05 or P<0.01). Seven cases with bile leakage were recovered by continuous drainage, but the incidence rate of bile leakage in continuous suture group was less than that in intermittent suture group (1.1% vs 5.3%, P=0.037). After 3-24 months of follow-up, there were no significant differences in the residual rate of stone and recurrence rate of cholecystolithias between the two groups. Conclusions Compared with intermittent suture, laparoscopic common bile duct exploration with primary suture by continuous suture is an effective and safe minimally invasive surgery for the elderly patients with common bile duct stones, which can shorten the operation time, reduce the complications, and accelerate the postoperative recovery. References | Related Articles | Metrics

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Behavioral experience of home management of volume overload in elderly patients with chronic heart failure based on COM-B theory: a qualitative study YU Wenhui, ZHU Huanhuan, CHEN Qiuju, ZHU Di, CHEN Yan 2024, 38 (6):  625-628.  doi: 10.3969/j.issn.1003-9198.2024.06.019 Abstract ( 77 )   PDF (1103KB) ( 427 )   Save Objective To explore the real-world experience of home volume management behaviors in the elderly patients with chronic heart failure (CHF) using the capacity-opportunity-motivation-behavior (COM-B) theoretical model as a framework, and to inform the development of a personalized home management plan for volume overload in the elderly patients. Methods Purposive sampling was used to conduct semi-structured interviews with 15 elderly CHF patients, and content analysis was applied to analyze the data. Results A total of three themes and nine sub-themes were distilled for volume overload home management behaviors in the elderly patients with CHF. The three themes were capacity, opportunity and motivation. Capacity included three sub-themes as poor symptom perception, lack of or deviated management knowledge and ineffective home management coping; Motivation included three sub-themes as lack of confidence in volume management, poor experience of volume management and low exercise self-efficacy; Opportunity included three sub-themes as hospital support, community support and family support. Conclusions The home management behavior of volume overload in the elderly patients with CHF is affected by multiple factors. It is necessary to expand the educational methods and approaches of volume management to effectively improve the self-decision-making and coping ability of the patients, to pay attention to the adverse experience, to establish positive beliefs, to stimulate the motivation for the behavior of volume management, to optimize the strategy of home volume management, and to strengthen the continuity of hospital-community-family volume management. References | Related Articles | Metrics

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Application of enhanced recovery after surgery combined with the improvement of surgical approach in laparoscopic radical prostatectomy WU Rongxin, ZHANG Heng, WANG Yan, HU Mingjin 2024, 38 (6):  629-633.  doi: 10.3969/j.issn.1003-9198.2024.06.020 Abstract ( 78 )   PDF (1074KB) ( 607 )   Save Objective To explore the application value of enhanced recovery after surgery(ERAS) combined with the improvement of surgical approach in laparoscopic radical prostatectomy. Methods A total of 30 cases receiving radical prostatectomy were divided into the control group (n=15) and the observation group (n=15). The control group received conventional perioperative treatment, and the surgical method was transperitoneal laparoscopic radical prostatectomy. The observation group received rapid rehabilitation surgical intervention mode, and the surgical method was extraperitoneal laparoscopic radical prostatectomy. The clinical parameters during surgery and after surgery and the complications were compared between the two groups. Results There were no significant differences in operative time and bleeding volume between the two groups (P>0.05). The time of getting out of bed, VAS score, time of anal exhaust, time of indwelling pelvic drainage tube, time of indwelling urinary catheter, hospital stay and medical cost in the observation group were lower than those in the control group (P<0.05). The incidence rates of respiratory symptoms, digestive symptoms, intestinal obstruction, urinary infection and incision infection in the observation group were lower than those in the control group(P<0.05), and the total clinical effective rate of the observation group was higher than that of the control group(P<0.05). Conclusions ERAS combined with the improvement of surgical approach in laparoscopic radical prostatectomy can reduce postoperative complications, speed up the process of rehabilitation and save medical costs, and it is worthy of clinical application and promotion. References | Related Articles | Metrics

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Application of clinical pathway of traditional Chinese medicine nursing in elderly patients with diabetes undergoing phacoemulsification cataract surgery DING Shan, WANG Xiaofeng 2024, 38 (6):  639-641.  doi: 10.3969/j.issn.1003-9198.2024.06.022 Abstract ( 84 )   PDF (1079KB) ( 579 )   Save Objective To improve the perioperative symptoms in the elderly patients with diabetes undergoing phacoemulsification cataract surgery by establishing and carrying out clinical pathway of traditional Chinese medicine nursing. Methods A total of 70 elderly patients with diabetes undergoing phacoemulsification cataract surgery were divided into the study group and the control group, with 35 cases in each group. The control group received routine perioperative nursing, while the study group received pathway of traditional Chinese medicine nursing on the basis of routine perioperative nursing. The clinical data of hospitalization days, plasma glucose, sight, postoperative complications, perioperative satisfaction and comfort were collected and compared between the two groups, and the effects of clinical pathway of traditional Chinese medicine nursing in improving the perioperative symptoms were analyzed. Results Compared with the control group, the sight showed no significant differences, and the level of postoperative plasma glucose and the incidence of complications were significantly lower, and the perioperative satisfaction and comfort were significantly higher in the study group (P＜0.05). Conclusions The clinical pathway of traditional Chinese medicine nursing is helpful to improve the perioperative symptoms and the patients’ satisfaction and comfort in the patients with diabetes undergoing phacoemulsification cataract surgery. References | Related Articles | Metrics

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Evaluation of the application effect of four-hand operation combined with ADOPT mode in the treatment of acute pulpitis in the elderly DAI Li, WANG Zengxiang, ZHANG Wang, ZHU Yanan, WU Ying, JIANG Siqi, ZHANG Yu, ZHOU Min, ZHU Min 2024, 38 (6):  642-645.  doi: 10.3969/j.issn.1003-9198.2024.06.023 Abstract ( 65 )   PDF (1053KB) ( 355 )   Save Objective To evaluate the application effect of four-hand operation combined with ADOPT mode in the treatment of acute pulpitis in the elderly. Methods A total of 80 elderly patients with acute pulpitis admitted to our hospital from January to December 2022 were randomly enrolled in this study using the random sampling method, and were divided into the experimental group and the control group according to the visiting time, with 40 cases in each group. The experimental group received four-hand operation combined with ADOPT mode treatment, and the control group received conventional four-hand operation treatment. Frankl Scale, Positive and Negative Affect Scale (PANAS), General Perceived Self-Efficacy Scale (GSES) and nursing satisfaction questionnaire were used to evaluate treatment adherence, positive and negative emotions, self-efficacy and nursing satisfaction of the patients, respectively, and the scores were compared between the two groups. Results The adherence rate in the experimental group was 80.0%, compared with 30.0% in the control group (P<0.05). The positive emotion score in the experimental group was 31.32±1.05, compared with 26.95±1.05 in the control group (P<0.05). The self-efficacy score in the experimental group after the intervention was 37.27±1.79, compared with 21.15±1.02 in the control group (P<0.05). Nursing satisfaction in the experimental group was 97.5%, compared with 72.5% in the control group (P<0.05). Conclusions Four-hand operation combined with ADOPT mode can significantly improve the patients’ treatment compliance, positive emotions and self-efficacy in the elderly patients with acute pulpitis, and improve the patients’ satisfaction with nursing work. References | Related Articles | Metrics