Table of Content

20 December 2024, Volume 38 Issue 12 Previous Issue    Next Issue

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A qualitative study of foot management experience in elderly patients with high-risk diabetic foot: based on the social ecological theory LIU Jing, ZHANG Ning, WENG Yajuan 2024, 38 (12):  1189-1193.  doi: 10.3969/j.issn.1003-9198.2024.12.001 Abstract ( 206 )   PDF (1165KB) ( 265 )   Save Objective To explore the foot self-management experience in the elderly patients with high-risk diabetic foot, so as to provide reference for targeted intervention programs. Methods From March 1 to May 31, 2024, a semi-structured interview was conducted among 15 elderly patients with high-risk diabetic foot based on the social ecological system theory. Content analysis was used to summarize and refine themes. Results In the elderly patients with high-risk diabetic foot, foot management experience was divided into three themes. The micro system—biological-psychological-behavior problems, including symptoms of pain, sleep disorder, social withdrawal, protective consciousness jagged, willingness to seek medical treatment, difficulties to evade and foot management information. The medium system—stakeholder interaction, including medical staff lack of communication, patients’ positive and negative influence, family support and other influence. The macroscopic system—social support dilemma, including the effect of education, shackles of thought, early screening not been implemented, poor medical treatment process. Conclusions The incidence of diabetic foot in the elderly is influenced by multiple factors including physical and comorbidities. Foot prevention is more important. Patients and stakeholders in the future all can take structured education to improve information dissemination media and the effect of foot management education. Foot management needs adopt the health management program, and further optimize the allocation of resources at the grassroots level to provide matching screening, monitoring, two-way referral and intervening in the chain, and improve the degree of resource utilization. References | Related Articles | Metrics

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Study on influencing factors of knowledge-belief-behavior of acute skin failure in ICU nurses XIE Yijie, SHEN Yihui, CHENG Haoran, ZHENG Jie, ZHOU Qing, FEI Guo, YANG Yan, MENG Defang, YU Shun 2024, 38 (12):  1194-1199.  doi: 10.3969/j.issn.1003-9198.2024.12.002 Abstract ( 71 )   PDF (1124KB) ( 143 )   Save Objective To investigate the current situation of knowledge-belief-behavior of acute skin failure(ASF) in intensive care unit (ICU) nurses and explore the influencing factors. Methods Using the convenience sampling method, a total of 439 ICU nurses from 15 tertiary hospitals and 6 secondary hospitals in Wuxi were surveyed by ASF knowledge-belief-behavior questionnaire in April 2024. The questionnaire included 3 dimensions of knowledge, belief, and behavior, with 40 entries. Results The total score and the scores of knowledge, belief and behavior dimensions of the questionnaire on ASF were 150.58±25.16, 45.99±13.10, 51.59±7.043, 53.00±12.32, respectively. Multiple linear regression analysis showed that the main influencing factors of ASF knowledge of ICU nurses in Wuxi were marital status, and wound stomy specialist nurses; The main influencing factors of ASF attitude were position and nurse level; The main influencing factors of ASF behavior were education, marital status and relevant training. Conclusions ICU nurses have more positive attitudes towards ASF nursing, but their knowledge and behavior level need to be improved. References | Related Articles | Metrics

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Skin tear in the elderly adults: a scoping review BAI Suping, LIANG Yiqing, ZHOU Fangfang, YAN Xueqin 2024, 38 (12):  1200-1204.  doi: 10.3969/j.issn.1003-9198.2024.12.003 Abstract ( 69 )   PDF (1132KB) ( 188 )   Save Objective To review the research on skin tear among elderly adults, and to investigate the research status of skin tear among elderly adults. Methods According to the method of the scoping review, the relevant literatures about skin tear among elderly adults in such academic databases as PubMed, Embase, CINAHL, Web of Science, Cochrane Library, SinoMed, CNKI, Wanfang and OpenGrey were collected. Time period was set from January 1990 to January 2024. Results A total of 40 articles were collected, including 36 in English and 4 in Chinese. Among them, 17 studies reported the incidence of skin tear among elderly adults and 7 studies reported the reasons of skin tear. The influencing factors of skin tear were classified into socio-demographic factors, health status-related factors, skin-related factors, and medical device-related factors. Two studies reported the influencing factors of skin tear healing among elderly adults,and 22 studies reported the skin tear assessment tools, and 11 studies reported prevention and intervention measures for skin tear. Conclusions Skin tear is common among the elderly adults, with complex and varied influencing factors and etiology. The relevant studies need to be enriched. Healthcare staffs should deepen their exploration of healing influences, risk assessment tools and risk prediction to prevent and intervene skin tear in the elderly. References | Related Articles | Metrics

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Effect of low-dose esketamine in hip replacement surgery on postoperative delirium and inflammatory factors in elderly patients with frailty CUI Yaomei, LI Xuefei, XIE Lixia, WU Honghui, WU Qian 2024, 38 (12):  1205-1209.  doi: 10.3969/j.issn.1003-9198.2024.12.004 Abstract ( 63 )   PDF (1168KB) ( 253 )   Save Objective To investigate the effect of low-dose esketamine on postoperative delirium (POD) and the levels of inflammatory factors after total hip replacement surgery in the elderly patients with frailty. Methods A total of 60 elderly patients with frailty aged 65 to 85 years undergoing total hip replacement surgery under general anesthesia from August 2021 to August 2022 were enrolled in this study, and were divided into esketamine group and control group, with 30 patients in each group. The esketamine group received 0.2 mg/kg esketamine during induction of anesthesia and the control group received the same volume of saline. Peripheral venous blood was collected 1 d before surgery, 1 d and 3 d after surgery; White blood cell count (WBC), neutrophil to lymphocyte ratio (NLR), the levels of interleukin-6 (IL-6) and high sensitivity C-reactive protein(hs-CRP)were detected. The operation time, blood loss, fluid rehydration, and intraoperative use of sufentanil, propofol, remifentanil and vasoactive drugs were recorded. The mean arterial pressure(MAP) and heart rate(HR)were recorded during anesthesia. The incidence of POD was evaluated with the Confusion Assessment Method(CAM) scale and the adverse reactions within 3 days after operation were recorded. Results Compared with the control group, the incidence rate of POD was significant decreased in the esketamine group. The intraoperative sufentanil consumption in the esketamine group was decreased than that in the control group(P<0.01). On the first and third day after operation, the levels of IL-6 and hs-CRP in the two groups were increased, especially in the control group (P<0.05). The levels of WBC and NLR in the two groups increased first and then decreased. On the first and third day after operation, the levels of WBC and NLR in the control group were significantly higher than those in the esketamine group (P<0.05). Compared with the control group, the levels of MAP and HR in the esketamine group were significantly decreased at different time points during anesthesia (P<0.05). There was no significant difference in the incidence rate of adverse reaction between the two groups. Conclusions The use of low-dose esketamine during induction of general anesthesia can reduce the incidence of POD in the elderly patients with frailty receiving hip replacement surgery, and the mechanism may be related to the inhibition of inflammation and stress reaction. References | Related Articles | Metrics

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Cross-sectional survey of community management in elderly patients with chronic diseases LU Chan, GUO Jianling, CHENG Yan, REN Liqun, WU Yanping 2024, 38 (12):  1210-1214.  doi: 10.3969/j.issn.1003-9198.2024.12.005 Abstract ( 62 )   PDF (1121KB) ( 106 )   Save Objective To investigate the current situation and the influencing factors of chronic disease management in the elderly patients with chronic diseases in the communities of Nanjing. Methods From July to September 2023, 120 elderly patients with chronic diseases were selected from the Xuanwu Lake Community Health Service Center and Suojin Village Community Health Service Center in Nanjing. A cross-sectional survey was conducted using a general information questionnaire, Satisfaction with Life Scale (SWLS), Social Support Rating Scale (SSRS), Family Adaption, Partnership, Growth, Affection, and Resolve(APGAR), and Patient Assessment of Chronic Illness Care (PACIC). Pearson correlation analysis and multiple linear regression analysis were conducted to investigate the influencing factors of the score of PACIC. Results The score of PACIC in the 120 elderly patients with chronic diseases was 2.75±0.47, indicating a moderate level of medical support. Among them, 5 cases (4.2%) presented with low-level medical support, 106 cases (88.3%) presented with moderate-level medical support, and 9 cases (7.5%) presented with high-level medical support. The results of single factor analysis showed that there were significant differences in SWLS, SSRS and APGAR scores among the three groups (P<0.05). Multiple linear regression analysis showed that life satisfaction and social support were influencing factors of the score of PACIC in the elderly patients with chronic diseases (P<0.05). Conclusions The level of chronic disease management in the elderly patients is not high and is influenced by various factors. Clinical medical staff need to develop chronic disease management strategies to improve health status and quality of life in the elderly. References | Related Articles | Metrics

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Effect of individualized blood pressure management on postoperative myocardial injury in elderly patients undergoing spinal surgery YANG Xiaoyan, JI Fuhai, WANG Yulan 2024, 38 (12):  1215-1219.  doi: 10.3969/j.issn.1003-9198.2024.12.006 Abstract ( 52 )   PDF (1116KB) ( 92 )   Save Objective To investigate the effects of different blood pressure (BP) management strategy on postoperative myocardial injury in the elderly patients undergoing spinal surgery. Methods A total of 60 elderly patients undergoing posterior lumbar interbody fusion (PLIF) surgery were randomly divided into standardized management group (group S, n=30) and individualized management group (group I, n=30). Group S maintained the level of intraoperative mean arterial pressure (MAP) at ≥ 65 mmHg or maintained the decrease ≤30% of the baseline level, and group I maintained MAP at 90% to 110% of the baseline level.The blood pressure and heart rate at preoperative visit (T0), before anesthesia (T1), at the beginning of surgery (T2), at the time of spinal decompression (T3), at the end of surgery (T4) and 24 h after surgery (T5) were recorded, and the levels of high sensitivity troponin T (hsTnT), serum creatinine (Cr) and blood urea nitrogen (BUN) were detected before and 24 h after surgery.The incidence of myocardial injury after non-cardiac surgery (MINS) was recorded in 2 groups. Results During the period of intraoperative spinal canal decompression, the level of MAP was significantly higher and the heart rate was significantly lower in group I than those in group S (P<0.05). The intraoperative urine volume in group I was higher than that in group S (P<0.05). The levels of hsTnT, Cr and BUN in group I were significantly lower than those in group S 24 h after operation (P<0.05).MINS occurred in 2 patients (6.7%) in group I and 10 patients (33.3%) in group S, with statistical difference (P<0.05). Conclusions Individualized BP management strategy can reduce the incidence of postoperative MINS in the elderly patients undergoing PLIF. It also reduces the levels of Cr and BUN. References | Related Articles | Metrics

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Correlation between preoperative plasma fibrinogen and postoperative delirium in elderly patients undergoing orthopedic surgery LIU Quanfang, DUAN Huawei, HU Xiaoyi, JI Muhuo, FAN Di 2024, 38 (12):  1220-1223.  doi: 10.3969/j.issn.1003-9198.2024.12.007 Abstract ( 64 )   PDF (1157KB) ( 145 )   Save Objective To explore the correlation between preoperative plasma fibrinogen and postoperative delirium (POD) in the elderly patients undergoing orthopedic surgery, and to explore the predictive value of preoperative plasma fibrinogen for POD. Methods A total of 440 elderly patients undergoing orthopedic surgery at the Second Affiliated Hospital of Nanjing Medical University from February 2021 to August 2023 were enrolled in this study. The clinical data were collected. According to the occurrence of POD, the patients were divided into POD group and Non-POD group. Logistic regression analysis and receiver operating characteristic (ROC) curve were used to analyze the correlation between preoperative plasma fibrinogen and POD and the predictive value of preoperative plasma fibrinogen for POD in the elderly patients undergoing orthopedic surgery. Results There were 74(16.82%) cases presenting with POD in this study. Compared with Non-POD group, the levels of age,American Society of Anesthesiologists (ASA) classification, surgical history,intraoperative blood loss, white blood cells, C-reactive protein, fibrinogen, creatinine and prothrombin time were significantly higher, while the levels of body mass index(BMI), preoperative Mini-Mental State Examination (MMSE) score,hemoglobin and albumin were significantly lower in POD group (P<0.05). Logistic regression analysis showed that ASA grade(OR=3.839, 95%CI: 1.613－9.140, P=0.002), preoperative MMSE (OR=0.895, 95%CI: 0.839－0.955, P=0.001), age (OR=1.098, 95%CI: 1.041－1.159, P=0.001) and fibrinogen (OR=1.695, 95%CI: 1.117－2.573, P=0.013) were the independent influencing factors of POD. ROC curve showed that the area under the curve(AUC)of age, preoperative MMSE, fibrinogen, and ASA classification predicting POD was 0.819(0.762-0.875), 0.779(0.713-0.846), 0.737(0.671-0.803), and 0.760(0.707-0.814), respectively. The AUC of the combination of four indicators in predicting POD was 0.889(0.848-0.930), with a sensitivity of 82.40% and a specificity of 82.00%. Conclusions Preoperative plasma fibrinogen is significantly increased in the elderly patients presenting with POD, which can be used as a predictive marker for POD. References | Related Articles | Metrics

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Distribution and drug resistance of vaginal pathogens in elderly women after hysterectomy ZHOU Lin, XIONG Keqin, LUAN Ting 2024, 38 (12):  1224-1228.  doi: 10.3969/j.issn.1003-9198.2024.12.008 Abstract ( 64 )   PDF (1125KB) ( 108 )   Save Objective To analyze the distribution of vaginal pathogens and drug resistance in the elderly women after hysterectomy, and to provide a reference for the reasonable selection of perioperative antibiotics. Methods A retrospective analysis was conducted on the clinical data of 347cases of elderly women admitted to Women’s Hospital of Nanjing Medical University from January to December 2022 who underwent hysterectomy and received the detection of postoperative vaginal secretion culture. The clinical characteristics, postoperative infection indicators, distribution of vaginal pathogens and drug resistance results were analyzed. Results There were more gram-negative bacteria than gram-positive bacteria detected in the vagina of the elderly women after hysterectomy, among which Escherichia coli (34.21%) was the most, followed by Enterococcus faecalis (28.42%) and Klebsiella pneumoniae (5.26%).There was no significant difference in the distribution of vaginal pathogens in the patients with different age, operation methods and diseases, but there was significant difference in the distribution of vaginal pathogens in the patients with different hysterectomy ranges (P<0.05).Moreover, postoperative fever was more common in gram-negative bacteria group.The results of drug sensitivity showed that more than 60.00% of Escherichia coli and Klebsiella pneumoniae were resistant to cephalosporins and penicillins, while the resistance rate of β-lactam/β-lactamase inhibitor complex was less than 5%, and no resistance to carbapenem was found.The total multiple drug resistance rate of vaginal pathogens in the elderly women after hysterectomy was 80.00% (140/175). Conclusions Gram-negative bacteria are more easily detected in the vagina of elderly women after hysterectomy, and Escherichia coli is the most easily detected. The total multiple drug resistance rate of pathogenic bacteria is high.When upgrading the use of antibiotics in elderly women after hysterectomy, β-Lactam/β-Lactamase inhibitor complex is recommended, and the direct use of carbapenems should be avoided as much as possible. References | Related Articles | Metrics

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Relationship of tumor necrosis factor and frailty with cognitive dysfunction in elderly patients with stroke WANG Lingling, SHEN Xiaozhu, GONG Chen, HU Guangyun 2024, 38 (12):  1229-1233.  doi: 10.3969/j.issn.1003-9198.2024.12.009 Abstract ( 57 )   PDF (1115KB) ( 237 )   Save Objective To analyze the relationship of tumor necrosis factor α (TNF-α) and frailty with cognitive impairment in the elderly patients with stroke. Methods Ninety-four elderly patients with stroke admitted to Lianyungang Second People’s Hospital from October 2022 to October 2023 were enrolled in this study. All patients underwent the assessment using Montreal Cognitive Assessment (MoCA) scale, Fried frailty index and National Institutes of Health Stroke Scale (NIHSS), respectively. The patients with MoCA score ≥26 were divided into the normal group (n=53), and those with score <26 were divided into the cognitive impairment group (n=41). The levels of TNF-α, apoptosis markers including cysteine-dependent aspartate-specific protease-3 (Caspase-3), fatty acid synthase (Fas), Fas ligand (FasL), and neurotransmitters including dopamine (DA), serotonin (5-HT), norepinephrine (NE) were measured and compared between the two groups. Multiple Logistic regression analysis was conducted to identify the independent factors influencing the occurrence of cognitive impairment. The predictive value of frailty and TNF-α for cognitive impairment was assessed by the receiver operating characteristic (ROC) curve. Results The scores of Fried and NIHSS, and the levels of TNF-α, Caspase-3, Fas and FasL were significantly higher, and the levels of DA, 5-HT and NE were significantly lower in the cognitive impairment group than those in the normal group. Multivariable analysis revealed that Fried and NIHSS scores, and the levels of TNF-α, Caspase-3, Fas, FasL, DA, 5-HT, and NE were independent influencing factors of cognitive impairment (all P<0.05). The sensitivity and specificity of the Fried score predicting cognitive impairment was 92.7%, 60.4%, while the sensitivity and specificity of TNF-α was 82.9%, 83.0%, respectively. Conclusions Higher levels of TNF-α and frailty are associated with an increased risk of cognitive impairment in the elderly patients with stroke. References | Related Articles | Metrics

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Effect of assisted treatment of semiconductor laser for periodontal basic therapy in elderly patients with periodontitis complicated with type 2 diabetes mellitus XU Jiali, ZHANG Min, MA Chunyi, LI Qiao, ZHOU Yan, MEI Youmin 2024, 38 (12):  1234-1237.  doi: 10.3969/j.issn.1003-9198.2024.12.010 Abstract ( 40 )   PDF (1097KB) ( 117 )   Save Objective To evaluate the effect of semiconductor laser combined with periodontal basic treatment in the elderly patients with periodontitis complicated with type 2 diabetes mellitus(T2DM). Methods A total of 32 elderly patients with chronic periodontitis complicated with T2DM were randomly divided into the observation group and the control group. The observation group received semiconductor laser treatment combined with periodontal basic treatment, while the control group received periodontal basic treatment only. Probing depth (PD), bleeding index (BI),clinical attachment loss (CAL) and tooth mobility(TM) were recorded and compared between the two groups before treatment, 6 weeks, 3 months and 6 months after treatment. And the scores of pain visual analogue scales(VAS)immediately after treatment and on the first day after treatment were also assessed and compared. Results The levels of PD and BI in the two groups 6 weeks, 3 months and 6 months after treatment were significantly improved compared with those before treatment (P<0.05), especially in the observation group (P<0.05). The pain degree in the observation group was lower than that in the control group immediately after treatment and on the first day after treatment(P<0.05). Conclusions The application of semiconductor laser combined with periodontal basic treatment in the elderly patients with chronic periodontitis complicated with T2DM is helpful to improve the clinical efficacy, and is worthy of clinical application. References | Related Articles | Metrics

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Effect of denosumab combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compressed fracture in elderly women HUANG Zhipeng, SONG Mengying, ZHAO Xiaolin, OUYANG Chuanwei, ZHANG Peng 2024, 38 (12):  1238-1241.  doi: 10.3969/j.issn.1003-9198.2024.12.011 Abstract ( 61 )   PDF (1095KB) ( 160 )   Save Objective To observe the efficacy of denosumab combined with percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compressed fracture (OVCF) in the elderly women. Methods A total of 102 elderly female patients with thoracolumbar vertebral compressed fracture who underwent PKP were divided into control group and treatment group according to whether they received denosumab treatment. The control group received oral calcium carbonate and vitamin D3 tablets and alfacalcidol soft capsules, while the treatment group received denosumab in addition to the control group’s dosage regimen. The scores of Visual Analogue Scale (VAS)and Oswestry Disability Index (ODI) were used to evaluate pain improvement and the effect of the patients before surgery and 3 days, 6 and 12 months after treatment. The incidence rate of adjacent vertebral refracture and changes in bone mineral density at 1-year followup were compared between the two groups. Results After 6 and 12 months of treatment, VAS and ODI scores of the control group increased, and the ODI scores of the treatment group decreased compared with those 3 days after treatment, and there were significant differences between the two groups (P＜0.05). After 12 months of treatment, the bone mineral density of the treatment group was significantly higher than that before treatment and that of the control group (P＜0.05); The adjacent vertebral refracture rate in the treatment group was significantly lower than that in the control group (P＜0.05). Conclusions Denosumab combined with PKP can prominently improve the clinical efficacy of OVCF treatment, effectively alleviate clinical symptoms, increase bone mineral density, reduce the risk of adjacent vertebral refracture after surgery and improve long-term prognosis of the elderly women patients. References | Related Articles | Metrics

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Effect of serratus anterior plane block on inflammatory factors in elderly patients undergoing thoracoscopic surgical ablation for atrial fibrillation XU Peilong, WANG Min, CHEN Yu, CHEN Xiaodong 2024, 38 (12):  1242-1245.  doi: 10.3969/j.issn.1003-9198.2024.12.012 Abstract ( 44 )   PDF (1099KB) ( 113 )   Save Objective To evaluate the effect of ultrasound-guided serratus anterior plane block (SAPB) combined with general anesthesia on postoperative inflammatory factors in the elderly patients undergoing thoracoscopic surgical ablation for atrial fibrillation. Methods This study was a single-center, prospective, randomized controlled trial involving 80 elderly patients, who were randomly divided into SAPB group and control group. The SAPB group received preoperative ultrasound-guided bilateral SAPB (20 mL of 0.375% ropivacaine on each side), while the control group did not receive nerve block. The levels of the inflammatory factors within 24 hours after the operation were compared between the two groups. Results The levels of interleukin-6 (IL-6) and high sensitivity C-reaction protein (hs-CRP) in the SAPB group were significantly lower than those in the control group (P＜0.01). The SAPB group showed more stable postoperative vital signs and significantly lower pain scores compared to the control group (P＜0.01). Conclusions SAPB combined with general anesthesia can effectively reduce postoperative inflammation in the elderly patients undergoing thoracoscopic surgical ablation for atrial fibrillation, and improve the postoperative recovery. References | Related Articles | Metrics

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A nomogram prediction model for risk of Alzheimer’s disease among the elderly WANG Bingsheng, CAO Shihua, CHENG Lingling, SHI Aili, SHI Yankai, YAO Jiani, LOU Xiajing, QI Wenhao, DONG Chaoqun, ZHU Xiaohong, WANG Bing, HE Danni, CHEN Yanfei 2024, 38 (12):  1246-1249.  doi: 10.3969/j.issn.1003-9198.2024.12.013 Abstract ( 50 )   PDF (1360KB) ( 319 )   Save Objective To investigate the risk factors of Alzheimer’s disease (AD) in the elderly and to develop a nomogram model for risk prediction. Methods The data of 2968 elderly cases were extracted from the National Alzheimer’s Coordinating Center (NACC), a public database in USA, including sociodemographic information, lifestyle, mental health, sleep patterns, disease history and medication usage. The subjects were randomly divided into a modeling group and an internal validation group at a ratio of 7∶3. Multivariable Logistic regression model was employed to identify the risk factors of AD in the elderly, and a nomogram prediction model was constructed based on these variables. The model’s discriminative ability and calibration were assessed by the area under the receiver operating characteristic (ROC) curve and calibration plots. The clinical value of the model was evaluated with clinical impact curves. Results The multivariable Logistic regression analysis showed that gender, educational level, systolic blood pressure, depression, anxiety, rapid eye movement sleep behavior disorder, age, history of traumatic brain injury and the number of medications were influencing factors of AD in the elderly (P<0.05). A risk prediction nomogram was established based on these nine factors. The area under the ROC curve and calibration plots showed good discriminative ability and accuracy of the model. The clinical impact curves demonstrated that the model had practical clinical utility within a substantial range of threshold values. Conclusions The nomogram prediction model for AD constructed in this study demonstrates good predictive performance and can provide a reference for the early identification of the elderly with high risk of AD. References | Related Articles | Metrics

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Efficacy of repetitive transcranial magnetic stimulation in relieving pain and quality of life in patients with acute central poststroke pain ZHANG Yanwu, WANG Hai, GAO Songnian, SUN Xiaoxing, CHEN Chao, SHEN Yuanyuan, DING Lei 2024, 38 (12):  1250-1254.  doi: 10.3969/j.issn.1003-9198.2024.12.014 Abstract ( 52 )   PDF (1131KB) ( 124 )   Save Objective To evaluate the efficacy of repetitive transcranial magnetic stimulation(rTMS) on pain and the quality of life in the patients with acute central poststroke pain(CPSP). Methods A total of 30 patients aged 60 years and over with acute CPSP were selected and randomly divided into two groups using a random number table. The rTMS group received rTMS intervention treatment (n=15),and the control group received sham rTMS treatment (n=15) for 3 weeks, respectively. At baseline and after 3 weeks of intervention, pain Numeric Rating Scale (NRS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and Brief World Health Organization Quality of Life (WHOQOL-BREF) were evaluated and compared between the two groups. Results There were no significant differences in general condition and the scores of above scales between the two groups at baseline (P>0.05). After 3 weeks of treatment, the score of NRS in the rTMS group was significantly lower than that at baseline and that in the control group (P<0.05); The scores of HAMA and HAMD in the rTMS group were significantly lower than those at baseline (P<0.05), but showing no statistical difference from those in the control group (P>0.05). After 3 weeks of treatment, the sum of the first 28 items of WHOQOL-BREF and the overall score of WHOQOL-BREF showed significant improvement in both groups (P<0.05), especially in the rTMS group(P<0.05). Conclusions rTMS applied to the affected motor cortex can effectively alleviate acute CPSP and improve pain-related emotional disorders and quality of life. References | Related Articles | Metrics

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Relationship between preoperative sarcopenia and postoperative anastomotic leakage in elderly patients with esophageal squamous cell carcinoma LU Peng, ZHANG Mingzhi, XU Keping, ZHANG Shaohong, WANG Weimin, TIAN Wenze 2024, 38 (12):  1255-1259.  doi: 10.3969/j.issn.1003-9198.2024.12.015 Abstract ( 50 )   PDF (1126KB) ( 116 )   Save Objective To explore the relationship between preoperative sarcopenia and postoperative anastomotic leakage in the elderly patients with esophageal squamous cell carcinoma undergoing minimally invasive radical surgery for esophageal cancer. Methods A retrospective analysis was conducted on the clinical data of 953 elderly patients with esophageal squamous cell carcinoma who underwent minimally invasive thoracolaparoscopy combined with radical esophagectomy in the Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University from January 2020 to December 2022. The incidence of sarcopenia and related clinical and pathological indicators of the patients were recorded, and the correlation between the above indicators and the incidence of postoperative anastomotic leakage was analyzed. Results The incidence rate of postoperative anastomotic leakage in the elderly patients with esophageal squamous cell carcinoma undergoing minimally invasive radical esophagectomy was 4.83%(46/953). Compared with the non-anastomotic leakage group, the anastomotic leakage group had higher proportion of preoperative sarcopenia, postoperative pneumonia and surgery time ＜4 hours (P<0.01). Multivariate Logistic analysis showed that preoperative sarcopenia, postoperative pneumonia and surgery time ＜4 hours were risk factors for postoperative anastomotic leakage in the patients with esophageal squamous cell carcinoma undergoing minimally invasive esophageal cancer radical surgery. Conclusions Preoperative sarcopenia is a high-risk factor for postoperative anastomotic leakage in the elderly patients with esophageal squamous cell carcinoma undergoing minimally invasive radical esophagectomy, and can be used as a key indicator for early preoperative evaluation. References | Related Articles | Metrics

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Interaction and compatibility optimization of propofol and etomidate in general anesthesia induction of elderly patients undergoing cardiopulmonary bypass assisted cardiac surgery WU Xiong, GU Xiaoping 2024, 38 (12):  1260-1265.  doi: 10.3969/j.issn.1003-9198.2024.12.016 Abstract ( 41 )   PDF (3525KB) ( 113 )   Save Objective To analyze the interaction between propofol and etomidate in general anesthesia induction in the elderly patients undergoing cardiopulmonary bypass assisted cardiac surgery through response surface methodology, and to explore the optimal compatibility concentration of target controlled infusion of propofol and etomidate. Methods A total of 200 elderly patients who undergoing extracorporeal circulation assisted cardiac surgery and intravenous general anesthesia induction in Nanjing Drum Tower Hospital from September 2019 to January 2022 were enrolled in this study. The starting concentration of propofol and etomidate target controlled infusion was selected, and the post anesthesia bispectral index (BIS), mean arterial pressure (MAP), heart rate (HR), and time to loss of consciousness (TLOC) were observed. Response surface modeling was applied to analyze the pharmacodynamic interaction between propofol and etomidate in anesthesia induction for elderly cardiac surgery, and the optimal concentration range for compatibility was calculated. Results The response surface model showed that propofol and etomidate had a significant synergistic effect on the body movement reaction and circulatory responses during general anesthesia induction in the elderly patients undergoing cardiac surgery. When the concentration of target controlled infusion of propofol was 3.10 μg/mL, the optimal concentration range of etomidate was 0.22 μg/mL; When the concentration of propofol in target controlled infusion was 3.20 μg/mL, the optimal concentration range of etomidate was 0.15-0.20 μg/mL; When the concentration of propofol in target controlled infusion was 3.30 μg/mL, the optimal concentration range of etomidate was 0.15-0.18 μg/mL; When the concentration of propofol in target controlled infusion was 3.40 μg/mL, the optimal concentration of etomidate was 0.16-0.17 μg/mL. Conclusions Propofol and etomidate have a synergistic sedative effect, and the combination of different pharmacological reactions creates the optimal compatibility concentration for propofol and etomidate, which can provide good anesthesia effects. References | Related Articles | Metrics

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Effects of immediate drug cardioversion and delayed cardioversion on prognosis in elderly patients with acute paroxysmal atrial fibrillation LI Yuqiao, CHEN Min, WANG Leilei, ZHOU Weihua 2024, 38 (12):  1266-1269.  doi: 10.3969/j.issn.1003-9198.2024.12.017 Abstract ( 51 )   PDF (1095KB) ( 228 )   Save Objective To analyze the effects of immediate drug conversion and delayed spontaneous conversion on the short-term prognosis in the elderly patients with paroxysmal atrial fibrillation (AF) admitted to the emergency department. Methods A retrospective analysis was conducted on the clinical data of 48 patients with paroxysmal AF admitted to Emergency Department of Jiangsu Province Official Hospital from January 2020 to October 2022. The patients were divided into the immediate drug conversion group and the delayed spontaneous conversion group according to the treatment method. The duration of AF, recurrence rate of AF within 4 weeks and the incidence rate of adverse events related to conversion were compared between the two groups. Results There were no significant statistical differences in the duration of AF and recurrence rate of AF within 4 weeks between the immediate drug conversion group and the delayed spontaneous conversion group (P>0.05). However, more patients in the immediate drug conversion group experienced chronic arrhythmia (29.17% vs 4.17%). Conclusions Immediate drug conversion may not be optimal for all paroxysmal AF; Instead, delayed spontaneous cardioversion can provide opportunities for spontaneous recovery while minimizing proarrhythmic effects associated with antiarrhythmic drugs. References | Related Articles | Metrics

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Analysis of the mediating effect of frailty on the relationship between sedentary behavior and quality of life in elderly patients with coronary heart disease JIANG Yulu, XIN Xiao, NI Xueping, CUI Peirong, WANG Qingqing, HUANG Wenni, QIN Shiyu, LI Xianhua 2024, 38 (12):  1270-1274.  doi: 10.3969/j.issn.1003-9198.2024.12.018 Abstract ( 44 )   PDF (1130KB) ( 160 )   Save Objective To investigate the relationship between sedentary behavior, frailty, and quality of life in the elderly patients with coronary heart disease. Methods A total of 264 elderly patients from Cardiology Outpatient Department in Ruijin Hospital were enrolled in the study. The basic data were collected with a general information questionnaire, and the sedentary behavior, frailty, and quality of life were assessed with Chinese Adult Sedentary Behavior Questionnaire, frailty scale, and European Quality of Life-5 Dimensions(EQ-5D), respectively. Spearman correlation analysis was used to analyze the correlation between sedentary behavior, frailty and quality of life, and the mediating effect of frailty between sedentary behavior and quality of life in the elderly patients with coronary artery disease was analyzed using SPSS macro program PROCESS 4.1 test, and the Bootstrap method was used to test the significance of the mediating effect. Results The elderly patients with coronary heart disease had an average daily sedentary behavior time of 6.5 (4.7, 8.5) hours. Among them, 58 patients (22.0%) presented with frailty, and 120 patients (45.4%) presented with pre-frailty. The score of frailty scale was 1.00 (0.00, 2.00), and the score of EQ-5D was 1.00 (0.87, 1.00). The duration of sedentary behavior was negatively correlated with the score of quality of life (r=-0.596), and positively correlated with the score of frailty scale (r=0.552), and the score of frailty scale was negatively correlated with the score of quality of life (r=-0.744). The direct effect of sedentary behavior on quality of life was -0.488, and the mediating effect was -0.309, with 95%CI of (-0.381, -0.244). The total effect was -0.797, and the proportion of the intermediate effect to the total effect was 38.77%. Conclusions Frailty plays a partial mediating role between sedentary behavior and quality of life in the elderly patients with coronary heart disease. Consequently, it is crucial to focus on both sedentary behavior and frailty to improve the quality of life of the elderly patients. References | Related Articles | Metrics

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Feasibility and effectiveness of mattress anastomosis in repairing microvascular injury in the elderly XU Kexiao, ZHANG Ping, ZHANG Mingliang, DING Yongbin, CHENG Hai 2024, 38 (12):  1275-1279.  doi: 10.3969/j.issn.1003-9198.2024.12.019 Abstract ( 35 )   PDF (1110KB) ( 99 )   Save Objective To analyze the feasibility and effectiveness of mattress anastomosis in repairing microvascular injury in the elderly. Methods From January 2020 to June 2023, a total of 30 elderly patients suffering from finger replantation who were admitted to Zhangjiagang Third People’s Hospital were enrolled in this study, and were randomly divided into the mattress group and the conventional group, with 15 cases in each group. Both groups underwent finger replantation, and mattress group received mattress anastomosis and conventional group used conventional interrupted anastomosis. The operation time, anastomosis time, ischemia-reperfusion time, vascular patency rate, the incidence rate of complications and the finger function in the two groups were recorded and compared. Results The anastomosis time and ischemia-reperfusion time in the mattress group were significantly shorter than those in the conventional group (P<0.05). There were no significant differences in the operation time between the two groups (P>0.05). There were no significant differences in the vascular patency rate between the two groups 1 week, 1, 3 and 6 months after operation (P>0.05). The incidence rate of thrombosis in the mattress group was lower than that in the conventional group (P<0.05), while the incidence rate of vascular stenosis in the mattress group was higher than that in the conventional group (P<0.05). There was no significant difference in the excellent rate of finger function between the two groups (P>0.05). Conclusions In the repairing operation of microvascular injury in the elderly, mattress anastomosis and conventional interrupted anastomosis have similar vascular patency rate and finger function recovery. Mattress anastomosis could decrease the anastomosis time, ischemia-reperfusion time and thrombosis rate, while could increase the vascular stenosis rate. References | Related Articles | Metrics