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@#Objective To analyze the echocardiographic characteristics of above grade 3+ mitral regurgitation (MR) patients by 3D transesophageal echocardiography (3D-TEE) in transcatheter edge-to-edge repair (TEER) and compare the intervention rate of TEER treatment in patients with different risk stratification. Methods We retrospectively analyzed the clinical data of 91 patients with above grade 3+ MR in Anzhen Hospital between June 2021 and April 2022. There were 45 males and 46 females aged 66.5±15.9 years. According to pathogenesis, the patients were divided into different anatomical groups and risk stratification groups. There were 34 patients in a simple degenerative group (simple DMR group), 28 patietns in a complex disease group (Complex group), 14 patients in a simple ventricular functional reflux group (simple VFMR group), 9 patients in a simple atrial functional reflux group (simple AFMR group), and 6 patients in a mixed functional reflux group (mixed FMR group). All patients were examined with a unified standard of transthoracic echocardiography (TTE) and 3D-TEE to compare the characteristic three-dimensional structural changes of the mitral valve in each group. According to the three partition strategy of preoperative anatomical evaluation of TEER, the risk stratification was conducted for the enrolled patients, which was divided into three regions from light to heavy: green area, yellow area, and red area. TEER treatment intervention rate of patients with different risk stratification was calculated. Results Ant leaf angle and post leaf angle were negative in the simple DMR and Complex groups, and non-planar angle, prolapse height and prolapse volume were higher than those of the other groups (P=0.000). Ant leaf angle and post leaf angle were positive in the VFMR group and the mixed FMR group. Anterior and posterior (AP) diameter of valve ring (P=0.036), tenting height and tenting volume were higher than those of other groups (P=0.000). AP diameter, tenting height and tenting volume were changed mildly in patients with simple AFMR. MR patients in red and yellow zone achieved a 28.1% TEER intervention rate. Conclusion Standardized TTE and TEE examinations are crucial for the qualitative and quantitative diagnosis of MR in the echo core-lab. 3D-TEE mitral valve parameter can help determine the exact pathogenesis of MR and to improve the interventional rate of challenging MR patients.
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ABSTRACT Introduction With the normalization of the prevention and control of the covid-19 epidemic, the proportion of outdoor sports in sports has gradually increased, but the risks have increased, resulting in joint injuries. Objective Explore the prevention of joint injuries in outdoor sports under the influence of covid-19. Methods 88 men and 64 women with ankle injuries, 45 men and 33 women with knee injuries, for a total of 133 men and 97 women volunteers were investigated by questionnaire, which included joint injuries, causes of injuries, and treatment methods after joint injuries, and the data were analyzed. Results Currently, most joint injuries in outdoor sports belong to minor injuries, which can recover after some minor readjustments and will not cause much impact on the sportsmen. However, there are also some serious injuries. Conclusion The athletes themselves must be fully prepared, including the use of protective gear and equipment, psychological adjustment, and learning knowledge about sports protection. Coaches and volunteers should give scientifically based and sensible guidance according to the actual situation of the sportsmen to reduce the incidence of joint injuries as much as possible. Level of Evidence II; Therapeutic studies - investigation of treatment outcomes.
RESUMO Introdução Com a normalização da prevenção e controle da epidemia de covid-19, a proporção de esportes ao ar livre no esporte tem aumentado gradualmente, mas os riscos têm aumentado, resultando em lesões articulares. Objetivo Explorar a prevenção de lesões nas articulações em esportes ao ar livre sob a influência da covid-19. Métodos 88 homens e 64 mulheres com lesões no tornozelo, 45 homens e 33 mulheres com lesões no joelho, num total de 133 homens e 97 mulheres voluntárias foram investigados por questionário, que incluiu lesões nas articulações, causas de lesões e métodos de tratamento após lesões nas articulações, tendo os dados sido analisados. Resultados Atualmente, a maioria das lesões nas articulações em esportes ao ar livre pertencem a lesões menores, que podem recuperar-se após alguns pequenos reajustes, o que não causará muito impacto nos esportistas, porém há também algumas lesões graves. Conclusão Os próprios esportistas devem estar totalmente preparados, incluindo o uso de aparelhos e equipamentos de proteção, o ajuste psicológico e o aprendizado dos conhecimentos sobre proteção esportiva. Os treinadores e voluntários devem dar orientações cientificamente fundamentadas e sensatas de acordo com a situação real dos praticantes do esporte, a fim de reduzir ao máximo a incidência de lesões articulares. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.
RESUMEN Introducción Con la normalización de la prevención y el control de la epidemia del covid-19, la proporción de deportes al aire libre en el deporte ha aumentado gradualmente, pero los riesgos han aumentado, dando lugar a lesiones articulares. Objetivo Explorar la prevención de lesiones articulares en deportes al aire libre bajo la influencia del covid-19. Métodos 88 hombres y 64 mujeres con lesiones de tobillo, 45 hombres y 33 mujeres con lesiones de rodilla, un total de 133 hombres y 97 mujeres voluntarios fueron investigados mediante un cuestionario, que incluía las lesiones articulares, las causas de las lesiones y los métodos de tratamiento después de las lesiones articulares, y se analizaron los datos. Resultados En la actualidad, la mayoría de las lesiones articulares en los deportes al aire libre pertenecen a lesiones menores, que pueden recuperarse tras unos pequeños reajustes, que no causarán mucho impacto en los deportistas, sin embargo, también hay algunas lesiones graves. Conclusión Los propios deportistas deben estar totalmente preparados, incluyendo el uso de equipos de protección, la adaptación psicológica y el aprendizaje de los conocimientos sobre protección deportiva. Los entrenadores y los voluntarios deben dar orientaciones con base científica y sensatas, de acuerdo con la situación real de los deportistas, para reducir al máximo la incidencia de las lesiones articulares. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.
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Objective:To develop and verify machine learning(ML)models for the early warning of ventilator-associated pneumonia(VAP)within 24 hours after invasive mechanical ventilation, so as to provide more evidence and ideas for the clinical management of VAP in elderly patients.Methods:In this study, clinical data of elderly patients with acute respiratory failure and invasive mechanical ventilation in intensive care unit were extracted from MIMIC Ⅳ 2.2 database.Using VAP as the outcome index, patients were divided into training set and testing set in a ratio of 7∶3.Four ML algorithms were used to build a model in the training set, and the performance of the model was verified by the test set.The model was compared with SOFA, systemic inflammatory response syndrome(SIRS) and acute physiology score(APS)Ⅲ scores in the same dataset.Results:A total of 1 859 elderly patients were included, 336 of whom were diagnosed with VAP.The area under the curve(AUC)of the receiver operator characteristic curve of ML models were higher than the clinical risk scores(SOFA score: 0.44, SIRS score: 0.49, APS Ⅲ score: 0.46), and the LightGBM model and XGBoost model had better predictive performance, with AUC of 0.85(95% CI: 0.82, 0.88)and 0.84(95% CI: 0.81, 0.87). SHAP was used to further explain the model.The results showed that SOFA neurological score, maximum white blood cell count, maximum respiratory rate, maximum alkali residual and age were important factors for early prediction of elderly VAP. Conclusions:In this study, ML algorithms were used to build an early warning model of VAP in elderly patients, which has important guiding significance for clinical timely initiation and adjustment of treatment plan.In the future, external verification of the model should be further carried out.
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Community acquired pneumonia(CAP)is characterized by high morbidity and mortality in immunocompromised patients, with the elderly as the main vulnerable population.However, current guidelines in China and elsewhere do not offer specific recommendations on the diagnosis and treatment of such patients.This paper reviews the definition, classification, epidemiology, etiological characteristics, clinical manifestations, diagnosis, treatment and prognosis of CAP in immunocompromised elderly patients, to provide a theoretical framework for its diagnosis and treatment and for the formulation of guidelines.
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With the rising aging population, the number of people with stroke, dementia and Parkinson's disease is huge.These patients often have swallowing dysfunction, cognitive decline, decreased immune function, long-term bed rest, malnutrition, and sarcopenia, and are prone to pneumonia.However, the clinical manifestations of these patients with pneumonia are non-specific.The patients often cannot accurately express their complaints, resulting in symptoms being ignored.The underlying diseases of the nervous system increase the risk of pneumonia-related death, and is associated with poor prognosis.This article aimed to review the risk factors, prevention and treatment of these three neurological disorders complicated with pneumonia.
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OBJECTIVE To investigated the anti-de-pressant effects of the fruit Areca catechu L.(ACL)and elucidated its potential underlying mechanism using a rat model of chronic unpredictable mild stress(CUMS).METHODS CUMS was induced in rats to establish a depression animal model for 28 d.According to the baseline sucrose preference,the male rats were divided into six different groups.They were treated with parox-etine hydrochloride,ACL,and water once a day until the behavioral tests were performed.The levels of corticoste-rone(CORT),malondialdehyde(MDA),catalase(CAT),and total superoxide dismutase(T-SOD)in serum were de-tected using a commercial kit,and the concentrations of 5-hydroxytryptamine(5-HT)and dopamine(DA)mono-amine neurotransmitters in the brain tissues were detect-ed by liquid chromatography-tandem mass spectrometry.Doublecortin(DCX)expression in the hippocampal den-tate gyrus(DG)was determined by immunofluorescence,and the relative abundance of brain-derived neurotrophic factor(BDNF),TrkB,PI3K,p-Akt/Akt,PSD-95,and p-GSK-3β/GSK-3β of brain tissues were assayed by West-ern blotting.RESULTS ACL markedly increased sucrose preference,decreased the immobility time,and short-ened the feeding latency of CUMS-induced rats.CUMS induction resulted in marked changes in the contents of the monoamine neurotransmitters(5-HT and DA)in the hippocampus and cortex of brain tissues and the levels of CORT,MDA,CAT,and T-SOD in serum,whereas ACL administration alleviated these considerable changes.ACL promoted DCX expression in DG and increased the protein levels of BDNF,TrkB,PI3K,p-Akt/Akt,PSD-95,and p-GSK-3β/GSK-3β in the brains of CUMS-induced rats.CONCLUSION Our results indicated that ACL may improve depression-like behaviors in CUMS-induced rats by decreasing the hyperfunction and oxidative stress of the hypothalamic-pituitary-adrenal axis,stimulating hippo-campal neurogenesis,and activating the BDNF signaling pathway.
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OBJECTIVE Microgravity exerts several negative effects on the learning and memory of astro-nauts during space flight.Rg1 and Rb1,the key steroidal components of ginseng,have shown potent neuroprotec-tive effects with a high safety profile.The object of the current study is to investigate the influence of Rg1 and Rb1 on simulated microgravity-induced memory and learning dysfunction in the hindlimb suspension(HLS)rat model.METHODS The HLS rats were orally administered Rg1(30 and 60 μmol·kg-1)or Rb1(30 and 60 μmol·kg-1)for four weeks.The Morris water maze test(MWM)and reward operating conditioning reflex test(ROCR)were conducted to evaluate spatial and associative learning and memory.After the behavior tests,the serum and the prefrontal cortex(PFC)were dissected to measure the mechanism.RESULTS Rg1 and Rb1 treatment amelio-rated the cognitive deficits of HLS-exposure rats in MWM and ROCR,reduced reactive oxygen species generation and increased antioxidant enzyme activity.Rg1 and Rb1 also assisted in the recovery of mitochondrial complex Ⅰ(NADH dehydrogenase)activities and Mfn2,and decrea-sed Drp-1 expression.Furthermore,Rg1 and Rb1 reduced the ratio of Bax/Bcl-2 and the expression of cleaved-cas-pase 3,cytochrome c,increased the levels of SYN,PSD95 and activated BDNF-TrkB/PI3K-Akt pathway in the PFC.CONCLUSION Rg1 and Rb1 treatment attenuated cog-nitive deficits induced by HLS,mitigated mitochondrial dysfunction,attenuated oxidative stress,inhibited apopto-sis,and increased the synaptic plasticity,which was partly mediated by the modulation of the BDNF-TrkB/PI3K-Akt signaling.
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@#Aortic stenosis (AS) is the most common primary valve lesion requiring surgery or transcatheter intervention in modern era. Its prevalence is rising rapidly as a consequence of the aging population. Transcatheter aortic valve replacement (TAVR) as a therapy option for older high-risk symptomatic severe AS patients has emerged and is currently extending its indications towards surgery intermediate- and low-risk subjects. Considering the common characteristics of frailty and high comorbidity among AS patients, cardiac rehabilitation (CR) has been proven to improve not only survival but also quality of life in previous reports. CR as a classⅠ recommendation in guidelines for the prevention and treatment of cardiovascular disease has been widely used in clinical practice. The purpose of this article is to sort out the current CR programs for TAVR patients in global medical management, and explore the CR optimization program fit for China medical model in post COVID-19 pandemic era.
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Aspiration is the entry of oropharyngeal or gastric contents into the lower respiratory tract through the glottis, a common and important cause of death in elderly patients due to lung infections.However, a lack of accurate and rapid clinical methods for the diagnosis of aspiration leads to misdiagnosis, missed diagnosis or delayed diagnosis of aspiration, especially aspiration pneumonia.In recent years, with further research into the mechanisms of aspiration syndromes, multiple aspiration biomarkers with potential and clinical translational value have been found, and may help early detection of aspiration and have important and practical significance for elderly health.Therefore, this article reviews aspiration biomarkers such as pepsin, α-amylase, bile acid and other potential biomarkers as well as current relevant research, detection methods, their clinical value and prospects concerning challenges and directions of innovation in future research.
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The population is susceptible to Coronavirus disease 2019(COVID-19), and the proportion of severe cases and fatality rate in the elderly are higher.For patients with COVID-19, clinicians routinely monitor their inflammatory markers, such as neutrophils, lymphocytes, C-reactive protein, procalcitonin, interleukin-6, serum amyloid A, tumor necrosis factor-α, serum albumin, interleukin-3 and others.This article reviews the diagnostic value of the above mentioned inflammatory markers for COVID-19 in the elderly.It aims to provide a reference for the clinical diagnosis and management of these patients.
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The population is commonly susceptible to the 2019 novel coronavirus(2019-nCoV), especially the elderly with comorbidities.Elderly patients infected with 2019-nCoV tend to have higher rates of severe illnesses and mortality.Immunoaging is an important cause of severe novel coronavirus pneumonia(NCP)in the elderly.Due to the combination of underlying diseases, elderly patients may exhibit a typical manifestations in clinical symptoms, supplementary examinations and pulmonary imaging, deserving particular attention.The general condition of the elderly should be considered during diagnosis and treatment.In addition to routine care and measures such as oxygen therapy, antiviral therapy and respiratory support, treatment of underlying disease, nutritional support, sputum expectoration, complication prevention and psychological support should also be considered for elderly patients.Based on literature review and expert panel discussion, we drafted the Key Points for the Prevention and Treatment of the Novel Coronavirus Pneumonia in the elderly, aiming to provide help with the prevention and treatment of NCP and the reduction of harm to the elderly population.
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Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.
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Objective:To compare the clinical characteristics of elderly-onset versus non-elderly-onset acute renal infarction(ARI).Methods:Fifty-two patients with ARI diagnosed by contrast-enhanced computed tomography(CECT)or renal arteriography were classified into elderly group(onset age ≥ 65 year, n=17)and non-elderly group(onset age <65 year, n=35). Demographic data, risk factors, initial clinical presentations, laboratory data, diagnosis, treatment and prognosis were analyzed and compared between the two groups.Results:Embolic ARI was more common in elderly group than in the non-elderly group(82.4% or 14/17 vs.45.7% or 16/35, χ2=6.290, P=0.012). Patients complicated with atrial fibrillation(64.7% or 11/17 vs.34.3% or 12/35, χ2=4.290, P=0.038), coronary artery disease(52.9% or 9/17 vs.8.6% or 3/35, P=0.001)and obesity(40.0% or 4/10 vs.8.0% or 2/25, P=0.043)were more and smokers were less( P=0.007)in the elderly group than in non-elderly group.The incidence of lumbar pain( P=0.038)and the platelet count was lower( P=0.016)in elderly group than in non-elderly group.The median duration from hospital presentation to the diagnosis of ARI was shorter in elderly group than in non-elderly group[18 h(2-192) vs.48 h(2-552), Z=2.404, P=0.021]. The CECT scan was the most common diagnostic technique and anticoagulation was the most common therapy in both groups.The median time from the beginning of treatment to disappearance of symptoms were 3 d(range, 1-9)and 11 d(range, 4-50), and the median time of hospital stay were 3 d(range, 1-12)and 13 d(range, 2-64)in the elderly and non-elderly group, respectively.There was no in-hospital mortality in both groups.There was no significant difference in the prognosis between the two groups after a mean follow-up of(39.4±35.8)months( P>0.05). Conclusions:Thromboembolism due to heart disease is the main etiology of ARI in the elderly.Although elderly patients can be diagnosed relatively early, the prognosis of elderly patients is the same as that of non-elderly patients after treatment.Meanwhile, delays in diagnosis and initiating treatment for the elderly with ARI are still common.
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The population is commonly susceptible to the 2019 novel coronavirus(2019-nCoV), especially the elderly with comorbidities.Elderly patients infected with 2019-nCoV tend to have higher rates of severe illnesses and mortality.Immunoaging is an important cause of severe novel coronavirus pneumonia(NCP)in the elderly.Due to the combination of underlying diseases, elderly patients may exhibit atypical manifestations in clinical symptoms, supplementary examinations and pulmonary imaging, deserving particular attention.The general condition of the elderly should be considered during diagnosis and treatment.In addition to routine care and measures such as oxygen therapy, antiviral therapy and respiratory support, treatment of underlying disease, nutritional support, sputum expectoration, complication prevention and psychological support should also be considered for elderly patients.Based on literature review and expert panel discussion, we drafted the Key Points for the Prevention and Treatment of the Novel Coronavirus Pneumonia in the elderly, aiming to provide help with the prevention and treatment of NCP and the reduction of harm to the elderly population.
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Sarcopenia is a complicated geriatric syndrome characterized by the loss of skeletal muscle mass and skeletal muscle dysfunction,which can lead to a significant increase in the risk of falls and disabilities in the elderly.Patients with chronic obstructive pulmonary disease (COPD) are more likely to suffer from sarcopenia,which may aggravate the deterioration degree of lung function.Exploring the mechanism and relationship of COPD with sarcopenia is helpful to understand the phenotype of COPD and to optimize a personalized treatment and management.Sarcopenia should be actively screened and intervened as early as possible to improve the prognosis of the elderly COPD patients.
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Screening Tool of Older Person's Prescriptions(STOPP)in Frail old patients(STOPP Frail)with limited life expectancy is a list of explicit criteria for potentially inappropriate medication (PIM)using in frail older adults.STOPP Frail criteria were initially created by the experts from Cork university hospital based on the clinical experience and literature appraisal and released in 2017 by an expert panel of Cork university hospital,Ireland.Using Delphi consensus methodology,the panelists ranked their agreement with each criterion on a 5-point Likert scale and provided a written feedback.Twenty-seven criteria with a median Likert response of 4/5 (agree/strongly agree)and a 25th centile of ≥4 scores were included in the final list.STOPP Frail may assist physicians in deprescribing medications to reduce the PIM use in frail older adults.
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Objective To evaluate the feasibility and accuracy of cardiac CT (CCT) in quantitation of extracellular volume (ECV) fraction in patients with heart failure, with 3 T Cardiac MR (CMR) as the reference. Methods Twenty?eight patients with variety reasons of heart failure were enrolled in this study. ECVs was calculated, the correlation between CCT and CMR ECV value and other cardiac function parameters (left ventricular end systolic volume LVESV, left ventricular end diastolic volume LVEDV, cardiac output CO and ejection fraction LVEF, and clinical bio?marker BNP) was determined. Interclass correlation coefficient (ICC) was used to evaluate the agreement of measurement by two radiologists. Results The average of ECV on CCT and CMR was 33% ± 8% and 31% ± 6%, respectively. A good correlation was revealed between myocardial ECV at CCT and that at CMR (r=0.854, P<0.001). Bland?Altman analysis between CCT and CMR showed a small bias (4.6%), with 95% limits of agreement of-18.2% to 27.4%. ICC for ECV at CCT was excellent (ICC=0.910). For both CCT and CMR, ECV was inversely related to LVEF. The radiation dose for CCT?ECV was (1.60±0.04) mSv. Conclusions ECV at CCT and that at CMR showed good correlation, suggesting the potential for myocardial tissue characterization using CCT. However, CCT?ECV would possibly overestimate the extent of ECV.
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Elderly individuals suffer from a variety of underlying diseaes as a result of physiological decline and are prone to adverse drug reactions and drug-induced diseases.Polypharmacy is a form of inappropriate medications and may increase the risk of adverse drug events,triggering prescription cascades and resulting in poor prognosis for the elderly.Identification and early intervention of inappropriate medications is critical in reducing the risk of medication complications and preventing adverse drug reactions.In recent years,research efforts have focused on the development of criteria for inappropriate medications in the elderly,the use of anticholinergic and sedative agents,polypharmacy issues and deprescribing of medications,among others.Research on inappropriate medications in elder people in China has been inadequate.
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The National Committee for Quality Assurance(NCQA)and the Pharmacy Quality Alliance(PQA)used the American Geriatrics Society(AGS)Beers Criteria to establish the quality measure system of high-risk medications and potentially harmful drug-disease interactions in the elderly.Medications included may be harmful to elderly adults,and negatively affect health care plans' quality ratings.AGS experts conducted a comprehensive literature review and prepared a list of drug-therapy alternatives with supporting references.NCQA,PQA,the 2015 AGS Beers Criteria panel,and the Executive Committee of the AGS reviewed the drug therapy alternatives and nonpharmacological approaches.Prescribers,pharmacists,patients,and health care plans may benefit from this list.
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Objective To Study the depression-like behavior and impairment of learning and memory induced by chronic injection of corticosterone in mice. Methods Forty male C57BL/6J mice were divided into four groups, the control group, and the corticosterone groups(20,40,80 mg/kg). The mice received subcutaneous injection of corticosterone once a day for 21 days. The depression-like behaviors were detected by open field test(OFT), tail suspension test(TST)and forced swimming test(FST). To select the most effective dose of corticosterone, TST, FST, object location recognition test, and Morris water maze(MWM)test were used to study the corticosterone-induced depression-like behaviors and impairment of learning and memory in the mice. Results Compared with the control group, the movement distance and duration were significantly decreased in the corticosterone injection groups(40,80 mg/kg)(P< 0.01 or P< 0.05). In the TST group,the immobilization time was significantly increased in the corticosterone injection group(40,80 mg/kg)(P< 0.05). The TST and FST showed that the immobilization time of the corticosterone injection group(40 mg/kg)was significantly increased(P < 0.05). The object recognition test showed that the discrimination indexes of the object location recognition were decreased in the corticosterone injection group(40 mg/kg). The MWM test showed that the escape latency was increased(P< 0.05),and the number of crossing in target quadrant and the velocity in target quadrant were decreased(P< 0.05)in the corticosterone injection group(40 mg/kg). Conclusions Chronic injection of corticosterone can induce depression accompanied with learning and memory impairment in mice.