Risk factors for adjacent vertebral compression fractures after percutaneous vertebroplasty / 中国组织工程研究

BACKGROUND:Percutaneous vertebroplasty is the most widely used method for the treatment of osteoporotic vertebral compression fractures,and most studies have concluded that percutaneous vertebroplasty increases the probability of adjacent vertebral secondary compression fractures in patients with osteoporotic vertebral compression fractures.However,controversy remains regarding the risk factors associated with adjacent vertebral re-fracture caused after percutaneous vertebroplasty. OBJECTIVE:To summarize the influencing factors of adjacent vertebral compression fractures after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures,in order to provide a certain reference for reducing the risk of its occurrence as well as formulating the corresponding treatment plan. METHODS:Using"osteoporosis,fracture,percutaneous vertebroplasty,adjacent vertebral compression fractures,risk factors"as the Chinese search terms,"osteoporosis,osteoporotic vertebral compression fractures,percutaneous vertebroplasty,adjacent vertebral compression fractures,risk factors"as English search terms,computerized searches were conducted on CNKI,Wanfang Medical Network,VIP,PubMed,Springer,ScienceDirect,and Elsevier databases.The search timeframe focuses on January 2018 through September 2023,with the inclusion of a few classic forward literature.The literature was screened by reading the titles and abstracts,and 83 papers were finally included in the review. RESULTS AND CONCLUSION:(1)Osteoporotic vertebral compression fractures are one of the most common complications of osteoporosis,placing elderly patients at a significant risk of disability and death.Percutaneous vertebroplasty is a practical and effective treatment for osteoporotic vertebral compression fractures.(2)With the popularity of percutaneous vertebroplasty,its secondary vertebral compression fractures have gradually increased,with adjacent vertebral compression fractures being the most common.(3)Previous studies have only discussed the effects of factors such as bone mineral density,multiple vertebral fractures,body mass index,age,sex,amount of bone cement,cement leakage,and anti-osteoporosis treatment on secondary compression fractures of adjacent vertebrae after percutaneous vertebroplasty,and summarized the number of vertebral fractures,timing of the operation,surgical approach,cement material,diffuse distribution of bone cement,recovery height of the injured vertebrae,and wearing of a support after surgery,which is not yet comprehensive.The analysis of the specific mechanisms of risk factor-induced adjacent vertebral fractures is relatively rare.(4)The results of the article showed that low bone mineral density,advanced age,perimenopausal women,multiple vertebral fractures,excessive recovery of the height of the injured vertebrae,cement leakage,comorbid underlying diseases,and poor lifestyle habits were the risk factors for secondary adjacent vertebral compression fractures after percutaneous vertebroplasty,and that maintaining a normal body mass index,early surgery,bilateral percutaneous vertebroplasty,use of a new type of cement material,an appropriate volume of bone cement injection and uniform cement dispersion,regular anti-osteoporosis treatment,and postoperative brace wearing are protective factors for secondary adjacent vertebral compression fractures after percutaneous vertebroplasty.

Analysis of pregnancy outcome of preimplantation genetic testing for aneuploidy in cycles with different indications / 安徽医科大学学报

Objective @#To analyze the pregnancy outcome of preimplantation genetic testing for aneuploidy (PGT-A) in cycles with different indications．@*Methods @#The clinical information of 549 couples who underwent PGT-A were retrospectively analyzed．The cycles were divided into 6 groups according to the indication for PGT-A，namely : recurrent pregnancy loss group(n = 304) ，repeated implantation failure group(n = 57) ，advanced age group( ≥38 years old，n = 80) ，history of adverse pregnancy group(chorionic trisomy or adverse pregnancy，n = 24) ，male factor infertility group (n = 67) ，and abnormal sex chromosome number group (n = 17) ．The basic information，the number of retrieved oocytes，embryo biopsy result and pregnancy outcome were compared among different indication groups. @*Results@#The average age and days of gonadotropin ( Gn) used among the six groups were statistically different (P＜0. 001) ．The average number of retrieved oocytes，the rate of good-quality embryos，mosaic embryos， abnormal embryos and normal embryos，the average ovarian sensitivity index ( OSI) among the six groups were statistically different (P = 0. 03，P ＜0. 001，P = 0. 03，P ＜0. 001，P ＜0. 001，P ＜0. 001 ) ．Advanced age group had the highest rate of abnormal embryos，the least average number of retrieved oocytes，the lowest OSI and the lowest rate of normal embryos．There were statistical differences in clinical pregnancy rate，ongoing pregnancy rate and cumulative pregnancy rate per oocyte retrieved cycle (P＜0. 001) among the six groups，but there were no statistical differences in clinical pregnancy rate，ongoing pregnancy rate per transfer cycle and cumulative pregnancy rate among the five groups except for the male factor infertility group．@*Conclusion@#PGT-A can detect euploid embryo to transfer thereby improving pregnancy efficiency．The advanced age women have normal embryo to transfer and can obtain a better pregnancy rate，which may shorten their time of“take- baby -home ”．At the same time， PGT-A can significantly improve the pregnancy outcome of those with male factor infertility.

Association between iron metabolism indexes and gestational diabetes mellitus in pregnant women with advanced age / 临床检验杂志

Objective To explore the association between iron metabolism indexes and the risk of gestational diabetes mellitus(GDM)in pregnant women with advanced age.Methods A total of 292 pregnant women,whose age were≥35 years old and gave birth in Taicang First People's Hospital from April 2021 to April 2023,were retrospectively included and divided into GDM group and non-GDM group.The differences of iron metabolism indexes[serum ferritin(SF),serum iron(SI)and hemoglobin(Hb)]measured from the 20 to 24 weeks of gestation were compared between the two groups.Multivariable Logistic regression model was used to explore the association of SF,SI and Hb with GDM.Based on the data of single nucleotide polymorphism from IEU OpenGWAS(http://gwas.mr-cieu.ac.uk/)and FinnGen datasets,two samples Mendelian randomization analysis were conducted to explore the causal relationship between iron metabolism indexes and GDM by using the methods of Inverse Variance Weighted(IVW).Results In the maximally ad-justed multi-factor logistic models,the statistically significant association between SF measured from 20 to 24 weeks of gestation and the risk of GDM was found[odds ratio(95％confident interval)=1.02(1.01-1.04),P=0.001].The association between Hb and GDM was marginally significant[odds ratio(95％confident interval)=1.04(1.00-1.07),P=0.044],but no association between SI and GDM reached statistical significance.However,Mendelian randomization analysis showed there was no significant evidence for causal association between SF,Hb and GDM.Conclusion SF examined at 20 to 24 weeks of gestation could be used as a biomarker of GDM in the pregnant women with advanced age,but no evidence supported the causal association between SF and GDM.

Effects of different endometrial preparation regimens on pregnancy outcomes and obstetrical outcomes for first euploid single blastocyst transfer after PGT-A / 实用医学杂志

Objective To explore the effects of different endometrial preparation regimens on the pregnancy and obstetrical outcomes of single euploid blastocyst transfer after preimplantation genetic testing for aneuploidies(PGT-A).Methods The clinical data on patients with single euploid blastocyst transfer after PGT-A in our center from September 2015 to July 2021 were analyzed retrospectively.According to the different preparation regimens,the patients were divided into a natural cycle group(n = 80 cycles)and a hormone replacement cycle group(n = 259 cycles).The differences of pregnancy and obstetrical outcomes between the two groups were com-pared.Binary logistic regression was used to explore the influencing factors of pregnancy and obstetrical outcomes after PGT-A.The pregnancy outcomes of different endometrial preparation regimens were further explored by age stratification.Results As compared with that in the natural cycle group,the rate of high-quality blastocyst was significantly higher in the hormone replacement cycle group,but the live birth rate was lower and the abortion rate was higher(P<0.05).There was no statistical difference in the clinical pregnancy rate between the two groups.The incidence of cesarean section and macrosomia was higher in the hormone replacement cycle group than that in the natural cycle group,while the rate of low birth weight was lower,but there were no significant differences(P>0.05).Binary logistic regression showed that female age was an independent influencing factor of abortion.Female age and the days of blastocyst development were independent influencing factors of live birth.However,endometrial prepa-ration regimen was not a factor affecting pregnancy and obstetrical outcomes(P>0.05).The results of further analysis showed that the live birth rate in the natural cycle group was significantly higher than that in the hormone replacement cycle group,while the abortion rate in the natural cycle group was significantly lower than that in the hormone replacement cycle group for female patients aged over 35(P<0.05).Conclusions The endometrial preparation regimens did not affect the pregnancy and obstetrical outcomes of patients receiving single euploid blas-tocyst transfer after PGT-A.However,in the older patients,the natural cycle regimen can obtain a higher live birth rate and a lower abortion rate.

Influencing factors of blood infection and death risk of Acinetobacter baumannii in elderly patients / 公共卫生与预防医学

Objective To investigate the death prognosis and risk factors of extensively drug-resistant Acinetobacter baumannii in hospitalized elderly patients with hematological infection, so as to facilitate clinical prevention and treatment. Methods The elderly (> 80 years old) hospitalized patients with hematological infection in our hospital from 2015 to 2021 were selected for analysis. Firstly, 314 patients with extensively drug-resistant Acinetobacter baumannii hematological infection were distinguished by etiological analysis. A total of 98 cases of death were detected during hospitalization (later referred to as the observation group). By comparing with the surviving patients (216 cases) (later referred to as the control group), the general data of patients with XDRAB infection were collected, and the risk of death and its influencing factors were analyzed. Results In the study, the proportion of patients in the observation group who used catheters was higher, the catheter retention time was longer, the acute physiology and chronic health status II scores were higher, and the proportion of patients who lost self-care ability was also higher. Conclusion The death of blood borne infection of extensively drug-resistant Acinetobacter baumannii in elderly patients is affected by many factors. Among them, patients who use catheters for a long time, have poor self-care ability and lose self-care ability have a higher risk of death, which is worthy of clinical attention.

Clinical efficacy of mechanical thrombectomy in advanced age patients with acute anterior circulation large vessel occlusive stroke / 中华神经医学杂志

Objective:To evaluate the benefits and risks of advanced age patients with acute anterior circulation large vessel occlusive stroke (ALVOS) accepted mechanical thrombectomy (MT), and explore the related influencing factors for prognoses in these patients.Methods:Six hundred and eighty patients with acute anterior circulation ALVOS accepted MT in 3 comprehensive stroke centers from January 2014 to December 2020 were sequentially collected. (1) Patients were divided into advanced age group (≥80 years old) and non-advanced age group (<80 years old) according to age, and the differences between the two groups were compared in successful postoperative vascular recanalization rate, incidence of perioperative complications, and good prognosis rate (modified Rankin scale [mRS] scores≤2) and mortality 90 d after onset. (2) Patients were divided into good prognosis group (mRS scores≤2) and poor prognosis group (mRS scores>2) according to the prognoses 90 d after onset; univariate analysis and multivariate Logistic regression analysis were used to investigate the independent factors for prognoses of the patients after MT. (3) According to the prognoses 90 d after onset, the advanced age patients were divided into good prognosis subgroup (mRS scores≤2) and poor prognosis subgroup (mRS scores>2). Univariate analysis and multivariate Logistic regression analysis were used to investigate the independent factors for prognoses of the elderly patients after MT.Results:(1) In these 680 patients, 92 patients (13.5%) were into the advanced age group and 588 patients (86.5%) were in the non-advanced age group; patients in the advanced age group had significantly lower successful recanalization rate (67.4% vs. 77.9%), significantly lower good prognosis rate 90 d after onset (20.7% vs. 50.2%), and statically higher mortality 90 d after onset (40.2% vs. 21.1%) as compared with the non-advanced age group ( P<0.05); however, there was no significant difference between the two groups in the incidences of symptomatic intracranial hemorrhage (sICH, 15.6% vs. 10.6%) and malignant cerebral edema (MCE, 12.2% vs. 17.6%, P>0.05). The baseline data of the advanced age and non-advanced age patients were further matched with propensity score matching analysis (1:1) and statistically analyzed: the 91 elderly patients had significantly lower good prognosis rate 90 d after onset (20.9% vs. 36.3%) and MCE incidence (12.4% vs. 33.3%) than the 91 non-elderly patients ( P<0.05); there was no significant differences in successful vascular recanalization rate (67.0% vs. 71.4%), sICH incidence (15.7% vs. 17.6%) or mortality 90 d after onset (39.6% vs. 37.4%) between the two groups ( P>0.05). (2) Among the 680 patients, 314 (46.2%) had good prognosis and 366 (53.8%) had poor prognosis. As compared with the good prognosis group, the poor prognosis group had significantly higher proportion of patients at advanced age, significantly lower proportion of male patients, significantly higher proportion of patients with hypertension, diabetes or atrial fibrillation, significantly lower baseline Alberta Stroke early CT (ASPECT) scores, significantly higher baseline National Institutes of Health Stroke Scale (NIHSS) scores, statistically higher proportion of patients with cardiogenic embolism, significantly lower incidence of tandem lesions, significantly shorter time from onset to sheathing, statistically higher proportion of internal carotid artery occlusion, significantly lower proportion of patients with grading 2 collateral circulation, and significantly lower proportion of successful vascular recanalization ( P<0.05). Advanced age ( OR=3.144, 95%CI: 1.675-5.900, P<0.001) was an independent factor for prognoses 90 d after MT, in addition to baseline ASPECT scores, baseline NIHSS scores, diabetes mellitus, successful recanalization, and collateral circulation grading. (3) In the advanced age group, there were 19 patients (20.7%) with good prognosis and 73 patients (79.3%) with poor prognosis. As compared with the good prognosis subgroup, the poor prognosis subgroup had significantly lower proportion of male patients, significantly lower proportion of patients with grading 2 collateral circulation or complete recanalization, and significantly higher baseline NIHSS scores ( P<0.05). Baseline NIHSS score ( OR=1.482, 95%CI: 1.187-1.850, P=0.001) was an independent factor for prognoses 90 d after MT in advanced age patients. Conclusion:Although advanced age is an independent risk factor for prognoses of patients with acute anterior circulation ALVOS accepted MT, there are still some advanced age patients benefiting from MT without increased complications, especially for those with low baseline NIHSS scores.

Efficacy of Qizi Yusi Pill on Pregnancy Outcomes in Women of Advanced Reproductive Age: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To evalvate efficacy of Qizi Yusi Pills (QYP), a Chinese medicine compound preparation, on in vitro fertilization-embryo transfer (IVF-ET) in women of advanced reproductive age.@*METHODS@#This multicenter, randomized, double-blind, placebo-controlled trial was conducted from June 2018 to October 2019. A total of 124 patients were randomly allocated to either the QYP group or the placebo group using a stratified block randomization design, with 62 patients in each group. All patients completed controlled ovarian stimulation using a standard gonadotropin-releasing hormone agonist (GnRH-a) long protocol. As the QYP group, QYP was administered while the control group received placebo. QYP and placebo were administered for a total of 24 to 30 days from the day of GnRH-a pituitary downregulation to transvaginal oocyte retrieval. Both medications were taken orally at doses of 10 g three times each day. The primary outcome was cumulative pregnancy rate, and the secondary outcomes were periodic medication, follicular status, serum hormone and endometrial receptivity. Follow-up continued until 4 weeks after delivery. Maternal and neonatal complications, such as gestational diabetes, were also observed.@*RESULTS@#Overall, 119 patients completed the study, 60 in the QYP group and 59 in the placebo group. Per protocol (PP) analysis revealed that 6-month cumulative pregnancy rate in the QYP group was significantly higher than that in the placebo group [43.33% (26/60) vs. 25.42% (15/59), P=0.040). Additionally, more oocytes were retrieved from the QYP group than those from the placebo group (8.95 ± 3.12 vs. 7.85 ± 1.91, P=0.022). Moreover, the endometrial thickness of HCG day in the QYP group was significantly higher than that in the placebo group (11.78 ± 2.27 mm vs. 10.68 ± 2.07 mm, P=0.012). Maternal and neonatal complications between the two groups were not significantly different (P>0.05). Intention-to-treat analysis was in line with PP results.@*CONCLUSIONS@#QYP can enhance ovarian reserve capacity and ovarian response, and possibly promote endometrial receptivity. QYP effectively improves cumulative pregnancy rates in older patients (⩾35 years) undergoing IVF-ET. (Registration No. ChiCTR1800014427).

Clinical characteristics of sepsis-associated acute kidney injury: a retrospective analysis of 197 cases / 中华急诊医学杂志

Objective:To retrospectively analyze the incidence, mortality, clinical characteristics and related factors of transient and persistent acute kidney injury in patients with sepsis in emergency department.Methods:Patients with sepsis ≥ 18 years old hospitalized in the Emergency Department of Guangdong Provincial Hospital of Chinese Medicine from June 2018 to May 2020 were selected as the research objects. According to the renal function injury at admission and the renal function recovery at 48 h after admission, patients with sepsis were divided into three groups: non-S-AKI group, transient S-AKI group, and persistent S-AKI group.Results:A total of 197 patients with sepsis were included, including 95 patients with non-S-AKI, 39 patients with transient S-AKI and 63 patients with persistent S-AKI. The mortality in the persistent S-AKI group was significantly higher than that in the non-S-AKI group (36.5% vs. 17.9%, P<0.05), but there was no significant difference between the transient S-AKI group and non-S-AKI group (20.5% vs. 17.9%, P>0.05). Multiple categorical disordered Logistic regression analysis showed that urea was associated with transient S-AKI ( OR=1.440, 95% CI: 1.235-1.680), and age ( OR=1.049, 95% CI: 1.008-1.092), urea ( OR=1.440, 95% CI: 1.277-1.733), and infection site in non-urinary tract ( OR=0.149, 95% CI: 0.050-0.448) were associated with persistent S-AKI. Conclusions:The incidence of persistent S-AKI is higher than that of transient S-AKI. Persistent S-AKI is related to the prognosis of patients with sepsis, and the mortality rate is higher, while transient S-AKI has no significant relationship. The urea of patients with S-AKI would increase significantly, and advanced age and urinary tract infection are related factors for the occurrence of persistent S-AKI. For patients with sepsis with such factors, attention should be paid to early protection of renal function to prevent persistent S-AKI.

Efficacy of long-stem hemiarthroplasty for elderly unstable intertrochanteric fracture / 中国综合临床

Objective:To investigate the clinical effect of long-stem hemiarthroplasty in the treatment of unstable intertrochanteric fracture in elderly patients with severe osteoporosis.Methods:A retrospective analysis was performed on 48 elderly patients with unstable intertrochanteric fractures of the femur with severe osteoporosis in Liaocheng People′s Hospital from April 2017 to April 2019.Twenty three patients received long-stem hemiarthroplasty (LHA group). Twenty five patients were treated with proximal femoral nail anti-rotation (PFNA) (PFNA group). PFNA group was used as the control group.The operative time, intraoperative blood loss, perioperative blood transfusion volume, number of intraoperative fluoroscopy, weight-bearing time after operation, the incidence of postoperative complications, hospitalization time, and Harris hip score of 1, 3, 6, 12 months after surgery, to investigate the efficacy of the application of long-stem hemiarthroplasty.Results:In LHA group, 23 patients were followed up for (18.6±3.9) (range from 12.0 to 26.0) months, and 25 patients in the PFNA group were followed up for (17.8±3.3)(range from 12.0 to 24.0) months.There was no significant difference in follow-up time between the two groups ( Z=-0.552, P=0.581). The operation time of LHA Group (60 (55, 73) h) was longer than that of PFNA Group (55 (50, 60) h). The intraoperative blood loss in LHA Group ((179.35±63.47) mL) was more than that in PFNA Group ((122.80±49.03) mL). The number of fluoroscopy in LHA Group (2 (2, 2) times)was less than that in PFNA Group (16 (14.5, 19.5) times). The time of weight bearing in LHA Group (4 (3, 5) d) was earlier than that in PFNA Group (33 (30, 36) d), and the differences were statistically significant ( Z=2.459, t=3.470, Z=6.216, Z=5.959; all P<0.05). There were no significant differences in perioperative blood transfusion, hospital stay and postoperative complications between the two groups (all P>0.05). Harris hip function score was significantly higher in LHA Group ((76.70±5.96), (82.13±6.38), (85.96±7.16), (88.78±7.67) points) and PFNA Group ((63.80±3.46), (71.56±2.55), (81.60±3.38), (88.08±4.83) points) increased gradually with the increase of follow-up time ( Fintra-group=432.557, Pintra-group<0.001), and the score reached the highest 12 months after operation.Harris hip function score of LHA group was higher than that of PFNA group( Finter-group=25.437, Pinter-group<0.001). There was interaction effect between follow-up time point and operation mode( Finteraction=53.464, Pinteraction<0.001). Conclusion:For the elderly patients with unstable intertrochanteric fracture with severe osteoporosis, the application of lengthened stem hemiarthroplasty can get out of bed early, reduce the complications of bed rest, reduce the number of intraoperative fluoroscopy, and recover the function of hip joint earlier and better with satisfactory results.

Correlation between body mass index and increased body mass during pregnancy and adverse pregnancy outcomes in elderly pregnant women / 公共卫生与预防医学

Objective To investigate the correlation between body mass index and the increase in body mass during pregnancy and adverse pregnancy outcomes in elderly pregnant women. Methods The clinical data was collected from 1,374 pregnant women who underwent regular prenatal care checkups and delivered a child at Jiangsu Maternity and Child Health Hospital from January 1, 2020 to May 1, 2020. According to the age of pregnant women, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG), the subjects were divided into different groups. The incidence of adverse pregnancy outcomes between groups was compared, and the correlation between pregnant women's age, pre-pregnancy BMI and GWG and adverse pregnancy outcomes was analyzed. Results Compared with the non-advanced age group, the elderly group had an increase in the incidence rate of gestational diabetes (GDM) (38.66% VS 19.54%), the incidence rate of large for gestational age (LGA) (LGA) (19.75% VS 14.43%), and the cesarean section rate (55.46% VS) 34.77%), and the differences between the groups were statistically significant (t=40.773, 4.270, 35.630, P=0.001, 0.039, 0.001). There were no significant differences between the non-advanced age group and the elder group in the incidence of pregnancy-induced hypertension (PIH) (10.92% VS 8.63%), the incidence of small for gestational age (2.52% VS 2.90%), and the incidence of neonatal asphyxia ( 2.10% VS 1.23%) (t=1.265, 0.105, 1.088, P=0.261, 0.746, 0.297). ). The incidence of GDM in overweight and obese elderly pregnant women was higher than that in underweight and normal pregnant women. The incidence of GDM in the elderly pregnant women with less GWG and excessive GWG was higher than that in the normal group (P<0.05). Conclusion The pre-pregnancy body mass index and the gain in body mass during pregnancy are related to the occurrence of adverse pregnancy outcomes. It is necessary to strengthen the monitoring and management of pre-pregnancy body mass index and pregnancy body quality in elderly pregnant women.

Successful treatment of an open tibial fracture in a 102-year-old woman: a case report / Journal of Rural Medicine

Introduction: As the average life expectancy is increasing, the number of patients aged >100 years who have fragility fractures will increase in the future. In female patients, the incidence of open fractures increases with age.Case Presentation: We present the case of a 102-year-old woman with open tibial and fibular diaphyseal fractures (Gustilo-Anderson classification type IIIb) treated with temporary external fixation, advancement flap, and negative pressure wound therapy in the first-stage surgery and treatment, and open reduction and internal fixation with skin grafting in the second-stage surgery. Open wound and bone healing were attained.Conclusion: Surgery should not be denied on the basis of age alone. Medical evaluation should focus on identifying risk factors, assessing risk in detail, optimizing status, predicting complications, and making the appropriate surgical plan for the patient status. Moreover, in the present case, meticulous postoperative management was the main reason for the successful surgical treatment.

Sexual health in Polish elderly men with coronary artery disease: Importance, expectations, and reality / 亚洲男科学杂志(英文版)

Deterioration in overall health, hormonal disturbances, and erectile dysfunction (ED) contributes to limitations in sexual activity in the elderly, which is further limited by incorrect beliefs about the hazards of sexual activity in cardiac patients. We aimed to analyze the occurrence of ED in elderly men, their perception of the relevance of good sexual function, and their expectations of physicians. A cross-sectional study encompassed 731 patients with coronary artery disease (CAD) subjected to cardiac rehabilitation. Demographic data and data on modifiable risk factors and patient expectations were collected. ED was assessed using the IIEF-5 questionnaire. Relationships among the risk factors for ED, occurrence of ED, and patient expectations, as well as the changes in the indicators between 2012 and 2016, were analyzed. The mean age of men was 70.7 ± 5.1 years. The prevalence of ED was 93.0%. The IIEF-5 score was significantly associated with age, tobacco smoking, exercise tolerance, time to diagnosis of CAD, and treatment with calcium channel blockers and diuretics. Patients declared that sexual activity was overall important (47.9%) or very important (25.6%). Three hundred and sixty (49.3%) patients expected their physician to show interest in their sexual health, but the topic was addressed in only 12.5%. Over the past few years, we have observed an increase in the awareness and importance of sexual health as well as a significant increase in patients' expectations of physicians to show interest in their sexual health. Patients' expectations of discussing and receiving treatment for ED remain an unmet medical need.

Clinical Observation on Modified Shoutaiwan with Si Junzitang Combined with Didroxyprogesterone Tablets in Treating Threatened Abortion in Advanced Age Patients / 中国实验方剂学杂志

Objective:To observe the immune factors， coagulation and curative effect of modified Shoutaiwan with Si Junzitang combined with dydrogesterone tablets in advanced age patients with early threatened abortion， and to explore its mechanism of action. Method:The 90 advanced age patients with threatened abortion and kidney deficiency and blood stasis syndrome differentiation in traditional Chinese medicine （TCM） were randomly divided into control group and observation group by random number table， with 45 cases in each group. Both groups took oral dydrogesterone tablets for luteal support. The control group additionally received natural vitamin E soft capsules by oral administration， while observation group received modified Shoutaiwan with Si Junzitang. The course of treatment was 10 days in both groups. The clinical efficacy， TCM syndrome score， immune factors and coagulation factors of the two groups were compared before and after treatment. Result:There was no statistically significant difference in TCM symptom scores， immune factors， and coagulation factors between two groups before treatment. After treatment， the scores of TCM syndromes were reduced in both groups （P<0.05）， the proportion of helper T lymphocyte （Th）， Th/Ts ratio， D-dimer （D-D） level and fibrinogen （FIB） were reduced while prothrombin time （PT） and the ratio of suppressor T lymphocyte （Ts） were increased in observation group （P<0.05）. After treatment， the proportion of Th， Th/Ts， D-D， and FIB levels in observation group were lower than those in control group， while PT and the proportion of Ts were higher than those in control group （P<0.05）. The proportion of natural killer cells （NK） had no significant change after treatment， also with no significant difference between two groups. The total effective rate was 84.4%（38/45） in observation group， higher than 64.4%（29/45） in control group （χ2=4.398，P<0.05）. There was no obvious adverse reaction in both groups during the treatment. Conclusion:Modified Shoutaiwan with Si Junzitang combined with dydrogesterone tablets can improve symptoms and the therapeutic effect for fetal protection by regulating the immune balance and coagulation function in advanced age patients with threatened abortion.

Aspectos clínicos y de laboratorio en pacientes con diagnóstico tardío de SIDA / Clinical and laboratory findings in patients with late diagnosis of AIDS

RESUMEN Introducción: El retraso diagnóstico de la infección por SIDA constituye un problema de gran magnitud con importantes repercusiones para los propios infectados y para la sociedad en general. Objetivos: Caracterizar a los pacientes con diagnóstico tardío de infección por VIH y su evolución a los 6 meses del diagnóstico. Material y Métodos: Se realizó un estudio longitudinal de corte prospectivo que incluyó 248 casos con diagnóstico positivo de infección por VIH durante su ingreso o en la consulta de infectología del Instituto de Medicina Tropical "Pedro Kourí" desde enero de 2015 hasta diciembre de 2016, los que se dividieron en dos grupos de comparación, según diagnóstico tardío (n=79) o no (n=169) de la enfermedad. Resultados: La edad avanzada y el sexo masculino fueron factores relacionados con el diagnóstico tardío de la infección por VIH. La fiebre (31,7%) y los síntomas respiratorios (20,3%) fueron las formas más frecuentes de presentación, mientras que la neumonía por Pneumocystis jirovecii fue la enfermedad con más incidencia en el momento del diagnóstico. La mitad de los pacientes se encontraban con inmunodepresión severa en el momento del diagnóstico. Los pacientes con diagnóstico tardío mostraron una supervivencia significativamente menor a los 6 meses del diagnóstico en comparación con los pacientes con diagnóstico precoz. La carga viral y el nivel de linfocitos CD4 fueron parámetros de laboratorio con un alto valor predictivo de mortalidad. Conclusiones: El diagnóstico tardío de infección por VIH conlleva un alto riesgo de mortalidad, mayor en aquellos con afectación de la carga viral y el nivel de linfocitos T CD4+.

ABSTRACT Introduction: Late diagnosis of HIV is a major problem with important consequences for the people infected with this virus and the society in general. Objectives: To characterize patients with late diagnosis of HIV infection and their evolution six months after diagnosis. Material and Methods: We conducted a prospective longitudinal study which included 248 cases with positive diagnosis of HIV infection during admission at the Pedro Kourí Tropical Medicine Institute between January 2015 and December 2016. They were divided into two comparison groups which included patients with late diagnosis (n=79) and those with no late diagnosis (n=169) of the disease. Results: Advanced age and male sex were factors related to the late diagnosis of HIV infection. Fever (31.7%) and respiratory symptoms (20.3%) were the most frequent forms of presentation, whereas Pneumocystis jirovecii pneumonia was the disease with the highest incidence at the time of diagnosis. Half of the patients were found to have severe immunosuppression at the time of diagnosis. Patients with late diagnosis showed a significantly diminished survival six months after being diagnosed compared with those patients with early diagnosis. Viral load and CD4+ T count were laboratory parameters with a high predictive value of mortality. Conclusions: Late diagnosis of HIV leads to a high risk of mortality, which is higher in those with affectation of the viral load and low CD4+ T cell count.

Anesthetic Considerations in a 98-year-old Man with Periprosthetic Femoral Shaft Fracture / 中国医学科学杂志(英文版)

A 98-year-old male patient with history of hemiarthroplasty suffered periprosthetic fracture of right femoral shaft and developed acute coronary event in three days after hospitalization. Femoral nerve and lateral femoral cutaneous nerve blocks combined with general anesthesia were implemented for the internal fixation surgery. The recovery was uneventful after discharge. In this case report, we discussed the main considerations of anesthesia specifically for this complicated case.

Timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age / 国际外科学杂志

Objective To investigate the timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age.Methods The clinical data for 56 advanced age patients with acute pyogenic cholecystitis in the Department of Hepatobiliary Surgery,the 900th Hospital of the Joint Logistics Support Force of People's Liberation Army from January 2018 to February 2019 were retrospectively analyzed.There were 31 males and 25 females,aged from 70 to 86 years,with average age was (75.52±3.57) years.According to the percutaneous transhepatic gallbladder drainage(PTGD) after laparoscopic cholecystectomy(LC) time interval,all patients were divided into three groups.Patients in the group A(n =12),B (n =21),and C (n =23) performed LC were within 2 months,during 2-4 months,and during 4-6 months,retrospectively.Observation indicators:(1) Surgical situations.The operation and postoperative basic condition of the three groups were compared.(2) Follow-up situations.Patients were followed-up by outpatient examination or telephone interview to detect the postoperative complication in the postoperative three months up to June 2019.Measurement data with normal distribution were represented as (Mean ± SD),and comparison multiple groups was done using single factor analysis of variance (AVONA test),and comparison between groups was done using the t test,and comparison of multiple groups in pairs was done using the SNK-q test,and hierarchical data were analyzed using Kruskal-wallis H test.Count data were analyzed using the chi-square test or Fisher exact probability.Results (1) Surgical situations:the thickness of gallbladder wall before LC,the rates of converting to laparotomy,the volume of intraoperative blood loss,the operation duration,and the duration of postoperative hospital stay were (0.57±:0.04) cm,50.0％,(95.83 ±11.45) ml,(107.50±21.90) min,(5.67±3.40) d in the group A,and (0.43 ±0.03) cm,9.5％,(69.52±24.59) ml,(71.43 ±12.16) min,(3.76±2.61) d in the group B,and (0.43 ± 0.05) cm,39.1％,(68.64 ±21.89) ml,(77.95 ±12.88) min,(5.05 ±2.95) d in the group C,respectively,showing significant differences in the above indicators between the three groups (P ＜ 0.05).The thickness of gallbladder wall before LC,the volume of intraoperative blood loss,the operation duration,those in group A were higher than the group B and C (P ＜0.05),and with no statistically significant different between the group B and C (P ＞ 0.05).The rates of converting to laparotomy,the duration of postoperative hospital stay in group B were better than the group A and C (P ＜ 0.05),and with no statistically significant different between the group A and C (P ＞0.05).The thickness of gallbladder wall before LC,the volume of intraoperative blood loss,the operation duration,and the duration of postoperative hospital stay were (0.43 ± 0.03) cm,(46.67 ± 9.82) ml,(67.69 ± 7.77) min,(2.64 ±0.58) d in the gallbladder wall thickness of successful LC patients,and (0.52±0.04) cm,(123.53 ±17.30) ml,(134.12±25.51) min,(8.47 ±0.80) d in the laparotomy patients,respectively,showing significant differences in the above indicators between the two groups (P ＜ 0.05).(2) Follow-up situations:56 patients were followed up and without perioperative death.No complications occurred after 3 months of follow-up.Conclusion Elective surgery that is performed in 2-4 months after PTGD for patients with acute pyogenic cholecystitis in the advanced age can reduce the volume of intraoperative blood loss and the rates of converting to laparotomy,shorten the operation duration and the duration of postoperative hospital stay,which is beneficial to the recovery of patients.

Timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age / 国际外科学杂志

Objective@#To investigate the timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age.@*Methods@#The clinical data for 56 advanced age patients with acute pyogenic cholecystitis in the Department of Hepatobiliary Surgery, the 900th Hospital of the Joint Logistics Support Force of People′s Liberation Army from January 2018 to February 2019 were retrospectively analyzed. There were 31 males and 25 females, aged from 70 to 86 years, with average age was (75.52±3.57) years. According to the percutaneous transhepatic gallbladder drainage(PTGD) after laparoscopic cholecystectomy(LC) time interval, all patients were divided into three groups. Patients in the group A(n=12), B(n=21), and C (n=23) performed LC were within 2 months, during 2-4 months, and during 4-6 months, retrospectively. Observation indicators: (1) Surgical situations. The operation and postoperative basic condition of the three groups were compared. (2) Follow-up situations. Patients were followed-up by outpatient examination or telephone interview to detect the postoperative complication in the postoperative three months up to June 2019. Measurement data with normal distribution were represented as (Mean±SD), and comparison multiple groups was done using single factor analysis of variance (AVONA test) , and comparison between groups was done using the t test, and comparison of multiple groups in pairs was done using the SNK-q test, and hierarchical data were analyzed using Kruskal-wallis H test. Count data were analyzed using the chi-square test or Fisher exact probability.@*Results@#(1) Surgical situations: the thickness of gallbladder wall before LC, the rates of converting to laparotomy, the volume of intraoperative blood loss, the operation duration, and the duration of postoperative hospital stay were (0.57±0.04) cm, 50.0%, (95.83±11.45) ml, (107.50±21.90) min, (5.67±3.40) d in the group A, and (0.43±0.03) cm, 9.5%, (69.52±24.59) ml, (71.43±12.16) min, (3.76±2.61) d in the group B, and (0.43±0.05) cm, 39.1%, (68.64±21.89) ml, (77.95±12.88) min, (5.05±2.95) d in the group C, respectively, showing significant differences in the above indicators between the three groups (P<0.05). The thickness of gallbladder wall before LC, the volume of intraoperative blood loss, the operation duration, those in group A were higher than the group B and C (P<0.05), and with no statistically significant different between the group B and C (P>0.05). The rates of converting to laparotomy, the duration of postoperative hospital stay in group B were better than the group A and C (P<0.05), and with no statistically significant different between the group A and C (P>0.05). The thickness of gallbladder wall before LC, the volume of intraoperative blood loss, the operation duration, and the duration of postoperative hospital stay were (0.43±0.03) cm, (46.67±9.82) ml, (67.69±7.77) min, (2.64±0.58) d in the gallbladder wall thickness of successful LC patients, and (0.52±0.04) cm, (123.53±17.30) ml, (134.12±25.51) min, (8.47±0.80) d in the laparotomy patients, respectively, showing significant differences in the above indicators between the two groups (P<0.05). (2) Follow-up situations: 56 patients were followed up and without perioperative death. No complications occurred after 3 months of follow-up.@*Conclusion@#Elective surgery that is performed in 2-4 months after PTGD for patients with acute pyogenic cholecystitis in the advanced age can reduce the volume of intraoperative blood loss and the rates of converting to laparotomy, shorten the operation duration and the duration of postoperative hospital stay, which is beneficial to the recovery of patients.

Analysis of prognostic related risk factors in elderly patients with severe community acquired pneumonia / 中国中西医结合急救杂志

Objective To analyze the related risk factors affecting the prognosis of elderly patients with severe community acquired pneumonia (SCAP). Methods A retrospective study method was conducted; the elderly (≥ 75 years old) patients with SCAP treated in the First Affiliated Hospital of Hainan Medical College from January 2015 to January 2019 were enrolled. The general data of patients were collected, including sex, age, oxygenation index (PaO2/FiO2), involved organs, presence or absence of following diseases or treatment: damage in multiple lung lobes, septic shock, basic diseases (cardiovascular disease, chronic lung disease, diabetes, hypertension, and cerebrovascular disease), invasive mechanical ventilation, ventilator-associated pneumonia (VAP), misinhalation event, hyponatremia, respiratory acidosis, hypoproteinemia, intubation times, total mechanical ventilation time, etc. According to the prognosis, the patients were divided into a death group and a survival group. The general data were compared between the two groups with different prognoses. Single factor analysis was carried out by selecting variables. The indicators with statistical significant differences in the results of univariate analysis were introduced into the multivariate Logistic regression analysis to analyze the related risk factors affecting the prognosis of elderly patients with SCAP. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive values of risk factors in the patients with SCAP. Results A total of 112 patients were included, 33 died, and the mortality rate was 29.46%. Univariate analysis showed that the following factors were higher in the death group than those in the survival group: organ involvement >2 [69.70% (23/33) vs. 35.44% (28/79)], lung lobe damage ≥ 3 [75.76% (25/33) vs. 51.90% (41/79)], invasive mechanical ventilation [72.73% (24/33) vs. 32.91% (26/79)], diabetes [30.30% (10/33) vs. 12.66% (10/79)], intubation times ≥2 [57.58% (19/33) vs. 48.10% (38/79)], hypoproteinemia [75.76% (25/33) vs. 41.77% (33/79)], hyponatremia [72.73% (24/33) vs. 48.10% (38/79)], respiratory acidosis [66.67% (22/33) vs. 44.30 %(35/79)] and total mechanical ventilation time ≥ 15 days [69.70% (23/33) vs. 40.51 (32/79)]; the factors in the death group lower than those in the survival group were: septic shock [3.03% (1/33) vs. 17.72% (14/79)], chronic lung disease [6.06% (2/33) vs. 25.32% (20/79)] and PaO2/FiO2 [mmHg (1 mmHg = 0.133 kPa): 102.89±14.78 vs. 109.56±14.08],the differences were statistically significant (all P < 0.05); there were no significant differences in gender, age, cardiovascular disease, hypertension, VAP, misinhalation events and cerebrovascular disease between the two groups (all P > 0.05). Multivariate Logistic regression analysis showed that diabetes mellitus [odds ratio (OR) = 1.074, 95% confidence interval (95%CI) = 1.017-1.287, P =0.045], septic shock (OR = 2.765, 95%CI = 1.083-3.411, P = 0.047), hyponatremia (OR = 1.792, 95%CI = 1.128-1.417, P = 0.006), hypoalbuminemia (OR = 2.187, 95%CI = 1.872-5.462, P = 0.046), invasive mechanical ventilation (OR = 5.870, 95%CI = 2.324-23.796, P = 0.001), respiratory acid poisoning (OR = 2.934, 95%CI = 2.454-7.275, P = 0.043), time of mechanical ventilation (OR= 1.986, 95%CI = 2.467-3.483, P = 0.034), number of intubation (OR = 6.760, 95%CI = 2.116-24.696, P = 0.001), PaO2/FiO2 (OR = 1.981, 95%CI = 1.006-1.417, P = 0.007), organ involvement > 2 (OR = 2.924, 95%CI = 2.534-6.285, P = 0.048), chronic lung disease (OR = 2.887, 95%CI = 1.487-3.483, P = 0.039), and lung lobe damage≥3 (OR = 2.754, 95%CI = 1.131-1.798, P = 0.045) were independent risk factors affecting the prognosis of elderly patients with SCAP. ROC analysis showed that hyponatremia, hypoalbuminemia, invasive mechanical ventilation, total mechanical ventilation time, PaO2/FiO2, organ involvement > 2, damage of lung lobes ≥ 3, had predictive values for the prognosis of SCAP [the areas under ROC curve (AUC) were 0.377, 0.267, 0.301, 0.646, 0.650, 0.329, and 0.381, respectively, all P < 0.05]. Conclusions Underlying disease, invasive mechanical ventilation, respiratory acidosis, total mechanical ventilation time, PaO2/FiO2, intubation times ≥ 2, chronic lung disease and lung damage≥ 3 lobes are the independent risk factors for the prognosis of elderly patients with severe community acquired pneumonia. Clinical treatment should focus on the above aspects to minimize the mortality of patients.

Survival Analysis of Off-pump Coronary Artery Bypass Grafting in Patients Aged Over 75 / 中国循环杂志

Objectives:To describe the early and long-term survival of off-pump coronary artery bypass grafting(OPCAB)and to analyze the impact and risk factors of peri-operative events on mortality and long-term survival in OPCAB patients aged over 75 years old. Methods:From January 2001 to December 2012,233 patients aged over 75 underwent OPCAB in our hospital, 173 cases (74.25%) were male,the average age was (77.1±2.3) years.The perioperative data was retrospectively collected.Binary Logistic regression was used to define the risk factors related to the perioperative events and mortality.Follow-up was performed regularly post-surgery. Univariate analysis and Cox regression model were used to find out factors affecting the long-term outcomes. Results:Fifteen out of 233 patients died during the perioperative period. Binary Logistic regression showed that preoperative arrhythmia (OR=6.767, P=0.002),IABP ( intraoperative, post-operative) (OR=4.292, P=0.040;OR=19.455, P＜0.001), ICU stay time (OR=1.500, P=0.001), mechanical ventilation time (OR=1.004, P=0.002), reintubation or tracheotomy (OR=30.000, P＜0.001), re-thoracotomy (OR=26.750, P＜0.001), postoperative cerebral infarction (OR=5.889, P=0.041) were risk factors of perioperative mortality. The remaining 218 patients were followed up for a mean of (92.84±45.52) months, 121 patients died during follow-up. The survival rate at l, 3, 5, 8 and 10 years was 90.99%, 87.55%, 85.31%, 68.93% and 56.70%, respectively. Univariate analysis showed that sex(male), hypertension, preoperative arrhythmia, reintubation or tracheotomy were risk factors of the long-term mortality (P＜0.05). Cox regression analysis showed that reintubation or tracheotomy (HR 4.387, 95%CI=1.876-10.259,P＜0.010) was the independent risk factor affecting the long-term survival. Conclusions:Preoperative arrhythmia, IABP (intraoperative, postoperative), ICU stay time, mechanical ventilation time, reintubation and tracheotomy, re-thoracotomy, postoperative cerebral infarction are risk factors of perioperative mortality. Reintubation or tracheotomy is the independent risk factor affecting the long-term survival.Taken together, OPCAB in patients aged over 75 is associated with favorable perioperative and long-term outcome,and it serves a safe and effective operative strategy for coronary artery revascularization in patients aged over 75.

Effect of Progestin-primed Ovarian Stimulation Protocol on Outcomes of Aged Infertile Women Who Failed to Get Pregnant in the First IVF/ICSI Cycle: A Self-controlled Study / 华中科技大学学报（医学）（英德文版）

This study aimed to explore the outcomes of progestin-primed ovarian stimulation protocol (PPOS) in aged infertile women who failed to get pregnant in the first IVF/ICSI-ET cycles with GnRH-a long protocol.A self-controlled study was conducted to retrospectively investigate the clinical outcomes of 104 aged infertile patients who didn't get pregnant in the first IVF/ICSI-ET treatment by stimulating with GnRH-a long protocol (non-PPOS group),and underwent PPOS protocol (PPOS group) in the second cycle between January 2016 and December 2016 in the Center for Reproductive Medicine,Renmin Hospital of Wuhan University.The primary outcomes included clinical pregnancy rate of frozen-thawed embryos transfer (FET) in PPOS group,and good-quality embryo rate in both groups.The secondary outcomes were fertilization rate,egg utilization rate and cycle cancellation rate.The results showed that there were no significant differences in basal follicle stimulating hormone (bFSH),antral follicle count (AFC),duration and total dosage of gonadotropin (Gn),number of oocytes retrieved,intracytoplasmic sperm injection (ICSI) rate,fertilization rate,and cycle cancellation rate between the two groups (P＞0.05).However,the oocyte utilization rate and good-quality embryo rate in PPOS group were significantly higher than those in non-PPOS group (P＜0.05).By the end of April 2017,62 FET cycles were conducted in PPOS group.The clinical pregnancy rate and embryo implantation rate were 22.58％ and 12.70％,respectively.In conclusion,PPOS protocol may provide better clinical outcomes by improving the oocyte utilization rate and good-quality embryo rate for aged infertile patients who failed to get pregnant in the first IVF/ICSI-ET cycles.