Effect of recombinant human brain natriuretic peptide on efficacy, hemodynamics and NT-proBNP in elderly patients with heart failure.

AIM: To investigate the effects of recombinant human brain natriuretic peptide (rhBNP) on efficacy, hemodynamics, and N-terminal pro-brain natriuretic peptide (NT-proBNP) in elderly patients with heart failure (HF). METHODS: In this retrospective analysis, the clinical data of 112 HF patients who visited the First Affiliated Hospital of Anhui University of Chinese Medicine between March 2019 and October 2022 were analyzed. On the basis of standard HF treatment, 52 patients additionally treated with milrinone intravenous were set as the control group (Con) and 60 patients with rhBNP were set as the observation group (Obs). The therapeutic efficacy and pre- and post-treatment echocardiographic indexes, NT-proBNP and hemodynamics were recorded and compared, and the adverse drug reactions and quality of life scores after treatment were counted. RESULTS: The Obs group showed a markedly higher post-treatment overall response rate than the Con (P=0.002). Besides, more obvious improvement of NT-proBNP and hemodynamic indexes were determined in the Obs group compared to the Con (P=0.000). Evidently ameliorated left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic diameter (LVESD) were observed in both groups after treatment, with more pronounced improvement in the Obs group (all P=0.000). The Obs group also exhibited an evidently lower incidence of adverse reactions and a better quality of life than the Con after treatment (P=0.000). CONCLUSIONS: rhBNP can effectively improve the cardiac function and hemodynamics in elderly HF patients, with high safety and few adverse reactions.

Intrinsic capacity decline as a predictor of functional disability in the elderly: A systematic review and meta-analysis.

OBJECTIVES: To examine the predictive value of intrinsic capacity decline on functional disability among the elderly. DESIGN: Meta-analysis. METHODS: PubMed, EMBASE, Web of Science, The Cochrane Library, Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched for relevant studies published from the inception until June 1, 2024. Stata 17.0 software was used to perform the meta-analysis. The methodological quality was evaluated using the Newcastle Ottawa Scale. The overall quality of evidence used GRADE guidelines to assess. A study protocol was registered in PROSPERO (CRD42023475461). RESULTS: The meta-analysis included 8 cohort studies including 9744 elderly people. Functional disability including ADL disability (n = 6) and IADL disability (n = 7). The results showed that intrinsic capacity decline could predict ADL disability (HR = 1.08, 95 %CI 1.04-1.12; I2 = 98.2 %, P < 0.001) and IADL disability (HR = 1.11, 95 %CI 1.05-1.17; I2 = 96.4 %, P < 0.001). The overall risk of bias was low. And the grade of evidence that assessed by GRADE guidelines was rated as moderate. CONCLUSIONS: Intrinsic capacity decline is a predictor of functional disability in the elderly. Therefore, screening intrinsic capacity decline has important clinical implications for early identifying the risk of functional disability, which contributes to providing individualized interventions ahead of potential functional disability for the elderly, thereby preventing functional disability, improving the quality of life and promoting healthy aging.

Profile and Prognostic Impact of Multimorbidity in Elderly Patients with Heart Failure: Are there Differences between Men and Women?

PURPOSE OF REVIEW: Heart failure (HF) represents a pathology in constant growth, but, despite the fact that a significant proportion of its population is comprised of elderly patients, they are not adequately represented in clinical trials or registries. They constitute a heterogeneous population with their particularities and interaction of the multiple comorbidities that characterize this age group, which makes the clinical course, prognosis and outcomes of the disease different. RECENT FINDINGS: Compared to men, women with HF tend to be older, with a greater burden of non-cardiovascular comorbidities, less ischemic heart disease and preserved ventricular function in most cases. This fact translates into worse self-perceived quality of life, with lower hospitalization and mortality rates. Moreover, paradoxically, women are less likely to receive treatment recommended by clinical practice guidelines, including revascularization and device placement. As there are not enough representative studies of this population, the reasons for these results with better prognosis and relatively benign impact in the elderly female population are unknown, which is why it is necessary to continue with research in order to obtain greater evidence of the exposed gaps.

Help or Hurt? The Impact of Digital Finance on the Physical Health of the Elderly in China.

Under the backdrop of global aging, the escalating number of elderly individuals in poor health poses a growing social burden and impacts economic development and social stability. A fundamental question arises as to whether the advancements of digital finance (DF) can effectively enhance the physical health of the elderly. This study aims to investigate the impact of DF on the physical health of the elderly by utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2013, 2015, and 2018. The results reveal a significant positive impact of DF on enhancing the physical health of the elderly. Furthermore, the study demonstrates that this impact is particularly pronounced among the elderly with higher educational attainment, stronger intergenerational links, and those residing in central cities. A mechanism analysis further reveals that DF contributes to improving the physical health of the elderly by augmenting household disposable income, alleviating liquidity constraints, and enhancing the utilization of medical services. These findings offer valuable insights for the future development of DF and the implementation of policies promoting healthy aging and active aging.

Balloon aortic valvuloplasty bridge to transcatheter aortic valve replacement is associated with worse in-hospital mortality.

BACKGROUND: Balloon aortic valvuloplasty (BAV) has gained renewed interest as a bridge to transcatheter aortic valve replacement (TAVR) for patients with aortic stenosis (AS). However, it is unclear whether they patients should undergo TAVR directly or receive a staged bridge to BAV before TAVR is unclear. We used a national database to examine the association between BAV and TAVR in patients with TAVR and its effect on in-hospital mortality. METHODS: Using the nationwide inpatient database of the Japanese registry of all cardiac and vascular diseases and the combination of the diagnosis procedure combination, we retrospectively analyzed 27,600 patients with AS who underwent TAVR between October 2013 and March 2021. Outcomes of the direct TAVR group (n = 27,387) were compared with those of the BAV bridge to TAVR group (n = 213), which received BAV at least 1 day before TAVR. RESULTS: The median age was 85 (interquartile range: 82-88) years, with 33.3% (n = 9188) being male. Unplanned/emergent admissions increased with TAVR, whereas the use of BAV bridge to TAVR decreased. The in-hospital mortality rate was 1.3% and decreased over time. However, the BAV bridge to TAVR had a significantly higher in-hospital mortality than direct TAVR (5.6% vs. 1.3%; p < .0001). Factors associated with in-hospital mortality included age, body mass index, chronic renal disease, percutaneous coronary intervention, and BAV bridge to TAVR. CONCLUSIONS: In unplanned/emergent and planned admission settings, the in-hospital mortality rate for BAV bridge to TAVR is worse than that for direct TAVR. Practical criteria for BAV bridge to TAVR should be proposed to improve outcomes.

[Clinical effect of the warm acupuncture of Mongolian medicine on insomnia in the elderly and its brain-gut peptide mechanism: a randomized controlled trial].

OBJECTIVE: To observe the clinical effect and safety of the warm acupuncture of Mongolian medicine in treatment of insomnia in the elderly, and to explore its underlying brain-gut peptide mechanism. METHODS: Sixty elderly patients with insomnia were randomly divided into a warm acupuncture group and a western medication group, 30 cases in each group. In the warm acupuncture group, the warm acupuncture of Mongolian medicine was operated at Dinghuixue (at the center of the vertex, the crossing site of the anterior midline and the line connected the upper edges of two ear apexes), Heyixue (at the depression of the spinous process of the 7th cervical vertebra) or Xinxue (at the depression of the spinous process of the 6th thoracic vertebra) in each treatment. Only one of the above points was selected and stimulated for 20 min one treatment and the three points were used alternatively. The treatment was given once every day or every other day, 3 times a week, and for a total of 3 weeks. In the western medication group, estazolam tablets were administered orally, once a day, 1 mg before bedtime, consecutively for 3 weeks. Before and after treatment, as well as in 1-month follow-up visit after the treatment completion, the scores of the Pittsburgh sleep quality index (PSQI) and the insomnia severity index (ISI) were observed in the two groups. The serum brain-related peptide markers (substance P [SP], neuropeptide Y [NPY], 5-hydroxytryptamine 1A [5-HT1A] and 5-hydroxytryptamine 2A [5-HT2A]) were measured before and after treatment, and the clinical efficacy and safety was evaluated in the two groups. RESULTS: After treatment and in follow-up, the scores of sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance and daytime dysfunction, as well as the total scores of PSQI, and ISI scores were all reduced in the two groups (P<0.05, P<0.01); and the scores in the warm acupuncture group were lower than those of the western medication group (P<0.05, P<0.01). After treatment, the levels of serum SP and 5-HT2A were decreased (P<0.01) and the levels of serum NPY and 5-HT1A were increased (P<0.01) when compared with those before treatment in the two groups. The levels of serum SP and 5-HT2A in the warm acupuncture group were lower than those of the western medication group (P<0.05), and the levels of serum NPY and 5-HT1A were higher than those of the western medication group (P<0.05). After treatment, the total effective rate was 93.3% (28/30) in the warm acupuncture group, which was higher than 83.3% (25/30) of the western medication group (P<0.05). No serious adverse reactions were found in the two groups. CONCLUSION: Warm acupuncture of Mongolian medicine can effectively improve the sleep quality of the elderly patients with insomnia, and its mechanism may be related to the regulation of the levels of serum SP, NPY, 5-HT1A and 5-HT2A.

Acupuncture for the treatment of diabetic peripheral neuropathy in the elderly: a systematic review and meta-analysis.

Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus, often causing pain or numbness in the patient's limbs and even leading to amputation and death. Elderly patients with DPN usually have higher morbidity and more severe results. Acupuncture has been widely used as an effective treatment for DPN in China. However, the efficacy of acupuncture in the treatment of DPN remains unclear. In this review, we aimed to explore the impact of acupuncture in alleviating symptoms of DPN. Method and analysis: Six databases were searched from inception to October 2023. We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and three Chinese databases, namely China National Knowledge Infrastructure (CNKI), SinoMed, and Wanfang. All randomized controlled trials related to the effect of acupuncture on DPN will be included. There was no restriction in language or publication year. The primary outcome is the response rate. The secondary outcomes are the Toronto clinical scoring system (TCSS), nerve conduction velocities (NCVs), and blood glucose before and after the treatment. Two researchers will be responsible for the selection of study, data extraction, and assessment of study quality independently. RevMan V5.1.0 software will be used to assess the risk of bias and generate data. Results: We searched 4518 studies, among which 9 RCTs were considered eligible. Overall, acupuncture treatment had a higher response rate than controls (relative risk (RR), -2.87 [95% confidence interval (CI), -5.27 to -0.48], p = 0.02) and significantly alleviated the symptoms of DPN patients, reduced their blood glucose levels, and improved their NCVs compared to the control group. This study will provide a high-quality synthesis of current available evidence for the clinical treatment of DPN with this therapy. Conclusion: The results suggested that acupuncture might be effective in improving symptoms of DPN in elderly patients. Owing to the overall low quality of the literature included, we need more large-sample, high-quality, and low-bias studies to prove it.

Marine algae-derived oligosaccharide via protein crotonylation of key targeting for management of type 2 diabetes mellitus in the elderly.

Global aging is a tendency of the world, as is the increasing prevalence of diabetes, and the two are closely linked. In our early research, Enteromorpha prolifera oligosaccharide (EPO) possesses the excellent ability of anti-oxidative, anti-inflammatory, and anti-diabetic. We aim to further explore the deeper mechanism of how EPO delays aging and regulates glycometabolism. EPO effectively impacts crotonylation procession to enhance glucose metabolism and reduce cell senescence in aging diabetic rats. Crotonylation modification of XPO1 influences the expression of critical genes, including p53, CDK1, and CCNB1, which affect cell cycle regulation and aging. Additionally, EPO improves glucose metabolism by inhibiting the crotonylation modification of HSPA8-K126 and activating the AKT pathway. EPO promotes crotonylation of histones in intestinal cells, influencing the aging process by increasing the butyric acid-producing bacteria Ruminococcaceae. The observed enhancement in pyrimidine metabolism underscores EPO's potential role in regulating intestinal health, presenting a promising avenue for delaying aging. In summary, our findings affirm EPO as a naturally bioactive ingredient with significant potential for anti-aging and antidiabetic interventions.

[Layer based epidemiological quality assessment of architecture of care security and geriatric wards]. / Warstwowa ocena epidemiologiczna architektury zakladów opiekunczo-leczniczych i oddzialów geriatrycznych.

BACKGROUND: The article describes the potential use of an original model called the layered epidemiological assessment (warstwowa ocena epidemiologiczna - WOE) for assessing the potential risk of infections in facilities intended for elderly individuals. MATERIAL AND METHODS: To verify the possibility of using the WOE method for assessing epidemiological safety hazards in the built environment, available literature sources related to the legal requirements in Poland regarding the assessment of medical facility ergonomics in terms of infection transmission were analyzed. The article also referred to the guidelines of the New European Bauhaus and the Baukultur Quality System as a standardized method for assessing the quality of the built environment. The article presents the fundamental assumption of the author's WOE method, which allows for the assessment of the risk of infection transmission separately for each component of a building. The effectiveness of the method was demonstrated by using it to assess the risk of infections in a geriatric ward room as an example. RESULTS: The article demonstrates that by employing the WOE, it is possible to clearly differentiate potential infection routes within the analyzed facilities and assign them to specific building components. Furthermore, by applying the presented method, it is possible to define necessary procedures and develop action plans to minimize the risk of infection spread within the analyzed properties. CONCLUSIONS: The application of the WOE for evaluating architectural solutions in facilities intended for the elderly offers several benefits. The WOE method presented in the article can serve as an expert tool for quick and precise assessment of potential epidemiological hazards. An important advantage of the WOE method is its ability to be used separately for different types of epidemiological hazards characterized by different routes of infection transmission. Med Pr Work Health Saf. 2024;75(3).

Characteristics of the top 100 cited electroencephalography articles on aging: a bibliometric analysis.

Electroencephalography (EEG) is a widely used tool in neuroscience. To explore the features of the top 100 cited articles related to EEG and aging over the past decade, we conducted a bibliometric analysis using Web of Science Core Collection (WoSCC) data as of January 21, 2024. The selected top 100 cited papers were analyzed using VOSviewer and Excel. We examined the distribution of publication years, authors, institutions, countries/regions, and journals. Hotspots were identified through keyword analysis. The analyzed articles were published between 2014 and 2021, with the majority being published before 2020 (n=91). Citation counts in WoSCC ranged from 24 to 250, with a median of 40 and a mean of 53. A total of 818 authors from 283 institutions in 35 countries/territories contributed to these top papers. The United States of America (USA) (n=37), Germany (n=14), and Canada (n=11) ranked in the top three in terms of total publications or citations. The predominant journals were in the fields of Neuroscience (n=58), Geriatrics & Gerontology (n=22), Clinical Neurology (n=13), and Anesthesiology (n=9), which published most of the high-quality articles. Key themes included EEG, aging, Alzheimer's disease, mild cognitive impairment, functional connectivity, and alpha oscillations. Emerging topics included sleep, machine learning, delirium, postoperative cognitive function, virtual reality, monitoring, resting state, coherence, and transcranial direct current stimulation. In conclusion, this study provides a comprehensive overview of the trends in scientific literature on EEG in aging over the past decade. Authors and institutions from North America, Europe, and East Asia led in contributions. Journals focusing on neuroscience, geriatrics, and anesthesiology published the majority of articles. Degenerative neurological diseases and cognitive impairment were prominent topics, suggesting future studies should explore EEG's diagnostic utility for these disorders.

Something to Chew on; Plate-Waste at an Ontario Veteran's Centre.

There is paucity of data assessing levels of food/beverage waste in long-term care (LTC) facilities, especially in Ontario. Observations in the Veteran's Centre (VC) at Sunnybrook Health Sciences Centre (Sunnybrook) indicated food/beverage waste may be high, potentially impacting sustainability efforts within our institution. Before proceeding with waste reduction efforts, we conducted a comprehensive 3-day waste-audit of food/beverage items provided to VC residents with the goal of understanding the extent of food/beverage waste at VC, items wasted, and any other factors that may inform future changes. Our results indicate that 28% of items served to residents were wasted. Lunch was the meal with greatest waste at 31% and waste of solid items was 12% higher than that of liquids. We observed a large variability in waste between residents and within each resident, with 15% of residents wasting >50% of items provided. This study provides a deeper insight into the magnitude of food/beverage waste in a LTC population and highlights the importance of considering individualized strategies to address waste to avoid negative impact on residents.

Bone metabolism factors in predicting the risk of osteoporosis fracture in the elderly.

OBJECTIVE: Osteoporosis (OS) is a systemic bone disease characterized by low bone mass and bone microstructure damage. This study. METHODS: According to the T value, 88 elderly fracture patients were grouped as the control group (without OS, 43 cases) and observation group (with T value <-2.5, which could be diagnosed as OS, 45 cases). The content of boney containing protein (BGP), total type 1 collagen amino terminal extender peptide (TPINP), ß-Crosslaps (ß-CTX), parathyroid hormone (PTH) and insulin-like growth factors-1 (IGF-1) was compared. Multivariate logistic regression was adopted to analyze the correlation between biochemical indexes and the occurrence of senile OS fracture and the related risk factors. The diagnostic value in the elderly was analyzed by receiver operating characteristic (ROC) curve. RESULTS: The levels of BGP, TPINP, ß-CTX, PTH and IGF-1 were elevated, and the level of IGF-1 was decreased in the observation group compared with the control group (P < 0.05). The elevated content of BGP, TPINP, ß-CTX and PTH, and the decreased expression of IGF-1 were influencing factors for OS fractures in the elderly (P < 0.05). The sensitivity and specificity to predict the occurrence of OS fractures in the elderly were 91.70% and 90.50%, respectively. The AUC of combined detection was 0.976 (95% CI: 0.952-1.000), which was memorably higher than single indicator detection (P < 0.05). Among 45 patients, 32 cases had good prognosis and 13 had poor prognosis. In comparison with the good prognosis group, the content of BGP, TPINP, ß-CTX and PTH were sensibly higher, the level of IGF-1 was prominently lower, and the proportion of fracture history was much higher in poor prognosis group (P < 0.05). Fracture history, BGP, TPINP, ß-CTX, PTH and IGF-1 were independent risk factors for poor prognosis of elderly OS fractures (P < 0.05). CONCLUSION: Bone metabolism factors were associated with poor prognosis of OS in the elderly. The combined detection had higher diagnostic value in calculating the risk of OS fracture in the elderly than single indicator detection.

Health-Related Issues of Users of Social Care Services for Elderly and Their Caregivers: A Cross-Sectional Study in a Day Care Center.

AIM: The aim of this study was to examine two hypotheses: 1) Users of Day Care Center for Elderly (DCCE) would have frail health and multiple age-related care needs, and 2) caregivers would have to deal with some levels of anxiety due to the burden of care, and similar levels of quality of life to the users. MATERIALS AND METHODS: The current cross-sectional study was carried out at a DCCE of the regional unit of Heraklion, Crete, Greece, between March-April 2022. The study sample comprised 29 DCCE social care services users and 51 caregivers. A short questionnaire sheet was created to record sociodemographic characteristics and general health-related issues. Additionally, the Anxiety Symptom Scale (Short Anxiety Screening Test (SAST)) and the Quality of Life (SF-12) were used to measure anxiety and quality of life of the participants. Comparison analysis was performed to detect differences between the two groups. RESULTS: The most common morbidities for users of DCCE were hypertension (58.6%), hypercholesterolemia (55.2%), rheumatoid arthritis (24.1%), diabetes (24.1%) and heart disease (41.4%). Users of social care services have significantly higher vaccination rates (influenza: 100%, COVID-19: 100%, herpes zoster: 44.8%, and pneumococcus: 86.2%) than their caregivers. About 75% (yes: 24% and sometimes: 51.8%) of the users and 45% of their caregivers (yes: 7.8%, and sometimes: 37.3%) felt lonely at least sometimes. All participants were found to have low mean levels of the SAST score (18.4, SD:4.9) and 18.7% were on the verge of severe symptoms. Users of social care services were found to have low average levels of quality of life (SF-12), with significantly lower physical health (28.2, SD: 6.6) compared to the Mental health subscale (39.6, SD: 9.3) (p <0.001). CONCLUSIONS: This study highlighted the main health-issues of DCCE users, and that they have low quality of life. Additionally, we found that caregivers faced a few health-issues, and had higher quality of life and lower SAST levels than the users. Therefore, social and health policy providers should consider our findings and assess the users' and caregivers' needs to provide holistic care, thus improving their quality of life.

Non-diabetic elderly populations: the MHR as a protective factor against bone abnormalities.

Objectives: In China, osteoporosis has become a major health concern among elderly population, imposing significant burden on the country's social and economic systems. The monocyte to high-density lipoprotein ratio (MHR) has been currently recommended as a novel marker of inflammation and oxidative stress associated with osteoporosis in type 2 diabetes mellitus (T2DM). However, its reliability in non-diabetic elderly populations remains unclear. The present study was to evaluate the association between MHR and osteoporosis in a non-diabetic elderly population. Methods: The clinical data of 240 non-diabetic elderly subjects (115 in the osteoporosis group and 125 in the normal bone group) were retrospectively analyzed and all statistical analyses were performed by using SPSS 26.0. Results: Differences in age, neutrophils, lymphocytes, monocytes, MHR, uric acid, creatinine, triglycerides,and high-density lipoprotein cholesterol were found to be statistically significant between the two groups. A binary logistic regression model was conducted by including age, MHR, UA and Cr as variables. The results showed that age was an independent risk factor and MHR was an independent protective factor for bone abnormality in the non-diabetic elderly population. The ROC analysis showed that the area under the curve for the predictive effect of MHR, age and their combined test on osteoporosis in non-diabetic elderly populations was 0.623, 0.728 and 0.761, respectively; the correlation analysis showed that MHR was positively correlated with lumbar and hip BMD, and negatively associated with femoral neck stress ratio, femoral intertrochanteric stress ratio, and femoral stem stress ratio, showing statistically significant differences (P<0.05). Conclusions: For the non-diabetic elderly population: the MHR is a protective factor against bone abnormalities and was significantly higher in the normal bone group than in the abnormal bone group.

Program of All-Inclusive Care for the Elderly: an untapped setting for research to advance pain care in older persons.

The Program of All-Inclusive Care for the Elderly (PACE) is a community-based care model in the United States that provides comprehensive health and social services to frail, nursing home-eligible adults aged 55 years and older. PACE organizations aim to support adequate pain control in their participants, yet few evidence-based pain interventions have been adopted or integrated into this setting. This article provides a roadmap for researchers who are interested in collaborating with PACE organizations to embed and evaluate evidence-based pain tools and interventions. We situate our discussion within the Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework that considers multi-level influences to implementation and evaluation of evidence-based programs. Within each CFIR domain, we identify key factors informed by our own work that merit consideration by research teams and PACE collaborators. Inner setting components pertain to the organizational culture of each PACE organization, the type and quality of electronic health record data, and availability of staff to assist with data abstraction. Outer setting components include external policies and regulations by the National PACE Association and audits conducted by the Centers for Medicare and Medicaid Services, which have implications for research participant recruitment and enrollment. Individual-level characteristics of PACE organization leaders include their receptivity toward new innovations and perceived ability to implement them. Forming and sustaining research-PACE partnerships to deliver evidence-based pain interventions pain will require attention to multi-level factors that may influence future uptake and provides a way to improve the health and well-being of patients served by these programs.

Do the elderly and those with comorbid chronic physical conditions have improved access to outpatient psychotherapy post structural reforms in Germany? Results of the ES-RiP study.

Background: In 2017, a reform of the German outpatient psychotherapy guideline was carried out, aiming to reduce waiting times and facilitate low-threshold access. This study analyzes the extent to which the implementation of the two new service elements 'psychotherapeutic consultation times' and 'acute short-term psychotherapeutic interventions' improved psychotherapeutic care for patients with mental disorders and chronic physical conditions (cMPs), for patients with mental disorders without chronic physical conditions (MnoP), and elderly patients. Methods: In a quantitative secondary analysis, we analyzed health insurance data of patients with psychotherapy billing codes obtained from the National Association of Statutory Health Insurance Physicians (KBV) for the years 2015-2019, evaluating descriptive statistical parameters for specific patient groups and care services. Results: Between 2015 and 2019, the number of mentally ill receiving psychotherapy at least once in the corresponding year increased by 30.7%. Among these, the proportion of cMPs-patients increased from 26.8% to 28.2% (+1.4%), while that of MnoP-patients decreased from 68.3% to 66.4% (-1.9%). The number of elderly people receiving treatment also increased. Conclusion: Since increases and decreases in the percentage shares occur evenly over the years investigated, it is questionable whether the reform in 2017 has had a direct influence on these changes. Study registration: ID DRKS00020344, URL: https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html.

The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach.

Acute cholecystitis (AC), generally associated with the presence of gallstones, is a relatively frequent disease that can lead to serious complications. For these reasons, AC warrants prompt clinical diagnosis and management. There is general agreement in terms of considering early laparoscopic cholecystectomy (ELC) to be the best treatment for AC. The optimal timeframe to perform ELC is within 72 h from diagnosis, with a possible extension of up to 7-10 days from symptom onset. In the first hours or days after hospital admission, before an ELC procedure, the patient's medical management comprises fasting, intravenous fluid infusion, antimicrobial therapy, and possible administration of analgesics. Additionally, concomitant conditions such as choledocholithiasis, cholangitis, biliary pancreatitis, or systemic complications must be recognized and adequately treated. The importance of ELC is related to the frequent recurrence of symptoms and complications of gallstone disease in the interval period between the onset of AC and surgical intervention. In patients who are not eligible for ELC, it is suggested to delay surgery at least 6 weeks after the clinical presentation. Critically ill patients, who are unfit for surgery, may require rescue treatments, such as percutaneous or endoscopic gallbladder drainage (GBD). A particular treatment approach should be applied to special populations such as pregnant women, cirrhotic, and elderly patients. In this review, we provide a practical diagnostic and therapeutic approach to AC, even in specific clinical situations, based on evidence from the literature.

China's policies: post-COVID-19 challenges for the older population.

On 7 December 2022, the State Council of China released 'Measures to Further Optimize the Implementation of the Prevention and Control of the New Coronavirus Epidemic'. The previous three-year dynamic zero epidemic prevention policy was then replaced with a full liberalization policy. On 5 May 2023, the World Health Organization declared that COVID-19 no longer constituted a 'public health emergency of international concern.' However, given the ongoing prevalence of coronavirus, emerging mutations, and the liberalization of restrictions, there are increased risks of vulnerable people contracting new variants. Low vaccination coverage among older people with compromised immune systems, puts them at further risk. The policy shift will increase pressure on already stretched health infrastructure and medical resources. This short article adds to the current debate arguing that the Chinese government should take commensurate preventive measures, including strengthening medical facilities and equipment and targeting ongoing vaccination in older people.

Paper ContextThe COVID-19 pandemic has disproportionately affected older people.This short paper discusses the consequences of China's liberalization policy on the older population.It suggests that the Chinese government should have taken targeted measures to mitigate health risks occurring under the changed circumstances.