[Objective] To evaluate the clinical efficiency of refratory edema based on daytime prelonged Online-HDF.[Methods] Six patients include four females and two males whose age ranging from 28 to 74 years old and average 55 years old.Online-HDF treatment for 3-9 times,vascular access was percutaneous femoral or internal jugular catheterization.One patient's temporary access was changed to permanent access because who needed continous hemodialysis.The machine version was Ganbro AK-100S.To filter by u2000 and replace fluid online for 6-10 hous,blood flow was 200-250ml/min,uf 1200-8600,the total fluid used for replacement was 20-42 liter,during the process,regular heparin or low molecular was used for anticoagulation.[Results]Three patients' clinical symptoms resulted from edema resolved,one patient accepted continous hemodialysis treatment for inpaired kidney function,one patient left hospital for expensive medical cost,one patient accepted ventilation treatment for respiratory failure in ICU.[Conclusion]Daytime prelonged Online-HDF is effective on the trentment of refratory edema,especially effective on dyspnea,tachypnea,chest distress that resulted from edema.

BACKGROUND: Female hypertension has its own epidemicologic character and the chief interventions on it are various.OBJECTIVE: To investigate the risk factors of female hypertension and observe the effects on rehabilitative and preventive intervention in demonstrative community for comprehensive prevention and treatment of cardiac cerebral vascular disease in Guizhou.DESIGN: Group randomization was designed. The samples of certain percentage were randomized according to total population from each village of 13 administrative areas.SETTING: Guizhou Institute of Cardiovascular Disease, Renmin Hospital of Yunyan District in Guiyang, Guizhou Clinical Examination Center.PARTICIPANTS: Since 1996, a series of comprehensive prevention and treatment had been carried in the communities for cardiac cerebral vascular disease in Guizhou, involved 13 administrative areas and 112 villagecitizen groups, in which, 26 604 people were employed, living in the regions between town and country. Social natural condition and life behavior of majority citizen reflected the common state of people in town and country. Totally 3 934 people aged over 15 years were investigated in the communities, and were all in the known of investigation. The samples without complete data were excluded.METHODS: ① Base-line investigation was carried on for the groups over 15 years old according to the requirement for administrative region designed by Institute of Preventive Medicine of China Academy of Sciences from April 1st 2001 to May 15th . ② Health education and health promotion activity were carried on for the included groups. ③ Survey after intervention was given for females according to the survey items designed by Institute of Preventive Medicine of China Academy of Sciences from July 2002to June 2003. ④ Normal body-mass index (BMI) was 18.5-23.9 kg/m2,overweight was indicated if BMI was 24-27.9 kg/m2 and obesity was diagnosed if BMI ≥28 kg/m2. ⑤ Analysis was applied on comparison of BMI,waist to hip ratio (WHR), average blood pressure, the rates of incidence,awareness and treatment of hypertension and rate of high-salty and lipid diet. ⑥ t test was adopted for comparison of means between two samples and x2 test was used for rate comparison.MAIN OUTCOME MEASURES: ① Comparison of the rates of incidence, awareness, treatment and control of hypertension for females of different ages in community base-line investigation in Guizhou. ② Comparison of BMI, WHR and BP of females of various ages in baseline investigation.③ Comparison of incident rate of hypertension for females with various BMI in baseline investigation. ④ Comparison of BMI, WHR, BP, smoke, alcohol, rate of high-salty and lipid diet, the rates of incidence, awareness,treatment and control of hypertension for females between baseline investigation and post-intervention survey.RESULTS: In baseline investigation, 6 361 correct and complete forms were collected, with 99.84% qualified rate, of which, there were 3 934females. 1 141 data were qualified after intervention. It was indicated in community baseline investigation: ① Rates of incidence, awareness and treatment of hypertension for females were improved with increased age (P ＜ 0.05), and the control rate was decreased with increased age (P ＜ 0.05). ② BMI, WHR, SBP (systolic blood pressure) and DBP (diastolic blood pressure) and PP (pulse pressure) were improved significantly with in creased age (P ＜ 0.01). BMI for females was increased with ages, but was declined with age ≥60 years. ③ The incident rates of hypertension for groups of normal body mass, overweight and obesity were 15.05%, 23.87% and 39.37% successively, indicating that the hypertension inci dent rate was increased significantly with improved BMI (paired compari son, P ＜ 0.05). Comparison between post-intervention survey and base-line investigation: ① In the comparison, the results of BMI, WHR and BP means were reduced for most cases at same age and significant difference was displayed in majority (P ＜ 0.05). ② After intervention, smoke rate of females was increased significantly and rate of high-salty and lipid diet was decreased (P ＜ 0.05). ③ Incident rate after health intervention was decreased significantly compared with that before intervention (P ＜ 0.05),and the rates of awareness, treatment and control of hypertension were enhanced significantly (P ＜ 0.05).CONCLUSION: ① The rates of incidence, awareness, treatment and control of female hypertension are different in ages in community of Guizhou. ② The severity of risk factor of female hypertension is enhanced with increased age in community of Guizhou. ③ The increased body mass is the important factor of incident rate of hypertension. ④ Health education probably decreases the severity of risk factor of hypertension and increases the rates of awareness, treatment and control.

Objective:To explore the risk factors for postoperative adverse events in older persons with gastrointestinal malignancies and thus provide reference for selection of surgery and evaluation of such patients.Methods:An observational study design was employed, the study cohort comprising patients aged 65 years and over with gastrointestinal malignancies who underwent elective surgery in Peking University Cancer Hospital from 2008 to 2022. In this study, we compared the clinical characteristics (disease type, tumor stage), surgical safety (combined organ resection, operation duration, comorbidities), and treatment outcomes (postoperative complications, unplanned reoperation, and perioperative mortality) of these patients. Multivariate logistic regression analysis was conducted to identify risk factors associated with adverse outcomes.Results:The study cohort comprised 10,135 patients, of whom 74.7% (7,568) were 65–75 years old (excluding 75 years old), 23.6% (2,391) 75–85 years old (excluding 85 years old), and 1.7% (176) ≥85 years old. The type of cancer was colorectal in 63.4% (6,427 patients) and gastric in 36.6% (3,708); 62.0% (6,284/10,135)of the patients had stage II or III disease. The proportion of stage III and stage IV tumors was higher in patients aged over 85 years (47.4% [73/154) and 11.0% [17/154]), respectively, than in those aged 75–85 years (41.6% [854/2 051) and 8.2% [168/2 051]), respectively, and those aged 65–75 years (40.1% [2,576/6,431) and 10.9% [700/6,431]); these differences are statistically significant (χ 2=27.95, P<0.01). Comorbidity was present in 50.6% (5,128/10,135) of the whole study cohort, comprising 58.0% (102/176) of those aged over 85 years, this being significantly higher than the 56.3% (1,346/2,391) in those aged 75–85 years and 48.6% (3,678/7,568) of those aged 65–75 years. The main comorbidities were hypertension (37.3%), diabetes (16.4%), and cardiovascular and cerebrovascular diseases (14.0%). Minimally invasive surgery was performed on 36.9% (3,740/10,135) of the whole study cohort, the 38.4% in 65–75 years old patients being significantly higher than the 32.5% in those aged 75–85 years and the 29.0% in those aged over 85 years; these differences are statistically significant (χ 2=31.97, P<0.01). Preoperative neoadjuvant therapy was administered to 9.1% (924/10,135) of the whole study cohort, the proportion of patients receiving preoperative neoadjuvant therapy being significantly higher in those aged 65–75 years (11.1%) than in those aged 75–85 years (3.4%) and over 85 years (0.6%); these differences are statistically significant (χ 2=148.98, P<0.01). Combined organ resection was performed in 4.9% (496/10,135) of the whole study cohort, the proportion undergoing combined organ resection being significantly lower in those aged over 85 years (2.3%) than in those aged 65–75 years (5.3%) and 75–85 years (3.8%); these differences are statistically significant (χ 2=11.20, P<0.01). The mean operating time was (182.2±76.8) minutes, being significantly higher in those aged 65–75 years (186.6±78.3 minutes) than in those aged 75–85 years (169.4±71.3 minutes) and over 85 years (153.2±53.7 minutes); these differences are statistically significant ( F=46.85, P<0.01). The overall incidence of postoperative complications was 10.9% (802/7,384); the incidence did not differ significantly between the three groups ( P>0.05). The incidence of unplanned reoperation was 1.9% (193/10,135) and of death during hospitalization 0.3% (32/10,135). The perioperative mortality in the three groups was 1.1%, 0.5% and 0.2% in those aged over 85, 75–85, and 65–75 years, respectively. These differences are statistically significant (χ 2=9.71, P<0.01). Among the patients with postoperative complications, 15.0% (120/802) underwent unplanned reoperation, which had a perioperative mortality of 1.0% (8/802), these rates being significantly higher than those for unplanned reoperation (1.1%, 73/6,582) and perioperative mortality (0.4%, 24/6,582) in patients without complications (all P<0.01). The median length of hospital stay was 11 days in patients aged over 85 years; this is significantly longer than the 9 days in those aged 65–75 years and 10 days in those aged 75–85 years (H=37.00, P<0.01). Multivariate logistic regression analysis showed that tumor stage IV (OR=1.56, 95%CI: 1.24–1.96, P<0.01), comorbidities (OR=1.26, 95%CI: 1.08–1.47, P<0.01), open surgery (OR=1.33, 95%CI: 1.13–1.56, P<0.01), and operation time >180 minutes (OR=1.82, 95%CI:1.53–2.15, P<0.01) were risk factors for adverse outcomes. Conclusion:Older patients with gastrointestinal tumors who have comorbidities and stage IV disease and undergo open surgery with a longer operation time are at higher risk of adverse outcomes than patients without these characteristics.

Objective:To explore the risk factors for postoperative adverse events in older persons with gastrointestinal malignancies and thus provide reference for selection of surgery and evaluation of such patients.Methods:An observational study design was employed, the study cohort comprising patients aged 65 years and over with gastrointestinal malignancies who underwent elective surgery in Peking University Cancer Hospital from 2008 to 2022. In this study, we compared the clinical characteristics (disease type, tumor stage), surgical safety (combined organ resection, operation duration, comorbidities), and treatment outcomes (postoperative complications, unplanned reoperation, and perioperative mortality) of these patients. Multivariate logistic regression analysis was conducted to identify risk factors associated with adverse outcomes.Results:The study cohort comprised 10,135 patients, of whom 74.7% (7,568) were 65–75 years old (excluding 75 years old), 23.6% (2,391) 75–85 years old (excluding 85 years old), and 1.7% (176) ≥85 years old. The type of cancer was colorectal in 63.4% (6,427 patients) and gastric in 36.6% (3,708); 62.0% (6,284/10,135)of the patients had stage II or III disease. The proportion of stage III and stage IV tumors was higher in patients aged over 85 years (47.4% [73/154) and 11.0% [17/154]), respectively, than in those aged 75–85 years (41.6% [854/2 051) and 8.2% [168/2 051]), respectively, and those aged 65–75 years (40.1% [2,576/6,431) and 10.9% [700/6,431]); these differences are statistically significant (χ 2=27.95, P<0.01). Comorbidity was present in 50.6% (5,128/10,135) of the whole study cohort, comprising 58.0% (102/176) of those aged over 85 years, this being significantly higher than the 56.3% (1,346/2,391) in those aged 75–85 years and 48.6% (3,678/7,568) of those aged 65–75 years. The main comorbidities were hypertension (37.3%), diabetes (16.4%), and cardiovascular and cerebrovascular diseases (14.0%). Minimally invasive surgery was performed on 36.9% (3,740/10,135) of the whole study cohort, the 38.4% in 65–75 years old patients being significantly higher than the 32.5% in those aged 75–85 years and the 29.0% in those aged over 85 years; these differences are statistically significant (χ 2=31.97, P<0.01). Preoperative neoadjuvant therapy was administered to 9.1% (924/10,135) of the whole study cohort, the proportion of patients receiving preoperative neoadjuvant therapy being significantly higher in those aged 65–75 years (11.1%) than in those aged 75–85 years (3.4%) and over 85 years (0.6%); these differences are statistically significant (χ 2=148.98, P<0.01). Combined organ resection was performed in 4.9% (496/10,135) of the whole study cohort, the proportion undergoing combined organ resection being significantly lower in those aged over 85 years (2.3%) than in those aged 65–75 years (5.3%) and 75–85 years (3.8%); these differences are statistically significant (χ 2=11.20, P<0.01). The mean operating time was (182.2±76.8) minutes, being significantly higher in those aged 65–75 years (186.6±78.3 minutes) than in those aged 75–85 years (169.4±71.3 minutes) and over 85 years (153.2±53.7 minutes); these differences are statistically significant ( F=46.85, P<0.01). The overall incidence of postoperative complications was 10.9% (802/7,384); the incidence did not differ significantly between the three groups ( P>0.05). The incidence of unplanned reoperation was 1.9% (193/10,135) and of death during hospitalization 0.3% (32/10,135). The perioperative mortality in the three groups was 1.1%, 0.5% and 0.2% in those aged over 85, 75–85, and 65–75 years, respectively. These differences are statistically significant (χ 2=9.71, P<0.01). Among the patients with postoperative complications, 15.0% (120/802) underwent unplanned reoperation, which had a perioperative mortality of 1.0% (8/802), these rates being significantly higher than those for unplanned reoperation (1.1%, 73/6,582) and perioperative mortality (0.4%, 24/6,582) in patients without complications (all P<0.01). The median length of hospital stay was 11 days in patients aged over 85 years; this is significantly longer than the 9 days in those aged 65–75 years and 10 days in those aged 75–85 years (H=37.00, P<0.01). Multivariate logistic regression analysis showed that tumor stage IV (OR=1.56, 95%CI: 1.24–1.96, P<0.01), comorbidities (OR=1.26, 95%CI: 1.08–1.47, P<0.01), open surgery (OR=1.33, 95%CI: 1.13–1.56, P<0.01), and operation time >180 minutes (OR=1.82, 95%CI:1.53–2.15, P<0.01) were risk factors for adverse outcomes. Conclusion:Older patients with gastrointestinal tumors who have comorbidities and stage IV disease and undergo open surgery with a longer operation time are at higher risk of adverse outcomes than patients without these characteristics.