Objective To analyze the predictive value of Alberta stroke program early CT score(ASPECTS),acute stroke registry and analysis of Lausanne(ASTRAL)and totaled health risks in vascular events(THRIVE)for prognosis of intravenous thrombolysis in elderly patients with acute cerebral infarction(ACI).Methods A total of 118 elderly ACI patients receiving intravenous thrombolytic therapy in Department of Emergency Medicine of Shengli Oilfield Central Hospital from January 2021 to September 2024 were prospectively recruited.According to the score of Modified Rankin scale(mRS)at 3 months after treatment,the patients were divided into good prognosis group(73 cases)and poor prognosis group(45 cases).The scores of ASPECTS,ASTRAL and THRIVE models were compared between the two groups.ROC curve was plotted to evaluate the predictive efficiency of the three models for 3-month prognosis,and the area under the curve(AUC)was calculated.Results The poor prognosis group had significantly higher ASTRAL score and THRIVE score but obviously lower ASPECTS score when compared to the good prognosis group(P＜0.01).ROC curve analysis revealed that the AUC value of ASPECTS,ASTRAL and THRIVE models for prognosis evaluation was 0.731,0.935 and 0.799,respectively(P＜0.01),with excellent goodness of fit.Conclusion All the three models can effectively predict the prognosis of elderly ACI patients at 3 months after intravenous thrombolytic therapy.

Objective To investigate the impact of new-onset atrial fibrillation(AF)on all-cause mortality in elderly patients with hypertension having no previous history of AF.Methods A retrospective study was conducted on 1352 elderly hypertensive inpatients who had no history of AF and received long-term follow-up in Chinese PLA General Hospital from January 2014 to June 2017.According to having newly developed AF or not,they were divided into a new-set AF group(191 cases)and a control group(1161 cases).Kaplan-Meier survival curve was plotted for survival analysis and multivariate Cox survival analysis was performed to identify risk factors for all-cause mortality.Results Compared with the control group,the new-onset AF group exhibited significantly advanced age,higher urea level,lower diabetes ratio,and decreased hemoglobin level(P＜0.05,P＜0.01).Kaplan-Meier survival curve analysis showed that the cumulative mortality of the new-onset AF group was significantly higher than that of the control group(P＜0.01).Multivariate Cox regression analysis revealed that age＞75 years(HR=4.562,95％CI:3.104-6.705,P＜0.01),anemia(HR=2.543,95％CI:1.939-3.334,P＜0.01),new-onset AF(HR=1.494,95％CI:1.185-1.884,P＜0.01),eGFR＜60 mL/(min·1.73 m2)(HR=1.729,95％CI:1.389-2.151,P＜0.01),and heart failure(HR=1.539,95％CI:1.173-2.019,P＜0.01)were risk factors for all-cause mortality in elderly hypertensive patients without a history of AF.Conclusions New-onset AF is closely associated with an increased risk of all-cause mortality in elderly hypertensive patients without a previous history of AF.

Objective To investigate the presumed correlation between lactate level and clearance during extracorporeal life support(ECLS)and death in elderly cardiac intensive care patients.Methods A total of 93 elderly cardiac intensive care patients who received ECLS in Department of Critical Care Medicine,Xiangya Medical College Affiliated Changsha Hospital,Central South University,from March 2019 to October 2024 were retrospectively included to manage low cardiac production syndrome after major cardiac surgery.According to hospital outcomes,the patients were divided into a death group(n=45)and a survival group(n=48).Blood lactate measurements were performed every 4 hours from the beginning of ECLS treatment to calculate peak lactate and lactate clearance rate(LCR).Routine ICU scores,such as sequential organ failure score(SOFA)and reactive organ dysfunction(ROD)score,and postoperative complications were recorded.Results The death group received larger amounts of packed red blood cell concentrate,fresh frozen plasma and platelet concentrate,and exhibited higher ratios of norepinephrine and epinephrine administration and higher incidences of re-thoracotomy and hemolytic episodes when compared with the survival group(P＜0.05,P＜0.01).At the end of ECLS,higher SOFA and ROD scores were observed in the death group(P＜0.01).The death group also demonstrated higher lactate level from venoarterial ECLS(P＜0.001)and increased median peak lactate level,but lower median LCR than the survival group(P＜0.01).Multivariate logistic analysis showed that peak lactate and LCR were independent prognostic factors in the elderly cardiac ICU patients(P＜0.05,P＜0.01).The AUC value(95％CI)of peak lactate and LCR in predicting patient outcomes was 0.723(95％CI:0.615-0.831)and 0.846(95％CI:0.761-0.932),respectively,and the value of their combination in predicting in-hospital death was 0.846(95％CI:0.762-0.931),with a sensitivity of 0.629 and a specificity of 0.937.Conclusion Lactate level and its clearance rate during ECLS can affect the survival rate of elderly cardiac intensive care patients.Peak lactate and LCR can predict the prognosis of elderly cardiac intensive care patients,and can be used as prognostic indicators for clinical monitoring.

Objective To investigate the predictive value of geriatric nutritional risk index(GNRI)combined with CHA2DS2-VASc-60 score for short-term prognosis of elderly multimorbid patients with atrial fibrillation.Methods A total of 220 elderly multimorbid patients with non-valvular atrial fibrillation admitted to our hospital from May 2020 to December 2022 were recruited.Clinical data were collected,and GNRI and CHA2DS2-VASc-60 score were calculated.With 98 as a cut-off value of GNRI,the patients were divided into normal nutritional group(109 cases)and nutritional risk group(GNRI ≤ 98,111 cases).Clinical characteristics were compared between the two groups.Multivariate logistic regression analysis was used to identify the influencing factors for compound events in elderly multimorbid patients with atrial fibrillation.Variance inflation factor was adopted for collinearity diagnosis.ROC curve was plotted to evaluate the prognostic value of GNRI,CHA2DS2-VASc-60 score and their combination.Results Compared with the normal nutritional group,the nutritional risk group had significantly advanced age,higher CHA2DS2-VASc-60 score,and larger proportion of concomitant chronic heart failure(P＜0.05).Age(OR=1.228,95％CI:1.112～1.357),GNRI(OR=0.693,95％CI:0.494～0.997)and CHA2DS2-VASc-60 score(OR=1.488,95％CI:1.008～2.194)were influencing factors for the occurrence of complex events(P＜0.05,P＜0.01).The AUC value of GNRI,CHA2DS2-VASc-60 score,and their combination in predicting complex events at the end of 6 months was 0.665(95％CI:0.539～0.791),0.689(95％CI:0.578～0.801),and 0.749(95％CI:0.653～0.844),respectively(P＜0.05).Conclusion Age,GNRI,and CHA2DS2-VASc-60 score are influencing factors for the occurrence of complex events in elderly multimorbid patients with atrial fibrillation.The combination of GNRI and CHA2DS2-VASc-60 score has predictive value for the short-term prognosis of the patients.

Objective To analyze the psychological status and related factors in elderly patients of different genders after percutaneous coronary intervention(PCI)for coronary heart disease(CHD).Methods A total of 303 eligible patients treated in our department from January 2021 to December 2024 were enrolled,and then divided into a male group(154 cases)and a female group(149 cases).Based on the 7-item Generalized Anxiety Disorder Scale,they were assigned into a female anxiety group(97 cases),a female non-anxiety group(52 cases),a male anxiety group(82 cases)and a male non-anxiety group(72 cases).According to the 9-item Patient Health Questionnaire,they were alsocategorized into a female depression group(92 cases),a female non-depression group(57 cases),a male depression group(75 cases)and a male non-depression group(79 cases).The basic clinical data and results of psychological assessment were recorded in each group.Statistical analysis was performed on the indicators,including total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C).Results The female patients had significantly higher scores of physical symptoms,anxiety and depression,and larger proportions of anxiety and depression than the male group(P＜0.05,P＜0.01).In the female patients,advance age,higher TC,TG and LDL-C levels and somatic symptom score were observed in those with anxiety than those without,and in those with depression group than those without(P＜0.05,P＜0.01).The male anxiety group exhibited older age,more lesion vessels,larger ratio of ≥2 stents,and higher physical symptom score when compared with the male non-anxiety group,and so were in the male depression group than the male non-depression group(P＜0.05,P＜0.01).Binary logistic regression analysis showed that age,TC,LDL-C,and somatic symptom score were risk factors for anxiety,and age,TC,HDL-C,LDL-C,and somatic symptom score were risk factors for depression in elderly female CHD patients(P＜0.05,P＜0.01).For the elderly male CHD patients,age,stents ≥2,and somatic symptom score were risk factors for anxiety(OR=1.068,95％CI:1.002-1.138,P＜0.05;OR=6.458,95％CI:2.807-14.858,P＜0.01;OR=1.148,95％CI:1.045-1.262,P＜0.01),and age,stents ≥2,and more lesion vessels were risk factors for depression(P＜0.01).Conclusion The female CHD patients undergoing PCI have higher anxiety and depression scores than the male patients.There are certain differences in the influencing factors for anxiety and depression between genders.Effective control of these risk factors may help improve the prognosis of CHD patients after PCI.

Objective To predict the value of admission dehydration state combined with fluid accumulation index for post-operative prognosis in elderly patients with intracerebral hemorrhage(ICH).Methods A retrospective study was conducted on 320 elderly ICH patients receiving surgical treatment in Department of Neurosurgery and then admitted to its Intensive Care Unit of the Affiliated Hospital of North China University of Science and Technology from May 2023 to March 2024.According to the survival status at 30 d after onset,they were divided into a survival group(202 cases)and a death group(118 cases).Clinical data such as basic information,admission vital signs,laboratory indicators,and fluid supplementation were compared between the two groups.ROC curve was plotted.Results The death group exhibited significantly advanced age,more bleeding sites,higher 7-day fluid accumulation index,and larger proportions of ventricular rupture,midline displacement and admission dehydration status,but lower uric acid level than the the survival group(P＜0.05,P＜0.01).Binary logistic regression analysis showed that admission dehydration status and 7-day fluid accumulation index were risk factors for 30-day mortality in elderly ICH patients after surgery(P＜0.01).ROC curve analysis showed that the AUC value of admission dehydration status combined with 7-day fluid accumulation index in predicting 30-day death of elderly ICH patients after surgery was 0.774(95％CI:0.722-0.825),and that of the combination was better than that of each indicator alone(P＜0.05).Conclusion Hospital dehydration status combined with 7-day fluid accumulation index has the best effectiveness in predicting 30-day mortality in elderly ICH patients after surgical treatment.

Objective To compare the clinical efficacy of using edaravone dexmedetomidine at different times after intravenous thrombolysis in elderly patients with acute ischemic stroke(AIS).Methods A prospective study was conducted on 180 elderly AIS patients undergoing intravenous thrombolysis with recombinant tissue-type plasminogen activator in our department from April 2022 to December 2023.The patients were randomly divided into immediate group,12 h group and 24 h group,receiving an edaravone dexmedetomidine injection immediately and at 12 and 24 h after thrombolysis,respectively.During the study period,2 cases were excluded from both the immediate group and the 24 h group.NIHSS and MMSE were used to assess neurological function and cognitive function.The levels of TNF-α,IL-6 and hs-CRP were detected.The occurrence of complications after thrombolytic therapy was recorded in the three groups.Results The NIHSS scores of the three groups were significantly lower at 7 d after thrombolysis and 3 months after discharge than those before thrombolysis(P＜0.05).The scores of the immediate group were obviously lower than those of the 12 h and 24 h groups 7 d after thrombolysis,and 3 months after discharge,and the scores of the 12 h group were significantly lower than that of the 24 h group at 3 months after discharge(P＜0.05).The MMSE scores were significantly higher in the three groups at 7 d after thrombolysis and 3 months after discharge than before thrombolysis(P＜0.05).The MMSE scores of the immediate group were significantly higher than those of the 12 h and 24 h groups at 7 d after thrombolysis,and 3 months after discharge(P＜0.05),and the MMSE scores of the 12 h group were significantly higher at 7 d after thrombolysis,and 3 months after discharge than those of the 24 h group(P＜0.05).At 7 d after thrombolysis,the levels of TNF-α,IL-6,and hs-CRP were significantly decreased in the three groups than before thrombolysis(P＜0.05),and the levels were notably lower in the immediate group than the 12 h and 24 h groups,and in the 12 h group than the 24 h group(P＜0.05).The incidence of complications was significantly lower in the immediate group than the 12 and 24 h groups(P＜0.05).At 3 months after discharge,good prognosis was observed in 22 cases(37.93％)from the immediate group,11 cases(18.33％)from the 12 h group,and 10 cases(17.24％)from the 24 h group,and the rate of good prognosis was significantly higher the immediate group than the other two groups(x2 three groups=8.558,x2 immediate group vs.12h group=4.623,x2 immediate group vs.24h group=6.214,P＜0.05).Conclusion Immediately using edaravone dexmedetomidine as adjuvant therapy for AIS after thrombolysis is more effective than using in 12 and 24 h after thrombolysis,which can significantly attenuate inflammatory reactions,better restore neurological and cognitive functions,reduce the occurrence of complications,and improve their short-term prognosis.

Objective To investigate the impact of acute-phase aspirin management strategies on the prognosis of elderly patients with non-major upper gastrointestinal bleeding(UGIB),and to evaluate the role of stratification for patients with a history of percutaneous coronary intervention(PCI).Methods A total of 526 elderly patients with upper UGIB were retrospectively enrolled from the Geriatric Disease Database of Chinese PLA General Hospital between January 2010 and December 2019,and another 380 UGIB patients from the MIMIC-Ⅳ database were included for external validation.All patients had received long-term low-dose aspirin treatment.Based on aspirin usage,patients were divided into a discontinuation group(no aspirin use within 10 d before admission or during hospitalization,n=476)and a continuation group(aspirin use maintained during hospitalization,n=50).Then according to whether there is a history of PCI,the cases are divided into 428 cases without a history of PCI and 98 cases with a history of PCI.The primary outcome was the 30-day composite adverse events(CAE).Multivariate logistic regression and propensity score matching analyses were employed.Results Compared with the discontinuation group,the continuation group had significantly higher proportions of PCI history,renal disease,myocardial infarction,and proton pump inhibitor use,but significantly lower rates of malignancy,platelet count,and estimated glomerular filtration rate(P＜0.05,P＜0.01).A history of PCI was a protective factor for in-hospital CAE.Aspirin use significantly increased the risk of CAE in patients without a PCI history(OR=5.34,95％CI:1.69～15.52,P＜0.01),whereas in patients with a PCI history,aspirin continuation did not increase the risk of adverse outcomes(OR=0.48,95％CI:0.00～11.88,P＞0.05).Consistent results were observed in the MIMIC-Ⅳ validation cohort.Conclusion In elderly patients with non-major UGIB,continuation or discontinuation of aspirin during the acute phase shows no significant difference in overall short-term prognosis.PCI history is a key stratifying factor:continued aspirin use may maintain cardiovascular protective benefits in high-risk post-PCI patients,whereas it may increase adverse risks in those without PCI history.

Objective To analyze the effectiveness and safety of low molecular weight heparin(LMWH)combined with urokinase thrombolysis in the treatment of elderly patients with acute ischemic stroke(AIS).Methods A total of 132 elderly AIS patients admitted in Department of Neurology of Wuhan No.1 Hospital from January 2023 to September 2024 were recruited,and randomized into control group,group A,group B and group C,with 33 cases in each group.Besides urokinase thrombolysis as basic treatment,the patients in groups A,B and C were given LMWH within 24,24-47 and 48-72 h after thrombolysis,respectively.After 1 week of treatment,the incidence rate of cerebrovascular re-occlusion was compared among the four groups.Plasma prothrombin time(PT),platelet count(PLT),fibrinogen(Fib),nerve growth factor(NGF),neuron-specific enolase(NSE),neurotrophic factor(NTF)and National Institutes of Health Stroke Scale(NIHSS)score were compared before and after treatment and among the four groups.The incidences of adverse reactions were also compared among them during treatment.Results Compared with the levels before treatment,the levels of NGF and NTF were significantly increased,while the PT,PLT,Fib and NSE levels and NIHSS score were obviously decreased in the four groups after 1 week of treatment(P＜0.05).At 1 week of treatment,group A obtained notably higher NGF and NTF levels,and remarkably lower PT,PLT,Fib and NSE levels and NIHSS score than the other three groups(P＜0.05).So were group B when compared with group C and control groups(P＜0.05),and group C when compared with control group(P＜0.05).There was no statistical significance in the comparison of total incidence rate of adverse reactions during treatment among the four groups(P＞0.05).Conclusion LMWH combined with urokinase thrombolytic therapy can effectively improve the coagulation status and neurological function for elderly AIS patients,and the earlier it is applied,the better the efficacy will be.

Objective To analyze the application effectiveness of combining stepwise rehabilitation training and electroacupuncture therapy for postoperative motor function recovery in elderly patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 102 elderly eligible patients admitted in our department from July 2022 to July 2024 were prospectively recruited and randomly divided into a control group(postoperative stepwise rehabilitation training on the basis of routine treatment)and a study group(electroacupuncture therapy besides all the treatments the control group received),with 51 cases in each group.The neurological deficits,motor function recovery and activities of daily living were compared between groups before treatment and at 1 and 3 months after treatment.Serum-related factors,quality of life and prognosis in the two groups were evaluated before treatment and at 6 months after treatment.Results At 1 month and 3 months after treatment,the study group exhibited significantly higher scores of upper limb motor function,lower limb motor function and Barthel index while obviously lower score of National Institute of Health Stroke Scale(NIHSS)when compared to the control group(P＜0.01).The study group also had significantly higher scores of psychological function,physiological function,environmental adaptability and social function than the control group at 6 months after treatment(P＜0.01).At this time point,there was a lower ratio of patients with poor prognosis in the study group than the control group(21.6％vss 41.2％,P＜0.05).Conclusion Stepwise rehabilitation training combined with electroacupuncture therapy shows an obvious efficacy in elderly HICH patients,and can help to improve the postoperative neurological function,and promote the motor function recovery.