Objective:To investigate the trajectory of frailty in elderly patients on maintenance hemodialysis(MHD)following SARS-CoV-2 infection and its associated risk factors.Methods:This prospective cohort study focused on elderly patients who underwent baseline frailty assessment(T0)during hemodialysis treatment at Beijing Friendship Hospital for over 3 months between December 1st, 2022, and December 31th, 2022, and were diagnosed with SARS-CoV-2 infection.The Fried Frailty Phenotype was evaluated at 1 month(T1), 3 months(T2), and 6 months(T3)post-infection.Frailty trajectory after infection was analyzed using repeated measurement ANOVA.Patients were divided into stable/improvement or exacerbation groups based on their frailty status at T0 and T3, with logistic regression analysis employed to identify risk factors for different frailty trajectories.Results:A total of 130 elderly maintenance hemodialysis patients, with a median age of 66 years(range: 63-71 years)and 62 males(47.7%), were included in the study.Six months after the infection, a majority of surviving patients saw their frailty scores return to baseline levels.Specifically, 72 patients(55.4%)either maintained or improved to robust or pre-frail states, while 9 patients(6.9%)progressed to a pre-frail state, 18 patients(13.8%)progressed to a frail state, and 31 patients(23.8%)remained in a frail state.Results from multivariate logistic regression analysis indicated that low grip strength( OR: 6.30, 95% CI: 1.48-26.73)and all-cause hospitalization( OR: 5.01, 95% CI: 1.19-21.03)were identified as risk factors for non-frail patients transitioning to frailty( P<0.05). Conclusions:The majority of elderly maintenance hemodialysis patients who survived SARS-CoV-2 infection returned to their baseline level of frailty or showed improvement within 6 months.Non-frail patients with low grip strength or those who were hospitalized were more likely to deteriorate towards frailty.

Objective:This study aims to evaluate the efficacy of levosimendan in elderly patients with acute heart failure across varying levels of renal function, utilizing real-world data.Methods:We conducted a retrospective cohort study involving 699 elderly patients with acute heart failure who were hospitalized at the Second Xiangya Hospital of Central South University and received positive inotropic drugs between January 2015 and December 2022.The median age of the participants was 71 years(interquartile range, 66 to 77), with 61.9% being male.Among these patients, 171 received non-levosimendan positive inotropic drugs(non-levosimendan group), while 528 were treated with levosimendan(levosimendan group).Baseline clinical data collected during hospitalization were analyzed.The primary outcomes assessed included the reduction in N-terminal pro-brain natriuretic peptide(NT-proBNP)levels following treatment, as well as mortality rates within 30 days and one year.Secondary outcomes encompassed the length of hospital stay and in-hospital mortality.Patients were categorized based on their estimated glomerular filtration rate(eGFR)prior to treatment, with groups defined as those with eGFR≥60 ml·min -1·1.73(m -1) 2 and those with eGFR between 15 and <60 ml·min -1·1.73(m -1) 2.The impact of levosimendan treatment on heart failure improvement and clinical prognosis was analyzed using a double robust method, which accounted for patients with varying levels of renal function. Results:In comparison to the non-levosimendan group, a significantly higher proportion of patients in the levosimendan group exhibited decreased NT-proBNP levels(31.0% vs.47.0%, P<0.001).However, there were no significant differences regarding the length of hospital stay, in-hospital mortality, or mortality rates at 30 days and 1 year(all P>0.05).After applying the double robust method for adjustment, levosimendan was shown to significantly reduce NT-proBNP levels( OR=1.553, 95% CI: 1.225-1.972, P<0.001), although it did not result in a significant improvement in 30-day or 1-year mortality rates.In patients with an eGFR of 15-<60 ml·min -1·1.73(m -1) 2, levosimendan significantly reduced NT-proBNP levels( OR=1.797, 95% CI: 1.308-2.481, P<0.001)and decreased 30-day mortality( HR=0.536, 95% CI: 0.292-0.986, P=0.045).Similarly, in patients with eGFR ≥60 ml·min -1·1.73(m -1) 2, levosimendan significantly reduced NT-proBNP levels( OR=1.965, 95% CI: 1.325-2.933, P<0.001), but did not improve 30-day mortality.Across varying levels of renal function, levosimendan had no significant effect on 1-year mortality. Conclusions:Levosimendan can significantly enhance cardiac function in elderly patients experiencing acute heart failure, irrespective of varying levels of renal function.Notably, greater benefits regarding short-term mortality were observed in patients with an eGFR of 15-<60 ml·min -1·1.73(m -1) 2.

Objective:To analyze the association between the number and type of comorbidities—specifically high-risk(HR)and at-risk(AR)—and the risk of in-hospital mortality among elderly patients aged 65 years and older with community-acquired pneumonia(CAP).Methods:A retrospective study was conducted to gather basic information, along with diagnostic and treatment data, for elderly CAP patients hospitalized at the Third Hospital of Peking University from January 1, 2010, to December 31, 2019.Binary logistic regression was employed to examine the relationships between both the number and type of coexisting chronic diseases and in-hospital mortality in this patient population.Results:This study included a total of 2 466 elderly patients aged ≥65 years with CAP, of whom 428(17.36%)died during hospitalization.The presence of HR comorbidities was associated with an increased likelihood of in-hospital mortality ( OR=1.81, 95% CI: 1.44-2.28, P<0.001).Similarly, the presence of AR comorbidities was significantly linked to higher in-hospital mortality ( OR=15.72, 95% CI: 7.39-33.42, P<0.001).The risk of mortality escalated with the accumulation of AR comorbidities, with risk ratios ranging from 5.46 to 44.72.Notably, elderly CAP patients with 4 to 5 AR comorbidities in conjunction with HR comorbidities exhibited the highest mortality risk ( OR=85.56, 95% CI: 19.86-368.67, P<0.001).Among the comorbidities assessed, chronic liver disease emerged as the most significant factor associated with mortality in elderly CAP patients, with an importance coefficient of 0.258. Conclusions:In addition to specific comorbidities, the total number of combined comorbidities and the interplay between AR and HR comorbidities may significantly influence the outcomes of hospitalized CAP patients aged 65 years and older.Therefore, it is essential to carefully consider the diagnosis and management of comorbidities in elderly CAP patients to mitigate their risk of mortality.

Objective:To investigate the clinical value of prognostic nutrition index(PNI)in the overall survival of patients with non-small cell lung cancer(NSCLC)aged 70 years and above treated with radiotherapy, and to construct a nomogram prediction model.Methods:General clinicopathological features and routine blood test in144 patients with pathologically confirmed NSCLC aged 70 years and above were collected, PNI(serum albumin+ 5× lymphocyte count)before radiotherapy were calculated, and prognostic factors affecting the survival were analyzed.Build a nomogram model and verify it.Statistical analysis was performed using R language 4.0.3 software.Results:125 elderly patients with NSCLC met the inclusion criteria, with the median survival time of 18.4 months.The optimal cutoff value of PNI was 42.3.PNI was closely correlated with age, chemotherapy, immunotherapy and radiation pneumonia in elderly NSCLC patients receiving radiotherapy( P<0.05).TNM stage, chemotherapy, immunotherapy and PNI were independent factors affecting the prognosis of NSCLC patients aged 70 years and above who had received radiotherapy( P<0.05).We use these independent risk factors to construct prognostic column charts at 1, 2, and 3 years.We use Bootstrap repeated sampling 1000 times, and validate through ROC curves and calibration curves. Conclusions:For NSCLC patients aged 70 years and above who have received radiotherapy, PNI is a simple prognostic indicator and has practical clinical application value.

Objective:To explore the effect of immobility on the quality of life in older adults.Methods:This cross-sectional study included 244 consecutive elderly patients aged 60 years and older who were admitted to the Department of Geriatrics at Xuanwu Hospital of Capital Medical University from May 2022 to March 2023.Among the participants, 52.5%(128/244)were male and 47.5%(116/244)were female, with a mean age of 69.2±7.4 years.All participants underwent a series of assessments, including the Short Physical Performance Battery(SPPB), grip strength measurement, gait speed evaluation, and the Timed Up and Go test(TUG).The Barthel Index was employed to assess activities of daily living, while the Medical Outcomes Study 36-Item Short Form Health Survey(SF-36)was used to evaluate quality of life.A score of SPPB ≤ 9 was used to diagnose immobility.Results:A total of 60 older adults met the criteria for immobility.Compared to the non-immobility group, the quality-of-life scores for older adults in the immobility group were significantly lower across various dimensions, including physical functioning, role-physical, bodily pain, general health, vitality, social functioning, physical component summary, and the total SF-36 score(all P<0.05).Furthermore, a positive correlation was identified between the SPPB scores and the quality-of-life scores across the dimensions of physical functioning, bodily pain, general health, vitality, social functioning, mental health, reported health transition, physical component summary, and the total SF-36 score among patients in the immobility group(all P<0.05).Additionally, older adults in the immobility group exhibited lower grip strength, slower gait speed, and longer TUG times, as well as a higher incidence of emergencies and falls over the past year(all P<0.05). Conclusions:The poorer quality of life and physical function, along with higher rates of emergencies and falls among older adults with immobility, indicate the necessity of addressing the health consequences that immobility inflicts on this population.

This review aims to analyze the current applications of open surgery, laparoscopic surgery, and robotic surgery in the treatment of colorectal cancer, particularly in elderly patients.It compares the differences among these three surgical methods in terms of surgical indicators, as well as short-term and long-term outcomes.Studies have shown that laparoscopic surgery has become the standard treatment for colorectal cancer, resulting in fewer postoperative complications and faster recovery times.While robotic surgery offers advantages in surgical precision and maneuverability, it is associated with longer surgical times and higher costs.For elderly patients, laparoscopic surgery has demonstrated fewer surgical complications and shorter hospital stays, with no significant difference in long-term survival rates compared to open surgery.However, there is limited research on the application of robotic surgery in elderly patients.Future studies should involve larger-scale, multi-centre randomized controlled trials to provide higher-level evidence and scientific guidance for the individualized treatment of elderly colorectal cancer patients.

With the acceleration of societal aging, heart failure in the elderly—characterized by a complex metabolic imbalance—has emerged as a pivotal challenge in public health.This condition severely compromises the physical well-being and quality of life among senior populations, primarily due to a pronounced imbalance between cardiac energy supply and demand.Among the various interventions studied, photosynthesis in plants, the principal energy source for aerobic organisms, presents a novel avenue for exploration.By effectively converting solar energy into chemical energy, photosynthesis sustains plant life.Introducing its principles into heart failure treatment could potentially optimize metabolism for elderly patients while significantly reducing oxidative stress and inflammation.Further investigations suggest that the antioxidants and bioactive byproducts generated during photosynthesis may play critical roles in heart failure treatments, particularly in modulating inflammatory pathways.In summary, emulating the mechanisms of photosynthesis could represent a promising strategy for treating heart failure in the elderly.This review aims to delve deeply into the application of photosynthesis in heart failure treatments for older adults and its underlying mechanisms, with the hope of providing insights and guidance for future endeavors in geriatric medicine.

Objective:To explore the clinical utility of peripheral immune-inflammatory markers in predicting late-life depression with cognitive impairment(LLD+ CI + ). Methods:A cross-sectional study was conducted between January 2020 and December 2021, collecting demographic data, peripheral blood inflammatory markers, and cognitive function scores from 40 patients with LLD+ CI + , 38 patients with late-life depression without cognitive impairment(LLD+ CI -), and 26 healthy controls(HCs). Logistic regression analysis and receiver operating characteristic(ROC)curve analysis were employed to assess the value of peripheral blood inflammatory markers in differentiating LLD+ CI + . Results:Patients with LLD+ CI + exhibited significantly different levels of lymphocytes, C-reactive protein(CRP), systemic immune-inflammation index(SII), systemic inflammation response index(SIRI), neutrophil-to-high-density lipoprotein cholesterol ratio(NHR), and neutrophil-to-lymphocyte ratio (NLR)compared with the LLD+ CI - group and the HGs group( F=4.000, 11.642, 13.541, 10.441, 6.623, 4.193; P=0.022, 0.003, 0.001, 0.005, 0.036, 0.018). The multivariate logistic regression analysis of factors influencing LLD+ CI + revealed that elevated levels of CRP( OR=4.933, 95% CI: 1.385-17.563, P=0.014), SII( OR=5.534, 95% CI: 1.336-22.927, P=0.018), and NLR( OR=3.386, 95% CI: 1.470-7.797, P=0.004)constitute risk factors for geriatric depression with cognitive impairment, while an increased lymphocyte count( OR=0.206, 95% CI: 0.058-0.725, P=0.014)serves as a protective factor.Further analysis identified CRP, lymphocytes, SII, and NLR as significant predictors for LLD+ CI + , with areas under the curve (AUC) values of 0.849(95% CI: 0.760-0.934), 0.847(95% CI: 0.761-0.933), 0.860(95% CI: 0.777-0.943), and 0.857(95% CI: 0.777-0.938), respectively, in distinguishing LLD with or without cognitive impairment. Conclusions:Peripheral immune-inflammatory markers represent an economical and effective approach for investigating the pathophysiological changes and predictive factors associated with LLD+ CI + .These findings provide valuable insights into the underlying mechanisms and potential therapeutic avenues.

Objective:To analyze the distribution characteristics and influencing factors of prolonged length in the elderly patients at a tertiary hospital.Methods:Medical records of patients receiving inpatient care at Xiangya Hospital, Central South University in Hunan province during January 1, 2021 and December 31, 2023 were collected.The generalized estimating equation(GEE)model was used to analyze the factors influencing prolonged hospitalization in elderly patients.Results:A total of 144 921 elderly inpatients were included, aged 60 to 104 years, with 84 950 males and 59 971 females.The average length of hospitalization was 7.81 days, with 2 614 patients hospitalized for more than 30 days (1 663 males and 951 females), and the average length of stay for these patients was 44.93 days.Most of the patients with prolonged length were hospitalized for 30 to 40 days, and in the group of aged 60-74 years.Disease categories mainly were related to health conditions, healthcare facility contact, tumors, and circulatory system diseases.The GEE model analysis showed that nosocomial infection [ OR(95% CI): 5.836(4.716-7.221)], age≥90 [ OR(95% CI): 2.415(1.680-3.472)], surgery [ OR(95% CI): 3.543(2.925-4.291)], number of complications>4[ OR(95% CI): 2.378(2.091-2.704)], unplanned hospital readmissions within 31 days [ OR(95% CI): 1.748(1.525-2.004)]were risk factors of prolonged hospitalization; female [ OR(95% CI): 0.901(0.824-0.986)] and no transferred hospitalization [ OR(95% CI): 0.154(0.140-0.169)] were protective factors. Conclusions:Prolonged hospitalization is related to the clinical and social factors.Administration department of the hospital should strengthen the monitoring of these influencing factors, reduce or prevent the occurrence of prolonged length of stay by adopting targeted measures, and further realize rational allocation of medical resources.

Objective:This study aims to investigate the alterations in m 6A methylation associated with age-related idiopathic pulmonary fibrosis(IPF). Methods:By collecting peripheral blood samples from IPF patients, we investigated the changes in m6A modification levels of total RNA and key regulatory factors in elderly IPF patients.Then, the pulmonary fibrosis models of young and old mice were constructed for verification.A total of 10 IPF patients and 10 healthy controls were selected for this study.The m 6A methylation quantitative kit was employed to assess the m 6A modification levels of total RNA.The expression levels of key m 6A methylation regulators, METTL3, METTL14, and FTO, were quantified using qRT-PCR.Additionally, thirty-two healthy male C57BL/6 mice, comprising 16 mice aged 10-12 weeks and 16 mice aged 6-7 months, were divided into four groups: young control(A), young pulmonary fibrosis(B), aged control(C), and aged pulmonary fibrosis(D), with 8 mice in each group.Mice in groups B and D were intratracheally administered bleomycin to establish a pulmonary fibrosis model, while those in groups A and C received normal saline.Twenty-eight days post-model establishment, the mice were euthanized, and lung tissues were collected for analysis.Histological evaluations were performed using hematoxylin and eosin(HE)staining, Masson staining, hydroxyproline content determination, and immunohistochemistry to assess the extent of pulmonary fibrosis.The m 6A methylation quantification kit was also utilized to measure the m 6A modification levels of total RNA in lung tissue.Furthermore, the mRNA and protein expression levels of the methyltransferase METTL3 were assessed by qRT-PCR and Western blot experiments. Results:The level of m 6A modification was significantly elevated in the aged IPF patient group(0.36±0.03)compared to the control group t=4.882( P<0.05).Furthermore, the expression of METTL3 was markedly higher in the aged IPF patients( t=6.082), while the expression of METTL14 was significantly lower t=17.58( P<0.05).In contrast, the expression level of FTO did not exhibit a significant difference.It is hypothesized that the increased m 6A modification of total RNA in aged IPF patients is closely associated with METTL3.Furthermore, the degree of lung fibrosis in aged mice was more severe than that in young mice.Immunohistochemistry results indicated that TGF-β1 expression was elevated in the lung fibrosis group, with higher levels observed in group D compared to group B( t=5.891, P<0.05), and in group C compared to group A t=4.135( P<0.05).The percentage of positive area for α-SMA was significantly greater in the lung fibrosis mouse model than in the control group t=20.08( P<0.05).The level of m 6A modification was increased in both lung fibrosis groups relative to the normal control group( P<0.05), although no significant difference was found between group D and group B. Overall, METTL3 mRNA and protein expression were upregulated in the lung fibrosis group, with expression in group D being lower than in group B( P<0.05). Conclusions:The level of m 6A modification is elevated in pulmonary fibrosis, and the expression of METTL3 is upregulated in this condition.The downregulation of METTL3 may be associated with the extent of aging, which subsequently exacerbates the progression of pulmonary fibrosis.