OBJECTIVES: To investigate the risk factors of overall postoperative complications in elderly patients undergoing gastrointestinal surgeries. METHODS: This study was conducted among a total of 1388 elderly patients, who underwent elective gastrointestinal surgeries at 17 centers across China between April, 2020 and April, 2022. The primary outcome was the incidence of postoperative complications within 30 days, including procedure-related, neuropsychiatric, respiratory, cardiovascular, and gastrointestinal complications as well as acute kidney injury. Baseline characteristics, preoperative psychological and functional status, intraoperative anesthesia and surgical factors, intraoperative medication, use of nerve block, and postoperative analgesia methods were compared between the patients experiencing one or more postoperative complications and those without complications. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for postoperative complications. The relationship between postoperative acute pain and each type of complication were explored. RESULTS: The incidence of overall postoperative complications was 50.8% (705/1388) in these patients. Multivariate analysis showed that age (OR: 1.026; 95% CI: 1.006-1.046), prognostic nutritional index (OR: 0.998; 95% CI: 0.997-1.000), preoperative EuroQol-5 dimensions score (OR: 0.094; 95% CI: 0.018-0.500), blood loss (OR: 1.002; 95% CI: 1.001-1.003), and acute postoperative pain (OR: 1.308; 95% CI: 1.033-1.657) were significantly associated with the occurrence of postoperative complications. Specifically, patients experiencing severe postoperative pain had a significantly higher incidence of neuropsychiatric (27.2% vs 19.8%), procedure-related (17.3% vs 10.2%), and cardiovascular complications (3.6% vs 1.7%). CONCLUSIONS An advanced age, a low preoperative nutritional index, a poor quality of life score, a greater volume of intraoperative blood loss, and acute postoperative pain are independent risk factors for postoperative complications in elderly patients undergoing gastrointestinal surgeries. There is a significant association between acute postoperative pain and multi-system complications.
Humans ; Postoperative Complications/etiology* ; Aged ; Risk Factors ; Digestive System Surgical Procedures/adverse effects* ; Male ; Female ; China/epidemiology* ; Pain, Postoperative/epidemiology* ; Incidence ; Aged, 80 and over

Objective To investigate persimmon leaf extract on secondary prevention of ischemic cerebrovascular disease, and the impact on blood pressure, blood sugar, blood lipid, hemorheology, blood rheology indexes and blood homocysteine levels in patients with ischemic cerebrovascular disease.Methods 200 cases of patients with ischemic cerebral vascular disease were chosen, which were randomly divided into observation group and control group with 100 cases in each group.Both of the groups were given conventional therapy.And the observation group received persimmon leaf extract intervention.Then the rate of recurrence of ischemic cerebrovascular disease was observed after 3 months and 6 months.At the same time, the indexes of blood pressure and blood sugar, blood lipid, hemorheology, blood flow and blood homocysteine were recorded and compared in the second morning after being selected and after 3 months and 6 months treatment.Results After treatment for 3 months, the recurrence rate of observation group was 4.40%, 3.70% of control group; after treatment for 6 months, 8.24% of observation group, 13.75% of control group, and there were no significant differences between two groups of recurrence of ischemic cerebrovascular disease.After 6 months, systolic and diastolic blood pressure in both groups were lower than before treatment.and they were lower in observation group than control group (all P<0.05).After 3, 6 months, TC, TG, LDLC levels decreased and HDLC increased compared with before treatment, and the above indexes improved more in observation group than control group (all P<0.05).After 3, 6 months, FBG, 2hPG, HbA1C levels decreased compared with before treatment, and the above indexes decreased more at the same time point in observation group than control group (all P<0.05).After 3, 6 months, HCY levels decreased compared with before treatment, and HCY decreased more at the same time point in observation group than control group ( all P<0.05 ).After 6 months, blood rheology indexes levels improved more compared with before treatment, and they improved more at the same time point in observation group than control group (all P<0.05).After 6 months, main artery blood flow velocity levels increased compared with before treatment, and they increased more at the same time point in observation group than control group ( all P<0.05 ) .Conclusion Persimmon leaf extract intervention therapy can effectively improve blood pressure , sugar, lipid, hemorheology, homocysteine and prevent platelet aggregation and thrombosis.

Objective To explore the changes of programmed death receptor-1 (PD-1) in chronic hepatitis B (CHB) patients with different baseline of hepatitis B virus (HBV) DNA levels after treatment with adefovir dipivoxil (ADV).Methods One hundred CHB patients with positive hepatitis B e antigen (HBeAg),1 × 104 copy/mL≤HBV DNA≤1 × 107 copy/mL,and positive human leukocyte antigen-A2 were divided into two groups according to the baseline HBV DNA level:47 cases in low virus load group whose HBV DNA level was ≤1 × 105 copy/mL; 53 cases in high virus load group whose HBV DNA level was＞1 × 105 copy/mL.Both groups were treated with ADV 10 mg/d.Serum HBV DNA,HBeAg seroconversion rate,alanine aminotransferase (ALT) and total bilirubin (TBil) levels of both groups before treatment and 12 months after treatment were compared.Flow cytometry was used to test peripheral blood HBV-specific cytotoxic T lymphocyte (CTL) surface PD-1 and peripheral blood HBV-specific CTL level.Categorical data were tested by x2 test; quantitative data was compared with t-test.Results Peripheral blood HBV-specific CTL surface PD-1 of CHB patients in low virus load group was 20.17 ％±1.69％,which was lower than that in high virus load group (41.38％±2.30％,t =53.02,P＜0.01) ; peripheral blood HBV specific CTL levels in two groups were 0.37％±0.02％ and 0.17％± 0.02％,respectively (t=50.47,P＜0.01) ; ALT and TBil levels in low virus load group were both lower than those of high virus load group (t=13.07,P＜0.01; t=5.06,P＜0.01).Twelve months after treatment,HBV DNA of 25 cases (53.2％) in low virus load group and 10 cases (18.9％) in high virus load group were lower than the detectable level (HBV DNA＜500 copy/mL,x2 =12.89,P＜0.01);HBeAg seroconversion was achieved in 15 cases(31.9％) and 1 case (1.9％),respectively (x2 =16.72,P＜0.01) ; peripheral blood HBV-specific CTL surface PD-1 expression levels were 9.00 ％ ±1.38 ％ and 29.40 ％ ± 3.76 ％,respectively (t =36.80,P＜ 0.01) ; peripheral blood HBV-specific CTL levels were 0.65％±0.10％ and0.48％±0.07％,respectively (t=9.61,P＜0.01).Conclusions After treatment with ADV,along with the decrease of HBV DNA load,HBV-specific CTL surface PD-1 expression decreases,while HBV-specific CTL level increases.The changes in low virus load group are much more remarkable.

Objective To explore relationship between genotypes HBV C and B with HBV specific cytotoxic T lymphocyte (CTL) surface programmed death receptor-1 (PD-1) and its significance in patients with chronic hepatitis B (CHB).Methods A total of 71 CHB patients were studied,human leukocyte antigen(HLA)-A2 positive,HBV DNA ＞ 103 copies/ml,of which 34 cases(47.89％)had genotype C and 36 cases (50.70％) had genotype B.Peripheral blood HBV specific CTL surface PD-1 expression level,HBV specific CTL level,HBV DNA level,ALT and TBil levels of patients infected with genotype C and B were compared.Results HBV specific CTL surface PD-1 expression level of CHB patients infected with genotype C (37.30 ± 3.05％) was higher than that of patients infected with genotype B (26.19 ± 3.06％),t =15.47,P ＜ 0.001,HBV specific CTL level (0.25 ± 0.03％) was lower than that of patients infected with genotype B (0.45 ±0.13％),t =21.54,P ＜0.001,HBV DNA level (6.75 ±0.77 log10 copies/ml) was higher than that of patients infected with genotype B (4.96 ± 1.12 log10 copies/ml),t =7.93,P ＜ 0.001,ALT level (487.39 ± 87.36IU/L) was higher than that of patients infected with genotype B (235.25 ± 90.911U/L),t =12.32,P ＜ 0.001,TBil level (49.73 ± 6.45) was higher than that of patients infected with genotype B (28.48 ± 5.89％),t =9.01,P ＜ 0.001.Conclusion Peripheral blood HBV specific CTL surface PD-1 expression level of CHB patients infected with genotype C was higher than that of patients infected with genotype B,resulting in lower HBV specific CTL level and higher HBV DNA level of patients infected with genotype C than patients infected with genotype B,so damage to liver functions was more serious than patients infected with genotype B.