Objective:To investigate the factors contributing to frailty in very elderly patients with multimorbidity.Methods:This cross-sectional study enrolled 119 very elderly patients with multimorbidity who were hospitalized in the Department of Geriatrics of Huadong Hospital Affiliated to Fudan University from August 2022 to March 2023.The study aimed to understand the basic status of multimorbidity by collecting general information, the number and types of diseases, and frailty status.The subjects were divided into frail and non-frail groups through comprehensive geriatric assessment.Various factors including gender, age, Tinetti balance gait score, risk of sarcopenia, dementia, depression, risk of deep vein thrombosis, dysphagia, comorbidity index, medication count, Basic Activities of Daily Living(BADL)score, Instrumental Activities of Daily Living(IADL)score, Nutritional Risk Screening 2002(NRS-2002)score, Norton pressure injury risk assessment score, and Social Support Rating Scale(SSRS)score were compared.The correlation between each factor and the occurrence of frailty was analyzed using univariate analysis and multivariate Logistic regression analysis.Results:A total of 119 elderly inpatients with multimorbidity, with an average age of 90.8±5.9 years old, were included in the study.The incidence of frailty was 68.9%(82 cases).Univariate analysis revealed significant statistical differences between the frail group and the non-frail group in various factors including age( t=-3.131, P=0.002), Tinetti score( Z=-5.544, P<0.001), risk of sarcopenia( χ2=39.205, P<0.001), dysphagia( χ2=5.937, P=0.015), Charlson comorbidity index( Z=-2.565, P=0.010), medication count( Z=-3.325, P<0.001), BADL( Z=-5.871, P<0.001), IADL( Z=-5.062, P<0.001), Norton score( Z=-5.922, P<0.001), and SSRS social support( Z=-2.637, P=0.008).Multivariate logistic regression analysis showed that the Tinetti score( OR=0.843, 95% CI: 0.737-0.966, P=0.014), decreased muscle strength( OR=11.226, 95% CI: 2.157-58.432, P=0.004), sarcopenia( OR=18.084, 95% CI: 2.041-106.211, P=0.009), Norton score( OR=0.462, 95% CI: 0.254-0.838, P=0.011), and medication count( OR=1.153, 95% CI: 1.000-1.329, P=0.049)were independently associated with frailty. Conclusions:In very elderly patients with multimorbidities, the occurrence of frailty is notably increased.Frailty is linked to multiple risks including falls, muscle weakness/sarcopenia, pressure ulcer risk, and polypharmacy, and these risks are independent of other factors.

Background/Aims: Ulcerative colitis (UC) is an incurable, relapsing-remitting inflammatory disease that increases steadily. Mucosal healing has become the primary therapeutic objective for UC. Nevertheless, endoscopic assessments are invasive, expensive, time-consuming, and inconvenient. Therefore, it is crucial to develop a noninvasive predictive model to monitor endoscopic activity in patients with UC. Methods: Clinical data of 198 adult patients with UC were collected from January 2016 to August 2022 at Huadong Hospital, China. Results: Patients with UC were randomly divided into the training cohort (70%, n=138) and the validation cohort (30%, n=60). The receiver operating characteristic curve value for the training group was 0.858 (95% confidence interval [CI], 0.781 to 0.936), whereas it was 0.845 (95% CI, 0.731 to 0.960) for the validation group. The calibration curve employed the Hosmer-Lemeshow test (p>0.05) to demonstrate the consistency between the predicted and the actual probabilities in the nomogram of these two groups. The decision curve analysis validated that the nomogram had clinical usefulness. Conclusions The nomogram, which incorporated activated partial thromboplastin time, fecal occult blood test, β2-globulin level, and fibrinogen degradation products, served as a prospective tool for evaluating UC activity in clinical practices.

Background: Colorectal polyp is a common lower gastrointestinal disease. Study of its risk factors is of great significance for prevention and treatment of colorectal polyps in clinical practice. Aims: To construct and verify a prediction model for risk of colorectal polyps. Methods: According to the inclusion and exclusion criteria, 254 subjects who were hospitalized for health examination in the Special Internal Medicine Ward of Shanghai Huadong Hospital from January 2019 to June 2021 were enrolled in the study. They were allocated into colorectal polyps group and non⁃polyp group based on the results of colonoscopy. The relevant risk factors of colorectal polyp were collected, including gender, age, cigarette smoking, alcohol drinking, hypertension, diabetes, hyperlipidemia, hyperuricemia, polyps/stones of gallbladder, fatty liver, etc. After screened by LASSO regression model, the selected factors were analyzed by multivariate Logistic regression to build the prediction model and nomogram. Furthermore, the prediction model was evaluated by ROC curve, C index, calibration curve and decision curve, and validated by internal samples. Results: Of the 254 subjects enrolled in the study, 116 cases were in colorectal polyps group and 138 in non⁃polyp group. The risk prediction model identified that gender (OR=2.11, 95% CI: 1.06⁃4.27), age (OR=2.76, 95% CI: 1.17⁃6.73), hypertension (OR=3.23, 95% CI: 1.52⁃7.12), diabetes (OR=4.37, 95% CI: 1.52⁃14.64), hyperlipidemia (OR=3.20, 95% CI: 1.74⁃5.95) and fatty liver (OR= 2.21, 95% CI: 1.13⁃4.35) were independent risk factors for colorectal polyps. The model showed good area under the ROC curve (0.807) and C index (0.807). The decision curve demonstrated that if the threshold probability of colorectal polyps was more than 12%, the model would be of clinical significance. Internal samples were randomly selected for validation, and the C index was 0.793. Conclusions: The prediction model and nomogram constructed by combination of risk factors including gender, age, hypertension, diabetes, hyperlipidemia and fatty liver have a substantial reference value for risk prediction of colorectal polyps.

Systemic juvenile idiopathic arthritis is one of the common rheumatic and immune diseases in children. It has a sudden onset, obvious systemic symptoms, and lung involvement. However, systemic juvenile idiopathic arthritis with an early manifestation of pulmonary ground-glass opacities combined with macrophage activation syndrome is rare. The clinical data of a child with systemic juvenile idiopathic arthritis with pulmonary ground-glass shadow and macrophage activation syndrome who was admitted to Hubei Maternal and Child Health Care Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology in December 2021 were analyzed retrospectively in order to improve the understanding of rheumatic diseases and pulmonary lesions. The child was admitted to the hospital for 10 days due to rash and fever. Thoracic CT showed scattered ground glass like shadows in both lungs due to the prevention and control screening of COVID-19 pneumonia epidemic situation. After admission, the child was still repeatedly flaccid with high fever, accompanied by dysfunction of both lower limbs. The knee joint MRI found that there was synovitis in the knee joint, and various laboratory indicators suggested macrophage activation syndrome. After that, systemic juvenile idiopathic arthritis was diagnosed. After being treated with methylprednisolone, cyclosporine and topzumab, the clinical remission and the ground-glass shadow of the lung basically disappeared. Through the analysis of this case, it is suggested that clinicians should not ignore other diseases that cause ground glass shadow in the lung during the current epidemic of COVID-19.

Objective:To evaluate liver functional reserve in healthy subjects of different age groups using the L-[1- 13C]-phenylalanine breath test( 13C-pheBT)and to investigate the patterns of changes in liver functional reserve with aging in comparison with elderly cirrhosis patients. Methods:Thirty-seven healthy volunteers were divided into a young and middle-aged group(n=10), an early elderly group(n=9), an advanced elderly group(n=9)and a longevity group(n=9). Eight elderly patients with liver cirrhosis were selected as the control group.An oral dose of 100 mg 13C-phe was administered to each subject.Expired breath samples were collected at pre-dose and at 12 different time points within 150 minutes post-dose.Isotope ratio mass spectrometer was used to measure the abundance of 13C.The percentage of the 13C excretion rate( 13CO 2ERt), the percentage of 13C cumulative excretion( 13Ccumt)at different time points, and the percentage of the 13C peak excretion rate( 13CO 2ERmax)after drug administration were calculated.In addition, associations between 13C-pheBT and common liver function parameters were analyzed. Results:Compared with healthy volunteers, 13CO 2ER 30, 13CO 2ER 45, 13CO 2ER 60, 13Ccum 45, 13Ccum 60, 13Ccum 75, 13Ccum 90 and 13Ccum 105, 13Ccum 120, 13Ccum 135, 13Ccum 150 showed significant differences in the longevity group, the young and middle-aged group and the young elderly group.There were statistically significant differences between the elderly cirrhosis group and the healthy volunteers in each subgroup(all P<0.05); The mean values of 13CO 2ERmax, 13CO 2ER 30, 13Ccum 45, 13Ccum 60, 13Ccum 75, 13Ccum 90, 13Ccum 105, 13Ccum 120, 13Ccum 135, 13Ccum 150 decreased following the order of the young and middle-aged group, the early elderly group, the advanced elderly group, the longevity group, and the elderly cirrhosis group(all P<0.05). In healthy volunteers, the 13CO 2 exclusion rate curve and the cumulative exclusion rate curve showed that the curves of the young and middle-aged group and the early elderly group almost overlapped, while the curves of the advanced group and the longevity group decreased with age, and the difference between the longevity group and the young and middle-aged group and between the longevity group and the early elderly group was markedly prominent. Conclusions:13C-pheBT is a safe, sensitive and reliable test for quantitation of liver function.Our recommendations include collecting samples within an hour of drug administration and using 13CO 2ERmax, 13CO 2ER 30, 13Ccum 45 and 13Ccum 60 as the main parameters.Overall, the functional reserve and compensatory capability of the liver are robust.The decline in liver functional reserve in healthy individuals is a gradual and slow process, with a significant decrease after age 80 and more so after age 90.

The elderly are a special group, with their unique pathophysiology and disease characteristics.The measures and goals of diagnosis and treatment for the elderly are different from those for children, young and middle-aged people.Taking into consideration of the national and international literature, the insight from our long-term clinical practice and in-depth reflections, the authors have written this article as a reference for our colleagues in geriatric care.

Objective:To investigate age-related histological and ultrastructural changes of the pancreas in Sprague-Dawley(SD)rats, and to provide a theoretical basis for the high incidence of pancreatic diseases in the elderly.Methods:Thirty 6-month-old specific pathogen-free male SD rats were fed until 6, 12, 18 and 25 months of age.Five rats of each age group were randomly selected, killed and then sampled to make histological(HE staining)and electron microscopic sections to observe age-related changes in pancreatic histology and ultrastructure.Results:The pancreatic tissue of rats showed increasing fibrosis with age, especially around the duct.Fat infiltration of the pancreatic tissue also increased with age( H=15.88, P=0.001). With the increase of age, the number(density)of pancreatic islets decreased gradually( F=3.55, P=0.039), but the average cross-sectional area of islets increased significantly( F=7.76, P=0.002), and the round and oval islets became irregular.Nuclear pyknosis, mitochondrial dehydration, mitochondrial swelling, and dilatation and loose organization of rough endoplasmic reticula were observed in the cytoplasm of pancreatic acinar cells and islet beat cells in aged rats.With the increase of age, the number of zymogen granules at the apical pole of pancreatic acinar cells of rats decreased( F=9.73, P<0.001), and the average area and total area of granules were significantly decreased( F=6.51, P=0.001; F=22.18, P<0.001); The number of non-senescent mitochondria and senescent mitochondria in the cytoplasm of acinar cells increased significantly( H=8.22, P=0.045; H=32.95, P<0.001); The amount of proinsulin in islet beta cells was significantly decreased( F=16.20, P<0.001). Conclusions:With aging, the rat pancreas exhibits a series of degenerative manifestations(stromal hyperplasia, adipose tissue infiltration, decreased numbers of zymogen granules in acinar cells, increases in the number of senescent mitochondria, reduced islets and reduced proinsulin in islet beta cells), while there are some compensatory phenomena(increasing numbers of islets and non-senescent mitochondria).

Objective:To investigate age-related morphological changes of the pancreas in healthy people using magnetic resonance imaging(MRI).Methods:From January 2017 to October 2019, people who took physical examinations at our hospital were enrolled and were divided into 7 groups according to age: 20-29 years old, 30-39 years old, 40-49 years old, 50-59 years old, 60-69 years old, 70-79 years old and ≥80 years.Also, the former four groups were classified as young and middle-aged(<60 years old)and the latter three as the elderly(≥60 years old). Morphological characteristics of the pancreas in each group were examined via MRI.Differences in parameters such as anteroposterior diameters of the head, body and tail and the pancreatic volume between the groups and the relationship between these parameters and age were analyzed.Results:A total of 191 cases who met the inclusion criteria were enrolled, including 96(50.3%)males and 95(49.7%)females, with 28 aged 20-29 years, 28 aged 30-39 years, 27 aged 40-49 years, 26 aged 50-59 years, 30 aged 60-69 years, 28 aged 70-79 years and 26 aged ≥80 years.There were 109 cases in the young and middle-aged category and 82 cases in the elderly category.MRI findings included pancreatic atrophy, which was most obvious in the tail; uneven and serrated edges of the pancreas and pancreatic lobulation; uneven signal intensity in the T 1-and T 2-weighted sequences; the "crispening effect" of pancreatic steatosis in the opposed-phase T 1-weighted sequences, and a trend of widening of the main pancreatic duct.The anteroposterior diameters of the pancreatic head, body and tail and the pancreatic volume reached the peak at(28.21±4.55)mm, (24.00±4.45)mm, (24.91±5.08)mm and(100.91±27.44)cm 3 between 30-39 years of age, and then gradually decreased to(18.87±3.82)mm, (15.63±3.96)mm, (13.70±3.70)mm and(43.88±10.47)cm 3 in those aged ≥80 years, with a decrease of 33.10%, 34.88%, 45.00% and 56.51%, respectively.The anteroposterior diameters of the pancreatic head, body, tail and the pancreatic volume in the elderly were(21.59±4.35)mm, (18.10±4.29)mm, (17.00±4.56)mm and(59.85±22.73)cm 3, which were smaller than those in the young and middle-aged category[(26.18±4.57)mm, (22.10±4.64)mm, (22.42±4.71)mm and(90.09±25.06)cm 3], and the differences were statistically significant( t=7.12, 6.19, 8.10 and 8.71, respectively, all P<0.001). The anteroposterior diameters of the head, body and tail and the pancreatic volume were negatively correlated with age( r=-0.52, -0.45, -0.56 and -0.57, respectively, P<0.001). Conclusions:The anteroposterior diameters of the head, body and tail and the pancreatic volume reach the peak between 30-39 years of age, and then gradually start to decline with the increase of age.After age 60, the decline become more evident, showing morphological signs of degeneration and dilatation of the main pancreatic duct.

Anorexia of aging is one of the common clinical geriatric syndrome in clinic, characterized by the persistent and significant decreasing of appetite and/or by reducing a food intake in the elderly, which can cause various adverse consequences and increase the morbidity and mortality.However, clinicians have insufficient understanding of anorexia in the elderly, and often regard the anorexia of aging as the normal phenomenon of aging and might ignore it.This article reviews the domestic and foreign relevant literatures on anorexia of aging.

Gastric cancer is a common malignant tumor in China, which seriously threatens the health of people. With the deepening of research on the prevention and treatment of gastric cancer in China, especially the effective control of risk factors related to gastric cancer and the continuous improvement of the level of screening and diagnosis and treatment of gastric cancer, the prevalence and mortality of gastric cancer in China are declining year by year. Although great progress has been made in the prevention and treatment of gastric cancer in China, due to the aging of population and large population base, gastric cancer is still the third most common malignant tumor and the second most lethal malignant tumor in China. It is still one of the major diseases endangering the health of Chinese people, and there is still a long way to go for its prevention and treatment, and further efforts should be made. This article reviewed the epidemiological changes and implications of gastric cancer in China.