Applications of digital health approaches for cardiometabolic diseases prevention and management in the Western Pacific region.

Cardiometabolic diseases (CMDs) are the major types of non-communicable diseases, contributing to huge disease burdens in the Western Pacific region (WPR). The use of digital health (dHealth) technologies, such as wearable gadgets, mobile apps, and artificial intelligence (AI), facilitates interventions for CMDs prevention and treatment. Currently, most studies on dHealth and CMDs in WPR were conducted in a few high- and middle-income countries like Australia, China, Japan, the Republic of Korea, and New Zealand. Evidence indicated that dHealth services promoted early prevention by behavior interventions, and AI-based innovation brought automated diagnosis and clinical decision-support. dHealth brought facilitators for the doctor-patient interplay in the effectiveness, experience, and communication skills during healthcare services, with rapidly development during the pandemic of coronavirus disease 2019. In the future, the improvement of dHealth services in WPR needs to gain more policy support, enhance technology innovation and privacy protection, and perform cost-effectiveness research.

Risk factors for incident venous thromboembolism in patients with renal tumor and inferior vena cava tumor thrombus: a retrospective case-control study.

BACKGROUND: Venous thromboembolism (VTE) is a principal cause of mortality and adverse oncologic outcomes in patients with renal tumor and inferior vena cava tumor thrombus (RT-IVCTT). However, the preoperative thrombotic risk factors in these patients remain not fully characterized. OBJECTIVES: To identify preoperative thrombotic risk factors in patients with RT-IVCTT. PATIENTS/METHODS: Two hundred fifty-seven consecutive postsurgical patients with RT-IVCTT aged 18-86 years were enrolled between January 2008 and September 2022. Clinicopathological variables were retrospectively reviewed. A multivariate logistic regression model was performed. Preoperative hemoglobin, neutrophils, and serum albumin levels were analyzed as both continuous and categorical variables. RESULTS: VTE was identified in 63 patients (24.5%). On both continuously and categorically coded variables, advanced IVC thrombus (OR 3.2, 95% CI: 1.4-7.0; OR 2.7, 95% CI: 1.2-6.1), renal sinus fat invasion (OR 3.4, 95% CI: 1.6-7.0; OR 3.7, 95% CI: 1.8-7.7), IVC wall invasion (OR 3.6, 95% CI: 1.6-7.9; OR 4.3, 95% CI: 1.9-10.0), IVC blockage status of greater than 75% (OR 5.2, 95% CI: 1.7-15.8; OR 6.1, 95% CI: 1.9-19.7), and higher neutrophils (OR 1.3, 95% CI: 1.0-1.7; OR 2.4, 95% CI: 1.1-5.4) were significantly associated with increased VTE risk in patients with RT-IVCTT. Except hemoglobin, categorically coded serum albumin (OR 0.36, 95% CI: 0.17-0.75) was validated as an independent risk factor for VTE. CONCLUSIONS: This study provided an insight of risk factors contributing to preoperative VTE in patients with RT-IVCTT, which may be beneficial for optimizing strategies to manage VTE in clinical practice.

Analysis of 24-hour Death Risk Factors in Circulatory Failure Patients Treated with Venoarterial Extracorporeal Membrane Oxygenation.

OBJECTIVE: To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment. METHODS: A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups. RESULTS: The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both). CONCLUSION: Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.

Association between different adiposity measures and all-cause mortality risk among centenarians: A prospective cohort study.

IMPORTANCE: Little evidence on the association between adiposity measures and all-cause mortality was observed among centenarians, and no targeted development of optimal weight recommendations for them. OBJECTIVE: To comprehensively assess the association between adiposity indices and all-cause mortality among centenarians. DESIGN SETTING, AND PARTICIPANTS: This prospective population-based cohort study included 1002 centenarians registered in 18 counties and cities in Hainan Province from June 2014 to May 2021. The age of participants at baseline was provided by the civil affairs bureau and verified before enrollment. MAIN OUTCOMES AND MEASURES: All-cause mortality was rigorously confirmed as the primary outcome. BMI was calculated by height and weight. BRI was calculated by height and waist circumference. RESULTS: At baseline, the mean (SD) age was 102.8 ± 2.7 years, and 180 participants (18.0%) were men. The median follow-up time was 5.0 (4.8-5.5) years, with 522 deaths. In BMI categories, compared with the lowest group (mean BMI = 14.2 kg/m2), the highest group (mean BMI = 22.2 kg/m2) had lower mortality (hazard ratio [HR], 0.61; 95%CI, 0.47-0.79) (P for trend = 0.001). In BRI categories, compared with the lowest group (mean BRI = 2.3), the highest group (mean BRI = 5.7) had lower mortality (hazard ratio [HR], 0.66; 95%CI, 0.51-0.85) (P for trend = 0.002), and the risk did not decrease after BRI exceeded 3.9 in women. Higher BRI was associated with lower HRs after adjusting for interaction with comorbidities status. E-values analysis suggested robustness to unmeasured confounding. CONCLUSIONS AND RELEVANCE: BMI and BRI were inverse linear associated with mortality risk in the whole population, while BRI was observed to be J-shaped in women. The interaction of lower multiple complication incidence and BRI had a significant effect on the reduced risk of all-cause mortality.

The Preventive Effect of Distal Perfusion Catheters on Vascular Complications in Patients Undergoing Venous Artery Extracorporeal Membrane Oxygenation.

Objective: To investigate the preventive effect of distal perfusion catheters (DPCs) on vascular complications in patients undergoing venous artery extracorporeal membrane oxygenation (VA-ECMO). Methods: Patients who underwent VA-ECMO through a femoral approach in our hospital were included in this study, and they were divided into two groups according to their use of DPC. Clinical indicators were compared between the two groups, including the ECMO running time, intensive care unit (ICU) time, length of hospital stay, ECMO auxiliary results, the incidence of limb ischemia and vascular complications. Results: In total, 250 patients were included in this study, including the DPC group (age: 48 [32-62] years old, 58.4% male, n = 125) and the non-DPC group (age: 51 [36-63] years old, 65.6% male, n = 125). The DPC group was less likely to have limb complications than the non-DPC group (6.4% vs 17.6%, P = 0.006), mainly resulting from distal ischemia (4.0% vs 15.2%, P = 0.003) and necrosis (1.6% vs 9.6%, P = 0.006). The ECMO duration had a median of 92.3 (75.7-109) h in the DPC group and 71.2 (59.4-82.8) h in the DPC group, with a difference close to the statistical threshold (P = 0.054). There was no significant difference in ICU time or length of hospital stay between the two groups. The multivariate analysis showed that the DPC implantation was negatively associated with limb complications (odds ratio: 0.265, 95% confidence interval: 0.107-0.657, P = 0.004) after adjustment for confounding factors. Conclusion: Distal perfusion catheter placement might be associated with a decreased risk of vascular complications and limb ischemia in patients undergoing femoral VA-ECMO cannulation. Further randomised studies are still needed to verify its benefit on clinical outcomes.

A novel prognostic model for patients with colon adenocarcinoma.

Background: Colon adenocarcinoma (COAD) is a highly heterogeneous disease, which makes its prognostic prediction challenging. The purpose of this study was to investigate the clinical epidemiological characteristics, prognostic factors, and survival outcomes of patients with COAD in order to establish and validate a predictive clinical model (nomogram) for these patients. Methods: Using the SEER (Surveillance, Epidemiology, and End Results) database, we identified patients diagnosed with COAD between 1983 and 2015. Disease-specific survival (DSS) and overall survival (OS) were assessed using the log-rank test and Kaplan-Meier approach. Univariate and multivariate analyses were performed using Cox regression, which identified the independent prognostic factors for OS and DSS. The nomograms constructed to predict OS were based on these independent prognostic factors. The predictive ability of the nomograms was assessed using receiver operating characteristic (ROC) curves and calibration plots, while accuracy was assessed using decision curve analysis (DCA). Clinical utility was evaluated with a clinical impact curve (CIC). Results: A total of 104,933 patients were identified to have COAD, including 31,479 women and 73,454 men. The follow-up study duration ranged from 22 to 88 months, with an average of 46 months. Multivariate Cox regression analysis revealed that age, gender, race, site_recode_ICD, grade, CS_tumor_size, CS_extension, and metastasis were independent prognostic factors. Nomograms were constructed to predict the probability of 1-, 3-, and 5-year OS and DSS. The concordance index (C-index) and calibration plots showed that the established nomograms had robust predictive ability. The clinical decision chart (from the DCA) and the clinical impact chart (from the CIC) showed good predictive accuracy and clinical utility. Conclusion: In this study, a nomogram model for predicting the individualized survival probability of patients with COAD was constructed and validated. The nomograms of patients with COAD were accurate for predicting the 1-, 3-, and 5-year DSS. This study has great significance for clinical treatments. It also provides guidance for further prospective follow-up studies.

Analysis of 24-hour Death Risk Factors in Circulatory Failure Patients Treated with Venoarterial Extracorporeal Membrane Oxygenation

ABSTRACT Objective: To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment. Methods: A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups. Results: The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both). Conclusion: Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.

Elevated D-dimer and Adverse In-hospital Outcomes in COVID-19 Patients and Synergism with Hyperglycemia.

Aim: One of the most common laboratory findings in COVID-19 patients has been observed to be hypercoagulability with elevated D-dimer levels. An activation of thrombosis may be generated by hyperglycemia. We aimed to explore the association between D-dimer and in-hospital outcomes, and evaluate the synergistic effect between elevated D-dimer and hyperglycemia on COVID-19 prognosis. Methods: A retrospective cohort study was undertaken with 2467 COVID-19 inpatients. D-dimer and fasting blood glucose (FBG) on admission and adverse in-hospital outcomes (events of death and aggravated severity) were collected. Cox proportional risk model was performed to assess the association of D-dimer and adverse in-hospital outcomes, and the combined effects of D-dimer and FBG. Results: Among these COVID-19 patients, 1100 (44.6%) patients had high D-dimer (≥0.50 mg/L). Patients with high D-dimer were older, with higher FBG (≥7.00 mmol/L), and had significantly higher adjusted risk of adverse in-hospital outcomes when comparing with those who with D-dimer<0.50 mg/L (hazard ratio, 2.73; 95% confidence interval, 1.46-5.11). Moreover, patients with high FBG and D-dimer levels had an increasing risk (hazard ratio, 5.72; 95% confidence interval: 2.65-12.34) than those with normal FBG and D-dimer. Conclusion: Risk of adverse in-hospital outcomes is higher among patients with high D-dimer levels. Additionally, this study found for the first time that elevated D-dimer and hyperglycemia had a synergistic effect on COVID-19 prognosis, and this risk was independent of diabetes history.

Establishment of a diagnostic model of coronary heart disease in elderly patients with diabetes mellitus based on machine learning algorithms.

OBJECTIVE: To establish a prediction model of coronary heart disease (CHD) in elderly patients with diabetes mellitus (DM) based on machine learning (ML) algorithms. METHODS: Based on the Medical Big Data Research Centre of Chinese PLA General Hospital in Beijing, China, we identified a cohort of elderly inpatients (≥ 60 years), including 10,533 patients with DM complicated with CHD and 12,634 patients with DM without CHD, from January 2008 to December 2017. We collected demographic characteristics and clinical data. After selecting the important features, we established five ML models, including extreme gradient boosting (XGBoost), random forest (RF), decision tree (DT), adaptive boosting (Adaboost) and logistic regression (LR). We compared the receiver operating characteristic curves, area under the curve (AUC) and other relevant parameters of different models and determined the optimal classification model. The model was then applied to 7447 elderly patients with DM admitted from January 2018 to December 2019 to further validate the performance of the model. RESULTS: Fifteen features were selected and included in the ML model. The classification precision in the test set of the XGBoost, RF, DT, Adaboost and LR models was 0.778, 0.789, 0.753, 0.750 and 0.689, respectively; and the AUCs of the subjects were 0.851, 0.845, 0.823, 0.833 and 0.731, respectively. Applying the XGBoost model with optimal performance to a newly recruited dataset for validation, the diagnostic sensitivity, specificity, precision, and AUC were 0.792, 0.808, 0.748 and 0.880, respectively. CONCLUSIONS: The XGBoost model established in the present study had certain predictive value for elderly patients with DM complicated with CHD.

Mechanical Properties and Strengthening Mechanism of Dredged Silty Clay Stabilized by Cement and Steel Slag.

The high moisture content and low strength of dredged soft soils result in significant difficulties in directly reutilizing them in engineering. Improving their mechanical properties effectively and achieving re-utilization with the maximum benefit in engineering is the key to disposing of dredged soils with high moisture content. This study investigated the influences of cement and steel slag ratio, moisture content, the maximum particle size of steel slag, and curing age on the compressive strength of dredged silty clay in a plastic flow state. The performance improvement of dredged silty clay stabilized with cement and steel slag was discussed by comparing to related previous studies. The strengthening mechanism of dredged soils stabilized with cement and steel slag was explored by microstructural observation. The results show that when the ratio of cement to steel slag was 9:6; namely, using steel slag to replace 40% of cement, the strength properties of dredged silty clay stabilized by cement and steel slag could ensure the minimum requirements of the project greater then 100 kPa, and their economics could achieve the best results. The finer the particle size of steel slag was, the better the stabilization effect was. The compressive strength of dredged silty clay stabilized by cement and steel slag with particle sizes of less than 0.075 mm was 1.06 times, 1.10 times, and 1.16 times that of 0.25 mm, 1 mm, and 2 mm and increased linearly over curing ages earlier than 28 days. The compressive strength of dredged silty clay stabilized by cement and steel slag cured for 28 days was 2.44 times, 1.59 times, and 1.36 times that of 3, 7, and 14 days, respectively. The evolution of microstructural characteristics showed that the internal pore sizes of dredged soil decreased the structural compactness increased significantly due to the formation of more calcium silicate hydrate and other agglomerated flocculent gel materials from the further reaction between steel slag and cement hydration products. The results of this study can provide technological parameters for the re-utilization of dredged soil stabilized with cement and steel slag.

Role of blood pressure on stroke-related mortality: a 45-year follow-up study in China.

BACKGROUND: Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations. METHODS: This is a 45-year follow-up cohort study and a total of 1696 subjects were enrolled in 1976 and 1081 participants died by the latest follow-up in 2020. COX proportional hazard model was used to explore the associations of stroke-related death with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) categories and BP changes from 1976 to 1994. The mediating and moderated mediating effects were performed to detect the possible influencing path from BP to stroke-related deaths. E value was calculated in the sensitivity analysis. RESULTS: Among 1696 participants, the average age was 44.38 ±â€Š6.10 years, and 1124 were men (66.3%). After a 45-year follow-up, a total of 201 (11.9%) stroke-related deaths occurred. After the adjustment, the COX proportional hazard model showed that among the participants with SBP ≥ 160 mmHg or DBP ≥ 100 mmHg in 1976, the risk of stroke-related death increased by 217.5% (hazard ratio [HR] = 3.175, 95% confidence interval [CI]: 2.297-4.388), and the adjusted HRs were higher in male participants. Among the participants with hypertension in 1976 and 1994, the risk of stroke-related death increased by 110.4% (HR = 2.104, 95% CI: 1.632-2.713), and the adjusted HRs of the BP changes were higher in male participants. Body mass index (BMI) significantly mediated the association of SBP and stroke-related deaths and this mediating effect was moderated by gender. CONCLUSIONS: In a 45-year follow-up, high BP and persistent hypertension are associated with stroke-related death, and these associations were even more pronounced in male participants. The paths of association are mediated by BMI and moderated by gender.

Effects of sodium-glucose cotransporter 2 inhibitors on cardiovascular outcomes in elderly patients with comorbid coronary heart disease and diabetes mellitus.

OBJECTIVE: To investigate the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular outcomes in elderly Chinese patients with comorbid coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM). METHODS: A retrospective cohort study was conducted on 501 elderly inpatients (≥ 60 years) with comorbid CHD/T2DM in Department of Cardiovascular Medicine and Endocrinology, Chinese PLA General Hospital from January 2018 to December 2019. These patients were divided into two groups according to the administration of SGLT2i. All the demographic characteristics and clinical data were collected. Cardiovascular outcomes, including all-cause mortality, major adverse cardiovascular events (MACE), and hospitalization for heart failure (HHF), were followed up. RESULTS: In the cohort, there were 167 patients in the SGLT2i group and 334 patients in the control group. In the efficacy analyses, the incidence of MACE was lower in the SGLT2i group than in the control group: 3.6% vs. 9.3% (P = 0.022). A lower risk of MACE was observed in the SGLT2i group [hazard ratio (HR) = 0.40, 95% CI: 0.17-0.95]. There was no significant difference in the incidence of all-cause mortality or HHF between the two groups. No significant difference of HR was observed for all-cause mortality (HR = 0.41, 95% CI: 0.12-1.41) or HHF (HR = 0.58, 95% CI: 0.12-2.81). CONCLUSIONS: SGLT2i treatment exhibited benefits for elderly patients with comorbid CHD/T2DM with a lower risk for MACE.

Synergistic Impact of Body Mass Index and Cognitive Function on All-Cause Mortality in Older Adults: A Nationwide Longitudinal Study.

Background: Body mass index (BMI) and cognitive function are independent predictors of mortality risk. However, little is known about the combined impact of BMI and cognitive function on the risk of all-cause mortality in older adults. In this study, we aimed to examine the associations between BMI, cognitive function, and all-cause mortality, including between-factor interactions, in the general population of older adults in China. Methods: We used the data between 2011 and 2018 from the Chinese Longitudinal Healthy Longevity Survey that included adults aged ≥65 years residing in the 23 provinces of China. The association between BMI and cognitive function on all-cause mortality was examined with the Cox proportional hazards regression model. Results: The study included 8,293 Chinese older adults. Low BMI (underweight) and cognitive impairment were associated with the highest risk of death after adjustments [hazard ratio (HR) = 2.18; 95% confidence interval (CI), 1.96-2.41]; this combined effect was more prominent among adults aged <100 years and women. In addition, there was an interaction effect of BMI and cognitive impairment on all-cause mortality (P <0.001). Concurrently, among older adults with normal cognition, the risk of mortality related to underweight was higher than among their cognitively impaired counterparts [55% (normal cognition) vs. 38% (cognitive impairment)]. Conclusions: Low BMI (underweight) and cognitive impairment were independently and jointly associated with increased risk of all-cause mortality among Chinese older adults, and females showed a stronger effect in this association. The association between BMI and mortality was more pronounced in the participants with normal cognition than in their cognitively impaired counterparts.

Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem.

BACKGROUND: Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. METHODS: We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10-30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. RESULTS: After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, -9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. CONCLUSIONS: This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.

The Role of BMI and Blood Pressure in the Relationship Between Total Cholesterol and Disability in Chinese Centenarians: A Cross-Sectional Study.

Background: Lower serum lipid metabolism might be associated with the decline of activity of daily living in the extreme longevity group. However, studies on models and possible paths of this correlation between total cholesterol (TC) and disability in centenarians are scarce. The aim of this study was to verify this correlation and explore the mediating effect of BMI and blood pressure on this relationship in Hainan centenarians. Methods: We conducted a cross-sectional analysis of 1002 centenarians from the China Hainan Centenarians Cohort Study (CHCCS). Data on demographics, anthropometry data, lifestyle, and TC levels were collected through interviews, physical examinations, and laboratory tests. The Barthel index and Lawton index, measuring the disability status, were used to estimate the activity of daily living (ADL) and instrumental activity of daily living (IADL). A multivariable logistic regression model was used to explore the correlation between disability and TC levels. Mediation analyses were used to explore the both direct and indirect effects of TC level on disability. Results: After adjusting for covariates, with 1 mmol/L increment in TC, the adjusted odds ratios (ORs) of ADL severe disability and ADL moderate & severe disability were 0.789(95%CI: 0.650-0.959) and 0.822(95%CI: 0. 0.699-0.966), respectively. There was a significant declining trend in the prevalence of different types of disability with increment in TC. The correlation was more pronounced among Hainan female centenarians. In the analysis of mediating effect among the female population, BMI significantly mediated the effect of TC levels on different types of disability. BMI and SBP, as chain mediators, multiply and chain mediated the effect of TC levels on IADL. Conclusion: Low TC levels might be correlated with a higher frequency of disability in female centenarians, and this correlation might be mediated by BMI and blood pressure.

Effect of Charlson Comorbidity Index and Treatment Strategy on Survival of Elderly Patients After Endoscopic Submucosal Dissection for Gastric Adenocarcinoma: A Multicenter Retrospective Study.

Background: The optimal treatment strategy for elderly patients with early gastric adenocarcinoma (EGAC) after non-curative endoscopic submucosal dissection (ESD) remains unclear. The purpose of this research was to explore the effectiveness of additional treatments after ESD and the factors affecting survival in elderly patients (≥60 years of age) with EGAC. Methods: A total of 639 elderly patients (≥60 years) treated with ESD for EGAC from 2006 to 2018 were retrospectively reviewed. Positive lymphatic infiltration, submucosal infiltration, and positive/indeterminate vertical resection margins are considered high risk factors in histology. According to the risk of lymph node metastasis in patients with EAGC and the treatment strategies adopted after ESD, patients were divided into three groups: there were 484 patients in group A with low risk, 121 patients in group B with high risk, without additional treatment, and 36 patients in group C with high risk, with additional treatment. The 5- and 8-year survival rate, as well as the prognostic factors of survival rate after ESD was studied. Results: The median follow-up time was 38, 40, and 49 months, respectively. There were 3, 4, and 3 deaths related to gastric adenocarcinoma in groups A, B, and C, while deaths from other diseases were 20, 5, and 3, respectively. There were significant differences in overall survival rates between groups (94.3; 86.4; 81.2%, p = 0.110), but there was no significant difference in disease-specific survival rates (98.4; 92.7; 92.4%, p = 0.016). In the multivariate analysis, the Charlson Comorbidity Index (CCI) ≥ 2 was an independent risk factor for death after ESD (hazard ratio 2.39; 95% confidence interval 1.20-4.77; p = 0.014). Conclusions: The strategy of ESD with no subsequent additional treatment for EGAC may be a suitable option for elderly patients at high risk, especially for CCI ≥ 2.

Health-Related Quality of Life and Its Correlation With Depression Among Chinese Centenarians.

Background: As evidence on depression and health-related quality of life (HRQoL) among the oldest-old is currently limited, this study aimed to re-examine the association between depression and HRQoL among centenarians. Methods: We analyzed cross-sectional data from the China Hainan Centenarian Cohort Study (CHCCS). The 15-item Geriatric Depression Scale (GDS-15) and three-level EuroQol five-dimensions (EQ-5D-3L) were used to evaluate depression and HRQoL, respectively. Poor health states were defined as EQ-5D index <0.665. Based on their GDS-15 score, individuals were categorized into three stages of depression: major depressive disorder (MDD; score ≥10), minor depressive disorder (MnDD; score between 6 and 9), and normal (score ≤ 5). Based on sex and comorbidity stratification, multivariable logistic regression was used to calculate the risk of poor health state in different levels of depression. We also used restricted cubic splines with a knot at 5 points (GDS-15) to flexibly model the association of GDS-15 scores with poor health states. Results: Totally, 1,002 participants were included in this study for analysis. Participants' median age was 102 years, and 82.04% were female. The median EQ-5D index was 0.68 (range: -0.149-1), and the mean VAS and GDS-15 scores were 61.60 (range: 0-100), and 5.23 (range: 0-15), respectively. Centenarians with MnDD and MDD accounted for 38.12 and 9.98%, respectively. While those with poor health states accounted for 45.11%. For every 1-point increase in GDS-15, the risk of poor health state increased by 20% (P < 0.001) after an adjustment for age, gender, ethnicity, marital status, education, residence type, smoking, drinking, weekly exercise, body mass index category, serum albumin, 25-hydroxyvitamin D, C-reactive protein, and comorbidities. MnDD and MDD were independent risk factors for poor health state (MnDD, OR = 2.76, P < 0.001; MDD, OR = 3.14, P < 0.001). The association was more prominent in centenarians without comorbidity. Conclusions: This study demonstrated a negative association between depression and HRQoL in Chinese centenarians, especially in centenarians without comorbidity. Large-scale prospective studies are needed to corroborate our findings and provide more information about the causal inference and internal mechanisms of this association.

Serum albumin and activities of daily living in Chinese centenarians: a cross-sectional study.

BACKGROUND: Objective deterioration in activities of daily living (ADLs) exists among older population, and particularly worsens with age. Considering the criterion standard of positive aging and longevity, little information focusing on centenarians is available. This study set out to explore the relationship between serum albumin and ADLs among centenarians in long-lived areas. METHODS: This population-based cross-sectional study investigated a full sample of Chinese centenarians in Hainan, the longest-lived area of China (n = 1002). We assessed serum albumin levels and basic and instrumental activities of daily living (BADLs and IADLs). RESULTS: Of 1002 participants included in the analysis, 287 (28.64%) had BADL disabilities and 648 (64.67%) had IADL disabilities. The median level of serum albumin was 38.5 g/L (interquartile range, 36.2-41.3). The multivariable analyses controlling for socio-demographic characteristics, lifestyle, morbidities, and other influential factors showed that albumin level was associated with the total score of BADL (standard ß = 0.335, P < 0.001) and IADL (standard ß = 0.206, P < 0.001). With the increasing of albumin level, the risk of ADLs disability decreased (BADL: odds ratios [OR] = 0.835, 95% Confidence interval [CI]: 0.797-0.876; IADL: OR = 0.863, 95%CI: 0.824-0.905). In the stratified analyses, similar results were found in both sex, but were more prominent in women. CONCLUSIONS: Higher levels of serum albumin was a protective factor for the decline of ADLs in centenarians. This association can be observed in both genders and is more pronounced in women.

Higher Normal Levels of Triglyceride and Low and High-Density Lipoprotein Cholesterol Might Have a Protective Effect Against Activities of Daily Living Disability Within Chinese Female Centenarians: A Cross-Sectional, Complete Sample Study.

BACKGROUND AND OBJECTIVE: Activities of daily living (ADL) disability seriously affects the quality of life in the elderly. This study aims to examine the prevalence of ADL disability and its possible correlation with lipid profile indicators (LDL-C, TG and HDL-C) among female centenarians in Hainan, China. METHODS: A cross-section of complete sample study including 822 female centenarians was conducted from the China Hainan Centenarians Cohort Study (CHCCS) from June 2014 to December 2016. Barthel index was used to estimate ADL disability and multivariate logistic regression model was used to explore the relationship between lipid profile indicator and ADL disability. RESULTS: A total of 822 female centenarians were recruited in Hainan province, and the median age was 102 (IQR: 101-104) years, and 244 (29.7%) centenarians had ADL disability. After adjustment, 1 mmol/L increment in LDL-C, TG and HDL-C were associated with 26.4% (aOR=0.736, 95% CI:0.592-0.915), 29.8% (aOR=0.702, 95% CI:0.521-0.948) and 60.5% (aOR=0.395, 95% CI:0.257-0.610) decline in ADL disability of female centenarian, respectively. The prevalence of ADL disability showed downward trend with the increase of the quintile of LDL-C, TG and HDL-C (Ptrend<0.05). Increment of HDL-C levels had the strongest protective effect against ADL disability. CONCLUSION: We concluded that a new possible association of higher normal lipid profile indicators, especially HDL-C, might have a protective effect on ADL disability among female centenarians.

Anemia in centenarians: prevalence and association with kidney function.

Objectives: Although anemia is a widespread condition that leads to an increase in morbidity and mortality, particularly as people age, little information on anemia in centenarians is available. The objective of this study was to determine the prevalence of anemia and examine the relationship between anemia and a decline in kidney function in Chinese centenarians.Methods: We conducted a population-based cross-sectional study of a sample of 1002 Chinese centenarians (180 men and 822 women) from 2014 to 2016. Anemia was defined as a hemoglobin level of <130 g/L for men and <120 g/L for women.Results: The prevalence of anemia and severe anemia (<100 g/L) were 68.5% (men, 76.1%; women, 66.8%) and 19.6% (men, 16.1%; women, 20.3%), respectively. The risk of anemia and estimated glomerular filtration rate (eGFR) showed a nonlinear relationship (nonlinear P = 0.021). The interaction analysis revealed that ethnicity and diabetes mellitus played a role in the association between the eGFR (<60 mL/min/1.73 m2) and anemia.Conclusion: Anemia is highly prevalent in Chinese centenarians, particularly among men. Decreased kidney function was an independent determinant of anemia, especially in Han participants and participants with diabetes mellitus. The possibility of decreased kidney function needs to be considered in the evaluation and treatment of anemia in centenarians.