Association between dietary patterns and the risk of all-cause mortality among old adults with obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea (OSA) was associated with the increased cardiovascular events and all-cause mortality. And anti-inflammatory dietary has potential to improve the prognosis of OSA. This study aimed to investigate the association of anti-inflammatory dietary patterns with all-cause mortality among individuals with OSA. METHODS: This retrospective cohort study involved 1522 older adults with OSA from 2005 to 2008 in the National Health and Nutrition Examinations Survey (NHANES). Mortality status was determined by routine follow-up through December 31, 2019, using the National Death Index. Anti-inflammatory dietary patterns included Alternate Mediterranean Diet Score (aMED), Healthy Eating Index-2015 (HEI-2015), and Alternate Healthy Eating Index-2010 (AHEI-2010). Weighted Cox proportional hazard regression models were performed to investigate the association between anti-inflammatory dietary pattern and all-cause mortality. RESULTS: After a median follow-up of 131 months, 604 participants were recorded all-cause mortality. The mean age of OSA patients was 68.99 years old, of whom 859 were male (52.34%). Higher adherence of aMED (HR = 0.61, 95%CI: 0.48 to 0.78) and HEI-2015 (HR = 0.75, 95%CI: 0.60 to 0.95) were associated with lower all-cause mortality risk in the elderly with OSA. Conversely, no association was found between AHEI-2010 dietary pattern and all-cause mortality in individuals with OSA. In the component analysis of aMED, it was found that a higher intake of vegetables and olive oil potentially contributes to the reduction all-cause mortality risk in the elderly with OSA (HR = 0.60, 95%CI: 0.48 to 0.76; HR = 0.67, 95%CI: 0.63 to 0.71). CONCLUSION: Higher adherence to the aMED and the HEI-2015 was associated with a lower risk of all-cause mortality in OSA. Future interventions in the elderly with OSA should considering adopting anti-inflammatory dietary patterns.

Effects of early mental state changes on physical functions in elderly patients with a history of falls.

BACKGROUND: Fear of falling is a potential consequence for older adults who have experienced a fall. Whether such psychological concerns related to falls, in turn, affect physical function? Especially those who have a history of falling but have not been diagnosed with anxiety, depression, or both. This study aimed to clarify the effects of early psychological changes on the physical function of older patients. METHODS: The 111 participants with falling history were divided into the poor physical function (PPF) group with the Short Physical Performance Battery (SPPB) ≤ 9 and the good physical function (GPF) group with SPPB > 9. Their physical function was assessed through 4-m gait speed (4MGS), five times sit-to-stand test (FTSST), grip strength, and Timed Up and Go tests TUGT. Their mental state was assessed by the self-rating anxiety/depression scale (SAS/SDS). RESULTS: (1) SAS/SDS scores were negatively correlated with the SPPB score, gait speed, and maximum grip strength (males). (2) Multivariate logistic regression analysis showed that the SPPB score was subject to such independent influence factors: cerebrovascular disease (OR = 11.805; P = 0.005), normal ratio of grip strength (OR = 0.046; P = 0.016), TUGT (OR = 1.717; P < 0.001), and SDS score (OR = 1.154; P = 0.008). (3) The area under the ROC curve was 0.699 (0.601, 0.797) for SAS score, with a sensitivity of 0.776 and a specificity of 0.547; the AUC was 0.694 (0.596, 0.792) for SDS score, with a sensitivity of 0.586 and a specificity of 0.755. CONCLUSIONS: In older adults with a history of falls without a diagnosis of anxiety or depression, higher SAS/SDS scores were associated with worse fall-related physical function, and there was a statistically significant correlation between the two. This may indicate a risk of falling again in the future.

Association of plasma bone morphogenetic protein-4 levels with arterial stiffness in hypertensive patients.

BACKGROUND: Arterial stiffness interacts with hypertension, becoming an early marker of hypertension-mediated target organ damage. This study aimed to assess the association between plasma concentrations of bone morphogenetic protein-4 (BMP-4) and arterial stiffness during hypertension. METHODS: Using cardio-ankle vascular index (CAVI) to determine arterial stiffness status, 204 individuals with essential hypertension were classified into two groups, high CAVI (abnormal) group (n = 94) and low (normal) CAVI group (n = 110). Data were collected including clinical characteristics and laboratory measurements. Plasma levels of BMP-4 were tested by using ELISA analysis. RESULTS: Plasma levels of BMP-4 were substantially greater in high CAVI group than that in low CAVI group [38.51 (31.79-50.83) pg/mL vs. 31.15 (29.38-32.37) pg/mL; p < 0.001]. As shown by spearman correlation analysis, BMP-4 concentrations were correlated with CAVI values in hypertensive individuals (r = 0.406, p < 0.001). After adjustment for potential confounders, elevated BMP-4 levels were related with high CAVI (OR, 1.070; 95% CI, 1.003-1.108; p < 0.001). The best BMP-4 cutoff value for identifying high CAVI, as determined by ROC curve analysis, was 33.34 pg/mL (AUC, 0.751; 95% CI, 0.683-0.818; p < 0.001). CONCLUSION: Plasma levels of BMP-4 are increased in hypertensive individuals with high CAVI. Elevated BMP-4 levels are strongly correlated with higher CAVI values, implying a predictive value of BMP-4 in arterial stiffness during hypertension.

Liver injury caused by fenofibrate within 48 h after first administration: a case report.

BACKGROUND: Fenofibrate is commonly used in the treatment of dyslipidemia. Fenofibrate is related to mild aminotransferase elevations and in some cases severe chronic injury such as fibrosis or cirrhosis, resulting in liver transplantation or death. The latency of disease has been reported to range between weeks to years. CASE PRESENTATION: A 63 years old male with hypertriglyceridemia developed symptoms of fatigue and anorexia 48 h after taking fenofibrate for the first time. The patient's aminotransferase level was more than 10 times ULN. Immediately, fenofibrate was discontinued and aminotransferase level returned to normal 23 days later. To assess causality between the drug and liver damage, the standardized Roussel Uclaf Causality Assessment Method (RUCAM) was used. The patient's RUCAM score was 7, which fell in the group of "probable". Eight months later, follow-up examination suggested the liver function was normal. CONCLUSIONS: Weakness, fatigue and abnormal liver function during fenofibrate therapy should be closely monitored and trigger prompt withdrawal if these symptoms occur.

Oral health in patients with dementia: A meta-analysis of comparative and observational studies.

OBJECTIVE: Poor oral health is common in dementia, but findings of epidemiological studies have been inconsistent. This meta-analysis examined oral health in patients with dementia diagnosed according to standardized diagnostic criteria. METHODS: Six international databases (PubMed, EMBASE, PsycINFO, Medline, Cochrane Library, and Web of Science) were searched from their commencement date until 8 November 2018. Oral health was measured by the Remaining Teeth (RT) and Decayed, Missing, and Filled Teeth (DMFT) Index. The mean differences (MD) and 95% confidence intervals (CI) of DMFT Index total and component scores were calculated using a random-effect model. RESULTS: Twenty-four studies were included for analyses. The pooled DMFT Index was 23.48 (95% CI: 22.34, 24.62), while the pooled score for each component was 2.38 (95% CI: 1.56, 3.20) in decayed teeth (DT), 18.39 (95% CI: 15.92, 20.87) in missing teeth (MT), 2.29 (95% CI: 0.62, 3.95) in filled teeth (FT), and 11.59 (95% CI: 9.14, 14.05) in RT. Compared to controls, people with dementia had significantly a higher DMFT Index total score (MD = 3.80, 95% CI: 2.21, 5.39, p < 0.00,001), and significantly lower number of RT (MD = -3.15, 95% CI: -4.23, -2.06, p < 0.00,001). Subgroup analyses revealed that higher DMFT Index score was significantly associated with year of survey (>2010), study design (case-control study), percentage of females (≤54.3), and the Mini Mental State Examination score (≤18.2). Higher MT score was significantly associated with study design (cross-sectional study), and lower FT score was significantly associated with year of survey (>2010). CONCLUSIONS: Oral health was significantly poorer in people with dementia compared with controls. Regular screening and effective treatment should be implemented for this population.

A prospective cohort study of the risk factors for new falls and fragility fractures in self-caring elderly patients aged 80 years and over.

BACKGROUND: This study aimed to prospectively analyze the risk factors for new falls and fragility fractures in self-caring elderly patients and to find suitable evaluation tools for community screening and follow-up interventions. METHODS: A total of 300 participants (187 male and 113 female), aged 80 or above and capable of caring for themselves, were enrolled in this study and observed for a period of 12 months. Their medical histories were collected, various indicators were measured, and the risk factors for new falls and fragility fractures were analyzed. RESULTS: A total of 290 participants were included in the statistical analysis. Eighty-seven participants (30%) had new falls. The incidence was negatively correlated with the activities of daily living (ADL, represented by the Barthel Index) score (P=0.008) but was positively correlated with the timed up-and-go (TUG) test score> 12 s (P=0.021). The results also revealed that 33 fragility fractures occurred in 29 patients (10.0%), which was positively correlated with new falls (P=0.000). New fragility fractures were negatively correlated with the bone mineral density (BMD) of the lumbar vertebrae (P=0.012) and walking speed (P=0.000). CONCLUSION: TUG, walking speed, the ADL score, and the fall risk assessment scale can simply and effectively assess the risk of new falls and fragility fractures in the elderly population, and their use should be widely implemented in the community.

Can primary palliative care education change life-sustaining treatment intensity of older adults at the end of life? A retrospective study.

BACKGROUND: Palliative care education has been carried out in some hospitals and palliative care has gradually developed in mainland China. However, the clinical research is sparse and whether primary palliative care education influence treatment intensity of dying older adults is still unknown. This study aims to explore the changes to the intensity of end-of-life care in hospitalized older adults before and after the implementation of primary palliative care education. METHODS: A retrospective study was conducted. Two hundred three decedents were included from Beijing Tongren Hospital's department of geriatrics between January 1, 2014 to December 31, 2019. Patients were split into two cohorts with regards to the start of palliative care education. Patient demographics and clinical characteristics as well as analgesia use, medical resources use and provision of life-sustaining treatments were compared. We used a chi-square test to compare categorical variables, a t test to compare continuous variables with normal distributions and a Mann-Whitney U test for continuous variables with skewed distributions. RESULTS: Of the total participants in the study, 157(77.3%) patients were male. The median age was 88 (interquartile range; Q1-Q3 83-93) and the majority of patients (N = 172, 84.7%) aged 80 years or older. The top 3 causes of death were malignant solid tumor (N = 74, 36.5%), infectious disease (N = 74, 36.5%), and cardiovascular disease (N = 23, 11.3%). Approximately two thirds died of non-cancer diseases. There was no significant difference in age, gender, cause of death and functional status between the two groups (p > 0.05). After primary palliative care education, pain controlling drugs were used more (p < 0.05), fewer patients received electric defibrillation, bag mask ventilation and vasopressors (p < 0.05). There was no change in the length of hospitalization, intensive care admissions, polypharmacy, use of broad-spectrum antibiotics, blood infusions, albumin infusions, nasogastric/nasoenteric tubes, parenteral nutrition, renal replacement and mechanical ventilation (p > 0.05). CONCLUSIONS: Primary palliative care education may promotes pain controlling drug use and DNR implementation. More efforts should be put on education about symptom assessment, prognostication, advance care planning, code status discussion in order to reduce acute medical care resource use and apply life-sustaining treatment appropriately.

Glass bead-activated clotting time (gb-ACT) for monitoring the anticoagulation effects in elderly patients with high risk of venous thromboembolism (VTE).

BACKGROUND: To find a new bedside method to monitor the anticoagulation effects of low-molecular-weight heparins (LMWHs) in patients with a high risk of venous thromboembolism (VTE). RESEARCH DESIGN AND METHODS: A total of 32 hospitalized patients (aged ≥60 years) who were at high risk of VTE were assigned to receive subcutaneous LMWH for 5 to 14 days. Plasma anti-factor Xa (anti-Xa) activity was conducted by a chromogenic method, and the glass bead-activated whole blood clotting time (gb-ACT) value was obtained by a Sonoclot Analyzer. RESULTS: A correlation between the gb-ACT values and the anti-Xa levels was suggested (R = 0.447, p = 0.002), and it was stronger in the older group aged 80 years above (R = 0.467, p = 0.008) and in the group of patients with an eGFR of 30 ~ 60 mL/min (R = 0.565, p = 0.005). The area under the curve (AUC) for gb-ACT by receiver operating characteristic (ROC) curve evaluation was 0.725 (p = 0.011), and the gb-ACT >282.5s provided a sensitivity of 60% and specificity of 74% for anti-Xa >0.800 IU/ml. CONCLUSIONS: The gb-ACT values detected by a Sonoclot Analyzer could act as a novel bedside method in the monitoring of LMWH anticoagulation.

2024 Chinese Expert Consensus Guidelines on the Diagnosis and Treatment of Atrial Fibrillation in the Elderly, Endorsed by Geriatric Society of Chinese Medical Association (Cardiovascular Group) and Chinese Society of Geriatric Health Medicine (Cardiovascular branch): Executive Summary.

The consensus guidelines of the Geriatric Society of Chinese Medical Association on the management of atrial fibrillation (AF) in the elderly was first published in 2011 and updated in 2016, with endorsement by Chinese Society of Geriatric Health Medicine. Since then, many important studies regarding the screening and treatment in the elderly population have been reported, necessitating this updated expert consensus guideline. The writing committee members comprehensively reviewed updated evidence pertaining to elderly patients with AF, and formulated this 2024 update. The highlighted issues focused on the following: screening for AF, geriatric comprehensive assessment, use of the Atrial fibrillation Better Care (ABC) pathway for the elderly patients, and special clinical settings related to elderly patients with AF. New recommendations addressing smart technology facilitated AF screening, ABC pathway based management, and optimal anticoagulation were developed, with a focus on the elderly.

Effects of temporal changes in resting heart rate on future diabetes-related outcomes.

Background and aims: Most studies have analyzed the relationship between resting heart rate (RHR) measured at only one time point and future clinical events. The current study aims to investigate the impact of long-term RHR changes on future clinical outcomes in a decade-long cohort with type 2 diabetes mellitus (T2DM). Methods: The two-staged follow-up involved 2,513 T2DM participants. The first stage (2008-2014) intended to identify levels and trends in RHR changes, while the second stage (2014-2018) attempted to collect new occurrence records of clinical results. Cox proportional hazards models were applied to predict hazard ratios (HRs), along with 95% confidence interval (CI) for the correlation between RHR changes and future events. Results: There is no significant correlation between baseline RHR levels and long-term clinical events. According to the range of RHR change, compared with the stable RHR group, the adjusted HRs for cardiovascular events and all-cause death in the large increase group were 3.40 (95% CI: 1.33-8.71, p=0.010) and 3.22 (95% CI: 1.07-9.64, p=0.037), respectively. While the adjusted HRs for all-cause death and major adverse cardiac and cerebrovascular events (MACCE) in the moderate decrease group were 0.55 (95% CI: 0.31-0.96, p=0.037) and 0.51 (95% CI: 0.26-0.98, p=0.046). According to the trend of RHR, compared with the normal-normal group, the adjusted HRs for composite endpoint events and cerebrovascular events in the normal-high group were 1.64 (95% CI: 1.00-2.68, p=0.047) and 2.82 (95% CI: 1.03-7.76, p=0.043), respectively. Conclusion: Changes in RHR had predictive value for long-term clinical events in diabetic populations. Individuals with significantly elevated RHR over a particular period of time showed an increased risk of adverse events.

Plasma levels of Sirtuin 7 are decreased in patients with essential hypertension.

BACKGROUND: Sirtuin 7 (SIRT7), as a nicotinamide adenine dinucleotide-dependent protein/histone deacetylase, has been implicated in the pathogenesis of cardiovascular diseases. However, whether SIRT7 is related to hypertension remains largely unclear. Thus, this study aims to explore the effects and correlation between SIRT7 and hypertension. METHODS: A total of 72 patients with essential hypertension and 82 controls with non-hypertension were recruited at Beijing Tongren Hospital Affiliated with Capital Medical University from July 2022 to June 2023. Plasma SIRT7 expression was measured using enzyme-linked immunosorbent assay analysis. Clinical baseline characteristics, laboratory measurements, echocardiographic data, and medical therapy were collected. RESULTS: Plasma levels of SIRT7 were lower in hypertensive patients compared with non-hypertensive patients [0.97 (0.58-1.30) vs. 1.24 (0.99-1.46) ng/mL, P < 0.001, respectively]. Furthermore, compared with the low SIRT7 group, there were lower levels of systolic blood pressure, hyperlipidemia, and the ultrasonic electrocardiogram parameters left ventricular end-diastolic diameter and left atrial in diastole in the high SIRT7 group (P < 0.05, respectively). More importantly, multivariate logistic regression analyses indicated that plasma SIRT7 was a predictor of hypertension [OR: 0.06, 95 % CI (0.02-0.19), P < 0.001]. Receiver operating characteristics curve analysis revealed that the optimal cutoff value for plasma SIRT7 levels in detecting hypertension was determined as 0.85 ng/mL with a sensitivity of 73.6 % and a specificity of 89.0 %. The area under the curve for SIRT7 was 0.821 (95 % CI, 0.751-0.878; P < 0.001). CONCLUSION: Plasma levels of SIRT7 are decreased in patients with essential hypertension, implying its potential as a biomarker for diagnosing essential hypertension..

Plasma levels of bone morphogenic protein-4 are downregulated in elderly hypertensive patients with heart failure with preserved ejection fraction.

OBJECTIVE: This study aimed to evaluate the association between plasma bone morphogenic protein-4 (BMP-4) levels and heart failure (HF) with preserved ejection fraction (HFpEF) or mildly reduced ejection fraction (HFmrEF) in elderly hypertensive patients. METHODS: A total of 222 hypertensive individuals meeting the inclusion criteria were enrolled from October 2021 to July 2022. Data were collected including clinical characteristics, laboratory tests and echocardiogram measurements. Plasma BMP-4 levels were tested using enzyme-linked immunosorbent assay analysis. RESULTS: Among 222 elderly hypertensive patients, 149 were without HF, 59 had HFpEF, and 14 had HFmrEF. Plasma BMP-4 levels were strikingly downregulated in hypertensive patients with HFpEF/HFmrEF [median (25th, 75th percentile): 15.89 (7.69, 23.12) pg/mL vs. 19.67 (10.60, 33.04) pg/mL; P = 0.002]. After univariate and multivariate logistic regression analysis, the risk of HFpEF/HFmrEF was declined in the 4th quartile BMP-4 group when compared with the 1st quartile BMP-4 group (odds ratio, 0.20, 95% confidence interval (CI), 0.04 to 1.00; P = 0.050, P for trend = 0.025). Receiver operating characteristic curve analysis revealed that BMP-4 ≤ 28.5 pg/mL exhibited a sensitivity of 95.9% and a specificity of 28.2% in HFpEF/HFmrEF diagnosis. Furthermore, the area under the curve (AUC) was 0.619 (95% CI:0.540-0.698, P < 0.001). The corresponding AUC for brain natriuretic peptide (BNP) was 0.781 (95% CI: 0.710-0.852), P < 0.001. Adding BMP-4 to BNP increased the AUC to 0.790 (95% CI: 0.724-0.856), vs. BMP-4, P < 0.001; vs. BNP, P = 0.730, respectively. CONCLUSIONS: Plasma BMP-4 levels are downregulated in elderly hypertensive patients with HFpEF. BMP-4 is a promising biomarker for diagnosing HFpEF/HFmrEF during hypertension.

Analysis of the Distribution and Antibiotic Resistance of Pathogens Causing Infections in Hospitals from 2017 to 2019.

Background: Antibiotic resistance is a global public health problem, leading to high mortality and treatment costs. To achieve more efficient treatment protocols and better patient recovery, the distribution and drug resistance of pathogens in our hospital were investigated, allowing significant clinical guidance for the use of antimicrobials. Methods: In this retrospective study (2017-2019), 3482 positive samples were isolated from 43,981 specimens in 2017; 3750 positive specimens were isolated from 42,923 specimens in 2018; and 3839 positive pathogens were isolated from 46,341 specimens in 2019. These samples were from various parts of the patients, including the respiratory tract, urine, blood, wound secretions, bile, and puncture fluids. The distribution and antibiotic resistance of these isolated pathogens from the whole hospital were analyzed. Results: The results from pathogen isolation showed that Escherichia coli (12.8%), Staphylococcus aureus (11%), Klebsiella pneumoniae (10.8%), Pseudomonas aeruginosa (10.7%), and Acinetobacter baumannii (6.4%) represented the five main pathogenic bacteria in our hospital. Pseudomonas aeruginosa (16.2% and 17.5%) occupied the largest proportion in the central intensive care unit (central ICU) and respiratory intensive care unit (RICU), while Acinetobacter baumannii (15.4%) was the most common pathogen in the emergency intensive care unit (EICU). The resistance rate of Escherichia coli to trimethoprim and minocycline was 100%, and the sensitivity rate to ertapenem, furantoin, and amikacin was above 90%. The resistance rate of Pseudomonas aeruginosa to all antibiotics, such as piperacillin and ciprofloxacin, was under 40%. The sensitivity rate of Acinetobacter baumannii to tigecycline and minocycline was less than 30%, and the resistance rate to many drugs such as piperacillin, ceftazidime, and imipenem was above 60%. Extended-spectrum ß-lactamases (ESBLs)-producing Klebsiella pneumoniae (ESBLs-KPN) and carbapenem-resistant Klebsiella pneumoniae (CRE-KPN), ESBLs-producing Escherichia coli (ESBLs-ECO) and carbapenem-resistant Escherichia coli (CRE-ECO), multidrug-resistant Acinetobacter baumannii (MDR-AB), multidrug-resistant Pseudomonas aeruginosa (MDR-PAE), and methicillin-resistant Staphylococcus aureus (MRSA) are all important multidrug-resistant bacteria found in our hospital. The resistance rate of ESBLs-producing Enterobacteriaceae to ceftriaxone and amcarcillin-sulbactam was above 95%. CRE Enterobacteriaceae bacteria showed the highest resistance to amcarcillin-sulbactam (97.1%), and the resistance rates of MDR-AB to cefotaxime, cefepime, and aztreonam were 100%. The resistance rates of MDR-PAE to ceftazidime, imipenem, and levofloxacin were 100%, and the sensitivity rate to polymyxin B was above 98%. The resistance rate of MRSA to oxacillin was 100%, and the sensitivity rate to linezolid and vancomycin was 100%. Conclusion: The distribution of pathogenic bacteria in different hospital departments and sample sources was markedly different. Therefore, targeted prevention and control of key pathogenic bacteria in different hospital departments is necessary, and understanding both drug resistance and multiple drug resistance of the main pathogenic bacteria may provide guidance for the rational use of antibiotics in the clinic.

Association between Cardio-Ankle Vascular Index and Masked Uncontrolled Hypertension in Hypertensive Patients: A Cross-Sectional Study.

Detection of masked uncontrolled hypertension (MUCH) that was defined for treated hypertensive individuals who had normal office blood pressure (BP) but elevated ambulatory BP remains largely challenging. Arterial stiffness is one of the leading risk markers for hypertension and can be clinically assessed by the cardio-ankle vascular index (CAVI). This study aimed to evaluate the association between CAVI and MUCH. A total of 155 hypertensive patients were included with their office BP levels and ambulatory BP monitoring measurements, which were divided into controlled hypertension (CH), MUCH, and sustained uncontrolled hypertension (SUCH) groups, respectively. There were 48 patients with CH, 56 patients with MUCH, and 51 patients with SUCH. Both MUCH and SUCH groups had a significantly higher CAVI than the CH group (9.05 (8.20-9.91) vs. 8.33 (7.75-9.15), p = 0.017, and 9.75 (8.35-10.50) vs. 8.33 (7.75-9.15), p = 0.002, respectively). There was no significant difference in CAVI values between the MUCH and SUCH groups. Multinomial logistic regression analysis exhibited that compared with the CH group, increased CAVI levels were positively associated with the presence of MUCH and SUCH (OR 2.046, 95% CI (1.239-3.381), p = 0.005; OR 2.215, 95% CI (1.310-3.747), p = 0.003) after adjusting for confounders. However, there was a similar trend of the CAVI in the MUCH and SUCH groups (OR 0.924, 95% CI (0.629-1.356), p = 0.686). In summary, our findings support, for the first time, the novel notion that CAVI as an arterial stiffness parameter is an independent risk factor for MUCH, being equally important to MUCH and SUCH. When the assessed CAVI is high in hypertensive patients with normotensive office BP levels, it is necessary to further investigate with a 24 h ambulatory BP monitoring to estimate the longstanding BP control. CAVI may be used as a noninvasive indicator to identify patients with MUCH earlier.

Depressive symptoms and gender differences in older adults in Hong Kong during the COVID-19 pandemic: a network analysis approach.

Background: The 2019 novel coronavirus disease (COVID-19) outbreak had a detrimental impact on the mental health of older adults. This study evaluated the central symptoms and their associations in the network of depressive symptoms and compared the network structure differences between male and female older adults in Hong Kong. Methods: Altogether, 3,946 older adults participated in this study. We evaluated the centrality indicators for network robustness using stability and accuracy tests, and examined the potential differences between the structure and connectivity of depression networks in male and female older adults. Results: The overall prevalence of depressive symptoms was 43.7% (95% CI=40.6-46.7%) in males, and 54.8% (95% CI=53.1-56.5%) in females (P<0.05). Sad Mood, Guilt, Motor problems and Lack of Energy were influential symptoms in the network model. Gender differences were found in the network global strength, especially in the following edges: Sad Mood--Guilt, Concentration--Guilt, Anhedonia--Motor, Lack of Energy--Suicide, Appetite--Suicide and Concentration--Suicide. Conclusions: Central symptoms in the depressive symptom network among male and female older adults may be prioritized in the treatment and prevention of depression during the pandemic.

Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022).

Malnutrition is a state of altered body composition and body cell mass due to inadequate intake or utilization of energy or nutrients, leading to physical and mental dysfunction and impaired clinical outcomes. As one of the most common geriatric syndromes, malnutrition in the elderly is a significant risk factor for poor clinical outcomes, causing a massive burden on medical resources and society. The risk factors for malnutrition in the elderly are diverse and include demographics, chronic diseases, and psychosocial factors. Presently, recommendations for the prevention and intervention of malnutrition in the elderly are not clear or consistent in China. This consensus is based on the latest global evidence and multiregional clinical experience in China, which aims to standardize the prevention and intervention of malnutrition in the elderly in China and improve the efficacy of clinical practice and the prognosis of elderly patients.

Diagnosis of a 65-year-old male patient with Takayasu's arteritis by 18F-FDG PET/CT.

Takayasu's arteritis (TA) is characterized by a chronic inflammatory arteriopathy with unknown etiology affecting large vessels. As TA occurs mostly in young females, elderly males with this disease may be under-diagnosed. A 65-year-old Chinese male with a 6-week history of fever, fatigue, low appetite, night sweats, and a 5-kg weight loss did not experience symptoms of jaw claudication, localized headache, sudden visual change, upper or lower extremity claudication, arthralgia, and rashes. On physical examination and laboratory findings, there was no evidence of infectious disease or malignancy. (18)F-Fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) was performed which suggested TA. The patient was treated with methylprednisolone and clopidogrel. His symptoms subsided gradually and hematological examination showed decreases of erythrocyte sedimentation rate and high-sensitivity C-reactive protein. We reported here a patient who presented with fever of unknown origin and was diagnosed with TA using PET/CT. Although elderly males are beyond the predominant population of TA, TA should be considered when there is no evidence of infectious disease and malignancy.

Association Between Metabolic Syndrome and Peripheral Arterial Disease in Elderly Patients with Type 2 Diabetes.

BACKGROUND: Peripheral artery disease (PAD) is a manifestation of atherosclerotic cardiovascular disease (ASCVD) and significantly increases the risk of myocardial infarction and stroke. As most patients with PAD are asymptomatic, this condition is largely neglected in clinical practice. Type 2 diabetes (T2DM) patients have higher prevalence of PAD. Therefore, early detection and intervention of diabetic PAD are very important. Metabolic syndrome (MetS) is a group of interrelated metabolic risk factors, a predictor of poor prognosis in elderly patients with ASCVD. Recently, many of the metabolic risk factors as well as the overall concept of MetS itself have sparked a great deal of debate regarding their precise roles in PAD. OBJECTIVE: To evaluate the relationship between metabolic syndrome (MetS) and peripheral arterial disease (PAD) in elderly patients with type 2 diabetes (T2DM). METHODS: Two hundred and eighty-one elderly T2DM patients admitted to Beijing Tongren Hospital from October 2016 to December 2017 were divided into PAD group (n=136) and non-PAD (NPAD) group (n=145). Their medical records, physical examination parameters and laboratory testing parameters were later recorded and analyzed by multivariate logistic regression analysis. RESULTS: No significant difference was detected in general clinical data and laboratory testing parameters between the two groups (P>0.05). The incidence of MetS was significantly higher in PAD group than in NPAD group (88.2% vs 70.3%, P=0.001). Multivariate logistic regression analysis showed that the risk of PAD was 1.762-fold higher in MetS patients after adjustment for age, sex, history of smoking and alcohol consumption, WC, SBP, serum TC and HbA1c level, eGFR and duration of DM (95% CI: 1.205-6.330, P=0.016). CONCLUSION: MetS closely correlates with PAD in elderly T2DM patients, though no significant difference has been detected in their metabolic indicators.

Proliferative diabetic retinopathy in patients with type 2 diabetes correlates with the presence of atherosclerosis cardiovascular disease.

BACKGROUND: Atherosclerosis cardiovascular disease (ASCVD) is the main cause of morbidity and mortality in type 2 diabetes mellitus (T2DM). As most diabetic patients with ASCVD are asymptomatic, it is most neglected in clinical practice. For this reason, identifying high-risk ASCVD population with intensified treatment is very important. In recent years, the relationship between diabetic retinopathy (DR) and ASCVD has caused much academic concern, but the results are inconsistent. Moreover, whether all grades of DR increase the risk of ASCVD remains controversial. Most importantly, very few data can be found in China. OBJECTIVE: Our aim is to discuss whether all grades of DR increase the risk of ASCVD after adjustment for the traditional cardiovascular risk factors and to assess the independent contribution of DR to cardiovascular events in patients with T2DM, hoping to provide more evidence for early identification of ASCVD. RESEARCH DESIGN AND METHODS: A total of 425 T2DM patients with complete physical and biochemical data were included in the study. The grade of DR was assessed with two 45 color digital retinal images. Based on the presence of history of ASCVD, 425 T2DM patients were divided into 2 groups: ASCVD group and non-ASCVD group. RESULTS: ASCVD patients were older and had a significantly higher fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) and proportion of history of ASCVD. At the same time, they were more likely to be females, and had lower level of alcohol and calculated glomerular filtration rate (eGFR) than non-ASCVD patients. Their trend to develop DR with ASCVD was significantly higher than patients with non-ASCVD (χ2 = 5.805, P  = 0.016). DR was an independent statistical indicator of the presence of ASCVD [odds ratio (OR) (95% CI): 2.321 (1.152-4.678), P = 0.018]. Furthermore, when DR was divided into non-proliferative retinopathy (NPDR) and proliferative retinopathy (PDR) according to its severity, only PDR was significantly associated with incident ASCVD [OR (95% CI): 8.333 (1.813-38.304), P = 0.006]. After adjusting for traditional ASCVD risk factors, such an association still existed [OR (95% CI): 7.466 (1.355-41.137), P = 0.021]. CONCLUSION: DR associates strongly with ASCVD in the Chinese population with T2DM. With the increasing severity of DR, the risk of ASCVD also increases. After adjustment for traditional risk factors, PDR is still an independent risk marker for ASCVD.

Workplace violence against frontline clinicians in emergency departments during the COVID-19 pandemic.

BACKGROUND: Frontline clinicians working in emergency departments (ED) were at disportionate risk of workplace violence (WPV). We investigated the prevalence of WPV and its relationship with quality of life (QOL) in this group of health professionals in China during the COVID-19 pandemic. METHODS: A cross-sectional, online study was conducted. The nine-item Workplace Violence Scale measured WPV. RESULTS: A total of 1,103 ED clinicians participated in this study. The overall prevalence of WPV against ED clinicians was 29.2% (95% CI [26.5%-31.9%]). Having family/friends/colleagues infected with COVID-19 (Odds Ratio (OR) = 1.82, P = 0.01), current smoking (OR = 2.98, P < 0.01) and severity of anxiety symptoms (OR = 1.08, P < 0.01) were independently and positively associated with WPV, while working in emergency intensive care units (OR = 0.45, P < 0.01) was negatively associated with WPV. After controlling for covariates, clinicians experiencing WPV had a lower global QOL compared to those without (F(1, 1103) = 10.9,P < 0.01). CONCLUSIONS: Prevalence of workplace violence against ED clinicians was common in China during the COVID-19 pandemic. Due to the negative impact of WPV on QOL and quality of care, timely preventive measures should be undertaken for ED clinicians.