Living experience and care needs of Chinese empty-nest elderly people in urban communities in Beijing,China:A qualitative study

Background:Empty-nest elders have considerable needs for daily living,health care,and social support in China.The growing need for care of an aging population requires to be met through adequate policy decision making by government.Aim:To explore care needs of Chinese empty-nest elderly people and to provide reference information for relevant authorities in making care-supporting policies.Method:A descriptive qualitative study design was adopted.Twenty-five senior citizens in urban communities who were not living with their children were recruited from three communities in different districts of Beijing.In-depth interviews with a semi-structured questionnaire were used to collect data.A qualitative content analysis method was used to analyze data.Results:A major care need by the empty-nest elderly was home-based care.In view of their physical condition,need of support and their own security problems,they would like to have aging-in-place,home-based care by housemaid employment,or have institutionalized care in the future.However,they had some concerns about institutionalized care.Conclusions:A combination of home-based and community-based care is a suitable mode of care for the empty-nest elderly,and institutionalized care is an expected supplementary form of care.

A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension： a cross-sectional study

Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients （age 79.5 ＋ 6.7 years, male 63.8%） were recruited to the study. Comprehensive geriatric assessment （CGA）, including measurements about activity of daily living （ADL）, nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti perform- ance oriented mobility assessment （POMA） and history of fall in the recent years. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index （BMI）, and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease （COPD）, cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile （P 〈 0.01 T3 vs. T1, P 〈 0.01 T3 vs. T2）. Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale （P 〈 0.001）, as well as CGA and POMA （P 〈 0.001）. Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL im- pairment （OR： 2.748, 95%CI： 1.598-4.725）, （OR： 3.310, 95%CI： 1.893-5.788）. Decreased Tinetti POMA score was associated with Mini-Mental State Examination （MMSE） （OR： 4.035, 95%CI： 2.100-7.751）, ADL （OR： 2.380, 95%CI： 1.357-4.175） and shortened MNA form （MNA-SF） impairment （OR： 2.692, 95%CI： 1.147-6.319）. Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effec- tive interventions.

Empty-nest elderly:mahjong and Chinese square dance for improving the cognitive function in the community

Objective: The elderly population has proliferated worldwide. The empty-nest family pattern has become predominant among the aging people, and they are more vulnerable to the development of cognitive disorders. However, there is no standardized service in the community nursing care that includes procedures on how to improve the cognitive function of the elderly. Meanwhile, the booming number of empty-nest elderly stimulates the community nurses to assume the responsibility for their care. All of these bring more difficulties and opportunities for community nurses who are dedicated to the prevention of geriatric cognitive disorders.Methods: The authors reviewed the literature related to "empty-nest elderly", "cognitive function","mahjong",and "Chinese square dance" in the Elsevier, Web of Science(WOS), China National Knowledge Infrastructure(CNKI), Springer and PubMed databases. The study illustrates the utility possibility of an efficient and straightforward method for improving the cognitive function among the elderly in the context of community nursing care in China and even in the rest of the world.Results: Mental and physical activity contributes to cognitive fitness and may be beneficial in delaying cognitive decline. Mental activities, such as playing mahjong, and physical activities, such as the Chinese square dance, are common Chinese activities. Both of them can affect cognitive function in some way.Conclusions: China is experiencing one of its most severe aging problems. Community health personnel and related professionals may consider using mahjong and Chinese square dance to promote psychological health in empty-nest elderly individuals in the community.

Factors associated with activities of daily living among the disabled elders with stroke

Objective:To determine the factors associated with activities of daily living(ADL)among the disabled elders post-stroke.Methods:A total of 158 patients were chosen from community health service stations in eighteen regions of Tianjin city by convenience sampling from March to November in 2013.The Barthel Index(BI)and the short-formmini-nutritional assessment(MNA-SF)were used to evaluate the ADL,the nutritional status respectively.Statistical analysis was performed using independent sample t-test,one-way ANOVA,Pearson correlation and multiple linear regression analysis.Barthel ADL index was the main outcome.Results:The mean score of ADL was 50.50±27.125.The multiple linear regression showed that the factors which had significant impact on ADL were stroke frequency,types of stroke,nutritional status,financial status,and age.Conclusions:Disabled elders with recurrent strokes,hemorrhagic stroke,dependent financial resources,older age,worse nutritional status and living with family had poorer strokerelated outcome.Healthcare providers can discover the high-risk groups of disability and implement individualized preventive interventions in accordance with the related factors.

Analysis on Long-Term Care and Influencing Factors of Empty-Nest Differently Abled Elderly People in China —Based on the Data from the Chinese Longitudinal Healthy Longevity Survey

Purpose: This study aimed to understand the actual needs of empty-nest differently abled elderly people and analyze their long-term care status including the factors affecting choice of care mode so adequate resources can be allocated to meet their healthcare needs. Methods: An empty-nest group was compared with a non-empty-nest group based on data from the 2014 Chinese Longitudinal Healthy Longevity Survey. Individual characteristics, family characteristics, and sociological factors were considered as independent variables, and long-term care model was the dependent variable in the three binary logistic regression method. Results: Age, gender, marriage, and disability were the most important factors influencing the choice of long-term care mode, including the willingness of the differently abled elderly. Family care can no longer meet the needs of the severely disabled elderly. Long-term care for such elderly people should be undertaken by professional and specialized social institutions. Conclusion: Multi-level services should be provided according to the elderly peoples’ needs, and the skill and expertise of professional personnel of care institutions should be strengthened. The government should deploy fund-raising initiatives, actively use the power of non-governmental organizations, and strive to resolve the financial issues faced by the empty-nested elderly people with disability.

Comparative study on ghrelin level change and its related factors in hypertensive elders with psychological distress

Objective To investigate the change of plasma ghrelin level and explore the related factors of ghrelin alteration in elderly hypertensive patients with psychological distress.Methods A total of 300 elders,who were screened with Hamilton Anxiety Scale(HAMA),Hamilton Rating Scale for Depression(HAMD),and the Symptom Checklist-90(SCL-90)for psychological stress and somato-psychological manifestations respectively,were divided into hypertension group(n=148)and non-hypertension group(n=152).Their blood samples were collected to measure the plasma level of ghrelin and total cortisol on the same day.Results The incidences of anxiety and depression were 27.7% and 11.7%,respectively,in all the enrolled elders.However,the rates of psychological distress,particularly anxiety,were significantly higher in the hypertensive elders than in the non-hypertensive ones(43.2% vs.12.5%).Anxiety was positively related to the cortisol level but negatively related to the plasma ghrelin level,and the latter two were negatively correlated with each other.Conclusion Chronic increase of plasma cortisol induced by long-term anxiety can lead to the reduction of ghrelin level,which then adversely affects blood pressure in elders with psychological distress.Therefore,ghrelin might be a selective antihypertensive medicine for hypertensive elders with anxiety.

Subjective Well-Being among Empty-Nest Elderly and Its Related Factors:Taking Guangdong Province as an Example

Objective:To explore the the status of happiness and social support of empty nesters in Guangdong Province and analyze the relationship between the above two variables.Method:Totally 1148 empty nesters(776 males,734 females)from 5 cities in Guangdong province are selected by stratified random sampling and conducted with Memorial University of Newfoundland Scale of Happiness(MUNSH),Social Support Rating Scale(SSRS),Mini-Mental State Examination(MMSE)and a self-edited questionnaire on the general information.Results:The total score of MUNSH is(10.20±6.37).The total score and the scores of the 3 dimensions of objective support,subject support,the use of support in SSRS are(30.79±5.51),(9.24±2.37),(19.38±4.95)and(9.22±2.15)respectively.Multiple variable linear regression show that are positively associated with the total scores of MUNSH(B=.227,.115,.098,.158,.082,respectively,P<.05).was negatively associated with total score of MUNSH(B=-.097,P<.05).Conclusion:It suggests that the sort of leisure,gender,progress rank,family characteristics,such as family economic condition and father’s career may be related factors of undergraduates life satisfaction.

Clinical use of low-dose aspirin for elders and sensitive subjects

The use of low-dose aspirin(LDA)has been a common preventive measure to reduce the risk of cardiovascular events.This is attributed to aspirin’s ability to inhibit platelet activation.On the other hand,the use of LDA in human subjects has been associated with the development of gastrointestinal injuries like ulcer and bleeding,especially for those sensitive subjects such as elder human subjects.This opinion review will summarize the recent clinical reports regarding the use of LDA and the development of gastrointestinal conditions in China.Based on these reports,it seems that the use of LDA is commonly associated with gastrointestinal injuries,and stopping its use leads to recovery in elderly subjects.Therefore,we would like to suggest that gastroduodenal health and conditions should be seriously taken into consideration when LDA is recommended to the elderly,or other alternative means to reduce the risk of cardiovascular events such as nutritional interventions should be suggested.

Situational Diagnosis of the Social Sphere of Elders Living in Retirement Homes

A situational diagnosis of the social sphere of elder permanent residents at retirement homes in Chihuahua City was created with the aid of the Social Resource Scale instrument. From the 51 participants, there were 30 female and 21 male elders. The results and conclusions of the present study highlight two major needs: a systematic assessment of permanent residents in retirement homes and the implementation of a physical activation program. The proposed physical activation program must focus on both, the recovery of motor independence and the increase of socialization activities which allows members of the retired community to improve their daily routine performance and lessens the work load on their caretakers.

Detecting Dementia-Related Wandering Locomotion of Elders by Leveraging Active Infrared Sensors

For elders with dementia, wandering is among the most problematic, frequent and dangerous behavior. Managing wandering behavior has become increasingly imperative due to its high prevalence, negative outcomes and burden on caregivers. We study to propose an active infrared-based method to identify wandering locomotion by monitoring rhythmical repetition of an elder’s indoor motion events. Specifically, we utilize our customized active infrared sensors to collect human indoor motions that will be converted into motion events by using hardware redundancy technique. Each motion event is a directed motion obtained via introducing temporal and dimensions into the spatial motion data. Based on the most cited spatial-temporal patterns of wandering locomotion, a spatiotemporal model is then proposed to identify wandering locomotion from an ongoing sequence of motion events. Experimental evaluation on eight individuals’ real-world motion datasets has shown that our proposed method is able to effectively identify wandering locomotion from repetitive events collected from active infrared sensors with a value over 98% for both accuracy and precision based on properly chosen parameters. Wandering in elders with dementia that follow specific spatiotemporal patterns can be reliably identified by analyzing repetitive motion events collected from active infrared sensors based on the well-known spatiotemporal patterns of wandering locomotion.

Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients?

BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with GC.METHODS The PubMed,EMBASE,and Cochrane Library databases were used to search for eligible studies from inception to April 1,2023.The mean difference(MD),odds ratio(OR)and 95%confidence interval(95%CI)were pooled for analysis.The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores.We used Stata(V.16.0)software for data analysis.RESULTS This study consists of six studies involving 878 elderly patients.By analyzing the clinical outcomes,we found that the ERAS group had shorter postoperative hospital stays(MD=-0.51,I2=0.00%,95%CI=-0.72 to-0.30,P=0.00);earlier times to first flatus(defecation;MD=-0.30,I²=0.00%,95%CI=-0.55 to-0.06,P=0.02);less intestinal obstruction(OR=3.24,I2=0.00%,95%CI=1.07 to 9.78,P=0.04);less nausea and vomiting(OR=4.07,I2=0.00%,95%CI=1.29 to 12.84,P=0.02);and less gastric retention(OR=5.69,I2=2.46%,95%CI=2.00 to 16.20,P=0.00).Our results showed that the conventional group had a greater mortality rate than the ERAS group(OR=0.24,I2=0.00%,95%CI=0.07 to 0.84,P=0.03).However,there was no statistically significant difference in major complications between the ERAS group and the conventional group(OR=0.67,I2=0.00%,95%CI=0.38 to 1.18,P=0.16).CONCLUSION Compared to those with conventional recovery,elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.

The prevalence of depression among the empty-nest elderly in China:a meta-analysis of cross-sectional studies

Empty-nest elderly are those who have no children or whose children are away from home,and they have to live alone or with their spouses.The prevalence of depression in the elderly is worrying,especially in the empty-nest elderly.This study aimed to examine the prevalence of depression among the empty-nest elderly in China and explore the factors that influence depression among the empty-nest elderly.Methods:We searched both international(PubMed,Cochrane Library,Embase,and Web of Science)and Chinese(CNKI,WanFang,SinoMed,and VIP)databases from their inception date until 12 April,2020,and collected cross-sectional studies on the prevalence of depression among the empty-nest elderly in China.Two reviewers independently screened the literature,extracted the data,and evaluated the risk of bias included in the study.Meta-analysis was performed using Stata12.0 software.Results:Twenty-seven cross-sectional studies were included in the meta-analysis.The pooled prevalence of depression among the empty-nest elderly in China was 41%(95%CI:32%–50%).Subgroup analysis revealed that the Geriatric Depression Scale versions,sampling methods,living areas,gender,age,chronic diseases,and living arrangements were associated with the prevalence of depression among the empty-nest elderly in China.Conclusions:The prevalence of depression among the empty-nest elderly in China was relatively high.Researchers could explore more reasons for the differences in the prevalence of depression among the empty-nest elderly from multiple perspectives in the future.Relevant departments should identify and routinely evaluate the negative emotions of the empty-nest elderly.Meanwhile,community nurses should care for the emotional needs of the empty-nest elderly,carry out targeted mental health education,and promote the realization of healthy aging.

Subpopulations of regulatory T cells are associated with subclinical atherosclerotic plaques,levels of LDL,and cardiorespiratory fitness in the elderly

Background:Atherosclerosis forms the pathological basis for the development of cardiovascular disease.Since pathological processes initially develop without clinically relevant symptoms,the identification of early markers in the subclinical stage plays an important role for initiating early interventions.There is evidence that regulatory T cells(Tregs)are involved in the development of atherosclerosis.Therefore,the present study aimed to identify and investigate associations with Tregs and their subsets in a cohort of healthy elderly individuals with and without subclinical atherosclerotic plaques(SAP).In addition,various lifestyle and risk factors,such as cardiorespiratory fitness,were investigated as associated signatures.Methods:A cross-sectional study was performed in 79 participants(male:n=50;age=63.6±3.7 years;body mass index=24.9±3.1 kg/m2;mean±SD)who had no previous diagnosis of chronic disease and were not taking medication.Ultrasound of the carotids to identify SAP,cardiovascular function measurement for vascular assessment and a cardiorespiratory fitness test to determine peak oxygen uptake were performed.Additionally,tests were conducted to assess blood lipids and determine glucose levels.Immunophenotyping of Tregs and their subtypes(resting(rTregs)and effector/memory(mTregs))was performed by 8-chanel flow cytometry.Participants were categorized according to atherosclerotic plaque status.Linear and logistic regression models were used to analyze associations between parameters.Results:SAP was detected in a total of 29 participants.The participants with plaque were older(64.8±3.6 years vs.62.9±3.5 years)and had higher peripheral systolic blood pressure(133.8±14.7 mmHg vs.125.8±10.9 mmHg).The participants with SAP were characterized by a lower percentage of rTregs(28.8%±10.7%vs.34.6%±10.7%)and a higher percentage of mTregs(40.3%±14.7%vs.30.0%±11.9%).Multiple logistic regression identified age(odds ratio(OR)=1.20(95%confidence interval(95%CI):1.011.42))and mTregs(OR=1.05(95%CI:1.021.10))as independent risk factors for SAP.Stepwise linear regression could reveal an association of peak oxygen uptake(β=0.441),low-density lipoprotein(LDL)(β=0.096),and SAP(β=6.733)with mTregs and LDL(β=0.104)with rTregs.Conclusion:While at an early stage of SAP,the total proportion of Tregs gives no indication of vascular changes,this is indicated by a shift in the Treg subgroups.Factors such as serum LDL or cardiopulmonary fitness may be associated with this shift and may also be additional diagnostic indicators.This could be used to initiate lifestyle-based preventive measures at an early stage,which may have a protective effect against disease progression.

Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique

BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbalance.

Prevalence and risk factors of diabetes mellitus among elderly patients in the Lugu community

BACKGROUND Age is a significant risk factor of diabetes mellitus(DM).With the develop of population aging,the incidence of DM remains increasing.Understanding the epidemiology of DM among elderly individuals in a certain area contributes to the DM interventions for the local elderly individuals with high risk of DM.AIM To explore the prevalence of DM among elderly individuals in the Lugu community and analyze the related risk factors to provide a valid scientific basis for the health management of elderly individuals.METHODS A total of 4816 elderly people who came to the community for physical examination were retrospectively analyzed.The prevalence of DM among the elderly was calculated.The individuals were divided into a DM group and a non-DM group according to the diagnosis of DM to compare the differences in diastolic blood pressure(DBP)and systolic blood pressure(SBP),fasting blood glucose,body mass index(BMI),waist-to-hip ratio(WHR)and incidence of hypertension(HT),coronary heart disease(CHD),and chronic kidney disease(CKD).RESULTS DM was diagnosed in 32.70%of the 4816 elderly people.The BMI of the DM group(25.16±3.35)was greater than that of the non-DM group(24.61±3.78).The WHR was 0.90±0.04 in the non-DM group and 0.90±0.03 in the DM group,with no significant difference.The left SBP and SBP in the DM group were 137.9 mmHg±11.92 mmHg and 69.95 mmHg±7.75 mmHg,respectively,while they were 126.6 mmHg±12.44 mmHg and 71.15 mmHg±12.55 mmHg,respectively,in the non-DM group.These findings indicate higher SBP and lower DBP in DM patients than in those without DM.In the DM group,1274 patients were diagnosed with HT,accounting for 80.89%.Among the 3241 non-DM patients,1743(53.78%)were hypertensive and 1498(46.22%)were nonhypertensive.The DM group had more cases of HT than did the non-DM group.There were more patients with CHD or CKD in the DM group than in the non-DM group.There were more patients who drank alcohol more frequently(≥3 times)in the DM group than in the non-DM group.CONCLUSION Older adults in the Lugu community are at a greater risk of DM.In elderly individuals,DM is closely related to high BMI and HT,CHD,and CKD.Physical examinations should be actively carried out for elderly people to determine their BMI,SBP,DBP,and other signs,and sufficient attention should be given to abnormalities in the above signs before further diagnosis.

Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and metaanalysis

BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between frailty and the outcomes,such as in-hospital complic-ations,post-procedural complications,and mortality,in elderly patients post-PCI.METHODS The PubMed/MEDLINE,EMBASE,Cochrane Library,and Web of Science databases were screened for publications up to August 2023.The primary outcomes assessed were in-hospital and all-cause mortality,major adverse cardiovascular events(MACEs),and major bleeding.The Newcastle-Ottawa Scale was used for quality assessment.RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included.Frailty was consistently associated with adverse outcomes.Frail patients had significantly higher risks of in-hospital mortality[risk ratio:3.45,95%confidence interval(95%CI):1.90-6.25],all-cause mortality[hazard ratio(HR):2.08,95%CI:1.78-2.43],MACEs(HR:2.92,95%CI:1.85-4.60),and major bleeding(HR:4.60,95%CI:2.89-7.32)compared to non-frail patients.CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality,development of MACEs,and major bleeding in elderly individuals undergoing percutaneous coronary intervention.

Gastrointestinal discomforts and dietary intake in Chinese urban elders:A cross-sectional study in eight cities of China

BACKGROUND Gastrointestinal(GI)discomforts are common in the elderly population;however,whether such discomforts are associated with dietary intake has not been studied.AIM To evaluate GI discomforts in Chinese urban elders and the associated factors.METHODS The gastrointestinal symptom rating scale(GSRS)was used to identify GI discomforts in 688 elders from eight cities of China.The semi-quantitative food frequency questionnaire and one time of 24 h dietary recall were used to access the food intake,identify dietary pattern,and calculate the nutrients intake.RESULTS About 83%of studied elders experienced at least one of GI discomforts in the past 6 mo;dyspepsia was the most commonly reported(66.7%),followed by reflux(44.8%),abdominal pain(35.9%),constipation(35.8%),and diarrhea(34.7%).Female gender,lower education level,and lower family income were associated with a higher GSRS score.Participants who were diagnosed with a GI-related disease had a higher score of constipation,but a lower score of reflux.Chronic diseases were positively associated with certain GI discomforts.Three dietary patterns were identified by the method of principal component analysis,which were characterized as high intake of salt and tea;more frequent intake of tubers,fruits,aquatic products,and soybeans;and high intake of cereal,vegetables,and meat,respectively.However,no associations between dietary patterns and GSRS score were found.The elders with a higher GSRS score had significantly lower intake of bean products.The elders whose GSRS score was≥21 and 18-20 decreased their bean production intake by 7.2(0.3,14.3)g/d and 14.3(1.2,27.3)g/d,respectively,compared with those who had a GSRS score≤17.There were no differences in other food categories,calories,or nutrients intake among elders with different GSRS scores.CONCLUSION GI discomforts are common in Chinese urban elders.GI discomforts might be associated with the choice of food.

Efficacy and safety of endoscopic submucosal dissection for early gastric cancer and precancerous lesions in elderly patients

BACKGROUND With advancements in the development of endoscopic technologies,the endo-scopic submucosal dissection(ESD)has been one of the gold-standard therapies for early gastric cancer.AIM To investigate the efficacy and safety ESD in the treatment of early gastric cancer and precancerous lesions in the elderly patients.METHODS Seventy-eight elderly patients with early gastric cancer and precancerous lesions admitted to the Third Affiliated Hospital of Qiqihar Medical University were se-lected and classified into two groups according to the different surgical therapies they received between January 2021 and June 2022.Among them,39 patients treated with ESD were included in an experimental group,and 39 patients treated with endoscopic mucosal resection(EMR)were included in a control group.We compared the basic intraoperative conditions,postoperative short-term recovery,long-term recovery effects and functional status of gastric mucosa between the two groups;the basic intraoperative conditions included lesion resection,intra-operative bleeding and operation time;the postoperative short-term recovery assessment indexes were length of hospital stay and incidence of surgical complic-ations;and the long-term recovery assessment indexes were the recurrence rate at 1 year postoperatively and the survival situation at 1 year and 3 years postoper-atively;and we compared the preoperative and predischarge serum pepsinogen I(PG I)and PG II levels and PG I/PG II ratio in the two groups before surgery and discharge.RESULTS The curative resection rate and the rate of en bloc resection were higher in the experimental group than in the control group.The intraoperative bleeding volume was higher in the experimental group than in the control group.The operation time was longer in the experimental group than that in the control group,and the rate for base residual focus was lower in the experimental group than that of the control group,and the differences were all statistically significant(all P<0.05).The length of hospital stay was longer in the experi-mental group than in the control group,and the incidence of surgical complications,1-year postoperative recu-rrence rate and 3-year postoperative survival rate were lower in the experimental group than in the control group,and the differences were statistically significant(all P<0.05).However,the difference in the 1-year postoperative survival rate was not statistically significant between the two groups(P>0.05).Before discharge,PG I and PG I/PG II ratio were elevated in both groups compared with the preoperative period,and the above indexes were higher in the experimental group than those in the control group,and the differences were statistically significant(both P<0.05).Moreover,before discharge,PG II level was lower in both groups compared with the preoperative period,and the level was lower in the experimental group than in the control group,and the differences were all statistically significant(all P<0.05).CONCLUSION Compared with EMR,ESD surgery is more thorough.It reduces the rate of base residual focus,recurrence rate,surgical complications,and promotes the recovery of gastric cells and glandular function.It is safe and suitable for clinical application.

Role of ghrelin in cognitive impairment of hypertensive elders with chronic psychological distress

Objective:To investigate ghrelin level change in combination with psychological stress in the hypertensive old people with cognitive impairment and to explore its effect as well as possible mechanism.Methods:The study population of 300 elders was divided into 2 groups,148 with hypertension and 152 non-hypertension,who were screened for psychological distress and cognition function,and had blood drawn to measure plasma levels of ghrelin and total cortisol on the same day.Results:The rates of anxiety and cognitive impairment were higher in the hypertension elders,which were negatively correlated with plasma ghrelin level,resulted from chronic cortisol response to anxiety.Conclusion:Chronic plasma cortisol increase to long-term anxiety leads a reduce in ghrelin level which then adversely affects blood pressure and cognitive function in old people.So measuring ghrelin of elders may be a diagnostic tool to predict cognitive development and ghrelin may be a selective antihypertensive medicine for cognitive impairment elders with or without chronic psychological stress.

Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.