Cirrhotic patients and older people

The global population is aging,and so the number of older cirrhotic patients is increasing.Older patients are characterised by a risk of frailty and comorbidities,and age is a risk factor for mortality in cirrhotic patients.The incidence of nonalcoholic fatty liver disease as an aetiology of cirrhosis is increasing,while that of chronic viral hepatitis is decreasing.Also,cirrhosis is frequently idiopathic.The management of portal hypertension in older cirrhotic patients is similar to that in younger patients,despite the greater risk of treatment-related adverse events of the former.The prevalence of hepatocellular carcinoma increases with age,but its treatment is unaffected.Liver transplantation is generally recommended for patients<70 years of age.Despite the increasing prevalence of cirrhosis in older people,little data are available and few recommendations have been proposed.This review suggests that comorbidities have a considerable impact on older cirrhotic patients.

Hierarchical Linear Model Approach to the Determinants of Activities of Daily Living of Chinese Oldest Old at Both Individual and Regional levels

Based on the Chinese longitudinal healthy longevity survey conducted in 2002, this paper uses hierarchical linear model (HLM) to make an approach to the possible determinants of activities of daily living (ADL) of Chinese oldest old (aged 80 and above) by combining both individual and provincial level factors. The descriptive analysis shows that there is a great differ- ential in ADL by province among Chinese oldest old. The findings turn out that there does exist a significant differential in ADL between oldest old and young old, and that there is also a great differential in ADL by province among Chinese oldest old. The HLM demonstrates that comorbidity, age, cognitive impairment, visual impairment, and emotion could be the most important indi- vidual factors while natural environment, medical facilities, type of staple food and poverty rate in urban areas are the most sig- nificantly regional determinants of ADL of oldest old. The find- ings imply that future actions should not only be taken at individ- ual level, but also at regional level in order to achieve the goal of a healthy aging society in China.

Delirium,insulin-like growth factor I,growth hormone in older inpatients

BACKGROUND Delirium is a common disorder in elderly medical inpatients with serious adverse outcomes and is characterized by sudden onset,disturbance in attention,awareness,consciousness and cognition,and often with behavioural disturbances.Central to understanding delirium,is understanding mechanisms by which body and brain wellbeing are linked and in particular how brain responses to bodily homeostatic stress is mediated.A number of studies have investigated the relationship between insulin-like growth factor I(IGF-I)and delirium in medically ill hospitalised patients with conflicting results.However,none have investigated growth hormone(GH)which is related to IGF-I via negative feedback.AIM To investigate the relationship between serum levels of IGF-I and GH,and the occurrence of delirium.METHODS Prospective,longitudinal,observational study.Consecutive elderly inpatients(aged 70+),were assessed twice weekly with Montreal cognitive assessment(MoCA),Confusion assessment method(CAM),Acute Physiology and Chronic Health Evaluation II.Delirium was defined using CAM.Previous history of dementia was evaluated with the Informant Questionnaire on Cognitive Decline in the Elderly.IGF-I and GH levels were estimated with the ELISA method.Generalized estimating equations(GEE)model was applied for the first five assessments to analyze those longitudinal data.RESULTS The sample consisted of 198 participants(mean age 80.63±6.81;range 70-97).Of these 92(46.5%)were females.Eighty six(43.4%)were identified with a history of dementia.Incident or prevalent delirium during hospitalisation was identified with CAM in 40 participants(20.2%).Evaluation of missing values with Little's MCAR test indicated that they were missing completely at random(MCARχ2=12.24,u:9,P=0.20).Using GEE for the analysis we found that low MoCA scores,low levels of IGF-I and high levels of GH were significantly associated with any delirium(prevalence,incident,or fluctuating,during the study period(Waldχ2=12.231;u:1,P<0.001,Waldχ2=7.196,u:1,P=0.007,Waldχ2=6.210;:u:1,P=0.013 respectively).CONCLUSION The results show that low levels of IGF-I,high levels of GH and low scores in cognition are independently associated with the occurrence of any delirium during the hospitalisation of medically ill older people.The results of the study supports the hypothesis that deficits in the immunoreactivity of the brain(low cerebral reserve)may be associated with delirium.

Nephroprevention in the oldest old with chronic kidney disease:Special considerations

Nephroprevention strategies are crucial for handling chronic kidney disease(CKD) complications, and slowing its progression. However, these preventative measures should be guided by major geriatrics principles in order to help nephrologists to adequately handle the oldest old with CKD. These geriatric concepts consist of taking into account the relevance of choosing an individualized therapy, handling clinical frailty, and keeping a geriatric perspective which means that a good quality of life is sometimes a more important therapeutic objective inoctogenarians than merely prolonging life. Even though nephroprevention strategies for treating the oldest old with CKD are basically similar to those applied to younger patients such as low sodium and protein diet, optimized hemoglobin levels, blood pressure and metabolic control, the treating physician or care provider must at all times be ready to make fundamental adjustments and tweak patient care paradigms and objectives if and when the initial therapeutic options applied have caused unintended clinical consequences and complications. Additionally, the sarcopenia status should also be evaluated and treated in very old CKD patients.

Creatinine, urea, uric acid, water and electrolytes renal handling in the healthy oldest old

Renal physiology in the healthy oldest old has the fol-lowing characteristics, in comparison with the renal physiology in the young： a reduced creatinine clear-ance, tubular pattern of creatinine back-fltration, pre-served proximal tubule sodium reabsorption and uric acid secretion, reduced sodium reabsorption in the thick ascending loop of Henle, reduced free water clear-ance, increased urea excretion, presence of medulla hypotonicity, reduced urinary dilution and concentra-tion capabilities, and fnally a reduced collecting tubules response to furosemide which expresses a reduced potassium excretion in this segment due to a sort of aldosterone resistance. All physiological changes of the aged kidney are the same in both genders.

Exercise interventions for older adults: A systematic review of meta-analyses

Background:The evidence concerning which physical exercise characteristics are most effective for older adults is fragmented.We aimed to characterize the extent of this diversity and inconsistency and identify future directions for research by undertaking a systematic review of metaanalyses of exercise interventions in older adults.Methods:We searched the Cochrane Database of Systematic Reviews,PsycInfo,MEDLINE,Embase,CINAHL,AMED,SPORTDiscus,and Web of Science for articles that met the following criteria:(1)meta-analyses that synthesized measures of improvement(e.g.,effect sizes)on any outcome identified in studies of exercise interventions;(2)participants in the studies meta-analyzed were adults aged 65+or had a mean age of 70+;(3)meta-analyses that included studies of any type of exercise,including its duration,frequency,intensity,and mode of delivery;(4)interventions that included multiple components(e.g.,exercise and cognitive stimulation),with effect sizes that were computed separately for the exercise component;and(5)meta-analyses that were published in any year or language.The characteristics of the reviews,of the interventions,and of the parameters improved through exercise were reported through narrative synthesis.Identification of the interventions linked to the largest improvements was carried out by identifying the highest values for improvement recorded across the reviews.The study included 56 meta-analyses that were heterogeneous in relation to population,sample size,settings,outcomes,and intervention characteristics.Results:The largest effect sizes for improvement were found for resistance training,meditative movement interventions,and exercise-based active videogames.Conclusion:The review identified important gaps in research,including a lack of studies investigating the benefits of group interventions,the characteristics of professionals delivering the interventions associated with better outcomes,and the impact of motivational strategies and of significant others(e.g.,carers)on intervention delivery and outcomes.

Predictive clinical features of cardioembolic infarction in patients aged 85 years and older

Objective To assess predictive clinical factors of cardioembolic infarction in very old patients(85 years of age and older).Methods Prospective hospital-based stroke registry("The Sagrat Cor Hospital of Barcelona Stroke Registry")is an acute-care teaching hospital in Barcelona,Catalonia,Spain.From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period,639 were younger than 85 years of age and 317 were 85 years or older(mean age:88.9 years).Demographics,clinical characteristics,risk factors and early outcome were compared.Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses.Results In a logistic regression model based on demographics,risk factors,clinical features and complications,female gender(odds ratio[OR]=1.74,95%confidence interval[CI]:1.27–2.39),heart failure(OR=2.27,95%CI:1.46–3.56),altered consciousness(OR=1.76,95%CI:1.28–2.42),and infectious complications(OR=2.01,95%CI:1.39–2.91)were predictors of cardioembolic stroke in the oldest age group.By contrast,heavy smoking,heart valve disease,hypertension,headache,early seizures,sensory deficit,and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group.Conclusions Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.

3omorbidity and survival of patients selected for radica prostatectomy at an age of 75 years or older

Radical prostatectomy in elderly patients is controversial. To identify very old candidates for radical prostatectomy with the highest probability of long-term survival, we studied 47 consecutive men who underwent radical prostatectomy between 1992 and 2005 at an age of 75 years or older. A heuristic approach was used to search for subgroups with particularly high long-term survival. Several two-sided comorbidity measures and combinations of these measures were investigated to find classifications best identifying healthy, long-living elderly candidates for radical prostatectomy. Four of the 25 two-sided comorbidity classifications or combinations reached the significance level with hazard ratios between 4.00 and 4.80. After 10 years, patients identified as healthy patients according to these comorbidity measurements had exhibited relative survival rates between 129% and 137% and overall survival rates between 86% and 95%, whereas those with comorbidities had exhibited relative survival rates of only 66%-84% and overall survival rates of 44%-58%. In conclusion, classifying comorbidity may identify a meaningful proportion of men selected for radical prostatectomy at an age of 75 years or older with an excellent long-term survival probability superseding that of the general population.

Associations of social participation, demographic, socioeconomic and disease factors with nutritional risk in a group of older Hong Kong adults

Aims: To identify the impact of social participation, socio-demographic, socio-economic and disease factors on nutritional risk among older persons in Hong Kong. Background: Few published work has investigated the relative risks of social participation, demographic, socioeconomic and disease factors with malnutrition in community-living older people, this study is to investigate the associations of these risk factors on the nutritional status in better nutrition support for the old age group. Design: A crosssectional study. Methods: It was a secondary analysis of a database in a mobile community centre between January 2008 and December 2009. One thousand seven hundred and thirty one participants aged between 54 and 103 were collected. With 319 full Mini Nutritional Assessment (MNA) completed, the participants’ demographic, socio-economic data, diseases, and nutritional status were analyzed with relative risk and 95% confidence interval level to identify the factors that make them vulnerable to nutritional risk. Results: The prevalence of malnutrition in the community-dwelling old was 3.95% and 83.7% of the sample was at risk of malnutrition. Living on allowances, young old who was socially engaged and good relationship with family members were at less risk to malnutrition. Conclusions: Special attention should be taken to these groups as they are prone to develop malnutrition.

Personalities and health in older cat and dog owners: A HUNT-study

The aim of this population study was to identify personality traits among older (>65 years) male and female owners of cats and dogs and to compare their general health status in relation to their personality. Further, the aim was to examine whether current cat and dog ownership could be predicted by the owners’ personality and health. Data were collected from the North-Tr&#248ndelag Health Study (HUNT) in Norway. Included were a total of 1897 cat or dog owners between the ages of 65 years and 101 years. The results showed that there were a higher proportion of introverted male cat owners than extraverted ones. Moreover, a majority of women with cats reported that their health was not good. Furthermore, female cat owners who displayed higher scores on neurotic traits experienced significantly poorer health compared to those female cat owners that experienced good health. The same was true for female cat owners who considered themselves to be introverted. Neither personality nor health could predict pet-ownership, but it was more likely for older individuals (80-101 years) to own a cat than a dog. This study has shown that human personality is associated with cat and dog ownership, but there are other factors connected with pet ownership as well.

Family structure and support for the oldest old:A cross-sectional study in Dujiangyan,China

Objective:In China,adult children have traditionally provided support for their aged parents.This model of care is increasingly challenged by the decline of the extended family.Recently,China’s decades-long one-child policy has eased.We examine the association of family size and composition with family support for nonagenarians and centenarians.Methods:Data were obtained through a questionnaire survey of 619 nonagenarians and cen-tenarians in Dujiangyan and were analyzed by chi-square tests,Student t tests,and multivariate logistic regression models.Results:This study revealed that an increased number of offspring might provide financial support for older people,but this does not necessarily translate into physical and emotional care.Conclusion:It is clear that although alternative sources of support for older people are in-creasingly needed,in China the family will continue to play an important role in supporting older people.

CYCLES EMBEDDING ON FOLDED HYPERCUBES WITH FAULTY NODES

Let FFv be the set of faulty nodes in an n-dimensional folded hypercube FQn with ｜FFv｜ ≤ n - 1 and all faulty vertices are not adjacent to the same vertex. In this paper, we show that if n ≥ 4, then every edge of FQn - FFv lies on a fault-free cycle of every even length from 6 to 2n - 2｜FFv｜.

EXPAT WRITERS GONE WILD Inside Isham Cook and Tom Olden's saucy new books

Sexual misadventures in the Wild East wonderland that is the Mainland run rampant in Tom Oldens Shanghai Cocktales and Isham Cooks The Exact Unknown and Other Tales of Modern China.Wliile the subject matter may run risque,both writers say their new books' motivation isn't to shock but to document the reality that the long-term expats have lived.

碳纳米葱(OLC)与微米金刚石(MD)烧结制备纳米聚晶金刚石复合材料(nPCD)的表征分析

在4~6GPa/1000~1400℃/5~30min条件下,用微米金刚石(MD)和碳纳米葱(OLC)混合物作为原材料制备了纳米聚晶金刚石(nPCD)复合材料。采用XRD、FESEM、HRTEM、Archimedes原理和Vickers硬度计表征了nPCD复合材料的组成、形貌、微观结构、密度和硬度。研究了MD和烧结参数对nPCD复合材料的组成、微观结构、性能。结果表明,MD在nPCD复合材料中分布均匀。MD作为晶核促进OLC向金刚石的转换。烧结压力的增加提高了nPCD复合材料的密度和硬度。当烧结压力从4GPa提高到6GPa时,nPCD复合材料的密度从2.72g/cm^(3)增加到3.02g/cm^(3),硬度从41.85GPa增加到56GPa。提高烧结温度和延长保持时间使nPCD复合材料的密度和硬度先升高后降低。在nPCD复合材料中nPCD区域具有孪晶结构。孪晶结构的存在提高了nPCD复合材料的硬度。

Metabolomic-based analysis reveals bile acid-mediated ovarian failure induced by low temperature in zebrafish

As ectotherms, fish are highly sensitive to temperature fluctuations, which can profoundly impact their reproductive cycles. In this study, we investigated the fertility and histological characteristics of zebrafish(Danio rerio) ovaries exposed to a temperature gradient ranging from the thermopreferendum temperature of the species,27℃, to lower temperatures of 22℃, 20℃, and 13℃ over a period of two weeks. Comparative metabolomic(six biological replicates for each temperature) and transcriptomic(four biological replicates for each temperature) analyses were conducted under the four temperature conditions. Results indicated that lower temperatures inhibited oocyte development and differential metabolites were involved in steroid hormone production,antioxidant function, and lipid and protein catabolism.Disrupted reproductive hormones, increased proteolysis,and lipid degradation significantly impeded oocyte development and egg maturation. Notably, a significant increase in bile acid content was noted in the ovaries of the cold-treated fish, indicating that bile acids play a critical role in ovarian failure. Overall, these findings provide valuable insights into the mechanisms governing the reproductive response of fish to cold stress.

Relationship between preoperative psychological stress and shortterm prognosis in elderly patients with femoral neck fracture

BACKGROUND Older adults are at high risk of femoral neck fractures(FNFs).Elderly patients face and adapt to significant psychological burdens,resulting in different degrees of psychological stress response.Total hip replacement is the preferred treatment for FNF in elderly patients;however,some patients have poor postoperative prognoses,and the underlying mechanism is unknown.We speculated that the postoperative prognosis of elderly patients with FNF may be related to preoperative psychological stress.AIM To explore the relationship between preoperative psychological stress and the short-term prognosis of elderly patients with FNF.METHODS In this retrospective analysis,the baseline data,preoperative 90-item Symptom Checklist score,and Harris score within 6 months of surgery of 120 elderly patients with FNF who underwent total hip arthroplasty were collected.We analyzed the indicators of poor short-term postoperative prognosis and the ability of the indicators to predict poor prognosis and compared the correlation between the indicators and the Harris score.RESULTS Anxiety,depression,garden classification of FNF,cause of fracture,FNF reduction quality,and length of hospital stay were independent influencing factors for poor short-term postoperative prognoses in elderly patients with FNF(P<0.05).The areas under the curve for anxiety,depression,and length of hospital stay were 0.742,0.854,and 0.749,respectively.The sensitivities of anxiety,depression,garden classification of FNF,and prediction of the cause of fracture were 0.857,0.786,0.821,and 0.821,respectively.The specificities of depression,FNF quality reduction,and length of hospital stay were the highest at 0.880,0.783,and 0.761,respectively.Anxiety,depression,and somatization scores correlated moderately with Harris scores(r=-0.523,-0.625,and-0.554;all P<0.001).CONCLUSION Preoperative anxiety,depression,and somatization are correlated with poor short-term prognosis in elderly patients with FNF and warrant consideration.

Cognitive clarity in colon surgery: The dexmedetomidine advantage

Colon cancer is one of the most prevalent cancers globally,especially in the older age group.A large number of older patients undergoing surgery for colon cancer suffer from postoperative cognitive dysfunction(POCD).The trial by Bu et al demonstrated that dexmedetomidine(Dex)significantly reduced the incidence of POCD compared to placebo in individuals undergoing colon cancer surgery.Additionally,better cerebral oxygenation and lower cerebral injury markers were reported with the use of Dex.The trial has some limitations,such as a single-center design and a smaller sample size,and further studies with larger patient populations and robust multi-center designs are warranted to establish these findings.

Design Strategy of Street Space Micro Renewal: A Case Study of Baihuazhou District of Nanchang City

Against the backdrop of incremental planning moving towards stock planning, strengtheningurban public space design to promote high-quality urban development has become a focus of attentionfor domestic scholars. Street is a linear element of urban public space, and it is of great significance forimproving the quality of urban public space by studying the micro renewal design strategy of street space.Based on the interpretation of two urban renewal cases, Wangjing Street in Beijing and Mengzhuiwan inChengdu, taking Baihuazhou area in Nanchang City as an example, this paper analyzes the main problemsin the current situation of street space in Baihuazhou area from three aspects: space use, traffic organization,and waterfront space creation, and explores the micro renewal design strategy of the street space.

Age Identity and Elderly Job Participation in China

In the context of rising life expectancy,there is a significant discrepancy between Chinese seniors’self-perceptions of the start of old age and the expectations of society around this age.The traditional paradigm,which forecasts individual economic behavior and formulates economic policies based on societal standards of age,is put to the test by this disparity.This study,which draws from the China Longitudinal Aging Society Survey(CLASS),examines the factors,processes,and improvement strategies that affect how older people choose to work.The following are our conclusions:(i)Chinese elderly believe their old age starts from 70 years on average;delaying perceived old age is a denial of aging and raises the likelihood of finding work.Elders who are youthful at heart have a 2.4%higher chance of remaining employed than elders who are old at heart.(ii)In contrast to old-at-heart elders,young-at-heart elders are more likely to maintain their middle-age lifestyles,continue working,become motivated to engage in social activities,and gain the confidence to face challenges and continue in their career.(iii)If the perceived old age is above 70 years,the milestone event of aging is retirement from work,and there are external pressures,particularly pressures from family intergenerational support,the perception of old age will have a more proactive impact on older workers.(iv)Despite rising pension benefits,older people’s decision to remain in the workforce is still heavily influenced by their perception of their age.However,this effect is notably gender-specific,as older women’s decision to remain in the workforce is not greatly influenced by their own perception of their age.

Design Strategies and Practice Paths for Improving Urban Quality in the Stock Era

In the middle and later stages of urbanization development,the growth of the real estate industry will stagnate,and urban renewal will become the mainstream.With the advancement of urban renewal,there are still problems in improving the quality of cities in the stock era and their design strategies.This paper analyzed the Linping Old City organic renewal project and the Xishui River ecological governance project in the stock era of urban quality improvement by sorting out the current development status,historical background,planning types,and design strategies of quality improvement in the stock era from the perspective of urban renewal,combining with project overview,main problems,design methods,and design content.Urban renewal is the leading direction for promoting urban development and construction on a global scale,and countries formulate different plans and practices based on their local characteristics.Urban renewal strategies should be diversified,and focus on livable environments,urban characteristics,etc.,while considering human factors,green innovation,etc.,in order to achieve smart community management and enhance the economic and social benefits brought by urban attractiveness.For successful cases such as the Linping Old City and Xishui River ecological governance project,corresponding urban quality improvement strategies and implementation plans should be formulated according to local conditions,with emphasis on social participation and people’s livelihood improvement.This study can help urban planning pay more attention to rational utilization and upgrading of existing urban resources,adapt to the current urban development situation,and promote sustainable urban development.