Abstract:Objective To understand the perceptions of preoperative prehabilitation in elderly patients with total knee arthroplasty(TKA),and to provide a basis for the development of a preoperative prehabilitation program.Methods A to-tal of 15 elderly patients who had received preoperative prerehabilitation to TKA in the Department of Joint Orthopedics of the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from May to December 2024 were se-lected by purposition-based sampling.Semi-structured in-depth interviews were conducted through the framework analysis method and the ATLAS.TI software.The interview materials were analyzed and sorted out,and finally the real perception and experience of elderly TKA patients regarding preoperative prerehabilitation were summarized.Results There were 4 themes regarding the true perception of preoperative prerehabilitation in elderly patients with TKA:the intentions of preop-erative prehabilitation(positive attitudes,willingness to try to accept,lack of intrinsic behavioral motivation),the benefits of preoperative prehabilitation(improved surgical outcomes,accelerated postoperative recovery),the challenges of preop-erative prehabilitation(pain management,poorly conditioned environment and facilities,and safety issues),and the de-mands for preoperative prehabilitation(demands for information and counseling services,demands for program refinement,demands for networking and support).Conclusions Elderly TKA patients have a positive attitude towards preoperative prehabilitation,which can effectively promote rapid postoperative recovery.Healthcare professionals should strengthen publicity and education,construct personalized preoperative prehabilitation programs,and improve a diversified social support system to enhance patients'adherence to exercise prehabilitation,so as to ensure that preoperative prehabilitation achieves the best results.

Abstract:As a key factor affecting medical decision-making and rehabilitation effect,hospital discharge readiness has become an important topic in clinical research.This paper reviews the concept,research status,assessment tools,in-fluencing factors and interventions of discharge readiness of primary caregivers of dementia patients,aiming to provide ref-erence for the assessment and intervention studies of discharge readiness of caregivers of dementia patients in China.

Abstract:Sarcopenia is highly prevalent among patients with chronic kidney disease(CKD),leading to diminished self-care ability,reduced quality of life,increased risk of complications,and higher mortality rates.Early identification of patients with sarcopenia or at high risk of sarcopenia plays a crucial role in promoting effective management of sarcopenia in CKD.This article reviews screening and assessment tools for sarcopenia in CKD,compares and analyzes different screening and assessment tools,and provides recommendations for their use,aiming to provide a reference for the screen-ing of sarcopenia in CKD patients.

Abstract:Objective To summarize the best evidence on non-pharmacological interventions for improving balance function in the elderly from domestic and international studies.Methods Following the top-down principle of the"6S"evidence model,a systematic search was conducted in domestic and international databases,and guideline websites,for evidence related to non-pharmacological interventions for balance function in the elderly.The search included guidelines,expert consensus statements,systematic reviews,meta-analyses,evidence summaries,and randomized controlled trials(RCTs),covering the period from the inception of the databases up to December 2023.Two researchers were responsible for evaluating the quality of the included literature,extracting data,and summarizing the evidence.Results A total of 32 articles were included,comprising 2 guidelines,1 expert consensus,7 systematic reviews,9 meta-analyses and 13 RCTs.From these,36 pieces of best evidence were identified across 9 categories:exercise interventions,cognitive inter-ventions,virtual technological interventions,dietary interventions,comprehensive interventions,health education,envi-ronmental interventions,other forms of interventions and the implementation and monitoring of interventions.Conclu-sions Non-pharmaceutical intervention measures for the balance function of the elderly are diverse in form and rich in content.Appropriate intervention plans should be selected based on the actual situation and the individual conditions of el-derly,and the quality monitoring of the intervention process should be well done.

Abstract:Objective To explore the effects of traditional Chinese medicine auricular acupressure combined with abdominal rotation exercise on constipation in patients with Parkinson's disease(PD)after deep brain stimulation(DBS)surgery.Methods A total of 102 PD patients who underwent DBS in the Department of Neurosurgery of Shandong Pro-vincial Third Hospital Affiliated to Shandong University and were discharged for home or community rehabilitation from March 2024 to December 2024 were selected as the research subjects.They were randomly divided into the control group and the observation group by random number table method,with 51 cases in each group.The control group was given rou-tine education,while the observation group was treated with traditional Chinese medicine auricular acupressure combined with abdominal rotation exercise on the basis of the control group.The colonic transit test,constipation severity score scale(CSS),and simple 8-item Parkinson's disease questionnaire(PDQ-8)were used to compare the colonic motility function,constipation symptoms,efficacy,and quality of life before and after treatment in the two groups.The levels of inflammato-ry factors C-reactive protein(CRP),interleukin-6(IL-6),and procalcitonin(PCT)before and after treatment were com-pared between the two groups.Results After treatment,the colonic transit test scores,CSS scores,PDQ-8 scores,and serum CRP and IL-6 levels in the observation group were lower than those in the control group,and the effective rate of con-stipation treatment was higher than that in the control group(all P<0.05).Conclusion Traditional Chinese medicine auricular acupressure combined with abdominal rotation exercise can enhance colonic motility function in PD patients after DBS,alleviate the severity of constipation,improve local intestinal inflammatory response,and improve the quality of life of patients.

Abstract:Objective To evaluate the effectiveness of home environmentalmodification in preventing falls among the elderly.Methods Computerized searches were performed across the following databases:CNKI,VIP,WanFang,PubMed,Cochrane Library,Web of Science,Embase,and EBSCO.The search focused on randomized controlled trials(RCTs)published from January 2000 to August 2024 that investigated home environmental modification for fall prevention and reduction in the elderly.Data analysis were conducted using RevMan 5.4 software.Results A total of 15 RCTs in-volving 6 154 older adults were included,with 2 546 in the intervention group(accepting home environmental modifica-tion)and 3 608 in the control group(without environment intervention).Meta-analysis showed that home environmental modification reduced the fall rate(RR=0.78,95%CI:0.68-0.90,P=0.000 8),the incidence of recurrent falls(RR=0.76,95%CI:0.58-1.00,P=0.05),and the incidence of fall-related injuries(RR=0.67,95%CI:0.54-0.83,P=0.000 3)compared to the control group.Conclusion Home environmental modification can prevent and reduce the fall rate,as well as the incidence of recurrent falls and fall-related injuries among the elderly.

Abstract:Objective To screen key senescence-associated genes closely associated with the development of diabet-ic nephropathy(DN)and to validate these genes.Methods Three DN-related human renal transcriptome datasets from the GEO database(GSE96804,GSE104948 and GSE30122)were standardized across platforms using the Shambhala algo-rithm.Differentially expressed genes(DEGs)were screened using the criteria of false discovery rate(FDR)adjusted P≤0.05 and fold change(FC)≥1.5.The DEGs were intersected with senescence-associated genes listed in the CellAge data-base to identify senescence-associated genes associated with DN.Functional enrichment analysis of these genes was per-formed using the clusterProfiler package(FDR-adjusted P≤0.05),and protein-protein interaction(PPI)networks were constructed using the STRING database to identify hub genes.Receiver operating characteristic(ROC)curve analysis was used to evaluate the discriminatory potential of the candidate genes for DN patients,and their expression was validated in an independent external dataset(GSE30528).BTBR ob/w heterozygous mice were bred,and at 5 weeks of age,mice were divided into BTBR w/w and BTBR ob/ob groups based on genotyping results.Fasting blood glucose,body weight,total cholesterol,kidney weight,24-hour urinary albumin,serum uric acid,serum creatinine,and blood urea nitrogen were monitored.Periodic acid-schiff(PAS)staining was used to assess renal pathological changes for assessing typical DN pa-thology.Quantitative PCR(qPCR)was conducted to validate the expression levels of key senescence-associated genes in mice renal tissues.Results A total of 918 DEGs associated with DN were identified,among which 90 were related to cel-lular senescence.Enrichment analysis indicated that these genes were primarily involved in biological processes such as"cellular response to hypoxia"and"cellular response to transforming growth factor beta(TGF-β)".PPI network analysis combined with validation in the GSE30528 dataset suggested that CDKN1B and MET may serve as key senescence-associat-ed genes in the development of DN.Compared to BTBR w/w mice,BTBR ob/ob mice exhibited higher levels of blood glu-cose,body weight,total cholesterol,kidney weight and 24-hour urinary albumin.Histological analysis revealed signifi-cant mesangial expansion and increased glomerulosclerosis index in BTBR ob/ob mice,indicating typical DN pathology.qPCR results showed that CDKN1B expression in kidney tissue of BTBR ob/ob mice(1.10±0.57)was lower than that in BTBR w/w mice(5.67±0.76),and the difference was statistically significant(P<0.05);however,there was no statisti-cally significant difference in MET expression between the two groups.Conclusions CDKN1B may be a core senes-cence-associated gene involved in the pathogenesis of diabetic nephropathy.Further research on this gene may provide new theoretical foundations and potential targets for the prevention and treatment of DN.

Abstract:Objective To explore the effect of isoliquiritigenin on the proliferation,invasion and immune killing sensitivity of NK/T cell lymphoma.Methods After intervention with isoliquiritigenin at multiple concentrations(0,2.5,5 and 12 µmol/L)and time points(0,12,24 and 48 h),the cell viability of NK/T cell lymphoma cells SNK-1 and SNT-8 was measured.Following intervention with different concentrations of isoliquiritigenin,clonogenic assays,flow cytometry and Transwell cell invasion experiments were used to detect changes in proliferation,apoptosis,and invasion capabilities of SNK-1 and SNT-8 cells.After extracting and isolating NK cells,the lactate dehydrogenase release assay was used to de-tect the changes in the cytotoxicity sensitivity of SNK-1 cells to NK cells before and after the treatment of Isoliquiritigenin.Flow cytometry was used to detect the expression changes of NKG2D ligands(MICA/B,ULBP1,ULBP2 and ULBP3)and HLA class I molecules on the surface of SNK-1 cells before and after the treatment of isoliquiritigenin.Results Isoliquiritigenin inhibited the proliferation of NK/T cell lymphoma SNK-1 and SNT-8 in a dose-and time-dependent man-ner,respectively(all P<0.05).Compared with the untreated group,SNK-1 and SNT-8 clone formation and cell invasion ability were weakened after treatment with isoliquiritigenin,and the apoptosis rate of cells increased(all P<0.05).At the effectual target ratios of 10∶1 and 20∶1,isoliquiritigenin could enhance the cytotoxicity sensitivity of SNK-1 cells to NK cells(all P<0.05).After the treatment of isoliquiritigenin,the expressions of MICA/B,ULBP2 and ULBP3 on the surface of SNK-1 cells was increased(all P<0.05).Conclusion Isoliquiritigenin inhibits the proliferation and invasion of NK/T cell lymphoma,promotes its apoptosis,and enhances NK cell-mediated immune killing against it.

Abstract:Objective To investigate the development status of integrated medical and elderly care services in Xian-ning,summarize its service mode and service content,analyze its development advantages and existing problems,and put forward targeted countermeasures.Methods The convenient sampling method was adopted to select 11 municipal exem-plary integrated medical and elderly care institutions in Xianning,with"one district,one city and four counties".The staff in the institutions(administrators,care staff,medical and paramedical personnel,senior care manager)and elderly resi-dents were selected as the research subjects,and the survey was conducted by comprehensive use of questionnaire survey and field observation method.Results The overall satisfaction rate of the elderly residents reached 83.33%.Xianning mainly has three integrated medical and elderly care service modes:"medical institutions incorporating eldercare","elder-ly care institutions incorporating medical services",and"integrated medical and elderly care".These services were primar-ily operated through public-private partnerships and private-run entities institutions.Fee structures were primarily deter-mined by nursing fees,bed fees,accommodation charges,and meal expenses.Services encompassed two main compo-nents:medical care and elderly care.The institution's overall environment was characterized by three features:eco-inte-grated site selection and layout,age-adapted environmental modifications,and modular functional zoning.Staff recommen-dations focused on six areas:salary and compensation,personnel allocation,medical facilities,professional training,multi-disciplinary elderly care talents,and insurance system.Elder residents'suggestions encompassed five aspects:cost subsi-dies,dietary management,staff quantity and quality,family visitation,and activities and social support.Conclusions The development of integrated medical and elderly care services in Xianning has the advantages of diverse service models,eco-logically advantaged environments,distinct characteristics of public hospitals for the elderly care,and the rejuvenation trend in teams shows positive momentum.However,there are some problems that have not been included in the long-term care insurance pilot,the allocation of care staff and part of medical facilities has not reached the prescribed standards,el-derly care classification standards require standardization,and critical gaps persist in professional training and multidisci-plinary elderly care talents.It is suggested to strengthen the safeguard mechanisms and financial support,standardize the standards of personnel,facilities configuration and elderly care classification in institutions,strengthen professional train-ing of service personnel and establish a multi-disciplinary professional care team,so as to promote the high-quality develop-ment of the integrated medical and elderly care services.

Abstract:Objective To analyze potentially inappropriate medication(PIM)in elderly inpatients using the 2019 Beers Criteria and the Chinese Criteria of Potentially Inappropriate Medication for Older Adults(2017 edition)(Chinese Criteria).Methods A total of 191 inpatients aged≥65 years admitted to the Department of Geriatrics of Shandong Pro-vincial Hospital Affiliated to Shandong First Medical University from January to June 2020 were selected.PIM analysis was performed based on the 2019 Beers Criteria and Chinese Criteria.The χ2 test was used to compare the incidence rates of PIM by two criteria across different indicators(age,sex,number of diseases,number of medications,renal function).Results According to the Beers Criteria and Chinese Criteria,the incidence rates of PIM were 72.25%(138/191)and 60.73%(116/191),respectively.The most frequent PIM were proton pump inhibitors(based on Beers Criteria)and clopidogrel(based on Chinese Criteria).Difference of PIM incidence was found according to both Beers Criteria and Chi-nese Criteria among elderly inpatients taking 1-4,5-9,and≥10 medications(all P<0.05).According to the Chinese Cri-teria,difference in PIM incidence was observed between patients with normal and abnormal renal function(P<0.05).Conclusions Based on the 2019 Beers Criteria and Chinese Criteria,the incidence of PIM among elderly inpatients is very high.Elderly patients taking more medications and those with abnormal renal function are more prone to PIM.

Abstract:Objective To explore the latent classification characteristics of anxiety levels among elderly and identify associated influencing factors.Methods Based on data from the 2018 wave of the Chinese Longitudinal Healthy Longevi-ty Survey(CLHLS),the Generalized Anxiety Disorder-7(GAD-7)scale was used to assess anxiety levels in the elderly,Latent Profile Analysis(LPA)was employed to identify potential categories of anxiety levels,and multivariate logistic re-gression models were used to examine the factors associated with different anxiety level categories.Results Anxiety lev-els among elderly were classified into three categories:Q1(low scores on all items,72.95%),Q2(moderate scores on all items,17.53%),and Q3(high scores on all items,9.52%).Multivariate logistic regression analysis indicated that gen-der,education level,economic status,self-rated health status,depression,and activities of daily living(ADL)were asso-ciated with anxiety levels in the elderly(all P<0.05).Male,higher education,and better economic status were associated with lower anxiety levels(all P<0.05);whereas poorer self-rated health status,higher levels of depression,and ADL limi-tations were linked to higher anxiety levels(all P<0.05).Additionally,the risk of anxiety was slightly higher in the young-er elderly compared to the oldest-old,and urban-rural disparities appeared to amplify anxiety severity in the elderly(all P<0.05).Conclusions Low anxiety levels are predominant among the elderly.The elderly who are female,have lower ed-ucation and economic status,limited ADL,poorer self-rated health,and depressive tendencies are more prone to anxiety and should be prioritized in screening and intervention efforts.

Abstract:Breast cancer,as one of the malignant tumors with the highest incidence rate among women worldwide,se-riously threatens the life and health of patients.It not only brings great physical pain to patients but also often causes psy-chological and physiological adverse reactions,significantly reducing their quality of life.In this context,self-advocacy has gradually become a key factor in improving the treatment experience and prognosis of breast cancer patients.This arti-cle aims to explore the concept,current situation,influencing factors,and intervention measures of self-advocacy in breast cancer patients,in order to provide references for medical staff to carry out relevant research and formulate targeted inter-vention plans.

Abstract:Objective To explore the causal relationship between rheumatoid arthritis and the risk of developing type 2 diabetes using two-sample Mendelian randomization.Methods Two-sample Mendelian randomization analysis was performed based on genome-wide association analysis(GWAS)data with single nucleotide polymorphism(SNP)as in-strumental variable,rheumatoid arthritis as the exposure,and type 2 diabetes as the outcome.The primary analysis meth-od was inverse variance weighting(IVW),the F statistic was calculated toaccess the stability of instrumental variables,and Cochran's Q statistic was used to test the heterogeneity among instrumental variables.Sensitivity analyses were con-ducted using MR-Egger regression,weighted median method(WME),simple mode-based estimation,and weighted mode-based estimation.Results A total of 30 SNPs were selected as instrumental variables.The IVW method indicated a positive causal relationship between rheumatoid arthritis and type 2 diabetes(OR=1.05,95%CI:1.01-1.08,P=0.006).The results of the heterogeneity test showed that there was no heterogeneity in the causal relationship between rheumatoid arthritis and type 2 diabetes(P>0.05).The results of the horizontal pleiotropy test showed that there was no ef-fect of horizontal pleiotropy on rheumatoid arthritis and type 2 diabetes(P>0.05).The results of the MR analysis pos-sessed good stability and did not have significant publication bias.Conclusion There is a positive causal relationship be-tween rheumatoid arthritis and the development of type 2 diabetes.