Abstract:Objective To investigate the relationship between burden of cerebral small vessel disease(CSVD)and cognitive impairment in the elderly with atrial fibrillation(AF),and to evaluate its potential regulatory effectiveness.Methods A total of 163 non-stroke patients with AF treated in our hospital from May 2021 to March 2024 were enrolled and divided into a cognitively normal group(122 cases)and a cognitively impaired group(41 cases)according to the results of Montreal cognitive assessment(MoCA)and mini-mental state examination(MMSE).Baseline data and imaging indicators were collected,and the total burden of CSVD was calculated.Pearson correlation analysis was used to analyze the correlation between the CSVD burden and cognitive impairment.Multivariate logistic regression analysis was employed to identify the risk factors of cognitive impairment in elderly AF patients.Results The cognitively impaired group had significantly advanced age and larger ratio of smoking,but shorter years of education and lower MoCA score than the cognitively normal group(P＜0.05,P＜0.01).Obviously more lacunar infarcts,higher white matter hyperintensities(WMH),higher total burden score,and larger ratios of cerebral microbleeds,brain atrophy and high-grade enlarged perivascular space(EPVS)were observed in the cognitively impaired group than the cognitively normal group(P＜0.05,P＜0.01).The total burden score of CSVD was negatively correlated with MoCA score(r=-0.425,P=0.000).Multivariate logistic regression analysis showed that age,years of education,basal ganglia WMH and total burden score were independent risk factors for cognitive impairment in elderly AF patients(P＜0.05,P＜0.01).After adjusting for age and years of education,multivariate logistic regression analysis still revealed that basal ganglia WMH(OR=3.140,95％CI:1.935～5.094,P＜0.01)and total burden score(OR=12.683,95％CI:4.167～38.608,P＜0.01)were risk factors for cognitive impairment in elderly AF patients.Conclusion The CSVD burden is related to cognitive impairment in elderly AF patients,and preventing the progression of CSVD may reduce the incidence of cognitive impairment.

Abstract:Objective To explore the value of CT derived fractional flow reserve(CT-FFR)difference(ΔCT-FFR)based on coronary computed tomography angiography(CCTA)in predicting adverse outcomes in elderly male patients with severe coronary artery calcification.Methods A retrospective study was conducted on 67 elderly male patients with suspected coronary heart disease who received CCTA examinations in Department of Radiology of the Second Medical Center of Chinese PLA General Hospital from March 2021 to September 2023.Based on whether major adverse cardiovascular events(MACE)occurred,they were divided into a MACE group(37 cases)and a non-MACE group(30 cases).The CT-FFR values of the proximal,distal,and distal 20 mm segments of the maximum stenotic lesions were compared between the two groups.Cox proportional hazards regression model and Kaplan Meier survival curve analysis were used to analyze the relationship of ΔCT-FFR and coronary stenosis ≥70％with incidence of adverse outcomes.Results The MACE group exhibited significantly larger proportions of stenosis ≥ 70％(43.2％vs 10.0％),CT-FFR ≤0.8(70.3％vs 30.0％),and ΔCT-FFR ≥0.165(59.5％vs 16.7％)than the non-MACE group(P＜0.01).Stenosis ≥ 70％and ΔCT-FFR ≥0.165 significantly increased the risk of MACE(P＜0.01).ΔCT-FFR ≥0.165 was a risk factor for MACE in elderly male patients with severe coronary calcification(P＜0.05).Conclusion ΔCT-FFR can be used to stratify the clinical risk of elderly male coronary heart disease patients with severe calcification,which optimizing the management strategies in invasive cardiovascular examination.

Abstract:Objective To investigate the relationship between fibrinogen-to-albumin ratio(FAR)and cerebral small vessel disease(CSVD)MRI burden and neurological outcome in elderly ischemic stroke patients.Methods A prospective study was conducted on 317 patients firstly diagnosed with mild acute ischemic stroke or transient ischemic attack admitted to Center for Neurological Diseases of our hospital from January 2021 to January 2024.According to the total burden score of head MRI,they were divided into CSVD 0,1～2 group,and 3～4 groups(45,164 and 108 cases).At admission,the plasma contents of fibrinogen and albumin were measured in all patients,and the FAR was calculated.The total burden of MRI included silent lacunar infarction,white matter hyperintensity,cerebral microbleeds,and enlarged perivascular spaces.National Institutes of Health Stroke Scale(NIHSS)was used to assess the cognitive function of the subjects at baseline and 28 d after enrollment.Spearman correlation analysis was employed to analyze the correlation between total MRI burden score and FAR,and multivariate logistic regression analysis was utilized to analyze the relationship between FAR and CSVD markers as well as total MRI burden score.Results Significantly younger age,lower ratio of smoking history and FAR were observed in the CSVD 0 group followed by the CSVD 1～2 group and the CSVD 3～4 group in turn(P＜0.05).The CSVD 1～2 group and the CSVD 3～4 group exhibited obviously higher 28-day NIHSS score than the CSVD 0 group(P＜0.05).Spearman correlation analysis showed that FAR was positively correlated with the total MRI burden score.Multivariate logistic regression analysis indicated that FAR was an independent risk factor for SLI(OR=27.149,95％CI:3.210-247.355,P＜0.05).Conclusion FAR may be associated with CSVD MRI burden and short-term neurological function in elderly ischemic stroke patients,and probably be regarded as a candidate CSVD biomarker.

Abstract:Objective To investigate the expression and clinical significance of transfer RNA-derived small RNA(tsRNA)in peripheral blood mononuclear cells(PBMC)from elderly patients with acute myocardial infarction(AMI).Methods A total of 90 elderly patients who underwent coronary angiography in Tongji Hospital affiliated to Huazhong University of Science and Technology from January to December 2022 were recruited in this study.According to clinical diagnosis,they were divided into an AMI group(51 cases)and a control group(39 cases).PANDORA-Seq was performed to detect the level of tsRNA-Lys-TTT in circulating PBMC.Receiver operating characteristic(ROC)curve analysis and logistic regression analysis were used to evaluate the value of tsRNA-Lys-TTT and high sensitivity C-reactive protein(hs-CRP)in diagnosing AMI.Results The AMI patients exhibited significantly higher expression levels of low-density lipoprotein cholesterol,lipoprotein(a),tsRNA-Lys-TTT than the control group(P＜0.05,P＜0.01).ROC curve analysis showed that the AUC value of combination of tsRNA-Lys-TTT and hs-CRP in diagnosis AMI was 0.823(95％CI:0.738～0.908,P＜0.01),with a sensitivity of 68.6％and a specificity of 84.6％.tsRNA-Lys-TTT was an independent risk factor for AMI in the elderly(OR=1.569,95％CI:1.112～2.369,P＜0.05).Conclusion tsRNA-Lys-TTT can be regarded as a potential biomarker for AMI in the elderly,and can exert regulatory effect on macrophage inflammation.

Abstract:Objective To investigate the application value of machine learning algorithms in predicting CHD risk among elderly patients with obstructive sleep apnea(OSA).Methods A total of 1 129 OSA patients aged ≥60 years who completed polysomnography at 6 tertiary hospitals(Chinese PLA General Hospital,Peking University International Hospital,People's Hospital of Peking University,Beijing Chaoyang Hospital,No.960 Hospital of PLA,and Affiliated Hospital of Gansu University of Chinese Medicine)between January 2015 and October 2017.According to the occurrence of CHD,the participants were assigned into a CHD group(202 cases)and a non-CHD group(927 cases).Baseline data were collected,and they were divided into training(n=678),validation(n=226),and testing sets(n=225)in a 6∶2∶2 ratio.Four machine learning algorithms were used to construct predictive models,that is,logistic regression,random forest,extreme gradient boosting,and gradient boosting machine.ROC curves were plotted to evaluate the predictive performance of the four models by calculating the area under the receiver operating characteristic curve(AUC).Results The CHD group exhibited significantly older age,larger waist circumference,higher SBP and FBG levels,and higher ratios of male,hyperlipidemia,diabetes,alcohol consumption and carotid atherosclerosis than the non-CHD group(P＜0.05,P＜0.01),and statistical differences were seen in body mass index and apnea-hypopnea index between the two groups(P＜0.05).In the testing set,the random forest model demonstrated best performance with an AUC value of 0.815(95％CI:0.756-0.874),which was higher than that of logistic regression model(AUC=0.746,95％CI:0.682-0.810).The accuracy was 73.9％,the sensitivity was 84.5％,and the specificity was 69.9％in the validation set for the random forest model.Feature importance analysis revealed that diabetes,age,SBP,oxygen desaturation index and blood glucose were the top five important predictive factors.Conclusion The machine learning-based CHD prediction model demonstrates good predictive performance in elderly OSA patients.This model can be used as an effective tool for cardiovascular risk stratification and clinical decision-making for elderly OSA patients.

Abstract:Objective To investigate the application of repetitive transcranial magnetic stimulation(rTMS)combined with neuromuscular electrical stimulation(NMES)at different frequencies in elderly patients with post-stroke dysphagia(PSD).Methods A prospective study was conducted on 181 elderly PSD patients admitted to our hospital from February 2021 to June 2024.They were randomly divided into a NMES group(n=61),a low-frequency rTMS group(n=60,NMES+low-frequency rTMS),and a high-frequency rTMS group(n=60,NMES+high-frequency rTMS).The swallowing function[water swallowing test,clinical dysphagia score(CDS),and standard swallowing function assessment(SSA)]and nutritional status were compared among the three groups.The Edmond Frailty Scale(EFS)scores and incidence of adverse reactions were compared among the three groups.Results After 1 month of treatment,both the high-and the low-frequency rTMS groups obtained significantly lower scores of water swallow test,CDS,and SSA,and higher albumin and prealbumin levels than the NMES group(P＜0.05).Furthermore,the high-frequency rTMS group had more improved above indicators than the low-frequency rTMS group(P＜0.05).Compared with baseline,the EFS scores in all three groups were in a trend of initial increase followed by subsequent decrease at 2 weeks and 1 month after treatment and 1-and 3-month follow-ups.The reduction was most pronounced in the high-frequency rTMS group,with significant group × time interaction effects(P＜0.05).There was no statistical difference in the incidence of adverse events among the NMES,low-and high-frequency rTMS groups(3.3％vs 5.0％vs 10.0％,P＞0.05).Conclusion The combination of rTMS and NMES can effectively improve the swallowing function and nutritional status of elderly PSD patients,and reduce the frailty,and best efficacy is observed in high frequency rTMS.

Abstract:Objective To explore the predictive value of hemodynamic parameters and blood pressure variability(BPV)in elderly patients with hypertension.Methods A total of 107 elderly hypertensive patients admitted to Department of Cardiology of Tianjin Chest Hospital from March 2020 to March 2024 were enrolled,and according to the occurrence of adverse cardiovascular events during a 12-month follow-up,they were divided into an occurrence group(25 cases)and a non-occurrence group(82 cases).The clinical data were compared between the two groups,including hemodynamic parameters and BPV.Binary logistic regression analysis were used to clarify the correlation between each indicator and adverse cardiovascular events,and ROC curve was drawn to evaluate the predictive value.Results The occurrence group exhibited significantly higher ratios of smoking and coronary heart disease,higher diastolic blood pressure(DBP),systolic blood pressure(SBP),pulse pressure,cardiac output,peak systolic velocity(Vs)/end-diastolic blood flow velocity(Vd)ratio,24-hour SBP variation coefficient and 24-hour SBP standard deviation,and lower Vd value than the non-occurrence group(P＜0.05,P＜0.01).Binary logistic regression analysis showed that pulse pressure,Vd,24-hour SBP variation coefficient,SBP and Vs/Vd ratio were risk factors for adverse cardiovascular events in elderly hypertensive patients(P＜0.05,P＜0.01).ROC curve analysis suggested that the AUC values of SBP,pulse pressure,Vd and 24-hour SBP variation coefficient were 0.945,0.891,0.825 and 0.838,respectively,in predicting adverse cardiovascular events in elderly hypertensive patients(P＜0.01).Conclusion Among the hemodynamic parameters,SBP,pulse pressure,Vd and 24 h SBP variation coefficients have high predictive value for adverse cardiovascular events in elderly hypertensive patients,and can be used as important reference indicators for clinical assessment of cardiovascular risk.

Abstract:Objective To investigate the effectiveness of drilling and drainage surgery for chronic subdural hematoma(CSDH)in elderly patients and the impact of using urokinase on clinical outcomes.Methods A retrospective analysis was conducted on 113 elderly CSDH patients admitted to our neurological disease center from February 2019 to March 2024.All patients underwent single burr-hole drainage.Modified Rankin scale(mRS)score was applied to assess clinical status at 6 months.Multivariate logistic model was employed to analyze the risk factors associated with postoperative urokinase use in CSDH patients.Results Sixty-seven patients(59.29％)received urokinase instillation through the subdural drain into the hematoma cavity.A total of 104 patients(92.04％)achieved a good prognosis at 6 months after surgery.Multivariate logistic regression analysis showed that age,preoperative hematoma size,and history of ischemic heart disease were independent influencing factors for urokinase use(P＜0.05,P＜0.01).There were no statistical differences in the length of hospital stay and incidence of complications between the patients with urokinase administration and those without(9.30±8.95 d vs 8.00±11.00 d,4.48％vs 8.70％,P＞0.05).The patients receiving urokinase injection had significantly lower mRS score at 6 months and recurrence rate at 1 year after surgery than those having no use of urokinase(P＜0.05,P＜0.01).Conclusion For elderly CSDH patients,using urokinase for subdural drainage after drilling and clearing hematoma under local anesthesia is a treatment strategy with advantages of effectiveness,safety,and low recurrence rate.

Abstract:Objective To explore the association between geriatric nutritional risk index(GNRI)and mortality risk among Chinese community-dwelling oldest-old.Methods This study was a prospective cohort study based on the Chinese Longitudinal Healthy Longevity Survey.Participants were selected from eight longevity regions in the 2008,2012,and 2014 survey waves.After excluding individuals with missing biomarker,anthropometric,or follow-up data,a total of 1819 community-dwelling oldest-old adults were included.According to GNRI tertiles,they were divided into a lower GNRI group(n=607),a middle GNRI group(n=606),and an upper GNRI group(n=606).Cox proportional hazards models were used to estimate the hazard ratios(HR)and 95％confidence intervals(CI)for all-cause mortality and cause-specific mortality(cardiovascular diseases,natural aging,and other chronic diseases).Restricted cubic spline models were employed to assess potential nonlinear relationships.Results Significant differences were observed among the three groups in terms of age,male ratio,smoking,drinking,systolic blood pressure,diastolic blood pressure,body mass index,hypertension,diabetes,albumin,hemoglobin,total cholesterol,triglycerides,high-density lipoprotein cholesterol,and fasting blood glucose(P＜0.05,P＜0.01).During a median follow-up of 1286 days,786 deaths(43.2％)occurred.After adjustment for multiple variables,each standard deviation increase in GNRI was associated with a 28％lower risk of all-cause mortality(HR=0.72,95％CI:0.62-0.83,P＜0.01),showing a nonlinear inverse association(P=0.050).Compared with the lower GNRI group,the upper GNRI group had a significantly lower risk of all-cause mortality(HR=0.72,95％CI:0.54-0.96,P＜0.05)and an obviously lower risk of death from other chronic diseases(HR=0.64,95％CI:0.44-0.93,P＜0.05).A significant nonlinear association was observed(P＜0.01).After adjustment,no significant associations were observed between GNRI and mortality from cardiovascular disease or natural death.Conclusion GNRI has potential application value in predicting mortality risk among the oldest-old population,supporting the focus on nutritional status assessment in context of population aging.

Abstract:Objective To explore the correlation between different-frequency repetitive transcranial magnetic stimulation(rTMS)and the recovery of upper-limb motor function as well as attention in stroke patients.Methods A total of 110 hospitalized stroke patients admitted to our department between June 2021 and June 2024 were enrolled,and then randomly divided by odd-even numbering into sham-rTMS group(n=38),low-frequency rTMS group(3 Hz,n=35)and high-frequency rTMS group(10 Hz,n=37).All groups received corresponding rTMS treatment and conventional upper-limb rehabilitation training at the same time,for 4 weeks.Resting motor threshold of the lesioned hemisphere was measured before and after treatment.Upper-limb motor function was evaluated with the Fugl-Meyer assessment-upper limb(FMA-UL),and attention and global cognitive status were evaluated with Montreal Cognitive Assessment(MoCA).Pearson correlation analysis was applied to analyze the correlation between total FMA-UL score and MoCA attention-related sub-items.Results The FMA-UL scores were increased significantly after treatment in all three groups(P＜0.05,P＜0.01).Both low-and high-frequency rTMS produced higher total MoCA attention-domain scores and 100-minus-7 serial subtraction task scores than sham stimulation(5.17±0.75,5.30±0.52 vs 4.40±0.98,P＜0.05;2.43±0.50,2.35±0.69 vs 1.87±0.88,P＜0.05).High-frequency rTMS further outperformed low-frequency rTMS in forward/backward digit-span task scores(1.97±0.41 vs 1.77±0.43,P＜0.05).Pearson correlation analysis showed positive correlations of total FMA-UL score with total MoCA attention-domain score,forward/backward digit-span score,and 100-minus-7 task score(r=0.369,r=0.288,r=0.311,P＜0.01).Conclusion Both low-and high-frequency rTMS can effectively promote recovery of upper-limb motor function and attention after stroke,and motor improvement is correlated with attention recovery.

Abstract:Objective To explore the short-term efficacy of combined application of repetitive transcranial magnetic stimulation(rTMS)and transcranial direct current stimulation(tDCS)on motor function and balance function in Parkinson's disease(PD)patients.Methods A prospective study was carried on 146 PD patients co-admitted in Departments of Rehabilitation Medicine and Neurological of our hospital.The patients were randomly divided into group A(routine rehabilitation training,38 cases),group B(rTMS,35 cases),group C(tDCS,38 cases),and group D(tDCS followed by rTMS,35 cases).Unified Parkinson's Disease Rating Scale-Ⅲ(UPDRS-Ⅲ)was performed before treatment(T0)and 4 weeks after treatment(T1)to compare the differences in the quantitative assessment of motor dysfunction,gait parameters(gait speed,stride length,cadence frequency),and balance parameters(movement trajectory area,movement trajectory circumference).Results UPDRS-Ⅲ score,motor track area,and motor track circumference were significantly deceased in the T1 period than the T0 period in the four groups(P＜0.01).The cadence frequency in group A was significantly lower at T0 than at T1,and those in groups B,C and D were obviously lower at T1 than at T0,but stride length in the three groups were notably larger at T1 than at T0(P＜0.01).Gait speeds in the four groups were greatly improved at T1 than at T0(P＜0.01).Group D obtained significantly better improvements in UPDRS-Ⅲ score,movement trajectory area,movement trajectory circumference,gait speed,and stride length than the other three groups(P＜0.01).Group B had obviously better improvement of movement trajectory parameters and gait indicators than group C(P＜0.05),but no statistical difference was observed in the improvement of UPDRS-Ⅲ score between the two groups(P＞0.05).Conclusion Combined application of rTMS and tDCS synergistically improves motor function and gait and balance in PD patients,with its short-term efficacy superior to that of single neuromodulation therapy(rTMS or tDCS)and conventional therapy,and the effects can last up to 4 weeks after treatment.

Abstract:Objective To compare and analyze the clinical efficacy of neuroendoscopic hematoma removal via frontal and temporal lobe approaches in the treatment of elderly patients with hypertensive intracerebral hemorrhage(HICH),and to explore the influence of two different approaches on neurological function and inflammatory factors.Methods Clinical data of 240 elderly HICH patients undergoing neuroendoscopic surgical treatment in our hospital from January 2019 to January 2024 were collected retrospectively.Based on the approaches for neuroendoscopic hematoma removal,the patients were divided into a frontal lobe group(115 cases,via frontal lobe approach)and temporal lobe group(125 cases,via temporal lobe approach).The clinical efficacy,inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),IL-6,TNF-α,IL-1 β,soluble triggering receptor expressed in myeloid cells-1(sTREM-1)],and neurological function indicators[brain-derived neurotrophic factor(BDNF),S100 calcium binding protein B(S100 B),nerve growth factor(NGF),neuron-specific enolase(NSE)]before and after surgery were compared between the two groups.National Institutes of Health Stroke Scale(NIHSS)score was used to evaluate neurological function.Prognosis at 1 month after surgery and occurrence of complications were observed and compared between the two groups.Results The total effective rate was significantly higher in the frontal lobe group than the temporal lobe group(89.57％vs 75.20％,P＜0.01).There were no statistical differences between the two groups in terms of serum hs-CRP,IL-6,TNF-α,IL-1β and sTREM-1 levels at 3 d after surgery(P＞0.05).The frontal lobe group exhibited obviously higher levels of serum BDNF and NGF while lower levels of serum S100B and NSE at 1 week after surgery than the temporal lobe group(P＜0.01).At 1 week and 1 month after surgery,the NIHSS scores and the rates of good prognosis were notably higher in the frontal lobe group than the temporal lobe group(P＜0.01).There was no significant difference in incidence of complications between the two groups(5.22％vs 12.00％,P＞0.05).Conclusion Compared with neuroendoscopic hematoma removal via temporal lobe approach,the surgery via frontal lobe approach has more significant clinical efficacy in the treatment of elderly HICH,with the advantages of effectively regulating the levels of neurological function indicators,promoting the recovery of neurological function and improving the prognosis of patients.

Abstract:Objective To analyze the correlation of pan-immune inflammation value(PⅡV)and C-reactive protein variation rate(ΔCRP)with myocardial fibrosis in elderly patients with acute myocardial infarction(AMI).Methods A total of 123 elderly AMI patients admitted to our department from January 2022 to July 2024 were enrolled,and then followed up for 6 months postoperatively.According to occurrence of ventricular remodeling or not,they were divided into a remodeling group(26 cases)and a non-remodeling group(97 cases),and based on presence of myocardial fibrosis,they were also assigned into a fibrosis group(31 cases)and a non-fibrosis group(92 cases).Cardiac MRI was performed after admission to diagnose myocardial fibrosis.PⅡV,ΔCRP,type Ⅲ procollagen N-terminal peptide(PⅢNP),and type Ⅰ collagen C-terminal peptide(CICP)levels were compared between the fibrosis and non-fibrosis groups.Pearson correlation analysis was used to assess the relationships of PⅡV and ΔCRP with PⅢNP and CICP.Multivariate logistic regression analysis was applied to identify factors influencing postoperative remodeling.ROC curve analysis was conducted to evaluate the clinical efficacy of PⅡV and ΔCRP in predicting postoperative remodeling.Results The fibrosis group exhibited significantly higher PⅡV,ΔCRP,PⅢNP,and CICP levels than the non-fibrosis group(P＜0.05,P＜0.01).Pearson analysis revealed positive correlations between PⅡV and PⅢNP/CICP(r=0.458,r=0.533,P＜0.01)and between ΔCRP and PⅢNP/CICP(r=0.591,r=0.627,P＜0.01).The remodeling group had obviously higher PⅡV(400.81±71.73 vs 335.45±71.19,t=4.151,P＜0.01)and ΔCRP[1.19±0.30 mg/(L·h)vs 0.90±0.15 mg/(L·h),t=6.878,P＜0.01]than the non-remodeling group.Multivariate logistic regression analysis identified age(OR=3.196,95％CI:1.597～6.398,P＜0.01),coronary Gensini score(OR=1.966,95％CI:1.295～2.984,P＜0.01),PⅡV(OR=3.470,95％CI:1.621～7.427,P＜0.01),and ΔCRP(OR=2.889,95％CI:1.431～5.836,P＜0.01)as risk factors for postoperative remodeling,while out-hospital medication adherence was a protective factor(OR=0.489,95％CI:0.319～0.748,P＜0.01).ROC curve analysis showed an AUC value of PⅡV,ΔCRP and their combination in the prediction was 0.735,0.778 and 0.905,respectively,with the combined two indicators having better efficiency(P＜0.01).Conclusion PⅡV and ΔCRP are closely associated with myocardial fibrosis and postoperative ventricular remodeling in elderly AMI patients.Combined detection of these two markers can optimize risk stratification and provide critical insights for clinical intervention.

Abstract:Objective To compare the clinical efficacy of using edaravone dexmedetomidine at different times after intravenous thrombolysis in elderly patients with acute ischemic stroke(AIS).Methods A prospective study was conducted on 180 elderly AIS patients undergoing intravenous thrombolysis with recombinant tissue-type plasminogen activator in our department from April 2022 to December 2023.The patients were randomly divided into immediate group,12 h group and 24 h group,receiving an edaravone dexmedetomidine injection immediately and at 12 and 24 h after thrombolysis,respectively.During the study period,2 cases were excluded from both the immediate group and the 24 h group.NIHSS and MMSE were used to assess neurological function and cognitive function.The levels of TNF-α,IL-6 and hs-CRP were detected.The occurrence of complications after thrombolytic therapy was recorded in the three groups.Results The NIHSS scores of the three groups were significantly lower at 7 d after thrombolysis and 3 months after discharge than those before thrombolysis(P＜0.05).The scores of the immediate group were obviously lower than those of the 12 h and 24 h groups 7 d after thrombolysis,and 3 months after discharge,and the scores of the 12 h group were significantly lower than that of the 24 h group at 3 months after discharge(P＜0.05).The MMSE scores were significantly higher in the three groups at 7 d after thrombolysis and 3 months after discharge than before thrombolysis(P＜0.05).The MMSE scores of the immediate group were significantly higher than those of the 12 h and 24 h groups at 7 d after thrombolysis,and 3 months after discharge(P＜0.05),and the MMSE scores of the 12 h group were significantly higher at 7 d after thrombolysis,and 3 months after discharge than those of the 24 h group(P＜0.05).At 7 d after thrombolysis,the levels of TNF-α,IL-6,and hs-CRP were significantly decreased in the three groups than before thrombolysis(P＜0.05),and the levels were notably lower in the immediate group than the 12 h and 24 h groups,and in the 12 h group than the 24 h group(P＜0.05).The incidence of complications was significantly lower in the immediate group than the 12 and 24 h groups(P＜0.05).At 3 months after discharge,good prognosis was observed in 22 cases(37.93％)from the immediate group,11 cases(18.33％)from the 12 h group,and 10 cases(17.24％)from the 24 h group,and the rate of good prognosis was significantly higher the immediate group than the other two groups(x2 three groups=8.558,x2 immediate group vs.12h group=4.623,x2 immediate group vs.24h group=6.214,P＜0.05).Conclusion Immediately using edaravone dexmedetomidine as adjuvant therapy for AIS after thrombolysis is more effective than using in 12 and 24 h after thrombolysis,which can significantly attenuate inflammatory reactions,better restore neurological and cognitive functions,reduce the occurrence of complications,and improve their short-term prognosis.

Abstract:Objective To investigate the predictive value of geriatric nutritional risk index(GNRI)combined with CHA2DS2-VASc-60 score for short-term prognosis of elderly multimorbid patients with atrial fibrillation.Methods A total of 220 elderly multimorbid patients with non-valvular atrial fibrillation admitted to our hospital from May 2020 to December 2022 were recruited.Clinical data were collected,and GNRI and CHA2DS2-VASc-60 score were calculated.With 98 as a cut-off value of GNRI,the patients were divided into normal nutritional group(109 cases)and nutritional risk group(GNRI ≤ 98,111 cases).Clinical characteristics were compared between the two groups.Multivariate logistic regression analysis was used to identify the influencing factors for compound events in elderly multimorbid patients with atrial fibrillation.Variance inflation factor was adopted for collinearity diagnosis.ROC curve was plotted to evaluate the prognostic value of GNRI,CHA2DS2-VASc-60 score and their combination.Results Compared with the normal nutritional group,the nutritional risk group had significantly advanced age,higher CHA2DS2-VASc-60 score,and larger proportion of concomitant chronic heart failure(P＜0.05).Age(OR=1.228,95％CI:1.112～1.357),GNRI(OR=0.693,95％CI:0.494～0.997)and CHA2DS2-VASc-60 score(OR=1.488,95％CI:1.008～2.194)were influencing factors for the occurrence of complex events(P＜0.05,P＜0.01).The AUC value of GNRI,CHA2DS2-VASc-60 score,and their combination in predicting complex events at the end of 6 months was 0.665(95％CI:0.539～0.791),0.689(95％CI:0.578～0.801),and 0.749(95％CI:0.653～0.844),respectively(P＜0.05).Conclusion Age,GNRI,and CHA2DS2-VASc-60 score are influencing factors for the occurrence of complex events in elderly multimorbid patients with atrial fibrillation.The combination of GNRI and CHA2DS2-VASc-60 score has predictive value for the short-term prognosis of the patients.

Abstract:Objective To investigate the presumed correlation between lactate level and clearance during extracorporeal life support(ECLS)and death in elderly cardiac intensive care patients.Methods A total of 93 elderly cardiac intensive care patients who received ECLS in Department of Critical Care Medicine,Xiangya Medical College Affiliated Changsha Hospital,Central South University,from March 2019 to October 2024 were retrospectively included to manage low cardiac production syndrome after major cardiac surgery.According to hospital outcomes,the patients were divided into a death group(n=45)and a survival group(n=48).Blood lactate measurements were performed every 4 hours from the beginning of ECLS treatment to calculate peak lactate and lactate clearance rate(LCR).Routine ICU scores,such as sequential organ failure score(SOFA)and reactive organ dysfunction(ROD)score,and postoperative complications were recorded.Results The death group received larger amounts of packed red blood cell concentrate,fresh frozen plasma and platelet concentrate,and exhibited higher ratios of norepinephrine and epinephrine administration and higher incidences of re-thoracotomy and hemolytic episodes when compared with the survival group(P＜0.05,P＜0.01).At the end of ECLS,higher SOFA and ROD scores were observed in the death group(P＜0.01).The death group also demonstrated higher lactate level from venoarterial ECLS(P＜0.001)and increased median peak lactate level,but lower median LCR than the survival group(P＜0.01).Multivariate logistic analysis showed that peak lactate and LCR were independent prognostic factors in the elderly cardiac ICU patients(P＜0.05,P＜0.01).The AUC value(95％CI)of peak lactate and LCR in predicting patient outcomes was 0.723(95％CI:0.615-0.831)and 0.846(95％CI:0.761-0.932),respectively,and the value of their combination in predicting in-hospital death was 0.846(95％CI:0.762-0.931),with a sensitivity of 0.629 and a specificity of 0.937.Conclusion Lactate level and its clearance rate during ECLS can affect the survival rate of elderly cardiac intensive care patients.Peak lactate and LCR can predict the prognosis of elderly cardiac intensive care patients,and can be used as prognostic indicators for clinical monitoring.

Abstract:Objective To investigate the value of combination of echocardiographic(ECG)parameters and geriatric nutritional risk index(GNRI)in predicting the prognosis of elderly chronic heart failure(CHF).Methods A retrospective study was conducted on 102 elderly CHF patients admitted to our hospital from February 2023 to July 2024.According to their clinical outcomes after 6 months of follow-up,they were divided into a good prognosis group(67 cases)and a poor prognosis group(35 cases).The clinical data,such as left ventricular ejection fraction(LVEF),left ventricular end-diastolic inner diameter(LVEDD)and left ventricular end-systolic inner diameter(LVESD),and GNRI were compared between two groups.Logistic regression analysis was adopted to identify the influencing factors of prognosis of elderly CHF patients,and ROC curve was plotted to analyze the predictive efficiency of ECG parameters and GNRI for the prognosis.Results The poor prognosis group exhibited significantly advanced age,higher LVEDD and LVESD,longer course of CHF,and lower LVEF and GNRI in comparison with the good prognosis group(P＜0.01).Multivariate logistic regression analysis indicated that LVEF,LVEDD,LVESD and GNRI were identified as influencing factors for elderly CHF prognosis(P＜0.05,P＜0.01).In evaluating the poor prognosis,LVEF,LVEDD,LVESD,GNRI and their combination presented an AUC value of 0.854,0.773,0.785,0.850 and 0.902,respectively.The evaluation efficiency of combined detection was superior to that of single detection in assessing the poor prognosis in elderly CHF patients(P＜0.01).Conclusion ECG parameters and GNRI are related to the prognosis in elderly CHF patients,and combined detection has good evaluation efficiency for the poor prognosis.

Abstract:Objective To investigate the correlation between platelet-to-albumin ratio(PAR)and occurrence of cerebral infarction after left atrial appendage closure(LAAC)in patients with non-valvular atrial fibrillation(NVAF).Methods A retrospective study was conducted on 259 NVAF patients undergoing LAAC in our department between 2019 and 2023.According to occurrence of cerebral infarction after LAAC or not,they were divided into a control group(241 cases)and a study group(18 cases).Their general data were collected,and Cox proportional hazards regression model was used to identify the risk factors for cerebral infarction.ROC curve was plotted to assess the predictive value of PAR for cerebral infarction in NVAF patients after LAAC,and the AUC value was calculated.Kaplan-Meier survival curve was drawn to analyze the incidence of cerebral infarction after LAAC in NVAF patients with different PAR values.Results The study group had significantly advanced age,higher SBP at admission,increased WBC,neutrophil,monocyte and platelet counts,longer thrombin time,elevated international normalized ratio(INR)and high-sensitivity C-reactive protein(hs-CRP)level,and higher PAR than the control group(P＜0.05,P＜0.01).Multivariate Cox regression analysis showed that PAR(HR=2.286,95％CI:1.182-4.420,P＜0.05)was an independent risk factor for cerebral infarction in NVAF patients after LAAC.ROC curve indicated that the AUC value of PAR in predicting cerebral infarction after LAAC in NVAF patients was 0.721(95％CI:0.586-0.856,P＜0.01),with an optimal cut-off value of 4.137,a sensitivity of 66.39％,and a specificity of 77.78％.Kaplan-Meier survival curve revealed that the higher the PAR value was,the higher the risk of cerebral infarction was(P＜0.01).Conclusion PAR is significantly correlated with cerebral infarction in NVAF patients after LAAC.The higher the PAR,the higher the risk of cerebral infarction,demonstrating its predictive value and being worthy of clinical promotion.

Abstract:Objective To investigate the intervention effect of sacubitril/valsartan(Sac/Val)on doxorubicin-induced heart failure(HF)in rabbits and its regulative effect on the transforming growth factor β1(TGF-β1)/SMAD family member 3(Smad3)/connective tissue growth factor(CTGF)signaling pathway.Methods Thirty-eight male New Zealand rabbits were subjected,and 8 of them were randomly assigned into a control group.The other 30 rabbits were injected with doxorubicin to establish a rabbit HF model,and finally,there were 6 rabbits in a model group,7 in a valsartan group,and 7 in a Sac/Val group.After 8 weeks of intervention,echocardiography[left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)],and myocardial histopathologic observation(HE staining,Masson staining)were performed,and collogen volume fraction(CVF)was calculated.The levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP),soluble growth stimulation expressed gene 2(sST2),galectin-3(Gal-3)were detected.Activities of renin-angiotensin-aldosterone system(RAAS)and levels of atrial natriuretic peptide,B-type brain natriuretic peptide(BNP),cyclic guanosine monophosphate(cGMP)and protein kinase G(PKG)were measured.The expression of α-smooth muscle actin(α-SMA),typeⅠ collagen,TGF-β1,Smad3,recombinant SMAD family member 7(Smad7)and CTGF in the myocardial tissues were detected.Results Compared with the control group,the model group exhibited significantly lower LVEF and LVFS and decreased expression of Smad7,higher LVEDD and LVESD(P＜0.01).The CVF of each group was(7.15±0.82)％、(43.20±5.09)％、(29.53±4.05)％、(22.48±2.93)％.Valsartan and Sac/Val treatment resulted in obvious increases in LVEF and LVFS,up-regulation of Smad7,decreased in LVEDD,LVESD and CVF,reduced levels of NT-proBNP,sST2,Gal-3,AngⅡ,aldosterone,atrial natriuretic peptide,BNP,cGMP and PKG,and down-regulation of α-SMA,collagen I,TGF-β1,Smad3 and CTGF when compared with the model group(P＜0.01).Sac/Val treatment showed better effects in above indicators than simple valsartan treatment(P＜0.01).Conclusion Sac/Val can reduce myocardial fibrosis and improve cardiac function in doxorubicin-induced HF rabbits,which may be related to the dual inhibition of TGF-β1/Smad3/CTGF signaling pathway by upregulating atrial natriuretic peptide and BNP levels and blocking RAAS activation.

Abstract:Objective To predict the value of admission dehydration state combined with fluid accumulation index for post-operative prognosis in elderly patients with intracerebral hemorrhage(ICH).Methods A retrospective study was conducted on 320 elderly ICH patients receiving surgical treatment in Department of Neurosurgery and then admitted to its Intensive Care Unit of the Affiliated Hospital of North China University of Science and Technology from May 2023 to March 2024.According to the survival status at 30 d after onset,they were divided into a survival group(202 cases)and a death group(118 cases).Clinical data such as basic information,admission vital signs,laboratory indicators,and fluid supplementation were compared between the two groups.ROC curve was plotted.Results The death group exhibited significantly advanced age,more bleeding sites,higher 7-day fluid accumulation index,and larger proportions of ventricular rupture,midline displacement and admission dehydration status,but lower uric acid level than the the survival group(P＜0.05,P＜0.01).Binary logistic regression analysis showed that admission dehydration status and 7-day fluid accumulation index were risk factors for 30-day mortality in elderly ICH patients after surgery(P＜0.01).ROC curve analysis showed that the AUC value of admission dehydration status combined with 7-day fluid accumulation index in predicting 30-day death of elderly ICH patients after surgery was 0.774(95％CI:0.722-0.825),and that of the combination was better than that of each indicator alone(P＜0.05).Conclusion Hospital dehydration status combined with 7-day fluid accumulation index has the best effectiveness in predicting 30-day mortality in elderly ICH patients after surgical treatment.