Objective To analyze the current status of metabolic syndrome (MetS) and its influencing factors among physical examination population aged 60 years old and above in Chengdu, and to provide evidence for the screening and management of MetS in people aged 60 years old and above. Methods Retrospective analysis of the data of people aged 60 years old and above who participated in physical examination in the North District of the Department of Health Management of Sichuan Provincial People’s Hospital between January 2018 and December 2020. According to whether the elderly occurred to have MetS, they were divided into MetS group and non-MetS group, to observe the distribution of MetS in different genders and different age groups, and to analyze the influencing factors of MetS by multivariate logistic regression. Results A total of 10 335 elderly were enrolled, 2 769 cases (26.79%) in MetS group and 7 566 cases (73.21%) in non-MetS group. Except for gender and low-density lipoprotein cholesterol (LDL-C) (P>0.05), there were significant differences in other general data between the two groups (P<0.05). There was a statistically significant difference in the detection rate of MetS among different age groups (χ²=64.332, P<0.001). In MetS group, 951 cases (34.34%) of abdominal obesity, 716 cases (25.86%) of high fasting blood glucose (FBG), 1 938 cases (69.99%) of hypertension, 1 011 cases (36.51%) of high triglycerides (TG) and 303 cases (10.94%) of low high-density lipoprotein cholesterol (HDL-C) were detected. Except hypertension and high TG (P>0.05), there were statistically significant differences in the detection rates of abdominal obesity, high FBG and low HDL-C among different genders in MetS (P<0.05). Except hypertension (P<0.05), there was no significant difference in the detection rates of MetS abdominal obesity, high FBG, low HDL-C and high TG in different age groups (P>0.05). Logistic regression analysis showed that body mass index [odds ratio (OR)=1.055, 95% confidence interval (CI) (1.014, 1.097), P=0.008], systolic blood pressure [OR=1.032, 95%CI (1.027, 1.037), P<0.001], diastolic blood pressure [OR=0.992, 95%CI (0.985, 1.000), P=0.049], FBG [OR=1.853, 95%CI (1.764, 1.947), P<0.001], TG [OR=3.787, 95%CI (3.352, 4.278), P<0.001], hemoglobin [OR=0.991, 95%CI (0.986, 0.996), P<0.001], waist circumference [OR=1.158, 95%CI (1.141, 1.175), P<0.001], HDL-C [OR=0.243, 95%CI (0.170, 0.346), P<0.001], total cholesterol [OR=0.615, 95%CI (0.490, 0.773), P<0.001], LDL-C [OR=1.594, 95%CI (1.303, 1.948), P<0.001], and uric acid [OR=1.001, 95%CI (1.000, 1.002), P=0.042] were related to MetS. Conclusions The prevalence of MetS is high among people aged 60 years old and above who undergo physical examination. Routine screening should be carried out during physical examination to take measures to intervene the controllable risk factors, so as to improve the health level of the region.
Objective To assess safety and feasibility of laparoscopic gastrectomy in the elderly with gastric cancer. Methods From January 2010 to September 2014, 146 elderly (age ≥65 years old) patients with gastric cancer underwent radical operations in the Department of General Surgery, Guangdong Academy of Medical Sciences and Guangdong General Hospital were collected, then were divided into a laparoscopy-assisted radical gastrectomy (LAG group, n=40) and an open radical gastrectomy (OG group, n=106) according to the operative mode. The differences of intraoperative and postoperative situation, and the postoperative complications were analyzed between the LAG group and the OG group. Results ① The age, gender, body mass index, albumin, ASA grade, tumor location, differentiation degree, TNM stage, radical gastrectomy, and digestive tract anastomosis had no significant differences between the LAG group and the OG group (P>0.05). ② None of the patients died during the operative period and there was no significant difference in the mean number of retrieved lymph nodes between these two groups (P>0.05). In the aspects of the intraoperative blood loss, the first flatus time or the first feeding time, and the postoperative hospitalization stay in the LAG group were significantly less than those in the OG group (P<0.05). For the operative time, the OG group showed a distinctive advantage with a significantdifference than the LAG group (P<0.05). ③ The rate of postoperative complication in the LAG group and OG group was 10.0% (4/40) and 15.1% (16/106) respectively, and the difference was not significant (χ2=0.64, P=0.591), the grade of the Clavien-Dindo complications had no significant difference (χ2=0.63, P=0.592). ④ None of the patients died following operation in the LAG group and one case died in the OG group because of the respiratory and circulatory failure caused by the pulmonary embolism. Conclusion Preliminary results of limited cases in this study show that LAG in the elderly patients with gastric cancer could reduce intraoperative blood loss, shorten the first flatus time or the first feeding time, and postoperative hospitalization stay, could obtain same radical effect without increasing incidence of postoperative complications as compared with OG, so it is safety and feasible.
ObjectiveTo investigate the short- and medium-term effectiveness of percutaneous compression plate (PCCP) internal fixation for femoral neck fractures in the elderly.MethodsThe clinical data of 32 elderly patients with femoral neck fracture treated with PCCP internal fixation between January 2012 and January 2019 were retrospectively analyzed. All of them were traumatic fractures. The causes of injury were falling in 20 cases, traffic accident in 7 cases, and falling from height in 5 cases. According to Garden classification, there were 7 cases of type Ⅱ, 15 cases of type Ⅲ, and 10 cases of type Ⅳ; there were 12 cases with Singh index level Ⅳ, 14 cases with level Ⅴ, and 6 cases with level Ⅵ; the bone mineral density of femoral neck was 0.610-0.860 g/cm2 (mean, 0.713 g/cm2). The time from injury to operation was 3-14 days, with an average of 5.8 days. Patients began to weight-bear gradually within 3 days postoperatively. The operation time, intraoperative blood loss, hospitalization stay, fracture reduction (Garden alignment index), fracture healing, failure of internal fixation, femoral neck shortening, and osteonecrosis of the femoral head were observed; hip function recovery was evaluated by Harris score.ResultsThe operation time was 35-135 minutes (mean, 73.4 minutes), the intraoperative blood loss was 75-385 mL (mean, 116.4 mL), the hospitalization stay was 3-15 days (mean, 8.3 days). At 1 week after operation, the Garden alignment index of fracture reduction was grade Ⅰ in 25 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 1 case. One case of superficial infection of the incision occurred after operation, and no early complications such as deep vein thrombosis in the lower extremities, pulmonary embolism, or bedsores occurred. All the patients were followed up 2.1-4.0 years, with an average of 2.7 years. Except for 2 cases of delayed union (displaced trans-neck and subhead fractures), no nonunion of fracture and failure of internal fixation occurred, the fracture healing time was 4-8 months, with an average of 4.9 months. Femoral neck shortening occurred in 12 cases (37.5%); osteonecrosis of the femoral head occurred in 3 cases (9.4%), all of which were displaced trans-neck and subhead fractures, of which 2 cases received total hip arthroplasty and the other received conservative treatment. The Harris scores of the hip joint at 3 months, 2 years after operation and at last follow-up were significantly improved when compared with those before operation (P<0.05); there was no significant difference between each time point after operation (P>0.05). At last follow-up, the hip joint function was evaluated according to Harris score, the results were excellent in 15 cases, good in 12 cases, and fair in 5 cases, with an excellent and good rate of 84.4%. There was no significant difference in postoperative hip function composition among patients with different ages, Garden classification, Singh index, and Garden alignment index (P>0.05).ConclusionFor elderly patients with femoral neck fractures without severe osteoporosis and with relatively good physical conditions, PCCP internal fixation can achieve satisfactory short- and medium-term effectiveness, but there is a certain risk of osteonecrosis of the femoral head.
With the rapid development of information science and technology, the development of internet medical service is irresistible, forming a new situation of digital ecological environment of medical cloud service. However, reform and innovation of medical service mode have brought many problems and challenges to the elderly with low level of information literacy and difficult operation of information and intelligent applications on mobile phones, forming a “digital gap” with intelligent medicine. This paper analyzes the status quo of the digital divide in the elderly group, and classifies the elderly according to the pain and difficulty of the elderly wisdom, and then implements a series of online and offline aging adaptation to build a harmonious and humanistic care Internet plus medical service ecosystem for the elderly. The project is closely related to the physical and psychological transformation of the elderly, and can be used for reference.
ObjectiveTo explore the influence of sentinel lymph node (SLN) status on the prognosis of elderly breast cancer patients ≥70 years old, and to screen patients who may be exempted from sentinel lymph node biopsy (SLNB), so as to guide clinical individualized treatment for such patients. MethodsA retrospective analysis was made on 270 breast cancer patients aged ≥70 years old who underwent SLNB in the Affiliated Hospital of Southwest Medical University from 2012 to 2021. The clinicopathological characteristics of the total cases were compared according to the status of SLN. Kaplan-Meier method was used to draw the survival curve, and the influence of SLN status on the overall survival (OS) time, local recurrence (LR) and distant metastasis (DM) of patients were analyzed, and used log-rank to compare between groups. At the same time, the patients with hormone receptor (HR) positive were analyzed by subgroup. The differences between groups were compared by single factor χ2 test, and multivariate Cox regression model was used to analyze and determine the factors affecting OS, LR and DM of patients. ResultsThe age of 270 patients ranged from 70 to 95 years, with a median age of 74 years. One hundred and sixty-nine (62.6%) patients’ tumor were T2 stage. Invasive ductal carcinoma accounted for 83.0%, histological gradeⅡ accounted for 74.4%, estrogen receptor positive accounted for 78.1%, progesterone receptor positive accounted for 71.9%, and human epidermal growth factor receptor 2 negative accounted for 83.3%. The number of SLNs obtained by SLNB were 1-9, and the median was 3. SLN was negative in 202 cases (74.8%) and positive in 68 cases (25.2%). Thirty-five patients (13.0%) received axillary lymph node dissection. There was no significant difference in LR between the SLN positive group and the SLN negative group (P>0.05), but the SLN negative group had fewer occurrences of DM (P=0.001) and longer OS time (P=0.009) compared to the SLN positive group. The results of univariate and multivariate analysis suggest that the older the patient, the shorter the OS time and the greater the risk of DM. Analysis of HR positive subgroups showed that SLN status did not affect patient survival and prognosis, but age was still associated with poor OS time and DM. ConclusionsFor patients with invasive ductal carcinoma of breast in T1-T2 stage, HR positive, clinical axillary lymph nodes negative, and age ≥70 years old, SLNB may be exempted. According to the patient’s performance or tumor biological characteristics, patients who need systemic adjuvant chemotherapy may still consider SLNB.
ObjectiveTo explore the clinical value of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and LC combined with laparoscopiccommom bile duct exploration and primary sture (LBDEPS) in the treatment of cholecystolithiasis complicated with choledocholithiasis in the elderly (age more than 75 years old).MethodsThe elderly patients with cholecystolithiasis complicated with choledocholithiasis in the Tianyou Hospital Affiliated to Wuhan University of Science and Technology from March 1, 2018 to June 30, 2019 were retrospectively collected, then were designed into an ERCP combined with LC therapy group (ERCP+LC group) and a LC combined with LBDEPS therapy group (LC+LBDEPS group) according to the therapy methods. The operative indexes (total operation time, general anesthesia time, intraoperative bleeding volume, LC conversion to laparotomy) and postoperative indexes (conversion to ICU, use time of ventilator in the ICU, drainage tube indwelling time, ventilation time, time of getting out of bed, postoperative hospitalization time, total hospitalization time, total hospitalization costs, stone clearance rate, and complications) were compared between the two groups.ResultsIn this study, 67 patients were collected, including 35 patients in the ERCP+LC group and 32 patients in the LC+LBDEPS group. There were no significant differences between the two groups in the terms of baseline data, such as the patients’ gender, age, preoperative symptoms, preoperative complications, number of choledocholithiasis, maximum diameter of choledocholithiasis, and diameter of common bile duct, etc. (P>0.05). Compared with the LC+LBDEPS group, the ERCP+LC group had more advantages in the terms of the total operation time, general anesthesia time, intraoperative bleeding, rate of LC conversion to laparotomy, time of ventilator use in the ICU, postoperative ventilation time, postoperative time of getting out of bed, and drainage tube indwelling time (P<0.05). The others indexes had no significant differences between the two groups (P>0.05).ConclusionsAccording to the results of this study, therapeutic efficacy of ERCP+LC and LC+LBDEPS in treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis have no significant differences, but ERCP+LC therapy has more advantages than LC+LBDEPS in total operation time, general anesthesia time, intraoperative bleeding, LC conversion to laparotomy, postoperative recovery and so on, and appropriate operation mode might be selected according to specific situation of patients and local medical conditions.
ObjectiveTo compare the long-term survival of elderly patients with esophageal squamous cell carcinoma (ESCC) treated with surgical versus non-surgical treatment. MethodsA retrospective analysis was conducted on the clinical data of elderly patients aged ≥70 years with ESCC who underwent esophagectomy or radiotherapy/chemotherapy at Sichuan Cancer Hospital from January 2009 to September 2017. Patients were divided into a surgical group (S group) and a non-surgical group (NS group) according to the treatment method. The propensity score matching method was used to match the two groups of patients at a ratio of 1∶1, and the survival of the two groups before and after matching was analyzed. ResultsA total of 726 elderly patients with ESCC were included, including 552 males and 174 females, with 651 patients aged ≥70-80 years and 75 patients aged ≥80-90 years. There were 515 patients in the S group and 211 patients in the NS group. The median follow-up time was 60.8 months, and the median overall survival of the S group was 41.9 months [95%CI (35.2, 48.5)], while that of the NS group was only 24.0 months [95%CI (19.8, 28.3)]. The 1-, 3-, and 5-year overall survival rates of the S group were 84%, 54%, and 40%, respectively, while those of the NS group were 72%, 40%, and 30%, respectively [HR=0.689, 95%CI (0.559, 0.849), P<0.001]. After matching, 138 patients were included in each group, and there was no statistical difference in the overall survival between the two groups [HR=0.871, 95%CI (0.649, 1.167), P=0.352]. ConclusionCompared with conservative treatment, there is no significant difference in the long-term survival of elderly patients aged ≥70 years who undergo esophagectomy for ESCC. Neoadjuvant therapy combined with surgery is still an important choice to potentially improve the survival of elderly patients with ESCC.
Esophageal cancer (EC) is the eighth dangerous cancer in the world. As the global population ages, the management of elderly patients with EC poses a challenge as they have many aging-associated diseases and physiological changes. In addition, the data on the tolerability of cancer treatment and the use of combined therapies in the patients to guide their treatment are limited. In this paper, we reviewed the literatures and discussed the effect of surgical resection and the potential complications of elderly patients. We reviewed the basic principles of combined therapy and the potential benefits of chemotherapy or chemoradiotherapy for patients and focused on the management of elderly patients with EC as well as the role of comprehensive assessment for aging to provide treatment options for elderly patients.
摘要:目的:探讨老年人股骨粗隆间骨折不同手术方式的选择。方法:我院2004年1月至2007年12月间应用不同术式治疗老年股骨粗隆间骨折110例,其中动力髋螺钉(DHS)25例, 股骨近端髓内钉(PFN)41例,人工股骨头置换44例。术后所有患者均获随访,平均12.6个月。对术后并发症和按照Kuderna 改良 Merli D’Aubigne标准得到的髋关节功能恢复优良数(率)进行评价。结果:术后出现并发症3例,其中PFN术式2例;人工股骨头置换术式1例。围手术期内无伤口感染,无死亡病例。三种术式总体优良数(率)为:107(97.3%)。结论:三种手术方式各有其优缺点,没有一种术式能普遍适用于各种类型粗隆间骨折,临床上,为了最大限度降低手术风险,我们没有必要专注或偏好于某一种手术方式,要根据患者的个体差异及每种术式的优缺点,灵活地为每例股骨粗隆间骨折患者制定出其最适宜的手术方式,大都能取得满意的疗效。Abstract: Objective: To investigate the chosen of 3 different surgical methods in the treatment of intertrochanteric femoral fractures in the elderly. Methods:From January, 2004 to December, 2007, 110 cases with the femoral intertrochanteric fractures in the elderly were treated with the followed 3 kinds of operations respectively:dynamic hip screw (25 cases), proximal femoral nail (41 cases), hip hemiarthroplasty (44 cases). After surgery all patients were followed up; Followedup period range from 6 months to 18 months(average 12.6 months). The good and excellent number (rate) of 3 surgical methods with Merli D’Aubigne evaluation criteria were evaluated, and compared in the postoperative complications. Results: 3 complications occurred postoperatively ( 2 with PFN,1 with hip hemiarthroplasty), none wound infection or died in Perioperatie. The total good successful number (rate) was 107(97.3%). Conclusion:Each has its advantages and its disadvantages. None of three kinds of surgical methods can be used generally all kinds of the femoral intertrochanter fracture. In clinical work, we don not need to focus on or prefer to the only one of them in order to minimize the risk. The good response to treatment will be get if we can choose the appropriate method according to the individual differences of the advantages and disadvantages of each method.
Objective To retrieve and summarize the best evidence for fall prevention after total hip arthroplasty in elderly patients. Methods BMJ Best Practice, UpToDate, JBI evidence-based healthcare center database, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, Cochrane Library, PubMed, Web of Science, EBSCO, International Collaboration of Orthopaedic Nurisng website, American Academy of Orthopaedic Surgeons website, European Society for Trauma and Emergency Surgery website, Medlive, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were systematically searched. The retrieval time was from the establishment of the databases to June 30, 2024. The quality of literature was evaluated, and evidence was extracted, evaluated, and summarized. Results A total of 12 articles were included, including 4 guidelines, 2 randomized controlled trials, 2 cohort studies, and 4 expert consensus studies. A total of 18 pieces of evidence were extracted, including 13 A-level recommendations and 5 B-level recommendations. The evidence covers six major themes of risk factors, assessment, multidisciplinary team support, health education, medication management, safety environment, and assistive devices. Conclusions The fall prevention after total hip arthroplasty in elderly patients involves multiple factors, and the fall prevention should be based on multidisciplinary team cooperation, achieving linkage between the hospital and the family to jointly ensure patient safety. In the future, it is recommended to combine individual patient differences with actual clinical scenarios when applying evidence.