Fan Liu, Huan Yu, Qing Xu, Jianwei Gong, Ming Huo, Fei Huang
Response to Letter in regards to Risk Assessment of Falls Among Older Adults Based on Probe Reaction Time During Water-Carrying Walking [Letter]
对 "基于提水行走时探针反应时间的老年人跌倒风险评估 "信函的回复[信函］
{"title":"Author Response to Letter to the Editor Regarding “Risk Assessment of Falls Among Older Adults Based on Probe Reaction Time During Water-Carrying Walking” [Response to Letter]","authors":"Fan Liu, Huan Yu, Qing Xu, Jianwei Gong, Ming Huo, Fei Huang","doi":"10.2147/cia.s460426","DOIUrl":"https://doi.org/10.2147/cia.s460426","url":null,"abstract":"Response to Letter in regards to Risk Assessment of Falls Among Older Adults Based on Probe Reaction Time During Water-Carrying Walking [Letter]","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"58 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139509318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Letter for the article Risk Assessment of Falls Among Older Adults Based on Probe Reaction Time During Water-Carrying Walking
致信《基于提水行走时探头反应时间的老年人跌倒风险评估》一文
{"title":"Risk Assessment of Falls Among Older Adults Based on Probe Reaction Time During Water-Carrying Walking [Letter]","authors":"Vernando Yanry Lameky","doi":"10.2147/cia.s458532","DOIUrl":"https://doi.org/10.2147/cia.s458532","url":null,"abstract":"Letter for the article Risk Assessment of Falls Among Older Adults Based on Probe Reaction Time During Water-Carrying Walking","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"13 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139497848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To explore the predictive value of nutritional risk for all-cause death and functional outcomes among elderly acute stroke patients. Patients and Methods: A total of 479 elderly acute stroke patients were enrolled in this study. The nutritional risk of patients was screened by the GNRI and NRS-2002. The primary outcome was all-cause death, and the secondary outcome was poor prognosis defined as a modified Rankin Scale (mRS) score ≥ 3. Results: Based on the NRS-2002, patients with nutritional risk had a higher risk of all-cause death at 3 months (adjusted OR: 3.642, 95% CI 1.046~12.689) and at 3 years (adjusted OR: 2.266, 95% CI 1.259~4.076) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 2.748, 95% CI 1.518~4.972. Based on the GNRI, compared to those without nutritional risk, patients with mild malnutrition also had a higher risk of all-cause death at 3 months (adjusted OR: 7.186, 95% CI 1.550~33.315) and at 3 years (adjusted OR: 2.255, 95% CI 1.211~4.199) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 1.947, 95% CI 1.030~3.680), so patients with moderate and severe malnutrition had a higher risk of all-cause death at 3 months (adjusted OR: 6.535, 95% CI 1.380~30.945) and at 3 years (adjusted OR: 2.498, 95% CI 1.301~4.799) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 2.213, 95% CI 1.144~4.279). Conclusion: Nutritional risk increases the risk of poor short-term and long-term outcomes in elderly patients with acute stroke. For elderly stroke patients, we should pay attention to early nutritional risk screening, and effective intervention should be provided to improve the prognosis of such patients.
目的：探讨营养风险对老年急性脑卒中患者全因死亡和功能预后的预测价值：本研究共纳入 479 名老年急性脑卒中患者。患者和方法：本研究共纳入 479 名老年急性脑卒中患者，通过 GNRI 和 NRS-2002 筛选患者的营养风险。主要结果为全因死亡，次要结果为不良预后，即改良Rankin量表（mRS）评分≥3：根据 NRS-2002，营养风险患者 3 个月时全因死亡风险较高（调整 OR：3.642，95% CI 1.046~12.689），3 年时全因死亡风险较高（调整 OR：2.266，95% CI 1.259~4.076），3 个月时不良功能预后风险较高（调整 OR：2.748，95% CI 1.518~4.972）。根据 GNRI，与无营养风险的患者相比，轻度营养不良患者 3 个月时全因死亡的风险更高（调整 OR：7.186，95% CI 1.550~33.315），3 年时全因死亡的风险更高（调整 OR：2.255，95% CI 1.211~4.199），3 个月时出现不良功能预后的风险更高（调整 OR：1.947，95% CI 1.030~3.680），因此中度和重度营养不良患者3个月时全因死亡风险更高（调整后OR：6.535，95% CI 1.380~30.945），3年时全因死亡风险更高（调整后OR：2.498，95% CI 1.301~4.799），3个月时不良功能结局风险更高（调整后OR：2.213，95% CI 1.144~4.279）：结论：营养风险会增加老年急性卒中患者短期和长期不良预后的风险。对于老年脑卒中患者，我们应重视早期营养风险筛查，并提供有效干预以改善此类患者的预后。 关键词：急性脑卒中；营养不良；营养筛查；全因死亡；GNRI；NRS-2002
{"title":"Predictive Value of Nutritional Risk for All-Cause Death and Functional Outcomes in Chinese Elderly Patients with Acute Stroke: A 3-Year Follow-Up Study","authors":"Wen-Jie Cong, Zhi-Peng Liu, Yi-Xin Liang, Sheng-Lie Ye, Zhong-Ming Cai, Hao-Man Chen, Cheng-Wei Liao, Qun-Li Lin, Ren-Qian Feng, Xu-Dong Zhou, Yan-Zhi Wu, Le-Qiu Sun, Xue-Rong Huang, Man-Man Zhang, Gui-Qian Huang, Bei-Lei Zhu","doi":"10.2147/cia.s447038","DOIUrl":"https://doi.org/10.2147/cia.s447038","url":null,"abstract":"<strong>Purpose:</strong> To explore the predictive value of nutritional risk for all-cause death and functional outcomes among elderly acute stroke patients.<br/><strong>Patients and Methods:</strong> A total of 479 elderly acute stroke patients were enrolled in this study. The nutritional risk of patients was screened by the GNRI and NRS-2002. The primary outcome was all-cause death, and the secondary outcome was poor prognosis defined as a modified Rankin Scale (mRS) score ≥ 3.<br/><strong>Results:</strong> Based on the NRS-2002, patients with nutritional risk had a higher risk of all-cause death at 3 months (adjusted OR: 3.642, 95% CI 1.046~12.689) and at 3 years (adjusted OR: 2.266, 95% CI 1.259~4.076) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 2.748, 95% CI 1.518~4.972. Based on the GNRI, compared to those without nutritional risk, patients with mild malnutrition also had a higher risk of all-cause death at 3 months (adjusted OR: 7.186, 95% CI 1.550~33.315) and at 3 years (adjusted OR: 2.255, 95% CI 1.211~4.199) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 1.947, 95% CI 1.030~3.680), so patients with moderate and severe malnutrition had a higher risk of all-cause death at 3 months (adjusted OR: 6.535, 95% CI 1.380~30.945) and at 3 years (adjusted OR: 2.498, 95% CI 1.301~4.799) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 2.213, 95% CI 1.144~4.279).<br/><strong>Conclusion:</strong> Nutritional risk increases the risk of poor short-term and long-term outcomes in elderly patients with acute stroke. For elderly stroke patients, we should pay attention to early nutritional risk screening, and effective intervention should be provided to improve the prognosis of such patients.<br/><br/><strong>Keywords:</strong> acute stroke, malnutrition, nutritional screening, all-cause death, GNRI, NRS-2002<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139482078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To investigate the correlation between specific fiber tracts and grip strength and cognitive function in patients with Alzheimer’s disease (AD) by fixel-based analysis (FBA). Methods: AD patients were divided into AD with low grip strength (AD-LGS, n=29) and AD without low grip strength (AD-nLGS, n=25), along with 31 normal controls (NC). General data, neuropsychological tests, grip strength and cranial magnetic resonance imaging (MRI) scans were collected. FBA evaluated white matter (WM) fiber metrics, including fiber density (FD), fiber cross-sectional (FC), and fiber density and cross-sectional area (FDC). The mean fiber indicators of the fiber tracts of interest (TOI) were extracted in cerebral region of significant statistical differences in FBA to further compare the differences between groups and analyze the correlation between fiber properties and neuropsychological test scores. Results: Compared to AD-nLGS group, AD-LGS group showed significant reductions in FDC in several cerebral regions. In AD patients, FDC values of bilateral uncinate fasciculus and left superior longitudinal fasciculus were positively correlated with Clock Drawing Test scores, while FDC of splenium of corpus callosum, bilateral anterior cingulate tracts, forceps major, and bilateral inferior longitudinal fasciculus were positively correlated with the Executive Factor Score of Memory and Executive Screening scale scores. Conclusion: Reduced grip strength in AD patients is associated with extensive impairment of WM structural integrity. Changes in FDC of specific WM fiber tracts related to executive function play a significant mediating role in the reduction of grip strength in AD patients.
Keywords: Alzheimer disease, grip strength, white matter, fixel-based analysis, cognition function
{"title":"Bridging Reduced Grip Strength and Altered Executive Function: Specific Brain White Matter Structural Changes in Patients with Alzheimer’s Disease","authors":"Shan-Wen Liu, Xiao-Ting Ma, Shuai Yu, Xiao-Fen Weng, Meng Li, Jiangtao Zhu, Chun-Feng Liu, Hua Hu","doi":"10.2147/cia.s438782","DOIUrl":"https://doi.org/10.2147/cia.s438782","url":null,"abstract":"<strong>Objective:</strong> To investigate the correlation between specific fiber tracts and grip strength and cognitive function in patients with Alzheimer’s disease (AD) by fixel-based analysis (FBA).<br/><strong>Methods:</strong> AD patients were divided into AD with low grip strength (AD-LGS, n=29) and AD without low grip strength (AD-nLGS, n=25), along with 31 normal controls (NC). General data, neuropsychological tests, grip strength and cranial magnetic resonance imaging (MRI) scans were collected. FBA evaluated white matter (WM) fiber metrics, including fiber density (FD), fiber cross-sectional (FC), and fiber density and cross-sectional area (FDC). The mean fiber indicators of the fiber tracts of interest (TOI) were extracted in cerebral region of significant statistical differences in FBA to further compare the differences between groups and analyze the correlation between fiber properties and neuropsychological test scores.<br/><strong>Results:</strong> Compared to AD-nLGS group, AD-LGS group showed significant reductions in FDC in several cerebral regions. In AD patients, FDC values of bilateral uncinate fasciculus and left superior longitudinal fasciculus were positively correlated with Clock Drawing Test scores, while FDC of splenium of corpus callosum, bilateral anterior cingulate tracts, forceps major, and bilateral inferior longitudinal fasciculus were positively correlated with the Executive Factor Score of Memory and Executive Screening scale scores.<br/><strong>Conclusion:</strong> Reduced grip strength in AD patients is associated with extensive impairment of WM structural integrity. Changes in FDC of specific WM fiber tracts related to executive function play a significant mediating role in the reduction of grip strength in AD patients.<br/><br/><strong>Keywords:</strong> Alzheimer disease, grip strength, white matter, fixel-based analysis, cognition function<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"211 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139475681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aims: Non-valvular atrial fibrillation (NVAF) patients face a 3– 5 times greater risk of acute ischemic stroke (AIS) compared to those without NVAF. This study aims to establish a novel clinical prediction model for AIS in elderly patients with NVAF by incorporating relevant biomarker indicators. Methods: A total of 301 individuals diagnosed with NVAF were selected for this investigation at the Third Affiliated Hospital of Anhui Medical University. Based on the presence of AIS, patients were categorized into two groups: the Stroke Cohort and the Non-Stroke Cohort. Predictor screening was performed using the least absolute shrinkage and selection operation (LASSO) regression algorithm. The binary logistic regression equation was applied to fit the model, followed by internal validation using the bootstrap resampling method (1000 times). Receiver operating characteristic (ROC) curve, calibration degree curve plots, and clinical decision curve analysis (DCA) were generated, respectively. Finally, a nomogram was constructed to present the prediction model. Results: The final results of this study revealed that neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), lipoprotein(a) (Lp(a)), systolic pressure, history of stroke, hyperlipidemia were independent risk factors for AIS in elderly patients with NVAF (P< 0.05). And the high-density lipoprotein cholesterol (HDL-C) was an independent protective factor (P< 0.05). By incorporating these indicators, a nomogram prediction model for predicting AIS in elderly patients with NVAF was constructed. Comparative analysis between the nomogram predictive model and CHA2DS2-VASc score revealed that the AUC of the nomogram predictive model surpassed that of the CHA2DS2-VASc score (AUC: 0.881vs 0.850). Conclusion: NLR, RDW, Lp(a), SP, history of stroke, hyperlipidemia, and HDL-C emerge as independent prognostic factors for acute ischemic stroke in elderly patients with non-valvular atrial fibrillation. The predictive utility of the nomogram model may potentially surpass that of the CHA2DS2-VASc scoring system.
{"title":"Development and Validation of a New Nomogram Model for Predicting Acute Ischemic Stroke in Elderly Patients with Non-Valvular Atrial Fibrillation: A Single-Center Cross-Sectional Study","authors":"Jiongchao Guo, Yuan Zhou, Bingfeng Zhou","doi":"10.2147/cia.s437065","DOIUrl":"https://doi.org/10.2147/cia.s437065","url":null,"abstract":"<strong>Background and Aims:</strong> Non-valvular atrial fibrillation (NVAF) patients face a 3– 5 times greater risk of acute ischemic stroke (AIS) compared to those without NVAF. This study aims to establish a novel clinical prediction model for AIS in elderly patients with NVAF by incorporating relevant biomarker indicators.<br/><strong>Methods:</strong> A total of 301 individuals diagnosed with NVAF were selected for this investigation at the Third Affiliated Hospital of Anhui Medical University. Based on the presence of AIS, patients were categorized into two groups: the Stroke Cohort and the Non-Stroke Cohort. Predictor screening was performed using the least absolute shrinkage and selection operation (LASSO) regression algorithm. The binary logistic regression equation was applied to fit the model, followed by internal validation using the bootstrap resampling method (1000 times). Receiver operating characteristic (ROC) curve, calibration degree curve plots, and clinical decision curve analysis (DCA) were generated, respectively. Finally, a nomogram was constructed to present the prediction model.<br/><strong>Results:</strong> The final results of this study revealed that neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), lipoprotein(a) (Lp(a)), systolic pressure, history of stroke, hyperlipidemia were independent risk factors for AIS in elderly patients with NVAF (<em>P</em>< 0.05). And the high-density lipoprotein cholesterol (HDL-C) was an independent protective factor (<em>P</em>< 0.05). By incorporating these indicators, a nomogram prediction model for predicting AIS in elderly patients with NVAF was constructed. Comparative analysis between the nomogram predictive model and CHA2DS2-VASc score revealed that the AUC of the nomogram predictive model surpassed that of the CHA2DS2-VASc score (AUC: 0.881vs 0.850).<br/><strong>Conclusion:</strong> NLR, RDW, Lp(a), SP, history of stroke, hyperlipidemia, and HDL-C emerge as independent prognostic factors for acute ischemic stroke in elderly patients with non-valvular atrial fibrillation. The predictive utility of the nomogram model may potentially surpass that of the CHA2DS2-VASc scoring system.<br/><br/><strong>Keywords:</strong> acute ischemic stroke, non-valvular atrial fibrillation, nomogram, clinical risk prediction model<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"17 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139413551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lijun Zuo, Yanhong Dong, Xiaoling Liao, Yang Hu, Yuesong Pan, Hongyi Yan, Xingao Wang, Xingquan Zhao, Yilong Wang, Raymond CS Seet, Yongjun Wang, Zixiao Li
Objective: The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is a novel indicator that measures systemic inflammation and nutritional status that has not been correlated with the risk of post-stroke cognitive impairment in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods: Study participants were recruited from 40 stroke centers in China. The HALP score was derived using a weighted sum of hemoglobin, albumin, lymphocytes and platelets, and study participants were categorized into 4 groups of equal sizes based on quartiles cutoffs of the HALP score. The Montreal Cognitive Assessment (MoCA)-Beijing Cognitive Assessment Scale (MoCA-Beijing) was performed at 2 weeks and 12 months following stroke onset. Post-stroke cognitive impairment was considered in patients with MoCA-Beijing≤ 22. Multiple logistic regression methods were employed to evaluate the relationship between the HALP score and the subsequent risk of developing post-stroke cognitive impairment. Results: The study population comprised 1022 patients (mean age 61.6± 11.0 years, 73% men). The proportion of individuals with MoCA-Beijing≤ 22 at 2 weeks was 49.2% and 32.4% at one year. Patients in the lowest quartile of HALP score (< 36.56) were observed to harbor the highest risk of post-stroke cognitive impairment at 12 months post-stroke/TIA compared to those in the highest quartile (odds ratio=1.59, 95% CI=1.07– 2.37, p=0.022), and lower domain scores for executive function, naming, and attention. There were no statistically significant differences between patients in the different quartiles of HALP score and HALP score at 2 weeks post-stroke/TIA. Conclusion: The HALP score is a simple score that could stratify the risk of post-stroke cognitive impairment in stroke/TIA patients to facilitate early diagnosis and interventions.
{"title":"Low HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) Score Increases the Risk of Post-Stroke Cognitive Impairment: A Multicenter Cohort Study","authors":"Lijun Zuo, Yanhong Dong, Xiaoling Liao, Yang Hu, Yuesong Pan, Hongyi Yan, Xingao Wang, Xingquan Zhao, Yilong Wang, Raymond CS Seet, Yongjun Wang, Zixiao Li","doi":"10.2147/cia.s432885","DOIUrl":"https://doi.org/10.2147/cia.s432885","url":null,"abstract":"<strong>Objective:</strong> The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is a novel indicator that measures systemic inflammation and nutritional status that has not been correlated with the risk of post-stroke cognitive impairment in patients with acute ischemic stroke or transient ischemic attack (TIA).<br/><strong>Methods:</strong> Study participants were recruited from 40 stroke centers in China. The HALP score was derived using a weighted sum of hemoglobin, albumin, lymphocytes and platelets, and study participants were categorized into 4 groups of equal sizes based on quartiles cutoffs of the HALP score. The Montreal Cognitive Assessment (MoCA)-Beijing Cognitive Assessment Scale (MoCA-Beijing) was performed at 2 weeks and 12 months following stroke onset. Post-stroke cognitive impairment was considered in patients with MoCA-Beijing≤ 22. Multiple logistic regression methods were employed to evaluate the relationship between the HALP score and the subsequent risk of developing post-stroke cognitive impairment.<br/><strong>Results:</strong> The study population comprised 1022 patients (mean age 61.6± 11.0 years, 73% men). The proportion of individuals with MoCA-Beijing≤ 22 at 2 weeks was 49.2% and 32.4% at one year. Patients in the lowest quartile of HALP score (< 36.56) were observed to harbor the highest risk of post-stroke cognitive impairment at 12 months post-stroke/TIA compared to those in the highest quartile (odds ratio=1.59, 95% CI=1.07– 2.37, p=0.022), and lower domain scores for executive function, naming, and attention. There were no statistically significant differences between patients in the different quartiles of HALP score and HALP score at 2 weeks post-stroke/TIA.<br/><strong>Conclusion:</strong> The HALP score is a simple score that could stratify the risk of post-stroke cognitive impairment in stroke/TIA patients to facilitate early diagnosis and interventions.<br/><br/><strong>Keywords:</strong> mild stroke, post stroke cognitive impairment, hemoglobin, albumin, lymphocyte, platelet<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"17 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139413609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yu Sun, Haixiang Miao, Han Gong, Yaxin Zhang, Weishi Hong
Background: Total hip arthroplasty (THA) has become the first-choice treatment for elderly patients with end-stage hip disease. The high amount of hidden blood loss (HBL) in overweight and obese patients after THA not only affects rapid recovery, but also results in a greater economic burden. We aimed to identify risk factors that contribute to elevated HBL in overweight and obese patients after THA by retrospective analysis, and establish a nomogram prediction model for massive HBL in overweight and obese patients after THA. Methods: A total of 505 overweight and obese patients treated with THA were included and randomly divided into modeling and validation sets according to a 7:3 ratio. The demographic and relevant clinical data of the patients were collected. The independent risk factors affecting HBL after THA in overweight and obese patients were obtained by Pearson, independent sample T-test, and multiple linear regression analyses. R software was used to establish a nomogram prediction model for postoperative HBL, as well as a receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results: HBL was 911± 438 mL, accounting for 79.5± 13.1% of the total perioperative blood loss (1104± 468 mL). A multiple linear regression analysis showed that HBL was associated with necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels. The areas under the ROC curve (AUC) for the modeling and validation sets were 0.751 and 0.736, respectively, while the slope of the calibration curve was close to 1. The DCA curve demonstrated a better net benefit at a risk of HBL ≥ 1000 ml in both the training and validation groups. Conclusion: HBL was an important component of total blood loss (TBL) after THA in overweight and obese patients. Necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels were independent risk factors for postoperative HBL in these patients. The predictive model constructed based these data had better discriminatory power and accuracy, and could result in better net benefit for patients.
{"title":"Risk Factors Analysis and Nomogram Model Establishment of Hidden Blood Loss in Overweight and Obese Elderly Patients After Total Hip Arthroplasty","authors":"Yu Sun, Haixiang Miao, Han Gong, Yaxin Zhang, Weishi Hong","doi":"10.2147/cia.s428307","DOIUrl":"https://doi.org/10.2147/cia.s428307","url":null,"abstract":"<strong>Background:</strong> Total hip arthroplasty (THA) has become the first-choice treatment for elderly patients with end-stage hip disease. The high amount of hidden blood loss (HBL) in overweight and obese patients after THA not only affects rapid recovery, but also results in a greater economic burden. We aimed to identify risk factors that contribute to elevated HBL in overweight and obese patients after THA by retrospective analysis, and establish a nomogram prediction model for massive HBL in overweight and obese patients after THA.<br/><strong>Methods:</strong> A total of 505 overweight and obese patients treated with THA were included and randomly divided into modeling and validation sets according to a 7:3 ratio. The demographic and relevant clinical data of the patients were collected. The independent risk factors affecting HBL after THA in overweight and obese patients were obtained by Pearson, independent sample <em>T</em>-test, and multiple linear regression analyses. R software was used to establish a nomogram prediction model for postoperative HBL, as well as a receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).<br/><strong>Results:</strong> HBL was 911± 438 mL, accounting for 79.5± 13.1% of the total perioperative blood loss (1104± 468 mL). A multiple linear regression analysis showed that HBL was associated with necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels. The areas under the ROC curve (AUC) for the modeling and validation sets were 0.751 and 0.736, respectively, while the slope of the calibration curve was close to 1. The DCA curve demonstrated a better net benefit at a risk of HBL ≥ 1000 ml in both the training and validation groups.<br/><strong>Conclusion:</strong> HBL was an important component of total blood loss (TBL) after THA in overweight and obese patients. Necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels were independent risk factors for postoperative HBL in these patients. The predictive model constructed based these data had better discriminatory power and accuracy, and could result in better net benefit for patients.<br/><br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"3 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139413815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne Lise Meulenbroek, Ewout W Steyerberg, Ties L Janssen, Stefanie R van Mil, Miriam C Faes, Lijckle van der Laan
<strong>Objective:</strong> Delirium is a common and serious postoperative complication in elderly patients undergoing abdominal aortic aneurysm (AAA) repair and is associated with a variety of adverse outcomes. Multimodal prehabilitation aims to identify and minimize potential risk factors for delirium and improve overall health. The aim of this study is to investigate the effect of multimodal prehabilitation on delirium incidence in elderly patients undergoing elective repair for AAA.<br/><strong>Methods:</strong> A single-centre cohort analysis was performed in the Netherlands for patients aged ≥ 70 years, undergoing elective repair for AAA (open surgery and endovascular aortic repair). Prehabilitation was gradually introduced between 2016 and 2019 and offered as standard care from 2019. The program was constructed to optimize overall health and included delirium risk assessment, home-based tailor-made exercises by a physical therapist, nutritional optimization by a dietician, iron infusion in case of anaemia and a comprehensive geriatric assessment by a geriatrician in case of frailty. The primary outcome was incidence of delirium within 30 days after surgery.<br/><strong>Results:</strong> A total of 81 control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (11.1% in the control group to 4.9% in the prehabilitation group), with too small numbers to reach statistical significance (p=0.09). Also, patients in the prehabilitation group had a small, non-significant decreased length of hospital stay (4 days) compared to the control group (5 days) (p=0.07).<br/><strong>Conclusion:</strong> Although no significant differences were found, we carefully conclude that this study provides some support for implementing multimodal prehabilitation for delirium prevention in elderly patients undergoing AAA repair. Further research with larger cohorts is necessary to identify and select patients that would most benefit from prehabilitation.<br/><br/><strong>Plain Language Summary:</strong> Delirium is a common complication in elderly patients after undergoing abdominal aortic aneurysm (AAA) repair. Delirium is associated with a prolonged hospital-stay, decreased quality of life and increased mortality. To prevent delirium it is important to identify possible risk factors and assess the patients’ overall fitness. This is best done preoperatively, since the patient is not yet recovering from a major surgery. This is called “prehabilitation”.<br/>In this study, we investigated the effect of multimodal prehabilitation in patients undergoing surgery for an AAA. The program consists of:Individual delirium risk-assessment,Personalized home-based tailor-made exercises,Nutritional optimization,Iron infusion in case of anaemia, andA comprehensive geriatric assessment by a geriatrician in case of frailty.<br/>Eighty-one control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (1
{"title":"The Potential Value of Prehabilitation for Preventing Delirium in Elective Surgery for Aneurysms of the Abdominal Aorta","authors":"Anne Lise Meulenbroek, Ewout W Steyerberg, Ties L Janssen, Stefanie R van Mil, Miriam C Faes, Lijckle van der Laan","doi":"10.2147/cia.s420861","DOIUrl":"https://doi.org/10.2147/cia.s420861","url":null,"abstract":"<strong>Objective:</strong> Delirium is a common and serious postoperative complication in elderly patients undergoing abdominal aortic aneurysm (AAA) repair and is associated with a variety of adverse outcomes. Multimodal prehabilitation aims to identify and minimize potential risk factors for delirium and improve overall health. The aim of this study is to investigate the effect of multimodal prehabilitation on delirium incidence in elderly patients undergoing elective repair for AAA.<br/><strong>Methods:</strong> A single-centre cohort analysis was performed in the Netherlands for patients aged ≥ 70 years, undergoing elective repair for AAA (open surgery and endovascular aortic repair). Prehabilitation was gradually introduced between 2016 and 2019 and offered as standard care from 2019. The program was constructed to optimize overall health and included delirium risk assessment, home-based tailor-made exercises by a physical therapist, nutritional optimization by a dietician, iron infusion in case of anaemia and a comprehensive geriatric assessment by a geriatrician in case of frailty. The primary outcome was incidence of delirium within 30 days after surgery.<br/><strong>Results:</strong> A total of 81 control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (11.1% in the control group to 4.9% in the prehabilitation group), with too small numbers to reach statistical significance (p=0.09). Also, patients in the prehabilitation group had a small, non-significant decreased length of hospital stay (4 days) compared to the control group (5 days) (p=0.07).<br/><strong>Conclusion:</strong> Although no significant differences were found, we carefully conclude that this study provides some support for implementing multimodal prehabilitation for delirium prevention in elderly patients undergoing AAA repair. Further research with larger cohorts is necessary to identify and select patients that would most benefit from prehabilitation.<br/><br/><strong>Plain Language Summary:</strong> Delirium is a common complication in elderly patients after undergoing abdominal aortic aneurysm (AAA) repair. Delirium is associated with a prolonged hospital-stay, decreased quality of life and increased mortality. To prevent delirium it is important to identify possible risk factors and assess the patients’ overall fitness. This is best done preoperatively, since the patient is not yet recovering from a major surgery. This is called “prehabilitation”.<br/>In this study, we investigated the effect of multimodal prehabilitation in patients undergoing surgery for an AAA. The program consists of:Individual delirium risk-assessment,Personalized home-based tailor-made exercises,Nutritional optimization,Iron infusion in case of anaemia, andA comprehensive geriatric assessment by a geriatrician in case of frailty.<br/>Eighty-one control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (1","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"8 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139396204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fan Liu, Huan Yu, Qing Xu, Jianwei Gong, Ming Huo, Fei Huang
Purpose: Falls are a significant factor affecting the health of older adults and are closely related to cognitive function. Adopting an effective method to evaluate the risk of falls in older adults is essential for improving their healthcare. This study combined cognitive and motor functions to determine a reliable probe reaction time during water-carrying walking. Patients and Methods: We divided 100 community-dwelling older adults (aged 65 years and over) into two groups according to their fall history: the fall group and no-fall group. All subjects were tested on fall tasks using the timed up-and-go (TUG) test, 10-m walk timing test, trail marking test part-A (TMT-A), and water-carrying walking probe reaction time (P-RT). Results: The fall group showed slower walking speeds and longer TUG, TMT-A, and P-RT times than the no-fall group. In the logistic regression analysis with falls as the dependent variable, water-carrying walking P-RT was identified as a useful factor, and the cut-off value of the water-carrying walking P-RT was 454 ms, which was evaluated using the receiver operating characteristic curve. Conclusion: The P-RT of the water-carrying walking test was found to be credible and useful for evaluating the fall risk in older adults. Therefore, it is recommended that the P-RT-based dual-task be used as a predictive indicator of future falls in the older population.
Keywords: falls, probe reaction time, older adults, dual task
{"title":"Risk Assessment of Falls Among Older Adults Based on Probe Reaction Time During Water-Carrying Walking","authors":"Fan Liu, Huan Yu, Qing Xu, Jianwei Gong, Ming Huo, Fei Huang","doi":"10.2147/cia.s438904","DOIUrl":"https://doi.org/10.2147/cia.s438904","url":null,"abstract":"<strong>Purpose:</strong> Falls are a significant factor affecting the health of older adults and are closely related to cognitive function. Adopting an effective method to evaluate the risk of falls in older adults is essential for improving their healthcare. This study combined cognitive and motor functions to determine a reliable probe reaction time during water-carrying walking.<br/><strong>Patients and Methods:</strong> We divided 100 community-dwelling older adults (aged 65 years and over) into two groups according to their fall history: the fall group and no-fall group. All subjects were tested on fall tasks using the timed up-and-go (TUG) test, 10-m walk timing test, trail marking test part-A (TMT-A), and water-carrying walking probe reaction time (P-RT).<br/><strong>Results:</strong> The fall group showed slower walking speeds and longer TUG, TMT-A, and P-RT times than the no-fall group. In the logistic regression analysis with falls as the dependent variable, water-carrying walking P-RT was identified as a useful factor, and the cut-off value of the water-carrying walking P-RT was 454 ms, which was evaluated using the receiver operating characteristic curve.<br/><strong>Conclusion:</strong> The P-RT of the water-carrying walking test was found to be credible and useful for evaluating the fall risk in older adults. Therefore, it is recommended that the P-RT-based dual-task be used as a predictive indicator of future falls in the older population.<br/><br/><strong>Keywords:</strong> falls, probe reaction time, older adults, dual task<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"90 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139374081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tong Wu, Da Liu, Fanhe Meng, Jing-han Lu, Yi-feng Chen, Zheng Fan
Purpose: Here, we introduce a novel strategy of awake unilateral biportal endoscopic (UBE) decompression, which applies conscious sedation combined with stepwise local anesthesia (LA) as an alternative to general anesthesia (GA). The study aims to evaluate the feasibility of awake UBE decompression for degenerative lumbar spinal stenosis (DLSS) in elderly patients. Patients and Methods: This retrospective study included 31 consecutive patients who received awake UBE decompression for DLSS in our institution from January 2021 to March 2022. Clinical results were evaluated using patient-reported outcomes measures (PROM) including visual analog scale for leg pain (VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. The anesthesia effectiveness and intraoperative experience were evaluated by intraoperative VAS and satisfaction rating system. Results: UBE decompression was successfully performed in all patients under LA combined with conscious sedation. 26 (83.9%) patients rated the intraoperative experience as satisfactory (excellent or good) and 5 (16.1%) as fair. The mean intraoperative VAS was 3.41± 1.26. The VAS and ODI at each follow-up stage after surgery were significantly improved compared to preoperative scores (p < 0.01). At the last follow-up, 28 patients (90.3%) classified the surgical outcome as good or excellent, and 3 (9.7%) as fair. There were no serious complications or adverse reactions observed in the study. Conclusion: Our preliminary results suggest that awake UBE decompression is a feasible and promising alternative for elderly patients with DLSS.
Keywords: awake spinal surgery, local anesthesia, degenerative lumbar disease, biportal endoscopic spine surgery, enhanced recovery after surgery
目的：在此，我们介绍了一种新型的清醒单侧双侧内窥镜（UBE）减压策略，该策略采用清醒镇静结合分步局部麻醉（LA）的方法替代全身麻醉（GA）。该研究旨在评估清醒状态下 UBE 减压治疗老年退行性腰椎管狭窄症（DLSS）的可行性：这项回顾性研究纳入了 2021 年 1 月至 2022 年 3 月期间在我院接受清醒 UBE 减压术治疗 DLSS 的 31 例连续患者。临床结果采用患者报告结果指标（PROM）进行评估，包括腿部疼痛视觉模拟量表（VAS-LP）、Oswestry残疾指数（ODI）和改良MacNab标准。麻醉效果和术中体验通过术中 VAS 和满意度评分系统进行评估：结果：所有患者均在 LA 联合意识镇静下成功实施了尿囊减压术。26名患者（83.9%）将术中体验评为满意（优或良），5名患者（16.1%）评为一般。术中 VAS 平均值为 3.41±1.26。术后各随访阶段的 VAS 和 ODI 与术前相比均有明显改善（P < 0.01）。在最后一次随访中，28 名患者（90.3%）认为手术效果良好或优秀，3 名患者（9.7%）认为手术效果一般。研究中未发现严重并发症或不良反应：我们的初步研究结果表明，对于患有腰椎退行性疾病的老年患者来说，清醒状态下的 UBE 减压术是一种可行且前景广阔的选择。 关键词：清醒脊柱手术；局部麻醉；腰椎退行性疾病；双侧内窥镜脊柱手术；术后恢复能力增强
{"title":"Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note","authors":"Tong Wu, Da Liu, Fanhe Meng, Jing-han Lu, Yi-feng Chen, Zheng Fan","doi":"10.2147/cia.s443792","DOIUrl":"https://doi.org/10.2147/cia.s443792","url":null,"abstract":"<strong>Purpose:</strong> Here, we introduce a novel strategy of awake unilateral biportal endoscopic (UBE) decompression, which applies conscious sedation combined with stepwise local anesthesia (LA) as an alternative to general anesthesia (GA). The study aims to evaluate the feasibility of awake UBE decompression for degenerative lumbar spinal stenosis (DLSS) in elderly patients.<br/><strong>Patients and Methods:</strong> This retrospective study included 31 consecutive patients who received awake UBE decompression for DLSS in our institution from January 2021 to March 2022. Clinical results were evaluated using patient-reported outcomes measures (PROM) including visual analog scale for leg pain (VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. The anesthesia effectiveness and intraoperative experience were evaluated by intraoperative VAS and satisfaction rating system.<br/><strong>Results:</strong> UBE decompression was successfully performed in all patients under LA combined with conscious sedation. 26 (83.9%) patients rated the intraoperative experience as satisfactory (excellent or good) and 5 (16.1%) as fair. The mean intraoperative VAS was 3.41± 1.26. The VAS and ODI at each follow-up stage after surgery were significantly improved compared to preoperative scores (<em>p</em> < 0.01). At the last follow-up, 28 patients (90.3%) classified the surgical outcome as good or excellent, and 3 (9.7%) as fair. There were no serious complications or adverse reactions observed in the study.<br/><strong>Conclusion:</strong> Our preliminary results suggest that awake UBE decompression is a feasible and promising alternative for elderly patients with DLSS.<br/><br/><strong>Keywords:</strong> awake spinal surgery, local anesthesia, degenerative lumbar disease, biportal endoscopic spine surgery, enhanced recovery after surgery<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139373653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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