Clinical Interventions in Aging最新文献

Purpose: To compare the medical accuracy and content comprehensiveness of three large language models (LLMs) in generating responses to frequently asked osteoporosis-related questions and to determine their potential role in clinical support.

Methods: Twenty-five questions covering six clinical domains were submitted to each model in isolated sessions. Five senior orthopedic physicians, each with over 25 years of clinical experience, independently rated the medical accuracy of each response using a 5-point Likert scale. Responses rated as "acceptable" or above were further evaluated for content comprehensiveness. Statistical analysis included the Kruskal-Wallis test and Dunn's post hoc test with Bonferroni correction.

Results: A total of 75 unique responses (25 questions × 3 models) were evaluated by five orthopedic experts, yielding 375 ratings. ChatGPT-4o achieved the highest accuracy score (median: 4.6; IQR: 4.4-4.8), significantly outperforming Gemini-2.5 Pro (p=0.039) and DeepSeek-R1 (p<0.001). For content comprehensiveness, both ChatGPT-4o and Gemini-2.5 Pro had a median score of 4.4, higher than DeepSeek-R1 (median: 4.2), though differences did not reach statistical significance (p=0.0536). Gemini-2.5 Pro was noted for its fluent and user-friendly language but lacked clinical depth in some responses. DeepSeek-R1, despite offering source citations, demonstrated greater inconsistency.

Conclusion: LLMs have clear potential as tools for patient education in osteoporosis. ChatGPT-4o demonstrated the most balanced and clinically reliable performance. Nonetheless, expert medical oversight remains essential to ensure safe and context-appropriate use in healthcare settings.

Purpose: To utilize the developed nomogram for evaluating the risk of recurrence in non-valvular atrial fibrillation (NVAF) patients after radiofrequency catheter ablation (RFCA) and compare the model's performance with the APPLE, ATLAS, and Antwerp scores.

Patients and methods: 242 patients with NVAF requiring RFCA were enrolled. These patients were randomly divided into a training cohort (n=169) and a validation cohort (n=73) according to 7:3. A nomogram was developed based on LAVI, RAVI, SII, NYHA classification, CHA₂DS₂-VASc score to estimate the risk of AF recurrence after RFCA. The APPLE, ATLAS, and Antwerp scores were calculated using the "pROC" package in R software. The AUC value of the nomogram compared with each of the three scores was evaluated using the DeLong test. The integrated discrimination improvement and net reclassification index were calculated to compare the predictive performance of the nomogram against the scores in R software.

Results: The nomogram achieved significantly higher values with an AUC of 0.837 (95% CI: 0.774-0.899) in the training cohort and 0.895 (95% CI: 0.823-0.968) in the validation cohort (all P < 0.05) than the three scores. It also achieved better positive and negative predictive values, indicating enhanced discriminatory power. By integrating multidimensional parameters and optimizing risk stratification, it significantly reduced misjudgment rates. Furthermore, the model demonstrated a more balanced sensitivity-specificity profile and greater predictive stability than single-dimensional scores. It also provides more robust clinical decision support for predicting post-RFCA recurrence across diverse datasets.

Conclusion: The APPLE, ATLAS, and Antwerp scores all demonstrated effectiveness in predicting AF recurrence after RFCA in patients with NVAF. Among these established scoring systems, the APPLE score showed better performance compared to the other two. More importantly, our newly developed nomogram exhibited superior performance compared to all three existing scores, demonstrating a marked improvement in predicting the risk of AF recurrence. While our model represents a promising tool, it is still in the preliminary stage and requires further validation in larger, multi-center, prospective cohorts to confirm its generalizability.

Objective: To develop an estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (ACR) risk stratification for rapid kidney function decline across aging phenotypes in older adults.

Methods: We included 1539 older adults (486 healthy aging, 661 aging with comorbidities, 392 aging with CKD) from the Rugao Longevity and Aging Study and Huashan Hospital. Rapid decline was defined as a ≥30% decrease in eGFR over 2 years. We estimated adjusted incidence of rapid decline across baseline eGFR (≥90, 75-<90, 60-<75, <60 mL/min/1.73 m²) and ACR (<30 vs ≥30 mg/g) categories within each aging phenotype. We defined adjusted incidence rate of <5%, 5-7.5%, 7.5-15%, and >15% as no risk, low risk, moderate risk, and high risk, respectively. Random forests assessed the relative contribution of pre-specified eGFR and ACR categories.

Results: Mean ages were 77.7 ± 4.4, 78.0 ± 4.1, and 77.7 ± 5.5 years in healthy, comorbidity, and CKD cohort, respectively. Among healthy participants, the adjusted incidence remained in low risk when eGFR was between 60 and 75 mL/min/1.73 m², but increased to moderate risk when eGFR <60 mL/min/1.73 m². In the comorbidity cohort, a low risk classification was observed with ACR <30 mg/g and eGFR ≥75 mL/min/1.73 m², or with ACR ≥30 mg/g and eGFR ≥90 mL/min/1.73 m², other combinations were associated with moderate risk. In the CKD cohort, moderate risk corresponded to ACR <30 mg/g with eGFR ≥60 mL/min/1.73 m² or ACR ≥30 mg/g with eGFR ≥75 mL/min/1.73 m², while all other scenarios were classified as high risk. Random forest results corroborated that eGFR dominated discrimination in healthy aging, whereas ACR carried greater weight in comorbidity and CKD cohorts.

Conclusion: Phenotype-specific eGFR-ACR thresholds provide pragmatic risk stratification to guide targeted monitoring and earlier intervention in older adults.

Background: Dysregulation of microRNAs contributes to bone diseases. However, the microRNAs involved in primary hyperparathyroidism (PHPT)-induced osteoporosis remain unknown.

Methods: The parathyroid tissue samples were obtained from PHPT patients with or without osteoporosis (n = 5/group) during parathyroid resection and subjected to high throughput microRNA sequencing. The differentially expressed microRNAs were identified and further verified using qRT-PCR. Alizarin Red Staining was performed to detected the osteogenic differentiation. Gain- and loss-of-function assays were performed to investigate the role of miR-874-3p, which was upregulated in PHPT patients with osteoporosis, in human mesenchymal stem cells (hMSCs) undergoing osteoblastic differentiation.

Results: We identified 32 significantly upregulated and 18 significantly downregulated microRNAs in PHPT patients with osteoporosis. miR-874-3p was increased in PHPT osteoporosis patients, meanwhile, miR-874-3p in parathyroid tissue and peripheral blood extracellular vesicles of PHPT osteoporosis mice were increased. The miR-874-3p level was remarkably elevated in hMSCs grown in osteogenic medium. Overexpression of miR-874-3p repressed the hMSC osteogenic differentiation and reduced the osteogenic marker expression in hMSCs, whereas miR-874-3p inhibitor showed a contrasting effect. The results of the dual luciferase reporting system showed that miR-874-3p could reduce the luciferase activity of wild-type FTO-WT-3 '-UTR. However, there was no significant change in the luciferase activity of the mutant compared with the control group.

Conclusion: MiR-874-3p might specifically binds to FTO suppress osteogenic differentiation of hMSCs, thereby contributing to the development of osteoporosis in PHPT patients.

Background: Coronary artery bypass grafting (CABG) is key for severe coronary artery disease, but postoperative acute kidney injury (AKI) may increase mortality and prolong hospital stays. Reliable models for early prediction of post-CABG AKI remain lacking.

Methods: Data of 520 CABG patients (September 2021-December 2024) from the Affiliated Hospital of Xuzhou Medical University were collected, and the patients were divided into a training group (70%, for model building) and a validation group (30%). Key variables were screened through Least Absolute Shrinkage and Selection Operator (LASSO) regression, followed by the construction of six machine learning models: Random Forest (RF), eXtreme Gradient Boosting (XGBoost), Logistic Regression (LR), Light Gradient Boosting Machine (LightGBM), Softmax Regression, and Support Vector Machine (SVM). The SHapley Additive exPlanations (SHAP) was used to quantify feature importance.

Results: The incidence of post-CABG AKI was 25.96%, and the median age of patients in the AKI group was significantly higher than that in the non-AKI group (66.09 ± 8.15 vs 64.32 ± 7.76, p = 0.025). In the training group, the XGBoost model using the top 5 important variables outperformed other models (Area Under the Curve [AUC] = 0.89, 95% Confidence Interval [CI]: 0.86-0.91), followed by the LightGBM model using the top 5 important variables and the RF model using the top 5 important variables (both had an AUC of 0.88; 95% CI: 0.85-0.90 and 0.85-0.91, respectively). In the validation group, the LR model using the top 15 important variables and the Softmax Regression model using the top 15 important variables maintained the highest stability (both had an AUC of 0.86, 95% CI: 0.79-0.92). SHAP analysis confirmed that estimated glomerular filtration rate (eGFR), intraoperative epinephrine use and calcium levels were the top three predictive factors.

Conclusion: The machine learning models constructed in this study can effectively predict post-CABG AKI, facilitating early identification of high-risk patients.

Background: Elderly trauma (ET) carries a high mortality rate due to comorbidities, frailty, and limited physiological reserve. Understanding its specific pathophysiology is essential for enabling precision treatment.

Objective: To identify characteristic metabolic dysregulations and specific pathways in geriatric trauma.

Methods: We retrospectively analyzed existing metabolomics data from ET, young and middle-aged trauma (YMAT), elderly controls (EC), and young and middle-aged controls (YMAC).

Results: An IVD integrating 8 significant metabolic pathways (SMPs) from ET vs EC and 10 SMPs from YMAT vs YMAC identified 3 pathways specific to ET: glyoxylate and dicarboxylate metabolism, galactose metabolism, and Pantothenate and coenzyme A (CoA) biosynthesis. The second IVD integrating these pathways with 3 SMPs from EC vs YMAC identified 2 metabolic pathways specific to ET independent of natural aging: glyoxylate and dicarboxylate metabolism, and pantothenate and CoA biosynthesis. Finally, the third IVD integrating them and 7 SMPs from ET vs YMAT identified glyoxylate and dicarboxylate metabolism as unique signature of geriatric trauma.

Conclusion: This study was one of few metabolomics studies that distinguish between geriatric trauma-related metabolic changes and baseline aging factors, and revealed glyoxylate and dicarboxylate metabolism disorder as a key pathway specific to geriatric trauma. Understanding it may inform the development of age-tailored strategies for improving trauma outcomes in the elderly.

Background: With the rapid aging of China's population, osteoporosis and sarcopenia have become major public health challenges. Denosumab, a first-line therapy for osteoporosis, may also improve muscle health, a possibility warranting further investigation.

Objective: This study evaluated the efficacy of denosumab in treating primary osteoporosis in the Chinese population and explored its potential effects on sarcopenia. A Mendelian randomization (MR) analysis was additionally performed to investigate the causal role of the RANKL pathway in sarcopenia.

Methods: This study included two components. In the clinical study, 45 patients with primary osteoporosis received denosumab, of whom 40 completed a 6-month follow-up and 15 completed a 1-year follow-up. Outcomes included bone turnover markers, bone mineral density, muscle strength, and physical performance measures. In the genetic study, two-sample MR was conducted using genome-wide association study (GWAS) summary statistics to assess the causal association between RANKL gene variants and sarcopenia-related traits, including appendicular lean mass and grip strength.

Results: Denosumab significantly reduced bone turnover markers and improved muscle function after 6 months, with further gains in bone mineral density and muscle strength observed at 1 year (all P < 0.05). Muscle mass showed upward but non-significant trends. MR analysis revealed a significant negative association between RANKL expression and both appendicular lean mass and grip strength, with no evidence of heterogeneity or pleiotropy.

Conclusion: Denosumab effectively treats osteoporosis and improves muscle function in Chinese patients. Genetic evidence supports a causal role of the RANKL pathway in sarcopenia, indicating that RANKL overexpression may contribute to its development. By integrating clinical and genetic evidence, our findings suggest that denosumab may represent a promising therapeutic option for patients with concurrent osteoporosis and sarcopenia.

The accelerated global aging process has amplified oral health challenges among older adults, emerging as a critical public health concern impacting quality of life. This study systematically reviews and synthesizes existing literature to construct a theoretical framework for oral frailty (OF) interventions in older adults. By mapping evidence clusters and gaps, we aim to inform evidence-based strategies for improving oral function to promote healthy longevity. This scoping review adhered to the methodology framework established by Arksey and O'Malley, utilizing the PRISMA-ScR guidelines to conduct a systematic search of PubMed, Web of Science, Cochrane, Embase, and PROSPERO, JBI Evidence Synthesis, Open Science Framework (up to October 2025). Eligible English-language primary studies investigating geriatric OF interventions were included for analysis. A total of 11,235 original papers were retrieved, and 14 eligible studies were finally included after deduplication and screening. Of these, 11 were cross-sectional study intervention trials, with 2 review and 1 longitudinal intervention trial. Current interventions primarily target mastication and swallowing dysfunction, focusing less on salivary secretion and oral motor skills disorders. Their effects are heterogeneous due to these differences in intervention type, implementation method, and participant characteristics. Current evidence shows that interventions hold promise for improving oral function in older adults, yet their long-term effects need systematic validation. Future research should prioritize advancements in related mechanisms, innovative technologies, and management-service models to develop universal integrated intervention programs and promote healthy aging.

Introduction: This study compared the quality of postoperative recovery among older patients undergoing day surgery with induction using remimazolam or etomidate.

Methods: This multicenter, randomized, parallel-group, double-blinded trial with a non-inferiority design was conducted in three tertiary university hospitals. Older patients undergoing day surgery were randomly assigned to receive either remimazolam or etomidate for pump-induced general anesthesia. The primary outcome was the 15-item Quality of Recovery (QoR-15) score on postoperative day 1 (POD1). The mean difference between the groups was compared against a non-inferiority margin of -8. Secondary outcomes included the QoR-15 score on POD2, scores for the five QoR-15 dimensions, and vital signs at predefined time points.

Results: In total, 118 older patients were randomized to the two groups. In the per-protocol set, the QoR-15 score on POD1 was 133.7 ± 12.9 in the remimazolam group, versus 131.2 ± 17.3 in the etomidate group, with a mean difference of 2.5 [95% confidence interval [CI]: -3.2, 8.2). In the modified intention-to-treat set, the QoR-15 scores were 133.5 ± 12.9 and 131.2 ± 17.6 in the remimazolam and etomidate groups, respectively, with a mean difference of 2.3 (95% CI: -3.3, 7.8). The lower limit of the confidence interval exceeded the predefined non-inferiority cutoff of -8, confirming the non-inferiority of remimazolam (P < 0.001). We compared the QoR-15 dimension scores on POD1 with the baseline scores in both groups. In the remimazolam group, only the physical independence score on POD1 was higher than at baseline, whereas in the etomidate group, the total QoR-15, physical comfort, physical independence, and emotional state scores were all lower on POD1 than at baseline. During anesthesia maintenance, the remifentanil dosage was higher in the remimazolam group than in the etomidate group (890.1 ± 5.7 µg vs 745.1 ± 45.3 µg, P = 0.037).

Conclusion: In older patients undergoing day surgery, remimazolam exhibited non-inferiority to etomidate for anesthesia induction in terms of QoR-15 scores on POD1.

Objective: Postoperative delirium (POD) and cognitive decline (POCD) are linked to inflammatory brain injury, and nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 1 (NLRP1) participates in neuroinflammation. Here, we investigated influential factors of serum NLRP1 levels and its predictive significance on POD and POCD of elderly patients with hip fracture.

Materials and methods: In this observational analytical study, serum NLRP1 levels were quantified in 100 controls, and preoperatively and postoperatively in 271 elderly patients undergoing hip fracture surgery. Primary outcome was postoperative three-month POCD [Montreal cognitive assessment (MoCA) scores below 26], and secondary outcomes included in-hospital POD and serum NLRP1 levels. The associations with them were analyzed using multivariate methods.

Results: Compared to controls, patients had markedly heightened postoperative, but not preoperative, serum NLRP1 levels. Postoperative serum NLRP1 levels were independently associated with postoperative C-reactive protein levels and FRAIL scores. Postoperative serum NLRP1 and FRAIL scale scores were independently associated with POD, and together with POD, were also independently related to the MoCA scores and effectively predicted POCD. The results of the regression analyses were comparatively robust based on collinearity evaluation, sensitivity analysis, subgroup analysis, interactivity investigation, and restricted cubic spline analysis. The independent predictors of POD and POCD were integrated separately to form the respective models. The models were graphically delineated via nomograms and were efficaciously used to distinguish the risk of POD or POCD based on the calibration, decision, and receiver operating characteristic curves. By applying mediation analysis, POD may partially mediate the association between the postoperative serum NLRP1 levels and POCD.

Conclusion: Serum NLRP1 may be a potential predictor of POD and POCD in elderly patients undergoing hip fracture surgery and the combined use of FRAIL and NLRP1 may optimize the efficiency of screening in high-risk populations.