Objective To summarize the characteristic manifestations in the middle and old aged people with meniscus injury and the outcome of the treatment under the arthroscope. Methods Fifty-two patients, aged 52-58 years, with meniscus injury to a total of 57 knee joints, were diagnosed and treated under the arthroscope. The history of their knee diseases was 1-21 years. Horizontal tearsoccurred in 19 knee joints, degenerative tears in 13 knee joints, complex tears in 9 knee joints, longitudinal tears in 5 knee joints, oblique tears in 4 knee joints, radial tears in 4 knee joints, and flap tears in 3 knee joints. Three meniscus tears were sutured and 54 meniscus tears were cut fully or partly under thearthroscope. Results All the postoperative patients were followed up for 6-15 months, and the average follow-up period after operation was 9 months. According to the DONG Tianxiang’s standards for the therapy under the arthroscope, the excellent result was achieved in 39 knee joints, good in 12 knee joints, and fair in 6 knee joints, with no failure. The excellent and good rate was 89.5%. Conclusion The clinical manifestations of meniscus injury are not typical in the middle and old aged people. The therapeutic effect with the help of the arthroscope is satisfactory with an advantage of minimal traumatic invasiveness to the knee joint.
ObjectiveTo systematically review the prevalence of osteoarthritis in Chinese aged 40 and above from January 2000 to December 2019.MethodsPubMed, ScienceDirect, Wiley Online Library, The Cochrane Library, CBM, VIP, CNKI and WanFang Data databases were electronically searched to collect cross-sectional studies on osteoarthritis in Chinese aged 40 and above from January 1st, 2000 to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using R 3.5.2 software.ResultsA total of 29 cross-sectional studies with a total sample of 60 711 cases and 19 707 patients were included. The results of meta-analysis showed that, the crude prevalence of osteoarthritis in Chinese aged 40 and over was 38.46% (95%CI 24.31% to 46.22%). Subgroup analysis results showed that the prevalence of lumbar osteoarthritis was the highest (24.79%, 95%CI 13.28% to 27.37%), followed by knee osteoarthritis prevalence (20.50%, 95%CI 14.51% to 27.23%) which increased with age. The prevalence of knee osteoarthritis in females (25.14%, 95%CI 19.54% to 31.19%) was higher than that in males (18.99%, 95%CI 13.86% to 24.71%). The prevalence of knee and lumbar osteoarthritis in rural areas was higher than that in urban areas. The prevalence of knee osteoarthritis in western China (23.59%, 95%CI 18.34% to 30.35%) was higher than that in eastern China (18.36%, 95%CI 12.43% to 27.92%) and central China (15.54%, 95%CI 11.22% to 21.53%). The prevalence of lumbar osteoarthritis in western China (31.17%, 95%CI 19.21% to 50.60%) was higher than that in eastern China (24.38%, 95%CI 16.26% to 36.54%). The incidence of cervical osteoarthritis in the eastern China (20.49%, 95%CI 13.90% to 30.21%) was higher than that in the western China (12.32% 95%CI 8.09% to 18.75%). The prevalence of hand osteoarthritis in western China (6.85%, 95%CI 2.71% to 8.13%) was higher than that in eastern China (2.7%, 95%CI 1.33% to 5.48%).ConclusionsCurrent evidence shows that the prevalence of osteoarthritis in Chinese aged 40 and above is high, and the prevalence of lumbar osteoarthritis is the highest, and the prevalence in western China is higher than that in eastern and central China, followed by knee osteoarthritis, in which the prevalence in females, rural areas, and western China is high. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
ObjectiveTo establish a hypertension prediction model for middle-aged and elderly people in China and to use the basic public health service database for performance validation. MethodsThe literature related to hypertension was retrieved from the internet. Using meta-analysis to assess the effect value of influencing factors. Statistically significant factors, which were also combined in the database, were extracted as the predictors of the models. The predictors’ effect values were logarithmarithm-transformed as the parameters of the Logit function model and the risk score model. Participants who were never diagnosed with hypertension at the physical examination of health service project of Hongguang Town Health Center in Pidu District of Chengdu from January 1, 2017, to January 1, 2022, were considered as the external validation group. ResultsA total of 15 original studies were involved in the meta-analysis and 11 statistically significant influencing factors for hypertension were identified, including age, female, systolic blood pressure, diastolic blood pressure, BMI, central obesity, triglyceride, smoking, drinking, history of diabetes and family history of hypertension. Of 4997 qualified participants, 684 individuals were identified with hypertension during the five-years follow-up. External validation indicated an AUC of 0.571 for the Logit function model and an AUC of 0.657 for the risk score model. ConclusionIn this study, we developed two different prediction models based on the results of meta-analysis. National basic public health service database is used to verify the models. The risk score model has a better prediction performance, which may help quickly stratify the risk class of the community crowd and strengthen the primary-level assistance system.
ObjectiveTo investigate the clinical characteristics and prognosis of cerebral hemorrhage in young and elderly patients, to provide evidences for individual clinical diagnosis and treatment, and lay a foundation for building a predictive model of prognosis in cerebral hemorrhage.MethodsPatients with spontaneous cerebral hemorrhage in the Third People’s Hospital of Chengdu were recruited prospectively and continuously from January 2014 to January 2019. They were divided into the youth group (≤50 years old) and the elderly group (>50 years old), and their risk factors, disease characteristics, etiology, and prognosis were analyzed.ResultsA total of 757 patients were recruited. There were 160 cases (21.1%) in the youth group, including 120 males and 40 females, aged from 17 to 50 years, with an average age of (42.06±7.62) years old; 597 cases (78.9%) in the elderly group, including 361 males and 236 females, aged from 51 to 96 years, with an average age of (69.34±10.56) years old. The incidences of hypertension (74.2% vs. 51.2%), diabetes (15.1% vs. 4.4%), coronary heart disease (12.1% vs. 1.3%), and the level of blood glucose at admission [7.1 (5.8, 8.4) vs. 6.3 (5.3, 8.1) mmol/L] in the elderly group were higher than those in the youth group (P<0.05), respectively. However, the proportions of males (60.5% vs. 75.0%), smoking (24.5% vs. 36.9%), and the diastolic blood pressure at admission [(92.37±18.50) vs. (100.95±25.25) mm Hg (1 mm Hg=0.133 kPa)] in the elderly group were lower than those in the youth group (P<0.05), respectively. There was no significant difference between the two groups in systolic blood pressure at admission, Glasgow Coma Score, National Institutes of Health Stroke Scale score, initial hematoma volume, hematoma enlargement, brain hernia, location of hemorrhage, midline shift, hydrocephalus, combined subarachnoid hemorrhage, or intraventricular extension (P>0.05). Hypertension was the most common etiology in the two groups. There was a significant difference in the etiology of cerebral hemorrhage between the two groups (P<0.05), the difference was mainly reflected in cerebral amyloid angiopathy, cavernous hemangioma, and arteriovenous malformation. The fatality rate during hospitalization (9.4% vs. 20.9%), 3 months after discharge (10.3% vs. 26.3%), and at 1 year follow-up (19.0% vs. 37.6%) in the youth group was lower than that in the elderly group (P<0.05), respectively. The disability rate 3 months after discharge and at 1 year follow-up in the youth group was lower than that in the elderly group (32.1% vs. 44.2%, 16.9% vs. 34.4%; P<0.05), respectively.ConclusionsThe education of healthy lifestyles should be strengthened to reduce the adverse effects of smoking in young patients. Young patients should choose antihypertensives that can control diastolic blood pressure better. There are more structural abnormalities in young patients, so routine vascular examination is reasonable. It is necessary to focus on whether the original underlying diseases are stable in elderly patients. Cerebral amyloid angiopathy is an important cause of cerebral hemorrhage in elderly patients, and is a risk factor of recurrence. Anticoagulation or antiplatelet therapy should be cautious.
ObjectiveTo analyze the effects of alcohol consumption on oral flora of middle-aged and elderly men from the core area of southwestern China, and explore the relationship between excessive-alcohol-consumption-related flora and alcohol-related cancer.MethodsFrom March to June 2018, saliva samples of target subjects were collected for 16S ribosomal RNA gene sequencing, and a questionnaire survey which took drinking history of each participant as the target variable was conducted. According to the amount of alcohol consumed, the subjects were divided into non-drinking group, moderate-drinking group, and excessive-drinking group. The microbial analysis of α diversity, analysis of group difference of oral flora abundance, bacterial function prediction, and receiver operating characteristic (ROC) curve model prediction were carried out.ResultsA total of 59 subjects were included. There were 23 cases (39.0%) in the non-drinking group, 23 cases (39.0%) in the moderate-drinking group, and 13 cases (22.0%) in the excessive-drinking group. The average age was (61.90±8.85) years. Excessive drinking increased the abundance of oral flora (P<0.05), and could change the abundance of specific genus such as Peptostreptococcus and TM7［G-6］ (P<0.05) and regulate cancer-related pathways (P<0.05). ROC analysis found that a panel of three genus oral bacteria such as TM7［G-6］ might effectively distinguish the non-drinking group from the excessive-drinking group (area under curve=0.915).ConclusionsGenus of Peptostreptococcus and TM7_［G-6］ are the potential oral flora biomarkers for the excessive-drinking of target subjects. Some excessive drinking-related flora are closely related to oral cancer.
ObjectiveTo analyze the prevalence, regional differences, and influencing factors of depression in the middle-aged and elderly population aged 45 years and above in China. MethodsData were obtained from the latest survey data of the China Health and Retirement Longitudinal Study (CHARLS) in 2020, and the CES-D-10 scale was used to assess depression among respondents, and χ2 test and binary logistic regression were used to screen for the influencing factors of depression. ResultsA total of 10 583 valid samples were included, with 47.7% males and 52.3% females, and the mean age was (65.3±8.0) years. The average CES-D-10 scale score of the study population was (9.11±6.53), and the prevalence rate of depression was 40.5% (95%CI 39.6% to 41.5%), with a significantly higher prevalence rate of depression in the Midwestern population than the Eastern population. The gender, age, living with a partner, education, region, urban/rural, duration of sleep, internet access, alcohol consumption, number of chronic diseases, and the presence of ADL and IADL disorders are the influencing factors of depression in middle-aged and elderly populations. ConclusionThe prevalence of depression in the middle-aged and elderly population in China is high, but there are significant differences in the prevalence rates of populations with different characteristics, and the high-risk groups should be emphasized when improving the mental health of the middle-aged and elderly population.
ObjectiveTo compare the mid-term effectiveness of arthroscopy versus conservative treatment on symptomatic discoid lateral meniscus (SDLM) in middle-aged and elderly patients. Methods The clinical data of 118 middle-aged and elderly patients (154 knees) with SDLM who received arthroscopy or conservative treatment between June 2014 and May 2016 were retrospectively analyzed, including 76 patients (96 knees) in the arthroscopy group (group A) and 42 patients (58 knees) in the conservative treatment group (group B). There was no significant difference in age, gender, and body mass index between the two groups (P>0.05). Compared with group B, the symptoms duration in group A was longer, the incidences of discoid lateral meniscus injury and mechanical symptoms were higher, and the visual analogue scale (VAS) score and Lysholm score before treatment were worse, with significant differences (P<0.05). VAS score and Lysholm score before and after treatment were recorded and compared. ResultsThe patients in both groups were followed up 60-74 months, with an average of 66.3 months. The follow-up time of group A and group B was (65.9±3.5) months and (67.0±4.0) months respectively, with no significant difference (t=–1.615, P=0.109). At last follow-up, in either group A or group B, the VAS score and Lysholm score significantly improved when compared with those before treatment (P<0.05). The differences of VAS score and Lysholm score in group A before and after treatment were significantly better than those in group B (P<0.05). ConclusionArthroscopy and conservative treatment have a satisfactory mid-term effectiveness on SDLM in middle-aged and elderly patients. However, the improvement of symptoms and function of arthroscopy was significantly better than that of conservative treatment. For middle-aged and elderly SDLM patients with invalidated conventional treatment for 6 months, severe clinical symptoms, long duration of symptoms, and combined with mechanical symptoms, arthroscopy should be given priority even if they are complicated with early osteoarthritis.
ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
ObjectiveTo summarize the effectiveness of limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis, and then to explore the strategy of surgical correction and functional reconstruction method.MethodsFrom the database of 23 310 cases of poliomyelitis sequelae treated by QIN Sihe Orthopaedic Surgical team between September 1982 and December 2017, 629 patients over 41 years old were retrieved and the epidemiological characteristics of the patients were analyzed. Between March 2011 and June 2015, 57 patients with poliomyelitis sequelae treated with limited operation and external fixation were followed up 2-6 years, and the history of poliomyelitis sequelae was 41-67 years (mean, 47.1 years). Preoperative histopathological gait included 29 cases of quadriceps gait, 17 cases of walking with crutch, and 11 cases of claudication only. The operative methods included Achilles tendon lengthening in 52 cases, supracondylar osteotomy in 39 cases, knee flexion release in 36 cases, calcaneal arthrodesis in 27 cases, flexion and hip arthrodesis in 21 cases, tibia and fibula osteotomy in 19 cases, triple arthrodesis in 11 cases, and tendon transposition in 1 case. After operation, 18 cases were treated with combined external fixator and 39 cases with Ilizarov ring external fixator.ResultsOf the 629 cases, 481 cases were less than 50 years old (76.47%), accounting for 144 cases between 51 and 65 years old (22.89%). Among them, 495 cases (78.70%) were diagnosed after 2003. Of the 57 patients obtained complete follow-up information, 7 had slight infection of needle path during traction orthopaedics, 2 had early postoperative venous thrombosis of lower extremities, and 2 had incomplete paralysis of the common peroneal nerve. There was no complications such as skin incision infection, vascular injury, and bone nonunion. According to the evaluation standard of postoperative efficacy standard in correction of lower extremity deformities, the results were excellent in 23 cases, good in 20 cases, fair in 12 cases, and poor in 2 cases, with an excellent and good rate of 75.44%. The 2 patients with poor effectiveness were reoperated to improve their function.ConclusionLimited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis can effectively correct deformities of lower limbs, improve function, delay the disability aggravated by decay, and avoid serious complications.