Objective To observe the clinical effect of enhanced recovery after surgery (ERAS) in elderly patients with right colon cancer. MethodsA total of 90 elderly patients who were diagnosed as right colon cancer and underwent radical resection of right colon cancer in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Qingdao University from April 2018 to October 2018 were enrolled prospectively. These patients were randomly divided into two groups: ERAS group (n=44) receiving ERAS during perioperative period and control group (n=46) undergoing conventional surgical treatment. To compare the occurrence of postoperative complications, the recovery of gastrointestinal function, and the changes of serum inflammatory factors between the two groups before and after operation. Results① There was no significant difference in the incidence of total postoperative complications and the incidence of complications (including anastomotic leakage, incision infection, postoperative bleeding, intestinal obstruction, cardiovascular complications, pulmonary infection, and urethral infection） between the ERAS group and the control group (P>0.05). ② The first anal exhaust time, postoperative fever time, postoperative hospitalization time, quality of life score, and hospitalization cost of the ERAS group were better than those of the control group (P<0.05). ③ There were no significant difference in serum IL-6, TNF-α, and CRP levels between the two groups before operation (P>0.05), but on the 1st and 3rd day after operation, the three indexes of the control group were higher than those of the ERAS group (P<0.05). ConclusionThe application of the idea of ERAS in the elderly patients with right colon cancer can promote the recovery of gastrointestinal function, shorten the hospitalization time, and improve the clinical outcome.
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.
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.
Objective To analyze the efficacy of off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation. Methods The clinical data of patients aged≥70 years with coronary artery disease complicated with moderate mitral regurgitation, and undergoing OPCABG from January 2009 to January 2020 in Beijing Anzhen Hospital were retrospectively analyzed. The echocardiographic indicators of the patients were compared preoperatively, postoperatively before discharge and during the follow-up. Results Finally 239 patients were enrolled. There were 136 males and 103 females, aged 74.1±3.2 years. Before postoperative discharge, 49 (20.5%) patients had no mitral regurgitation, 144 (60.3%) mild regurgitation, 46 (19.2%) moderate regurgitation, and 0 severe regurgitation. The area of mitral regurgitation was significantlyimproved (2.5±1.8 cm2 vs. 5.6±1.0 cm2, P<0.001). There were 10 (4.2%) patients of hospital death, 23 (9.6%) of low cardiac output, 3 (1.3%) of myocardial infarction, and 8 (3.3%) of nervous system injury after operation. As a result, 208 (90.8%) patients were followed up and the mean follow-up time was 3.4 years (range 1-9 years). The cumulative survival rates at postoperative 2, 4, 6, and 8 years were 95.8%, 88.0%, 78.4%, and 73.1%, respectively. Postoperative follow-up showed significant improvements compared with those before surgery in the area of mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and left ventricular end-systolic diameters (all P＜0.05). Duirng the follow-up, the major adverse cardiac and cerebrovascular events were all cause death in 22 (10.6%) patients, including cardiac death in 17 (8.2%) patients, myocardial infarction in 7 (3.4%) patients, heart failure in 24 (11.5%) patients, cerebrovascular events in 11 (5.3%) patients, re-hospitalization due to heart disease in 23 (11.1%) patients, and none of the patients with myocardial infarction were revascularized. Conclusion The mid- and long-term outcomes of OPCABG in the treatment for elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation is good.
Objective To investigate the feasibility and effectiveness of the novel bone hook combined with finger-guided technique in the treatment of irreducible intertrochanteric femoral fractures in elderly. Methods Between January 2021 and August 2023, 23 elderly patients with irreducible intertrochanteric femoral fractures were treated with the novel bone hook combined with finger-guided technique. There were 10 males and 13 females; the age ranged from 68 to 93 years (mean, 76.2 years). The time from injury to operation ranged from 36 to 76 hours (mean, 51.2 hours). According to the classification standard proposed by TONG Dake et al in 2021, there were 10 cases of typeⅠA, 1 case of typeⅠB, 6 cases of type ⅡA, 4 cases of type ⅡB, and 2 cases of type ⅡC. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequences, and quality of fracture reduction were recorded. The fracture healing time and occurrence of postoperative complications were observed during follow-up. At last follow-up, the Harris scoring system was used to evaluate the hip joint function. Results The operation time was 42-95 minutes (mean, 52.1 minutes). The intraoperative blood loss was 40-420 mL (mean, 126.5 mL). Intraoperative fluoroscopy was performed 14-34 times (mean, 20.7 times). According to the criteria proposed by Chang et al, the quality of fracture reduction was rated as good in 20 cases and acceptable in 3 cases. All patients were followed up 6-20 months (mean, 10.2 months). X-ray film showed that all fractures healed with the healing time of 3.0-5.5 months (mean, 4.0 months). At last follow-up, the Harris score of the hip joint ranged from 82 to 97 points (mean, 90.4 points). Among them, 14 cases were rated as excellent and 9 cases as good. No complication such as coxa vara, cutting of the cephalomedullary nail, nail withdrawal, or nail breakage occurred during follow-up. Conclusion The treatment of elderly patients with irreducible intertrochanteric femoral fractures by using the novel bone hook combined with finger-guided technique can achieve high-quality fracture reduction and fixation, and has a good effectiveness.
With the rapid development of digital medical technology, digital rehabilitation medicine has become an emerging way of geriatric rehabilitation. Digital medicine utilizes intelligent devices such as digital technology and virtual reality to provide patients with immersive treatment services, or through online and remote internet platforms to provide self-active rehabilitation interaction and support, promoting patient rehabilitation training and self-management. But the acceptability and feasibility of digital rehabilitation are key factors that need to be considered for the elderly. Based on the characteristics of the elderly, strengthening the popularization of digital rehabilitation will truly help them in active rehabilitation.
Objective To explore the effect of antihypertensive treatment on target-organ damage in very elderly patients (gt;80 years). Methods One hundred and sixty-seven very elderly hypertensive patients were randomized into two groups, i.e. anti-hypertension treatment group and placebo-control group. All the patients received echocardiographic examination of left ventricular mass index, laboratory tests of urinary creatinine and urinary albumin and 24-hour ambulatory blood pressure monitoring 2 months after placebo washout period and at the end of the one year treatment, respectively. Results After treatment, the improvement in all the dynamic blood pressure parameters except daytime diastolic blood pressure and heart rate(24 h, daytime and night time), were significantly better than that of placebo-control group(Plt;0.05).The improvement in left ventricular and renal functional parameters were significantly better than that of placebo-control group(Plt;0.05). Conclusion Anti-hypertension treatment may significantly improve left ventricular pachynsis and renal function damage in very elderly hypertensive patients.
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.
Objective To explore the correlations between nutritional markers and pressure injury (PI) in elderly patients with chronic obstructive pulmonary disease (COPD). Methods Retrospective analysis was conducted on elderly patients with COPD and PI who were admitted to the geriatric department of West China Hospital of Sichuan University or Dujiangyan People’s Hospital between January 2020 and December 2021. The blood biochemical indicators mainly including nutritional markers were collected, and their correlations with PI risk factor index Braden score and PI severity index PI stage were analyzed. Results A total of 293 patients with COPD and PI were included. Among the five Braden score groups, the differences in the levels of albumin and prealbumin were statistically significant (P<0.05), and the Braden score was positively correlated with albumin (rs=0.241, P<0.001), prealbumin (rs=0.179, P=0.002), and hemoglobin (rs=0.199, P=0.001). Among the six PI stage groups, the differences in the levels of albumin, globulin, red blood cell count, serum sodium, blood chloride and C-reactive protein were statistically significant (P<0.05), and the PI stage was negatively correlated with albumin (rs=−0.192, P=0.001), and positively correlated with serum sodium (rs=0.139, P<0.001), blood chloride (rs=0.184, P<0.001), and C-reactive protein (rs=0.177, P=0.020). Conclusion When PI risk assessment and severity assessment are performed on elderly COPD patients, it is necessary to pay more attention to nutritional markers and assess whether the patients are at risk of protein malnutrition, which will help to improve the accuracy of PI risk assessment and severity prediction, and effectively improve the efficacy of PI prevention and treatment.
ObjectivesTo examine the cognitive performance among the elderly and associated influencing factors.MethodsUsing data from the six issues of Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted from 1998 to 2011, selecting adults aged 80 years or above, multilevel hierarchical model was utilized to estimate the trend of the elderly's cognitive performance and its influencing factors.ResultsA total of 128 cases were studied. The descent in MMSE was not significant with the growth of age (P=0.834). Female's MMSE scores were lower than male's (P=0.011) and descended quicker (P=0.015). Furthermore, ADL status and level of leisure activity were significantly related to the cognitive performance of both male and female (P<0.05).ConclusionsParticipation in leisure activities were the crucial protective factor for cognitive performance. It's recommended that measures be taken respectively for elderly males and females, and policies be stressed to enhance their cognitive performance, thus to guarantee their healthy aging.