Function In Elderly Patients Research Articles

Effects of dexmedetomidine on renal function, inflammatory markers, and cognitive functioning in elderly patients undergoing hip replacement surgery.

To investigate the effects of dexmedetomidine on renal function, inflammatory markers, and cognitive outcome, and to identify factors influencing early postoperative cognitive dysfunction (POCD) in elderly patients undergoing hip replacement surgery. A retrospective analysis was conducted on 162 elderly patients who underwent hip replacement surgery at Cangzhou Central Hospital from March 2022 to May 2023. Patients were divided into a control group (without dexmedetomidine) and an experimental group (with dexmedetomidine). Measurements included creatinine (Cr), blood urea nitrogen (BUN), interleukin 1β (IL-1β), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), Montreal Cognitive Assessment (MoCA) score, and the incidence of POCD seven days postoperatively. Univariate and logistic regression analyses were employed to investigate the predictors of early POCD. Significant differences were observed between the groups in terms of renal function, inflammatory markers, and cognitive outcome (Cr, BUN, IL-1β, TNF-α, IL-6 and MoCA scores) (all P<0.05). The experimental group showed a significantly lower incidence of POCD at seven days post-surgery (P<0.05). Logistic regression identified having a neuron-specific enolase (NSE) level seven days post-surgery ≥7.0 pg/ml as a risk factor for early POCD (P=0.001, OR=3.987, 95% CI: 1.789-8.886), whereas intraoperative use of dexmedetomidine was a protective factor (P=0.041, OR=0.424, 95% CI: 0.187-0.964). The use of dexmedetomidine in hip replacement surgery can mitigate postoperative renal injury and inflammatory response, enhance cognitive outcome, and significantly reduce the incidence and risk of early POCD in elderly patients.

Assessment of cognitive function in elderly patients with heart failure.

To compare the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) tests for the identification of cognitive deficit (CD) in elderly patients with heart failure (HF). This was a cross-sectional study with an observational design involving 43 elderly patients with HF of both sexes, treated by the Unified Health System, who were able to understand and follow the study instructions. A sociodemographic and clinical questionnaire and the MMSE and MoCA neurocognitive tests were applied. The mean age of the patients was 67 years; 67.44% were male; 53.49% were white; 58.14% had 1-4 years of schooling; 58.14% had an income of half to one minimum wage; 55.81% were married; 53.49% had a family history of HF; 90.7% denied smoking; 83.72% denied alcohol intake; 65.12% did not practice physical activity; 83.72% were hypertensive; 30.23% were diabetic; 57.89% had LVEF ≥ 50%; 39.53% have NYHA II; and 88.37% did not have a pacemaker. In the identification of CD, the MMSE test detected it in 25.58% of the patients, while the MoCA test identified it in 23.26% (p=0.043). It was concluded that the MMSE test performed better than the MoCA test in the identification of CD in elderly patients with HF.

Effect of postoperative hydrocodone analgesia on inflammatory factors, NSE levels, and cognitive function in elderly patients undergoing hip arthroplasty.

To explore the effect of postoperative hydrocodone analgesia on inflammatory factors, NSE levels, and cognitive function in elderly patients undergoing hip arthroplasty. A retrospective analysis was conducted on elderly patients undergoing hip arthroplasty from January 2020 to December 2023. Among them, 43 patients with postoperative hydrocodone analgesia were included in an observation group, and 57 patients without postoperative hydrocodone analgesia in a control group. We compared the differences of general clinical data, inflammatory factors (CRP, WBC and PCT), NSE levels, and cognitive function. After surgery, the VAS scores decreased in both groups compared to before treatment, and the decrease was more significant in the observation group than the control group (P < 0.05). The NSE, WBC, CRP, and PCT level in the control group were significantly higher than those in the observation group at one day, 3 days, and 7 days after surgery (P < 0.05). Moreover, the MMSE score and the serum S100β protein concentration significantly improved in the observation group at one day, 3 days and 7 days after surgery compared to the control group (P < 0.05). Postoperative hydrocodone analgesia can reduce the release of inflammatory factors after elderly hip replacement surgery, alleviating postoperative pain, and reducing the incidence of early postoperative cognitive impairment.

Effectiveness of bone-filled mesh bag technology and angle vertebroplasty in the treatment of osteoporotic thoracic vertebral compression fractures in the elderly.

To evaluate the effectiveness, pain level, and lung function in elderly patients with osteoporotic thoracic vertebral compression fractures using bone filling mesh bag technology compared to curved vertebroplasty. This retrospective analysis reviewed 72 elderly patients with osteoporotic thoracic vertebral compression fractures treated at Xindu District People's Hospital of Chengdu between February 2021 and January 2022. The patients were separated into two groups according to surgery approach: an observation group using bone filling mesh bag technology and a control group using curved vertebroplasty. The overall response rate, pain degree, pulmonary function, life quality grades, surgical indicators, and bone cement leakage rates of the two groups were evaluated. The variation in overall response rate (P=0.420), pain degree (P=0.270), pulmonary function (peak expiratory flow: P=0.660, forced expiratory volume in the first second: P=0.775, forced vital capacity: 0.062), and life quality grades (physical health: P=0.949, social function: P=0.935, physiological function: P=0.970, vitality: P=0.778) between the observation group and the control group after treatment was not statistically meaningful. The Cobb angle (P<0.001) and vertebral height (P<0.001) of patients in the observation group were significantly higher than those in the control group after therapy. The leakage rates of bone cement (intervertebral disc leakage, paravertebral vein leakage, paravertebral soft tissue leakage) of patients in the observation group were notably lower than those in the control group after therapy (P=0.029). Bone filling mesh bag technology offers significant improvements in Cobb angle and vertebral height for treating elderly patients with osteoporotic thoracic vertebral compression fractures, and reduced the leakage rate of bone cement. This technique achieves comparable therapeutic outcomes to curved vertebroplasty.

Effects of Cycloergometer on Cardiopulmonary Function in Elderly Patients after Coronary Artery Bypass Grafting: Clinical Trial.

Despite all the improvements in surgical and anesthetic techniques, this procedure is still associated with pulmonary and cardiovascular complications in the postoperative period, and early rehabilitation, done through the use of cycloergometer, can minimize such complications, besides reducing the length of hospital stay. Therefore, the aim of the study was to assess the impact of cardiovascular exercise on lung function, respiratory muscle strength, and functional capacity in elderly patients after heart bypass surgery. To this purpose, a randomized and controlled clinical trial was conducted. Research participants were randomized to the cycle ergometer group (CEG) or to the control group (CG). The CG was managed based on the institution's protocol. The CEG also carried out all the activities of the control group, but there was the inclusion of cycle ergometry through a device built by the researchers. Pulmonary function (vital capacity (VC) and peak expiratory flow (PEF)), ventilatory muscle strength (maximum inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), and functional capacity (six-minute walk test) were evaluated before surgery, at ICU, and hospital discharge. During the research period, 122 patients were evaluated, 61 in each group. The MIP of the cycle ergometry group was higher at discharge from the ICU 95% CI 8 (5.46 to 10.54) and at hospital discharge 95% CI 14 (16.89 to 11.11). MEP was higher in the cycle ergometry group at discharge from the ICU with 95% CI 6 (8.18 to 3.82) and at hospital discharge with 95% CI 9 (11.69 a 6.31). Vital capacity at ICU discharge with 95% CI 6 (7.98 to 4.02) and at hospital discharge with 95% CI 7 (8.98 to 5.02), as well as peak flow at ICU discharge with 95% CI 43 (75.27 to 10.73), showed relevance, being higher in the group that used the cycle ergometer. The CEG showed improvement in functional capacity at the time of hospital discharge with a 95% CI 56 (30.37 to 81.63). We conclude that application of cycloergometry after CABG decreases the loss of pulmonary function, muscle strength, and functional capacity. This trial is registered with RBR-39yrht6.

Herbal Medicine for Sarcopenia: A Systematic Review of Randomized Controlled Trials

Objectives: Sarcopenia is an age-associated skeletal muscle disorder that can profoundly impact the health of elderly people. However, the efficacy of herbal medicine in sarcopenia is uncertain. This review aims to investigate evidence of the effect of herbal medicine on sarcopenia.Methods: We systematically searched 12 electronic databases for relevant randomized controlled trials (RCTs). Only trials that met the inclusion criteria were selected, and the characteristics of the included studies were extracted and synthesized in a narrative manner. The quality of the included studies was assessed using Cochrane’s Risk of Bias (RoB) 2.0 tool.Results: 7 RCTs involving 672 participants with sarcopenia met the inclusion criteria. The intervention combining herbal medicine and conventional treatment (i.e., exercise, nutritional support) had a significant therapeutic effect compared with the conventional treatment, showing improvement in muscle strength (i.e., grip strength), muscle mass (i.e., appendicular skeletal muscle mass index), and physical function (i.e., gait speed, short physical performance battery, and timed up and go test). However, the methodological quality of the included RCTs was relatively low due to their high RoB, making it difficult to evaluate the efficacy of herbal medicine in sarcopenia. In terms of safety, several adverse events were reported.Conclusion: This review suggests that herbal medicine has a positive effect on muscle strength, muscle mass, and physical performance in elderly patients with sarcopenia, but there is a clear need for further research in this area.

Efficacy and prognostic impact of Pericarpium Trichosanthis injection combined with nicorandil for intractable angina pectoris in elderly patients: A retrospective study.

Coronary artery disease (CAD) is a leading cause of global cardiovascular mortality. Refractory angina pectoris, a manifestation of CAD, requires effective drug treatments. Pericarpium Trichosanthis injection, a traditional Chinese medicine, improves cardiovascular symptoms, while nicorandil alleviates spasms and angina. Both have potential in treating CAD. To investigate the therapeutic effects of combining Pericarpium Trichosanthis injection and nicorandil in elderly patients suffering from refractory angina caused by coronary heart disease. A retrospective analysis was conducted on the data of 130 patients diagnosed with refractory coronary heart disease. Based on the different treatment regimens administered during hospitalization, the patients were divided into a control group (58 cases) and a study group (72 cases). The control group received conventional treatment, which included aspirin, statins, and nitrate vasodilators. In addition to the conventional medication, the study group received a combination treatment of Pericarpium Trichosanthis injection and nicorandil. After treatment, the study group showed significantly higher left ventricular ejection fraction and cardiac output, and lower brain natriuretic peptide and C-reactive protein levels compared to the control group. The study group also exhibited improvements in angina, quality of life, exercise endurance, and lipid profiles. Multivariate logistic regression analysis revealed a relationship of lipid levels and heart function with the combined treatment. Some patients in the study group experienced headaches during treatment, but no significant adverse reactions were observed. Follow-up showed that the treatment was well-tolerated, with no drug-related adverse reactions detected. Combination of Pericarpium Trichosanthis injection and nicorandil is more effective than conventional treatment in improving symptoms and heart function in elderly patients with refractory angina pectoris.

Clinical Significance of Prealbumin Level Measurement Before Neoadjuvant Chemotherapy in Elderly Patients With Locally Advanced Esophageal Cancer.

Radical esophagectomy after preoperative neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). However, careful treatment selection is required when considering organ function in elderly patients. Prealbumin, a rapid turnover protein, is a short-term dynamic nutritional index, and its relationship with long-term postoperative survival in various cancers has been previously reported. However, the association between serum prealbumin level before NAC and survival in elderly patients remains unclear. This study investigated the clinical significance of prealbumin level measurement before NAC in elderly patients with locally advanced ESCC who underwent surgery after NAC. Eighty patients aged ≥65 years diagnosed with cStage II/III ESCC and undergoing radical esophagectomy after cisplatin and 5-fluorouracil therapy as NAC, were included. The cutoff value of the serum prealbumin level before NAC was set at 18.2 mg/dl using receiver operating characteristic curve analysis, and postoperative complications, recurrence, and overall survival were compared between the low and high prealbumin groups. There were no differences in patient background, clinicopathological characteristics, postoperative complications, or recurrence-free survival between the two groups. Overall survival (OS) was significantly worse in the low prealbumin group than in the high prealbumin group (5-year survival, 33.3% vs. 67.0%; p=0.0341). Furthermore, on univariate and multivariate analysis, low prealbumin level was an independent poor OS factor (p=0.036). In elderly patients with locally advanced ESCC, serum prealbumin level before NAC may be a useful prognostic factor and may be important in selecting a treatment strategy that considers individual organ function.

Effect of Traditional Chinese Emotional Nursing Combined with Lung Rehabilitation Training and Oral Nutrition Preparation on Improving the Nutritional Status and Lung Function in Elderly Patients with Chronic Obstructive Pulmonary Disease

This study aimed to investigate the effect of traditional Chinese emotional nursing combined with lung rehabilitation training and oral nutrition preparation on improving the nutritional status and lung function of elderly patients with chronic obstructive pulmonary disease. The control group received conventional Western medicine and lung rehabilitation training, while the observation group received traditional Chinese emotional nursing combined with oral nutrition preparation. After nursing, the self-rating depression scale and self-rating anxiety scale scores in the observwere lower than those in the control group (P &lt; 0.05), whereas forced vital capacity, forced expiratory volume in 1 s, and 6-min walk distance were higher (P &lt; 0.05). Serum albumin, prealbumin, transferrin, immunoglobulin A, immunoglobulin G, and immunoglobulin M levels were higher than those in the control group (P &lt; 0.05). After nursing, the scores for physical, material, social, and psychological functions in the observation group were higher than those in the control group (P &lt; 0.05). In conclusion, traditional Chinese emotional nursing combined with lung rehabilitation training and oral nutrition preparation can relieve negative emotions, promote pulmonary function and nutritional status, and improve the quality of life of elderly patients with chronic obstructive pulmonary disease.

The association between oral health status and physical function in elderly patients with acute heart failure.

Oral health problems are common and are associated with various geriatric conditions in older adults. The importance of oral health has not been fully highlighted in the assessment and management of patients with heart failure. Here, we investigated the association between oral health status and the decline in physical function during hospitalization in elderly patients with acute heart failure. We evaluated oral health using the revised oral assessment guide in 77 patients aged 65 years or older who were admitted to hospital for acute heart failure. Oral health problems were defined as a revised oral assessment guide score ≥9. Oral health problems were identified in 66.2% of the patients. Patients with oral health problems had high prevalence of decreased physical function, undernutrition, and cognitive impairment. A reduction in the Barthel Index, as an indicator of activities of daily living during hospitalization, was significant in the enrolled patients. The Barthel Index decreased more in patients with oral health problems than those with normal oral health. Furthermore, the revised oral assessment guide score on admission was found to be the only independent predictor of changes in the Barthel Index during hospitalization in the multivariate analyses. Oral assessment using the revised oral assessment guide during hospitalization could provide useful information for the management of elderly heart failure patients.

The relationship between polypharmacy and physical performance in patients with early-stage Alzheimer’s disease

Introduction Our aim was to evaluate the association between polypharmacy and certain physical performance measures used to assess ambulation in early-stage Alzheimer patients. Materials and methods This cross-sectional study was conducted in the dementia outpatient clinic of a tertiary care center. The usage of five or more drugs per day was accepted as polypharmacy and patients with moderate and severe dementia were excluded. Usual gait speed (UGS), timed up and go (TUG), and chair sit-to-stand test (CSST) were applied to assess physical performance status. Results There were 134 participants in our study (67.9% female, mean age 80.2 ± 7.9 years) and 75 (56%) patients were polypharmacy patients. The patients with polypharmacy showed poor physical performance compared to the patients without polypharmacy (UGS p = .005, TUG p < .001, CSST p < .001). The parameters that were significantly higher and more common in the polypharmacy group were body mass index (p = .026), hypertension (p = .013), diabetes mellitus (p = .018), ischemic heart disease (p < .001), atrial fibrillation (p = .030), depression (p = .012), and hypothyroidism (p = .007). In multivariate analyses, polypharmacy was independently associated with slow UGS [Odds ratio (OR) 1.248 (95%) confidence interval (CI) 1.145–1.523, p = .007]; long TUG [OR 1.410 (95%) CI 1.146–1.736, p = .001]; and long CSST [OR 1.892 (95%) CI 1.389–2.578, p < .001]. Conclusion Our study demonstrated the association of polypharmacy with poor physical performance in patients with early stage Alzheimer’s disease. Prospective long-term studies investigating the relationship of polypharmacy and drug subgroups with physical performance in elderly patients with Alzheimer’s disease would be appropriate.

Effect of methoxymine on prevention and treatment of myocardial injury and cardiac function in elderly patients with hypotension during intraspinal anesthesia.

We aimed to investigate the effects of methoxamine to prevent hypotension in the elderly with intraspinal anesthesia (IA) on myocardial injury and cardiac function. A retrospective study was conducted by enrolling sixty elderly patients who underwent femoral head replacement (FHR) under IA in our hospital from August 2019 to August 2020. The patients were divided into two groups according to the random number table method. In the control group (CG) (30 patients), 5 mg of ephedrine was administered sedately when patients developed hypotension (20% below basal blood pressure). In the research group (RG) (30 cases), 2 μg/(kg·h) of methoxamine hydrochloride was given as a constant-rate pump before anesthesia, and 1 mg of methoxamine hydrochloride was administered intraoperatively if hypotension occurred. The hemodynamic [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR)], myocardial injury indexes [cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB), fatty acid binding protein (FABP), plasma amino-terminal brain natriuretic peptide precursor (NT-proBNP)], cardiac function indexes [systemic vascular resistance (SVR), stroke volume (SV), net percentage ejection time (ET)] were observed before anesthesia (T1), at the end of surgery (T2), and 6 h after surgery (T3) in both groups. The Bruggemann Comfort Score (BCS) and Visual Analog Scale (VAS) scores at T3, 12 h postoperatively (T4) and 24 h postoperatively (T5) in both groups were observed, and the incidence of adverse reactions to intralesional anesthesia in both groups was counted. SBP, DBP and HR at T2 were lower than those at T1 in both groups, and SBP, DBP and HR at T3 were higher than those at T2, and SBP, DBP and HR at T2 and T3 in the RG were higher than those in the CG (p<0.05). In both groups, cTnⅠ, CK-MB and FABP were higher at T2 and T3 than at T1, higher at T3 than at T2, and NT-proBNP was higher at T2 than at T1 and T3, and lower in the RG than in the CG (p<0.05). In both groups, SVR and SV at time point T2 were lower than at time point T1 and ET was higher than at time point T1, SVR and SV at time point T3 were higher than at time point T2 and ET was lower than at time point T2, SVR and SV in the RG were higher than in the CG and ET was lower than in the CG (p<0.05). VAS scores were higher in both groups at T4 and T5 than at T3, and lower in the RG than in the CG (p<0.05). Methoxamine can effectively reduce the risk of hypotension in geriatric endotracheal anesthesia, which can reduce myocardial injury and stabilize cardiac function in patients.

Retracted: Effects of Chronic Heart Failure on Longitudinal Changes of Cognitive Function in Elderly Patients

Retracted: Effects of Chronic Heart Failure on Longitudinal Changes of Cognitive Function in Elderly Patients

Vascular endothelial growth factor-D plasma levels in fluid overload and cardiac function evaluation of elderly patients with cardiovascular disease.

This study aimed to investigate the clinical significance of vascular endothelial growth factor (VEGF) subtypes and growth differentiation factor-15 (GDF-15) plasma levels in evaluating the fluid overload and cardiac function of elderly patients with cardiovascular disease. The plasma levels of VEGF-C, VEGF-D, and GDF-15 were measured using ELISA. Their correlations with N-terminal pro B-type natriuretic peptide (NT-Pro BNP) and echocardiography data were analyzed. 1. Higher plasma levels of VEGF-D and GDF-15 were observed in elderly patients with cardiovascular disease and heart failure(P < .01). VEGF-D plasma levels were higher in patients with chronic heart failure than those with acute myocardial infarction (P < .01). VEGF-D plasma levels were positively correlated with amino-terminal pro-B type natriuretic peptide (NT-pro BNP) (P < .001). VEGF-D plasma levels were positively correlated with echocardiographic parameters, including left atrial diameter, left ventricular end-diastolic diameter and left ventricular ejection fraction, in patients with cardiovascular disease (P < .01). 2. VEGF-C plasma levels were higher in acute myocardial infarction group (P < .05). The plasma levels of VEGF-C were not correlated with either VEGF-D or NT-pro BNP plasma levels. VEGF-C plasma levels had no correlation with echocardiographic parameters. 3. GDF-15 plasma levels were positively correlated with sera biomarkers of cardiac injury (creatine kinase isoenzyme MB and cardiac troponin I). GDF-15 plasma levels were positively correlated with urinary biomarkers of tubular injury (N-acetyl-β-galactosidase and α1-microglobulin). Both GDF-15 and NT-pro BNP plasma levels were correlated with age, estimated glomerular filtration rate (eGFR), and nutritional biomarkers (albumin and hemoglobin plasma levels). VEGF-D plasma levels is a potential biomarker of fluid overload and cardiac function in elderly patients with cardiovascular disease. Age, nutrition, and kidney injury are factors influencing both GDF-15 and NT-pro BNP plasma levels in estimating cardiac function and fluid overload.

Short and long-term renal function changes with direct oral anticoagulants in elderly patients with atrial fibrillation

Abstract Background Atrial Fibrillation (AF) and chronic kidney disease (CKD) frequently coexist in elderly patient. Previous evidence showed that vitamin K antagonists (VKAs) may be associated with an accelerated decrease of estimated glomerular filtration rate (eGFR) compared to direct oral anticoagulants (DOACs). However, there is little evidence on DOACs in the elderly population and in real life settings; the evidence available to us comes from randomized clinical trials with younger populations. Purpose The main objective of this study was to investigate the medium to long term renal function changes in older AF patients treated with DOACs and VKAs. Methods Enrolled patients underwent 3 eGFR measurements during follow-up, and the between arms difference in eGFR lost over time was investigated by 1) the Linear Mixed Models (LMM) and 2) group-based trajectory model (GBTM) analyses. Analysis was done according to short-term (3.2 years) and long-term follow-up (6.7 years). During the study period 420 enrolled AF patients (77.0±6.0 years, 136 on VKAs and 284 on DOACs) underwent 1260 eGFR assessments. Results After a median follow-up of 4.9 years, in the whole sample eGFR decreased from 67.4±18.2 ml/min/1.73 m2 to 47.1±14.3 ml/min/1.73 m2, p&amp;lt;0.001. Patients on DOACs experienced a significantly lower eGFR decrease that those treated with VKAs (-21.3% vs -45.1%, p&amp;lt;0.001). The benefit of DOACs compared with VKAs was evident both in the short term (eGFR decline -6.6 (95% CI: -9.1 to -4.0) ml/min/1.73 m2 vs -19.9 (95% CI: -23.6 to -16.2) ml/min/1.73 m2 respectively) and in the long-term, (eGFR -13.5 (95% CI: -16.1 to -11.0) ml/min/1.73 m2 in DOACs group vs -34.2 (95% CI: -37.9 to -30.5) ml/min/1.73 m2), respectively). After stratifying our study population into 5 groups according to trajectories of renal function decline, from the first (lowest decline in eGFR) to the fifth (greatest decline in eGFR), the first trajectory consisted of 80% patients on DOACs therapy. Logistic regression showed that the group on DOACs therapy was 3.03- to 4.24-fold more likely to belong to the trajectory with less eGFR decline than the VKAs group. Conclusions In conclusion, DOACs were associated with less long term decline in renal function in elderly patients with AF compared with VKAs.

Effects of entecavir and tenofovir alafenamide fumarate treatment on renal function in Japanese elderly patients with chronic hepatitis B.

Entecavir (ETV) and tenofovir alafenamide fumarate (TAF) are considered safe nucleoside/nucleotide analogs (NA) for the kidney. This study aimed to investigate the long-term effects of ETV or TAF on renal function in elderly patients with chronic hepatitis B (CHB) in Japan. The study included 246 CHB patients treated with ETV (184 patients) or TAF (62 patients) for at least 2years. These patients were divided into two groups: those <65years of age (130 patients) and those ≥65years of age (116 patients). The effects of the NAs on renal functions were examined by comparing the estimated glomerular filtration rates (eGFR) from baseline to 2years between the two groups. The change in eGFR from baseline to 1 or 2years after treatment was significantly decreased in both groups. However, the amount of change at 1 and 2years was significantly greater in the group aged ≥65years than in the group aged <65years. The amount of change in eGFR from baseline to 1 and 2years after treatment was significantly greater in the group aged ≥65years than in the group aged <65years, regardless of the type of NA, the prior treatment history, cirrhosis/chronic hepatitis, hypertension, dyslipidemia, and diabetes. Additionally, logistic regression analysis showed that age ≥65years was independently associated with a decreased eGFR after 2years of NA treatment. Long-term administration of NA to CHB patients over 65years of age should be carefully monitored for renal impairment.

Effect of dexmedetomidine on convalescence quality after general anesthesia and postoperative delirium, and on cognitive function in elderly patients undergoing lower limb surgery

Purpose: To investigate the effect of different doses of dexmedetomidine on the quality of postoperative recovery, incidence of postoperative delirium, and cognitive function in elderly patients undergoing lower limb surgery.&#x0D; Methods: A total of 112 patients who received treatment in the Department of Anesthesiology, Affiliated Hospital of Inner Mongolia Medical University, Hothot, China from January 2021 to January 2023 were divided into 3 groups, consisting of low-dose group (35 patients received 0.2 mg/kg), medium-dose group (39 patients received 0.4 mg/kg), and high-dose group (38 patients received 0.6 mg/kg). Parameters including, convalescence quality of general anesthesia, incidence of postoperative delirium, adverse reactions, Mini- mental State Examination (MMSE) scores, sedation effect (Ramsay), analgesia effect (visual analogue scale (VAS)), and stress indices, viz, norepinephrine (NE), epinephrine (E), and cortisol (COR) levels), were evaluated and compared.&#x0D; Results: There was no significant difference in tracheal extubation time, recovery time of spontaneous breathing, calling eye-opening time, or full awakening time among the three groups (p &gt; 0.05). However, MMSE score was significantly higher in low-dose group on days 1 and 3 after surgery (p &lt; 0.05) and VAS scores were significantly higher in low-dose group at 12 and 24 h after recovery compared to other groups (p &lt; 0.05). Ramsay score was significantly higher in high-dose group (p &lt; 0.05). Levels of NE, E, and COR were significantly lower in medium-dose group compared to other groups (p &lt; 0.05). Incidence of adverse reactions were significantly lower in low and medium-dose groups compared to high- dose group (p &lt; 0.05).&#x0D; Conclusion: Medium-dose dexmedetomidine demonstrates favorable sedative and analgesic effects with minimal impact on cognitive function and stress response in elderly patients undergoing lower limb surgery. Furthermore, it does not affect quality of postoperative recovery nor incidence of postoperative delirium. More large-scale, randomized controlled studies are needed to confirm these results.

Effects of dexmedetomidine on early cognitive function in elderly patients after abdominal surgery: a meta-analysis.

This meta-analysis aims to investigate the effect of dexmedetomidine (Dex) on postoperative cognitive dysfunction (POCD) in elderly patients undergoing abdominal surgery under general anesthesia. Six online databases were searched for studies on the effects of Dex on POCD in elderly patients (≥60 years) who underwent abdominal surgery under general anesthesia. The experimental group was treated with Dex and the control group with normal saline. The retrieval period was from the database's inception to March 2023. Stata 15.0 statistical software was utilized to analyze the data. In total, 14 studies were entered into this meta-analysis, including 675 patients. On the first, third, and seventh days after surgery, the Mini-Mental State Examination (MMSE) scores in the experimental group were significantly higher than those in the controls (first day: weighted mean difference [WMD] = 2.52, 95% CI: 1.13~3.90, P<0.001; third day: WMD=2.58, 95% CI: 0.76~4.40, P=0.005; seventh day: WMD=1.43, 95% CI: 0.57~2.29, P=0.001). On the first day after surgery, there was a lot less cognitive dysfunction in the Dex group than in the controls (odds ratio [OR] = 0.25, 95% CI: 0.15~0.42, P<0.001). Dex administered intraoperatively can enhance early cognitive function in elderly patients undergoing abdominal surgery.

The Effect of Dexmedetomidine on the Mini-Cog Score and High-Mobility Group Box 1 Levels in Elderly Patients with Postoperative Neurocognitive Disorders Undergoing Orthopedic Surgery.

Dexmedetomidine prevents postoperative cognitive dysfunction by inhibiting high-mobility group box 1 (HMGB1), which acts as an inflammatory marker. This study investigated the HMGB1 levels and the cognitive function using a Mini-Cog© score in elderly patients undergoing orthopedic surgery with dexmedetomidine infusion. In total, 128 patients aged ≥ 65 years were analyzed. The patients received saline in the control group and dexmedetomidine in the dexmedetomidine group until the end of surgery. Blood sampling and the Mini-Cog© test were performed before the surgery and on postoperative days 1 and 3. The primary outcomes were the effect of dexmedetomidine on the HMGB1 levels and the Mini-Cog© score in terms of postoperative cognitive function. The Mini-Cog© score over time differed significantly between the groups (p = 0.008), with an increase in the dexmedetomidine group. The postoperative HMGB1 levels increased over time in both groups; however, there was no significant difference between the groups (p = 0.969). The probability of perioperative neurocognitive disorders decreased by 0.48 times as the Mini-Cog© score on postoperative day 3 increased by 1 point. Intraoperative dexmedetomidine has shown an increase in the postoperative Mini-Cog© score. Thus, the Mini-Cog© score is a potential tool for evaluating cognitive function in elderly patients.

Development of an improved ELISA method based on gold nanoparticles to evaluate the correlation of serum occludin and zonula occludin-1 (ZO-1) levels with cognitive impairment in elderly patients with acute cerebral infarction

The present study evaluated an improved Enzyme linked immunosorbent assay (ELISA) method based on gold nanoparticles by investigating the correlations of measured serum occludin and zonula occludin-1 (ZO-1) levels with cognitive impairment in elderly patients with acute cerebral infarction (ACI). The present study comprised a total of 98 patients with ACI that were divided into patients with normal cognitive function (normal group) and patients with cognitive impairment (PSCI group) according to mini-mental state examination (MMSE) scores. Serum levels of triglycerides, total cholesterol, and low-density lipoprotein were measured using an automatic biochemical analyzer. Serum occludin and ZO-1 levels in both groups were measured using a modified ELISA assay with nanogold particles. Neurological function in elderly patients with ACI was assessed using the National Institutes of Health Stroke Scale (NIHSS) score. Pearson’s correlation coefficient was calculated for the correlations between serum occludin levels, serum ZO-1 levels, and cognitive impairment in elderly patients with ACI. Receiver operating characteristics (ROC) curves were used to analyze the diagnostic value of serum occludin and ZO-1 levels in detecting cognitive impairment in elderly patients with ACI. Logistic regression analysis was used to identify factors associated with cognitive impairment in elderly patients with ACI. In the PSCI group, a significantly higher proportion of patients had hypertension, coronary heart disease, and diabetes compared to the normal group. Serum occludin and ZO-1 levels were significantly lower in the PSCI group compared to the normal group (P &lt;0.05). Serum occludin and ZO-1 levels in elderly patients with ACI were negatively associated with NIHSS score (P &lt;0.05). Receiver operating characteristic analysis demonstrated that the area under the curve (AUC) of serum occludin and ZO-1 in detecting cognitive impairment in elderly patients with ACI was 0.926 and 0.824 respectively, with a combined AUC of 0.945 indicating a synergistic effect in detecting cognitive impairment. Logistic regression analysis showed that hypertension, diabetes, coronary heart disease, and lower serum occludin, and ZO-1 levels were all independent risk factors for cognitive impairment in elderly patients with ACI. Lower serum levels of occludin and ZO-1 level had diagnostic value in detecting cognitive impairment in elderly patients with ACI and may have utility as an auxiliary diagnostic index for cognitive dysfunction in patients with ACI.