Volume 104 · Issue 46 · 2024

With the acceleration of global population aging, the incidence and mortality of cardiovascular disease (CVD) among the older adults are continuously rising, posing an essential public health challenge that severely threatens their health and quality of life. In recent years, significant progress has been made in the research on epidemiological characteristics, risk factors, and prevention strategies of CVD in older adults. This review aims to summarize the current research status of CVD in the old adults, explore key factors affecting cardiovascular health, including genetic factors, lifestyle, and metabolic abnormalities, and evaluate the effectiveness of novel interventions. The goal is to provide a scientific basis for developing CVD prevention and management strategies tailored to the old adults.

The World Health Organization′s (WHO) International Agency for Research on Cancer (IARC) released the fifth edition of the Classification of Tumors of the Hematopoietic and Lymphoid Tissues, renaming myelodysplastic syndrome (MDS) to myelodysplastic neoplasm (still abbreviated as MDS). This new classification integrates next-generation sequencing data to standardize the disease′s nature. The name change reflects a deeper understanding of the disease, transitioning from the vague "syndrome" to a clearly defined neoplastic disease. The new classification divides MDS into two major categories: cytogenetic abnormalities and morphological abnormalities. Cytogenetic abnormalities include MDS with low blasts and isolated 5q deletion, MDS with low blasts and SF3B1 mutation, and MDS with biallelic TP53 alterations. Morphological abnormalities include MDS with low blasts, MDS with increased blasts and hypoplastic MDS. This revision provides a foundation for precise diagnosis and treatment of MDS, further restricting the application of immunosuppressive therapy and advancing genetic research in diagnostics and therapeutics.

To analyze the thyroid stimulating hormone (TSH) levels in different genders and ages, and the association between TSH level and the risk of coronary heart disease.

The baseline survey was conducted using a multi-stage cluster random sampling method from September to December 2015, in Jurong City, Jiangsu Province. A total of 10 703 participants were included in the analysis. The proportion of participants with abnormally elevated TSH defined by three cut-off values (4.5, 7.0, and 10.0 mU/L) were calculated. The cohort was followed up until August 2023 to collect and verify new cases of coronary heart disease. The population was divided into age-and gender-specific quintile subgroups based on TSH. Multivariate Cox regression analysis was used to examine the relationship between TSH and the risk of coronary heart disease.

The median age was [M (Q₁, Q₃)] 61.1(51.8, 67.9) years-old, and there were 4 168 males (38.94%) in the study. The proportions of participants with abnormally increased TSH rose with aging in different genders, and was higher in females than in males (all P_trend0.05). A total of 206 participants with coronary heart disease at baseline were excluded, and the other 10 497 were followed up for an average of (7.33±1.49) years, during which 350 new cases of coronary heart disease occurred, and the cumulative incidence rate was 3.34%. The cumulative incidence rates among TSH quintile Q1-Q5 groups were 3.62%, 3.32%, 3.56%, 3.28% and 2.57% respectively. Multivariate Cox regression analysis indicated that compared with TSH Q1 group, participants in Q5 group had a lowest risk of coronary heart disease (HR=0.704, 95%CI: 0.498-0.994). The TSH Q5 group was associated with a reduced risk of coronary heart disease in individuals60 years old (HR=0.484, 95%CI: 0.243-0.965), and the risk of coronary heart disease decreased as TSH levels increased (P_trend=0.008).

TSH level increases with aging, and is higher in females than in males. In individuals 60 years old, higher levels of TSH may assaciate with a lower incidence rate of coronary heart disease.

To explore the associations of plasma acylcarnitine and bile acid levels with the risk of incident coronary heart disease (CHD) in Chinese adults.

The baseline survey of China Kadoorie Biobank (CKB) took place in 10 areas across China during 2004-2008, and the first resurvey took place from July to October 2008, with collection of data via questionnaire, physical examination and blood samples. The current study was based on 2 159 individuals with targeted mass spectrometry metabolomic measurements from the first resurvey of CKB. The associations of acylcarnitines and bile acids with incident CHD were assessed using Cox proportional hazards regression models. Unweighted metabolites scores were constructed to assess the overall effect of acylcarnitines and bile acids on incident CHD. The impact of metabolites on the performance of CHD prediction model was evaluated with the receiver operating characteristic (ROC) area under the curve (AUC). Follow-up for CHD incidence was censored on December 31, 2018.

The mean age of the participants was (53.1±9.8) years and 754 were males (34.9%). During (10.5±0.1) years of follow-up, 140 cases of CHD were recorded. Four metabolites including acylcarnitines C3-OH, C5:1, C5:1-DC, and deoxycholic acid (DCA) showed associations with CHD incidence and the HR (95%CI) were 1.474 (1.230-1.767), 0.761 (0.637-0.909), 0.773 (0.650-0.918), and 1.309 (1.113-1.539), respectively [false discovery rate (FDR)0.05]. All metabolite scores, including short-chain, medium-chain, long-chain acylcarnitines, primary and secondary bile acids scores were associated with the risk of CHD (FDR0.05). Compared to the traditional models, the addition of DCA or 4 key metabolites increased the AUC of the predictive model from 0.803 (0.761-0.845) to 0.812 (0.772-0.852) and 0.817 (0.778-0.857), respectively (all P0.05).

Acylcarnitine and bile acid levels are associated with the risk of CHD, and DCA or 4 key metabolites can improve the predictive ability for CHD incidence.

To explore the impact of adherence to plant-based and animal-based dietary patterns on blood lipid level in Chinese older adults aged≥65.

The study subjects were from the Chinese Longitudinal Health Biomarker Survey on Aging conducted between 2008 and 2018. The project carried out a baseline survey on elderly people in nine longevity areas of China from 2008 to 2009, and conducted 3 follow-up visits respectively in 2011-2012, 2014, and 2017-2018. The information about their demographic characteristics, lifestyles, physical examinations and fasting venous blood samples were collected. Food Frequency Questionnaire was used to collect data on food intake frequency. Priori plant-based and priori animal-based dietary patterns were constructed, and plant-based diet index (PDI) and animal-based diet index (ADI) were calculated in 2 011 older adults. Linear mixed-effects models were used to analyze the associations of different dietary pattern indices with blood lipid level in older adults.

The average age of 2 011 subjects was (83.1±11.5) years, 52.8% (1 061) of them were women. The PDI and ADI [M (Q₁, Q₃)] were 41.0 (38.0, 45.0) and 43.0 (39.0, 46.0), respectively. After adjusting for covariates, the results of the linear mixed effects model analysis showed that for each increment of 10-unit in PDI, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels decreased by 0.097 (95%CI:-0.151--0.042) mmol/L and 0.078 (95%CI:-0.118--0.038) mmol/L, respectively. For each increment of 10-unit in ADI, TC and LDL-C levels increased by 0.096 (95%CI: 0.042-0.151) mmol/L and 0.078 (95%CI: 0.038-0.118) mmol/L, respectively.

In Chinese older adults≥65 years, higher adherence to the plant-based dietary pattern may lead to reductions in TC and LDL-C levels, while higher adherence to the animal-based dietary pattern may lead to increases in TC and LDL-C levels.

To explore the effect of low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) ratio on the severity of coronary artery disease and 2-year adverse events in elderly patients with coronary heart disease.

This prospective, multicenter, observational cohort study was from the prospective observational multicenter cohort for ischemic and hemorrhage risk in coronary artery disease patients (PROMISE) study, in which 18 701 patients with coronary heart disease (CHD) were included from January 2015 to May 2019. Among them, 6 770 elderly patients with CHD were enrolled in the current study. According to the median of LDL-C/HDL-C ratio (2.1), the patients were divided into two groups: low LDL-C/HDL-C group (LDL-C/HDL-C≤2.1, n=3 346) and high LDL-C/HDL-C group (LDL-C/HDL-C2.1, n=3 424). Baseline data and 2-year outcomes (including death, myocardial infarction, revascularization, stroke) were collected and analyzed in order to found the differences of elderly CHD patients with different LDL-C/HDL-C levels, and explore the correlation between LDL-C/HDL-C ratio with the severity of coronary artery disease and prognosis using Cox multivariate regression analysis.

Patients in the low LDL-C/HDL-C group were older [(71.9±5.5) vs (71.5±5.4) years old, P=0.003], and there was no statistically significant difference in the proportion of males between the two groups (61.9% vs 63.4%,P=0.208). The indicators reflecting the severity of coronary artery lesions, including the number of target lesions, the number of coronary artery disease, preoperative SNYTAX score, and the proportion of triple-vessel disease (1.01±0.81 vs 0.88±0.78, 2.28±0.81 vs 2.14±0.83, 16.05±10.67 vs 13.59±9.49, 49.0% vs 41.0%, respectively, all P0.05) were higher in the high LDL-C/HDL-C group. The 2-year follow-up showed that there was no statistically significant difference in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause mortality, cardiac death, myocardial infarction, and revascularization between the high LDL-C/HDL-C ratio group and the low LDL-C/HDL-C ratio group. Compared by gender, the incidence of all-cause death and cardiac death in the high LDL-C/HDL-C group of female patients were higher than the low LDL-C/HDL-C group (6.9% vs 4.8%, 5.3% vs 3.7%, both P0.05, respectively); There was no statistically difference in the incidence of adverse events between the two groups of male patients. Cox multivariate regression analysis showed that, regardless of gender, the LDL-C/HDL-C ratio was not a risk factor for 2-year MACCE in elderly patients with CHD (male: HR=1.21, 95%CI: 0.87-1.69; female: HR=0.96, 95%CI: 0.65-1.43;total: HR=1.09, 95%CI: 0.85-1.39,all P0.05).

The severity of coronary artery disease is higher in elderly patients with high LDL-C/HDL-C ratio than in those with low LDL-C/HDL-C ratio. The LDL-C/HDL-C ratio is not a risk factor for 2-year adverse cardiovascular and cerebrovascular events in elderly patients with coronary heart disease. However, the incidences of 2-year adverse cardiovascular events of female patients with high LDL-C/HDL-C ratio are higher than patients with low LDL-C/HDL-C ratio.

To analyze the relationship between cumulative body mass index (BMI) and cognitive score or cognitive impairment at different age groups among elderly adults aged≥60 years old.

Participants were recruited from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR). A total of 27 227 participants aged≥60 years old, who completed at least 2 physical examinations between 1992-1994 and 2018-2021, and completed cognitive function tests from 2018 to 2021, were included in the final analysis. Cognitive score was assessed using the Minimum Mental State Examination (MMSE). Cognitive impairment was defined based on education level: illiterate individuals with MMSE≤17, primary school graduates with MMSE≤20, and secondary school graduates with MMSE≤24. Multivariate linear regression or multivariate logistic regression models were used to analyze the association between 10-year weighted cumulative BMI and cognitive score or cognitive impairment in the general population, as well as in specific age groups (including 60-64 years, 65-69 years, 70-74 years, and≥75 years). Restricted cubic spline was adopted to explore the dose-response relationship.

The age of enrolled participants was (72.3±5.8) years, and 10 639 (39.1%) were males. The mean MMSE score was (24.9±6.8), and 4 171 (15.4%) participants had cognitive impairment. In the general population, the MMSE score increased and the risk of cognitive impairment decreased with the increase in cumulative BMI when cumulative BMI was280 kg/m² (β=0.095, 95%CI: 0.060-0.130; OR=0.962, 95%CI: 0.946-0.978). When cumulative BMI≥280 kg/m², the associations between cumulative BMI level and MMSE score and cognitive impairment risk were not statistically significant (β=-0.105, 95%CI:-0.212-0.001; OR=1.047, 95%CI: 0.992-1.102). Subgroup analysis according to age groups revealed a potential"U-shaped"correlation between cumulative BMI and MMSE score or cognitive impairment risk in participants aged75 years old. For cumulative BMI levels280 kg/m², the OR and 95%CI for cognitive impairment were 0.983 (0.904-1.069), 0.953 (0.919-0.987), and 0.951 (0.922-0.982) for each 10 kg/m² increment in cumulative BMI in the 60-64, 65-69, and 70-74 years old groups, respectively. For cumulative BMI≥280 kg/m², the OR and 95%CI were 1.548 (1.134-2.186), 1.037 (0.938-1.139), and 1.109 (1.014-1.208) in the 60-64, 65-69, and 70-74 age groups. Among those aged≥75 years old, the cumulative BMI level was statistically associated with the increased MMSE score and decreased cognitive impairment (β=0.132, 95%CI: 0.074-0.190; OR=0.961, 95%CI: 0.944-0.979).

Overall, when cumulative BMI is280 kg/m², an increase in cumulative BMI is associated with a reduced risk of cognitive impairment in the general population. However, the association varies among individuals aged75 years old and those≥75 years old when cumulative BMI is≥280 kg/m². The findings highlight the necessity of personalized weight management strategies for elderly individuals across different age groups.

To analyze the treatment situation at each time node in the standard in-hospital-stroke(IHS) in the general hospital compared with that in the emergency(community)-onset stroke (COS) group.

A single-center retrospective case-control study was performed.The clinical cases of acute COS group and IHS group who were treated by the same stroke green channel team at Peking Union Medical College Hospital from Jan.2021 to Apr.2024 were included. The treatment process of acute stage of stroke was divided into four time nodes (onset, recognition, admission, and treatment), and the time of each time node was compared and analyzed.

A total of 219 ischemic stroke cases were included, comprising 83 and 136 cases in IHS and COS groups, respectively. There were 134 male patients (61.2%) with a mean onset age of (66.3±15.1) years. IHS occurred across various departments, mainly in surgical departments(55/83, 66.2%). Of the perioperative IHS events, 93.7% (45/48) occurred after the surgery. Compared with the COS group, the IHS group showed a higher rate of post-waking stroke[11/32(34.4%) vs 18/136(13.2%), P=0.004], a lower rate of intravenous thrombolysis[9/32 (29.0%) vs 128/136 (94.8%), P0.001], and a higher rate of mechanical thrombectomy [11/32(34.4%) vs 4/136 (2.9%), P0.001].The overall median onset-CT time in the IHS group was shorter than that in the COS group[M (Q₁, Q₃)] [100 (59, 189)min vs 135(75, 210)min, P=0.030]. In different stages, median time from stroke onset to recognition[25(1, 140) vs 1(1, 30)min,P=0.005] and the on-site/reception CT [30 (19, 40) min vs 16 (11, 26) min, P=0.001] in the IHS group were longer than those in the COS group, while the median time from recognition to admission[30 (10, 48) min vs 76 (53, 137)min, P0.001]was shorter than that in the COS group.

By using the standard ischemic stroke care system, the overall treatment time for IHS group is shorter than that of COS groups. However, compared with COS patients, the onset-recognition and admission to examination/treatment time was significantly prolonged for IHS patients, reflecting the need for further optimization of the standardized in-hospital stroke treatment process.

To compare the short-and medium-term ischemia and bleeding risk between unfractionated heparin and bivalirudin in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).

A total of 742 patients with ACS who underwent emergency PCI in Xinxiang Central Hospital of Henan Province from January 2016 to June 2022 were selected and divided into unfractionated heparin group (385 cases) and bivalirudin group (357 cases) according to the anticoagulant regimen. All patients were followed up for 6 months. The incidence of ischemic and bleeding events at 30 days and 6 months after operation were compared between the two groups. Multivariate Cox proportional regression model was used to analyze the risk factors of ischemic and bleeding events in the two groups. Kaplan Meier method was used to calculate the cumulative survival rate, and log rank method was used to analyze the difference in survival rates.

The age of 742 patients was (62.5±14.8) years old, and male accounted for 58.5% (434 cases). The age of unfractionated heparin group was (61.8±14.8) years old, and male accounted for 59.2% (228 cases); The age of bivalirudin group was (63.3±14.8) years old, and male accounted for 57.7% (206 cases). The incidence of bleeding events at 30 days and 6 months in the unfractionated heparin group were 6.8% (26 cases) and 9.9% (38 cases), respectively, which were higher than 3.4% (12 cases) and 4.5% (16 cases) in the bivalirudin group (all P0.05); The incidence of ischemic events at 30 days and 6 months in the unfractionated heparin group were 7.5% (29 cases) and 11.2% (43 cases), respectively, which were not observed to be significantly different with those in the bivalirudin group [6.2% (22 cases) and 9.5% (34 cases)] (all P0.05). Compared with patients using bivalirudin, the HR value (95%CI) of bleeding events after emergency PCI in patients using unfractionated heparin was 1.964 (1.317-3.125) (P0.05), and the HR value (95%CI) of ischemic events was 0.948(0.595-1.510) (P0.05). The cumulative incidence of bleeding events was 9.9% in unfractionated heparin group and 4.5% in bivalirudin group (P=0.005); The cumulative incidence of ischemic events was 11.2% in unfractionated heparin group and 9.5% in bivalirudin group (P=0.459).

The incidence of short-term hemorrhage events in ACS patients treated with bivalirudin anticoagulation after emergency PCI is lower than that of unfractonated heparin, which can reduce the risk of short-term hemorrhage.

Mediastinal emphysema is one of the complications of esophageal endoscopic mucosal dissection (ESD). Severe emphysema can cause respiratory and circulatory dysfunction, which requires timely surgical intervention. A patient with severe mediastinal emphysema caused by ESD with early esophageal cancer was reported. After gastroscopic nasogastric tube drainage, the symptoms and signs improved and the increased risk of surgical treatment was avoided.

Rotavirus (RV) is one of the most common pathogens causing diarrhea in children, seriously affecting children's health. With the emergence and promotion of RV vaccine, RV-related hospitalization and mortality were significantly reduced. In view of the differences in antigen composition and vaccination strategies of existing RV vaccines, this paper reviews the research progress of RV vaccine at home and abroad, and reviews the etiology, epidemiology, safety and efficacy of RV vaccines on the market and under development at home and abroad, main problems and development directions, so as to understand the current status of RV vaccine and provide reference for the development and application of RV vaccine.

17 α-hydroxylase/17,20-lyase deficiency (17OHD) is an autosomal recessive disease in which 17 α-hydroxylase/17,20-lyase activity is deleted to varying degrees due to CYP17A1 gene variation. The clinical phenotype of patients with 17OHD is highly heterogeneous, and the clinical phenotype is closely related to residual enzyme activity, which is typical of hypertension, hypokalemia and gonadal dysplasia. Because the early symptoms of patients are atypical, the rate of clinical misdiagnosis and missed diagnosis is high, and the delay in diagnosis and treatment affects the quality of life and prognosis of patients. This article reviews the clinical phenotype, diagnosis and treatment of 17OHD.

Both localized renal cell carcinoma and metastatic renal cell carcinoma require adjuvant therapy. At present, treatment based on immune checkpoint inhibitors brings a good prognosis to patients, but the current combination treatment regimen such as "multi-immune checkpoint inhibitor combination" or "targeted drug-immune checkpoint inhibitor combination" The optimal regimen is still undetermined. Combination therapy brought better tumor suppressor effects, but unpredictable immune-related adverse reactions also occurred. This review summarizes the developed immune checkpoint drugs and the current clinical trials of immune checkpoint inhibitors in the treatment of renal cell carcinoma, hoping to provide research directions for optimizing combination therapy regimens and also provide a basis for multi-target drug development, so as to better improve the effect of combination therapy.

In recent years, as an emerging technology, brain-computer interface has been gradually applied to the treatment of neurological diseases, especially in the rehabilitation of hemiplegic limb motor function after stroke. The non-invasive brain-computer interface based on scalp EEG realizes a closed-loop interaction between the brain and the outside world by collecting EEG signals, processing and decoding the data, and then controlling external devices. With the development and maturity of technology, the clinical application paradigms of brain-computer interface are diverse. The application in limb movement disorders after stroke covers exoskeleton robots, functional electrical stimulation, virtual reality devices and even multi-modal feedback systems, and its efficacy has been verified to a certain extent. In the future, brain-computer interface technology should focus on strengthening technical support, improving the accuracy and accuracy of signal acquisition, and realizing accurate output, so as to truly realize targeted regulation and two-way interactive integration of brain-computer.