Objective
To retrospectively analyze the effectiveness of percutaneous anterior odontoid and transarticular screw fixation for type II odontoid fracture treated in the elderly patients.
Methods
Between October 2009 and March 2012, 5 patients with odontoid fracture were treated with anterior triple screws fixation. There were 4 males and 1 female with an average age of 69.4 years (range, 65-74 years). Fracture was caused by falling injury from height in all cases. The average time between injury and operation was 6.8 days (range, 3-12 days). According to Anderson-D’Alonzo classification system, all 5 cases were classified as type II odontoid fractures; 1 case accompanied by anterior arch fracture. Four cases were rated as grade E and 1 case as grade D on the basis of Frankel classification system on nerve function evaluation. Percutaneous anterior odontoid and transarticular screw fixation were used in all cases. The operation time, intra-operative blood loss, X-ray exposure time, and complications were recorded. The X-ray films were taken to observe atlantoaxial stability and implant conditions.
Results
All patients were successfully complete the surgery, and no open operation was needed. The average operation time was 103.6 minutes (range, 93-114 minutes). The average intra-operative blood loss was 5.6 mL (range, 3-10 mL). The average X-ray exposure time was 24.2 seconds (range, 17-32 seconds). Good reduction of atlantoaxial joint and primary healing of incision were obtained in 5 patients. The average follow-up duration was 21.4 months (range, 12-35 months). Transient dysphagia occurred in 3 cases, and was cured after 5 days of expectant treatment. No major complications of carotid artery laceration, spinal cord injury, esophageal perforation, airway obstruction, and implant failure occurred. The X-ray films showed odontoid bony union, atlantoaxial stability and good position of screws. The average time of odontoid fracture union was 7 months (range, 5-10 months). Five patients had normal neurological function (Frankel grade E) at last follow-up. Three patients complained of neck discomfort and movement limitation and had normal daily activities without special therapy; the other 2 patients had no clinical symptom of discomfort.
Conclusion
Percutaneous anterior odontoid and transarticular screw fixation is a safe and effective procedure for treatment of type II odontoid fractures in the elderly patients with minimally invasive surgical advantages.
Objective Evidence-based medicine was used to make an individualized treatment plan for newly diagnosed prostatic hyperplasia in an elderly patient. Methods After clinical problems were discovered, evidence was collected from CBM, CNKI, The Cochrane Library, PubMed, EMBASE, ScienceDirect, Springer, and ProQuest databases according to our predefined search strategy. The search was done through 2008. The internal and external validity of the evidence was assessed. The evidence, combined with the patient value, was applied to the patient. Results A total of 39 systematic reviews involving 137 randomized controlled trials were identified. A rational treatment plan was made upon a critical evaluation of the data. After one year follow-up, the treatment protocol was proven correct. Conclusion The treatment efficacy in newly diagnosed prostatic hyperplasia in the elderly has been improved by determining an individualized treatment protocol according to evidence-based methods.
Objective To explore the expression levels and clinical significance of serum long noncoding RNA myocardial infarction associated transcript (lncRNA MIAT) and microRNA-515-5p (miR-515-5p) in elderly patients with chronic obstructive pulmonary disease (COPD) at different periods. Methods From April 2021 to June 2023, 90 elderly patients with acute exacerbation of COPD treated in Huaibei People’s Hospital were selected as a COPD acute exacerbation group, 88 elderly patients with stable COPD as a COPD stable group, and 90 healthy elderly individuals undergoing physical examination as a control group. The white blood cell count (WBC) and serum lncRNA MIAT and miR-515-5p expression levels were detected in all subjects, blood gas analysis and pulmonary function indexes [oxygenation index (PaO2/FiO2), arterial blood carbon dioxide partial pressure (PaCO2), ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC), and FEV1 as a percentage of predicted value (FEV1%pred)] were detected in the patients with COPD. The correlation between serum lncRNA MIAT, miR-515-5p and smoking, WBC, blood gas analysis and pulmonary function indexes were analyzed in the elderly patients with acute exacerbation of COPD. The influencing factors of acute exacerbation of COPD, and the value of serum lncRNA MIAT, miR-515-5p in predicting the occurrence of acute exacerbation of COPD were also analyzed. Results The smoking proportion, WBC, serum lncRNA MIAT expression levels of the control group, the COPD stable group and the COPD acute exacerbation group were increased in turn, serum miR-515-5p expression levels were decreased in turn (P<0.05). Compared with the COPD stable group, PaCO2 was significantly increased in the COPD acute exacerbation group, while PaO2/FiO2, FEV1/FVC and FEV1%pred were significantly decreased (P<0.05); serum lncRNA MIAT in the elderly patients with acute exacerbation of COPD was positively correlated with smoking, WBC, PaCO2 (P<0.05), and negatively correlated with PaO2/FiO2, FEV1/FVC, FEV1%pred, miR-515-5p (P<0.05); serum miR-515-5p was negatively correlated with smoking, WBC, PaCO2 (P<0.05), and positively correlated with PaO2/FiO2, FEV1/FVC, FEV1%pred (P<0.05). Smoking, WBC, PaCO2, and lncRNA MIAT were risk factors affecting the acute exacerbation of COPD patients, PaO2/FiO2, FEV1/FVC, FEV1%pred, miR-515-5p were protective factors affecting the acute exacerbation of elderly COPD patients (P<0.05). The area under the ROC curve (AUC) of serum lncRNA MIAT, miR-515-5p and their combination in predicting acute exacerbation in elderly COPD patients were 0.823, 0.862 and 0.919, respectively, higher than the AUC predicted by serum lncRNA MIAT and miR-515-5p separately (P<0.05). Conclusions Serum lncRNA MIAT expression was high in elderly patients with COPD, and serum miR-515-5p expression was low, and the changes of both were more obvious in patients with acute exacerbation. Both were correlated with blood gas analysis and pulmonary function indexes in patients with acute exacerbation, and have high value in predicting the occurrence of acute exacerbation in elderly patients with COPD.
Objective Methods of evidence-based medicine were used to make an individualized treatment plan concerning newly diagnosed diffuse large-B-cell lymphoma in elderly patients. Methods After clinical problems were put forward, evidence was collected from MEDLINE (Jan. 1990 to Dec. 2004) and http://sumsearch.uthscsa.edu/searchform4.htm. Subject words were: NHL; aggressive non-Hodgkin’s lymphoma; diffuse large-B-cell lymphoma; chemotherapy; CHOP; rituximab; RCT; economic evaluation; older patient. Results A total of 11 randomized controlled trials and 8 systematic reviews about chemotherapy regimen, and 1 systematic review about economic evaluation were identified. A rational treatment plan was made upon a critical evaluation of the data. After 5 months follow-up, the plan was proved optimal. Conclusions The treatment effectiveness in newly diagnosed diffuse large-B-cell lymphoma in the elderly has been improved by an individual treatment plan according to evidence-based methods.
ObjectiveTo investigate clinical outcomes and summarize perioperative management experience of heart valve replacement (HVR)in elderly patients.
MethodsWe retrospectively analyzed clinical data of 47 elderly patients undergoing HVR in Affiliated Hospital of Xuzhou Medical College from January 2011 to May 2014. There were 19 male and 28 female patients with their age of 60-79 years. There were 35 patients with rheumatic heart disease, 10 patients with degenerative valvular disease, and 2 patients with congenital bicuspid aortic valve. Preoperatively, there were 23 patients in NYHA functional class Ⅱ, 19 patients in class Ⅲ, and 5 patients in class Ⅳ. All the patients received HVR under cardiopulmonary bypass (CPB), and some patients received concomitant tricuspid valvuloplasty (TVP), left atrial thrombectomy or coronary artery bypass grafting (CABG). Postoperative mortality, morbidity and heart function improvement were evaluated.
ResultsTwenty-seven patients received mitral valve replacement (MVR), 15 patients received aortic valve replacement (AVR), and 5 patients received MVR+AVR. Concomitantly, 4 patients received TVP, 3 patients received left atrial thrombectomy, and 6 patients received CABG. Operation time was 138-412 (196±52)minutes, CPB time was 48-301 (108±33)minutes, aortic cross-clamping time was 34-196 (87±21)minutes, and length of hospital stay was 12-31 (19±5)days. There was no intraoperative death, and 2 patients (4.3%)died postoperatively because of left ventricular failure and multiple organ dysfunction syndrome respectively. Twenty-three patients (51.1%)had postoperative complications including respiratory failure in 6 patients, pulmonary infection in 5 patients, arrhythmias in 5 patients, wound infection in 2 patients, pleural effusion in 2 patients, low cardiac output syndrome in 2 patients, and acute renal failure in 1 patient. Forty-five survival patients were followed up by telephone, online video and at the outpatient department for 1-32 months, and follow-up rate was 100%. There were 11 patients in NYHA functional classⅠ, 32 patients in class Ⅱ, and 2 patients in class Ⅲ.
ConclusionAccording to clinical characteristics of elderly patients with valvular heart disease, meticulous surgical techniques and perioperative management can effectively reduce mortality and morbidity after HVR.
ObjectiveTo investigate and analyze comorbidities of elderly patients with total hip/knee arthroplasty, so as to provide a basis for the management of comorbidities.MethodsConvenience sampling was used to select elderly patients who underwent total hip/knee arthroplasty in the Department of Orthopedics in West China Hospital of Sichuan University from June to December 2019 as the research objects. We collected general data and comorbidity data of patients, and statistically analyzed the comorbidities of elderly patients undergoing total hip/knee arthroplasty, and the characteristics of perioperative psychology, sleep, postoperative complications, and length of hospital stay in elderly patients undergoing total hip/knee arthroplasty with comorbidities.ResultsA total of 263 patients were included, of whom 64.6% had comorbidities. The number of comorbidities in elderly patients undergoing total hip/knee arthroplasty ranged from 2 to 12. The most common comorbidity was hypertension. Between patients with comorbidities and non-comorbidities, there were statistically significant differences in age (Z=?2.225, P=0.026), preoperative Huaxi Emotion Index scores (9.6±4.6 vs. 6.4±5.0; t=5.126, P<0.001), preoperative Pittsburgh Sleep Quality Index scores (13.3±3.1 vs. 12.3±2.5; t=?2.972, P=0.003), hospital stay [(5.2±0.8) vs. (4.8±0.4) d; t=4.243, P<0.001], and incidence of postoperative complications (13.5% vs. 5.4%; χ2=4.201, P=0.040).ConclusionsComorbidities are common in elderly patients with total hip/knee arthroplasty, which may aggravate negative emotions, reduce sleep quality, increase postoperative complications and prolong length of stay. Medical staff should strengthen the management of comorbidity in elderly patients with total hip/knee arthroplasty, so as to reduce its influence on perioperative period and promote the rehabilitation of patients.
Objective To evaluate the efficacy of normalization management on prognosis in elderly patients with coronary artery disease, in aspects of drug compliance, readmission rate and quality of life. Methods A total of 110 patients above 65 years old with coronary artery disease visiting West China Hospital from August 2010 to February 2011 were investigated. The patients were divided into two groups: the intensive management group (n=55) and the general management group (n=55). The measures such as regular follow-up, regular examination and medical education were conducted in the intensive management group, and the two groups were observed in aspects of drug compliance, readmission rate and quality of life. Results After 1-year follow-up, the percentages of patients taking aspirin/clopidogrel (98.18% vs. 67.27%, Plt;0.05), nitrate (85.45% vs. 40.00%, Plt;0.05), ACEI/ARB (56.36% vs. 18.18%, Plt;0.05), β receptor blocker (58.18% vs. 29.09%, Plt;0.05) and statin (94.55% vs. 32.73%, Plt;0.05) were higher in the intensive management group than those in the general management group. Also, the readmission rate was lower (12.73% vs. 41.42%, Plt;0.05) and the score of quality of life was higher in the intensive management group than that in the general management group. Conclusion The normalization management guided by evidence-based medicine for the elderly patients with coronary artery disease is helpful to improve the drug compliance, reduce the readmission rate, and improve the quality of life.
Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.
Objective To study the suitable operation method of elderly patients with acute cholecystitis. Methods The clinical data of 149 elderly patients with acute cholecystitis were retrospectively analyzed. All patients were divided into two groups according to the operation: open cholecystectomy group (OC group, n=76) and laparoscopic cholecystectomy group (LC group, n=73). Some clinical data were compared in this paper such as operation time, blood loss, length of hospital stay, time of resumption of food, time of intestinal function recovery and complications. Results No marked difference was found between OC group and LC group about basic data except WBC count and examination of gallbladder by B ultrasound（P＞0.05）. But there were significant difference in operation time, blood loss, time of resumption of food, time of intestinal function recovery, length of hospital stay and complications between OC group and LC group （P＜0.01）. Conclusion Individualized treatment should be emphasized on elderly patients with acute cholecystitis. Selection of OC or LC to these patients should be based on the clinical condition and taken the safety as the first principle.
ObjectiveTo investigate influencing factors of postoperative cognitive dysfunction (POCD) in elderly patients underwent laparoscopic surgery.
MethodsThe elderly patients underwent laparoscopic surgery were collected in the Daye City People's Hospital and Yangxin County People's Hospital from September 14, 2014 to January 1, 2016 and the Traditional Chinese Medicine Hospital of Daye City from June 19, 2014 to January 1, 2016. Factors included in the registration of patients in general and a variety of influencing factors during perioperative period were recorded. The independent factors associated with POCD were analyzed by multivariate logistic regression analysis.
ResultsThree hundred and seventy-eight elderly patients underwent laparoscopic surgery were included according to the inclusion and exclusion criteria, of which 43 patients with POCD and 335 patients without POCD within 3 days after laparoscopic surgery. The baseline data had no significant differences between the patients with POCD and without POCD. The cerebral infarction, preoperative fear, preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, operation time, low SpO2 during anesthesia induction, PaCO2 after pneumoperitoneum, postoperative patient controlled epidural analgesia (PCEA), postoperative VAS score on day 3 were associated with the POCD (P < 0.05). The results of logistic regression analysis showed that the preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, and postoperative PCEA were the independent protective factors of the POCD (P < 0.05). The operation time and PaCO2 after pneumoperitoneum were the independent risk factors of the POCD (P < 0.05).
ConclusionFor elderly patients underwent laparoscopic surgery, clinicians should be alert to occurrence of POCD according to the influence factors of it, and timely screen relevant scale so as to early diagnose and early intervent and effectively delay progress of patient's POCD.
