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Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique

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World Journal of Gastrointestinal Oncology 2024年第4期16卷 1227-1235页

作者： Wen-Jing Hu Gang Bai Yan Wang Dong-Mei Hong Jin-Hua Jiang Jia-Xun Li Yin Hua Xin-Yu Wang Ying Chen Intensive Care Unit Shanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200434China Department of Anesthesia and Perioperative Medicine Shanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200434China Department of Nursing Shanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200434China Department of Thyroid Breast and Vascular SurgeryShanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200434China

BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbal

关键词： elderly patients Abdominal cancer Postoperative delirium Synthetic minority oversampling technique Predictive modeling Surgical outcomes

Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial

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The Journal of Biomedical Research 2024年第1期38卷 66-75页

作者： Mingfeng He Chanjuan Gong Yinan Chen Rongting Chen Yanning Qian Department of Anesthesiology and Perioperative Medicine the First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu 210029China

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.

关键词： remimazolam propofol elderly patients hypotension left ventricular systolic function systematic vascular resistance

Impact of Sedation Protocols on elderly patients Undergoing Mechanical Ventilation and Off-Line Weaning

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Journal of Clinical and Nursing Research 2024年第4期8卷 322-333页

作者： Yihui Li Yamin Yuan Jinquan Zhou Li Ma The Second Hospital&Clinical Medical School Lanzhou UniversityDepartment of Critical Care MedicineLanzhou 730030Gansu ProvinceChina

The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.

关键词： elderly patients Mechanical ventilation Off-line strategy Sedation treatment

Clinical Evaluation of a Vancomycin Dosage Strategy Based on a Serum Trough Concentration Model in elderly patients with Severe Pneumonia

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Biomedical and Environmental Sciences 2023年第5期36卷 397-405页

作者： YAN Wei SUN Xiao Yan WANG Meng ZHAO Fei Fan ZHOU Qing Tao Department of Respiratory and Critical Care Medicine Peking University Third HospitalBejing 100191China

Objective This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly patients.Methods This prospective single-center, open-label, randomized controlled trial categorized 66 elderly patients with severe pneumonia into study and control groups. The control group received vancomycin using a regimen decided by the attending physician. Meanwhile, the study group received individualized vancomycin therapy with a dosing strategy based on a serum trough concentration model. The primary endpoint was the proportion of patients with serum trough concentrations reaching the target values.The secondary endpoints were clinical response, vancomycin treatment duration, and vancomycinassociated acute kidney injury(VA-AKI) occurrence.Results All patients were at least 60 years old(median age = 81 years). The proportion of patients with target trough concentration achievement(≥ 15 mg/L) with the initial vancomycin regimen was significantly higher in the study group compared to the control group(75.8% vs. 42.4%, P = 0.006).Forty-five patients(68.2%) achieved clinical success, the median duration of vancomycin therapy was10.0 days, and VA-AKI occurred in eight patients(12.1%). However, there were no significant differences in these parameters between the two groups. The model for predicting vancomycin trough concentrations was upgraded to: serum trough concentration(mg/L) = 17.194-0.104 × creatinine clearance rate(mL/min) + 0.313 × vancomycin daily dose [mg/(kg·d)].Conclusion A vancomycin dosage strategy based on a serum trough concentration model can improve the proportion of patients achieving target trough concentrations in elderly patients with severe pneumonia.

关键词： Pneumonia Clinical trials Vancomycin Trough concentration elderly patients

Comparison of involved-field intensity-modulated radiotherapy combined with S-1 vs radiotherapy alone for elderly patients with esophageal cancer

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World Journal of Clinical Cases 2022年第21期10卷 7365-7375页

作者： Li-Hua Liu Mao-Hui Yan Yu-Peng Di Zhi-Guang Fu Xiao-Dan Zhang Hong-Qi Li Department of Radiotherapy Heze Hospital of Traditional Chinese MedicineHeze 274000Shandong ProvinceChina Department of Radiotherapy Air Force Medical CenterChinese People’s Liberation ArmyBeijing 100142China

BACKGROUND It is estimated that about 30%of esophageal cancer(EC)patients are over 70 years old.Therefore,there is less evidence on the diagnosis and management of elderly EC patients.It is important to explore how elderly EC patients benefit from radical radiochemotherapy regimens,including the target area of radiotherapy(RT),radiation dose and fraction,and choice of chemotherapy drugs.AIM To compare the efficacy of involved-field intensity-modulated RT(IF-IMRT)combined with S-1 vs RT alone in the treatment of elderly EC patients in terms of safety,short-term response,and survival.METHODS Thirty-four EC patients aged>70 years were prospectively enrolled between December 2017 and December 2019.Based on the random number table,they were divided into an IF-IMRT+S-1 group and an IF-IMRT alone group,with 17 patients in each group.All patients were treated with IF-IMRT at a dose of 50.4-56 Gy in 28-30 fractions(1.8-2 Gy/fraction,5 fractions/wk).Oral S-1 was administered concomitantly in the IF-IMRT+S-1 group for 14 consecutive days,and a second cycle was started 7 d after drug withdrawal.After RT,4 cycles of S-1 treatment were offered as the consolidation chemotherapy.The safety,short-term response,and survival were observed after the treatment.RESULTS As of April 2022,these 34 patients had been followed up for 15.2-32.5 mo,with a median follow-up period of 24.5 mo.Complete efficacy indicators were obtained from all the patients.The objective response rate was 88.2%vs 76.5%,respectively,in the IF-IMRT+S-1 group and the RT alone group,where as the disease control rate was 100%vs 82.4%,respectively.The incidence of adverse events including grade 1-2 fatigue,granulocytopenia,thrombocytopenia,anemia,radiation esophagitis,radiation-induced skin injury,and radiation-induced lung injury was not significantly different between these two groups,so was the incidence of the grade 3 radiation esophagitis(0%vs 5.7%).The rate of progressive disease(PD)was 52.9%(n=9)in the IF-IMRT+S-1 group and 64.7%(n=11)in the RT alone group.The m

关键词： elderly patients Esophageal cancer Involved-field radiation therapy S-1 Chemotherapy

Tear inflammation related indexes after cataract surgery in elderly patients with type 2 diabetes mellitus

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World Journal of Clinical Cases 2023年第2期11卷 385-393页

作者： Jun Lv Cheng-Jian Cao Wei Li Shuang-Le Li Jun Zheng Xiu-Li Yang Department of Optometry North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina Zigong Academy of Medical Sciences Zigong First People’s HospitalZigong 643000Sichuan ProvinceChina FB Biologie Philipps-Universitaet MarburgMarburg 35043Germany Department of Ophthalmology Zigong First People’s HospitalZigong 643000Sichuan ProvinceChina

BACKGROUND Quantitative studies on the changes in inflammation-related content in tears,especially the effect of diabetes,are lacking.In this study,we measured the preoperative and postoperative tear inflammatory mediator levels in cataract patients,focusing on the expression of inflammatory factors in postoperative cataracts in the diabetic,and investigated the effect of drugs on the control of postoperative inflammation.AIM To study the expression of inflammatory factors in elderly people with type 2 diabetes after cataract surgery.METHODS patients with a mean age of 70.3±6.3 years were divided into group A(composed of elderly patients with cataracts and type 2 diabetes,n=20 eyes)and group B(patients with age-related cataract,n=20 eyes).Their tears were collected before each operation and on days 1 and 3,and weeks 1,2,3,and 4 post-surgery.Saline(150μL)was dropped into the conjunctival sac of the surgical eye,followed by oculogyration in four directions.The fluid in the conjunctival sac was extracted using a sterile syringe and stored in Eppendorf tubes at-80°C until measurement.The expression levels of matrix metalloproteinase-2(MMP-2),MMP-9,tissue inhibitor of metalloproteinase-1(TIMP-1),TIMP-2,interleukin-6(IL-6),and IL-20 in tear fluid were measured using enzyme-linked immunosorbent assays.RESULTS The postoperative expression levels of MMP-2,MMP-9,TIMP-2,IL-6,and IL-20 in group A were significantly higher than those in group B,whereas the concentration of TIMP-1 in group A remained lower than that in group B.The levels of MMP-2 and IL-6 in both groups continuously increased until the peak in the first postoperative week,and then gradually decreased over the next three weeks.Ultimately,MMP-2 declined to a lower level than that preoperatively at week 4,but IL-6 decreased to the same level as that preoperatively.The level of MMP-9 peaked in the first two weeks postoperative and then returned to the same level as 1-day post-operation.The concentration of TIMP-1 post-operation remained constant at a lower level t

关键词： Type 2 diabetes mellitus elderly patients Cataract surgery Tear inflammation-related indicators Temporal changes Prognosis

Comparison of short-term efficacy between totally laparoscopic gastrectomy and laparoscopic assisted gastrectomy for elderly patients with gastric cancer

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World Journal of Gastrointestinal Surgery 2022年第9期14卷 950-962页

作者： Rui-Yang Zhao Hang-Hang Li Ke-Cheng Zhang Hao Cui Huan Deng Jing-Wang Gao Bo Wei Department of General Surgery First Medical CenterChinese PLA General HospitalBeijing 100853China Medical School of Chinese PLA Chinese PLA General HospitalBeijing 100853China School of Medicine Nankai UniversityTianjin 300071China

BACKGROUND Totally laparoscopic gastrectomy(TLG)entails both gastrectomy and gastrointestinal reconstruction under laparoscopy.Compared with laparoscopic assisted gastrectomy(LAG),TLG has been demonstrated in many studies to require a smaller surgical incision,result in a faster postoperative recovery and less pain and have comparable long-term efficacy,which has been a research hotspot in recent years.Whether TLG is equally safe and feasible for elderly patients remains unclear.AIM To compare the short-term efficacy of and quality of life(QOL)associated with TLG and LAG in elderly gastric cancer(GC)patients.METHODS The clinicopathological data of 462 elderly patients aged≥70 years who underwent LAG or TLG(including distal gastrectomy and total gastrectomy)between January 2017 and January 2022 at the Department of General Surgery,First Medical Center,Chinese PLA General Hospital were retrospectively collected.A total of 232 patients were in the LAG group,and 230 patients were in the TLG group.Basic patient information,clinicopathological characteristics,operation information and QOL data were collected to compare efficacy.Compared with those in the LAG group,intraoperative blood loss in the TLG group was significantly lower(P220 min were independent risk factors for postoperative complications in elderly patients with GC(P0.05).Compared with the laparoscopic-assisted total gastrectomy group,patients who received totally laparoscopic total gastrectomy had lower nausea and vomiting scores and higher satisfaction with their body image(Ppatients

关键词： Totally laparoscopic gastrectomy Laparoscopic assisted gastrectomy Gastric cancer elderly patients Efficacy comparison Quality of life

Impact of body mass index in elderly patients treated with laparoscopic liver resection for hepatocellular carcinoma

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World Journal of Gastrointestinal Surgery 2023年第1期15卷 72-81页

作者： Maria Conticchio Riccardo Inchingolo Antonella Delvecchio Francesca Ratti Maximiliano Gelli Massimiliano Ferdinando Anelli Alexis Laurent Giulio Cesare Vitali Paolo Magistri Giacomo Assirati Emanuele Felli Taiga Wakabayashi Patrick Pessaux Tullio Piardi Fabrizio di Benedetto Nicola de’Angelis Javier Briceño Antonio Rampoldi RenèAdam Daniel Cherqui Luca Antonio Aldrighetti Riccardo Memeo Unit of Hepato-Pancreatic-Biliary Surgery “F.Miulli”Regional General HospitalBari 70021Italy Interventional Radiology Unit “F.Miulli”Regional General HospitalBari 70021Italy Unit of Hepatobiliary Surgery San Raffaele HospitalMilano 20132Italy Departement de Chirurgie Viscérale Gustave Roussy Cancer Campus Grand ParisParis 94800France Unit of Oncologic and Pancreatic Surgery Hospital University Reina SofíaCordoba 14004Spain Assistance Publique-Hôpitaux de Paris Department of Digestive and Hepatobiliary SurgeryCentre Hospitalier Universitaire Henri MondorCréteilParis 94000France Service of Abdominal Surgery Poliambulanza FoundationBrescia 25124Italy Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit University of Modena and Reggio EmiliaModena 41121Italy Institut de Recherche Contre les Cancers de l’Appareil Digestif(IRCAD) Strasbourg 67000France Service de Chirurgie Viscérale et Digestive Nouvel Hôpital CivilStrasbourg 67000France Department of Surgery Hôpital Robert DebréReims 51092France Interventional Radiology Unit Niguarda HospitalMilan 20162Italy Department of Surgery Centre HepatobiliaireHopital Paul BrousseParis 94000France

BACKGROUND The impact of obesity on surgical outcomes in elderly patients candidate for liver surgery is still debated.AIM To evaluate the impact of high body mass index(BMI)on perioperative and oncological outcome in elderly patients(>70 years old)treated with laparoscopic liver resection for hepatocellular carcinoma(HCC).METHODS Retrospective multicenter study including 224 elderly patients(>70 years old)operated by laparoscopy for HCC(196 with a BMIpatients in two groups presented comparable results,in terms of operative time(median range:200 min vs 205 min,P=0.7 respectively in non-obese and obese patients),complications rate(22%vs 26%,P=1.0),length of hospital stay(median range:4.5 d vs 6.0 d,P=0.1).There are no significant differences in terms of short-and long-term postoperative results.CONCLUSION The present study showed that BMI did not impact perioperative and oncologic outcomes in elderly patients treated by laparoscopic resection for HCC.

关键词： Hepatocellular carcinoma Body mass index Laparoscopy Surgical resection elderly patients Propensity score matching

Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

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World Journal of Psychiatry 2023年第7期13卷 444-452页

作者： Ai-Di Zheng Li-Li Cai Jing Xu Department of Cardiology Affiliated Hangzhou First People’s HospitalZhejiang University School of MedicineHangzhou 310006Zhejiang ProvinceChina

BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(Pelderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.

关键词： Chronic heart failure elderly patients Health concept model Detailed behavioral care Patient mood Quality of life Nursing effect