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Background: Perioperative cognitive maintenance and protection in older adults is an important patient safety imperative. In addition to foundational care, one area of growing interest is integrating cognitive prehabilitation into the surgical trajectory. This review aimed to evaluate the effectiveness and safety of cognitive prehabilitation on cognitive functional capacity and postoperative cognitive outcomes among older adults undergoing elective surgery. Methods: The MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, CBM, CNKI, WANFANG, and VIP databases were systematically searched up to September 5, 2024, to identify randomized controlled trials published for English or Chinese. Two authors independently completed the study selection process, data extraction process and methodological quality assessment. The Patient, Intervention, Comparison, Outcome, Study design framework was used to construct the search strategy. The predefined primary outcomes of interest included the incidence of postoperative delirium (POD) and the incidence of delayed neurocognitive recovery (dNCR). The quality of the studies was evaluated by the PEDro scale. Owing to the small number of trials and clinical and methodological diversity, a narrative synthesis was undertaken in accordance with the Synthesis Without Meta-analysis guidelines. This study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Results: Six studies were analysed. These trials involved 645 total participants, with 316 in the intervention group (mean age, 66.0-73.8 years; 38.4-77.8% male) and 329 in the comparator group (mean age, 67.5-72.6 years; 31.8-88.9% male). The effects of preoperative cognitive training on reducing the incidence of dNCR, the incidence of POD, the length of hospital stay and the incidence of postsurgical complications as well as improving postoperative global cognitive function and activities of daily living are quite uncertain. The results of this study should be interpreted with caution owing to the limited number of trials and low to very low certainty of evidence. Conclusion: Current evidence on the effectiveness and safety of cognitive prehabilitation on cognitive and noncognitive outcomes in older patients undergoing elective surgery is limited and unclear. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277191, Identifier CRD42021277191. [ABSTRACT FROM AUTHOR]

Background: China's rapidly aging population presents challenges for cognitive health and mental well-being among the older adults. This study examines how the number of children affects cognitive function in middle-aged and older adults and whether depressive symptoms mediate this relationship. Methods: This study analyzed data from waves 1 to 5 (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS), involving 5932 participants aged 45 and older. Participants were grouped by the number of children: childless, only child and multiple children. We used Logarithmic Generalized Linear Models (LGLMs) to explore the relationships among the number of children, depressive symptoms, and cognitive function. Indirect effect coefficients and 95% bias-corrected and accelerated confidence intervals (BCaCI) were estimated using Simultaneous Equation Models (SEM) with three-stage least squares (3SLS) and the bootstrap method to assess the mediating effect of depressive symptoms. Results: In middle-aged and older adults, a negative association was observed between the number of children and overall cognitive functioning (all p < 0.01). This association remained significant even after adjusting for covariates in groups with three (β = −0.023, p < 0.05) and four or more children (β = −0.043, p < 0.001). Conversely, the positive association between the number of children and depression also persisted after adjusting for covariates, although it weakened as the number of children increased (all p < 0.01). Depressive symptoms consistently correlated negatively with overall cognitive function (p < 0.001) and partially mediated the relationship between the number of children and cognitive function (pMe = 20.36%, p < 0.05). The proportion of the mediating effect attributed to depression was more pronounced in middle-aged and older adults who had experienced the loss of children (pMe = 24.31%) or had two children (pMe = 25.39%), with stronger mediating effects observed in males (pMe = 48.84%) and urban residents (pMe = 64.58%). Conclusions: The findings indicate that depressive symptoms partially mediate the relationship between the number of children and cognitive function in middle-aged and older adults in China. These results highlight the significance of considering mental health factors when studying cognitive function in this demographic. Notably, in families without children and those with two children, depressive symptoms play a crucial role in explaining the decline in cognitive function. [ABSTRACT FROM AUTHOR]

Objective: To explore the distribution of thrombin–antithrombin complex (TAT), plasmin-α2-antiplasmin inhibitor complex (PIC), thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC) in healthy older Chinese adults, and establish the reference intervals (RIs). Methods: The Biotech Shine i2900 chemiluminescence immune assay was used to measure the plasma concentrations of TAT, PIC, TM, and t-PAIC in 1628 adults ≥ 60 years. The RIs were established using the 2.5th and 97.5th percentiles of the distribution. Results: TAT levels were lower in males than females across all ages. Differences between the ages of 60–79 and ≥ 80 in both sex groups were statistically significant, with an upward trend with age. PIC levels showed no difference between the sexes but increased with age in both groups. TM levels did not differ between the sex groups, with slight fluctuation with age. The level in females aged 60–69 was slightly higher than that in the other groups; the difference was statistically significant. T-PAIC levels were not significantly different between the sex groups, with less fluctuation with sex and age. The level in males ≥ 80 years old was slightly lower than that in the other groups; the difference was statistically significant. The RIs for all markers in healthy older Chinese adults were determined and statistically reported by age and sex. For TAT, the RIs for males aged 60–79 and ≥ 80 are 0.51–2.30 ng/mL and 0.88–3.72 ng/mL, respectively, whereas for females aged 60–79 and ≥ 80, the RIs are 0.68–2.82 ng/mL and 1.02–3.67 ng/mL, respectively. For PIC, the RIs for the age groups 60–69, 70–79, and ≥ 80 are 0.10–0.89 µg/mL, 0.12–1.00 µg/mL, and 0.21–1.04 µg/mL, respectively. The RI of TM for females aged 60–69 is 3.32–13.22 TU/mL, whereas it is 2.96–13.26 TU/mL for the other groups. The RI of t-PAIC for males aged ≥ 80 is 1.63–10.68 ng/mL, whereas it is 2.33–11.34 ng/mL for the other groups. Conclusions: Discrepancies exist in thrombus markers among different sex and age groups. The RIs of TAT, PIC, TM and t-PAIC for healthy older Chinese adults were successfully established. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study aimed to investigate the intensity of needs for home health care services (HHCs) among elderly patients with chronic diseases and to identify the associated factors. Design: A cross‐sectional survey was conducted in Wuhou District, Chengdu, Sichuan Province, China, from April to November 2021. Methods: Convenient sampling was used to screen elderly patients with chronic diseases managed by Yulin Community Health Service Center. The questionnaires included general information and the Chinese version of the Community Healthy Intensity Rating Scale were completed according to patients' conditions. The data were analyzed using descriptive statistics and binary logistic regression. Results: A total of 371 patients (10.40%) completed the survey. The mean age of the elderly patients was 84.04 years (SD = 7.07); these patients suffered from 1 to 7 kinds of chronic diseases, and the most common were hypertension (78.98%) and diabetes (40.97%). The need intensity of patients for HHCs was moderate (41.51%) or severe (58.49%). For each additional chronic disease that patients suffered from, the need intensity increases by 1.289 times (OR = 1.289; 95% CI: 1.055–1.575, p =.013); in additional, those aged more than 90 years, with a personal monthly income less than 2500 yuan ($387.00), with a poor health current status, and with only basic medical insurance presented greater need intensity (p <.05). Conclusion: Our data analysis revealed that economic status, insurance condition, poor health status, and multiple comorbidities may be the most common factors associated with the need intensity for HHCs. These characteristics may help medical staff to identify and help those with urgent health problems. [ABSTRACT FROM AUTHOR]

Background: Fine particular matter (PM2.5) has been associated with dementia, but limited information is available regarding the association between PM2.5 components and dementia. Aims: We aimed to identify the major components of PM2.5 that affect cognitive function to further investigate its mechanism of action, and develop a prevention strategy for dementia. Methods: In this study, we included 7804 participants aged ≥ 60 years recruited from seven counties in Zhejiang province, eastern China. The participants completed the baseline survey between 2014 and 2015, and were followed up until the end of 2020. We adopted single-component robust Poisson regression models for analyses, and estimated relative risks and 95% confidence intervals describing associations between the chemical constituents of PM2.5 exposure and incident cognitive impairment in those who were free from cognitive impairment at baseline. Results: Significantly positive associations were observed between sulfate, nitrate, ammonium, and organic matter in PM2.5 and incident cognitive impairment across different exposure periods; the relative risks of 10-year exposure before enrollment ranged from 1.01 to 1.02. However, we did not find a significant association between black carbon and cognitive impairment. The point estimates of the relative risk values did not change substantially after performing the sensitivity analyses. Conclusions: Our findings strengthen the idea that long-term exposure to PM2.5 mass and its chemical components is associated with an elevated risk of incident cognitive impairment among older adults. [ABSTRACT FROM AUTHOR]

BackgroundObjectivesMethodsResultsConclusionQuality of life, social support, and loneliness are common problems among older adults in China , but the relationships among these issues have not been clearly identified.The present study aimed to determine the relationships among Quality of life, social support, and loneliness.A total of 560 older adults were randomly selected , the social support rating scale (SSRS), University of California at Los Angeles (UCLA) loneliness scale, and Short-Form 12 (SF-12) were employed to measure their degree of social support, level of loneliness, and quality of life.The average physical component summary (PCS) score was 49.97±16.33, and the average mental component summary (MCS) score was 47.26±11.49. Loneliness plays a partial mediating role between social support and quality of life.Loneliness and a lack of social support will affect the quality of life of the older adults. Thus, we need to urgently strengthen the care and support for the older adults and alleviate the loneliness of the older adults in the community. [ABSTRACT FROM AUTHOR]

Background and Purpose: Sarcopenia is a common muscle disease among the older population, posing an increased risk for functional decline and loss of independence in daily living. Early detection of sarcopenia among older people before functional decline would be beneficial in enhancing their quality of life. The Asian Working Group for Sarcopenia (AWGS) 2019 recommends the use of 3 screening methods for community-based sarcopenia detection: calf circumference (CC), or the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire, or the SARC-F in combination with CC (SARC-CalF) questionnaire. This study aims to compare the relative performance of these 3 methods as screening tools for sarcopenia within a community-dwelling older population. Methods: A total of 700 community-dwelling older adults participated in the current study. Muscle mass, muscle strength, and physical performance were measured with bioelectrical impedance analysis, handgrip strength, and gait speed, respectively. The AWGS 2019 criteria were considered the criterion standard The sensitivity/specificity, receiver operating characteristic (ROC) curve, and area under the receiver operating characteristic curve (AUROC) analyses were determined for CC, SARC-F, and SARC-CalF to determine their relative diagnostic performance. Results: Sarcopenia was identified in 21.4% of participants according to the AWGS2019 criteria. The overall prevalence of sarcopenia was 56.6%, 14.7%, and 22.9% according to CC, SARC-F, and SARC-CalF, respectively. Calf circumference showed the highest sensitivity but lowest specificity based on AWGS 2019 as the criterion standard regardless of age, gender, and body mass index. The SARC-CalF showed better sensitivity but similar specificity than the SARC-F. The AUROC of CC was significantly better than that of SARC-F and SARC-CalF. The AUROCs of CC, SARC-F, and SARC-CalF were statistically significant in all populations, as well as in the categories of age, gender, and body mass index (P < .05). Conclusions: Calf circumference is useful in ruling out the presence of sarcopenia while the SARC-F is more effec-tive in ruling in sarcopenia, especially in the context of population-based screening. Future studies should be carried out to investigate the value of population-based sarcopenia detection using these screening tools. [ABSTRACT FROM AUTHOR]

Aim: To explore the views and experiences of formal caregivers caring for older inpatients with physical disabilities. Methods: It was a qualitative phenomenological study. Using purposive sampling, twelve formal caregivers were chosen in a tertiary comprehensive hospital in Hangzhou, China. Semi-structured, face-to-face interviews were conducted, guided by open-ended questions that focused on gaining rich insights into participants' views and experiences. Coding reliability thematic analysis was used to guide data analysis and categorize, based on Lazarus and Folkman's theory of transactional coping. Results: Four themes emerged from the data analysis: (1) Caregiving Threats. (2) motivations. (3) Responsibility Management. (4) Fear. Conclusion: Despite facing significant pressure at work, formal caregivers of elderly inpatients with physical disabilities possess the drive and various coping strategies to excel in their role. Identifying caregivers' experiences of care can be helpful in improving resilience to stress and maintaining stability in formal caregivers. [ABSTRACT FROM AUTHOR]

To explore depression prevalence and related risk factors among elderly coronavirus disease 2019 (COVID‐19) survivors, while also evaluating research characteristics. We searched Web of Science, PubMed, Embase, Scopus, CNKI and Wanfang Data for studies that reported COVID‐19 and depression in older adults. 'Bibliometrix' facilitated bibliometric analysis and information visualisation. Random‐effects models merged depression prevalence and relevant risks. Publication bias and its impact were examined using funnel plots, Begg's test, Egger's linear regression, and trim‐and‐fill method. Meta‐regression, bubble plots, and Baujat plots probed heterogeneity. Sensitivity analysis applied the leave‐one‐out method. The study is registered with PROSPERO, CRD42023417706. The bibliometric analysis comprised 138 studies. Publication frequency peaked in the US, China, and Italy, reflecting significant growth. The meta‐analysis comprised 43 studies. Elderly COVID‐19 patients exhibit 28.33% depression prevalence (95% CI: 21.24–35.97). Severe cases (43.91%, 95% CI: 32.28–55.88) experienced higher depression prevalence than mild cases (16.45%, 95% CI: 11.92–21.50). Sex had no depression prevalence impact based on bubble plots. Notably, depression risk did not significantly differ between elderly and young COVID‐19 patients (odds ratio (OR) = 1.1808, 95% CI: 0.7323–1.9038). However, COVID‐19 infection emerged as a substantial elderly depression risk factor (OR = 1.8521, 95% CI: 1.2877–2.6639). Sensitivity analysis confirmed result robustness. Elderly COVID‐19 survivors are likely to develop depression symptoms with regional variations. Severe cases are associated with heightened depression prevalence. COVID‐19 infection stands out as a key elderly depression risk factor, while sex does not influence prevalence. The field's expansion necessitates sustained collaboration and extensive research endeavours. [ABSTRACT FROM AUTHOR]

Aim: To investigate frailty trajectories in nursing home residents, and to test whether chewing difficulty was a significant factor associated with frailty trajectories. Methods: This is a 1‐year prospective cohort study. Data were collected from 27 nursing home residents in China at baseline, 6 months, and 12 months. Latent class growth modeling was used to identify frailty trajectories. Multilevel multinomial logistic regression was used to test the relative risk ratios (RRRs) with 95% confidence intervals (CIs) of the chewing difficulty assessed at baseline on frailty trajectories. Results: In total, 269 nursing home residents were included in the analysis. Three frailty trajectories identified were non‐frailty trajectory (n = 181, 67.3%), stable frailty trajectory (n = 52, 19.3%), and progressive frailty trajectory (n = 36, 13.4%). Chewing difficulty was found among 138 (51.3%) nursing home residents. With the non‐frailty trajectory group as the reference, residents with chewing difficulty were more likely to demonstrate stable frailty trajectory (RRR = 2.55, 95% CI [1.28–5.11]) or progressive frailty trajectory (RRR = 3.46, 95% CI [1.47–8.15]). Conclusions: Changes in the frailty of nursing home residents are heterogeneous and chewing difficulty should be assessed and addressed on a routine basis in nursing homes to prevent the deterioration of frailty or reverse it. Geriatr Gerontol Int 2023; 23: 803–808. [ABSTRACT FROM AUTHOR]

Background: With the aging population and the ongoing pandemic, older persons account for a large proportion of ICU admissions. Despite numerous studies on the impact of COVID‐19 on older persons, there has been a small body of research investigating nursing practice with critically ill older patients admitted to ICU for COVID‐19. Aims: To explore current challenges in the nursing care of older persons with severe COVID‐19 through the experience of frontline nurses. Study Design: A qualitative descriptive design was used. In‐depth and semi‐structured interviews with 18 ICU nurses were conducted to explore the experience of providing care for older persons with severe COVID‐19 in the Omicron wave. A content analysis approach was adopted to analyse qualitative data. Findings: Three themes emerged as follows: (1) no plan survives first contact with the enemy, (2) expectations versus Reality and (3) difficulty in providing holistic care. Conclusions: Challenges could be encountered in different stages of providing care for older persons with severe COVID‐19, including the preparation and training of knowledge and skills in the early stage, the challenges posed by old age in the diagnostic and treatment stage and the challenges of psychological care and rehabilitation care. Relevance to Clinical Practice: With the regular prevention and control of COVID‐19, our study provides guidance for establishing measures (training courses of ICU nurses) to improve the nursing quality of older persons with severe COVID‐19. [ABSTRACT FROM AUTHOR]

Purpose: The efficacy of mortality risk prediction models among older patients in China remains uncertain. We aimed to validate and compare the performances of the Walter Index, Geriatric Prognostic Index (GPI), Charlson Comorbidity Index (CCI), and FRAIL Scale in predicting 1-year all-cause mortality post-discharge in geriatric inpatients in China.Patients and Methods: This study was conducted at a geriatric ward of a tertiary Hospital in Beijing, including patients aged 70 years or older with a documented comprehensive geriatric assessment, discharged between January 1, 2016, and December 31, 2021. Patients with a hospital stay ≤ 24 h or > 60 days were excluded. All-cause mortality data within one year of discharge were collected from medical files and telephone interviews between August 2022 and February 2023. Multiple imputation, Logistic regression analysis, Brier scores, C-statistics, Hosmer-Lemeshow goodness-of-fit-test, and calibration plots were employed for statistical analysis.Results: We included 832 patients with a median (interquartile range) age of 77 (74– 82) years. One-hundred patients (12.0%) died within one year. After adjusting for covariates—marital status, social support, cigarette use, length of stay, number of medications, hemoglobin levels, handgrip strength, and Short Physical Performance Battery—CCI scores of 3– 4 and > 4, and increased Walter Index, GPI, and FRAIL Scale scores were significantly associated with 1-year mortality risk. The Brier scores varied from 0.07 (Walter Index) to 0.10 (FRAIL Scale). The C-statistic ranged from 0.74 (95% confidence interval, 0.69– 0.78) for FRAIL Scale to 0.88 (95% confidence interval, 0.84– 0.91) for the Walter Index. Calibration curves showed that the Walter Index, GPI, and FRAIL Scale were well calibrated, while the CCI was poor.Conclusion: Combining the Brier score, discrimination and calibration, the Walter Index was confirmed for the first time to be the best model to predict the 1-year mortality risk of geriatric inpatients in China among the four models. [ABSTRACT FROM AUTHOR]

Objective of this study was to identify factors that impact the successful implementation of integrated care for older adults with multimorbidity in China.Patients and Methods: From July 2022 to May 2023, 33 healthcare providers and managers involved in the delivery and management of healthcare services for older adults with multimorbidity were recruited from Zhejiang Province, China using purposeful and maximum variation sampling methods. Semi-structured, face-to-face in-depth interviews were conducted by the same interviewer in the participants' native Chinese language until data saturation was reached. Inductive thematic analysis was used to analyze the data, and then, themes were mapped onto six dimensions using the Rainbow Model of Integrated Care to allow for a comprehensive view of the study's findings.Results: Eleven themes were generated as facilitators and barriers to integrated care for older adults with multimorbidity in China. These themes include (1) clinical integration: patient-centered care, (2) professional integration: interdisciplinary teams and training, (3) organizational integration: resources and accessibility, (4) system integration: community and funds, incentives, and health insurance, (5) functional integration: electronic health record systems, workforce, and guidelines, and (6) normative integration: shared mission.Conclusion: Guided by the Rainbow Model of Integrated Care, various factors at both micro, meso, and macro levels that impact the implementation of integrated care for older adults with multimorbidity in the Chinese context have been identified in this study. The strategies for future interventions and policies should focus on promoting facilitators and addressing barriers. [ABSTRACT FROM AUTHOR]

Background: Subjective memory impairment (SMI) is common in older people. The aim of this study was to investigate the factors influencing SMI among older people in China, with specific focus on the interaction effect of midday napping duration and depressive symptoms on the risk of SMI. Methods: Using a dataset representative of the Chinese population from a longitudinal study of health and retirement in China, subjects with SMI were screened using the question "how do you feel about your memory now?" and the Mini-Mental State Examination. A logistic regression model was applied to explore the factors affecting SMI. Additive and multiplicative models were used to analyze the interaction effect of midday napping duration and depressive symptoms on the risk of SMI. Results: We enrolled 8,254 subjects included and the incidence of SMI was 63.9%. Depressive symptoms, nap time, and physical activity were influencing factors of SMI. Midday napping duration and depressive symptoms had positive additive interaction effects on the risk of SMI. When extended-length naps and depressive symptoms coexisted, the risk of SMI was 1.06 times greater than that for either alone (RERI, relative excess risk due to interaction = 0.27, 95% CI = 0.07–0.43; AP, attributable proportion = 0.14, 95% CI = 0.01–0.23; S, synergy index = 1.06, 95% CI = 0.57–1.62). When short naps and depressive symptoms coexisted, the risk of SMI was 1.2 times higher than that for either alone (RERI = 0.12, 95% CI=-0.14–0.39; AP = 0.13, 95% CI=-0.07–0.22; S = 1.20, 95% CI = 0.79–1.82). Limitations: Since this was a cross-sectional study, the cause-and-effect relationships between the associated variables cannot be inferred. Conclusions: The interaction effect that exists between nap time and depressive symptoms in older people is important for the identification and early intervention of people at risk for SMI. [ABSTRACT FROM AUTHOR]

Background: Despite much evidence showing the effectiveness of structured self-management education for diabetes, poor glycemic control remains a challenge among empty nest older adults. Objective: We explored the effect of a health education intervention based on the PRECEDE-PROCEED model on the self-management of empty nest older adults with type 2 diabetes in Lanzhou, China. Methods: We conducted a 2-armed, randomized controlled trial using a multistage sampling method. A total of 100 patients were randomly assigned to receive either community nurse–led diabetes education based on the PRECEDE-PROCEED model or general community diabetes education. Self-management scores and blood glucose were compared at baseline and at 3 and 6 months after the intervention. Results: Analyses were conducted on the 98 patients completing follow-up. In the experimental group, diabetes self-management knowledge (t = 7.578, P <.001), self-management attitude (t = 9.155, P <.001), self-management behavior (t = 7.809, P <.001), and overall self-management scores (t = 7.626, P <.001) improved, with hemoglobin A1c (t = −2.825, P =.006), fasting plasma glucose (t = −3.100, P =.003), 2-hour postprandial blood glucose (t = −3.812, P <.001), and diastolic blood pressure (t = −2.104, P =.038) decreasing compared with the control group at 6 months postintervention. Conclusions: This study demonstrated that education based on the PRECEDE-PROCEED model was more effective than general health education in improving diabetes self-management and glycemic control among empty nest older adults. [ABSTRACT FROM AUTHOR]

Objectives: To systematically assess the prevalence of decreased intrinsic capacity in older adults, stratified by relevant factors such as country, sex, sample source, and region. Methods: We conducted a comprehensive search of PubMed, Web of Science, EMBASE, The Cochrane Library, PsychINFO, CINAHL, China Knowledge Resource Integrated Database, Wanfang Database, Weipu Database, and Chinese Biomedical Database to collect studies published on the decline of intrinsic capacity in older adults before February 24, 2023. The results of the study were analyzed using the Stata 15.0 software package, using a random-effects model to estimate the pooled detection rate of decreased intrinsic capacity in older adults. The Joanna Briggs Institute Critical Appraisal Tool was used to assess the quality of all included studies. Results: A total of 16 studies (67,881 older adults in 4 countries) were included. The results showed that the pooled detection rate of decreased intrinsic capacity in older adults was 76.1% (95% CI: 68.0%–84.2%). The 16 studies had obvious heterogeneity, and further subgroup analysis showed that the detection rate of decreased intrinsic capacity in older adults was higher in developed countries, females, and hospitals. Thirteen studies found that the pooled detection rate was 73.7% (95%: CI 64.5%–82.8%) for decreased intrinsic capacity in Chinese older adults, with higher rates in mainland China and Hong Kong than in Taiwan. Conclusions: Our study suggests that intrinsic capacity declines more rapidly in older adults. Understanding the degree of decline in the intrinsic capacity of older adults will help to provide an important basis for the formulation and development of care policies for older adults. Trial registration number: PROSPERO (CRD42023402680). [ABSTRACT FROM AUTHOR]

The study's aims were to translate the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to Chinese and examine its psychometric properties. Adapting it for use in China involved forward translation, synthesis, back translation, expert review, and pretesting. A convenience sample of 201 Chinese older adults completed the Chinese version (CHAMPS-C) to evaluate its construct validity index and associations with physiological, psychosocial, and energy expenditure measures. The construct validity index of the CHAMPS-C was 0.95, and it had fair to moderate associations with physiological and psychosocial measures, other scales of physical activity, and accelerometer measurements. Our structured, stepwise process of cross-cultural adaptation produced a scale (i.e., CHAMPS-C), with items equivalent in meaning to the English version, for use with Chinese older adults. The findings of this study indicate that the CHAMPS-C has acceptable reliability and validity to assess the physical activity of older Chinese adults. [ABSTRACT FROM AUTHOR]

Delirium is a common and disturbing postoperative complication that might be ameliorated by propofol-based anaesthesia. We therefore tested the primary hypothesis that there is less delirium after propofol-based than after sevoflurane-based anaesthesia within 7 days of major cancer surgery. This multicentre randomised trial was conducted in 14 tertiary care hospitals in China. Patients aged 65–90 yr undergoing major cancer surgery were randomised to either propofol-based anaesthesia or to sevoflurane-based anaesthesia. The primary endpoint was the incidence of delirium within 7 postoperative days. A total of 1228 subjects were enrolled and randomised, with 1195 subjects included in the modified intention-to-treat analysis (mean age 71 yr; 422 [35%] women); one subject died before delirium assessment. Delirium occurred in 8.4% (50/597) of subjects given propofol-based anaesthesia vs 12.4% (74/597) of subjects given sevoflurane-based anaesthesia (relative risk 0.68 [95% confidence interval {CI}: 0.48–0.95]; P =0.023; adjusted relative risk 0.59 [95% CI: 0.39–0.90]; P =0.014). Delirium reduction mainly occurred on the first day after surgery, with a prevalence of 5.4% (32/597) with propofol anaesthesia vs 10.7% (64/597) with sevoflurane anaesthesia (relative risk 0.50 [95% CI: 0.33–0.75]; P =0.001). Secondary endpoints, including ICU admission, postoperative duration of hospitalisation, major complications within 30 days, cognitive function at 30 days and 3 yr, and safety outcomes, did not differ significantly between groups. Delirium was a third less common after propofol than sevoflurane anaesthesia in older patients having major cancer surgery. Clinicians might therefore reasonably select propofol-based anaesthesia in patients at high risk of postoperative delirium. Chinese Clinical Trial Registry (ChiCTR-IPR-15006209) and ClinicalTrials.gov (NCT02662257). [ABSTRACT FROM AUTHOR]

Experimental evidence indicates that i.v. anaesthesia might reduce cancer recurrence compared with volatile anaesthesia, but clinical information is observational only. We therefore tested the primary hypothesis that propofol-based anaesthesia improves survival over 3 or more years after potentially curative major cancer surgery. This was a long-term follow-up of a multicentre randomised trial in 14 tertiary hospitals in China. We enrolled 1228 patients aged 65–90 yr who were scheduled for major cancer surgery. They were randomised to either propofol-based i.v. anaesthesia or to sevoflurane-based inhalational anaesthesia. The primary endpoint was overall survival after surgery. Secondary endpoints included recurrence-free and event-free survival. Amongst subjects randomised, 1195 (mean age 72 yr; 773 [65%] male) were included in the modified intention-to-treat analysis. At the end of follow-up (median 43 months), there were 188 deaths amongst 598 patients (31%) assigned to propofol-based anaesthesia compared with 175 deaths amongst 597 patients (29%) assigned to sevoflurane-based anaesthesia; adjusted hazard ratio 1.02; 95% confidence interval (CI): 0.83–1.26; P =0.834. Recurrence-free survival was 223/598 (37%) in patients given propofol anaesthesia vs 206/597 (35%) given sevoflurane anaesthesia; adjusted hazard ratio 1.07; 95% CI: 0.89–1.30; P =0.465. Event-free survival was 294/598 (49%) in patients given propofol anaesthesia vs 274/597 (46%) given sevoflurane anaesthesia; adjusted hazard ratio 1.09; 95% CI 0.93 to 1.29; P =0.298. Long-term survival after major cancer surgery was similar with i.v. and volatile anaesthesia. Propofol-based iv. anaesthesia should not be used for cancer surgery with the expectation that it will improve overall or cancer-specific survival. ChiCTR-IPR-15006209; NCT02660411. [ABSTRACT FROM AUTHOR]

Background/Aim: Polypharmacy is prevalent among older inpatients and associated with adverse outcomes. To determine whether a geriatrician-led multidisciplinary team (MDT) management mode could reduce medications use among older inpatients. Methods: A retrospective cohort study was conducted in a geriatric department of a tertiary hospital in China with 369 older inpatients, including 190 patients received MDT management (MDT cohort), and 179 patients received usual treatment (non-MDT cohort). The primary outcome was to compare the changes of the amount of medications before and after hospitalization in two cohorts. Results: We reported that MDT management significantly reduced the number of medications used in older inpatients at discharge (at home: n = 7 [IQR: 4, 11] vs at discharge: n = 6 [IQR: 4, 8], p < 0.05). Hospitalization with the MDT management had a significant effect on the change in the amount of medications (F = 7.813, partial-η2 = 0.011, p = 0.005). The discontinuance of medications was associated with polypharmacy at home (OR: 96.52 [95% CI: 12.53-743.48], p < 0.001), and the addition of medications was associated with a diagnosis of chronic obstructive pulmonary disease (COPD) (OR: 2.36 [95% CI: 1.02-5.49], p = 0.046). Conclusion: The results indicated that the geriatrician-led MDT mode during hospitalization could reduce the number of medications used by older patients. The patients with polypharmacy were more likely to “deprescription” after MDT management, while the patients with COPD were more likely to be underprescription at home, polypharmacy which could be made up for after MDT management. [ABSTRACT FROM AUTHOR]

Aims: This study aims to explore the correlation between fear of dementia and insomnia among community‐dwelling older adults and to examine the mediating roles of social isolation and resilience on this correlation. Methods: A total of 259 community‐dwelling older adults from Mianyang, China were recruited from June 2021 to August 2021 using convenience sampling. The Chinese versions of the Fear of Dementia Scale (FODS), Lubben Social Network Scale (LSNS‐6), 25‐item Connor‐Davidson Resilience Scale (CD‐RISC‐25) and Athens Insomnia Scale (AIS) were used to collect specific, study‐related information from the subjects. Correlations between variables of interest were examined by Pearson analysis, and mediation analysis was conducted to explore the direct, indirect and total effects of the fear of dementia on insomnia vis‐à‐vis social isolation and resilience. Results: Results from 259 older adults indicated that fear of dementia and insomnia in older adults are positively correlated, that social isolation and resilience mediate the relationship between them, and that social isolation and resilience also had a statistically significant serial mediating effect. Conclusion: Fear of dementia is positively related to insomnia in older community‐dwelling Chinese adults, but resilience and social support may buffer the negative impact of fear of dementia and improve sleep quality. Impact: Fear of dementia is becoming more and more common in community‐dwelling older adults in China, and this emotional response to ageing and disease anxiety may be to blame for the poor sleep quality of some ageing populations. However, social support and resilience may buffer the negative impact of fear of dementia. The findings in this study indicate a need for well‐trained community nurses and other health practitioners to implement targeted strategies to reduce insomnia among older adults with fear of dementia. These strategies should strengthen resilience as well as social support. [ABSTRACT FROM AUTHOR]

Background: The purpose of this scoping review was to organize and describe the literature on the application of clown care to the elderly population in nursing homes, including intervention time, intervention methods and intervention effects, so as to provide reference ideas for other scholars to explore clown care programs suitable for the elderly population in nursing homes. Methods: Employing Arksey and O'Malley's methodology, we searched for PubMed, Web of Science, Embase, Cochrane, CNKI, WanFang, VIP, and CBM systematically and thoroughly, and the search period was from the establishment of each database to December 12, 2022. Two researchers with evidence-based learning experience independently conducted literature retrieval, information extraction, and cross-checking in strict accordance with the inclusion and exclusion criteria. The review process is reported according to PRISMA. Results: 148 literature were initially obtained after searching, of which 18 were finally included. Among them, 17 were in English and 1 was in Chinese. There are 16 quantitative studies and 2 qualitative studies published from 2010 to 2022. It is found that the current clown care intervention program has not established a unified intervention standard and effective evaluation program. Conclusions: The results of this scoping review conclude that clown care played a significant role in the nursing home. At first, it can reduce negative emotions, cognitive impairments and physical pain among older adults. In addition, it can improve their quality of life, life satisfaction, etc. It is suggested to learn from the advanced experience of clown care in foreign countries and carry out more clown care among the elderly population in nursing homes in China. [ABSTRACT FROM AUTHOR]

Aims: To investigate the incidence of accidental falls and develop a fall risk prediction tool in elderly patients with diabetes mellitus. Background: The risk of fall in elderly patients with diabetes is higher than that in the general elderly, there is fewer fall assessment tools for elderly patients with diabetes. Design: A prospective cohort study. Methods: Between June and September 2019, a total of 1007 elderly patients with diabetes were enrolled from a tertiary specialist diabetes hospital in Tianjin and were prospectively followed up for 6 months to determine outcomes of accidental falls through telephone. Demographic and diseases related factors were collected at baseline. Incidence of falls was investigated, and a nomogram was developed based on logistic regression model. SPSS 21.0 and R 3.6.3 were used to analyse the data. The article was reported in accordance with STROBE guidelines. Results: Among 1007 elderly patients, 950 finished the follow‐up. A total of 133 falls occurred in 93 patients during the follow‐up period, with a fall rate of 9.79%. Diabetic peripheral neuropathy, walking aids, depression, fall history, fatigue and sex were independent predictors of accidental fall in diabetes elderly patients. The sensitivity and specificity of the predictive model were 73.12% and 52.63%, respectively, and a fall risk prediction nomogram was developed based on the regression model. Conclusions: A nomogram including 6 easily available prediction factors (diabetic peripheral neuropathy, walking aids, depression, fall history within 1 year, fatigue, sex) was developed, and it can be used in safety management among Chinese elderly patients diagnosed with diabetes. Relevance to clinical practice: Nomogram can be used to identify diabetic elderly patients at high risk of accidental falls. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Beijing University of Civil Engineering & Architecture is the property of Journal of Beijing University of Civil Engineering & Architecture Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This paper investigates how the public–private partnership (PPP) functions in the care provision for older people in Guangdong, China, particularly for ageing‐in‐place programs. Methods: Three cities with diversified PPP forms of care provision for older people were chosen as case studies. Focus groups were conducted in these cities for the local authorities and care homes involved in the partnerships. Results: Three forms of PPP, including private sector involvement for the ownership, construction, and operation of the facilities delivering care services, were identified. The public–private co‐constructed and privately run model with greater private sector involvement may lead to higher quality care in one specific program. The publicly constructed and privately run program is widely used in many cities, advancing the expansion of ageing‐in‐place programs in more communities. These PPPs reflect flexible and practical collaboration between the public and private sectors at the local level in the Chinese context. Conclusions: PPP have accelerated the development of a better care system for older people, mainly in terms of more affordable and higher‐quality care options for the public. They are also a feasible solution for the local government due to more cost‐effective and sustainable care provisions than previous publicly provided programs. The specific forms adopted are primarily associated with the scale of home care provision for ageing‐in‐place and the local government's financial capacity. Despite increasing private sector involvement, the public sector retains its crucial role in delivering care services targeting ageing in China. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the effects of transitional care (TC) programs on the health outcomes of discharged older patients with osteoporotic vertebral compression fractures (OVCFs). Methods: A total of 160 older patients were recruited from two campuses of a public teaching hospital in China. Patients were grouped according to the campus to which they were admitted. The TC programs commenced one day before discharge and lasted 6 months after discharge. Repeated‐measures analysis of variance was used to analyse the effects of the TC programs. Results: The TC programs improved the discharge of older patients with OVCF in their activities of daily living (ADLs), pain levels and social support, and decreased fracture recurrence rates. Conclusions: This study provides evidence of concurrent clinical improvements and health outcomes in discharged older patients with OVCFs from the effects of TC programs based on social support theory. [ABSTRACT FROM AUTHOR]

Objective: The low recognition rate of postoperative delirium has gradually aroused clinical attention in China. The present study was to investigate the impact of consultation‐liaison psychiatry on postoperative delirium in elderly hip fracture patients. Methods: From March 2012 to September 2013, 89 patients with hip fractures hospitalized in Wuhan Mental Health Center were included in this prospective study as the consultation‐liaison group. A total of 81 patients selected from August 2010 to February 2012 were defined as the conventional group. The delirium was evaluated using the confusion assessment method (CAM) recommended by the American Psychiatric Association guidelines. Results: There was no difference of sex, age, trauma, surgical methods, and anesthesia between two groups (p > 0.05). The consultation rate of consultation‐liaison group was significantly higher than that of conventional group (37.07% vs 17.28%, p < 0.05). After the consultation, there were 26 cases (78%) and nine cases (64%) of delirium in the consultation‐liaison and conventional group, respectively (p > 0.05). In the consultation‐liaison group, three patients (9.09%) were diagnosed with anxiety and three patients (9.09%) were diagnosed with depression, while in the conventional group, three patients (21.42%) were diagnosed with communication and one patient (7.14%) was diagnosed with depression. In addition, this study showed the incidence of delirium in consultation‐liaison group was significantly higher than that of conventional group (29.21% vs 11.11%, p < 0.05). The average hospital stay in consultation‐liaison group was significantly lower than that of conventional group (11.42 ± 2.63 vs. 15.17 ± 2.38 days, p < 0.01). Conclusion: Consultation‐liaison psychiatry could improve the recognition rate of postoperative delirium in elderly hip fracture patients, shorten hospitalization time. The training of mental health knowledge for non‐psychiatrists could improve the ability of early identification and treatment of delirium. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Medicina do Esporte is the property of Redprint Editora Ltda. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Luochuan area is an important area for apple production in China. With the renewal and transformation of aged apple orchards, the occurrence of apple replant disease (ARD) was inevitable and has seriously affected the sustainable development of apples. Therefore, we randomly selected 14 soil samples from aged apple orchards in the Luochuan area to study the structural changes in the soil fungal community. The results showed that there were significant differences in the diversity of fungal communities between different aged apple orchards. The harmful fungi Gibberella, Fusarium, and Cryptococcus existed in 14 aged apple orchards in the Luochuan area, but their abundances were different in different aged apple orchards. A FUN Guild analysis showed that fungi were mainly present in the aged apple orchards in Luochuan in the saprotroph and pathotroph nutrition modes. Pathogenic fungi were widely present, which increased the risk of disease and seriously affected the growth and development of fruit trees. To sum up, there was a strong correlation between the ages of orchards and the unbalanced microbial community structure. Therefore, pathogenic fungi could be prevented and controlled during the renewal and transformation of aged orchards to reduce the impact of ARD on the apple industry. [ABSTRACT FROM AUTHOR]

Background: The actual relative dose intensity (RDI) of the attenuated R-CCOP regimen (rituximab, cytoxan, pegylated liposomal doxorubicin [PLD], vincristine, and prednisone) has not been fully investigated in Chinese geriatric patients with diffuse large B-cell lymphoma (DLBCL). In particular, the optimum dose for PLD remains unclear.Methods: We retrospectively collected clinical data from patients with untreated DLBCL aged 65-80 years subsequently treated with the R-CCOP. The restricted cubic spline model (RCS) was used to test the non-linear relationship between the predictors and outcomes.Results: Eighty-four patients were enrolled, with a median age of 73.5 years. More than half of the patients (54.8%) received at least 6 cycles. The median dose per cycle of cytoxan and PLD were 605.5 and 19.9 mg/m2. The 5-year progression-free survival (PFS), overall survival rate, and disease-specific survival rates were 38.7%, 44.8%, and 57.2%, respectively. The RDI of PLD (PLD-RDI, <70% vs ≥ 70%) was only significant in the univariate analysis (P = 0.002) but not in the multivariate analysis. The RCS model showed a decreasing trend of hazards with an increasing PLD dose per cycle after adjustment. No significant difference was observed between the low- and high-risk groups with PLD-RDI ≥ 70% (P = 0.548). However, patients in the high-risk group had unfavorable PFS with PLD-RDI < 70% (P = 0.006).Conclusion: The optimal dose of PLD for elderly patients with DLBCL in China remains to be determined. Evaluating the tolerance and identifying risk categories are critical for clinical decision-making in this population. [ABSTRACT FROM AUTHOR]

To develop and externally validate a machine learning–based fall prediction model for ambulatory nursing home residents. The focus is on predicting fall occurrences within 6 months after baseline assessment through a binary classification task, aiming to provide staff with an effective and user-friendly fall-risk assessment tool. Prospective cohort study. A total of 864 older residents living in 4 nursing homes between May 2022 and March 2023 in China. Potential fall-risk predictors were collected through in-person interviews and assessments of anthropometric and physical function. Participants were followed for 6 months, with falls recorded by trained nurses. Seven machine learning algorithms, including Logistic Regression (LR), Gradient Boosting Machine (GBM), eXtreme Gradient Boosting (XGBoost), Random Forest (RF), Support Vector Machine (SVM), Neural Networks (NN), and Decision Tree (DT), were used to develop prediction models. Performance was evaluated using the area under the receiver operating characteristic curve (ROC-AUC) and Precision-Recall curve (PR-AUC), with calibration assessed via a calibration curve. Feature importance was visualized using SHapley Additive exPlanations (SHAP). The 6 selected predictors were balance, grip strength, fatigue, fall history, age, and comorbidity. The ROC-AUC for the models ranged from 0.710 to 0.750, PR-AUC from 0.415 to 0.473, sensitivity from 0.704 to 0.914, and specificity from 0.511 to 0.687 in the validation cohort. The LR model was converted into a nomogram. The machine learning–based fall-prediction models effectively identified nursing home residents at high risk of falls. The developed nomogram can be integrated into clinical practice to enhance fall risk assessment protocols, ultimately improving patient safety and care in nursing homes. [ABSTRACT FROM AUTHOR]

Background: Herpes zoster increases the burden on the elderly in an aging society. Although an effective vaccine licensed by China Food and Drug Administration in 2019 was introduced into the market in June 2020, the willingness and influencing factors of herpes zoster vaccines in Chinese adults ≥ 50-years-old during coronavirus disease-2019 pandemic are yet to be elucidated.Methods: An online questionnaire survey was conducted using a simple random sampling method in October 2021 for viewers of the broadcast program. A binary logistic regression and multiple response analysis were conducted for herpes zoster vaccine and vaccination willingness. Pareto's graphs were plotted to present the multiple-choice questions of influencing factors.Results: A total of 3838 eligible participants were included in this study. Among them, 43.02% intended to be vaccinated, including 10.34% self-reported about receiving at least one shot of shingles vaccine, 30.22% declined, and 26.76% were hesitant. This population comprised a large proportion of middle-aged and older people (≥ 50-years-old) who have not experienced an episode of herpes zoster (54.98%) or are unaware of the virus (33.22%). The strongest determinants of vaccine hesitancy among older people were education background of Master's degree or above compared to senior high or equivalent and below, personal monthly income < 3000 RMB compared to 3000-5999 RMB, and living in a rural area.Conclusions: The willingness to get shingles vaccines can be improved further. Professional education and credible recommendation might prompt the elderly to improve their willingness and reassure them of the safety and efficacy of the vaccine. Also, accessibility and affordability should also be improved in the future. [ABSTRACT FROM AUTHOR]

Background: Little research has been conducted on the mediational role of inflammation on the association between chronic diseases and physical functioning among older Chinese adults. Methods: Data were from the China Health and Retirement Longitudinal Study (CHARLS in 2011, 2015, and 2018). Chronic diseases were assessed by the summed scores of self-reported physician diagnosed of 14 chronic diseases in 2011. High-sensitivity C-reactive protein (CRP) and white blood cell (WBC) counts were used tomeasure inflammation in 2015. Physical functioning wasmeasured by activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in 2018. Longitudinal mediational models adjusting sex, age, residential areas, marital status, and health behaviors were used. Results: The sample size was 3,328 for CRP and 3,349 for WBCs, respectively. Chronic diseases in 2011 had direct effects on CRP in 2015 (b = 0.06, p < 0.001) and ADLs in 2018 (b = 0.25, p < 0.001), whereas the association between CRP and ADLswas not statistically significant (b = 0.07, p > 0.05). Higher number of chronic diseases were associated with higher levels of WBCs (b = 0.12, p < 0.001) and greater ADLs (b = 0.22, p < 0.001), and WBCs were also associated with greater ADLs (b = 0.04, p < 0.05). Similar results were found except that CRP was also associated with greater IADLs (b = 0.13, p < 0.001). Conclusion: Inflammatory biomarkers partially mediate the association between chronic diseases and physical functioning. A better understanding of the social and biological processes that lead to disability could potentially improve the health status of the Chinese adults in the future. [ABSTRACT FROM AUTHOR]

Globally, populations are ageing and the estimated number of hip fractures will increase from 1.7 million in 1990 to more than 6 million in 2050. The greatest increase in hip fractures is predicted in Low- and Middle-Income Countries (LMICs), largely in the Asia-Pacific region where direct costs are expected to exceed $US15 billion by 2050. The aims of this qualitative study are to identify barriers to, and enablers of, evidence-informed hip fracture care in LMICs, and to determine if the Blue Book standards, developed by the British Orthopaedic Association and British Geriatrics Society to facilitate evidence-informed care of patients with fragility fractures, are applicable to these settings. This study utilized semi-structured interviews with clinical and administrative hospital staff to explore current hip fracture care in LMICs. Transcribed interviews were imported into NVivo 12 and analysed thematically. Interviews were conducted with 35 participants from 11 hospitals in 5 countries. We identified five themes-costs of care and the capacity of patients to pay, timely hospital presentation, competing demands on limited resources, delegation and defined responsibility and utilization of available data-and within each theme, barriers and enablers were distinguished. We found a mismatch between patient needs and provision of recommended hip fracture care, which in LMICs must commence at the time of injury. This study describes clinician and administrator perspectives of the barriers to, and enablers of, high-quality hip fracture care in LMICs; results indicate that initiatives to overcome barriers (in particular, delays to definitive treatment) are required. While the Blue Book offers a starting point for clinicians and administrators looking to provide high-quality hip fracture care to older people in LMICs, locally developed interventions are likely to provide the most successful solutions to improving hip fracture care. [ABSTRACT FROM AUTHOR]

Objective To summarize the clinical features, treatment options and prognosis of late - onset and very late - onset neuromyelitis optica spectrum disorders (LO - NMOSDs and VLO - NMOSDs). Methods Total 68 patients with NMOSDs admitted to Beijing Tongren Hospital, Capital Medical University from January 2015 to December 2021 were included, while 55 with LO -NMOSDs and 13 with VLO-NMOSDs. The sex, first-onset symptoms, Extended Disability Status Scale (EDSS), complications, anti- aquaporin 4 (AQP4) antibody and autoimmune antibody, imaging examinations (optic nerve and spinal cord), therapeutic schedule and prognosis were compared between 2 groups. Results Compared with LO - NMOSDs group, VLO-NMOSDs group had higher EDSS scores at nadir (Z = - 2.119, P = 0.034), but there were no significant differences in sex, first-onset symptoms, combination with other autoimmune diseases or tumors, anti - AQP4 antibody and autoimmune antibody, optic nerve and spinal cord involvement sites, therapeutic schedule and EDSS scores within 14 d after acute treatment (P > 0.05, for all). Conclusions Patients with VLO - NMOSDs and LO - NMOSDs have similar demographic characteristics, clinical characteristics, therapeutic schedule and short - term prognosis, but the VLO - NMOSDs has more severe disability at nadir, and its long-term prognosis remains to be further explored. [ABSTRACT FROM AUTHOR]

Biliary tract carcinoma (BTC) is a group of malignant tumors that originate in the digestive system and occurs with a high incidence in China. Few consistent and comparable assessments of BTC disease burden have been conducted at national or subnational levels, and little is known about the demographic, temporal, and geographic patterns of epidemiological characteristics and disease burden of BTC in China. The incidence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs) due to premature death and years lived with disability (YLDs) of BTC were comprehensively examined by age, sex, and calendar year in the Chinese population, using the methodological framework and analytical strategies used for the 2021 Global Burden of Disease study. All-age incidence increased from 17,077 to 51,720 between 1990 and 2021, and the age-standardized incidence rate rose by 13.62%; all-age deaths increased from 17,251 to 37,833, but the age-standardized mortality rate fell by nearly one-fifth. The DALYs rose by 89.57% while the age-standardized DALY rate fell by 23.24%. Variations of the tendencies in BTC burden were found between sexes and age groups. Data for each provincial region indicate that coastal eastern provincial regions have higher incidence and YLD levels, whereas northern provincial regions have higher mortality, DALY, and YLL levels. The proportions of DALYs attributable to high body mass index (BMI) illustrate the growing attribution obesity has made, and high BMI usually puts more burden on northern provincial regions. These results provide evidence to support precise, targeted, and customed public health strategies aimed at enhancing biliary tract health among the Chinese population., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Purpose: Genetic factors play an important role in the pathogenesis of stroke(S). This study aimed to screen the loci associated with S risk in northwestern Chinese population by genome-wide association analysis (GWAS)., Methods: A total of 1394 subjects, including 682 S patients and 692 controls, were enrolled in this study. SPSS 25.0 software was used for statistical analysis, and the independent sample t-test as well as Chi-square test were used to analyze the differences in age and gender between the case and control groups. The Precision Medicine Diversity Array (PMDA) genotyping chip was used in this study. The genotyping platform was the Gene Titan multi-channel instrument, and the Axiom Analysis Suite 6.0 software was used for the data analyzing. Besides, the LASSO analysis, SNP-SNP and GO/KEGG analysis were conducted to analyze the association between significant loci and S risk., Results: A total of 30 SNPs were found to be associated with the S risk based on additive model (p < 5 × 10 -8 ). After the LASSO screening, 22 SNPs showed the diagnostic value in S. The SNPs interaction analysis further screened the SNP-SNP interaction groups associated with the S risk(p < 0.05). Finally, the GO/KEGG analysis discovered the suggestive significance loci could be involved in the S development mainly by immune-related functions and pathways., Conclusion: This study discovered 30 S related SNPs and analyzed the potential pathways associated with genes located on the 30 SNPs, which were beneficial for enriching the genetic mechanism analysis of S in northwestern Chinese population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

This study delves into the relationship between environmental metal exposure and QT interval corrected for heart rate (QTc) prolongation, a critical marker for cardiovascular risk in the elderly. Although the interplay between metal exposure and QTc prolongation is important for predicting sudden cardiac death, it remains underexplored. Our analysis of 6478 participants from the Shenzhen aging-related disorder cohort involved measuring urinary concentrations of 22 trace metals and using mitochondrial DNA copy number (mtDNA-CN) as an indicator of mitochondrial dysfunction. Utilizing Bayesian kernel machine regression, and structural equation modeling, we assessed the effects of mixed trace metals on QTc prolongation. Our findings indicated a direct association between certain metals (Sb, Cu, Zn) and a 7 % increase in QTc prolongation risk, while Li, V, and Rb were associated with a 5 % reduction in risk. Elevated levels of V, Ti, and Cr corresponded to higher mtDNA-CN. Notably, restricted cubic splines revealed a U-shaped, nonlinear relationship between mtDNA-CN and QTc prolongation. After adjusting for metal exposure, an inverse correlation was observed between mtDNA-CN and QTc prolongation, suggesting mitochondrial dysfunction as a partial mediator., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objective: To investigate the comorbidity status of hypertension, diabetes, and dyslipidemia (the"three diseases") among residents aged≥40 in Liaoning Province, and to explore the correlation between the comorbidity and cardiovascular disease mortality. Methods: This investigation was a prospective cohort study. From February 2017 to March 2019, a multi-stage stratified cluster random sampling method was used to carry out a baseline survey of 18 758 permanent residents aged≥40 years in Liaoning Province. Demographic information and history of hypertension, diabetes, and dyslipidemia were collected and followed up every year. Death was mainly identified by linkage to the Population Death Information Registration Management System. Cox proportional hazard regression model was used to analyze the association between the comorbidity of the "three diseases" and cardiovascular disease mortality risk. Results: A total of 18 758 residents aged≥40 in Liaoning Province were included, with an age of (60.3±9.9) years and 7 325 males (39.1%). The comorbidity rate of hypertension, diabetes, and dyslipidemia was 6.7% (1 256/18 758), and the standardized prevalence rate was 5.4%. The comorbidity rate increased with age (P<0.001), which was higher in women than in men, and more significant in urban areas than in rural areas (all P <0.001). The comorbidity of "three diseases" accounted for 39.3% (1 256/3 198), 18.7% (1 256/6 710), and 11.8% (1 256/10 653) in patients with diabetes, dyslipidemia, and hypertension, respectively. With a follow-up of (4.3±0.6) years, 463 people died of cardiovascular disease. The mortality rate of cardiovascular disease in the comorbidity of hypertension, diabetes, and dyslipidemia was 8.74/1 000 person-years. After adjusting potential confounders, Cox proportional hazard regression model analysis showed that compared with normal individuals, the hazard ratio of cardiovascular disease mortality in patients with the "three diseases" was 2.55 (95% CI : 1.63-3.99). Conclusion: The prevalence of comorbidity of hypertension, diabetes, and dyslipidemia among residents aged≥40 in Liaoning Province was relatively high, and the risk of cardiovascular disease mortality in patients with the "three diseases" was increased.

Background: People are exposed to metals in various ways during their daily lives. However, the association between metal exposure and gallstones remains unclear., Objectives: To investigate the relationship between serum elemental concentrations and the risk of gallstones., Methods: Participants (n = 4204) were drawn from the Henan Rural Cohort. Gallstone diagnosis was based on abdominal ultrasound reports during follow-up. Baseline serum elemental concentrations were measured using inductively coupled plasma mass spectrometry. The relationship between serum elemental levels and gallstones was evaluated using robust Poisson regression, restricted cubic spline (RCS), quantile g-computation (Qgcomp), grouped weighted quantile sum (GWQS) and Bayesian kernel machine regression (BKMR)., Results: 121 individuals were diagnosed with gallstone (incidence rate of 2.88 %). In robust Poisson regression, after adjusting for confounding factors, the highest quartile of arsenic concentration compared to the lowest quartile had a 1.90 times higher relative risk (RR) [95 % confidence interval (CI): 1.05, 3.44]. Conversely, the highest quartile of zinc concentration compared to the lowest quartile had a 0.50 times lower RR (95 % CI: 0.28, 0.89). RCS showed an approximately "S"-shaped nonlinear relationship between serum arsenic levels and gallstones, with increasing arsenic concentration leading to a higher risk of gallstones; however, the risk plateaued when arsenic concentration exceeded 0.62 μg/L. Both the Qgcomp and GWQS indicated that arsenic plays a significant role in increasing the risk of gallstones, whereas zinc plays a significant role in reducing the risk of gallstones. BKMR showed that raising arsenic exposure from the 25th to the 75th percentile increased the risk of gallstones, while raising serum zinc concentration reduced it., Conclusions: Higher serum arsenic concentration increases the risk of gallstones, whereas higher zinc concentration may reduce the risk. Effective prevention of gallstones may require further reduction of arsenic exposure and appropriate increases in zinc intake., Competing Interests: Declaration of competing interest All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this study., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The current evidence regarding the association between long-term exposure to ozone (O 3 ) and hypertension incidence is limited and inconclusive, particularly at low O 3 concentrations. Therefore, our research aims to investigate the potential link between long-term O 3 exposure and hypertension in a region with low pollution levels., Methods: From 2010 to 2012, we conducted a cohort prospective study by recruiting nearly 10,000 attendees through multistage cluster random sampling in Guizhou Province, China. These individuals were followed up from 2016 to 2020, and 5563 cases were finally included in the analysis. We employed a high-resolution model with both temporal and spatial accuracy to estimate the maximum daily 8-h average O 3 and utilized annual average O 3 concentrations for three exposure periods (2009&#95;10, 2007&#95;10, 2005&#95;10) as the exposure indicator. Time-dependent covariates Cox regression model was exerted to estimate the hazard ratios (HRs) of hypertension incidence. Generalized linear model was employed to assess the association between O 3 and systolic, diastolic, pulse, and mean arterial pressure. The dose-response curve was explored using a restricted cubic spline function., Results: 1213 hypertension incidents occurred during 39,001.80 person-years, with an incidence density of 31.10/1000 Person Years (PYs). The average O 3 concentrations during the three exposure periods were 66.76 μg/m 3 , 67.85 μg/m 3 , and 67.21 μg/m 3 , respectively. Per 1 μg/m 3 increase in O 3 exposure was associated with 11 % increase in the incidence of hypertension in the single-pollution model, and the association was more pronounced in Han, urban, and higher altitude areas. SBP, PP, and MAP were increased by 0.619 (95 % CI, 0.361-0.877) mm Hg, 0.477 (95 % CI, 0.275-0.679) mm Hg, 0.301 (95 % CI, 0.127-0.475) mm Hg, respectively. Furthermore, we observed a nonlinear exposure-response relationship between O 3 and hypertension incidence., Conclusions: Long-term exposure to low-level O 3 exposure is associated with an increased risk of hypertension., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Complete mesocolic excision (CME) is being increasingly used for the treatment of right-sided colon cancer, although there is still no strong evidence that CME provides better long-term oncological outcomes than D2 dissection. The controversy is mainly regarding the survival benefit from extended lymph node dissection emphasized by CME., Methods: This multicenter, open-label, randomized controlled trial (ClinicalTrials.gov identifier: NCT02619942) was performed across 17 hospitals in China. Patients diagnosed with stage T2-T4aNanyM0 or TanyN + M0 right-sided colon cancer were randomly assigned (1:1) to undergo either CME or D2 dissection during laparoscopic right colectomy. The primary outcome was the 3-year disease-free survival (DFS), and the main secondary outcome was the 3-year overall survival (OS)., Results: Between January 11, 2016, and December 26, 2019, 1,072 patients were randomly assigned (536 patients to CME and 536 patients to D2 dissection). In total, 995 patients (median age 61 years, 59% male) were included in the primary analysis (CME [n = 495] v D2 dissection [n = 500]). No significant differences were found between the groups in 3-year DFS (hazard ratio [HR], 0.74 [95% CI, 0.54 to 1.02]; P = .06; 86.1% in the CME group v 81.9% in the D2 group) or in 3-year OS (HR, 0.70 [95% CI, 0.43 to 1.16]; P = .17; 94.7% in the CME group v 92.6% in the D2 group)., Conclusion: This trial failed to find evidence of superior DFS outcome for CME compared with standard D2 lymph node dissection in primary surgical excision of right-sided colon cancer. Standard D2 dissection should be the routine procedure for these patients. CME should only be considered in patients with obvious mesocolic lymph node involvement.

Introduction: Osteoporosis is a debilitating bone disease that significantly contributes to disability and a loss of autonomy among older adults. This study aimed to characterize osteoporosis and explore the feasibility of combining OSTA and BMR for osteoporosis prediction., Methods: A cross-sectional study involving 1435 participants (1300 women and 135 men) was conducted. Spearman's correlation, simple linear regression analyses, and multiple linear regression models were utilized to investigate the association between OSTA, BMR, and bone mineral density (BMD). Furthermore, the efficacy of integrating OSTA with BMR for osteoporosis screening and prediction was assessed through receiver operating characteristic (ROC) curves., Results: In the total population, the sensitivity of combination variable W was 58.63%, and the specificity was 70.90%. When OSTA and BMR were employed separately to diagnose osteoporosis, the sensitivity was 47.70% and 55.34%, respectively, while the specificity was 63.80% and 69.80%, respectively., Conclusions: The combined utilization of OSTA and BMR formula represents an effective screening method for osteoporosis., Competing Interests: Declarations Ethics approval and consent to participate The study protocol was approved by the Ethics Committee of The Second Affiliated Hospital of Xi’an Jiaotong University (No.2023264) and written informed consent was obtained from each participant. Consent for publication All authors consented to the publication of this study. The hospital committee of ethics approved the study, and informed consent was obtained from the patients/participants included in this study. Following the guidelines, the patient’s permission to publish is indicated as “Not Applicable” in this section. Figures authenticity All figures submitted have been created by the authors who confirm that the images are original with no duplication and have not been previously published in whole or in part. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Performing spinal anesthesia in elderly patients with spine degeneration is challenging for novice practitioners. This stratified randomized controlled trial aims to compare the effectiveness of mixed reality-assisted spinal puncture (MRasp) with that of landmark-guided spinal puncture (LGsp) performed by novice practitioners in elderly patients., Methods: This prospective, single-center, stratified, blocked, parallel randomized controlled trial will include 168 patients (aged ≥ 65 years) scheduled for elective surgery involving spinal anesthesia. All spinal punctures will be performed by anesthesiology interns and residents trained at Huadong Hospital. Patients will be randomly assigned to the MRasp group (n = 84) or the LGsp group (n = 84). Based on each intern/resident's experience in spinal puncture, participants will be stratified into three clusters: the primary group, intermediate group, and advanced group. The primary outcome will be the comparison of the rate of successful first-attempt needle insertion between the MRasp group and the LGsp group. Secondary outcomes will include the number of needle insertion attempts, the number of redirection attempts, the number of passes, the rate of successful first needle pass, the spinal puncture time, the total procedure time, and the incidence of perioperative complications. A stratified subgroup analysis will also be conducted for interns/residents at different experience levels., Discussion: The findings from this trial establish the effectiveness of MRasp by novice practitioners in elderly patients. This trial may provide experimental evidence for exploring an effective visualization technology to assist in spinal puncture., Trial Registration: Chinese Clinical Trials Registry ChiCTR2300075291. Registered on August 31, 2023. https://www.chictr.org.cn/bin/project/edit?pid=189622 ., Competing Interests: Declarations Ethics approval and consent to participate {24} Ethics approval has been obtained from the Medical Ethics Committee of Huadong Hospital affiliated to Fudan University, China (approval no. 20220140, Chairperson Prof Yinghao Sha; date of approval, 1st December 2022) (Additional file 2) and conforms to the principles of the Helsinki Declaration. The investigators will obtain written informed consent (available from the corresponding author) from all participants (Additional file 3). Consent for publication {32} If images of an individual person are used for publication of the trial, written consent will be obtained from that person for the publication of these details. Competing interests {28} The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: Poor adherence to chronic cardiovascular treatments can impede targeted clinical outcomes. This study estimates the potential benefits of improving adherence among patients with cardiovascular disease requiring secondary prevention in Mexico, Thailand, and China., Methods and Results: We performed Markov model simulation for patients with cardiovascular disease in 3 countries from health care and societal perspectives over a lifetime horizon. Two scenarios were compared: (1) optimal adherence based on a meta-analysis of 51 randomized controlled trials and (2) status quo. The association between adherence and cardiovascular disease outcomes derives from a dose-response meta-analysis of 4 051 338 patients. Outcomes include the accumulated number of cardiovascular events and associated costs in 2022 US dollars, life years, and quality-adjusted life years. Optimal adherence could prevent 42 (95% credible interval [CrI], 29-56) cardiovascular events in Mexico, 34 (95% CrI, 24-50) in Thailand, and 63 (95% CrI, 43-89) in China per 1000 patients over a lifetime. Incremental effectiveness per patient was 0.60 (95% CrI, 0.47-0.74) life-years in Mexico, 0.68 (95% CrI, 0.37-0.94) quality-adjusted life years in Thailand, and 0.93 (95% CrI, 0.44-1.27) quality-adjusted life years in China. Cost savings from societal perspective amounted to $412 (95% CrI, $211-$723), $316 (95% CrI, $187-$541), and $700 (95% CrI, $355-$1144) per patient for Mexico, Thailand, and China, respectively. Findings remained cost saving in deterministic and probabilistic sensitivity analyses., Conclusions: Achieving optimal adherence in patients with cardiovascular disease requiring lipid-lowering therapy saves costs and improves health outcomes in Mexico, Thailand, and China. These findings support national health care systems implementing strategies to improve adherence in these countries.

Background: Osteoarthritis (OA) is a degenerative joint disease prevalent in the elderly. Currently, the relationship between the senescence inhibitor Klotho and OA remains unclear. This study investigated the relationship between serum soluble Klotho (S-Klotho) and OA., Methods: This cross-sectional study was based on the 2007-2016 National Health and Nutrition Examination Survey (NHANES). Three multifactorial logistic regression models were constructed to assess the association between serum Klotho and OA. Restricted cubic spline (RCS) curves were further used to assess whether there was a nonlinear relationship between serum Klotho and OA. Finally, stratified analyses and interaction tests were used to evaluate the association's stability. To further investigate the relationship between serum Klotho and OA, we recruited 107 patients for analysis at the First Affiliated Hospital of Guangxi Medical University., Results: The final 8,918 participants included in this study comprised 50.55% females and 49.45% males, with 18.10% of participants suffering from OA and a mean S-Klotho level of 846.41 (5.61) pg/ml. All three logistic regression models observed a negative association between continuous S-Klotho and OA risk. When S-Klotho was categorized into tertiles, the fully adjusted model showed that participants in the third tertile had a 17% lower risk of OA than those in the first tertile (OR = 0.83, 95% CI: 0.70, 0.99, P = 0.035). The RCS curves showed a linear negative association between S-Klotho and the incidence of OA (P for overall = 0.025; P for non-linearity = 0.667). Further subgroup analyses and interaction tests suggested that the negative association between S-Klotho and OA remained stable in different conditions. Research conducted in China has shown that the negative correlation between serum Klotho levels and the prevalence of OA remains evident among Chinese individuals (OR: 0.77, 95% CI: 0.66, 0.90, P<0.001)., Conclusion: Our study suggests that elevated levels of the senescence inhibitor S-Klotho may be a potential protective factor for OA, which may provide new insights into the diagnosis and treatment of OA., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Qiu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Tuberculosis (TB) is a chronic infectious disease that harms human health for a long time. TB epidemiological distribution analysis can help governments to control TB in high TB incidence areas. The distribution trend of TB cases varies in different regions. The unbalanced temporal and spatial trends of pulmonary TB (PTB) risk at a fine level in Fujian Province remain unclear., Objective: The purpose was to analyze different distribution characteristics, explore the prevalence of TB in this region, and provide a scientific basis for further guidance of TB control work in Fujian Province, China., Methods: Prefectural-level and county-level notified PTB case data were collected in Fujian Province. A joinpoint regression model was constructed to analyze the unbalanced temporal patterns of PTB notification rates from 2005 to 2021 at prefecture-level city scales. The spatial clustering analysis and spatial autocorrelation analysis were performed to assess the inequality of the locations of PTB cases. Demographical characteristics were explored by the method of descriptive analysis., Results: TB cases reported in Fujian showed an overall downward trend from 2005 to 2021 (in 2005: n=32,728 and in 2021: n=15,155). TB case numbers showed obvious seasonal changes. The majority of TB cases were middle-aged and older adult male patients (45 years and older; n=150,201, 42.6%). Most of the TB cases were farmers (n=166,186, 47.1%), followed by houseworkers and the unemployed (n=48,828, 13.8%) and workers (n=34,482, 9.8%). Etiologically positive TB cases continue to be the main source of TB cases (n=159,702, 45.3%). Spatially, the reported TB cases were mainly distributed in cities in southeastern Fujian, especially at the county level. TB case numbers showed 2 spatial groups; cases within each group shared similar case characteristics. In terms of geographical distribution, TB showed obvious spatial correlation, and local areas showed high aggregation., Conclusions: The TB incidence trend decreased annually in Fujian Province. TB cases distributed commonly in the male population, middle-aged and older people, and farmers. Etiologically positive cases are still the main source of Mycobacterium tuberculosis infection. TB incidence is higher in the cities with a developed economy and large population in the southeast. TB control should be strengthened in these populations and areas, such as via early screening of cases and management of confirmed cases., (© Shanshan Yu, Meirong Zhan, Kangguo Li, Qiuping Chen, Qiao Liu, Laurent Gavotte, Roger Frutos, Tianmu Chen. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Background: There is no relevant research on the symptoms and emotions of patients with advanced thyroid cancer in mainland China., Aim: To investigate the symptoms and negative emotions of patients with advanced thyroid cancer and to analyze the correlation between the two preliminarily., Methods: Using a convenience sampling method, 180 patients who visited a multidisciplinary outpatient service for advanced thyroid cancer at West China Hospital of Sichuan University from January 2023 to December 2023 were selected as the research subjects. A cross-sectional survey was conducted using the M.D. Anderson Symptom Inventory-Thyroid Cancer module (MDASI-THY) and Hospital Anxiety and Depression Scale (HADS). The correlation between symptom severity and negative emotions was determined by Spearman correlation analysis., Results: Disturbed sleep was the symptom with the highest incidence (74.4%) and the greatest severity (3.0 points), while mood distress was the symptom with the highest incidence (63.3%) and the greatest severity (2.0 points). 71 patients (39.4%) had anxiety, and 62 patients (34.4%) had depression. All symptoms and symptom interference were positively correlated with anxiety and depression (P < 0.05)., Conclusion: Patients with advanced thyroid cancer have multiple symptoms that seriously affect their daily lives and emotions. Medical staff should conduct targeted observation and preventive treatment to reduce the burden of symptoms and improve the negative emotions of patients., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University [Ethics Approval Number 2022(1781)]. Each participant had a face-to-face meeting with the researchers during which the researchers ensured that the patients met the study criteria and explained the study in detail. The researchers provided enough time for the patients to ask questions. Each participant signed the written consent to the study. All methods were ensured by following the relevant guidelines and regulations. Consent for publication Informed consent was obtained from the patient for publication of this article. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Existing researches have predominantly focused on the implications of dynamic alterations in the triglyceride-glucose (TyG) index and traditional obesity measures for cardiovascular disease (CVD) risk. However, the application of the weight-adjusted waist index (WWI), which incorporates the dynamically changing body composition factors of weight and waist circumference, alongside the TyG index for predicting CVD risk, remains unexplored. This study explores the relationships between baseline TyG-WWI index and its dynamic changes with CVD risk., Methods: Subjects were drawn from the China Health and Retirement Longitudinal Study. Logistic regression analyses were conducted to determine the relationships between baseline and longitudinal changes in the TyG-WWI index and CVD risk, quantified through odds ratios (ORs) and 95% confidence intervals (CIs). The robustness of results was confirmed via subgroup analyses and E-values. Additionally, restricted cubic spline and quartile-based methods evaluated the relationships between baseline and cumulative TyG-WWI indices and CVD risk., Results: Over two survey waves, 613 CVD events were recorded. Analysis using adjusted multivariable models demonstrated a significant relationship between the cumulative TyG-WWI index and increased CVD risk, with an adjusted OR (95% CI) of 1.005 (1.000, 1.009). Class 2 of the TyG-WWI index change showed greater risk of CVD compared to Class 1, with ORs of 1.270 (1.008, 1.605). However, no significant connection was observed between the baseline TyG-WWI index and CVD risk (OR = 1.007, 95% CI: 0.996, 1.019). These findings were corroborated through extensive sensitivity analyses., Competing Interests: Declarations Ethics approval and consent to participate Ethical approval for this program was granted by the Biomedical Ethics Review Board of Peking University, with approval numbers IRB00001052-11015 and IRB00001052-11014. All participants provided informed consent before inclusion in this program. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Examine the cost-effectiveness of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) for Chinese patients with severe aortic stenosis (AS) at intermediate and high surgical risk., Design: A two-phase model, comprising a 1-month decision tree to simulate perioperative outcomes and a 5-year Markov model with monthly cycles to simulate long-term outcomes, has been developed to evaluate the cost-effectiveness of TAVI compared with SAVR for Chinese patients with AS at intermediate and high risk. The event rates for both phases are sourced from the Placement of Aortic Transcatheter Valves IA and IIA trials, while the cost inputs and utility values are sourced from local sources or published literature. Adjustments for inflation were made using consumer price indexes for healthcare to enhance precision. To ensure the reliability and robustness of the model, sensitivity analyses were conducted to assess their impact on outcomes., Setting: China healthcare system perspective., Participants: A hypothetical cohort of Chinese patients with AS in intermediate and high surgical risk., Interventions: TAVI versus SAVR., Outcome Measures: Cost, quality-adjusted life-years (QALYs), life-years gained and incremental cost-effectiveness Ratio (ICER)., Result: For both intermediate- and high-risk AS patients, offering TAVR resulted in high healthcare costs but moderate benefits compared with SAVR. Specifically, in the intermediate-risk population, TAVR led to a 0.34 QALY increase over SAVR, with an incremental cost of $16 707.58, resulting in an ICER of $49 176.60/QALY. Similarly, in the high-risk population, TAVR showed a 0.15 QALY increase over SAVR, with an incremental cost of $18 093.52, leading to an ICER of $122 696.37/QALY. However, both ICERs exceeded the willingness-to-pay threshold of $37 654.50/QALY. Sensitivity analyses confirmed the model's stability under parameter uncertainty., Conclusion: TAVI was deemed not cost-effective compared with SAVR for patients with AS at intermediate or high surgical risk in the Chinese healthcare system. Lowering valve costs was considered an effective approach to improve the cost-effectiveness of TAVI., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)