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Bixi Li,1 Yun Li,1 Yaxin Zhang,1 Pan Liu,1 Yu Song,1 Yaru Zhou,1 Lina Ma2 1Department of Geriatrics, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China; 2Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of ChinaCorrespondence: Lina Ma, Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, #45 Changchun Street, Xicheng District, Beijing, 100053, People’s Republic of China, Email malina0883@126.com Yun Li, Department of Geriatrics, Xuanwu Hospital Capital Medical University, #45 Changchun Street, Xicheng District, Beijing, 100053, People’s Republic of China, Email liy_xw@sina.comBackground: Frailty and obesity are associated with poor outcomes in older adults. Previous studies have shown that excessive visceral fat leads to frailty by promoting inflammation. However, the association between visceral fat obesity (VFO) and frailty has not been elucidated. We aimed to investigate the correlation between VFO and frailty in middle-aged and older adults.Methods: A total of 483 adults aged ≥ 45 years were recruited. Estimated visceral fat area (eVFA) and total fat (TF) were determined by bioimpedance analysis. Waist circumference, body mass index (BMI), and waist-to-hip ratio (WHR) were recorded. Frailty was assessed using the Fried frailty phenotype. Logistic regression analysis was used to analyze the association between frailty and other variables. Spearman correlation coefficients were calculated to assess the correlations between the frailty phenotype score, eVFA/TF, and other factors.Results: Frail adults were older and had higher waist circumference, eVFA metabolic indicators, and coronary artery disease incidence. Participants with frailty had a higher prevalence of VFO than those without. After adjusting for age, sex, and chronic diseases, frailty was associated with eVFA but not waist circumference, WHR, or BMI. Spearman correlation analysis showed that the frailty phenotype score was positively associated with eVFA and BMI in women but not men. After adjusting for age, frailty was not associated with BMI or WHR. The eVFA/TF ratio was negatively correlated with grip strength and walking speed and positively correlated with the clinical frailty scale score in middle-aged and older adults.Conclusion: Middle-aged and older adults with VFO had a higher risk of frailty. Frailty was associated with a higher eVFA but not with BMI or WHR. The frailty score was positively associated with eVFA and BMI in women, but not in men. A higher eVFA was correlated with worse physical function, even after adjusting for TF.Keywords: visceral fat obesity, visceral fat area, frailty, middle-aged and older adults

To investigate the effects of different anesthetic methods on postoperative immune function in patients undergoing gastrointestinal tumor resection. Ninety patients undergoing laparoscopic gastrointestinal tumor resection were divided into 3 groups. Patients in the GA group were anesthetized by total intravenous anesthesia. The GE group was anesthetized by general anesthesia combined with epidural anesthesia. The GN group was anesthetized by general anesthesia combined with bilateral Transversus Abdominis Plane block (TAP) and rectus sheath nerve blocks. General anesthesia is total intravenous anesthesia in all three groups. Blood samples were taken to test the changes of peripheral lymphocyte subtype analysis, and levels of plasma cortisol, epinephrine, norepinephrine. Also, the dosage of anesthetic drugs, recovery time, and visual analog scale (VAS) scores were recorded. Postoperative immune indexes, including CD4 count, CD8 count, B, and NK cells, in the GE group were significantly higher than those in NA and GA groups (P P P P

Hypertension is one of the most common chronic cardiovascular diseases in older adults. Frailty and hypertension often coexist in older people, but few studies have explored frailty in older hypertensive adults. We aimed to explore the association of frailty with quality of life in older hypertensive adults. We collected the data of 291 patients with hypertension aged ≥ 60 years. Blood pressure was measured with a standard aneroid sphygmomanometer and an ambulatory blood pressure monitor. The characteristics of the Fried phenotype were used to assess physical frailty. The Medical Outcomes Study’s 36-Item Short Form Health Survey (SF-36) was used to assess the quality of life. Forty-eight (16.5%) patients were frail. Compared with pre-frail or robust older hypertensive patients, those who were frail were older, had higher incidences of living alone, a longer duration of hypertension, lower grip strength, and slower walking speed. Moreover, frail patients had a lower diastolic blood pressure (DBP) and mean arterial pressure (MAP), more chronic diseases, a lower proportion of beta-blocker usage, and worse quality of life. Frailty was positively correlated with pulse pressure and negatively correlated with DBP and MAP, but these associations disappeared after adjustment by age. The SF-36 score was negatively correlated with frailty and positively correlated with grip strength and walking speed. After adjusting for age, the SF-36 total score remained negatively correlated with frailty and positively correlated with walking speed. Frailty states remained significantly associated with the SF-36 score. Frailty was associated with a worse quality of life in older adults with hypertension. Frailty prevention and intervention may help improve the quality of life of older adults with hypertension.

Purpose To investigate the predictive significance of different pneumonia scoring systems in clinical severity and mortality risk of patients with severe novel coronavirus pneumonia. Materials and methods A total of 53 cases of severe novel coronavirus pneumonia were confirmed. The APACHE II, MuLBSTA and CURB-65 scores of different treatment methods were calculated, and the predictive power of each score on clinical respiratory support treatment and mortality risk was compared. Results The APACHE II score showed the largest area under ROC curve in both noninvasive and invasive respiratory support treatment assessments, which is significantly different from that of CURB-65. Further, the MuLBSTA score had the largest area under ROC curve in terms of death risk assessment, which is also significantly different from that of CURB-65; however, no difference was noted with the APACHE II score. Conclusion For patients with COVID, the APACHE II score is an effective predictor of the disease severity and mortality risk. Further, the MuLBSTA score is a good predictor only in terms of mortality risk.

Objecive : This study aimed to evaluate whether Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can be detected in the tears in the eyes of Coronavirus Disease 2019 (COVID-2019) infect...

Objectives Postoperative delirium (POD) is the most common complication in patients after hip fracture surgery, and the incidence of POD is associated with mortality and disability in patients following hip fracture surgery. Therefore, this study aimed to identify the individual as well as anesthetic and operative risk factors associated with the POD in adult patients after hip fracture surgery. Methods We searched relevant articles published to February 2020 in Cochrane Library, PubMed, and Embase. Studies involving adult patients who underwent hip fracture surgery were regarded as relevant if the studies contained the individual or anesthetic and surgical characteristics of participants. The pooled relative risk ratios (RRs) or weight mean difference of the variables were estimated by the Mantel-Haenszel or Inverse-Variance methods. Results A total of 44 studies were included, which altogether included 104572 participants with hip fracture surgery (17703 patients with POD and 86869 patients without POD) and the incidence of POD was 16.93%. A total of 14 risk factors, classified into two categories which were individual as well as anesthetic and operative factors, were identified originally, which included age (weight mean difference [WMD]:2.33;95% confidential interval [CI]: 1.64-3.03), sex (RR: 0.89; 95% CI:0.85-0.93), American society of Anesthesiologists classification(RR:0.56; 95%CI:0.51-0.59), body mass index (WMD:-0.62; 95%CI:-0.81 to -0.44), function dependency(RR:1.52; 95% CI:1.24-1.87), visual impairment (RR:1.62; 95% CI: 1.16-2.27), smoking (RR:0.86; 95% CI:0.79-0.94), preoperative delirium (RR: 2.71; 95% CI: 2.50-2.72), dementia (RR:2.60; 95% CI:2.50-2.72), hypertension (RR: 1.10; 95% CI:1.04-1.15), chronic obstructive pulmonary disease (RR:1.08; 95% CI: 1.01-1.16), regional anesthesia (RR:1.20; 95% CI: 1.01-1.43), transfusion (RR: 1.41; 95% CI: 1.22-1.63), and elective surgery (RR: 0.91; 95% CI: 0.84-0.99). Conclusions Patients possessed above risk factors might be high-risk patients. Clinician should maintain keen vigilance at those patients.

Background Robot-assisted laparoscopic radical prostatectomy ( RALRP) has better effects than conventional laparoscopic radical prostatectomy (LRP). However, limited data is available regarding the incidence and risk factors for developing postoperative delirium in patients undergoing these two procedures. This study aimed to assess the incidence of postoperative delirium in patients undergoing RALRP and LRP, and evaluated the risk factors for developing postoperative delirium Methods From June 2013 to December 2019, 81 cases of RALRP patients and 71 cases of LRP patients were included in this study. The unpaired Student t tests, repetitive measure analysis of variance and chi-square test were used to compare several different parameters. The binary logistic regression analysis was used to explore the independent risk factors of postoperative delirium . Results The incidences of postoperative delirium in group RALRP and LRP were (17.3% VS 32.4%, P = 0.03), IAP was (12.72 ± 1.87 VS 13.37 ± 1.12 mmHg; P = 0.01), PaCO2 at post-pneumoperitoneum and after loosening pneumoperitoneum were (47.89 ± 10.89 VS 38.65 ± 16.32 mmHg; P VS 43.57 ± 4.54 mmHg; P = 0.001), the overall cost was (8.29 ± 5.55 VS 5.18 ± 1.51 Ten thousand RMB, P r), post-pneumoperitoneum PaCO2 and IAP. Conclusion The RALRP group had a lower IAP, lower incidence of postoperative delirium and shorter recovery time compared with the LRP group, but the overall cost was higher. IAP was the main factor affecting the incidence of postoperative delirium.

Introduction: Electrical vagal nerve stimulation is known to decrease gut permeability and alleviate gut injury caused by traumatic hemorrhagic shock. However, the specific mechanism of action remains unclear. Glycocalyx, located on the surface of the intestinal epithelium, is associated with the buildup of the intestinal barrier. Therefore, the goal of our study was to explore whether vagal nerve stimulation affects enterocyte glycocalyx, gut permeability, gut injury, and remote lung injury. Materials and methods: Male Sprague Dawley rats were anesthetized and their cervical nerves were exposed. The rats underwent traumatic hemorrhagic shock (with maintenance of mean arterial pressure of 30–35 mmHg for 60 min) with fluid resuscitation. Vagal nerve stimulation was added to two cohorts of animals before fluid resuscitation, and one of them was injected with methyllycaconitine to block the cholinergic anti-inflammatory pathway. Intestinal epithelial glycocalyx was detected using immunofluorescence. Intestinal permeability, the degree of gut and lung injury, and inflammation factors were also assessed. Results: Vagal nerve stimulation alleviated the damage to the intestinal epithelial glycocalyx and decreased intestinal permeability by 43% compared with the shock/resuscitation phase (P

BackgroundAcute lung injury (ALI) is a common complication after THS/R, and vagus nerve stimulation (VNS) could alleviate lung injury by activating cholinergic anti-inflammatory pathway (CAP) during traumatic hemorrhagic shock/resuscitation (THS/R). The purpose of this study was to explore the effects of VNS on intestinal epithelial glycocalyx and acute lung injury associated with THS/R.MethodsSprague-Dawley rats were subjected to traumatic hemorrhagic shock/ resuscitation to induce ALI. The measurements of intestinal barrier permeability, intestinal epithelial glycocalyx, and the level of inflammation factors and histology of lung and gut tissue were made in each group.ResultsThe level of TNF-α，IL-6 and MPO in lung and gut tissue were significantly decreased in the VNS-treated group. In addition, the shedding of intestinal epithelial glycocalyx and increased gut barrier permeability were alleviated in the VNS-treated group, and the gut tissue and lung tissue injury were mitigated in the VNS-treated group. However, pretreated with methyllycaconitine could reverse the protective effect of VNS.ConclusionsVNS could relieve lung injury associated with THS/R by alleviating the damage of intestinal epithelial glycocalyx, which might be achieved by activating CAP.

Objective: The objective is to compare the effect of general anesthesia (GA) and monitored anesthesia care (MAC) on clinical outcomes in patients with endovascular therapy for vertebrobasilar occlusion stroke. Methods: 139 patients undergoing endovascular therapy for vertebrobasilar stroke, were recruited. The patients were randomized into GA group and MAC group (about 1:1 ratio). GA group received general anesthesia and MAC group received monitored anesthesia care during endovascular therapy. The primary outcome measure was the shift in the degree of disability among the 2 groups as measured by the modified Rankin scale score (mRS) at 90 days (80-100 days). Secondary end points included infarct volume and related complications. Results: The patients were assigned randomly (about 1:1 allocation) to GA group (n=72) and MAC group (n=67). The primary outcome of functional independence measured by 90-day mRS score was not significantly different between the 2 groups (median (IQR), 2 (1-3) vs. 3 (1-4); P=0.316). Final infarct volume was smaller in the GA group than in the MAC group (median (IQR), 27.60 (13.75-83.52) vs. 33.60 (26.85-92.95); P=0.045). There were no differences with statistical significance in rates of successful reperfusion (modified Thrombolysis in Cerebral Ischemia (mTICI) 2b-3) between 2 groups (73.61% vs. 76.12%; P=0.734). Early neurological outcomes measured by the 24-hour National Institutes of Health Stroke Scale scores (NIHSS) showed that 11 (interquartile range (IQR), 3-22) in GA group and 11 (interquartile range (IQR), 7-25) in MAC group, but were not statistically significant. There was no statistical difference in postoperative complications between the two groups. Conclusion: For patients who underwent endovascular therapy for vertebrobasilar occlusion strok caused by occlusions in the posterior circulation, MAC appears to be as effective as GA. However, MAC is associated with bigger final infarct volume. Future studies are warranted to confirm our findings.

Objecive: This study aimed to evaluate whether the coronavirus can be detected in the tears in the eyes of 2019- novel coronavirus (2019-nCoV) infected patients and compa re the detection consistency of two simultaneously collected samples, from the tears and throat swabs, of these patients.Methods: A total of 35 diagnosis confirmed patients with 2019-nCoV infection disease,from January 26 to February 19, 2020, at central theater Wuhan general hospital of PLA, were included in this cross-sectional case series study. The diagnosis was confirmed by both clinical and laboratory ways. Throat samples from all enrolled patients were collected with sampling swab, and simultaneously ,tear samples were collected w ith sampling swab from 9 patients (No.1-9) and with Schirmer's strip from the remaining patients (No.10-35) (bilateral eyes for all patients). Sample collecting and testing were performed in three separate time points: first from patients No.1-9,second from p atients No.10-29,and third from patients No.30-35. Reverse-transcriptase-polymerase-chai n-reaction (RT-PCR) assay was performed by the same technician(Researcher Zhang), who was blind to the patients profile, within 4 hours after each collection.Results: Among enrolled patients, 29 (No.1-29) had mild or moderate clinical symptoms and 6 (No.30-35) had severe symptoms. The mean time interval from the sample collection day to diagnosis confirmation day was 9.71±6.50 days (ranged from 3 to 29 days). None of the patients had conjunctivitis. Nineteen out of 35 (54.3%) throat samples presented positive Rt-PCR results. Three (no.13,21,31) out of 35 (8.6%) tear samples presented positive RT-PCR results. Two(no.21, 31) of these three patients were throat swab positive and one (No. 13) was negative. The consistency analysis indicated that tears and throat samples showed poor consistency ( Kappa=-0.009, P=0.9 ).The cycle threshold value (Ct-value) of tears samples collected by sampling swab was significantly higher than that by Schirmer's strip(t=2.288, P=0.03).Conclusion: In spite of the low 2019-nCoV positive detection rate of tear samples from 2019-nCoV infected patients, we cannot fully rule out the transmission by ocular surface. Whether tear testing can be used as an aid in judging of 2019-nCoV infection need further investigation.Authors Ying Yan and Bo Zeng contributed equally to this study

With the merging of cyber world and physical world, event-based social networks have been playing an important role in promoting the spread of offline social events through online channels. Event recommendation in social networks, which is to recommend a list of upcoming events to a user according to his preference, has attracted a lot of research interests recently. In this paper, we study the event recommendation problem based on the graph theory. We first construct a heterogeneous graph to represent the interactions among different types of entities in an event-based social network. Based on the constructed graph, we propose a novel event scoring algorithm called reverse random walk with restart to obtain the userevent recommendation matrix. In practice, the participant capacity of an event may be constrained to a limited number of users. Then based on the userevent recommendation matrix, we further propose two participant scale control algorithms to coordinate unbalanced user arrangements among events. After the rearrangement, each user will be assigned a list of recommended events, which considers both local user preference and global event capacity. Experiment results on Meetup dataset show that the proposed method outperforms the state-of-art algorithms in terms of higher recommendation precision and larger recommendation coverage. Construct a heterogeneous graph for an event based social network.Propose a reverse random walk with restart to compute node proximity on the graph.Propose two algorithms to implement event participant scale control.Conduct experiments to confirm the superiority of the proposed scheme.

Sedation with propofol alone during gastroscopy has many side effects. Etomidate has advantages in terms of circulation and respiration compared to propofol. We hypothesized that etomidate plus propofol during gastroscopy would be more safe and effective than propofol alone. Four hundred (n = 400) patients were randomly divided into a propofol group (P group) and a etomidate plus propofol group (EP group). The P group was given the first dose of 1 % propofol 1 mg/kg before gastroscopy, and the EP group was given 1 % propofol 0.5 mg/kg plus etomidate 0.1 mg/kg. Repeated doses of 10–20 mg propofol or 5–10 mg propofol plus 1–2 mg etomidate were administered to maintain an adequate level of sedation. The sedation depth was maintained by bispectral index value of 40–60. The EP group had a lower incidence of systolic hypotension (13.0 vs. 32.5 %; P

Highlights • The serum levels of IL-6 and CRP have a significant correlation with the severity of COVID-19. • The serum levels of IL-6 and CRP can be used as independent factors to predict disease risk. • The validity of PTC needs to be further investigated., Background The inflammatory response plays a critical role in coronavirus disease 2019 (COVID-19), and inflammatory cytokine storm increases the severity of COVID-19. Objective To investigate the ability of interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin (PCT) to predict mild and severe cases of COVID-19. Study design This retrospective cohort study included 140 patients diagnosed with COVID-19 from January 18, 2020, to March 12, 2020. The study population was divided into two groups according to disease severity: a mild group (MG) (n = 107) and a severe group (SG) (n = 33). Data on demographic characteristics, baseline clinical characteristics, and the levels of IL-6, CRP, and PCT on admission were collected. Results Among the 140 patients, the levels of IL-6, CRP, and PCT increased in 95 (67.9 %), 91 (65.0 %), and 8 (5.7 %) patients on admission, respectively. The proportion of patients with increased IL-6, CRP, and PCT levels was significantly higher in the SG than in the MG. Cox proportional hazard model showed that IL-6 and CRP could be used as independent factors to predict the severity of COVID-19. Furthermore, patients with IL-6 > 32.1 pg/mL or CRP > 41.8 mg/L were more likely to have severe complications. Conclusion The serum levels of IL-6 and CRP can effectively assess disease severity and predict outcome in patients with COVID-19.

Apoptosis and mitochondrial dysfunction are the main cause of neurological injury after cardiopulmonary resuscitation (CPR). However, the effects of distal ischemic treatments on ischemia induced apoptosis are rarely studied, and the mechanism by which mitochondrial dysfunction contributes to CPR still unclear. A rat model of distal ischemia was established by clipping the right femoral artery. Rats were divided into blank, model, pre distal ischemic treatment, per-treatment, and post-treatment groups. Neurological deficit score was scored to evaluate neurologic function after cardiopulmonary resuscitation for 72 hr. We employed TUNEL and flow cytometry to measure the rate of apoptosis of hippocampal neurons, the integrity of mitochondrial membrane and the degree of mitochondrial permeability transition pore (mPTP) opening. The rate of apoptosis rate of hippocampal CA1 neurons in the pre-treatment and post-treatment groups were significantly lower than that of the model group. Moreover, the integrity of the mitochondrial membrane in the pre-treatment and post-treatment groups was higher than that in the model and per- treatment groups. Furthermore, the degree of mPTP opening was lower in the pre-treatment and post-treatment groups than the untreated and per-treatment groups. Taken together, our results show that ischemic preconditioning and post processing can maintain the integrity of mitochondria, perhaps by inhibiting the opening of mPTP, and reducing apoptosis of hippocampal neurons by regulating expression of apoptosis related proteins after CPR, to improve neurological function. This study highlights a novel target pathway for treatment of CPR.

Recently, social event recommendation, which is to recommend a list of upcoming events to a user, has attracted a lot of research interests. In this paper, we first construct a heterogeneous graph to express the interactions among different types of entities in event-based social network. Based on the constructed graph, we propose a novel recommendation algorithm called reverse random walk with restart to obtain the recommended events for each user. Since the participant capacity of an event may be constrained to a limited number of users, we further propose a scale control algorithm to coordinate unbalanced user arrangements among events. Experiment results on Meetup dataset show that the proposed method outperforms the state-of-art algorithms in terms of higher recommendation precision, larger recommendation coverage.

Prolonged pneumoperitoneum has cerebral adverse effects that may delay recovery and cause postoperative cognitive changes. The purpose of this study was to investigate the effect of mannitol infusion after pneumoperitoneum initiation on cerebral oxygen balance and quality of postoperative recovery in patients undergoing prolonged retroperitoneal laparoscopy. Forty patients scheduled for retroperitoneal laparoscopic radical excision of prostatic carcinoma were randomly divided into two groups (n = 20, each) to receive either 0.5 g/kg of 20% mannitol 150 min after the initiation of pneumoperitoneum or an equal volume of 0.9% normal saline. After surgery, time to extubation and recovery time were recorded. The Observer’s Assessment of Alertness/Sedation (OAA/S) scale was used to assess the quality of recovery. The Mini-Mental State Exam (MMSE) was given to test cognitive function preoperatively and at 1, 2, and 3 h after extubation. Blood samples from the jugular bulb and the radial artery were collected for blood gas analysis before CO2 insufflation and at 10, 60, and 180 min after insufflation. In the control group (without mannitol), the difference between arterial and venous oxygen content (CaO2–CvO2) before insufflation (6.21 ± 2.58 mL/dL) was significantly greater than it was 3 h after insufflation (2.63 ± 1.29 mL/dL; p