Comparison of Regression and Machine Learning Methods in Depression Forecasting Among Home-Based Elderly Chinese: A Community Based Study

BackgroundDepression is highly prevalent and considered as the most common psychiatric disorder in home-based elderly, while study on forecasting depression risk in the elderly is still limited. In an endeavor to improve accuracy of depression forecasting, machine learning (ML) approaches have been recommended, in addition to the application of more traditional regression approaches.MethodsA prospective study was employed in home-based elderly Chinese, using baseline (2011) and follow-up (2013) data of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative cohort study. We compared four algorithms, including the regression-based models (logistic regression, lasso, ridge) and ML method (random forest). Model performance was assessed using repeated nested 10-fold cross-validation. As the main measure of predictive performance, we used the area under the receiver operating characteristic curve (AUC).ResultsThe mean AUCs of the four predictive models, logistic regression, lasso, ridge, and random forest, were 0.795, 0.794, 0.794, and 0.769, respectively. The main determinants were life satisfaction, self-reported memory, cognitive ability, ADL (activities of daily living) impairment, CESD-10 score. Life satisfaction increased the odds ratio of a future depression by 128.6% (logistic), 13.8% (lasso), and 13.2% (ridge), and cognitive ability was the most important predictor in random forest.ConclusionsThe three regression-based models and one ML algorithm performed equally well in differentiating between a future depression case and a non-depression case in home-based elderly. When choosing a model, different considerations, however, such as easy operating, might in some instances lead to one model being prioritized over another.

Effect of general and sub-arachnoid anesthesia on the incidence of postoperative delirium and cognitive impairments in elderly Chinese patients

Purpose: To investigate the effect of general and subarachnoid (spinal) anesthesia on the incidence of postoperative delirium and cognitive impairments in elderly Chinese patients. Methods: Elderly Chinese patients (n = 281) aged 65 – 79 years (mean age = 74.12 ± 4.15 years) who underwent proximal femoral fracture surgery were recruited over a 1-year period for this study. The patients were evaluated using neuropsychological assessment battery (NAB) 24 h before surgery, and on the first day 1 month after surgery. Data on activity of daily living (ADL) (in this case toileting at the time of discharge) were recorded and analyzed. Results: There was no significant difference in the number of patients that developed postoperative delirium between the two anesthesia groups (p > 0.05). Although the trail making test (TMT) scores (parts A and B) were increased on the first day 1 month after surgery, there were no significant differences in NAB results between the two groups (p > 0.05). Patients who received subarachnoid (spinal) anesthesia had significantly higher dependency for toileting at the time of discharge than those who received general anesthesia (p < 0.05). Conclusion: These results show that general and subarachnoid (spinal) anesthesia do not cause postoperative delirium and cognitive dysfunction in elderly Chinese patients who underwent proximal femoral fracture surgery.

Ticagrelor Versus Clopidogrel in The Treatment of Elderly Chinese Chronic Total Occlusion Patients Undergoing PCI

Background: Taking thrombosis and bleeding risks into consideration, little real world study data is available to dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in elderly Chinese chronic total occlusion (CTO) patients. Methods: We assigned 504 CTO patients aged ≥75 years who successfully underwent PCI from December 2009 to May 2020. The patients were randomized to Clopidogrel and Ticagrelor group and received DAPT for up to 12 months. Efficacy endpoints were evaluated by major adverse cardiac events (MACE) consisting of all-cause death, nonfatal myocardial infarction (MI) and clinically driven revascularization. The safety endpoints were recorded as the incidence of Bleeding Academic Research Consortium (BARC) bleeding. Results: Patients in Clopidogrel group were older, they had a higher percentage of BMI, diastolic blood pressure and HDL-C than those in Ticagrelor group. Clopidogrel group had a lower percentage of hyperlipidemia, prior PCI, glucose, TG and LDL-C. No significant difference was found as to the Angiographic and procedural characteristics (P＞0.05 for all). After 12 months' follow-up, the incidence of MACE (12.19% vs. 11.04%, P=0.763) and bleeding (9.38% vs. 13.64%, P=0.205) had no significant difference. After clinical characteristics balanced matching by IPTWs model, we found that Ticagrelor had an unfavorable effect on reducing the incidence of bleeding with the IPTWs model (IPTW-OR, 1.81, 95% CI: 1.18-2.76, P=0.006). Conclusions: This clinical study demonstrated that Clopidogrel should be recommended to elderly CTO patients after PCI, especially those with a high bleeding risk. Trial registration: The study protocol was approved by the Ethics Committee of Air Force Medical University (KY20172019-1).

Association Among Calf Circumference, Physical Performance, and Depression in the Elderly Chinese Population: A Cross-Sectional Study

Background: Depression and sarcopenia are common diseases in the elderly population. However, the association between them is controversial. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database, a cross-sectional study was conducted to explore the relationship between calf circumference, physical performance, and depression.Methods: From the 8th wave of CLHLS conducted in 2018, data on calf circumference, physical performance, depressive symptoms, and demographic, socioeconomic, and health-related characteristics were collected. A statistical analysis was conducted to explore the relationship between calf circumference, physical performance, and depressive symptoms. Confounding factors were adjusted for in the multiple logistic regression analysis.Results: A total of 12,227 participants, including 5689 (46.5%) men and 6538 (53.5%) women (mean age, 83.4 years), were included in this study. After adjusting for confounding factors, the association between calf circumference and depression disappeared (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 0.92–1.17, p = 0.58). However, a significant inverse correlation persisted between physical performance and depressive symptoms (OR = 1.16, 95% CI: 1.13–1.20, p＜0.001). The subgroup analysis revealed a significant association of calf circumference (OR = 1.3, 95% CI: 1.04–1.62, p = 0.02) and physical performance (OR = 1.15, 95% CI: 1.08–1.22, p < 0.001) with depression in the regular exercise group.Conclusions: Physical performance was significantly associated with depression in the elderly Chinese population. Attention should be paid to assess depressive symptoms in patients with poor muscle condition.

Solitary multicystic lesion lung cancer: two case reports and review of the literature

Background Lung cancer associated with cystic airspaces, especially solitary multicystic lesion lung cancer, is a rare disease (a rare imaging performance of non-small cell lung cancer). It is difficult to diagnose owing to the lack of a clear definition; therefore, diagnosis of these neoplastic lesions remains challenging. Case presentation We outlined two cases of elderly Chinese men who were admitted to the hospital with a solitary multicystic lesion of the lung and subsequent surgical resection, confirming a diagnosis of adenocarcinoma. Conclusions For solitary pulmonary cystic airspaces (especially solitary multicystic lung lesions), it is important to properly recognise their imaging features. Due to the possibility of malignancies, timely surgery is an effective treatment strategy for early diagnosis.