Yaxiong Gao,1 Tiansheng Bu21Department of Acupuncture and Tuina, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, 730000, People’s Republic of China; 2Department of Traditional Chinese Medicine, The First People’s Hospital of Baiyin City, Baiyin, Gansu, 730900, People’s Republic of ChinaCorrespondence: Tiansheng Bu, Department of Traditional Chinese Medicine, The First People’s Hospital of Baiyin City, Baiyin, Gansu, 730900, People’s Republic of China, Email 18009439561@163.comAbstract: Quadriceps weakness is a major determinant of disability in knee osteoarthritis (KOA), particularly in later life, yet weakness often exceeds the loss of muscle size. This discrepancy is clinically important because joint-derived activation failure occurs against a background of declining neuromuscular and regenerative reserve. We critically examine an evidence-bounded joint–afferent–motor unit framework in which abnormal afferent input from the diseased knee reduces effective neural drive through arthrogenic muscle inhibition (AMI). Persistent under-recruitment may be associated with altered motor-unit behavior and loading, impaired muscle quality, and greater reliance on compensatory reinnervation. We deliberately distinguish demonstrated human observations from provisional transitions and hypothesis-generating mechanistic extensions. Human evidence supports AMI and impaired muscle quality and provides preliminary cross-sectional evidence of altered motor-unit behavior; however, human studies have not established a temporal sequence from persistent AMI to motor-unit remodeling or denervation–reinnervation. Direct KOA-related neuromuscular junction (NMJ) evidence remains predominantly preclinical, and progressive NMJ degeneration has not been demonstrated in humans with KOA. Aging, sex, obesity, diabetes, systemic inflammation, pain sensitization, inactivity, and other comorbidities are treated as effect modifiers and competing explanations rather than proof of causation. We propose a testable, multimodal validation strategy combining joint imaging, standardized voluntary-activation testing, neurophysiology, high-density electromyography, motor-unit-number estimation, muscle imaging, and, when justified, tissue-level NMJ phenotyping. For older adults, the practical implication is mechanism-directed care: restore joint-related activation when inhibition dominates, use neural augmentation to enable adequate loading, address muscle-quality and metabolic constraints when present, and reserve NMJ-directed interventions for future human subgroups defined by convergent structural and physiological evidence.Keywords: knee osteoarthritis, arthrogenic muscle inhibition, motor unit, neuromuscular junction, aging, muscle quality
Mei Wu,1 Chunli Zhang,2 Yongmei Wang,3 Yuan Zhao41School of Nursing, Dali University, Dali, Yunnan, People’s Republic of China; 2Department of Rehabilitation, Eryuan County People’s Hospital of Dali Prefecture, Dali, Yunnan, People’s Republic of China; 3Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Dali University, Dali, Yunnan, People’s Republic of China; 4School of Public Health, Dali University, Dali, Yunnan, People’s Republic of ChinaCorrespondence: Yuan Zhao, School of Public Health, Dali University, No. 22, Wanhua Road, Dali, Yunnan, 671000, People’s Republic of China, Tel +86-15877750880, Email zy750880@163.comAbstract: With the acceleration of population aging and the progressive decline in physiological function, older adults with diabetes frequently present with multiple chronic conditions. This not only increases the complexity of clinical management but also adversely affects disease prognosis, quality of life, and the efficient allocation of healthcare resources. Traditional single-disease-centered management models are increasingly inadequate for addressing the complex and heterogeneous healthcare needs of these patients. Consequently, there is an urgent need to shift toward personalized and integrated management strategies guided by patients’ overall health status and functional needs. A literature search was conducted in PubMed and Web of Science for studies published from 2014 to 2026, using combinations of keywords related to diabetes, older adults, multimorbidity, comorbidity, polypharmacy, comprehensive geriatric assessment, and multidisciplinary management. Inclusion criteria encompassed original studies, clinical trials, systematic reviews, meta-analyses, clinical guidelines, and consensus statements focusing on multimorbidity and its management in older adults with diabetes. Studies unrelated to the target population or research topic were excluded. The available evidence indicates that multimorbidity in older adults with diabetes is characterized by complex interactions across multiple organ systems and presents substantial challenges in therapeutic decision-making, polypharmacy, and treatment adherence. Comprehensive geriatric assessment, individualized treatment targets, shared decision-making, medication optimization and deintensification, and multidisciplinary collaboration represent important approaches to addressing these challenges. Emerging technologies, including real-time continuous glucose monitoring, electronic health records, digital health platforms, and integrated data analytics, may further facilitate dynamic risk monitoring, coordinated decision-making, and continuity of care. Overall, management should progressively shift from a disease-centered paradigm toward personalized, integrated, and function-oriented care, with greater emphasis on preserving functional independence, minimizing treatment burden, and improving quality of life in older adults with diabetes and multimorbidity.Keywords: older adults with diabetes, multimorbidity, diabetes management, chronic disease management, personalized care
Xiaoxiao Yan,1 Tingting Zhang,2 Mian Lin21Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 2Department of Orthopedics, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of ChinaCorrespondence: Mian Lin, Email 13858753895@163.comObjective: This study evaluated the associations of the preoperative systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) with postoperative delirium (POD) and assessed whether adding these biomarkers to baseline clinical factors improved discrimination in older patients undergoing proximal femoral nail antirotation (PFNA) for intertrochanteric fractures.Methods: This retrospective cohort study included 346 patients aged ≥ 60 years (mean age, 79.30 ± 8.16 years), comprising 233 women (67.3%) and 113 men (32.7%), who underwent PFNA for intertrochanteric fractures. Multivariable logistic regression was used to evaluate the associations of SII and PNI with POD. A baseline clinical model incorporating age, smoking, alcohol consumption, chronic obstructive pulmonary disease, and previous stroke was compared with models incorporating SII, PNI, or both biomarkers. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC), and AUCs were compared using the DeLong test. An exploratory nomogram was developed from the combined model.Results: Postoperative delirium (POD) occurred in 78 patients (22.54%). In the primary linear model, each 100-unit increase in systemic immune-inflammation index (SII) was associated with higher odds of POD (adjusted odds ratio [OR], 1.054; 95% confidence interval [CI], 1.011– 1.100; P = 0.014), whereas each one-unit increase in prognostic nutritional index (PNI)was associated with lower odds of POD (adjusted OR, 0.929; 95% CI, 0.869– 0.994; P = 0.033). The baseline model yielded an AUC of 0.733 (95% CI, 0.666– 0.799). Adding SII increased the AUC to 0.776 (95% CI, 0.716– 0.836; ΔAUC, 0.043; DeLong P = 0.003), whereas adding PNI increased the AUC to 0.763 (95% CI, 0.704– 0.822; ΔAUC, 0.030; DeLong P = 0.016). The combined model yielded an AUC of 0.788 (95% CI, 0.732– 0.843; ΔAUC, 0.055; DeLong P = 0.001).Conclusions: Higher SII and lower PNI were associated with POD in older patients undergoing PFNA for intertrochanteric fractures. Although adding these biomarkers produced statistically significant improvements in discrimination, the absolute improvements were modest, and the combined model retained only moderate discriminative performance. The model should therefore be considered exploratory and requires external validation before clinical implementation.Keywords: hip fracture, intertrochanteric fracture, postoperative delirium, systemic immune-inflammation index, prognostic nutritional index, risk prediction
Chensong Yang,1 Mingchong Liu,1 Zhibang Zhao,2 Cong Lv,1 Yutao Pan,1 Guixin Sun,1 Feng Yin31Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China; 2Emergency Trauma Center, Nanyang Second People’s Hospital, Nanyang, Henan, People’s Republic of China; 3Department of Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of ChinaCorrespondence: Guixin Sun, Email sunguixin@tongji.edu.cn; Feng Yin, Email 001yinfeng@sina.comObjective: To evaluate the prognostic utility of LE8 and LC9 for mortality and functional recovery following hip fracture surgery.Methods: This multicenter prospective cohort study enrolled 1796 patients aged 50 years or older who underwent surgical treatment for hip fracture at two tertiary medical institutions in China between January 2017 and December 2022. Patients were followed for 1 year post-surgery. LE8 and LC9 were calculated on the first day after admission. Discriminative performance was assessed using receiver operating characteristic curve analysis; independent prognostic value was determined using multivariable Cox proportional hazards and logistic regression models.Results: Among 1796 participants, 311 deaths (17.3%) occurred during 1-year follow-up. LC9 demonstrated superior predictive accuracy compared with LE8 for 1-year mortality and free walking ability. Patients with low LE8 and LC9 experienced dramatically elevated 1-year mortality rates and markedly reduced functional recovery. In multivariable analyses, increase in both LE8 and LC9 related to significant mortality risk reduction and improved functional recovery, independent of age, comorbidity burden, and surgical factors.Conclusions: In this multicenter prospective cohort study, LC9 was independently associated with mortality and functional recovery and demonstrated greater discriminative performance than LE8, with psychological health assessment providing critical incremental value. Integration of LC9 into clinical practice may enhance risk stratification and inform targeted perioperative interventions for this vulnerable population.Keywords: hip fracture, life’s essential 8, life’s crucial 9, outcome, multicenter study
