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Song W, La Fontaine J, Shibuya N, Prochaska J, Jupiter DC. The Effect of Limb Salvage Efforts in Different Age Groups: Relationships Between Major and Minor Amputations. J Foot Ankle Surg 2024; 63:380-385. [PMID: 38266807 DOI: 10.1053/j.jfas.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/14/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
"Limb salvage" efforts, such as performing minor amputations before infections spread proximally from the foot to decrease major lower extremity amputation, are an important part of healthcare today. It is unclear whether these efforts are preventing the number of major amputations and improving patients' quality of life and the cost-effectiveness of the U.S. healthcare system. Rates of non-traumatic lower extremity amputation (NLEA) among patients with diabetes decreased in the early 2000s but rebounded in the 2010s. We analyzed the proportion of major amputations and differences in amputation rates between age groups in Texas. Patient data was extracted from the Texas Hospital Discharge Data Public Use Data File. Population estimates were obtained from the Texas Population Estimates Program from 2011 to 2015 and from intercensal estimates provided by the U.S. Census Bureau from 2006 to 2010. Raw numbers of minor, major, and all NLEA surgeries and the ratio of major amputations to total amputations per year were reported for each age group. Poisson regression and Joinpoint analyses were performed to capture these changes in trends. Rates of amputations increased, with significant decreasing relative prevalence of major amputations. Patients aged 45 to 64 with diabetes are likely driving these increases. Rates of lower extremity amputation in patients with diabetes increased from 2009 to 2015. This holds for all and minor amputations. In contrast, the ratio of major to all amputations decreased from 2010. Utilization of major and minor amputation differs between age groups, remaining stable in the youngest subjects, with minor amputation rates increasing in those aged 45 to 64.
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Affiliation(s)
- Wenye Song
- Graduate School of Biomedical Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Javier La Fontaine
- University of Texas Rio Grande Valley, School of Podiatric Medicine, Edinburg, TX
| | - Naohiro Shibuya
- Texas A&M University, College of Medicine, Temple, TX; Section of Podiatry, Surgical Services, Central Texas Veterans Affairs Health Care System, Temple, TX.
| | - John Prochaska
- Department of Population Health and Health Disparities, The University of Texas Medical Branch, Galveston, TX
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX; Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
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Maezawa Y, Taguchi M, Kawakami T, Inui T, Okauchi S, Numata T, Shiozawa T, Miyazaki K, Nakamura R, Iguchi K, Endo T, Sakamoto T, Satoh H, Hizawa N. Patient Age and EGFR-positive Non-small Cell Lung Cancer: A Multicenter Retrospective Study. Anticancer Res 2024; 44:1751-1757. [PMID: 38537995 DOI: 10.21873/anticanres.16974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIM The median age of subjects in many clinical trials of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor conducted to date has been approximately 60 years. However, it is not uncommon to encounter EGFR gene-positive patients in their 70s or 80s. Based on information obtained from these clinical trials, EGFR gene-positive non-small cell lung cancer (NSCLC) patients are considered to be younger than EGFR-negative patients. In this study, we analyzed clinical data to identify whether this assumption is true. PATIENTS AND METHODS We retrospectively reviewed the medical records of NSCLC patients diagnosed in a multicenter clinical practice from 2009 to 2023. Patients included all cases of non-advanced and advanced NSCLC. RESULTS Information on 2,540 patients, including 605 EGFR gene-positive patients, was collected. The median age of EGFR-positive and EGFR-negative patients was 72 years and 71 years, respectively, and there was no significant difference in the age of patients between these two groups (p=0.7887). The most common age in these two groups was 70 years. Among the EGFR gene subtypes, the frequency of exon 19 deletion decreased with age, whereas that of EGFR L858R increased. CONCLUSION Patients in their 70s and 80s with non-small cell lung cancer were relatively frequently EGFR gene-positive. To avoid missing out on treatment opportunities, EGFR gene testing should also be performed on patients in this age group.
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Affiliation(s)
- Yosuke Maezawa
- Divisions of Respiratory Medicine and Thoracic Surgery, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Manato Taguchi
- Division of Respiratory Medicine, Kobari General Hospital, Noda, Japan
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takeshi Kawakami
- Division of Respiratory Medicine, Kobari General Hospital, Noda, Japan
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshihide Inui
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Division of Respiratory Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Shinichiro Okauchi
- Divisions of Respiratory Medicine and Thoracic Surgery, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Takeshi Numata
- Departments of Respiratory Medicine and Surgery, National Hospital Organization Mito Medical Center, Ibarakimachi, Japan
| | - Toshihiro Shiozawa
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kunihiko Miyazaki
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Ryota Nakamura
- Departments of Respiratory Medicine and Surgery, National Hospital Organization Mito Medical Center, Ibarakimachi, Japan
| | - Kesato Iguchi
- Divisions of Respiratory Medicine and Thoracic Surgery, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Takeo Endo
- Departments of Respiratory Medicine and Surgery, National Hospital Organization Mito Medical Center, Ibarakimachi, Japan
| | - Tohru Sakamoto
- Division of Respiratory Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Hiroaki Satoh
- Divisions of Respiratory Medicine and Thoracic Surgery, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan;
| | - Nobuyuki Hizawa
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Yazdanpanah Ghadikolaei P, Ghaleno LR, Vesali S, Janzamin E, Gilani MAS, Sajadi H, Dizaj AVT, Shahverdi A, Drevet JR, Moghadam Masouleh AA. Epidemiology of sperm DNA fragmentation in a retrospective cohort of 1191 men. Andrology 2023; 11:1663-1672. [PMID: 37280171 DOI: 10.1111/andr.13472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/11/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND The scientific and clinical communities now recognize that sperm DNA integrity is crucial for successful fertilization, good embryo development, and offspring quality of life. Despite the apparent unanimity, this criterion is rarely evaluated in clinical practice. We evaluated the sperm DNA fragmentation index of nearly 1200 sperm samples and its connections based on the patient's age, body mass index, the season of sperm collection, geographical location, medical history, and addictive behaviors. METHODS A cohort of 1503 patients who were referred to the Royan Institute between July 2018 and March 2020 was examined. Only 1191 patient records with demographic data, complete semen analysis, and DNA fragmentation index measurements were included in the final cohort. Documents were classified, incorporated into statistical models, and analyzed. RESULTS The results confirmed previous findings that the sperm DNA fragmentation index was significantly higher in aging men. The sperm DNA fragmentation index and high DNA stainability levels were significantly higher in spring and summer samples than in those of other seasons. No correlation was found between semen DNA fragmentation index and patient body mass index, although the study cohort was significantly overweight. Contrary to what might be expected, we observed that the sperm DNA fragmentation index was higher in rural than in urban patients. Intriguingly, epileptic patients exhibited significantly higher sperm DNA fragmentation index levels. DISCUSSION AND CONCLUSION Age is the factor that is most strongly associated with sperm DNA fragmentation index levels. Our analysis of 1191 samples indicates that between the ages of 19 and 59, the sperm DNA fragmentation index increases by an average of 2% each year. Intriguingly, from an epidemiological perspective, the warm season (spring/summer) is associated with a higher sperm DNA fragmentation index in the study population, possibly due to the deleterious effect of temperature on sperm quality. Some neurological diseases, such as epilepsy, are associated with decreased sperm DNA integrity. This observation could be related to the iatrogenic effects of associated therapies. In the study cohort, body mass index did not appear to be correlated with the DNA fragmentation index.
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Affiliation(s)
- Parisa Yazdanpanah Ghadikolaei
- Department of Molecular and Cellular Biology, Faculty of Basic Sciences and Advanced Technologies in Biology, University of Science and Culture, Tehran, Iran
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Leila Rashki Ghaleno
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Samira Vesali
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ehsan Janzamin
- SABA Biomedical Science -Based Company, Tehran, Iran
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hesamoddin Sajadi
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ahmad Vosough Taghi Dizaj
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Abdolhossein Shahverdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Joël R Drevet
- Faculty of Medicine, GReD Institute, Clermont-Ferrand, France
| | - AliReza Alizadeh Moghadam Masouleh
- Department of Molecular and Cellular Biology, Faculty of Basic Sciences and Advanced Technologies in Biology, University of Science and Culture, Tehran, Iran
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Gyn-medicum, Center for Reproductive Medicine, Göttingen, Germany
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen, Germany
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Eto HC, Miranda F, Rios D, Honório HM, Janson G, Massaro C, Garib D. Erosive Tooth Wear in Subjects with Normal Occlusion: A Pioneering Longitudinal Study up to the Age of 60. J Clin Med 2023; 12:6318. [PMID: 37834962 PMCID: PMC10573230 DOI: 10.3390/jcm12196318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
The aim of this study was to assess the erosive tooth wear (ETW) at early and mature adulthood in subjects with natural normal occlusion. The sample consisted of 23 untreated subjects with normal occlusion. Dental models were taken longitudinally from the same subjects at 13 (T0), 17 (T1) and 60.9 years of age (T2) at a university. Evaluation of ETW was performed using a modified Basic Erosive Wear Examination (BEWE) index. Interphase changes were evaluated using Friedman and Dunn's test. Ordinal logistic regression was used to assess the influence of sex, dental arch, tooth and dental surfaces on the erosive tooth wear. Linear regression was used to evaluate whether the ETW degree at T1 could discriminate the degree of ETW at T2. The significance level adopted was 5%. ETW showed a significant increase with aging. The median ETW index at T0, T1 and T2 was 2, 4 and 7, respectively. ETW was greater in males in the incisors and canines and on the incisal/occlusal and lingual tooth surfaces. No significant differences were found between the maxillary and mandibular arches. Subjects with severe ETW at mature adulthood had greater tooth wear at age 17. In conclusion, ETW significantly increased during aging in subjects with normal occlusion. The greater the degree of tooth wear at early adulthood, the greater the tooth wear at mature adulthood. Preventive care should be recommended during early adulthood in patients demonstrating erosive tooth wear in order to avoid worsening with aging.
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Affiliation(s)
- Henrique Campos Eto
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru Dental School, University of São Paulo, Bauru 17012-901, SP, Brazil
| | - Felicia Miranda
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru Dental School, University of São Paulo, Bauru 17012-901, SP, Brazil
| | - Daniela Rios
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru Dental School, University of São Paulo, Bauru 17012-901, SP, Brazil
| | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru Dental School, University of São Paulo, Bauru 17012-901, SP, Brazil
| | - Guilherme Janson
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru Dental School, University of São Paulo, Bauru 17012-901, SP, Brazil
| | - Camila Massaro
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru Dental School, University of São Paulo, Bauru 17012-901, SP, Brazil
| | - Daniela Garib
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru Dental School, University of São Paulo, Bauru 17012-901, SP, Brazil
- Department of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru 17012-900, SP, Brazil
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Šefeldaitė S, Mitalauskienė A, Trakinienė G, Vasiliauskas A, Lopatienė K, Venskutonis T. Correlation Between Third Molar Mineralization and Midpalatal Suture Maturity: A Cone Beam Computed Tomography Study. Med Sci Monit 2023; 29:e940539. [PMID: 37598290 PMCID: PMC10448776 DOI: 10.12659/msm.940539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/01/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Midpalatal suture ossification varies in patients of different ages, which can lead to making inaccurate presumptions when considering effective treatment timing based on chronological age. Chronological age provides only general information, whereas dental development correlates with skeletal growth, which suggests that tooth mineralization could be considered to be a precise criterion for determining the midpalatal suture's maturity. The present study was conducted to investigate the association between third-molar mineralization and midpalatal suture's maturation stages using cone-beam computed tomography (CBCT) images. MATERIAL AND METHODS The study involved 97 CBCT images of patients aged 8-37 years with normal growth and development. Subjects with cleft lip and palate, caries treatment, or present cavities in the third molars were not included in the study. The stages of midpalatal suture ossification were evaluated according to the protocol suggested by Angelieri et al, and the third-molar mineralization degree was measured by the Demirjian index. Statistical analysis was performed to evaluate correlations between the variables. RESULTS Patients with advanced third-molar mineralization stages were found to have greater midpalatal suture maturity. A statistically significant positive correlation was found between the stages of third-molar mineralization and midpalatal suture maturation (R=0.814, P<0.01). Third-molar development was also found to be associated with chronological age (R=0.883, P<0.01). CONCLUSIONS A measure of third-molar mineralization does not allow for accurate determination of the midpalatal suture maturation stage.
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Affiliation(s)
- Simona Šefeldaitė
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Austėja Mitalauskienė
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Giedrė Trakinienė
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arunas Vasiliauskas
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristina Lopatienė
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tadas Venskutonis
- Department of Dental and Oral Pathology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Barbieri V, Piccoliori G, Mahlknecht A, Plagg B, Ausserhofer D, Engl A, Wiedermann CJ. Adolescent Mental Health during the COVID-19 Pandemic: The Interplay of Age, Gender, and Mental Health Outcomes in Two Consecutive Cross-Sectional Surveys in Northern Italy. Behav Sci (Basel) 2023; 13:643. [PMID: 37622783 PMCID: PMC10451173 DOI: 10.3390/bs13080643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the mental health and well-being of adolescents. This study aimed to investigate the development of health-related quality of life (HRQoL) and mental health among adolescents in Northern Italy by comparing cross-sectional surveys conducted in 2021 and 2022, with a particular focus on the influence of age and gender. The sample included adolescents aged 11-19 years from public schools in South Tyrol. Validated psychometric instruments were used to assess HRQoL, anxiety and depression symptoms, and psychosomatic complaints. Sociodemographic variables, COVID-19 burden, and pandemic-related factors were measured. Statistical analyses included chi-square tests, correlation coefficients, and logistic regression analyses. The results indicated that while the self-reported burden of adolescents decreased significantly in 2022 (n = 1885) compared to 2021 (n = 1760), there were no significant differences in symptoms of anxiety, depressive symptoms, low HRQoL, and increased psychosomatic complaints between the two surveys for both early and late adolescents. Females consistently had higher percentages for all outcome variables, and symptoms of anxiety increased with age in females, but not in males. Both genders experienced an increase in depressive symptoms and low HRQoL with age. The co-occurrence of mental health outcomes was observed, suggesting overlapping patterns among anxiety, depression, low HRQoL, and psychosomatic complaints. These findings underscore the intricate relationship between age, gender, and mental health outcomes among adolescents during the pandemic. It is important to recognize that late adolescents may exhibit distinct vulnerabilities and may require tailored support approaches to address their specific mental health challenges, differing from those needed for early adolescents.
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Affiliation(s)
- Verena Barbieri
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
| | - Angelika Mahlknecht
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
| | - Barbara Plagg
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
- Faculty of Education, Free University of Bolzano, 39100 Bolzano, Italy
| | - Dietmar Ausserhofer
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
| | - Adolf Engl
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
| | - Christian J. Wiedermann
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.E.)
- Department of Public Health, Medical Decision Making and Health Technology Assessment, University of Health Sciences, Medical Informatics and Technology—Tyrol, 6060 Hall, Austria
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Gahl S. Bilingualism as a risk factor for false reports of stuttering in the Early Childhood Longitudinal Study (ECLS-K:2011). Front Psychol 2023; 14:1155895. [PMID: 37546483 PMCID: PMC10399746 DOI: 10.3389/fpsyg.2023.1155895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Bilingualism has historically been claimed to be a risk factor for developmental stuttering. The Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011) ostensibly contains evidence to test that claim. Methods We analyze data from monolingual and bilingual children in Kindergarten through fifth grade in the ECLS-K:2011. Results and discussion The prevalence, male/female ratio, and onset and recovery of reported stuttering in the ECLS are inconsistent with widely-accepted clinical reports of stuttering. We argue that the reported figures may be misleading. We discuss some factors that may inflate the reported prevalence, including a lack of awareness of the difference between stuttering vs. normal disfluencies, and the informal usage of the word "stuttering" on the part of teachers and parents to describe typical disfluencies.
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Słowińska M, Czarnecka I, Czarnecki R, Tatara P, Nasierowska-Guttmejer A, Lorent M, Cierniak S, Owczarek W. Clinical, Dermoscopic, and Histological Characteristics of Melanoma Patients According to the Age Groups: A Retrospective Observational Study. Life (Basel) 2023; 13:1369. [PMID: 37374151 DOI: 10.3390/life13061369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/27/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Although the role of melanoma risk factors is well documented, their correlation with patients' age is less frequently analyzed. METHOD The analysis was performed among 189 melanoma patients in different age groups, including <30 years, 31-60 years, and >60 years, to investigate the risk factors, topography, and coexistence of morphological features of 209 melanomas (dermoscopic and histopathological). RESULTS Among the youngest age group, no correlation with the presence of estimated risk factors was found. The most common dermoscopic pattern was spitzoid and multicomponent asymmetric. The group of middle-aged patients was the most diverse in terms of the occurrence of risk factors, solar lentiginosis, dermoscopic patterns, topography, histological subtypes, and invasiveness of melanomas. The oldest group characterized a strong correlation between solar lentiginosis, NMSC comorbidity, the prevalence of facial melanomas, the dermoscopic pattern of melanoma arising on chronic sun-damaged skin, and regression. CONCLUSION The findings regarding the presence of age-specific features in melanoma patients, especially in the youngest and middle-aged groups, might be helpful for clinicians and to target secondary prevention efforts.
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Affiliation(s)
- Monika Słowińska
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
- Evimed Medical Centre Ltd., Private Dermatologic Practice, JP Woronicza 16, 02-625 Warsaw, Poland
| | - Iwona Czarnecka
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Robert Czarnecki
- Department of Cardiology, LUX MED Oncology, Limited Liability Company, St. Elizabeth Hospital, Goszczynskiego 1, 02-616 Warsaw, Poland
| | - Paulina Tatara
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Anna Nasierowska-Guttmejer
- Department of Pathomorphology, Central Clinical Hospital of Ministry of Interior and Administration-National Medical Institute, Woloska 137, 02-507 Warsaw, Poland
- Faculty of Medicine, Lazarski University, Swieradowska 43, 02-662 Warsaw, Poland
| | - Małgorzata Lorent
- Department of Pathomorphology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Szczepan Cierniak
- Department of Pathomorphology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Witold Owczarek
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
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Cheng E, Shamavonian R, Mui J, Hayler R, Karpes J, Wijayawardana R, Barat S, Ahmadi N, Morris DL. Overall survival and morbidity are not associated with advanced age for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience. Pleura Peritoneum 2023; 8:83-90. [PMID: 37304160 PMCID: PMC10249755 DOI: 10.1515/pp-2022-0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/18/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has enabled better prognosis for patients with peritoneal surface malignancies. However, in older age groups, short -and long-term outcomes are still perceived as poor. We evaluated patients aged 70 and over and determine if age is a predictor of morbidity, mortality and overall survival (OS). Methods A retrospective cohort analysis was performed on CRS/HIPEC patients and categorised by age. The primary outcome was overall survival. Secondary outcomes included morbidity, mortality, hospital and incentive care unit (ICU) stay and early postoperative intraperitoneal chemotherapy (EPIC). Results A total of 1,129 patients were identified with 134 aged 70+ and 935 under 70. There was no difference in OS (p=0.175) or major morbidity (p=0.051). Advanced age was associated with higher mortality (4.48 vs. 1.11 %, p=0.010), longer ICU stay (p<0.001) and longer hospitalisation (p<0.001). The older group was less likely to achieve complete cytoreduction (61.2 vs. 73 %, p=0.004) and receive EPIC (23.9 vs. 32.7 %, p=0.040). Conclusions In patients undergoing CRS/HIPEC, age of 70 and above does not impact OS or major morbidity but is associated with increased mortality. Age alone should not be a limiting factor in selecting CRS/HIPEC patients. Careful multi-disciplinary approach is needed when considering those of advanced age.
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Affiliation(s)
- Ernest Cheng
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Raphael Shamavonian
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - Jasmine Mui
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Raymond Hayler
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Josh Karpes
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Ruwanthi Wijayawardana
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - Shoma Barat
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - Nima Ahmadi
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - David L. Morris
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
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10
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Jimenez HR, Bover Manderski MT, Natali KM, Boachie N, Suh JS. Prevalence of Comorbidities and Polypharmacy in a Historically Minoritized Community and Their Impact on Virologic Suppression in Persons with HIV. AIDS Patient Care STDS 2023; 37:297-305. [PMID: 37294281 DOI: 10.1089/apc.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Improved life expectancy from advances in antiretroviral therapy (ART) has been followed by a rise in comorbidities and polypharmacy in this aging population. Historically, polypharmacy has been associated with suboptimal virologic outcomes in persons with HIV, although data in the current ART era and among historically marginalized populations in the United States are limited. We measured the prevalence of comorbidities and polypharmacy, evaluating their impact on virologic suppression. This retrospective IRB-approved cross-sectional study reviewed health records of adults with HIV on ART and receiving care (≥2 visits) in 2019 at a single center in a historically minoritized community. Virologic suppression (HIV RNA <200 copies/mL) based on polypharmacy (≥5 non-HIV medications) or multimorbidity (≥2 chronic conditions) was evaluated. Logistic regression analyses were performed to identify factors associated with virologic suppression, with age, race/ethnicity, and CD4 < 200 cells/mm3 as covariates. Of the 963 individuals that met the criteria, 67%, 47%, and 34% had ≥1 comorbidity, multimorbidity, and polypharmacy, respectively. The cohort demographics were: mean of 49 years (range, 18-81), 40% cisgender women, 46% Latinx individuals, 45% Black individuals, 8% White individuals. Virologic suppression rates were 95% among patients with polypharmacy compared with 86% in those with a lower pill burden (p = 0.0001). The odds of virologic success were higher for individuals with polypharmacy [adjusted odds ratio, aOR = 2.3 (95% confidence interval, CI: 1.2-4.4)] and Latinx identity [aOR = 2.4 (95% CI: 1.5-3.8)], but lower if a CD4 count <200 cells/mm3 [aOR = 0.07 (95% CI: 0.04-0.1)]. The comorbidity burden was higher than previously described, which are driving polypharmacy rates. In the current ART era, polypharmacy is not inherently associated with worse virologic outcomes.
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Affiliation(s)
- Humberto R Jimenez
- Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
| | | | - Kayla M Natali
- Department of Pharmacy, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Naana Boachie
- Department of Pharmacy, Parkview Health, Fort Wayne, Indiana, USA
| | - Jin S Suh
- Division of Infectious Diseases, St. Joseph's University Medical Center, Paterson, New Jersey, USA
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11
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Valladales-Restrepo LF, Velasquez-Quimara S, Machado-Alba JE. Pharmacological Treatment of Herpes Zoster and Factors Associated with Its Recurrence. Antibiotics (Basel) 2023; 12:antibiotics12040757. [PMID: 37107118 PMCID: PMC10135046 DOI: 10.3390/antibiotics12040757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
The burden of herpes zoster disease is significant worldwide, with millions affected and an increasing incidence. Increased age and immunosuppression due to disease or drugs have been related to its recurrence. The aim of this work was to determine the pharmacological management of herpes zoster and identify factors associated with recurrence, representing a longitudinal retrospective study identifying the pharmacological management of patients with herpes zoster and the factors related to the first recurrence using a population database. Follow-up was carried out for up to 2 years, and descriptive analysis and Cox proportional hazards regression were performed. A total of 2978 patients with herpes zoster were identified, with a median age of 58.9 years and 65.2% being women. The treatment mainly involved acyclovir (98.3%), acetaminophen (36.0%), and non-steroidal anti-inflammatory drugs (33.9%). A total of 2.3% of patients had a first recurrence. Corticosteroids were used in a greater proportion for recurrence than for the initial herpes episode (18.8% vs. 9.8%, respectively). Being female (HR:2.68;95%CI:1.39-5.17), age ≥60 years (HR:1.74;95%CI:1.02-2.96), having liver cirrhosis (HR:7.10;95%CI:1.69-29.80), and having hypothyroidism (HR:1.99;95%CI:1.16-3.40) were associated with greater probability of a first recurrence. The vast majority of patients were managed with acyclovir, and the use of acetaminophen or non-steroidal anti-inflammatory drugs for pain management was frequent. Several conditions were found that increased the probability of presenting a first recurrence of herpes zoster, such as age over 60 years, being a woman, suffering from hypothyroidism, and liver cirrhosis.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira 660003, Colombia
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia
| | - Santiago Velasquez-Quimara
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira 660003, Colombia
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12
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Tal O, Ben Shem E, Peled O, Elyashiv O, Levy T. Age Disparities in End of Life Symptom Management Among Patients with Epithelial Ovarian Cancer. J Palliat Care 2023; 38:184-191. [PMID: 35225068 DOI: 10.1177/08258597221083418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the symptoms of women with epithelial ovarian cancer (EOC) during their last admission before death and analyze invasive palliative management administered in relation to symptom control and survival. MATERIALS & METHODS A retrospective review of Israeli patients with EOC, primary peritoneal cancer (PPC) and tubal cancer, admitted to our department prior to death between 2008-2018. Basic palliative treatment was defined as administration of IV fluids, analgesics, oxygen, antiemetics, antibiotics and/or blood transfusions. Procedures regarded as invasive included: peritoneal or pleural fluid drainage; placement of an indwelling catheter, administration of total parenteral nutrition (TPN), chemotherapy and ventilation. RESULTS 82 patients were included. Most suffered from weakness and fatigue, gastrointestinal complaints, pain and shortness of breath. 34 patients (41.5%) required only basic palliative treatment to alleviate their symptoms; however, in 48 patients (58.5%) invasive interventions were needed. Patients treated with invasive procedures were younger at death by almost 9 years (mean age of 65.73 ± 9.5 vs. 74.78 ± 9.8; p = 0.001). There were significantly more women with platinum sensitive disease in the invasive interventions group compared to the basic palliative care (60.42% vs. 32.35%; p = 0.012). No survival difference was found between the groups from diagnosis to death, relapse to death, last chemotherapy to death and last admission to death. CONCLUSIONS EOC patients suffer from high disease burden and multiple symptoms before death. We found that physicians tend to use more invasive care in dying younger patients. However, this aggressive treatment does not prolong survival. Futile treatments influencing quality of life should be avoided.
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Affiliation(s)
- Ori Tal
- E. Wolfson Medical Center, Holon, Sackler Medicine, Tel Aviv University, Holon, Israel
| | - Erez Ben Shem
- E. Wolfson Medical Center, Holon, Sackler Medicine, Tel Aviv University, Holon, Israel
| | - Ofri Peled
- E. Wolfson Medical Center, Holon, Sackler Medicine, Tel Aviv University, Holon, Israel
| | - Osnat Elyashiv
- E. Wolfson Medical Center, Holon, Sackler Medicine, Tel Aviv University, Holon, Israel
| | - Tally Levy
- E. Wolfson Medical Center, Holon, Sackler Medicine, Tel Aviv University, Holon, Israel
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13
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Leyh-Bannurah SR, Wagner C, Schuette A, Liakos N, Karagiotis T, Mendrek M, Rachubinski P, Oelke M, Tian Z, Witt JH. Feasibility of robot-assisted radical prostatectomy in men at senior age ≥75 years: perioperative, functional, and oncological outcomes of a high-volume center. Aging Male 2022; 25:8-16. [PMID: 34957914 DOI: 10.1080/13685538.2021.2018417] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess whether age ≥75 years impairs surgical, functional, and oncological outcomes after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS Patients with prostate cancer (PCa) were stratified in ≥75(n = 669) vs. <70 years(n = 8,268). Multivariable cox regression analyses (MVA) tested for effect of senior age on erectile function-, urinary continence-recovery, biochemical recurrence (BCR), and metastatic progression (MP). RESULTS RARP duration, blood loss, and 30d complication rates were similar between groups. For patients ≥75 vs. <70 years, rates of erectile function after 36 and urinary continence after 12 months were 27 vs. 56% (p < 0.001) and 85 vs. 86% (p = 0.99), respectively. Mean quality of life (QoL) score after 12 months improved in both groups (p = 0.9). At 48 months, BCR- and MP-free rates were 77 vs. 85% (p < 0.001) and 97 vs. 98% (p = 0.3), respectively. MVA confirmed the negative effect of senior age on erectile function but no significant effect on urinary continence, BCR or MP, before and after propensity score matching. CONCLUSION Apart from erectile function, senior age has no significant effect on urinary continence recovery, BCR- or MP-free rates after RARP. Post-RARP QoL improved even in senior patients. Modern therapy of senior PCa patients should be based on individual counseling than just age.
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Affiliation(s)
- Sami-Ramzi Leyh-Bannurah
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
| | - Christian Wagner
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
| | - Andreas Schuette
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
| | - Nikolaos Liakos
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
| | - Theodoros Karagiotis
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
| | - Mikolaj Mendrek
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
| | - Pawel Rachubinski
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
| | - Matthias Oelke
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
| | - Jorn H Witt
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
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14
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Lohan L, Marin G, Faucanie M, Laureau M, Perier D, Pinzani V, Giraud I, Villiet M, Sebbane M, Sultan A, Breuker C. Frequency, Characteristics, and Predictive Factors of Adverse Drug Events in an Adult Emergency Department according to Age: A Cross-Sectional Study. J Clin Med 2022; 11. [PMID: 36233599 DOI: 10.3390/jcm11195731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Adverse drug events (ADEs) are a major public health concern, given their consequences in terms of morbi-mortality and associated healthcare costs. Many studies have focused on the elderly, who are considered particularly vulnerable in this respect. We aimed to determine and compare the frequency, characteristics, and predictive factors of ADEs according to age in an adult population. A prospective seven-year cross-sectional study was conducted in a university hospital emergency department. Structured medication reviews and ADE detection were performed. Patient data and ADE characteristics were collected. Descriptive statistics and logistic regression were performed in two age groups: Group 1 (age < 65 years) and 2 (age ≥ 65 years). Among the 13,653 patients included, 18.4% in Group 1 and 22.6% in Group 2 experienced an ADE. Differences were identified in terms of the ADE type (more ADEs due to noncompliance in Group 1) and ADE symptoms (greater bleeding in Group 2). In the multivariable analysis, several specific predictive factors were identified, including kidney failure and antidiabetic drug use in Group 1 and inappropriate prescription and antithrombotic treatment in Group 2. Analysis by age provided a more refined vision of ADEs as we identified distinct profiles of iatrogenesis. These results will lead to a better detection of ADEs.
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15
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Lerchenmüller C, Vujic A, Mittag S, Wang A, Rabolli CP, Heß C, Betge F, Rangrez AY, Chaklader M, Guillermier C, Gyngard F, Roh JD, Li H, Steinhauser ML, Frey N, Rothermel B, Dieterich C, Rosenzweig A, Lee RT. Restoration of Cardiomyogenesis in Aged Mouse Hearts by Voluntary Exercise. Circulation 2022; 146:412-426. [PMID: 35862076 PMCID: PMC9357140 DOI: 10.1161/circulationaha.121.057276] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The human heart has limited capacity to generate new cardiomyocytes and this capacity declines with age. Because loss of cardiomyocytes may contribute to heart failure, it is crucial to explore stimuli of endogenous cardiac regeneration to favorably shift the balance between loss of cardiomyocytes and the birth of new cardiomyocytes in the aged heart. We have previously shown that cardiomyogenesis can be activated by exercise in the young adult mouse heart. Whether exercise also induces cardiomyogenesis in aged hearts, however, is still unknown. Here, we aim to investigate the effect of exercise on the generation of new cardiomyocytes in the aged heart. METHODS Aged (20-month-old) mice were subjected to an 8-week voluntary running protocol, and age-matched sedentary animals served as controls. Cardiomyogenesis in aged hearts was assessed on the basis of 15N-thymidine incorporation and multi-isotope imaging mass spectrometry. We analyzed 1793 cardiomyocytes from 5 aged sedentary mice and compared these with 2002 cardiomyocytes from 5 aged exercised mice, followed by advanced histology and imaging to account for ploidy and nucleation status of the cell. RNA sequencing and subsequent bioinformatic analyses were performed to investigate transcriptional changes induced by exercise specifically in aged hearts in comparison with young hearts. RESULTS Cardiomyogenesis was observed at a significantly higher frequency in exercised compared with sedentary aged hearts on the basis of the detection of mononucleated/diploid 15N-thymidine-labeled cardiomyocytes. No mononucleated/diploid 15N-thymidine-labeled cardiomyocyte was detected in sedentary aged mice. The annual rate of mononucleated/diploid 15N-thymidine-labeled cardiomyocytes in aged exercised mice was 2.3% per year. This compares with our previously reported annual rate of 7.5% in young exercised mice and 1.63% in young sedentary mice. Transcriptional profiling of young and aged exercised murine hearts and their sedentary controls revealed that exercise induces pathways related to circadian rhythm, irrespective of age. One known oscillating transcript, however, that was exclusively upregulated in aged exercised hearts, was isoform 1.4 of regulator of calcineurin, whose regulation and functional role were explored further. CONCLUSIONS Our data demonstrate that voluntary running in part restores cardiomyogenesis in aged mice and suggest that pathways associated with circadian rhythm may play a role in physiologically stimulated cardiomyogenesis.
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Affiliation(s)
- Carolin Lerchenmüller
- Department of Cardiology, University Hospital Heidelberg, 69120 Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.,Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ana Vujic
- Department of Stem Cell and Regenerative Biology and the Harvard Stem Cell Institute, Harvard University, Cambridge, MA 02138, USA
| | - Sonja Mittag
- Department of Cardiology, University Hospital Heidelberg, 69120 Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.,Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Annie Wang
- Department of Stem Cell and Regenerative Biology and the Harvard Stem Cell Institute, Harvard University, Cambridge, MA 02138, USA
| | - Charles P. Rabolli
- Department of Cardiology, University Hospital Heidelberg, 69120 Heidelberg, Germany.,Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Chiara Heß
- Department of Cardiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Fynn Betge
- Department of Cardiology, University Hospital Heidelberg, 69120 Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Ashraf Y. Rangrez
- Department of Cardiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Malay Chaklader
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Christelle Guillermier
- Harvard Medical School, Boston, MA 02115, USA.,Center for NanoImaging and Division of Genetics, Brigham and Women’s Hospital, Cambridge, MA 02115, USA.,Aging Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Frank Gyngard
- Harvard Medical School, Boston, MA 02115, USA.,Center for NanoImaging and Division of Genetics, Brigham and Women’s Hospital, Cambridge, MA 02115, USA.,Aging Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Jason D. Roh
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Haobo Li
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Matthew L. Steinhauser
- Harvard Medical School, Boston, MA 02115, USA.,Center for NanoImaging and Division of Genetics, Brigham and Women’s Hospital, Cambridge, MA 02115, USA.,Aging Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Norbert Frey
- Department of Cardiology, University Hospital Heidelberg, 69120 Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Beverly Rothermel
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA,Department of Molecular Biology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Christoph Dieterich
- Department of Cardiology, University Hospital Heidelberg, 69120 Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Anthony Rosenzweig
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA.,Co-senior and co-corresponding authors who equally supervised the study: Anthony Rosenzweig, MD, Massachusetts General Hospital, Cardiology Division, 55 Fruit Street, Boston, MA 02114, , Tel: (617) 724-1430; Richard T. Lee, MD, Harvard University, Sherman Fairchild Building, Room 159, 7 Divinity Avenue, Cambridge, MA 02138, , Tel: (617) 496-5394
| | - Richard T. Lee
- Department of Stem Cell and Regenerative Biology and the Harvard Stem Cell Institute, Harvard University, Cambridge, MA 02138, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA.,Co-senior and co-corresponding authors who equally supervised the study: Anthony Rosenzweig, MD, Massachusetts General Hospital, Cardiology Division, 55 Fruit Street, Boston, MA 02114, , Tel: (617) 724-1430; Richard T. Lee, MD, Harvard University, Sherman Fairchild Building, Room 159, 7 Divinity Avenue, Cambridge, MA 02138, , Tel: (617) 496-5394
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16
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Freak-Poli R, Ryan J, Tran T, Owen A, McHugh Power J, Berk M, Stocks N, Gonzalez-Chica D, Lowthian JA, Fisher J, Byles J. Social isolation, social support and loneliness as independent concepts, and their relationship with health-related quality of life among older women. Aging Ment Health 2022; 26:1335-1344. [PMID: 34219569 DOI: 10.1080/13607863.2021.1940097] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: To assess whether social isolation, social support, and loneliness are independently associated with health-related quality of life (HRQoL).Method: Retrospective analysis including 10,517 women aged 70-75 years from the Australian Longitudinal Study on Women's Health (ALSWH). Social isolation, social support (Duke Social Support Index), and loneliness (single item) were investigated for their association with standardised HRQoL (physical [PCS] and mental [MCS] components of the SF-36® questionnaire). Analyses were adjusted for sociodemographic variables and number of medical conditions.Results: Only 3% reported being socially isolated, having low social support and being lonely, and 34% reported being not socially isolated, high social support and not being lonely. Each construct was independently associated with HRQoL, with loneliness having the strongest inverse association (PCS: isolation -0.98, low support -2.01, loneliness -2.03; MCS: isolation -1.97, low support -4.79, loneliness -10.20; p-value < 0.001 for each). Women who were not isolated or lonely and with high social support had the greatest HRQoL (compared to isolated, low social support and lonely; MCS: 17 to 18 points higher, PCS: 5 to 8 points higher). Other combinations of social isolation, social support and loneliness varied in their associations with HRQoL.Conclusion: Ageing populations face the challenge of supporting older people to maintain longer, healthy, meaningful and community-dwelling lives. Among older women, social isolation, low social support and loneliness are distinct, partially overlapping yet interconnected concepts that coexist and are each adversely associated with HRQoL. Findings should be replicated in other cohorts to ensure generalisability across other age groups and men.
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Affiliation(s)
- Rosanne Freak-Poli
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Thach Tran
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Michael Berk
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Nigel Stocks
- Discipline of General Practice, The University of Adelaide, Adelaide, Australia
| | - David Gonzalez-Chica
- Discipline of General Practice, The University of Adelaide, Adelaide, Australia.,Adelaide Rural Clinical School, The University of Adelaide, Adelaide, Australia
| | - Judy A Lowthian
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Australia.,Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - Jane Fisher
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Julie Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, Australia
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17
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Ordiñaga-Monreal E, Castanera-Gratacós D, Castanera F, Fambuena-Muedra I, Vega F, Millán MS. Pupil size differences between female and male patients after cataract surgery. J Optom 2022; 15:179-185. [PMID: 33549502 PMCID: PMC9068520 DOI: 10.1016/j.optom.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 05/31/2023]
Abstract
PURPOSE To evaluate the changes in pupil diameter in women and men after cataract surgery. The correlation of pupillary changes with the variables age and anterior chamber depth will be analyzed. METHODS The values of 109 randomized eyes who underwent cataract surgery were obtained and divided into two groups, 71 women and 38 men. Pupil diameter was measured preoperatively and 3-months postoperatively using the pupillometer software of the Topolyzer Vario (Wavelight Laser Technologie AG). Anterior chamber depth was obtained with Pentacam® (Oculus). Differences in pupillary diameters were investigated and correlations with age and anterior chamber depth were analyzed. RESULTS For mesopic pupils, the male group had greater reduction in their postoperative pupillary diameter, -0.56 mm (-12.4%), than the female group, -0.38 mm (-8.2%), P = 0.025. Photopic postoperative pupils reduced to a lesser extent, yet more in men than in women (-0.11mm [-4.5%] vs. -0.04 [-1.6%], P = 0.048). Weak significant negative correlation was found between photopic pupillary changes in women with age (r = -0.24, P = 0.041), and positive correlation for mesopic pupillary changes in men with age (r = +0.34, P = 0.039). CONCLUSIONS Patients experience pupil reduction after cataract surgery in general, but more in men than in women and for both photopic and mesopic lighting conditions. The differences are statistically significant and have moderate clinical relevance. Concerning pupillary changes, weak but opposite sign correlations were found between male/female gender and age. Trial registration number at ClinicalTrials.gov Identifier: NCT04286646.
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Affiliation(s)
- Enrique Ordiñaga-Monreal
- Clínica Oftalmológica TACIR, Centro Médico TEKNON, Barcelona, Spain; Departament d'Òptica i Optometria, Universitat Politècnica de Catalunya - BARCELONATECH, Terrasa, Spain.
| | | | | | | | - Fidel Vega
- Departament d'Òptica i Optometria, Universitat Politècnica de Catalunya - BARCELONATECH, Terrasa, Spain
| | - María S Millán
- Departament d'Òptica i Optometria, Universitat Politècnica de Catalunya - BARCELONATECH, Terrasa, Spain
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18
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Singab H, Sami G, Tag El Sabah M. Silent Kawasaki Disease Affecting Multiple Coronary Arteries in a 39-Year-Old Egyptian Woman. Tex Heart Inst J 2022; 49:480201. [PMID: 35420684 DOI: 10.14503/thij-20-7261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Kawasaki disease, an acute febrile illness, can cause vasculitis in the coronary arteries. It is the chief acquired cause of myocardial infarction and sudden cardiac death in infants, children, and young adults in developed countries. We report a case of chronic, silent Kawasaki disease complicated by multivessel thrombosis in a 39-year-old Egyptian woman. The patient presented with progressive, unstable angina but was otherwise asymptomatic and at negligible risk of ischemic heart disease. Coronary angiograms showed critical arterial stenosis with multiple aneurysms. During revascularization surgery, the patient's harvested left internal mammary artery was found to have occlusive lesions and aneurysmal areas that made it unfit for bypass grafting, and subsequent histopathologic examination revealed features characteristic of chronic Kawasaki disease-associated systemic vasculitis. We think that this is only the second report of Kawasaki disease in the Arabian Mediterranean region. In addition to the patient's case, we discuss the epidemiology and management of Kawasaki disease, in hopes of increasing clinicians' awareness.
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Affiliation(s)
- Hamdy Singab
- Department of Cardiac Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Gamal Sami
- Department of Cardiac Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Tag El Sabah
- Department of Pathology, Misr University for Science and Technology, 6th of October City, Giza, Egypt
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19
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Dziarmaga R, Ke D, Sapir-Pichhadze R, Cardinal H, Phan V, Piccirillo CA, Mazer B, Foster BJ. Age- and sex-mediated differences in T lymphocyte populations of kidney transplant recipients. Pediatr Transplant 2022; 26:e14150. [PMID: 34569133 DOI: 10.1111/petr.14150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Graft failure rates increase through childhood and adolescence, decline in adulthood, and are higher in female than male kidney transplant recipients (KTR) until middle age. We aimed to describe age- and sex-related differences in T-cell subsets among KTR to determine which differences may help to explain the differences in kidney graft failure rates. METHODS Effector T (Teff)-cell and regulatory T (Treg)-cell phenotypes in PBMCs from healthy controls and KTR, who were at least 1 year post-transplant with stable graft function under immunosuppression, were analyzed by flow cytometry. The effects of age, sex, and status (KTR or control) were analyzed using linear regressions. RESULTS We enrolled 20 male and 21 female KTR and 20 male and 20 female controls between 3 and 29 years of age. CD3+ T-cell frequencies were not associated with age or sex but were higher in KTR than controls. There were no differences in CD4+ and CD8+ frequencies. Th1 (IFNγ+ IL-4- IL-17A-) and Th17 (IL-17A+) frequencies within the CD4+ T-cell population were higher at older ages. The frequencies of FOXP3 + Helios + Treg cells in CD4+ CD25+ CD127- T cells were lower in females than males and in KTR than controls. CONCLUSIONS Increasing frequencies of Th1 and Th17 cells with increasing age mirrors the increasing graft failure rates from childhood to young adulthood. Importantly, sex differences in frequencies of circulating Treg cells may suggest a role in the sex differences in graft failure rates.
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Affiliation(s)
- Robert Dziarmaga
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Danbing Ke
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Nephrology and Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Héloïse Cardinal
- Département de Médecine, Université de Montréal, Montreal, Quebec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Véronique Phan
- Département de Pédiatrie, Université de Montréal, Montreal, Quebec, Canada.,Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Ciriaco A Piccirillo
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Bruce Mazer
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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20
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Wright MC, Bunning T, Eleswarpu SS, Heflin MT, McDonald S, Lagoo-Deenadalayan S, Whitson H, Martinez-Camblor P, Deiner SG, Berger M. A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study. Anesth Analg 2022; 134:149-158. [PMID: 34252066 PMCID: PMC8678136 DOI: 10.1213/ane.0000000000005660] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Some older adults show exaggerated responses to drugs that act on the brain. The brain's response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG-based measure of the brain's resistance to volatile anesthetics and hypothesized that low scores on it would be associated with postoperative delirium risk. METHODS We defined the Duke Anesthesia Resistance Scale (DARS) as the average bispectral index (BIS) divided by the quantity (2.5 minus the average age-adjusted end-tidal minimum alveolar concentration [aaMAC] inhaled anesthetic fraction). The relationship between DARS and postoperative delirium was analyzed in 139 older surgical patients (age ≥65) from Duke University Medical Center (n = 69) and Mt Sinai Medical Center (n = 70). Delirium was assessed by geriatrician interview at Duke, and by research staff utilizing the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument at Mt Sinai. We examined the relationship between DARS and delirium and used the Youden index to identify an optimal low DARS threshold (for delirium risk), and its associated 95% bootstrap confidence bounds. We used multivariable logistic regression to examine the relationship between low DARS and delirium risk. RESULTS The relationship between DARS and delirium risk was nonlinear, with higher delirium risk at low DARS scores. A DARS threshold of 28.755 maximized the Youden index for the association between low DARS and delirium, with bootstrap 95% confidence bounds of 26.18 and 29.80. A low DARS (<28.755) was associated with increased delirium risk in multivariable models adjusting for site (odds ratio [OR] [95% confidence interval {CI}] = 4.30 [1.89-10.01]; P = .001), or site-plus-patient risk factors (OR [95% CI] = 3.79 [1.63-9.10]; P = .003). These associations with postoperative delirium risk remained significant when using the 95% bootstrap confidence bounds for the low DARS threshold (P < .05 for all). Further, a low DARS (<28.755) was associated with delirium risk after accounting for opioid, midazolam, propofol, phenylephrine, and ketamine dosage as well as site (OR [95% CI] = 4.21 [1.80-10.16]; P = .002). This association between low DARS and postoperative delirium risk after controlling for these other medications remained significant (P < .05) when using either the lower or the upper 95% bootstrap confidence bounds for the low DARS threshold. CONCLUSIONS These results demonstrate that an intraoperative processed EEG-based measure of lower brain anesthetic resistance (ie, low DARS) is independently associated with increased postoperative delirium risk in older surgical patients.
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Affiliation(s)
| | - Thomas Bunning
- Anesthesiology Department, Duke University Medical Center, Durham NC
| | | | - Mitchell T. Heflin
- Geriatrics Division, Department of Medicine, Duke University Medical Center, Durham NC
| | - Shelley McDonald
- Geriatrics Division, Department of Medicine, Duke University Medical Center, Durham NC
| | | | - Heather Whitson
- Geriatrics Division, Department of Medicine, Duke University Medical Center, Durham NC,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
| | | | - Stacie G Deiner
- Geriatrics and Palliative Care Medicine, Department of Medicine, Mount Sinai Medical Center, New York, NY,Anesthesiology Department, Mount Sinai Medical Center, New York, NY,Neurosurgery Department, Mount Sinai Medical Center, New York, NY,Geisel School of Medicine, Dartmouth College, New Hanover, New Hampshire
| | - Miles Berger
- Anesthesiology Department, Duke University Medical Center, Durham NC,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC,Center for Cognitive Neuroscience, Duke University, Durham NC
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21
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Tesch ME, Speers C, Diocee RM, Gondara L, Peacock SJ, Nichol A, Lohrisch CA. Impact of TAILORx on chemotherapy prescribing and 21-gene recurrence score-guided treatment costs in a population-based cohort of patients with breast cancer. Cancer 2021; 128:665-674. [PMID: 34855202 DOI: 10.1002/cncr.33982] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The trial assigning individualized options for treatment (Rx) (TAILORx) confirmed the predictive value of the 21-gene recurrence score (RS) assay in hormone receptor (HR)-positive, HER2-negative, node-negative breast cancer and established thresholds for chemotherapy benefit in younger and older patients. Real-world chemotherapy use and RS-guided treatment costs in British Columbia post-TAILORx were examined. METHODS The authors assembled 3 cohorts of HR-positive, HER2-negative, node-negative patients with breast cancer defined by diagnosis: before RS funding (cohort 1 [C1]: January 2013-December 2013), after introduction of public RS funding (cohort 2 [C2]: July 2015-June 2016), and after TAILORx results (cohort 3 [C3]: July 2018-June 2019). Chemotherapy use was compared between cohorts by age and RS. Budgetary impacts of RS testing on chemotherapy costs were evaluated pre- and post-TAILORx. RESULTS Among the 2066 patients included, chemotherapy use declined by 19% after RS funding was introduced and by an additional 23% after TAILORx publication (P = .001). Reduction in chemotherapy use was significant for RS 11-20 tumors (C3 vs C2, P = .004). There was no significant change in chemotherapy use in patients >50 years old (C2:12% vs C3:10%, P = .22). RS testing was associated with higher cost savings post-TAILORx, except in patients 70 to 80 years old, where testing led to excess costs when adjusting for the low rate of RS-concordant chemotherapy prescribed. CONCLUSIONS TAILORx has had population-based impacts on chemotherapy prescribing in intermediate RS tumors and patients ≤50 years old. The lower clinical use of RS and increased spending in patients 70-80 years old highlights the importance of careful selection of older candidates for high-cost genomic testing. LAY SUMMARY The 21-gene recurrence score (RS) test helps predict whether patients with hormone-positive, HER2-negative, lymph node-negative breast cancer are likely to benefit from chemotherapy. The recent trial assigning individualized options for treatment (Rx) (TAILORx) found that patients with intermediate RS tumors did not benefit from chemotherapy. The authors assessed whether TAILORx results translated to real-world changes in chemotherapy prescribing patterns. In this study, chemotherapy use decreased by 23% after TAILORx, with the greatest reductions seen among intermediate RS tumors and younger patients. In contrast, RS testing had lower clinical value and increased treatment costs in elderly patients, which requires further study to ensure optimal care for this age group.
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Affiliation(s)
- Megan E Tesch
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Caroline Speers
- Breast Cancer Outcomes Unit, BC Cancer, Vancouver, British Columbia, Canada
| | - Rekha M Diocee
- Breast Cancer Outcomes Unit, BC Cancer, Vancouver, British Columbia, Canada
| | - Lovedeep Gondara
- Breast Cancer Outcomes Unit, BC Cancer, Vancouver, British Columbia, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Alan Nichol
- Department of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Caroline A Lohrisch
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
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22
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Joyce J, Ryan J, Owen A, Hu J, Power JM, Shah R, Woods R, Storey E, Britt C, Freak-Poli R. Social isolation, social support, and loneliness and their relationship with cognitive health and dementia. Int J Geriatr Psychiatry 2021; 37:10.1002/gps.5644. [PMID: 34741340 PMCID: PMC9068834 DOI: 10.1002/gps.5644] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Poor social health is prevalent in older adults and may be associated with worse cognition, and increased dementia risk. The aim of this study was to determine whether social isolation, social support and loneliness are independently associated with cognitive function and incident dementia over 5 years in older adults, and to investigate potential gender differences. METHODS Participants were 11,498 community-dwelling relatively healthy Australians aged 70-94, in the ASPREE Longitudinal Study of Older Persons (ALSOP). Social isolation, social support, loneliness and cognitive function were assessed through self-report. Outcomes examined were cognitive decline (>1.5 SD decline in cognitive performance since baseline) and incident dementia (adjudicated according to DSM-IV criteria). RESULTS Most participants self-reported good social health (92%) with very few socially isolated (2%), with low social support (2%) or lonely (5%). Among women, social isolation and low social support were consistently associated with lower cognitive function (e.g., social support and cognition β = -1.17, p < 0.001). No consistent longitudinal associations were observed between baseline social health and cognitive decline (over median 3.1 years) or incident dementia (over median 4.4 years; social isolation: HR = 1.00, p = 0.99; low social support: HR = 1.79, p = 0.11; loneliness: HR = 0.72, p = 0.34 among women and men). CONCLUSION Our study provides evidence that social isolation and a low social support are associated with worse cognitive function in women, but not men. Social health did not predict incident cognitive decline or dementia, but we lacked power to stratify dementia analyses by gender.
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Affiliation(s)
- Johanna Joyce
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Jessie Hu
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Raj Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Robyn Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Elsdon Storey
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Carlene Britt
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Rosanne Freak-Poli
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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23
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Manns K, Khan A, Carlson KV, Wagg A, Baverstock RJ, Trafford Crump R. The use of onabotulinumtoxinA to treat idiopathic overactive bladder in elderly patients is in need of study. Neurourol Urodyn 2021; 41:42-47. [PMID: 34618366 DOI: 10.1002/nau.24809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Injecting onabotulinumtoxinA (BoTN-A) into the bladder has been established as an effective treatment of overactive bladder (OAB) and well-tolerated by patients. However, there evidence suggests the efficacy and safety of this treatment may decrease with age due to increased comorbidities and frailty. This study's objective was to establish empirical evidence regarding age-related differences in outcomes related to BoTN-A for the treatment of idiopathic OAB. METHODS MEDLINE, EMBASE, and the Cochrane Central Registry for Controlled Trials were systematically searched. Results were restricted to randomized control trials of BoTN-A bladder injections for the treatment of idiopathic OAB. The resulting articles' abstracts were screened independently by two reviewers. Those passing the screen were reviewed in full. Articles were excluded if participants were <18 years old, diagnosed with neurogenic overactivity, or treated with both oral medications and BoTN-A; if the frequency and severity of OAB symptoms were not specified; or, if symptoms were not stratified by age. RESULTS The initial search resulted in 1572 articles; 166 were reviewed in full. None met all inclusion/exclusion criteria. However, 21 studies met all criteria except age stratification. Authors were contacted to obtain raw data to perform an independent age-based analysis, but sufficient data was not received. CONCLUSION While the initial systematic review did not generate the expected results, it did reveal that age-related outcomes of BoTN-A for the treatment of OAB are significantly under-studied. Given that the prevalence of OAB increases with age, this is an important knowledge gap. Our article explains the rationale for further study in this area.
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Affiliation(s)
- Kate Manns
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Asher Khan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin V Carlson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - R Trafford Crump
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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24
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González Serrano A, Martínez Tapia C, de la Taille A, Mongiat-Artus P, Irani J, Bex A, Paillaud E, Audureau E, Barnay T, Laurent M, Canouï-Poitrine F. Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study. Cancers (Basel) 2021; 13:4694. [PMID: 34572921 PMCID: PMC8468518 DOI: 10.3390/cancers13184694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 02/02/2023] Open
Abstract
The guidelines on prostate cancer treatment in older men recommend evaluating the patient's underlying health status before treatment selection. We aimed to evaluate the frequency of a guideline-discordant treatment (GDT), identify factors associated with GDT, and assess the relationship between GDT and overall survival. We studied patients with prostate cancer aged 70 or older included in the ELCAPA cohort between 2010 and 2019. Multivariable logistic regression assessed GDT-associated factors. The restricted mean survival time (RMST) assessed the 24- and 36-month OS using stabilized inverse probability of treatment weighting of propensity scores. We included 356 patients (median age: 81 years), and 164 (46%) received a GDT (95% confidence interval (CI) = (41-51%)). Patients with metastases were less likely to receive a GDT (adjusted odds ratio (95% CI) = 0.34 (0.17-0.69); p = 0.003). After weighting, the RMST at 24 months was shorter in the GDT group (13.9 months, vs. 17 months for compliant treatments; difference (95% CI): -3.1 months (-5.3, -1.0); p = 0.004). RMST at 36 months was 18.5 months, vs. 21.8 months (difference: -3.3 months (-6.7, 0.0); p = 0.053). GDT is common in older patients with prostate cancer and especially those with non-metastatic disease. GDT was associated with worse survival, independently of health status and tumour characteristics.
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Affiliation(s)
- Adolfo González Serrano
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
| | - Claudia Martínez Tapia
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
| | - Alexandre de la Taille
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Urology, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
| | - Pierre Mongiat-Artus
- Université de Paris, INSERM UMR_S1165, F-75010 Paris, France;
- Department of Urology, AP-HP, Hôpital Saint Louis, F-75010 Paris, France
| | - Jacques Irani
- Faculty of Medicine, Université Paris Saclay, F-94270 Le Kremlin-Bicêtre, France;
- Department of Urology, AP-HP, Hôpital Bicêtre, F-94270 Le Kremlin-Bicêtre, France
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London NW3 2QG, UK;
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Geriatrics, Paris Cancer Institute CARPEM, AP-HP, Hôpital Européen Georges Pompidou, F-75006 Paris, France
- Faculty of Health, Univeristé de Paris, F-75006 Paris, France
| | - Etienne Audureau
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Public Health, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
| | - Thomas Barnay
- ERUDITE Research Unit, Univ Paris Est Creteil, F-94010 Créteil, France;
| | - Marie Laurent
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Internal Medicine and Geriatrics, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Public Health, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
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25
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Freak-Poli R. It's not age that prevents sexual activity later in life. Australas J Ageing 2021; 39 Suppl 1:22-29. [PMID: 32567179 PMCID: PMC7317726 DOI: 10.1111/ajag.12774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/16/2022]
Abstract
Objective To describe key factors that facilitate sexual behaviour in later life. Methods Re‐analysis of data from a study of 2,374 Dutch older adults. Results Partner availability, gender and health are likely to be more important factors influencing sexual behaviour engagement than the factor of age in later life. Lack of partner availability, traditional gender roles and poor health are associated with older age. However, current generations of older adults will be more capable, less ashamed of their sexual desires and engage in more sexual behaviour than prior generations. Conclusion This analysis observed that sexual activity is associated with partner availability and better health, rather than age, countering stereotypes of decline in sexual behaviour and normalising sexual activity and desire in later life.
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Affiliation(s)
- Rosanne Freak-Poli
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.,Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
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26
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Lee HJ, Lee H, Na CB, Song IS, Ryu JJ, Park JB. Evaluation of the Age- and Sex-Related Changes of the Osteogenic Differentiation Potentials of Healthy Bone Marrow-Derived Mesenchymal Stem Cells. ACTA ACUST UNITED AC 2021; 57:medicina57060520. [PMID: 34067350 PMCID: PMC8224625 DOI: 10.3390/medicina57060520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/28/2022]
Abstract
Background andObjectives: Human bone marrow-derived mesenchymal stem cells (BMSCs) are promising sources for cell-based regenerative therapy. The purpose of the present study was to elucidate the roles of age and sex on the cellular viability and osteogenic potential of BMSCs cultured in osteogenic media. Materials and Methods: Human BMSCs were isolated and expanded from 3 age groups—20s, 30s, and 50s—from both sexes. The total number of aspirates was ten, and each subgroup had five for 20s (two females and three males), three for 30s (one female and two male), and two for 50s (one female and one male). Analyses of the cell morphology, the cell viability, the expression of the stem cell marker SSEA-4, the secretion of human vascular endothelial growth factor (VEGF), the expression of Runx2 and collagen I, the metabolic activity, and the formation of mineralization nodules were performed. Results: No significant differences were found in the cell viability of human BMSCs cultured in osteogenic media among the different age groups. There were no significant differences in the expression of SSEA among the age groups or between males and females. There were no significant differences in the secretion of human VEGF between males and females. No significant differences in Runx2 or collagen I expression were noted by age or gender. Moreover, no significant differences were shown in osteogenesis by alizarin red staining. Conclusions: The human BMSCs showed no age-related decreases in cellular viability or osteogenic differentiation potential.
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Affiliation(s)
- Hyun-Jin Lee
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-J.L.); (H.L.); (C.-B.N.)
| | - Hyuna Lee
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-J.L.); (H.L.); (C.-B.N.)
| | - Chae-Bin Na
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-J.L.); (H.L.); (C.-B.N.)
| | - In-Seok Song
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul 02841, Korea
- Correspondence: (I.-S.S.); (J.-B.P.); Tel.: +82-10-9099-5357 (I.-S.S.); +82-2-2258-6290 (J.-B.P.)
| | - Jae-Jun Ryu
- Department of Prosthodontics, Korea University Anam Hospital, Seoul 02841, Korea;
| | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-J.L.); (H.L.); (C.-B.N.)
- Correspondence: (I.-S.S.); (J.-B.P.); Tel.: +82-10-9099-5357 (I.-S.S.); +82-2-2258-6290 (J.-B.P.)
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Abstract
Background Road traffic accident (RTA) fatalities account for a significant number of unnatural deaths in Pakistan. Hence, it is necessary to investigate RTA fatalities in order to implement measures to reduce them. In the present study, we aimed to assess the detailed epidemiological characteristics of RTA fatalities by analyzing the data obtained from medico-legal autopsies performed at the Jinnah Postgraduate Medical Centre (JPMC) in 2019 and 2020. We assessed age- and gender-based variations in the pattern of RTA fatalities and determined the anatomical cause of death and sites of fractures among the fatalities. Moreover, we assessed the monthly distribution of cases in 2019 and 2020 to determine the impact of the coronavirus disease 2019 (COVID-19) on the number of RTA fatalities reported each month. Methodology In this retrospective study, data obtained from medico-legal autopsies of all RTA victims in 2019 and 2020 (n = 246) were collected from the Forensic Department of JPMC, Karachi. The data were then entered into Statistical Package for the Social Sciences version 24.0 (IBM Corp., Armonk, NY, USA) for analysis. Results The highest number of fatalities was recorded in the age group of 18-40 years (54.5%), while the lowest number was recorded in the age group of ≥60 years (8.5%). The male:female autopsy ratio was 6.03:1. Most fatalities were recorded from 6:00 am to 11:59 am (41.9%), followed by 12:00 pm to 5:59 pm (37.4%). Moreover, most victims (76.8%) died instantaneously within seconds to minutes of the incident. The number of RTA fatalities reported in 2019 (50.4%) was similar to that reported in 2020 (49.6%). However, the number of RTA fatalities reported in March-July 2020 was 35.6% lower than that reported in the same period in 2019, possibly because of the restrictions (such as lockdowns) that were imposed to control the spread of the COVID-19 pandemic in 2020. There was a statistically significant difference in the number of RTA fatalities reported in March-July 2020 and that reported in the remaining months of 2019 and 2020 (p = 0.006). The cause of death was head injury in 159 (64.6%) cases and multiple traumatic injuries in 65 (26.4%) cases. Injury to the chest, abdomen, and pelvis caused death in 11 (4.5%), nine (3.7%), and two (0.8%) cases, respectively. Assessment of the site of fractures revealed skull fractures to be the most common type of fractures (53%), followed by rib/sternal fractures (19%). Upper limb and lower limb fractures occurred in 10% and 9% of the cases, respectively, while pelvic and neck fractures occurred in 6% and 3% of the cases, respectively. Conclusions Efforts need to be made at both government and individual levels to reduce RTA fatalities. Strict implementation of traffic laws is necessary. Although we noted a male preponderance, the reluctance to get females autopsied should not be disregarded. The significant decrease in RTA fatalities during March-July 2020 could be attributed to the reduced traffic burden due to the restrictions imposed to control the COVID-19 pandemic and the preventive measures taken, such as staying at home, to avoid contracting the virus.
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Affiliation(s)
| | - Aruba Sohail
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Maman Khurshid
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Mir U Shah
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Asra A Jaffry
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Moradzadeh A, Howard LE, Freedland SJ, Amling CL, Aronson WJ, Cooperberg MR, Kane CJ, Klaassen Z, Terris MK, Daskivich TJ. The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy. Urol Pract 2021; 8:238-245. [PMID: 37145618 DOI: 10.1097/upj.0000000000000189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Older men with major comorbidities have higher risks of morbidity and mortality from androgen deprivation therapy, and the benefits of immediate androgen deprivation therapy after biochemical recurrence in these men are unclear. We assessed variation in timing of androgen deprivation therapy by age and comorbidity in a cohort of men with biochemical recurrence after radical prostatectomy. METHODS We analyzed 2,097 men with biochemical recurrence after radical prostatectomy from 2000 to 2017 in the VA SEARCH database. We ascertained age and Deyo-Charlson comorbidity index scores at biochemical recurrence. Kaplan-Meier analysis and multivariable logistic regression were used to determine association of age and Deyo-Charlson comorbidity index with prostate specific antigen at the initiation of androgen deprivation therapy. RESULTS In Kaplan-Meier analysis with prostate specific antigen at androgen deprivation therapy as the outcome, median prostate specific antigen at androgen deprivation therapy initiation was 6.2 ng/ml (95% CI 5.1-7.1) across all patients but differed among those who received adjuvant/salvage radiation (3.6 ng/ml, 95% CI 2.8-4.3) and those who did not (12.1 ng/ml, 95% CI 9.6-15.2, p <0.001). In multivariable Cox regression, advanced age (p=0.03) but not worse comorbidity (p=0.25) was associated higher prostate specific antigen at initiation of androgen deprivation therapy. Across all patients, prostate specific antigen at androgen deprivation therapy was lower among those <60 years old (3.7 ng/ml, 95% CI 2.6-5.8) compared to those 60-64 (5.0 ng/ml, 95% CI 3.9-6.6), 65-69 (6.6 ng/ml, 95% CI 4.9-8.8), 70-74 (8.8 ng/ml, 95% CI 6.1-12.3) and ≥75 years old (14.1 ng/ml, 95% CI 5.5-37.8). In contrast, prostate specific antigen at androgen deprivation therapy was similar among comorbidity subgroups (Deyo-Charlson comorbidity index 0: 6.3 ng/ml, 95% CI 5.0-7.9 vs Deyo-Charlson comorbidity index 3 or higher: 5.6 ng/ml, 95% CI 4.1-7.4). In general, these relationships were consistent among subgroups receiving adjuvant/salvage radiation. CONCLUSIONS Men with comorbid disease at increased risk of morbidity and mortality with androgen deprivation therapy often receive androgen deprivation therapy at low prostate specific antigen values.
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Affiliation(s)
- Ariel Moradzadeh
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lauren E Howard
- Division of Urology, Durham Veterans Affairs Medical Center, Durham, North Carolina
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Stephen J Freedland
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Urology, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | | | - William J Aronson
- Division of Urology, West Los Angeles Veterans Affairs Medical Center, Los Angeles, California
| | | | | | - Zachary Klaassen
- Department of Surgery, Section of Urology, Augusta University, Augusta, Georgia
| | - Martha K Terris
- Department of Surgery, Section of Urology, Augusta University, Augusta, Georgia
- Division of Urology, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia
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Smith AJ, Farstad SM, von Ranson KM. Self-reported eating disorder psychopathology prevalence in community-based female and male Albertans: Gender and age group comparisons. Int J Eat Disord 2021; 54:438-444. [PMID: 33296105 DOI: 10.1002/eat.23434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We describe and compare eating disorder (ED) psychopathology prevalence in Canadian females and males across five age groups. METHOD This secondary data analysis study used the Eating Disorder Examination Questionnaire (EDE-Q) to assess ED psychopathology in 1,316 Alberta community-based female and male participants, aged 15 to 71. RESULTS Overall, 15.3% of female and 8.2% of male participants reported clinically-significant ED disturbances. Female participants reported greater global ED psychopathology than male participants, except older men and women aged 65-71, who reported similar, relatively low levels of global ED psychopathology. Women aged 65-71 endorsed less global ED psychopathology than younger females. More females than males reported regular binge eating and self-induced vomiting, whereas other ED behaviors were endorsed at similar rates. DISCUSSION This large-scale study, the first involving a Canadian sample, contributes to a small literature on ED psychopathology in community-based samples. The finding that 15% of female and 8% of male Albertans aged 15 to 71 endorsed clinically-significant ED disturbances is concerning; however, women aged 65-71 reported lower ED psychopathology than younger females. Gender and age differences were observed in global ED psychopathology. Routine ED screening of non-clinical adolescents and adults is warranted to permit prevention and early intervention.
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Affiliation(s)
- Alyssa J Smith
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Sarah M Farstad
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Abstract
PURPOSE While the true incidence of secondary hypospadias repair is unknown, the current literature cites a 3.3% to 6.7% reoperation rate after distal hypospadias repair and an association with age. We hypothesized that secondary surgery rates are associated with patient factors and have been underreported due to limited followup. MATERIALS AND METHODS We used an academic practice plan consortium database to identify a population that underwent primary hypospadias repair in 2009 and 2010. Secondary surgeries between 2009 and 2019 were captured. The association of variables such as age, insurance type, region, surgeon volume and surgeon years in practice with all-inclusive and specific secondary surgery procedures were analyzed using mixed effects multiple logistic regression models. RESULTS We identified 5,178 boys who had primary hypospadias repair performed by 84 pediatric urologists at 46 hospitals in 2009 and 2010. During the ensuing 9 to 10 years, distal, proximal and perineal hypospadias repair had a 12.6%, 37.9% and 46.6% rate of secondary surgery, respectively. After adjusting for all other variables in the model, patients with noncommercial insurance had a 26% (OR 1.26, p=0.04) increased odds of secondary surgery. Patient age and surgeon years in practice were not associated with all-inclusive secondary surgery except for endoscopic treatment. Surgeon volume was not associated with secondary surgery. CONCLUSIONS This study demonstrated that secondary surgery rates are underreported if followup is limited to less than 6 years. Patient age, surgeon volume and experience did not associate with all-inclusive reoperation rates whereas insurance status was a major predictor of reoperation.
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Chang H, Min JY, Yoo D, Lee SU, Hwang SY, Yoon H, Cha WC, Shin TG, Jo IJ, Kim T. National Surveillance of Injury in the Republic of Korea: Increased Injury Vulnerability in the Late Middle Age. Int J Environ Res Public Health 2021; 18:ijerph18031210. [PMID: 33572916 PMCID: PMC7908217 DOI: 10.3390/ijerph18031210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/24/2022]
Abstract
Surveillance of injury patterns and comparisons among different age groups help develop a better understanding of recent injury trends and early prevention. This study conducted a national surveillance of injury by age group. Data were collected retrospectively from Emergency Department-Based Injury In-Depth Surveillance (EDIIS) in South Korea, between January 2011 and December 2017. Patients were divided into the following four groups by age: Group 1–18 to 34 years, Group 2–35 to 49 years, Group 3–50 to 64 years, and Group 4—≥65 years. A total of 1,221,746 patients were included in the study. Findings revealed that, each year, the injury rate increased in the population aged ≥65 years. The place and mechanism of injury in Group 3 were similar to those in younger age groups, while injury outcomes and injured body parts were similar to those in Group 4. Further, hospital admission rate, ICU admission rate, hospital death, traumatic brain injury, and injury severity increased with an increase in age. In our study, each age group showed diverse characteristics pertaining to the mechanism, place, time, and outcomes of injuries. Interestingly, Group 3, which represented the late middle age, exhibited increased vulnerability to injury, and emerged as a gray zone between the young and old age groups. Therefore, different injury prevention methods are needed for each age group. Specifically, early prevention methods need to be implemented from the late middle age to improve the old age group’s injury outcomes.
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Affiliation(s)
- Hansol Chang
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea;
| | - Ji Young Min
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea;
| | - Dajeong Yoo
- Samsung Medical Center, Research Institute of Future Medicine, Seoul 06351, Korea;
| | - Se Uk Lee
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
| | - Sung Yeon Hwang
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
| | - Hee Yoon
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
| | - Won Chul Cha
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea;
- Health Information and Strategy Center, Samsung Medical Center, Seoul 06351, Korea
| | - Tae Gun Shin
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
| | - Ik Joon Jo
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
| | - Taerim Kim
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
- Correspondence: ; Tel.: +82-2-3410-2053; Fax: +82-2-3410-0049
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Meisel P, Nauck M, Kocher T. Individual predisposition and the intricate interplay between systemic biomarkers and periodontal risk in a general population. J Periodontol 2021; 92:844-853. [PMID: 33315240 DOI: 10.1002/jper.20-0591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/16/2020] [Accepted: 12/08/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Increasing age is associated with systemic diseases as well as with periodontal diseases. We wondered whether a biological age score constructed exclusively from systemic biomarkers would reflect periodontal risk factors at baseline and tooth loss as well as periodontal outcome during 10 years follow-up. METHODS From the Study of Health in Pomerania (SHIP) 2256 participants (1072 male, 1184 female) were studied for the relationship of the systemic biomarkers glycated hemoglobin (HbA1c), low density lipoprotein cholesterol (LDL), fibrinogen, white blood cell count, blood pressure, and waist circumference to their age. Construction of a biological age (BA) score allowed its comparison with the participants' actual chronological age (CA) and their predisposition to periodontal disease. RESULTS Though nearly identical in CA, participants appearing younger than their true age had a significantly reduced burden of periodontal risk factors. If BA > CA, then risk factors were more frequent including smoking, oral hygiene, dental visits, education, and income. After 10 years, in participants with identical CA, tooth loss followed their BA calculated at baseline, that is, with BA > CA fewer teeth were preserved. Similarly, periodontal measures varied according to BA; sex differences were obvious. Most significant were BA-related differences in inflammatory and anthropometry parameters. CONCLUSIONS The results support the assumption that risk profiles aggregated in BA constitute a characteristic susceptibility pattern unique to each individual, common to both systemic and periodontal diseases. Although BA was constructed exclusively from systemic measures at baseline, BA reflects the oral conditions at follow-up.
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Affiliation(s)
- Peter Meisel
- Dental Clinics, Department of Periodontology, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Diagnostics, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Dental Clinics, Department of Periodontology, University Medicine Greifswald, Greifswald, Germany
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Abu Hammour K, Abdel Jalil M, AlHabeis S, Abu Hammour G, Manaseer Q. Prevalence of potentially inappropriate prescribing in older adults in Jordan: Application of the STOPP criteria. Australas J Ageing 2020; 40:e70-e78. [PMID: 33247532 DOI: 10.1111/ajag.12855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To measure the prevalence of cases of potentially inappropriate prescribing (PIP) for older patients and to identify the risk factors for identified cases of PIP. METHODS STOPP criteria version 2 were used for identifying cases of PIP for older patients (>65 years) who were admitted to a tertiary hospital in Jordan over a period of 18 months. Data were collected by prospectively reviewing the clinical and prescription records of included patients. Descriptive analysis, univariate analysis and multiple linear regression were used to analyse the results. RESULTS Upon admission, during hospitalisation and on discharge, 144, 182 and 156 cases of PIP were identified, respectively. There was a statistically significant association between the number of prescribed medications and cases of PIP during the hospital journey (P < .05). CONCLUSION Inappropriate prescribing of medications is highly prevalent among older patients. Application of validated (STOPP) criteria can help to detect and direct development of interventions to prevent PIP occurrence among older patients.
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Affiliation(s)
- Khawla Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Mariam Abdel Jalil
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | | | - Ghayda' Abu Hammour
- Pharmacy Department, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Qusai Manaseer
- Faculty of Medicine, The University of Jordan, Amman, Jordan
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Doege D, Thong MSY, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B, Pritzkuleit R, Waldmann A, Zeissig SR, Brenner H, Arndt V. Age-specific prevalence and determinants of depression in long-term breast cancer survivors compared to female population controls. Cancer Med 2020; 9:8713-8721. [PMID: 33022889 PMCID: PMC7666751 DOI: 10.1002/cam4.3476] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors. Methods About 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression. Results Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups <80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease‐free survivors and controls, but prevalence in disease‐free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression. Conclusions Long‐term BC survivors <80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care.
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Affiliation(s)
- Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Hamburg Cancer Registry, Hamburg, Germany.,Institute of Social Medicine and Epidemiology, University Lübeck, Lübeck, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Kapicibasi HO. Age differences in blunt chest trauma: a cross-sectional study. Kardiochir Torakochirurgia Pol 2020; 17:123-6. [PMID: 33014086 DOI: 10.5114/kitp.2020.99074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/15/2020] [Indexed: 01/22/2023]
Abstract
Introduction Trauma is the most common cause of presentation to hospital emergency services. After extremity and cranial injuries, blunt thoracic trauma is the third most common injury. Aim In this study, we aimed to present and assess blunt chest trauma in adults aged below 65 and elderly (age ≥ 65). Material and methods In this study, 130 patients (86 young (age 18-64) and 44 elderly (age ≥ 65)) who applied to the emergency department with blunt thoracic trauma between October 2017 and October 2019 were evaluated retrospectively. Results Of the patients, 99 (76.1%) were male, and 31 (23.9%) were female. The mean age was 54.41 ±20.13 years, and the patients were between 18 and 95 years of age. The most common cause of blunt thoracic trauma in the elderly group was a fall (n = 27; 61.3%), while in-vehicle traffic accident was most common in the young group (n = 43; 50%). "Flail chest," which is observed as a complication after multiple rib fractures, was present in 1 patient in the young group and in 10 patients in the elderly group; the difference was statistically significant (p > 0.05). Seven (5.3%) patients died. The mean hospital stay was 5.1 (1-60) days, which was borderline-significantly higher in the elderly group (p = 0.056). Conclusions Due to its life-threatening properties, the detection of blunt thorax trauma is a priority among multiple-trauma patients. For this reason, an aggressive diagnosis and treatment approach is essential in the whole patient group, especially among the elderly.
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Moth G, Christensen MB, Christensen HC, Carlsen AH, Riddervold IS, Huibers L. Age-related differences in motives for contacting out-of-hours primary care: a cross-sectional questionnaire study in Denmark. Scand J Prim Health Care 2020; 38:272-280. [PMID: 32700648 PMCID: PMC7470132 DOI: 10.1080/02813432.2020.1794160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Demands for out-of-hours primary care (OOH-PC) services are increasing. Many citizens call because of non-urgent health problems. Nevertheless, the patients' motives for requesting medical help outside office hours remains an understudied area. This study aimed to examine motives for calling OOH-PC services in various age groups. DESIGN Cross-sectional paper based questionnaire study conducted during two weeks in 2015. SETTING The OOH-PC services in two Danish regions. SUBJECTS Randomly selected patients calling the two healthcare services and accepting to participate in the study received a questionnaire on patient characteristics, health problems, and 26 pre-defined motives based on the Andersen Behavioural Model. Multivariate regression analyses were conducted for various age groups to calculate the probability of each motive to be a significant factor for the decision to call. RESULTS A total of 1,871 patients were included in the study; half were parents of children aged 0-12 years. Young adults (18 to 39 years) differed significantly from other age groups as they more often stated perceived barriers and benefits such as "Own GP no time available soon enough" and "Need for quick help because of work". CONCLUSION Young adults more often perceive barriers and benefits, which may suggest af difference in expectations regarding the purpose of out-of-hours services and accessibility. Further research is needed to address this issue and further explore the potential gap between the citizens' expectations to the OOH-PC services and the prevailing health policies. Key points The out-of-hours primary healthcare services are increasingly contacted for non-urgent problems, but little is known about the citizens' motives for calling. Age is associated with differences in the perceived importance of various motives for calling out-of-hours care. Young adults are more often than other age groups motivated to call due to logistical issues, such as their job.
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Affiliation(s)
- Grete Moth
- Research Unit for General Practice, Aarhus, Denmark
- CONTACT Grete Moth Research Unit for General Practice, Aarhus, Denmark
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Nassim G, Redmond ML, Ofei-Dodoo S, Benton M, Lu K. Nutrition Self-Efficacy and Dietary Patterns among Older African American Women in Kansas. Kans J Med 2020; 13:209-213. [PMID: 32843925 PMCID: PMC7440852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/12/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Nutrition is the key contributor to disparities in many chronic diseases. However, little is known about the dietary habits and nutrition self-efficacy beliefs of older African American women with chronic diseases. This study looked at the relationship between nutrition self-efficacy and dietary patterns among older African American women. METHODS A total of 115 African American women 55 years and older, with one or more chronic diseases such as hypertension, diabetes, and hyperlipidemia, were recruited from a midwestern city in Kansas. Participants completed a survey comprised of dietary intake items and the Physical Activity and Nutrition Self-Efficacy (PANSE) scale. Data were analyzed with descriptive statistics, Spearman correlation, and Wilcoxon rank sum test (Mann-Whitney U Test). RESULTS There was a 79% (91/115) participation rate. Participants were confident in their ability to maintain healthy behaviors (57.67/72; SD = 11.22). The mean dietary score for fats and carbohydrate consumption was 32.67 ± 2.48 compared to 5.89 ± 3.52 for fruit and vegetable intake. A significant positive correlation was observed between fruit and vegetable intake and nutrition self-efficacy. A higher fruit and vegetable intake were observed among married women (mean = 7.35; SD = 4.45). CONCLUSION Our findings shed new light on older African American women's perceptions of healthy eating and the confidence to eat heathy. Based on these results, older African American women met the daily fruit and vegetable recommendations; however, more work is needed to understand how to intervene to improve dietary behaviors regarding fat and carbohydrate consumption in this population. While more research is needed, the findings indicated behavioral theories such as nutrition self-efficacy may have utility in tailoring nutrition interventions in an older African American population.
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Affiliation(s)
- Grace Nassim
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Michelle L. Redmond
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Samuel Ofei-Dodoo
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Mary Benton
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Kelsey Lu
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
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38
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Freak-Poli R, Malta S. An overview of sexual behaviour research in later life-Quantitative and qualitative findings. Australas J Ageing 2020; 39 Suppl 1:16-21. [PMID: 32567181 DOI: 10.1111/ajag.12773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/19/2022]
Abstract
AIM This article provides an overview of current sexual behaviour research in later life by describing associated factors, including the physical and psychological benefits. METHODS Recent systematic reviews were interrogated for findings on sexual behaviour research in adults aged 60+. RESULTS Regardless of research methods employed, all studies showed that there were a range of physical and psychological benefits to remaining sexually active in later life. While quantitative studies placed an emphasis on measuring penile-vaginal intercourse, they provided no definitive conclusion about the benefits due to 'inconsistent results' across studies. Qualitative studies described the myriad ways in which older adults redefine what constitutes sexual activity despite the onset of dysfunction and disability. CONCLUSION While the different research methods show that engaging in sexual behaviour has physical and psychological benefits at all adult ages, there is limited conclusive evidence about what the overall benefits might be in later life.
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Affiliation(s)
- Rosanne Freak-Poli
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sue Malta
- Sexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia.,National Ageing Research Institute, Parkville, Vic., Australia
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Piedimonte S, Kessous R, Laskov I, Abitbol J, Kogan L, Yasmeen A, Salvador S, Lau S, Gotlieb WH. Similar Overall Survival Using Neoadjuvant Chemotherapy or Primary Debulking Surgery in Patients Aged Over 75 Years with High-Grade Ovarian Cancer. J Obstet Gynaecol Can 2020; 42:1339-1345. [PMID: 32859533 DOI: 10.1016/j.jogc.2020.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To perform a hypothesis-generating evaluation of patient outcomes following neoadjuvant chemotherapy (NACT) compared with those following primary debulking surgery (PDS) in patients over age 75 with high-grade ovarian cancer. METHODS This was a retrospective cohort study of consecutive patients aged 75 years and older, with high-grade ovarian cancer. Data were analyzed in SPSS 25.0 using descriptive statistics to characterize groups based on primary treatment modality, Kaplan-Meier survival curves to estimate overall and progression-free survival, and Cox proportional hazards to analyze confounders. RESULTS Of 429 patients with stages III and IV high-grade ovarian cancer (endometrioid and serous), 71 were aged older than 75 years and met our criteria for inclusion; 58 were treated with NACT while 13 underwent primary debulking. Sixteen patients did not undergo interval debulking following NACT. There were no significant differences in demographic characteristics between the groups. Following NACT, more patients were completely debulked-36.2% versus 21% (P = 0.000)-and had a shorter length of stay (5 vs. 7 d; P = 0.018). Overall survival was similar between the NACT and PDS groups (58.7 vs. 59.7 mo; LR -0.836; P = 0.361) despite lower progression-free survival in the NACT group (25.9 vs. 47.1 mo; P = 0.042; LR 4.31). Both progression-free and overall survival were significantly higher when patients undergoing NACT achieved complete debulking (21.7 and 102.3 mo, respectively) compared with suboptimal debulking (12.03 and 14.2 mo, respectively). CONCLUSION In this select group older patients with stage III and IV high-grade ovarian cancers, neoadjuvant chemotherapy may be considered without compromising outcomes and contributes to complete debulking.
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Affiliation(s)
- Sabrina Piedimonte
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Ido Laskov
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Liron Kogan
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC.
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40
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Mah K, Shapiro GK, Hales S, Rydall A, Malfitano C, An E, Nissim R, Li M, Zimmermann C, Rodin G. The impact of attachment security on death preparation in advanced cancer: The role of couple communication. Psychooncology 2020; 29:833-840. [PMID: 32043679 DOI: 10.1002/pon.5354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Attachment security protects psychological well-being in patients with advanced cancer, but its effect on death preparation in this population has not been demonstrated. We examined the relationship of attachment security to death preparation in advanced cancer and tested whether couple communication mediates this relationship and whether gender and age moderate this mediating effect, using longitudinal data from a psychotherapy trial. METHODS Patients with advanced cancer who lived with a partner (Nbaseline = 289) completed measures of attachment security (attachment avoidance, attachment anxiety), couple communication, and death preparation (preparation for end of life, life completion) and attendant health involvement (relationship with healthcare provider). A moderated mediation model was evaluated at each time period (baseline, 3 months, and 6 months). RESULTS Couple communication mediated the relationship of attachment security to preparation for end of life and life completion (b's = -.06 to -.10). Anxiety × Gender effects on baseline couple communication (P's = .016) indicated that women with greater attachment anxiety reported worse communication than their male counterparts. Couple-communication × Gender × Age effects on baseline preparation for end of life (P = .007-.020) suggested that women showed better preparation with better couple communication. Younger patients reported less preparation than older patients, especially with poorer communication, but their preparation increased with better communication, especially in younger men. CONCLUSIONS Attachment security supports death preparation in advanced cancer partly through better couple communication. Couple-based psychotherapeutic interventions, especially for younger individuals and women with attachment anxiety, may facilitate constructive conversations and death preparation.
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Affiliation(s)
- Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative, and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Ekaterina An
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative, and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative, and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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41
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Leeser DB, Thomas AG, Shaffer AA, Veale JL, Massie AB, Cooper M, Kapur S, Turgeon N, Segev DL, Waterman AD, Flechner SM. Patient and Kidney Allograft Survival with National Kidney Paired Donation. Clin J Am Soc Nephrol 2020; 15:228-237. [PMID: 31992572 PMCID: PMC7015097 DOI: 10.2215/cjn.06660619] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/14/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In the United States, kidney paired donation networks have facilitated an increasing proportion of kidney transplants annually, but transplant outcome differences beyond 5 years between paired donation and other living donor kidney transplant recipients have not been well described. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using registry-linked data, we compared National Kidney Registry (n=2363) recipients to control kidney transplant recipients (n=54,497) (February 2008 to December 2017). We estimated the risk of death-censored graft failure and mortality using inverse probability of treatment weighted Cox regression. The parsimonious model adjusted for recipient factors (age, sex, black, race, body mass index ≥30 kg/m2, diabetes, previous transplant, preemptive transplant, public insurance, hepatitis C, eGFR, antibody depleting induction therapy, year of transplant), donor factors (age, sex, Hispanic ethnicity, body mass index ≥30 kg/m2), and transplant factors (zero HLA mismatch). RESULTS National Kidney Registry recipients were more likely to be women, black, older, on public insurance, have panel reactive antibodies >80%, spend longer on dialysis, and be previous transplant recipients. National Kidney Registry recipients were followed for a median 3.7 years (interquartile range, 2.1-5.6; maximum 10.9 years). National Kidney Registry recipients had similar graft failure (5% versus 6%; log-rank P=0.2) and mortality (9% versus 10%; log-rank P=0.4) incidence compared with controls during follow-up. After adjustment for donor, recipient, and transplant factors, there no detectable difference in graft failure (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77 to 1.18; P=0.6) or mortality (adjusted hazard ratio, 0.86; 95% confidence interval, 0.70 to 1.07; P=0.2) between National Kidney Registry and control recipients. CONCLUSIONS Even after transplanting patients with greater risk factors for worse post-transplant outcomes, nationalized paired donation results in equivalent outcomes when compared with control living donor kidney transplant recipients.
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Affiliation(s)
- David B Leeser
- Department of Surgery, East Carolina University, Greenville, North Carolina;
| | - Alvin G Thomas
- Department of Surgery and.,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Ashton A Shaffer
- Department of Surgery and.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Sandip Kapur
- Department of Surgery, Cornell University, New York, New York
| | - Nicole Turgeon
- Department of Surgery, Dell School of Medicine, University of Texas at Austin, Austin, Texas
| | - Dorry L Segev
- Department of Surgery and.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Amy D Waterman
- Department of Nephrology, University of California, Los Angeles, Los Angeles, California.,Terasaki Research Institute, Los Angeles, California; and
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Shamout F, Zhu T, Clifton L, Briggs J, Prytherch D, Meredith P, Tarassenko L, Watkinson PJ, Clifton DA. Early warning score adjusted for age to predict the composite outcome of mortality, cardiac arrest or unplanned intensive care unit admission using observational vital-sign data: a multicentre development and validation. BMJ Open 2019; 9:e033301. [PMID: 31748313 PMCID: PMC6887005 DOI: 10.1136/bmjopen-2019-033301] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Early warning scores (EWS) alerting for in-hospital deterioration are commonly developed using routinely collected vital-sign data from the whole in-hospital population. As these in-hospital populations are dominated by those over the age of 45 years, resultant scores may perform less well in younger age groups. We developed and validated an age-specific early warning score (ASEWS) derived from statistical distributions of vital signs. DESIGN Observational cohort study. SETTING Oxford University Hospitals (OUH) July 2013 to March 2018 and Portsmouth Hospitals (PH) NHS Trust January 2010 to March 2017 within the Hospital Alerting Via Electronic Noticeboard database. PARTICIPANTS Hospitalised patients with electronically documented vital-sign observations OUTCOME: Composite outcome of unplanned intensive care unit admission, mortality and cardiac arrest. METHODS AND RESULTS Statistical distributions of vital signs were used to develop an ASEWS to predict the composite outcome within 24 hours. The OUH development set consisted of 2 538 099 vital-sign observation sets from 142 806 admissions (mean age (SD): 59.8 (20.3)). We compared the performance of ASEWS to the National Early Warning Score (NEWS) and our previous EWS (MCEWS) on an OUH validation set consisting of 581 571 observation sets from 25 407 emergency admissions (mean age (SD): 63.0 (21.4)) and a PH validation set consisting of 5 865 997 observation sets from 233 632 emergency admissions (mean age (SD): 64.3 (21.1)). ASEWS performed better in the 16-45 years age group in the OUH validation set (AUROC 0.820 (95% CI 0.815 to 0.824)) and PH validation set (AUROC 0.840 (95% CI 0.839 to 0.841)) than NEWS (AUROC 0.763 (95% CI 0.758 to 0.768) and AUROC 0.836 (95% CI 0.835 to 0.838) respectively) and MCEWS (AUROC 0.808 (95% CI 0.803 to 0.812) and AUROC 0.833 (95% CI 0.831 to 0.834) respectively). Differences in performance were not consistent in the elder age group. CONCLUSIONS Accounting for age-related vital sign changes can more accurately detect deterioration in younger patients.
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Affiliation(s)
- Farah Shamout
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Tingting Zhu
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Lei Clifton
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jim Briggs
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, UK
| | - David Prytherch
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, UK
| | - Paul Meredith
- Research and Innovation Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, Oxford, UK
| | - David A Clifton
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
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Abstract
The second derivative of photoplethysmogram (SDPTG) is used as an arterial stiffness marker. This study aimed to examine the associations between SDPTG indices and age, in addition to hemodynamic, autonomic, adiposity, and emotional factors.This study had a cross-sectional chart review design, and electronic medical records of 262 women outpatients (mean ± SD,|38.57| ± |11.64 years) were reviewed. Among SDPTG measurements, b/a, c/a, d/a, and (b-c-d)/a were considered. Hemodynamic measurements included systolic and diastolic blood pressure (SBP and DBP) and cardiac output. Autonomic measurements included low and high frequency (LF and HF) values of the heart rate variability. Adiposity measurements included body mass index (BMI) and waist-hip ratio (WHR). Tension, anger, depression, fatigue, confusion, and vigor scores using the Profile of the Mood States were included as emotional markers. All data were normalized through the Box-Cox transformation, and 4 hierarchical regression models were constructed.Age was independently predictive of SDPTG, hemodynamic, autonomic, and adiposity factors (β; 0.143-0.648).After the adjustment for age, SBP and DBP showed negative correlations with d/a (r = -0.201, -0.262), whereas BMI, WHR, LF, and HF showed positive correlations with c/a (r = 0.126, 0.131, 0.151, 0.234). In the hierarchical regression modeling, age and hemodynamic factors were directly predictive of SDPTG indices (β; 0.103-0.626). Age had moderating effects between diastolic blood pressure, heart rate, depression scores, and SDPTG indices (β; 0.104-0.176).In conclusion, age, hemodynamic, adiposity, and autonomic factors may be independently associated with SDPTG indices for women. As age has moderating effects between hemodynamic, emotional factors, and SDPTG indices, its moderating effects should be considered when assessing arterial stiffness using SDPTG indices.
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Affiliation(s)
- Young-Jae Park
- Department of Biofunctional Medicine and Diagnostics, College of Korean Medicine, Kyung Hee University
- Department of Diagnosis and Biofunctional Medicine, Kyung Hee University Hospital at Gangdong
- Department of Human Informatics of Korean Medicine, Graduate School, Kyung Hee University
| | - Jin-Moo Lee
- Department of Women Health Clinic, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Soon-Hyuk Kwon
- Department of Human Informatics of Korean Medicine, Graduate School, Kyung Hee University
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Abstract
OBJECTIVE To analyze the impact of maternal age on sex chromosome aneuploidies (SCA). METHODS Pregnant women who had karyotype analysis of amniotic fluid in Women's Hospital, Zhejiang University School of Medicine from January 2014 to July 2018 were recruited. The association of the maternal age with fetal SCAs was analyzed. RESULTS The incidence of 45, X in age group >34-<38 was lower than that of ≤ 28 age group (P<0.05). For the incidences of total sex chromosome trisomy and 47, XXY in age groups 34-<38 and ≥38 were higher than age groups ≤28 and >28-34 (P<0.05 or P<0.01). The incidence of 47, XXX in age group ≥ 38 was higher than that in age group>28-34 (P<0.05). However, the incidence of 47, XYY had no differences among the four groups (P>0.05). After excluding the high risk of sex chromosome abnormalities by non-invasive prenatal testing (NIPT), we found that for 45, X, the incidences of two groups with advanced age were lower than that of ≤ 28 year-old group of age group (P<0.05 or P<0.01), and incidence in age group >34-<38 was also lower than that in age group >28-34 (P<0.05). The other results were consistent with those without excluding the high risk of sex chromosome abnormalities by NIPT. CONCLUSIONS Advanced age decreases the incidence of 45, X, but increases the risk of sex chromosome trisomy, especially 47, XXX and 47, XXY.
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Affiliation(s)
| | - Minyue DONG
- 董旻岳(1964—), 男, 博士, 主任医师, 博士生导师, 主要从事生殖遗传学研究; E-mail:
;
https://orcid.org/0000-0002-4344-7924
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45
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Jeong MJ, Kwon SU, Kim MJ, Han Y, Kwon TW, Cho YP. Effects of patient age on outcomes after carotid endarterectomy: A retrospective, single-center study in Korea. Medicine (Baltimore) 2019; 98:e16781. [PMID: 31393403 PMCID: PMC6708719 DOI: 10.1097/md.0000000000016781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In this single-center, retrospective study, we aimed to compare early and late outcomes after carotid endarterectomy (CEA) between younger and elderly patients and to investigate the impact of patient age on the overall incidence of cardiovascular events after CEA.A total of 613 patients with 675 CEAs between January 2007 and December 2014 were stratified by patient age into 2 groups: younger (≤60 years, n = 103 CEAs, 15.3%) and elderly (>60 years, n = 572 CEAs, 84.7%) groups. The study outcomes were defined as the occurrence of major adverse events (MAEs), including fatal or nonfatal stroke or myocardial infarction (MI), or any-cause mortality, and overall cardiovascular events (meaning the composite incidence of stroke or MI) during the perioperative period and within 4 years after CEA.Although there were no significant differences in the incidence of 30-day MAEs and any of the individual MAE manifestations between the 2 groups, the differences in the MAE incidence (P = .006) and any-cause mortality (P = .023) within 4 years after CEA were significantly greater in patients in the elderly group. For overall incidence of cardiovascular events, no significant difference was noted between the 2 groups (P = .096). On multivariate analysis, older age (>60 years) did not affect the incidence of perioperative MAEs and individual MAE manifestations; however, older age was significantly associated with an increased risk of 4-year MAEs (hazard ratio [HR], 3.68, 95% confidence interval [CI], 1.35-10.0; P = .011) and any-cause mortality (HR, 3.26, 95% CI, 1.02-10.5; P = .047). With regard to the 4-year overall incidence of cardiovascular events, older age was not an independent predictor of increased risk of these cardiovascular events.Our study indicates that the risks of perioperative MAEs and the 4-year overall incidence of cardiovascular events do not significantly differ between younger and elderly Korean patients undergoing CEA, although there was a higher risk of 4-year any-cause mortality in the elderly patients. Older age does not appear to be an independent risk factor for perioperative MAEs and overall cardiovascular events within 4 years after CEA.
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Affiliation(s)
| | | | - Min-Ju Kim
- Departments of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Youngjin Han
- Department of Surgery, Division of Vascular Surgery
| | - Tae-Won Kwon
- Department of Surgery, Division of Vascular Surgery
| | - Yong-Pil Cho
- Department of Surgery, Division of Vascular Surgery
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46
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Tejera‐Vaquerizo A, Ribero S, Puig S, Boada A, Paradela S, Moreno‐Ramírez D, Cañueto J, de Unamuno B, Brinca A, Descalzo‐Gallego MA, Osella‐Abate S, Cassoni P, Carrera C, Vidal‐Sicart S, Bennássar A, Rull R, Alos L, Requena C, Bolumar I, Traves V, Pla Á, Fernández‐Orland A, Jaka A, Fernández‐Figueres MT, Hilari JM, Giménez‐Xavier P, Vieira R, Botella‐Estrada R, Román‐Curto C, Ferrándiz L, Iglesias‐Pena N, Ferrándiz C, Malvehy J, Quaglino P, Nagore E. Survival analysis and sentinel lymph node status in thin cutaneous melanoma: A multicenter observational study. Cancer Med 2019; 8:4235-4244. [PMID: 31215168 PMCID: PMC6675713 DOI: 10.1002/cam4.2358] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 12/27/2022] Open
Abstract
Mitotic rate is no longer considered a staging criterion for thin melanoma in the 8th edition of the American Joint Committee on Cancer Staging Manual. The aim of this observational study was to identify prognostic factors for thin melanoma and predictors and prognostic significance of sentinel lymph node (SLN) involvement in a large multicenter cohort of patients with melanoma from nine tertiary care hospitals. A total of 4249 consecutive patients with thin melanoma diagnosed from January 1, 1998 to December 31, 2016 were included. The main outcomes were disease-free interval and melanoma-specific survival for the overall population and predictors of SLN metastasis (n = 1083). Associations between survival and SLN status and different clinical and pathologic variables (sex, age, tumor location, mitosis, ulceration, regression, lymphovascular invasion, histologic subtype, Clark level, and Breslow thickness) were analyzed by Cox proportional hazards regression and logistic regression. SLN status was the most important prognostic factor for melanoma-specific survival (hazard ratio, 13.8; 95% CI, 6.1-31.2; P < 0.001), followed by sex, ulceration, and Clark level for patients who underwent SLNB. A mitotic rate of >2 mitoses/mm2 was the only factor associated with a positive SLN biopsy (odds ratio, 2.9; 95% CI, 1.22-7; P = 0.01. SLN status is the most important prognostic factor in thin melanoma. A high mitotic rate is associated with metastatic SLN involvement. SLN biopsy should be discussed and recommended in patients with thin melanoma and a high mitotic rate.
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Affiliation(s)
| | - Simone Ribero
- Medical Sciences Department, Section of DermatologyUniversity of TurinTurinItaly
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Aram Boada
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Sabela Paradela
- Departamento de DermatologíaHospital Universitario de la CoruñaLa CoruñaSpain
| | - David Moreno‐Ramírez
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | - Javier Cañueto
- Servicio de DermatologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Instituto de Investigación Biomédica de SalamancaComplejo Asistencial Universitario de SalamancaSalamancaSpain
| | - Blanca de Unamuno
- Departamento de DermatologíaHospital Universitario La FeValenciaSpain
| | - Ana Brinca
- Department of DermatologyUniversity Hospital of CoimbraCoimbraPortugal
| | | | - Simona Osella‐Abate
- Medical Sciences Department, Section of Surgical PathologyUniversity of TurinTurinItaly
| | - Paola Cassoni
- Medical Sciences Department, Section of Surgical PathologyUniversity of TurinTurinItaly
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Sergi Vidal‐Sicart
- Nuclear Medicine DepartmentHospital Clinic Barcelona, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Antoni Bennássar
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Ramón Rull
- Surgery DepartmentHospital ClinicBarcelonaSpain
| | - Llucìa Alos
- Pathology Department, Hospital ClinicUniversidad de BarcelonaBarcelonaSpain
| | - Celia Requena
- Dermatology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Isidro Bolumar
- Surgery DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Víctor Traves
- Pathology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Ángel Pla
- Otorhinolaringology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - A. Fernández‐Orland
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | - Ane Jaka
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | | | - Josep M. Hilari
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Pol Giménez‐Xavier
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Ricardo Vieira
- Department of DermatologyUniversity Hospital of CoimbraCoimbraPortugal
| | | | - Concepción Román‐Curto
- Servicio de DermatologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Instituto de Investigación Biomédica de SalamancaComplejo Asistencial Universitario de SalamancaSalamancaSpain
| | - Lara Ferrándiz
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | | | - Carlos Ferrándiz
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Pietro Quaglino
- Medical Sciences Department, Section of DermatologyUniversity of TurinTurinItaly
| | - Eduardo Nagore
- Dermatology DepartmentInstituto Valenciano de OncologíaValenciaSpain
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Ni K, Cooter M, Gupta DK, Thomas J, Hopkins TJ, Miller TE, James ML, Kertai MD, Berger M. Paradox of age: older patients receive higher age-adjusted minimum alveolar concentration fractions of volatile anaesthetics yet display higher bispectral index values. Br J Anaesth 2019; 123:288-297. [PMID: 31279479 DOI: 10.1016/j.bja.2019.05.040] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Minimum alveolar concentration (MAC) and MAC-awake decrease with age. We hypothesised that, in clinical practice, (i) end-tidal MAC fraction in older patients would decline by less than the predicted age-dependent MAC decrease (i.e. older patients would receive relatively excessive anaesthetic concentrations), and (ii) bispectral index (BIS) values would therefore be lower in older patients. METHODS We examined the relationship between end-tidal MAC fraction, BIS values, and age in 4699 patients > 30 yr in age at a single centre using unadjusted local regression (locally estimated scatterplot smoothing), Spearman's correlation, stratification, and robust univariable and multivariable linear regression. RESULTS The end-tidal MAC fraction in older patients declined by 3.01% per decade (95% confidence interval [CI]: 2.56-3.45; P<0.001), less than the 6.47% MAC decrease per decade that we found in a meta-regression analysis of published studies of age-dependent changes in MAC (P<0.001), and less than the age-dependent decrease in MAC-awake. The BIS values correlated positively with age (ρ=0.15; 95% CI: 0.12-0.17; P<0.001), and inversely with the age-adjusted end-tidal MAC (aaMAC) fraction (ρ= -0.13; 95% CI: -0.16, -0.11; P<0.001). CONCLUSIONS The age-dependent decline in end-tidal MAC fraction delivered in clinical practice at our institution was less than the age-dependent percentage decrease in MAC and MAC-awake determined from published studies. Despite receiving higher aaMAC fractions, older patients paradoxically showed higher BIS values. This most likely suggests that the BIS algorithm is inaccurate in older adults.
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Affiliation(s)
- Katherine Ni
- Mount Sinai School of Medicine, New York, NY, USA
| | - Mary Cooter
- Anesthesiology Department, Duke University Medical Center, Durham, NC, USA
| | - Dhanesh K Gupta
- Anesthesiology Department, Duke University Medical Center, Durham, NC, USA
| | - Jake Thomas
- Anesthesiology Department, Duke University Medical Center, Durham, NC, USA; Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Thomas J Hopkins
- Anesthesiology Department, Duke University Medical Center, Durham, NC, USA
| | - Timothy E Miller
- Anesthesiology Department, Duke University Medical Center, Durham, NC, USA
| | - Michael L James
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA; Neurology Department, Duke University Medical Center, Durham, NC, USA
| | - Miklos D Kertai
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Miles Berger
- Anesthesiology Department, Duke University Medical Center, Durham, NC, USA.
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Friedlander DF, von Landenberg N, Löppenberg B, Noldus J, Lipsitz SR, Cole AP, Abdollah F, Nguyen PL, Choueiri TK, Kibel AS, Trinh QD. Facility Level Variation in Rates of Definitive Therapy for Low Risk Prostate Cancer in Men with Limited Life Expectancy: An Opportunity for Value Based Care Redesign. J Urol 2019; 201:728-34. [PMID: 30633112 DOI: 10.1097/JU.0000000000000006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE We sought to identify facility level variation in the use of definitive therapy among men diagnosed with clinically localized, low risk prostate cancer who were more than 65 years old and had a limited life expectancy of less than 10 years. MATERIALS AND METHODS Using data from the National Cancer Database we identified 18,178 men older than 65 years with less than a 10-year life expectancy receiving definitive therapy at a total of 1,172 facilities for biopsy confirmed localized, low risk prostate cancer diagnosed between January 2004 and December 2013. A multilevel, hierarchical, mixed effects logistic regression model was fitted to predict the odds of receiving definitive therapy. RESULTS Overall 18,178 men (76%) older than 65 years with limited life expectancy and a diagnosis of low risk prostate cancer received definitive therapy, although the rate of therapy decreased significantly with time (p <0.001). Patients receiving definitive therapy were more often younger (80 years or older vs 66 to 69 years OR 0.12, 95% CI 0.09-0.15, p <0.001) and white rather than black (OR 0.86, 95% CI 0.75-0.98, p = 0.03). Conversely, being uninsured (OR 0.37, 95% CI 0.21-0.63, p <0.001) and receiving care at an academic medical center (OR 0.36, 95% CI 0.28-0.46, p <0.001) conferred decreased odds of undergoing definitive therapy. The proportion of men undergoing definitive therapy ranged from 0.12% to 100% across facilities. CONCLUSIONS We found significant facility level variation in rates of definitive therapy in men with localized prostate cancer and limited life expectancy. Health care providers and policy makers alike should be aware of the varying frequency with which this potentially low value service is performed.
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Salari K, Kuppermann D, Preston MA, Dahl DM, Barrisford GW, Efstathiou JA, Blute ML, Vesprini D, Loblaw A, Zietman AL, Klotz L, Feldman AS. Active Surveillance of Prostate Cancer is a Viable Option for Men Younger than 60 Years. J Urol 2019; 201:721-7. [PMID: 30664083 DOI: 10.1097/JU.0000000000000031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE At most centers strict age criteria are lacking for eligibility for active surveillance of prostate cancer. Younger men are often counseled to undergo definitive treatment despite limited data on the outcomes of active surveillance in younger men. We compared clinical characteristics and outcomes in men who enrolled in active surveillance at age less than 60 vs 60 years old or older. MATERIALS AND METHODS We retrospectively reviewed the records of 2 institutional cohorts of a total of 2,084 men in whom prostate cancer was managed by active surveillance between 1995 and 2016. We compared outcomes in men who began active surveillance at age 60 vs 60 years or older using the Kaplan-Meier method and Cox proportional hazards regression. RESULTS We identified 417 and 1,667 men who began active surveillance at younger than 60 and 60 years old or older, respectively, who met study inclusion criteria. At a median followup of 6.2 years we found no significant difference between men younger than 60 and 60 years old or older in the 5-year rates of biopsy progression-free survival (83% vs 83%), treatment-free survival (74% vs 71%), metastasis-free survival (99.7% vs 99.0%) or prostate cancer specific survival (100% vs 99.7%). Of the younger men 131 (31%) ultimately underwent treatment, including for pathological progression in 67% and prostate specific antigen progression in 18%. On multivariate analysis significant predictors of biopsy progression and progression to treatment among younger men were 20% or greater involvement of any core on diagnostic biopsy (HR 2.21, p = 0.003) and prostate specific antigen density 0.15 ng/ml/ml or greater (HR 1.93, p = 0.01). CONCLUSIONS Active surveillance is a viable option in select men younger than 60 years with low volume, low risk prostate cancer. However, patients must be surveyed closely and understand the significant likelihood of ultimately requiring treatment.
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Abstract
BACKGROUND Preterm infants have low plasma levels of erythropoietin (EPO), providing a rationale for the use of erythropoiesis-stimulating agents (ESAs) to prevent or treat anaemia. Darbepoetin (Darbe) and EPO are currently available ESAs. OBJECTIVES To assess the effectiveness and safety of late initiation of ESAs, between eight and 28 days after birth, in reducing the use of red blood cell (RBC) transfusions in preterm or low birth weight infants. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), MEDLINE via PubMed (1966 to 5 June 2018), Embase (1980 to 5 June 2018), and CINAHL (1982 to 5 June 2018). We searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of late initiation of EPO treatment (started at ≥ eight days of age) versus placebo or no intervention in preterm (< 37 weeks) or low birth weight (< 2500 grams) neonates. DATA COLLECTION AND ANALYSIS We performed data collection and analyses in accordance with the methods of the Cochrane Neonatal Review Group. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS We include 31 studies (32 comparisons) randomising 1651 preterm infants. Literature searches in 2018 identified one new study for inclusion. No new on-going trials were identified and no studies used darbepoetin.Most included trials were of small sample size. The meta-analysis showed a significant effect on the use of one or more RBC transfusions (21 studies (n = 1202); typical risk ratio (RR) 0.72, 95% confidence interval (CI) 0.65 to 0.79; typical risk difference (RD) -0.17, 95% CI -0.22 to -0.12; typical number needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 5 to 8). There was moderate heterogeneity for this outcome (RR I² = 66%; RD I² = 58%). The quality of the evidence was very low. We obtained similar results in secondary analyses based on different combinations of high/low doses of EPO and iron supplementation. There was no significant reduction in the total volume (mL/kg) of blood transfused per infant (typical mean difference (MD) -1.6 mL/kg, 95% CI -5.8 to 2.6); 5 studies, 197 infants). There was high heterogeneity for this outcome (I² = 92%). There was a significant reduction in the number of transfusions per infant (11 studies enrolling 817 infants; typical MD -0.22, 95% CI -0.38 to -0.06). There was high heterogeneity for this outcome (I² = 94%).Three studies including 404 infants reported on retinopathy of prematurity (ROP) (all stages or stage not reported), with a typical RR 1.27 (95% CI 0.99 to 1.64) and a typical RD of 0.09 (95% CI -0.00 to 0.18). There was high heterogeneity for this outcome for both RR (I² = 83%) and RD (I² = 82%). The quality of the evidence was very low.Three trials enrolling 442 infants reported on ROP (stage ≥ 3). The typical RR was 1.73 (95% CI 0.92 to 3.24) and the typical RD was 0.05 (95% CI -0.01 to 0.10). There was no heterogeneity for this outcome for RR (I² = 18%) but high heterogeneity for RD (I² = 79%). The quality of the evidence was very low.There were no significant differences in other clinical outcomes including mortality and necrotising enterocolitis. For the outcomes of mortality and necrotising enterocolitis, the quality of the evidence was moderate. Long-term neurodevelopmental outcomes were not reported. AUTHORS' CONCLUSIONS Late administration of EPO reduces the use of one or more RBC transfusions, the number of RBC transfusions per infant (< 1 transfusion per infant) but not the total volume (mL/kg) of RBCs transfused per infant. Any donor exposure is likely not avoided as most studies included infants who had received RBC transfusions prior to trial entry. Late EPO does not significantly reduce or increase any clinically important adverse outcomes except for a trend in increased risk for ROP. Further research of the use of late EPO treatment, to prevent donor exposure, is not indicated. Research efforts should focus on limiting donor exposure during the first few days of life in sick neonates, when RBC requirements are most likely to be required and cannot be prevented by late EPO treatment. The use of satellite packs (dividing one unit of donor blood into many smaller aliquots) may reduce donor exposure.
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Affiliation(s)
- Sanjay M Aher
- Neocare HospitalNeonatal Intensive Care UnitMumbai NakaNashikIndia422002
| | - Arne Ohlsson
- University of TorontoDepartments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and Evaluation600 University AvenueTorontoCanadaM5G 1X5
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