Epigenomic alterations and gene expression profiles in respiratory epithelia exposed to cigarette smoke condensate

Limited information is available regarding epigenomic events mediating initiation and progression of tobacco-induced lung cancers. In this study, we established an in vitro system to examine epigenomic effects of cigarette smoke in respiratory epithelia. Normal human small airway epithelial cells and cdk-4/hTERT-immortalized human bronchial epithelial cells (HBEC) were cultured in normal media with or without cigarette smoke condensate (CSC) for up to 9 months under potentially relevant exposure conditions. Western blot analysis showed that CSC mediated dose- and time-dependent diminution of H4K16Ac and H4K20Me3, while increasing relative levels of H3K27Me3; these histone alterations coincided with decreased DNA methyltransferase 1 (DNMT1) and increased DNMT3b expression. Pyrosequencing and quantitative RT-PCR experiments revealed time-dependent hypomethylation of D4Z4, NBL2, and LINE-1 repetitive DNA sequences; up-regulation of H19, IGF2, MAGE-A1, and MAGE-A3; activation of Wnt signaling; and hypermethylation of tumor suppressor genes such as RASSF1A and RAR-beta, which are frequently silenced in human lung cancers. Array-based DNA methylation profiling identified additional novel DNA methylation targets in soft-agar clones derived from CSC-exposed HBEC; a CSC gene expression signature was also identified in these cells. Progressive genomic hypomethylation and locoregional DNA hypermethylation induced by CSC coincided with a dramatic increase in soft-agar clonogenicity. Collectively, these data indicate that cigarette smoke induces 'cancer-associated' epigenomic alterations in cultured respiratory epithelia. This in vitro model may prove useful for delineating early epigenetic mechanisms regulating gene expression during pulmonary carcinogenesis.

Noninvasive imaging evaluation of tumor immune microenvironment to predict outcomes in gastric cancer

BACKGROUND

The tumor immune microenvironment can provide prognostic and predictive information. A previously validated ImmunoScore of Gastric Cancer (ISGC) evaluates both lymphoid and myeloid cells in the tumor core and invasive margin with immunohistochemical staining of surgical specimens. We aimed to develop a noninvasive radiomics-based predictor of ISGC.

PATIENTS AND METHODS

In this retrospective study including four independent cohorts of 1778 patients, we extracted 584 quantitative features from the intratumoral and peritumoral regions on contrast-enhanced computed tomography images. A radiomic signature [radiomics ImmunoScore (RIS)] was constructed to predict ISGC using regularized logistic regression. We further evaluated its association with prognosis and chemotherapy response.

RESULTS

A 13-feature radiomic signature for ISGC was developed and validated in three independent cohorts (area under the curve = 0.786, 0.745, and 0.766). The RIS signature was significantly associated with both disease-free and overall survival in the training and all validation cohorts [hazard ratio (HR) range: 0.296-0.487, all P < 0.001]. In multivariable analysis, the RIS remained an independent prognostic factor adjusting for clinicopathologic variables (adjusted HR range: 0.339-0.605, all P < 0.003). For stage II and stage III disease, patients with a high RIS derived survival benefit from adjuvant chemotherapy {HR = 0.436 [95% confidence interval (CI) 0.253-0.753], P = 0.002; HR = 0.591 (95% CI 0.428-0.818), P < 0.001, respectively}, whereas those with a low RIS did not.

CONCLUSION

The RIS is a reliable tool for evaluation of immunoscore and retains the prognostic significance in gastric cancer. Future prospective studies are required to confirm its potential to predict treatment response and select patients who will benefit from chemotherapy.

Gene therapy for the treatment of oral squamous cell carcinoma

Despite advances in surgery, radiotherapy, and chemotherapy, the survival of patients with oral squamous cell carcinoma has not significantly improved over the past several decades. Treatment options for recurrent or refractory oral cancers are limited. Gene therapy for oral cancer is currently under investigation in clinical trials. The goal of cancer gene therapy is to introduce new genetic material into target cells without toxicity to non-target tissues. This review discusses the techniques used in cancer gene therapy for oral squamous cell carcinoma and summarizes the ongoing strategies that are being evaluated in clinical trials.

Thickness-induced structural phase transformation of layered gallium telluride

We report a spontaneous phase transformation of GaTe, occurring when the bulk is exfoliated to a few layers. The results demonstrate the crucial role of interlayer interactions in the structural stability.

Liver antioxidant defenses in mice fed ethanol and the AIN-76A diet

The effects of chronic alcohol (EtOH) ingestion on antioxidant defenses in mice fed AIN-76A liquid diets were investigated. C57Bl/6 female mice were divided into three groups and fed the AIN-76A liquid EtOH diet containing EtOH to provide 31% of total caloric intake (TCI), the same basic diet containing EtOH to provide 35% of TCI, or an isocaloric AIN-76A liquid control diet. After 3 weeks, the mice were killed and livers were excised for biochemical analysis. Liver reduced glutathione (GSH) levels, and activities of both Mn-superoxide dismutase (SOD) and Cu/Zn-SOD were significantly decreased by both levels of EtOH. Activities of catalase and glutathione transferase (GT) were significantly increased, whereas glutathione peroxidase (GP) activity was not affected by either level of EtOH. Our previous study using the Lieber-DeCarli liquid EtOH diet caused a decline of total SOD and GP activities. The results suggest that chronic EtOH administration decreases liver antioxidant defenses; however, the mice fed the AIN-76A EtOH liquid diet can maintain a higher antioxidant defense capability than those fed Lieber-DeCarli EtOH liquid diet.

NO-1886 decreases ectopic lipid deposition and protects pancreatic beta cells in diet-induced diabetic swine

The synthetic compound NO-1886 (ibrolipim) is a lipoprotein lipase activator that has been proven to be highly effective in lowering plasma triglycerides. Recently, we found that NO-1886 also reduced plasma free fatty acids and glucose in high-fat/high-sucrose diet-induced diabetic rabbits. In the current study, we investigated the effects of NO-1886 treatment on ectopic lipid deposition and the islet pathology in miniature swine fed a high-fat/high-sucrose diet. Our results showed that feeding this diet to miniature swine caused insulin resistance, increased lipid deposition in non-adipose tissue, such as in the heart, skeletal muscle, liver and pancreas, and also caused pancreatic beta cell damage. However, supplementing 1% NO-1886 (200 mg/kg per day) into the high-fat/high-sucrose diet decreased ectopic lipid deposition, improved insulin resistance, and alleviated the beta cell damage. These results suggest that improvement of lipid disorder, non-adipose tissue steatosis and insulin resistance may be very important for the protection of beta cell damage. Therefore, NO-1886 is potentially beneficial for the treatment of insulin-resistance syndrome.

Local-Migrant Gaps in Healthcare Utilization Between Older Migrants and Local Residents in China

BACKGROUND

Older migrants in China without local resident registration (hukou) are a vulnerable population and face barriers to receiving local healthcare.

OBJECTIVES

We aimed to quantify the disparities in healthcare utilization between older migrants and local residents in Shanghai, China.

DESIGN

This was a cross-sectional study.

SETTING

The study was conducted in Shanghai, China, in 2016.

PARTICIPANTS

Older adults (aged ≥60 years) were recruited based on a three-stage stratified cluster sampling method (2571 older locals and 1920 older migrants).

MEASUREMENTS

We compared utilization of outpatient care, inpatient care, preventive care, emergency room (ER) admission, and dental care, as well as medication use between older migrants and local residents. The local-migrant gap was parsed into observed and unobserved components using the Blinder-Oaxaca decomposition method.

RESULTS

Older migrants were less likely to utilize outpatient (odds ratio [OR] = 0.757; 95% confidence interval [CI] = 0.617-0.928), inpatient (OR = 0.642; 95% CI = 0.443-0.931), and preventive care (OR = 0.743; 95% CI = 0.643-0.858) and were more likely to use medication (OR = 1.254; 95% CI = 1.089-1.445) than local residents. Differences in ER admissions and dental care utilization were not significant in the regression analysis. The decomposition results indicated that 55% and 71% of the local-migrant gap in outpatient and preventive care utilization were attributable to individual characteristics, like health insurance. Unobserved components, including hukou-related factors and personal heterogeneous preferences, contributed 59% and 63% to utilization of inpatient care and medication use, respectively.

CONCLUSION

We identified local-migrant gaps in healthcare utilization among older adults in China. Further research is needed into integration of the health insurance system, accessibility of public health welfare benefits, and reconstruction of social networks among older migrants. J Am Geriatr Soc 68:1560-1567, 2020.

Effect of health education combining diet and exercise supervision in Chinese women with perimenopausal symptoms: a randomized controlled trial

OBJECTIVE

This study aimed to evaluate the effect of health education combining diet and exercise supervision on menopausal symptoms and diet/exercise habits.

METHODS

The randomized controlled study enrolled 60 patients with perimenopausal syndrome (Kupperman Menopause Index (KMI) score ≥15). The participants were randomized into either an intervention group (n = 30) or a control group (n = 30). Women were interviewed with questionnaires about perimenopausal symptoms, diet pattern and exercise habit. Their height and weight were measured. Women in the intervention group received health education, diet supervision and exercise supervision twice a week while those in the control group continued as normal. The total KMI score, scores of individual symptoms, diet pattern and exercise habit were measured after intervention.

RESULTS

The total KMI score, the individual KMI scores for paresthesia, irritability, depression/suspicious, fatigue, arthralgia/myalgia, and palpitations of the intervention group were significantly lower compared with the control group after intervention. The intake of cereal, meat, fats and oils of the intervention group were significantly lower at week 12 compared with baseline. The percentage of women with a regular exercise habit was significantly higher in the intervention group than in the control group after intervention.

CONCLUSIONS

Twelve weeks intervention of health education combining diet and exercise supervision could improve perimenopausal symptoms and help the patients establish good living habits.

15-hydroxyeicosatrienoic acid (15-HETrE) suppresses epidermal hyperproliferation via the modulation of nuclear transcription factor (AP-1) and apoptosis

The purpose of this study was to ascertain whether the antiproliferative effect of 15-hydroxyeicosatrienoic acid (15-HETrE), a monohydroxy fatty acid generated from dihomo-gamma-linolenic acid, in an experimentally induced guinea pig hyperproliferative model involves alterations in nuclear transcription factor (AP-1) and apoptosis. The topical application of docosahexaenoic acid (DHA) to normal guinea pig skin elicited a severe hyperplasia which was accompanied by the suppression of AP-1 expression in a time-dependent manner. Since apoptosis is pivotal in tissue turnover, the expression of two apoptotic proteins (Bcl-2 and caspase-3) after DHA and 15-HETrE treatment was explored. DHA-induced hyperproliferation enhanced the expression of Bcl-2 (an antiapoptotic protein) but inhibited the expression of caspase-3 (an apoptotic protein). 15-HETrE, on the other hand, reversed the DHA-induced epidermal hyperplasia, and upregulated epidermal AP-1 expression. These events paralleled the suppression of Bcl-2 and the elevation of caspase-3. Taken together, these results suggest that the antiproliferative effect of 15-HETrE may, at least in part, be via the modulation of AP-1 and apoptosis.

Cloning and characterization of the cDNA encoding rice elongation factor 1 beta

We have cloned and sequenced a cDNA coding for rice elongation factor 1 beta (EF-1 beta). The clone was 1420 bp long and contained an open reading frame coding for 229 amino acids. The overall identity between rice EF-1 beta and rice EF-1 beta' [Matsumoto, S., Oizumi, N., Taira, H. and Ejiri, S. (1992) FEBS Lett. 311, 46-48] is 60% at the amino acid sequence level; a higher percent identical residues (81%) were especially observed in the C-terminal region. Rice EF-1 beta has no conserved phosphorylation site for casein kinase II and no leucine zipper motif, although these motifs are well conserved in EF-1 delta (= beta in plants) subunits of animal EF-1.

Microstructural damage pattern of vascular cognitive impairment: a comparison between moyamoya disease and cerebrovascular atherosclerotic disease

Moyamoya disease and cerebrovascular atherosclerotic disease are both chronic ischemic diseases with similar presentations of vascular cognitive impairment. The aim of the present study was to investigate the patterns of microstructural damage associated with vascular cognitive impairment in the two diseases. The study recruited 34 patients with moyamoya disease (age 43.9 ± 9.2 years; 20 men and 14 women, 27 patients with cerebrovascular atherosclerotic disease (age: 44.6 ± 7.6 years; 17 men and 10 women), and 31 normal controls (age 43.6 ± 7.3 years; 18 men and 13 women) from Huashan Hospital of Fudan University in China. Cognitive function was assessed using the Mini-Mental State Examination, long-term delayed recall of Auditory Verbal Learning Test, Trail Making Test Part B, and the Symbol Digit Modalities Test. Single-photon emission-computed tomography was used to examine cerebral perfusion. Voxel-based morphometry and tract-based spatial statistics were performed to identify regions of gray matter atrophy and white matter deterioration in patients and normal controls. The results demonstrated that the severity of cognitive impairment was similar between the two diseases in all tested domains. Patients with moyamoya disease and those with cerebrovascular atherosclerotic disease suffered from disturbed supratentorial hemodynamics. Gray matter atrophy in bilateral middle cingulate cortex and parts of the frontal gyrus was prominent in both diseases, but in general, was more severe and more diffuse in those with moyamoya disease. White matter deterioration was significant for both diseases in the genu and body of corpus callosum, in the anterior and superior corona radiation, and in the posterior thalamic radiation, but in moyamoya disease, it was more diffuse and more severe. Vascular cognitive impairment was associated with regional microstructural damage, with a potential link between, gray and white matter damage. Overall, these results provide insight into the pathophysiological nature of vascular cognitive impairment. This study was approved by the Institutional Review Board in Huashan Hospital, China (approval No. 2014-278). This study was registered with ClinicalTrials.gov on December 2, 2014 with the identifier NCT02305407.

Suppression of proto-oncogene (AP-1) in a model of skin epidermal hyperproliferation is reversed by topical application of 13-hydroxyoctadecadienoic acid and 15-hydroxyeicosatrienoic acid

The present study was conducted to delineate whether a possible mechanism for 13-(S)-hydroxyoctadecadienoic acid (13-HODE) and 15-hydroxyeicosatrienoic acid (15-HETrE) reversal of experimentally-induced skin hyperproliferation in guinea pig is via the modulation of epidermal nuclear mitogen activator protein (AP-1), a nuclear transcription factor associated with tissue turnover. The data revealed that topical application of 13-HODE and/or 15-HETrE on the induced hyperproliferative skin reversed the hyperproliferation and up-regulated the suppressed AP-1 expression. A further analysis of the two major subunits of AP-1 (c-fos and c-jun) revealed a selective up-regulation of c-fos. These results underscore the modulatory role of lipoxygenase-derived hydroxy fatty acids on nuclear transcription factors and explains, at least in part, the antiproliferative effects of 13-HODE and 15-HETrE.

Introduction to DOK2 and its potential role in cancer

Cancer is a complex, multifactorial disease that modern medicine ultimately aims to overcome. Downstream of tyrosine kinase 2 (DOK2) is a well-known tumor suppressor gene, and a member of the downstream protein DOK family of tyrosine kinases. Through a search of original literature indexed in PubMed and other databases, the present review aims to extricate the mechanisms by which DOK2 acts on cancer, thereby identifying more reliable and effective therapeutic targets to promote enhanced methods of cancer prevention and treatment. The review focuses on the role of DOK2 in multiple tumor types in the lungs, intestines, liver, and breast. Additionally, we discuss the potential mechanisms of action of DOK2 and the downstream consequences via the Ras/MPAK/ERK or PI3K/AKT/mTOR signaling pathways.

Whole-genome SNP data unravel population structure and signatures of selection for black plumage of indigenous chicken breeds from Jiangxi province, China

Ten indigenous chicken breeds were originally distributed in Jiangxi Province, China, and they define a critical component of Chinese chicken genetic resources. We have investigated the population genetics of seven Jiangxi chicken breeds using 600K chicken BeadChip SNP data. To provide a genome-wide perspective for the population structure of all 10 Jiangxi chicken breeds, we herein genotyped 78 additional individuals from the seven breeds and 63 chickens from three uninvestigated breeds-Yugan Black (YG), Nancheng Black (NC) and Wanzai Yellow using 55K chicken SNP arrays. We then explored merged data of 17 101 SNPs from 235 individuals to infer the population structure of the 10 breeds. We showed that NC and YG are two regional populations of the same breed, as individuals from the two populations clustered together to form a branch separate from the other breeds in the neighbor-joining tree, they always grouped together in multidimensional principal component analyses and they displayed an identical pattern of ancestral lineage composition. Hence, NC and YG should be considered a single breed in the state-supported conservation scheme. Moreover, we conducted a genome scan for signatures of selection for black plumage. bayescan and hapflk analyses of two contrasting groups (three black-feathered breeds vs. six non-black-feathered breeds) consistently detected 25 putative regions under selection. Nine pigmentation- associated genes (DCT, SLC24A5, SLC30A4, MYO5A, CYP19A1, NADK2, SLC45A2, GNAQ and DCP2) reside within these regions, and these genes are interesting candidates for black plumage and provide a starting point for further identification of causative mutations for black feathers in chicken.

Disrupted neural signals in patients with concomitant exotropia

PURPOSE

Decreased binocular and oculomotor function in strabismics has recently been considered as cortical in origin. This study aimed to investigate functional abnormalities using a frequency-specific neuroimaging method in patients with concomitant exotropia (XT), and to demonstrate the clinical implications.

METHODS

Resting-state functional magnetic resonance imaging data were collected in 26 XT patients and 26 matched controls. To evaluate the local spontaneous neural activity, the amplitude of low frequency fluctuations (ALFF) was calculated in the typical frequency band (0.01-0.08 Hz) as well as five narrowly-defined frequency bands (slow-6: 0-0.01 Hz, slow-5: 0.01-0.027 Hz, slow-4: 0.027-0.073 Hz, slow-3: 0.073-0.167 Hz, and slow-2: 0.167-0.25 Hz), respectively.

RESULTS

Patients with XT showed decreased ALFF in the bilateral parieto-occipital sulcus (POS), and increased ALFF in the bilateral thalamus within the typical frequency band. Frequency-dependent ALFF alterations were found in the higher visual areas such as the right lateral occipital complex (LOC). Furthermore, ALFF in the right LOC in the slow-5 band was positively correlated with fusion control score (r = 0.70, p < 0.0001) and binocular function score (r = 0.67, p = 0.0002). Regression analyses showed that early age of onset remained the only significant explanatory factor for ALFF reduction in the right POS in the typically-measured frequency band (also referred to as the typical frequency band) (Odds ratio, 0.038; 95% confidence interval, 0.001 to 0.075).

CONCLUSIONS

Our findings provide spatial information regarding the functionally disrupted regions in XT. Moreover, the frequency-dependent ALLF alteration in the right LOC might reflect a potential plastic capacity in binocular function, which could be a potential objective index for evaluating disease severity.

Liver endogenous antioxidant defenses in mice fed AIN-76A diet and infected with murine AIDS

The effects of murine AIDS infection on endogenous antioxidant defenses in mice fed the AIN-76A liquid diet were investigated. C57BL/6 female mice were divided into 2 groups: one group was injected interperitoneally with LP-BM5 murine retrovirus (MAIDS) stock, and the other group served as the non-infected control. Two weeks after the infection, the mice were killed and livers were excised for biochemical analysis of the antioxidant defenses. Liver reduced glutathione (GSH) levels and activities of both cytosolic superoxide dismutase (SOD) and mitochondrial SOD were significantly depressed by MAIDS infection. Activities of glutathione reductase (GR) selenium (Se)-dependent glutathione peroxidase (GPx), catalase and glutathione-S-transferase (GST) toward 1-chloro-2,4-dinitrobenzene (CDNB) were not affected by MAIDS infection. A previous study by this laboratory using the Lieber-DeCarli (L-D) all purpose liquid diet caused a decline in total SOD activity and GPx activity, but not GSH levels. The results suggest that MAIDS infection depresses liver antioxidant defenses; however, MAIDS infection of mice fed the AID-76A liquid diet depresses different liver antioxidant defense parameters when compared to those of the mice fed the L-D all purpose liquid diet.

A novel approach to measuring circulating blood volume: the use of a hemoglobin-based oxygen carrier in a rabbit model

Hemoglobin-based oxygen carriers (HBOC) may be ideal for monitoring circulating plasma volume (CV-P) and circulating blood volume (CV-B). We used an HBOC (Hemoglobin glutamer-200 [bovine], Oxyglobin; Biopure, Cambridge, MA) as an indicator for relative CV-B in the rabbit model. Accuracy of the technique was determined by comparison with the Evans blue dye (EBD) dilution technique in 19 anesthetized female New Zealand rabbits weighing 2.0 to 10.6 kg. The measurements were performed at baseline, after hemorrhage (1/3 of CV-B), normovolemic hemodilution (replacement of 1/3 CV-B by Hextend; Abbot Laboratories, North Chicago, IL), and hypervolemic hemodilution (additional infusion of Hextend(R) in a volume equal to 1/3 of CV-B). Hemoglobin concentration was measured by using a HemoCue photometer (HemoCue AB, Angelholm, Sweden). EBD concentration was analyzed by using linear regression to estimate Time 0 concentration; Time 0 was defined as EBD injection time. The difference between CV-P values determined by EBD and HBOC dilution was independent from the magnitude of the CV-P value. The relative bias was 1.29 mL, and the precision (one SD) was 2.82 mL. The difference did not reach statistical significance.

IMPLICATIONS

Circulating plasma and blood volumes can be accurately estimated by plasma hemoglobin concentration measurements by using hemoglobin-based oxygen carrier infusion.

Deficits of Visual Cortex Function in Acute Acquired Concomitant Esotropia Patients

Purpose

The purpose of this study was to explore the cortical deficits of patients with acquired concomitant esotropia (AACE) using the resting-state functional magnetic resonance imaging (rs-fMRI) technique.

Methods

Rs-fMRI signals from 25 patients with AACE and 25 matched controls were collected. The repeated-measures analysis of variance (RM-ANOVA) test and two-sample t-test were used to investigate statistical differences of the amplitudes of low-frequency fluctuation (ALFF) signals and correlation analysis was performed to validate the relationship of signal change and clinical features.

Results

The AACE group showed decreased ALFF in both hemispheres symmetrically (t = 0.38, P = 0.71), with peak t in both middle occipital gyrus. The ALFF signal from the upper left inferior frontal gyrus was negatively correlated with the age of onset (r = 0.62, P = 0.0008), and the ALFF signal from the right superior temporal gyrus was negatively correlated with the near work hours (r = 0.63, P = 0.0008). The ALFF signal in the left fusiform gyrus was positively correlated with both near (r = 0.48, P = 0.01) and far (r = 0.44, P = 0.03) deviation, whereas it was only positively correlated with far deviation (r = 0.44, P = 0.03) in the right. Besides, the age of onset and the near work hour were independent factors of signal changes.

Conclusions

Using the ALFF signal of rs-fMRI, we found functional deficits in the primary visual cortex and dorsal pathway in patients with AACE. There were functional changes in the fusiform gyrus, and the greater the deviation angle, the higher the changing level. These findings reveal the association of AACE and the visual center, giving us more clues about the treatment of AACE.

Short-Term Near Stereoacuity Improvements Following Favorable Surgical Alignment in Exotropic and Esotropic Patients

PURPOSE

Surgical treatment for strabismus is to promote binocular vision, and the study is to evaluate the effect of surgical realignment on near stereopsis in exotropic and esotropic patients.

METHODS

The records of patients who underwent strabismus surgery were retrospectively reviewed. Visual acuity, ocular deviations, fusion control, ocular motility, strabismus subtype and duration, surgery procedures, and stereopsis at before and at one month after surgery were collected. RMANOVA was performed to analyze stereopsis improvement by surgery. A logistic analysis was used to investigate the factors for stereopsis improvement.

RESULTS

143 exotropic and 40 esotropic patients were enrolled. The stereopsis was not significantly improved in patients with exotropia (p > .05), but not in esotropic patients (p < .01). Small degree of near deviation (β = 0.01), without vertical surgery (β = 0.11), and the high pre-surgery Titmus (β = -0.44) were related factors for stereopsis improvement in exotropia patients; male (β = 0.21) and the high pre-surgery Titmus (β = -0.36) were related factors for stereopsis improvement in esotropia patients.

CONCLUSION

The loss of stereopsis was significantly restored by surgery in esotropia patients and the extent of stereopsis recovery by surgery depends on the deviation at near distance, vertical surgery, and pre-surgery stereopsis in exotropes and on sex and pre-surgery Titmus in esotropes.

Comparison of laparoscopic and open inguinal-hernia repair in elderly patients: the experience of two comprehensive medical centers over 10 years

PURPOSE

The safety of laparoscopic inguinal-hernia repair must be carefully evaluated in elderly patients. Very little is known regarding the safety of the laparoscopic approach in elderly patients under surgical and medical co-management (SMC). Therefore, this study evaluated the safety of the laparoscopic approach in elderly patients, especially patients with multiple comorbidities under SMC.

METHODS

From January 2012 to December 2021, patients aged ≥ 65 years who underwent open or laparoscopic inguinal-hernia repair during hospitalization were consecutively enrolled. Postoperative outcomes included major and minor operation-related complications, and other adverse events. To reduce potential selection bias, propensity score matching was performed between open and laparoscopic groups based on patients' demographics and comorbidities.

RESULTS

A total of 447 elderly patients who underwent inguinal-hernia repair were enrolled, with 408 (91.3%) underwent open and 39 (8.7%) laparoscopic surgery. All postoperative outcomes were comparable between open and laparoscopic groups after 1:1 propensity score matching (all p > 0.05). Moreover, compared to the traditional care group (n = 360), a higher proportion of the SMC group (n = 87) was treated via the laparoscopic approach (18.4% vs. 6.4%, p = 0.00). In the laparoscopic approach subgroup (n = 39), patients in the SMC group (n = 16) were older with multiple comorbidities but were at higher risks of only minor operation-related complications, compared to those in the traditional care group.

CONCLUSIONS

Laparoscopic inguinal-hernia repair surgery is safe for elderly patients, especially those with multiple comorbidities under SMC.