Age Cutoff Research Articles

MAFLD might be better in identifying subjects with sarcopenia or cardiovascular risk than NAFLD: A nationwide study.

Clinical features of non-alcoholic fatty liver disease (NAFLD), but not fulfilling the diagnostic criteria of metabolic dysfunction-associated fatty liver disease (MAFLD), remain unclear. We investigated the risk of sarcopenia and cardiovascular disease (CVD) in MAFLD and non-metabolic risk (MR) NAFLD. Subjects were selected from the Korean National Health and Nutrition Examination Surveys 2008-2011. Liver steatosis was assessed using fatty liver index. Significant liver fibrosis was defined using fibrosis-4 index, categorized by age cut-offs. Sarcopenia was defined as the lowest quintile sarcopenia index. Atherosclerotic CVD (ASCVD) risk score >10% was defined as high probability. A total of 7248 subjects had fatty liver (137 with non-MR NAFLD, 1752 with MAFLD/non-NAFLD, and 5359 with overlapping MAFLD and NAFLD). In non-MR NAFLD group 28 (20.4%) had significant fibrosis. The risk of sarcopenia (adjusted odds ratio [aOR]=2.71, 95% confidence index [CI]=1.27-5.78) and high probability of ASCVD (aOR=2.79, 95% CI=1.23-6.35) was significantly higher in MAFLD/non-NAFLD group than in non-MR NAFLD group (all P<0.05). The risk of sarcopenia and high probability of ASCVD was similar between subjects with and without significant fibrosis in non-MR NAFLD group (all P>0.05). However, the risk was significantly higher in MAFLD group than in non-MR NAFLD group (aOR=3.38 for sarcopenia and 3.73 for ASCVD; all P<0.05). The risks of sarcopenia and CVD were significantly higher in MAFLD group but did not differ according to fibrotic burden in non-MR NAFLD group. The MAFLD criteria might be better for identifying high-risk fatty liver disease than the NAFLD criteria.

Does cost minimization of hypofractionated radiation therapy content all health stakeholders?

Does cost minimization of hypofractionated radiation therapy content all health stakeholders?

Presepsin as a diagnostic marker of sepsis in children and adolescents: a short critical update.

Sepsis is a potentially fatal condition which strikes 1.2 million children worldwide per year. New biomarkers have been proposed in the assessment of the risk of sepsis progression and in the identification of patients with the worst outcome. This review aims to assess the diagnostic value of presepsin, a promising new biomarker, in pediatric sepsis, with particular attention to its usefulness in emergency department. We performed a literature search of the last 10 years to find presepsin related studies and reports concerning pediatric population aged from 0 months to 18 years. We mainly focused on randomized placebo-control studies, followed by case-control studies, observational (both retrospective or prospective), and finally systematic reviews and meta-analysis. The article selection process was carried out independently by three reviewers. Results: A total of 60 records were identified in literature, 49 were excluded according to the exclusion criteria. The highest presepsin sensitivity value was 100%, with a high cut-off (800.5 pg/mL). The highest sensitivity-specificity ratio was 94% vs 100%, with a similar considered presepsin cut-off (855 ng/L). As regards the presepsin cut-offs reported in the various studies, several authors agree on a critical threshold of about 650 ng/L to guarantee a sensitivity> 90%. The analyzed studies show a wide variability for patients' age and presepsin risk cut-offs. Conclusions: Presepsin seems to be a new useful marker for early diagnosis of sepsis, even in a pediatric emergency setting. Being a new marker of sepsis, more studies are required to better understand its potential.

Using an age and fibrinogen levels adjusted D-dimer cutoff significantly improves the specificity of two equivalent D-dimer assays for excluding pulmonary embolism

ObjectivesOur single-center prospective study compared two methods of D-dimer determination used in the exclusion of pulmonary embolism: bioMérieux method, VIDAS® D-Dimer Exclusion™ II, and Diagnostica Stago method, STA®-Liatest® D-Di Plus. For each of these two methods, we calculated optimized variable cutoffs based on fibrinogen and/or age to improve the specificity of the methods. Patients – methods2530 patients admitted to the Emergency Department of the Brest University Hospital for suspected pulmonary embolism were included in this study. The comparison of the two methods was performed by calculating their different characteristics: sensitivity, specificity and negative predictive value for different cutoffs systems: fixed or age-adjusted according to Douma et al. An optimization of the variable cutoff according to age and fibrinogen was then performed. ResultsThe two methods VIDAS and STAGO are approximately equivalent in terms of performance even if the STAGO method presents a better specificity (57.1 %) at the fixed cutoff of 0.5 μg/mL. The adoption of age-adjusted, fibrinogen-adjusted or doubly-adjusted (age and fibrinogen) cutoffs, significantly improves the specificity of the tests without affecting their excellent sensitivity. These specificities peak respectively at 75.8 % and 76 % for the VIDAS and STAGO tests when using a doubly-adjusted, age and fibrinogen, cutoff, i.e. a gain in specificity of approximately 10 % compared with the age-adjusted cutoff of Douma et al. and of approximately 20 % compared with the fixed cutoff of 0.5 μg/mL. ConclusionAdopting an optimized variable cutoff based on fibrinogen and/or age significantly improves specificity of D-dimer methods for pulmonary embolism exclusion.

#4160 PHASE ANGLE (PA), AGE AND MIS AS MORTALITY PREDICTORS IN PATIENTS WITH ADVANCED CKD

Abstract Background and Aims Survival study in Advanced CKD patients according to age, MIS and phase angle Method We studied 225 patients with ACKD, 153 men (68.3%), xage 70.09±12.72 years. We analyze survival at 120 months and how the Phase angle (PA) and MIS scale influence mortality. We chose these parameters, one of body composition (BIA-vector) and the MIS malnutrition-inflammation scale, since they are described as independent predictive factors. Results We defined the cut-off point for PA with the ROC curve, appearing as 3.75 (sensitivity 67% and specificity 55%). With 83 (37.1%) ≤3.75 and 141 (62.9%) greater than 3.75 PA, with significance between men and women p0.001. Analyzing the % of deaths with PA with PC- 3.75 there is a significant difference between groups p0.001 with difference between men and women With a cut-off point of 5 for MIS, we established 162 (72.3%) with ≤5 and 82 (22.7%) with MIS&amp;gt;5. Analyzing the % of deaths according to MIS strata, there is a significant difference p 0.001, Sig difference between men and women p0.021 We define with COR cut-off point age = 70.5 years sens 85% spec 63% 79 patients (64.6%) died in 120 months, 53/152 (65.1%) men and 45/71 (63.4%) women pns. xage deceased 76.39±9.16 vs 66.63±13.14 years p0.001. The survival curves for the 3 variables by Kaplan Meier are significant with the established cut-off points (Fig. 1). In the univariate analysis we found that age (CP-70.5 years) p0.001, and PA (CP-3.75) p0.04 are significant, but not MIS(CP-5). In the Cox analysis we evaluated age, PA and MIS, with age appearing as a priority, followed by PA and finally the statistical MIS Wald 18.73, 3.77 and 2.26 respectively. Conclusion 1-Age, phase angle and MIS are independent mortality risk factors for ACKD patients. 2-In the multivariate model Age and phase angle are predictors of mortality. 3-Independent of age, the phase angle is the best predictor of mortality.

68Ga]-DOTATATE PET/MR-based evaluation of physiologic somatostatin receptor 2 expression in the adult pituitary gland as a function of age and sex in a prospective cohort.

The pituitary gland has the fourth highest physiologic avidity of [68Ga]-DOTATATE. In order to guide our understanding of [68Ga]-DOTATATE PET in clinical contexts, accurate characterization of the normal pituitary gland is first required. This study aimed to characterize the normal pituitary gland using dedicated brain [68Ga]-DOTATATE PET/MRI as a function of age and sex. A total of 95 patients with a normal pituitary gland underwent brain [68Ga]-DOTATATE PET examinations for the purpose of diagnosing CNS SSTR2 positive tumors (mean age: 58.9, 73% female). Maximum SUV of the pituitary gland was obtained in each patient. SUV of superior sagittal sinus was obtained to calculate normalized SUV score (SUVR) of the gland. The anatomic size of the gland was collected as maximum sagittal height (MSH). Correlations with age and sex were analyzed. The mean SUV and SUVR of the pituitary gland were 17.6 (range: 7-59.5, SD = 7.1) and 13.8 (range: 3.3-52.6, SD = 7.2), respectively. Older females had significantly higher SUV of the pituitary gland compared to younger females. When stratified by age and sex, both older and younger females had significantly higher pituitary SUV than older males. SUVR did not differ significantly by age or sex. MSH of the pituitary gland in younger females was significantly greater than in younger males at all age cutoffs. This study provides an empiric profiling of the physiological [68Ga]-DOTATATE avidity of the pituitary gland. The findings suggest that SUV may vary by age and sex and can help guide the use of [68Ga]-DOTATATE PET/MRI in clinical and research settings. Future studies can build on these findings to investigate further the relationship between pituitary biology and demographic factors.

Evaluation of the Evan’s and Bicaudate index for South Karnataka Population using computed tomography

Background: Radiological markers that are useful in the diagnosis of normal pressure hydrocephalus include the Bicaudate index (BCI) and the Evans index (EI), which are practical indicators of ventricular volume. Worldwide, variation exists in normative studies for both these indices. The majority of research for EI and BCI is based on data from the Western population. The study has been performed on the South Karnataka population. Aims and Objectives: This study’s goal is to derive age and gender specific cutoff values on normative data of Evans and BCI. Materials and Methods: This was a prospective and observational study.Patients referred to “RL Jalappa Hospital” for computed tomography (CT) scan of the brain who meet the inclusion criteria will be included in this study. CT brain of all the patients will be performed in Siemens Somatom emotion 16 slice CT scanner. Ninety-seven were selected for this study, and EI and BCI were calculated for them. Results: The mean value of EI and BCI in our study was 0.26±0.02 and 0.1167±0.02, respectively. The difference in EI and BCI between males and females shown significant statistical difference between males and females but the values increased as increase in age. Conclusion: Our study for South Indian population concludes that EI and BCI have a significant statistical difference between males and females. Both EI and BCI values increase with age. Hence cutoff values of EI and BCI index according to age and gender are important for evaluation of hydrocephalus.

Redefining early-onset cancer and risk of hereditary cancer predisposition.

10510 Background: For most solid tumors, early age of onset, a marker for potential increased inherited risk, has been arbitrarily defined as a diagnosis of cancer at age &lt; 50. However, this disregards the variation in mean age of diagnoses across solid tumors resulting in the potential misclassification of patients at increased risk of germline alterations. Methods: 25,305 prospectively ascertained cancer patients, representing 32 solid tumor types, underwent sequencing analysis of up to 90 cancer predisposition genes using next-generation genetic analysis with reporting of germline likely pathogenic (LP) and pathogenic variants (P). Mean age of diagnosis by cancer type, with standard deviations (STD), were calculated according to Surveillance, Epidemiology, and End Results Program (SEER) data. Early-onset (EO-CA), average-onset (AO-CA), and late-onset (LO-CA) cancers were defined as cancers diagnosed &lt; -1 STD, -1 &lt; STD &gt; 1, and &gt; 1 STD around the mean age at diagnosis for the specific cancer type, respectively. Prevalence of LP/P variants was classified according to age of onset. Statistical analyses were performed using STATA. Results: Among 25,305 patients with 32 solid tumor types classified as per SEER data, 31% (n = 7,854) of patients were categorized as having EO-CA. Overall prevalence of germline alterations varied as a function of age at diagnosis with 19.2%(n = 1509), 15.9% (n = 2588/16,299), and 12.9% (149/1152) of EO-CA, AO-CA, and LO-CA patients harboring a germline LP/P variant (p &lt; 0.0001). The enrichment of variants in EO-CAs was driven by high- and moderate-penetrance genes with 13.2%, 9.2% and 5.1% of EO-CA, AO-CA, and LO-CA patients having an LP/P variant (p &lt; 0.0001); low-penetrance germline alterations were static across the age groups (6%, 6.7%, 7.8%). An age cutoff of 50 for early-onset cancer was &gt; 1 STD below the mean age at diagnosis in 20 cancer types resulting in 2,226 patients who would not have been classified as having EO-CA inclusive of 394 patients who tested positive for a germline LP/P, representing 26.1% of all germline EO-CA positives. Conclusions: Early-onset cancer should be defined taking into consideration the mean age at diagnosis for a specific cancer type as an arbitrary cutoff of age &lt; 50 misses over 25% of patients with an inherited cancer predisposition syndrome. Due to the high prevalence of inherited predisposition syndromes, genetic testing of all patients with EO-CA, irrespective of tumor type, is warranted.

Early onset gastric cancer: An analysis of epidemiological and environmental risk factors.

e16103 Background: Gastric cancer is the fourth most common malignancy in the world and the second leading cause of cancer related deaths. Its overall incidence has decreased in recent years, but recent data suggests that its rate has actually been increasing specifically amongst younger adults. Emerging data suggests that it is the combination of biological risk factors and environmental triggers that are the cause for this increasing rate. There has been increased interest in studying early onset gastric cancer (EOGC) as a proxy for understanding the genetic alterations that lead to gastric cancer at any age. However, understanding the environmental factors that lead to the development of cancer at a younger age is an area of study that requires more exploration. In this study, we investigate the epidemiology, environmental risk factors and common presenting symptoms associated with early onset gastric cancer patients. Methods: This is a retrospective cohort study of 174 patients with newly diagnosed gastric adenocarcinoma at three safety net hospitals in Los Angeles between 2010 and 2022. The patients were divided into two groups, with an age cutoff of 45 years old for early onset gastric cancer. We compared the rates of smoking, alcohol use, infection with H pylori and gender between the two groups. The stage at time of presentation, rates of misdiagnosis, presenting symptoms, and mortality rates were also compared. Results: There was no statistically significant difference (p &lt; 0.05) in rates of smoking, alcohol use, and H. pylori infection between the groups. However, patients with early onset gastric cancer were 10% more likely to be misdiagnosed, and 6% more likely to present with metastatic disease. They were also 16% more likely to be female, 17% more likely to be Hispanic, and 22% more likely to expire compared to patients older than 45. An analysis conducted on patients’ presenting symptoms indicated that hematemesis was much more likely to be associated with patients less than 45 to a statistically significant level (p = 0.035). Conclusions: Based on our findings, EOGC was more likely to be seen in females and Hispanic populations. Additionally, no risk factors were identified to be more closely associated with either cohort. EOGC patients were more likely to be misdiagnosed and therefore present with advanced disease, leading to higher rates of mortality. Further investigation into both genetic alterations and environmental factors associated with early onset gastric cancer is warranted, as this holds important implications for patients regarding diagnosis, treatment, and overall outcomes.

WITHDRAWN: Facteurs influençant le devenir fonctionnel des fractures de l’apophyse antérieure du calcanéus

IntroductionFractures of the anterior process of the calcaneus (APC) are easily overlooked in clinical practice. Most patients have good to excellent clinical outcome after conservative treatment, while some patients may have persisting symptoms and unfavorable functional outcomes. The aim of this study was to identify the risk factors associated with unfavorable functional outcome after conservative treatment in APC fractures. MethodsAll patients presenting with APC fractures and receiving conservative treatment from April 2019 to April 2020 were retrospectively assessed. The primary outcome measurement was the ankle joint function assessed using Karlsson Scoring System at 2 years post-injury. The risk factors associated with unfavorable functional outcomes (Karlsson score≤80) were evaluated by logistic regression analysis. ResultsEighty-four patients were included with a mean age of 40 years. Twenty-six (31 %) patients presented with unfavorable functional outcome at 2 years post-injury. In multivariate logistic regression, concomitant fractures of talonavicular (TN) joints and older age were significantly associated with unfavorable functional outcome (p<0.05). Patients with concomitant fractures of TN joints had an odds ratio of 3.623 for unfavorable functional outcome. The optimal cutoff age for an unfavorable outcome was ≥ 47.5 years, with an odds ratio of 5.010. ConclusionMost patients with APC fractures achieved good to excellent results when treated conservatively. Attention should be paid to those with concomitant fractures of TN joints and with age ≥ 47.5 years, which might lead to unfavorable functional recovery. Level of evidenceIV; Case series.

The prevalence of chronic kidney disease among type 2 diabetes mellitus patients in central South Africa.

Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease (CKD). The prevalence of CKD among T2DM patients in Africa is 22.0%. The cut-off age for dialysing diabetic patients in the resource-limited state sector in South Africa is 50 years. Type 2 diabetes mellitus patients who develop CKD are likely to be excluded from chronic dialysis and rely on control of risk factors, including blood pressure and blood glucose levels, to prevent CKD progression. We aimed to determine the prevalence of CKD among T2DM patients attending the diabetes clinic at Pelonomi Academic Hospital, Bloemfontein. In this retrospective cross-sectional study, medical records of patients (January 2016 and December 2018) were reviewed to collect demographic and clinical information. In total, 244 records were reviewed. Sixty-one (25.0%, 95% confidence interval [CI]: 20% - 30.8%) T2DM patients had CKD. The rate of CKD was slightly higher in males (n= 24/81; 29.6%) compared with females (n= 37/163; 22.7%). Most patients with CKD (n= 58; 95.1%) were 50 years of age. Only 17.8% of patients achieved a glycosylated haemoglobin (HbA1c) of 7.0%. Blood pressure was controlled in 14.3% of hypertensive patients. Renin-angiotensin-aldosterone system inhibitors were used by 78.6% of patients. A high prevalence of clinically significant CKD among T2DM patients with poor prospects of chronic dialysis in a resource-limited setting was observed. The risk factors for CKD development and progression should be adequately managed in T2DM patients.Contribution:This study emphasises the need for further research and innovation to improve outcomes of T2DM patients with CKD in resource-constrained settings.

Temporal changes in characteristics and external validity of randomized controlled trials in older people from 2012 to 2019

BackgroundOlder individuals are often underrepresented in clinical trials. In 2012 only 7% of RCT’s specifically studied older people and their geriatric characteristics were poorly reported. The aim of this review was to investigate temporal changes in characteristics and external validity of randomized controlled trials in older people from 2012 to 2019.MethodsPubMed was searched for randomized clinical trials (RCTs) published in 2019. Firstly, the proportion of RCTs specially designed for older people were determined by the following criteria: a reported mean age of ≥ 70 years or a lower age cutoff of ≥ 55. Secondly, the trials with a majority of older people, defined by a reported mean age of ≥ 60 years, were screened for reporting of geriatric assessments. Both parts were compared with identical reviews performed in 2012.ResultsFrom a 10% random sample, 1446 RCTs were included in this systematic review. First, 8% of trials were specifically designed for older people in 2019 compared to 7% in 2012. Secondly, 25% of the trials included a majority of older people in 2019, compared to 22% in 2012. Thirdly, in 52% of these trials in 2019 one or more of the geriatric assessments were reported compared to 34% in 2012.ConclusionsAlthough in 2019 the proportion of published RCTs specifically designed for older people remains low, more characteristics on geriatric assessments were reported compared to 2012. Continued efforts should be paid to increase both the number and the validity of trials for older people.

Associations of animal source foods, cardiovascular disease history, and health behaviors from the national health and nutrition examination survey: 2013–2016

BackgroundSome individuals adopt vegetarian or plant-based diets to improve their health. Observational evidence suggests diets composed of higher amounts of animal-source foods (ASFs) are associated with increased risk for disease and early mortality. In many of these studies, those who ate fewer animal-source foods reported fewer disease risk factors and unhealthy behaviors, which could indicate bias. PurposeThis study aims to examine the relationships between ASF consumption, health behaviors, and cardiovascular disease (CVD) prevalence in a population-representative sample of U.S. civilians controlling for confounders. MethodsRespondent data were collected from the National Health and Nutrition Examination Survey (NHANES) 2013–2016 collection years. Collected data included demographics, ASF intake, healthy lifestyle variables, body mass index, and blood lipids. ResultsThere was a higher proportion of those with CVD history who consumed red meat (61.3%; C.I. 41.7%–77.8%), but the proportion was lower for white (23.3%; C.I. 12.6%–39.0%) and processed meat (15.4%; C.I. 6.5%–32.3%). When adjusted for sex, the odds of CVD history increased for red meat compared to processed meat consumption (OR 2.95; C.I. 1.14–7.66). Unhealthy lifestyle increased the odds of CVD history by nearly 8-fold (OR 7.8; C.I. 3.44–17.7). Individual factors including age, smoking history, body mass index, and blood lipids, and demographic factors, including education level, race, and income, were also associated with increased odds for CVD history. ROC analysis revealed 77.2% AUC for CVD history classified by individual factors (BMI ≥30 kg/m**2, ≤ 30 min moderate physical activity, smoker, fiber intake ≤25 g, dental visit more than two years ago, and age above 60 years). Three or more factors moderately predicted CVD history when optimized for sensitivity (73.4%) and specificity (71%). Adjusted for sex, the relationship between CVD and moderate physical activity became stronger possibly reflecting lifestyle changes. Despite evidence of lifestyle changes, modifiable risk factors persisted in the CVD group. CVD diagnosis in males was substantially delayed compared to females concerning the sex-specific age cutoff associated with higher risk. The healthy lifestyle group was characterized by earlier CVD diagnosis and fewer overall risk factors compared to the unhealthy lifestyle group. ConclusionCVD history was strongly associated with demographic, lifestyle, and dietary factors. Future research should focus on multidimensional models for disease risk stratification and prevention, including individual, behavioral, and sociodemographic factors.

International Newborn Screening Practices for the Early Detection of Congenital Adrenal Hyperplasia

Introduction: Newborn screening (NBS) programmes vary internationally in their approach to screening. Guidelines for congenital adrenal hyperplasia (CAH) screening recommend the use of two-tier testing and gestational age cutoffs to minimise false-positive results. The aims of this study were to describe (1) the approaches; (2) protocols used; and (3) available outcomes for CAH screening internationally. Methods: All members of the International Society for Neonatal Screening were asked to describe their CAH NBS protocols, with an emphasis on the use of second-tier testing, 17-hydroxyprogesterone (17OHP) cutoffs, and gestational age and birth weight adjustments. If available, screening outcomes were requested. Results: Representatives from 23 screening programmes provided data. Most (n = 14; 61%) recommend sampling at 48–72 h of life. Fourteen (61%) use single-tier testing and 9 have a two-tier testing protocol. Gestational age cutoffs are used in 10 programmes, birth weight cutoffs in 3, and a combination of both in 9. One programme does not use either method of adjusting 17OHP cutoffs. Case definition of a positive test and the response to a positive test differed between programmes. Conclusions: We have demonstrated significant variation across all aspects of NBS for CAH, including timing, the use of single versus two-tier testing and cutoff interpretation. Collaboration between international screening programmes and implementation of new techniques to improve screen efficacy will facilitate ongoing expansion and quality improvement in CAH NBS.

Factors that influence outcomes and device use for pediatric cochlear implant recipients with unilateral hearing loss.

Candidacy criteria for cochlear implantation in the United States has expanded to include children with single-sided deafness (SSD) who are at least 5 years of age. Pediatric cochlear implant (CI) users with SSD experience improved speech recognition with increased daily device use. There are few studies that report the hearing hour percentage (HHP) or the incidence of non-use for pediatric CI recipients with SSD. The aim of this study was to investigate factors that impact outcomes in children with SSD who use CIs. A secondary aim was to identify factors that impact daily device use in this population. A clinical database query revealed 97 pediatric CI recipients with SSD who underwent implantation between 2014 and 2022 and had records of datalogs. The clinical test battery included speech recognition assessment for CNC words with the CI-alone and BKB-SIN with the CI plus the normal-hearing ear (combined condition). The target and masker for the BKB-SIN were presented in collocated and spatially separated conditions to evaluate spatial release from masking (SRM). Linear mixed-effects models evaluated the influence of time since activation, duration of deafness, HHP, and age at activation on performance (CNC and SRM). A separate linear mixed-effects model evaluated the main effects of age at testing, time since activation, duration of deafness, and onset of deafness (stable, progressive, or sudden) on HHP. Longer time since activation, shorter duration of deafness, and higher HHP were significantly correlated with better CNC word scores. Younger age at device activation was not found to be a significant predictor of CNC outcomes. There was a significant relationship between HHP and SRM, with children who had higher HHP experiencing greater SRM. There was a significant negative correlation between time since activation and age at test with HHP. Children with sudden hearing loss had a higher HHP than children with progressive and congenital hearing losses. The present data presented here do not support a cut-off age or duration of deafness for pediatric cochlear implantation in cases of SSD. Instead, they expand on our understanding of the benefits of CI use in this population by reviewing the factors that influence outcomes in this growing patient population. Higher HHP, or greater percentage of time spent each day using bilateral input, was associated with better outcomes in the CI-alone and in the combined condition. Younger children and those within the first months of use had higher HHP. Clinicians should discuss these factors and how they may influence CI outcomes with potential candidates with SSD and their families. Ongoing work is investigating the long-term outcomes in this patient population, including whether increasing HHP after a period of limited CI use results in improved outcomes.

Establishing a genomic radiation-age association for space exploration supplements lung disease differentiation.

One possible way to quantify each individual's response or damage from ionizing radiation is to estimate their accelerated biological age following exposure. Since there is currently no definitive way to know if biological age estimations are accurate, we aim to establish a rad-age association using genomics as its foundation. Two datasets were combined and used to empirically find the age cutoff between young and old patients. With age as both a categorical and continuous variable, two other datasets that included radiation exposure are used to test the interaction between radiation and age. The gene lists are oriented in preranked lists for both pathway and diseases analysis. Finally, these genes are used to evaluate another dataset on the clinical relevance in differentiating lung disease given ethnicity and sex using both pairwise t-tests and linear models. Using 12 well-known genes associated with aging, a threshold of 29-years-old was found to be the difference between young and old patients. The two interaction tests yielded 234 unique genes such that pathway analysis flagged IL-1 signaling and PRPP biosynthesis as significant with high cell proliferation diseases and carcinomas being a common trend. LAPTM4B was the only gene with significant interaction among lung disease, ethnicity, and sex, with fold change greater than two. The results corroborate an initial association between radiation and age, given inflammation and metabolic pathways and multiple genes emphasizing mitochondrial function, oxidation, and histone modification. Being able to tie rad-age genes to lung disease supplements future work for risk assessment following radiation exposure.

A review of elderly transplantation regarding complications, outcomes, and survival

BackgroundRenal transplant adds survival benefits to end-stage renal disease patients over dialysis, and a similar concept applies to elderly patients. Some of the challenges of transplanting old patients may involve age-related cancers and comorbid conditions such as cardiovascular disease. Studies had shown that advanced age is associated with better outcomes compared to dialysis despite receiving poorer quality organs. AimThis extended literature review aims to identify the common complications, outcomes, and survival benefits of kidney transplantation in the elderly population. MethodsAn extended literature review was done to identify studies that compared elderly transplant recipients with the younger kidney transplant recipient population. The study population included elderly kidney recipients aged sixty and above and younger kidney recipients below the age of sixty. This literature review aims to discuss complications facing elderly kidney recipients and compare transplant outcomes to younger kidney recipients. PubMed, Midline, and google scholar databases were searched and papers meeting the pre-set inclusion criteria were identified. ResultsA total of 212 papers were identified. After screening the results, 12 papers met the inclusion criteria and were included for review. 10/12 papers included patients' age cutoff point, one paper had cut-off age between 60 and 80 years, while the last paper recruited patients with ages above 70. Most of the studies mentioned young group age as below 60, 2/12 papers divided the young group into further subgroups of age. Two studies used paired donor organs for both young and elderly groups to eliminate donor bias. While other studies used living, deceased, or both living and deceased donors for both elderly and young groups. One study matched donor type and gender in both groups. The studies looked at patient and graft survival and complications. Elderly transplant patients suffered more hospitalization, infections, cardiovascular complications, malignancy, and surgical complications. Post-transplant diabetes was higher in the young recipient group in one study. ConclusionIn the case of elderly renal transplant recipients, the cut-off point for age to perform renal transplant is not clear but studies showed better survival and cost-effectiveness in elderly patients compared to patients on the waiting list even in older patient cohorts

Does the current age cutoff for screening miss too many cases of cervical cancer in older women?

Does the current age cutoff for screening miss too many cases of cervical cancer in older women?

Intensive Blood Pressure Control and Cardiovascular Outcomes in Elderly Patients: A Secondary Analysis of SPRINT Study Based on a 60-Year Age Cutoff.

In the original SPRINT article, age was categorized at 75 years, which was contrary to many previous clinical trials which is at 60 years. The SPRINT trial randomized 9,361 hypertensive patients to a target blood pressure of <120 vs. <140 mm Hg (intensive vs. standard treatment, respectively). Age was re-categorized as <60 and ≥60 years and hazard ratios (HRs) were calculated with 95% confidence intervals (CIs) for outcomes and adverse events. Intensive treatment reduced primary outcome significantly in both <60 and ≥60 years of age subgroups with a relative risk reduction (RRR) of 36% and 22%, respectively, and HR of 0.58 [95% CI, 0.36-0.94] and 0.78 [95% CI, 0.65-0.93], respectively. Although the intensive treatment rendered no effect on myocardial infarction (MI) in the overall comparison, it significantly reduced MI in patients <60 years of age with an RRR of 58% and HR of 0.39 [95% CI, 0.17-0.91]. In the ≥60-year age subgroup, reduced heart failure incidence was noted after intensive treatment, including death from other cardiovascular causes; however, these were not observed in the <60-year age subgroup. Intensive treatment resulted in significant hypotension, syncope, acute renal failure, or acute kidney injury in the ≥60-year age group; conversely, the risk of these adverse effects in patients <60 years of age did not increase. Intensive blood pressure control is beneficial for elderly patients (age ≥60 years), albeit with increased risk of adverse events.

55. Increased Patient Age as a Risk Factor following Free Flap Reconstruction after Breast Cancer: A Single Institutional Review of 2,300 Cases

PURPOSE: Elderly patients are increasingly undergoing free flap breast reconstruction (FF-BR). However, some surgeons do not offer FF-BR to patients of advanced age due to perceived increased peri-operative risk. The authors sought to determine the risks of FF-BR with increasing patient age. METHODS: Patients undergoing FF-BR at our institution from 2005-2018 were included. Logistic regression models were fit to determine association of age with probability of all complications, venous thromboembolism (VTE), surgical site infection (SSI), flap loss, and mortality. ROC (receiver operating characteristic) curve analyses were performed to predict optimal age cutoff by outcome. Generalized linear modeling (with spline regression) was then used to graph risk of outcomes over continuous age. RESULTS: A cohort of 2,300 with an average age of 51.5 years (SD 6.5) was identified. Odds of multiple post-operative complications increased after the age of 50 though this risk attenuated between 60-65 years and did not marginally increase thereafter. FF-BR after age 60 was associated with higher risk of VTE. There were no differences in length of stay or odds of SSI, flap loss, or risk-adjusted mortality with increasing age. CONCLUSION: While a set age cutoff for patients undergoing FF-BR does not appear warranted, older age does predispose patients to specific complications which should guide preoperative counseling. Further, additional consideration should be given to optimal VTE prophylaxis for elderly patients undergoing FF-BR.