Elderly Individuals Research Articles

Acute abdomen: an atypical presentation of acquired hemophilia

Acquired hemophilia is a rare but potentially life-threatening disorder characterized by the development of acquired hemophilia A, leading to bleeding complications. Spontaneous, mild-to-life-threatening bleeding in typically elderly individuals without a personal or family history of bleeding is the hallmark of acquired hemophilia A (AHA), a rare autoimmune bleeding illness caused by the formation of auto-antibodies against endogenous factor VIII (FVIII). This hallmark represents our present case, with no obvious history related to the bleeding issue. Prompt detection and treatment of bleeding are essential for the best outcomes. We present a case of a 66-year-old male who had acute-onset severe abdominal pain and with constipation for five days, associated with nausea and loss of appetite. On physical examination, the patient appeared pale, and abdominal examination revealed diffuse tenderness with guarding. Initial evaluation revealed tachycardia and hypotension. Initial abdomen X-rays revealed features suggestive of small bowel obstruction. The patient was stabilized with intravenous fluids, referred to a surgical team, and admitted to the acute bed in the general ward for further management. Keywords: Acquired Hemophilia; Auto-Antibodies; Factor VIII; Intraabdominal Bleeding Citation: Hehsan MR. Acute abdomen: an atypical presentation of acquired hemophilia. Anaesth. pain intensive care 2024;28(5):974−976; DOI: 10.35975/apic.v28i5.2556 Received: March 19, 2024; Reviewed & Accepted: September 08, 2024

PROMOVENDO O BEM-ESTAR PSICOLÓGICO: ESTRATÉGIAS DE PREVENÇÃO DE DEPRESSÃO EM IDOSOS DE 60 A 80 ANOS

Aging is a normal and natural phase of society's development, deeply linked to health and illness conditions, and influenced by neurobiological, genetic, functional, and sociocultural factors. Quality of life plays a central role in characterizing aging as healthy or pathological, making it clear that an individual's psychological health is a result of the context in which he or she lives. Therefore, this study aimed to analyze the nursing strategies adopted to prevent depression in elderly individuals aged 60 to 80 years. This is a narrative review study, carried out through research in the Virtual Health Library (VHL) and Google Scholar, using the following descriptors: depression AND elderly AND nursing AND prevention. The eligibility criteria adopted were: complete works that addressed the topic between the years 2019 and 2024. Dissertations, theses, theoretical essays, and experience reports were excluded. In the end, eight studies were selected. Among the strategies used by nurses, the following are mentioned: encouraging the maintenance of Activities of Daily Living (ADLs); encouraging the active participation of the social support network; keeping the home environment well ventilated; cleaning and disinfecting frequently touched surfaces, such as bed headboards, remote controls, doorknobs, cell phones and canes, with 70% alcohol; and promoting a healthy diet, accompanied by good fluid intake, as priority measures to reduce the chances of contamination by COVID-19. Thus, it is concluded that health professionals need to redefine the provision of care and attention to the elderly in health services, in addition to promoting the training of the nursing team to meet gerontological needs more adequately.

Analysis of the transformation of demand willingness for housing reverse mortgages in China based on a scenario simulation experiment

AbstractAs the population rapidly ages, Housing Reverse Mortgages (HRMs) have emerged as a valuable addition to the multilevel pension insurance system, helping to alleviate the pressure on pension financing. However, the HRM market in China faces challenges due to the limited financial literacy among middle‐aged and elderly residents; there is a “cognitive bias” toward understanding the mechanisms and benefits of HRMs leading to “insufficient effective demand.” This study empirically investigates the likelihood of changing the “demand willingness” for an HRM through a scenario‐simulation experiment focused on HRM‐related information disclosure. The findings include: (1) Up to 46.78% of the subjects' attitudes toward adopting HRMs shifted from “unwilling” to “willing” after receiving disclosed information, indicating that cognitive bias significantly impacts the insufficient effective demand for these housing products. The information disclosure experiment can correct the inadequate financial literacy to a certain extent, thereby significantly enhancing the potential demand willingness. (2) After the experiment, subjects with strong motives to bequeath their property to family members (referred to as “strong bequest motives”) significantly changed their willingness to adopt HRMs (“demand willingness”). This suggests that a clear, comprehensive promotional strategy can better align middle‐aged and elderly residents' perceptions of the role of HRMs in protecting inheritances, reducing the impact of bequest‐related considerations on their financial decisions. (3) Participants initially exhibiting lower financial literacy also demonstrated notable shifts in their demand willingness postexperiment. Access to easily understood, high‐quality information appears to help older individuals recognize the potential benefits of HRMs, mitigating the negative effects of cognitive limitations on their decision‐making. These findings highlight the importance of enhancing financial literacy and promoting a better understanding of HRMs among middle‐aged and elderly individuals, which may effectively manage the challenges associated with an aging population and the pressures on pension financing.

Association between plasma trimethylamine N-oxide and coronary heart disease: new insights on sex and age differences.

Elevated plasma trimethylamine N-oxide (TMAO) is related to atherosclerosis. Whether the relationship of TMAO and coronary heart disease (CHD) is influenced by sex or age is uncertain. We aim to explore the sex and age differences in the relationship between plasma TMAO and CHD risk and severity. A case-control study was conducted in patients undergoing elective coronary angiography. Matched by sex, age (±2 years), and operation date (±180 days), a total of 429 CHD case-control pairs were included. Plasma TMAO was quantified using liquid chromatography-tandem mass spectrometry. Logistic regression analyses were performed to evaluate the association between plasma TMAO and CHD risk and severity. The overall median (interquartile range) plasma TMAO level was 0.11 (0.06-0.18) μg/ml. After stratification by sex and age, and adjustment for common CHD risk factors, the association between TMAO and CHD risk was significant in the older (≥65 years) male subgroup [odds ratios (OR) = 1.57, 95% confidence interval (CI): 1.09-2.28, P = 0.016], but not in other sex-age subgroups (all P > 0.05). The relationship of plasma TMAO and CHD risk was modified by age (adjusted P interaction = 0.001) in male individuals. Plasma TMAO was also associated with a higher risk of multi-vessel disease in male patients with CHD (OR = 1.65, 95% CI: 1.18-2.32, P = 0.004), but not in females. Plasma TMAO is significantly positively associated with the risk and severity of CHD in Chinese men. Age has an interactive effect on the relationship between plasma TMAO and CHD risk in men. Our findings warrant further investigation.

Uncovering the effects of pandemic conditions on hearing aid experiences: a dual perspective from audiologists and hearing aid users

Purpose: This study examines the effects of the pandemic on hearing aid experiences from the perspectives of audiologists and patients, as well as communication challenges faced by both users and non-users of hearing aids. Materials and Methods: The study consisted of two phases: a longitudinal study examining the services provided by audiologists during the peak of the COVID-19 pandemic and after the first vaccination dose. The second phase involved a survey of 120 elderly individuals with hearing loss, divided into hearing aid users and non-users for assessing communication challenges. Data was collected from comprehensive audiology clinics using a series of checklists. Results: Analysis of the frequency of services related to hearing aids revealed that during the peak period, the majority of visits were for acquiring batteries and hearing aids, while fewer visits were for fitting and fine-tuning the devices. After vaccination the pattern was changed. In the second phase, significant differences were observed between the hearing aid users and non-users with regards to their ability to comprehend speech while wearing mask, communicating at a safe distance, and following TV news. Conclusions: The distribution of requested services differed during the peak period and the post-vaccination period. There was a noticeable increase in the purchase and fitting of hearing aids after vaccination. However, patients encountered difficulties due to the limited availability of tele-audiology services and delayed services from hearing aid companies. The benefits of hearing aids were impacted by the pandemic as many people did not seek adjustments for their devices.

Adoption of mobile dementia prevention services for middle-aged and older adults: applying the theory of coping strategies for dementia risks.

The prevalence of dementia is increasing due to the aging population, leading to significant investments in information technology-based dementia care solutions such as mobile dementia prevention services (MDPS). These services aim to facilitate early diagnosis and prevent cognitive decline, with the ultimate goal of reducing medical costs. This study examines how aging individuals perceive and evaluate MDPS and how these perceptions influence their adoption intentions. Drawing from a coping perspective, we analyze the impact of susceptibility and severity dimensions in dementia risk perception on the perceived usefulness and self-incongruence in MDPS adoption. Focusing on middle-aged and older adults aged 55 and above, the study reveals significant but contrasting effects of susceptibility and severity. Perceived susceptibility of dementia is associated with emotion-focused coping, positively influencing self-incongruence with MDPS. Perceived severity of dementia is linked to problem-focused coping, negatively impacting self-incongruence but positively influencing the perceived usefulness of MDPS, promoting adoption. These findings provide insights into promoting MDPS by considering dementia risk perceptions and contribute to the development of effective dementia-related strategies for aging individuals.

Development and justification of a method for presenting radiation risks associated with medical exposure of patients

The practical implementation of radiation protection principles in the medical exposure of patients often tends to fall into one of two extremes: either excessive simplification of the methodology for assessing radiation health detriment, or its excessive complexity. An example of an excessively simplified approach is the assessment of radiation risk to patients using effective dose and radiation damage coefficients (nominal risk coefficients) as presented in Norms of the Radiation Safety NRB-99/2009. An example of an unjustifiably complex approach can be considered Tables 1-2 in MR 2.6.1.0215-20 "Assessment of radiation risk to patients during X-ray diagnostic radiological examinations," which indicate "lifetime risk values of death taking into account harm from reduced quality of life due to cancer of various organs and tissues and genetic effects from medical examinations" for a wide range of medical diagnostic X-ray radiological examinations in five-year age groups of patients. The main shortcomings of the simplified approach can be considered the lack of differences in risk assessment between individuals of different sexes and ages, although the fact of higher radiosensitivity in children compared to adults and in women compared to men can be considered universally recognized. The risk assessment approach proposed in MR 2.6.1.0215-20 addresses these shortcomings. However, in the view of the authors of this study, it offers an unnecessarily detailed picture considering uncertainties inherent in risk assessments at low doses, as well as uncertainties in the method of interpopulation transfer of radiation risk proposed by the International Commission on Radiological Protection. The aim of this study was to develop and justify a simpler and more straightforward method of presenting information on radiation risks associated with medical X-ray radiological examinations, free from the main drawbacks of the two aforementioned methods. To achieve this goal, radiation risks were calculated using two methods (using effective dose and using the risk model of the International Commission on Radiological Protection). A comparative analysis of the calculation results was conducted with estimates presented in Tables 1-2 of MR 2.6.1.0215-20. As a result of the analysis, an original applied method for presenting qualitative characteristics of radiation risks was developed for use in prescribing X-ray radiological examinations and informing patients about potential health risks. The practical outcome of the study is the formation of a table of radiation risks associated with conducting studies on patients from the Russian population, using the developed method of presenting information on radiation risks.

Association between nighttime sleep duration and quality with low back pain in middle-aged and older Chinese adults

BackgroundThis study aims to investigate the association between sleep duration, sleep quality, and the risk of low back pain (LBP) among middle-aged and elderly individuals in China. MethodsUtilizing data from the China Health and Retirement Longitudinal Study spanning 2011 to 2020, we categorized sleep duration into long, medium, and short categories, and sleep quality into good, fair, and poor levels. LBP status was determined based on self-reported information by participants. Multivariable logistic regression analysis was employed to assess the relationship between sleep duration, sleep quality, with the risk of LBP. ResultsA total of 6750 individuals were included in the longitudinal study. After 9 years of follow-up, the prevalence of LBP was 25.69 %. In the fully adjusted model, compared to individuals with medium sleep duration, those with short sleep duration had a 28 % increased risk of developing LBP (OR = 1.28, 95%CI: 1.12, 1.46). Additionally, when compared to individuals with good sleep quality, those with fair and poor sleep quality had a 35 % (OR = 1.35, 95%CI: 1.19, 1.54) and 33 % (OR = 1.33, 95%CI: 1.12, 1.58) increased risk of LBP, respectively. Joint analysis of both factors revealed that individuals with poor sleep quality and short sleep duration had the highest risk of LBP. ConclusionAmong middle-aged and elderly individuals in China, short sleep duration and poor sleep quality were associated with an increased risk of LBP. Future studies should further explore the mechanisms underlying this association and validate the findings through randomized controlled trials.

The under-recognition and significance of frailty syndrome - a geriatric and forensic conundrum.

Frailty syndrome occurs in elderly individuals with declining muscle mass (sarcopenia), unintentional weight loss, decreasing physical strength and activity, exhaustion, and slow ambulation. It significantly increases morbidity and mortality with cardiovascular, renal disease and neurological disorders, osteoporosis and fractures, endocrine and immunological dysfunction and a variety of malignancies. It is increasing in incidence as the population ages. However, unfortunately as identification relies on clinical and not pathological evaluations, its contribution to a wide range of comorbidities and its role in terminal episodes may not be recognized in a forensic context.

12217 Exploring Thyroid-stimulating Hormone As A Potential Cardiovascular Disease Risk Marker In Euthyroid Individuals

Abstract Disclosure: A.P. Neto: None. H. Lucchesi: None. C.C. Silva Janovsky: None. I. Bensenor: None. L.S. Ward: None. L.L. Cunha: None. Previous studies have suggested that TSH levels may predict longevity primarily in elderly individuals. Aging is associated with a high prevalence of cardiovascular and metabolic diseases that reduce survival. However, the relationship between serum TSH levels and these conditions, especially traditional cardiovascular risk markers, remains poorly explored. We employed data from the longitudinal multicenter cohort study ELSA-Brasil, which includes workers from five Brazilian Universities, to evaluate thyroid function in 8,452 participants aged between 34 and 75 years, classified as euthyroid and followed for 8.9 ± 0.6 years. The participants were evaluated for the presence of diabetes, hypertension, angina, peripheral arterial disease, and cardiovascular mortality. Additionally, we measured cardiovascular markers, including global cardiovascular risk score, HbA1c, microalbuminuria (mg/dl), LDL levels, and triglyceride levels. Statistical analysis was used to compare TSH levels with clinically relevant outcomes and classical cardiovascular risk markers. We observed that higher TSH levels correlated negatively with global cardiovascular risk (Spearman rank -0.023, p-value=0.038), microalbuminuria (Spearman rank -0.055, p<0.000), and HbA1c (Spearman rank -0.041, p<0.000). However, TSH levels were positively correlated with hypertriglyceridemia (Spearman rank +0.125, p<0.000) but had no relationship with LDL (p >0.05). The appraisal of cardio-metabolic diseases showed that individuals without diabetes had higher TSH levels (1.79 mIU/L, IQR 1.07) than individuals with diabetes (1.71 mIU/L, IQR 1.07). Patients with arteriosclerosis diseases, such as coronary and peripheral arterial disease, had lower TSH levels (1.66, IQR 0.98 and 1.67, IQR 0.94, respectively) than those who did not have these comorbidities (1.79, IQR 1.07, and 1.79, IQR 1.07). Furthermore, TSH levels did not correlate with the incidence of hypertension (p >0.05). Finally, we divided the population into two groups: higher and lower TSH levels based on the median TSH levels (1.78 mIU/L, IQR 1.06). The Kaplan-Meier curve did not show a difference between these groups (p=0.758) in survival after cardiovascular events (08 events in total) during follow-up. In conclusion, our results suggest that higher serum TSH levels in euthyroid individuals are associated with a lower prevalence of metabolic and cardiovascular disease. However, the relatively short observation duration and low frequency of cardiovascular events in our cohort made it difficult to statistically analyze several endpoints, such as survival. Further investigation is necessary to completely understand whether TSH is a cardiovascular risk indicator. Presentation: 6/2/2024

Effects of Human Milk Oligosaccharide 2′-Fucosyllactose Ingestion on Weight Loss and Markers of Health

Background: 2′-Fucosyllactose (2′-FL) is an oligosaccharide contained in human milk and possesses prebiotic and anti-inflammatory effects, which may alleviate skeletal muscle atrophy under caloric restriction. This study evaluated the impacts of 12 weeks of 2′-FL supplementation in conjunction with exercise (10,000 steps/day, 5 days/week) and energy-reduced (−300 kcals/day) dietary interventions on changes in body composition and health-related biomarkers. Methods: A total of 41 overweight and sedentary female and male participants (38.0 ± 13 years, 90.1 ± 15 kg, 31.6 ± 6.6 kg/m2, 36.9 ± 7% fat) took part in a randomized, double-blind, and placebo-controlled study. The participants underwent baseline assessments and were then assigned to ingest 3 g/day of a placebo (PLA) or Momstamin 2′-F while initiating the exercise and weight-loss program. Follow-up tests were performed after 6 and 12 weeks. Data were analyzed using general linear model statistics with repeated measures and mean changes from baseline values with 95% confidence intervals (CIs). Results: No group × time × sex interaction effects were observed, so group × time effects are reported. Participants in both groups saw comparable reductions in weight. However, those with 2′-FL demonstrated a significantly greater reduction in the percentage of body fat and less loss of the fat-free mass. Additionally, there was evidence that 2′-FL supplementation promoted more favorable changes in resting fat oxidation, peak aerobic capacity, IL-4, and platelet aggregation, with some minimal effects on the fermentation of short-chain fatty acids and monosaccharides in fecal samples. Moreover, participants’ perceptions regarding some aspects of the functional capacity and ratings of the quality of life were improved, and the supplementation protocol was well tolerated, although a small, but significant, decrease in BMC was observed. Conclusions: The results support contentions that dietary supplementation of 2′-FL (3 g/d) can promote fat loss and improve exercise- and diet-related markers of health and fitness in overweight sedentary individuals initiating an exercise and weight-loss program. Further research is needed to explore the potential health benefits of 2′-FL supplementation in both healthy and elderly individuals (Registered clinical trial #NCT06547801).

Acute Coronary Syndrome in Elderly Patients: How to Tackle Them?

Elderly patients diagnosed with acute coronary syndromes (ACS) represent a growing demographic population. These patients typically present more comorbidities and experience poorer outcomes compared to younger patients. Furthermore, they are less frequently subjected to revascularization procedures and are less likely to receive evidence-based medications in both the short and long-term periods. Assessing frailty is crucial in elderly patients with ACS because it can influence management decisions, as well as risk stratification and prognosis. Indeed, treatment decisions should consider geriatric syndromes, frailty, polypharmacy, sarcopenia, nutritional deficits, prevalence of comorbidities, thrombotic risk, and, at the same time, an increased risk of bleeding. Rigorous clinical assessments, clear revascularization criteria, and tailored approaches to antithrombotic therapy are essential for guiding personalized treatment decisions in these individuals. Assessing frailty helps healthcare providers identify patients who may benefit from targeted interventions to improve their outcomes and quality of life. Elderly individuals who experience ACS remain significantly underrepresented and understudied in randomized controlled trials. For this reason, the occurrence of ACS in the elderly continues to be a particularly complex issue in clinical practice, and one that clinicians increasingly have to address, given the general ageing of populations. This review aims to address the complex aspects of elderly patients with ACS to help clinicians make therapeutic decisions when faced with such situations.

5045 The Effects Of Non-functioning Adrenal Incidentalomas On Metabolic Comorbidities And Clinical Characteristics Changes: A Systematic Review And Meta-Analysis

Abstract Disclosure: X. Li: None. H. Lan: None. J. Wen: None. G. Chen: None. W. Lin: None. The Effects of Non-functioning Adrenal Incidentalomas on Metabolic Comorbidities and Clinical Characteristics Changes: A Systematic Review and Meta-analysis. Context: Adrenal incidentalomas (AI) are frequently detected during abdominal imaging, with non-functioning adrenal incidentalomas (NFAI) being particularly common, even in elderly individuals. This meta-analysis investigates the influence of NFAI on metabolic comorbidities, comparing non-surgical and surgical patient groups, and assessing alterations in NFAI characteristics. Design: Our comprehensive meta-analysis utilized data from multiple databases, encompassing studies from January 2000 to August 21, 2023.Setting: Data sources included PubMed, Embase, Cochrane Library, and Web of Science. Participants: The analysis comprises 24 articles involving 2,770 NFAI patients, categorized into non-surgical and surgical groups. Intervention: The non-surgical group underwent no surgery, while the surgical group underwent tumor resection. Main Outcome Measure: The study investigated changes in metabolic comorbidities (hypertension, diabetes, obesity, lipid metabolism disorders), tumor characteristics, and hormone production in NFAI patients during follow-up or after surgery. Results: In the non-surgical NFAI patient group (20 studies), metabolic comorbidities exhibited a discernible upward trajectory during follow-up. The initial hypertension prevalence of 58.3% increased by 4.2% over a 4-5 year follow-up period. Moreover, diabetes, obesity, and lipid metabolism disorders experienced significant increases of 5.8%, 2.2%, and 8.8%, respectively. In contrast, the surgical group (6 studies) demonstrated a notable reduction in hypertension, with 43.9% of initially hypertensive patients achieving hypertension-free status after surgery. As for tumor changes in the non-surgical group, they were generally inconsequential, with only 5% of patients witnessing tumor growth exceeding 10mm over approximately 3.3 years, and 8% undergoing functional changes. These findings underscore the divergent impact of non-surgical and surgical interventions on metabolic comorbidities in NFAI patients. Conclusion: The study advocates for regular monitoring of blood glucose and blood pressure in NFAI patients, especially those with metabolic comorbidities. When necessary, adenoma resection should be considered. Further investigation is warranted to elucidate the mechanisms connecting NFAI with metabolic factors. Presentation: 6/1/2024

Incidence and risk factors of venous thromboembolism in patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to determine the annual incidence rate of venous thromboembolism (VTE) and identify risk factors of VTE in amyotrophic lateral sclerosis (ALS) patients. A comprehensive search of three databases was conducted up to April 8, 2024, to identify longitudinal studies reporting VTE incidence in ALS patients. The included studies were either prospective or retrospective, following up with ALS patients. Quality assessment was performed using the NIH tool for observational cohort studies. Meta-analysis was conducted using Open Meta Analyst, employing a random-effect model. Subgroup, Meta-regression, and sensitivity analyses were also carried out. Our analysis included eight studies comprising a total of 26,758 ALS patients that met the inclusion criteria. The pooled annual incidence of VTE across all studies was found to be 22 cases per 1,000 person-year (95% CI = 18 to 27). Subgroup analysis revealed that the annual incidence of VTE in males was 19 cases per 1,000 person-year (95% CI = 15 to 22), while in females, it was 20 cases per 1,000 person-year (95% CI = 16 to 25). Leave-one-out analysis demonstrated that the incidence ranged from 21 to 28 cases per 1,000 person-year when excluding each study individually. Meta-regression analysis did not find a significant association between age and the risk of VTE (P = 0.079). Based on the included studies, risk factors of VTE in ALS patients included a history of VTE, non-invasive ventilation, immobility, and decreased functional status. Patients with ALS face a higher risk of developing VTE compared to individuals of the same age. These findings underscore the importance of implementing preventive measures and closely monitoring VTE in ALS patients.

9265 Racial/Ethnical Differences in Classic and 11-Oxygenated Androgens

Abstract Disclosure: C. Lee: None. R.J. Auchus: None. J. McDonald: None. J. Rege: None. W.E. Rainey: None. A.F. Turcu: None. Background: Malignancies modulated by sex-steroids, such as prostate and breast cancer, as well as disorders of androgen excess, like polycystic ovary syndrome, display prevalence and/or phenotype differences across races/ethnicities. Such differences have been attributed, in part, to testosterone (T). A set of adrenal-derived 11-oxygenated C19 steroids (11-oxyandrogens) has emerged as relevant to several androgen-dependent pathologies. Classic and 11-oxyandrogens are impacted differently by age and adiposity. Data on race and ethnic variations in 11-oxyandrogen concentrations are lacking. Setting and Participants: Participants in the population-based, multiethnic cohort of the Dallas Heart Study, phase 2. Measurements: T, androstenedione (A4), 11β-hydroxyandrostenedione (11OHA4), 11β-ketoandrostenedione (11KA4), 11-hydroxytosterone (11OHT), and 11-ketotestosterone (11KT) were quantified simultaneously in peripheral blood using liquid chromatography-tandem mass spectrometry. Steroids were compared across races stratified by gender, and adjusted for age and BMI, using linear mixed models in SAS (NC, USA). Results: Of the 1966 participants included, 1137 (57.8%) were women, 49% were non-Hispanic Black, 35% non-Hispanic White, and 14% Hispanic. The mean age of study participants was 51.3 +/- 10.3 years, and mean BMI was 31.0 +/- 7.1 kg/m2. Compared to White individuals of similar age and BMI, 11KT concentrations were higher in both Black women (β = 3.5 +/- 1.2, p = 0.004), and Black men (β = 5.8 +/- 1.9, p = 0.002). The immediate precursor of 11KT, 11KA4, displayed higher concentrations in Black vs. White men (β = 2.9+/- 0.7, p < 0.0001), with similar trends in women (β = 3.0 +/- 1.6, p = 0.056). The weak androgen 11OHT was higher in Black vs. White women (β = 3.0 +/- 0.91, p = 0.0009), but did not differ across races in men. Compared to White individuals of the corresponding gender, age- and BMI-adjusted 11OHA4 concentrations were higher in Hispanic women (β = 10.8 +/- 5.4, p = 0.043), and in Black men (β = 20.9 +/- 4.8, p < 0.0001). The classic androgen T was higher in Black women and men (β = 3.7 +/- 1.4 and β = 41.5 +/- 14.7, respectively, p < 0.01 for both), as well as in Hispanic men (β = 46.6 +/- 21.8, p = 0.03) compared to their White counterparts with similar age and BMI. A4 concentrations were similar across races. Conclusions: The bioactive androgens 11KT and T were higher in Black women and men compared to White individuals with similar age and BMI. Conversely, in Hispanic men, only T was higher compared to White men. In addition to T, 11KT might also contribute to disproportionately high prevalence of androgen-related pathologies in Black individuals. Acknowledgements: This work was supported by grant R01AG08051601 from the National Institute of Aging, and, in part, by grant UL1TR001105 from the National Center for Advancing Translational Science, National Institutes of Health. Presentation: 6/1/2024

12474 Demographic Characteristics Of Patients With Prediabetes Who Reverted To Normoglycemia Or Progressed To Diabetes At 1 Year Follow Up

Abstract Disclosure: E.M. Niedzialkowska: None. F. El Sayed: None. M. Townsend: None. U. Bhatia: None. S. Roy: None. R. Homayouni: None. A. Halalau: None. Background: Pre-diabetes (PD), characterized by hyperglycemia influenced by lifestyle factors, genetics, age, and ethnicity, is considered a risk factor for development of diabetes. However, only a small proportion of PD individuals progress to type-2 diabetes (T2D) each year. More refined diabetes risk prediction tools are needed to direct proactive health management strategies for at-risk populations. Question and Significance: Our study explored the associations between age, race, gender and BMI in PD individuals who either progressed to T2D or reverted to normoglycemia (NG) over a one-year follow-up period. Methods and Design: This is a retrospective observational study of 38,228 patients with PD, based on having two consecutive years of hemoglobin A1c (HbA1c) between 5.7% and 6.5%. We compared the demographic characteristics of individuals who progressed to T2D or regressed to NG within one year using bivariate (Kruskal-Wallis or Chi-squared) or multivariate logistic regression analysis. Results: The study cohort included 57.36% females, 66.13% Whites, 19.41% Blacks and 4.36% Asians with a median age of 69. Bivariate analysis revealed significant age differences between PD patients who reverted to NG with median age of 67 in those who reverted vs 70 in those who did not revert (p< 0.0001). In addition, the proportion of males who progressed to T2D was significantly higher and the proportion of Blacks who reverted to NG was significantly lower.Using multivariate regression (adjusting for age, gender, race and BMI), we found that each year in age significantly lowered the odds of reversion from PD to NG (OR 0.98, p<0.0001) but was not associated with progression to T2D. PD males had significantly higher odds of progression to T2D (OR 1.28, p<0.0001). Both Asians (OR 0.62, p<0.0007) and Blacks (OR 0.68, p<0.0004) had significantly lower odds of reversion to NG from PD compared to Whites. Surprisingly, BMI was not associated with neither reversion to NG nor progression to T2D, after adjusting for age, gender, and race. Discussion: Our findings underscore significant racial disparities and gender differences in regression to normoglycemia and progression to diabetes. This emphasizes the need for personalized interventions and targeted strategies for prediabetic populations to mitigate progression to T2D and to achieve normoglycemia. Presentation: 6/1/2024

Phenotyping Kidney Function in Young Adults With High Blood Pressure: The African-PREDICT Study.

Biomarkers of kidney function, including glomerular, tubular, and fibrotic markers, have been associated with blood pressure in elderly populations and individuals with kidney and cardiovascular diseases. However, limited information is available in young adults. In this study, we compared levels of several kidney function biomarkers between normotensive and hypertensive young adults and explored the associations of these biomarkers with blood pressure within these groups. In this cross-sectional assessment, twenty-four-hour (24-h) blood pressure measurements of 1055 participants (mean age=24.6years) were used to classify hypertension as per the 2018 ESC/ESH guidelines. Biomarkers of kidney function included estimated glomerular filtration rate, urinary albumin, alpha-1 microglobulin (uA1M), neutrophil gelatinase-associated lipocalin (uNGAL), uromodulin (uUMOD), and the CKD273 classifier. All urinary biomarkers, except for the CKD273 classifier, were standardized for urinary creatinine (Cr). In the hypertensive group (61.0% White; 73.2% men), urinary albumin-to-creatinine ratio (uACR), uNGAL/Cr and uUMOD/Cr were lower than the normotensive group. In multiple regression analyses, 24-h systolic blood pressure (SBP) (β=0.14; p=0.042), 24-h diastolic blood pressure (DBP) (β=0.14; p=0.040), and 24-h mean arterial pressure (MAP) (β=0.16; p=0.020) associated positively with uA1M/Cr in the hypertensive group, while 24-h MAP positively associated with uACR (β=0.17; p=0.017). In exploratory factor analysis, positive associations of 24-h DBP and 24-h MAP with a factor pattern including tubular biomarkers were observed in the hypertensive group (24-h DBP: β=0.18; p=0.026, 24-h MAP: β=0.17; p=0.032). In the setting of hypertension, high perfusion pressure in the kidneys may play a role in the development of proximal tubule damage and promote early deterioration in kidney function in young adults. Trial Registration: ClinicalTrials.gov identifier: NCT03292094.

8709 FABP4+ Bone Marrow Endothelial Cells Support Hematopoietic Stem Cell Niches And Osteogenesis In Response To Vascular Insufficiency

Abstract Disclosure: Y. Kim: None. M. Song: None. H. Sun: None. S. Cho: None. Background: Numerous non-communicable and aging-related diseases are linked to systemic vascular insufficiency. The consequences of vascular insufficiency in bone marrow extend to compromising osteogenesis and hematopoiesis, with a more pronounced impact on aging individuals compared to younger counterparts affected by these conditions. Recent advances in scRNA-seq have shed light on the cellular taxonomy in bone marrow; however, a comprehensive understanding of cellular complexity requires further elucidation, and there are limitations in delineating impaired osteogenesis and hematopoiesis resulting from vascular insufficiency. In this study, we employed a combined approach of scRNA-seq and intensive ex vivo investigations to elucidate the regeneration process of bone marrow microenvironment following vascular insufficiency. Method Female C57BL/6 mice at different ages (6-wkks and 14 weeks) were subjected to sham (sham group) or right femoral artery ligation surgery (ischemia group). Reperfusion duration was quantified by color laser doppler. Osteogenesis was assessed by H&E staining, DXA and microCT scan. Flow cytometry was employed to count the number of type H endothelial cell (THEC, Endomucinhi). Bone marrow regeneration capacity was examined in vitro by treating with conditioned medium (CM) of THEC and in vivo via THEC injection. scRNA-seq was performed on the bone marrow of both sham and ischemia group 7 days post-ischemia. Result In young mice, reperfusion occurred within 7 days and osteogenesis was not different between sham and ischemia group. However, in old mice, reperfusion extended to 6 weeks, and accompanied by a reduction in osteogenesis, which did not recover until 12 weeks post-ischemia compared to sham group. The percentage of THEC increased after ischemia in young mice from 1.01% to 3.12 % (n=10, p<0.05), while those were comparable between sham and ischemia group in old mice (from 0.66% to 1.02%, n = 10, p=0.56). in MC3T3-E1 preosteoblast cell line, treatment with THEC-CM upregulated gene expressions associated with bone formation such as Alpl, Bglap, and Col1a1. In vivo THEC injection in old mice following ischemia surgery resulted in a reduction in reperfusion duration and an improvement in osteogenesis. scRNA-seq of bone marrow identified a significant increase of bone marrow stromal cells (BMSCs) and Cxcl12-abundant reticular (CAR) cells 7-days post-ischemia, which provides favorable microenvironment for dormant hematopoietic stem cells (HSCs). The number of FABP4+ THEC synchronized with the increase in BMSCs and CARs. In addition, FABP4+ THEC expressed Col1a1 and Col1a2, associated with osteogenesis, along with Cxcl12 and Foxc1, linked to HSC niches. Conclusion: FABP4+ THECs contribute to favorable microenvironment for HSCs and play a pivotal role in angiogenesis-osteogenesis coupling following vascular insufficiency. Presentation: 6/1/2024

Global, Regional, and National Trends Analysis in Incidence of Genital Herpes Among the Population Aged 15-49 Years - Worldwide, 1990-2021.

Genital herpes infection is a chronic condition that can cause recurrent symptoms, significantly affecting both quality of life and sexual relationships. However, there is currently no available data on the global trends and regional variations in the incidence of genital herpes among individuals of reproductive age. From 1990 to 2021, there was a 51.97% increase in global incident cases of genital herpes among individuals aged 15-49 years. The incidence rates also rose in low-middle socio-demographic index region, South Asia, Southern Sub-Saharan Africa, and Central Europe. Among these regions, countries in Southern Sub-Saharan Africa experienced the highest burden of genital herpes among individuals aged 15-49 years. Given the rise in global incident cases and incidence rates in some regions among individuals of reproductive age from 1990 to 2021, it is imperative to prioritize the implementation of preventive strategies and interventions for genital herpes infection. This includes a significant focus on the development of vaccines.

Risk factors for nonunion in femoral neck fracture patients with internal fixation: A multicenter (TRON group) retrospective study

IntroductionFemoral neck fractures (FNFs) are common in elderly individuals. When minimally displaced, they are typically treated with internal fixation. Nonunion is a complication of internal fixation of FNF, that sometimes necessitates reoperation. Radiographic parameters, including the Pauwels angle and posterior tilt angle, are risk factors for nonunion. However, these parameters are assessed solely in a two-dimensional context. We developed a novel radiographic parameter named the “Kindex.” This multicenter investigation aimed to identify risk factors for nonunion following FNF fixation and evaluate the validity of this index. MethodsThis retrospective multicenter study collected data from 939 FNF patients who underwent internal fixation between 2016 and 2020 at 11 facilities (TRON group). The following exclusion criteria were applied: age <65, insufficient data, and Garden Stage III or IV fracture. Patient data, including age, sex, BMI, ASA classification, alcohol and smoking history, and comorbidities, were recorded. Radiographic measurements of the Pauwels angle and posterior tilt angle at the time of injury were used to calculate the Kindex. Correlations between the Pauwels angle, posterior tilt angle, Kindex, and nonunion were evaluated. A multivariate logistic regression analysis was performed to investigate independent risk factors for nonunion. A receiver operating characteristic (ROC) analysis was performed to determine the cutoff value of the Kindex, and the area under the curve (AUC) was calculated. ResultsThe study included 594 patients (males, n = 151; females, n = 443; average age, 80.9 years). Nonunion was observed in 13 cases (2.2 %). While the Pauwels angle and posterior tilt angle did not show significant correlations, the Kindex exhibited strong correlations with both parameters. In the multivariate analysis, the Kindex and renal impairment were independent risk factors for nonunion (Kindex: OR 1.06, p = 0.015; renal impairment: OR 1.48, p = 0.021). In the ROC analysis, a Kindex of 50 was identified as the optimal cutoff value (AUC 0.72). ConclusionThe nonunion rate after internal fixation of FNF was 2.2 %. Renal impairment and the Kindex were identified as independent risk factors. The Kindex at the time of injury may serve as a novel radiographic parameter to consider when evaluating the need for internal fixation in FNF cases.