Age Cutoff Research Articles

Simultaneous Bilateral Surgery for Accessory Naviculars does not Have a Negative Effect on Postoperative Outcome.

Accessory navicular tends to occur bilaterally; however, unilateral surgery is performed more often than simultaneous bilateral surgery. The purpose of this study was to compare the clinical outcomes of unilateral and simultaneous bilateral surgeries. Between 2018 and 2022, 42 feet in 26 patients underwent resection for a type-II symptomatic accessory navicular. Patients were classified into 2 groups according to unilateral (group Uni) or bilateral (group Bi) surgery. Clinical outcomes and time to postoperative walking, jogging, and return to full athletic activities were compared between the groups. There were 10 and 16 patients in group Uni and group Bi, respectively. A comparison between group Uni and group Bi revealed no significant differences in the number of days until walking, jogging, or full athletic activity. There were no statistically significant differences between groups in terms of mean postoperative SAFE-Q scores for any of the subscales. To avoid the influence of age, stratified analysis was conducted by dividing the participants into those aged ≤ 16 years and those aged > 16 years. No statistically significant differences were observed between the group Uni and group Bi. Similar results were also observed in the t-test. In addition, we conducted a similar analysis by changing the age cutoff to 15 or 19 years, but no qualitative changes were observed in the results. There is no clear evidence that bilateral surgery for type-II symptomatic bilateral accessory navicular delays recovery, and there might be no need to avoid bilateral simultaneous surgery, regardless of age. LEVEL OF CLINICAL EVIDENCE: Level 4.

No Age Cutoff Accurately Prognosticates the Likelihood of 30-Day Medical Complications, Unplanned Readmissions, and Death after Elective Primary Total Shoulder Arthroplasty

No Age Cutoff Accurately Prognosticates the Likelihood of 30-Day Medical Complications, Unplanned Readmissions, and Death after Elective Primary Total Shoulder Arthroplasty

Determinants of pregnancy outcomes in early-onset intrahepatic cholestasis of pregnancy.

To analyze pregnancy outcomes and factors influencing early-onset intrahepatic cholestasis of pregnancy (ICP), offering insights to improve the management, diagnosis, and treatment of ICP during pregnancy. We categorized 127 pregnant women with ICP into two groups based on a gestational age cutoff of 28weeks. The analysis centered on biochemical markers, pregnancy complications, and outcomes to identify factors influencing early-onset ICP. We found that biochemical markers including alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase (GGT), alkaline phosphatase, total bilirubin, direct bilirubin (DBIL), indirect bilirubin, and cholesterol were significantly lower in early-onset ICP compared to late-onset ICP. Importantly, premature birth rates were higher in the early-onset ICP group. Through univariate and multivariate logistic regression analyses of these biochemical markers, GGT and DBIL emerged as significant predictive factors (OR=0.84 and 0.54). Early-onset ICP is characterized by its early onset, prolonged duration, and a higher incidence of premature births compared to late-onset ICP, leading to adverse perinatal outcomes. This research underscores theprotective role of GGT and DBIL in early-onset ICP.

Determining the Optimal Age for Extracranial-Intracranial Bypass Surgery: A Post Hoc Analysis of the CMOSS Randomized Trial.

Previous trials have failed to demonstrate the benefits of extracranial-intracranial (EC-IC) bypass surgery for patients with carotid or middle cerebral artery occlusion. However, little evidence has focused on the effect of age on prognosis. This study aimed to explore whether EC-IC bypass surgery can provide greater benefits than medical therapy alone in specific age groups. A post hoc analysis was performed of the CMOSS (Carotid or Middle Cerebral Artery Occlusion Surgery Study), which was a randomized, open-label, outcome assessor-blinded trial conducted at 13 centers in China between June 2013 and March 2018. A total of 324 patients with internal carotid artery or middle cerebral artery occlusion with transient ischemic attack or nondisabling ischemic stroke attributed to hemodynamic insufficiency were randomized into a surgical group (n=161) that underwent EC-IC bypass surgery with medical therapy, and a medical group (n=163) that received antiplatelet therapy and stroke risk factor control alone. The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days up to 2 years after randomization. Receiver operating characteristic curves were drawn to explore the optimal age boundary, and survival analyses were used to explore differences between groups. Among the 324 patients (median age, 52.7 years; 79.3% men), an age cutoff of 55.5 years predicted the primary outcome in the surgical group (area under the curve, 0.649 [95% CI, 0.530-0.769]). Patients were further divided into an older group (>55.5 years) and a younger group (≤55.5 years). Younger patients who underwent bypass surgery showed a lower risk of the primary outcome (log-rank P=0.001) than older patients. Patients who underwent EC-IC bypass surgery had a lower risk than patients with medical therapy alone in the younger group (3.2% versus 11.6%; hazard ratio, 0.255 [95% CI, 0.071-0.916]; P=0.036), but not in the older group (17.5% versus 13.3%; adjusted hazard ratio, 0.597 [95% CI, 0.225-1.580]; P=0.298). In patients aged 55.5 years or younger with symptomatic atherosclerotic occlusion of the internal carotid artery or middle cerebral artery and hemodynamic insufficiency, the addition of EC-IC bypass surgery to medical therapy significantly improved prognosis. These findings suggest that the clinical application of EC-IC bypass surgery needs more research to explore refined patient selection criteria incorporating more clinical features. URL: https://www.clinicaltrials.gov; Unique identifier: NCT01758614.

Predictors of Early Death in Patients With Wild-Type Transthyretin Cardiac Amyloidosis.

For the time being, tafamidis is the only approved treatment for wild-type transthyretin cardiac amyloidosis. However, benefits on all-cause death only emerge after ≈18 months. The current available staging systems are unable to specifically discriminate patients at high risk of death within 18 months from diagnosis, and the selection of patients who are expected to benefit from tafamidis is left to the clinical judgment of treating physicians, being often based primarily (and sometimes only) on age. We searched baseline variables able to discriminate patients at risk of death within 18 months. We randomly divided our prospectively maintained database in 2 cohorts, a testing (two thirds) and a validating (one third) set, respectively. We used the Eastern Cooperative Oncology Group-Performance Status as a simple scoring of frailty. We analyzed the clinical, laboratory and instrumental features of 691 consecutive wild-type transthyretin cardiac amyloidosis patients diagnosed between 2006 and 2021. Median follow-up was 43 months, and 367 patients (53%) died. Eighteen-month death was predicted by NT-proBNP (N-terminal pro-B-type natriuretic peptide; cutoff 4200 ng/L), cardiac troponin I (cutoff 92 ng/L), and age (cutoff 80 years). At multivariable analysis, Eastern Cooperative Oncology Group-Performance Status >1 along with the selected variables were independent prognostic determinants and outperformed New York Heart Association functional class. The combination of these variables identified standard- and high-risk patients (all variables above the cutoffs) with a median survival of 57 and 17 months, respectively (P<0.001). This was confirmed in the validation set. A simple scoring system including age, cardiac biomarkers, and Eastern Cooperative Oncology Group-Performance Status identifies subjects with cardiac wild-type transthyretin cardiac amyloidosis at high risk of early death.

Is severe medial knee osteoarthritis a risk factor for dissatisfaction following medial open-wedge high tibial osteotomy in patients 55 years of age or younger?

Although previous studies have shown that severe medial knee osteoarthritis (OA) (Kellgren-Lawrence grade IV) is a risk factor for patient dissatisfaction following medial open-wedge high tibial osteotomy (MOWHTO), it is uncommon to perform arthroplasty as a primary surgical option in patients 55 years of age or younger. Thus, the purpose of our study was to evaluate whether severe medial knee OA is a risk factor for dissatisfaction following MOWHTO depending on patient age based on a cutoff of 55 years. We retrospectively reviewed the data of 270 consecutive patients who underwent MOWHTO with a minimum of 2 years of follow up. Patients were divided into 2 groups based on satisfaction following surgery, a Satisfied group (new Knee Society Score satisfaction subscore >20) and a Dissatisfied group (≤20). In order to assess risk factors for patient dissatisfaction depending on the age range, a subgroup analysis was conducted based on a cutoff age of 55 years. Preoperative demographics, OA grade, articular cartilage and meniscus status, severity of varus deformity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and surgical factors were compared. At 2 years after surgery, binomial logistic regression analysis showed that severe medial knee OA was associated with patient dissatisfaction following HTO in the entire cohort (odds ratio [OR] 4.557, 95% confidence interval [CI] 2.300-9.030, p < 0.001). In subgroup analysis depending on age range, severe medial OA was not a risk factor for dissatisfaction in the age ≤55 years group. However, severe medial knee OA in the age >55 years group was a significant risk factor for dissatisfaction after MOWHTO (OR 6.78, 95% CI 2.979-15.431, p < 0.001). Severe medial OA was not a risk factor for dissatisfaction in patients age 55 years or younger who underwent MOWHTO. Therefore, surgeons can take this result into account when counseling younger patients considering MOWHTO. III.

School Starting Age, Fertility, and Family Formation: Evidence From the School Entry Cutoff Using Exact Date of Birth

In the past 50 years, the age at first birth in Norway and other European countries has shifted, leading to concerns that individuals begin childbearing too late to reach their intended family size. This article analyzes the effect of school starting age on fertility and family formation by utilizing Norway's age-based school entry policy. Using individual-level register data and a regression discontinuity design, we find that being born after the age cutoff for school start results in an increased age at first birth of 2.9 months for women and 4.0 months for men, whereas completed cohort fertility was unchanged. Similarly, being born after the cutoff increased the age at first marriage by 4.7 months for women and 2.4 months for men, with no effect on the overall probability of having a partner. Results show that age at completed education and earnings development are important mechanisms in this fertility postponement. Additionally, we analyze detailed age- and parity-specific effects, providing important insights into how age at starting school affects fertility timing but not overall fertility.

Noninvasive Skin Autofluorescence of Advanced Glycation End Products in Patients with Degenerative Cervical Myelopathy.

To clarify the association between skin autofluorescence of advanced glycation end products (AGEs) and clinical outcomes and pain in patients with degenerative cervical myelopathy (DCM). Consecutive patients with DCM were prospectively enrolled. AGEs assessed by skin autofluorescence (the AGE score) were examined at the middle fingertip in eligible patients. Patients were divided into lower AGE score (AGE-L) and higher AGE score (AGE-H) groups based on a cutoff AGE score of 0.54. Demographic data, laboratory data, maximum spinal cord compression, clinical outcomes, such as European Quality of Life-5 Dimensions, Neck Disability Index, and Japanese Orthopaedic Association score, and Numerical Rating Scale (NRS) score for neck, arm, hand, leg, and foot pain were compared between the two groups. Multiple linear regression analysis was performed to assess the association between the AGE score and the NRS score for pain in the lower limbs. Of the 263 patients, 93 were included in this study (41 with the AGE-L group and 52 with the AGE-H group). Demographic data, laboratory data, maximum spinal cord compression, and clinical outcomes were comparable between the two groups. The AGE-H group had significantly higher NRS scores for leg and foot pain than the AGE-L group. Multiple linear regression analysis revealed that higher AGE scores were significantly associated with more severe pain in the lower limbs in patients with DCM. Noninvasive skin autofluorescence of AGEs may be a useful biomarker for pain symptoms in the lower limbs in patients with DCM.

Simple clinical predictors for making directive decisions in osteoporosis screening for women: a cross-sectional study

BackgroundOsteoporosis screening strategies vary according to a country’s policies. Simple and highly accurate diagnostic predictors should be developed and utilized. This cross-sectional study aimed to determine the diagnostic performances of weight, body mass index (BMI), and age for osteoporosis. Moreover, this study proposes and validates new cutoff values for these indicators.MethodsWomen aged 50 years or older who underwent Dual-energy x-ray absorptiometry (DXA) and did not receive any treatment for osteoporosis were enrolled. Age, weight, and BMI were used to analyze the diagnostic models. New cutoff values were proposed using the maximum Youden index value.ResultsA total of 1598 women were classified into normal bone mineral density, osteopenia, and osteoporosis groups. The mean age, weight, and BMI were 73.2 years, 53.6 kg, and 23.2 kg/m2, respectively, in the osteoporosis group, which significantly differed from those of the other groups. The new cutoff values for diagnosing osteoporosis at any site were 57.4 kg for weight, 23.8 kg/m2 for BMI, and 72 years for age. The area under the receiver operating characteristic curve (AUC) for weight < 57.4 kg, BMI < 23.8 kg/m2, and age ≥ 72 years cutoff values were 0.664, 0.633, and 0.558, respectively. The weight cutoff value yielded a significantly higher AUC than the BMI and age cutoff values (P = 0.002 and P < 0.001, respectively).ConclusionsThis study proposes new cutoff values for simple clinical predictors to facilitate directive decision-making in osteoporosis screening in women. Weight, which are easily obtained in clinical practice, are the most effective predictors of osteoporosis screening.

Who, when, where, and why: A systematic review of "late diagnosis" in autism.

An autism diagnosis can be a critical milestone toward effective and affirming support. Despite the sharp increase in the number of studies focused on late diagnosis over the last 15 years, there remains no consensus as to what constitutes a late diagnosis of autism, with cutoffs ranging from infancy to middle adulthood. This preregistered systematic review evaluated (a) the field's current quantification of late diagnosis in autism, (b) how the threshold for late diagnosis varies as a function of demographic and population factors, and (c) trends over time. Of the 11,697 records retrieved, N = 420 articles met inclusion criteria and were extracted. Articles spanned 35 years (1989-2024) and included participants from every continent except Antarctica. Only 34.7% of included studies provided a clear threshold for "late diagnosis" (n = 146/420). Late diagnosis cutoffs averaged 11.53 years (range = 2-55 years; median = 6.5 years) with a bimodal distribution (3 and 18 years). The threshold for late diagnosis varied by participant location, F(5,140) = 10.4, p < 0.0001, and sample age, F(5,140) = 20.1, p < 0.0001. Several key rationales for age determinations emerged, including access to services, considerations for adult diagnoses, and data driven approaches. What authors consider to be a "late" diagnosis of autism varies greatly according to research context. Justifications for a specific late-diagnosis age cutoff varied, underscoring the need for authors to contextualize their conceptualizations.

Kidney Transplantation in Older Recipients Regarding Surgical and Clinical Complications, Outcomes, and Survival: A Literature Review.

Context: The best treatment for end-stage chronic kidney disease (ESKD) is kidney transplantation (KT). As a result of an aging population, each year more kidney transplants in older adults are performed. Nevertheless, older recipients, characterized by more comorbidities and frailty, raise concerns about the outcomes, potential complications, and the general approach. Aim: The aim of this literature review was to study the outcomes, graft and patient survival, as well as common complications, to establish safety and increase awareness of the potential complications of kidney transplantation in the older population. Methods: PubMed and Google scholar databases were searched. The cut-off age defining an old patient was 60 years. The inclusion criteria were as follows: first kidney transplantation, and studies in English language. The exclusion criteria were as follows: more than one organ transplant, dual transplants, articles published before 2015, meta-analysis, reviews, letter to the editor, case reports, and studies published only as a conference abstract. Comparative and noncomparative studies addressing patient survival, death-censored graft survival, surgical complications, and clinical complications, such as delayed graft function (DGF) and biopsy proven acute rejection (PBAR), were included. Results: After screening the papers, 17 studies met the inclusion criteria and were included for review. Eleven papers compared older recipients with younger recipients and in six papers only older patients were analysed. Two studies used paired deceased donors to eliminate donor bias. The rest of the studies used either deceased donors or both living and deceased donors. The majority of patients were male (61.83%) and received a kidney from a deceased donor (58.08%). Conclusions: Kidney transplantation is safe and can be beneficial for recipients over 60 years of age. Older patients suffered more infectious complications, which were also one of the main reasons for death. Most studies did not show a significant difference in death-censored graft survival compared to the younger population. More research is needed to establish the prevalence of surgical complications, and some clinical complications.

Outcomes of endovascular thrombectomy for acute ischaemic stroke in patients aged ≥80 years: A Hong Kong stroke center experience

BackgroundElderly patients contribute to the large proportion of ischaemic stroke worldwide. Currently, treatment for elderly stroke remains aggressive, as the exact age cutoff for endovascular thrombectomy (EVT) has not been well established due to a lack of large-scale randomized control trials. In this study we investigate the difference in outcome after EVT in the octogenarian and above, compared to their younger counterparts. MethodsEVT patients were divided into two groups, the octogenarian group and younger group (below age of 80). Primary outcome were the 90-days post-thrombectomy functional independence (modified Rankin scale), and Barthel index. Secondary and safety outcomes of post-thrombectomy were also analyzed, including reperfusion status (modified Thrombolysis in Cerebral Infarction (TICI) score), National Institutes of Health Stroke Scale (NIHSS), major complications and mortality rate. ResultsA total 340 patients were included from 2020 to 29 Feb 2024, and patients’ demographics were obtained. Poorer neurological outcome and functional independence were noted in octogenarian group compared with younger counterpart (OR 0.33; 95 % CI 0.14-0.51; p < 0.001). A slightly higher trend of overall post-procedural death was also identified in elder group compared with the younger group (OR 1.48; 95 % CI 0.85-2.60, p = 0.08). Subgroup analysis with more advanced age cutoff at 90 took a step further and proposed that advanced age resulting in more devastating neurological outcome. ConclusionOutcomes after endovascular thrombectomy in the elder group were significantly worse than their younger counterparts. More than 80 % of elder group who were treated with EVT required moderate functional dependence, and one in four were dead within 90-days post-EVT.

RADT-26. RADIATION FRACTIONATION IN THE MANAGEMENT OF ELDERLY PATIENTS WITH GLIOBLASTOMA BY AGE

Abstract Multiple studies have investigated hypofractionated radiation (HFX) for elderly patients with glioblastoma (GBM), using varying age cut-offs. This leads to uncertainty about who benefits most from a hypofractionated course. This study examines the use of and outcomes with HFX, between two commonly used cut offs to define elderly GBM: 65 versus 70 years old. In this retrospective review, 309 patients diagnosed with GBM who were treated with radiation at a single academic institution were included. The Kaplan-Meier method was used to analyze overall survival. A Chi-square test was conducted to compare the use of SFX and HFX and the median survival between those 65-69 versus 70-74 years old. Patients aged 70-74 were more likely to receive HFX radiation compared to those aged 65-69 (80.00% vs. 42.65%, p=0.0002). Median survival for the entire cohort was 12 months. Among those 65-69 years old, SFX was associated with a significantly higher median survival compared to HFX (14 months vs. 7 months, HR 2.00, 95% CI 1.16 – 3.46, p=0.03). This was also true for those 70-74 years old, (18 months vs. 4 months, HR 4.50, 95% CI 1.84 – 11.01, p=0.03). We demonstrate a decrease in the use of SFX in patients 65 years or older, and that that standard fractionation is associated with longer survival in older patients with GBM. This suggests that in a well selected population, SFX should be considered even among elderly patients. Additional work is needed to determine whether these findings are causal or due to patient selection. Performance status and MGMT methylations status, for instance, should guide clinical decision making. Such results highlight the importance of further studies to fine tune radiation dose and fractionation elderly patients with GBM.

Mortality and prognosis in herpes simplex Virus-1 encephalitis long-term follow up study

Background and objectivesHerpes simplex virus-1 (HSV-1) encephalitis is the most prevalent form of viral encephalitis worldwide. Consensus statements on the rate of mortality are lacking, with most studies emphasizing short-term mortality risks. We aimed to describe variables effecting mortality for HSV-1 encephalitis in a long term well defined HSV cohorts. MethodsThis is a retrospective study, encephalitis patients who were HSV-positive (HSV- 1,HSV-2 and VZV) in the cerebrospinal fluid (CSF) in 23 years' time frame were compared. Clinical, electrophysiological, imaging, and laboratory data were analyzed. ResultsWe identified 47 HSV-1, 8 HSV-2 and 216 with VZV patients with a molecular CSF PCR diagnosis. The median age at diagnosis was 63.3 (interquartile range(IQR) 50.42–72.52) for HSV-1, 46.79 (IQR 36.55–55.05) for HSV-2 and 60.33.(IQR 33.78–74.11) for VZV (p = 0.14). The mean follow up time was 6.25 ± 5.92 years for the group as whole. Among HSV-1 patients, during the follow-up period, 26 patients (55.31 %) died. Ten deaths occurred within the first year, with a median age of death of 70.6 [63.53–75.39]. Patients who died were older (70.6 [63.53–75.39 vs.48.59 [37.88–61.71], p < 0.001), had a longer time to treatment initiation (4.01 ± 5.69 vs. 1.96 ± 3.58 days, p = 0.026), with cancer comorbidities more prevalent (42.3 % vs. 0 %, p < 0.001). Univariate analysis showed older age (HR 1.07, 95 % CI 1.03–1.10, p < 0.01), and cancer comorbidity (HR 5.55, 95 % CI 2.31–13.33, p < 0.001) were associated with significantly higher risk for mortality. Multivariate analysis confirmed that older age (HR 1.096, 95 % CI 1.04–1.15, p < 0.001), cancer comorbidity (HR 11.02, 95 % CI 2.76–43.9, p < 0.001) and lower lymphocyte count (HR 0.97, 95 % CI 0.95–0.99, p = 0.032) influenced mortality risk. The optimal cut-off age to predict mortality based on AUC-ROC curve was 63.29 (AUC = 0.83, sensitivity = 0.76, specificity = 0.80, PPV = 0.83, NNV = 0.73, p < 0.001). Patients above this age cutoff had a significantly greater cumulative incidence of mortality than did those aged 50–63 years (p < 0.01). DiscussionMortality due to HSV-1 was high and highest in patients >63 years or immunocompromised patients. Favorable outcomes were associated with increased lymphocyte levels in CSF, and early antiviral treatment. These finding may help explain the wide discrepancies in reported mortality rates for HSV encephalitis patients.

Significant age cutoff of 73 years for advanced ovarian serous cystadenocarcinoma patients: Insights from real-world study

Significant age cutoff of 73 years for advanced ovarian serous cystadenocarcinoma patients: Insights from real-world study

Patients Have Acceptable Patient-Reported Outcome Measures After Medial Unicompartmental Knee Arthroplasty Regardless of Age

BackgroundContemporary evidence-based indications no longer consider age regarding eligibility for medial unicompartmental knee arthroplasty (mUKA). This has led to more surgical candidates; however, whether patients still have satisfactory outcomes lacks evidence. This study examined the association between age and change in patient-reported outcome measures after mUKA as well as the achievement of patient acceptable symptom state (PASS) and minimal important change (MIC). MethodsWe included 782 mUKAs performed between February 1, 2016, and April 26, 2023. The mean change from preoperative Oxford knee score (OKS), forgotten joint score (FJS), and activity and participation questionnaire (APQ) was assessed at 3, 12, and 24 months after surgery, respectively. The achievement of 12-month PASS (OKS ≥ 30) and MIC (changes in OKS ≥ 8; FJS ≥ 14) was also assessed. Patients were divided into the following age groups: <55, 55 to < 65, 65 to < 75 years (reference group), and ≥ 75 years. There were 432 women (55%), and patients had a mean age of 67 years (range, 29 to 93) and a mean body mass index of 30 (range, 20 to 53). ResultsMedian OKS, youngest to eldest, were 34, 35, 36, and 35 (3 months); 40, 39, 41, and 43 (12 months); 42, 41, 43, and 42 (24 months), respectively. We found no differences in change in OKS between groups. Patients aged 55 to < 65 years had lower changes in FJS at 24 months and APQ at 12 and 24 months. Patients ≥ 75 years had lower 24-month changes in APQ. We found no association between age and the fraction achieving either PASS or MIC (youngest to eldest, 90, 90, 94, and 95%). ConclusionsWe found good patient-reported outcome measures improvements and satisfactory outcomes after mUKA in all age groups; however, patients aged 55 to < 65 years had worse changes in FJS and APQ. Results support contemporary indications for mUKA, and applying an age cutoff is unwarranted.

Effects of anakinra on patients with heart failure below and above 60 years of age

Abstract Background Anakinra, an interleukin-1 (IL-1) blocker, is being explored in heart failure (HF) to improve cardiorespiratory fitness (CRF). CRF declines with increasing age. Purpose We aimed to determine the influence of anakinra on CRF in aging patients with HF. Methods We analyzed data from 73 patients with HF (55 [51-62] years, 37 (51%) female) treated with anakinra 100 mg subcutaneously daily. Patients were stratified into two groups according to a predetermined cut-off age of 60 years. We measured peak oxygen consumption (peak VO2) and C-reactive protein (CRP), a surrogate for IL-1 activity. Results We included 49 (67%) patients with age &amp;lt;60 years and 24 (33%) with age ≥60 years. The duration of treatment with anakinra was 4 [2-12] weeks. Age was negatively correlated with peak VO2 at baseline and during treatment with anakinra (Spearman’s Rho= -0.375, p=0.001 and Rho= -0.334, p=0.004, respectively). Younger patients had higher baseline peak VO2 (15.2 [12.4–17.7] vs 12.4 [10.3–14.3] mLO2·kg-1·min-1, p=0.001) but similar CRP (6.6 [3.6-16.6] vs 5.1 [2.7-11.2] mg/L, p=0.18). In both groups, anakinra decreased CRP (&amp;lt;60 years: from 6.6 [3.6–16.6] to 1.5 [0.9–3.8] mg/L, p&amp;lt;0.001; ≥60 years: from 5.1 [2.7–11.2] to 1.0 [0.5–3.4] mg/L, p&amp;lt;0.001)(Figure 1A) and increased peak VO2 (&amp;lt;60 years: from 15.2 [12.4–17.7] to 16.0 [14.0–18.7] mLO2·kg-1·min-1, p=0.036; ≥60 years: from 12.4 [10.3–14.3] to 13.7 [11.7–15.8] mLO2·kg-1·min-1, p&amp;lt;0.001)(Figure 1B). No significant differences in interval changes were observed between the groups. Conclusions Older patients with HF have a greater impairment in CRF than younger patients, yet they appear to benefit similarly from treatment with anakinra.Figure 1

Nutritional Assessment Based on Mid-upper Arm Circumference Among Tribal Preschool Children of Three Distinct Ecological Zones of India

Undernutrition among infants and children retards the physical and cognitive growth and increases susceptibility to infections and diseases. Educational attainment and productivity of children get adversely affected by undernutrition, NFHS (2019–2020) and IIPS (2021) found the prevalence of undernutrition indicators to be high among the under-five children of the nation and tribal children to be in a more vulnerable condition. Mean mid-upper arm circumference (MUAC) is a quick, simple and precise screening tool to use in large-scale community-based nutritional programme. The present study aimed to assess the prevalence of undernutrition based on MUAC among three tribes of three distinct ecological zones of India, namely Bhil Tribe (Desert ecology), Dhodia tribe (Coastal ecology) and Kinnaura tribe (Himalayan ecology). The present cross-sectional study consists of 985 tribal children (509 boys and 476 girls) belonging to the age group 0–1 through 5+ years (below six years). Z-score was computed using WHO (2006) recommended age and sex-specific cutoff points for MUAC and the prevalence of undernutrition was assessed for children of below five years of age. MUAC has been found to have significant age difference among all communities ( p &lt; .001). Prevalence of undernutrition was found to be the highest among the Bhil tribe, the one residing in the desert ecology (41.03%) followed by Dhodia (18.06%) and Kinnaura tribe (12.16%). Among Bhil and Kinnaura children, prevalence of undernutrition was higher among the girls, while the Kinnaura boys manifested higher prevalence of undernutrition in comparison to their counterpart. Significant ( p &lt; .01) sex difference in undernutrition prevalence was found only in case of Bhil tribe (boys: 33.33%, girls: 48.02%). The prevalence of undernutrition significantly differs among the tribes of three distinct ecological zones ( p &lt; .001). The nutritional status of the tribal children, particularly that of the Bhil children, was unsatisfactory. To improve the nutritional wellbeing of the tribal population of the nation, studies at regular intervals focusing on the causes responsible for nutritional status are needed.

Clinical and Radiographic Outcomes in Kienbock Disease Following Radial Closing Wedge Osteotomy: An Age Comparative Study and Literature Review.

Age is a preoperative prognostic factor for radial closing wedge osteotomy (RCWO) in Kienbock disease. Specifically, for cases classified as Lichtman stage III, clear criteria for selecting RCWO have not been established. We believe that age can provide vital information for determining the appropriate surgical procedure for Kienbock disease. The aim of this study was to investigate RCWO outcomes for Lichtman stage III by examining different age groups from clinical and radiological perspectives. Sixteen patients with Lichtman stage III Kienbock disease underwent RCWO. The median age was 59 years, and the median follow-up period was 2.9 years. We determined the age cutoffs for clinical and radiological outcomes using a receiver operating characteristic curve. Subsequently, we conducted intergroup comparisons of postoperative outcomes between the younger and older age groups. Age cutoffs were established at 52.5 and 30 years for clinical and radiological outcomes, respectively. In the comparative analysis, the younger age group (≤52 years; n = 7) demonstrated significantly superior clinical results, including improved range of motion and pain relief, higher postoperative Mayo Wrist Score, and lower Disability of the Arm, Shoulder, and Hand scores. From a radiological perspective, the younger age group (≤30 years; n = 3) experienced segmented lunate bone fragments healing, indicating an improved disease stage compared with the older group. Based on previous literature and our research findings, it is reasonable to conclude that RCWO results in improved clinical outcomes for patients up to their mid-50s and enhanced radiological outcomes for those up to approximately at the age of 30 years. Further studies on these age cutoffs will contribute to refining the surgical selection criteria for RCWO. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cervical length measurement between 11 and 13 + 6 weeks of pregnancy: Comparison of maternal and ultrasonographic characteristics between term and preterm deliveries.

The aim of this study was to evaluate the maternal and ultrasonographic characteristics of pregnant women who underwent cervical length (CL) measurement by transvaginal ultrasound between 11 and 13 + 6 weeks of gestation and who delivered at term or preterm. A retrospective cohort study was carried out between March 2013 and December 2018 by analyzing ultrasound data of singleton pregnant women who underwent CL measurement by transvaginal ultrasound during the first trimester scan. CL was compared between the two groups (full-term and preterm birth [PB]) using Student's t-test. A total of 5097 pregnant women were enrolled, of whom 5061 (99.3%) had term and 36 (0.7%) had PB < 34 weeks. CL measurements did not differ between the term and preterm groups (36.62 vs. 37.83 mm, p = 0.08). Maternal age showed a significant and linear association with CL (r = 0.034, p = 0.012) and CRL (r = 0.086, p < 0.001). Smoking status was associated with shorter CL (36.64 vs. 35.09 mm, p = 0.003). When we analyzed the CL of the pregnant women in the term and preterm groups, according to the gestational age cut-offs for prematurity (28, 30, 32, and 34 weeks), we found that there was no significant difference between the measurements in all groups (p > 0.05). We observed no significant differences between CL measurements between 11 and 13 + 6 weeks in pregnant women who had preterm and term deliveries. Gestational age and CRL showed a significant and linear association with CL measurement.