Age Cut-off Points Research Articles

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 < .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 < .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 < .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.

A personalized prognostic model for long-term survival in patients with intrahepatic cholangiocarcinoma: a retrospective cohort study.

This study aimed to determine the optimal cutoff points for age and tumor size of patients with intrahepatic cholangiocarcinoma (ICC) and to establish and verify a predictive nomogram of overall survival at 1, 3, and 5 years. From the SEER (Surveillance, Epidemiology, and End Results) database, 1,325 ICC patients were selected and randomly divided into training and testing cohorts at a 7:3 ratio. Using the X-tile software, age and tumor size were classified into 3 subgroups: ≤61, 62-74, and ≥75 years and ≤35, 36-55, and ≥56 mm. Subsequently, univariate and multivariate Cox regression analyses were performed using the R software in the training cohort to determine independent risk factors, compile the prediction nomogram, and verify it with the testing cohort findings. The C-indexes of the new prediction nomograms in the training and testing cohorts were 0.738 (95% confidence interval [CI], 0.718-0.758) and 0.750 (95% CI, 0.72-0.78), respectively. Furthermore, the areas under the 1-, 3-, and 5-year receiver operating characteristic (ROC) curves based on the nomogram were 0.792, 0.853, and 0.838, respectively, higher than the ROC based on the 7th and 8th editions of the American Joint Cancer Commission (AJCC) staging system. This study established and verified a prognostic nomogram that improved the accuracy of the 1-, 3-, and 5-year survival predictions for ICC patients, compared with that based on the 7th and 8th editions of the AJCC staging system, and can help clinicians make personalized survival predictions.

Robotic sacrocolpopexy for the treatment of pelvic organ prolapse in elderly women: comparative analysis of safety and efficacy versus younger women

IntroductionPelvic organ prolapse is a condition with high prevalence in elderly women. With increasing life expectancy and a desire for improved quality of life, a rise in the frequency of surgical treatments for these women is anticipated. The aim is to compare complication, success, and satisfaction rates among elderly patients (aged >70 years) in comparison to younger women undergoing robotic sacrocolpopexy, thereby assessing the safety and efficacy of this surgery in this group of patients. MethodA prospective observational comparative study of 123 robotic sacrocolpopexies conducted between December 2016 and June 2022. Patients were stratified by age (cutoff point: 70 years). Baseline characteristics, type, and grade of prolapse, intra and postoperative data, complications, functional and anatomical outcomes, and satisfaction levels were collected. ResultsAmong the 123 patients, 62.6% were under 70 years old, while 37.4% were 70 years or older, exhibiting similar baseline characteristics, prolapse grade, and type. The percentages of intraoperative (6.5%) and postoperative complications (4.4–9%) were comparable in both age groups. Furthermore, success and satisfaction rates exceeded 90%, with no significant differences between women under and over 70 years during a two-year follow-up. ConclusionRobotic sacrocolpopexy is at least as effective and safe in women aged 70 years or older as in younger individuals, with no higher rates of intra and postoperative complications and similar rates of anatomical and subjective success.

Colposacropexia robótica para el tratamiento del prolapso de órganos pélvicos en mujeres de edad avanzada: análisis comparativo de la seguridad y eficacia frente a mujeres jóvenes

IntroductionPelvic organ prolapse is a condition with high prevalence in elderly women. With increasing life expectancy and a desire for improved quality of life, a rise in the frequency of surgical treatments for these women is anticipated. The aim is to compare complication, success, and satisfaction rates among elderly patients (aged>70 years) in comparison to younger women undergoing robotic sacrocolpopexy, thereby assessing the safety and efficacy of this surgery in this group of patients. MethodA prospective observational comparative study of 123 robotic sacrocolpopexies conducted between December 2016 and June 2022. Patients were stratified by age (cutoff point: 70 years). Baseline characteristics, type, and grade of prolapse, intra and postoperative data, complications, functional and anatomical outcomes, and satisfaction levels were collected. ResultsAmong the 123 patients, 62.6% were under 70 years old, while 37.4% were 70 years or older, exhibiting similar baseline characteristics, prolapse grade, and type. The percentages of intraoperative (6.5%) and postoperative complications (4.4-9%) were comparable in both age groups. Furthermore, success and satisfaction rates exceeded 90%, with no significant differences between women under and over 70 years during a two-year follow-up. ConclusionRobotic sacrocolpopexy is at least as effective and safe in women aged 70 years or older as in younger individuals, with no higher rates of intra and postoperative complications and similar rates of anatomical and subjective success.

Does Old Age Comprise Distinct Subphases? Evidence from an Analysis of the Relationship between Age and Activities of Daily Living, Comorbidities, and Geriatric Syndromes.

Older individuals are usually treated as a homogenous group despite evidence that old age consists of distinct subphases. This observational study including 493 older patients aimed to identify differences among age subgroups of older persons. Receiver operating characteristic (ROC) curve analysis was then applied to identify the optimal age cutoff points to distinguish those age groups. Data were collected on the demographics of older patients, their medical and medication histories, dependence on activities of daily living (ADLs), and instrumental activities of daily living (IADLs). Non-parametric tests (Kruskal-Wallis and Mann-Whitney U tests) and ROC curves were used for statistical analysis. The 65-79 and ≥80 years of age groups showed distinct frailty status, comorbidity, and dependency in ADLs. The median age to remain completely independent in IADLs was 76-79 years, while the median age for being free from geriatric syndromes was slightly higher (77-80 years) and reached 82 years for the absence of delirium, falls, and swallowing problems. In the ROC analysis, the optimal cutoff ages for the presence of frailty, cognitive impairment, and dependency in ADLs were 80-82 years. The 65-79 and ≥80 years of age groups differed significantly in numerous parameters, underscoring the need to address these distinct age groups differently, both for applying medical therapies and interventions, as well as for conducting health research.

Analysis of prognostic factors and establishment of prediction model of lung adenocarcinoma based on SEER database.

Few models have been developed to predict survival outcomes for lung adenocarcinoma (LUAD). In this study, we aimed to establish a nomogram for the prediction of cancer-specific survival (CSS) in LUAD patients which can be further developed as a convenient web-based calculator. We performed a retrospective analysis of 50,007 LUAD patients selected from the Surveillance, Epidemiology, and End Result (SEER) 18 registry database. To enhance the reliability of the analysis, the patients' data were further randomly divided into the training cohort (70%) and validation cohort (30%). The optimal age cut-off points were determined using X-tile software, and patients were divided into three age groups: 10-72, 73-79, and 80-99 years. We selected independent prognostic factors from 17 variables by Cox regression, and plotted a visual nomogram to predict the 1-, 3-, and 5-year CSS. The predictive performance of the nomogram was evaluated through the concordance index (C-index), calibration curve and receiver operating characteristic (ROC) curve. To facilitate CSS forecast, a web-based calculator has subsequently been developed. We selected sex, age, race, marital status, N stage, tumor size, surgery, radiotherapy, chemotherapy, and metastasis (bone, brain, liver, and lung) as independent prognostic factors. The C-index was 0.779 [95% confidence interval (CI): 0.775-0.783] in the training set prediction model, and 0.782 (95% CI: 0.778-0.786) in the validation set. ROC analysis showed that area under the curve (AUC) values were 0.700, 0.733 and 0.669 for the 1-, 3- and 5-year CSS in the training set and 0.700, 0.744 and 0.669 in the validation set, respectively. In the nomogram calibration curve, there was strong correlation between the observed and predictive values. A web-based calculator can be accessed at: https://hjhlovelfb.shinyapps.io/DynNomapp/. This nomogram model has good predictive power and can help clinicians identify LUAD patients at high risk of cancer-related death. This nomogram is expected to be a precise and personalized tool for predicting the prognosis of patients with LUAD.

2 years is a reasonable age cut-off level for prognostic assessment of children with hepatoblastoma.

We aimed to elucidate the prognostic significance of age in hepatoblastoma patients. Data from 783 patients with hepatoblastoma were obtained from the Surveillance, Epidemiology and End Results database (2000-2018). The best age cut-off level was determined by X-tile, and the Kaplan-Meier method was used to estimate overall survival (OS) and cancer-specific survival (CSS). The results of the X-tile were verified by selecting the appropriate cut-off value to maximize the difference in survival outcomes at intervals of 1 year. The Cox regression model was used to determine the prognostic impact of risk factors and age. X-tile analysis determined that 2 years was the best cut-off age for OS and CSS. The overall prognosis in the ≥ 2 years group was worse than that in the < 2 years group (OS: p = 0.00017; CSS: p < 0.0001). In Cox univariate analysis, when 2 years was used as the standard group, the numbers of patients in the two groups were similar, with high hazard ratio (HR) value and narrow 95% confidence interval (CI) (OS: HR, 1.834; 95% CI, 1.329 - 2.532; p < 0.001; CSS: HR, 1.988; 95% CI, 1.410 - 2.801; p < 0.001), which was consistent with the age cut-off point determined by X-tile. Cox multivariate analysis showed that age ≥ 2 years, black ethnicity, no surgery, no chemotherapy, distant metastasis, and tumor size ≥ 5 cm were independent predictors of poor OS and CSS. On subgroup analysis, patients aged ≥ 2 years had worse survival if they were Caucasian, had elevated alpha-fetoprotein, tumor size ≥ 5 cm, or distant metastasis. Age is an important prognostic factor for hepatoblastoma. Age ≥ 2 years at diagnosis may predict poor prognosis and more active treatment measures can be implemented.

Analysis of clinicopathological characteristics and prognosis of papillary thyroid carcinoma in children and adolescents at different ages

Objectives: To examine the age cut-off point for poor clinicopathological characteristics and prognosis of differentiated thyroid carcinoma (DTC) in children and adolescents. Methods: The clinicopathological features of 74 patients with DTC aged 18 years and younger who underwent surgery in the Department of Thyroid Surgery, the First Hospital of China Medical University from January 2011 to December 2020 were retrospectively analyzed. There were 20 males and 54 females, aged (M(IQR)) 16 (4) years (range: 8 to 18 years). Firstly, the cut-off point of age affecting prognosis was determined according to the receiver operator characteristic curve, the patients included in the study were grouped according to the age cut-off, and then the univariate and multivariate analysis for prognostic factors were performed using the Cox risk proportional regression model. The Kaplan-Meier survival curve was used to verify the factors affecting the prognosis and analyzed the possible mechanisms by bioinformatics. Results: The cut-off value of age was 15 years. Age ≤15 years was the only prognostic factor for recurrence (HR=4.427, 95%CI: 1.236 to 15.859, P=0.022). The number of metastatic cervical lymph nodes was higher in patients aged ≤15 years, and the 10-year recurrence-free survival rate was much lower than in patients aged >15 years (50.4% vs. 84.1%, P=0.018). Gene enrichment analysis and differential gene identification showed that differential genes between ≤15 years old group and>15 years old group were closely related to the transforming growth factor-β signaling pathway and some metabolism-related signaling pathways. Conclusions: Age ≤15 years is the only prognostic factor for the prognosis of DTC in children and adolescents. Age ≤15 years had more cervical lymph node metastases and a worse prognosis. For younger DTC patients, more active treatment and a stricter postoperative management strategy should be adopted.

DS04 Clinical outcomes of the management of basal cell carcinomas in individuals aged 90 years and over

Abstract This retrospective cohort study examined our practice for the management of basal cell carcinoma (BCC) in the very elderly, to identify subgroups where intervention could be minimized, based on frailty and trends in survival. All patients aged ≥ 90 years with histologically confirmed BCC during 2017 and 2018 were included within the study (n = 319). Data on lesion characteristics (size, location and subtype), presence or absence of symptoms, patient characteristics (age, comorbidities, frailty score, anticoagulant use and presence of pacemaker) and treatment choice (surgery, radiotherapy, topical, systemic or observation) were collected. Overall survival was the primary endpoint. Age was the most significant predictor of survival [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.04–1.17; P = 0.001] with a maximum threshold analysis identifying 93 years as the significant age cutoff point. Median survival was 40 months for those aged ≤ 93 years and 28 months for those aged &amp;gt; 93 years (P = 0.002). Patients with dementia had a worse survival than those without [median survival 25 months vs. 35 months (HR 1.92, 95% CI 1.18–3.13); P = 0.009]. None of the 23 individuals with a diagnosis of dementia was alive at 5 years. There was a statistically significant difference in survival for patients who received treatment for their BCC (n = 294) compared with those observed [n = 25; median survival 34 months vs. 21 months (HR 0.54, 95% CI 0.34–0.85); P = 0.007]. There was no difference in survival in individuals with a history of cancer, cardiac or cerebrovascular disease or immunocompromise, compared with those without. Similarly, the use of anticoagulants or presence of pacemaker did not affect survival. Basal cell carcinoma subtype (nodular, infiltrative) did not impact outcomes either, although the difference between lesion size (&amp;lt; 10 mm, ≥ 10 mm) was approaching statistical significance (HR 1.36, 95% CI 0.98–1.87; P = 0.062). No patients required Mohs surgery in the study period. Factors that appeared to influence the preference for primary radiotherapy over surgery were the concurrent use of anticoagulants (P = 0.05) and site of lesion (P = 0.04). All 25 of the lesions treated with radiotherapy were on the head and neck. This study provides evidence in support of the active treatment of BCC in individuals aged ≥ 90 years seen in secondary care. Being fit enough to attend hospital appointments could be seen as a self-selecting process. Conservative options may be preferable in patients with dementia or those &amp;gt; 93 years old. While survival in this cohort is good, accurate assessment of patient frailty is key for selecting those individuals with a poor prognosis to ensure they are not referred for unnecessary intervention.

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

The development of a parent report instrument of early communication and language skills of infants and toddlers in mainland China.

This study was designed to produce a new parent-report measure, the Diagnostic Receptive Expressive Assessment of Mandarin-Infant Toddler Assessment of Communication and Language (DREAM-IT) in order to provide norms for the developmental skills of children aged 0-36 months in four areas: expressive language, receptive language, cognitive play and social skills. The scale was designed to be both broader and deeper than existing instruments that neglect one or more of these significant domains involved in early language. Items were chosen by a group of specialists with clinical experience working with the age group and with attention to the developmental literature. Caregivers were tested individually by a trained person who asked the questions and provided examples. In addition to an extensive health questionnaire, caregivers answered questions in Mandarin about their child's behaviour using a scale of 'not yet', 'sometimes' or 'always' or listing out words and/or sounds understood or said by the child. The 476 participating caregivers were recruited at maternal and child healthcare clinics centred in Chengdu, China, 191 of whom were tested a second time seven months later. The children were sampled in three-month age-bands from 0 to 36 months. The sample was balanced for child gender by age band, and parental education was balanced. Caregivers of 0-24-month-old children and caregivers of 12-36 months were each asked a different set of questions, to determine the appropriate age range and cutoff points for each question, requiring the sample size to be doubled for children aged 12-24 months. The results were subject to item-response theory analysis to remove outlying items, and the resulting internal reliability was high for each domain (average Cronbach's alpha=0.87). The final instrument (between 67 and 113 questions in total) was refined to include the least redundant questions that had the highest intercorrelations, with attention paid to coverage of all domains across the age range. Two scales were developed: one for children 0-18 months, the second for children aged 18-36 months. The longitudinal design permitted the creation of growth curves and norms for each domain for six-month intervals from 0 to 36 months. A small sample of 32 parents of children with Down syndrome aged 18-36 months provided validation that the scales are highly sensitive to developmental delay. The instrument shows considerable promise for detecting early communication problems in children in China. What is already known on the subject In China, efforts were made in recent years to develop language assessments for infants and toddlers, but limitations existed with the domains included and number of items included per age group. Many clinical practitioners also continued to rely on language subtests of general developmental scales, which were limited in depth and breadth of language skills tested and were never intended for diagnosis of language delay. What this paper adds to existing knowledge This paper discusses the development of a valid caregiver report instrument for early communication and language skills of infants and toddlers in mainland China. The Diagnostic Receptive Expressive Assessment of Mandarin-Infant Toddler (DREAM-IT) includes foundational domains necessary for language and communication development in young children (receptive language, expressive language, cognitive play and social communication domains). The results show strong internal reliability (Cronbach's alpha) for each domain on a sample of 716 children sampled in three-month age bands from 0 to 36 months. The external validity proved strong when tested on a group of 32 young children with Down syndrome. What are the potential or actual clinical implications of this work? Besides helping to inform the diagnosis of language delays in infants and toddlers in China, the caregiver report instrument has special features to support clinical practitioners in a field that is just emerging in China. The unique support features include the automatic generation of a profile of relative strengths and weaknesses of the child on the report and the recommendation of child-specific caregiver coaching videos on a companion app.

Correlation of age and the tumor transcriptomic profile in patients (pts) with advanced prostate cancer (PCa).

233 Background: In general, older pts are likely to have an advanced stage PCa, hence poor overall survival (PMID: 18660852). Owing to increased awareness and better diagnostics, the incidence of PCa has steadily increased amongst older adolescents and young adult pts (PMID: 31553489). Recent reports suggest that younger pts often are staged less adequately, present with more advanced stages, and could have worse outcomes than older pts (PMID: 33575208). Hence, elucidating the underlying molecular biology of PCa by age may unravel specific biologic features and distinct genomic expressions specific to young-age PCa, and help investigate new therapeutic targets. Methods: In this IRB-approved retrospective study, eligibility criteria included pts diagnosed with advanced PCa with available tumor-based comprehensive transcriptomic profiling from a CLIA-certified lab. DeSeq2 analysis was implemented in Bioconductor software to analyze differentially expressed genes based on the cohort's age cut-off points (&lt; 65 vs. ≥65 years). DeSeq2 results included the Log2 Fold change, Wald-Test p-values, and Benjamini-Hochberg adjusted p-values for each differentially expressed gene. These results were then subjected to Gene Set Enrichment Analysis (GSEA) to identify pathways upregulated or downregulated in each cohort. All bioinformatic analysis was conducted in R-Studio, version 4.1.1. The statistical significance level was predetermined at 0.05. Results: 80 pts were eligible: &lt; 65 (n=44) vs ≥65 years (n=36). No differences in Gleason score (&lt;8/≥8), baseline PSA levels, and disease volume (high/low) between the cohorts (Table). As compared to pts ≥65 years; in young pts, (1) the three most upregulated significant pathways were oxidative phosphorylation (OXPHOS), bile acid, and fatty acid metabolism pathways, and (2) the three most downregulated significant pathways were tumor necrosis factor-alpha (TNFα) via NF-Κb, transforming growth factor-β (TGF β), and inflammatory response pathways. Differential individual gene expression profiles will be presented at the meeting. Conclusions: These hypothesis-generating data show distinct genomic pathways to be upregulated in younger pts vs. older pts with advanced PCa and may guide further drug development, e.g., OXPHOS inhibitors in younger pts vs. drugs targeting inflammatory response in older pts. These hypothesis-generating results, upon external validation, may provide the rationale for personalized therapy in pts with PCa. [Table: see text]

High Incidence of Appendiceal Neoplasms in the Elderly: A Critical Concern for Non-Surgical Treatment

Objective: Appendiceal neoplasms (ANs) are rare tumors that are often discovered incidentally during histopathological examinations. The increasing incidence of ANs is a critical issue in the non-operative management of acute appendicitis. This study aimed to document the temporal trends over a 12-year period by analyzing the clinical presentation, imaging findings, and histopathological features of ANs. Subjects and Methods: Health records of patients who underwent appendectomy from 2011 to 2022 were examined. Demographic and clinical data, laboratory results, imaging findings, and histopathological features were documented. The characteristics of both ANs and non-neoplastic cases were evaluated. Results: A total of 22,304 cases were identified, of which 330 (1.5%) were diagnosed with ANs. The odds ratio for ANs increased with age, with the highest odds ratio observed in patients aged 70 or older. Receiver Operating Characteristic analysis showed that age and appendiceal diameter were significant predictors of ANs. An optimal age cut-off point of 28.5 years was determined, yielding a sensitivity of 72% and a specificity of 64%. For appendiceal diameter, the optimal cut-off was found to be 9.5 mm, exhibiting a sensitivity of 77% and a specificity of 56%. Conclusion: Although the incidence of ANs remains relatively low, a steady increase has been observed over the past decade. The increasing rate of ANs raises concerns regarding non-surgical management options. The results of this study highlight the importance of considering ANs as a potential diagnosis in older patients and in patients with an appendix diameter greater than 9.5 mm. These findings may have implications for treatment and management.

Late Bloomer Offending Patterns: Towards a Harder Empirical Definition—Commentary on Matsuda et al. (2022)

Matsuda et al. (2022) show that late bloomers also exist in self-report data. They use a “dynamic” definition of late bloomer offending pattern as they have concerns with definitions based on arbitrary age cutoff points. But the approach does not make the groups less arbitrary than hard definitions. In this commentary, I argue that a hard definition has important advantages and demonstrates an alternative using a hard definition while exploring heterogeneity within the late onset group.

Children and Young People’s Participation in decision-making in Foster Care

Children’s participation in decisions about their lives is a crucial point of the UN Convention on the Rights of the Child, which is the basis of child welfare and protection worldwide. Despite these clear guidelines, there is evidence that children’s voices may be heard but often with little impact on the decisions made by professionals in the childcare system. This study seeks to ascertain whether the voice of children living in foster care is considered and respected when making decisions that concern them, whether the children effectively exercise it, and what factors impact their participation. A systematic scoping review was performed to clarify concepts and unveil research gaps, using eleven scientific databases and publishers that allowed us to identify twelve recent studies in critical journals. In the light of the Bouma et al., (2018) model, the findings showed that there is, in general, a lack of effective children’s participation, namely in terms of information, listening, and involvement. Children’s voices still have a minimum impact on the decisions made in the childcare system. It will be necessary to avoid the bureaucratic assumption that there is an age cut-off point to promote participation. More, it is stressed the importance of a trusting, sincere and confidential relationship between the child and the social worker and the need to ensure training for professionals who intervene in review/statutory meetings or judicial proceedings, namely in the court of law.

Efficacy and safety of PARP inhibitors in elderly patients with advanced ovarian cancer: a systematic review and meta-analysis

BackgroundPoly-(ADP-ribose)-polymerase (PARP) inhibitors have shown to be effective as maintenance treatment in patients with advanced ovarian cancer. Although most ovarian cancers develop after age 65, older patients are often under-represented...

Comparison Of The Gut Microbiota In Different Age Groups In China.

Aging is now the most profound risk factor for almost all non-communicable diseases. Studies have shown that probiotics play a specific role in fighting aging. We used metagenomic sequencing to study the changes in gut microbes in different age groups and found that aging had the most significant effect on subjects’ gut microbe structure. Our study divided the subjects (n=614) into two groups by using 50 years as the age cut-off point for the grouping. Compared with the younger group, several species with altered abundance and specific functional pathways were found in the older group. At the species level, the abundance of Bacteroides fragilis, Bifidobacterium longum, Clostridium bolteae, Escherichia coli, Klebsiella pneumoniae, and Parabacteroides merdae were increased in older individuals. They were positively correlated to the pathways responsible for lipopolysaccharide (LPS) biosynthesis and the degradation of short-chain fatty acids (SCFAs). On the contrary, the levels of Barnesiella intestinihominis, Megamonas funiformis, and Subdoligranulum unclassified were decreased in the older group, which negatively correlated with the above pathways (p-value<0.05). Functional prediction revealed 92 metabolic pathways enriched in the older group significantly higher than those in the younger group (p-value<0.05), especially pathways related to LPS biosynthesis and the degradation of SCFAs. Additionally, we established a simple non-invasive model of aging, nine species (Bacteroides fragilis, Barnesiella intestinihominis, Bifidobacterium longum, Clostridium bolteae, Escherichia coli, Klebsiella pneumoniae, Megamonas funiformis, Parabacteroides merdae, and Subdoligranulum unclassified) were selected to construct the model. The area under the receiver operating curve (AUC) of the model implied that supplemented probiotics might influence aging. We discuss the features of the aging microbiota that make it more amenable to pre-and probiotic interventions. We speculate these metabolic pathways of gut microbiota can be associated with the immune status and inflammation of older adults. Health interventions that promote a diverse microbiome could influence the health of older adults.

QHBsAg for the Identification of Liver Histological Abnormalities in HBeAg-Negative Chronic Hepatitis B Patients with Normal and Mildly Elevated ALT Levels.

Backgrounds Noninvasive detection of histological abnormalities remains challenging in patients with HBeAg-negative chronic HBV infection with normal or mildly elevated levels of alanine aminotransferase (ALT). This study aimed to assess the utility of serum quantitative hepatitis B surface antigen (qHBsAg) in identifying significant histological lesions in this population. Methods This is a single-center study with retrospective analysis of 392 treatment-naive patients of HBeAg-negative chronic HBV infection with normal or mildly elevated levels of ALT. Results In this cohort, significant necroinflammation and fibrosis were found in 69.4% and 61.5% of patients, respectively. Patients with qHBsAg >1000 IU/mL (N = 236) had more hepatic inflammation of ≥G2 (75.4% vs. 60.9%, P < 0.01) or fibrosis ≥ S2 (66.1% vs. 54.5%, P < 0.05) compared to those without (N = 156). Serum HBsAg (cutoff point = 1000 IU/mL), aspartate aminotransferase (AST) level (cutoff point = 25 IU/L), age (cutoff point = 40 years), and HBV family history were identified as independent predictors of significant histological abnormalities in multivariate logistic analysis. Conclusions A significantly higher proportion of patients with histological abnormalities were found in patients with qHBsAg >1000 IU/mL than those without. The qHBsAg level together with age, AST, and family history of HBV infection could be used as an algorithm to help noninvasive patient selection for antiviral therapy.

Development and Validation of a Nomogram-Based Prognostic Model to Predict High Blood Pressure in Children and Adolescents-Findings From 342,736 Individuals in China.

ObjectivesPredicting the potential risk factors of high blood pressure (HBP) among children and adolescents is still a knowledge gap. Our study aimed to establish and validate a nomogram-based model for identifying youths at risk of developing HBP.MethodsHBP was defined as systolic blood pressure or diastolic blood pressure above the 95th percentile, using age, gender, and height-specific cut-off points. Penalized regression with Lasso was used to identify the strongest predictors of HBP. Internal validation was conducted by a 5-fold cross-validation and bootstrapping approach. The predictive variables and the advanced nomogram plot were identified by conducting univariate and multivariate logistic regression analyses. A nomogram was constructed by a training group comprised of 239,546 (69.9%) participants and subsequently validated by an external group with 103,190 (30.1%) participants.ResultsOf 342,736 children and adolescents, 55,480 (16.2%) youths were identified with HBP with mean age 11.51 ± 1.45 years and 183,487 were boys (53.5%). Nine significant relevant predictors were identified including: age, gender, weight status, birth weight, breastfeeding, gestational hypertension, family history of obesity and hypertension, and physical activity. Acceptable discrimination [area under the receiver operating characteristic curve (AUC): 0.742 (development group), 0.740 (validation group)] and good calibration (Hosmer and Lemeshow statistics, P > 0.05) were observed in our models. An available web-based nomogram was built online on https://hbpnomogram.shinyapps.io/Dyn_Nomo_HBP/.ConclusionsThis model composed of age, gender, early life factors, family history of the disease, and lifestyle factors may predict the risk of HBP among youths, which has developed a promising nomogram that may aid in more accurately identifying HBP among youths in primary care.

Is Age ≥ 55 years an optimal cutoff point among patients with differentiated thyroid Microcarcinoma? a preliminary study

PurposeAge ≥ 55 years is regarded as a pivotal component of TNM stage classification in differentiated thyroid carcinoma (DTC). However, whether this cutoff point is still adaptable for differentiated thyroid microcarcinoma (DTMC) is rarely investigated. MethodsWe reviewed and analyzed the data of DTC patients aged ≥ 55 years from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were used to determine the potential risk factors of cancer-specific survival (CSS) in DTMC patients aged ≥ 55 years. The Kaplan-Meier survival curves were used to estimate CSS probability. Receiver operating characteristic (ROC) curves were used to analyze the best age cutoff point for DTMC. ResultsAmong the DTMC patients, there was no significant difference in the 1-, 3-, 5-, and 7-year CSS probability between the 55–59 years and 60–64-years subgroup (p = 0.72). The ROC curves indicated that 65 years, 65 years, and 64 years were the cutoff age point of 3-, 5-, and 7-year CSS probability in DTMC patients, respectively. Besides, N1b (Hazard ratio (HR) = 3.90, 95% Confidence interval (CI): 2.01–7.57; p < 0.001), extrathyroidal extension (HR = 2.53, 95 %CI: 1.39–4.62; p = 0.002), and M1 (HR = 11.42, 95 %CI: 5.04–25.90; p < 0.001) were the independent risk factors in CSS of DTMC patients. ConclusionsOur results suggested age at diagnosis ≥ 55 years is not the best cutoff point in stratifying the stage of the DTMC patients. On the contrary, those patients aged above 65 years have a significantly lower probability of CSS, which perhaps should be taken into consideration for treatment decision-making.