Elderly Patients Research Articles

Mid-term outcomes of acetabular fractures treated with acute fix and replace versus ORIF in the elderly: a multicentric study with minimum 5-year follow-up.

Acetabular fractures in elderly patients are increasing and present complex management challenges. This multicentric retrospective study compares mid-term clinical and radiographic outcomes of acute "fix and replace" versus ORIF, focusing on implant survival, complications, and functional performance at a minimum five-year follow-up, addressing the current lack of extended outcome data. This study is an update of a previously published multicentric retrospective cohort including patients aged ≥ 60 years with acetabular fractures treated surgically at three hospitals in central Italy between 2013 and 2025. Patients received either acute "fix and replace" (ORIF combined with acute THA) or ORIF alone, with a minimum clinical and radiographic follow-up of five years. Functional outcomes were assessed using PROMs (SF-12, PDI) and clinician-based scores (HHS, Modified Merle d'Aubigné and Postel). Radiographs were reviewed for healing, implant integrity, osteolysis, loosening, osteoarthritis, and heterotopic ossifications. Complications and implant survival were analyzed using Kaplan-Meier curves with revision surgery as the endpoint. A total of 41 patients (21 ORIF, 20 CHP) completed a minimum five-year follow-up. No significant differences were found between groups regarding age, BMI, or follow-up duration. Two revisions to total hip arthroplasty occurred in the ORIF group, with no revisions in the CHP group. Radiographic findings, including heterotopic ossifications and implant loosening, were comparable. Functional scores (HHS, MAPM, SF-12 PCS and MCS) showed no significant differences between groups at both two and five years. The CHP group, however, demonstrated significantly lower pelvic discomfort index (PDI) scores at 60months (p = 0.04). No significant intra-group variations were observed over time. Both ORIF and CHP provide satisfactory mid-term outcomes in elderly patients with acetabular fractures. However, CHP demonstrated fewer reoperations and better pelvic discomfort scores at five years. These findings support the growing evidence favoring acute fix-and-replace strategies in this population.

Effect of general anesthesia combined with epidural block on hemorheology in elderly patients with laparoscopic radical resection of colorectal cancer: A randomized controlled trial.

BackgroundLaparoscopic surgery is widely used in the field of clinical surgery due to its minimal trauma, minimal bleeding, short hospital stay, and fast postoperative recovery. There were several studies found that elderly patients undergoing laparoscopic surgery are more prone to coagulation disorders, increased blood viscosity, and the influence of CO2 pneumoperitoneum, which can easily lead to changes in blood rheology There are no studies have investigated the effects on blood rheology of general anesthesia combined with epidural block on hemorheology in elderly patients undergoing laparoscopic radical resection of rectal cancer. This trial investigated to explore the effect of general anesthesia combined with epidural block on blood rheology in elderly patients undergoing laparoscopic radical resection of rectal cancer, providing experimental basis for clinical anesthesia to regulate blood rheology characteristics and prevent hyperviscosity and its complications.MethodsA total of 60 patients undergoing laparoscopic radical resection of colorectal cancer, aged 60-75 years, with American Society of Anesthesiologists physical status III, were enrolled in this study. All the subjects were randomly divided into general anesthesia group (group G, n = 30) and general anesthesia in combination with epidural block group (group G + E, n = 30) according to a random number table. Patients in the group G received the general anesthesia alone while those in the group G + E were given the combined epidural block based on anesthetic method of group G. The arterial blood gas indexes (pH, PaCO2 and HCO3-) and hemodynamic indexes(Hŋb, Lŋb,ηp, EAI, Hct and ESR) were measured at four time points: before induction of general anesthesia (T0), 5 min before establishment of pneumoperitoneum (T1), 30 min after establishment of pneumoperitoneum (T2) and 30 min after elimination of pneumoperitoneum (T3).ResultsThere was no significant statistical difference (p > 0.05) in pH, PaCO2, and HCO3- between the two groups at T1, T2, and T3. At T0, there was no significant difference (p > 0.05) in Hŋb, Lŋb, ηp, Erythrocyte Aggregation Index (EAI), Hct, and Erythrocyte Sedimentation Rate (ESR) between the two groups. However, these indices were significantly lower in group G + E than in group G (p < 0.05) at T1, T2, and T3.ConclusionCombining general anesthesia with epidural block can effectively reduce the hemorheological indexes of patients and improve the hemorheological state in elderly patients with malignant tumors undergoing laparoscopic surgery.

Influencing mechanisms of kinesiophobia in middle-aged and elderly patients with chronic obstructive pulmonary disease: a cross-sectional study

BackgroundThe aim of this study is to explore the mechanism of the role of kinesiophobia in patients with chronic obstructive pulmonary disease (COPD), to construct a structural equation model of the factors influencing kinesiophobia in patients with COPD, and to provide a theoretical basis for the development of targeted intervention strategies.MethodsThe cross-sectional design was conducted from December 2023 to July 2024, and middle-aged and elderly patients with COPD from a tertiary hospital in Guangzhou, China, were selected using convenience sampling. A general demographic information questionnaire, Breathlessness Beliefs Questionnaire scale (BBQ), modified Medical Research Council Dyspnea Scale (mMRC), Fatigue Scale (FS-14), Hospital Anxiety and Depression Scale (HADS), Self-Efficacy for Exercise (SEE), and Social Support Rating Scale (SSRS) were used for data collection. Spearman correlation analysis and structural equation modeling (SEM) were used for data analysis.ResultsA total of 278 COPD patients were included. Correlation analysis showed that dyspnoea (r = 0.689, p < 0.01), fatigue (r = 0.731, p < 0.01) and anxiety (r = 0.678, p < 0.01) were significantly positively correlated with kinesiophobia, whereas social support (r=-0.518, p < 0.01) and exercise self-efficacy (r=-0.740, p < 0.01) were significantly negatively correlated with kinesiophobia. SEM analyses revealed six significant pathways of action: dyspnoea, exercise self-efficacy was a direct predictor of kinesiophobia. Fatigue, and social support were indirect predictors of kinesiophobia. Anxiety was a direct and indirect predictor of kinesiophobia.ConclusionsDyspnoea, fatigue, anxiety, social support and exercise self-efficacy are important predictors of kinesiophobia in COPD patients. Clinical interventions should focus on the synergistic effects of these five types of variables to establish a multidimensional and comprehensive management programme.Trial registrationThe protocol was reviewed by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University (Ethics Code: LCYJ-2023-055).

Isolation of Mycobacterium europaeum from a clinical sample in China: report of genome sequence and literature review.

Mycobacterium europaeum, of Mycobacterium simiae complex, is a rare nontuberculous mycobacterium associated with human diseases. We report a case with an isolate from bronchoalveolar lavage fluid and summarize M. europaeum cases from literature. M. europaeum may cause respiratory infections and colonization in immunocompromised, elderly, and/or chronic pulmonary illness patients.

Assessment of Prescription Trends and Quantifying Medication Appropriateness in Geriatric Stroke Patients

In order to ensure sensible drug use, prescription pattern studies are crucial, especially for elderly stroke patients who are more likely to experience adverse events, polypharmacy, and drug interactions. This prospective observational study, conducted over six months in a tertiary care hospital, 120 stroke cases (≥65 years) were examined to evaluate prescription trends, medication burden, and compliance with WHO prescribing guidelines. 72.5% of the patients experienced an ischemic stroke, and 27.5% experienced a hemorrhagic stroke; the frequency was higher in men (60%). Ages 65 to 70 were the most affected (56.6%). Seizures (22.5%) and pneumonia (13.3%) were the predominant complications, while the most common risk factors were hypertension (85%), alcohol use (65%), and diabetes (33.3%). According to chi-square analysis, 45% of patients were in the hospital for 6–10 days, and there was a significant correlation between the kind of stroke and length of stay (p &lt; 0.05). The most commonly prescribed medications were pantoprazole (67.5%), atorvastatin (88.3%), and aspirin (97.5%). Single antiplatelet therapy (66.6%) was chosen over combination therapy (33.3%). Although 94.93% of medications met the Essential Drug List, WHO prescribing indicators revealed polypharmacy (8.07 pharmaceuticals per prescription), low generic prescribing (48.43%), and high injection use (36.82%), all of which significantly deviated from WHO guidelines (p &lt; 0.001). Excessive polypharmacy and irregular prescribing patterns were noted in spite of adherence to stroke treatment recommendations. Improving therapeutic safety and patient outcomes in this high-risk population requires optimizing pharmaceutical use through deprescribing tactics, medication reconciliation, and pharmacist involvement.

Prognostic Effect of CEA Cut-Off in Patients with Resectable Colorectal Liver Metastases: A Meta-Analysis and Meta-Regression.

Although preoperative carcinoembryonic antigen (CEA) is a variable used in most prognostic scores assessing the outcome of patients with colorectal liver metastases (CRLM) undergoing resection, it is unclear what the optimal cut-off is or in which patient subgroups CEA is most relevant. The purpose of this study is to evaluate the prognostic effect of CEA in resected CRLM patients and to explore in which subgroups CEA is most closely associated with overall survival (OS). A systematic literature search was performed, selecting studies that evaluated a relationship between preoperative CEA and OS in patients undergoing CRLM radical surgery. A meta-analysis assessed the overall effect size of the relationship on the selected study cohorts, based on CEA cut-off. An evaluation of 21 baseline variables was performed to explore their possible effect on the relationship between CEA and OS. The study confirms a significant negative prognostic effect of increased CEA on OS (HR 1.46, CI 1.30-1.65), but heterogeneity among studies is significant. The effect is consistent for all CEA cut-offs, although the relationship tends to weaken in more recent studies for cut-offs < 10 ng/mL. Meta-regressions also suggest that the prognostic effect may be more pronounced in the elderly. In addition, the effect of CEA ≥ 20 ng/mL on OS appears significantly reduced in the subgroup with mutated RAS carcinoma. For patients with resectable CRLM, the CEA cut-off should be increased to 20 ng/mL, and evaluation in prospective studies of the more pronounced negative prognostic effect of preoperative CEA in the elderly and wild-type RAS CRLM patients is recommended.

Factors Affecting the Functional Status of Multimorbid Elderly Patients With Essential Hypertension

Factors Affecting the Functional Status of Multimorbid Elderly Patients With Essential Hypertension

Extracapsular hip fractures are more prone to perioperative thrombosis than intracapsular hip fractures in elderly patients undergoing arthroplasty for hip fractures: a retrospective cohort study.

Whether fracture site has any effect on perioperative deep vein thrombosis (DVT) in elderly patients with hip fractures undergoing arthroplasty is still controversial. This study aimed to evaluate the association between fracture site and perioperative DVT in elderly patients undergoing hip arthroplasty. A retrospective cohort analysis was conducted on elderly hip fracture patients who underwent hip arthroplasty and were admitted between January 2015 and December 2021. Patient data, including demographics, comorbidities, injury-related information, laboratory test results at admission, and surgery-related information, were collected. Univariate and multivariate regression analyses, along with subgroup analyses and sensitive analysis, were performed to identify the association between fracture site and DVT. The study included 593 patients, consisting of 353 patients with intracapsular hip fractures (ICF) and 240 patients with extracapsular hip fractures (ECF), with an average age of 80.7 ± 7.6. The incidence of DVT diagnosed by ultrasonography was 16.9% in all patients. The prevalence of DVT for ECF patients and ICF patients was 22.5% and 13.0%, respectively. In all adjusted multivariate regression analysis model, ECF patients exhibited an increased risk of DVT compared to ICF patients (OR 2.03; 95% CI 1.19-3.47, p = 0.009). Subgroup analyses revealed that female patients with ECF had a higher likelihood of DVT than those with ICF (OR 2.25; 95% CI 1.22-4.13), as did patients aged 65 to 80years (OR 4.06; 95% CI 1.44-11.41), patients with hemoglobin levels above 110g/L (OR 2.30; 95% CI 1.08-4.92), and patients with albumin levels above 35g/L (OR 2.47; 95% CI 1.29-4.73). Sensitivity analysis found similar results. The findings indicate a significant association between fracture site and perioperative DVT in elderly hip fracture patients undergoing hip arthroplasty, with ECF patients demonstrating a higher likelihood of developing DVT than ICF patients.

Effects of Combined Aerobic and Resistance Training on Muscle Strength in Middle-Aged Type 2 Diabetics

ABSTRACT Background: Type 2 diabetes (T2D) is a prevalent metabolic disorder associated with various complications, including muscle weakness, which can affect quality of life. Combined aerobic and resistance exercises have shown potential in improving physical strength and function in T2D patients, but the specific effects on muscle strength in elderly diabetic patients remain underexplored. Objective: This study aimed to investigate the effects of combined aerobic and resistance exercise on muscle strength in geriatric patients (aged 40–60 years) with Type 2 diabetes. Methods: A quasi-experimental study was conducted with 30 participants diagnosed with Type 2 diabetes. Participants were enrolled through convenient sampling and completed a 12-week exercise program consisting of aerobic exercises (walking, running, cycling) and resistance exercises (step-ups, bodyweight exercises, and resistance bands). The muscle strength of key muscle groups, including knee extensors, knee flexors, ankle dorsiflexors, shoulder abductors, elbow flexors, and hip flexors, was measured before and after the intervention using both dynamometry (force in Newtons) and Manual Muscle Testing (MMT) (0–5 scale). Paired t-tests were used to compare pre- and post-test results, and effect sizes (Cohen’s d) were calculated for dynamometry data. Results: Significant improvements were observed in all muscle groups post-intervention. The knee extensors showed the greatest improvement (21.5%, p &lt; 0.001), followed by knee flexors (17.0%, p &lt; 0.001), and ankle dorsiflexors (15.6%, p &lt; 0.001). The effect sizes for dynamometry measurements ranged from moderate to large (Cohen’s d = 0.61–1.52). Additionally, MMT scores showed a significant increase in muscle strength across the assessed muscle groups (p &lt; 0.001). Conclusion: The results suggest that a combined aerobic and resistance exercise program can significantly enhance muscle strength in geriatric patients with Type 2 diabetes. These findings emphasize the importance of incorporating both aerobic and resistance exercises in managing muscle weakness in T2D, potentially improving functional capacity and reducing the risk of diabetic complications in elderly patients. Keywords: Resistance training, Type 2 diabetes mellitus, Combined exercise, Geriatric population

Our Experience With Arteriovenous Fistula in Elderly Patients With Chronic Kidney Disease.

In recent years, advances in medical care have expanded the boundaries of aging, leading to an increasing number of elderly individuals requiring hemodialysis (HD). The use of arteriovenous (AV) fistulas for HD in elderly patients remains controversial due to concerns about life expectancy, vascular aging, and comorbidities. This study aimed to compare AVF outcomes in patients aged ≥ 70 years with those aged < 70 years to evaluate the safety and efficacy of AVFs in elderly patients. This retrospective, single-center study included 202 patients who underwent AVF creation for end-stage kidney disease between 2022 and 2024. Patients were divided into two groups: ≥ 70 years (n = 76) and < 70 years (n = 126). AVF maturation, complication rates, the need for new AVF, and primary and secondary patency rates were compared. Kaplan-Meier analysis and the log-rank test were used to assess patency outcomes. AVF maturation rates were comparable between the ≥ 70 years group (50.0%) and the < 70 years group (56.9%) (p = 0.330). The need for a new AVF within 6 months was 11.2% in the ≥ 70 years group and 17.6% in the < 70 years group (p = 0.387). There were no significant differences in late complications (p = 0.157), AVF location preferences (p = 0.450), or secondary intervention rates (p = 0.967). Kaplan-Meier analysis revealed no significant difference in primary (p = 0.411) or secondary (p = 0.432) patency between the two groups. Despite age-related concerns, AVF outcomes in elderly patients were comparable to those in younger individuals. AVFs should be considered a viable vascular access option for HD in elderly patients, provided that patient-specific factors are taken into account.

Risk assessment of postoperative atelectasis in elderly lung cancer patients undergoing thoracoscopic surgery based on a nomogram model

BackgroundLung cancer is a leading cause of death in the elderly. Thoracoscopic surgery, though minimally invasive, poses a greater risk of postoperative atelectasis in this group owing to age and comorbidities. The aim of this study was to identify risk factors for atelectasis in elderly lung cancer patients and develop a nomogram model for clinical prediction.MethodsClinical data from 322 elderly patients with lung cancer were retrospectively analysed and split into a training set (n = 226) and a validation set (n = 96) at a 7:3 ratio. Independent risk factors for postoperative atelectasis were identified via univariate and multivariate logistic regression. A nomogram prediction model was constructed and evaluated for discrimination (ROC curves), calibration (Hosmer–Lemeshow test, calibration curves), and clinical utility (decision curve analysis, DCA).ResultsThe multivariate logistic regression analysis revealed that the independent risk factors for postoperative atelectasis (P < 0.05) were age ≥ 70 years, a smoking history, decreased preoperative forced expiratory volume in one second (FEV1), and lobectomy. The areas under the ROC curves of the nomogram model were 0.826 (95% CI: 0.767–0.885) and 0.918 (95% CI: 0.802–0.991) in the training and validation sets, respectively. The calibration curves demonstrated a strong consistency between the predicted and observed outcomes. The DCA curves revealed that the model provided a high net clinical benefit when the threshold probability ranged from 0.07 to 0.60, with a maximum net benefit of 73%.ConclusionThe independent risk factors identified for postoperative atelectasis in elderly lung cancer patients undergoing thoracoscopic surgery are age ≥ 70 years, smoking history, reduced preoperative FEV1, and lobectomy.

Barriers and facilitators to prehabilitation of elderly patients with early lung cancer from the perspective of different clinical professionals: a qualitative study

BackgroundUnderstanding the barriers and facilitators of prehabilitation in elderly patients with early-stage lung cancer is of significant importance. This study aimed to elucidate these barriers and facilitators from the perspectives of different clinical professionals.MethodsA qualitative descriptive study was undertaken. Semi-structured interviews with clinical professionals, using purposive sampling and content analysis were conducted in March to May 2023 to summarize and refine the key themes.ResultsFrom the perspective of clinical professionals, the facilitators of prehabilitation have been categorized into five major themes. These include the recognized importance of prehabilitation, the positive attitude of clinical professionals, the support of leadership, the willingness of the majority of patients to accept prehabilitation, and the initial implementation of an enhanced recovery after surgery - multidisciplinary team (ERAS-MDT) approach. Conversely, clinical professionals identify several barriers to prehabilitation, which are grouped into seven themes. These impediments encompass a lack of knowledge regarding clinical practice, insufficient preoperative preparation time, the absence of an aging-friendly clinical practice scheme, an immature multidisciplinary cooperation mechanism, a lack of explicit regulations, inadequate emergency safeguards, and a shortage of specialized professionals. Practice strategies for promoting prehabilitation in elderly patients with early lung cancer include development of evidence summaries, develop healthcare training materials, develop patient health education brochures, clarify the division of labor of ERAS-MDT, improve patient safety and monitoring measures, optimize practice flow and obtain funding support.ConclusionTo enhance the feasibility and clinical relevance of prehabilitation, clinical professionals should consider establishing a multidisciplinary information consulting team, developing a comprehensive prehabilitation program, and reinforcing the support system prior to surgery.

Bridging the gap: summative content analysis of understanding barriers in elderly patient education from nurses’ perspectives

BackgroundOne of the main tasks of nurses in providing health therapeutic services is patient education, an essential component of nursing care. This educative process is necessary for elderly patients with multiple and personalized needs. Hence, this study identified and prioritized the factors that hinder nurses from educating elderly patients admitted to teaching hospitals.MethodsData were collected through an electronic survey (Porsline) via summative content analysis. This study was conducted with nurses in teaching hospitals in Hamadan, western Iran, from December 2024 to January 2025. Seven hundred twenty-four nurses were recruited through convenience sampling to answer the following open-ended question: “In your opinion, what are the causes and factors that you when educating elderly patients in the hospital ward?”ResultsThe analysis was organized into 12 main categories and 26 subcategories, which were ultimately reduced to six main themes, and their frequencies were calculated. The most frequent category was “staff training,” which appeared 1,387 times, whereas the least frequent category was “lack of motivation,” with 91 repetitions. Other categories were identified through data analysis on the basis of frequency and significance, including “hospital setting,” “memory issues,” “attention deficits,” language and communication difficulties,” sensory impairments,” family involvement,” peer support,” mobility issues,” pain and discomfort,” anxiety and depression.”ConclusionsThis study identified the main barriers preventing nurses from educating elderly patients in Iranian hospitals. Nurses can address these barriers by being more thorough in training, improving human resources, and upgrading relevant capacities and methods, leading to enhanced health literacy, self-care management, and improved quality of care overall for this population group. Organized community in-process support for multimorbidity patients is the key to strengthening self-care management. Implications of all the available evidence The results of this study have implications for practice. These findings may serve as a foundation for developing interventions and policies to address these barriers and enhance care for geriatric patients.Clinical trial numberNot applicable.

EMCC dispatch priority for trauma patients in Norway: a retrospective cohort study

BackgroundDispatch priority assessments in emergency medical communication centres (EMCC) play a crucial role in determining how quickly emergency medical services reach the scene after an injury. Consequently, accurate prioritization of resources is important in ensuring that patients requiring specialized care receive timely treatment to optimize their outcome. Both dispatch under-triage, where patients with severe injuries receive low priority, and dispatch over-triage, which unnecessarily allocates limited emergency resources, can impact patient outcomes and system efficiency. This study aimed to assess dispatch priority in the EMCC for a cohort of trauma patients in Norway.MethodsThis registry-based study included 3633 patients from the Norwegian Trauma Registry and Oslo EMCC during 2019–2020. We assessed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative rate (dispatch under-triage rate), false positive rate (dispatch over-triage rate), and accuracy of dispatch priority. The New Injury Severity Score (NISS) > 15 was used as a reference standard. Differences in dispatch priority assessments were analysed using descriptive statistics. Two logistic regression models were used to examine the relationship between dispatch priority and factors associated with the assessment.ResultsOur analysis revealed the following dispatch metrics: sensitivity (85%), specificity (11%), PPV (38%), NPV (53%), dispatch under-triage rate (15%), dispatch over-triage rate (89%), and overall accuracy (40%). Under-triaged dispatches frequently involved elderly trauma patients (53%) and patients with low-energy falls (51%). Elderly trauma patients had more than 7 times the odds of receiving inappropriately low dispatch priority compared to children and nearly twice the odds compared to adults, after accounting for factors such as injury mechanism. Similarly, female patients had 81% higher odds of receiving inappropriately low dispatch priority compared to male patients, when controlling for factors like age and injury mechanism. Among over-triaged dispatches, transport-related injuries accounted for half of the cases (50%).ConclusionThis study primarily evaluated the national trauma system’s dispatch priority criteria. Our findings indicate that elderly trauma patients, those with low-energy falls and female patients were often assigned inadequate priority by current criteria, indicating a need to reassess the current criteria to better address these patients’ needs. Additionally, we found that patients involved in transport-related accidents were overrepresented among over-triaged dispatches, highlighting a potential misallocation of resources.

Impact of impaired intrinsic capacity on postoperative frailty in elderly patients undergoing colorectal surgery: study protocol for a single-center, prospective, cohort study

IntroductionFrailty is characterized by a decline in multiple physiological systems, increasing vulnerability to stressors such as surgery and anesthesia. A decline in intrinsic capacity is common among elderly populations and has been demonstrated to be a predictor of frailty in community-dwelling seniors. However, the relationship between preoperative intrinsic capacity decline and postoperative frailty in surgical patients remains unclear.MethodsThis study is a single-center, prospective, cohort study. The study will recruit participants aged 60 years and above who are scheduled to undergo elective colorectal surgery. Participants will be classified into an exposed group (intrinsic capacity score ≤ 8) and a non-exposed group (intrinsic capacity score ≥ 9) according to their preoperative intrinsic capacity assessment. The primary outcome is the risk of frailty in elderly patients with impaired intrinsic capacity within one year following colorectal surgery. The secondary outcomes include postoperative pain scores, sleep quality, recovery quality, grip strength, fall risk, activities of daily living, onset time of moderately frailty, incidence of moderately frailty, and adverse events. All assessments will be conducted at predetermined intervals through face-to-face interviews during hospitalization and via telephone follow-up post-discharge.DiscussionThis study aims to clarify the risk of postoperative frailty in older patients with impaired intrinsic capacity. This study seeks to enable the early identification of patients with impaired intrinsic capacity, allowing for the implementation of targeted interventions to reduce the risk of postoperative frailty.

Impact of age and comorbidities on colorectal endoscopic submucosal dissection outcomes: Large multicenter study in a Western cohort

AbstractEndoscopic submucosal dissection (ESD) has emerged as the standard treatment for colorectal lesions. Considering aging of the global population, we aimed to assess effectiveness and safety of colorectal ESD in patients aged ≥ 80 years compared with those aged 65 to 79 years in a large Western cohort.We retrospectively enrolled patients aged &gt; 64 years undergoing colorectal ESD, classifying them into a very elderly group (VE-Group, aged &gt; 80 years) and elderly group (E-Group, 65–79 years). Procedure outcomes and safety were compared between the VE-Group and E-Group and between patients with comorbidities and those who were healthy (1-CM-Group and H-Group).A total of 980 patients were included (269; 27.5% in the VE-Group and 711; 72.5% in the E-Group). En-bloc, R0, and oncological curative resection rates did not differ, nor did intra-procedure or post-procedure adverse events (AEs). Delirium occurrence was registered in VE-group [6 (2.2%) in VE-Group vs 1 (0.1%) in E-Group; P = 0.001; OR = 16.2, (95%CI:1.9–135.2)]. The 1-CM-Group had a higher rate of intra-procedure bleeding (P = 0.001), delayed perforation (P = 0.03), fever onset (P &lt; 0.001), and systemic infections (P = 0.02) compared with the H-Group. Having one or more comorbidities was associated with increased overall AEs (P &lt; 0.001; OR 2.3, 95% CI 1.5–3.6).Colorectal ESD is feasible in elderly patients. Physicians should consider delirium a possible AE in patients older than age 80 years. These findings, which bridge the gap between Asian and Western clinical data, underscore the importance of tailored pre-procedure and post-procedure assessments in a global clinical context.

Modern and promising therapies for postherpetic neuralgia

Postherpetic neuralgia (PHN) is highly prevalent among the elderly and immunocompromised patients and decreases patients' quality of life. Currently, much attention is paid to the prevention of this disease and the development of new therapies and treatment approaches. The article discusses new targets for treating this type of pain, both pharmacotherapy and invasive methods. Analysis of clinical trials shows that a combination of different therapies can improve symptom management and patients' quality of life. It was shown that the earlier the treatment of PHN begins, the higher the probability of gaining control over the pain severity. The article emphasizes the need for further research to optimize approaches to PHN treatment and raise the medical community's awareness about new treatment options.

Intravascular Lithotripsy Versus Rotational Atherectomy for Calcified Coronary Lesions: A Systematic Review and an Updated Meta-Analysis of Clinical Outcomes.

Severe coronary artery calcification (CAC) remains a significant challenge in interventional cardiology, especially in elderly and comorbid patients, such as diabetes or chronic kidney disease. CAC often leads to complications such as stent thrombosis and restenosis, therefore leading to bad clinical outcomes and increased major adverse cardiovascular events (MACE) rates. Traditional approaches, including rotational atherectomy (RA), are commonly used to treat calcified plaques; however, are limited by procedural complexity, length of procedures, and risk of vascular injury. In contrast, intravascular lithotripsy (IVL) has emerged as a novel therapy using acoustic pressure waves to break calcified plaques with minimal vascular trauma. Despite its increasing use, direct comparisons between IVD and RA in the context of severe CAC are scant and leave critical evidence gaps for therapy optimization. This study compares IVL and RA outcomes to improve strategies for severe CAC management. This study aims at comparing the clinical outcomes such as procedural success, safety evaluations and clinical efficacy of IVL with RA in the treatment of severe CAC. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD42024626551). Searches were performed in PubMed, ScienceDirect, Embase, and Scopus databases using the descriptors "Rotablator," "Lithotripsy," and "Coronary Disease" combined with Boolean operators ("AND" and "OR"). Eligible studies directly compared IVL and RA, assessing outcomes such as procedural success, safety, and efficacy. Inclusion criteria were directed to retrospective cohorts and randomized studies with at least 6 months of follow-up, excluding case reports, reviews, and conference abstracts. Two independent reviewers performed data extraction with a third resolving discrepancies. The ROBINS-I tool was used to assess the risk of bias in non-randomized studies, while statistical analyses were done using R software (version 4.3.2). Eleven studies with a total of 2120 patients were included. IVL demonstrated significant benefits over RA, such as reduced use of contrast (MD: -17.45 mL; 95% CI: -32.79 to -2.11) and lower procedural time (MD: -27.90 min; 95% CI: -30.11 to -25.68; I² = 92.3%). IVL also effectively treated complex lesions, such as bifurcations and calcified left main arteries, by fragmenting plaques with minimal vascular trauma and reduced procedural risks. While luminal gain showed no differences between groups (MD: -0.07 mm²; 95% CI: -0.34 to 0.35), IVL provided higher rates of stent deployment success and lower target lesion revascularization, indicating better long-term vessel patency. The meta-analysis for mortality outcome showed a pooled OR of 0.55 (95% CI: 0.28-1.06; I² = 1%; p = 0.42) under the common-effect model and 0.70 (95% CI: 0.35-1.42) under the random-effects model, with negligible heterogeneity (I² = 1%). These consistent findings across studies reinforce IVL as a safer and effective strategy for severe CAC and warrant further trials to establish long-term benefits. IVL showed slight advantages over RA in severe CAC, including reduced contrast use, shorter procedure times, and fewer complications. Further trials are needed to confirm these findings and to reduce the heterogeneity of the studies.

Associations between Aβ40, Aβ42, and tau and postoperative delirium in older adults undergoing cardiac surgery.

Postoperative delirium is a significant complication in older adults undergoing cardiac surgery. This study investigated associations between serum amyloid beta (Aβ40, Aβ42), their ratio Aβ42/Aβ40 (AβR), and total tau (tTau) and postoperative delirium. This analysis included participants aged ≥ 60years undergoing elective cardiac surgery with cardiopulmonary bypass. Serum Aβ40, Aβ42 and tTau were measured before surgery and on postoperative day one using a digital immunoassay. The primary outcome was postoperative delirium, assessed twice daily for 3days using the Confusion Assessment Method. Postoperative delirium developed in 12% (38/312) of participants. In adjusted analyses examining preoperative biomarkers, the odds of postoperative delirium were independently associated with Aβ40 (OR 1.44 per standard deviation increase, 95% CI 1.06-1.98; p = 0.021), AβR (OR 0.65, 95% CI 0.42-0.99; p = 0.046), and tTau (OR 1.65, 95% CI 1.01-2.68; p = 0.045). Aβ42 was statistically significant only in unadjusted analyses (OR 1.43, 95% CI 1.00-1.88; p = 0.012). In adjusted analyses examining postoperative biomarkers, the odds of postoperative delirium were independently associated with Aβ42 (OR 1.60, 95% CI 1.08-2.37; p = 0.020) and tTau (OR 1.56, 95% CI 1.09-2.23; p = 0.015). Aβ40, AβR, and tTau were associated with postoperative delirium in elderly patients undergoing elective cardiac surgery. These findings suggest that postoperative delirium may be linked to pre-existing vulnerabilities shared with neurodegenerative processes along the Alzheimer's disease spectrum, offering new insights into its underlying mechanisms and potential connection to long-term cognitive decline.

Periprosthetic Fracture Rate in Elderly Patients Undergoing Hip Hemiarthroplasty: A Comparison of Fit-and-Fill, Tapered-Wedge, and Cemented Stems.

To compare the periprosthetic fracture rates of three stem designs: cemented, press-fit fit-and-fill, and tapered wedge for hemiarthroplasty in geriatric patients with femoral neck fractures. Design: Retrospective review. Two institutions, including one level I trauma center. Patients aged 70 years or older with a displaced femoral neck fracture (OTA/AO 31B) treated with press-fit or cemented hemiarthroplasty were included. Patients treated with total hip arthroplasty, conversion procedures, concomitant acetabular fracture, and pathologic fractures were excluded. Rates of intraoperative and postoperative periprosthetic femur fracture (PFF), 30-day and 1-year mortality, operative time, length of stay, and rate of reoperation were compared between stem subtypes. A total of 758 consecutive patients (404 tapered wedge, 227 fit-and-fill, and 127 cemented) were included. The mean follow-up was 10.1±14.1, 13.0±16.6, 6.8±10.9 months, for tapered wedge, fit-and-fill, and cemented stems, respectively. Tapered wedge stems had an average age of 83.6 years (range 70-100) with 29.2% male; fit-and-fill stems had an average age of 84.3 years (70-102) with 34.8% male; and cemented stems had an average age of 84.1 years (range 70-100) with 26.0% male. 56 (41 intraoperative and 15 postoperative) PFFs were identified. The rate of PFF between tapered wedge (9.4%), fit-and-fill (4.8%), and cemented stems (5.5%) differed significantly (P = 0.01). Fit-and-fill implants had a lower rate of PFF than tapered wedge implants (P = 0.04) and were equivalent to cemented fixation (P = 0.78). Among intraoperative PFFs, tapered wedge stems had a significantly higher calcar fracture rate than fit-and-fill (P = 0.03) and cemented (P = 0.02) stems. Use of fit-and-fill stems did not result in a higher rate of intraoperative calcar fracture than cemented stems (P = 0.85). Postoperative PFF reoperation rates did not reach statistical significance between fit-and-fill (1.8%), tapered wedge (1.7%), and cemented (0.8%) stems (P = 0.39). Fit-and-fill stems had significantly less operative time than cemented stems (93.6 ± 30.0 vs 108.7 ± 41.0 minutes, respectively; P <0.001). No differences in 30-day (4.5%, 4.9%, 5.5%; P = 0.88) or 1-year mortality (17.1%, 17.0%, 22.4%; P = 0.37) were observed between tapered wedge, fit-and-fill, and cemented stems, respectively. When treating displaced femoral neck fractures, tapered wedge stems may result in a higher rate of PFF. As an alternative, fit-and-fill stems may lower PFF rates without the risk of bone cement implant syndrome and longer operative times. Therapeutic Level III.