BackgroundAcute appendicitis often presents diagnostic challenges, especially in pediatric and elderly patients. Delays can cause serious complications. While imaging aids diagnosis, it is not always accessible. Machine learning offers a promising solution. This study aimed to develop a simple, accurate model using basic demographic and laboratory data to improve diagnosis in low-resource settings.Materials and methodsThis retrospective, single-center study analyzed 453 patients undergoing appendectomy for suspected acute appendicitis. Clinical, laboratory, and histopathological data were collected and classified into normal, uncomplicated, or complicated appendicitis. Data preprocessing included feature encoding, scaling, and balancing. Seven machine learning models were trained and evaluated using stratified five-fold cross-validation, and interpretability was assessed using SHapley Additive exPlanations (SHAP).ResultsAmong 453 patients, appendicitis was confirmed in 68.87%, predominantly in males (p < 0.001). Patients with appendicitis were significantly older (p = 0.0012), exhibiting elevated white blood cells(WBC) count, neutrophils, and C-reactive protein (CRP) levels, and lower lymphocytes (all p < 0.001). The Support Vector Classifier (SVC) performed best in classifying appendicitis (accuracy = 75.82%, ROC-AUC = 76.39%). SHAP analysis identified WBC, lymphocyte percentage, gender, age, and neutrophil percentage as influential predictors. For differentiating complicated versus uncomplicated appendicitis, SVC achieved moderate accuracy (70.19%) and ROC-AUC (76.33%), but low precision (14.85%) indicated challenges in minimizing false positives.ConclusionMachine learning models based on CBC and CRP show preliminary potential for predicting appendicitis, but given the surgical-only cohort and modest performance, further validation is needed before clinical use, particularly in low-resource settings.

Cerebral oximetry-guided anaesthesia and postoperative delirium in elderly patients undergoing off-pump coronary artery bypass grafting: a randomized controlled trial.

To investigate the effects of prebiotics combined with β-hydroxy-β-methylbutyrate (HMB) on muscle function, intestinal barrier integrity, and inflammation in elderly patients with sarcopenia. A randomized controlled trial was conducted on 78 elderly sarcopenic patients recruited from Tongji University Affiliated Tenth People's Hospital and Baoshan District Geriatric Care Hospital (Jan 2023 - Jan 2025). Participants were randomly assigned Group A (n = 32, standard diet + HMB-supplement), Group B (n = 31, standard diet + HMB + fructooligosaccharides), or Group C (n = 15, standard diet alone) for 30 days. Outcomes included muscle function (skeletal muscle mass index, grip strength, calf circumference), intestinal barrier markers (serum diamine oxidase, D-lactic acid, endotoxin), and inflammatory and nutritional markers (CRP, neutrophil/lymphocyte ratio, systemic immune inflammation index, albumin, prealbumin). Baseline indicators did not differ among groups (P > 0.05). After intervention, skeletal muscle mass index and grip strength improved significantly in Groups A and B (P < 0.05), with higher grip strengths to Group B than C (adj. P = 0.017). Calf circumference decreased in all groups (P < 0.05), most in Group C (t = 4.461, P = 0.001). Group B exhibited lower diamine oxidase, D-lactic acid, and endotoxin levels than Groups A and C (P < 0.05) and the greatest reductions in CRP, NLR, and SII (P < 0.001). Albumin or prealbumin showed no significant changes (P > 0.05). HMB improves muscle function in sarcopenic elderly, prebiotics combined with HMB further enhance intestinal barrier repair and reduce inflammation, offering a promising gut-muscle-targeted nutritional strategy.

Objective This study aimed to further investigate the correlation between C-X-C motif chemokine 8‌ (CXCL8) and the prognosis of bacterial upper respiratory tract infections (BURTIs) in the elderly population (≥65 years) and to evaluate its potential as a clinical biomarker in this specific high-risk cohort. Methods A total of 58 elderly patients with BURTIs admitted to our hospital between January 2023 and June 2023 (observation group) and 42 healthy individuals (control group) who underwent physical examinations concurrently were selected as the research subjects. Peripheral blood CXCL8 levels were measured in both the observation and control groups at admission and reassessed in the observation group after treatment to determine differences in CXCL8 between groups and changes in CXCL8 before and after treatment in the observation group. The correlation of CXCL8 with BURTI clinical effectiveness was analyzed. Subsequently, BURTI patients were followed up for 1 year, and the effect of post-treatment CXCL8 expression on the prognostic recurrence of BURTIs was evaluated. Results The CXCL8 in the observation group was higher than that in the control group (89.67 ± 8.33 pg./mL vs. 71.20 ± 10.88 pg./mL) and decreased after treatment ( p &amp;lt; 0.05). Patients with recurrence showed higher CXCL8 levels than those without (78.44 ± 8.84 pg./mL vs. 69.67 ± 5.51 pg./mL, p &amp;lt; 0.05). According to the receiver operating characteristic (ROC) curve analysis, CXCL8 exhibited excellent effects on the occurrence and prognostic recurrence of BURTIs (AUC = 0.788). Conclusion CXCL8 is elevated in elderly patients with BURTIs, demonstrating good evaluation effects on the occurrence and prognostic recurrence of BURTIs. However, these findings position CXCL8 as a promising biomarker for guiding personalized treatment in elderly BURTI patients, though further validation and integration with clinical scores are needed to improve risk stratification.

Background: Chemoimmunotherapy combinations represent the standard first-line treatment for non-oncogene addicted metastatic NSCLC (mNSCLC). However, evidence in elderly patients remains limited and conflicting. We conducted an analysis of the efficacy and safety of chemoimmunotherapy in patients aged ≥75 years enrolled in the Real-Combo Lung study, an observational study including patients with non-oncogene-addicted mNSCLC and PD-L1 expression &lt; 50%. Patients and Methods: The primary objective of the study was to compare progression-free survival (PFS) and overall survival (OS) between patients aged ≥75 (elderly cohort) and those aged &lt;75 years (non-elderly cohort). Safety outcomes were evaluated as a secondary objective. Results: A total of 495 patients were enrolled, with 89 (18%) aged ≥75 and 406 (82%) aged &lt;75 years. No significant differences in PFS and OS were observed between the two cohorts. The median PFS was 13.3 months (95% CI: 9.3–NR) in the elderly cohort and 10.5 months (95% CI: 9.5–12.9) in the non-elderly cohort (unadjusted HR 0.84, 95% CI: 0.61–1.16, p = 0.29). The median OS was 17.5 months (95% CI: 14.7–NR) versus 21.4 months (95% CI: 17–NR), respectively (unadjusted HR 1.09, 95% CI: 0.76–1.56, p = 0.63). In multivariable analysis, ECOG PS ≥ 2 and baseline use of steroids were significantly associated with a worse outcome in the elderly cohort for both PFS and OS. Safety data did not differ significantly between cohorts. Conclusions: In this real-world study, elderly patients with mNSCLC derived outcomes comparable to those of younger patients, with similar efficacy and a manageable safety profile when treated with chemoimmunotherapy combinations.

A multidimensional approach to sialorrhea management in elderly patients: Insights from the theory of unpleasant symptoms.

Elevated risks of pneumonia, cognitive dysfunction, and cerebrovascular disorder in super-elderly knee arthroplasty patients: insights from a nationwide Japanese database.

Pathology of the long head of the biceps tendon (LHBT) is a common source of anterior shoulder pain. Nanoscopic techniques allow minimally invasive tenotomy under local or regional anesthesia. Suprascapular nerve block (SSNB) provides targeted intraarticular analgesia and may facilitate awake shoulder procedures. To evaluate the feasibility, procedural tolerance, visualization quality, and short-term clinical outcomes of nanoscopic LHBT tenotomy performed under SSNB in elderly patients with isolated LHBT-related pain. Eight patients (mean age 72.5 ± 2.7years; range 68-76) with ≥ 12months of isolated LHBT-related pain were included after screening 30 candidates. All had LHBT tendinopathy or partial tear confirmed by ultrasound or MRI and had failed ≥ 3 physiotherapy cycles and ≥ 2 corticosteroid injections. Procedures were performed with the Arthrex NanoScope under ultrasound-guided SSNB (6mL). Pain (VAS) and function (Constant Score, CS) were recorded preoperatively and at 1day, 2weeks, and 6weeks postoperatively. Exploratory one-way ANOVA was used to assess temporal improvements. All procedures were completed without sedation, conversion, or complications. Mean operative time was 12min. VAS improved from 7.8 preoperatively to 4.2 (day 1), 4.0 (2weeks), and 3.4 (6weeks). CS improved from 51.5 to 68.4, 70.2, and 71.8, respectively. ANOVA demonstrated significant temporal change (VAS: F = 158.4, p < 0.0001; CS: F = 355.5, p < 0.0001). Visualization quality averaged 4.5/5. Mean patient satisfaction at 6weeks was 4.6/5, with return to daily activity at 10days. No Popeye deformity was observed. Nanoscopic LHBT tenotomy under SSNB is feasible, safe, and well tolerated in elderly patients selected for isolated LHBT pathology. Early pain and function outcomes improved consistently. Larger comparative studies with longer follow-up are required. Trial registration RNN/60/25/KE.

The study aimed to assess the predictive significance of various inflammatory biomarkers among critically ill elderly patients with osteoporotic hip fracture (OHF). The research identified critically ill elderly patients with OHF through the MIMIC-IV database. Nine systemic inflammatory indicators, formed by diverse combinations of neutrophils, lymphocytes, monocytes, and platelets, were evaluated for their associations with 30-day all-cause mortality after ICU admission. An examination of the receiver operating characteristic curve was conducted to determine the strongest predictive biomarker. In addition, the least absolute shrinkage and selection operator (LASSO) regression was applied to identify potential influencing factors. Furthermore, Cox proportional hazards regression and restricted cubic spline analyses were further applied to evaluate the association between the optimal biomarker and time-to-event outcomes. Seven inflammatory markers demonstrated significant predictive value for 30-day all-cause mortality, among which the platelet-to-lymphocyte ratio (PLR) exhibited the largest area under the curve (AUC = 0.783). Subsequently, individuals were categorized into quartiles according to PLR. Multivariate Cox proportional hazards models demonstrated a significant association between elevated PLR levels and 30-day all-cause mortality. After adjustment for variables selected by LASSO regression, elevated PLR remained an independent prognostic factor for mortality (adjusted hazard ratio, 1.43; 95% confidence interval, 1.24-1.65; P < 0.001). Additionally, restricted cubic spline analysis further demonstrated a consistently increasing risk of all-cause mortality with rising PLR levels. This study demonstrates that PLR is an independent predictor of 30-day all-cause mortality in critically ill elderly patients with osteoporotic hip fracture. Patients with a PLR ≥ 188.64 exhibit a significantly increased non-linear risk of 30-day all-cause mortality. Furthermore, patients with a PLR ≥ 302.11 can be classified as high-risk individuals. PLR represents an inexpensive and readily accessible tool for rapidly identifying high-risk patients and optimizing individualized treatment strategies in ICU clinical practice.

A machine learning-based discriminative framework for mild cognitive impairment risk in middle-aged and elderly Chinese patients with depression: evidence from CHARLS and CLHLS.

IntroductionCT-guided biopsy has good diagnostic accuracy, but adverse events such as pneumothorax are common. There are few reports on the safety and efficacy of CT-guided biopsy in the elderly.MethodsThis was a retrospective single-centre cohort study. Patients who underwent CT-guided lung biopsy between February 2017 and August 2024 were included. Patient background, disease background, examination status, and adverse events were ascertained. Elderly were defined as those aged 75 years and older. The primary outcome was the incidence of all adverse events, and the secondary outcomes were the incidence of pneumothorax and diagnostic accuracy. Categorical variables were compared by Chi-square test, and continuous variables by t-test. Multivariable analysis was performed by logistic regression analysis adjusted for age, sex, lung comorbidities, and radiological findings of target lesion.ResultsThere were significant differences between the two groups in ECOG-PS and the distance from the surface to pleura and target. In the primary outcome, any adverse events occurred in 207 patients (56.2%), with no significant difference between elderly (97/180, 53.9%) and non-elderly (110/188, 58.5%) patients (p = 0.401). Pneumothorax was the most common adverse event, occurring in 151 (41.0%) patients, with no significant difference between elderly (68/180, 37.8%) and non-elderly (83/188, 44.1%) (p = 0.244). On multivariate analysis, elderly (75years or older) was not clearly associated with the occurrence of all or severe adverse events, pneumothorax, and confirmed diagnosis. Location in the lower lung field and distant from the pleura were significantly associated with the incidence of all adverse event. In the secondary outcomes, emphysema or interstitial pneumonia, location in the lower lung field, and distant from the pleura were significantly associated with pneumothorax. There was no significant difference in the diagnostic accuracy disease between the elderly and non-elderly patients.ConclusionsThe incidence of adverse events and diagnostic accuracy of CT-guided biopsy are similar in elderly and non-elderly patients, and this method is useful even in elderly patients.Key pointThe safety and efficacy of CT-guided lung biopsy in elderly patients are equivalent to those in non-elderly patients.

Comparison of pericapsular nerve group block and supra-inguinal fascia iliaca compartment block for preoperative analgesia in elderly patients with hip fracture: A prospective, randomized controlled study.

Comparison of Endovascular Therapy Versus Anticoagulation Alone for the Treatment of Subacute Iliofemoral Deep Vein Thrombosis in Elderly Patients: Measures of 2-Year Clinical Outcome and Quality of Life.

ObjectiveThis study aimed to investigate the clinical characteristics of elderly chronic kidney disease (CKD) patients; and the correlation among their biochemical indicators, physical activity, and functional parameters. The findings of this study will hopefully a scientific basis for better understanding the causes and developing the best management methods for CKD in this population.MethodsIn total, 280 elderly patients with CKD participated in this cross-sectional study. All patients underwent a multidimensional assessment of clinical data, physical activity, and functional performance. Patients were stratified by disease severity into two groups: CKD stages 1-3 and stages 4-5. Additionally, they were categorized as sedentary or nonsedentary based on metabolic equivalent of task (MET) levels. Inter-group differences and correlations among the variables were subsequently analyzed.ResultsResearch findings indicated that although male patients predominated in the overall cohort, female patients were more prevalent among those with advanced CKD (stages 4-5) and those reporting a sedentary lifestyle, and these subgroups also demonstrated a higher likelihood of hypertension and anemia. Compared to patients with CKD stages 1-3, those in stages 4-5 had significantly lower estimated glomerular filtration rate (eGFR), hemoglobin, albumin, and MET values (P < .05), along with higher serum creatinine and Barthel Index of Activities of Daily Living (BADL) values (P < .05). Similarly, when compared to nonsedentary patients, those with a sedentary lifestyle exhibited lower eGFR, hemoglobin, and MET levels (P < .05), alongside elevated procalcitonin (PCT) and BADL values (P < .05). Correlation analyses further revealed that renal function was significantly associated with both BADL and MET values in the studied CKD population (P < .05). Our correlation analysis also revealed that renal function in elderly advanced CKD patients is closely associated with levels of PCT and Hb (P < .05). Moreover, among sedentary elderly CKD patients, renal function was correlated not only with PCT and Hb (P < .05), but also with albumin and physical activity levels MET (P < .05).ConclusionsOur study identified a predominance of female patients in advanced CKD stages and among those leading sedentary lifestyles. Furthermore, our findings suggest that renal function may be associated with physical activity and functional performance, with this relationship appearing most pronounced in sedentary individuals. The results also point to a potential interrelationship between renal function, inflammation, and nutritional status in advanced CKD.

ABSTRACTBackgroundCatheter ablation is an effective treatment for symptomatic supraventricular tachycardia (SVT). Most studies target the general adult population; data on the elderly are less robust. We studied the clinical and procedural characteristics and outcomes in elderly patients undergoing SVT ablation.MethodsAll patients undergoing atrioventricular nodal re‐entry tachycardia (AVNRT), atrioventricular re‐entry tachycardia (AVRT), and/or atrial tachycardia (AT) ablation between May 2011 and May 2022 at a tertiary center were included. Cases with concurrent ablation of atrial flutter, atrial fibrillation, and ventricular arrhythmias were excluded. Clinical and procedural characteristics and outcomes were compared between patients aged ≥ 70 years and those aged < 70 years.ResultsThere were 1758 cases of SVT ablation; 1608 patients were < 70 years old, and 150 patients were ≥ 70 years old. Elderly patients were more likely to have underlying structural heart disease and/or ischemic heart disease, more likely to have AVNRT and less likely to have AVRT (p < 0.001). Consequently, elderly patients were more likely to undergo right‐sided ablation (p < 0.001). The use of stereotaxis, intracardiac echocardiography, and electroanatomical mapping did not differ significantly. Procedure time, radiofrequency application time and fluoroscopy time were shorter in elderly patients (p < 0.05). Importantly, immediate complication and success rates did not differ significantly.ConclusionIn our study, the acute success rates are high, and complication rates are low across both cohorts despite differences in clinical and procedural characteristics. SVT ablation should be considered for symptomatic patients regardless of age. Further data including patient comorbidities and longer‐term outcomes may help patient selection.

Elderly patients with lower extremity fractures are at high risk for deep vein thrombosis (DVT) and its potentially fatal complication, pulmonary embolism. As perioperative physicians, anesthesiologists serve pivotal roles in mitigating thrombosis risk and optimizing patient outcomes, thus requiring a comprehensive understanding of the pathophysiology and management of DVT in this vulnerable population. Despite its significant clinical importance, comprehensive literature on perioperative DVT management for elderly patients with lower extremity fractures remains scarce. This review synthesizes evidence regarding epidemiology, pathophysiology, diagnostic challenges, multimodal prevention strategies for fracture-related thrombosis, and specific anesthetic considerations for this vulnerable population. It emphasizes the importance of routine preoperative Doppler ultrasonography and early DVT prevention. Besides pharmacological prevention, physical prevention and early mobilization constitute essential DVT prophylaxis components. Anesthesiologists must judiciously weigh thromboprophylaxis benefits against hemorrhage risks while addressing the inherent conflict between preoperative comorbidity optimization and timely surgical intervention, striving to perform surgery within 48 h after injury. Intraoperatively, neuraxial anesthesia should be preferred in the absence of contraindications, and anticoagulation and effective analgesia should be resumed early postoperatively to facilitate early mobilization. Through rigorous evaluation of contemporary literature and clinical practice, this review delivers evidence-based recommendations to enhance clinical decision-making and improve perioperative anesthesia management for this high-risk population.

Associations between preoperative frailty and major postoperative complications in older surgical patients.

Extended follow-up after gastrectomy in elderly patients: Improved postrecurrence survival but no overall survival benefit in patients aged 73 years or older.

Prevalence of suicidal ideation and its correlates in young and elderly patients with chronic schizophrenia.

Biomechanical analysis of column fixation and acute total hip arthroplasty with an anti-protrusion cage in a typical geriatric acetabular fracture.