Group Of Elderly Patients Research Articles

Identification of Osteoarthritis Inflamm-Aging Biomarkers by Integrating Bioinformatic Analysis and Machine Learning Strategies and the Clinical Validation

To identify inflamm-aging related biomarkers in osteoarthritis (OA). Microarray gene profiles of young and aging OA patients were obtained from the Gene Expression Omnibus (GEO) database and aging-related genes (ARGs) were obtained from the Human Aging Genome Resource (HAGR) database. The differentially expressed genes of young OA and older OA patients were screened and then intersected with ARGs to obtain the aging-related genes of OA. Enrichment analysis was performed to reveal the potential mechanisms of aging-related markers in OA. Three machine learning methods were used to identify core senescence markers of OA and the receiver operating characteristic (ROC) curve was used to assess their diagnostic performance. Peripheral blood mononuclear cells were collected from clinical OA patients to verify the expression of senescence-associated secretory phenotype (SASP) factors and senescence markers. A total of 45 senescence-related markers were obtained, which were mainly involved in the regulation of cellular senescence, the cell cycle, inflammatory response, etc. Through the screening with the three machine learning methods, 5 core senescence biomarkers, including FOXO3, MCL1, SIRT3, STAG1, and S100A13, were obtained. A total of 20 cases of normal controls and 40 cases of OA patients, including 20 cases in the young patient group and 20 in the elderly patient group, were enrolled. Compared with those of the young patient group, C-reactive protein (CRP), interleukin (IL)-6, and IL-1β levels increased and IL-4 levels decreased in the elderly OA patient group (P<0.01); FOXO3, MCL1, and SIRT3 mRNA expression decreased and STAG1 and S100A13 mRNA expression increased (P<0.01). Pearson correlation analysis demonstrated that the selected markers were associated with some indicators, including erythrocyte sedimentation rate (ESR), IL-1β, IL-4, CRP, and IL-6. The area under the ROC curve of the 5 core aging genes was always greater than 0.8 and the C-index of the calibration curve in the nomogram prediction model was 0.755, which suggested the good calibration ability of the model. FOXO3, MCL1, SIRT3, STAG1, and S100A13 may serve as novel diagnostic biomolecular markers and potential therapeutic targets for OA inflamm-aging.

Comparison of the Efficacy and Safety of Cyp2c19 Gene-guided Oral Administration of Different P2Y12 Inhibitors in Elderly Patients with Acute Coronary Syndrome

Objective To explore the survival prognosis and safety analysis of the cyp2c19 gene-guided ACS elderly patient group using Tegretol and Clopidogrel. Methods Three hundred and eighty-five ACS patients aged ≥65 years were selected, tested for polymorphisms in the cyp2c19 gene, and divided into two groups according to the oral P2Y12 receptor inhibitor: 320 patients in the clopidogrel group and 165 patients in the tegretol group. Patients were followed up for 1 year after discharge from the hospital, with the primary end point being a composite end point of adverse cardiovascular events including cardiac death, nonfatal infarction, or absence of stroke, and the secondary end point including unstable angina, in-stent stenosis, target vessel revascularization, and all-cause mortality, as well as bleeding events. Results The 1-year rate of ischemic events was lower in patients treated with tegretol compared with the clopidogrel group [28.5% (47/165) versus 26.3% (84/320), P = 0.599], and the difference in the 1-year rate of BARC 2, 3, and 5 events between the two groups was not statistically significant [6.0% (10/165) versus 3.4% (11/320), P = 0.179]. P = 0.179]. Conclusion In elderly patients with cyp2c19-directed ACS, there was no significant difference in survival prognosis, ischemic events, or bleeding risk between tegretol and clopidogrel at 1 year.

Neoadjuvant chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in elderly patients with stage III-IVa nasopharyngeal carcinoma: A real-world study based on medical comorbidities.

To evaluate the outcomes and toxicities of adding neoadjuvant chemotherapy (NAC) to concurrent chemoradiotherapy (CCRT) in elderly (≥65 years) patients with locoregionally advanced nasopharyngeal carcinoma (LANPC, stage III-IVa). Using an NPC-specific database, 245 elderly patients with stage III-IVa NPC, receiving CCRT +/- NAC, and an Adult Co-morbidity Evaluation 27 (ACE-27) score <2 were included. Recursive partitioning analysis (RPA) based on TNM stage and Epstein-Barr virus (EBV) DNA were applied for risk stratification. The primary end point was disease-free survival (DFS). Two risk groups were generated by the RPA model. In the high-risk group (EBV DNA < 4000 copy/ml with stage IVa & EBV DNA ≥4000 copy/ml with stage III-IVa), patients treated with NAC plus CCRT achieved improved 5-year DFS rates compared to those who received CCRT alone (56.9% vs. 29.4%; p = 0.003). But we failed to observe the survival benefit of additional NAC in the low-risk group (EBV DNA <4000 copy/ml with stage III). The most common severe acute toxic effects were leucopenia (46.8% vs. 24.4%) and neutropenia (43.7% vs. 20.2%) in the NAC plus CCRT group versus CCRT group with statistically significant differences. The addition of NAC to CCRT was associated with better DFS for the high-risk group of elderly LANPC patients with ACE-27 score <2. However, the survival benefit of additional NAC was not observed in low-risk patients.

Characteristics and demography of low energy fall injuries in patients > 60 years of age: a population-based analysis over a decade with focus on undertriage

BackgroundAn increasing group of elderly patients is admitted after low energy falls. Several studies have shown that this patient group tends to be severely injured and is often undertriaged.MethodsPatients > 60 years with low energy fall (< 1 m) as mechanism of injury were identified from the Stavanger University Hospital trauma registry. The study period was between 01.01.11 and 31.12.20. Patient and injury variables as well as clinical outcome were described. Undertriage was defined as patients with a major trauma, i.e., Injury Severity Score (ISS) > 15, without trauma team activation. Statistical analysis was performed using the Chi-squared test for categorical variables and the Mann–Whitney U test for continuous variables.ResultsOver the 10-year study period, 388 patients > 60 years with low energy fall as mechanism of injury were identified. Median age was 78 years (IQR 68–86), and 53% were males. The location of major injury was head injury in 41% of the patients, lower extremities in 19%, and thoracic injuries in 10%. Thirty-day mortality was 13%. Fifty percent were discharged to home, 31% to nursing home, 9% in hospital mortality, and the remaining 10% were transferred to other hospitals or rehabilitation facilities. Ninety patients had major trauma, and the undertriage was 48% (95% confidence interval, 38 to 58%).ConclusionsPatients aged > 60 years with low energy falls are dominated by head injuries, and the 30-day mortality is 13%. Patients with major trauma are undertriaged in half the cases mandating increased awareness of this patient group.

Evaluation of the results of laparoscopic surgical treatment for acute appendicitis in elderly patients

Objectives: The aim of this study was to evaluate the clinical and paraclinical characteristics and results of treatment of acute appendicitis in elderly patients. Methods: A prospective study was conducted on 189 patients, including 42 of them over the age of 60, diagnosed with acute appendicitis or peritonitis due to appendicitis based on clinical and paraclinical symptoms and treated with laparoscopic surgery from April 2022 to June 2023 at the Department of Digestive Surgery, Hue University of Medicine and Pharmacy Hospital. Results: Elderly patients with acute appendicitis admitted to the hospital had an average age of 69.3 years. The time from symptom onset to hospital admission in elderly patients was 30.1 hours compared to 19.1 hours in the non-elderly group. The elderly group had a rate of peritonitis of 40,5% compared to 13.6% in the non-elderly group (p &lt; 0.001). The mean time for passing initial gas in elderly patients was 18,1 hours compared to 13.3 hours in the non-elderly group (p = 0.004). Postoperative hospital stay in elderly patients was 4.7 days compared to 3.5 days in the non-elderly group (p &lt; 0.001). Postoperative complications in the elderly patient group were 2.4% compared to 0% in the non-elderly group (p = 0.222). There were no complications during surgery or 30-day mortality. Conclusions: Elderly patients with acute appendicitis were hospitalized later, had a higher rate of peritonitis and had a longer postoperative hospital stay than non-elderly patients. Laparoscopic surgery to treat acute appendicitis in the elderly is a safe method. Key words: acute appendicitis, elderly, laparoscopic appendectomy, appendicitis peritonitis.

Clinical Results and Hematologic Predictors of Linear Accelerator–Based Stereotactic Radiosurgery or Fractionated Stereotactic Radiotherapy for Brain Metastasis in Patients Aged 75 Years or Older: A Retrospective Study

This study aimed to evaluate prognostic factors including pre-radiosurgical blood count in elderly patients (EPs) with brain metastasis (BM) who were treated using linear accelerator (linac)-based, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) with a micro-multileaf collimator. Between January 2011 and November 2021, 101 consecutive elderly patients with BM were treated by linac-based SRS or fSRT using linac with a micro-multileaf collimator. EPs were defined as patients aged ≥75 years. The tumors originated from the lungs (n = 90, 89.1%), colon (n = 2, 2.0%), and others (n = 9, 8.8%) in these EPs. The median pretreatment Karnofsky Performance Scale (KPS) score was 80 (range: 40–100). The median follow-up time was 10 (range: 0–76) months, as was the median survival time. The 6-month and 1 and 2-year survival rates in the EP group were 58.3%, 43.2%, 28.5%, respectively. Freedom from local failure at 6 months and 1 and 2 years were 97%, 95%, and 91.5%, respectively. Freedom from distant failure at 6 months and 1 and 2 years in EPs were 70.6%, 59.4%, and 54.2%, respectively. A high neutrophil/lymphocyte ratio (NLR) >5.33 was an unfavorable predictor of prognosis for EPs with BMs treated with SRS and fSRT (p<0.001). In the EPs, the prognostic factors associated with prolonged survival time in the Cox proportional hazards model were being female and a good pretreatment KPS score. The findings of our study highlight the efficacy of linac-based SRS and fSRT with a micro-multileaf collimator in the treatment of EPs with BMs. NLR can be an important factor in treatment decisions for EPs with BMs.

Efficacy and Safety of Pulsed Radiofrequency of Dorsal Root Ganglion in Elderly Patient Population With Acute and Subacute Zoster-Related Pain.

Background: Herpes zoster (HZ) is typically characterized by a burning, stabbing pain, hyperalgesia, and allodynia. In some patients, despite the lesions resolving, the pain persists and becomes chronic. If the pain continues for more than 6 months after the onset of the pain phase, this condition is called postherpetic neuralgia (PHN). The frequency and severity of PHN increase with advancing age. The pain in PHN can be severe, sometimes resistant to medications, significantly impacting the patients' quality of life. The elderly patient population cannot tolerate the medications due to their side effects. In this situation, interventional pain treatment should be applied in the elderly patient group who have a high risk of developing PHN compared to other age groups. Method: We included patients over 65 years of age with HZ-related pain who underwent dorsal root ganglion (DRG) pulsed radiofrequency (PRF) within the first 6 months from the onset of pain. We divided these patients into 2 groups: patients who underwent intervention within the first 1 month from the onset of pain and patients who underwent intervention between 1 and 6 months. We recorded medication doses and Numeric Rating Scale (NRS) scores before the procedure and at 1 week, 1 month, 3 months, and 6 months after the procedure. Results: After the DRG PRF treatment, NRS scores improved significantly in both groups (p < 0.05). The mean NRS score in the early DRG PRF group was significantly lower than that in the late DRG PRF group (p < 0.05). The medication doses in the early DRG PRF group were significantly lower than those in the other group (p < 0.05). Conclusions: Interventional pain treatment should be applied as soon as possible in the elderly patient group who do not respond to first-line medical treatment or cannot tolerate medical treatment due to its side effects and who have a high risk of developing PHN compared to other age groups. DRG PRF, applied in the early period of medical treatment-resistant acute HZ, is safe and effective, preventing the progression to PHN.

Optimizing Nerve Sparing in Robotic-Assisted Radical Prostatectomy: A Comparative Investigation of Traditional and Modified Endopelvic Fascia Preservation Techniques.

Prostate cancer (PCa) is the second most common cancer and the sixth leading cause of cancer-related mortality in men. In 2000, Abbou performed the first robot-assisted radical prostatectomy, and radical prostatectomy has developed rapidly. Robot-assisted radical prostatectomy (RARP) is a valuable therapeutic option for the management of localized Pca. To present the functional outcome of robot-assisted laparoscopic radical prostatectomy using traditional and modified endopelvic fascia preservation methods in a single center in Vietnam. We prospectively analyzed a series of 65 patients diagnosed with prostate cancer from 2020 to 2023. All of those were operated by DaVinci Si system robot-assisted laparoscopic prostatectomy. Twenties patients were applied with a modified nerve-sparing technique, intrafascial dissection, and lateral prostatic fascia preservation, leaving the lateral tissue, including the neurovascular bundle, untouched and covered. We used the traditional approach, intrafascial nerve-sparing with open endopelvic fascia and lateral prostatic fascia in 45 cases. Patients were followed up to 12 months to assess the continence and erectile function by using IIEF-5 and EPIC questionnaires. The study sample included 65 cases; the mean patient age was 64.21 ± 6.68, erection rate after surgery at six months in bilateral NS was 36.58% (15/41) in the traditional group, and 68.42% (13/19) in the modified group (p=0.028). The patient did not recover erectile ability in the group of elderly patients (>65 years old) and unilateral nerve-sparing group. The continence rate six months after surgery was 86.66 % in the conventional group and 85% in the modified group, with no significant difference between the two groups. In the potency group, the IIEF-5 score was 13 ± 4.9, and the EPIC-26 score was 62.20 ± 10.04. Erectile ability in the modified group was better than the traditional group at six months after surgery. Our results showed better potency recovery in the modified group. These results should be tested in future research with randomized studies.

The dynamics of recovery of external breathing function in patients after laparoscopic cholecystectomy in the acute period under the influence of the rehabilitation program.

Aim: To determine the dynamics of renewal of the function of external respiration in patients after laparoscopic cholecystectomy at the acute stage of rehabilitation under the influence of a rehabilitation program. Materials and Methods: The study is randomized, simple with blinded assessors. The forced vital capacity (FVC, l), forced expiratory volume in the first second (FEV1, l) and peak expiratory flow rate (PEFR, l/s) were assessed. Spirometry was performed 120 patients on the first day of admission of patients to the surgical department for surgical intervention, on the second day and on the day of discharge. Methods of mathematical statistics: arithmetic mean (M) and standard error of the mean (}m), Student's t-test were calculated, differences at p<0,05 were considered statistically significant. Results: It has been established that laparoscopic cholecystectomy leads to a statistically significant decrease in the parameters of respiratory function in all age categories. More pronounced positive dynamics of respiratory function in the group of respiratory therapy. It was established that without respiratory therapy on the day of discharge there was no restoration (р<0.05) in groups of elderly patients of group of FVC l, FEV1 l, PEFR l/s; in middle-aged patients did no restoration FEV1, l, PEFR, l/s; in younger patients there was no recovery of FEV1, l. Conclusions: The results of the study indicate the effectiveness of the introduction of diaphragmatic breathing exercises in combination with early mobilization at the acute and subacute stages of rehabilitation in patients after laparoscopic cholecystectomy in order to restore the function of the respiratory system.

Skin Diseases in Geriatric Patients: One-year Single Center Experience

Purpose: The aim of this study was to investigate the distribution and frequency of skin diseases in geriatric age group, as well as the variation of this frequency according to age, sex, and season.&#x0D; Methods: Data from 1039 geriatric patients admitted to dermatology clinic between January 1, 2022 and January 1,2023 were retrospectively analysed according to sex, age and seasons.&#x0D; Results: The five most frequently observed disease groups in elderly patients were eczematous dermatitis (22.4%), fungal infections (14.4%), infestations (10.1%), pruritus (6.9%), and premalignant skin lesions (6.4%). The most common five dermatologic diseases in all patients were contact dermatitis (11.16%), scabies (8%), tinea ungium (6.8%), actinic keratosis (6.1%), and generalized pruritus (6.1%), respectively. Generalized pruritus was significantly less frequent in the 65-74 age group compared with the other two groups (p

Characteristics of proton pump inhibitor-resistant severe reflux esophagitis and efficacy of vonoprazan in elderly (older than 75 years) and non-elderly groups.

Previous studies on age differences in proton pump inhibitor (PPI)-resistant reflux esophagitis (RE) have found that stenosis and bleeding complications were significantly more common in the elderly than in the non-elderly. We sought to examine differences between two groups of elderly (75 years or older) and non-elderly (<75 years) patients with (PPI)-resistant severe RE and also the efficacy of vonoprazan (VPZ) in these patients. There were 14 patients in the elderly group and 15 in the non-elderly group. Information was obtained on patient background (sex, body mass index [BMI], gastric mucosal atrophy, and the presence of hernia and collagen disease), and all patients underwent the saliva secretion test and esophagogastroduodenoscopy (EGD). The saliva secretion test (amount of saliva secreted, salivary pH, and the acid-buffering capacity) was performed by chewing sugar-free gum for 3 min before EGD. The efficacy of VPZ in both groups was also assessed. Saliva secretion, sex, BMI, and the presence of gastric mucosal atrophy did not significantly differ between the two groups. The number of hernias larger than 4 cm was significantly higher in the elderly PPI-resistant group, and significantly more patients had collagen disease in the non-elderly group. The efficacy of VPZ was not significantly different between the two groups; however, 10 patients in the non-elderly group had collagen disease, and 4 did not achieve esophageal mucosal healing even with VPZ 20 mg. The number of large hernias (>4 cm) was significantly higher in the elderly group, while significantly more non-elderly patients had collagen disease. In the non-elderly group with scleroderma, the efficacy of VPZ 20 mg may not be sufficient.

Prognostic Accuracy of Common Mortality Prognostic Scales in Very Old Patients with Intracerebral Haemorrhage

Background Spontaneous intracerebral haemorrhage (SICH) is the most severe form of all stroke types. Stratification of SICH severity is important for group comparisons and treatment decisions. The existing prognostic scores for clinical prediction in SICH have not been specifically validated in the very old (≥75 years). Therefore, we aimed to evaluate the accuracy of different SICH vital prognostic scores in the very old. Purpose To compare the short-term accuracy of three vital prognostic scores: Functional Outcome in Patients with Primary Intracerebral Haemorrhage (FUNC), Modified Emergency Department Intracerebral Haemorrhage (mEDICH) and the Intracerebral Haemorrhage Score (‘ICH score’) in patients aged 75 or older. Methods Comparison of the discriminative performance of three SICH prognostic scores in a consecutive case series of patients ≥75 years. The prognostic discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). Additionally, a binary logistic regression was conducted to determine independent prognostic factors associated with mortality. Results The case-fatality was 40.6%. The AUROC and Younden index for the three scores was as it follows: ‘ICH score’ 0.882 and 0.648; mEDICH 0.867 and 0.571; FUNC 0.802 and 0.519. The main independent risk factors of death were presence of intraventricular extension (OR = 4.000,95% CI= 1.933–8.276), INR value (OR = 2.173, 95% CI = 1.146–4.117), haemorrhage volume (OR = 1.881, 95% CI = 1.029–3.440) and GCS (OR = 0.119, 95% CI = 0.060–0.236) for mEDICH. Haemorrhage volume (OR = 3.020, 95% CI = 1.806–5.050) and GCS (OR = 0.043, 95% CI = 0.013–0.151) for FUNC. Haemorrhage volume (OR = 4.950, 95% CI = 2.249–10.897) and intraventricular haemorrhage (OR = 3.811, 95% CI = 1.833–7.924) for ‘ICH score’. Conclusion The three scores (‘ICH score’, FUNC and mEDICH) showed an excellent capability of discriminating the group of elderly patients at risk of short-term death. Age per se may not be crucial for accurate discrimination of death in the group of elderly. Instead, the inclusion of available physiological markers of fragility would be more scientifically meaningful than age.

Intertrochanteric Femoral Fractures: A Comparative Analysis of Clinical and Radiographic Outcomes Between Talon Intramedullary Nail and Intertan Nail.

Introduction Hip fractures in the elderly constitute a significant health concern, and their incidence is on the rise. It has been reported that intertrochanteric femoral fractures comprisea large portion of hip fractures, and they are especially prevalent among women. Over 75% of these types of fractures in the elderly occur as a result of simple falls.Surgical intervention must be performed for these fractures to expedite the healing process in patients. The application of a proximal femoral nail (PFN) is conducted using a minimally invasive technique after the fracture has been reduced using closed techniques. This technique maintains the fracture hematoma while minimizing the occurrence of consequences such as surgical trauma, hemorrhaging, infection, and issues with the wound site.This study aimed to assess the radiologic and functional outcomes among the groups following surgical procedures utilizing two distinct PFNs. Methods Between November 2021 and June 2023, a total of 96 individuals (38 males and 58 females) who underwent surgery for ITF using PFN were included in the study.Our surgical team utilized the Talon™ DistalFix™ PFN system (Orthopedic Designs North America Inc., FL, USA) and the Trigen InterTAN® nail (Smith & Nephew). Results The surgery time (number of scopes) for the Talon PFN was recorded as 25 (25-30), while it was 30 (30-35) in the InterTAN group (p<0.001). No nail protrusion was observed in the InterTAN group, whereas nail protrusion was observed in 12 patients (31.6%) in the Talon PFN group (p<0.001). Nail jamming was observed in two (5.3%) patients in the Talon PFN group, while none was observed in the InterTAN group (p<0.07). Conclusion In ITF fractures, the InterTAN nail is a more reliable implant. The shorter surgery time, reduced radiation exposure, and more minimally invasive nature of the Talon PFN might be preferred for geriatric patient populations with comorbidities where prolonged anesthesia could elevate mortality risks or for fractures of two or three pieces (Evans-Jansen Type 1 and Type 2). However, for more unstable fractures (Evans-Jensen Type 3) and in the active elderly patient group, we recommend the use of the InterTAN nail.

Disease Activity and Progression of Disability in Multiple Sclerosis Patients Aged Over 50 With or Without Disease-Modifying Drug Treatment: A Retrospective Cohort Study.

Background This study aimed to clarify the need for disease-modifying drug (DMD) treatment in elderly patients with multiple sclerosis (MS) aged 50 years or older. MS is an autoimmune, demyelinating disease of the central nervous system that predominantly affects young women. Various DMDs are effective in preventing relapses and slowing the progression of disability in patients with MS. Although disease activity in MS is believed to decrease with aging, a consensus on the appropriate DMD treatment for elderly patients with MS is lacking. Methodology This study included elderly patients with MS (>50 years old). We compared the occurrence of relapses, worsening of disability, and conversion to secondary progressive MS (SPMS) between patients with DMD treatment and those without. Logistic regression analysis was performed to determine the predictors of these outcomes. Confounding factors were adjusted using propensity scores. Results From January 1991 to October 2022, 76 elderly patients with MS were included. The mean age at the last visit was 57.4 ± 6.3 years, with 51 patients being female. The mean age of onset of MS was 37.1 ± 10.1 years. Fifty-four patients were included in the DMD treatment group. The overall relapse rate was 38% (33% and 48% in the DMD treatment and untreated groups, respectively). No significant differences in relapse rates (p = 0.72) or in the Expanded Disability Status Scale (EDSS) scores were identified between the two groups. Kaplan-Meier curves showed no differences in the time to first relapse within five years between the two groups. Additionally, no significant predictors of relapse were identified. Among 61 patients with relapsing-remitting MS, 25% converted to SPMS during the observation period. Logistic regression analysis showed that older age at the final visit and the presence of brainstem lesions at the age of 50 years were associated with a higher rate of transition to SPMS. Conclusions In the present study, no significant difference was found in the rate of relapse, disability progression, and conversion to SPMS between the DMD treatment and untreated groups in elderly patients with MS. Therefore, in patients without long-term relapse, no poor prognostic functional factorsor predictors of conversion to SPMS, discontinuation of DMDs may beconsidered. In addition, the presence of brainstem lesions at 50 years of age may predict the conversion to SPMS. Thus, the continuation of DMD or conversion to an appropriate DMD should be considered in patients with brainstem lesions at 50 years of age.

ПРИЧИНЫ УДАЛЕНИЯ ЗУБОВ У ПАЦИЕНТОВ ПСИХИАТРИЧЕСКОГО СТАЦИОНАРА

According to the literature, in a mentally healthy population, the main cause of tooth extraction is complications of caries and periodontitis, mainly in elderly and senile patients. In patients with psychiatric pathology, many authors note the high prevalence of dental diseases and emphasize the need for tooth extraction.&#x0D; The aim of the investigation was to study the structure of dental diseases requiring tooth extraction in psychiatric hospital patients.&#x0D; Material and methods of research. Information was copied from 1812 dental records of patients who were on inpatient treatment at the V.N. Bekhterev RCPB in the period from 2014 to 2016 at the age of 16 to 82 years (879 men and 933 women). The main reason for hospitalization of most patients was the diagnosis of schizophrenia (59%). The statistical software package SPSS 13.0 (1999) was used for statistical processing of the results.&#x0D; The results of the study. During the study period, the dental surgeons of the RCPB received 1812 patients who had 2187 teeth removed. Mostly, the tooth extraction operation was performed for chronic periodontitis (47.2%). The greatest number of removals for periodontitis was observed in elderly patients (57.1%). The smallest number of teeth removed due to periodontitis was observed in the group of middle-aged patients (45–59 years) and amounted to 36.3% of the total number of teeth removed. This is due to the predominance of chronic periodontitis in these patients, which is comparable to the indicators in patients without psychiatric pathology. In the group of elderly and senile patients, tooth extraction surgery for chronic periodontitis was performed in 49.3% of cases.&#x0D; Conclusions. The main reason for tooth extraction in mentally ill patients was chronic periodontitis and its exacerbation – 47.2%. The average age of these patients was 59.16 ± 14.33 years in men and 52.91 ± 11.85 years in women. The predominance of chronic periodontitis in the structure of the causes of tooth extraction in patients of the middle age group indicates an early clinical manifestation of inflammatory and destructive changes in the periodontium.

Evaluating the Effectiveness of Risk Adjustment Using Dynamic Frailty Assessment in Treating Newly Diagnosed Multiple Myeloma in Elderly Patients

Background: The treatment of newly diagnosed multiple myeloma (NDMM) in elderly patients is challenging due to various problems. To address these challenges, the European Myeloma Network (EMN) recommends conducting a frailty assessment before NDMM treatment in elderly patients. If the assessment identifies an intermediate fit or frail group, dosage reduction is recommended to avoid excessive treatment. However, as frailty status improves, there may be a risk of insufficient treatment leading to poor outcomes. In order to explore the optimal treatment approach for elderly NDMM patients in real-world settings, a retrospective analysis was conducted on the effectiveness of dynamically adjusting treatments based on frailty assessment in intermediate-fit and frail groups of elderly NDMM patients. Methods: Patients who were initially diagnosed with multiple myeloma and assessed as intermediate fit or frail patients by IMWG-GA frailty assessment at the Department of Hematology, Affiliated Hospital of Hebei University from January 1, 2018 to April 1, 2023 were included in this study.The initial treatment regimen for all patients in this group consisted of a combination of Bortezomib with dexamethasone (BD) or Ixazomib with dexamethasone (ID) .Frailty assessment and efficacy evaluation were conducted every 2-3 courses during the treatment period. In the frail group, treatment in those frailty status improved was adjusted based on prognosis stratification by adding a third drug to high-risk R-ISS patients and subsequently adjusting it according to efficacy evaluation; additionally, a third drug was added to patients who did not reach partial response (&amp;lt;PR). For the intermediate fit group, sequential addition of a third drug occurred during courses 2-3.The options for the third drug included cyclophosphamide, lenalidomide, and thalidomide，and common regimens used were ICD, IRD, VRD, VCD, and VTD.The response rate, discontinuation rate, early death, and adverse drug reactions were observed. Results: A total of 45 patients with newly diagnosed NDMM were included in this study. Among them, 37 patients were assessed as frail .24 /45 patients were treated with the BD regimen and 21/45 patients with the ID regimen. During treatment, dynamic frailty assessment showed significant improvement in frail status during courses 3-4 (see Table 1). Following dynamically adjusted principles, additional drugs were administered to certain patients: 24 /37 frail patients received a third drug; among the intermediate fit patients, all received a third drug. The best ORR achieved throughout the study was at an impressive rate of 82.2% (37/45), with a corresponding best efficacy above VGPR seen in 51.1% (23/45) of cases. Twenty-one patients experienced disease progression for various reasons during treatment, with a median PFS of 14.0 (3.0-96.0) months. During the follow-up period, a total of 17 patients died, while none died within 6 months. The median overall survival (OS) was found to be 18.0 months (ranging from 3.0 to 115.5 months). Safety evaluation was conducted on all 45 patients within the first year and they tolerated the treatment well. Most adverse reactions reported were of grade 1-2 according to CTCAE version 5.0. Conclusion: This study is a retrospective study that the initial treatment involved administering a low-intensity regimen consisting of either BD or ID two-drug combination. Serious adverse reactions, drug withdrawal, and early death decreased in both groups. The treatment intensity was increased for high-risk patients or those with poor efficacy in the frail group after the improvement of frailty status. This new therapeutic strategy which integrates dynamic changes of frailty status, cytogenetic risk factors, efficacy evaluation and dynamic adjustment of treatment, has shown improved efficacy for patients with two different levels of frailty. Additionally, it has been found to reduce early mortality rates. These promising results warrant further investigation through prospective studies.

Overall Survival in Patients with Ccus Depends on Presence of Anemia

Introduction Clonal cytopenia of undetermined significance (CCUS) is a recently recognized hematological disorder characterized by the presence of one or more cytopenias, evidence of clonal hematopoiesis and not fulfilling the criteria for a myeloid neoplasm. In contrast to myelodysplastic syndromes (MDS) where 95% of the patients are anemic at time of diagnosis, that is only the case for around 60% of patients with CCUS (Weeks et al. Prediction of Risk for Myeloid Malignancy in Clonal Hematopoiesis. NEJM Evid. 2023). Furthermore, as recent studies on survival in CCUS primarily included younger patients (Weeks et al. NEJM Evid. 2023) or population-based cohorts not specifically referred for diagnostic work up of unexplained cytopenia (UC) (Rossi et al. Clinical relevance of clonal hematopoiesis in persons aged ≥80 years, Blood 2021) additional survival data on patients with CCUS are warranted. In this study, we investigated survival outcomes in patients with CCUS referred for primary work up of UC. Methods We included 241 patients with CCUS and compared them to 144 patients with low-risk MDS, defined as having less than 5% blasts in the bone marrow. Bone marrow biopsies and next-generation sequencing (NGS) were performed in all patients and cytogenetic analyses using G-band karyotyping was done in 362 (94%) of cases. For NGS, we used a gene panel with the most commonly mutated genes in MDS. The patients were included at 6 different institutions in Denmark from 2013 and onwards. A cut-point of 5 years follow-up was chosen for more robust survival data, and patients were censored at this time point if followed for more than 5 years. Patients with CCUS were stratified into 3 groups dependent on the type of cytopenia present at diagnosis. CCUS patients with pancytopenia (n = 35), and CCUS patients without pancytopenia were split based on whether they were anemic (n = 143) or not (n =63). We compared overall survival between the CCUS groups and low-risk MDS in a Cox proportional hazards model adjusted for age, sex, number of variants and presence of high-risk variants. Results Of the 241 CCUS patients, 178 (74%) were anemic (hemoglobin &amp;lt; 12 and 13 g/dL for women and men, respectively), while this was the case for 130 (90%) of the patients with MDS. A total of 772 variants were identified in the entire cohort with a median of 2 (IQR: 1-3) per patient for both CCUS and MDS patients. The overall survival at 5 years was 45% for low-risk MDS patients and 62% for CCUS patients. For CCUS patients without anemia, CCUS patients with anemia and CCUS patients with pancytopenia overall survival at 5 years was 85%, 52% and 55%, respectively (p &amp;lt; 0.0001). In the adjusted Cox proportional hazards model, we found a significantly superior overall survival for CCUS patients without anemia compared to those with anemia (HR: 0.28, 95%-CI: 0.13-0.58, p = 0.001) and pancytopenia (HR: 0.22, 95%-CI: 0.09-0.53, p = 0.001) and patients with low-risk MDS (HR: 0.18, 95%-CI: 0.09-0.38, p &amp;lt; 0.001). There was no significant survival difference between CCUS patients with pancytopenia and low-risk MDS patients (HR: 0.67, 95%-CI: 0.46-1.50, p = 0.5). Of the remaining variables, age was the strongest prognostic factor with hazard ratio increasing with a factor 1.05 (95%-CI: 1.03-1.07, p &amp;lt; 0.001) per year aged. Predicted survival probabilities for a 65-year-old and 80-year-old person demonstrate a substantial difference in overall survival across all 3 categories of CCUS (figure 1). Discussion Here we show that the presence of anemia impacts overall survival among CCUS patients. We observe that CCUS patients without anemia, representing 26% of CCUS patients in our cohort, have a superior overall survival compared to those with anemia, even with a comparable mutational profile. Our findings indicate that other factors than mutational signatures impact overall survival. Moreover, the prevalence of CCUS increases with age, and our findings demonstrate a considerable difference in survival between a 65-year-old and 80-year-old person diagnosed with CCUS. This raises the concern that prediction models can overestimate the survival rates if the elderly group of CCUS patients is not well represented in these models. In conclusion, we show that age and hemoglobin levels are important factors in overall survival for CCUS patients, and that patients with CCUS without anemia have a superior overall survival and should be considered as a separate group within the CCUS category.

Infective endocarditis of the aortic valve in an 85-year-old man due to translocation of the intestinal flora

Infective endocarditis (IE) is an infectious and inflammatory disease of the endocardium that is associated with a high incidence of complications and mortality. Elderly patients are the most vulnerable age group for the IE. Infective endocarditis caused by E. coli is a rare disease due to both bacteria life-cycle and human immune system protection. Nevertheless, recent years the incidence of IE associated with E. coli has been increasing in the group of elderly patients. It seems important to reassess the indications for antibiotic prophylaxis in certain categories of patients (including the elderly patients with an unobvious but increased risk of IE). This clinical case demonstrates a native valve endocarditis caused by E. coli developed after bowel preparation with osmotic laxatives and endoscopic procedure in an 85 year-old male without significant chronic diseases. Despite the fact that the patient did not belong to the category of increased risk of IE, he had the predisposing conditions for the development of IE (weaked immune system, bacteremia, heart valve sclerosis), that realized in the active manifest disease. Treatment with antibiotics led to an improvement in the patient’s condition and regression of infectious vegetations on the valve. Repeat blood cultures were negative. When planning endoscopic procedure for patients at risks (elderly person, weakened immune system, minimal aortic valve lesions), antibacterial prophylaxis should be considered. Additional research is required to develop clear algorithms for antibacterial prophylaxis.

УГЛЫ ОТХОЖДЕНИЯ ПОЧЕЧНЫХ АРТЕРИЙ ОТ БРЮШНОЙ АОРТЫ У ПАЦИЕНТОВ РАЗЛИЧНЫХ СОМАТОТИПОВ

In the course of this study, the authors measured the angles of origin of the renal arteries from the ab-dominal aorta. in patients with a hypersthenic body type, the highest values of deviation angles are recorded for the LPA &lt; 99.820° and the normosthenic type &lt; 88.740° for the PPA), the smallest among patients with an asthenic body type (&lt; 75.650° for the PPA and &lt; 83.600° for the LPA). Taking into account gender, it was found that the smallest values of the angles of the VA in men were found in old age (47.79° ± 8.76° for the RA and 60.43° ± 9.14° for the LAA), the maximum values were recorded in patients in adulthood (72.65° ± 6.75°). In women, the RAA extends at a more acute angle only in the group of elderly patients (52.77° ± 10.02°).

Real-Word Analysis of Clinical Characteristics and Outcomes Among Elderly Patients (pts) with Multiple Myeloma (MM)

Multiple Myeloma (MM) occurs commonly among older adults and the median age at diagnosis is 70 years old. While modern MM therapeutic agents have increased overall survival (OS), the prognosis of elderly patients (pts) (defined as age &amp;gt;75 yo) has been trailing behind younger pts (age &amp;lt;65 yo). This gap has been ascribed to frailty. However, it is unknown if older MM pts have different disease biology compared with younger pts. The MMRF CoMMpass study is a longitudinal international, multicentric prospective study of 1143 pts with newly diagnosed MM. We interrogated this dataset to describe the disease characteristics and to identify prognostic factors for OS amongst pts. The MMRF CoMMpass IA19 dataset was used for all analyses. Pts were followed for a minimum of 8 years after diagnosis. One hundred forty-six patients were &amp;gt; 75 yo, referred to as the elderly patient group (EPG), (12.8% of the cohort). Patient and disease characteristics are described in Table 1. Overall, 59% are male, and 41% are female; 79.5% were white, and 18.5% were black. At presentation, 63% of pts have anemia, 15.1% have hypercalcemia, and 9.6% have renal insufficiency (defined as Cr&amp;gt;2mg/dL). The EPG more commonly presented with advanced staging (ISS III: 46.6% vs. 22.9%, p&amp;lt;0.001), anemia (63.0% vs. 52.6%, p&amp;lt;0.001), lower performance status (ECOG ≥2: 26% vs. 8.9% (p&amp;lt;0.001) compared to the &amp;lt;65 yo group. Regarding treatment, the EPG are more likely to receive only PI-based first-line treatment (45.2%), followed by PI/IMIDs-based combined therapy (36.3%). Only 10 elderly pts (6.9%) underwent high-dose melphalan and autologous stem cell transplant (ASCT). In terms of best overall response to any line of therapy, the EPG is much less likely to achieve deep responses (sCR or better: 22.2 vs. 3.5%, p &amp;lt; 0.001) and had worse OS compared to the &amp;lt;65 and 65-75 yo groups (47 months vs. NR vs. 80 months, respectively). The cause of death in the three age groups (disease progression vs. others was not statistically different, p=0.278). Notably, elderly pts who received triplet therapy versus double therapy at diagnosis have improved clinical outcomes with deeper responses (≥ sCR of 22.2 vs. 3.5%, p &amp;lt; 0.001) and increased median OS (47.6 months vs. 20.3 months, p &amp;lt; 0.001). We performed Cox regression analysis to evaluate prognostic factors for OS (Figure 1). Triplet therapy in the first line is associated with better OS (p=0.004). Conversely, decreased performance status (ECOG &amp;gt;1) and advanced ISS stage at presentation portend a worse prognosis (p=0.049 and p=0.044, respectively). Noteworthy, there is a higher attrition rate (defined as death or lost to follow-up) in the EPG. The attrition rate was 50.7% after first-line therapy, compared to 34.0% and 33.3% for the under 65 and 65-75 age groups, respectively (p&amp;lt;0.001). The attrition rate for elderly pts remained significantly higher after second and third-line therapies (p&amp;lt;0.001 and p=0.004, respectively). We analyzed if the clinical characteristics of the EPG differ based on race. We found that non- white patients were more likely to present with advanced stage (p=0.039) and target organ damage: anemia, p&amp;lt;0.001), hypercalcemia (p=0.046), and renal insufficiency (p&amp;lt;0.001). We did not find other differences in clinical characteristics, treatment received, attrition rates, and overall survival. In conclusion, our study adds to the knowledge that elderly pts are more likely to present with advanced disease and diminished functional status. They are less likely to receive combined PI/IMIDs therapy and ASCT as first-line treatment and to obtain deeper treatment responses. Moreover, our data showed high attrition rates in this population. These factors could result in the shorter overall survival seen in the elderly population and underscore the importance of prompt initiation of effective and safe therapies in the elderly population. Further clinical studies are needed to characterize disease heterogeneity better and to identify interventions to improve clinical outcomes of older adults with myeloma.