Impaired Life Expectancy Research Articles

The gender paradox in health-impaired lifetime-end of amyth?

Women live longer than men, but they spend more life years with health-impairment. This article examines the extent to which this gender paradox can be explained by two factors: the "mortality effect," which results from the higher life expectancy of women, and "differential item functioning" (DIF), which refers to gender differences in reporting behavior. Impaired life expectancy at age50 is calculated for the health indicators general health, limitations, and chronic morbidity using the Sullivan method. Data on health prevalence are obtained from the 2012 survey "Gesundheit in Deutschland aktuell" (GEDA), data on mortality is taken from the Human Mortality Database. The gender difference in impaired life expectancy is decomposed into the mortality effect and the health effect. The latter is finally adjusted for DIF effects on the basis of vignettes from the 2004 SHARE survey. The gender paradox can be resolved not only partially but completely for all three health indicators considered by the mortality effect and DIF. After taking these two factors into account, the gender difference in impaired life expectancy reverses from higher values for women to higher values for men. The causes of the gender paradox are highly complex and the differences between women and men in total and impaired life expectancy are not necessarily going into contradictory directions. The extent of women's higher impaired life expectancy depends decisively on the underlying health indicator and is largely explained by the mortality effect.

Pricing Life Contingencies Linked to Impaired Life Expectancies Using Intuitionistic Fuzzy Parameters

Several life contingency agreements are based on the assumption that policyholders have impaired life expectancy attributable to factors, such as lifestyle, social class, or preexisting health issues. Quantifying two crucial variables, augmented death probabilities and the discount rate of projected cash flows, is essential for pricing such agreements. Information regarding the correct values of these parameters is subject to vagueness and imprecision, which further intensifies if impairments must be considered. This study proposes modelling mortality and interest rates using a generalization of fuzzy numbers (FNs), known as intuitionistic fuzzy numbers (IFNs). Consequently, this paper extends the literature on life contingency pricing with fuzzy parameters, where uncertainty in variables, such as interest rates and death probabilities, is modelled using FNs. While FNs introduce epistemic uncertainty, the use of IFNs adds bipolarity to the analysis by incorporating both positive and negative information regarding actuarial variables. Our analysis focuses on two agreements involving policyholders with impaired life expectancies: determining the annuity payment in a substandard annuity and pricing a life settlement over a whole life insurance policy. In particular, we emphasize modelling interest rates and survival probabilities using triangular intuitionistic fuzzy numbers (TIFNs) owing to their ease of interpretation and implementation.

Prevalence and Influence Factors for Non-Alcoholic Fatty Liver Disease in Long-Term Hospitalized Patients with Schizophrenia: A Cross-Sectional Retrospective Study.

Long-term hospitalized patients with schizophrenia (SCZ) are vulnerable to physical illness, leading to impaired life expectancy and treatment outcomes. There are few studies on the influence of non-alcoholic fatty liver disease (NAFLD) in long-term hospitalized patients. This study aimed to investigate the prevalence of and influence factors for NAFLD in hospitalized patients with SCZ. This cross-sectional retrospective study included 310 patients who had experienced long-term hospitalization for SCZ. NAFLD was diagnosed based on the results of abdominal ultrasonography. The T-test, Mann-Whitney U-test, correlation analysis, and logistic regression analysis were used to determine the influence factors for NAFLD. Among the 310 patients who had experienced long-term hospitalization for SCZ, the prevalence of NAFLD was 54.84%. Antipsychotic polypharmacy (APP), body mass index (BMI), hypertension, diabetes, total cholesterol (TC), apolipoprotein B (ApoB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), triglycerides (TG), uric acid, blood glucose, gamma-glutamyl transpeptidase (GGT), high-density lipoprotein, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio significantly differed between the NAFLD and non-NAFLD groups (all P<0.05). Hypertension, diabetes, APP, BMI, TG, TC, AST, ApoB, ALT, and GGT were positively correlated with NAFLD (all P<0.05). The results of the logistic regression analysis indicated that APP, diabetes, BMI, ALT, and ApoB were the influence factors for NAFLD in patients with SCZ. Our results suggest a high prevalence of NAFLD among patients hospitalized long-term due to severe SCZ symptoms. Moreover, a history of diabetes, APP, overweight/obese status, and increased levels of ALT and ApoB were identified as negative factors for NAFLD in these patients. These findings may provide a theoretical basis for the prevention and treatment of NAFLD in patients with SCZ and contribute to the development of novel targeted treatments.

Outcome of patients with tetralogy of Fallot with pulmonary atresia.

Tetralogy of Fallot patients with pulmonary atresia (TOFPA) have a largely varying source of pulmonary perfusion with often hypoplastic and even absent central pulmonary arteries. A retrospective single center study was undertaken to assess outcome of these patients regarding type of surgical procedures, long-term mortality, achievement of VSD closure and analysis of postoperative interventions. 76 consecutive patients with TOFPA operated between 01.01.2003 and 31.12.2019 are included in this single center study. Patients with ductus dependent pulmonary circulation underwent primary single stage full correction including VSD closure and right ventricular to pulmonary conduit implantation (RVPAC) or transanular patch reconstruction. Children with hypoplastic pulmonary arteries and MAPCAs without double supply were predominantly treated by unifocalization and RVPAC implantation. The follow up period ranges between 0 and 16,5 years. 31 patients (41%) underwent single stage full correction at a median age of 12 days, 15 patients could be treated by a transanular patch. 30 days mortality rate in this group was 6%. In the remaining 45 patients the VSD could not be closed during their first surgery which was performed at a median age of 89 days. A VSD closure was achieved later in 64% of these patients after median 178 days. 30 days mortality rate after the first surgery was 13% in this group. The estimated 10-year-survival rate after the first surgery is 80,5% ± 4,7% showing no significant difference between the groups with and without MAPCAs (p > 0,999). Median intervention-free interval (surgery and transcatheter intervention) after VSD closure was 1,7 ± 0,5 years [95% CI: 0,7-2,8 years]. A VSD closure could be achieved in 79% of the total cohort. In patients without MAPCAs this was possible at a significant earlier age (p < 0,01). Although patients without MAPCAs predominantly underwent single stage full correction at newborn age, the overall mortality rate and the interval until reintervention after VSD closure did not show significant differences between the two groups with and without MAPCAs. The high rate of proven genetic abnormalities (40%) with non-cardiac malformations did also pay its tribute to impaired life expectancy.

Antithrombotic Treatment Patterns of Patients with Symptomatic Peripheral Arterial Occlusive Disease in Germany: Evidence from Health Insurance Claims Data.

Objectives: Patients with peripheral arterial occlusive disease (PAOD) are at risk of worsening limb symptoms, major adverse cardiovascular events and exhibit an impaired life expectancy. There is a lack of evidence on the extent of pharmacological secondary prevention in PAOD patients. This study assesses treatment patterns of antithrombotic agents in symptomatic PAOD patients. Methods: This is a retrospective cohort study using data from the second largest insurance fund in Germany, BARMER. We included symptomatic PAOD patients undergoing in-hospital treatment with an index admission between 1 January 2010 and 31 December 2017. Outcomes were proportions of single antiplatelets (SAPT), dual antiplatelets (DAPT), vitamin-K antagonists (VKA), or direct oral anticoagulants (DOAC) in the 12 months prior and 6 months after the index hospitalization. Non-parametric cumulative incidence for competing risks was estimated to account for censoring and death after discharge from hospital stay. Patient flows were visualised by alluvial diagrams. All analyses were stratified by intermittent claudication (IC) and chronic limb-threatening ischaemia (CLTI). The protocol was registered to ClinicalTrials.gov (NCT03909022). Results: A total of 80,426 unique patient encounters were identified. Mean age was 72.7 (46.3% female). Amongst all patients, 25.6% were on SAPT, 4.1% on DAPT, 9.1% on VKA, 3.9% on DOAC, 3.9% on both antiplatelets and oral anticoagulation, and 53.3% without any antithrombotic therapy during the 12 months before index stay. The estimated cumulative incidence was 37.9% SAPT, 14.8% DAPT, 7.5% VKA, 4.3% DOAC, 7.4% both, and 28.1% without any antithrombotic therapy during the 6 months after index stay. The considerable increases in antiplatelet therapy were mainly driven by the group of patients without antithrombotics before index stay. As compared with IC, patients who suffered from CLTI received less often antiplatelets but more often anticoagulants both before and after index stay. Conclusions: Utilisation rates of antithrombotic therapy increased considerably after in-hospital treatment for PAOD. Yet, remarkably high rates of symptomatic patients without any blood-thinning therapy constitute a major concern with respect to adequate secondary prevention of PAOD patients.

Research Progress of Diabetes Mellitus Complicated with Cardiovascular Disease

Diabetes is a chronic disease recognized by the World Health Organization, which is harmful to human life and health. With the improvement of people’s quality of life, people’s diet structure has changed greatly, and the primary “three high” prevalence rate has risen sharply. The main reason for the impaired life expectancy of a large number of diabetic patients is the threat of a series of cardiovascular complications. According to statistics, the risk of cardiovascular disease in diabetic patients are 2-4 times higher than that in non-diabetic patients. More than 80% of patients with type 2 diabetes die of cardiovascular disease every year, and 75% of them have ischemic heart disease [1]. All kinds of data show that diabetes mellitus complicated with cardiovascular diseases have become a worldwide public health problem. We must try our best to find a cure mechanism and give patients a healthy life. In order to effectively curb the threat of diabetes complicated with cardiovascular disease patients, we should strengthen the research in this field. Through the analysis of the risk factors of diabetic cardiovascular disease, we can let the majority of medical workers understand the superficial and potential risk factors, to formulate scientific and reasonable treatment plan, for further improving the quality of life of patients. In the following, the author first introduces the basic situation of diabetes and cardiovascular complications, then introduces the main risk factors of diabetic cardiovascular disease one by one, hoping that this study can help to improve the cure rate of diabetes complicated with cardiovascular disease.

Projection of Impaired Life Expectancy in Individuals in the United Kingdom Using Mortality Ratios.

Projections of life expectancy are widely used in medicine, actuarial practice, and in the medicolegal and insurance fields. For individuals considered to have average future survival, nationally-derived life expectancy tables are available, referred to as the Ogden Tables. In the United Kingdom, updated tables (the 8th edition) were published in July 2020. We have calculated impaired projected life expectancies for the United Kingdom based on age and gender, derived from the 8th edition of the Ogden Tables together with various assumed lifelong mortality ratios.

Demographic and Socioeconomic Disparities in Life Expectancy With Hearing Impairment in the United States.

Hearing impairment is one of the most common disabilities among older people, and its prevalence will increase as the U.S. population ages. However, little is known about social disparities in onset or transitions into and out of hearing impairment, nor how these transitions impact years of life to be spent impaired. We investigate the number of years an "average" person can expect to live with and without hearing impairment after age 50; sex, race, educational, and regional differences in these expectancies; and the implication of hearing impairment for remaining life expectancy. Bayesian multistate life table methods are applied to 9 waves of data from the Health and Retirement Study (1998-2014) to investigate social disparities in life expectancy with hearing impairment (n = 20,200) for the general population, people hearing impaired at age 50, and people hearing unimpaired at age 50. Men, Hispanics, persons with less educational attainment, and those born in the south can expect to live a larger proportion of their remaining lives hearing impaired. Although transitions from hearing impaired to unimpaired occur, those with some hearing impairment at age 50 can expect to live more years with hearing impairment, and hearing impairment does not shorten remaining life expectancy. Significant sociodemographic disparities in hearing impaired life expectancy exist. In contrast to past research, we find that hearing impairment does not affect total life expectancy. Future research should consider the consequences of hearing impairment for years to be lived with other age-related and potentially downstream health outcomes.

P270 Complex cyanotic heart disease in adult patient with down syndrome accompanied by mild pulmonary hypertension

Abstract Funding Acknowledgements No funding Introduction Patients with Down syndrome and complex unrepaired cyanotic heart disease have impaired life expectancy. The clinical status of each patient depends both on the primary lesion type as well as the cummulative haemodynamic burden in the cardiovascular system. Assessment of an adult patient with complex congenital heart disease that has not been surgically repaired presents several challenges since initial haemodynamic parameters and compensatory mechanisms have to be taken into account. Case presentation A 43 year old male patient with known history of Down syndrome and no regular follow up presented to the Outpatient Department of our hospital to undergo pre-operative control for minor soft tissue surgery. The patient exhibited typical morphological features of Down syndrome as well as central cyanosis and digital clubbing. On auscultation a holosystolic type murmur 3/6 on the 3rd left parasternal border was audible. His blood gases revealed hypoxia and mild metabolic acidosis. Electrocardiogram displayed right axis deviation and signs of right ventricular hypertrophy. Transthoracic echocardiography demonstrated a large perimembranous ventricular septal defect (VSD) with normal anatomy and function of the aortic valve and no overiding aorta. Of note was excessive infundibular subpulmonary stenosis which resulted in a functionally double chambered right ventricle. Left ventricle was of normal diamater with good overall systolic function while the right ventricle was non-dilated with significant hypertrophy. Intracavitary gradient was estimated at 60 mmHg. Continuous Doppler showed mild mitral regurgitaion and mild tricuspid regurgitaion with estimated systolic pulmonary pressure of 40 mmHg. Bidirectional flow with low velocities at the level of the defect was recorded. Inferior vena cava was mildly dilated with normal respiratory variation. Discussion/ Conclusion: The natural history of large VSDs results in progressive dilatation of the right ventricle, the left ventricle and the left atrium with gradually increasing pylmonary vascular resistance and development of pulmonary hypertension, followed by right ventricular hypertrophy, flow reversal and Eisenmenger syndrome. However when RVOT obstruction at any level coexists, significant right ventricular hypertrophy develops and the incresed right ventricular systolic pressures acts protectively by minimizing the shunt at the VSD level. Thus a restrictive VSD due to a functionally double chambered right ventricle created a very fragile balance; a cyanotic heart disease with mild bidirectional flow depending on preload and afterload conditions that survived to adulthood. Abstract P270 Figure. Complex unrepaired CHD

Geroprotective effects of ethylmethylhydroxypyridine succinate in an experimental study

To study an effect of mexidol on the life expectancy, weight, seizure response thresholds, and impaired cognitive and motor functions during aging in male Wistar rats. In a long-term experiment, male Wistar rats, aged 3-26 months, were assessed for impaired cognitive functions (passive avoidance conditioned reflex test), convulsive threshold (test with pentylenetetrazole), motor deficits (tests of rotating rod and pulling on the crossbar), and life expectancy. The rats received mexidol in the form of 0,15% solution, which replaced drinking water, during two 2 month courses at the age of 18-20 and 22-24 month. A dose of mexidol consumed by the rat was 40-75 mg/kg/day. In old male Wistar rats, the long-term treatment with mexidol increases the life expectancy, improves learning, preservation and reproduction of the memory trace in the passive avoidance conditioned reflex test, increases the convulsive threshold and improves muscle tone and coordination of movements that are impaired during aging. Mexidol increases the threshold of convulsive reaction, restores cognitive and neurological deficits that occur during aging in male Wistar rats and increases the by its ability to influence mitochondriogenesis and antioxidant properties.

Upregulation of SCUBE2 expression in dyslipidemic type 2 diabetes mellitus is associated with endothelin-1

Type 2 diabetes mellitus (T2DM) is a major health problem for morbidity and mortality world-wide due to diabetic vascular complication. Following T2DM, dyslipidemia is known well for the main reason of vascular complication leading to atherosclerosis and impaired life expectancy in diabetes. Thus, a new prediction marker in T2DM could help prevent the progression disease despite of metabolic control. Signal peptide–CUB-EGF like containing protein 2 (SCUBE2), has been detected in vascular endothelium and was affected by cytokines. Recently, SCUBE2 was reported to increase in atherosclerotic human coronary artery, involving vascular smooth muscle cells (VSMCs) and macrophages. The aims of this study were to examine the expression level of SCUBE2 in T2DM patients with dyslipidemia and its correlation with endothelial dysfunction marker, endothelin-1 (ET-1) in this group. This study design was cross sectional control study, recruited 28 patients diagnosed as T2DM who were found with dyslipidemia and 15 healthy control subjects. Our results showed that T2DM patients showed higher LDL cholesterol, triglycerides, and ET-1 expression level compared to healthy subjects. Further, we found that SCUBE2 had strong correlation with ET-1 in these dyslipidemic T2DM patients. In conclusion, our study confirmed first that SCUBE2 was upregulated in T2DM with dyslipidemia. Moreover, Pearson correlation analysis of ET-1 and SCUBE2 in this group showed high correlation r = 0.797, P < 0.001, suggesting that SCUBE2 may plausible target in vascular function changes in dyslipidemic T2DM. Improving our exploration of these findings may lead to uncover SCUBE2 involvement in diabetic vascular complication in T2DM.

Depression, Anxiety, and Cognitive Impairment : Comorbid Mental Health Disorders in Heart Failure.

Depression, anxiety, and cognitive impairment constitute established risk markers for incident cardiovascular disease (CVD) and are associated with impaired life expectancy and quality of life and high hospitalization rates and healthcare expenditure. This review summarizes current knowledge about mental health disorders in patients with CVD and heart failure (HF). Emerging evidence suggests various shared pathophysiological mechanisms between psychological comorbidities and CVD (e.g., systemic inflammation and autonomic dysfunction). Bi-directional interactions involving the central nervous and cardiovascular systems may help explain the rising prevalence of comorbid mood disorders with increasing CVD severity and support the concept of alternative pathophysiological mechanisms in the presence of severe somatic illness, making symptoms less responsive or unresponsive to psychotropic pharmacotherapy. Considering high prevalence and negative impact of psychological comorbidities in CVD and HF, routine care should integrate screening for these conditions. Multidisciplinary treatment approaches with active patient participation in disease management were shown to improve outcomes. However, better understanding of factors mediating the adverse prognostic effects of mood disorders is needed. This might enable more targeted treatment and possibly also facilitate better understanding of the pathophysiological mechanisms driving CVD.

Change in cognitively healthy and cognitively impaired life expectancy in the United States: 2000–2010

ObjectiveTo determine how cognitively healthy and cognitively impaired life expectancy have changed from 2000 to 2010 among American men and women 65 years of age and over. MethodsThe prevalence of dementia, cognitive impairment without dementia (CIND), and normal cognition is determined from nationally representative data from the U.S. Health and Retirement Study (HRS). Mortality rates are from U.S. Decennial Life Table for 2000 and the U.S. annual life table for 2010. Life expectancy by cognitive status is estimated using the Sullivan method. ResultsMost of the increase in life expectancy has been concentrated in cognitively healthy years in this 10 year period. The increase in expected years cognitively intact at age 65, which exceeded that in total life expectancy, was 1.8 for men and 1.6 for women. ConclusionThis study provides evidence suggesting that there has been a compression of cognitive morbidity.

Accelerated hyperfractionation plus temozolomide in glioblastoma.

IntroductionHyperfractionated (HFRT) or accelerated hyperfractionated radiotherapy (AHFRT) have been discussed as a potential treatment for glioblastoma based on a hypothesized reduction of late radiation injury and prevention of repopulation. HFRT and AHFRT have been examined extensively in the pre-Temozolomide era with inconclusive results. In this study we examined the role of accelerated hyperfractionation in the Temozolomide era.Materials and methodsSixty-four patients who underwent AHFRT (62 of which received Temozolomide) were compared to 67 patients who underwent normofractionated radiotherapy (NFRT) (64 of which received TMZ) between 02/2009 and 10/2014. Follow-up data were analyzed until 01/2015.ResultsMedian progression-free survival (PFS) was 6 months for the entire cohort. For patients treated with NFRT median PFS was 7 months, for patients treated with AHFRT median PFS was 6 months. Median overall survival (OS) was 13 months for all patients. For patients treated with NFRT median OS was 15 months, for patients treated with AHFRT median OS was 10 months. The fractionation regimen was not a predictor of PFS or OS in univariable- or multivariable analysis. There was no difference in acute toxicity profiles between the two treatment groups.ConclusionsUnivariable and multivariable analysis did not show significant differences between NFRT and AHFRT fractionation regimens in terms of PFS or OS. The benefits are immanent: the regimen does significantly shorten hospitalization time in a patient collective with highly impaired life expectancy. We propose that the role of AHFRT + TMZ should be further examined in future prospective trials.

Incidence of renal failure and nephroprotection by RAAS inhibition in heterozygous carriers of X-chromosomal and autosomal recessive Alport mutations

We studied here the clinical course of heterozygous carriers of X-linked Alport syndrome and a subgroup of patients with thin basement membrane disease due to heterozygous autosomal recessive Alport mutations whose prognosis may be worse than formerly thought. We analyzed 234 Alport carriers, including 29 with autosomal recessive mutations. Using Kaplan-Meier estimates and log-rank tests, autosomal and X-linked carriers were found to have similar incidences of renal replacement therapy, proteinuria, and impaired creatinine clearance. Further, age at onset of renal replacement therapy did not differ between X-chromosomal and autosomal carriers. Both groups showed an impaired life expectancy when reaching renal replacement therapy. RAAS inhibition significantly delayed the onset of end-stage renal failure. Not only carriers of X-linked Alport mutations but also heterozygous carriers of autosomal recessive mutations were found to have an increased risk for worse renal function. The risk of end-stage renal disease in both groups affected life expectancy, and this should cause a greater alertness toward patients presenting with what has been wrongly termed 'familial benign hematuria.' Timely therapy can help to delay onset of end-stage renal failure. Thus, yearly follow-up by a nephrologist is advised for X-linked Alport carriers and patients with thin basement membrane nephropathy, microalbuminuria, proteinuria, or hypertension.

A Decision Analysis of Reduced-Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplantation for Older Patients with De-Novo Myelodysplastic Syndrome (MDS): Early Transplantation Offers Survival Benefit in Higher-Risk MDS

Abstract 115Reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation is a curative approach for older patients with myelodysplastic syndrome (MDS), but is associated with early mortality risk. We previously used decision modeling to define the role of myeloablative transplantation in younger MDS patients aged <60 years, stratified by IPSS risk (Cutler et al, Blood 2004). We thereafter undertook a similar analysis to define the role of RIC transplantation in older MDS patients.We constructed a Markov decision model in de-novo MDS patients aged 60–70 years to evaluate life expectancy after a strategy of early T-replete RIC transplantation versus standard-of-care non-transplantation approaches. Patients with chronic myelomonocytic leukemia, isolated 5q-, unclassifiable and therapy-related MDS were excluded. Patients undergoing transplantation with anti-thymocyte globulin or alemtuzumab-based conditioning or HLA mismatched or umbilical cord donors were also excluded. We undertook adjustments for quality-of-life (QoL) using standard utility estimates for different MDS and transplantation states (0.84: RBC transfusion-independent low/intermediate-1 MDS; 0.6: RBC transfusion-dependent low/intermediate-1 MDS; 0.53: intermediate-2/high MDS; 0.92: post transplantation-overall; 0.6: post transplantation-GVHD)We evaluated survival of 92 patients after HLA matched RIC transplantation (Dana-Farber, Fred Hutchinson and CIBMTR datasets) stratified by IPSS risk state, versus survival with: best supportive care for 183 non-anemic low/intermediate-1 IPSS patients (IMRAW and Pavia datasets); hematopoietic growth factors for 78 anemic low/intermediate-1 IPSS patients (Nordic MDS Group and GFM datasets); and hypomethylating agents for 160 intermediate-2/high IPSS risk patients (Celgene AZA-001, GFM compassionate use azacytidine and M. D. Anderson decitabine datasets).For older patients with low/intermediate-1 IPSS risk, early RIC transplantation impaired life expectancy compared to non-transplantation approaches (Table). Excluding patients transplanted beyond 12 months from diagnosis did not alter the conclusion. QoL adjustment narrowed the gap in quality adjusted life expectancy (QALE), but sensitivity analysis did not support RIC transplantation as the preferred strategy across a broad range of possible utility estimates (0.5–1), indicating that MDS-associated morbidity (e.g. RBC transfusion-dependence) does not favor early transplantation unless its QoL impact is substantial (state utility <0.4).For older patients with intermediate-2/high IPSS risk, early RIC transplantation improved life expectancy compared with hypomethylating agents (Table). Excluding patients transplanted beyond 12 months from diagnosis did not alter the conclusion. However, transplantation is associated with early mortality such that the life expectancy benefit was apparent only after modeling survival beyond 5 years. Importantly, QoL adjusted survival benefit of transplantation was apparent both at 5 years and beyond, highlighting the morbidity of higher-risk MDS. In sensitivity analyses, QoL adjustment across the range of plausible transplantation-associated utility estimates (0.5–1) did not change the conclusion of QALE benefit.We conclude that for de-novo MDS patients aged 60–70 years with low/intermediate-1 disease, early transplantation is not the preferred strategy unless MDS-associated QoL impairment is substantial. For intermediate-2/high IPSS risk, early RIC transplantation offers a life expectancy benefit, with quality adjusted survival benefit detectable earlier.TableEarly RIC transplantationNo early RIC transplantationLow/intermediate-1 IPSSOverall Life Expectancy (months)3877QALE: Transfusion-independent MDS morbidity (months)3565QALE: Transfusion-dependent MDS morbidity (months)3546Intermediate-2/high IPSSOverall Life Expectancy (months)3628QALE: Higher-risk MDS morbidity (months)3315QALE: GVHD morbidity (months)2215 Disclosures:Fenaux:Celgene: Honoraria, Research Funding. Hellstrom-Lindberg:Celgene: Consultancy, Research Funding. Gale:celgene: Employment; unitedhealthcare: Consultancy; oxford health plans: Consultancy. Beach:celgene: Employment. Greenberg:novartis: Consultancy, Research Funding; glaxosmithkline: Research Funding; onconova: Research Funding; amgen: Consultancy, Research Funding.

Long-term results after surgery for acute mesenteric ischemia

Background. Acute mesenteric ischemia is associated with high mortality rates, and little is known about the long-term prognosis of patients after initially successful surgical intervention. Methods. Ninety patients were treated by vascular reconstruction or bowel resection, or both, between 1972 and 1993. The overall mortality was 66%. The outcomes and rehabilitational statuses of those 31 patients who were discharged from the hospital were analyzed retrospectively. Anticoagulation consisted of vitamin K antagonists in patients with venous thrombosis and arterial embolism or inhibition of thrombocyte aggregation in patients with arterial thrombosis and nonocclusive mesenteric ischemia. Results. In 31 patients discharged from the hospital venous thrombosis, arterial embolism, arterial thrombosis, and nonocclusive disease occurred in 19, 5, 5, and 2 patients, respectively. The 2-and 5-year survival rates were 70% and 50% and mainly related to cardiovascular comorbidity and malignant disease. Only one patient died after a recurrent attack of arterial mesenteric thrombosis. Twenty percent of the patients suffered from chronic short bowel syndrome after extensive bowel resection, but none required permanent parenteral nutrition. Conclusions. Under appropriate anticoagulation there is a remarkably low risk of recurrent mesenteric ischemia. The impaired life expectancy of long-surviving patients is mainly due to cardiovascular comorbidity and malignancies.