Intermediate Age Groups Research Articles

The Impact of Age and Gender on Outcomes of Patients With Advanced Renal Cell Carcinoma Treated With Targeted Therapy.

A growing body of evidence suggests that age and gender play a role in cancer outcomes. The objective of this study was to investigate the effect of age and gender on survival of patients with metastatic renal cell carcinoma (RCC). We conducted a pooled analysis of patients with metastatic RCC treated on phase II and III clinical trials. Patients were stratified by age (young [<50 years], intermediate [50-70 years], versus elderly [>70 years]) and gender. Statistical analyses were performed using Cox regression adjusted for several risk factors and the Kaplan-Meier method. We identified 4736 patients with metastatic RCC. Overall, there was no difference in overall survival (OS) when stratified by age (21.0 vs. 17.3 months for elderly vs. intermediate age groups, P= .382; 20.0 vs. 17.3 months for young vs. intermediate age groups, P= .155) or gender (19.8 vs. 19.0 for male vs. female, P= .510). Progression-free survival (PFS) was shorter in younger individuals compared with the intermediate age patients (6.0 vs. 7.1 months, P< .001), but similar across gender groups. Although all grade adverse events were more common in elderly patients (fatigue, diarrhea, decreased appetite, and weight), serious adverse events were similar between groups. Although OS was similar between age groups, younger individuals had a shorter PFS. Gender was not an independent determinant of survival. Elderly patients experienced more adverse events than their younger counterparts. These findings are important to guide clinicians when counseling patients about expectations and toxicity associated with therapy.

Splenectomy Modulates the Erythrocyte Turnover and Basigin (CD147) Expression in Mice

The present study was designed to study the splenectomy induced modulation of erythrocyte turnover in mice. We have also studied the modulation of reactive oxygen species (ROS) and basigin (CD147) expression level on erythrocytes in splenectomized condition. The erythrocyte turnover was studied by a newly developed double in vivo biotinylation(DIB) technique. This technique enables to discriminate three different age (young, intermediate and old) groups of erythrocytes. The expression level of ROS and CD147 was studied by staining with CM-H2DCFDA stain and anti-mouse CD147 monocloclonal antibody followed by flow cytometry. We observed that intermediate and old age groups of erythrocytes were randomly eliminated in splenectomized condition. A marked surge in the blood reticulocyte count was observed in splenectomized mice. Splenectomy induced the level of ROS and CD147 expression on erythrocytes. The expression level of ROS was induced up to 35days, but it reversed to basal level by 42days indicating the emergence of refractoriness to splenectomy. The CD147 expression was significantly higher on day 7, 21 and 28 but it also normalizes on later time points. We conclude that erythrocyte turnover is significantly modulated in splenectomized mice. The enhanced level of ROS and CD147 expression may be a possible cause to increase erythrocyte removal in splenectomized mice.

Productivity costs among people involved in traffic accidents.

This paper aimed to characterize the productivity costs of people involved in traffic accidents (TA) in a medium-sized municipality. A longitudinal household-based study was conducted from 2013 to 2015. During this period, individuals with TA were interviewed, and followed-up and costs of productivity were calculated. The measured and estimated values were considered for the calculation of the gross and per capita values and facilitated the establishment of costs of lost productivity (days off work) and costs of return to productivity (health professionals, medication, transportation, auxiliary devices and vehicle repair). It was shown that the costs of loss were more significant against the costs of return. Among the items that underpin the return to productivity, higher costs were observed in men, young adults, drivers, users of two-wheeled vehicles, people with public employment relationships, intermediate age groups and fracture-type injuries. It is necessary to evaluate and target the stages of recovery of those involved to minimize the social burden generated by these events.

Actitudes y Uso del Lenguaje Inclusivo según el Género y la Edad

El objetivo del presente trabajo fue describir la relación entre las actitudes y uso del Lenguaje Inclusivo (LI) con las variables demográficas género y edad. El Lenguaje Inclusivo es aquel uso del lenguaje que no reconoce al género masculino como genérico de la humanidad, buscando reducir los estereotipos y discriminación a través de la comunicación. Para ello, se trabajó con un diseño cuantitativo, ex post facto prospectivo de grupo único, en el se analizaron las respuestas a un cuestionario autoadministrable de 613 participantes, residentes en la Ciudad Autónoma de Buenos Aires, obtenidas a través de un muestreo no probabilístico e intencional. El rango de edades fue de 18 a 70 años; y la distribución de los géneros de 346 participantes femeninas, 256 masculinos y 11 no binariosm, a través de un método ex post facto prospectivo. En los resultados se hallaron diferencias, según el Género, para las actitudes positivas hacia el Lenguaje Inclusivo y para la frecuencia de su uso. Las participantes de género femenino tendrían una mayor valoración positiva del Lenguaje Inclusivo, y lo utilizarían más respecto a aquellos de género masculino. Por otro lado, en la franja etaria más baja (18 a 23 años) y más alta (50 a 70 años), se observaron menores actitudes positivas hacia el Lenguaje Inclusivo, mientras que los grupos de edades intermedias obtuvieron valores más elevados para esta variable. Es necesario continuar estudiando los alcances y límites del Lenguaje Inclusivo en otros factores psicosociales.

Eruptive cherry angiomas and skin melanoma: a fortuitous association?

The aim of the study was to assess the association between eruptive cherry angiomas (CAs) and malignant melanoma (MM). Secondary objectives included investigating (i) this association in different age subgroups, and (ii) the association of eruptive CAs with other variables such as malignant tumours, in general, and immunosuppressive treatments. This cross-sectional study involved all patients referred to the outpatient Dermatology-Oncology Units of the universities of Ferrara and Bologna, Italy, and submitted to total body skin examination. These patients were included in a previously collected series. We recorded age, sex, cutaneous and noncutaneous malignancies, immunosuppressive treatments, and presence of CAs. CAs were arbitrarily considered as 'eruptive' when more than or equal to 10. Variables significantly associated with eruptive CAs were included in the logistic regression analysis, also stratified by age. A total of 1693 patients were included in the present study: 500 patients had malignancies, 460 malignant skin tumours, 263 had MM; 150 patients were immunosuppressed; 804 (47.49%) patients had eruptive CAs. In the whole study population, age, immunosuppressive treatment, MM, other skin and nonskin malignant tumours were significantly associated with eruptive CAs at the multivariate analysis. Multivariate analysis in each age subgroup revealed that the association between MM and eruptive CAs was highly significant in younger patients (≤50 years), significant in the 51-70 year-old subgroup, whereas it lost significance in older patients. These findings suggest an association between MM and eruptive CAs, particularly in the lower and intermediate age groups. Both the nature of this association and its possible impact in clinical practice, especially in MM screening, are yet to be established.

Docetaxel in older patients for metastatic prostate cancer.

187 Background: Docetaxel use has led to a significant prolongation in overall survival in metastatic prostate cancer (MPC). There is however limited information on treatment tolerance and outcomes in patients 80 years old and over in routine clinical practice. With the ever aging population it is becoming more important to assess outcomes in this age group. Methods: Patients diagnosed with MPC and treated with docetaxel from 2006 to 2016 were identified and their records retrospectively reviewed via electronic clinical and prescribing systems in a single centre in the UK. Data was assessed for prostate specific antigen (PSA) response, number of cycles and dosing of docetaxel and castrate resistant overall survival (OS). Results: 209 consecutive patients with MPC receiving docetaxel were reviewed. Three patient groups were identified; younger than 75 years old (n = 150, 37 early (as part of initial therapy) docetaxel), 75-79 years (n = 40, 2 early docetaxel) and 80 years or over (n = 19, no early docetaxel). When comparing mean OS excluding early docetaxel treatment, respective mean survival times for each of the three age groups, younger to older were 1001, 1045 and 1294 days, with between class difference being insignificant. The PSA response rates to docetaxel excluding first line use were compared between the age groups and did not show a significant difference at 39% in the youngest group, 38% in the intermediate age group and 42% for the oldest patients. There was a trend that the older the patient, the more likely docetaxel was the final systemic treatment given at 42% (80 years or over), 32% (75-79 years) and 23% (younger than 75 years). The 80 years or over group received fewer docetaxel cycles (3.8, p = 0.006) and less dose per course (226mg/m2, p = 0.004) than the group less than 75 years (5.8 cycles, 409mg/m2) and 75-79 years (5.1 cycles, 341mg/m2). Conclusions: In this group of patients, in routine clinical practice, the 80 years and over age group received fewer cycles of docetaxel in MPC and less dose per course, but nevertheless achieved similar PSA response rates and castrate resistant OS. Given these results, docetaxel should be considered as a treatment option in suitable patients of 80 years and over.

Serum Thyroid Hormone and Thyrotropin Concentrations in Adult Horses as They Age

With more horses remaining active longer in life, it is important to characterize changes that occur normally with aging, so that these can be differentiated from development of disease. The objective of the study was to test the hypotheses that geriatric horses have lower circulating concentrations of thyroid hormones and/or higher serum thyrotropin (TSH) concentrations compared to younger horses. Serum thyroid hormone and TSH concentrations from 71 normal, healthy horses that had participated in prior research projects were analyzed for effects of age, sex, and season when samples were obtained. All samples had been assayed in the same previously validated radioimmunoassays. There were no differences in serum concentrations of thyroid hormones or TSH by sex or season. Serum total thyroxine (T4) was greater in 3- to 6-year-old horses compared to all other age groups and was negatively correlated with age. There were no differences among age groups for free T4 and total and free tri-iodothyronine (T3). Serum TSH concentration was significantly greater in old horses (≥15 or ≥20 years) compared to young (3–10 years) and intermediate (11–14 years) age groups. Serum TSH was positively correlated with age. There were no significant differences in thyroid hormone responses to thyrotropin releasing hormone (TRH) among young, intermediate, or old horses. However, the TSH response to TRH was significantly different in both groups of older horses compared to intermediate and young horses. Serum total thyroxine concentrations decrease and serum TSH concentrations increase in horses as they age, with no changes in free T4 or T3.

Relationships between aeroallergen levels and hospital admissions for asthma in the Brussels-Capital Region: a daily time series analysis

BackgroundOutdoor pollen grain and fungal spore concentrations have been associated with severe asthma exacerbations at the population level. The specific impact of each taxon and the concomitant effect of air pollution on these symptoms have, however, still to be better characterized. This study aimed to investigate the short-term associations between ambient concentrations of various aeroallergens and hospitalizations related to asthma in the Brussels-Capital Region (Belgium), an area recording especially high rates of admissions.MethodsBased on administrative records of asthma hospitalizations and regular monitoring of 11 tree/herbaceous pollen taxa and 2 fungal spore taxa, daily time series analyses covering the 2008–2013 period were performed. Effects up to 6 days after exposure were captured by combining quasi-Poisson regression with distributed lag models, adjusting for seasonal and long-term trends, day of the week, public holidays, mean temperature and relative humidity. Effect modification by age and air pollution (PM, NO2, O3) was tested.ResultsA significant increase in asthma hospitalizations was observed for an interquartile range increase in grass (5.9%, 95% CI: 0.0, 12.0), birch (3.2%, 95% CI: 1.1, 5.3) and hornbeam (0.7%, 95% CI: 0.2, 1.3) pollen concentrations. For several taxa including grasses, an age modification effect was notable, the hospitalization risk tending to be higher in individuals younger than 60 years. Air pollutants impacted the relationships too: the risk appeared to be stronger for grass and birch pollen concentrations in case of high PM10 and O3 concentrations respectively.ConclusionsThese findings suggest that airborne grass, birch and hornbeam pollen are associated with severe asthma exacerbations in the Brussels region. These compounds appear to act in synergy with air pollution and to more specifically affect young and intermediate age groups. Most of these life-threatening events could theoretically be prevented with improved disease diagnosis/management and targeted communication actions.

Temporal analysis of IgG antibody responses to Plasmodium falciparum antigens in relation to changing malaria epidemiology in a West African setting

BackgroundCoordinated scaled-up malaria control interventions have substantially contributed to the dramatic decrease of malaria-related morbidity and mortality in several endemic countries, including Senegal. However, the impacts of a given malaria control intervention on vector and parasite populations, acquired immunity, and disease burden remain very poorly documented largely due to the lack of continuous surveys. This study took advantage of the sera bank established as part of the Dielmo longitudinal project to investigate the dynamics of IgG antibody responses that accompanied the epidemiological changes resulting from malaria control interventions. Schizonts crude extract of a local strain of Plasmodium falciparum (Pfsch07/03) was used in ELISA to measure and compare seroprevalence and magnitude of IgG antibody responses from 2000 to 2012.ResultsThe prevalence of Pfsch07/03 IgG antibody responses progressively decreased from 97.25% in 2000 to 57.3% in 2012. The prevalence of Pfsch07/03 antibodies categorized between three different age groups (<7, 7–15, and >15 years) revealed increased seroprevalence with age ranging from 47.19 to 62.67 and 89.45%, respectively in (<7, 7–15, and >15 years) old age groups. A marked drop in seroprevalence was observed after 2008 and was significant in the younger (<7 years) and intermediate (7–15 years) age groups, unlike older individuals aged >15 years (p = 1.00).ConclusionsThe study revealed a substantial contribution of all malaria control interventions to the decrease of IgG antibodies responses to Pfsch07/03 throughout prevention of human-mosquitos contacts, or reduction of parasite biomass. The present study demonstrates the wider potential of sero-epidemiological analysis in monitoring changes in malaria transmission resulting from a given malaria control intervention.

Trends in Cancer Mortality Among Adolescents and Young Adults in Brazil.

Adolescents and young adults (AYA) with cancer comprise an intermediate age group between pediatric and adult oncology, and have a spectrum of different types of cancers. Survival among this group has not improved as much as in younger children with cancer. The aim of this study was evaluate the trends in cancer mortality of AYA aged 15-29 years in Brazil. Data were extracted from the Atlas of Cancer Mortality databases from 1979 to 2013. Age-specific mortality rates were calculated based on the deaths from each type of cancer and the period via a direct method using the proposed world population age groups. To identify significant changes in the trends, we performed joinpoint regression analysis. The mortality rates per million were 54 deaths in those aged 15-19 years, 61 deaths in those aged 20-24 years, and 88 deaths in those aged 25-29 years. Leukemias, lymphomas, and central nervous system (CNS) tumors occurred at high rates in all age groups. Rates of cervical cancer were highest in those aged 25-29 years. There were significant increases in mortality trends in the North and Northeast regions for all tumor groups, especially CNS tumors. A small decrease in the mortality rate from lymphomas was observed in the South and Southeast regions. Mortality in Brazilian AYA was slightly higher than in other studies conducted throughout the world. When separated by tumor type, Brazil presents a specific pattern, with high mortality from cervical cancer.

Identification of Stages of Erythroid Differentiation in Bone Marrow and Erythrocyte Subpopulations in Blood Circulation that Are Preferentially Lost in Autoimmune Hemolytic Anemia in Mouse.

Repeated weekly injections of rat erythrocytes produced autoimmune hemolytic anemia (AIHA) in C57BL/6 mice after 5–6 weeks. Using the double in vivo biotinylation (DIB) technique, recently developed in our laboratory, turnover of erythrocyte cohorts of different age groups during AIHA was monitored. Results indicate a significant decline in the proportion of reticulocytes, young and intermediate age groups of erythrocytes, but a significant increase in the proportion of old erythrocytes in blood circulation. Binding of the autoantibody was relatively higher to the young erythrocytes and higher levels of intracellular reactive oxygen species (ROS) were also seen in these cells. Erythropoietic activity in the bone marrows and the spleen of AIHA induced mice was examined by monitoring the relative proportion of erythroid cells at various stages of differentiation in these organs. Cells at different stages of differentiation were enumerated flow cytometrically by double staining with anti-Ter119 and anti-transferrin receptor (CD71) monoclonal antibodies. Erythroid cells in bone marrow declined significantly in AIHA induced mice, erythroblast C being most affected (50% decline). Erythroblast C also recorded high intracellular ROS level along with increased levels of membrane-bound autoantibody. No such decline was observed in spleen. A model of AIHA has been proposed indicating that binding of autoantibodies may not be a sufficient condition for destruction of erythroid cells in bone marrow and in blood circulation. Last stage of erythropoietic differentiation in bone marrow and early stages of erythrocytes in blood circulation are specifically susceptible to removal in AIHA.

The Disproportionate Effect of Perioperative Complications on Mortality within 1Year After Colorectal Cancer Resection in Octogenarians.

Risks and benefits of colorectal cancer resection in octogenarians are not clearly defined. This study aimed to assess the relationship between morbidity and mortality within 1year after colorectal cancer resection in octogenarians compared with other age groups. A single-institution, prospectively maintained database was queried to identify patients with sporadic, pathological stages I-III colorectal adenocarcinoma, electively undergoing radical resection with curative intent between 2000 and 2012. Patients were divided into three age groups: 'octogenarians' if≥80years of age; 'intermediate' if≥65and<80years of age; and 'younger' if<65years of age. Overall, 2485 patients fulfilled the inclusion criteria-326 in the octogenarian age group, 949 in the intermediate age group, and 1210 in the younger age group. Postoperative morbidity disproportionally increased 1-year mortality in octogenarians when compared with the younger age group (37 vs. 6.5%; p<0.001). Anastomotic leak, abdominopelvic abscess, reoperation, and readmission rates were comparable among different age groups, but were associated with a disproportionate risk of 1-year mortality in octogenarians (67, 43, 33, and 41%, respectively). Multivariate analysis indicated that older age and postoperative complications were the only two independent variables associated with 30- and 90-day mortality. Besides these, American Society of Anesthesiologists (ASA) and pathological stage III were additional independent variables associated with 1-year mortality. An interaction test confirmed that age and postoperative complications were independent variables, with additive effect on 30-day, 90-day, and 1-year mortality. Age plays an important and independent role in affecting mortality when complications occur following surgery for colorectal cancer. The full magnitude of postoperative risks should be taken into consideration when discussing colorectal cancer surgery in octogenarians.

Developmental Dynamics and Seasonal Variation of Measures of Cerebral Circulation in Children and Adolescents in the European North

Transcranial Doppler sonography was used to study the developmental dynamics and seasonal variation in cerebral blood flow in 95 middle school students aged 7–18 years, natives of Arkhangelsk District. Results obtained from long-term (2005–2014) monitoring of schoolchildren are presented. Linear blood flow velocity (LBF) was found to decrease gradually from junior to senior school age, mean levels in the middle cerebral artery were lower and those in the basilar arteries were higher than normal for the mid latitudes. The influence of the seasonal factor was greater in children of the younger (in boys) and intermediate (in girls) age groups and disappeared in the older group. The largest seasonal variations in LBF were seen in the arteries of the carotid basin and the most constant LBF was seen in the basilar artery. Assessment of the index of resistivity of circulatory resistance in schoolchildren of the younger and intermediate age groups decreased in the arteries of the carotid basin in spring and summer and in the basin of the posterior cerebral artery in winter. Levels of LBF variability identified groups of children with different levels of “sensitivity” to the effects of the seasonal factor.

Age Related Prevalence of Pre-Eruptive Intracoronal Radiolucent Defects in the Permanent Dentition.

The present study aimed to determine if the prevalence of pre-eruptive intracoronal radiolucent defects is higher for young age groups, in which there are more unerupted teeth. A retrospective study of panoramic and bitewing radiographs was conducted. An inclusion criterion was the presence of un-erupted permanent teeth with a formed and clearly visible crown. Age groups were: young (6-8 years), intermediate (9-12 years) and adults (13-53 years). Significance level was set at p≤0.05. Thirteen (3.9%) pre-eruptive lesions were detected in 335 records. No lesions were found in the young group (7.4%), in the intermediate and adult age groups six and seven lesions were found, respectively. In most cases the pre-eruptive lesion was found in a third molar. The prevalence of pre-eruptive intracoronal lesions was not higher for young age groups. The prevalence of pre-eruptive intra coronal radiolucent lesions is 3.9%, irrespective of age.

Switch hands! Mapping proactive and reactive cognitive control across the life span.

We investigated the effects of age on proactive and reactive cognitive control in a large population sample of 809 individuals, ranging in age between 5 and 97 years. For that purpose, we used an anticue paradigm, which required a consistent remapping of cue location and response hand: Left-sided cues required right-hand responses and vice versa. After a random preparation interval of 100-850 ms, these anticues were followed by a target stimulus, which prompted a response with the index or middle finger of 1 of 2 hands. A neutral control condition involved uninformative cues, indicating all 4 possible response locations. The primary outcome measure was the difference between neutral and anticue reaction time (RT). Negative values indicated RT costs of the anticue, relative to the neutral condition, reflecting reactive cognitive control. Positive values indicated RT benefits, reflecting proactive cognitive control. Results were twofold. First, the switch from RT costs to benefits took place at longer preparation intervals in the youngest and oldest age groups than in the intermediate age groups. Second, irrespective of preparation interval, anticue performance followed an inverted U-shaped trajectory as a function of age, with a relatively steep improvement during childhood and adolescence, relative stability between 26 and 60 years, and a slightly accelerating decline into old age. Both patterns of results suggest an age-related transition from a primarily reactive, to a primarily proactive mode of cognitive control in early life and back again from a primarily proactive, to a primarily reactive mode of control in later life. (PsycINFO Database Record

The Registry of the International Society for Heart and Lung Transplantation: Eighteenth Official Pediatric Heart Transplantation Report—2015; Focus Theme: Early Graft Failure

The Registry of the International Society for Heart and Lung Transplantation: Eighteenth Official Pediatric Heart Transplantation Report—2015; Focus Theme: Early Graft Failure

Prevalence of chronic diseases in individuals assisted by the family health program in Niteroi, Brazil: evaluation of selection bias and protocol

Background: The strategy of the Family Health Program has been used as an alternative scenario for prevalence studies. This study intended to present the protocol of the Digitalis Study (DS), prevalence study of chronic diseases, to assess sources of possible selection bias and estimate their impact on the prevalence of self-reported hypertension, diabetes, and myocardial infarction. Methods: Randomization was performed between 38 160 registered individuals with 45 to 99 years by the Family Health Program .Differences between the sources of selection bias (non-acceptance, non-attendance, substitutions) were observed for gender and age. Results: Of the 1,190 residents contacted, 67.1% agreed to participate. There were 144 residents who were not randomly selected but whose participation was confirmed (substitutes). Women and individuals in the intermediate age groups and the prevalence of hypertension were higher among substitutes compared with the randomly selected individuals. Conclusion: The approach of the DS was adequate for the purposes of estimating prevalences, but there was a significant percentage of non-participation. The randomization strategy did not assume outdated records; alternative schedules for visits were not provided for; follow-up at the invitation stage was not sufficient to prevent substitutions and the inclusion of substitutes with a higher prevalence of hypertension.

The Impact of Recent Screening Recommendations on Prostate Cancer Screening in a Large Health Care System

The United States Preventive Services Task Force recently recommended against routine prostate cancer screening, stating that the risks of screening outweigh the benefits. We determined the impact of this recommendation on prostate cancer screening in a large health system. We obtained data on all screening prostate specific antigen tests performed at University Hospitals Case Medical Center and affiliated hospitals in northeastern Ohio from January 2008 to December 2012. We examined the total number of prostate specific antigen tests ordered with time and adjusted for patient volume by fitting a regression line. The overall trend was examined and stratified by location (urban, suburban or rural), patient age and provider type (primary care or urology). A total of 43,498 screening prostate specific antigen tests were performed from January 2008 to December 2012. Most tests were ordered by specialists in internal medicine (64.9%), followed by family medicine (23.7%), urology (6.1%) and hematology/oncology (1.3%). Prostate specific antigen screening increased with time until March 2009, when initial screening trials were published. Prostate specific antigen testing then decreased significantly and continued to decrease after the task force recommendations. Similar patterns were noted in almost all subgroups. The greatest decrease in screening wasobserved by urologists and in patients in the intermediate age group (50 to 59 years). United States Preventive Services Task Force recommendations appeared to have decreased prostate cancer screening. The greatest impact was seen for urologists and patients in the intermediate age group. Further study is needed to determine the long-term effects of these recommendations on the screening, diagnosis, treatment and prognosis of this prevalent malignancy.

Mechanical Prosthesis Is Reasonable for Mitral Valve Replacement in Patients Approximately 65 Years of Age

The long-term results of mitral valve replacement (MVR; n = 631) with a bileaflet mechanical prosthesis or a Carpentier-Edwards Perimount bioprosthesis were evaluated in Japanese patients of different age groups. A total of 507 bileaflet mechanical prostheses and 124 bioprostheses have been implanted since 1982 at our institution. Follow-up was completed for 6,598 patient-years in 98.4% of the cases. Among the patients 70 years of age and older, the rate of freedom from valve-related death and valve-related morbidity at 10 years after surgery were significantly better in the bioprostheses group (93.3% ± 6.4% and 83.7% ± 8.7%, respectively; n = 35) than in the mechanical prostheses group (71.1% ± 8.0% and 60.9% ± 8.9%, respectively; n = 82), and neither structural valve deterioration (SVD) nor resulting re-MVR were observed for bioprostheses. In contrast, among the patients 64 years and younger, no significant differences were observed in long-term survival between the mechanical prostheses group (n = 347) and the bioprostheses group (n = 76), while significantly lower rates of freedom from SVD and re-MVR were observed in the bioprostheses group compared with those obtained in the mechanical prostheses group. As for the controversial intermediate-age group of 65 to 69 years, the general tendencies were similar to those observed in the group 64 years and younger. Based on our comparative evaluation, bioprostheses should be chosen for MVR in patients 70 years of age and older, whereas mechanical prostheses were better in the patients 64 years of age and younger. The use of bioprostheses in Japanese patients 65 to 69 years of age is not preferable for preventing SVD and subsequent re-MVR.

Platelet count predicts cardiovascular mortality in very elderly patients with myocardial infarction

The prognosis of elderly patients with acute myocardial infarction (AMI) is poor, and information on specific risk factors remains scarce. The aim of our study was to assess the influence of platelet count on cardiovascular mortality in very elderly patients with acute myocardial infarction (≥ 85 years of age). We identified 208 elderly AMI patients and compared the platelet count with 208 matched young AMI patients (≤ 65 years) and 208 matched intermediate age AMI patients (66-84 years) who derived from the same cohort. During a median follow-up of 4·7 years, 25% of patients (n = 156) died of cardiovascular causes (97 very elderly, 46 intermediate age and 13 young age patients). We detected a mean platelet count of 227G/l (SD ± 83) in very elderly AMI patients, of 236G/l (SD ± 78) in the intermediate AMI group and of 254G/l (SD ± 79) in 208 young AMI patients (ANOVA P = 0·002). We revealed a significant interaction between age and platelet count with regard to cardiovascular mortality (p for interaction = 0·014). Platelet count displayed a significant risk transformation from an independent risk factor for cardiovascular mortality in very elderly AMI patients (adj. hazard ratio (HR) per 1-SD increase 1·25;95%CI 1·02-1·54;P = 0·028), via displaying no association with mortality in the intermediate age group (P = 0·10), to a strong inverse association in young patients (adj. HR 0·36;95%CI 0·18-0·68;P = 0·002). Our study demonstrates an independent association between elevated platelet count and long-term cardiovascular mortality in the growing and vulnerable group of very elderly AMI patients. Nevertheless, the pathophysiologic mechanisms underlying this age-dependent effect have to be further clarified.