Longer Life Expectancy Research Articles

The efficacy of training based on the family-centered empowerment model on the mental health of aged women: a stratified randomized controlled trial

BackgroundMental health among older women is substantial due to their longer life expectancy. They are more susceptible to mental disorders like depression and anxiety compared to older men. Additionally, older women fulfill essential family roles and depend on social support for age-related health issues. Family-centered education provides a platform to assist families and foster a collaborative relationship between the patient, family members, and health care providers in end-of-life care. The study aimed to explore how education based on family‑centered empowerment model affects mental health in aged women.MethodsThis randomized controlled trial involved a group of 60 elderly women aged 60 years and older, specifically selected from elderly-friendly health centers in Tabriz-East Azerbaijan, who were randomly assigned to either an intervention or control group with an equal ratio. The intervention group received a family-centered healthy lifestyle intervention weekly for 10 sessions, while the control group received standard care from elderly-friendly centers. The mean score of mental health using a three-part questionnaire of demographic-anthropometric characteristics and a mental health questionnaire (GHQ) were assessed before the intervention, 4 and 8 weeks after the intervention through SPSS/version 13 using, ANCOVA, independent t‑test, and repeated measure analysis at a significant level of p < 0.05.ResultsThe average age (standard deviation: SD) was 64.0 (3.8) years. The literacy level of the more than half of the participants was primary school. Regarding occupation and marital status, the majority of them were married and housekeeper. Two months after the intervention (end of the intervention), a significant decrease was detected in terms of overall mental health score in the intervention group compared to the control (the adjusted difference was − 5.7 with a 95% CI from − 10.3 to -1.1, and the p-value was 0.015). In the intragroup analysis, two months after the intervention, there was a significant decrease in overall mental health score compared to baseline in the intervention group (the mean change was − 5.4, with a 95% CI from − 9.9 to -0.9, and a p-value of 0.015). Moreover, a significant decrease was indicated in the physical subscale score in the intervention group compared to the control group (the adjusted difference was − 5.7, with a 95% CI from − 10.2 to -1.2, and a p-value of 0.015). There was no significant difference between the two groups in other subscales (p > 0.05). In the intragroup analysis, there was a significant decrease in the physical subscale score (the mean change was − 1.7, with a 95% CI from − 2.9 to -0.2, and a p-value of 0.038) and anxiety symptoms (the mean change was − 1.8, with a 95% CI from − 3.4 to -1.0, and a p-value of 0.033) compared to the baseline in the intervention group.ConclusionAn education based on family-centered empowerment model could improve the overall mental health score in elderly women. Hence, it may be recommended to regard this approach as a practicable educational strategy for improving the well-being of the elderly.Trial registrationIranian Registry of Clinical Trials; https://irct.behdasht.gov.ir/trial/30535 (IRCT20161126031087N2), registered (03/08/2018).

Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis-We Need a Well-Designed Randomized Control Trial.

Bicuspid aortic stenosis is a common pathology, typically seen in patients a decade younger than those with tricuspid valves. Surgical aortic valve replacement has been the mainstay treatment for bicuspid disease, especially considering the prevalence of concomitant aortic aneurysmal pathology. Transcatheter aortic valve replacement has shown equivalent results in bicuspid compared to tricuspid pathology in highly selected patient populations in single-arm registries and observational studies. For older patients with favorable bicuspid pathology, TAVR is reasonable. However, as younger patients with longer life expectancy are now being treated with TAVR, what is "best" is a question only answered by a well-designed randomized controlled trial. Herein, we describe the current evidence for treating bicuspid aortic stenosis and provide a framework for future trials. Yet, the question of equipoise remains, and who will we enroll?

Prognostic significance of coexistent coronary artery disease in patients undergoing transcatheter aortic valve implantation for aortic stenosis

Abstract Background The optimal management of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) is uncertain. As TAVI expands into lower risk cohorts with longer life expectancies there is increasing need to determine the prognostic significance of coexistent CAD and identify which lesions may benefit from revascularisation. Purpose To evaluate the prognostic significance of coexistent CAD in patients with AS undergoing TAVI stratified according to myocardial territories at risk. Methods Using a retrospective, single-centre, observational registry, patients undergoing TAVI for severe AS between 2015 and 2020 were included. CAD was angiographically determined using computed tomography or invasive coronary angiography. CAD was stratified into 1) low-risk: &amp;lt;70% stenosis in all major epicardial coronary arteries or &amp;lt;50% in the left main (LM); 2) intermediate-risk: ≥70% stenosis in one or two arteries, except the proximal left anterior descending (LAD) and LM; 3) high-risk: ≥70% stenosis in the proximal LAD, ≥70% stenosis in 3 arteries or LM stenosis ≥50%. Patients with previous CABG were categorised as high-risk if: ≥70% stenosis of 3 coronary grafts or graft supplying a proximally stenosed LAD; and intermediate-risk if: ≥70% stenosis of 1 or 2 non-LAD grafts. Baseline characteristics and procedural outcomes were compared between the 3 cohorts, with the impact of CAD on outcomes evaluated after adjustment for demographics and comorbidities. Results 1805 patients were included; median age 84 (79-88), 51% male sex, median logistic Euroscore 13 (8-21). 1281 (71%), 384 (21%) and 140 (8%) patients were characterised as low-, intermediate- and high-risk coronary anatomy respectively. High risk patients were older than the other groups, however, did not have the highest prevalence of comorbidities (Table 1). Other than pacemaker implantation (9% vs 12% vs 6%, p=0.04), there were no differences in procedural complications or in-hospital mortality between groups (Table 1). At a median follow-up of 3.5 (2.3-4.8) years, 920 patients (51%) died, 292 (16%) had hospitalisation for heart failure (HHF) and 565 patients (31%) had a major adverse coronary event (MACE); defined as either myocardial infarction, HHF or cardiovascular death. Coronary anatomical stratification was associated with MACE (Log rank p&amp;lt;0.001) (Figure 1). After multivariate adjustment, high-risk anatomy was associated with all-cause mortality (hazard ratio (HR): 1.34, 95% confidence interval (CI): 1.06-1.68, p=0.013), HHF (HR: 1.49, 95% CI: 1.01-2.21, p=0.046) and MACE (HR: 1.68, 95% CI: 1.27-2.21, p&amp;lt;0.001). Conclusions Whilst the presence of CAD does not impact TAVI procedural safety, untreated high-risk coronary anatomy is associated with future adverse events and may warrant intensive medical therapy and/or revascularisation.

Living alone and care levels’ distribution in first-time recipients of long-term care in Germany

Abstract Background As demographic shifts occur, along with longer life expectancies and advancements in medical care, there is a noticeable rise in the population requiring long-term care. In Germany, the Medical Service oversees the assessment for long-term care needs, which specifically evaluates the extent of limitations in maintaining independent living. These limitations are categorized into care levels ranging from 1 (indicating minor limitations) to 5 (denoting the most severe limitations). Methods Data from the long-term care assessment conducted nationwide in Germany are utilized for the analysis presented. The study focuses on individuals aged 60 and above with a first-time recognition of need of long-term care. Descriptive analysis is conducted on the distribution of care levels and living arrangements. Results The analysis encompassed 339,486 individuals, with an average age of 79.6 years (standard deviation: 8.4), of whom 59.0% were female. Approximately half of the sample were categorized under care level 2, while 32.4% fell into care level 1. Higher care levels (3-5) were less frequent (16.2%, 4.8%, 1.7% respectively). Individuals living alone were predominantly found in the lower care levels, whereas those not living alone were more commonly represented in care levels 3-5. Additionally, older individuals were more frequently assigned higher care levels. Conclusions Over 75% of initial applicants are classified within the lowest care levels (1 and 2) with a higher proportion of those living alone. One possible explanation is that within partnerships, the presence of a partner may serve as a form of support during the early phases of long-term care, with external assistance becoming necessary only as care needs escalate to higher levels. Further research should focus on examining the role of living alone in the need for long-term care. Key messages • Initial applicants of long-term care in Germany living alone are more often classified in lower care levels (indicating minor limitations) than in higher care levels (indicating severe limitation). • Partnerships may delay higher long-term care needs; research should explore living alone’s impact on long-term care.

The Impact of Changes in Population Structure on the Economic Development in China and the US

Abstract: China and the United States are both undergoing notable shifts in their population dynamics, marked by longer life expectancy and fewer births. This shift is resulting in population aging, with a growing proportion of elderly people compared to younger generations. Studying the impact of population changes on economic development offers valuable guidance for policymakers in China and the US. The research will utilize statistical analysis, data collection, literature review, and comparative case studies as its methodologies. And it informs effective policies in healthcare, education, retirement, and workforce planning. Both China and the United States are witnessing demographic changes marked by aging populations, impacting labor force participation, healthcare expenses, and social security outlays. And both nations confront challenges in maintaining skilled workforces and have implemented policies like fertility incentives, immigration reform, and education investments to address these issues. However, the impacts of demographic changes vary significantly between the two countries. This is due to differences in government policies and culture, such as immigration and fertility policies. Therefore, each country needs to address issues based on the actual changes in its population structure. By leveraging mutual learning and implementing tailored policies, both China and the United States can adeptly navigate demographic shifts, fostering sustainable growth and prosperity.

Toxicity surveillance in FDA pivotal registration trials for immune checkpoint inhibitors: Are we missing the mark?

215 Background: Immune checkpoint inhibitors (ICIs) have changed the treatment landscape for a multitude of malignancies, leading to prolonged survival and durable responses. Despite this, a significant number of patients will develop immune-related adverse events (irAEs) with significant associated morbidity and mortality. A retrospective study has previously demonstrated that 28% of patients can develop IrAEs from 6 months up to 2 years after starting therapy (1). Surveillance for toxicity is essential for understanding the long-term risk associated with ICIs. We aimed to analyze the reporting timeframes used in clinical trials of immuno-oncology agents leading to FDA approval. Methods: In this retrospective study, we interrogated the HemeOnc knowledgebase to curate a list of all clinical trial publications leading to FDA approval from 2011 to 2024. We manually selected from this list any trial including an immune checkpoint inhibitor either as monotherapy or in combination with another systemic therapy. The adverse event follow-up time was then extrapolated by manually reviewing the trial publication, supplemental materials or the trial protocol depending on where this information was listed. All trials were categorized based on trial initiation dates. Results: We identified 175 clinical trials leading to FDA approvals, with trial initiation dates ranging from 2004 to 2019. 165 trials were included in the analysis with 10 being excluded due to lack of language regarding follow-up. 62% of the trials included were Phase III trials with the remaining 38% Phase I/II trials. The median follow-up days for all trials across this timeframe was 90, with a range of 28 to 135. The median follow-up time for AE monitoring increased by nearly 30%, rising from 70 days in 2004 to 90 days in 2013. Subsequently, we observed a consistent median follow-up time of 90 days (28 to 130 days) from that point onward, with no further increase. Conclusions: To our knowledge this is the first systematic review of IrAE monitoring in clinical trials leading to FDA approval. In our study we revealed that, despite advancements in the understanding of IrAEs and their potential for late presentation, registration trials leading to regulatory approval remain inadequately designed to capture chronic and delayed immunotherapy toxicities. As these therapies advance into earlier stages of disease with longer life expectancy, it will be critical for regulatory bodies, study sponsors, and trial investigators to either redesign clinical trials or for there to be an alternative method that comprehensively captures the incidence and pattern of late-presenting toxicities. 1. Durbin, ASCO 2023.

Transcatheter aortic valve implantation versus surgery: 4-year survival according to life expectancy.

In the last years, transcatheter aortic valve implantation (TAVI) indication has expanded to younger and lower risk patients. Consequently, interest in mid and long-term follow up and in the role of life expectancy, as a key factor for selecting the most tailored treatment, has grown. The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement (AVR) vs. TAVI at our department. From September 2017 to December 2020, 673 consecutive patients with severe aortic valve stenosis were enrolled for AVR (n = 283) or TAVI (n = 390). Inclusion criteria was isolated severe aortic stenosis, while exclusion criteria were redo surgery, valve-in-valve procedure and the need for concomitant surgical procedures. Based on the Lee index, patients were divided into four groups according to their 4-year life expectancy. Four-year survival was assessed and reported using the Kaplan-Meier method. A multivariate regression analysis of risk factors for 4-year mortality was performed. Four years survival is always superior in the AVR patients (89.8% vs. 75.6%, P < 0.001). Surgery is associated with a higher incidence of acute kidney injury (23% vs. 5.1%, P < 0.001), while TAVI is related to a higher incidence of new onset left bundle branch block (0 vs. 23.8%, P < 0.001), pace-maker implantation (2.5% vs. 11.8%, P = 0,02) and mild-to-moderate paravalvular leak (0.3% vs. 5.4%, P < 0.001). The independent risk factors for 4-years mortality are post-procedural AKI, poor mobility and transcatheter procedure. In our analysis, 4 years survival is always superior in the AVR patients. Life expectancy is a key factor for selecting the most appropriate approach for each patient. A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.

Comprehensive analysis of the expression and prognosis for cyclin-dependent protein kinase family in osteosarcoma

Background and Objective Cyclin-dependent protein kinases (CDKs) have been suggested as prospective therapeutic targets because they control processes vital to the survival and growth of cancer cells. However, research on the varied CDK expression profiles and prognostic factors in osteosarcoma is still lacking. Methods The osteosarcoma microRNA (GSE65071) and gene expression profiles were retrieved from the Gene Expression Omnibus (GEO) database (GSE42352). A substantial variation in prognosis was discovered in CDKs using the TARGET database. Cytoscape was used to construct the miRNAs-CDKs network, and functional and pathway enrichment analyses were completed. It was looked at how immune checkpoint genes, m6A-related genes, and CDKs interact. Results In patients with osteosarcoma compared to normal samples, CDK1-5, CDK18, CDK16, and CDK17 gene expression levels were considerably greater, whereas CDK7-9, CDK11B, CDK16, and CDK20 gene expression levels were significantly lower. Patients with osteosarcoma who had low CDK3 and 18 gene levels or high CDK6, 9 gene levels were predicted to have a favorable prognosis and a long-life expectancy. Immune checkpoint genes, m6A-related gene expression, and CDKs expression all showed some connection. Finally, a network of crucial CDKs and miRNAs was constructed. Conclusion According to our research, CDK3, 6, 9, and 18 have been identified as possible therapeutic targets for osteosarcoma, and CDKs may have a role in controlling m6A mutations in tumor cells as well as immune checkpoint regulation.

The Neuroprotective Role of Tangeritin

The prevalence of neurodegenerative diseases has increased with longer life expectancies, necessitating the exploration of novel neuroprotective agents. Tangeretin, a polymethoxylated flavone derived from citrus fruits, has gathered attention for its potential therapeutic effects. This review highlights the neuroprotective properties of tangeretin via its antioxidant and anti-inflammatory mechanisms. Tangeretin demonstrates efficacy in mitigating oxidative stress, neuroinflammation, and neuronal damage across various neurodegenerative conditions, including Alzheimer's disease, Parkinson's disease, cerebral ischemia, and epilepsy. It shows promise in ameliorating cognitive deficits and memory impairments associated with these diseases. Moreover, tangeretin modulates multiple signalling pathways and protects against neuronal apoptosis, underscoring its potential as a therapeutic agent.

Comprehensive review on pharmacological activities of Adansonia digitata

, commonly known as the baobab tree, founded mainly in Africa and is also found in Indiana region. It associates to the kapok tree group and this tree hold record of highest wood tree in the world. The baobab is an adaptable plant that provides protection, food, clothing, medicament and raw materials for multiple products. All eatable section including seeds, leaves, roots, flowers, pulp and bark, are shared to be beneficial. Baobab trees are over 4,000 years old. contains many phytochemicals such as vitamin C, steroids, flavonoids, epicatechin, campestral and amino acids. This large tree can growth a height of 20-25 meters and a cyclize of up to 9 meters and has been in place for centuries.It is called the "Queen of Carbon Storage" because it can absorb so much carbon from the air. The tree is known for its size, unique shape and long-life expectancy, often surviving for thousands of years. Baobab has a variety of biological properties, including antibacterial, antimalarial, antidiarrheal, antianemic, antiasthmatic, antiviral, antioxidant. Phytochemical analysis has revealed the presence of flavonoids, phytosterols, amino acids, fatty acids, vitamins, and minerals. Parts of the plant are used for treating bronchial asthma, dermatitis, sickle cell anemia, diuretic, antidiabetic, antidiarrheal, antidysenteric, laxative, and hiccups in children. This article summarizes the pharmacological, phytochemical, and pharmacological properties of the baobab tree.

Proton pencil beam scanning radiotherapy in the postoperative treatment of p16 positive squamous cell tonsillar cancer – evaluation of toxicity and effectivity

PurposePatients with p16 positive tonsillar cancer (p16 + TC) have an excellent prognosis and long-life expectancy. Deintensification of therapy is a prevalent topic of discussion. Proton radiotherapy is one way to reduce radiation exposure and thus reduce acute and late toxicity. The aim is to evaluate treatment outcomes and toxicity of postoperative treatment with intensity-modulated proton therapy (IMPT).MethodsBetween September 2013 and November 2021, 47 patients with p16 + TC were treated postoperatively with IMPT. Median age was 54.9 (38.2–74.9) years, 31 were males and 16 were females. All patients had squamous cell carcinoma and underwent surgery as a primary treatment. Median dose of radiotherapy was 66 GyE in 33 fractions. Bilateral neck irradiation was used in 39 patients and unilateral in 8. Concomitant chemotherapy was applied in 24 patients.ResultsMedian follow-up time was 4.2 (0.15–9.64) years. Five-year overall survival, relapse free survival and local control were 95.7%, 97.8% and 100%. The most common acute toxicities were dermatitis and mucositis, with grade 2 + in 61.7% and 70.2% of patients. No acute percutaneous gastrostomy insertion was necessary and intravenous rehydration was used in 12.8% of patients. The most common late toxicity was grade 1 xerostomia in 70.2% of patients and grade 2 in 10.6% of patients. Subcutaneous fibrosis of grades 2 and 3 occurred in 17.0% and 2.1% of patients, respectively. One patient developed late severe dysphagia and became PEG-dependent.ConclusionIMPT for the postoperative treatment of p16 + TC is feasible with excellent efficiency and acceptable acute and late toxicity.

Interplay between physical activity volume and intensity with modeled life expectancy in women and men: A prospective cohort analysis

BackgroundThere is a lack of research examining the interplay between objectively measured physical activity volume and intensity with life expectancy. MethodsIndividuals from UK Biobank with wrist-worn accelerometer data were included. The average acceleration and intensity gradient were extracted to describe the physical activity volume and intensity profile. Mortality data were obtained from national registries. Adjusted life expectancies were estimated using parametric flexible survival models. Results40,953 (57.1%) women (median age = 61.9 years) and 30,820 (42.9%) men (63.1 years) were included. Over a median follow-up of 6.9 years, there were 1719 (2.4%) deaths (733 in women; 986 in men). At 60 years, life expectancy was progressively longer for higher physical activity volume and intensity profiles, reaching 95.6 years in women and 94.5 years in men at the 90th centile for both volume and intensity, corresponding to 3.4 (95% confidence interval (95%CI): 2.4–4.4) additional years in women and 4.6 (95%CI: 3.6–5.6) additional years in men compared to those at the 10th centiles. An additional 10-min or 30-min daily brisk walk was associated with 0.9 (95%CI: 0.5–1.3) and 1.4 (95%CI: 0.9–1.9) years longer life expectancy, respectively, in inactive women; and 1.4 (95%CI: 1.0–1.8) and 2.5 (95%CI: 1.9–3.1) years in inactive men. ConclusionHigher physical activity volumes were associated with longer life expectancy, with a higher physical activity intensity profile further adding to a longer life. Adding as little as a 10-min brisk walk to daily activity patterns may result in a meaningful benefit to life expectancy.

Evolving data on risk and current screening recommendations for colorectal cancer in cystic fibrosis: Pre- and posttransplant.

Advances in treatment for cystic fibrosis (CF), including cystic fibrosis transmembrane conductor regulator (CFTR) modulators, have ushered in an era where patients with CF have much longer life expectancies. This shift in life expectancy demands increased attention to diseases of aging in patients with CF. A notable complication of CF is early-onset colorectal cancer (CRC), which is especially prevalent in patients with severe mutations and after transplant. CFTR acts as a tumor suppressor gene based on knockout models. Lack of CFTR expression promotes carcinogenic processes such as intestinal inflammation and deleterious gut microbiome changes. The consensus Cystic Fibrosis Foundation recommendations advocate treating this population as a high-risk group, using a colonoscopy-only screening strategy starting at age 40 in patients without transplant and at age 30 after transplant. Screening should be considered every 5 years if negative and every 3 years or sooner for patients with adenomatous polyps. Future research will determine the role of noninvasive CRC screening tools in this population, as well as the effects of CFTR modulators on the risk of developing CRC.

Role of gut microbiome in the outcome of lymphoma patients treated with checkpoint inhibitors-The MicroLinf Study.

Biomarkers for immune checkpoint inhibitors (ICIs) response and resistance include PD-L1 expression and other environmental factors, among which the gut microbiome (GM) is gaining increasing interest especially in lymphomas. To explore the potential role of GM in this clinical issue, feces of 30 relapsed/refractory lymphoma (Hodgkin and primary mediastinal B-cell lymphoma) patients undergoing ICIs were collected from start to end of treatment (EoT). GM was profiled through Illumina, that is, 16S rRNA sequencing, and subsequently processed through a bioinformatics pipeline. The overall response rate to ICIs was 30.5%, with no association between patients clinical characteristics and response/survival outcomes. Regarding GM, responder patients showed a peculiar significant enrichment of Lachnospira, while non-responder ones showed higher presence of Enterobacteriaceae (at baseline and maintained till EoT). Recognizing patient-related factors that may influence response to ICIs is becoming critical to optimize the treatment pathway of heavily pretreated, young patients with a potentially long-life expectancy. These preliminary results indicate potential early GM signatures of ICIs response in lymphoma, which could pave the way for future research to improve patients prognosis with new adjuvant strategies.

Fluid-Solid Interaction Analysis for Developing In-Situ Strain and Flow Sensors for Prosthetic Valve Monitoring.

Transcatheter aortic valve implantation (TAVI) was initially developed for adult patients, but there is a growing interest to expand this procedure to younger individuals with longer life expectancies. However, the gradual degradation of biological valve leaflets in transcatheter heart valves (THV) presents significant challenges for this extension. This study aimed to establish a multiphysics computational framework to analyze structural and flow measurements of TAVI and evaluate the integration of optical fiber and photoplethysmography (PPG) sensors for monitoring valve function. A two-way fluid-solid interaction (FSI) analysis was performed on an idealized aortic vessel before and after the virtual deployment of the SAPIEN 3 Ultra (S3) THV. Subsequently, an analytical analysis was conducted to estimate the PPG signal using computational flow predictions and to analyze the effect of different pressure gradients and distances between PPG sensors. Circumferential strain estimates from the embedded optical fiber in the FSI model were highest in the sinus of Valsalva; however, the optimal fiber positioning was found to be distal to the sino-tubular junction to minimize bending effects. The findings also demonstrated that positioning PPG sensors both upstream and downstream of the bioprosthesis can be used to effectively assess the pressure gradient across the valve. We concluded that computational modeling allows sensor design to quantify vessel wall strain and pressure gradients across valve leaflets, with the ultimate goal of developing low-cost monitoring systems for detecting valve deterioration.

Contribution of deaths of despair to the Hispanic mortality advantage in the USA by person, place and time: an ecological analysis of vital registration data

IntroductionIn the USA, Hispanics exhibit longer life expectancy (LE) compared to non-Hispanic whites despite facing greater socioeconomic adversity and greater health risk factors, a phenomenon known as the Hispanic paradox....

Management considerations and treatment outcomes for newly diagnosed prostate cancer in advanced age patients (≥80 years): real-world data from a single urological center over a 10-year period.

There is ongoing debate regarding prostate cancer (PCa) screening in advanced age males, leading to treatment decisions often based on tumor staging and life expectancy. A critical gap in clinical evidence and tailored guidelines for the advanced age with PCa persists. This study aims to compare survival outcomes of various treatment approaches in this demographic. We analyzed data from a large urological center for advanced age patients suspected of having PCa between 2012 and 2022. We collected clinical and pathological characteristics and evaluated treatment modalities, including palliative therapy and definitive therapy. Propensity score matching (PSM) analysis was implemented to reduce bias between treatment modalities. Kaplan-Meier and multivariate Cox proportional hazard regression analyses were conducted to evaluate progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Out of 4,333 suspected patients, 376 individuals aged 80 years and older underwent prostate biopsy. The overall detection rate of PCa was 78.7%, with a high prevalence of high-grade tumors [International Society of Urological Pathology (ISUP) grade ≥2]. Most patients (86.5%) received palliative therapy, while 13.5% underwent definitive therapy. Patients in the definitive therapy group had lower prostate-specific antigen (PSA) values, lower tumor stage, and Charlson Comorbidity Index (CCI), longer life expectancy, and a higher Geriatric 8 (G8) score compared to the palliative therapy group. The median OS for the entire cohort was 72.0 months, with 70.0 months for palliative therapy and 96.0 months for definitive therapy. Multivariable analyses identified lymphatic and bone metastasis, as well as definitive therapy, as independent prognostic factors for PFS, CSS, and OS. Advanced age patients, although a small group, have distinct characteristics, including higher PSA levels, positive biopsy rates, and pathological grading and staging. In medically fit elderly patients, especially those with localized PCa and a life expectancy of ≥5 years, definitive therapy could improve survival outcomes.

Techniques and Strategies to Minimize Radiation Exposure in Pediatric Computed Tomography (CT) Abdominal Examinations: A Review.

As children are more vulnerable to radiation-induced cancers and have longer life expectancies, it is essential to implement strict radiation protection measures in pediatric imaging. This study aimed to review radiation dose-minimizing measures in pediatric abdominal computed tomography (CT) examinations. A systematic search across various databases, including Web of Science, PubMed, SpringerLink, ScienceDirect, and Google Scholar, yielded a total of 7,314 articles. The search used keywords that aligned with the objectives of the study. This study included 77 publications after applying the criteria for inclusion and exclusion. We carefully reviewed these selected articles for compliance with the inclusion criteria and excluded them if they did not meet the specified criteria. Only 12 articles fulfilled the strict criteria. An in-depth review of 12 selected articles demonstrated the radiation dose reduction techniques and strategies, which include prefiltering and post-processing algorithms, careful adjustment of exposure parameters such as tube voltage (kVp) and current (mAs), and the establishment of diagnostic reference levels (DRL). Reduction of radiation exposure in pediatric CT imaging demands multifaceted approaches. To reduce the ionizing radiation dose while still obtaining high-quality diagnostic images, healthcare practitioners should adhere to DRL, adjust exposure factors, implement prefiltration, employ AI, and use post-processing algorithms.

Retirement and unemployment as an opportunity for use and social interaction in urban public spaces / Jubilación y desempleo como oportunidad de uso e interacción social en los espacios públicos urbanos

Demographic changes, associated with longer life expectancy and a lower birth rate, have led to population ageing in societies. There is also a high rate of unemployment linked to job insecurity, temporary employment, school drop-out rates and overqualification, among others. These phenomena have generated a new social challenge. This research paper, based on a sample of 259 people, aims to analyse the extent to which socio-occupational status influences the use of public spaces (parks and squares) and users’ perceptions about the possibilities of contact promoted by different public spaces and the quality of relationships with other users. Findings indicate that there are differences depending on socio-occupational status with regard to the perception of social relations and frequency of use. In particular, unemployed and retired people use urban public spaces to a greater extent, and they also show a more positive perception of the possibilities of contact in public spaces and the quality of relationships.

Coronary angiography following transcatheter aortic valve replacement: Insights from the SWEDEHEART registry.

Transcatheter aortic valve replacement (TAVR) is the most common treatment in patients with symptomatic severe aortic stenosis (AS). As concomitant coronary artery disease is common in AS patients, access to the coronary arteries following TAVR is of increasing importance. This study evaluated the incidence and risk factors for unplanned coronary angiography following TAVR and, using fluoroscopic time as a surrogate, analyzed the complexity of coronary artery cannulation. All patients who underwent TAVR in Sweden between 2008 and 2022 were identified using the SWEDEHEART registry. The cumulative incidence of coronary angiography after TAVR was analyzed with mortality as a competing risk. Angiography and PCI complexity were analyzed using fluoroscopic time and compared across different transcatheter heart valve designs. Out of 9806 patients, 566 subsequently required coronary angiography. The incidence was highest for three-vessel and/or left main disease. Younger age, the extent of prior coronary artery disease, and peripheral vascular disease were associated with an increased risk of coronary angiography. Fluoroscopy time was increased in TAVR patients compared to the control group with the longest fluoroscopy times observed in cases involving supra-annular and self-expanding valves. The incidence of coronary angiography following TAVR is still low. Younger patients and patients with concomitant coronary artery disease have a higher risk. Procedural time is longer in patients with a previous THV replacement. As TAVR is emerging as the first-line treatment in patients with longer life expectancy, facilitating coronary access is an important factor when considering which THV device to implant.