Non-elderly Patients Research Articles

Prognostic value of surgical treatment in elderly patients with ulcerative colitis‐associated colorectal cancer: A subanalysis of a nationwide Japanese multicenter study

AbstractAimOur study aimed to examine the characteristics of elderly patients diagnosed with ulcerative colitis‐associated colorectal cancer (UAC) and evaluate the impact of surgical intervention on prognosis.MethodsA total of 1086 patients diagnosed with UAC between 1980 and 2020 were retrospectively enrolled. Data were collected through the Japanese Society for Cancer of the Colon and Rectum project. The patients were divided into two groups: 248 elderly patients in the E‐UAC group and 838 nonelderly patients in the NE‐UAC group. Patients aged >65 y at cancer diagnosis were considered elderly.ResultsThe recurrence rate did not differ between the two groups. Segmental resection was the only common independent risk factor for recurrence in both the E‐UAC and the NE‐UAC groups. The E‐UAC patients had significantly better 5‐y disease‐specific survival (DSS) than the NE‐UAC patients (94.7% vs 91.0%, p = 0.04). There were no differences in 5‐y recurrence‐free survival (RFS; 89.3% vs 86.6%, respectively, p = 0.24) or overall survival (OS; 88.8% vs 89.6%, p = 0.50). The E‐UAC patients who underwent segmental resection had poorer RFS than those who underwent total proctocolectomy, but there were no significant differences in DSS or OS.ConclusionDespite the elevated risk of cancer recurrence observed in the UAC patients who underwent segmental resection in both the E‐UAC the NE‐UAC groups, our findings suggested that segmental resection may be a viable alternative to total proctocolectomy in terms of survival rate for the E‐UAC patients.

Effects of Continuous Positive Airway Pressure Treatment on Vascular Function in a Real-Life Cohort of Elderly Patients with Obstructive Sleep Apnoea Syndrome

Background: Obstructive sleep apnoea syndrome (OSAS) is an independent risk factor for cardiovascular morbidity and mortality and has a detrimental effect on vascular function, in particular on arterial stiffness and endothelial function. Continuous positive airway pressure (CPAP) is the gold-standard therapy for OSAS and its effects on arterial stiffness and endothelial function have been demonstrated in non-elderly patients. Objectives: The objective of this study was to evaluate the effect of one year of CPAP treatment on arterial stiffness, through assessment of carotid–femoral pulse wave velocity (cf-PWV), and on endothelial function, through the reactive hyperaemia index (RHi), in a real-life cohort of elderly patients with moderate-to-severe OSAS and several comorbidities. Methods: In this nonrandomised prospective study, we enrolled 469 consecutive elderly patients affected by moderate-to-severe OSAS distributed in two groups: CPAP-treated (n = 225) and untreated patients (n = 244). Results: At one-year follow-up, in the treated group emerged an important improvement in poligraphics (AHI, ODI, TC90, mean SpO2%), laboratory (HOMA index, eGFR, hs-CRP) and vascular function parameters: cf-PWV. The stepwise multivariate linear regression demonstrated a significant correlation between the delta of the polygraph parameters and the delta of PWV and RHi. Conclusions: Our study confirmed the favourable effects of CPAP therapy in a cohort of elderly patients affected by OSAS and several comorbidities on sleep respiratory parameters and vascular function; early diagnosis and treatment with CPAP might be beneficial to delay or prevent the occurrence of cardiovascular events in these groups of patients.

CT pulmonary angiography in the inpatients: A 5-year retrospective view at the end of COVID-19 public health emergency.

To retrospectively evaluate the trends in utilization and results of computed tomography pulmonary angiography (CTPA study) for detection of acute pulmonary embolism (PE) in the hospital inpatients during different phases of COVID-19 public health emergency. We conducted an Institutional Review Board (IRB)-approved retrospective review of CTPA studies for our hospital inpatients in the years from 2019 to 2023, ranging from the prepandemic year (2019) to the year coinciding with the end of public health declarations (2023). Collected characteristics included patient age, patient sex, and result of the study. The utilization of CTPA studies for inpatients was higher in 2020 to 2023, compared to 2019 (3.8% in 2023 compared to 2.4% in 2019, P < .001). The increase in utilization was also statistically significant in each group, when stratified by age and sex (OR = 1.46 for female, OR = 1.71 for male, OR = 1.93 for elderly, and OR = 1.29 for non-elderly inpatients in 2023, compared to 2019). The positivity rate of acute PE in the inpatients was overall higher in 2021, 2022, and 2023, compared to 2019 (for example, 18.5% in 2023 compared to 14.3% in 2019, P = .01). When stratified by age and sex, only the non-elderly patients continued to have a significantly higher rate of acute PE in 2023, compared to 2019 (OR = 1.39). While studies spanning longer time frames and involving multiple institutions are needed to understand and generalize this conclusion, we conclude that the utilization and positivity rates of CTPA studies in inpatients remains high at the end of the COVID-19 pandemic public health emergency.

Fentanyl Initiation Rate Following the Requirement for Specialist Approval.

Healthcare organizations attempt to address unwarranted fentanyl use, which often leads to increased risk of addiction and overdose. To assess the impact of a requirement for a specialist's approval on fentanyl initiation for non-oncological pain. A retrospective cohort study based on observational data. All 4.4 million non-oncological members of Clalit Health Services were included, from July 20, 2021, to July 19, 2023. The rate of fentanyl initiation was assessed before and after the implementation of the requirement for specialist's approval, which was introduced on July 2022, and expanded 6months later for continued use. A sub-group analysis by age group was performed, and patient characteristics and indications were assessed. We also compared total opioid dispensation in the 6th and 12th months after the implementation with the predicted rate based on pre-implementation rates. Fentanyl initiation rate in the year before the requirement was 711 per million capita, which decreased following the requirement by - 81% (95% CI: - 77%; - 85%). The decrease attenuated with age. The prevalence of diagnosis with substance abuse disorders at the time of fentanyl initiation decreased from 6 to 3%. In the 6th and 12th months after the requirement was implemented, the morphine milligram equivalent (MME) from dispensation of total opioids was lower than predicted based on pre-implementation rates by 7% and 26%, respectively. Requiring specialist approval for fentanyl initiation for non-oncological chronic pain was associated with a decrease in fentanyl prescription initiations, especially among non-elderly patients. A decrease also occurred gradually in total opioid dispensations, further decreasing following the extension of the requirement to continuous fentanyl. The requirement for specialist approval upon fentanyl initiation and continuous fentanyl may present an effective tool for limiting the use of fentanyl and total opioids in healthcare systems.

Association between nighttime urinary frequency and clinical outcomes in Japanese patients with ulcerative colitis.

Nocturia is a common symptom of lower urinary tract syndrome (LUTS). In previous studies, a close association between LUTS and colorectal inflammation has been reported. However, evidence regarding the association between nighttime urinary frequency and ulcerative colitis (UC) is limited. Herein, we investigated the association between nighttime urinary frequency and clinical outcomes of UC. We surveyed 287 Japanese patients with UC. A self-administered questionnaire was used to collect the information on the variables studied. Patients were divided into three groups based on nighttime urinary frequency: (1) no voids, (2) one void, and (3) two or more voids. The assessment of clinical outcomes was based on mucosal healing (MH) and clinical remission (CR). The association between nighttime urinary frequency and prevalence of MH and CR was evaluated using multivariate logistic regression analyses. The prevalence of one nighttime frequency and two or more nighttime frequency in this cohort was 35.5% and 26.8%, respectively. The percentage of MH and CR was 24.7% and 59.2%, respectively. Two or more nighttime frequency (adjusted odds ratio [OR]: 0.31, 95% confidence interval [CI]: 0.13-0.73) was independently and inversely associated with MH. In nonelderly patients (<70 years) and patients in CR, an association between two or more nighttime frequency and MH remained significant (non-elderly: adjusted OR: 0.27, 95% CI: 0.09-0.72 and only CR: adjusted OR: 0.34, 95% CI: 0.12-0.90). Nighttime urinary frequency was independently and inversely associated with MH in Japanese patients with UC. Nighttime urinary frequency may serve as a complementary physical sign of MH in patients with UC.

Real world effectiveness of oral semaglutide: Focus on patients with type 2 diabetes older than 75 years

AimData on the efficacy of oral semaglutide (OS) in elderly patients with type 2 diabetes are still lacking. This study evaluates the effectiveness of OS in a real world setting with a large ≥75 year old population. MethodsThis study includes all type 2 diabetic patients who started OS between October 2021 and December 2023 in seven diabetes centers. Data were collected at baseline, 6 (T6) and 12 (T12) months. Effectiveness measures were assessed on the total sample and by patient age (<65, 65–75, >75 years). ResultsOverall 1824 patients started OS, of those 18.7 % were over 75 years (>75 yr). OS resulted in a significant reduction in rate of patients using sulphonylureas, rapid and basal insulin therapy, HbA1c reduced by 0.87 % at T6 and at T12 (both p < 0.0001), body weight by 2.78 Kg (p < 0.0001) at T6 and 3.89 Kg (p < 0.0001) at T12. Similarly, >75 yr showed HbA1c reduction at T6 (p < 0.0001) and T12 (p = 0.0003), body weight significantly reduced (p for interaction 0.005) both at T6 (−1.57 Kg; p = 0.0003) and T12 (−2.74 Kg; p < 0.0001). ConclusionIn our study, OS results efficacy in non-elderly and elderly patients, making it an effective treatment option also for very elderly type 2 diabetic patients.

The Clinical Application Value of a Novel Chip in the Detection of Pathogens in Adult Pneumonia: A Multi-Centre Prospective Study in China.

The detection of pathogenic microorganisms plays a significant role in the diagnosis and management of pneumonia that are responsible for a substantial number of deaths worldwide. However, conventional microbiological tests (CMT) have low accuracy and are time-consuming. In this study, we aim to evaluate the clinical value of Chips for Complicated Infection Detection (CCID) in detecting pneumonia pathogens. This study was conducted at nine hospitals in China from January 2021 to September 2022. Respiratory samples from adult pneumonia patients were collected from each patient. CMT and CCID were performed in parallel to identify the pathogens. A total of 245 patients were included, with 73% being elderly. CCID identified pathogenic microbes in 78.0% of patients and conventional microbiological tests (CMT) in 57.1% of the patients (p<0.001). The overall positive and negative percent agreements between CCID and CMT for pathogen detection were 90.07% and 38.46%, respectively. 38.8% of patients were diagnosed with mixed infections with at least two pathogens by CCID. Bacterial infections identified by CCID accounted for 60.0% of 245 patients, with the top 3 being Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterococcus faecium, respectively. K. pneumoniae was the most common pathogen in elderly patients, with a significantly higher prevalence compared to non-elderly patients (p = 0.0011). Among the 197 patients who had used antibiotics before sample collection, the positive rate of CCID was significantly higher than that of CMT (p < 0.001). This study indicates that compared to CMT, this novel chip has significant advantages in detecting pathogens in pneumonia patients, especially in the elderly.

Impact of isoniazid monoresistance on overall and vulnerable patient populations in Taiwan

ABSTRACT Isoniazid is an early bactericidal anti-tuberculosis (TB) agent and isoniazid mono-resistance TB is the most prevalent drug-resistant TB worldwide. Concerns exist regarding whether resistance to isoniazid would lead to delayed culture conversion and worst outcomes. From January 2008 to November 2017, adult culture-positive pulmonary TB patients receiving isoniazid, rifampicin, pyrazinamide, and ethambutol were identified through Taiwan Center for Disease Control database and were followed until the end of 2017. Primary outcomes included time to sputum culture conversion (SCC) within two months. Secondary outcomes included death and unfavourable outcomes at the end of 2nd month. A total of 37,193 drug-susceptible and 2,832 isoniazid monoresistant pulmonary TB patients were identified. Compared with no resistance, isoniazid monoresistance was not associated with a delayed SCC (HR: 0.99, 95% CI: 0.94─1.05, p = 0.8145), a higher risk of 2-month mortality (HR: 1.19, 95% CI: 0.92─1.53, p = 0.1884), and unfavourable outcomes at 2nd month (OR: 1.05, 95% CI: 0.97─1.14, p = 0.2427). Isoniazid monoresistance was associated with delayed SCC (HR: 0.90, 95% CI: 0.83─0.98, p = 0.0099) and a higher risk of unfavourable outcomes (OR:1.18, 95% CI: 1.05─1.32, p = 0.0053) in patients aged between 20 and 65, and delayed SCC in patients without underlying comorbidities (HR: 0.90, 95% CI: 0.81─0.98, p = 0.0237). Isoniazid mono-resistant TB had a comparable outcome with drug-susceptible TB at the end of the intensive phase. Healthy, and non-elderly patients were more likely to had culture persistence, raising concerns about disease transmission in these subgroups and warranting early molecular testing for isoniazid resistance.

Predictors of in-hospital mortality in non-elderly adult patients requiring emergency admission for acute pancreatitis: a retrospective analysis based on a generalized additive model

Predictors of in-hospital mortality in non-elderly adult patients requiring emergency admission for acute pancreatitis: a retrospective analysis based on a generalized additive model

Efficacy and safety of immunotherapy combined with chemotherapy in patients with ES-SCLC: A systematic review and network meta-analysis of RCTs and RWSs.

To evaluate the efficacy and safety of programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors in the treatment of extensive-stage small-cell lung cancer (ES-SCLC), we conducted a systematic review and meta-analysis that included randomized controlled trials (RCTs) and real-world studies (RWS). By scanning PubMed, Web of science, Embase, and other relevant clinical information public databases, nine RCTs and eight RWSs involving 5205 patients were included in the study. We directly compared the differences between chemotherapy and PD-1/PD-L1 inhibitors plus chemotherapy, and determined the optimal treatment strategy through network meta-analysis (NMA). Compared to chemotherapy, the addition of PD-1/PD-L1 inhibitors significantly improves the overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) in SCLC patients. Regarding safety, both RCTs and RWSs indicated no significant difference in grade 3-4 adverse events between chemotherapy and chemoimmunotherapy. NMA showed serplulimab plus chemotherapy (Serp_Chemo) appears to provide the best OS, PFS, and ORR benefit, while nivolumab plus chemotherapy shows higher toxicity than other regimens. In subgroup analysis, for elderly patients (age ≥65) and non-elderly (age <65) patients, the most promising quality regimens for achieving better OS extension are atezolizumab plus chemotherapy (Atez_Chemo) and Serp_Chemo, respectively. For patients with PD-L1 ≥ 1% and lactate dehydrogenase (LDH) > upper limit of normal (ULN), there is no apparent OS benefit from immune therapy. In ES-SCLC treatment, adding PD-1/PD-L1 inhibitors to standard chemotherapy improves OS, PFS, and ORR, with Serp_Chemo shows the most promise. Atez_Chemo and Serp_Chemo provided better survival for elderly and non-elderly patients, respectively.

Prophylactic barbiturate step-down infusion therapy has similar and favorable effects in elderly and non-elderly patients with severe traumatic brain injuries

With the aging population, the number of elderly patients with severe traumatic brain injury (sTBI) inevitably increases. The high mortality rate for sTBI in the elderly necessitates effective solutions. While we have previously reported the beneficial effects of a novel barbiturate therapy, a prophylactic step-down infusion of barbiturates (sdB), using thiamylal with normothermia (NOR) in patients with sTBI, its effects on elderly patients remain unclear. Therefore, we compared the efficacy and safety of sdB between elderly and non-elderly patients with sTBI.This study included 25 patients with sTBI who underwent sdB between January 2013 and March 2020. Patient characteristics were similar between elderly (≥75 years, n = 8) and non-elderly patients (<75 years, n = 17), except for the sex ratio. The hospitalization period tended to be longer for elderly patients. There were no differences in side effects or complications of sdB between the groups. The primary (favorable outcome at discharge and at 6–12 months) and secondary (composite death at discharge and at 6–12 months) endpoints were similar between the groups. Intracranial pressure and cerebral perfusion pressure were well controlled in the elderly patients.Our results suggest that sdB + NOR is as effective in elderly patients with sTBI as it is in non-elderly patients.

Short-Term Postoperative Outcomes after Resective Colorectal Surgery in Elderly vs. Nonelderly Patients: A Single Centre Retrospective Analysis

Background/Objectives: Life expectancy for people in their 60s is 24.3 years in high-income countries. Health systems face the burden of disease in the elderly population and must assess the impact of treatments such as major surgery. The aim of this study is to quantify the impact of advanced age on short-term postoperative outcomes after resective colorectal surgery (RCRS). Methods: All patients who underwent RCRS at our institution between July 2022 and November 2023 were entered into a database. Preoperative, perioperative, and early (within 30 days) postoperative data were recorded. Patients were categorized into a young group (under 75 years, YG) and an elderly group (over 75 years, EG). A retrospective comparative analysis of postoperative outcomes was performed between the two groups; postoperative complications were graded according to the Clavien classification. Results: Fifty-three and ninety-five patients were in the EG and YG, respectively. Indications for RCRS was cancer in 83% of EG patients and 61.1% of YG patients (p = 0.006), and the clinical presentation, localization, and rate of neoadjuvant treatment in oncological patients were comparable. Another indication for RCRS was complicated diverticular disease (17% of EG patients and 38.9% of YG patients; p = 0.006). With respect to the baseline characteristics, the ASA and CCI scores were worse in the EG (p = 0.001). No significant differences in the surgical approach, mini-invasive approach, conversion rate, definitive stoma creation, or number of harvested lymph nodes were found between the two groups. Overall, EG reported a higher relative risk (RR) of short-term postoperative complications (1.64, CI: 1.03–2.63), but no significant differences were found in terms of grade ≥3 complications (RR: 0.9, CI: 0.23–3.44). In the EG, a higher risk of ICU admission (RR:2.69, CI: 1.5–4.8) and a one-day longer postoperative hospital stay (6 vs. 5 days) were reported. Conclusions: Advanced age does not seem to contraindicate RCRS, especially in colorectal cancer patients. The impact of elderly age on short-term outcomes seems to be minimal and acceptable.

P008 COMPARISON OF CLINICAL OUTCOME OF ELDERLY (AGED &gt;65 YEARS) VS NON-ELDERLY HYPERTENSIVE STEMI PATIENTS: RESULTS FROM NAMI REGISTRY

Background and Objective: Elderly hypertensive ST-segment elevation myocardial infarction (STEMI) patients had increased morbidity and mortality. Little is known regarding clinical outcome of elderly hypertensive STEMI patients worldwide. This study aimed to compare clinical outcome of elderly and non-elderly hypertensive STEMI Bangladeshi patients. Methods: This prospective observational study- National Heart Foundation Hospital Acute Myocardial Infarction (NAMI) Registry was carried out in our hospital over eight years (2015-2022). All hypertensive STEMI patients were included in this study. Clinical outcome of elderly (aged &gt;65 years) and non-elderly (aged ≤65 years) patients were compared. Results: NAMI registry enrolled 10488 STEMI patients. Among them 6890 (65.69%) patients were hypertensive and included in this study. Of them 1127 (16.4%) patients were elderly, and 5763 (83.6%) patients were non-elderly. The mean age of the elderly patients was 72.93 ± 5.5 years and non-elderly patients 52.54 ± 8.69 years. Although male were predominant in both groups (79.3% vs 85.0%; p=0.001), significantly more female were in elderly group (20.7% vs 15.0%; p=0.001). Most of the elderly patients had chronic kidney disease (85.1% vs 41.3%; p=0.001). Most of the non-elderly patients were smokers (52.8% vs 41.3%; p=0.001), dyslipidemic (81.1% vs 76.0%; p=0.001), and obese (38.8% 31.4%; p=0.001). Elderly patients received less invasive therapy (thrombolytic therapy- 14.3% vs 19.0%, p=0.002; primary percutaneous coronary intervention- 10.6% vs 11.6%; pharmaco-invasive therapy-5.9% vs 11.4%, p=0.001; only percutaneous coronary intervention- 18.4% vs 20.0%) and more medical therapy (50.9% vs 38.1%; p=0.001). Elderly patients were more prone to complications (cardiogenic shock- 14.8% vs 10.8%, p=0.001; acute left ventricular failure- 33.9% vs 22.7%, p=0.001; conduction disturbance- 15.2% vs 9.7%, p=0.001; arrhythmias- 13.1% vs 8.2%, p=0.001; cardiac arrest-7.5% vs 4.7%, p=0.001; in-hospital death- 7.9% vs 4.2%, p=0.001). Conclusions: Most of the elderly hypertensive STEMI patients had chronic kidney disease, less risk factor, received less invasive therapy but more medical therapy and were more prone to complications in comparison to younger counterpart.

A Prospective Clinical Trial of Radiofrequency Ablation in Patients with Low-Risk Unifocal Papillary Thyroid Microcarcinoma Favoring Active Surveillance Over Surgery.

Background: Active surveillance (AS) of papillary thyroid microcarcinomas (PTMC) is emerging as an alternative to immediate surgery. While thermal ablation has also shown promise for low-risk PTMC, it has not been prospectively studied in patients appropriate for AS. This study aimed to evaluate the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for tumor control and quality of life (QoL) management in patients with PTMC who favored AS over immediate surgery. Methods: This prospective clinical trial was conducted at a single tertiary referral hospital from 2018 to 2021. Of 227 adult patients aged ≤60 years with low-risk unifocal PTMC favoring AS over immediate surgery, 100 patients underwent RFA for their management. The primary endpoint was the disease progression rate, and secondary endpoints were technical success, volume reduction rate (VRR), complication rates, and QoL. Results: The median age of the study population was 42 years (range, 27-59 years), and 83% (83/100, [CI: 66.1-100]) were female. The median follow-up was 30 months (range, 12-56 months). All 100 patients underwent RFA with technical success. Most of the ablation zones showed continuous volume reduction, and 95.9% (94/98, [CI: 77.5-100.0]) showed complete disappearance at the last follow-up. The median VRR was 100.0% at 1-year follow-up and persisted throughout the last follow-up. The cumulative disease progression rate among 98 patients who underwent at least 1-year follow-up was 3.1% (3/98, [CI: 0.6-9.0]); one patient had lymph node metastasis (treated with surgery), and two patients had new PTMC (1 treated with RFA, 1 ongoing AS). Major complications were not observed. Psychological (baseline vs. last follow-up, 7.3 vs. 8.0, p = 0.002) and social (8.0 vs. 8.7, p = 0.005) QoL scores significantly improved during follow-up without compromising physical QoL (8.6 vs. 8.5, p = 0.99). Conclusions: RFA can be a reasonable strategy for effectively and safely controlling tumors and improving QoL in non-elderly patients with low-risk PTMC appropriate for AS. Clinical Trial registration: This trial is registered with ClinicalTrials.gov: NCT03432299.

53658 Trends in utilization and cost of immune checkpoint inhibitors in non-elderly metastatic melanoma patients with private insurance

53658 Trends in utilization and cost of immune checkpoint inhibitors in non-elderly metastatic melanoma patients with private insurance

Critical view of safety in elderly versus non-elderly patients with acute cholecystitis: prospective observational study

Critical view of safety in elderly versus non-elderly patients with acute cholecystitis: prospective observational study

Type I Interferonopathy among Non-Elderly Female Patients with Post-Acute Sequelae of COVID-19.

The pathophysiological mechanisms of the post-acute sequelae of COVID-19 (PASC) remain unclear. Sex differences not only exist in the disease severity of acute SARS-CoV-2 infection but also in the risk of suffering from PASC. Women have a higher risk of suffering from PASC and a longer time to resolution than men. To explore the possible immune mechanisms of PASC among non-elderly females, we mined single-cell transcriptome data from peripheral blood samples of non-elderly female patients with PASC and acute SARS-CoV-2 infection, together with age- and gender-matched non-PASC and healthy controls available from the Gene Expression Omnibus database. By comparing the differences, we found that a CD14+ monocyte subset characterized by higher expression of signal transducers and activators of transcription 2 (STAT2) (CD14+STAT2high) was notably increased in the PASC patients compared with the non-PASC individuals. The transcriptional factor (TF) activity analysis revealed that STAT2 and IRF9 were the key TFs determining the function of CD14+STAT2high monocytes. STAT2 and IRF9 are TFs exclusively involving type I and III interferon (IFN) signaling pathways, resulting in uncontrolled IFN-I signaling activation and type I interferonopathy. Furthermore, increased expression of common interferon-stimulated genes (ISGs) has also been identified in most monocyte subsets among the non-elderly female PASC patients, including IFI6, IFITM3, IFI44L, IFI44, EPSTI1, ISG15, and MX1. This study reveals a featured CD14+STAT2high monocyte associated with uncontrolled IFN-I signaling activation, which is indicative of a possible type I interferonopathy in the non-elderly female patients with PASC.

Nuclear Receptors and Stress Response Pathways Associated with the Development of Oral Mucositis Induced by Antineoplastic Agents.

Oral mucositis (OM) is one of the common adverse events associated with cancer treatment that decreases the quality of life and affects treatment outcomes. However, the medications used to manage OM are generally only palliative, and our knowledge of the syndrome is limited. The etiology of the syndrome is thought to be complex and multifactorial. We investigated the trends and characteristics of OM and estimated molecular initiating events (MIEs) associated with the development of the syndrome using the FDA Adverse Event Reporting System. The study of trends and characteristics suggested that OM is significantly more likely to occur in females and nonelderly patients and is likely to be induced by protein kinase inhibitors such as afatinib and everolimus. Next, we used Toxicity Predictor, an in-house quantitative structure-activity relationship system, to estimate OM-associated MIEs. The results revealed that the agonist activity of the human pregnane X receptor, thyroid-stimulating hormone-releasing hormone receptor, and androgen receptor may be associated with OM development. Our study findings are expected to help avoid the risk of OM induction during the drug discovery process and clinical use of antineoplastic agents.

The Clinical Characteristics and Outcomes of Acute Pancreatitis Are Different in Elderly Patients: A Single-Center Study over a 6-Year Period.

Objectives: This study aims to analyze the clinical characteristics of elderly patients with acute pancreatitis (AP) and investigate the effects of age on the clinical outcomes of AP. Methods: Patients aged ≥ 18 years with AP admitted within 72 h from 1 September 2013 to 31 August 2019 were included. Patients were divided into elderly (≥60 years) and non-elderly (<60 years) groups. Clinical data and outcomes were compared. Results: A total of 756 elderly and 4896 non-elderly patients with AP were included. The elderly patients had different etiological distributions and more severe clinical markers and scores. Age was an independent risk factor for mortality [odds ratio (OR): 2.911, 95% CI: 1.801-4.706, p < 0.001], intensive care unit admission (OR: 1.739, 95% CI: 1.126-2.685, p = 0.013), persistent organ failure (OR: 1.623, 95% CI: 1.326-1.987, p < 0.001), multiple organ failure (OR: 1.757, 95% CI: 1.186-2.604, p = 0.005), and infection (OR: 2.451, 95% CI: 1.994-3.013, p < 0.001). Adjusted multiple logistic regression and trend analysis confirmed the risk of the age for the outcomes. The deaths of elderly patients showed a biphasic pattern with peaks in the first and fifth weeks, in contrast to the single peak in the first week in the non-elderly patients. Conclusions: Elderly patients with AP were associated with worse clinical outcomes. It is crucial to devote considerable attention to the optimization of therapeutic approaches to reduce late mortality in this group of patients.

Retrospective analysis of the efficacy of low-intensity extracorporeal shock wave therapy on young and middle-aged patients with erectile dysfunction responsive to PDE5Is: reducing the use of PDE5Is.

Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a new method for treating erectile dysfunction (ED), but there are no standards yet for its indications. The study aimed to suggest the early clinical efficacy of Li-ESWT and explore its related factors in young and middle-aged patients with ED who responded to phosphodiesterase type 5 Inhibitors (PDE5Is). Data from 61 patients with ED who had previously responded to oral PDE5Is and subsequently underwent Li-ESWT were collected. This included information on age, body mass index, total testicular volume, sex hormones, as well as IIEF-EF scores before treatment and at 1, 3, and 6months after treatment. The treatment regimen involves a weekly session for four consecutive weeks, with each session administering 5000 shock wave pulses. Linear regression analysis was utilized to identify factors associated with the efficacy of Li-ESWT treatment. Additionally, the improvement in different severity groups of ED before and after treatment, along with their IIEF-EF scores, was compared. Li-ESWT was more targeted and effective for young and middle-aged patients with erectile dysfunction who responded to PDE5Is. The age of enrolled patients ranges from 22 to 53years old, and the IIEF-EF scores at 1month, 3months, and 6months after treatment were compared to baseline for efficacy assessment, showing significant improvements (P < .0001) in all instances. Linear regression analysis using baseline data revealed predictive factors associated with treatment efficacy: treatment efficacy was negatively correlated with baseline IIEF-EF scores (t = -2.599, P = .013) and positively correlated with baseline LH levels (t = 2.170, P = .036). Given the considerable cost of Li-ESWT treatment and the emphasis on treatment continuity, we hope to identify the most suitable candidates for Li-ESWT therapy, thereby optimizing its application. Our findings provide a better solution for nonelderly ED patients who are responsive to PDE5Is. This study was limited by our sample size and follow-up time. After 3months of Li-ESWT, the IIEF-EF score gradually stabilizes and short-term maintenance of PDE5Is medication increases the responsiveness to shock wave therapy.