Young Elderly Patients Research Articles

The best indices of anesthesia depth monitored by electroencephalogram in different age groups

Introduction Current electroencephalogram (EEG) indices for monitoring the depth of anesthesia have not been adjusted for age. This study aims to identify the most suitable EEG indices for monitoring anesthesia depth across different age groups. Method In here, we conducted a prospective observational trial to observe whether different EEG features in different age groups can detect anesthesia depth and compare their performance. Results In Group 1, absolute θ had the highest prediction probability (Pk) value (0.78 ± 0.07), while relative γ had the lowest relative coefficient of variation (CV) value in states 1 (0.160), 2 (0.153), 3 (0.214), and 4 (0.144). In Group 2, absolute θ had the highest Pk value (0.81 ± 0.09), and relative γ had the lowest CV value in states 1 (0.159), 2 (0.178), 3 (0.140), and 4 (0.095). In Group 3, absolute δ had the highest Pk value (0.79 ± 0.08), with absolute slow wave having the lowest CV value in states 1 (0.196), 2 (0.258), 3 (0.295), and 4 (0.181). In Group 4, absolute δ had the highest Pk value (0.75 ± 0.10), and absolute slow wave had the lowest CV value in states 1 (0.176), 2 (0.192), 3 (0.185), and 4 (0.144). Conclusions In this study, we found that absolute θ and relative γ are the most suitable choices for young and middle-aged patients, while absolute δ and absolute slow wave are the most suitable choices for young elderly and elderly patients.

Risk factors for occurrence and progression of external auditory canal cholesteatoma

ObjectiveExternal auditory canal cholesteatoma (EACC) is characterized by retained squamous debris within the external canal and variable amounts of localized bone destruction. The etiology of primary EACC remains incompletely understood. This study was conducted to analyze the clinical features and backgrounds of patients with primary EACC and to clarify the risk factors for the occurrence and progression of EACC. MethodsSixty-nine ears of 62 patients diagnosed with primary EACC were included in this study (EACC group). Additionally, 74 ears of 60 patients with chronic otitis media (COM) with perforation who underwent tympanoplasty or myringoplasty were included as controls (COM group). We retrospectively investigated the clinical features, life history, and medical history of the patients in both groups. In addition, to investigate the risk factors for progression of EACC, we compared the clinical features and medical history of patients with stage IV (advanced) disease versus stage I + II (mild) disease. ResultsThe inferior wall of the bony canal was the main structure affected in patients with primary EACC of all stages. The following factors were significantly more common in the EACC than COM group: older age, female sex, left-sided disease, osteoporosis, renal dysfunction, anemia, and treatment with bisphosphonates. Among these, the most significant factor associated with EACC was renal dysfunction (odds ratio, 11.4; 95 % confidence interval, 2.32–55.9). The significant factors observed in patients with stage IV disease were younger age, male sex, posterior wall involvement, and otorrhea. Surgical treatment was required for more than half of the patients with stage III and IV EACC. ConclusionPatients with renal dysfunction are at risk of primary EACC. In particular, younger patients and relatively younger elderly patients with posterior wall involvement have a risk of progression to advanced-stage EACC. Canalplasty should be considered in patients with EACC who have these risk factors to prevent progression to advanced-stage disease.

An 11-Year-Long Analysis of the Risks Associated With Age in Patients Undergoing Anterior Cervical Discectomy and Fusion in a Large, Urban Academic Hospital.

A retrospective database study of patients at an urban academic medical center undergoing an Anterior Cervical Discectomy and Fusion (ACDF) surgery between 2008 and 2019. ACDF is one of the most common spinal procedures. Old age has been found to be a common risk factor for postoperative complications across a plethora of spine procedures. Little is known about how this risk changes among elderly cohorts such as the difference between elderly (60+) and octogenarian (80+) patients. This study seeks to analyze the disparate rates of complications following elective ACDF between patients aged 60-69 or 70-79 and 80+ at an urban academic medical center. We identified patients who had undergone ACDF procedures using CPT codes 22,551, 22,552, and 22,554. Emergent procedures were excluded, and patients were subdivided on the basis of age. Then each cohort was propensity matched for univariate and univariate logistic regression analysis. The propensity matching resulted in 25 pairs in both the 70-79 and 80+ y.o. cohort comparison and 60-69 and 80+ y.o. cohort comparison. None of the cohorts differed significantly in demographic variables. Differences between elderly cohorts were less pronounced: the 80+ y.o. cohort experienced only significantly higher total direct cost (P = .03) compared to the 70-79 y.o. cohort and significantly longer operative time (P = .04) compared to the 60-69 y.o. cohort. Octogenarian patients do not face much riskier outcomes following elective ACDF procedures than do younger elderly patients. Age alone should not be used to screen patients for ACDF.

The Emergency Surgery Frailty Index (EmSFI) in Elderly Patients with Acute Appendicitis: An External Validation of Prognostic Score

BackgroundIdentification of reliable risk-stratification tools is critical for surgical decision making, particularly in frail and elderly. The aim of the study is to validate the Emergency Surgery Frailty Index (EmSFI), in over 65 years old patients operated on for acute appendicitis.MethodsAn observational study was conducted enrolling elderly patients with diagnosis of acute appendicitis who underwent emergency appendicectomy or right colectomy, between 2016 and 2021. All patients were treated according to the last SIFIPAC/WSES/SICG/SIMEU guidelines.ResultsOverall, 61 patients were analyzed. Complication rate was higher for patients in the second EmSFI risk Class. Moreover, ROC analyses identified 3 as the best cutoff value in predicting risk of adverse postoperative events. Complication rate was higher in oldest elderly patients—over 80 years—(42.9 vs 22.5%; p 0.05) and was mainly related to medical complications (42.9 vs 12.5%, p 0.007). However, intestinal obstruction, peri-appendicular abscess on preoperative CT, peritonitis and a longer duration of surgery are related with increased risk of complications in the group of patients under 80 years.ConclusionThe EmSFI score results a valid prognostic marker for frailty status, and it may support the surgeon in emergency setting for acute appendicitis. Patients aged 80 years or older have a higher risk of complications, independent from those factors which relate to increased morbidity in younger elderly patients. Age alone is not a reliable indicator of the real surgical risk, but it must encourage the adoption of multidisciplinary collaborative models of care for this group of patients.

A web-based calculator combining Geriatric Nutritional Risk Index (GNRI) and Tilburg Frailty Indicator (TFI) predicts postoperative complications among young elderly patients with gastric cancer.

Nutritional status and frailty are significant indicators reflecting physiological reserve. We sought to establish and validate a web-based calculator containing the Geriatric Nutritional Risk Index (GNRI) and the Tilburg Frailty Indicator (TFI) together with general clinical information to predict total complications among elderly patients with gastric cancer. This was a prospective cohort study of 582 elderly patients with gastric cancer in a tertiary hospital in China. Nutritional status and frailty were assessed by the GNRI and the TFI, respectively. The nomogram was built and further converted into a web-based calculator. The receiver operating characteristic analysis was performed to evaluate the discrimination of the nomogram. Calibration was assessed using the calibration curve and Hosmer-Lemeshow test via the bootstrap resampling procedure. The decision curve analyses (DCAs) were employed to quantify the net benefits of a certain threshold probability for assessing the clinical values. The GNRI (odds ratio [OR],0.921; 95% confidence interval [CI],0.895-0.949; P < 0.001), the TFI (OR,1.243; 95% CI,1.113-1.386; P < 0.001), surgical approach (OR,1.913; 95% CI,1.073-3.408; P=0.028) and comorbidity (OR=1.599, 95%CI=1.028-2.486, P=0.037) were independently associated with total complications. The nomogram demonstrated good discrimination (area under the receiver operating characteristic curve: training cohort,0.735; validation cohort,0.777) and calibration (P=0.135). The DCA curves of the nomogram also showed good positive net benefits. The web-based calculator incorporating the GNRI, the TFI, surgical approach, and comorbidity could successfully predict total complications among elderly patients with gastric cancer with good accuracy in a convenient manner. Geriatr Gerontol Int 2023; 23: 205-212.

Multi-institutional study on the role of post-operative radiotherapy in elderly patients with endometrial cancer

ObjectiveTo investigate the prognostic factors for survival and toxicities in elderly (≥65 years) patients with endometrial cancer who underwent post-operative radiotherapy. Additionally, to compare the treatment outcomes between the older...

Unincreased risk of hospitalized infection under targeted therapies versus methotrexate in elderly patients with rheumatoid arthritis: a retrospective cohort study

BackgroundInfection is one of the primary concerns during treatment for rheumatoid arthritis (RA) in elderly patients. However, infection risk of patients with RA receiving targeted therapy (TT) including biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKIs) in elderly patients are scarce. The aim of this study was to compare the risk of hospitalized infection (HI) with TT versus methotrexate (MTX) therapy among young, elderly, and older elderly patients with RA.MethodsUsing Japanese claims data, patients satisfying the following criteria were enrolled: (1) ≥ one ICD10 code for RA; (2) ≥ one prescription of MTX or TT (bDMARDs and JAKIs) between April 2008 and September 2018; and (3) ≥16 years old. We calculated the incidence rate (IR) of HI per 100 patient-years in the young, elderly, and older elderly groups (those aged 16–64, 65–74, and ≥75 years, respectively) and the IR ratio (TT vs. MTX) of HI. A logistic regression model was used to estimate the associations between HI and TT versus MTX in each group.ResultsThe overall IR of HI per 100 patient-years (95% confidence interval) was 3.2 [2.9–3.5], 5.0 [4.6–5.4], and 10.1 [9.5–10.9] in the young, elderly, and older elderly groups, respectively. Concomitant use of MTX or immunosuppressive DMARDs with TT was less frequent in the elderly and older elderly groups. The adjusted odds ratio of TT vs. MTX for HI was 1.3 (1.0–1.7; p = 0.021), 0.79 (0.61–1.0; p = 0.084), and 0.73 (0.56–0.94; p = 0.015) in the young, elderly, and older elderly groups, respectively.ConclusionThe overall IR of HI was increased with age. The risk of HI under TT compared to MTX was not elevated in elderly and older elderly patients after adjusting for patients’ characteristics and concomitant treatments.

P-224 Тoxicity and tolerability of the mFOLFIRINOX regimen in young elderly and older elderly patients with pancreatic carcinoma (PC)

Currently, the median age of PC patients is about 70 years. By 2030 nearly 70% of PC are expected to be diagnosed in the elderly. These patients are poorly represented in large clinical trials. Hence, there are limited data about the tolerability and efficacy of mFOLFIRINOX regimen in elderly patients. Methods We retrospectively analyzed the data of patients with PC 60 years and older who were treated with mFOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 150 mg/m2, leucovorin 400 mg/m2, 5FU 2400 mg/m2 for 46h) regimen in our center. Results Between 2010 and 2021 104 patients were included in the analysis. 92 patients were young elderly (60-74 years) and 12 were older elderly (75-90 years). The median age was 68 (range, 60 - 78). mFOLFIRINOX was administered postoperatively, as part of induction therapy in borderline/locally advanced or as palliative chemotherapy in 1, 42 and 61 patients, respectively. All patients had ECOG PS 0-2. Most common all grade and grade 3/4 toxicity were neutropenia (69,2% and 42,3%), febrile neutropenia (5,8%), thrombocytopenia (21,2% and 0,96%), anemia (17,3%), diarrhea (41,3% and 8,7%), nausea/vomiting (58,7% and 3,8%), asthenia (50,9% and 3,8%), neurotoxicity (20,1% and 0,96%). Dose reduction was performed in 45 patients (43.2%), 7 (6.7%) permanently discontinued treatment due to toxicity. The median number of cycles administered was 6 (range, 1 - 17). Primary and secondary G-CSF prophylaxis was used in 23% and 28.8% of patients, respectively. No treatment-related deaths were observed. Of the 104 patients, 12 were older elderly. The median age was 76 years (range 75-78). Dose reduction was required more often than the young elderly (58.3% vs 41,3%), but no patient stopped treatment due to toxicity. Most common all grade and grade 3/4 toxicity in older elderly group were neutropenia (16,7% and 50%), thrombocytopenia 1/2 grade (25%), diarrhea (58,3% and 25%), asthenia (66,7% and 0%). Tolerability didn’t differ between ECOG status. mFOLFIRINOX regimen is tolerable and demonstrates manageable toxicity in selected elderly patients with pancreatic carcinoma. This is a retrospective analysis of older patients with pancreatic adenocarcinoma treated with the mFOLFIRINOX regimen. Ages Eligible for Study: 60 Years and older Sexes Eligible for Study: All Criteria Inclusion Criteria: Histologically-confirmed pancreatic adenocarcinoma No prior chemotherapy for pancreatic cancer. ECOG performance status ≤3 Exclusion Criteria: Prior chemotherapy or any other investigational agents for the treatment of pancreatic cancer Concurrent use of any other anti-cancer therapy, including chemotherapy, targeted therapy, immunotherapy, or biological agents. The authors.

Decision-making and treatment results of complex proximal humeral fractures in geriatric patients: retrospective study from a level 1 trauma centre

Proximal humeral fractures are common in elderly, but despite the high incidence, optimal treatment is still discussed and remains a topic of controversy. Nonoperative treatment continuous to be the main modality. However, due to advancements in surgical technology with new techniques and implants, operative treatment could lead to better outcomes and less complications, even in older patients. Decision-making in elderly should incorporate comorbidities, activity level and patient expectations. This study was performed with the intention to find out, if there is a significant difference in treatment strategy and number of operations, in the last five years. Patients older than 65 years with proximal humeral fractures were included. Retrospective analysis of radiographic material and post-injury data was performed, from patients treated in 2015, 2019 and 2020. Last two years were also compared separately to exclude the effect of Coronavirus disease 2019 (COVID-19) pandemic. Epidemiological data assessment, fracture type and treatment strategy were analysed for corresponding years. Statistical analysis was focused on complex three-and four-part fractures. There were no statistically significant differences regarding incidence between the analysed years. Low energy fall was the mechanism of injury in majority of patients. Patients with tuberosity fractures were in average younger than patients in other groups. Although there were more computed tomography (CT) scans done in younger elderly patients, there was no significant difference in number of CTs compared to older patients (year 2015: p = 0.246; year 2019: p = 0.710, year 2020: p = 0.849). The number of operative interventions was the lowest in 2019 (p = 0.498) and the same was for the osteosynthesis using intramedullary nails (p = 0.014). Frequency of reversed shoulder arthroplasty surgeries is increasing, but the difference is not significant (p = 0.390). Both operative and nonoperative treatment result in similar range of motion (ROM) measurements (p = 0.164 for anteflexion. p = 0.163 for abduction), however the groups were not comparable regarding exact fracture types. In the analysed period of 5 years, epidemiology and treatment strategy of proximal humeral fractures did not change. Nonoperative approach remained the main treatment modality. No significant difference was noted in number of interventions or implants used, although there seemed to be an increased trend towards treatment with reverse shoulder arthroplasty (RSA) in complex fractures. A strong correlation was observed between radiographic indications for conservative treatment and actual implementation of it. However, when surgical treatment was indicated using the same radiological criteria, there were more than half of patients, who were not operated on. Radiologic indications are thus not enough for decision-making in treatment of three- and four-part fractures, and patient factors, such as comorbidities and pre-injury activity level, play a major role.

1365 Analysis of Outcomes Pre- and Post-Physiotherapy Protocol for Centenarian Patients Presenting with Neck of Femur Fractures

Abstract Aim The number of centenarians has quadrupled over the last 2 decades with an increase in the number presenting with proximal femur fractures. Very little is known about mortality and morbidity in this age group. There is a subjective assumption that they are too frail and may not do well with surgery. This audit aims to outline improved outcomes of surgery in centenarian patients with NOF fractures following dedicated modified physiotherapy intervention. Method Data reviewing centenarian NOF outcomes over a two-year period (2015-2016) was compared with outcomes following a dedicated post-operative physiotherapy trust protocol for centenarian NOF patients. 16 patients (15 female, 1 male) from Jan 2017- August 2019 were identified. Data was analysed for patient demographics, surgical details including anaesthesia, post-operative complications, physiotherapy outcomes and mortality. Results 10 patients had dynamic hip screws and 6 patients had hemiarthroplasties. Inpatient mortality was 0% compared to previous audit of 8.3%. The average length of stay had reduced from 23.3 days in previous audit to 18.5 days in current. 82% of patients could transfer with frame in the post-operative period. Conclusions Positive surgical outcomes are demonstrated even in centenarians particularly when given tailored post-operative physiotherapy with reduced length of stay, mortality, and high levels of physiotherapy compliance. Comparisons with younger elderly patients will help guide future management.

Effect of controlling optical wavelength by spectacle lenses on visual quality

In this study, the effects of selectively yellow-cut lenses on contrast sensitivity were investigated in healthy young and middle-aged individuals and elderly patients with cataract. Contrast sensitivity in middle-aged healthy individuals and elderly patients with cataract was higher when measured while the subjects were wearing selectively yellow-cut lens (NeoContrast; Mitsui Chemicals, Inc., Tokyo, Japan) compared to no yellow-cut lens. Controlling optical wavelength could provide an improved quality of vision through improved visibility.

Anti-osteoporosis medication treatment pattern after osteoporotic fracture during 2010-2016 in Fujian, China.

The objective of this study was to investigate the prescription patterns and related influencing factors of anti-osteoporosis drug prescribing after osteoporotic fracture in Fujian, China, between 2010 and 2016. This is a retrospective cohort study based on an existing electronic health record database (National Healthcare Big Data in Fuzhou, China, 37 hospitals included). Patients over 50 years old with newly diagnosed osteoporotic fractures between 2010 and 2016 were included. Postfracture osteoporosis therapies were summarized by overall and fracture site. Multivariate logistic regression was performed to identify influencing factors of anti-osteoporosis medication (AOM) prescription. Overall, 22.1% of women and 9.5% of men over 50 years old received AOM treatment after osteoporotic fracture within 1 year during 2010-2016, with particular low use of bisphosphonates, 5.3% in women and 1.5% in men. The highest rate of AOM treatment was found in patients with hip fracture (24.5%), followed by vertebral fracture (14.2%) and wrist fracture (2.3%). Of the AOM-treated patients, 90.5% received calcitonin therapy. The treatment rate of AOM showed a slight decline during 2010-2016, but steady rise trends were observed in Ca/vitamin D (VD) prescription. Hospital level, age, sex, previous osteoporosis, previous AOM prescription, and previous oral glucocorticoid prescription were strong predicting factors of AOM prescription. In a real-world setting, AOM treatment was suboptimal and the treatment rate even decreased over time among osteoporosis fracture patients in Fujian, China. The suboptimal treatment was particularly critical among men, low-level hospitals, wrist/vertebral fracture, and the younger elderly patients.

Displaced femoral neck fractures in patients 60-69 years old – treatment and patient reported outcomes in a register cohort

BackgroundSeveral randomized studies have compared arthroplasty and internal fixation (IF) and found better patient reported outcome measure (PROM) and fewer reoperations for arthroplasty. But consensus is lacking regarding which method to use in the "young elderly” patients aged 60-69; IF tend to fail in up to 1/3 of the cases but can offer the benefits of a biologically intact hip if successful. To add to this, revision of failed IF with secondary arthroplasty has increased risk for complications. This register study aims to describe current treatment and mortality rates for displaced hip fractures based on register data, with focus on young elderly. A secondary aim is to compare changes in PROM between treatments. MethodsData was retrieved from the Swedish Fracture Register, SFR. We found 9,564 femoral neck fractures classified as displaced (AO/OTA 31-B3) in patients 60 years or older. 883 patients were aged 60-69 years. In the final analysis of treatment allocation and PROM mean differences, 723 of these met the inclusion criteria. We adjusted for age, sex and baseline PROM, in patients treated with either IF or total hip arthroplasty (THA) in a regression model. ResultsIn the 60-69 years group, THA was used in 512 (58%), IF 211 (24%) and hemi arthroplasty (HA) 160 (18%) of the patients. As HA patients differed from those selected to THA and IF in regards to baseline characteristics and response rates, we omitted them from the PROM-analysis. When comparing only THA and IF we found no significant differences in mortality nor PROM means one year after injury. Treatment with THA was more common in women. Conclusions: In young elderly patients THA is a common treatment for displaced FNF in Sweden. Patients in this segment treated with HA differ from patients treated with THA and IF, with baseline results in PROM indicating poorer health and function, as well as higher mortality and lower response rates. We found no differences in crude mortality between IF and THA treatment, and no significant influence from treatment on PROM outcome comparing THA and IF.

Sacral Reflex Characteristics of Patients with Multiple System Atrophy.

Objectives To observe and analyze the parameters of the sacral reflex and pudendal nerve somatosensory evoked potential (SSEP) in patients with multiple system atrophy (MSA) with respect to factors such as age, disease course, and subtype and provide evidence for the clinical diagnosis of MSA. Materials and Methods A total of 51 MSA patients and 30 healthy controls were selected from the First Affiliated Hospital of Wenzhou Medical University from May 2013 to November 2015. Electrophysiological sacral reflex detection and SSEP detection were performed using the Keypoint EMG/EP system. The extraction rate, latency, and amplitude of the sacral reflex and SSEP in the MSA group and control group were compared. Results The sacral reflex latency and amplitude in patients with MSA were statistically different from those of the healthy controls. The latency of sacral reflex increases with the prolongation of the disease course, and the amplitude and initiation rate decrease with the prolongation of the disease course. There was no significant difference in sacral reflex latency and amplitude between MSA patients of different ages and subtypes. There was no significant difference in the latency or amplitude of SSEP between the MSA group and healthy control group. Conclusions The latency of sacral reflex increases with the prolongation of the disease course, and the amplitude and extraction rate decrease with the prolongation of the disease course. There was no significant difference in the parameters of sacral reflex between young MSA patients and elderly patients. And there was no statistically significant difference between MSA-P subtypes and MSA-C subtypes. This trial is registered with ISRCTNCR2009041.

Outcomes in a Case Series of Elderly Patients with Aneurysmal Subarachnoid Hemorrhages in the Barrow Ruptured Aneurysm Trial (BRAT)

Aneurysmal subarachnoid hemorrhage (aSAH) is debilitating in elderly patients, but literature regarding this population is scarce, and clinical decision-making remains debated. Outcomes of elderly patients with aSAH stratified by age and clinical presentation were analyzed. Patients treated for aSAH were retrospectively analyzed. Patients were trichotomized into a young cohort (aged <60 years [n= 268]) and 2 elderly cohorts (aged 60-65 years [n= 60] and ≥65 years [n= 77]). The elderly cohorts were analyzed by poor or good scores at presentation (Hunt and Hess [HH] score >3 vs. ≤3, respectively) and poor functional outcome (modified Rankin Scale score >2). Of 137 elderly patients, 121 had a 6-year follow-up. The >65-year-olds (75% [52/69]) were more likely to have poor functional outcomes than the 60 to 65-year-olds (48% [25/52]) (odds ratio, 3.3; 95% confidence interval, 1.5-7.1; P= 0.002). Among those with an HH score ≤3 at presentation (n= 90), the >65-year-old cohort had poorer outcomes than the 60 to 65-year-old cohort at 6-year follow-up (69% [35/51] vs. 36% [14/39], respectively; odds ratio, 3.9; 95% confidence interval, 1.6-9.4; P= 0.003). Among patients with an HH score >3, no statistically significant differences in functional outcome were observed between the >65-year-old (n= 18) and 60 to 65-year-old (n= 13) cohorts. Elderly patients with aSAH are at high risk for poor functional outcomes. However, among those presenting with good HH scores, younger-elderly patients (aged 60-65 years) tend to fare better than older-elderly patients (aged >65 years). Elderly patients presenting with high-grade aSAH fare poorly regardless of age, which can inform clinical decision-making and prognostication.

The effects of comorbidity factors on the prognosis in geriatric sepsis patients in the intensive care unit

Mortality rates in geriatric sepsis patients are very high in the intensive care unit. The aim of our study is to evaluate the prognosis of geriatric patients diagnosed with sepsis according to age groups in the intensive care unit. The data of 189 geriatric patients were reviewed retrospectively. Elixhauser Comorbidity index was calculated. The patients were divided into three different age groups young-old (65-74 years), middle-old (75-84 years) and oldest-old (85 years and above). The prognosis was evaluated in patients with Elixhauser Comorbidity index score ≥ 10. The mean length of ICU stays of those aged over 85 years (21.10±23.75) and 75-84 years (17.45±20.59) was compared with that of 65-74-year-old patients (10.23±12.19). Young elderly patients had shorter length of ICU stay than other groups (95% confidence interval) (p=0.01 p0.05). Oldest-old and middle-old patients’ length of stay in the intensive care unit was longer period than young-old patients. Mortality rate in geriatric sepsis patients with Elixhauser Comorbidity Index was greater than 10 is over 70%, but ICU stay did not affect 30-day mortality.

2206. Patterns of Care and Outcomes in Elderly Patients Hospitalized with Community-acquired Pneumonia in the United States

BackgroundCommunity-acquired pneumonia (CAP) is a common cause of morbidity and mortality in the elderly. Few studies compare the elderly (>65) and very elderly (≥85 years). We aimed to describe characteristics and patterns of care for very elderly patients hospitalized with CAP.MethodsWe conducted a retrospective cohort study using administrative data from 2010 to 2015 of about 660 US hospitals in the Premier database. Adults aged ≥65 years hospitalized with CAP, identified by either a principal ICD-9 code of pneumonia or a principal diagnosis of sepsis or respiratory failure coupled with a secondary code for pneumonia, were included. We compared demographics, insurance status, comorbidities, presentation characteristics and treatments among three age groups: 65–74, 75–84, and ≥ 85 years.ResultsThe final sample included 488,382 patients aged ≥65 years, a third of whom were ≥85 years. Geriatricians cared for <1% of patients during hospitalization, regardless of patient age. Compared with those aged 65–74 years, the patients ≥85 were more likely to be female, of white race, have Medicare insurance, and a principal diagnosis of aspiration pneumonia (17.1% vs. 7%) (Table 1). The oldest group had higher rates of cardiac comorbidities, chronic kidney disease and dementia, but lower rates of diabetes, obesity, pulmonary disease, and smoking. On presentation, more of the very elderly had concomitant urinary tract infections. They were less likely to receive opiates and benzodiazepines, but more likely to receive foley catheters and antipsychotic medications. Antibiotics given in the first 2 days were similar across the groups. Fewer very elderly patients were admitted to the ICU or got ventilation compared with younger groups. More of the very elderly were discharged to hospice and fewer were discharged home. Compared with younger ages, the very elderly had similar lengths of stay but lower costs, and higher in-hospital mortality and 30-day readmission.ConclusionThe very elderly represent a unique population with distinct clinical characteristics and outcomes from younger elderly patients. They have different co-morbidities and appear to receive less aggressive treatment with lower costs and higher mortality despite similar lengths of stay. Disclosures All authors: No reported disclosures.

P2687Impact of cardiovascular risk factors on effectiveness of remote ischemic preconditioning in the setting of ischemia/reperfusion-injury in a langendorff heart model

Abstract Introduction Cardiovascular diseases are the most frequent cause of death in the western world. During myocardial infarction both, ischemia and reperfusion after therapeutic intervention cause myocardial damages, resulting in ischemia/reperfusion-injury (I/R-injury). Research therefore searches cardio protective interventions, aiming to reduce myocardial injury and following consequences such as heart failure. A promising method, named Remote Ischemic Preconditioning (RIPC), consists of transient local ischemia distant from the heart. Its cardio-protective effects were already proved in basic research but failed in clinical trials. Purpose The aim of the study is to examine the impact of cardiac risk factors like diabetes mellitus (DM) or age on effectiveness of RIPC in order to identify distinct groups of patients who might benefit from RIPC in the clinical setting and to reveal the effectiveness of cardioprotection delivered by plasma samples of these groups of patients. Methods RIPC (3 x 5 min arm ischemia, induced by an inflated blood pressure cuff) was performed on young and healthy volunteers and elderly patients with coronary heart disease with or without diabetes mellitus. Blood was taken before (Baseline) and 30 minutes after the intervention. The coronary system of murine hearts in a Langendorff heart model was perfused using dialysate from the human plasma obtained before and after RIPC. This was followed by 40 minutes of global ischemia. After 60 minutes of reperfusion left ventricular function was analysed. The infarct size was measured after 120 minutes reperfusion time using a TTC staining. Results Addition of dialysate of plasma obtained from healthy volunteers after RIPC to the coronary system of Langendorff perfused murine hearts significantly improved the recovery of left ventricular developed pressure (39±15.1 vs 26±8.5% of baseline levels, p=0.04) and reduced the infarct size (37.5±15.6 vs 21.2±11.4% of the ventricular volume, p=0.03) compared to baseline-dialysate treated controls. While plasma dialysate obtained from elderly patients with DM undergoing RIPC failed to show significant cardio protective effects of RIPC, murine hearts treated with plasma dialysate of elderly patients with coronary heart disease without diabetes after undergoing RIPC showed significant improvement of cardiac function (20±6.5 vs 24±7% of baseline levels, p=0.02) and infarct size (33.2±8.0 vs 11.1±2.5% of the ventricular volume, p=0.01). Conclusion The cardio-protective effect of RIPC on myocardial function and infarct size after I/R is influenced by diabetes but not by age or the presence of coronary heart disease. In consequence, RIPC might protect patients with coronary heart disease without DM but not diabetic patients from cardiac I/R injury. This important finding potentially explains why RIPC yielded promising results in various basic science experiments but failed to show cardio protective effects in clinical trials. Acknowledgement/Funding Forschungskommission of the Faculty of Medicine of the Heinrich-Heine-University Düsseldorf

Analyzing the regulation of miRNAs on protein-protein interaction network in Hodgkin lymphoma

BackgroundHodgkin Lymphoma (HL) is a type of aggressive malignancy in lymphoma that has high incidence in young adults and elderly patients. Identification of reliable diagnostic markers and efficient therapeutic targets are especially important for the diagnosis and treatment of HL. Although many HL-related molecules have been identified, our understanding on the molecular mechanisms underlying the disease is still far from complete due to its complex and heterogeneous characteristics. In such situation, exploring the molecular mechanisms underlying HL via systems biology approaches provides a promising option. In this study, we try to elucidate the molecular mechanisms related to the disease and identify potential pharmaceutical targets from a network-based perspective.ResultsWe constructed a series of network models. Based on the analysis of these networks, we attempted to identify the biomarkers and elucidate the molecular mechanisms underlying HL. Initially, we built three different but related protein networks, i.e., background network, HL-basic network and HL-specific network. By analyzing these three networks, we investigated the connection characteristic of the HL-related proteins. Subsequently, we explored the miRNA regulation on HL-specific network and analyzed three kinds of simple regulation patterns, i.e., co-regulation of protein pairs, as well as the direct and indirect regulation of triple proteins. Finally, we constructed a simplified protein network combined with the regulation of miRNAs on proteins to better understand the relation between HL-related proteins and miRNAs.ConclusionsWe find that the HL-related proteins are more likely to connect with each other compared to other proteins. Moreover, the HL-specific network can be further divided into five sub-networks and 49 proteins as the backbone of HL-specific network make up and connect these 5 sub-networks. Thus, they may be closely associated with HL. In addition, we find that the co-regulation of protein pairs is the main regulatory pattern of miRNAs on the protein network in the HL-specific network. According to the regulation of miRNA on protein network, we have identified 5 core miRNAs as the potential biomarkers for diagnostic of HL. Finally, several protein pathways have been identified to closely associated with HL, which provides deep insights into underlying mechanism of HL.

Outcome analysis of osteosynthesis versus hemiarthroplasty for the treatment of displaced femoral neck fracture in young elderly patients of Northern India

Objective: The objective of this study lies in the outcome analysis of osteosynthesis versus hemiarthroplasty for the treatment of displaced femoral neck fracture in young elderly patients of northern India. Study Design: Retrospective study. Setting and Duration: This study was conducted at the Department of Orthopaedics, Institute of Medical Sciences, Benaras Hindu University (BHU), at a trauma center setting from January 2015 to January 2017 and were followed up for an average duration of 12 months. Methods: Patients of displaced neck of femur fracture (Pauwell's Types III and IV) divided into two groups who were treated with osteosynthesis with cannulated cancellous screws versus hemiarthroplasty at a trauma center, BHU, were considered for this study, and their retrospective data were analyzed for the incidence of union, infection, functional outcome, and complications in the osteosynthesis versus hemiarthroplasty group. Out of a total of 84 patients studied, 40 belonged to the osteosynthesis group and 44 belonged to the hemiarthroplasty group. Results: In terms of functional outcome, the hemiarthroplasty group consistently outperformed the osteosynthesis group using Harris Hip Score and Palmer and Parker mobility score. This difference was found statistically significant (P = 0.003). As for the complications, in the osteosynthesis group, 6 patients suffered avascular necrosis of the femoral head and 12 patients suffered nonunion of the femoral head with screw cutout. This led to the reoperation of 16 patients. None of the patients in the osteosynthesis group suffered infection. In the hemiarthroplasty group, one patient suffered infection leading to reoperation and thorough debridement of one hip. Hemireplacement group showed a significantly lower percentage of complication as compared to the osteosynthesis group. Conclusion: It is evident that the functional outcome is much better in the hemiarthroplasty group as compared to the osteosynthesis group in displaced femoral neck fractures. Advantages of hemiarthroplasty are early mobilization and rehabilitation, early return to work as compared to the osteosynthesis group which has higher incidence of nonunion, screw cutout, delayed rehabilitation, and prolonged period of nonweight bearing. A significant disadvantage of osteosynthesis is prolonged immobilization, which has cost implications and loss of daily wages in a low-resource country like India.