Younger Group Research Articles

041. A Case of Cholangiocarcinoma in A Young Adolescent

Background: Cholangiocarcinoma usually occurs in 50-70 years age group. Recent study showed an increased incidence in younger age group. We describe a case of Cholangiocarcinoma in an adolescent girl in order to understand its natural history. Case: A 16 year old girl presented with 2 months history of jaundice, itchyness, right upper quadrant abdominal pain, pale stool and dark urine. Initial investigation showed : Total Bilirubin 8.87, (Direct 3.53, Indirect 12.40), SGOT 75, SGPT 56, ALP 240, GGT 59, Hepatitis B and C negative, AFP 1.96, CA19-9 3.1, and CEA 5.1. Imaging showed dilated hepatic duct with 1.5cm mass in mid-Common Bile Duct (CBD). Due to unforeseen personal circumstances, surgery was done 16 months from onset of complaints. Tumor was found at junction of cystic duct + CBD. The CBD and Gallbladder was resected (with frozen section), lymph node dissected along hepatic artery, Roux-en-Y hepaticojejunostomy anastomosis and Jejuno-Jejunostomy anastomosis was performed. Histopathology showed Cholangiocarcinoma grade 2 with perineural + lymphovascular invasion, and malignant cells’ perineural invasion at proximal margin. She underwent adjuvant chemotherapy (Gemcitabine + Cisplatin). CT scan 6 months post Chemotherapy showed 3cm lesion in CBD. After a further 2 months of chemotherapy, CT evaluation showed no residual mass left. Conclusion: This highlight that despite significant time lapse from onset of symptoms, surgery with curative intent may still be considered. Secondly, chemotherapy is an extremely important part of the treatment, especially in presence of malignant cells at resection margin.

Assessing Pain Levels Using Bioelectrical Impedance in Low Back Pain Patients: Clinical Performance Evaluation.

Musculoskeletal pain is one of the leading causes of years lived with disability worldwide and has a negative impact on daily life and quality of life. The purpose of this study was to analyze the electrical characteristics of back pain by measuring and calculating bioelectrical impedance variables (R, Z, PA) in 85 subjects (45 in the Healthy group and 40 in the LBP group). Additionally, impedance measurements were conducted on 20 subjects (10 in the Young group and 10 in the Older group) to assess the impact of aging. Bioelectrical impedance parameter values were higher in cases of back pain, and correlation analysis showed that there was a statistically significant difference between the Healthy and LBP groups (p < 0.05). A positive correlation was found between impedance parameters and pain related indices (ODI, RMDQ, VAS) (mean R, Z, PA: 0.68, 0.54, 0.75), with BMI positively correlating only with PA (0.493). Diagnostic accuracy for detecting back pain exceeded 95% (R, Z, PA: 0.984, 0.984, 0.963). Results indicated that aging did not significantly affect impedance values. The bioelectrical impedance measurement device used in this study, with its simultaneous diagnostic and therapeutic capabilities, proved useful for real-time pain diagnosis and treatment monitoring, highlighting its potential clinical utility.

Comparison of Short Fast Fourier Transform and Continuous Wavelet Transform in Study of Stride Interval

Neurodegenerative diseases (NDD) are a heterogeneous group of complex diseases characterized by neuronal loss and progressive degeneration of different areas of the nervous system. Gait analysis presents an early recognition system for NDD which is important to increase the patient’s awareness of their health conditions. However, it is very difficult to identify and formulate suitable digital biomarkers from the data collected from gait experiments such as stride interval and swing. The objective of this paper is to compare the result of Short - Time Fourier Transform (STFT) and Continuous Wavelet Transform (CWT) on the collected stride interval of healthy young people and healthy old people. In this paper, STFT and CWT are performed on the collected stride interval and from the result of the STFT and CWT, further features are extracted like instantaneous RMS and maximum RMS value. STFT is performed on the collected stride interval from a window length of 64 to 512 while CWT is performed on the collected stride interval from the scale of 128 to 2048. The processing time of the STFT and CWT with varied window lengths and scales respectively are collected. Besides, the actual maximum time from the time - frequency plot derived from STFT and CWT is also collected. Both STFT and CWT show that the young group has a higher maximum RMS, an indication of higher stride interval than the old group and higher variance, an indication of higher gait complexity. The suitable window lengths for STFT in analyzing the stride interval are 64 and 128 while the scale for CWT should be set to the lowest scale. Overall, STFT with a window length of 64 and 128 is better in analyzing the stride interval due to low processing time at the expense of slightly less accurate time - frequency representation.

Differences in Fibromyalgia Characteristics by Mode of Commute and Age in Women: The Al-Ándalus Project.

This study aimed to test whether fibromyalgia-related characteristics differ by mode of commute and by age in women with fibromyalgia. A total of 450 women with fibromyalgia (aged 52.0 ± 8.0 years old) were included. Data on their body composition, socioeconomic factors, health-related quality of life (HRQoL), depressive symptoms, sleep quality, pain-related outcomes, fatigue, and mode of commute, as well as the impact of fibromyalgia on their lives, were obtained. We performed linear regression analyses to test the differences in fibromyalgia-related characteristics between the participants engaged in active/passive modes of commuting. To analyze in depth the differences, a one-way analysis of covariance with Bonferroni's correction for multiple comparisons was conducted. In the younger group, active commuters presented differences in fibromyalgia-related characteristics (all, p < 0.01): they were less impacted by having fibromyalgia, had lower levels of fatigue, and had a higher HRQoL than passive commuters. We observed no differences in symptoms between active and passive commuters in the older group (all, p > 0.05). The possible positive effect of active commuting on fibromyalgia-related characteristics might be reduced by age and by a decrease in total physical activity. Physical activity programs for women with fibromyalgia focused on improving fibromyalgia-related characteristics should consider active commuting behaviors to increase their effectiveness.

Aging, not Parkinson's disease, decreases a recalibration of body ownership caused by vision-respiratory interaction.

Recalibration of body ownership perception occurs through an integration among multiple modalities. A recent study has shown that respiratory rhythm also causes the recalibration of ownership perception. However, the risk factors influencing the recalibration of ownership perception caused by vision-respiratory interaction remain unclear. In this study, focusing on aging and Parkinson's disease (PD), we examined the effects of those risk factors on the recalibration. By applying the rubber hand illusion (RHI), which temporarily alters ownership perception, and using a device that synchronizes the respiratory rhythm with the movement of a mannequin hand, we measured a change in ownership perception in RHI training by vision-respiratory interaction. The changed ownership was compared among the elderly healthy, PD, and young healthy groups. The results showed no difference in the changed ownership between the elderly healthy and PD groups, while the two groups decreased the change in the ownership perception compared to the young healthy group. The finding suggests that aging, not PD, related to the recalibration of ownership perception by vision-respiratory interaction. An anomaly in body perception due to aging may be associated with a mechanism in which respiratory rhythm affects the adaptation of body representations.

Iron Deficiency Anemia Among Women in Skardu, Gilgit-Baltistan

ABSTRACT Objective: To determine the frequency of iron deficiency anemia among women in Skardu, Gligit-Baltistan. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Skardu, Pakistan, from Dec 2021 to May 2022. Methodology: A total of 202 women were selected through consecutive sampling from General Medical OPD of Combined Military Hospital, Skardu, Pakistan. Hemoglobin globin levels (Hb gram/deciliter), mean corpuscular volume (MCV fL) and red cell distribution width (RDW%) were determined for all enrolled patients. Results: Mean age of participants in this study was 34.46±10.93 years. Reduced Hb was observed in 62(30.69%) women with a mean hemoglobin level of 9.48±1.59 gl/deciliter and mean corpuscular volume of 79.97±10.7d fL. Among these women, 5(2.47%) were severely anemic (6.56±0.39 gl/deciliter), 28(13.86%) moderately anemic (8.51±0.83 gl/deciliter) while 29(14.35%) were mildly anemic (10.92±0.48 gl/deciliter). Women of younger age group, between18-35 years, were found to suffer more from iron deficiency anemia (39.14%) with mean hemoglobin levels of 11.31±1.80 and mean corpuscular volume of 79.34±10.86 fL. Conclusion: Iron Deficiency Anemia is present in female population of Gilgit-Baltistan in general and woman of childbearing age in particular. Emergency measures for awareness and fortification of basic food items with iron should be undertaken at large scale.

AN ANALYSIS OF ALGOSPEAK AND THE DREADED ALGORITHM

Algospeak has become avaluable part of how the internet functions today. Millions of individuals see algospeak every day while they are browsing various social media apps and websites. The popularity of algospeak may even have a measurable impact on day-to-day modern language. Communicating online is becoming increasingly widespread, and people are using algospeak terms in more thantheir social media posts. Individuals may question how this language is being understood by the wider public. If algospeak ismisinterpreted , content creators and other users may fail to comprehendthe intended message. This research aims to determine how well people understand algospeak, which algospeak terms are most widely understood, and which age groups understand algospeak the best. Results have indicated that the younger age groups understand algospeak the best, but it is generally not very well understood. The researchers conclude with insight into the evident trends. Recommendations for future research are also proposed.

PREDICTORS AND COMPONENTS OF INPATIENT ASTHMA HOSPITAL COST: A CROSS SECTIONAL STUDY

Asthma, a chronic respiratory condition, continues to impose a significant economic burden on healthcare systems worldwide. Objective: The main objective of the study is to find the predictors and components of inpatient asthma hospital cost. Methods: This cross-sectional study was conducted at a tertiary care hospital from January 2024 to June 2024. Data were collected from 245 patients suffering from asthma. Patients were selected based on the International Classification of Diseases (ICD) codes related to asthma documented in their medical records. Patients aged &gt;18 years with complete medical and billing records available were included in the study. Results: The results show that gender did not significantly affect hospital costs, with males averaging $7,400 and females $7,000 (p = 0.12). Age was a significant predictor, as older patients (65+ years) incurred higher costs ($9,800) compared to younger groups (p &lt; 0.01). Socioeconomic status also impacted costs, with lower-income patients averaging $8,100 compared to $6,200 for higher-income patients (p &lt; 0.05). Age (65+ years) increased costs by $1,800 in univariate analysis and by $1,500 in multivariate analysis (p &lt; 0.01). Asthma severity had the strongest effect, with severe cases adding $5,500 in univariate analysis and $4,800 in multivariate analysis (p &lt; 0.001). Comorbidities increased costs by $4,000 univariately and $3,500 in multivariate models (p &lt; 0.01).Conclusion: It is concluded that asthma severity, comorbidities, and socioeconomic status are the primary predictors of inpatient asthma hospital costs.

A Study to Assess the Effectiveness of Video Assisted Teaching Programme on Knowledge Regarding Prevention of Coronary Artery Disease among Students In A Selected Arts College of Durg, Chhattisgarh (State)

Coronary artery disease is an obstructed blood flow through the coronary arteries to the heart muscles. The primary cause of coronary artery disease is atherosclerosis. The term acute coronary syndrome is used to encompass the continuum of coronary artery disease. Coronary artery disease is most prevalent type of cardiovascular disease in adults, more death occurs in middle aged adults. In India, even younger age group are prone to get heart disease due to their health damaging life style. This study was conducted to assess the effectiveness of video assisted teaching programme on knowledge regarding prevention of coronary artery disease among students in a selected arts college of Durg, Chhattisgarh (State) The conceptual framework used in this study was based on J.W.Kenney’s open system model. A quantitative approach was used for the present study. Using purposive sampling technique,60 arts students were selected and video assisted teaching given after pre-test. Followed by that post test was conducted on day 7, the collected data was analyzed using descriptive and inferential statistics. The overall analysis of prevention of coronary artery disease the mean post-test knowledge score of the subjects 28.07 is higher than the mean pre-test knowledge score 18.17. Thecalculated‘t’ value 19.769nis greater than of table value (1.984) at 0.001 level of significance. This indicates that video assited teaching programme was effective in gaining knowledge regarding the prevention of coronary artery disease. The association between socio demographic variables with pre-test knowledge score significance (p&lt;0.001) was tested. Based on the findings indicate that there is a significant difference between pre-test and post-test knowledge score on prevention of coronary artery disease in a selected arts college students at Durg.

Sarcopenia severity is related to arterial stiffness and hypertension in older Korean population without underweight and obesity: population based cross-sectional study.

Aging and obesity are considered causes of arterial stiffness, which triggers hypertension in the older population. However, a substantial number of older adults without obesity have hypertension, suggesting that arterial stiffness and hypertension are related to different risk factors in older adults without obesity. This cross-sectional study aimed to determine whether sarcopenia is related to arterial stiffness or hypertension in older Korean adults without underweight and obesity. A total of 2,237 male and female adults in the Korea National Health and Nutritional Examination Survey who were ≥60 years and did not have underweight and obesity (18.5 ≤ body mass index <25.0 kg/m2) were involved. They were classified as moderate- (n = 276) or severe-sarcopenia (n = 528) as their sarcopenia index was 1 or 2 standard deviations lower than the mean of the young reference group. Arterial stiffness was confirmed using an estimated pulse wave velocity (ePWV) formula, and hypertension was diagnosed based on blood pressure or antihypertensive medication use. Arterial stiffness and systolic and diastolic blood pressure showed an increasing trend from normal to moderate-to-severe sarcopenia (p < 0.001 for both). The distribution of subjects in the highest ePWV tertile and hypertension from normal to moderate-to-severe sarcopenia showed an increasing trend (p < 0.001 for both). Subjects with moderate or severe sarcopenia were 3.545 or 8.903 times more likely to be in the highest tertile of ePWV, and those with moderate or severe sarcopenia were 2.106 or 11.725 times more likely to be hypertension (p < 0.001 for all). Sarcopenia severity is related to arterial stiffness and hypertension in older Korean populations without underweight and obesity.

Shape analysis of the craniofacial skeleton in children prenatally exposed to anticonvulsant medications using geometric morphometrics.

Children exposed prenatally to antiepileptic drugs may have a typical facies characterized by midfacial retrusion, a short nose, and anteverted nares. Our aim was to determine whether the shape of the maxilla was altered in its sagittal displacement, or whether the defect in the underlying articulation with the cranial base was responsible for the appearance of midface retrusion. Our hypothesis was that the sphenoid bone as well as the maxilla and other bones in the cranial base were affected by the anticonvulsant medication. The lateral cephalograms of 65 children exposed prenatally to monotherapy (phenobarbital, phenytoin, or carbamazepine) were evaluated using various analyses derived from geometric morphometrics (GM) on different studied areas (maxilla, entire cranial base, spheno-occipital region, and the total study area) and the resulting configurations compared with those of control children. Procrustes ANOVA suggested that shape variation for all the regions correlated significantly (p < 0.0001) with exposure to antiepileptic drugs, and principal component analysis revealed a noticeable separation between the means of the two groups when PC1 was plotted against PC2 for all the areas studied. The cross-validation resulting from the discriminant function analysis accurately classified between 79.5% and 88.6% of the control group and between 73.8% and 90.7% of the study group when looking at the different anatomic regions. Canonical variate analysis, applied to the sample after its separation following biological sex and stratification into two age groups, showed unequal results between males and females as well as during circumpubertal growth of the cranial base. Thus, in the exposed subjects, while the glabella was projected forward with a similar prominence in males and females, the rhinion, which is relocated more posteriorly, was more severely displaced in females as opposed to the sella, where the most important displacement occurred in males. Regarding the age groups, it revealed that patients in the younger group of both sexes exhibited a facial shape difference very early (p < 0.0001) when the comparison was performed between exposed and non-exposed subjects. This difference was maintained in females at older ages but not in males. These details may help isolate the mechanism for the anomalies because of GM's use of shape instead of traditional linear and angular cephalometric measurements.

Aging-Induced Changes in Cutibacterium acnes and Their Effects on Skin Elasticity and Wrinkle Formation

Skin aging involves biomechanical changes like decreased elasticity, increased wrinkle formation, and altered barrier function. The skin microbiome significantly impacts this process. Here, we investigated the effects of decreased Cutibacterium acnes abundance and increase in other skin microorganisms on skin biomechanical properties in 60 healthy Koreans from Seoul, divided into younger (20–29 years) and older (60–75 years) groups. Metagenomic sequencing and skin assessments showed that the older group exhibited decreased C. acnes dominance and increased microbial diversity, correlating with reduced skin elasticity and increased wrinkles. In the younger age group, the enriched pathways included zeatin biosynthesis, distinct biotin metabolism pathways, and cofactor and vitamin metabolism in the younger age group, whereas pathways related to lipid metabolism, energy metabolism, and responses to environmental stressors, including UV damage and pollution, were enriched in the older group, according to functional analysis results. Network analysis indicated higher microbial connectivity in the younger group, suggesting a more stable community, whereas the older group’s community displayed higher modularity, indicating more independent and specialized clusters. This study enhances our understanding of the impact of skin microbiome changes on skin aging, particularly the anti-aging effects of C. acnes. Future research should focus on the physiological mechanisms of skin microbiota on skin aging and explore therapeutic potentials to enhance skin health.

COLONOSCOPIC TREATMENT FOR EARLY STAGE RECTUM ADENOCARCINOMA

Colorectal cancer is a malignant neoplasm that arises in the colon or rectum, characterized by the uncontrolled growth of epithelial cells, forming invasive tumors that can metastasize. It is the third most common neoplasm globally, with approximately 1.9 million new cases per year. In Brazil, in 2022, 5,573 deaths from rectal cancer were recorded, with a high incidence among women and a growing concern in younger age groups. Risk factors include type II Diabetes Mellitus, use of anti-inflammatory drugs, smoking and obesity, which is related to chronic inflammation and hormonal changes that favor cancer. Approximately 20% of patients with non-metastatic tumors can develop metastases, often affecting the gastrointestinal tract and organs such as the liver and lungs. The main treatment involves surgery and, in some cases, radiotherapy. Recommended screening for people aged 50 and over includes colonoscopy, with recent suggestions to start screening five years earlier, due to the global increase in the incidence of these conditions.

Krankenhaussterblichkeit bei Patienten mit und ohne Demenz

Background: Studies reported a higher in-hospital mortality in patients living with dementia (PlwD) with limited evidence across age groups, clinical departments and admission diagnoses. Study aim was to compare the in-hospital mortality rate of PlwD with non-demented controls across groups, clinical departments and admission diagnoses. Methods: This case-control study included patients aged ≥ 60 years hospitalized in one of 36 German hospitals between January 2019 and July 2023. PlwD were matched to non-demented controls. The associations between dementia and in-hospital mortality across groups were assessed using univariable logistic regression analyses. Results: 29,203patients with and 29,203 without dementia were included (mean age: 84 years, 60% female). PlwD had a significantly higher in-hospital mortality rate than non-dementia controls. The excess mortality rate was highest in the youngest age group (60–70 years), decreased with age, and became non-significant in the oldest age group (≥ 90 years). Significant differences were found for digestive system, cardiovascular and cerebrovascular disorders, endocrine, nutritional and metabolic diseases, and pneumonia, as well as for internal medicine and gastroenterology departments. Conclusion: The excess mortality rate was highest in younger age groups, where the general mortality and complication rate is relatively low in the general population. Appropriate approaches are needed.

An electronic patient-reported outcome symptom monitor: the Chinese experience with rapid development of a ready-to-go symptom monitor

BackgroundMonitoring symptoms is crucial for the early detection of disease progression and timely intervention, which is essential for reducing severe cases and mortality rates in rapidly spreading pandemics, such as COVID-19. Therefore, during infectious disease pandemics, the rapid development of real-time symptom monitoring platforms is essential. This study aimed to explore the urgent development process of an electronic system for patient-reported outcome monitoring in emergency situations.MethodsThe development of the electronic patient-reported outcome COVID-19 symptom monitoring platform (ePRO-CoV-SM) included the following steps: (1) modifying an electronic patient-reported outcome symptom-reporting platform to assess patients with COVID-19 and validating its feasibility and sensitivity for longitudinal symptom measurement; (2) updating the system to accommodate the newly emerged severe acute respiratory syndrome coronavirus 2 BA.2.2 variant; and (3) applying it in real-world settings. Literature review, expert consultation, and subject-group discussions were used to develop symptom items. Response rate and missing item rate were used as validation indicators for ePRO-CoV-SM.ResultsThe ePRO-CoV-SM (2.0) consists of a core set of symptom items, a WeChat mini program, an online project design backend, a management and communication front, and a database. During the 2020 verification, the response rate of ePRO symptom monitoring reached 89.47% and the item missing rate was 0.33%, the monitoring revealed that a considerable number of asymptomatic patients were experiencing undesirable symptoms during the isolation period. In its real-world application in 2022, the response rate was 85.93% and the item missing rate was 4.84%, the monitoring found the symptom burden was higher in the younger group (18–40 years old) than in the older group (40–67 years old), and over 30% of patients reported symptoms such as cough (36.08%), dry mouth (35.67%), sleep disorders (32.27%), appetite loss (32.17%), and sputum (30.79%) during the isolation period.ConclusionsElectronic patient-reported outcome measurement was demonstrated to be sensitive and feasible for monitoring symptoms in patients with COVID-19. By integrating smartphone-based data collection with real-time online data transmission and secure data storage using Secure Sockets Layer encryption, an electronic platform for monitoring critical symptoms can be rapidly established in emergency situations.

Interpreting the direct- and derived-Trail Making Test scores in Argentinian children: regression-based norms, convergent validity, test-retest reliability, and practice effects

Objective: We carried out two research studies (using a cross-sectional and a longitudinal design) to establish regression-based normative data, and to examine the convergent validity, the test-retest reliability, and the changes in performance with practice (1-month and 1-year interval) of the direct- and derived- (B-A, B + A, and B/A ratio) Trail Making Test (TMT) scores in Spanish-speaking children. Method: In S1 (n = 413 6- to 15-year-old children and adolescents), regression-based norming procedure and partial correlations were employed. In S2 (n = 110 6- to 12-year-old children), intraclass correlation coefficient (ICC2,1), Pearson’s r-product-moment correlations, and paired t-tests were used. Results: S1 demonstrated that age was associated with better performance on both TMT-A and TMT-B. This improvement was more strongly related to direct scores than derived measures B-A and B/A. Additionally, TMT-B was found to be more related to other executive functions (EF) compared to the performance of TMT-A. Among the derived scores, only the B-A was related primarily to cognitive flexibility, while the B + A index was associated with most EF, suggesting a general measure of cognitive functioning. In S2, fair to good test-retest reliability coefficients were found at Time 2 for TMT-A and TMT-B, as well as the B + A index, both in 6 to 8-year-olds (ICCs .61 to .74) and 9 to 12-year-olds (ICCs .53 to .65). There was a significant increase in performance on TMT-A and TMT-B from the first assessment (Time 1) to the follow-up testing at Time 2 in older children. However, this significant improvement was not observed for TMT-B in the younger group. Test scores on the TMT direct measures improved significantly across 1-year. The B-A and B/A ratio scores did not change across examinations. Conclusions: These findings have important implications for assessing EF and developing interventions that target cognitive flexibility in pediatric populations.

Influence of the functional intervention on the development of essential social skills in children with life-limiting conditions

Life-limiting conditions often cause children to be overlooked as participants in everyday activities. For parents child development should lead to independence in daily living activity. For parents of children who are disabled, independence is a step to a better quality of a child’s life. The aim of the study was to examine the effectiveness of functional intervention of self-service activities in children with life-limiting conditions at the age of 3–6 years of life. 32 children aged 3–6 years (N = 32, girls and boys) were followed for two years. The Progress Assessment Chart of Personal and Social Development (PPAC) H.C Gunzburg according to Witkowski inventory was used to assess. After two years of functional intervention, statistically significant improvement in everyday activities was observed in examining group. The control group showed less progress than the study group, even though the children in the control group were older. Functional intervention allows for effective work with a patient with life-limited conditions. Better progress was observed in the younger group, subjected to therapy for the existence of developmental potential occurring in children with limitations in intellectual development.

The Effect of a Tailored Educational Flyer on Colorectal Cancer Screening Among Rural Residents: Lessons Learned from a Pilot Randomized Trial.

Background/Objectives: Stool-based tests, such as the fecal immunochemical test (FIT), have been widely used for increasing colorectal cancer (CRC) screening. Small media, such as printed materials or flyers, are known to be an effective intervention to increase CRC screening by fecal tests. However, more evidence is needed to determine whether such small media are effective in improving screening uptake of a mailed FIT intervention targeted at rural populations in the USA. Methods: In this randomized study, 1230 FIT kits were mailed from July to December 2022 to rural Nebraskans aged 45-74 who were not up to date on CRC screening. Half of the participants (n = 608) also received a tailored, one-page, gender-specific educational flyer created based on focus groups with rural residents. Logistic regression was used to determine predictors of returning the FIT. Results: Study participants were predominantly female (76%), non-Hispanic White (83%), and within the age group of 55-64 (43%). Overall, 192 (15.6%) kits were returned (16.1% from the flyer group; 15.1% from the no-flyer group). However, we found no significant differences between the flyer and no-flyer groups (Adjusted Odds Ratio [AOR]: 1.21; 95% CI: 0.88-1.66). Females (AOR: 1.78; 95% CI: 1.19-6.14) and the oldest (65-74) age group (AOR: 5.03; 95% CI: 2.78-8.47) were more likely to return FIT kits than males and the youngest (45-54) age group. Conclusions: A tailored educational flyer was not effective in improving the CRC-screening-rate-by-mailed-FIT approach for rural populations. Future research should explore the content, timing, and mode of delivery of educational interventions as well as other multi-component strategies to improve screening rates. Public health officials might also consider developing strategies targeted at males and younger (45-54) age groups.

Relationship between white-coat hypertension and office isolated systolic or diastolic hypertension: an ambulatory blood pressure monitoring study.

This study investigated the prevalence of white-coat hypertension (WCH) among individuals with office isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). We evaluated 9122 individuals [57.0 ± 14.5 years, 51% men] with office blood pressure ≥140/90 mmHg who underwent ambulatory blood pressure monitoring (ABPM) and were categorized into younger (<40-years), middle-aged (≥40 and <60-years) and older (≥60-years) groups. The prevalence of WCH in SDH, ISH, and IDH was 18, 61, and 37% in younger, 16, 55, and 29% in middle-aged, and 23, 51, and 40% in older individuals. Multivariable logistic regression analysis showed a higher likelihood of WCH in ISH (4.1, 3.6, and 2.1-fold all p < 0.001) and IDH (1.9, 1.5, and 1.5-fold; all p < 0.001) compared to SDH among younger, middle-aged and older individuals, respectively. These data indicate that ISH and, to a minor extent, IDH are linked to a higher prevalence of WCH derived from ABPM exams.

Age-dependent changes in cardiac output following balloon pulmonary angioplasty: Implications for combination therapy in chronic thromboembolic pulmonary hypertension

Abstract Background Balloon pulmonary angioplasty (BPA) is an accepted treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, some patients still have exercise intolerance even after normalizing mean pulmonary arterial pressure with BPA. Although medical therapy may be a potential option for such patients, it cannot be necessary for all patients. Low cardiac output (CO) after BPA is associated with exercise intolerance. However, the change in CO with BPA could be affected by the patient’s age and pulmonary hypertension (PH) medication status. The specific patients’ characteristics that require medical therapy following BPA remain unknown. Methods This single-centre, retrospective observational study included 286 patients with CTEPH who underwent BPA and right heart catheterization one year BPA at our hospital. The patients were classified into three age groups (younger: age &amp;lt; 60 years, n=91; middle-aged: 60 ≤ age &amp;lt; 70 years, n=91; elderly: 70 years ≤ age, n=104), and also stratified by two groups based on PH medication status (Group 1: patients without PH medications before and after BPA, Group 2: patients who received PH medications before BPA and discontinued them after BPA). CO and its percent change were compared between Groups 1 and 2 in each age group. Results CO increased significantly in the younger group (4.3±0.2 to 4.5±0.1 L/min, p=0.040) and decreased in the elderly group (4.0±0.1 to 3.8±0.1 L/min, p=0.035), resulting in no significant change overall. CO in the younger and middle-aged groups significantly increased after BPA in Group 1, whereas in Group 2, those in the middle-aged and elderly groups significantly decreased after BPA. The percent CO changes declined in an age-dependent manner in both groups. Conclusions Increasing CO with BPA alone may be challenging in elderly patients. Adjuvant medical therapy might be necessary, even after successful BPA, especially in elderly patients.Percent change in CO stratified by age