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Background The latest guidelines recommended that common bile duct stones (CBDSs) should be removed, preferably endoscopically, regardless of the presence of symptoms or complications. However, the removal of CBDSs may not be feasible in very old patients or those with co-morbidities. In these cases, it is important to understand the risk factors for the development of CBDSs-related complications to decide whether or not to treat high-risk patients. Herein, we aimed to identify the risk factors for the development of complications after the diagnosis of CBDSs. Methods The medical records of patients with CBDSs between October 2005 and September 2019 were retrospectively analyzed. All patients with radiologically-diagnosed CBDSs, including those who received treatment and those who did not, were analyzed. Results A total of 634 patients were included and 95 (15.0%) patients had CBDS-related complications during the mean follow-up period of 32.6 months. Forty-four (6.9%) high-risk patients remained asymptomatic and did not receive treatment during the follow-up period. In multivariate analyses, size of CBDSs ≥ 5 mm and no treatment within 30 days were independent risk factors for the development of complications. The spontaneous passage of CBDSs was proved radiologically in 9 out of 81 (11.1%) patients within 30 days. Conclusions It is recommended treating CBDSs within 30 days from the diagnosis, even in high-risk patients, especially if the size is larger than 5 mm.

Increasing data suggests that chronic low-grade inflammation plays an important role on development of sarcopenia. The present study was designed to identify the association between fibrinogen, fibrin degradation products (FDP) and sarcopenia risk in hospitalized old patients.A total of 437 patients were enrolled in this cross-sectional study (148 with sarcopenia and 289 without sarcopenia). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Body composition, grip strength and gait speed were performed to participants. Fibrinogen, FDP levels were measured. Logistic regression analyses were carried out to assess the association between fibrinogen and sarcopenia, between FDP and sarcopenia, respectively.Compared to non-sarcopenic patients, fibrinogen and FDP levels were found to be higher in the sarcopenic group (3.07 g/L vs 2.79 g/L, 1.75 μg/mL vs 1.00 μg/mL, respectively, p 0.05). Multiple linear regression analysis showed a significant negative association between fibrinogen and gait speed (β: -0.164, p = 0.008), and muscle strength (β: -0.231, p 0.001). Multivariable logistic regression analysis showed that fibrinogen and FDP were independently associated with sarcopenia (odds ratio 1.32 [95% confidence interval 1.03, 1.70], p = 0.009; odds ratio 1.07 [95% confidence interval 1.01, 1.19], p = 0.049, respectively). ROC curve revealed that the cutoff values of fibrinogen and FDP to predict sarcopenia risk were 2.54 g/L and 1.15 μg/mL, respectively.In hospitalized old patients, serum fibrinogen and FDP levels are elevated in sarcopenia patients than those without sarcopenia. Fibrinogen and FDP are associated with sarcopenia in a concentration-dependent manner.

Purpose Frailty is a common condition among critically ill patients. Usually evaluated in a mixed population of medical, cardiac and surgical patients, we aimed to assess the impact of frailty on short- and long-term mortality exclusively in critically ill older medical patients. Materials and methods We included 285 patients aged≥70 years admitted to ICU (2009–2017). Comorbidities, severity scores, treatment intensity and complications were recorded. Pre-hospital frailty, measured by Clinical Frailty Scale (CFS), was defined as a score ≥ 5 according to this scale. Results Prevalence of frailty (CFS ≥ 5) of 18.6%. Frail patients were more likely to be female (64.2% vs. 35.6%, p

There is little data regarding the impact of patient age on the physical and psychological effectiveness of cardiac rehabilitation (CR). The aim of the present study was therefore to compare the effects of an exercise-based CR program on physical and psychological parameters in young, old, and very old patients. We also aimed to identify the features that best predicted CR outcome.A total of 733 patients were divided into 3 subgroups: YOUNG (65 years old), OLD (between 65 and 80 years old), and VERY OLD (≥ 80 years old). Physical variables such as peak workload and estimated peak VOPerformance in all tests and scores for all questionnaires were significantly improved in all patients (P0.05). Age was significantly correlated with all the initial values (P0.05) but not with post-CR values. In addition, lower initial values of peak workload were associated with larger post-CR improvements irrespective of age. However, higher pre-CR anxiety and depression scores were associated with greater post-CR increases in physical performance in YOUNG and OLD patients, respectively.CR induced significant improvements of physical and psychological parameters for all patient groups. More interestingly, our results suggest that patients with the greatest physical impairments at baseline would benefit the most from CR, whatever their age. However, the value of initial mental state as a predictor of post-CR improvement depends on the age of the patient.

The aim was to describe the impact of infective endocarditis (IE) on functional, cognitive and nutritional statuses, and to estimate the influence of these parameters on surgical management and mortality.This was a prospective study over 13 months in 14 French hospitals, including patients ≥75 years of age with definite or possible IE. A comprehensive geriatric assessment (CGA) was performed during the first week of hospitalization, including a retrospective estimation of functional status 2 months before hospitalization, and 3 months after.A total of 120 patients were included (mean age 83.1 ± 5.0 (75-101) years). IE was associated with a dramatic impairment of functional status between 2 months prior hospitalization and the first geriatric evaluation (90.8% able to walk vs. 35.5% (p 0.0001), ADL (Activities in Daily Living) 5.0 ± 1.7 vs. 3.1 ± 2.1 (p 0.0001)). The 19 operated patients (15.8%) had less comorbidities (cumulative illness rating scale geriatric 10.8 ± 8.2 vs. 15.3 ± 7.1 (p 0.0176)), better functional (ADL 5.9 ± 0.4 vs. 4.9 ± 1.8 (p 0.0171) and nutritional (mini nutritional assessment 20.4 ± 5.0 vs. 17.3 ± 6.2 (p 0.0501)) statuses than non-operated patients. Among all infectious, cardiac and geriatric parameters, body mass index (HR 0.9, range 0.8-1, p 0.05) and ADL at the time of the first evaluation (HR 0.7, range 0.6-0.9, p 0.002) were the sole independent predictors of the 3-month (32.5%) and 1-year mortality (42.5%). Three months later, the 57 assessed patients only partially recovered their ADL (3.7 ± 1.9 vs. 5.3 ± 1.4 2 months prior hospitalization and 4.6 ± 1.9 at the first CGA; p 0.0001).Functional and nutritional abilities are crucial components that can be accurately explored through a CGA when managing IE in oldest patients.

Background: COVID-19has become a worldwide pandemic and precise fatality data by age grouare needed urgently This study to delineate the clinical characteris

Background: The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (>70 years old) with COVID-19 admitted in the intensive care unit (ICU). Methods: Characteristics, management, and prognosis of critically-ill old patients (>70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality. Findings: The analysis included 1,199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72 – 78] years). Fifty-three percent, 31%, and 16% were 70-74, 75-79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2-3). Upon admission, the PaO2/FiO2 ratio was 154 (105 – 222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO2/FiO2 ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; Hazard Ratio 1·68; 95% CI, 1·24 – 2·27; p

OBJECTIVES This study aimed to evaluate actual skeletal muscle mass change and factors associated with its increase in patients aged ≥80 years undergoing hip fracture rehabilitation. METHODS This case-control study was conducted in the rehabilitation hospital. Participants were 368 patients aged ≥80 years undergoing hip fracture rehabilitation. Patients were divided into two groups based on the change of skeletal muscle mass index (SMI) during hospitalization: two groups with increased SMI and without increased SMI, after evaluation of skeletal muscle mass changes. Analysis between two groups and multivariate logistic regression analysis were performed to evaluate the factors associated with SMI increases. RESULTS The SMI at discharge was significantly increased (5.20 kg/m2) compared to baseline (5.00 kg/m2; p

Introduction: Centenarians and nonagenarians constitute a rapidly growing age group in Western countries and they are expected to be admitted to hospital with hip fractures. The aim of this study was to compare outcomes of centenarian and nonagenarian patients following a hip fracture and to identify risk factors related to in-hospital and post-discharge mortality in both groups. Patients and methods: A prospective evaluation of centenarian patients and nonagenarian controls admitted to a tertiary university hospital in Barcelona with hip fractures over a period of 5 years and 9 months. Baseline characteristics and outcomes in both patient groups were compared. Variables associated with in-hospital, 30-day, 3-month and 1-year mortality were also analyzed. Results: Thirty-three centenarians and 82 nonagenarians were included. The most relevant statistically significant differences found were: Barthel index at admission (61.90 vs. 75.22), number of drugs before admission (4.21 vs 5.55), in-hospital complication rates (97 vs. 78%), readmissions at 3 months and 1 year (0 vs 11.7% and 3.4 vs. 19.5% respectively) and mortality at 3 months and 1 year (41.4 vs. 20.8% and 62.1 vs. 29.9%, respectively). Mean number of complications, rapid atrial fibrillation, mean age, and urinary tract infection were risk factors associated with mortality. Conclusions: Centenarian patients had similar in-hospital outcomes to nonagenarians, but experienced more complications and twice the 3-month and 1-year mortality rate. The mean number of complications was the risk factor most consistently related to in-hospital and post-discharge mortality. These findings emphasize the need to improve care in very old patients to prevent complications. (C) 2018 Elsevier Ltd. All rights reserved.

Acetabular labral tears represent a common finding on magnetic resonance imaging of the hip. Labral tears can arise from a multitude of underlying pathological processes or they may be an asymptomatic incidental finding. The prevalence of labral tears and their lack of specificity make this an area vulnerable to potential overdiagnosis. The overdiagnosis of labral tears leads to overtreatment by exposing patients to unnecessary surgeries as well as complications ranging from unsatisfying outcomes to deep venous thrombosis. This risk is compounded by the tabloid popularization of labral surgeries by celebrities such as Lady Gaga, which could potentiate patient perception of a two-tiered level of health care. Following a similar situation with spine nomenclature, one solution to this issue is to reclassify "labral tears" as "labral fissures" in some or all cases to mitigate the acute traumatic connotation of the term "tear."

We investigated the Japanese WAIS-III short form utility in mild neurocognitive disorder and dementia. Our sample consisted of 108 old patients (ages: 65-89; mean age = 78.3). Fifteen short forms (SFs) and full-scale (FS) IQs were compared. The SFs included Dyads (SF1, SF2), Triads (SF3), Tetrads (SF4, SF5, SF6, SF7), Pentad (SF8), Six-subtest (SF9), Seven-subtests (SF10(a)(b), SF11(a)(b), SF12), and Nine-subtest (SF13). Correlations between SFIQs and FSIQ were all significant. Significant differences also were found in paired t-test between FSIQ and 5 SFIQs (SF2: t = -4.16, SF5: t = -7.06, SF7; t = 2.59, SF10(a): t = 2.56, SF12: t = -4.82; p .05). On the point of clinical accuracy, two SFs led to an appropriate estimated IQ (SF11(a): 84.3%, SF13: 91.7%; within 95% confidence interval and 2 standard error of measurements of FSIQ). However, SF13 was considered to still have a long administration time. The present results suggest that SF11(a) could be the most useful to estimate IQ for Japanese speaking patients with mild neurocognitive disorder and dementia. SF11(a) consists of seven subtests of Similarities, Arithmetic, Digit Span, Information, Picture Completion, Digit Symbol-Coding, and Matrix Reasoning (RyanWard, 1999), and the formula (Axelrod et al., 2001) should be adopted to convert scaled scores into estimated IQ scores.

Objective This study aimed to explore the epidemiological characteristics of antihypertensive drug use by community residents in Beijing, China. Methods Based on well-established statistical sampling techniques such as cluster, stratification, and random selection, 2832, 1828, and 2277 elderly residents aged ≥60 years in Beijing in 2000, 2004, and 2007, respectively, were included. The trend in antihypertensive drug use by elderly patients with hypertension was analyzed. Results The proportion of patients using angiotensin converting enzyme inhibitors (ACEIs) or β-blockers increased, while the proportions of both male and female patients using Chinese single-pill combination decreased. The proportion of relatively young patients using ACEIs or β-blockers increased, as did the proportion of relatively old patients using calcium channel blockers (CCB), ACEIs, or β-blockers. The proportions of both relatively young and relatively old patients using Chinese single-pill combination decreased. The proportion of urban patients using ACEIs, or β-blockers and the proportion of rural patients using CCBs or diuretics increased, while the proportion of both urban and rural patients using Chinese single-pill combination decreased. Conclusion During the 7-year study period in Beijing, the proportion of patients using CCBs, ACEIs, diuretics, or β-blockers increased, while the proportion of patients using Chinese single-pill combination decreased. Our results provide important data for the limited evidence on the trend of prevalence of antihypertensive drug used in China.

Background Glioblastoma multiforme (GBM) is the most common and aggressive primary malignant brain tumor. However, it rarely invades and destroys bone. We report the first case of GBM of a very old patient, which eroded the dura and bone and finally resulted in a large facio-cranial subcutaneous lesion in the absence of prior surgery or radiation. Case description A 93-year-old woman was presumed with a low-grade glioma (LGG), and the lesion was followed up with magnetic resonance imaging (MRI). Serial monitoring revealed no tumor growth until 2 years later, when the patient was admitted to our institution for anorexia and lack of spontaneity and flow of conversation. On admission, she oftentimes complained of severe right forehead skin pain. Computed tomography (CT) revealed enhancing mass lesions in the right frontal lobe and bone destruction. Upon inspection and palpation, a soft and swelling subcutaneous mass was evident at the forehead, the site of bone destruction. Contrast-enhanced MRI revealed ring-enhancing lesions with irregular borders, and the malignant transformation of LGG into GBM was suspected. The patient had severe skin pain at the region of the subcutaneous mass, so tumor resection of the subcutaneous mass was performed for removing the pain and a definitive diagnosis. The pathological diagnosis was isocitrate dehydrogenase (IDH)-mutated glioblastoma. Immunostaining revealed that the tumor was positive for IDH-1 and p53mutations but negative for ATRX. The patient died due to aspiration pneumonitis. Conclusions We report a first case of GBM in a very old patient untreated with surgery or radiation that invaded and destroyed the calvaria during the natural progression of the disease. Calvarial destruction without prior surgery or radiation in very old patients association with extra- and intra-axial neoplasm should include GBM in the differential diagnosis, although this is very rare.

Background Treatment of pressure ulcer with necrotic tissue formation is challenging in old patients with severe comorbidities. Although indicated and recommended, surgical debridement cannot always be applied because of general conditions. Simple, convenient, and minimally invasive intervention is required to facilitate chemical debridement of necrotic tissue. Methods Seventeen patients suffering from intractable pressure ulcer complicated with necrotic tissue formation underwent conventional debridement (CD) or mango cut incision (MCI). Feasibility of MCI method was evaluated by comparing clinical outcomes between patients who underwent CD and MCI. Results Between patients undergoing CD and MCI, there was no significant difference in time for necrotic tissue clearance (3.1 ± 2.0 vs. 4.0 ± 1.5 weeks, P = 0.366), nor in time for pressure ulcer cure (14.7 ± 6.2 vs. 12.7 ± 5.6 weeks, P = 0.566). Time required for intervention was significantly longer in CD than that in MCI (173.8 ± 44.5 vs. 29.4 ± 13.3 s, P Conclusions MCI allows minimally invasive clearance of necrotic tissue with clinically acceptable outcomes compatible to CD, and can be a choice of method for necrosis-complicated pressure ulcers in patients with severe comorbidities.

Objective Stereotactic biopsy is an everyday procedure implemented in numerous neurosurgical departments. The procedure is performed to obtain tumor tissue of unclear diagnosis. Going in hand with low complication rates and high diagnostic yield, stereotactic biopsies can be performed in adults and children likewise for histopathologic evaluation of lesions in eloquent localizations. However, little is known about whether aged patients do benefit from stereotactic biopsy or rather the therapy that is derived from histopathologic results. In this study, we therefore focused on old (80–84 years) and very old patients (85 years and older) to evaluate whether stereotactic biopsy should be performed leading to further therapy. We also assessed the complication rates of the procedure in this aged population. Methods We performed a retrospective analysis of our database and included all patients older than 80 years who underwent stereotactic biopsy at our department from October 2005 until May 2016. Forty-seven patients were included in this study. These patients were divided into 2 subgroups: group 1 consisted of patients from 80 to 84 years old and group 2 of patients aged 85 years and older. All patients underwent stereotactic biopsy to establish histopathologic diagnosis. We excluded patients who underwent cyst puncture or puncture of a hemorrhage because the procedure was not performed for diagnostic purposes. We assessed gender, neuroradiologic diagnosis, Karnofsky Performance Score (KPS), number of tissue samples taken, histopathologic diagnosis, localization, postoperative hemorrhage, modality of anesthesia anticoagulation, and further therapy. Results Group 1 consisted of 34 patients and group 2 of 13 patients. KPS was 80 and 70, respectively. A histopathologic diagnosis was possible in all but 1 patient. In group 1, 61.8% of the patients agreed to further postoperative therapy (radiation, 35.3%; chemotherapy, 11.8%; combined radiochemotherapy, 11.8%; complication that prevented therapy, 2.9%), as did 53.8% of the patients in group 2 (resection, 7.7%; radiation, 15.4%; combined radiochemotherapy, 30.7%). In group 1, 38.2% declined further therapy, as did 64.1% in group 2. Conclusions Also in old and very old patients, a final histopathologic diagnosis should be established to provide adequate therapy. Our data show that most of these aged patients want to be treated.

Purpose We tested the hypothesis that clinician knowledge, clinician barriers, and perceived parental barriers relevant to the human papillomavirus (HPV) vaccination account for the variation in vaccine delivery at the practice-site level. Methods We conducted a survey from October 2015 through January 2016 among primary care clinicians (n = 280) in a 27-county geographic region to assess clinician knowledge, clinician barriers, and perceived parental barriers regarding HPV vaccination. Primary care clinicians included family medicine physicians, general pediatricians, and family and pediatric nurse-practitioners. We also used the Rochester Epidemiology Project to measure HPV vaccination delivery. Specifically we used administrative data to measure receipt of at least one valid HPV vaccine dose (initiation) and receipt of three valid HPV vaccine doses (completion) among 9–18 year old patients residing in the same 27-county geographic region. We assessed associations of clinician survey data with variation in vaccine delivery at the clinical site using administrative data on patients aged 9–18 years (n = 68,272). Results Consistent with our hypothesis, we found that greater knowledge of HPV and the HPV vaccination was associated with higher rates of HPV vaccination initiation (Incidence rate ratio [IRR] = 1.05) and completion of three doses (IRR = 1.28). We also found support for the hypothesis that greater perceived parental barriers to the HPV vaccination were associated with lower rates of initiation (IRR = 0.94) and completion (IRR = 0.90). These IRRs were statistically significant even after adjustment for site-level characteristics including percent white, percent female, percent ages 9–13, and percent with government insurance or self-pay at each site. Conclusions Clinician knowledge and their report of the frequency of experiencing parental barriers are associated with HPV vaccine delivery rates—initiation and completion. Higher measures of knowledge correlated with higher rates. Fewer perceived occurrences of parental barriers correlated with lower rates. These data can guide efforts to improve HPV vaccine delivery in clinical settings.

On February 20, 2020, a man living in the north of Italy was admitted to the emergency room with an atypical pneumonia that later proved to be COVID-19. This was the trigger of one of the most serious clusters of COVID-19 in the world, outside of China. Despite aggressive restraint and inhibition efforts, COVID-19 continues to increase, and the total number of infected patients in Italy is growing daily. After 6 weeks, the total number of patients reached 128,948 cases (April 5, 2020), with the higher case-fatality rate (15,887 deaths) dominated by old and very old patients. This sudden health emergency severely challenged the Italian Health System, in particular acute care hospitals and intensive care units. In 1 hospital, geriatric observation units were created, the experience of which can be extremely useful for European countries, the United States, and all countries that in the coming days will face a similar situation.

Purpose This study was conducted to investigate the feasibility and clinical potential of using the 3D printing technology (3DPT) versus typical strategy (thin-layer CT scan) for the treatment of complicated proximal humeral fractures (PHFs) in old people. Methods Sixty-six old patients age ranging from 61 to 76 years with persistent complicated PHFs were randomly assigned to two groups as per the controlled randomization table (34 cases in the test group and 32 cases in the control group). In the test group, 3DPT was applied to build the 3D facture model of a patient, according to the data acquired from the thin-layer CT scan and subsequently processed with Mimics software. This helped to confirm the diagnosis, design the individual operation plan, simulate the surgical procedures and perform the surgery as plan. In the control group, only thin-layer CT scan was applied for the design of the operation plan prior to the surgery. Here, parameters including surgery duration, blood loss volume during surgery, the number of fluoroscopy, time to union were statistically analyzed for two groups after the operation. The screw lengths designed before the surgery and measured during the surgery were compared. Results The 3D PHF model generated using 3DPT was able to provide the visual display and omni-directional observation of the direction and severity of the fracture dislocation, which facilitated preoperative diagnosis, operation planning and design, data measurement, preselection of internal fixator and surgical outcome simulation. According to the follow-up ranging from 12∼28 months for the 66 patients, the results showed no significant difference in time to union between the two groups ( P > 0.05). Apart from that, less surgery duration, less blood loss during surgery, less number of fluoroscopy can be observed compared with the control group ( P Conclusions In this study, 3DPT showed great clinical feasibility of the treatment of complicated PHFs. The 3D-print PHF model had the ability to clearly display the fracture and thus was useful to determine the fracture classification and the magnitude of fracture injury. It benefited surgeons to gain a better understanding of complicated PHFs, design a most suitable operation plan prior to surgery and facilitate the doctor-patient communication. This therefore enabled the reduction of intraoperative injury and the optimization of surgical outcomes.

Background Aging of the French population confronts our society with enormous challenges, including an adaptation of the health system. The elderly population consumes a disproportionate amount of available healthcare, especially when provided by hospitals. This reflects the higher prevalence of most chronic diseases and disabilities among older persons. These facts illustrate the lack of appropriate organization necessary for the healthcare system to deal with the comorbid conditions and disabilities presented by old patients. In 2007, the ministerial circular for the development of geriatric care described organizational procedures designed to help hospitals optimize care for the elderly and stimulate coordination among healthcare providers. We report the development of geriatric departments in the hospitals of the Nord-Pas-de-Calais region as they were implanted over the last decade, and discuss the successes, the benefits and the limitations of this organization. Methods We monitored the development of geriatric departments in the region and propose a reflection on the benefits and shortcomings of their organization, taking into consideration changing needs in terms of quantity of care. An annual declarative regional survey was conducted for 8 years. More qualitative information was obtained from onsite visits of the regional health agency. These elements helped explain some of the quantitative findings. Results Although geriatric departments were successfully developed in recent years using the hospital sector organizational scheme, the fact remains that the offer of care for old patients remains insufficient. This insufficiency stems from growing needs due to changes in the demographic make-up of the population that also has an important impact outside the realm of healthcare. Conclusion We demonstrate the need for regulatory changes and reflection on ways to favor a healthcare referral scheme that would take into full consideration the possibilities of care outside the hospital setting and the potential for multidisciplinary coordination among all adult specialties, including general medicine.

Objective: The aims of this research were to assess and describe the clinical changes in the nostril that shows depression and asymmetry in patients with unilateral cleft lip and palate (UCLP) treated with presurgical nasoalveolar molding (PNAM) in the Center of Medical Specialties of the State of Veracruz (CEMEV). Material and methods: An observational, descriptive, longitudinal and prospective cohort study was carried out. 15 patients with ages between 0 and 6 months were part of the study. Measurements of t nostril height, nostril width, nasal basal width and columella length were performed at three times (T1, T2 and T3). Results: The vertical, horizontal and nostril base lengths showed a signifi cant decrease in the initial measurement (T1), presenting a close similarity with the healthy nostril, with only 0.8 mm of difference with the healthy nostril in the vertical dimension (p ≤ 0.000982 t Wilcoxon); in a horizontal dimension, 5.02 mm (p ≤ 0.000023 t Student) and compared with the measurements of the nasal base it was found that at T3 it decreased 51%, (p ≤ 0.00004 t Student). This refl ects the effectiveness of the nasal molding treatment for correcting the nasal asymmetry caused by a nasal, lip and alveolar cleft. Conclusion: Treatment with the PNAM is effective since it reduced by 50% at least nasal depression, compared with the initial and fi nal measurements.

P.O. Lang *, M. Petrovic , O. Dalleur , N. Ferahta , A. Benetos , B. Boland h,i Health and Wellbeing academy, Anglia Ruskin University, Cambridge, United Kingdom Geriatric and Geriatric rehabilitation division, University Hospital of Lausanne, Lausanne , Switzerland Department of Geriatrics, Ghent University Hospital, Ghent, Belgium Clinical Pharmacy Research Group, Louvain Drug Research Institute, Catholic University of Louvain, Brussels, Belgium e Pharmacy, Saint-Luc University Hospital, Brussels, Belgium Department of Geriatrics, University Hospitals of Nancy, 54500 Nancy, France g Inserm U1116, Universite de Lorraine, 54000 Nancy, France Health and Society Research Institute, Catholic University of Louvain, Brussels, Belgium Geriatric division, Saint-Luc University Hospital, Brussels, Belgium

Primary splenic leiomyosarcoma has not been included in the recent WHO classification of tumours of spleen. Primary splenic leiomyosarcomas are exceedingly rare. Most cases of splenic leiomyosarcomas are described in animals. These tumours are very rarely encountered in human, usually in old patients, and frequently presented with constitutional symptoms or in autopsy setting. Surgical pathologists should be aware of their existence. We present a case of a primary splenic leiomyosarcoma and a comprehensive review of other rarely encountered splenic sarcomas.

Background Age-associated decline in nicotinamide adenine dinucleotide (NAD) tissue levels has emerged as potential driving mechanism in the establishment of energy metabolism perturbations in the context of chronic diseases, notably heart failure. Objective The aim of this study was to measure the blood NAD levels in a healthy blood donor population and in a population of elderly patients hospitalized for decompensated heart failure. Method Whole blood sample was collected from 151 healthy voluntary blood donors, aged 19 to 68 years, and from 19 patients aged 75 to 101 years and hospitalized for decompensated heart failure in a geriatric ward. Metabolites were extracted by the hot buffered ethanol procedure and NAD was quantified in triplicate for each sample. Results The mean concentration of NAD in blood of healthy donors was 23.4 (SD 4.05) μmol/L. There was no significant correlation between NAD levels and donors' age nor sex in the healthy population when studied as a whole. However, the linear regression curves of NAD concentration plotted against age differed between males and females (p = 0.0283) with a trend in males to decline with age that was not observed in females. The mean concentration of NAD in whole blood samples of the geriatric population was 20.7 (SD 3.6) μmol/L (p = 0.007 versus the healthy blood donor population). There were no differences between males and females (p = 0.7) nor between patients with ejection fraction inferior or superior to 50% (p = 0.86) in the geriatric population. Conclusion This study highlighted a diminution of NAD blood levels for elderly patients hospitalized for decompensated heart failure in comparison to a healthy population, suggesting that new therapeutics to restore NAD stock and energy metabolism would be a major progress in the management of this type of geriatric patients.

Purpose Women are under-represented in heart failure (HF) trials and the reason remains unknown. To evaluate sex differences among patients who do not participate, we analyzed non-enrollment in SUSTAIN-IT, a multi-center study comparing health-related quality of life outcomes in 60-80 year old patients implanted with left ventricular assist devices as destination therapy (DT) or who awaited heart transplantation (HT). Methods 238 patients were approached and not enrolled in SUSTAIN-IT. Reasons for not enrolling and for refusing were documented. Sex differences were evaluated for the cohort and then stratified by DT vs HT Results 50 women (29 DT, 21 HT) and 187 men (81 DT, 106 HT) approached did not enroll in SUSTAIN-IT. Women were more likely than men to refuse (92% vs 76%, P=0.015) and the reasons varied by sex. Women were more likely too tired, stressed, anxious, depressed, or unable to concentrate while men were mostly not interested (Table 1). When stratified by HF therapy, women were more likely to refuse when approached for HT (100% HT vs 86% DT, P=0.13), while refusal for men did not differ with HF therapy (76% HT and 77% DT). Refusal also varied by therapy with the majority of HT non-enrollers not interested (38% women, 52% men) and DT non-enrollers refusing for different reasons (women 56% symptoms; men 31% symptoms, 32% not interested). Conclusion Women approached who did not enroll in SUSTAIN-IT were more likely than men to refuse to participate. Reasons for refusal varied for both women and men based on type of advanced HF therapy. Our novel findings may provide tailored guidance when recruiting men and women in clinical trials.

Backgrounds and aims To analyze whether serum cholesterol and albumin may be factors associated with early and late mortality, independent from other variables such as comorbidity, functional and mental status, in very old patients admitted with acute illness. Methods Prospective study of all patients admitted for medical causes in the year 2009. The primary outcome was the mortality at 6 and 36 months in relation to serum levels of albumin (categorized as > 3.5 g/dL; 3–3.5 and Results One thousand two hundred and eighty-eight patients were studied, mean age 86.7 years (SD 6.69), 66.1% female. During follow-up, 848 patients died. In Cox regression multivariate analysis, decreased albumin was significantly associated with increased mortality at 6 months [HR: 1.55 (CI95% = 1.03–2.34) for 3–3.5 g/dL albumin, and HR: 1.82 (CI95% = 1.15–2.86) for albumin Conclusions In very old patients admitted for acute medical conditions decreased levels of albumin may be associated with increased mortality.

Objectives: In our study we aimed to investigate the quality and quantity of medical management inside ambulances for 14 and over 14 years old patients transported to a level three emergency department (ED). Material and methods: Our study was conducted prospectively at a level three ED. 14 and over 14 years old patients who were transported to the ED by ambulance were included in the study consecutively. “Lack of vital rate” was described as missing of one or more of five vital rates during ambulance transportation. Both of two attending emergency physicians evaluated the medical procedures and management of patients at the ambulance simultaneously and this was recorded on the study forms. Results: Four hundred and fifty six patients were included in the study. Missing vital signs were identified for 90.1% (n = 322) of the patients that were transported by physicians and 92.4% (n = 73) of the patients that were transported by paramedics. For five patients with cardiac arrest two (33.3%) had cardiopulmonary resuscitation (CPR), one (20%) was intubated, one (20%) received adrenaline. Out of 120 patients, needed spinal immobilization, 69 (57.5%) had spinal board. Cervical collar usage was 65.1% (n = 69) We have revealed that 316 (69.3%) patients did not receive at least one of the necessary medical intervention or treatment. Conclusion: During ambulance transportation, life-saving procedures like cardiopulmonary resuscitation, vital sign measurement, crucial treatment administration, endotracheal intubation, defibrillation, fracture immobilization were not performed adequately. Increasing the training on the deficient interventions and performing administrative inspections may improve quality of patient care. Keywords: Emergency department, Ambulance, Prehospital emergency care

Clinical data and evidence-based guidelines for prescriptions for older patients are rare, and older patients are often excluded from clinical trials. The aim of this study was to use a questionnaire to assess the interest of pharmaceutical companies in including patients over 70 years of age in relevant pharmaceutical clinical trials. Additionally, the use of geriatric assessment tools was assessed. Overall, 35 international pharmaceutical companies were selected to report all studies performed over a 10-year period (1999 to 2009), and a total of 26 studies reported by eight companies were evaluated. In 19.2% of the studies, older patients were included but not analyzed separately. In 53.9% of the studies, age was either considered as a covariate or analyzed in a subgroup analysis. Seven studies included only patients aged 70 years and older. However, geriatric assessment tools were only utilized in four studies. Older patients were sufficiently included and analyzed in only a minority of company-initiated pharmaceutical studies. Given current demographic changes, there is an urgent need to address this situation.

The notion of a limited, early period of plasticity of the visual system has been challenged by more recent research demonstrating functional enhancement even into adulthood. In amblyopia (“lazy eye”) it is still unclear to what extent the reduced effect of treatment after early childhood is due to declining plasticity or lower compliance with prescribed patching. The aim of this study was to determine the dose–response relationship and treatment efficiency from acuity gain and electronically recorded patching dose rates, and to infer from these parameters on a facet of age dependence of functional plasticity related to occlusion for amblyopia. The Occlusion Dose Monitor was used to record occlusion in 27 participants with previously untreated strabismic and/or anisometropic amblyopia aged between 5.4 and 15.8 (mean 9.2) years during 4 months of conventional treatment. Group data showed improvement of acuity throughout the age span, but significantly more in patients younger than 7 years despite comparable patching dosages. Treatment efficiency declined with age, with the most pronounced effects before the age of 7 years. Thus, electronic recording allowed this first quantitative insight into occlusion treatment spanning the age range from within to beyond the conventional age for patching. Though demonstrating improvement in over 7 year old patients, it confirmed the importance of early detection and treatment of amblyopia. Treatment efficiency is presented as a tool extending insight into age-dependent functional plasticity of the visual system, and providing a basis for comparisons of effects of patching vs. emerging alternative treatment approaches for amblyopia.

Older patients are associated with increased stroke prevalence, worse outcome, and risk of undertreatment in comparison with younger patients. The aim of the present study was to compare risk factor distribution and functional outcome in stroke survivors older and younger than 80 years.The analysis was based on consecutive patients admitted within 6 hours after stroke onset and discharged with ischemic stroke, surviving at least 3 months after ictus. To prevent bias, the analysis was based on a registry from before implementation of tissue plasminogen activator treatment; all patients received stroke unit care in accordance with the guidelines. The population was dichotomized into patients aged less than 80 years and 80 years of age or older. Modified Rankin Scale (mRS) score and Barthel Index (BI) were used to assess 3-month and 1-year outcome.Patients 80 years of age or older presented with significantly more severe strokes than younger patients, median Scandinavian Stroke Scale score 39 vs 42 (P = .003). Median mRS score before stroke was significantly higher in patients aged 80 years or older (P .001) and remained high 3 months and 1 year after ictus (P .001); the BI was equivalently lower (P .001). The decline in function was comparable between groups. Patients 80 years of age or older of whom the majority were women (P .001) presented with atrial fibrillation (P .001), and hypertension (P = .005).Risk factors vary significantly with age, suggesting different stroke mechanisms. Patients older than 80 years experience more severe strokes and frequently have minor impairments before stroke. The increase in impairment after stroke is comparable with what is observed in younger patients, suggesting that good recovery after stroke may also be expected in older patients.

Aminoglycosides still represent an important antimicrobial class for the treatment of gram-negative infections. Their spectrum of activity and the possibility to act synergistically with β-lactams offer the opportunity of being used in severe infections or infections sustained by resistant pathogens. However, the fear of side effects, related to their narrow therapeutic index and toxicodynamic profile, limits sometimes the use of aminoglycosides, especially in old or very old patients. Improved knowledge of antimicrobial pharmacokinetics and pharmacodynamics in the last years has allowed improving regimens and dosing on an individual basis, according to the patient's pathophysiological conditions and pathogen's susceptibility profile. Optimised aminoglycoside use yields to a more rapid bacterial killing and, likely, prevention of resistance development. Some advances toward an improved aminoglycoside usage and application of pharmacodynamic concepts to avoid or limit toxicity are herein briefly discussed.

Transcatheter aortic valve implantation (TAVI) has rapidly emerged as a valid therapeutic option for patients with severe symptomatic aortic stenosis who are high risk or ineligible for conventional surgical aortic valve replacement. Despite its minimally invasive nature, TAVI is invariably associated with complications in these old patients that may affect outcomes. Although the success of TAVI is determined by multiple factors, good screening and appropriate patient selection is crucial. Selection of the right patient includes the determination of risk levels and feasibility of a safe procedure in each individual case. Here, we describe below our critical appraisal of patient selection for TAVI.

To research the effects of hyperhomocysteinemia (HHcy)on blood pressure variability, heart, kidney and brain target organ injury in elderly patients with essential hypertension with stroke. From June 2015 to February 2016, 66 elderly inpatients with essential hypertension complicated with acute

Recent studies have suggested that clopidogrel response may vary significantly with age. Limited data are available exploring the age dependency of ex vivo aspirin response in young and old patients with stable coronary artery disease. Patients with stable coronary artery disease (n = 583) who had been treated with aspirin 75 to 325 mg/day for ≥1 week were recruited from a general cardiology practice. The study cohort was divided into 2 groups: patients aged75 years (n = 438) and patients aged ≥75 years (n = 145). Aspirin response was determined using the VerifyNow Aspirin Test, and resistance was defined as ≥500 or 550 aspirin reaction units (ARU). The independent predictive value of age on VerifyNow score (as a continuous function) was determined using multivariate linear regression, adjusted for gender, body mass index, and diabetes mellitus. Younger and older patients had similar baseline clinical profiles, including relative doses of aspirin therapy. The mean VerifyNow Aspirin Test score was significantly higher in patients aged ≥75 years: 450 ± 54 versus 434 ± 53 ARU (p = 0.0007). After accounting for the primary covariates, age remained a predictor of VerifyNow score (p = 0.007). Aspirin resistance on the basis of the 500-ARU cutoff was higher in older patients (19% vs 11%, p = 0.009), but there was no difference when the 550-ARU cutoff was used (7% vs 5%, p = 0.40). In conclusion, aspirin response differs significantly by age in patients with stable CAD.

Key points A growing number of old or very old patients benefits from a surgical procedure. Age is an independent risk factor of postoperative mortality and postoperative complications including cognitive dysfunction. The choice of anesthetic technique does not significantly modify this risk. Preventive strategies and preoperative procedures can be implemented. A multidisciplinary management involving all care providers around the patient is essential to reduce the risk of dependence after surgery which is higher in this population. Early postoperative rehabilitation is recommended in the elderly to improve the prognosis.

Objectives We wanted to compare autonomy recovery after open and endovascular infrainguinal surgery for critical limb ischaemia (CLI) in octogenarians. Materials and methods We performed a retrospective analysis of 167 consecutive CLI octogenarians who underwent infrainguinal open surgery (OS) or endovascular surgery (ES) between 2003 and 2008. OS and ES groups were compared in terms of autonomy level (Parker score), survival, limb salvage and patency rates. Results Preoperative autonomy level was similar in both groups (OS n = 109, ES n = 58) but 6-month postoperative autonomy level was better after ES ( p = 0.01). There was a trend towards better survival after OS (74% at 1 year, 62% at 2 years, 32% at 4 years with OS and 68%, 50%, 17% respectively for ES p = 0.06), but no difference regarding limb salvage (91% at 1 year, 90% at 2 years, 89% at 4 years for OS and 94%, 87%, 86% respectively for ES, p = 0.939) and primary patency (76% at 1 year, 59% at 2 years, 50% at 4 years for OS and 82%, 75%, 32% respectively for ES, p = 0.467). Conclusions ES is justified in CLI octogenarians, because it allows restoring a higher autonomy level, with limb salvage and patency rates comparable to OS.

Objective The relationship between the major proteinases in dentine matrix metalloproteinases (MMPs) and the formation of collagen-less sclerotic dentine is still unknown. This study is to compare the concentrations of dentinal MMP-1, -2, -3, -8, and -9 between human sound and sclerotic dentine. Design Eleven sound third molars from young patients and twenty-two attrited molars with sclerotic dentine from old patients were collected and three groups of dentine samples were obtained: sound dentine of young tooth (SDY), non-sclerotic dentine of attrited tooth (NDA) and sclerotic dentine of attrited tooth (SDA). The dentine powder from each group was subjected to demineralization and protein extraction in turn. Then the contents of MMP-1, -2, -3, -8 and -9 were quantitatively evaluated by Fluorescent Microsphere Immunoassay. The occlusal and fractured axial surfaces of sound and sclerotic dentine were observed using FEI-SEM. Results There was no significant difference in the concentration of MMP-1 amongst all tested groups (p > 0.05). The contents of MMP -2 and MMP-3 in SDY were significantly higher than those in NDA and SDA (p