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Abstract Objective To construct and verify a risk prediction model for sleep disturbance in elderly patients with hypertension, aiming to offer guidance for sleep management in this demographic. Methods A cohort of 6,708 elderly hypertensive patients from the NHANES database, spanning 2005 to 2018, met the inclusion criteria and were selected for this study. Participants were randomly assigned to a development group (n = 4,696) and a verification group (n = 2,012) in a 7:3 ratio. The occurrence of sleep disturbance was assessed across the subjects. Independent risk factors for sleep disturbance were analyzed using weighted multivariate logistic regression within the development group. A predictive model for sleep disturbance risk in elderly hypertensive patients was developed and verified using Stata 17.0. The model's predictive accuracy and stability were evaluated using the verification group's data. Results Of the 6,708 subjects, 2,014 (30.02%) were identified with sleep disturbance, and the weighted prevalence of sleep disturbance among elderly hypertensive patients was 33.283%. Weighted multivariate logistic regression analysis in the development group revealed that six factors were independently associated with sleep disturbance: higher total depression scores, higher education level, asthma, overweight, arthritis, and work restriction (OR > 1 and P

Jing Zhong,1 Hua Zhang,1 Jie Wu,2 Bosen Zhang,2,3 Liubing Lan1,2 1Department of Obstetrics, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China; 2Department of Prenatal Diagnostic Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China; 3Department of Ultrasound, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of ChinaCorrespondence: Liubing Lan, Department of Prenatal Diagnostic Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, No. 63 huangtang Road, Meijiang District, Meizhou, People’s Republic of China, Email lanliubing@126.comObjective: Gestational diabetes mellitus (GDM) is a complication of abnormal glucose tolerance during pregnancy, with incidence is on the rise. There are inconsistent results on the risks of GDM and it has not been reported in our region. The purpose of this study is to explore the risk factors of GDM.Methods: A total of 383 pregnant women were analyzed, including 67 (17.5%) pregnant women with GDM and 316 (82.5%) with normal glucose tolerance (NGT). The relationship of personal history, family history and reproductive history of pregnant women, the levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), inflammatory markers in blood cell analysis at the first prenatal examination, and fetal ultrasound indices and the risk of GDM were analyzed.Results: The fetal biparietal diameter, head circumference, and femur length were negatively correlated with HCG level, but not inflammatory markers. The proportion of pregnant women aged ≥ 30 years old, body mass index (BMI) in early pregnancy≥ 24.0 kg/m2, history of polycystic ovary syndrome (PCOS), cesarean section, adverse pregnancy, and oral contraceptive use, and pregnant women who conceived through assisted reproduction in GDM group were higher than those in NGT group. Logistic regression analysis showed that age of pregnant woman ≥ 30 years old (≥ 30 vs < 30 years old, odds ratio (OR): 2.142, 95% confidence interval (CI): 1.183– 3.878, p=0.012), BMI≥ 24.0 kg/m2 (≥ 24.0 kg/m2 vs 18.5– 23.9 kg/m2, OR: 1.887, 95% CI: 1.041– 3.420, p=0.036), history of adverse pregnancy (yes vs no, OR: 1.969, 95% CI: 1.022– 3.794, p=0.043), and history of oral contraceptive use (yes vs no, OR: 2.868, 95% CI: 1.046– 7.863, p=0.041) were associated with GDM.Conclusion: Age of pregnant woman ≥ 30 years old, BMI≥ 24.0 kg/m2, history of adverse pregnancy and oral contraceptive use were independent risk factors for GDM.Keywords: gestational diabetes mellitus, advanced age, overweight, history of adverse pregnancy, history of oral contraceptive use

Objective: To construct and verify a risk prediction model for sleep disturbance in elderly patients with hypertension, aiming to offer guidance for sleep management in this demographic. Methods: A cohort of 6,708 elderly hypertensive patients from the NHANES database, spanning 2005 to 2018, met the inclusion criteria and were selected for this study. Participants were randomly assigned to a development group (n = 4,696) and a verification group (n = 2,012) in a 7:3 ratio. The occurrence of sleep disturbance was assessed across the subjects. Independent risk factors for sleep disturbance were analyzed using weighted multivariate logistic regression within the development group. A predictive model for sleep disturbance risk in elderly hypertensive patients was developed and verified using Stata 17.0. The model's predictive accuracy and stability were evaluated using the verification group's data. Results: Of the 6,708 subjects, 2,014 (30.02%) were identified with sleep disturbance, and the weighted prevalence of sleep disturbance among elderly hypertensive patients was 33.283%. Weighted multivariate logistic regression analysis in the development group revealed that six factors were independently associated with sleep disturbance: higher total depression scores, higher education level, asthma, overweight, arthritis, and work restriction (OR > 1 and P < 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) for the nomogram prediction model was 0.709 in the development group and 0.707 in the verification group, indicating good discrimination ability. Brier scores for the nomogram model were 0.185 in the development group and 0.189 in the verification group, both below 0.25, suggesting good calibration. Decision Curve Analysis (DCA) determined that the nomogram's clinical net benefit was maximized when the threshold probability for sleep disturbance in elderly hypertensive patients was 0.13–0.67 in the development group and 0.14–0.61 in the verification group, highlighting the model's clinical utility. Limitations: This study is not without its limitations, including issues with data collection, the absence of external validation, and the non-extrapolation of results. Conclusion: The prevalence of sleep disturbance among elderly hypertensive patients stands at 33.283%. The nomogram model, based on identified risk factors for sleep disturbance in this population, has demonstrated good predictive efficiency and clinical relevance. It serves as a valuable tool to assist healthcare providers in identifying elderly hypertensive patients at high risk for sleep disturbance. [ABSTRACT FROM AUTHOR]

Abstract Background The objective of this study is to identify and evaluate the risk factors associated with the development of postoperative pulmonary complications (PPCs) in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia. Methods The retrospective study consecutively included elderly patients (≥ 70 years old) who underwent thoracoscopic lobectomy at Xuanwu Hospital of Capital Medical University from January 1, 2018 to August 31, 2023. The demographic characteristics, the preoperative, intraoperative and postoperative parameters were collected and analyzed using multivariate logistic regression to identify the prediction of risk factors for PPCs. Results 322 patients were included for analysis, and 115 patients (35.7%) developed PPCs. Multifactorial regression analysis showed that ASA ≥ III (P = 0.006, 95% CI: 1.230 ∼ 3.532), duration of one-lung ventilation (P = 0.033, 95% CI: 1.069 ∼ 4.867), smoking (P = 0.027, 95% CI: 1.072 ∼ 3.194) and COPD (P = 0.015, 95% CI: 1.332 ∼ 13.716) are independent risk factors for PPCs after thoracoscopic lobectomy in elderly patients. Conclusion Risk factors for PPCs are ASA ≥ III, duration of one-lung ventilation, smoking and COPD in elderly patients over 70 years old undergoing thoracoscopic lobectomy. It is necessary to pay special attention to these patients to help optimize the allocation of resources and enhance preventive efforts.

Background and purpose: With the aging population, the number of elderly patients with colorectal cancer (CRC) is increasing. To date, elderly patients with stage Ⅱ CRC often receive a weakened chemotherapy regimen or even no chemotherapy after radical surgery, and It is still unclear whether this will lead to adverse oncological outcomes. This study aimed to explore the prognostic impact of advanced age on stage Ⅱ CRC patients after removing bias through a multivariate COX regression approach. Methods: We retrospectively collected data of 3314 colorectal cancer patients with postoperative pathology of stage Ⅱ, no history of previous tumors, no secondary primary tumors within 5 years after surgery and no preoperative neoadjuvant therapy. This study was reviewed by the medical ethics committee of Fudan University Shanghai Cancer Center (ethics number: 050432-4-2108*). The optimal threshold for calculating age relative to survival using survminer package of R software (version 3.0) (surv_cutpoint algorithm) was 73 years. We compared the clinical and pathological characteristics, overall survival (OS) and disease-free survival (DFS) between the older group (age>73 years) and the younger group (age≤73 years). The alignment diagram prediction model was drawn using the survival package and RMS package. Results: The elderly and non-elderly groups were evenly comparable in terms of gender, tumor location, differentiation, vascular invasion, perineural invasion and pT stage. Multivariate COX regression showed that advanced age was an independent prognostic risk factor for OS [hazard ratio (HR)=3.725 (3.051-4.549), P

Objective  Vestibular schwannoma (VS) are benign, often slow growing neoplasms. Some institutions opt for radiosurgery in symptomatic patients of advanced age versus surgical resection. The aim of the study is to analyze surgical outcomes of VS in patients over the age of 65 who were either not candidates for or refused radiosurgery. Methods  This includes retrospective analysis of VS patients between 1988 and 2020. Demographics, tumor characteristics, surgical records, and clinical outcomes were recorded. Patient preference for surgery over radiosurgery was recorded in the event that patients were offered both. Facial nerve outcomes were quantified using House-Brackmann (HB) scores. Tumor growth was defined by increase in size of >2 mm. Results  In total, 64 patients were included of average age 72.4 years (65-84 years). Average maximum tumor diameter was 29 mm (13-55 mm). Forty-five patients were offered surgery or GKRS, and chose surgery commonly due to radiation aversion (48.4%). Gross total resection was achieved in 39.1% ( n  = 25), near total 32.8% ( n  = 21), and subtotal 28.1% ( n  = 18). Average hospitalization was 5 days [2-17] with 75% ( n  = 48) discharged home. Postoperative HB scores were good (HB1-2) in 43.8%, moderate (HB3-4) in 32.8%, and poor (HB5-6) in 23.4%. HB scores improved to good in 51.6%, moderate in 31.3%, and remained poor in 17.1%, marking a rate of facial nerve improvement of 10.9%. Tumor control was achieved in 95.3% of cases at an average follow-up time of 37.8 months. Conclusion  VS resection can be safely performed in patients over the age of 65. Advanced age should not preclude a symptomatic VS patient from being considered for surgical resection.

Background: The goal of this study was to compare mitochondrial activity in cumulus cells (CCs) between young and advancing-aged women, the factors that affect mitochondrial activity, and their association with blastocyst quality. Materials and methods: This prospective study included 80 infertile women who underwent ICSI between May and October 2023. Participants were divided into two groups: older and younger than 38. The oocyte mitochondrial activity from CCs was evaluated using MitoTracker, and the mean fluorescence intensity (MFI) was also evaluated. Results: The univariate and multivariate analyses revealed a significant difference in the MFI between the woman ≥ 38 age group and the lower age group (162.68 ± 79.87 vs. 228.39 ± 121.38; p-value = 0.005; 95%CI 19.97, 111.45). The factors that affected the MFI were women ≥ 38 years of age (p-value = 0.005; 95%CI −111.45, −19.91), total gonadotropin dosages (p-value = 0.006; 95%CI −0.08, 0.01), and gonadotropin-releasing hormone agonist (GnRHa) triggering (p-value = 0.006; 95%CI 36.46, 210.06). However, only women aged ≥38 years remained statistically significant after a multivariable regression analysis (p-value = 0.014; 95%CI −121.00, −14.30). In addition, only male age (mean age ± SD = 38.26 ± 5.13) was associated with high blastocyst quality in univariate and mixed multivariate analyses (OR 0.91; 95%CI 0.56, 3.04). The chemical pregnancy rate was not significantly different between the two age groups (34.5% vs. 56.7%; p-value = 0.162; 95%CI 0.2, 1.30). Conclusion: Advancing age decreased mitochondrial activity in CCs but did not affect blastocyst quality. By contrast, male age may be a predictor of high-grade blastocyst quality. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to identify and evaluate the risk factors associated with the development of postoperative pulmonary complications (PPCs) in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia. Methods: The retrospective study consecutively included elderly patients (≥ 70 years old) who underwent thoracoscopic lobectomy at Xuanwu Hospital of Capital Medical University from January 1, 2018 to August 31, 2023. The demographic characteristics, the preoperative, intraoperative and postoperative parameters were collected and analyzed using multivariate logistic regression to identify the prediction of risk factors for PPCs. Results: 322 patients were included for analysis, and 115 patients (35.7%) developed PPCs. Multifactorial regression analysis showed that ASA ≥ III (P = 0.006, 95% CI: 1.230 ∼ 3.532), duration of one-lung ventilation (P = 0.033, 95% CI: 1.069 ∼ 4.867), smoking (P = 0.027, 95% CI: 1.072 ∼ 3.194) and COPD (P = 0.015, 95% CI: 1.332 ∼ 13.716) are independent risk factors for PPCs after thoracoscopic lobectomy in elderly patients. Conclusion: Risk factors for PPCs are ASA ≥ III, duration of one-lung ventilation, smoking and COPD in elderly patients over 70 years old undergoing thoracoscopic lobectomy. It is necessary to pay special attention to these patients to help optimize the allocation of resources and enhance preventive efforts. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether advanced age is a risk factor for complications following pelvic organ prolapse (POP) repair surgeries using the Clavien-Dindo classification system. Methods: In this retrospective cohort study, 260 women who had undergone POP repair surgery at the Soroka University Medical Center (SUMC) between the years 2014–2019 were included. A univariate analysis was conducted to compare the demographical, clinical, obstetrical and operative characteristics of patients by age group (younger or older than 70 years). We performed a similar analysis to assess for the possible association between several variables and post-operative complications. Variables that were found to be associated with post-operative complications (P < 0.2) were included in a multivariate analysis along with advanced age. Results: During the 12 months follow-up period, more than half of the women had experienced at least one post-operative complication. Minor complications (grades 1–2 according to the Clavian-Dindo classification system) were the most common. One woman had died during the follow-up period, and none had experienced organ failure (grade 4). Hysterectomy, as part of POP surgery, was found to be significantly associated with post-operative complications. Additionally, grandmultiparity (> 5 births) showed a tendency towards an increased risk for post-operative complications, however this reached only borderline significance. We found no association between advanced age and post-operative complications. Conclusions: POP repair surgeries are safe for women of all ages. Major complications (grades 3–5) are rare in all age groups. Although advanced age was associated with a higher prevalence of comorbidity and a higher grade of prolapse, no significant difference in the post-operative complications was found between age groups. Concomitant hysterectomy at the time of POP repair surgery is a risk factor for post-operative complications. [ABSTRACT FROM AUTHOR]

Background and purpose: With the aging population, the number of elderly patients with colorectal cancer (CRC) is increasing. To date, elderly patients with stage II CRC often receive a weakened chemotherapy regimen or even no chemotherapy after radical surgery, and It is still unclear whether this will lead to adverse oncological outcomes. This study aimed to explore the prognostic impact of advanced age on stage II CRC patients after removing bias through a multivariate COX regression approach. Methods: We retrospectively collected data of 3314 colorectal cancer patients with postoperative pathology of stage II, no history of previous tumors, no secondary primary tumors within 5 years after surgery and no preoperative neoadjuvant therapy. This study was reviewed by the medical ethics committee of Fudan University Shanghai Cancer Center (ethics number: 050432-4-2108*). The optimal threshold for calculating age relative to survival using survminer package of R software (version 3.0) (surv_cutpoint algorithm) was 73 years. We compared the clinical and pathological characteristics, overall survival (OS) and disease-free survival (DFS) between the older group (age-73 years) and the younger group (age≤73 years). The alignment diagram prediction model was drawn using the survival package and RMS package. Results: The elderly and non-elderly groups were evenly comparable in terms of gender, tumor location, differentiation, vascular invasion, perineural invasion and pT stage. Multivariate COX regression showed that advanced age was an independent prognostic risk factor for OS -hazard ratio (HR)=3.725 (3.051-4.549), P<0.001 and DFS HR=2.431 (2.029-2.912), P0.001. The nomogram (alignment diagram) prediction model constructed based on multivariate COX regression could effectively evaluate the prognosis of stage CRC patients and provide guidance for practical clinical work. Conclusion: In stage CRC patients, older age is associated with shorter OS and DFS. Adequate intensity of adjuvant chemotherapy may be necessary. Treatment decisions can be adjusted based on the predicted model scores of the patient's alignment diagram. [ABSTRACT FROM AUTHOR]

Objectives: To assess the safety and immunogenicity of a fourth vaccination (second booster) in individuals aged ≥75 years. Methods: Participants were randomized to BNT162b2 (Comirnaty, 30 µg) or messenger RNA (mRNA)-1273 (Spikevax, 100 µg). The primary end point was the rate of two-fold antibody titer increase 14 days after vaccination, targeting the receptor binding domain (RBD) region of wild-type SARS-CoV-2. The secondary end points included changes in neutralizing activity against wild-type and 25 variants. Safety was assessed by monitoring solicited adverse events (AEs) for 7 days. Results: A total of 269 participants (mean age 81 years, mRNA-1273 n = 135/BNT162b2 n = 134) were included. Two-fold anti-RBD immunoglobulin (Ig) G titer increase was achieved by 101 of 129 (78%) and 116 of 133 (87%) subjects in the BNT162b2 and the mRNA-1273 group, respectively (P = 0.054). A second booster of mRNA-1273 provided higher anti-RBD IgG geometric mean titer: 21.326 IU/mL (95% confidence interval: 18.235-24.940) vs BNT162b2: 15.181 IU/mL (95% confidence interval: 13.172-17.497). A higher neutralizing activity was noted for the mRNA-1273 group. The most frequent AE was pain at the injection site (51% in mRNA-1273 and 48% in BNT162b2). Participants in the mRNA-1273 group had less vaccine-related AEs (30% vs 39%). Conclusions: A second booster of either BNT162b2 or mRNA-1273 provided substantial IgG increase. Full-dose mRNA-1273 provided higher IgG levels and neutralizing capacity against SARS-CoV-2, with similar safety profile for subjects of advanced age.

Ganglioglioma is a rare neoplasm most common in children and adolescents. It is typically located in the supratentorial compartment, with the temporal lobe being the most common tumor location. Anaplastic ganglioglioma is a WHO grade III ganglioglioma, a rare subtype accounting for a small minority of ganglioglioma cases. Posterior fossa anaplastic ganglioglioma in an adult is incredibly rare; only 3 prior cases have been reported. Only 1 adult anaplastic ganglioglioma in the cerebellum has been reported. We present the second reported adult cerebellar anaplastic ganglioglioma.

Background With the rapid development of economy and the change of fertility concept in modern population, the number of advanced maternal age is increasing year by year. Compared with appropriate maternal age, advanced maternal age is more likely to suffer from depressive symptoms due to personal, family, work, and other reasons. Objective To systematically evaluate the detection rate of postpartum depression in advanced maternal age (≥35 years at delivery) in China to provide relevant evidence for early prevention and intervention. Methods CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science were searched for articles on the detection rate of postpartum depression in advanced maternal age in China by combining subject terms and free terms from inception to July 2023. The process of literature screening, data extraction and quality assessment were carried out by two researchers independently. Stata 16.0 software was used for data analysis. Results A total of 21 studies were included, with a total sample size of 5 163. The results of Meta-analysis showed that the overall detection rate of postpartum depression in advanced maternal age in China was 20.0% (95%CI=17.4%-22.6%). The subgroup analysis revealed that the detection rate of postpartum depression was 19.5% (95%CI=13.8%-25.3%) in women < 40 years old, 40.3% (95%CI=11.4%-69.3%) in women ≥ 40 years old, 19.7% (95%CI=11.7%-27.7%) in women with high school education level or higher, 30.7% (95%CI=19.1%-42.3%) in women with high school education level or lower, 21.1% (95%CI=14.4%-27.9%) in primipara, 16.2% (95%CI=12.9%-19.6%) in multipara, 16.4% (95%CI=12.2%-20.6%) in natural childbirth, 27.8% (95%CI=20.9%-34.8%) in cesarean section, 20.7% (95%CI=15.6%-25.8%) in women with male newborn and 27.3% (95%CI=20.5%-34.0%) in women with female newborn; there were 38.7% (95%CI=22.6%-54.8%) women with pregnancy complications, 11.7% (95%CI=7.6%-15.8%) women without pregnancy complications, 29.5% (95%CI=17.9%-41.1%) women with adverse pregnancy and childbirth history, 27.7% (95%CI=16.6%-38.8%) women without adverse pregnancy and childbirth history, 18.0% (95%CI=16.5%-19.4%) published the year before 2020, 19.5% (95%CI=18.0%-21.0%) published the year after 2020, 20.4% (95%CI=18.2%-22.6%) in the north and 18.2% (95%CI=17.0%-19.4%) in the south, 20.0% (95%CI=18.5%-21.5%) in the Edinburgh Postnatal Depression Scale (EPDS) score ≥ 13 and 16.9% (95%CI=15.2%-18.5%) in the EPDS score ≥ 10. The Egger's test (t=1.76, P=0.095) and the Begg's test (Z=1.48, P=0.147) indicated no significant publication bias. Conclusion The detection rate of postpartum depression is higher for advanced maternal age in China, including women ≥ 40 years old, with high school education level or lower, primipara, cesarean section, female newborn, pregnancy complications and adverse pregnancy and childbirth history, publish year after 2020, areas of the north, EPDS score ≥ 13, attention should be paid to the psychological status of advanced maternal age, and corresponding prevention and intervention measures should be formulated.

ObjectiveAging-related changes and caregiver burden may increase the risk for sleep disturbances among older caregivers, yet few studies have examined the prevalence of insomnia and daytime sleepiness in this group. We examined the relationship of caregiver status with insomnia and daytime sleepiness among persons of advanced age (>75 years of age).DesignCross-sectional.SettingCommunity.ParticipantsYale Precipitating Events Project participants (n=383, mean age 84.4 years, 67% female, 12% African American, 25% caregivers).MeasurementsCaregivers were persons who reported caring for another person in the past week or caring for/helping a friend or relative >4 times in the past month. We examined the correlates of caregiver status, including demographic (age, sex, race/ethnicity, education, marital status), psychosocial (living alone, Medicaid eligibility, depressive symptoms, social support, hours volunteered), and physical (obesity, chronic conditions, medication use, self-rated health status, physical activity, functional disability, cognitive impairment) factors. We used the Insomnia Severity Index (ISI) to establish insomnia severity (ISI score 0–28) or clinically significant insomnia symptoms (ISI ≥8). We used the Epworth Sleepiness Scale to establish daytime sleepiness (ESS score 0–24) or hypersomnia (ESS ≥10). In nonparametric multivariable regression analyses, we examined the relationship of caregiver status with insomnia or daytime sleepiness.ResultsCompared to non-caregivers, caregivers were younger, more educated, less likely to be Medicaid eligible and had lower rates of depression, obesity, poor self-rated health, low physical activity, functional disability, and cognitive impairment. Mean ISI and ESS scores were in the normal range and similar among non-caregivers and caregivers (ISI scores of 6.9±5.6 and 6.9±5.4, and ESS scores of 6.4±4.7 and 6.1±4.3, in non-caregivers and caregivers, respectively). Multivariable-adjusted models demonstrated no significant differences in ISI and ESS scores between non-caregivers and caregivers (regression coefficients for ISI and ESS scores of −0.01 [95% CI = −1.58, 1.21] and −0.10 [−1.05, 1.21], respectively).ConclusionWhen compared to older non-caregivers, older caregivers had more advantageous demographic, psychosocial, and physical profiles and had similar levels of insomnia and daytime sleepiness on standardized questionnaires. Future research is needed to elucidate contextual factors (e.g., caregiving intensity and care partner disease) that may increase the risk of sleep disturbances among caregivers of advanced age.

Abstract Background Female fertility declines with increased maternal age, and this decline is even more rapid after the age of 35 years. Follicular fluid (FF) is a crucial microenvironment that plays a significant role in the development of oocytes, permits intercellular communication, and provides the oocytes with nutrition. Exosomes have emerged as being important cell communication mediators that are linked to age-related physiological and pathological conditions. However, the metabolomic profiling of FF derived exosomes from advanced age females are still lacking. Methods The individuals who were involved in this study were separated into two different groups: young age with a normal ovarian reserve and advanced age. The samples were analysed by using gas chromatography–time of flight mass spectrometry (GC–TOFMS) analysis. The altered metabolites were analysed by using Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis to identify the functions and pathways that were involved. Results Our data showed that metabolites in exosomes from FF were different between women of young age and women of advanced age. The set of 17 FF exosomal metabolites (P ≤ 0.05) may be biomarkers to differentiate between the two groups. Most of these differentially expressed metabolites in FF were closely involved in the regulation of oocyte number and hormone levels. Conclusions In this study, we identified differences in the metabolites of exosomes from FF between women of young age and women of advanced age. These different metabolites were tightly related to oocyte count and hormone levels. Importantly, these findings elucidate the metabolites of the FF exosomes and provide a better understanding of the nutritional profiles of the follicles with age.

Abstract Background Several studies on pregnancy complications of poor ovarian response (POR) patients did not draw a consistent conclusion. The POSEIDON criteria introduces the concept of “low prognosis” and divides POR patients into four groups based on age, AFC and AMH for individualized management. We analyzed low-prognosis population and patients with regular ovarian response, compared maternal and neonatal complications and discussed the relevant risk factors. Methods A retrospective cohort study was conducted of females who achieved a singleton clinical pregnancy after IVF / ICSI—fresh embryo transfer in a single center from January 2014 to March 2019. Participants with low prognosis, as defined by the POSEIDON criteria, were enrolled in the study groups. The controls were defined as AFC ≥ five and number of retrieved oocytes > nine. Maternal and neonatal complications were compared among those groups. Results There were 2554 cycles in POSEIDON group 1, 971 in POSEIDON group 2, 141 in POSEIDON group 3, 142 in POSEIDON group 4, and 3820 in Control. Univariate analysis roughly showed that Groups 2 and 4 had an increased tendency of pregnancy complications. Multi-variable generalized estimating equations (GEE) analysis showed that the risks of GDM, total pregnancy loss, and first-trimester pregnancy loss in Groups 2 and 4 were significantly higher than in Control. The risk of hypertensive disorders of pregnancy (HDP) in Groups 2 and 3 increased, and Group 4 had an increased tendency without statistical significance. After classification by age, GEE analysis showed no significant difference in risks of all complications among groups ≥ 35 years. In patients

Aim. To assess the condition severity and predict postoperative complications and mortality in elderly and senile patients with perforated gastric and duodenal ulcer using the P-POSSUM score. Materials and methods. To conduct a scientific study, 80 (100.0 %) cases of treatment for patients aged 60 to 89 years with a diagnosis of gastric or duodenal ulcer perforation were analyzed. At the stage of hospitalization, the general condition was assessed using the variables of the P-POSSUM score. All patients underwent emergency surgery. Results. The obtained sum of points was compared with postoperative complications and mortality. We defined the discrimination point as >43 points for postoperative complications and >48 points for mortality. Based on the result, the patients were divided into group A with a sum of points up to 43 inclusive – 39 patients (48.8 %), and with a greater number of points – 41 patients (51.2 %) – group B. Evaluation of the detected complications in the postoperative period and comparison with the sum of points significantly confirmed an increase in their frequency in group B (sum of points >43) as compared to group A (sum of points ≤43) – p = 0.0018, U = 474.0. To compare the mortality rate, all the patients were divided into group C – 48 (60.0 %) patients with a sum of points ≤48, and group D – 32 patients (40.0 %) with a sum of points ≥49. In the group of patients with a total score >48 (group D), the mortality rate was significantly increased compared to group C with a score ≤48, p = 0.0002, U = 384.0. Conclusions. Our study has led to the following conclusions: the P-POSSUM score use in elderly and senile patients with perforated gastric and duodenal ulcers significantly confirms the increase in the frequency of postoperative complications, in group A – 6 (15.4 %) patients, while in group B – 23 (56.1 %), p = 0.0018, U = 474.0 and increased mortality, in group C – 6.3 %, in group D – 56.3 %, p = 0.0002, U = 384.0; the P-POSSUM score provides reliable prediction an increase in the risk of postoperative complications and mortality. This, in turn, makes it possible to predict and change treatment approaches and improve the quality of emergency surgical care for elderly and senile patients.

Objective: The aim of this study was to investigate the safety and quality of Turkish videos about the provincial age exercise program on YouTube. Materials and Methods: On August 22, 2022, an internet search was made using YouTube, the popular search engine in Turkey, and the exercises recommended for the ages were evaluated. Forty YouTube videos were rated by two supervisors (physiatrists). The videos included in the study were evaluated using the Quality Criteria for Consumer Health Information (DISCERN) tool and Global Quality and Services (GQS) benchmarks. In addition, video duration, likes, dislikes, number of comments, duration of the video on the internet, video power index, viewing rate and liking rates were evaluated. Results: According to the evaluation of both observers, the videos were found to be of medium to poor quality. While the average DISCERN score of the first observer was 41.3±17.5, the average of the DISCERN score of the second observer was 44.2±17.1, and according to the analysis, the intraclass correlation coefficient value was found to be 0.898 and it was seen that there was a very good agreement. There was a high level of agreement between the two observers in terms of the DISCERN score category (κ=0.683, p

Magnetic resonance imaging (MRI) studies of brain and neurocognitive aging rarely include oldest-old adults (ages 80 +). But predictions of neurocognitive aging theories derived from MRI findings in younger-old adults (ages ~55-80) may not generalize into advanced age, particularly given the increased prevalence of cognitive impairment/dementia in the oldest-old. Here, we reviewed the MRI literature in oldest-old adults and interpreted findings within the context of regional variation, compensation, brain maintenance, and reserve theories. Structural MRI studies revealed regional variation in brain aging as larger age effects on medial temporal and posterior regions for oldest-old than younger-old adults. They also revealed that brain maintenance explained preserved cognitive functioning into the tenth decade of life. Very few functional MRI studies examined compensatory activity in oldest-old adults who perform as well as younger groups, although there was evidence that higher brain reserve in oldest-old adults may mediate effects of brain aging on cognition. Despite some continuity, different cognitive and neural profiles across the older adult lifespan should be addressed in modern neurocognitive aging theories.

Background: Ovarian endometrioma (OMA) is a common gynecological condition affecting women of reproductive age, often requiring laparoscopic surgery for removal. However, the management of OMA, including postoperative hormone therapy, is complex and must be tailored to the individual's conditions. Therefore, to provide meaningful insights, we aimed to analyze 10 years of accumulated data from patients who underwent laparoscopic surgery for OMA, with a primary focus mainly on postoperative OMA recurrence and live birth outcomes. Methods: We reviewed the medical records of 158 patients who underwent laparoscopic surgery for OMA, including total laparoscopic cystectomy (TLC) (79 patients), total laparoscopic adnexectomy (TLA) (62 patients), or both unilateral TLA and contralateral TLC (17 patients), between January 2014 and December 2023. Among the OMA patients, we identified 7 cases of postoperative OMA recurrence out of 158 patients, and 23 live births among 79 TLC patients. We performed a multivariate logistic regression analysis to assess the impact of each representative factor on postoperative OMA recurrence and live birth achievement. Results: The multivariate analyses of the 158 patients revealed that advance age and massive blood loss were significantly associated with an increased risk of postoperative OMA recurrence, while postoperative hormone treatment was associated with a decreased risk of recurrence. In the analysis of live birth achievement among the 79 TLC patients, advanced age, postoperative hormone treatment and cancer antigen 125 (CA125) positivity were significantly associated with a reduced likelihood of achieving live birth. Conclusions: Our data highlight the unfavorable effects of advanced age, massive blood loss and CA125 positivity on the outcomes of laparoscopic surgery for OMA. Additionally, postoperative hormone treatment was found to decrease postoperative OMA recurrence. These findings may offer more accurate information to guidance in selecting treatment options for patients with OMA.

Abstract Background Declining oocyte quality in women with advanced age has been a major impediment to assisted reproductive treatments’ (ART) success rate. However, aging is often accompanied by a diminished ovarian reserve (DOR). Cumulus cells (CCs) are known to play an important role in the development and maturation of oocytes, and the quality of CCs actually reflects the quality of the oocyte. In this study, CCs were used to investigate the real reasons for the decline in oocyte quality in older women. Methods Ninety-nine CC samples were subdivided into 4 different groups according to the different age and ovarian reserve status. Other than clinical ART results, transcriptional expression profiles were performed in CCs to detect the differences. Results The results were that DOR, no matter in young or advanced age group, was found to be significantly associated with adverse ART outcomes. Of note, there were no statistically significant changes in ART outcomes in the group at advanced age with normal ovarian reserve (NOR), compared to the young with NOR. DOR induced a series of transcriptional variations in CCs commonly enriched in oxygen metabolism. Conclusion Our results revealed that the ART outcomes in advanced patients were attributable to the DOR. The oxygen metabolic changes may interfere with CCs’ function of supporting oocytes. This study can provide guidance for ART practice that not age but ovarian reserve status is the main predictor for ART outcomes, and ovarian reserve status should be timely assessed when the clinical manifestations are still mild in elderly women.

Abstract Background This randomized controlled trial was performed to observe the effect of remimazolam with sufentanil on hemodynamics during anesthetic induction in elderly patients with mild hypertension undergoing orthopedic surgery of the lower limbs. Methods Sixty elderly patients were randomly assigned to undergo general anesthesia with intravenous injection of either remimazolam besylate (25 mg/vial, batch number 10T11011; Yichang Humanwell Pharmaceutical Co., Ltd., Yichang, China) at 0.2 mg/kg (Group R, n = 30) or propofol at 1.5 mg/kg (Group P, n = 30). Both injections were completed within 15 to 20 s. If the bispectral index value did not reach 40 to 60, then 0.05 mg/kg of remimazolam was added in Group P and 1 mg/kg of propofol was added in Group R. When the BIS value reached 40 to 60, sufentanil was administered at 0.3 to 0.5 µg/kg and cisatracurium was administered at 0.15 to 0.2 mg/kg in both groups. Three minutes later, tracheal intubation and controlled ventilation were performed to maintain the end-tidal carbon dioxide partial pressure at 4.5 to 5.0 kPa. The mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), continuous cardiac index (CI), systemic vascular resistance (SVR), and pulse oxygen saturation were recorded before induction (T0), when the eyelash reflex disappeared (T1), immediately after endotracheal intubation (T2), 1 min after endotracheal intubation (T3), and 5 min after endotracheal intubation (T4). The disappearance time of the eyelash reflex, injection pain, hypotension, bradycardia, hiccupping, nausea and vomiting, and other adverse events were observed. Results The MAP, HR, CO, and CI at T1, T2, T3, and T4 were significantly higher in Group R than P, while SVR was significantly lower in Group R than P (P

Abstract Purpose Pre‐existing comorbidities play an important role in choice of cancer treatment. We retrospectively evaluated the relationship between pre‐existing comorbidities and receipt of local and systemic therapy in a cohort of Black women with Stage I–III breast cancer. Methods The study population for analysis included 1169 women with Stage I–III disease enrolled in the Detroit Research on Cancer Survivors (ROCS) cohort. Information on comorbidities, socio‐demographic, and clinical variables were obtained from self‐reported questionnaires and the cancer registry. Comorbidities were analyzed individually, and comorbidity burden was categorized as low (0–1), moderate (2–3) or high (≥4). We used logistic regression analysis to evaluate factors associated with receipt of local treatment (surgery ± radiation; N = 1156), hormonal (N = 848), and chemotherapy (N = 680). Adjusted models included variables selected a priori that were significant predictors in univariate analysis. Results Receipt of treatment was categorized into local (82.6%), hormonal (73.7%), and/or chemotherapy (79.9%). Prior history of arthritis and depression were both associated with a lower likelihood to receive local treatment, [odds ratio (OR), 95% confidence interval (CI), 0.66, 0.47–0.93, and 0.53, 0.36–0.78], respectively. Obesity was associated with higher likelihood of receiving hormonal therapy (OR: 1.64, 95% CI: 1.19, 2.26), and heart failure a lower likelihood (OR: 0.46, 95% CI: 0.23, 0.90). Older age (Ptrend

Bronchopulmonary foregut malformation (BPFM) is a rare developmental malformation disease due to embryonic defects, with an even rarer occurrence in adults. We report a diagnosed case in an adult patient, and notably, this is the first reported case of such advanced age. Additionally, she experienced coughing up approximately 1 liter of blood and partial lung tissue, accompanied by respiratory failure and shock. Following treatment with transcatheter arterial embolization, her condition improved, and she has remained stable during follow-up. We present a case report and conducted a systematic review on this particular case.

Background: Several studies on pregnancy complications of poor ovarian response (POR) patients did not draw a consistent conclusion. The POSEIDON criteria introduces the concept of "low prognosis" and divides POR patients into four groups based on age, AFC and AMH for individualized management. We analyzed low-prognosis population and patients with regular ovarian response, compared maternal and neonatal complications and discussed the relevant risk factors. Methods: A retrospective cohort study was conducted of females who achieved a singleton clinical pregnancy after IVF / ICSI—fresh embryo transfer in a single center from January 2014 to March 2019. Participants with low prognosis, as defined by the POSEIDON criteria, were enrolled in the study groups. The controls were defined as AFC ≥ five and number of retrieved oocytes > nine. Maternal and neonatal complications were compared among those groups. Results: There were 2554 cycles in POSEIDON group 1, 971 in POSEIDON group 2, 141 in POSEIDON group 3, 142 in POSEIDON group 4, and 3820 in Control. Univariate analysis roughly showed that Groups 2 and 4 had an increased tendency of pregnancy complications. Multi-variable generalized estimating equations (GEE) analysis showed that the risks of GDM, total pregnancy loss, and first-trimester pregnancy loss in Groups 2 and 4 were significantly higher than in Control. The risk of hypertensive disorders of pregnancy (HDP) in Groups 2 and 3 increased, and Group 4 had an increased tendency without statistical significance. After classification by age, GEE analysis showed no significant difference in risks of all complications among groups ≥ 35 years. In patients < 35 years, the risk of HDP in POSEIDON group 3 was significantly higher than in controls (< 35 years), and there was no significant increase in the risk of other complications. Conclusion: Compared to patients with regular ovarian response, low-prognosis population have increased tendency of maternal and neonatal complications. In low-prognosis patients, advanced age (≥ 35 years) might be the predominant risk factor for pregnancy complications. In those < 35 years, poor ovarian reserve could contribute to HDP. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate whether advanced age is an absolute contraindication for radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) through a single-center case series and a systematic review with meta-analysis. Materials and methods: In the single-center case series, 588 UTUC patients who underwent RNU between May 2003 and June 2019 in West China Hospital were enrolled, and cancer-specific survival (CSS) was the primary outcome of interest. In the systematic review with meta-analysis, PubMed, Scopus, Embase, and Cochrane databases were systematically searched for related articles for further analysis. The endpoints for meta-analyses were overall survival (OS) and CSS. Results: The single-center case series included 57 (9.7%) octogenarians. The CSS of octogenarians after RNU was comparable to that of younger people. Advanced age (≥80) was not an independent risk factor for poor CSS (HR, 1.08; 95% CI, 0.48, 2.40). In a systematic review with meta-analysis, the cut-off value of advanced age is 70, and the results showed that advanced age was associated with inferior OS (pooled HR, 1.55; 95% CI, 1.29, 2.01) and CSS (pooled HR, 1.37; 95% CI, 1.08, 1.65). However, the subgroup analysis of countries found no positive correlation between advanced age and CSS (pooled HR, 1.33; 95% CI 0.92, 1.74) in Chinese. Conclusions: Advanced age may no longer be an absolute contraindication for RNU. RNU can be safely and effectively performed on UTUC patients of advanced age after a comprehensive presurgical evaluation. [ABSTRACT FROM AUTHOR]

We aimed to investigate the blood pressure (BP) patterns of hypertensive disorders of pregnancy (HDP) in the first and second trimesters and its contributing factors, which may help us understand its pathogenesis and identify this group of diseases in a timely manner. SPSS 21.0 was used to describe the BP patterns of 688 HDP as well as 2050 normotensive pregnancies respectively before 28 gestational weeks, and the repeated measurements and two-way ANOVA was used to decide the significant difference of blood pressure in the same period. The results revealed blood pressure in HDP underwent a mid-pregnancy drop as normal while the drop was unremarkable in advanced-age or obesity pregnancies. Besides, we found blood pressure was significantly higher in patients during first and second trimesters, not just after 20 weeks. In conclusion, our study indicated a significant elevation of blood pressure had appeared before 20 weeks in HDP pregnancies, we should pay more attention to monitoring blood pressure before 20 weeks, especially for advanced age and obese women. What is already known on this subject? Gestational hypertension, preeclampsia as well as eclampsia were supposed to have the similar pathogenesis and their time of onset was strictly defined after 20 gestational weeks, while the reason for the time point was not clear. On the other hand, higher blood pressure in the first trimester was associated with increasing risk of developing HDP, while the blood pressure(BP) pattern of normal as well as HDP pregnancy was still controversial, especially for the existence of mid-trimester drop. What do the results of this study add? Firstly, we found blood pressure in HDP underwent a mid-pregnancy drop as normal while the BP drop was unremarkable in advanced-age or obesity pregnancies. Secondly, we noticed the blood pressure in HDP was significantly higher than the normal before 20 weeks, which had not been proved before. What are the implications of these findings for clinical practice and/or further research? On one hand, both the abnormal elevation of BP and the development of the placenta happened in the first trimester suggested toxic substances caused by the defective placenta played a vital role in the onset and aggravation of HDP, which guides us to pay more attention to monitor blood pressure before 20 weeks, especially for advanced age and obesity pregnancies. On the other hand, our results about BP patterns in HDP help us identify this group of diseases in time which can contribute to a better outcome. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the safety and quality of Turkish videos about the provincial age exercise program on YouTube. Materials and Methods: On August 22, 2022, an internet search was made using YouTube, the popular search engine in Turkey, and the exercises recommended for the ages were evaluated. Forty YouTube videos were rated by two supervisors (physiatrists). The videos included in the study were evaluated using the Quality Criteria for Consumer Health Information (DISCERN) tool and Global Quality and Services (GQS) benchmarks. In addition, video duration, likes, dislikes, number of comments, duration of the video on the internet, video power index, viewing rate and liking rates were evaluated. Results: According to the evaluation of both observers, the videos were found to be of medium to poor quality. While the average DISCERN score of the first observer was 41.3±17.5, the average of the DISCERN score of the second observer was 44.2±17.1, and according to the analysis, the intraclass correlation coefficient value was found to be 0.898 and it was seen that there was a very good agreement. There was a high level of agreement between the two observers in terms of the DISCERN score category (κ=0.683, p<0.001). Again, according to both observers, GQS average of the videos was determined as moderate-poor results and positive correlation was found between both. Conclusion: It was determined that the content of the videos on YouTube about the age exercise programs was generally inadequate or of poor quality. It has been determined that there is a need for videos that can contribute to the preparation of higher quality and informational videos based on international guidelines, and to increase public awareness about patient compliance and exercise programs. [ABSTRACT FROM AUTHOR]

Aim. To assess the condition severity and predict postoperative complications and mortality in elderly and senile patients with perforated gastric and duodenal ulcer using the P-POSSUM score. Materials and methods. To conduct a scientific study, 80 (100.0 %) cases of treatment for patients aged 60 to 89 years with a diagnosis of gastric or duodenal ulcer perforation were analyzed. At the stage of hospitalization, the general condition was assessed using the variables of the P-POSSUM score. All patients underwent emergency surgery. Results. The obtained sum of points was compared with postoperative complications and mortality. We defined the discrimination point as >43 points for postoperative complications and >48 points for mortality. Based on the result, the patients were divided into group A with a sum of points up to 43 inclusive - 39 patients (48.8 %), and with a greater number of points - 41 patients (51.2 %) - group B. Evaluation of the detected complications in the postoperative period and comparison with the sum of points significantly confirmed an increase in their frequency in group B (sum of points >43) as compared to group A (sum of points ≤43) - p = 0.0018, U = 474.0. To compare the mortality rate, all the patients were divided into group C - 48 (60.0 %) patients with a sum of points ≤48, and group D - 32 patients (40.0 %) with a sum of points ≥49. In the group of patients with a total score >48 (group D), the mortality rate was significantly increased compared to group C with a score ≤48, p = 0.0002, U = 384.0. Conclusions. Our study has led to the following conclusions: the P-POSSUM score use in elderly and senile patients with perforated gastric and duodenal ulcers significantly confirms the increase in the frequency of postoperative complications, in group A - 6 (15.4 %) patients, while in group B - 23 (56.1 %), p = 0.0018, U = 474.0 and increased mortality, in group C - 6.3 %, in group D - 56.3 %, p = 0.0002, U = 384.0; the P-POSSUM score provides reliable prediction an increase in the risk of postoperative complications and mortality. This, in turn, makes it possible to predict and change treatment approaches and improve the quality of emergency surgical care for elderly and senile patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the influencing factors and countermeasures of the difficulty in inserting peripheral inserted central venous catheter(PICC) among elderly patients. Methods A total of 172 patients over 80 years old who received PICC catheterization from January 2020 to January 2022 were selected. Selection of catheter access and abnormal conditions of catheter placement were analyzed. The rate of difficulty in inserting PICC was observed and compared between patients with different body mass index (BMI), selection of catheter access, history of central venous catheter placement and limb joint contractures. Results Patients with BMI < 18. 5 kg/m2 had a higher incidence of difficulty in inserting PICC compared with BMI ≥ 18. 5 kg/m2 (P＜0. 01). The incidence of difficulty in inserting PICC via cephalic vein was significantly higher than that via basilic vein and brachial vein (P＜0. 01). Patients with multiple history of central vein catheterization had a significantly higher incidence of difficulty in inserting PICC than those without history of central vein catheterization (P＜0. 01). The rate of difficulty in inserting PICC in patients with limb joint contractures was significantly higher than that in patients with limb joint abduction (P< 0. 05). Conclusion There is a relatively high risk of difficulty in inserting PICC among elderly patients with BMI lower than 18. 5 kg/m2, catheter placed via the cephalic vein, multiple history of central vein catheterization and limb joint contractures. It is required to adequately evaluate patients’ condition before catheterization and select the catheter access reasonably. Operators should be familiar with catheterization skills and able to improve the success rate of catheterization. (目的 探讨高龄患者经外周静脉置入中心静脉导管(PICC)时送管困难的影响因素及对策。方法 回顾性分析2020年1月—2022年1月医院收治的行PICC置管的172例80岁以上高龄患者的临床资料, 统计患者置管静脉选择和置管过程中发生的异常情况, 总结处理方法。比较分析患者不同体质指数(BMI)、置管静脉选择、既往中心静脉置管史、肢体挛缩等情况下送管不畅发生率。结果 BMI＜18. 5 kg/m2的患者送管不畅发生率更高(P＜0. 05); 经头静脉置管患者送管不畅发生率高于经贵要静脉及肱静脉置管(P＜0. 01); 有多次中心静脉置管史患者送管不畅发生率较无置管史者增高(P＜0. 01); 穿刺肢体挛缩患者送管不畅发生率高于穿刺肢体充分外展患者(P＜0. 05)。结论 高龄患者BMI＜18. 5 kg/m2、经头静脉置管、有多次中心静脉置管史、肢体挛缩等情况下, 置管过程中出现送管不畅风险较高。在置管前应充分评估患者, 合理选择静脉, 同时操作者熟练掌握送管技巧, 提高置管成功率。)

Abstract Background Advanced age is associated with decreased likelihood of colorectal cancer treatment. Here, we investigated the extent to which comorbidities are accountable for this lesser treatment. Methods Using population‐based datasets, the pattern of care among CRC cases in South Australia during 2004–2013 was investigated. Models were used to investigate associations of age with each treatment type, and differences in these associations were explored by comorbidity and cancer site. Results The presence of comorbidity was associated with a significantly weaker relationship of age with surgery and chemotherapy. The association of age with surgery also varied for colon and rectal primary cancer sites. Individual comorbidity types varied in their associations with each treatment category. For example, dementia was associated with less chemotherapy provision, however, it was not significantly related to the likelihood of surgery. Conclusion This study indicates that the association of age with surgical treatment differed significantly by the CRC subsite. Comorbidity moderated the negative association of age with chemotherapy, and less so, with extent of surgery. Results were novel in indicating associations of multiple individual comorbidity types with CRC treatment modalities. The data suggest that different individual comorbidity types may have different effects on treatment and should be studied separately.

Yadeta Dessie School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaCorrespondence: Yadeta Dessie, Email yad_de2005@yahoo.comAbstract: Primiparity at an advanced age, which means having a first birth at age 35 years and beyond, is a recent emerging phenomenon in low- and middle-income countries that significantly affects maternal and child health. However, this evolving phenomenon has not been given due attention as many countries still deal with health-related issues during early-age pregnancies. This paper describes the emerging trend of primiparity during advanced age, focusing on low- and middle-income countries, elaborates on the linked adverse feto-maternal outcomes, and outlines potential interventions to bring the scenario to policymakers’ and practitioners’ attention.Keywords: primiparity, maternal, child, advanced age, birthing, SDG, complications, adverse

We aimed to investigate the blood pressure (BP) patterns of hypertensive disorders of pregnancy (HDP) in the first and second trimesters and its contributing factors, which may help us understand its pathogenesis and identify this group of diseases in a timely manner. SPSS 21.0 was used to describe the BP patterns of 688 HDP as well as 2050 normotensive pregnancies respectively before 28 gestational weeks, and the repeated measurements and two-way ANOVA was used to decide the significant difference of blood pressure in the same period. The results revealed blood pressure in HDP underwent a mid-pregnancy drop as normal while the drop was unremarkable in advanced-age or obesity pregnancies. Besides, we found blood pressure was significantly higher in patients during first and second trimesters, not just after 20 weeks. In conclusion, our study indicated a significant elevation of blood pressure had appeared before 20 weeks in HDP pregnancies, we should pay more attention to monitoring blood pressure before 20 weeks, especially for advanced age and obese women.IMPACT STATEMENT What is already known on this subject? Gestational hypertension, preeclampsia as well as eclampsia were supposed to have the similar pathogenesis and their time of onset was strictly defined after 20 gestational weeks, while the reason for the time point was not clear. On the other hand, higher blood pressure in the first trimester was associated with increasing risk of developing HDP, while the blood pressure(BP) pattern of normal as well as HDP pregnancy was still controversial, especially for the existence of mid-trimester drop. What do the results of this study add? Firstly, we found blood pressure in HDP underwent a mid-pregnancy drop as normal while the BP drop was unremarkable in advanced-age or obesity pregnancies. Secondly, we noticed the blood pressure in HDP was significantly higher than the normal before 20 weeks, which had not been proved before. What are the implications of these findings for clinical practice and/or further research? On one hand, both the abnormal elevation of BP and the development of the placenta happened in the first trimester suggested toxic substances caused by the defective placenta played a vital role in the onset and aggravation of HDP, which guides us to pay more attention to monitor blood pressure before 20 weeks, especially for advanced age and obesity pregnancies. On the other hand, our results about BP patterns in HDP help us identify this group of diseases in time which can contribute to a better outcome.

Background: Declining oocyte quality in women with advanced age has been a major impediment to assisted reproductive treatments' (ART) success rate. However, aging is often accompanied by a diminished ovarian reserve (DOR). Cumulus cells (CCs) are known to play an important role in the development and maturation of oocytes, and the quality of CCs actually reflects the quality of the oocyte. In this study, CCs were used to investigate the real reasons for the decline in oocyte quality in older women. Methods: Ninety-nine CC samples were subdivided into 4 different groups according to the different age and ovarian reserve status. Other than clinical ART results, transcriptional expression profiles were performed in CCs to detect the differences. Results: The results were that DOR, no matter in young or advanced age group, was found to be significantly associated with adverse ART outcomes. Of note, there were no statistically significant changes in ART outcomes in the group at advanced age with normal ovarian reserve (NOR), compared to the young with NOR. DOR induced a series of transcriptional variations in CCs commonly enriched in oxygen metabolism. Conclusion: Our results revealed that the ART outcomes in advanced patients were attributable to the DOR. The oxygen metabolic changes may interfere with CCs' function of supporting oocytes. This study can provide guidance for ART practice that not age but ovarian reserve status is the main predictor for ART outcomes, and ovarian reserve status should be timely assessed when the clinical manifestations are still mild in elderly women. [ABSTRACT FROM AUTHOR]

Objective: We aimed to analyze the risk of cardiac rupture (CR) in aged diabetic patients with acute ST-segment elevated myocardial infarction (STEMI) who were followed up for one month, and analyze its independent risk factors. Methods: A total of 3063 aged patients with first onset STEMI admitted to Beijing Anzhen Hospital from January 2001 to December 2020 were retrospectively included. There were 2020 patients without diabetes mellitus (DM) and 1043 patients with DM. We used propensity scores matching (PSM) method to balance baseline exposure factors between patients with or without DM, and all were divided the DM group (1043 cases) and the non-DM group (1043 cases) after the PSM. The primary outcome was CR (the composite rate of papillary muscle rupture, ventricular septum perforation, free wall rupture), which was diagnosed based on clinical manifestations and/or echocardiographic findings. Kaplan-meier survival analyses and log-rank test was used to evaluate the risk of CR between the two groups, and Cox regression analysis was used to evaluate the independent risk factors for CR. Results: After PSM, the baseline clinical data were similar between the DM and non-DM group (all P>0.05). However, level of glycated hemoglobin was significantly higher in the DM group (P<0.05). During 1 month of follow-up, there were 55 (2.64%) cases of CR, most occurred within 48h after admission (40 cases). Among the 55 cases, 11(0.53%) had papillary muscle rupture, 18(0.86%) had ventricular septum perforation, and 26(1.25%) had free wall rupture. Kaplan-meier survival analyses detected that the DM group was associated with significantly increased risk of CR (3.36% vs. 1.92%, HR=1.532, 95% CI: 1.054-2.346, P=0.030), ventricular septum perforation (1.05% vs. 0.67%, HR=1.464, 95% CI: 1.021-2.099, P=0.038) and free wall rupture (1.63% vs. 0.86%, HR=1.861, 95% CI: 1.074-3.225, P=0.027) than those in the non-DM group. Among the 2031 aged STEMI patients without CR, 144 cases (6.90%, 144/2086) died; and among the 55 patients with CR, 37 cases (1.77%, 37/2086) died due to CR. Therefore, twenty percent (20.44%, 37/181) of death was due to CR. Multivariate Cox regression analysis indicated that DM (HR=1.532, 95%CI: 1.054-2.346), age (HR=1.390, 95%CI: 1.079-1.791), female (HR=1.183, 95%CI: 1.049-1.334), troponin I (HR=1.364, 95%CI: 1.108-1.679), brain natriuretic peptide (HR=1.512, 95%CI: 1.069-2.139), revascularization (HR=0.827, 95%CI: 0.731-0.936) and β-receptor blocker (HR=0.849, 95%CI: 0.760-0.948) were independent risk factors of CR (all P<0.05). Conclusion: DM as well as a few other factors, are independent determinants of CR. CR is not a rare event among the aged STEMI patients and twenty percent of deaths are due to CR. However, large sample-sized studies are warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Background and Objectives: Delayed childbearing in advanced age might be associated with a low prognosis for achieving pregnancy. Therefore, it is important to establish a predictive tool that will optimize the likelihood of a live birth at advanced age. Material and Methods: The retrospective study was conducted at the Ferona Fertility Clinic in Novi Sad (Republic of Serbia), between January 2020 and May 2021. The survey included 491 women aged ≥35 who met the inclusion criteria and who were subjected to an IVF (in vitro fertilization) treatment cycle. Results: The average number of retrieved oocytes, MII (metaphase II) oocytes, and developed embryos significantly decreased in advanced age. Age was also found to have a significant adverse effect on pregnancy and live birth rates. In women aged ≥35, 10/12 MII oocytes or 10/11 embryos are required for reaching an optimal live birth rate/cumulative live birth rate. Optimal CLBR (cumulative live birth rate) per one oocyte was achieved when 9 MII oocyte were retrieved. Conclusions: The study indicates that the cut-off for increased risk is ≥42 year. However, despite low live birth rates, autologous IVF for these women is not futile. An increase in the number of retrieved mature oocytes and a generation of surplus cryopreserved embryos could reinforce LBR (live birth rate) and CLBR. Clinicians should be very cautious in counseling, as autologous IVF may only be applicable to women with good ovarian reserve. [ABSTRACT FROM AUTHOR]

Purpose: Pre‐existing comorbidities play an important role in choice of cancer treatment. We retrospectively evaluated the relationship between pre‐existing comorbidities and receipt of local and systemic therapy in a cohort of Black women with Stage I–III breast cancer. Methods: The study population for analysis included 1169 women with Stage I–III disease enrolled in the Detroit Research on Cancer Survivors (ROCS) cohort. Information on comorbidities, socio‐demographic, and clinical variables were obtained from self‐reported questionnaires and the cancer registry. Comorbidities were analyzed individually, and comorbidity burden was categorized as low (0–1), moderate (2–3) or high (≥4). We used logistic regression analysis to evaluate factors associated with receipt of local treatment (surgery ± radiation; N = 1156), hormonal (N = 848), and chemotherapy (N = 680). Adjusted models included variables selected a priori that were significant predictors in univariate analysis. Results: Receipt of treatment was categorized into local (82.6%), hormonal (73.7%), and/or chemotherapy (79.9%). Prior history of arthritis and depression were both associated with a lower likelihood to receive local treatment, [odds ratio (OR), 95% confidence interval (CI), 0.66, 0.47–0.93, and 0.53, 0.36–0.78], respectively. Obesity was associated with higher likelihood of receiving hormonal therapy (OR: 1.64, 95% CI: 1.19, 2.26), and heart failure a lower likelihood (OR: 0.46, 95% CI: 0.23, 0.90). Older age (Ptrend <0.01) and increasing co‐morbidity burden (Ptrend = 0.02) were associated with lower likelihood of receiving chemotherapy. Conclusion: History of prior co‐morbidities has a potentially detrimental influence on receipt of recommended cancer‐directed treatment among women with Stage I–III breast cancer. [ABSTRACT FROM AUTHOR]

Background: This randomized controlled trial was performed to observe the effect of remimazolam with sufentanil on hemodynamics during anesthetic induction in elderly patients with mild hypertension undergoing orthopedic surgery of the lower limbs. Methods: Sixty elderly patients were randomly assigned to undergo general anesthesia with intravenous injection of either remimazolam besylate (25 mg/vial, batch number 10T11011; Yichang Humanwell Pharmaceutical Co., Ltd., Yichang, China) at 0.2 mg/kg (Group R, n = 30) or propofol at 1.5 mg/kg (Group P, n = 30). Both injections were completed within 15 to 20 s. If the bispectral index value did not reach 40 to 60, then 0.05 mg/kg of remimazolam was added in Group P and 1 mg/kg of propofol was added in Group R. When the BIS value reached 40 to 60, sufentanil was administered at 0.3 to 0.5 µg/kg and cisatracurium was administered at 0.15 to 0.2 mg/kg in both groups. Three minutes later, tracheal intubation and controlled ventilation were performed to maintain the end-tidal carbon dioxide partial pressure at 4.5 to 5.0 kPa. The mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), continuous cardiac index (CI), systemic vascular resistance (SVR), and pulse oxygen saturation were recorded before induction (T0), when the eyelash reflex disappeared (T1), immediately after endotracheal intubation (T2), 1 min after endotracheal intubation (T3), and 5 min after endotracheal intubation (T4). The disappearance time of the eyelash reflex, injection pain, hypotension, bradycardia, hiccupping, nausea and vomiting, and other adverse events were observed. Results: The MAP, HR, CO, and CI at T1, T2, T3, and T4 were significantly higher in Group R than P, while SVR was significantly lower in Group R than P (P < 0.05). In Group P, the MAP, HR, CO, and CI were significantly lower and the SVR was significantly higher at T1, T2, T3, and T4 than at T0 (P < 0.05). Adverse events occurred in 8 (20%) patients in Group R and 22 (73%) in Group P. The total incidence of adverse events was significantly lower in Group R than P (P < 0 0.001). Conclusion: Remimazolam combined with sufentanil for general anesthesia induction has the advantages of small hemodynamic fluctuations, stable circulation, and few adverse reactions, making it suitable for elderly patients with mild hypertension. Trial registration: Chinese Clinical Trial Registry (ChiCTR2300069224, 10/03/2023). [ABSTRACT FROM AUTHOR]

Abstract Background Immunosenescence is a complex process characterized by an age-related remodelling of immune system. The prominent effects of the immunosenescence process is the thymic involution and, consequently, the decreased numbers and functions of T cells. Since thymic involution results in a collapse of the T-cell receptor (TCR) repertoire, a reliable biomarker of its activity is represented by the quantification of signal joint T-cell receptor rearrangement excision circles (sjTRECs) levels. Although it is reasonable to think that thymic function could play a crucial role on elderly survival, only a few studies investigated the relationship between an accurate measurement of human thymic function and survival at old ages. Methods and findings By quantifying the amount sjTRECs by real-time polymerase chain reaction (PCR), the decrease in thymic output in 241 nursing home residents from Calabria (Southern Italy) was evaluated to investigate the relationship between thymic function and survival at old ages. We found that low sjTREC levels were associated with a significant increased risk of mortality at older ages. Nursing home residents with lower sjTREC exhibit a near 2-fold increase in mortality risk compared to those with sjTREC levels in a normal range. Conclusion Thymic function failure is an independent predictor of mortality among elderly nursing home residents. sjTREC represents a biomarker of effective ageing as its blood levels could anticipate individuals at high risk of negative health outcomes. The identification of these subjects is crucial to manage older people’s immune function and resilience, such as, for instance, to plan more efficient vaccinal campaigns in older populations.

The development of diabetic retinopathy is associated with matrix metalloproteinases, but they are rarely used to predict this pathology. The purpose of the study is to predict the development of nonproliferative diabetic retinopathy in old age based on the level of matrix metalloproteinases in blood plasma. The main group of the study consisted of 63 patients 60–74 years old with nonproliferative diabetic retinopathy, control consisted of 56 patients of the same age without the diabetic retinopathy and other ophthalmopathology at present and in history. Examination of patients in both groups included: tonometry, visiometry, standard fundus photography, optical coherence tomography, optical coherence tomography-A, fluorescence angiography. Determination of matrix metalloproteinases was carried out by the method of enzyme-linked immunosorbent assay. A statistically significant increase in matrix metalloproteinase was found — 9 in the main group of patients to 55,7 ± 2.6 ng / ml versus 40.2 ± 1.9 ng / ml in age control, matrix metalloproteinase — 2 to 269.8 ± 1.2 ng / ml versus 221.9 ± 3.6 ng / ml, respectively. Based on the level of matrix metalloproteinases — 2 (X1) and (X2) of the blood by the regressive method for predicting the development of diabetic retinopathy, which has the form Y = 28.315 + 3.892 × X1 + 2.453 × X2, which will allow detecting the disease at an early stage.

Background Immunoglobulin A nephropathy (IgAN) has been well studied among young people, but few data on clinicopathological characteristics, treatment response and outcomes for elderly IgAN patients are available.Methods A cohort study of elderly IgAN patients was performed. The combined endpoints of renal outcome were a 50% decline in eGFR compared with the time of renal biopsy, end-stage kidney disease and/or death. Risk factors associated with poor renal outcomes were then determined. The benefits of immunosuppressant therapies were also evaluated by Kaplan-Meier survival curve analysis.Results This study ultimately included 126 elderly patients with IgAN. Comparison between the endpoint and non-endpoint groups indicated that patients with poor outcomes had more severe clinical features, such as worse kidney function, severe hematuria and lower albumin levels. Cox regression analysis indicated that age (HR 1.15, 95% CI 1.02–1.29, p = 0.021), male gender (HR 9.71, 95% CI 1.00–97.56, p = 0.050), and urine red blood cells (HR 1.003, 95% CI 1.000–1.006, p = 0.029) were independent risk factors for poor renal outcome in elderly IgAN patients. To explore possible reasons accounting for the predictive value of age and sex, patients were divided into two groups based on these two variables. Patients in the geriatric group had lower serum albumin, estimated glomerular filtration rate, hemoglobin and aspartate aminotransferase levels than those in the quinquagenarian group. Male patients tended to have higher hemoglobin, higher alanine aminotransferase, and lower triglycerides and cholesterol levels than female patients. To investigate different treatment responses, patients were classified into two groups depending on treatment strategies (renin-angiotensin system inhibitors and immunosuppressive therapy), and the survival analysis indicated no significant difference in kidney outcome between the two groups (p > 0.05). This result still holds after adjusting for age, sex, eGFR, hematuria, and proteinuria.Conclusion Advanced age, male, and hematuria might be independently associated with poor kidney outcomes in elderly patients with IgAN. Immunosuppressive therapy might confer no overall benefit to older IgAN patients.

Disability is an essential criterion for public health, which identifies high mortality rates, low longevity and quality of life. The article analyzes the problem re disability in the adult population in the Russian Federation with focus on the major category of elderly persons. The results of the study in the proportion of older people with disabilities in the disability re-structure, dynamics and level of the repeated disability due to all classes of diseases according to ICD 10 for a long period (2005–2014). The results of the analysis indicate about the dynamics of increase of re-entry for senior citizens on disability due to basic socially significant diseases in the Russian Federation by reducing this rate among young and middle-age. Determined the leading nosologies in the structure of the secondary disablement: diseases of the circulatory system (1 rank), malignant neoplasms (rank 2), illnesses of bone-muscular system (rank 3), diseases of the organ of vision (4 rank), diseases of the endocrine and nervous systems (5th – 6th ranking place), mental disorders (7 rank), the effects of trauma and poisoning (8 rank). Especially the growing dynamics of the level of disability seen in the categories of older people with disabilities due to malignant neoplasms, over a ten-year period increased from 10.1 to 41.6 per 10 thousand of the relevant population.

The number of advanced-age patients with spinal metastases is rising. This study was performed to clarify the characteristics and surgical outcomes of spinal metastases in advanced-age patients. We prospectively analyzed 216 patients with spinal metastases from 2015 to 2020 and divided them into three age groups: <70 years (n = 119), 70–79 years (n = 73), and ≥80 years (n = 24). Although there were no significant intergroup differences in preoperative characteristics and surgery-related factors except for age, patients aged ≥80 years tended to have a worse performance status (PS), Barthel index, and EuroQol-5 dimension (EQ-5D) before and after surgery than the other two groups. Although the median PS, mean Barthel index and mean EQ-5D greatly improved postoperatively in each group, the median PS and mean Barthel index at 6 months and the mean EQ-5D at 1 month postoperatively were significantly poorer in the ≥80-year group than the 70–79-year group. The rates of postoperative complications and re-deterioration of the EQ-5D were significantly higher in the oldest group than in the other two groups. Although surgery for spinal metastases improved the PS, Barthel index, and EQ-5D regardless of age, clinicians should be aware of the poorer outcomes and higher complication rates in advanced-age patients. [ABSTRACT FROM AUTHOR]

Background: Advanced age is associated with decreased likelihood of colorectal cancer treatment. Here, we investigated the extent to which comorbidities are accountable for this lesser treatment. Methods: Using population‐based datasets, the pattern of care among CRC cases in South Australia during 2004–2013 was investigated. Models were used to investigate associations of age with each treatment type, and differences in these associations were explored by comorbidity and cancer site. Results: The presence of comorbidity was associated with a significantly weaker relationship of age with surgery and chemotherapy. The association of age with surgery also varied for colon and rectal primary cancer sites. Individual comorbidity types varied in their associations with each treatment category. For example, dementia was associated with less chemotherapy provision, however, it was not significantly related to the likelihood of surgery. Conclusion: This study indicates that the association of age with surgical treatment differed significantly by the CRC subsite. Comorbidity moderated the negative association of age with chemotherapy, and less so, with extent of surgery. Results were novel in indicating associations of multiple individual comorbidity types with CRC treatment modalities. The data suggest that different individual comorbidity types may have different effects on treatment and should be studied separately. [ABSTRACT FROM AUTHOR]

Background: Infertility is a common problem presented in women with endometriosis especially as it is often associated with poor quality of life. Therefore, surgical Intervention has been considered as the first-line treatment of choice. On the other hand, surgery itself has detrimental effects on ovarian reserve and is associated with ovarian failure. Case Report: We present a case of a 39-year-old woman para 1 with multiple myoma uteri, bilateral endometriosis cyst, left hydrosalpinx, deep infiltrating endometriosis (DIE), and adhesion (Figure 1). She comes with a history of heavy abnormal uterine bleeding, lower abdominal pain, and unable to conceive 11 years after their first child despite adequate unprotected intercourse. The patient was anemic (Hemoglobin 7.30 g/dL) with low Anti Mullerian Hormone (AMH; 0.26 mg/ml). We decided to perform laparoscopic uterine myoma with multiple bilateral endometrial cysts, left salpingectomy, and adhesiolysis (Figure 2). Patient then underwent an ultra-long protocol with three cycles of leuprolide acetate 3.75 mg. Ovum pick-up was performed and we retrieved five M-II oocytes and from embryo culture, two embryos with good and moderate quality were collected for vitrification procedure. Prior frozen embryo transfer, extra acetylsalicylic acid 80 mg once a day and estradiol valerate 4 mg thrice a day were given for 18 days. The patient soon became pregnant after a few weeks of embryo transfer with βHCG of 185 mIU/m. Conclusion: Individualized treatment plans based on the patient’s symptoms and respective reproductive goals are important points to be discussed in endometriosis-associated infertility patients. Surgical intervention before IVF/ICSI is deemed as necessary to preserve ovarian reserve and to restore normal anatomy to increase the success rate of embryo implantation.

Abstract Background As older adults ≥80 years are often underrepresented in previous studies, little is known about their characteristics associated with the utilization of nursing care services. Therefore, this study examined individual (predisposing, enabling, and need) predictors of nursing care utilization in the very old population of North Rhine-Westphalia (NRW) in Germany. Methods Data from a representative cross-sectional study included 1531 community-dwelling individuals and nursing home residents aged ≥80 years. Multinomial regression was applied to investigate the factors that explain the use of outpatient care services, day care, and/or private care (odpNCU), and inpatient nursing care (inpNCU). Results Overall, 1083 (69.9%) participants did not use nursing care services (noNCU), 339 (21.9%) used outpatient, day, and/or private care, and 127 (8.2%) used inpatient nursing care. Compared to noNCU, odpNCU was associated with a higher likelihood of being older [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.01-1.11], having no partner (OR = 0.58, 95%CI: 0.37-0.91), experiencing higher functional (basic activities of daily living, OR = 0.02, 95%CI: 0.01-0.04; instrumental activities of daily living, OR = 0.18, 95%CI: 0.11-0.30) and cognitive disabilities (OR = 0.63, 95%CI: 0.44-0.89). Compared to noNCU, nursing home residents were more likely older (OR = 1.14, 95%CI: 1.07-1.22), had lower socioeconomic status (OR = 0.98, 95%CI: 0.97-1.00), were childless (OR = 3.83, 95%CI: 1.71-8.56) and without partners (OR = 0.43, 95%CI: 0.20-0.96), socially isolated (OR = 3.94, 95%CI: 2.06-7.55), were more likely to be lonely (OR = 2.94, 95%CI: 1.58-7.89), more functionally (basic activities of daily living, OR = 0.01, 95%CI: 0.00-0.03; instrumental activities of daily living, OR = 0.04, 95%CI: 0.02-0.09) and cognitively impaired (OR = 0.48, 95%CI: 0.31-0.74), but they were less likely to experience five or more chronic conditions (OR = 0.42, 95%CI: 0.20-0.88) and less likely to be physically pre-frail (OR = 0.24, 95%CI: 0.10-0.58) and frail (OR = 0.09, 95%CI: 0.03-0.27). Conclusions Individual need factors dominated in explaining odpNCU, suggesting that the very old population in NRW may have equitable access to these services. As social structure, region, and social resources explain inpNCU, this type of care may be inequitably accessible.

Abstract Background Erenumab, a fully human monoclonal antibody that targets the calcitonin gene-related peptide receptor, has demonstrated efficacy and safety in the prevention of episodic and chronic migraine. There exists an unmet need to establish the safety of erenumab in older individuals, in view of existing multiple comorbidities, polypharmacy, and age-related physiological changes. This pooled analysis of five large migraine-prevention studies examined the safety of erenumab stratified across age groups, particularly in older populations. Methods Pooled and age-stratified analysis of safety data from the 12-week double-blind treatment phase (DBTP) of five randomized, placebo-controlled Phase 2 and 3 studies of erenumab in participants with episodic or chronic migraine across the age groups

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