Outcomes of Colonic Endoscopic Mucosal Resection for Large Polyps in Elderly Patients.

OBJECTIVE: The aim of this study is to investigate the short-term outcomes of endoscopic mucosal resection (EMR) for large colonic polyps in elderly patients (≥80 years) compared with those in younger patients (<80 years). PATIENTS AND METHODS: A total of 339 patients who underwent colon EMR ≥2 cm were included. Sixty-five colon EMRs were performed on 46 patients ≥80 years (Group A) and 401 resections were performed on 293 patients <80 years. Demographics, operative and short-term results were compared between the two groups. RESULTS: The median age in Group A was 83.5 years (range 80-91 years) and 66 years in Group B (range 26-79 years, P < .001). The proportion of patients with American Society of Anesthesiologists class III was significantly high in Group A (39.1% versus 17.7%, P = .001). There was no significant difference in sex ratio, body mass index, tumor size, and tumor distribution between the two groups. Median operating time was similar between the two groups (30 versus 30 minutes, P = .839). En bloc resection rate was 33.8% in Group A and 29.2% in Group B (P = .445). No anesthesia-associated adverse events or deaths occurred in both groups. Complication rate was similar between the two groups, perforation rate was 2.2% in Group A and 1.7% in Group B (P = .823), and delayed bleeding rate was 4.3% versus 3.1% (P = .650), respectively. CONCLUSIONS: Colon EMR is feasible and safe in very elderly patients.

[Correlations among metabolic syndrome and mild cognitive impairment].

OBJECTIVE: To determine the correlations between metabolic syndrome (MS), its individual components and mild cognitive impairment (MCI). METHODS: We selected 168 MS patients and 150 healthy control subjects from our hospital from June 2009 to June 2010. Socio-demographic characteristic data including gender, age, education level, height, weight waist circumference and blood pressure, past history of coronary heart disease, stroke, diabetes mellitus, hypertension, hyperlipidemia and unhealthy habit of smoking and drinking, were investigated. The patient levels of fasting plasma glucose, fast insulin glycated, hemoglobin and blood lipids were measured on the next day. All subjects were evaluated with regards to the scores of Montreal cognitive assessment (MoCA), clinical memory scale (CMS), daily living skills assessment (ADL) and Hamilton depression scale (HAMD). RESULT: (1) MCI was more frequently detected in MS subjects than that in the healthy controls (24.4% vs 1.2%); (2)the scores of general MoCA and several parts of MoCA were lower in the MS subjects (scores of general 26.8 ± 0.5, EF4.40 ± 0.04, NAM2.60 ± 0.06, MEM3.60 ± 0.20, ATT5.60 ± 0.09, LANG2.60 ± 0.08, ABS1.50 ± 0.10, ORT5.40 ± 0.13)than those of the controls (scores of general 27.6 ± 0.4, EF4.50 ± 0.05, NAM2.70 ± 0.08, MEM4.20 ± 0.11, ATT5.70 ± 0.08, LANG2.60 ± 0.09, ABS1.60 ± 0.07, ORT5.40 ± 0.10). No statistically significant differences existed in the scores of general MoCA and several parts except for memory and abstract (P > 0.05). The scores of general CMS and several parts of CMS were lower in the MS subjects (scores of general 72 ± 8, memory function reflected in memory 14 ± 2, associating study 14 ± 3, free image memory 14 ± 4, recognition of meaningless figure 16 ± 3, recollection ability of human figure 14 ± 3) than those in the controls (scores of general 85 ± 7, memory function reflected in memory 16 ± 2,associating study 16 ± 3, free image memory 17 ± 3, recognition of meaningless figure 18 ± 3, recollection ability of human figure 17 ± 3). And the differences had statistical significance (P < 0.05); (3) a high degree of education was a protective factor of MCI (OR = 0.512, P = 0.011) while diabetes, insulin resistance and metabolic syndrome were the independent risk factors of MCI (OR(1) = 4.240, P(1) = 0.014; OR(2) = 7.230, P(2) = 0.023; OR(3) = 8.620, P(3) = 0.001). CONCLUSION: Diabetes mellitus and metabolic syndrome are the independent risk factors of MCI.