Development and validation of a nomogram for predicting pulmonary complications in elderly patients undergoing thoracic surgery.

BACKGROUND: Postoperative pulmonary complications (PPCs) remain a prevalent concern among elderly patients undergoing surgery, with a notably higher incidence observed in elderly patients undergoing thoracic surgery. This study aimed to develop a nomogram to predict the risk of PPCs in this population. METHODS: A total of 2963 elderly patients who underwent thoracic surgery were enrolled and randomly divided into a training cohort (80%, n = 2369) or a validation cohort (20%, n = 593). Univariate and multivariate logistic regression analyses were conducted to identify risk factors for PPCs, and a nomogram was developed based on the findings from the training cohort. The validation cohort was used to validate the model. The predictive accuracy of the model was evaluated by receiver operating characteristic (ROC) curve, area under ROC (AUC), calibration curve, and decision curve analysis (DCA). RESULTS: A total of 918 (31.0%) patients reported PPCs. Nine independent risk factors for PPCs were identified: preoperative presence of chronic obstructive pulmonary disease (COPD), elevated leukocyte count, higher partial pressure of arterial carbon dioxide (PaCO2) level, surgical site, thoracotomy, intraoperative hypotension, blood loss > 100 mL, surgery duration > 180 min, and malignant tumor. The AUC value for the training cohort was 0.739 (95% CI: 0.719-0.762), and it was 0.703 for the validation cohort (95% CI: 0.657-0.749). The P-values for the Hosmer-Lemeshow test were 0.633 and 0.144 for the training and validation cohorts, respectively, indicating a notable calibration curve fit. The DCA curve indicated that the nomogram could be applied clinically if the risk threshold was between 12% and 84%, which was found to be between 8% and 82% in the validation cohort. CONCLUSION: This study highlighted the pressing need for early detection of PPCs in elderly patients undergoing thoracic surgery. The nomogram exhibited promising predictive efficacy for PPCs in elderly patients undergoing thoracic surgery, enabling the identification of high-risk patients and consequently aiding in the implementation of preventive interventions.

Routine single-incision laparoscopic common bile duct exploration with concomitant cholecystectomy for elderly patients: a 6-year retrospective comparative study.

BACKGROUND: While single-incision laparoscopic cholecystectomy (SILC) has gained more popularity in recent years, its application to elderly patients needs further evaluation. Few SILC studies regarded this rapidly growing vulnerable population, and single-incision laparoscopic common bile duct exploration (SILCBDE) was never mentioned. We conducted an observational study of 146 routine SILCBDE to address this issue. METHODS: One hundred forty-six consecutive patients underwent SILCBDE with concomitant cholecystectomies during a period of 6 years (July 2012-June 2016 and July 2018-July 2020). Forty patients with an age of 65 years or older were the study target. Characteristics and operative outcomes were compared with the remaining 106 younger patients by retrospective chart review. The primary outcomes include complications and mortality, while the secondary outcomes contain intraoperative blood loss, operative time, procedural conversions, postoperative length of hospital stay, and bile duct stone recurrence. RESULTS: There was no mortality. The bile duct stone clearance rate was 98.6%. The elderly group had higher American Society of Anesthesiologists (ASA) scores, higher comorbidity rate, higher acute cholangitis rate, lower completion intraoperative cholangiography (IOC) rate, longer operative time, more blood loss, longer postoperative hospital stay (p < .001), longer total hospital stay (p < .001), higher procedural conversion rate (p < .05), higher complication rate (p < .001), and the exclusive open conversion (2.5%). The difference in complications derived from Clavien-Dindo grade I. CONCLUSION: Routine SILCBDE with concomitant cholecystectomy by experienced surgeons is safe and efficacious for elderly patients as for younger patients. Randomized controlled trials are anticipated.

Postoperative delirium: A tragedy for elderly cancer patients.

In this editorial, we comment on the article by Hu et al entitled "Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique". We wanted to draw attention to the general features of postoperative delirium (POD) as well as the areas where there are uncertainties and contradictions. POD can be defined as acute neurocognitive dysfunction that occurs in the first week after surgery. It is a severe postoperative complication, especially for elderly oncology patients. Although the underlying pathophysiological mechanism is not fully understood, various neuroinflammatory mechanisms and neurotransmitters are thought to be involved. Various assessment scales and diagnostic methods have been proposed for the early diagnosis of POD. As delirium is considered a preventable clinical entity in about half of the cases, various early prediction models developed with the support of machine learning have recently become a hot scientific topic. Unfortunately, a model with high sensitivity and specificity for the prediction of POD has not yet been reported. This situation reveals that all health personnel who provide health care services to elderly patients should approach patients with a high level of awareness in the perioperative period regarding POD.

Assessing the Risk of Postoperative Delirium Through Comprehensive Geriatric Assessment and Eastern Cooperative Oncology Group Performance Status of Elderly Patients With Gastric Cancer.

BACKGROUND: Postoperative delirium is especially common and often problematic among elderly patients undergoing surgery. This study aimed to explore factors that can predict postoperative delirium in elderly patients undergoing gastric cancer surgery. METHODS: This cohort study included 255 patients age 75 years or older who underwent gastric cancer surgery between July 2010 and December 2020. All the patients underwent preoperative comprehensive geriatric assessment (CGA) evaluation by a geriatrician. In addition to the CGA items, this study investigated the association between postoperative delirium and clinicopathologic factors, including Eastern Cooperative Oncology Group performance status (ECOG-PS). RESULTS: The most common postoperative complication was delirium, present in 31 patients (12.2%). The group with delirium was significantly more likely to have ECOG-PS ≥ 2, diabetes mellitus, cardiovascular disease, or cerebral infarction. The CGA showed frailty in the Instrumental Activities of Daily Living scale (IADL), the Mini-Mental State Examination (MMSE), the Vitality Index (VI), and the Geriatric Depression Scale 15 (GDS-15). In the multivariate analysis, the independent risk factors for delirium were ECOG-PS ≥ 2 (P = 0.002) and MMSE-frailty (P < 0.001). Using an MMSE score of ≤ 23 and an ECOG-PS score of ≥ 2 as cutoffs, postoperative delirium was predicted with a sensitivity of 80.7% and a specificity of 74.1%. CONCLUSION: Postoperative delirium might be more easily predicted based on the combination of MMSE and ECOG-PS for elderly patients with gastric cancer undergoing gastrectomy.

Frailty and 6-month trajectory of elderly trauma patients over the age of 65 years admitted to intensive care unit for severe trauma: experience of a level 1 trauma center.

BACKGROUND: The aging global population forecasts a significant rise in severe trauma cases among individuals aged 65 and above. Frailty emerges as a paramount predictor of post-traumatic outcomes, surpassing age and trauma severity indices. Despite this, scant attention is given to the trajectory of elderly patients post-intensive care unit (ICU) stay following severe trauma, justifying this study. The objective of this study was to analyze trajectories (frailty, place of residence) following a major trauma requiring an ICU stay. MATERIALS AND METHODS: An observational cohort study was conducted, leveraging data from a level 1 trauma center spanning 2018 to 2023. Inclusion criteria included elderly patients aged 65 and above admitted to the ICU for severe trauma. Data encompassed demographic profiles, trauma severity scores, clinical parameters, and frailty assessments sourced from the Traumabase database. RESULTS: Among 293 patients included 190 were non-frail, frailty was correlated with elevated mortality rates (114 (38.9%) at 6 months), heightened incidence of traumatic brain injuries, and notable declines in post-traumatic autonomy. Only 39.2% of patients had resumed residence at home six months post-injury, with a conspicuous trend towards institutionalization, particularly among frail individuals. CONCLUSION: This study highlights the role of frailty in determining the outcomes of elderly patients following severe trauma. Frailty is associated with higher mortality, increased rates of institutionalization, and a decline in functional status. These results highlight the importance of assessing frailty in the trajectory of severely injured patients over the age of 65 years-old.

Dual effects of dulaglutide on glycemic control and knee osteoarthritis pain in elderly patients with Type 2 diabetes.

Aim: This study aims to evaluate the dual benefits of dulaglutide in improving glycemic control and reducing knee OA pain.Patients & methods: Elderly T2DM patients diagnosed with bilateral knee OA on conventional OA treatment for at least 3 months were studied for their glycemic metrics, OA pain scores and NSAID consumption at baseline, 3 months and 6 months.Results: Significant improvements in glycemic control were observed, HbA1c decreased from 8.7% to 6.5% over 6 months. Pain scores, NSAID, body weight and BMI showed substantial reductions over time. Positive correlation (r = 0.73, p < 0.001) was found between glycemic control and pain reduction.Conclusion: Dulaglutide improves glycemic control, knee joint OA pain and weight management in elderly patients with T2DM.

What is this article about? We looked into how well dulaglutide works to both control blood sugar and reduce knee pain in people with type 2 Diabetes and osteoarthritis. This could be a useful treatment for older patients dealing with both conditions.What were the results? The most relevant findings were:Better Blood Sugar Control: After using dulaglutide for three and 6 months, there were noticeable improvements in blood sugar levels.Less Knee Pain: People experienced less knee pain from osteoarthritis and used fewer painkillers.Weight Loss: The average body weight and body mass index (BMI) decreased with this treatment.Pain Relief Linked to Better Blood Sugar: As blood sugar levels improved, knee pain from osteoarthritis also lessened. What do the results of the study mean? The results showed that elderly T2DM patients prescribed with dulaglutide would be able to achieve improved glycemic control, knee joint OA pain and weight management.

Assessing the effect of high-dose rosuvastatin in elderly patients over 75 with acute coronary syndrome.

BACKGROUNDS AND OBJECTIVE: Statins, inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, are pivotal in managing hypercholesterolemia and reducing cardiovascular risk. While rosuvastatin demonstrates superior efficacy and tolerability compared to other statins, its safety profile in elderly patients older than 75 years old with acute coronary syndrome (ACS) remains underexplored. So, the objective of this study is to evaluate the frequency of adverse reactions and investigate the efficacy of high-dose rosuvastatin on lipid profiles in elderly patients aged over 75 with ACS. METHODS: In this observational study, 110 consecutive elderly ACS patients attending Modarres Hospital in Tehran, Iran, in 2019 were enrolled. The effects of high-dose rosuvastatin were assessed in elderly patients older than 75 years old by comparison of the adverse effects, lipid profile, cardiac function, and other biomarkers at the baseline and after 6 weeks of rosuvastatin therapy with a dose of 40 mg. RESULTS: Following 6 weeks of treatment, there was a significant reduction in total cholesterol (136.2 ± 24.3 to 115.5 ± 24.0, p = 0.001) and LDL levels (72.6 ± 17.5 to 50.9 ± 18.9, p = 0.001), accompanied by a notable increase in HDL levels (38.3 ± 7.1 to 47.2 ± 7.4, p = 0.001). Cardiac function, as measured by ejection fraction (EF), significantly improved from 43.4 ± 8.8 to 48.5 ± 8.5 (p = 0.001). Adverse effects such as cramps (N = 12, p = 0.001), weakness (N = 28, p = 0.001), and anorexia (N = 12, p = 0.001) were reported but did not warrant discontinuation of therapy. Notably, no cases of jaundice were observed. Two deaths occurred due to major adverse cardiac events (MACE) during the study period, unrelated to stroke or recurrent myocardial infarction. CONCLUSION: Totally, high-dose rosuvastatin therapy effectively improved lipid profiles, cardiac function, and liver enzyme levels in elderly ACS patients, with manageable adverse effects. These findings underscore the importance of rosuvastatin in optimizing cardiovascular health in this vulnerable population.

A simple HPLC-MS/MS method for the determination of polymyxin B in human plasma and its application in the pharmacokinetic study in elderly patients infected with multidrug-resistant Gram-negative bacteria.

Introduction: Polymyxin B is widely used to treat infections caused by multidrug-resistant Gram-negative bacteria. However, the pharmacokinetic study data of PB in the elderly are scarce. Herein, a simple method to measure the concentration of PB in human plasma was developed and validated by high performance liquid chromatography-tandem mass spectrometry, and it was applied to a PK study in the elderly. Methods: PB was extracted from human plasma by a rapid protein-precipitation method using 0.1% formic acid in methanol and then separated on an ultimate AQ-C18 column using linear gradient elution with a 0.5-mL/min flow rate. Subsequently, PB was detected using a mass spectrometer operated in positive-ion and multiple-reaction-monitoring modes. Results: The lower limits of quantification of the method for Polymyxin B1 and Polymyxin B2 were 1.00 and 0.10 µg/mL, respectively. The linear ranges for PB1 and PB2 were 1.00-20.02 and 0.10-2.04 µg/mL, respectively. Patients receiving a 75-mg maintenance dose every 12h had AUCss, 24 h, and Css, av values of 117.70 ± 37.03 µg h/mL and 4.14 ± 1.74 µg/mL, respectively. For patients receiving a 100 mg maintenance dose, these values were 152.73 ± 70.09 µg h/mL and 5.43 ± 2.85 µg/mL, respectively. Conclusion: The validated HPLC-MS/MS method was successfully applied to a study on the pharmacokinetics of PB in elderly patients infected with multidrug-resistant Gram-negative bacteria. Both two dose strategies in this study would have a excessive PB exposure in the elderly patients then the therapeutic window recommended by guidelines.

Recurrent Left Periprosthetic Posterior Knee Dislocation in an Elderly Woman With Dementia and Altered Mental Status: A Case Report.

The case presented in this article is one of recurrent left posterior periprosthetic knee dislocation (PPKD) in a patient with altered mental status (AMS). The patient, a 69-year-old female with a complex medical history including dementia, Ménière's syndrome, and left total knee arthroplasty, presented to the emergency department with AMS whereupon a left PPKD was discovered. Less than three weeks before this presentation, she sustained a left PPKD during a previous admission. During her current admission, she sustained yet another left PPKD after trials of closed reduction and immobilization. The patient eventually underwent a left cemented revision total knee arthroplasty with a hinged prosthesis. The implant was noted to be stable, and the patient had minimal pain postoperatively with no vascular or neurological injury. Upon outpatient follow-up, the patient reported doing well. There have been few documented cases of recurrent or chronic PPKD in individuals with AMS or restricted intellect. These comorbidities create a complex approach to diagnosing and treating the aforementioned orthopedic injury, and as this injury can have devastating consequences, quickly and effectively delivering diagnosis and treatment is vital. This case highlights the importance of early identification, risk factors, preoperative management, and appropriate operative course for patients with AMS and recurrent PPKDs.

Preoperative nutritional status is a useful predictor of the feasibility of postoperative treatment in octogenarian-plus pancreatic ductal adenocarcinoma patients.

BACKGROUND: The suitability of radical surgery for very elderly pancreatic cancer (PC) patients remains controversial due to concerns about postoperative functional reserve. Inflammatory-nutritional status may help identify elderly patients at risk of compromised postoperative treatment tolerance. METHODS: This retrospective analysis included 121 patients over eighty who were diagnosed with PC in 2010-2019, 40 of whom underwent radical surgery. Surgical outcomes were compared with those of 205 younger patients (under 80 years-old) who underwent radical surgery. K-means cluster analysis was conducted with four inflammatory-nutritional indices (NLR, PLR, PNI, and mGPS) to define, and the indices using ordinal logistic analysis were evaluated in each cluster to create a formula named 'nutritional index (NTI)', which was then used to redefine the clusters. The predictive ability of the NTI was validated in other octogenarians who underwent pancreatectomy for PC between 2020 and 2023. RESULTS: Patients older than eighty exhibited comparable overall survival to younger patients (median survival time, 30.7/37.1 months, p = 0.20). However, octogenarian-plus patients had lower rates of adjuvant chemotherapy (AC) initiation (45/80 %) and treatment upon recurrence (52/84 %), resulting in shorter survival after recurrence (7.4/11.1 months, p = 0.06). Inflammatory-nutritional status was significantly associated with overall survival, with poor nutritional status being linked to lower rates of AC initiation and/or treatment upon recurrence. NTI effectively predicted AC feasibility. CONCLUSIONS: Radical surgery for octogenarian-plus PC patients meeting the current criteria was safe, but lower rates of postoperative treatment initiation may lead to poorer outcomes after recurrence. Inflammatory-nutritional status assessment could enhance surgical eligibility in octogenarian-plus PC patients.

The increasing prevalence of cancer in the elderly: An investigation of epidemiological trends.

Cancer poses a significant health threat to the elderly, accounting for a substantial proportion of cancer patients aged 65 and above. As life expectancy continues to rise and the population ages, the incidence of cancer in the elderly is expected to increase further. Age is a major risk factor for the majority of common cancers, with the incidence and prevalence rising as individuals grow older. Factors such as chemoprevention and environmental carcinogen elimination may influence the process of carcinogenesis. Studies reveal that the incidence and mortality rates of various cancers in the elderly and extremely old individuals are on the rise worldwide, with most types peaking around the age of 75 to 90, followed by a sharp decline. Birth cohort and period effects also play a complex role in the connection between aging and cancer risk. Clinical trials often exclude older individuals, limiting our understanding of cancer treatments' effects on this particular age group. More research is needed to focus on the unique requirements of older adults with cancer.

Supportive care needs, quality of life and social support among elderly colorectal cancer patients undergoing chemotherapy: a longitudinal study.

Objective: The purpose of this study is to examine the changes in supportive care needs, quality of life and social support during different chemotherapy cycles among elderly colorectal cancer patients. Methods: This prospective longitudinal study recruited 160 elderly colorectal cancer patients using convenience sampling at a hospital in Guangxi between August 2023 and April 2024. To assess supportive care needs, quality of life, and social support, we used a short form of the Supportive Care Needs Survey (SCNS-SF34), a Functional Assessment of Cancer Therapy-colorectal (FACT-C), and a perceived social support scale (PSSS) prior to chemotherapy, as well as after the first, third, and sixth cycles. Repeated measures analysis of variance was used to validate the changes over time in supportive care needs, quality of life, and social support. Results: 155 participants completed all questionnaire sessions across the six cycles. From pre-chemotherapy until after the sixth cycle of chemotherapy, the extent of physical and daily living requirements among all respondents fluctuated between 47.23% and 88.26%, psychological needs ranged from 60.84% to 97.67%, patient care and support needs ranged from 83.75% to 99.35%, healthcare system and information needs varied from 85.98% to 99.00%, while the level of sexual needs decreased from 1.51% to 0.65%. The mean SCNS-SF34 scores for these participants ranged between 103.81 ± 2.28 and 144.10 ± 1.08. Significant increases over time were seen for all domains of SCNS-SF34 (F=126.99, 347.41, 65.00, 72.34, 160.15, p<0.001), keeping a clear upward trend, except for sexual needs(F=0.712, p=0.546). The mean FACT-T scores dropped from 68.80 ± 1.00 to 51.24 ± 1.40, while the mean PSSS scores dropped from 55.77 ± 0.83 to 43.28 ± 1.05. The scores of FACT-T and PSSS showed statistically significant differences (F=231.21, 112.28, p<0.001), maintaining clear downward trends. Conclusion: During chemotherapy, elderly colorectal cancer patients continue to require high levels of supportive care, while their quality of life and social support gradually decline. This study offers healthcare practitioners a foundational understanding to identify and address the supportive care needs of elderly colorectal cancer patients across various chemotherapy phases, which facilitates the development of tailored strategies aimed at enhancing patients' quality of life.

How safe is lung transplantation in patients of 65 years or older? A single-center retrospective cohort.

INTRODUCTION: With increasing experience in high-volume centers, age alone should not be an absolute contra-indication to lung transplantation (LT) but be considered as part of the patient's initial characteristics. The objective of this study is to provide early and long-term outcomes of LT in recipients aged 65 or older, compared with their younger counterparts. METHODS: This is a retrospective study, including all patients undergoing LT in Bichat Hospital (Paris, France) from January 2014 to March 2019. Two groups were defined depending on the patients' age when they were transplanted: patients older than 65 were defined as the "elderly group" and patients younger than 65 years old were defined as the « younger group ¼. Primary endpoint was 90-day mortality. Secondary endpoints included 1-year mortality, 1-year FEV1 (forced expiratory volume in one second), and 5-year overall survival. RESULTS: From September 2014 to March 2019, 22 patients were included in the "elderly group" and 213 were included in the « younger group ¼. The elderly group had more single LT (SLT) (82% vs. 29%, p < 0.001), with a shorter cold ischemic time (243 min vs. 310 min, p = 0.001) and a lower rate of early humoral rejection (9% vs. 30%, p = 0.045) compared to the younger group. Ninety-day mortality was not significantly different between elderly and younger group (9% vs. 14%, p = 0.95, respectively), nor were 1-year mortality (23% vs. 25%, p = 0.9, respectively) and 5-year overall survival. Six months after LT, FEV1 was significantly better in the elderly group compared to the younger group (77.0% vs. 65.5%, p = 0.037 respectively), but the difference did not reach statistical significance after one year (78.5 vs. 68.3%, p = 0.18 respectively). CONCLUSION: Elderly patients underwent more frequently single LT, and achieved similar short and long term postoperative outcomes compared to their younger counterparts. LT for patients 65 years or older should be routinely considered when carefully selected.

Non-invasive respiratory support in elderly hospitalized patients.

INTRODUCTION: The proportion of elderly people among hospitalized patients is rapidly growing. Between 7% to 25% of ICU patients are aged 85 and over and noninvasive respiratory support is often offered to avoid the risks of invasive mechanical ventilation or in patients with a 'do-not-intubate' order. However, while noninvasive respiratory support has been extensively studied in the general population, there is limited data available on its efficacy in elderly patients with ARF. AREAS COVERED: PubMed/Medline, Web of Science, Scopus and Embase online databases were searched for studies that assessed clinical efficacy of high flow nasal cannula, continuous positive airway pressure and noninvasive ventilation in patients ≥ 65 years old with acute de novo ARF, showing that short to mid-term benefits provided by noninvasive respiratory support in elderly patients in terms of reduction of mechanical ventilation risk and mortality are similar to younger patients, if adjusted for the severity of comorbidities and respiratory failure. EXPERT OPINION: Noninvasive support strategies can represent an effective opportunity in elderly patients with ARF, especially in patients too frail to undergo endotracheal intubation and in whom received or decided for a 'do not intubate' order. Indeed, noninvasive support has a different impact, depending on the setting.

Safety analysis of fluoroquinolone drugs in elderly patients over 65 based on FAERS.

OBJECTIVE: This study investigates adverse drug event (ADE) reports from the FAERS related to FQs drugs in patients aged 65 and older. The findings aim to guide the rational clinical use of these drugs in elderly patients. METHODS: We employed Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR) methods to analyze ADE reports for the representative FQ drugs from Q1 2015 to Q4 2023, covering 36 quarters. RESULTS: The analysis identified 6883 ADE cases for ciprofloxacin, 5866 for levofloxacin, 1498 for moxifloxacin, and 317 for ofloxacin. Moxifloxacin showed higher incidences of Cardiac disorders and Psychiatric disorders ADEs (4.01%, 23.11%). Ciprofloxacin and levofloxacin showed higher ADE rates in musculoskeletal and connective tissue diseases (20.18% and 26.97%) compared to moxifloxacin (3.62%) and ofloxacin (9.25%). Additionally, moxifloxacin and ofloxacin showed higher ADE rates for eye disorders (10.61% and 15.03%). CONCLUSION: Different FQs exhibit varying ADE profiles across cardiovascular, vascular and lymphatic, renal and urinary, psychiatric, musculoskeletal and connective tissue, and ocular systems. Patients with underlying systemic diseases should avoid FQs with higher ADE risks for their conditions. Personalized medication plans for elderly patients should also be strengthened.

The impact of age, sex, comorbidities, and use of antithrombotics on the clinical course severity among patients surgically treated for urinary bladder tamponade.

Objectives: To examine the relationship between clinical patient characteristics and the severity of the disease course in patients hospitalized due to urinary bladder tamponade. The severity was assessed based on hemoglobin (Hgb) levels upon admission, the requirement for red blood cell transfusion (RBCT), and length of hospital stay. Materials and Methods: A retrospective analysis was conducted at a single center, involving 75 patients who were hospitalized due to urinary bladder tamponade. Results: Bladder cancer (33.3%) and postoperative bleeding (28%) were the most common causes of bladder tamponade. Patient age exhibited a negative correlation with Hgb levels upon admission (r = -0.539, P < 0.001) and a positive correlation with the quantity of administered RBCT units (r = 0.425, P < 0.001) and the length of hospitalization (r = 0.541, P < 0.001). The number of comorbidities exhibited a negative correlation with Hgb levels upon admission (r = -0.555, P < 0.001) and a positive correlation with the quantity of administered RBCT units (r = 0.522, P < 0.001) and the length of hospitalization (r = 0.543, P < 0.001). Patients taking antithrombotic therapy (AT) had lower mean Hgb levels on admission (87.8 ± 13.5 g/L vs. 107.6 ± 18.7 g/L, P < 0.001), a higher mean number of administered RBCT units (2.8 ± 2.1 vs. 1.1 ± 1.3, P < 0.001) and longer hospitalizations (4.6 ± 1.6 days vs. 3.1 ± 1.1 days, P < 0.001) compared to those not taking AT. Conclusion: Older patients with multiple comorbidities, particularly those taking AT, should be expected to have a more severe clinical course of bladder tamponade. Therefore, special clinical attention is necessary for this vulnerable patient group.

Differences Among Elderly Patients Having Asymmetric Sensorineural Hearing Loss With and Without Cerebellopontine Angle Tumors.

Objective: Asymmetric sensorineural hearing loss (ASNHL) exhibits a higher prevalence among the elderly compared to younger individuals, yet optimal management remains subject to ongoing debate. We aimed to elucidate the clinical disparities among elderly patients with ASNHL, distinguishing between those with and without cerebellopontine angle (CPA) tumors. Methods: A retrospective analysis was conducted on elderly patients (aged ≥65 years) diagnosed with ASNHL who underwent magnetic resonance imaging (MRI) between January 2012 and December 2022 at our tertiary referral center. Results: A total of 119 patients were enrolled, with a median age of 71 years (range: 65-89 years). Among them, 11 patients (9.2%) exhibited abnormal MRI findings. In the CPA tumors group, vestibular schwannoma was the most prevalent abnormality (63.6%), with a mean growth rate of 0.53 mm/year (range: 0-1.33 mm/year). The prevalence of CPA tumors in patients with diabetes mellitus (DM) and ASNHL was significantly lower than in those without DM (P = .021). Vertigo emerged as a significant associated symptom in cases with CPA tumors (P = .011). However, there were no significant differences in mean hearing thresholds or asymmetry of hearing loss at individual frequencies between the 2 groups. Conclusions: Elderly patients with ASNHL and vertigo should undergo radiological assessment. Patients with DM exhibit a lower prevalence of CPA tumors than those without DM, warranting careful observation and follow-up due to the limited diagnostic yield of MRI. No discernible differences in audiometric patterns were detected between patients with and without CPA tumors.

Predicting clinically significant prostate cancer in elderly patients: A nomogram approach with shear wave elastography.

PURPOSE: This study was to construct a nomogram utilizing shear wave elastography and assess its efficacy in detecting clinically significant prostate cancer (csPCa). METHODS: 290 elderly people with suspected PCa who received prostate biopsy and shear wave elastography (SWE) imaging were respectively registered from April 2022 to December 2023. The elderly participants were stratified into two groups: those with csPCa and those without csPCa, which encompassed cases of clinically insignificant prostate cancer (cisPCa) and non-prostate cancer tissue, as determined by pathology findings. The LASSO algorithm, known as the least absolute shrinkage and selection operator, was utilized to identify features. Logistic regression analysis was utilized to establish models. Receiver operating characteristic (ROC) and calibration curves were utilized to evaluate the discriminatory ability of the nomogram. Bootstrap (1000 bootstrap iterations) was employed for internal validation and comparison with two models. A decision curve and a clinical impact curve were employed to assess the clinical usefulness. RESULTS: Our nomogram, which contained Emean, ΔEmean, prostate volume, prostate-specific antigen density (PSAD), and transrectal ultrasound (TRUS), showed better discrimination (AUC = 0.89; 95% CI: 0.83-0.94), compared to the clinical model without SWE parameters (p = 0.0007). Its accuracy, sensitivity and specificity were 0.83, 0.89 and 0.78, respectively. Based on the analysis of decision curve, the thresholds ranged from 5% to 90%. According to our nomogram, biopsying patients at a 20% probability threshold resulted in a 25% reduction in biopsies without missing any csPCa. The clinical impact curve demonstrated that the nomogram's predicted outcome is closer to the observed outcome when the probability threshold reaches 20% or greater. CONCLUSION: Our nomogram demonstrates efficacy in identifying elderly individuals with clinically significant prostate cancer, thereby facilitating informed clinical decision-making based on diagnostic outcomes and potential clinical benefits.

Clinical features and prognostic factors in elderly patients with sepsis in the emergency intensive care unit.

PURPOSE: The objective of this research is to analyze the clinical progression and identify prognostic factors among elderly patients with sepsis admitted to the emergency intensive care unit (EICU). METHODS: A total of 211 patients with sepsis, aged 65 years or above, were selected for inclusion in the study. These patients were admitted to the EICU of the Emergency Department at Harrison International Peace Hospital Affiliated to Hebei Medical University from August 2018 to June 2023. The clinical features, Acute Physiology and Chronic Health Evaluation (APACHE) Π score, Sequential Organ Failure Assessment (SOFA) score, and routine laboratory test indicators were documented. All patients were followed up for 28 days. The factors associated with mortality in both the sepsis group and septic shock group were analyzed by receiver operating characteristic (ROC) curve, MedCalc software, and Kaplan-Meier curve. RESULTS: Among the 211 patients, 101 were identified as having septic shock. A significant elevation in blood urea nitrogen-to-albumin ratio (BAR) and inflammatory indicators, APACHE II score, and SOFA score was observed in the septic shock group compared to the sepsis group (P<0.001). Moreover, the sepsis group exhibited a higher proportion of males (P=0.002), while there was no statistically significant difference in age (P=0.467). Further analysis revealed that BAR within 24 h after admission exhibited a positive correlation with infection indicators procalcitonin (PCT) and C-reactive protein (CRP), as well as disease severity scores APACHE Π and SOFA. Additionally, BAR was found to be positively associated with the 28-day mortality rate in patients with sepsis (r = 0.169, P=0.001). The results of the ROC curve analysis showed that BAR exhibited the highest predictive capability for 28-day mortality in elderly patients with sepsis who were admitted to the EICU (AUC=0.614). The Kaplan-Meier survival curve, which identified the optimal cut-off value (≥0.3) of BAR as the most accurate predictor of 28-day mortality in this individual, revealed a significantly higher mortality rate among patients with BAR≥0.3 (χ2 = 12.340, P=0.000). CONCLUSION: The elderly patients with sepsis in the EICU are generally over the age of 70, with a higher prevalence of males than females, and the albumin level is generally low on admission. Furthermore, BAR is significantly and positively correlated with infectious indexes and has a high predictive value for their mortality outcomes.